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\"From New Yorker editor and writer Michael Luo, a vivid, urgent history of two centuries of Chinese exclusion and the birth of anti-Asian feeling in America. In 1889, when the Supreme Court upheld the Chinese Exclusion Act-a measure barring Chinese laborers from entering the United States that remained in effect for more than fifty years-Justice Stephen Johnson Field characterized the Chinese as a people \"residing apart by themselves.\" They were, Field concluded, \"strangers in the land.\" Today, there are more than twenty-two million people of Asian descent in the United States, yet this label still hovers over Asian Americans. In Strangers in the Land, Luo traces anti-Asian feeling in America to the first wave of immigrants from China in the mid-nineteenth-century: laborers who traveled to California in search of gold and railroad work. Their communities almost immediately faced mobs of white vigilantes who drove them from their workplaces and homes. In his rich, character-driven history, Luo tells stories like that of Denis Kearney, the sandlot demagogue who became the face of the anti-Chinese movement, and of activists who fought back, like Massachusetts Senator George Frisbie Hoar and newspaperman Wong Chin Foo. After the halt on immigration in 1889, the Chinese-American community who remained struggled to survive and thrive on the margins of American life. In 1965, when LBJ's Immigration and Nationality Act forbade discrimination by national origin, America opened its doors wide to families like those of Luo's parents, but he finds that the centuries of exclusion of Chinese-Americans left a legacy: many Asians are still treated, and feel, like outsiders today. Strangers in the Land is a sweeping narrative of a forgotten chapter in American history, and a reminder that America's present reflects its exclusionary past\"-- Provided by publisher.

Background The 1-3-7 approach to eliminate malaria was first implemented in China in 2012. It has since been expanded to multiple countries, but no systematic review has examined the evidence for its use. A systematic review was conducted aiming to evaluate the impact and effectiveness of the strategy and identify key challenges and variations in its implementation across different countries. Methods PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CABS Abstracts, LILACS, Global Health, Medrxiv, Biorxiv were searched for all studies containing 1-3-7 and articles included if they contained information on 1-3-7 impact, effectiveness, challenges and/or adaptations for implementation in different countries. Results 31 studies were included from China (19), Thailand (6), Myanmar (2), Tanzania (1), Cambodia (1), India (1) and Vietnam (1). During 1-3-7 implementation, malaria cases in China decreased by 99.1–99.9%, in Thailand by 66.9% during 2013–19, 65,1% in Cambodia during 2015–17 and 30.3% in India during 2015–16, with some differences in implementation. It was not possible to separate the impact of 1-3-7 from that due to other contemporaneous interventions. Implementing the 1-3-7 policy was largely effective, with reporting within 1 day in 99.8–100% of individuals in China and 36–100% in other countries, investigation within 3 days in 81.5–99.4% in China and 79.4–100% in other countries, and foci investigation within 7 days in 90.1–100% in China and 83.2–100% in other countries. Adaptations to 1-3-7 were described in 5 studies, mostly adjustment of the timing and/or definitions of each component. Key challenges identified included those related to staffing, equipment, process, and patient-provided information. Conclusion Overall, the 1-3-7 approach was effectively implemented with a concomitant decrease in cases in malaria elimination settings, however, it was not possible to quantify impact as it was not implemented in isolation. Implementing adequate measures for testing, reporting, treatment, and containment is crucial for its success, which is dependent on the availability of resources, infrastructure, staffing, and consistent compliance across regions and throughout the year. However, achieving this nationally and maintaining compliance, especially at borders with malaria-affected countries, poses significant challenges.

Abstract Background: The achievement of an optimal return to sport (RTS) has remained a key goal after sports-related injuries, with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament (ACL) rupture. This study aims to assess clinical outcomes and RTS across various surgical methods, such as anatomical single-bundle reconstruction (ASBR), central-axial single-bundle reconstruction (CASBR), and double-bundle reconstruction (DBR). Methods: A randomized clinical trial was conducted, comprising 191 patients who underwent ACL rupture. These patients were divided into three groups based on the ACL reconstruction techniques they received (ASBR, CASBR, DBR). Over the 2-year follow-up period, the study assessed RTS through four single-hop tests, isokinetic extension tests, and limb asymmetry indices. Postoperative graft status was determined using the signal-to-noise quotient (SNQ), while knee function was evaluated using the International Knee Documentation Committee 2000 (IKDC-2000) score, Lysholm score, Tegner score, and degree of knee laxity. A binary logistic regression model was developed to forecast the factors influencing ideal RTS. Results: DBR (67.63%) and CASBR (58.00%) exhibited higher RTS passing rates compared to ASBR (30.39%; χ2 = 19.57, P <0.05). Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS (χ2 = 17.08, P <0.05). The RTS rate was influenced by SNQs of the graft’s tibial site (odds ratio: 0.544) and quadriceps strength of the reconstructed knee joint at 60°/s (odds ratio: 6.346). Notably, the DBR group showed enhanced knee stability, evidenced by superior results in the Lachman test (χ2 = 13.49, P <0.01), objective IKDC-2000 (χ2 = 27.02, P = 0.002), and anterior instability test (χ2 = 9.46, P <0.01). Furthermore, DBR demonstrated superior clinical outcomes based on the Lysholm score (DBR: 89.57 ± 7.72, CASBR: 83.00 ± 12.71, ASBR: 83.21 ± 11.95; F = 10.452, P <0.01) and IKDC-2000 score (DBR: 90.95 ± 7.00, CASBR: 84.64 ± 12.68, ASBR: 83.63 ± 11.41; F = 11.78, P <0.01). Conclusion: For patients with ACL rupture, more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups. Autograft status and quadriceps strength are postively related to RTS. Trial Registration: ClinicalTrials.gov (NCT05400460)

Purpose In July 2022, the World Health Organization (WHO) declared monkeypox virus’s global spread a “public health emergency of international concern.” About a quarter of monkeypox cases feature ophthalmic symptoms. We assessed trends in worldwide search interest in monkeypox ophthalmic involvement and inclusion in online search engine queries. Methods The following keywords were searched on Google Trends from April 1, 2022, to August 12, 2022: monkeypox + eye, pink eye, eye infection, eyelid, vision, blurry vision, vision loss, blindness, eye symptoms, eye problems, eye pain, eye redness, conjunctivitis, conjunctiva, cornea, keratitis, corneal ulcer, and blepharitis. We analyzed trends, correlated search interest with case count data, and compared popularity of search terms via nonparametric Mann–Whitney-U analysis. Inclusion of ophthalmic symptoms in Google search results for “monkeypox symptoms” was assessed. Results “Monkeypox eye” had the highest average search interest worldwide and in the United States. Search interest peaked between mid-May and late July 2022. When compared to interest in “monkeypox rash,” the most searched monkeypox symptom, the average interest in “monkeypox eye” was lower ( p  < 0.01). Of the first 50 results from the Google search of “monkeypox symptoms,” 10/50 (20%) mentioned ophthalmic symptoms. 6/50 (12%) mentioned the eye as a route of virus transmission. Conclusion Search interest in monkeypox ophthalmic symptoms corresponds with geographic and temporal trends, i.e., timing and location of the first reported non-endemic cases and WHO announcement. Although ophthalmic symptoms are not as widely searched currently, inclusion in public health messaging is key for diagnosis, appropriate management, and reduction of further transmission.

Large Language Models (LLMs) have achieved remarkable capabilities across diverse and complex tasks, yet a fundamental decoupling persists between frontier models and the thousands of downstream AI applications with domain-specific needs. This division limits both performance and efficiency: models are trained and served without knowledge of downstream applications. In this dissertation, we design systems and algorithms that couple the model and application layers together—advancing application-aware infrastructure and models.We first present three systems for application-aware infrastructure that optimize cost and performance. Agentix is a serving engine that introduces application-aware scheduling for AI agents. By tracking dependencies between LLM calls and leveraging application-level statistics, Agentix improves end-to-end response-times by 4-15× over state-of-the-art systems like vLLM, which reduces costs. Next, Stylus is a scalable model router that retrieves and composes the best adapters from a pool of over 100K LoRAs, which improves performance over base Stable Diffusion. Finally, Starburst is a cost-aware scheduler for hybrid cloud ML infrastructure that dynamically allocates waiting time based on job characteristics, reducing cloud costs by up to 91% while maintaining minimal job completion times.Next, we then demonstrate that coupling models with applications via reinforcement learning (RL) unlocks both higher performance and lower cost. Through the Agentica Project, we show that small models trained with application-specific RL can match frontier models at a fraction of the cost. DeepScaleR is a 1.5B model that surpasses o1-preview on mathematical reasoning with only 3,800 GPU hours—an 18× cost reduction over prior approaches. DeepCoder achieves o3-mini level performance on competitive programming with a 14B model. Finally, DeepSWE trains a 32B state-of-the-art autonomous coding agent, beating all prior open-source agents by over 12 percentage points.Overall, these contributions democratize access to frontier-level AI capabilities for application-builders and organizations alike.

Purpose To assess technical and clinical outcomes following lumen-apposing covered self-expanding metallic stent (LAMS) placement for symptomatic pancreatic fluid collections (PFC) with CT and MRI. Methods In this retrospective study, patients with PFC who underwent LAMS placement between March 2015 and June 2018 were included. Primary outcomes included technical success, defined as successful stent placement with resolution of PFC, and clinical success, defined as lack of fluid recurrence after stent removal. Secondary outcomes included time duration from stent placement to removal, complications, and re-intervention need. Results 28 consecutive patients (20 men, mean age: 53 years ± 17; range 21–75) who underwent endoscopic drainage of symptomatic walled-off necrosis (WON, 21/28, 75%), pseudocyst (PC, 5/28, 18%) or acute necrotic collection (ANC, 2/28, 7%) were included. LAMS were placed successfully in 27/28 (96%) patients. On follow-up imaging after at least one month ( n = 24), the volume of the PFC decreased by 99.9% from 425 cm 3 [IQR 214 – 636] to 0.6 cm 3 [IQR 0–43.9]. After stent removal, 26/27 (96%) patients remained collection free. The median time duration from stent placement to removal was 42 days [IQR 34–71]. Complications (10/28; 36%) included stent occlusion ( n = 1), stent migration ( n = 3), intraprocedural bleeding ( n = 2), postprocedural bleeding ( n = 2), and pseudoaneurysm formation ( n = 2). Re-intervention was required in 7/27 (26%). Conclusion Following LAMS placement in patients with symptomatic PFC, high technical and clinical success rates of 96% and 96%, respectively, are achieved. Awareness of common complications seen on cross-sectional imaging might help radiologists and gastroenterologist in the patients’ management.

Purpose The purpose of this study was to evaluate clinical, functional, and radiographic outcomes following total knee arthroplasty (TKA) performed with patient-specific instrumentation (PSI), computer-assisted surgery (CAS), and manual instruments at short-term follow-up.Methods 122 TKAs were performed by a single surgeon: 42 with PSI, 38 with CAS, and 40 with manual instrumentation. Preoperative, 1-month, and 6-month clinical and functional outcomes were measured using the Knee Society scoring system (knee score, function score, range of motion, and pain score). Improvements in clinical and functional outcomes from the preoperative to postoperative period were analyzed. Preoperative and postoperative radiographs were measured to evaluate limb and component alignment.Results Preoperative, 1-month postoperative, and 6-month postoperative knee scores, function scores, range of motion, and pain scores were highest in the PSI group compared to CAS and manual instrumentation. At 6-month follow-up, PSI TKA was associated with a statistically significant improvement in functional score when compared to manual TKA. Otherwise, there were no statistically significant differences in improvements among PSI, CAS, and manual TKA groups.Conclusion The higher preoperative scores in the PSI group limits the ability to draw definitive conclusions from the raw postoperative scores, but analyzing the changes in scores revealed that PSI was associated with a statistically significant improvement in Knee Society Functional score at 6-month post-TKA as compared to CAS or manual TKA. This may be attributable to improvements in component rotation and positioning, improved component size accuracy, or other factors that are not discernible on plain radiograph.

Emergy theory and method are used to evaluate the contribution of irrigation water, and the process of its utilization, in three agricultural systems. The agricultural systems evaluated in this study were rice, wheat, and oilseed rape productions in an irrigation pumping district of China. A corresponding framework for emergy evaluation and sensitivity analysis methods was proposed. Two new indices, the fraction of irrigation water （FIW）, and the irrigation intensity of agriculture （IIA）, were developed to depict the contribution of irrigation water. The calculated FIW indicated that irrigation water used for the rice production system （34.7%） contributed more than irrigation water used for wheat （5.3%） and oilseed rape （11.2%） production systems in a typical dry year. The wheat production with an IIA of 19.0 had the highest net benefit from irrigation compared to the rice （2.9） and oilseed rape （8.9） productions. The transformities of the systems＇ products represented different energy efficiencies for rice （2.50E ＋ 05 sej .J^-1）, wheat （1.66E ＋ 05 sej .J^-1） and oilseed rape （2.14E ＋ 05 sej .J^-1） production systems. According to several emergy indices, of the three systems evaluated, the rice system had the greatest level of sustainability. However, all of them were less sustainable than the ecological agricultural systems. A sensitivity analysis showed that the emergy inputs of irrigation water and nitrogenous fertilizer were the highest sensitivity factors influencing the emergy ratios. Best Management Practices, and other agroecological strategies, could be implemented to make further improvements in the sustainability of the three systems.

ObjectiveTo explore factors influencing UK medical students’ specialty choices and examine variations in these influences across demographic groups and stages of training.DesignNational, cross-sectional online survey.SettingAll 44 UK medical schools recognised by the General Medical Council.Participants8,395 medical students.Primary and secondary outcomesThe primary outcome was the specialty preferences of UK medical students. The secondary outcomes were factors behind these preferences and how these factors vary across demographic groups and different stages of training.ResultsGeneral Practice (15.3%), Paediatrics (10.6%) and Anaesthetics (9.9%) were the most preferred specialties among final-year students. Work-life balance (84.1%), compatibility with family life (78.2%), positive training experiences (85.2%) and future specialty outlook (74.9%) were key factors influencing specialty choice. Only 23.1% of students felt confident about securing a specialty training post, with confidence higher among males (OR 1.36, 95% CI 1.21 to 1.52, p<0.0001) and privately educated students (OR 1.18, CI 1.03 to 1.35, p=0.02). Males were also more certain about their career choices (OR 1.19, 95% CI 1.07 to 1.31, p<0.0001). Confidence in securing a training place was positively associated with extracurricular achievements, including having a PubMed-indexed publication (OR 1.67, 95% CI 1.39 to 2.00, p<0.0001).ConclusionsThis study highlights disparities in specialty preferences and influencing factors among UK medical students. A focus on improving career guidance, exposure to various specialties and supporting equitable access to training opportunities is essential for fostering a motivated and sustainable medical workforce.

The purpose of this study was to determine whether differences in clinical, functional, or radiographic outcomes existed at 5-year follow-up between patients who underwent computer-assisted or manual total knee arthroplasty (TKA). Seventy-eight consecutive TKAs were performed by a single surgeon who had extensive experience performing computer-assisted and manual TKA. The manual group (n=40) and computer-assisted group (n=38) were similar with regard to age, sex, diagnosis, body mass index, surgical technique, implants, perioperative management, Knee Society scores, and anteroposterior mechanical axis. Sixty-three (manual group, n=34; computer-assisted group, n=29) patients were available for final follow-up. At 5-year follow-up, no statistically significant differences were found in Knee Society knee score ( P =.289), function score ( P =.272), range of motion ( P =.284), pain score ( P =.432), or UCLA activity score ( P =.109) between the 2 groups. Postoperative radiographs showed a significant difference in the mechanical axis ( P =.004) between the 2 groups; however, both groups achieved a neutral mechanical axis of ±3° (computer-assisted group mean, 2.0°; manual group mean, −0.24°). When TKA was performed by an experienced surgeon, no significant difference was identified at 5-year follow-up between patients who underwent computer-assisted vs manual TKA.