cssi/SciSciGPT-SciSciNet huggingface dataset:
Development of a Veterans Affairs Hybrid Operating Room for Transcatheter Aortic Valve Replacement in the Cardiac Catheterization Laboratory

Importance Transcatheter aortic valve replacement (TAVR) revolutionized the treatment of aortic stenosis. Developing a TAVR program with a custom-built hybrid operating room (HOR) outside the surgical operating room area poses unique challenges in Veterans Affairs (VA) institutions. Objective To present the process by which the San Francisco VA Medical Center developed a VA-approved TAVR program, in which an HOR exists in a cardiac catheterization laboratory, as a guideline for future programs. Design, Setting, and Participants Retrospective review of each required approval process for developing an HOR in a cardiac catheterization laboratory in a VA designated for complex surgery. Participants included San Francisco VA Medical Center health care professionals and individuals responsible for new program initiation in VA institutions. Exposures External reviews by industry vendors, the VA Central Office, and the Office for Construction, Facilities, and Management and an internal Healthcare Failure Mode and Effect Analysis. Main Outcomes and Measures The timeline for each process. Results Developing a TAVR program required vetting and approval from industry vendors, who provided training and expertise. Architectural plans for construction of the HOR began in 2010-2011, followed by approval from Edwards Lifesciences, Inc, in 2012 and fundamentals training on February 8 and 9, 2013. Following a pilot launch of the first VA TAVR program at the Houston VA Medical Center, subsequent programs were required to submit a plan to the VA Central Office for proposed restructuring of their clinical programs. After the San Francisco VA Medical Center proposal submission on February 3, 2013, a site visit consisting of a National Chief of Catheterization Laboratory Managers, a cardiac surgeon, and an interventional cardiologist with TAVR experience was conducted on April 12, 2013. During construction, HOR plans were inspected by the Office for Construction, Facilities, and Management followed by on-site inspection on August 8, 2013, to assess the adequacy of the HOR, newly built restricted corridors, equipment storage areas, and altered staff and patient flow patterns. Last, a Healthcare Failure Mode and Effect Analysis was performed to mitigate any negative effects of the HOR not being colocated in the surgical operating room area. Approval was then granted on November 13, 2013. Our first 10 TAVR cases were successfully completed as of April 2, 2014. Conclusions and Relevance The primary factor for development of a successful TAVR program is integration of the heart valve team. Particular adaptations to the cardiac catheterization laboratory environment are required to accommodate an uncompromised HOR in which cardiac and vascular surgeons can be as comfortable as their interventional cardiology colleagues.
Bcl-xL Regulates CD1d-Mediated Antigen Presentation to NKT Cells by Altering CD1d Trafficking through the Endocytic Pathway

NKT cells are a unique subset of T cells that recognize glycolipid Ags presented in the context of CD1d molecules. NKT cells mount strong antitumor responses and are a major focus in developing effective cancer immunotherapy. It is known that CD1d molecules are constantly internalized from the cell surface, recycled through the endocytic compartments, and re-expressed on the cell surface. However, little is known about the regulation of CD1d-mediated Ag processing and presentation in B cell lymphoma. Prosurvival factors of the Bcl-2 family, such as Bcl-xL, are often upregulated in B cell lymphomas and are intimately linked to sphingolipid metabolism, as well as the endocytic compartments. We hypothesized that Bcl-xL can regulate CD1d-mediated Ag presentation to NKT cells. We found that overexpression or induction of Bcl-xL led to increased Ag presentation to NKT cells. Conversely, the inhibition or knockdown of Bcl-xL led to decreased NKT cell activation. Furthermore, knockdown of Bcl-xL resulted in the loss of CD1d trafficking to lysosome-associated membrane protein 1+ compartments. Rab7, a late endosomal protein, was upregulated and CD1d molecules accumulated in the Rab7+ late endosomal compartment. These results demonstrate that Bcl-xL regulates CD1d-mediated Ag processing and presentation to NKT cells by altering the late endosomal compartment and changing the intracellular localization of CD1d.
Numerical integration methods based on variation diminishing polynomial approximation for the solution of algebraic differential equations in the context of circuit simulation

Numerical integration techniques based on the Bernstein approximation are presented. A common approach to solving the initial value problems representing the algebraic differential equations is to formulate the solution as a polynomial function. In general, any algorithm capable of calculating the exact value of the unknown state variable for an initial value problem having an exact solution in the form of a kth degree polynomial is called a numerical integration formula of order k. Of course, in almost all cases the exact solution is not a polynomial, and the solution is an approximate one. However, the Weiestrass approximation theorem asserts that any continuous function can be uniformly approximated within any closed interval by a polynomial of sufficiently high degree. Hence, even if the solution is not a polynomial, a numerical integration formula of sufficiently high order can, in principle, be used to evaluate the state variable to any desired accuracy. Not all polynomial interpolants, however, would satisfy Weiestrass approximation theorem. Bernstein polynomials provide a weighted uniform approximation basis, and they are also used to construct one of the many proofs of the Weiestrass approximation theorem. Predictor-based integration formulas are obtained by formulating the solution function as a Bernstein polynomial. >
Effect of mixing methods on the physical properties of dental stones.

Abstract Objectives This in vitro comparative study evaluated the effect of different stone mixing methods on material properties of four dental stones. Two ADA type IV stones (Silky-Rock and Snap-Stone), one type V high expansion stone (Die Keen), and one recently introduced type V specialty stone (HandiMix) were chosen for this study. Methods Forty cylindrical specimens (25 mm × 12.5 mm) were cast for each of the nine stone sub-groups and bench dried at 23 ± 2 °C for 1 and 24 h. Specimens were then tested in an Instron in tensile and compression modes at crosshead speeds of 0.5 and 1.0 mm/min, respectively. Four rectangular-shaped specimens (30 mm × 15 mm × 15 mm) of each stone type were cast and bench dried for 48 h. Knoop microhardness measurements were obtained from defined areas on each specimen for surface hardness testing using 200 g load and 20 s dwell time. A 12.6 mm 2 area was then delimited in the center of two sides of each specimen and photographed under low power magnification (40×). The average pore number per area was then determined for each specimen for surface porosity testing. The setting time and setting expansion for each stone type was recorded as well. Results ANOVA ( P P Conclusion Within the limitations of this study, the newly introduced mixing method did not appear to have an effect on the physical properties of HandiMix stone.
Papillary Thyroid Carcinoma

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, comprising 80% of all thyroid carcinomas. From 1973 to 2002, the incidence of all thyroid cancers increased 2.4-fold, and the increase was virtually entirely due to an increase in papillary carcinomas. Over this 30-year period, the incidence of PTC increased more by 5 per 100,000, a 2.9-fold increase. Despite the increasing incidence of PTC, the mortality from thyroid cancer has remained stable over the years.
Multiseasonal-multispectral remote sensing of phenological change for natural vegetation inventory

The author has identified the following significant results. Variations in phenological development among plant species was noted, as well as the tendency for the seasonal appearance of some vegetation types to be dominated by the appearance of one or a few similarly developing species. Most of the common plants in the study area could be characterized by temporal aspects of their phenological development. There was a strong similarity among the spectral signatures of vegetation types in which the spectral return was dominated by green plant material. When the soil background dominated the spectral return from a vegetation stand, then the spectral radiance and the vegetation physiognomy were apparently related. When the deciduous shrubs lost their leaves, their spectral signature altered with a slight decrease of radiance in the visible wavelengths and a strong decrease in the near infrared. As the foliage of perennial grasses cured from August to November, its apparent green radiance remained unchanged, red radiance increased over 50 percent, and near infrared radiance decreased approximately 30 percent. A reflective mineral surface exhibited high radiance levels in all four bands, thus providing a marked contrast to the absorption characteristics of vegetation canopies.
Health policy: Strategies to optimize expedited investigational new drug safety reports.

Accurate and efficient expedited investigational new drug (IND) reporting is a crucial component of clinical research. The FDA, pharmaceutical companies, institutional review boards, and clinical investigators should develop dynamic standardized electronic forms with preferred, predetermined terms to harmonize their practices and to help optimize the quality of clinical research and maximize patient safety.
Multifunctions and Inverse Cluster Sets

In this paper the notion of inverse cluster set, which was recently introduced and studied for functions by T. R. Hamlett and P. E. Long (Proc. Amer. Math. Soc, 53 (1975), 470-476), is extended to and investigated for multifunctions. We generalize the notion of inverse cluster set, extend to multifunctions and generalize some known results for inverse cluster sets of functions and offer some new results. In the latter sections, compactness generalizations are characterized in terms of inverse cluster sets and some results on connected and conectivity functions are extended to multifunctions.
Racializing Discourse in Public and Private: Social Differentiation and the Question of Mexicanness at an Arizona High School

Using discourse analysis, this article explores how Mexican-American students at an Arizona high school exploited intersections of race, gender, and socioeconomic class to position themselves and their peers along a racial continuum from less to more Mexican. Thus, private social distinctions among students both mirrored and transformed publicly circulating discourses of belonging, foreignness, and civility. The findings inform understandings of the complex, day-to-day construction of race and other social categories among students in U.S. schools.
Embedded instruction: Proxy voicing in couples therapy

Abstract This paper takes up the issue of how instruction can be accomplished in circumstances in which an instructional orientation during interaction is considered to be or is treated as problematic. In couple therapy, as with other interactional settings, talk about an actor's experience, especially when participants have different access to that experience, can be a delicate matter. Therapist's formulations can make a client's talk or conduct accountable as a lapse of competence or conduct, leading to client opposition in therapy. One procedure used to avoid the possibility of such opposition is to embed a formulation of a client's talk in an understanding check using a form of reported speech called proxy voicing ( Seedall and Butler, 2006 ) in which the therapist speaks to a client as that client. In this paper, I show the way that proxy voicing is produced to serve as a form of embedded instruction in a Jeffersonian sense. As the basis for a therapeutic enactment, the therapist's candidate understanding, is not simply a form of repair or correction, it is a form of embedded instruction in the form of a demonstration. I show that embedded instruction provides both opportunities and resources for clients as learners to engage in learning's work ( Zemel, 2014 ) under the supervision of the therapist while relieving the client of the requirement that he or she account for what the therapist considers a therapeutic problem of competence or conduct.
Enrichment of rab11, a small GTP-binding protein, in gastric parietal cells.

Parietal cell secretion of acid requires the coordinated fusion of H(+)-K(+)-adenosinetriphosphatase (ATPase)-containing tubulovesicles with a secretory canalicular target membrane. We have previously reported the presence of rab2 on parietal cell tubulovesicles (L. H. Tang, S. A. Stoch, I. M. Modlin, and J. R. Goldenring. Biochem. J. 285: 715-719, 1992). Since 60% of the small GTP-binding protein sequences obtained from parietal cells were > 95% homologous with human rab11 (J. R. Goldenring, K. R. Shen, H. D. Vaughan, and I.M. Modlin. J. Biol. Chem. 268: 18419-18422, 1993), we sought to study rab11 in gastric parietal cells. A complete rab11 sequence was obtained, and the deduced amino acid sequence of rabbit rab11 was identical to that for human. Rab11 mRNA was present throughout the gastrointestinal mucosa. mRNA for both rab11 and rab2 were enriched in isolated parietal cells compared with chief cells. A polyclonal antiserum against rab11 labeled a single 25-kDa band in isolated parietal cells. Immunostaining of rat fundic tissue demonstrated prominent staining of parietal cells. Rab11 staining cosegregated with alpha-H(+)-K(+)-ATPase staining in enriched preparations of rabbit parietal cell tubulovesicles. These results suggest that rab11 is enriched in parietal cells and is associated with intracellular tubulovesicles.
Small-for-gestational-age infants among uncomplicated pregnancies at term: a secondary analysis of 9 Maternal-Fetal Medicine Units Network studies

Background Most small (birthweight Objective We sought to compare composite neonatal morbidity among uncomplicated term singleton pregnancies with small vs appropriate for gestational age. Study Design We culled collected data from 9 completed Maternal-Fetal Medicine Units studies conducted from 1989 through 2004. All data were collected prospectively by trained staff. We excluded women who delivered Results Of the >91,000 women enrolled in the studies, 60% (n = 50,011) met the inclusion criteria. Among the uncomplicated pregnancies, 10.8% (n = 5416) were small for gestational age. The rate of composite neonatal morbidity of 16% in small for gestational age and 10% in appropriate for gestational age persisted (adjusted odds ratio, 1.75; 95% confidence interval, 1.71–1.78). After adjustment for confounders, the following neonatal morbidities were significantly more common among term small than appropriate for gestational age: Apgar Conclusion Among uncomplicated pregnancies at term, small- compared to appropriate-for-gestational-age newborns have a significantly higher likelihood of composite neonatal morbidity, stillbirth, and neonatal mortality. A large multicenter trial is warranted to determine if improved detection of small for gestational age among uncomplicated pregnancies can mitigate morbidities and mortality, without disproportionate interventions and iatrogenic complications.
The Lost Art of Dress: The Women Who Once Made America Stylish. By Linda Przybyszewski. (New York, NY: Basic Books, 2014. Pp. xv, 347. $28.99.)

Early twentieth‐century discourse concerning American fashion revealed insecurity about taste. While the nation's practical, ready‐to‐wear clothing was widely celebrated, American women turned to a...
Demonstration of a silicon photonic neural network

Silicon photonic integration could enable high-performance brain-inspired photonic processors. We demonstrate a 3 node recurrent photonic neural network. Cusp and Hopf bifurcations induced by synaptic reconfiguration are shown as proof-of-concept. The prototype represents an early step towards network-based models of physical computing with integrated photonics.
Tumor growth models

Tumor growth models broadly encompass dynamic models representing tumor size data that are used to characterize the dynamics of tumor growth and response to treatment. In this chapter, we discuss specific aspects of mathematical modeling of tumor growth. We present deterministic and stochastic models of tumor dynamics, along with their applications and limitations.
Leg Ulcers in Sickle Cell Anemia Are Associated with Laboratory Markers of Hemolysis and SNPs in KL and Genes of the TGF-β/BMP Pathway.

Sickle cell disease patients have a high risk of developing leg ulcers. In the CSSCD database we found 378 patients with a confirmed history of leg ulcers and chose 920 patients without ulcers to serve as controls. α Thalassemia reduces hemolysis in sickle cell anemia which is consistent with our finding using an age-adjusted comparison, that sickle cell anemia-α thalassemia was more frequent among controls than cases (OR: 0.7, 95% CI: 0.5–0.9). This suggests that sickle cell anemia-α thalassemia patients are significantly less likely to have leg ulcers. Also, leg ulcer patients had lower hemoglobin levels, higher LDH, bilirubin, AST, reticulocyte and white blood cell count than controls. These differences were highly statistically significant (p p was KL (rs685417 and rs516306; p values , TEK (rs603085 and rs671084; p values SMAD1 (rs1899784, rs10519733 and rs2068991; p values SARA1 (rs2271690 and rs870801; p values KL directly or indirectly promotes endothelial NO production. The TEK receptor tyrosine kinase (TIE2) is expressed almost exclusively in endothelial cells, is involved in angiogenesis and is the ligand for angiopoietin-1 ( ANG1 ). SMAD1 and SARA1 are members of the TGF-β/BMP pathway. The TGF-β receptor signals through the SMAD family of transcriptional regulators that are anchored to the cell membrane by factors like SARA (SMAD Anchor for Receptor Activation). This pathway modulates immunosuppression, cell migration, wound healing and angiogenesis, among its other functions. Hemolysis is likely to be an antecedent of certain vascular complications of sickle cell disease, like pulmonary hypertension This, and the current studies, suggest that there is a hemolysis-driven phenotype in sickle cell disease that now includes leg ulcers. While candidate genes that might modulate the rate of hemolysis have not yet been studied, we find that SNPs in genes that may be pathogenetically important in sickle vasculopathy are associated with the disease subphenotype of leg ulcer. Linking gene polymorphisms with disease subphenotypes, may eventually provide useful means of foretelling the likelihood of complications and allow better individualized treatment.
Encouraging Curiosity in Case-Based Reasoning and Recommender Systems

A key benefit of case-based reasoning (CBR) and recommender systems is the use of past experience to guide the synthesis or selection of the best solution for a specific context or user. Typically, the solution presented to the user is based on a value system that privileges the closest match in a query and the solution that performs best when evaluated according to predefined requirements. In domains in which creativity is desirable or the user is engaged in a learning activity, there is a benefit to moving beyond the expected or “best match” and include results based on computational models of novelty and surprise. In this paper, models of novelty and surprise are integrated with both CBR and Recommender Systems to encourage user curiosity.
Plasmonic gold nanostars as optical nano-additives for injection molded polymer composites

Nanoscale engineering of noble metal particles has provided numerous material configurations to selectively confine and manipulate light across the electromagnetic spectrum. Transitioning these materials to a composite form while maintaining the desired resonance properties has proven challenging. In this work, the successful integration of plasmon-focusing gold nanostars (GNSs) into polymer nanocomposites (PNCs) is demonstrated. Tailored GNSs are produced with over a 90% yield and methods to control the branching structures are shown. A protective silica capping shell is employed on the nanomaterials to facilitate survivability in the high temperate/high shear processing parameters to create optically-tuned injection molded PNCs. The developed GNS PNCs possess dichroic scattering and absorption behavior, opening up potential applications in the fields of holographic imaging, optical filtering and photovoltaics.
Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis

Importance Childhood anxiety is common. Multiple treatment options are available, but existing guidelines provide inconsistent advice on which treatment to use. Objectives To evaluate the comparative effectiveness and adverse events of cognitive behavioral therapy (CBT) and pharmacotherapy for childhood anxiety disorders. Data Sources We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and SciVerse Scopus from database inception through February 1, 2017. Study Selection Randomized and nonrandomized comparative studies that enrolled children and adolescents with confirmed diagnoses of panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, or separation anxiety and who received CBT, pharmacotherapy, or the combination. Data Extraction and Synthesis Independent reviewers selected studies and extracted data. Random-effects meta-analysis was used to pool data. Main Outcomes and Measures Primary anxiety symptoms (measured by child, parent, or clinician), remission, response, and adverse events. Results A total of 7719 patients were included from 115 studies. Of these, 4290 (55.6%) were female, and the mean (range) age was 9.2 (5.4-16.1) years. Compared with pill placebo, selective serotonin reuptake inhibitors (SSRIs) significantly reduced primary anxiety symptoms and increased remission (relative risk, 2.04; 95% CI, 1.37-3.04) and response (relative risk, 1.96; 95% CI, 1.60-2.40). Serotonin-norepinephrine reuptake inhibitors (SNRIs) significantly reduced clinician-reported primary anxiety symptoms. Benzodiazepines and tricyclics were not found to significantly reduce anxiety symptoms. When CBT was compared with wait-listing/no treatment, CBT significantly improved primary anxiety symptoms, remission, and response. Cognitive behavioral therapy reduced primary anxiety symptoms more than fluoxetine. The combination of sertraline and CBT significantly reduced clinician-reported primary anxiety symptoms and response more than either treatment alone. Head-to-head comparisons were sparse, and network meta-analysis estimates were imprecise. Adverse events were common with medications but not with CBT and were not severe. Studies were too small or too short to assess suicidality with SSRIs or SNRIs. One trial showed a statistically nonsignificant increase in suicidal ideation with venlafaxine. Cognitive behavioral therapy was associated with fewer dropouts than pill placebo or medications. Conclusions and Relevance Evidence supports the effectiveness of CBT and SSRIs for reducing childhood anxiety symptoms. Serotonin-norepinephrine reuptake inhibitors also appear to be effective based on less consistent evidence. Head-to-head comparisons between various medications and comparisons with CBT represent a need for research in the field.
A COMPARATIVE LOOK AT SOVIET PSYCHIATRY: TRAINING, CONCEPTS, AND PRACTICE

Under the Health Agreement signed in 1972 by the Soviet Union and the United States, a collaborative research project was undertaken by the Institute of Psychiatry of the Academy of Medical Sciences in Moscow, and the National Institute of Mental Health. The first clinical phase of the work was done at the Institute in Moscow during the academic year ‘72-’73. The project in which I participated was a clinical study with Dr. Irina Shakhmatova, aimed at understanding the Soviet classification of major mental illness. We attempted to develop a system which incorporated the subtypes of schizophrenia used by Soviet and American psychiatrists (2). Agreement on clinical diagnosis of schizophrenia was necessary as preparation for the second stage of the study in which biological specimens from patients with schizophrenia would be studied, as part of a collaborative research program in biologic and genetic aspects of schizophrenia. The biologic research, still in early planning stages, continues to be developed.
A Glutamate Homeostat Controls the Presynaptic Inhibition of Neurotransmitter Release

We have interrogated the synaptic dialog that enables the bi-directional, homeostatic control of presynaptic efficacy at the glutamatergic Drosophila neuromuscular junction (NMJ). We find that homeostatic depression and potentiation use disparate genetic, induction, and expression mechanisms. Specifically, homeostatic potentiation is achieved through reduced CaMKII activity postsynaptically and increased abundance of active zone material presynaptically at one of the two neuronal subtypes innervating the NMJ, while homeostatic depression occurs without alterations in CaMKII activity and is expressed at both neuronal subtypes. Furthermore, homeostatic depression is only induced through excess presynaptic glutamate release and operates with disregard to the postsynaptic response. We propose that two independent homeostats modulate presynaptic efficacy at the Drosophila NMJ: one is an intercellular signaling system that potentiates synaptic strength following diminished postsynaptic excitability, while the other adaptively modulates presynaptic glutamate release through an autocrine mechanism without feedback from the postsynaptic compartment.
Verse Drama in England, 1900–2015: Art, Modernity and the National Stage by Irene Morra (review)

Irene Morra’s Verse Drama in England, 1900–2015 offers an overdue reassessment of English verse drama of the twentieth century, considers the role of verse drama in post-war constructions of Englis...
Testing for Initialization Bias in the Mean of a Simulation Output Series

An initial state for a computer simulation model must be specified each time the program is run. Often convenient starting conditions (such as an empty system) are unlikely to occur naturally and introduce initialization bias in the output. One of the most important manifestations of initialization bias is a change in the output process mean near the beginning of a run while the program “warms up”. Sometimes a change in the output mean is obscured by random variations in the process being simulated. An approach to measuring the significance of initialization bias in a output series is presented in [1]. The method is general in that the supporting assumptions are not very restrictive.
Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder

An increased awareness of the spiritual aspects of health and illness has recently led to changes in psychiatry residency training as well as hospital accreditation requirements. The spiritual impact of trauma has been an area of particular interest, as trauma evokes certain existential questions and crises. It is estimated that from 5–11% of trauma survivors will go on to develop posttraumatic stress disorder (PTSD). Given the spiritual challenges of the experience of trauma, patients with PTSD could benefit from spiritual assessment and intervention as part of their overall treatment plan, and clergy can be utilized to perform this. The literature exploring the spiritual impact of trauma and the use of clergy in the treatment of trauma survivors is reviewed. The methods used by three chaplains in a residential treatment program for PTSD at one facility are described and discussed. Both the literature and the experiences of the clergy suggest that exploration of trauma-related existential conflicts in patients with PTSD is beneficial. However, there is a notable dearth of controlled scientific studies evaluating the effectiveness of spiritual interventions with this treatment population. The need for controlled studies to verify the usefulness of spiritual assessment and intervention in patients with PTSD is noted, and a more rigorous analysis of how clergy can best serve this treatment population is encouraged.
Modulation of protein function by isoketals and levuglandins.

Oxidative stress, defined as an increase in reactive oxygen species, leads to peroxidation of polyunsaturated fatty acids and generates a vast number of biologically active molecules, many of which might contribute in some way to health and disease. This chapter will focus on one specific class of peroxidation products, the levuglandins and isoketals (also called isolevuglandins). These γ-ketoaldehydes are some of the most reactive products derived from the peroxidation of lipids and exert their biological effects by rapidly adducting to primary amines such as the lysyl residues of proteins. The mechanism of their formation and remarkable reactivity will be described, along with evidence for their increased formation in disease conditions linked with oxidative stress and inflammation. Finally, the currently known effects of these γ-ketoaldehydes on cellular function will then be discussed and when appropriate compared to the effects of α,β-unsaturated fatty aldehydes, in order to illustrate the significant differences between these two classes of peroxidation products that modify proteins.
Multifocal Ventricular Arrhythmias Originating From the His-Purkinje System: Incidence, Characteristics, and Outcome of Catheter Ablation

Abstract Objectives This study sought to reveal the characteristics and radiofrequency catheter ablation (RFCA) outcomes of multifocal His-Purkinje system (HPS) ventricular arrhythmias (VAs). Background The details of those VAs, especially the safety and efficacy of their RFCA treatment, remain unclear. Methods Thirty consecutive patients who underwent RFCA of focal HPS VAs between 2010 and 2016 (unifocal = 24, multifocal = 6) were studied by measuring the electrophysiological variables within the HPS. Results Multifocal premature ventricular contractions (n = 1) and ventricular fibrillation (VF) (n = 5) were identified in the left posterior (n = 6), anterior (n = 4), and septal fascicles (n = 1), as well as the basal left bundle branch (LBB) (n = 2) and right bundle branch (RBB) (n = 2). In 2 patients with unifocal VAs and 4 patients with multifocal VAs, preferential conduction from an origin within the proximal fascicle (n = 4) or LBB (n = 2) to ≤3 breakout sites in the distal fascicles occurred with split or fractionated Purkinje potentials and/or conduction block at the site of origin. Among the multifocal VAs, 11 fascicle VAs, 1 RBB VA, and 1 LBB VA were successfully ablated with fascicular and/or bundle branch block, and complete atrioventricular block (CAVB), respectively. In the remaining LBB VAs and RBB VAs, RFCA was abandoned to avoid CAVB. Recurrence of ablated VAs or the incidence of VF did not differ between the unifocal and multifocal HPS VAs. Freedom from any HPS VA after RFCA was significantly higher in the patients with unifocal VAs than in the patients with multifocal VAs (92% vs. 33%; p = 0.001). Conclusions Multifocal HPS VAs could occur and often present with preferential conduction from proximal origins to distal breakout sites within the HPS with abnormal Purkinje potentials and/or conduction properties. RFCA was effective but was limited by the risk of HPS impairment.
Artificial intelligence in economics - expert systems modelling of microeconomic systems

Abstract Expert systems provide a means to overcome the limitations of pure mathematical modelling of microeconomic systems. In addition, they can serve as data generators in analyses aimed at determining the impact of institutional changes or bidder strategy modifications. The present paper outlines these uses of expert systems, emphasizing the ability of expert systems to incorporate critical behavioral information and relationships.
A study of axial backmixing in a 0.76-m flotation column

The liquid-phase mixing within CAN MET’s Western Research Centre’s (WRC) 0.76-m-diam pilot-plant flotation column was characterized using a salt tracer. The process variables studied were frother addition and gas and liquid flow rates. The response of the column to a tracer pulse was monitored at three axial and two radial locations. The results showed that the 2-tph flotation column was well mixed. Discussed are the implications of this observation to column design and scale-up.
Polylactide Foams with Tunable Mechanical Properties and Wettability using a Star Polymer Architecture and a Mixture of Surfactants

Commercially available low-density, hydrophilic foams are principally produced from nonrenewable petrochemical feedstocks and suffer from challenging disposal avenues and effective recycling. We ai...
Neighborhood Residence and Assessments of Racial Profiling Using Census Data

People frequently compare the racial composition of stopped individuals with the racial composition of the local residential population to assess unequal policing. This type of evaluation rests on ...
Tissue Engineering: Then, Now, and the Future.

Impact Statement This “invited submission” concisely reviews the author's involvement in the early era of tissue engineering and summarizes his perspective. He points out the journal was present in...
The Effect of Exposure to Racialized Cues on White and Black Public Support for Justice Reinvestment

Racial priming theory predicts that exposure to racialized cues causes whites to express stronger opposition to social policies designed to ameliorate racial disparities. This study uses racial pri...
Canonical Correlation Analysis with Missing Values: A Structural Equation Modeling Approach

Canonical correlation analysis (CCA) is a generalization of multiple correlation that examines the relationship between two sets of variables. When there are missing values, spectral decomposition in CCA becomes complicated and difficult to implement. This article investigates structural equation modeling approach to Canonical correlation analysis when data have missing values.
Desmoplastic Melanoma: Clinical Characteristics and Survival in the US Population.

Objective Desmoplastic melanoma (DM) is a rare variant of invasive malignancy of the skin pigmented cells. We present a comprehensive study reporting on US demographics, disease characteristics, and survival, to contribute to the current knowledge and raise awareness of this rare disease. Materials and methods The demographics of DM patients diagnosed from January 1, 2004, to December 31, 2015, were obtained by querying the National Cancer Database. The characteristics of DM were compared with common malignant melanoma (CMM) using univariate and multivariate regression models. Five-year overall survival (OS) curves were estimated using Kaplan-Meier analyses and the Cox proportional regression model. Results Our query found 5,895 patients diagnosed with DM and 292,939 patients with CMM. DM tended to present at an older age, a more advanced stage, and with a Breslow depth greater than 4 mm at diagnosis (P<.05). The Kaplan-Meier survival analysis demonstrated a five-year OS for DM and CMM of 75% and 76%, respectively, without any statistical difference (P=.07). Cox regression analysis demonstrated that age at diagnosis and comorbidities were independent predictors of five-year OS for DM (P<.001). Conclusions Older age, advanced stage, and higher Breslow depth were found to be independent positive factors associated with DM.
Ethno-Religious Philanthropy: Lessons from a Study of United States Jewish Philanthropy

This article discusses methodological challenges to the study of Jewish philanthropy. Based on a study of US Jewish-founded grant-making organizations between 2000 and 2015, the article examines existing and recently developed methods used in research about the philanthropic organizations of the Jewish community and the structure of their philanthropic activity. The authors discuss methodological dilemmas concerning the inclusion and exclusion of data and the double-counting of grants, and explore the methodological implications of the growing importance of donor advised funds. The article proposes a new methodological approach for the study of Jewish institutional philanthropy, emphasizing the identities and backgrounds of the funders in identifying Jewish philanthropies rather than limiting the definition of Jewish philanthropy based on the goals and activities of the recipient organizations.
Linear dilatons, NS5-branes and holography

We argue that vacua of string theory which asymptote at weak coupling to linear dilaton backgrounds are holographic. The full string theory in such vacua is ``dual'' to a theory without gravity in fewer dimensions. The dual theory is generically not a local quantum field theory. Excitations of the string vacuum, which can be studied in the weak coupling region using worldsheet methods, give rise to observables in the dual theory. An interesting example is string theory in the near-horizon background of parallel NS5-branes, the CHS model, which is dual to the decoupled NS5-brane theory (``little string theory''). This duality can be used to study some of the observables in this theory and some of their correlation functions. Another interesting example is the ``old'' matrix model, which gives a holographic description of two dimensional string theory.
Comparative Environmental Sensitivity of Offshore Gulf of Mexico Waters Potentially Impacted by Ultra-Deep Oil Well Blowouts

Environmental sensitivity indices (ESIs) have long been used to identify coastal and shoreline resources particularly vulnerable to oil spills and ensuing mitigation measures. In the Gulf of Mexico, oil production by the United States and Mexico has increasingly focused on deepwater sources. As oil exploration and production continue further offshore, deepwater and open ocean pelagic resources increasingly become the focus of susceptibility to oil well blowouts. Methodologies are proposed to spatially quantify ESIs specifically for offshore living marine resources. A multi-attribute utility model is proposed to integrate biological resource sensitivity measures and measures of potential economic losses to define spatially explicit environmental sensitivity. Model sensitivity is examined using three weighting schemes for various environmental attributes. The relative environmental sensitivities of four simulated deepwater blowouts in the Gulf of Mexico were analyzed and compared. While differences were found between four oil well blowout scenarios in terms of the overall sensitivity and to the individual attributes, results were relatively insensitive to the weights assigned to various attributes. The uses of ESIs in optimizing oil production locations to minimize potential impacts on sensitive ecological resources and economic uses are discussed.
The Chronic (Missed) Elbow Dislocation

Chronic elbow dislocations, while rare, may cause significant loss of function for patients. Due to significant soft tissue contractures and intra-articular fibrosis, treatment for these injuries is challenging and is approached on an individual basis based on the nature of the injury and the patient’s goals. Presented here is a case of a 27-year-old male with a 2-week-old elbow fracture dislocation treated with open reduction, internal fixation of the ulna, radial head replacement, and lateral ulnar collateral ligament repair along with a 1-year follow-up. The intraoperative considerations, treatment algorithms, and management of a common complication, heterotopic ossification, are outlined.
Method for improving skin color accuracy of three-dimensional printed training models for early pressure ulcer recognition

Abstract The purpose of this study was to develop a method to create color-accurate three-dimensional (3D) printed models of the human skin, based on digital 3D scans of the skin surface. In future, this methodology could be applied to create more intricate and life-like training models for educating health-care workers on recognition of early stage pressure ulcers in patients with diverse skin tones. In this study, a transfer function was derived to compensate for color errors introduced via the 3D printing process, for a specific model of color 3D printer. The effectiveness of the transfer function was tested by measuring color errors for a set of 3D printed color blocks fabricated with and without the transfer function color correction method. Lastly, a feasibility study was conducted to demonstrate the application of the color correction algorithm to 3D printed skin models generated from 3D color scans of healthy human subjects of varying skin tones.
Voluntary Disclosure Through the Ranking of Risk Factors in the 10-K

In this study, we examine whether managers rank risk factors and list them in order of their importance in Item 1A of the 10-K. We focus on firms’ credit risk disclosures and where they are positioned in Item 1A. Firms that place the credit risk factor closer to the beginning have lower credit ratings and higher bond spreads. They are also more likely to experience future rating downgrades and bankruptcies. Risk factor position, or rank, is a more robust measure of risk than disclosure characteristics examined in prior studies. We also use firms’ proximity to the investment grade threshold as an exogenous disclosure cost measure and find that firms with ratings near the threshold are more likely to move their credit risk factor to a less prominent position. Our study provides evidence on firms’ voluntary risk disclosure behavior and informs the SEC debate on whether to require risk factor ordering.
Performing Medical Education Research in Urology: Challenges and Opportunities

The Accreditation Council for Graduate Medical Education (ACGME) mandates educating resident physicians in evidence-based medicine (EBM) as a core program requirement. However, despite the significant emphasis placed on EBM, graduate medical education is far from evidence-based, and urology is a specialty where medical education research (MER) is particularly sparse. We want to articulate the challenges and opportunities with performing meaningful medical education research in urology training programs. Some studies suggest that the rigor of MER could be much stronger. The nature of GME requires researchers to use alternative study designs. Further, the unique role of residents as both learner and study subject and the dual role of faculty as researcher and educator pose challenges to carrying out research. There is a tremendous opportunity for improvement and innovation in both quality and efficiency of urology resident education. Rigorous MER is required to advance this opportunity, and the fundamental key is development of mentors and collaboration.
Patient-centered care and the electronic health record: exploring functionality and gaps.

Objective Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. Materials and methods We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. Results Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2-4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. Discussion and conclusion There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign.
In situ / operando synchrotron x-ray studies of metal additive manufacturing

Additive manufacturing (AM) comprises a group of transformative technologies that are likely to revolutionize manufacturing. In particular, laser-based metal AM techniques can not only fabricate parts with extreme complexity, but also provide innovative means for designing and processing new metallic systems. However, there are still several technical barriers that constrain metal AM. Overcoming these barriers requires a better understanding of the physics underlying the complex and dynamic laser–metal interaction at the heart of many AM processes. This article briefly describes the state of the art of in situ/operando synchrotron x-ray imaging and diffraction for studying metal AM, mostly the laser powder-bed fusion process. It highlights the immediate impact of operando synchrotron studies on the advancement of AM technologies, and presents future research challenges and opportunities.
Hepatocellular carcinoma clinical update: Current standards and therapeutic strategies

Abstract Hepatocellular carcinoma (HCC) accounts for the vast majority of primary hepatic malignancies. The overall incidence of this disease has always been significant, but in recent years it has continued to rise, now making HCC one of the leading causes of cancer deaths worldwide. Fortunately, research into the mechanisms of carcinogenesis and treatment options for this disease has also been progressing rapidly. Although the future for new insights and therapies appears more promising than ever, it also remains important to understand both the nature of HCC and the current state-of-the-art for treating affected patients. Although surgery is often considered to be a first choice, many patients present with extensive disease and are therefore not operative candidates. Fortunately, significant clinical advances over the last decade have contributed a number of new or improved treatment options. Many of these treatments require expertise from a variety of different clinical subspecialties. Indeed, managing patients with HCC has rapidly become a multi-modality, multi-disciplinary endeavor in which the details of each individual’s circumstance can greatly impact outcomes, and strategies can be quite nuanced. The purpose of this review is to provide a perspective on the disease itself, the patients who become afflicted, the spectrum of currently available treatment options, and the strategies for their optimal implementation. Such knowledge can be critically important as new data become available on the research front.