cssi/SciSciGPT-SciSciNet huggingface dataset:
Particle Filters With Adaptive Resampling Technique Applied to Relative Positioning Using GPS Carrier-Phase Measurements

Particle filters are widely used when the system is nonlinear and non-Gaussian. In real-time applications, their estimation accuracy and efficiency are significantly affected by the number of particles. For a multivariate state, the appropriate number of particles is estimated adaptively for bounds on the error of the sample mean and variance that are given by the confidence range of a normal distributed probability. The resampling time is determined when the required sample number maintaining the variance accuracy becomes greater than the required sample number maintaining the mean accuracy. The Particle Filter with adaptive resampling is applied to the relative position estimation using GPS carrier-phase measurements. We estimate the probability density function of the position by sampling from the position space with the particle filter and resolve the ambiguity problem without any integer ambiguity search procedures. The adaptive resampling manages the number of position samples for real-time kinematics GPS navigation. The experimental results show the performance of the adaptive resampling technique and the insensitivity of the proposed approach to GPS carrier-phase cycle-slips.
Injectable and implantable antiretroviral strategies for HIV prevention

Antiretroviral preexposure prophylaxis has huge potential for reducing the rates of new HIV infections in at risk populations. Oral and vaginal antiretroviral formulations have been evaluated in multiple Phase IIB and Phase III effectiveness trials and there is clear evidence that these products work when used. The converse is also true; antiretrovirals do not work when they are not used and unfortunately adherence is a problem for both HIV treatment and prevention. As a consequence, long-acting injectable and implantable antiretroviral formulations are being developed for the treatment and prevention of HIV infection. It is hoped they will reduce the burden of product adherence associated with the use of oral and topical products and improve clinical outcomes associated with their use. The purpose of this review is to summarize recent preclinical and clinical research in this area of HIV prevention.
Nanofabrication of ultra-low reflectivity black silicon surfaces and devices (Presentation Recording)

Optical devices with features exhibiting ultra low reflectivity on the order of 10-7 specular reflectance in the visible spectrum are required for coronagraph instruments and some spectrometers employed in space research. Nanofabrication technologies have been developed to produce such devices with various shapes and feature dimensions to meet these requirements. Infrared reflection is also suppressed significantly with chosen wafers and processes. Particularly, devices with very high (>0.9) and very low reflectivity (<10-7) on adjacent areas have been fabricated and characterized. Significantly increased surface area due to the long needle like nano structures also provides some unique applications in other technology areas. We present some of the approaches, challenges and achieved results in producing and characterizing such devices currently employed in laboratory testbeds and instruments.
Improving Patient Care Through Medical Image Perception Research

The interpretation of medical images across medical specialties is critical to patient care. As technology changes, so does health care, and clinicians today are increasingly viewing medical images...
From State Rule to Practice: How ESOL Push-in Looks Like in the Classroom

K-12 English Learners (ELs) in Georgia increased by 13.4% from 2010 to 2013, with an average annual growth rate of 4.28% (GaDOE Student Record) in contrast to the 1.95% in total K-12 population, inclusive of ELs, with an average annual growth rate of 0.65% from 2010 to 2013. There is little question that if this trend continues, all teachers will soon have an EL in their classrooms; hence it is critical that all teachers have the skills to be successful with ELs who come from different cultural backgrounds and have varying levels of English language proficiency. Moreover, the implementation of the Common Core State Standards, which requires K–12 districts and schools to establish common goals and shared ownership of curriculum and instruction to successfully reach all learners, including ELs, makes collaborative partnership between content and ESOL teachers on how best to meet the needs of their EL students undoubtedly crucial. Collaborative teaching between ESOL and content teachers is a promising practice in K-12 classrooms because it ensures access to the core content curriculum and language proficiency standards-based instruction for English Learners. Teachers will develop lesson plans and create
Politiques macroéconomiques et croissance à long terme: Étude théorique et empirique

Le present document expose les aspects theoriques et empiriques de la relation entre les politiques macroeconomiques et le taux de croissance a long terme du PNB. Les politiques macroeconomiques examinees ici sont les politiques budgetaire, monetaire et de taux d`interet, la politique du secteur exterieur et la politique de reforme des marches des biens et des services, y compris les ajustements des prix a la production et des salaires. En regle generale, ces politiques ont une incidence directe sur la croissance ou une incidence indirecte qui s`exerce par le biais aussi bien de l`investissement en capital physique et humain, que de la productivite des facteurs. Les preuves empiriques disponibles confirment les effets de politiques macroeconomiques et financieres specifiques sur la croissance a long terme.
Amphiphilic Silica Nanoparticles at the Decane−Water Interface: Insights from Atomistic Simulations

The properties of 3 nm-diameter silica nanoparticles with different surface chemistry were systematically investigated at the decane−water interface using molecular dynamics simulations. Our results show that the decane−water interfacial tension is not much influenced by the presence of the nanoparticles. The three-phase contact angle increases with nanoparticle surface hydrophobicity. Contact angles observed for the nanoparticles at 300 and at 350 K differ very little. The contact angle of the nanoparticle with randomly dispersed hydrophobic groups is smaller than that observed in Janus nanoparticles of equal overall surface chemistry composition. The energy necessary to desorb Janus nanoparticles from the interface is usually higher than that required to desorb the corresponding homogeneous nanoparticles. Desorption from the interface into the aqueous phase is preferred over that into the organic phase for all except one of the nanoparticles considered. Structural and dynamic properties including nanopa...
Reduced lysosomal acid lipase activity – A potential role in the pathogenesis of non alcoholic fatty liver disease in pediatric patients

Abstract Background Within the spectrum of nonalcoholic fatty liver disease (NAFLD), recent evidence suggests that adult patients with nonalcoholic steatohepatitis (NASH) have significantly lower blood lysosomal acid lipase (LAL) activity than those with steatosis. This has not been studied in pediatric patients with NAFLD. Aim Investigate blood LAL activity in pediatric patients with NAFLD and assess its correlation with histological severity. Methods We collected data on consecutive children with biopsy-proven NAFLD including demographics, anthropometrics, and routine laboratory tests. The histological features were graded according to the NAFLD activity scoring proposed by Kleiner et al. Blood LAL activity was measured prospectively using Lalistat 2. Results A total of 168 children were included for analysis. Mean age was 12.6 ± 8.5 years, 60.1% were males and 52.4% had NASH. Children with significant fibrosis (stage 2–3, n = 64) had a significantly lower LAL activity compared to those with mild fibrosis (stage 0–1, n = 104). There was no significant difference in LAL activity between children with NASH compared to those without NASH. Conclusion Reduced blood LAL activity correlates with severity of liver fibrosis in children with NAFLD indicating a potential role of reduced LAL activity in the pathogenesis of NAFLD-induced fibrosis.
Discussion, Managerial Implications, Current and Future Research

The purpose of this chapter is to join the findings from the descriptive and content analyses in order to highlight the main insights from the study, the managerial implications and discuss some of the most recent research that tries to tackle emerging gaps in the literature while proposing an agenda for future research in the field.
Syncope in the Athlete

Publisher Summary Over the past half century, anecdotal reports have described common experiences of dizziness, nausea, and symptoms of syncope in endurance-trained athletes. However, the mechanisms underlying syncope in athletes are unclear. Early cross-sectional investigations demonstrated that lower orthostatic tolerance was associated with greater venous compliance in the legs of athletes as compared to nonathletes. Syncope in athletes occurs in a few high-endurance trained individuals. It is important that the predisposition to syncope in a few elite athletes not detract from the health benefits to be gained by sedentary individuals who undertake aerobic exercise programs. The phenomenon of syncope in the elite athlete most likely represents a mechanical change in the cardiovascular system that benefits the athlete during exercise and should not be interpreted as a clinical abnormality.
Transitional Urology for Male Adolescents: What Adult Urologists Should Know

In recent years, there has been increasing interest in transitional urology, or how to best prepare patients with major congenital urologic diseases, such as bladder exstrophy and neuropathic bladder, to manage their own health care with adult urologists. However, common pediatric urologic conditions may be encountered by the adult urologist with more regularity. This review focuses on three relatively common conditions which may be identified in childhood, the consequences from which a patient may seek help from an adult urologist: cryptorchidism, varicocele, and Klinefelter syndrome.
Using a Constant Family in Role-Plays for Training MFTs

ABSTRACTMarriage and Family Therapy training programs use role-plays and simulations to train their students in interviewing skills and in various therapeutic models. A review of literature shows that these training tools do not allow student-therapists to experience therapy beyond the first session. This article presents a modified version of the role-play, in which a constant family is used in preparing student-therapists for clinical work. This article describes a training scenario using the constant family role play and includes feedback from student-therapists. The authors present the benefits, limitations, and potential training considerations that can enhance use of the constant family role play.
Structural and Practical Identifiability Issues of Immuno-Epidemiological Vector–Host Models with Application to Rift Valley Fever

In this article, we discuss the structural and practical identifiability of a nested immuno-epidemiological model of arbovirus diseases, where host–vector transmission rate, host recovery, and disease-induced death rates are governed by the within-host immune system. We incorporate the newest ideas and the most up-to-date features of numerical methods to fit multi-scale models to multi-scale data. For an immunological model, we use Rift Valley Fever Virus (RVFV) time-series data obtained from livestock under laboratory experiments, and for an epidemiological model we incorporate a human compartment to the nested model and use the number of human RVFV cases reported by the CDC during the 2006–2007 Kenya outbreak. We show that the immunological model is not structurally identifiable for the measurements of time-series viremia concentrations in the host. Thus, we study the non-dimensionalized and scaled versions of the immunological model and prove that both are structurally globally identifiable. After fixing estimated parameter values for the immunological model derived from the scaled model, we develop a numerical method to fit observable RVFV epidemiological data to the nested model for the remaining parameter values of the multi-scale system. For the given (CDC) data set, Monte Carlo simulations indicate that only three parameters of the epidemiological model are practically identifiable when the immune model parameters are fixed. Alternatively, we fit the multi-scale data to the multi-scale model simultaneously. Monte Carlo simulations for the simultaneous fitting suggest that the parameters of the immunological model and the parameters of the immuno-epidemiological model are practically identifiable. We suggest that analytic approaches for studying the structural identifiability of nested models are a necessity, so that identifiable parameter combinations can be derived to reparameterize the nested model to obtain an identifiable one. This is a crucial step in developing multi-scale models which explain multi-scale data.
A Forgotten Episode in the History of the Secular Acceleration: William Whiston, Arthur Ashley Sykes and the Eclipse of Phlegon

In 1734 William Whiston published Six Dissertations dealing with biblical history and astronomical chronology. Tucked away in a long discussion of the calculation of ancient eclipses, Whiston referred to Halley’s discovery of the moon’s secular acceleration, remarking that “This I have all along esteemed one of Dr. Halley’s greatest Discoveries in Astronomy”, and provided an estimate of the correction to be applied to the calculation of the time of syzygy on account of the moon’s secular acceleration, the first ­correction for the secular acceleration to appear in print. Whiston’s discussion of the secular acceleration was presented within an ongoing acri­monious dispute between Whiston and Arthur Ashley Sykes, a Cambridge educated clergyman and prolific writer of controversial religious pamphlets, over whether the eclipse reported by Phlegon should be associated with the darkness during Christ’s crucifixion, and appears to have passed other astronomers by without making any impression. As we will see, only one other scholar, George Costard made any reference to Whiston’s discussion of the secular acceleration, which quickly became a forgotten episode in the history of its study, missing from all later (and contemporary) accounts of the subject.
Polymer cloaking modulates the carbon nanotube protein corona and delivery into cancer cells

Carbon nanotube-based molecular probes, imaging agents, and biosensors in cells and in vivo continue to garner interest as investigational tools and clinical devices due to their unique photophysical properties. Surface chemistry modulation of nanotubes plays a critical role in determining stability and interaction with biological systems both in vitro and in vivo. Among the many parameters that influence the biological fate of nanomaterials, surface charge is particularly influential due to direct electrostatic interactions with components of the cell membrane as well as proteins in the serum, which coat the nanoparticle surface in a protein corona and alter nanoparticle–cell interactions. Here, we modulated functional moieties on a helical polycarbodiimide polymer backbone that non-covalently suspended the nanotubes in aqueous media. By derivatizing the polymer with either primary amine or carboxylic acid side chains, we obtained nanotube complexes that present net surface charges of opposite polarity at physiological pH. Using these materials, we found that the uptake of carbon nanotubes in these cells is highly dependent on charge, with cationic nanotubes efficiently internalized into cells compared to the anionic nanotubes. Furthermore, we found that serum proteins drastically influenced cell uptake of the anionic nanotubes, while the effect was not prominent for the cationic nanotubes. Our findings have implications for improved engineering of drug delivery devices, molecular probes, and biosensors.
John Lydus’ knowledge of Latin and language politics in sixth-century Constantinople

This article contextualizes an old debate about the extent of knowledge of Latin by John Lydus, a state official and an erudite from sixth-century Constantinople, within a broader issue of the role of Latin in early Byzantium. It is argued here that Lydus’ startling etymological explanations had no relation to his level of knowledge of Latin, but reflected the declining official use of Latin in Byzantium by resurrecting the theory about Latin as a dialect of Greek.
Use of Vessel-Sealing Devices during Vaginal Hysterectomy

Abstract Study Objective To demonstrate the proper use of vessel-sealing devices during vaginal hysterectomy. Design Educational video (Canadian Task Force classification level III). Setting University hospital. Intervention The video reviews the principles on the use of energy in minimally invasive surgery. We focus on how vessel-sealing devices function and the benefits of their use in difficult vaginal hysterectomy. The video explains the 2 major types of complications, inadequate vessel sealing and undesired thermal injury, and demonstrates techniques to avoid these complications. Measurements and Main Results Laboratory, intraoperative, and cadaveric recordings demonstrate proper use and the complications that may arise in the setting of improper use. Conclusion Vessel-sealing devices may be a useful tool for surgeons performing vaginal hysterectomy. This video demonstrates their use and underlines the importance of understanding the principles of energy devices and their proper usage in surgery.
Market characteristics associated with community health assessments by local health departments

Abstract Objectives Community health assessments (CHAs) have been promoted as a strategy for population health. This study uses the resource dependence theory (RDT) to examine how external market characteristics are associated with CHAs conducted by local health departments (LHDs) and subsequent partnering with hospitals for CHAs in the United States. Study design The RDT was used to guide the conceptualization of the market in the context of local public health. RDT emphasizes that organizations are not in control of all the resources they need and, to some extent, must rely on the external environment to provide those necessary resources. Binary measures were used to examine whether LHDs conducted CHAs and whether they did so in partnership with a local hospital. Independent variables were identified to measure the RDT constructs of munificence (resource availability in the environment), complexity (level of heterogeneity), and dynamism (level of environmental turbulence). Methods Bivariate (Chi-squared and t-tests) and multivariate (logistic regression) cross-sectional analyses were conducted using secondary data from the National Association of County and City Health Officials 2013 Profile Survey, the 2013 County Health Rankings data set, and the Health Resources and Services Administration's Area Health Resource File. Results Two of three variables measuring munificence were positively associated with having conducted a CHA; one variable was also related to doing so in conjunction with a local hospital. One measure of market complexity was negatively associated with having conducted a CHA. No measure of dynamism was related to the dependent variables. Conclusions Study results provide partial support for the use of RDT in understanding the relationship between market factors and LHDs' activities around CHAs. Local hospitals as partners and other market factors should be considered by LHDs when conducting CHAs. Findings from this work will be of interest to public health practitioners, policy-makers, and researchers interested in public health and population health improvement.
Collaborative PCK in Practice: Bringing Together Secondary, Tertiary, and Informal Learning in a STEM Residency Program

In this chapter, the authors discuss the potential, value, and barriers to supporting PCK in the science, technology, engineering, and math (STEM) disciplines through collaborations across learning settings, with special attention to the role of informal science learning institutions in preservice teacher preparation. Particular focus is provided on the National Science Foundation (NSF)-funded Math and Science Teacher Education Residency (MASTER) program for teacher preparation. MASTER is a collaborative among the New York Hall of Science, Hunter College School of Education, and the New York City Department of Education through New Visions for Public Schools.
Age and height trajectories of exhaled nitric oxide in schoolchildren

Introduction: Exhaled nitric oxide (FeNO), produced by inducible nitric oxide synthase in airway epithelial cells, is a marker of airway inflammation used in clinical care and research. Sex, age, and height associations with FeNO during the period of somatic growth have been explained by differences in lung size. These studies are primarily based on cross-sectional data (e.g., Jacinto, T. et al. J Breath Res 2015; 9(3):036005), with little longitudinal data reported. Aims: Describe trajectories of FeNO as a function of sex, age, and height in schoolchildren. Methods: 50 ml/s FeNO was collected longitudinally in a population-based sample of 1806 southern California schoolchildren without asthma (starting at ages 7-9), with 6 visits over 8 years. Smooth sex-specific trajectories of log FeNO versus height or age were estimated using a generalized additive mixed model, with participant-level random intercepts. Results: 55% of participants had 5+ measurements of FeNO. Trajectories were different for males and females, with linear trajectories in height (Figure 1). Nonlinear trajectories in age were similar by sex until age ~11.5, after which boys had higher FeNO. Conclusions: FeNO trajectories estimated using longitudinal data provide novel evidence of sex differences after age 11 and nonlinearity prior to age 14. Future efforts will investigate joint effects of age and height.
Witnessing bullying at school: the association between being a bystander and anxiety and depressive symptoms

It is well documented that bullying victimization and perpetration are associated with mental health problems, including anxiety and depressive symptoms. Although the majority of students report witnessing bullying as bystanders, very few studies have investigated whether negative consequences associated with bullying extend beyond targets and perpetrators to students who are bystanders. The present study examined the association between witnessing bullying and anxiety and depressive symptoms among middle school students. Middle school students (N = 130; grades 6th through 8th) completed questionnaires assessing experiences as a bystander, target, and perpetrator of bullying, as well as anxiety and depressive symptoms. Hierarchical regression analyses were conducted to determine whether bystander status was associated with anxiety and depressive symptoms over and above the effects of victimization and perpetration and to examine bullying victimization and perpetration as moderators of these relationships. Analyses indicated being a bystander was associated with higher levels of anxiety (β = .40, p < .001) and depressive symptoms (β = .37, p < .001) even after controlling for frequency of being a target or perpetrator of bullying. Bystanders who were also targets of bullying reported the highest level of depressive symptoms; however, being a target of bullying did not moderate the relationship between being a bystander and anxiety. Furthermore, bullying perpetration did not moderate the relationship between being a bystander and anxiety or depressive symptoms. Findings indicate witnessing bullying uniquely contributes to anxiety and depressive symptoms for middle school students. For student bystanders who are also targets of bullying, depressive symptoms may be particularly high due to co-victimization or re-victimization experienced when witnessing bullying.
Technology for Behavioral Change in Rural Older Adults with Obesity.

AbstractBackground: Mobile health (mHealth) technologies comprise a multidisciplinary treatment strategy providing potential solutions for overcoming challenges of successfully delivering health pr...
Practicing Music by Design: Historic Virtuosi on Peak Performance

Practicing Music by Design: Historic Virtuosi on Peak Performance explores pedagogical practices for achieving expert skill in performance. It is an account of the relationship between historic practices and modern research, examining the defining characteristics and applications of eight common components of practice from the perspectives of performing artists, master teachers, and scientists. The author presents research past and present designed to help musicians understand the abstract principles behind the concepts. After studying Practicing Music by Design, students and performers will be able to identify areas in their practice that prevent them from developing. The tenets articulated here are universal, not instrument-specific, borne of modern research and the methods of legendary virtuosi and teachers. Those figures discussed include: Luminaries Franz Liszt and Frederic Chopin Renowned performers Anton Rubinstein, Mark Hambourg, Ignace Paderewski, and Sergei Rachmaninoff Extraordinary teachers Theodor Leschetizky, Rafael Joseffy, Leopold Auer, Carl Flesch, and Ivan Galamian Lesser-known musicians who wrote perceptively on the subject, such as violinists Frank Thistleton, Rowsby Woof, Achille Rivarde, and Sydney Robjohns Practicing Music by Design forges old with new connections between research and practice, outlining the practice practices of some of the most virtuosic concert performers in history while ultimately addressing the question: How does all this work to make for better musicians and artists?
Infant, Maternal, and Neighborhood Predictors of Maternal Psychological Distress at Birth and Over Very Low Birth Weight Infants' First Year of Life.

OBJECTIVE To use a social-ecological conceptualization to analyze change of maternal distress, defined as depression, anxiety, and perinatal-specific post-traumatic stress (PPTS), across very low birth weight (VLBW) infants' first year of life and to identify infant, maternal, and neighborhood predictors of these changes over time. METHODS Mothers of VLBW infants (n = 69) completed psychological distress questionnaires 2 to 4 weeks after infant birth, 2 weeks before infant discharge from neonatal intensive care unit, and at infants' 4- and 8-month corrected age (age adjusted for prematurity). Infant and maternal sociodemographic data were collected from medical chart review. Neighborhood data were obtained through US census data. Multilevel linear growth modeling was used to (1) predict unstandardized estimates of mothers' initial levels of depression, anxiety, and PPTS at the time of infant's birth and the rate of change of these markers of distress over time and (2) model unstandardized estimates of infant, maternal, and neighborhood as predictors of distress at infants' birth and change over time. RESULTS Unstandardized estimates from multilevel linear growth modeling revealed depression (-2.8), anxiety (-1.4), and PPTS (-0.7) declined over infants' first year of life (<0.001). Mothers residing in lower-income homes and neighborhoods, respectively, reported lower anxiety (-11.2, p = 0.03) and PPTS (-31.1, p = 0.01) at infant birth. Greater infant birth weight predicted both lower anxiety (-0.02, p = 0.02) and lower PPTS (-0.02, p = 0.005). CONCLUSION Mothers psychologically recover over VLBW infants' first year of life. Results add to a building literature about socioeconomically disadvantaged mothers of preterm infants, reporting lower distress; this warrants additional research.
Patient-Specific Explanations for Predictions of Clinical Outcomes.

Background Machine learning models that are used for predicting clinical outcomes can be made more useful by augmenting predictions with simple and reliable patient-specific explanations for each prediction. Objectives This article evaluates the quality of explanations of predictions using physician reviewers. The predictions are obtained from a machine learning model that is developed to predict dire outcomes (severe complications including death) in patients with community acquired pneumonia (CAP). Methods Using a dataset of patients diagnosed with CAP, we developed a predictive model to predict dire outcomes. On a set of 40 patients, who were predicted to be either at very high risk or at very low risk of developing a dire outcome, we applied an explanation method to generate patient-specific explanations. Three physician reviewers independently evaluated each explanatory feature in the context of the patient's data and were instructed to disagree with a feature if they did not agree with the magnitude of support, the direction of support (supportive versus contradictory), or both. Results The model used for generating predictions achieved a F1 score of 0.43 and area under the receiver operating characteristic curve (AUROC) of 0.84 (95% confidence interval [CI]: 0.81–0.87). Interreviewer agreement between two reviewers was strong (Cohen's kappa coefficient = 0.87) and fair to moderate between the third reviewer and others (Cohen's kappa coefficient = 0.49 and 0.33). Agreement rates between reviewers and generated explanations—defined as the proportion of explanatory features with which majority of reviewers agreed—were 0.78 for actual explanations and 0.52 for fabricated explanations, and the difference between the two agreement rates was statistically significant (Chi-square = 19.76, p-value Conclusion There was good agreement among physician reviewers on patient-specific explanations that were generated to augment predictions of clinical outcomes. Such explanations can be useful in interpreting predictions of clinical outcomes.
Financial Advisor Titles: Informational Complexity and the Role of Regulatory Simplification

Today's complex financial markets require high levels of financial literacy that most consumers do not possess. Consumers may choose to mitigate their information disadvantage by hiring a financial professional. In searching for such a professional, however, consumers will find a multitude of financial advising titles that may or may not signal competence, education, and professionalism. Various regulatory bodies, and piecemeal regulation over the past 80 years, have resulted in an incoherent code of law. Two narrow protections for senior citizens specifically address financial credentials, however. These model regulations were drafted by the National Association of Insurance Commissioners (NAIC) and the North American Securities Administrators Association (NASAA) in 2008. This commentary explores why some states have adopted these regulations while others have not and notes the need for research to systematically evaluate the effectiveness of such regulations.
Ontological analyses reveal clinically-significant clear cell renal cell carcinoma subtypes with convergent evolutionary trajectories into an aggressive type

Abstract Background Clear cell renal cell carcinoma (ccRCC) is a particularly challenging tumor type because of its extensive phenotypic variability as well as intra-tumoral heterogeneity (ITH). Clinically, this complexity has been reduced to a handful of pathological variables such as stage, grade and necrosis, but these variables fail to capture the breadth of the disease. How different phenotypes affect patient prognosis and influence therapeutic response is poorly understood. Extensive ITH illustrates remarkable plasticity, providing a framework to study tumor evolution. While multiregional genomic analyses have shown evolution from an ancient clone that acquires metastatic competency over time, these studies have been conducted agnostic to morphological cues and phenotypic plasticity. Methods We established a systematic ontology of ccRCC phenotypic variability by developing a multi-scale framework along three fundamental axes: tumor architecture, cytology and the microenvironment. We defined 33 parameters, which we comprehensively evaluated in 549 consecutive ccRCCs retrospectively. We systematically evaluated the impact of each parameter on patient outcomes, and assessed their contribution through multivariate analyses. We measured therapeutic impact in the context of anti-angiogenic therapies. We applied dimensionality reduction by t-distributed stochastic neighbor embedding (t-SNE) algorithms to tumor architectures for the study of tumor evolution superimposing tumor size and grade vectors. Evolutionary models were refined through empirical analyses of directed evolution of tumor intravascular extensions, and metastatic competency (as determined by tumor reconstitution in a heterologous host). Findings We discovered several novel ccRCC phenotypes, developed an integrated taxonomy, and identified features that improve current prognostic models. We identified a subset of ccRCCs refractory to anti-angiogenic therapies. We developed a model of tumor evolution, which revealed converging evolutionary trajectories into an aggressive type. Interpretation This work serves as a paradigm for deconvoluting tumor complexity and illustrates how morphological analyses can improve our understanding of ccRCC pleiotropy. We identified several subtypes associated with aggressive biology, and differential response to targeted therapies. By analyzing patterns of spatial and temporal co-occurrence, intravascular tumor extensions and metastatic competency, we were able to identify distinct trajectories of convergent phenotypic evolution.
Is healthcare caring in Hawai'i? Preliminary results from a health assessment of lesbian, gay, bisexual, transgender, questioning, and intersex people in four counties.

This paper presents findings from a statewide needs assessment of lesbian, gay, bisexual, transgender, questioning, and intersex (LGBTQI) people in Hawai‘i that relate to health status and health-related risk factors such as having health insurance coverage, having a regular doctor, experiencing sexual orientation (SO) or gender identity/expression (GI/E) discrimination in health/mental health care settings, and delaying care due to concerns about SO and GIE discrimination in Hawai‘i, Honolulu, Kaua‘i, and Maui counties. Results suggest that LGBTQI people in these counties generally rated their self-assessed health as “very good” or “excellent,” but had slightly higher rates of smoking and less health insurance coverage than the general population of Hawai‘i. Many respondents reported challenges to their health, and negative experiences with healthcare. Unlike prior studies that have shown no difference or a rural disadvantage in care, compared to urban locations, Hawai‘i's counties did not have a clear rural disadvantage. Honolulu and Kaua‘i Counties demonstrated better health indicators and lower percentages of people who had delayed care due to gender identity concerns. Findings suggest that health/mental health care providers should address potential bias in the workplace to be able to provide more culturally competent practice to LGBTQI people in Hawai‘i.
Efficacy and safety of cap-assisted endoscopic mucosal resection of ileocecal valve polyps

Background and study aims Standard endoscopic mucosal resection (EMR) of ileocecal valve (ICV) polyps is challenging. Cap-assisted endoscopic mucosal resection (C-EMR) can be performed when polyps are not easily amenable to standard EMR. Current literature is limited regarding its efficacy and safety for ICV polyps. The objectives of this study were to assess the efficacy and safety of C-EMR for ICV polyps. Patients and methods A retrospective review was conducted from September 2008 to November 2018 at a tertiary care center. Patients included in the study underwent C-EMR for ICV polyps by a single gastroenterologist (LHJ). Polyps were successfully eradicated if they were removed en-bloc as confirmed by pathology, or had a negative biopsy on follow-up colonoscopy. Outcomes of the procedures were evaluated, including complete adenoma clearance and adverse events. Results Twenty-one ICV polyps were removed with C-EMR. Median polyp size was 15 mm (range, 5–45). The rate of complete adenoma clearance was 100 %. Procedure-related complications occurred in five patients (24 %): delayed GI bleeding (4.8 %) and deep mucosal resection/visible vessel (14.3 %). Three patients had subsequent surveillance colonoscopies at 8, 56, and 67 months, respectively. The third patient was found to have a 6-mm flat polyp at the edge of the previous polypectomy site. This was treated with C-EMR and repeat colonoscopy 6 months later did not show residual. Conclusion C-EMR is highly effective in treating ICV polyps with a low complication rate. It is our suggested method in approaching ICV polyps that are difficult to remove via standard freehand snare EMR technique.
ADJUVANT TREATMENT OF OCD LESIONS OF THE KNEE WITH BONE STIMULATORS

Background:Recently, bone stimulators have been increasingly used for fracture care, particularly in the context of delayed healing and nonunions. Bone stimulation provides upregulation of osteogen...
FDG-PET Versus PSMA-PET: A Patient With Prostate Cancer:

A 64-year old male presented to the hospital with a 1-week history of stools with bright red blood. Subsequent colonoscopy with a biopsy revealed a low-lying, moderately differentiated, rectal adenocarcinoma. A pelvic magnetic resonance imaging done afterwards showed a possible T3N1 rectal cancer with intact muscularis mucosa and a singular presacral lymph node enlargement. Furthermore, a suspicious peripheral prostatic enlargement and a possible left iliac crest sclerotic bone lesion were incidentally identified. 18F-FDG (fluorodeoxyglucose) PET (positron emission tomography) scan confirmed a primary FDG avid rectal tumor and a presacral lymph node; however, there was no prostate or iliac crest uptake. A serum prostate-specific antigen performed in the hospital returned with a value of 37 ng/mL, which prompted a prostate biopsy, eventually returning as positive for adenocarcinoma. Consequently, a 68Ga-PSMA PET scan to rule out possible metastatic prostate disease revealed increased PSMA expression in the prostate only. After consultation with the radiologist and nuclear medicine physician who concluded the iliac crest lesion is likely not cancerous, the final diagnosis of T3N1 rectal cancer with simultaneous high-grade prostate adenocarcinoma was declared. This case highlights the low sensitivity of 18F-FDG PET scans for prostate cancer, the need for routine serum prostate-specific antigen screening, and the progression of 68Ga-PSMA PET as a diagnostic tool for prostate cancer.
Quantifying the dynamic nature of vagal responsivity in infancy: Methodological innovations and theoretical implications

According to polyvagal theory, rapid modulation of the vagal brake develops early in infancy and supports social interactions. Despite being viewed as a dynamic system, researchers typically assess vagal regulation using global measures of respiratory sinus arrhythmia (RSA; an index of vagal tone). This study sought to capture the dynamic property of RSA and evaluate individual differences in within-infant RSA responsivity during mother-infant interaction. RSA was evaluated in a sample of 135 6-month-old Mexican-American infants during a 5-min free play task. Mothers reported on their children's behavioral problems and competence at 18 months using the Brief Infant-Toddler Social and Emotional Assessment. Time-varying estimates of infant RSA during the interaction were obtained using a multiple window technique and spectrogram analysis. Using structural equation modeling, we evaluated whether within-infant SD of RSA predicted infants' behavioral problems and competence at 18 months, after adjusting for infants' mean RSA and covariates. Greater within-infant SD of RSA predicted more behavior problems at 18 months. This study demonstrates that assessing intra-individual variability in RSA, or the extent to which infants fluctuate around their average level of RSA during a task, enhances our ability to test polyvagal theory's central tenet: vagal regulation supports well-regulated social interaction.
Effect of Left Ventricular Morphology on Right Ventricular Systolic Function in Hypoplastic Left Heart Syndrome

Purpose: Right ventricular (RV) failure is a common cause of mortality and transplantation for patients with hypoplastic left heart syndrome (HLHS). The left ventricle (LV) morphology and size may affect the RV function before and after Fontan palliation. We sought to assess the impact of LV morphology on RV function in patients with HLHS using cardiac magnetic resonance (CMR) imaging data. Methods: Institutional HLHS registry was …
Cost-Effectiveness of Open Versus Endoscopic Carpal Tunnel Release.

Background Carpal tunnel syndrome is the most common upper-extremity nerve compression syndrome. Over 500,000 carpal tunnel release (CTR) procedures are performed in the U.S. yearly. We estimated the cost-effectiveness of endoscopic CTR (ECTR) versus open CTR (OCTR) using data from published meta-analyses comparing outcomes for ECTR and OCTR. Methods We developed a Markov model to examine the cost-effectiveness of OCTR versus ECTR for patients undergoing unilateral CTR in an office setting under local anesthesia and in an operating-room (OR) setting under monitored anesthesia care. The main outcomes were costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We modeled societal (modeled with a 50-year-old patient) and Medicare payer (modeled with a 65-year-old patient) perspectives, adopting a lifetime time horizon. We performed deterministic and probabilistic sensitivity analyses (PSAs). Results ECTR resulted in 0.00141 additional QALY compared with OCTR. From a societal perspective, assuming 8.21 fewer days of work missed after ECTR than after OCTR, ECTR cost less across all procedure settings. The results are sensitive to the number of days of work missed following surgery. From a payer perspective, ECTR in the OR (ECTROR) cost $1,872 more than OCTR in the office (OCTRoffice), for an ICER of approximately $1,332,000/QALY. The ECTROR cost $654 more than the OCTROR, for an ICER of $464,000/QALY. The ECTRoffice cost $107 more than the OCTRoffice, for an ICER of $76,000/QALY. From a payer perspective, for a willingness-to-pay threshold of $100,000/QALY, OCTRoffice was preferred over ECTROR in 77% of the PSA iterations. From a societal perspective, ECTROR was preferred over OCTRoffice in 61% of the PSA iterations. Conclusions From a societal perspective, ECTR is associated with lower costs as a result of an earlier return to work and leads to higher QALYs. Additional research on return to work is needed to confirm these findings on the basis of contemporary return-to-work practices. From a payer perspective, ECTR is more expensive and is cost-effective only if performed in an office setting under local anesthesia. Level of evidence Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.
A Synthetic Nervous System Model of the Insect Optomotor Response

We seek to increase the sophistication of our insect-like hexapod robot MantisBot’s visual system. We assembled and tested a benchtop robotic testbed with which to test our dynamical neural model of the insect visual system. Here we specifically model wide-field vision and the optomotor response. The system is composed of a Raspberry Pi with a camera outfitted with a 360° lens. The camera sits on a motorized turntable, which represents the “robot”. Above the turntable sits another motorized system that rotates a drum with printed patterns around the camera, which represents the visual “background”. The camera downsamples the visual scene and sends it to a synthetic nervous system (SNS) model of the insect optic lobe. The optic lobe is columnar. Each column detects changes in receptor intensity (retina), inhibits adjacent columns to increase dynamic range (lamina), compares time-delayed activities of adjacent columns to detect motion (medulla), then pools the motion of each column in a directionally-specific connectivity to compute the direction and speed of the wide-field scene (lobula plate). Our robotic model successfully encodes lateral wide-field visual speed into the activity of a pair of opposing Lobula Plate Tangential Cells (LPTCs). Furthermore, the optomotor response can be recreated by using the LPTCs to stimulate the neck motor neurons (MNs), producing a real-time, closed-loop dynamical model of the optomotor response.
Atraumatic Vertebral Artery Dissection in a Patient With a Migraine Headache.

This case discusses a 34-year-old active duty male who presented to the emergency department with a 2-week persistent headache. His initial review of symptoms was reassuring until a detailed neurologic examination on his second visit revealed a visual deficit in the left upper quadrant. Additionally, he complained of intermittent tension headaches for the last several years but had no history of diagnosed migraines until he was seen 4 days prior for empiric migraine therapy in the same emergency department and left without improvement in symptoms. On his return visit, computerized tomography scan with intravenous contrast revealed a left vertebral artery dissection and hematoma. The patient was admitted for medical management and subsequently found to have suffered a small infarction of right lingual gyrus cortex on magnetic resonance imaging. This case illustrates the importance of maintaining a broad differential diagnosis and high index of suspicion in the patient with new focal neurologic findings in order to diagnose a potentially fatal disease.
"What Does Your Robot Do?" A Tabletop Role-Playing Game to Support Robot Design

Social robot co-design requires aiding users as they imagine these novel devices within their everyday lives and enabling designers to understand and address users’ experiences. This paper presents the exploratory development and evaluation of a role-playing game aimed at identifying the desired features and uses of a social robot that can assist people diagnosed with depression. Participants (n = 16) played the game as a character with depression, designed a companion robot for that character, and chose reactions to daily challenges. Though participants initially selected robot capabilities based on their own needs, after the game they identified alternative designs that would better address daily challenges faced by individuals with depression. We discuss aspects of the game that allowed participants to understand how various robot characteristics can address the experience of depression and suggest how role-playing games can support users and designers in identifying beneficial features and uses of emerging robotic technologies.
Quackery in the classroom: the aspirations of the creationists

Ever since the Scopes Trial, creationists have been successful in their campaign to eliminate mention of evolution from school science textbooks. Although most evolutionists have not considered it necessary to respond to creationists in the past, they now realized that creationists pose a threat to the funding of research on evolution, as well as a threat to society. The creationists make an appeal for ‘fair play’. They go under the modern guise of ‘creation science’, and claim that ‘my scientist is just as good as your scientist’. A closer study of ‘creation science’ shows that creation science isn't ‘good science’, or indeed, science at all. A discussion of various court trials involving creationists, and a review of court decisions resulting from these trials, highlight the subtle and powerful tactics used by modern creationists in their attempts to remove mention of evolution from classrooms in the United States.