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To compare the efficacy of 2 equine-origin antivenom products on correction of coagulation abnormalities noted on thromboelastography (TEG) caused by Crotalus atrox venom in vitro.Prospective in vitro controlled study.Veterinary teaching hospital.Six healthy dogs.Blood from each dog was used for 4 separate kaolin-activated TEG analyses: A negative control (blood-saline) and positive control (blood-Crotalus atrox venom) were used to assess the dog's normal coagulation and the effect of venom on TEG parameters. Thromboelastographic analyses were then run with blood, venom, and either Argentinian or North American antivenom. All TEG analyses from each dog were compared for efficacy.The mean R values between the North American antivenom and negative controls were not significantly different (P = 0.681), but were significantly different (P = 0.024) between the Argentinian antivenom and negative controls. The mean fibrinolysis values measured 30 minutes after maximum amplitude achieved between the North American antivenom and negative controls were not significantly different (P = 0.198), but were significantly different (P 0.001) between the Argentinian antivenom and negative controls. The mean K values between the Argentinian antivenom and negative controls were not significantly different (P = 0.274), but were significantly different (P = 0.043) between the North American antivenom and negative controls.The North American antivenom normalized time to clot formation and fibrinolysis, while the Argentinian antivenom normalized rate of clot formation. Further studies in naturally envenomated patients are necessary to determine if these in vitro results would translate into different clinical outcomes.

BACKGROUND: Forensic interviewers are taught to ask children invitations using the word “time” to refer to a specific episode (e.g., “Tell me about the last time he touched you.”). However, children may interpret the word “time” as requesting conventional temporal information rather than narrative information. OBJECTIVE: We examined the rates at which children misinterpreted invitations containing the word “time,” comparing invitations asking “about” an episode to invitations asking what “happened” during an episode. PARTICIPANTS: This study examined 827 forensic interviews of children aged 4 to 15 (M(age) = 8.1 years) in cases of suspected sexual abuse. METHODS: We identified 1405 invitations using the word “time,” and coded them for whether they asked “about” or what “happened.” Children’s responses were coded for whether they gave exclusively conventional temporal information, expressed temporal ignorance or uncertainty, requested clarification, or gave a don’t know response. RESULTS: Children responded to About invitations with higher rates of conventional temporal information (11%) than Happened invitations (6%, p < .001). Children were also more inclined to express uncertainty about temporal information when asked About invitations (p = .04). In a third of the cases where children exhibited misunderstanding, interviewers failed to clarify their intentions. CONCLUSIONS: Forensic interviewers can reduce children’s unresponsiveness to invitations by using Happened invitations that overcome the ambiguity associated with “time.”

Forensic interviewers are routinely advised to instruct children that they should indicate when they do not understand a question. This study examined whether administering the instruction with a practice question may help interviewers identify the means by which individual children signal incomprehension. We examined 446 interviews with children questioned about abuse, including 252 interviews in which interviewers administered the instruction with a practice question (4- to 13-year-old children; Mage = 7.7). Older children more often explicitly referred to incomprehension when answering the practice question and throughout the interviews, whereas younger children simply requested repetition or gave “don’t know” responses, and individual children’s responses to the practice questions predicted their responses later in the interviews. Similarly, older children were more likely to seek confirmation of their understanding of interviewers’ questions and to request specification. The results highlight the need for interviewers to test and closely monitor younger children’s responses for ambiguous signs of incomprehension.

Spontaneous extrusion of a kidney stone is an extremely rare event with few reported cases. We present the unusual case of a 62-year-old female who presented with worsening of fever and flank pain over a 5 day period. Imaging revealed retroperitoneal and abdominal wall abscesses that upon evaluation of prior imaging were attributed to spontaneously extruded kidney stones. Prior reports suggest surgical exploration and extraction is the preferred treatment option for extruded renal calculi. Based on the experience presented here, conservative management may be an attractive first-line treatment option for patients with extruded renal stones and associated retroperitoneal abscesses.

Children’s ability to adequately describe clothing placement is essential to evaluating their allegations of sexual abuse. Intermediate clothing placement (partially removed clothing) may be difficult for young children to describe, requiring more detailed explanations to indicate the location of clothing (e.g., the clothes were pulled down to the knees). The current study investigated 172 3- to 6-year-olds’ descriptions of clothing placement when responding to commonly used questions ( yes/no, forced-choice, open-choice, where), as well as children’s on-off response tendencies when describing intermediate placement (i.e., labeling the clothing as fully on or off). Results revealed that where questions were superior in eliciting intermediate descriptions, even for the youngest children. Children sometimes exhibited tendencies to describe intermediate placements as “on” or “off,” which varied by question-type and clothing placement. The implications of the findings for interviewing young children about sexual abuse are discussed.

To validate published risk criteria for informing use of neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC), and to examine outcomes of low-risk (LR) patients treated with immediate radical cystectomy (RC). We identified 1931 patients who underwent RC for MIBC from 1980 to 2016. Patients were considered high risk (HR) with hydronephrosis, lymphovascular invasion, variant histology and/or cT3/4 disease. Kaplan–Meier survival estimates were compared to patients classified as LR, and logistic regression was used to examine factors associated with pathologic downstaging. A total of 1025 LR and 906 HR patients were identified. Median follow-up was 6.3 years (IQR 2.6–12), during which time 1321 (68%) patients died, 753 (39%) from bladder cancer. HR patients had significantly lower 5-year CSS than LR patients (50% vs. 68%, p = 0.001). Of 561 cisplatin-eligible LR patients treated with RC without NAC, 293 (52%) had pathologic non-organ confined disease; of these, 81 (14%) received adjuvant chemotherapy; 78 (14%) did not due to a perioperative event, while 134 (24%) did not due to patient/provider choice. NAC in LR patients was associated with greater odds of pT0 (OR 3.05; p

Objective To determine the influence of propofol or methohexital, with and without doxapram, on the examination of laryngeal function in dogs. Study design Experimental study. Animals Forty healthy dogs randomly assigned to 4 groups: propofol with saline (n = 10), propofol with doxapram (n = 10), methohexital with saline (n = 10), or methohexital with doxapram (n = 10). Methods Propofol and methohexital were administered to effect. Investigators examined laryngeal function (initial) simultaneously with video laryngoscopy. Doxapram or saline was administered, and laryngeal function was reevaluated (second). Laryngeal motion, quality of laryngeal exposure, and the degree of swallowing, laryngospasm, and jaw tone were scored at each evaluation. Adverse events were recorded. Initial and second videos were evaluated by a masked observer, and still images obtained from both evaluations were evaluated for change in rima glottidis size by 2 masked observers. Results Administration of doxapram and saline was delayed with propofol (P = .001). Laryngeal function did not differ between dogs receiving propofol or methohexital, irrespective of doxapram administration. Doxapram improved breathing scores in both groups (P

We investigated the incidence and survival impact of symptomatic venous thromboembolism after nephrectomy with inferior vena cava tumor thrombectomy.We retrospectively reviewed the records of 183 patients who underwent nephrectomy with inferior vena cava tumor thrombectomy (level I-IV) for renal cell carcinoma between 2000 and 2010. Postoperative venous thromboembolism was defined as symptomatic bland thrombus or embolism confirmed on imaging. The cumulative incidence of venous thromboembolism was estimated by the Kaplan-Meier method. Associations of clinicopathological features with time to thromboembolism after surgery and all cause mortality were evaluated on multivariable analysis with Cox models.Symptomatic venous thromboembolism developed in 55 patients a median of 23 days (IQR 5-142) postoperatively, including pulmonary thrombosis in 24, deep venous thrombosis in 17, bland inferior vena cava thrombosis in 13 and portal vein thrombosis in 1. The cumulative incidence of thromboembolism 30, 90 and 365 days following surgery was 17%, 22% and 27%, respectively. A history of smoking (HR 2.15, 95% CI 1.09-4.24, p = 0.028), ECOG (Eastern Cooperative Oncology Group) performance status 1 or greater (HR 2.15, 95% CI 1.17-3.93, p = 0.013), hypercoagulability disorder (HR 5.12, 95% CI 1.93-13.59, p = 0.001) and bulky lymphadenopathy at surgery (HR 4.84, 95% CI 1.87-12.51, p = 0.001) was significantly associated with an increased risk of venous thromboembolism on multivariable analysis. Postoperative venous thromboembolism was significantly associated with an increased risk of all cause mortality (HR 1.53, 95% CI 1.04-2.23, p = 0.029).Venous thromboembolism after nephrectomy and tumor thrombectomy is common within 90 days of surgery. Symptomatic venous thromboembolism in this population is independently associated with a greater risk of mortality.

Kidney disease is common among captive cheetahs ( Acinonyx jubatus). Serum creatinine is the most common measurement to estimate glomerular filtration rate (GFR) because of the ease of its clinical use, but it is a crude estimate that only increases after significant disease is already present and is affected by extrarenal factors. Symmetric dimethylarginine (SDMA) is a renal biomarker in humans, dogs, and cats that correlates with serum creatinine and GFR and appears to be an earlier and more specific biomarker for kidney disease. Ninety-two banked serum samples from 11 cheetahs housed at the Oklahoma City Zoo from 1992 to 2012 were retrospectively analyzed. Histopathology results were available for 10/11 cheetahs, and all 10 had histologic renal lesions. General categories of renal lesions included glomerulosclerosis (7/10; 70%), amyloidosis (7/10; 70%), inflammatory (9/10; 90%), and oxalate nephrosis (2/10; 20%). SDMA immunoassay and mass spectrometry were measured for validation and compared with creatinine to assess for correlation. Serum creatinine concentrations were determined by enzymatic colorimetric methods. SDMA immunoassay was validated in cheetahs and correlated well with serum creatinine ( R

The current study tested the effects of two interview techniques on children's report productivity and accuracy following exposure to suggestion: implicit encouragement (backchanneling, use of children's names) and the putative confession (telling children that a suspect "told me everything that happened and wants you to tell the truth"). One hundred and forty-three, 3–8-year-old children participated in a classroom event. One week later, they took part in a highly suggestive conversation about the event and then a mock forensic interview in which the two techniques were experimentally manipulated. Greater use of implicit encouragement led to increases, with age, in children's narrative productivity. Neither technique improved or reduced children's accuracy. No increases in errors about previously suggested information were evident when children received either technique. Implications for the use of these techniques in child forensic interviews are discussed.

An 8-year-old, intact female, mixed-breed dog presented to the Oklahoma State University Boren Veterinary Medical Teaching Hospital for evaluation of progressive lameness and joint effusion of multiple joints. Physical examination revealed joint effusion of the elbow, hock, and stifle joints bilaterally, enlarged left axillary and right popliteal lymph nodes, a subcutaneous mass over the left elbow, and a subcutaneous mass involving the left second and third mammary glands. Cytologic examination of the mammary mass, enlarged lymph nodes, and joint fluid from most affected joints revealed a monomorphic population of loosely cohesive neoplastic epithelial cells. The patient was humanely euthanized, and subsequent necropsy with histopathologic examination revealed a complex mammary carcinoma with metastases to enlarged lymph nodes, subcutaneous tissue over the left elbow, and the synovium of multiple joints. Immunohistochemical stains were performed and showed diffusely positive pan cytokeratin, CK8/18, and CK19 staining in the neoplastic luminal epithelial cells of the mammary carcinoma, synovium, and lymph nodes, and showed diffusely positive vimentin staining of the myoepithelial cells. Myoepithelial calponin positivity was diffuse in the mammary mass and lymph nodes but minimal in the synovium. Only the mammary mass showed p63 positivity. Metastatic mammary neoplasia is relatively common in dogs; however, metastasis to the synovium has only been reported once previously in the literature. This is the first case utilizing immunohistochemistry for confirmation and characterization of metastases.

This study examined the utility of two interview instructions designed to overcome children’s reluctance to disclose transgressions: eliciting a promise from children to tell the truth and the putative confession (telling children that a suspect “told me everything that happened and wants you to tell the truth”). The key questions were whether the instructions increased disclosure in response to recall questions and in response to recognition questions that were less or more explicit about transgressions, and whether instructions were differentially effective with age. Two-hundred and seventeen 4- to 9-year-old maltreated and comparable non-maltreated children played with a stranger. This included playing with a set of toys. For half of the children within each group, two of the toys appeared to break while they were playing. The stranger admonished secrecy. Shortly thereafter, children were questioned about what happened in one of the three interview conditions. Some children were asked to promise to tell the truth. Others were given the putative confession, and still others received no interview instructions. When coupled with recall questions, the promise was only effective at increasing disclosures among older children, whereas the putative confession was effective regardless of age. Across interview instruction conditions, recognition questions that did not suggest wrongdoing elicited few additional transgression disclosures; recognition questions that explicitly mentioned wrongdoing elicited some true reports but also some false alarms. No differences in disclosure emerged between maltreated and non-maltreated children. Results highlight the potential benefits and limitations of different interviewing approaches when questioning reluctant children.

When interviewing a child who may have witnessed a crime, the interviewer must ask carefully directed questions in order to elicit a truthful statement from the child. The presented work uses Granger causal analysis to examine and represent child–interviewer interaction dynamics over such an interview. Our work demonstrates that Granger Causal analysis of psycholinguistic and acoustic signals from speech yields significant predictors of whether a child is telling the truth, as well as whether a child will disclose witnessing a transgression later in the interview. By incorporating cross-modal Granger causal features extracted from audio and transcripts of forensic interviews, we are able to substantially outperform conventional deception detection methods and a number of simulated baselines. Our results suggest that a child’s use of concreteness and imageability in their language are strong psycholinguistic indicators of truth-telling and that the coordination of child and interviewer speech signals is much more informative than the specific language used throughout the interview.

Although in recent years it has become a bit easier to discuss mental health challenges in public, mental illness is still somehow viewed by many in the public as a moral failing. It is that underlying judgement, that unwillingness to look at the many sources that leads to profound misunderstandings by the public, particularly in the context of a criminal trial. In this article I examine these issues in that context in order to better identify, and come to a better understanding of where our shared biases get in the way of a reasoned view of such evidence. The article examines some broad policy questions regarding what we, as a society, do with our mentally ill, and then looks at public perceptions and their impact on criminal justice decision making.

Children's potential confusion between "ask" and "tell" can lead to misunderstandings when child witnesses are asked to report prior conversations. The verbs distinguish both between interrogating and informing, and between requesting and commanding. Children's understanding was examined using both field (Study 1) and laboratory methods (Studies 2-4). Study 1 examined 100 5- to 12-year-olds' trial testimony in child sexual abuse cases, and found that potentially ambiguous use of ask and tell was common, typically found in yes-no questions that elicited unelaborated answers, and virtually never clarified by attorneys or child witnesses. Studies 2 to 4 examined 345 maltreated 6- to 11-year-olds' understanding of ask and tell. The results suggest that children initially comprehend telling as saying, and thus believed that asking is a form of telling. As such, they often endorsed asking as telling when asked yes-no questions, but distinguished between asking and telling when explicitly asked to choose. Their performance was impaired by movement between different use of the words. Child witnesses' characterization of their conversations can easily be misconstrued by the way in which they are questioned, leading questioners to misinterpret whether they were coached by disclosure recipients or coerced by abuse suspects. (PsycINFO Database Record

Prior research documents a negative aggregate earnings-returns relation. In contrast, we posit that the sign of the relation varies, depending upon the macroeconomic and financial market conditions that exist in the earnings announcement quarter. We argue that the existing macroeconomic and financial market conditions influence market participants’ frame of reference, which in turn affects whether they interpret aggregate earnings surprises to be informative about the expected inflation component of the discount rate, the market risk premium component of the discount rate, or aggregate future cash flows. Consistent with this, we find that the sign of the aggregate earnings-returns relation changes numerous times across our sample period. We also find that market participants interpret aggregate earnings to be informative about changes in expected inflation (market risk premium) when the sign of the aggregate earnings-returns relation is negative (positive). Finally, we identify macroeconomic and financial market conditions under which the aggregate earnings-returns relation is more (less) likely to be negative (positive).

Ross Cheit’s book The Witch-Hunt Narrative highlights the difficulties of prosecuting child sexual abuse. Drawing examples from a single case, Alex A., we examine the ways in which false acquittals of sexual abuse are likely to occur. First, prosecutors tend to question children in ways that undermine their productivity and credibility. Second, prosecutors have difficulty in explaining to juries the dynamics of sexual abuse and disclosure, making children’s acquiescence to abuse and their failure to disclose when abuse first occurs incredible. Third, attorneys undermine children’s credibility by pushing them to provide difficult to estimate temporal and numerical information. A post-script to the Alex A. case illustrates the costs of wrongful acquittals.

Previous research has examined young and middle-aged adults' perceptions of child witnesses; however, no research to date has examined how potential older adult jurors may perceive a child witness. The present investigation examined younger (18-30 years, N = 100) and older adults' (66-89 years, N = 100) lie-detection and credibility judgments when viewing children's truthful and dishonest reports. Participants viewed eight child interview videos where children (9 to 11 years of age) either provided a truthful report or a coached fabricated report to conceal a transgression. Participants provided lie-detection judgments following all eight videos and credibility assessments following the first two videos. Participants completed a General Lifespan Credibility questionnaire to assess credibility evaluations across various witness ages. Lie-detection results indicated that older adults had significantly lower discrimination scores, a stronger truth bias, and greater confidence compared to younger adults. Older adults also rated children as more competent to testify in court, credible, honest, believable, and likeable than younger adults. Participants with greater differences in their credibility evaluations for truth and lie-tellers were significantly more accurate at detecting lies. Responses to the Lifespan Credibility questionnaire revealed significant differences in younger and older adults' credibility evaluations across the lifespan.

In recent years, evidence has emerged to suggest that many developmental and physiological processes in plants, including the hypersensitive response (HR) to pathogen attack, involve programmed cell death (PCD) similar to apoptosis in animals. Morphological features of apoptosis, such as membrane bleb-bing, chromatin condensation and DNA cleavage, can be observed in the HR. Changes in gene transcription, protein phosphorylation, the oxidative burst, ion fluxes and lipid-based signalling are detected at early stages of PCD in both animals and plants. Furthermore, sequencing projects are revealing plant genes with intriguing similarities to apoptosis-related animal genes. In animals, specific cysteine proteases, termed caspases, are involved in the execution phase of apoptosis. Although cysteine proteases appear to have a role in plant PCD, and at least one of the targets of caspases, poly (ADP-ribose) polymerase, is cleaved during the HR, caspase-encoding genes have not yet been identified in plants. Moreover, a role for the mitochondrion, central in either regulating or effecting apoptosis in animals, has yet to emerge in plant PCD. Evidence exists for more ancient PCD mechanisms than those executed by caspases, and these may ultimately be what is evolutionarily conserved between plants and animals.

We propose that young children exhibit an order of encoding bias, such that they are inclined to report or act out events in the order in which they were originally encoded. This bias helps to explain why children assume that events they first hear described are in chronological order and why they often appear to understand “after” better than “before” when they are questioned about experienced events. Asking children about a sequence of events as a whole (in particular using “first”) could avoid order of encoding biases, because children would not have to answer questions about events within the sequence. In the present study, 100 2- to 4-year-old children participated in creating simple stories in which a story child interacted with five objects, thus creating five unrelated events. Children then responded to questions asking them to identify which action occurred “before” and “after” the third event and which action occurred “first” and “last” in the story. We hypothesized that (1) children would exhibit a tendency to answer “before” and “after” questions with the event that occurred after the queried event, thus impairing performance on “before” questions; (2) children would respond more accurately to questions about what occurred “first” and “last” than to questions about “before” and “after”; (3) children would respond more accurately to questions about “first” than questions about “last,” and (4) children’s performance would improve with age. The hypotheses were supported. Critically, children’s errors when responding to “before”/ “after” questions were consistent with an order of encoding bias.

This study explored whether children's (N = 158; 4- to 9 years old) nonverbal facial expressions can be used to identify when children are being deceptive. Using a computer vision program to automatically decode children's facial expressions according to the Facial Action Coding System, this study employed machine learning to determine whether facial expressions can be used to discriminate between children who concealed breaking a toy(liars) and those who did not break a toy(nonliars). Results found that, regardless of age or history of maltreatment, children's facial expressions could accurately (73%) be distinguished between liars and nonliars. Two emotions, surprise and fear, were more strongly expressed by liars than nonliars. These findings provide evidence to support the use of automatically coded facial expressions to detect children's deception.

Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence. Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival. Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 – 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 - year survival. Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

We investigated the risks of new onset and worsened hypertension after radical vs partial nephrectomy.Using a national administrative database of privately and Medicare insured patients we performed a retrospective cohort study of 9,207 and 4,686 patients who underwent radical and partial nephrectomy, respectively, for a renal mass between January 1, 2007 and December 31, 2016. One-to-one propensity score matching was done to balance the surgical groups based on patient demographics, baseline comorbidities, current medications and surgery year. Primary outcomes included new onset hypertension among patients with no history of hypertension and worsened hypertension among patients with baseline hypertension. We performed subgroup analyses stratified by patient age (75 or greater vs less than 75 years) and the presence of baseline kidney disease. Incidence rates and Cox proportional hazards models were used to compare outcomes in matched cohorts.Among 3,106 propensity matched patients without preexisting hypertension radical nephrectomy was associated with a higher risk of new onset hypertension compared to partial nephrectomy (HR 1.40, 95% CI 1.22-1.60, p0.001). Similarly among 6,250 propensity matched patients with hypertension prior to surgery radical nephrectomy was associated with a higher risk of worsening baseline hypertension (HR 1.18, 95% CI 1.10-1.26, p0.001). Subgroup analyses were consistent with the main study findings of worsened hypertension (p for interaction ≥0.05).Radical nephrectomy was associated with a higher risk of new onset and worsened hypertension compared to partial nephrectomy, including among elderly patients and individuals with normal kidney function. Given prior noted associations between hypertension and noncancer related morbidity, our results further encourage the preferential use of partial nephrectomy to manage localized renal masses when technically feasible.

Hypocotyl-derived calli of genotypes and segregating populations of Coffea arabica, differing in susceptibility to Colletotrichum kahawae, were used to produce cell suspensions and protoplasts which were exposed to partially purified culture filtrates (PPCFs) prepared from the pathogen. The growth and viability of PPCF-treated cells and protoplasts were measured using packed cell volume, fluorescein diacetate staining and a colorimetric assay involving the tetrazolium salt MTT. Differential responses of cells and protoplasts were influenced by genotype, time of exposure and PPCF concentration. Protoplasts of resistant genotypes responded differentially from more susceptible genotypes as early as 4 h after challenge with the phytotoxin, suggesting that they were more sensitive than cell suspensions to the treatments. Protoplasts exposed to PPCFs from C. kahawae may therefore be used to screen and select genotypes resistant to, or tolerant of, coffee berry disease.

Background Children are often hesitant to disclose transgressions, particularly when they feel implicated, and frequently remain reluctant until confronted with direct questions. Given the risks associated with direct questions, an important issue is how interviewers can encourage honesty through recall questions. Objective The present study examined the use of three truth induction strategies for increasing the accuracy and productivity of children’s reports about a transgression. Participants A total of 285 4-to-9-year-old maltreated and nonmaltreated children. Methods Each child took part in a play session with a stranger during which the child appeared to break some toys. A research assistant interviewed the child with narrative practice rapport building and recall questions. The study included manipulations of back-channel utterances (brief expressions used to communicate attention and interest), whether (and when) the child was asked to promise to tell the truth, and the use of a post-recall putative confession. Results Back-channel utterances failed to increase disclosure (OR = 0.79 [95% CI: 0.48, 1.31]) but increased the productivity of children’s reports about broken (p = 0.04, ηp = 0.02) and unbroken toys (p = 0.004, ηp = 0.03). A promise to tell the truth significantly increased children’s disclosures, but only among nonmaltreated children (OR = 3.65 [95% CI: 1.23, 10.90]). The post-recall putative confession elicited new disclosures from about half of children who had failed to disclose. Conclusions The findings highlight the difficulties of eliciting honest responses from children about suspected transgressions and the need for flexible questioning strategies.

Intraoperative hypothermia (IOH) has been suggested to adversely impact outcomes following surgery. The objective of this study was to evaluate the association between IOH and survival following radical cystectomy (RC).Patients who underwent RC for bladder cancer from 2003 to 2018 were identified in our cystectomy registry. Intraoperative temperatures were extracted from the anesthesia record. IOH was defined as a median intraoperative temperature36°C, and severe IOH as ≤ 35°C. Time under 36°C was assessed as a continuous variable. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Associations between IOH and outcomes were assessed with multivariable Cox proportional hazards models.A total of 852 patients were identified, among whom 274 (32%) had IOH. Median follow up among survivors was 4.9 years (IQR 2.4-8.7), during which time 483 patients died, including 343 from bladder cancer. Two-year survival was not significantly different between patients with and without IOH (CSS: 74% vs. 71%, P= 0.31; OS: 68% vs. 67%, P= 0.13). Following multivariable adjustment, neither IOH nor time under 36°C was significantly associated with survival. A total of 37 patients (4.3%) had severe IOH. These patients were observed to have significantly lower 2-year OS (56% vs. 68%, P= 0.005); however, this association did not remain statistically significant after multivariable adjustment (P= 0.92).IOH was not independently associated with survival following RC. These data do not support IOH as a prognostic factor for cancer outcomes among patients undergoing RC.

Background Children alleging sexual abuse rarely exhibit emotion when disclosing, but they may be able to describe their subjective reactions to abuse if asked. Objective This study examined the extent to which different types of questions in child sexual abuse interviews elicited subjective content, namely emotional reactions, cognitive content, and physical sensations. Participants and setting The study included transcripts of 205 Child Advocacy Center interviews with 4- to 12-year-old children alleging sexual abuse. Methods We coded questions for question type, distinguishing among invitations, wh- questions, yes/no and forced-choice questions, and suggestive questions. We coded both questions and answers for whether they referenced subjective content. Results When questions did not reference subjective content, the most productive questions were invitations, though they elicited subjective content less than 5% of the time. When questions specifically referenced subjective content, children were likely to explicitly mention such content, particularly in response to “how feel” and “what think” questions. Children’s responsiveness and productivity was enhanced by requests to elaborate on their subjective responses, and both emotional and physical reactions could be elicited. There was little evidence of non-responsiveness or counterintuitive reactions to abuse. Younger children were less likely than older children to provide subjective responses to questions that did not reference subjective content, but were no less likely to do so when asked questions with subjective content. Conclusions Children, even young children, can be successfully encouraged to provide subjective content about sexual abuse, particularly when free recall questions are supplemented with “how feel” or “what think” questions.

BACKGROUND: Research has largely overlooked expressions of reluctance in commercially sexually exploited adolescent (“CSEA”) victims. This is problematic because gaining information from known victims is of the utmost importance in order to better serve the needs of current and potential future victims. OBJECTIVE: The current study proposes a novel conceptualization of reluctance based on CSEA victims’ transcripts from police interviews and courtroom examinations. PARTICIPANTS AND SETTING: The study examined police interviews (n = 8 victims, 1558 utterances) and courtroom transcripts (n = 6 victims, 1961 utterances) conducted with female CSE adolescent victims aged 15-17 years old (M(age) = 16.29). The victims were associated with the same trafficker and were thus interviewed by the same police officers, and for those who testified, were questioned by the same lawyers in court. RESULTS: Sixteen reluctance tactics were identified, including several that have been overlooked in previous literature. The current reluctance measure identified more reluctance than previous studies’ reluctance measures. Reluctance was much more common in police interviews (26.4%; p < .001) than in court (5.5%), and if victims were more reluctant in the police interviews, they were less likely to appear in court (p = .001). CONCLUSIONS: These findings have implications for future conceptualizations of reluctance, and illustrate the importance of considering the age of the victim and the circumstances under which the victim is questioned in identifying reluctance.

Introduction To develop a technique to collect fluid expressed during robot-assisted radical prostatectomy (RARP) to assess whether malignant cells may have been inadvertently introduced into the surgical field. Methods Men with clinically localized grade group 2 to 5 prostate adenocarcinoma undergoing RARP were identified. Following bladder neck division, fluid expressed via prostatic urethra during seminal vesicle dissection was aspirated (specimen A). After specimen removal, an ex vivo seminal vesicle aspiration was performed as well (specimen B). Specimens were prepared with ThinPrep (Hologic, Marlborough, MA) and stained with 4 immunohistochemical markers: keratin-7, PAX-8, prostate-specific antigen (PSA), and prostatic acid phosphatase (PACP). Results Between December 2018 and May 2019, 15 men undergoing RARP were included. Median age was 60 years (range: 47–77), median PSA 8.5 ng/ml (range 5.1–24), and 7 (47%) had AUA high-risk disease. Specimen A had adequate cellularity in 13 patients (87%). Five patients were excluded from assessment of malignancy due to acellularity of specimen A (n = 2) or specimen B (n = 3). Three of the remaining 10 patients (30%) had cytologic features suspicious for malignancy on specimen A. Immunohistochemistry supported prostatic origin with positive PSA and PACP staining and negative PAX8 stains. Specimen B was not suspicious in any patient. Conclusion We report a technique for intraoperative collection of fluid expressed during RARP. Three patients with adverse pathologic features had evidence of cancer cells within the operative field. Further work is needed to confirm this observation and to determine whether these cells are associated with adverse oncologic outcomes.

Objective To determine the association of statin use with oncological outcomes and risk of pathologic upgrading following radical prostatectomy. Materials and Methods Using a prospectively populated database of 3042 men who underwent open radical prostatectomy, patients were grouped according to reported statin use at the time of surgery. The primary outcome was time to biochemical recurrence. The secondary outcome was risk of pathologic upgrading among a subset of 1256 patients with Gleason pattern 3 + 3 = 6 on biopsy. A multivariable Cox model was used to assess risk of biochemical recurrence, and multivariable logistic regression was used to assess risk of pathologic upgrading. Results Eight hundred twenty-four men (27%) reported statin use at the time of radical prostatectomy. Statin users were older and had higher body mass index, higher Charlson Comorbidity Index, and lower pretreatment prostate-specific antigen values than statin nonusers. Over a median follow-up of 70 months (interquartile range: 36-107), a total of 455 men (15%) experienced biochemical recurrence. Statin use was not associated with biochemical recurrence (adjusted hazard ratio: 1.06, 95% confidence interval: 0.86-1.31). Of those men with biopsy Gleason 3 + 3 = 6 disease, 647 (52%) were upgraded to higher grade disease following radical prostatectomy; however, statin use was not associated with pathologic upgrading (adjusted odds ratio: 0.78, 95% confidence interval: 0.58-1.04). Conclusion Preoperative statin use at the time of radical prostatectomy was not associated with biochemical recurrence or risk of pathologic upgrading in this cohort. These data add to the existing body of literature suggesting that statin use is not associated with more favorable clinical outcomes following radical prostatectomy.

This study examined the effects of secret instructions (distinguishing between good/bad secrets and encouraging disclosure of bad secrets) and yes/no questions (DID: "Did the toy break?" versus DYR: "Do you remember if the toy broke?") on 262 maltreated and non-maltreated children's (age range 4-9 years) reports of a minor transgression. Over two-thirds of children failed to disclose the transgression in response to free recall (invitations and cued invitations). The secret instruction increased disclosures early in free recall, but was not superior to no instruction when combined with cued invitations. Yes/no questions specifically asking about the transgression elicited disclosures from almost half of the children who had not previously disclosed, and false alarms were rare. DYR questions led to ambiguous responding among a substantial percentage of children, particularly younger children. The findings highlight the difficulties of eliciting transgression disclosures without direct questions. Copyright © 2017 John Wiley & Sons, Ltd.

Despite the significant attention transmission switching (TS) has gained over the last decade, important challenges remain. This paper addresses the state-of-the-art challenges of TS by studying the benefits of corrective switching using authentic Independent System Operator of New England (ISO-NE) data and software. Thus, the results and analyses presented in this paper are more convincing than any other study conducted to date. TS is successfully implemented for reliability applications as a corrective mechanism. ISO-NE maintains $N-1$ reliability based on the preventive dispatch and enforcing proxy reserve requirements along with $N-1-1$ reliability based on reserves and interface limits. This paper incorporates TS as a corrective mechanism in response to both the $N-1$ and $N-1-1$ events. Not only does this paper investigate the capability of corrective switching to alleviate thermal overloads but also the economic benefits of corrective switching with actual market data and in-house market software at ISO-NE. The results show that corrective TS can improve the reliability of the system and save millions of dollars each year by providing a cheaper corrective action alternative for ISO-NE. The results also suggest that TS would provide more significant benefits for systems with more transmission congestion such as Pennsylvania New Jersey Maryland, Midcontinent Independent System Operator, and Electric Reliability Council of Texas.

The increasing incidence of pediatric nephrolithiasis is a growing concern and its association with obesity continues to be an area of debate. We present data on urine chemistries of overweight/obese children compared to those with a normal body mass index and history of urolithiasis treated at a single institution in the United States, and assess risk factors.We retrospectively identified 110 stone forming patients who underwent 24-hour urine collection and stratified them according to the Centers for Disease Control and Prevention definitions of overweight/obese (body mass index above 85th/95th percentile). Absolute urine collection quantities were compared between groups. Stone risk factors were analyzed according to Litholink® specified reference ranges.Compared to patients with low or normal body mass index, overweight and obese patients had lower body surface area adjusted citrate (242 mg/1.73 m(2) vs 315 mg/1.73 m(2), p = 0.03), lower urine phosphate (12 mg/kg vs 14 mg/kg, p = 0.04), lower urine magnesium (1.2 mg/kg vs 1.6 mg/kg, p = 0.01) and increased incidence of hypercalciuria (31% vs 11%, p = 0.02). Differences in urine citrate, phosphate and magnesium were not apparent when analyzing stone risk factors. There was no association between body mass index and urine pH.Overweight and obese stone forming children have decreased levels of urine citrate, phosphate and magnesium compared to patients with normal body mass index. The incidence of hypercalciuria is increased in overweight/obese patients. In contrast to findings in adults, there is no association between urine pH and body mass index.

This study investigated the role of the hypogastric nerve and β-adrenergic mechanisms in the inhibition of nociceptive and non-nociceptive reflex bladder activity induced by pudendal nerve stimulation (PNS). In α-chloralose-anesthetized cats, non-nociceptive reflex bladder activity was induced by slowly infusing saline into the bladder, whereas nociceptive reflex bladder activity was induced by replacing saline with 0.25% acetic acid (AA) to irritate the bladder. PNS was applied at multiple threshold (T) intensities for inducing anal sphincter twitching. During saline infusion, PNS at 2T and 4T significantly ( P < 0.01) increased bladder capacity to 184.7 ± 12.6% and 214.5 ± 10.4% of the control capacity. Propranolol (3 mg/kg iv) had no effect on PNS inhibition, but 3-[(2-methyl-4-thiazolyl)ethynyl]pyridine (MTEP; 1–3 mg/kg iv) significantly ( P < 0.05) reduced the inhibition. During AA irritation, the control bladder capacity was significantly ( P < 0.05) reduced to ∼22% of the saline control capacity. PNS at 2T and 4T significantly ( P < 0.01) increased bladder capacity to 406.8 ± 47% and 415.8 ± 46% of the AA control capacity. Propranolol significantly ( P < 0.05) reduced the bladder capacity to 276.3% ± 53.2% (at 2T PNS) and 266.5 ± 72.4% (at 4T PNS) of the AA control capacity, whereas MTEP (a metabotropic glutamate 5 receptor antagonist) removed the residual PNS inhibition. Bilateral transection of the hypogastric nerves produced an effect similar to that produced by propranolol. This study indicates that hypogastric nerves and a β-adrenergic mechanism in the detrusor play an important role in PNS inhibition of nociceptive but not non-nociceptive reflex bladder activity. In addition to this peripheral mechanism, a central nervous system mechanism involving metabotropic glutamate 5 receptors also has a role in PNS inhibition.

Power systems face growing uncertainty from intermittent renewable resources. This uncertainty makes it harder to schedule generators efficiently because the economics depend on unknown outcomes. This research modifies security-constrained unit commitment to anticipate the cost of dispatching backup capacity if and when it is needed. The model uses capacity constraints to cover individual scenarios by defining scenario response sets, which are revised iteratively using a mixed-integer program. The approach provides a mathematical way to derive capacity requirements like those used today in CAISO and ISO-NE. Testing on the IEEE 73-bus test case demonstrates the capacity requirements are economical compared to other deterministic policies from the literature.

This study aimed at understanding thermal effects on nerve conduction and developing new methods to produce a reversible thermal block of axonal conduction in mammalian myelinated nerves. In 13 cats under α-chloralose anesthesia, conduction block of pudendal nerves ( n = 20) by cooling (5–30°C) or heating (42–54°C) a small segment (9 mm) of the nerve was monitored by the urethral striated muscle contractions and increases in intraurethral pressure induced by intermittent (5 s on and 20 s off) electrical stimulation (50 Hz, 0.2 ms) of the nerve. Cold block was observed at 5–15°C while heat block occurred at 50–54°C. A complete cold block up to 10 min was fully reversible, but a complete heat block was only reversible when the heating duration was less than 1.3 ± 0.1 min. A brief (

Objective To compare the outcomes of ureteroscopic intervention in terms of both the stone-free rate and complications in both prepubertal and adolescent patients. Although safety of pediatric ureteroscopic intervention is well established, a comparative outcome of prepubertal and adolescent patients is lacking. Materials and Methods Pediatric patients who underwent ureteroscopic treatment of a renal or ureteral stone at our institution from July 2005 to August 2014 were retrospectively identified. Patients were classified by age either as prepubertal (≤11 years) or adolescent (>11 years) for purposes of comparison. Demographic and intraoperative variables as well as 30-day postoperative complication rates were compared between groups. Data were analyzed using χ 2 and Fisher's exact tests as appropriate. Results A total of 104 patients were identified, of whom 64 (62%) were prepubertal and 40 (38%) were adolescent. Ureteroscopic failure occurred in a minority of patients (5% vs 4.7%, P > .9). Complication rates including ureteral perforation (0% vs 1.6%, P > .9), postoperative urinary tract infection (2.5% vs 4.7%, P > .9), hematuria with clot passage (0% vs 7.8%, P = .15), and persistent flank pain (15% vs 17%, P = .85) were not significantly different between adolescent and prepubertal patients, respectively. Conclusion In spite of small size and small body habitus, the ureteroscopic management of pediatric urolithiasis can be performed successfully in both the prepubertal and adolescent patients with acceptable and equivalent morbidity as well as successful clearance of stone.

Objective To determine whether children discharged with prophylactic antibiotics following laparoscopic pyeloplasty with indwelling ureteral stent have a decrease risk of postoperative urinary tract infections (UTIs) compared to those discharged without antibiotics. Materials and Methods A retrospective review of all minimally invasive pyeloplasties performed at our institution from January 2009 to March 2015 was conducted. Patients were discharged home with or without daily prophylactic-dose antibiotics continued until 3 days after ureteral stent removal per surgeon preference. The primary outcome was incidence of culture-positive UTI. Secondary outcomes included bacteriuria at time of stent removal and adverse events associated with extended antibiotic therapy. Results Of 163 pyeloplasties (106 robotic and 57 pure laparoscopic) performed over the study period, 126 patients were discharged on prophylactic antibiotics whereas 37 patients were discharged without prophylaxis. Groups were different with respect to median age (7.1 vs 12.0 years, P = .03) and median duration of ureteral stent (35 days vs 28 days, P = .02). The incidence of culture-positive UTI between the time of discharge and stent removal was comparably low between groups; 2/126 (1.6%) in the prophylaxis group and 1/37 (2.7%) in the group not on prophylaxis. At time of stent removal, perioperative urine culture was positive in 2/20 (10.0 %) patients who received prophylactic antibiotics and in 1/25 (4.0%) patients who did not (P = .54). Conclusion The administration of extended prophylactic antibiotics showed no significant impact on the rate of UTI following minimally invasive pyeloplasty.

Adenocarcinoma of the rete testis is a rare and aggressive malignancy arising from the epididymal epithelium. We present a case of a 66-year-old male who presented with left testis mass. Histopathological analysis of orchiectomy specimen was consistent with adenocarcinoma of the rete testis. Subsequent retroperitoneal lymph node dissection revealed metastatic disease not detected on preoperative PET-CT. Prior reports have suggested poor response rates to both systemic chemotherapy and radiation therapy. Aggressive surgical management of the retroperitoneum should be considered even in clinically node-negative patients given the paucity of other effective treatment regimens. Keywords: Rete testis, Retroperitoneal lymph node dissection, Adenocarcinoma