cssi/SciSciGPT-SciSciNet huggingface dataset:
Radiation dose selection in Hodgkin's disease patients with large mediastinal adenopathy treated with combined modality therapy.

Abstract Purpose: To determine the effective dose of consolidation radiation in Hodgkin's disease (HD) patients with large mediastinal adenopathy (LMA) treated with combined modality therapy (CMT). Methods and Materials: Eighty-three HD patients with LMA receiving CMT between 1983 and 1997 at Duke University and Yale University were identified. Patients underwent complete clinical staging. The staging breakdown was: IA, 4 patients; IB, 1 patient; IIA, 25 patients; IIB, 33 patients; IIIA, 3 patients; IIIB-6 patients; IVA, 2 patients; and IVB, 9 patients. All patients received induction chemotherapy (CT) as follows: MOPP/ABV(D), 31 patients; BCVPP, 15 patients; ABVD, 24 patients; MOPP, 3 patients; and other regimens, 10 patients. Following 6 cycles of CT, patients were restaged and classified as having either complete response (CR) or induction failure (IF). Post-CT gallium scans were obtained in 52 patients. Patients with residual radiographic abnormalities were classified as having CR if they were gallium-negative and clinically well otherwise. Following induction CT, 78 patients had a CR. There were 5 IFs. Consolidation irradiation was administered to all sites of initial involvement in patients who had achieved CR. RT dose varied. Patients were grouped into the following dose ranges: ≤ 20 Gy, 12 patients; 20–25 Gy, 24 patients; 25–30 Gy, 30 patients; ≥ 30 Gy, 12 patients. Results: Overall survival and failure-free survival were both 76% at 10 years. Of the 78 CR patients, 15 failed. Patterns of failure were in-field alone, 8 patients; out of field alone, 2 patients; and combined, 5 patients. Failure patterns by RT dose were: ≤ 20 Gy, 0/12; 20–25 Gy, 7/24; 25–30 Gy, 5/30; ≥ 30 Gy, 3/11. There was no apparent correlation between RT dose and subsequent failure. Post chemotherapy gallium scans were helpful in predicting for failure. Of 48 patients in whom the gallium was negative after chemotherapy, there were 6 failures, compared with 9 failures among 30 patients in whom gallium was not done after chemotherapy ( p = 0.066). Additionally, patients receiving adriamycin-based chemotherapy regimens had improved outcomes compared to those not receiving adriamycin ( p = 0.03.) Conclusions: These retrospective data suggest that low-dose radiotherapy following CR achieved with induction chemotherapy (particularly when documented with gallium scanning) may be as effective as higher doses for bulky HD at presentation. Phase III trials are necessary for confirmation of this hypothesis.
Phase relations in the CH4-H2O-NaCl system at 2 kbar, 300 to 600°C as determined using synthetic fluid inclusions

Abstract Synthesis of fluid inclusions in the CH4-H2O-NaCl system was accomplished by subjecting fractured quartz or fluorite, along with known quantities of CH4, H2O, and NaCl, to a pressure of 2 kbar and temperatures of 300, 400, 500, or 600°C, in sealed Au capsules. Under the elevated P-T conditions, some of the fractures healed, trapping fluids as inclusions. Microthermometric measurements conducted on the fluid inclusions show that at 2 kbar and 400 to 600°C, there are very broad regions of fluid unmixing in the CH4-H2O-NaCl system. For those bulk fluid compositions that lie in the two-phase (i.e., immiscible fluids) field, the high-density phase is enriched in NaCl, whereas the low-density phase is enriched in CH4. For any given bulk composition, the degree of NaCl enrichment in the high-density phase increases, whereas the degree of CH4 enrichment in the low-density phase decreases, as temperature increases from 400 to 600°C. Our experimental constraints on the size of the two-phase field are generally consistent with results generated using the equation-of-state GEOFLUIDS (available at http://geotherm.ucsd.edu/geofluids/). However, when comparing the compositions of coexisting immiscible fluids, as determined experimentally vs. calculated using GEOFLUIDS, we find that some relatively small but probably significant differences exist between our experiments and this equation of state.
Dialectic as Argument: On the Structure of Dialectical Reasoning in the Social and Policy Science

In Chapter 1 we introduced our initial qualitative model of the dialectic. Chapters 2 and 3 then presented two quantitative models of this initial formulation. Chapter 4 presented a discussion of an experiment basd on the concepts of Chapter 3.
The Calculation of Marginal Effective Tax Rates

The objective of this working paper is to describe the methodology used to undertake the marginal effective tax rate (METR) calculations contained in the final report issued by the Technical Committee on Business Taxation. The data underlying the computations are also described and presented, as are various illustrative calculations that supplement the cases covered by the effective tax rates presented in the Technical Committee’s report. The model used to calculate the METRs updates, and expands on, earlier Canadian work. The main extensions to the model are: for METRs on tangible capital, incorporation of federal and provincial capital taxes, and provincial sales taxes on capital inputs, in addition to federal and provincial corporate income taxes; METRs on research and development (RD METRs for non-tax-paying firms; and finally, METRs on tangible and intangible capital using industry-specific debt-asset ratios. These additions allow for an analysis of METRs on a broader range of production inputs and accounting for a larger variety of federal and provincial taxes. This has become more relevant for the study of the impact of taxation, given the increase in the relative importance of taxes that are not sensitive to profits (i.e. payroll and capital taxes).The METRs for the current Canadian corporate tax system vary across firm size, asset type and industries. Generally, small firms face lower METRs than large firms, regardless of the type of investment they make. Investments in machinery, R&D, and exploration and development (E&D) are subject to lower METRs than investment in structures, land and inventories, and METRs on labour are appreciably lower than METRs on capital (except R&D). Finally, a comparison of METRs across industries shows that, in general, service industries are treated less favourably than manufacturing and resource industries.Also provided, to allow international comparisons, is a calculation of METRs on tangible capital in the G-7 countries and Mexico. Canadian METRs on tangible capital are generally lower than those in Germany, Italy and Japan, but higher than those in the rest of the G-7 countries and Mexico. However, investment in manufacturing equipment is treated more favourably in Canada than in most of the other G-7 countries, including the United States, and investment in R&D is treated more favourably in Canada than in the United States.Finally, a simulation of the Technical Committee’s policy package shows that the Committee’s recommendations would result in little change in the overall level of METRs, but that the variation in METRs would be reduced substantially, especially those across industries.
Natriuretic Effect of Alpha Melanocyte Stimulating Hormone (α-MSH) in Hypophysectomized or Adrenalectomized Rats

SummaryA 12-fold increase in sodium excretion occurred in hypophysectomized or adrenalectomized water-loaded rats after ip injection of 10 μg of α-MSH compared with the low sodium excretion in saline-injected control rats. Potassium excretion also increased significantly but to a much lesser degree. There was no change in the urine output. The results indicate that neither the pituitary gland nor the adrenals mediate the natriuresis produced by MSH.The authors thank Miss Susan Willsey for her excellent technical assistance in these studies.
Gestures of Noncompliance: Resisting, Inventing, and Enduring in Citizen 13660

Mine Okubo's Citizen 13660 documents the ways in which edicts based upon essentialist notions of race that demonized the "Japanese" body were resisted by Japanese American internees through gestures and through invention. In the book's preface Okubo states, "I am not bitter." However, this stated lack of bitterness contrasts with illustrations showing Okubo sticking her tongue out at figures of authority and with images of internees shielding themselves from their surroundings with their hands. These physical gestures demonstrate acts of resistance toward environmental elements and serve as symbolic gestures of resistance against forced incarceration.
Environmental determinants of seasonal body size variation in the milkweed leaf beetle, Labidomera clivicollis (Kirby) (Coleoptera: Chrysomelidae)

Milkweed leaf beetles, Labidomera clivicollis (Kirby), eclosing later in the fall in central Texas have smaller adult sizes. Laboratory studies show that this seasonal decline is more probably due to deteriorating larval food supplies than to decreasing temperature, decreasing photoperiod, or maternal effects on egg weight. Adult size can vary greatly, because larvae in the last stadium become competent to metamorphose at weights much lower than those normally attained under favorable nutritional conditions. Because Labidomera can diapause only in the adult stage, the ability to complete development at low larval weights should be adaptive when the environment becomes increasingly foodand time-limited.
Regulating doctors' fees H. E. Frech III, editor Washington, DC: American enterprise institute press, 1991, 446 pp.

This review article examines the issues raised by shifting from the "customary, prevailing, and reasonable" system of paying doctors under Medicare to a fee schedule based on construction of relative resource costs, in particular relative physician work effort. The volume edited by H.E. Frech III provides the basis to consider issues such as whether a relative surplus of specialist physicians exists and if so, whether changes in reimbursement will alleviate the maldistribution. Regulation of physician fees is likely to impact patient access, especially if balance billing is not allowed. Early research on the implementation of the new system indicates that fees have been set far below private insurance rates. Alternatives to price regulation are proposed.
MR IMAGING OF MUSCULOSKELETAL TUMORS IN THE ELBOW REGION

MR imaging is useful in the evaluation of benign and malignant osseous and soft-tissue masses in the elbow. It allows for multiplanar, high-contrast images that provide precise definition of local tumor extent. The paucity of fat and a high concentration of small soft-tissue structures such as tendons, ligaments, and nerves in this area makes MR imaging more advantageous than CT for delineating tumor margins in the soft tissue. This article describes some of the more common tumors around the elbow with emphasis on their MR imaging characteristics.
CLIMATOLOGICAL CLASSIFICATION OF SEVERE WIND-DRIVEN RAIN EVENTS AFFECTING THE SOUTHERN UNITED STATES

This paper follows recent studies of wind-driven rain (WDR), and statistically defines a “severe” WDR event. The research suggests a classification for severe WDR events by association with larger-scale weather systems. The study incorporates data for the period 1971 to 1995 and, from these data, the analysis reveals that severe WDR events are confined mainly to the southern United States and occur most frequently in the cold and transition seasons. Extratropical cyclones are the most common synoptic-scale weather systems associated with severe WDR events. Extratropical cyclones originating in three areas accounted for more than 70 percent of the severe events in the study. The cyclone types are referred to as Colorado Lows (CLs), Gulf Lows (GLs), and Texas Lows (TLs). The attendant synoptic-scale conditions of cyclones that produced severe WDR events differ significantly from extratropical cyclones originating in similar areas but not producing severe events. Key differences between the two cyclone popul...
Confronting the “Indian summer monsoon response to black carbon aerosol” with the uncertainty in its radiative forcing and beyond

While black carbon aerosols (BC) are believed to modulate the Indian monsoons, the radiative forcing estimate of BC suffers from large uncertainties globally. We analyze a suite of idealized experiments forced with a range of BC concentrations that span a large swath of the latest estimates of its global radiative forcing. Within those bounds of uncertainty, summer precipitation over the Indian region increases nearly linearly with the increase in BC burden. The linearity holds even as the BC concentration is increased to levels resembling those hypothesized in nuclear winter scenarios, despite large surface cooling over India and adjoining regions. The enhanced monsoonal circulation is associated with a linear increase in the large-scale meridional tropospheric temperature gradient. The precipitable water over the region also increases linearly with an increase in BC burden, due to increased moisture transport from the Arabian sea to the land areas. The wide range of Indian monsoon response elicited in these experiments emphasizes the need to reduce the uncertainty in BC estimates to accurately quantify their role in modulating the Indian monsoons. The increase in monsoonal circulation in response to large BC concentrations contrasts earlier findings that the Indian summer monsoon may break down following a nuclear war.
Inequalities for entire functions of exponential type satisfying $$ f(z) \equiv e^{i\gamma } e^{i\tau z} \overline {f(\bar z)} $$

Let f be an entire function of exponential type satisfying the condition \( f(z) \equiv e^{i\gamma } e^{i\tau z} \overline {f(\bar z)} \) for some real γ. Lower and upper estimates for ∫−∞∞|f′(x)|p dx in terms of ∫−∞∞|f(x)|p dx, for such a function f belonging to Lp(R), have been known in the case where p ∊ [1, ∞) and γ = 0. In this paper, these estimates are shown to hold for any p ∊ (0, ∞) and any real γ.
Timeline: An Operating System Abstraction for Time-Aware Applications

Having a shared and accurate sense of time is critical to distributed Cyber-Physical Systems (CPS) and the Internet of Things (IoT). Thanks to decades of research in clock technologies and synchronization protocols, it is now possible to measure and synchronize time across distributed systems with unprecedented accuracy. However, applications have not benefited to the same extent due to limitations of the system services that help manage time, and hardware-OS and OS-application interfaces through which timing information flows to the application. Due to the importance of time awareness in a broad range of emerging applications, running on commodity platforms and operating systems, it is imperative to rethink how time is handled across the system stack. We advocate the adoption of a holistic notion of Quality of Time (QoT) that captures metrics such as resolution, accuracy, and stability. Building on this notion we propose an architecture in which the local perception of time is a controllable operating system primitive with observable uncertainty, and where time synchronization balances applications' timing demands with system resources such as energy and bandwidth. Our architecture features an expressive application programming interface that is centered around the abstraction of a timeline – a virtual temporal coordinate frame that is defined by an application to provide its components with a shared sense of time, with a desired accuracy and resolution. The timeline abstraction enables developers to easily write applications whose activities are choreographed across time and space. Leveraging open source hardware and software components, we have implemented an initial Linux realization of the proposed timeline-driven QoT stack on a standard embedded computing platform. Results from its evaluation are also presented.
Multi-dimensional Roles of Ketone Bodies in Fuel Metabolism, Signaling, and Therapeutics

Ketone body metabolism is a central node in physiological homeostasis. In this review, we discuss how ketones serve discrete fine-tuning metabolic roles that optimize organ and organism performance in varying nutrient states and protect from inflammation and injury in multiple organ systems. Traditionally viewed as metabolic substrates enlisted only in carbohydrate restriction, observations underscore the importance of ketone bodies as vital metabolic and signaling mediators when carbohydrates are abundant. Complementing a repertoire of known therapeutic options for diseases of the nervous system, prospective roles for ketone bodies in cancer have arisen, as have intriguing protective roles in heart and liver, opening therapeutic options in obesity-related and cardiovascular disease. Controversies in ketone metabolism and signaling are discussed to reconcile classical dogma with contemporary observations.
Desymmetrization of Diarylmethylamido Bis(phenols) through Peptide-Catalyzed Bromination: Enantiodivergence as a Consequence of a 2 amu Alteration at an Achiral Residue within the Catalyst

Diarylmethylamido bis(phenols) have been subjected to peptide-catalyzed, enantioselective bromination reactions. Desymmetrization of compounds in this class has been achieved such that enantioenriched products may be isolated with up to 97:3 er. Mechanistically, the observed enantioselectivity was shown to be primarily a function of differential functionalization of enantiotopic arenes, although additional studies unveiled a contribution from secondary kinetic resolution of the product (to afford the symmetrical dibromide) under the reaction conditions. Variants of the tetrapeptide catalyst were also evaluated and revealed a striking observation—enantiodivergent catalysis is observed upon changing the achiral amino acid residue in the catalyst (at the i+2 position) from an aminocyclopropane carboxamide residue (97:3 er) to an aminoisobutyramide residue (33:67 er) under a common set of conditions. An expanded set of catalysts was also evaluated, enabling structure/selectivity correlations to be considered ...
Time of flight parametric image reconstruction from variable random fraction dynamic PET data

Dynamic PET imaging allows the time course of the activity distribution to be measured and modelled, therefore estimating parametric images of micro- or macro-parameters. Due to the need for increased temporal sampling, frames of low statistics are often reconstructed, leading to noisy dynamic data and subsequently to kinetic parameters of reduced precision and accuracy. TOF image reconstruction can substantially improve upon the kinetic parameter SNR. However, variable contributions to TOF variance reduction between true and random events, owing to their spatial distribution, results in SNR improvements depending on the random fraction and leading to variable TOF gains amongst temporal frames within a dynamic study. Such variable gains between early/late frames (high/low random fractions) are also expected to be more pronounced at increasing injected doses. Therefore, we hypothesize that certain kinetic parameters receive differential improvements depending upon the part of the time-activity curve they are estimated from. Using simulated dynamic [15O]H 2 O datasets at ever increasing doses and random fractions, we investigate the variable TOF gain in dynamic imaging and its effect on the kinetic parameters. Data are presented at improving TOF resolutions and using both indirect and direct methods to kinetic parameter estimation. Initial results suggest that kinetic parameter TOF gain is highly variable (increasing) at ever increasing injected doses, but such variation is different for each parameter based on the part of the dynamic data it is derived from, owing to the variable TOF gain within dynamic frames.
Precision irrigation in wine grape using a proximal leaf monitor system for measuring plant water status

Abstract. Measurement of plant water status (PWS) provides the key information necessary for efficient irrigation management schemes. A continuous leaf monitoring system based on leaf temperature and relevant microclimatic variables that can provide real-time PWS is currently available. Crop water stress index (CWSI) or modified crop water stress index (MCWSI) values are usually computed with leaf monitor data, which requires a knowledge of well-watered and fully stressed conditions. We proposed a methodology to compute CWSI and MCWSI using the leaf monitor data, where the well-watered and dry conditions were measured using a well-watered vine and simulated dry leaf. The objectives of this research were to implement a PWS based site-specific irrigation management scheme in a vineyard and to assess PWS of grapes by comparing MCWSI and CWSI with stem water potential (SWP). Samples were obtained prior to harvest to determine grape quality and yield information. The stressed based treatments received 69% of the amount of water compared to the grower treatment. Yield results show no significant differences between stressed and grower treatments, while quality results showed a significant difference in malic acid content (all other quality attributes were similar), suggesting this method of precision irrigation may be a useful tool for irrigation scheduling and controlling PWS in grapes, while conserving water and enhancing quality of the product.
Halide: decoupling algorithms from schedules for high-performance image processing

Writing high-performance code on modern machines requires not just locally optimizing inner loops, but globally reorganizing computations to exploit parallelism and locality---doing things such as tiling and blocking whole pipelines to fit in cache. This is especially true for image processing pipelines, where individual stages do much too little work to amortize the cost of loading and storing results to and from off-chip memory. As a result, the performance difference between a naive implementation of a pipeline and one globally optimized for parallelism and locality is often an order of magnitude. However, using existing programming tools, writing high-performance image processing code requires sacrificing simplicity, portability, and modularity. We argue that this is because traditional programming models conflate the computations defining the algorithm with decisions about intermediate storage and the order of computation, which we call the schedule.We propose a new programming language for image processing pipelines, called Halide, that separates the algorithm from its schedule. Programmers can change the schedule to express many possible organizations of a single algorithm. The Halide compiler then synthesizes a globally combined loop nest for an entire algorithm, given a schedule. Halide models a space of schedules which is expressive enough to describe organizations that match or outperform state-of-the-art hand-written implementations of many computational photography and computer vision algorithms. Its model is simple enough to do so often in only a few lines of code, and small changes generate efficient implementations for x86, ARM, Graphics Processors (GPUs), and specialized image processors, all from a single algorithm.Halide has been public and open source for over four years, during which it has been used by hundreds of programmers to deploy code to tens of thousands of servers and hundreds of millions of phones, processing billions of images every day.
OUTCOMES OF CATHETER ABLATION FOR SUPRAVENTRICULAR TACHYCARDIA IN ADULT PATIENTS WITH CONGENITAL HEART DISEASE

Supraventricular tachyarrhythmias (SVT) are common in adult patients with congenital heart disease (CHD). There is paucity of data regarding the safety and outcomes associated with catheter ablation in these patients. We queried the National Inpatient Sample (NIS) to identify all adults patients >
Dropping Safety Aids and Maximizing Retrieval Cues: Two Keys to Optimizing Inhibitory Learning During Exposure Therapy

Abstract The inhibitory learning model of exposure therapy posits that clinical anxiety is most effectively treated when clinicians employ strategies that maximize the (a) violation of negative expectancies and (b) generalization of nonthreat associations. Translation of basic learning research to exposure therapy via this explanatory model underscores two keys to optimizing inhibitory learning during exposure: dropping safety aids and maximizing retrieval cues. Although topographically similar, safety aids and retrieval cues are functionally distinct as well as therapeutically incompatible. In the present article, we delineate safety aids and retrieval cues in the context of exposure therapy from an inhibitory learning perspective, providing illustrative case examples of how clinicians may address the two when treating patients with clinical anxiety.
A prospective randomized study of stent graft placement after balloon angioplasty versus balloon angioplasty alone for the treatment of hemodialysis patients with prosthetic graft outflow stenosis.

Abstract Background Hemodialysis graft outflow stenosis is a significant complication occurring in hemodialysis patients with prosthetic grafts for vascular access. Balloon angioplasty remains the first-line endovascular treatment of this complication, although covered stent graft implantation after balloon angioplasty also appears to be an effective and promising treatment. The aim of this study was to evaluate the efficacy and durability of stent graft placement after balloon angioplasty in comparison to balloon angioplasty alone for the treatment of graft outflow stenosis in hemodialysis patients. Methods We conducted a prospective randomized study of 98 patients with clinically significant dialysis graft outflow stenosis treated in the vascular surgery section of a tertiary medical center. The patients were randomized into two groups; 49 patients were treated with stent graft placement after balloon angioplasty, and 49 patients were treated with balloon angioplasty alone. All patients underwent angiography of the graft site at 3 and 6 months after intervention, and restenosis rates were compared between the two groups. In addition, the duration of postintervention primary patency in the two groups was recorded and analyzed. Results The postintervention restenosis rate of the stent graft placement group was superior to that seen in the balloon angioplasty alone group (9% vs 69% at 3 months [ P P P Conclusions The use of stent grafts in hemodialysis patients with graft outflow stenosis yielded superior results compared with the results seen in hemodialysis patients treated with balloon angioplasty alone. Patients treated with stent grafts after balloon angioplasty had a lower restenosis rate and a longer duration of postintervention primary patency. The placement of a stent graft after balloon angioplasty appears to be an optimal therapeutic approach for the treatment of hemodialysis patients with graft outflow stenosis.
Molecular drivers of metastatic castrate-resistant prostate cancer: New roads to resistance.

Numerous growth-inducing signaling pathways have been implicated in the development of metastatic castrate-resistant prostate cancer, but their cross-talk with androgen receptor functions remains poorly understood. A recent study published in Science Signaling by Chen et al.1 has identified a novel androgen-mediated signaling axis driven by loss of SPDEF and gain of TGFBI to facilitate metastasis, which may explain the acquisition of resistance to androgen deprivation therapy. These findings suggest that therapeutic inhibition of androgen signaling may inadvertently promote castrate resistance by inhibiting tumor suppressive functions of the androgen receptor.
On the Necessity of Legislating Morality for Genetic Decisions

The initial question I want to touch on is whether genetic disease should be of governmental concern. The specific thesis I then want to argue is that, to the extent governmental concern takes the form of mandating tests or screening, to that extent its action can be construed as an instance of the legislation of morality. Since the “legislation of morality” is popularly considered to be wrong in our society, a choice will then have to be made. Either we abandon the notion that the legislation of morality is in all instances a wrongful governmental act; or we declare ‐‐ to preserve the purity of the distinction between public policy and private morality ‐‐ that the government should stay entirely out of the area of genetic disease, at least out of it to the extent of passing no mandatory laws of any kind bearing on the control of genetic disease. I realize that by no means all members of our society, or of our legislatures, believe that the legislation of morality is necessarily bad; they may have no particular problem with my line of reasoning. My special challenge will be to those who want to uphold a strict separation of law and morality while at the same time pressing for greater governmental intervention into procreative decisions which give promise of maintaining or increasing the present individual and societal burden of genetic disease. Just whose foot the shoe I am going to fashion will fit will have to be left to those prepared to try it on.
Comparing k Independent Sample Means with a Known Standard

Both one-sided and two-sided alternative hypotheses are considered. For each case, an overall test procedure is initially discussed and then followed by a multiple comparison procedure. The critical values required for the multiple comparison procedures..
ASD Staff Training Model

Increase knowledge of ASD Staff Training Model Increase knowledge of considerations in establishing an ASD staff training model in your district
Expanding to 3D Space

Consider a 3D version of the 2D/4A problem discussed in Chapter 3. The purpose of this chapter is to investigate the impact of an increase in the dimension on the complexity of computations. A switch from 2D to the 3D case should cause a significant expansion of the operational district and a change of the mobility of the agents.
Talking the Talk and Walking the Walk: Reviving Global Trade and Development after Doha

The collapse of the Doha “Development” Round of WTO trade negotiations marked the end of a decade of dashed hopes and recriminations. Drawing on the insights of international relations theory and comparative political institutionalism, this Article suggests that Doha’s demise can be attributed, at least in part, to the legal-discursive shortcomings of the international trading system — that is, a lack of means to identify, express, and reconcile competing normative claims of trade and development. As a means of addressing this defect and enhancing the effectiveness of the international trading system, this Article presents the concept of development rights as a descriptive and prescriptive framework for expressing ideas regarding the appropriate boundaries of international economic law in development-specific contexts. In contrast to existing doctrinal and normative explanations, this Article critically examines in a new light the access to essential medicines campaign during the Doha Round as a case study that illustrates the applications and limitations of development rights.
Penile Reinnervation Surgery: A Comprehensive Review of the Literature.

Background Modern approaches to erectile dysfunction (ED) often entail the use of multimodal medical therapy and surgery; however, with recent advances in microsurgery, new options may exist for patients suffering from ED. This comprehensive review of the literature serves to reevaluate anatomical and physiological principles that mediate erection to improve understanding for reconstructive surgeons hoping to offer new interventions. Methods A search strategy for this review was agreed upon by all authors. Articles were divided into 2 categories - primary and secondary. Primary articles were defined as those in which the anatomy of the pelvis and/or perineum was the primary focus of the article, whereas secondary did not directly focus on anatomic considerations. Select historical texts and textbook chapters were also included to provide well established and critical anatomical evidence for this review. Results Several approaches may be used to restore nerve function to treat neurogenic and vasculogenic ED. Somatic sensory loss can be treated by either direct neurorrhaphy or neuroplasty in the location of disruption. Microvascular techniques also exist to improve flow or to repair small vessels injured in the pelvis. Classical approaches to impotence include vein stripping to reduce venous outflow or direct vascularization to improve inflow. Conclusions Postradical prostatectomy ED has been demonstrated to improve with microsurgical interventions. In the coming years, innovation will continue and collaboration between plastic surgeons and urologists will allow us to tackle this common and difficult problem.
Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults

BACKGROUND/OBJECTIVES Guideline-based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties. DESIGN National cross-sectional survey. SETTING Ambulatory. PARTICIPANTS Random sample of geriatricians, general internists, and cardiologists from the American College of Physicians. MEASUREMENTS Electronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases. RESULTS In each specialty, 750 physicians were surveyed, with a response rate of 26% for geriatricians, 26% for general internists, and 12% for cardiologists. Over 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason for deprescribing for all specialties. Geriatricians also commonly reported deprescribing in the setting of limited life expectancy. Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians' treatment plans and patient reluctance. In hypothetical cases, over 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were most likely and cardiologists were least likely to consider deprescribing cardiovascular medications in cases of limited life expectancy (all P < .001), such as recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists), Alzheimer dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists), or significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists). CONCLUSIONS While barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. Implementing deprescribing will require improved processes for both physician-physician and physician-patient communication. J Am Geriatr Soc 68:78-86, 2019.
Applications of the fast multipole fully coupled poroelastic displacement discontinuity method to hydraulic fracturing problems

Abstract In this study, a fast multipole method (FMM) is used to decrease the computational time of a fully-coupled poroelastic hydraulic fracture model with a controllable effect on its accuracy. The hydraulic fracture model is based on the fully-coupled poroelastic formulation of the displacement discontinuity method (DDM) which is a special formulation of the boundary element method (BEM). DDM is a powerful and efficient method for problems involving fractures. However, this method involves the multiplication of a dense matrix with a vector in several places. Thus, the DMM algorithm slows down drastically as the number of elements increases, and even more so with the inclusion of necessary details such as poroelasticity, which makes the solution history-dependent. Rather, FMM is a technique to expedite matrix-vector multiplications, within a controllable error range, by approximating the far-range interactions without forming the matrix explicitly. In doing so, FMM offers a leverage in the computational efficiency by modifying the algorithm of the fully-coupled poroelastic displacement discontinuity method (PDMM) in two places. The first modification is in the time-marching scheme, which accounts for the solution of previous time steps to compute the current time step. The second modification is in the generalized minimal residual method (GMRES), where the unknowns are solved for iteratively. Several examples are provided to show the efficiency of the proposed fast multipole fully-coupled poroelastic displacement discontinuity model (FMPDDM) in problems with large degrees of freedom (in time and space). These examples include hydraulic fracturing of a horizontal well and randomly distributed pressurized fractures at different orientations with respect to principal horizontal stresses. The results of FMPDDM are compared to PDDM in terms of computational time and accuracy, which demonstrates that FMPDDM decreases the computation time by up to a factor of 70 for a case with 20000 piece-wise constant elements and a single time step. The difference between the computational times of FMPDDM and PDDM can be higher for a larger number of elements and time steps. Moreover, the associated absolute value of relative error for a problem of this size is observed to be less than 4% for the hydraulic fracture example, and less than 0.5% for the example of randomly distributed pressurized fractures. Furthermore, the solution of tip displacements using both methods are used to compare the computation of stress intensity factors (SIF) in mode I and II, which are needed for fracture propagation. The calculated displacement discontinuities reveal that the SIF calculation using FMPDDM has a negligible error compared to PDDM. Therefore, FMPDDM will not affect the estimation of the fracture propagation direction. Accordingly, the proposed algorithm may be used for fracture propagation studies to substantially reduce the computational time.
Viral modulation of the host response to infection

Betaherpesviruses such as HCMV dramatically affect host cell physiology and encode a wide variety of functions that modulate the infected host cell as well as the immune response (Mocarski, 2002, 2004). Major structural and nonstructural proteins modulate host cell transcriptional repression (Saffert and Kalejta, , Tavalai et al., 2006), cell-intrinsic responses (Abate et al., ; Goldmacher, 2004), responses to interferon (Child et al., ; Khan et al., 2004) and natural killer (NK) lymphocytes (Lodoen and Lanier, 2005), and adaptive antibody or T-lymphocyte immunity (Chapter 62). The host immune components that are targets of modulation by HCMV are the same host functions that are important in suppressing virus infection, suggesting that the balance between host clearance and viral escape mechanisms dictates many aspects of viral pathogenesis. By reducing the overall impact of antiviral defenses, HCMV seems to be able to escape the full brunt of host innate and adaptive immunity, thereby allowing the virus to persist. It now appears that an overwhelming majority of viral gene products are dedicated to modulation of host cell and immune modulation (Chapter 15). The overwhelming majority (∼100 gene products) may be implicated in modulation because they are dispensable for replication in cultured fibroblasts (Dunn et al., ; Yu et al., 2003).
A tibioperoneal trunk mycotic pseudoaneurysm successfully treated with ligation

Abstract We present the case of a 68-year-old man with a tibioperoneal trunk mycotic pseudoaneurysm, a rarity in the modern age of antibiotics. We describe the patient's hospitalizations and workups that ultimately led to this diagnosis and our management with open ligation without bypass. This case highlights the importance of combining a thorough history and physical examination with laboratory and imaging data while keeping in mind a broad differential diagnosis.
Structural and catalytic roles of the human 18S rRNA methyltransferases DIMT1 in ribosome assembly and translation

rRNA-modifying enzymes participate in ribosome assembly. However, whether the catalytic activities of these enzymes are important for the ribosome assembly and other cellular processes is not fully understood. Here, we report the crystal structure of WT human dimethyladenosine transferase 1 (DIMT1), an 18S rRNA N6,6-dimethyladenosine (m26,6A) methyltransferase, and results obtained with a catalytically inactive DIMT1 variant. We found that DIMT1+/− heterozygous HEK 293T cells have a significantly decreased 40S fraction and reduced protein synthesis but no major changes in m26,6A levels in 18S rRNA. Expression of a catalytically inactive variant, DIMT1-E85A, in WT and DIMT1+/− cells significantly decreased m26,6A levels in 18S rRNA, indicating a dominant-negative effect of this variant on m26,6A levels. However, expression of the DIMT1-E85A variant restored the defects in 40S levels. Of note, unlike WT DIMT1, DIMT1-E85A could not revert the defects in protein translation. We found that the differences between this variant and the WT enzyme extended to translation fidelity and gene expression patterns in DNA damage response pathways. These results suggest that the catalytic activity of DIMT1 is involved in protein translation and that the overall protein scaffold of DIMT1, regardless of the catalytic activity on m26,6A in 18S rRNA, is essential for 40S assembly.
Solid-state reactive sintering of dense and highly conductive Ta-doped Li7La3Z2O12 using CuO as a sintering aid

Cubic-phase garnet-type Li7La3Z2O12 is a promising candidate for an electrolyte of all-solid-state lithium-ion batteries; however, its poor sinterability due to Li sublimation during firing has impeded large scale development. This study demonstrates a solid-state reactive sintering (SSRS) process with added CuO as a sintering aid to enable enhanced materials processing at lower temperatures. Applying the SSRS process with the addition of 1 wt% CuO decreased the sintering temperature for 0.5 mol%Ta-doped LLZTO pellets having over 90% relative density from 1250 to 1100 °C to reduce Li loss. The 1 wt% CuO addition did not lead to secondary phase formation as detected by XRD, nor to appreciable electronic conduction below 100 °C as measured by four-point probe method. The 1 wt% CuO-mixed LLZTO pellet exhibited high conductivity of approximately 3.0 × 10−4 S·cm−1 (bulk) and 5.45x10−5 S·cm−1 (grain boundary). The mechanism of CuO function as a sintering aid is presumed to be enabling liquid-phase sintering along with enhancing the decomposition of LiOH. The combined SSRS process along with optimized CuO sintering aid addition is a one-step process that is a practical technique to enhance the preparation of LLZO-based electrolyte for all-solid-state lithium-ion batteries.
Cultural values as a resilience resource for Latino/a adolescents and young adults coping with parental cancer.

Purpose: Although research on how adolescents and young adults (AYAs) cope with their own cancer is expanding, there is little knowledge on how AYAs cope with a parent’s cancer. And, thus, little e...
Proton Therapy for Skull-Base Chordomas and Chondrosarcomas: Initial Results From the Beaumont Proton Therapy Center.

Background:Skull-base chordomas and chondrosarcomas are rare tumors that arise directly adjacent to important critical structures. Appropriate management consists of maximal safe resection followed by postoperative dose-escalated radiation therapy. Proton beam therapy is often employed in this context to maximize the sparing of organs at risk, such as the brainstem and optic apparatus. METHODS This is a single-institutional experience treating skull-base chordomas and chondrosarcomas with postoperative pencil beam scanning proton therapy. We employed a simultaneous integrated boost to the gross tumor volume (GTV) for increased conformality. Demographic, clinicopathologic, toxicity, and dosimetry information were collected. Toxicity was assessed according to Common Terminology Criteria for Adverse Events (CTCAE), v. 4.0. RESULTS Between 2017 and 2020, 13 patients were treated with postoperative proton therapy. There were 10 patients with chordoma (77%) and three with chondrosarcoma (23%). A gross total resection was achieved in six (60%) patients with chordoma and one patient with chondrosarcoma (33%). Nine patients (69%) received postoperative therapy, whereas four (31%) received treatment at recurrence/progression following re-excision. The median dose to the GTV was 72.4 cobalt-Gray equivalents (range, 70.0 to 75.8). The mean GTV was 3.4 cc (range, 0.2-38.7). There were no grade 3 or greater toxicities. One patient developed grade 2 temporal lobe necrosis. At 10.7 months' median follow-up (range, 2.1-30.6), the rates of local control and overall survival were 100%. CONCLUSIONS Proton beam therapy with pencil beam scanning and simultaneous integrated boost to the GTV affords excellent early local control with the suggestion of low morbidity. This method deserves consideration as an optimal method for limiting dose to adjacent organs at risk and delivering clinically effective doses to the treatment volume.
Identification and Analysis of Key Equipment for Power Supply Reliability of Distribution Network based on ETAP

The identification and analysis of key equipment for power supply reliability is helpful to find out the vulnerable link of system and provide important information for power system planning, operation and maintenance. In this paper, an identification and analysis method of key equipment for power supply reliability of distribution network is proposed based on ETAP. The grid model is built in the ETAP reliability evaluation module. The power supply reliability evaluation is carried out and the key importance of each type of equipment is calculated. The key equipment and factors affecting the power supply reliability of the system are identified by the ranking of key importance, and then the suggestions for improving the reliability are put forward. Results of the example on a 10kV feeder show that the proposed method is feasible and effective, and has certain engineering practical value.
Theoderic and the Roman Imperial Restoration

This book provides a new interpretation of the fall of the Roman Empire and the 'barbarian' kingdom known conventionally as Ostrogothic Italy. Relying primarily on Italian textual and material evidence, and in particular the works of Cassiodorus and Ennodius, Jonathan J. Arnold argues that contemporary Italo-Romans viewed the Ostrogothic kingdom as the Western Roman Empire and its 'barbarian' king, Theoderic (r.489/93–526), as its emperor. Investigating conceptions of Romanness, Arnold explains how the Roman past, both immediate and distant, allowed Theoderic and his Goths to find acceptance in Italy as Romans, with roles essential to the Empire's perceived recovery. Theoderic and the Roman Imperial Restoration demonstrates how Theoderic's careful attention to imperial traditions, good governance, and reconquest followed by the re-Romanization of lost imperial territories contributed to contemporary sentiments of imperial resurgence and a golden age. There was no need for Justinian to restore the Western Empire: Theoderic had already done so.
Legal Liability for Athletic Injuries

(1958). Legal Liability for Athletic Injuries. Journal of Health, Physical Education, Recreation: Vol. 29, No. 2, pp. 12-76.