Search

HIV infection remains a serious global public health problem. Although current drug treatment is effective and can reduce plasma viral loads below the level of detection, it cannot eradicate the virus. The reasons for the low virus persistence despite long-term therapy have not been fully elucidated. In addition, multiple HIV infection, i.e., infection of a cell by multiple viruses, is common and can facilitate viral recombination and mutations, evading the immune system and conferring resistance to drug treatment. The mechanisms for multiple HIV infection formation and their respective contributions remain unclear. To answer these questions, we developed a mathematical modeling framework that encompasses cell-free viral infection and cell-to-cell spread. We fit sub-models that only have one transmission route and the full model containing both to the multi-infection data from HIV-infected patients, and show that the multi-infection data can only be reproduced if these two transmission routes are both considered. Computer simulations with the best-fitting parameter values indicate that cell-to-cell spread leads to the majority of multiple infection and also accounts for the majority of overall infection. Sensitivity analysis shows that cell-to-cell spread has reduced susceptibility to treatment and may explain low HIV persistence. Taken together, this work indicates that cell-to-cell spread plays a crucial role in the development of HIV multi-infection and low HIV persistence despite long-term therapy, and therefore has important implications for understanding HIV pathogenesis and developing more effective treatment strategies to control or even eliminate the disease.

Rates of alcohol use and alcohol-related harms increase with greater alcohol availability. However, regional differences in sociodemographic characteristics and built environment may affect this association. This study evaluated the association between off-premise alcohol availability and alcohol use in Ontario, Canada, and the degree to which this association varies between cities.This was a cross-sectional spatial analysis of urban neighborhoods in Ontario, Canada (There was an overall positive association between alcohol availability and high-volume alcohol use (male coefficient estimate (β) = 0.19, 95% credible interval [CI] [0.16, 0.22]; female β = 0.17, 95% CI [0.13, 0.21]). However, the association was eliminated in models that allowed for this association to vary between cities via an interaction term (male β = -0.04, 95% CI [-0.26, 0.19]; female β = -0.04, 95% CI [-0.34, 0.26]). This was explained by variability in the association between cities, where some cities demonstrated a positive association between availability and use and others demonstrated a negative association.Although there is a province-wide positive association between off-premise alcohol availability and high-volume alcohol use, there is substantial regional variation in this association that may affect the local effectiveness of alcohol regulation policies.

Background: Person-centered health care is becoming the norm which has prompted a need for educating academic and health care professionals upstream to embed this culture and philosophy in graduates prior to beginning their role in a professional health care setting. The Planetree International Certification for Excellence in Person-Centered Care is recognized as the highest mark of achievement an organization can earn, demonstrating a commitment to include patients, families, staff, and the community in the planning process to improve overall health and well-being. Previously the Planetree certification had been reserved for health care enterprises. This article highlights the journey of the first academic institution to achieve the Planetree Silver Certification level of recognition.Methods: Gap analyses of curriculum, culture, operations, student resources, and data for evidence-based evaluation were systematically undertaken.Results: After 18 months of collaboration, multiple site visits by Planetree leaders, and the compilation of a 550+ page self-study detailing the methodology used to address each Planetree standard of person centeredness, the National University, former School of Health and Human Services achieved the level of Planetree Certified Silver recognition.Conclusions: Achieving sustained success remains a continuum of efforts and embraces the journey to the destination while celebrating successes along the way. Early faculty engagement and “grass roots” efforts were sought to lead the National University former School of Health and Human Services toward the first-of-a-kind academic Planetree Silver Certification. Efforts are underway in seeking the Planetree Gold Certification level.

Objectives: The purpose of this study is to establish a consensus estimate of operating room cost per minute based on currently published literature. Design: Literature review. Main outcome measurement: Operating room cost per unit time. Results and conclusions: Google Scholar search produced 51 articles regarding ““operating room cost per minute” of which 14 had novel estimates for OR cost per minute. The mean of these estimates was $46.04 ± $32.31. There was little consistency in methodology among the included articles, which is reflected in the large range of values. Level of Evidence: IV; Review Keywords: Business, management, human resources, cost, value, efficiency. (J Ortho Business 2022; Volume 2, Issue 4: Pages)

The Alpha Text (AT) and Old Greek (OG) versions of Esther include six chapter-length passages—the “Additions”—not paralleled in the Hebrew Masoretic Text (MT) of Esther. In Addition A, Mordecai sees a dream marked by battle cries, confusion, thunder, earthquake, chaos, a pair of dragons, preparations for war, darkness and gloom, affliction and anguish, and an outcry to God from a frightened nation of righteous people. A small spring emerges from the outcry and turns into a mighty river, which consumes those held in esteem. Addition F offers a limited interpretation of several elements of this dream but leaves much of the dream uninterpreted. This paper offers a fresh perspective on the Addition A dream and its relationship to the plot of both AT- and OG-Esther in light of Artemidorus’s Oneirocritica, a second-century CE handbook of dream interpretation.

Background: The ideal central venous catheter (CVC) tip position placement is controversial, and CVCs do not remain in a fixed position after placement. This study evaluates both patient and procedural factors which may influence CVC tip migration and subsequent catheter dysfunction. Materials and Methods: This study evaluates CVC placements at a single institution. Patient age, gender, body mass index (BMI), catheter laterality, CVC type and indication for central venous access were recorded. Catheter tip location relative to the carina was measured at time of placement and removal utilizing supine fluoroscopic imaging. Patients’ electronic medical records were reviewed for evidence of catheter dysfunction. Statistical analysis was performed utilizing odds ratios and two tailed Student’s t-test. Results: 177 patients were included (101 female; mean age 55; mean BMI 29.2). Catheter types included 122 ports, 50 tunneled large bore central venous catheters (≥9 French), and 5 tunneled small bore central venous catheters (2 cm had more than 7× greater risk of dysfunction compared to catheters that migrated ≤2 cm (odds ratio of 7.2; p = 0.0001). Left sided CVCs were significantly more likely to have >2 cm of cranial migration (odds ratio 6.9, 95% CI 3.4–14.2, p < 0.0001) and had a higher rate of dysfunction, likely due to this cranial migration (32% vs. 4.7%; p = 0.00001). Gender and BMI were not found to be associated with catheter dysfunction or an increased odds ratio of >2 cm cranial migration. Conclusions: Left-sided CVCs migrate an average of 2.4 cm cranially more than right-sided catheters. Additionally, when migration occurs, left-sided catheters are more likely to be dysfunctional. These suggest that lower initial placement may be beneficial in left-sided catheters.

Negative-pressure wound therapy (NPWT) is commonly utilized to treat traumatic injuries sustained on the modern battlefield. However, NPWT has failed to decrease the incidence of deep tissue infections experienced by Wounded Warriors, despite attempts to integrate common antimicrobials, like Ag+ nanoparticles, into the wound dressing. The purpose of this study was to incorporate a unique antibiofilm compound (CZ-01179) into the polyurethane matrix of NPWT foam via lyophilized hydrogel scaffolding. Foam samples with 2.5%, 5.0%, and 10.0% w/w CZ-01179 were produced and antibiofilm efficacy was compared to the current standards of care: V.A.C.® GRANUFOAM SILVER™ and V.A.C.® GRANUFOAM™. Gravimetric analysis and elution kinetics testing confirmed that this loading technique was both repeatable and controllable. Furthermore, zone of inhibition and antibiofilm efficacy testing showed that foam loaded with CZ-01179 had significantly increased activity against planktonic and biofilm phenotypes of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii compared to the clinical standards. These findings motivate additional ex vivo and in vivo work with NPWT foam loaded with CZ-01179 with the overall objective of reducing NPWT-associated infections that complicate battlefield-related and other wounds.

Whole body CT in the setting of trauma has been shown to improve patient outcomes and decrease mortality in the emergency department (ED). Our institutional WBCT protocol allows for easy inclusion of the lower extremities, circumventing the need for diagnostic radiographs of the lower extremities. We hypothesized that this WBCT protocol would decrease time in the ED, reduce time to ED discharge, and decrease the number of lower extremity radiographs obtained in this patient population.To assess patient throughput in the ED by determining total time in the ED, number of lower extremity radiographs, cost of radiographs, and total cost of imaging before and after the implementation of a WBCT protocol for trauma.The trauma registry from an urban level 1 trauma center was searched for blunt trauma patients 6 months before and 6 months after the implementation of a WBCT protocol for trauma. Time between admission and discharge from the ED, total number of radiographs, total radiographs cost, total cost of ED imaging, and radiation dose estimations before and after WBCT implementation were calculated.There was a statistically significant decrease in time in the ED (76 min, p = 0.033) and number of lower extremity radiographs (decreased by 2 per patient, p 0.01) following the implementation of the WBCT for trauma protocol. The cost of radiographs was decreased by 28.5% (p = 0.013) but the total cost of ED imaging was increased by approximately 4 × (p 0.0001). Calculated effective radiation dose to the lower extremities increased by a factor of 1.9 × after implementation of WBCT for trauma.Implementation of a WBCT protocol for trauma resulted in statistically significant decreased time in the ED and decreased the number of radiographs at the expense of increased imaging costs and radiation exposure.

In Jewish Antiquities 14–17, Josephus draws extensively on Nicolaus of Damascus’s Universal History. Josephus and his immediate audience in Rome at the end of the first century would have seen Nicolaus’s work as a direct competitor for telling the history of the Jewish people in the Herodian period. This essay looks at Josephus’s use of conventional historiographical polemic to impugn the motivations of his predecessor and rival. By casting Nicolaus the historical actor as biased, Josephus casts doubt on the reliability of the Universal History. Ultimately, this opens up a new perspective on the Antiquities’s more censorious posture vis-à-vis Herod (relative to the more generous posture in his earlier work, the Jewish War): in a virtual competition with Nicolaus, Josephus seeks to win admiration for his own work as frank and impartial in its assessment of Herod while simultaneously fostering suspicion of Nicolaus’s work as obsequious and partisan.

The operational safety of Automated Driving System (ADS)-Operated Vehicles (AVs) are a rising concern with the deployment of AVs as prototypes being tested and also in commercial deployment. The robustness of safety evaluation systems is essential in determining the operational safety of AVs as they interact with human-driven vehicles. Extending upon earlier works of the Institute of Automated Mobility (IAM) that have explored the Operational Safety Assessment (OSA) metrics and infrastructure-based safety monitoring systems, in this work, we compare the performance of an infrastructure-based Light Detection And Ranging (LIDAR) system to an onboard vehicle-based LIDAR system in testing at the Maricopa County Department of Transportation SMARTDrive testbed in Anthem, Arizona. The sensor modalities are located in infrastructure and onboard the test vehicles, including LIDAR, cameras, a real-time differential GPS, and a drone with a camera. Bespoke localization and tracking algorithms are created for the LIDAR and cameras. In total, there are 26 different scenarios of the test vehicles navigating the testbed intersection; for this work, we are only considering car following scenarios. The LIDAR data collected from the infrastructure-based and onboard vehicle-based sensors system are used to perform object detection and multi-target tracking to estimate the velocity and position information of the test vehicles and use these values to compute OSA metrics. The comparison of the performance of the two systems involves the localization and tracking errors in calculating the position and the velocity of the subject vehicle, with the real-time differential GPS data serving as ground truth for velocity comparison and tracking results from the drone for OSA metrics comparison.

The interface between two-dimensional topological Dirac states and an s-wave superconductor is expected to support Majorana bound states that can be used for quantum computing applications. Realizing these novel states of matter and their applications requires control over superconductivity and spin-orbit coupling to achieve spin-momentum locked topological surface states which are simultaneously superconducting. While signatures of Majorana bound states have been observed in the magnetic vortex cores of bulk FeTe0.55Se0.45, inhomogeneity and disorder from doping makes these signatures unclear and inconsistent between vortices. Here we report superconductivity in monolayer FeTe1-ySey (Fe(Te,Se)) grown on Bi2Te3 by molecular beam epitaxy. Spin and angle resolved photoemission spectroscopy directly resolve the interfacial spin and electronic structure of Fe(Te,Se)/Bi2Te3 heterostructures. We find that for y = 0.25 the Fe(Te,Se) electronic structure overlaps with the topological Bi2Te3 interfacial states which disrupts the desired spin-momentum locking. In contrast, for y = 0.1 a smaller Fe(Te,Se) Fermi surface allows for clear spin-momentum locking observed in the topological states. Hence, we demonstrate the Fe(Te,Se)/Bi2Te3 system is a highly tunable platform for realizing Majorana bound states where reduced doping can improve characteristics important for Majorana interrogation and potential applications.

The purpose of this study was to develop and test a 3D multi-parameter MR fingerprinting (MRF) method for brain imaging applications. The subject cohort included 5 healthy volunteers, repeatability tests done on 2 healthy volunteers and tested on two multiple sclerosis (MS) patients. A 3D-MRF imaging technique capable of quantifying T1, T2 and T1ρ was used. The imaging sequence was tested in standardized phantoms and 3D-MRF brain imaging with multiple shots (1, 2 and 4) in healthy human volunteers and MS patients. Quantitative parametric maps for T1, T2, T1ρ, were generated. Mean gray matter (GM) and white matter (WM) ROIs were compared for each mapping technique, Bland-Altman plots and intra-class correlation coefficient (ICC) were used to assess repeatability and Student T-tests were used to compare results in MS patients. Standardized phantom studies demonstrated excellent agreement with reference T1/T2/T1ρ mapping techniques. This study demonstrates that the 3D-MRF technique is able to simultaneously quantify T1, T2 and T1ρ for tissue property characterization in a clinically feasible scan time. This multi-parametric approach offers increased potential to detect and differentiate brain lesions and to better test imaging biomarker hypotheses for several neurological diseases, including MS.

In this article, we explore the experiences of people who carry monetary sanction (or penal) debt across eight U.S. states. Using 519 interviews with people sentenced to fines and fees, we analyze the mental and emotional aspects of their experiences. Situating our analysis within research on the social determinants of health and the stress universe, we suggest that monetary sanctions create an overwhelmingly palpable sense of fear, frustration, anxiety, and despair. We theorize the ways in which monetary sanctions function as both acute and chronic health stressors for people who are unable to pay off their debts, highlight the mechanisms linking penal debt with mental and emotional burdens, and generalize our findings using national data from the U.S. Federal Reserve. We find that the system of monetary sanctions generates a great deal of stress and strain that becomes an internalized punishment affecting many realms of people’s lives.

Although men’s incarceration rates have declined in the United States, women’s have stayed steady and even risen in some areas. At the same time, courts have increased their use of monetary sanctions, especially for low-level offenses. We propose that women’s incarceration trends can be partially explained by county dependence on monetary sanctions as a source of revenue. We suggest that monetary sanctions expose female defendants to processes that increase their likelihood of incarceration, especially in counties more reliant on monetary sanctions as a source of revenue, and where women’s poverty rates are high. Using data from Washington State, we find county dependence on monetary sanctions is positively associated with rates of women sentenced to incarceration. Although rural counties’ rates are higher, they depend on monetary sanctions no more than nonrural counties do.

Legal scholars have long studied why laws are implemented differently across local court contexts. Key to understanding this localized variation is understanding how new laws are communicated, interpreted, and negotiated within the legal field. Few studies, however, have directly examined the process by which court actors interpret and negotiate new laws within the court. We explore these sensemaking processes through interviews and observations of court actors in Washington and Missouri after changes to monetary sanction laws. We identify three primary forms of sensemaking and analyze contextual factors that shape these processes. We find key differences in sensemaking based on differing levels of regulatory oversight but also that normative and cultural factors were still important in determining legal interpretation and implementation within each state. These findings have important implications for our theoretical understanding of courtroom communities and for policymakers seeking to enact reform.

The immunosuppressive tumor microenvironment (TME) is a formidable barrier to the success of adoptive cell therapies for solid tumors. Oncolytic immunotherapy with engineered adenoviruses (OAd) may disrupt the TME by infecting tumor cells, as well as surrounding stroma, to improve the functionality of tumor-directed chimeric antigen receptor (CAR)-T cells, yet efficient delivery of OAds to solid tumors has been challenging. Here we describe how mesenchymal stromal cells (MSCs) can be used to systemically deliver a binary vector containing an OAd together with a helper-dependent Ad (HDAd; combinatorial Ad vector [CAd]) that expresses interleukin-12 (IL-12) and checkpoint PD-L1 (programmed death-ligand 1) blocker. CAd-infected MSCs deliver and produce functional virus to infect and lyse lung tumor cells while stimulating CAR-T cell anti-tumor activity by release of IL-12 and PD-L1 blocker. The combination of this approach with administration of HER.2-specific CAR-T cells eliminates 3D tumor spheroids in vitro and suppresses tumor growth in two orthotopic lung cancer models in vivo. Treatment with CAd MSCs increases the overall numbers of human T cells in vivo compared to CAR-T cell only treatment and enhances their polyfunctional cytokine secretion. These studies combine the predictable targeting of CAR-T cells with the advantages of cancer cell lysis and TME disruption by systemic MSC delivery of oncolytic virotherapy: incorporation of immunostimulation by cytokine and checkpoint inhibitor production through the HDAd further enhances anti-tumor activity.

PURPOSE This study evaluated risk factors predicting unplanned 30-day acute service utilization among adults subsequent to hospitalization for a new diagnosis of leukemia, lymphoma, or myeloma. This study explored the prevalence of medical complications (aligned with OP-35 measure specifications from the Centers for Medicare & Medicaid Services [CMS] Hospital Outpatient Quality Reporting Program) and the potential impact of psychosocial factors on unplanned acute care utilization. METHODS This study included 933 unique patients admitted to three acute care inpatient facilities within a nonprofit community-based health care system in southern California from 2012 to 2017. Integrated comprehensive data elements from electronic medical records and facility oncology registries were leveraged for univariate statistics, predictive models constructed using multivariable logistic regression, and further exploratory data mining, with predictive accuracy of the models measured with c-statistics. RESULTS The mean age of study participants was 65 years, and 55.1% were male. Specific diagnoses were lymphoma (48.7%), leukemia (35.2%), myeloma (14.0%), and mixed types (2.1%). Approximately one fifth of patients received unplanned acute care services within 30 days postdischarge, and over half of these patients presented with one or more symptoms associated with the CMS medical complication measure. The predictive models, with c-statistics ranging from 0.7 and above for each type of hematologic malignancy, indicated good predictive qualities with the impact of psychosocial functioning on the use of acute care services ( P values < .05), including lack of consult for social work during initial admission (lymphoma or myeloma), history of counseling or use of psychotropic medications (lymphoma), and past substance use (myeloma). CONCLUSION This study provides insights into patient-related factors that may inform a proactive approach to improve health outcomes, such as enhanced care transition, monitoring, and support interventions.

Bone remodeling is a continuous process between bone-forming osteoblasts and bone-resorbing osteoclasts, with any imbalance resulting in metabolic bone disease, including osteopenia. The HERC1 gene encodes an E3 ubiquitin ligase that affects cellular processes by regulating the ubiquitination of target proteins, such as C-RAF. Of interest, an association exists between biallelic pathogenic sequence variants in the HERC1 gene and the neurodevelopmental disorder MDFPMR syndrome (macrocephaly, dysmorphic facies, and psychomotor retardation). Most pathogenic variants cause loss of HERC1 function, and the affected individuals present with features related to altered bone homeostasis. Herc1-knockout mice offer an excellent model in which to study the role of HERC1 in bone remodeling and to understand its role in disease. In this study, we show that HERC1 regulates osteoblastogenesis and osteoclastogenesis, proving that its depletion increases gene expression of osteoblastic makers during the osteogenic differentiation of mesenchymal stem cells. During this process, HERC1 deficiency increases the levels of C-RAF and of phosphorylated ERK and p38. The Herc1-knockout adult mice developed imbalanced bone homeostasis that presented as osteopenia in both sexes of the adult mice. By contrast, only young female knockout mice had osteopenia and increased number of osteoclasts, with the changes associated with reductions in testosterone and dihydrotestosterone levels. Finally, osteocytes isolated from knockout mice showed a higher expression of osteocytic genes and an increase in the Rankl/Opg ratio, indicating a relevant cell-autonomous role of HERC1 when regulating the transcriptional program of bone formation. Overall, these findings present HERC1 as a modulator of bone homeostasis and highlight potential therapeutic targets for individuals affected by pathological HERC1 variants.

The number and distribution of recessive alleles in the population for various diseases are not known at genome-wide-scale. Based on 6447 exome-sequences of healthy, genetically-unrelated Europeans of two distinct ancestries, we estimate that every individual is a carrier of at least 2 pathogenic variants in currently known autosomal recessive (AR) genes, and that 0.8-1% of European couples are at-risk of having a child affected with a severe AR genetic disorder. This risk is 16.5-fold higher for first cousins, but is significantly more increased for skeletal disorders and intellectual disabilities due to their distinct genetic architecture.

The ancient Greek novel introduced to the history of literature a new topos: the “complex of emotions.” This became a staple of storytelling and remains widely in use across a variety of genres to the present day. The Hellenistic Jewish text Joseph and Aseneth employs this topos in at least three passages, where it draws attention to the cognitive-emotional aspect of the heroine’s conversion. This is interesting for what it contributes to our understanding of the genre of Aseneth, but it also has social-historical implications. In particular, it supports the idea that Aseneth reflects concerns about Gentile partners in Jewish-Gentile marriages, that Gentile partners might convert out of expedience or that they might be less than fully committed to abandoning “idolatrous” attachments. The representations of deep, grievous, and complex emotions in Aseneth’s transformational turn from idolatry to monolatry, then, might play a psychagogic role for the Gentile reader interested in marrying a Jewish person.

Heparin-induced thrombocytopenia (HIT) is a highly thrombogenic condition. Cancer patients are already at high risk of thrombosis. The treatment and outcomes of HIT in cancer patients are not well established. We retrospectively identified patients with active cancer who were diagnosed with HIT at our institution. Only patients with a positive HIT assay and intermediate to high 4Ts score were included. We assessed patients for baseline characteristics, HIT characteristics, non-heparin agent usage, and outcomes (recurrent thrombosis, bleeding, and death) up to 180 days after diagnosis of HIT. Between November 1, 2006 and December 31, 2016, 39 patients with active cancer received a diagnosis of HIT. Of these, 35.9% had thrombotic complications at diagnosis. Gastrointestinal cancer was the most common solid organ malignancy while myeloproliferative neoplasm (MPN) was the most common hematological malignancy. Fondaparinux was the most often used parenteral agent at any point of follow-up (87.2%), followed by argatroban (41.0%). Less than half the patients transitioned to an oral agent. The recurrent thrombosis rate was 17.9%, the bleeding rate was 20.5%, the major bleeding rate was 10.3%, and the mortality rate was 15.4% in the entire cohort. HIT in cancer patients is associated with poor outcomes.

In this study, we evaluate the impact of whole genome and transcriptome analysis (WGTA) on predictive molecular profiling and histologic diagnosis in a cohort of advanced malignancies. WGTA was used to generate reports including molecular alterations and site/tissue of origin prediction. Two reviewers analyzed genomic reports, clinical history, and tumor pathology. We used National Comprehensive Cancer Network (NCCN) consensus guidelines, Food and Drug Administration (FDA) approvals, and provincially reimbursed treatments to define genomic biomarkers associated with approved targeted therapeutic options (TTOs). Tumor tissue/site of origin was reassessed for most cases using genomic analysis, including a machine learning algorithm (Supervised Cancer Origin Prediction Using Expression [SCOPE]) trained on The Cancer Genome Atlas data. WGTA was performed on 652 cases, including a range of primary tumor types/tumor sites and 15 malignant tumors of uncertain histogenesis (MTUH). At the time WGTA was performed, alterations associated with an approved TTO were identified in 39 (6%) cases; 3 of these were not identified through routine pathology workup. In seven (1%) cases, the pathology workup either failed, was not performed, or gave a different result from the WGTA. Approved TTOs identified by WGTA increased to 103 (16%) when applying 2021 guidelines. The histopathologic diagnosis was reviewed in 389 cases and agreed with the diagnostic consensus after WGTA in 94% of non-MTUH cases (n= 374). The remainder included situations where the morphologic diagnosis was changed based on WGTA and clinical data (0.5%), or where the WGTA was non-contributory (5%). The 15 MTUH were all diagnosed as specific tumor types by WGTA. Tumor board reviews including WGTA agreed with almost all initial predictive molecular profile and histopathologic diagnoses. WGTA was a powerful tool to assign site/tissue of origin in MTUH. Current efforts focus on improving therapeutic predictive power and decreasing cost to enhance use of WGTA data as a routine clinical test.

Students' perceptions of challenges in biology influence performance outcomes, experiences, and persistence in science. Identifying sources of student struggle can assist efforts to support students as they overcome challenges in their undergraduate educations. In this study, we characterized student experiences of struggle by 1) quantifying which external factors relate to perceptions of encountering and overcoming struggle in introductory biology and 2) identifying factors to which students attribute their struggle in biology. We found a significant effect of Course, Instructor, and Incoming Preparation on student struggle, in which students with lower Incoming Preparation were more likely to report struggle and the inability to overcome struggle. We also observed significant differences in performance outcomes between students who did and did not encounter struggle and between students who did and did not overcome their struggle. Using inductive coding, we categorized student responses outlining causes of struggle, and using axial coding, we further categorized these as internally or externally attributed factors. External sources (i.e., Prior Biology, COVID-19, External Resources, Classroom Factors) were more commonly cited as the reason(s) students did or did not struggle. We conclude with recommendations for instructors, highlighting equitable teaching strategies and practices.

Ocean warming is increasing the incidence, scale, and severity of global-scale coral bleaching and mortality, culminating in the third global coral bleaching event that occurred during record marine heatwaves of 2014-2017. While local effects of these events have been widely reported, the global implications remain unknown. Analysis of 15,066 reef surveys during 2014-2017 revealed that 80% of surveyed reefs experienced significant coral bleaching and 35% experienced significant coral mortality. The global extent of significant coral bleaching and mortality was assessed by extrapolating results from reef surveys using comprehensive remote-sensing data of regional heat stress. This model predicted that 51% of the world’s coral reefs suffered significant bleaching and 15% significant mortality, surpassing damage from any prior global bleaching event. These observations demonstrate that global warming’s widespread damage to coral reefs is accelerating and underscores the threat anthropogenic climate change poses for the irreversible transformation of these essential ecosystems.

Organic semiconductors, including graphitic carbon nitride (g-C3N4, CN), represent an important class of materials for the development of novel antimicrobial or biomedical technologies. Of principal interest is the ability of these materials to catalyze the reduction of elemental oxygen to generate reactive oxygen species (ROS), including hydrogen peroxide (H2O2). Here, we describe the fabrication of photoactive van der Waals heterojunctions incorporating 1,4,5,8-naphthalene tetracarboxylic dianhydride (NTCDA) and CN. The composite heterojunction systems were characterized by a combination of physical (TEM, SEM, pXRD), spectroscopic (FT-IR, XPS, DRUV, photoluminescence, TCSPC) and kinetic experiments. Electronic interactions between the two components of the heterojunction increase the rate of photochemical production of H2O2 from elemental oxygen by 410%, relative to samples of pure CN. Mechanistic analysis reveals that interaction of NTCDA with the surface of CN modifies the mechanism of H2O2 formation in the heterojunction photocatalysts. The photochemical production of H2O2 by irradiation of the most active heterojunction composition is sufficient to reduce the viability of E. coli O157:H7, S. aureus and Ps. aeruginosa PAO1 by 99%. Importantly, H2O2 production by the NTCDA/CN heterojunctions suppresses Ps. aeruginosa biofilm formation, even at light exposure doses that had a lesser impact on overall planktonic cell growth.

Purpose To critically review the literature reporting biomechanical outcomes of superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears. Methods A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the PubMed, MEDLINE, and Cochrane Library databases in August 2020. Cadaveric studies were assessed for glenohumeral translation, subacromial contact pressure, and superior humeral translation comparing SCR with an intact cuff with reference to a torn control state. Results A total of 15 studies (142 shoulders) were included in our data analysis. SCR showed improvements in superior humeral translation, subacromial contact force, and glenohumeral contact force when biomechanically compared with the massive and/or irreparably torn rotator cuff. No statistically significant differences were found between SCR and the intact rotator cuff regarding superior humeral translation (standard mean difference [SMD], 2.09 mm vs 2.50 mm; P = .54) or subacromial contact force (SMD, 2.85 mPa vs 2.83 mPa; P = .99). Significant differences were observed between SCR and the intact cuff for glenohumeral contact force only, in favor of the intact cuff (SMD, 1.73 N vs 5.45 N; P = .03). Conclusions SCR may largely restore static restraints to superior humeral translation in irreparable rotator cuff tears, although active glenohumeral compression is diminished relative to the intact rotator cuff. Clinical Relevance Investigating the biomechanical outcomes of SCR will help surgeons better understand the effectiveness of this treatment option.

Evapotranspiration is a necessary input and one of the most uncertain hydrologic variables for quantifying the water balance. Key to accurately predicting hydrologic processes, particularly under data scarcity, is the development of an understanding of the regional variation of the impact of potential evapotranspiration (PET) data inputs on model performance and parametrization. This study explores this impact using four different potential evapotranspiration products (of varying quality). For each data product, a lumped conceptual rainfall–runoff model (GR4J) is tested on a sample of 57 catchments included in the MOPEX data set. Monte Carlo sampling is performed, and the resulting parameter sets are analyzed to understand how the model responds to differences in the forcings. Test catchments are classified as energy- or water-limited using the Budyko framework and by eco-region, and the results are further analyzed. While model performance (and parameterization) in water-limited sites was found to be largely unaffected by the differences in the evapotranspiration inputs, in energy-limited sites model performance was impacted as model parameterizations were clearly sensitive to evapotranspiration inputs. The quality/reliability of PET data required to avoid negatively impacting rainfall–runoff model performance was found to vary primarily based on the water and energy availability of catchments. HIGHLIGHTS Model sensitivity to potential evapotranspiration (PET) errors was explored based on eco-regional and Budyko classifications.; Although the model was not found to be sensitive to eco-region classification, the sensitivity varied along the water- to energy-limited continuum.; This information, critically, can be used to better allocate limited resources for performing data collection and modeling and has benefits in data-scarce regions.

BACKGROUND Same-day bilateral total knee arthroplasty (BiTKA) is a controversial topic in orthopedics, prompting a consensus statement to be released by national experts. To date, no studies have evaluated the trends of this method since these recommendations. This study utilized a national database to evaluate: 1) incidence; 2) patient characteristics; 3) hospital characteristics; and 4) inpatient course for same-day BiTKAs in the United States from 2009 to 2016. METHOD The National Inpatient Sample database was queried for individuals undergoing same-day BiTKAs, yielding 245,138 patients. Patient demographics included age, sex, race, obesity status and Charlson Comorbidity Index (CCI) score. Hospital characteristics consisted of location/teaching status, geographic region, charges, and costs. Inpatient course included length of stay, discharge disposition, and complications. RESULTS Same-day BiTKA incidence decreased from 5.6% to 4.0% over the study (p

Monetary sanctions are a common tool for enforcing accountability within the criminal justice system. However, it is unclear how individuals with disabilities who have a limited capacity to work interact with the system of monetary sanctions. Drawing on courtroom observations and interviews in Washington State, we find that although the court does take disability into account when imposing economic sanctions and monitoring payment compliance, individuals with disabilities end up in a perpetual cycle of administrative hearings that can result in serious financial and health consequences for those involved. Implications for findings are discussed.