cssi/SciSciGPT-SciSciNet huggingface dataset:
Adipose Triglyceride Lipase (ATGL) Expression Is Associated with Adiposity and Tumor Stromal Proliferation in Patients with Pancreatic Ductal Adenocarcinoma

Background: Obesity is an established risk factor for the development of pancreatic ductal adenocarcinoma (PDAC). However, the pathophysiology of how increased adiposity increases the risk for PDAC has not been fully elucidated. Adipose triglyceride lipase (ATGL) is a lipase that catabolizes triglyceride hydrolysis and has been implicated in the development of breast cancer. We hypothesized that overweight patients with PDAC would demonstrate higher tumor ATGL expression compared to non-overweight patients with PDAC. Materials and Methods: Immunohistochemical analysis for ATGL expression was performed on PDAC tissues from 44 patients after Whipple procedure or distal pancreatectomy. Correlation of ATGL expression with clinicopathological features was evaluated. Results: A total of 23/44 (52.2%) PDACs showed low level ATGL immunoreactivity, while 21/44 (47.8%) showed a high level, with moderate to strong positive ATGL immunoreactivity in more than 50% of the tumor cells. Chi-squared testing revealed a statistically significant association between high ATGL expression and both BMI >25 kg/m2 (χ2=5.74, p=0.017) and increased tumor stroma (χ2=19.14, p<0.001). Chi-squared testing failed to reveal a statistically significant association when comparing ATGL expression by lymph node metastasis, histological grade, tumor size, patient age, patient sex and presence of fat invasion. Conclusion: Our results suggest that increased ATGL expression is associated with increased adiposity and stromal proliferation in patients with PDAC, making it a possible key protein in how obesity increases the risk of PDAC.
Multi-field/-scale interactions of turbulence with neoclassical tearing mode magnetic islands in the DIII-D tokamak

We present the first localized measurements of long and intermediate wavelength turbulent density fluctuations ( n) and long wavelength turbulent electron temperature fluctuations ( Te) modified by m/n=2/1 Neoclassical Tearing Mode (NTM) islands (m and n are the poloidal and toroidal mode numbers, respectively). These long and intermediate wavelengths correspond to the expected Ion Temperature Gradient and Trapped Electron Mode scales, respectively. Two regimes have been observed when tracking n during NTM evolution: (1) small islands are characterized by a steep Te radial profile and turbulence levels comparable to those of the background; (2) large islands have a flat Te profile and reduced turbulence level at the O-point. Radially outside the large island, the Te profile is steeper and the turbulence level increased compared to the no or small island case. Reduced turbulence at the O-point compared to the X-point leads to a 15% modulation of n2 across the island that is nearly in phase with the Te ...
Pupation Site Selection and Enemy Avoidance in the Introduced Pine Sawfly (Diprion similis)

Abstract Insects that pupate on the branches of trees and shrubs suffer mortality from both predators and parasitic wasps. Which natural enemy represents the greater threat and therefore the stronger selection force on pupation site selection depends upon the time of year, the relative abundance of predators versus parasitoids, and the availability of alternative prey or hosts. Predation by foraging birds and mammals is likely to occur most commonly in winter when leaves have fallen, cocoons are conspicuous, and higher quality prey are scarcer. Inaccessibility and crypsis of pupation sites may provide protection from visually hunting predators. Attacks by parasitic wasps, which take place only during warmer months, may not be as easily avoided by inaccessibility or crypsis. We studied the patterns and mortality risks of pupation site selection in Diprion similis (Hymenoptera: Diprionidae; Introduced Pine Sawfly). Cocoons that were smaller than average and situated in relatively inaccessible sites (thinner...
An Architectural Solution for Health Information Exchange

Health information technology HIT systems including electronic health records EHRs have a market saturation nearing 92% at individual institutions but are still unsuited for cross-institutional collaboration of stakeholders e.g., medical providers such as physicians, hospitals, clinics, labs, etc. in support of health information exchange HIE of different HIT systems in geographically separate locations. In the computer science field, software architectures such as service-oriented architecture, grid computing, publish/subscribe paradigm, and data warehousing are well-established approaches for interoperation. However, the application of these software architectures to support HIE has not been significantly explored. To address this issue, this paper proposes an architectural solution for HIE that leverages established software architectural styles in conjunction with the emergent HL7 standard Fast Healthcare Interoperability Resources FHIR. FHIR models healthcare data with XML or JSON schemas using a set of 93 resources to track a patient's clinical findings, problems, allergies, adverse events, history, suggested physician orders, care planning, etc. For each resource, a FHIR CRUD RESTful Application Program Interface API is defined to share data in a common format for each of the HITs that can then be easily accessible by mobile applications. This paper details an architectural solution for HIE using software architectural styles in conjunction with FHIR to allow HIT systems of stakeholders to be integrated to facilitate collaboration among medical providers. To demonstrate the feasibility and utility of HHIEA, a realistic regional healthcare scenario is introduced that illustrates the interactions of stakeholders across an integrated collection of HIT systems.
Commentary on ‘Current economic obstacles to biochar use in agriculture and climate change mitigation’ regarding uncertainty, context-specificity and alternative value sources

ABSTRACTA recent study in Carbon Management, by Bach et al., argues that biochar amendments’ positive impacts on crop yields and soil carbon sequestration have been overestimated, and biochar amendment to soil is hence unlikely to be an economically viable technique for cropping system management or C abatement. We question the data selection and analysis techniques that the authors used to assess the effect of biochar on crop yield, biochar stability in soil, and biochar production cost. Although the research article was not intended as a meta-analysis – and hence the data reported need not be analyzed with the full rigor of a systematic review – we assert that the employed data set, while containing a sufficient quantity of data, requires closer inspection and a more careful interpretation to avoid significant bias in the conclusions. Furthermore, we assert that proper implementation of biochar and inclusion of non-yield benefits in the analysis would render it more economically viable for both cropping...
Demography and climate in Late Eneolithic Ukraine, Moldova, and Romania: Multiproxy evidence and pollen-based regional corroboration

Abstract Attempts to correlate macro-scale climate dynamics with anomalies in local and regional archaeological data sets should account for differences in geographic scale and effect size. Using the modern analogue technique, this paper reconstructs temperature, precipitation, and growing degree-day trends in Ukraine, Moldova, and Romania from a set of 20 pollen cores in order to explicate the regional impact of the 6.0–5.0 ka BP rapid climate change interval observed in the GISP2 K+ glacio-chemical sequence. Results are compared against a model of regional demographic development covering the time span of 6000–3000 BCE. This study indicates that, while macro-scale trends are discernible in Eastern Europe, climatic instability during the fourth millennium BCE was regionally variable and resultant demographic responses were highly targeted and heterogeneous in nature. A period of cooling ca. 3825–3650 cal BCE resulted in the fracturing of Eneolithic complexes in Romania and generally spurred adaptation to more mobile systems of settlement and subsistence. However, a contemporaneous alternative response involved large-scale migrations to peripheral regions, including the establishment of the Tripolye giant-settlements in Central Ukraine. The methods used illustrate the need for obtaining more proximate confirmation when applying large-scale climate processes to explanations of local and regional archaeological contexts.
Breast cancer risk according to serum 25-hydroxyvitamin D: meta-analysis of dose-response

3078 Background: An inverse association was observed between serum 25-hydroxyvitamin D [25(OH)D] levels and risk of female breast cancer in four recent observational studies. However, the exact 25(OH)D serum levels associated with a specific level of reduction in breast cancer incidence are still imprecise. Methods: Data were combined from all studies that provided data on risk of breast cancer by quantile of serum 25(OH)D, using Review Manager (Copenhagen: Nordic Cochrane Centre, 2007). The analysis was performed according to published international standards for meta-analyses of data from observational studies. The number of individuals and person-years at risk in each quantile (generally quartiles or quintiles) of each study was determined, and a record was created for each individual from each study, with a study number identifying the study, a serial number for the individual, the median 25(OH)D concentration in the individual’s quantile in their study, and a code indicating whether the individual was a case or noncase. Records from the cohort studies were combined into an inclusive dataset in which individuals were divided into quintiles of 25(OH)D. There was an approximately equal number of individuals in each quintile. Measures of risk (incidence rates or odds ratios) were calculated for each quintile, providing an estimate of the pooled dose-response relationship. The procedure was performed separately for cohort and case-control studies. Results for each type of study, and all studies combined, were plotted and tested for goodness of fit to a classical dose-response curve. Results: A sigmoid dose-response gradient was observed between serum 25(OH)D and risk of breast cancer, and was approximately consistent across all studies. A higher serum 25(OH)D level (100-120 nmol/L) was associated with a projected 50% lower risk of breast cancer, compared to the serum 25(OH)D level associated in previous observational studies with 50% lower risk of colon cancer (80 nmol/L). Conclusions: Serum 25(OH)D is recognized as the optimal measure of vitamin D status. This study provides the most precise estimate available to date of the dose-response curve of the inverse association of 25(OH)D with risk of breast cancer, as estimated by observational studies. A substantially higher serum 25(OH)D level was needed for a projected reduction by half in incidence of breast cancer than for a similar reduction in risk of colon cancer, based on observational studies. The dose-response curve will help project the association of vitamin D deficiency states with risk of breast cancer, and will provide useful information for planning future clinical trials. Additional cohort and other epidemiological studies also would be worthwhile to further characterize this association.
Repurposing of the CDK inhibitor PHA-767491 as a NRF2 inhibitor drug candidate for cancer therapy via redox modulation

Oxidative stress and cellular response mechanisms such as NRF2-mediated antioxidant responses play differential roles in healthy and diseased cells. Constant generation and elimination of high levels of reactive oxygen species is a hallmark of many cancer cell types; this phenomenon is not observed during steady state of healthy cells. Manipulation of NRF2 transcriptional activity and the cellular redox homeostasis therefore has potential to be therapeutically exploitable for cancer therapy by preferentially targeting cancer cells for induction of oxidative stress. We found that the NRF2 inhibitor brusatol triggered increased oxidative stress while compromising viability and proliferation of multiple myeloma cells. Using a repurposing approach we discovered that the Cdc7/CDK9 inhibitor PHA-767491 is also a potent inhibitor of NRF2 transcriptional activity. The molecule was identified by high throughput screening of a library of about 5900 drug-like molecules. Screening assays included two cell-based assays using HepG2 hepatocellular carcinoma cells: a) A NRF2 nuclear translocation assay, and b) A NRF2 luciferase reporter assay. Validation assays were performed in multiple myeloma cells and included detection of mitochondrial superoxide levels and MTS assays. We found that PHA-767491 treatment of multiple myeloma cells was associated with inhibition of nuclear translocation of NRF2, increased mitochondrial superoxide levels and inhibition of cell growth. Our findings suggest that PHA-767491 is a promising drug candidate for cancer therapy with NRF2 inhibitory potency contributing to its anti-cancer properties.
First-principles investigation of surface properties and adsorption of oxygen on Ni-22Cr and the role of molybdenum

Abstract Nickel-based alloys are extensively utilized in high-temperature applications where corrosion resistance and mechanical strength are important. The formation of an oxide-layer on these surfaces is associated with corrosion resistance but the early stages of this process are not well understood and difficult to model. The studies in the available literature are currently limited to introducing an element such as Cr to the top layer of the nickel surface slab. While this approach has yielded some useful insights, it is not entirely accurate. In this work, we used the special quasi-random structure (SQS) method to first build reliable representations of the Ni-Cr alloy. Next, several surface slabs were cut from these alloys and oxygen adsorption at 0.25 ML coverage was investigated. It was generally observed that Cr made the oxygen adsorption process more thermodynamically favorable and the nature of the interaction was partially electrostatic. We then introduced Mo substitutions to the top layer of the surface to investigate the effect of low levels of Mo on the oxygen adsorption. It was revealed that Mo helped further stabilize the adsorbed configuration. A correlation was observed between the net charge transferred and the thermodynamic stability of the metal-oxygen system and the stability of the adsorbate on the alloy surface was mainly dependent on the local environment of the adsorbate. The subsurface atoms for the cases considered in this study provided only minor contribution to the stability of the alloy-oxygen system and hence utilizing the doping approach on the top layer may be appropriate for studying oxygen adsorption on this particular alloy surface to a good approximation but this issue requires further investigation. Finally, the workfunctions of the surfaces and the effects of oxygen adsorption on the workfunctions were also characterized and the implications of the results for corrosion resistance were discussed.
Humanoid Dynamic Synchronization Through Whole-Body Bilateral Feedback Teleoperation

This paper presents a method to achieve human and legged robot dynamic synchronization through bilateral feedback teleoperation. Our study shows how we can explore the interplay between human Extrapolated Center of Mass and the contact forces with the environment in order to transmit to the robot the underlying balancing and stepping strategy. All the necessary key equations for the frontal plane coupled dynamics are presented along with the human feedback law derived from the proposed state normalization in length and time. Here, we pay special attention to how the natural frequency of each system influences the resulting motion and analyze how the coupled system responds to various robot sizes. Experiments in which a human operator controls a simulated bipedal robot show how the Balance Feedback Interface force varies according to different scales and responds to external disturbances. Finally, we show the method's robustness to uneven terrain and how we can allow the point feet robot to synchronously take steps with the operator. This is an introductory study that aims to grant legged robots motor capabilities for power manipulation comparable to humans.
Somaclonal Variation in Zinnia

The genus Zinnia (Asteraceae, Helianthus tribe) consists of about 17 species of annuals, perennial herbs, or small shrubs native to the southwestern United States and Central and South America. Zinnia elegans Jacq., native to Mexico, is a commercially important herbaceous annual grown as a bedding plant or cut flower. The wide variety of flower types, flower colors, and plant heights combined with drought tolerance and long bloom all contribute to make zinnias popular. Zinnias have accounted for more seed packet sales than any other garden flower sold by mail or garden center display. However, its susceptibility to Alternaria zinnia Pape (causal agent of alternaria blight), Erysiphe cichoracearum DC. ex Merat (causal agent of powdery mildew), and X anthomonas campestris pv. zinniae Hopkins and Dowson (causal agent of bacterial leaf and flower spot) has in recent years posed an economic threat to commercial seed producers. Most zinnias available on today’s market are F1 hybrids derived from inbred hybridization. Some open-pollinated cultivars remain.
International Humanitarian Law Teaching Supplement: Volume 2 - International Criminal Law

This supplement is designed to provide comprehensive yet focused materials on international humanitarian law (IHL), or the law of armed conflict, for inclusion in other substantive courses, such as public international law, international criminal law, or foreign relations law. The supplement is divided into four main substantive chapters on IHL — when does IHL apply, conflict classification, and means and methods of combat — with an emphasis on how these concepts would arise in a legal proceeding, such as a war crimes prosecution. Each chapter contains an introduction to the main IHL concepts; cases and primary source materials drawn from the jurisprudence of the international criminal tribunals; notes and questions for discussion; and a series of problems to enables students to further explore the topics at hand.
Redox Activation of Benzotriazine N-Oxides: Mechanisms and Potential as Anticancer Drugs

A distinguishing feature of solid tumors compared to most, if not all, normal tissues is their regions of low oxygen tension1. Because hypoxic cells are resistant both to radiation-induced cell killing and to the cytotoxic action of some chemotherapeutic drugs, they have long been considered to be a problem for the radiotherapist and, in some cases, for cancer treatment by cytotoxic drugs. More recently, however, tumor hypoxia is beginning to be regarded as a potentially exploitable difference between normal and neoplastic tissue which might be manipulated for therapeutic benefit, and there are a number of different ways in which this might be achieved.
RIBOSOME UTILIZATION AND REGULATION OF PROTEIN SYNTHESIS DURING LYMPHOCYTE ACTIVATION

Publisher Summary This chapter focuses on the ribosome utilization and regulation of protein synthesis during lymphocyte activation. The increased synthesis of proteins is the dominant event of the initial period of lymphocyte activation. Free ribosomes and the subunits comprising them may be distinguished from ribosomes active in protein synthesis and from native subunits by their behavior in salt solutions of different strengths. All eukaryotic cells studied to date, whether resting or growing, produce and maintain a free ribosome pool of varying size. The early PHA effects on both dissociation and initiation do not require synthesis of new proteins. Presumably, the primary increase in the activity of either DF or initiation factors is achieved by activating preexisting proteins.
AMBIENT TEMPERATURE BATTERIES FOR ELECTRIC VEHICLES AND ENERGY STORAGE

Publisher Summary This chapter discusses the recent developments in low cost room-temperature batteries, especially lead–acid and zinc–bromine. Lead-acid is being restudied for both large scale load leveling and energy storage for solar panels. In both cases, satisfactory constructions exist to provide needed capacity and energy density, but longer cycle life and lower cost aspects still have to be resolved. The metal–halogen systems can be considered candidates for ambient temperature, low-cost batteries. The zinc-bromine development at Exxon Research and Engineering Co. is based on a circulating electrolyte bipolar flow-cell concept, using a soluble complex (quaternary ammonium salt complexes), to separate bromine on charge for storage outside the battery. The batteries are constructed of high conductivity carbon polyolefin composition with a conductivity of approximately 1 ohm–cm, providing the necessary surfaces for zinc deposition and bromine evolution at extremely low cost.
Sprint to work: A novel model for team science collaboration in academic medicine

Collaborative research in academic medicine is often inefficient and ineffective. It often fails to leverage the expertise of interdisciplinary team members, does not seek or incorporate team input at opportune times, and creates workload inequities. Adapting approaches developed in venture capital, we created the ‘sprint model’ for writing academic papers based on the analysis of secondary data. The ‘sprint model’ minimizes common barriers that undermine collaboration in academic medicine. This model for team science collaboration begins with team members convening for a highly focused, guided session. In this session, a facilitator moves the group through a structured process to create the study plan. This includes refining the research questions, developing the study design, and prototyping the presentation of results. After adopting this model, our team has drastically reduced time from idea inception to final product submission through increased efficiencies and reduced redundancies. From December 2016 to April 2018, our team has initiated 15 paper sprints. The median time from sprint to submission for paper sprints has been 1.7 months (minimum: 0.5; maximum: 9). Although our current ‘sprint’ approach has already demonstrated a substantial improvement in our ability to rapidly produce high-quality research, we believe the ‘pre-sprint’ preparation and ‘post-sprint’ processes can be further refined. Finally, we discuss the limitations of this model and our efforts to adapt the process to meet the evolving needs of research teams.
Microglial Cells Impact Gut Microbiota and Gut Pathology in Angiotensin II-Induced Hypertension

Rationale: Increased microglial activation and neuroinflammation within autonomic brain regions have been implicated in sustained hypertension, and their inhibition by minocycline—an anti-inflammat...
Increasing Chocolate's Sugar Content Enhances Its Psychoactive Effects and Intake.

Chocolate elicits unique brain activity compared to other foods, activating similar brain regions and neurobiological substrates with potentially similar psychoactive effects as substances of abuse. We sought to determine the relationship between chocolate with varying combinations of its main constituents (sugar, cocoa, and fat) and its psychoactive effects. Participants consumed 5 g of a commercially available chocolate with increasing amounts of sugar (90% cocoa, 85% cocoa, 70% cocoa, and milk chocolates). After each chocolate sample, participants completed the Psychoactive Effects Questionnaire (PEQ). The PEQ consists of questions taken from the Morphine-Benzedrine Group (MBG), Morphine (M,) and Excitement (E) subscales of the Addiction Research Center Inventory. After all testing procedures, participants completed the Binge Eating Scale (BES) while left alone and allowed to eat as much as they wanted of each of the different chocolates. We found a measurable psychoactive dose–effect relationship with each incremental increase in the chocolate’s sugar content. The total number of positive responses and the number of positive responses on the E subscale began increasing after tasting the 90% cocoa chocolate, whereas the number of positive responses on the MBG and M subscales began increasing after tasting the 85% cocoa chocolate sample. We did not find a correlation between BES scores and the total amount of chocolate consumed or self-reported scores on the PEQ. These results suggest that each incremental increase in chocolate’s sugar content enhances its psychoactive effects. These results extend our understanding of chocolate’s appeal and unique ability to prompt an addictive-like eating response.
A clinician survey of using speech recognition for clinical documentation in the electronic health record

Abstract Objective To assess the role of speech recognition (SR) technology in clinicians’ documentation workflows by examining use of, experience with and opinions about this technology. Materials and Methods We distributed a survey in 2016–2017 to 1731 clinician SR users at two large medical centers in Boston, Massachusetts and Aurora, Colorado. The survey asked about demographic and clinical characteristics, SR use and preferences, perceived accuracy, efficiency, and usability of SR, and overall satisfaction. Associations between outcomes (e.g., satisfaction) and factors (e.g., error prevalence) were measured using ordinal logistic regression. Results Most respondents (65.3%) had used their SR system for under one year. 75.5% of respondents estimated seeing 10 or fewer errors per dictation, but 19.6% estimated half or more of errors were clinically significant. Although 29.4% of respondents did not include SR among their preferred documentation methods, 78.8% were satisfied with SR, and 77.2% agreed that SR improves efficiency. Satisfaction was associated positively with efficiency and negatively with error prevalence and editing time. Respondents were interested in further training about using SR effectively but expressed concerns regarding software reliability, editing and workflow. Discussion Compared to other documentation methods (e.g., scribes, templates, typing, traditional dictation), SR has emerged as an effective solution, overcoming limitations inherent in other options and potentially improving efficiency while preserving documentation quality. Conclusion While concerns about SR usability and accuracy persist, clinicians expressed positive opinions about its impact on workflow and efficiency. Faster and better approaches are needed for clinical documentation, and SR is likely to play an important role going forward.
Effect of Intermetallic Compound Growth on Electromigration Failure Mechanism in Low-Profile Solder Joints

This paper describes the kinetic and microstructural mechanism of electromigration (EM) failure found in low-profile solder joints where EM and intermetallic phase formation compete for the same volume of Sn. The low-profile solder joint used in our study was made of 20-25um thick solder situated in between a Cu pillar and a Ni coated Cu lead frame (LF). The samples were EM tested in a temperature range of 140-170oC with the current densities varying between 35-45 KA/cm2 in an oil bath to induce failure without Joule Heat induced artifacts. Our studies on EM failure kinetics and microstructural mechanism have produced two key findings. The first finding suggests that the EM diffusivity (Z*D) of diffusing species (Sn, Ni, Cu) in the solder matrix can be uniquely ranked from microstructural analysis, and it is estimated to be (Z*D) Cu> (Z*D) Sn>(Z*D) Ni. This difference in EM diffusivity causes Cu-Sn and Ni-Sn intermetallic compounds (IMC) to develop in distinctively different manners under EM, leading to different EM failure mechanisms. The second finding is that EM in low-profile solder joints consists of multiple failure stages: a) with EM-related voiding in Sn dominating at lower temperatures; while b) thermally-induced IMC growth and invasion competes with EM-induced Sn voiding at high temperatures leading to the complete failure of each joint.
General concepts in biostatistics and clinical epidemiology: observational studies with case-control design

Case-control studies have been essential to the field of epidemiology and in public health research. In this design, data analysis is carried out from the outcome to the exposure, that is, retrospectively, as the association between exposure and outcome is studied between people who present a condition (cases) and those who do not (controls). They are thus very useful for studying infrequent conditions, or for those that involve a long latency period. There are different case selection methodologies, but the central aspect is the selection of controls. Data collection can be retrospective (obtained from clinical records) or prospective (applying data collection instruments to participants). Depending on the objective of the study, different types of case-control studies are available; however, all present a particular vulnerability to information bias and confounding, which can be controlled at the level of design and in the statistical analysis. This review addresses general theoretical concepts concerning case-control studies, including their historical development, methods for selecting participants, types of case-control studies, association measures, potential biases, as well as their advantages and disadvantages. Finally, concepts about the relevance on this study design are discussed, with a view to aid comprehension for undergraduate and graduate students of the health sciences. This is the third of a methodological series of articles on general concepts in biostatistics and clinical epidemiology developed by the Chair of Scientific Research Methodology at the School of Medicine, University of Valparaiso, Chile.
Serial fetal echocardiograms in hypoplastic left heart syndrome fetuses: Does it affect immediate post-natal care?

Abstract Guidelines recommend serial fetal echocardiograms when congenital heart disease is diagnosed. Necessity, timing, and frequency of serial echocardiograms are based on clinical judgment. Fetuses with hypoplastic left heart syndrome (fHLHS) may undergo multiple studies prior to birth. Goal of this study was to determine if the need for unexpected, emergent cardiac interventions were required immediately post-natally, if there were no concerns on initial fetal echocardiogram. Methods Fetal echocardiograms performed between 2006 and 2018 on fHLHS were reviewed. fHLHS were excluded if initial fetal scan documented any other concerns. Unexpected, emergent catheterization or surgical procedures, intubation, or inotropic support within the first 72 h of life were recorded. Results Total of 80 fHLHS were reviewed. Thirty-two fHLHS were excluded because of concerns on the initial fetal echocardiogram. Sixteen fHLHS had one scan, 14 had two scans, 13 had three scans, and 5 had four scans. No patient underwent an unexpected, emergent catheterization or surgical procedure within the first 72 h of life. Seven patients required intubation and 1 patient received inotropic support within the first 72 h of life. Conclusion No fHLHS underwent an unexpected, emergent catheterization or surgical procedure within the first 72 h of life if the initial fetal echocardiogram had no significant concerns. Medical interventions did occur immediately post-natally, but could not be directly attributed to a missed fetal cardiac diagnosis. Frequent serial fetal echocardiograms may not necessarily be needed to predict the need for an unexpected, emergent procedure.
Mercury bioaccumulation in tropical bats from a region of active artisanal and small-scale gold mining.

Mercury negatively affects human and animal health. Artisanal and small-scale gold mining can be a major local source of mercury contamination, especially into aquatic systems in tropical areas. Animals associated with mercury-contaminated aquatic systems are at high risk of experiencing effects of this heavy metal, but it is not clear how far the effects may extend into nearby terrestrial systems. We report mercury contamination levels in bats in agricultural areas at increasing distances from gold mining (~3–89 km of distance). We hypothesized that bat mercury concentrations would differ between feeding guilds, land use types, and be higher at sites closer to gold mining areas. We collected 112 fur samples from 30 bat species and eight guilds, and provide the first reports of concentrations in 12 species. All mercury concentrations were below the level at which health is likely to be affected (10 ppm). We found guild-influenced differences among mercury concentration levels, with the highest concentrations in aerial insectivores and carnivores, and the lowest in canopy frugivores. Our results suggest insectivorous and carnivorous bats may still be at some risk even at sites distant from aquatic mercury contamination. We did not find an effect of agricultural land-use type on mercury concentrations within species or guilds, suggesting mercury contamination did not extend to agricultural sites from areas of gold mining activities, and that these agricultural activities themselves were not an important source of mercury. We conclude bats did not demonstrate a signature of mercury risk either as a result of proximity of gold mining, or as a result of agricultural activities.
The use of virtual reality for Peri-procedural pain and anxiety at an outpatient spine clinic injection visit: an exploratory controlled randomized trial

Chronic pain is a major public health problem. There is a need to develop novel treatment strategies to address this growing issue. Virtual reality is emerging as an alternative approach to help people suffering from chronic pain. The purpose of this work was to explore the feasibility, acceptability, and impact of a brief virtual reality relaxation video on peri-procedural pain and anxiety in chronic low back pain patients receiving spinal injections. The intervention was delivered in the context of a busy fluoroscopy injection clinic. Upon arrival to the clinic, consented patients were randomized into one of three groups: (1) Audiovisual monitor-flat screen (AV) (2) Virtual Reality headset (VR) and (3) Control-no intervention. The main questions we set out to answer were: (1) Is it feasible to deliver the intervention in the context of clinical care? (2) Was the intervention acceptable to patients? and (3) Did the intervention impact pain and anxiety surrounding the injection procedure? Viewing a brief relaxation nature video in AV or VR format was not associated with statistically lower pain scores following an injection procedure compared to controls. However, the intervention was associated with lower anxiety scores recorded prior to the injection compared to controls. Importantly, the virtual reality intervention was acceptable and feasible to integrate into a clinic setting, however, to maximize effectiveness, the content delivered to this population should be targeted and delivered over a longer duration. In addition, alternative outcomes and settings beyond peri-procedural pain surrounding an injection should be explored.
Functional principal component based landmark analysis for the effects of longitudinal cholesterol profiles on the risk of coronary heart disease

Patients' longitudinal biomarker changing patterns are crucial factors for their disease progression. In this research, we apply functional principal component analysis techniques to extract these changing patterns and use them as predictors in landmark models for dynamic prediction. The time-varying effects of risk factors along a sequence of landmark times are smoothed by a supermodel to borrow information from neighbor time intervals. This results in more stable estimation and more clear demonstration of the time-varying effects. Compared with the traditional landmark analysis, simulation studies show our proposed approach results in lower prediction error rates and higher area under receiver operating characteristic curve (AUC) values, which indicate better ability to discriminate between subjects with different risk levels. We apply our method to data from the Framingham Heart Study, using longitudinal total cholesterol (TC) levels to predict future coronary heart disease (CHD) risk profiles. Our approach not only obtains the overall trend of biomarker-related risk profiles, but also reveals different risk patterns that are not available from the traditional landmark analyses. Our results show that high cholesterol levels during young ages are more harmful than those in old ages. This demonstrates the importance of analyzing the age-dependent effects of TC on CHD risk.
The Nature of Technology

Technology is an important part of the STEM acronym and unites and provides processes to tie all of the STEM disciplines together. Science, Engineering, and Math all depend on Technology to visualize and solve problems. Technology assists the other STEM fields to be creative but also carries with it its own social and cultural implications. To discuss the nature of technology we must first come to a shared definition of technology. This task can be difficult because there are many different lenses through which technology can be viewed. For example, technology can be a thought process, a way of knowing, and a tool. Definitions of technology are influenced by how it is used in practice and the professional organizations like IEEE, ISTE, CSTA, and NCTM that provide guidance and standards for how technology can and should be used. As our lives become more dependent on technology, and jobs become possible only by its use, the ethical nature of technology grows more important to both our present and our future. This chapter ends with a discussion of the work to be done including research on how technology and its affordances interacts with the work and creative activity in the other STEM fields and how technology could be leveraged to support curriculum in the other STEM areas.
Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives

International hospitals and healthcare facilities are facing catastrophic financial challenges related to the COVID-19 pandemic. The American Hospital Association estimates a financial impact of $202.6 billion in lost revenue for America's hospitals and healthcare systems, or an average of $50.7 billion per month. Furthermore, it could cost low- and middle-income countries ~ US$52 billion (equivalent to US$8.60 per person) each four weeks to provide an effective healthcare response to COVID-19. In the setting of the largest daily COVID-19 new cases in the US, this burden will influence patient care, surgeries, and surgical outcomes. From a global economic standpoint, The World Bank projects that global growth is projected to shrink by almost 8% with poorer countries feeling most of the impact, and the United Nations projects that it will cost the global economy around 2 trillion dollars this year. Overall, a lack of preparedness was a major contributor to the struggles experienced by healthcare facilities around the world. Items such as personal protective equipment (PPE) for healthcare workers, hospital equipment, sanitizing supplies, toilet paper, and water were in short supply. These deficiencies were exposed by COVID-19 and have prompted healthcare organizations around the world to invent new essential plans for pandemic preparedness. In this paper, we will discuss the economic impact of COVID-19 on US and international hospitals, healthcare facilities, surgery, and surgical outcomes. In the future, the US and countries around the world will benefit from preparing a plan of action to use as a guide in the event of a disaster or pandemic.
Conceptions of Homeless Education: The Continuing Importance of Supporting and Educating Teachers

Although research on resilience and supporting homeless students have made great strides in recent years, many districts still struggle to provide basic services. This mixed-method examination of one mid-sized, high-poverty southern city suggests that educating public school teachers remains an unevenly distributed — but, we argue, vital — means of promoting homeless student adaptation and success in school. Most teachers in our study had not received any training specific to the challenges of this population. Furthermore, our interviews uncovered that many teachers feel emotionally taxed by witnessing their students’ struggles. We discuss how our research informs directions for research, policy, and practice.
Should We Use Expired Drugs When Necessary

Abstract Background Medication shortages commonly occur in resource-poor settings. The relatively short expiry dates on many medications exacerbate these shortages, often requiring clinicians to choose between providing needed medications to the patient and violating rules governing drug dispensing. Case Report A patient presented to an emergency department in a resource-poor setting with an acute anterior myocardial infarction. Standard of care required using thrombolytics due to the unavailability of percutaneous coronary intervention. The only available thrombolytic, streptokinase, was 2 weeks past its labeled expiration date. The physicians faced the ethical dilemma of violating regulations and using the medication vs. failing to provide the patient with the best available therapy. Discussion The physicians in this case needed to weigh their obligation to improve the patient's health against the professional danger to themselves, their colleagues, and their institution for violating a health care regulation. The information they needed to make this decision and to provide the patient with factual informed consent requires an understanding of the myths, regulations, and science surrounding drug expiry dates. Two myths about medications pervade both the professional and lay communities—that they are uniformly effective and that medications taken past their expiry dates may be ineffective or even harmful. Scientific studies have demonstrated that both are false. Conclusions Ethically, physicians have a duty to place their patient's welfare above their own self-interest. In a time of increasing medication shortages around the globe, clinicians need to push rule makers to synchronize drug expiry dates with scientific findings.
Aiding Material Design Through Machine Learning

Machine learning is a field that has been around for decades whose impact and presence continues to increase across scientific and commercial communities. However, until recently, machine learning has not been thought of as a viable methodology that could significantly aid novel material discovery and design. That is, machine learning-aided material design and/or discovery is an emerging research topic, but one that holds immense potential. Such a system could, theoretically, be used to discover novel materials or surfaces that possess desirable properties across the electromagnetic spectrum under specific conditions. Herein, we present our preliminary machine learning- based framework for novel material design and discovery. We emphasize that our proposed framework is in its infancy; however, it is laying the foundation for the discovery of fundamental theories and knowledge for this novel technology. Baseline elementary experiments are presented as a proof-of-concept to show the feasibility of our proposed framework for the task of material design. Specifically, we put forth a multi-stage machine learning framework for new material discovery considering material surface geometries for predicting object signatures in the X band. Our proposed multi-stage framework is structured as follows: 1) a deep neural network (NN) is trained for predicting the time response scattered from an object based upon surface geometries (micro-feature spacing, height, etc.); and 2) a genetic algorithm is used to search for the optimal surface geometry configuration whose predicted scattered response (closely) matches that of a desired object response in the X band.
Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term.

OBJECTIVE This study aimed to evaluate whether racial and ethnic disparities in adverse perinatal outcomes exist at term. STUDY DESIGN We performed a secondary analysis of a multicenter observational study of 115,502 pregnant patients and their neonates (2008-2011). Singleton, nonanomalous pregnancies delivered from 37 to 41 weeks were included. Race and ethnicity were abstracted from the medical record and categorized as non-Hispanic White (White; referent), non-Hispanic Black (Black), non-Hispanic Asian (Asian), or Hispanic. The primary outcome was an adverse perinatal composite defined as perinatal death, Apgar score < 4 at 5 minutes, ventilator support, hypoxic-ischemic encephalopathy, subgaleal hemorrhage, skeletal fracture, infant stay greater than maternal stay (by ≥ 3 days), brachial plexus palsy, or facial nerve palsy. RESULTS Of the 72,117 patients included, 48% were White, 20% Black, 5% Asian, and 26% Hispanic. The unadjusted risk of the primary outcome was highest for neonates of Black patients (3.1%, unadjusted relative risk [uRR] = 1.16, 95% confidence interval [CI]: 1.04-1.30), lowest for neonates of Hispanic patients (2.1%, uRR = 0.80, 95% CI: 0.71-0.89), and no different for neonates of Asian (2.6%), compared with those of White patients (2.7%). In the adjusted model including age, body mass index (BMI), smoking, obstetric history, and high-risk pregnancy, differences in risk for the primary outcome were no longer observed for neonates of Black (adjusted relative risk [aRR] = 1.06, 95% CI: 0.94-1.19) and Hispanic (aRR = 0.92, 95% CI: 0.81-1.04) patients. Adding insurance to the model lowered the risk for both groups (aRR = 0.85, 95% CI: 0.75-0.96 for Black; aRR = 0.68, 95% CI: 0.59-0.78 for Hispanic). CONCLUSION Although neonates of Black patients have the highest frequency of adverse perinatal outcomes at term, after adjustment for sociodemographic factors, this higher risk is no longer observed, suggesting the importance of developing strategies that address social determinants of health to lessen extant health disparities. KEY POINTS · Term neonates of Black patients have the highest crude frequency of adverse perinatal outcomes.. · After adjustment for confounders, higher risk for neonates of Black patients is no longer observed.. · Disparities in outcomes are strongly related to insurance status..
Sketching for Elimination of Communication Links in LQG Teams

We consider here a scenario where a team of agents want to switch from a fully connected communication network to a network with limited bandwidth because of a cyber attack. The goal is to identify which communication link should still be active in the new network for near-optimal overall performance. This is formulated as a cardinality constrained quadratic minimization problem, which is NP-hard in general. To obtain an approximately optimal solution efficiently, we used random projection (RP) for dimensionality reduction. We show that the value of the sketched team is bounded above by a constant factor times the optimal value of the team with high probability.