cssi/SciSciGPT-SciSciNet huggingface dataset:
Telemedicine in Prehospital Stroke Evaluation and Thrombolysis: Taking Stroke Treatment to the Doorstep

Importance Mobile stroke treatment units (MSTUs) with on-site treatment teams that include a vascular neurologist can provide thrombolysis in the prehospital setting faster than treatment in the hospital. These units can be made more resource efficient if the need for an on-site neurologist can be eliminated by relying solely on telemedicine for physician presence. Objective To test whether telemedicine is reliable and remote physician presence is adequate for acute stroke treatment using an MSTU. Design, Setting, and Participants Prospective observational study conducted between July 18 and November 1, 2014. The dates of the study analysis were November 1, 2014, to March 30, 2015. The setting was a community-based study assessing telemedicine success of the MSTU in Cleveland, Ohio. Participants were the first 100 residents of Cleveland who had an acute onset of stroke-like symptoms between 8amand 8pmand were evaluated by the MSTU after the implementation of the MSTU program at the Cleveland Clinic. A vascular neurologist evaluated the first 100 patients via telemedicine, and a neuroradiologist remotely assessed images obtained by mobile computed tomography (CT). Data were entered into the medical record and a prospective registry. Main Outcomes and Measures The study compared the evaluation and treatment of patients on the MSTU with a control group of patients brought to the emergency department via ambulance during the same year. Process times were measured from the time the patient entered the door of the MSTU or emergency department, and any problems encountered during his or her evaluation were recorded. Results Ninety-nine of 100 patients were evaluated successfully. The median duration of telemedicine evaluation was 20 minutes (interquartile range [IQR], 14-27 minutes). One connection failure was due to crew error, and the patient was transported to the nearest emergency department. There were 6 telemedicine disconnections, none of which lasted longer than 60 seconds or affected clinical care. Times from the door to CT completion (13 minutes [IQR, 9-21 minutes]) and from the door to intravenous thrombolysis (32 minutes [IQR, 24-47 minutes]) were significantly shorter in the MSTU group compared with the control group (18 minutes [IQR, 12-26 minutes] and 58 minutes [IQR, 53-68 minutes], respectively). Times to CT interpretation did not differ significantly between the groups. Conclusions and Relevance An MSTU using telemedicine is feasible, with a low rate of technical failure, and may provide an avenue for reducing the high cost of such systems.
Electrochemical Gold(III) Sensor with High Sensitivity and Tunable Dynamic Range

We report the design and fabrication of a sensitive, specific, and selective electrochemical ion (E-ION) sensor for detection of Au(III). The signaling mechanism is based on the interactions between Au(III) and adenine; formation of these complexes rigidifies the methylene blue (MB)-modified oligoadenine probes, resulting in a concentration-dependent reduction in the MB signal. The dynamic range of the sensor can be tuned by simply changing the length of the DNA probe (six (A6) or 12 (A12) adenines). Independent of the probe length, both sensors have demonstrated to be sensitive, with a limits of detection of 50 and 20 nM for the A6 and A12 sensors, respectively. With further optimization, this sensing strategy may offer a promising approach for analyzing Au(III).
Bringing the Emergency Room to the Classroom: Using "Grey's Anatomy" to Simplify Situational Leadership.

Situational leadership has been noted as one of the most recognizable leadership concepts (Northouse, 2007). Teaching the model to a college student audience may become more of monotony than a learning experience. Using popular media technology to teach situational leadership can appeal to more learning styles than the typical lecture, and make the study of leadership more exciting. Grey’s Anatomy (2007) is a popular drama television series that shows the directing, coaching, supporting, and delegating styles of situational leadership. Using media clips from this series, students can relate to the dramatic relationships and daily demands of the student intern characters. They also learn more about situational leadership through living in the “leadership moment” of the scenes.
Grape Phylloxera., Daktulosphaira vitifoliae (Homoptera: Phylloxeridae), Susceptibility to Carbofuran: Stage and Clonal Variability

Establishment of first-instargrape phylloxera, Daktulosphaira vitifoliae (Fitch), was disrupted by carbofuran in tests with clones from Napa and Monterey counties in California. Egg hatch, nymphal survival, and survival of adults were less sensitive to the insecticide. Developmental times, long-term survivorship, and fecundity of individuals that survived sublethal concentrations (< LC50) were unaffected. Variability in response between clonal colonies was low.
Race and Ethnicity Missingness in the Traffic Stop Data Reported by 308 Massachusetts Police Agencies

Data reported by police agencies were at the core of most analyses of Driving While Black in the 1990s and 2000s. There is, however, no previous macro-level research directed exclusively at the acc...
Surgical treatment of patients with back problems covered by workers compensation versus those with other sources of payment.

Study DesignThe present study examines relationships between workers' compensation coverage and the surgical treatment of patients with low back problems.ObjectivesTo examine the mix of surgical procedures, reoperation rates, and resource use among patients receiving workers' compensation and those
Abstracts of recent doctoral dissertations in computer algebra

Polynomial multiplication is a key algorithm underlying computer algebra systems (CAS) and its efficient implementation is crucial for the performance of CAS. In this context coefficients of polynomials come from domains such as the integers, rationals and finite fields where arithmetic is performed exactly without rounding error.
The Denotational Semantics-based the Formal Analysis of UML Sequence Diagrams

Unified modeling language(UML) is a hotspot of researches in software engineering.It provides various diagrams to depict system characteristics and complex environment from different viewpoints and different application layers.It also contains a lot of standard elements with vague and sparse semantics.Whereas the half formal characteristic of UML,This paper mainly researches how to combine UML with formal method in order to improve UML semantic accuracy.This paper defines syntax domains,abstract syntax of UML sequence diagram using denotational semantics and provides the foundation for defining semantic domains,semantic functions of UML sequence diagram.
Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

BackgroundPatients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. MethodsPatients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of as...
A Non-Human Primate Model of Acute Group A Streptococcus Pharyngitis

This chapter describes methods for using non-human primates as a model of group A streptococcal (GAS) pharyngitis. This model has been used successfully to study host-pathogen interactions occurring during pharyngeal GAS infections. The protocol as described will compare two different GAS strains for their ability to cause clinical symptoms of pharyngitis.
Urban research in a hostile setting: Godfrey Wilson in Broken Hill, Northern Rhodesia, 1938-1940

Acknowledged for his pioneering urban anthropological research in Broken Hill through the publication of An Essay on the Economics of Detribalization in Northern Rhodesia (Parts I and II, 1940 and 1941), Godfrey Wilson’s professional career was cut short by his death during World War II. The late 1990s transfer and cataloguing at the University of Cape Town of the Monica and Godfrey Wilson papers has made an enormously rich research archive accessible to the public. For the first time, Godfrey Wilson’s notes from his fieldwork in Broken Hill enable us to examine his research project through his own observations. Based on a preliminary overview of these records and a tentative analysis of some of their contents, this article revisits the Broken Hill research project against the background of the published essay on the economics of detribalisation. Wilson’s argument about temporary urbanisation is demonstrated through migration histories, information about length of stay in towns, and an analysis of the economics of urban livelihoods that focuses on wages including rations, household expenditures, and urban–rural transfers. But the published essay barely explains how in fact he conducted his field research. Although there are very few direct indications, we can infer some of his fieldwork practices and field methodology from notes that occasionally evoke an immediate sense of the trials and tribulations of everyday African life in Broken Hill in the early World War II years. How might experiences in the field have influenced Wilson’s analysis? Overall, I discuss his work from two angles, first in the context of a time and place characterised by conflicting agendas, and secondly, in retrospect as the conceptual space and time of early World War II colonial Northern Rhodesia have yielded to different explanatory perspectives.
Chronic steroid and immunosuppressant therapy in children.

1. Abraham Gedalia, MD* 2. Avinash K. Shetty, MD† 1. *Professor of Pediatrics and Head, Division of Pediatric Rheumatology, Louisiana State University Health Sciences Center and Children’s Hospital, New Orleans, La 2. †Assistant Professor of Pediatrics, Division of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC After completing this article, readers should be able to: 1. Describe the mechanism of action, list indications for therapy, and discuss the adverse effects of corticosteroid therapy in children. 2. Delineate the mechanism of action and adverse effects of other immunosuppressive agents frequently used in children. 3. Discuss the immunization recommendations for children receiving immunosuppressive therapy. Corticosteroids are the most potent, naturally occurring anti-inflammatory agents known. Despite more than 50 years of controversy regarding their clinical use, risks, and benefits, corticosteroids still play a significant role in the management of a wide variety of diseases. They have reduced the morbidity and mortality significantly in children afflicted with leukemia, asthma, rheumatic diseases, and other inflammatory disorders. In this article, we review the mechanism of action, clinical indications, and adverse effects of corticosteroids and other commonly used immunosuppressive agents in children. We also review immunization recommendations for children receiving immunosuppressive therapy. Corticosteroids have a diverse role in the human body at the physiologic level. The actions of glucocorticoids include: 1) negative feedback modulation of corticotropin-releasing factor and adrenocorticotropic hormone; 2) regulation of blood glucose and liver glycogen levels; 3) maintenance of water-electrolyte homeostasis; 4) influence on the metabolism of protein, fat, and purine; 5) maintenance of normal cardiovascular, central nervous system (CNS), and renal functions; 6) influence on circadian rhythmicity; 7) maintenance of bone and muscle work capacity; and 8) protection of the body against moderate stress. Glucocorticoids also have pharmacologic properties that are used in the treatment of rheumatic and other inflammatory diseases. Cellular receptors for cortisol are ubiquitous in cell cytoplasm, reflecting the critical role of the hormone in maintaining cell homeostasis. The type 1 glucocorticoid receptor, known as the mineralocorticoid receptor, has high affinity for aldosterone. The type 2 glucocorticoid receptor, known as the glucocorticoid receptor, exhibits strong affinity for dexamethasone. Although …
Neurons that Underlie Drosophila melanogaster Reproductive Behaviors: Detection of a Large Male-Bias in Gene Expression in Fruitless-Expressing Neurons

Male and female reproductive behaviors in Drosophila melanogaster are vastly different, but neurons that express sex-specifically spliced fruitless transcripts (fru P1) underlie these behaviors in both sexes. How this set of neurons can generate such different behaviors between the two sexes is an unresolved question. A particular challenge is that fru P1-expressing neurons comprise only 2–5% of the adult nervous system, and so studies of adult head tissue or whole brain may not reveal crucial differences. Translating Ribosome Affinity Purification (TRAP) identifies the actively translated pool of mRNAs from fru P1-expressing neurons, allowing a sensitive, cell-type-specific assay. We find four times more male-biased than female-biased genes in TRAP mRNAs from fru P1-expressing neurons. This suggests a potential mechanism to generate dimorphism in behavior. The male-biased genes may direct male behaviors by establishing cell fate in a similar context of gene expression observed in females. These results suggest a possible global mechanism for how distinct behaviors can arise from a shared set of neurons.
Detection of species substitution in raw and cooked meats using immunoassays.

Federal and state laws require that raw and cooked meats be accurately represented as to the species of meat they contain. A total of 806 raw and 96 cooked meat samples collected from Florida retail markets were examined for regulatory control of these products. An agar-gel immunodiffusion method was used for the identification of beef, pork and horse species in uncured raw meats. Enzyme-linked immunosorbent assays were used to identify poultry and sheep in raw meats and all species in cured raw meats and cooked meats. A positive violative sample was reported only if the target extraneous species present exceeded a 1% level. Results indicated that the overall rate of substituted species in both cooked and raw meat samples was 16.6%. Percentage of violation in cooked products was higher than that in raw meats (22.9% versus 15.9%). The undeclared species found in ground beef and veal products included sheep, pork and poultry, in descending order of frequency. The major substituting species found in ground pork, ground turkey and ground lamb, however, was beef. Horse meat was not detected in any sample tested. Intact pieces of raw meat tested were all correctly labeled. The source of substitution/contamination also was investigated and discussed. Current retail practices in meat markets show a significant problem with mixing of undeclared species in ground and comminuted meat products.
Improving Teaching-Learning Process and Experience Based on Students, Faculty and Staff Perspectives

In order to make strategic decisions, the new leadership team at the College of Agriculture at the California State Polytechnic University, Pomona conducted a series of focus group interviews with its students, faculty, and staff members. The purpose of this qualitative study was to poll the opinions of these important stakeholders to improve the teaching-learning process in the college, to promote job satisfaction among the employees, to better fulfill the college’s mission of advancing learning and knowledge, and to prepare students for lifelong learning and leadership in agricultural careers. Six themes emerged from student groups and four from faculty/staff groups, with lack of resources emerging as a common theme from both groups. The leadership team deliberated on the findings, and the results of this study provided the leadership team with specific items to solve needs.
Interpersonal problems across levels of the psychopathology hierarchy

We examined the relationship between psychopathology and interpersonal problems in a sample of 825 clinical and community participants. Sixteen psychiatric diagnoses and five transdiagnostic dimensions were examined in relation to self-reported interpersonal problems. The structural summary method was used with the Inventory of Interpersonal Problems Circumplex Scales to examine interpersonal problem profiles for each diagnosis and dimension. We built a structural model of mental disorders including factors corresponding to detachment (avoidant personality, social phobia, major depression), internalizing (dependent personality, borderline personality, panic disorder, posttraumatic stress, major depression), disinhibition (antisocial personality, drug dependence, alcohol dependence, borderline personality), dominance (histrionic personality, narcissistic personality, paranoid personality), and compulsivity (obsessive-compulsive personality). All dimensions showed good interpersonal prototypicality (e.g., detachment was defined by a socially avoidant/nonassertive interpersonal profile) except for internalizing, which was diffusely associated with elevated interpersonal distress. The findings for individual disorders were largely consistent with the dimension that each disorder loaded on, with the exception of the internalizing and dominance disorders, which were interpersonally heterogeneous. These results replicate previous findings and provide novel insights into social dysfunction in psychopathology by wedding the power of hierarchical (i.e., dimensional) modeling and interpersonal circumplex assessment.
Tracking Multiple Objects Outside the Line of Sight Using Speckle Imaging

This paper presents techniques for tracking non-line-of-sight (NLOS) objects using speckle imaging. We develop a novel speckle formation and motion model where both the sensor and the source view objects only indirectly via a diffuse wall. We show that this NLOS imaging scenario is analogous to direct LOS imaging with the wall acting as a virtual, bare (lens-less) sensor. This enables tracking of a single, rigidly moving NLOS object using existing speckle-based motion estimation techniques. However, when imaging multiple NLOS objects, the speckle components due to different objects are superimposed on the virtual bare sensor image, and cannot be analyzed separately for recovering the motion of individual objects. We develop a novel clustering algorithm based on the statistical and geometrical properties of speckle images, which enables identifying the motion trajectories of multiple, independently moving NLOS objects. We demonstrate, for the first time, tracking individual trajectories of multiple objects around a corner with extreme precision (< 10 microns) using only off-the-shelf imaging components.
Parametric bandwidth synthesis for active sonar

This talk presents an unconventional range processing technique applicable to linear FM pulsed and continuous active sonar. Parametric bandwidth synthesis (BWS) involves performing linear-predictive extrapolation using a low-order parametric autoregressive (AR) model to extend the bandwidth of received sonar returns. Synthetically increasing the bandwidth of echoes results in improved range resolution and greater pulse compression gain compared to standard matched filtering. It should be noted that despite the resolution improvement, BWS does not improve ranging accuracy beyond that of the transmitted signal. Using a low-order AR model for BWS enhances specular target returns and discrete scatterers, while not enhancing diffuse multipath, reverberation, and noise returns. BWS performance was verified in simulation and with sea trial data from the Littoral Continuous Active Sonar 2015 (LCAS-15) experiment. Processed results confirm that BWS improves range resolution of the echo repeater target, while suppressing multipath, diffuse reverberation, and noise. Analysis of the practical limits of BWS are also included.This talk presents an unconventional range processing technique applicable to linear FM pulsed and continuous active sonar. Parametric bandwidth synthesis (BWS) involves performing linear-predictive extrapolation using a low-order parametric autoregressive (AR) model to extend the bandwidth of received sonar returns. Synthetically increasing the bandwidth of echoes results in improved range resolution and greater pulse compression gain compared to standard matched filtering. It should be noted that despite the resolution improvement, BWS does not improve ranging accuracy beyond that of the transmitted signal. Using a low-order AR model for BWS enhances specular target returns and discrete scatterers, while not enhancing diffuse multipath, reverberation, and noise returns. BWS performance was verified in simulation and with sea trial data from the Littoral Continuous Active Sonar 2015 (LCAS-15) experiment. Processed results confirm that BWS improves range resolution of the echo repeater target, while suppr...
DXA-Determined Regional Adiposity Relates to Insulin Resistance in a Young Adult Population with Overweight andObesity

Abstract Obesity is a well-established risk factor for insulin resistance and type 2 diabetes mellitus, and body fat distribution has important implications for this metabolic risk. In this cross-sectional study, we used dual X-ray absorptiometry body composition data from 123 young adult participants with overweight or obesity, and correlated with 2 indices of insulin resistance calculated from oral glucose tolerance tests. Participants were 70% women, with mean (standard error) age 30.1 (0.6) yr, body mass index (BMI) 34.0 (0.6) kg/m 2 , homeostatic model assessment of insulin resistance (HOMA-IR) of 2.1 (0.2), and Matsuda insulin sensitivity index (Matsuda ISI) of 5.8 (0.4). In women, the strongest correlations were observed with the android-to-gynoid ratio ( r = 0.52, p r = −0.46, p r = 0.40, p = 0.01 for HOMA-IR; r = −0.37, p = 0.02 for Matsuda ISI). Visceral adipose tissue was correlated with HOMA-IR and Matsuda ISI in women, and only with Matsuda ISI in men. BMI correlated with HOMA-IR and with Matsuda ISI in both women and men. Regional adiposity determined by dual X-ray absorptiometry correlates with indices of insulin resistance in sedentary young adults with overweight and obesity.
Broodstock management of Crassostrea gigas

Abstract The results of time-course conditioning trials indicate that there is an optimum conditioning interval during which the proportion of viable gametes is at a maximum. When matings are accomplished before or after this optimum interval, reduced gamete viability results. In this case, spawning and fertilization may appear to be normal, but setting success is substantially reduced. The degree of conditioning required to reach this optimum window is dependent on the stage of gonadal development in the broodstock when conditioning is started, and reflects substantial seasonal variation, which is repeated on an annual cyclic basis. Performance of the larval rearing system, reflected in the proportion of ova which survive to the spat stage, may be substantially improved by managing broodstock conditioning to maximize the proportion of viable gametes. This may be accomplished by empirical observation of the annual gonadal cycle in the area where the broodstock is maintained, and then determining the optimum conditioning interval for the various seasons.
The Membranes of the Body

Membranes forming cell walls or lining cavities typically are complex systems mediating transfer between compartments—or, as in the case of the skin, between external and internal environments. I shall consider some of these briefly, but the main emphasis in this chapter will be on fascia which, according to many anatomists, is sufficiently important a tissue to justify its inclusion into the category of organ systems.
On Reasons and Causes

Having defended the distinction between reasons and causes often and having argued that psychological explanations cannot ignore the former (Robinson, 1976, 1978, 1979), I can only commend Rychlak for recognizing the distinction and for developing certain theoretical implications arising from it. Before examining his version of the distinction and the theoretical uses to which he puts it, however, a few words must be devoted to the historical passages in his essay.
Analysis of atmospheric attenuation using the Telescope Array central laser data

Located in the western desert of the state of Utah, the Telescope Array (TA) experiment measures the properties of ultra high energy cosmic ray (UHECR) induced extensive air showers. TA employs a hybrid detector comprised of a large surface array of scintillator detectors overlooked by three fluorescence telescopes stations. The TA Low Energy extension (TALE) detector has operated as a monocular Cherenkov/fluorescence detector for nearly five years, and has recently been complemented by a closely spaced surface array to operate in hybrid mode. The TAx4 upgrade is underway and aims to, as the name suggests, quadruple the size of the surface array to improve statistics at the highest energies (post-GZK events).The analysis of the TA fluorescence detectors (FD) data requires knowledge of the degree of the atmospheric attenuation of UV light produced by shower particles. This attenuation depends partially on the amount of aerosols present in the atmosphere at the time of shower observation. Being highly variable, real time measurement of the aerosols light attenuation is accomplished through the use of a central laser facility (CLF) located at the center of the surface array, and in the field of view of the three FDs, as well as, the TALE FD. In this proceeding we will describe the experiment, and the CLF data and analysis, and give results on measured aerosols attenuation, yearly averaged. FD measurements of shower energy and Xmax, involve corrections for atmospheric attenuation due to the presence of aerosols. We discuss the errors introduced into the shower parameters reconstruction due to uncertainty about aerosols attenuation.
A Craniometric Analysis of the Posterior Cranial Base After Posterior Vault Distraction.

Background Posterior vault distraction osteogenesis (PVDO) has been demonstrated to effectively increase intracranial volume, treat increased intracranial pressure, and improve head shape in syndromic patients. The purpose of this study is to compare changes along the posterior cranial base before and after distraction. Methods A retrospective review was completed of subjects who underwent PVDO with computed tomography scans at 2 time-points: within 3 months preoperatively and 1 to 6 months postoperatively. Using Mimics software, craniometric landmarks were identified and surface area of the foramen magnum was calculated. A comparison of pre- to postoperative measurements was completed using Wilcoxon matched-paired signed rank tests and linear regression. Results A total of 65 PVDO subjects were identified, 12 subjects met inclusion criteria. Mean operative age was 3.0 ± 4.0 years. The cranial vault was distracted on average 25.0 ± 6.0 mm, with those 12 months of age distracted 22.0 ± 4.9 mm (P = 0.0543). There was a significant increase in pre- to postoperative foramen magnum surface area (52.1 ± 63.2 mm, P = 0.002), length (0.9 ± 1.4 mm, P = 0.050), and width (0.6 ± 1.0 mm, P = 0.050). Similarly, linear distances between nasion and posterior cranial base landmarks such as foramen magnum (3.4 ± 4.2 mm, P = 0.010), and occipital protuberance (9.1 ± 9.6 mm, P = 0.003) were increased. Subjects under 12 months had a greater percentage increases in posterior vault length than those over 12 months. Conclusion Posterior vault distraction osteogenesis is associated with an increase in size of the foramen magnum, and lengthening of the posterior cranial base, both of which may be beneficial in patients with turribrachycephaly.
Tight Trade-offs for the Maximum k-Coverage Problem in the General Streaming Model

We study the maximum k-coverage problem in the general edge-arrival streaming model: given a collection of m sets F, each subset of a ground set of elements U of size n, the task is to find k sets whose coverage is maximized. The sets are specified as a sequence of (element, set) pairs in an arbitrary order. Our main result is a tight (up to polylogarithmic factors) trade-off between the space complexity and the approximation factor α\in(1/(1-1/e), \tildeOmega (\sqrtm )]$ of any single-pass streaming algorithm that estimates the maximum coverage size. Specifically, we show that the optimal space bound is $\tildeTheta (m/α^2)$. Moreover, we design a single-pass algorithm that reports an α-approximate solution in $\tildeO (m/α^2 + k)$ space. Our algorithm heavily exploits data stream sketching techniques, which could lead to further connections between vector sketching methods and streaming algorithms for combinatorial optimization tasks.
Sample-Based Optimal Pricing

Pricing is central to many industries and academic disciplines ranging from Operations Research to Computer Science and Economics. In the present paper, we study data-driven optimal pricing in low informational environments. We analyze the following fundamental problem: how should a decision-maker optimally price based on a single sample of the willingness-to-pay (WTP) of customers. The decision-maker's objective is to select a general pricing policy with maximum competitive ratio when the WTP distribution is only known to belong to some broad set. We characterize optimal performance across a spectrum of non-parametric families of distributions, α-strongly regular distributions, two notable special cases being regular and monotone hazard rate distributions. We develop a general approach to obtain structural lower and upper bounds on the maximin ratio characterized by appropriate dynamic programming value functions. In turn, we develop a tractable procedure to evaluate these bounds. The bounds allow to characterize the maximin ratio up to 1.3% across a spectrum of values of α.
Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma.

Background Intra-arterial chemotherapy has an increasingly prominent role in the management of retinoblastoma. One concern regarding this technique is procedural radiation exposure. Objectives To examine the effects of our institution’s procedural technique on fluoroscopy parameters for patients undergoing intra-arterial chemotherapy infusions for intraocular retinoblastoma. Secondary goals included describing the effect of anatomical variations of the carotid siphon and ophthalmic artery on radiation dose. Methods A retrospective review of pediatric patients with retinoblastoma referred to interventional neuroradiology for chemosurgery was performed. Techniques were classified as: A (1.2 Fr or 1.5 Fr microcatheter with continuous verapamil flush, advanced without guide through a 2 Fr sheath) or B (1.5 Fr or 1.7 Fr microcatheter advanced within a 4 Fr base catheter, through a 4 Fr sheath). Statistical analysis was performed to determine if there was a significant difference in fluoroscopy parameters based on technique or due to anatomical variation. Results 26 patients were treated with 94 intra-arterial chemotherapy infusions. 34 procedures were performed using technique A and 60 using technique B. Mean fluoroscopy time (4.75 min), fluoroscopy dose (23.3 mGy), and dose–area product (DAP; 85.2 μGy.m2) for technique A were significantly lower (p value Conclusions Microcatheter-only technique with continuous verapamil infusion resulted in decreased fluoroscopy times, DAP, and radiation doses at our institution for the treatment of intraocular retinoblastoma. Furthermore, our fluoroscopy times using this technique are the lowest reported in the current literature. Additionally, our anatomical analysis has demonstrated a positive correlation between increasing vessel tortuosity and fluoroscopy times.
Atypical Glands Suspicious for Cancer (ATYP)

The diagnostic term “atypical glands suspicious for cancer (ATYP),” or “atypical small acinar proliferation (ASAP),” describes a small focus of prostate glands that exhibits architectural and cytological atypia and is suspicious for, yet falls short of, the diagnostic threshold for prostate cancer. It is not a distinct biological entity; rather, it encompasses a range of lesions of varying clinical significance, including under-sampled cancer, high-grade prostatic intraepithelial neoplasia (HGPIN), benign lesions that mimic cancer, and benign prostate glands with reactive atypia. An ATYP diagnosis in prostate needle biopsy is considered a risk factor for finding prostate cancer in subsequent biopsies. Such risk ranges from 27% to 47%, with an average of 42%, in recent studies. National Comprehensive Cancer Network (NCCN) recommends patients with ATYP on initial biopsies for additional biomarker testing, such as free PSA %, prostate health index (PHI) or 4Kscore, and imaging studies, to assess the risk of high-grade cancer and consider repeated biopsy with relative increased sampling of the site of the atypical diagnosis.
Digoxin Use in Cardiac Amyloidosis

Introduction With limited options for rate control of atrial fibrillation in the setting of low-output heart failure (HF), digoxin may appear to be a reasonable option for patients with cardiac amyloidosis (CA). However, current guidelines, based on historical case reports and an in vitro study, state that digoxin should generally be avoided in CA due to increased sensitivity for digoxin toxicity. A recent study of 107 patients with AL amyloidosis given digoxin showed relative safety with cautious use, with 11% of patients developing significant arrhythmias. We describe our institution's experience with digoxin in patients with CA and the suspected digoxin-related arrhythmias and toxicity. Methods This is a retrospective examination of patients diagnosed with CA seen between November 1995 and October 2018 at the Cleveland Clinic. CA patients were screened for a history of digoxin use; patients with less than 7 days of digoxin use were excluded, as well as those with incomplete medical records. Suspected digoxin-related arrhythmias and toxicity events were defined as: unexplained altered mental status, use of digoxin immune fab, ventricular tachycardia/fibrillation, paroxysmal atrial tachycardia with 2:1 block, new-onset junctional rhythm, and symptomatic bradycardia. Results Of 756 patients with CA identified, 71 patients were treated with digoxin for ≥7 days: 42 with transthyretin (ATTR) CA and 29 with light chain (AL) CA. Median duration of digoxin therapy was 10 months (IQR 3-38) for the ATTR-CA cohort and 2 months (IQR 1-7) for the AL-CA cohort. Digoxin was used for rate control of atrial fibrillation in 66% of the total population (64% ATTR, 69% AL) and management of symptomatic HF in 34% (36% ATTR, 31% AL). Suspected digoxin-related arrhythmias and toxicity occurred in 10%, described in detail in Table 1. 21% of the digoxin population died while on therapy, but only one death may have been attributed to digoxin use or toxicity. Conclusions In carefully-selected patients with CA treated with digoxin, 90% did not have a digoxin-related adverse event over a median treatment duration of 10 months. 10% had an adverse event potentially attributable to digoxin, with one death that may or may not have been related. Despite current guidelines, digoxin may be used cautiously in selected patients with ATTR- or AL-CA who have no good options for rate control in atrial fibrillation or for low output heart failure. Risks and benefits of using digoxin in CA should be evaluated on a patient by patient basis.
Staphylococcus aureus bloodstream infections: pathogenesis and regulatory mechanisms.

Staphylococcus aureus is an opportunistic pathogen that normally colonizes the human anterior nares. At the same time, this pathogen is one of the leading causes of life-threatening bloodstream infections, such as sepsis and endocarditis. In this review we will present the current understanding of the pathogenesis of these invasive infections, focusing on the mechanisms of S. aureus clearance from the bloodstream by the immune system, and how this pathogen hijacks the host defense and coagulation systems and further interacts with the blood vessel endothelium. Additionally, we will delve into the regulatory mechanisms S. aureus employs during an invasive infection. These new insights into host–pathogen interactions show promising avenues for the development of novel therapies for treating bloodstream infections.
Exploring the Potential of an Intelligent Tutoring System for Sketching Fundamentals

Sketching is a practical and useful skill that can benefit communication and problem solving. However, it remains a difficult skill to learn because of low confidence and motivation among students and limited availability for instruction and personalized feedback among teachers. There is an need to improve the educational experience for both groups, and we hypothesized that integrating technology could provide a variety of benefits. We designed and developed an intelligent tutoring system for sketching fundamentals called Sketchtivity, and deployed it in to six existing courses at the high school and university level during the 2017-2018 school year. 268 students used the tool and produced more than 116,000 sketches of basic primitives. We conducted semi-structured interviews with the six teachers who implemented the software, as well as nine students from a course where the tool was used extensively. Using grounded theory, we found ten categories which unveiled the benefits and limitations of integrating an intelligent tutoring system for sketching fundamentals in to existing pedagogy.
Smart Infrastructure: Solutions to Improve Privacy and Security

The development and implementation of smart infrastructure raises legitimate security and privacy concerns for both the specific users of these systems as well as the public at large. The consolidation of big data through smart applications within smart infrastructure systems allows large tech companies and government entities to gather and potentially exploit the personal information of consumers. These powerful organizations collect consumer data in order to perform analysis on it, trade or sell it, or simply store it for later use. The gathering of big data or metadata, data about data, provides an opportunity for the collector to observe or predict the behaviors of specific individuals or groups. Those holding this information could use it to promote their own agendas or to otherwise exploit those from whom it has been collected without their knowledge or consent. Additionally, the current lack of legislation and policies concerning the security of smart applications or IoT devices makes the possibility of security and privacy breaches more prevalent. A breach would allow access to sensitive information which would be a threat to security and privacy at an individual and/or national scale. Due to the dynamic nature of smart infrastructure, we employed a systems analysis of this problem as a methodological approach leading to three solutions. We recommend a three-part solution-based analysis, consisting of 1.) Financial Backing 2.) Creation of Policies and Regulations and 3.) Technical Integration. This solution addresses market mitigation, data privacy for consumers, and data authentication between smart technologies and critical infrastructure. Preliminary results of this research suggest that these components are necessary for a sustainable smart infrastructure.
Quantum Smectic Gauge Theory.

We present a gauge theory formulation of a two-dimensional quantum smectic and its relatives, motivated by their realizations in correlated quantum matter. The description gives a unified treatment of phonons and topological defects, respectively, encoded in a pair of coupled gauge fields and corresponding charges. The charges exhibit subdimensional constrained quantum dynamics and anomalously slow highly anisotropic diffusion of disclinations inside a smectic. This approach gives a transparent description of a multistage quantum melting transition of a two-dimensional commensurate crystal (through an incommensurate crystal---a supersolid) into a quantum smectic, which subsequently melts into a quantum nematic and isotropic superfluids, all in terms of a sequence of Higgs transitions.
Sources of lumbar back pain during aging and potential therapeutic targets

Lumbar back pain during aging is a major clinical problem, the origins and underlying mechanisms of which are challenging to study. Degenerative changes occur in various parts of the functional spinal unit, such the vertebral endplate and intervertebral disc. The homeostasis of these structural components is regulated by signaling molecules, such as transforming growth factor-β and parathyroid hormone. Previous efforts to understand sources of lumbar back pain focused on sensory innervation in the degenerative intervertebral disc, but intervertebral disc degeneration is frequently asymptomatic. An in vivo mouse model of lumbar spine aging and degeneration, combined with genetic technology, has identified endplate innervation as a major source of lumbar back pain and a potential therapeutic target. In this review, we consider how each structural component of the functional spinal unit contributes to lumbar back pain, how the homeostasis of each component is regulated, and how these findings can be used to develop potential therapies.
Dynamic allostery controls the peptide sensitivity of the Ly49C natural killer receptor.

Using a variety of activating and inhibitory receptors, natural killer (NK) cells protect against disease by eliminating cells that have downregulated class I major histocompatibility complex (MHC) proteins, such as in response to cell transformation or viral infection. The inhibitory murine NK receptor Ly49C specifically recognizes the class I MHC protein H-2Kb. Unusual among NK receptors, Ly49C exhibits a peptide-dependent sensitivity to H-2Kb recognition, which has not been explained despite detailed structural studies. To gain further insight into Ly49C peptide sensitivity, we examined Ly49C recognition biochemically and through the lens of dynamic allostery. We found that the peptide sensitivity of Ly49C arises through small differences in H-2Kb-binding affinity. Although molecular dynamics simulations supported a role for peptide-dependent protein dynamics in producing these differences in binding affinity, calorimetric measurements indicated an enthalpically as opposed to entropically driven process. A quantitative linkage analysis showed that this emerges from peptide-dependent dynamic tuning of electrostatic interactions across the Ly49C–H-2Kb interface. We propose a model whereby different peptides alter the flexibility of H-2Kb, which in turn changes the strength of electrostatic interactions across the protein–protein interface. Our results provide a quantitative assessment of how peptides alter Ly49C-binding affinity, suggest the underlying mechanism, and demonstrate peptide-driven allostery at work in class I MHC proteins. Lastly, our model provides a solution for how dynamic allostery could impact binding of some, but not all, class I MHC partners depending on the structural and chemical composition of the interfaces.
Yin Yang 1 sets up the stage for cerebellar astrocyte maturation

Abstract Diverse subpopulations of astrocytes tile different brain regions to accommodate local requirements of neurons and associated neuronal circuits. Nevertheless, molecular mechanisms governing astrocyte diversity remain mostly unknown. We explored the role of a zinc finger transcription factor Yin Yang 1 (YY1) that is expressed in astrocytes. We found that specific deletion of YY1 from astrocytes causes severe motor deficits in mice, induces Bergmann gliosis, and results in simultaneous loss of GFAP expression in velate and fibrous cerebellar astrocytes. Single cell RNA-seq analysis showed that YY1 exerts specific effects on gene expression in subpopulations of cerebellar astrocytes. We found that although YY1 is dispensable for the initial stages of astrocyte development, it regulates subtype-specific gene expression during astrocyte maturation. Moreover, YY1 is continuously needed to maintain mature astrocytes in the adult cerebellum. Our findings suggest that YY1 plays critical roles regulating cerebellar astrocyte maturation during development and maintaining a mature phenotype of astrocytes in the adult cerebellum.
Sexual function outcomes of radiation and androgen deprivation therapy for localized prostate cancer in men with good baseline function.

Sexual dysfunction, including erectile dysfunction and loss of libido, are common among men undergoing treatment for localized prostate cancer. Both local treatments and systemic androgen deprivation therapy may contribute to these outcomes and are differentially indicated based on disease characteristics. We sought to compare sexual function through 5 years after radiation treatment with and without androgen deprivation therapy in men with good baseline sexual function to better understand long-term effects in this understudied subset of patients. We retrospectively reviewed a prospectively assembled population-based cohort of men who underwent radiation with and without androgen deprivation therapy for intermediate or high-risk localized prostate cancer. Sexual function was assessed longitudinally over 5 years. Men with erections sufficient for intercourse at baseline were selected for inclusion. Out of 167 patients included, 73 underwent radiation alone and 94 received androgen deprivation therapy plus radiation (51 with intermediate and 43 with high-risk disease). Androgen deprivation therapy use was associated with worse sexual function through 1 year regardless of disease risk. This difference was no longer statistically significant at 3 years in the intermediate-risk group. Compared to radiation alone, androgen deprivation therapy in high-risk disease was associated with worse sexual function at 3 years (effect: −20.3 points, CI [−31.8, −8.8], p < 0.001) but not at 5 years (effect: −3.4, CI [−17.2, 10.5], p = 0.63). Androgen deprivation therapy plus radiation is associated with worse sexual function through 3-years follow-up in men with high-risk prostate cancer compared to radiation alone. The addition of androgen deprivation therapy in the treatment of intermediate-risk disease does not appear to result in worse sexual function at 3 or 5-year follow-up compared to radiation alone.
Creating Democratic Civic Universities in a Post-COVID-19 World: The IAU and Global Collaboration

This essay is organized around four questions, the answers to which should, in my judgment, be helpful in thinking about universities now and in a post-pandemic world. My goal is to contribute to discussions and actions that result in the creation of democratic civic universities.