cssi/SciSciGPT-SciSciNet huggingface dataset:
Randomized trial of 1-week versus 2-week intervals for endoscopic ligation in the treatment of patients with esophageal variceal bleeding

The appropriate interval between ligation sessions for treatment of esophageal variceal bleeding is uncertain. The optimal interval would provide variceal eradication as rapidly as possible to lessen early rebleeding while minimizing ligation-induced adverse events. We randomly assigned patients hospitalized with acute esophageal variceal bleeding who had successful ligation at presentation to repeat ligation at 1-week or 2-week intervals. Beta-blocker therapy was also prescribed. Ligation was performed at the assigned interval until varices were eradicated and then at 3 and 9 months after eradication. The primary endpoint was the proportion of patients with variceal eradication at 4 weeks. Four-week variceal eradication occurred more often in the 1-week than in the 2-week group: 37/45 (82%) versus 23/45 (51%); difference = 31%, 95% confidence interval 12%-48%. Eradication occurred more rapidly in the 1-week group (18.1 versus 30.8 days, difference = −12.7 days, 95% confidence interval −20.0 to −5.4 days). The mean number of endoscopies to achieve eradication or to the last endoscopy in those not achieving eradication was comparable in the 1-week and 2-week groups (2.3 versus 2.1), with the mean number of postponed ligation sessions 0.3 versus 0.1 (difference = 0.2, 95% confidence interval −0.02 to 0.4). Rebleeding at 4 weeks (4% versus 4%) and 8 weeks (11% versus 9%), dysphagia/odynophagia/chest pain (9% versus 2%), strictures (0% versus 0%), and mortality (7% versus 7%) were similar with 1-week and 2-week intervals. Conclusion: One-week ligation intervals led to more rapid eradication than 2-week intervals without an increase in complications or number of endoscopies and without a reduction in rebleeding or other clinical outcomes; the decision regarding ligation intervals may be individualized based on patient and physician preferences and local logistics and resources. (Hepatology 2016;64:549-555)
131 ACADEMIC INTERNISTS' ATTITUDES AND BELIEFS ABOUT THE PHYSICIAN-PHARMACEUTICAL INDUSTRY RELATIONSHIP.

The pharmaceutical industry spent $14.2 billion on clinical trials and sponsored 57% of biomedical research in 2003 and funded over 60% of continuing medical education (CME) in 2001. Two recent books, The Truth about Drug Companies and On the Take, each written by a former editor of The New England Journal of Medicine, raise serious concerns about the physician-pharmaceutical industry (PI) relationship. We wanted to understand how our internal medicine faculty regarded this relationship. From November 2004 through February 2005, we conducted three group discussions focused on power and influence within health care with internists at our medical school. We recorded in-depth, 1-hour interviews with seven distinguished researchers and educators on our faculty that emphasized relationships with PI. We analyzed each transcript for comments about personal involvement with PI, clinical research, CME, and clinical practice. All had substantial involvement with PI in clinical research, medical education, or both. They regarded PI-funded clinical research as prevalent and useful for generating information and money for themselves and their divisions. They stated that such research, while not as highly regarded as investigator-initiated and peer-reviewed projects, was acceptable and valued. They did not report personal experience with suppression or manipulation of results. They all attended and/or taught at PI-sponsored CME programs. They felt that PI funding was “the way to get things done” in clinical research and CME. They also felt that CME “would not survive without it.” Most reported no PI control or influence on the content of their CME presentations. One reported that support for independently chosen speakers was becoming more difficult and the content of talks more controlled. He attributed these changes to new regulations. All acknowledged strong PI influence on clinical research, medical education, and clinical practice but did not feel compromised or inappropriately influenced themselves. None reported being counseled or criticized by their leaders about their relations with the PI. They did not include information or advice about these relationships in the formal curriculum for their trainees. Interviews with a small number of highly regarded medical faculty suggest that they have accepted an increasingly powerful role of PI in clinical research and education and that they do not advocate additional regulation or envision alternative ways to support these activities. Therefore, if change occurs in these relationships, it will likely come from sources outside of medical schools.
Toward an Understanding of Consumer Feedback in the Online Environment: Does Managerial Participation Help?

The monitoring and management of consumer generated WOM present major challenges for firms (Stewart and Kamins 2002). More specifically, the prevalence of electronic Word-of-Mouth (WOM) and the potential implications of consumer generated information for the attitude and behavior of other consumers substantiate the need for firms to identify and manage the effects of information exchange in online review forums. Traditionally, to minimize the proliferation of negative information among consumers, and to the advantage of their brands, firms have responded to consumer discontent with direct communications as well as through consumer informed product related improvements (Stewart and Kamins 2002; Chen et al. 2003; Sproull and Arriaga 2007). The marketing literature indicates that such responses have led to improvements in brand perception, and increased sales (Albrecht and Zemke 1985; Bitner et al. 1990; Chen et al. 2003; Haugtvedt et al. 2005; Roehm and Brady 2007). In online forums consumers are not directly expressing their discontent to the organization, but such expression is generally between consumers and conducted in public, in the sense that the organization as well as other consumers can observe and react to it. This level of opinion exchange and its rapid spread in the online environment present new challenges to the organization and these issues have not been fully addressed by current theoretical and empirical work.
Basic Concepts and Methods of Probability Theory and Statistics

Probability theory is the branch of mathematics that deals with random events, that is, events whose occurrence we cannot predict with certainty. Random phenomena are a feature of every sphere of natural and social existence and of life. From the genetic makeup of plants, animals, and human beings to planetary configurations, from games such as poker and backgammon to movements in financial markets, and from weather patterns to social and political events (such as elections results), we witness stochastic or random phenomena.
Asymmetric Division of Cancer Stem Cells

Cancer cells usually proliferate by symmetric division, producing identical copies of themselves. However, a small subset of cancer cells, mainly cancer stem cells, are capable of asymmetric cell division (ACD), producing a self-renewing daughter cell and a more differentiated daughter cell. During division, symmetry is broken by the spatial imbalance of polarity proteins and cell fate determinants. Present in both prokaryotes and eukaryotes, ACD can help establish diversity and hierarchy in the cell population and stabilize the number of stem and progenitor cells and balance it with functional cells. Abolishment of ACD in favor of symmetric self-renewal generates hyperproliferative cancer precursors with aberrantly specified fate, although ACD could enhance tumor resistance to chemo- and radiation therapies by producing a reservoir of quiescent cells. This chapter reviews the regulation of ACD and the functional consequences of ACD disruption in a variety of cancers.
Subclinical pregnancy loss in clomiphene citrate-treated women.

Objective To ascertain the subclinical pregnancy loss rate in clomiphene citrate (CC)-treated infertile women compared with women of normal fertility. Design Following a prospective format, serum samples were taken during the luteal phase of 92 menstrual cycles associated with CC treatment and 47 cycles in normal women. Human chorionic gonadotropin (hCG) assay sensitivity was 0.25 IU/L. Human chorionic gonadotropin assay was validated against 95 nonpregnant cycles. Criterion for pregnancy was a single serum sample ≥ 0.5 IU/L. Setting All subjects were under clinical management at the University of Virginia Health Sciences Center. Patients and Participants Patients undergoing CC induction of ovulation with satisfactory ovulatory response were candidates for the study group (n = 34). Control subjects of proven normal fertility were recruited (n = 22). Nonpregnant control subjects were sexually abstinent or had been surgically sterilized (n = 89). Intervention A serum sample was taken during the late luteal phase of all subjects. Results Thirteen percent of CC-treated cycles and 4.3% of normal control cycles were subclinical losses ( P = 0.09). Fifty percent of CC-induced pregnancies were subclinical losses compared with 16.6% of normal control pregnancies ( P = 0.05). Of CC patients who had at least one subclinical loss 47.6% later conceived a term pregnancy compared with 15.3% who did not have a subclinical loss ( P = 0.06). Conclusion Subclinical pregnancy loss is more common in CC-treated women than normal women and may be a predictor of subsequent normal conception.
Angles in metric spaces

If a,b,c are points of a metric space, then it follows from the triangle ineouality that -i < (ab 2 + ac 2 bc2)/2ab 9 ac < i~ where juxtaposition denotes the distance between two points. Thus calling the symbol bac an angle with vertex a~ its value is given by the formula 2 (i) bac = Arc cos [ (ab 2 + ac bc2)/2ab 9 acl. wilson introduced this concept of angle in general metric spaces. Of course there may be no significant relationship between bac and dae even when d and e are points between a and b and a and c~ respectively. Wilson overcame this objection by defining an angle (p,o) of two rays (congruent images of half-lines) p~J with common initial point a by
De La quinta Dayana a Cheila, una casa pa’ maíta:Representaciones de transexualidad femenina

En este ensayo se analiza Cheila, una casa pa’ maita (2010), de Eduardo Barberena, el primer filme de ficcion hecho en Venezuela que incluye a una protagonista transexual. La pelicula fue hecha por la Villa del Cine, creada por el gobierno de Hugo Chavez en 2006. Se trata de una adaptacion de La quinta Dayana (2009), obra teatral del dramaturgo venezolano Elio Palencia, estrenada en Caracas en 2007, quien tambien escribio el guion cinematografico. El articulo se enfoca en algunos de los cambios mas significativos de la adaptacion y propone una explicacion de sus significados prestando atencion a la representacion del sujeto transexual.
A single-stage three-phase AC-AC converter for inductive power transfer systems

A three-phase ac-ac matrix converter for inductive power transfer (IPT) systems with soft-switching operation and bidirectional power flow is introduced. The proposed converter can generate high-frequency current directly from a three-phase ac power source without a dc link. Unlike conventional ac-dc-ac converters, the proposed converter can provide a high frequency current without any current sag around ac source zero-crossings for IPT systems. The proposed topology is expected to have high reliability and extended lifetime due to the soft-switching operation and elimination of short life electrolytic capacitors. Soft-switching operation will also reduce switching stress, switching losses, and electromagnetic interference (EMI) of the converter. A simple control strategy based on energy injection and free oscillation technique is used as the control method. The proposed converter is comprised only seven switches, which in turn increase the reliability, efficiency and reduce cost. The converter operates in eight modes, which are described in detail. Theoretical analysis and simulation results on a 2kW IPT system, show that the current control method can fully regulate the output current with low ripple which is suitable waveforms for IPT applications.
The College Science Learning Cycle: An Instructional Model for Reformed Teaching

Finding the time for developing or locating new class materials is one of the biggest barriers for instructors reforming their teaching approaches. Even instructors who have taken part in training workshops may feel overwhelmed by the task of transforming passive lecture content to engaging learning activities. Learning cycles have been instrumental in helping K-12 science teachers design effective instruction for decades. This paper introduces the College Science Learning Cycle adapted from the popular Biological Sciences Curriculum Study 5E to help science, technology, engineering, and mathematics faculty develop course materials to support active, student-centered teaching approaches in their classrooms. The learning cycle is embedded in backward design, a learning outcomes-oriented instructional design approach, and is accompanied by resources and examples to help faculty transform their teaching in a time-efficient manner.
Cross-Level Research without Cross-Ups in Community Psychology

A central tenet of community psychology is that human behavior must be understood in context. Community and other ecologically oriented psychologists have proposed typologies of contexts for behavior (Altman RBarker, 1968; Bronfenbrenner, 1979, 1986; Murrell, 1973; Rappaport, 1977; Seidman, 1988), with the twin goals of understanding the interplay of people and contexts, and of exhorting psychologists to include ever-broader contexts of behavior in their theory, research, and intervention practices. Typically, the typologies are organized from narrower to broader contexts or from lower to higher levels of analysis
Dilation of Chisini-Jensen-Shannon Divergence

Jensen-Shannon divergence (JSD) does not provide adequate separation when the difference between input distributions is subtle. A recently introduced technique, Chisini Jensen Shannon Divergence (CJSD), increases JSD's ability to discriminate between probability distributions by reformulating with operators from Chisini mean. As a consequence, CJSDs also carry additional properties concerning robustness. The utility of this approach was validated in the form of two SVM kernels that give superior classification performance. Our work explores why the performance improvement to JSDs is afforded by this reformulation. We characterize the nature of this improvement based on the idea of relative dilation, that is how Chisini mean transforms JSD's range and prove a number of propositions that establish the degree of this separation. Finally, we provide empirical validation on a synthetic dataset that confirms our theoretical results pertaining to relative dilation.
Flexible CuInSe2 Nanocrystal Solar Cells on Paper

Solar cells on paper have the potential to be inexpensive and portable due to several unique features of the substrate: paper is cheap, flexible, lightweight, biodegradable, and manufactured by roll-to-roll processing. Here, we report the first nanocrystal photovoltaic devices (PVs) made on paper. Using spray-deposited CuInSe2 nanocrystals as the absorber material on substrates composed of bacterial cellulose nanofibers synthesized by the microorganism Gluconacetobacter hansenii, these devices demonstrate exceptional electrical and mechanical integrity. There is no significant loss in PV device performance after more than 100 flexes to 5 mm radius, and the devices continue to perform when folded into a crease. The practical use of these paper PVs is demonstrated with a prototype device powering liquid crystal displays (LCDs) mounted to various kinds of surfaces.
Family Therapists’ Perspectives on Implementing Musical Interventions in Family Therapy: A Mixed-Methods Study

ABSTRACTFamily musical interventions offer significant therapeutic outcomes when applied by music therapists. Although mainly focused on individuals with special needs, interventions contribute to family well-being by promoting family communication, shared emotions, relationships, roles, dynamics, mutual trust, and parental functioning. Despite the potential, family-based musical interventions are rarely used by family therapists or studied in family therapy programs. Thirty-five family therapists participated in an explanatory mixed-methods research aimed at identifying therapists’ perceptions toward musical interventions in clinical work, illuminating numerous sources influencing therapists’ inclination to refrain from using musical interventions. This article discusses implications for promoting use of musical interventions.
Which Employee Characteristics Move Stock Prices?: Evidence from the Boston Celtics

I use data from the Boston Celtics, which traded on the New York Stock Exchange from 1986 to 1998, to investigate the employee characteristics that move stock prices. Investors positively value top-level training when firms seek to hire inexperienced employees. For all added employees, most of whom are experienced, investors respond positively to expected complementarities with existing workers but do not respond to salary. Investors positively value the removal of an older, highly-paid worker but negatively value the removal of a long-tenured worker. These results suggest that a firm’s employee base affects its value.
In search of a future: A critical analysis of research on web-based teaching and learning

Despite the explosion of interest in Web-based teaching and learning,many criticisms of research with past technologies have re-surfaced.Research efforts are often so diffuse and contradictory as toconfuse rather than enlighten. We have failed to break much newpedagogical ground with our collective effort to date. In thiscommentary, we briefly examine research questions and methods onand with technology, analyze current Web-based research focus andpractice, and identify directions we believe to be especiallypromising.
Age-Related Driving Performance: Effect of Fog Under Dual-Task Conditions

The present study investigated the driving performance of older and younger drivers using a dual-task paradigm. Drivers were required to do a car-following task while detecting a signal light change in a light array above the roadway in the driving simulator under different fog conditions. Decreased accuracies and longer response times were recorded for older drivers, compared to younger drivers, especially under dense fog conditions. In addition, older drivers had decreased car following performance when simultaneously performing the light-detection task. These results suggest that under poor weather conditions (e.g. fog), with reduced visibility, older drivers may have an increased accident risk because of a decreased ability to perform multiple tasks.
Essential Metal Uptake in Gram-negative Bacteria: X-ray Fluorescence, Radioisotopes, and Cell Fractionation

We demonstrate a scalable method for the separation of the bacterial periplasm from the cytoplasm. This method is used to purify periplasmic protein for the purpose of biophysical characterization, and measure substrate transfer between periplasmic and cytoplasmic compartments. By carefully limiting the time that the periplasm is separated from the cytoplasm, the experimenter can extract the protein of interest and assay each compartment individually for substrate without carry-over contamination between compartments. The extracted protein from fractionation can then be further analyzed for three-dimensional structure determination or substrate-binding profiles. Alternatively, this method can be performed after incubation with a radiotracer to determine total percent uptake, as well as distribution of the tracer (and hence metal transport) across different bacterial compartments. Experimentation with a radiotracer can help differentiate between a physiological substrate and artefactual substrate, such as those caused by mismetallation. X-ray fluorescence can be used to discover the presence or absence of metal incorporation in a sample, as well as measure changes that may occur in metal incorporation as a product of growth conditions, purification conditions, and/or crystallization conditions. X-ray fluorescence also provides a relative measure of abundance for each metal, which can be used to determine the best metal energy absorption peak to use for anomalous X-ray scattering data collection. Radiometal uptake can be used as a method to validate the physiological nature of a substrate detected by X-ray fluorescence, as well as support the discovery of novel substrates.
Resources in Parks and Police Management Applying Decision Utility to Solve Problems With Limited Resources

This is the first research article that attempts to relate public service to managing an organization and explains systems with realistic yet simplistic examples. This article is the first of its kind to relate public service to managing organizations that relate public service such as parks and police. It measures and implements maximin value functions. A maximin value function applies when the criteria are totally non-substitutable: a decrease in a critical criterion cannot be compensated for by an increase in another criterion. This article illustrates situations where a maximin value function is an appropriate model, develops a method to measure a decision maker's maximin value function, and demonstrates how a maximin value function can be used in applications such as park and police systems. The measurement technique is easy to understand and most decision makers can complete the process in a short period of time. For quantitative scheduling techniques found in journals, their wider use in applications has been declining due to a variety of obstacles. This article will first list a number of these obstacles and then suggest ways to overcome them. Parks and Police departments are government agencies that both have limited and competing resources. In these circumstances, it is an ideal situation to share the resources as much as possible. In this article, examples are shown of where the limited resources may occur in both agencies, and how the manager may overcome these problems by sharing the resources. Examples of affective and just sharing of resources are given for both parks and police departments. In Parks Management, affective trade-offs are shown among trim mowing, tractor mowing, garbage collection and ball-field dragging. In Police departments affective trade-offs are shown among foot patrol, car patrol, detective analysis and office work.
Deconstructing Women’s Leadership: Those Who Laugh Last

There is much research that illustrates the “glass ceiling” effect for women in elite leadership positions. Examining female academic chairs’ leadership in a male domain provides insight into leadership practices. The author interviewed three female clinical chairs and integrated the findings into a women's leadership model. Deconstructive thematic analysis of the subsequent text gathered systematic and in-depth information about this case at a U.S. top-tier academic medical center. A deconstructive view suggests that women leaders will be both masculine and feminine, that gender is not an issue although issues were identified by their laughter, that communal behavior may be considered a weakness but became their strength, and that threat may be “in the air" but not noticed. All three female chairs simultaneously accommodated and resisted constructs within the literature. All the barriers described in a model of women's leadership were dismantled by these successful women chairs.
Isogeometric analysis for simulation of progressive damage in composite laminates

The increasing popularity of composite materials in aerospace applications is creating the need for a new class of predictive methods and tools for the simulation of progressive damage in laminated...
Transcriptional Analysis of the Three Phosphoglycolate Phosphatase Genes in Wild Type and the pgp1 Mutant of Chlamydomonas Reinhardtii

Phosphoglycolate phosphatase (PGPase) is an essential enzyme in the photorespiration pathway in plants and photosynthetic algae. In Chlamydomonas reinhardtii, mutants deficient in phosphoglycolate phosphatase (PGPase-1) were reported to require elevated levels of CO2 for growth in the light. Here we described that thispgp1 mutant reverted naturally and regained the ability to survive under low CO2 conditions. Quantitative RT-PCR analysis demonstrated that the upregulation of PGP2 in the pgp1 revertants might contribute to this reversion in the growth phenotype.
Obesity of Infancy and Early Childhood

Considerable attention has been focused on the eating disorders of early childhood that result in growth failure, such as failure to thrive syndrome and rumination. In contrast, the eating disorders that result in excessive weight gain have been virtually ignored. DSM-III-R has reinforced this prejudice by refusing to classify any form of obesity as an eating disorder (American Psychiatric Association, 1987). Instead, it describes obesity as a physical disorder. As a result of this lack of interest in obesity of early childhood, there are many widely held misconceptions about its etiology, course, and even heterogeneity of subtypes. The state of clinical ignorance about the fundamentals of infantile obesity makes a scientific strategy for intervention difficult.
How Forum Determines Substance in Judicial Debt Collection

In an email to the Small Claims Task Force, a committee appointed by the Indiana Supreme Court to investigate allegations of abuse in the Marion County Small Claims Court, an Indiana attorney claimed that collection attorneys were forum shopping in Indiana small claims court. In its subsequent report, the task force confirmed that some forum shopping is occurring in Marion County Small claims courts. This study takes that allegation a step further and looks beyond the small claims courts of Marion County to examine the forum shopping practices of collection attorneys throughout Indiana. The evidence suggests that collection firms do forum shop between courts in individual judicial districts. This article takes a closer look at forum shopping by exploring the possible motivations for the forum shopping and its implications for consumers.
Adhesive Contact of Solid Surfaces

The rapid progress in microand nanofabrication techniques over the last several decades has led to the development of various miniature electromechanical systems, such as microvibromotors [1], MEMS RF switches [2, 3], MEMS optical tweezers [4, 5], and MEMS mirrors [6, 7]. These have attracted great interest in using movable micromechanical structures in various MEMS and NEMS devices. The performance and lifetime of MEMS and NEMS devices are limited by the material confinement in submicron structures with large surface area, high electric field, large stress gradient, and other factors normally nonexistent in macroscale structures. On the microscale, material behavior is more controlled by surface-driving effects than by bulk effects. For example, frictional effects play a much more important role than inertia in the control of rotary or linear micromotors; i.e., the start-up conditions strongly depend on static friction and moving/rotational speed on kinetic friction. If there exists electric field, field-assisted contact is present. One of major concerns for long-term applications of MEMS and NEMS structures is mechanical failure, including surface contact, fracture and fatigue. Surface contact of micromechanical structures can contribute to stiction (adhesive contact), damage, pitting, and surface hardening over local contact area. The presence of stiction is due to high compliance and large surface-to-volume ratio of micromechanical structures, which do not have enough restoring force to overcome the surface interaction after mechanical contact. Stiction can be classified into two categories: release-related stiction and in-service stiction [8]. Release-related stiction appears during the removal of sacrificial layers for the release of micromechanical structures, which basically is due to liquid bridges and is controlled by the Laplace pressure and the surface tension of liquid etchants. Practical solutions to the problem
Information Exchange and Environmental Justice

The Environmental Justice Movement is an aggregate of community-based, grassroots efforts against proposed and existing hazardous waste facilities and the organizations that assist them. The movement has created a context in which low-income communities and people of color are able to act with power. Using interviews, participant observation, and various archival records, a case study of the organization HOPE located in Perry, Florida, was developed. The case compared key factors in community mobilization and campaign endurance. Special attention was paid to the process of issue construction, the formation of collective identity, and the role of framing in mobilizing specific constituencies. In the case of the PG (2) the role of information process and the relationship of multiple stakeholders; and (3) the agency of those with the least access to resources. This study explores the information exchange and the movement's identity on both an individual and group level. When people become involved in the movement they experience a shift in personal paradigm that involves a progression from discovery of environmental problems, through disillusionment in previously accepted folk ideas, to personal empowerment.
Effects of Laser Selective Reflow on Solder Joint Microstructure and Reliability

New applications and materials continue to pose challenges and opportunities for automated microelectronics manufacturing. Alternative approaches are becoming available but for most purposes the use of soldering in high volume applications still offer major advantages. However, the inability of many inexpensive materials to survive conventional mass reflow temperatures present a serious obstacle to this. One potential work-around still offering a relatively high throughput would be the use of selective laser reflow. This allows the local heating of solder joints and paste deposits for such a short time that other parts of the assembly are not heated nearly as much. Of course the properties of the resulting solder joints are somewhat different than typically achieved with mass reflow. An example of the use of a commercial infrared (IR) laser reflow instrument and its consequences in terms of solder joint properties was considered. Details including the impact of material properties and sample geometry on thermal profiles will be described for a representative example. The unique solder microstructures achieved because of the high heating and cooling rates were characterized, and associated properties such as creep rates and fatigue life quantified. Results are discussed in terms of consequences for life under realistic long term service conditions.
Bounds on the Capacity Region of the Three-User One-to-Three MIMO Interference Channel

The one-to-three MIMO interference channel (IC) is a partially connected three-user IC with multiple antenna terminals where one transmitter is heard at all three receivers, thus causing interference at its two unintended receivers, whereas the other two transmitters are heard only at their respective intended receivers. In this paper, we present inner and outer bounds on the capacity region of the one-to-three MIMO IC, quantify the gap between the two bounds, and show that the gap is independent of the SNRs and INRs. In particular, the achievable scheme involves multi-level superposition coding with linear precoding based on the generalized singular value decomposition (GSVD). The outer bound is obtained using various combinations of genie information provided to the receivers.
Dried leaf Artemisia annua efficacy against non-small cell lung cancer.

Abstract Background Non-small cell lung cancer (NSCLC) is a major subtype of lung cancer with poor prognosis. Artemisinin (AN), produced naturally in Artemisia annua L., has anti-cancer activity. Artemisinin delivered as dried leaf Artemisia (DLA) showed efficacy against malaria in rodents and humans. Hypothesis/Purpose DLA is posited as being at least as efficacious as artesunate (AS) in its ability to induce cytotoxicity in NSCLC cells and also inhibit tumor growth in a NSCLC xenograft murine model. Study Design Three NSCLC cell lines were used, a non-cancerous human fibroblast line, and xenograft murine models to compare efficacy of artemisinin delivered p.o. via DLA, DLA extracts (DLAe), and AS. Methods DLAe was compared to AS using NSCLC cell lines A549, H1299 and PC9 as well as non-cancerous human dermal fibroblasts (HDF) CCD-1108Sk line. Cell viability, cell migration and cell cycle were compared for AS and DLAe. Westerns measured activated caspases-3, -8 and -9 to determine involvement of intrinsic and/or extrinsic apoptotic pathways. Xenograft murine models of A549 and PC9 cells were used to measure tumor growth inhibition by AS or DLA, with tumor volume the primary endpoint. Results Both DLAe and AS suppressed A549, H1299 and PC9 cell viability with no inhibition of non-cancerous HDF CCD-1108Sk cells. Caspases-3, -8 and -9 were activated, suggesting cell death was stimulated through both intrinsic and/or extrinsic apoptotic pathways. Both drugs induced G2/M or mitotic arrest in PC9 and H1299 cells, and DLAe induced G1 arrest in A549 cells. AS and DLAe induced DNA damage as double stranded breaks evidenced by phosphorylation of histone H2AX. DLAe inhibited migration of PC9 and A549 cells. In A549 xenografted animals, p.o. AS and DLA inhibited relative tumor growth by 40% and 50%, respectively, compared to controls. AS was ineffective at inhibiting PC9-induced tumor growth, but DLA inhibited relative tumor growth by ∼50% compared to controls. Conclusion This is the first study demonstrating efficacy of DLA and mechanistic differences of DLAe vs. AS, against NSCLC cells. Compared to AS, DLA possesses qualities of a novel therapeutic for patients with NSCLC.
Efficacy of using a 3D printed lumbosacral spine phantom in improving trainee proficiency and confidence in CT-guided spine procedures

Minimally-invasive spine procedures provide targeted, individualized diagnosis and pain management for patients. Competence in these procedures is acquired through experience and training. We created a 3D printed model of a degenerative lumbosacral spine with scoliosis and spondylosis, using materials that mimic bone and soft tissue density under CT. In this study, we evaluate the efficacy of using such a spine model to improve novice trainee confidence and proficiency in performing CT-guided facet joint injections. Thirteen medical students with no prior exposure to CT-guided spine procedures were divided into two groups. Both groups received an introductory didactic lecture, as well as identical pre- and post- test assessments. The Training group (7 students) received two separate training sessions using the simulation model. The Control group (6 students) received only one training session. The Training group demonstrated significantly fewer needle readjustments during the second simulation session, compared with the first session (p = 0.005). Both groups demonstrated significant increase in confidence in ability to perform CT-guided spine procedures on the post-test (p = 0.004 for the Control group and p = 0.00001 for the Training group). A 3D printed lumbosacral spine phantom with realistic spondylosis can be made to facilitate novice training in minimally-invasive spine procedures. Training using a realistic lumbosacral spine model helps novices acquire the skills and confidence to perform CT-guided spine procedures.
Mixed-Ability Collaboration for Accessible Photo Sharing

We conducted two online surveys about current and potential collaborative photo sharing processes among blind and sighted people. We describe existing challenges that blind and visually impaired people encounter when trying to write alternative text for their own photographs and examine how their online sighted friends and family members might be able to contribute assistance as they make their content more accessible to other people with visual impairments.
Transactive memory: Learning who knows what in work groups and organizations.

D. M. Wegner was the first to analyze transactive memory, especially as it occurs in couples. A transactive memory system can thus provide a group's members with more and better information than any of them could remember alone. This chapter discusses most interested in three factors associated with the operation of transactive memory systems. The first of these factors was memory differentiation, or the tendency for group members to specialize in remembering different aspects of the assembly process. The second factor was task coordination, or the ability of group members to work together efficiently on the radio. The final factor was task credibility, or the level of trust among group members in one another's radio knowledge. Videotapes of the groups were again rated by several judges, using the same procedures as before. A major strength of the interpersonal approach is that knowledge about a task can be shared in ways that are tailored to a worker's specific needs.
Transitions of care

Diverse population health needs have led the academic medical community to respond with unprecedented changes. The clinical relevance of cultural competence and psychosocial aspects of health and i...
Hyperelastic phase-field fracture mechanics modeling of the toughening induced by Bouligand structures in natural materials

Abstract Bouligand structures are widely observed in natural materials; elasmoid fish scales and the exoskeleton of arthropods, such as lobsters, crabs, mantis shrimp and insects, are prime examples. In fish scales, such as those of the Arapaima gigas, the tough inner core beneath the harder surface of the scale displays a Bouligand structure comprising a layered arrangement of collagen fibrils with an orthogonal or twisted staircase (or plywood) architecture. A much rarer variation of this structure, the double-twisted Bouligand structure, has been discovered in the primitive elasmoid scales of the coelacanth fish; this architecture is quite distinct from “modern” elasmoid fish scales yet provides extraordinary resistance to deformation and fracture. Here we examine the toughening mechanisms created by the double-twisted Bouligand structure in comparison to those generated by the more common single Bouligand structures. Specifically, we have developed an orientation-dependent, hyperelastic, phase-field fracture mechanics method to computationally examine the relative fracture toughness of elasmoid fish scales comprising single vs. double-twisted Bouligand structures of fibrils. The model demonstrates the critical role played by the extra inter-bundle fibrils found in coelacanth fish scales in enhancing the toughness of Bouligand-type structures. Synthesis and fracture tests of 3-D printed Bouligand-type materials are presented to support the modeling and complement our understanding of the fracture mechanisms in Bouligand-type structures.
Adapt or Die? The Effects of Venture Identity Experimentation on Funding and Survival

Creating a legitimate, distinctive and socially acceptable venture identity is a key part of a venture’s emergence process. Recent literature has provided many insights on the content, structure, a...
Ketamine and Cognitive Behavioral Therapy for Rapid Opioid Tapering With Sustained Opioid Abstinence: A Case Report and 1-Year Follow-up.

Background Ketamine, a potent analgesic and N-methyl-D-aspartate-(NMDA)-receptor antagonist, improves analgesic outcomes in patients with complex regional pain syndrome (CRPS). The NMDA receptor has also been implicated in opioid withdrawal. The use of ketamine to assist with a rapid opioid taper in the setting of CRPS has not been previously described. Case We present a case in which a 5-day continuous ketamine infusion was utilized in a robust multimodal analgesia regimen in combination with cognitive behavioral therapy (CBT) to successfully taper a patient with complex regional pain syndrome (CRPS) who was taking 330 mg of daily morphine equivalents completely off of opioids, minimize withdrawal symptoms, and produce sustained results. Discussion CRPS may involve catecholamine hypersensitivity and central sensitization and can be notoriously challenging to treat by itself even outside of the context of an opioid taper. The patient we describe here received one additional 5-day infusion at 6 months and remained opioid-free while experiencing a major improvement in function and lifestyle that he still maintains. This was possible through a combination of aggressive inpatient management with ketamine as the centerpiece, followed by consistent outpatient CBT to maintain results without the need for a return to opioids. This combination has previously not been described in the setting of a rapid opioid taper and this patient's underlying CRPS made it all the more remarkable.
Load-Leveling Trainer for Demand Side Management on a 45kW Cyber-Physical Microgrid

Improving the reliability and efficiency of microgrids to handle diverse load types will lead to more dependable electrical grids in small communities, reduce costs for both consumers and suppliers, and reduce carbon emissions. Better demand side management (DSM) has been proposed as a solution for creating more efficient m icrogrids a swell as limiting the need for increases in power generation capacity and transmission. This paper proposes a hardware implementation of DSM in an actual microgrid system to support grid needs. An algorithm for achieving DSM through load-leveling at the micro-level is presented and implemented on a physical microgrid and evaluated in order to create a Load-Leveling Trainer. A simulated case study, based on the electrical load needs of small communities in Bangladesh, is reviewed to prove that the Load-Leveling Trainer can be used to better balance electrical load demands.
PERCEIVING VALUE IN ORGANISATIONAL INNOVATION: BUILDING A CULTURE OF CHANGE

This paper uses Transactional Management Theory to examine the extent to which an organisational culture is apt to encourage organisational innovation by using reward mechanisms. We gathered respon...
Combined MEK and STAT3 inhibition reprograms the tumor microenvironment to overcome immunotherapy resistance in pancreatic cancer

ABSTRACT Pancreatic ductal adenocarcinoma (PDAC) is characterized by immune exclusion, stromal desmoplasia, and resistance to immune checkpoint inhibition (ICI). We have previously demonstrated that reciprocally activated RAS/RAF/MEK/ERK and JAK/STAT3 pathways mediate therapeutic resistance, while combined MEK and STAT3 inhibition (MEKi/STAT3i) overcomes this resistance in PDAC. Herein, we show that combined MEKi/STAT3i alters stromal architecture and remodels the tumor-infiltrating innate and adaptive immune compartments by downregulating immunosuppressive myeloid populations and promoting T-cell enrichment and activation in Ptf1acre/+;LSL-KrasG12D/+;Tgfbr2flox/flox (PKT) mice. MEKi/STAT3i-mediated reprogramming of the PDAC tumor microenvironment primes tumor-infiltrating CD8+ T-cells for PD-1 blockade to augment their activation and functional cytotoxicity. As such, the addition of MEKi/STAT3i to PD-1 blockade dramatically inhibits tumor growth and prolongs survival, overcoming resistance to ICI, in PKT mice. Importantly, treatment of a patient with chemotherapy-refractory metastatic PDAC with MEKi (Trametinib), STAT3i (Ruxolitinib), and PD-1 inhibitor (Nivolumab) was not only well-tolerated but also yielded significant clinical benefit. Significance These data uncover a novel paradigm in which combined MEKi/STAT3i reprograms the stromal and immune microenvironment to overcome immunotherapy resistance in PDAC. The clinical efficacy of combined MEKi, STAT3i, and anti-PD1 treatment in chemotherapy-refractory PDAC provides encouraging signals for its translatability, and is being currently pursued in a clinical trial.
Wildfire and the patterns of floodplain large wood on the Merced River, Yosemite National Park, California, USA

Abstract We quantified floodplain large wood load (m3 wood/ha) and spatial distribution on the Upper Merced River in Yosemite National Park, California, USA. The upstream portion of the study area includes a recently burned section of the Merced River corridor and the downstream portion contains floodplain with undisturbed forest, facilitating investigation of the effects of wildfire on floodplain large wood. We used measurements of wood load and spatial distribution to test hypotheses regarding floodplain wood dynamics in the channel versus the floodplain and in burned versus unburned portions of the study area. The median wood load on the Merced River floodplain, as measured along numerous transects, is 259 m3/ha overall, with non-significant differences between burned (median 196 m3/ha) and unburned (median 277 m3/ha) portions of the floodplain. We found that jams can occur across the entire width of the floodplain. Burned wood pieces are present throughout the study area in the channel but are largely absent from unburned portions of the floodplain, despite the occurrence of overbank flows since the wildfire. A greater proportion of large wood is within logjams in burned portions of the floodplain. We infer that wood recruited to the channel via bank erosion moves readily downstream within the channel, whereas wood moving from the channel onto the floodplain concentrates near the margin of the main channel or within secondary channels and depressions on the floodplain, leading to the formation of long, narrow logjams.
Veillonellaceae family members uniquely alter the cervical metabolic microenvironment in a human three-dimensional epithelial model.

Bacterial vaginosis (BV) is a gynecologic disorder characterized by a shift in cervicovaginal microbiota from Lactobacillus spp. dominance to a polymicrobial biofilm composed of diverse anaerobes. We utilized a well-characterized human three-dimensional cervical epithelial cell model in conjunction with untargeted metabolomics and immunoproteomics analyses to determine the immunometabolic contribution of three members of the Veillonellaceae family: Veillonella atypica, Veillonella montpellierensis and Megasphaera micronuciformis at this site. We found that Veillonella spp. infections induced significant elevation of polyamines. M. micronuciformis infections significantly increased soluble inflammatory mediators, induced moderate levels of cell cytotoxicity, and accumulation of cell membrane lipids relative to Veillonella spp. Notably, both V. atypica and V. montpellierensis infections resulted in consumption of lactate, a key metabolite linked to gynecologic and reproductive health. Collectively our approach and data provide unique insights into the specific contributions of Veillonellaceae members to the pathogenesis of BV and women’s health.
Automated Detection of Postoperative Surgical Site Infections Using Supervised Methods with Electronic Health Record Data.

The National Surgical Quality Improvement Project (NSQIP) is widely recognized as "the best in the nation" surgical quality improvement resource in the United States. In particular, it rigorously defines postoperative morbidity outcomes, including surgical adverse events occurring within 30 days of surgery. Due to its manual yet expensive construction process, the NSQIP registry is of exceptionally high quality, but its high cost remains a significant bottleneck to NSQIP's wider dissemination. In this work, we propose an automated surgical adverse events detection tool, aimed at accelerating the process of extracting postoperative outcomes from medical charts. As a prototype system, we combined local EHR data with the NSQIP gold standard outcomes and developed machine learned models to retrospectively detect Surgical Site Infections (SSI), a particular family of adverse events that NSQIP extracts. The built models have high specificity (from 0.788 to 0.988) as well as very high negative predictive values (>0.98), reliably eliminating the vast majority of patients without SSI, thereby significantly reducing the NSQIP extractors' burden.