cssi/SciSciGPT-SciSciNet huggingface dataset:
Carcinosarcoma of the prostate with urothelial and squamous components.

A 51-year-old male smoker presented with gross hematuria and obstructive voiding symptoms. Digital rectal examination was notable for a palpable abnormality of the prostate. Prostate specific antigen (PSA) level was 0.4 g/ml. Basic laboratory values, urinalysis, cytology and cystoscopic examination were within normal limits. Ultrasound guided prostate needle biopsy demonstrated sarcomatoid carcinoma with squamous and urothelial features in the epithelial component. Contrast enhanced magnetic resonance imaging of the pelvis revealed an enlarged prostate with central necrosis consistent with a necrotic neoplasm (fig. 1). Other imaging modalities showed no evidence of metastatic disease. Radical retropubic prostatectomy was attempted but the prostatic mass was found invading the bladder. Therefore, radical cystoprostatectomy with bilateral pelvic lymphadenectomy and ileal conduit diversion were performed. The resected prostate specimen had a grayish-white necrotic tumor located centrally measuring 4.2 cm in greatest dimension. The tumor extended out of the prostate at the base, involving the soft tissue around the seminal vesicles. Histological examination of the prostate demonstrated carcinosarcoma, including areas of urothelial carcinoma and squamous differentiation (fig. 2). No glandular component (ie adenocarcinoma) was identified in the serially sectioned and totally submitted specimen. The bladder specimen was normal on gross and microscopic examination, supporting a prostatic origin of the tumor. Postoperative course was uneventful and the patient was referred for counseling regarding adjuvant treatments.
Semiconductor Spherical Resonator of Millimeter Wave Band

Necessity for research of high-order wave modes to solve the problems of solid-state electronic engineering for millimeter and submillimeter wavelengths. For study of similar waves, the approaching object is the spherical semiconductor resonator.
A 96-GHz ortho-mode transducer for the Polatron

We describe the design, simulation, fabrication, and performance of a 96-GHz ortho-mode transducer (OMT) to be used for the Polatron-a bolometric receiver with polarization capability. The OMT has low loss, good isolation, and moderately broad bandwidth, and its performance closely resembles simulation results.
Critical incidents in paediatric critical care: who is at risk?

We evaluated the characteristics of children for whom critical incidents (CIs) were reported by performing prospective collection of patient data and retrospective review of reported CIs in a multidisciplinary neonatal–paediatric intensive care unit of a tertiary care university children’s hospital. A period of 1 year was analysed (January to December 2007; 1,251 admissions). CIs comprised adverse events (actual patient injury), as well as near-misses. The report form of critical incidents was web-based and reporting was voluntary, anonymous and non-punitive. The severity of all CIs was divided into minor, moderate and major. Patients with and without CIs were compared regarding the following characteristics: Paediatric Index of Mortality (PIM2), duration of mechanical ventilation, length of stay in the intensive care, admission mode (surgery, cardiopulmonary bypass, cardiac/non-cardiac unit), age and sex. There were 360 CI reports (83 per 1,000 patient days; 13% major, 26% moderate, 61% minor severity). Of these, 310 CIs could be assigned to 198 specific patients. In the univariate analysis, patient-related risk factors for CIs were higher PIM2 score (p < 0.0001), increased length of stay (p < 0.0001), mechanical ventilation (p < 0.0001), increased ventilator days (p < 0.0001), male gender (p = 0.022) and young age (p < 0.0001). Using a logistic regression model, mechanical ventilation (p < 0.0001), male gender (p = 0.034) and length of stay (p < 0.0001) continued to be associated with the occurrence of CIs. Conclusion CIs often occur in paediatric intensive care. Among the patient-related factors, male gender, mechanical ventilation, and length of stay are independently associated with CIs. Already known at admission to intensive care are male gender and, usually, requirement for mechanical ventilation. Improved knowledge of the risk factors for CIs could help to minimize their frequency and thus improve quality of care.
Stochastic approximate dynamic programming with link estimation for high quality path selection in Wireless Mesh Networks

A lot of work has recently been published regarding metrics that could identify high quality paths in Wireless Mesh Networks (WMN). While results are encouraging, no optimal strategy has yet been identified that could estimate link quality and incorporate both the link reliability measurements as well as the bandwidth capacity. Furthermore, link estimation remains an open problem. Considering multi-user environment, any optimal solution would also need to consider multiple communication flows. These arguments have led us to study an approximate dynamic programming (DP) solution capable of utilizing limited network knowledge and stochastic process. Instead of proposing yet another link metric, we analyze a stochastic DP solution to the routing problem using a well established routing metric. Unlike deterministic DP where communication demands are fixed a priori and an optimal path is calculated before any real demands are known, we consider a more realistic scenario with stochastic metrics and formulate the optimal strategy for routing in WMNs. Performance results are given using simulation results.
On-orbit performance of Gravity Probe B drag-free translation control and orbit determination

The Gravity Probe B (GP-B) Relativity Mission is a fundamental physics experiment to test Einstein’s theory of General Relativity based on observations of spinning gyroscopes onboard a satellite in a near-polar, near-circular orbit at an altitude of about 640 km around the Earth. The GP-B mission was designed to test two predictions of Einstein’s theory, the geodetic effect and the frame-dragging effect, to an accuracy better than 5 · 10 � 4 arcsec/yr. Drag-free control technology is implemented in the GP-B translation control system to minimize support forces and support induced torques on the gyroscopes. A Global Positioning System (GPS) receiver onboard the GP-B satellite provides real-time position, velocity and timing data. The GP-B orbit is determined on the ground based on the 3-axis GPS position data and verified independently with ground-based laser ranging measurements. This paper describes the design and implementation of the drag-free translation control and orbit determination system of the GP-B satellite. The on-orbit performance of the drag-free translation control system satisfies the requirements of the GP-B science experiment. The residual accelerations from the gyroscope control efforts are less than 4 · 10 � 11 m/s 2 (along the satellite roll axis) and less than 2 · 10 � 10 m/s 2 (transverse to the satellite roll axis) between 0.01 mHz and 10 mHz in inertial space. The non-gravitational acceleration along the satellite roll axis, including a nearly constant component (which is kept below 1 · 10 � 7 m/s 2 ) and a sinusoidal component (whose amplitude varies from about 5 · 10 � 7 m/s 2 to less than 1 · 10 � 8 m/s 2 ), causes the gyroscope spin axis to drift less than 9 · 10 � 5 arcsec/yr. The orbit determination system is found to provide overlapping orbit solution segments having RMS (root mean square) position and velocity errors of a few meters and a few mm/s, well within the RMS mission requirements of 25 m and 7.5 cm/s. � 2007 Published by Elsevier Ltd on behalf of COSPAR.
Kinetics of coalescence, annihilation, and the q-state Potts model in one dimension

Abstract The kinetics of the q -state Potts model in the zero temperature limit in one dimension is analyzed exactly through a generalization of the method of empty intervals, previously used for the analysis of diffusion-limited coalescence, A + A → A . In this new approach, the q -state Potts model, coalescence, and annihilation ( A + A →0) all satisfy the same diffusion equation, and differ only in the imposed initial condition.
Venom from the Ectoparasitic Wasp Melittobia digitata (Hymenoptera: Eulophidae) Induces Paralysis and Developmental Delay in Natural and Factitious Hosts

Abstract Melittobia digitata Dahms (Hymenoptera: Eulophidae) is a gregarious ectoparasitoid that attacks the pupae of solitary bees and wasps. Although this wasp has been intensively studied in terms of behavior and life history, almost nothing is known about its venom. Moreover, the use of venom in the host–parasite relationship has been disputed despite observations that parasitized hosts seem to be halted in development and enter a state of paralysis. In this study, we examined the role of venom from M. digitata during parasitism by comparing the developmental fate of natural (alfalfa leafcutting bee, Megachile rotundata F.) and factitious [yellow mealworm, Tenebrio molitor L. and flesh fly, Sarcophaga bullata (Parker)] hosts after either natural envenomation or artificial venom injection. Isolated crude venom collected either by “milking” adult females or by dissections of venom glands was nearly equally effective in halting the development of M. rotundata, T. molitor, and S. bullata. Host responses t...
Neutrality Between Church and State: Mission Impossible?

As I sat at my desk in Connecticut to consider what I could contribute to this volume as a cultural historian of American law, I recalled a remarkable visit I took recently to Cincinnati, Ohio. My wife and I had visited Cincinnati immediately following a three-week stay in Germany, and because I hope it will shed light on how many Americans understand the relation between church and state, I wish to begin this essay by describing why I was in Ohio and painting a picture of some of the men and women I met there — a kind of American portrait in thick description. Before I do, however, I wish at the outset to state my basic view of the subject of religion and state neutrality. My view is that state neutrality toward religion can and should remain a guiding aspiration of American constitutionalism, but that the ideal has been complicated in practice by an old and continuing American tradition — one that I believe contrasts with socio-legal life in post-war Germany and, perhaps, Israel, in which universalistic liberal ideals and institutions are grounded in and viewed as inseparable from particularistic religious commitments. The U.S. Supreme Court, furthermore, has played an important institutional role in coping with the cultural tension to which this popular belief system has given rise, using the concept of neutrality as a tool of constitutional cultural management for a society that is at once highly religious, liberal, and increasingly pluralistic.
Changes in HPBMC markers of immmune function following controlled short-term inhalation exposures of humans to hardwood smoke

Previous studies have shown that complex mixtures containing particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) produce systemic immunotoxicity in animal models following inhalation exposures. While we and others have shown that emissions associated with hardwood smoke (HWS), cigarette smoke and diesel exhaust can suppress the immune systems of animals in vitro and in vivo, there have been few immune function studies on human peripheral blood mononuclear cells (HPBMC) following exposure of humans to HWS. Our work shows that T cells are an important targets of PM and PAH immunotoxicity. These studies were conducted on HPBMC from 14 human volunteers receiving four 2 h nightly exposures to clean air or HWS at a concentration of 500 ug/m(3). We measured anti-CD3/anti-CD28 stimulated T-cell proliferation and HPBMC cytokine production in cell supernatants, including interleukin 1β (IL-1β), tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), TH1 cytokines γIFN and IL-2, TH2 cytokine IL-4, Th17 cytokine interleukin 17A (IL-17A) and interleukin 10 (IL-10). We analyzed results using analysis of variance (ANOVA), t-tests and Pearson correlation. Results showed that there was significant variation in the amount of T-cell proliferation observed following polyclonal activation with anti-CD3/anti-CD28 antibodies in both the air and HWS-exposed groups. There was not a significant effect of HWS on T-cell proliferation. However, we did find a strong relationship between the presence of proinflammatory cytokines (IL-1β, TNF-α, IL-6, but not IL-8) and the amount of T-cell proliferation seen in individual donors, demonstrating that brief exposures of humans to HWS can produce changes in systemic immunity that is associated with proinflammatory cytokines.
Toward robust localization and mapping for shallow water ROV inspections

We propose a portfolio of filtering methods for a remotely-operated vehicle (ROV) that relies on a compass, gyro, depth sensor and ultra-short baseline (USBL) positioning system for localization in shallow-water environments. Our goal is to maintain an accurate state estimate that will be suitable as a basis for decision-making in the course of carrying out an autonomous underwater inspection. We employ Kalman filters in conjunction with an outlier filter to produce a reliable estimate in the presence of noisy and spurious data. Our localization result is then used as a basis for 3D occupancy mapping, in which further filtering and inference techniques are applied to remove false returns from the ROV's scanning sonar. Localization results from two field deployments of the ROV are given.
Structural and Compositional Characterization of the Adhesive Produced by Reef Building Oysters

Oysters have an impressive ability to overcome difficulties of life within the stressful intertidal zone. These shellfish produce an adhesive for attaching to each other and building protective reef communities. With their reefs often exceeding kilometers in length, oysters play a major role in balancing the health of coastal marine ecosystems. Few details are available to describe oyster adhesive composition or structure. Here several characterization methods were applied to describe the nature of this material. Microscopy studies indicated that the glue is comprised of organic fiber-like and sheet-like structures surrounded by an inorganic matrix. Phospholipids, cross-linking chemistry, and conjugated organics were found to differentiate this adhesive from the shell. Symbiosis in material synthesis could also be present, with oysters incorporating bacterial polysaccharides into their adhesive. Oyster glue shows that an organic–inorganic composite material can provide adhesion, a property especially impo...
The Young Gide's Reaction to Nietzsche

One of the most significant aspects of the intellectual climate of the 1890's in France is undoubtedly the rapid spreading of Nietzsche's thought. Numerous fragmentary translations from his work were published in the literary reviews of the period, such as l'Ermitage, the Revue Blanche, le Banquet, and above all the Mercure de France. Articles on this philosopher were legion, and translations of complete Nietzschean works also began to appear with increasing frequency. The whole process has been described in detail by Genevieve Bianquis in her well-known study of Nietzsche's influence on French thought. By 1895 Nietzscheanism, though still in a rather vague form, was an essential part of the general intellectual atmosphere, and by the end of the decade we can speak of a true Nietzsche vogue.
Carl Schorske in Prague

In this essay, I describe the ways I have used some of the classic methods and models of intellectual history not only to integrate East European literary figures into wider European cultural debates, but also to re-cast the East–West boundaries of those debates.
NJ262 Induces Apoptosis in Breast Cancer Cells

Gene deletion in normal host cells is one of the prevailing causes of breast cancer in humans. In this investigation, breast cancer cell line, MCF-7, was treated with our newly discovered DNA polymorphic biomarker, NJ262, {NIH/NCBI Accession Number DQ676892}. NJ262 is present in normal human mammary epithelial cell line, MCF-10A but absent in breast cancer cell line, MCF-7. MCF-7 cells expressing NJ262 displayed cytoplasmic swelling and DNA laddering that are evidence of cell death by necrosis. Some of the transformed cells exhibit chromatin condensation, membrane blebbing, cytoplasmic condensation and nuclear membrane margination that are typical of cells death by apoptosis. NJ262 expression in MCF-7, therefore, induces cell death by both apoptosis and necrosis. The cell proliferation and apoptotic assays of transformed MCF-7 cells revealed that NJ262 reduced MCF-7 cell proliferation by over 50%, and increased cell death by 200%. This study, for the first time, showed that treatment of breast cancer cells with NJ262 down-regulated cell proliferation and drastically induced cell death in breast cancer cells.
Valuation: The State of the Art

There is a pervasive skepticism about formal valuation models, so much so that practitioners often discard them, preferring rough-cut methods such as pricing on the basis of comparables or simple P/E ratios. This paper provides a critique of standard valuation models, identifying what is being captured (and what is not being captured) in these models. The paper then strives to develop an agenda towards more robust valuation. It stresses three points. First, any valuation must be in accord with the well-established theory of finance. However, second, the valuation must also be practical. Both are important wedges in driving a solution. Third, valuation is a matter of accounting; a valuation model is only as good as the accounting that it involves. The last point is the basis for a critique of IFRS accounting.
INTERFERON PRODUCTION AND NATURAL CYTOTOXICITY BY HUMAN LYMPHOCYTES FRACTIONATED BY PERCOLL DENSITY GRADIENT CENTRIFUGATION

Publisher Summary This chapter examines the interferon (IFN) production and natural cytotoxicity by human lymphocytes fractionated by percoll density gradient centrifugation. Interferons are potent immunoregulatory molecules, which are produced by most nucleated cells. Their stimulatory effect for natural cell-mediated cytotoxicity has been well documented. Human IFN have been classified into fibroblast/leukocyte and immune types/depending upon the cells producing them and according to their physical, biological, and antigenic characteristics. In a stud described in the chapter, peripheral blood lymphocytes were obtained from two different donors, and subpopulations were obtained by Percoll density gradient centrifugation. The donors were selected for their weak and strong cytotoxicity against K562 target cells. The chapter presents the results obtained with lymphocytes from the donor reacting weakly against K562. The antiviral activity of IFN was assayed using vesicular stomatitis virus and G-11 cells in Microtest I plates. The data show that the cytotoxic activity was strongest in fraction I, with declining activity toward the bottom of the gradient. The densest fraction exhibited a slight increase in activity against K562 compared to the fractions immediately above it. IFN production was greatest among the lighter cells harvested from the top of the gradient.
Increased lethality of endotoxemia in murine frostbite

Because frostbite (FB) is associated with increased intravascular coagulability, it is reasonable to assume that endotoxin, by enhancing platelet aggregation, will adversely affect FB. Swiss mice (25 +/- 2 g) were anesthetized, and the tails of the animals totally immersed in a freezing solution of equal volumes of ethylene glycol and water (-18 C) for 8 min. The tails were then thawed at room temperature (24 C). Half an hour after removal from the freezing solution, the animals were given either (Group A) 0.1 cc saline I.P. or (Group B) 0.1 mg E. coli endotoxin (055:B5; 1/3 LD50 dose) in 0.1 cc saline IP. A third group (Group C), was given the same dose of endotoxin but was not subjected to frostbite. Survivals in each group at 2 weeks were as follows: (A) 14/14 (100%), (B) 4/20 (20%), (C) 13/14 (93%). Using Fisher's exact test, A versus B P less than .001; B versus C P less than .001; A versus C NS. The data presented here emphasize the increased lethality of endotoxemia in murine FB.
A 5-Year Update on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States.

Background:This study was undertaken to update our report from academic years 2004-2005 through 2008-2009, to include 5 additional years of the Association of American Medical Colleges GME Track data. This study will test the hypothesis that, when compared with the data from 2004-2005 through 2008-2
Tributyltin exposure alters cytokine levels in mouse serum.

AbstractTributyltin (TBT), a toxic environmental contaminant, has been widely utilized for various industrial, agricultural and household purposes. Its usage has led to a global contamination and its bioaccumulation in aquatic organisms and terrestrial mammals. Previous studies suggest that TBT has debilitating effects on the overall immune function of animals, rendering them more vulnerable to diseases. TBT (at concentrations that have been detected in human blood) alters secretion of inflammatory cytokines from human lymphocytes ex vivo. Thus, it is important to determine if specified levels of TBT can alter levels of cytokines in an in vivo system. Mice were exposed to biologically relevant concentrations of TBT (200, 100 or 25 nM final concentrations). The quantitative determination of interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL2, IL5, IL7, IL12βp40, IL13, IL15, keratinocyte chemoattractant (KC), macrophage inflammatory protein 1β (MIP), MIP2 and regulated on activation ...
Resilience in the Care of Children with Palliative Care Needs

Pediatric palliative care is an interdisciplinary medical specialty addressing the complex needs of children with life-limiting illnesses, and their families. Its core concerns involve the treatment of troublesome symptoms and assisting families in medical decision-making and determining the goals of care. In addition to biomedical issues, pediatric palliative care teams attempt to attend to social, psychological, and spiritual aspects of the patient experience. Research directed at a mechanistic understanding of resilience in pediatric palliative care is burdened by conceptual and definitional difficulties, as well as the limitations in any effort to measure psychosocial outcomes in a population with high morbidity and mortality. Although research on resilience among these patients is limited, addressing suffering, supporting the role of parental goals and preferences and, when possible, supporting the child’s voice through the process of care, has important implications for the child’s resilience. These efforts in themselves may be understood as being motivated by the desire to promote and sustain resilience, as the child’s sense of intactness is supported and protected through “regoaling,” addressing suffering, and promoting meaningful, identity-enrich responses to the challenges of serious illness.
Fecal Incontinence in Children

Fecal incontinence (FI) in children is frequently encountered in pediatric practice and represents a difficult and distressing problem. Usually, this is a functional defecation disorder. In approximately 80 % of cases FI is related to constipation, being the result of overflow incontinence, whereas in the remaining 20 % no constipation or other underlying cause can be found; these children suffer from functional nonretentive fecal incontinence (FNRFI). A thorough medical history and physical examination are typically sufficient for an adequate assessment of the underlying cause of functional FI. The non-pharmacological treatment of functional FI consists of education, demystification, a daily bowel diary, and a toilet program with a reward system. The pharmacological treatment of functional FI depends on the underlying cause. Treatment of constipation starts with oral laxatives, preferably polyethylene glycol. In addition, there is anecdotal evidence that loperamide or imipramine could be beneficial in children with FNRFI.
Bloch sphere model for two-qubit pure states

The two-qubit pure state is explicitly parameterized by three unit 2-spheres and a phase factor. For separable states, two of the three unit spheres are the Bloch spheres of each qubit. The third sphere parameterizes the degree and phase of concurrence, an entanglement measure. This sphere may be considered a variable complex imaginary unit where the stereographic projection maps the qubit-A Bloch sphere to a complex plane with this variable imaginary unit. This Bloch sphere model gives a consistent description of the two-qubit pure states for both separable and entangled states. We argue that the third sphere (entanglement sphere) parameterizes the nonlocal properties, entanglement and a nonlocal relative phase, while the local relative phases are parameterized by the azimuth angles of the two quasi-Bloch spheres. On these three unit spheres and a phase factor, the two-qubit pure states and unitary gates can be geometrically represented. Accomplished by means of Hopf fibration, the complex amplitudes of a two-qubit pure state and the Bloch sphere parameters are related by a single quaternionic relation.
The Practices and Meanings of Care for Nurses Working on a Pediatric Bone Marrow Transplant Unit

Bone marrow transplant (BMT) units are stressful work environments with high staff burnout, anxiety, and turnover. A qualitative study was undertaken to better understand care for nurses within the context of their clinical practice on a pediatric BMT unit. Understanding care practices for BMT nurses will allow us to design interventions and provide appropriate support for this subspecialty of nurses. Focus groups were held with 24 nurses as key participants, and 2 focus groups with general participants: unit management (N = 2) and caregivers of inpatients (N = 7). Data were analyzed using a thematic analysis. Data were transcribed verbatim and coded to consensus by members of the research team. Five themes emerged from the data: ( a) experiencing stressful situations that impede care, ( b) growing and developing personally and professionally, ( c) providing trustworthy and respectful care, ( d) acquiring meaningful coping skills, and ( e) sharing with others versus isolation. Stress management, professional development, and interdisciplinary communication were areas that emerged for potential intervention.
Complete or Culprit-Only Revascularization for Patients With Multivessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis of Randomized Trials

Abstract Objectives The authors sought to compare the effectiveness of the different revascularization strategies in ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease undergoing primary percutaneous coronary intervention (PCI). Background Recent randomized trials have suggested that multivessel complete revascularization at the time of primary percutaneous coronary intervention (PCI) is associated with better outcomes, however; the optimum timing for nonculprit PCI is unknown. Methods Trials that randomized STEMI patients with multivessel disease to any combination of the 4 different revascularization strategies (i.e., complete revascularization at the index procedure, staged procedure during the hospitalization, staged procedure after discharge or culprit-only revascularization) were included. Random effect risk ratios (RRs) were conducted. Network meta-analysis was constructed using mixed treatment comparison models, and the 4 revascularization strategies were compared. Results A total of 10 trials with 2,285 patients were included. In the pairwise meta-analysis, complete revascularization (i.e., at the index procedure or as a staged procedure) was associated with a lower risk of major adverse cardiac events (MACE) (RR: 0.57; 95% confidence interval [CI]: 0.42 to 0.77), due to lower risk of urgent revascularization (RR: 0.44; 95% CI: 0.30 to 0.66). The risk of all-cause mortality (RR: 0.76; 95% CI: 0.52 to 1.12), and spontaneous reinfarction (RR: 0.54; 95% CI: 0.23 to 1.27) was similar. The reduction in the risk of MACE was observed irrespective of the timing of nonculprit artery revascularization in the mixed treatment model. Conclusions Current evidence from randomized trials suggests that the risk of all-cause mortality and spontaneous reinfarction is not different among the various revascularization strategies for multivessel disease. Complete revascularization at the index procedure or as a staged procedure (either during the hospitalization or after discharge) was associated with a reduction of MACE due to reduction in urgent revascularization with no difference between these 3 strategies. Future trials are needed to determine the impact of complete revascularization on the risk of all-cause mortality and spontaneous reinfarction.
Abstract 137: Gastrointestinal Bleeding in Acute Ischemic Stroke: A Nationwide Inpatient Sample Study

Introduction: Gastrointestinal bleeding (GIB) has been reported as a complication in acute cerebrovascular ailments. Here, we examined the incidence, risk factors, and outcomes of GIB in acute ischemic stroke (AIS) using the largest all-payer inpatient database in the U.S. Methods: The Nationwide Inpatient Sample (2002-2011) was queried to identify all adult patients with a primary diagnosis of AIS both with and without a secondary diagnosis of GIB. We utilized multivariate analyses, adjusting for patient and hospital factors, to identify risk factors for GIB in AIS patients and to determine the effect of GIB on in-hospital complications and outcomes. Results: Of 3,988,667 patients admitted with AIS, there were 49,348 cases of GIB (1,237 per 100,000 patients) with 25.7% receiving blood transfusions. Multivariate analysis revealed several independent predictors of GIB in AIS: age 55-64 (OR: 1.39, 95% CI: 1.33-1.45), age 65-74 (OR: 1.52, 95% CI: 1.44-1.59), age 75+ (OR: 1.79, 95% CI: 1.71-1.88), alcohol use (OR: 1.23, 95% CI: 1.17-1.30), coagulopathy (OR: 1.69, 95% CI: 1.62-1.77), cancer (OR: 1.70, 95% CI: 1.60-1.80), fluid/electrolyte disturbance (OR: 1.91, 95% CI: 1.87-1.96), liver disease (OR: 2.44, 95% CI: 2.29-2.60), and history of peptic ulcer disease (OR: 2.47, 95% CI: 2.13-2.86) (all p Conclusion: Age and several preexisting comorbidities are strong risk factors for GIB in AIS. GIB occurrence precipitates further in-hospital complications and adverse clinical outcomes in AIS, significantly increasing disability and mortality.
Student Healthcare Clinicians' Illness Narratives: Professional Identity Development and Relational Practice

ABSTRACTIn this qualitative, grounded theory study we examine how the intersection of self-reflection, illness narratives and perceived messages of professional identity inform care provided by medical, nursing, and medical family therapy students to patients and families. We discovered four common challenges students faced navigating personal experiences of illness and connecting to patients: 1) discrepancies between ideal and lived experiences, 2) challenges of healthcare work and culture, 3) navigating power and hierarchy, and 4) developing a shell of privacy. Discussion and implications include interdisciplinary training and collaboration and the unique role of medical family therapists in healthcare.
Anticoagulation in Patients With Atrial Fibrillation in the Setting of Prior Hemorrhage: An Ongoing Dilemma.

See releated articles, pp 2653, 2660, 2665, 2671 A clinician needs to counsel a patient with atrial fibrillation on the advisability of resuming anticoagulation after a parenchymal brain hemorrhage resulting in a persistent, albeit nondisabling functional impairment. The issue to be addressed is straightforward; the advice to be offered, however, is far from clear. Relevant prospective, randomized controlled trials are lacking,1,2 and the vagaries of providing recommendations based on observational studies and experience (eminence-based medicine) often lead to choices that are later refuted when adequately tested. This is, in part, because historic event rates in populations can change over time,3,4 and conclusions from observational studies can be affected by several biases.5 Causing further uncertainty, the results of case–control and other nonrandomized studies may be contradictory because of differences in cohort characteristics and unmeasured confounding.6 Yet, the patient cannot await the collection of the high-quality data required to support more definitive guidance. Healthcare providers turn to authoritative clinical guidelines to review current evidence-based opinions for patient evaluation and management. The American College of Chest Physicians guidelines indicate that, “In patients with a history of a symptomatic primary intracerebral hemorrhage, we suggest against the long-term use of antithrombotic therapy for the prevention of ischemic stroke.”1 The writers, however, remark that patients might benefit from antithrombotic therapy if they are at relatively low risk of recurrent intracerebral hemorrhage (ICH) and relatively high risk (>7% per year) of thromboembolic events. Similarly, the American Heart Association/American Stroke Association secondary stroke prevention guidelines suggest that, “The decision to restart antithrombotic therapy after intracerebral hemorrhage related to antithrombotic therapy depends on the risk of subsequent arterial or venous thromboembolism, the risk of recurrent ICH, and the overall status of the patient and must, therefore, be …
Real-time imaging reveals that lytic polysaccharide monooxygenase promotes cellulase activity by increasing cellulose accessibility

The high cost of enzymes is one of the key technical barriers that must be overcome to realize the economical production of biofuels and biomaterials from biomass. Supplementation of enzyme cocktails with lytic polysaccharide monooxygenase (LPMO) can increase the efficiency of these cellulase mixtures for biomass conversion. The previous studies have revealed that LPMOs cleave polysaccharide chains by oxidization of the C1 and/or C4 carbons of the monomeric units. However, how LPMOs enhance enzymatic degradation of lignocellulose is still poorly understood. In this study, we combined enzymatic assays and real-time imaging using atomic force microscopy (AFM) to study the molecular interactions of an LPMO [TrAA9A, formerly known as TrCel61A) from Trichoderma reesei] and a cellobiohydrolase I (TlCel7A from T. longibrachiatum) with bacterial microcrystalline cellulose (BMCC) as a substrate. Cellulose conversion by TlCel7A alone was enhanced from 46 to 54% by the addition of TrAA9A. Conversion by a mixture of TlCel7A, endoglucanase, and β-glucosidase was increased from 79 to 87% using pretreated BMCC with TrAA9A for 72 h. AFM imaging demonstrated that individual TrAA9A molecules exhibited intermittent random movement along, across, and penetrating into the ribbon-like microfibril structure of BMCC, which was concomitant with the release of a small amount of oxidized sugars and the splitting of large cellulose ribbons into fibrils with smaller diameters. The dividing effect of the cellulose microfibril occurred more rapidly when TrAA9A and TlCel7A were added together compared to TrAA9A alone; TlCel7A alone caused no separation. TrAA9A increases the accessible surface area of BMCC by separating large cellulose ribbons, and thereby enhances cellulose hydrolysis yield. By providing the first direct observation of LPMO action on a cellulosic substrate, this study sheds new light on the mechanisms by which LPMO enhances biomass conversion.
Novel ecosystems: A bridging concept for the consilience of cultural landscape conservation and ecological restoration

Abstract We evaluate the historical, philosophical, and practical relationships between two fields of theory and practice: cultural landscape conservation and ecological restoration. Each field has distinct intellectual and disciplinary roots, bodies of theory, norms of practice, institutions, and modes of professional discourse. Yet both aim to understand and wisely steward environments for the benefit of humans and non-human nature, and both grapple with similar issues inherent in the complex nexus of nature, society, history, and sustainability. Increasingly, the thinking and the practices that once clearly distinguished their respective efforts have begun to converge — reaching similar conclusions on challenging issues, and thus building consilience. Coincident with this trend toward consilience, the concept of “novel ecosystems” has arisen. Novel ecosystems are ecological assemblages that form self-organizing systems that have no historical precedent. We argue that the novel ecosystems concept is a useful frame through which to expose, articulate, and address many of the philosophical, ethical, and pragmatic challenges and tradeoffs that cultural landscape conservationists and ecological restorationists grapple with today: the fuzzy lines that distinguish humans from nature, the impossibility of going back in time, the resulting problems of defining goals given diversity of potential priorities, and the value of greater social inclusivity in the practice of restoration. We believe novel ecosystems also provide a powerful bridging concept through which we can understand and align with one another's epistemological perspectives, and continue building consilience and collaborations to conserve, steward, and celebrate our cultural and natural heritage and environment.
An Historical Perspective on Child Welfare

The field of child welfare has changed dramatically in the United States over the years. There are multiple reasons for this transformation. Some directly reflect changing concepts of childhood, historic debates regarding the importance of child saving versus family preservation, and differing views about public responsibility for children. Other reasons derive from changes in the larger society including the size and composition of the child population, growth in the economy, and alternating views of the powers and responsibilities of different levels of government.
Circum-menarcheal bone acquisition is stress-driven: A longitudinal study in adolescent female gymnasts and non-gymnasts.

Abstract Mechanical loading through youth exercise is highly modifiable and represents a strategy to maximize peak adult bone mass, with the potential for broad implementation across the population to lower fracture risk. For girls, circum-menarcheal growth is critical, with around 50% of adult bone acquired over a 4-year period. Here, we prospectively followed 10 gymnasts and 12 age-matched non-gymnasts across approximately 4 years circum-menarche. A combination of pQCT and subject-specific finite element models were used to measure differences in bone acquisition and structure between the groups, and to determine the degree to which specific mechanical factors predict change in bone structure. At baseline, gymnasts had stronger bone, including 26% higher BMC, 51% greater compressive strength, and 21% higher trabecular density. Over the study period, both groups more than doubled their bone strength. Pre-menarcheal principal stresses predicted change in pQCT variables for non-gymnasts, but not gymnasts. The bone of non-gymnasts became more asymmetrical than the bone of gymnasts. Our results suggest that exposure to the diverse, intense mechanical signals of gymnastic loading during adolescence imparts substantial benefits to bone geometry and mechanical function. Specifically, the bone of gymnasts is better able to resist loading from multiple directions, and operates with a higher factor of safety compared to non-gymnasts.
Arthroscopic Partial Rotator Cuff Repair for an Irreparable Tear

Massive, irreparable rotator cuff tears can result in significant functional disability and loss of muscle strength. Despite the difficulty, massive cuff tears pose for surgeons and their relatively high incidence, there is no consensus on the optimal surgical treatment method. The rationale for performing arthroscopic partial rotator cuff repair is to turn an irreparable tear into a “functional tear” by restoring the shoulder force couples. Outcome studies for partial repair are generally favorable; however, numerous controversies exist including which should be the exact optimal technique. This article provides a historical framework and the contemporary outcomes associated with arthroscopic partial repair as well as a modified surgical technique of the original description. The authors advocate mobilizing the torn rotator cuff tendon to maximize surface area coverage of the greater tuberosity footprint so as to optimize tendon-bone healing and minimize retear rates.
Comparison of keystone flaps and skin grafts for oncologic reconstruction: A retrospective review.

Background and objectives Two common options for the closure of complex defects are local flaps and skin grafting. The keystone flap, a fasciocutaneous flap based on perforators, has demonstrated compelling ease of use, reproducibility, and low complication rates without requiring a distant donor site. Our objective for this study was to compare postoperative outcomes for keystone flaps and skin grafts in cancer resection. Methods A retrospective review was conducted of patients undergoing keystone flap closure or skin grafting for soft tissue defects resulting from cancer resection at a single institution from June 2017 to June 2018. Patient demographics, operative indications, length of stay, time to heal, and complications were reviewed. Results A total of 34 patients were identified having undergone either keystone reconstruction (n = 16) or skin graft (n = 18) after oncologic resection. Patients undergoing keystone flap reconstruction had significantly shorter mobility restriction and healing times. Length of hospital stay and overall complication rates were not significantly different. Conclusion The keystone flap is an adaptable tool that can safely be used for the coverage of complex defects with faster healing, shorter mobility restriction, and comparable complication rates to skin grafting without the need for a distant donor site.
ASHP national survey on informatics: assessment of the adoption and use of pharmacy informatics in U.S. hospitals--2007.

Purpose. Results of the 2007 ASHP national survey on informatics are presented. Methods. All types and sizes of hospitals in the United States were included in the sample of 4112 pharmacy directors surveyed using an online data collection tool. The survey included over 300 data elements and was designed to assess the adoption and use of pharmacy informatics and technology within the medication-use process. Results. In this national probability sample survey, the response rate was 25.9%. Hospitals appear to be moving toward an enterprise approach to information technology adoption and away from a best-of-breed approach. Although nearly half of hospitals have components of an electronic medical record (EMR), a complete digital hospital with a fully implemented EMR is far in the future, with only 5.9% of hospitals being fully digital (without paper records). An estimated 12.0% of hospitals use computerized prescriber-order-entry systems with decision support, 24.1% use bar-code medication administration, and 44.0% use intelligent infusion devices (smart pumps). Many of these technologies were not optimally configured, and significant advances must be made for hospitals to fully realize the benefits of these technologies. Hospitals have implemented many technologies in drug distribution, with 82.8% of hospitals having automated dispensing cabinets, 10.1% having robots, and 12.7% having carousel systems to manage inventory. Finally, most hospitals reported plans to adopt most of these technologies. Conclusion. This survey found that informatics and medication-use system technologies are widely present in all steps of the medication-use process. These technologies touch all health care professionals in the hospital and demonstrate the significant responsibility the pharmacy department holds for these technologies.
Imputation Strategy for Reliable Regional MRI Morphological Measurements.

Regional morphological analysis represents a crucial step in most neuroimaging studies. Results from brain segmentation techniques are intrinsically prone to certain degrees of variability, mainly as results of suboptimal segmentation. To reduce this inherent variability, the errors are often identified through visual inspection and then corrected (semi)manually. Identification and correction of incorrect segmentation could be very expensive for large-scale studies. While identification of the incorrect results can be done relatively fast even with manual inspection, the correction step is extremely time-consuming, as it requires training staff to perform laborious manual corrections. Here we frame the correction phase of this problem as a missing data problem. Instead of manually adjusting the segmentation outputs, our computational approach aims to derive accurate morphological measures by machine learning imputation. Data imputation techniques may be used to replace missing or incorrect region average values with carefully chosen imputed values, all of which are computed based on other available multivariate information. We examined our approach of correcting segmentation outputs on a cohort of 970 subjects, which were undergone an extensive, time-consuming, manual post-segmentation correction. A random forest imputation technique recovered the gold standard results with a significant accuracy (r = 0.93, p 250).
Examining collaboration across organizations in an age-friendly community.

Collaboration among organizations is fundamental to promoting age-friendly environments. This study questions: To what extent do organizations collaborate with other organizations in age-friendly c...
Philosophy and science: critique of Bergson’s use of Boltzmann’s argument against the reversibility of the universe

This paper seeks to understand the relationships and exchanges between philosophy and science by analysing a specific case: Bergson’s use of Boltzmann’s argument against the reversibility or recurrence of the universe (“Zermelo’s paradox”). This argument is used by Bergson to indirectly support his conception of the irreversibility of the universe based on an elan vital. We criticize Bergson’s interpretation that turns into an “absolute impossibility” what Boltzmann states only as a “practical impossibility”. We will show that the French philosopher distorts the argument, leaving aside two fundamental points: a) Boltzmann’s particular epistemological position with respect to scientific theories and their relation to experience, b) the atomism that serves as the basis for Boltzmann’s argument, an atomism that Bergson rejects. We conclude that Boltzmann’s argument is not valid in Bergson’s metaphysical (epistemological and ontological) framework. We hope this paper contributes to a better understanding of the problems arising in the conceptual exchanges between science and philosophy.Keywords: Bergson, Boltzmann, irreversibility.