cssi/SciSciGPT-SciSciNet huggingface dataset:
Interrelationship of hysteroid dysphoria and borderline personality disorder.

Most but not all hysteroid dysphorics seeking outpatient treatment meet DSM-III criteria for borderline personality disorder in terms of their usual behavior prior to entering treatment. Hysteroid dysphoric patients may benefit specifically from combined treatment with monoamine oxidase inhibitors and psychotherapy. In a pilot study, some borderline features seemed more responsive to this regimen than others. Among the most responsive features were feelings of chronic emptiness or boredom, discomfort in being alone, and impulsivity.
The Clinical and Electroencephalographic Spectrum of Tilt-Induced Syncope and "Near Syncope" in Youth.

Abstract Background The aim of the study was to characterize the clinical and electroencephalographic (EEG) patterns associated with tilt-induced reflex syncope and delayed orthostatic hypotension without syncope in youth. Methods We conducted a prospective observational study of 95 patients referred to a pediatric neurology clinic for head-upright tilt testing. Clinical signs, symptoms, video EEG, and continuous blood pressure and heart rate were monitored. Results Eighty patients had reflex syncope, and 15 had delayed-onset hypotension without syncope. The mean age was 15.3 (standard deviation ±2.3) years; 75 (78.9%) were female. All patients with hypotension only had corresponding signs and symptoms; 13 (86.7%) had corresponding EEG slowing. The duration of EEG slowing with hypotension far exceeded the presyncope interval from onset of slowing to loss of consciousness among patients with syncope ( P P P P P = 0.003), vocalizations ( P = 0.002), and arm flexion ( P P = 0.006) during tilt-induced syncope. Conclusions Among otherwise healthy youth, orthostatic signs and symptoms vary across the spectrum of tilt-induced reflex syncope and delayed hypotension without syncope. Delayed hypotension without syncope may represent the poorly defined phenomenon of "near syncope" in some patients.
Supercooling points of diapausing forest tent caterpillar (Lepidoptera: Lasiocampidae) eggs

Forest tent caterpillar (Malacosoma disstria Hubner; Lepidoptera: Lasiocampidae) is a widely distributed defoliator that undergoes intermittent outbreaks. It overwinters as pharate larvae within egg bands, is univoltine, and experiences low winter temperatures in its northern range. Little is known about how low temperatures affect winter survival and cold tolerances, their cold tolerance strategy, or how cold tolerances may vary over time and among populations. We evaluated supercooling points (SCPs) from four populations of M. disstria eggs collected along a 552 km latitudinal gradient from southern Wisconsin to northern Minnesota, United States of America. To test for potential effects of winter environment, we also administered three overwintering regimes (Madison, Wisconsin; Cloquet, Minnesota; Ely, Minnesota). Supercooling points were recorded in November, February, and March of 2011–2012. Supercooling points varied with maternal source (egg band), time of winter season, population source, and overwintering treatment. Means ranged from −26.8 °C (±0.5 °C) to −40.3 °C (±0.3 °C), accordingly. In a separate laboratory experiment, 89% of pharate larvae held at −20 °C (18.3 °C above coolest mean SCP) survived, but none held at −45 °C (6.7 °C below lowest mean SCP) survived. This relatively high degree of cold tolerance in its overwintering stage, due to freeze avoidance, may partially explain survival patterns and limits of overwintering M. disstria in northern populations.
Vibrational Spectroscopic Studies of Solid C60 Films

Experimental studies of the vibrational modes of pristine and photopolymerized solid C60 films are presented. A modest flux of visible or ultraviolet light is shown in the temperature range 250 > T > 373 K to transform C60 into a second solid phase which is identified with a polymeric form. A photochemical “2+2 cycloaddition” reaction mechanism is proposed to form the C60 polymer.
Thromboembolism-in-Transit and Patent Foramen Ovale: Should Screening Echocardiogram Be Routine for Thromboembolic Disease?

Background: Thromboembolism-in-transit straddling a patent foramen ovale (PFO) is a rare condition that requires urgent surgical intervention to prevent arterial emboli. Case Report: We present the case of a 42-year-old female who presented with a symptomatic pulmonary embolism. Echocardiography identified a PFO, with a bridging thrombus-in-transit and evidence of right ventricular strain. Urgent surgery was performed because of the risk of systemic embolism. A large thrombus was identified during biatrial exploration. Pulmonary embolectomy and primary PFO closure were performed. Conclusion: Because of the 20%-30% incidence of PFOs in the general population, we suggest that echocardiography should be considered for routine surveillance in thromboembolism because of the risk of systemic sequelae.
Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique

INTRODUCTION Greater occipital nerve blocks (GONB) have been used for headache but their benefit may be short. Ready et al performed intrathecal injections on rabbits and reported neurologic/histologic changes that required concentrations of at least 8%. Our study tests the hypothesis that the neurolytic effects of GONB with 10% lidocaine can prolong relief. METHODS After an approval from Henry Ford Hospital Institutional Review Board, a chart review was performed for patients who had GONB with 10% lidocaine. Patients received 10% lidocaine after short response ( 50% relief) to GONB with 1 cc of a solution containing 9 mL 0.5 % bupivacaine and 40 mg methylprednisolone. They received a block with 10% lidocaine with volume given at <80% of the maximum dose of 4 mg/kg. Injections were performed under fluoroscopic guidance after injection of 0.1 cc of contrast (isovue or magnevist). All patients had intravenous access and were given fentanyl and midazolam. The visual analog scale (VAS) scores were recorded on follow-up, and the duration of response was noted. VAS changes with 10% lidocaine and comparison of duration with methylprednisolone were performed using paired t-test. RESULTS Thirteen patients were reviewed; 12 were female and the mean age was 47. Ten were diagnosed with migraine, and three with occipital neuralgia; 12 had bilateral symptoms. Baseline VAS prior to 10% lidocaine averaged 86.92 mm. The mean volume injected per nerve was 1.096 mL. There was significant decrease in mean% VAS with 10% lidocaine at 60.4% (mean: -52.69 mm) (P=0.001). The mean duration of relief was significantly higher with 10% lidocaine at 148.05 days ([standard deviation]=98.87) versus methylprednisolone at 6.33 days (standard deviation=5.01) (P=0.001). No complications or side effects were reported. CONCLUSION Ten percent lidocaine may be a useful neurolytic agent in prolonging the duration of GONB.
Molecular Biology of Leukemias

Normal hematopoiesis is a meticulously controlled process of cell division and differentiation arising from hematopoietic stem cells with self-renewal capacity. This process is regulated through several signaling pathways that appear to be, to some degree, redundant. In many neoplastic processes, alteration of one or several signaling pathways has been observed, implicating these pathways in pathogenesis.
Is There the “Sweet Spot” for Age at Marriage and Positive Marital Outcomes?:

Using three nationally representative data sets, researchers analyzed the trends in age at marriage, marital stability, and marital satisfaction across the 20th century. Although there is a well-established link between age at marriage and marital stability, less is understood about the link between age at marriage and marital satisfaction. Previous work in this area suggested that it is the absolute age at first marriage that makes a difference. This study examined this hypothesis as well as a second hypothesis that cultural expectations about the “right” age to marry make a difference. Neither hypothesis was completely supported. Trends in normed marital satisfaction scores varied by birth cohort, years married, and age at marriage in nonlinear ways. Implications for relationship educators and practitioners are discussed.
A Practical Guide to the Control of Latex Particle Size and Its Distribution in Emulsion Polymerization

In emulsion polymerization primary latex particles are formed by (i) homogeneous nucleation of single growing oligomeric free radicals in solution (1), (ii) aggregative nucleation of several oligomeric radicals from solution (2) or, possibly, (iii) capture of oligomeric free radicals from solution by monomer-swollen surfactant micelles when these are present (3). The primary particles are very small, on the order of 1 to 2nm in diameter for those formed by homogeneous nucleation (4) and somewhat larger for those formed in micelles. The free radicals are being generated continuously in solution* at a rate R.. A certain fraction, (1-b), of these radicals will mutally terminate prior to reaching the critical chain length, jcrit, required for nucleation (5). In case(i) above this means that the fraction b of all radicals formed will self-nucleate to form primary particles. In case (ii), aggregative nucleation, b represents the reciprocal of the aggregation number, i.e. b = 1/(no. oligoradicals per nucleus). In micellar nucleation, b is the fraction of oligoradicals successfully captured to form primary particles. Then at the very beginning of the latex polymerization the rate of appearance of primary particles is equal to the product of the fraction b and the rate of initiation: (1)
Still Unfair to the Working Class: Health Care under the Affordable Care Act

The Affordable Care Act appears likely to worsen rather than cure the significant (but generally unrecognized) unfairnesses to middle- and lower-income working people that have long characterized private health care financing in the U.S. For example, the law’s mandate that individuals purchase “essential health benefits” requires them to pay for marginal benefits that many consumers with other needs might rationally reject. Also, the new law’s various elements of social insurance are to be financed, not from public funds, but by higher premiums paid by all insureds, like a regressive “head tax.” Lower-income insureds may also be shortchanged on the receiving end, getting less out of their insurance plans than better-off insureds while bearing the same premium cost. Finally, health insurance will still enable the many health care providers with monopoly power in specific submarkets to earn far more than just ordinary monopoly profits, all at the expense of insured consumers, whose exploitable number the new legislation will substantially increase. Nothing in the Affordable Care Act seems capable of offsetting not only the major unfairnesses and regressive redistributions of wealth already inherent in U.S. health care but also the new burdens the Act will impose on the working class.
How important is the CO 2 chemoreflex for the control of breathing? Environmental and evolutionary considerations.

Haldane and Priestley (1905) discovered that the ventilatory control system is highly sensitive to CO2. This "CO2 chemoreflex" has been interpreted to dominate control of resting arterial PCO2/pH (PaCO2/pHa) by monitoring PaCO2/pHa and altering ventilation through negative feedback. However, PaCO2/pHa varies little in mammals as ventilation tightly couples to metabolic demands, which may minimize chemoreflex control of PaCO2. The purpose of this synthesis is to (1) interpret data from experimental models with meager CO2 chemoreflexes to infer their role in ventilatory control of steady-state PaCO2, and (2) identify physiological causes of respiratory acidosis occurring normally across vertebrate classes. Interestingly, multiple rodent and amphibian models with minimal/absent CO2 chemoreflexes exhibit normal ventilation, gas exchange, and PaCO2/pHa. The chemoreflex, therefore, plays at most a minor role in ventilatory control at rest; however, the chemoreflex may be critical for recovering PaCO2 following acute respiratory acidosis induced by breath-holding and activity in many ectothermic vertebrates. An apparently small role for CO2 feedback in the genesis of normal breathing contradicts the prevailing view that central CO2/pH chemoreceptors increased in importance throughout vertebrate evolution. Since the CO2 chemoreflex contributes minimally to resting ventilation, these CO2 chemoreceptors may have instead decreased importance throughout tetrapod evolution, particularly with the onset and refinement of neural innovations that improved the matching of ventilation to tissue metabolic demands. This distinct and elusive "metabolic ventilatory drive" likely underlies steady-state PaCO2 in air-breathers. Uncovering the mechanisms and evolution of the metabolic ventilatory drive presents a challenge to clinically-oriented and comparative respiratory physiologists alike.
Analysis on the Heisenberg Group

Here we build on the material in Chapter 3 to prove some fairly profound results about the boundedness of the Szegő integral operator on the boundary of the unit ball. All the key ideas about singular integrals, homogeneous dimension, the Calderon-Zygmund theory, and interpolation of operators come into play.
Support vector regression methodology for estimating global solar radiation in Algeria

Accurate estimation of Daily Global Solar Radiation (DGSR) has been a major goal for solar energy applications. In this paper we show the possibility of developing a simple model based on the Support Vector Regression (SVM-R), which could be used to estimate DGSR on the horizontal surface in Algeria based only on sunshine ratio as input. The SVM model has been developed and tested using a data set recorded over three years (2005-2007). The data was collected at the Applied Research Unit for Renewable Energies (URAER) in Ghardaia city. The data collected between 2005-2006 are used to train the model while the 2007 data are used to test the performance of the selected model. The measured and the estimated values of DGSR were compared during the testing phase statistically using the Root Mean Square Error (RMSE), Relative Square Error (rRMSE), and correlation coefficient ( $r^{2}$ ), which amount to 1.59(MJ/m2), 8.46 and 97,4%, respectively. The obtained results show that the SVM-R is highly qualified for DGSR estimation using only sunshine ratio.
Replicon Particle Administration Prior to Challenge Reduces PRRSV Viremia

Vaccination of swine with an alphavirus-derived replicon particle vaccine stimulates a non-specific immune response. This effect was seen when animals were challenged with PRRSV at 24 hours post-vaccination. Animals that received vaccine had reduced viremia as measured by quantitative RT-PCR when compared to placebo. These results highlight the potential of replicon particle vaccines to induce robust immune responses in swine.
CRUDE OIL/BRINE INTERFACIAL TENSIONS

Interfacial tension (IFT) between crude oil and brine is an important variable in water/oil and water/oil/gas displacements. IFT influences capillary pressure, capillary number, adhesion tension, and the dimensionless time for imbibition. Despite its importance, there is little data available and even less data that can be related to key crude oil chemical properties such as acid and base number. In this paper we present the results of a study of interfacial tensions for 41 wellcharacterized stock-tank crude oil samples. Transient IFTs measured by the pendant drop technique were monitored as a function of time. The effects of salinity and pH (over the range from 3 to 10) have been investigated and correlations observed between IFT and an oil’s acid number, base number, and amount of asphaltenes. This extensive data set will be of use to core analysts when they compare capillary pressures measured with different fluid pairs or design core floods with model fluids, and in many other applications. It can also be used to examine mechanistic explanations for the magnitude of IFT between a crude oil and brine.
Critical thinking, critical practice

Nursing leaders in critical care can use strategies such as questioning, clinical scenarios, conferences, and context-dependent test items to assess and improve their staff's critical thinking skills.
Families and Crime

This volume highlights the theoretical and empirical connections between family sociology and criminology. We review the historical interconnections between these two fields. We argue for greater i...
‘Small cell’ simulations: physiological features of a phase difference detector

The ‘small cell’ is a descriptive designation given an identified cell type in lamina 6 of the torus semicircularis of the weakly electric fish Eigenmannia that behaves as a coincidence detector similar to the cells of nucleus laminaris of the owl. A compartmental model of the small cell with Hodgkin-Huxley channel kinetics was used to explore the origin of the cell’s temporal disparity sensitivity. This model was compared with a system level model of the time disparity detecting cell of the nucleus laminaris. The small cell has no identified inhibitory synaptic input yet will fire in response to a single input and cease firing when a second one is added at certain phase differences, a functional inhibitory effect. Simulations showed that such an effect could occur due to the internal inhibition provided by voltage-sensitive potassium channels. An initial subthreshold excitatory posts ynaptic potential (EPSP) can thereby increase the threshold for a subsequent EPSP. In contrast to the n. laminaris model, this model shows a abrupt changes in rate at certain time disparities. This characteristic is not seen in the real cell and detracts from the cell’s ability to code arbitrary disparities. Obtaining a small cell response that varies smoothly with input will require either adding noise or adding more complex dynamics to the model. These alternatives could be assessed physiologically with current-clamp.
Exploring the Potential of RET Kinase Inhibition for Irritable Bowel Syndrome: A Preclinical Investigation in Rodent Models of Colonic Hypersensitivity

Abdominal pain represents a significant complaint in patients with irritable bowel syndrome (IBS). While the etiology of IBS is incompletely understood, prior exposure to gastrointestinal inflammation or psychologic stress is frequently associated with the development of symptoms. Inflammation or stress-induced expression of growth factors or cytokines may contribute to the pathophysiology of IBS. Here, we aimed to investigate the therapeutic potential of inhibiting the receptor of glial cell line-derived neurotrophic factor, rearranged during transfection (RET), in experimental models of inflammation and stress-induced visceral hypersensitivity resembling IBS sequelae. In RET-cyan fluorescent protein [(CFP) RetCFP/+] mice, thoracic and lumbosacral dorsal root ganglia were shown to express RET, which colocalized with calcitonin gene-related peptide. To understand the role of RET in visceral nociception, we employed GSK3179106 as a potent, selective, and gut-restricted RET kinase inhibitor. Colonic hyperalgesia, quantified as exaggerated visceromotor response to graded pressures (0-60 mm Hg) of isobaric colorectal distension (CRD), was produced in multiple rat models induced 1) by colonic irritation, 2) following acute colonic inflammation, 3) by adulthood stress, and 4) by early life stress. In all the rat models, RET inhibition with GSK3179106 attenuated the number of abdominal contractions induced by CRD. Our findings identify a role for RET in visceral nociception. Inhibition of RET kinase with a potent, selective, and gut-restricted small molecule may represent a novel therapeutic strategy for the treatment of IBS through the attenuation of post-inflammatory and stress-induced visceral hypersensitivity.
Comparison of photovoltaic module luminescence imaging techniques: Assessing the influence of lateral currents in high-efficiency device structures

Abstract We investigate the implications of using partial or patterned illumination for luminescence imaging of photovoltaic modules. Partial illumination induces local photovoltage variations that drive lateral current flow into non-illuminated cell regions, causing the average injection level to vary over the course of luminescence measurement. The extent of lateral current depends on material properties and is especially significant for high-efficiency devices such as the silicon heterojunction with intrinsic thin layer (HIT) modules that we investigate. We compare four module imaging methods including large-area illumination, scanning-laser illumination, contactless electroluminescence, and pattern-illuminated photoluminescence. By evaluating the statistical correlation among the different methods under varying laser fluences, we conclude that most methods converge to similar results at matched photon dose per cell (not laser power density) for the modules that we study, while pattern-illuminated photoluminescence yields distinct images from the other techniques regardless of the illumination power. Our combined analysis using multiple luminescence imaging techniques gives specific insight into the causes of HIT module degradation, including suspected degradation of the transparent conductive oxide and passivation layer.
Increased Phenolic Compounds in Potato Chips Vacuum Impregnated with Green Tea.

This studied tested the feasibility of producing vacuum fried potato chips enriched with antioxidants by introducing green tea extract using vacuum impregnation (VI) technology. Total phenolic content (TPC) was used to find the optimal VI parameters. Sliced potatoes were fried under vacuum at 110, 120, or 140 °C from 20 to 720 s to test the thermal degradability of the TPC. Three frying systems were also compared: vacuum frying (VF), dual-step (DS) frying, and atmospheric frying (AF). Green tea concentration of 5%, vacuum time of 10 min, and a pressure of 80 kPa gave the maximum TPC of 196.11 ± 15.41 mg GAE/100 g of dry matter. Samples fried at 120 °C showed an overall greater phenolic retention capacity compared to the chips fried at 140 and 110 °C. Using the optimal VI and VF parameters (140 °C, 100 s), the three frying systems were then compared. Samples fried using the AF system contained twice as much the oil content as those fried using the VF or DS systems. VF chips had the highest percentage in TPC increase (209%) while AF chips had the lowest (163%). A consumer panel found the samples fried under AF more acceptable and were given the highest scores for all quality. VI had a negative effect on the color scoring of the participants (they were dark). Overall, VI is a suitable precursor of VF to create potato chips with a high phenolic content. PRACTICAL APPLICATION: Vacuum impregnated potato chips with green tea extract have potential for manufacture of functional snacks that may influence the public into consuming phenol-rich fruit and vegetable snack.; © 2019 Institute of Food Technologists®.
Multi-covariate Imaging of Sub-resolution Targets

Conventional B-mode ultrasound imaging assumes that targets consist of collections of point scatterers. Diffraction, however, presents a fundamental limit on a scanner’s ability to resolve individual scatterers in most clinical imaging environments. Well-known optics and ultrasound literature has characterized these diffuse scattering targets as spatially incoherent and statistically stationary. In this paper, we apply a piecewise-stationary statistical model to diffuse scattering targets, in which the covariance of backscattered echoes can be described as the linear superposition of constituent components corresponding to echoes from distinct spatial regions in the field. Using this framework, we present Multi-covariate Imaging of Sub-resolution Targets (MIST), a novel estimation-based method to image the statistical properties of diffuse scattering targets, based on a decomposition of aperture domain spatial covariance. The mathematical foundations of the estimator are analytically derived, and MIST is evaluated in phantom, simulation, and in vivo studies, demonstrating consistent improvements in contrast-to-noise ratio and speckle statistics across imaging targets, without an apparent loss in resolution.
Analysis on GENIE reveals novel recurrent variants that affect molecular diagnosis of sizable number of cancer patients.

Significant numbers of variants detected in cancer patients are often left labeled only as variants of unknown significance (VUS). In order to expand precision medicine to a wider population, we need to extend our knowledge of pathogenicity and drug response in the context of VUS’s. In this study, we analyzed variants from AACR Project GENIE Consortium APG (Cancer Discov 7:818-831, 2017) and compared them to the COSMIC database Forbes et al. (Nucleic Acids Res 43:D805-811, 2015) to identify recurrent variants that would merit further study. We filtered out known hotspot variants, inactivating variants in tumor suppressors, and likely benign variants by comparing with COSMIC and ExAC Lee et al. (Science 337:967-971, 2012). We have identified 45,933 novel variants with unknown significance unique to GENIE. In our analysis, we found on average six variants per patient where two could be considered as pathogenic or likely pathogenic and the majority are VUS’s. More importantly, we have discovered 730 recurrent variants that appear more than 3 times in GENIE but less than 3 in COSMIC. If we combine the recurrences of GENIE and COSMIC for all variants, 2586 are newly identified as occurring more than 3 times than when using COSMIC alone. Although it would be inappropriate to blindly accept these recurrent variants as pathogenic, they may warrant higher priority than other observed VUS’s. These newly identified recurrent variants might affect the molecular profiles of approximately 1 in 6 patients. Further analysis and characterization of these variants in both research and clinical contexts will improve patient treatments and the development of new therapeutics.
Delayed Gastric Emptying (DGE) Following Total Pancreatectomy with Islet Auto Transplantation in Patients with Chronic Pancreatitis.

The prevalence and factors associated with delayed gastric emptying (DGE) in patients undergoing total pancreatectomy with islet auto transplantation (TP-IAT) for chronic pancreatitis are unknown. A retrospective study of all patients who underwent TP-IAT at Johns Hopkins Hospital (JHH) from August 2011 to November 2014 was performed. The International Study Group of Pancreatic Surgery (ISGPS) clinical grading of DGE was used in this study. A total of 39 patients with chronic pancreatitis underwent TP-IAT during the study period. The prevalence of DGE following TP-IAT was 35.9 %. Twenty-five patients (64.1 %) had no DGE, 10 (25.6 %) had grade A, 2 (5.1 %) had grade B, and 2 patients (5.1 %) had grade C DGE. Patients with DGE had 5.7-fold higher odds of having a hospital length of stay (LOS) greater than 14 days (OR 5.70, 95 % CI 1.37–23.76, p = 0.02). Patients undergoing laparoscopic TP-IAT had significantly shorter LOS (10.5 vs. 14 days, p = 0.02) and lower need for prokinetics (0.01) during the postoperative course. DGE is common after TP-IAT and can prolong LOS. Laparoscopic TP-IAT lowers LOS and need for prokinetics postoperatively. Further studies are needed to determine if laparoscopic approaches will improve long-term dysmotility.
Apparel and Textile Design Scholarship: Shared Knowledge, Dissemination, and Evaluation:

Apparel and textile (AT) design scholarship can be classified in diverse ways. As a professional organization, International Textile and Apparel Association is in a unique position to lead in ident...
The Microdemographic Community-Study Approach: Improving Survey Data by Integrating the Ethnographic Method

Survey methods have been criticized for producing unreliable, invalid data and for failing to provide contextual information to test complex causal hypotheses. We discuss a technique that combines ...
Burnout and Association With Resident Performance as Assessed by Pediatric Milestones: An Exploratory Study.

Abstract Introduction Prior work demonstrating that burnout is associated with decreased performance in medical trainees has relied on self-report and/or single site studies. We explored the relationship between burnout status and Milestones-based scores in pediatric residents nationally. Methods In April-June 2016 we confidentially surveyed residents using the Maslach Burnout Inventory (MBI). Separately, programs submitted resident Milestones scores in June 2016. We examined the relationship between burnout and performance as assessed by Milestones scores for each domain of competence. We performed multivariate analysis to determine which components of burnout (depersonalization (DP), emotional exhaustion (EE), lack of personal accomplishment (PA)) were most impactful. Results 1494/2368 (63%) residents at 32 programs completed the MBI and had Milestones scores submitted. Residents who scored positive for burnout scored lower in all Milestones domains. Sub-group analysis demonstrated that this association was only significant (p Conclusion Burnout is associated with decreased Milestones performance for pediatric PGY1 residents. DP and low PA were associated with lower PC scores in PGY1 residents. Future research should address whether strategies to mitigate burnout improve PGY1 performance.
Ideal Extensions and Directly Infinite Matrix Algebras

A method for constructing and analyzing matrix embeddings of algebras $E$ with an ideal isomorphic to $M_\infty(K)$, the infinite matrix algebra with only finitely many nonzero elements, is introduced. This method utilizes the fact that one can express such algebras as an extension of some algebra $A$ by $M_\infty(K)$. Two equivalence relations are then introduced to classify these extensions. The latter equivalence relation will then be used to classify matrix embeddings of the Toeplitz-Jacobson algebra. Finally, with the help of a function which serves as a measure of how far from invertible a matrix is, an infinite family of algebras $\mathcal T_i$ will be constructed such that $M_\infty(K)$ is an ideal of $\mathcal T_i$ and $\mathcal T_i/M_\infty(K) \simeq K[x,x^{-1}]$.
Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome among never cigarette smokers.

Introduction Although smoking is a strong risk factor for lung diseases including asthma, COPD, and asthma-COPD overlap syndrome (ACOS), studies are needed to examine the association between e-cigarettes and asthma, COPD, and ACOS. This study evaluated the association between e-cigarette use and self-reported diagnosis of asthma, COPD, and ACOS using a large nationally representative sample of adults aged ≥18 years in the United States. Methods Cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2016 to 2018 was used to examine self-reported information on current e-cigarette use, demographic variables, and asthma and COPD status among never cigarette smokers (n=8736). Asthma and COPD were measured by self-reported diagnosis, and respondents who reported having both diagnoses were then classified as having ACOS. Of the 46079 never cigarette smokers, 4368 non-e-cigarette smokers were 1:1 propensity score-matched to e-cigarette smokers on age, sex, race/ethnicity and education level. We used multinomial logistic regression to examine association between current e-cigarette use and self-report asthma, COPD, and ACOS while controlling for marital status and employment in addition to matching variables. Results Compared with never e-cigarette smokers, e-cigarette smokers had increased odds of self-reported ACOS (OR=2.27; 95% CI: 2.23-2.31), asthma (OR=1.26; 95% CI: 1.25-1.27) and COPD (OR=1.44; 95% CI: 1.42-1.46). Conclusions Data from this large nationally representative sample suggest that e-cigarette use is associated with increased odds of self-reported asthma, COPD, and ACOS among never combustible cigarette smokers. The odds of ACOS were twice as high among e-cigarette users compared with never smokers of conventional cigarettes. The findings from this study suggest the need to further investigate the long-term and short-term health effects of e-cigarette use, since the age of those at risk in our study was 18-24 years.
Cardiovascular exercise as a treatment of postural orthostatic tachycardia syndrome: A pragmatic treatment trial.

Background Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of orthostatic intolerance with few proven treatments. Objective The purpose of this study was to determine the efficacy of an unsupervised at-home training regimen for the treatment of POTS. Methods We reviewed the medical records including autonomic function testing, symptom scores, and activities of daily living in individuals with POTS who were invited to participate in a 6-month outpatient cardiovascular exercise program. Results Seventy-seven individuals were invited (invited group), 48 of 77 (62%) participated (treated group) and 43 of 77 (56%) of those completed. Twenty-nine of 77 (38%) did not participate (control group). After 6 months, 11 of 48 (23%) individuals in the treated group met heart rate criteria for POTS compared with 27 of 29 (93%) in the control group (χ2 test, P Conclusion In this study, we report a successful pragmatic clinical trial of an outpatient exercise protocol in a tertiary care referral population that significantly improved cardiovascular function and quality of life in patients with POTS.
Factors mediating pain-related risk for opioid use disorder.

Abstract Pain is a complex experience with far-reaching organismal influences ranging from biological factors to those that are psychological and social. Such influences can serve as pain-related risk factors that represent susceptibilities to opioid use disorder. This review evaluates various pain-related risk factors to form a consensus on those that facilitate opioid abuse. Epidemiological findings represent a high degree of co-occurrence between chronic pain and opioid use disorder that is, in part, driven by an increase in the availability of opioid analgesics and the diversion of their use in a non-medical context. Brain imaging studies in individuals with chronic pain that use/abuse opioids suggest abuse-related mechanisms that are rooted within mesocorticolimbic processing. Preclinical studies suggest that pain states have a limited impact on increasing the rewarding effects of opioids. Indeed, many findings indicate a reduction in the rewarding and reinforcing effects of opioids during pain states. An increase in opioid use may be facilitated by an increase in the availability of opioids and a decrease in access to non-opioid reinforcers that require mobility or social interaction. Moreover, chronic pain and substance abuse conditions are known to impair cognitive function, resulting in deficits in attention and decision making that may promote opioid abuse. A better understanding of pain-related risk factors can improve our knowledge in the development of OUD in persons with pain conditions and can help identify appropriate treatment strategies. This article is part of the special issue on ‘Vulnerabilities to Substance Abuse.’.
Realistic PointGoal Navigation via Auxiliary Losses and Information Bottleneck.

We propose a novel architecture and training paradigm for training realistic PointGoal Navigation -- navigating to a target coordinate in an unseen environment under actuation and sensor noise without access to ground-truth localization. Specifically, we find that the primary challenge under this setting is learning localization -- when stripped of idealized localization, agents fail to stop precisely at the goal despite reliably making progress towards it. To address this we introduce a set of auxiliary losses to help the agent learn localization. Further, we explore the idea of treating the precise location of the agent as privileged information -- it is unavailable during test time, however, it is available during training time in simulation. We grant the agent restricted access to ground-truth localization readings during training via an information bottleneck. Under this setting, the agent incurs a penalty for using this privileged information, encouraging the agent to only leverage this information when it is crucial to learning. This enables the agent to first learn navigation and then learn localization instead of conflating these two objectives in training. We evaluate our proposed method both in a semi-idealized (noiseless simulation without Compass+GPS) and realistic (addition of noisy simulation) settings. Specifically, our method outperforms existing baselines on the semi-idealized setting by 18\%/21\% SPL/Success and by 15\%/20\% SPL in the realistic setting. Our improved Success and SPL metrics indicate our agent's improved ability to accurately self-localize while maintaining a strong navigation policy. Our implementation can be found at this https URL.
All Politics Are Local: A Single Institution Investigation of the Educational Impact of Residents and Fellows Working Together.

BACKGROUND Most general surgery residents pursue fellowship; there is limited understanding of the impact residents and fellows have on each other's education. The goal of this exploratory survey was to identify these impacts. MATERIALS AND METHODS Surgical residents and fellows at a single academic institution were surveyed regarding areas (OR assignments, the educational focus of the team, roles and responsibilities on the team, interpersonal communication, call, "other") hypothesized to be impacted by other learners. Impact was defined as "something that persistently affects the clinical learning environment and a trainee's education or ability to perform their job". Narrative responses were reviewed until dominant themes were identified. RESULTS Twenty-three residents (23/45, 51%) and 12 fellows (12/21, 57%) responded. Responses were well distributed among resident year (PGY-1:17% [4/23], PGY-2, 35% [8/23], PGY-3 26% [6/23], PGY-4 9% [2/23%], PGY-5 13% [3/23]). Most residents reported OR assignment (14/23, 61%) as the area of primary impact, fellows broadly reported organizational categories (Roles and responsibilities 33%, educational focus 16%, interpersonal communication 16%). Senior residents reported missing out on operations to fellows while junior residents reported positive impacts of operating directly with fellows. Residents of all levels reported that fellows positively contributed to their education. Fellows, senior residents, and junior residents reported positive experiences when residents and fellows operated together as primary surgeon and assistant. CONCLUSIONS Residents and fellows impact one another's education both positively and negatively. Case allocation concerns senior residents, operating together may alleviate this, providing a positive experience for all trainees. Defining a unique educational role for fellows and delineating team expectations may maximize the positive impacts in this relationship.
Diuretics for the Treatment of Hypertension

Diuretics are agents commonly used in diseases characterized by excess extracellular fluid, including chronic kidney disease, nephrotic syndrome, cirrhosis, and heart failure. Diuretics are also commonly used either as monotherapy or in combination with other antihypertensive agents in the management of hypertension. Multiple diuretic classes, including thiazide-type diuretics, loop diuretics, and potassium-sparing diuretics, are used to treat patients with these diseases. An understanding of what determines a patient’s response to a diuretic is a prerequisite to the correct use of these drugs. The response of patients with these diseases to diuretics, which is related to the dose, is best described by a sigmoid curve whose contour can become distorted by any of the several sodium-retaining states that are directly or indirectly associated with renal disease. The pharmacodynamic effect of diuretics as used in the treatment of hypertension involves both a volume removal element and more long-term vasodilation. Diuretic actions are of considerable importance to patients who have renal disease, as their effective use assists in extracellular fluid volume control, reducing excretion of protein in urine and lessening the risk of developing hyperkalemia. Diuretic-related adverse events that involve the uric acid, sodium, and potassium axes are not uncommon; therefore, the clinician must be vigilant in looking for biochemical disturbances. As a result of diuretic-related adverse events, clinicians must be resourceful in the dose amount and frequency of dosing.
Puerto Rican Elders and Merchant Establishments: Natural Caregiving Systems or Simply Businesses?

Abstract Puerto Rican merchant establishments cover a wide range of types; these institutions historically have played important and varied natural support roles within the community. However, the professional human service literature has generally focused on grocery stores and religious institutions, ignoring most other types. This article will focus on commercial establishments not generally addressed in the literature (clothing, gift, and furniture stores, beauty parlors, botanical shops, radio stations) and draw implications for social service delivery to elders. Data were obtained through an asset assessment of a Puerto Rican community in a New England city (Holyoke, Massachusetts).
Endothelin-3 regulation of retinal hemodynamics in nondiabetic and diabetic rats.

PURPOSE To investigate the mechanisms of action of endothelin (ET)-3 on the regulation of retinal hemodynamics in diabetic and nondiabetic rats. METHODS Retinal blood flow changes were measured using video fluorescein angiography. Measurements were made before and after intravitreal injections of different ET-3 concentrations in nondiabetic rats and rats with streptozotocin (STZ)-induced diabetes. The effect of ET-3 on retinal blood flow was also investigated in nondiabetic rats after pretreatment with N:(G)-monomethyl-L-arginine (L-NMMA), a nitric oxide synthase (NOS) inhibitor; BQ-788, an ET receptor B (ETB) antagonist; and BQ-123, an ET receptor A (ETA) antagonist. Control animals were injected intravitreally with vehicle alone. RESULTS In nondiabetic rats, ET-3 induced a dose-dependent rapid increase in retinal blood flow 2 minutes after intravitreal injection (maximal at 10(-)(8) M, P < 0. 01) followed 15 and 30 minutes after ET-3 injection by dose-dependent decreases in retinal blood flow (maximal effect at 10(-)(6) M, P < 0.05). The ET-3-stimulated retinal blood flow increase was inhibited by 10(-)(4) M BQ-788 (P < 0.01) and 10(-)(3) M L-NMMA (P < 0.05). The ET-3-stimulated decrease in retinal blood flow at later times (15 minutes) was inhibited (P < 0.03) by 10(-4) M BQ-123. In diabetic rats, baseline retinal blood flows were decreased compared with nondiabetic rats (P < 0.01), showed dose-dependent increases 2 minutes after ET-3 injection (P < 0.03), and at later times remained significantly increased (P < 0.05) in contrast to flows in nondiabetic rats. CONCLUSIONS The ET-3-induced initial rapid retinal blood flow increase in nondiabetic rats is mediated by the ET-3/ETB and NOS action. The subsequent retinal blood flow decrease is mediated by ET-3/ETA action. Diabetic rats showed comparable ET-3-induced retinal blood flow increases indicating normal ET-3/ETB action. However, at later times, retinal blood flow remained increased, suggesting an abnormal ET-3/ETA action.
248 EMBRYO DEVELOPMENT IN MICRODROPS AND MICROCHANNELS: COMPARISON OF NCSU23 SEQUENTIAL AND NON-SEQUENTIAL CULTURE MEDIUM

The in vitro culture systems used to produce pig embryos generally result in few embryos developing to the blastocyst stage. The use of pyruvate (pyr) and lactate (lac) during the culture of zygotes to the 8-cell stage followed by glucose (glu) supplementation replacing pyr and lac appears to be beneficial for embryo development in the pig. The aim of this study was to compare the embryo development rates from pig oocytes fertilized with and without cumulus cells in 100-μL microdrops (MD) and cultured in 100-μL MD or microchannels (MC), using NCSU23 containing 8 mg/mL of BSA and supplemented with (1) glu or (2) pyr/lac or (3) pyr/lac for the first three days and then with just glu for the remainder of culture period (pyr/lac-glu). Sow oocytes were matured in TCM199 supplemented with gonadotropins for the first 22 h, and for an additional 22 h without hormones. After 44 h of maturation, oocytes were placed in MD of modified tris-buffered medium to be fertilized using 3 × 105 sperm/mL. Oocytes were divided into two groups for fertilization: with and without cumulus cells. Following 6 h of fertilization, all inseminated oocytes were washed, divided into groups of 15, allotted to the three culture media treatment groups as described above, and incubated in either MD or MC. With the exception of one treatment there were no significant differences in development rates among embryos cultured in MD or MC, hence data were pooled from these two culture devices. Only oocytes fertilized without cumulus cells and cultured in pyr/lac in MC appeared to have lower rates of blastocyst formation (11.67%) than those cultured in MD (26.67%) in the same culture medium. When the six treatments were compared, oocytes fertilized with cumulus cells and cultured in glu had significantly higher (P < 0.05) blastocyst rates and hatching rates compared with the other treatments, with the exception of those fertilized without cumulus cells and cultured in pyr/lac-glu. There were no significant differences among other treatments in Day 7 blastocyst or in Day 9 hatching rates. In conclusion, both culture devices can be used to reach similar blastocyst rates with different treatments. In this experiment, the removal of cumulus cells before fertilization appeared to enhance embryo development in vitro when sequential media are used. On the other hand, the presence of cumulus cells before fertilization seems to enhance embryo development when non-sequential glu medium is used. Table 1. Embryo development rates on Day 9 for three different culture treatments
Knowledge Sharing and Knowledge Management System Avoidance: The Role of Knowledge Type and the Social Network in Bypassing an Organizational Knowledge Management System

Knowledge sharing is a difficult task for most organizations, and there are many reasons for this. In this article, we propose that the nature of the knowledge shared and an individual's social network influence employees to find more value in person-to-person knowledge sharing, which could lead them to bypass the codified knowledge provided by a knowledge management system (KMS). We surveyed employees of a workman's compensation board in Canada and used social network analysis and hierarchical linear modeling to analyze the data. The results show that knowledge complexity and knowledge teachability increased the likelihood of finding value in person-to-person knowledge transfer, but knowledge observability did not. Contrary to expectations, whether the knowledge was available in the KMS had no impact on the value of person-to-person knowledge transfer. In terms of the social network, individuals with larger networks tended to perceive more value in the person-to-person transfer of knowledge than those with smaller networks.