cssi/SciSciGPT-SciSciNet huggingface dataset:
Screening for depression in the occupational health setting

BACKGROUND The cost of workplace absenteeism and presenteeism due to depression in the USA is substantial. AIMS To assess the frequency of depression and its impact at the point of care in an occupational health (OH) practice. METHODS Patients presenting to an OH practice completed a standardized depression screening tool and were compared to an unscreened group in the same clinic. Respondents with a nine-item Patient Health Questionnaire (PHQ-9) score >15 and untreated for depression were referred for further evaluation per usual practice. A comparison group of unscreened patients were selected from the same clinic from 1 year prior and records were reviewed for evidence of prior depression, treatment and outcomes. After 1 year, frequency of depression, PHQ-9 scoring for screened patients, days absent from work, days on restricted duties and permanent restrictions were recorded for both groups. RESULTS Two hundred and five patients were screened for depression. Screening was associated with increased frequency of a diagnosis of current depression (30 versus 4%; P < 0.05). Screening was associated with similar rates of absenteeism but lower number of days on restricted duties (97 versus 159 days; P < 0.001). After adjusting for age, sex, history of and treatment for depression, screening was associated with lower odds of being on work restrictions [odds ratio (OR) 0.55; 95% confidence interval (CI) 0.38-0.78] or permanent restrictions (OR 0.35; 95% CI 0.23-0.52). CONCLUSIONS Depression was common in this OH practice. Screening for depression, with appropriate recognition and referral, may reduce time for employed patients on restricted duties and permanent restrictions.
Design of Climbing Robot Platform with Universal Protection Device

A kind of climbing robot with universal protection device was developed.This paper introduced the basic anti-thrown device of the robot and elaborates the design concept and progress of support frame,the main structure of the robot.The support frame was designed after the shape of turtle shell and as a collection of negative pressure plate,fan frame and fixed mount of travelling mechanism,which reduced the cost and also simplified assembly process of the robot.The control system used DSP as main control chip and WIFI module as communication module,and the user interface was developed in Android system.These made the operation simple,easy to control.The platform was tested after successful establishment.The result shows that the prototype works very well and has a certain resistance to impact,which provides a kind of thought and a reference for the research of the properties of climbing robot.
Changes of Symptom and Sign Integral and Relation to Course of Treatment with Three Method Treating Children's H.Pylori Gastropathy of Accumulation Symptom of Heat in Middle-Jiao

Objective:To observe changes of symptom and sign integral and relation to course of treatment,with three method treating children's H.pylori gastropathy of accumulation symptom of heat in middle-jiao,trying to find the best therapy method.Method:Adopting a ratio of 1:1:1,totally 108 H.pylori gastropathy chilren were randomed into three groups;the Traditional Chinese Medicine(TCM)groups(A)with AnYou granule(consisting of thubarb,root of herbaceous peong,Areca catechu L,red sage root,copitis thizome,netgrass flatsedge thizome);the western medicine group(B)with Clarithromycin,Losec;and the combined treated group(C)with Anyou grenule and Clarithromycin,Losec in combination.The efficacy was evaluated after four weeks of treatment.Results:Comparion within group:compared one week treatment with four week,there aren't diffience of statistical significence in total symptom and in cardinal symptom for(B)group(P0.05)?;showing diffience of statistical significance both in cardinal symptom and total symptom for(A)groups and(C)group(P0.01).Comparion among groups:(A)groups compared with(C)group,there are diffience of statistical significence in cardinal symptom(P0.05)and there aren't diffience of statistical significence in total symptom for one week treatment(P0.05);there aren't diffience of statistical significance both in cardinal symptom and total symptom for four weeks(P0.05).(A)groups compared with(B)group,(B)groups compared with(C)group,all showing diffience of statistical significance in one week and four week treatment both in cardinal symptom and total symptom(P0.01).Conclusion:Combination of treatment of traditional chinese medicine and westren medicine can decreased symptom and sign integral evidently in children's H.pylori gastropathy of accumulation symptom of heat in middle-jiao,and can improve the clinical symptom.The effect of traditional chinese medicine treatment relates to course of treatment,the longer course of treatment can gain better effect.
The Natives are Restless: The Effect of Age And Interativity on Consumer Response to Digital Information Products

New hardware platforms such as the Amazon Kindle™ and Apple’s iPad™ are providing new form factors for consuming information in digital form. In the same way that commerce has been transformed through the Internet, information consumption has seen two major transformations: the transformation of physical media from paper to computer screen as well as the transformation of readers into computer users. One of the key factors at work on consumer response to this transformation may be the potential for interactivity. The effect of interactivity on consumer satisfaction has been documented in web site, advertising and online shopping contexts. However, research regarding interactivity in the context of digital information products is limited. Additionally, education scholars have theorized that “digital natives,” who came of age in the era of proliferation of the World Wide Web, differ from “digital immigrants” in fundamental ways that would impact their response to the consumption of digital information (Prensky, 2005). This paper suggests that the positive effects of interactivity found in the contexts of web sites, advertising, and online shopping may be moderated by whether the consumer is a “digital native” or a “digital immigrant.”
The Conductor As Visual Guide: Gesture and Perception of Musical Content.

Ensemble conductors are often described as embodying the music. Researchers have determined that expressive gestures affect viewers’ perceptions of conducted ensemble performances. This effect may be due, in part, to conductor gesture delineating and amplifying specific expressive aspects of music performances. The purpose of the present study was to determine if conductor gesture affected observers’ focus of attention to contrasting aspects of ensemble performances. Audio recordings of two different music excerpts featuring two-part counterpoint (an ostinato paired with a lyric melody, and long chord tones paired with rhythmic interjections) were paired with video of two conductors. Each conductor used gesture appropriate to one or the other musical element (e.g., connected and flowing or detached and crisp) for a total of sixteen videos. Musician participants evaluated 8 of the excerpts for Articulation, Rhythm, Style, and Phrasing using four 10-point differential scales anchored by descriptive terms (e.g., disconnected to connected, and angular to flowing.) Results indicated a relationship between gesture and listeners’ evaluations of musical content. Listeners appear to be sensitive to the manner in which a conductor’s gesture delineates musical lines, particularly as an indication of overall articulation and style. This effect was observed for the lyric melody and ostinato excerpt, but not for the chords and interjections excerpt. Therefore, this effect appears to be mitigated by the congruence of gesture to preconceptions of the importance of melodic over rhythmic material, of certain instrument timbres over others, and of length between onsets of active material. These results add to a body of literature that supports the importance of the visual component in the multimodal experience of music performance.
Evidence of Partisan Alignment in Parliament, 1833–1847

In view of the evident importance that candidates, electors and others attached to a member’s voting record in the House of Commons, it is reasonable to consider whether a methodical investigation of such divisions has anything to contribute to the present study. In the past, historians have analysed the parliaments that met between 1833 and 1847, but reached no clear consensus. Derek Beales and David Close, for instance, influenced by Norman Gash’s view of Peel and party, believed that party discipline was advanced between 1835 and 1845, and the line separating liberals and conservatives strong. To test (‘confirm’ might be the better word) the hypothesis, Beales turned to a very small number of indisputably outstanding divisions which he identified as ‘touchstones’ of party, and likely indicative of a strong pattern of party alignment. Perhaps unsurprisingly, under these guidelines, his position appeared to be verified.1 Ian Newbould found fault with Beales’s over-reliance on Gash’s methods and conclusions, and convincingly undercut the latter by a rigorous analysis of hundreds of divisions from the same period.2 Newbould’s findings show that party discipline, supposed by Beales and others to be a new phenomenon resulting from the general elections of 1835 and 1837, was neither weaker nor stronger than it had been in the early 1830s and, when compared with the work of Austin Mitchell, much weaker than it had been in the 1810s and 1820s.3
The New Basel Capitol Accord: Is 8% Adequate?

The 1988 Basel Accord established 8% of risk weighted assets as the minimum equity capital standard that reflected bank risks at that time. The New Basel Capital Accord, to be implemented in 2006, maintains the 8% equity capital as the minimum standard, and it changes with the way the capital standard is computed in order to take certain risks into account. Nevertheless, this article argues that it does not reflect the higher degree of risks that banks face today. These risks include more off-balance sheet derivatives, real estate loans, subprime loans and over-exposure to equities. Because of the increased risks, a higher equity capital ratio is needed.
“Getting It Over With”: Choosing a Four-Year College

Financial stability, early college planning, and having a career goal are the three factors that were most influential for Latino/a students attempting a BA degree at a four-year institution. I assess the resources that buoyed four-year college students and the structural barriers to continuance that many still struggled with, including lack of counseling, and the difficulty many faced in balancing classwork and employment. Included in this chapter are the stories of three respondents who “reverse-transferred”—that is, they started attending a four-year college, but switched to two-year colleges. Latino/a four-year attendees fell into two camps: those working to maintain a middle-class status (status maintenance) and those hoping to vault into it, using college as the means of doing so (status mobility).
The positive predictive value of PI-RADS 4 lesions stratified by lesion number in biopsy naïve men.

29Background: To assess the positive predictive value (PPV) of PI-RADS 4 lesions stratified by suspicion for tumor multi-focality. Methods: Between April 2015 and July 2016, 62 biopsy naive men with at least one PI-RADS 4 lesion underwent mpMRI/US fusion biopsy. Patients were placed into group 1 if they had a single lesion, group 2 if they had an additional PI-RADS 3 or 2 lesion, and group 3 if they had an additional PI-RADS 4 or 5 lesion. Image interpretation was performed prospectively and assessed using PI-RADS version 2. The ANOVA and chi-square tests were used to assess differences between continuous and categorical variables, respectively. Results: Using systematic and targeted biopsy combined, the overall and GS ≥ 7 cancer detection rate for the entire cohort was 80.6% (50/62), and 53.2% (33/62), respectively. There were a total of 88 lesions with 26,14, and 48 lesions in groups 1,2, and 3, respectively. There were no significant differences in mean age, PSA density, race, or lesion location betwee...
Postsplenectomy vaccination guideline adherence: Opportunities for improvement.

Background and purpose Patients undergoing splenectomy for trauma are at life-long risk for rapidly progressive septicemia. The purpose of this study was to investigate long-term patient understanding and follow-up with recommendations regarding their asplenia. Methods Patients undergoing splenectomy for trauma January 2010–December 2014 were analyzed. Medical records were reviewed and telephone follow-up interviews were conducted in October–December 2015. Patients were asked a standard set of questions that included hospitalizations, awareness of infectious risks associated with asplenia, need for revaccination, and vaccines they had received since their index hospitalization. Findings Two hundred forty-four patients underwent splenectomy during the study period. A total of 95 patients (39%) were included in the study. Thirty (32%) had been hospitalized since their trauma admission. Only 46% were aware of the risks for sepsis and the need to revaccinate. Only 7% reported having rapid access to antibiotics. Conclusions Despite uniform education prior to discharge, most patients undergoing splenectomy for trauma were unaware of the risks for sepsis and did not follow recommended guidelines for risk reduction. Implications for practice Improvements that have direct implications for advanced practice included the need to refer for vaccination, educate regarding infection risks, and facilitate rapid access to antibiotic treatment.
Lord, Lewis, and the Institutional Theory of Art

the Humanities Department at the University of Arizona. lack of spontaneity in artworks, i.e., the loss of flexibility espoused by Dickie's definition, is established by Lord via two routes: a) arguing that being a work of art is incompatible with institutionality (Incompatibility Argument), and b) arguing that the creation, presentation, and appreciation of a work of art is not governed by conventions (Nonconventionality Argument.) (In order to remain consistent with Lord's emphasis, analysis (a) will mainly discuss the freedom, originality and conventions involved in the creation of a work
Professional Satisfaction and the Career Plans of US Physicians.

Abstract Objective To evaluate the relationship between burnout, satisfaction with electronic health records and work-life integration, and the career plans of US physicians. Participants and Methods Physicians across all specialties in the United States were surveyed between August 28, 2014, and October 6, 2014. Physicians provided information regarding the likelihood of reducing clinical hours in the next 12 months and the likelihood of leaving current practice within the next 24 months. Results Of 35,922 physicians contacted, 6880 (19.2%) returned surveys. Of the 6695 physicians in clinical practice at the time of the survey (97.3%), 1275 of the 6452 who responded (19.8%) reported it was likely or definite that they would reduce clinical work hours in the next 12 months, and 1726 of the 6496 who responded (26.6%) indicated it was likely or definite that they would leave their current practice in the next 2 years. Of the latter group, 126 (1.9% of the 6695 physicians in clinical practice at the time of the survey) indicated that they planned to leave practice altogether and pursue a different career. Burnout (odds ratio [OR], 1.81; 95% CI, 1.49-2.19; P P P =.001) were independent predictors of intent to reduce clinical work hours and leave current practice. Conclusion Nearly 1 in 5 US physicians intend to reduce clinical work hours in the next year, and roughly 1 in 50 intend to leave medicine altogether in the next 2 years to pursue a different career. If physicians follow through on these intentions, it could profoundly worsen the projected shortage of US physicians.
Applying Challenge-Based Learning in the (Feminist) Communication Classroom: Positioning Students as Knowledgeable Change Agents.

This article explores the potential of challenge-based learning (CBL) for feminist pedagogy. In a qualitative case study of an introductory mass communication and social theory course, students were more likely to indicate sophisticated, intersectional understandings of course concepts following the CBL project. Before the CBL project, students spoke tentatively and hypothetically about “making change.” Self-reported ability to take action was defined passively and negatively. In contrast, after the CBL project, students employed positive frames when discussing ability to act, and proposed avenues for action were expanded. The paper concludes with a discussion of how faculty might incorporate CBL.
Realism and prophecy in Machiavelli and in Italian political culture

That Niccolo Machiavelli was a realist political theorist is perhaps one of the few claims on which scholars agree almost unanimously. The truth, however, is that his writings exhibit a blend of po...
The Role of Ethnic and Racial Disparities in Mobility and Physical Function in Older Adults

Objective: To compare estimates of the prevalence of mobility and physical function limitations by race and ethnicity using data from the Medical Expenditure Panel Survey (MEPS). Method: The sample comprised of 28,854 adults aged ≥60 from the MEPS (2004-2013). Physical function (limitations in basic and instrumental activities of daily living [ADL/IADL]) and mobility limitations were assessed by self-report. Results: Non-Hispanic Whites (NHWs) represented the majority of the sample followed by non-Hispanic Blacks (NHBs), Hispanic and non-Hispanic Other (Other). For mobility limitation, NHBs had the highest prevalence followed by NHWs and Hispanics (33.3%, 28.6%, and 26.2%, respectively). Multivariable logistic regression analyses were performed for the primary outcome of mobility limitation. In the adjusted model, Hispanics had lower odds of mobility limitations (prevalence odds ratio [POR]: 0.78; 95% confidence interval [CI] = [0.67,0.91]) compared with NHWs. For ADL limitations, NHBs had higher odds of having ADLs (POR: 1.87; 95% CI = [1.44, 2.44]) when compared with NHWs. Conclusion: This article evaluated the influence of race and ethnicity, on the prevalence of mobility and functional limitations that are not always consistent with expected racial and ethnic differences.
A circuit for safe diagnostic electrical stimulation of the human brain.

AbstractAn electronic circuit for controlled electrical stimulation of the human brain has been designed to optimize safety in charge transfer from electrodes to brain and to eliminate the likelihood of unwanted currents from the neurostimulator resulting from component failure. The circuit schematics feature the following designs: (1) a highly accurate and versatile rate generator 0.5 p.p.s. to 99 in increments of 0.5 p.p.s., (2) symmetrically-biphasic lead and lag pulses of 100 μsec duration, (3) photo-isolated driver amplifiers with accurate waveform, reproduction, (4) true biphasic passive-current regulators driven by an isolated battery supply voltage for switch-selectable currents of 0.25 to 5 ma or variable current regulation, (5) accurate current and voltage waveform monitors that isolate the stimulating electrodes from the monitors, and (6) capacity-coupled outputs to guarantee no net D.C. component at the end of each biphasic pulse. Relay-switching circuits are also shown that allow sequential s...
Inducible Excision Repair in Escherichia coli

Excision repair of ultraviolet-irradiation (UV) damage in wild type Escherichia coli results in a bimodal distribution of repair patch sizes.1 The majority of lesions are repaired with short patches approximately 20 nucleotides in length by a pathway mediated by DNA polymeras I, while a minority are repaired with much longer patches by a recA+ -dependent pathway.2 Excision repair assayed by closure of incision breaks similarly seems to proceed via two pathways, one which is polymerase I-dependent and one which is recA+-dependent. The latter pathway additionally requires the lexAnotype and protein synthesis.3 The long patch pathway and the recA+-dependent closure of incision breaks presumably represent manifestations of a single process, having a number of features in common with the coordinately controlled group of responses to DNA damage known collectively as “SOS functions”.4 Indeed, it has recently been shown that long patch repair is UV-inducible and requires protein synthesis, unlike the constitutive short patch pathway;5 moreover, the requirement for the lexA + genotype as well as recA+ for long patch repair has been confirmed.° However, the role of the long patch pathway, its relationship to other inducible responses to damage, and its importance for cell survival have yet to be established. We have begun to address these questions through use of the tif mutations7 to induce the long patch pathway prior to DNA damage.
LA EMPRESA COLABORATIVA Y AMBIDIESTRA

This article aims to advance our understanding of the organizational prerequisites of ambidexterity. Ambidexterity is the ability simultaneously to exploit existing capabilities and to explore new opportunities. Prior research suggests that ambidexterity requires a strong bond of trust among the relevant actors. However, trust can also stifle innovation. We resolve this contradiction by developing a typology of trust, differentiating the traditionalistic (clan) type from the charismatic, contractual, and collaborative types, and we show how this last, collaborative type supports ambidexterity by its distinctive values (based on contribution to a shared purpose), norms (based on interdependent process management), and congruent authority and economic systems. We illustrate our argument with a case study of Kaiser Permanente, a large health system in the USA.
Completely Regular Spaces

Up to this point in the text, we have not assumed any separation axioms for the topological space on which our ring of continuous functions is defined. Indeed, separation axioms were irrelevant to most of the subjects discussed. We have now reached the stage where separation properties of the space do enter in an essential way, so that we are forced to make a decision about what class or classes of spaces to consider. We have no desire to become involved in finding the weakest axiom under which each theorem can be proved, but prefer, if possible, to stick to a single class of topological spaces that is wide enough to include all of the interesting spaces, and, at the same time, restrictive enough to admit a significant theory of rings of continuous functions.
CD8+ lymphocytes modulate acute ZIKV viremia, innate antiviral immunity and tissue dissemination in nonhuman primates

The critical importance of CD8+ lymphocytes during chronic viral infection is well established, but their roles in acute ZIKV infection remain incompletely explored. Importantly, antiviral CD8 responses could modulate neurological manifestations that have accompanied recent ZIKV outbreaks. The rhesus macaque model of ZIKV is a particularly valuable tool to understand immune mechanisms of ZIKV control due to similarities in immune function to humans and due to their susceptibility to infection with primary human isolates of the virus. In the present study, we infected four adult male rhesus macaques with ZIKV, two of which had been depleted of CD8+ lymphocytes prior to infection. CD8 depletion resulted in delayed viremia and a near absence of innate immune responses in the blood, demonstrated by a complete lack of neutrophil recruitment to the blood and a striking absence of transcriptional changes in type I interferon response and other key immune genes relative to non-depleted controls during acute infection. Depletion also resulted in differential patterns of monocyte expansion and reduced monocyte activation measured by CD169 expression. Notably, CD8-depleted macaques showed possible evidence of compensatory CD4 T cell responses and persistence of neutralizing antibodies at later timepoints, despite clearance of virus from serum. Neural lesions were also evident in both CD8-depleted animals. One of the depleted animals recovered CD8+ lymphocytes by 21 days post-infection and mounted a high magnitude CD8 T cell response against the virus. The other CD8-depleted animal did not recover CD8+ lymphocytes over the course of the study, and post-mortem histology revealed severe brainstem encephalomalacia as well as enhanced viral dissemination in the semen and seminal vesicle. Together, these data support a potential role for CD8+ lymphocytes in control of ZIKV dissemination and in maintaining immune regulation during acute infection of rhesus macaques.
Randomized trial of a web-based survivor intervention on melanoma prevention behaviors of first-degree relatives.

Melanoma can be prevented through reducing sun exposure and detected early by increasing examination of skin for lesions. First-degree relatives of melanoma cases have higher risk than the general population and, therefore, could be targets of behavioral interventions through families. We tested the effects of a family-based web delivered intervention to melanoma families on the melanoma risk reduction behaviors of first-degree relatives of melanoma cases. A total of 313 families that included one first-degree relative were recruited to join this randomized trial. All intervention families received access to the Suntalk website developed to promote family communication and behavioral risk reduction among families of melanoma survivors. First degree relatives in the intervention arm significantly increased their yearly performance of both skin self examination and thorough provider examination from baseline to 12-month follow-up while the control FDRs decreased their yearly performance of both of those behaviors (p’s = 0.006 and 0.005, respectively). Several sun protection behaviors increased significantly in FDRs in the intervention arm but not the control arm, including wearing a covering on the head (p = 0.005), staying in available shade (p = 0.008), and avoiding sun exposure during peak hours (p = 0.010). Some of these changes were mediated by perceptions of risk and other process variables. A web-based intervention can reduce risk of melanoma through changes in relevant behaviors among first-degree relatives of melanoma survivors. Future research should identify methods for making this type of intervention accessible to more families and for broadening the reach to other types of cancer families. This program can be provided to melanoma families to improve their sun protection and screening behaviors, at the point of diagnosis.
Severe Maternal Morbidity, A Tale of 2 States Using Data for Action—Ohio and Massachusetts

Purpose Describe how Ohio and Massachusetts explored severe maternal morbidity (SMM) data, and used these data for increasing awareness and driving practice changes to reduce maternal morbidity and mortality. Description For 2008-2013, Ohio used de-identified hospital discharge records and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify delivery hospitalizations. Massachusetts used existing linked data system infrastructure to identify delivery hospitalizations from birth certificates linked to hospital discharge records. To identify delivery hospitalizations complicated by one or more of 25 SMMs, both states applied an algorithm of ICD-9-CM diagnosis and procedure codes. Ohio calculated a 2013 SMM rate of 144 per 10,000 delivery hospitalizations; Massachusetts calculated a rate of 162. Ohio observed no increase in the SMM rate from 2008 to 2013; Massachusetts observed a 33% increase. Both identified disparities in SMM rates by maternal race, age, and insurance type. Assessment Ohio and Massachusetts engaged stakeholders, including perinatal quality collaboratives and maternal mortality review committees, to share results and raise awareness about the SMM rates and identified high-risk populations. Both states are applying findings to inform strategies for improving perinatal outcomes, such as simulation training for obstetrical emergencies, licensure rules for maternity units, and a focus on health equity. Conclusion Despite data access differences, examination of SMM data informed public health practice in both states. Ohio and Massachusetts maximized available state data for SMM investigation, which other states might similarly use to understand trends, identify high risk populations, and suggest clinical or population level interventions to improve maternal morbidity and mortality.
Terrorism prevention with reelection concerns and valence competition

In recent decades, fear of terrorism has increased among voters in liberal democracies. In response, governments have adopted counterterrorist measures that curtail civil liberties, at times prompt...
Effects of Air Exposure on Survival of Yellowstone Cutthroat Trout Angled from a Stream with Warm Water Temperatures

Abstract We evaluated the effects of air exposure on Yellowstone Cutthroat Trout Oncorhynchus clarkii bouvieri caught and released in a cold-water stream with elevated water temperatures (i.e., > 1...
Chapter 17 – Canonicity in Broca's Sentence Comprehension: The Case of Psychological Verbs*

Publisher Summary The psychological verbs (psych verbs) denote mental states of an emotional sort. In linguistics, these verbs have been given special attention because they are non agentive, and as a result constitute an interesting test case for theories on the mapping between semantic arguments and syntactic functions/ positions when the agent–subject connection is not available. Psych verbs are divided into two main classes. They are subject-experiencer (fear-type) and object-experiencer (frighten-type). Besides being non-agentive, a subclass of these predicates object-experiencer (frighten-type) has the feature that in active sentences it links its “volitional” thematic role to the object position. This is in fact what makes these types of verbs interesting. They represent a direct counter example to the overwhelming generalization observed crosslinguistically that the more agent-like argument must be linked to the most prominent grammatical relation (subject) in simple declarative active sentences. In the case of object-experiencer verbs, it is the theme (least agent like) and not the experiencer (most agent like) argument that is linked to subject position. The argument linking hypothesis (ALH) is based on the notion that in the language system there are two linking mechanisms.
Exploring the validity of allostatic load in pregnant women.

Abstract Background The theory of allostatic load has gained momentum in perinatal research to understand the biological pathways of the impact of maternal chronic stress on adverse perinatal outcomes. However, due to physiological changes of pregnancy, including large variations across gestation, the extent to which allostatic load measured in pregnancy is valid has not been queried in depth. Objectives This study aimed to assess the gestational patterns of selected individual allostatic load indicators and to explore whether a pregnancy allostatic load index score had face validity in relation to chronic sociodemographic stress. Design This is a secondary analysis using data from the 1999–2006 National Health and Nutrition Examination Survey. Methods A total of 1056 pregnant women were included for analyses. Using ten physiological indicators commonly included in an index of allostatic load, we described individual indicator and index score patterns across gestation and assessed differences in allostatic load index scores between women with and without sociodemographic stress. Findings The average allostatic load index score at any gestational month was not statistically significantly different from the average allostatic load index score in the non-pregnant sample. We also found the allostatic load index score remained steady across gestational month, despite very different gestational patterns of individual allostatic load indicators, as long as gestation-specific risk quartiles were used to calculate the allostatic load index score. Face validity was affirmed via higher allostatic load index scores in women with sociodemographic stress compared to those without such stress. Conclusion Our study suggests that measuring allostatic load in pregnancy is valid for reflecting women's true physiological functions and chronic stress, but gestational age should be considered when scoring the allostatic load index for women at different gestational age. Implications for practice As a valid measure of chronic stress, a pregnancy allostatic load index may contribute to research on health inequities and perinatal outcomes.
Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors.

Importance Use of electronic cigarettes (e-cigarettes) is high among adolescents, but the extent to which the JUUL e-cigarette brand accounts for the high prevalence has not been explored using population-based surveys. Objective To examine e-cigarette and JUUL use among adolescents in New Jersey. Design, Setting, and Participants Survey study using data from the 2018 New Jersey Youth Tobacco Survey, a cross-sectional statewide representative survey of tobacco use. The survey was school based and sampled New Jersey students in grades 9 to 12. Exposures Use of tobacco products; JUUL as first tobacco product tried; exposure to JUUL at school; number of friends perceived as JUUL users; liking or following a tobacco brand on social media; and buying or receiving tobacco-branded merchandise. Main Outcomes and Measures Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL. Results In this sample of 4183 adolescents, respondents were 49.6% female and 49.6% non-Hispanic white. Students were evenly distributed across grades 9 through 12. Overall, the estimate for current use of e-cigarettes inclusive of JUUL was higher (24.2%; 95% CI, 22.5%-25.9%) compared with current use assessed by use of e-cigarettes only (17.8%; 95% CI, 16.4%-19.4%) or JUUL use only (21.3%; 95% CI, 19.7%-23.0%). Divergence in e-cigarette use estimates was higher for certain subgroups, including female respondents and non-Hispanic black respondents. Also, 88.8% (95% CI, 86.6%-91.1%) of current e-cigarette users reported JUUL as a brand they used. Hispanic students (PR, 0.78; 95% CI, 0.69-0.89) and non-Hispanic students of other races (PR, 0.64; 95% CI, 0.51-0.81) were significantly less likely than non-Hispanic white students to be current e-cigarette users, and students in 12th grade were more likely than those in 9th grade to be current users (PR, 1.29; 95% CI, 1.11-1.48). Current e-cigarette use was positively associated with current use of other tobacco products (PR, 2.57; 95% CI, 2.24-2.95), endorsing a tobacco brand on social media (PR, 1.43; 95% CI, 1.19-1.72), having tobacco-branded merchandise (PR, 1.70; 95% CI, 1.46-1.97), having close friends who used JUUL (PR, 3.81; 95% CI, 3.17-4.58), and seeing JUUL used on school grounds (PR, 1.43; 95% CI, 1.24-1.65). Estimates of prevalence were greater when modeling frequent use. Conclusions and Relevance This study found that prevalence of current and frequent e-cigarette use among adolescents was higher when inclusive of JUUL use, and JUUL was by far the most common e-cigarette brand used, providing support for inclusion of brand-specific questions when assessing e-cigarette use. The results also identify characteristics of adolescents who may be more likely to use e-cigarettes.
3040 – IN VITRO RECAPITULATION OF MURINE T CELL DEVELOPMENT FROM SINGLE HEMATOPOIETIC STEM CELLS

The spatio-temporal complexity of T cell differentiation from hematopoietic stem and progenitor cells (HSPCs) in the thymus has been challenging to recapitulate in vitro. While the OP9-DL1 monolayer co-culture system revolutionized thymopoiesis studies, serum-dependent monolayer systems can have inconsistent results. Our recently developed serum-free, 3D Artificial Thymic Organoid (ATO) system supports full in vitro T cell differentiation from human HSPCs and pluripotent stem cells; however, results using identical conditions with murine cells are suboptimal. Here, we demonstrate that culturing murine bone marrow (BM) HSPCs in a modified murine ATO system (M-ATO) consistently reproduces normal murine thymopoiesis. The M-ATO produces all T cell stages: from early thymic progenitors to mature T cell subsets, including TCRγδ+, single positive (SP8 and SP4) TCRαβ+, and FoxP3+ cells. RNA sequencing aligned M-ATO-derived populations with phenotypically identical primary thymocytes. M-ATO-derived CD3+TCRαβ+ SP cells are mature, functional T cells that exhibit a broad TCR Vβ repertoire and respond to TCR activation. M-ATOs initiated with Rag1-/- marrow produced the same differentiation block as seen in the endogenous thymus, and the transgenic Notch reporter (TNR) mouse model revealed that M-ATOs induce Notch signaling patterns in developing thymocytes similar to that in the thymus. Thymopoiesis can be established in M-ATOs from a range of BM and or thymic populations, including Lineage negative c-Kit+Sca-1+ (LSK), SLAM+ hematopoietic stem cells (HSC), lymphoid-primed multipotential progenitors (LMPP), common lymphoid progenitors (CLP) or early thymic progenitors (ETPs). The M-ATO is highly efficient at producing millions of T cells with a broad repertoire even when starting from purified single HSC or LSK cells. Thus, the M-ATO is a reproducible and efficient platform to study clonal murine T cell development and maturation from single HSCs and progenitors.
A dynamic simulation framework for CT perfusion in stroke assessment built from first principles.

Purpose Physicians utilize cerebral perfusion maps (e.g., cerebral blood flow, cerebral blood volume, transit time) to prescribe the plan of care for stroke patients. Variability in scanning techniques and post-processing software can result in differences between these perfusion maps. To determine which techniques are acceptable for clinical care, it is important to validate the accuracy and reproducibility of the perfusion maps. Validation using clinical data is challenging due to the lack of a gold standard to assess cerebral perfusion and the impracticality of scanning patients multiple times with different scanning techniques. In contrast, simulated data from a realistic digital phantom of the cerebral perfusion in acute stroke patients would enable studies to optimize and validate the scanning and post-processing techniques. Methods We describe a complete framework to simulate CT perfusion studies for stroke assessment. We begin by expanding the XCAT brain phantom to enable spatially varying contrast agent dynamics and incorporate a realistic model of the dynamics in the cerebral vasculature derived from first principles. A dynamic CT simulator utilizes the time-concentration curves to define the contrast agent concentration in the object at each time point and generates CT perfusion images compatible with commercially available post-processing software. We also generate ground truth perfusion maps to which the maps generated by post-processing software can be compared. Results We demonstrate a dynamic CT perfusion study of a simulated patient with an ischemic stroke and the resulting perfusion maps generated by post-processing software. We include a visual comparison between the computer-generated perfusion maps and the ground truth perfusion maps. The framework is highly tunable; users can modify the perfusion properties (e.g., occlusion location, CBF, CBV, and MTT), scanner specifications (e.g., focal spot size and detector configuration), scanning protocol (e.g., kVp and mAs), and reconstruction parameters (e.g., slice thickness and reconstruction filter). Conclusions This framework provides realistic test data with the underlying ground truth that enables a robust assessment of CT perfusion techniques and post-processing methods for stroke assessment.
A Hydrogel Strategy to Augment Tissue Adenosine to Improve Hindlimb Perfusion.

Objective Adenosine is an important vasodilatory, anti-inflammatory, and antithrombotic agent; however, its delivery for the treatment of cardiovascular diseases is challenging due to the drug's short half-life and dose-limiting side effects. Peripheral artery disease, one of the most prevalent atherosclerotic diseases of the cardiovascular system, remains without adequate nonsurgical treatments, resulting in significant morbidity due to ischemia and inflammation. Here, we hypothesize that we can use an enzyme-loaded synthetic hydrogel for local adenosine production. Approach and Results: We engineer a protease-sensitive poly(ethylene glycol)-maleimide-based hydrogel and characterize its rheological parameters when modulating poly(ethylene glycol) density and tethering a peptide to the gel backbone, then test degradation in response to collagenase. We load the gel with an ecto-nucleotidase, CD73, which catalyzes adenosine production from phosphorylated substrates, and use the CD73-loaded gel to generate adenosine in vitro and inhibit neutrophils' oxidative burst. When delivered in vivo, the CD73 hydrogel augments adenosine levels in hindlimb skeletal muscles 24 hours after induction of peripheral arterial ischemia and increases lower limb perfusion compared with control gel in healthy mice on laser Doppler imaging. Conclusions This enzyme-delivering hydrogel provides a strategy for local and sustained adenosine generation to improve perfusion, and future work will optimize its use for disease modulation.
Bone-Specific Enhancement of Antibody Therapy for Breast Cancer Metastasis to Bone

Therapeutic antibodies have gone a long way toward realizing their clinical potential and have become very useful for treating a variety of pathologies. Despite the rapid evolution of therapeutic antibodies, their clinical efficacy in treatment of bone tumors has been hampered by the inadequate pharmacokinetics and poor bone tissue accessibility of these large macromolecules. Here, we show that engineering therapeutic antibodies to include bone-homing peptide sequences dramatically enhances their concentration in the bone metastatic niche, resulting in significantly reduced survival and progression of breast cancer bone metastases. To enhance the bone tumor-targeting ability of engineered antibodies, we introduced varying numbers of a bone-homing peptide into permissive internal sites of the anti-HER2 antibody trastuzumab. Compared to the unmodified antibody, the engineered bone-targeting antibodies have similar pharmacokinetics and in vitro cytotoxic activity against HER2-positive cancer cells, but exhibit improved bone tumor distribution in vivo. Accordingly, in xenograft models of breast cancer metastasis to bone sites, engineered antibodies with enhanced bone specificity exhibit increased inhibition of both initial bone metastases and secondary multi-organ metastases from bone lesions. Furthermore, this engineering strategy is also applied to prepare bone-targeting antibody-drug conjugates with enhanced therapeutic efficacy. These results demonstrate that adding bone-specific targeting to antibody therapy results in robust delivery of therapeutic antibodies to the bone tumor niche. This provides a powerful strategy for overcoming inadequate treatment of bone cancer and the development of potentially acquired resistance to therapy.
Continuous Glucose Monitoring and HbA1c in Cystic Fibrosis: Clinical Correlations and Implications for CFRD Diagnosis.

Context The clinical utility and implications of continuous glucose monitoring (CGM) in cystic fibrosis (CF) are unclear. Objective We examined the correlation between CGM measures and clinical outcomes in adults with CF, investigated the relationship between hemoglobin A1c (HbA1c) and CGM-derived average glucose (AG), and explored CGM measures that distinguish CFRD from normal and abnormal glucose tolerance. Design Prospective observational study. Participants 77 adults with CF. Main outcomes CGM and HbA1c measured at 2-3 time-points three months apart. Results Thirty-one of the 77 participants met American Diabetes Association-recommended diagnostic criteria for CFRD by oral glucose tolerance testing and/or HbA1c. In all participants, CGM measures of hyperglycemia and glycemic variability correlated with nutritional status and pulmonary function. HbA1c was correlated with AG (R 2=0.71, p= 140 mg/dL and 3.4% time >180 mg/dL had sensitivities of 87% and 90%, respectively, and specificities of 95%, for identifying CFRD. Area under the curve and percent of participants correctly classified with CFRD were higher for AG, standard deviation, % time >140, >180, and >250 mg/dL than HbA1c. Conclusions CGM measures of hyperglycemia and glycemic variability are superior to HbA1c in distinguishing those with and without CFRD. CGM-derived AG is strongly correlated with HbA1c in adults with CF, with a similar relationship to other diabetes populations. Future studies are needed to investigate CGM as a diagnostic and screening tool for CFRD.
Early Results from the Flexibility in Surgical Training Research Consortium: Resident and Program Director Attitudes Toward Flexible Rotations in Senior Residency.

Objective To assess the attitudes of residents and program directors (PDs) involved in flexible training to gauge satisfaction with this training paradigm and elicit limitations. Design Anonymous surveys were sent to residents and PDs in participant programs. Respondents were asked to rate responses on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). Setting A total of 9 residency programs that are collaborating to prospectively study the effect of flexible tracks on resident performance and outcome. Participants A total of 138 residents who were in clinical years 4 and 5 and 10 PDs. Results Of the 138 possible residents, 100 responded to the resident survey (72.5% response rate). Among resident respondents, 33% were participating in a flexible track option. The most frequently listed specialties of focus were cardiothoracic surgery (19%), vascular surgery (13%), acute care surgery (11%), colorectal surgery (8%), surgical oncology (7%), and pediatric surgery (7%). Participants in flexible tracks tended to strongly agree that their career would be enhanced by flexible rotations; interestingly, of those not in flexible tracks, most tended to also agree that flexible rotations would enhance their future careers. Flexible track participants report receiving greater autonomy on flexible rotations and believe they would be better prepared for fellowship and career. They express overall very high satisfaction with the flexible experience. Limitations expressed by residents (in flexible tracks or not) include uncertainty for how this paradigm serves those interested in comprehensive general surgery, concern about scheduling difficulties, and some displeasure in missing high-volume general surgery rotations in lieu of specialty-focused rotations. The PD survey was completed by 8 of 9 PDs for a response rate of 89%. All the respondents agreed or strongly agreed that careers of residents are enhanced by flexible rotations and that important operative and clinical experiences are gained. Overall, 87.5% of PD respondents agreed or strongly agreed that those in flexible tracks have greater opportunities for mentorship in their chosen field. PDs also expressed high levels of satisfaction with flexible rotations. Limitations include concerns that the flexibility option presents scheduling difficulties and does not go far enough in reforming postgraduate education. Conclusions This survey of 9 residency programs participating in flexible tracks indicates satisfaction with this training option. The role of comprehensive general surgery as a training end point and scheduling difficulties remain as major challenges. Outcomes of graduates in these tracks and control peers are being prospectively evaluated.