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Hairy cell leukemia (HCL) is a rare mature B-cell lymphoproliferative disorder and most often presents as classic hairy cell leukemia. This entity is characterized by an indolent course and the presence of the BRAF V600E mutation. We report the case of an 80-year-old man with a history of classical hairy cell leukemia who presented with fatigue, dizziness, shortness of breath, blurring of vision, and headache. His initial diagnosis was 9 years prior, and he received treatments with cladribine, pentostatin, and rituximab. The workup showed an elevated white blood cell count with atypical lymphocytes, anemia, and thrombocytopenia. A peripheral blood smear confirmed HCL relapse, and a magnetic resonance imaging (MRI) of the brain showed diffuse, nonenhancing masses in the supratentorial and infratentorial regions of the brain. He was initiated on treatment with vemurafenib, with improvements in his white blood cell count and a recovery of his platelet count and hemoglobin. A repeat MRI of the brain after 3 months showed complete resolution of the lesions. Vemurafenib was discontinued after 6 months, with bone marrow biopsy showing no evidence of residual hairy cell leukemia. There have only been limited reports of HCL involvement in the central nervous system in the literature. Due to the rarity of the condition, it is not clear which treatments can be effective for intracranial disease control. Our report shows the successful use of vemurafenib, resulting in complete remission of relapsed HCL with CNS involvement.

BackgroundDiagnoses of HIV in the US decreased by 17% in 2020 due to COVID-related disruptions. The extent to which this decrease is attributable to changes in HIV testing versus HIV transmission is unclear. We seek to better understand this issue by analyzing the discrepancy in expected versus observed HIV diagnoses in 2020 among persons who acquired HIV between 2010-2019, as changes in diagnosis patterns in this cohort cannot be attributed to changes in transmission.MethodsWe developed three methods based on the CD4-depletion model to estimate excess missed diagnoses in 2020 among persons with HIV (PWH) infected from 2010-2019. We stratified the results by transmission group, sex assigned at birth, race/ethnicity, and region to examine differences by group and confirm the reliability of our estimates. We performed similar analyses projecting diagnoses in 2019 among PWH infected from 2010-2018 to evaluate the accuracy of our methods against surveillance data.ResultsThere were approximately 3100-3300 (approximately 18%) fewer diagnoses than expected in 2020 among PWH infected from 2010-2019. Females (at birth), heterosexuals, persons who inject drugs, and Hispanic/Latino PWH missed diagnoses at higher levels than the overall population. Validation and stratification analyses confirmed the accuracy and reliability of our estimates.ConclusionsThe substantial drop in number of previously infected PWH diagnosed in 2020, suggests that changes in testing played a substantial role in the observed decrease. Levels of missed diagnoses differed substantially across population subgroups. Increasing testing efforts and innovative strategies to reach undiagnosed PWH are needed to offset this diagnosis gap. These analyses may be used to inform future estimates of HIV transmission during the COVID-19 pandemic.

Medical and health sciences librarians have been participating in supporting their communities of researchers with systematic reviews for over two decades (Boynton, 1998; McKibbon, 1998). Now systematic and related types of literature reviews which attempt to analyze the literature on a particular research question in a repeatable and transparent way are gaining momentum and popularity in other science and social sciences fields. Researchers are using them to ascertain the best and most effective interventions across fields such as public health, biology, education, social work, and political science. In many ways, this type of research is exactly what libraries have been waiting for and it often makes excellent use of library resources; however, supporting this work can also require significant library personnel time, a high level of database searching skills, depth of subject knowledge, and skills with specialized software. The process or the review type itself is sometimes prone to being deeply misunderstood by the researchers most wanting to undertake them. Are academic librarians prepared to provide the necessary and intensive assistance with this type of research? What does this assistance look like and what kinds of professional development is needed? This session will provide an overview of the current state of systematic and scoping review support among academic libraries in the United States. It will also present the case study of the efforts of a small group of librarians attempting to build their own support community in a large research institution. This case study will examine how librarians can scale this type of research support and offer assistance even when they don’t feel entirely comfortable or equipped to do so.

Heading your college paper is relatively simple. However, it shows that you are a detail-oriented student. Proofreading is essential to make sure that your header is grammatically correct. Do not copy-paste words and enlarge font size just to copy-paste it to the bottom. If you don`t have enough skills or time then get help with college paper writing at special writing services. Your paper's header should reflect your intellectual skills, and making it look unprofessional can negatively affect your reputation as a student. When it comes to heading a college paper, a few simple rules apply. First, the heading should be in the upper left-hand corner of the page, not the bottom. The font should be 12 points, and it should be recognizable by your audience. The font style should be Times New Roman, although you can use any type. Other acceptable styles include Arial, Lucina, Palermo, or any other type of 12-point font. Generally, college papers should be formatted according to the Modern Language Association formatting style, which includes the first and last names at the top of each page and all other lines aligned at the left margin. Next, the heading should contain the name of the student, professor, or teacher. Make sure the first name of the instructor is placed in the middle of the first line. The professor or teacher's name should be on the second line, followed by the word Professor. The final line should include the date. The day should be in numerical format, while the month and year should be in alphabetical order. When referencing a book, it is best to use MLA formatting. Depending on the writing style, you may need to include multiple levels of headings. You may have a section within a section, and you should include all of them. Whether you're using the MLA format or not, you'll need to keep the format consistent throughout your document. When you are submitting a college entry write-up, you must select all of the headings, and choose the "Align Text to the Left" option. You'll need to head your college paper with a title. Some instructors may ask you to include a cover page, which means your original title is on the cover page. Check with your instructor to determine if this is necessary. APA stylebook provides guidelines for proper headings. Also, remember to avoid plagiarism. It's illegal to copy and paste. In addition to being plagiarism-free, it's unprofessional to copy a college paper. A college paper's heading is typically composed of a group of data that is usually at the top. It is important to remember that a college paper's heading is not as simple as a high school paper's title. It is a crucial part of the academic paper. Including the proper information in a college paper's heading is essential for its quality. For example, if the author's name is listed, they should include it in the header. Then, the reader can see what they're writing. Before heading a college paper. Before heading a college paper you should include the author's name the professor's name, and the university's guidelines for the paper. Then, you need to make sure the header is legible. You should avoid decorative style and over-the-top punctuation. Your title should have a formal appearance. You should also double-check your grammar. If you don't know what to put in your header, ask someone else to read it. The title of your paper should be centered on the following line. To make your title stand out, use the Case style. You should also make sure to indent the paper one inch below the top margin. The next line in your document should contain your page number. Then, your page should have a header. If you're unsure how to head a college paper, it is important to study the instructions carefully. The title of a college paper is very important. It should be unique. When writing a research paper, it is imperative to be original and descriptive. While you should follow the guidelines of your professor, there are many exceptions. Nevertheless, you should follow the instructions of your instructor to make your work stand out. If you're unsure about a specific requirement, consult your professor. This will help you choose the best topic for your paper.

Sustainability in poultry production is evident in efforts to reduce inputs and a focus on bird welfare and livability. Dietary protein alternatives to traditional sources such as soybean meal aim to meet or exceed efficiency benchmarks and be cost-effective. Environmental enrichment encouraging activity may reduce the occurrence of the predominant breast muscle myopathy, woody breast (WB); interventions to minimize muscle damage and economic loss have yet to be established. The study objectives were to maintain or improve broiler performance and breast quality through environmental enrichment and partially replacing dietary soybean meal with Spirulina. Twelve hundred Ross 708 broilers were randomly assigned to enrichment (LASER; laser enrichment, or CON; no laser enrichment) and diet (algae; 2.5% Spirulina algae, or control) in a 2 × 2 factorial design for 49 days. The same 70 randomly selected birds were examined for contact dermatitis wk 1–6. Breast width was measured weekly on 200 growing broilers beginning on d22. On d42 and 49 slaughter, WB score was assigned using a tactile 0–3 scale and the right breast filet was weighed (n = 200). RNA isolated from 30 breast muscle samples each at d42 and 49 was analyzed using real-time qPCR. Laser enrichment increased body weight at all timepoints (d49: 0.148 kg, P < 0.001). Feed conversion ratio was improved in LASER-enriched birds by 3 points in the starter period (P = 0.003). Breast width was increased at all timepoints in LASER-enriched birds compared to CON (d49: 0.47 cm, P < 0.001). Algae inclusion increased body weight at d28 (0.059 kg, P = 0.005). At d42, 12% more LASER-enriched WB scores were 0 (normal) compared to CON, and at d49, 15% more enriched scores were 0. At d42, 5% more algae-fed broiler scores were 0 compared to control. LASER-enriched broiler breast tissue showed upregulated expression of myogenin, muscle regulatory factor 4, insulin-like growth factor 1, and myostatin compared to CON (P < 0.01). Both laser enrichment and algae inclusion improved broiler performance without negatively impacting environmental or physiological outcomes. LASER enrichment decreased severity of WB score and positively shifted myogenic gene expression in the breast muscle at slaughter.

Digital overgrowth has been documented as one of the most common foot abnormalities observed in U.S. commercial sow breeding herds and often leads to lameness and culling. Previous research has reported that 8.2% of lactating sows had digital overgrowth. When examining a 3,500 gestating sows, at least 32% were scored with moderate or severe digital overgrowth. Digital overgrowth negatively impacts piglet pre-wean mortality, lower NBA, and lower weaning weights. In addition to the digital overgrowth, sows have increased risk for cracked hooves and other hoof lesions. The objective of this study was to characterize a true standard (mm) for digital overgrowth and to determine if varying toe cell structure contributes to toe overgrowth. Initially, 2 crossbred sows that visually exhibited digital overgrowth were evaluated into this case study. Sows were euthanized at the Iowa State Veterinary Diagnostic Laboratory. Sow toe measurements were collected from the tip of the toe to the coronary band that is anatomically located at the sagittal line. Medial and lateral toe measurements were recorded for each limb. The mean toe measurements were front right limb: lateral digit (LD; 40 mm), medial digit (MD; 40 mm); front left limb: LD (36.5 mm), MD (38.5 mm); hind right limb: LD (73.5 mm), MD (49 mm); hind left limb: LD (50.5 mm), MD (50 mm). Dew claw and histopathological evaluations are in progress.

Supplemental material, ECE_Impacts_on_SN_MANUSCRIPT_SUPP_R3 for The Effects of Early Care and Education Settings on the Kindergarten Outcomes of Doubly Vulnerable Children by Owen N. Schochet, Anna D. Johnson and Deborah A. Phillips in Exceptional Children

The cold chain third-party logistics (3PLs) industry is comprised of 250 companies in the United States, representing a $5.7 billion dollar market (G. C. C. Alliance, 2019). The cold chain 3PL industry manages the storage of the food products the manufacturers produce and the logistics activities on behalf of the shipper. Currently, it is reported that over 94 billion pounds of food are stored in cold chain 3PL warehouses, with a projected growth to $2 billion dollars of goods and services tracked annually by 2023 (G. C. C. Alliance, 2017). Given industry growth, regulatory pressures, and serious disintermediation in the chain due to changing business models and alternative channels of distribution, the need for innovation-driven value from traditionally conservative, slow-to-change 3PLs is urgent. Therefore, I addressed the following research questions with this study: (a) What is the state of Organizational Innovativeness in cold chain 3PL firms? and (b) What is the nature of the relationship between cold chain 3PL firms’ innovativeness and their capacity to innovate? I am embedded in a cold chain 3PL, and my firm has a vested interest in understanding where to focus its efforts to effect change and create high levels of innovation capacity. All levels of the organizations were represented in the 192 participants who responded to a survey. The tested model represents a five-dimensional second-order latent construct for organizational innovativeness and its influence on a firm’s capacity to innovate. I evaluated the model using WarpPLS™ 6.0 (Koch, 2017). The findings suggest that all five dimensions had a strong positive influence on organizational innovativeness, which validated prior research. In turn, organizational innovativeness, as a second-order construct, was a significant predictor of innovation capacity. Size was a control. Open-ended questions were asked to allow open commentary on innovation in the respective organization and for the industry at large.

PAN: Philosophy Activism Nature, vol. 10 (2013), p. 103-111 urn:ISSN:1443-6124

The Mentor, Volume 17, ISSN: 1521-2211

While urban ecosystems can host surprisingly high levels of biodiversity, there are still many shifts in the characteristics of the biotic communities found in cities. My dissertation explores patterns of plant community assembly in urban residential vacant lots. Firstly, I reviewed the literature to describe how various components of urban ecosystems impact vegetation diversity and composition and presented a novel conceptual model of spatiotemporal variation in plant community composition. Secondly, I described how spatially heterogeneous legacies of human land use within vacant lots structured plant community diversity and composition, relative to spatial and environmental variation. Plant community compositional variation was primarily explained by differences in human land use legacies, compared to local environmental variation (abiotic soil characteristics) and environmental context (lot area, proximity to other vacant lots and tree canopy). Thirdly, I examined how successional processes interacted with spatial variation in land use by constructing a chronosequence of vacant lot properties. I found no evidence of changes in plant community diversity over time but demonstrated significant shifts in functional composition in building footprint sections over time, primarily related to seed dispersal. Finally, I conducted a greenhouse experiment to uncover the interaction between local biotic and abiotic pressures on community structure. I replicated each seed mix across three soil environments (urban soils, soil from an unmanaged suburban lawn/field area, and greenhouse potting mix) and crossed soil and seeded species assemblages with a treatment to remove individuals emerging from the soil seed bank. I found that soil environment had the strongest impact on seeded species establishment. Weeding reduced overall community diversity in vacant lot soils but increased seeded species diversity.Overall, my dissertation results described patterns of community assembly of spontaneous plant communities in vacant lots at a spatial scale appropriate for guiding urban ecological management decisions.

The interface between wetting (W) and non-wetting (NW) fluids in a porous medium includes contributions from three morphologies. One is the interface between the bulk connected volumes of W and NW phases. A second arises when blobs of one phase become disconnected from the parent bulk phase. Examples of this morphology include pendular rings of W phase held at grain contacts and lenses of W in pore throats. Finally, there is the thin film of W coating the walls of pores containing NW. We describe a theoretical means of estimating these contributions during drainage (NW displacing W). The technique is based on a physically representative and geometrically determinate network model of granular media that allows a priori predictions of pore-scale transport phenomena. The predicted total from all three wetting phase morphologies agrees with the trend of measurements reported in the literature, indicating that the experimental techniques used did not discriminate between the morphologies.

Stroke and TIA diagnostic algorithm. (PDF 358Â kb)

COMPASS study CONSORT flow diagram (DOCX 52 kb)

COMPASS study CONSORT flow diagram (DOCX 52 kb)

Additional file 1: Figure S1. Days to Clinic Visit After Discharge. Histogram of percent of patients seen for follow up clinic by days after discharge.

Example COMPASS Care Plan. (PDF 583Â kb)

Additional file 1: Figure S1. Days to Clinic Visit After Discharge. Histogram of percent of patients seen for follow up clinic by days after discharge.

Example COMPASS Care Plan. (PDF 583Â kb)

CONSORT 2010 randomized trial reporting checklist: the COMPASS study (DOC 216 kb)

CONSORT 2010 randomized trial reporting checklist: the COMPASS study (DOC 216 kb)

Stroke and TIA diagnostic algorithm. (PDF 358Â kb)