Now I Know My “ACBs”: The Right to Literacy Following an Incremental Path

It is a tragic irony that a nation with enormous wealth will not provide the most basic of education rights to its citizens. Despite continual judicial and legislative measures to ensure access to education, or a facsimile thereof, no judicial or legislative body has taken the step to ensure that literacy is a fundamental right for the citizens of the United States. The issue has been, and continues to be, presented to both Congress and the courts. While Congress has passed legislation to some degree, both institutions have largely failed to ensure the population receives the fundamental right of literacy. There is not much pushback to the argument that education and literacy are important. But questions remain: How much education is necessary to claim that literacy is a right? Is literacy important enough to shine brightly on the national consciousness

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

TCT-118 Propensity-Adjusted Population-Based Analysis of Impella in Patients Undergoing High-Risk PCI From a Large-Scale Claims Dataset

Background: Impella (Abiomed) was FDA approved in 2015 for use in high-risk percutaneous coronary intervention (PCI). We compared post-approval outcomes and costs of Impella versus intra-aortic balloon pump (IABP) support for high-risk PCI in real-world contemporary practice in US hospitals. Methods: From April 2016, to June 2019, 48,179 patients from the Premier Healthcare Database underwent Impella- or IABP-supported PCI at 304 hospitals. We selected patients with nonemergent admission undergoing single PCI procedures with either Impella or IABP support on the day of admission, excluding patients presenting with acute ST-elevation myocardial infarction (STEMI) or cardiogenic shock (CS). Propensity adjustment was used to control baseline differences between treatment groups. Outcomes included in-hospital survival, MI, CS, stroke, bleeding requiring transfusion, acute kidney injury (AKI), index hospitalization length of stay (LOS), and costs. Results: The 2,156 patients meeting nonemergent high-risk PCI criteria were treated with Impella (n = 1,447) or IABP (n = 709). After propensity adjustment, Impella use was associated with improved survival (odds ratio [OR]: 1.55, 95% confidence interval [CI]: 1.02-2.36) and less MI (OR: 0.29; 95% CI: 0.18-0.46) and CS (OR: 0.54; 95% CI: 0.39-0.74). Stroke, bleeding requiring transfusion, and AKI were similar among groups. Impella use was associated with shortened LOS but increased hospitalization costs versus IABP. In-hospital complications, including MI, CS, stroke, and bleeding requiring transfusion, were strong predictors of death. Conclusion: In this propensity-adjusted analysis, use of Impella during nonemergent high-risk PCI was associated with improved survival and reduced in-hospital MI and CS versus IABP. Categories: CORONARY: Hemodynamic Support and Cardiogenic Shoc

Coded-aperture x-ray/gamma-ray telescope for arc-minute localization of gamma-ray bursts

MARGIE (Minute-of-Arc Resolution Gamma-Ray Imaging Experiment) will be a large-area (approx. 104 cm2), wide field-of-view (approx. 26° half-angle), hard X-ray/gamma-ray imaging telescope capable of providing accurate positions for faint gamma-ray bursts in near-real-time and of performing a sensitive survey of both steady and transient cosmic sources. The instrument is designed to image faint bursts at the low-intensity (high-redshift) end of the log N - log S distribution. MARGIE was recently selected by NASA for a mission-concept study for an Ultra Long Duration Balloon flight. We describe a program to develop an instrument based on the new detector technology of either cadmium zinc telluride room-temperature semiconductors or pixellated cesium iodide scintillators viewed by fast timing charge-coupled devices

Importance of mitral regurgitation inpatients undergoing percutaneous coronary intervention for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.

OBJECTIVES: We sought to determine the prognostic importance of mitral regurgitation (MR) in patients undergoing percutaneous coronary intervention for acute myocardial infarction (AMI). BACKGROUND: Mitral regurgitation has been associated with a poor prognosis in patients treated with thrombolytic therapy for AMI. The prognostic significance of MR in patients undergoing mechanical reperfusion therapy for AMI is unknown. METHODS: Left ventriculography was performed during the index procedure in 1,976 (95%) of 2,082 non-shock patients enrolled in a prospective, multicenter, randomized trial of mechanical reperfusion strategies in AMI. The severity of operator-assessed MR was divided into four strata: none (n = 1,726), mild (n = 192), and moderate/severe (n = 58). RESULTS: Patients with progressively more severe MR were older (p \u3c 0.0001), were more often women (p \u3c 0.0001), and had higher Killip class (p = 0.0007). More severe grades of MR correlated with triple-vessel disease (p \u3c 0.0001) and lower left ventricular ejection fraction (LVEF) as measured during the index procedure (p = 0.0004). Increasingly severe MR was strongly associated with a higher mortality at 30 days (1.4% vs. 3.7% vs. 8.6%, respectively; p \u3c 0.0001) and at one year (2.9%, 8.5%, 20.8%, respectively; p \u3c 0.0001). By multivariate analysis, the presence of even mild MR was an independent predictor of long-term mortality (mild MR, relative risk [RR] = 2.40, p = 0.005; moderate/severe MR, RR = 2.82, p = 0.006). CONCLUSIONS: Mitral regurgitation of any degree present on the baseline left ventriculogram during the index procedure is a powerful, independent predictor of mortality in patients undergoing mechanical reperfusion therapy for AMI. The presence of MR identifies high-risk patients in whom close out-patient follow-up is warranted, and who may benefit from aggressive adjunctive medical or surgical therapies

Large-scale exfoliation of inorganic layered compounds in aqueous surfactant solutions

A method to exfoliate MoS 2 in large quantities in surfactant-water solutions is described. The layered material tends to be exfoliated as dispersions of thin, relatively defect-free flakes with lateral sizes of hundreds of nanometers. This method can be extended to a range of other layered compounds. The dispersed flakes can be mixed with nanotubes or graphene to greate functional hybrid materials. Copyright 2011 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim

Synthesis and styrene copolymerization of novel alkoxy ring-substituted isobutyl phenylcyanoacrylates

Novel alkoxy ring-substituted isobutyl phenylcyanoacrylates, RPhCH=C(CN)CO2CH2CH(CH3)2 (where R is 2-methoxy, 3-methoxy, 4-methoxy, 2-ethoxy, 3-ethoxy, 4-ethoxy, 4-propoxy, 4-butoxy, 4-hexyloxy) were prepared and copolymerized with styrene. The acrylates were synthesized by the piperidine catalyzed Knoevenagel condensation of ring-substituted benzaldehydes and isobutyl cyanoacetate and characterized by CHN elemental analysis, IR, 1H- and 13C-NMR. All the acrylates were copolymerized with styrene in solution with radical initiation (ABCN) at 70C. The composition of the copolymers was calculated from nitrogen analysis, and the structures were analyzed by IR, 1H and 13C-NMR. Thermal properties of the copolymers are characterized by DSC and TGA. Decomposition of the copolymers in nitrogen occurred in two steps, first in the 200-500ºC range with residue (1.8-3.3% wt.), which then decomposed in the 500-800ºC range

Doxorubicin in combination with cisplatin, 5-flourouracil, and vincristine is feasible and effective in unresectable hepatoblastoma: A Children\u27s Oncology Group study.

BACKGROUND: The Children\u27s Oncology Group (COG) adopted cisplatin, 5-flourouracil, and vincristine (C5V) as standard therapy after the INT-0098 legacy study showed statistically equivalent survival but less toxicity in comparison with cisplatin and doxorubicin. Subsequent experience demonstrated doxorubicin to be effective in patients with recurrent disease after C5V, and this suggested that it could be incorporated to intensify therapy for patients with advanced disease. METHODS: In this nonrandomized, phase 3 COG trial, the primary aim was to explore the feasibility and toxicity of a novel therapeutic cisplatin, 5-flourouracil, vincristine, and doxorubicin (C5VD) regimen with the addition of doxorubicin to C5V for patients considered to be at intermediate risk. Patients were eligible if they had unresectable, nonmetastatic disease. Patients with a complete resection at diagnosis and local pathologic evidence of small cell undifferentiated histology were also eligible for an assessment of feasibility. RESULTS: One hundred two evaluable patients enrolled between September 14, 2009, and March 12, 2012. Delivery of C5VD was feasible and tolerable: the mean percentages of the target doses delivered were 96% (95% CI, 94%-97%) for cisplatin, 96% (95% CI, 94%-97%) for 5-fluorouracil, 95% (95% CI, 93%-97%) for doxorubicin, and 90% (95% CI, 87%-93%) for vincristine. Toxicity was within expectations, with death as a first event in 1 patient. The most common adverse events were febrile neutropenia (n = 55 [54%]), infection (n = 48 [47%]), mucositis (n = 31 [30%]), hypokalemia (n = 39 [38%]), and elevated aspartate aminotransferase (n = 28 [27%]). The 5-year event-free and overall survival rates for the 93 patients who did not have complete resection at diagnosis were 88% (95% CI, 79%-93%) and 95% (95% CI, 87%-98%), respectively. CONCLUSIONS: The addition of doxorubicin to the previous standard regimen of C5V is feasible, tolerable, and efficacious, and this suggests that C5VD is a good regimen for future clinical trials

Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection

Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID-19]) spreading across the globe has led to widespread COVID-19 acute hospitalizations and death. The rapidity and highly communicable nature of the SARS-CoV-2 outbreak has hampered the design and execution of definitive randomized, controlled trials of therapy outside of the clinic or hospital. In the absence of clinical trial results, physicians must use what has been learned about the pathophysiology of SARS-CoV-2 infection in determining early outpatient treatment of the illness with the aim of preventing hospitalization or death. This article outlines key pathophysiological principles that relate to the patient with early infection treated at home. Therapeutic approaches based on these principles include 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4) antiplatelet/antithrombotic therapy, and 5) administration of oxygen, monitoring, and telemedicine. Future randomized trials testing the principles and agents discussed will undoubtedly refine and clarify their individual roles; however, we emphasize the immediate need for management guidance in the setting of widespread hospital resource consumption, morbidity, and mortality

Pathophysiological basis and rationale for early outpatient treatment of SARS-CoV-2 (COVID-19) infection

Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID-19]) spreading across the globe has led to widespread COVID-19 acute hospitalizations and death. The rapidity and highly communicable nature of the SARS-CoV-2 outbreak has hampered the design and execution of definitive randomized, controlled trials of therapy outside of the clinic or hospital. In the absence of clinical trial results, physicians must use what has been learned about the pathophysiology of SARS-CoV-2 infection in determining early outpatient treatment of the illness with the aim of preventing hospitalization or death. This article outlines key pathophysiological principles that relate to the patient with early infection treated at home. Therapeutic approaches based on these principles include 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4) antiplatelet/antithrombotic therapy, and 5) administration of oxygen, monitoring, and telemedicine. Future randomized trials testing the principles and agents discussed will undoubtedly refine and clarify their individual roles; however, we emphasize the immediate need for management guidance in the setting of widespread hospital resource consumption, morbidity, and mortality