cssi/SciSciGPT-SciSciNet huggingface dataset:
Operational two-stage tapered gyro-TWT amplifier

A two-stage Ka-band gyro-TWT amplifier experiment operating in the TE/sub 10/ rectangular tapered waveguide with a 33 kV, 1.5 A beam has been operated successfully at the Naval Research Laboratory. The device incorporates precise axial tapering of both the magnetic field and the interaction circuit for broadband operation. The objective of this program is to demonstrate the stable wideband operation of a low voltage tapered gyro-TWT having high gain and good gain uniformity. By employing an electron beam with /spl alpha/ of near 0.7 at the entrance of the tapered waveguide circuit, stable operation is observed at full beam current. Small signal gain of 30 dB and saturated gain of 25 dB are observed over a wide (20%) instantaneous frequency range (32-39 GHz). Saturated efficiency of 16% has been obtained in good agreement with theory. The beam velocity spread on the tapered geometry can cause a sharp drop in gain when the electrons add up destructively in phase. The bandwidth of the two-stage tapered gyro-TWT amplifier can be extended by reducing the interaction length or beam voltage. >
Shared decision-making and patient decision AIDS: is it time?

The quality and cost of medical care is determined in large part by the decisions that clinicians and patients make every day about seeking care, having tests, starting treatments, and stopping treatments. There are situations in medicine in which a treatment or approach has considerable evidence of significant benefit with minimal or no harm. High-quality decisions in these situations are about efficiently delivering proven, effective care to all those who may benefit. Articles see p 251 and 260 A surprising number of medical decisions, however, do not have a single “best” answer; instead, they require clinicians and patients to make tradeoffs. In these situations, often called preference-sensitive decisions, the quality of the decision is determined by whether the test or treatment is clinically appropriate and reflects patient's informed goals and preferences.1 Shared decision-making is one approach to ensure that patients are informed and involved in decision-making and that treatments are tailored to their goals. Recent clinical guidelines put out by the American College of Cardiology and the American Heart Association emphasize the relevance of this approach and state that “patients should be informed of the risks, benefits, and alternatives to a particular treatment and be involved in shared decision-making whenever feasible.”2 Patient decision aids are tools designed to support shared decision-making. There are established criteria for the development of these tools and more than 86 randomized, controlled trials documenting their efficacy.3,4 In general, the tools have been shown to improve the patient's knowledge, reduce decisional conflict, and increase concordance between the patient's goals and their choices. Two studies in this issue of Circulation: Cardiovascular Quality and Outcomes evaluate the impact of patient decision aids on the quality …
Babesiosis-associated immune thrombocytopenia

Thrombocytopenia is a common feature of babesiosis. The mechanism for thrombocytopenia in babesiosis remains elusive. We report a case of babesiosis with severe new onset immune thrombocytopenia (ITP). In addition to antibiotics treatment for babesiosis, ITP therapy was administered. ITP in the present case was most likely triggered by the babesia infection. The severity of ITP in this case was not proportional to the severity of parasitemia. The neoantigen triggering the autoimmune response in babesiosis requires further characterization.
What Have We Learned from SH2 Domains

SH2 domains first shed light on the key role of modular binding domains in cell signaling. Much of what we now know about the logic and design principles underlying cell signaling mechanisms, and how such mechanisms might have evolved, can be traced back to early work on SH2 domains. Here we briefly outline several key concepts that emerged from such studies.
Navigation and Robotics in Knee Arthroplasty.

Computer-assisted surgery for total knee arthroplasty can be performed with use of computer-assisted navigation, handheld navigation, partially or fully robot-assisted technology, and patient-specific instrumentation.Computer-assisted navigation leads to improved component alignment and a reduction
Building Community Informed and Driven Data Services at the National Center for Atmospheric Research

At the National Center for Atmospheric Research (NCAR), being able to enable and facilitate scientific progress by providing advanced computing capabilities has been a key focus for multiple decades. Additional developments of dedicated technical infrastructures for supporting data-related activities, such as visualization, analysis, processing, and transformation, have also been prioritized. However, in order to meet the diverse existing and emerging data needs from the scientific community, data services must couple technical development with human and organizational services. Data services have a better chance to be accepted and used by the target community if the community members are represented and consulted during the design and implementation process. This paper discusses NCAR's Data Stewardship Engineering Team (DSET), which was created to facilitate cross-organizational participation and communication. The NCAR DSET includes representatives and stakeholders from the NCAR science and technical divisions to leverage the expertise of both groups, and ensures that feedback from users is built into the process. The goal of the DSET is to enable data services, including the technical infrastructures, to be developed in alignment with the community's research and data needs.
Mathematics teachers’ self-captured video and opportunities for learning

Numerous video-based programs have been developed to support mathematics teachers in reflecting on and examining classrooms interactions without the immediate demands of instruction. An important premise of such work is that teacher learning occurs at the time that the video is viewed and discussed with teachers. Recent advances in technology, however, offer new approaches for the use of video with teachers. We claim that these new technologies provide important opportunities for teacher learning prior to the viewing and discussion of video with colleagues. In particular, we believe that important teacher learning can occur from the activities of (1) capturing video from one’s own classroom and (2) selecting clips to share with others. The goal of this article is to introduce key strategies that three groups of middle and high school mathematics teachers use prior to, during, and after instruction as they engage in this work. We believe that increased attention to these strategies is necessary in order to better understand how to support teacher learning in the context of new digital technologies.
Placating plato with plates of pasta: An interactive tool for teaching the dining philosophers problem

There has been a recent surge in the need for computer science educational resources. Often, this need is addressed with computer-based learning tools. However, many of these tools target coding skills and software design rather than teaching foundational topics. This work proposes an interactive tool for teaching process management using the common abstraction of the Dining Philosophers Problem. We demonstrate the effectiveness and entertainment value of this tool with feedback from undergraduate students enrolled in computer science courses. We believe this type of educational tool more adequately addresses the upcoming need for additional teaching resources in computer science, especially when used in conjunction with a traditional teaching environment.
Fabrication, calibration, and recovery of chemical nanosensor array for ammonia detection

The low selectivity of nanosensors is one of their major obstacles for their wide deployment. To enhance the selectivity, nanosensor array made from zinc oxide (ZnO) nanowires and carbon nanotubes (CNTs) was assembled through dielectrophoresis (DEP). The fabricated nanosensor array was used to detect ammonia (NH3) in a well-controlled environment at room temperature. Because of their opposite material types, ZnO nanowire based sensor behaved oppositely to CNT based sensor. In this study, it is also demonstrated that DC biases can quickly recover both sensing elements. After collecting sensing signals from two transducers under different NH3 concentrations, the concentration of NH 3 can be estimated through regression methods. It is shown that quadratic model with the lasso performs well on the collected data.
Measurements of the Relationship Between CT Hounsfield Units and Acoustic Velocity and How It Changes With Photon Energy and Reconstruction Method

Transcranial magnetic resonance-guided focused ultrasound continues to gain traction as a noninvasive treatment option for a variety of pathologies. Focusing ultrasound through the skull can be accomplished by adding a phase correction to each element of a hemispherical transducer array. The phase corrections are determined with acoustic simulations that rely on speed of sound estimates derived from CT scans. While several studies have investigated the relationship between acoustic velocity and CT Hounsfield units (HUs), these studies have largely ignored the impact of X-ray energy, reconstruction method, and reconstruction kernel on the measured HU, and therefore the estimated velocity, and none have measured the relationship directly. In this paper, 91 ex vivo human skull fragments from two skulls are imaged by 80 CT scans with a variety of energies and reconstruction methods. The average HU from each fragment is found for each scan and correlated with the speed of sound measured using a through transmission technique in that fragment. As measured by the $R$ -squared value, the results show that CT is able to account for 23%–53% of the variation in velocity in the human skull. Both the X-ray energy and the reconstruction technique significantly alter the $R$ -squared value and the linear relationship between HU and speed of sound in bone. Accounting for these variations will lead to more accurate phase corrections and more efficient transmission of acoustic energy through the skull.
Analysis of Preoperative Portal Vein Embolization Outcomes in Patients with Hepatocellular Carcinoma: A Single-Center Experience.

Abstract Purpose To analyze outcomes of patients with hepatocellular carcinoma (HCC) undergoing preoperative portal vein embolization (PVE). Materials and Methods A retrospective analysis of survival, recurrence, and complications was performed in 82 patients with HCC undergoing preoperative PVE and surgical treatment with curative intention from June 2006 to December 2014. Results Rate of major adverse events after PVE was 11% with no mortality. Twenty-eight (34.1%) patients showed radiologic progression of HCC after PVE; 72 patients (87.8%) eventually were accepted as surgical candidates. Median interval between PVE and surgery was 37 days, and 69 patients (84.1%) ultimately underwent surgical resection. At 1 and 3 years, disease-free survival rates were 81.3% and 53.1%, respectively, and overall patient survival rates were 77.5% and 63.1%. Compared with patients accepted as surgical candidates, patients who did not undergo surgery had a higher median number of HCC tumors (1 [range, 1–5] vs 2 [range, 1–4], P = .031). At 1 and 3 years, patients with disease progression after PVE but who still underwent surgical resection showed similar recurrence-free (90% vs 79.6% and 75% vs 48.6%) and overall (72.2% vs 78.4% and 57.8% vs 64%) survival rates as the rest of the patients who underwent resection. Conclusions PVE is a safe technique with good outcomes that potentially increases the number of patients with initially unresectable HCC who can be offered resection. Radiologic progression after PVE should not be seen as a contraindication to offer resection if it is still deemed possible.
A model of an advanced practice provider led melanoma survivorship clinic at a NCI-designated cancer center.

41Background: Melanoma cancer survivors present unique challenges for survivorship care due to their increasing numbers as well as the rapidly expanding options for adjuvant treatment including imm...
Diagnostic Approach for Classic Compared With Localized Whipple Disease

Background Whipple disease (WD), a rare systemic infection caused by Tropheryma whipplei, can be a diagnostic challenge due to its variable presentation. The role of T. whipplei polymerase chain reaction (PCR) is unclear as small bowel biopsy with Periodic acid-Schiff (PAS) staining remains the diagnostic gold standard. Individualized diagnostic approaches based on variable clinical manifestations are underutilized. We investigated the methodologies employed at our institution to diagnose WD. Methods We retrospectively collected all cases of WD diagnosed from 1994 to 2016. Microbiology laboratory and anatomic pathology databases were queried. Case characteristics and disease clinical phenotypes (classical, localized WD arthritis, and localized central nervous system [CNS] disease) were described. The diagnostic approach and testing yield were analyzed and reported. Results Thirty-three cases of WD were diagnosed (18 classic WD [CWD], 9 localized WD arthritis [LWD], 6 CNS WD). Misdiagnosis and delay in diagnosis were frequent. Diagnostic approach and test yield differed by classical vs localized WD involvement. Small bowel tissue biopsy PAS stain/PCR was overwhelmingly positive (86%/92%) in CWD, yet seldom positive (12%/42%) in LWD (P < .001). Affected joint synovial fluid PCR was frequently positive in both CWD (100%, 3/3) and LWD (85%, 6/7). Conclusions These results support the role of small bowel biopsy PAS stain/PCR in the diagnosis of CW, though this approach may be of limited utility in LWD or CNS WD without gastrointestinal symptoms. Affected joint synovial fluid or cerebrospinal fluid PCR was frequently positive in both CWD and LWD, supporting its diagnostic usefulness.
Porous CARDIOFORM Septal Occluder Balloons Within the Right Atrial Cavity

A 68-year-old woman presented with fatigue, atrial fibrillation, and tachy-brady syndrome requiring a pacemaker. Transesophageal echocardiography revealed an 8-mm secundum atrial septal defect with shunt fraction (Qp/Qs) of 2.7 ([Figure 1A][1], [Online Video 1][2]). Atrial septal defect closure was
Epitope-based human leukocyte antigen matching for transplantation: a personal perspective of its future.

PURPOSE OF REVIEW This study reflects my personal experience with the characterization of human leukocyte antigen (HLA) epitopes and their significance in HLA matching for transplantation. It offers a subjective assessment what further studies are needed to have this concept be applied in the clinical setting. RECENT FINDINGS This study addresses the structural characteristics of antibody-reactive HLA epitopes determined by different methods, eplet-associated antibody analysis and acceptable mismatching for sensitized patients and eplet immunogenicity and determination of mismatch permissibility. BASIC IMPLICATIONS: for clinical practice and research consider the need for further studies of the structural basis of antibody-verified HLA epitopes determined in different techniques and their clinical relevance, the biological basis of epitope immunogenicity and determinations of permissible mismatches and a computerized clinical transplant database with an Artificial Intelligence component that can generate evidence-based information for the practical application of epitope-based HLA matching.
Effects of Consultation on Professional Learning Communities.

School psychologists can impact student outcomes by consulting with teams around data. The current study investigated the effects of consultation with Professional Learning Communities (PLC) teache...
The utility of cardiac magnetic resonance imaging in post-Fontan surveillance.

OBJECTIVE Gated cardiac MRI offers the most detailed and accurate noninvasive method of assessing cardiac anatomy, particularly in patients with complex congenital heart disease. The proposed benefits of using cMRI as a routine screening tool in the Fontan population include early recognition of asymptomatic, postoperative anatomic and physiologic changes. In 2011, we therefore instituted at our center a recommended practice of cMRI screening in patients with Fontan physiology at 3 and 8 years post-Fontan operation. The purpose of this study was to determine the impact of this standardized practice of cMRI screening on the clinical management of a Fontan population. DESIGN We retrospectively reviewed charts from our institutional Fontan database to determine which patients were eligible for cMRI under the current guidelines and who underwent imaging from November 2002 to June 2015. We reviewed the frequency of cMRI and number of changes in management based on the results. Statistical significance was determined using a chi-square test. RESULTS There were 141 cMRIs performed on 121 patients who met inclusion criteria. The odds of a change in management were significantly greater after clinically indicated cMRI compared to screening cMRI (OR = 3.79, 95% CI: 1.48-9.66, P = .004). There were near significant odds of change in management if the cMRI occurred <8 years after Fontan regardless of whether it was for screening or clinically indicated purposes (OR = 2.43, 95% CI: 0.97-6.08, P = .052). The most frequent change in management was referral for catheterization with pulmonary artery angioplasty. CONCLUSIONS There is an important role for cMRI in routine surveillance of post-Fontan patients. Screening cMRI performed less than 8 years after Fontan palliation offers increased utility compared to studies performed later. The optimal timing of such imaging after Fontan palliation remains unclear.
The fitness cost of a congenital heart defect shapes its genetic architecture

Background: In newborns, severe congenital heart defects are rarer than mild ones. The reason why is unknown, but presumably related to a liability threshold that rises with the severity of a defect. Because the same genetic mutation can cause different defects, other variables may contribute to pushing an individual past a defect-specific liability threshold. We consider here how variables in the genetic architecture of a heart defect depend upon its fitness cost, as defined by the likelihood of survival to reproductive age in natural history studies. Methods: We phenotyped ~10,000 Nkx2-5+/- newborn mice, a model of human congenital heart disease, from two inbred strain crosses. Genome-wide association analyses detected loci that modify the risk of an atrial septal defect, membranous or muscular ventricular septal defect, or atrioventricular septal defect. The number of loci, heritability and quantitative effects on risk of pairwise (GxG-Nkx) and higher-order (GxGxG-Nkx) epistasis between the loci and Nkx2-5 mutation were examined as a function of the fitness cost of a defect. Results: Nkx2-5+/- mice have pleiotropic heart defects; about 70% have normal hearts. The model recapitulates the epidemiological relationship between the severity and incidence of a heart defect. Neither the number of modifier loci nor heritability depends upon the severity of a defect, but GxG-Nkx and GxGxG-Nkx effects on risk do. Interestingly, GxGxG-Nkx effects are three times more likely to suppress risk when the genotypes at the first two loci are homozygous and from the same, rather than opposite strains in a cross. Syn- and anti-homozygous genotypes at GxGxG-Nkx interactions can have an especially large impact on the risk of an atrioventricular septal defect. Conclusions: Given a modestly penetrant mutation, epistasis contributes more to the risk of severe than mild congenital heart defect. Conversely, genetic compatibility between interacting genes, as indicated by the protective effects of syn-homozygosity at GxGxG-Nkx interactions, plays a newfound role in the robustness of cardiac development. The experimental model offers practical insights into the nature of genetic risk in congenital heart disease. The results more fundamentally address a longstanding question regarding how mutational robustness could arise from natural selection.
Integrating and amplifying signal from riboswitch biosensors.

Abstract Biosensors offer a built-in energy supply and inherent sensing machinery that when exploited correctly may surpass traditional sensors. However, biosensor systems have been hindered by a narrow range of ligand detection capabilities, a relatively low signal output, and their inability to integrate multiple signals. Integration of signals could increase the specificity of the sensor and enable detection of a combination of ligands that may indicate environmental or developmental processes when detected together. Amplifying biosensor signal output will increase detector sensitivity and detection range. Riboswitches offer the potential to widen the diversity of ligands that may be detected, and advances in synthetic biology are illuminating myriad possibilities in signal processing using an orthogonal parts-based engineering approach. In this chapter, we describe the design, building, and testing of a riboswitch-based Boolean logic AND gate in bacteria, where an output requires the activation of two riboswitches, and the biological circuitry required to amplify the output of the AND gate using natural extracellular bacterial communication signals to “wire” cells together.
Towards High-Efficiency Synthesis of Xenonucleic Acids

Beyond their central role in storing and transmitting genetic information, nucleic acids are renowned for their high-specificity, high-affinity hybridization. In the past several decades, scientists have become increasingly interested in emulating this unique property of nucleic acids using synthetic mimics. Many creative strategies for the synthesis of xenonucleic acids (XNAs) have been developed, with the field ultimately striving for high-efficiency, scalable routes to achieving sequence-controlled XNA synthesis. Emerging strategies in both biology (e.g., directed evolution) and chemistry (e.g., dynamic covalent reactions) are leading to new breakthroughs in XNA synthesis that will make applications of nucleic acids, such as gene therapy, agricultural disease management, and electronics, more accessible.
Safety Analysis of AMI Networks Through Smart Fraud Detection

Advanced metering infrastructure (AMI)is a critical part of a modern smart grid that performs the bidirectional data flow of sensitive power information such as smart metering data and control commands. The real-time monitoring and control of the grid are ensured through AMI. While smart meter data helps to improve the overall performance of the grid in terms of efficient energy management, it has also made the AMI an attractive target of cyberattackers with a goal of stealing energy. This is performed through the physical or cyber tampering of the meters, as well as by manipulating the network infrastructure to alter collected data. Proper technology is required for the identification of energy fraud. In this paper, we propose a novel technique to detect fraudulent data from smart meters based on energy consumption patterns of the consumers by utilizing deep learning techniques. We also propose a method for detecting the suspicious relay nodes in the AMI infrastructure that may manipulate the data while forwarding it to the aggregators. We present the performance of our proposed technique, which shows the correctness of the models in identifying the suspicious smart meter data.
Tracking banking in the Western Climate Initiative cap-and-trade program

The Western Climate Initiative is a multilateral cap-and-trade program in California and Quebec. The California climate regulator has called for cap-and-trade to deliver nearly half of the emission reductions needed to achieve the state's legally binding limit on greenhouse gas emissions in 2030, making the program the single biggest driver of the state's post-2020 policy portfolio. However, the program's supply of compliance instruments has persistently exceeded emissions subject to the program—a condition known as overallocation, which independent studies have projected may continue into the mid-2020s. If market participants purchase and bank excess compliance instruments for future use, they may be able to comply with the program's regulations while nevertheless emitting significantly in excess of the state's legally binding 2030 limit. Here, we present methods for tracking observed banking behavior on both an annual and multi-year compliance period basis. By the end of 2018, market participants had already acquired more unused compliance instruments than the regulator anticipated for 2020. The size of the private bank is now comparable to the cumulative mitigation expected from the program over the period 2021 through 2030, raising questions about the program's ability to achieve its expected reductions. Beyond diagnosing market conditions, banking metrics can also help policymakers design dynamic program reforms that increase program stringency conditional on observed market behavior deviating from expectations.
Simulation-Based Training for Assessment of Competency, Certification, and Maintenance of Certification

Today’s clinical practice requires clinicians to collaborate and function in complex teams with other healthcare professionals to provide high quality, safe patient care. The interprofessional collaborative skills required for modern clinical practice are not easily taught nor assessed using traditional education methods but are well suited for simulation-based training. Traditional models of health professional education and training no longer adequately prepare clinicians for practice in the dynamic and ever-changing modern healthcare system. Traditional educational models were designed to ensure clinicians “knew” and “knew how” but offered no evidence that clinicians could “show” or “demonstrate” competency. Simulation-based training and assessment offers novice and expert clinicians an opportunity to practice and demonstrate their skills and competence in an environment that closely replicates clinical practice, yet poses minimal harm to patients. The competence-based education movement has shifted health professional education towards novel, experiential learning modalities such as simulation-based training. We can expect to see more simulation-based training and assessment in health professional education and development in the future.
Cytopathology of classic type epithelioid sarcoma: a series of 20 cases and review of the literature.

Introduction As a rare soft tissue malignancy, epithelioid sarcoma (EpS) is infrequently subjected to cytopathologic analysis. With the exception of a few series, the cytology literature regarding EpS is largely limited to single case reports. Our purpose was to evaluate our experience with EpS, and review the literature regarding its cytopathology. Materials and methods A search was made of our cytopathology and surgical pathology databases for cases diagnosed as EpS. Fine-needle aspiration biopsy smears and imprint smears were performed and examined using standard technique. Effusion samples were processed using liquid-based slides. Results Twenty cases of EpS were retrieved from 10 patients (M:F 1:1; mean age = 36 years). One patient had 5, 1 patient had 3, and 3 patients had 2 separate specimens. All patients had prior or subsequent tissue confirmation of EpS; all were of the classic/distal type. Seven were new patient cases, 7 were locally recurrent, and 6 were metastases. Sites included lower extremity (8 cases), upper extremity (4), trunk (4), serous effusion (2), scalp (1), and mediastinum (1). Specific cytologic diagnosis were EpS (13 cases), sarcoma not otherwise specified (5), and malignant neoplasm (2). All cases where cell-block SMARCB-1 staining was used were specifically recognized as EpS. Cytomorphology was composed primarily of epithelioid/plasmacytoid cells having eccentrically positioned nuclei, moderate cytoplasm, and variable nuclear pleomorphism. Conclusion The cytopathology of EpS is somewhat variable, morphologically non-specific, and mimics that of other neoplasms with epithelioid features. Ancillary immunostaining is necessary for a specific diagnosis in newly encountered patients.
An exploration of social work educators’ personal experiences of self-awareness

Self-awareness as a core concept in professional development has captured the attention of social work educators and researchers over the past few decades. Although practicing professional self-awa...
MAC Attack: Clinical Correlates of Mycobacterium avium Complex Infection Among Patients With and Without Cancer.

Background: In 2007 the American Thoracic Society (ATS) released guidelines on management of Mycobacterium avium complex (MAC), an increasingly common respiratory organism worldwide. Determining when this represents a true respiratory pathogen remains controversial and becomes increasingly challenging in patients with cancer. This study aims to 1) describe the phenotype that exists among cancer patients with MAC colonization and MAC pulmonary infection when compared to non-cancer patients; 2) assess whether cancer, symptoms, and radiographs, were associated with the decision to treat MAC pulmonary infection with antibiotics. Methods: We retrospectively analyzed 550 adult, non-human immunodeficiency virus (HIV) patients, among whom MAC was identified in respiratory cultures or tissue. Radiographs, clinical symptoms and cancer status were studied. Patients were categorized as having MAC pulmonary infection based on 2007 ATS guidelines, and antibiotic treatment was thereafter reviewed. Fisherâ€™s exact test and Wilcoxon Rank sum assessed differences. Results: Median age of the 550 patients was 68 years; most were female (56%) and white (83%). Symptoms and radiographic abnormalities accompanying MAC isolation were common, occurring among 83% and 99.6% respectively of all patients. There were 444 patients with MAC who had current or inactive cancers, most commonly hematologic (30%) and lung (25%) malignancies, while 106 patients never had cancer. Cancer patients were younger (P = 0.028), less often female (P < 0.001), and had less-frequent pre-existing lung disease (P = 0.017) than those without cancer. There were 196 (35%) patients determined to have MAC pulmonary infection, among whom 49 (9%) received directed antibiotics. Those receiving antibiotics had lower body mass index (BMI) (P < 0.0001), more frequent pre-existing lung disease (P = 0.003) and lower cancer rates (P = 0.008) than those not receiving antibiotics. Patients receiving antibiotics were more likely to have cavitary disease (P = 0.001), cough/dyspnea (P = 0.012), hemoptysis (P < 0.001), and constitutional symptoms (P = 0.001). Conclusions: In concordance with ATS guidelines, hemoptysis, constitutional symptoms, cough/dyspnea and cavitary disease were associated with highest likelihood to treat with antibiotics. The phenotype in cancer patients was quite different than the classic Lady Windermere syndrome. MAC pulmonary infection was treated less often in cancer patients. This study extends beyond the ATS guidelines to examine the potential import of malignancy on the colonization and potential treatment of MAC. J Clin Med Res. 2020;12(3):142-149 doi: https://doi.org/10.14740/jocmr4058 Â
The Enhanced Danger of Physicians’ Off-Label Prescribing During a Public Health Emergency

The COVID-19 pandemic represents a major challenge to both technologically advanced and resource-poor countries There are currently no effective treatments for severe disease other than supportive care and advanced life support measures, including the use of mechanical ventilators With the urgency and necessity bred from desperation, there have been many calls to utilize unproven therapies, such as hydroxychloroquine, for which little evidence of efficacy exists We have previously argued that such off-label use, while legal, is problematic (and even dangerous) and have suggested several regulatory remedies that could protect patients and advance their interests while preserving the reasonable authority of physicians to do what they and their patients think is the best course of action In this essay we ask whether the special conditions existing in a public healthcare crisis, such as the current pandemic, would justify a relaxing of our argument and permit ongoing unregulated off-label use We outline at least four areas of concern, all of which can be exacerbated by the widespread distress and despair amongst doctors, patients and other stakeholders We contend that, if anything, these conditions warrant even more caution and scrutiny of this practice
COPD Management in Older Adults with Dementia

COPD and dementia are often treated together, and it is important to arm the practitioner with tools in the primary care setting. Diagnosis can be a challenge as pulmonary function tests (PFTs) are less accurate in memory loss, and caregiver report may be more reliable than patient reported symptoms. We recommend assessing cognitive ability before ordering PFTs while also interpreting results with age-related changes in mind. Periodically testing cognitive ability as well as functional status can help to tailor treatment plan to the patient/caregiver unit. Inhaler therapy compliance is very poor, but specific strategies can be used to improve their use in elderly patients. Reassessment in a short frame of time is important to assess compliance and need for adapting. Non-pharmacological treatments should be considered depending on their potential to improve preventative care and quality of life. Lastly, planning for end of life is another cornerstone of treatment of elderly patients with dementia.
Outcomes of Isolated Neutropenia Referred to Pediatric Hematology-Oncology Clinic.

BACKGROUND: Children with isolated neutropenia (absolute neutrophil count [ANC] METHODS: We performed a 5.5-year institutional review board–approved retrospective chart review of children referred to our pediatric hematology and oncology clinics for isolated neutropenia. Neutropenia was categorized as mild (ANC of 1001–1500/μL), moderate (ANC of 500–1000 μL), severe (ANC of 201–500/μL), or very severe (ANC of ≤200/μL). RESULTS: Among 155 children referred with isolated neutropenia, 45 (29%) had mild neutropenia, 65 (42%) had moderate neutropenia, 30 (19%) had severe neutropenia, and 15 (10%) had very severe neutropenia. Only 29 (19%) children changed to an ANC category lower than their initial referral category. At a median follow-up of 12 months, 101 children had resolution of neutropenia, 40 children had mild neutropenia, 10 children had moderate neutropenia, 3 children had severe neutropenia, and 1 patient had very severe neutropenia. A specific diagnosis was not identified in most (54%) children. The most common etiologies were viral suppression (16%), autoimmune neutropenia (14%), and drug-induced neutropenia (8%). Black children had a 3.5 higher odds of having persistent mild neutropenia. Six (4%) children received granulocyte colony-stimulating factor therapy. CONCLUSIONS: Most children referred for isolated neutropenia do not progress in severity and do not require subspecialty interventions or hospitalizations.
The Profitability of Technical Analysis during Financial Bubbles

This article examines the use of technical analysis, namely, a moving-average technique, to improve upon a buy-and-hold investment strategy during financial bubbles. Econometric techniques can identify financial bubbles in real time, and these techniques successfully identify commonly acknowledged bubbles in the US stock market. The authors find that technical analysis significantly improves investment returns over a buy-and-hold strategy during three of the five financial bubbles since 1928 and performs identically in the other two. The authors also demonstrate similar results using three international markets. TOPICS:Developed markets, financial crises and financial market history, portfolio theory, technical analysis Key Findings • Technical trading techniques may be effective during periods of market instability, such as a financial bubble. • Econometric techniques can identify stock market financial bubbles in real time. • The combination of technical trading and real-time identification of financial bubbles can be used to significantly outperform a buy-and-hold strategy.
Evaluating Perception of Child Health and Safety Needs in a Community Through the Perspective of Caregivers and Physicians

Objective: To identify and compare child health and safety concerns in the community from the perspective of physicians and caregivers in Louisville. Design: We administered surveys to physicians and caregivers who were asked to list, via open-ended questions, the top three health or safety concerns they had for children in three separate age groups (≤ 3, 4-11, and ≥12 years old). Four reviewers assigned responses to a pre-specified category/subcategory through a schematic designed by the study team and a fifth reviewer addressed any discrepancies and assigned final categories. Agreement in assigning overall categories was measured using Fleiss Kappa and descriptive statistics were used to characterize the responses. Setting: Surveys were administered to caregivers who attended community events in Park Duvalle, a lower socioeconomic neighborhood in Louisville whose residents are predominantly black. Surveys were simultaneously administered to physicians throughout the University of Louisville/Norton Healthcare system. Participants: A total of 41 caregivers with at least one child and 43 physicians were surveyed in this study. Results: Overall categorical agreement between reviewers was k = 0.839, indicating good agreement on assignment. Injury/violence was identified by both caregivers and physicians as the top concern for children across all age groups. Wide variation was found when analyzing specific injury/violence subcategories, with caregivers more worried about household safety (17-40%) and gangs/unsafe neighborhoods (10-50%) while physicians were more concerned about sleep safety (36%), domestic violence (8-27%), and unintentional injury (10-20%). Conclusions: Survey administration was a feasible method of comparing health and safety concerns among caregivers and physicians. We identified injury/violence as the top health and safety concern across all age groups in our community but noted variation on the specific type of injury/violence. Replication of our study methodology in other neighborhoods may allow for improved comparison of caregiver and physician concerns.
A Natural Approach to Net Zero

A widely accepted view among leading sustainability standard setters and guidance providers holds that to achieve Net Zero, companies must first prioritize reducing the greenhouse gases (GHG) in their value chains before compensating for any unabated emissions that remain through the use of carbon credit offsets. This chapter argues that this view, the received Net Zero logic, suffers from conceptual failings that threaten to divert private sector resources from one of the most underfunded but critically important areas for climate action, namely Nature Based Solutions (NBS). The chapter provides examples of how the received Net Zero logic has disincentivized the purchase of carbon linked to the protection of natural ecosystems. In response, the chapter argues that recent innovations in the carbon markets linked to NBS credits, particularly the use of a jurisdictional rather than a project-based approach, offer an improved way to incorporate carbon credits into a credible corporate Net Zero strategy. In addition, the chapter explores how structuring NBS credits through the lens of “contributions” to supply-country emissions reductions efforts, rather than “offsets,” may offer a way to avoid double-counting and misleading claims. These innovations help ensure greater “demand side” and “supply side” integrity as well as improve the accuracy and integrity of the global accounting framework for Net Zero. The paper concludes by calling for increased investment into NBS credits to bring greater scale, integrity, and impact to the voluntary carbon market.
Insurancev — Scope of Doctrine of Friendly Fire

In Freeberg Pie Co. v. St. Paul Mutual Insurance, the defendant issued to the plaintiff its Minnesota standard fire insurance policy. This policy insured the furnishings, fixtures, and equipment in the plaintiff’s wholesale baking establishment. Due to a failure of a thermostatic control on a baking oven, the flame of the oven became uncontrolled and excessive, causing extensive damage to the oven and its contents. The court held that the fire which caused the damage was a “hostile” fire, and the loss or damage was therefore covered by the insurance policy. The general rule followed by the great weight of American authority distinguishes between a “friendly” fire and a “hostile” fire. A “friendly” fire is described as being one lit and contained in its appropriate place, and a “hostile” fire is described as one the flame or, sometimes, heat of which has in some way “escaped” from its appropriate place. However, there is some ambiguity regarding the scope of the “friendly fire” doctrine, and closer consideration of the case history of this doctrine is necessary.
Spectrophotometric Determination of Trace Amounts of Palladium in Antibiotics and Catalysts with Thio-Michler's Ketone

In order to determine trace amounts of palladium reproducibly, a spectrophotometric method using thio-Michler's ketone (TMK) was developed. In this method, it was found that addition of hydroxylamine hydrochloride effectively suppressed oxidation and decomposition of TMK and Pd (II)-TMK complex. A good linear relationship was obtained in the concentration range of 0.1-0.5 ppm for Pd(II). The molar absorptivity was 1.9×105dm3 mol-1 cm-1 and the coefficient of variation was 1%. The method proposed here could be applied successfully to the determination of trace amounts of palladium in antibiotics and in catalysts for automobile exhaust purifiers.
Effect of irrigation method on transmission to and persistence of Escherichia coli O157:H7 on lettuce

In this study, the transmission of Escherichia coli O157:H7 to lettuce plants through spray and surface irrigation was demonstrated. For all treatments combined, the number of plants testing positive following a single exposure to E. coli O157: H7 through spray irrigation (29 of 32 plants) was larger than the number testing positive following surface irrigation (6 of 32 plants). E. coli O157:H7 persisted on 9 of 11 plants for 20 days following spray irrigation with contaminated water. Immersion of harvested lettuce heads for 1 min in a 200 ppm chlorine solution did not eliminate all E. coli O157:H7 cells. The results of this study suggest that regardless of the irrigation method used, crops can become contaminated; therefore, the irrigation of food crops with water of unknown microbial quality should be avoided.
Aircraft Flight Regimes and Applications

Having defined an aircraft, consideration is given to the nature of the primary forces that act on a platform in flight. The means of generating lift in the context of lighter-than-air craft and fixed and rotating wing platforms are discussed. The development of thrust and the associated propulsion and overall efficiencies are described as they are affected by the type of power plant employed. This enables the many classes of operational aircraft to be placed in flight regimes determined by the speed and altitude at which they fly. Comments are made on some unusual and outstanding designs. The interaction of take-off and landing with the local environment is considered. Keywords: atmosphere; environment; lift; drag; power plant thrust; efficiency; take-off; landing; platform applications; Mach number; altitude; runway; air traffic control
Multicriteria spatial price networks: Statics and dynamics

In this paper, we develop a spatial price network equilibrium model in which consumers at the demand markets consider both the transportation cost and the transportation time associated with obtaining the particular commodity. We provide the governing equilibrium conditions for the multicriteria spatial price problem and derive the variational inequality formulation. We establish existence and uniqueness of the equilibrium commodity shipment and demand price pattern and then propose a dynamic tatonnement process whose set of stationary points coincides with the set of solutions of the variational inequality problem. An iterative scheme is described which provides a time discretization of the continuous time adjustment process and which converges to a stationary point. Numerical examples are given for illustrative purposes.
Low Copy Number DNA

Polymerase chain reaction-based DNA tests have greatly improved the capabilities of forensic laboratories, allowing highly specific DNA profiles to be derived from tiny quantities of cellular material. The great successes of these tests have inevitably led to efforts to characterize very minute amounts of material. As the quantity of DNA template associated with a DNA profile test decreases, the likelihood that the results of the test will be compromised by stochastic effects (allelic drop-in and drop-out, exaggerated peak height imbalance, and stutter) increases. Even when minute quantities (i.e., that arising from fewer than 20 cells) do give rise to an interpretable test result, questions about the significance of result often remain due to the ease with which such tiny amounts of material can be transferred and DNA's known ability to persist on articles for long periods of time. Keywords: DNA profiling low copy number; LCN; stochastic effects; low template; LTDNA
"Car seat dermatitis": a newly described form of contact dermatitis.

Abstract: Over the last several years, our clinic has documented an increasing trend of contact dermatitis presenting in areas that are in direct contact with certain types of car seats composed of a shiny, nylon-like material. Our practice has encountered these cases in both atopic and nonatopic infants, with a seasonal predilection for the warmer months. This brief report highlights some of the key features of this condition and alerts the clinician to this newly described form of contact dermatitis.
Harmonic burst mode control strategy for full-bridge series resonant convertersfor electric vehicles application

An effective output voltage regulation method using harmonic burst mode control strategy is presented. By using this strategy, the operating performance of the full-bridge series resonant dc-dc converter (SRC) applied to electric vehicle (EV) battery charging is improved. The proposed control strategy not only performs load regulation, but it also achieves soft switch both at turn-on and turn-off under any load condition. It also improves the system efficiency over 10% for light load conditions compared to the traditional frequency modulation control method, without adding extra hardware. Theoretical, compensation and loss analysis are discussed in details along this paper. Experimental results based on a 1-kW prototype with 20 cm air gap between the primary and secondary side of the SRC converter are presented to demonstrate the effectiveness of the proposed control strategy.
Real-time telephone channel simulation

The paper describes the real-time implementation of a telephone channel simulator on the TMS32010 digital signal processor. Several characteristics are simulated, including harmonic distortion, attenuation distortion, group delay distortion, listener echo, frequency offset, phase jitter, gaussian noise, impulsive noise, phase jumps and gain hits. A design program written in Pascal and running on a personal computer allows the user to specify and test a channel response, then generate the TMS32010 code for the real-time implementation.