cssi/SciSciGPT-SciSciNet huggingface dataset:
Anesthetic Care During Modified Fontan Procedure Without Cardiopulmonary Bypass

Objective: The purpose of this study was to report the anesthetic care of patients during performance of a Fontan procedure without cardiopulmonary bypass (CPB). Design: Retrospective chart review. Setting: Operating room of a university hospital. Participants: Seven pediatric-patients undergoing inferior vena cava (IVC)-to-pulmonary artery (PA) anastomosis for completion of the Fontan procedure. Interventions: Charts were reviewed for anesthetic technique, hemodynamic and ventilatory changes occurring during the procedure, and anesthetic interventions that were provided. Measurements and Main Results: The off-bypass Fontan procedure was attempted in 7 patients (age: 26 months-7 years, weight: 13 to 28 kg). Exposure of the PA was not feasible in 1 patient because of a markedly enlarged right atrium. In the remaining 6 patients, before cross-clamping of the PA to allow for the proximal anastomosis between the PA and the conduit, alkalosis (pH ≥7.5) was maintained by the administration of sodium bicarbonate. After PA cross-clamping, fluid administration was necessary in 5 patients and dopamine (3-7 μg/kg/min) was necessary in 4 patients. The minute ventilation was increased by 18 ± 7% to maintain baseline PaCO2 values. Before the placement of the PA cross-clamp, the end-tidal PaCO2 difference was 7 ± 4 mmHg and the transcutaneous (TC)-PaCO2 difference was 3 ± 2 mmHg. The end-tidal PaCO2 difference increased to 14 ± 6 mmHg during cross-clamping of the PA, whereas no change was noted in the TC-PaCO2 difference. Once the proximal anastomosis was completed, a bridge was placed to redirect blood from the IVC to the right atrium while the IVC was clamped and attached to the distal end of the conduit. After placement of the distal end of the bridge into the IVC, fluid administration to maintain the blood pressure was necessary in 3 patients. In 1 patient, 20 minutes after placement of the bridge, the authors noted a progressive increase in the central venous pressure reading measured from the left femoral vein and the need for the administration of volume to maintain the mean arterial pressure. Examination of the bridge revealed occlusion with thrombus despite an activated coagulation time value of 250 to 300 seconds. The tracheas of 3 of the 6 patients were extubated in the operating room, whereas the other 3 were extubated in the pediatric intensive care unit within 4 hours of completion of the procedure. The 1 patient who required the use of CPB required reintubation and had a protracted intensive care unit course. The other 6 patients were discharged home on postoperative days 7 to 12. Conclusions: With alteration of the anesthetic technique, the Fontan procedure can be performed in selected patients without the need for CPB.
Attentional capture by social stimuli in young infants

We investigated the possibility that a range of social stimuli capture the attention of 6-month-old infants when in competition with other non-face objects. Infants viewed a series of six-item arrays in which one target item was a face, body part, or animal as their eye movements were recorded. Stimulus arrays were also processed for relative salience of each item in terms of color, luminance, and amount of contour. Targets were rarely the most visually salient items in the arrays, yet infants’ first looks toward all three target types were above chance, and dwell times for targets exceeded other stimulus types. Girls looked longer at faces than did boys, but there were no sex differences for other stimuli. These results are interpreted in a context of learning to discriminate between different classes of animate stimuli, perhaps in line with affordances for social interaction, and origins of sex differences in social attention.
Teaching Children to Learn Word Meanings from Context: A Synthesis and Some Questions:

This article reviews 14 studies investigating approaches that aimed at teaching children to be more efficient at learning words from context. In nearly all of the studies reviewed, treatments were effective at improving children's skill in learning words from context compared to a no-treatment control. However, in the 4 studies that included a practice-only treatment, no significant differences were found between the strategy treatment and practice-only groups. These findings suggest that the effects of the treatments were due to the practice rather than to the specific strategies taught. Suggestions are made for improving research examining the effects of context-clue strategies.
Performance Comparison of Frequency Domain Quadrupole and Dipole Electromagnetic Induction Sensors in a Landmine Detection Application

This work provides a performance comparison between two frequency-domain electromagnetic induction (EMI) sensors - one quadrupole and one dipole sensor for the detection of subsurface anti-personnel and anti-tank landmines. A summary of the physical differences between the two sensors and from those of other EMI sensors will be discussed. Previously we presented a performance analysis of the dipole sensor for a variety of detection algorithms over data collected at a government test facility indicating robust performance using the dipole sensor. The algorithms considered previously included an energy detector, matched subspace detector and a kNN probability density estimation approach over the features of a four parameter phenomenological model. The current sensor comparison will include, in addition to the previous detection methods, a Random Forests classification algorithm and utilize a larger training data set.
Regression Analysis As Analytical Procedures: A Simulation Study Of The Effect Of Error Term Nonnormality On Auditor Decisions

Regression analysis has been shown through research to be a useful audit tool. One underlying assumption of regression theory is error-term normality. Decision rules were applied to models developed using simulated data with normal and nonnormal error terms. Material errors were seeded into the audit period data, and incorrect rejections and acceptances were tabulated for both types of models. The results of this study suggest that nonnormality of error terms may not significantly affect auditor decisions.
What is wisdom? Cross-cultural and cross-disciplinary syntheses.

This article explores the nature of wisdom using an integrative cross-cultural and cross-disciplinary approach by drawing on contemporary research as well as the philosophical and contemplative dis...
Synthesis of Monolayer Molybdenum Disulfide and ToF-SIMS Characterization

Two dimensional (2D) materials have attracted much attention in the past decade. This family of materials includes metallic graphene and semiconducting transition metal dichalcogenides such as MoS2. Due to the excellent mechanical flexibility, electron transportation property, and transparency, 2D materials have great potential applications in electronics, sensor, and supercapacitor. Mechanical exfoliation and chemical vapor deposition (CVD) are two common methods to prepare the monolayer and a few atomic layer films. Because of the high yield and good quality of the monolayer film, the CVD method becomes the main stream to prepare 2D materials.
Civil and Uncivil Society

The debate over civil society remains unsettled, with varying, often conflicting ideas about its definition, purposes, and effects. Lurking within this argument is another even more amorphous concept, ‘uncivil society.’ Proposed sometimes as a resonant and seemingly obvious contrast to the real object of interest, uncivil society has increasingly taken on a life of its own, particularly in the post 9/11 period. This chapter argues that the concept of uncivil society should be strangled in the crib. In its various guises, it contributes to needless conceptual proliferation while adding little of analytic value. Worse, as typically used, uncivil society mixes a pretense at rigor with an overwhelming dose of obloquy. The term is used to place organizations, goals, or tactics beyond the political pale. Groups to the analyst’s liking are starred as civil, while those she abhors are tarred as uncivil. Such labeling is both acceptable and expected as a rhetorical tack in the thick of ideological combat. But if scholars are serious about understanding rather than politicking, uncivil society should be unceremoniously dispatched.
Tetravalent Ce in the Nitrate-Decorated Hexanuclear Cluster [Ce6(μ3-O)4(μ3-OH)4]12+: A Structural End Point for Ceria Nanoparticles

We describe the synthesis and characterization of three glycine-stabilized hexanuclear CeIV cluster compounds, each containing the [Ce6(μ3-O)4(μ3-OH)4]12+ core structure. Crystallized from aqueous nitrate solutions with pH < 0, the core cluster structures exhibit variable decoration by nitrate, glycine, and water ligands depending on solution conditions, where increased nitrate and glycine decoration of the cluster core was observed for crystals synthesized at high Ce and nitrate concentrations. No other crystalline products were observed using this synthetic route. In addition to confirming the tetravalent oxidation state of cerium in one of the reported clusters, cyclic voltammetry also indicates that CeIV is reduced at ∼+0.60 V vs Ag/AgCl (3 M NaCl), which is significantly less than the standard electrode potential. This large decrease in the CeIV/CeIII reduction potential suggests that CeIV is significantly stabilized relative to CeIII within the examined cluster. These compounds are discussed in term...
Production of cytoplasmic azurophilic inclusions in connective tissue cells by suspending agents.

Comment and summaryThe evidence presented indicates that various suspending agents produce characteristic changes in fibroblasts and macrophages of loose connective tissue. Similar alterations occurred in endothelial system. The azurophilic inclusions were so named because they stain with the azur component of the polychrome dyes used. The data indicate that administration of cortisone acetate in conjunction with the suspending agents tends to increase the number of affected fibroblasts in areas remote from the site of injection.The number of azurophilic inclusions in each fibroblast and their persistence for many days following a single injection suggests that the function of this cell may be altered. This possibility should be taken into account in evaluating the action of Cortone on connective tissue reactions. Further, since the suspending agents also affect endothelial cells it is conceivable that they (as well as cortisone itself) could be responsible for modifying capillary permeability as describe...
BAP1 protein loss by immunohistochemistry: a potentially useful tool for prognostic prediction in patients with uveal melanoma.

Background Uveal melanoma is the most common primary malignant intraocular tumour in adults. Recently, biallelic inactivation of the BAP1 gene was shown to be associated with increased risk of metastasis in patients with uveal melanoma. Immunohistochemical (IHC) assessment of BAP1 protein loss has been shown to be an excellent surrogate for biallelic inactivation of BAP1. In this pilot study, we investigated whether loss of BAP1 expression by IHC is associated with prognosis in uveal melanoma patients. Methods We retrieved clinical data, reviewed pathological slides, and performed IHC for BAP1 in 40 primary uveal melanomas. Tumour cell type was classified as: spindle (>90% spindle cells); epithelioid (>90% epithelioid cells); or mixed. BAP1 expression was scored as diffuse (nuclear staining in >90% of tumour cells), heterogenous (nuclear staining in Results Tumours were obtained from 20 males and 20 females, with a median age of 60 years (range 31-81 years). Tumour cell types were: epithelioid (n=7, 18%), mixed (n=20, 50%), and spindled (n=13, 33%). BAP1 expression was absent in 23 (58%) tumours, heterogenous in seven (18%) tumours, and diffuse in 10 (25%) tumours. Absent BAP1 expression was more frequently seen in epithelioid/mixed cell tumours (19/27, 70%) than was heterogenous (3/27, 11%) or diffuse (5/27, 19%) expression; the corresponding figures for spindle cell tumours were 4/13 (31%), 4/13 (31%) and 5/13 (38%), respectively (p=0.057). Factors associated with improved survival were diffuse or heterogenous BAP1 expression (compared with absent expression, p=0.03) and age less than 60 years (p=0.049). Conclusion Analysis of BAP1 protein expression using immunohistochemistry may serve as a rapid and cost-effective means of identifying uveal melanoma patients with aggressive disease, who can then be managed appropriately.
Native Sources of Japanese Industrialization, 1750-1920

Acknowledgments Introduction 1 Premodern Economic Growth: Japan and the West 2 The Land Tax in the Tokugawa Period 3 Farm Family By-Employments in Preindustrial Japan 4 Peasant Families and Population Control in Eighteenth-Century Japan 5 Japan's Aristocratic Revolution 6 The Discontented 7 "Merit" as Ideology in the Tokugawa Period 8 Okura Nagatsune and the Technologists 9 Peasant Time and Factory Time in Japan 10 The Right to Benevolence: Dignity and Japanese Workers, 1890-1920 Index
Determination of lamotrigine in serum by HPLC

Objective To establish a HPLC method of determination of lamotrigine concentration in serum.Methods Hypersil-C18 column was used,temperature of colum was 30 ℃,mobile phase was 1% Tris(hydroxymethyl) aminomethane-acetonitrile(70∶30),flow rate was 0.8 mL·min-1.The detecting wavelength was at 230 nm.Results The linear range of lamotrigine serum samples was 0.39%-50.00 mg·L-1.The intra-day and inter-day precisions of 3 different concentrations(1.56,6.25,25.00 mg·L-1) were all less than 5%.The methodology recoveries were(103.8±3.6)%,(100.0±2.2)%,(99.1±4.2)%,respectively.Conclusion The method with high recovery,good accuracy,easy operation is suitable for clinical routine monitoring for serum concentrations of lamotrigine.
Factors Influencing the Infectivity of Poliovirus Ribonucleic Acid.

SummaryEvidence presented shows that the influence of salt concentration of the environment on RNA infectivity for mammalian cells is due at least in part to alteration of the state of susceptibility of the host cell. The 3 different cell lines tested simultaneously responded differently when exposed to the same RNA preparation diluted in varying salt concentrations. Other factors which alter host cell susceptibility, sucrose concentration, age of host cell, nutritional environment of host cell and temperature during the adsorption interval, emphasize the importance of the physiological state of the cell at time of exposure to RNA to the degree of infectivity expressed.
FGF23 in Chronic Kidney Disease

Chronic kidney disease (CKD) is a growing public health epidemic that is associated with a markedly increased risk of cardiovascular mortality. Disordered mineral metabolism and particularly, disordered phosphorus metabolism appears to be a contributing factor. Fibroblast growth factor 23 (FGF23) regulates phosphorus and vitamin D metabolism. Its levels increase progressively beginning in early CKD, presumably as a physiological adaptation to maintain normal serum phosphate levels or normal phosphorus balance. FGF23 promotes phosphaturia and decreases production of calcitriol. Recent studies suggest that increased FGF23 is associated with mortality, left ventricular hypertrophy, endothelial dysfunction and progression of CKD. These results were consistently independent of serum phosphate levels. At the very least, FGF23 is emerging as a novel biomarker that may help identify which CKD patients might benefit most from aggressive management of disordered phosphorus metabolism. It is also possible that markedly increased FGF23 levels in CKD could contribute directly to tissue injury in the heart, vessels and kidneys, an exciting question that is sure to be the topic of intense investigation in the near future.
Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study

OBJECTIVES: By self-report, interruptions may contribute to up to 80% of ordering errors. A greater understanding of the frequency and context of interruptions during ordering is needed to identify targets for intervention. We sought to characterize the epidemiology of interruptions during order placement in the pediatric inpatient setting. METHODS: This prospective observational study conducted 1-hour-long structured observations on morning rounds and afternoons and evenings in the resident workroom. The primary outcome was the number of interruptions per 100 orders placed by residents and physician assistants. We assessed the role of ordering provider, number, type and urgency of interruptions and person initiating interruption. Descriptive statistics, χ2, and run charts were used. RESULTS: Sixty-nine structured observations were conducted with a total of 414 orders included. The interruption rate was 65 interruptions per 100 orders during rounds, 55 per 100 orders in the afternoons and 56 per 100 orders in the evenings. The majority of interruptions were in-person (n = 144, 61%). Interruptions from overhead announcements occurred most often in the mornings, and phone interruptions occurred most often in the evenings (P = .002). Nurses initiated interruptions most frequently. Attending physicians and fellows were more likely to interrupt during rounds, and coresidents were more likely to interrupt in the evenings (P = .002). CONCLUSIONS: Residents and physician assistants are interrupted at a rate of 57 interruptions per 100 orders placed. This may contribute to ordering errors and worsen patient safety. Efforts should be made to decrease interruptions during the ordering process and track their effects on medication errors.
Estrogen Modulation of Blood Copper and Other Essential Metal Concentrations

The modulation of serum copper/ iron and zinc by estrogens during pregnancy and oral contraceptive usage has long been described. The current understanding is that serum copper or ceruloplasmin is elevated almost 100% above control values, whereas serum iron and zinc are slightly depressed from control levels. The effect of estrogen on serum copper does not appear to correlate well with either serum or urinary estrogen levels, suggesting a secondary relationship. One mechanism for elevated serum copper involves a polypeptide produced by monocytes described in infectious disease, leukocyte endogenous mediators (LEM). Since estrogens stimulate monocyte populations and a number of features of estrogen effects are similar to LEM actions, we hypothesize that estrogens modulate serum copper (ceruloplasmin) through monocyte release of LEM and its actions.
Husserl and Derrida on the Origin of Geometry

When considering the difference between something and the essence of something, Aristotle seems undecided as to whether this difference is discerned by different capacities of the psyche, or by the same capacity in different relations (On the Soul, 429b, 10-23). Proceeding from the recogni-tion that the state of affairs at issue is such that there are many cases in which there is indeed a difference between something, e.g., magnitude, water, flesh, straight, and its essence, Aristotle finds in the difference or differences at issue a reference to the psyche’s capacity to discern the terms of this difference.
Steady Nonintegrable High-Dimensional Fluids

We consider the existence of steady incompressible fluids (solutions to the Euler equations) on Riemannian manifolds of dimensions three and higher. We demonstrate that, as in the case of the ABC fields in dimension three, there exist chaotic Beltrami fields – nonsingular eigenfields of the curl operator – in higher dimensions. We give an explicit set of analytic examples on a non-Euclidean five-torus T5. We also detail a ‘plug’ construction for inserting chaotic vortices into a Beltrami field. These constructions employ contact-topological techniques.
DNA Repair Processes can alter the Frequency of Mutations Induced in Diploid Human Cells

The ability of DNA excision-repair processes in diploid human fibroblasts to eliminate potentially cytotoxic and mutagenic lesions induced by UV radiation or several chemical carcinogens, including N-acetoxy-2-acetylaminofluorene or the “anti” 7,8-diol-9,10-epoxide of benzo(a)pyrene, was investigated. Cells with normal rates of excision were compared with cells with an intermediate rate of excision (XP2BE or XP5BE) and cells with an excision rate ∼1% that of normal (XP12BE) for sensitivity to the killing and mutagenic action of these agents. The normal cells proved resistant to doses which significantly reduced the survival of the XP cells and increased the frequency of mutations to 8-azaguanine resistance in the XP cells 5- to 10-fold over background. Cells in confluence were exposed to cytotoxic and mutagenic doses of these agents and allowed to carry out excision repair. After various lengths of time they were replated at lower densities to allow for expression of mutations to 6-thioguanine resistance and/or at cloning densities to assay survival. Normal cells and XP cells with reduced rates of excision repair (from complementation groups C or D) exhibited a gradual increase in survival from an initial level of 15–20% to 80–100% if held in confluence. Recovery from UV irradiation was complete in less than 24 hours, whereas after treatment with the chemical agents, repair continued for several days and recovery followed similar kinetics. In contrast, XP12BE cells showed no excision repair and no increase from an initial survival of 20%, even when held for 7 days. Normal cells treated with these agents in confluence, but prevented from replicating for 7 days, exhibited background or near background mutation frequencies, whereas the mutation freuency in XP12BE cells did not change with the time in confluence.
Fully-Integrated Non-Magnetic 180nm SOI Circulator with > 1W P1dB, >+50dBm IIP3 and High Isolation Across 1.85 VSWR

There has been recent progress on CMOS non-magnetic circulators based on switch-based spatio-temporal conductivity modulation, but these initial demonstrations remain limited in transmitter power handling, linearity, and ability to combat antenna variations. This paper describes a non-magnetic circulator in 180nm SOI CMOS that uses no external components, and employs various linearity enhancement techniques such as device stacking, optimal switch biasing, and localized ESD design to achieve >1W TX-ANT PldB and >+50dBm TX-ANT IIP3 at 1GHz. A new loss-free and inductor-free antenna balancing approach enables high isolation for as high as 1.85 ANT VSWR and beyond. The circulator also exhibits low insertion losses of 2.1dB/2.9dB in the TX-ANT and ANT-RX paths, and ANT-RX NF of 3.1dB. These results represent a 10–100×enhancement in linearity/power handling over prior CMOS non-reciprocal circulators, and are shown to lower the power consumption of a communication link when compared with state-of-the-art electrical balance duplexers in scenarios where dynamic range is limited by P1dB, NF.
Abstract 1339: Development of a novel autophagy-inducing multikinase inhibitor for the treatment of castration-resistant prostate cancer

Inhibition of the androgen axis has revolutionized the treatment of metastatic castration-resistant prostate cancer (mCRPC). However, mCRPC continues to be a leading cause of cancer-related deaths in men. Here, we characterized a phase I-cleared multikinase inhibitor, ESK981, in prostate cancer preclinical models. ESK981 was markedly more potent in vitro than other kinase inhibitors, including cabozantinib and crizotinib, that have been evaluated clinically in prostate cancer. Surprisingly, we observed that ESK981 was a potent inducer of cellular vacuolization that was associated with an autophagic response. ESK981-induced autophagy could be blocked by either the depletion of the autophagy vesicle formation gene, atg5, or by autophagy inhibitors such as bafilomycin. ESK981 was further shown to induce autophagy in yeast, which is an evolutionarily conserved core cellular pathway. Moreover, ESK981 triggered prostate cancer cells to release chemokines such as CXCL10 into the cell secretome, thus suggesting that ESK981 may stimulate immune surveillance while exerting its tumor inhibitory effect. Together, ESK981 is a novel and potent autophagy-inducing multikinase inhibitor that effectively inhibits CRPC growth through the activation of the autophagic cascade. Citation Format: Yuanyuan Qiao. Development of a novel autophagy-inducing multikinase inhibitor for the treatment of castration-resistant prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1339.
Impact of residual stress on thermal damage accumulation, and Young's modulus of fiber-reinforced ultra-high temperature ceramics

Abstract Ultra-high temperature ceramic matrix composites (UHTCMCs) based on ZrB2-matrix reinforced with 45 vol% of unidirectional continuous carbon fibers are studied through the thermal mechanical hysteresis in order to investigate the thermal damage accumulation. The analysis carried out allowed to extrapolate the Young's modulus of the matrix from thermal expansion measures. It was found that the initial matrix Young's modulus of 195 GPa steadily decreases by thermal cycling the samples between RT and 1300 °C as a consequence of matrix cracking. On the other hand, the analysis suggested that carbon fibers keep their Young's modulus constant at 780 GPa. Finally, the residual stresses due to the different coefficient of thermal expansion between matrix and carbon fibers are discussed and let to justify the Young's modulus of 230 GPa, which cannot be explained with the so-called “rule of mixtures” generally valid and widely used in the composite science.
SIG (Space) Gets Started

The SIG (Space) had its first meeting in September 1982. Staff support was provided by Air Force Col. Gil Rye, National Security Council director for space programs, who had an ambitious agenda for reforming U.S. space efforts. The group chose three topics for initial study: space launch policy, a possible space station, and remote sensing (observing the Earth from orbit). By December, at Rye’s initiative SIG (Space) also began an effort to develop a comprehensive national space strategy.
FarSight: Long-Range Depth Estimation from Outdoor Images

This paper introduces the problem of long-range monocular depth estimation for outdoor urban environments. Range sensors and traditional depth estimation algorithms (both stereo and single view) predict depth for distances of less than 100 meters in outdoor settings and 10 meters in indoor settings. The shortcomings of outdoor single view methods that use learning approaches are, to some extent, due to the lack of long-range ground truth training data, which in turn is due to limitations of range sensors. To circumvent this, we first propose a novel strategy for generating synthetic long-range ground truth depth data. We utilize Google Earth images to reconstruct large-scale 3D models of different cities with proper scale. The acquired repository of 3D models and associated RGB views along with their long-range depth renderings are used as training data for depth prediction. We then train two deep neural network models for long-range depth estimation: i) a Convolutional Neural Network (CNN) and ii) a Generative Adversarial Network (GAN). We found in our experiments that the GAN model predicts depth more accurately. We plan to open-source the database and the baseline models for public use.
Smap L4 Assessment of the Us Northern Plains 2017 Flash Drought

A rapidly developing "flash drought" occurred over the US Northern Plains in the summer of 2017, spurred by unusually high temperatures and strong evaporative demand. The impacts of the drought included widespread reductions in rangeland and agricultural productivity that cascaded into significant economic losses. Here, we used satellite information from the NASA Soil Moisture Active Passive (SMAP) mission to clarify the nature and impact of the drought on regional vegetation growth. The model enhanced SMAP Level 4 Soil Moisture (L4SM) and Carbon (L4C) products were used with other ancillary data to examine spatial and seasonal anomalies in surface to root zone soil moisture and vegetation productivity (GPP). We find that the flash drought was triggered by a mid-July heat wave, conditioned by exceptionally low spring rainfall. The drought resulted in anomalous low soil moisture levels and regional GPP collapse, coinciding with severe (D3) to exceptional (D4) drought conditions indicated from the US Drought Monitor. The SMAP L4C GPP anomalies closely tracked reported county-level crop production anomalies for the major regional crop types, indicating generally larger productivity decline in managed croplands than surrounding natural areas. The SMAP L4 global products provide an effective indicator of vegetation growth changes and moisture-related restrictions on ecosystem productivity that are complementary with more traditional drought assessment tools.
18 Resolving pediatric population-level gaps: success of an inreach model

Background Primary care settings have implemented processes to resolve population-level care gaps, including patient reminders, health record prompts, and outreach to patients/families. When patients present outside of primary care but still within the larger health system, these primary-care based processes are not applied, and opportunities to resolve care gaps are missed. We hypothesized that we could resolve care gaps outside the primary care setting by creating an ‘inreach’ process within the larger healthcare system. Objectives Among children 2–66 months of age within our primary care registry, we aimed to identify and resolve care gaps for children admitted to the hospital medicine service, Our goal was to contact the inpatient team for at least 80% of these patients, and to increase the percent of care gaps closed from 30% to 50%. Methods A multidisciplinary team of physicians, nurses and improvement experts mapped the baseline process. Failure modes were predicted, and a key driver diagram was developed. Through multiple PDSA cycles, we designed and tested a prototype inreach process. We then operationalized this process for patients admitted to the hospital medicine service, and focused on weekly failures to achieve process reliability. Results Assessments of care gaps increased from 0% to 88% by the end of December 2018. The percentage of care gap resolution has increased from 30% to 40%. Conclusions Using QI methods, a new process to help improve population health for children can be successfully implemented outside of the traditional domain of primary care.
Hoarse cry in a newborn with epidermolysis bullosa simplex, generalized severe

Hoarse cry and respiratory stridor are the signs of potentially life-threatening laryngeal involvement in selected severe and frequently early lethal subtypes of inherited epidermolysis bullosa (EB). We present a newborn with generalized skin blistering and onychodystrophy who developed a hoarse cry and inspiratory stridor. Ultrastructural skin examination revealed tonofilament clumping in basal keratinocytes and genetic testing identified the de novo missense mutation p.Arg125Cys in the KRT14 gene, consistent with EB simplex generalized severe, which is characterized by major morbidity in infancy but a favorable long-term prognosis. The present case underlines the importance to consider EB simplex generalized severe in the differential diagnosis of EB infants presenting hoarseness and stridor.
Flow over a hydrofoil in the wake of a propeller

Abstract Large Eddy Simulations are reported on the flow around a rudder operating in the wake of a propeller. Results demonstrate the production of important spanwise flows within the boundary layer on the hydrofoil, mainly tied to the behavior of the largest coherent structures populating the propeller wake. The two branches of the hub vortex are shifted from the pressure towards the suction sides of the rudder. The pressure and suction side branches of the tip vortices move outward and inward, respectively. This phenomena increase the asymmetry between pressure and suction sides, with wider areas of the rudder surface affected by the propeller wake on the pressure sides. In the vicinity of the leading edge the main sources of turbulent fluctuations within the boundary layer on the hydrofoil are the two branches of the hub vortex, with also an evident signature of the tip vortices, especially on the suction sides, where they experience a stronger stretching. Moving from the leading edge towards the trailing edge both momentum and turbulence within the rudder boundary layer become obviously higher on the pressure sides than on the suction sides, because of the impingement operated by the propeller wake, whose azimuthal velocity is directed towards the pressure sides of the hydrofoil. Such effect is evident across the whole spanwise extent affected by the propeller wake, involving also the outer radii populated by the tip vortices. However, moving away from the surface of the hydrofoil the turbulent stresses become higher on the suction sides, due to the shear generated by the contraction of the propeller wake, which is instead expanding on the pressure sides.
Clinical Team Perspectives on the Psychosocial Aspects of Transition to Adult Care for Patients With Childhood-Onset Systemic Lupus Erythematosus

OBJECTIVE The transition from pediatric to adult care for youth with childhood-onset systemic lupus erythematosus (SLE) is a vulnerable period. Adverse outcomes during this transition include gaps in care, unscheduled health care utilization, loss of insurance, and high disease activity. The objective of this study was to examine the clinical care teams' perspective on the psychosocial factors associated with transition outcomes, which are poorly understood in this population. METHODS We conducted in-depth interviews with clinical care team members who interact with childhood-onset SLE patients during transfer from pediatric to adult rheumatology. A semistructured interview guide was used to prompt participants' perspectives about the psychosocial factors associated with the transition process for patients with childhood-onset SLE. Audio recordings were transcribed and analyzed using the constant comparative method. We stopped conducting interviews once thematic saturation was achieved. RESULTS Thirteen in-depth interviews were conducted. Participants included pediatric rheumatologists (n = 4), adult rheumatologists from both academic and private practice settings (n = 4), nurses (n = 2), a nurse practitioner, a social worker, and a psychologist. We identified several themes deemed by clinical care teams as important during the transition, including the impact of the family, patient resilience and coping mechanisms, the role of mental health and emotional support, and the need for education, peer support, and social connectedness. CONCLUSION We identified several psychosocial themes that clinical team members believe impact the transition of patients with childhood-onset SLE into adult care. The role of parental modeling, youth resilience, mental health and emotional care, improved childhood-onset SLE education, and structured peer support and social connectedness are highlighted, which may be amenable to interventions.
An examination of electrophysiological release from masking in young and older adults.

The effect of age on release from masking (RFM) was examined using cortical auditory evoked potentials (CAEPs). Two speech-in-noise paradigms [i.e., fixed speech with varying signal-to-noise ratios (SNRs) and fixed noise with varying speech levels], similar to those used in behavioral measures of RFM, were employed with competing continuous and interrupted noises. Young and older normal-hearing adults participated (N = 36). Cortical responses were evoked in the fixed speech paradigm at SNRs of −10, 0, and 10 dB. In the fixed noise paradigm, the CAEP SNR threshold was determined in both noises as the lowest SNR that yielded a measurable response. RFM was demonstrated in the fixed speech paradigm with a significant amount of missing responses, longer P1 and N1 latencies, and smaller N1 response amplitudes in continuous noise at the poorest −10 dB SNR. In the fixed noise paradigm, RFM was demonstrated with significantly lower CAEP SNR thresholds in interrupted noise. Older participants demonstrated significantly longer P2 latencies and reduced P1 and N1 amplitudes. There was no evidence of a group difference in RFM in either paradigm.
Racial Trauma and Dissociated Worlds within Psychotherapy: A Discussion of “Racial Difference, Rupture, and Repair: A View from the Couch and Back”

The accounts of three Black authors (also patients and therapists), Matee, Jwili, and Vilakazi, offer a unique opportunity to expand understandings of racial trauma and racial dynamics in psychothe...
Functional cell death, corneoptosis, requires temporally controlled intracellular acidification.

As the mammalian body’s largest organ, the skin is the first defense against a host of environmental insults. Specifically, the outermost layer of the skin, the stratum corneum (SC), provides much of the essential barrier function of the epidermis, protecting the body’s surface from mechanical force, water loss, pathogens, toxins, and allergens (1). Epithelial cells of the skin, called keratinocytes, undergo various sequential stages of differentiation on their way to this outermost layer of the stratified epithelium. Proliferative keratinocytes originate in the stratum basale (SB) and first differentiate into the stratum spinosum (SS) layers (2, 3). They continue differentiating, forming the three layers of the stratum granulosum (SG3, SG2, and SG1), with a tight junction-mediated barrier forming in SG2. Finally, SG1 cells undergo a very specific kind of cell death, beginning the process of cornification and leading to the formation of the SC, layers of dead keratinocytes and the functional barrier of the skin (4, 5). This differentiation step is perhaps one of the most interesting, as the remnants of this mode of cell death (corneocytes) remain functional and essential to the skin barrier. This complex form of keratinocyte death involves degradation of membraneless organelles called keratohyalin granules (KHGs), formation of the cornified envelope which replaces the plasma membrane, and degradation of the nucleus (Fig. 1) (1, 4). However, the exact cellular and molecular mechanisms underpinning this unique process of cell death are still not fully understood. Matsui et al. (6) combine elegant in vivo and in … [↵][1]1To whom correspondence may be addressed. Email: jessica.l.moore{at}yale.edu or valentina.greco{at}yale.edu. [1]: #xref-corresp-1-1
Validation of Urban Flood Inundation Models Applied Using Nationally Available Data Sets: Novel Analyses of Observed High Water Information

AbstractThis paper presents novel spatial analysis techniques to evaluate simulations of urban flood inundation from two hydrologic models applied using nationally available datasets. These techniq...
Considerations for designing and implementing combination HIV cure trials: findings from a qualitative in-depth interview study in the United States.

Author(s): Dube, Karine; Kanazawa, John; Dee, Lynda; Taylor, Jeff; Sauceda, John A; Gianella, Sara; Smith, Davey; Deeks, Steven G; Peluso, Michael J | Abstract: BackgroundAn increasing number of HIV cure trials involve combining multiple potentially curative interventions. Until now, considerations for designing and implementing complex combination HIV cure trials have not been thoroughly considered.MethodsWe used a purposive method to select key informants for our study. Informants included biomedical HIV cure researchers, regulators, policy makers, bioethicists, and community members. We used in-depth interviews to generate ethical and practical considerations to guide the design and implementation of combination HIV cure research. We analyzed the qualitative data using conventional content analysis focused on inductive reasoning.ResultsWe interviewed 11 biomedical researchers, 4 community members, 2 regulators, 1 policy researcher, and 1 bioethicist. Informants generated considerations for designing and implementing combination interventions towards an HIV cure, focused on ethical aspects, as well as considerations to guide trial design, benefit/risk determinations, regulatory requirements, prioritization and sequencing and timing of interventions, among others. Informants also provided considerations related to combining specific HIV cure research modalities, such as broadly neutralizing antibodies (bNAbs), cell and gene modification products, latency-reversing agents and immune-based interventions. Finally, informants provided suggestions to ensure meaningful therapeutic improvements over standard antiretroviral therapy, overcome challenges of designing combination approaches, and engage communities around combination HIV cure research.ConclusionThe increasing number of combination HIV cure trials brings with them a host of ethical and practical challenges. We hope our paper will inform meaningful stakeholder dialogue around the use of combinatorial HIV cure research approaches. To protect the public trust in HIV cure research, considerations should be periodically revisited and updated with key stakeholder input as the science continues to advance.
Chapter 9 The Kdp System: A Bacterial K+ Transport ATPase

Publisher Summary Escherichia coli essentially have two transport systems that are capable of accumulating K+ in order to achieve high cellular concentrations. These two systems generally exhibit certain common features. When E. coli is grown in customary media containing excess K+, only the constitutive Trk system, which has a modest affinity for K+(Km = 1.5 mM ) is present. When the Trk system is not able to satisfy their K+ needs, the cells derepress a second system, commonly called Kdp. This system has a very high affinity for K+ (Km= 2 μM ), which allows it to scavenge traces of K+ in the medium. This chapter focuses on Kdp system and describes its structure, function, and regulation. Kdp appears to have a reaction cycle involving an acyl phosphate intermediate similar to that of the vertebrate transport ATPases. The regulation of Kdp largely reflects the needs of its bacterial home. Its transport activity is feedback regulated by the turgor pressure and osmotic pressure difference exerted across the cell membrane. Turgor pressure is also implicated as the force that is responsible for derepressing the Kdp system when the cells require K+.
TU-G-210-01: Modeling for Breast and Brain HIFU Treatment Planning

Modeling can play a vital role in predicting, optimizing and analyzing the results of therapeutic ultrasound treatments. Simulating the propagating acoustic beam in various targeted regions of the body allows for the prediction of the resulting power deposition and temperature profiles. In this session we will apply various modeling approaches to breast, abdominal organ and brain treatments. Of particular interest is the effectiveness of procedures for correcting for phase aberrations caused by intervening irregular tissues, such as the skull in transcranial applications or inhomogeneous breast tissues. Also described are methods to compensate for motion in targeted abdominal organs such as the liver or kidney. Douglas Christensen – Modeling for Breast and Brain HIFU Treatment Planning Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Learning Objectives: 1. Understand the role of acoustic beam modeling for predicting the effectiveness of therapeutic ultrasound treatments. 2. Apply acoustic modeling to specific breast, liver, kidney and transcranial anatomies. 3. Determine how to obtain appropriate acoustic modeling parameters from clinical images. 4. Understand the separate role of absorption and scattering in energy delivery to tissues. 5. See how organ motion can be compensated for in ultrasound therapies. 6. Compare simulated data with clinical temperature measurements in transcranial applications. Supported by NIH R01 HL172787 and R01 EB013433 (DC); EU Seventh Framework Programme (FP7/2007-2013) under 270186 (FUSIMO) and 611889 (TRANS-FUSIMO)(TP); and P01 CA159992, GE, FUSF and InSightec (UV).
VARIATION THEORY: A VIEW FROM CREOLE CONTINUA

Practictioners of the area of linguistic investigation referred to as “quantitative” or “variacionist” sociolinguistics genereally see their as being to uncover mid account for the systematicity underlying veriation in speech behaviour. To this end, the have employed a variety of methods as well as analytic models aimed at incorporating variablility into linguistic description. Among the approaches are Labov’s variable rule’ model, and Bickerton’s “implicational” model. The present papar examines the relevance of these models of variation to Caribbean English creole continua and concludes that neither is well suited to providing a satisfactory account of the sociolinguistic heterogeneity characteristic of such situations. Like other speech communities, Caribbean creole continua manifest patterns of social and stylistic diffrerentiation of linguistic choices. But, unlike typical dialect situations, they display slzarp internal differences in linguistic repertoires and relationships which cannot be subsumed under a single grammar. The failure of variationist theory to adequately describe the orderly heterogeneity of such continuo has to do first, with the architecture of the proposed models, and second, with its tendency to treat sociolinguistic phenomena as though they could be translated directly into grammars, because of this, the social correlates of variation have tended to play a subordinate role to the main goal of variation theory, which is to construct grammars. The result is that many descriptions of variation play only in service to social explanation, or are indeed a-social in character. As long as variation theory continues to see its main objective as being to incorporate variability into current models of grammar, its contribution to a unified theory of a imbrication of language and socio-cultural organization will remain limited.
Noninvasive diagnosis of a false left ventricular aneurysm with radioisotope gated cardiac blood pool imaging. Differentiation from true aneurysm

Unlike the true left ventricular aneurysm, false aneurysms have recently been shown to be subject to late rupture. Rarely diagnosed before surgery or autopsy, the false aneurysm has never been identified by noninvasive techniques. We report the first such noninvasive diagnosis employing radioisotope gated cardiac blood pool imaging. Due to the unique and possibly life-threatening clinical course and potential for surgical cure of false left ventricular aneurysm, early noninvasive diagnosis by imaging techniques may be critical. The methods shown here are generally applicable, becoming widely available and may help in evaluation of false left ventricular aneurysm as a cause of sudden death.
The Insulin-like Growth Factor I Receptor: A Key to Tumor Growth?

Abstract The insulin-like growth factor I receptor (IGF-IR) belongs to the family of transmembrane tyrosine kinase receptors, like the receptors for platelet-derived growth factor, the epidermal growth factor, insulin, and others. Genetic evidence has shown that the IGF-IR is required for optimal growth in vitro and in vivo. Even more important, however, have been recent findings from several laboratories clearly showing that the IGF-IR is an absolute requirement for the establishment and maintenance of the transformed phenotype, both in vivo and in vitro and in several cell types. These findings indicate that the IGF-IR plays a central role in the mechanism of transformation and, as such, could be a preferred target for therapeutic interventions.