cssi/SciSciGPT-SciSciNet huggingface dataset:
Perspectives in the Use of Antiviral Agents for Prevention and Treatment of Respiratory Virus Infections

Respiratory viral infections are the most common infectious diseases of man and a major cause of morbidity and mortality globally. In developing countries respiratory viruses remain an important cause of childhood mortality (1). Acute respiratory diseases, which are frequently caused by viral infections, account for 20% of childhood mortality and in some parts of the world are the commonest cause of death in children (1). It is estimated that 2.2 million deaths occur throughout the world annually as a result of acute respiratory diseases. These diseases account for about 13% of all deaths in Africa, Central America and the developing countries of Asia, compared to 3% in North America (1). In developed countries certain viral infections continue to cause significant mortality in high-risk groups, particularly infants and the elderly. In the United States, influenza virus epidemics have been estimated to have been associated with over 10,000 excess deaths during 18 of the past 28 years (2).
Blood Clots and Vascular Networks: Self-Healing Materials

Perhaps one of the biggest differences between most living organisms and engineered materials is the ability to adapt and heal in response to damage and degradation (Nosonovsky, Self-repairing materials. In: Bhushan B (ed) Encyclopedia of nanotechnology. Springer, Netherlands, pp 2382–2385, 2012). Because engineered materials generally lack the inherent ability to fix themselves and deteriorate over time due to degradation, engineers are researching and developing self-healing materials—materials that can recover from damage without external intervention—in hopes that this will not be the case for certain applications in which self-repairing ability would be particularly advantageous (Ghosh, Self-healing materials: fundamentals, design strategies, and applications. In: Ghosh SK (ed) Self-healing materials: fundamentals, design strategies, and applications. Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim, pp 1–28, 2009). Though healing mechanisms of living organisms are extremely complex, making it difficult to mimic them, nature is a source of bio-inspiration for researchers who are seeking to create self-healing materials for the future of engineering. One such source of bio-inspiration includes blood clotting, which has taken the form of encapsulation (White et al., Nature 409:794–797, 2001) and hollow glass fibers in self-healing materials (Trask et al., Bioinspir Biomim 2(1):1–12, 2007). Vascular systems are another source of bio-inspiration and have led engineers to create circulatory concepts that also enable self-healing (Andersson et al., Self healing polymers and composites. In: van der Zwaag S (ed) Self healing materials. An alternative approach to 20 centuries of materials science. Springer, Netherlands, pp 19–44, 2008). This chapter shows how and why engineers used these natural mechanisms to develop self-healing materials and delves into the ways these self-healing materials can revolutionize the field of engineering and technology with a variety of applications ranging from self-repairing glass, corrosion protection, innovative aerospace composites, and more.
Qualitative and quantitative gonad-pituitary feedback.

Publisher Summary This chapter presents a line of evidence that for at least one anterior pituitary hormone, feedback control is not only quantitative but also qualitative. This means that the target gland—in this case, the gonad in its “back-talk” to the pituitary or brain-pituitary system—can dictate not only the amount of tropic hormone to be secreted but also the kind of tropic hormone. The chapter presents an evidence that in a rat, there is a set of changes in the biological and chemical characteristics of the FSH secreted by the pituitary that seems to bear no fixed relationship to either the degree or direction of any concomitant quantitative changes in FSH and LH secretory rates. These qualitative changes can be induced rapidly by alterations in the gonadal steroid environment to which the pituitary or brain-pituitary system is exposed. Furthermore, they can occur within a physiological range of circulating sex steroid levels. In the absence of gonadal steroids, the pituitary of the rat synthesizes, stores, and releases a type of FSH that is called “neuter-FSH.” In response to androgen replacement, both stored and circulating forms of FSH change in three ways. The pituitary begins to secrete a different hormone, “andro-FSH,” for which the index of discrimination, apparent molecular size, and capacity to survive in the circulation all are greater than they are for “neuter-FSH.” Ovarian steroid(s) appear to have an opposite effect. The index of discrimination for the FSH in female rat pituitaries is low, and the apparent molecular size of this FSH is even less than that of “neuter-FSH.” It seems reasonable to speculate that the female rat releases a relatively short-lived “gyno-FSH” into the circulation. The chapter also discusses the discovery of the types of FSH heterogeneity.
Identifying the forefront of electrocatalytic oxygen evolution reaction: Electronic double layer

Abstract Developing a fundamental understanding of oxygen evolution reactions (OER) is essential to advancing state-of-the-art energy conversion and storage technologies such as electrolysis. However, it is extremely difficult to directly observe the forefront of the reaction interface, i.e. the electronic double layer (EDL). Herein, electrochemical diagnostic tools are developed to study interfacial behaviors during alkaline OER. Using the traditional linear sweep voltammetry method, we observe that increasing the potential scan rate improves the performance of amorphous Ir oxides, while, for cubic NiCo2O3 with higher mass-transport resistance, the effect of scan rate is reversed. The results further confirm that the EDL capacitive and pseudocapacitive processes have a significant impact on electrocatalytic OER. Moreover, continuous EDL reconstruction is observed from double-potential-step chronoamperometry. This reconstruction, mainly caused by chemical phase modification, has a positive influence on OER performance for the Ni-Co oxide, but a negative influence for the Ir oxide. By studying EDL effects, our findings open up new strategies to design promising catalysts and elucidate OER mechanisms.
Implementing small‐scale poultry‐for‐nutrition projects: Successes and lessons learned

This paper examines Helen Keller International's model for nutrition-sensitive poultry production using a programme implemented in four diverse African contexts-three rural and one urban. Consecutive cross-sectional surveys conducted every 5 months among ~15% of participating households show that despite project-provided training and inputs, there was only limited uptake of many "best practices." Few households constructed improved henhouses; vaccination rates varied and were highest when support was provided. Poultry mortality was high. Egg productivity remained average for village poultry systems, and egg consumption remained low (two to six eggs consumed per household per fortnight). However, children whose mothers were exposed to project messages on nutrition were more likely to eat eggs, and consumption was consistently higher among households with chickens. Women's involvement in chicken rearing was widespread, but their control over revenues from the sale of poultry products was limited. Key lessons learned from implementation were as follows: (a) strong behaviour change communication is needed to encourage egg consumption, (b) nutrition-sensitive village poultry programmes should often focus more on improved practices than improved breeds, (c) supporting women's chicken production is not a route to empowerment without complementary activities that directly support women's ownership and decision making. There is also a need for rigorous research on the role of village poultry in livelihoods, food systems, and consumption as well as the structure of poultry and egg markets in low-resource areas.
Quantifying snow drift on Arctic structures: A case study at Summit, Greenland, using UAV-based structure-from-motion photogrammetry

Abstract Designing a building for polar stations involves countless cost-benefit trade-offs. One critical decision for planners is whether to elevate structures or place them on the snow surface. For planners wishing to minimize the impact of drifting, elevated structures are generally more desirable, with the tradeoff of added construction cost. Surface-based structures are less expensive to construct, but accumulate drift more rapidly than their elevated counterparts, thus incurring an added recurring expense of snow removal. To estimate this added cost, we quantified the volume of snow drifted on several structures at Summit, Greenland, using structure-from-motion photogrammetry from a small UAV. We find that while the elevated “Bighouse” accumulated negligible drift, the surface-based “Greenhouse” accumulated 4862 ±444 m 3 of snow. We then use estimates of equipment efficiency at snow removal coupled with equipment operating cost to determine the time and cost of snow removal (69 ± 6 h for the Greenhouse). Finally, we analyze a 10-year record of winds from Summit, and estimate the total amount of snow drifted on the structures in any given year. We estimate that the Greenhouse at Summit accumulates an average of 11,702 m 3 of snow per year, and that clearing that snow costs an average of $41,000 per year. The expense of snow removal for surface-based structures should be factored into the total lifetime cost of the building, making elevated structures much more cost-competitive than they may initially appear.
Theory of coupled-bunch longitudinal instabilities in a storage ring for arbitrary rf potentials

We present a theory of coupled-bunch longitudinal instabilities that is based on the coupled set of Vlasov equations governing the particle distribution function, and can be applied to arbitrary longitudinal potentials. We find that the coupled-bunch growth rate is given by a dispersion relation that is parametrized by the eigenvalues of the linear (harmonic) coupled-bunch matrix problem. Our theory therefore treats the wakefield-driven source of the instability and the effect of Landau damping together and on equal footing, and also indicates that the stabilizing effects of Landau damping can approximately be compared to the instability growth rates in a harmonic potential that has the same bunch length. We then apply the theory to a weakly nonlinear oscillator and to a quartic potential that is relevant for ultralow emittance storage rings that employ bunch-lengthening systems. In the latter case we find that the theory compares quite favorably with particle tracking simulations for the parameters of the planned upgrade of the Advanced Photon Source.
Utilization of pain medications and its effect on quality of life, health care utilization and associated costs in individuals with chronic back pain.

Purpose Pain medications are widely prescribed to treat chronic back pain (CBP). However, the effect of using pain medications on individuals with CBP has received very little attention. Objective The aim of this study was to determine the patterns of pharmacological treatment in the population with CBP and assess its impact on quality of life, health care utilization and associated costs in USA. Patients and methods Retrospective, cross-sectional data obtained from the Medical Expenditure Panel Survey (MEPS), from 2011 to 2015, were utilized for this study. Pharmacological treatment for CBP was categorized into three mutually exclusive categories: 1) opioids only, 2) nonsteroidal anti-inflammatory drugs (NSAIDs) only, 3) opioids and NSAIDs (combination). The effect of the use of these treatments was also evaluated. Results A total of 5,203 individuals with CBP were identified. Of these, 2,568 (49.4%) utilized opioids only, 1,448 (27.8%) utilized NSAIDs only and 1,187 (22.8%) utilized both pain medications. Lower health-related quality-of-life scores on both the Short Form Health Survey-12 version 2 (SF-12v2) components (mental component summary score: 44.42 vs 46.67, P<0.001; physical component summary score: 35.34 vs 40.11, P<0.001) were observed for the opioid-only group compared to the NSAID-only group. In addition, individuals utilizing opioids only had greater utilization of inpatient services, office-based services, outpatient services and emergency room visits along with higher related health care costs. Conclusion Future researchers need to investigate the long-term risks and benefits of opioids, and policy makers should evaluate the prescribing guidelines to aim for a more patient-centered care.
Development of a social media-based intervention targeting tobacco use and heavy episodic drinking in young adults.

Tobacco use and heavy episodic drinking (HED) commonly co-occur in young adults. We developed and tested usability of the Smoking Tobacco and Drinking (STAND) intervention for young adults delivered on Facebook. To inform the intervention, focus groups were held with 25 young adults age 18 to 25 (12% female; Mean age = 20.4) who smoked cigarettes and reported at least one HED episode in the past month. Facebook intervention posts (N = 180) were tailored to readiness to quit smoking, and tested in two private Facebook behavioral change groups (Ready, Not Ready) with N = 29 young adults (10% female; Mean age = 20.8). Participants flagged posts in need of change, and we assessed engagement (comment frequency). Focus groups revealed preference for changing one substance at a time and greater receptivity to quitting smoking than reducing drinking. Mean comments per post were 5.3 (SD = 1.1) in Ready groups and 11.7 (SD = 5.1) in Not Ready groups; 94/180 (52.2%) posts were flagged for change. The level of engagement and the flagging of posts for change did not differ by group or by whether the post targeted tobacco, alcohol, or both substances combined (all p > .10). Overall, STAND was rated as easy to understand, providing sound advice, worthy of recommendation, and helpful (all agreement 100% among Ready; 50–70% among Not Ready). The current findings informed development of a social media-based intervention targeting tobacco and alcohol use in young adults. Although there was greater interest in making changes in smoking than drinking behavior, receptivity and acceptability of the Facebook post messages in the STAND intervention was high overall. The intervention is being further refined for evaluation in a larger trial. Trial registration Name of the registry Smoking Tobacco and Drinking Study (STAND); Trial registration number NCT03163303; Date of registration 5/23/17; URL of trial registry record https://clinicaltrials.gov/ct2/show/NCT03163303 .
Pediatric Laparoscopic Common Bile Duct Exploration: An Opportunity to Decrease ERCP Complications.

Abstract Background Laparoscopic intraoperative cholangiogram (IOC) with common bile duct exploration (CBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are two therapeutic techniques for choledocholithiasis. The preferred technique is unclear. Materials and methods We identified subjects who underwent laparoscopic cholecystectomy (LC) and IOC/CBDE or ERCP from July 1, 2006, to December 31, 2016. We retrospectively reviewed 81 patients (≤ 18 y) who received these interventions for suspected choledocholithiasis. Main outcomes analyzed were success of intervention and complications. Results Of the 81 patients, 21 ERCPs and three endoscopic ultrasounds (EUSs) were performed before LC. Eighteen of 21 (85.7%) patients had stones or sludge cleared by ERCP, whereas 3 (14.3%) had normal common bile ducts without evidence of stones. Five of 24 (20.8%) had significant post-ERCP complications. Seven of 24 (29.2%) had more than one admission. Sixty of 81 patients underwent LC with IOC ± CBDE. Twenty one of 60 (36.2%) were found to have abnormal IOC. Eight of 15 (53.3%) attempted laparoscopic CBDE were successful. Eleven of 21 (52.4%) patients with abnormal IOC had post-LC ERCP (10) and EUS (1). Patients admitted to the Pediatric Surgery service were more likely to undergo LC first than ERCP/EUS (OR 3.46, 95% CI 1.26 to 9.45, P = 0.016). Patients undergoing LC first had a shorter length of stay (mean LOS 5.13 d versus 4.07, median 5.0 versus 3.0 d, P-value Conclusions Successful and safe laparoscopic treatment of choledocholithiasis is possible in the pediatric patient. A laparoscopic-first approach to suspected choledocholithiasis may reduce the number of procedures needed in this patient population.
The alkaliphilic side of Staphylococcus aureus

Abstract The genome of Staphylococcus aureus has eight structurally distinct cation/proton antiporters (CPA) that play significant roles in maintaining cytoplasmic pH and ions in extreme conditions. These antiporters enable S. aureus to persist under conditions that are favorable to the bacterium but unfavorable to animal host including humans. In this study, we report physiological roles and catalytic properties of NhaC (NhaC1, NhaC2 and NhaC3), CPA1 (CPA1-1 and CPA1-2) and CPA2 family antiporters and how these antiporters crosstalk with Mnh1, a CPA3 family antiporter, recently shown to play important roles in virulence and pH tolerance. Catalytic properties of antiporters were determined by Na+/H+ and K+/H+ antiport assays using everted membrane vesicles of a CPA-deficient E. coli KNabC host. NhaC and CPA1 candidates exhibited Na+/H+ and K+/H+ antiporter activity in the pH range between pH 7 to 9.5 but did not show significant role in halotolerance and osmotolerance alone. Interestingly, NhaC3 exhibited significant antiporter activity at alkaline pH and play major roles in pH and salt tolerance. CPA2 neither exhibited Na+or K+/H+ exchange nor showed any active role in pH and salt tolerance. Double deletion of mnhA1 with nhaC1, nhaC3, cpa1-1 or cpa1-2 respectively, made S. aureus severely sensitive at pH 7.5 under stress conditions indicating synergistic relationship of Mnh1 with these antiporters. The functional loss study of these antiporters in in-vivo mouse infection model, nhaC3 deletion showed significant loss of S. aureus virulence. Altogether, the current study indicates NhaC3 as a potential target against S. aureus virulence under extreme pH and salt conditions. Importance In this study, we established catalytic properties and physiological roles of S. aureus NhaC, CPA1 and CPA2 family antiporters and their importance under salt and alkaline stress conditions. Except CPA2, all five antiporters of both families were active for Na+/H+ and K+/H+ exchange. CPA1-1 showed significant role in pH homeostasis at pH 7.5 whereas CPA1-2 and NhaCs were major contributors to halotolerance and osmotolerance at alkaline pH. The severity of growth deficit in double knockouts of mnhA1 with each of nhaC1, nhaC2, nhaC3, cpa1-1 or cpa1-2 establishes their synergistic relationship in regulating pH and salt homeostasis. Deletion of cpa1-1, cpa1-2 and nhaC1, nhaC2, and nhaC3 were assessed in mice model and NhaC3 was shown to play a major role in S. aureus virulence.
Prognosis for Recovery of Foot Drop after Transforaminal Endoscopic Decompression of Far Lateral Lumbar 5-Sacral 1 Herniated Disc: Case Series.

Background Foot drop that results from compression of the exiting L5 nerve as a result of far lateral disc herniation (FLDH) at L5-S1 poses a significant surgical challenge to the minimally-invasive spine surgeon given the narrow corridor for an extraforaminal approach because of the high iliac crest. Objectives Here we describe our experience with transforaminal endoscopic decompression for the treatment of foot drop secondary to FLDH at L5-S1. Study design Retrospective case review. Setting This study took place in a single-center, academic hospital. Methods A technique for the transforaminal endoscopic treatment of foot drop secondary to L5-S1 FLDH is presented in a series of 5 consecutive patients treated over a period of 3 years. Preoperative and postoperative clinical data with 1-year follow-up are presented. Results A consecutive series of 211 patients who underwent transforaminal endoscopic treatment for lumbar radiculopathy between 2011 and 2014 are presented. Seventy-seven patients had L5-S1 discectomies and 5 of those patients presented with foot drop and FLDH. The mean visual analog scale score for radicular pain improved from an average pain score before surgery of 7.2 to 0.8 one year after surgery, and the mean motor score for anterior tibialis strength improved from an average motor score before surgery of 2.6 to 4.8 one year after surgery. Limitations Small case series evaluated retrospectively with one year follow-up. Conclusions Transforaminal endoscopic surgical access to FLDH pathology may be a unique approach to the treatment of foot drop because it allows for neural decompression of disc and foraminal pathology without requiring significant destabilizing bone removal. Key words Endoscopic spine surgery, minimally-invasive, transforaminal, foot drop, far lateral disc herniation.
Determinants of Success in Online Social Lending: A Peak at US Prosper & UK Zopa

This paper examines social or peer to peer lending in two platforms, Prosper in the United States and Zopa in the United Kingdom. The hand-collected sample consists of 600 random loan requests -- 300 in each platform -- in different stages of fulfillment during the month of February 2011. The results show significant platform differences in terms of basic common characteristics such as loan amount, maturity and interest rate, as well as credit rating and borrower experience. Furthermore, the different measures in the speed of funding emphasize the importance of credit risk in both platforms as well as the likely use of rules of thumb by retail lenders. Lenders appear to have limits in the capital invested per loan and fund more slowly loans with lower credit ratings and loan purposes that may be related to lower credit scores. In the case of Zopa, besides lending more slowly, they also propose higher rates. Overall, evidence suggests that there are commonalities but also significant differences between Prosper in the US and Zopa in the UK.
A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death: by B. J. Miller, MD and Shoshana Berger. New York, NY: Simon & Schuster, 2019, 520 pp., $28.00 (hardcover), ISBN 978-1-5011-5716-5

As the book’s jacket proclaims, it is truly “The first and only all-encompassing action plan for the end of life.”Dr. B. J. Miller, a hospital and palliative medicine physician who has worked in a ...
A Dual-Axis Resonant Accelerometer Based on Electrostatic Stiffness Modulation in Epi-Seal Process

We report on the implementation of a novel vacuum-encapsulated dual-axis resonant accelerometer utilizing electrostatic stiffness modulation. Novel flexure designs are used to enable fully-decoupled in-plane dual-axis translational motions of the proof-mass to achieve low cross-axis sensitivity with the translational mode frequencies above 20 kHz for high bandwidth applications. Differential frequency readout scheme mitigates the temperature effects on frequency stability of resonators and reduces off-axis sensitivity. The fabricated device measures a scale factor of 22Hz/g (119ppm/g) with low cross-axis sensitivity. The accelerometer demonstrates high performance with 18μg/√Hz VRW and 27μg BI in ambient environment. Optimization of the oscillator circuits and implementation of chip-level ovenization can further improve the performance of the design, with potentials to reach sub-μg performance for emerging high-bandwidth application.
Guidance concerning chiropractic practice in response to COVID-19 in the U.S.: a summary of state regulators' web-based information.

The COVID-19 pandemic led to unprecedented changes, as many state and local governments enacted stay-at-home orders and non-essential businesses were closed. State chiropractic licensing boards play an important role in protecting the public via regulation of licensure and provision of guidance regarding standards of practice, especially during times of change or uncertainty. The purpose of this study was to summarize the guidance provided in each of the 50 United States, related to chiropractic practice during the COVID-19 pandemic. A review of the public facing websites of governors and state chiropractic licensing boards was conducted in the United States. Data were collected regarding the official guidance provided by each state’s chiropractic licensing board as well as the issuance of stay-at-home orders and designations of essential personnel by state governors. Descriptive statistics were used to report the findings from this project. Each of the 50 state governor’s websites and individual state chiropractic licensing board’s websites were surveyed. Stay-at-home or shelter-in-place orders were issued in 86% of all states. Chiropractors were classified as essential providers in 54% of states, non-essential in one state (2%), and no guidance was provided in the remaining 44% of all states. Fourteen states (28%) recommended restricting visits to only urgent cases and the remaining states (72%) provided no guidance. Twenty-seven states (54%) provided information regarding protecting against infectious disease and the remaining states (46%) provided no guidance. Twenty-two states (44%) provided recommendations regarding chiropractic telehealth and the remaining states (56%) provided no guidance. Seventeen states (34%) altered license renewal requirements and eight states (16%) issued warnings against advertising misleading or false information regarding spinal manipulation and protection from COVID-19. State guidance during the COVID-19 pandemic was heterogenous, widely variability in accessibility, and often no guidance was provided by state chiropractic licensing boards. Some state chiropractic licensing boards chose to assemble guidance for licensees into a single location, which we identified as a best practice for future situations where changes in chiropractic practice must be quickly communicated.
P152 Snacks Offered to Young, Recreational Soccer Players

Background Organized sports offer opportunities to promote healthy eating among children. Yet, research on older children shows that unhealthy snacks and beverages are often offered during sports events. Objective Assess attitudes of coaches and parents toward sports snack policies and what snack foods and beverages are offered to child athletes; and determine nutrient content of available sports snacks. Study Design, Setting, Participants Beverage and snack questionnaires were distributed among all parents (n = 120) and coaches (23) participating in a recreational under 5 years old (U5) and under 6 years old (U6) soccer league within a large Southeastern town. Snack observations for randomly selected U5 and U6 teams (n = 18) were recorded using an observational checklist following all scheduled combined practices/games. Measurable Outcome/Analysis Beverage and snack questionnaires assessed socio-demographic information; types, as well as frequency, of snacks and beverages offered to children; reasons for snack and beverage choices; and attitudes toward snack policies. Mean values across all observed snack foods and beverages were calculated for the following key nutrients: calories, protein, fat, carbohydrates, fiber, sugars, and sodium. Results Forty-four parents (36.7% response rate) and 23 coaches (100%) completed the questionnaire. Nutrition was the primary factor in snack and beverage selection. Yet, parents and coaches reported offering many low-nutrient foods to their children as snacks. Parents and coaches were receptive to different policy options to support healthy snack options. A total of 687 items were observed across 32 U5 and 28 U6 teams. The most popular snack category was grain-based desserts (31.3% of all snack foods) and 54.9% of all beverages were sugar-sweetened. Less than half (44.4%) of all snack foods and beverages met USDA snack nutrition standards. Snacks offered, on average, 205 calories per child. No vegetables were served during the observations. Conclusions Numerous nutrition education opportunities exist to improve the snack food and beverage offerings among parents and coaches in recreational sports settings.
Designing Effective Sustainability Assignments: How and Why Definitions of Sustainability Impact Assignments and Learning Outcomes.

The importance of, and interest in, sustainability in management education has increased significantly over the past three decades. However, the definition of sustainability remains complex and elu...
Race/Ethnicity and County-Level Social Vulnerability Impact Hospice Utilization Among Patients Undergoing Cancer Surgery

Integration of palliative care services into the surgical treatment plan is important for holistic patient care. We sought to examine the association between patient race/ethnicity and county-level vulnerability relative to patterns of hospice utilization. Medicare Standard Analytic Files were used to identify patients undergoing lung, esophageal, pancreatic, colon, or rectal cancer surgery between 2013 and 2017. Data were merged with the Centers for Disease Control and Prevention’s social vulnerability index (SVI). Logistic regression was utilized to identify factors associated with overall hospice utilization among deceased individuals. A total of 54,256 Medicare beneficiaries underwent lung (n = 16,645, 30.7%), esophageal (n = 1427, 2.6%), pancreatic (n = 6183, 11.4%), colon (n = 26,827, 49.4%), or rectal (n = 3174, 5.9%) cancer resection. Median patient age was 76 years (IQR 71–82 years), and 28,887 patients (53.2%) were male; the majority of individuals were White (91.1%, n = 49,443), while a smaller subset was Black or Latino (racial/ethnic minority: n = 4813, 8.9%). Overall, 35,416 (65.3%) patients utilized hospice services prior to death. Median SVI was 52.8 [interquartile range (IQR) 30.3–71.2]. White patients were more likely to utilize hospice care compared with minority patients (OR 1.24, 95% CI 1.17–1.31, p < 0.001). Unlike White patients, there was reduced odds of hospice utilization (OR 0.97, 95% CI 0.96–0.99) and early hospice initiation (OR 0.94, 95% CI 0.91–0.97) as SVI increased among minority patients. Patients residing in counties with high social vulnerability were less likely to be enrolled in hospice care at the time of death, as well as be less likely to initiate hospice care early. The effects of increasing social vulnerability on hospice utilization were more profound among minority patients.
AML-405: T-Cell Dynamics Associated with Outcomes in Acute Myeloid Leukemia Before and After Allogeneic Stem Cell Transplant

Background Allogeneic hematopoietic stem cell transplantation (HSCT) is curative for many patients with adverse-risk acute myeloid leukemia (AML). This is principally mediated by donor T-cells through the graft-versus-leukemia (GVL) effect. Therefore, we sought to characterize the T cell repertoire in AML before and after HSCT and compare those who achieve durable remission to those with relapse. Methods We identified 77 bone marrow biopsy samples from 33 patients with AML who were paired pre- and post-HSCT (19 patients who relapsed and 14 in remission for > 2 years as of last follow-up). We performed immunosequencing of the TCRβ repertoire (Adaptive Biotechnologies). DNA was amplified in a bias-controlled multiplex PCR, resulting in amplification of rearranged VDJ segments, followed by high-throughput sequencing. Changes in the TCR repertoire were characterized with the following metrics: (1) clonality (range: 0–1; values closer to 1 indicate a more oligoclonal repertoire); (2) richness (higher numbers indicating a more diverse repertoire with more unique rearrangements); (3) T cell density (range: 0–1; values closer to 1 indicate a higher proportion of T cells in the sample). Results The median age of patients was 52 years (range: 19–70); 43% and 37% of patients had a matched, related donor in the remission and relapse cohorts, respectively. Richness was greater in the pre-HSCT samples for patients who relapsed (13750 vs 3982, P = 0.001) compared to post-HSCT samples (3319 vs 2920, P = 0.1). Patients who relapsed had a greater productive clonality compared to remission patients in post-HSCT (0.15 vs 0.05, P = 0.06) samples, but were similar in pre-HSCT (0.07 vs 0.02, P = 0.1) samples. Patients who relapsed had a higher T cell density than those who achieved remission in both pre- (0.36 vs 0.13, P = 0.01) and post-HSCT (0.14 vs 0.11, P = 0.01) samples. Conclusion A more diverse baseline host TCR response was associated with relapse after HSCT. This may reflect host-intrinsic immune factors that affect transplant outcomes. To adequately capture how the GVL effect influences outcomes, studies incorporating TCR sequencing of the HSCT donor samples are ongoing.
"Is it Reasonable to Study Decision-Making Quantitatively?"

Scientists studying decision-making often provide a set of choices, each specified with values or distributions of values, and probabilities or distributions of probabilities. For example, "Would you prefer $100 with probability 1.0 or $1 with probability .9 and $1,000 with probability 0.1?" Other decision research examines choices made in the absence of most quantitative information; for example, "Would you prefer a Ford now or a Porsche a year from now?," "Which food would you prefer," but models the findings with precise quantitative assumptions. Yet other research does neither; for example, modeling verbally stated choices with verbally stated heuristics. This article asks about the relevance of the first two research approaches for much of the decision-making made in life. The use of quantitative research and modeling is unsurprising, given that this approach underlies most of science. In life, values and probabilities are almost always partly or wholly vague and qualitative rather than quantitative. For example, when deciding which house to buy, there are relevant features such as size, color, neighborhood schools, construction materials, attractiveness, and many more, but the decision-maker finds it difficult and of little use to assign these precise values or weights. Nonetheless, humans have evolved to make decisions in such vaguely specified settings. I provide an example showing how a very high degree of uncertainty can defeat the application of quantitative decision-making, but such a demonstration is not critical if quantitative research and modeling produce a good understanding of and a good approximation to decision-making in the natural environment. This perspective addresses these issues.
An irritability-based approach to whiplash-associated concussion rehabilitation: a case series.

Background: An estimated 45% of concussions are reported to be related to motor vehicle collisions (MVC). However, limited research exists involving the treatment of MVC-related concussion, especia...
P101 The Effects of a Community- and Clinical-Based Fruit and Vegetable Prescription Program (FVRx)® with Expanded Nutrition Education for Low-income Individuals

Background FVRx programs combining produce prescription and nutrition education have the potential to improve multiple diet-related behaviors of low-income adults. In 2018, the Athens FVRx program expanded nutrition education from 1 SNAP-Ed program (2017) to 2 SNAP-Ed programs and 1 financial literacy program. Objective To examine the effects of an FVRx program with expanded nutrition education and financial literacy education on nutrition and clinical outcomes in low-income adults. Study Design, Settings, Participants A 6-month non-randomized, parallel, controlled trial with 1 intervention (FVRx [n = 31]) and 2 comparison groups (Ad-hoc Nutrition Education (n = 10), and control [n = 16]). The final analytic sample (n = 36) included food insecure adults with a diet-related condition (mean age 53.8 ± 12.2 years (P Measurable Outcome/Analysis Pre- and post-intervention, 3 separate self-administered surveys assessed dietary intake, food security, food purchasing practices, and financial and food resource management. Clinical biomarkers (blood lipids, HbA1c) and biometrics (blood pressure, BMI) were measured. Descriptive analysis and one-way ANOVA were conducted. Results Post-intervention, FVRx participants significantly increased the frequency of consuming vegetables (once a day-once a week) by 22.2%, and knowledge, purchase, and preference of seasonally and locally available produce by (44.4%, 72.2%, and 16.7% respectively) compared to the comparison groups (P Conclusion Combining expanded nutrition and financial literacy education with produce prescription improves low-income adults’ financial and food resources, knowledge, purchase, preference, and consumption of locally grown vegetables.
Surgical Resection of Colorectal Liver Metastases: Attitudes and Practice Patterns in the Deep South.

Background Metastatic disease is the leading cause of mortality in colorectal cancer. Resection of colorectal liver metastases, when possible, is associated with improved long-term survival and the possibility of cure. However, nationwide studies suggest that liver resection is under-utilized in the treatment of colorectal liver metastases. This study was undertaken to understand attitudes and practice patterns among medical oncologists in the Deep South. Methods A survey of medical oncologists in the states of Alabama, Mississippi, and the Florida panhandle was performed. Respondents were queried regarding perceptions of resectability and attitudes towards surgical referral. Results We received 63 responses (32% response rate). Fifty percent of respondents reported no liver surgeons in their practice area. Commonly perceived contraindications to liver resection included extrahepatic metastatic disease (72%), presence of > 4 metastases (72%), bilobar metastases (61%), and metastases > 5 cm (46%). Bilobar metastatic disease was perceived as a contraindication more frequently by non-academic medical oncologists (70% vs. 33%, p = 0.03). Conclusions Wide variations exist in perceptions of resectability and referral patterns for colorectal liver metastases among surveyed medical oncologists. There is a need for wider dissemination of resectability criteria and more liver surgeon involvement in the management of patients with colorectal liver metastases.
Promoting Resilience: Suggestions for Families, Professionals, and Students

The majority of children who are deaf mature and become healthy adults who have fulfilling relationships and meaningful careers and they contribute to society. Unfortunately, the professional literature in the field of deaf education tends to be oriented toward deficiencies and problems. This chapter stresses a strength-based perspective and begins by presenting the results of three small-scale studies that examined the perceptions of successful students, adults, and families. Central themes from those studies are presented and then interwoven with a summary of practical suggestions for promoting resilience.
Reverberations of Haiti in the American North: Black Saint Dominguans in Philadelphia

In 1791, two black independence movements began a thousand miles apart; within a matter of months their paths would intersect. On lush, green Saint Domingue (the western portion of the island of Hispaniola), black rebellion erupted after nearly two centuries of killing plantation labor had swallowed up the lives of thousands of slaves, who on one-sixth of the land area of Virginia produced nearly half of the world's sugar and coffee. In Philadelphia, at the same time, a group of free blacks, who had worked their way out of bondage only a few years before, published plans for the first free black church in the United States, thereby planting the seed of a black Christianity unregulated by ecclesiastic authorities and relatively free from the social and psychological domination of white churches. Ina ringing broadside appeal for support in July 1791, the founding trustees of the African Church of Philadelphia, as the black leaders called it, argued "the necessity and propriety of separate and exclusive means, and opportunities of worshipping God, of instructing their youth, and taking care of their poor."1 Such an act of self-assertiveness signaled the pivotal role in the life of emancipated slaves that the black church would assume. The first historian of the church, its later minister William Douglass, described this creative striving for dignity and self-generated power. It was an "age of a general and searching inquiry into the equity of old and established customs," a time when "a moral earthquake had awakened the slumber of ages" and caused "these humble men, just emerged from the house of bondage ... to rise above those servile feelings which all their antecedents were calculated to cherish, and to assume, as they did, an attitude of becoming men, conscious of invaded rights."2 Just eight weeks after launching their church plan, Philadelphia's black leaders heard for the first time that in Saint Domingue, among other men "conscious of invaded rights," African sugar and coffee workers rose en masse to ignite the greatest black rebellion ever seen in the Americas.3 Shortly, black Philadelphians would see how the path of their non-violent revolution in Philadelphia crossed that of the epochal revolution in the Caribbean. For two years Absalom Jones, Richard Allen, and other leaders of the black church plan gathered small donations for their church. Assisting them was Philadelphia's generalissimo of reform, Dr. Benjamin Rush?called "Mr. Great Heart" by the Reverend Jeremy Belknap of Boston after the character in Bunyan's Pilgrims Progress who battled every hydra, hobgoblin, and giant blocking the way to the Celestial City. Working behind the scenes, Rush opened
Scientific Perspectives on Therapeutic Protein Drug–Drug Interaction Assessments

The purpose of this chapter is to describe our review of the literature on drug interactions involving therapeutic proteins (TPs), the FDA's expanded recommendations on TP-drug–drug interactions (DDIs) in the updated draft drug interaction guidance, and FDA-approved product labels that include TP-DDI information. The information presented in this chapter includes the following: TPs with drug interaction studies conducted during product development; types of study designs used to evaluate TP-DDIs; and impact of study results on product label. Keywords: drug–drug interactions; therapeutic proteins; U.S. Food and Drug Administration; drug interaction studies; study designs; product label
A middleware system for protecting against application level denial of service attacks

Recently, we have seen increasing numbers of denial of service (DoS) attacks against online services and web applications either for extortion reasons, or for impairing and even disabling the competition. These DoS attacks have increasingly targeted the application level. Application level DoS attacks emulate the same request syntax and network level traffic characteristics as those of legitimate clients, thereby making the attacks much harder to be detected and countered. Moreover, such attacks usually target bottleneck resources such as disk bandwidth, database bandwidth, and CPU resources. In this paper we propose server-side middleware to counter application level DoS attacks. The key idea behind our technique is to adaptively vary a client's priority level, and the relative amount of resources devoted to this client, in response to the client's past requests in a way that incorporates application level semantics. Application specific knowledge is used to evaluate the cost and the utility of each request and the likelihood that a sequence of requests are sent by a malicious client. Based on the evaluations, a client's priority level is increased or decreased accordingly. A client's priority level is used by the server side firewall to throttle the client's request rate, thereby ensuring that more server side resources are allocated to the legitimate clients. We present a detailed implementation of our approach on the Linux kernel and evaluate it using two sample applications: Apache HTTPD micro-benchmarks and TPCW. Our experiments show that our approach incurs low performance overhead and is resilient to application level DoS attacks.
Ecological importance of the Southern Boundary of the Antarctic Circumpolar Current

The Southern Ocean surrounds the Antarctic continent and supports one of the most productive marine ecosystems. Migratory and endemic species of whales, seals and birds benefit from the high biomass of their principal prey, krill (Euphausia superba) and cephalopods, in this area. Most species of baleen whales and male sperm whales in the Southern Hemisphere migrate between low-latitude breeding grounds in winter and highly productive Antarctic feeding grounds in summer. Here I show the importance of the southernmost reaches of the strongest ocean current, the Antarctic Circumpolar Current (ACC), to a complex and predictable food web of the Southern Ocean. The circumpolar distributions of blue, fin and humpback whales from spring to midsummer trace the non-uniform high-latitude penetration of shoaled, nutrient-rich Upper Circumpolar Deep Water, which is carried eastward by the ACC. The poleward extent of this water mass delineates the Southern Boundary1 of the ACC and corresponds not only to the circumpolar distributions of baleen whales, but also to distributions of krill and to regions of high, seasonally averaged, phytoplankton biomass. Sperm whales, which feed on cephalopods2, also congregate in highest densities near the Southern Boundary. The association of primary production, Krill, and whales with the Southern Boundary, suggests that it provides predictably productive foraging for many species, and is of critical importance to the function of the Southern Ocean ecosystem.
A deeper look at the teaching and practice of management and leadership

This work addresses the relationship between values and actions. The premise is that ethics must be integrated into all aspects of management and leadership in order for the action to be purposeful and beneficial to society. Leadership is treated here as representative of action. Ethics provide the basis for value systems that govern, or should govern, action. Action and values are incorporated into a framework for purposeful action. This framework combines management principles explicitly with a value system based upon ancient wisdom - rendering it more universal and timeless than those based upon narrowly interpreted religious or cultural traditions, or prevailing laws.
COMPARATIVE PHYSIOLOGY OF ANTIBIOTIC-RESISTANT STRAINS OF STAPHYLOCOCCUS AUREUS

Brown, Ruby L. (North Carolina State College, Raleigh) and James B. Evans. Comparative physiology of antibiotic-resistant strains of Staphylococcus aureus. J. Bacteriol. 85:1409–1412. 1963.—A collection of antibiotic-resistant strains of Staphylococcus aureus isolated from clinical sources was studied with respect to nutritional requirements and common diagnostic tests. Contrary to numerous reports in the literature indicating changes in these characteristics in antibiotic-resistant mutants, the present cultures were typical members of the taxonomic species S. aureus. They were coagulase-positive, fermented both glucose and mannitol under anaerobic conditions, produced acetoin from glucose, grew and produced black colonies on tellurite glycine agar, required both thiamine and nicotinic acid, and did not require other vitamins or purines. It is suggested that in most instances these cultures from clinical sources represent spontaneous mutants having genetic changes limited largely to loci concerned with antibiotic resistance. Most reports of extensive changes in physiology and nutritive requirements by antibiotic-resistant strains of S. aureus are based on studies of resistant strains selected after exposing a large population of the parent sensitive strain to toxic levels of antibiotics, chemical mutagens, or irradiation. Such isolates may have widespread genetic damage at other loci in addition to those concerned with their antibiotic resistance.