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College students are frequent social media users. Heightened racial tensions across college campuses and the United States have increased the volume of racial discourse on social media, suggesting a need to understand social media’s influence on how students make meaning of race. Using symbolic interactionism and racial identity theories, this qualitative study examined the social media engagement of 10 undergraduate students of Color and its impact on their understanding of race and racial identity.

Author(s): Chan, Jason; Fan, Bensen; Zhao, Caixia; Sabharwal, Sanjeev | Abstract: IntroductionThe variability in exposure to various subspecialty rotations during orthopaedic residency across the United States has not been well studied.MethodsData regarding program size, resident's sex, department leadership, university-based status of the program, outsourcing of subspecialty rotation, and geographic location were collected from websites of 151 US allopathic orthopaedic residency programs. The relationship of these factors with the time allotted for various clinical rotations was analyzed.ResultsThe number of residents in a program correlated positively with time allocated for elective rotations (r = 0.57, P = 0.0003). Residents in programs where the program director was a general orthopaedic surgeon spent more time on general orthopaedic rotations (22 versus 9.9 months, P = 0.001). Programs where the program director or chairman was an orthopaedic oncologist spent more time on oncology rotations ([3.8 versus 3 months, P = 0.01] and [3.5 versus 2.7 months, P = 0.01], respectively). Residents in community programs spent more time on adult reconstruction than university-based programs (6.6 versus 5.5 months, P = 0.014). Based on multiple linear regression analysis, time allotted for adult reconstruction (t = 2.29, P = 0.02) and elective rotations (t = 2.43, P = 0.017) was positively associated with the number of residents in the program.ConclusionsSubstantial variability exists in the time allocated to various clinical rotations during orthopaedic residency. The effect of this variability on clinical competence, trainees' career choices, and quality of patient care needs further study.

Rationale Over the past six decades, residents of farming villages in multiple countries of the Balkan peninsula have been suffering from a unique type of chronic renal disease, Balkan endemic nephropathy (BEN). It was speculated that environmental pollution by aristolochic acids (AAs) produced naturally by Aristolochia clematitis L., a weed that grows in the area, was causing the disease. However, the human exposure pathway to this class of phytotoxin remains obscure. Knowledge of the sink and stability of AAs in the environment would assist in the formulation of policy reducing exposure risk. Methods Using our newly developed liquid chromatography/tandem mass spectrometry method of high sensitivity and selectivity, we analysed over 130 soil samples collected from cultivation fields in southern Serbia for the presence of AAs. The environmental stability of AAs was also investigated by incubating soil samples spiked with AAs at various temperatures. Results The analysis detected AA-I in over two-fifths of the tested samples at sub-μg/kg to μg/kg levels, with higher concentrations observed in more acidic farmland soil. Furthermore, analysis of soil samples incubated at various temperatures revealed half-lives of over 2 months, indicating that AAs are relatively resistant to degradation. Conclusions Cultivation soil in southern Serbia is being extensively contaminated with AAs released from the decomposition of A. clematitis weeds. Since AAs are resistant to degradation, it is possible that AAs could have been taken up by root absorption and transported to the edible part of food crops. Prolonged exposure to AA-contaminated food grown from polluted soil could be one of the main aetiological mechanisms of BEN observed in the area.

Darknet markets have been increasingly used for the transaction of illegal products and services in the last decade. In particular, it is estimated that drugs make up two-thirds of darknet market transactions. The growth of illicit transactions on darknet markets have led enforcement agencies to invest greater proportion of time and efforts to monitor and crack down on criminal activities on the darknet websites. Despite the successes in convicting perpetrators, it is unknown whether these policing efforts are truly effective in deterring future darknet transactions, given that the identities of the transacting parties are well protected by the markets’ features and that these participants may migrate to other darknet platforms to transact. To this end, this study attempts to empirically evaluate the susceptibility of darknet markets breaking down upon successful policing of participants on the platform. Using drug review data from three largest darknet markets, we rely on a difference-in-difference procedure to assess the impact of policing on future transaction levels, by contrasting various outcomes from the policed site with those from the non-policed sites. Our analyses found that enforcement efforts produce a negative effect on subsequent transactions on the policed site, for both vendors in the same country and in different countries as that of the arrested perpetrators. Not only do the average number of transactions per vendor decreased, we also found that the number of active vendors that remained on the site dropped significantly. This dampening effect cannot be explained by migratory behaviors, to which we interpret as evidence of a deterrence effect at work. Furthermore, we find heterogeneity effects in the enforcement effort, wherein small vendors and vendors with short site tenure are relatively more affected by the arrest shock. Study findings have policy and theoretical implications to law makers, enforcement agencies, and academicians.

The objectives of this work were to investigate the presence of a variety of mycotoxins in Canadian wheat and durum and to characterize the relationship between concentrations of the Fusarium-produced deoxynivalenol (DON) and the presence of visible Fusarium damage. There is a lack of reported mycotoxin surveillance data for Canadian wheat and durum; this work addresses this information gap. Wheat and durum harvest samples from the 2010, 2011 and 2013–2016 growing seasons were analysed for mycotoxins produced by a variety of fungal species, including Fusarium graminearum and Alternaria alternata. The Alternaria-produced tentoxin was observed the most frequently; it was present in 90% of the samples analysed at concentrations up to 0.063 mg kg−1. Fusarium-produced DON and enniatins B and B1 were present in over 70% of samples analysed. The plant transformation product DON-3-glucoside was quantified in up to 30% of samples. There was variability in the presence of the various mycotoxins amongst years. In particular, for DON, the variability reflected the level of visible Fusarium damage noted in grain samples. The geographic source of samples also influenced DON concentrations, which decreased from eastern to western growing regions on the Prairies. Concentrations of DON varied from 0.066 to 0.895 mg kg−1 in south central Manitoba and −1 in central Alberta. DON concentrations were significantly correlated (P Fusarium damage in Canada Western Red Spring wheat for all four years investigated. For Canada Eastern Soft Red Winter wheat and Canada Western Amber Durum, there were significant correlations (P Fusarium damage occurred when the presence of Fusarium species other than the DON-producing F. graminearum were predominant. This work provides a picture of the presence, and absence, of a number of mycotoxins in Canadian wheat and durum.

Purpose GEN-003 is a candidate therapeutic HSV-2 vaccine containing a fragment of infected cell protein 4 (ICP4.2), a deletion mutant of glycoprotein D2 (gD2ΔTMR), and Matrix-M2 adjuvant. In a dose-ranging phase 1/2a clinical trial, immunization with GEN-003 reduced viral shedding and the percentage of reported herpetic lesion days. Here we examine the immune responses in the same trial, to characterize vaccine-related changes in antibody and cell-mediated immunity. Methods Participants with genital HSV-2 infection were randomized to 1 of 3 doses of GEN-003, antigens without adjuvant, or placebo. Subjects received 3 intramuscular doses, three weeks apart, and were monitored for viral shedding, lesions and immunogenicity. Antibody titers were measured by ELISA and neutralization assay in serum samples collected at baseline and 3 weeks post each dose. T cell responses were assessed pre-immunization and 1 week post each dose by IFN-γ ELISpot and intracellular cytokine staining. Blood was also collected at 6 and 12 months to monitor durability of immune responses. Results Antibody and T cell responses increased with vaccination and were potentiated by adjuvant. Among the doses tested, the rank order of reduction in viral shedding follows the ranking of fold change from baseline in T cell responses. Some immune responses persisted up to 12 months. Conclusion All measures of immunity are increased by vaccination with GEN-003; however, a correlate of protection is yet to be defined.

Background: Adherence to Baby Friendly Initiative (BFI) practices is low in Canadian hospitals, despite evidence showing a positive impact of BFI practices on breastfeeding rates and duration. In 2012, the provincial Ontario Ministry of Health and Long Term Care added BFI status to its progress indicators for Public Health Units, which are now required to begin BFI implementation. Objective: This study aims to explore health care workers’ self-reported knowledge of the BFI and their perceptions of the importance of its components. Methods: A questionnaire was electronically sent to 2237 employees working at our institution. Results: Questionnaires were completed by 651 participants, of which 110 (16.9%) and 87 (13.5%) participants reported having good knowledge of the BFI and the Ten Steps to Successful Breastfeeding, respectively. Multiple logistic regression showed that having children and having received formal breastfeeding education were associated with higher self-reported knowledge. Additionally, 481 (75%) participants reported that it was important or very important to them that the institution adopt the BFI. Having children and being an allied health professional were associated with perceiving the implementation of the BFI as important. Conclusion: The results of our study have allowed us to identify potential barriers to implementation of the BFI, which can be targeted through system changes and staff education. Through this approach, we hope to facilitate acceptance of the BFI at our institution and increase support for optimal breastfeeding practices among our patients.

Research on college men and masculinities has been of interest within higher education, yet there is limited focus on the experiences of students with multiple marginalized identities. Through semi-structured interviews with gay, bisexual, and queer Filipino undergraduate men, this study examined how students defined, understood, and experienced masculinity, with emphases on the influence of environmental factors within family, cultural, and campus contexts. Overarching themes and implications for student affairs practice are discussed.

This article presents a critical review of 112 works of research on Asian Americans and Pacific Islanders (AAPIs) in higher education. It focuses on ways previous scholarship framed AAPIs in higher education, and specifically on how those works engaged in a sustained project of countering the model minority myth (MMM). Many publications on AAPIs in higher education mentioned the MMM and neglected to account for the original purpose of the MMM—to maintain anti-Black racism and White supremacy. We identified four key and interconnected limitations implicit in the counter-MMM framework that result from a lack of a critical recognition of the model minority as an instrument to maintain White dominance. Our analysis suggests that the well-established counter-MMM scholarly project is fundamentally flawed in its ability to humanistically reframe and advance research on AAPIs. Therefore, we call for a reframing of research on AAPIs in higher education.

Key Points Question Is exposure to the National Comprehensive Cancer Center guidelines associated with decreased decisional conflict and increased rates of guideline-concordant care in patients with non–small cell lung cancer? Findings In this nonrandomized clinical trial, exposure to the National Comprehensive Cancer Center guidelines in 76 patients with non–small cell lung cancer was associated with increased smoking cessation counseling and decreased use of adjuvant chemotherapy after resection of early-stage disease. Use of the tool during consultation was also associated with decreased decisional conflict and greater satisfaction with their decision by the patients. Meaning The findings of this study suggest that use of cancer treatment guidelines is not in conflict with shared decision-making; increasing patients’ access to guidelines appears to improve the quality of oncologic care., Importance The association of guideline-based decision support with the quality of care in patients with non–small cell lung cancer (NSCLC) is not known. Objective To evaluate the association of exposure to the National Comprehensive Cancer Center (NCCN) guidelines with guideline-concordant care and patients’ decisional conflict. Design, Setting, and Participants A nonrandomized clinical trial, conducted at a tertiary care academic institution, enrolled patients from February 23, 2015, to September 28, 2017. Data analysis was conducted from July 19, 2019, to April 22, 2020. A cohort of 76 patients with NSCLC seen at diagnosis or disease progression and a retrospective cohort of 157 patients treated before the trial were included. Adherence to 6 NCCN recommendations were evaluated: (1) smoking cessation counseling, (2) adjuvant chemotherapy for patients with stage IB to IIB NSCLC after surgery, (3) pathologic mediastinal staging in patients with stage III NSCLC before surgery, (4) pathologic mediastinal staging in patients with stage III NSCLC before nonsurgical treatment, (5) definitive chemoradiotherapy for patients with stage III NSCLC not having surgery, and (6) molecular testing for epidermal growth factor receptor and anaplastic lymphoma kinase alterations for patients with stage IV NSCLC. Subgroup analysis was conducted to compare the rates of guideline concordance between the prospective and retrospective cohorts. Secondary end points included decisional conflict and satisfaction. Interventions An online tool customizing the NCCN guidelines to patients’ clinical and pathologic features was used during consultation, facilitated by a trained coordinator. Main Outcomes and Measures Concordance of practice with 6 NCCN treatment recommendations on NSCLC and patients’ decisional conflict. Results Of the 76 patients with NSCLC, 44 were men (57.9%), median age at diagnosis was 68 years (interquartile range [IQR], 41-87 years), and 59 patients (77.6%) had adenocarcinoma. In the retrospective cohort, 91 of 157 patients (58.0%) were men, median age at diagnosis was 66 years (IQR, 61-65 years), and 105 patients (66.9%) had adenocarcinoma. After the intervention, patients received more smoking cessation counseling (4 of 5 [80.0%] vs 1 of 24 [4.2%], P, This nonrandomized clinical trial examines the inclusion of National Comprehensive Cancer Network (NCCN) guidelines in a tool used by patients with non–small cell lung cancer to facilitate decision-making.

Increasing number of firms are adopting enterprise social media (ESMs), however it is unclear whether and how it enables better communication. In this paper, we focus on the workgroups feature that...

6563 Background: To determine the negative predictive value (NPV) of 12-14 week post-treatment PET/CT for 2-year progression-free survival (PFS) and 2-year locoregional control (LRC) in NRG-HN002, which is a two-arm phase II trial for patients with low-risk, non-smoking associated p16-positive LA-OPC randomized in a 1:1 ratio to reduced-dose IMRT with or without cisplatin. Methods: PET/CT scans were reviewed both centrally and locally by participating institutions. Tumor response evaluations for primary site, right neck, and left neck were carried out using a 5-point ordinal scale (‘Hopkins Criteria’). Overall scores were then assigned as ‘Negative,’ Positive,’ or ‘Indeterminate.’ Patients who had a ‘Negative’ score for all three evaluation sites were given an overall score of ‘Negative.’ The endpoints were NPV for LRC and PFS at 2 years testing NPV ≤ 90% vs > 90% (1-sided alpha 0.10 and 76% power). Results: There were 316 patients enrolled, of whom 306 were randomized and eligible. Of these, 131 (42.8%) patients consented to a post-therapy PET/CT, and 117 (89.3%) patients were eligible for PET/CT analysis. The median time from end of treatment to PET/CT scan was 94 days (range 52-139). The rates of 2-yr PFS and LRC in the analysis subgroup were 91.3% and 93.8%, respectively. Based on central review, post-treatment scans were negative for residual tumor for 115 patients (98.3%) and positive for 2 patients (1.7%). The NPV for 2-year LRC was 94.5% (90% lower confidence bound [LCB] 90.6%; p = 0.07). NPV for 2-year PFS was 92.0% (90% LCB 87.7%; p = 0.30). Similar NPV results were obtained based on analysis of local reviews. Conclusion: Within the context of deintensification with reduced-dose radiation, the NPV of a 12-14 week post-therapy PET/CT for 2-year LRC is statistically > 90%, similar to that reported for patients receiving standard chemoradiation. However, in this study, there was not enough evidence to conclude that the NPV of a 12-14 week post-therapy PET/CT for 2-year PFS is > 90%. Grant acknowledgement: This project was supported by grants U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC), U24CA180803 (IROC), UG1CA189867 (NRG Oncology NCORP) from the National Cancer Institute (NCI). This project is funded, in part, under a Grant with the Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analyses, interpretations or conclusions. Clinical trial information: NCT02254278 .

Purpose This study suggests a lifelong learning-based convolutional neural network (LL-CNN) algorithm as a superior alternative to single-task learning approaches for automatic segmentation of head and neck (OARs) organs at risk. Methods and materials Lifelong learning-based convolutional neural network was trained on twelve head and neck OARs simultaneously using a multitask learning framework. Once the weights of the shared network were established, the final multitask convolutional layer was replaced by a single-task convolutional layer. The single-task transfer learning network was trained on each OAR separately with early stoppage. The accuracy of LL-CNN was assessed based on Dice score and root-mean-square error (RMSE) compared to manually delineated contours set as the gold standard. LL-CNN was compared with 2D-UNet, 3D-UNet, a single-task CNN (ST-CNN), and a pure multitask CNN (MT-CNN). Training, validation, and testing followed Kaggle competition rules, where 160 patients were used for training, 20 were used for internal validation, and 20 in a separate test set were used to report final prediction accuracies. Results On average contours generated with LL-CNN had higher Dice coefficients and lower RMSE than 2D-UNet, 3D-Unet, ST- CNN, and MT-CNN. LL-CNN required ~72 hrs to train using a distributed learning framework on 2 Nvidia 1080Ti graphics processing units. LL-CNN required 20 s to predict all 12 OARs, which was approximately as fast as the fastest alternative methods with the exception of MT-CNN. Conclusions This study demonstrated that for head and neck organs at risk, LL-CNN achieves a prediction accuracy superior to all alternative algorithms.

Background: Readiness for making behavioral changes is a key factor determining success in the adoption of technologies like CGM in type 1 diabetes (T1D). SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale-Diabetes Version) can classify individuals into 1 of 5 motivational stages: Precontemplation, Contemplation, Determination, Action and Maintenance. It was used in the CGM TIME Trial, a multicenter pediatric RCT comparing simultaneous pump and CGM (“SIM” group) to initiation of CGM 6 months later (“DEL” group) (MiniMed Veo™ System). Aim: To examine the association of SOCRATES scores with 1) A1C at trial entry and 2) CGM adherence and change in A1C 6 months after CGM initiation. Methods: 97/99 eligible children aged 10-18 years and 136/141 eligible parents completed SOCRATES at trial entry and 6 months. Multivariable linear regression tested the association between motivational stage and 1) child’s A1C at trial entry, and 2) change in A1C and CGM adherence 6 months after CGM initiation, adjusted for randomization group, gender, age, and diabetes duration. Results: At trial entry, mean adjusted A1C was 1.02% lower for children in Precontemplation than those in Action (p Conclusions: SOCRATES scores were associated with A1C at trial entry, but did not predict future CGM adherence or change in A1C. SOCRATES was a poor measure of readiness for change in children with T1D and their parents who were participating in a clinical trial. CGM adherence was related more to timing of CGM initiation than motivational stage. Disclosure K. Verbeeten: None. J. Chan: None. N. Sourial: None. M.L. Lawson: None.

All eye/orbit malignancies are uncommon: per ACS, approximately 2,390 new cases/year. Percentage of malignant tumors increases with age, due to increases in primary orbital lymphoma (OL) and metastatic lesions in the elderly (both in choroid and in the orbit). Most common intraocular malignancy in adults: choroidal metastasis, usually adenocarcinoma, especially from lung, breast, and prostate. Most common primary eye malignancy in adults: uveal melanoma. Most common primary eye malignancy in children: retinoblastoma. Most common primary orbital malignancy in adults: lymphoma. Most common primary orbital malignancy in children: rhabdomyosarcoma. This chapter will discuss uveal melanoma, OL, intraocular lymphoma (IOL), thyroid ophthalmopathy, and orbital lymphoid hyperplasia (for Retinoblastoma and Rhabdomyosarcoma, see Part XI).

This chapter will discuss unusual neoplasms of the head and neck. General principles regarding workup and management paradigms are discussed for a subset of these diseases.

This chapter will discuss the epidemiology, workup, and management of Hodgkin’s lymphoma, with an emphasis on external beam radiotherapy technique and published evidence.

Of all breast cancer patients, about 70% are ER+ and 10% are ER+/HER2+. The ER+/HER2+ patients have a worse outcome compared to ER+/HER2- patients. Currently there is a lack of effective prognosis biomarkers for the prediction of outcome in ER+/HER2+ patients. Genome-wide differences in ER binding between the endocrine-responsive and endocrine-resistant cells were discovered using ChIP-seq, and combined with gene expression microarray data to identify direct ER target genes. These genes were correlated to survival outcome using publicly available breast cancer patient cohorts. We found the expression of the gene SERPINA1 to have a significant predictive value for the overall survival (OS) of ER+ patients in the TCGA cohort, and validated this finding in the Curtis cohort. SERPINA1 also has a significant predictive value for the OS of ER+/HER2+ patients in the TCGA cohort, with validation in the Bild cohort. The expression of SERPINA1 can be suppressed by fulvestrant and HER2 siRNA. Our results indicate that ER is constitutively activated, resulting in an E2-independent ER binding to the SERPINA1 gene and upregulation of SERPINA1 expression. Importantly, results of survival correlation suggests that high expression of SERPINA1 could be predictive for a better clinical outcome of ER+ and ER+/HER2+ patients.

By-products of cereal grain cleaning were analysed for a number of mycotoxins. Deoxynivalenol (DON) was the most frequently detected in by-products from commercial-scale cleaning procedures (maximum 2.94 mg/kg), followed by zearalenone (ZEA; maximum 0.045 mg/kg) and ochratoxin A (OTA; maximum 0.019 mg/kg). These three mycotoxins were also the most frequently detected in four different fractions collected from wheat run through a dockage tester, a piece of equipment used in the Canadian inspection process to separate material other than grain from wheat. Concentrations of mycotoxins were highest in the ‘light dockage’ fraction that contained dust and roughage such as glumes, fragments of stem, or rachis. Mycotoxin concentrations in this fraction reached up to 32 mg/kg (DON), 0.532 mg/kg (ZEA), and 0.249 mg/kg (OTA). Concentrations of DON in light dockage were significantly correlated with concentrations in whole grain that was un-cleaned or had undergone basic cleaning, indicating that the light dockage fraction could be used as a readily available matrix for the rapid screening of DON in wheat. This would eliminate the time required for additional sampling and preparation of whole grain, and move towards a truly rapid method for the screening of DON in wheat.

The challenge of assembling semiconducting single-wall carbon nanotubes (s-SWCNTs) into densely packed, aligned arrays has limited the scalability and practicality of high-performance nanotube-based electronics technologies. The aligned deposition of s-SWCNTs via floating evaporative self-assembly (FESA) has promise for overcoming this challenge; however, the mechanisms behind FESA need to be elucidated before the technique can be improved and scaled. Here, we gain a deeper understanding of the FESA process by studying a stationary analogue of FESA and optically tracking the dynamics of the organic ink/water/substrate and ink/air/substrate interfaces during the typical FESA process. We observe that the ink/water interface serves to collect and confine the s-SWCNTs before alignment and that the deposition of aligned bands of s-SWCNTs occurs at the ink/water/substrate contact line during the depinning of both the ink/air/substrate and ink/water/substrate contact lines. We also demonstrate improved control over the interband spacing, bandwidth, and packing density of FESA-aligned s-SWCNT arrays. The substrate lift rate (5-15 mm min

This paper presents differential pressure based flow configuration software implemented using FDT2 technology. FDT2 is a latest version of FDT standard (IEC62453) which is useful for configuration, monitoring, diagnosis and asset management of field device. Using FDT2 technology, client server system for flow configuration will be achieved keeping the interoperability of host system. The original design achieving unified application implementation on FDT2 without the difference of host integration technology and communication protocols is shown. The flow configuration business logic implemented in server function on FDT2 can be integrated as FITS (FDT IIOT Server) and a lot of benefits will be achieved referring to RAMI4.0. This will greatly improve plant operation in future.

To examine the relationship between physical activity, tic severity and quality of life (QoL) in children and adolescents with persistent tic disorder and Tourette Syndrome.Baseline data was examined from a larger randomized controlled trial (Clinicaltrials.gov NCT02153463). Physical activity was assessed via pedometers with daily step count recorded. Tic severity (assessed via Yale Global Tic Severity Scale or YGTSS) and QoL (assessed via PEDs QL 4.0) were compared between those more physically active (≥12,000 steps/day) and less physically active (12,000 steps/day).Thirteen children participated; four had ≥12,000 steps/day and nine had12,000 steps/day. The active group had a lower total tic severity (p = 0.02), and total YGTSS score (p=0.01). The vocal tic severity score was lower in the active group (p=0.02). Motor tic severity was not different amongst the two groups. For Peds QL scores, the active group performed better in physical functioning (p=0.01), social functioning (p=0.03), school functioning (p=0.02), psychosocial functioning (p=0.03) and total PEDs QL score (p=0.01).Higher physical activity levels are associated with lower vocal tic severity and improved aspects of quality of life. Further research is needed to determine the utility of physical activity as therapy for tics.Examiner la relation entre l’activité physique, la gravité des tics et la qualité de vie (QdV) des enfants et adolescents souffrant d’un trouble de tics persistants et du syndrome de Tourette.Les données de base ont été examinées d’après un essai randomisé contrôlé plus vaste (Clinicaltrials.gov NCT02153463). L’activité physique a été évaluée par des podomètres enregistrant le compte de pas quotidien. La gravité des tics (évaluée par l’échelle globale de gravité des tics de Yale ou la YGTSS) et la QdV (évaluée par l’inventaire de la qualité de vie des jeunes adultes, PEDs QL 4.0) ont été comparées entre les enfants plus actifs physiquement (≥12 000 pas/jour) et les enfants moins actifs physiquement (12 000 pas/jour).Treize enfants ont participé; 4 avaient ≥12 000 pas/jour et 9 avaient12 000 pas/jour. Le groupe actif avait un total plus faible de gravité des tics (p = 0,02), et un score total moindre à la YGTSS (p = 0,01). Le score à la gravité des tics sonores était plus faible dans le groupe actif (p = 0,02). La gravité des tics moteurs n’était pas différente chez les 2 groupes. Pour les scores à la Peds QL, le groupe actif a eu un meilleur rendement au fonctionnement physique (p = 0,01), au fonctionnement social (p = 0,03), au fonctionnement scolaire (p = 0,02), au fonctionnement psychosocial (p = 0,03) et au score total de la PEDs QL (p = 0,01).Des niveaux supérieurs d’activité physique sont associés à une gravité plus faible des tics sonores et à des aspects améliorés de la qualité de vie. Il faut plus de recherche pour déterminer l’utilité de l’activité physique comme thérapie pour les tics.

Objective Rapid response systems using medical emergency teams reduce hospital wide cardiorespiratory arrest and mortality. While rapid response systems improve hospital-wide outcomes, children receiving medical emergency team review may still be at increased risk for morbidity and mortality. The study purpose was to compare the length of stay and mortality rate in children receiving a medical emergency team review with those of other hospitalized children. Design Retrospective cohort study. Setting Tertiary Pediatric Hospital, Children's Hospital of Eastern Ontario, Ottawa, Canada. Patients Cohort of 42,308 pediatric admissions to the general inpatient ward. Interventions Data over 7 years were obtained from a prospectively maintained rapid response systems database. Measurements and main results From the cohort, 995 (2.35%) of the admissions had one and 276 (0.65%) had multiple medical emergency team activations. When compared with patients without, children having one or multiple medical emergency team reviews had 13.34 (95% CI, 5.33-33.2) and 50.10 (95% CI, 19.86-126.39) times the odds of death, respectively. Patients experiencing a medical emergency team review stayed in hospital 1.59 times (95% CI, 1.39-1.82) longer, whereas those with multiple medical emergency team reviews stayed 2.44 times (95% CI, 1.85-3.20) longer. The associations remained significant after controlling for important confounders and excluding elective admissions from the analyses. Most repeat medical emergency team reviews occurred within a day of the initial review or involved patients with multiple comorbidities. Conclusions Our study suggests that pediatric patients reviewed by the medical emergency team are at significantly higher risk of mortality and longer length of stay than general ward inpatients. As well, patients with multiple medical emergency team reviews were at particularly high risk compared with patients with one medical emergency team review. Patients who experience medical emergency team reviews should be recognized as a high-risk group, and future studies should consider how to decrease morbidity and mortality. Based on our findings, we suggest that these patients be followed for 24-48 hours after any medical emergency team activation.

The effect of law changes on public sector productivity is a growing, yet underresearched, area in economics. Nineteen states enacted state wiretapping legislation following the 9/11 terror attacks, the provisions of which mirror the provisions in the USA PATRIOT Act that relaxed the use of wiretap surveillance. Using a proxy variable approach, we estimate wiretap productivity in terms of producing arrests and convictions originating from wiretap orders issued on narcotics offenses from 1998 to 2005. We find that the post-9/11 state wiretap law changes increased the unobserved total factor productivity, a measure of productive efficiency.

The Internet facilitates information flow between sex workers and buyers, making it easier to set up paid sexual transactions online. Despite the illegality of selling sexual services online, Section 230 of Communications Decency Act shields websites from liability for unlawful postings by third parties. Consequently, websites such as Craigslist have become a haven for prostitution-related ads. With prostitution-related sites still in operation, it is imperative to understand the link between these sites and prostitution trends. Specifically, in this paper, we quantify the economic impact of Craigslist’s entry on prostitution incidence, and identify potential pathways in which the website affects the sex industry. Using a national panel data set for 1,796 U.S. counties from 1999 to 2008, our analyses suggest that entry of Craigslist to a county leads to a 17.58 percent increase in prostitution cases. In addition, the analyses reveal that a majority of prostitution activity on Craigslist are induced by organized vice groups, in addition to voluntary participation by smaller set of independent providers. Further, we find site entry has a stronger impact in counties with a past history of prostitution and produces spillover effects in neighboring locations that are not directly served by Craigslist. Sex workers providing niche sexual services are found to increase with site entry. In addition, we learn that site entry leads to an increase in transactions of existing workers and also attracts new workers to the market. We find that the increase in prostitution arrests does not catch up with the growth in prostitution trends brought in by Craigslist. Finally, we find complementarity effects between erotic and casual sex ads in leading to the increase of prostitution. Our results contribute broadly to the emerging literature on the societal challenges associated with online intermediaries and Internet penetration, and serve to provide guidelines for policy makers in regulating the sex industry in the Internet era.

The most commonly cited issues with mobile apps are low user engagement and retention levels. In this paper, we explore the efficacy of crowdsourcing features on enhancing user engagement and retention in the context of mobile gaming apps. To do so, we examine two specific crowdsourcing features, namely, the ability to contribute content and the ability to access crowdsourced content. Under a 2×2 factorial design, we assess the impact of these crowdsourcing features on usage outcomes via a randomized field experiment. In our experiment, we also examine the underlying mechanisms that lead to the main observed effects. Interestingly, we find that even without contributing content, users exhibited heightened user engagement and retention when they are given the option to contribute gaming content to the app. But with actual content submission, usage improvement is promoted to a larger magnitude. In particular, results show that the content contribution feature reduces users’ hazard of ending a session and abandoning the app by 11% and 14%, respectively. Results also show that content access option only has positive effect on user retention but not user engagement. Moreover, the greatest improvement in user retention is achieved when users are treated with the full-crowdsourcing feature, which enables users to both contribute content and view crowdsourced content from the community. Finally, we find heterogeneous treatment effects in our study setting: full-crowdsourcing features tend to enhance the retention of heavy game players, while they heighten the engagement level of casual gamers. Study implications for app design and crowdsourcing are discussed.

Objectives The objective of the present study was to assess if the presence and severity of CAD is associated with decreased LVEF recovery after TAVI. Background Coronary artery disease (CAD) and low left ventricular ejection fraction (LVEF) are common findings in patients undergoing transcatheter aortic valve implantation (TAVI). The impact of CAD on LVEF recovery after TAVI has not been specifically evaluated. Methods All patients with LVEF≤50% who underwent TAVI between March 2006 and May 2012 were included in the study. The presence and severity of coronary artery disease was measured using the Duke Myocardial Jeopardy Score (DMJS). A DMJS = 0 corresponds to patients without CAD or complete revascularization and a DMJS > 0 to those with incomplete revascularization. LVEF recovery was assessed by transthoracic echocardiography, measuring the change in LVEF from baseline to 3-months post-TAVI. Myocardial viability was evaluated in a subgroup of patients using cardiac magnetic resonance (CMR) imaging pre-TAVI. Results Fifty-six patients were included in the study. Twenty-eight patients (50%) had a DMJS > 0. At 3 months, patients with incomplete revascularization (DMJS > 0) demonstrated less LVEF recovery post-TAVI (2.0 ± 9.2% versus 11.7 ± 8.9% if DMJS = 0; P = 0.001). On multivariate analysis, DMJS and presence of significant delayed-enhancement were found to be independent predictors of LVEF recovery. Patients with incomplete revascularization exhibited a worse prognosis with higher mortality at 30-days (22.2% versus 0% if DMJS = 0; P = 0.010) and 1-year (25.9% versus 3.5% if DMJS = 0; P = 0.019). Conclusions The present study demonstrates an independent association between incomplete revascularization and decreased LVEF recovery in patients with left ventricular dysfunction undergoing TAVI for severe aortic stenosis. © 2014 Wiley Periodicals, Inc.

Background The Amplatzer™ Amulet™ (Amulet) is the evolution of the Amplatzer™ Cardiac Plug, a dedicated device for percutaneous left atrial appendage (LAA) occlusion. The new device has been designed to facilitate the implantation process, improve the sealing performance and further reduce the risk of complications. The objective of the study was to describe the initial experience with the Amplatzer Amulet for percutaneous LAA occlusion. Methods This was a prospective single-center study of patients undergoing percutaneous LAA occlusion. The indication for LAA closure was a formal contraindication for oral anticoagulation or previous history of stroke due to INR lability. All procedures were done under general anesthesia and transesophageal echocardiography (TEE) guidance. Transthoracic echocardiography was performed 24 h after the procedure in order to rule out procedural complications before discharge. Further follow-up was done with a clinical visit and TEE at 1–3 months. Results Between July-2012 and June-2013, 25 patients with a mean CHA2DS2-VASC of 4.3 ± 1.7 underwent LAA occlusion with the Amplatzer Amulet. The device was successfully implanted in 24 patients (96%) without any procedural stroke, pericardial effusion or device embolization. None of the patients presented any clinical event at follow-up. Follow-up TEE showed complete LAA sealing in all patients with no residual leaks > 3 mm and no device embolization. One patient (4.1%) presented a device thrombosis at follow-up without clinical expression. Conclusion In this initial series of patients, the Amulet showed a remarkable acute and short-term performance in terms of feasibility and safety as depicted by the high successful implantation rate and the low incidence of complications.

This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for primary and adjuvant treatment of cancer of the glottic larynx are reviewed here in a systematic fashion according to stage.

Self-expanding (SE) valves are characterized with long stent frame design and the radial force of the device exists both in the inflow and outflow level. Therefore, we hypothesized that device success of SE-valves may be influenced by ascending aortic dimensions (AAD). The aim of this study was to determine the influence of AAD on acute device success rates following SE transcatheter aortic valve replacement (TAVR).In 4 centers in the United States and Asia, 214 consecutive patients underwent SE-TAVR. Outcomes were assessed in line with Valve Academic Research Consortium criteria. AAD was defined as the sum of the short and long axis aortic diameter divided by 2. Overall, device success rate was 85.0%. Multivariate analysis revealed that increased AAD (Odds ratio 1.27) and % oversizing (Odds ratio 0.88) were found to be independent predictors of unsuccessful device implantation. The c-statistic of the model for device success was area under the curve 0.79, sensitivity 81.3% and specificity 44.0%. Co-existence of several risk factors was associated with an exponential fall to 64.2% in device success rate. For a large AAD, however, optimally oversized SE-valves (threshold 16.2%) resulted with high device success rates compared to suboptimal oversizing (88.6% vs. 64.2%, p=0.005).Larger AAD and smaller degrees of oversizing were confirmed to be the most relevant predictors of unsuccessful device implantation following SE-valve implantations. Optimal oversizing of great significance was noted, particularly that with a large AAD.

While radiation therapy is the mainstay of treatment for nasopharyngeal carcinoma, the anatomic location of the nasopharynx in close proximity to radiation-sensitive organs such as the salivary glands, optic nerves and chiasm, cochlea, brainstem and temporal lobes presents a special challenge. Technological approaches to reducing the morbidity of nasopharyngeal cancer irradiation have been historically successful with the evolution from 2D techniques to increasingly conformal forms of radiation therapy. This report reviews normal tissue dose constraints and major considerations in target delineation for patients with nasopharyngeal cancer in the intensity-modulated radiation therapy era. Furthermore, this report discusses more contemporary approaches to toxicity reduction such as the judicious reduction or omission of radiation to low-risk regions and the potential role of particle beam therapy.

Chemical modifications of proteins have been well-documented to play important roles in normal cell physiology such as cell signaling and protein functions. They have also been demonstrated to be one of the milestones in the pathophysiology of many human diseases such as cancer, age-related pathology, and neurodegenerative disorders. Here, we report the initial identification of a novel protein modification, cysteine thiazolidination, through reaction with endogenous and exogenous formaldehyde with cysteine residues in proteins. Using an isotope-dilution liquid chromatography–tandem mass spectrometric (LC–MS3) method, we initiated the study by quantitating thioproline in formaldehyde-treated Escherichia coli (E. coli) protein. The study was then extended to quantitate thioproline in protein obtained from formaldehyde- and oxidant-exposed E. coli. Furthermore, N6-formyllysine, a well-defined formylation product between formaldehyde and lysine, was exploited in a comparative study to evaluate the relative r...

1079 Background: Brain metastases (BM) are a common and fatal complication of breast cancer but survival varies widely based on various prognostic factors (PF). Hence, patient counseling and therapeutic decisions should be individualized. We previously published a prognostic index (Breast GPA) based on cohort A (1985-2007, n = 642), updated it with tumor subtype in cohort B (1993-2010, n = 400) and are now updating it with a larger contemporary cohort (C). Methods: A multi-institutional (19) multi-national (3) retrospective database of 2473 breast cancer patients with BM diagnosed from 1/1/2006-12/31/2017 was created and compared to our prior cohorts. Demographic, clinical, molecular factors, tumor subtype and treatment were correlated with survival. Kaplan-Meier survival estimates were calculated and compared with log-rank tests. Results: The median survival (MS) for cohorts A, B and C improved over time [12, 14 and 16 mo, respectively ( < 0.01)] despite the subtype distribution becoming less favorable: Luminal B (ER/PR/HER2+) decreased from 26% to 21%; HER2 (HER2+/ER/PR-) decreased from 31% to 17%, Luminal A (ER/PR+/HER2-) increased from 20% to 31%; Basal (ER/PR/HER2-) was unchanged at 24%.MS by subtype improved from 21 to 27 mo in Luminal B, 18 to 25 mo in HER2, 10 to 14 mo in Luminal A and 6 to 9 mo in Basal tumors. The number of BM was 1 in 35%, ≤4 in 67% and > 10 in 18%. PF significant for survival were tumor subtype, age, KPS, number of BM and extracranial metastases (ECM) (all < 0.01). Surprisingly, Hispanic women (7%) showed improved survival (p < 0.01). BRCA1 was mutated in 57/533 (11%) and those patients showed a trend (0.16) toward improved survival. Treatment patterns have changed: the use of whole brain radiation therapy decreased from 71% to 67% to 47% in cohorts A, B and C, respectively. Conclusions: Despite the shift to less favorable tumor subtypes, MS has improvedbut varies widely by diagnosis-specific PF. Compared to prior cohorts, number of BM and ECM were identified as new PF. Ethnic, genetic and treatment differences between the eras are apparent. The updated Breast GPA, based on these data, and the correlation between BRCA1 and tumor subtype will be presented.

Background: Syncope is a common problem but can have any of a broad range of underlying causes. Initial evaluation of the patient in the emergency department often does not identify a specific cause, and the cornerstone of management is reliable risk stratification with clinical decision rules. Objectives: The primary objective is to validate the utility and safety of the Canadian Syncope Risk Score (CSRS) as a clinical decision rule when assessing patients who present with syncope to Australian emergency departments. Our secondary objective is to evaluate the economic benefits of diverting patients with syncope at low risk of serious adverse events from admission to hospital. Methods and analysis: Prospective, observational study. Patients aged 18 years or more who present to the emergency department (ED) after syncope in the preceding 24 hours and have returned to their baseline state will be enrolled. Patients will be contacted by telephone to determine whether they have experienced any adverse events within 30 days of their initial presentation to the ED. The CSRS will be applied retrospectively to determine the relationship between whether patients were admitted to hospital or discharged home and the reporting of serious adverse events for each CSRS risk level. We will also undertake a cost-effectiveness analysis from the health care perspective. Ethics approval: Prince Charles Hospital Human Research Ethics Committee (reference, HREC/17/QPCH/48). Dissemination of results: Outcomes will be disseminated by Queensland Health and the funding body via social media, presented at local and national emergency medicine conferences, and published in international emergency medicine and health economics journals. Clinical trials registration: Not applicable.

The purpose of this retrospective cohort study was to evaluate the effect of tumor location and other major factors on the risk of complications from stereotactic body radiation therapy (SBRT) in non-small cell lung cancer (NSCLC) patients with a history of thoracic surgery and/or radiation therapy. Medical records of patients with recurrent or second primary NSCLC treated with SBRT between 2005 and 2015 were reviewed. All patients had prior thoracic surgery and/or radiation therapy and were treated with image-guided, robotic SBRT. Time to local failure and toxicity was evaluated by using cumulative incidence and competing risk regression analysis. Overall survival was estimated using the Kaplan-Meier method. Fifty-six patients with 74 tumors treated with SBRT were included for analysis. Of the 74 tumors, 19 (26%) were centrally located within 2 cm of the proximal bronchial tree. At a median follow-up of 27 months (range = 5–129), the 2-year cumulative incidence of LF was 13% for peripheral tumors and 16% for central tumors (p = 0.95). Neither prior thoracic surgery nor radiation therapy was associated with increased LF or toxicity. Among the 56 patients, eight (14%), three (5%), and one (2%) experienced grade 2, 3, and 4 complications following SBRT. Patients with a ≥ 50 pack-year smoking history were more likely to develop ≥ grade 2 toxicity (HR 5.3; 95% CI 1.4–19.9, p = 0.01). Central tumor location was associated with higher risk of toxicity (HR 3.4; 95% CI 1.1–10.5, p = 0.04) as was planning tumor volume > 30 mL (HR 4.3; 95% CI 1.1–16.3, p = 0.047). In a multivariable model, central location remained significant after adjusting for smoking history and planning tumor volume. After prior thoracic surgery and/or radiation, SBRT retreatment for NSCLC provided durable local control and was well tolerated in most patients. Patients with a history of previously operated and/or radiated lung cancer with new central tumors, PTV volume > 30 mL, or smoking history ≥ 50 pack-years were at higher risk of complications from SBRT.

The goal of this study is to demonstrate the feasibility of a novel fully-convolutional volumetric dose prediction neural network (DoseNet) and test its performance on a cohort of prostate stereotactic body radiotherapy (SBRT) patients. DoseNet is suggested as a superior alternative to U-Net and fully connected distance map-based neural networks for non-coplanar SBRT prostate dose prediction. DoseNet utilizes 3D convolutional downsampling with corresponding 3D deconvolutional upsampling to preserve memory while simultaneously increasing the receptive field of the network. DoseNet was implemented on 2 Nvidia 1080 Ti graphics processing units and utilizes a 3 phase learning protocol to help achieve convergence and improve generalization. DoseNet was trained, validated, and tested with 151 patients following Kaggle completion rules. The dosimetric quality of DoseNet was evaluated by comparing the predicted dose distribution with the clinically approved delivered dose distribution in terms of conformity index, heterogeneity index, and various clinically relevant dosimetric parameters. The results indicate that the DoseNet algorithm is a superior alternative to U-Net and fully connected methods for prostate SBRT patients. DoseNet required ~50.1 h to train, and ~0.83 s to make a prediction on a 128 × 128 × 64 voxel image. In conclusion, DoseNet is capable of making accurate volumetric dose predictions for non-coplanar SBRT prostate patients, while simultaneously preserving computational efficiency.