cssi/SciSciGPT-SciSciNet huggingface dataset:
Reverse engineering resistant ROM design using transformable via-programming structure

Read only memories (ROMs) serve as an important non-volatile memory in various hardware systems to store predefined data and programs. Its pre-determined layout pattern makes unauthorized data extraction through chip-level reverse engineering easy to carry out. This paper proposes a new transformable via-programming ROM design to address the vulnerability to reverse energy attacks. Irreversible via transform triggered b y reverse engineering completely changes the electrical properties and the physical structure of ROMs that determine the stored data. Simulation results demonstrate the improvement against reverse engineering without incurring read failures or unacceptable noise margin reduction in ROMs.
Framework for Lifecycle Cost Assessment of Steel Buildings under Seismic and Wind Hazards

AbstractDespite the importance of considering multiple extreme events when designing structures, the current treatment of multiple hazard design in code provisions and assessment guidelines is rather vague. This is primarily because design and assessment of structures have traditionally been geared toward meeting the demand of a single hazard. In recent years, there has been a spike in interest by researchers and engineers in evaluating and designing structures for different hazard combinations. In this paper, a probabilistic framework is provided for assessing design alternatives based on estimating the lifecycle cost for two steel buildings with different heights subjected to different seismic and wind intensities. The intensities are specified based on probability of exceedance as per code standards. The total lifecycle cost is estimated using the initial cost and failure cost where the failure cost is a function of the probability of failure, which is calculated based on specified performance objectiv...
Altered sleep and EEG power in the P301S Tau transgenic mouse model.

Objective Sleep disturbances are prevalent in human tauopathies yet despite the importance of sleep, little is known about its relationship with tau pathology. Here, we investigate this interaction by analyzing sleep and tau pathology throughout tauopathy disease progression in P301S human tau transgenic mice. Methods P301S and wild-type mice were analyzed by electroencephalography (EEG)/electromyography at 3, 6, 9, and 11 months of age for sleep/wake time, EEG power, and homeostatic response. Cortical volume and tau pathology was also assessed by anti-phospho-tau AT8 staining. Results P301S tau mice had significantly decreased rapid eye movement (REM) sleep at 9 months of age and decreased REM and non-REM (NREM) sleep as well as increased wakefulness at 11 months. Sleep loss was characterized by fewer wake, REM, and NREM bouts, increased wake bout duration, and decreased sleep bout duration. Decreased REM and NREM sleep was associated with increased brainstem tau pathology in the sublaterodorsal area and parafacial zone, respectively. P301S mice also showed increased EEG power at 6 and 9 months of age and decreased power at 11 months. Decreased EEG power was associated with decreased cortical volume. Despite sleep disturbances, P301S mice maintained homeostatic response to sleep deprivation. Interpretation Our results indicate that tau pathology is associated with sleep disturbances that worsen with age and these changes may be related to tau pathology in brainstem sleep regulating regions as well as neurodegeneration. Tau-induced sleep changes could affect disease progression and be a marker for therapeutic efficacy in this and other tauopathy models.
Morality at Work: Do Employees’ Moral Commitments Inhibit Service Disparities and Reactive Workplace Behaviors?:

The current study draws from contemporary theories of morality to examine moral motives underlying service employees’ interactions with clientele. Specifically, we posit that employees who exhibit ...
Treating Aging with Testosterone

Most patients on testosterone are being treated for normal symptoms of aging. Given that the diagnostics are questionable and the benefits are unconvincing, the risks of testosterone, some of which may be life-threatening, are not worth taking.
Associations of Distance to Trauma Care, Community Income, and Neighborhood Median Age With Rates of Injury Mortality.

Importance Rural, low-income, and historically underrepresented minority communities face substantial barriers to trauma care and experience high injury incidence and mortality rates. Characteristics of injury incident locations may contribute to poor injury outcomes. Objective To examine the association of injury scene characteristics with injury mortality. Design, Setting, and Participants In this cross-sectional study, data from trauma center and emergency medical services provided by emergency medical services companies and designated trauma centers in the state of Maryland from January 1, 2015, to December 31, 2015, were geocoded by injury incident locations and linked with injury scene characteristics. Participants included adults who experienced traumatic injury in Maryland and were transported to a designated trauma center or died while in emergency medical services care at the incident scene or in transit. Exposures The primary exposures of interest were geographic characteristics of injury incident locations, including distance to the nearest trauma center, designation level and ownership status of the nearest trauma center, and land use, as well as community-level characteristics such as median age and per capita income. Main Outcomes and Measures Odds of death were estimated with multilevel logistic regression, controlling for individual demographic measures and measures of injury and health. Results Of the 16 082 patients included in this study, 8716 (52.4%) were white, and 5838 (36.3%) were African American. Most patients were male (10 582; 65.8%) and younger than 65 years (12 383; 77.0%). Odds of death increased by 8.0% for every 5-mile increase in distance to the nearest trauma center (OR, 1.08; 95% CI, 1.01-1.15; P = .03). Compared with privately owned level 1 or 2 centers, odds of death increased by 49.9% when the nearest trauma center was level 3 (OR, 1.50; 95% CI, 1.06-2.11; P = .02), and by 80.7% when the nearest trauma center was publicly owned (OR, 1.81; 95% CI, 1.39-2.34; P P = .02), and decreased by 26.6% when the per capita income was greater than $25 000 (OR, 0.73; 95% CI, 0.54-0.99; P = .05). Conclusions and Relevance Injury scene characteristics are associated with injury mortality. Odds of death are highest for patients injured in communities with higher median age or lower per capita income and at locations farthest from level 1 or 2 trauma centers.
Ileo-ileal fistula with severe malnutrition caused by strangulated ileus surgery while preserving ischemic ileum: A case report.

Abstract Introduction Entero-enteric fistulas are rare complications that occur in patients with inflammatory bowel disease and other intestinal diseases. In this report, we present an ileo-ileal fistula accompanied by severe malnutrition caused by strangulated ileus surgery while preserving the ischemic ileum in a very elderly patient. Case presentation A 90-year-old woman underwent emergency surgery without bowel resection for strangulated ileus in another hospital. Minor abdominal pain and slight fever persisted after surgery. She lost weight, losing approximately 10 kg within half a year. She gradually became difficult to move due to dyspnea upon exertion and generalized edema and visited at our hospital. Pleural effusions, ascites and severe malnutrition were observed. An elastic hard mass with mild tenderness was palpated in her abdomen. Computed tomography showed a loop-like ileum and ileo-ileal fistula with adjacent fat stranding. We performed a partial small bowel resection. The resected specimen demonstrated an ileo-ileal fistula and circumferential ulceration in the loop-like adhesion. After the operation, the nutrition status was resolved immediately without any medications. Discussion In cases of strangulated ileus, there are no deterministic criteria for evaluating intestinal blood flow. This is the first report of ileo-ileal fistula onset after surgery for strangulated ileus without intestinal resection. Furthermore, this fistula caused severe malnutrition duo to chronic inflammation, ulcer formation, and the blind-loop syndrome. Conclusions When preserving the intestinal tract in the operation of strangulated ileus, the occurrence of entero-enteric fistulas should be considered. Since malnutrition in the elderly is a serious problem, it should be treated promptly.
Dynamic Collapse of Underwater Metallic Structures – Recent Investigations: Contributions after the 2011 Murray Lecture

The Murray Lecture that was delivered in 2011 included a historical perspective on salient features of research conducted and published by Arun Shukla. A review of experimental work since the Murray Lecture is presented in this paper on the topic of imploding underwater structures. Specifically, the dynamic underwater collapse of metallic structures was studied under free-field and confined environments using novel applications of the Digital Image Correlation (DIC) technique. During these implosion experiments, the implodable volumes became unstable under hydrostatic and combined hydrostatic-explosive conditions. Moreover, there are two types of confinements explored in this paper. A semi-confinement, where a large tubular structure is open to a reservoir at one end and closed at the other end, which leads to water hammer waves on the closed end after implosions. Also, a full-confinement, where a large tubular structure is closed at both ends, which leads to limited hydrostatic potential energy during the implosion. For accurate displacement and velocity measurements of the collapsing structures, the 3D DIC technique is calibrated for underwater measurements in a small-scale setup for each experimental configuration. High-speed cameras are then used to record the dynamic implosion event while dynamic pressure transducers measure the emitted pressure pulses. The results of these experimental series show that the 3D DIC technique can be successfully used for displacement measurements of submerged objects by extracting intrinsic and extrinsic parameters using a submerged calibration grid. The implodable volume in an open-ended semi-confining structure displays a reduced collapse velocity with respect to a free-field configuration. This is primarily caused by a near-field pressure drop from the superposition of low-pressure implosion waves inside confining structure. Semi-confined implosion also exhibits high-pressure hammer pulses at the closed end. Implosions in fully confined vessels show significant reduction/delays in the implosion process due to limited energy present in the vessel. Lastly, during fully confined explosive experiments, the shock wave impact leads to structural vibrations in the implodable volume. The amplitude of these vibrations increases with higher hydrostatic pressures until the implodable volume shows an instability.
Riskalyzer: Inferring Individual Risk-Taking Propensity Using Phone Metadata

An individual's risk-taking propensity is "the stable tendency to choose options with a lower probability of success, but greater rewards". This risk propensity plays a central role in decision making by customers as well as managers, and is a mediator in behavior associated with security, privacy, health, finance, and well-being. Most common approach to understanding an individual's risk propensity remain lab-based games and surveys. Administering such surveys and games is a manual, time, and money intensive process that is also fraught with multiple biases. Recently, smartphones are increasingly seen as large-scale sensors of human activity, recording data related to physical and social aspects of people's lives. Building on this trend we investigate the potential of passive phone-based data for automatically inferring an individual's risk propensity. Specifically, we describe a novel approach to model an individual's risk propensity based on her mobile phone usage. Based on a 10-week field + lab study involving 50 participants, we report that: (1) multiple phone-based features (e.g., average gyradius) are intricately associated with participants' risk propensity; and (2) a phone-based model outperforms demography-based models by 39% in terms of accuracy of predicting risk propensity. In organizational terms, a better understanding of risk behavior could contribute significantly to risk management programs. At the same time, such results could open doors for more nuanced understanding of the underlying human risk phenomena and their interconnections with social and mobility behavior.
Function-specific and Enhanced Brain Structural Connectivity Mapping via Joint Modeling of Diffusion and Functional MRI

A joint structural-functional brain network model is presented, which enables the discovery of function-specific brain circuits, and recovers structural connections that are under-estimated by diffusion MRI (dMRI). Incorporating information from functional MRI (fMRI) into diffusion MRI to estimate brain circuits is a challenging task. Usually, seed regions for tractography are selected from fMRI activation maps to extract the white matter pathways of interest. The proposed method jointly analyzes whole brain dMRI and fMRI data, allowing the estimation of complete function-specific structural networks instead of interactively investigating the connectivity of individual cortical/sub-cortical areas. Additionally, tractography techniques are prone to limitations, which can result in erroneous pathways. The proposed framework explicitly models the interactions between structural and functional connectivity measures thereby improving anatomical circuit estimation. Results on Human Connectome Project (HCP) data demonstrate the benefits of the approach by successfully identifying function-specific anatomical circuits, such as the language and resting-state networks. In contrast to correlation-based or independent component analysis (ICA) functional connectivity mapping, detailed anatomical connectivity patterns are revealed for each functional module. Results on a phantom (Fibercup) also indicate improvements in structural connectivity mapping by rejecting false-positive connections with insufficient support from fMRI, and enhancing under-estimated connectivity with strong functional correlation.
Energetics of Swimming With Hand Paddles of Different Surface Areas

ABSTRACT Crocker, GH, Moon, JF, Nessler, JA, and Newcomer, SC. Energetics of swimming with hand paddles of different surface areas. J Strength Cond Res 35(1): 205-211, 2021-Hand paddles are one of the most common training aids used by the competitive swimmer, yet little is known regarding how hand paddle surface area affects the metabolic cost of transport (COT) while swimming. The purpose of this study was to determine how altering hand paddle size affects energy use during submaximal, front-crawl (i.e., freestyle) swimming. Twenty-six proficient, adult swimmers (13 men and 13 women) completed six 3-minute trials in a flume at a constant pace (102 cm·s-1; 1:38 per 100 m). Trials were performed in random order, using 1 of 5 pairs of hand paddles of different sizes or no paddles at all. Paddle surface areas were 201, 256, 310, 358, and 391 cm2 per hand. Without paddles, COT, arm cadence, and distance per stroke were 7.87 ± 1.32 J·kg-1·m-1, 29.4 ± 4.9 min-1, and 2.13 ± 0.34 m, which corresponded to a rate of oxygen consumption (Vo2) of 23.3 ± 3.7 ml·kg-1·min-1 and a heart rate (HR) of 118 ± 17 b·min-1. The use of larger hand paddles decreased COT, cadence, Vo2, and HR and increased distance traveled per stroke (all p < 0.001). However, the magnitude of the change of COT decreased as paddle size increased, indicating diminishing marginal return with increasing paddle surface area. The largest sized paddles increased COT per stroke compared with swimming without paddles (p = 0.001). Therefore, results from this study suggest that an optimal hand paddle size exists (210-358 cm2) for proficient, adult swimmers, which reduces COT without increasing COT per stroke.
Effects of Cannabinoids on Reproduction and Development

Publisher Summary This chapter discusses the effects of cannabinoids on reproduction and development. The potential importance of the effects of marihuana on reproduction and development has been recognized. This recognition has led to an increasing number of studies and reports on the action of marihuana and its purified cannabinoid fractions on reproductive capacity and events and on embryonic and fetal development. Cannabinoids exert a direct inhibitory action on testicular androgen synthesis and cell metabolism. This is in contrast to the variable weight changes but explains in part the drop in plasma testosterone levels following cannabinoid intake. The addition of tetrahydrocannibinol (Δ 9 -THC) or cannabinol to mouse testes minces in incubation medium inhibited endogenous testosterone production by more than 50%. The acute administration of marihuana by smoking usually leads to a decrease in circulating testosterone and luteinizing hormone levels. The effect of cannabinoids on maternal physiology during pregnancy and lactation is also elaborated in the chapter.
“Wow!” - A Tantalizing Candidate

This chapter discusses the “Wow! signal” detected on August 15, 1977 by the Ohio State University Radio Observatory (OSURO) radio telescope (often called the “Big Ear”). Let’s start with some history of OSURO prior to that detection.
Pedunculopontine tegmentum cholinergic loss leads to a progressive decline in motor abilities and neuropathological changes resembling progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is the most common atypical Parkinsonism. Although PSP shares some symptomology with Parkinson's disease (PD), PSP has a different underlying pathology characterized by tau aggregation. Furthermore, PSP sufferers respond poorly to PD medications and there are no effective alternative therapeutics. The development of both palliative and disease altering therapeutics has been hampered by the lack of an animal model that displays relevant PSP-like pathology and behavioral deficits. Previously, our lab found that in rats the selective removal of cholinergic pedunculopontine neurons (whose axonal projections overlap with areas of PSP pathology), mimics the extensive loss of cholinergic pedunculopontine neurons seen in PSP, and produces a unique PSP-like combination of deficits in: startle reflex, attention, and motor function. The present study extends those findings by allowing the lesion to incubate for over a year and compares behavioral and post-mortem pathology of pedunculopontine-cholinergic-lesioned and sham-lesioned rats. There was an early startle reflex deficit which did not improve over time. Progressive declines in motor function developed over the course of the year, including an increase in the number of "slips" while navigating various beams and poorly coordinated transitions from an elevated platform into homecages. Histological analysis discovered that the loss off cholinergic pedunculopontine neurons precipitated a significant loss of substantia nigra tyrosine hydroxylase-positive neurons and a significant enlargement of the lateral ventricles. The latter is a distinguishing feature between PSP and PD. This preclinical animal model of PSP has the potential to further our understanding of PSP and aid in the testing of potential therapeutic agents.
Optimization of the Intercept Temperature for High Temperature Superconducting Current Lead

Current leads containing high temperature superconducting (HTS) components have the potential to greatly reduce the heat leak to liquid helium environment. However, significant heat leak reduction can only be achieved by intercepting heat at the joint between the upper (copper) and the lower (high temperature superconducting) sections of current leads. An optimization analysis has been performed to minimize the net room temperature refrigeration power required for operating HTS current leads. The analysis shows that competing factors of cryocooler efficiencies and the influence of HTS material properties on the required helium liquefaction power determine an optimum intercept temperature in the range between 70 and 80 K.
Seismic graph analysis to aid seismic interpretation

AbstractDuring the seismic interpretation process, geoscientists rely on their experience and visual analysis to assess the similarity between seismic sections. However, evaluating all of the seism...
Use of endotracheal isoproterenol for severe bronchospasm while weaning from cardiopulmonary bypass

Introduction Weaning from cardiopulmonary bypass (CPB) is a complex process that focuses on cardiac function and rhythm, but adequate pulmonary function is also essential. We will present a case in which severe bronchospasm posed a substantial threat to the weaning process, but it was responsive to a novel treatment, endotracheal isoproterenol, in addition to intravenous ketamine and inhaled albuterol. Methods Case Report. Results 36-year old male with a history of Tetralogy of Fallot and asthma who presented with right-sided heart failure secondary to pulmonary stenosis and subsequent severe tricuspid regurgitation was initially managed with transcatheteter pulmonic valve placement and then scheduled for a surgical tricuspid valve replacement. CPB weaning was complicated by inability to ventilate due to severe bronchospasm, which was managed with isoproterenol (120mcg in divided dosing via endotracheal tube), ketamine, and albuterol. This treatment resulted in adequate ventilation and consequently, a successful wean without tachyarrhythmias or hypotension. Discussion This case demonstrated treating bronchospasm while weaning from CPB with a novel administration route of a largely abandoned medication in the United States. Isoproterenol causes relaxation of bronchial smooth muscle amongst other effects including increasing heart rate/contractility and peripheral vasodilation, which could potentiate arrhythmias and hypotension1. These adverse effects could be detrimental following CPB but the risk may be drastically reduced by endotracheal tube administration. Notably, treatment of the pediatric population with asthma exacerbations in the 1970s with intravenous isoproterenol found associations with arrhythmias2. However, recent data with inhalation isoproterenol has demonstrated safety in addition to increased efficacy compared to inhalation salbutamol3. Thus, more research is needed to evaluate if endotracheal isoproterenol should be utilized for management of obstructive lung disease in the OR.
Optimal On-Line Allocation Rules with Verification

We consider a principal who allocates an indivisible object among a finite number of agents who arrive on-line, each of whom prefers to have the object than not. Each agent has access to private information about the principal’s payoff if he receives the object. The decision to allocate the object to an agent must be made upon arrival of an agent and is irreversible. There are no monetary transfers but the principal can verify agents’ reports at a cost and punish them. A novelty of this paper is a reformulation of this on-line problem as a compact linear program. Using the formulation we characterize the form of the optimal mechanism and reduce the on-line version of the verification problem with identical distributions to an instance of the secretary problem with one fewer secretary and a modified value distribution. This reduction also allows us to derive a prophet inequality for the on-line version of the verification problem.
Imaging and Other Diagnostic Modalities in Varicocele Diagnosis

The diagnosis of varicocele is generally based on medical history and clinical examination. Imaging modalities have been used as an adjunct to confirm or clarify the diagnosis in situations where history and clinical examination are indeterminate. Treatment of clinically nonpalpable varicoceles, that is, those only diagnosed on imaging, has shown no benefit in improving fertility rates and is not recommended in guidelines. This has led to a limited role for imaging in the investigation of subclinical varicoceles. Technological advances in available imaging studies may potentially expand the role of imaging in the diagnosis and treatment of varicoceles. This chapter provides a review of the available imaging modalities for varicoceles.
Postoperative Management After Headache and Migraine Surgery

An uncomplicated postoperative recovery begins with a thorough preoperative workup, appropriate patient selection, and management of patient expectations. Adverse outcomes after migraine surgery are minor in nature and most commonly include paresthesias, numbness, and discomfort. Major complications are rare. Surgical outcomes reported over the last two decades show consistently good outcomes with up to 90% of patients experiencing partial or complete resolution of symptoms. The more challenging patients are those who continue to experience headache pain after surgery, which often represents the unmasking of preexisting trigger sites. We recommend that patients continue to follow up with their neurologist or chronic pain specialists for tapering of medications and generally avoid narcotic medications in the postoperative period.
Powhatan Indian Place Names in Tidewater Virginia, By Martha W. McCartney and Helen C. Rountree : Baltimore: Genealogical Publishing Company. 2017. Pp. xi +130. $22.00 (PB), ISBN: 978-0-8063-2062-5

To fully appreciate the significance of this comprehensive compendium of eastern Virginia place names, one needs to know something about the people, their language, and the geographic area where th...
Using a Do-It-Yourself Artificial Pancreas: Perspectives from Patients and Diabetes Providers.

Background:A growing number of people with diabetes are choosing to adopt do-it-yourself artificial pancreas system (DIYAPS) despite a lack of approval from the US Food and Drug Administration.We d...
Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings.

Introduction Communication failures are common root causes of serious medical errors. Standardized, structured handoffs improve communication and patient safety. I-PASS is a handoff program that decreases medical errors and preventable patient harm. The I-PASS mnemonic is defined as illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver. I-PASS was validated for physician handoffs, yet has the potential for broader application. The objectives of this quality improvement initiative were to adapt and implement I-PASS to handoff contexts throughout a pediatric hospital, including those with little or no known evidence of using I-PASS. Methods We adapted and implemented I-PASS for inpatient nursing bedside report, physician handoff, and imaging/procedures handoff. Throughout the initiative, end-user stakeholders participated as team members and informed the adaptation of the I-PASS mnemonic, handoff processes, written handoff documents, and performance evaluation methods. Peers observed handoffs, scored performance, and provided formative feedback. Adherence to I-PASS was the primary outcome. We also evaluated changes in handoff-related error frequency and clinician attitudes about the effects of I-PASS on personal and overall handoff performance. Results All 5 elements of the I-PASS mnemonic were used in 87% of inpatient nursing, 76% of physician, and 89% of imaging/procedures handoffs. Inpatient nurses reported reductions in handoff-related errors following I-PASS implementation. Clinicians across most handoff settings reported that using I-PASS improved both general and personal handoff performance. Conclusions I-PASS is adaptable to many handoff settings, which expands its potential to improve patient safety. Clinicians reported reductions in errors and improvements in handoff performance. We identified broad institutional support, customized written handoff documents, and peer observations with feedback as crucial factors in sustaining I-PASS usage.
Nuclear DNA mutation causing a phenotypic Leber hereditary optic neuropathy plus

Abstract To our knowledge, we detail the first case of a phenotypic expression of Leber hereditary optic neuropathy plus caused by a nuclear gene mutation in a 22-year-old female with painless, bilateral, sequential vision loss and dystonia associated with heterozygous mutations in the NDUFAF5 gene.
Effect of Facility on Operative Costs of Total Ankle Arthroplasties

Cost containment and bundled payments are becoming increasingly important in health care. The purpose of this study was to investigate if ambulatory surgery centers (ASCs) can deliver lower cost care and to identify sources of those cost savings in total ankle replacement (TAR). A cost identification analysis of primary TAR was performed at a single academic medical center. Multiple costs and time measures were taken from 730 consecutive patients over 5 years at either an inpatient facility or ASC. The relationships between total cost and operative time and multiple variables were examined, using multivariate analysis and regression modeling. The mean operative cost over 4 years was significantly greater at the inpatient facility than at the outpatient facility. Significant cost drivers of this difference were inpatient, physical and occupational therapy, pharmacy, and operating room costs. The most significant predictor of cost was facility type. This study supports the use of ASC facilities to achieve efficient resource use in the operative treatment of~total ankle arthroplasties (Journal of Surgical Orthopaedic Advances 27(4):321-324, 2018).
Barriers and facilitators to influenza-like illness absenteeism among healthcare workers in a tertiary-care healthcare system, 2017-2018 influenza season.

Objective: Influenza can be introduced and propagated in healthcare settings by healthcare workers (HCWs) working while ill with influenza. However, reasons driving this behavior are unclear. In this study, we examined barriers to and facilitators of absenteeism during the influenza season. Design: Cross-sectional mixed methods study. Setting: Ambulatory and inpatient settings in a large, tertiary-care healthcare system. Methods: An anonymous electronic survey was sent to HCWs between June 11 and July 13, 2018, asking participants to self-report influenza-like illness (ie, ILI symptoms of fever, chills, cough, or sore throat) during the 2017–2018 influenza season. We conducted a logistical regression analysis to identify factors associated with absenteeism. Results: Of 14,250 HCWs, 17% responded to the survey. Although 1,180 respondents (51%) reported symptoms of ILI, 575 (43%) did not stay home while ill. The most commonly perceived barriers to ILI absenteeism included being understaffed (odds ratio [OR], 1.78; P = .04), unable to find a replacement for work (OR, 2.26; P = .03), desiring not to use time off (OR, 2.25; P = .003), and paid by the hour or unable to afford being absent (OR, 2.05; P = .02). Common perceived facilitators of absenteeism included support from coworkers and management, clearer policy, better sick days availability, and lower perceived threat of disciplinary action. Conclusions: Reporting to work with ILI symptoms is common among HCWs. Most barriers and facilitators are related to systems. Addressing system factors, such as policies regarding sick days and sick leave and ensuring adequate backup staffing, is likely to facilitate absenteeism among ill HCWs.
P161 Anal Cancer Screening Practices: Current Expert Opinions

Background Anal cancer incidence is high among people with HIV (PWH), men who have sex with men (MSM), and women with lower genital tract disease (LGTD). Anal cancer is preceded by persistent high-risk human papillomavirus infection and subsequent high-grade squamous intraepithelial lesions (HSIL). Emerging screening practices may reduce anal cancer incidence. However, no national or international screening guidance exists. The International Anal Neoplasia Society (IANS) solicited expert opinion to understand preferred current anal screening practices. Methods IANS members and meeting attendees were invited to complete an online survey of screening practices. Screening initiation age, screening tool, and high resolution anoscopy (HRA) referral threshold were assessed. Recommendations for age and tool were delineated for PWH, sub-grouped female/non-MSM-male/MSM; and for women with LGTD, sub-grouped by disease (HSIL/cancer) and anatomic site (vulvar/cervico-vaginal). HRA referral threshold compared immunocompetent versus immunocompromised patients. Results Of 1150 individuals contacted, 140 (12%) participated and were included; 113 (81%) were HRA providers. Similar proportions of respondents specified a screening initiation age in all PWH (range 61–64%); however, there was no consensus for the specific age to begin screening for any PWH sub-group. More respondents preferred ’no age restriction’ for MSM (36%) compared to non-MSM-male counterparts (22%). Among LGTD groups, ’no age restriction’ was more commonly preferred (range 44–55%). Of tools, across all PWH and LGTD groups, cytology (79–89%) and digital anorectal exam (DARE) (73–83%) were most frequently recommended. For HRA referral threshold, ‘any abnormality’ was more often selected for both immunocompromised (56%) and immunocompetent (46%) patients than a specific cytology result (29%,36%). Among those who specified cytology, consensus was lacking and did not vary by immune status. Conclusion Respondents concurred cytology and DARE were preferred screening modalities. Screening initiation age and HRA referral threshold showed less consensus. Evidence-based guidance is needed and may lead to more consistent screening practices.
Trends in Pressure Injury Development in Patients With Lower Motor Neuron and Upper Motor Neuron Lesions: A Retrospective Descriptive Study.

BACKGROUND Persons with spinal cord injury (SCI) are at high risk of pressure injury (PrI) development, but there is limited information about the effect of injury patterns (ie, upper motor neuron [UMN] or lower motor neuron [LMN] presentations) on PrI risk. PURPOSE This study was conducted to explore the rate of PrI development in patients with LMN and UMN lesions. METHODS A retrospective descriptive review of data from patients who were treated at a specialized outpatient SCI rehabilitation center in Baltimore, MD, between January 1, 2013, and December 31, 2019. Patients with neurological levels T8 and below, any type of SCI motor ability, and whose records were complete were included in the study. Data extracted included age, sex, date of injury, injury type, modified Ashworth Scale (MAS) score (ie, scale representing resistance to passive movement), date MAS was performed, body mass index, Spinal Cord Independent Measures-III, Braden Scale scores, ambulatory status, antispasticity medication, presence or history of PrI, and method of closure. Patients with a score of 0 on the MAS and without pharmacological management for spasticity were included in the LMN group, and patients with a score greater than 0 on the MAS with or without pharmacological management were included in the UMN group. Variables were compared using mean ± standard deviations, range, t-test, and Pearson's chi-squared and Fisher exact tests where appropriate. P values < .05 were considered statistically significant. RESULTS Of the 602 records examined, 194 were complete and met inclusion criteria. Most patients (119, 61.34%) were male and classified in the UMN group (162, 84%). Mean age and time since injury were 35.20 ± 18.78 and 6.20 ± 7.62 years, respectively. Seventy-three (73) of 194 patients (37.6%) had, or had a history of, a PrI; 21 (66%) in the LMN and 52 (32%) in the UMN group (X21 = 12.8; P < .001). Statistically significant differences were noted between persons with LMN and UMN in terms of Braden Scale scores, age, body mass index, Spinal Cord Independent Measures-III, and time since injury. Compared with the UMN group, more patients in the LMN group had motor complete injuries with ISNCSCI levels A/B (P < .001) and were nonambulatory (P < .001). CONCLUSION The results of this study confirm that patients with SCI have a high rate of PrI development. The percentage of PrIs was significantly higher in the LMN than in the UMN group. Additional studies to examine the other variables that were significantly different between groups and their effect on PrI risk are needed.
Experimental animal models for moyamoya disease and treatment: a pathogenesis-oriented scoping review

Objective Moyamoya disease (MMD) is an intracranial steno-occlusive pathology characterized by progressive narrowing of proximal large vessels, including the terminal internal carotid arteries (ICAs), middle cerebral arteries, or anterior cerebral arteries. Named for the "puff of smoke" appearance of the anomalous vascularization visualized on cerebral angiography, MMD lacks a well-defined etiology, although significant insights have been made, including the identification of a susceptibility gene, RNF213, in humans with the disease. A limitation to advancing the understanding and treatment of MMD has been the lack of experimental animal models that authentically reflect the clinical pathogenesis. In an effort to analyze characteristics of currently available models and identify strategies for future model generation, the authors performed a scoping review of experimental animal models that have been used to study MMD. Methods A systematic search of PubMed, Web of Science, and Scopus was performed to identify articles describing animal models used to study MMD. Additional articles were identified via citation searching. Study selection and data extraction were performed by two independent reviewers based on defined inclusion and exclusion criteria. Results A total of 44 articles were included for full-text review. The methods used to generate these animal models were broadly classified as surgical (n = 25, 56.8%), immunological (n = 7, 15.9%), genetic (n = 6, 13.6%), or a combination (n = 6, 13.6%). Surgical models typically involved permanent ligation of one or both of the common carotid arteries or ICAs to produce chronic cerebral hypoperfusion. Genetic models utilized known MMD or cerebrovascular disease-related genes, such as RNF213 or ACTA2, to induce heritable cerebral vasculopathy. Finally, immunological models attempted to induce vasculitis-type pathology by recapitulating the inflammatory milieu thought to underlie MMD. Conclusions Models generated for MMD have involved three general approaches: surgical, immunological, and genetic. Although each reflects a key aspect of MMD pathogenesis, the failure of any individual model to recapitulate the development, progression, and consequences of the disease underscores the importance of future work in developing a multietiology model.
Preparedness of Countries To Constrain COVID-19 Pandemic Crisis and Support Timely Vaccinations: Analysis of the Performance and Underlying Structural Factors

One of the problems in pandemic crisis of the Coronavirus Disease 2019 (COVID-19) is the evaluation of the preparedness of crisis management in countries to cope with COVID-19 pandemic and to face new infectious diseases. In this settings, the main goal of this study is to propose the Index r (as resilience) that detects which countries have had the best performance to reduce the negative impact of mortality related to COVID-19 pandemic and the Index p (as prevention) that assesses best-performer countries to support COVID-19 vaccinations in order to prevent the diffusion of future waves of COVID-19, reducing socioeconomic issues and risk of exposure to future epidemics of the COVID-19 and similar infections. On the one side, Index of resilience produces a score based on average mortality, average daily hospital occupancy and Intensive Care Units (ICUs) occupancy per 100 000 people; on the other side, Index of prevention produces a synthetic score by focusing on indicators of COVID-19 vaccinations, such as doses of vaccines administrated and total vaccinates per 100 000 people. The application of these indexes on a case study of European countries, having a similar socioeconomic structure, reveal that best-performer countries to cope with COVID-19 pandemic crisis have a smaller size of population and better governance, not limited to healthcare system. These indexes can support a strategies of crisis management to constrain current and future pandemic threat of the COVID-19 and similar infectious diseases.
Eyes of the Beholders: First-year medical students' perceptions of surgeons and the field of surgery.

BACKGROUND Medical students have negative perceptions of surgery prior to their clerkships. To explore possible explanations, we examined the association between these perceptions, individual identity and vulnerability to stereotype threat (ST). METHODS All first-year medical students at a single school received an electronic survey which assessed identity groups, vulnerability to ST and perceptions of surgeons/surgery. Multi-method analyses examined these associations. RESULTS Women held more negative than positive views about the field of surgery (p = 0.007) but not surgeons. Students vulnerable to ST had negative views about both surgeons (p < 0.0001) and surgery (p = 0.007). They were also less interested in pursuing a surgical career compared to non-vulnerable students (56% vs. 80% p = 0.03). CONCLUSION For some students, negative views of surgeons and surgery appear to be associated with individual identity and ST. Future research should aim to confirm these findings and identify strategies to develop positive perceptions for these populations.
Against the clock towards new Ebola virus therapies

Since the end of 2013, West Africa has been suffering the largest Ebola virus (EBOV) outbreak in recorded history. The lack of health care infrastructure in the affected countries, as well as a concentration of infected cases in the most populated areas allowed the virus to spread with no control during the first months of the outbreak. With no specific treatment available to combat EBOV infection and its associated disease, an extraordinary worldwide effort was made to confront the severity of the situation and to establish new therapeutic strategies that would lead to better and faster control and eradicate the outbreak. In the last two years, several candidate therapies and potential vaccines against EBOV have arisen and human clinical trials are ongoing, in hopes of starting their deployment in the affected countries. This article reviews the current candidate therapies against EBOV, their stage of development and future prospects in battling EBOV outbreaks.
Current state of the mass storage system reference model

IEEE SSSWG was chartered in May 1990 to abstract the hardware and software components of existing and emerging storage systems and to define the software interfaces between these components. The immediate goal is the decomposition of a storage system into interoperable functional modules which vendors can offer as separate commercial products. The ultimate goal is to develop interoperable standards which define the software interfaces, and in the distributed case, the associated protocols to each of the architectural modules in the model. The topics are presented in viewgraph form and include the following: IEEE SSSWG organization; IEEE SSSWG subcommittees & chairs; IEEE standards activity board; layered view of the reference model; layered access to storage services; IEEE SSSWG emphasis; and features for MSSRM version 5.
Evaluating Energy Efficiency

Nature of resource planning has changed dramatically since 1970s due to increased diversity in resource options such as renewable alternatives, demand-side management, space conditioning, cogeneration of heat and electricity in industrial applications, and deregulation of the energy market. Along with that new objectives have been added to the utilities’ decision-making processes beyond cost minimization (Hobbs, Eur. J. Oper. Res., 83:1–20, 1995). Moreover; technological development, instability in fuel markets, and government regulations are taking place faster than ever before and as a result complexity and uncertainty involved in decision-making practices have become increasingly significant. This chapter provides an approach based on hierarchical decision modeling to consider new factors in evaluating energy efficiency technologies.
Keeping the Lights on: Examining and Re-Imagining NLRA Preemption in a Time of Electric Necessity

Strikes or lockouts at an electric utility can lead to delayed maintenance in the best case, or blackouts in the worst. In a society dependent on electricity for everything from health care to safe drinking water, a disruption in utility service could cause untold damage. Yet thanks to the expansive doctrine of preemption under the National Labor Relations Act (NLRA), many public utility commissions (“PUCs”) — the state entities that regulate electric utilities — have concluded that they are prohibited from intervening in labor disputes, even when public safety is threatened. Given the magnitude of harm that could be caused by electric service disruptions, clarification of PUCs’ authority is necessary. This article analyzes the extent to which state agencies retain the power to regulate utilities and protect their citizens, even when their actions may, either directly or indirectly, impact collective bargaining or alter the balance of power between labor and management. The article illustrates the authority of state utility regulators to set service and safety standards, oversee utility staffing, and intervene in labor disputes. In addition, the article proposes a re-thinking of NLRA preemption doctrine as applied to electric utilities, and suggests possible reforms to accommodate the role electricity plays in today’s society.
Using Tobacco to Treat Cancer

Plant biotechnology brings us closer to personalized therapies as tobacco plants are genetically reprogrammed to produce a vaccine to treat lymphoma.
Optical polymer waveguide based cantilevers for chemical and biological sensors

A novel polymer optical waveguide cantilever-based transducer is presented in this paper. This cantilever-based transducer can be used for chemical and biological sensing in both air and liquid environments. Compared with current cantilever transducers, this particular transducer has high sensitivity due to an internal optical readout mechanism, yet is a simple structure without the need for complex optical adjustments, and can be potentially integrated with circuits on a single chip. Due to a low intrinsic Young's modulus, the polymer cantilever is more flexible than those made of traditional semiconductor materials. Thus, it provides a larger degree of deflection and offers higher sensitivity to the adsorption of molecules, compared to other transducers. A deflection length of 50 nm has been verified
Fuel Cells and Batteries

This chapter provides an overview of fuel cells and batteries—electrochemical devices that convert chemical energy directly into electrical energy without combustion. In an internal or external combustion engine, electrons are transferred from the fuel directly to the oxidizer, releasing the stored energy as heat. Converting the heat into mechanical energy is subject to the limitations of the Carnot cycle. In a fuel cell or battery, the fuel releases electrons to an electrode. In batteries, the fuel, as well as the oxidizer, is stored inside the battery. There are a number of different types of fuel cells based on the electrolyte used, which in turn determines the operating temperature. Several parameters determining the performance of the fuel cell—gas pressure and purity, gas stoichiometry, gas humidification, current density (CD) and changes in CD, and temperature are discussed.