cssi/SciSciGPT-SciSciNet huggingface dataset:
Food and Drug Administration Analysis of Ticagrelor: Using Data From an Enriched Trial to Evaluate Benefit-Risk Difference in an Unstudied Population.

Prognostic enrichment strategies are often used in cardiovascular outcome trials and enroll patients who are at higher risk for cardiovascular outcome events. By increasing the rate of outcome events, prognostic enrichment increases the absolute difference between treatment and control groups for a given risk reduction, making the demonstration of efficacy more efficient.1 However, this strategy poses an important practical question: Can the trial results be generalized to lower-risk individuals? This determination is particularly challenging when the drug poses a serious risk (eg, bleeding), because the benefit-risk balance for drug treatment could conceivably be considerably less favorable in the lower-risk patients than in the enriched populations, and preclude extrapolation of trial results to lower-risk individuals. We discuss here the Food and Drug Administration risk-benefit analysis to inform a regulatory decision regarding the scope of a new indication for ticagrelor (Brilinta, AstraZeneca), a platelet inhibitor originally approved in 2011 for the reduction of major adverse cardiac events (MACE; the composite of cardiovascular death, myocardial infarction [MI], or stroke) in patients with acute coronary syndrome. The new indication for secondary prevention of MACE in patients with a prior MI was approved without imposing any restrictions of use to high-risk patients. In 2015, the Food and Drug Administration received an efficacy supplement, proposing to expand the indication for ticagrelor beyond the acute setting; data submitted in support of this proposal came from the PEGASUS study (The Prevention of Cardiovascular Events in Patients with …
Castles made of sand: building sustainable digitized collections using XML

When he began to use XML, this author visualized the items in his collections as grains of sand that could be used and reused, shaped, and restructured. That way, his data would be usable in the future, even when technological changes wash over the digital landscape.
Studies of Lambda-neutron interaction through polarization observables for final-state interactions in exclusive Lambda photoproduction off the deuteron

Theoretical studies suggest that experimental observables for hyperon production reactions can place stringent constraints on the free parameters of hyperon-nucleon potentials, which are critical for the understanding of hypernuclear matter and neutron stars. Here we present preliminary experimental results for the polarization observables S, Py, Ox, Oz, Cx, and Cz for final-state interactions (FSI) in exclusive L photoproduction off the deuteron. The observables were obtained from data collected during the E06-103 (g13) experiment with the CEBAF Large Acceptance Spectrometer (CLAS) in Hall B at Jefferson Lab. The g13 experiment ran with unpolarized deuteron target and circularly- and linearly-polarized photon beams with energies between 0.5 GeV and 2.5 GeV and collected about 51010 events with multiple charged particles in the final state. To select the reaction of interest, the K+ and the L decay products, a proton and a negative pion, were detected in the CLAS. The missing-mass technique was used to identify exclusive hyperon photoproduction events. Final-state interaction events were selected by requesting that the reconstructed neutron has a momentum larger than 200 MeV/c. The large statistics of E06-103 provided statistically meaningful FSI event samples, which allow for the extraction of one- and two-fold differential single- and double-polarization observables. Heremore » we present preliminary results for a set of six observables for photon energies between 0.9 GeV and 2.3 GeV and for several kinematic variables in the Ln center-of-mass frame. Our results are the very first estimates of polarization observables for FSI in hyperon photoproduction and will be used to constrain the free parameters of hyperon-nucleon potentials.« less
Political Peoplehood: The Roles of Values, Interests, and Identities

Rogers Smith’s scholarship has contributed a great deal to the fields of American political development and the history of American political thought, and has always been both deeply normative and ...
Mechanical design method for a high-speed surface permanent magnet rotor

Mechanical design of the rotor is an important part of the design process for high-speed electric machines. This paper proposes an analytical method for finding an approximate rotor length and diameter for a surface permanent magnet machine rotor early in the design process. Specifically, the method can be used to find approximate rotor length and diameter dimensions that will balance the need for acceptable factor of safety for rotor sleeve stress and the need for an acceptable separation margin between the operating and critical speeds. Analytical design results are compared to finite element analysis for both the mechanical stress and the natural frequency of the rotor.
Aluminum multicharged ion generation from femtosecond laser plasma

Aluminum multicharged ion generation from femtosecond laser ablation is studied. A Ti:sapphire laser (wavelength 800 nm, pulse width ∼100 fs, and maximum laser fluence of 7.6 J/cm2) is used. Ion yield and energy distribution of each charge state are measured. A linear relationship between the ion charge state and the equivalent acceleration energy of the individual ion species is observed and is attributed to the presence of an electric field within the plasma-vacuum boundary that accelerates the ions. The ion energy distribution follows a shifted Coulomb-Boltzmann distribution. For Al1+ and Al2+, the ion energy distributions have two components; the faster one can be attributed to multiphoton laser ionization, while the slower one is possibly due to collisional processes. Ion extraction from the plasma is increased with an applied external electric field, which is interpreted to be due to the retrograde motion of the plasma edge as a result of the external electric field. Multicharged ion generation by f...
Paper 7. Unsteady Flow around a Slender Fish-Like Body:

This paper attempts to extend some recent theoretical calculations on the unsteady flow generated by body movements of a slender ‘flat’ fish by further including the effect of finite body thickness in the consideration for various configurations of side and caudal fins as major appendages. Based on the slender-body approximation, the cross-flow is determined for different longitudinal body sections which are characterized by a variety of cross-sectional shapes and flow conditions (such as having smooth or fin-edged body contours, with or without vortex sheets alongside the body section). The effect of body thickness is found to arise primarily from its interaction with the vortex sheet already existing in the cross-flow. New results for the transverse hydro-dynamic force acting on the body are obtained, and their physical significances are discussed.
Choosing Between “Life” and Livelihoods

This chapter explores spatial and social tensions in Quezon City, an expanding and rapidly developing city within the Metro Manila region that is also addressing its high number of informal settler communities. Against this backdrop of urban change and global “growth”, a group of women who live in an informal settlement tell stories of abortion, sexual conflict, contraceptive use, and their own personal faith. Their intimate livelihoods are deeply affected by threats of eviction, but are also organized around the absences of their partners who themselves work as casual laborers in development sites within the metropolis. Sexual relations and family planning are timed by the demands of “flexibilized” labor and “3G” economies, rather than just religious discourses on “life” and “death”.
Scanning Techniques in Transabdominal and Intraoperative/Laparoscopic Ultrasound

This chapter reviews the basic scanning techniques used during transabdominal, intraoperative, and laparoscopic ultrasound for imaging the liver, biliary tract, and pancreas. Techniques for general scanning and specialized methods for specific organ scanning are illustrated.
Service und Flexibilität

Wenn ein Umzug der Menschheit auf einen neuen Spitzberg notwendig wurde, geriet die Organisation immer wieder zu einem Fiasko. Wer’s nicht selber erlebt hat, kann sich nicht vorstellen, was bei einem Umzug alles schief gehen kann. Und das ging dann auch alles schief.
Teacher-Made Scripted Lessons

Publisher Summary This chapter defines explicit instruction, explaining how its systematic use can result in both improved academic achievement and decreased undesirable behavior of students. Scripted lessons are planned for teaching academic skills that comprise a series of chained behaviors, such as spelling, math computation, and discrete behaviors including vocabulary terms and math facts. All lessons are based on clearly stated and communicated objectives that specify what the students should be able to do or say after the lesson. For each subcomponent of the task analysis, the teacher provides clear instruction and explanation, and the teacher models the step to provide guided practice to students. During the numerous group and individual practice opportunities, the teacher initially uses prompts to guide the student through the steps delineated in the task analysis and fades that assistance as the students acquire mastery of the content. After the choral response, the teacher can either model the next step or ask an individual student a follow-up question related to the step to ensure that all students are engaged with the material. After presenting the first two steps of an objective, the learning process can be facilitated by modeling those steps in sequence.
Selectivity and racial bias in a mandatory death sentence dispensation: a South African case study

This contribution reports an analysis of prosecution, sentencing, and execution data for the Republic of South Africa during the late 1980s. The data are of special interest for three reasons. First, we document the operation of a judicial system that was administering a death sentence statute that was essentially a mandatory model in cases of murder. Second, the statistics show a pattern of selectivity depending on the race of a homicide victim that is as extreme as any to be found in the world literature on the death sentence. Finally, the outcome seriously challenges the constitutionality not only of the death sentence dispensation that was the focus of the study, but even more pertinently of the present South African death sentence dispensation with its wider discretion.
A superelement for two-dimensional singular boundary value problems in linear elasticity

The finite element method for elliptic boundary value problems has been modified to deal with boundary singularities. We introduce a singular-super-element (SSE) which incorporates the known expansion for the singular solution explicitly over the internal region surrounding the singular point, whilst using blended trial functions over the intermediate region, which joins the internal and external regions smoothly. The SSE conforms with the mesh used in the external region, and may be easily incorporated into standard finite element programs. The calculations yield the expansion coefficients directly, as well as an accurate representation of the displacements in the vicinity of the singular point, for a crack or V-notch of any angle subject to any mode of loading. The SSE has been applied to determine stress intensity factors for two-dimensional crack and V-notch problems, including mixed mode. The computations converge rapidly, yielding results of high accuracy.
Relationships among udder shape, udder capacity, cow longevity and calf weights.

Udder capacity and udder shape were scored on 3- to 10-yr-old cows from a large Hereford herd. Udder capacity was scored from 1 (small) and 5 (large) and udder shape was scored from 1 (balanced, udder level with ground) to 5 (unbalanced, funnel-shaped udder). Data were analyzed within age of cow for udder capacity scores from 1 to 4 and for udder shape scores from 1 to 3 because of the limited number of observations in other categories. Year of birth of cow was a significant source of variation in both udder capacity and udder shape. Days in lactation (ranging from 81 -+ 23 d in 3-yr-old cows to 71 +- 25 d in 4-yr-old cows) was an important source of variation for udder capacity; as lactation progressed udder capacity score declined. Body condition of the cow was an important source of variation for udder capacity in 3- and 4-yr-old cows; cows with more external body condition had larger udder capacity scores. The heritability estimates of udder capacity and udder shape for 3-yr-old cows were .12 -+ .14 and .15 -+ .16, respectively; the repeatability estimates of scores over years were .14 +- .02 and .16 +- .03, respectively. Residual correlations between udder capacity and udder shape were low, ranging from -.10 in 3-yr-old cows to .10 in 6-yr-old cows. Neither udder characteristic affected the number of years a cow remained in the herd, but cows with unbalanced udders had more udder defects. The regressions of early weight of the calf and weaning weight of the calf on udder capacity score were significant within each age of cow. Regressions of early weights ranged from 4.3 -+ 1.3 to 8.1 -+ 1.4 kg/capacity unit; regressions of weaning weight ranged from 6.1 +- 1.7 to 9.4 -+ 1.8 kg/capacity unit. However, little of the variation in weights at either age was explained by udder capacity.
Biomechanical Comparison of Intramedullary Beaming and Plantar Plating Methods for Stabilizing the Medial Column of the Foot: An In Vitro Study.

Abstract Charcot neuroarthropathy often results in a rocker-bottom foot deformity, which leads to ulceration, infection, and amputation. Surgical techniques to reconstruct the medial column include intramedullary beaming and plantar plating, with disagreement regarding which approach provides a stronger construct with superior stability and fixation. The objective of the present cadaveric study was to compare the construct rigidity and strength of beaming and plantar plating of the medial column of 5 paired bilateral feet. Cannulated titanium beams and plates were implanted in the right and left feet, respectively. The specimens underwent interval testing to generate load-displacement and load-strain curves, cyclic loading at low loads, and then were loaded to failure. The beamed and plated specimens had statistically similar stiffness (p = .80) with a mean of 11.1 ± 3.9 N/mm and 11.3 ± 5.9 N/mm, respectively. The beamed and plated specimens had a statistically similar mean strain of −164 ± 75.1 µe and −208 ± 87.8 µe on the dorsal (p = .45) and 92 ± 90.4 µe and 221 ± 100.5 µe on the plantar (p = .08) surfaces of the first metatarsal. Three beamed specimens failed from talus fracture (60%), and 2 beams plastically deformed (40%). Two plated specimens failed from talus fracture (40%), and 3 experienced screw pullout (60%). The beamed and plated specimens withstood a mean load to failure of 234 ± 111.4 N and 140 ± 68.9 N, respectively, with the difference statistically significant (p = .04). Overall, beaming was more robust than plantar plating, because it was less sensitive to specimen size and bone quality.
Endovascular Venous Sinus Stenting for Refractory Idiopathic Intracranial Hypertension: A Systematic Review of the Literature (P1.203)

Objective: To identify cases of idiopathic intracranial hypertension (IIH) treated with venous sinus stenting (VSS), summarize the patient population and outcomes, and determine rates of complication. Background: IIH is characterized by raised intracranial pressure outside the context of space-occupying or obstructive lesions. It is well accepted that most IIH patients have transverse sinus stenosis impairing cerebral venous outflow. Untreated, this may cause optic nerve damage and permanent visual loss. The reported annual incidence is 0.9–1.07/100,000 but may reach 15–19/100,000 in subpopulations of overweight women aged 20–44. Medically refractory IIH has historically been treated by therapeutic lumbar punctures, cerebrospinal fluid (CSF) diversion, and optic nerve sheath fenestration. Recurrence rates with medication have reached 40%. Shunt failure and revision rates are as high as 60% with infection-related complications reaching 10%. ONSF carries significant risks with failure rates and concomitant recurrence of visual symptoms up to 32%. Since 2002, VSS has emerged as an alternative treatment option for refractory IIH. Design/Methods: A systematic literature review was performed to identify all patients with IIH who underwent treatment with VSS. Relevant data on demographics, clinical course, and outcomes were extracted. Results: A total of 518 subjects were identified (89% female, mean age 34.6+/− 7.4y, mean body mass index 34.9+/−6.3 kg/m2). Initial symptoms included headache(92%), resolved/improved in 76% post-stenting; papilledema(82%), resolved/improved in 88%; visual defects (63%), resolved/improved in 83%; and pulse-synchronous tinnitus(34%), resolved in 94%. Mean follow-up was 16.8+/−11.2 m clinically and 16.9+/−19.3 m radiologically. Mean stenotic pressure gradient improved from 18.4+/−7.6 mmHg to 3.2+/−3.0 mmHg after stenting. The complication rate was 18.9% with an 8.9% re-stenting rate and a 3.4% post-stent surgical re-treatment rate. Conclusions: VSS is a safe and effective alternative to invasive treatments, such as CSF diversion and ONSF, in patients with IIH. Given the excellent clinical outcomes documented in the literature, further investigation with a multi-center randomized clinical trial would be beneficial. Disclosure: Dr. Bond has nothing to disclose. Dr. Bond has nothing to disclose. Dr. Ilorah has nothing to disclose. Dr. Kattah has nothing to disclose.
Availability of global health opportunities in North American Paediatric Orthopaedic Fellowship Programmes.

Abstract Purpose Orthopaedic residents are increasingly seeking international health electives (IHEs) during training, many of which involve providing paediatric orthopaedic care. However, little i...
Developing RNA aptamers for potential treatment of neurological diseases

AMPA receptor antagonists are drug candidates for potential treatment of a number of CNS diseases that involve excessive receptor activation. To date, small-molecule compounds are the dominating dr...
iAdhere: A voice interactive assistant to improve adherence to medical treatments: demo abstract

Adherence to prescribed medical treatments is crucial for health outcomes in chronic diseases. Recent advancements in smartwatch technologies have opened opportunities to use these wearables in improving adherence through reminders and tracking. This paper presents iAdhere, an Apple Watch based system for reminders and tracking adherence to the prescribed activities for stroke patients.
Evaluation of CisBio ELISA for Chromogranin A Measurement

Background: Chromogranin A (CgA) is a nonspecific marker for the presence of neuroendocrine tumors and neuroendocrine differentiation. The objective of this study was to evaluate the performance of the CisBio CgA ELISA. Methods: Precision, linearity, limit of blank, and recovery of the CisBio CgA ELISA were evaluated. Seventy waste serum samples obtained from the clinical laboratory at Memorial Sloan Kettering Cancer Center were analyzed by the CisBio CgA ELISA. Results were compared to those obtained from a reference laboratory that used a proprietary ELISA for serum CgA measurement. Paired waste plasma samples were also collected from 24 of these patients to assess possible differences between CgA in serum and plasma. Finally, a preliminary reference range study was performed with samples from healthy volunteers in serum (n = 60) and plasma (n = 60). Results: Within-run and between-run precision ranged from 3.0% to 5.1% and 4.8% to 12.9%, respectively. The limit of blank was 2.4 ng/mL. Recovery ranged from 88% to 102%. A statistically significant bias was observed when the CisBio CgA assay results were compared to those of a reference laboratory. Comparison of the 2 assays yielded a slope of 9.05, intercept of −18.0, and a correlation coefficient of 0.955. CgA values in serum correlated well to values measured in plasma. Conclusions: The analytical performance of the CisBio CgA ELISA was acceptable. However, CgA results are method-specific owing to lack of standardization and use of different antibodies. This lack of standardization results in several challenges for the clinical laboratory when evaluating a CgA assay.
Modified Bridgman anvils for high pressure synthesis and neutron scattering

A simple modified Bridgman design for large volume pressure anvils usable in the Paris-Edinburgh (PE) press has been demonstrated at Oak Ridge National Laboratory Spallation Neutron Source....
Unicompartmental Knee Arthroplasty Techniques: Mako

The benefits of robotic-assisted unicompartmental knee surgery are centered around the ability to anatomically plan the surgery, make dynamic adjustments intraoperatively, and then accurately execute the plan in a reproducible manner. The benefits of “MAKOplasty” still follow the principles of strict patient selection and appropriate planning. Meticulous cementing technique and minimized soft tissue dissection enable consistent results. Haptic boundaries allow the surgeon to safely and efficiently perform the surgery through minimally invasive mobile windows, coupled with computer interactions. Improved patient satisfaction and implant survivorship are important considerations when adopting robotic technology.
Stem cells of the suture mesenchyme in craniofacial bone development, repair and regeneration

Development of the skeleton is mediated through two distinct ossification mechanisms. Craniofacial bones are formed mainly through intramembranous ossification, a mechanism different from endochondral ossification required for development of the body skeleton. The skeletal structures are quite distinct between the two, thus they are likely to have their unique stem cell populations. The sutures serve as the growth center critical for healthy development of the craniofacial skeleton. Defects in suture morphogenesis cause its premature closure, resulting in development of craniosynostosis, a devastating disease affecting 1 in ~2,500 individuals. The suture mesenchyme has been postulated to act as the niche of skeletal stem cells essential for calvarial morphogenesis. However, very limited knowledge is available for suture biology and suture stem cells (SuSCs) have yet to be isolated. Here we report the first evidence for identification and isolation of a stem cell population residing in the suture midline. Genetic labeling of SuSCs shows their ability to self-renew and continually give rise to mature cell types over a 1-year monitoring period. They maintain their localization in the niches constantly produce skeletogenic descendants during calvarial development and homeostastic maintenance. Upon injury, SuSCs expand drastically surrounding the skeletogenic mesenchyme, migrate to the damaged site and contribute directly to skeletal repair in a cell autonomous fashion. The regeneration, pluripotency and frequency of SuSCs are also determined using limiting dilution transplantation. In vivo clonal expansion analysis demonstrates a single SuSC capable of generating bones. Furthermore, SuSC transplantation into injured calvaria facilitates the healing processes through direct engraftments. Our findings demonstrate SuSCs are bona fide skeletal stem cells ideally suited for cell-based craniofacial bone therapy as they possess abilities to engraft, differentiate.(Presented at the 1980th Meeting, April 16, 2019).
Strong correlations between empathy, emotional intelligence, and personality traits among podiatric medical students: A cross-sectional study.

Background: The ability of health-care providers to demonstrate empathy toward their patients results in a number of positive outcomes improving the quality of care. In addition, a provider's level of emotional intelligence (EI) can further the doctor–patient relationship, stimulating a more personalized and comprehensive manner of treating patients. Furthermore, personality traits of a clinician may positively or negatively influence that relationship, as well as clinical outcomes. This study was designed to evaluate empathy levels in podiatric medical students in a 4-year doctoral program. Moreover, this study aimed to determine whether EI, personality traits, and demographic variables exhibit correlations with the observed empathy patterns. Methods: This cross-sectional study collected data using an anonymous web-based survey completed by 150 students registered at the New York College of Podiatric Medicine. There were four survey sections: (1) demographics, (2) empathy (measured by the Jefferson Scale of Physicians' Empathy), (3) EI (measured by the Assessing Emotions Scale), and (4) personality traits (measured by the NEO-Five-Factor Inventory-3). Results: Empathy levels were significantly correlated with EI scores (r = 0.62, n = 150, P< 0.0001). All the five domains of personality were also shown to correlate with empathy scores, as well as with EI scores. With respect to demographics, Asian-American students had lower mean empathy scores than students of other races (P = 0.0018), females had higher mean empathy scores compared to men (P = 0.001), and undergraduate grade point average correlated with empathy scores in a nonmonotonic fashion (P = 0.0269). Discussion: When measuring the variables, it was evident that there was a strong correlation between empathy, EI, and personality in podiatric medical students. Given the suggested importance and effect of such qualities on patient care, these findings may serve as guidance for possible amendments and warranted curriculum initiatives in medical education.
Exposure to a Tobacco-Specific Carcinogen Among Adolescent Smokeless Tobacco Users in Rural California, United States.

Introduction Approximately the same percentage of male high school students in the United States currently uses conventional smokeless tobacco as smokes cigarettes, resulting in toxin exposure. Methods This study assessed tobacco product use (smokeless, combustible, and electronic cigarettes) and nicotine and carcinogen exposures in a sample of 594 male rural high school baseball players-a population traditionally at risk for smokeless tobacco use. Salivary specimens were assayed for cotinine (a biomarker of nicotine exposure) and urine specimens for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL, a biomarker of the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) using liquid chromatography-tandem mass spectrometry. Results The prevalence of past 30-day use of any tobacco product was 29%. Past 7-day smokeless tobacco use (prevalence: 13%) was associated with the highest levels of cotinine and NNAL observed in the sample, whether smokeless tobacco was used exclusively (geometric means: cotinine 11.1 ng/mL; NNAL 31.9 pg/mg-creatinine) or in combination with combustible products (geometric means: cotinine 31.6 ng/mL; NNAL 50.0 pg/mg creatinine). Cotinine and NNAL levels were incrementally higher in each increasing category of smokeless tobacco use frequency. However, observed levels were lower than previously reported for adults, likely reflecting less smokeless use per day among adolescents. Conclusions Based on these biomarker observations, adolescents who use conventional smokeless tobacco products are exposed to substantial levels of nicotine and NNK. Although exposed to lower levels than adult smokeless users, the findings are concerning given the young age of the sample and tendency for smokeless tobacco users to increase use intensity over time. Implications This study demonstrates that adolescents using smokeless tobacco are exposed to levels of nicotine and NNK that increase with use frequency and that exceed exposures among peers using other tobacco products. Youth smokeless tobacco use in the United States has not declined along with youth smoking prevalence, giving greater importance to this health concern. To reduce youth (and adult) exposures, needed actions include effective smokeless tobacco use prevention, potentially in combination with reducing the levels of harmful and potentially harmful chemicals in smokeless tobacco products currently popular among adolescents.
Novel Two-electrode Excitation Mode for 3D Electrical Capacitance Tomography

The problem of traditional 3D ECT (electrical capacitance tomography) system is serious, the inadaptability and the uneven distribution of the sensitivity field result in poor quality of image reconstruction. In order to improve these problems, on the basis of analyzing the single electrode excitation mode, a novel mode is presented, which is two-electrode excitation mode for non-same layer electrodes. The results of simulation show that the two-electrode excitation mode can increase the charge of detection electrode, facilitate the measurement of small signal, improve the uniformity of sensitive field distribution, reduce the artifacts of reconstructed image, and obtain better quality of reconstructed image.
Activation During Sinus Rhythm in Ventricles With Healed Infarction: Differentiation Between Arrhythmogenic and Nonarrhythmogenic Scar.

Background: In infarct-related ventricular tachycardia (VT), the circuit often corresponds to a location characterized by activation slowing during sinus rhythm (SR). However, the relationship betw...
Diblock brush-arm star copolymers via a core-first/graft-from approach using γ-cyclodextrin and ROMP: a modular platform for drug delivery

The design and synthesis of a novel multifunctional core initiator based on γ-cyclodextrin (γ-CD) functionalized with eight norbornenes is reported, and a core-first approach to make eight-arm star polymers using ring-opening metathesis polymerization is carried out by grafting-from the initiator using norbornene-functionalized hexaethylene glycol. The living nature of the polymerization was verified through chain extension of the ω-functional arms with norbornene-functionalized poly(ethylene glycol) (PEG, Mn ≈ 2 kDa) to generate water-soluble diblock brush-arm star copolymers (DBASCs) with high molar masses (Mn,NMR = 187–268 kDa) and low dispersities (Đ = 1.12–1.19). The size of the corresponding star polymers was confirmed by transmission electron microscopy and dynamic light scattering (Dh ≈ 10.0–11.0 nm). The thermal properties (e.g., Tg) of the DBASCs were determined by thermogravimetric analysis and differential scanning calorimetry, the latter of which showed well-ordered materials in the solid state (prominent Tc and Tm peaks). The long-range order and crystallinity of solid-state DBASCs was further supported by well-defined powder X-ray diffraction patterns. Lastly, since γ-CD possesses an order of magnitude greater solubility in water and enhanced drug-binding capabilities compared to that for β-CD, a representative DBASC was evaluated against healthy human umbilical vein endothelial cells (and exhibited low toxicity), and was also investigated as a delivery vehicle for the anticancer drug doxorubicin as its hydrochloride salt (DOX·HCl), resulting in greater potency against MCF-7 breast cancer cells relative to that of the free DOX·HCl treatment. The star polymers reported herein represent a new modular polymeric platform with potential applications in nanostructure self-assembly and drug delivery.
New-onset depression among children, adolescents, and adults with hidradenitis suppurativa.

Background Information on the risk of depression among children, adolescents, and adults with hidradenitis suppurativa (HS) is limited. Objective To compare the risk of new-onset depression in patients with HS with that of control individuals. Methods Retrospective cohort analysis of 49,280 adult and 3042 pediatric patients with HS and matched control individuals identified by using electronic health record data. The primary outcome was incident depression. Results The crude incidence rate was 4.8 per 100 person-years in adult patients with HS compared to 3.0 per 100 person-years in control individuals. Among pediatric patients, the crude incidence rate was 4.2 per 100 person-years in patients with HS compared with 2.3 per 100 person-years in control individuals. In adjusted analysis, adults and pediatric patients with HS had a 10% (hazard ratio, 1.10; 95% confidence interval, 1.07-1.13; P Limitations Patients not seeking care in health systems within the database were not captured. Conclusion Children, adolescents, and adults with HS are at an increased risk for developing depression, independent of other common risk factors for depression.
Association between asthma and dental caries in US (United States) adult population.

Objective: To investigate the associations of asthma with dental-caries-experience (DFT: decayed and filled teeth) and untreated-dental-caries (DT: decayed teeth) in the US adult population.Methods...
Expression and purification of active human kinases using Pichia pastoris as a general-purpose host.

Abstract Background The heterologous expression of human kinases in good purity and in a monomeric, soluble and active form can be challenging. Most of the reported successful attempts are carried out in insect cells as a host. The use of E. coli for expression is limited to a few kinases and usually is facilitated by large solubility tags that can limit biophysical studies and affect protein–protein interactions. In this report, we evaluate the methylotrophic yeast Pichia pastoris (P. pastoris) as a general-purpose host for expression of human kinases. Methods Six diverse kinases were chosen due to their therapeutic importance in human cancers. Tested proteins include serine/threonine kinases cyclin-dependent kinases 4 and 6 (CDK4 and 6) and aurora kinase A (AurKA), receptor tyrosine kinase erbB-2 (HER2), and dual specificity kinase mitogen-activated protein kinase kinase 3 (MKK3b). Noting that positively charged kinases expressed with higher yield, we sought to improve expression of two challenging targets, CDK6 and HER2, by fusing the highly basic, N-terminal domain of the secreted tyrosine-protein kinase VLK. The standard expression procedure for P. pastoris was adopted, followed by purification using affinity chromatography. Purity and activity of the proteins were confirmed and compared to published values. Results Some kinases were purified with good yield and purity and with comparable activity to commercially available versions. Addition of the VLK domain improved expression and decreased aggregation of CDK6 and HER2.
Conservation tillage supports soil macrofauna communities, infiltration, and farm profits in an irrigated maize-based cropping system of Colorado.

In the past several decades conservation tillage systems have been introduced to address the negative impacts of intensive tillage, but the potential of these technologies to improve soil function and maintain yields is still not fully understood. This study sought to examine the effects of conservation tillage on key soil quality parameters and profitability at a production scale. We evaluated soil properties and yields during the fifth and sixth years (2015 and 2016) of a field study comparing two conservation tillage systems: minimum tillage (MT) and strip tillage (ST), versus a conventional tillage control (CT). Measurements included residue cover, macrofauna abundance and diversity, permanganate oxidizable carbon (POXC), aggregate stability, and infiltration. Results from both years suggest that conservation tillage can enhance macrofauna abundance (especially earthworms) and diversity. For example, ST had higher abundance of macrofauna (486 ind. m‒2) than CT (178 ind. m‒2) in 2015, while MT had greater species richness than CT (4.12 vs. 2.00 taxa sample-1; respectively). Infiltration rate in the ST treatment was 18% higher when compared with CT in 2015. Residue cover was positively correlated with earthworm abundance, while earthworm abundance was positively correlated with aggregated stability and infiltration. When comparing economic costs and profitability across systems, ST and MT treatments had a 34% and 22% greater net return relative to CT. These results suggest that conservation tillage has potential to improve soil quality, water dynamics, and increase farmer incomes within furrow-irrigated systems of Colorado and beyond.
IDH mutations in older patients with diffuse astrocytic gliomas.

Abstract In 2016, the World Health Organization recommended that isocitrate dehydrogenase (IDH) mutation status be included in the classification of diffuse astrocytic gliomas. IDH mutations are part of the current definition of oligodendrogliomas and are predictive of a better outcome in diffuse astrocytic gliomas. A few studies, examining the role of routine IDH testing in older patients, came to differing conclusions and made differing recommendations regarding a routine IDH testing algorithm with respect to patient age. The purpose of this study was to examine IDH mutations in a series of diffuse astrocytic gliomas [N = 381; 53 diffuse astrocytomas (WHO grade II), 66 anaplastic astrocytomas (WHO grade III) and 262 glioblastomas (WHO grade IV)], paying particular attention to age of patient and any relationship between age and IDH status. IDH status was evaluated by immunohistochemistry with IDH-1 (R132H) antibody and if negative staining was noted, followup polymerase chain reaction (PCR) testing assessing for IDH-1 and IDH-2 mutations was performed. Overall, IDH mutations were discovered in 50.1% of grade II tumors, 54.4% of grade III tumors and 15.1% of grade IV tumors. Of tumors studied, 224 tumors (58.8%) arose in patients 55 years or older. Higher rates of IDH mutations were observed in the patient group less than 55 years of age versus those 55 years or older. By PCR testing in patients 55 years or older, non IDH-1 (R132H) mutations were noted in 0/4 grade II tumors, 3/11 grade III tumors and 26/37 grade IV tumors. The results of this study suggest that although IDH mutations in diffuse astrocytic gliomas are more frequently encountered in patients less than 55 years of age, a significant subset of older patients have mutations that would not be discovered on routine immunohistochemistry and therefore, followup PCR testing is recommended for all patients whose tumors are negative by immunohistochemistry.
Efficacy of progestin-only treatment for the management of menopausal symptoms: a systematic review.

IMPORTANCE Menopause is associated with bothersome symptoms for many women, including mood changes, hot flushes, sleep problems, and fatigue. Progesterone is commonly prescribed in combination with estrogen therapy. Although monotherapy with progestins has been used as treatment of menopausal symptoms in women with contraindications to estrogens, the optimal route, and dosage of progestin monotherapy has not been established. OBJECTIVE To assess whether progestin as a standalone treatment is effective for treating vasomotor and mood symptoms associated with menopause. EVIDENCE REVIEW We conducted a systematic review using PubMed and Embase databases from January 1980 to January 2020. We included randomized controlled trials (RCTs) that investigated different forms of progestin for the treatment of vasomotor or mood symptoms associated with menopause. FINDINGS A systematic search of 892 studies identified seven RCTs involving a total of 601 patients. The available literature was heterogeneous in terms of formulation and dose of progesterone; administration ranged from 5 to 60 mg of transdermal progesterone, 10 to 20 mg oral medroxyprogesterone acetate, and 300 mg of oral micronized progesterone. Duration of treatment also differed between studies, ranging from 21 days to 12 months (median: 12 wks). Three of seven RCTs reported that progestin therapy led to an improvement of vasomotor symptoms (VMS) in postmenopausal women. The largest study administering oral progestin using 300 mg micronized progesterone reported a 58.9% improvement in VMS (vs 23.5% in placebo group, n = 133), whereas the largest study using transdermal progesterone reported no improvement (n = 230). No study reported an improvement of mood symptoms. Side effects, such as headaches and vaginal bleeding, were significant in five of seven RCTs and led to discontinuation of treatment in 6% to 21% of patients. CONCLUSIONS AND RELEVANCE A beneficial effect was reported in some trials with the transdermal route at longer duration and with oral treatment at higher doses for VMS for progesterone-only therapy. This report may help to inform future studies of progestin-only therapy for the treatment of menopausal symptoms.
Design and analysis of magnetostrictive sensors for wireless temperature sensing.

Magnetostrictive transducers are commonly used as actuators and sonar transducers, and in remote non-destructive evaluation. Their use in wireless thermometry is relatively unexplored. Since magnetostriction-based sensors are passive, they could potentially enable long-term near-field thermometry. While the temperature sensitivity of resonance frequency in magnetostrictive transducers has been reported in previous studies, the origin of the temperature sensitivity has, however, not been elucidated. Here, we identify material properties that determine temperature sensitivity and identify ways to improve sensitivity as well as the detection technique. Using a combination of analytical and computational methods, we systematically identify the material properties that directly influence the temperature coefficient of resonance frequency (TCF). We first experimentally measure the shift in resonance frequency due to temperature changes in a Metglas strip to be 0.03% K−1. Using insights from theory, we then experimentally demonstrate a fivefold improvement to the TCF by using Terfenol in place of Metglas as the magnetostrictive sensor material. We further demonstrate an alternate temperature sensing technique that does not require measuring the resonance frequency, consequently reducing instrument complexity. This work provides a general framework to analyze magnetostrictive materials and the sensing scheme for near-field wireless thermometry.
Platforms as Blackacres

While writing this Article, I interviewed a journalist who writes stories about harmful technologies. To do this work, he gathers information from websites to reveal trends that online platforms would prefer to hide. His team has exposed how Facebook threatens people’s privacy and safety, how Amazon hides cheaper deals from consumers, and how Google diverts political speech from our inboxes. You’d think the journalist might want credit for telling these important stories, but he instead insisted on anonymity when we talked because his lawyer was worried he’d be confessing to breaking the law—to committing the crime and tort of cyber-trespass. Cyber-trespass law makes it illegal to access websites and gather information without a platform’s permission. Some courts treat all websites as “blackacres”—as enclaves of private property that platforms may govern much like people may exert dominion over their private land in the real world. This legal regime empowers platforms to selectively and arbitrarily grant and withhold their consent when people attempt to access their websites. Platforms have long exercised these gatekeeper rights through their computer code, restricting access through authentication barriers like password gates. But cyber-trespass law empowers platforms to limit access through legal code, using their terms of service or cease-and-desist letters to deter people from gathering information for any reason whatsoever. This Article argues that this indiscriminate treatment of all websites as blackacres violates the First Amendment. Applying cyber-trespass rules identically across the internet undermines core constitutional values by giving platforms unlimited discretion to prevent access to information that’s already within the public sphere. To avoid these unconstitutional applications of cyber-trespass law, courts should recognize two types of cyberspaces: Cyber-trespass law should have no force on websites that are accessible to the general public, but it should offer robust privacy protections when they’re inaccessible. Whether a website is publicly accessible for constitutional purposes should turn on the social structure of communicative practices on particular websites, not merely whether a website sits behind a password gate. Adopting this framework would not only satisfy the First Amendment, but also protect privacy interests that are increasingly threatened in the digital age.
Implementation of a triage nurse role and the effect on hospitalist workload

Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can b...
Spontaneous Coronary Artery Dissection Case Series: Clinical Presentation, Angiographic Imaging, Management, and Outcomes.

Spontaneous coronary artery dissection (SCAD) is a rare but more frequently recognized cause of acute coronary syndrome (ACS). Due to the low incidence rate of this condition, there are no consensus guidelines to treat this clinical entity. Most of the information on the clinical presentation and management of SCAD originates from case reports and series; however, there has not been yet a prospective randomized study to guide treatment of SCAD. It is mostly seen in women and particularly those of younger ages. Most cases have an underlying etiology although the underlying pathophysiology is not fully understood. Patients might present in various ways including chest pain, ST- elevation ACS, ventricular arrhythmia, and sudden cardiac death. Although conservative management is mostly recommended with better outcomes, revascularization should be considered in certain circumstances. In this article, we describe a case series of five patients with SCAD. Additionally, this article reviews clinical presentation, incidence, diagnostic modalities, management and risk of recurrences in patients diagnosed with SCAD.
The size of physiological spinal curvatures and functional parameters of trunk muscles in children with idiopathic scoliosis

Objective: To examine the influence of the spinal contour changes on the functioning of trunk muscles in children with idiopathic scoliosis. Background: In the early stage of scoliosis progression, changes in the sagittal plane often manifest themselves in curving in the lumbar lordosis and curving out of the thoracal scoliosis. An increase or decrease in the size of anteroposterior spinal curvatures may disturb functioning of the trunk muscles. Method: Thirty five girls (mean age: 14.7 ± 2.3 yr) with idiopathic scoliosis took part in this study. In terms of location, thoracal scoliosis was dominant. Photogrammetry with automatic Moire fringe analysis system was used to assess the spinal contour. Activity of the spinal flexors and extensors was tested isokinetically at 3 angular velocities: 60, 90 and 120°/s. The measured force-velocity parameters were analysed according to location of the scoliosis (primary thoracal or primary thoraco-lumbar scoliosis), the size of the deformity and posture type: lordotic, kyphotic or equivalent (balanced) (a posture type, where thoracic kyphosis and lumbar lordosis are of similar size - they are balanced). Results and conclusions: A step-by-step discriminant analysis indicated that parameters associated with muscle endurance were the most diversified regardless of the division criterion applied. It was also revealed that functioning of the trunk muscles was related to the spine asymmetry in the frontal plane as well as on the spinal contour in the sagittal plane.
The Real Numbers

To begin our study we must take a rigorous approach to understanding the real number system. This set has been built on intuition throughout your mathematical career and we seek to develop a concrete foundation to support this intuitive understanding before progressing to a study of functions of a real variable. In order to make sure we have a firm baseline established, the opening section provides a list of necessary preliminaries.