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The Paris System for Reporting Urinary Cytology (TPS) uses hyperchromasia as major diagnostic criterion for high-grade urothelial carcinoma (HGUC). The purpose of the study was to evaluate cases that were diagnosed as HGUC by TPS and determine whether there are different chromatin distribution patterns (ie, subsets).Digital image annotations were performed on microscopic images of HGUC urine specimens with surgical biopsy/resection follow-up. Median gray values were generated for each cell. Neutrophils (polymorphonuclear leukocyte [PMN]) were also enumerated in each case to serve as an internal control. A HGUC/PMN ratio was generated for each case, and the cases were distributed.Sixty-nine HGUC cases yielded 2660 cells, including 2078 HGUC (30.1 cells/case) and 582 PMNs (8.4 cells/case). The average median gray value of an HGUC was 50.6 and of a PMN was 36.8 (P.0001). Eight of 69 cases (11.6%) contained nuclei that, on average, were darker than or as dark as a PMN (extremely dark, ie, "India ink"). Fifty-one of 69 cases (74.0%) contained nuclei that, on average, were slightly brighter than a PMN (hyperchromatic). Ten of 69 cases (14.5%) contained nuclei that, on average, were much brighter than a PMN (hypochromatic). Within a single case, all cases showed heterogeneity with the hypochromatic cases showing the most dramatic effect.Digital image analysis reveals that there are large variations in chromasia between cases including a subset of cases with hypochromasia and another with extremely dark or "India ink" nuclei. There was much heterogeneity of chromasia seen within a single sample.

We describe four patients with a neurodevelopmental disorder and de novo missense variants in SLC32A1, the gene that encodes the vesicular GABA transporter (VGAT). The main phenotype comprises moderate to severe intellectual disability, early onset epilepsy within the first 18 months of life and a choreatic, dystonic or dyskinetic movement disorder. In silico modeling and functional analyses in cultured neurons reveal that three of these variants, which are located in helices that line the putative GABA transport pathway, result in reduced quantal size, consistent with impaired filling of synaptic vesicles with GABA. The fourth variant, located in the VGAT N-terminus, does not affect quantal size, but increases presynaptic release probability, leading to more severe synaptic depression during high frequency stimulation. Thus, variants in VGAT can impair GABAergic neurotransmission via at least two mechanisms, by affecting synaptic vesicle filling and by altering synaptic short-term plasticity. This work establishes de novo missense variants in SLC32A1 as a novel cause for a neurodevelopmental disorder with epilepsy.

Pediatric salivary gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a small proportion of malignancies. This international, multi-institutional cohort evaluated the application of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and the risk of malignancy (ROM) for each diagnostic category.Pediatric (0- to 21-year-old) salivary gland FNA specimens from 22 international institutions of 7 countries, including the United States, England, Italy, Greece, Finland, Brazil, and France, were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. Cytology-histology correlation was performed where available, and the ROM was calculated for each MSRSGC diagnostic category.The cohort of 477 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 10.3%; nonneoplastic, 34.6%; AUS, 5.2%; benign neoplasm, 27.5%; SUMP, 7.5%; SM, 2.5%; and malignant, 12.4%. Histopathologic follow-up was available for 237 cases (49.7%). The ROMs were as follows: nondiagnostic, 5.9%; nonneoplastic, 9.1%; AUS, 35.7%; benign neoplasm, 3.3%; SUMP, 31.8%; SM, 100%; and malignant, 100%. Mucoepidermoid carcinoma was the most common malignancy (18 of 237; 7.6%), and it was followed by acinic cell carcinoma (16 of 237; 6.8%). Pleomorphic adenoma was the most common benign neoplasm (95 of 237; 40.1%).The MSRSGC can be reliably applied to pediatric salivary gland FNA. The ROM of each MSRSGC category in pediatric salivary gland FNA is relatively similar to the ROM of each category in adult salivary gland FNA, although the reported rates for the different MSRSGC categories are variable across institutions.

Introduction COVID19 has raised concerns for resource allocation across various sectors of healthcare. At the frontlines, emergency departments are required to triage a wide range of acuity and non-specific symptomology. Methods This retrospective study aimed to pave the way for more concrete detection and triage of patients by analyzing symptomology, physical findings, diagnostic testing and relevant hospital course of the 458 suspected cases that initially presented to an academic level one trauma center emergency department between March and August 2020. A total of 202 COVID positive cases were analyzed. Results The most common symptoms were cough (70.63%), fatigue (77%), and shortness of breath (59%). There was a significantly higher percentage of abnormal chest imaging in inpatient groups compared to the ED discharge group (42.86% vs 79%, p

Behavioral and neuroimaging studies show that people trust and collaborate with others based on a quick assessment of the facial appearance. Based on the morphological characteristics of the face, i.e., features, shape, or color, it is possible to determine health, attractiveness, trust, and some personality traits. The study attempts to indicate the features influencing the perception of attractiveness and trust. In order to select individual factors, a model of backward stepwise logistic regression was used, analyzing the results of the psychological tests and the attractiveness and trust survey. Statistical analysis made it possible to select the most important personality traits related to attractiveness and trust assessments.

Awareness about food allergy and food-induced anaphylaxis (FIA) has increased dramatically over the past decade. It remains unclear, however, whether concordance with guidelines for FIA management has improved over time.Our objective was to describe changes in emergency department (ED) concordance with guidelines for FIA management.We analyzed data from 2 multicenter retrospective studies of patients with food-related acute allergic reactions seen in 1 of 17 EDs during 2 time periods: 1999 to 2001 and 2013 to 2015. Visits were identified similarly across years-for example, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 693.1, 995.60, 995.61-995.69, 995.0, and 995.3. Anaphylaxis was defined as an acute allergic reaction with involvement of 2+ organ systems or hypotension. We compared concordance between time periods for 4 guideline recommendations: (1) treatment with epinephrine, (2) discharge prescription for an epinephrine autoinjector (EAI), (3) referral to an allergist/immunologist, and (4) instructions to avoid offending allergen.We compared 290 patients with FIA during 1999 to 2001 and 459 during 2013 to 2015. Any treatment with epinephrine (pre-ED or in the ED) for patients with FIA increased over time (38% vs 56%; P.001). Prescriptions for EAI at discharge (24% vs 54%; P.001) and documentation for referral to an allergist/immunologist (14% vs 24%; P = .001) approximately doubled, whereas instructions to avoid the offending allergen did not change significantly (37% vs 43%; P = .08). Receipt of 3+ guideline recommendations remained low but almost quadrupled over the study interval (6% vs 23%; P.001).Over the nearly 15-year study interval, we observed clinically and statistically significant increases in ED concordance with epinephrine-related guidelines for FIA. Management gaps remain and interventions to standardize care still appear warranted.

Background Urinary tract cytology (UTCy) is used for screening urothelial carcinoma (UC) and it must have a high negative predictive value (NPV) to be an effective test. To the authors' knowledge, the literature regarding the NPV of UTCy provides little information regarding the risk of malignancy, especially for patients with high-grade urothelial carcinoma (HGUC). Methods Patients with negative UTCy specimens were identified in the pathology files at the study institution for the years 2012 through 2013. Cases were deemed true-negative cases if there was at least 1 subsequent negative specimen or negative clinical follow-up within 6 months of the index case. False-negative cases were defined as HGUC or carcinoma in situ by surgical biopsy and/or any UTCy with suspicious for HGUC or HGUC follow-up. Results A total of 2614 UTCy specimens from 2089 patients were identified. There was a disease prevalence of 6.5%. There were 87 false-negative results for HGUC, which corresponded to an overall NPV of 96.7%. When categorized by clinical indication, hematuria resulted in the highest NPV of 99.5% followed by other indications (97.7%) and a history of UC (90.1%). When categorized by the specimen type, voided urine specimens were found to have the highest NPV of 98.7% followed by other indications (96.9%) and washing specimens (96.2%). Of the 717 patients with a history of UC, the NPV was lower for washing specimens (89.8%) than for voided urine specimens (96.2%). When including either low-grade urothelial carcinoma or HGUC as a positive follow-up, the NPV dropped to 93.3% from 96.7% (HGUC only). The sensitivity of the diagnostic category of atypical urothelial cells or higher was 93.0%. Conclusions Overall, UTCy appears to have a good NPV and a high sensitivity for HGUC. The clinical indication had a greater impact on NPV compared with the specimen type.

The purpose of the present study was to identify the effect of acoustic neurofeedback on brain activity during consecutive stages of mental rotation of 3D objects. Given the fact that the process of mental rotation of objects is associated with desynchronisation of beta rhythm (beta ERD), it was expected that suppression in this band would be greater in the experimental group than in the controls. Thirty-three participants were randomly allocated to two groups performing the classic Shepard–Metzler mental rotation task (1971). The experimental group received auditory stimuli when the level of concentration fell below the threshold value determined separately for each participant based on the engagement index [β/(α + Θ)]. The level of concentration in the control group was not stimulated. Compared to the controls, the experimental group was found with greater beta-band suppression recorded above the left parietal cortex during the early stage and above the right parietal cortex during the late stage of mental rotation task. At the late stage of mental rotation, only the experimental group was found with differences in beta ERD related to varied degrees of the rotation angle and the control condition (zero angles, no rotation) recorded above the right parietal cortex and the central area of cerebral cortex. The present findings suggest that acoustic feedback might improve the process of mental rotation.

Erosion, which is considered to be global problem, is the process of soil environment degradation due to the impact of wind (soil blowing, deflation) and water (soil washing, deep erosion). This leads to destruction of its structure, nutrients removal and finally bedrock exposition and desertification. One of the ways to prevent this phenomenon is the soil conditioners usage. These substances, also called soil flocculants, are macromolecular compounds which contribute to the reinforcement of soil structure as a result of its adsorption on the mineral surface. The soil conditioners commonly used in agriculture is ionic polyacrylamide (PAM)—both anionic and cationic. These macromolecular substances affect soil surface properties and adsorption behaviour of substances present in the environment—nutrients, organic molecules and also hazardous compounds as well as toxic heavy metals (i.e. chromium(VI) ions). The aim of this study was to investigate the impact of solution pH, type of ionic groups in the polyacrylamide macromolecules and chromium(VI) ion concentration on the adsorption mechanism of Cr(VI) and PAM on the montmorillonite surface. The adsorption and electrokinetic properties of the montmorillonite—AN PAM or CT PAM/Cr(VI) systems were examined by means of spectrophotometry, potentiometric titration, SEM, XRD and DRS methods. It was shown that in the adsorbed layer composed of PAM-Cr(VI) complexes reduction of Cr(VI) to Cr(III) takes place.

Understanding how humans evaluate credibility is an important scientific question in the era of fake news. Message credibility is among crucial aspects of credibility evaluations. One of the most direct ways to understand message credibility is to use measurements of brain activity of humans performing credibility evaluations. Nevertheless, message credibility has never been investigated using such a method before. This article reports the results of an experiment during which we have measured brain activity during message credibility evaluation, using EEG. The experiment allowed for identification of brain areas that were active when participant made positive or negative message credibility evaluations. Based on experimental data, we modeled and predicted human message credibility evaluations using EEG brain activity measurements with F1 score exceeding 0.7.

Biodiversity decline causes a loss of functional diversity, which threatens ecosystems through a dangerous feedback loop: this loss may hamper ecosystems’ ability to buffer environmental changes, leading to further biodiversity losses. In this context, the increasing frequency of climate and human-induced excessive loading of nutrients causes major problems in aquatic systems. Previous studies investigating how functional diversity influences the response of food webs to disturbances have mainly considered systems with at most two functionally diverse trophic levels. Here, we investigate the effects of a nutrient pulse on the resistance, resilience and elasticity of a tritrophic—and thus more realistic—plankton food web model depending on its functional diversity. We compare a non-adaptive food chain with no diversity to a highly diverse food web with three adaptive trophic levels. The species fitness differences are balanced through trade-offs between defense/growth rate for prey and selectivity/half-saturation constant for predators. We showed that the resistance, resilience and elasticity of tritrophic food webs decreased with larger perturbation sizes and depended on the state of the system when the perturbation occured. Importantly, we found that a more diverse food web was generally more resistant, resilient, and elastic. Particularly, functional diversity dampened the probability of a regime shift towards a non-desirable alternative state. In addition, despite the complex influence of the shape and type of the dynamical attractors, the basal-intermediate interaction determined the robustness against a nutrient pulse. This relationship was strongly influenced by the diversity present and the third trophic level. Overall, using a food web model of realistic complexity, this study confirms the destructive potential of the positive feedback loop between biodiversity loss and robustness, by uncovering mechanisms leading to a decrease in resistance, resilience and elasticity as functional diversity declines.

The objective of this study was to evaluate the educational impact following the implementation of a robotic thoracic surgery program on cardiothoracic (CT) surgery trainees. We hypothesized that the introduction of a robotic thoracic surgery program would adversely affect the CT surgery resident experience, decreasing operative involvement and subsequent competency of surgical procedures. CT surgery residents and thoracic surgery attendings from a single academic institution were administered a recurring, electronic survey from September 2019 to September 2020 following each robotic thoracic surgery case. Surveys evaluated resident involvement and operative performance. This study was exempt from review by our Institutional Review Board. Attendings and residents completed surveys for 86 and 75 cases, respectively. Residents performed 50% of the operation independently at the surgeon console in 66.2 and 73.3% of cases according to attending and resident responses, respectively. The proportion of trainees able to perform 75% of the operation increased with each increasing year in training (p = 0.002). Based on the Global Evaluative Assessment of Robotic Skills grading tool, third-year residents averaged higher scores compared to first-year residents (22.9 versus 17.4 out of 30 possible points, p 0.001), indicating that more extensive prior operative experience could shorten the learning curve of robotic thoracic surgery. CT surgery residents remain actively involved in an operative role during the establishment of a robotic thoracic surgery program. The transition to a robotic thoracic surgery platform appears feasible in a large academic setting without jeopardizing the educational experience of resident trainees.

Proportional electroluminescence (EL) in noble gases is used in two-phase detectors for dark matter searches to record (in the gas phase) the ionization signal induced by particle scattering in the liquid phase. The "standard" EL mechanism is considered to be due to noble gas excimer emission in the vacuum ultraviolet (VUV). In addition, there are two alternative mechanisms, producing light in the visible and near infrared (NIR) ranges. The first is due to bremsstrahlung of electrons scattered on neutral atoms ("neutral bremsstrahlung", NBrS). The second, responsible for electron avalanche scintillation in the NIR at higher electric fields, is due to transitions between excited atomic states. In this work, we have for the first time demonstrated two alternative techniques of the optical readout of two-phase argon detectors, in the visible and NIR range, using a silicon photomultiplier matrix and electroluminescence due to either neutral bremsstrahlung or avalanche scintillation. The amplitude yield and position resolution were measured for these readout techniques, which allowed to assess the detection threshold for electron and nuclear recoils in two-phase argon detectors for dark matter searches. To the best of our knowledge, this is the first practical application of the NBrS effect in detection science., Comment: 26 pages, 22 figures, 3 tables

Backgrounds from long-lived radon decay products are often problematic for low-energy neutrino and rare-event experiments. These isotopes, specifically $${}^{210}\hbox {Pb}$$ 210 Pb , $${}^{210}\hbox {Bi}$$ 210 Bi , and $${}^{210}\hbox {Po}$$ 210 Po , easily plate out onto surfaces exposed to radon-loaded air. The alpha emitter $${}^{210}\hbox {Po}$$ 210 Po is particularly dangerous for detectors searching for weakly-interacting dark matter particles. Neutrons produced via ($$\upalpha $$ α , n) reactions in detector materials are, in some cases, a residual background that can limit the sensitivity of the experiment. An effective solution is to reduce the $${}^{222}\hbox {Rn}$$ 222 Rn activity in the air in contact with detector components during fabrication, assembly, commissioning, and operation. We present the design, construction, calibration procedures and performance of an electrostatic radon detector made to monitor two radon-suppressed clean rooms built for the DARKSIDE-50 experiment. A dedicated data acquisition system immune to harsh operating conditions of the radon monitor is also described. A record detection limit for $${}^{222}\hbox {Rn}$$ 222 Rn specific activity in air achieved by the device is $$0.05\,\hbox {mBqm}^{-3}$$ 0.05 mBqm - 3 (STP). The radon concentration of different air samples collected from the two DARKSIDE-50 clean rooms measured with the electrostatic detector is presented.

Experiments searching for the neutrinoless double beta decay in $$^{76}$$ 76 Ge are currently achieving the lowest background level and, in connection with the excellent energy resolution of germanium detectors, they exhibit the best discovery potential for the decay. Expansion to a ton scale of the active target mass is presently considered – in this case on-site production of the detectors may be an option. In this paper we describe the fabrication and characterization procedures of a prototype detector with a small p+ contact, which enhances the abilities of the pulse shape discrimination – one of the most important tools for background reduction. Simulations of the shapes of pulses from the detector were carried out and tuned, taking the advantage of the fact that all the parameters of the Ge crystal, cryostat and of the spectroscopic chain were known. As a result, the pulse shape analyses performed on the simulated and measured data agree very well. The worked out method allows to optimize geometry and crystal parameters in terms of pulse shape analysis efficiency, before the actual production of the detectors.

Aria is a plant hosting a$${350}\,\hbox {m}$$350mcryogenic isotopic distillation column, the tallest ever built, which is being installed in a mine shaft at Carbosulcis S.p.A., Nuraxi-Figus (SU), Italy. Aria is one of the pillars of the argon dark-matter search experimental program, lead by the Global Argon Dark Matter Collaboration. It was designed to reduce the isotopic abundance of$${^{39}\hbox {Ar}}$$39Arin argon extracted from underground sources, called Underground Argon (UAr), which is used for dark-matter searches. Indeed,$${^{39}\hbox {Ar}}$$39Aris a$$\beta $$β-emitter of cosmogenic origin, whose activity poses background and pile-up concerns in the detectors. In this paper, we discuss the requirements, design, construction, tests, and projected performance of the plant for the isotopic cryogenic distillation of argon. We also present the successful results of the isotopic cryogenic distillation of nitrogen with a prototype plant.

The GERmanium Detector Array (GERDA) collaboration searched for neutrinoless double-$\beta$ decay in $^{76}$Ge with an array of about 40 high-purity isotopically-enriched germanium detectors. The experimental signature of the decay is a monoenergetic signal at Q$_{\beta\beta}$ = 2039.061(7)keV in the measured summed energy spectrum of the two emitted electrons. Both the energy reconstruction and resolution of the germanium detectors are crucial to separate a potential signal from various backgrounds, such as neutrino-accompanied double-$\beta$ decays allowed by the Standard Model. The energy resolution and stability were determined and monitored as a function of time using data from regular $^{228}$Th calibrations. In this work, we describe the calibration process and associated data analysis of the full GERDA dataset, tailored to preserve the excellent resolution of the individual germanium detectors when combining data over several years., Comment: 12 pages, 7 figures

Synaptotagmins confer calcium-dependence to the exocytosis of secretory vesicles, but how coexpressed synaptotagmins interact remains unclear. We find that synaptotagmin-1 and synaptotagmin-7 when present alone act as standalone fast and slow Ca2+-sensors for vesicle fusion in mouse chromaffin cells. When present together, synaptotagmin-1 and synaptotagmin-7 are found in largely non-overlapping clusters on dense-core vesicles. Synaptotagmin-7 stimulates Ca2+-dependent vesicle priming and inhibits depriming, and it promotes ubMunc13-2- and phorbolester-dependent priming, especially at low resting calcium concentrations. The priming effect of synaptotagmin-7 increases the number of vesicles fusing via synaptotagmin-1, while negatively affecting their fusion speed, indicating both synergistic and competitive interactions between synaptotagmins. Synaptotagmin-7 places vesicles in close membrane apposition (2+-dependent priming as a prelude to fast and slow exocytosis triggering.

The GERmanium Detector Array (GERDA) experiment searched for the lepton-number-violating neutrinoless double-$\beta$ ($0\nu\beta\beta$) decay of $^{76}$Ge, whose discovery would have far-reaching implications in cosmology and particle physics. By operating bare germanium diodes, enriched in $^{76}$Ge, in an active liquid argon shield, GERDA achieved an unprecedently low background index of $5.2\times10^{-4}$ counts/(keV$\cdot$kg$\cdot$yr) in the signal region and met the design goal to collect an exposure of 100 kg$\cdot$yr in a background-free regime. When combined with the result of Phase I, no signal is observed after 127.2 kg$\cdot$yr of total exposure. A limit on the half-life of $0\nu\beta\beta$ decay in $^{76}$Ge is set at $T_{1/2}>1.8\times10^{26}$ yr at 90% C.L., which coincides with the sensitivity assuming no signal., Comment: 7 pages, 3 figures, submitted to Physical Review Letters

Understanding how humans evaluate credibility is an important scientific question in the era of fake news. Source credibility is among the most important aspects of credibility evaluations. One of the most direct ways to understand source credibility is to use measurements of brain activity of humans performing credibility evaluations. Nevertheless, source credibility has never been investigated using such a method before. This article reports the results of an experiment during which we have measured brain activity during source credibility evaluation, using EEG. The experiment allowed for identification of brain areas that were active when a participant made positive or negative source credibility evaluations. Based on experimental data, we modeled and predicted human source credibility evaluations using EEG brain activity measurements with F1 score exceeding 0.7 (using 10-fold cross-validation).

Objectives The most common technique of determining biological paternity or another relationship among people are the investigations of DNA polymorphism called Fingerprinting DNA. The key concept of these investigations is the statistical analysis, which leads to obtain the likelihood ratio (LR), sometimes called the paternity index. Methods Among the different assumptions stated in these computations is a mutation model (this model is used for all the computations). Results and conclusions Although its influence on LR is usually negligible, there are some situations (when the mother–child mutation arises) when it is crucial.

Objective A resident-run minor surgery clinic was developed to increase resident procedural autonomy. We evaluated whether 1) there was a significant difference between complications and patient satisfaction when procedures were independently performed by surgical residents vs. a surgical attending and 2) if participation was associated with an increase in resident procedural confidence. Design Third year general surgery residents participated in a weekly procedure clinic from 2014-2018. Post-procedure complications and patient satisfaction were compared between patients operated on by residents vs. the staff surgeon. Residents were surveyed regarding their confidence in independently performing a variety of clinic-based patient care tasks. Setting Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Participants Post-graduate year three general surgery residents that ran the clinic as part of a general surgery rotation. Results 1230 patients underwent 1592 procedures (612 in resident clinic, 980 in attending clinic). There was no significant difference in the 30-day complication rate between patients operated on by the resident vs. attending (2.5% vs. 1.9%, p = 0.49). 459 patient satisfaction surveys were administered with a 79.1% response rate. There was no significant difference in the overall quality of care rating between residents and the attending surgeon (87.5% top-box rating vs. 93.1%, p = 0.15). Twenty-one residents completed both a pre- and post-rotation survey (77.8% response rate). The proportion of residents indicating that they could independently perform a variety of patient care tasks significantly increased across the rotation (all p Conclusion Mid-level general surgery residents can independently perform office-based procedures without detriment to safety or patient satisfaction. The resident-run procedure clinic serves as an environment for residents to grow in confidence in both technical and non-technical skills. Given the high rate at which patients provide resident feedback, future work may investigate how to best incorporate patient derived evaluations into resident assessment.

The functional consequences of the co-expression of synaptotagmin-1 and synaptotagmin-7 are unclear. We show that when present separately, synaptotagmin-1 and synaptotagmin-7 act as standalone fast and slow Ca2+-sensors for vesicle fusion in mouse chromaffin cells. When present together, synaptotagmin-7 stimulates Ca2+-dependent vesicle priming and inhibits depriming. The priming effect of Synaptotagmin-7 extends to the Readily Releasable Pool, whose fusion is executed by synaptotagmin-1, indicating synergistic action of the two Ca2+-sensors, although they are only partially colocalized. Synaptotagmin-7 promotes ubMunc13-2-dependent priming and the absence of synaptotagmin-7 renders phorbolesters less effective in stimulating priming, although synaptotagmin-7 independent priming is also observed. Morphologically, synaptotagmin-7 places vesicles in close membrane apposition (< 6 nm); in its absence vesicles accumulate out of reach of the fusion complex (20-40 nm). We suggest that a synaptotagmin-7-dependent movement toward the membrane is involved in Munc13-2/phorbolester/Ca2+-dependent priming and sets the stage for fast and slow exocytosis triggering.

Using the large database of STR (Short Tandem Repeat) DNA results of south-eastern Polish population were validated with regard to the correctness of data by testing the interdependence of loci and the Hardy-Weinberg hypothesis. It turned that the data was correct so that this topic was given up. Furthermore, dividing this population according to the place of birth, we evaluated the F ST , Nei’s distance value and other measures used in Phylogenetics, of the subpopulations chosen in that way. phylogenetic trees for this supopulation were obtained and the focus was made validation of hierarchical classifications. We evaluate classifications with the Dunn’s index, and compared the inter classifications using the cophenetic correlation of classifications. After comparing and validating the classification methods the behaviour of these distances was simulated in the following generations. We gathered information about migration (emigration as well as immigration) rate in the considered subpopulation. Therefore changes of phenotype frequencies could be simulated in the these generations based on some reasonable assumptions. On the basis of these simulated frequencies the future distance arrays were computed. If the maximum of this distance is smaller than the assumed level, we state that differences between the subpopulations vanish. We focus on the number of generations till all the differences vanish. It is worthwhile mentionary that the migrations in south-eastern Poland are significant, thus that number is relatively small.

The electrical and optoelectronic properties of nanometer-sized ZnO structures are highly influenced by its native point defects. Understanding and controlling these defects are essential for the development of high-performance ZnO-based devices. Here, an electrical device consisting of a polycrystalline ZnO-coated silica nanospring was fabricated and used to characterize the electrical and photoconductive properties of the ZnO layer using near-UV (405 nm) and sub-bandgap (532 and 633 nm) excitation sources. We observe a photocurrent response with all three wavelengths and notably with 532 nm green illumination, which is the energy associated with deep oxygen vacancies. The polycrystalline ZnO-coated silica nanospring exhibits a high responsivity of 1740 A W−1 with the 405 nm excitation source. Physical models are presented to describe the photocurrent rise and decay behavior of each excitation source where we suggest that the rise and decay characteristics are highly dependent on the energy of the excitation source and the trapping of electrons and holes in intermediate defect levels in the bandgap. The energy levels of the trap depths were determined from the photoconductive decay data and are matched to the reported energy levels of singly and doubly ionized oxygen vacancies. A phenomenological model to describe the dependence of the saturation photocurrent on excitation intensity is presented in order to understand the characteristics of the observed breaks in the slopes of the saturation photocurrent versus excitation intensity profile.

Background: Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73–94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. Design: Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss’ Kappa and Cohen’s Kappa equations were used to look at inter-rater variability. Results: When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss’ Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. Conclusions: Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.

Objectives The electroencephalographic signal is largely exposed to external disturbances. Therefore, an important element of its processing is its thorough cleaning. Methods One of the common methods of signal improvement is the independent component analysis (ICA). However, it is a computationally expensive algorithm, hence methods are needed to decrease its execution time. One of the ICA algorithms (fastICA) and parallel computing on the CPU and GPU was used to reduce the algorithm execution time. Results This paper presents the results of study on the implementation of fastICA, which uses some multi-core architecture and the GPU computation capabilities. Conclusions The use of such a hybrid approach shortens the execution time of the algorithm.

Introduction The Paris System (TPS) for Reporting Urinary Cytology (UCyto) was published in 2016, but to date, no study addressing the unsatisfactory (UNSAT) category has been published. We aimed to identify the negative predictive value (NPV) for UNSAT UCyto after the implementation of TPS at our institution. Method For the period from January 1, 2017, to December 31, 2019, we identified all cases with UNSAT diagnosis on UCyto specimens and available cytologic and/or surgical pathology follow-up within 6 months from the UNSAT diagnosis. Cases were deemed true negative (TN) if the follow-up was “negative for high-grade urothelial carcinoma” (NHGUC). Information regarding previous medical history, clinical indications, and specimen type were tabulated and analyzed. Results From 6348 UCyto specimens, there were 230 (3.6%) UNSAT diagnoses made on 209 patients (112 [53.6%] men and 97 [46.4%] women) with a median age of 64 years. Of these, 116 UCyto specimens from 106 patients, which had cytologic and/or surgical pathology follow-up within 6 months, were further studied. Most UNSAT UCyto specimens were bladder washing/barbotage (BW/BB), and the most common indication for UCyto was cancer surveillance. The main cause of UNSAT UCyto was low cellularity. There were 5 false-negative (FN) results for high-grade urothelial carcinoma (HGUC), which corresponds to an overall NPV of 84.4%. NPV was highest for patients with UCyto for hematuria, and for patients with BW/BB as UCyto specimen type. Conclusions Our results show that UNSAT diagnoses have a lower NPV than that typical of NHGUC diagnoses, and should be managed accordingly.

Introduction The Paris System for Reporting Urinary Cytology (TPS) was developed for standardization purposes and it placed an emphasis on screening for high-grade urothelial carcinoma (HGUC). Since then, it has shown to reduce atypia rates and better correlate with surgical specimens. The aim of this study was to calculate the negative predictive value (NPV) of urinary cytology for detecting HGUC using TPS and compare these data to our recently published pre-TPS cohort. As a screening test, it is imperative that TPS has a high NPV. Material and methods A search of our institution's pathology database for the term “negative for HGUC” from January 1, 2016, to December 31, 2017, was conducted. A true negative was defined as a patient with at least 1 subsequent negative urine cytology/surgical biopsy specimen or the patient being clinically negative for 6 months. NPV rates were calculated based on the data obtained. Results The cohort consisted of 2960 urine cytology specimens from 1894 patients. A total of 99 false negatives were identified, generating a NPV of 96.7% (2861/2960). This NPV is identical to our previously published pre-TPS cohort (years 2012-2013; NPV: 96.7%). The clinical indication most effected NPV, with a history of urothelial carcinoma with a NPV of 93.9% followed by hematuria at 98.9%. The atypia rate in years 2012-2013 was 8.2% and in 2016-2017 it was 5.7% (P Conclusions We demonstrate that TPS did not alter the NPV for detecting HGUC compared to our pre-TPS cohort. We believe that TPS is an effective reporting system for screening HGUC in urinary cytology.

We present the first search for bosonic superweakly interacting massive particles (super-WIMPs) as keV-scale dark matter candidates performed with the GERDA experiment. GERDA is a neutrinoless double-β decay experiment which operates high-purity germanium detectors enriched in Ge76 in an ultralow background environment at the Laboratori Nazionali del Gran Sasso (LNGS) of INFN in Italy. Searches were performed for pseudoscalar and vector particles in the mass region from 60 keV/c2 to 1 MeV/c2. No evidence for a dark matter signal was observed, and the most stringent constraints on the couplings of super-WIMPs with masses above 120 keV/c2 have been set. As an example, at a mass of 150 keV/c2 the most stringent direct limits on the dimensionless couplings of axionlike particles and dark photons to electrons of gae<3×10−12 and α′/α<6.5×10−24 at 90% credible interval, respectively, were obtained.

We present the first search for bosonic superweakly interacting massive particles (super-WIMPs) as keV-scale dark matter candidates performed with the GERDA experiment. GERDA is a neutrinoless double-s decay experiment which operates high-purity germanium detectors enriched in ^{76}Ge in an ultralow background environment at the Laboratori Nazionali del Gran Sasso (LNGS) of INFN in Italy. Searches were performed for pseudoscalar and vector particles in the mass region from 60 keV/c^{2} to 1 MeV/c^{2}. No evidence for a dark matter signal was observed, and the most stringent constraints on the couplings of super-WIMPs with masses above 120 keV/c^{2} have been set. As an example, at a mass of 150 keV/c^{2} the most stringent direct limits on the dimensionless couplings of axionlike particles and dark photons to electrons of g_{ae}

Objective Neonatal orthotopic heart transplantation was introduced in the 1980s as a treatment for complex congenital heart disease. Progress in single-ventricle palliation and biventricular correction has resulted in a decline in neonatal heart transplant volume. However, limited reports on neonatal heart transplants have demonstrated favorable outcomes. We report the long-term outcomes of patients with neonatal heart transplants at our institution spanning nearly 30 years. Methods A retrospective analysis of neonatal heart transplants and neonates listed for transplant was performed at Children's Hospital Colorado. Primary outcomes were early and late survival. Secondary outcomes were rejection episodes, retransplantation, and development of cardiac allograft vasculopathy or post-transplant lymphoproliferative disease. Results A total of 21 neonates underwent orthotopic heart transplantation at our institution. Among these, 10 neonates were transplanted from 1991 to 2000, 8 neonates were transplanted from 2001 to 2010, and 3 neonates were transplanted from 2011 to 2020. The average age of these patients was 17 days, and the average weight was 3.43 kg. Early survival was 95.2%. Survival at 1 and 5 years was 85.7% (confidence interval [CI], 61.9%-95.2%) and 75% (CI, 45.6%-85.5%), respectively. Of eligible patients, the 10-year and 20-year survival was 72.2% (CI, 45.1%-85.3%) and 50% (CI, 25.9%-70.1%), respectively. Conclusions Our institution reports favorable outcomes of neonatal heart transplantation. These results should be considered within the context of outcomes for patients awaiting transplant and the limited donor availability. However, the successful nature of these procedures suggest it may be necessary to reevaluate the indications for neonatal heart transplantation, particularly where risk of mortality and morbidity with palliative or corrective surgery is high.

We report on an improved measurement of the $^8$B solar neutrino interaction rate with the Borexino experiment at the Laboratori Nazionali del Gran Sasso. Neutrinos are detected via their elastic scattering on electrons in a large volume of liquid scintillator. The measured rate of scattered electrons above 3 MeV of energy is $0.223\substack{+0.015 \\ -0.016}\,(stat)\,\substack{+0.006 \\ -0.006}\,(syst)$ cpd/100 t, which corresponds to an observed solar neutrino flux assuming no neutrino flavor conversion of $\Phi\substack{\rm ES \\ ^8\rm B}=2.57\substack{+0.17 \\ -0.18}(stat)\substack{+0.07\\ -0.07}(syst)\times$10$^6$ cm$^{-2}\,$s$^{-1}$. This measurement exploits the active volume of the detector in almost its entirety for the first time, and takes advantage of a reduced radioactive background following the 2011 scintillator purification campaign and of novel analysis tools providing a more precise modeling of the background. Additionally, we set a new limit on the interaction rate of solar $hep$ neutrinos, searched via their elastic scattering on electrons as well as their neutral current-mediated inelastic scattering on carbon, $^{12}$C($\nu,\nu'$)$^{12}$C* ($E_{\gamma}$= 15.1 MeV).

Understanding how humans evaluate credibility is an important scientific question in the era of fake news. Source credibility is among the most important aspects of credibility evaluations. One of the most direct ways to understand source credibility is to use measurements of brain activity of humans who make credibility evaluations. Nevertheless, source credibility has never been investigated using such a method before. This article reports the results of an experiment during which we have measured brain activity during source credibility evaluation using EEG. The experiment allowed for identification of brain areas that were active when a participant made positive or negative source credibility evaluations. Based on experimental data, we modelled and predicted human source credibility evaluations using EEG brain activity measurements with F1 score exceeding 0.7 (using 10-fold cross-validation).

The Borexino detector at Gran Sasso has now accumulated over ten years of continuous data which represent a magnificent opportunity to study the cosmic muon flux at a deep underground location. We present here a precision measurement of the flux and of the expected seasonal modulation. We present the correlation with the atmospheric temperature variations from global atmospheric models. We measure the correlation parameters and infer the kaon-to-pion ratio in the production of cosmic muons from high energy primaries. We also find evidence of a long term modulation that is not present in the atmospheric data and we investigate a possible positive correlation with the solar activity. Finally we observe a seasonal modulation of the production rate of cosmogenic neutrons that is in phase with the muon modulation but shows a surprisingly larger amplitude.

The Borexino liquid scintillator neutrino observatory has a unique capability to perform high-precision solar neutrino observations thanks to its exceptional radiopurity and good energy resolution (5% at 1 MeV). A comprehensive study of the pp-chain neutrinos was presented that includes the direct measurements of 7Be, pp and pep neutrino fluxes with the highest precision ever achieved (down to 2.8% in the 7Be component), the 8B with the lowest energy threshold, the best limit on CNO neutrinos and the first Borexino limit on hep neutrinos. These results are important to validate the MSW-LMA oscillation paradigm across the full solar energy range and to exclude possible Non-Standard neutrino Interactions (NSIs). In particular the effects of neutrino-flavor-diagonal Neutral-Current (NC) interactions that modify the vee and vτe couplings while preserving their chiral and flavor structures, have been investigated. At detection, the shape of the electron-recoil spectrum is affected by changes in the vee and vτe couplings, quantified by the parameters ε e L / R and ε τ L / R . New bounds to all four parameters were obtained, quite stringent compared to the global ones. In particular, the best constraint to-date on ε e L was achieved. A comprehensive summary of all the recent results on solar neutrinos from Borexino is reported in the present paper.

We reanalize data collected with the DarkSide-50 experiment and recently used to set limits on the spin-independent interaction rate of weakly interacting massive particles (WIMPs) on argon nuclei with an effective field theory framework. The dataset corresponds to a total (16660 $\pm$ 270) kg d exposure using a target of low-radioactivity argon extracted from underground sources. We obtain upper limits on the effective couplings of the 12 leading operators in the nonrelativistic systematic expansion. For each effective coupling we set constraints on WIMP-nucleon cross sections, setting upper limits between $2.4 \times 10^{-45} \, \mathrm{cm}^2$ and $2.3 \times 10^{-42} \, \mathrm{cm}^2$ (8.9 $\times 10^{-45} \, \mathrm{cm}^2$ and 6.0 $\times 10^{-42} \, \mathrm{cm}^2$) for WIMPs of mass of 100 $\mathrm{GeV/c^2}$ (1000 $\mathrm{GeV/c^2}$) at 90\% confidence level., Accepted by PRD

Borexino is a 280-ton liquid scintillator detector located at the Laboratori Nazionali del Gran Sasso (LNGS), Italy and is one of the two detectors that has measured geoneutrinos so far. The unprecedented radio-purity of the scintillator, the shielding with highly purified water, and the placement of the detector at a 3800 m w.e. depth have resulted in very low background levels and has made Borexino an excellent apparatus for geoneutrino measurements. The new update of the Borexino geoneutrino measurement, using the data obtained from December 2007 to April 2019, has been presented. Enhanced analysis techniques, adopted in this measurement, have been also presented (poster presentation #39 by S. Kumaran). The updated statistics and the new elaborate analysis have led to more than a factor two increase in exposure ((1.12 ± 0.05) × 1032 protons × yr) when compared to the latest Borexino result from 2015. The resulting geoneutrino signal of 47.0 − 7.7 + 8.4 ( stat ) − 1.9 + 2.4 ( sys ) TNU has − 17.2 + 18.3 % total precision. The geological interpretations of this measurement have been discussed. In particular, the 99% C.L. observation of the mantle signal by exploiting the relatively well-known lithospheric contribution, the estimation of the radiogenic heat, as well as the comparison of these results to the predictions based on different geological models. The upper limits on the power of a hypothetical georeactor that might be present at different locations inside the Earth have been set.

In the Internet era, understanding why humans find messages from unknown receivers credible (such as fake news) is an important research topic. Message credibility is an important theoretical aspect of credibility evaluation that relies only on message contents and design. For the first time in the field, we study message credibility by directly measuring brain activity of humans who make credibility evaluations in an experiment that controls message design. Brain activity as measured using EEG is used to investigate areas of the brain involved in message credibility evaluation. We also model and predict human message credibility evaluations using EEG brain activity measurements.

Erythropoietin (EPO), named after its role in hematopoiesis, is also expressed in mammalian brain. In clinical settings, recombinant EPO treatment has revealed a remarkable improvement of cognition, but underlying mechanisms have remained obscure. Here, we show with a novel line of reporter mice that cognitive challenge induces local/endogenous hypoxia in hippocampal pyramidal neurons, hence enhancing expression of EPO and EPO receptor (EPOR). High-dose EPO administration, amplifying auto/paracrine EPO/EPOR signaling, prompts the emergence of new CA1 neurons and enhanced dendritic spine densities. Single-cell sequencing reveals rapid increase in newly differentiating neurons. Importantly, improved performance on complex running wheels after EPO is imitated by exposure to mild exogenous/inspiratory hypoxia. All these effects depend on neuronal expression of the Epor gene. This suggests a model of neuroplasticity in form of a fundamental regulatory circle, in which neuronal networks—challenged by cognitive tasks—drift into transient hypoxia, thereby triggering neuronal EPO/EPOR expression., EPO treatment improves cognition, but underlying mechanisms were unknown. Here the authors describe a regulatory loop in which brain networks challenged by cognitive tasks drift into functional hypoxia that drives—via neuronal EPO synthesis—neurodifferentiation and dendritic spine formation.

This chapter focuses on using an algorithmic approach to reporting negative findings in serous fluids, rather than providing detailed morphologic descriptions of benign entities. Specimens may be negative for malignancy (NFM) and yet be pathologic, but most serous fluids are collected to screen for primary or metastatic neoplasia. This chapter provides report examples for pathologic entities that do not represent atypical or malignant processes.

Borexino is a 280-ton liquid scintillator detector located at the Laboratori Nazionali del Gran Sasso (LNGS), Italy and is one of the two detectors that has measured geoneutrinos so far. The unprecedented radio-purity of the scintillator, the shielding with highly purified water, and the placement of the detector at a 3800 m w.e. depth have resulted in very low background levels and have made Borexino an excellent apparatus for geoneutrino measurements. The analysis techniques of the latest geoneutrino results with Borexino were presented using the data obtained from December 2007 to April 2019, corresponding to an exposure of (1.12 ± 0.05) × 1032 protons × yr. Enhanced analysis techniques, such as an increased fiducial volume, improved veto for cosmogenic backgrounds, extended energy and coincidence time windows, as well as a more efficient α/β particle discrimination have been adopted in this measurement. The updated statistics and these elaborate resulted in a geoneutrino signal of 47.0 − 7.7 + 8.4 ( stat ) − 1.9 + 2.4 ( sys ) TNU with − 17.2 + 18.3 % total precision.

Dopamine controls striatal circuit function, but its transmission mechanisms are not well understood. We recently showed that dopamine secretion requires RIM, suggesting that it occurs at active zone-like sites similar to conventional synapses. Here, we establish using a systematic conditional gene knockout approach that Munc13 and Liprin-α, active zone proteins for vesicle priming and release site organization, are important for dopamine secretion. Correspondingly, RIM zinc finger and C2B domains, which bind to Munc13 and Liprin-α, respectively, are needed to restore dopamine release in RIM knockout mice. In contrast, and different from conventional synapses, the active zone scaffolds RIM-BP and ELKS, and the RIM domains that bind to them, are expendable. Hence, dopamine release necessitates priming and release site scaffolding by RIM, Munc13, and Liprin-α, but other active zone proteins are dispensable. Our work establishes that molecularly simple but efficient release site architecture mediates fast dopamine exocytosis.

Intraoperative adverse events (iAEs) are defined as inadvertent injuries that occur during an operation and are associated with increased mortality, morbidity, and health care costs. We sought to study the impact of attending surgeon experience as well as resident training level on the occurrence of iAEs.The institutional American College of Surgeons-National Surgical Quality Improvement Program and administrative databases for abdominal surgeries were linked and screened for iAEs using the International Classification of Diseases, Ninth Revision, Clinical Modification-based Patient Safety Indicator "accidental puncture/laceration." Each flagged record was systematically reviewed to confirm iAE occurrence and determine the number of years of independent practice of the attending surgeon and the postgraduate year (PGY) of the assisting resident at the time of the operation. The attending surgeon experience was divided into quartiles (6 years, 6-13 years, 13-20 years,20 years). The resident experience level was defined as Junior (PGY-1 to PGY-3) or Senior (PGY-4 or PGY-5). Univariate/bivariate then multivariable logistic regression analyses adjusting for patient demographics, comorbidities, and operation type and/or complexity (using RVUs as a proxy) were performed to assess the independent impact of resident and attending surgeon experience on the occurrence of iAEs.A large tertiary care teaching hospital.Patients included in the 2007-2012 ACS-NSQIP that had an abdominal surgery performed by both an attending surgeon and a resident.A total of 7685 operations were included and iAEs were detected in 159 of them (2.1%). Junior residents participated in 1680 cases (21.9%), while senior residents were involved in 6005 (78.1%). The iAE rates for attending surgeons with6, 6-13, 13-20, and20 years of experience were 2.7%, 1.7%, 2.4%, and 1.4%, respectively. In multivariable analyses, the risk of occurrence of an iAE was significantly decreased for surgeons with20 years of experience compared to those with6 years of experience (odds ratio=0.52, 95% confidence interval 0.32-0.86, p = 0.011). On bivariate analyses, iAEs occurred in 1.2% of junior resident cases, while senior residents had an iAE rate of 2.3%. However, after risk adjustment on multivariable analyses, the resident experience level did not significantly impact the rate of iAEs.The surgeon's level of experience, but not the resident's, is associated with the occurrence of iAEs in abdominal surgery. Efforts to improve patient safety in surgery should explore the value of pairing junior surgeons with the more experienced ones thru formalized coaching programs, rather than focus on curbing resident operative autonomy.

The expansion and structural parameters for a series of crosslinked porous polymers are discussed during their swelling. In the study, commercial Amberlite XAD2, XAD4 XAD16 and XAD7HP resins of varying porosity and polarity were used as model polymers. Videomicroscopy LM is combined with in-situ strain-stress measurements during the process of wetting the polymer with ethanol. The force exerted by the expansion of the spherical polymer particle due to swelling reflects the structural properties of the polymer and is related to the total porosity of a given type of polymer matrix. The pore structure of the samples was characterized by liquid nitrogen adsorption and their swelling degree was assessed by light microscopy. The deswelling curves, represented by strain-stress curves, are stepped for polymers of lower porosity; the first step represents the evacuation of the solvent from the pores. This process is regulated by the external pore openings in a particle; the second, elongated step on the deswelling curve represents the evaporation of the solvent from the polymer network.

Objective To describe inpatient satisfaction with surgical resident care given the increasing importance of patient satisfaction as a quality metric. Design Surgical inpatients were invited to complete a survey that addressed their satisfaction with and attitudes regarding surgical resident care. The survey was based on the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS). Patients were required to positively identify photos of resident physicians prior to providing ratings. Adapted S-CAHPS items were scored using the “top-box” method. Setting Massachusetts General Hospital, a tertiary academic center. Participants General surgery inpatients recovering from elective, major abdominal surgery were recruited on postoperative days 2 to 4. Results Ninety-one percent of approached patients participated (102/112, mean age = 62.9, 51.6% male). Patients positively identified both seniors and interns 88% of the time. Thirteen seniors and 19 interns were rated, with 1 to 14 evaluations per trainee. Overall quality of care ratings for seniors and interns were 9.35 and 9.09, respectively (0-10 scale, 10 = “best possible care”). Sixty-three percent of senior resident evaluations and 60% of intern evaluations received a score of 10. The proportion of residents receiving top-box scores ranged from 59.5% to 97.7% depending on the item. Forty percent of senior resident and 38% of intern evaluations received top-box scores for all 8 items. Over 96% of patients reported strong or moderate agreement with the statements “I feel it is important to help in the education of future surgeons.” Conclusions Surgical inpatients willingly completed ratings about their surgery residents, typically can recognize their resident physicians, and rate quality of care highly. Despite many high ratings, there is room for improvement in some S-CAHPS domains. These results indicate patients are a valuable source of feedback regarding a resident's progress in several core competencies such as interpersonal skills, communication, professionalism, and patient care.