cssi/SciSciGPT-SciSciNet huggingface dataset:
Osteolysis of the Hips in a Patient with long term Rheumatoid Arthritis

Case presentation: A fifty four year old African American female with history of rheumatoid arthritis (RA) presented to the emergency room with signs and symptoms of community acquired pneumonia. Patient was diagnosed with RA 30 years ago and was treated initially with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and gold injections for 3 months since then she didn’t receive any disease modifying anti rheumatic drugs (DMARD) or corticosteroids. On examination, she was wheelchair bound with multiple joint deformities: ulnar deviation, swan neck deformities, without any signs of active synovitis. Rheumatoid nodules were absent. She had severe limitation of passive and active movement of the hip joints bilaterally. Images of the pelvis showed resporption of the femoral (1). Marked subchondral sclerosis was noted in the acetabulum. CT scan of the pelvis was done to rule out subcapital femoral neck fracture. It demonstrated advanced degenerative changes in both hip joints with partial resorption of both femoral heads worse on the left, no fracture was noted. Conclusion: Osteolysis is a complication of long term untreated RA that is rarely seen in adults with RA and is more common in JRA. Key words: Rheumatoid Arthritis, Tempomandibular Joint, Osteolysis, Hip joint
Analysis of Instrumentation Selection and Placement to Monitor the Hydrologic Performance of Permeable Pavement Systems and Bioinfiltration Areas at the Edison Environmental Center in New Jersey

Infiltration is one of the primary functional mechanisms of green infrastructure stormwater controls, so this study explored selection and placement of embedded soil moisture, water level, and temperature sensors to monitor surface infiltration and infiltration into the underlying soil for permeable pavement systems and bioinfiltration areas at the Edison Environmental Center in Edison, NJ. In 2009, the U.S. Environmental Protection Agency constructed a 0.4-ha (1-acre) parking lot surfaced with three permeable pavement types (interlocking concrete pavers, porous concrete, and porous asphalt) and six bioinfiltration areas. The six bioinfiltration areas were designed with three different ratios of drainage area to bioinfiltration surface area (5.5:1, 11:1, and 22:1). A series of time domain reflectometers (TDRs), piezometers, and thermistors were installed at various depths in the profile in each control and in the underlying soil. A drain gauge (passive capillary lysimeter) was installed in one bioinfiltration area. The ongoing objective for this research is to develop instrument lists, placement strategies, and data analysis techniques to determine when a deviation in the control’s typical performance occurs to then establish when maintenance or replacement is required. Initial results with TDRs installed in the gravel storage layer of permeable pavement systems have shown that these sensors can measure a different response when water enters the surface as direct rainfall versus rainfall combined with runoff from a contributing drainage area. This change in response represents a condition where the permeable surface upgradient of the TDRs has become clogged, so it also receives surface runoff from the contributing area.
Dissemination of invasive aspergillosis: diagnostic and management dilemmas

Invasive aspergillosis is a highly lethal opportunistic infection that poses a significant threat to immunocompromised patients. With studies suggesting that the incidence of this disease is increasing, and mortality rates remain high, early diagnosis and treatment are very important to improve patient survival. We present a case of a 63-year-old woman on an immunosuppression regimen with methylprednisolone and azathioprine for the treatment of autoimmune hepatitis, who presented with neurological and respiratory symptoms leading to a rapid clinical decline. A final diagnosis of disseminated invasive aspergillosis was made at autopsy. This case emphasises the importance in maintaining a high index of suspicion to ensure that the proper workup, diagnosis and treatment can be initiated earlier in the clinical presentation in an effort to decrease the extremely high mortality in these cases.
Incidence of Zoophthora phytonomi (Zygomycetes: Entomophthorales) in Hypera postica (Coleoptera: Curculionidae) Larvae in Virginia

Infection rates of Zoophthora phytonomi (Arthur) Batko in alfalfa weevil, Hypera postica (Gyllenhal), larvae were monitored from 1979 through 1981 in Rockbridge County, Va. Infection rates of the pathogen were highest near the end of the spring alfalfa crop when alfalfa weevil larval populations were declining. Z. phylonomi was effective in suppressing alfalfa weevil populations below economic threshold levels only during a period of higher rainfall that occurred in 1979. A negative correlation between infection rates of Z. phytonomi and parasitization rates of the ichneumonidparasite Bathyplectes anurus (Thomson) (Hymenoptera: Ichneumonidae) suggests a possible interference between these two natural control agents.
Contrast-Enhanced Sonography for Detection of Secondary Lymph Nodes in a Melanoma Tumor Animal Model

Objectives To investigate the use of contrast-enhanced ultrasound imaging (US) for detection of secondary lymph nodes (LNs) in a naturally occurring melanoma swine model compared to surgery and pathologic assessment. Methods Twenty-seven Sinclair swine were studied. The perfluorobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) was administered (1.0 mL total dose) around the melanoma, and contrast-enhanced US was used to localize contrast-enhanced sentinel lymph nodes (SLNs). Then Sonazoid (dose, 0.25–1.0 mL) was injected into the SLNs to detect contrast-enhanced efferent lymphatic channels and secondary LNs. After peritumoral injection of blue dye, a surgeon (blinded to the contrast-enhanced US results) performed a radical LN dissection. Contrast-enhanced US was used to guide removal of any enhanced secondary LNs left after radical LN dissection. Clustered conditional logistic regression analyzed the benefit of contrast-enhanced US–directed secondary LN dissection over radical LN dissection using pathologic findings as the reference standard. Results A total of 268 secondary LNs were resected, with 59 (22%) containing metastases. Contrast-enhanced US detected 92 secondary LNs; 248 were identified by radical LN dissection; and 68 were identified by both methods. Metastases were detected in 20% (51 of 248) and 40% (37 of 92) of the secondary LNs identified by radical LN dissection and contrast-enhanced US, respectively. Thus, secondary LNs detected by contrast-enhanced US were nearly 5 times more likely to contain metastases than secondary LNs removed by radical LN dissection (odds ratio, 4.8; P < .0001). Twenty-two of the 180 secondary LNs (12%) identified only by radical LN dissection contained metastases, whereas contrast-enhanced US identified 20 secondary LNs after the surgeon completed the radical LN dissection, of which 8 (40%) contained metastases. Conclusions Secondary LNs can be detected by using contrast-enhanced US after injection of Sonazoid into SLNs. Secondary LNs detected with contrast-enhanced US are significantly more likely to contain metastases than those removed by radical LN dissection.
Distortion of 3-Dimensional Object Produced by Laser Lithography

We developed an optical machining system that fabricates steric objects automatically by stacking plastic layers by scanning a UV laser beam on liquid photopolymer. Some distortions are found along the lower side of the fabricated objects but they are only a noticeable problem of this system. Many experiments carried out under various conditions, by changing a speed of laser scan, thickness of layers, and irradiation power, revealed that the shrinkage of the photopolymer results in deformation. We propose a new hypothesis, that is, the speed of photopolymerization is the second major cause of this curious disortion.
E-038 Stenting for Pseudotumor: The Conduit Technique

Introduction Carefully selected pseudotumor cerebri patients with dural sinus stenosis and pressure gradients can be considered for sinus stenting. The tortuous sigmoid sinus-jugular bulb junction and transverse-sigmoid sinus stenosis can contribute to the complexity of stent delivery. Materials and Results Distal access guide catheters as 6Fr 070 Neuron guide catheters and 6Fr 088 Neuron Max sheaths (Penumbra, Inc., Alameda, CA), 6Fr Shuttle sheaths (Cook Medical, Inc., Bloomington, IN), 6Fr Chaperon guide catheters (Microvention-Terumo, Irvine, CA), over a diagnostic insert catheter can provide distal support during delivery of Cordis Precise stents (Cordis Corporation, Bridgewater, NJ). We report nineteen cases where the guide catheter was able to achieve access beyond the jugular bulb and in all cases the stent was successfully deployed across the target lesion. No guide catheter or stent complications were encountered in our series. Conclusion We outline our “conduit” approach in sinus stenting using distal access guide catheters which allows for superior navigability and trackability of the guide catheters across the tortuous and stenotic sinus system, and successful deployment of the stent. Disclosures I. Chaudry: 2; C; Penumbra, Microvention. A. Spiotta: None. H. Hawk: None. A. Miranpuri: None. R. Turner: 2; C; Microvention, Penumbra. A. Turk: 2; C; Penumbra, Microvention.
Analysis of the archives situation of medical equipment and countermeasures in the disease prevention and control system in Qujing city

The archives of medical equipment are formed from the equipment data,image carrier,approval documents and calibration and maintenance records,which come from the whole process of medical equipment purchase,approval to use,repair and abandoned.With the continuous development of public health and science and technology,and enhance the ability of monitoring and detection,medical equipment became more and more important in the center for disease control and prevention work.So the equipment archives are an important part of the equipment management.To explore the new method of construction and management of equipment archives on the basis of what medical equipment that normal operation and file status in the center for disease control and prevention system of Qujing city.
Infectious complications of cervical cerclage

A study of 115 gravid patients who required cervical cerclage indicated that the optimum time to perform the surgical procedure was between the fourteenth and eighteenth weeks. If the operation is delayed until later in the second trimester, the incidence of chorioamnionitis is increased 2.6-fold, and premature rupture of the membranes prior to the thirty-second week of gestation is trebled. Amniocentesis performed in nine patients with chorioamnionitis and intact membranes after cerclage demonstrated the polymicrobial nature of the amniotic fluid infection. The isolation of such organisms at Bacteroides bivius, Eubacterium lentum, and Staphylococcus epidermidis indicates their potential importance in chorioamnionitis. Early recourse to amniocentesis is recommended when chorioamnionitis is suspected, and, moreover, prophylactic antibiotics should be used when cerclage is performed after the eighteenth week of pregnancy.
The impact of Disability Studies curriculum on education professionals' perspectives and practice: Implications for education, social justice, and social change

As a field, Disability Studies has gained ground in the past few decades by highlighting alternative ways of thinking about disability as a social, cultural, and political phenomenon. As more education professionals pursue advanced degrees with a Disability Studies framework, there is a need to understand how, if at all, Disability Studies influences their perspectives and practices. This study employed semi-structured interviews with nine doctoral students enrolled in a Doctorate of Philosophy in Education program that used the framework of Disability Studies, who are also practicing education professionals, to explore how gaining knowledge about Disability Studies impacted their daily work in the field of education. Through their experiences, they indicated that Disability Studies has transformed their conceptualization of disability, their practices, and themselves.
The role of computed tomography scanning in the initial assessment and the follow-up of malignant pleural mesothelioma.

Between October 1983 and April 1987, 20 patients with malignant mesothelioma underwent computed tomography scans of the chest and upper abdomen to evaluate the extent of disease before treatment. Twelve of these 20 patients deemed to have some potential for long-term survival had scans performed every 3 months after operation to help detect recurrent disease. Anatomic correlation of computed tomography scan findings was available in all 20 patients. The limitations of computed tomography in initial evaluation were its difficulties in assessing (1) chest wall involvement (nine patients), (2) mediastinal lymph nodes (four patients), (3) transdiaphragmatic extension of tumor (four patients), and (4) peritoneal studding and solid organ metastases less than 2 mm in size (one patient). Computed tomography was helpful in detecting recurrent disease in the 12 patients having long-term follow-up. In six of eight cases with histologically proved recurrence, computed tomography detected tumors from 1 to 8 months before the onset of signs or symptoms. Although computed tomography is known to provide far more information about the extent of disease than plain radiographs, it remains an imperfect tool for the staging of disease in patients with malignant mesothelioma. Despite its limitations, computed tomography is probably the most accurate way to provide follow-up for patients during treatment
Resistivity of Rotated Graphite-Graphene Contacts

Robust electrical contact of bulk conductors to two-dimensional (2D) material, such as graphene, is critical to the use of these 2D materials in practical electronic devices. Typical metallic contacts to graphene, whether edge or areal, yield a resistivity of no better than 100 Ω μm but are typically >10 kΩ μm. In this Letter, we employ single-crystal graphite for the bulk contact to graphene instead of conventional metals. The graphite contacts exhibit a transfer length up to four-times longer than in conventional metallic contacts. Furthermore, we are able to drive the contact resistivity to as little as 6.6 Ω μm2 by tuning the relative orientation of the graphite and graphene crystals. We find that the contact resistivity exhibits a 60° periodicity corresponding to crystal symmetry with additional sharp decreases around 22° and 39°, which are among the commensurate angles of twisted bilayer graphene.
Internet Pornography Use, Perceived Addiction, and Religious/Spiritual Struggles

Prior work has demonstrated that religious beliefs and moral attitudes are often related to sexual functioning. The present work sought to examine another possibility: Do sexual attitudes and behaviors have a relationship with religious and spiritual functioning? More specifically, do pornography use and perceived addiction to Internet pornography predict the experience of religious and spiritual struggle? It was expected that feelings of perceived addiction to Internet pornography would indeed predict such struggles, both cross-sectionally and over time, but that actual pornography use would not. To test these ideas, two studies were conducted using a sample of undergraduate students (N = 1519) and a sample of adult Internet users in the U.S. (N = 713). Cross-sectional analyses in both samples found that elements of perceived addiction were related to the experience of religious and spiritual struggle. Additionally, longitudinal analyses over a 1-year time span with a subset of undergraduates (N = 156) and a subset of adult web users (N = 366) revealed that perceived addiction to Internet pornography predicted unique variance in struggle over time, even when baseline levels of struggle and other related variables were held constant. Collectively, these findings identify perceived addiction to Internet pornography as a reliable predictor of religious and spiritual struggle.
Collaborative Interferon-γ and Interleukin-17 Signaling Protects the Oral Mucosa from Staphylococcus aureus.

Infections with Staphylococcus aureus are a continuing and growing problem in community and hospital settings. Preclinical animal modeling of S. aureus relies on experimental infection, which carries some limitations. We describe here a novel, spontaneous model of oral staphylococcal infection in double knockout mice, deficient in the receptors for IL-17 (IL-17RA) and interferon (IFN)-γ (IFNγRI), beginning at 6 to 8 weeks of age. IFNγRI −/− IL17RA −/− (GRAKO) mice developed progressive oral abscesses. Cytometric methods revealed extensive neutrophilic infiltration of oral tissues in GRAKO mice; further investigation evidenced that IL-17 predominated neutrophil defects in these mice. To investigate the contribution of IFN-γ signaling to this native host defense to S. aureus , we observed perturbations of monocyte recruitment and macrophage differentiation in the oral tissues of GRAKO mice, and CXCL9/chemokine ligand receptor (CXCR)3-driven recruitment of T-cell oral tissues and draining lymph nodes. To address the former finding, we depleted macrophages and monocytes in vivo from IL17RA −/− mice using liposomes loaded with clodronate. This treatment elicited oral abscesses, recapitulating the phenotype of GRAKO mice. From these findings, we propose novel collaborative functions of IL-17 and IFN-γ, acting through neutrophils and macrophages, respectively, in native mucocutaneous host defenses to S. aureus .
On the Goodness of Skinner’s System of Naturalistic Ethics in Solving Basic Value Conflicts

The system of ethics and values proposed by B. F. Skinner is one that has “naturalized” ethics and is therefore able to resolve conflicts by empirical means. Skinner has demonstrated that the naturalistic fallacy proposed by Moore (1903/1966) is a groundless theoretical argument, and that “good” can be adequately and effectively naturalized and placed within the realm of scientific scrutiny. Skinner’s naturalistic ethical system has effectively bridged the gap between what “is” and what “ought to be” in an ethical sense. On the level of individual conflicts, a science of behavior can tell us who is right by scientifically and rationally probing the best methods for achieving our purposes, and these purposes can best be operationalized as survivability. Critics of Skinner’s ethical system have claimed that they see no good reason to work for the good of the culture, undermining Skinner’s argument concerning the significance of the survivability of the species. Implications for Skinner’s naturalistic ethics are presented and analyzed. It is concluded that as our society and our world move closer and closer to extinction from individual desires rising above the good of society, immediate aversive consequences for these behaviors will begin to take place. A Skinnerian ethical analysis entails changing the contingencies of reinforcement to affect a majority of individuals, so that they may emit behaviors consistent with what is good for our culture and species as a whole.
The hearing aid industry is more helpful than suggested.

A letter to the editor is presented in response to the article "Opening the Market for Lower Cost Hearing Aids: Regulatory Change Can Improve the Health of Older Americans" by J. Blustein and B.E. Weinstein which appears in a 2016 issue of the journal.
Calcium: Fruit yields, tree size, and mineral nutrition relationships in ‘valencia’ orange trees as affected by liming

Two liming treatments were compared against an unlimed control in a field experiment with ‘Valencia’ orange (Citrus sinensis (L.) Osbeck) trees planted on a deep acid sand. The two 1ime treatments were: 1) dolomitic limestone (DL) applied as needed to maintain soil pH 7, and 2) combinations of calcitic limestone (CL) and gypsum (G) to maintain pH 7 and to provide, annually, a total of 224 kg added Ca per ha. The experiment started when the trees were 2 years old and continued for 15 years. Trees on the limed plots produced significantly higher fruit yields in 10 of 11 crops. Fruit production increased steadily throughout the period in direct relation to increases in tree size with little tendency to level off. Trees on the limed plots increased canopy volume twice as fast as trees on the unlimed plots where the soil pH remained at approximately 5.0. Tree growth and fruit yield responses to liming were very similar for both lime treatments. Liming reduced the concentrations of N and K in the leave...
The Effects of Graphite Filler on the Tribological Properties of Polydopamine/PTFE Coatings

This investigation examines the effects of incorporating graphite as a filler in the polytetrafluoroethylene (PTFE) topcoat of a polydopamine/PTFE dual-layer coating. Polydopamine (PDA) is used to enhance the adhesion of PTFE coatings to the substrate, and graphite is used to improve the formation of a transfer film on the counterface and to take advantage of the low-friction properties of graphite. The results show that incorporating only 1.0 wt% graphite in PDA/PTFE coatings can increase their durability fivefold and reduce friction by 17 %. Examination of the wear morphology indicates that these improvements in tribological properties are in fact the result of the formation of a transfer film on the counterface that allows the coating to essentially slide against itself, creating a low shear strength interface that exhibits exceptionally low friction and low wear. Linearly increasing load scratch tests show that the improvement in durability is also the result of improved adhesion between the PTFE topcoat and the PDA basecoat, preventing large-scale delamination of the coating.
Developing An Alternative Way to Analyze NanoString Data

OF DISSERTATION Developing An Alternative Way to Analyze NanoString Data Nanostring technology provides a new method to measure gene expressions. It’s more sensitive than microarrays and able to do more gene measurements than RT-PCR with similar sensitivity. This system produces counts for each target gene and tabulates them. Counts can be normalized by using an Excel macro or nSolver before analysis. Both methods rely on data normalization prior to statistical analysis to identify differentially expressed genes. Alternatively, we propose to model gene expressions as a function of positive controls and reference gene measurements. Simulations and examples are used to compare this model with Nanostring normalization methods. The results show that our model is more stable, efficient, and able to control false positive proportions. In addition, we also derive asymptotic properties of a normalized test of control versus treatment.
H-Ferritin Ferroxidase Activity Induces Cytoprotective Pathways and Inhibits Microvascular Stasis in Transgenic Sickle Mice

Abstract 378 Hemolysis, oxidative stress, inflammation, vaso-occlusion and organ infarction are hallmarks of sickle cell disease (SCD). We hypothesize that intravascular heme, liberated from hemoglobin S derived from hemolyzed sickle red blood cells, is fundamental to inflammation and vaso-occlusion in SCD. Heme can be degraded by heme-oxygenase-1 (HO-1), releasing Fe2+, carbon monoxide (CO), and biliverdin/bilirubin. We have previously shown that increases in HO-1 activity inhibit vascular inflammation and vaso-occlusion in transgenic mouse models of SCD. HO-1 products, CO and biliverdin/bilirubin, also are protective in SCD, but Fe2+ released from the heme ring requires further processing. The released Fe2+ from heme is oxidized by ferritin heavy chain (FHC) ferroxidase activity and safely stored as catalytically-inactive Fe3+ inside ferritin clusters. FHC overexpression has been shown to be cytoprotective in response to inflammation and oxidative stress in vivo and in vitro. In this study, we hypothesize that overexpression of FHC with its ferroxidase activity will inhibit inflammation and microvascular stasis in transgenic sickle mice in response to stroma-free hemoglobin. We utilized a Sleeping Beauty transposase plasmid to deliver a human wt-ferritin heavy chain (wt-FHC) transposable element by hydrodynamic tail vein injections to NY1DD SCD mice. Control mice were infused with the same volume of lactated Ringer9s solution LRS) or a triple missense (ms-) human FHC plasmid encoding no ferroxidase enzyme activity. Eight weeks after injection, the mice were implanted with dorsal skin-fold chambers to access microvascular blood flow. LRS-treated mice had 40% microvascular stasis (% non-flowing venules) when infused with stroma-free hemoglobin, while wt-FHC overexpressing mice had only 5% stasis (p Disclosures: Vercellotti:Sangart Inc: Consultancy, Research Funding. Chen:Sangart Inc: Research Funding. Hebbel:Sangart Inc: Consultancy, Research Funding. Belcher:Sangart Inc: Research Funding.
Book Review: Schleiermacher: Christmas Dialogue, the Second Speech, and Other Selections:

Schleiermacher: Christmas Dialogue, The Second Speech, and Other Selections. Edited and translated by Julia A. Lamm. The Classics of Western Spirituality. Mahwah, N.J.: Paulist Press, 2014. xvii + 296 pp. $29.95 (paper).Friedrich Schleiermacher is known by many as the "father of modem theology" and a masterful preacher. In this welcome volume, Julia Lamm offers readers a masterful introduction and an important body of texts for understanding Schleiermacher as both a theorist and literary genius of Christian spirituality. In Schleiermacher the term of art is Frommigkeit or piety; Lamm seeks to build upon this well-known theological concept and demonstrates that contemporary research on Christian spirituality identifies key markers (anthropological, social, historical, and practical) that are all present in Schleiermacher's writings.One of the most helpful interpretive proposals of the introduction is Lamms pairing of Schleiermacher with Pierre Hadot, the French philosopher and author of Philosophy as a Way of Life. By considering Schleiermachers theology as a spiritual exercise (pp. 36-44), Lamm demonstrates why examination of his earlier spiritual writings requires constant reference to the later theological writings, but also (and perhaps more importantly) why reading the earlier literary and homiletical texts are essential if one is to understand correctly Schleiermachers later, more systematic reflections on the spiritual life.The Christmas Dialogue is a fitting entrance into the selections, maintaining suggestive hints of Schleiermachers spirituality while embedding these hints within the discourse of various personalities. The earnest piety of the daughter Sofie initiates reflection upon the Christmas holiday, with a high point in Karoline's opinion about the interactive nature of universal and particular joy: joy here is really the central concept that ties this text to Schleiermacher s sense of Frommigkeit. The story of the evening closes with the entrance of Josef, who ends the speeches abruptly and returns the festive group to a consideration of the child: "The speechless subject demands or generates in me a speechless joy, and in my joy I can only smile and cheer like a child" (p. 150).Lamm's translation of the Second Speech from On Religion: Speeches to Its Cultured Despisers is the first English version of the 1806 edition, allowing for a revealing comparison with the 1799 speech with which many are already familiar through Richard Crouter's translation. Gone is the celebrated entreaty for the despisers of religion to familiarize themselves with the idea of an "intuition of the universe." Language of Wissenschaft and erkennen also increases as language of Metaphysik decreases, and the despisers are now also suggestively labeled Wissenden in a few places, translated by Lamm as "Knowing Ones. …
Improving the design of atomic magnetometer arrays for RF interference mitigation in NQR detection of explosives

Nuclear Quadrupole Resonance (NQR), a type of radio frequency spectroscopy, holds the promise of unambiguous detection of particular explosives; the associated resonant frequencies are virtually unique. This specificity is spoiled by natural and anthropogenic interference that can swamp the NQR signal. Fortunately, the spatial magnetic signature from the explosive differs significantly from that of interference and can be exploited to separate the signals. An array of coils, however, cannot provide truly independent measurements due to the inductive coupling between the coils. Single coil configurations can cancel out constant interference and retain the signal from an NQR coil, but the balance between arms of the coil is compromised by differential coupling to the environment. Atomic magnetometers, an emergent technology predicted to surpass the sensitivity of coil detection, do not suffer from such coupling and have no fundamental limitation to forming an array of independent sensors. We have demonstrated up to 94× interference rejection with a 4-sensor array spanning 25 cm. The array symmetry permits rejection of linearly varying interference. We discuss the prevention of reradiation from DC field coils used to set the magnetometer resonance frequency. Such reradiation leads to non-linear variation. The benefits of larger sensor arrays are also explored.
Dying From Cancer: Communication, Empathy, and the Clinical Imagination

Medical oncologists and patients with advanced cancer struggle to discuss prognosis, goals, options, and values in a timely fashion. As a consequence, many patients die receiving aggressive treatment potentially inconsistent with their fully informed preferences and experience increased symptom burden and distress. The goals of patient - oncologist communication include exchanging information, building relationship, and engaging in shared decisions. Empathy is perhaps especially essential to effective patient - oncologist communication when the end of life is approaching. We speculate that, in addition to being a skilled response to a patient's negative emotions, empathy is an emergent property of the relationship that allows the patient and oncologist to imagine what it will be like to navigate the transition from living with to dying from cancer; and to prepare for the transition. We propose that effective empathy: 1) requires an attentive, curious and imaginative physician; 2) acknowledges the complex and shifting goals as the end of life approaches; and 3) begins with a willingness of physicians to check in and find out what she may have misunderstood or misperceived. Empathy in end of life conversations cultivates the shared experiences necessary to co-create the new goals of care that underlie excellent end of life care.
Modeling a 5-DOF Haptic Interface for Isotropic Force Control

Abstract This paper describes a multivariable modeling and control strategy that increases the bandwidth of isotropic force transmission in multi-degree of freedom haptic interfaces. The controller structure leads to a straightforward model identification procedure and yields a simple control law that can be easily implemented. Experimental results show that this technique significantly improves force tracking performance on a 5 degree-of-freedom in-parallel haptic interface.
Controlled Activity of the Salmonella Invasion-Associated Injectisome Reveals Its Intracellular Role in the Cytosolic Population.

ABSTRACT The Salmonella invasion-associated type III secretion system (T3SS1) is an essential virulence factor required for entry into nonphagocytic cells and consequent uptake into a Salmonella-containing vacuole (SCV). While Salmonella is typically regarded as a vacuolar pathogen, a subset of bacteria escape from the SCV in epithelial cells and eventually hyperreplicate in the cytosol. T3SS1 is downregulated following bacterial entry into mammalian cells, but cytosolic Salmonella cells are T3SS1 induced, suggesting prolonged or resurgent activity of T3SS1 in this population. In order to investigate the postinternalization contributions of T3SS1 to the Salmonella infectious cycle in epithelial cells, we bypassed its requirement for bacterial entry by tagging the T3SS1-energizing ATPase InvC at the C terminus with peptides that are recognized by bacterial tail-specific proteases. This caused a dramatic increase in InvC turnover which rendered even assembled injectisomes inactive. Bacterial strains conditionally expressing these unstable InvC variants were proficient for invasion but underwent rapid and sustained intracellular inactivation of T3SS1 activity when InvC expression ceased. This allowed us to directly implicate T3SS1 activity in cytosolic colonization and bacterial egress. We subsequently identified two T3SS1-delivered effectors, SopB and SipA, that are required for efficient colonization of the epithelial cell cytosol. Overall, our findings support a multifaceted, postinvasion role for T3SS1 and its effectors in defining the cytosolic population of intracellular Salmonella. IMPORTANCE A needle-like apparatus, the type III secretion system (T3SS) injectisome, is absolutely required for Salmonella enterica to enter epithelial cells; this requirement has hampered the analysis of its postentry contributions. To identify T3SS1-dependent intracellular activities, in this study we overcame this limitation by developing a conditional inactivation in the T3SS whereby T3SS activity is chemically induced during culture in liquid broth, permitting bacterial entry into epithelial cells, but is quickly and perpetually inactivated in the absence of inducer. In this sense, the mutant acts like wild-type bacteria when extracellular and as a T3SS mutant once it enters a host cell. This “conditional” mutant allowed us to directly link activity of this T3SS with nascent vacuole lysis, cytosolic proliferation, and cellular egress, demonstrating that the invasion-associated T3SS also contributes to essential intracellular stages of the S. enterica infectious cycle.
Factor analysis of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis.

BACKGROUND Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS), which examines various aspects of olfactory dysfunction. It is unknown if certain factors of the QOD-NS differentially impact QOL. METHODS Patients with chronic rhinosinusitis (CRS) completed the QOD-NS, 22-item Sino-Nasal Outcome Test (SNOT-22), Medical Outcomes Study Short Form 6-D (SF-6D) health utility measure, and Patient Health Questionnaire-2 (PHQ-2) depression screen. Exploratory factor analysis of the QOD-NS was performed. Associations between QOD-NS factors and other QOL metrics were analyzed before and after endoscopic sinus surgery (ESS). RESULTS Outcomes were examined on 132 patients. The QOD-NS contains 4 distinct factors. There was no difference in associations between the different factors and baseline clinical characteristics. ESS had greatest effect size (d) on factors 2 and 4 (d = 0.29 and 0.27, respectively, p < 0.05). Postsurgical changes in the SF-6D and SNOT-22 had the strongest correlation with factor 2 scores (r = 0.29 and 0.34, respectively, p < 0.05), and changes in the PHQ-2 had the strongest correlation to factor 3 (r = 0.24, p < 0.05). Abnormal QOD-NS scores at baseline were associated with effect size increases of 50% to 100% (p < 0.05). CONCLUSION The QOD-NS measures 4 distinct factors. Eating-related questions had the greatest improvement after ESS. Health utility and CRS-specific QOL improvement most strongly associated with factor 2, while PHQ-2 changes are most highly associated with factor 3, suggesting a differential impact of the factors of the QOD-NS on varying aspects of QOL.
The Politics of Palliative Care in Resource Limited Settings

Whose lives are valuable? Whose lives are worth living? This essay examines these questions by investigating the ways in which global health development programs deal with palliative care, specifically care for people living with HIV, in resource-limited settings. Through interviews and participant observation, I explore the concept of worth as expressed by a particular funding agency and the Central Hospital Network’s (CHN) palliative care staff in an Asian country (not specified due to ethical considerations). Based on six months of ethnographic investigation conducted during an internship from February through August 2015 in a palliative care hospital and organization associated with CHN focused on caring for the poor living with HIV/AIDS, I argue that decisions regarding funding for people with incurable diseases are inseparably tied to understandings of whose lives are more valuable than others. I argue that palliative care that seeks to improve the quality of life for persons with life-threatening illness—especially in resource-limited settings—will continue to face barriers to its development as long as it is judged by utilitarian, neoliberal development standards.
Productivity Versus Creativity

The high cost and quality issues of higher education in many countries need a solution. What is being proposed, and acted on, appears by and large to be the nineteenth century industrial paradigm of productivity to achieve such efficiency, technology being the important factor in cost reduction. However, how does this need for efficiency through productivity–doing more of the same with fewer resources–affect trust in the universities in teaching future generations, i.e. transferring extant knowledge, and especially creativity, i.e. discovering new knowledge, developing new solutions, and expressions of art? In particular, the economies of scale thinking in producing “more” versus creativity in producing “new” are elaborated on. Creativity and productivity are both individual and social concepts however creativity is much more at the individual and small team, personal exchange end and productivity on at specialized, large scale, impersonal exchange end. A key point is that creativity cannot be easily measured in a continuous variable–a solution is either creative or not–and measuring productivity in the economic sense–on the margin and as a percentage change–appears insufficient as a guide to higher education. It turns out that universities my not only loose trust in its mission to teach and do research–as financial returns on (or increasing funding of) universities do not appear to translate into comparable social gains–but creativity is also lost, creating more questions on the use of standard productivity measures on higher education. This may reflect a loss of purpose in higher education, abandoning the thought of solving problems.
Flux-depression factors for scattering and absorbing media

The method of elementary solutions, along with Chandrasekhar's invariance principles, is used to solve a two-region problem relevant to flux-depression calculations. An improved P-L-type approximation is also discussed.
The cost of a catheter: An environmental perspective on single use clean intermittent catheterization

Methods We estimated the prevalence of CIC use in the United States using a neurogenic population, consisting of persons with multiple sclerosis, spina bifida, and spinal cord injury. We measured catheter samples to obtain the amount of waste per catheter. Results At least 300 800 persons in the United States perform CIC for neurogenic bladder management. Assuming five catheterization events per day, the amount of waste generated by single-use CIC is between 26 500 to 235 400 pounds or 22 600 to 564 000 liters per day, depending on catheter model. Conclusions Single-use CIC may generate up to 85 million pounds or 206 million liters of waste annually, equivalent to more than 26 000 cars or 80 Olympic-sized swimming pools. Laid end-to-end, there is enough catheter length circumscribe the world more than 5.5 times. The most common materials used in catheter construction have little to no degradation once in a landfill. Given the unproven clinical benefit of single-use catheterization, the environmental impact and alternatives should be considered.
Another Window on the World: English for Creative Expression in the Indian Context

The use of English language for creative expression in the Indian context raises questions of a complex nature. English in India is a language that has understandably been viewed as imposed from outside, as part of the colonial baggage, and as a language that is learnt more for material and practical motivations than for integrative purposes. Over its 150 years of co-existence with regional languages and Bhasha literatures, English begins to inspire creative energy in bilingual or trilingual contexts; it problematises the being of the creative self in multiple ways – it affects the sociocultural nodes of the creative voice; it riffs on the originating sources of artistic expression; and it struggles for cadence and gains a measure of it. The critics of Indian English Literature argue that the dissonance that a ‘foreign’ language injects into the indigenous culture and traditions affects and distorts creativity not just in the area of linguistic ease but also in the authenticity of the creative voice. This essay, ‘Another Window on the World: English for Creative Expression in the Indian Context’, counters such arguments, arguing that English language in India is uniquely positioned now and that it has become a part of the Indian landscape, having been dynamically engaged with the multilingual and multicultural traditions of India over a long period. In its forging of the creative energies of its near-native writers in multiple genres and in its diverse and colourful uses by over 50 million speakers, English continues to deliver rich dividends in terms in original expression as well as in translations from and into Bhasha domains.
Is Submarine Groundwater Discharge (SGD) Important for the Historical Fish Kills and Harmful Algal Bloom Events of Mobile Bay

Large-scale fish and crustacean kills, locally known as Jubilees, and harmful algal blooms (HABs) have been occurring in Mobile Bay (Alabama) for more than a century. In fact, the first record describing a Jubilee event in Mobile Bay during 1867 was the first ever-documented case of mass mortalities of marine animals caused by hypoxia. To evaluate the importance of submarine groundwater discharge (SGD) in the occurrence of Jubilees and HABs in Mobile Bay, a 3-year study was conducted using a multi-method approach. Significant spatial and temporal variations of SGD were revealed in the bay only by applying a combination of geochemical and shallow geophysical techniques. The development of seasonal hypoxia observed in bay waters in areas impacted by Jubilees was the result of anoxic SGD inputs, which magnitude and spatial distribution were controlled by shallow lithological heterogeneities created during the modern development of the bay. Although when compared to the river discharge SGD contributed between 0.2 (wet season) and 5% (dry season) of the total freshwater inputs to Mobile Bay, 80% of the total SGD in the bay occurred in areas ecologically impacted by hypoxia and Jubilees. In these areas, SGD comprised up to 37% of the total water inputs during the dry season, coinciding with the time of the year when Jubilees and HABs occur. In conclusion, while SGD might not be a significant source of fresh water to Mobile Bay or other estuaries worldwide, enhanced SGD caused by site-specific lithological heterogeneities can have a critical role in the development of hypoxia and ecological issues in nearshore waters.
Overview of 3-D Printed Substrates for Enhanced Microstrip Patch Antenna Design

This paper presents an overview of the different uses of additive manufacturing of substrates to enhance the performance of microstrip patch antenna design. Innovations with the substrates using 3-D printing is reported to result in wider bandwidths, higher gains, and in some cases substrate flexibility and performance stability with substrate curvature.
Defects and the Convergence of Padé Approximants

A selective survey is given of convergence results for sequences of Pade approximants. Various approaches for dealing with the convergence problems due to `defects" are discussed. Attention is drawn to the close relationship between analyticity properties of a function and the `smoothness" of its Taylor series coefficients. A new theorem on the convergence of horizontal sequences of Pade approximants to functions in the Baker–Gammel–Wills conjecture function class is presented.
Discovering China in Africa: Race and the Chinese Perception of Africa and Black Peoples

An overarching theme of this chapter is an argument that the images of Africa and black people have been portrayed and constructed as a non-Chinese “Other” throughout history that often reflects China’s own problems and desires. From the Kunlun nu during the Tang Dynasty to todays’ “discovering China in Africa,” whatever the particular circumstance, however, a relationship between two racially superior/inferior human groups is either implied or demonstrated in the narratives and discourses of such an interaction.
(277) Racial/Ethnic Disparities in Opioid Prescribing for Long-Bone Fractures at Emergency Department Discharge: A Cross-Sectional Analysis of 22 Centers from a Single Healthcare Delivery System

Evidence for racial/ethnic disparities in opioid prescribing for long-bone fractures (LBFs) in emergency departments (EDs) is mixed; furthermore, no studies have examined differences in prescribed opioid potency between different racial/ethnic groups. We conducted a cross-sectional analysis of electronic health records (EHR) data from 22 EDs within a single healthcare delivery system in northern California in 2016 and 2017. We examined differences in opioid prescribing and morphine-milligram-equivalent (MME) dosing among adult patients presenting to the ED with a LBF, using regression modeling with statistical adjustment for other patient demographics and clinical characteristics. We excluded patients with a history of fracture in the 3 months prior to their first ED admission during the study period or those who were admitted to the hospital from the ED. We identified 11,576 patients with a visit to the ED for an LBF, with a mean age of 57 years; 65% were non-Hispanic white (NHW), 16% were Hispanic, 7% were African American (AA), 6% were Asian, and 6% were other/unknown. Overall, 66% of patients received an opioid at ED discharge. Hispanic patients had greater odds of receiving an opioid at discharge compared with NHWs (Odds Ratio: 1.17; P=0.014); no differences were observed across other racial/ethnic groups. Among those with an opioid prescription, NHWs received a mean MME dosing of 132 units, with racial/ethnic minority groups receiving dosages that were lower by 4% for Hispanics, 6% for AA, and 8%, each, for Asians and other/unknown (P