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Objective: The current model of obstetric care does not integrate multiple subspecialty services for high-risk pregnancies with substance use disorder (SUD), resulting in fragmented care. We describe the framework of our multidisciplinary and integrated perinatal substance use clinic and provide recent clinical outcomes., Methods: We detail the Partnering for the Future (PFF) clinic, which integrates numerous subspecialty and support services for patients with SUDs and complex mental health needs. Additionally, a retrospective chart review of patients receiving care in the PFF clinic from 2017 to 2021 was completed., Results: Seven integrated services are detailed with a focus on reducing stigma, providing trauma-informed care and mitigating harm. During the study period, 182 patients received care in PFF clinic, with opioid use disorder the most common indication for care. Co-occurring mental illness was common (81%). NICU admissions and severe NOWS diagnosis declined after the implementation of Eat-Sleep-Console. Social services identified care coordination, transportation assistance and adjustment counseling as the most common needs. A novel virtual behavioral health consultation service was successfully launched., Conclusions: Our integrated care model supports the holistic care of pregnant people with SUD and mental health disease. Patient-centered care and co-located services have improved perinatal outcomes, particularly for opioid-exposed pregnancies., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Morbidity and mortality from poison- and drug-related illness continue to rise in the USA. Medical toxicologists are specifically trained to diagnose and manage these patients. Inpatient medical toxicology services exist but their value-based economic benefits are not well established., Methods: This was a retrospective study where length of stay (LOS) and payments received between a hospital with an inpatient medical toxicology service (TOX) and a similar hospital in close geographic proximity that does not have an inpatient toxicology service (NONTOX) were compared. Controlling for zip code, demographics and distance patients lived from each hospital, we used a fitted multivariate linear regression model to identify factors associated with changes in LOS and payment., Results: Patients admitted to the TOX center had 0.87 days shorter LOS per encounter and the hospital received an average of $1800 more per patient encounter., Conclusion: In this study, the presence of an inpatient medical toxicology service was associated with decreased patient LOS and increased reimbursement for admitted patients. Differences may be attributable to improved direct patient care provided by medical toxicologists, but future prospective studies are needed.

For several decades there has been recognition that water resource development alters river flow regimes and impacts ecosystem values. Determining strategies to protect or restore flow regimes to achieve ecological outcomes is a focus of water policy and legislation in many parts of the world. However, consideration of existing environmental flow assessment approaches for application in Queensland identified deficiencies precluding their adoption. Firstly, in managing flows and using ecosystem condition as an indicator of effectiveness, many approaches ignore the fact that river ecosystems are subjected to threatening processes other than flow regime alteration. Secondly, many focus on providing flows for responses without considering how often they are necessary to sustain ecological values in the long-term. Finally, few consider requirements at spatial-scales relevant to the desired outcomes, with frequent focus on individual places rather than the regions supporting sustainability. Consequently, we developed a risk-based ecohydrological approach that identifies ecosystem values linked to desired ecological outcomes, is sensitive to flow alteration and uses indicators of broader ecosystem requirements. Monitoring and research is undertaken to quantify flow-dependencies and ecological modelling is used to quantify flow-related ecological responses over an historical flow period. The relative risk from different flow management scenarios can be evaluated at relevant spatial-scales. This overcomes the deficiencies identified above and provides a robust and useful foundation upon which to build the information needed to support water planning decisions. Application of the risk assessment approach is illustrated here by two case studies.

Acoustic communication is prominent in adult anuran amphibians, in reproductive, territorial and defensive contexts. In contrast, reports on vocalizations of juvenile anurans are rare and anecdotal, and their function unstudied. We here provide conclusive evidence for vocalizations in juvenile spadefoot toads (Pelobates fuscus) in very early terrestrial stages. While the aquatic tadpoles did not emit sounds, first vocalizations of metamorphs were heard as early as in stages 42-43, and calls were regularly emitted from stage 44 on, often from specimens still bearing extensive tail stubs. Three main types of calls could be distinguished, of which one consists of a series of short notes, one of a typically single longer and pulsed note, and one of a single tonal note. In experimental setups, the number of calls per froglet increased with density of individuals and after feeding, while on the contrary calls were not elicited by playback. The function of these juvenile calls remains unclarified, but they might reflect a general arousal in the context of feeding. Further evidence is necessary to test whether such feeding calls could confer a signal to conspecifics and thus might represent intraspecific acoustic communication in these immature terrestrial amphibians.

The presence and movements of organisms both reflect and influence the distribution of ecological resources in space and time. The monitoring of animal movement by telemetry devices is being increasingly used to inform management of marine, freshwater and terrestrial ecosystems. Here, we brought together academics, and environmental managers to determine the extent of animal movement research in the Australasian region, and assess the opportunities and challenges in the sharing and reuse of these data. This working group was formed under the Australian Centre for Ecological Analysis and Synthesis (ACEAS), whose overall aim was to facilitate trans-organisational and transdisciplinary synthesis. We discovered that between 2000 and 2012 at least 501 peer-reviewed scientific papers were published that report animal location data collected by telemetry devices from within the Australasian region. Collectively, this involved the capture and electronic tagging of 12 656 animals. The majority of studies were undertaken to address specific management questions; rarely were these data used beyond their original intent. We estimate that approximately half (~500) of all animal telemetry projects undertaken remained unpublished, a similar proportion were not discoverable via online resources, and less than 8.8% of all animals tagged and tracked had their data stored in a discoverable and accessible manner. Animal telemetry data contain a wealth of information about how animals and species interact with each other and the landscapes they inhabit. These data are expensive and difficult to collect and can reduce survivorship of the tagged individuals, which implies an ethical obligation to make the data available to the scientific community. This is the first study to quantify the gap between telemetry devices placed on animals and findings/data published, and presents methods for improvement. Instigation of these strategies will enhance the cost-effectiveness of the research and maximise its impact on the management of natural resources., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Forecasting population persistence in environments subjected to periodic disturbances represents a general challenge for ecologists. In arid and semiarid regions, climate change and human water use pose significant threats to the future persistence of aquatic biota whose populations typically depend on permanent refuge waterholes for their viability. As such, habitats are increasingly being lost as a result of decreasing runoff and increasing water extraction. We constructed a spatially explicit population model for golden perch Macquaria ambigua (Richardson), a native freshwater fish in the Murray-Darling Basin in eastern Australia. We then used the model to examine the effects of increased aridity, increased drought frequency, and localized human water extraction on population viability. Consistent with current observations, the model predicted golden perch population persistence under the current climate and levels of water use. Modeled increases in local water extraction greatly increased the risk of population decline, while scenarios of increasing aridity and drought frequency were associated with only minor increases in this risk. We conclude that natural variability in abundances and high turnover rates (extinction/recolonization) of local populations dictate the importance of spatial connectivity and periodic cycles of population growth. Our study also demonstrates an effective way to examine population persistence in intermittent and ephemeral river systems by integrating spatial and temporal dynamics of waterhole persistence with demographic processes (survival, recruitment, and dispersal) within a stochastic modeling framework. The approach can be used to help understand the impacts of natural and anthropogenic drivers, including water resource development, on the viability of biota inhabiting highly dynamic environments.

The primary objective is to identify and describe the complications associated with the use of intravenous lipid emulsion (ILE) therapy as an antidote for lipophilic drug toxicity. This study is a retrospective chart review of patients treated with ILE at two academic medical centers between 2005 and 2012. Based on previously reported complications, we hypothesized that pancreatitis, ARDS, and lipemia-induced laboratory interference might occur. Clinical definitions of these complications were defined a priori. Subjects treated with ILE who did not develop at least one complication were excluded. A total of nine patients were treated with ILE during the study period, six of whom experienced potential complications as a result of the ILE. Two patients developed pancreatitis, and four patients had lipemia-induced interference of interpretation of laboratory studies, despite ultracentrifugation. Laboratory interference precluded one patient from being an organ donor. Three patients developed ARDS; although temporally associated, a causal relationship between ILE and the development of ARDS cannot be clearly established. As ILE is increasingly used for less severe cases of drug toxicity, clinicians should be aware of potential complications associated with its use. A risk-benefit assessment for the use of ILE should be implemented on a case-by-case basis.

Prosthetic hip-associated cobalt toxicity (PHACT) is gaining recognition due to the use of metal-on-metal total hip replacements. Identifying true toxicity from merely elevated cobalt levels can be extremely difficult due to the lack of available data. An extensive review of the medical literature was undertaken to characterize cobalt toxicity from prosthetic hips. As an objective approach to making the diagnosis of PHACT, we suggest the following criteria: (1) elevated serum or whole blood cobalt levels due to a prosthetic hip, (2) at least two test-confirmed findings consistent with cobalt toxicity, and (3) exclusion of other etiologies. Adhering to objective diagnostic data for PHACT is a realistic and prudent method by which to eliminate the subjectivity of vague or difficult to identify complaints. These diagnostic criteria are not meant to evaluate prosthetic hardware failure, but as a means to identify systemic cobalt toxicity. Finally, assessment of cobalt toxicity from prosthetic hips should be done in conjunction with a medical toxicologist.

Background: Mandibular fractures are one of the most frequently seen injuries in trauma. In terms of facial trauma, mandible fractures constitute 40%-62% of all facial bone fractures. The tongue blade test (TBT) has been shown to be a sensitive screening tool when compared with plain films. However, recent studies have demonstrated that computed tomography (CT) scan is more sensitive for determining mandible fractures than the traditionally used plain films., Objective: The purpose of the study was to determine the sensitivity and specificity of the TBT as compared with the new gold standard of radiologic imaging, CT scan., Methods: Any patient suffering from facial trauma was prospectively enrolled during the study period (August 1, 2010 to April 11, 2012) at a single urban, academic Emergency Department. A TBT was performed by the resident physician and confirmed by the supervising attending. CT facial bones were then obtained for the ultimate diagnosis. Inter-rater reliability (κ) was calculated, along with sensitivity, specificity, negative predictive value, and likelihood ratio (-) based on a 2 × 2 contingency table generated., Results: During the study period, 190 patients were enrolled. Inter-rater reliability was κ = 0.96 (95% confidence interval [CI] 0.93-0.99). The following parameters were then calculated based on the contingency table: sensitivity 0.95 (95% CI 0.88-0.98), specificity 0.68 (95% CI 0.57-0.77), negative predictive value 0.92 (95% CI 0.82-0.97), and likelihood ratio (-) 0.07 (95% CI 0.03-0.18)., Conclusions: Based on the test characteristics calculated (negative predictive value 0.92, sensitivity 0.95, likelihood ratio -0.07), the TBT is a useful screening tool to determine the need for radiologic imaging., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The coagulation and fibrinolytic systems are complex, inter-connected biological systems with major physiological roles. The complex, nonlinear multi-point relationships between the molecular and cellular constituents of two systems render a comprehensive and simultaneous study of the system at the microscopic and macroscopic level a significant challenge. We have created an Agent Based Modeling and Simulation (ABMS) approach for simulating these complex interactions. As the scale of agents increase, the time complexity and cost of the resulting simulations presents a significant challenge. As such, in this paper, we also present a high-speed framework for the coagulation simulation utilizing the computing power of graphics processing units (GPU). For comparison, we also implemented the simulations in NetLogo, Repast, and a direct C version. As our experiments demonstrate, the computational speed of the GPU implementation of the million-level scale of agents is over 10 times faster versus the C version, over 100 times faster versus the Repast version and over 300 times faster versus the NetLogo simulation.

Background: Transposition techniques alter the muscle paths thereby creating new directions of muscle force. Extraocular muscle transposition procedures have been used to treat abducens palsy, Duane's retraction syndrome, double-elevator palsy and other complex ocular motility abnormalities. The purpose of this study was to evaluate the surgical and functional results of rectus muscle transposition in patients with different aetiologies of severe ocular motility deficits., Patients and Methods: Between 1992 and 2008 rectus muscle transposition surgery has been performed on 31 patients. In this retrospective case series one patient with an abducens nerve palsy is presented as an example. In addition, six patients with motility disorders of different aetiologies who had transposition manoeuvers were evaluated. Preoperative, surgical and postoperative data are reported., Results: Rectus muscle transposition has been performed because of severe functional loss of the lateral rectus muscle, the superior rectus muscle or the medial rectus muscle as well as in myopic strabismus fixus. One of the patients had traumatic sixth nerve palsy. The underlying pathology in patients who had superior transposition of the horizontal rectus muscles were double-elevator palsy, congenital oculomotor nerve palsy and hypotropia caused by sphenoid wing hypoplasia. A nasal transposition of the vertical rectus muscles was performed in traumatic and tumour-associated muscle loss of the medial rectus muscle. The large preoperative deviations were markedly reduced postoperatively and even ocular motility partially improved., Conclusions: Transposition surgery seems to be a suitable procedure for the treatment of complex ocular motility disorders. In cases of a complete lack of function of an extraocular muscle or in complex, uncommon conditions, which are difficult to treat with any other surgery, muscle transposition seems to be an effective procedure.

A synthesized photochromic compound-pyrrylfulgide--is prepared as a thin film doped in a polymethylmethacrylate (PMMA) matrix. Under irradiation by UV light, the film converts from the bleached state into a colored state that has a maximum absorption at 635 nm and is thermally stable at room temperature. When the colored state is irradiated by a linearly polarized 650 nm laser, the film returns to the bleached state; photoinduced anisotropy is produced during this process. Application of optical image processing methods using the photoinduced anisotropy of the pyrrylfulgide/PMMA film is described. Examples in non-Fourier optical image processing, such as contrast reversal and image subtraction and summation, as well as in Fourier optical image processing, such as low-pass filtering and edge enhancement, are presented.

Optical films containing the genetic variant bacteriorhodopsin BR-D96N were experimentally studied in view of their properties as media for holographic storage. Different polarization recording schemes were tested and compared. The influence of the polarization states of the recording and readout waves on the retrieved diffractive image's intensity and its signal-to-noise ratio were analyzed. The experimental results showed that, compared with the other tested polarization relations during holographic recording, the discrimination between the polarization states of diffracted and scattered light is optimized with orthogonal circular polarization of the recording beams, and thus a high signal-to-noise ratio and a high diffraction efficiency are obtained. Using a He-Ne laser (633 nm, 3 mW) for recording and readout, a spatial light modulator as a data input element, and a 2D-CCD sensor for data capture in a Fourier transform holographic setup, a storage density of 2 x 10(8) bits/cm2 was obtained on a 60 x 42 microm2 area in the BR-D96N film. The readout of encoded binary data was possible with a zero-error rate at the tested storage density.

In polymeric films of bacteriorhodopsin (BR) a photoconversion product, which was named the F620 state, was observed on excitation of the film with 532 nm nanosecond laser pulses. This photoproduct shows a strong nonlinear absorption. Such BR films can be used for write-once-read-many (WORM) optical data storage. We demonstrate that a photoproduct similar or even identical to that obtained with nanosecond pulses is generated on excitation with 532 nm femtosecond pulses. This photoproduct also shows strong anisotropic absorption, which facilitates polarization storage of data. The product is thermally stable and is irretrievable to the initial B state either by photochemical reaction or through a thermal pathway. The experimental results indicate that the product is formed by a two-photon absorption process. Optical WORM storage is demonstrated by use of two polarization states, but more polarization states may be used. The combination of polarization data multiplexing and extremely short recording time in the femtosecond range enables very high data volumes to be stored within a very short time.

Photoinduced anisotropy of a photochromic pyrrylfulgide/PMMA film was investigated by using two linearly polarized beams. Excitation by linearly polarized light induces into the film an optical axis that has the same polarization as the excitation beam. This causes a change of the transmittance and of the polarization state of the detection beam. With a microscope a matrix of 4x4 light spots with different polarizations were recorded in the pyrrylfulgide/PMMA film. If readout with non-polarized light, the matrix of light spots show no information pattern. However, when readout with differently polarized lights, different patterns can be displayed. The experiment demonstrates that pyrrylfulgide/PMMA films can be used to hide two differently polarized patterns, which may be applied in camouflage technology.

BR-D96N was a genetically mutated product of bacteriorhodopsin (BR) with obvious improved photochromic effect. Compared with the wild type BR, BR-D96N had a lifetime of M state prolonged to 5 min, showing obvious saturation absorption and lower light intensity in saturation absorption (0.4 mW/cm(2)). In case of holographic recording, dynamic grating was recorded in the BR-D96N film, its characteristic parameter was not light exposure energy but light intensity. The writing time of the holographic grating depended on the recording light intensity. The higher the recording light intensity, the faster the grating builds up. Under a weak reconstruction light, the recording light intensity resulting in maximal diffraction efficiency was consistent with the saturation absorption intensity. The reconstruction light could partly erase the grating. With lower intensity of reconstruction light, higher diffraction efficiency (1.8%) could be reached, but the diffraction intensity was not high. To get highest diffraction intensity, a properly high intensity of reconstruction light was needed (80 microW/cm(2)). The result of these experiments showed that holographic images could be recorded on the BR-D96N film.