cssi/SciSciGPT-SciSciNet huggingface dataset:
Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization.

Abstract Some previous research has examined pain-related variables on the basis of prescription opioid dose, but data from studies involving patient-reported outcomes have been limited. This study examined the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Participants were recruited from 2 large integrated health systems, Kaiser Permanente Northwest (n = 331) and VA Portland Health Care System (n = 186). To be included, participants had to have musculoskeletal pain diagnoses and be receiving stable doses of long-term opioid therapy. We divided participants into 3 groups on the basis of current prescription opioid dose in daily morphine equivalent dose (MED): low dose (5–20 mg MED), moderate dose (20.1–50 mg MED), and higher dose (50.1–120 mg MED) groups. A statistically significant trend emerged where higher prescription opioid dose was associated with moderately sized effects including greater pain intensity, more impairments in functioning and quality of life, poorer self-efficacy for managing pain, greater fear avoidance, and more health care utilization. Rates of potential alcohol and substance use disorders also differed among groups. Findings from this evaluation reveal significant differences in pain-related and substance-related factors on the basis of prescription opioid dose. Perspective This study included 517 patients who were prescribed long-term opioid therapy and compared differences on pain- and mental health-related variables on the basis of prescription opioid dose. Findings reveal small- to medium-sized differences on pain-related variables, alcohol and substance use, and health care utilization on the basis of the dose of opioid prescribed.
Delineation of priority areas for management of groundwater resources in gravel aquifers with respect to transport of contaminates

Die Dimensionierung realisierbarer wasserwirtschaftlicher Vorranggebiete als Instrument des vorbeugenden Trinkwasserschutzes in der Regionalplanung bereitet in Kies-Grundwasserleitern mit ausgedehnten Einzugsgebieten und hohen Stromungsgeschwindigkeiten oftmals Schwierigkeiten. Es wird ein Vorschlag fur eine praktikable oberstromige Abgrenzung in Abhangigkeit von der Schutzfunktion der Grundwasseruberdeckung, der Abstandsgeschwindigkeit, der Grundwasserneubildung und der spezifischen Oberflache der Sedimente solcher Aquifere unter Berucksichtung von Transport, Ruckhaltung und Abbau haufig im Grundwasser vorkommender Schadstoffe unterbreitet. Die Moglichkeit einer Anwendung des Verfahrens auch zur Abschatzung der oberstromigen Grenze der weiteren Schutzzone III bzw. III B von Trinkwasserschutzgebieten in solchen Fallen wird zur Diskussion gestellt.
Liver transplantation for severe alcoholic hepatitis- The PRO view

Although liver transplantation has become accepted as a life-saving treatment of last resort for most life-threatening liver disorders, the use of liver transplantation to rescue patients with severe alcoholic hepatitis unresponsive to medical therapy remains controversial. I propose the concepts that alcohol use disorder is an illness, that on occasion results in alcoholic liver disease and that treatment of alcoholic liver disease, including treatment of patients with severe alcoholic hepatitis, combines treatment of the alcohol use disorder and of alcoholic liver disease. From this I derive the following principal to govern selection of patients for liver transplantation of patients with alcohol use disorder: that alcohol use disorder should impact suitability for liver transplantation as a co-morbid disorder, in the same way as other common co-morbid disorders such as diabetes mellitus or systemic hypertension, are factored in the selection process. We should relate the risk of drinking relapse to the prognosis of the patient after transplantation, rather than in a binary construct of likelihood of maintaining abstinence vs drinking.
Fermi Liquid and “QCD” Aspects of the Nucleus

Recent exclusive electron scattering results which involve the ejection of a proton from the nucleus, have established properties of the nucleus that can be brought into one-to-one correspondence with Fermi Liquid properties of infinite homogeneous systems. Theoretical calculations in finite nuclei are discussed which establish these “Fermi Liquid” properties by including the coupling of single-particle motion to more complicated states in an energy domain of about 100 MeV around the Fermi energy. Although sufficient to explain the shape of the experimental strength distributions, these calculations need to be supplemented by including the coupling to even higher energy states for quantitative agreement. Such calculations are reported for nuclear matter. These results clearly establish the importance of the coupling between low-lying single-particle states and very high-lying 2p1h-states. This coupling is provided within the constraints of non-relativistic many-particle theory by the use of a strongly repulsive realistic interaction between nucleons. This feature is illustrated with numerical results. The simulation of QCD degrees of freedom in terms of short-range correlations turns out to be crucial for a quantitative understanding of (e, e’p) results as well as other electron scattering data, as will be discussed for various examples.
G336 Team briefings in general paediatrics: Improving learning experiences and team work

Aims The general paediatric team at our hospital provides secondary paediatric care as well as tertiary and quaternary services. Our inpatient numbers vary from 40 to 120 across 15 wards. Our team comprises of over 20 junior members with varying levels of training needs. We are thus challenged to provide safe high quality patient care while maintaining situational awareness and addressing trainee needs. Briefing and debriefing are important tools used in other safety critical industries with some data from within healthcare. Our aim was to analyse if the introduction of a structured briefing and debriefing would effect the number of supervised learning events (SLEs), non-ward based work (such as clinic letters), attendance at educational meetings, team morale and perceived consultant situational awareness. Methods This prospective study ran over six weeks, with alternate weeks of briefing and not briefing (control). Briefings occurred after the morning handover and debriefings before the evening handover. At briefing, white boards were used to answer pre-defined questions regarding trainee need for SLEs, identification of educational opportunities and situational awareness issues (such as staff numbers). At debriefing, the team compared the outcomes with aims, and suggestions for improvements were carried forward. We obtained qualitative data from consultants using a SWOT analysis. The junior team completed anonymised questionnaires daily. The questions used Likert scaling and ‘Yes/No’ responses with an opportunity for free text. Results The qualitative feedback was generally positive. Overall, more SLEs were completed during briefing weeks: (Table 1) More aims were met during briefing weeks: (Table 2) Team morale, colleague support and situational awareness were rated as being higher during briefing compared with non-briefing weeks. Conclusions The introduction of briefing and debriefing space improved learning needs even when service demands were high. The exploration of reasons for not completing SLEs lead to better awareness of how to improve this. We now plan to develop our briefing tool as part of a quality improvement project to improve other outcomes such as patient flow.
Reducing Collateral Damage in Responses to the Opioid Crisis.

The authors reflect on the harmful side effects of U.S. legal actions against prescription opioid use and how to counteract those side effects. They talk about opioid tolerance and factors behind opioid overdoses. They mention the need to properly care for substance use disorders and chronic pain. They talk about the need for improved community engagement of outreach and service provision after disrupting drug supply chains. They consider supply-side risk reduction outside of medical clinics.
18Fluorodeoxyglucose Positron Emission Tomography Imaging of Atherosclerotic Plaque Inflammation Is Highly Reproducible: Implications for Atherosclerosis Therapy Trials

Objectives This study tested the near-term reproducibility of 18fluorodeoxyglucose positron emission tomography (FDG-PET) imaging of atherosclerosis. Background It is known that FDG-PET can measure inflammation within the aorta, carotid, and vertebral arteries with histologic validation in humans and animal models of disease. By tracking changes in inflammation over time, PET could be used as a surrogate marker of antiatheroma drug efficacy. However, the short-term variability and reproducibility of the technique are unknown. Methods We imaged the carotid arteries and aorta in 11 subjects with FDG-PET/computed tomography twice, 14 days apart. We assessed interobserver and intraobserver agreement and interscan variability. Results Interscan plaque FDG variability over 2 weeks was very low; intraclass correlation coefficients (ICC) ranged between 0.79 and 0.92. Interobserver agreement was high across all territories imaged except aortic arch (ICC values from 0.90 to 0.97, arch 0.71). Intraobserver agreement was high, with ICC values between 0.93 and 0.98. Conclusions Spontaneous change in plaque FDG uptake is low over 2 weeks, with favorable inter- and intraobserver agreement. Power calculations suggest that drug studies using FDG-PET imaging would require few subjects compared with other imaging modalities. This study strengthens the case for FDG-PET as a noninvasive plaque imaging technique.
Oliguria. A sign of renal success or impending renal failure

Oliguria can be one of the first intraoperative clinical clues heralding inadequate renal perfusion. This article reviews the identifiable factors known to increase the risk for perioperative renal insufficiency and the preoperative maneuvers that should be instituted to limit renal injury in high-risk patients. Next, the physiology of urine formation, the influence of anesthesia on renal perfusion, and the pathogenesis of perioperative acute renal failure are discussed. The problem of intraoperative renal monitoring is explored and a conceptual framework for verification, diagnosis, and treatment of intraoperative oliguria is offered.
Integration of EEG and brain imaging: advancing the understanding of neuro-cognitive dysfunction.

The early history of electroencephalography (EEG) focused on discrete phenomena and patterns that could be identified in the electrical rhythms generated by the brain and measured between a scalp electrode and a reference electrode. The waking state is associated with fast activity (greater than 12 Hz). The alpha rhythm (8–12 Hz) was noted to be associated with eyes-closed resting. Slow waves (less than 8 Hz) have been associated with certain phases of sleep and fast activity occurs in rapid eye-movement sleep. The most notable abnormalities are the spike waves associated with seizures, slowing of rhythms associated with brain tumors, and the periodic sharp wave complexes characteristic of Creutzfeld-Jacob disease. Non-specific slowing is also observed in dementia. In the past, these observations have represented the limits of information obtainable from the EEG. EEG represents a phenomenon generated in the radially-oriented apical dendrites of pyramidal neurons in cortical structures of the encephalon, including the neocortex, and paleocortex, and archicortex. The source of the recorded signal at the scalp can be any combination of activities anywhere in the vicinity between the scalp electrode and the reference electrode.
Abstract 050: Hypertensive Urgency: An Emergency Department Pipeline to Primary Care Pilot Study

Introduction: The incidence of HTN related ED visits is high and increasing. The optimal management of hypertensive urgency in the ED is not well established but the 2017 ACC/AHA HTN guidelines rec...
Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study.

Objective: To evaluate the safety and efficacy of premature infant treatment managed by hybrid telemedicine versus conventional care. Methods: Prospective, noninferiority study comparing outcomes o...
Editorial Commentary: Shoulder Superior Capsular Reconstruction: When a Systematic Review of a Procedure Can Be Misleading.

Abstract Shoulder superior capsular reconstruction as described by Mihata et al. achieves excellent results using 6 to 8 mm thick autologous fascia lata. Superior capsular reconstruction using 3-mm-thick dermal allograft is not equivalent and may yield results no better than technically well performed rotator cuff repairs, partial repairs, or tendon transfers.
Identifying the Intersections: User Experience + Research Scientist Collaboration in a Generative Machine Learning Interface

Creative generative machine learning interfaces are stronger when multiple actors bearing different points of view actively contribute to them. User experience (UX) research and design involvement in the creation of machine learning (ML) models help ML research scientists to more effectively identify human needs that ML models will fulfill. The People and AI Research (PAIR) group within Google developed a novel program method in which UXers are embedded into an ML research group for three months to provide a human-centered perspective on the creation of ML models. The first full-time cohort of UXers were embedded in a team of ML research scientists focused on deep generative models to assist in music composition. Here, we discuss the structure and goals of the program, challenges we faced during execution, and insights gained as a result of the process. We offer practical suggestions for how to foster communication between UX and ML research teams and recommended UX design processes for building creative generative machine learning interfaces.
Architectural Modification of Conformal PEG-Bottlebrush Coatings Minimizes Anti-PEG Antigenicity While Preserving Stealth Properties

Poly(ethylene glycol) (PEG), a linear polymer known for its "stealth" properties, is commonly used to passivate the surface of biomedical implants and devices, and it is conjugated to biologic drugs to improve their pharmacokinetics. However, its antigenicity is a growing concern. Here, the antigenicity of PEG is investigated when assembled in a poly(oligoethylene glycol) methacrylate (POEGMA) "bottlebrush" configuration on a planar surface. Using ethylene glycol (EG) repeat lengths of the POEGMA sidechains as a tunable parameter for optimization, POEGMA brushes with sidechain lengths of two and three EG repeats are identified as the optimal polymer architecture to minimize binding of anti-PEG antibodies (APAs), while retaining resistance to nonspecific binding by bovine serum albumin and cultured cells. Binding of backbone- versus endgroup-selective APAs to POEGMA brushes is further investigated, and finally the antigenicity of POEGMA coatings is assessed against APA-positive clinical plasma samples. These results are applied toward fabricating immunoassays on POEGMA surfaces with minimal reactivity toward APAs while retaining a low limit-of-detection for the analyte. Taken together, these results offer useful design concepts to reduce the antigenicity of polymer brush-based surface coatings used in applications involving human or animal matrices.
Under Pressure: Exploring Agency–Structure Dynamics with a Rhetorical Approach to Register

ABSTRACTThis study traced the adoption of a new social language among financial advisors responding to intense regulatory pressures. Register – specialized vocabularies, argumentative moves, and sy...
PreLatPUF: Exploiting DRAM Latency Variations for Generating Robust Device Signatures

Physically unclonable functions (PUFs) are potential security blocks to generate unique and more secure keys in low-cost cryptographic applications. Dynamic random-access memory (DRAM) has been proposed as one of the promising candidates for generating robust keys. Unfortunately, the existing techniques of generating device signatures from DRAM is very slow, destructive (destroy the current data), and disruptive to system operation. In this paper, we propose precharge latency-based PUF (PreLatPUF) that exploits DRAM precharge latency variations to generate signatures. The proposed PreLatPUF is fast, robust, least disruptive, and non-destructive. The silicon results from commercially available DDR3 chips from different manufacturers show that the proposed key generation technique is at least ~1,192X faster than the existing approaches, while reliably reproducing the key in extreme operating conditions.
Non-fullerene Acceptors for Harvesting Excitons from Semiconducting Carbon Nanotubes

Semiconducting single-walled carbon nanotubes (s-SWCNTs) are promising materials for solar energy conversion and photodetectors. Fullerenes and their derivatives, being widely employed as electron ...
Insights from open source software supply chains (keynote)

Open Source Software (OSS) forms an infrastructure on which numerous (often critical) software applications are based. Substantial research was done to investigate central projects such as Linux kernel but we have only a limited understanding of how the periphery of the larger OSS ecosystem is interconnected through technical dependencies, code sharing, and knowledge flows. We aim to close this gap by a) creating a nearly complete and rapidly updateable collection of version control data for FLOSS projects; b) by cleaning, correcting, and augmenting the data to measure several types of dependencies among code, developers, and projects; c) by creating models that rely on the resulting supply chains to investigate structural and dynamic properties of the entire OSS. The current implementation is capable of being updated each month, occupies over 300Tb of disk space with 1.5B commits and 12B git objects. Highly accurate algorithms to correct identity data and extract dependencies from the source code are used to characterize the current structure of OSS and the way it has evolved. In particular, models of technology spread demonstrate the implicit factors developers use when choosing software components. We expect the resulting research platform will both spur investigations on how the huge periphery in OSS both sustains and is sustained by the central OSS projects and, as a result, will increase resiliency and effectiveness of the OSS.
Simulation of integrative physiology for medical education

Medical education is founded on the understanding of physiology. While lecture materials and reading contribute to the learning of physiology, the richness and complexity of the subject suggest that more active learning methods may provide a richer introduction to the science as it applies to the practice of medicine. Simulation has been previously used in basic science to better understand the interaction of physiological systems. In the current context, simulation generally refers to interactive case studies performed with a manikin or anatomic device. More recently, simulation has grown to encompass computational simulation: virtual models of physiology and pathophysiology where students can see in a mechanistic setting how tissues and organs interact with one another to respond to changes in their environment. In this manuscript, we discuss how simulation fits into the overall history of medical education, and detail two computational simulation products designed for medical education. The first of these is an acute simulator, JustPhysiology, which reduces the scope of a large model, HumMod, down to a more focused interface. The second is Sycamore, an electronic health record-delivered, real time simulator of patients designed to teach chronic patient care to students. These products represent a new type of tool for medical and allied health students to encourage active learning and integration of basic science knowledge into clinical situations.
Selective impact of lateral orbitofrontal cortex inactivation on reinstatement of alcohol seeking in male Long-Evans rats

Abstract The orbitofrontal cortex (OFC) plays a fundamental role in motivated behavior and decision-making. In humans, OFC structure and function is significantly disrupted in drug using and dependent individuals, including those exhibiting chronic alcohol use and alcoholism. In animal models, the OFC has been shown to significantly influence the seeking of non-alcohol drugs of abuse. However direct investigations of the OFC during alcohol seeking and use have been more limited. In the studies reported here, we inactivated lateral (lOFC) or medial OFC (mOFC) subregions in rats during multiple stages of alcohol seeking. After one month of intermittent access to homecage 20% ethanol (EtOH), rats were trained to self-administer EtOH under an FR3 schedule and implanted with cannulae directed to lOFC or mOFC. We inactivated OFC subregions with baclofen/muscimol during EtOH self-administration, extinction, cue-induced reinstatement, and progressive ratio testing to broadly characterize the influence of these subregions on alcohol seeking. There were no significant effects of mOFC or lOFC inactivation during FR3 self-administration, extinction, or progressive ratio self-administration. However, lOFC, and not mOFC, inactivation significantly decreased cue-induced reinstatement of EtOH seeking. These findings contribute new information to the specific impact of OFC manipulation on operant alcohol seeking, support previous studies investigating the role of OFC in seeking and consumption of alcohol and other drugs of abuse, and indicate a specific role for lOFC vs. mOFC in reinstatement.
Tungsten-doped Ge2Sb2Te5 phase change material for high-speed optical switching devices

The large impedance mismatch between the highly resistive amorphous state and the highly conductive crystalline state of Ge 2 Sb 2 Te 5 is an impediment for the realization of high-speed electrically switched optical devices. In this paper, we demonstrate that tungsten doping can reduce this resistivity contrast and also results in a lower amorphous state resistivity. Additionally, it lowers the contact resistance, improves the optical contrast, and extends the face-centered-cubic state up to 35 0 ° C, with a minimal impact on thermal conductivity.
Sequential Methods for Detecting a Change in the Distribution of an Episodic Process

A new class of stochastic processes called episodic processes is introduced to model the statistical regularity of data observed in several applications in cyberphysical systems, neuroscience, and medicine. Algorithms are proposed to detect a change in the distribution of episodic processes. The algorithms can be computed recursively using finite memory and are shown to be asymptotically optimal for well-defined Bayesian or minimax stochastic optimization formulations. The application of the developed algorithms to detect a change in waveform patterns is also discussed.
Gaining Ground: An Exploration into the Lives of Missouri's Lesbian Farmers

Formerly “invisible,” lesbian farmers have received increased attention recently, within both sociological scholarship and the popular media. Despite this attention, preconceptions about their lives persist. Assumptions of gay culture existing exclusively in metropolitan areas and of rural culture remaining organized by blood linkage and land ownership, combined with the continued predominance of men in agriculture, make this evolving realm of inquiry relevant to social scientists, agriculturalists, and extension professionals. In light of these intersections of identities and assumptions, and the remaining gaps in scholarship concerning this population, I conducted a case study, which was situated within a framework of ecogender studies. As such, the research focused on gendered relationships with nature and the emancipatory potential of women reclaiming their connections to nature through agriculture. The experiences of this population provide transferable lessons about humans as food system participants and present opportunities for rural development through sustainable agriculture. See the press release for this article.
Accentuated Intraday Stock Price Volatility

For a simple reason, intra-day volatility is important not only to traders with very short holding periods, but to longer term investors as well: volatility in brief time intervals is a manifestation of the efficiency with which prices are set, and inefficient pricing can lead to unduly high execution costs for the short -run trader and the longer-run investor alike. While short period, intraday volatility has been observed to be high, the reason for its accentuation has not been adequately understood.
An Engineered Mouse to Identify Proliferating Cells and Their Derivatives

Background Cell proliferation is a fundamental event during development, disease, and regeneration. Effectively tracking and quantifying proliferating cells and their derivatives is critical for addressing many research questions. Cell cycle expression such as for Ki67, proliferating cell nuclear antigen (PCNA), or aurora kinase B (Aurkb), or measurement of 5-bromo-2'-deoxyuridine (BrdU) or 3H-thymidine incorporation have been widely used to assess and quantify cell proliferation. These are powerful tools for detecting actively proliferating cells, but they do not identify cell populations derived from proliferating progenitors over time. Aims We developed a new mouse tool for lineage tracing of proliferating cells by targeting the Aurkb allele. Results In quiescent cells or cells arrested at G1/S, little or no Aurkb mRNA is detectable. In cycling cells, Aurkb transcripts are detectable at G2 and become undetectable by telophase. These findings suggest that Aurkb transcription is restricted to proliferating cells and is tightly coupled to cell proliferation. Accordingly, we generated an Aurkb ER Cre/+ mouse by targeting a tamoxifen inducible Cre cassette into the start codon of Aurkb. We find that the Aurkb ER Cre/+ mouse faithfully labels proliferating cells in developing embryos and regenerative adult tissues such as intestine but does not label quiescent cells such as post-mitotic neurons. Conclusion The Aurkb ER Cre/+ mouse faithfully labels proliferating cells and their derivatives in developing embryos and regenerative adult tissues. This new mouse tool provides a novel genetic tracing capability for studying tissue proliferation and regeneration.
List 3-coloring Pt-free graphs with no induced 1-subdivision of K1,s

Abstract Let s and t be positive integers. We use P t to denote the path with t vertices and K 1 , s to denote the complete bipartite graph with parts of size 1 and s respectively. The one-subdivision of K 1 , s is obtained by replacing every edge { u , v } of K 1 , s by two edges { u , w } and { v , w } with a new vertex w . In this paper, we give a polynomial-time algorithm for the list 3-coloring problem restricted to the class of P t -free graph with no induced 1-subdivision of K 1 , s .
Comprehensive Evaluation of Voice-Specific Outcomes in Patients With Essential Tremor Before and After Deep Brain Stimulation.

Summary Objective Deep brain stimulation (DBS) is a treatment for medically refractory essential tremor (ET), but there is a paucity of literature examining the effects of DBS on voice in patients with ET pre-DBS and post-DBS. This study aimed to report a comprehensive evaluation of voice in patients with ET pre-DBS and 6-months post-DBS. Study Design Case series. Methods Five patients receiving DBS for ET underwent voice evaluations pre-DBS and 6-months post-DBS. One patient had concurrent ET of the vocal tract (ETVT). The evaluation included patient-reported, perceptual, acoustic, and phonatory aerodynamic analyses of voice. Voice Handicap Index-10, Grade, Roughness, Breathiness, Asthenia, Strain Scale, perturbation measures, cepstral spectral index of dysphonia, cepstral peak prominence, and mean phonatory airflow measures were also among the data collected. Results Patients with ET presented with minimal changes in perceptual, acoustic, and phonatory aerodynamic parameters. Perceived vocal roughness significantly increased 6-months post-DBS (P = 0.047). The patient with ETVT presented with clinically significant improvement in almost all collected voice parameters 6-months post-DBS. Conclusion This is the first study to provide data encompassing auditory perceptual voice analysis, voice-specific patient-reported quality of life measures, acoustic, and phonatory aerodynamic outcomes in patients pre-DBS and 6-months post-DBS for ET. The results of our preliminary study have implications for the use of a comprehensive voice assessment to identify and measure change in voice outcomes in patients with ET and ETVT pre- and postsurgery.
Effect of an interventional educational wheelchair program on medical students' understanding of manual wheelchair use.

BACKGROUND There is limited literature exploring the benefits of interactive wheelchair educational programs in medical student curricula. OBJECTIVE To identify the effect of an educational interactive wheelchair program on medical students' understanding of wheelchair use. Researchers hypothesized that the program would increase understanding. DESIGN Repeated-measures survey study with postintervention comparison. SETTING Inpatient acute rehabilitation center. PARTICIPANTS Out of 123 eligible fourth-year medical students on a mandatory physical medicine and rehabilitation clerkship, 79 students participated. INTERVENTION All participants underwent a 2-hour educational wheelchair program consisting of (1) a disability lecture; (2) a video on the importance of proper wheelchair type and fit, wheelchair prescription, as well as recreational wheelchair use; and (3) an interactive wheelchair experience. MAIN OUTCOME MEASURES Pre- and postsurvey Likert scale questions measured medical students' understanding of four main areas: (1) impact of manual wheelchair use, (2) challenges of manual wheelchair use, (3) manual wheelchair skills, and (4) wheelchair etiquette. RESULTS A two-tailed sign test demonstrated a highly significant increase from pre- to postsurvey scores in each survey section (P < .001). Presurvey and postsurvey mean scores for impact of manual wheelchair use, challenges of manual wheelchair use, manual wheelchair skills, and wheelchair etiquette survey sections were 3.9 and 4.4, 3.1 and 4.4, 2.4 and 4.4, and 2.5 and 4.0, respectively. CONCLUSIONS This study demonstrates that an interactive educational wheelchair program effectively increases medical students' understanding of manual wheelchair use. The addition of an educational interactive wheelchair program to medical student curricula is recommended to improve medical students' understanding of manual wheelchair use and its impact on users.
A Global Approach to Estimating the Abundance and Duplication of Polyketide Synthase Domains in Dinoflagellates

Many dinoflagellate species make toxins in a myriad of different molecular configurations but the underlying chemistry in all cases is presumably via modular synthases, primarily polyketide synthas...
Evaluation of team communication in an interprofessional inpatient transition of care simulation

Abstract Background Interprofessional education (IPE) provides unique opportunities for students to better understand their roles, roles of other healthcare professionals, and prepare for teamwork for patient benefit. Interprofessional team education is recognized as a key element in the 2016 ACPE standards. Objective Assess student self-perceived competence in four IPEC domains after an inpatient simulation activity. Methods Pre/post-test design used the Interprofessional Education Collaborative Competency Survey. The activity included medical, nursing, social work, and pharmacy students working in healthcare teams to develop collaborative treatment plans for simulated patients with altered mental status. Results Ninety-seven health profession students completed the activity, while 49 second-year (P2) student pharmacists participated in the study. All completed a pre-test and 47/49 (96%) completed a post-test. At pre-test, students ranked themselves highest in abilities to respect patient privacy (100% strongly agree) and acting with honesty and integrity in relationships (100% strongly agree). They reported lower ability in describing team development process. At post-test, significant increases were seen in managing ethical dilemmas (p Conclusion Significant differences in student perceptions of ethics and communication were observed after participation in a transition of care inpatient IPE simulation.
The Use of Dexmedetomidine in the Emergency Department: A Cohort Study

Introduction: Management of sedation, analgesia, and anxiolysis are cornerstone therapies in the emergency department (ED). Dexmedetomidine (DEX), a central alpha-2 agonist, is increasingly being used, and intensive care unit (ICU) data demonstrate improved outcomes in patients with respiratory failure. However, there is a lack of ED-based data. We therefore sought to: 1) characterize ED DEX use; 2) describe the incidence of adverse events; and 3) explore factors associated with adverse events among patients receiving DEX in the ED. Methods: This was a single-center, retrospective, cohort study of consecutive ED patients administered DEX (January 1, 2017–July 1, 2019) at an academic, tertiary care ED with an annual census of ~90,000 patient visits. All included patients (n= 103) were analyzed for characterization of DEX use in the ED. The primary outcome was a composite of adverse events, bradycardia and hypotension. Secondary clinical outcomes included ventilator-, ICU-, and hospital-free days, and hospital mortality. To examine for variables associated with adverse events, we used a multivariable logistic regression model. Results: We report on 103 patients. Dexmedetomidine was most commonly given for acute respiratory failure, including sedation for mechanical ventilation (28.9%) and facilitation of non-invasive ventilation (17.4%). Fifty-four (52.4%) patients experienced the composite adverse event, with hypotension occurring in 41 patients (39.8%) and bradycardia occurring in 18 patients (17.5%). Dexmedetomidine was stopped secondary to an adverse event in eight patients (7.8%). Duration of DEX use in the ED was associated with an increase adverse event risk (adjusted odds ratio, 1.004; 95% confidence interval, 1.001, 1.008). Conclusion: Dexmedetomidine is most commonly administered in the ED for patients with acute respiratory failure. Adverse events are relatively common, yet DEX is discontinued comparatively infrequently due to adverse events. Our results suggest that DEX could be a viable option for analgesia, anxiolysis, and sedation in ED patients.
Intraspecific variation in the rates of mutations causing structural variation in Daphnia magna.

Mutations that cause structural variation are important sources of genetic variation upon which other evolutionary forces can act, however they are difficult to observe and therefore few direct estimates of their rate and spectrum are available. Understanding mutation rate evolution, however, requires adding to the limited number of species for which direct estimates are available, quantifying levels of intraspecific variation in mutation rates, and assessing whether rate estimates co-vary across types of mutation. Here, we report structural variation-causing mutation rates (svcMRs) for six categories of mutations (short insertions and deletions, long deletions and duplications, and deletions and duplications at copy number variable [CNV] sites) from 9 genotypes of Daphnia magna collected from three populations in Finland, Germany, and Israel using a mutation accumulation approach. Based on whole genome sequence data and validated using simulations, we find svcMRs are high (2 orders of magnitude higher than base substitution mutation rates measured in the same lineages), highly variable among populations, and uncorrelated across categories of mutation. Furthermore, to assess the impact of scvMRs on the genome, we calculated rates while adjusting for the lengths of events and ran simulations to determine if the mutations occur in genic regions more or less frequently than expected by chance. Our results pose a challenge to most prevailing theories aimed at explaining the evolution of the mutation rate, underscoring the importance of obtaining additional mutation rate estimates in more genotypes, for more types of mutation, in more species, in order to improve our future understanding of mutation rates, their variation, and their evolution.
Studies on the hemoglobins of pinnipeds.

The hemoglobins of seven species of pinnipeds-elephant, ribbon, fur, harbor, and grey seals, walrus, and California sea lion-had two major and one minor hemoglobin fractions on electrophoresis at pH 8.6. One of the major fractions in all seven species had the same electrophoretic mobility. The second fractions of the gray, harbor, and ribbon seals were similar, but different from the second fractions of the walrus, fur seal, and sea lion. The second fraction of the elephant seal was different from all the others. The proportion of the two major fractions was about 3:1 in the elephant, grey, ribbon, and harbor seals, and about 1:1 in the fur seal, walrus, and sea lion. These results correlated well with the pinniped phylogenetic chart derived by classical morphology. All hemoglobin fractions were found to be alkali sensitive and heat stable. Gel filtration studies with Sephadex G-75 and G-100 indicated that the elephant seal hemoglobins had a mol wt of about 65,000. The amino acid compositions of the chains isolated from the hemoglobin fractions suggested that in the elephant seal one major fraction had two alpha and two beta chains, and the other major fraction had four like chains. The presence of a hemoglobin which is composed of a tetramer of like chains could be functionally advantageous to deep diving mammals.
EFECTO DEL FRACCIONAMIENTO Y CALIDAD DE LOS HIDRATOS DE CARBONO DE LA DIETA SOBRE PARÁMETROS DE CONTROL METABÓLICO EN SUJETOS DIABÉTICOS TIPO 2 INSULINO REQUIRENTES

Introduction: Currently there is no consensus regarding fragmentation, quantity and quality of carbohydrates (CHO) that should be followed by insulin treated type 2 diabetic individuals (ITT2D). Objective: To determine the relationship between the meal times, quality of available CHO in every meal and the metabolic control parameters in ITT2D individuals with a single or double dose of intermediate-acting insulin. Methods: 40 ITT2D individuals were evaluated, using food surveys to obtain the quantity of CHO, glycemic index (GI), glycemic load (GL) in every meal and meal times. The metabolic control was determined through lab exams (glycated hemoglobin; HbA1c, venous fasting glycaemia) and fasting (FBG), preprandial (PreG), postprandial (PostG) and bed time (BTG) capilar glycaemia using a glucometer. Statistical analysis were applied considering significant as p<0,05. Results: Individuals recorded an average of 4,9 ± 1,1 meals a day. It was found an asociation between lunch GL and PostG (r=0,317; p<0,05) and BTG (r=0,321; p<0,05). BTG was inversely correlated with the meals’ distribution (r = -0,346; p<0,05) and there was a trend to show lower values of BTG with individuals conducting ≥ 5 meals per day. It was observed that FBG predicts a 65% the variability of HbA1c (r =0,805; r2 =0,648; p<0,001). Conclusion: The meal times in ITT2D individuals with s single or double dose of intermediate-acting insulin could improve BTG.
Adaptive pricing for customers with probabilistic valuations

In this paper, we examine the problem of choosing discriminatory prices for customers with probabilistic valuations and a seller with indistinguishable copies of a good. We show that under certain assumptions this problem can be reduced to the continuous knapsack problem (CKP). We present a new fast Ɛ-optimal algorithm for solving CKP instances with asymmetric concave reward functions. We also show that our algorithm can be extended beyond the CKP setting to handle pricing problems with overlapping goods (e.g. goods with common components or common resource requirements), rather than indistinguishable goods. We provide a framework for learning distributions over customer valuations from historical data that are accurate and compatible with our CKP algorithm, and we validate our techniques with experiments on pricing instances derived from the Trading Agent Competition in Supply Chain Management (TAC SCM). Our results confirm that our algorithm converges to an Ɛ-optimal solution more quickly in practice than an adaptation of a previously proposed greedy heuristic
Between Scylla and Charybdis: Reply to Commentaries

In this reply, the author responds to discussions by Owen Renik and Janine de Peyer of his paper “Reclaiming Desire: Love Is Not Enough.” Renik and de Peyer alert us to potential pitfalls in analytic treatment, on the one side of straying too far from lived clinical reality and on the other of failure to anticipate alternative versions of relational configurations. The author contends that the danger, the Scylla and Charybdis, of emphasis on these poles is the potential to overlook a fundamental developmental and treatment trajectory that reflects two sides of human experiencing and of the treatment process, which together enable patients to take full possession of their agency and desire. I am grateful to Miki Rahmani, M.A., and Yakinton Shavelsky, Psy.D., for their timely and thoughtful comments on this discussion.
Neonatal tolerance induction to Mlsa. I. Tolerance to Mlsa is restricted by shared MHC determinants.

Abstract In this paper we have examined the influence of MHC (major histocompatibility complex) on neonatal tolerance to Mlsa (minor lymphocyte stimulating). By employing a novel approach we have shown that tolerance to Mlsa is restricted by shared MHC determinants. Thus, neonatal Mlsb mice, injected at birth with spleen cells from Mlsa mice, were tested as adults for Mlsa specific responses by interleukin-2 limiting dilution analysis, a technique which allows us to discriminate between responses to MHC + Mlsa and to MHC alone. Tolerance to Mlsa was in the context of any MHC type examined—donor, host, and third-party MHC products. These results show that tolerance to Mlsa is restricted by shared MHC determinants and extend previous studies indicating that activation of Mlsa responses is similarly restricted.
Anion-translocating ATPases

Publisher Summary This chapter describes the bacterial resistance to arsenicals and antimonials, other anion-translocating atpases, and arsenite resistance in eukaryotes. Arsenic is an active ingredient in a variety of commonly used insecticides, rodenticides, and herbicides and can be categorized into three groups: (1) the inorganic salts of the arsenical oxyanions arsenate (pentavalent) and arsenite (trivalent), (2) organic arsenicals, both trivalent and pentavalent, and (3) arsine gas. Bacterial resistance results from the activity of the ArsA, ArsB, and ArsC proteins. The ArsA and ArsB proteins form a membrane-bound oxyanion-translocating ATPase that confers resistance to arsenite and antimonite. Because of their toxicity, the use of arsenical and antimonial drugs is now limited to the treatment of a few topical protozoan diseases. Pentavalent antimony in the form of pentostam is still a widely used chemotherapeutic agent in the treatment of leishmaniasis. Treatment failure results from the emergence of pentostam-resistant Leishmani; Pentostam-resistant clinical isolates are cross-resistant to trivalent antimony, when cultured in macrophages.
Habermas and Critical Thinking

In this paper, I propose to examine some of the implications of Jurgen Habermas’s discourse ethics for critical thinking. Since the argument that Habermas presents is complex and multi-dimensional, I will not be able to confront its entirety. Instead, I will briefly summarize the argument and then examine the implications of his standards for reason and communication for education and critical thinking. Critical thinking is also a broad topic with conflicting interpretations. Therefore, I will ground my use of critical thinking in a conception similar to that of Richard Paul’s account, which I will also summarize briefly. Given this background, I will argue that Habermas’s theory directly confronts the central problem in characterizing critical thinking. The problematic tension in his theory — between the acceptance of profound social differences, and the attempt to ground moral reasoning in universal principles — is also a challenge for critical thinking. Critical thought must be characterized in a way that allows for different subject matter and different methods without sacrificing its usefulness for particular disciplines and diverse learners. I argue that although the requirements that Habermas places on reasoning may need to be broadened to incorporate different kinds of thought, his theory demonstrates the epistemological and ethical need for a general commitment on the part of the thinker to reflect critically on personal and social beliefs.
Comparison of recovery of propofol and methohexital sedation using an infusion pump

Two sedative anesthetic agents administered by an infusion pump were compared during third molar surgery. Forty American Society of Anesthesiologists (ASA) class I or II volunteers were randomly allocated to two groups. All subjects received supplemental oxygen via a nasal hood, fentanyl (0.0007 mg/kg intravenous [i.v.] bolus), and midazolam (1 mg/2 min) titrated to effect. Patients then received either 0.3 mg/kg of methohexital or 0.5 mg/kg of propofol via an infusion pump. Upon completion of the bolus, a continuous infusion of 0.05 mg/kg/min methohexital or 0.066 mg/kg/min propofol was administered throughout the procedure. Hemo-dynamic and respiratory parameters and psychomotor performance were compared for the two groups and no significant differences were found. The continuous infusion method maintained a steady level of sedation. Patients receiving propofol had a smoother sedation as judged by the surgeon and anesthetist.
What Triggers Anger in Everyday Life? Links to the Intensity, Control, and Regulation of These Emotions, and Personality Traits

Why do people experience anger? Most of our knowledge on anger-triggering events is based on the study of reactions at a single time point in a person's life. Little research has examined how people experience anger in their daily life over time. In this study, we conducted a comprehensive examination of the situational determinants of anger over the course of 3 weeks. Using daily diary methodology, people (N = 173; 2,342 anger episodes) reported their most intense daily anger and, with an open-ended format, described the trigger. Participants also answered questions on anger intensity, control, and regulatory strategies, along with baseline personality trait measures. Using an iterative coding system, five anger trigger categories emerged: other people, psychological and physical distress, intrapersonal demands, environment, and diffuse/undifferentiated/unknown. Compared with other triggers, when anger was provoked by other people or when the source was unknown, there was a stronger positive association with anger intensity and lack of control. Personality traits (i.e., anger, mindfulness, psychological need satisfaction, the Big Five) showed few links to the experience and regulation of daily anger. Although aversive events often spur anger, the correlates and consequences of anger differ depending on the source of aversion; personality traits offer minimal value in predicting anger in daily life.