cssi/SciSciGPT-SciSciNet huggingface dataset:
Studies of Patients with Osteogenesis Imperfecta

Twenty children and five adults with osteogenesis imperfecta were studied for one year or more, and thirteen of the patients were treated with sodium fluoride (0.25 to 0.90 milligrams fluoride per kilogram of body weight per day). No significant abnormality of calcium, phosphorus, nitrogen, magnesium, or potassium balance, serum chemistries, urinary amino acid excretion, or calcium dynamics was detected before treatment, nor were changes seen during treatment. The over-all results do not warrant the general use of fluoride for the treatment of osteogenesis imperfecta but do warrant further study, especially of the dose-related effect.
Fatal Bipolaris spicifera infection in an immunosuppressed child.

A 20-month-old boy with a history of hypoplastic left heart syndrome and a heart transplant was transferred to our institution due to cardiorespiratory failure. His course had been complicated by chronic rejection requiring significant immunosuppression. Over the few weeks prior to transfer, he started developing dark macular skin lesions on the forehead, toes and fingers. The lesions rapidly progressed to necrotic ulcers within approximately 1 month of their onset (figure 1A,B). Figure 1 Purple/black lesion on the medial aspect of the right foot (A) and advanced necrotic ulcer …
A Gain-boost Cascode Transconductance Amplifier with Improved Structure

In this paper,a full differential transconductance amplifier suitable for pipelined ADC is presented.The gain-boost method of the single-ended gain-boost amplifier makes the operation amplifier have a high DC gain,smaller area and better territory match in layout.By using improved CMFB circuit,the settling time and jitter of output common-mode voltage are decreased.The whole circuit was simulated with SMIC 0.18 μm CMOS technology.The result shows that DC-gain is 119.3 dB,GBW is 378.1 MHz and the phase margin is 60°.
Allergies in children.

Two patients are described who present typical histories and physical findings of allergic sensitization. The significance of the symptomatology and correlated laboratory findings are discussed. Of the greater importance is a discussion regarding the adequate handling of the severe episodes and the necessity of carrying therapeutic and prophylactic programs to the home. Inspection of the home environment and interpretation of the program in that environment are most essential for good results.
Convolutional neural network pre-trained with projection matrices on linear discriminant analysis

Recently, the hybrid architecture of a neural network (NN) and a hidden Markov model (HMM) has shown significant improvement on automatic speech recognition (ASR) over the conventional Gaussian mixture model (GMM)-based system. The convolutional neural network (CNN), a successful NN-based system, can represent local spectral variations spanning the time-frequency space. Meanwhile, spectro-temporal features have been widely studied to make ASR more robust. Typically, the spectro-temporal features are extracted from acoustic spectral patterns using a 2D filtering process. Convolutional layers in CNN that have various local windows can also be regarded as an efficient feature extractor to capture 2D spectral variations. In a standard procedure, the local windows in CNN are initialized randomly before the pre-training and are iteratively updated with a back propagation algorithm in the pre-training and fine-tuning steps. In this paper, we explore using projection matrices composed of eigenvectors estimated by linear discriminant analysis (LDA) objective function as initial weights for the first convolutional layer in CNN. From analysis of the local windows trained by the proposed method, we can see the eigenvectors of LDA has desirable properties as initial weights of CNN. The proposed method yielded a 8.1% relative improvement compared to CNN with local weights initialized randomly.
Asthma self-management programs can reduce the need for hospital-based asthma care.

UNLABELLED Mortality from asthma and its complications is increasing as is the expense associated with treating this disease. We hypothesized that an asthma-education program, already in place, had reduced hospitalizations (HOS) and emergency-department (ED) visits for asthmatic patients who participated. METHODS We compared asthmatic patients' ED visits and HOS for the 12-month periods immediately before and after treatment in our center. METHODS All patients received physician-directed medical management based upon the National Asthma Education Panel recommendations. One group (PART, n = 13) received instruction in self-management using the peak-flow meter (PFM) and an action plan (AP) to adjust medication dosages in response to changing post-bronchodilator peak-flow meter readings. Average cost for this intervention was $820 (2 visits, each with 60-90 minutes of instruction). The other group (FULL, n = 13), in addition to receiving a PFM and AP, completed a multidisciplinary education program stressing trigger identification and avoidance, environmental control, proactive adjustment of anti-inflammatory agents, and stress management. Average cost for this intervention was $1,700 (multidisciplinary evaluations and 12 hours of instruction). Those who did not enter the education program did so by choice or circumstance (ie, transportation problems, inability to commit the required time for the program, insurance denial). RESULTS Of the 13 PART-group subjects, 8 experienced all 31 ED and/or HOS in the year prior to our program. Four of 13 accounted for the 15 ED and/or HOS after discharge from the program (50% improvement, p < 0.05). Of the 14 patients in the FULL group, 7 accounted for 25 ED and/or HOS prior to the program. There were no ED and/or HOS after the program (100% improvement, p < 0.05). CONCLUSION Based on this sample, it is evident that both PART and FULL programs can significantly impact the frequency with which hospital-based asthma care is required and thus reduce the overall cost of caring for patients with asthma.
The Familial Living Donor in Renal Transplantation

AbstractA survey is made of the 20-year experience with more than 300 living donors in renal transplantation at the Peter Bent Brigham Hospital. Details are given pertaining to the first transplantation of the kidney from one living person to another in December 1954. The surgical technique, the complications and the results of renal transplantation from a living donor are summarized. The philosophic and psychologic problems encountered are described. A comparison of results summarized by Murray of living, related donor transplants to cadaveric donor transplants is included. This paper constitutes a salute to the familial living donor.
Early Modern China and Northeast Asia: Kinship and succession in China, Japan, and Korea

The last chapter examined how northeast conquest regimes and nearby states shaped a ritual vocabulary imported from the Central Plain to meet their specific situations. By exploring issues surrounding the legitimacy of royal succession that arose when newly emergent states in Korea and Japan adopted Chinese-style legal codes, this chapter aims to provide a fresh perspective on the idiosyncrasies of Chinese Confucian practices. The native legacy of rulership and succession which constrained the exportability of Confucian practices helps explain how, despite commonalities in their initial kinship systems, Japanese and Korean regimes ended up with strikingly different resolutions in their attempts to implement Chinese-style political structures. The fundamental problem was the Chinese legal code that was introduced into the emerging states of the Korean peninsula and thence into the Japanese archipelago during the state-building era. The normative ideas of political legitimacy embedded in the codes were generally regarded as Confucian, referring to a set of principles which were incorporated into the education of elites and rulers. Assumed to be universally applicable, these norms were in actuality predicated on the Chinese patrilineal kinship system rather than the very different indigenous kinship and succession systems practiced in early Korea and Japan. Ancient Japanese and Korean kingship was based on bilateral kinship, which emphasized the blood lines of mothers as well as fathers. Rulership was dominated by a royal lineage, which practiced brother–sister marriage. Chinese legal principles denied inheritance rights to daughters and wives and dictated that only sons could ascend the throne. They proved difficult to implement, especially because they threatened the legitimacy of native rulers. Although Japan and Korea eventually adopted patrilineal principles, the end results deviated from the Chinese system and from each other in significant respects. This chapter begins with a brief survey of the Chinese patrilineal kinship system, which marked status differences by gender, generation, and birth order within the descent group or lineage.
Operation of 4H-SiC Schottky diodes at dV/dt values over 700 kV/μs

This work describes the operation of commercial 4H-SiC Junction-Barrier Schottky (JBS) Diodes at extreme voltage slew rates (dV/dt) in an attempt to force failures. Slew rates in excess of 700 kVμs were required to damage parts, in combination with high values of the reverse bus voltage. Cryogenic temperatures reduced the maximum bus voltage required to induce failure. Large quantities of parts were subjected to repetitive dV/dt stress with a slew rate of 400 kVμs, then tested for avalanche ruggedness in unclamped inductive switching (UIS) conditions. No differences were detected between the stressed diode population and a control population, indicating that dV/dt stress induces neither immediate failures nor latent weakness.
Comment on “The size and structure of selected hydrated ions and implications for ion channel selectivity” by Z.-H. Yang, RSC. Adv., 2015, 5, 1213.

Common misconceptions about the properties of water solutions appear in the work of Yang (RSC Adv., 2015, 5, 1213). The issues addressed pertain to all aspects of the properties and behaviors of aqueous solutions of strong electrolytes: proper hydration numbers and their dependence on temperature, the extent of ion pair formation and its effect on hydration numbers, and the correct form of the equilibrium constant for ion pair formation. These aspects are fundamental for understanding the behavior of water solutions in chemistry and in biology. The present work points out the misconceptions, the faults resulting from them, and the ensuing confusion.
Equivalence Class Formation Using Stimulus-Pairing and Yes-No Responding

Equivalence classes were established using a stimuluspairing/yes-no procedure. On all trials, two stimuli were presented with the second introduced 250 ms after termination of the first. Pressing one of two keys labeled YES or NO was required during the second stimulus. AB, BC, and CO relations were established by reinforcing the YES response on within-set trials (A 1-B 1, A2-B2, B1-C1, B2-C2, C1-01, and C2-02), and the NO response on between-set trials (A 1-B2, A2-B1, B1-C2, B2-C1, C1-02, and C2- 01). For 10 of 18 college students, the YES response occurred on all within-set emergent relations probes for symmetry (B1-A 1, C1- B1, 01-C1, B2-A2, C2-B2, and 02-C2), transitivity (A1-C1, B1-01, A1-01, A2-C2, B2-02, and A2-02), and equivalence (C1-A1, 01- B1, 01-A 1, C2-A2, 02-B2, and 02-A2), and the NO response occurred on all between-set probes (B1-A2, C1-B2, 01-C2, B2-A 1, C2-B1, 02-C1, A 1-C2, B1-02, A 1-02, A2-C1, B2-01, A2-01, C2- A 1, 02-B1, 02-A 1, C1-A2, 01-B2, and 01-B2). Thus, a stimuluspairing/ yes-no procedure established the prerequisite conditional relations of equivalence classes, assessed symmetry, transitivity, and their combined effects, and documented the emergence of equivalence classes. After class formation, emergent relations probes presented in a matching-to-sample format occasioned class-consistent responding, showing the maintenance of the classes across testing formats and contingencies. Because stimulus pairing/yes-no and matching-to-sample formats differ, matching procedures are not needed to assess the emergence of equivalence classes or form their prerequisites.
The Use of Structural Family Therapy With a Latino Family: A Case Study

The purpose of this article is to provide culturally sensitive interventions through a Structural Family Therapy model with a Mexican-American family. In the past few decades, there has been an increasingly great need for mental health services within the Latino population. The Latino population is becoming the largest and fastest-growing minority group in the United States, which makes it imperative that we provide high quality mental health care (Davis & Liang, 2015). Research found that when working with Latino families, it is crucial to take the culture's values, themes, and gender stereotypes into consideration. The clinical implications of the research consist of always including the family system in therapy, having culturally sensitive and aware therapists, and recognizing the effectiveness of Structural Family Therapy.
The Impact of Race, Age, and Sex in Follicular Lymphoma (FL): A Comprehensive SEER Analysis in the Pre- and Post-Rituximab Eras

Abstract 1576 Background: While racial disparity has been documented in a number of cancers, the impact of race, sex, and socioeconomic status (SES) on FL outcomes is not well defined. Furthermore, the impact of modern therapeutics on these disparities has not been fully explored. Methods: We examined population-based FL overall survival (OS) data from SEER 13 (1993–2008) for race, sex, age, and socioeconomic status (SES) over two consecutive 8-year periods: Era 1 (1993–2000, n=7,409) and Era 2 (2001–2008, n=9,083). Results: We identified a total 16,492 FL patients (pts) (white (W): n=13,441 (81.5%); Hispanic (H): n=1,417 (8.5%); Asian/Pacific Islander (A/PI): n=887 (5.3%); and Black (B): n=747 (4.5%)). Median age at diagnosis differed significantly according to race: (in years, yrs) W: 62.1, H: 57.3, A/PI: 60.5, B: 56.6; P<0.01 for each race vs. W. For all pts, OS was superior in Era 2 vs. Era 1 (5-yr OS: 77% vs. 68%, respectively, P<0.0001). Further, OS was significantly improved for all age groups (<50, 50–59, 60–69, and 70–79 yrs) as well as for males (P=0.0019) and females (P<0.0001) across eras. Interestingly, females had superior OS compared with males in Era 1 (P=0.004), but not in Era 2 (P=0.83). We subsequently compared OS within and across races (see Table). All races, except A/PI, had improved 5-yr OS rates (age adjusted) from Era 1 to Era 2 (W: <0.001, H: 0.049, A/PI: 0.15, B: 0.003). Notably, A/PIs had the highest OS in Era 1, while H had the poorest OS in Era 2. These differences were more evident in males compared with females within each race. Finally, pts with higher SES had improved OS compared with low SES in both eras (P=0.02 in era 1 and <0.0001 in era 2), although OS was improved across eras within low and high SES populations (P<0.0001). Conclusions: Collectively, we identified improved OS in FL across eras, which was apparent for all ages, both sexes, and all races. However, racial disparities persist, including inferior OS for H and superior OS for A/PIs in the contemporary era. The disproportionate improvement in OS over eras and persistent inequality in outcomes based on race warrants continued examination. | 5-yr OS | P values | |:-------:| -------- | ---------- | | Era 1 | W vs. H | W vs. A/PI | W vs. B | | W | B | H | A/PI | | | | | 68% | 64% | 68% | 73% | 0.20 | 0.85 | 0.007 | | Era 2 | | | | | W | B | H | A/PI | | | | | 77% | 75% | 73% | 79% | <0.0001 | 0.019 | 0.11 | Table. OS across eras based on race Disclosures: No relevant conflicts of interest to declare.
Serial Versus Direct Dilation of Small Diameter Stents Results in a More Predictable and Complete Intentional Transcatheter Stent Fracture: A PICES Bench Testing Study

Balloon-expandable stents, implanted in infants and children with congenital heart disease (CHD), often require redilation to match somatic growth. Small diameter stents may eventually require longitudinal surgical transection to prevent iatrogenic vascular stenosis. Intentional transcatheter stent fracture (TSF) is an emerging alternative approach to stent transection, but little is known about the optimal stent substrate and best protocol to improve the likelihood of successful TSF. Bench testing was performed with a stent dilation protocol. After recording baseline characteristics, stents were serially or directly dilated using ultra-high-pressure balloons (UHPB) until fracture occurred or further stent dilation was not possible. Stent characteristics recorded were as follows: cell design, metallurgy, mechanism, and uniformity of fracture. Stents tested included bare-metal coronary stents, premounted small diameter stents, and ePTFE-covered small diameter premounted stents. Ninety-four stents representing 9 distinct models were maximally dilated, with 80 (85%) demonstrating evidence of fracture. Comprehensive fracture details were recorded in 64 stents: linear and complete in 34/64 stents (53.1%), linear and incomplete in 9/64 stents (14.1%), transverse/complex and complete in 6/64 stents (9.4%), and transverse/complex and incomplete in 15/64 stents (23.4%). Stent fracture was not accomplished in some stent models secondary to significant shortening, i.e., “napkin-ring” formation. Serial dilation resulted in evidence of fracture in 62/67 (92.5%) stents compared with 18/27 (66.7%) stents in the direct dilation group (p = 0.003). Intentional TSF is feasible in an ex vivo model. Serial dilation more reliably expanded the stent and allowed for ultimate stent fracture, whereas direct large diameter dilation of stents was more likely to generate a “napkin-ring” configuration, which may be more resistant to fracture. In vivo animal and human testing is necessary to better understand the response to attempted TSF for newly developed stents as well as those currently in use.
Oxidative Modifications in Tissue Pathology and Autoimmune Disease.

Abstract Significance: Various autoimmune syndromes are characterized by abnormalities found at the level of tissues and cells, as well as by microenvironmental influences, such as reactive oxygen species (ROS), that alter intracellular metabolism and protein expression. Moreover, the convergence of genetic, epigenetic, and even environmental influences can result in B and T lymphocyte autoimmunity and tissue pathology. Recent Advances: This review describes how oxidative stress to cells and tissues may alter post-translational protein modifications, both directly and indirectly, as well as potentially lead to aberrant gene expression. For example, it has been clearly observed in many systems how oxidative stress directly amplifies carbonyl protein modifications. However, ROS also lead to a number of nonenzymatic spontaneous modifications including deamidation and isoaspartate modification as well as to enzyme-mediated citrullination of self-proteins. ROS have direct effects on DNA methylation, leading to...
Tilting at Windmills

Just then they came in sight of thirty or forty windmills that rise from that plain. And no sooner did Don Quixote see them that he said to his squire, “Fortune is guiding our affairs better than w...
Reversibility of peripheral blood leukocyte phenotypic and functional changes after exposure to and withdrawal from tofacitinib, a Janus kinase inhibitor, in healthy volunteers.

This study evaluated the short-term effects of tofacitinib treatment on peripheral blood leukocyte phenotype and function, and the reversibility of any such effects following treatment withdrawal in healthy volunteers. Cytomegalovirus (CMV)-seropositive subjects received oral tofacitinib 10 mg twice daily for 4 weeks and were followed for 4 weeks after drug withdrawal. There were slight increases in total lymphocyte and total T-cell counts during tofacitinib treatment, and B-cell counts increased by up to 26%. There were no significant changes in granulocyte or monocyte counts, or granulocyte function. Naive and central memory T-cell counts increased during treatment, while all subsets of activated T cells were decreased by up to 69%. T-cell subsets other than effector memory cluster of differentiation (CD)4+, activated naive CD4+ and effector CD8+ T-cell counts and B-cell counts, normalized 4 weeks after withdrawal. Following ex vivo activation, measures of CMV-specific T-cell responses, and antigen non-specific T-cell-mediated cytotoxicity and interferon (IFN)-γ production, decreased slightly. These T-cell functional changes were most pronounced at Day 15, partially normalized while still on tofacitinib and returned to baseline after drug withdrawal. Total natural killer (NK)-cell counts decreased by 33%, returning towards baseline after drug withdrawal. NK-cell function decreased during tofacitinib treatment, but without a consistent time course across measured parameters. However, markers of NK-cell-mediated cytotoxicity, antibody-dependent cellular cytotoxicity and IFN-γ production were decreased up to 42% 1 month after drug withdrawal. CMV DNA was not detectable in whole blood, and there were no cases of herpes zoster reactivation. No new safety concerns arose. In conclusion, the effect of short-term tofacitinib treatment on leukocyte composition and function in healthy CMV+ volunteers is modest and largely reversible 4 weeks after withdrawal.
The impact of the chemoradiation to surgery interval on pathological complete response: Short and long-term overall survival in esophageal cancer patients.

2Background: The association of the interval between neoadjuvant chemo-radiation and surgery (CRT-S), and cancer outcomes in patients with esophageal cancer is not clear. We aimed to determine the ...
A Wrong-Way Driving Crash Risk Reduction Approach for Cost-Effective Installation of Advanced Technology Wrong-Way Driving Countermeasures:

Wrong-way driving (WWD) is hazardous on high-speed limited access facilities. Traditional signage and pavement markings will not always prevent intoxicated or confused drivers from entering these f...
Natural strain has advantages for biotissue models and can be quickly and accurately approximated

Publisher Summary Exceptlung, the instantaneous bulk modulus of soft biotissues is much greater than the shear moduli. Because a net flow of water into or out of the tissue is needed to change the volume appreciably, the dilatation is greatly dependent on loading frequency. In contrast, the response to distortion in cyclic loading is insensitive to frequency. Because the dilatational and the distortional response of soft tissues are drastically different, a strain tensor that intrinsically separates dilatation from distortion is potentially advantageous. Toward this end, natural strain is useful because dilatation and distortion additively decouple into the spherical and deviatoric parts of natural strainy. Also, with a novel method of approximating it, natural strain can be quickly and accurately calculated for biotissues. For this approximation, the error diminishes as the strain decreases. For pure shear, the approximation is exact. Regardless of the distortion, the dilatational or spherical part of this approximation for natural strain is always exact.
Searches for Higgs Particles in the Decays of Open and Hidden Beauty

In the past decade we have been inundated by the numerous successes of the Standard Model (SM), the most spectacular of which are the observation of the weak gauge bosons at the predicted masses. [1] However, the mechanism by which masses are given to these originally massless gauge bosons implies the appearance of a physically observable “Higgs” scalar of unspecified mass, which so far has eluded experimental observation.
Open Licensing—Advanced Sharing

In order to encourage sharing and bolster the intellectual commons, this chapter provides an introduction to open licensing. First, free and open-source software licenses are evaluated to gather lessons for open-source hardware (OSHW) developers. Then, the current selection of OSHW licenses and the Open Source Hardware Association's principles and definition are detailed. Although these licenses have unproven legal validity, they act as a social mechanism, which can assist scientific hardware users and designers gain entrance into the open-source community and benefit from the associated innovation acceleration. After licensing rules are established, a review of OSHW best practices and etiquette is provided in the context of the Golden Rule to help innovators integrate into the open-source community. Finally, remaining intellectual property challenges are discussed and some conclusions are drawn about where we are now and where we are going in the future legally to enable everyone to benefit from OSHW.
The Maning of Thomas Kuhn’s “Different Worlds”

In the recent literature in the philosophy of science, there is one citation notable for its frequency and the puzzlement it engenders. It was as puzzling to its author as to those who mention it, usually with strong convictions for or against its apparent thesis. The remark in question is Thomas Kuhn’s regarding the change in the science of chemistry produced in the interval from Priestley to Lavoisier: Lavoisier [Kuln says] saw oxygen where Priestley had seen dephlogisticated air and where others had seen nothing at all. In learning to see oxygen, however, Lavoisier also had to change his view of many other more familiar substances. He had, for example, to see a compound ore where Priestley and his contemporaries had seen an elementary earth, and there were other changes besides. At the very least, as a result of discovering oxygen, Lavoisier saw nature differently. And in the absence of some recourse to that hypothetical fixed nature that he “saw differently,” the principle of economy will urge us to say that after discovering oxygen he worked in a different world.1
Ramie Fiber Reinforced Natural Plastics

Fully biodegradable, environmentally friendly composites were made from short and long ramie fibers and soy protein polymer composites. Since both the fibers and the protein-based resin contain polar groups, they showed good interaction and high interfacial shear strength. The short fiber composites can be used for packaging uses. The long fiber composites can be used in structural housing or transportation uses.
Epinephrine synthesis in the rat iris.

Epinephrine (E) alters blood flow, intraocular pressure and pupillary constriction. The rat iris contained E-forming activity that was moderately specific for a phenylethanolamine and was inhibited by the phenylethanolamine-N-methyltransferase (PNMT) inhibitor SKF 29661. Unilateral superior cervical ganglionectomy decreased iris norepinephrine (NE) 63%, but failed to lower PNMT activity or E in the iris. Removal of both adrenal medullae markedly lowered circulating E levels, but had no effect on iris E. Further treatment with 6-hydroxydopamine and reserpine greatly lowered iris NE levels, but failed to decrease either iris E or E forming activity. The rat iris has non-neuronal E-forming enzymes which appear to synthesize most of the E contained in the iris. Invest Ophthalmol Vis Sci 31:677-680,1990 Epinephrine (E) has such important effects on the eye that both E and /3-adrenergic blocking agents are common ophthalmic medications. Epinephrine stimulates the same a and 0-1 receptors as norepinephrine (NE), but also stimulates 0-2 receptors. The iris has a rich autonomic innervation and j8 receptors in the iris inhibit constriction of the sphincter muscle. 1 It is generally thought that NE is made in noradrenergic neurons and E is synthesized in the adrenal medulla and to a small extent in the brain. However, Cohen and Hadjiconstantinou 2 reported that E and its synthetic enzyme phenylethanolamine-N-methyltransferase (PNMT) were present in rat retina. Since adrenergic receptors alter blood flow and intraocular pressure, E synthesis by other structures in the eye could be quite important. We examined E synthesis in the rat iris, since the iris is relatively easy to study and has been the target of several prior studies of sympathetic neuronal influences.
Rubella virus neutralizing antibody response after a third dose of measles-mumps-rubella vaccine in young adults

Abstract Background Third doses of measles-mumps-rubella (MMR) vaccine have been administered during mumps outbreaks and in various non-outbreak settings. The immunogenicity of the rubella component has not been evaluated following receipt of a third dose of MMR vaccine. Methods Young adults aged 18–31 years with documented two doses of MMR vaccine received a third dose of MMR vaccine between July 2009 and October 2010. Rubella neutralizing antibody titers were assessed before, 1 month, and 1 year after receipt of a third dose of MMR vaccine. Results Among 679 participants, 1.8% had rubella antibody titers less than 10 U/ml, immediately before vaccination, approximately 15 years after receipt of a second dose of MMR vaccine. One month after receipt of a third dose of MMR vaccine, average titers were 4.5 times higher and >50% of participants had a 4-fold boost. Response was highest among those with titers less than 10 U/ml prior to vaccination (geometric mean titer ratio = 18.8; 92% seroconversion) and decreased with increasing pre-vaccination titers. Average titers declined 1 year postvaccination but remained significantly higher than pre-vaccination levels. The proportion classified as low-positive antibody levels increased from 3% 1 month postvaccination to 24% 1 year postvaccination. Conclusions Vaccination with a third dose of MMR vaccine resulted in a robust boosting of rubella neutralizing antibody response that remained elevated 1 year later. Young adults with low rubella titers are more likely to benefit from a third dose of MMR vaccine.
Gratitude in School: Benefi ts to Students and Schools

Establishing social relationships and achieving a sense of identity are two main challenges in adolescents that occur against the backdrop of many changes (e.g., physical, sexual, cognitive, and emotional). Such turbulence may make a grateful outlook diffi cult to hold, but doing so may be benefi cial and transformative. It can focus individuals on the good turns in their life and the enablers that likely played a role, if they only took a moment to look. Th e above quote, written by a student in a study on gratitude and youth (Froh, 2008), illustrates this nicely.
Health care utilization and end of life care in patients with primary malignant brain tumors.

e14072Background: Patients with primary malignant brain tumors experience high symptom burden and short overall survival. However, their utilization of health care services at the end of life is no...
Optimization of immune-related adverse event management in a thoracic oncology clinic.

261Background: Improved awareness and management of immune checkpoint inhibitor (ICI) related adverse events (IRAEs) is a mandate for best practice given widespread use of ICIs in clinic. IRAE grad...
Risk of Subsequent Joint Arthroplasty in Contralateral or Different Joint After Index Shoulder, Hip, or Knee Arthroplasty: Association with Index Joint, Demographics, and Patient-Specific Factors.

BACKGROUND The risk of subsequent joint replacement following an index joint replacement for osteoarthritis and the association of this risk with demographic and patient-specific factors are not well understood. The purpose of this study was to determine how demographic and other patient-specific factors are associated with the risk of subsequent joint replacement in the contralateral or a different joint following an index joint replacement for osteoarthritis. METHODS The Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) of New York was used to identify the first (primary) total hip arthroplasty (THA), total knee arthroplasty (TKA), or total shoulder arthroplasty (TSA) and the risk of subsequent joint replacement in the contralateral or a different joint over 5 to 8 years. The association of demographic and other patient-specific factors with subsequent joint replacement was assessed via multivariable Cox proportional hazards modeling. We also investigated the time between the index and subsequent joint replacement. RESULTS Of 85,616 patients, 20,223 (23.6%) underwent a subsequent replacement of the contralateral joint within 5 to 8 years (median, 343 days) after the index joint replacement. The strongest predictors were obesity (adjusted hazard ratio [HR] = 1.28; p < 0.001) and index TKA compared with THA (1.72; p < 0.001). A total of 3,197 patients (3.7%) underwent a subsequent replacement of a different joint within 5 to 8 years (median, 876 days) after the index joint replacement. The strongest predictors were obesity (adjusted HR = 1.41; p < 0.001) and index TSA compared with THA (adjusted HR = 2.52; p < 0.001). CONCLUSIONS There is a relatively high risk of subsequent replacement of the contralateral joint and a relatively low risk of subsequent replacement of a different joint within 5 to 8 years after an index THA, TKA, or TSA. Obesity was associated with a higher risk of subsequent replacement of the contralateral joint or a different joint. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Evolution of Educational Inclusion Policy Discourse in Jamaica: From Colonialism to Globalization

Built on the theoretical and analytical frameworks of postcolonial studies, and drawing on policy documents and other texts, this chapter examines the complicated history and evolution of educational inclusion in Jamaica and the implications for educational inclusion policy in the current globalization era. The chapter explores the evolving meanings of and justifications for educational equity policy discourses through three different time periods—colonial/postcolonial, post-independence, and the current neoliberal globalization age. I argue that each era has its own (national and international) political-economic and sociocultural conditions that impact (and justify) the definition and implementation of educational inclusion policies. I find that in the early colonial and postcolonial period, educational inclusion was largely considered through the lens of race and color to increase social opportunities for the formerly enslaved and otherwise oppressed Black majority. In this era, concepts of difference and, therefore, inclusion were limited to the vagaries of race and (increasingly) skin shade. During the post-independence period, inclusive education developed through more social welfare approaches but also showed early signs of human rights and political justifications for inclusion. The new globalization era is increasingly dominated by concepts of educational inclusion focused primarily on individual rights to economic opportunity and social mobility, which vastly expands the parameters of past notions of inclusion, with important policy implications. The chapter ends with a note of caution as to how we consider success when thinking about inclusive education policies driven by international discourses and adopted locally in a postcolonial development setting as Jamaica.
Knowledge and Skills in Complex Assurance Engagements: The Case of XBRL

What knowledge and skills (KSs) are necessary for complex Agreed-Upon Procedures (AUP) engagements, such as those that include eXtensible Business Reporting Language (XBRL) tagged data? This study ...
Stress Conditions Induced by Locoregional Therapies Stimulate Enrichment and Proliferation of Liver Cancer Stem Cells

Abstract Purpose This study tested the hypothesis that stress conditions that simulated percutaneous thermal ablation (PTA), transarterial embolization (TAE), or transarterial chemoembolization stimulated enrichment of hepatocellular carcinoma (HCC) cancer stem cells (hCSCs) and that hCSC inhibitors can suppress this effect. Materials and Methods Human HCC cell lines HepG2 and PLC/PRF/5 were subjected to a 46.5°C heat bath for 10 minutes or to 1% hypoxia for 72 hours without fetal bovine serum and with or without doxorubicin. Cells were then treated with a β-catenin inhibitor (FH535 or XAV939), a PI3 kinase inhibitor (Ly294002), or niclosamide, a US Food and Drug Administration-approved antihelminthic drug that acts as a mitochondrial decoupler and mixed inhibitor. Surviving cells were analyzed for hCSC markers by flow cytometry, for stemness by colony-forming assay or sphere-forming assay, and for proliferative capacity by MTT assay (where MTT is 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide). Expression of proteins related to CSC renewal and proliferation were analyzed by immunoblotting and immunostaining. Results Conditions that simulated PTA, TAE, and transarterial chemoembolization resulted in an enrichment of cells bearing hCSC markers (CD133, CD44, and EpCAM). Cells surviving heat stress exhibited higher colony- or sphere-forming capacity and a greater proliferative state. These effects could be suppressed by niclosamide and inhibitors of β-catenin and PI3 kinase. Conclusions Stress conditions induced by locoregional therapies stimulated hCSC enrichment and proliferation, which could be suppressed by niclosamide and inhibitors of pathways important for hCSC renewal. Future studies will determine whether combining locoregional therapies with adjuvant hCSC inhibitors reduces HCC recurrence.
Non-neoplastic Marrow Findings

Non-neoplastic bone marrow findings due to a variaety of causes such as infections and marrow failure
Mesh fistula after ventral hernia repair: What is the optimal management?

Abstract Background A mesh-related intestinal fistula is an uncommon and challenging complication of ventral hernia repair. Optimal management is unclear owing to lack of prospective or long-term data. Methods We reviewed our prospective data for mesh-related intestinal fistulas from 2004 to 2017and compared suture repair versus ventral hernia repair with mesh at the time of mesh-related intestinal fistula takedown. Results Eighty-two mesh-related intestinal fistulas were treated; none of the fistulas had closed spontaneously, and all fistula persisted at the time of our treatment. Mean age was 61 ± 12 years with 33-month follow-up. Comorbidities were similar between groups. Defects were 2.5-times larger in ventral hernia repair with mesh (324 ± 392 cm2 vs 1301 ± 133 cm2; P = .044). Components separation (64% vs 21%; P = .0003) and panniculectomy (35% vs 7%; P = .0074) were more common in ventral hernia repair with mesh. Mortality occurred in 4 patients. Complications were similar. In patients undergoing ventral hernia repair with non-bridged, acellular, porcine dermal matrix, hernia recurrence was less than in patients without mesh (26% vs 66%; P = .0030). Only partial excision of the mesh involved with the fistula resulted in a substantial increase in developing another fistula (29% vs 6%; P Conclusion Patients undergoing preperitoneal ventral hernia repair with mesh for mesh-related intestinal fistula had a lesser rate of hernia recurrence and similar complications compared to suture repair despite larger hernias. Complete mesh excision decreases the risk of fistula recurrence. We maintain that ventral hernia repair with mesh during mesh-related intestinal fistula takedown represents the best opportunity for a durable herniorrhaphy.
Radiographic Diagnosis of Patients with Vertebral Compression Fractures

This chapter reviews the clinical presentation, diagnostic evaluation, and imaging characterization of vertebral compression fractures (VCF). We review the imaging features that best characterize the age/chronicity of a fracture and how these features correlate with the likelihood of benefit to procedural intervention with vertebroplasty or kyphoplasty. Additionally, we review morphometric and signal intensity patterns on CT and MRI which aid in discrimination between benign osteoporotic fractures and pathologic fractures. Newer techniques for fracture characterization including diffusion-weighted imaging, chemical shift imaging, and dynamic contrast-enhanced imaging are discussed. Finally, we review imaging alternatives for patients with contraindication to MRI.
Synthesis Control of Layered Oxide Cathodes for Sodium-Ion Batteries: A Necessary Step Toward Practicality

Interest in sodium-ion battery cathode materials, particularly for grid-scale energy-storage applications, has considerably increased in the last few years, sparking a push toward industrially prac...
An Analysis of Suicide Risk Factors among Farmers in the Midwestern United States

Research on the complex relationships of variables contributing to farmer suicide is limited. The purpose of the study was to examine factors associated with suicide risk through the use of standardized instruments measuring psychological (depression, anxiety), social (social support), and contextual factors. A questionnaire was completed by 600 farmers in the Midwestern United States. A multiple linear regression model was used to analyze associations with suicide risk (SBQ-R), including depression (PHQ-9), anxiety (GAD-7), Brief COPE subscales (BC), social support (MSPSS), and select demographic and farming characteristics. The only variable that emerged as having a significant relationship with the natural log-transformed suicide risk score was coping through self-blame. While suicidality is often considered the outcome of mental illness, our findings do not suggest that suicide risk among farmers is related to mental illness, and a further examination of self-blame as a coping strategy is warranted.
Does testing for sleep-disordered breathing pre-discharge versus post-discharge result in different treatment outcomes?

STUDY OBJECTIVES Treatment of sleep-disordered breathing may improve health-related outcomes postdischarge. However timely definitive sleep testing and provision of ongoing therapy has been a challenge. Little is known about how the time of testing-during hospitalization vs after discharge-affects important outcomes such as treatment adherence. METHODS We conducted a 10-year retrospective study of hospitalized adults who received an inpatient sleep medicine consultation for sleep-disordered breathing and subsequent sleep testing. We divided them into inpatient and outpatient sleep testing cohorts and studied their clinical characteristics, follow-up, positive airway pressure adherence, pressure adherence, hospital readmission and mortality. RESULTS Of 485 patients, 226 (47%) underwent inpatient sleep testing and 259 (53%) had outpatient sleep testing. The median age was 68 years old (interquartile range = 57-78), and 29.6% were females. The inpatient cohort had a higher Charlson Comorbidity Index (4 [3-6] vs 3[2-5], P ≤ .0004). A higher Charlson Comorbidity Index (hazard ratio = 1.14, 95% confidence interval:1.03-1.25, P = .001), body mass index (hazard ratio = 1.03, 95% confidence interval:1.0-1.05, P = .008), and stroke (hazard ratio = 2.22, 95% confidence interval:1.0-4.9, P = .049) were associated with inpatient sleep testing. The inpatient cohort kept fewer follow-up appointments (39.90% vs 50.62%, P = .03); however positive airway pressure adherence was high among those keeping follow-up appointments (88.9% [inpatient] vs 85.71% [outpatient], P = .55). The inpatient group had an increased risk for death (hazard ratio: 1.82 95% confidence interval 1.28-2.59, P ≤ .001) but readmission rates did not differ. CONCLUSIONS Medically complex patients were more likely to receive inpatient sleep testing but less likely to keep follow-up, which could impact adherence and effectiveness of therapy. Novel therapeutic interventions are needed to increase sleep medicine follow-up postdischarge, which may result in improvement in health outcomes in hospitalized patients with sleep-disordered breathing. CITATION Orbea CP, Jenad H, Kassab LL, et al. Does testing for sleep-disordered breathing predischarge vs postdischarge result in different treatment outcomes? J Clin Sleep Med. 2021;17(12):2451-2460.
The International Food Aid Policies of the United States

The United States’ (US) current food aid foreign policies do not allow it to fulfill the primary goal of providing food aid to people in other countries who need it. The US’s current policies encourage dumping its agricultural surpluses into other countries’ markets in the form of food aid. Although this practice may further US economic pursuits, it undermines the goals of the US’ food aid programs by distorting markets and undermining producers in recipient countries. These countries then become dependent on US food aid, which further tilts the global market toward US agricultural products. US food aid foreign policy also exhibits structural issues, such as monetization and requirements that food aid be purchased from US farmers and shipped on US vessels. These practices waste money that the US could have spent on feeding more people. Drawing on government statistics, policy experts’ opinions, news reports, and recent examples of food aid policies’ effects, this brief delineates three policy options to more closely align US food aid foreign policy with its intended objectives. It will ultimately recommend that the US resolve its structural mismanagement issues impeding the efficacy of its food aid programs and divert funds away from development projects and toward disaster relief.
Altered costimulatory signals and hypoxia support chromatin landscapes limiting the functional potential of exhausted T cells in cancer

Abstract Immunotherapy has changed cancer treatment with major clinical successes, but response rates remain low due in part to elevated prevalence of dysfunctional, terminally exhausted T cells. However, the mechanisms promoting progression to terminal exhaustion remain undefined. We profiled the histone modification landscape of tumor-infiltrating CD8 T cells throughout differentiation, finding terminally exhausted T cells possessed chromatin features limiting their transcriptional potential. Active enhancers enriched for bZIP/AP-1 transcription factor motifs lacked correlated gene expression, which were restored by immunotherapeutic costimulatory signaling. Epigenetic repression was also driven by an increase in histone bivalency, which we linked directly to hypoxia exposure. Our study is the first to profile the precise epigenetic changes during intratumoral differentiation to exhaustion, highlighting their altered function is driven by both improper costimulatory signals and environmental factors. These data suggest even terminally exhausted T cells remain poised for transcription in settings of increased costimulatory signaling and reduced hypoxia.
The epistemology of evolutionary debunking

Fifteen years ago, Sharon Street and Richard Joyce advanced evolutionary debunking arguments against moral realism, which purported to show that the evolutionary history of our moral beliefs makes moral realism untenable. These arguments have since given rise to a flurry of objections; the epistemic principles Street and Joyce relied upon, in particular, have come in for a number of serious challenges. My goal in this paper is to develop a new account of evolutionary debunking which avoids the pitfalls Street and Joyce encountered and responds to the most pressing objections they faced. I begin by presenting a striking thought experiment to serve as an analogy for the evolution of morality; I then show why calibrationist views of higher-order evidence are crucial to the evolutionary debunking project; I outline a new rationale for why finding out that morality was selected to promote cooperation suggests that our moral judgments are unreliable; and I explain why evolutionary debunking arguments do not depend on our having a dedicated faculty for moral cognition. All things considered, I argue, evolutionary debunking arguments against moral realism are on relatively secure footing – provided, at least, that we accept a calibrationist account of higher-order evidence.