UC Irvine

In Spring 2020, colleges across the nation swiftly transitioned their operations—including both classes and student support services—to remote delivery on an emergency basis in response to the crisis posed by the COVID-19 pandemic. While prior research has documented that the transition was associated with decrements in student outcomes, there remains limited understanding of the organizational factors that might have mitigated these negative associations during the pandemic. Drawing on administrative data from the California Community College system, along with a novel survey conducted among distance education leaders, our study reveals that the degree of declines in course completion and course passing rates varied based on pre-COVID online education resources (such as the ratio of distance education personnel to students and the availability of pre-COVID professional development programs in online learning): Colleges with greater pre-COVID online resources experienced more modest declines in student performance. To a lesser extent, we also found that declines in student performance during the onset of the pandemic varied depending on the responses implemented in reaction to the pandemic, such as the extent of technology delivery to students. The implications of our findings extend to the realm of planning for the continuity of operations in potential future crises.

PURPOSE: Pelvic lymph node metastases (ypN+) after multiagent neoadjuvant chemotherapy (NAC) is a poor prognostic sign in nonmetastatic muscle-invasive bladder cancer (nmMIBC). We sought to create a nomogram predicting probability of ypN+ after NAC for cN0 nmMIBC and determine association with overall survival (OS). METHODS AND MATERIALS: We reviewed the National Cancer Database for patients with cT2-4N0M0 urothelial carcinoma of the bladder receiving multiagent NAC and surgery from 2004 to 2020. Following a data split, univariate logistic regression identified variables associated with ypN+ at P < .05. Eligible variables were used for multivariate logistic regression and nomogram generation. A threshold for 95% sensitivity defined high- and low-risk groups for ypN+. Fine-Gray models assessed ypN+ risk group and OS, accounting for competing risks of surgical mortality. RESULTS: A total of 6194 patients were identified with a median follow-up of 39.5 months (interquartile range [IQR], 20.5-67.2 months). Most patients had high-grade (97.7%) cT2 disease (70.8%) with nonpapillary urothelial histology (67.3%) and initiated NAC at a median of 41.0 days after diagnosis (IQR, 28.0-59.0 days).The nomogram included age in decades (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.87-1.03; P = .172), weeks from diagnosis to NAC (OR, 1.02; 95% CI, 1.01-1.04; P = .004), nonpapillary histology (OR, 1.17; 95% CI, 0.99-1.39; P = .068), and clinical T-stage. Within the testing cohort, ypN+ was found in 392 (22.8%) high-risk and 12 (8.0%) low-risk patients (P < .001), with median OS of 36.1 and 74.0 months, respectively (P < .001). High-risk patients had worse OS despite competing risks of 30-day (subdistribution hazard ratio [SHR], 1.80; 95% CI, 1.49-2.18; P < .001) and 90-day surgical mortality (SHR, 1.68; 95% CI, 1.39-2.04; P < .001). CONCLUSIONS: This is the first study to provide a tool for predicting ypN+ and prognosticate worse OS in primarily high-grade nmMIBC and could select patients for alternative neoadjuvant therapy and facilitate future study.

CLINICAL RELEVANCE: Although diabetes is associated with a classic microvascular disease of the retina, it is also increasingly being recognized as a cause of retinal neuropathy. Preclinical evidence suggests that retinal neuropathy in diabetes manifests in part as photoreceptor dysfunction, preceding the development of vascular features in experimental models. It remains unknown whether such findings are relevant to patients with diabetes. METHODS: Here, we review 4 lines of clinical evidence suggesting that diabetes-associated photoreceptor pathology is linked to the development of retinal microvascular disease. RESULTS: First, a major population-based investigation of susceptibility loci for diabetic retinopathy (DR) implicated a photoreceptor protein product as a protective factor. Next, electroretinography and other studies of visual function collectively show that rod and/or cone-derived abnormalities occur decades before the development of vascular features of DR. Third, protection from DR seemingly develops in patients with coincident retinitis pigmentosa, as suggested by several case series. Finally, based on anatomic features, we propose that the beneficial effect of macular laser in DR occurs via ablation of diseased photoreceptors. CONCLUSIONS: The evidence we present is limited due to the small patient populations used in the studies we cite and due to the lack of methodologies that allow causative relationships to be inferred. Collectively, however, these clinical observations suggest that photoreceptors are involved in early diabetic retinal disease and may in fact give rise to the classic features of DR. FINANCIAL DISCLOSURES: Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.

As a practicing clinical nurse, a phenomenon I experienced at times was the sudden acute sense that something was going wrong with a person in care at the sub-critical unit in the hospital where I worked. In fact, many hospital nurses have their story of somethings not right in relation to a person they were caring for/with, in that the day started with them on a coherent path to healing and then suddenly the nurse feels something is going very wrong, and yet there is nothing observable that would justify such a feeling. This feeling would be called intuition by many nurses, a concept most notably theorized in nursing by Patricia Benner in her extensive program of scholarship. Benner defines intuition as understanding without rationale. Benner opposes embodied intuition and rational abstract reasoning and creates criteria for the use of each by nursing depending on whether the clinical situation is familiar or novel. The philosophical idea is that the new must be reasoned with a different mode of thought than the familiar. Charles Sanders Peirce was a philosopher of reasoning. He defined logic as the theory of reasoning, which by the end of his career he was declaring was only another name for semiotic. Peirce argued that all reasoning/semiosis is done through signs, or more accurately sign-activity. Semiotic is the philosophical schema providing the concepts and methods by which semiosis - reasoning - happens. Importantly, semiotic does not oppose different modes of thought, and conceptualizes reasoning as a process that functions in familiar as well as novel situations. In this paper I describe Peirces philosophy of semiotic. I then provide an example relevant to nursing by conducting a semiosis of the nursing scenario above to show how nursing works chance, or novelty, in a way that doesnt need to resort to rational abstract reasoning and yet is different than Benners notion of intuition.

Climate change is disrupting floral traits that mediate mutualistic and antagonistic species interactions. Plastic responses of these traits to multiple shifting conditions may be adaptive, depending on natural selection in new environments. We manipulated snowmelt date over three seasons (3-11 d earlier) in factorial combination with growing-season precipitation (normal, halved, or doubled) to measure plastic responses of volatile emissions and other floral traits in Ipomopsis aggregata. We quantified how precipitation and early snowmelt affected selection on traits by seed predators and pollinators. Within years, floral emissions did not respond to precipitation treatments but shifted with snowmelt treatment depending on the year. Across 3 yr, emissions correlated with both precipitation and snowmelt date. These effects were driven by changes in soil moisture. Selection on several traits changed with earlier snowmelt or reduced precipitation, in some cases driven by predispersal seed predation. Floral trait plasticity was not generally adaptive. Floral volatile emissions shifted in the face of two effects of climate change, and the new environments modulated selection imposed by interacting species. The complexity of the responses underscores the need for more studies of how climate change will affect floral volatiles and other floral traits.

PURPOSE: With the growing popularity of badminton worldwide, the incidence of badminton-related ocular injuries is expected to rise. The high velocity of shuttlecocks renders ocular traumas particularly devastating, especially with the possibility of permanent vision loss. This study investigated the mechanism behind ocular complications through simulation analyses of mechanical stresses and pressures upon shuttlecock impact. DESIGN: Computational simulation study. PARTICIPANTS: None. METHODS: A 3-dimensional human eye model was reconstructed based on the physiological and biomechanical properties of various ocular tissues. Finite element analysis simulations involved a frontal collision with a shuttlecock projectile at 128.7 km/hour (80 mph). Intraocular pressure (IOP) changes and tissue stress were mapped and quantified in the following ocular structures: the limbus, ciliary body, zonular fibers, ora serrata, retina, and optic nerve head. MAIN OUTCOME MEASURES: Intraocular pressure and tissue stress. RESULTS: Upon shuttlecock impact, compressive force was transferred to the anterior pole of the cornea, propagating posteriorly to the optic nerve head. Deflection of forces anteriorly contributed to refractory oscillations of compressive and tensile stress of ocular tissue. Initial impact led to a momentary (<1 ms) spike in IOP 5.66 MPa (42.5 × 103 mmHg) that radially distributed for a very brief instance (<1 ms) of pressure at the trabecular meshwork of the iridocorneal angle of 1.25 MPa (9.4 × 103 mmHg). The lens had a maximal posterior displacement of 1.5 mm with peak zonular fiber tensile strain of 52%. The limbus, ciliary body, and ora serrata had a peak tensile stress of 5.16 MPa, 1.90 MPa, and 0.62 MPa, respectively. Compressive force from the sclera concentrated at the optic nerve head for a peak stress of 5.97 MPa while peak pressure from vitreous humor was 7.99 MPa. CONCLUSIONS: Shuttlecock impact led to a very brief, substantial rise in pressure and stress significant for tissue damage and subsequent complications, such as secondary glaucoma, angle recession, lens subluxation, hyphema, or retinal dialysis. Our findings offer valuable mechanistic insights into how ocular structures are affected by shuttlecock projectile impact to inform clinical assessments and treatment strategies, while highlighting the importance of protective eyewear in racket sports. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Inspired by recent human studies, this paper investigates the benefits of employing varying navigation strategies in robot teams. We explore how mixed navigation strategies impact task completion time, environment exploration, and overall system effectiveness in multi-robot systems. Experiments were conducted in a simulated rectangular environment using Clearpath PR2 robots and evaluated different navigation strategies observed in humans: 1) Route (RT) knowledge where agents follow a predefined path, 2) Survey (SW) knowledge where agents take the shortest path while avoiding obstacles, 3) Mixed strategies with varying proportions, such as 40% RT and 60% SW (0.4RT 0.6SW) and 60% RT and 40% SW (0.6RT 0.4SW), and 4) An additional strategy where agents switch from RT to SW 10% of the time (0.9RT 0.1SW). While SW strategy is the most time-efficient, RT strategy covers more of the environment. Mixed strategies offer a balanced trade-off. These findings highlight the advantages of variability in navigation strategies, suggesting benefits in both biological and robotic populations. Additionally, we have observed that human participants in a similar study would start on a route, and then 10% of the time switch to survey. Therefore, we investigate a 90% Route 10% Survey (0.9RT 0.1SW) strategy for individual team members. While a pure Survey strategy is the most efficient regarding time taken and a pure Route strategy covers more of the environment, a mixture of strategies appears to be a beneficial tradeoff between time taken to complete a mission and area coverage. These results highlight the advantages of population variability, suggesting potential benefits in both biological and robotic populations.

Despite ART, we detected occasional microglia containing cell-associated HIV RNA and HIV DNA integrated into open regions of the hosts genome (∼0.005%) should be corrected to: Despite ART, we detected occasional microglia containing cell-associated HIV RNA and HIV DNA integrated into open regions of the hosts genome (∼0.5%).

In this case report, we describe a diagnosis of papillary renal cell carcinoma in a 76-year-old male patient who was incidentally found to have a left adrenal mass during routine aneurysm surveillance. Computed tomography demonstrated a left adrenal mass and left renal structure which was concerning for renal cell carcinoma. He underwent left adrenalectomy and initial histopathology demonstrated papillary renal cell carcinoma. He subsequently underwent left radical nephrectomy with lymph node dissection. Histopathological analysis of the removed left renal and nodal specimens revealed papillary renal cell carcinoma with lymph node metastasis. However, re-review of the adrenal pathology slides determined the specimen as represented by primary kidney tumor and not adrenal metastasis. This report reviews the presentation and radiological findings of synchronous papillary renal cell carcinoma and differential diagnosis for indeterminate adrenal mass on computed tomography.

INTRODUCTION/AIMS: Prospective, randomized, controlled trials of intravenous immunoglobulin (IVIG) maintenance therapy in myasthenia gravis (MG) are lacking. In this trial, we evaluated the safety and efficacy of caprylate/chromatography-purified IVIG; (IGIV-C) in patients with generalized MG undergoing standard care. METHODS: Sixty-two patients enrolled in this phase 2, multicenter, international, randomized trial (1:1 IGIV-C [2 g/kg loading dose; 1 g/kg every 3 weeks through week 21] or placebo). Efficacy was assessed by changes in Quantitative MG (QMG) score at week 24 versus baseline (primary endpoint) and percentage of patients with clinical improvement in QMG, MG Composite (MGC), and MG-Activities of Daily Living (MG-ADL) scores (secondary endpoints). Safety assessments reported all adverse events (AEs). RESULTS: The change in QMG at 24 weeks was -5.1 for IGIV-C and -3.1 for placebo (p = .187). Seventy percent of patients in the IGIV-C group had improvement in MG-ADL (≥2-point decrease) versus 40.6% in the placebo group (p = .025). Patients showing clinical improvement in QMG and MGC (≥3-point decrease) were 70.0% for IGIV-C versus 59.4% for placebo (p = .442) and 60.0% for IGIV-C versus 53.1% for placebo (p = .610). IGIV-C was well tolerated; serious AEs were similar between arms. Three of four MG exacerbations requiring hospitalizations occurred in the IGIV-C arm with one death. DISCUSSION: Several efficacy parameters showed numerical results greater than those seen in the placebo group. This was a small study and may have been underpowered to see significant differences. Additional studies may be warranted to fully determine the efficacy of IVIG maintenance therapy in MG.