cssi/SciSciGPT-SciSciNet huggingface dataset:
Fast Tracking After Ivor Lewis Esophagogastrectomy

Objectives: We streamlined our care using an algorithm for the postoperative care of patients who undergo Ivor Lewis esophagogastrectomy to try to reduce hospital stay to 7 days and maintain safety and patient satisfaction. Methods: A consecutive series of 90 patients who underwent elective esophageal resection by one general thoracic surgeon were studied. An algorithm to guide postoperative care was used, featuring avoidance of the ICU, early ambulation, jejunal tube feeds starting on postoperative day (POD) 1, removal of nasogastric tube and epidural on POD 3, a gastrograffin swallow on PODs 4 or 5, and discharge on POD 7. Results: There were 90 patients (70 men). Fifty-two patients (58%) underwent preoperative radiation and chemotherapy. Esophagectomies were done for cancer or high-grade dysplasia. Forty-two of the last 55 patients (77%) went directly to the floor. Sixteen patients (17.7%) had major complications, which included pneumonia in 5 patients and aspiration pneumonia in 4 patients. There were no anastomotic leaks, and there were four operative deaths (4.4%). There was a greater incidence of failure to fast track, and to have a major complication in patients who underwent neoadjuvant treatment (p 0.025 and p 0.048, respectively). Median hospital stay was 7 days (range, 6 to 74 days). Complications or mortality could not be definitively attributed to fast tracking. Ninety-seven percent reported excellent satisfaction with their hospital stay, and four patients were readmitted within 1 month of discharge. Conclusions: Fast tracking patients using an algorithm after esophageal resection is safe and delivers minimal morbidity and mortality, and a high patient satisfaction rate. A median hospital stay of 7 days is possible, and the ICU can be avoided in most patients. (CHEST 2004; 126:1187–1194)
Time course of imaging changes of GBM during extended bevacizumab treatment.

Glioblastoma multiforme (GBM) are morphologically heterogeneous tumors, with varying amounts of necrosis, and edema. Previous studies have shown that treatments incorporating the VEGF antibody bevacizumab can reduce edema and tumor burden in GBM. Additionally it has been suggested that bevacizumab regimen treatment reduces the percent of tumoral necrosis. Therefore we sought to (1) determine the time course of change in necrosis, tumor, and edema volume in patients who respond to bevacizumab regimen treatment and (2) determine if GBM that progress following a response to bevacizumab regimen treatment are morphologically different from their appearance at prior tumor progression. Therefore, we retrospectively assessed tumor, necrosis, and edema volumes on MRI scans from 15 patients with recurrent GBM who responded to bevacizumab regimen treatment, and had extended (>7 month) follow-up. We found that the median time to best tumor response was 158 days (range, 16–261, SD = 63). The median best response was 72.1% reduction in tumor volume and 72.8% reduction in peritumoral edema. Most tumors (77.8%) showed resolution of necrotic areas. The relative reduction of edema and necrosis was sustained, even in patients (n = 7) who developed tumor progression. Thus the mean ratio of edema-to-tumor volume at progression on bevacizumab regimen treatment was 38.4% lower than that for the same tumors seen on progression scans following prior chemotherapy. The percentage of necrotic tumor also was diminished following progression on bevacizumab regimen treatment. These findings illustrate the time course of changes in edema and tumor volume with prolonged bevacizumab regimen treatment, and support the conclusion that the morphology of recurrent GBM following bevacizumab regimen therapy is distinct from that on other chemotherapy.
Employing Memory Narratives to Dissect the Well-Being of Lesbian, Gay, and Bisexual Adolescents

The relationship between lesbian, gay, and bisexual (LGB) identities and negative psychoemotional outcomes among teens is well established; this study analyzed happy memory narratives written by 390 LGB adolescents to investigate positive life experiences that might improve the well-being of LGB youth. A significant number of narratives were classified as everyday leisure or special occasions. Happy memory narratives were also highly likely to reference friends. Few LGB adolescents recalled LGB-specific events. The data suggest LGB adolescents recall happy memories that would be considered normalized experiences similar to those of heterosexual adolescents. Implications for understanding the well-being of LGB youth are discussed.
Is group cohesiveness a double-edged sword : An investigation of the effects of cohesiveness on performance

The study investigates the relationship between cohesiveness and group effectiveness. The link between the two constructs is predicted to be moderated by the orientation (whether task or nontask) and strength of work group norms. Datafrom a 1995 survey of army units in the Danish military were used. Multiple regression was used to test hypotheses, and the results indicated strong supportfor the existence of a moderator
A Test of Screening Discrimination with Employer Learning

This paper tests for the presence of screening discrimination, a type of statistical discrimination that occurs when employers are less able to evaluate the ability of workers from one group than from another. Using data from the 2000 release of the NLSY79, the author examines wage equations in a framework of employer learning to test the hypothesis that the market receives less reliable productivity signals at labor market entry from black men than from white men. The estimation results support this hypothesis. Variables that are difficult for employers to observe, such as the AFQT score, had less influence on the wages of black men (and easily observed variables had more influence) than on the wages of white men. The influence of hard-to-observe variables on wages, however, increased faster with experience for black men.
Effect of methomyl and oxamyl soil applications on early control of nematodes and insects.

BACKGROUND: Methomyl is a widely used carbamate insecticide that has traditionally been applied as a foliar spray. More recently, methomyl has been labeled as a soil application via drip chemigation. Not much is known about the insecticidal and nematicidal potential of soil-applied methomyl. Methomyl soil applications were evaluated for their potential to control soil nematodes and foliar insect pests in a series of lab and greenhouse tests. RESULTS: Methomyl showed rapid knockdown of Meloidogyne incognita (Kof. & White) Chitwood in aqueous assays, with EC50 and EC90 values that were similar to oxamyl and averaged 4.9 and 15.2 mg L−1. In the greenhouse, soil applications of methomyl ranging from 0.56 to 4.0 kg ha−1 provided significant M. incognita control similar to oxamyl during early growth (up to 25 days after planting) of pea and bean. Higher application rates and split applications improved nematode control, but also increased the risk of phytotoxicity. Methomyl soil applications were highly effective on several insects including Myzus persicae (Sulzer), Aphis gossypii (Glover), Frankliniella occidentalis Perg. and Spodoptera exigua (Hubner). Methomyl was about 5–9-fold more potent on M. persicae and A. gossypii when applied via soil drench as opposed to foliar spray. Potency on Bemisia tabaci Genn., S. exigua and Trichoplusia ni Hubner was about the same with the two application methods. CONCLUSION: Methomyl soil applications showed good potential for early control of various insect and nematode pests. Further testing is required to verify activity under field conditions. Copyright © 2011 Society of Chemical Industry
Antecedents of Information and System Quality: An Empirical Examination Within the Context of Data Warehousing

Understanding the successful adoption of information technology is largely based upon understanding the linkages among quality, satisfaction, and usage. Although the satisfaction and usage constructs have been well studied in the information systems literature, there has been only limited attention to information and system quality over the past decade. To address this shortcoming, we developed a model consisting of nine fundamental determinants of quality in an information technology context, four under the rubric of information quality (the output of an information system) and five that describe system quality (the information processing system required to produce the output). We then empirically examined the aptness of our model using a sample of 465 data warehouse users from seven different organizations that employed report-based, query-based, and analytical business intelligence tools. The results suggest that our determinants are indeed predictive of overall information and system quality in data warehouse environments, and that our model strikes a balance between comprehensiveness and parsimony. We conclude with a discussion of the implications for both theory and the development and implementation of information technology applications in practice.
Fluid and Electrolytes: Clinical Aspects

Dr Daniel C. Darrow, a clinician and one of the investigators whose contributions helped lay the foundation of modern fluid therapy, made the following observation in his book, A Guide to Learning Fluid Therapy: "Fluid therapy inevitably is carried out by rules which achieve results without requiring continual resort to complicated scientific reasoning. The chief difficulty is that no simple rules based on body weight or surface area meet the varying physiological requirements by infants, children, and adults. Nevertheless, by recognizing that body size has two dimensions, the same general rules apply at all ages to patients of different weights." The dimensions of body size pertinent to fluid therapy are caloric production and weight. The usual ongoing fluid expenditures—maintenance fluids—are related to energy production, while restoration of normal body composition in patients with water and electrolyte deficits on excesses are related to changes in body weight. It should be added that when fluids for a patient are prescribed based on "convenient rules," the physician must be aware of the assumptions that renal function is not significantly impaired and that the homeostatic mechanisms for conservation and excretion of water and solute are intact. If this is not the case, the provision of water and electrolytes must be based on assessment of ongoing fluid expenditures.
A New Model for Tensile Creep of Silicon Nitride

The tensile creep rate of most commercial grades of Si3N4 increases strongly with stress. Although the usual power-law functions can represent the creep data, the data often show curvature and systematic variations of slope with temperature and stress. In this article, we present a new approach to understanding the creep of ceramics, such as Si3N4, where a deformable second phase bonds a deformation-resistant major phase. A review of experimental data suggests that the rate of formation and growth of cavities in the second phase controls creep in these materials. The critical step for deformation is the redistribution of the second phase away from the cavitation site to the surrounding volume. The effective viscosity of the second phase and the density of active cavities determine the creep rate. Assuming that the hydrostatic stresses in pockets of the second phase are normally distributed leads to a model that accurately describes the tensile creep rate of grades of Si3N4. In this model, the creep rate increases exponentially with the applied stress, is independent of Si3N4 grain size, is inversely proportional to the effective viscosity of the deformable phase, and is proportional to the cube of the volume fraction of the deformable phase.
Selective Activation of A3 Adenosine Receptors With N6-(3-Iodobenzyl)Adenosine-5′-N-Methyluronamide Protects Against Myocardial Stunning and Infarction Without Hemodynamic Changes in Conscious Rabbits

Abstract To examine the cardioprotective role of A3 adenosine receptors during myocardial ischemia/reperfusion injury, we tested the effect of N6-(3-iodobenzyl)adenosine-5′-N-methyluronamide (IB-MECA), a potent and selective A3 adenosine receptor agonist, in models of myocardial stunning and infarction in chronically instrumented conscious rabbits. In phase I (studies of myocardial stunning), rabbits were subjected to six 4-minute coronary occlusions, each separated by 4-minute reperfusion periods, after which the recovery of systolic wall thickening was measured (ultrasonic crystals). In phase II (studies of myocardial infarction), rabbits were subjected to a 30-minute coronary occlusion followed by 3 days of reperfusion. In both phases, IB-MECA was administered as an intravenous bolus (100 μg/kg) 10 minutes before the first coronary occlusion. This dose of IB-MECA was determined in pilot studies to have no effect on heart rate, arterial blood pressure, or plasma histamine concentration in rabbits. In ph...
Brief communication: Haplogroup X confirmed in prehistoric North America.

Haplogroup X represents approximately 3% of all modern Native North American mitochondrial lineages. Using RFLP and hypervariable segment I (HVSI) sequence analyses, we identified a prehistoric individual radiocarbon dated to 1,340 +/- 40 years BP that is a member of haplogroup X, found near the Columbia River in Vantage, Washington. The presence of haplogroup X in prehistoric North America, along with recent findings of haplogroup X in southern Siberians, confirms the hypothesis that haplogroup X is a founding lineage.
Zinc deficiency suppresses plasma leptin concentrations in rats

Leptin concentrations during zinc deficiency were measured. Leptin is produced by adipose tissue and has potent affects on body weight and food intake regulation. Zinc deficiency results in anorexia, but the cause for this anorexia is not well understood. Aberrant regulation during zinc deficiency of leptin expression or secretion could be a factor in this anorexia. Two groups of Sprague-Dawley male rats were provided AIN-93-based diets made either adequate or deficient in zinc (+Zn, −Zn; 30 or 1 mg Zn/kg diet) and a third group (PF) was provided the +Zn diet at the reduced levels consumed by −Zn rats. In Study 1, +Zn, −Zn, and PF rats (n = 12 ea.) were fed using a 4-hr meal-feeding protocol for 4, 9, and 28 days. Leptin concentrations in −Zn rats were lower than both +Zn and PF groups (P < 0.05) on Days 9 and 28. In Study 2, 24 rats were divided into −Zn (n = 6), +Zn (n = 6), and PF (n = 12) groups. On day 21, six PF rats were provided a meal (PF-fed: PF-F); the other six PF rats were not offered this final meal (PF-restricted: PF-R). Plasma leptin concentrations were again lowest in the −Zn group. Reduced leptin levels during zinc deficiency suggest that leptin is responding normally, signaling low body fat levels during zinc deficiency. It seems that leptin is not a dominant factor in the development of zinc deficiency-induced anorexia.
Insect Arrival Pattern and Succession on Buried Carrion in Michigan

This study examined pig carcasses buried at two different depths, 30 and 60 cm, to determine if insects were able to colonize buried carcasses, when they arrive at each depth, and what fauna were present over seven sampling dates to establish an insect succession database on buried carrion in East Lansing, MI. Thirty-eight pigs were buried, 18 at 30 cm and 20 at 60 cm. Four control carcasses were placed on the soil surface. Three replicates at each depth were exhumed after 3, 7, 14, 21, 30, and 60 d, respectively. One pig also was exhumed from 60 cm after 90 d and another after 120 d. Sarcophaga bullata (Parker) (Diptera: Sarcophagidae) and Hydrotaea sp. (Diptera: Muscidae) were found colonizing buried carrion 5 d after burial at 30 cm. Insect succession at 30 cm proceeded with flesh and muscid flies being the first to colonize, followed by blow flies. Insects were able to colonize carcasses at 60 cm and Hydrotaea sp. and Megaselia scalaris (Loew) (Diptera: Phoridae) were collected 7 d after burial. Insect succession at 60 cm did not proceed similarly, instead muscid and coffin flies were the only larvae collected. Overall these results reveal postburial interval estimates for forensic investigations in mid-Michigan during the summer, depending on climatic and soil conditions.
Cumulative Muscle Protein Synthesis and Protein Intake Requirements

Muscle protein synthesis (MPS) fluctuates widely over the course of a day and is influenced by many factors. The time course of MPS responses to exercise and the influence of training and nutrition can only be pieced together from several different investigations and methods, many of which create unnatural experimental conditions. Measurements of cumulative MPS, the sum synthesis over an extended period, using deuterium oxide have been shown to accurately reflect muscle responses and may allow investigations of the response to exercise, total protein intake requirements, and interaction with protein timing in free-living experimental conditions; these factors have yet to be carefully integrated. Such studies could include clinical and athletic populations to integrate nutritional and exercise recommendations and help guide their revisions to optimize the skeletal muscle function that is so important to overall health.
Development of a high-throughput screen for inhibitors of replication protein A and its role in nucleotide excision repair

The heterotrimeric protein, replication protein A (RPA), is essential for DNA repair and replication. RPA is a viable target in the treatment of cancer as many chemotherapeutic agents act by blocking DNA replication. Furthermore, inhibition of RPA could prove useful in treating cancers that have acquired resistance to DNA damaging agents through enhanced DNA repair mechanisms as has been observed with certain platinum-resistant carcinomas. In an effort to identify inhibitors of RPA, we employed a novel fluorescent reporter and established a homogeneous high-throughput screening assay to measure RPA's DNA binding activity. Using this assay, we have screened a collection of small molecules and determined the effect they have on the RPA-DNA interaction. Of the 2000 compounds screened, 79 scored positive for inhibition of RPA binding activity. Secondary screenings were performed using an electrophoretic mobility shift assay; of the 79 compounds, 9 scored positive and were further characterized in titration experiments to determine the most potent inhibitor, resulting in several compounds showing an IC50 in the low micromolar range. Fluorescence polarization analyses were also performed to determine the mechanism of inhibition for each compound. Validation of the inhibitory activity of selected compounds was verified using in vitro nucleotide excision repair (NER) catalyzed excision of a single cisplatin lesion in a duplex DNA. The identification and use of RPA inhibitors may aid in inhibiting NER activity that could potentially circumvent resistance to certain chemotherapeutic agents as well as be useful in the characterization of RPA and its interaction with DNA.
How do Systems Manage Their Adaptive Capacity to Successfully Handle Disruptions? A Resilience Engineering Perspective.

A large body of research describes the importance of adaptability for systems to be resilient in the face of disruptions. However, adaptive processes can be fallible, either because systems fail to adapt in situations requiring new ways of functioning, or because the adaptations themselves produce undesired consequences. A central question is then: how can systems better manage their capacity to adapt to perturbations, and constitute intelligent adaptive systems? Based on studies conducted in different high-risk domains (healthcare, mission control, military operations, urban firefighting), we have identified three basic patterns of adaptive failures or traps: (1) decompensation – when a system exhausts its capacity to adapt as disturbances and challenges cascade; (2) working at cross-purposes – when sub-systems or roles exhibit behaviors that are locally adaptive but globally maladaptive; (3) getting stuck in outdated behaviors – when a system over-relies on past successes although conditions of operation change. The identification of such basic patterns then suggests ways in which a work organization, as an example of a complex adaptive system, needs to behave in order to see and avoid or recognize and escape the corresponding failures. The paper will present how expert practitioners exhibit such resilient behaviors in high-risk situations, and how adverse events can occur when systems fail to do so. We will also explore how various efforts in research related to complex adaptive systems provide fruitful directions to advance both the necessary theoretical work and the development of concrete solutions for improving systems’ resilience.
Allergic encephalomyelitis: passive transfer across major histocompatibility barrier.

SummaryPassive transfer of allergic encephalomyelitis by injection of living, immunized lymph node cells into normal recipients constitutes a graft of lymphoid cells. It has been accomplished previously when histocompatibility barriers were absent, minor, or undefined. Treatment with an immunosuppressive drug and cells bearing donor-type antigens has now made passive transfer possible despite differences in major transplantation antigens between Lewis donor and BN recipient rats.
A note on the reaction of protoplasm.

A variety of considerations lead to the view that the pH of living matter is lower than that of its immediate extra-cellular medium. It is customarily stated, nevertheless, that protoplasm is “neutral or faintly alkaline” in reaction. If this were invariably so, difficulty would arise in understanding the behavior of nervous tissues of insects, for example, where the hemolymph may be acid.Indirect estimations tend to show that the contents of echinoderm eggs (Vies) are distinctly acid in reaction. Calculations of the inner pH of nerve have been made (Adams) from the standpoint of the Donnan equilibrium probably concerned in the production of the current of action; but these have involved the assumption that the pH of the fluid bathing the nerve is the same as that of the blood.The direct determination of intra-cellular acidities is difficult because suitable indicators do not as a rule accumulate within the cell. In some instances, however, dibromthymolsulfonephthalein does serve as a non-toxic indicator ...
Totally cystic schwannoma of the tenth cranial nerve mimicking an epidermoid

A rare case of a vagus nerve schwannoma exhibited an atypical MR feature, ie, it did not enhance after administration of contrast medium; however, MR did show the extent of the tumor, its configuration, and cyst-like contents
Path analysis of the influencing factors of self-management behavior among coronary heart disease patients in Xinjiang

Objective:To explore the influencing factors of self-management behavior among coronary heart disease(CHD)patients in Xinjiang.Methods:We investigated the influencing factors of self-management behavior among CHD patients by self-designed self-management scale and analysed by path analysis.Results:The influencing factors of self-management behavior among CHD patients were as follows:disease course,ethnic group,,age,self-efficacy,job,social support,quality of life,gender,individual income per month and medical payment.Conclusion:The self-management behavior among CHD patients is affected by many factors,So nurses should improve the level of self-management,delay and controll their complications and improve the quality of life among CHD patients by tailored intervention.
A continuum model for nonlinear lattices under large deformations

Abstract A continuum model is developed for hexagonal lattices, composed of a set of masses connected by linear axial and angular springs, with nonlinearity arising solely from geometric effects. For a set of lattice parameters, these lattices exhibit complex deformation patterns under uniform loading conditions due to instabilities. A continuum model accounting for these instabilities is developed from explicit expressions of the potential energy functional of a unit cell. This functional is non-convex, it captures the bistable nature of the lattice, and is used to derive its effective constitutive behavior. Finite element simulations of continuum medium illustrate the formation of microstructural patterns with discontinuous displacement gradients, similar to the features observed in nonlinear elasticity and finite deformation plasticity. A comparison of discrete lattice simulations and finite element analysis under general loading conditions illustrates that the continuum model captures the effective behavior due to instabilities within the lattice.
Measuring Cognitive Efficiency of Novel Speedometer Displays

Cognitive efficiency has been defined as the ratio of display informativeness to mental workload required for processing information. In the study, we used Cognitive Efficiency (CE) metric to measure the efficiency of novel speedometer displays which were previously used to aid multitask performance in driving. The study also investigated whether encoding information into ‘beat pattern’, a redundant dimension, improves the cognitive efficiency of the displays. The level of cognitive efficiency was found to be similar among the ambient-visual, auditory, and tactile speedometer displays and it increased largely when information was encoded into a redundant beat pattern of the auditory display. In addition, the cognitive efficiency of novel speedometer display was sensitive to contextual factors such as wind effects. These findings enlarge our understanding of multifactor constructs of cognitive efficiency, which are expected to be more predictive of multitask performance than the measure of each of its cons...
Going Viral: The Neoliberal Infiltration of the Living Human Web

Rogers-Vaughn investigates how neoliberal governance has infiltrated and modified the social, interpersonal, and psychological dimensions of human experience. Observing that the cultural norm of neoliberalism weakens all social institutions, Rogers-Vaughn identifies how neoliberal hegemony has marginalized and appropriated religion. The consequent separation of individuals from collectives, he asserts, has led to social fragmentation and a replacement of religion with spirituality, which lacks the shared search for truth and commitment to social justice that characterizes religious collectives. Secularization theory now appears as an accomplice to neoliberalization. Rogers-Vaughn identifies how neoliberal governance has marginalized intimate relationships and created a form of emotional capitalism in which interpersonal life follows the rules and principles of economic exchange. Meanwhile, the notion of self has been reduced and reinvented, and suffering has been privatized.
A statistical overview of information system security in application quality assurance

Application quality assurance is a critical phase of application development. This is the last stage at which a product is subjected to a series of tests before it is generally available to the customer. It is therefore critical that attempts be made to ensure the integrity of the product-certification process. At this stage of application development, there are series of possible breaches that can occur. This paper is an attempt to identify, design, and develop a strategic plan that will minimise the possibility of security leaks in the development process.
Is EEG causal to fNIRs

Causality analysis of simultaneous measurements of the brain's electrical activity and its hemodynamic activity provides the opportunity to study the neural underpinning of hemodynamic fluctuations. This multimodal analysis can also be used to extract valuable information regarding the location of the generators of various electrical events such as Alpha rhythms or epileptiform activity. To best of our knowledge, we are the first propose a method to assess causality from EEG to the hemodynamic activity measured using functional near-infrared spectroscopy (fNIRs). The main challenge in studying causality within this setting arises from the low sampling rate of the fNIRs and the mixed frequency nature of the data. Our method of analysis consists of two parts. Through a simple modification of Geweke's formulation of contamination, we first show that the low sampling frequency of the fNIRs does not cause contamination in estimating causality from EEG to fNIRs. We then apply a novel causality test to avoid the down-sampling of the EEG when measuring for causality. The method of analysis proposed here can be generalized to study causality in other biomedical signal analysis applications and mixed frequency settings.
Economical Doubly Electron-Attached Equation-of-Motion Coupled-Cluster Methods with an Active-Space Treatment of Three-Particle-One-Hole and Four-Particle-Two-Hole Excitations.

The previously developed active-space doubly electron-attached (DEA) equation-of-motion (EOM) coupled-cluster (CC) method with up to four-particle–two-hole (4p-2h) excitations [Shen, J.; Piecuch, P. J. Chem. Phys. 2013, 138, 194102], which utilizes the idea of applying a linear electron-attaching operator to the CC ground state of an (N – 2)-electron closed-shell system to generate ground and excited states of the N-electron open-shell species of interest, has been extended to a considerably less expensive model, in which both 3p-1h and 4p-2h terms rather than 4p-2h contributions only are selected using active orbitals. As illustrated by the calculations involving low-lying singlet and triplet states of methylene, trimethylenemethane, cyclobutadiene, and cyclopentadienyl cation and bond breaking in F2, the proposed DEA-EOMCC method with the active-space treatment of 3p-1h and 4p-2h excitations and its lower-level counterpart neglecting 4p-2h contributions are capable of accurately reproducing the results ...
A Case Report of Hypoglycemia and Hypogammaglobulinemia: DAVID Syndrome in a Patient With a Novel NFKB2 Mutation

Context Deficient anterior pituitary with variable immune deficiency (DAVID) syndrome is a rare disorder in which children present with symptomatic adrenocorticotropic hormone (ACTH) deficiency preceded by hypogammaglobulinemia from B-cell dysfunction with recurrent infections, called common variable immunodeficiency (CVID). Subsequent whole exome sequencing studies have revealed germline heterozygous C-terminal mutations of NFKB2 as a cause of DAVID syndrome or of CVID without clinical hypopituitarism. However, to the best of our knowledge there have been no cases in which the endocrinopathy has presented in the absence of a prior clinical history of CVID. Case description A previously healthy 7-year-old boy with no history of clinical immunodeficiency presented with profound hypoglycemia and seizures. He was found to have secondary adrenal insufficiency and was started on glucocorticoid replacement. An evaluation for autoimmune disease, including for antipituitary antibodies, was negative. Evaluation unexpectedly revealed hypogammaglobulinemia [decreased immunoglobulin G (IgG), IgM, and IgA]. He had moderately reduced serotype-specific IgG responses after pneumococcal polysaccharide vaccine. Subsequently, he was found to have growth hormone deficiency. Six years after initial presentation, whole exome sequencing revealed a de novo heterozygous NFKB2 missense mutation c.2596A>C (p.Ser866Arg) in the C-terminal region predicted to abrogate the processing of the p100 NFKB2 protein to its active p52 form. Conclusions Isolated early-onset ACTH deficiency is rare, and C-terminal region NFKB2 mutations should be considered as an etiology even in the absence of a clinical history of CVID. Early immunologic evaluation is indicated in the diagnosis and management of isolated ACTH deficiency.
Mitochondrial Fatty Acid Oxidation Disorders Associated with Cardiac Disease

To elucidate the role metabolic pathways have on pathophysiological mechanisms involving the heart, it is essential to understand how biochemical pathways influence pathophysiology, clinical findings, and treatment. In this review, we focus on fatty acid oxidation disorders that affect the heart. We enumerate the defects that arise from each step of fatty acid oxidation leading to cardiomyopathy, conduction defects, arrhythmias, and sudden death. With the advent of newborn screening, careful interpretation of diagnostic findings and early treatment, morbidity, and mortality associated with these conditions have significantly decreased. However, treatment of the energy defect alone is not enough. New potential therapies and pathobiological mechanisms will be mentioned. Mitochondrial fatty acid oxidation disorders associated with energy defects leading to cardiac disease are reviewed (clinical, biochemical findings and treatment); while highlighting the biochemical pathways involved in the pathophysiology of these disorders.
Center Effect and Socioeconomic Determinants of Overall Survival (OS) of Diffuse Large B Cell Lymphoma (DLBCL)

Abstract Introduction: DLBCL is a heterogeneous disease with increasingly complex treatment selection. Prior studies demonstrated improved outcomes of hematologic malignancies managed in academic centers and based on socioeconomic factors. We aimed to compare OS of patients with DLBCL based on the type of treatment facility and other factors. Methods: This retrospective study utilized the National Cancer Data Base (NCDB) to identify patients with DLBCL diagnosed between 1998 and 2012. Health care facilities were categorized as either academic (academic/research program) or non-academic (comprehensive community cancer program, community cancer program, and other programs). Patients with complete data for sex, age, race, education, income, distance traveled for health care, hospital type, facility location, urban/rural, insurance, Charlson co-morbidity score, chemotherapy use, time from diagnosis to treatment initiation, use of hematopoietic stem cell transplant, last contact, and vital status were included. OS of patients who received first course treatment at academic centers, was compared to those treated at non-academic centers. Kaplan Meier curves for OS were compared using log-rank test. Multivariate Cox proportional hazard model was performed to identify determinants of OS. Results: Of 264,697 patients with DLBCL, 33% were treated at academic centers. Patients treated at academic centers differed from non-academic centers in mean age (65 vs. 68 years; p $63,000, p Conclusion: Our study demonstrated differences in the characteristics of patients with DLBCL based on the facility type. Academic centers were more likely to treat patients who were younger, females, of ethnic minorities, with less education, higher income levels, private insurance, less comorbidities and higher stage disease. The receipt of frontline therapy at academic centers was associated with increased OS in patients with DLBCL. Some of the possible reasons for this difference may include provider experience, increased access to resources and clinical trials. Our study also demonstrated cancer health disparities based on other socioeconomic factors such as gender, race, income and insurance status. Further investigations into the factors contributing to such disparities should be a research priority to help standardize care and improve outcomes. Download : Download high-res image (259KB) Download : Download full-size image Download : Download high-res image (97KB) Download : Download full-size image Disclosures Armitage: Conatus - IDMC: Consultancy; Roche: Consultancy; Spectrum Pharmaceuticals: Consultancy; GlaxoSmithKline IDMC: Consultancy; ZiopharmOncology: Consultancy; Tesaro bio Inc: Membership on an entity's Board of Directors or advisory committees.
A method for the topographical identification and quantification of high frequency oscillations in intracranial electroencephalography recordings.

Abstract Objective To develop a reliable software method using a topographic analysis of time-frequency plots to distinguish ripple (80–200 Hz) oscillations that are often associated with EEG sharp waves or spikes (RonS) from sinusoid-like waveforms that appear as ripples but correspond with digital filtering of sharp transients contained in the wide bandwidth EEG. Methods A custom algorithm distinguished true from false ripples in one second intracranial EEG (iEEG) recordings using wavelet convolution, identifying contours of isopower, and categorizing these contours into sets of open or closed loop groups. The spectral and temporal features of candidate groups were used to classify the ripple, and determine its duration, frequency, and power. Verification of detector accuracy was performed on the basis of simulations, and visual inspection of the original and band-pass filtered signals. Results The detector could distinguish simulated true from false ripple on spikes (RonS). Among 2934 visually verified trials of iEEG recordings and spectrograms exhibiting RonS the accuracy of the detector was 88.5% with a sensitivity of 81.8% and a specificity of 95.2%. The precision was 94.5% and the negative predictive value was 84.0% (N = 12). Among, 1,370 trials of iEEG recording exhibiting RonS that were reviewed blindly without spectrograms the accuracy of the detector was 68.0%, with kappa equal to 0.01 ± 0.03. The detector successfully distinguished ripple from high spectral frequency ‘fast ripple’ oscillations (200–600 Hz), and characterize ripple duration and spectral frequency and power. The detector was confounded by brief bursts of gamma (30–80 Hz) activity in 7.31 ± 6.09% of trials, and in 30.2 ± 14.4% of the true RonS detections ripple duration was underestimated. Conclusions Characterizing the topographic features of a time-frequency plot generated by wavelet convolution is useful for distinguishing true oscillations from false oscillations generated by filter ringing. Significance Categorizing ripple oscillations and characterizing their properties can improve the clinical utility of the biomarker.
History, Classification, and Taxonomy of Viruses in the Family Bunyaviridae

Viruses in the family Bunyaviridae are found worldwide. Most are arboviruses (arthropod-borne animal viruses), maintained in nature by a biological (propagative) transmission cycle between susceptible vertebrate hosts and hematophagous arthropods, such as mosquitoes, biting flies, and ticks. Vertebrate hosts of these viruses include rodents and other small mammals, primates, birds, and ungulates. Arboviruses usually occur in silent, sylvatic transmission cycles; however, more than 60 members of the family Bunyaviridae have been reported to cause disease in humans or livestock and some cause disease in sea birds or plants (Table I).
Silicon photonic terabit/s network-on-chip for datacenter interconnection

Abstract Silicon photonic integration is an enabling technology for power- and cost-effective optical interconnects in exascale performance computers and datacenters which require extremely low power consumption and dense integration for a higher interface bandwidth density. In this paper, we experimentally demonstrate a fully integrated optical transceiver network on a silicon substrate using heterogeneous integration. High performance on-chip lasers, modulators and photodetectors are enabled by transferring III–V materials to a pre-patterned silicon substrate. Wavelength division multiplexed transceivers with eight wavelength channels are monolithically-integrated on a single chip, forming an optical network-on-chip circuit with total transmission capacity up to 8 × 8×40 Gbps, and bandwidth density over 2 Tbps/cm. We show that the heterogeneous silicon integration provides the design flexibility and scalability for high-speed optical communication systems.
Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography.

PURPOSE We aimed to investigate patients with lower gastrointestinal bleeding who presented to the emergency department requiring initial conventional angiography. We report risk-stratified and mesenteric conventional angiography outcomes. METHODS We retrospectively reviewed patients with lower gastrointestinal bleeding between 2001 and 2012. We included all consecutive patients with clinical lower gastrointestinal bleeding with a requirement of further angiography and possible embolization. Patients who had prior interventions or surgery were excluded. RESULTS A total of 88 patients (35 women, 53 men) with a median age of 71 years (range, 23-99 years) were included in the analysis. Conventional angiography was positive and endovascular treatment was intended in 35 patients. Once the source of bleeding was found angiographically, endovascular treatment had a technical success rate of 90.3% and clinical success rate of 71.4%. Overall early rebleeding rate ( 30 days) was 13.6%. CONCLUSION Identifying the source of lower gastrointestinal bleeding remains to be a clinical and angiographic challenge. Although we did not observe an association between mortality and clinical success, increased early rebleeding rates were associated with higher mortality rates.
One Thousand Pediatric Liver Transplants During Thirty Years: Lessons Learned.

Background Pediatric liver transplantation (pLTx) has been the standard of care for children with liver failure since the 1980s. This study examined the world's largest single-center experience and aimed to identify unique preoperative predictors of early graft and patient survival for primary transplantation (1°-pLTx) and retransplantation (Re-pLTx). Study Design We conducted an IRB-approved, retrospective study of all consecutive, isolated pLTx patients 18 years of age or younger. Twenty-eight demographic, laboratory, and perioperative variables were analyzed as potential outcome predictors. Univariate and multivariate analyses were performed using log-rank test and Cox's proportional hazards model. Results There were 806 children who received 1,016 isolated pLTx between February1984 and June 2017. Median follow-up was 12 years. Leading indications for pLTx were cholestatic liver disease (40%), re-pLTx (21%), and fulminant hepatic failure (14%). Seventy-three percent received cadaveric whole grafts. Overall graft and patient survival rates at 0.5, 1, 5, 10, and 20 years were: 76%, 73%, 67%, 63%, 53%, and 87%, 86%, 81%, 78%, 69%, respectively. Relative to 1°-pLTx, re-pLTx recipients were significantly older, larger, with worse renal function, and more likely to be awaiting pLTx in an ICU. Independent significant predictors of graft survival for 1°-pLTx included weight, transplantation era, and renal replacement therapy; for re-pLTx, warm ischemia time and time between 1°-pLTx and re-pLTx. Independent significant predictors of patient survival were renal function, mechanical ventilation, and etiology of liver disease. Conclusions This is the largest reported single-center experience of pLTx with substantial follow-up time and a large re-pLTx experience. Important transplant predictors of graft survival include weight, renal function, modern era, warm ischemia time, and time between primary transplantation and re-pLTx. Renal function, mechanical ventilation, and underlying cause of liver disease affect patient survival. Awareness of these factors can help in the decision making for children requiring pLTx.
Offset-electrode profile acquisition strategy for electrical resistivity tomography

Abstract We present an electrode layout strategy that allows electrical resistivity profiles to image the third dimension close to the profile plane. This “offset-electrode profile” approach involves laterally displacing electrodes away from the profile line in an alternating fashion and then inverting the resulting data using three-dimensional electrical resistivity tomography software. In our synthetic and field surveys, the offset-electrode method succeeds in revealing three-dimensional structures in the vicinity of the profile plane, which we could not achieve using three-dimensional inversions of linear profiles. We confirm and explain the limits of linear electrode profiles through a discussion of the three-dimensional sensitivity patterns: For a homogeneous starting model together with a linear electrode layout, all sensitivities remain symmetric with respect to the profile plane through each inversion step. This limitation can be overcome with offset-electrode layouts by breaking the symmetry pattern among the sensitivities. Thanks to freely available powerful three-dimensional resistivity tomography software and cheap modern computing power, the requirement for full three-dimensional calculations does not create a significant burden and renders the offset-electrode approach a cost-effective method. By offsetting the electrodes in an alternating pattern, as opposed to laying the profile out in a U-shape, we minimize shortening the profile length.
Amygdala Functional and Structural Connectivity Predicts Individual Risk Tolerance

Summary Risk tolerance, the degree to which an individual is willing to tolerate risk in order to achieve a greater expected return, influences a variety of financial choices and health behaviors. Here we identify intrinsic neural markers for risk tolerance in a large (n = 108) multimodal imaging dataset of healthy young adults, which includes anatomical and resting-state functional MRI and diffusion tensor imaging. Using a data-driven approach, we found that higher risk tolerance was most strongly associated with greater global functional connectivity (node strength) of and greater gray matter volume in bilateral amygdala. Further, risk tolerance was positively associated with functional connectivity between amygdala and medial prefrontal cortex and negatively associated with structural connectivity between these regions. These findings show how the intrinsic functional and structural architecture of the amygdala, and amygdala-medial prefrontal pathways, which have previously been implicated in anxiety, are linked to individual differences in risk tolerance during economic decision making.
Delirium's Arousal Subtypes and Their Relationship with 6-Month Functional Status and Cognition.

Objective We sought to determine how delirium subtyped by arousal affected 6-month function and cognition in acutely ill older patients. Methods This was secondary analysis of a prospective cohort study which enrolled hospitalized patients ≥65 years old. Delirium and arousal were ascertained daily in the emergency department and the first 7 days of hospitalization using the modified Brief Confusion Assessment Method and Richmond Agitation Sedation Scale, respectively. For each day, patients were categorized as having no delirium, delirium with normal arousal, delirium with decreased arousal, or delirium with increased arousal. Preillness and 6-month functional status were determined using the Older American Resources and Services activities of daily living scale which ranges from 0 (completely dependent) to 28 (completely independent). Preillness and 6-month cognition were determined using the Informant Questionnaire on Cognitive Decline in the Elderly which ranges from 1 (markedly improved cognition) to 5 (severe cognitive impairment). Multiple linear regression was performed adjusted for preillness Older American Resources and Services activities of daily living and Informant Questionnaire on Cognitive Decline in the Elderly and other relevant confounders. Results In 228 older patients, delirium with normal arousal was the only subtype independently associated with poorer 6-month function and cognition. For every day spent in this subtype, the 6-month Older American Resources and Services activities of daily living decreased by 0.84 points (95% confidence interval: −1.59 to −0.09) and the patient's 6-month Informant Questionnaire on Cognitive Decline in the Elderly significantly increased by 0.14 points (95% confidence interval: 0.06–0.23). Conclusions Delirium with normal arousal, as opposed to delirium with decreased or increased arousal, was the only arousal subtype significantly associated with worsening 6-month function and cognition. Subtyping delirium by arousal may have important prognostic value.