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Using OH reactivity we assess the major daytime OH radical sinks in western U.S. wildfire plumes and other smoke impacted environments, testing their current model representation while providing a roadmap for future model development.

Peptide receptor radioligand therapy (PRRT) was Food and Drug Administration approved in 2018 for the treatment of unresectable somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (NETs) and provides an important option for patients with advanced disease. A known adverse effect of this treatment is hematologic toxicity, although usually transient. We present 3 patients with metastatic gastroenteropancreatic NETs treated with PRRT who were evaluated for severe persistent thrombocytopenia.Three patients who commenced therapy with PRRT were known to proceed to a bone marrow (BM) biopsy for persistent severe thrombocytopenia and were included in this study. These patients were identified retrospectively and evaluated for their tumor properties, including immunohistochemical markers, treatment modalities, and clinical outcomes.All 3 patients had metastatic NETs that progressed on prior lines of therapy and were treated with 1 to 4 doses of 177Lu-DOTATATE 7.4 GBq (200 mCi) before developing grade 3 (25,000 to 50,000/μL) refractory thrombocytopenia. All patients had concurrent bone metastases, and 2 of the 3 had baseline grade 1 thrombocytopenia. In all 3 cases, BM biopsy documented widespread tumor infiltration.Severe refractory thrombocytopenia after PRRT is rare and may result from numerous known causes, including radiation-induced myelotoxicity, myelodysplastic syndrome, and tumor BM infiltration. We present 3 cases of thrombocytopenia related to persistent or progressive BM metastasis. Although known bone metastasis is not a contraindication to PRRT, thrombocytopenia may be a manifestation of tumor progression and should be considered when making decisions about continuation of therapy.

We collected fishes and habitat data at 138 streams to evaluate the effects of introduced brown trout ( Salmo trutta) and habitat conditions on occurrence, detection, abundance, and size structure of sculpin ( Cottus spp.), longnose dace ( Rhinichthys cataractae), and southern redbelly dace ( Chrosomus erythrogaster) in the Driftless Area, USA. Sculpin detection decreased with increasing stream velocity, whereas southern redbelly dace detection increased with stream depth. Sculpin occupancy declined with increasing stream temperature and velocity and increased with increasing forested land, boulder substrate, and brown trout length and abundance. Longnose and southern redbelly dace occupancy and abundance declined with increasing brown trout abundance and occupancy increased with stream temperature. Longnose dace occupancy also increased with increasing stream temperature and cobble substrate and declined with increasing elevation. Native fish size structure was unrelated to brown trout presence. Our results suggest that effects of brown trout are not ubiquitous across native fishes and depend on abiotic conditions and species-specific habitat requirements, highlighting the need to consider both biotic and abiotic conditions when balancing native species conservation with introduced sportfish management.

Background: Lyme Borreliosis accounts for less than 1% of all uveitis cases. The challenge in diagnosing Lyme-associated uveitis in a seropositive patient is determining whether the serology status is causative or incidental. We describe a case that illustrates this challenge: a post-fever retinitis in a patient with persistent positive Lyme serology. Case Presentation: A patient presented to the eye clinic with complaints of blur and foreign body sensation in his right eye after getting sawdust in his eye. Further lab workup was only remarkable for Lyme IgG and IgM and the patient was subsequently diagnosed with a post-fever retinitis. Management and Outcomes: The patient was treated with oral prednisone, and a subsequent IOP spike was managed with topical ocular hypotensive drops until the course of steroid therapy was completed. The uveitis resolved over seven weeks. Conclusions: Post-fever retinitis is a diagnosis of exclusion, and diagnosis can be challenging in the presence of positive serology for other known causes of uveitis. This case highlights the importance of detailed case history and clinical findings in determining alternative causes of uveitis in patients with positive LB serology. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/a-case-of-post-fever-retinitis-in-a-patient-with-positive-lyme-borreliosis-serology) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Background HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella corrodens, and Kingella spp.) group organisms are responsible for 0.8% to 6% of all infective endocarditis cases, with Cardiobacterium spp. being the third most commonly implicated HACEK microorganism. Within this genus is Cardiobacterium valvarum (C. valvarum), a novel organism described in 2004. To date, only 15 cases of C. valvarum infection have been reported in the English-language literature, and have primarily been cases of infective endocarditis in patients with valvular disease. C. valvarum has not been reported to cause infections spreading to the surrounding bone. Case presentation We present a case of a 57-year-old man with a history of aortic dissection followed by aortic endograft replacement who presented with back pain. He was found to have radiographic evidence of an infected aortic endograft, along with vertebral osteomyelitis, discitis, and epidural phlegmon. Blood cultures identified C. valvarum as the causative organism. The patient was treated with ceftriaxone and surgical intervention was deferred due to the patient’s complex anatomy. His course was complicated by septic cerebral emboli resulting in cerebrovascular accident. Conclusions This case report highlights C. valvarum, a rare and emerging HACEK group microorganism that warrants consideration in high-risk patients with evidence of subacute infection and disseminated disease. While C. valvarum classically presents as infective endocarditis, extra-cardiac manifestations have also been described. As demonstrated in this case, endograft involvement and osteomyelitis may occur in rare circumstances.

Improper management of cattle near streams can negatively affect the processes that support stream and riparian ecosystems. To judge the success of riparian management strategies, public land management agencies often evaluate two metrics of livestock disturbance, stubble height and streambank alteration. There are concerns associated with how well these disturbance metrics reflect livestock use and incorporate additional effects due to wild ungulates. We sought to address these questions in 39 riparian areas by using time-lapse cameras to estimate ungulate use and then measuring near stream ungulate disturbance in these same reaches. We found daytime measures of livestock use were related to stubble height and streambank alteration. Explaining the variation in the relationship between stubble height and livestock use was improved by incorporating covariates, whereas covariates did little to improve our understanding of streambank alteration. This suggests greater flexibility in how different stream reaches are managed when stubble height is the guideline. As streambank alteration was explained solely by ungulate use, the simplest way to reduce disturbance was to reduce use. In most stream reaches, the additive presence of wild ungulates was minimal but sufficient to be included in the best models describing the effects of ungulate disturbance. On most days, no cattle were seen in the evaluated riparian reaches. Although large groups of cattle (> 20 individuals) were occasionally observed within riparian areas, they generally occurred in small groups of one to four individuals. Across the riparian reaches we evaluated, cattle presence and density were generally low enough that metrics of livestock disturbance suggested little risk to stream conditions important to aquatic biota. However, there were some riparian areas where cattle stayed too long or occurred in large enough numbers that their use along the streambanks could negatively affect stream habitat conditions.

The evolution of organic aerosol (OA) and brown carbon (BrC) in wildfire plumes, including the relative contributions of primary versus secondary sources, has been uncertain in part because of limited knowledge of the precursor emissions and the chemical environment of smoke plumes. We made airborne measurements of a suite of reactive trace gases, particle composition, and optical properties in fresh western US wildfire smoke in July through August 2018. We use these observations to quantify primary versus secondary sources of biomass-burning OA (BBPOA versus BBSOA) and BrC in wildfire plumes. When a daytime wildfire plume dilutes by a factor of 5 to 10, we estimate that up to one-third of the primary OA has evaporated and subsequently reacted to form BBSOA with near unit yield. The reactions of measured BBSOA precursors contribute only 13 ± 3% of the total BBSOA source, with evaporated BBPOA comprising the rest. We find that oxidation of phenolic compounds contributes the majority of BBSOA from emitted vapors. The corresponding particulate nitrophenolic compounds are estimated to explain 29 ± 15% of average BrC light absorption at 405 nm (BrC Abs(405)) measured in the first few hours of plume evolution, despite accounting for just 4 ± 2% of average OA mass. These measurements provide quantitative constraints on the role of dilution-driven evaporation of OA and subsequent radical-driven oxidation on the fate of biomass-burning OA and BrC in daytime wildfire plumes and point to the need to understand how processing of nighttime emissions differs.

As part of a larger study on the effects of fatigue on various attentional and behavioural measures, we had participants complete a modified version of Luna et al.'s (J Neurosci Methods 306:77-87, Luna et al., J Neurosci Methods 306:77-87, 2018) ANTI-Vea task (mANTI-Vea) at the beginning and end (pre/post) of each of two 8-h testing sessions. Between these administrations of the mANTI-Vea our participants spent ~ 6 h performing an intervening task. Our intent in this project was two-fold: first, to replicate the pattern of effects reported in Luna et al.'s original presentation of the ANTI-Vea; second, to assay the impact of fatigue on vigilance and attention by observing shifts in mANTI-Vea performance as a function of time on task and before versus after the intervening task. With time-on-task (the mANTI-Vea is divided into six sub-blocks) we observed that participants became increasingly conservative in their biases to respond towards infrequent targets, showed a decline in sensitivity, and lapsed in responding in the psychomotor vigilance task with greater frequency. In the pre/post comparison, we observed an increase in the proportion of lapses, but not in participants' response biases. Attentional network scores were found to be somewhat insensitive to our fatigue manipulations; the effect of time-on-task was only significant for orienting scores on RT, and our pre/post comparison was only significant for RT derived executive functioning scores.

Wildfires are an important source of nitrous acid (HONO), a photolabile radical precursor, yet in situ measurements and quantification of primary HONO emissions from open wildfires have been scarce. We present airborne observations of HONO within wildfire plumes sampled during the Western Wildfire Experiment for Cloud chemistry, Aerosol absorption and Nitrogen (WE-CAN) campaign. ΔHONO/ΔCO close to the fire locations ranged from 0.7 to 17 pptv ppbv

Lava domes form by the effusive eruption of high-viscosity lava and are inherently unstable and prone to collapse, representing a significant volcanic hazard. Many processes contribute to instability in lava domes and can generally be grouped into two categories: active and passive. Active collapses are driven directly by lava effusion. In contrast, passive collapses are not correlated with effusion rate, and thus represent a hazard that is more difficult to assess and forecast. We demonstrate a new workflow for assessing and forecasting passive dome collapse by examining a case study at Sinabung Volcano (North Sumatra, Indonesia). We captured visual images from the ground in 2014 and from unoccupied aerial systems (UAS) in 2018 and used structure-from-motion photogrammetry to generate digital elevation models (DEMs) of Sinabung’s evolving lava dome. By comparing our DEMs to a pre-eruption DEM, we estimate volume changes associated with the eruption. As of June 2018, the total erupted volume since the eruption began is 162 × 106 m3. Between 2014 and 2018, 10 × 106 m3 of material collapsed from the lava flow due to passive processes. We evaluate lava dome stability using the Scoops3D numerical model and the DEMs. We assess the passive collapse hazard and analyze the effect of lava material properties on dome stability. Scoops3D is able to hindcast the location and volume of passive collapses at Sinabung that occurred during 2014 and 2015, and we use the same material properties to demonstrate that significant portions of the erupted lava potentially remain unstable and prone to collapse as of late 2018, despite a pause in effusive activity earlier that year. This workflow offers a means of quantitatively assessing passive collapse hazards at active or recently active volcanoes.

Proton transfer reaction (PTR) is a commonly applied ionization technique for mass spectrometers, in which hydronium ions (H3O+) transfer a proton to analytes with higher proton affinities than the water molecule. This method has most commonly been used to quantify volatile hydrocarbons, but later-generation PTR instruments have been designed for better throughput of less volatile species, allowing detection of more functionalized molecules as well. For example, the recently developed Vocus PTR time-of-flight mass spectrometer (PTR-TOF) has been shown to agree well with an iodide-adduct-based chemical ionization mass spectrometer (CIMS) for products with 3–5 O atoms from oxidation of monoterpenes (C10H16). However, while several different types of CIMS instruments (including those using iodide) detect abundant signals also at “dimeric” species, believed to be primarily ROOR peroxides, no such signals have been observed in the Vocus PTR even though these compounds fulfil the condition of having higher proton affinity than water. More traditional PTR instruments have been limited to volatile molecules as the inlets have not been designed for transmission of easily condensable species. Some newer instruments, like the Vocus PTR, have overcome this limitation but are still not able to detect the full range of functionalized products, suggesting that other limitations need to be considered. One such limitation, well-documented in PTR literature, is the tendency of protonation to lead to fragmentation of some analytes. In this work, we evaluate the potential for PTR to detect dimers and the most oxygenated compounds as these have been shown to be crucial for forming atmospheric aerosol particles. We studied the detection of dimers using a Vocus PTR-TOF in laboratory experiments, as well as through quantum chemical calculations. Only noisy signals of potential dimers were observed during experiments on the ozonolysis of the monoterpene α-pinene, while a few small signals of dimeric compounds were detected during the ozonolysis of cyclohexene. During the latter experiments, we also tested varying the pressures and electric fields in the ionization region of the Vocus PTR-TOF, finding that only small improvements were possible in the relative dimer contributions. Calculations for model ROOR and ROOH systems showed that most of these peroxides should fragment partially following protonation. With the inclusion of additional energy from the ion–molecule collisions driven by the electric fields in the ionization source, computational results suggest substantial or nearly complete fragmentation of dimers. Our study thus suggests that while the improved versions of PTR-based mass spectrometers are very powerful tools for measuring hydrocarbons and their moderately oxidized products, other types of CIMS are likely more suitable for the detection of ROOR and ROOH species.

Severely calcified coronary stenoses remain a significant challenge during contemporary percutaneous coronary intervention (PCI), often requiring advanced therapies to circumvent suboptimal lesion preparation and major adverse cardiac events (MACEs). Recent reports suggest combined coronary atherectomy and intravascular lithotripsy (IVL) may achieve superior preparation of severely calcified coronary stenoses during PCI. We sought to evaluate the safety and utility of combined orbital atherectomy (OA) and IVL for the modification of coronary artery calcification (CAC) prior to drug-eluting stent (DES) implantation in PCI.We performed a retrospective review of all patients who underwent coronary OA and IVL within a single PCI procedure at our institution. The primary outcome was procedural success, defined as successful DES implantation with a residual percent diameter stenosis of30% and Thrombolysis in Myocardial Infarction (TIMI) 3 flow following PCI without occurrence of in-hospital MACE (cardiac death, myocardial infarction, or target-vessel revascularization). MACE was additionally assessed at 30 days post intervention.Eight patients underwent combined coronary OA and IVL within a single PCI procedure. The mean percent diameter stenosis prior to intervention was 80.5 ± 8.3%, with a mean calcific arc of 338 ± 42°. Procedural success was achieved in 7 of 8 cases (87.5%). Both in-hospital and 30-day MACE rates were 0%.We report the safe and effective use of combined coronary OA and IVL for the preparation of severely calcified coronary stenoses during PCI. Through their distinct yet complementary mechanisms of action, the combined use of these therapies may achieve superior preparation of severely calcified coronary stenoses during PCI.

Contains fulltext : 250236.pdf (Publisher’s version ) (Open Access) Given that parental caregiving quality affects child development from birth onwards, it is important to detect parents who are at risk for low-quality caregiving as early as possible, preferably before or soon after birth. This study investigated whether cortisol (CORT) and testosterone (T) measured during the last trimester of pregnancy and six weeks postpartum were associated with observed caregiving quality at child age 3 in mothers (N = 63) and fathers (N = 45). CORT and T were measured during an interaction with a simulator infant (pregnancy) and their own infant (postpartum). In mothers, no associations were found with CORT and T during pregnancy, but higher postpartum CORT during a mother-infant interaction was related to higher caregiving quality during toddlerhood. In fathers, the association between T during pregnancy and caregiving quality in toddlerhood was more negative for fathers with low CORT. In contrast to mothers, higher postpartum CORT in fathers was associated with lower caregiving quality in toddlerhood. These findings proved robust after applying the Benjamini–Hochberg procedure to control for false discovery rate. Our findings indicate that CORT and T during the perinatal period can forecast caregiving quality in both mothers and fathers. Moreover, our results provided evidence for the dual-hormone hypothesis, but only in fathers. These findings contribute to our growing understanding on how endocrine measures explain individual differences in caregiving quality in mothers and fathers. 12 p.

The coronavirus disease of 2019 (COVID-19) pandemic declared by the World Health Organization on March 11, 2020 impacted healthcare services with provider and patient cancellations, delays, and patient avoidance or delay of emergency department or urgent care. Limited data exist on the population proportion affected by delayed healthcare, which is important for future healthcare planning efforts. Our objective was to evaluate the impact of the COVID-19 pandemic on healthcare service cancellations or delays and delays/avoidance of emergency/urgent care overall and by population characteristics.This was a cross-sectional study.Our sample (n = 2314) was assembled through a phone survey from 8/12/2020-10/27/2020 among non-institutionalized St. Louis County, Missouri, USA residents ≥18 years. We asked about provider and patient-initiated cancellations or delays of appointments and pandemic-associated delays/avoidance of emergency/urgent care overall and by participant characteristics. We calculated weighted prevalence estimates by select resident characteristics.Healthcare services cancellations or delays affected ∼54% (95% CI 50.6%-57.1%) of residents with dental (31.1%, 95% CI 28.1%-34.0%) and primary care (22.1%, 95% CI 19.5%-24.6%) being most common. The highest prevalences were among those who were White, ≥65 years old, female, in fair/poor health, who had health insurance, and who had ≥1 medical condition. Delayed or avoided emergency/urgent care impacted ∼23% (95% CI 19.9%-25.4%) of residents with a higher prevalence in females than males.Healthcare use disruptions impacted a substantial proportion of residents. Future healthcare planning efforts should consider these data to minimize potential morbidity and mortality from delayed care.

We present a novel method, the Gaussian observational model for edge to center heterogeneity (GOMECH), to quantify the horizontal chemical structure of plumes. GOMECH fits observations of short-lived emissions or products against a long-lived tracer (e.g., CO) to provide relative metrics for the plume width (wi/wCO) and center (bi/wCO). To validate GOMECH, we investigate OH and NO3 oxidation processes in smoke plumes sampled during FIREX-AQ (Fire Influence on Regional to Global Environments and Air Quality, a 2019 wildfire smoke study). An analysis of 430 crosswind transects demonstrates that nitrous acid (HONO), a primary source of OH, is narrower than CO (wHONO/wCO = 0.73-0.84 ± 0.01) and maleic anhydride (an OH oxidation product) is enhanced on plume edges (wmaleicanhydride/wCO = 1.06-1.12 ± 0.01). By contrast, NO3 production [P(NO3)] occurs mainly at the plume center (wP(NO3)/wCO = 0.91-1.00 ± 0.01). Phenolic emissions, highly reactive to OH and NO3, are narrower than CO (wphenol/wCO = 0.96 ± 0.03, wcatechol/wCO = 0.91 ± 0.01, and wmethylcatechol/wCO = 0.84 ± 0.01), suggesting that plume edge phenolic losses are the greatest. Yet, nitrophenolic aerosol, their oxidation product, is the greatest at the plume center (wnitrophenolicaerosol/wCO = 0.95 ± 0.02). In a large plume case study, GOMECH suggests that nitrocatechol aerosol is most associated with P(NO3). Last, we corroborate GOMECH with a large eddy simulation model which suggests most (55%) of nitrocatechol is produced through NO3 in our case study.

Proton-transfer-reaction (PTR) is a commonly applied ionization technique for mass spectrometers, where hydronium ions (H3O+) transfer a proton to analytes with higher proton affinities than the water molecule. This method has most commonly been used to quantify volatile hydrocarbons, but later generation PTR-instruments have been designed for better throughput of less volatile species, allowing detection of more functionalized molecules as well. For example, the recently developed Vocus PTR time-of-flight mass spectrometer (PTR-TOF) has been shown to agree well with an iodide adduct based chemical ionization mass spectrometer (CIMS) for products with 3-5 O-atoms from oxidation of monoterpenes (C10H16). However, while several different types of CIMS instruments (including those using iodide) detect abundant signals also at “dimeric” species, believed to be primarily ROOR peroxides, no such signals have been observed in the Vocus PTR, even though these compounds fulfil the condition of having higher proton affinity than water. More traditional PTR instruments have been limited to volatile molecules as the inlets have not been designed for transmission of easily condensable species. Some newer instruments, like the Vocus PTR, have overcome this limitation, but are still not able to detect the full range of functionalized products, suggesting that other limitations need to be considered. One such limitation, well-documented in PTR literature, is the tendency of protonation to lead to fragmentation of some analytes. In this work, we evaluate the potential for PTR to detect dimers and the most oxygenated compounds, as these have been shown to be crucial for forming atmospheric aerosol particles. We studied the detection of dimers using a Vocus PTR-TOF in laboratory experiments as well as through quantum chemical calculations. Only noisy signals of potential dimers were observed during experiments on the ozonolysis of the monoterpene α-pinene, while a few small signals of dimeric compounds were detected during the ozonolysis of cyclohexene. During the latter experiments, we also tested varying the pressures and electric fields in the ionization region of the Vocus PTR-TOF, finding that only small improvements were possible in the relative dimer contributions. Calculations for model ROOR and ROOH systems showed that most of these peroxides should fragment partially following protonation. With inclusion of additional energy from the ion-molecule collisions driven by the electric fields in the ionization source, computational results suggest substantial or nearly complete fragmentation of dimers. Our study thus suggests that while the improved versions of PTR-based mass spectrometers are very powerful tools for measuring hydrocarbons and their moderately oxidized products, other types of CIMS are likely more suitable for the detection of ROOR and ROOH species.

The true prevalence of COVID-19 is difficult to estimate due to the absence of random population-based testing. To estimate current and past COVID-19 infection prevalence in a large urban area, we conducted a population-based survey in St. Louis County, Missouri.The population-based survey of active infection (PCR) and seroprevalence (IgG antibodies) of adults (≥18 years) was conducted through random-digit dialing and targeted sampling of St. Louis County residents with oversampling of Black residents. Infection prevalence of residents was estimated using design-based and raking weighting.Between August 17 and October 24, 2020, 1245 residents completed a survey and underwent PCR testing; 1073 residents completed a survey and underwent PCR and IgG testing or self-reported results. Weighted prevalence estimates of residents with active infection were 1.9% (95% CI, 0.4%-3.3%) and 5.6% were ever infected (95% CI, 3.3%-8.0%). Overall infection hospitalization and fatality ratios were 4.9% and 1.4%, respectively.Through October 2020, the percentage of residents that had ever been infected was relatively low. A markedly higher percentage of Black and other minorities compared to White residents were infected with COVID-19. The St. Louis region remained highly vulnerable to widespread infection in late 2020.

Background The management of flat epithelial atypia (FEA) on core needle biopsy remains controversial. The upstaging rates after surgical excision are variable. In this study, we seek to determine the upstaging rate of FEA at our institution. Methods Patients with a diagnosis of FEA were identified from the institution’s pathology database from 2009 to 2018. Patients were included in the study if FEA alone, without atypia or cancer, was identified on core needle biopsy. Patient demographics, imaging, management, and pathology characteristics were obtained. Statistical analysis performed using IBM SPSS 26.0 (Armonk, NY, USA). Results FEA was diagnosed on core needle biopsy in 235 patients from 2009 to December 2018. Forty-eight patients met the inclusion criteria. The majority of patients presented with calcifications on mammogram (n = 21, 64%) with the remainder as masses (n = 6, 18%) or architectural distortion (n = 6, 18%). Of those, 15 (31%) patients declined surgical excision, of which none developed cancer over a mean follow-up of 4.4 years. Of the 33 (69%) patients undergoing excisional biopsy, 17 (52%) confirmed FEA, 11 (33%) had benign findings, and 3 (9%) demonstrated atypical ductal hyperplasia on final pathology. One (3%) case revealed ductal carcinoma in situ (DCIS) and 1 (3%) was upgraded to invasive cancer for an overall upstaging rate of 4% (2/48). After a mean follow-up of 3.4 years, none of the excisional biopsy patients developed invasive breast cancer. Adjuvant therapy was used in the cases of DCIS and invasive cancer; however, chemoprevention with raloxifene or tamoxifen was not chosen by any of the remaining patients. Conclusion In our cohort, expectant management of FEA alone appears to be a safe option as our upstaging rate to DCIS or invasive cancer for FEA diagnosed on core biopsy was only 4%. Our study suggests that close follow-up is a safe and feasible option for pure FEA without a radiographic discordance found on core biopsy.

Understanding changes in macroinvertebrate communities is important because they play a large role in stream ecosystem functioning, and they are an important food resource for fish. Beaver‐induced changes to stream morphology could alter macroinvertebrate communities, which in turn could affect food webs and ecosystem function. However, studies investigating the effects of North American beaver activities on macroinvertebrates are rare in the inter‐mountain west, an area with high potential for beaver‐assisted restoration. The aim of this study was to quantify differences in the macroinvertebrate community between unaltered segments of streams and within beaver ponds in north‐eastern Utah, U.S.A. We assessed macroinvertebrate species richness, biomass, density, functional feeding group composition, mobility group composition, and macroinvertebrate habitat characteristics to test the hypothesis that macroinvertebrate communities will differ among habitat types (undammed stream segments and beaver ponds) in beaver‐occupied streams. Beaver pond communities significantly differed from lotic reach communities in many ways. Beaver ponds were less diverse with 25% fewer species. Although there was variability among streams, in general, beaver ponds had 75% fewer individuals and 90% lower total macroinvertebrate biomass compared to lotic reaches. Regarding functional feeding groups, beaver ponds contained more engulfers, while lotic reaches contained more scrapers, filterers, and gatherers. For mobility groups, beaver ponds had more sprawlers, while lotic reaches had more clingers. Swimmers were also more prevalent in lotic reaches, although this is probably due to the abundance of Baetis within lotic reaches. More beaver pond taxa were classified as lentic‐dwelling insects, while more lotic reach taxa were categorised as preferring lotic habitats. The creation of ponds by beavers fundamentally altered the macroinvertebrate community in north‐eastern Utah streams. Such changes to stream macroinvertebrate communities suggest that recolonisation of beavers across North America may be altering stream functioning and food webs. Our study highlights the need to further investigate the effects of beaver recolonisation on stream communities.

Chemical ionization mass spectrometry (CIMS) techniques have become prominent methods for sampling trace gases of relatively low volatility. Such gases are often referred to as being “sticky”, i.e., having measurement artifacts due to interactions between analyte molecules and instrument walls, given their tendency to interact with wall surfaces via absorption or adsorption processes. These surface interactions can impact the precision, accuracy, and detection limits of the measurements. We introduce a low-pressure ion–molecule reaction (IMR) region primarily built for performing iodide-adduct ionization, though other adduct ionization schemes could be employed. The design goals were to improve upon previous low-pressure IMR versions by reducing impacts of wall interactions at low pressure while maintaining sufficient ion–molecule reaction times. Chamber measurements demonstrate that the IMR delay times (i.e., magnitude of wall interactions) for a range of organic molecules spanning 5 orders of magnitude in volatility are 3 to 10 times lower in the new IMR compared to previous versions. Despite these improvements, wall interactions are still present and need to be understood. To that end, we also introduce a conceptual framework for considering instrument wall interactions and a measurement protocol to accurately capture the time dependence of analyte concentrations. This protocol uses short-duration, high-frequency measurements of the total background (i.e., fast zeros) during ambient measurements as well as during calibration factor determinations. This framework and associated terminology applies to any instrument and ionization technique that samples compounds susceptible to wall interactions.

To compare the accuracy of preoperative biometry-based formulas to intraoperative aberrometry (IA) with respect to predicting refractive outcomes after cataract surgery in short eyes.Private practice and community-based ambulatory surgery center.Retrospective consecutive case series.Eyes with an axial length (AL) shorter than 22.1 mm underwent cataract extraction and intraocular lens (IOL) implantation. The predicted residual refractive error was calculated preoperatively using Hoffer Q, Holladay 2, Haigis, Barrett Universal II, and Hill-RBF formulas and intraoperatively using IA. The postoperative spherical equivalent (SE) was compared with the predicted SE to evaluate the accuracy of each aforementioned method.Fifty-one eyes from 38 patients met criteria to be included in the analysis. Without optimizing the formulas specifically for short eyes, the mean numerical errors (MNEs) associated with Hoffer Q, Holladay 2, Haigis, Barrett Universal II, Hill-RBF, and IA were -0.08 (95% confidence interval [CI], -0.30 to 0.13), -0.14 (95% CI, -0.35 to 0.07), +0.26 (95% CI, 0.05 to 0.47), +0.11 (95% CI, -0.10 to 0.32), +0.07 (95% CI, -0.14 to 0.28), and +0.00 (95% CI, -0.21 to 0.21), respectively (P .001). The proportion of eyes within ±0.5 diopter (D) of the predicted SE were 49.0%, 43.1%, 52.9%, 52.9%, 60.8%, and 58.8%, respectively (P = .06). The prediction outcomes from IA were statistically better than Haigis, but not other formulas. When formula and IA predictions differed by 0.5 D or more, IA's ability to recommend a more emmetropic outcome was no better than chance (50%).Intraoperative aberrometry is not significantly different from the best preoperative biometry-based methods available for IOL power selection in short eyes.

Background: Some clinical trials report improvement in persistent post-concussive symptoms (PCS) with hyperbaric oxygen (HBO2) following mild traumatic brain injury (mTBI), but questions remain regarding the utility of HBO2 for PCS, the effects of HBO2 on post-traumatic stress disorder (PTSD), and the influences of sham control exposures. Methods: A systematic review and pooled analysis was conducted to summarize available evidence for HBO2 in mTBI-associated PCS ± PTSD. Data aggregated from four Department of Defense (DoD) studies with participant-level data (n=254) were grouped into pooled HBO2 and sham intervention groups. Changes from baseline to post-intervention on PCS, PTSD, and neuropsychological measures were assessed using linear mixed models to evaluate main intervention and intervention-by-baseline PTSD effects. Potential dose-response relationships to oxygen partial pressures were investigated. Intervention effects from three other published studies with summary-level participant data (n=135) were also summarized. Results: Pooled DoD data analyses indicated trends toward improvement favoring HBO2 for PCS (Rivermead Total Score: -2.3, 95% CI [-5.6, 1.0], p=0.18); PTSD (PTSD Checklist Total Score: -2.7, 95% CI [-5.8, 0.4], p=0.09); and significant improvement in verbal memory (CVLT-II Trial 1-5 Free Recall: 3.8; 95% CI [1.0, 6.7], p=0.01). A dose-response trend to increasing oxygen partial pressure was also found, with a greater HBO2 effect in mTBI-associated PTSD suggested. The direction of results was consistent with other published studies. Conclusions: A definitive clinical trial, with an appropriate control group, should be considered to identify the optimal HBO2 dosing regimen for individuals with mTBI-associated PTSD ± PCS.

By combining a focused inert-gas ion beam instrument and a custom magnetic-sector mass spectrometer, high spatial resolution imaging and chemical analysis are provided within a single instrument. Sub-nanometer image resolution is achieved by secondary electron (SE) imaging, limited only by the probe-size of the primary beam, while the spatial resolution for chemical mapping obtained via secondary ion mass spectrometry (SIMS) is limited mainly by beam-sample interactions to about 10 nm. This article introduces the background behind this development, describes the instrument and its various operating modes, and presents examples of its applications.

To date, several Department of Defense (DoD) and civilian studies have evaluated hyperbaric oxygen for mild forms of traumatic brain injury. Prior to the DoD-sponsored "Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA)" trial, none included post-intervention follow-up beyond three to six months. Post-hoc attempts at long-term follow-up were complicated by low participation and potential self-selection bias. BIMA planned for follow-up through 12 months but was amended to add post-concussive and post-traumatic stress disorder, quality of life, pain, depression, anxiety, and alcohol use assessments at 24 and 36 months. A total of 42 of 71 BIMA participants consented to extendedfollow-up, and 40 and 14 completed a 24- or 36-month visit, respectively, representing an overall response rate of 59% and 20%. Participants who completed extended follow-up were similar to the study group that did not in terms of demographics, perceived intervention allocation, and initial response to intervention. There were no significant differences at 24 or 36 months between intervention groups, and group mean scores were near pre-intervention values. This return to baseline could be due to waning treatment effect, selection bias, or participant or perception effects. Though BIMA implemented several participant retention strategies, more frequent participant contact and increased compensation might improve long-term retention in future studies. clinicaltrials.gov Identifier NCT01611194.

Traumatic brain injury (TBI) is a major cause of death and disability in the United States (U.S.), with the Centers for Disease Control and Prevention reporting approximately 2.8 million TBI-related emergency department visits, hospitalizations, and deaths in 2012 [1]. For those under 45 years of age, TBI is the number one cause of disability and mortality worldwide [2]. Within military populations TBI remains especially problematic. While the incidence of TBI in the U.S. military peaked in 2011, Department of Defense personnel continue to experience approximately 18,000 new cases each year, with 383,473 total cases between 2000 and the first quarter of 2018 [3]. Eighty-two percent of these injuries were classified as mild TBI (mTBI) [3].

Background Significant reductions in ambient pressure subject an individual to risk of decompression illness (DCI); with incidence up to 35 per 10,000 dives. In severe cases, the central nervous system is often compromised (>80%), making DCI among the most morbid of diving related injuries. While hyperbaric specialists suggest initiating recompression therapy with either a Treatment Table 6 (TT6) or 6A (TT6A), the optimal initial recompression treatment for severe DCI is unknown. Methods Swine were exposed to an insult dive breathing air at 7.06 ATA (715.35 kPa) for 24 min followed by rapid decompression at a rate of 1.82 ATA/min (184.41 kPa/min). Swine that developed neurologic DCI within 1 hour of surfacing were block randomized to one of four United States Navy Treatment Tables (USN TT): TT6, TT6A-air (21% oxygen, 79% nitrogen), TT6A-nitrox (50% oxygen, 50% nitrogen), and TT6A-heliox (50% oxygen, 50% helium). The primary outcome was the mean number of spinal cord lesions, which was analyzed following cord harvest 24 hours after successful recompression treatment. Secondary outcomes included spinal cord lesion incidence and gross neurologic outcomes based on a pre- and post- modified Tarlov assessment. We compared outcomes among these four groups and between the two treatment profiles (i.e. TT6 and TT6A). Results One-hundred and forty-one swine underwent the insult dive, with 61 swine meeting inclusion criteria (43%). We found no differences in baseline characteristics among the groups. We found no significant differences in functional neurologic outcomes (p = 0.77 and 0.33), spinal cord lesion incidence (p = 0.09 and 0.07), or spinal cord lesion area (p = 0.51 and 0.17) among the four treatment groups or between the two treatment profiles, respectively. While the trends were not statistically significant, animals treated with TT6 had the lowest rates of functional deficits and the fewest spinal cord lesions. Moreover, across all animals, functional neurologic deficit had strong correlation with lesion area pathology (Logistic Regression, p < 0.01, Somers’ D = 0.74). Conclusions TT6 performed as well as the other treatment tables and is the least resource intensive. TT6 is the most appropriate initial treatment for neurologic DCI in swine, among the tables that we compared.

Refractory osteomyelitis is defined as a chronic osteomyelitis that persists or recurs after appropriate interventions have been performed or where acute osteomyelitis has not responded to accepted management techniques [1]. To date, no randomized clinical trials examining the effects of hyperbaric oxygen (HBO2) therapy on refractory osteomyelitis exist, and the number of new osteomyelitis clinical trials conducted over the past decade has been limited. However, based on a comprehensive review of the scientific literature, the addition of HBO2 therapy to routine surgical and antibiotic treatment of previously refractory osteomyelitis appears to be both safe and ultimately improves infection resolution rates. In most cases, the best clinical results are obtained when HBO2 treatment is administered in conjunction with culture-directed antibiotics and initiated soon after clinically indicated surgical debridement. Where extensive surgical debridement or removal of fixation hardware is relatively contraindicated (e.g., cranial, spinal, sternal, or pediatric osteomyelitis), a trial of culture-directed antibiotics and HBO2 therapy prior to undertaking more than limited surgical interventions provides a reasonable prospect for osteomyelitis cure. HBO2 therapy is ordinarily delivered on a once daily basis, five-seven days per week, for 90-120 minutes using 2.0-3.0 atmospheres absolute (ATA) pressure. Where prompt clinical improvement is seen, the existing regimen of antibiotics and HBO2 therapy should be continued for approximately four to six weeks. Typically, 20-40 HBO2 sessions are required to achieve sustained therapeutic benefit. In contrast, if prompt clinical response is not noted or osteomyelitis recurs after this initial treatment period, then continuation of the current antibiotic and HBO2 treatment regimen is unlikely to be effective. Instead, clinical management strategies should be reassessed and additional surgical debridement and/or modification of antibiotic therapy considered. Subsequent reinstitution of HBO2 therapy will again help maximize the overall chances for treatment success in these persistently refractory patients.

Wildfire emissions affect downwind air quality and human health. Predictions of these impacts using models are limited by uncertainties in emissions and chemical evolution of smoke plumes. Using hi...

Understanding the efficiency and variability of photochemical ozone (O3) production from western wildfire plumes is important to accurately estimate their influence on North American air quality. A set of photochemical measurements were made from the NOAA Twin Otter research aircraft as a part of the Fire Influence on Regional to Global Environments and Air Quality (FIREX-AQ) experiment. We use a zero-dimensional (0-D) box model to investigate the chemistry driving O3 production in modeled plumes. Modeled afternoon plumes reached a maximum O3 mixing ratio of 140 ± 50 ppbv (average ± standard deviation) within 20 ± 10 min of emission compared to 76 ± 12 ppbv in 60 ± 30 min in evening plumes. Afternoon and evening maximum O3 isopleths indicate that plumes were near their peak in NOx efficiency. A radical budget describes the NOx volatile - organic compound (VOC) sensitivities of these plumes. Afternoon plumes displayed a rapid transition from VOC-sensitive to NOx-sensitive chemistry, driven by HOx (=OH + HO2) production from photolysis of nitrous acid (HONO) (48 ± 20% of primary HOx) and formaldehyde (HCHO) (26 ± 9%) emitted directly from the fire. Evening plumes exhibit a slower transition from peak NOx efficiency to VOC-sensitive O3 production caused by a reduction in photolysis rates and fire emissions. HOx production in evening plumes is controlled by HONO photolysis (53 ± 7%), HCHO photolysis (18 ± 9%), and alkene ozonolysis (17 ± 9%).

ImportanceWomen and gender-diverse individuals have faced disproportionate socioeconomic burden during COVID-19. There have been reports that this has translated into greater negative changes in mental health, but this has been based on cross-sectional research that has not accounted for pre-COVID-19 differences.ObjectiveTo compare mental health symptom changes since pre-COVID-19 by sex or gender.Data SourcesMEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework (December 31, 2019 to August 30, 2021).Study SelectionEligible studies compared mental health symptom changes from pre-COVID-19 to COVID-19 by sex or gender.Data Extraction and SynthesisData was extracted by a single reviewer with validation by a second reviewer. Adequacy of study methods and reporting was assessed using an adapted version of the Joanna Briggs Institute Checklist for Prevalence Studies. A restricted maximum-likelihood random-effects meta-analyses was conducted.Main Outcomes and MeasuresAnxiety symptoms, depression symptoms, general mental health, and stress measured continuously or dichotomously.Results12 studies (10 unique cohorts) were included. All compared females or women to males or men; none included gender-diverse individuals. Continuous symptom change differences were not statistically significant for depression (standardized mean difference [SMD]= 0.12, 95% CI -0.09 to 0.33; 4 studies, 4,475 participants; I2=69.0%) and stress (SMD= - 0.10, 95% CI -0.21 to 0.01; 4 studies, 1,533 participants; I2=0.0%), but anxiety (SMD= 0.15, 95% CI 0.07 to 0.22; 4 studies, 4,344 participants; I2=3.0%) and general mental health (SMD= 0.15, 95% CI 0.12 to 0.18; 3 studies, 15,692 participants; I2=0.0%) worsened more among females or women than males or men during COVID-19. There were no significant differences in changes in proportion above a cut-off: anxiety (difference= -0.05, 95% CI -0.20 to 0.11; 1 study, 217 participants), depression (difference= 0.12, 95% CI -0.03 to 0.28; 1 study, 217 participants), general mental health (difference= -0.03, 95% CI -0.09 to 0.04; 3 studies, 18,985 participants; I2=94.0%), stress (difference= 0.04, 95% CI -0.10 to 0.17; 1 study, 217 participants).Conclusion and RelevanceMental health outcomes did not differ or were worse by amounts below thresholds for clinical significance for women compared to men.RegistrationPROSPERO (CRD42020179703).KEY MESSAGESQuestionDid mental health symptoms worsen more for females or women than males or men in COVID-19?FindingsWe reviewed almost 65,000 citations and identified 12 studies that provided data to directly compare mental health symptom changes from pre-COVID-19 to during COVID-19 for females or women versus males or men. Statistically significant, but small, sex- or gender-based differences were found in 2 of 8 mental health outcomes.MeaningMental health changes among females or women were not significantly different from males or men for most outcomes, and differences that were identified were small and less than minimally important difference thresholds.

The inorganic fraction of fine particles affects numerous physicochemical processes in the atmosphere. However, there is large uncertainty in its burden and composition due to limited global measurements. Here, we present observations from eleven different aircraft campaigns from around the globe and investigate how aerosol pH and ammonium balance change from polluted to remote regions, such as over the oceans. Both parameters show increasing acidity with remoteness, at all altitudes, with pH decreasing from about 3 to about −1 and ammonium balance decreasing from almost 1 to nearly 0. We compare these observations against nine widely used chemical transport models and find that the simulations show more scatter (generally R2

Wildfires are increasing in size across the western U.S., leading to increases in human smoke exposure and associated negative health impacts. The impact of biomass burning (BB) smoke, including wildfires, on regional air quality depends on emissions, transport, and chemistry, including oxidation of emitted BB volatile organic compounds (BBVOCs) by the hydroxyl radical (OH), nitrate radical (NO3), and ozone (O3). During the daytime, when light penetrates the plumes, BBVOCs are oxidized mainly by O3 and OH. In contrast, at night, or in optically dense plumes, BBVOCs are oxidized mainly by O3 and NO3. This work focuses on the transition between daytime and nighttime oxidation, which has significant implications for the formation of secondary pollutants and loss of nitrogen oxides (NOx = NO + NO2), and has been understudied. We present wildfire plume observations made during FIREX-AQ (Fire Influence on Regional to Global Environments and Air Quality), a field campaign involving multiple aircraft, ground, satellite, and mobile platforms that took place in the United States in the summer of 2019 to study both wildfire and agricultural burning emissions and atmospheric chemistry. We use observations from two research aircraft, the NASA DC-8 and the NOAA Twin Otter, with a detailed chemical box model, including updated phenolic mechanisms, to analyze smoke sampled during mid-day, sunset, and nighttime. Aircraft observations suggest a range of NO3 production rates (0.1–1.5 ppbv h−1) in plumes transported both mid-day and after dark. Modeled initial instantaneous reactivity toward BBVOCs for NO3, OH, and O3 is 80.1 %, 87.7 %, 99.6 %, respectively. Initial NO3 reactivity is 10–104 times greater than typical values in forested or urban environments and reactions with BBVOCs account for ≥ 98 % of NO3 loss in sunlit plumes (jNO2 up to 4 x 10–3 s–1), while conventional photochemical NO3 loss through reaction with NO and photolysis are minor pathways. Alkenes and furans are mostly oxidized by OH and O3 (11–43 %, 54–88 % for alkenes; 18–55 %, 39–76 %, for furans, respectively), but phenolic oxidation is split between NO3, O3, and OH (26–52 %, 22–43 %, 16–33 %, respectively). Nitrate radical oxidation accounts for 26–52 % of phenolic chemical loss in sunset plumes and in an optically thick plume. Nitrocatechol yields varied between 33 % and 45 %, and NO3 chemistry in BB plumes emitted late in the day is responsible for 72–92 % (84 % in an optically thick mid-day plume) of nitrocatechol formation and controls nitrophenolic formation overall. As a result, overnight nitrophenolic formation pathways account for 56 ± 2 % of NOx loss by sunrise the following day. In all but one overnight plume we model, there is remaining NOx (13 %–57 %) and BBVOCs (8 %–72 %) at sunrise.

Coronary intravascular lithotripsy (IVL) is an emerging therapy for the modification of coronary artery calcification (CAC). Data on its use in several clinical and lesion subsets are limited due to their exclusion from preapproval trials.We performed a retrospective review of patients who were excluded from preapproval trials of coronary IVL and underwent CAC modification with the off-label use of a peripheral IVL system. The primary outcome was a composite of procedural success, defined as residual stenosis10%, and no major adverse cardiac event (MACE), ie, cardiac death, myocardial infarction, or target- vessel revascularization, in hospital and at 30 days.Between June 2019 and April 2020, a total of 9 patients who underwent off-label coronary IVL were identified. Exclusion criteria from preapproval trials included a target lesion within an unprotected left main coronary artery (ULMCA; n = 3) and/or ostial location (n = 5), a target lesion involving in-stent restenosis (n = 3), a second target-vessel lesion with50% stenosis (n = 1), and/or New York Heart Association class III/IV heart failure (n = 5). The primary outcome was achieved in 8 patients. MACE rate was 0% in hospital and at 30 days. For ULMCA lesions (n = 3), residual stenosis was 0% in 2 patients and 10% in 1 patient. For right coronary artery lesions (n = 3), residual stenosis was 0% in 2 patients and 40% in 1 patient. For left anterior descending coronary artery lesions (n = 3), residual stenosis was 0% in all patients.Coronary IVL with a peripheral IVL system may be an effective therapy for CAC modification within ULMCA disease, ostial disease, in-stent restenosis, and New York Heart Association class III/IV heart failure.

Reactive nitrogen (Nr) within smoke plumes plays important roles in the production of ozone, the formation of secondary aerosols, and deposition of fixed N to ecosystems. The Western Wildfire Experiment for Cloud Chemistry, Aerosol Absorption, and Nitrogen (WE-CAN) field campaign sampled smoke from 23 wildfires throughout the western U.S. during summer 2018 using the NSF/NCAR C-130 research aircraft. We empirically estimate Nr normalized excess mixing ratios and emission factors from fires sampled within 80 min of estimated emission and explore variability in the dominant forms of Nr between these fires. We find that reduced N compounds comprise a majority (39%-80%; median = 66%) of total measured reactive nitrogen (ΣNr) emissions. The smoke plumes sampled during WE-CAN feature rapid chemical transformations after emission. As a result, within minutes after emission total measured oxidized nitrogen (ΣNOy) and measured total ΣNHx (NH3 + pNH4) are more robustly correlated with modified combustion efficiency (MCE) than NOx and NH3 by themselves. The ratio of ΣNHx/ΣNOy displays a negative relationship with MCE, consistent with previous studies. A positive relationship with total measured ΣNr suggests that both burn conditions and fuel N content/volatilization differences contribute to the observed variability in the distribution of reduced and oxidized Nr. Additionally, we compare our in situ field estimates of Nr EFs to previous lab and field studies. For similar fuel types, we find ΣNHx EFs are of the same magnitude or larger than lab-based NH3 EF estimates, and ΣNOy EFs are smaller than lab NOx EFs.