Benefits of Accepting Infectious Diseases Pharmacist Recommendations: A 5-Year Outcome Study in a Multihospital System.

Infectious diseases (ID) pharmacists are pivotal members of antimicrobial stewardship teams. Prospective audit and feedback is a strong recommendation by The Infectious Diseases Society of America Guidelines for Antimicrobial Stewardship Programs (ASP). Utilizing customized ASP intervention documentation tools known as "ivents" in Epic, we aimed to assess the impact of interventions by measuring outcomes that were accepted compared to those that were rejected in a multihospital health system over 5 years.

Dermatofibrosarcoma protuberans of the breast in pregnancy.

Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive fibroblastic mesenchymal neoplasm, typically derived from the dermis, with the intramammary subtype being seen infrequently. We present a case of a 40-year-old woman whom was diagnosed with an intramammary DFSP during pregnancy, whom underwent successful surgical management during her second trimester. Our case demonstrates the importance of increased clinical awareness in the diagnosis and treatment of breast DFSP with careful multidisciplinary consideration.

An RNA Damage Response Network Mediates the Lethality of 5-FU in Clinically Relevant Tumor Types.

5-fluorouracil (5-FU) is a successful and broadly used anti-cancer therapeutic. A major mechanism of action of 5-FU is thought to be through thymidylate synthase (TYMS) inhibition resulting in dTTP depletion and activation of the DNA damage response. This suggests that 5-FU should synergize with other DNA damaging agents.

Design of a brain-penetrant CDK4/6 inhibitor for glioblastoma.

CDK4 and CDK6 are kinases with similar sequences that regulate cell cycle progression and are validated targets in the treatment of cancer. Glioblastoma is characterized by a high frequency of CDKN2A/CCND2/CDK4/CDK6 pathway dysregulation, making dual inhibition of CDK4 and CDK6 an attractive therapeutic approach for this disease. Abemaciclib, ribociclib, and palbociclib are approved CDK4/6 inhibitors for the treatment of HR+/HER2- breast cancer, but these drugs are not expected to show strong activity in brain tumors due to poor blood brain barrier penetration.

Intrinsic Rewards for Maintenance, Approach, Avoidance, and Achievement Goal Types.

In reinforcement learning, reward is used to guide the learning process. The reward is often designed to be task-dependent, and it may require significant domain knowledge to design a good reward function. This paper proposes general reward functions for maintenance, approach, avoidance, and achievement goal types.

Hierarchical Deep Reinforcement Learning for Continuous Action Control.

Robotic control in a continuous action space has long been a challenging topic. This is especially true when controlling robots to solve compound tasks, as both basic skills and compound skills need to be learned. In this paper, we propose a hierarchical deep reinforcement learning algorithm to learn basic skills and compound skills simultaneously.

MK2 contributes to tumor progression by promoting M2 macrophage polarization and tumor angiogenesis.

Chronic inflammation is a major risk factor for colorectal cancer. The p38/MAPKAP Kinase 2 (MK2) kinase axis controls the synthesis of proinflammatory cytokines that mediate both chronic inflammation and tumor progression. Blockade of this pathway has been previously reported to suppress inflammation and to prevent colorectal tumorigenesis in a mouse model of inflammation-driven colorectal cancer, by mechanisms that are still unclear.

Assessing Human Judgment of Computationally Generated Swarming Behavior.

Computer-based swarm systems, aiming to replicate the flocking behavior of birds, were first introduced by Reynolds in 1987. In his initial work, Reynolds noted that while it was difficult to quantify the dynamics of the behavior from the model, observers of his model immediately recognized them as a representation of a natural flock. Considerable analysis has been conducted since then on quantifying the dynamics of flocking/swarming behavior.

Co-Operative Coevolutionary Neural Networks for Mining Functional Association Rules.

In this paper, we introduce a novel form of association rules (ARs) that do not require discretization of continuous variables or the use of intervals in either sides of the rule. This rule form captures nonlinear relationships among variables, and provides an alternative pattern representation for mining essential relations hidden in a given data set. We refer to the new rule form as a functional AR (FAR).

Trusted Autonomy and Cognitive Cyber Symbiosis: Open Challenges.

This paper considers two emerging interdisciplinary, but related topics that are likely to create tipping points in advancing the engineering and science areas. Trusted Autonomy (TA) is a field of research that focuses on understanding and designing the interaction space between two entities each of which exhibits a level of autonomy. These entities can be humans, machines, or a mix of the two.

A Pleiotropic RNA-Binding Protein Controls Distinct Cell Cycle Checkpoints to Drive Resistance of p53-Defective Tumors to Chemotherapy.

In normal cells, p53 is activated by DNA damage checkpoint kinases to simultaneously control the G1/S and G2/M cell cycle checkpoints through transcriptional induction of p21(cip1) and Gadd45α. In p53-mutant tumors, cell cycle checkpoints are rewired, leading to dependency on the p38/MK2 pathway to survive DNA-damaging chemotherapy. Here we show that the RNA binding protein hnRNPA0 is the "successor" to p53 for checkpoint control.

Couples constructing their experiences of dementia: A relational perspective.

Many people with dementia are cared for by their spouse or partner, therefore there is a need to understand the ways in which dementia and couple relationships impact upon each other. This study aimed to contribute to our understanding of the experience of dementia from a relational perspective. Seven couples, in which one person had a diagnosis of dementia, were interviewed about their experience of being in a couple where one partner had a diagnosis of dementia.

A game theoretic framework for incentive-based models of intrinsic motivation in artificial systems.

An emerging body of research is focusing on understanding and building artificial systems that can achieve open-ended development influenced by intrinsic motivations. In particular, research in robotics and machine learning is yielding systems and algorithms with increasing capacity for self-directed learning and autonomy. Traditional software architectures and algorithms are being augmented with intrinsic motivations to drive cumulative acquisition of knowledge and skills.

A Cdk7-Cdk4 T-loop phosphorylation cascade promotes G1 progression.

Eukaryotic cell division is controlled by cyclin-dependent kinases (CDKs), which require phosphorylation by a CDK-activating kinase (CAK) for full activity. Chemical genetics uncovered requirements for the metazoan CAK Cdk7 in determining cyclin specificity and activation order of Cdk2 and Cdk1 during S and G2 phases. It was unknown if Cdk7 also activates Cdk4 and Cdk6 to promote passage of the restriction (R) point, when continued cell-cycle progression becomes mitogen independent, or if CDK-activating phosphorylation regulates G1 progression.

Chemical genetics reveals a specific requirement for Cdk2 activity in the DNA damage response and identifies Nbs1 as a Cdk2 substrate in human cells.

The cyclin-dependent kinases (CDKs) that promote cell-cycle progression are targets for negative regulation by signals from damaged or unreplicated DNA, but also play active roles in response to DNA lesions. The requirement for activity in the face of DNA damage implies that there are mechanisms to insulate certain CDKs from checkpoint inhibition. It remains difficult, however, to assign precise functions to specific CDKs in protecting genomic integrity.

Why minimal is not optimal: driving the mammalian cell cycle--and drug discovery--with a physiologic CDK control network.

Progression through the eukaryotic cell division cycle is governed by the activity of cyclin-dependent kinases (CDKs). For a CDK to become active it must (1) bind a positive regulatory subunit (cyclin) and (2) be phosphorylated on its activation (T) loop. In metazoans, multiple CDK catalytic subunits, each with a distinct set of preferred cyclin partners, regulate the cell cycle, but it has been difficult to assign functions to individual CDKs in vivo.

Chemical-genetic analysis of cyclin dependent kinase 2 function reveals an important role in cellular transformation by multiple oncogenic pathways.

A family of conserved serine/threonine kinases known as cyclin-dependent kinases (CDKs) drives orderly cell cycle progression in mammalian cells. Prior studies have suggested that CDK2 regulates S-phase entry and progression, and frequently shows increased activity in a wide spectrum of human tumors. Genetic KO/knockdown approaches, however, have suggested that lack of CDK2 protein does not prevent cellular proliferation, both during somatic development in mice as well as in human cancer cell lines.

Switching Cdk2 on or off with small molecules to reveal requirements in human cell proliferation.

Multiple cyclin-dependent kinases (CDKs) control eukaryotic cell division, but assigning specific functions to individual CDKs remains a challenge. During the mammalian cell cycle, Cdk2 forms active complexes before Cdk1, but lack of Cdk2 protein does not block cell-cycle progression. To detect requirements and define functions for Cdk2 activity in human cells when normal expression levels are preserved, and nonphysiologic compensation by other CDKs is prevented, we replaced the wild-type kinase with a version sensitized to specific inhibition by bulky adenine analogs.

Voiding dysfunction following suburethral tape.

Voiding dysfunction (VD) is relatively common following suburethral tape insertion. Our study aimed to identify perioperative variables that predict VD. Women who underwent suburethral tapes (TVT(TM) and TVT-O(TM)), either as sole procedure or with a concomitant prolapse repair, were studied retrospectively.

A virtual cycle: theory and experiment converge on the exit from mitosis.

The cell division cycle can be modelled as a series of quantitative thresholds of cyclin-dependent kinase (CDK) activity. DNA synthesis has a lower threshold requirement for CDK than does entry into mitosis, and mitotic exit and re-setting of replication origins occur upon collapse of CDK activity below both thresholds, so that the simple rise and fall of CDK with each cell cycle might suffice to ensure repeated alternation of chromosome duplication and segregation. Recent experimental dissections of mitotic exit, which have both guided and been informed by computational modelling, suggest a more complicated mechanism, in which unidirectional progression is ensured by systems-level control of CDK function and the balance between mitotic CDK and phosphatase activities.

Putting one step before the other: distinct activation pathways for Cdk1 and Cdk2 bring order to the mammalian cell cycle.

Eukaryotic cell division is controlled by the activity of cyclin-dependent kinases (CDKs). Cdk1 and Cdk2, which function at different stages of the mammalian cell cycle, both require cyclin-binding and phosphorylation of the activation (T-) loop for full activity, but differ with respect to the order in which the two steps occur in vivo. To form stable complexes with either of its partners-cyclins A and B-Cdk1 must be phosphorylated on its T-loop, but that phosphorylation in turn depends on the presence of cyclin.