cssi/SciSciGPT-SciSciNet huggingface dataset:
Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings

Importance A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (TA 49% female; mean age, 5.4 [range, 0-17] years) and 96 592 ambulatory patients (37% male; 35% female; 28%, masked; mean age, 7.6 [range, 0-17] years) underwent analysis. The ratio of ambulatory to inpatient procedures was 5:1. Inpatients demonstrated more comorbidities (≤8, compared with ≤4 for HBF and ≤3 for FSF patients) and, in general, their complication rates were 2 to 5 times higher (seen in 1% to 12% of patients) than those in HBFs (0.2% to 5%), and more than 10 times higher than those in the FSFs (0% to 0.38%), with rates varying markedly by age range and facility type. Tonsillectomy and adenoidectomy was associated with increased risk for all complication types in both settings, reaching an odds ratio of 8.5 (95% CI, 6.6-11.1) for respiratory complications in the ambulatory setting. Inpatients aged 0 to 9 years experienced higher rates of airway and respiratory complications, peaking at an odds ratio of 7.5 (95% CI, 3.1-18.2) for airway complications in the group aged 0 to 11 months. Conclusions and Relevance Large numbers of pediatric patients undergo T&A in ambulatory settings despite higher rates of complications in younger patients and patients with more comorbidities. Fortunately, a high percentage of these patients has been appropriately triaged to the inpatient setting. Further research is needed to elucidate the subgroups that warrant postoperative hospitalization.
Effects of Toxorhynchites Amboinensis on Laboratory-Reared Aedes Aegypti Populations (Diptera: Culicidae)

Several levels of predation were tested in the laboratory to determine the immediate and long-term effects of Toxorhynchites amboinensis on laboratory-reared populations Aedes aegypti . The Ae. aegypti populations were maintained the periodic addition of lst-instar larvae; numbers of larvae corresponded to those found in comparably sized containers in the field. Significant reduction in the emergence of Ae. aegypti adults was not observed until the 2nd week following introduction of predators. The degree of control obtained during the 2nd and 3rd weeks (postintroduction) was proportional to the number of predatory larvae originally introduced. The addition of 1 predator per week gave better control during the 4th week after predator introduction than did a 1-time introduction of 1 or 2 predators.
Re-entrant Lithium Local Environments and Defect Driven Electrochemistry of Li- and Mn-Rich Li-Ion Battery Cathodes

Direct observations of structure–electrochemical activity relationships continue to be a key challenge in secondary battery research. 6Li magic angle spinning (MAS) nuclear magnetic resonance (NMR) spectroscopy is the only structural probe currently available that can quantitatively characterize local lithium environments on the subnanometer scale that dominates the free energy for site occupation in lithium-ion (Li-ion) intercalation materials. In the present study, we use this local probe to gain new insights into the complex electrochemical behavior of activated 0.56Li2MnO3·0.56LiMn0.5Ni0.5O2, lithium- and manganese-rich transition-metal (TM) oxide intercalation electrodes. We show direct evidence of path-dependent lithium site occupation, correlated to structural reorganization of the metal oxide and the electrochemical hysteresis, during lithium insertion and extraction. We report new 6Li resonances centered at ∼1600 ppm that are assigned to LiMn6-TMtet sites, specifically, a hyperfine shift related ...
Dysfunctional immune-mediated inflammation in rheumatoid arthritis dictates that development of anti-rheumatic disease drugs target multiple intracellular signaling pathways

A skewed repertoire of pro-inflammatory cytokines produced by the Th1 subset, one of the hallmarks of rheumatoid arthritis (RA), is characterized by an overabundance of pro-inflammatory cytokines. Tumor necrosis factor-α, interleukin- 1 (IL-1), IL-6, IL-7, IL-8, IL-21, IL-12/IL-23, IL-15, IL-17, IL-18, IL-32, and interferon-γ are primarily responsible for immune-mediated inflammation of RA by activating Janus kinases (JAK) -1, -2, -3, p38 kinase, C-Jun-Nterminal kinase, extracellular signal-regulated kinase 1/2 and the phosphatidylinosotide-3-kinase/Akt/mTor pathways. Activation of these signaling pathways results in up-regulation of pro-inflammatory cytokines, cyclooxygenase-2, matrix metalloproteinases, pro-angiogenesis proteins and anti-apoptosis proteins, the latter resulting in abnormal survival of activated T- and B-cells. Further, IL-17 also regulates the differentiation of CD4+ T-helper cells by inducing a Th17 T-cell subset, and a subpopulation of T-regulatory (Treg) cells. Although Treg cells are sufficiently abundant in RA synovial fluid, they fail to induce immune tolerance suggesting a functional deficiency likely coupled to putative protein kinase signaling abnormalities. The results of in vitro and studies in animal models of arthritis have indicated that inhibiting individual signaling pathways can blunt the synthesis of several of the pro-inflammatory biomarkers characteristic of human RA pathology. However, RA clinical trials indicated that small molecule inhibitors of JAK-1, -2-, 3 and/or p38 kinase while exhibiting acceptable safety and tolerability profiles have only marginal and transient clinical effectiveness. These results suggested that future RA clinical studies using these or other kinase inhibitors will have to consider strategies designed to simultaneously inhibit multiple kinase pathways.
Tissue red cell and plasma distribution changes due to irreversible hemorrhagic shock in dogs.

SummaryExperiments were designed to define the relative changes in red-cell and plasma distribution in skin and muscle during irreversible hemorrhagic shock. The blood of anesthetized, splenectomized dogs was labeled with red cells-51Cr or albumin-131I. Radioactivity in muscle and paw, was monitored by a collimated scintillation probe. Following a one hour control period dogs were hemorrhaged to and maintained at 30 mm Hg mean pressure until 25% of the shed blood was taken up. The remainder was then reinfused. The peripheral beds studied showed marked decreases in red cell and plasma following hemorrhage. Muscle red cells and plasma rose to levels about midway to the control level during the late hypotensive period and then increased to or above the control level after reinfusion. Cutaneous red cells and plasma remained at the low level to the end of the hypotensive period and then increased somewhat following reinfusion. Accumulation of red cells and plasma occurs in muscle and since it is the largest bo...
Research of Connection Mode of the Small Current Transformer Site Verification

Grid loss management is very important in electric company,which can reduce grid loss and enhance economic benefit.It is also a good way to put energy conservation and carbon emission reduction program of China into effect.This paper generally analyzes the actualities of grid loss management in China and the necessity of building grid loss management system.Then it gives a solution based on CIM and distributed Multi-data source technique.At last,it discusses the influence of smart grid supervision and control system to grid loss management.
A case-control study on the effectiveness of varicella vaccination on varicella outbreaks in schools and children′s institutions

Objective The aim of this study was to access the effectiveness of varicella vaccine,which was administered according to the present single dose schedule,against varicella in different age groups at schools and children′s institutions.Methods Children in the affected schools and institutions were divided into different age groups and the history of vaccination with varicella vaccine was analyzed.A 1∶1 matched case-control study were conducted.Results Varicella vaccine was administered in the children at the age of 1 to 2.For the 2 to 8 year age group,OR was 0.083(95%CI 0.037～0.185) and the effectiveness of vaccination was 91.7%(95%CI 81.5%-96.3%).For the 9 to 15 year age group,significant difference was not found.Conclusion Varicella vaccine provides a satisfactory protection last 6 year but the benefits may not continue much longer after a single dose injection at the age of 1～2 year old.A booster dose is recommended.
Effect of bisoprolol on heart rate variability in patients with stable pulmonary heart disease induced by chronic obstructive pulmonary disease

Objective To investigate the effect of high cardiovascular-selective β-blocker bisoprolol on heart rate variability( HRV) in patients with stable pulmonary heart disease( PHD) induced by chronic obstructive pulmonary disease( COPD). Methods A total of 36 patients with stable PHD induced by COPD were recruited in this study from 2011. 1 to 2012. 7. All patients were administrated with bisoprolol( 2. 5mg, once daily) on the basis of standard treatment to PHD,COPD and the concomitant diseases. All subjects were followed up for 4 weeks. The HRV and forced expiratory volume in the first second( FEV1) were examined in all subjects at enrollment and at the end of study. Results In comparison with the levels at enrollment,the levels of HRV at the end of study were significantly improved,P 0. 05. There were no significant differences on FEV1 between the levels at the beginning and end of study,P 0. 05. Conclusion The levels of HRV might be improve by Bisoprolol in patients with stable PHD induced by COPD.
Chapter 26 – Is Surgery still Necessary for Prostate Cancer?

This chapter provides a brief comparison of radical prostatectomy (RP) with current treatment modalities in terms of efficacy, complications, quality of life, and salvage of treatment failure. In addition, retropubic versus perineal versus laparoscopic prostatectomy approaches are also discussed. Radical prostatectomy remains a mainstay of prostate cancer treatment. In organ-confined diseases, it offers the only potentially curative option. Currently available data suggest that in a young and healthy patient, the procedure is associated with negligible mortality and acceptable morbidity, while offering the highest disease-free survival rates. Currently, there are three different approaches that can be used to perform radical proctectomy: retropubic, perineal, and laparoscopic. Studies comparing the retropubic versus perineal approach have demonstrated comparable rates of cure, positive margins, prostate specific antigen (PSA) failures, and tumor progression. The retropubic approach has been reported to have a higher incidence for positive apical margins, while the perineal approach has a higher incidence of positive anterior margins. The preliminary results of laparoscopic prostatectomy are also comparable; however, until the long follow-up data are available and the learning curve improves, the widespread use of this procedure should still be approached cautiously.
Embracing a Western Identity: Jewish Oregonians, 1849–1950 . By Ellen Eisenberg.

Embracing a Western Identity: Jewish Oregonians, 1849–1950 . By Ellen Eisenberg. Oregon State University Press, 2015. x + 304 pp. Illustrations, tables, notes, bibliography, index. $24.95, paper.) Ellen Eisenberg has written a meticulously researched book on nearly a century of Jewish experience and influence in Oregon. Building upon her previous work on Jews on the West Coast, Eisenberg provides a sophisticated analysis of the ways in which living in Oregon influenced Jewish identity and practices. She also offers description and analysis of the ways in which Jewish individuals and organizations have helped shape life in Oregon—from early businesses and community organizations to political leadership and civil rights activism. She succeeds in making more complex our understanding of … dsoden{at}whitworth.edu
Misconceptions—A Column about Errors in Geoscience Textbooks: Misconceptions of Thermal Energy in Real MaterialsITLE

(2002). Misconceptions—A Column about Errors in Geoscience Textbooks. Journal of Geoscience Education: Vol. 50, No. 3, pp. 342-344.
Surface degradation of ductile metals in elevated temperature gas-particle streams

Abstract The mechanisms and rates of erosion and combined erosion-corrosion of 9Cr-1Mo steel (where the composition is in approximate weight per cent) and type 310 stainless steel at elevated temperatures were investigated to understand better the behavior of piping steels in fluidized bed combustor environments. Tests were performed in a partially inert gas atmosphere to study erosion behavior and in an air atmosphere to study combined erosion-corrosion behavior. It was determined that the erosion rate remained constant or decreased with increasing temperature in nitrogen until a temperature was reached at which the tensile strength started to decrease more rapidly with increasing test temparature. Above this temperature the erosion rate increased rapidly with temperature. In an erosion-corrosion environment, corrosion was the dominant mechanism at all test conditions. At higher temperatures and velocities the material loss mechanism changed from low loss rate chipping of the scale to high loss rate periodic spailing. The continuous scale formed on 9Cr-1Mo steel in air appeared to protect the metal surface, decreasing its loss rate in α = 30° tests compared with that of type 310 stainless steel tested in the same conditions in nitrogen where a continuous scale did not form.
Hierarchical Consistent Hashing for Heterogeneous Object-Based Storage

Distributed storage systems play an increasingly critical role in data centers to meet the ever-increasing data growth demand. Heterogeneous storage systems, with the coexistence of hard disk drives (HDDs) and solid state drives (SSDs), can be an attractive distributed store solution due to the balanced performance, large capacity, and economic cost. The consistent hashing distribution algorithm that is widely used in distributed storage systems can achieve scalable and flexible mappings, but do not take full advantages of different characteristics of heterogeneous devices. In this research, we propose a hierarchical consistent hashing (HiCH) algorithm to better manage data distribution in a heterogeneous object-based storage system and better explore the potential of heterogeneous devices. HiCH divides heterogeneous storage devices into different buckets and applies separate consistent hashing rings for each bucket. It places data into various hashing rings according to the hotness, access time, and other data access patterns. The evaluation based on the Sheepdog, a distributed objectbased storage system, confirms that HiCH can improve the performance of storage systems, and also make better utilization of heterogeneous storage devices.
Toward clinically-feasible noninvasive electrophysiological imaging: investigating the impact of local anatomical details

Noninvasive Cardiac electrophysiological (EP) imaging aims to compute cardiac electrical dynamics from body surface potential. Anatomical data acquisition and processing computations, to reconstruct detailed geometry of heart and torso, are complex and time consuming tasks that are incompatible with clinical requirements. Our ultimate goal is to improve noninvasive EP imaging techniques toward clinical feasibility by investigating the minimum anatomical information. As the first step toward this goal, in this study we investigate the impact of local geometrical details on cardiac EP imaging. It is known that, global geometrical factors such as size, position and orientation of heart are important in noninvasive electrocardiography problem; but the effect of local geometrical details is unknown and it is difficult to accurately capture. We hypothesize that, as long as global geometrical parameters are captured, local details of realistic cardiac geometry do not significantly impact diagnostic effectiveness of cardiac EP imaging. We verify this hypothesis by developing simple geometrical model instead of realistic heart that enables us to measure local anatomical error, and applying it in EP imaging for detection of myocardial infarction. The results computed based on simple geometrical model are comparable to that of the realistic heart geometry. Thus, it confirms our hypothesis that discarding local geometrical details does not affect diagnostic cardiac EP imaging. The findings of this study pave the road for further studies on tomographic input data processing toward clinical feasibility.
6.609 – Orthopedic Implant Use and Infection

Joint replacement or arthroplasty is one the most widely used surgical procedures in medicine and has high success rates and tremendous benefits to the well-being of a large patient population, therefore continuously increasing demand for more and better joint implants. Despite the proven success of arthroplasty, the problem of implant-associated infection remains an immensely destructive complication that leads to repeated surgical interventions, extensive disability, and long rehabilitation. Half a century ago, Sir John Charnley, the father of modern arthroplasty, considered the 7% rate of infection unacceptable – yet, to date, that incidence has not changed drastically. When the orthopedic implant fails, appropriate management involves revision surgeries and removal of the infected joint. As a result, these infections harm both the patient and society at large, with rising cost, pain, and suffering. The advent of the latest large spectrum antibiotics and of complex implant coatings and engineering designs have only had a minimal impact on the problem. Therefore, no implant nor efficient strategy exists to prevent and eradicate periprosthetic infection while preserving the integrity of the joint.
Drought and Water Policy in the Western USA: Genesis and Structure of a Multi-level Field

This chapter analyses the methodological conditions for applying the notion of field to a specific kind of policy: water policy. It represents one of the few extensions of field theory into public policy outside the work of Bourdieu on housing. In that work, he approaches the policy by separating different levels of decisions and applying his theory to each independently. However, this research on the west of the USA explores the possibility of applying field theory on public policy by integrating all the levels into a common frame of analysis. We present the obstacles encountered in this process and the usefulness of field as an operative notion, rather than a fixed and closed theory.
Board level solder reliability simulation for epoxy mold compound based power package

This study focuses on the board level solder joint reliability of Epoxy Mold compound (EMC) based power package. A 3-D non-linear finite element analysis (FEA) model was established to predict the JEDEC standard temperature cycling (TMCL) test reliability performance of board level solder between package lead and the print circuit board (PCB). The modeling work studied the solder TMCL reliability with the package attached on different PCBs. It shows that different PCB designs with different geometry dimensions and materials) can impact the board level solder joint reliability significantly. This paper also studies different package designs and board level solder volumes to improve solder joint reliability performance through simulation. Through this study, we wish to gain a better understanding of the TMCL reliability performance of solder between an EMC based power package and PCB.
Craniofacial asymmetry as a marker of socioeconomic status among undocumented Mexican immigrants in the United States.

This study examines levels of fluctuating asymmetry (FA) in Mexican residents, U.S. residents, and undocumented border crossers (UBCs) from Mexico to the United States. Craniofacial structures develop symmetrically under ideal circumstances; however, during periods of developmental stress random deviations from perfect symmetry, or FA, can occur. It is hypothesized that the UBC sample would represent individuals of a lower socioeconomic status (SES) who experienced higher stress levels during development, and that these individuals would consequently have higher levels of FA. Three-dimensional cranial landmarks were collected from 509 individuals representing the three resident groups. Geometric morphometric methods were used to calculate an FA score for each individual. The FA score provides a distance measure that is a scalar measure of the magnitude of FA in each individual. The results show that the difference in the means of the FA scores between UBCs and U.S. residents is 0.43 (p = 0.02), with UBCs showing significantly higher levels of FA compared to U.S. residents. Moreover, Mexican residents' FA levels are intermediate between and not significantly different from the other two samples. These results suggest that levels of FA may prove useful for reconstructing individuals' social and economic circumstances, and that craniofacial asymmetry provides a suitable biological marker for analyzing differences in SES among different groups.
Resurrecting My Revolution

In previous work we reported that resources linked in tweets disappeared at the rate of 11% in the first year followed by 7.3% each year afterwards. We also found that in the first year 6.7%, and 14.6% in each subsequent year, of the resources were archived in public web archives. In this paper we revisit the same dataset of tweets and find that our prior model still holds and the calculated error for estimating percentages missing was about 4%, but we found the rate of archiving produced a higher error of about 11.5%. We also discovered that resources have disappeared from the archives themselves (7.89%) as well as reappeared on the live web after being declared missing (6.54%). We have also tested the availability of the tweets themselves and found that 10.34% have disappeared from the live web. To mitigate the loss of resources on the live web, we propose the use of a “tweet signature”. Using the Topsy API, we extract the top five most frequent terms from the union of all tweets about a resource, and use these five terms as a query to Google. We found that using tweet signatures results in discovering replacement resources with 70+% textual similarity to the missing resource 41% of the time.
Ion-Transport Engineering of Alkaline-Earth Hydrides for Hydride Electrolyte Applications

The heavier alkaline-earth hydrides (AeH2; Ae = Ca, Sr, Ba) are promising materials for hydrogen energy applications, due to their excellent ionic conductivity and thermal stability. We use first-principles calculations to elucidate their defect chemistry and ion-transport mechanisms. On the basis of calculated formation energies, we find that hydrogen vacancies (VH) are present in large concentrations, and hence, transport is vacancy-mediated. The vacancy migration barrier depends strongly on the charge state of the vacancy, with VH+ yielding the lowest barriers. The activation energy for ionic transport, which is the sum of the migration barrier and formation energy, can be further reduced by lowering the formation energy of the vacancies. This goal can be achieved by doping with acceptors, such as alkali-metal impurities, which induces larger concentrations of VH+. We show that, with optimized conditions for doping, ionic conductivities can be improved by several orders of magnitude; for BaH2, the cond...
Development of Water Content Dependent Tissue Dielectric Property Models

We propose dielectric tissue property models dependent on both water and air content covering the microwave frequency range. Water is the largest constituent of biological tissues, and its effect on the dielectric properties of biological tissue has been studied. However, dehydration effects due to thermal heating have not been fully characterized. We combined 1) Maxwell–Fricke mixture theory with a four-pole Cole–Cole equation to include water and air content dependence and, as the second approach, a different 2) Maxwell mixture model was coupled with a Debye function. The proposed approaches (1 and 2) were able to predict the permittivity ( ϵ’ ) and conductivity ( σ ) of bovine liver and swine lung tissues at different hydration and inflation states from 1 to 15 GHz. A second approach coupling Maxwell and Debye models required fewer assumptions and modeled tissue properties with higher accuracy (less than 15% mean percent error in all tissue types). These models may help improve the accuracy of microwave ablation simulation when tissue water content changes as a result of vaporization and may facilitate personalized treatment planning.
On Translating the Chronicle of Felice di Michele Brancacci’s Visit to Sultan Barsbay

This chapter discusses the role of translators and interpreters in the diplomatic and commercial mission of Felice Brancacci in the fifteenth century, as well as the course of transmission and translation of the documents. It situates Felice’s chronicle in contemporary “network” studies and travel literature as literature of encounter, reflecting upon the task of translation as historical, cultural, and ethical production.
Polycystic Ovarian Syndrome

A 28-year-old female presents to her primary care doctor for concern of increased weight gain and amenorrhea. She has had irregular menses since menarche at 11 years of age. She has been intermittently on oral contraceptive pills (OCPs) in the past which regularized her menses, but she hasn’t taken an OCP in the past 2 years. She was overweight as a teenager but has had a recent abrupt weight gain of 30 lbs in the past year. She has tried to lose weight with a low-fat diet and exercise in the past and lost 10 lbs 2 years ago, which she subsequently regained. Although her menses were irregular in the past, she would have 3–4 cycles/year, but now her last menstrual period was 6 months ago. Home pregnancy test is negative. She has always had facial hair which she has managed cosmetically by waxing, but she feels this has now become excessive and darker over the past year. She has a family history of type 2 diabetes in her mother. She is not trying to conceive but she is anxious about her fertility in the future. Her physical examination is significant for a body mass index (BMI) of 32 kg/m2, waist circumference 95 cm, BP 130/80, moderate hirsutism and acne, and acanthosis nigricans around the neck. She has no clinical stigmata suggestive of Cushing’s syndrome. Laboratory tests reveal a total testosterone level of 60 ng/dl (reference range, 14–53 ng/dl), calculated free testosterone level of 15.3 pg/ml per milliliter (reference range, 0.6–6.8 pg per milliliter), TSH 3.5 μIU/ml, FBG 102 mg/dl, and HbA1c 5.7%.
Enhancing Outcomes for Struggling Readers: Empirical Analysis of the Fluency Development Lesson.

This study investigated the efficacy of the Fluency Development Lesson (FDL) in improving reading achievement in primary grade struggling readers. 30 readers, enrolled in a summer reading clinic, p...
Basaloid Squamous Cell Carcinoma of the Larynx: A National Cancer Database Analysis.

ObjectiveBasaloid squamous cell histology is a rare variant that accounts for about 2% of all head and neck squamous cell laryngeal carcinomas. The purpose of this study was to examine overall surv...
Extending the Library's Web Presence: Building an Online Timeline Using MIT's SIMILE Exhibit

Extending the libraryâs presence beyond a brick and mortar structure is essential as resources become increasingly available in electronic format. One way to achieve this is to create a broad-reaching tool like a timeline using the Massachusetts Institute of Technologyâs Semantic Interoperability of Metadata and Information in unLike Environments Exhibit (MITâs SIMILE Exhibit), a cloud-based program that allows for the creation of data-driven websites with minimal programming or Web expertise. With this easy-to-learn technology, a library can extend its Web presence by providing online access to its rich historical collections. This article is a case study on the implementation of an online timeline, the âSonoma County Timelineâ, which was used to showcase the libraryâs resources at Sonoma State University. The author also demonstrates how to build a timeline using MITâs SIMILE Exhibit software, and how a timeline can be used to extend the libraryâs presence to its community. A guide to managing the project, a status report for the Sonoma State University Libraryâs instance of Exhibit, and a discussion of best practices are also detailed in the article.
Enhancing Student Learning in Removable Partial Denture Design by Using Virtual Three-Dimensional Models Versus Traditional Two-Dimensional Drawings: A Comparative Study.

PURPOSE To compare the use of virtual 3D casts as an alternative to paper-based exercises in preclinical removable partial denture (RPD) design in terms of student outcomes (as evidenced by exercise evaluation scores), as well as student attitudes related to the 2 formats. The first hypothesis of this study is that virtual 3D digital models in the exercise will result in better student outcomes as evidenced by the final exercise score compared to the 2D drawings. The second hypothesis is that virtual 3D digital models in the exercise will result in greater student acceptance compared to the 2D drawings. MATERIALS AND METHODS Students were divided into 2 equal, randomly assigned groups Both groups were made to solve 2 exercises: a class II exercise and a class IV exercise. Group 1 received the first exercise (exercise #1) as a Kennedy class IV design exercise in virtual 3D and the second exercise (exercise #2) as a Kennedy class II design exercise in traditional format. Group 2 would receive the opposite exercise #1 as a Kennedy class IV in traditional format and exercise #2 as a Kennedy class II in virtual 3D format. Virtual 3D casts were made to be identical to the traditional exercises. Students were then asked to complete a short survey to assess their preferences. The Wilcoxon Rank Sum test was used to compare the distribution of scores of exercises using the virtual 3D format with the scores when students used the traditional 2D format. Preference comparisons for the 2 formats were accomplished using exact binomial tests. RESULTS There was no difference in learning outcomes based on the distribution of student scores for either exercise independent of presentation format (p > 0.52). There was also no difference in individual student score between 2 identical exercises, independent of whether the exercise was using 3D virtual models or 2D drawings. A greater proportion of students agreed with the statements that favored the use of the virtual 3D models than disagreed with respect to all 7 questions asked, based upon the sign test (comparing agreement vs. disagreement with the statement, p < 0.0003 in all instances). CONCLUSION Despite there being no difference in learning outcomes (final scores), the students showed an overwhelming preference in having the virtual 3D casts part as part of the curriculum.
The cost-effectiveness of requiring universal vs contextual self-injectable epinephrine autoinjector for allergen immunotherapy.

Abstract Background Aeroallergen immunotherapy (AIT) is a safe and effective disease-modifying treatment associated with rare therapy-associated fatality. Significant practice variation surrounds universal or contextual prescription of self-injectable epinephrine (SIE) for patients receiving AIT. Objective To characterize the cost-effectiveness of a universal vs contextual SIE requirement for patients receiving AIT. Methods An economic evaluation using cohort and microsimulation was performed from both the societal and health care sector perspectives for patients undergoing AIT, assessing a universal requirement to fill SIE prescriptions at the outset of therapy compared with requiring this only after a systemic reaction to immunotherapy (SRIT). Results A universal SIE requirement for AIT is not cost-effective, with the incremental cost-effectiveness ratio for this strategy estimated at $669,327,730 per quality-adjusted life-year (QALY). In the microsimulation (n = 10,000), the mean (SD) costs of a universal approach exceeded that of a more context-specific strategy where SIE was only prescribed for patients after an initial SRIT ($19,653.36 [$4296.66] vs $16,232.14 [$5204.32]), and given the effects on rates of AIT discontinuation, the universal approach was less effective (mean [SD], 25.555 [2.285] QALYs) compared with a contextualized approach (mean [SD], 25.579 [2.345] QALYs). Universal SIE prescription could be cost-effective if it provided a 1000 times protection against AIT fatality at a value-based cost of $24, and the annual AIT fatality rates unrealistically exceed 2.6 per 10,000 patients. Conclusion In a simulation of potential SIE-prescribing strategies for patients receiving AIT, a universal approach to an epinephrine autoinjector requirement was not cost-effective when compared with an approach in which an SIE is prescribed only to patients with prior SRIT.
Retard to the Limit: Closed-Loop COVIMEP Control for Aggressive Exhaust Heating

Abstract During cold-starts, diesel engines equipped with aftertreatment systems typically use combustion phasing retard to increase exhaust gas enthalpy to hasten catalyst light-off, resulting in lower tailpipe emissions. Although later combustion phasing can help achieve faster catalyst light-off, combustion variability increases which can physically manifest as vibration and erratic engine behavior. To achieve faster catalyst light-off while remaining within combustion variability constraints, the premise of closed-loop control of Coefficient of Variation of IMEP (COVIMEP) to a target value using feedback from an in-cylinder pressure sensor has been explored. COVIMEP controllers have been designed using a model and validated via simulation and experiment at steady-state. The simulation and experimental results indicate that closed-loop COVIMEP control is a viable technique for retarding combustion phasing to the combustion variability limit at steady-state conditions.
FIRST IN HUMAN: THE EFFECTS OF BIVENTRICULAR PACING ON CARDIAC OUTPUT IN SEVERE PULMONARY HYPERTENSION

Primary pulmonary hypertension (pHTN) carries high mortality (30-50% over 3 years), and only suboptimal treatment options exist. In severe pHTN, the late diastolic pressure in the RV can exceed that in the LV. Interventricular septal bowing can then occur, hindering LV diastolic filling and reducing
Cardiomegaly on the Lateral Chest Radiograph

Evaluation cardiac size is best made with a frontal chest x-ray (Herring W. Learning radiology recognizing the basics. Chapter 13. Elsevier, Philadelphia, 2016). Lateral chest x-rays can still provide signs of cardiomegaly. The posterior border of the heart extending to the anterior border of the thoracic spine is a sign of cardiomegaly (Herring W. Learning radiology recognizing the basics. Chapter 13. Elsevier, Philadelphia, 2016). Lateral x-rays can also reveal specifics of each chamber of the heart. For example, a left ventricular enlargement presents as a posterior margin of the left ventricle extending >2 cm posterior to the inferior vena cava. On the other hand, a right ventricular enlargement presents as obliteration of the retrosternal clear space from dilation of outflow tract (Hutchison SJ. Principle of cardiovascular radiology, 2012). Cardiomegaly can be secondary to multiple conditions including cardiomyopathy, pericardial effusion, or pleural effusion (Kramer et al. Noninvasive cardiac imaging. In: Goldman-Cecil medicine, Saunders, 2016).
J-A2 Characterization of Crack-Tip Fields: Extent of J-A2 Dominance and Size Requirements

The requirements for J-dominance, limits of the single-parameter criterion to characterize the fracture of engineering structures, and two-parameter fracture analyses are first reviewed. Through comparison, it is argued that the two-parameter fracture methodology based on the J-A 2 theory is a reasonable extension of the single parameter (J-integral) fracture methodology. Consequently the extent of J-A 2 dominance in various specimens under either tension or bending is investigated in detail in this paper. Using the J 2 flow theory of plasticity and within the small-strain framework, full field finite element solutions are obtained for both deep and shallow crack geometries of single edge notch bar under pure bending [SEN(B)] and central cracked panel in uniform tension [CC(T)]. These crack-tip stresses are compared with those in the HRR singularity fields and the J-A 2 asymptotic fields at the same level of applied J. The comparison indicates that the size R of the region dominated by the J-A 2 field is much larger than that of the HRR field around the crack tip. Except for deeply-cracked SEN(B) in low hardening material (n=10) under fully plastic conditions, the numerical results near the crack tip in both SEN(B) and CC(T) match very well with the J-A 2 asymptotic solutions in the area of interest 1<r/(J/σ0)<5 from well-contained to large scale plasticity. The implications of these results on the minimal specimen size requirements essential to a two-parameter fracture criterion based on the J-A 2 asymptotic solution are then discussed.
Breathable, Stimuli-Responsive, and Self-Sealing Chemical Barrier Material Based on Selectively Superabsorbing Polymer

The occasional use of chemical warfare agents (CWAs) by rogue states in current conflicts provides a reminder that these hazards are a real threat. Although hazmat suits made of fully impermeable b...
On Unsupervised Simultaneous Kernel Learning and Data Clustering

Abstract A novel optimization framework for joint unsupervised clustering and kernel learning is derived. Sparse nonnegative matrix factorization of kernel covariance matrices is utilized to categorize data according to their information content. It is demonstrated that a pertinent kernel covariance matrix for clustering can be constructed such that it is block diagonal within arbitrary row and column permutations, while each diagonal block has rank one. To achieve this, a linear combination of a dictionary of kernels is sought such that it has rank equal to the number of clusters while a certain kernel eigenvalue is maximized by a novel difference of convex functions formulation. We establish that the proposed algorithm converges to a stationary solution. Numerical tests with different datasets demonstrate the effectiveness of the proposed scheme whose performance is very close to supervised methods, and performs better than unsupervised alternatives without the need of painstaking parameter tuning.
Acute stress enhances tolerance of uncertainty during decision-making

Abstract Acute stress has been shown to influence reward sensitivity, feedback learning, and risk-taking during decision-making, primarily through activation of the hypothalamic pituitary axis (HPA). However, it is unclear how acute stress affects decision-making among choices that vary in their degree of uncertainty. To address this question, we conducted two experiments in which participants repeatedly chose between two options—a high-uncertainty option that offered highly variable rewards but was advantageous in the long-term, and a low-uncertainty option that offered smaller yet more consistent rewards. The Socially Evaluated Cold Pressor Task (SECPT) was utilized to induce acute stress. Participants in Experiment 1 (N = 114) were exposed to either the SECPT or a warm-water control condition and then completed the decision-making under uncertainty task. Compared to the control condition, those exposed to the acute stress manipulation chose the high-uncertainty option that provided highly variable but larger rewards over the option that provided stable, smaller rewards. Experiment 2 (N = 95) incorporated a salivary cortisol measure. Results replicated the behavioral findings in Experiment 1 and demonstrated that the acute stress manipulation increased salivary cortisol. This work suggests that moderate acute stress is associated with tolerance of outcome variability in contexts that depend on learning to maximize rewards.
The Jiankang Empire in Chinese and World History: Andrew Chittick, Oxford: Oxford University Press, 2020. xi, 430 pp.

At the end of the second century of the Common Era came the effective end of a “colossal empire” that had for four centuries held in its grip most of the lands and peoples of mainland East Asia.1 T...
One size does not fit all: variation in thermal eco-physiology among Pacific salmonids

Pacific salmonids, cold-water fishes native to the northern hemisphere, span a massive geographic range (~ 33° latitude) and are exposed to a wide variety of environmental conditions regionally and temporally. California is home to the greatest concentration of at-risk anadromous salmonids and warming river temperatures pose both current and future threats to numerous populations. Thermal standards for management of California populations are currently based on guidelines for multiple salmonid species and from populations across the Pacific Coast. However, a growing body of literature suggests that salmonid populations exhibit population-specific thermal requirements. Furthermore, in California, salmonid populations regularly encounter temperatures that exceed current thermal standards based upon performance of outside populations. This review focuses on Chinook salmon (Oncorhynchus tshawytscha), providing evidence for interpopulation variation in thermal performance across life stages, and explores the drivers of variation. To describe the formation of interpopulation variation, we define fundamental and ecological thermal physiologies. Fundamental thermal physiology is the composite of intrinsic physiological traits and abiotic factors that define a species’ thermal window. Ecological and environmental interactions constrain this fundamental thermal physiology, yielding an ecological thermal physiology. Thermal physiology, viewed through this lens, provides researchers and managers avenues for salmonid research and conservation at the population scale. A more nuanced approach to west-coast salmonid conservation will be required to protect the most at-risk and vulnerable populations. Successful salmonid management must incorporate population-specific traits and present and future watershed conditions.
A contemporary analysis of xanthogranulomatous cholecystitis in a Western cohort.

Abstract Background Xanthogranulomatous cholecystitis is a particularly destructive variant of cholecystitis marked by unique inflammatory changes evident in pathologic specimens. Multiple case series have evaluated this process. However, these often focus on differentiating it from malignancy and have largely been conducted in Asia, where the disease may differ from that seen in the Western hemisphere. This study evaluated surgical outcomes after cholecystectomy for xanthogranulomatous cholecystitis at a high-volume tertiary care institution in the United States. The goal was to determine whether the process can be identified preoperatively and whether modifications should be made to the operative approach in this setting. Methods Patients with histopathological confirmation of xanthogranulomatous cholecystitis who underwent cholecystectomy between 2002 and 2019 were identified from an updated institutional database. Data regarding demographics, imaging findings, surgical procedures, and perioperative complications were reviewed retrospectively. A cohort of patients undergoing cholecystectomy for more typical diagnoses was also identified for comparison. Results Twenty-seven patients with a histopathologic diagnosis of xanthogranulomatous cholecystitis were identified. The median age was 64, and 17/27 (63.0%) were male. The majority of cases were done electively on patients admitted that day (17/27). Seventeen patients were evaluated with diagnostic ultrasonography, 21 with computed tomography scan, and 8 with magnetic resonance imaging; 21/27 patients had multiple modality studies. The most common singular finding was gallbladder wall thickening, but the radiographic findings were otherwise inconsistent. Twenty-five patients had planned laparoscopic cholecystectomies, but only 10 were completed. Only 8 of the 15 converted procedures were completed as simple cholecystectomies. Five patients required subtotal cholecystectomy. Median estimated blood loss was 250 cm3, and the median time of procedure was nearly 3 hours. Eight patients had complications, including 6 severe complications such as intraoperative bile duct injury. Conclusion Xanthogranulomatous cholecystitis unfortunately has a nonspecific presentation, which can make it difficult to recognize preoperatively. It is to be suspected in cases featuring a distended, severely inflamed gallbladder that does not match the benign appearance of the patient. When the diagnosis is suspected, an open approach is justified and patients should be counseled as to the increased likelihood of atypical approaches and elevated risk of complication. Referral to a hepatobiliary specialist is to be considered.
Framing choice: The origins and impact of consumer rhetoric in US health care debates.

Abstract This paper examines the origins of consumerist discourse in health care from a communication perspective via a historical textual analysis of health writing in popular magazines from 1930 to 1949. The focus is on Consumers Union's Consumer Reports and the American Medical Association's lay health magazine, Hygeia. Findings from Consumer Reports show that the consumer movement of the 1930s–40s staunchly advocated for universal health insurance. Whereas consumer rights language nowadays tends towards individual choice and personal responsibility, consumerism in health care during that era articulated ideas about consumer citizenship, framing choice and responsibility in collectivist terms and health care as a social good. This paper also illuminates the limits and weaknesses of a central tenet in consumerism—freedom of choice—by analyzing stories in Hygeia about the doctor–patient relationship. A textual analysis finds that the AMA's justification in the 1930s–40s against socialized medicine, i.e., the freedom to choose a doctor, was in practice highly controlled by the medical profession. Findings show that long before the rhetoric of the “empowered consumer” became popular, some patients exercised some choice even in an era when physicians achieved total professional dominance. But these patients were few and tend to occupy the upper socioeconomic strata of US society. In reality choice was an illusion in a fee-for-service era when most American families could not afford the costs of medical care.