cssi/SciSciGPT-SciSciNet huggingface dataset:
Laparoscopic adrenalectomy: A new standard of care

Abstract Objectives Adrenalectomy is the mainstay of treatment for adrenal tumors. A variety of surgical approaches to the adrenal gland have been described. We studied the feasibility of laparoscopic adrenalectomy (LA), compared laparoscopic with open adrenalectomy (OA), and studied the hemodynamic changes in patients with pheochromocytoma. Methods Our early experience with 20 consecutive LAs is compared with a contemporaneous, matched control cohort of 20 patients who underwent OA via a flank or subcostal incision. LA was performed via a transperitoneal approach, following a standardized surgical technique. Results LA was successfully completed in 18 of 20 cases. Average operating time in the first 5 cases was 261 minutes, but, with further experience, a significant decrease in operative time was seen in the last cohort of 4 patients (155 minutes) ( P = 0.0018). There was no significant difference in operative time or degree of blood loss between LA and OA groups. Patients who underwent LA required lower doses of postoperative parenteral narcotics ( P = 0.0169), had a shorter hospital stay (mean 3.2 days) ( P P Conclusions LA is a safe and effective approach in most patients with adrenal pathology. Benefits include excellent operative exposure and visualization, less postoperative pain, shorter hospital stay and convalescent period, and improved cosmetic result. Pheochromocytoma is not a contraindication to LA. Patients with large adrenal tumors (larger than 6 cm), evidence of venous involvement, or invasion into surrounding tissue should be approached cautiously.
Horizontal gene transfer and the rock record: comparative genomics of phylogenetically distant bacteria that induce wrinkle structure formation in modern sediments

Wrinkle structures are sedimentary features that are produced primarily through the trapping and binding of siliciclastic sediments by mat-forming micro-organisms. Wrinkle structures and related sedimentary structures in the rock record are commonly interpreted to represent the stabilizing influence of cyanobacteria on sediments because cyanobacteria are known to produce similar textures and structures in modern tidal flat settings. However, other extant bacteria such as filamentous representatives of the family Beggiatoaceae can also interact with sediments to produce sedimentary features that morphologically resemble many of those associated with cyanobacteria-dominated mats. While Beggiatoa spp. and cyanobacteria are metabolically and phylogenetically distant, genomic analyses show that the two groups share hundreds of homologous genes, likely as the result of horizontal gene transfer. The comparative genomics results described here suggest that some horizontally transferred genes may code for phenotypic traits such as filament formation, chemotaxis, and the production of extracellular polymeric substances that potentially underlie the similar biostabilizing influences of these organisms on sediments. We suggest that the ecological utility of certain basic life modes such as the construction of mats and biofilms, coupled with the lateral mobility of genes in the microbial world, introduces an element of uncertainty into the inference of specific phylogenetic origins from gross morphological features preserved in the ancient rock record.
ASYMPTOTIC DISTRIBUTIONS OF SEMIPARAMETRIC MAXIMUM LIKELIHOOD ESTIMATORS WITH ESTIMATING EQUATIONS FOR GROUP-CENSORED DATA

Summary Semiparametric maximum likelihood estimation with estimating equations (SMLE) is more flexible than traditional methods; it has fewer restrictions on distributions and regression models. The required information about distribution and regression structures is incorporated in estimating equations of the SMLE to improve the estimation quality of non-parametric methods. The likelihood of SMLE for censored data involves complicated implicit functions without closed-form expressions, and the first derivatives of the log-profile-likelihood cannot be expressed as summations of independent and identically distributed random variables; it is challenging to derive asymptotic properties of the SMLE for censored data. For group-censored data, the paper shows that all the implicit functions are well defined and obtains the asymptotic distributions of the SMLE for model parameters and lifetime distributions. With several examples the paper compares the SMLE, the regular non-parametric likelihood estimation method and the parametric MLEs in terms of their asymptotic efficiencies, and illustrates application of SMLE. Various asymptotic distributions of the likelihood ratio statistics are derived for testing the adequacy of estimating equations and a partial set of parameters equal to some known values.
Confronting Carl Rogers A Developmental-Interactional Approach to Person-Centered Therapy

The author argues that person-centered therapy in its pure form is too person-centered. An overly optimistic belief in the actualizing tendency and organismic valuing process has led to de facto pa...
Respiratory protection and the risk of Mycobacterium tuberculosis infection

Tuberculosis (TB) can be transmitted to susceptible healthcare workers via inhalation of droplet nuclei carrying viable Mycobacterium tuberculosis bacilli. Several types of respiratory protective devices are compared with respect to efficacy against droplet nuclei penetration: surgical masks, disposable dust/mist particulate respirators (PRs), elastomeric halfmask respirators with high-efficiency (HEPA) filters, and powered air-purifying respirators (PAPRs) with elastomeric halfmask facepieces and HEPA filters. It is estimated that these devices permit, respectively, 42%, 5.7%, 2%, and 0.39% penetration of droplet nuclei into the facepiece. More limited data for the disposable HEPA filtering-facepiece respirator suggest that it would allow droplet nuclei penetration of 3% or less, similar to the value estimated for the elastomeric halfmask HEPA filter respirator. Because a respirator wearer's cumulative infection risk depends on the extent of droplet nuclei penetration, the cumulative risk will differ, given use of these different respirators. Hypothetical but realistic "low-exposure" and "high-exposure" scenarios are posed that involve, respectively, a 1.6% and a 6.4% annual risk of infection for healthcare workers. For the low-exposure scenario, the 10-year cumulative risks given no respirators versus surgical masks versus disposable dust/mist PRs versus elastomeric halfmask HEPA filter respirators versus HEPA filter PAPRs are, respectively, 15%, 6.7%, 0.94%, 0.33%, and .064%. For the high-exposure scenario, the 10-year cumulative risks for no respirator use versus use of the same four types of respirators are, respectively, 48%, 24%, 3.7%, 1.3%, and 0.26%. The use of disposable HEPA filtering-facepiece respirator should permit cumulative risks close to those estimated for the elastomeric halfmask HEPA filter respirator. It is concluded that when an infectious TB patient undergoes a procedure that generates respiratory aerosols, and when droplet nuclei source control is inadequate, healthcare workers attending the patient may need to wear highly protective respirators, such as HEPA filter PAPRs.
“A Caretaker Responsibility”: Revisiting Klamath and Modoc Traditions of Plant Community Management

Abstract Conventionally, the Klamath and Modoc Indians of south-central Oregon and northeastern California are depicted as hunter-gatherers, who took no active role in the management of plant communities. In the course of a multi-year ethnographic effort, however, tribal elders have identified a complex of interrelated plant management practices that are consistent with contemporary definitions of plant cultivation. These include the management of black huckleberry (Vaccinium membranaceum) yields in subalpine environments, the management of marsh-edge environments for yellow pond lily (Nuphar polysepalum), the tending of “epos” or yampah (Perideridia spp.) digging sites, and the selective harvest of tree cambium, sap, and wood – especially from pines (Pinus spp.) and junipers (Juniperus spp). Together, these accounts suggest that plant management was widespread, that it often served to geographically concentrate culturally preferred species, and that it was rooted as much in cosmological motivations as ec...
Single-Mask Double-Patterning Lithography for Reduced Cost and Improved Overlay Control

We propose shift-trim double-patterning lithography (ST-DPL), a cost-effective double-patterning technique for achieving pitch relaxation with a single photomask. The mask is re-used for the second exposure by applying a translational mask-shift. An additional non-critical trim exposure is applied to remove extra printed features. ST-DPL can be used to pattern critical layers and is very suitable for regular and gridded layouts, where redesign effort and area overhead are minimal. In this paper, the viability of ST-DPL is demonstrated through a design implementation at the poly and contacts layers in bidirectional layouts. Standard-cell layouts are constructed so as to avoid layout decomposition conflicts, which are found to be the limiting factor for the pitch relaxation that can be achieved with double patterning (ST-DPL as well as standard DPL). 2t pitch relaxation being associated with a considerable area overhead, 1.8 t pitch relaxation is achieved in our implementation while ensuring no layout decomposition conflicts and a small area overhead. Specifically, in comparison to layouts assumed to be feasible with a hypothetical single-patterning process, we observe virtually no area overhead when ST-DPL is applied to the poly layer (<; 0.3% cell-area overhead) and no more than 4.7% cell-area overhead when ST-DPL is applied at both the poly and contacts layers. The proposed method has many benefits over standard pitch-split double patterning: 1) cuts mask-cost to nearly half; 2) reduces overlay errors between the two patterns; 3) alleviates the bimodal line-width distribution problem in double patterning; and 4) slightly enhances the throughput of critical-layer scanners.
Brands and Their Surfeits

This article approaches the brand from its surfeits, those material forms and immaterial social meanings that exceed its authority and intelligibility. By thinking through “counterfeits” and other unauthorized brand forms, on the one hand, and the novel and often unpredictable social meanings that emerge through moments of brand consumption, on the other hand, I argue that at the heart of the brand is an instability, a tendency toward an excess of meaning and materiality. Showing how brand and surfeit emerge out of the commodity form in late-19th-century consumer markets, the article then demonstrates how in recent decades the brand has mediated, and been mediated by, shifts in the global economy; in particular, I examine the respatialization of labor, the financialization of capital, and the neoliberal economic and legal reforms that have made such shifts possible. I argue that the capacity of the brand to function as a financial instrument of global capital has turned on its ability to both produce and police those surfeits that threaten to decenter it. This tension between brand and surfeit requires us to rethink the study of brands. In particular, any approach to the brand requires ethnographic sensitivity to those moments when the brand displaces itself in ways that enable novel social imaginaries, performative possibilities, and material forms that cannot be easily recouped by it. [brands, counterfeits, trademark, neoliberalism, globalization]
Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial.

background. Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI). objective. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage. design. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months. setting. Barnes-Jewish and St. Louis Children’s Hospitals, St. Louis, Missouri, 2007–2009. participants. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds. interventions. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% mupirocin ointment applied to the nares twice daily, intranasal mupirocin plus daily 4% chlorhexidine body washes, or intranasal mupirocin plus daily dilute bleach water baths. results. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the mupirocin group ( vs controls), 55% of those P p .03 in the mupirocin and chlorhexidine group ( ), and 63% off those in the mupirocin and bleach group ( ). Of 229 participants P p .05 P p .006 with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group ( vs controls), P p .40 54% in the mupirocin and chlorhexidine group ( ), and 71% in the mupirocin and bleach group ( ). At 1 and 4 months,
Management of stroke in cancer

Cerebrovascular disorders, including brain infarction, brain hemorrhage, and cerebral venous thrombosis, can occur as an early sign of cancer, but typically occur late in the clinical course. These disorders are due to a variety of pathogenic mechanisms, including coagulation disorders associated with the cancer, invasion or compression of vessels from tumor in or adjacent to the brain, and the adverse effects of cancer therapy. The appropriate therapy for these cerebrovascular disorders is empiric in most instances, because as yet there are no prospective treatment trials for them. A review of the existing literature reveals that improvement in patient quality of life and prevention of further cerebrovascular events can be obtained in some clinical situations.
Mentalizing about emotion and its relationship to empathy

Mentalizing involves the ability to predict someone else’s behavior based on their belief state. More advanced mentalizing skills involve integrating knowledge about beliefs with knowledge about the emotional impact of those beliefs. Recent research indicates that advanced mentalizing skills may be related to the capacity to empathize with others. However, it is not clear what aspect of mentalizing is most related to empathy. In this study, we used a novel, advanced mentalizing task to identify neural mechanisms involved in predicting a future emotional response based on a belief state. Subjects viewed social scenes in which one character had a False Belief and one character had a True Belief. In the primary condition, subjects were asked to predict what emotion the False Belief Character would feel if they had a full understanding about the situation. We found that neural regions related to both mentalizing and emotion were involved when predicting a future emotional response, including the superior temporal sulcus, medial prefrontal cortex, temporal poles, somatosensory related cortices (SRC), inferior frontal gyrus and thalamus. In addition, greater neural activity in primarily emotion-related regions, including right SRC and bilateral thalamus, when predicting emotional response was significantly correlated with more self-reported empathy. The findings suggest that predicting emotional response involves generating and using internal affective representations and that greater use of these affective representations when trying to understand the emotional experience of others is related to more empathy.
DiMES: multilevel fast direct solver based on multipole expansions for parasitic extraction of massively coupled 3D microelectronic structures

Boundary element methods are being successfully used for modeling parasitic effects in cutting-edge circuit design. The dense system matrix generated therein presents a time and memory bottleneck. Fast iterative solver techniques, developed to address the problem, suffer from convergence issues which become pronounced for large number of right hand sides as is the case for massively coupled systems. In this paper an iteration free solution scheme is presented. The dense matrix is rendered sparse by applying multilevel multipole expansions, and the resultant sparse matrix is solved by a traditional sparse matrix solver. The accuracy and time and memory requirements for the solver are compared against the regular methods. The advantage of the presented method over the corresponding iterative scheme is also demonstrated.
Effects of nitric oxide synthase blockers on renal function

Three isoforms of nitric oxide synthase (NOS) [neuronal NOS (bNOS), inducible NOS (iNOS) and endothelial NOS (eNOS)] are expressed in the kidney. The use of pharmacological inhibitors of these enzymes has been a major experimental tool to determine the role of nitric oxide (NO) in renal physiology and pathophysiology. Studies performed in both human and experimental animals demonstrate that NOS blockade increases renal vascular resistances and decreases the glomerular ultrafiltration coefficient. These studies also support the presence of an important interaction between NO, angiotensin and renal nerves in the control of renal function. Renal iNOS activity is significantly increased in various pathophysiological conditions including autoimmune tubulo-interstitial nephritis and sepsis. Interestingly, recent evidence suggests that high NO levels secondary to increased iNOS activity may inhibit eNOS activity and through this mechanism lead to renal vasoconstriction and reductions in glomerular filtration rate. The use of NOS blockers has generated a great deal of information on the role of NO in the control of renal function and has also allowed us to begin to understand the high level of complexity of this system.
A Novel Approach to Gathering and Acting on Relevant Clinical Information: SCAMPs

The current tools to adequately inform the process of improving health-care delivery consist primarily of retrospective studies, prospective trials, and clinical practice guidelines. We propose a novel and systematic approach that bridges the gap of our current tools to affect change, provides an infrastructure to improve health-care delivery, and identifies unnecessary resource utilization. The objective of this special article is to introduce the rationale and methods for this endeavor entitled "Standardized Clinical Assessment and Management Plans" (SCAMPs). SCAMPs take a relatively heterogeneous patient population and through a process of iterative analysis and modification of standardized assessment and management algorithms, SCAMPs allow the intrinsic biologic variability in a patient population to emerge and be understood. SCAMPs can be used to complement our currently available tools in order to result in incremental and sustained improvement in health-care delivery.
Effect of JPEG compression on 24-bit color images: impact of compression on quantitative measures of velocity and flow rate in a flow convergence model

It has been previously demonstrated, using objective and subjective analyses, that grayscale echocardiographic images with 95% JPEG compression show no significant loss in diagnostic or image quality. Here, the authors investigate how the quantitative measurements of velocity and flow rate are affected when 24-bit color Doppler images are compressed using JPEG. Adobe Photoshop was used to compress a set of images to 5 levels ranging from 7:1 to 65:1 using JPEG algorithm. The images were analyzed using Khoros (public domain image processing software) and customized C programs. The results show that even at a compression ratio of 65:1, the correlation of velocities in the region of interest is as high as 0.943. >
On the verification of hypothesized matches in model-based recognition

Model-based recognition methods often use ad hoc techniques to decide if a match of data to a model is correct. Generally an empirically determined threshold is placed on the fraction of model features that must be matched. We instead rigorously derive conditions under which to accept a match. We obtain an expression relating the probability of a match occurring at random to the fraction of model features accounted for by the match, as a function of the number of model features, the number of image features, and a bound on the degree of sensor noise.
A Developmental Perspective on Interconnection

The within-person factors that we conceptualized as common causes of multiple forms of violence are proposed to be fairly stable over time as well as generalized across contexts. To understand the origins of these factors, in this chapter, we draw on developmental theory and research to explore how experiences in childhood and adolescence can give rise to the cognitive, emotional, biological, and behavioral processes that give rise to violence.
Christian Wiltberger and the Rhetorical Construction of Liberia

Of the four documentary records of American Colonization Society (ACS) agents first to travel to Africa in order to establish what would become Liberia, only the journal of Christian Wiltberger, who was part of the second exploratory journey in 1821, remains exclusively in the archive. Wiltberger's frank record of their year-long travel to and in West Africa sheds light on the 19th-century rhetorical turn in the West's conception of Africa. While British constructions of Africa through the creation of Sierra Leone typically remained ambivalent to Africa and Africans, the four ACS agents responsible for finding and establishing Liberia shifted Western rhetoric towards a moralizing characterization of a fallen, distressed Africa in need of spiritual guidance and salvation above all else, a rhetoric most poignantly presented by Wiltberger's unhesitating evangelism. Bringing Wiltberger's unpublished journal into contemporary public critique can help to flesh out the origins of the founding of Liberia, an often stepped-over piece of its history. Doing so, however, is more importantly an essential step in isolating the first stage of the broad rhetorical turn in constructions of Africa in the 19th century, one that cannot be substantiated without a careful consideration of Wiltberger's text.
Institutional Efficiency and the Investment Share of FDI

This paper models and tests the implications of institutional efficiency on the pattern of FDI. We posit that domestic agents have a comparative advantage over foreign agents in overcoming some of the obstacles associated with corruption and weak institutions. Under these circumstances, FDI is more sensitive to increases in enforcement costs. We then test this prediction, comparing institutional efficiency levels for a large cross section of countries in 1989 to subsequent FDI flows 1990-9, finding that institutional efficiency is positively associated with the ratio of subsequent foreign direct investment flows to both gross fixed capital formation and to private investment.
Abstract 180: Use of Hospital Teams Tasked to Reduce Readmissions in the VA

Objective: The Department of Veterans Affairs (VA) joined the American College of Cardiology and the Institute for Health Care Improvement’s in their Hospital To Home (H2H) initiative. This initiative attempts to improve the transition of care following discharge for patients with acute myocardial infarction and Heart Failure. The Chronic Heart Failure (CHF) Quality Enhancement Research Initiative (QUERI) worked with providers at each VA hospital to encourage facility enrollment. Ultimately, 86 VA facilities enrolled. The purpose of this study was to determine the extent of existing quality improvement projects in place at each of the 86 enrolled facilities. Method: Contacts at each of the 86 VA facilities enrolled in H2H were asked to complete a web-based survey. This survey focused on each facility’s QI efforts that were currently in place for all their heart failure patients. We had a 93% (n=80) response rate from these facilities. Results: Findings showed that QI national initiatives that the VA facilities joined included H2H (76%), Re-Engineered Discharge (RED) Project (11%), Transitional Care Model (10%) and other local or regional collaboratives (31%). Of note, 81% (n=65) of the facilities had QI teams devoted to reducing preventable readmissions for patients with heart failure. These QI teams included a variety of staff: 89% included physicians, 83% included nurses, 74% included advanced practice nurses or physician assistants, 74% included QI/quality management staff, 63% included pharmacists, and 57% included senior management of the hospital. Conclusions: Many VA facilities have teams devoted to preventing r eadmissions for heart failure. These teams almost always include physicians in addition to managers and other providers. Facilities often participate in multiple national initiatives to improve their goal of reducing readmissions.
Performance on the children's form of the Trail Making Test in a psychiatric population.

Summary.-The child form of the Trail Making Test was given to 393 children, aged 9 to I5 yr., referred for psychiatric evaluation. All scores on the test, including Part B-A, were found to be influenced by both age and IQ. Scores on Part A+B were influenced by a significant interaction between age and IQ. Tabled data of time in seconds corresponding to the median and quartiles for each combination of age and IQ are given. The adult form of the Trail Making Test has achieved some popularity as an instrument sensitive co differences between adults with and without brain damage ( 1, 3, 4, 5, 7, 8, 11). One sntdy with the child form produced evidence suggestive of a similar usefulness with children (2). However, no guidelines have yet been made available concerning whether and how this test might be employed in a general clinical setting to identify children with cortical dysfunction. Before this question could be approached meaningfully, it seemed important to describe the performance of a general clinical population on the test. In the interest of obtaining s~lch "normative" data, the child form of the Trail Making Test was included in a battery of tests administered routinely to all children, aged 9 to 15 yr., who were evaluated in the Colorado Children's Diagnostic Center (CDC). The present report summarizes experience with this test over approximately 3 yr.
In vitro investigation of contrast flow jet timing in patient-specific intracranial aneurysms.

Background: The direction and magnitude of intra-aneurysmal flow jet are significant risk factors of subarachnoid hemorrhage, and the change of flow jet during an endovascular procedure has been used for prediction of aneurysm occlusion or whether an additional flow diverter (FD) is warranted. However, evaluation of flow jets is often unreliable due to a large variation of flow jet on the digital subtraction angiograms, and this flow pattern variation may result in incorrect clinical diagnosis Therefore, factors contributing to the variation in flow jet are examined at an in vitro setting, and the findings can help us to understand the nature of flow jet and devise a better plan to quantify the aneurysmal hemodynamics accurately. Methods: Intra-aneurysmal flows in three patient-specific aneurysms between 11 and 25 mm were investigated in vitro, and a FD was deployed in each aneurysm model. X-ray imaging of these models were performed at injection rates between 0.2 and 2 mL/s. Pulsatile blood pump and aneurysm model were imaged together to determine the timing of flow jet. Results: The contrast bolus arrives at the aneurysm early at high contrast injection rates. The flow patterns with slow injection rates exhibit strong inertia that is associated with the systole flow. Flow jets arrive at the aneurysms at the peak systole when the bolus is injected at 0.2 mL/s. The contrast-to-signal ratio is the highest at the injection rate of 0.5 mL/s. Effect of flow diversion can only be assessed at an injection rate greater than 0.5 mL/s. Conclusions: Intra-aneurysmal flow jet is highly dependent on the injection rate of the contrast agent. For the internal carotid artery (ICA) aneurysms, the systolic flows can be visualized at slow injection rates ( 1 mL/s). Dependence of flow jet on the contrast injection rate has serious clinical implications and needs to be considered during diagnostic procedures; a protocol with a consistent injection rate is highly recommended.
A Novel Acousto-optic Modulation Technique for Na Wind/Temperature Lidars

Na Wind/Temperature lidar is a powerful technique for studying the climatology and dynamics of the mesopause region. To make wind and temperature observations, it is necessary to tune a narrowband pulsed laser to at least three different frequencies within the Na D2a spectrum to measure the Doppler-broadening (temperature) and Doppler-shifting (wind speed) of the Na fluorescence spectrum. While the technique is potentially very accurate, the approach is susceptible to laser tuning errors and errors caused by Na density fluctuations during the measurement period. We discuss the design and operation of a new acousto-optic frequency shifter which eliminates these errors. The laser is locked to one of the hyperfme lines near the D2a peak and then frequency shifted by ± 630 MHz by the acousto-optic modulator. This approach virtually eliminates the effects of laser tuning errors. Because the response time of the acousto-optic modulator is quite fast, the laser frequency can be shifted on a pulse to pulse basis also eliminating errors caused by Na density variations. In this paper, we describe the acousto-optic frequency shifter and present examples of the temperature, density and wind measurements obtained with this new Na lidar. The results illustrate the significant improvement in resolution and accuracy that can be achieved by using this new technique.
Ganglioside-Mediated Internalization of Choleragen

Systems using proteins as receptors for extracellular ligands have been extensively characterized in the last decade (Kaplan, 1981). Only recently has attention been given to the receptor function of gangliosides (Holmgren et al., 1980). Gangliosides serve as receptors for a variety of ligands including interferon, viruses, toxins and glycoprotein hormones. Ganglioside GM1-choleragen distinguishes itself as one of the most promising systems for biochemical studies. Ganglioside GM1 exist ubiquitously in all eukaryotic cells. In addition, the central role of the metabolism of cyclic AMP, which is activated by choleragen, certifies the importance of the GM1-choleragen systems (Lin and Taniuchi, 1980).
Probe: Performance Review of Balanced Efficiency

Abstract An objective evaluation of system efficiency may be unattainable in the absence of applicable criteria for measuring operational performance. The methodology outlined provides for a heuristic approach which establishes a basis of comparison for isomorphic systems and designates the most likely areas for corrective actions. It thus facilitates application of a simulation technique which determines the impact of various alternative actions and the magnitude of their influence on the system components.
Pancho's Burritos (Abridged)

This case, an abridged version of "Pancho's Burritos" (UVA-OM-1539). Pancho's Burritos is a high-end fast-food restaurant located in Charlottesville, Virginia. Due to a recent surge in customers, the lines at the restaurant during peak hours are becoming very long and causing excessive customer waiting. To improve current customer wait times and plan for future growth requirements, Francisco “Pancho” Escoba, the proprietor, wants to get a better understanding of the current operational capacity. The key decision Escoba must make is how to redesign his burrito-making process to increase the capacity and reduce customer wait time.Suitable for an undergraduate or MBA course, the case can be used in an introductory operations course to teach capacity analysis and queuing. The case provides a relatable and understandable setting for students without an operations background to gain a better grasp of basic course concepts and illustrates how interactions between capacity and queuing affect one another. As an exam or review case it works well because it contains standard process calculations that all students should know how to perform. Excerpt UVA-OM-1555 Rev. May 24, 2017 Pancho's Burritos (Abridged) It was Friday night, and Francisco “Pancho” Escoba, manager and owner of high-end fast-food restaurant Pancho's Burritos, was performing his regular restocking order when he noticed something odd. As he walked into the restaurant, he saw a number of customers walking out, frustrated with the long line that spread all the way across the restaurant. Customers leaving at the sight of a long line during peak demand hours was a recent trend that worried Escoba. In order to put an end to the fleeing customers and to improve the customer experience, Escoba decided to analyze his operations by taking some time studies of the burrito-making process. The Arrival of Pancho's Burritos Escoba was born an entrepreneur. At age 12, he started his first business, a home movie theater that served his friends and family. By age 16, he owned and operated a number of small businesses in his hometown of Guadalajara, Mexico, including a lawn-care service, a neighborhood food-delivery service, and an airport-ride service. Due in part to the stable income he received from his businesses, he was able to attend and pay for college at Universidad Panamericana. Following graduation, he returned to Guadalajara where he started a furniture design, manufacturing, and retail store. After laboring for several years just to break even, he decided to return to school for his MBA at the University of Virginia's Darden School of Business. . . .
Laparoscopic Left Hemicolectomy

Although laparoscopic left hemicolectomy is technically demanding that necessitates successful completion of a challenging learning curves. The requisite learning is limited not only to the techniques and methods, but as importantly to appropriated patient selection. Moreover some preoperative evaluation(s) may be valuable to facilitate the procedure. Specifically, computed tomography (CT) scan can be useful in assessing the extent of the disease; water soluble contrast enema and/or small bowel series may be helpful to anatomically localize any stenosis or fistula tract in patients with inflammatory processes. Colonoscopy with biopsy is widely performed to determine the pathology, however it may not always accurately detect the anatomical site. Intraoperative localization can be both difficult and time consuming, particularly when the surgical indication is an endoscopically unresectable adenoma or a small carcinoma.
God’s Messenger: Ellen G. White

This chapter will explicate the life and major religious contributions of the founder of the largest new religion to emerge from the Americas. Seventh-day Adventism has surpassed Mormonism in number of adherents worldwide, but Ellen Harmon White is understudied by scholars and is almost unknown outside of Seventh-day Adventism. Specifically the chapter will trace White’s life by exploring both: (1) important formative events prior to and early in her prophetic career (especially her early religious seekership, personal conversion experience, attachment to the Millerite Millennial movement, participation in the Methodist “shout” tradition and subsequent expulsion from her congregation, early visionary experiences, and role in organizing the Seventh-day Adventist church); and (2) the evolution of Ellen White’s leadership—from competing with other visionaries (including other female visionaries) seeking to influence former Millerites, to a fledgling leader of a small new religion who played a primary role in settling disputes among male religious leaders, to a confident messenger of God who incorporated gender innovations in her messages. The chapter will consider her insistence that women participate fully in religious work in a variety of capacities, including in ministry, and as professionals and administrators in Adventist institutions, as well as her calls for men to participate more fully in the domestic realm. Ellen White’s voluminous writings continue to play a critical role in the movement today, and the chapter will conclude by considering the legacy of her thinking and writing about gender in the contemporary movement, including in the current debate about women’s ordination.
Safety in treatment of hepatocellular carcinoma with immune checkpoint inhibitors as compared to melanoma and non-small cell lung cancer

Hepatocellular carcinoma (HCC) is a major health problem worldwide with increasing incidence rates. As HCC traditionally occurs in chronically inflamed livers, this inflammation aids to drive oncogenesis and often renders these lesions to be immunogenic and therefore potential targets for immunotherapy. As patients with HCC generally have underlying liver dysfunction, we sought to determine if immune checkpoint inhibitors were safe to use in patients with HCC as compared to melanoma and non-small cell lung cancer (NSCLC) in terms of the gastrointestinal side effects of elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and diarrhea as well as patients who drop out of the study due to drug toxicity and death secondary to drug toxicity. A literature review was performed for clinical trials that have been completed with single agent immune checkpoint inhibitors for patients with HCC, melanoma, and NSCLC. Gastrointestinal related adverse events including elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and diarrhea were analyzed as well as those patients who were taken off therapy secondary to drug related toxicity and patients who died as a result of therapy. We found that although patients with HCC treated with immune checkpoint inhibitors have a substantial increase in AST/ALT as compared to patients with melanoma and NSCLC, this does not cause the patients to come off therapy or cause death secondary to drug toxicity. We propose immune checkpoint inhibitors are safe to pursue in the treatment of HCC.
Monitoring T cell–dendritic cell interactions in vivo by intercellular enzymatic labelling

Interactions between different cell types are essential for multiple biological processes, including immunity, embryonic development and neuronal signalling. Although the dynamics of cell-cell interactions can be monitored in vivo by intravital microscopy, this approach does not provide any information on the receptors and ligands involved or enable the isolation of interacting cells for downstream analysis. Here we describe a complementary approach that uses bacterial sortase A-mediated cell labelling across synapses of immune cells to identify receptor-ligand interactions between cells in living mice, by generating a signal that can subsequently be detected ex vivo by flow cytometry. We call this approach for the labelling of 'kiss-and-run' interactions between immune cells 'Labelling Immune Partnerships by SorTagging Intercellular Contacts' (LIPSTIC). Using LIPSTIC, we show that interactions between dendritic cells and CD4+ T cells during T-cell priming in vivo occur in two distinct modalities: an early, cognate stage, during which CD40-CD40L interactions occur specifically between T cells and antigen-loaded dendritic cells; and a later, non-cognate stage during which these interactions no longer require prior engagement of the T-cell receptor. Therefore, LIPSTIC enables the direct measurement of dynamic cell-cell interactions both in vitro and in vivo. Given its flexibility for use with different receptor-ligand pairs and a range of detectable labels, we expect that this approach will be of use to any field of biology requiring quantification of intercellular communication.
Optical nondestructive dynamic measurements of wafer-scale encapsulated nanofluidic channels

Nanofluidic channels are of great interest for DNA sequencing, chromatography, and drug delivery. However, metrology of embedded or sealed nanochannels and measurement of their fill-state have remained extremely challenging. Existing techniques have been restricted to optical microscopy, which suffers from insufficient resolution, or scanning electron microscopy, which cannot measure sealed or embedded channels without cleaving the sample. Here, we demonstrate a novel method for accurately extracting nanochannel cross-sectional dimensions and monitoring fluid filling, utilizing spectroscopic ellipsometric scatterometry, combined with rigorous electromagnetic simulations. Our technique is capable of measuring channel dimensions with better than 5-nm accuracy and assessing channel filling within seconds. The developed technique is, thus, well suited for both process monitoring of channel fabrication as well as for studying complex phenomena of fluid flow through nanochannel structures.
The multiplicities of multilingual interaction

This paper explores how the authors to the papers in this issue understand how communication takes place when interlocutors use different named languages or use different semiotic resources to make...
A Unique Complication Associated with Concurrent Chemoradiation for the Treatment of Locally Advanced Head and Neck Cancer

Background: Concurrent chemoradiation is becoming an increasingly popular treatment for patients with locally advanced head and neck cancer. The full extent of treatment related complications has not been completely documented in the literature. Methods: We present the case of a patient treated with definitive intensity modulated radiation therapy and concurrent carboplatin and fluorouracil for a locally advanced oral cavity and base of tongue cancer. Results: The patient suffered acute grade 4 dermatitis and mucositis during treatment. One month after completion of treatment, the patient was found to have permanent adherence of the tongue to the buccal mucosa as a result of severe scar tissue formation. Conclusions: As more patients undergo chemoradiation for the treatment of locally advanced head and neck cancer, the full extent of treatment related complications are being identified. To our knowledge, this is the first report of chemoradiation for head and neck cancer resulting in adherence of the tongue to the buccal mucosa.
Breaking Barriers: The Relation between Contract and Intellectual Property Law

This Article examines the -symbiotic relationship between copyright and contract law. The intellectual property bargain, or the delicate balance that allegedly exists in current intellectual property law, cannot be seen merely as a matter of a balance stated in property law rules. An interaction between intellectual property and contract rules has always been a primary characteristic of intellectual property distributed in the open market and that interaction is central to whatever balance has been achieved. When one speaks about an existing balance in the property rights sector, it is futile to focus solely on the statutory provisions of the copyright, patent or trademark laws. One must, of necessity, understand and incorporate the fact that the policy choice has always assumed that property rights are routinely transferred, waived, released, and licensed. Only the most naive observer, or one with a clear political agenda, can look at the intellectual property laws and their history and suggest that policy in the property sphere trumps or precludes the influence of contract. In contractual relationships, underlying property rights are often relatively unimportant. They provide "default rules" that state a legal position that exists between the contracting parties unless the parties otherwise agree. Contract law provides other default rules. In the digital world, the contract rather than the underlying property law defines the product. This being said, however, there are some settings in which contract law, intellectual property, or competition law place limits on the ability to enforce some contract terms. This Article explores some of these areas and describes their limited role in modem commerce.
“I Am Crying…This Really Touched My Heart”: Disabled Intimacy and the Thick Materiality of the Virtual

The book starts with Anastasia Todd’s piece on disabled vloggers Charisse and Rikki Poynter. Their vlogs, Todd argues, offer spaces of mediated intimacies that affectively reorient able-bodied publics into tolerant, neoliberal citizens. By using the comments sections of the vlogs as a means to unearth the affective readings of the vlogs, Todd extrapolates that the vlogs reorient the able-bodied viewer into being accepting of the diversity of the disabled body. As intimate publics, they are co-opted as signs of neoliberal inclusionism. Building on the work of Sara Ahmed, Todd states that the promise of diversity is future oriented and, in being included, erases the signs of exclusion. The affective reorientations that image futures of tolerance thus function to depoliticize disability.
Vernier spectrometer using counterpropagating soliton microcombs

Determination of laser frequency with high resolution under continuous and abrupt tuning conditions is important for sensing, spectroscopy, and communications. We show that a single microresonator provides rapid and broadband measurement of optical frequencies with a relative frequency precision comparable to that of conventional dual-frequency comb systems. Dual-locked counterpropagating solitons having slightly different repetition rates were used to implement a vernier spectrometer, which enabled characterization of laser tuning rates as high as 10 terahertz per second, broadly step-tuned lasers, multiline laser spectra, and molecular absorption lines. Besides providing a considerable technical simplification through the dual-locked solitons and enhanced capability for measurement of arbitrarily tuned sources, our results reveal possibilities for chip-scale spectrometers that exceed the performance of tabletop grating and interferometer-based devices.
Electronic Tools and Media for Teaching Microscopic Skills

The most common digital visual media used to teach microscopic skills are still images of significant findings. More recently, whole slide imaging applications are available which allow for slide scanning simulations. Both are important innovations for teaching and assessment, but both have limitations. The single still image is easily delivered and embedded into interactive tools, but the single image does not simulate the discovery aspect of microscopy nor does it provide sufficient contextual information necessary for the critical thinking aspects. The whole slide imaging method provides this context but requires the delivery of gigabyte quantities of digital data and thus requires special host servers and viewers. These limit the usefulness of the media and preclude embedding the media into interactive learning tools. Neither method allows for exploration of focal planes, which is often necessary to the discovery and interpretation of findings. We created a new media alternative yielding interactive teaching applications that address some of the limitations of the commonly used methods. These applications provide for both scanning simulation and focal plane exploration. The applications also model the critical thinking components of practice. All media is prepared in standard formats requiring, at most, single-digit megabyte levels of data transfer. This allows for versatility in embedding into a variety of interactive learning and assessment tools. Applications will be demonstrated in Hematology, Urinalysis, Parasitology and Body Fluid analysis. We are prepared to discuss the image collection, preparation and implementation of the tools. Note A short silent video of a body fluid teaching exercise can be found here. http://alliedhealth.lsuhsc.edu/ClinicalLaboratory/bodyFluids/lsuhsc_demo.mp4