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By 2050, the U.S. plans to increase solar energy from 3% to 45% of the nation's electricity generation. Quantifying wildfire smoke's impact on solar photovoltaic (PV) generation is essential to meet this goal, especially given previous studies documenting sizable PV output losses due to smoke. We quantify smoke-driven changes in baseline solar resource availability [i.e., amount of direct normal (DNI) and global horizontal (GHI) irradiance] at different spatial and temporal scales using radiative transfer model output and satellite-based smoke, aerosol, and cloud observations. We show that irradiance decreases as smoke frequency increases at the state, regional, and national scale. DNI is more sensitive to smoke with sizable losses persisting downwind of fires. Large reductions in GHI-the main PV resource-are possible close to fires, but mean GHI declines minimally (<5%) due to transported smoke. PV resources remain relatively stable across most of CONUS even in extreme fire seasons., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Traditional σ, π, and δ types of covalent chemical bonding have been extensively studied for nearly a century. In contrast, ϕ-type bonding involving n f ( n = 4, 5) orbitals has received less attention due to their high contraction and minimal orbital overlap. Herein, we theoretically predict a singly occupied ϕ···ϕ bonding between two 5f orbitals, facilitated by B 6 group orbitals in the hexa-boron diuranium inverse sandwich structure of U 2 B 6 . From ab initio quantum chemical calculations, the global minimum structure has a septuplet state with D 6 h symmetry. Chemical bonding analyses reveal that the 5f and 6d atomic orbitals of the two uranium atoms interact with the ligand orbitals of the central B 6 ring, exhibiting favorable energy matching and symmetry compatibility to form delocalized σ-, π-, δ-, and ϕ-type bonding orbitals. Notably, even though the ϕ···ϕ bonding orbital is singly occupied, it still has a significant role in stability and cannot be overlooked. Furthermore, the U 2 B 6 cluster model can be viewed as a building block of UB 2 solid materials from both geometric and electronic perspectives. This work predicts the first example of ϕ···ϕ bonding, highlighting the complexity and diversity of chemical bonds formed in actinide boride clusters.

Research has shown that complications are more common in truth tellers' accounts than in lie tellers' accounts, but there is currently no experiment that has examined the accuracy of observers' veracity judgments when looking at complications. A total of 87 participants were asked to judge 10 transcripts (five truthful and five false) derived from a set of 59 transcripts generated in a previous experiment by Deeb et al. Approximately half of the participants were trained to detect complications (Trained), and the other half did not receive training (Untrained). Trained participants were more likely to look for complications, but they did not detect them accurately, and thus their veracity judgments did not improve beyond Untrained participants' judgments. We discuss that the training may have been too brief or not sensitive enough to enhance decision-making.

We report an investigation on the structures and chemical bonding in a series of di-lanthanum boron clusters, La 2 B n - ( n = 4-6), using photoelectron spectroscopy and theoretical calculations. Well-resolved photoelectron spectra are obtained and used to verify the global minima of the lanthanide boron clusters. The structures of La 2 B 4 - and La 2 B 5 - are found to consist of open B 4 and B 5 rings, respectively, around the La 2 dimer equatorially. Theoretical evidence of La-La σ bonding is obtained in La 2 B 4 - , whereas the bonding in La 2 B 5 - is similar to that of an incomplete inverse sandwich without real La-La bonding. The global minimum of La 2 B 6 - is completely different, where one of the La atoms can be viewed as substituting a B atom of the B 7 cluster due to the high electronic stability of the B 7 3- borozene. The resulting lanthaborozene [LaB 6 ] 3- forms a half-sandwich structure with the second La atom, with evidence of La-La σ bonding. Lanthanide-lanthanide bonds are relatively rare in chemistry. The current work suggests that binary lanthanide boron clusters provide interesting systems to study lanthanide-lanthanide bonding.

Introduction: The primary objective of this study was to evaluate the association between the U.S. Air Force Critical Care Air Transport (CCAT) provider operational experience with compliance for lung protective ventilation (LPV) volumes recommended by Acute Respiratory Distress Syndrome Clinical Network guidelines., Materials and Methods: We performed a retrospective cohort study of CCAT providers transporting combat casualties requiring mechanical ventilation from the Middle East to Germany from 2007 to 2012. We reviewed CCAT medical records from 2007 to 2012 for the total number of patient transports by CCAT physicians and respiratory care practitioners (RCPs). Center for Sustainment of Trauma and Readiness Skills Cincinnati process improvement questionnaire data described provider demographics and clinical backgrounds. We linked these data to patient demographics and in-flight ventilation management from a prior CCAT cohort study. Patient inclusion criteria included transport by CCAT from the Middle East to Germany for traumatic injury requiring mechanical ventilation between 2007 and 2012. We excluded patients with no documented height or tidal volume. LPV compliance was defined as tidal volumes ≤8 mL/kg of predicted body weight during en route critical care transport. We performed a logistic regression analysis. This study was reviewed and approved by the 59th Medical Wing institutional review board (IRB)., Results: We analyzed 491 patient transports conducted by 71 (RCPs and 84 physicians. Patients had a median age of 25 years (IQR 22-30), 98% were male, median injury severity score was 24 (IQR 17-34), and median preflight PaO2/FiO2 was 285 (IQR 220-365). Median experience was 26 missions (IQR 13-40) for RCPs and 23 missions (IQR 12-38) for physicians. All in-flight tidal volumes were LPV compliant in 58.3% of missions. Unadjusted analysis showed higher LPV compliance for RCPs with in-garrison critical care experience. Multivariate models did not find an association between missions flown and LPV compliance but did demonstrate a positive association with physician specialty of medical intensivist (OR 3.0, 95% CI 1.6-5.7) and a negative association with flights in 2008 (OR 0.4, 95% CI 0.2-0.7) for LPV compliance., Conclusion: No association was found between number of missions flown by CCAT providers and lung protective tidal volume compliance. Linkage of multiple data sources enabled investigation of clinical and operational currency associations with a care quality metric compliance in the combat en route care environment. Future studies should evaluate the impact of ongoing CCAT training and quality improvement interventions on LPV compliance., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

In light of recently reported monovalent lanthanide in borozene complexes LnB 8 - (Ln = La, Pr, Tb, Tm, Yb), the corresponding AnB 8 - (An = Ac, Pa, Bk, Md, No) actinide species within the same group were theoretically investigated in respect of oxidation state, stability, electronic structure and chemical bonding pattern. Our investigations reveal the feasibility of actinides, especially for the late actinide borozene compounds (BkB 8 - , MdB 8 - , NoB 8 - ) adopting a monovalent oxidation state of +I, a phenomenon fine-tuned by the doubly aromatic borozene B 8 2- . Early actinides (AcB 8 - , PaB 8 - ) however exhibit a tendency towards higher trivalent oxidation states.

Introduction: During high-fidelity simulations in the Critical Care Air Transport (CCAT) Advanced course, we identified a high frequency of insulin medication errors and sought strategies to reduce them using a human factors approach., Materials and Methods: Of 169 eligible CCAT simulations, 22 were randomly selected for retrospective audio-video review to establish a baseline frequency of insulin medication errors. Using the Human Factors Analysis Classification System, dosing errors, defined as a physician ordering an inappropriate dose, were categorized as decision-based; administration errors, defined as a clinician preparing and administering a dose different than ordered, were categorized as skill-based. Next, 3 a priori interventions were developed to decrease the frequency of insulin medication errors, and these were grouped into 2 study arms. Arm 1 included a didactic session reviewing a sliding-scale insulin (SSI) dosing protocol and a hands-on exercise requiring all CCAT teams to practice preparing 10 units of insulin including a 2-person check. Arm 2 contained arm 1 interventions and added an SSI cognitive aid available to students during simulation. Frequency and type of insulin medication errors were collected for both arms with 93 simulations for arm 1 (January-August 2021) and 139 for arm 2 (August 2021-July 2022). The frequency of decision-based and skill-based errors was compared across control and intervention arms., Results: Baseline insulin medication error rates were as follows: decision-based error occurred in 6/22 (27.3%) simulations and skill-based error occurred in 6/22 (27.3%). Five of the 6 skill-based errors resulted in administration of a 10-fold higher dose than ordered. The post-intervention decision-based error rates were 9/93 (9.7%) and 23/139 (2.2%), respectively, for arms 1 and 2. Compared to baseline error rates, both arm 1 (P = .04) and arm 2 (P < .001) had a significantly lower rate of decision-based errors. Additionally, arm 2 had a significantly lower decision-based error rate compared to arm 1 (P = .015). For skill-based preparation errors, 1/93 (1.1%) occurred in arm 1 and 4/139 (2.9%) occurred in arm 2. Compared to baseline, this represents a significant decrease in skill-based error in both arm 1 (P < .001) and arm 2 (P < .001). There were no significant differences in skill-based error between arms 1 and 2., Conclusions: This study demonstrates the value of descriptive error analysis during high-fidelity simulation using audio-video review and effective risk mitigation using training and cognitive aids to reduce medication errors in CCAT. As demonstrated by post-intervention observations, a human factors approach successfully reduced decision-based error by using didactic training and cognitive aids and reduced skill-based error using hands-on training. We recommend the development of a Clinical Practice Guideline including an SSI protocol, guidelines for a 2-person check, and a cognitive aid for implementation with deployed CCAT teams. Furthermore, hands-on training for insulin preparation and administration should be incorporated into home station sustainment training to reduced medication errors in the operational environment., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

The United States Naval Academy long-term scintillation measurement campaign was a multi-year effort to characterize optical turbulence in the near-maritime atmospheric boundary layer (ABL). At its core, the field experiment consists of in situ measurements of bulk atmospheric and oceanographic parameters, as well as path-averaged measurements of the refractive index structure parameter, C n 2, collected using a large-aperture scintillometer. The field experiment ran from January 1st, 2020, through September 26th, 2023, representing the most comprehensive collection of optical turbulence measurements in the near-maritime ABL to date. Long-term measurements enable researchers to evaluate existing theory and develop new models applicable to this environment. The present study characterizes some of the physical relationships that affect optical turbulence. This characterization focuses on the relationship between local optical turbulence and select atmospheric and oceanographic parameters. The impact of temperature gradients on the extent of optical turbulence was analyzed, along with its interactions with relative humidity and wind speed. The diurnal and seasonal variations in measured C n 2 were examined, with comparisons drawn against other environments. Further information and the full dataset are publicly available through the optical turbulence benchmark repository [Jellen et al., GitHub, 2023].

Background: Childhood-onset dystonia is often progressive and severely impairs a child´s life. The pathophysiology is very heterogeneous and treatment responses vary in patients with dystonia. Factors influencing treatment effects remain to be elucidated. We hypothesize that differences in brain connectivity and fiber coherence contribute to the heterogeneity in treatment response among pediatric patients with inherited and acquired dystonia., Methods: Twenty patients with childhood-onset dystonia were retrospectively recruited including twelve patients with inherited or idiopathic, and eight patients with acquired dystonia (mean age 10 years; 8 female/12 male). Fiber density between the internal part of the globus pallidus and selective target regions, as well as the diffusion measures of fractional anisotropy (FA) and mean diffusivity (MD) were analyzed and compared between different etiologies., Results: Patients with acquired dystonia presented higher fiber density to the premotor cortex and putamen and lower FA values in the thalamus compared to patients with inherited/idiopathic dystonia. MD in the premotor cortex was higher in patients with acquired dystonia, while it was lower in the thalamus., Conclusion: Diffusion MRI reveals microstructural and network alterations in patients with dystonia of different etiologies., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anne Koy reports financial support was provided by Dr. Hans Günther and Dr. Rita Herfort Foundation. Anne Koy reports financial support was provided by Boston Scientific Neuromodulation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Many atmospheric aerosols are hygroscopic and play an important role in cloud formation. Similarly, aerosols become sites of micro-condensation when they deposit to the upper and lower surfaces of leaves. Deposited salts, in particular can trigger condensation at humidities considerably below atmospheric saturation, according to their hygroscopicity and the relative humidity within the leaf boundary layer. Salt induced water potential gradients and the resulting dynamics of concentrated salt solutions can be expected to affect plant water relations., Methods: Hydroponic sunflowers were grown in filtered (FA) and unfiltered, ambient air (AA). Sap flow was measured for 18 days and several indicators of incipient drought stress were studied., Results: At 2% difference in mean vapor pressure deficit (D), AA sunflowers had 49% higher mean transpiration rates, lower osmotic potential, higher proline concentrations, and different tracer transport patterns in the leaf compared to FA sunflowers. Aerosols increased plant conductance particularly at low D., Discussion: The proposed mechanism is that thin aqueous films of salt solutions from deliquescent deposited aerosols enter into stomata and cause an extension of the hydraulic system. This hydraulic connection leads - parallel to stomatal water vapor transpiration - to wick-like stomatal loss of liquid water and to a higher impact of D on plant water loss. Due to ample water supply by hydroponic cultivation, AA plants thrived as well as FA plants, but under more challenging conditions, aerosol deposits may make plants more susceptible to drought stress., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Burkhardt, Zinsmeister, Roth-Nebelsick, Hüging and Pariyar.)

Competing Interests: Declaration of Competing Interest None Declared.

Anthocyanins in red cabbage, sweet potato, and Tradescantia pallida leaves were characterised. A total of 18 non-, mono-, and diacylated cyanidins was identified in red cabbage by high performance liquid chromatography-diode array detection coupled to high-resolution and multi-stage mass spectrometry. Sweet potato leaves contained 16 different cyanidin- and peonidin glycosides being predominantly mono- and diacylated. In T. pallida leaves, the tetra-acylated anthocyanin tradescantin prevailed. The large proportion of acylated anthocyanins resulted in a superior thermal stability during heating of aqueous model solutions (pH 3.0) coloured with red cabbage and purple sweet potato extracts as compared to that of a commercial Hibiscus-based food dye. However, their stability was still outperformed by that of the most stable Tradescantia extract. Comparing vis spectra from pH 1-10, the latter had an additional, uncommon absorption maximum at approx. 585 nm at slightly acidic to neutral pH values, yielding intensely red to purple colours., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Accurate prediction of atmospheric optical turbulence in localized environments is essential for estimating the performance of free-space optical systems. Macro-meteorological models developed to predict turbulent effects in one environment may fail when applied in new environments. However, existing macro-meteorological models are expected to offer some predictive power. Building a new model from locally measured macro-meteorology and scintillometer readings can require significant time and resources, as well as a large number of observations. These challenges motivate the development of a machine-learning informed hybrid model framework. By combining a baseline macro-meteorological model with local observations, hybrid models were trained to improve upon the predictive power of each baseline model. Comparisons between the performance of the hybrid models, selected baseline macro-meteorological models, and machine-learning models trained only on local observations, highlight potential use cases for the hybrid model framework when local data are expensive to collect. Both the hybrid and data-only models were trained using the gradient boosted decision tree architecture with a variable number of in situ meteorological observations. The hybrid and data-only models were found to outperform three baseline macro-meteorological models, even for low numbers of observations, in some cases as little as one day. For the first baseline macro-meteorological model investigated, the hybrid model achieves an estimated 29% reduction in the mean absolute error using only one day-equivalent of observation, growing to 41% after only two days, and 68% after 180 days-equivalent training data. The data-only model generally showed similar, but slightly lower performance, as compared to the hybrid model. Notably, the hybrid model's performance advantage over the data-only model dropped below 2% near the 24 days-equivalent observation mark and trended towards 0% thereafter. The number of days-equivalent training data required by both the hybrid model and the data-only model is potentially indicative of the seasonal variation in the local microclimate and its propagation environment.

Background: Hip fractures in the elderly population are common and the number of patients is rising. For young and geriatric patients with undisplaced fractures osteosynthesis is the primary type of treatment. The dynamic hip screw (DHS) is around for many years and proved its value especially in displaced fractures. Since 2018 the femoral neck system (FNS) is available as an alternative showing promising biomechanical results. The aim of this study is to evaluate clinical results of the FNS and compare it to the DHS., Materials and Methods: Patients older than 18 years with Garden I-IV fractures that were treated with osteosynthesis in a level 1 trauma center were included in the study. Between January 2015 and March 2021, all patients treated with FNS (1-hole plate, DePuy-Synthes, Zuchwil, Switzerland) or DHS (2-hole plate, DePuy-Synthes, Zuchwil, Switzerland) for proximal femur fractures were included in the study. Closed reduction was achieved using a traction table. All operations were carried out by experienced orthopedic trauma surgeons. Primary outcome measures were rate of implant failure (cut out) and surgical complications (hematoma, infection). Secondary outcome measures were Hb-difference, length of hospital stay and mortality., Results: Overall, 221 patients were included in the study. 113 were treated with FNS, 108 with DHS. Mean age was 69 ± 14 years. There were 17.2% Garden I, 47.5% Garden II, 26.7% Garden III and 8.6% Garden IV fractures. No difference between the groups for age, body mass index (BMI), Charlson comorbidity index (CCI), time to surgery, Pauwels and Garden classification, rate of optimal blade position or tip apex distance was found. FNS showed lower pre- to postoperative Hb-difference (1.4 ± 1.1 g/l vs. 2.1 ± 1.4 g/l; p < 0.05), shorter operating time (36.3 ± 11.6 min vs. 54.7 ± 17.4 min; p < 0.05) and hospital stay (8.8 ± 4.3 d vs. 11.2 ± 6.8 d; p < 0.05). Surgical complications (FNS 13.3% vs. DHS 18.4%, p > 0.05), rate of cut out (FNS 12.4% vs. DHS 10.2%, p > 0.05) and mortality (FNS 3.5%; DHS 0.9%; p > 0.05) showed no difference between the groups. Logistic regression showed that poor blade position was the only significant predictor for cut out and increased the risk by factor 7. Implant related infection (n = 3) and hematoma/seroma (n = 6) that needed revision was only seen in DHS group., Conclusion: FNS proved to be as reliable as DHS in all patients with hip fractures. Not the type of implant but blade positioning is still key to prevent implant failure. Still due to minimal invasive approach implant related infections and postoperative hematomas might have been prevented using the FNS., (© 2022. The Author(s).)

Depending on the ambient pH, ionizable substances are present in varying proportions in their neutral or charged form. The extent to which these two chemical species contribute to the pH-dependant toxicity of ionizable chemicals and whether intracellular ion trapping has a decisive influence in this context is controversially discussed. Against this background, we determined the acute toxicity of 24 ionizable substances at up to 4 different pH values on the embryonic development of the zebrafish, Danio rerio, and supplemented this dataset with additional data from the literature. The LC 50 for some substances (diclofenac, propranolol, fluoxetine) differed by a factor of even >10 3 between pH5 and pH9. To simulate the toxicity of 12 acids and 12 bases, six models to calculate a pH-dependant logD value as a proxy for the uptake of potentially toxic molecules were created based on different premises for the trans-membrane passage and toxic action of neutral and ionic species, and their abilities to explain the real LC 50 data set were assessed. Using this approach, we were able to show that both neutral and charged species are almost certainly taken up into cells according to their logD-based distribution, and that both species exert toxicity. Since two of the models that assume all intracellular molecules to be neutral overestimated the real toxicity, it must be concluded, that the toxic effect of a single charged intracellularly present molecule is, on the average, lower than that of a single neutral molecule. Furthermore, it was possible to attribute differences in toxicity at different pH values for these 24 ionizable substances to the respective deltas in logD at these pH levels with high accuracy, enabling particularly a full logD-based model on the basis of logP ow as a membrane passage descriptor to be used for predicting potential toxicities in worst-case scenarios from existing experimental studies, as stipulated in the process of registration of chemicals and the definition of Environmental Quality Standards (EQS)., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare, (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Many of the ethnic and racial workforce inequities in the United States are present in health care systems. Low representation of African American/Black individuals in the health care system workforce can be traced to a history of exclusionary practices that leave such individuals less likely to pursue health careers. Past research found that low representation is driven by inequities in health, education, and employment that are a result of structural racism. Pathways programs have been identified as one of the methods to increase recruitment, retention, and promotion in health-related career fields for African American/Black individuals. As prior research has shown, these programs recruit and support the graduation of students from underrepresented communities at all educational stages to increase their representation in specific fields. This article describes the development of key factors in framework design for the Health System-Community Pathways Program (HCPP), which aims to increase representation of African American/Black communities in the health care system workforce and improve the quality of their experience in pursuing careers in these fields. The HCPP framework of key factors is informed by an environmental scan, interviews and focus groups, and an expert discussion panel session. The article's authors come from diverse backgrounds; the team included African American/Black physicians and members of other historically marginalized communities. The qualitative research drew insights from diverse African American/Black community stakeholders; the study was reviewed by many stakeholders to ensure that the design of the research and the end product maximally benefits the community on which it focuses., (Copyright © 2023 RAND Corporation.)

Background: Feedback and assessment are difficult to provide in the emergency department (ED) setting despite their critical importance for competency-based education, and traditional end-of-shift evaluations (ESEs) alone may be inadequate. The SIMPL (Society for Improving Medical Professional Learning) mobile application has been successfully implemented and studied in the operative setting for surgical training programs as a point-of-care tool that incorporates three assessment scales in addition to dictated feedback. SIMPL may represent a viable tool for enhancing workplace-based feedback and assessment in emergency medicine (EM)., Methods: We implemented SIMPL at a 4-year EM residency program during a pilot study from March to June 2021 for observable activities such as medical resuscitations and related procedures. Faculty and residents underwent formal rater training prior to launch and were asked to complete surveys regarding the SIMPL app's content, usability, and future directions at the end of the pilot., Results: A total of 36/58 (62%) of faculty completed at least one evaluation, for a total of 190 evaluations and an average of three evaluations per faculty. Faculty initiated 130/190 (68%) and residents initiated 60/190 (32%) evaluations. Ninety-one percent included dictated feedback. A total of 45/54 (83%) residents received at least one evaluation, with an average of 3.5 evaluations per resident. Residents generally agreed that SIMPL increased the quality of feedback received and that they valued dictated feedback. Residents generally did not value the numerical feedback provided from SIMPL. Relative to the residents, faculty overall responded more positively toward SIMPL. The pilot generated several suggestions to inform the optimization of the next version of SIMPL for EM training programs., Conclusions: The SIMPL app, originally developed for use in surgical training programs, can be implemented for use in EM residency programs, has positive support from faculty, and may provide important adjunct information beyond current ESEs., Competing Interests: The following authors declare no potential conflict of interest: RH, KWS, MGD. GMW is the Director of Operations of the 501c3 nonprofit research collaborative, the Society for Improving Medical Professional Learning (SIMPL). He is paid 50% of his salary from SIMPL, and his compensation is not directly tied to publication, membership, or any other operations metric for the collaborative. BCG serves as the Executive Director of SIMPL, a position for which he is not paid. This work was funded by a University of Michigan Institutional Graduate Medical Education (GME) Innovations grant conceived and written by JB. JB, MRCH and CEH received salary support from the grant to complete this work., (© 2023 Society for Academic Emergency Medicine.)

Aerosols can contribute to plant nutrition via foliar uptake. The conditions for this are best at night because the humidity is high and hygroscopic, saline deposits can deliquesce as a result. Still, stomata tend to be closed at night to avoid unproductive water loss. However, if needed, nutrients are on the leaf surface, and plants could benefit from nocturnal stomatal opening because it further increases humidity in the leaf boundary layer and allows for stomatal nutrient uptake. We tested this hypothesis on P-deficient soil by comparing the influence of ambient aerosols and additional foliar P application on nocturnal transpiration. We measured various related leaf parameters, such as the foliar water loss, minimum leaf conductance (g min ), turgor loss point, carbon isotope ratio, contact angle, specific leaf area (SLA), tissue element concentration, and stomatal and cuticular characteristics. For untreated leaves grown in filtered, aerosol-free air (FA), nocturnal transpiration consistently decreased overnight, which was not observed for leaves grown in unfiltered ambient air (AA). Foliar application of a soluble P salt increased nocturnal transpiration for AA and FA leaves. Crusts on stomatal rims were shown by scanning electron microscopy, supporting the idea of stomatal uptake of deliquescent salts. Turgor loss point and leaf moisture content indicated a higher accumulation of solutes, due to foliar uptake by AA plants than FA plants. The hypothesis that deliquescent leaf surface salts may play a role in triggering nocturnal transpiration was supported by the results. Still, further experiments are required to characterize this phenomenon better.

This online intervention study examined whether system- and action-related information alone, together with goal setting, or together with goal setting and feedback helps people change their video streaming activities in a pro-environmental way. The participants ( N  = 92) documented their video streaming activities for one week prior to the intervention (week 1), three weeks after the onset of the intervention (weeks 2-4), and in a follow-up period two weeks later (week 7). A reduction of greenhouse gas emissions associated with video streaming was observed over the course of the intervention, together with reduced streaming durations and lowered resolution settings across all groups. There were no differences between the groups. It appears that as regards video streaming, information combined with self-monitoring has considerable potential to change individual behaviour and its associated ecological impact., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2023.)

Background: Sketching while narrating is an effective interview technique for eliciting information and cues to deceit. The current research examined the effects of introducing a Model Sketch in investigative interviews andis pre-registered on https://osf.io/kz9mc (accessed on 18 January 2022)., Methods: Participants ( N = 163) completed a mock mission and were asked to tell the truth or to lie about it in an interview. In Phase 1 of the interview, participants provided either a free recall (control condition), sketched and narrated with exposure to a Model Sketch (Model Sketch-present condition), or sketched and narrated without exposure to a Model Sketch (Model Sketch-absent condition). In Phase 2, all participants provided a free recall without sketching., Results: Truth tellers reported significantly more information than lie tellers. The Model Sketch elicited more location details than a Free recall in Phase 1 and more veracity differences than the other Modality conditions in Phase 2., Conclusion: The Model Sketch seems to enhance the elicitation of information and to have carryover veracity effects in a follow-up free recall.

Major parts of anthropogenic and natural aerosols are hygroscopic and deliquesce at high humidity, particularly when depositing to leaf surfaces close to transpiring stomata. Deliquescence and subsequent salt creep may establish thin, extraordinary pathways into the stomata, which foster stomatal uptake of nutrients and water but may also cause stomatal liquid water loss by wicking. Such additional water loss is not accompanied by a wider stomatal aperture with a larger CO 2 influx and hypothetically reduces water use efficiency (WUE). Here, the possible direct impacts of aerosols on physical and physiological parameters of camphor ( Cinnamomum camphora ) were studied (i) in a greenhouse experiment using aerosol exclusion and (ii) in a field study in Taiwan, comparing trees at two sites with different aerosol regimes. Scanning electron microscopy (SEM) images showed that leaves grown under aerosol exclusion in filtered air (FA) were lacking the amorphous, flat areas that were abundant on leaves grown in ambient air (AA), suggesting salt crusts formed from deliquescent aerosols. Increasing vapor pressure deficit (VPD) resulted in half the Ball-Berry slope and double WUE for AA compared to FA leaves. This apparent contradiction to the wicking hypothesis may be due to the independent, overcompensating effect of stomatal closure in response to VPD, which affects AA more than FA stomata. Compared to leaves in a more polluted region in the Taiwanese Southwest, NaCl aerosols dominated the leaf surface conditions on mature camphor trees in Eastern Taiwan, while the considerably lower contact angles and the 2.5 times higher minimum epidermal conductances might have come from organic surfactants. Interpretations of SEM images from leaf surface microstructures should consider amorphous areas as possible indicators of aerosol deposition and other hygroscopic material. The amount and type of the material determine the resulting impacts on plant water relations, together with the surrounding atmosphere and ecophysiological traits., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chi, Zinsmeister, Lai, Chang, Kuo and Burkhardt.)

Background: The aneurysmal bone cyst (ABC) is a benign, but locally aggressive cystic lesion of the bone. It usually occurs in the metaphysis of long bones of adolescents and young adults but can also affect the pelvis., Methods: This single-center study is a retrospective review of 17 patients with primary ABCs of the pelvis. It examines the importance of polidocanol instillations as minimally invasive treatment option for ABCs of the pelvis compared to intralesional curettage or marginal resection., Results: Seventeen patients with the diagnosis of a primary ABC of the pelvis were included in the study. Six patients were male (35%) and 11 patients female (65%); the mean age was 18 (9-49) years. The mean follow-up time was 50 months (12-136 months). The most common location of manifestation was the pubis (6; 35%), followed by the ilium (6; 35%), the sacrum (3; 18%) and the ischium (2; 12%). Eight patients were treated by intralesional curettage with the use of adjuvants, one patient by marginal resection, seven by sequential instillation of polidocanol and one patient by simple observation. Five patients received an additional transarterial embolization. After intralesional curettage local recurrence was detected in 4/8 cases (50%). After instillation therapy six patients (86%) had a stable disease without recurrence, only one patient (14%) had a persistent disease with need of additional treatment and was therefore converted to intralesional curettage without local recurrence in the follow-up., Conclusions: Sequential instillations of polidocanol are a promising, minimally invasive treatment method for ABCs of the pelvis and can be well combined with transarterial embolization., (© 2022. The Author(s).)

Epilepsy affects more than three million people in the United States. In approximately one-third of this population, anti-seizure medications do not control seizures. Many patients pursue surgical treatment that can include a procedure involving the implantation of electrodes for intracranial monitoring of seizure activity. For these cases, accurate mapping of the implanted electrodes on a patient's brain is crucial in planning the ultimate surgical treatment. Traditionally, electrode mapping results are presented in static figures that do not allow for dynamic interactions and visualizations. In collaboration with a clinical research team at a Level 4 Epilepsy Center, we developed N-Tools-Browser, a web-based software using WebGL and the X-Toolkit (XTK), to help clinicians interactively visualize the location and functional properties of implanted intracranial electrodes in 3D. Our software allows the user to visualize the seizure focus location accurately and simultaneously display functional characteristics (e.g., results from electrical stimulation mapping). Different visualization modes enable the analysis of multiple electrode groups or individual anatomical locations. We deployed a prototype of N-Tools-Browser for our collaborators at the New York University Grossman School of Medicine Comprehensive Epilepsy Center. Then, we evaluated its usefulness with domain experts on clinical cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Burkhardt, Sharma, Tan, Franke, Leburu, Jeschke, Devore, Friedman, Chen and Haehn.)

Background: Engaging in regular physical activity requires continued complex decision-making in varied and dynamic individual, social and structural contexts. Widespread shortfalls of physical activity interventions suggests the complex underlying mechanisms of change are not yet fully understood. More insightful process evaluations are needed to design and implement more effective approaches. This paper describes the protocol for a process evaluation of the JU:MP programme, a whole systems approach to increasing physical activity in children and young people aged 5-14 years in North Bradford, UK., Methods: This process evaluation, underpinned by realist philosophy, aims to understand the development and implementation of the JU:MP programme and the mechanisms by which JU:MP influences physical activity in children and young people. It also aims to explore behaviour change across wider policy, strategy and neighbourhood systems. A mixed method data collection approach will include semi-structured interview, observation, documentary analysis, surveys, and participatory evaluation methods including reflections and ripple effect mapping., Discussion: This protocol offers an innovative approach on the use of process evaluation feeding into an iterative programme intended to generate evidence-based practice and deliver practice-based evidence. This paper advances knowledge regarding the development of process evaluations for evaluating systems interventions, and emphasises the importance of process evaluation., (© 2021. The Author(s).)

Background: Despite efforts to increase the overall diversity of the medical student body, some medical specialties have a less diverse applicant pool based on both gender and race than would be expected based on medical graduate demographics., Objectives: To identify whether women and Underrepresented in Medicine (URiM) medical students have baseline differences in their career interests or if their career plans change more during medical school when compared to men and non-URIM students., Methods: Secondary data analyses of all medical students who applied through ERAS from 2005-2010 was conducted. Binary logistic regression models with the response being a planned career in one of four medical specialties (internal medicine, pediatrics, OB/GYN, and general surgery/surgical specialties) at medical school entry and graduation. Regression models included demographics, student attitudes, debt, academic metrics, and medical school experiences., Results: Comparatively, women were less likely to be interested in internal medicine and surgery and more interested in pediatrics and OB/GYN at matriculation. URiM students expressed more interest in OB/GYN and surgery when starting medical school. At graduation, women were less likely to plan for internal medicine and surgery and were more interested in pursuing OB/GYN and pediatrics. URiM students were more likely to plan for a career in internal medicine and less likely to choose pediatrics., Conclusions: From matriculation to graduation, women have relatively stable preferences regarding planned medical specialties. In contrast, URiM students' specialty plans shifted over time among the four specialties, with variation in preferences occurring between matriculation and graduation., Competing Interests: The authors have declared that no competing interests exist.

Innovation has a crucial role in developing breakthrough drugs and vaccines that can change patients' lives. To better understand this role, we evaluated recent outcomes for assets developed using different types of innovation. Although all approaches have delivered breakthroughs, assets that modulate established biological targets with innovative scientific or technological designs provide a unique combination of reduced development risk, high patient impact, and high commercial value. This type of asset currently represents a relatively small proportion of approved drugs and vaccines, but we anticipate that an increasing body of scientific knowledge and ongoing technological advancements could offer opportunities to grow this category in the future., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: It is essential to engage learners in efforts aimed at dismantling racism and other contributors to health care disparities. Barriers to their involvement include limited access to data. The objective of our study was to create a data dashboard using an existing quality improvement (QI) infrastructure and provide resident access to data to facilitate exploratory analysis on disparities in emergency department (ED) patient care., Methods: Focusing on patient populations that have previously been shown in the literature to suffer significant disparities in the ED, we extracted outcomes across a variety of metrics already collected as part of routine ED operations. Using data visualization software, we developed an interactive dashboard for visual exploratory analyses., Results: We designed a dashboard for our resident learners with views that are flexible and allow user selected filters to view clinical outcomes by patient age, treatment area, and chief complaint. Learners were also allowed to select grouping and outcomes of interest to investigate questions and form new hypotheses of their choosing. Available dashboard views included summary counts view to assess ED visits over time by selectable group, a rooming and triage acuity view, time-to-event survival curve view, histogram and box plot views for continuous variables, a view to assess outcome variables by time of day of ED arrival, customizable contingency table views, and correspondence analysis., Conclusions: Utilizing an existing QI infrastructure, we developed a dashboard that provides a new perspective into commonly collected ED operations data to allow for the exploration of disparities in ED care that is accessible to learners. Future directions include using these data to refine hypotheses on ED disparities, understand root causes, develop interventions, and measure their impact., Competing Interests: The authors have no potential conflicts to disclose., (© 2021 by the Society for Academic Emergency Medicine.)

Purpose: The United States Medical Licensing Examination (USMLE) sequence and the Accreditation Council for Graduate Medical Education (ACGME) milestones represent 2 major components along the continuum of assessment from undergraduate through graduate medical education. This study examines associations between USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores and ACGME emergency medicine (EM) milestone ratings., Method: In February 2019, subject matter experts (SMEs) provided judgments of expected associations for each combination of Step examination and EM subcompetency. The resulting sets of subcompetencies with expected strong and weak associations were selected for convergent and discriminant validity analysis, respectively. National-level data for 2013-2018 were provided; the final sample included 6,618 EM residents from 158 training programs. Empirical bivariate correlations between milestone ratings and Step scores were calculated, then those correlations were compared with the SMEs' judgments. Multilevel regression analyses were conducted on the selected subcompetencies, in which milestone ratings were the dependent variable, and Step 1 score, Step 2 CK score, and cohort year were independent variables., Results: Regression results showed small but statistically significant positive relationships between Step 2 CK score and the subcompetencies (regression coefficients ranged from 0.02 [95% confidence interval (CI), 0.01-0.03] to 0.12 [95% CI, 0.11-0.13]; all P < .05), with the degree of association matching the SMEs' judgments for 7 of the 9 selected subcompetencies. For example, a 1 standard deviation increase in Step 2 CK score predicted a 0.12 increase in MK-01 milestone rating, when controlling for Step 1. Step 1 score showed a small statistically significant effect with only the MK-01 subcompetency (regression coefficient = 0.06 [95% CI, 0.05-0.07], P < .05)., Conclusions: These results provide incremental validity evidence in support of Step 1 and Step 2 CK score and EM milestone rating uses., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Drinking water utilities rely on samples collected from the distribution system to provide assurance of water quality. If a water contamination incident is suspected, samples can be used to determine the source and extent of contamination. By determining the extent of contamination, the percentage of the population exposed to contamination, or areas of the system unaffected can be identified. Using water distribution system models for this purpose poses a challenge because significant uncertainty exists in the contamination scenarios (e.g., injection location, amount, duration, customer demands, contaminant characteristics). This article outlines an optimization framework to identify strategic sampling locations in water distribution systems. The framework seeks to identify the best sampling locations to quickly determine the extent of the contamination while considering uncertainty with respect to the contamination scenarios. The optimization formulations presented here solve for multiple optimal sampling locations simultaneously and efficiently, even for large systems with a large uncertainty space. These features are demonstrated in two case studies.

Macro-meteorological models predict optical turbulence as a function of weather data. Existing models often struggle to accurately predict the rapid fluctuations in C n 2 in near-maritime environments. Seven months of C n 2 field measurements were collected along an 890 m scintillometer link over the Severn River in Annapolis, Maryland. This time series was augmented with local meteorological measurements to capture bulk-atmospheric weather measurements. The prediction accuracy of existing macro-meteorological models was analyzed in a range of conditions. Next, machine-learning techniques were applied to train new macro-meteorological models using the measured C n 2 and measured environmental parameters. Finally, the C n 2 predictions generated by the existing macro-meteorological models and new machine-learning informed models were compared for four representative days from the data set. These new models, under most conditions, demonstrated a higher overall C n 2 prediction accuracy, and were better able to track optical turbulence. Further tuning and machine-learning architectural changes could further improve model performance.

Pharmaceutical and biotechnology companies rarely disclose their use of translational emerging safety biomarkers (ESBs) during drug development, and the impact of ESB use on the speed of drug development remains unclear. A cross-industry survey of 20 companies of varying size was conducted to understand current trends in ESB use and future use prospects. The objectives were to: (1) determine current ESB use in nonclinical and clinical drug development and impact on asset advancement; (2) identify opportunities, gaps, and challenges to greater ESB implementation; and (3) benchmark perspectives on regulatory acceptance. Although ESBs were employed in only 5-50% of studies/programs, most companies used ESBs to some extent, with larger companies demonstrating greater nonclinical use. Inclusion of ESBs in investigational new drug applications (INDs) was similar across all companies; however, differences in clinical trial usage could vary among the prevailing health authority (HA). Broader implementation of ESBs requires resource support, cross-industry partnerships, and collaboration with HAs. This includes generating sufficient foundational data, demonstrating nonclinical to clinical translatability and practical utility, and clearly written criteria by HAs to enable qualification. If achieved, ESBs will play a critical role in the development of next-generation, translationally-tailored standard laboratory tests for drug development., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Sketching while narrating is effective for eliciting information and veracity cues in single interviews. In the current research, we tested this technique in multiple interviews. Participants were interviewed three times over three weeks about a genuine (truth tellers) or a fabricated (lie tellers) memorable event. They sketched while narrating in Week 1, Week 2, Weeks 1 and 2, or not at all (verbal statement only). Statements were coded for total, core, peripheral, and common knowledge details, self-handicapping strategies, complications, plausibility, and proportions of complications and core details. In the third interview and across interviews, the Sketch instruction resulted in a higher proportion of core details. Truth tellers reported more total and core details and complications and fewer common knowledge details and exhibited a higher proportion of complications than lie tellers. Truth tellers' stories also sounded more plausible than lie tellers' stories. The interaction effects were not significant. Thus, sketching while narrating seemed to have a similar effect on truth tellers and lie tellers in the current study., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Lead (Pb) in drinking water has re-emerged as a modern public health threat which can vary widely in space and in time (i.e., between homes, within homes and even at the same tap over time). Spatial and temporal water Pb variability in buildings is the combined result of water chemistry, hydraulics, Pb plumbing materials and water use patterns. This makes it challenging to obtain meaningful water Pb data with which to estimate potential exposure to residents. The objectives of this review paper are to describe the root causes of intrinsic Pb variability in drinking water, which in turn impacts the numerous existing water sampling protocols for Pb. Such knowledge can assist the public health community, the drinking water industry, and other interested groups to interpret/compare existing drinking water Pb data, develop appropriate sampling protocols to answer specific questions relating to Pb in water, and understand potential exposure to Pb-contaminated water. Overall, review of the literature indicated that drinking water sampling for Pb assessment can serve many purposes. Regulatory compliance sampling protocols are useful in assessing community-wide compliance with a water Pb regulatory standard by typically employing practical single samples. More complex multi-sample protocols are useful for comprehensive Pb plumbing source determination (e.g., Pb service line, Pb brass faucet, Pb solder joint) or Pb form identification (i.e., particulate Pb release) in buildings. Exposure assessment sampling can employ cumulative water samples that directly capture an approximate average water Pb concentration over a prolonged period of normal household water use. Exposure assessment may conceivably also employ frequent random single samples, but this approach warrants further investigation. Each protocol has a specific use answering one or more questions relevant to Pb in water. In order to establish statistical correlations to blood Pb measurements or to predict blood Pb levels from existing datasets, the suitability of available drinking water Pb datasets in representing water Pb exposure needs to be understood and the uncertainties need to be characterized., (Published by Elsevier Ltd.)

Objectives: Violent behavior is influenced by individual and societal characteristics, but the role of environmental factors is less understood. Our aims were to use national-level data to identify the association between criminal behavior and short-term temperature conditions, including the departure of daily temperatures from normal conditions., Methods: We conducted a multi-stage hierarchical time-series model across 436 U.S. counties and 14-years representing 100.4 million people to investigate the association between daily mean temperature and daily mean temperatures departing from normal conditions with violent and non-violent crime counts. First-stage comparisons were made within counties to control for population and geographic heterogeneities, while a second stage combined estimates. We evaluated differences in risk based on county sociodemographic characteristics and estimated non-linear exposure-response relationships., Results: We observed a total of 9.0 million violent crimes and 20.9 million non-violent property crimes between 2000 through 2013. We estimated that each 10 °C increase in daily temperature or daily departure from long-term normal temperatures were associated with 11.92% (95% PI: 11.57, 12.27) and 10.37% (95% PI: 10.05, 10.69) increase in the risk of violent crime, respectively. Similar, but lower in magnitude trends, were observed for property crime risks. We found that crime risk plateaus and decreases at high daily temperatures, but for temperatures departing from normal, the association with crime increased linearly. Seasonal variations showed that anomalously warm temperatures days during cool months had the greatest risk., Conclusions: Our study revealed an association between higher temperatures and high departure from normal temperatures with both violent and non-violent crime risk, regardless of community-type. However, our findings on seasonal and daily trends suggest that daily mean temperature may impact crime by affecting routine activities and behavior, as opposed to a temperature-aggression relationship. These results may advance public response and planning to prevent violent behavior., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Prediction of the index of refraction structure constant C n 2 in the low-altitude maritime environment is challenging. To improve predictive models, deeper understanding of the relationships between environmental parameters and optical turbulence is required. To that end, a robust data set of C n 2 as well as numerous meteorological parameters were collected over a period of approximately 15 months along the Chesapeake Bay adjacent to the Severn River in Annapolis, Maryland. The goal was to derive new insights into the physical relationships affecting optical turbulence in the near-maritime environment. Using data-driven machine learning feature selection approaches, the relative importance of 12 distinct, measurable environmental parameters was analyzed and evaluated. Random forest nodal purity analysis was the primary machine learning approach to relative importance determination. The relative feature importance results indicated that air temperature and pressure were important parameters in predicting C n 2 in the maritime environment. In addition, the relative importance findings suggest that the air-water temperature difference, temporal hour weight, and time of year, as measured through seasonality, have strong associations with C n 2 and could be included to improve model prediction accuracy.

Stomatal pore area is heterogeneous across leaf surfaces. This has been considered as "patchy stomatal conductance," and may have substantial implications for photosynthetic efficiency. Aerosols have always been important elements of plant environments, but their effects on stomatal control of plant water relations, and stomatal heterogeneity specifically, have not been considered. Here we evaluate the spatial coordination of pore area in the glabrous and homobaric leaves of Vicia faba grown under two aerosol treatments and measured at four levels of VPD. We construct a large dataset ( n > 88,000 discrete comparisons) of paired pore areas and distances between the pores. Plants were grown in ambient urban air and in filtered air (FA) to determine the effect of ambient aerosol on stomatal properties. Pore area exhibited spatial organization, as well as considerable variability among closely co-located pores. The difference between pore areas was positively correlated with the distance between the pores, in both aerosol treatments and at all VPDs. However, aerosol deposition reduced both the magnitude of variability between pores and the rate at which this variability increased with pore separation distance. These data support previous conclusions that deposition of hygroscopic aerosol may create a thin aqueous film across the leaf surface that connects neighboring stomata to each other and to the leaf interior. Aerosol impacts on stomatal heterogeneity and gas exchange are not adequately considered in current assessments of stomatal control., (Copyright © 2020 Grantz, Karr and Burkhardt.)

Objective: The objective of the current study was to evaluate the implementation of clinical pathways (CPs) in hip fracture management., Methods: Six hundred and five proximal femoral fractures were prospectively included into a hospital data-base. The effects of CPs were evaluated using a pre-during-post design. Different procedural (time to surgery, length of stay, discharge, etc.) and patient outcome parameters (mortality, complications, etc.) were evaluated., Results: In both categories significant changes could be detected during the three-year period. E.g. significant reduction of time to surgery, improvement of discharge management, reduction of internal complications. However, no significant changes could be demonstrated for mortality or revision rate., Conclusion: We could show a relevant improvement with the implementation of clinical pathways for the treatment of proximal femoral fractures in elderly patients., Level of Evidence: III, prospective non-randomised cohort study., (Copyright © 2019. Published by Elsevier Masson SAS.)

Purpose: Chronic granulomatous disease (CGD) is an innate immune deficiency, primarily affecting the phagocytic compartment, and presenting with a diverse phenotypic spectrum ranging from severe childhood infections to monogenic inflammatory bowel disease. Dihydrorhodamine (DHR) flow cytometry is the standard diagnostic test for CGD, and correlates with NADPH oxidase activity. While there may be genotype correlation with the DHR flow pattern in some patients, in several others, there is no correlation. In such patients, assessment by flow cytometric evaluation of NADPH oxidase-specific (NOX) proteins provides a convenient and rapid means of genetic triage, though immunoblotting has long been used for this purpose., Methods and Results: We describe the clinical utility of the NOX flow cytometry assay through assessment of X-linked and autosomal recessive CGD patients and their first-degree relatives. The assessment of specific NOX proteins was correlated with overall NADPH oxidase function (DHR flow), clinical phenotype and genotype. NOX-specific protein assessment is a valuable adjunct to DHR assessment and genotyping to classify and characterize CGD patients., Conclusions: The atypical clinical presentation of some CGD patients can make genotype-phenotype correlation with DHR flow data challenging. Genetic testing, while useful for confirmation of diagnosis, can take several weeks, and in some patients does not provide a conclusive answer. However, NADPH-oxidase-specific protein flow assessment offers a rapid alternative to identification of the underlying genetic defect in cellular subsets, and can be utilized as a reflex test to an abnormal DHR flow. Further, it can provide insight into correlation between oxidative burst relative to protein expression in granulocytes and monocytes.

Study Objective: Women and students underrepresented in medicine are less likely to apply for residency in emergency medicine. The latter are from racial or ethnic populations that are underrepresented as physicians relative to the general population. The factors that result in lower application rates from women and groups underrepresented in medicine are inadequately described in the literature. This study's objective was to test whether female students and those underrepresented in medicine have lower interest in emergency medicine even after controlling for academic ability, student indebtedness, and common career values consistent with emergency medicine career interest., Methods: Secondary data analyses were conducted on a cross section of all residency applicants from 2005 to 2010. Data sources included American Medical College Application Service, the Electronic Residency Application Service, and the Graduating Questionnaire. Data linkage was by the Association of American Medical Colleges and provided deidentified to the authors. A binary logistic regression model was fitted with the outcome variable planned career into emergency medicine versus another specialty on the Graduating Questionnaire. The binary logistic regression model independent variables included demographics, student attitudes, debt, grade point average, standardized tests, and medical school experiences., Results: The binary logistic regression model included 17,067 individuals. Being a woman (odds ratio 0.75) and from a background underrepresented in medicine (odds ratio 0.68) independently correlated with lower emergency medicine interest. Age, medical debt, importance of work-life balance, confidence in specialty choice, and plan to care for underserved populations were positively associated with emergency medicine interest. Importance of specialty competitiveness and importance of mentorship advice were correlated with lower emergency medicine interest., Conclusion: Female medical students and those underrepresented in medicine were less likely to plan for a career in emergency medicine. This correlation remained significant even when other previously identified factors that have predicted a career in emergency medicine were controlled for., (Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Violence is a leading cause of death and an important public health threat, particularly among adolescents and young adults. However, the environmental causes of violent behavior are not well understood. Emerging evidence suggests exposure to air pollution may be associated with aggressive or impulsive reactions in people., Methods: We applied a two-stage hierarchical time-series model to estimate change in risk of violent and nonviolent criminal behavior associated with short-term air pollution in U.S. counties (2000-2013). We used daily monitoring data for ozone and fine particulate matter (PM2.5) from the Environmental Protection Agency and daily crime counts from the Federal Bureau of Investigation. We evaluated the exposure-response relation and assessed differences in risk by community characteristics of poverty, urbanicity, race, and age., Results: Our analysis spans 301 counties in 34 states, representing 86.1 million people and 721,674 days. Each 10 µg/m change in daily PM2.5 was associated with a 1.17% (95% confidence interval [CI] = 0.90, 1.43) and a 10 ppb change in ozone with a 0.59% (95% CI = 0.41, 0.78) relative risk increase (RRI) for violent crime. However, we observed no risk increase for nonviolent property crime due to PM2.5 (RRI: 0.11%; 95% CI = -0.09, 0.31) or ozone (RRI: -0.05%; 95% CI = -0.22, 0.12). Our results were robust across all community types, except rural regions. Exposure-response curves indicated increased violent crime risk at concentrations below regulatory standards., Conclusions: Our results suggest that short-term changes in ambient air pollution may be associated with a greater risk of violent behavior, regardless of community type.

Objective: Our objectives were 2-fold: to describe the creation of a flight nurse (FN) ultrasound (US) program and to evaluate whether critical care US performed by nonphysician providers in the prehospital setting can clarify patient assessment., Methods: Twenty FNs completed a didactic and hands-on US curriculum focusing on critical care modalities. FNs displayed competency by successful completion of an objective-structured clinical examination. Portable US devices were used during patient transports when deemed clinically indicated by the FN. If US was subsequently performed, the FN was asked if US use prompted a change in assessment. Associations were evaluated with chi-square and bivariate logistic regression analyses., Results: FNs reported US use during 102 (12.3%) patient transports, of which intensive care unit (ICU) to ICU (58.8%) constituted the majority of cases followed by emergency department (ED) to ED (28.4%), ED to ICU (4.9%), and scene to ED (2.9%). FNs agreed or strongly agreed that US use clarified the cause of patient symptoms in 67.4% of transports., Conclusion: FNs were more likely to perform US when they expressed lower confidence in their initial patient assessment. FNs reported that US helped to clarify patient assessments., (Copyright © 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of the current study was to evaluate the effect of a quality management system on treatment and care delivery of proximal femoral fractures. Specifically, our hypothesis was that the "plan-do-check-act (PDCA)" philosophy of the ISO 9001 quality management system results in a continuous improvement process., Methods: 1015 proximal femoral fractures were prospectively included into a hip fracture database over a 5-year period, after a restructuring process with implementation of clinical pathways and standard operation procedures. A close and structured ortho-geriatric co-management (certified ortho-geriatric center) was the basis for treatment. ISO 9001 certification was granted for the first time in 2012. Procedural and patient outcome parameters were analyzed by year and evaluated statistically using SPSS 25.0., Results: In both categories (procedural and outcome) significant changes could be detected during the 5-year period, e.g., significant reduction of time to surgery for the first 2 years, improvement in discharge management, and reduction of surgical complications. However, no significant changes could be demonstrated for mortality or internal complications such as pneumonia, urinary tract infections, or postoperative delirium. However, the incidence of the latter was already on a very low level at the onset of the quality improvement process., Conclusion: We could show a relevant and continuous improvement of several quality indicators during a 5-year period after implementation of a quality management system based on the PDCA philosophy for the treatment of proximal femoral fractures in elderly patients. However, other parameters (internal complications, cost-effectiveness, etc.) need our close attention in the future.

The contamination of groundwater sources with per- and polyfluoroalkyl substances (PFAS) in the United States is a widespread problem for the drinking water industry. Well water supplies in the municipalities of Fountain, Security, and Widefield, Colorado, contain perfluorooctanoic acid and perfluorooctane sulfonate levels greater than the U.S. Environmental Protection Agency (USEPA) health advisory level of 70 ng/L. The source of PFAS has been associated with aqueous film-forming foam at Peterson Air Force Base. To assist property owners and limit the exposure of PFAS to residential drinking water systems, treatability studies were conducted by the USEPA on the PFAS removal effectiveness of commercially available point-of-use/point-of-entry units using reverse osmosis treatment and granular activated carbon adsorbents. Household water systems were tested with a test water containing the water quality characteristics and six PFAS contaminants found in Widefield aquifer region groundwater samples. This study also documents the installation, startup, and continuous/intermittent operation of the treatment systems.

Sampling of drinking water distribution systems is performed to ensure good water quality and protect public health. Sampling also satisfies regulatory requirements and is done to respond to customer complaints or emergency situations. Water distribution system modeling techniques can be used to plan and inform sampling strategies. However, a high degree of accuracy and confidence in the hydraulic and water quality models is required to support real-time response. One source of error in these models is related to uncertainty in model input parameters. Effective characterization of these uncertainties and their effect on contaminant transport during a contamination incident is critical for providing confidence estimates in model-based design and evaluation of different sampling strategies. In this paper, the effects of uncertainty in customer demand, isolation valve status, bulk reaction rate coefficient, contaminant injection location, start time, duration and rate on the size and location of the contaminant plume are quantified for two example water distribution systems. Results show that the most important parameter was the injection location. The size of the plume was also affected by the reaction rate coefficient, injection rate and the injection duration, while the the exact location of the plume was additionally affected by the isolation valve status. Uncertainty quantification provides a more complete picture of how contaminants move within a water distribution system and provides more information when using modeling results to select sampling locations.

Biomarkers are invaluable drug development tools to assess and monitor safety in early clinical trials especially when exposure margins are limiting for promising therapeutics. Although progress has been made towards identifying and implementing translational safety biomarkers for a number of organ toxicities such as kidney and liver, significant biomarker gaps still exist to monitor toxicities for testis, pancreas, etc. Several precompetitive consortia [e.g., Predictive Safety Testing Consortia (PSTC), Innovative Medicines Initiative (IMI)] are working with industry, academia, government, patient advocacy groups and foundations with a goal to qualify biomarkers such that they can be used in preclinical studies and clinical trials to accelerate drug development. This manuscript discusses the complexities of novel biomarker discovery, validation and international regulatory qualifications intended for clinical trial applications and shares specific examples from Pfizer Research and Development. As safety biomarkers become widely accepted and qualified by the regulatory agencies, they will increasingly be implemented in early clinical trials, play a key role in decision making and facilitate the progression of promising therapeutics from preclinical through clinical development.

Adjuvants such as surfactants are commonly incorporated into agrochemical formulations to enhance the biological efficiency of foliar sprays by improving the wetting behavior of the spray and/or the penetration of the active ingredients into the leaf tissues. Penetration accelerating adjuvants are known to increase the cuticular permeability and may alter the cuticular barrier to water loss. However, none or very little emphasis has been given to the impacts of adjuvants on crop water balance or drought tolerance, a very important factor affecting crop performance under water scarcity. Two model crops with strongly varying leaf traits, kohlrabi (Brassica oleracea) and apple (Malus domestica) seedlings were grown in controlled environments. Three adjuvants with varying solubility in the cuticle, i.e. octanol-water partition coefficients (logKow) were selected: rapeseed methyl ester (RME) and the surfactants alkyl polyglycoside (APG) and polyoxyethylated tallow amine (POEA). The higher the logKow of the adjuvant, the stronger was the increase of minimum epidermal conductance (g min , an essential parameter describing plant drought tolerance). However, such effects depended on the physio-chemical properties of the leaf surface. In comparison to kohlrabi, the adjuvant effects on g min of apple leaves were relatively weak. The increase of g min was associated with a decrease in contact angle and with an alteration of the wax microstructure. Furthermore, POEA affected photochemical efficiency of kohlrabi leaves. Some adjuvants could have a temporal influence on transpirational water loss and g min. At repeated applications, they might alter the effective water use and possibly reduce drought tolerance of some horticultural crops., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)