cssi/SciSciGPT-SciSciNet huggingface dataset:
Safety of Repeated Use of Intravenous Thrombolysis for Recurrent Acute Ischemic Stroke (S21.007)

Objective: To assess the safety of repeated use of intravenous thrombolysis (IV-tPA) in patients with recurrent acute ischemic stroke. Background: Approximately 25% of all ischemic strokes are recurrent events. IV-tPA is associated with improved outcomes when given to patients with acute ischemic stroke. It is uncertain whether repeated use of IV-tPA in patients with recurrent acute ischemic stroke is safe. We sought to evaluate the rate of use and safety of repeated IV-tPA in a large, heterogeneous cohort of patients with acute ischemic stroke. Design/Methods: Using administrative claims data, we identified all adults with acute ischemic stroke who received IV-tPA at California, New York and Florida hospitals from 2005–2013. Our exposure variable was prior use of IV-tPA for acute ischemic stroke. Our primary outcome was intracerebral hemorrhage and our secondary outcome was inpatient mortality. Both our exposure and outcomes were defined using using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. We used logistic regression to compare rates of outcomes in patients with and without use of IV-tPA for prior acute ischemic stroke. Results: We identified 35,307 patients with acute ischemic stroke treated with IV-tPA, of whom 385 (1.1%) received IV-tPA at a previous encounter for acute ischemic stroke. Of all patients who received IV-tPA, the rate of ICH was 5.9% (95% CI, 5.7–6.2%) and death occurred in 11.6% (95% CI, 11.2–11.9%) of patients. After adjusting for demographics, vascular risk factors and the Elixhauser Comorbidity Index, repeated use of IV-tPA for recurrent acute ischemic stroke was not associated with an increased risk of ICH (OR, 0.8; 95% CI, 0.5–1.3; P = 0.38) or an increased risk of death (OR 0.7; 95% CI, 0.5–1.1; P = 0.13). Conclusions: Repeated use of IV-tPA was not associated with an increased risk of intracerebral hemorrhage or death in patients with recurrent acute ischemic stroke. Disclosure: Dr. Atalay has nothing to disclose. Dr. Merkler has nothing to disclose.
Successful treatment of platinum refractory ovarian clear cell carcinoma with secondary cytoreductive surgery and implantable transponder placement to facilitate targeted volumetric arc radiation therapy

We describe a case of the first successful treatment of platinum refractory clear cell ovarian cancer with secondary cytoreductive surgery and placement of Calypso transponders to facilitate post-operative volumetric arc radiation therapy. In the setting of both primary and recurrent disease, patients with clear cell ovarian cancer are less responsive to standard chemotherapy and those treated with radiation therapy may have improved outcomes compared to the use of other treatment modalities. Volumetric arc radiation therapy with implantable transponders is feasible, and allows for the targeted treatment of sites of metastatic disease while limiting toxicity to surrounding structures and can be considered for patients with recurrent ovarian cancer and oligometastatic disease.
Patent Traders or Trolls: Innovation Accelerators or Inhibitors

Non-performing entities (NPEs) act as intermediaries between inventors and those who commercialize inventions. NPEs are patent-holding organizations that do not engage in the production of goods us...
Correction: Guideline levels for PFOA and PFOS in drinking water: the role of scientific uncertainty, risk assessment decisions, and social factors

This paper was originally published under a standard licence. This has now been amended to a CC BY licence in the PDF and HTML.
Estimates of willingness to accept compensation to manage pine stands for ecosystem services

Abstract Many ecosystem services are often overlooked in active management of private forests leading to their production below the levels preferred by the society. This study used the contingent valuation method (CVM) to estimate willingness to accept (WTA) compensation for managing a hypothetical tract of loblolly pine (Pinus taeda) for multiple ecosystem services. The CVM scenario involved four forest management alternatives representing increasing levels of forest management restrictions. A structural random effects probit model was constructed to quantify WTA compensation amounts. Mean WTA estimates ranged from $190.22 to $595.23 per hectare (ha) per year and increased with the intensity of forest management restrictions. Based on the WTA estimates, the total cost of increasing ecosystem production ranged from $0.88 to $4.76 billion per year. Increased budgets and private partnerships might be needed to implement forest management regimes facilitating multiple ecosystem services.
Canopy Adjustment and Improved Cloud Detection for Remotely Sensed Snow Cover Mapping

Author(s): Rittger, Karl; Raleigh, Mark S; Dozier, Jeff; Hill, Alice F; Lutz, James A; Painter, Thomas H
Pharmacotherapy for Interstitial Cystitis/Bladder Pain Syndrome

Current literature regarding pharmacotherapy treatment strategies available for the management of interstitial cystitis/bladder pain syndrome (IC/BPS) will be addressed including oral, transdermal, and intravesical therapies. Pharmacotherapies with emerging data will be addressed, but the focus is on those treatments described by the AUA guidelines for IC/BPS. While multiple pharmacotherapy options for the management of IC/BPS exist, the evidence for most medical therapies is not strong and frequently yields mixed results. It has been over two decades since a new medication has gained FDA approval for the treatment of IC/BPS. This has prompted clinicians to reassess the approach to evaluating patients with IC/BPS, leading to the advent of phenotype-directed multimodal therapy. Though national and international guidelines recommend a step-wise treatment algorithm beginning with the most conservative treatment options, the evidence for most therapies is mixed. Furthermore, recent randomized controlled trials of promising treatment options have yielded negative results, highlighting the importance of phenotype-directed classification to aid in the current management of IC/BPS and to allow for better research trial designs.
Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial

Background: Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use. Objective: This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences. Methods: This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor’s-level and master’s-level therapist electronic coaches posting relevant content and responding to participants’ posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups. Results: We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT. Conclusions: The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking. Trial Registration: ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586.
Temperature observations in Florence, Italy, after the end of the Medici Network (1654–1670): the Grifoni record (1751–1766)

This paper deals with the earliest meteorological observations in Florence after the Medici Network (1654–1670), i.e., from mid-seventeenth to mid-eighteenth century, and puts them in the context of the history of meteorology in Florence. After the gap caused by the Inquisition, observations started again in the eighteenth century, made by Cipriano Antonino Targioni (1728–1748), Giovanni Targioni-Tozzetti (1737–1740), Pietro Gaetano Grifoni (1751–1766), Leonardo Ximenes (1752), and Luca Martini (1756–1772). The first two records were lost, and this paper considers those by Grifoni and Ximenes. The latter is affected by severe bias; the former is of good quality and has been recovered and analyzed. Both the observers made only one reading a day and the metadata are scarce. The paper discusses several issues: the conversion from the apparent solar time to the Central Europe Time; the transformation from a single reading to a daily average; the identification of the thermometric liquid and the scale; the test made with the snow benchmark; the comparison with the contemporary series in Bologna. The comparison of the reconstructed series with other periods, i.e., 1654–1670, 1881–1910, 1961–1990, and 1991–2017, reveals that in mid-eighteenth century the temperature reached the lowest levels, especially in summer, and showed a sudden warming in the most recent decades.
Pediatric Hypersensitivity Pneumonitis: Clinicopathologic Characteristics of Two Cases with Fungal Triggers.

Background: Hypersensitivity pneumonitis (HP) infrequently presents in childhood. Asthma or a pneumonia-like clinical presentation may lead to diagnostic delay, especially in children. Case Report: We present two cases of HP, a 6-year-old (Case 1) male and a 5-year-old (Case 2) female. Both cases had a negative infectious work-up and patchy ground glass lung opacities on chest computed tomography. Lung biopsies demonstrated lymphocytic bronchiolitis with granulomatous interstitial and peribronchial inflammation. Serology demonstrated elevated immunoglobulin precipitins toward Thermoactinomyces and Aspergillus species in Case 1 and Aspergillus fumigatus in Case 2. Both patients received steroid therapy and had symptom resolution. Conclusions: A diagnosis of HP should be considered in pediatric lung biopsies with granulomatous interstitial and peribronchial inflammation, if infectious etiologies are excluded. Integration of clinical, radiological, and laboratory findings can facilitate a timely diagnosis.
The Reemergence of Vaccine Nationalism

This short essay explores the reemergence of vaccine nationalism during the COVID-19 pandemic The essay traces the pre-COVID origins of vaccine nationalism and
Implementation of generalized coarse-mesh rebalance in NEWTRNX for acceleration of parallel block-jacobi transport

The NEWTRNX [1] transport module solves the multigroup, discrete-ordinates source-driven or k-eigenvalue transport equation in parallel on a 3-D unstructured tetrahedral mesh using the extended step characteristics (ESC) [2], also known as the slice-balance approach (SBA), spatial discretization. The spatial domains are decomposed using METIS [3]. NEWTRNX is under development for nuclear reactor analysis on computer hardware ranging from clusters to massively parallel machines, like the Cray XT4. Transport methods that rely on full sweeps across the spatial domain have been shown to display poor scaling for thousands of processors. The Parallel Block-Jacobi (PBJ) algorithm allows each spatial partition to sweep over all discrete-ordinate directions and energies independently of all other domains, potentially allowing for much better scaling than possible with full sweeps [4]. The PBJ algorithm has been implemented in NEWTRNX using a Gauss-Seidel iteration in energy and an asynchronous communication by an energy group, such that each partition utilizes the latest boundary solution available for each group before solving the withingroup scattering in a given group. For each energy group, the within-group scattering converges with a generalized minimum residual (GMRES) solver [5], preconditioned with beta transport synthetic acceleration (β-TSA) [6].
A Mixed-Methods Evaluation to Measure 4-H STEM Program Quality

The 4-H Science: Building a 4-H Career Pathway Initiative was a 3-year collaboration among National 4-H Council, Lockheed Martin, and state 4-H grantees to help more than 50,000 youth in 13 states develop STEM and workforce skills for STEM professions. A mixed-methods design used observations and interviews to assess program quality. Researchers observed 4-H STEM programming and conducted individual and focus group interviews with youth, parents, community volunteers, corporate volunteers, and professionals. Observations were conducted using a validated observational tool, the Out-of-School Time (OST) Observation Instrument with STEM Plug-In. This instrument measured youth relationship building, youth participation, staff relationship building, staff instructional strategies, activity content and structure, and STEM instruction. Findings from the observations and interviews were combined to assess program quality. Sites scoring highest on the OST Observation Instrument reported using quality STEM curriculum, especially National 4-H Youth Science Day lessons. The 4-H STEM programs demonstrated highly evident and consistent youth relationship building (e.g., being friendly and collaborative) and youth participation (e.g.., contributing ideas and taking leadership). Yet, in many cases, STEM youth skill development (e.g., drawing connections to real-world concepts) and STEM staff instructional practices (e.g., discussing how youth could pursue STEM content through their education and/or career) were inconsistent and rarely evident. Recommendations include substantive professional and volunteer development for both STEM competencies and enhanced youth development. The OST Observation Instrument with STEM Plug-In provided a comprehensive tool to evaluate program quality, and it is recommended for use in evaluating other 4-H STEM programs.
Multi-class Mental Task Classification Using Statistical Descriptors of EEG by KNN, SVM, Decision Trees, and Quadratic Discriminant Analysis Classifiers

Five mental tasks, baseline, multiplication, letter-composing, rotation, and counting, were studied. In our work, we evaluated the performance of six statistical features including the mean of raw signal, the standard deviation of raw signal, the mean of the absolute value of the first derivative of the signal, the mean of the absolute values of the first derivative of the normalized signal, the mean of the absolute values of the second derivative of the raw signal, and the mean of the absolute values of the second derivative of the normalized signal. K-nearest-neighbor, support vector machines, decision trees and quadratic discriminant analysis classifiers were designed. Mental task classification was investigated by using both hemispheres, right-hemisphere-only, and left-hemisphere-only. Accuracy rates were calculated between 85% and 100% for the KNN, SVM, and quadratic discriminant analysis classifiers.
Bounded rationality or bounded morality? The National Basketball Association response to COVID-19

Research question: The COVID-19 pandemic created a crisis rife with complexity and ethical dilemmas for sport organizations. The purpose of this study is to examine the decision-making process of o...
Pre-Post Evaluation of Collaborative Oncology Palliative Care for Patients With Stage IV Cancer.

Abstract Context The Collaborative Care Model improves care processes and outcomes but has never been tested for palliative care. Objectives To develop and evaluate a model of collaborative oncology palliative care for Stage IV cancer. Methods We conducted a pre-post evaluation of Collaborative Oncology Palliative Care (CO-Pal), enrolling patients with Stage IV lung, breast or genitourinary cancers and acute illness hospitalization. CO-Pal has 4 components: 1) oncologist communication skills training; 2) patient tracking; 3) palliative care needs assessment; and 4) care coordination stratified by high vs. low palliative care need. Health record reviews from hospital admission through 60 days provided data on outcomes - goals-of-care discussions (primary outcome), advance care planning, symptom treatment, specialty palliative care and hospice use, and hospital transfers. Results We enrolled 256 patients (n = 114 pre and n = 142 post-intervention); 60-day mortality was 32%. Comparing patients pre vs post-intervention, CO-Pal did not increase overall goals-of-care discussions, but did increase advance care planning (48% vs 63%, P = 0.021) and hospice use (19% vs 31%, P = 0.034). CO-Pal did not impact symptom treatment, overall treatment plans, or 60-day hospital transfers. During the intervention phase, high-need vs low-need patients had more goals-of-care discussions (60% vs. 15%, P Conclusion Collaborative oncology palliative care is efficient and feasible. While it did not increase overall goals-of-care discussions, it was effective to increase overall advance care planning and hospice use for patients with Stage IV cancer.
Prenatal metal mixtures and sex-specific infant negative affectivity.

Prenatal exposure to metals has been associated with a range of adverse neurocognitive outcomes; however, associations with early behavioral development are less well understood. We examined joint exposure to multiple co-occurring metals in relation to infant negative affect, a stable temperamental trait linked to psychopathology among children and adults. Methods Analyses included 308 mother-infant pairs enrolled in the PRISM pregnancy cohort. We measured As, Ba, Cd, Cs, Cr, Pb, and Sb in urine, collected on average during late pregnancy, by ICP-MS. At age 6 months, we assessed negative affect using the Infant Behavior Questionnaire-Revised. We used Weighted Quantile Sum (WQS) regression with repeated holdout validation to estimate the joint association between the metals and global negative affectivity, as well as four subdomains (Fear, Sadness, Distress to Limitations, and Falling Reactivity). We also tested for a sex interaction with estimated stratified weights. Results In adjusted models, urinary metals were associated with higher scores on the Fear scale (βWQS = 0.20, 95% confidence interval [CI]: 0.09, 0.30), which captures behavioral inhibition, characterized by startle or distress to sudden changes in the environment and inhibited approach to novelty. We observed a significant sex interaction (95% CI for the cross-product term: -0.19, -0.01), and stratified weights showed girls (61.6%) contributed substantially more to the mixture effect compared with boys (38.4%). Overall, Ba contributed the greatest mixture weight (22.5%), followed by Cs (14.9%) and As (14.6%). Conclusions Prenatal exposure to metals was associated with increased infant scores on the temperamental domain of fear, with girls showing particular sensitivity.Key words: Prenatal; Metals; Mixtures; Temperament; Infancy; Negative affect.
Association of US Nurse and Physician Occupation With Risk of Suicide.

Importance Nurses are the largest component of the US health care workforce. Recent research suggests that nurses may be at high risk for suicide; however, few studies on this topic exist. Objectives To estimate the national incidence of suicide among nurses and examine characteristics of nurse suicides compared with physicians and the general population. Design, setting, and participants This retrospective cohort study used US data from 159 372 suicides reported in the National Violent Death Reporting System from 2007 to 2018. With the use of workforce denominators, sex-specific suicide incidence estimates were generated among nurses, physicians, and the general population (age, ≥30 years). Associations between clinician type and method of suicide and results of toxicology examination at death were calculated, adjusted for sociodemographic characteristics. Statistical analysis was performed from October 16, 2020, to January 10, 2021. Exposure Occupation as a nurse or physician. Main outcome and measures Suicide incidence and characteristics associated with suicides. Results A total of 2374 suicides among nurses (1912 women [80.5%]; mean [SD] age, 52.8 [11.8] years), 857 suicides among physicians (723 men [84.4%]; mean [SD] age, 59.8 [15.3] years), and 156 141 suicides in the general population (121 483 men [77.8%]; mean [SD] age, 53.1 [14.7] years) were identified. Overall, suicide was more common among nurses compared with the general population (sex-adjusted incidence in 2017-2018, 23.8 per 100 000 vs 20.1 per 100 000; relative risk, 1.18 [95% CI, 1.03-1.36]). Among women in 2017-2018, the suicide incidence among nurses was 17.1 per 100 000 (506 among 2 966 048) vs 8.6 per 100 000 (8879 among 103 731 387) in the general female population (relative risk, 1.99 [95% CI, 1.82-2.18]). In absolute terms, being a female nurse was associated with an additional 8.5 suicides per 100 000 (95% CI, 7.0-10.0 per 100 000) compared with the general population of women. By sex, physician suicide rates were not statistically different from the general population other than among female physicians in 2011-2012 (11.7 per 100 000 [95% CI, 6.6-16.8 per 100 000] female physicians vs 7.5 per 100 000 [95% CI, 7.2-7.7 per 100 000] general population; P = .04). In terms of the characteristics of suicides, clinicians were more likely to use poisoning than the general population; for example, 24.9% (95% CI, 23.5%-26.4%) of nurses used poisoning compared with 16.8% (95% CI, 16.6%-17.0%) of the general suicide population. The presence of antidepressants, benzodiazepines, barbiturates, and opiates was more common among clinician suicides than suicides in the general population. Conclusion and relevance This study suggests that, in the US, the risk of suicide compared with the general population was significantly greater for nurses but not for physicians. Further research is needed to assess whether interventions would be associated with benefit in reducing suicide risk among nurses.
Survivors of gynecologic malignancies (GYN CA): Impact of treatment on health and well-being

Purpose While overall survival from gynecologic malignancies has greatly improved over the last three decades, required treatments can lead to multiple health issues for survivors. Our objective was to identify health concerns that gynecologic cancer survivors face.
The term structure of returns: Facts and theory ☆

Abstract We summarize and extend the new literature on the term structure of equity. Short-term equity claims, or dividend strips, have higher average returns and Sharpe ratios than the aggregate stock market. The returns on short-term dividend claims are risky as measured by volatility, but safe as measured by market beta. These facts are hard to reconcile with traditional macro-finance models and we provide an overview of new models that can reproduce some of these facts. We relate our evidence on dividend strips to facts about other asset classes such as nominal and corporate bonds, volatility, and housing. We discuss the broader economic implications of our findings by linking the term structure of returns to real economic decisions such as hiring and investment. We conclude with an outline of empirical and theoretical extensions that we consider interesting avenues for future research.
Applications of Narrative Medicine to Surgical Education.

Narrative medicine describes the application of story to medical education and practice. Although it has been implemented successfully in many medical schools as a part of undergraduate medical edu...
Timing of pregnancy discovery among women seeking abortion

Abstract Objective Little is known about the incidence and causes of delay in recognition of pregnancy. Delay in pregnancy recognition is associated with later presentation for abortion and exacerbates the burdens in accessing care. Using Turnaway study data, this study assessed the prevalence of later pregnancy recognition among a sample of people who obtained or were denied a wanted abortion. Study design The Turnaway Study included telephone interviews of 956 women who sought an abortion in the first trimester or just over or under the gestational limit of one of 30 abortion facilities across the United States and in-depth interviews with 31 who completed 5 years of surveys. We describe women's experiences discovering pregnancy and conducted multivariate analyses assessing factors associated with later pregnancy discovery (after 13 weeks since last menstrual period [LMP]). Results Most women seeking second trimester abortions recognized their pregnancy more than 8 weeks after their LMP; more than 1 in 5 recognized pregnancy after 20 weeks. In interviews, women explained that recognition was delayed because of a lack of pregnancy symptoms or concurrence of other conditions with symptoms similar to pregnancy. According to multivariate analyses, women who had never given birth (adjusted odds ratio [aOR] = 1.71; 95% confidence interval [CI]: 1.24, 2.35) and those who used hormonal contraceptives in the month of conception (aOR = 1.83; 95% CI: 1.35, 2.47) were more likely to discover pregnancy after 13 weeks. Conclusion Laws imposing gestational limits will make abortion unavailable to people who discover pregnancy after the limit. Such bans are likely to disproportionately affect people using contraceptive methods to prevent pregnancy and those who have never given birth. Implications Some pregnant people have few pregnancy symptoms and/or have conditions with symptoms similar to pregnancy, such as irregular periods or chronic pain. Gestational limits to abortion are likely to disproportionately affect people who recognize pregnancy later in pregnancy, particularly those without prior pregnancy experiences and who are using contraception.
Acral lentiginous melanoma: Incidence and survival patterns in the United States, 1986-2004

3853 Introduction: Acral lentiginous melanoma (ALM) is the fourth most common subtype of melanoma, with an estimated frequency of 2-5% amongst all melanomas. ALM is the most common type of melanoma found in people of color and is most often found on the palms and soles. This is in contrast to cutaneous malignant melanoma (CMM) overall which is predominantly found on sun-exposed areas. Several small single-institution case series of ALM have been published; however, they have been limited by small sample sizes and have not been population-based. Therefore, we conducted a population-based evaluation of ALM to examine its incidence and survival patterns in the United States. Methods: To analyze the incidence and survival patterns of ALM in the general US population, we used the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute to evaluate 1683 histologically confirmed cases of ALM reported to 17 population-based registries from 1986 to 2004. Results: The age-adjusted ALM incidence rate overall was 1.9 per million persons. The incidence rate varied among different racial groups (Hispanic Whites--2.2, Non-Hispanic Whites--2.0, Blacks--1.7, and Asian/Pacific Islanders--1.3). The proportion of ALM among all other melanoma subtypes was greatest in people of color--37% in Blacks, 20% in Asian/Pacific Islanders, 10% in Hispanic Whites, and 2% in Non-Hispanic Whites. Overall, ALM had 5- and 10-year survival rates of 71.3% and 52.8%, respectively. This survival is substantially less than for all CMM with 5- and 10-year survival rates of 80% and 69.6%. Also, for ALM, 5- and 10-year survival rates were highest in Non-Hispanic Whites (73.6% and 53.9%), intermediate in Hispanic Whites (68.8% and 52.3%), and lowest in Blacks (58.8% and 49.6%) and Asian/Pacific Islanders (64.3% and 46.9%). The thickness of ALM correlated with survival in different racial groups. ALM was most frequently thin (0.01-1.00 mm) in Non-Hispanic Whites--44.6%, followed by Blacks--40.9%, Hispanic Whites--37.2%, and Asian/Pacific Islanders--30%. Asian/Pacific Islanders had the highest percentage of thick ALM, >4.0 mm, with 25%, followed by Blacks--18.3%, Non-Hispanic Whites--12.5%, and Hispanic Whites--10.9%. Conclusions: Population-based data showed that ALM is associated with a worse prognosis than CMM overall. Asian/Pacific Islanders have worse survival rates than other groups, and factors such as increased tumor thickness and more advanced stage at presentation are the most likely explanations. The reasons for delayed diagnosis require future study. Even though ALM is rare, given its poor survival rates, it is important that physicians maintain a high index of suspicion and closely examine a patient’s palms and soles, particularly in people of color.
Six Stages of Engagement in ADHD Treatment Described by Diverse, Urban Parents

BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in children. Although ADHD is treatable, barriers remain to engagement in treatment, especially among socioeconomically disadvantaged and racial and ethnic minority families. Our goal was to examine the process by which families engage in ADHD treatment and to identify targets for an intervention to improve engagement in care. METHODS We conducted in-depth semistructured qualitative interviews with 41 parents of diverse youth aged 3 to 17 years old in treatment of ADHD at an urban safety net hospital. Parents were asked about their journey through diagnosis and treatment, community attitudes about ADHD, and other factors influencing treatment access and decision-making. Transcripts were analyzed by using thematic analysis. RESULTS Of children with ADHD, 69.2% were male, 57.7% were Black or African American, and 38.5% were of Hispanic, Latino, or Spanish origin. Parents were 92.7% female, were 75.6% English speaking, and had a median income of $20 000. Parents described 6 stages to the process of engaging in care for their child’s ADHD, which unfolded like a developmental process: (1) normalization and hesitation, (2) fear and stigmatization, (3) action and advocacy, (4) communication and navigation, (5) care and validation, and (6) preparation and transition. Barriers often occurred at points of stage mismatch between parents and providers and/or systems. Difficulty resolving an earlier stage interfered with the progression through subsequent stages. CONCLUSIONS The 6 stages framework could be used to develop new strategies to measure engagement and to design family-centered interventions to facilitate engagement in ADHD treatment.
Abstract PO-028: Pancreatic ductal adenocarcinoma is dependent on an unconventional pathway for polyamine synthesis

Targeting altered metabolism in pancreatic ductal adenocarcinoma (PDAC) has been an area of extensive investigation for over a decade now. A major hurdle however, for most anti-tumor metabolic strategies, is the high risk for toxicity, given the essential roles of metabolic pathways in the maintenance of normal tissue homeostasis. Indeed, this has been the case for targeting polyamines in cancers. Polyamines are small, highly positively charged molecules involved in multiple fundamental processes of cell growth and survival, including the synthesis of nucleic acids, modifications of chromatin structure, gene transcription and mRNA translation. Polyamine levels are significantly increased in many cancers, including PDAC. Prior anti-tumor strategies focused on pharmacological inhibition of the rate-limiting enzyme of polyamine synthesis, ornithine decarboxylase (ODC1) with little success, partially due to risk of harming normal tissues at higher drug doses. In this project, using both in vitro and in vivo mouse models of PDAC, we identified a dependency of PDAC on an unconventional way for the synthesis of the polyamine precursor ornithine, specifically from glutamine via ornithine aminotransferase (OAT); this is in contrast to its synthesis in most adult normal tissues from arginine via arginase (ARG) activity. We also identified potential key players mediating the induction of this metabolic pathway via KRAS, the main oncogenic driver in PDAC and are currently characterizing the downstream effects of polyamines on pancreatic tumor cells. The high dependency of PDAC, compared to normal tissue, on de novo ornithine synthesis via OAT provides an attractive therapeutic window for treating pancreatic cancer patients with minimal toxicity. Citation Format: Min-Sik Lee, Insia Naqvi, Courtney Dennis, Lucas Dailey, Alireza Lorzadeh, Tamara Zaytouni, Ashley Adler, Daniel S. Hitchcock, Lin Lin, Unmesh Jadhav, Clary B. Clish, Nada Y. Kalaany. Pancreatic ductal adenocarcinoma is dependent on an unconventional pathway for polyamine synthesis [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PO-028.
Ethics Consultation in U.S. Hospitals: New Findings about Consultation Practices.

While previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.To address this gap, we surveyed a ra...
Abstract 250: 6β-hydroxytestosterone, A Cytochrome P450 1b1-derived Metabolite Of Testosterone, Mediates Increase In Thirst, Renal Dysfunction, And End Organ Damage Associated With Angiotensin II-induced Hypertension In Male Mice

Recently, we showed that 6β-hydroxytestosterone (6β-OHT), a cytochrome P450 1B1 (CYP1B1)-derived metabolite of testosterone, contributes to the development of angiotensin II (Ang II)-induced hypertension and associated cardiovascular pathophysiology. In view of the critical role of Ang II in renal homeostasis and end organ damage, we determined the contribution of 6β-OHT to Ang II actions on water consumption and renal function in male Cyp1b1 +/+ and Cyp1b1 -/- mice. Eight weeks old male Cyp1b1 +/+ and Cyp1b1 -/- intact or castrated mice were injected with 6β-OHT (15 μg/g, i.p. every 3 rd day) or vehicle (DMSO, 50 μl), and infused with Ang II (700 ng/kg/min) or vehicle for 2 weeks. Urine was collected for 24 hours on the final day of experiment. Castration attenuated Ang II-induced increase in water consumption and urine output, proteinuria and decrease in osmolality in both Cyp1b1 +/+ , and Cyp1b1 -/- mice (Table 1). 6β-OHT did not alter Ang II-induced increase in water intake, urine output, proteinuria and decrease in osmolality in Cyp1b1 +/+ mice, but restored these effects of Ang II in Cyp1b1 -/- or castrated mice (Table 1). Cyp1b1 gene disruption or castration prevented Ang II-induced renal fibrosis, inflammation, and oxidative stress. 6β-OHT did not alter Ang II-induced renal fibrosis, inflammation or oxidative stress in Cyp1b1 +/+ mice, however in Cyp1b1 -/- or castrated mice it restored these effects of Ang II. These data suggest that 6β-OHT, contributes to increased thirst, impairment of renal function and end organ damage associated with Ang II-induced hypertension in male mice, and that CYP1B1 could serve as a novel target for the treatment of renal disease and hypertension.
Parent Involvement in the Schools

(1977). Parent Involvement in the Schools. The Clearing House: A Journal of Educational Strategies, Issues and Ideas: Vol. 50, No. 7, pp. 297-299.
Pulsar astronomy at meter and decameter wavelengths: Results from Arecibo

We review the state of groundbased research in pulsar astronomy at low frequencies with an emphasis on new results from Arecibo. We have obtained high signal-to-noise profiles for six pulsars at 25, 47 and 111.5 MHz, along with several higher frequencies. Three of the pulsars in our sample had been previously reported to exhibit sporadic and intense interpulse emissions at decameter wavelengths. Our 25 MHz data show no evidence of off-pulse activity exceeding 4% of the main pulse intensity for PSR 0834+06, 2% for PSR 0950+08, and 1% for PSR 1133+16. Multifrequency timing data collected over a broad frequency range (25 → 4800 MHz) were used to derive accurate pulsar dispersion measures. We find that pulse arrival times obeyed a cold plasma dispersion law to high accuracy over a 200:1 frequency range. This result is compared with reports of low-frequency “superdispersion.” The timing data have also been used to set limits on the size and location of the radio emitting region in six pulsars. By analyzing the effects of retardation, abberation and magnetic sweepback on pulse arrival times we find the radial extent of the emission region to be < 200 km over a 100:1 frequency range. The data indicate emission altitudes less than 3 stellar radii above the surface of the neutron star.
A Direct Comparison of ABS and Telephone Sampling in a Pilot Study of Children's Health

This pilot study was designed to determine the relative strengths and weaknesses of ABS (mixed-mode web/telephone) as a sampling alternative to list-assisted RDD in a statewide study of a targeted population study of children’s health. Additionally, the pilot served as a feasibility study aimed at determining whether ABS can be used effectively for small studies (relative to national-scale data collection) that do not rely on substantial budgets. The results of this pilot study provide support for the contention that ABS sampling improves coverage (i.e., reduces coverage error) when compared to traditional RDD sampling.
SYNERGISTIC ENHANCEMENT OF BOTH INITIATION AND ELONGATION BY ACIDIC TRANSCRIPTION ACTIVATION DOMAINS

The effects of activation domain synergy on transcription initiation and elongation have been examined utilizing a system that permits the targeting of a defined number of activation modules to promoter DNA. As predicted, incremental increases in targeted activation potential were found to result in corresponding increases in transcription initiation. Surprisingly, however, transcriptional processivity, and hence mRNA synthesis, required a threshold level of activation domain synergy that exceeded the level required for at least modest levels of transcription initiation. The degree to which transcriptional processivity was enhanced was shown to depend on the quantity of activation modules targeted to the promoter DNA, rather than the quality. While the RNA-sequence specific HIV-1 Tat trans-activator was also shown to enhance processivity in this assay system, Tat differed from DNA-sequence specific activation domains in exerting a more dramatic effect on the efficiency of transcript elongation.
Parent Participation in the Initial Placement/IEP Conference Ten Years After Mandated Involvement

This study investigated parents' participation in and perceptions of the conference on initial placement and the Individual Education Plan (IEP) and their knowledge regarding the decisions made during the conference. Twenty-six conferences were observed for children referred for possible learning disabilities. Observational data included the time parents spent asking questions, commenting, and responding to other team members. The number of parental questions and responses was also recorded. Immediately following the conference, parents participated in a structured interview. Observational data suggest that the majority of parents asked few questions and responded little during the conferences. However, interview data indicated that for the most part parents were satisfied with the conferences and had no further questions. Results are discussed relative to the intent of P.L. 94-142 and research on the IEP conference that was conducted soon after enactment of the law. A retrospective look at the law that m...
Neural induction in Xenopus: Requirement for ectodermal and endomesodermal signals via Chordin, Noggin, β-Catenin, and Cerberus

The origin of the signals that induce the differentiation of the central nervous system (CNS) is a long-standing question in vertebrate embryology. Here we show that Xenopus neural induction starts earlier than previously thought, at the blastula stage, and requires the combined activity of two distinct signaling centers. One is the well-known Nieuwkoop center, located in dorsal-vegetal cells, which expresses Nodal-related endomesodermal inducers. The other is a blastula Chordin- and Noggin-expressing (BCNE) center located in dorsal animal cells that contains both prospective neuroectoderm and Spemann organizer precursor cells. Both centers are downstream of the early beta-Catenin signal. Molecular analyses demonstrated that the BCNE center was distinct from the Nieuwkoop center, and that the Nieuwkoop center expressed the secreted protein Cerberus (Cer). We found that explanted blastula dorsal animal cap cells that have not yet contacted a mesodermal substratum can, when cultured in saline solution, express definitive neural markers and differentiate histologically into CNS tissue. Transplantation experiments showed that the BCNE region was required for brain formation, even though it lacked CNS-inducing activity when transplanted ventrally. Cell-lineage studies demonstrated that BCNE cells give rise to a large part of the brain and retina and, in more posterior regions of the embryo, to floor plate and notochord. Loss-of-function experiments with antisense morpholino oligos (MO) showed that the CNS that forms in mesoderm-less Xenopus embryos (generated by injection with Cerberus-Short [CerS] mRNA) required Chordin (Chd), Noggin (Nog), and their upstream regulator beta-Catenin. When mesoderm involution was prevented in dorsal marginal-zone explants, the anterior neural tissue formed in ectoderm was derived from BCNE cells and had a complete requirement for Chd. By injecting Chd morpholino oligos (Chd-MO) into prospective neuroectoderm and Cerberus morpholino oligos (Cer-MO) into prospective endomesoderm at the 8-cell stage, we showed that both layers cooperate in CNS formation. The results suggest a model for neural induction in Xenopus in which an early blastula beta-Catenin signal predisposes the prospective neuroectoderm to neural induction by endomesodermal signals emanating from Spemann's organizer.
Pharmacotherapy During Saphenous Vein Graft Intervention

Coronary revascularization using saphenous vein grafts is an important treatment modality for patients with severe coronary artery disease. Percutaneous intervention of these grafts is often the best option for patients who develop severe stenosis of the vein grafts. Use of adjunctive glycoprotein IIb/IIIa inhibitors does not confer added benefit with ischemic endpoints as compared with heparin alone, but it increases the risk of bleeding. Bivalirudin used as the primary anticoagulant lowers the risk of bleeding. No-reflow frequently complicates vein graft interventions but can be treated with vasoactive agents such as calcium channel blockers, adenosine, and nitroprusside.
Use of trans fat information on food labels and its determinants in a multiethnic college student population.

Abstract Objectives To examine the correlates of trans fat knowledge and trans fat label use; to examine the influence of trans fat knowledge, trans fat label use, and dietary attitudes on intake of high trans fat food. Design Cross-sectional survey. Setting An urban commuter college. Subjects Two hundred twenty-two college students. Variables measured Trans fat knowledge, food label use, high trans fat food consumption, dietary attitudes, and sociodemographic factors. Analysis Chi-square tests and multivariate logistic regression analysis assessed relationships between trans fat knowledge, trans fat label use, and consumption of high trans fat food. Results Thirty-seven percent of participants reported never using trans fat information on food labels. Males and minority ethnic groups were less likely to report always using trans fat label information and displayed lower trans fat knowledge compared to females and non-Hispanic whites, respectively. Trans fat knowledge and importance of eating a low-fat diet were positively associated with both food label use and use of trans fat information on food labels. Nonuse of food labels and trans fat information on food labels were associated with higher consumption of fried food. Conclusions and Implications Trans fat education and promotion of food label use is needed in college students, especially in high-risk groups such as males and ethnic minorities.
Expert-novice differences in performance skills and problem representations of youth and adults during tennis competition

Abstract Expert and novice tennis players selected from three different age groups (i.e., 10–11 years, 12–13 years, and collegiate adults) were examined for differences in performance skills (i.e., behavioral analyses of video recordings) and problem representations (i.e., verbal report analyses of tape recordings) during matched competition. Factorial analyses of variance on behavioral measures indicated that experts' performances exhibited higher levels of decision and execution than novices, regardless of age. Kruskal-Wallis tests on verbal report measures indicated that experts generated more total, varied, and sophisticated condition and action concepts than novices. Within experts, adults accessed more sophisticated problem representations than youth. Both current event and action plan profiles guided and mediated adult experts' response selections and executions, respectively. Youth experts primarily used action plan profiles to guide their response selections. Novices, regardless of age, accessed ...
Anticardiolipin antibodies associated with HTLV-III infection.

Summary. Anticardiolipin antibody levels were determined in 73 homosexual men. Thirty of these patients had acquired immunodeficiency syndrome (AIDS), 16 patients had the AIDS-related complex (ARC) and 27 were healthy. Antibodies to human T-lymphotropic virus type III (HTLV-III) were detected in all patients with AIDS and ARC and in 11 of the healthy homosexuals. Eight patients with positive fluorescent treponemal antibody absorption test were excluded from the study. High levels of IgG-anticardiolipin antibodies were present in 23 of the 28 patients with AIDS; 12 of the 14 with ARC; five of the 10 HTLV-III positive healthy homosexuals; and none of the 13 HTLV-III negative healthy homosexuals. High levels of IgM-ACA were detected only in four patients with AIDS. The IgG-anticardiolipin levels were higher in the HTLV-III positive patients than in the HTLV negative group (P=0·013). None of the patients with anticardiolipin antibodies exhibited venous thrombosis.