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Medication adherence and persistence patterns among patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) were analyzed. Electronic medical records of patients from the Reliant Medical Group were examined to evaluate adherence and persistence patterns. A total of 1,807 patients with LUTS/BPH were included in the study, and the number of patients at least 50 years of age was 1,748/1,807 (97%). Overall, 15.77% of patients were prescribed index prescription once, and no patients on combination alpha-blocker and 5-alpha reductase inhibitor therapies were prescribed their index prescriptions once. For all patients with LUTS/BPH, the mean number of prescriptions filled was 6.26, and the percentage of men persisting on index therapy for ≥4 years was 48%. Patients with LUTS/BPH showed a high proportion of both adherent and persistent treatment patterns, especially among patients taking combination therapy. The long follow-up time in our study provides evidence that patients are experiencing sufficient symptom relief to tolerate the challenges of remaining adherent and persistent.

The vast peat deposits in the Peruvian Amazon are crucial to the global climate. Palm swamp, the most extensive regional peatland ecosystem faces different threats, including deforestation and degradation due to felling of the dominant palm Mauritia flexuosa for fruit harvesting. While these activities convert this natural C sink into a source, the distribution of degradation and deforestation in this ecosystem and related C emissions remain unstudied. We used remote sensing data from Landsat, ALOS-PALSAR, and NASA's GEDI spaceborne LiDAR-derived products to map palm swamp degradation and deforestation within a 28 Mha area of the lowland Peruvian Amazon in 1990-2007 and 2007-2018. We combined this information with a regional peat map, C stock density data and peat emission factors to determine (1) peatland C stocks of peat-forming ecosystems (palm swamp, herbaceous swamp, pole forest), and (2) areas of palm swamp peatland degradation and deforestation and associated C emissions. In the 6.9 ± 0.1 Mha of predicted peat-forming ecosystems within the larger 28 Mha study area, 73% overlaid peat (5.1 ± 0.9 Mha) and stored 3.88 ± 0.12 Pg C. Degradation and deforestation in palm swamp peatlands totaled 535,423 ± 8,419 ha over 1990-2018, with a pronounced dominance for degradation (85%). The degradation rate increased 15% from 15,400 ha y -1 (1990-2007) to 17,650 ha y -1 (2007-2018) and the deforestation rate more than doubled from 1,900 ha y -1 to 4,200 ha y -1 . Over 1990-2018, emissions from degradation amounted to 26.3 ± 3.5 Tg C and emissions from deforestation were 12.9 ± 0.5 Tg C. The 2007-2018 emission rate from both biomass and peat loss of 1.9 Tg C yr -1 is four times the average biomass loss rate due to gross deforestation in 2010-2019 reported for the hydromorphic Peruvian Amazon. The magnitude of emissions calls for the country to account for deforestation and degradation of peatlands in national reporting., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Rationale: Cystic fibrosis (CF) newborn screening (NBS) algorithms in the United States vary by state. Differences in CF NBS algorithms could potentially affect the detection rate of CF newborns and lead to disparities in CF diagnosis amongst different racial and ethnic groups., Objectives: Generate a database of CF NBS algorithms in the United States and identify processes that may potentially lead to missed diagnoses or lead to healthcare disparities., Methods: We sent an online survey to state and regional CF and NBS leaders about the type and threshold of immunoreactive trypsinogen (IRT) cutoff used and methods used for CFTR  gene variant analysis. Follow-up by email and phone was done to ensure a response from every state, clarify responses, and resolve discordances., Results: There is wide variation in the NBS algorithms employed by different states. Approximately half the states use a floating IRT cutoff, and half use a fixed IRT cutoff. CFTR variant analysis also varies widely, with two states analyzing only for the F508del variant and four states incorporating CFTR gene sequencing. The other states use CFTR variant panels ranging from 23 to 365 CFTR variants., Conclusions: CF NBS algorithms vary widely amongst the different states in the United States, which affects the ability of CF NBS to diagnose newborn infants with CF consistently and uniformly across the country and potentially may miss more infants with CF from minority populations. Our results identify an important area for quality improvement in CF NBS., (© 2022 Wiley Periodicals LLC.)

Introduction: Concomitant plate fixation as an adjunct to intramedullary nailing (IMN) of proximal third tibia fractures is a proven technique. Benefits include its role as a minimally invasive reduction aid, allowing for minimal soft tissue disruption. Expanding its indications as adjunct fixation to IMN throughout the tibia, we aimed to study outcomes in a multi-centre initiative., Materials and Methods: From May 1999 to March 2010, a total of 1302 operatively treated tibial fractures (including plateau and pilon fractures) with complete medical records were identified for review. Of these, 376 cases were treated via IMN, of which 30 cases were treated via combined IMN and plating, meeting inclusion criteria. Primary outcome was union rates, time to union, and complication rates. Secondary outcomes included mean alignment from the immediate postoperative period to the time of final follow-up., Results: Twenty-seven out of 30 patients were available for follow-up. Twenty-five (93%) achieved bony union; the remaining two patients, sustained Type IIIA and B injuries respectively, went onto non-union secondary to deep infection and required multiple re-operations before achieving ultimate union. Mean time at final follow-up was 20 ± 10 months, 96% were ambulatory at full weight bearing status with no malunions. No significant changes in alignment in either the coronal or sagittal planes were noted at time of final follow-up., Conclusion: Combined IMN and plate fixation is a reliable tool not only in the treatment of fractures of the proximal tibia, but also for those fractures in the diaphysis and segmental fractures with proximal and/or distal metadiaphyseal extension with consistent ability to maintain high union rates and maintained alignment. However, longer-term follow-up and prospective trials will be necessary before coming to a definitive conclusion., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Computer-assisted anterior cruciate ligament (ACL) reconstruction in the United States has been used to help improve clinical outcomes and investigate tunnel placement and kinematic activity. Computer-assisted techniques were developed to improve accuracy of tunnel placement, because of concerns about the accuracy of manual tunnel placement causing revisions. Several authors have demonstrated improved tunnel location with computer assistance, although others have demonstrated little or no difference. More recently, American investigators have used computer assistance to evaluate the position and biomechanical behavior and kinematics of theoretical tunnel placement and also to assess in vitro and in vivo knee stability following ligament reconstruction. Computer assistance of anterior ligament reconstruction has demonstrated its value as a research and clinical tool in the United States.

Introduction: Certain patients with pilon fractures present with significant soft-tissue swelling or with a poor soft-tissue envelope typically not amenable to definitive fixation in the early time period. The objective of this study was to review the treatment of simple intra-articular fractures of the tibial plafond (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 43C1-C2) via intramedullary nailing (IMN) with the assessment of clinical and radiographic results and any associated complications., Materials and Methods: Retrospective clinical and radiological reviews of 31 patients sustaining AO/OTA type 43C distal tibial fractures treated with IMN were evaluated. Our main outcome measurement included achievable alignment in the immediate postoperative period and at the time of union along with complications or need for secondary procedures within the first year of follow-up., Results: Seven patients were lost to follow-up. All the remaining patients achieved bony union at a mean union time of 14.1 ± 4.9 weeks with no evidence of malunion or malrotation. All patients were at full-weight-bearing status at 1-year follow-up. Complications were notable for one delayed union, one non-union, one patient with superficial wound drainage, two with deep infection, one with symptomatic hardware and one with deep vein thrombosis., Conclusion: Simple articular fractures of the tibial plafond (AO/OTA type 43C) treated via IMN can achieve excellent alignment and union rates with proper patient selection and surgical indication. One should not hesitate to use additional bone screws or plating options to help achieve better anatomic reduction. However, larger, prospective randomised trials comparing plating versus nailing, in experienced hands, are needed to completely delineate the utility of this treatment modality., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The successful growth of suspended carbon nanotubes is normally based on purely empirical results. Here we demonstrate the ability to predict the successful suspension of nanotubes across a range of trench widths by combining experimental growth data with a theoretical description of nanotube mechanics at the growth temperature. We show that rare thermal oscillations much larger than the rms amplitude combined with the large nanotube-substrate adhesion energy together are responsible for unsuccessful nanotube suspensions. We derive an upper limit on the number of deleterious nanotube-substrate interactions that can be tolerated before successful growth becomes impossible, and we are able to accurately explain literature reports of suspended nanotube growth. The methodology developed here should enable improved growth yields of suspended nanotubes, and it provides a framework in which to analyze the role of nanotube-substrate interactions during nanotube growth by chemical vapor deposition.

A new type of nanoscale bioswitch based on the electrical detection of chemically induced cleavage of chemical bonds, which bind individual nanowires across a pair of electrodes is demonstrated. Carbon nanofibers are manipulated using dielectrophoresis to form single-nanowire bridges across microelectrode junctions, and are anchored through a biomolecular interaction. Once in place, chemically induced cleavage of a recognition site along the bonds linking the nanowire to the electrodes allows the nanowire to be easily removed by a flow of fluid; this removal can be detected in real time via changes in the AC electrical response. This form of sensing is inherently digital in nature as the removal of a single nanowire produces a sudden decrease in the current between electrodes and is essentially a chemoselective fuse. These results suggest that this sensing principle could be a general method for digital chemical and/or biological sensing using individual nanowires.

We combine the use of dielectrophoretic positioning with electrical impedance measurements to detect and discriminate between individual bacterial spores on the basis of their electrical response. Using lithographically defined microelectrodes, we use dielectrophoresis to manipulate individual bacterial spores between the electrodes. The introduction of a single spore between the microelectrodes produces a significant change in electrical response that is species-dependent. When positioned between two electrodes and an AC voltage was applied, single spores caused current increases averaging 6.8 (+/-2.4) pA for Bacillus mycoides to 1.18 (+/-0.37) pA for Bacillus licheniformis. Using a mixture of spores of two different species, we demonstrate the ability to distinguish the species of individual spores in real time. This work demonstrates the feasibility of using impedance measurements for real-time detection and discrimination between different types of spores.

Dielectrophoretic manipulation of nanoscale materials is typically performed in nonionic, highly insulating solvents. However, biomolecular recognition processes, such as DNA hybridization and protein binding, typically operate in highly conducting, aqueous saline solutions. Here, we report investigations of the manipulation and real-time detection of individual nanowires bridging microelectrode gaps in saline solutions. Measurements of the electrode impedance versus frequency show a crossover in behavior at a critical frequency that is dependent on the ionic strength. We demonstrate that by operating above this critical frequency, it is possible to use dielectrophoresis to manipulate nanowires across electrode gaps in saline solutions. By using electrical ground planes and nulling schemes to reduce the background currents, we further demonstrate the ability to electrically detect bridging and unbridging events of individual nanowires in saline solutions. The ability to both manipulate and detect bridging events with electrical signals provides a pathway toward automated assembly of nanoscale devices that incorporate biomolecular recognition elements.

Recent studies have demonstrated that carbon, in the form of diamond, can be functionalized with molecular and/or biomolecular species to yield interfaces exhibiting extremely high stability and selectivity in binding to target biomolecules in solution. However, diamond and most other crystalline forms of carbon involve high-temperature deposition or processing steps that restrict their ability to be integrated with other materials. Here, we demonstrate that photochemical functionalization of amorphous carbon films followed by covalent immobilization of DNA yields highly stable surfaces with excellent biomolecular recognition properties that can be used for real-time biological detection. Carbon films deposited onto substrates at 300 K were functionalized with organic alkenes bearing protected amine groups and characterized using X-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy. The functionalized carbon surfaces were covalently linked to DNA oligonucleotides. Measurements show very high selectivity for binding to the complementary sequence, and a high density of hybridizing DNA molecules. Samples repeatedly hybridized and denatured 25 times showed no significant degradation. The ability to use amorphous carbon films as a basis for real-time biosensing is demonstrated by coating quartz crystal microbalance (QCM) crystals with a thin carbon film and using this for covalent modification with DNA. Measurements of the resonance frequency show the ability to detect DNA hybridization in real time with a detection limit of <3% of a monolayer, with a high degree of reversibility. These results demonstrate that functionalized films of amorphous carbon can be used as a chemically stable platform for integrated biosensing using only room-temperature processing steps.

The ability to integrate carbon nanotubes, especially single-walled carbon nanotubes, seamlessly onto silicon would expand their range of applications considerably. Though direct integration using chemical vapor deposition is the simplest method, the growth of single-walled carbon nanotubes on bare silicon and on ultrathin oxides is greatly inhibited due to the formation of a noncatalytic silicide. Using X-ray photoelectron spectroscopy, we show that silicide formation occurs on ultrathin oxides due to thermally activated metal diffusion through the oxide. Silicides affect the growth of single-walled nanotubes more than multi-walled nanotubes due to the increased kinetics at the higher single-walled nanotube growth temperature. We demonstrate that nickel and iron catalysts, when deposited on clean silicon or ultrathin silicon dioxide layers, begin to form silicides at relatively low temperatures, and that by 900 degrees C, all of the catalyst has been incorporated into the silicide, rendering it inactive for subsequent single-walled nanotube growth. We further show that a 4-nm silicon dioxide layer is the minimum diffusion barrier thickness that allows for efficient single-walled nanotube growth.

Exposing single-walled carbon nanotubes to room-temperature UV-generated ozone leads to an irreversible increase in their electrical resistance. We demonstrate that the increased resistance is due to ozone oxidation on the sidewalls of the nanotubes rather than at the end caps. Raman and X-ray photoelectron spectroscopies show an increase in the defect density due to the oxidation of the nanotubes. Using ultraviolet photoelectron spectroscopy, we show that these defects represent the removal of pi-conjugated electron states near the Fermi level, leading to the observed increase in electrical resistance. Oxidation of carbon nanotubes is an important first step in many chemical functionalization processes. Because the oxidation rate can be controlled with short exposures, UV-generated ozone offers the potential for use as a low-thermal-budget processing tool.

Biological cells are complex objects that have the potential to act as templates for the subsequent construction of nanoscale structures. We demonstrate the ability to controllably and reversibly manipulate individual, live bacterial cells across micron-sized electrical gaps, and to detect bridging directly through changes in the electrical response. Our model system, Bacillus mycoides, is a rod-shaped bacterium approximately 800 nm wide and 5 microm long, similar in size and shape to many inorganic nanowires.

Contrast in the phase response of intermittent-contact atomic force microscopy (IC-AFM) reveals in-plane structural and mechanical properties of polymer monolayers. This result is unexpected, as IC-AFM has previously only been considered as a probe of out-of-plane properties. Until now, AFM measurements of nanoscale in-plane properties have employed contact mode techniques. In-plane property measurements are possible with intermittent contact AFM because there is a small but significant component of tip motion parallel to the sample surface. This in-plane component of tip displacement is virtually universal in AFM, implying that oscillating-tip techniques generally are sensitive to in-plane material properties. We present a simple Hertzian model of intermittent-contact AFM that includes such an in-plane displacement.

Phase contrast in intermittent-contact atomic force microscopy (AFM) reveals in-plane structural and mechanical properties of polymer monolayers. This is surprising, because measurements of nanoscale in-plane properties typically require contact mode microscopies. Our measurements are possible because the tip oscillates not just perpendicular but also parallel to the sample surface along the long axis of the cantilever. This lateral tip displacement is virtually universal in AFM, implying that any oscillating-tip AFM technique is sensitive to in-plane material properties.

The purpose of this study was to characterize the nutritional status of infants diagnosed with cystic fibrosis (CF) through neonatal screening and to determine if they would achieve normal nutrition when managed with early intervention. In addition, nutrient intake was assessed to determine energy and macronutrient-consumption patterns. Evaluation of growth revealed that normal patterns could be achieved with mean energy intake values at ages 6 and 12 mo of 481 and 426 kJ/kg body wt (115 and 102 kcal/kg body wt), respectively. Biochemical assessment demonstrated low alpha-tocopherol and linoleic acid values at diagnosis in the majority of infants whereas one-third had abnormal indices of protein nutriture. Essential fatty acid deficiency was also demonstrated at diagnosis by abnormal triene-tetraene ratio values in 27% of screened infants. With predigested formula and dietary supplementation, there was improvement in all indices of nutritional status and only a low percentage of patients showed mild biochemical abnormalities at age 12 mo.

The effects of various levels and types of dietary chloride salts on blood pressure were examined in three studies. Weanling Sprague-Dawley rats were fed semipurified diets that contained moderate (1.9 mg Cl/g diet) and supplemental (15.6 mg Cl/g diet) chloride as NaCl, KCl, lysine monohydrochloride with or without CaCO3, or MgCl2 for 56 or 119 d. Rats fed excess chloride excreted more than 84% of the chloride in urine, excreted increased urine volumes (from 3 to 7 wk), tended to consume more fluids (especially if NaCl was fed), had significantly increased blood pressure (7 and 13 wk), had hypertrophied kidneys (8 and 17 wk) and had altered levels of sodium and potassium in their kidneys (17 wk), but experienced no changes in the size of fluid compartments, such as plasma volume or bromine space. Altogether, 56% of the variance in blood pressure measurements at wk 7 could be predicted on the basis of urinary chloride excretion during wk 7 and kidney weight as a percentage of body weight and kidney sodium concentration, but only 30% of the variance in blood pressure measurements at wk 16 could be predicted on the basis of urinary chloride excretion during wk 16 and kidney sodium concentrations.

Presymptomatic infants diagnosed through neonatal screening for cystic fibrosis can have biochemical evidence of malnutrition. With aggressive dietary management and treatment with pancreatic enzymes, normal biochemical indices of nutrition can be achieved at 12 months of life in most cases. Males with cystic fibrosis appear to be more at risk than females for abnormal growth and biochemical indices of nutrition in the first year of life. This may be related to the observed decrease in fat intake when compared to females. Males, especially, should be carefully observed for development of nutritional abnormalities based on this data. Careful attention should be paid to vitamin E and essential fatty acid status in all CF infants. The numbers in this study are small and the long-term consequences of early nutritional intervention await the conclusion of the randomized, controlled study on-going in Wisconsin.

The effect of supplementing a basal diet containing 697 mg calcium daily (17.4 mmol/d) with an additional 900 mg Ca daily from milk, Ca chloride, or a Ca carbonate preparation was examined in eight adult males during a 56-d metabolic balance study. The ingestion of the milk or Ca supplements had no overall effect on Ca retention by these subjects because the milk and supplements depressed apparent absorption of Ca in the gut and fractional tubular reabsorption of Ca in the kidneys. Supplementation of the diet with CaCl and to a lesser extent with milk significantly increased renal acid excretion whereas supplementation with CaCO3 depressed renal acid excretion. The three Ca supplements significantly altered magnesium and phosphorus absorption and urinary excretion in different manners but had no overall effect on retention of P or Mg. The responses of our subjects to these treatments may be different than those of subjects who are chronically in negative balance in regard to Ca.

Five lactating Holstein cows averaging 13 wk postpartum were used in a Latin square design to examine the effect of daily abomasal infusion of choline (22 g), myo-inositol (37 g), soy oil (325 ml), or crude soy lecithin (900 ml) on lactation performance. Dry matter intake was reduced by infusion of soy lecithin as compared with infusion of water (18.1 and 21.1 kg/d, respectively). Plasma beta-hydroxybutyrate concentration was increased when cows received the myo-inositol or soy lecithin infusion, and plasma glucose was lower when cows received the choline or soy lecithin treatment. Infusion of soy lecithin caused approximately a twofold increase in plasma triglyceride-rich lipoprotein concentration. Milk fat percentage and milk fat yield were greater during soy lecithin infusion (3.54%, 1.11 kg/d) than during water (3.09%, .98 kg/d) or soy oil (3.06%, .98 kg/d) infusion. This resulted in greater 3.5% FCM yield during soy lecithin infusion (31.6 kg/d) than during water (29.5 kg/d) or soy oil (29.6 kg/d) infusion. Infusion of phospholipid with triglyceride allowed more fatty acid to be infused without causing diarrhea. Infusion of triglyceride in the presence of phospholipid increased milk fat synthesis whereas infusion of triglyceride alone did not.