cssi/SciSciGPT-SciSciNet huggingface dataset:
Magnetic Resonance Imaging As A Case Study Of Cost Factors In High Technology Health Care Delivery

The perception of MRI as the technology flagship of diagnostic imaging has generated an "arms race" in terms of hardware development, search for academic recognition and physician utilization, all this leading to excessive costing of what is a basically sound and useful technology. Governmental regulation has been unable to deal with cost issues, and in some cases has added cost. The pressure of reality is now driving the process of rationalizing costs. Lower costs will not negatively impact on diagnostic capabilities of MRI.
Evaluation of the General Practice Research Database congenital heart defects prevalence: comparison to United Kingdom national systems.

BACKGROUND: As part of an effort to validate the General Practice Research Database (GPRD) for future studies of medication use in pregnancy, this study examined whether the rates of all, and specific types of, congenital heart defects obtained from the GPRD are similar to those obtained from UK national systems. METHODS: The prevalence rates of heart defects for 2001–2003 were determined from the GPRD and compared with both the National Congenital Anomaly System (NCAS) and the European Concerted Action of Congenital Anomalies and Twins (EUROCAT). Rate ratios (RRs) and 95% CIs were calculated comparing the prevalence of all congenital heart defects as well as specific types of heart defects in the three data sources. In addition, the effect of the child's age on the frequency of heart defects in the GPRD was determined. RESULTS: The prevalence of heart defects in the GPRD was more than twice as high as in the NCAS and slightly higher than in the EUROCAT. All differences were statistically significant. The prevalence of specific heart defects varied across the GPRD, NCAS, and EUROCAT. The measured prevalence of congenital heart defects in the GPRD was higher if calculated including children up to age 6. CONCLUSIONS: The comparisons of the GPRD prevalence rates to national prevalence estimates demonstrate that the GPRD can serve as a more complete source of background prevalence for the most commonly occurring congenital heart defects, which is essential to properly assess possible associations between maternal exposures and congenital heart defects. Birth Defects Research (Part A) 2007. © 2007 Wiley-Liss, Inc.
The Effect of L2 Proficiency and Study-Abroad Experience on Pragmatic Comprehension

This cross-sectional study examined the effect of general proficiency and study-abroad experience on pragmatic comprehension in second-language English. Participants were 25 native English speakers and 64 Japanese college students of English divided into three groups. Group 1 (n = 22) had lower proficiency and no study-abroad experience. Group 2 (n = 20) and Group 3 (n = 22) had higher proficiency than Group 1 but differed in their study-abroad experience. Group 2 had no study-abroad experience, but Group 3 had a minimum of 1 year of study-abroad experience in an English-speaking country. They completed a pragmatic listening test measuring their ability to comprehend conventional and nonconventional implicatures. Group performance was compared for the comprehension accuracy scores and response times. There was a significant effect of proficiency on response times but no effect of study-abroad experience. Comprehension accuracy scores revealed mixed findings. It was advantageous for students to have study-abroad experience in the comprehension of nonconventional implicatures and routine expressions but not in indirect refusals.
Goal-related navigation of a neuromorphic virtual robot

The field of biologically inspired technology has evolved to the emergence of robots that operate autonomously. Some studies have focused on developing social robots that interact with humans by following social behaviors where other research have centered their efforts on mobile robots with the ability to navigate in their well-known environment. These general-purpose autonomous robots can perform a variety of functions independently, from recognizing people or objects to navigating in a familiar room. As of yet, no humanoid robot has been capable of traveling through a new suburban environment to reproduce goal-related learning and navigational activities. Based on experimental findings, we propose a computational model that is composed of critical interacting brain regions and utilizes fundamental learning mechanisms. It is incorporated in a sophisticated robotic system where a virtual robot navigates through a new environment, learns and recognizes visual landmarks, and consequently makes correct turning decisions to reach a reward. The detailed brain architecture included visual, entorhinal, prefrontal and premotor cortices, as well as the hippocampus. Our microcircuitry replicated some fundamental mammalian dynamics, which were integrated in a robotic loop. This virtual robotic system was designed around a number of components unique to our NeoCortical simulator (NCS) and our Virtual NeuroRobotic (VNR) paradigm. The neural simulation was executed on a remote computing cluster and was networked to the other system components (NCSTools, Webots, Gabor filter) using our Brain Communication Server (BCS), a server developed specifically for integration with NCS. The virtual humanoid was able to navigate through a new virtual environment and reach a reward after a sequence of turning actions. Along the way, it encountered familiar and non-familiar external cues to provide guidance and follow the correct direction. This is the first bio-inspired robot that showed high functionality during navigation while utilizing spiking cortical neurons in a real-time simulation. More importantly, it could take us a step closer to understanding memory impairments in Alzheimer’s patients.
The distribution of polycyclic aromatic hydrocarbons in the surficial sediments of Penobscot Bay (Maine, USA) in relation to possible sources and to other sites worldwide

Abstract Sediments from the Penobscot Bay region of the Gulf of Maine were analyzed by HPLC and GC-MS for polycyclic aromatic hydrocarbons (PAHs). Total PAH concentrations ranged from 286 to 8794 ppb (dry weight) and formed a distinct gradient decreasing seaward from the head. Gradients of decreasing concentration were also measured in the various harbors in the bay. PAH composition was uniform throughout Penobscot Bay. Atmospherically transported particulate combustion products are hypothesized as a major source of PAH contamination. Sedimentary PAH concentrations from around the world which have been reported in the literature are compiled in a Table. PAH levels in Penobscot Bay sediments fall within the range found in industrialized regions throughout the world and are significantly higher than would be expected for an area previously considered to be uncontaminated.
Investment Portfolio Strategies Based On Options Market Activity

We propose a multiple regression model that incorporates options market activity to forecast future stock prices. To capture the information content from the options market, we use a predictor based on the activity of call and put options as measured by relative open interest across available strike prices. We use a sample of stocks with actively traded options on the Chicago Board Options Exchange to test the model. Investment strategies that use these forecasts are shown to be superior to more simple strategies which ignore options market activity.
The effect of record flying height on trackedge noise in thin film media

The effects of record spacing on trackedge noise are studied for CoCrTa and CoCrPt-CoCrTa media. Variations in record spacing (separation from magnetic media to write head pole tips) are accurately achieved by using an identical set of disks for each type of media, with different overcoat thicknesses. Trackedge noise is characterized using track profiles of the media noise. An integrated spectral technique is used to measure media noise, and the effects of the different playback spacings (separation from magnetic media to read head pole tips or read element) are removed by dividing the spectral playback loss factor from the media noise spectra. Track profiles were performed at three linear record densities for each record spacing. For both media, on-track noise and trackedge noise are found to decrease with reduced record spacing, and the amount of decrease is found to be record density dependent. However, the trackedge noise did not decrease as dramatically as the on-track noise with reduced record spacing.
The climate history of early Mars: insights from the Antarctic McMurdo Dry Valleys hydrologic system

The early climate of Mars (Noachian Period, the first ~20% of its history) is thought to differ significantly from that of its more recent history (Amazonian Period, the last ~66%) which is characterized by hyperarid, hypothermal conditions that result in mean annual air temperatures (MAAT) well below 0°C, a global cryosphere, minimal melting on the ground surface, and a horizontally stratified hydrologic system. We explore the nature of the fluvial and lacustrine environments in the Mars-like hyperarid, hypothermal McMurdo Dry Valleys (MDV), where the MAAT is well below 0°C (~ -14 to -30°C) in order to assess whether the Late Noachian geologic record can be explained by a climate characterized by "cold and icy" conditions. We find that the MDV hydrological system and cycle provide important insights into the potential configuration of a "cold and icy" early Mars climate in which MDV-like ephemeral streams and rivers, and both closed-basin and open-basin lakes could form. We review a series of MDV fluvial and lacustrine features to guide investigators in the analysis of the geomorphology of early Mars and we outline a new model for the nature and evolution of a "cold and icy" Late Noachian climate based on these observations. We conclude that a cold and icy Late Noachian Mars with MAAT below freezing, but peak seasonal and peak daily temperatures above 0°C, could plausibly account for the array of Noachian-aged fluvial and lacustrine features observed on Mars. Our assessment also provides insight into the potential effects of punctuated warming on a cold and icy early Mars, in which impact crater formation or massive volcanic eruptions cause temperatures in the melting range for decadal to centennial timescales. We outline a set of outstanding questions and tests concerning the nature and evolution of these features on Mars.
Metanephric mesenchyme contains embryonic renal stem cells.

Renal epithelial cells derive from either cells of the metanephric mesenchyme or ureteric bud cells, but the origin of other renal cells is unclear. To test whether metanephric mesenchymal cells ge...
Depression and frailty: concurrent risks for adverse health outcomes.

Objectives: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury.Methods: Data come from five waves (2004–2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies – Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury.Results: Prevalence of frailty increased over the study period (24.1%–32.1%), while the prevalence of depression was relatively constant over time (approximately 13%). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Fr...
JTT-130, a novel intestine-specific inhibitor of microsomal triglyceride transfer protein, ameliorates lipid metabolism and attenuates atherosclerosis in hyperlipidemic animal models.

JTT-130 was developed as an intestine-specific MTP inhibitor designed to rapidly catabolize after absorption to avoid causing hepatotoxicity due to hepatic MTP inhibition. In previous reports, we have demonstrated that JTT-130 suppresses dietary lipid absorption in the small intestine without inducing hepatic steatosis. Thus, in this report, JTT-130 was administered to hyperlipidemic animals fed a Western diet to investigate the effect of intestinal MTP inhibition on lipid metabolism and progression of atherosclerosis. JTT-130 potently lowered plasma non-high density lipoprotein-cholesterol, and elevated plasma high density lipoprotein-cholesterol (HDL-C), indicating improvement in atherogenic index in hamsters. HDL fractions obtained after two weeks treatment with JTT-130 significantly increased the efflux of cholesterol from macrophages, as an index parameter of HDL function. Furthermore, long-term treatment with JTT-130 also improved the plasma lipid profile without inducing hepatic steatosis in rabbits, resulting in the suppression of atherosclerosis formation in aortas. From these results, JTT-130 ameliorates lipid metabolism accompanied with the enhancement of the anti-atherosclerotic function of HDL, and attenuates the progression of atherosclerosis in hyperlipidemic animals. These findings indicate that intestinal MTP inhibition may be atherogenic in vivo and that JTT-130 may be a useful compound for the treatment of dyslipidemia and a potential anti-atherogenic drug.
Space Needs for Jobs

As America’s housing market will be transformed, so will its nonresidential spaces such as offices and shopping—maybe more than some might think. In most urbanized areas, nonresidential space accounts for a third or more of the built environment (excluding rights-of-way and other public spaces) and often accounts for half or more of the taxable value. It is also prone to more rapid depreciation, potential blight, and renewal than residential development.
Structural Studies of IRF4 Reveal a Flexible Autoinhibitory Region and a Compact Linker Domain

IRF4 is a unique member of the interferon regulatory factor (IRF) family playing critical regulatory roles in immune cell development, regulation of obesity-induced inflammation, and control of thermogenic gene expression. The ability of IRF4 to control diverse transcriptional programs arises from its proficiency to interact with numerous transcriptional partners. In this study, we present the structural characterization of full-length IRF4. Using a combination of x-ray and small angle x-ray scattering studies, we reveal unique features of the interferon activation domain, including a set of β-sheets and loops that serve as the binding site for PU.1, and also show that unlike other IRF members, IRF4 has a flexible autoinhibitory region. In addition, we have determined the small angle x-ray scattering solution structure of full-length IRF4, which, together with circular dichroism studies, suggests that the linker region is not extended but folds into a domain structure.
Boundary of the Firm Decisions in BOP Markets: Cross-Sector Partnership Drivers in Microfinance

In order to effectively address the poorest of the poor in BOP markets, microfinance institutions must tackle institutional voids and a market for solutions that encompasses a wide variety of products and services. The literature on the boundary of the firm is utilized to understand the unique factors that drive partnership formation for MFIs in BOP markets. We then develop a contingency fit model for MFI cross-sectoral partnerships that examines the critical factors and resources that apply in different contexts. This model is further explicated with a number of practical MFI examples of cross-sectoral partnering. The paper concludes with implications for research and practice.
Preferential Interaction Coefficients of Proteins in Aqueous Arginine Solutions and Their Molecular Origins

Preferential interaction coefficients provide a thermodynamic measure to quantify the interactions between cosolutes and a protein. Preferential interactions of cosolutes can be measured experimentally using dialysis/densimetry and vapor pressure osmometry (VPO) techniques. The cosolute arginine is a widely used aggregation suppressor with a seemingly unique behavior. Its role in protein aggregation has been studied extensively, although a complete mechanistic understanding of its behavior is lacking. Moreover, due to experimental limitations, experimental preferential interaction data for arginine has only been reported at low concentrations. Schneider and Trout (J. Phys. Chem. B 2009, 113, 7) have reported experimental preferential interaction data for argHCl (up to 0.7 m), and their study raised several interesting questions about the preferential interaction of arginine with proteins. Arginine is attracted to proteins at low concentrations but it was highly excluded at high concentrations. Furthermore...
Subjective, Objective, and Conceptual Relativisms

Frequently, throughout the history of modern philosophy, it has been held that although claims to knowledge can be adequately defended against relativistic arguments, judgments of value cannot. Positions of this type were widely accepted in Anglo-American philosophy during the last half-century. To be sure, some philosophers have at all times attacked such a dichotomy, holding that arguments similar to those which justify a rejection of relativism is mistaken in both spheres. Recently, however, there has been an attack on the same dichotomy from the opposite direction. An increasing number of philosophers have accepted positions that lead to a relativization of judg ments of fact as well as of judgments of value. This tendency has many in dependent roots, and those who accept it in one form or another may hold an tithetical positions on a variety of other issues. I shall therefore not attempt to disentangle the presuppositions which underlie contemporary relativistic theories of knowledge, though I shall indicate some of them in passing; rather, I shall confine myself to showing that an acceptance of relativism in the theory of knowledge frequently?and perhaps always?involves a prior commitment to non-relativistic interpretations of at least some judgments concerning matters of fact. Consequently, whatever may be the case with respect to judgments of value, epistemological relativism may be said to be self-limiting.1
Photodetachment cross sections of the C 2 n H − ( n = 1 – 3 ) hydrocarbon-chain anions

We report theoretical results of the low-energy photodetachment cross sections of the ${\mathrm{C}}_{2}\mathrm{H}{}^{\ensuremath{-}},\phantom{\rule{0.16em}{0ex}}{\mathrm{C}}_{4}\mathrm{H}{}^{\ensuremath{-}}$, and ${\mathrm{C}}_{6}\mathrm{H}{}^{\ensuremath{-}}$ hydrocarbon-chain anions. The complex Kohn variational technique is used to calculate molecular-frame transition dipole moments from the anion ground state to a photoelectron in the continuum of the neutral radical. We employ the Franck-Condon approximation and include interchannel electronic coupling to determine the low-energy photodetachment cross sections and asymmetry parameters. We discuss the behavior of the cross section, especially near thresholds, and describe the role of electronic resonances and excited channels. The theoretical results reproduce the main characteristics of recent measurements of absolute photodetachment cross sections.
Tolerance to the induction of interferons by endotoxin and virus: role of a humoral factor.

SummaryThe intravenous inoculation of either endotoxin or Sindbis virus rendered a rabbit tolerant to the interferon-inducing action of endotoxin or virus. There was crossed tolerance in the sense that animals first inoculated with endotoxin became tolerant to virus. By 6 hours after receiving an inoculation of endotoxin, the animals became tolerant to endotoxin and remained so for at least 3 days, but by the 6th day, sensitivity to endotoxin had been regained. Concurrent with the development of tolerance to endotoxin, a serum humoral factor which could inactivate or decrease the interferon-inducing capacity of endotoxin was found. It is suggested that this factor may play a role in producing tolerance to endotoxin.
Evaluating the solid electrolyte interphase formed on silicon electrodes: a comparison of ex situ X-ray photoelectron spectroscopy and in situ neutron reflectometry

This work details the in situ characterization of the interface between a silicon electrode and an electrolyte using a linear fluorinated solvent molecule, 0.1 M lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) in deuterated dimethyl perfluoroglutarate (d6-PF5M2) (1.87 × 10−2 mS cm−1). The solid electrolyte interphase (SEI) composition and thickness determined via in situ neutron reflectometry (NR) and ex situ X-ray photoelectron spectroscopy (XPS) were compared. The data show that SEI expansion and contraction (breathing) during electrochemical cycling were observed via both techniques; however, ex situ XPS suggests that the SEI thickness increases during Si lithiation and decreases during delithiation, while in situ NR suggests the opposite. The most likely cause of this discrepancy is the selective removal of SEI components (top 20 nm of the SEI) during the electrode rinse process, which is required to remove the electrolyte residue prior to ex situ analysis, demonstrating the necessity of performing SEI characterization in situ.
A taxonomic study on the genus Myospila from Sichuan,China (Diptera:Muscidae:Mydaeinae)

This paper deals with main characters and the present condition of the genus Myospila Rondani 1856. A key to twenty-two Sichuan's species of the genus Myospila is provided, among them a new species of Myospila mimelongata Feng, sp.nov. is described. The type specimens are depsited in the Institute of Plant Physiology Ecology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.Myospila mimelongata Feng, sp.nov. Male: Body length 8.5mm. This new species is similar to Myospila elongata (Emden, 1965) from Malaya, but differs from the latter in: the 3rd antennal segment 4 times as long as its broad, that for the latter 1.8 times as long as its one; hind femur without pv bristle, that for the latter with a row ones; surstyli embrace-like in posterior view, that for the latter gateway-like; cerci with a gap on postmarginal distal in lateral view, that for the latter without it, and it with shorter setae on posterior half, that for the latter with longer ones on wholly.Female: Body length 8.0 mm. Eyes scattered covered with microchaetae; index of frons 0.310; vitta frontalis black dark, both of sides parallel;ocellar triangle reached frontal anterior margin; fromtal bristles in inward 5, and in backward 2; thorax covered with blue greyish pollen; ia 0+2; mid femur each with a row of a and av bristles on basal half, and with a row of pv bristles, among of them, end-broken morely, weaker and slender on distal half; narrow of a stripe and deformed spots on abdomenal dorsal; 3rd to 5th tergites with blue greyish pollen; spermatheca 3, testaceous, roundly. Other characters as this male of species.Bionomics: The adults of this new species are captured from the human faeces on the erth's surface and withered spikes of Swertia bimaculata on the hill.Holotype ♂, Ya'an (Mt. Jinfeng, 860 m; 29°59′N, 102°56′E), Sichuan Province, China, 1993-11-12, collected by Feng Yan, Paratype, 1♀, Ya'an (Mt. Laoban, 800 m; 29°59′N, 102°57′E), Sichuan Province, China, 1989-11-08, same collector as holotype.
2D numerical simulation of underwater explosion near free surface based on level-set method

The problem of underwater explosion near free surface is a dynamic process involving multi-medium and transient nonlinearity.The dominant difficulty is how to trace the moving interface between different medium.The level-set technique is adopted herein to capture the time-dependent changes of the free surface and the moving interface of explosive gaseous product and water.To simulate compressible-fluid flow in which discontinuous shocks are present,the high-resolution method of Total Variation Diminishing(TVD) scheme is used.A numerical method has been first developed for numerical simulation of 2-D underwater explosion near free surface.The method is then extended to account for the interaction of fluid and a rigid structure present in water.The non-reflection boundary condition technique developed by Thomson is finally employed for considering the infinite flow field.
Stationary Crossflow Breakdown due to Mixed Mode Spectra of Secondary Instabilities

Numerical simulations are used to study laminar breakdown characteristics associated with stationary crossflow instability in the boundary-layer flow over a subsonic swept-wing configuration. Previous work involving the linear and nonlinear development of individual, fundamental modes of secondary instability waves is extended by considering the role of more complex, yet controlled, spectra of the secondary instability modes. Direct numerical simulations target a mixed mode transition scenario involving the simultaneous presence of Y and Z modes of secondary instability. For the initial amplitudes investigated in this paper, the Y modes are found to play an insignificant role during the onset of transition, in spite of achieving rather large, O(5%), amplitudes of RMS velocity fluctuation prior to transition. Analysis of the numerical simulations shows that this rather surprising finding can be attributed to the fact that the Y modes are concentrated near the top of the crossflow vortex and exert relatively small influence on the Z modes that reside closer to the surface and can lead to transition via nonlinear spreading that does not involve interactions with the Y mode. Finally, secondary instability calculations reveal that subharmonic modes of secondary instability have substantially lower growth rates than those of the fundamental modes, and hence, are less likely to play an important role during the breakdown process involving complex initial spectra.
Activation of Vascular Cells by Microparticles and Other Danger Signals Via the CD36 Scavenger Receptor

Abstract SCI-12 Clinically significant thrombotic events are common complications of many systemic diseases associated with chronic inflammation, including atherosclerosis, diabetes mellitus, cancer, and chronic autoimmune rheumatologic disorders. Many of these potentially life-threatening thrombi occur in the arterial circulation and likely relate to inappropriate platelet activation and/or vessel wall injury. CD36 is a type B scavenger receptor expressed on platelets, monocytes, microvascular endothelial cells (MVEC), and vascular smooth muscle cells (VSMC) that recognizes and responds to endogenous and exogenous “danger signals” including advanced glycated proteins (AGE), microbial cell wall components, and oxidized phospholipids that are found on the surface of oxidized LDL (oxLDL) and cell-derived microparticles (MP). Mouse FeCl3 thrombosis model systems revealed that genetic deletion of cd36 rescued the prothrombotic phenotypes associated with hyperlipidemia, oxidant stress, or diabetes/hyperglycemia. Interestingly, compared to wild type mice, fewer MP were incorporated into thrombi formed in cd36 null mice after FeCl3-induced vascular injury. Cd36 deficiency also provides partial protection from atherosclerosis in experimental mouse models. On a cellular level, the prothrombotic, pro-atherogenic, and anti-angiogenic activities of CD36 relate to ligand-dependent alterations of platelet, macrophage, and vessel wall cellular functions. For example, CD36 binding to MP, AGE, or oxLDL “sensitizes” platelets to activation by low doses of agonists, such as ADP. In macrophages, CD36 interactions with oxLDL leads to lipid internalization, foam cell formation, and inhibition of migration. In the vessel wall CD36 promotes VSMC oxidant stress and MVEC apoptosis. Mechanistically, CD36 transmits intracellular signals in response to ligand engagement that involve recruitment of specific Src family kinases to its short cytoplasmic tail, with subsequent activation of specific MAP kinase pathways and Vav family guanine nucleotide exchange factors. These signaling pathways remain incompletely understood, but impact many important cellular processes, including cytoskeletal dynamics, cell polarity, transcription of antioxidant genes controlled by the transcription factor Nrf2, and activation of NADPH oxidases. Specific components of CD36 signaling pathways depend on the cellular context and in some cases involve engagement of co-receptors, including integrins, TLRs, and tetraspanins. Recent targeted genome-wide association studies suggest that cd36 polymorphisms associate with CD36 expression levels on platelets and monocytes as well as with risk of thrombotic, metabolic, and atherosclerotic disorders. Targeting CD36 may therefore provide novel approaches to many important human vascular diseases. Disclosures: No relevant conflicts of interest to declare.
Treatment of Cerebral Radiation Necrosis with Bevacizumab: The Cleveland Clinic Experience (S56.005)

BACKGROUND: Cerebral radiation necrosis is a devastating complication of radiation therapy of brain tumors. Recent studies have explored the role of bevacizumab, a humanized monoclonal antibody directed against vascular endothelial growth factor in the treatment of radiation necrosis of the brain. We report twenty patients with cerebral radiation necrosis who were treated with bevacizumab. DESIGN/METHODS: Twenty patients diagnosed with cerebral radiation necrosis and treated with bevacizumab between July 2007 and January 2011 were identified from the Cleveland Clinic Brain Tumor and Neuro-Oncology Center9s database. Pre- and post-treatment magnetic resonance imaging (MRI) studies were compared to evaluate bevacizumab efficacy. RESULTS: Post-treatment MRI demonstrated a radiographic response in all patients on the fluid-attenuated inversion-recovery (FLAIR) sequences and 19 of 20 patients showed improvement in the T1-weighted post-Gadolinium contrast images. The average area change in the T1-weighted post-Gadolinium contrast abnormalities was a decrease of 50.3%, and the average change in the FLAIR images was a decrease of 51.8% (using McDonald criteria). There was a mean daily dose reduction of 9.6 mg of dexamethasone after initiation of bevacizumab in patients who were on steroids at the start of bevaciuzmab therapy for radiation necrosis. CONCLUSIONS: Bevacizumab reduced cerebral edema in radiographic imaging and demonstrated a clinical benefit in patients with cerebral radiation necrosis. Bevacizumab may be onsidered as a therapeutic option in cases that do not respond to traditional corticosteroid therapy. Disclosure: Dr. Stevens has received personal compensation for activities with UCB PHARMA as speakers board member. Dr. Hashemi Sadrawi has nothing to disclose. Dr. Chao has nothing to disclose. Dr. Osei-Botang has nothing to disclose. Dr. Rahmathulla has nothing to disclose. Dr. Murphy has nothing to disclose. Dr. Suh has nothing to disclose. Dr. Rosenfeld has nothing to disclose. Dr. Rich has nothing to disclose. Dr. Peereboom has nothing to disclose. Dr. Ahluwalia has received personal compensation for activities with Elkta as an advisory board member, from Monteris Medical as a consultant, and from Merl as a speaker.
Rare Concomitance of Primary Systemic Amyloidosis with Immunoglobulin M Monoclonal Gammopathy or Waldenstrom Macroglobulinemia.

Introduction: Primary systemic amyloidosis occurs when a clonal plasma cell population secretes light chains (or light chain fragments) that deposit in tissues as amyloid and cause organ failure and ultimately patient death. Primary systemic amyloidosis generally results from non-proliferative small populations of plasma cells. While it is known that IgG, IgA and light chain producing plasma cells can secrete amyloid in association with myeloma, fewer medical professionals recognize that IgM-secreting lymphoplasmacytic cells can produce amyloid proteins. When monoclonal IgM secreting marrow lymphocytes are present, amyloidosis can result with or without overt Waldenstrom Macroglobulinemia. Patients and Methods: All patients seen at the Mayo Clinic between January 1968 and August 2000 with both a serum IgM monoclonal protein and biopsy-proven amyloidosis were analyzed. The Mayo Clinic Dysproteinemia Database recognized 128 patients (42 female, 86 male) with a median age of 65 years. Results: Seventy-two percent (n=92) of the patients have died with a median survival of 1.72 years following biopsy proven amyloidosis (figure 1). Median serum IgM monoclonal spike was 1.38 g/dL. In addition, serum IgM kappa to lambda light chain ratios (1:3) were found to be reversed in patients with IgM gammopathy when amyloid was present (compared to the reverse ratio (3:1) in patients with Waldenstrom macroglobulinemia in the absence of amyloidosis). Subcutaneous fat, rectum and bone marrow revealed amyloid in 72%, 69% and 70%, respectively, providing non-invasive techniques for amyloidosis diagnosis without the risks of bleeding associated with renal or hepatic percutaneous biopsy. Variables not shown to affect survival included the following: age, gender, serum M spike, urine protein, alkaline phosphatase, creatinine, light chain isotype, ejection fraction, and percent marrow plasma cells. The presence of amyloid cardiomyopathy (defined as a cardiac interventricular septal thickness greater than 12 mm.) was the only variable to adversely affect survival. Of the patients with echocardiographic evidence of cardiomyopathy, the median survival was 10.8 months. In contrast, the patients without echocardiographic evidence of cardiomyopathy at diagnosis had a median survival of 39 months (figure 2). Conclusion: Amyloidosis is underappreciated and should be considered in the differential diagnosis of all patients presenting with IgM gammopathy. Patients found to have amyloidosis in this setting should be tested for amyloid cardiomyopathy, as its presence predicts poor outcome. Lambda light chain in serum IgM samples should increase the index of suspicion for the presence of amyloid since IgM lambda is present in only 25% of IgM MGUS or Macroglobulinemia patients but is seen in 75% of IgM amyloidosis patients.
Virtual patient simulations for brief assessment of mental health disorders in integrated care settings

This mixed-methods pilot investigation evaluated the use of virtual patient simulations for increasing self-efficacy and diagnostic accuracy for common behavioral health concerns within an integrat...
iPSC-derived familial Alzheimer’s PSEN2 N141I cholinergic neurons exhibit mutation-dependent molecular pathology corrected by insulin signaling

Type 2 diabetes (T2D) is a recognized risk factor for the development of cognitive impairment (CI) and/or dementia, although the exact nature of the molecular pathology of T2D-associated CI remains obscure. One link between T2D and CI might involve decreased insulin signaling in brain and/or neurons in either animal or postmortem human brains as has been reported as a feature of Alzheimer’s disease (AD). Here we asked if neuronal insulin resistance is a cell autonomous phenomenon in a familial form of AD. We have applied a newly developed protocol for deriving human basal forebrain cholinergic neurons (BFCN) from skin fibroblasts via induced pluripotent stem cell (iPSC) technology. We generated wildtype and familial AD mutant PSEN2N141I (presenilin 2) BFCNs and assessed if insulin signaling, insulin regulation of the major AD proteins Aβ and/or tau, and/or calcium fluxes is altered by the PSEN2N141I mutation. We report herein that wildtype, PSEN2N141I and CRISPR/Cas9-corrected iPSC-derived BFCNs (and their precursors) show indistinguishable insulin signaling profiles as determined by the phosphorylation of canonical insulin signaling pathway molecules. Chronic insulin treatment of BFCNs of all genotypes led to a reduction in the Aβ42/40 ratio. Unexpectedly, we found a CRISPR/Cas9-correctable effect of PSEN2N141I on calcium flux, which could be prevented by chronic exposure of BFCNs to insulin. Our studies indicate that the familial AD mutation PSEN2N141I does not induce neuronal insulin resistance in a cell autonomous fashion. The ability of insulin to correct calcium fluxes and to lower Aβ42/40 ratio suggests that insulin acts to oppose an AD-pathophysiology. Hence, our results are consistent with a potential physiological role for insulin as a mediator of resilience by counteracting specific metabolic and molecular features of AD.
The Intensity of Behavioral Restraint: Determinants and Cardiovascular Correlates

We sketch here an understanding of self-regulatory restraint and cardiovascular responses that may accompany it. The understanding represents an application of an integrative analysis that has long guided research in our laboratory and has distinctive implications relative to traditional self-regulation perspectives. One core idea is that restraint intensity varies proximally with the magnitude of the urge resisted—first rising and then falling, with the fall occurring where regulatory success appears impossible or excessively difficult given its importance. Another is that regulatory ability factors, including fatigue, have different influences on restraint intensity depending on the magnitude of an urge and the importance of resisting it. Cardiovascular responses accompanying self-regulatory restraint may be those associated with beta-adrenergic sympathetic nervous system activation. Direct evidence for this understanding is limited, but indirect evidence—from nonregulatory tests of the integrative analysis and its application—is abundant.
Hyperfine-structure constants for 47Ti I 3d24s2 3P.

We report magnetic dipole hyperfine-structure constants, obtained by doing nonrelativistic configuration-interaction calculations, for $^{47}\mathrm{Ti}$ i 3${\mathit{d}}^{2}$4${\mathit{s}}^{2}$ $^{3}$P, which are in excellent agreement with experiment [theory (experiment) ${\mathit{A}}_{2}$=-23.150 (-25.215) MHz, ${\mathit{A}}_{1}$=2.202 (2.665) MHz] in contrast with Hartree-Fock and some semiempirical values. Second-order electrostatic effects, arising mainly from the 3${\mathit{d}}^{3}$4s configuration, are crucial to understanding this system. The nuclear quadrupole coupling constant is -138.4 MHz and 69.2 MHz\ifmmode\times\else\texttimes\fi{}Q (in b) (J=1,2). By combining with measurement, we predict Q=0.346 b. Hyperfine-structure constants are also given for the 3${\mathit{d}}^{3}$4s and 3${\mathit{d}}^{4}$ $^{3}$P terms.
Bridging the Digital Divide in Rural Appalachia: Internet Usage in the Mountains

This project looks at Internet usage within the Melungeon community of Appalachia. Although much has been written on the coal mining communities of Appalachia and on ethnicity within the region, there has been little written on electronic media usage by Appalachian communities, most notably the Melungeons. The Melungeons are a group who settled in the Appalachian Mountains as early as 1492, of apparent Mediterranean descent. Considered by some to be tri-racial isolates, to a certain extent, Melungeons have been culturally constructed, and largely self- identified. According to the founder of a popular Melungeon Web site, the Internet has proven an effective tool in uncovering some of the mysteries and folklore surrounding the Melungeon community. This Web site receives more than 21,000 hits a month from Melungeons or others interested in the group. The Melungeon community, triggered by recent books, films, and video documentaries, has begun to use the Internet to trace their genealogy. Through the use of oral history interviews, this study examines how Melungeons in Appalachia use the Internet to connect to others within their community and to the world at large.
Concussion Epidemiology in Athletes Who Are Deaf or Hard-of-Hearing Compared With Athletes Who Are Hearing.

Objective To compare the epidemiology of concussion between athletes who are deaf or hard-of-hearing (D/HoH) and athletes who are hearing. Design Descriptive epidemiology study. Setting Data were collected from 2 Division III athletic programs. One institution is the world's only university designed to be barrier-free for students who are D/HoH. Participants Six hundred ninety-three athletes who are D/HoH and 1284 athletes who are hearing were included in this study. Athletes participated in collegiate athletics during the 2012 to 2013 through the 2016 to 2017 academic years. Interventions Concussion data were provided by the athletic training staff at each institution. Main outcome measures Concussion counts, concussion rate, and injury rate ratios (IRRs) with 95% confidence intervals (95% CIs). Results Thirty athletes who are D/HoH and 104 athletes who are hearing suffered concussions. Athletes who are hearing had an increased injury rate compared with athletes who are D/HoH for all sports combined (IRR = 1.87, 95% CI, 1.26-2.78). Football athletes who are hearing also had an increased injury rate compared with football athletes who are D/HoH (IRR = 3.30, 95% CI, 1.71-6.37). Concussion rate was higher for male athletes who are hearing than male athletes who are D/HoH (IRR = 2.84, 95% CI, 1.62-4.97). No other significant differences regarding concussion risk were identified. Conclusions Athletes who are D/HoH in sex-comparable sports may not have a higher rate of concussion than athletes who are hearing. Rate of concussion in football may be greater among athletes who are hearing compared with athletes who are D/HoH.
Absolute binding free energies for the SAMPL6 cucurbit[8]uril host–guest challenge via the AMOEBA polarizable force field

As part of the SAMPL6 host–guest blind challenge, the AMOEBA force field was applied to calculate the absolute binding free energy for a cucurbit[8]uril host complexed with 14 diverse guests, ranging from small, rigid structures to drug molecules. The AMOEBA results from the initial submission prompted an investigation into aspects of the methodology and parameterization employed. Lessons learned from the blind challenge include: a double annihilation scheme (electrostatics and van der Waals) is needed to obtain proper sampling of guest conformations, annihilation of key torsion parameters of the guest are recommended for flexible guests, and a more thorough analysis of torsion parameters is warranted. When put in to practice with the AMOEBA model, the lessons learned improved the MUE from 2.63 to 1.20 kcal/mol and the RMSE from 3.62 to 1.68 kcal/mol, respectively. Overall, the AMOEBA protocol for determining absolute binding free energies benefitted from participation in the SAMPL6 host–guest blind challenge and the results suggest the implementation of the methodology in future host–guest calculations.
The dual-staged pathway for closure in cloacal exstrophy: Successful evolution in collaborative surgical practice.

Abstract Introduction A successful abdominal wall and bladder closure is critical in the management of cloacal exstrophy (CE). This study examines closure outcomes and practices over the last 4 decades at the authors' institution. Beginning in 1995, the authors' institution standardized CE closure and management with the Dual-Staged Pathway (DSP). The DSP consists of a staged bladder closure, a staged or concurrent osteotomy, and postoperative immobilization with external fixation. The authors hypothesize that the DSP has provided better outcomes in CE closures. Methods A prospective database of 1332 Exstrophy–Epispadias Complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. The DSP consists of a staged osteotomy and a staged bladder closure in CE patients with a diastasis greater than 4 cm. To evaluate the DSP, outcomes of closure at the authors' institution were compared between two equal, twenty-year periods before and after its implementation. Data on timing of closure, postoperative management, surgical complications, and outcomes were collected. Results There are 142 CE patients in the database. In this study, 49 CE patients with 50 closures met inclusion criteria. The overall success rate of closures from 1975 to 1994 was 88% (14 of 16), while the success rate of the DSP was 100% (n = 34), p = 0.098. Twenty-two (65%) primary and 12 (35%) secondary closures were performed using the DSP. Overall complication rates of the DSP remained similar to previous closures, (29% vs 19%, p = 0.508). Since incorporation of the DSP, patients referred for closure have generally had a larger preclosure diastasis (7.2 cm vs 5.1 cm, p = 0.011). Conclusion The standardized DSP closure has proven successful in 34 primary and reoperative cloacal closures in the past 20 years. With this approach, the authors feel that the DSP offers greater patient safety and better outcomes. Level of evidence Level III, retrospective comparative study.
Life Expectancy and Assessment of Functional Status in Older Adults

Men and women of age 65 years or older represent the fastest growing segment of the US population. With older adults living well into their 80s, trauma centers will be treating a higher volume of these patients as the population ages. There is notable heterogeneity in health and function among older adults, with many maintaining an active lifestyle late in life. Therefore, age may not be an accurate measure of function, especially as it relates to decisions concerning surgical treatment. Measures of frailty may be a better indicator of function than chronologic age, particularly for identifying patients at risk of poor surgical outcomes. Screening for frailty can better inform treatment decisions and potentially improve care. Assessments of physical performance can be used to evaluate recovery and to compare the effectiveness of different treatments. Well-validated measures including gait speed, the 6 m walk test, and the Short Physical Performance Battery (SPPB) have established clinically meaningful differences among older adult populations.
Funhouse Mirror Reflections: Resisting Internalized Sexism in Family Therapy and Building A Women-Affirming Practice

Despite increasingly nuanced conversations about women’s issues in family therapy, discussion about internalized oppression in women remains limited. Without addressing internalized sexism within o...
Agree to Disagree? Ideological Cleavages in Paid Parental Leave and Abortion Rights Support

The lack of US paid parental leave policies has increasingly gained public and political attention. Yet it is unclear whether public support for such a policy will translate to enactment. To better...
Ambulatory Robotic-Assisted Partial Nephrectomy: Safety and Feasibility Study

Abstract OBJECTIVE To evaluate the feasibility and safety of performing robotic-assisted laparoscopic partial nephrectomy (RAPN) as outpatient surgery in patients with renal masses. MATERIALS AND METHODS We analyzed RAPN performed by a single surgeon at an academic medical center from July 2018 to June 2019 and identified those individual patients who were discharged on the same day. These cases were then compared to a concurrent inpatient RAPN group. Relationships with outcome analyzed using Fisher's exact test and Student's t test. RESULTS Twenty-three of 84 RAPNs (27.4%) were performed as ambulatory. Mean age was 57.4 years. Average tumor size was 2.24 cm. The mean total operative time was 99.4 minutes. Average estimated blood loss was 51.0 mL. When compared to the cohort of patients who stayed overnight, on multivariate analysis, the tumor size (2.24 ± 0.71 vs 3.65 ± 1.55 cm, P CONCLUSION RAPN can be performed safely as ambulatory in select patients with comparable outcome without complication or hospital readmission.
A Means–End Analysis of Mothers’ Infant Feeding Choices:

In this research, the authors focus on the choice of an infant feeding method as a public policy issue and present the results of a qualitative study of mothers’ motivations to initiate and termina...