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本研究旨在探討於不同程度與類型之死亡威脅對消費者自我控制之影響，以自尊、自我偏誤為調節變項。研究採22因子設計，實驗一結果為：(1)死亡威脅對不健康食品購買意願有顯著影響；(2)高死亡威脅對不健康食品購買意願高於低死亡威脅之購買意願；(3)低自尊者在高死亡威脅下對不健康食品購買意願高於低死亡威脅；(4)高自尊者在高死亡威脅下對健康食品購買意願高於低死亡威脅。實驗二結果為：(1)自我偏誤對不健康食品購買意願具邊際顯著影響；(2)自我負向偏誤者對不健康食品購買意願高於自我正向偏誤者；(3)土石流死亡威脅下，自我負向偏誤者對購買不健康食品的意願高於自我正向偏誤者。 This study examines the effects of mortality salience on consumers’self-control. Two experiments were conducted with a 22 factorial design. The result of study 1 found that the morality salience has significantly effect on purchase intention of unhealthy food; while in high mortality salience. For purchase intention of unhealthy food is higher than low mortality salience. In high mortality salience, low self-esteem for purchasing intention of unhealthy food is significantly higher than high. In high self-esteem, high mortality salience causes significantly higher purchase intent of healthy food than low mortality salience; The result of study 2 found that self-bias causes marginally significant effect on purchase intention of unhealthy food, and self-negativity biased people’s purchase intention of unhealthy food is significantly higher than self-positivity biased people’s. In mudslide mortality salience, self- negativity biased people’s purchase intent of unhealthy food is significantly higher than self-positivity biased people’s. &nbsp

Objective There is a current and anticipated labor shortage of endocrinologists in the United States. Over the past decade, the number of applications to endocrinology fellowship programs has plateaued despite increased available positions, and interest in endocrinology has declined relative to other internal medicine subspecialty fields. The examination of driving factors for pursuit of endocrinology as a subspecialty career is needed. Methods A 12-question online survey was developed to identify the primary reasons for current endocrinology fellows/trainees to pursue the field. This survey was sent to 152 U.S. endocrinology fellowship program directors for completion by their fellows between July and August 2021. Results A total of 176 of 629 fellows (28.0%) completed the survey. The majority (57.4%) had decided to pursue endocrinology as a career during residency, while 27.3% had decided during medical school. The endocrinology rotation during residency was ranked by 79 fellows (44.9%) as the most influential factor, followed by having positive experiences with a clinical mentor (27.3%). Endocrinology exposure during medical school was sparse, with only 2.8% noting the availability of an endocrinology student interest group, while 59.7% reported inadequate endocrinology exposure during their medical school curriculum. Conclusion The majority of current endocrinology fellows/trainees report that exposure to the field during medical school was limited, and that their endocrinology elective and mentorship experiences during residency were the most influential factors for pursuing endocrinology as a subspecialty. Improved integration of endocrinology experiences between medical school and residency may enhance career interest in endocrinology.

Double or multiple pituitary adenomas are rare and account for only 1.6-3.3% of all corticotroph tumors. We describe 2 distinct pituitary corticotroph adenomas in a 43-year-old female presenting with ACTH-dependent Cushing disease (CD). Although pre-operative pituitary MRI noted a single 8×6mm left sided pituitary microadenoma, which was confirmed at trans-nasal trans-sphenoidal surgery, she was found to an additional 7mm right sided microadenoma. Histopathology confirmed 2 separate corticotroph adenomas and she exhibited immediate remission of her CD with nadir cortisol of 1mcg/dL. Whole exome sequencing demonstrated a somatic mutation in the 21-alpha-hydroxylase (CYP21A2) gene in both tumors. CYP21A2 transcript and protein expression were absent in the index case but both CYP21A2 transcript and protein were demonstrated in a series of 9 other pituitary corticotroph adenomas and 12 normal pituitary tissues. This unusual case which prompted us to examine CYP21A2 expression in the pituitary allows us to describe for the first time evidence of locally generated pituitary-derived cortisol and indicate this could play a paracrine role on the corticotroph and may contribute to growth of ACTH pituitary adenomas in some instances. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Background: Immune checkpoint inhibitors (ICI) have revolutionized the treatment of many advanced cancers but are recognized to cause treatment-limiting immune-related adverse events (IrAE). ICI-associated thyroiditis is the most common endocrine IrAE and usually resolves to permanent hypothyroidism. Optimal thyroid hormone replacement in these patients remains unclear. We report the levothyroxine (LT4) dose needed to achieve stable euthyroid state in patients with hypothyroidism from ICI-associated thyroiditis, with comparison to patients with Hashimoto's thyroiditis (HT) and athyreotic state. Methods: We conducted a retrospective study of adults with ICI-associated hypothyroidism treated with LT4 at an academic medical center. Patient data were collected from the electronic medical record. Cases had ICI exposure followed first by hyperthyroidism and then subsequent hypothyroidism. Controls were HT (positive thyroid autoantibodies, requiring LT4) and athyreotic (total thyroidectomy or radioiodine ablation, requiring LT4) patients. Patients with central hypothyroidism, thyroid cancer, pregnancy, gastrointestinal stromal tumors, and use of L-triiodothyronine were excluded. Our primary outcome compared LT4 dose needed to achieve euthyroid state (thyrotropin 0.3-4.7 mIU/L over >6 consecutive weeks) for ICI-associated hypothyroidism, HT, and athyreotic patients, considering the impact of age and possible interfering medications by linear regression modeling. Secondary analysis considered the impact of endocrine specialty care on the time to euthyroid state. Results: One hundred three patients with ICI-associated thyroiditis were identified. Sixty-six of the 103 patients achieved euthyroid state; 2 with intrinsic thyroid gland function recovery and 64 on LT4. The mean LT4 dose achieving stable euthyroid state was 1.45 ± standard deviation (SD) 0.47 mcg/[kg·day] in ICI-associated hypothyroidism, 1.25 ± SD 0.49 mcg/[kg·day] in HT, and 1.54 ± SD 0.38 mcg/[kg·day] in athyreotic patients, using actual body weight. The difference in dose between ICI-associated hypothyroidism and HT was statistically significant (p = 0.0093). Dosing differences were not explained by age or use of interfering medications. Conclusions: ICI-associated thyroiditis represents an increasingly recognized cause of hypothyroidism. Our study demonstrates that patients with ICI-associated hypothyroidism have different thyroid hormone dosing requirements than patients with HT. Based on our findings and prior reports, we recommend that in patients with ICI-associated thyroiditis LT4 therapy be started at an initial weight-based dose of 1.45 mcg/[kg·day] once serum free thyroxine levels fall below the reference range.

Subclinical hyperthyroidism (SCHyper) is a biochemical diagnosis characterized by a decreased serum thyroid-stimulating hormone (TSH) and normal serum thyroxine (T4) and triiodothyronine (T3) concentrations. Because SCHyper can be resolved, it is recommended to repeat serum TSH, T3, and T4 concentrations in 3 to 6 months before confirming a diagnosis of SCHyper to consider treatment. Proposed grading systems distinguish between mild (TSH, 0.1-0.4 mIU/L) and severe SCHyper (TSH

Background: Aristolochic acids (AA) and arsenic are chemical carcinogens associated with urothelial carcinogenesis. Here we investigate the combined effects of AA and arsenic toward the risk of developing upper tract urothelial carcinoma (UTUC). Methods: Hospital-based (n = 89) and population-based (2,921 cases and 11,684 controls) Taiwanese UTUC cohorts were used to investigate the association between exposure to AA and/or arsenic and the risk of developing UTUC. In the hospital cohort, AA exposure was evaluated by measuring aristolactam-DNA adducts in the renal cortex and by identifying A>T TP53 mutations in tumors. In the population cohort, AA exposure was determined from prescription health insurance records. Arsenic levels were graded from 0 to 3 based on concentrations in well water and the presence of arseniasis-related diseases. Results: In the hospital cohort, 43, 26, and 20 patients resided in grade 0, 1+2, and 3 arseniasis-endemic areas, respectively. Aristolactam-DNA adducts were present in >90% of these patients, indicating widespread AA exposure. A>T mutations in TP53 were detected in 28%, 44%, and 22% of patients residing in grade 0, 1+2, and 3 arseniasis-endemic areas, respectively. Population studies revealed that individuals who consumed more AA-containing herbs had a higher risk of developing UTUC in both arseniasis-endemic and nonendemic areas. Logistic regression showed an additive effect of AA and arsenic exposure on the risk of developing UTUC. Conclusions: Exposure to both AA and arsenic acts additively to increase the UTUC risk in Taiwan. Impact: This is the first study to investigate the combined effect of AA and arsenic exposure on UTUC.

To characterize the current landscape of preclinical medical endocrine education in U.S. allopathic medical schools.U.S. endocrine curriculum directors were asked to voluntarily complete a 16-question email survey surveying the status of endocrine preclinical education at their medical school.Sixty-nine of 155 (45%) endocrine block director respondents completed the online survey between July 2021 and September 2021. A larger incoming class, a longer duration of the endocrine curriculum, and the offering of a separate endocrine curriculum (ie apart from the teaching of other organ systems) were each independently associated with an increased number of faculty teaching the course. Schools that used a gland-/organ-based curriculum only and those that used a combination of gland-/organ-based curriculum with topic-based curriculum differed significantly in their use of large lectures, small groups, and several curriculum components, including point of care glucose testing, continuous glucose monitoring, and insulin pumps.This survey study reports the current landscape of preclinical endocrine education in the United States and describes opportunities to improve interest in pursuing endocrinology as a career.

Background The incidence of intrathyroidal parathyroid adenoma varies from Clinical Case A 59-year-old female with osteopenia and a recent history of traumatic vertebral fracture presented for workup of asymptomatic hypercalcemia. Labs showed intact parathyroid hormone (iPTH) 168 pg/mL (reference 11-51 pg/mL), serum total calcium 12.2 mg/dL (reference range 8.6-10.4 mg/dL), albumin 4.7 g/dL (reference 4.1-5.3 g/dL), phosphorus 2.1 mg/dL (reference 2.3-4.4 mg/dL), creatinine 0.7 (reference 0.6-1.3 mg/dL), and 25-OH vitamin of 28 ng/mL (reference 20-50 ng/mL). Cervical ultrasound showed a 2.1 cm hypoechoic left thyroid nodule. Subsequent 99mTc-Sesatmibi scan showed increased tracer retention in the left posterior thyroid lobe. FNA of the left thyroid nodule was performed with cytology showing follicular lesion of undetermined significance (FLUS). Molecular testing with Thyroseq v2 showed parathyroid tissue consistent with intrathyroidal parathyroid adenoma. The patient underwent successful left thyroid lobectomy with removal of an intrathyroidal parathyroid gland, with subsequent decrease of iPTH to 44 pg/mL (reference 11-51 pg/mL) and total serum calcium to 9.5 mg/dL (reference 8.6-10.4 mg/dL). Surgical pathology confirmed parathyroid adenoma. Discussion Due to the ubiquity of thyroid FNAs to rule out malignancy, there has been a rise in the number of incidental parathyroid gland aspirations. Thyroid lesions with diagnosis of FLUS or oncocytic features are prone to misdiagnosis due to similarities in morphologic overlap and anatomic proximity. Molecular testing such as Thyroseq v2 routinely tests for PTH and can identify parathyroid tissue in lesions initially diagnosed as indeterminate thyroid nodules. Newer molecular test versions including ThyroSeq v3 similarly have high analytical accuracy in detecting thyroid cancer and parathyroid lesions. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

A 74-year-old woman with a history of primary hyperparathyroidism, thyroid nodules, atrial fibrillation and pacemaker placement for sick sinus syndrome presented with fatigue, constipation and persistent lower extremity oedema. She underwent subtotal parathyroidectomy and left thyroid lobectomy. Histopathology revealed amyloidosis affecting the thyroidand parathyroids confirmed by Congo Red Staining with Mayo Clinic subtyping of light chain kappa-type amyloidosis. She was found to have combined systolic and diastolic cardiac dysfunction, carpal tunnel neuropathy and pre-diabetes suggestive of systemic amyloidosis with involvement of the heart, nerves and pancreas. Congo red stain was positive for amyloidosis on bone marrow biopsy suggestive of a diagnosis of systemic amyloidosis. She was treated with daratumumab with good clinical response. This case illustrates the necessity of considering systemic amyloidosis in patients with incidentally discovered diffuse amyloid deposits on biopsy of an endocrine organ, as endocrine effects are a rare but likely underdiagnosed consequence of systemic amyloidosis.

Hypoglycemic episodes are associated with worse hospital outcomes. All adult patients admitted to our burn center from 2015 to 2019 were retrospectively reviewed. Patient demographics and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes were total length-of-stay and intensive care unit length-of-stay. All patients experiencing at least one hypoglycemic episode were compared to patients who did not experience hypoglycemia. There were 914 patients with acute burns admitted during the study period, 33 of which (4%) experienced hypoglycemic episodes. Of these, 17 patients (52%) experienced a single hypoglycemic episode, while the remainder experienced multiple hypoglycemic episodes. Patients with one or more hypoglycemic events were matched to non-hypoglycemic controls using propensity matching. Patients that experienced hypoglycemia had significantly less TBSA involvement (5% vs. 13%,median, p < 0.0002), higher prevalence of diabetes (48% vs. 18%, p < 0.0001), higher mortality (18% vs. 7%, p = 0.01), longer total length-of-stay (22 vs. 8 days, median, p < 0.0001), and longer ICU length-of-stay (12 vs. 0 days, median, p < 0.0001). A single hypoglycemic episode was associated with prolonged total (IRR = 1.91, p < 0.0001) and ICU length-of-stay (IRR = 3.86, p < 0.0001). Hypoglycemia was not associated with higher mortality in the survival analysis (p = 0.46).

A myriad of physical phenomena, such as fluid flows, magnetic fields, and population dynamics are described by vector fields. More often than not, vector fields are complex and their analysis is challenging. Vector field topology is a powerful analysis technique that consists in identifying the most essential structure of a vector field. Its topological features include critical points and separatrices, which segment the domain into regions of coherent flow behavior, provide a sparse and semantically meaningful representation of the underlying data. However, a broad adoption of this formidable technique has been hampered by the lack of open source software implementing it. The Visualization Toolkit (VTK) now contains the filter vtkVectorFieldTopology that extracts the topological skeleton of 2D and 3D vector fields. This paper describes our implementation and demonstrates its broad applicability with two real-world examples from hydrology and space physics.

Introduction Hypoglycemic episodes are associated with worse hospital outcomes, and their incidence varies by institution. We sought to define the prevalence of hypoglycemic episodes at our burn center and determine their association with hospital outcomes. Methods We retrospectively reviewed all consecutive adult and pediatric patients admitted to our burn center from 2015 to 2019. Patient demographics and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes were total length of stay (LOS) and intensive care unit LOS (ICU LOS). All patients experiencing hypoglycemic episodes were compared to patients who did not experience hypoglycemic episodes (controls) using two-tailed t, chi-squared, and multivariate logistic and multiple linear regression analyses. Results A total of 914 patients with acute burns were admitted during the study period. Thirty-three patients (4%) experienced hypoglycemic episodes (< 60 mg/dL). Of these, 17 patients (52%) experienced a single hypoglycemic episode, while the remainder (N=16) experienced multiple hypoglycemic episodes. There were no significant differences in age, sex, or presence of inhalation injury between hypoglycemic patients and controls. Patients that experienced a hypoglycemic episode had significantly greater TBSA involvement (23% vs. 11%, p< 0.00), higher prevalence of diabetes (48% vs. 20%, p< 0.00), higher mortality (18% vs. 7%, p=0.01), longer total LOS (39 vs. 13 days, p< 0.00), and longer ICU LOS (28 vs. 4 days, p< 0.00). A single hypoglycemic episode was associated with prolonging total LOS by 19 days (p< 0.00) and ICU LOS by 18 days (p< 0.00). Hypoglycemic episodes were not associated with higher odds of mortality (OR=0.9, 95% CI 0.3–3.0, p >0.05). There were no differences in outcomes between patients with single or multiple hypoglycemic episodes. Patients with multiple hypoglycemic episodes more frequently had a history of diabetes (81% vs. 18%, p< 0.00), and worse glucose control (HbA1c, 9% vs. 7%, p=0.04) compared to patients with single episodes. Conclusions Hypoglycemic episodes were associated with longer total and ICU LOS in our study but did not portend higher mortality. Applicability of Research to Practice Quality improvement efforts to prevent hypoglycemic episodes should focus efforts on known diabetics with high HbA1c levels.

BACKGROUND: Complete androgen insensitivity (CAIS) is a rare cause of primary amenorrhea and is usually diagnosed in menarche. Patients with CAIS are phenotypically female with a 46, XY karyotype, have elevated testosterone, LH, and FSH levels, and have little or no virilization due to androgen receptor gene mutations. The recommended treatment is orchiectomy due to the increased risk of gonadal malignancy and post-operative hormonal therapy. CLINICAL CASE: A 31-year-old female with no past medical history presented for evaluation of primary amenorrhea. She was born full term with a normal IQ, and no developmental delays or disabilities. The patient had no menstrual periods, minimal breast development, and sparse facial, axillary, and pubic hair growth. She reported having a shallow vaginal canal and absence of a cervix. All of her siblings had normal sexual development with no reproductive or gynecological disorders, and have been able to conceive without any problems. Review of systems was negative for vision changes, galactorrhea, abdominal pain, urinary or defecation problems however positive for headaches. Patient identified as a lesbian. On physical exam the patient had normal vital signs, height of 164 cm and 86 kg (calculated BMI 32); increased muscular tone; no voice deepening; no abdominal pain; sparse hair in the pubic region, upper lip, chin, and bilateral axillae; and Tanner stage 2 breasts. Genitourinary exam was notable for large labia majora, clitoromegaly, palpable testes in inguinal canal, blind vaginal pouch, and absent uterus and cervix. Labs showed normal estradiol (17pg/mL; male 5-52pg/mL), elevated testosterone (273ng/dL; male 249-836ng/dL, female

Avoidant/restrictive food intake disorder (ARFID) is a diagnosis in diagnostic and statistical manual of mental disorders-5 (DSM-5) manifested by persistent failure to meet nutritional and/or energy needs. Pudendal nerve entrapment (PNE) often causes pelvic discomfort in addition to constipation and painful bowel movements. Current literature on ARFID is sparse and focuses on the pediatric and adolescent population. No association between PNE and ARFID has been described. We present a case of ARFID in an adult male with PNE resulting from subsequent scarring from testicular cancer surgery. The patient's gastrointestinal symptoms due to PNE caused significant food avoidance and restriction subsequently leading to severe malnourishment. Clinicians should be aware that distressing gastrointestinal symptoms arising from a secondary disease process such as PNE might lead to dietary restriction and food aversion. More research is needed for proper screening, detection, and treatment of ARFID. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:84-87).

Pre-boundary lengthening, also known as phrase-final lengthening, is a well-established phenomenon. In stress languages, pre-boundary lengthening has been shown to interact with lexical prominence (i.e., stress), affecting the boundary-adjacent constriction gestures in stress-final words, but being attracted towards the stressed syllable when stress is non-final. However, the interaction between pre-boundary lengthening and lexical prominence in a language with lexical pitch accent, like Japanese, is not well understood. The current study uses kinematic data collected with Electromagnetic Articulography (EMA) to investigate this interaction in Japanese. We examine pre-boundary lengthening in trisyllabic phrase-final words as a factor of pitch accent position (initial-accented, medial-accented, final-accented, and no accent). Preliminary results based on duration measurements of the consonant constriction gestures comprising the phrase-final words show that in words with no pitch accent, pre-boundary lengthening has a progressive effect extending two syllables away from the right edge of the phrase, being strongest in the word-final syllable. If pitch accent is present, pre-boundary lengthening is affected by the former’s position. The lengthening effect is limited to the final syllable in initial- and medial-accented words, and disappears in final-accented words. Typological dimensions of the interaction between prominence and boundaries are discussed. [Work supported by NSF.]

The human pathogens enterohemorrhagic and enteropathogenic Escherichia coli (EHEC and EPEC), as well as the related mouse pathogen Citrobacter rodentium , utilize a type III secretion system (T3SS) to inject multiple effector proteins into host cells. The E. coli O157:H7 strain EDL933 carries two copies of non-locus of enterocyte effacement (LEE)-encoded protein H, designated NleH1 and NleH2, both of which bind to the human ribosomal protein S3 (RPS3), a subunit of NF-κB transcriptional complexes. In this study, we describe significant functional differences between NleH1 and NleH2 in their ability to regulate the host NF-κB pathway. We show that the EHEC and EPEC NleH effectors are functionally equivalent in their ability to affect RPS3 nuclear translocation. NleH1, but not NleH2, inhibited NF-κB activity without altering the kinetics of IκBα phosphorylation/degradation. We also determined that the class I PSD-95/Disc Large/ZO-1 (PDZ)-binding domain of NleH was important for its activity in the NF-κB pathway. In addition to binding RPS3, we found that NleH1 and NleH2 are able to bind to each other in vitro and in vivo , suggesting an additional mechanism by which the E. coli NleH effectors may regulate the extent and duration of NF-κB activation after their T3SS-dependent translocation. We also performed mouse infection experiments and established that mouse mortality and Citrobacter colonization were reduced in mice infected with Δ nleH . Complementing Δ nleH with NleH1 restored Citrobacter virulence and colonization to wild-type levels, whereas complementing with NleH2 reduced them. Taken together, our data show that NleH1 and NleH2 have pronounced functional differences in their ability to alter host transcriptional responses to bacterial infection.

Many Japanese varieties, including Tokyo Japanese, have lexical pitch accent patterns that can result in homophones that vary across dialects, such as ame HL 'rain (Tokyo)' and ame LH 'candy (Tokyo), rain (Kansai)'. Experimental research on lexical pitch accent in Japanese has been limited, however, to Tokyo Japanese and accentless varieties (Utsugi, Koizumi & Mazuka, 2011). This study explores homophone effects of minimal accent pairs for speakers of Kansai Japanese, a dialect that, unlike Tokyo Japanese, has base tone melodies, HL or LHL (Haraguchi, 1977), in addition to lexical pitch accent. Unlike previous studies on processing effects of Japanese homophones (Cutler & Otake, 1999; Minematsu & Hirose, 1995) that focus on visual recognition in Tokyo Japanese (Hino, Kusunose, Lupker & Jared, 2013; Sekiguchi, 2006), the current experiment measures reaction times to auditory stimuli in a lexical decision task comparing Tokyo Japanese with Kansai Japanese, whose speakers are typically bi-dialectal speakers ...

The goal of higher education is to provide students an equal opportunity to access their education for success. With significant competition within the peer group, potential students look for quality, flexibility, and affordability in the educational environment. In addition, the relationship between students and the institution involves a concentrated and more specific set of expectations. In order to improve students’ academic performance and fulfill individual needs, universities aim to enhance the quality of students’ learning environment and academic achievements. The higher education system relies on efficient operation and strategic planning to fulfill students’ needs through an internal emphasis on institutional performance improvement. A study on measuring the performance of higher education is presented. The research was focused on four-year and above, public and not-for-profit private universities in the southern region (AL, AR, KY, LA, MS, OK, TN, and TX) of the United States. The data includes 270 universities which were obtained from the Institute of Education Sciences, U.S. Department of Education. This study applied the Data Envelopment Analysis (DEA) approach; the purpose is to use a linear programming model to demonstrate a novel benchmarking process of higher education institutional performance and determine an overall benchmark for institutions within each classified group. From the results, suggestions are provided for the general guidance of planners and decision makers in the higher education system.