cssi/SciSciGPT-SciSciNet huggingface dataset:
Performance evaluation of Code-Spread OFDM using Vandermonde spreading

Spectral nulls present in a channel can severely degrade or cancel out OFDM tones, resulting in an irreducible error rate. To combat this, standards typically employ forward error correction (FEC) techniques. In Code-Spread OFDM (CS-OFDM), each sinewave carries a weighted sum of all the information symbols being transmitted in an OFDM block interval. In this paper, the MMSE estimator is derived for each symbol for a number of cases, including when the number of carriers is greater than the number of symbols. The performance of CS-OFDM is evaluated using Hadamard and Vandermonde spreading and compared to standard OFDM1.
Teaching a Hypothesis-driven Physical Diagnosis Curriculum to Pulmonary Fellows Improves Performance of First-Year Medical Students.

Rationale: Hypothesis-driven physical examination emphasizes the role of bedside examination in the refinement of differential diagnoses and improves diagnostic acumen. This approach has not yet been investigated as a tool to improve the ability of higher-level trainees to teach medical students.Objectives: To assess the effect of teaching hypothesis-driven physical diagnosis to pulmonary fellows on their ability to improve the pulmonary examination skills of first-year medical students.Methods: Fellows and students were assessed on teaching and diagnostic skills by self-rating on a Likert scale. One group of fellows received the hypothesis-driven teaching curriculum (the “intervention” group) and another received instruction on head-to-toe examination. Both groups subsequently taught physical diagnosis to a group of first-year medical students. An oral examination was administered to all students after completion of the course.Measurements and Main Results: Fellows were comfortable teaching physical diag...
Examining the role of Rh/Si cooperation in alkene hydrogenation by a pincer-type [P2Si]Rh complex

A bis(phosphine)/triflatosilyl pincer-type Rh(i) complex can reversibly store one equivalent of H2 across the Si-Rh bond upon triflate migration from silicon to rhodium. The triflatosilyl complex serves as an effective precatalyst for norbornene hydrogenation, but Si-OTf bond cleavage is not implicated in the major catalytic pathway. The combined findings suggest possible strategies for M/Si cooperation in catalytic processes.
Solving Inverse Radiation Transport Problems with Multi-Sensor Data in the Presence of Correlated Measurement and Modeling Errors

Inverse radiation transport focuses on identifying the configuration of an unknown radiation source given its observed radiation signatures. The inverse problem is traditionally solved by finding the set of transport model parameter values that minimizes a weighted sum of the squared differences by channel between the observed signature and the signature pre dicted by the hypothesized model parameters. The weights are inversely proportional to the sum of the variances of the measurement and model errors at a given channel. The traditional implicit (often inaccurate) assumption is that the errors (differences between the modeled and observed radiation signatures) are independent across channels. Here, an alternative method that accounts for correlated errors between channels is described and illustrated using an inverse problem based on the combination of gam ma and neutron multiplicity counting measurements.
Alcohol Consumption in Adolescence: a Translational Perspective

Alcohol use becomes normative in adolescence and sometimes reaches high levels. Studies have shown that both adolescent rats and their human counterparts often drink two to three times more ethanol per occasion than adults, suggesting potential evolutionarily conserved, biological contributors. These elevated intakes may be promoted by neural changes that increase adolescent sensitivity to desired ethanol effects while attenuating sensitivity to undesired consequences likely serving as cues to moderate intake; while based primarily in rodent work, similar (albeit limited) findings are available in humans, suggesting some consilience—i.e., comparability in findings across species. A variety of neural, cognitive, behavioral, and affective alterations, along with an elevated propensity for elevations in later alcohol use, have been reported after repeated ethanol exposure in both species. In those cases where roughly comparable measures have been used across species, signs of consilience are often apparent. Such emerging consiliences may help to guide future research efforts in this understudied and rapidly evolving research area.
National Institute of Allergy and Infectious Diseases (NIAID) Preclinical Resources for Product Development

One of the biggest challenges to product development for infectious diseases is the cost of moving promising candidates through the pipeline. Recognizing this challenge, NIAID can help provide the critical information necessary to advance products and lessen the financial risks associated with investing in product development.
Development of a Collaborative Capability-Based Tradeoff Environment for Complex System Architectures

Presented at the 44th AIAA Aerospace Sciences Meeting and Exhibit 9 - 12 January 2006, Reno, Nevada.
Living Arrangements of American Urban Widows

Abstract This paper is devoted to the examination of the residential arrangements of widows and of the reasons they do not live with married children. It is based on interviews with a modified area probability sample of 301 widows, aged 50 and over, residing in metropolitan Chicago. The conclusion of the analyses is that older widows expect problems in living with married children or are enjoying the ease and independence of living alone sufficiently to offset its disadvantages. Although one-quarter of the widows live in arrangements which they do not like, in terms of sharing a residence, most express satisfaction with their current location. The tendency toward, and satisfaction with, independent living is associated with age, education, and attitudes toward selected social relations, particularly toward children. Widows sharing a residence tend to be with never married children or those undergoing a disorganization of their marriage and to be the head of such a household. Very few Chicago area widows l...
Diversity : Political and societal barriers

This essay describes the many political and societal barriers that impede libraries from having a staff that reflects diversity. The efforts to kill affirmative action programs, the diminution of civil rights laws and other laws to protect minorities, the small number of minorities that are recruited to the profession have been barriers quite difficult to overcome. It was President Johnson who was very firm in his belief that affirmative action was necessary. Presidents who have followed him have given lip service; or we have had a president such as Prsedient Reagan, who ran on a platform to do away with affirmative action. During the decline in affirmative action activity, the corporate section of America began to call their affirmative efforts diversity management. Libraries followed the lead of the corporate community and began to call their efforts diversity managemen to replace affirmative action. The author contends that if the affirmative action programs had been carried out as President Johnson envisioned we would not be riding the wave of diversity in 1998. The author asserts that the greatest societal barrier is racism, which permeates all of American society's paradigms. Jesey calls for an increase in the number of minorities attending ALA accredited library schools. In addition he calls for more libraries to recruit minorities so that library staffs will mirror the people they serve
Religious Memetics Institutional Authority in Digital/Lived Religion

Recently leaders of the Church of Jesus Christ of Latter-day Saints (LDS/Mormon) faith have called upon members to “sweep the earth” with positive religious messages through social media. This digital moment in Mormonism exemplifies the interrelation and concomitant tension between everyday lived religion, technology, and religious institutions. While studies on digital religion have emphasized the push of participatory culture into everyday lived religion, this research on religious memes contributes to an emergent vein of digital religion scholarship focused on institutional authority. In our analysis of the “doubt your doubts” meme and antimemes we theorize religious memetics as a space for the reconnection of the everydayness of religious practice, which boils down meaningful moments of faith into facile, nonthreatening avenues for sharing religion. While this is beneficial for institutions, the reflexive and metonymic function of religious memes ruptures routine, offering participants momentary pause...
The Common School Before and After Brown: Democracy, Equality, and the Productivity Agenda

Martha Minow’s book, In Brown’s Wake, addresses the impact of the Supreme Court’s landmark decision on education rights across a wide range of student differences and group identities. At a time when productivity and competition have captured the policy discussion on schooling worldwide, the book is a timely and sobering reminder that education is not simply about the marketplace.In this Review, I use the framework of Brown’s legacy to examine more explicitly some of the themes related to the purposes of schooling that the book implicitly touches upon. I both widen the lens and narrow it. On the first count, I situate Brown more definitively in the broad historical evolution of the common school. On the second, I look more critically at the federal government’s growing control and oversight of a system initially designed to preserve state and local autonomy over education. I survey historic moments, from mid-nineteenth-century interests in nation building, to mid- to late-twentieth century concerns with equalizing opportunities beyond individual differences, to current economic and global pressures. Guided in part by initiatives announced subsequent to the book’s publication, including the Race to the Top program and the Obama Administration’s Blueprint for Reform, I maintain that today’s productivity agenda falls short in fulfilling Brown’s dual promise: to break down barriers that impede equal opportunity, and to preserve democratic government and the nation’s political standing as a world leader. I maintain that as we move toward a more assertive federal role with a one-size-fits-all view of schooling, we are moving away from equal opportunity as an overarching principle. That progressive shift undercuts post-Brown guarantees to an appropriate and meaningful education. It risks sacrificing one Brown legacy for another and may, in the end, more deeply divide students by race and social class. In the end, I argue that we should strive toward designing an education agenda that incorporates, in a measured way, the political vision of the early common school and the social awareness of post-Brown reforms, while maintaining the nation’s competitive edge.
Don't Just Do Something, Stand There? Unraveling the Complexities of Riata.

As electrophysiologists we confront the challenge of articulating the risks and benefits of various management options to our patients and their families. Weighing the upfront risk typically associated with an interventional procedure against potential adverse events in the long term is a vexing problem that we frequently face in clinical practice. This discussion involves both the immediate risks of an intervention (doing something) and the protracted risks of observation (standing there). Assessing the risk-benefit ratio of intervening today versus possibly intervening tomorrow when a device malfunction has already occurred is challenging to the experts in the field, let alone patients and their families. It is therefore not too surprising that we often find ourselves, after a long discussion in which we present the salient medical facts and evidence-based reasoning to our patients, we face the question, “What would you do if I was your family member?” Management of implantable cardioverter-defibrillator leads with a known high rate of failure is anxiety-producing for both patients and physicians. See Article by Parkash et al Many of our patients continue to live with the St Jude Medical Riata family of leads, which were placed under US Food and Drug Administration advisory in 2011. These leads have well-described design problems associated with a tendency toward inside-out abrasion, resulting in conductor cable externalization. They also display an increased rate of electrical failure, although the rate of failure and its relationship to conductor cable externalization have been debated. Although most observational studies have shown a …
Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects.

Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and abnormal ranges of tongue mobility, and provide evidence in support of a reliable and efficient measure of tongue mobility. A prospective cohort study of 1052 consecutive patients was evaluated during a 3-month period. Age, gender, ethnicity, height, weight, BMI, maximal interincisal mouth opening (MIO), mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP), Kotlow’s free-tongue measurement, and presence of severe tongue-tie were recorded. Secondary outcome measures include tongue range of motion deficit (TRMD, difference between MIO and MOTTIP) and tongue range of motion ratio (TRMR, ratio of MOTTIP to MIO). Results indicate that MIO is dependent on age and height; MOTTIP and TRMD are dependent on MIO; Kotlow’s free-tongue measurement is an independent measure of free-tongue length and tongue mobility. TRMR is the only independent measurement of tongue mobility that is directly associated with restrictions in tongue function. We propose the use of tongue range of motion ratio as an initial screening tool to assess for restrictions in tongue mobility. “Functional” ankyloglossia can thus be defined and treatment effects followed objectively by using the proposed grading scale: grade 1: tongue range of motion ratio is >80%, grade 2 50–80%, grade 3 < 50%, grade 4 < 25%.
Focused Real-Time Ultrasonography for Nephrologists

We propose that renal consults are enhanced by incorporating a nephrology-focused ultrasound protocol including ultrasound evaluation of cardiac contractility, the presence or absence of pericardial effusion, inferior vena cava size and collapsibility to guide volume management, bladder volume to assess for obstruction or retention, and kidney size and structure to potentially gauge chronicity of renal disease or identify other structural abnormalities. The benefits of immediate and ongoing assessment of cardiac function and intravascular volume status (prerenal), possible urinary obstruction or retention (postrenal), and potential etiologies of acute kidney injury or chronic kidney disease far outweigh the limitations of bedside ultrasonography performed by nephrologists. The alternative is reliance on formal ultrasonography, which creates a disconnect between those who order, perform, and interpret studies, creates delays between when clinical questions are asked and answered, and may increase expense. Ultrasound-enhanced physical examination provides immediate information about our patients, which frequently alters our assessments and management plans.
Induction of IL21 in Peripheral T Follicular Helper Cells Is an Indicator of Influenza Vaccine Response in a Previously Vaccinated HIV-Infected Pediatric Cohort.

HIV-infected patients of all ages frequently underperform in response to seasonal influenza vaccination, despite virologic control of HIV. The molecular mechanisms governing this impairment, as well as predictive biomarkers for responsiveness, remain unknown. This study was performed in samples obtained prevaccination (T0) from HIV-infected children who received the 2012–2013 seasonal influenza vaccine. Response status was determined based on established criterion for hemagglutination inhibition titer; participants with a hemagglutination titer ≥1:40 plus a ≥4-fold increase over T0 at 3 wk postvaccination were designated as responders. All children had a history of prior influenza vaccinations. At T0, the frequencies of CD4 T cell subsets, including peripheral T follicular helper (pTfh) cells, which provide help to B cells for developing into Ab-secreting cells, were similar between responders and nonresponders. However, in response to in vitro stimulation with influenza A/California/7/2009 (H1N1) Ag, differential gene expression related to pTfh cell function was observed by Fluidigm high-density RT-PCR between responders and nonresponders. In responders, H1N1 stimulation at T0 also resulted in CXCR5 induction (mRNA and protein) in CD4 T cells and IL21 gene induction in pTfh cells that were strongly associated with H1N1-specific B cell responses postvaccination. In contrast, CD4 T cells of nonresponders exhibited increased expression of IL2 and STAT5 genes, which are known to antagonize peripheral Tfh cell function. These results suggest that the quality of pTfh cells at the time of immunization is important for influenza vaccine responses and provide a rationale for targeted, ex vivo Ag-driven molecular profiling of purified immune cells to detect predictive biomarkers of the vaccine response.
Long-Term Survival of Patients with Myelofibrosis Treated with Allogeneic Hematopoietic Stem Cell Transplantation.

Myelofibrosis with myeloid metaplasia (MMM) is a disorder characterized by clonal myeloproliferation, ineffective erythropoiesis, extramedullary hematopoiesis and bone marrow fibrosis. Between 4/1998 and 1/2006, 17 patients with MMM were treated with allogeneic hematopoietic stem cell transplantation. Patients included 8 males and 9 females with a median age of 51.8 years (range 37–66). All patients were transfusion-dependent at the time of transplantation, 3 (18%) had abnormal cytogenetics and 4 (24%) had a prior splenectomy. Six patients (35%) received a reduced intensity conditioning regimen consisting of either fludarabine and busulfan (1 pt), fludarabine and low dose total body irradiation (1 pt), fludarabine and melphalan (3 pts) or fludarabine and cyclophosphamide (1 pt). Eleven patients (65%) received an ablative regimen of either busulfan and cyclophosphamide (10 pts) or cyclophosphamide and total body irradiation (1 pt). Patients with unrelated donors also received ATG as part of their conditioning. The hematopoietic cell source was peripheral blood in 12 pts (71%) and bone marrow in 5 pts (29%). Six pts (35%) received cells from an HLA-identical sibling, 1 pt (6%) had a 1 Antigen mismatch sibling and 10 pts (59%) received stem cells from an unrelated donor. Graft-versus-host disease prophylaxis consisted of tacrolimus in 15 pts (88%) and cyclosporine in 2 pts (12%). Transplant-related mortality was 17% (sepsis 1 pt, VOD 1 pt, acute GVHD 1 pt) all occurring in the group treated with a myeloablative regimen. Of the remaining 14 patients, all achieved hematological recovery and transfusion independence. There were 2 relapses and one patient died of disease recurrence; both relapses occurred in the group receiving a reduced intensity regimen. The other 12 patients remain alive and in remission. The 6-year actuarial survival is 67% with no statistical difference between the groups who received a reduced intensity versus a myeloablative regimen. In conclusion, Myelofibrosis with Myeloid Metaplasia can be successfully treated with allogeneic hematopoietic stem cell transplantation with a significant proportion of patients achieving long-term survival. Hematopoietic recovery can be achieved despite the presence of marrow fibrosis. The optimal preparative regimen remains to be determined with more relapses observed in the reduced intensity regimen group and a higher mortality seen in the myeloablative group. A risk-stratification strategy for regimen selection should be considered in future studies.
Long‐Term Structural Evolution of an Intercalated Layered Semiconductor

Intercalated molecules can dramatically modify the electronic band structure of layered semiconductors, significantly altering the optical properties of the material. In the layered monochalcogenide Gallium Telluride (GaTe), exposure to air induces a nearly 1 eV reduction of its band gap due to the interlayer diffusion and chemisorption of oxygen. The effect of oxygen chemisorption at the Te-terminated surfaces on the structure of GaTe, however, is much less known. To better understand the structure–property relationship of intercalated GaTe, a systematic, long-term, X-ray diffraction study has been performed on GaTe exfoliated crystals exposed to ambient conditions. It is observed that the structural changes are not limited to a previously observed short-term increase in lattice expansion. Over the course of months and even years after exfoliation, the oxygen adsorbates continue to modify the structure of GaTe, inducing significant disorder and grain reorientation. It is estimated that approximately one out of every two grains is slightly displaced by the intercalating oxygen, demonstrating a significant increase in grain mosaicity, while still maintaining the original {−2 0 1} out-of-plane texture. Correlating these structural transformations to observed changes in electrical and optical properties will enable capitalization of the use of adsorbates to engineer novel properties in these layered materials.
How Do I Grow a Practice: Marketing, Word of Mouth, Getting Referrals

Building a practice starts with service excellence to patients, staff, and other referral sources. Patients will be a major referral source if treated with respect by you and your staff. Identify other referral sources and build relationships to maintain and grow them. Make it easy for referrals to get you and maintain availability. Establish yourself as an expert and take your share of the difficult cases. Communicate quickly and clearly with physician referral sources and send their patients back to them. Direct to consumer marketing can supplement relationship building. Track your referral sources and be sure to prioritize your referral base.
Next-Generation Sequencing Based Clinical Molecular Diagnosis of Primary Immunodeficiency Diseases

Primary immunodeficiency diseases (PIDs) are a group of disorders caused by defects in one or multiple components of the immune system. PID patients usually present with recurrent or severe infections and can be difficult to manage with conventional treatments. The types of infections in patients with PIDs are related to which arm of the immune system is affected, and often provide the first clues to the nature of the immunologic defect. Without appropriate therapy, many patients die in infancy or early childhood. Because of the clinical heterogeneity and broadly overlapping phenotypes among the PIDs, it is often challenging to reach a definitive clinical diagnosis. Compelling evidence has demonstrated that most PIDs are genetic disorders, and there are more than 240 genes that have been identified in association with different PIDs. Accurate gene sequencing in PIDs not only can bring a definite molecular diagnosis at an early stage, but can also improve the clinical prognosis of patients by facilitating initiation of appropriate therapies based on the underlying diagnosis. However, Sanger-based single gene sequencing is time-consuming and costly if multiple genes need to be analyzed sequentially due to genetic and phenotypic heterogeneity. Thus, it is not practical for the prompt definitive diagnosis of PIDs. Next-generation sequencing (NGS) is a recently developed, massively parallel sequencing technology, which can sequence all targeted regions (multiple genes, whole exome, or whole genome) of the human genome simultaneously. In fact, the NGS technology has made it possible to sequence all known disease causing genes in one experiment. As a result, NGS has become a primary approach for both clinical molecular diagnosis and discovery of novel genes in Mendelian human disorders (Gilissen et al. Genome Biol 12:228, 2011; Shendure and Ji Nat Biotechnol 26:1135–1145, 2008). In this chapter, we describe the most recent applications of NGS technology to PIDs with a focus on clinical molecular diagnosis.
Hedge Fund Valuation: Retailization, Regulation, and Investor Suitability

Hedge fund pricing and valuation errors do happen despite efforts to ensure fair pricing at all times. The credit crunch and the global financial crisis have illustrated that the valuation of complex financial products and hard-to-value assets is one of the most pressing issues affecting confidence in the financial industry today.The paper analyzes the factors that contribute to the valuation problem and summarizes existing proposals and rules as they pertain to valuation of hedge funds. Following a discussion of the phenomenon of “retailization” and how it is recognized and addressed by regulators in various jurisdictions, the paper analyzes the reasons for a different treatment of retail and qualified investors. The paper concludes with a discussion of regulatory options to address the differences as well as potential problems with such options and analyzes alternatives.
Uniting Jimmy and Jackie: Foundation for a Research Program in Developmental Ecological Psychology

The research program described here is based on an approach to doing developmental research that has at its foundation principles of Ecological Psychology set forth by James Gibson and which has it...
Accurate Evaluation of Local Averages on GPGPUs

We discuss fast and accurate evaluation of local averages on GPGPU. This work was motivated by the need to calculate reference fluid densities in the classical density functional theory (DFT) of electrolytes proposed in Gillespie et al. (2002). In Knepley et al. (2010) we developed efficient algorithms for the minimization of three-dimensional DFT models of biological ion channel permeation and selectivity. One of the essential bottlenecks of 3D DFT models is the evaluation of local screening averages of the chemical species’ densities. But the problem has wider applicability and fast evaluation of averages over the local spherical screening neighborhood of every grid point are typically inaccurate due to the use of collocation approximations of densities on Cartesian grids. Accurate evaluations based spectral quadrature were proposed and used in Knepley et al. (2010), but they are significantly more computationally expensive because of their nonlocal nature in the Fourier space. Here we show that the passage to the Fourier space can, in fact, make the averaging calculation much more amenable to efficient implementation on GPGPU architectures. This allows us to take advantage of both improved accuracy and hardware acceleration to arrive at a fast and accurate screening calculations.
Avoiding MRI-Related Accidents: A Practical Approach to Implementing MR Safety.

MRI is a ubiquitous medical imaging technology typically using superconductivity to generate a strong, homogeneous, and generally ceaseless magnetic field. MRI and its magnetic field pose many safety hazards, including magnetic forces on metals, tissue heating and burns, nerve stimulation, bioeffects, acoustic noise, and contrast agent complications. The primary concern is that a wide variety of patients, staff members, technologists, and physicians can approach the incessant magnetic field, creating great potential for accidents that could occur if metals from the environment, adornments, implants, and other unintended sources are also present in or near the field. Many accidents have occurred and are occasionally reported in the United States and countries all over the world. Through carefully structured oversight and the establishment of strict guidelines regarding access, responsibilities, and training, these risks can be mitigated, and accidents can be prevented. Fortunately, there is currently a wide variety of resources available to facilitate the successful implementation of an effective MRI safety program. This article presents a general overview of and the authors' experience with an MRI safety program in terms of risk management and training. The MR safety program requirements and regulations in the United States devised by The Joint Commission and the ACR are also discussed. With these resources and a carefully selected team, the risk for MRI-related accidents can be vastly reduced if not completely eliminated.
Assessment of Humoral, Innate, and T-Cell Immune Responses to Adeno-Associated Virus Vectors

Adeno-associated virus (AAV)-based gene therapy is being applied to treat a wide array of diseases. Preexisting host immune responses to AAV and immune responses elicited by AAV vector administration remain a problem that needs to be further studied. Here we present a series of protocols to assess immune responses before and after AAV vector administration that are applicable to multiple animal models and phase 1 clinical trials. More specifically, they may be use to evaluate (1) the humoral immune response, through levels of AAV-neutralizing and binding antibodies; (2) the innate immune response, through the acute induction of inflammatory cytokines; and (3) the T-cell immune response, through the activation of transgene- and vector-specific CD8+ and CD4+ T cells.
A Rat Model of Cerebellar Hemorrhage Using Bacterial Collagenase Injection

Cerebellar hemorrhage causes unique functional deficits, including ataxic, sensorimotor, and memory deficiencies. Despite the occurrence of CH, most studies have focused on intracerebral hemorrhage. Yet, the unique behavioral deficits of CH necessitates attention for the development of treatments. This chapter details the bacterial collagenase injection model for creating cerebellar hemorrhage. This model is unique in that it leads to reproducible postural deficits caused by a well-defined hemorrhage within the cerebellum. Cerebellar hemorrhage leads to acute increases in brain water content and acute sensorimotor and postural deficits, as well as long-term sensorimotor and memory deficits due to cerebellar tissue atrophy. Herein, the surgical procedures, evaluation of outcomes, caveats, limitations, and alternatives are described.
Normal variations in brain oxygen extraction fraction are partly attributed to differences in end-tidal CO2

Cerebral oxygen extraction fraction is an important physiological index of the brain's oxygen consumption and supply and has been suggested to be a potential biomarker for a number of diseases such as stroke, Alzheimer's disease, multiple sclerosis, sickle cell disease, and metabolic disorders. However, in order for oxygen extraction fraction to be a sensitive biomarker for personalized disease diagnosis, inter-subject variations in normal subjects must be minimized or accounted for, which will otherwise obscure its interpretation. Therefore, it is essential to investigate the physiological underpinnings of normal differences in oxygen extraction fraction. This work used two studies, one discovery study and one verification study, to examine the extent to which an individual's end-tidal CO2 can explain variations in oxygen extraction fraction. It was found that, across normal subjects, oxygen extraction fraction is inversely correlated with end-tidal CO2. Approximately 50% of the inter-subject variations in oxygen extraction fraction can be attributed to end-tidal CO2 differences. In addition, oxygen extraction fraction was found to be positively associated with age and systolic blood pressure. By accounting for end-tidal CO2, age, and systolic blood pressure of the subjects, normal variations in oxygen extraction fraction can be reduced by 73%, which is expected to substantially enhance the utility of oxygen extraction fraction as a disease biomarker.
Rib Fractures: Validation of an Interdisciplinary Classification System

Thoracic injuries, specifically rib fractures, are of significant clinical and forensic interest and occur in high frequencies in homicides, accidents, and motor vehicle crashes. However, current analysis of rib fractures lacks a systematic method for characterizing and interpreting these injuries. The goal of the present research is to provide a standardized classification system dedicated to describing and quantifying fractures for utilization across scientific disciplines. The novel system was designed around identifying rib fracture characteristics (location, pattern of propagation, number, and severity) and using these characteristics to describe, quantify, and classify fractures using a three-part hierarchical method. For validation, mid-thoracic ribs (n = 347) were subjected to dynamic anterior-posterior blunt force loading (i.e., a bending mechanism), and the resulting fractures were analyzed using our rib fracture classification system. Fracture locations, defined as a percentage of the total curve length of each rib, ranged from 11–89% (mean = 63%), and six different fracture groups were observed. The number of fractures observed per rib ranged from one to three, and injury severities—based on the hierarchical severityof each fracture group and the number of fractures present—of each rib ranged from minor to severe. The success rate in classifying fractures was 99.2%. This novel fracture classification system provides additional detail and clarity for defining features of rib fractures compared to previous methods. By establishing common language and specific fracture characteristics to include in all rib fracture analyses,this classification system has the potential to be utilized across disciplines (i.e., clinical, forensic, and biomechanical settings).
Selecting the surgical approach in complex reoperative partial nephrectomies: Does robotics have a role?

658Background: Minimally invasive surgery (MIS) has shown equal oncologic efficacy as the open approach for treating small renal masses but results in improved perioperative parameters. Surgical pr...
BCR-Induced Ca 2+ Signals Dynamically Tune Key Checkpoints that Control the Survival, Metabolic Reprogramming, and Proliferation of Naïve B Cells

B cell receptor engagement induces naive B cells to differentiate and perform critical immune-regulatory functions. Acquisition of functional specificity requires that each cell navigate through checkpoints that control its survival, cell cycle entry, and proliferative expansion. Dynamic changes in BCR-induced calcium concentration critically regulate these checkpoints. Here we establish that variations in BCR signaling strength are encoded as calcium signals that tune each cell’s fate by dynamically regulating NF-κB, NFAT, and mTORC1 dependent control of gene expression. We find that weak BCR signaling induces apoptosis by failing to activate c-Rel-dependent Bcl-xL expression. Progressively stronger signals, which generate quantitatively distinct calcium signals, are required to promote c-Rel dependent survival, drive metabolic reprogramming, initiate cell cycle entry, and drive proliferation via NFAT-, mTORC1-, and Myc-dependent mechanisms. Finally, we establish the mechanism by which CD40 and PAMP costimulation decrease the calcium threshold for these key steps of B cell activation and differentiation. As altered BCR signaling is linked to autoimmunity and B cell malignancies, our results have important implications for understanding the pathogenesis of aberrant B cell differentiation.
Workplace Reflection in the Age of AI: Materiality, Technology, and Machines:

The ProblemThis article explores the nature of reflection within the workplace during the fourth industrial revolution (4IR), a period characterized by the proliferation of cognitive technologies—l...
CD81 knockout promotes chemosensitivity and disrupts in vivo homing and engraftment in acute lymphoblastic leukemia

Relapse remains a major obstacle to achieving 100% overall survival rate in pediatric hematologic malignancies like acute lymphoblastic leukemia (ALL). Relapse often results from the development of chemoresistance. One of the mechanisms of chemoresistance involves ALL cell interactions with the bone marrow (BM) microenvironment, providing a sanctuary. This phenomenon is known as BM microenvironment-induced chemoprotection. Members of the transmembrane 4 superfamily (tetraspanins; TSPANs) are known to mediate microenvironmental interactions and have been extensively studied in solid tumors. Although the TSPAN family member CD81 is a minimal residual disease marker, its biological role in ALL is not well characterized. We show for the first time that CD81 knockout induces chemosensitivity, reduces cellular adhesion, and disrupts in vivo BM homing and engraftment in B-ALL. This chemosensitization is mediated through control of Bruton tyrosine kinase signaling and induction of p53-mediated cell death. We then show how CD81-related signaling can be disrupted by treatment with the epigenetic drug combination of DNA hypomethylating agent azacitidine (aza) and histone deacetylase inhibitor panobinostat (pano), which we previously used to sensitize ALL cells to chemotherapy under conditions that promote BM microenvironment-induced chemoprotection. Aza/pano-mediated modulation of CD81 surface expression is involved in decreasing BM load by promoting ALL cell mobilization from BM to peripheral blood and increasing response to chemotherapy in disseminated patient-derived xenograft models. This study identifies the novel role of CD81 in BM microenvironment-induced chemoprotection and delineates the mechanism by which aza/pano successfully sensitizes ALL cells via modulation of CD81.
Ranking the States by Fiscal Condition

For the fifth and final year, we rank states according to their financial condition. On the basis of FY 2016 financial reports of the 50 states, this study ranks the states’ fiscal solvency using 13 indicators that assess the extent to which the states can meet their obligations. State finances are analyzed according to five dimensions of solvency: cash, budget, long-run, service-level, and trust fund solvency. These five dimensions are combined to produce an overall ranking of state fiscal solvency. Nebraska, South Dakota, Tennessee, Florida, and Oklahoma rank as the top five most fiscally solvent states. Kentucky, Massachusetts, New Jersey, Connecticut, and Illinois rank as the bottom five states. This ranking highlights the relative performance of the states in one year, but understand- ing financial health requires looking at the underlying objective performance of each state over time. We complement this year’s ranking with a 10-year trend analysis of the states’ financial performance. We find that although, on average, state budgets have not fallen to the lows they reached during the recession, they also have not quite improved to prerecession levels. There has been a slight decline in average state operating ratios since FY 2014, but most states are still able to match revenues with expenses. Long-term liabilities have, on average, increased over time. Long-term liabilities increased the most significantly in FY 2015, largely as a result of new Government Accounting Standards Board rules that require states to report unfunded pension obligations on their balance sheets. Unfunded pension liabilities remain an ongoing problem for the states, and their magnitude is only more transparently revealed by these reporting changes. Pairing these findings with what we have learned from the past four editions of this study, we conclude with recommendations for future research that emphasize pairing quantitative and qualitative data in context to analyze state financial condition.
Robotic upper tract surgery in infants 6 months or less: is there enough space?

Robot-assisted laparoscopic surgery (RALS) has recently been described in children < 1 year old. However, little data exist on robotic utilization in infants ≤ 6 months old, likely due to concerns for limited intraabdominal space and decreased distance between ports in this cohort. We hypothesized that the robotic approach can be successfully used for infants ≤ 6 months old. A prospectively collected database of patients undergoing urologic robotic surgery at our institution was reviewed. Patients ≤ 6 months and ≥ 4 kg were included. Patient demographics, intraoperative details, hospital length of stay, and complications were reviewed. Descriptive statistics were performed. Twelve patients ≤ 6 months old underwent urologic robotic surgery by three surgeons at our institution (2013–2019): pyeloplasty (6), ureteroureterostomy (4), heminephrectomy (1), and nephrectomy (1). Median age at surgery was 4.75 months (IQR 4, 6). Median weight was 7.09 kg (IQR 6.33, 7.78). Median console time was 105 min (IQR 86, 123). For all procedures, 8-mm robotic arm ports were used. No procedures were converted to open. Median post-operative hospital stay was 24 h (IQR). Febrile UTI was the only complication occurring within 30 days of surgery (n = 4, 33%; 7–20 days, Clavien grade 2). For those undergoing pyeloplasty or ureteroureterostomy (n = 10), postoperative ultrasound showed improved (n = 9) or stable hydronephrosis (n = 1). At a median follow-up of 19.73 months (IQR 4.27, 38.32), no patient required an unplanned secondary intervention. Robotic upper urinary tract surgery is feasible and safe in patients ≤ 6 months of age and can be performed successfully with the same technique as for older children.
Transformation of facial basal cell carcinoma to squamous cell carcinoma following vismodegib

Abstract Objective(s) Vismodegib, a unique hedgehog pathway inhibitor, has been demonstrated to be effective in the treatment of non-operable and metastatic basal cell carcinoma (BCC). While effective, concerns regarding its role in the development of cutaneous squamous cell carcinoma (CSCC) remain. The primary objective is to describe a unique case of locally advanced BCC of the face and subsequent transformation to CSCC following treatment with vismodegib. Methods Case report. Results A 64-year-old Caucasian female presented with a 3-year history of a progressive and erosive lesion involving the entirety of her forehead with involvement of the left medial canthus and upper eyelid. Biopsies performed at the periphery of the lesion demonstrated superficial and nodular BCC. As surgical management would result in significant morbidity, the patient elected for treatment with oral vismodegib, 150 mg daily, with curative intent. Dramatic tumor response was experienced over an 18-month period; however, surveillance MRI demonstrated concern for tumor progression at the periphery of the mass without evidence of intracranial extension or metastases. Subsequent biopsies at the superior and left supraorbital margins demonstrated invasive SCC. Following immunohistochemistry analysis, intravenous nivolumab, 480 mg monthly was initiated; the patient remains progression-free after 18 months of therapy. Conclusion This case highlights the importance of close surveillance in patients treated with vismodegib for non-operable BCC. Serial biopsies of new or suspicious appearing tumors should be performed given the potential for CSCC transformation.
Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis.

OBJECTIVE Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. RESEARCH DESIGN AND METHODS The current analysis involved moderate or severe DKA episodes (n = 714) in children age RESULTS The rate of change of pH did not differ by treatment arm, but Pco2 increased more rapidly in the fast versus slow fluid infusion arms during the initial 4 h of treatment. The anion gap also decreased more rapidly in the fast versus slow infusion arms during the initial 4 and 8 h. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 h. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% versus 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) versus the slow arms (35.2%). CONCLUSIONS In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and Pco2 than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.
Pictures of Health: Examining Well-being and Resistance of Graduate Students of Color

This photovoice study engages a Black feminist thought lens to identify the sites of oppression that posed barriers to the well-being of 22 graduate Students of Color (GSOC) enrolled at Clemson Uni...
Assessing screening, brief intervention, and referral to treatment (SBIRT) compliance and disparities for pediatric inpatients at a tertiary care facility

Background Pediatric trauma centers are required to screen patients for alcohol or other drug use (AOD), Briefly Intervene, and Refer these patients to Treatment (SBIRT) to meet Level 1 and 2 trauma center requirements set by the American College of Surgeons. We evaluated if a mandatory electronic medical record tool increased SBIRT screening compliance for all trauma and non-trauma adolescent inpatients. Methods A SBIRT electronic medical record tool was implemented for pediatric inpatient AOD screening. A positive screen prompted brief intervention and referral for treatment in coordination with social work and psychiatric consultants. We compared pre and post- implementation screening rates among inpatients age 12-18 years and performed sub-group analyses. Results There were 873 patients before and 1,091 after implementation. Questionnaire screening increased from 0% to 34.4% (p Conclusion Multidisciplinary training along with an electronic medical record tool increased SBIRT protocol compliance. Demographic disparities in intervention rates may exist.