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Background: While Human Factors (HF) methods have been applied to the design of decision support systems (DSS) to aid clinical decision-making, the role of HF to improve decision-support for population health outcomes is less understood. We sought to comprehensively understand how HF methods have been used in designing digital population health DSS. Materials and methods: We searched English documents published in health sciences and engineering databases (Medline, Embase, PsychINFO, Scopus, Comendex, Inspec, IEEE Xplore) between January 1990 and September 2023 describing the development, validation or application of HF principles to decision support tools in population health. Results: We identified 21,581 unique records and included 153 studies for data extraction and synthesis. We included research articles that had a target end-user in population health and that used HF. HF methods were applied throughout the design lifecycle. Users were engaged early in the design lifecycle in the needs assessment and requirements gathering phase and design and prototyping phase with qualitative methods such as interviews. In later stages in the lifecycle, during user testing and evaluation, and post deployment evaluation, quantitative methods were more frequently used. However, only three studies used an experimental framework or conducted A/B testing. Conclusions: While HF have been applied in a variety of contexts in the design of data-driven DSSs for population health, few have used Human Factors to its full potential. We offer recommendations for how HF can be leveraged throughout the design lifecycle. Most crucially, system designers should engage with users early on and throughout the design process. Our findings can support stakeholders to further empower public health systems. [ABSTRACT FROM AUTHOR]

Road traffic collisions (RTCs) are a global public health concern; however, research on the impact of bereavement on families remains limited. A critical realist approach was adopted to explore experiences of families suffering bereavement following RTCs, using interviews with 14 participants in the United Kingdom (UK) who have lost a family member. Three key themes were identified: (1) worsening mental health following bereavement, (2) negative impact of an RTC-related bereavement upon family members, (3) limited support following an RTC. Findings highlighted the requirement for appropriate support for bereaved families, and outlined significant flaws within the UK legal system, sentencing, and treatment of families. [ABSTRACT FROM AUTHOR]

The exact solution to the simple pendulum problem has long been known in terms of Jacobi elliptic functions, of which an efficient numerical evaluation is standard in most scientific computing software packages. Alternatively, and as done in V. Fairén, López and L. Conde (Power series approximation to solutions of nonlinear systems of differential equation, Am. J. Phys.   56 (1988) 57–61], the pendulum equation can be analytically solved exactly by the power series solution method. Although recursive formulae for the series coefficients were provided in V. Fairén et al. , the series itself—as well as the optimal location about which an expansion should be chosen to maximize the domain of convergence—has not yet been examined, and this is provided here. By virtue of its representation as an elliptic function, the pendulum function has singularities that lie off of the real axis in the complex time plane. This, in turn, imposes a radius of convergence on the power series solution in real time. By choosing the expansion point at the top of the trajectory, the power series converges all the way to the bottom of the trajectory without being affected by these singularities. We provide an exact resummation of the pendulum series that accelerates the series' convergence uniformly from the top to the bottom of the trajectory. We also provide the formulae needed to extend the pendulum series for all time via symmetry. The pendulum problem, in its relative simplicity, provides an explicit demonstration of the effect of singularity structure and initial condition location on convergence properties of power series solutions. [ABSTRACT FROM AUTHOR]

Premature closure is often described as a significant contributor to diagnostic error. Therefore, developing strategies to mitigate premature closure could reduce diagnostic errors and improve patient care. Here we propose the novel concept of pursuit of an "endpoint diagnosis" as a cognitive forcing strategy (CFS) for avoiding premature diagnostic closure. We define an "endpoint diagnosis" as an underlying causative explanation for a patient's signs, symptoms, and laboratory and radiographic data that exhausts additional relevant diagnostic evaluation. We have observed four contexts in which the error of not pursuing an endpoint diagnosis most often occurs: (1) diagnoses that appear to result in the same treatment regardless of etiology, (2) cases that are particularly complex, (3) clinical scenarios that are vulnerable to systems errors, and (4) situations in which patients' problems are attributed to uncontrolled underlying risk factors or an exacerbation of a known condition. Additionally, we address why we believe endpoint diagnoses are not universally pursued, delineate when this approach might be particularly useful, attempt to reconcile the potential conflict between accepting diagnostic ambiguity in certain instances and pursuing endpoint diagnoses, and outline possible concerns that might arise with using this CFS, including the possibility of lengthy evaluations resulting in overdiagnosis and overtreatment. Our overarching goal is for this CFS to help clinicians in their daily clinical practice as they seek to optimize their diagnostic skill and patient care. [ABSTRACT FROM AUTHOR]

A novel map display concept named Mirror in the Sky (MitS) has been introduced to improve performance and reduce workload in navigation tasks. However, this display will be novel to most users and as such, an evaluation of MitS in comparison with more conventional map formats is warranted. This study investigated the effects of map display format (MitS vs. north-up and track-up maps) and user expertise on mental workload (MWL) and performance, using both soldiers (experts) and civilians (novices) as participants. Participants followed a prescribed route to a destination in a virtual environment (route following task) while also performing a secondary task (detection response task). Soldiers generally performed better than civilians. Soldiers reported a higher MWL with MitS than with the north-up map, whereas civilians reported a higher MWL with MitS than with the track-up map. Regardless of user expertise, there were performance and workload challenges with MitS, despite its potential. Practitioner summary: A new map display concept called Mirror in the Sky (MitS) was compared with two conventional map formats: a north-up and track-up map. The experiment tested soldier and civilian users in a route following task. Both groups got further into the route and had fewer obstacle collisions with north-up and track-up maps than they did with the MitS map. MWL measures generally indicated higher workload with MitS. Abbreviations: MitS: mirror in the sky; FFOV: forward field of view; AR: augmented reality; MWL: mental workload; VR: virtual reality; HF: human factors; HR: heart rate; HRV: heart rate variability; DRT: detection response task; DRDC: defence research and development Canada; VE: virtual environment; RT: response time; ANOVA: analysis of variance [ABSTRACT FROM AUTHOR]

The next generation of displays for soldiers may include augmented reality capabilities. One such display, called Mirror in the Sky (MitS), presents survey information in the upper visual field. Using a virtual reality simulation of a military reconnaissance scenario, we compared a MitS prototype to a familiar electronic 2D north-up map. Participants (24 soldiers) were told to follow a prescribed route, detect potential threats, and reroute around them. They also performed a secondary task as a measure of mental workload. At the end of the route, the soldiers were asked to recall the locations of threats and route changes. Participants made better reroute decisions with the north-up map than with MitS, although no differences were observed for threat detection or mental workload. They also scored higher on recall with the north-up map than with MitS. Practitioner Summary: An augmented reality navigation aid was compared to an electronic north-up map in a military reconnaissance scenario, in a virtual reality simulation. Participants made better route decisions and had better recall with the north-up map, but no mental workload differences were found between displays. [ABSTRACT FROM AUTHOR]

The expansion of Antarctic sea ice since 1979 in the presence of increasing greenhouse gases remains one of the most puzzling features of current climate change. Some studies have proposed that the formation of the ozone hole, via the Southern Annular Mode, might explain that expansion, and a recent paper highlighted a robust causal link between summertime Southern Annular Mode (SAM) anomalies and sea ice anomalies in the subsequent autumn. Here we show that many models are able to capture this relationship between the SAM and sea ice, but also emphasize that the SAM only explains a small fraction of the year‐to‐year variability. Finally, examining multidecadal trends, in models and in observations, we confirm the findings of several previous studies and conclude that the SAM–and thus the ozone hole–are not the primary drivers of the sea ice expansion around Antarctica in recent decades. Plain Language Summary: Unlike its Arctic counterpart, sea ice around Antarctica has been growing since 1979, even as the levels of carbon dioxide in the atmosphere have increased. Given that the ozone hole formed over the South Pole around the same time, one is led to ask whether the ozone hole may be responsible for the growth of Antarctic sea ice (recall that there is no ozone hole over the North Pole). In this study, looking at both models and observations, we show that the ozone hole is capable of affecting the surface winds and these, in turn, can make sea ice expand. However, the magnitude of this effect is small. Also since the ozone hole started healing after the year 2000, while Antarctic sea ice kept expanding, we conclude that ozone depletion is not the main reason for the expansion of Antarctic sea ice in recent decades. Key Points: Many CMIP5 models are able to capture the observed seasonal correlation between summertime Southern Annular Mode (SAM) and Antarctic sea ice extentThe SAM, however, only explains 15 of the year‐to‐year sea ice extent variability in the fall, in both models and observationsSAM trends, and ozone depletion, are not the primary drivers of the observed Antarctic sea ice expansion in the last four decades [ABSTRACT FROM AUTHOR]

We analyze two preindustrial experiments from the Community Earth System Model version 2 to characterize the impact of sea ice physics on differences in coastal sea ice production around Antarctica and the resulting impact on the ocean and atmosphere. The experiment in which sea ice is a more realistic "mushy" mixture of solid ice and brine has a substantial increase in coastal sea ice frazil and snow ice production that is accompanied by decreasing bottom ice growth and increasing bottom melt. The more realistic "mushy" physics leads to an increase in water mass formation at denser water classes due primarily to surface ice processes. As a result, the subsurface ocean is denser, saltier, and there is an increase in Antarctic Bottom Water formation of ∼0.5 Sv. For the atmosphere, "mushy" ice physics leads to decreased turbulent heat flux and low level cloud cover near the Antarctic coast. Plain Language Summary: We analyze experiments from the Community Earth System Model to better understand the impacts of representing sea ice as a mixture of salty water and solid ice rather than just solid ice. We focus on sea ice produced around the Antarctic coasts and find that the ways in which the sea ice grow and melt change with the two representations of sea ice, but the differences compensate so that the average sea ice state is minimally changed. However, the near surface ocean water is denser in the experiment with sea ice represented by a mix of solid ice and salty water, mainly because the ocean is saltier due to surface sea ice processes. This leads to increased formation of dense Antarctic Bottom Water. In addition, there is less energy input into the atmosphere and less low level cloud cover around the Antarctic coasts in the experiment with the sea ice represented as a mix of salty water and solid ice. Thus, there are important impacts on the Earth system based solely on the way sea ice is represented. Key Points: Choice of sea ice thermodynamics does not lead to large differences in sea ice state due to compensating thermodynamic changesAntarctic Bottom Water production increases by 0.5 Sv and upper ocean becomes denser due to increasing salinity with mushy thermodynamicsWintertime air‐sea fluxes, atmospheric low‐level mixing, and low cloud cover all decrease with mushy thermodynamics [ABSTRACT FROM AUTHOR]

We are developing ovine models of spinal cord injury to test novel neuromodulation-based methods on spasticity. The hemisection has been reported in a number of large animal studies. Our aim is to duplicate a hemisection injury in the sheep. Our effort is explored here. Methods and Results: Three sheep underwent hemi-sectioning of the spinal cord. Quantitative gait analysis was completed both pre- and post-injury. While measurable differences in most of the 20 gait metrics were observed, relatively few were above the predicted thresholds based on error levels expected from the data. Variations in severity of injury across the three sheep were observed. Conclusions: The hemisection ovine model of spinal cord injury shows promise as a large-animal platform for developing new therapies for treating spinal cord injuries. While variability in injury severity was observed across animals, as has been observed with weight drop-based SCI models, the hemi-section approach has the advantages of procedural ease and reduced technical complexity. [ABSTRACT FROM AUTHOR]

The temperature dependence of the indirect bandgap in thallium bromide has been determined using variable temperature (5K to 300 K) cathodoluminescence. The spectra include transitions associated with both the indirect (2.66 eV at 5K) and the direct (3.0 eV at 5K) bandgaps. Leastsquares analysis has been used to obtain fitting parameters for three analytical models commonly applied to describe the dependence of the bandgap on temperature for the lowest energy indirect transition. The indirect bandgap emission shifts to an energy of 2.86 eV at 300 K. We find a significant difference in the behavior of the luminescence associated with the direct bandgap, which does not appear to shift to the extent predicted by earlier measurements of the exciton absorption edge. [ABSTRACT FROM AUTHOR]

What has become known in bioethics as "the Nazi analogy" likens a change's potential to precipitate moral deterioration to Nazi atrocities of the mid-20th century. This analogy has been applied in physician aid-indying (PAD) deliberations by those fearful that a physician's role in enabling a patient's death is too similar to Nazi physicians' roles in systematic murders during the Holocaust. This article suggests the importance of carefully distinguishing between when the Nazi analogy is aptly applied and when its use is limited to urging great caution about abuse or inequity. [ABSTRACT FROM AUTHOR]

Earth system models are valuable tools for understanding how the Arctic snow-ice system and the feedbacks therein may respond to a warming climate. In this analysis, we investigate snow on Arctic sea ice to better understand how snow conditions may change under different forcing scenarios. First, we use in situ, airborne, and satellite observations to assess the realism of the Community Earth System Model (CESM) in simulating snow on Arctic sea ice. CESM versions one and two are evaluated, with V1 being the Large Ensemble experiment (CESM1-LE) and V2 being configured with low- and hightop atmospheric components. The assessment shows CESM2 underestimates snow depth and produces overly uniform snow distributions, whereas CESM1-LE produces a highly variable, excessively-thick snow cover. Observations indicate that snow in CESM2 accumulates too slowly in autumn, too quickly in winter-spring, and melts too soon and rapidly in late spring. The 1950–2050 trends in annual mean snow depths are markedly smaller in CESM2 (−0.8 cm decade−1) than in CESM1-LE (−3.6 cm decade−1) due to CESM2 having less snow overall. A perennial, thick sea-ice cover, cool summers, and excessive summer snowfall facilitate a thicker, longer-lasting snow cover in CESM1-LE. Under the SSP5-8.5 forcing scenario, CESM2 shows that, compared to present-day, snow on Arctic sea ice will: (1) undergo enhanced, earlier spring melt, (2) accumulate less in summer-autumn, (3) sublimate more, and (4) facilitate marginally more snow-ice formation. CESM2 also reveals that summers with snow-free ice can occur ∼30–60 years before an ice-free central Arctic, which may promote faster sea-ice melt. [ABSTRACT FROM AUTHOR]

We examine the response of the Community Earth System Model Versions 1 and 2 (CESM1 and CESM2) to abrupt quadrupling of atmospheric CO2 concentrations (4xCO2) and to 1% annually increasing CO2 concentrations (1%CO2). Different estimates of equilibrium climate sensitivity (ECS) for CESM1 and CESM2 are presented. All estimates show that the sensitivity of CESM2 has increased by 1.5 K or more over that of CESM1. At the same time the transient climate response (TCR) of CESM1 and CESM2 derived from 1%CO2 experiments has not changed significantly—2.1 K in CESM1 and 2.0 K in CESM2. Increased initial forcing as well as stronger shortwave radiation feedbacks are responsible for the increase in ECS seen in CESM2. A decomposition of regional radiation feedbacks and their contribution to global feedbacks shows that the Southern Ocean plays a key role in the overall behavior of 4xCO2 experiments, accounting for about 50% of the total shortwave feedback in both CESM1 and CESM2. The Southern Ocean is also responsible for around half of the increase in shortwave feedback between CESM1 and CESM2, with a comparable contribution arising over tropical ocean. Experiments using a thermodynamic slab‐ocean model (SOM) yield estimates of ECS that are in remarkable agreement with those from fully coupled Earth system model (ESM) experiments for the same level of CO2 increase. Finally, we show that the similarity of TCR in CESM1 and CESM2 masks significant regional differences in warming that occur in the 1%CO2 experiments for each model. Plain Language Summary: Computer models of the Earth's climate system are complex. Our best guess scenarios for how the climate system will change due to human activity over the next century are also complex. They include estimates of changing greenhouse gas (e.g., CO2) levels in the atmosphere, aerosol (e.g., smog and haze) emissions, and land use changes (e.g., deforestation and urbanization). To help understand this complex system, the climate modeling community has designed two simplified experiments: abrupt CO2 quadrupling (4xCO2) and 1% annual CO2 increase (1%CO2). In these experiments all human‐induced factors in the climate system are held constant (at preindustrial levels) except for CO2 in the atmosphere. Results of these experiments from different climate models can be compared to gain insight into the climate system. We look at two versions of the Community Earth System Model (CESM1 and CESM2). The warming simulated in the 4xCO2 experiment (climate sensitivity) has increased substantially in CESM2. This is related to changes in clouds over the Southern Ocean and tropics. At the same time warming in in the 1%CO2 experiment has not increased. This is related to differences in how CESM1 and CESM2 simulate northern oceans (Arctic, North Atlantic, and North Pacific). Key Points: Climate sensitivity has increased from 4 K to over 5 K in CESM2 compared to CESM1Shortwave radiation feedbacks over the Southern Ocean play a key role in determining the response of CESM to increasing CO2Various measures of climate response, including equilibrium climate sensitivity (ECS) and transient climate response (TCR), are not simply related in CESM [ABSTRACT FROM AUTHOR]

An overview of the Community Earth System Model Version 2 (CESM2) is provided, including a discussion of the challenges encountered during its development and how they were addressed. In addition, an evaluation of a pair of CESM2 long preindustrial control and historical ensemble simulations is presented. These simulations were performed using the nominal 1° horizontal resolution configuration of the coupled model with both the "low‐top" (40 km, with limited chemistry) and "high‐top" (130 km, with comprehensive chemistry) versions of the atmospheric component. CESM2 contains many substantial science and infrastructure improvements and new capabilities since its previous major release, CESM1, resulting in improved historical simulations in comparison to CESM1 and available observations. These include major reductions in low‐latitude precipitation and shortwave cloud forcing biases; better representation of the Madden‐Julian Oscillation; better El Niño‐Southern Oscillation‐related teleconnections; and a global land carbon accumulation trend that agrees well with observationally based estimates. Most tropospheric and surface features of the low‐ and high‐top simulations are very similar to each other, so these improvements are present in both configurations. CESM2 has an equilibrium climate sensitivity of 5.1–5.3 °C, larger than in CESM1, primarily due to a combination of relatively small changes to cloud microphysics and boundary layer parameters. In contrast, CESM2's transient climate response of 1.9–2.0 °C is comparable to that of CESM1. The model outputs from these and many other simulations are available to the research community, and they represent CESM2's contributions to the Coupled Model Intercomparison Project Phase 6. Plain Language Summary: The Community Earth System Model (CESM) is an open‐source, comprehensive model used in simulations of the Earth's past, present, and future climates. The newest version, CESM2, has many new technical and scientific capabilities ranging from a more realistic representation of Greenland's evolving ice sheet, to the ability to model in detail how crops interact with the larger Earth system, to improved representation of clouds and rain, and to the addition of wind‐driven waves on the model's ocean surface. The data sets from a large set of simulations that include integrations for the preindustrial conditions (1850s) and for the 1850‐2014 historical period are available to the community, representing CESM2's contributions to the Coupled Model Intercomparison Project Phase 6 (CMIP6). Key Points: Community Earth System Model Version 2 includes many substantial science and infrastructure improvements since its previous versionPreindustrial control and historical simulations were performed with low‐top and high‐top with comprehensive chemistry atmospheric modelsComparisons to observations are improved relative to previous versions, including major reductions in radiation and precipitation biases [ABSTRACT FROM AUTHOR]

The admittances and subthreshold characteristics of capacitors and MOSFETs on buried and surface In0.53Ga0.47As channel flatband wafers, with a dielectric of Al2O3 deposited on In0.53Ga0.47As, are reported. The admittance characteristics of both wafers indicate the presence of defect states within the oxide, in common with a number of other oxides on In0.53Ga0.47As. The two wafers studied have not been hydrogen annealed, but do show some similar features to FGA treated oxides on n+ substrates. We discuss how the possible presence of residual hydroxyl ions in as-grown Al2O3 may explain these similarities and also account for many of the changes in the properties of FGA treated n+ samples. The issues around the comparison of subthreshold swing (SS) results and the impact of transistor design parameters on the energy portion of the defect state distribution affecting efficient device switching are discussed. The interface state model is applied to low source-drain voltage SS data to extract an effective interface state density (Dit) that includes interface and oxide traps. The logarithmic gate voltage sweep rate dependence of the SS Dit is used to extract an oxide trap density (Dot) and a simple method is used to estimate the Fermi level position within the band gap, Et. The Al2O3 Dit(Et) and Dot(Et) distributions are found to be similar to each other and to the results of our analysis of Gd0.25Ga0.15O0.6/Ga2O3 and HfO2/Al2O3 on In0.53Ga0.47As, adding weight to the suggestion of there being a common defect state distribution and perhaps a common cause of defects states for a number of oxides on In0.53Ga0.47As. [ABSTRACT FROM AUTHOR]

We have performed comprehensive studies of the optical, thermoelectric, and electrical properties of Mg doped InN with varying Mg doping levels and sample thicknesses. Room temperature photoluminescence spectra show a Mg acceptor related emission and the thermopower provides clear evidence for the presence of mobile holes. Although the effects of the hole transport are clearly observed in the temperature dependent electrical properties, the sign of the apparent Hall coefficient remains negative in all samples. We show that the standard model of two electrically well connected layers (n-type surface electron accumulation and p-type bulk) does not properly describe Hall effect in p-type InN. [ABSTRACT FROM AUTHOR]

The admittance characteristics of a well understood oxide system of Gd0.25 Ga0.15 O0.60/Ga2 O3 on In0.53 Ga0.47As are studied at low temperature where the majority of the defect states are frozen. The capacitance-voltage (C-V) characteristics are broadened beyond those expected for an ideal sample. The broadening is ascribed to the presence of a non-uniform surface potential. We report a simple method for measuring the surface potential distribution width using the ac signal amplitude dependence of the C-V profile. A distribution of surface potentials can explain the observed behavior, but only if it includes the admittance of the semiconductor. This is in contrast to the usual approximation that the effect of a distribution of surface potentials on the admittance of the semiconductor is ignored. It is found that the charge state of defect states in the oxide and variation in the doping density of the substrate contribute to the broadening. The implications for inclusion of the semiconductor admittance for the interpretation of ideal characteristics and for the analysisof characteristics with interface states are explored. Both the conductance method and the quasi-equilibrium C-V methods are affected to some extent. An alternative method that can more accurately extract information from the admittance characteristics of the MOS samples is proposed. [ABSTRACT FROM AUTHOR]

The admittances and subthreshold characteristics of capacitors and MOSFETs on buried InxGa1-xAs channel wafers with a dielectric stack of Gd0.25Ga0.15O0.6/Ga2O3 deposited on GaAs and In0.53Ga0.47As are reported. Both the GaAs and InGaAs interface samples show admittance characteristics indicative of the presence of defect states within the oxide, in agreement with previously reported data from the same oxides on n+ substrates. The interface state model is applied to the admittance data to extract an apparent interface state density (Dit) that includes interface and oxide states. The Dit profiles are very different and have pronounced effects on the device performance. The device subthreshold swings (SS) at low source-drain voltages are also used to extract an apparent Dit. A simple method is used to estimate the Fermi-level position within the bandgap (Et) at threshold, and the resulting Dit(Et) are found to be in good agreement with the admittance data. The importance of proper interpretation of SS and Dit in general and in GaAs interface devices in particular is emphasized. A model that accounts for the logarithmic sweep rate dependence of the extracted Dit due to the presence of oxide states is reported and used to estimate their density from SS measurements. The implications of the band parameters of an oxide with defect states within it for the comparison of different oxides on the same substrate and the issues around the comparison of results in general are discussed. [ABSTRACT FROM AUTHOR]

The electrical characteristics of n+ GaAs and In0.53Ga0.47As MOS capacitors with a dielectric stack of Ga2O3/Gd0.25Ga0.15O0.6 have been examined in detail and compared to the interface state model. The deviations from the model are assessed and the limitations of different interface state density extraction techniques are highlighted. The results of a model which accounts for many of the electrical characteristics of the InGaAs material by including states within the oxide and at the interface are reported. A hypothesis that may explain the difference between the GaAs and InGaAs characteristics and the similarities between the properties of many different oxides on InGaAs is discussed, leading to suggestions on how the oxide quality may be improved. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including understanding the care of unrepresented patients such as elderly, homeless, and mentally disabled, examines difficulties with the legal guardian system, and life-sustaining treatment.

Background Timely and consistent recognition of a 'clinical crisis', a life threatening condition that demands immediate intervention, is essential to reduce 'failure to rescue' rates in general wards. Aim To determine how different clinical caregivers define a 'clinical crisis' and how they respond to it. Design An international survey. Methods Clinicians working on general wards, intensive care units or emergency departments in the Netherlands, the United Kingdom and Denmark were asked to review ten scenarios based on common real-life cases. Then they were asked to grade the urgency and severity of the scenario, their degree of concern, their estimate for the risk for death and indicate their preferred action for escalation. The primary outcome was the scenarios with a National Early Warning Score (NEWS) ≥7 considered to be a 'clinical crisis'. Secondary outcomes included how often a rapid response system (RRS) was activated, and if this was influenced by the participant's professional role or experience. The data from all participants in all three countries was pooled for analysis. Results A total of 150 clinicians participated in the survey. The highest percentage of clinicians that considered one of the three scenarios with a NEWS ≥7 as a 'clinical crisis' was 52%, while a RRS was activated by <50% of participants. Professional roles and job experience only had a minor influence on the recognition of a 'clinical crisis' and how it should be responded to. Conclusion This international survey indicates that clinicians differ on what they consider to be a 'clinical crisis' and on how it should be managed. Even in cases with a markedly abnormal physiology (i.e. NEWS ≥7) many clinicians do not consider immediate activation of a RRS is required. [ABSTRACT FROM AUTHOR]

This review focuses on current understanding of prenatal, prepubertal and post-pubertal development of the male reproductive system of cattle. The critical developmental events occur during the first 3 to 4 months of gestation and the first ~6 to 9 months after birth. The Wilms Tumor-1 and SRY proteins play critical roles in early development and differentiation of the fetal testis, which in turn drives gestational development of the entire male reproductive system. The hypothalamic–pituitary–gonadal axis matures earlier in the bovine fetus than other domestic species with descent of the testes into the scrotum occurring around the 4th month of gestation. An array of congenital abnormalities affecting the reproductive system of bulls has been reported and most are considered to be heritable, although the mode of inheritance in most cases has not been fully defined. Early postnatal detection of most of these abnormalities is problematic as clinical signs are generally not expressed until after puberty. Development of genomic markers for these abnormalities would enable early culling of affected calves in seedstock herds. The postnatal early sustained increase in lutenising hormone secretion cues the rapid growth of the testes in the bull calf leading to the onset of puberty. There is good evidence that both genetic and environmental factors, in particular postnatal nutrition, control or influence development and maturation of the reproductive system. For example, in Bos taurus genotypes which have had sustained genetic selection pressure applied for fertility, and where young bulls are managed on a moderate to high plane of nutrition puberty typically occurs at 8 to 12 months of age. However, in many Bos indicus genotypes where there has been little selection pressure for fertility and where young bulls are reared on a low plane of nutrition, puberty typically occurs between 15 to 17 months. Our understanding of the control and expression of sexual behavior in bulls is limited, particularly in B. indicus genotypes. [ABSTRACT FROM AUTHOR]

This review focuses on current understanding of prenatal, prepubertal and post-pubertal development of the male reproductive system of cattle. The critical developmental events occur during the first 3 to 4 months of gestation and the first ~6 to 9 months after birth. The Wilms Tumor-1 and SRY proteins play critical roles in early development and differentiation of the fetal testis, which in turn drives gestational development of the entire male reproductive system. The hypothalamic–pituitary–gonadal axis matures earlier in the bovine fetus than other domestic species with descent of the testes into the scrotum occurring around the 4th month of gestation. An array of congenital abnormalities affecting the reproductive system of bulls has been reported and most are considered to be heritable, although the mode of inheritance in most cases has not been fully defined. Early postnatal detection of most of these abnormalities is problematic as clinical signs are generally not expressed until after puberty. Development of genomic markers for these abnormalities would enable early culling of affected calves in seedstock herds. The postnatal early sustained increase in lutenising hormone secretion cues the rapid growth of the testes in the bull calf leading to the onset of puberty. There is good evidence that both genetic and environmental factors, in particular postnatal nutrition, control or influence development and maturation of the reproductive system. For example, in Bos taurus genotypes which have had sustained genetic selection pressure applied for fertility, and where young bulls are managed on a moderate to high plane of nutrition puberty typically occurs at 8 to 12 months of age. However, in many Bos indicus genotypes where there has been little selection pressure for fertility and where young bulls are reared on a low plane of nutrition, puberty typically occurs between 15 to 17 months. Our understanding of the control and expression of sexual behavior in bulls is limited, particularly in B. indicus genotypes. [ABSTRACT FROM AUTHOR]

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Introduction Contemporary haemophilia care demands Patient-Reported Outcomes. SO- FIT is a UK multi-centre study, assessing self-reported function, health-related quality of life ( HRQoL) and joint health in boys with severe haemophilia. Methods Subjective physical function (PedHAL, HEP-Test-Q) and HRQoL (Haemo-QoL Short Form [SF]) were assessed alongside joint health using the objective Haemophilia Joint Health Score (HJHS v2.1). Demographic and clinical data were collected. Results Data from 127 boys mean age 12.38 ± 2.5 (range 8-17) treated at 16 sites were analysed. One-hundred-and-thirteen had haemophilia A, 25/9 past/current inhibitor, 124 were treated prophylactically (46.8% primary) and three on-demand. In the preceding 6 months, boys reported median 0 joint bleeds (range 0-8) with a median HJHS score of 1 (range 0-30). Boys reported good physical functioning; HEP-Test-Q (M = 80.32 ± 16.1) showed the highest impairments in the domain 'endurance' (72.53 ± 19.1), in Ped HAL (M = 85.44 ± 18.9) highest impairments were in the domains 'leisure activities & sports' (M = 82.43 ± 23.4) and 'lying/sitting/kneeling/standing' (M = 83.22 ± 20.3). Boys reported generally good HRQoL in Haemo-QoL SF SF (M = 22.81 ± 15.0) with highest impairments in the domains 'friends' (M = 28.81 ± 30.5) and 'sports & school' (M = 26.14 ± 25.1). HJHS revealed low correlations with the Haemo-QoL SF ( r = .251, P < .006), the PedHAL ( r = −.397, P < .0001) and the HEP-Test-Q ( r = −.323, P < .0001). A moderate correlation was seen between HEP-Test-Q and Haemo-QoL SF of r = −.575 ( P < .0001) and between Ped HAL and Haemo-QoL SF r = −.561 ( P < .0001) implying that good perceived physical function is related to good HRQoL. Conclusions The SO- FIT study has demonstrated that children with severe haemophilia in the UK report good HRQoL and have good joint health as reflected in low HJHS scores. [ABSTRACT FROM AUTHOR]

Entamoeba histolytica is an enteric pathogen responsible for amoebic dysentery and liver abscess. It alternates between the host-restricted trophozoite form and the infective environmentally-stable cyst stage. Throughout its lifecycle E. histolytica experiences stress, in part, from host immune pressure. Conversion to cysts is presumed to be a stress-response. In other systems, stress induces phosphorylation of a serine residue on eukaryotic translation initiation factor-2α (eIF2α). This inhibits eIF2α activity resulting in a general decline in protein synthesis. Genomic data reveal that E. histolytica possesses eIF2α (EheIF2α) with a conserved phosphorylatable serine at position 59 (Ser59). Thus, this pathogen may have the machinery for stress-induced translational control. To test this, we exposed cells to different stress conditions and measured the level of total and phospho-EheIF2α. Long-term serum starvation, long-term heat shock, and oxidative stress induced an increase in the level of phospho-EheIF2α, while short-term serum starvation, short-term heat shock, or glucose deprivation did not. Long-term serum starvation also caused a decrease in polyribosome abundance, which is in accordance with the observation that this condition induces phosphorylation of EheIF2α. We generated transgenic cells that overexpress wildtype EheIF2α, a non-phosphorylatable variant of eIF2α in which Ser59 was mutated to alanine (EheIF2α-S59A), or a phosphomimetic variant of eIF2α in which Ser59 was mutated to aspartic acid (EheIF2α-S59D). Consistent with the known functions of eIF2α, cells expressing wildtype or EheIF2α-S59D exhibited increased or decreased translation, respectively. Surprisingly, cells expressing EheIF2α-S59A also exhibited reduced translation. Cells expressing EheIF2α-S59D were more resistant to long-term serum starvation underscoring the significance of EheIF2α phosphorylation in managing stress. Finally, phospho-eIF2α accumulated during encystation in E. invadens, a model encystation system. Together, these data demonstrate that the eIF2α-dependent stress response system is operational in Entamoeba species. [ABSTRACT FROM AUTHOR]

In this review we critically analyze pulmonary, gastrointestinal and cardiac manifestations of childhood-onset systemic lupus erythematosus (cSLE). Clinical manifestations of these organ systems may be the initial manifestation of cSLE; frequently occur with very active cSLE; and are potential life-threatening manifestations often presenting to the emergency department and requiring admission to the intensive care unit. Early recognition and treatment of the pulmonary, gastrointestinal and cardiac manifestations of cSLE will result in improved prognosis and better outcomes. [ABSTRACT FROM AUTHOR]

We report the first demonstration of InAs FinFETs with fin width \textrm W{\mathrm{fin}} in the range 25–35 nm, formed by inductively coupled plasma etching. The channel comprises defect-free, lattice-matched InAs with fin height \textrm H{\mathrm{fin}}=20 nm controlled by the use of an etch stop layer incorporated into the device heterostructure. For a gate length \textrm L{{\textrm {g}}}=1~\mu \text{m} , peak transconductance \textrm g{{\textrm {m,{\mathrm{ peak}}}}}=1430~\mu \text{S}/\mu \text{m} is measured at \textrm V{\textrm {d}}=0.5 V demonstrating that electron transport in InAs fins can match planar devices. [ABSTRACT FROM PUBLISHER]

This study investigates whether or not predictability always decreases for more extreme events. Predictability is measured by the Mean Squared Error (MSE), estimated here from the difference of pairs of ensemble forecasts, conditioned on one of the forecast variables (the 'pseudo-observation') exceeding a threshold. Using an exchangeable linear regression model for pairs of forecast variables, we show that the MSE can be decomposed into the sum of three terms: a threshold-independent constant, a mean term that always increases with threshold, and a variance term that can either increase, decrease, or stay constant with threshold. Using the generalised Pareto distribution to model wind speed excesses over a threshold, we show that MSE always increases with threshold at sufficiently high threshold. However, MSE can be a decreasing function of threshold at lower thresholds but only if the forecasts have finite upper bounds. The methods are illustrated by application to daily wind speed forecasts for London made using the 24 member Met Office Global and Regional Ensemble Prediction System from 1 January 2009 to 31 May 2011. For this example, the mean term increases faster than the variance term decreases with increasing threshold, and so predictability decreases for more extreme events. [ABSTRACT FROM AUTHOR]

Biopharmaceuticals (BPs) represent a rapidly growing class of approved and investigational drug therapies that is contributing significantly to advancing treatment in multiple disease areas, including inflammatory and autoimmune diseases, genetic deficiencies and cancer. Unfortunately, unwanted immunogenic responses to BPs, in particular those affecting clinical safety or efficacy, remain among the most common negative effects associated with this important class of drugs. To manage and reduce risk of unwanted immunogenicity, diverse communities of clinicians, pharmaceutical industry and academic scientists are involved in: interpretation and management of clinical and biological outcomes of BP immunogenicity, improvement of methods for describing, predicting and mitigating immunogenicity risk and elucidation of underlying causes. Collaboration and alignment of efforts across these communities is made difficult due to lack of agreement on concepts, practices and standardized terms and definitions related to immunogenicity. The Innovative Medicines Initiative (IMI; ), ABIRISK consortium [Anti-Biopharmaceutical (BP) Immunization Prediction and Clinical Relevance to Reduce the Risk; ] was formed by leading clinicians, academic scientists and EFPIA (European Federation of Pharmaceutical Industries and Associations) members to elucidate underlying causes, improve methods for immunogenicity prediction and mitigation and establish common definitions around terms and concepts related to immunogenicity. These efforts are expected to facilitate broader collaborations and lead to new guidelines for managing immunogenicity. To support alignment, an overview of concepts behind the set of key terms and definitions adopted to date by ABIRISK is provided herein along with a link to access and download the ABIRISK terms and definitions and provide comments (). [ABSTRACT FROM AUTHOR]

Background: Early consultant review has been shown to improve outcomes in patients presenting to the Acute Medical Unit (AMU). The Society for Acute Medicine (SAM) clinical quality indicators use the time of arrival on the AMU for target rather than arrival in the Emergency Department (ED) although this is where most acute medical patients present. Aim: To determine the effect of a 7-day Consultant Acute Physician model on patient waiting times and assess the impact of starting the clock for medical patients at time of ED arrival. Design: We performed an audit at a University Hospital AMU in the North West of England. Methods: Data were collected prospectively for 15 consecutive days in May-June 2013 for all patients presenting to the AMU at University Hospital of South Manchester and were repeated for the same time period in 2014 following the introduction of a new Consultant working model. Results: Four hundred and five patients were admitted to the AMU in the 2013 cohort compared to 456 in the 2014 cohort. There was a significant improvement in the median waiting time for Consultant review from AMU admission to 5 h 53 min from 8 h 15 min (P<0.001). The compliance with the SAM quality indicator for Consultant review improved from 88.7 to 93.7% (P = 0.022). Conclusion:A 7-day Acute Physician working model is improving performance with regards to patient waiting times. We suggest that starting the clock for acute medical patients in the ED is a better measure of performance than on arrival to the AMU. [ABSTRACT FROM AUTHOR]

A linear correlation between quadrupole moment (Qzz) and enantioselectivity (es) advocates the notion that a cation–π interaction is a contributing factor in the addition of uncharged nucleophiles to iminium salts derived from MacMillan's 1st generation catalyst. The quadrupole moment of the aryl shielding group is a useful qualitative parameter for predicting selectivity (Qzz ＜ 0 → high es). [ABSTRACT FROM AUTHOR]

The assessment and prediction of mine water rebound has become increasingly important for the gold mining industry in South Africa. The cessation of mine dewatering has led to large volumes of contaminated discharges in the western parts of the Witwatersrand Basin. Towards the eastern extremity of the Basin, the detached Evander Goldfield has been mined since the early 1950s at depths of between 400 m and 2 000 m below ground level, while overlain by shallower coal mining operations. The hydrogeology of the Evander Basin can be categorised by a shallow weathered-fractured rock aquifer comprising of the glacial and deltaic sediments of the Karoo Supergroup, while the deeper historically confined fractured bedrock aquifer consists predominantly of quartzite with subordinate lava, shale and conglomerate of the Witwatersrand Supergroup. The deep Witwatersrand aquifer has been actively dewatered for the past 60 years at a peak rate of 60 ML/cl in the mid-to-late 1960s. Modelling the impacts of mine dewatering and flooding on a regional scale as for the Evander Goldfield presents many challenges including the appropriate discretisation of mine voids and the accurate modelling of layered aquifer systems. To predict the environmental impacts of both the historic and future deep-mining operations at Shaft 6, a detailed conceptual model of the aquifer systems and a 3-dimensional model of the mine voids were incorporated into a numerical groundwater model. This model was used to simulate the dewatering and post-closure rebound of the water tables in the vicinity of the mine. This model could serve as an example for the successful modelling of mine dewatering and flooding scenarios for other parts of the Witwatersrand Basin. [ABSTRACT FROM AUTHOR]

Iron is a key nutrient for phytoplankton growth in the surface ocean. At high latitudes, the iron cycle is closely related to the dynamics of sea ice. In recent decades, Arctic sea ice cover has been declining rapidly and Antarctic sea ice has exhibited large regional trends. A significant reduction of sea ice in both hemispheres is projected in future climate scenarios. In order to adequately study the effect of sea ice on the polar iron cycle, sea ice bearing iron was incorporated in the Community Earth System Model (CESM). Sea ice acts as a reservoir for iron during winter and releases the trace metal to the surface ocean in spring and summer. Simulated iron concentrations in sea ice generally agree with observations in regions where iron concentrations are relatively low. The maximum iron concentrations simulated in Arctic and Antarctic sea ice are much lower than observed, which is likely due to underestimation of iron inputs to sea ice or missing mechanisms. The largest iron source to sea ice is suspended sediments, contributing fluxes of iron of 2.2 x 108 mol Fe month-1 in the Arctic and 4.1 x 106 mol Fe month-1 in the Southern Ocean during summer. As a result of the iron flux from ice, iron concentrations increase significantly in the Arctic. Iron released from melting ice increases phytoplankton production in spring and summer and shifts phytoplankton community composition in the Southern Ocean. Results for the period of 1998 to 2007 indicate that a reduction of sea ice in the Southern Ocean will have a negative influence on phytoplankton production. Iron transport by sea ice appears to be an important process bringing iron to the central Arctic. The impact of ice to ocean iron fluxes on marine ecosystems is negligible in the current Arctic Ocean, as iron is not typically the growth-limiting nutrient. However, it may become a more important factor in the future, particularly in the central Arctic, as iron concentrations will decrease with declining sea ice cover and transport. [ABSTRACT FROM AUTHOR]

Context. Prescription opioid abuse is a major public health concern and an ongoing epidemic in the United States. Loperamide is a widely available and inexpensive over-the-counter antidiarrheal with peripheral mu-opioid receptor activity. Online resources discuss the use of loperamide for the amelioration of withdrawal symptoms or recreational abuse. We describe the clinical course of 5 patients abusing loperamide, 3 of whom had life-threatening cardiac arrhythmias. Methods. In this observational case series, patients with cardiac arrhythmias or history of loperamide abuse with cardiac arrhythmias were identified; 5 patients were identified and 4 of the 5 patients were seen directly at the bedside. Clinical profile and outcome of patients is reported. Results. We report 5 patients with history of loperamide abuse; 3 of the 5 patients had life-threatening cardiac arrhythmias. One of the patients experienced a second life-threatening arrhythmia after he resumed loperamide abuse. Loperamide levels were obtained in 4 of the 5 patients and were at least one order of magnitude greater than therapeutic concentrations. Discontinuation of loperamide resulted in complete resolution of cardiac conduction disturbances. Conclusion. This case series describes several patients with cardiac conduction abnormalities and life-threatening ventricular arrhythmias temporally related to loperamide abuse. With the recent efforts to restrict the diversion of prescription opioids, increasing abuse of loperamide as an opioid substitute may be seen. Toxicologists should be aware of these risks and we urge all clinicians to report such cases to FDA Medwatch®. [ABSTRACT FROM AUTHOR]