cssi/SciSciGPT-SciSciNet huggingface dataset:
Comment on 'The Royal College of Ophthalmologists Guidelines on retinal vein occlusions: executive summary'.

Comment on ‘The Royal College of Ophthalmologists Guidelines on retinal vein occlusions: executive summary’
Stability in flexibility: A British lens on constitutional success

This chapter challenges Ginsburg & Huq’s schema of constitutional success as presented in the book, Assessing Constitutional Performance. It argues that the unique constitutional dynamic in the United Kingdom - a co-existence of constitutional success and constitutional crisis - highlights a key variable omitted in their calculations: the effective management of constitutional change, or the balance between stability and flexibility in constitutional arrangements. The British experience suggests a contextualized assessment of that balance is a necessary element for establishing constitutional success from a functional perspective.
Inherited Tubulopathy Manifested of Low Molecular Weight Proteinuria

Inherited tubulopathies is easy to be overlooked or misdiagnosed due to insidious onset and insufficient specific clinical manifestation.A considerable proportion of the patients will be progressed to the end stage renal disease.Herein several inherited renal tubular diseases manifested of low molecular weight proteinuria were introduced in order to improve the understanding of these diseases and avoid unnecessary treatment.
Synthesis and Properties of Poly(N-methyl-5-vinyltetrazole)s

Poly(N-methyl-5-vinyltetrazole)s(PMVT) was synthesized with poly(5-vinyltetrazole)(PVT) and dimethyl sulfate as primary materials with yield of up to 97.36%.The structure of PMVT was identified by IR and NMR.Further,the thermodynamic behavior of PMVT was studied by DSC-TG analysis,while the safety performance of PMVT was evaluated by the mechanical sensitivity testing.Results show that the temprature of thermal decomposition of the pendanted tetrazole group of PMVT is higher than that of PVT,and the sensitivity of PMVT is closed to that of PVT.
Followup of abdominal neourethra.

AbstractAbdominal neourethrostomy is a highly satisfactory form of urinary diversion for patients with irreparable urethral stricture or destruction. Normal renal function, structure and urinary continence have been observed in 7 patients for as long as 17 years.
Doping control in sports--a perspective from the 1996 Olympic Games

Doping-control (DC) procedures, particularly as used at the 1996 Olympic Games, are described, and the role of pharmacists in DC is discussed. DC procedures must be strict and precisely followed to avoid contamination of samples, the appearance of bias, and breaches in security and confidentiality. The process of selecting athletes for testing can be random, nonrandom, or a combination of the two. Escorts are used to notify athletes of their selection, verify their identity, and accompany them to the DC station. When urine specimens are obtained for DC, the voiding process must be directly observed. The specimen is checked for pH and specific gravity and then processed for shipping to a laboratory to be analyzed for banned substances. Medication histories are also obtained, giving athletes the opportunity to declare any substance that has been taken for legitimate medical purposes. Laboratory analysis involves screening and confirmation phases. During the Atlanta Games, roughly 50 pharmacists participated in the DC program as escorts or technical officers. It is logical to involve pharmacists in DC programs because they can develop and conduct drug-testing protocols; educate athletes, coaches, and trainers about drug use and abuse; and help ensure the safe and effective use of medications. Sophisticated doping-control procedures have been developed for athletic competitions, and pharmacists have much to offer DC programs.
A remote monitoring program evaluation: a retrospective study.

Objective Using an integrated model, the Donabedian Quality and Logic Model, we examined a remote monitoring heart failure disease management program. Method This quantitative research used post-test only case matched design. The sample consisted of 210 participants from 23 home health care agencies. Results Logistic regression results indicated statistical significance, there was an inverse relationship between caregiver support and the complexity of decision making; X2 (3, n = 210) = 29.984, P = 0.012. The DTreg suggested that participants who were advised to go to the ER had a 1.00 probability of doing so, and those who were instructed otherwise had a 0.37 probability of going to the ER. Among participants who experienced a hospital readmission, there was 0.50 probability that patient education or other clinical intervention was implemented prior to the admission. Conclusion As home health care agencies consider disease management programs, it is important to gain a comprehensive understanding of the potential of innovative programs and the resources they require. While the agency invested the resources required by the remote monitoring program, the study demonstrated that caregiver support was a critical structural component of the program and may affect change in nurses' decision making to mitigate hospital utilization. We recommend that home health care agencies take greater consideration of the family and social support in implementing a remote monitoring system.
Down on the upside: redemption, contamination, and agency in the lives of adult children of alcoholics

We investigated differences in the nature and implications of Adult Children of Alcoholics (ACOAs; n = 53) and non-ACOAs' (n = 80) narrative identities. Participants described six autobiographical narratives and completed measures of emotional functioning. Narratives were coded for redemptive (bad things turning good), contaminated (good things turning bad), and agentic (perceived control) imagery. ACOAs exhibited similar levels of redemptive and contaminated imagery, and lower levels of agency in their narratives, relative to non-ACOAs. In addition, themes of redemption, contamination, and agency corresponded divergently with emotional functioning. Among ACOAs, narrative redemption and agency were related to poorer emotional functioning whereas, among non-ACOAs, narrative contamination predicted poorer emotional functioning. These findings provide indication of the manner in which ACOAs story their lives. They also align with the emerging area of research noting that, among certain vulnerable populations, redemptive and agentic imagery serve as predictors of maladaptive functioning.
Building Connections among Classes of Polynomial Functions.

Amajor thrust of Principles and Standards for School Mathematics is that teachers should help students see mathematics as an inte grated whole rather than as a series of isolated top ics. "Mathematics makes more sense and is easier to remember and apply when students can connect new knowledge to existing knowledge in meaningful ways" (NCTM 2000, p. 20). The document maintains that new concepts should be introduced, whenever possible, as extensions of familiar mathematics. The activity that follows emphasizes the commonalities among classes of polynomial functions and the themes that are transferred from one class to another.
Observation of single top at CDF

We present observation of electroweak single top quark production using 3.2 fb{sup -1} of data collected by the CDF experiment. Candidate events are selected for further classification by five parallel analysis techniques: one using a likelihood discriminant, one using a matrix-element discriminant, one using decision trees, one using a neural network, and one using a complementary dataset. The results of these analyses are combined in order to improve the expected sensitivity. The significance of the observed data is 5.0 standard deviations, and the expected sensitivity is in excess of 5.9 standard deviations. We also present the most current value of the CKM matrix element |V{sub tb}|.
Marijuana use and physical dating violence among adolescents and emerging adults: A systematic review and meta-analysis.

Background As restrictions on marijuana are loosened, there is concern of a coming increase in marijuana use among adolescents and emerging adults, which could be coupled with commensurate increases in behavioral problems associated with use, such as physical dating violence (PDV). To summarize what is known about the association between marijuana use and PDV victimization and perpetration among 11–21 year olds, we conducted a systematic review and meta-analysis of the relevant literature published between 2003 and 2015.
The Parsonage Exemption

The parsonage exemption allows “ministers of the gospel” to exclude the value of housing benefits from income, whether received in-kind or as a cash allowance. Critics argue that the provision violates the First Amendment’s Establishment Clause, while supporters contend that it does not single religion out for a cognizable benefit. Alternately, supporters claim that is a permissible accommodation for religion under the First Amendment’s Free Exercise Clause. This Article fills an important gap in the debate by offering a nuanced explanation of how the parsonage exemption and other housing provisions function within the tax code. Placing the exemption in its proper context makes clear that the parsonage exemption (1) operates as a unique subsidy for religious actors, (2) involves significantly more church-state entanglement than would its elimination; (3) violates core tax principles of horizontal and vertical equity; and (4) differs significantly from other exemptions for religious actors.
Treatment of urticaria. An evidence-based evaluation of antihistamines.

Urticaria is a cutaneous syndrome characterized by dermal edema (wheal) and erythema (flare) that blanches with pressure. The lesions typically last less than 24 hours and are usually pruritic. In 1983, Christensen and Maibach summarized the theory behind the use of histamine H1 receptor antagonists (antihistamines) in clinical dermatology. These agents remain the mainstay of treatment for urticaria. This article reviews the medical literature on the effectiveness of antihistamines in urticarial syndromes, including acute, chronic idiopathic and the physical urticarias. Older antihistamines, such as chlorpheniramine and hydroxyzine, are effective in the treatment of urticarias, but they also have marked sedative and anticholinergic effects. Newer nonsedating antihistamines (second-generation antihistamines) have been developed that have reduced adverse effects because they do not cross the blood-brain barrier; these agents (acrivastine, cetirizine, loratadine, mizolastine, fexofenadine, ebastine, azelastine and epinastine) cause significantly less sedation and psychomotor impairment than their older counterparts. A review of the literature reveals that there are few studies which document the efficacy of second-generation antihistamines in the treatment of acute urticaria, a biologic entity that usually resolves within 3 weeks. We did not identify controlled studies that suggested superiority of any antihistamine in the treatment of acute urticaria. Loratadine or cetirizine, and possibly mizolastine, appear to be treatments of choice for chronic idiopathic urticaria. For symptomatic dermatographism, the combination of an antihistamine and an H2 antagonist, e.g. chlorpheniramine and cimetidine, appears to be effective. Very few studies have been conducted on the use of antihistamines in the treatment of cold, cholinergic, and pressure urticaria. Antihistamines are the mainstay of urticarial therapy. This evidence-based review suggests that there are efficacy differences between newer, nonsedating antihistamines and older agents in some forms of the disorder. Clearly, further well-controlled clinical trials in larger numbers of patients are needed to clarify the role of these agents in the treatment of urticaria.
Enhancing Reflective Practice through Alternative Assessment.

Rural educators are asked to meet multiple and sometimes conflicting demands: to raise academic standards, teach basic skills, teach students to be good citizens, and prepare students for jobs. Alternative assessment strategies, grounded in reflective practice, have the possibility to enliven instruction and improve students' knowledge, reasoning, and communication skills. The following article suggests that alternative assessment is consistent with the development ofthe knowledge and dispositions associated with critical democratic citizenship. A rubric and alternative assessment example is provided for teachers to incorporate this strategy into their classroom instruction.
Dynamics of Neutrino Oscillations and the Cosmological Constant Problem

The cosmological constant problem continues to represent a major challenge for theoretical physics and cosmology. The main difficulty arises from the large numerical discrepancy between observational limits of the cosmological constant and quantum predictions based on gravitational effects of the vacuum energy. In this work we argue that the experimental value of this constant may be recovered from the dynamics of neutrino oscillations.
Penetrating wounds of the neck.

Penetrating wounds of the neck require immediate evaluation and management. Surgical and conservative management each provide adequate treatment if employed appropriately. The review of both treatment paradigms provides useful information in making a management decision.
Evaluating Success Rates After Artificial Urinary Sphincter Placement: A Comparison of Clinical Definitions.

Objective To assess success rates of primary artificial urinary sphincter (AUS) implantation using various objective, subjective, or retreatment definitions. Materials and Methods We identified 309 male patients who underwent primary AUS placement at the Mayo Clinic from 2010 to 2016. Of those, 214 had not undergone repeat surgery, were sent a mailed survey, and 148 of 214 (69.2%) responded. Eleven definitions of success were evaluated among responders. Associations between the definitions and patient-reported success were assessed via logistic regression and c-statistic. Results Treatment success rates were highly variable depending on the definition used (14.8%-86.7%). Median follow-up was 24 months (interquartile range [IQR] 8, 40), during which 72% did not undergo reoperation. Among survey respondents, 87% felt at least “much better,” and 47% reported surgery was “very successful.” Roughly 15% reported zero pad use. Patient-reported success was most strongly associated with the Patient Global Impression of Improvement (PGI-I) score (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.02-0.19; P Conclusion The “success rate” after primary AUS implantation varies widely depending on the definition used. Although most patients report that surgery was beneficial, zero pad count was less common. Among definitions evaluated, the PGI-I had the strongest association with patients' evaluation of surgical success.
Novel Approaches to Deliver Molecular Therapeutics in Cardiac Disease Using Adeno-Associated Virus Vectors

Cardiac diseases are the leading cause of mortality in the Western World. Despite significant process in the treatment of cardiovascular diseases, curative treatments remain elusive. In recent years, gene therapy for the treatment of cardiac diseases has emerged as a promising and conceptually novel treatment paradigm. Of all the vectors used for cardiac gene delivery, adeno-associated virus (AAV)-based vectors are the most promising. This is due in part to their nonpathogenic nature, the comparatively low immunogenicity, and their ability to transduce efficiently many of the cell types of the cardiovascular system, in particular cardiomyocytes, resulting in long-term, high-level transgene expression.
Despite losses, community newspapers still dominate the U.S. market:

Closures and mergers resulted in a net loss of more than 1,800 newspapers from 2004 to 2015, the overwhelming majority of them weeklies. But community weeklies remain the most common (70 percent of...
Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study

PURPOSE Our purpose was to assess whether a practice’s adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control. METHODS We divided practices into quartiles of blood pressure control performance and considered the top quartile as the benchmark for comparison. Using abstracted clinical data from electronic health records, we performed a cross-sectional study to assess the association of top quartile hypertension control and (1) the baseline practice adaptive reserve (PAR) scores and (2) baseline practice leadership scores, using modified Poisson regression models adjusting for practice-level characteristics. RESULTS Among 181 practices, 46 were in the top quartile, which averaged 68% or better blood pressure control. Practices with higher PAR scores compared with lower PAR scores were not more likely to reside in the top quartile of performance (prevalence ratio [PR] = 1.92 for highest quartile; 95% CI, 0.9–4.1). Similarly, high quality improvement leadership capability compared with lower capability did not predict better blood pressure control performance (PR = 0.94; 95% CI, 0.57–1.56). Practices with higher proportions of commercially insured patients were more likely than practices with lower proportions of commercially insured patients to have top quartile performance (37% vs 26%, P =.002), whereas lower proportions of the uninsured (8% vs 14%, P =.055) were associated with better performance. CONCLUSIONS Our findings show that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project. Our findings, however, may be limited by a lack of patient-related factors and small sample size to preclude strong conclusions.
Maternal antibiotic use and child asthma: is the association causal?

Maternal antibiotic use before, during and after pregnancy is associated with higher child asthma risk. Lack of specificity to the pregnancy period suggests the association is not causal or the window of susceptibility extends outside pregnancy. http://ow.ly/U29f30kFD2I
Leveraging students knowledge: introducing CS 1 concepts

This paper presents a means to leverage students' a priori knowledge of fundamental concepts from the CS-1 body of knowledge. We demonstrate how the pedagogic principles of interestingness, utilization of existing memory structures, and cross-contextual reminding can be applied to improve absorption, accessibility and transferability of core Computer Science knowledge. We also describe an experiential learning activity that confirms students' familiarity with fundamental object oriented concepts and is appropriate for use in the first week of a CS-1 course. The activity addresses object oriented modeling and analysis and reduces potential confusion about references to things and the things themselves.
A challenge for nurses, a potential nightmare for patients

The alkylator-like agent ifosfamide, which has been found to be useful in the treatment of a number of solid tumors, can have severe central nervous system (CNS) side effects in addition to causing myelosuppression, nephrotoxicity, nausea and vomiting, pulmonary edema, and interstitial pneumonitis. This article, including a case study and a protocol, prepares nurses to do patient education and to observe, assess, and provide care for patients who may experience the CNS toxicity that ranges from mild changes to severe disturbances of mental state.
Artificial Intelligence Gaming Assistant for Google Glass

The interaction between humans and computers has traditionally been through the medium of desktop computing. However, in recent years, an alternative computing concept known as ubiquitous computing is ushering in various wearable computing technologies, such as Google Glass. These technologies enable even more immediate ways to share and access information. Our research seeks to explore novel methods in which these wearable technologies can be combined with more powerful computing techniques to compute useful context-specific information. The scope of this research is in utilizing Google Glass to act as an artificially intelligent game assistant. The approach of this work is to make use of Google’s Mirror API to build a web-based service to interact with Glass. The Mirror API is used to share an image from Glass to a web-based service where the image is processed and key features are extracted. An appropriate algorithm is then used to compute a near-optimal game move depending on the game being played. The results are promising, and the Glassware that was implemented suggests appropriate moves while playing a game of Connect Four. Our results foreshadow what is possible when wearable technology is combined with artificially intelligent computation in the cloud.
Implementing new technologies in a middle school curriculum: a rural perspective

The purpose of this study was to examine the impact of a new school technology on teachers and students in rural middle schools. The study involved teachers and seventh grade students in two Title I rural Texas school districts and was framed through a constructivist lens using a project-based approach. Pre- and post-intervention surveys assessed learning and perceptions, and data were analyzed using one-way Analysis of Variance. Findings suggested that new school technology does not ensure teacher understanding or student learning. For new school technologies to be successful, significant planning, teacher training, and resources must be in place.
Vaping in the News: The Influence of News Exposure on Perceived e-Cigarette Use Norms

Background: Research has documented the impact of descriptive norms on tobacco use, but few studies have investigated how media exposure shapes e-cigarette use norms.Purpose: The purpose of this st...
Challenges and opportunities for the simulation of calcium waves on modern multi-core and many-core parallel computing platforms.

State-of-the-art distributed-memory computer clusters contain multicore CPUs with 16 and more cores. The second generation of the Intel Xeon Phi many-core processor has more than 60 cores with 16 GB of high-performance on-chip memory. We contrast the performance of the second-generation Intel Xeon Phi, code-named Knights Landing (KNL), with 68 computational cores to the latest multicore CPU Intel Skylake with 18 cores. A special-purpose code solving a system of nonlinear reaction-diffusion partial differential equations with several thousands of point sources modeled mathematically by Dirac delta distributions serves as realistic test bed. The system is discretized in space by the finite volume method and advanced by fully implicit time-stepping, with a matrix-free implementation that allows the complex model to have an extremely small memory footprint. The sample application is a seven variable model of calcium-induced calcium release (CICR) that models the interplay between electrical excitation, calcium signaling, and mechanical contraction in a heart cell. The results demonstrate that excellent parallel scalability is possible on both hardware platforms, but that modern multicore CPUs outperform the specialized many-core Intel Xeon Phi KNL architecture for a large class of problems such as systems of parabolic partial differential equations.
Hop-Skip-Jump: Monovalent Metals on the Surface of the Phenalenyl Radical

The phenalenyl radical (P) and its relatively stable cation and anion are of interest for applications in areas spanning magnetic materials and ligand development for reaction catalysis. We report on a broad investigation of the bonding, thermochemistry, and kinetics of PM complexes where M is a group 1 or 11 metal atom. The PM species that are considered in this work afford a simplified picture of the behavior of metal adatoms on hydrogen terminated graphene fragments, and, more crucially, we expand a still nascent understanding of the organometallic chemistry of P. The exceptional fluxionality of group 1 metals on the phenalenyl surface is predicted, the associated energy barriers are quantified, and the major role of relativistic effects in restricting the fluxionality of Au on the surface is demonstrated. Although relativistic effects swell the barriers to isomerization, we find that orbital size and energies, even in the absence of relativistic effects, dictate different path preferences for the moti...
Multidisciplinary Optimization of an Electric Quadrotor Urban Air Mobility Aircraft

Urban Air Mobility (UAM) vehicles have the potential to augment urban transportation systems, allowing passengers to skip the traffic below for a fee. This emerging market is opening up the design space for a new class of Urban Air Mobility (UAM) vehicles which could be powered by electric propulsion systems to be economical and environmentally friendly. However, development of these UAM concepts presents several additional challenges in the design process. First, these concept designs require including new disciplinary models for subsystems including the electric motors, cables, batteries and thermal management systems. Second, correctly designing and evaluating these various subsystems requires tight coupling between the discipline models to capture interactions. This paper presents the continued development of a multidisciplinary design optimization environment to aid in the development of these vehicle concepts. The multidisciplinary environment fully couples the various subsystem models allowing for the full vehicle to be designed and optimized simultaneously. In this research, the developed modeling approach is demonstrated in the analysis of a small, all-electric quadrotor UAM concept. Results from these studies show that numerous disciplines can be tightly coupled and producing improved overall vehicle designs.
Transvaginal Paravaginal Native Tissue Anterior Repair Technique: Initial Outcomes

Abstract Objective To present the surgical technique and initial outcomes for a novel lattice-work technique, developed to increase the durability of the native tissue repair. Methods/ Materials All patients undergoing transvaginal anterior prolapse repair with a single surgeon with at least 30 days of follow-up were prospectively enrolled starting in 2017. All patients received the same repair (Fig. 1). 2.0 polydioxanone (PDS) sutures are placed at the level of the obturator fascia/arcus tendineus distally and proximally on each side. The midline anterior colporrhaphy is performed with 4 2.0 PDS sutures which are then intertwined with the obturator sutures and tied to form a lattice of sutures to reinforce the cystocele repair and elevate the central defect repair laterally. Clinic notes, objective physical exam, and standardized subjective patient questionnaires (Pelvic Floor Disorders Inventory) were evaluated for patient outcomes. Recurrence was defined anatomically (Pelvic organ prolapse-Q Ba ≥-1) and subjectively (bothersome vaginal bulge). Results There were 109 patients enrolled with a mean follow-up time was 12 months. Over the follow-up period, there were 12 anatomic recurrences (11%). This was not associated with concomitant apical or posterior repair. Mean time to recurrence was 13.9 months. There were no intraoperative complications. Transient urinary retention was the most notable complication (19%, managed conservatively). Rate of de novo stress urinary incontinence was low at 4%. Conclusion This novel lattice-work technique is simple to perform and has excellent short term anatomic outcomes. Transient postoperative retention was observed; however, all cases self-resolved. Further follow-up is ongoing to characterize the long-term durability of this repair.
Spectral hole burning spectroscopy of molecular electronic transitions in amorphous solids

The shapes of the real-phonon and pseudo-phonon sideband holes (PSBH) which occur in hole-bumed spectra in amorphous solids are both wavelength and bum time dependent. The theory previously proposed to simulate hole shapes in the short burn time limit is extended to examine the PSBH shapes at arbitrary times and at different bum wavelengths. The simulated spectra are compared with experimental data for tetraphenyl porphyrin in polystyrene. It is also shown the stimulated spectra may be used to deconvolve the antihole spectrum from the hole spectrum.
Private Islamic Education in Africa

This chapter examines the history of the madrasas in Africa and the multiple attempts to reform and control them throughout the continent. It shows that, as a private Islamic education institution, the madrasa has long served the education needs of a significant population in Muslim societies during and after European colonization. Based on a case study of Senegal and a review of the literature on various African countries, the chapter argues that the various calls for reform of private Islamic education institutions in recent years constitute a continuation of the history of colonial and postcolonial powers’ attempts to control the madrasas and police their curricula. Today, these strategies are couched in modernization and reform discourses and framed as a fight against terrorism.
Hemochromatosis, alcoholism and unhealthy dietary fat: a case report.

Hereditary hemochromatosis is an autosomal recessive disorder where the clinical phenotype of skin pigmentation and organ damage occurs only in homozygotes. Simple heterozygotes, that is, just C282Y, typically do not develop iron overload. Here we present a case where a simple heterozygote in combination with alcoholism developed high ferritin and high transferrin saturation levels indicative of iron overload. Though alcoholism alone could explain her presentation, we hypothesize that an inflammatory cocktail of iron and alcohol probably caused our patient to succumb to acute liver failure at a very young age. A 29-year-old Caucasian woman presented to the hospital with progressively worsening yellowish discoloration of her eyes and skin associated with anorexia, nausea, vomiting, diffuse abdominal discomfort, increasing abdominal girth, dark urine and pale stools for about 2 weeks. Family history was significant for hereditary hemochromatosis. Her father was a simple heterozygote and her grandmother was homozygous for C282Y. Physical examination showed scleral icterus, distended abdomen with hepatomegaly and mild generalized tenderness. Lab test results showed an elevated white blood cell count, ferritin 539 ng/dL, transferrin saturation 58.23%, elevated liver enzymes, elevated international normalized ratio (INR), low albumin, Alcoholic Liver Disease/Nonalcoholic Fatty Liver Disease (ALD/NAFLD) Index (ANI) of 2.6, suggesting a 93.2% probability of alcoholic liver disease, and phosphatidyl ethanol level of 537ng/ml. Genetic testing showed that the patient was heterozygous for human homeostatic iron regulator protein (HFE) C282Y mutation and the normal allele. Computed tomography (CT) of the abdomen revealed hepatomegaly, portal hypertension and generalized anasarca. Magnetic resonance cholangiopancreatography (MRCP) showed negative results for bile duct pathology. Workup for other causes of liver disease was negative. A diagnosis of acute alcoholic hepatitis was made, with Maddrey’s discriminant function of > 32, so prednisolone was started. Her bilirubin and INR continued to increase despite steroids, and the patient unfortunately died. Our case highlights the importance of considering hemochromatosis in the differential diagnosis of young patients presenting with liver failure, including cases suggestive of alcoholism as the likely etiology. Larger studies are needed to investigate the role of non-iron factors like alcohol and viral hepatitis in the progression of liver disease in simple heterozygotes with hereditary hemochromatosis, given the high prevalence of this mutation in persons of Northern European descent.
Evaluating the clinical utility of early exome sequencing in diverse pediatric outpatient populations in the North Carolina Clinical Genomic Evaluation of Next-generation Exome Sequencing (NCGENES) 2 study: a randomized controlled trial.

Exome sequencing (ES) has probable utility for shortening the diagnostic odyssey of children with suspected genetic disorders. This report describes the design and methods of a study evaluating the potential of ES as a routine clinical tool for pediatric patients who have suspected genetic conditions and who are in the early stages of the diagnostic odyssey. The North Carolina Clinical Genomic Evaluation by Next-generation Exome Sequencing (NCGENES) 2 study is an interdisciplinary, multi-site Phase III randomized controlled trial of two interventions: educational pre-visit preparation (PVP) and offer of first-line ES. In this full-factorial design, parent-child dyads are randomly assigned to one of four study arms (PVP + usual care, ES + usual care, PVP + ES + usual care, or usual care alone) in equal proportions. Participants are recruited from Pediatric Genetics or Neurology outpatient clinics in three North Carolina healthcare facilities. Eligible pediatric participants are < 16 years old and have a first visit to a participating clinic, a suspected genetic condition, and an eligible parent/guardian to attend the clinic visit and complete study measures. The study oversamples participants from underserved and under-represented populations. Participants assigned to the PVP arms receive an educational booklet and question prompt list before clinical interactions. Randomization to offer of first-line ES is revealed after a child’s clinic visit. Parents complete measures at baseline, pre-clinic, post-clinic, and two follow-up timepoints. Study clinicians provide phenotypic data and complete measures after the clinic visit and after returning results. Reportable study-related research ES results are confirmed in a CLIA-certified clinical laboratory. Results are disclosed to the parent by the clinical team. A community consultation team contributed to the development of study materials and study implementation methods and remains engaged in the project. NCGENES 2 will contribute valuable knowledge concerning technical, clinical, psychosocial, and health economic issues associated with using early diagnostic ES to shorten the diagnostic odyssey of pediatric patients with likely genetic conditions. Results will inform efforts to engage diverse populations in genomic medicine research and generate evidence that can inform policy, practice, and future research related to the utility of first-line diagnostic ES in health care. ClinicalTrials.gov NCT03548779 . Registered on June 07, 2018.
A Painful Beginning: Early Life Surgery Produces Long-Term Behavioral Disruption in the Rat.

Early life surgery produces peripheral nociceptive activation, inflammation, and stress. Early life nociceptive input and inflammation have been shown to produce long-term processing changes that are not restricted to the dermatome of injury. Additionally stress has shown long-term effects on anxiety, depression, learning, and maladaptive behaviors including substance abuse disorder and we hypothesized that early life surgery would have long-term effects on theses complex behaviors in later life. In this study surgery in the rat hindpaw was performed to determine if there are long-term effects on anxiety, depression, audiovisual attention, and opioid reward behaviors. Male animals received paw incision surgery and anesthesia or anesthesia alone (sham) at postnatal day 6. At 10 weeks after surgery, open field center zone entries were decreased, a measure of anxiety (n = 20) (P = 0.03) (effect size, Cohen’s d = 0.80). No difference was found in the tail suspension test as a measure of depression. At 16–20 weeks, attentional performance in an operant task was similar between groups at baseline and decreased with audiovisual distraction in both groups (P < 0.001) (effect size, η2 = 0.25), but distraction revealed a persistent impairment in performance in the surgery group (n = 8) (P = 0.04) (effect size, η2 = 0.13). Opioid reward was measured using heroin self-administration at 16–24 weeks. Heroin intake increased over time in both groups during 24-h free access (P < 0.001), but was greater in the surgery group (P = 0.045), with a significant interaction between time and treatment (P < 0.001) (effect size, Cohen f 2 = 0.36). These results demonstrate long-term disruptions in complex behaviors from surgical incision under anesthesia. Future studies to explore sex differences in early life surgery and the attendant peripheral neuronal input, stress, and inflammation will be valuable to understand emerging learning deficits, anxiety, attentional dysfunction, and opioid reward and their mechanisms. This will be valuable to develop optimal approaches to mitigate the long-term effects of surgery in early life.
Economic Methodology in the Twenty-First Century (So Far): Some Post-Reflection Reflections

This paper provides my personal reflections on the development of economic methodology during the 21st century as well as a discussion of the methodological literature immediately preceding it. It is based on my experience – both as an editor and researcher within the field – and to some extent it reflects my own interests and concerns. It provides an interpretative history of the field and the various forces at work within it – doing so with a fairly broad brush, but at times focusing in and being much more specific.
Evaluating Mental Health-Related Symptoms Among Cancer Survivors During the COVID-19 Pandemic: An Analysis of the COVID Impact Survey.

PURPOSE:The COVID-19 pandemic has affected the mental health of adults in the United States because of recommended preventive behaviors such as physical distancing. Our objective was to evaluate me...
Health Measurement Model—Bringing a Life Course Perspective to Health Measurement: The PRISM Model

Health is a multidimensional concept that is challenging to measure, and in the rapidly evolving developmental changes that occur during the first 21 years of human life, requires a dynamic approach to accurately capture the transitions, and overall arc of a complex process of internal and external interactions. We propose an approach that integrates a lifecourse framework with a layered series of assessments, each layer using a many to many mapping, to converge on four fundamental dimensions of health measurement-Potential, Adaptability, Performance, and Experience. The four dimensions can conceptually be mapped onto a plane with each edge of the resulting quadrilateral corresponding to one dimension and each dimensions assessment calibrated against a theoretical ideal. As the plane evolves over time, the sequential measurements will form a volume. We term such a model the Prism Model, and describe conceptually how single domain assessments can be built up to generate the holistic description through the vehicle of a layer of Exemplar Cases. The model is theoretical but future work can use the framework and principles to generate scalable and adaptable applications that can unify and improve the precision of serial measurements that integrate environmental and physiologic influences to improve the science of child health measurement.
Climate change affects the parasitism rate and impairs the regulation of genes related to oxidative stress and ionoregulation of Colossoma macropomum.

Global climate change represents a critical threat to the environment since it influences organismic interactions, such as the host-parasite systems, mainly in ectotherms including fishes. Rising temperature and CO2 are predicted to affect this interaction other and critical physiological processes in fish. Herein, we investigated the effects of different periods of exposure to climate change scenarios and to two degrees of parasitism by monogeneans in the host-parasite interaction, as well as the antioxidant and ionoregulatory responses of tambaqui (Colossoma macropomum), an important species in South American fishing and aquaculture. We hypothesized that temperature and CO2 changes in combination with parasite infection would interfere with the host’s physiological processes that are related to oxidative stress and ionoregulation. We experimentally exposed C. macropomum to low and high levels of parasitism in the current and extreme climate scenarios (4.5 °C and 900 ppm CO2 above current levels) for periods of seven and thirty days and we use as analyzed factors; the exposure time, the climate scenario and parasitism level in a 2 × 2 × 2 factorial through a three-way ANOVA as being fish the experimental unit (n = 8). An analysis of gill enzymatic and gene expression profile was performed to assess physiological (SOD, GPx and Na+/K+-ATPase enzymes) and molecular (Nrf2, SOD1, HIF-1α and NKA α1a genes) responses. A clear difference in the parasitism levels of individuals exposed to the extreme climate scenario was observed with a rapid and aggressive increase that was higher after 7 days of exposure though showed a decrease after 30 days. The combination of exposure to the extreme climate change scenario and parasitism caused oxidative stress and osmoregulatory disturbance, which was observed through the analysis of gene expression (Nrf2, SOD1, HIF-1α and NKA α1a) and antioxidant and ionoregulatory enzymes (SOD, GPx and Na+/K+-ATPase) on the host, possibly linked to inflammatory processes caused by the high degree of parasitism. In the coming years, these conditions may result in losses of performance for this species, and as such will represent ecological damage and economical losses, and result in a possible vulnerability in relation to food security.
State v. Stucky

Pedestrians moving along Main Street sidewalks made good obsta cles in a game of follow-the-leader, but after several cursings and one close call (they both nearly ran over the same outraged little dog), Tex hopped off his bike and sauntered into Manny's Barbershop. A moment later, to his satisfaction, Jack followed. They'd known each other a month now, and what had begun as a disaster, a punishment handed down by the sudden, harebrained marriage of their parents, was beginning to resemble a friendship. Though, at the same time, Tex realized he felt less at ease than ever; he could not toss a baseball, or ride a bike, or even drop coins into a pop machine, it seemed, without feeling Jack's flinty green eyes all over him.
Growth potential of halophilic bacteria isolated from solar salt environments: carbon sources and salt requirements.

Eighteen strains of extremely halophilic bacteria and three strains of moderately halophilic bacteria were isolated from four different solar salt environments. Growth tests on carbohydrates, low-molecular-weight carboxylic acids, and complex medium demonstrated that the moderate halophiles and strains of the extreme halophiles Haloarcula and Halococcus grew on most of the substrates tested. Among the Halobacterium isolates were several metabolic groups: strains that grew on a broad range of substrates and strains that were essentially confined to either amino acid (peptone) or carbohydrate oxidation. One strain (WS-4) only grew well on pyruvate and acetate. Most strains of extreme halophiles grew by anaerobic fermentation and possibly by nitrate reduction. Tests of growth potential in natural saltern brines demonstrated that none of the halobacteria grew well in brines which harbor the densest populations of these bacteria in solar salterns. All grew best in brines which were unsaturated with NaCl. The high concentrations of Na+ and Mg2+ found in saltern crystallizer brines limited bacterial growth, but the concentrations of K+ found in these brines had little effect. MgSO4 was relatively more inhibitory to the extreme halophiles than was MgCl2, but the reverse was true for the moderate halophiles.
Geographies of Health Care Access

Geographies of access to health care are multiple in purpose and form. Access is a complex concept and spatial accessibility is conditioned by social and political decision and imperatives. There is no consensus measure of access, let alone spatial access, though almost all agree that the geographic characteristics of health services use and accessibility are key to optimal health outcomes. Keywords: geography; health care; place
Half-sync/half-async: an architectural pattern for efficient and well-structured concurrent I/O

This paper describes the Half-Sync/Half-Async pattern, which integrates synchronous and asynchronous I/O models to support both programming simplicity and execution efficiency in complex concurrent software systems. In this pattern, higher-level tasks use a synchronous I/O model, which simplifies concurrent programming. In contrast, lower-level tasks use an asynchronous I/O model, which enhances execution efficiency. This pattern is widely used in operating systems such as UNIX, Mach, Windows NT, and VMS, as well as other complex concurrent systems.
US regulatory framework for rare plasma protein diseases

Patients with rare plasma protein deficiencies who do not have access to specific replacement products may have increased morbidity and mortality. The rarity of these diseases presents many challenges to developing specific therapeutic agents for their treatment. These include the cost of research and clinical trials, the limited market, and the regulatory burden on sponsors and investigators. In addition the natural history of the disease is often not adequately understood, and the number of patients available for any given clinical study can be extremely small. Some products to treat rare deficiencies are available in other parts of the world but are not yet licensed in the U.S. Importation and off-label use of these products is not an adequate solution to long term patient care. To alleviate the unmet medical needs of these patients, FDA has established various regulatory mechanisms and financial incentives designed to facilitate licensure of new products and new indications of existing products.
Outer retinal tubulations response to anti-VEGF treatment

Aim To review the longitudinal changes of outer retinal tubulations (ORTs) in wet age-related macular degeneration (AMD) and their response to anti-vascular endothelial growth factor (VEGF) therapy by spectral-domain optical coherence tomography (SD-OCT), and to correlate these observations with disease activity, presence or absence of fluid, and patients’ demographics. Methods Retrospective study of wet AMD eyes treated with anti-VEGF agents and showing ORTs on SD-OCT, and the patients’ fellow eye with wet AMD but without ORTs. Results Fifty-one wet AMD eyes from 31 patients diagnosed and treated for wet AMD were included in the review and analysis of data; 33 eyes showed ORTs at baseline, while 18 fellow eyes had no ORTs. During a median follow-up treatment period of 11 months, 23 eyes had stable ORTs and 10 eyes had ORT changes. Among the 10 eyes with ORTs changes, ORTs collapsed during anti-VEGF treatment in 5 eyes but then reappeared within 12 months after stopping treatment. In two eyes, ORTs increased in size during anti-VEGF treatment, while in two other eyes ORTs collapsed without any treatment. In a single eye, ORTs collapsed within 10 months of no treatment and did not reappear upon recurrence of fluid. Eyes with ORTs tended to have lower visual acuity than eyes with no ORTs due to greater disruption of the external limiting membrane in the fovea. Conclusions ORTs documented by SD-OCT may exhibit multiple types of longitudinal changes, such as collapse, recurrence or enlargement, which could be associated with anti-VEGF treatment or spontaneous. Some ORTs may have a vascular component or may be vascular in nature, considering their response to anti-VEGF treatment, while other ORTs are likely composed only of degenerating photoreceptor cells and may collapse independently from anti-VEGF treatments.