cssi/SciSciGPT-SciSciNet huggingface dataset:
Managing Prolonged Pain After Surgery: Examining the Role of Opioids

A notable minority of patients experience persistent postsurgical pain and some of these patients consequently have prolonged exposure to opioids. Risk factors for prolonged opioid use after surgery include preoperative opioid use, anxiety, substance abuse, and alcohol abuse. The window to intervene and potentially prevent persistent opioid use after surgery is short and may best be accomplished by both surgeon and anesthesiologist working together. Anesthesiologists in particular are well positioned in the perioperative surgical home model to affect multiple aspects of the perioperative experience, including tailoring intraoperative medications and providing consultation for possible discharge analgesic regimens that can help minimize opioid use. Multimodal analgesia protocols reduce opioid consumption and thereby reduce exposure to opioids and theoretically the risk of persistent use. Regional anesthesia and analgesia techniques also reduce opioid consumption. Although many patients will recover without difficulty, the small minority who do not should receive customized care which may involve multiple office visits or consultation of a pain specialist. Enhanced recovery pathways are useful in optimizing outcomes after surgery.
Case 19: Zone I Open Globe Injury with Traumatic Cataract Requiring Secondary Lens Extraction in a Pediatric Case

A 10-year-old male presented with a Zone I corneal laceration with possible lens violation of the left eye on pre-operative evaluation. Given the limitations of the pre-operative examination and intra-operative view of the lens, the globe corneal laceration was repaired primarily without lens extraction. As the corneal edema improved, the view to the lens improved and it was clear the patient had a traumatic cataract with lens violation. Subsequently, secondary cataract extraction and lens implantation was performed with safe lens positioning into the capsular bag 9 days after open globe repair. The patient’s vision slowly improved over time as the corneal wound continued to heal. The pediatric ocular trauma score (POTS) has been devised to predict visual prognosis after pediatric eye injury, and may be a useful tool when counseling families.
Early post-approval experience with transcatheter aortic valve replacement in the USA.

BACKGROUND Transcatheter aortic valve replacement (TAVR) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TAVR versus surgical aortic valve repair (SAVR) in the real-world setting since USA TAVR approval in 2012. METHODS The Nationwide Inpatient Sample (NIS) dataset was analyzed by quarter (June 2012 to December 2014). Patients (>65 years old) undergoing TAVR or SAVR were identified and risk stratified based on APR-DRG Mortality risk score. Outcomes were in-hospital mortality, length of stay (LOS), discharge location, and hospitalization cost. RESULTS TAVR cases per quarter increased from 1900 to 5445 over the study period. TAVR patients were older and had more comorbidities (P<0.001). TAVR patients had longer LOS (8 vs. 7 days; P<0.001), were less likely to discharge to home (67% vs. 73%; P<0.001), had higher inpatient mortality (5.5% vs. 0.69%; P<0.001) and overall hospital cost ($ 227,985 vs. $ 148,019; P<0.001) than SAVR patients. On multivariate analysis TAVR was associated with increased cost (β=0.42; P<0.001) and increased mortality (OR=5.228, CI: 3.508-7.791; P<0.001) but not associated with increased LOS (β=0.297; P=0.078) or discharge to facility (OR=1.004, CI: 0.833-1.213; P=0.960). In the last two quarters of 2014 there was no difference between TAVR and SAVR LOS, however TAVR cost did not decrease over the study period. CONCLUSIONS TAVR patients represented a sicker population, however LOS and discharge location outcomes were equivalent to SAVR. TAVR remained significantly more expensive across all risk groups and cost did not fall over the course of the study.
Practice Patterns in Office-Based Rhinology: Survey of the American Rhinologic Society.

BackgroundRecent years have witnessed significant expansion in office-based rhinology. This study assesses practice patterns of the American Rhinologic Society (ARS) membership regarding office-bas...
"I Thought You Loved Me too?": Outcomes of Discrepant Involvement in Romantic Relationships

As romantic relationships begin and evolve, it is sometimes the case that partners are discrepant in their attraction to, love for, and commitment to each other. Data were collected from 460 undergraduates who completed a 40 item Internet survey on the various types of discrepancies and outcomes for their respective relationships. Results revealed that half of participants had been in a discrepant relationship in which they were more attracted to, in love with, and committed to their partner and half were less attracted, in love and committed than a partner in a current or past relationship. Men were significantly more likely than women to report that they had been in a discrepant relationship in which they were more in love with their partner. Being more attracted and less attracted, in love with, and committed was positively associated with infidelity. Depression was positively associated with being more or less attracted to, in love with and committed. Alcohol/drug use was positively associated with being more attracted and in love with a partner, as well as being less attracted and committed to a partner. Of discrepant relationships that ended, 45% were by the respondent, 20% mutually, and 11% by the partner. Of discrepant relationships that continued, 44% of the respondents reported that the discrepancies did not matter and that the respondents were happy despite the discrepancies.
Functional Outcomes of Intravenous Thrombolysis in Octogenarians and Nonagenarians Through Telestroke: Single-Center Experience.

Background: Patients aged ≥80 years are often underrepresented in stroke trials. Observational studies have shown that older patients have worse outcomes compared with younger patients, but outcome...
The Impact of Workers' Compensation on Patient-Reported Outcomes Measurement Information System Upper Extremity and Legacy Outcome Measures in Patients Undergoing Arthroscopic Rotator Cuff Repair.

Purpose To examine the preoperative performance of the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Computer Adaptive Test (CAT) with respect to legacy scores in patients receiving rotator cuff repair (RCR). In addition, to define the impact of Workers' Compensation (WC) status on both performance and floor and ceiling effects. Methods The PROMIS UE CAT was administered preoperatively alongside legacy patient-reported outcome measures (PROMs) to patients undergoing isolated arthroscopic RCR from November 2017 to September 2018. Performance was assessed using Spearman correlation coefficients, and floor and ceiling effects were examined. Results One hundred twenty-two patients (WC, n = 32; non-WC, n = 90; 62.3% male, 53.6 ± 11.5 years) were included. PROMs assessing physical function (r = 0.41-0.77) correlated more strongly to the PROMIS UE CAT than did multidomain or mental health PROMs (r = 0.25-0.61). In WC patients, the PROMIS UE CAT demonstrated diminished correlative strength relative to shoulder function PROMs. WC patients also demonstrated relative floor effects for Single Assessment Numerical Evaluation (SANE; 18.8%) and Constant-Murley (15.6%) and relative ceiling effects for the Brief Resilience Scale (53.1%), Short Form 12 Mental Component Score (50%), and Veterans Rand 12 Mental Component Score (53.1%) and were more likely to report the minimum SANE score (P Conclusions Compared with a non-WC cohort, WC patients have significantly lower preoperative PROMIS UE CAT scores, are more likely to report the absolute minimum and maximum scores for various PROMs, and demonstrated relative floor and ceiling effects for PROMs assessing mental health. The absence of significant floor/ceiling effects for the PROMIS UE CAT may suggest improved outcome discrimination and may support the adoption of PROMIS UE for the assessment of functional status in WC patients with rotator cuff pathology. Level of Evidence Level III, retrospective comparative trial.
Adaptive Equalization Super-Resolution Time Delay Estimation with High Accuracy and Low Complexity

An adaptive multipath equalization time delay estimation (METDE) algorithm is presented to estimate the time delays of received signals through a multipath channel with high accuracy and resolution. The proposed approach is developed utilizing a sequential minimization of a square error function that is updated according to the difference of received data and pre-known model at each moment. The METDE algorithm is uniquely established through a multi-tap equalizer structure and without using any complex optimization or matrix inversion operation. Thus, it will have lower complexity and better compatibility with practical hardware implementation in the real-time systems. The mathematical formulation and the accuracy analyses of the METDE algorithm are derived in the paper through numerical simulations and experimental tests. Providing 95% improved resolution compared to the Fourier limit, the proposed approach is a good candidate in low-frequency applications to mitigate the Fourier limit on the range resolution and achieve higher penetration in lossy environments.
East German letters to Angela Davis: from myth to solidarities unfolding

This essay applies the lens of myth to convey new insight in the well-documented historical context of the National United Campaign to Free Angela Davis (NUFCAD) in the German Democratic Republic (...
Selected aspects of the state of the art in biomaterials for cardiovascular applications.

Abstract A review of selected aspects of biomaterials used for cardiovascular applications is presented in honor of the long-term editorship of John Brash of the journal Colloids and Surfaces B: Biointerfaces. The topics to be discussed include the following: 1. Hemostasis, a high barrier to the use of biomaterials in the cardiovascular system; 2. Newer fundamental studies of protein interactions with surfaces; 3. Recent research on protein resistant materials; 4. Clinical application of nonfouling polymers; 5. A brief comment on “superhydrophobic” surfaces; 6. A short history of my many interactions with John Brash. The review topics were chosen on the basis of interest to the author as well as relevance to the research interests of John Brash, and on each topic chosen only a few representative articles are reviewed here.
Surgical management of appendiceal mucinous neoplasm: Is appendectomy sufficient?

Background and objectives Due to the rarity of appendiceal mucinous neoplasms (AMNs), there are few established treatment guidelines. The clinical course varies from incidental detection to progressive spread with pseudomyxoma peritonei (PMP). This study investigated the extent of resection on the prognosis and outcomes of AMNs. Methods This multicenter retrospective study evaluated patients with AMN who underwent surgery between 4/2006 to 9/2017. Primary endpoints included overall survival (OS) and disease-specific survival (DSS). Secondary endpoints included PMP incidence and treatment with cytoreductive surgery (CRS). Results Of the 138 patients with AMN, 70 patients (54%) underwent appendectomy, 26 (19%) cecectomy, and 37 (27%) right hemicolectomy. The median age was 59.7 years and 57 patients (41%) were male. Males were less likely to undergo cecectomy (P = .03). Rupture rates, tumor characteristics, and incidence of PMP were similar across surgery groups. Median follow-up was 61.3 months. Five-year OS and DSS for the total cohort were 94.9% and 98.6%, respectively, and remained similar across all surgery groups. CRS patients were more likely to undergo right hemicolectomy with no difference in survival by surgery type (P = .03). Conclusions Patients with AMN have a good overall prognosis and there may be minimal benefit to performing extended surgical resection in these patients.
Deep Neural Network-based Speaker-Aware Information Logging for Augmentative and Alternative Communication

People with complex communication needs can use a high-technology augmentative and alternative communication device to communicate with others. Currently, researchers and clinicians often use data logging from high-tech augmentative and alternative communication devices to analyze augmentative and alternative communication user performance. However, existing automated data logging systems cannot differentiate the authorship of the data log when more than one user accesses the device. This issue reduces the validity of the data logs and increases the difficulties of performance analysis. Therefore, this paper presents a solution using a deep neural network-based visual analysis approach to process videos to detect different augmentative and alternative communication users in practice sessions. This approach has significant potential to improve the validity of data logs and ultimately to enhance augmentative and alternative communication outcome measures.
GLUT5 is a determinant of dietary fructose-mediated exacerbation of experimental colitis

The Western diet has been suggested to contribute to the rising incidence of inflammatory bowel diseases. This has led to the hypothesis that fructose, a component of the Western diet, could play a role in the pathogenesis of inflammatory bowel diseases. A high-fructose diet is known to exacerbate experimental colitis. This study tested whether the expression of GLUT5, the fructose transporter, is a determinant of the severity of experimental colitis during elevated fructose consumption and whether ileal inflammation is associated with altered GLUT5 expression in Crohn's disease. Studies in genetically engineered mice showed that in comparison to Glut5+/+ mice, feeding a 15 kcal% fructose diet to Glut5-/- mice led to worse dextran sodium sulfate (DSS)-induced colitis. This effect was associated with elevated levels of colonic fructose and a shift in the fecal microbiota in Glut5-/- mice. Importantly, treatment with broad-spectrum antibiotics protected against the worsening of colitis mediated by dietary fructose in Glut5-/- mice. Gene expression analysis revealed that GLUT5 levels are reduced in the intestines of patients with ileal Crohn's disease. Moreover, levels of GLUT5 negatively correlated with expression of proinflammatory mediators in these samples. Collectively, these results demonstrate that dietary constituent (fructose)-host gene (GLUT5) interactions can shape the colonic microbiota, thereby impacting the severity of colitis.NEW & NOTEWORTHY This study provides the first evidence that reduced levels of GLUT5, the fructose transporter, worsen experimental colitis upon fructose feeding, an effect mediated by changes in the gut microbiota. Moreover, GLUT5 expression is reduced in Crohn's ileitis. Overall, these findings demonstrate the importance of interactions between dietary fructose and host GLUT5 as determinants of both the composition of colonic microbiota and severity of experimental colitis.
Redoing Criminal Law: Taking the Deviant Turn

This is a review of Larry Alexander and Kim Ferzan’s Reflections on Crime and Culpability, a sequel to the authors’ Crime and Culpability. The two books set out a sweeping proposal for reforming our criminal law in ways that are at once commonsensical and mindbogglingly radical. But even if one is not on board with such a radical experiment, simply thinking it through holds many unexpected lessons: startlingly new insights about the current regime and about novel ways of doing legal theory, some of which are explored in this essay.
Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease: The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients With Coronary Heart Disease (UNWIND) Randomized Clinical Trial.

Importance Anxiety is common among patients with coronary heart disease (CHD) and is associated with worse health outcomes; however, effective treatment for anxiety in patients with CHD is uncertain. Objective To determine whether exercise and escitalopram are better than placebo in reducing symptoms of anxiety as measured by the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) and in improving CHD risk biomarkers. Design, Setting, and Participants This randomized clinical trial was conducted between January 2016 and May 2020 in a tertiary care teaching hospital in the US and included 128 outpatients with stable CHD and a diagnosed anxiety disorder or a HADS-A score of 8 or higher who were older than 40 years, sedentary, and not currently receiving mental health treatment. Interventions Twelve weeks of aerobic exercise 3 times per week at an intensity of 70% to 85% heart rate reserve, escitalopram (up to 20 mg per day), or placebo pill equivalent. Main Outcomes and Measures The primary outcome was HADS-A score. CHD biomarkers included heart rate variability, baroreflex sensitivity, and flow-mediated dilation, along with 24-hour urinary catecholamines. Results The study included 128 participants. The mean (SD) age was 64.6 (9.6) years, and 37 participants (29%) were women. Participants randomized to the exercise group and escitalopram group reported greater reductions in HADS-A (exercise, −4.0; 95% CI, −4.7 to −3.2; escitalopram, −5.7; 95% CI, −6.4 to −5.0) compared with those randomized to placebo (−3.5; 95% CI, −4.5 to −2.4;P = .03); participants randomized to escitalopram reported less anxiety compared with those randomized to exercise (−1.67; 95% CI, −2.68 to −0.66;P = .002). Significant postintervention group differences in 24-hour urinary catecholamines were found (exercisezscore = 0.05; 95% CI, −0.2 to 0.3; escitalopramzscore = −0.24; 95% CI, −0.4 to 0; placebozscore = 0.36; 95% CI, 0 to 0.7), with greater reductions in the exercise group and escitalopram group compared with the placebo group (F1,127 = 4.93;P = .01) and greater reductions in the escitalopram group compared with the exercise group (F1,127 = 4.37;P = .04). All groups achieved comparable but small changes in CHD biomarkers, with no differences between treatment groups. Conclusions and Relevance Treatment of anxiety with escitalopram was safe and effective for reducing anxiety in patients with CHD. However, the beneficial effects of exercise on anxiety symptoms were less consistent. Exercise and escitalopram did not improve CHD biomarkers of risk, which should prompt further investigation of these interventions on clinical outcomes in patients with anxiety and CHD. Trial Registration ClinicalTrials.gov Identifier:NCT02516332
Chapter 17 – Brain Evolution

The evolution of the human brain has been a combination of reorganization of brain components, and increase of brain size through both hyperplasia and hypertrophy during development, underlain by neurogenomic changes. Paleoneurology based on endocast studies is the direct evidence demonstrating volume changes through time, and if present, some convolutional details of the underlying cerebral cortex. Reorganizational changes include a reduction of primary visual cortex and a relative enlargement of posterior association cortex and expanded Broca's regions, as well as cerebral asymmetries. The size of the hominid brain increased from about 450 ml at 3.5 million years ago to our current average volume of 1350 ml. These changes through time were sometimes gradual but not always.
Provocative Infrared Telethermography in Knee Osteoarthritis: The Role of the Sympathetic Nervous System in Pain (P3.305)

OBJECTIVE: To evaluate the use of provocative infrared telethermography (IRT) in a knee osteoarthritis model (KOA). BACKGROUND: Knee osteoarthritis (KOA) pain is debilitating and difficult to treat. Traditional theory as to mechanism rests primarily on chronic inflammation of joint (mechanical ‘grinding’ and/or pro-inflammatory dysmodulation). However, therapeutic approaches based on these theoretical patho-mechanisms are insufficient and ineffective much of the time. Recent literature suggests a role of peripheral and central neuropathic mechanisms, and this may involve not only afferent, but efferent systems (e.g ‘sympathetically maintained pain’). METHODS: This study evaluated the effect of a functional provocation on thermographic imaging of KOA subjects. Two hundred twenty-two IRT images of 37 subjects were captured before and at 30 second intervals after walking up and down a flight of stairs. Images were then analyzed using Thermoteknix TherMonitor software ®, a freeform tool that allowed the analysis of the mean temperature of the entire joint of both the ipsilateral (‘worse’ knee) and the contralateral knee. The subjects’ pain was measured before and after provocation by the Numeric Rating Scale (NRS). RESULTS: Both knees became significantly cooler (p < 0.003) after provocation resulting in significant increase in pain (p < 0.001), with no difference in the rate of change (p = 0.71) between limbs. CONCLUSION: Traditional theory would predict that with provocation, the affected knee would become warmer due to increased local inflammation and resultant vasodilation. However, this pilot suggests that the opposite occurs, with both knees becoming significantly cooler. This suggests a centrally-mediated response, most likely sympathetic-mediated vasoconstriction. Disclosure: Dr. Gerson has nothing to disclose. Dr. Saracoglu has received research support from Forest Laboratories. Dr. Connolly has received research support from Forest Pharmaceuticals. Dr. Kirsling has nothing to disclose. Dr. Harden received personal compensation for activities with GlaxoSmithKline, Johnson & Johnson, and King Pharmaceuticals.
The effect of exogenous substrate concentrations on true and apparent metabolism of hyperpolarized pyruvate in the isolated perfused lung.

Although relatively metabolically inactive, the lung has an important role in maintaining systemic glycolytic intermediate and cytosolic redox balance. Failure to perform this function appropriately may lead to lung disease progression, including systemic aspects of these disorders. In this study, we experimentally probe the response of the isolated, perfused organ to varying glycolytic intermediate (pyruvate and lactate) concentrations, and the effect on the apparent metabolism of hyperpolarized 1-13C pyruvate. Twenty-four separate conditions were studied, from sub-physiological to super-physiological concentrations of each metabolite. A three-compartment model is developed, which accurately matches the full range of experiments and includes a full account of evolution of agent concentration and polarization. The model is then refined using a series of approximations which are shown to be applicable to cases of physiological relevance, and which facilitate an intuitive understanding of the saturation and scaling behavior. Perturbations of the model assumptions are used to determine the sensitivity to input parameter estimates, and finally the model is used to examine the relationship between measurements accessible by NMR and the underlying physiological parameters of interest. Based on the observed scaling of lactate labeling with lactate and pyruvate concentrations, we conclude that the level of hyperpolarized lactate signal in the lung is primarily determined by the rate at which NAD+ is reduced to NADH. Further, although weak dependences on other factors are predicted, the modeled NAD+ reduction rate is largely governed by the intracellular lactate pool size. Conditions affecting the lactate pool can therefore be expected to display the highest contrast in hyperpolarized 13C-pyruvate imaging. The work is intended to serve as a basis both to interpret the signal dynamics of hyperpolarized measurements in the normal lung and to understand the cause of alterations seen in a variety of disease and exposure models. Copyright © 2014 John Wiley & Sons, Ltd.
Interactions of membrane receptors and cell signaling systems with the cytoskeleton

Publisher Summary The role of the cytoskeleton in particular cellular responses is quite varied, depending on the cell type, the signal involved and the magnitude of the response. Endocytosis and exocytosis involve a substantial remodeling of parts of the cortical cytoskeleton. Motility necessitates plasticity of the cytoskeleton and major remodeling of specific cytoskeletal structures, particularly the cortical actin network. Cell-cell and cell-matrix interactions result in morphological alterations requiring major reorganization of cytoskeletal structures. Cytoskeletal reorganizations occurring as a result of these interactions play a vital role in normal differentiation and development. Mitogenesis, which culminates in cell division, represents an extreme in cytoskeletal reorganization, requiring global changes in all of the cellular cytoskeletal systems. Many of these same types of morphological and cytoskeletal changes occur during neoplastic transformation in which the cell loses its normal growth regulation. Signaling via hydrophilic ligands occurs by binding to cell surface receptors. The most complex receptors are the ligand-gated ion channel receptors multi-subunit receptors forming pores, which are opened and closed by means of ligand-induced conformational changes.
Medical Imaging with Microwave: Thermoacoustic Tomography

After introducing the principles of thermoacoustic tomography and pure microwave imaging, we summarize the mechanisms attributable to the dielectrical properties of biological tissues in the microwave frequency range. Next, we introduce some theoretical results from studies of thermoacoustic tomography, including information about optimal microwave frequencies, effects of acoustical heterogeneity on breast thermoacoustic tomography, limited-view thermoacoustic tomography, reconstruction algorithms, and spatial resolution. The experimental setups and the results of thermoacoustic tomography in planar and circular geometries are discussed. Finally, in vivo and in vitro results of both thermoacoustic tomography and pure microwave imaging are presented.
Discrete Quantum Gravity

We discuss the causal set approach to discrete quantum gravity. We begin by describing a classical sequential growth process in which the universe grows one element at a time in discrete steps. At each step the process has the form of a causal set and the "completed" universe is given by a path through a discretely growing chain of causal sets. We then introduce a method for quantizing this classical formalism to obtain a quantum sequential growth process which may lead to a viable model for a discrete quantum gravity. We also give a method for quantizing random variables in the classical process to obtain observables in the corresponding quantum process. The paper closes by showing that a discrete isometric process can be employed to construct a quantum sequential growth process.
NADPH Oxidase–Derived Peroxynitrite Drives Inflammation in Mice and Human Nonalcoholic Steatohepatitis via TLR4-Lipid Raft Recruitment

The molecular events that link NADPH oxidase activation and the induction of Toll-like receptor (TLR)-4 recruitment into hepatic lipid rafts in nonalcoholic steatohepatitis (NASH) are unclear. We hypothesized that in liver, NADPH oxidase activation is key in TLR4 recruitment into lipid rafts, which in turn up-regulates NF-κB translocation to the nucleus and subsequent DNA binding, leading to NASH progression. Results from confocal microscopy showed that liver from murine and human NASH had NADPH oxidase activation, which led to the formation of highly reactive peroxynitrite, as shown by 3-nitrotyrosine formation in diseased liver. Expression and recruitment of TLR4 into the lipid rafts were significantly greater in rodent and human NASH. The described phenomenon was NADPH oxidase, p47phox, and peroxynitrite dependent, as liver from p47phox-deficient mice and from mice treated with a peroxynitrite decomposition catalyst [iron(III) tetrakis(p-sulfonatophenyl)porphyrin] or a peroxynitrite scavenger (phenylboronic acid) had markedly less Tlr4 recruitment into lipid rafts. Mechanistically, peroxynitrite-induced TLR4 recruitment was linked to increased IL-1β, sinusoidal injury, and Kupffer cell activation while blocking peroxynitrite-attenuated NASH symptoms. The results strongly suggest that NADPH oxidase–mediated peroxynitrite drove TLR4 recruitment into hepatic lipid rafts and inflammation, whereas the in vivo use of the peroxynitrite scavenger phenylboronic acid, a novel synthetic molecule having high reactivity with peroxynitrite, attenuates inflammatory pathogenesis in NASH.
Industry-Generated Charts for the Selection of Stented Aortic Valve Prostheses: Clinical Tool or Marketing Ploy?

In fact, House and coworkers [3] compared data from the Perimount Magna EOAI chart with postoperative echocardiographic data and found that the sensitivity of the Perimount chart for predicting postoperative PPM was only 35%, with a negative predictive valve of only 53%. We created an EOAI valve chart comparing four popular stented aortic bioprostheses utilizing their manufacturers’ instructions for use and premarket approval data, and found each valve’s potential for creating PPM to be more similar than many industry charts would imply (Fig 1) [4‐7]. We also found that the charts were easily altered to confer advantage or disadvantage to one valve over another, by using EOA data from the wide range of hemodynamic valve studies in the surgical literature [8‐10]. Another way to create a favorable EOAI chart is to alter the definitions used to determine mild, moderate, and severe PPM. A recent St. Jude Medical promotion for their Epic stented tissue valve changes the definition of mild or no PPM from more than 0.85 cm 2 /m 2 to more than 0.75 cm 2 /m 2 , and decreases the range of moderate PPM to 0.65 cm 2 /m 2 to 0.75 cm 2 /m 2 . The result is a chart that is almost entirely green, implying a very small likelihood of creating PPM with this brand of valve. The prevention of PPM by calculating the projected indexed EOA should be a routine exercise for each patient undergoing aortic valve replacement with a bioprosthesis. This calculation should be based on EOA data from reputable clinical studies instead of industryprovided charts. Because other factors besides hemodynamic performance must also be taken into account when selecting a bioprosthesis (sizing variability, durability, implantability), it is important that surgeons familiarize themselves with all of the features of a given valve before selecting it for use. Given that there is no industry standard for creating valve charts, that they are constructed with inconsistent data sources and definitions, and that their utility for predicting PPM is controversial at best, surgeons should exercise caution when using them to select one manufacturer’s aortic valve prosthesis over another. These charts are not recognized by either The Society of Thoracic Surgeons or the American Asso
Granuloma annulare and sarcoidosis

Granuloma annulare (GA) and sarcoidosis are two diseases of unknown cause which involve the skin and whose basic pathology is a mononuclear histiocytic cellular reaction. Biopsy plays the major role in the diagnosis of both diseases, and no other routine laboratory test for either disease is currently available. Sarcoidosis is generally considered to be an allergic or immune granuloma with inconstant defects in cell-mediated immunity (Broom & MacLaurin, 1973). There have been no immunological studies of GA. We recently studied 14 cases and found circulating lymphokines (macrophage migration inhibition factor) in 11 which correlated with circulating macrophage migration inhibition factor in sarcoidosis (9 of 10 cases) (Umbert, Belcher & Winkelmann, 1976). The co-existence of GA and sarcoidosis in 5 patients suggests to us that there are very similar immunological reactions as well as pathology in both diseases and that the elucidation of the pathogenesis of one disease should aid in understanding the other. To our knowledge, there are no prior reports of systemic sarcoidosis coexisting with or manifesting the histological picture of GA. In this report we have demonstrated by clinical and histological criteria that GA and sarcoidosis can co-exist.
Fracture Resistance in Multiphase Alloys

The fracture behavior of Nb-based in-situ composites is reviewed to elucidate the effects of alloy additions on the fracture process in multiphase alloys. The overview paper summarizes the current understanding of the processes by which alloying addition and microstructure alter the near-tip deformation and fracture mechanism, and presents a methodology for predicting the fracture toughness of the constituent phases and the composite. The alloying effects observed in Nb-based in-situ composites can be attributed to changes in dislocation mobility in the metallic solid solution matrix that provides ductile phase toughening in the composites. The size, volume fraction, and the continuity of the intermetallic phases dictate the fracture path and impact significantly the facture toughness of the in-situ composites.
Effects of soman on norepinephrine uptake and electrically stimulated release from human uterine arteries

The effects of soman on the uptake and electrically induced release of norepinephrine (noradrenaline) from isolated human uterine artery have been investigated. Soman did not alter the uptake of norepinephrine by human uterine artery, but reduced the electrically induced release of norepinephrine from the artery. This reduced norepinephrine release may augment the fall in blood pressure induced by accumulated acetylcholine stimulating muscarinic receptors following cholinesterase inhibition.
Transient and steady-state radiation response of CMOS/SOS devices

In an investigation to characterize the radiation properties of a pilot line product capability for manufacture of MNOS memory arrays, a CMOS test vehicle proposed as the building block for the array electronics was tested in a nuclear environment. The test device was a CD4007 configuration fabricated with an unhardened SiO 2 gate insulator on a sapphire substrate. Test devices were made with aluminum and silicon gates, and test samples were selected to satisfy the requirement of operating satisfactorily with a source-drain voltage ≤21.5 volts. All tests were conducted with a drain-source voltage of 20 volts and gate biases in the range of 0 to 20 volts. The tests were as follows: (1) transient photo-current, (2) transient annealing, (3) total dose, (4) survivability, and (5) neutrons. Facilities at AFCRL were used for the first four and the Aberdeen Pulse Reactor for the last test. The tests were conducted in the order listed above on different batches of samples for each test.
Unexpected tunneling current from downstream neutral modes

We analyze transport through a quantum point contact in fractional quantum Hall states with counter-propagating neutral edge modes. We show that both the noise (as expected and previously calculated by other authors) and (perhaps surprisingly) the average transmitted current are affected by downstream perturbations within the standard edge state model. We consider two scenarios for downstream perturbations. We argue that the change in transmitted current should be observable in experiments that have shown increased noise.
Lipids of stages in the life-cycle of the cestode Spirometra mansonoides

Abstract The kinds and amounts of the lipids of each stage (egg, coracidium, procercoid, plerocercoid, adult) in the life-cycle of the cestode Spirometra mansonoides , and of environmental lipids, have been examined by combinations of TEAE-cellulose and silicic acid column, silica gel thin-layer and SCOT column gas-liquid chromatography. Major lipids of all stages were triacylglycerols, cholesterol, diphosphatidylglycerol, phosphatidlethanolamine, phosphatidylserine, phosphatidylinositol, and phosphatidylcholine. Minor lipids were sterol esters, fatty acids, benzoquinones, partial glycerides, phosphatidic acid, sphingolipids and lysolipids. Triacylglycerols decreased and cholesterol and phospholipids, particularly diphosphatidylglycerol and phosphatidylcholine, increased during embryo-genesis (egg to coracidium). Neutral and phosphoglycerides had characteristic fatty acyl group patterns irrespective of life-cycle stage, except for procercoid lipids, which were unique in their content of branched and odd-numbered forms. The patterns seen in the total lipids of the various life-cycle stages were qualitatively similar to those of the environments of those stages, but were often quantitatively dissimilar.
C9orf72-Associated FTD/ALS: When Less Is More

Hexanucleotide repeat expansions in C9ORF72 cause neurodegeneration in FTD and ALS by unknown mechanisms. A new report, by Donnelly et al. (2013), finds that these repeats trigger a pathogenic gain-of-function cascade that can be corrected by suppressing expression of the repeat transcript, paving the way for therapeutic strategies aimed at eliminating the toxic RNA.
Fair division as a means of apportioning software engineering class projects

In a junior- or senior-level undergraduate software engineering course that uses real-world projects for real clients, different parts of a project are inherently unequal in difficulty, time requirements, and desirability. A perennial problem is assigning portions of the project to student teams equitably. Fair division is a highly effective strategy for making an equitable, proportional, and envy-free assignment of tasks and in serving as the basis for fair grading of assignments which vary in difficulty, desirability, and time requirements.
The statistical zap versus the shotgun approach

Multivariate analysis is used in the search for one or more types of structure. The statistical zap applies a single method to determine one preselected type of structure. Several zaps suffice to ascertain several types of structure. The statistical shotgun represents an alternative approach. Here, a series of methods is applied to the data with the intent of ascertaining all possible types of structure that may exist. If strong structure is present, an appropriate zap will probably reveal it, and a variety of techniques will determine the same general structure. If only the main structure is required, the zap is adequate. In this situation, the shotgun will display a basic consistency which is at least reassuring. However, zaps may fail to detect a more subtle secondary structure of geological interest which will be displayed by the shotgun. For weakly structured data, a zap will only determine one type of structure but the shotgun reveals all. Study of the ontogeny of Parastylonurus myops(Clarke), a Lower Silurian eurypterid from New York (USA) shows the virtues of the statistical shotgun.
Three-year growth responses of Pinus taeda L. to simulated rain chemistry, soil magnesium status, and ozone

Height, diameter, and biomass were measured for loblolly pine (Pinus taeda L) seedlings grown in soil containing 15 or 35 Μg Mg g−1 and exposed from May to October in 1987, 1988, and 1989 to three O3 concentrations (sub-ambient, ambient, or twice-ambient) and to rain pH levels of 3.8 or 5.2. Reduction in biomass accumulation in seedlings exposed to twice-ambient O3vs sub-ambient O3 was 14% (P = 0.03) in 1987, 11.4% (P = 0.002) by 1988, and 8% (P = 0.15) by 1989. The greatest height growth occurred in seedlings exposed to twice-ambient O3, and the greatest stem diameter growth occurred in seedlings exposed to sub-ambient O3. A comparison of stem volume (d2h) with stem biomass suggested that tissue density was reduced by elevated O3. Biomass accumulation response to rainfall chemistry was small (5.5% reduction in the low pH treatment in 1989) and not statistically significant for most plant tissues. Growth response to soil Mg status was not significant. Hoewever, in 1989 treatment interactions between rainfall chemistry and soil Mg status were observed. Height was 5% greater (P = 0.02) and biomass was 6% greater (P = 0.10) in seedlings grown in higher-Mg soil and receiving higher-pH rainfall than seedlings grown in any of the other pH-Mg treatment combinations. The data suggest direct adverse effects of near ambient O3 and indirect, slower acting and interacting adverse effects of rainfall chemistry and soil nutrient status on growth of loblolly pine.
Capacity Building: A New Focus for Collaborative Approaches to Community-Based Suburban Deer Management?

Increasing human-wildlife interactions in urban and suburban environments have created new challenges for management agencies as residents seek to become more involved in the decision-making process. White-tailed deer (Odocoileus virginianus) management may best illustrate both the challenges and the opportunities that exist in human-dominated environments. In these settings wildlife managers are increasingly being expected to engage stakeholders in identifying objectives and implementing management actions tailored to local needs and circumstances. We argue that successful management in these environments is closely related to several attributes of the stakeholder involvement process. Thus, additional theoretical developments and more empirical research will be needed to help managers facilitate community-based decision-making processes that are truly collaborative. We believe the next frontier for continued advancement and increased community and agency satisfaction with suburban deer management is improving local knowledge and leadership. We contend this can best be done through comprehensive intervention programs. In this paper we draw on the body of wildlife agency collaborative management process research to identify and describe the role of knowledge and local leadership in collaboration.
Regulation of the G2/M transition in oocytes of xenopus tropicalis.

Abstract The molecular events regulating hormone-induced oocyte activation and meiotic maturation are probably best understood in Xenopus laevis. In X. laevis, progesterone activates the G2-arrested oocyte, induces entry into M phase of meiosis I (MI) and resumption of the meiotic cell cycles, and leads to the formation of a mature, fertilizable egg. Oocytes of Xenopus tropicalis offer several practical advantages over those of X. laevis, including faster and more synchronous meiotic cell cycle progression, less seasonal variability, and the availability of transgenic approaches. Previous work found several similarities in the pathways regulating oocyte maturation in the two species. Here, we report several additional ones that are conserved in X. tropicalis. (1) Injection of Mos mRNA into G2-arrested oocytes activates the MAP kinase cascade and induces the G2/MI transition. (2) Injection of the β subunit of the kinase CK2 (a negative regulator of Mos and oocyte activation) delays the G2/MI transition. (3) Elevating PKA activity blocks progesterone-induced maturation; repressing PKA activity induces entry into MI in the absence of progesterone. (4) LF (anthrax lethal factor), which cleaves certain MAP kinase kinases, strongly reduces both the rate and extent of entry into MI. In contrast to the one previously reported major difference between oocytes of the two species, we find that injection of egg cytoplasm (“MPF activity”) into G2-arrested X. tropicalis oocytes induces entry into meiosis I even when protein synthesis is blocked, just as it does in oocytes of X. laevis. These results indicate that much of what we have learned from studies of X. laevis oocytes holds for those of X. tropicalis, and suggest that X. tropicalis oocytes offer a good experimental system for investigating certain questions that require a rapid, synchronous progression through the G2/meiosis I transition.
The value of [14C]iphenyl acetic dipalmitate (PADP) as a test for maldigestion

Abstract [ 14 C]phenyl acetic dipalmitate (PADP) was prepared and evaluated in vitro and in vivo . Upon incubation with lipase it was hydrolyzed into phenyl acetic acid and monoglycerides. Phenyl acetic acid is not metabolized by the body and is quantitatively excreted in urine. When tested in rats there was no tissue deposition of the 14 C label in any of the organs studied. There was also no evidence of absorption from the colon. The newly prepared compound was evaluated in 15 human volunteers and 24 patients with chronic pancreatitis and compared to fecal fat and d -xylose. Normal volunteers had a urinary excretion of 34.5 ± 6.4% of the administered 14 C label in 5h. Both fecal fat and PADP were abnormal in 16 of 20 patients with chronic pancreatitis. They were both normal in two, while in two other patients fecal fat was normal and PADP abnormal. Both of the latter patients had clinical evidence of steatorrhea but reduced oral intake due to pain. d -xylose was abnormal in five patients presumably due to bacterial overgrowth. Our findings indicate that PADP is a simple, accurate and rapid test for pancreatic function; is not dependent on fat intake and may be run concomitantly with d -xylose.
Distributed primate cognition: a review

A model of "distributed cognition" is contrasted with the "mental representation" model exemplified by Tomasello and Call's Primate Cognition. Rather than using behavior as a basis for inferences to invisible mental events such as intentions, the distributed approach treats communicative interactions as, themselves, directly observable cognitive events. Similar to a Vygotskian approach, this model characterizes cognition as "co-constructed" by the participants. This approach is thus particularly suitable for studying primates (including humans), whose reliance on multiparty negotiations can undermine the researcher's ability to extrapolate from observable outcomes back to individual intentions. Detailed (e.g., frame-by-frame) analyses of such interactions reveal cross-species differences in the relevant media of information flow (e.g., behavioral coordination, relative gaze) as well as in the flexibility and complexity of the trajectories observed. Plus, with its focus on dynamics, the distributed approach is especially useful for modeling developmental and evolutionary processes. In discussing enculturation and the ontogeny of imitation, its emphasis is on changes in how expert and novice participate in such events, rather than how either may represent them. Primate cognitive evolution is seen as involving changes in context sensitivity, multi-tasking, and the coordination of social attention. Humans in particular – in, especially, the context of teaching – are seen as having specialized in linking co-perception with the refined sensory-motor coordination that enables them to translate observed behavior into strategically similar action. Highlighting the continuity between human and nonhuman development, this promising, complementary model enables us to tap the richness of micro-ethology as a cognitive science.
Experimental renal papillary necrosis in the Syrian hamster.

Abstract These studies evaluate the susceptibility of the Syrian hamster to the induction of renal papillary lesions after exposure to 2-bromoethylamine (2-BEA), mefenamic acid, indomethacin, acetaminophen and phenylbutazone. In most cases there were 25 animals per dose group. Papillary necrosis was produced by single or multiple ip doses of 75 mg 2-BEA/kg and above, and was present within 12 hr of administration of a dose of 500 mg/kg body weight. There were lesions in the renal papilla of hamsters 10 days after a single dose of 500 mg 2-BEA/kg. The severity of papillary lesions increased up to 4 days after exposure in hamsters given a single dose of either 250 or 500 mg 2-BEA/kg. The severity of papillary lesions did not increase with the number of doses in hamsters given multiple doses (2–5) of 100 mg 2-BEA/kg. Renal papillary necrosis was observed in about 40% of hamsters given 100, 200 or 400 mg mefenamic acid/kg. Only a few of the hamsters given indomethacin had renal papillary lesions and none of those given acetaminophen (up to 400 mg/kg) or phenylbutazone (up to 600 mg/kg) developed renal papillary lesions.