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Background: The Extracorporeal Life Support Organization Supplies Platform (https://Supplies.ELSO.org) was created out of Extracorporeal Membrane Oxygenation (ECMO) disposable product shortage prior to and during the Coronavirus Disease 2019 (COVID-19) pandemic. This novel Platform supports Centers in obtaining disposables from other Centers when alternative avenues are exhausted. Methods: Driven by the opportunity for increased patient care by using the product availability of the 962 ELSO centers worldwide was the motivation to form an efficient online supply sharing Platform. The pandemic created by COVID-19 became a catalyst to further recognize the magnitude of the supply disruption on a global scale, impacting allocations and guidelines for institutions, practice, and patient care. Conclusions: Records kept on the Platform website are helpful to the industry by providing insights into where difficulties exist in the supply chain for needed equipment. Yet, the common thread is awareness, of how critical situations can stretch resources and challenge our resolve for the best patient care. ELSO is proud to support member centers in these situations, by providing a means of attaining needed ECMO life support products to cover supply shortages.

Focal lesions causing specific neurological or psychiatric symptoms can occur in multiple different brain locations, complicating symptom localization. Here, we review lesion network mapping, a technique used to aid localization by mapping lesion-induced symptoms to brain circuits rather than individual brain regions. We highlight recent examples of how this technique is being used to investigate clinical entities and identify therapeutic targets.To date, lesion network mapping has successfully been applied to more than 40 different symptoms or symptom complexes. In each case, lesion locations were combined with an atlas of human brain connections (the human connectome) to map heterogeneous lesion locations causing the same symptom to a common brain circuit. This approach has lent insight into symptoms that have been difficult to localize using other techniques, such as hallucinations, tics, blindsight, and pathological laughter and crying. Further, lesion network mapping has recently been applied to lesions that improve symptoms, such as tremor and addiction, which may translate into new therapeutic targets.Lesion network mapping can be used to map lesion-induced symptoms to brain circuits rather than single brain regions. Recent findings have provided insight into long-standing clinical mysteries and identified testable treatment targets for circuit-based and symptom-based neuromodulation.

Tuberous sclerosis complex (TSC) is associated with focal brain "tubers" and a high incidence of autism spectrum disorder (ASD). The location of brain tubers associated with autism may provide insight into the neuroanatomical substrate of ASD symptoms.We delineated tuber locations for 115 TSC participants with ASD (n = 31) and without ASD (n = 84) from the Tuberous Sclerosis Complex Autism Center of Excellence Research Network. We tested for associations between ASD diagnosis and tuber burden within the whole brain, specific lobes, and at 8 regions of interest derived from the ASD neuroimaging literature, including the anterior cingulate, orbitofrontal and posterior parietal cortices, inferior frontal and fusiform gyri, superior temporal sulcus, amygdala, and supplemental motor area. Next, we performed an unbiased data-driven voxelwise lesion symptom mapping (VLSM) analysis. Finally, we calculated the risk of ASD associated with positive findings from the above analyses.There were no significant ASD-related differences in tuber burden across the whole brain, within specific lobes, or within a priori regions derived from the ASD literature. However, using VLSM analysis, we found that tubers involving the right fusiform face area (FFA) were associated with a 3.7-fold increased risk of developing ASD.Although TSC is a rare cause of ASD, there is a strong association between tuber involvement of the right FFA and ASD diagnosis. This highlights a potentially causative mechanism for developing autism in TSC that may guide research into ASD symptoms more generally. ANN NEUROL 2022.

Migratory connectivity is a metric of the co-occurrence of migratory animals originating from different breeding sites, and like their spatio-temporal distributions, can vary substantially during the annual cycle. Together, both these properties affect the optimal times and sites of population censusing.We tracked taiga bean geese (Anser fabalis fabalis) during 2014–2021 to study their migratory connectivity and non-breeding movements, and determine optimal periods to assess the size of their main flyway population. We also compared available census data with tracking data, to examine how well two existing censuses covered the population.Daily Mantel’s correlation between breeding and non-breeding sites lay between 0 and 0.5 during most of the non-breeding season, implying birds from different breeding areas were not strongly separated other times in the annual cycle. However, the connectivity was higher among birds from the westernmost breeding areas compared to the birds breeding elsewhere. Daily Minimum Convex Polygons showed tracked birds were highly aggregated at census times, confirming their utility. The number of tracked birds absent at count sites during the censuses however exceeded numbers double-counted at several sites, indicating that censuses might have underestimated the true population size.Our results show that connectivity can vary in different times during the non-breeding period, and should be studied throughout the annual cycle. Our results also confirm previous studies, which have found that estimates using marked individuals usually produce higher population size estimates than total counts. This should be considered when using total counts to assess population sizes in the future.

We present multiwavelength observations of supernova (SN) 2017hcc with the Chandra X-ray telescope and the X-ray telescope onboard Swift (Swift-XRT) in X-ray bands, with the Spitzer and the TripleSpec spectrometer in near-infrared (IR) and mid-IR bands and with the Karl G. Jansky Very Large Array (VLA) for radio bands. The X-ray observations cover a period of 29 to 1310 days, with the first X-ray detection on day 727 with the Chandra. The SN was subsequently detected in the VLA radio bands from day 1000 onwards. While the radio data are sparse, synchrotron-self absorption is clearly ruled out as the radio absorption mechanism. The near- and the mid-IR observations showed that late time IR emission dominates the spectral energy distribution. The early properties of \snhcc\ are consistent with shock breakout into a dense mass-loss region, with $\dot M \sim 0.1 M_\odot \rm yr^{-1}$ for a decade. At few 100 days, the mass-loss rate declined to $\sim 0.02 M_\odot \rm yr^{-1}$, as determined from the dominant IR luminosity. In addition, radio data also allowed us to calculate a mass-loss rate at around day 1000, which is two orders of magnitude smaller than the mass-loss rate estimates around the bolometric peak. These values indicate that the SN progenitor underwent an enhanced mass-loss event a decade before the explosion. The high ratio of IR to X-ray luminosity is not expected in simple models and is possible evidence for an asymmetric circumstellar region., Comment: 11 pages, 10 figures, 3 tables, Accepted for publication in MNRAS

During the commissioning of {\em JWST}, the Medium-Resolution Spectrometer (MRS) on the Mid-Infrared Instrument (MIRI) observed the planetary nebula SMP LMC 058 in the Large Magellanic Cloud. The MRS was designed to provide medium resolution (R = $\lambda$/$\Delta\lambda$) 3D spectroscopy in the whole MIRI range. SMP LMC 058 is the only source observed in {\em JWST} commissioning that is both spatially and spectrally unresolved by the MRS and is a good test of {\em JWST's} capabilities. The new MRS spectra reveal a wealth of emission lines not previously detected in this planetary nebula. From these lines, the spectral resolving power ($\lambda$/$\Delta\lambda$) of the MRS is confirmed to be in the range R $=$ 4000 to 1500, depending on the MRS spectral sub-band. In addition, the spectra confirm that the carbon-rich dust emission is from SiC grains and that there is little to no time evolution of the SiC dust and emission line strengths over a 17-year epoch. These commissioning data reveal the great potential of the MIRI MRS for the study of circumstellar and interstellar material., Comment: 12 pages, 7 figures, 3 tables, accepted MNRAS

Background: Syringe services programs (SSPs) are critical healthcare access points for people with opioid use disorder (OUD) who face treatment utilization barriers. Co-locating care for common psychiatric comorbidities, like posttraumatic stress disorder (PTSD), at SSPs may reduce harms and enhance the health of individuals with OUD. To guide the development of onsite psychiatric care at SSPs, we examined the prevalence of PTSD, substance use patterns and treatment experiences associated with a probable PTSD diagnosis, and attitudes regarding onsite PTSD care in a convenience sample of registered SSP clients in New York City. Methods: Participants were administered the PTSD Checklist for the DSM-5 (PCL-5) and asked about current drug use, OUD and PTSD treatment histories, and desire for future SSP services. Probable PTSD diagnosis was defined as a PCL-5 score > 31. Results: Of the 139 eligible registered SSP clients surveyed, 138 endorsed at least one potentially traumatic event and were included in the present analysis. The sample was primarily male at birth (n = 108, 78.3%), of Hispanic or Latinx ethnicity (N=76, 55.1%), and middle-aged (M=45.0 years, s.d. = 10.6). The mean PCL-5 score was 35.2 (s.d. = 21.0) and 79 participants (57.2%) had a probable PTSD diagnosis. We documented frequent SSP utilization, significant unmet PTSD treatment need, and high interest in onsite PTSD treatment. Conclusions: Study findings point to the ubiquity of PTSD in people with OUD who visit SSPs, large gaps in PTSD care, and the potential for harm reduction settings like SSPs to reach underserved people with co-occurring OUD and PTSD.

The purpose of this study was to evaluate the effectiveness of telemedicine appointments in a tertiary orthopedic hip clinic during the COVID-19 pandemic, as a substitute for traditional in-person visits. One hundred sixty-three patients had a telemedicine visit from March to September 2020. Patients were divided into two cohorts. The presurgical group included all patients who had not undergone any prior surgical hip procedures. The pre-surgical group was further subdivided into two groups based on the purpose of the visit: conservative treatment and imaging review. Patients who were indicated for surgical treatment from these two groups were identified to assess their compliance with the surgical indication. The effectiveness was measured by assessing whether patients required an in-person visit before the scheduled follow-up after the telemedicine visit for further medical assessment. Fifty (30.7%) men and 113 (69.3%) women had a telemedicine visit during the 6-month period. The mean age was 43.68 (±16.95) years. There were 92 (56.4%) patients in the presurgical group, of whom 41% followed up after indication for conservative treatment and 59% visited to review imaging. From these groups, 27% were indicated for surgical treatment. The postsurgical group contained 71 (43.6%) patients, divided into three groups based on their surgery date: 0 to 3 months (27%), 4 to 12 months (59%), and more than 12 months (14%). All patients were compliant with the scheduled follow-up after their telemedicine visit. This study showed that telemedicine can be an effective tool for patient–physician communication, obviating the need for subsequent follow-up beyond regularly scheduled visits. [ Orthopedics . 2023;46(3):e173–e178.]

Historically, pathological brain lesions provided the foundation for localization of symptoms and therapeutic lesions were used as a treatment for brain diseases. New medications, functional neuroimaging and deep brain stimulation have led to a decline in lesions in the past few decades. However, recent advances have improved our ability to localize lesion-induced symptoms, including localization to brain circuits rather than individual brain regions. Improved localization can lead to more precise treatment targets, which may mitigate traditional advantages of deep brain stimulation over lesions such as reversibility and tunability. New tools for creating therapeutic brain lesions such as high intensity focused ultrasound allow for lesions to be placed without a skin incision and are already in clinical use for tremor. Although there are limitations, and caution is warranted, improvements in lesion-based localization are refining our therapeutic targets and improved technology is providing new ways to create therapeutic lesions, which together may facilitate the return of the lesion.

Activation of the mammalian target of rapamycin (mTOR) pathway is an important and early event in tobacco carcinogen–induced lung tumorigenesis, and therapies that target mTOR could be effective in the prevention or treatment of lung cancer. The biguanide metformin, which is widely prescribed for the treatment of type II diabetes, might be a good candidate for lung cancer chemoprevention because it activates AMP-activated protein kinase (AMPK), which can inhibit the mTOR pathway. To test this, A/J mice were treated with oral metformin after exposure to the tobacco carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Metformin reduced lung tumor burden by up to 53% at steady-state plasma concentrations that are achievable in humans. mTOR was inhibited in lung tumors but only modestly. To test whether intraperitoneal administration of metformin might improve mTOR inhibition, we injected mice and assessed biomarkers in liver and lung tissues. Plasma levels of metformin were significantly higher after injection than oral administration. In liver tissue, metformin activated AMPK and inhibited mTOR. In lung tissue, metformin did not activate AMPK but inhibited phosphorylation of insulin-like growth factor-I receptor/insulin receptor (IGF-1R/IR), Akt, extracellular signal–regulated kinase (ERK), and mTOR. This suggested that metformin indirectly inhibited mTOR in lung tissue by decreasing activation of insulin-like growth factor-I receptor/insulin receptor and Akt upstream of mTOR. Based on these data, we repeated the NNK–induced lung tumorigenesis study using intraperitoneal administration of metformin. Metformin decreased tumor burden by 72%, which correlated with decreased cellular proliferation and marked inhibition of mTOR in tumors. These studies show that metformin prevents tobacco carcinogen–induced lung tumorigenesis and support clinical testing of metformin as a chemopreventive agent. Cancer Prev Res; 3(9); 1066–76. ©2010 AACR.

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We present new HST imaging photometry for the site of the Type IIn supernova (SN) 2009ip taken almost a decade after explosion. The optical source has continued to fade steadily since the SN-like event in 2012. In the F606W filter, which was also used to detect its luminous blue variable (LBV) progenitor 13~yr before the SN, the source at the position of SN2009ip is now 1.2mag fainter than that quiescent progenitor. It is 6-7mag fainter than the pre-SN outbursts in 2009--2011. This definitively rules out a prediction that the source would return to its previous state after surviving the 2012 event. Instead, the late-time fading matches expectations for a terminal explosion. The source fades at a similar rate in all visual-wavelength filters without significant color changes, therefore also ruling out the hypothesis of a luminous dust-obscured survivor or transition to a hotter post-LBV survivor. The late-time continuum with steady color and strong H$\alpha$ emission detected in a narrow F657N filter are, however, entirely expected for ongoing shock interaction with circumstellar material in a decade-old core-collapse SN. Interestingly, the ultraviolet flux has stayed nearly constant since 2015, supporting previous conjectures that the F275W light traces main-sequence OB stars in an underlying young star cluster. We expect that the visual-wavelength continuum will eventually level off, tracing this cluster light. Without any additional outbursts, it seems prudent to consider the 2012 event as a terminal SN explosion, and we discuss plausible scenarios., Comment: 11 pages, accepted by MNRAS June 10

Chronic tinnitus is a clinical symptom that affects 10% to 15% of the adult population. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment, but significant heterogeneity exists in the treatment outcomes and stimulation parameters. In this study, we perform a qualitative systematic review to determine if there is an optimal rTMS site to treat tinnitus.A literature search was performed by searching the MEDLINE, Embase, Web of Science, and Cochrane databases.Sham-controlled studies in adults were included that contained10 patients with tinnitus for3 months and utilized 10 to 20 electroencephalography coordinates. Study outcomes were considered positive if the treatment arm reported a significant reduction in the primary tinnitus score relative to sham.There were 1211 studies screened. Nineteen studies met the inclusion criteria, and 8 unique stimulation sites were reported. Studies had 53.7 ± 46.0 patients (mean ± SD). The mean duration of follow-up was 10.3 ± 9.6 weeks. Positive outcomes regarding tinnitus suppression were reported in 5 of 5 (100%) studies stimulating the temporoparietal junction midway between T3 and P3 or between T4 and P4. Tinnitus suppression at all other sites was less frequent with a combined success rate of only 8 of 14 (57.1%).Significant heterogeneity exists in the literature in regard to the optimal transcranial magnetic stimulation target. These preliminary findings suggest that the temporoparietal junction midway between T3 and P3 or T4 and P4 is a promising nonauditory rTMS target in the setting of chronic tinnitus. Future research should elucidate the effectiveness of this site for tinnitus suppression.

To determine the percent maximal outcome improvement willingness thresholds (MOWTs) for the Nonarthritic Hip Score (NAHS) and the visual analog scale (VAS) for pain that were associated with a patient's willingness to undergo surgery, in retrospect, given the known outcome of their primary hip arthroscopy with concomitant endoscopy for gluteus medius (GM) tear repair.An anchor question was provided to patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome with concomitant endoscopic GM tear repair between April 2008 to April 2020. Patients were included if they answered the anchor question and had baseline and postoperative minimum 1-year follow-up scores for the NAHS and VAS. Patients were excluded if they had a previous ipsilateral hip surgery, Tönnis grade1, hip dysplasia, previous hip conditions, or a preoperative score that was already at the maximum value for the NAHS and VAS scores. Receiver operating characteristic (ROC) analysis was used to determine the MOWT. Significance was indicated by aA total of 107 patients (107 hips) were included, with 101 (94.4%) females and 6 (5.6%) males. The average age and body mass index was 56.20 ± 9.88 years and 28.80 ± 4.92 kg/mThe MOWTs that were predictive of willingness to undergo surgery again following primary hip arthroscopy with concomitant endoscopy for GM tear repair were 54.7% and 62.6% for the NAHS, and VAS, respectively.Outcome assessment has been a point of increasing emphasis in hip preservation surgery. Having a tool to measure whether patients would go through the process of surgery again knowing their current outcome status is important to understanding outcomes after surgery.

Drug addiction is a public health crisis for which new treatments are urgently needed. In rare cases, regional brain damage can lead to addiction remission. These cases may be used to identify therapeutic targets for neuromodulation. We analyzed two cohorts of patients addicted to smoking at the time of focal brain damage (cohort 1 n = 67; cohort 2 n = 62). Lesion locations were mapped to a brain atlas and the brain network functionally connected to each lesion location was computed using human connectome data (n = 1,000). Associations with addiction remission were identified. Generalizability was assessed using an independent cohort of patients with focal brain damage and alcohol addiction risk scores (n = 186). Specificity was assessed through comparison to 37 other neuropsychological variables. Lesions disrupting smoking addiction occurred in many different brain locations but were characterized by a specific pattern of brain connectivity. This pattern involved positive connectivity to the dorsal cingulate, lateral prefrontal cortex, and insula and negative connectivity to the medial prefrontal and temporal cortex. This circuit was reproducible across independent lesion cohorts, associated with reduced alcohol addiction risk, and specific to addiction metrics. Hubs that best matched the connectivity profile for addiction remission were the paracingulate gyrus, left frontal operculum, and medial fronto-polar cortex. We conclude that brain lesions disrupting addiction map to a specific human brain circuit and that hubs in this circuit provide testable targets for therapeutic neuromodulation.

The prevalence of coral bleaching due to thermal stress has been increasing on coral reefs worldwide. While many studies have documented how corals respond to warming, fewer have focused on benthic community responses over longer time periods or on the response of non-coral taxa (e.g., crustose coralline algae, macroalgae, or turf). Here, we quantify spatial and temporal changes in benthic community composition over a decade using image analysis of permanent photoquadrats on Palmyra Atoll in the central Pacific Ocean. Eighty permanent plots were photographed annually between 2009 and 2018 on both the wave-exposed fore reef (FR, 10 m depth, n = 4 sites) and the wave-sheltered reef terrace (RT, 5 m depth, n = 4 sites) habitats. The El Niño events of 2009–2010 and 2015–2016 resulted in acute thermal stress and coral bleaching was observed at both reef habitats during these events. Across 10 yr and two bleaching events, the benthic community structure on Palmyra shows evidence of long-term stability. Communities on the RT exhibited minimal change in percent cover of the dominant functional groups, while the FR had greater variability and minor declines in hard coral cover. There was also spatial variation in the trajectory of each site through time. Coral cover decreased at some sites 1 yr following both bleaching events and was replaced by different algal groups depending on the site, yet returned to pre-bleaching levels within 2 yr. Overall, our data reveal the resilience of calcifier-dominated coral reef communities on Palmyra Atoll that have persisted over the last decade despite two bleaching events, demonstrating the capacity for these reefs to recover from and/or withstand disturbances in the absence of local stressors.

Vertigo is a common neurological complaint, which can result in significant morbidity and decreased quality of life. While pathology to peripheral and subtentorial brain structures is a well-established cause of vertigo, cortical lesions have also been linked to vertigo and may lend insight into relevant neuroanatomy. Here, we investigate the supratentorial lesion locations associated with vertigo and test whether they map to a common brain network. We performed a systematic literature search and identified 23 cases of supratentorial brain lesions associated with vertigo. We mapped the lesion locations to a standard brain template and computed the network of brain regions functionally connected to each lesion location, using a ‘wiring diagram’ of the human brain termed the human connectome (n = 1000). Sensitivity was assessed by identifying the most common connection to lesion locations associated with vertigo, and specificity was assessed through comparison with control lesions associated with symptoms other than vertigo (n = 68). We found that functional connectivity between lesion locations and the bilateral ventral posterior insula was both sensitive (22/23 lesions) and specific (voxel-wise family-wise error-corrected P < 0.05) for lesion-induced vertigo. We computed connectivity with this hub region to define a lesion-based vertigo network, which included regions in the bilateral insula, somatosensory cortex, higher-level visual areas, cingulate sulcus, thalamus and multiple cerebellar regions in the territory of the posterior inferior cerebellar artery. Next, we used stereo-electroencephalography (80 stimulation sites across 17 patients) to test whether stimulation sites associated with vertigo mapped to this same network. We found that 36/42 (86%) of stimulation sites eliciting vertigo fell within the lesion-based vertigo network in contrast to 16/39 (41%) of stimulation sites that did not elicit vertigo. Connectivity between stimulation sites and our lesion-based hub in the ventral posterior insula was also significantly associated with vertigo (P < 0.0001). We conclude that cortical lesions and direct electrical stimulation sites associated with vertigo map to a common brain network, offering insights into the causal neuroanatomical substrate of vertigo.

Chemical modification of cytidine in non-coding RNAs plays a key role in regulating translation and disease. However, the distribution and dynamics of many of these modifications remains unknown due to a lack of sensitive site-specific sequencing technologies. Here we report a protonation-dependent sequencing reaction for detection of 5-formylcytidine (5fC) and 5-carboxycytidine (5caC) in RNA. First, we evaluate how protonation combined with electron-withdrawing substituents alters the molecular orbital energies and reduction of modified cytidine nucleosides, highlighting 5fC and 5caC as reactive species. Next, we apply this reaction to detect these modifications in synthetic oligonucleotides as well as endogenous human tRNA. Finally, we demonstrate the utility of our method to characterize a patient-derived model of 5fC-deficiency, where it enables facile monitoring of both pathogenic loss and exogenous rescue of NSUN3-dependent 5fC within the wobble base of human mitochondrial tRNAMet. These studies showcase the ability of protonation to enhance the reactivity and sensitive detection of 5fC in RNA, and provide a molecular foundation for applying optimized sequencing reactions to better understand the role of oxidized RNA cytidine nucleobases in disease.

To test for the degree of species-specific variation in clutch initiation date in relation to spring thaw, we recorded first egg dates in 1433 nests of seven large bodied long-distance migratory waterbird species breeding on Ayopechan Island in the Chaun Delta, Chukotka, in the Russian Arctic during 2002–2020. Pacific Loon Gavia pacifica, Sandhill Crane Grus canadensis and Glaucous Gull Larus hyperboreus all adjusted timing of clutch initiation completely to annual variation in first frost-free dates. First egg dates of Spectacled Eider Somateria fischeri also significantly advanced in warmer springs, but the rate of change was significantly less than unity, implying a reduced capacity to accommodate change in vernal thaw that may not be able to keep up with greater change in the future. Long-tailed Duck Clangula hyemalis and Vega Gull Larus vegae showed a tendency for earlier first egg dates in years with earlier first frost-free date, but for both species, the relationship failed to reach statistical significance. Bewick’s Swan Cygnus columbianus showed almost no change in mean first egg date across the observed variation in first frost-free dates. Based on these data, we suggest that while all seven species showed signs of plasticity in their timing of onset of breeding, Pacific Loon, Sandhill Crane and Glaucous Gull showed greater adaptability to adjust the timing of their breeding season to recent variation in spring thaw than the other four species studied here over this period.

BACKGROUND: Over 80% of the global population consider themselves religious, with even more identifying as spiritual, but the neural substrates of spirituality and religiosity remain unresolved.METHODS: In two independent brain lesion datasets (N1 = 88; N2 = 105), we applied lesion network mapping to test whether lesion locations associated with spiritual and religious belief map to a specific human brain circuit.RESULTS: We found that brain lesions associated with self-reported spirituality map to a brain circuit centered on the periaqueductal gray. Intersection of lesion locations with this same circuit aligned with self-reported religiosity in an independent dataset and previous reports of lesions associated with hyper-religiosity. Lesion locations causing delusions and alien limb syndrome also intersected this circuit.CONCLUSIONS: These findings suggest that spirituality and religiosity map to a common brain circuit centered on the periaqueductal gray, a brainstem region previously implicated in fear conditioning, pain modulation, and altruistic behavior.

Background Syringe services programs (SSPs) complement substance use disorder treatment in providing services that improve the health of people who use drugs (PWUD). Buprenorphine treatment is an effective underutilized opioid use disorder treatment. Regulations allow buprenorphine prescribing from office-based settings, potentially including SSPs although few studies have examined this approach. Our objective was to assess the attitudes among PWUD toward the potential introduction of buprenorphine treatment in an SSP. Methods In this qualitative study, we recruited 34 participants who were enrolled at a New York City-based SSP to participate in one of seven focus group sessions. The focus group facilitators prompted participants to share their thoughts in five domains: attitudes toward (1) medical clinics; (2) harm reduction in general; (3) SSP-based buprenorphine treatment; (4) potential challenges of SSP-based treatment; and (5) logistical considerations of an SSP-based buprenorphine treatment program. Four researchers analyzed focus group transcripts using thematic analysis. Results Of the 34 participants, most were white (68%), over the age of 40 years old (56%), and had previously tried buprenorphine (89%). Common themes were: 1) The SSP is a supportive community for people who use drugs; 2) Participants felt less stigmatized at the SSP than in general medical settings; 3) Offering buprenorphine treatment could change the SSP's culture; and 4) SSP participants receiving buprenorphine may be tempted to divert their medication. Participants offered suggestions for a slow intentional introduction of buprenorphine treatment at the SSP including structured appointments, training medical providers in harm reduction, and program eligibility criteria. Conclusion Overall, participants expressed enthusiasm for onsite buprenorphine treatment at SSPs. Research on SSP-based buprenorphine treatment should investigate standard buprenorphine treatment outcomes but also any effects on the program itself and medication diversion. Implementation should consider cultural and environmental aspects of the SSP and consult program staff and participants.

The need to predict acoustic propagation through marine sediments that contain gas bubbles has become increasingly important for civil engineering and climate studies. There are relatively few in situ acoustic wave propagation studies of muddy intertidal sediments, in which bubbles of biogenic gas (generally methane, a potent greenhouse gas) are commonly found. We used a single experimental rig to conduct two in situ intertidal acoustical experiments to improve understanding of acoustic remote sensing of gassy sediments, eventually including gas bubble size distributions. In the first experiment, we measured sediment sound speed and attenuation between four aligned hydrophones for a quasi-plane wave propagating along the array. The second experiment involved a focused insonified sediment volume created by two transducers emitting coincident sound beams at different frequencies that generated bubble-mediated acoustic signals at combination frequencies. The results from sediment core analyses, and comparison of in situ acoustic velocity and attenuation values with those of water-saturated sediments, together provide ample evidence for the presence of in situ gas bubbles in the insonified volumes of sediments. These datasets are suitable for linear and non-linear inversion studies that estimate in situ greenhouse gas bubble populations, needed for future acoustical remote sensing applications.

Introduction Domestic violence (DV) is a major health issue on both a national and global scale. In Richmond County, Georgia, there are 18.1 calls per 1000 women for DV, exceeding the national average of 5.9 and Georgia average of 15.3 calls per 1000 women. The goal of the study is to map epidemiologic and spatial trends in communities of DV survivors thereby assessing the feasibility of a prospective intervention initiative for high-risk areas. Methods In partnership with “SafeHomes”, a local women’s shelter, a retrospective review of physical addresses was compiled from first-time residential clients 18 and older from January 1, 2019 to December 31, 2019. Hot zones were overlaid with Census tracts to assess sociodemographic correlates including race, ethnicity, age, poverty, education, and employment status. Results From all records (n = 85), 5 hot zones were identified. Analysis of census tract data revealed minority predominance in all hot zones, in addition to an unemployment rate above the state average (23%, 12%, 8%, 5%, and 19%, respectively, vs 3.4%). Conclusion DV affects both the inner city and suburban areas of Richmond County. Hot zone frequency was disproportionately increased in the urban center where community demographics showed minority predominance, especially of African-Americans. These hot zones also have more individuals living below the federal poverty line and experience unemployment rates greater than the state and national average of 3.4 and 3.5, respectively. This study demonstrated that mapping domestic violence epidemiologic and spatial trends is possible, allowing for targeted support and intervention to reduce the rate of domestic violence.

Ocean warming is killing corals, but heat-tolerant populations exist; if protected, they could replenish affected reefs naturally or through restoration. Palau’s Rock Islands experience consistently higher temperatures and extreme heatwaves, yet their diverse coral communities bleach less than those on Palau’s cooler outer reefs. Here, we combined genetic analyses, bleaching histories and growth rates ofPoritescf.lobatacolonies to identify thermally tolerant genotypes, map their distribution, and investigate potential growth trade-offs. We identified four genetic lineages ofP. cf.lobata. On Palau’s outer reefs, a thermally sensitive lineage dominates. The Rock Islands harbor two lineages with enhanced thermal tolerance; one of which shows no consistent growth trade-off and also occurs on several outer reefs. This suggests that the Rock Islands provide naturally tolerant larvae to neighboring areas. Finding and protecting such sources of thermally-tolerant corals is key to reef survival under 21stcentury climate change.

Corals in the northern Red Sea exhibit high thermal tolerance despite the increasing heat stress. It is assumed that corals throughout the Red Sea have similar bleaching thresholds (32°C or higher), and hence greater bleaching tolerance of corals in the northern Red Sea region is likely due to lower ambient water temperatures (25–28°C) that remain well below the corals’ physiological maxima. Whether bleaching patterns across the Red Sea are independent of the local maximum monthly mean of seawater temperature and aligned with an assumed 32°C threshold has yet to be determined. Here, we used remotely sensed surface sea temperature data spanning 1982–2020 to model spatial distributions of Degree Heat Weeks across the Red Sea in relation to assumed coral thermal threshold values of 30, 31, and 32°C. We also used the Coupled Model Intercomparison Project Phase 5 model outputs to predict warming trends in the Red Sea under different greenhouse gas representative concentration pathways (RCPs). We show that applying 32°C thresholds dramatically reduces effective Degree Heat Weeks in the north, but not in central or southern Red Sea regions, a finding that is consistent with historical bleaching observations (1998–2020) throughout the Red Sea. Further, model predictions under the most extreme RCP8.5 scenario exhibited ~3°C warming by the end of the 21st century throughout the Red Sea with less pronounced warming for the northern Red Sea (2–2.5°C) compared to the central and southern regions (2.7–3.1°C).This warming rate will remain below the assumed thermal threshold for the northern Red Sea which should help this region to serve as refugia (i.e., maintaining favorable temperatures) for corals to persist for decades ahead. Together, our results support the notion that corals have similar thresholds throughout the Red Sea; hence, coral bleaching thresholds are independent of the local maximum monthly mean. Consequently, where regional warming projections suggest the northern Red Sea will not reach assumed bleaching thresholds (32°C) before the end of the 21st century, coral reefs in the northern region may be among the last standing against climate change.

Background Hands-Free Georgia Law (HB673) was designed to prevent motor vehicle collisions (MVCs) by banning drivers from using their hands for non-driving-related activities, including cell phone use. We investigate HB673 effect on trauma activations secondary to MVCs in Georgia. Methods The Georgia Trauma Registry (GTR) was queried for MVCs from 2017 to 2019, representing the 18 months prior and following implementation of HB673. The number of MVCs for each period and severity of MVC designated by the average injury severity score (ISS) for each trauma activation were collected. Results Prior to implementation, a total of 43 080 traumas were recorded in GTR, 11 111 (25.8%) were attributed to an MVC. Following implementation, 12 130 (23.6%) occurred secondary to MVCs. Statewide MVC-related traumas per 1000 residents increased from 1.07 to 1.14 with increased mortality rate and unchanged median ISS per MVC. Conclusions The Hands-Free Georgia Law seems to have not had a major reduction in mortality in its early implementation.

Injectable opioid agonist treatment (iOAT) is a novel approach to treating opioid use disorder (OUD) that is typically reserved for treatment-experienced persons who inject drugs (PWID) with long-standing OUD. This study examined PWID's past OUD treatment histories and their attitudes toward iOAT with hydromorphone.This cross-sectional study recruited syringe services program participants with OUD in New York City. Participants self-reported past OUD care episodes (detoxification; outpatient, inpatient, or medication treatment; or mutual aid groups) and current interest in iOAT with hydromorphone (assessed on a 4-point scale with 3 or 4 considered "interested"). Participants with 2 or more treatment episodes in the past 5 years were considered treatment-experienced. We examined whether the number of past care episodes was associated with interest in iOAT.Of 108 PWID, most participants were male (68.5%) and Hispanic (68.5%) with a mean age of 43 years (±10.8). Nearly all (98.1%) had severe OUD and had received past OUD care (96.3%), with the mean number of care episodes being 17.4 (SD, ±15.9). Most participants (59.8%) were treatment-experienced. Interest in iOAT with hydromorphone was high (64.8%), but there was no significant association between total past care episodes and expressing interest in iOAT (odds ratio, 1.02; 95% confidence interval, 0.99-1.05).Participants were highly treatment-experienced, and iOAT interest was high regardless of prior OUD treatment. New OUD treatment options, such as iOAT with hydromorphone, would be welcomed by PWID whose OUD has not remitted with conventional treatment as well as other PWID.

A confluence of evidence indicates that brain functional connectivity is not static but rather dynamic. Capturing transient network interactions in the individual brain requires a technology that offers sufficient within-subject reliability. Here, we introduce an individualized network-based dynamic analysis technique and demonstrate that it is reliable in detecting subject-specific brain states during both resting state and a cognitively challenging language task. We evaluate the extent to which brain states show hemispheric asymmetries and how various phenotypic factors such as handedness and gender might influence network dynamics, discovering a right-lateralized brain state that occurred more frequently in men than in women and more frequently in right-handed versus left-handed individuals. Longitudinal brain state changes were also shown in 42 patients with subcortical stroke over 6 months. Our approach could quantify subject-specific dynamic brain states and has potential for use in both basic and clinical neuroscience research.

Population growth rates in geese can be sensitive to small changes in survival and/or production of young, explain more variation in population change can be crucial for implementing effective conservation actions. Here, we show that annual adult survival and production of young (assessed in winter) explained most variation in annual population growth rate across 36 years in GreenlandWhite-fronted Geese Anser albifrons flavirostris, during which time the population showed a sustained increase followed by a decline. In contrast, there was no strong relationship between annual population growth rate and juvenile survival following autumn migration, suggesting that variation in this demographic parameter contributed little to the population trajectory over the same period. Quantifying the influence of decisions made by Greenland White-fronted Geese throughout the annual cycle will improve our ability to target seasonal conservation actions that reduce adult mortality and/or increase pro duction of young where possible.

Given the applied nature of business disciplines, simulations are useful in helping students bridge theory learned in the classroom and practical skills needed to succeed in industry. Much of the l...

Injecting alone is a suspected risk factor for opioid overdose death among people who inject drugs (PWID). Better understanding of PWID's injecting practices and preferences could guide pragmatic harm reduction and overdose prevention interventions. We investigated injection practices and preferences among PWID attending syringe services programs (SSPs). We surveyed 108 PWID with opioid use disorder from 3 New York City SSPs between November 2020 and August 2021 to ascertain harm reduction service preferences. This secondary analysis examined injection behavior preferences, reasons for these preferences, and self-reported non-fatal lifetime overdoses. Slightly more participants preferred injecting alone (56%) than with someone present (44%), but most in both groups inject alone most of the time (97% vs 52%, p lt; 0.01). Commonly reported reasons for preferring to inject alone were privacy (82%) and not wanting to be judged (78%), whereas many preferred to inject with others to have someone present in case of overdose (92%), for camaraderie (69%), and to share drugs (65%). Those preferring to inject alone (vs. with someone present) self-reported higher mean number of lifetime overdoses (3.1 vs 2.6), but differences were not statistically significant. In conclusion, most participants injected alone regardless of preference. While not associated with prior non-fatal overdose, injection preference likely carries risk for future overdose. Participants preferred injecting alone to avoid shame or injecting with others in case of overdose, which can inform public health interventions that support both preferences. Reducing stigma while facilitating rapid overdose response can mitigate the risk of fatal overdose.

Background and Objectives:Brain lesions are a well-recognized etiology of dystonia. These cases are especially valuable as they offer causal insight into the neuroanatomical substrates of dystonia. To date, knowledge of lesion-induced dystonia comes mainly from isolated case reports or small case series, restricting broader description and analysis.Methods:Cases of lesions-induced dystonia were first identified from a systematic review of published literature. Latent class analysis then investigated whether patients could be classified into subgroups based on lesion location and body regions affected by dystonia. Regression analyses subsequently investigated whether subgroup membership predicted clinical characteristics of dystonia.Results:359 published cases were included. Lesions causing dystonia occurred in heterogeneous locations, most commonly in the basal ganglia (46.2%), followed by the thalamus (28.6%), brainstem (22.6%), and white matter (21.2%). The most common form of lesion-induced dystonia was focal dystonia (53.2%), with the hand (49.9%) and arm (44.3%) most commonly affected. Of all cases, 86.6% reported co-occurring neurological manifestations, and 26.1% reported other movement disorders. Latent class analysis identified three distinct subgroups of patients: those with predominantly limb dystonias, which were associated with basal ganglia lesions; those with predominantly cervical dystonia, associated with brainstem and cerebellar lesions; and those with predominantly hand dystonia, associated with thalamic lesions. Regression demonstrated significant differences between these subgroups on a range of dystonia symptoms, including dystonic tremor, symptom latency, other movement disorders, and dystonia variability.Discussion:While dystonia can be induced by lesions to numerous brain regions, there are distinct relationships between lesion locations and dystonic body parts. This suggests that the affected brain networks are different between types of dystonia.

Within low-nutrient tropical oceans, islands and atolls with higher primary production support higher fish biomass and reef organism abundance. External energy subsidies can be delivered onto reefs via a range of physical mechanisms. However, the influence of spatial variation in primary production on reef fish growth and condition is largely unknown. It is not yet clear how energy subsidies interact with reef depth and slope. Here we test the hypothesis that with increased proximity to deep-water oceanic nutrient sources, or at sites with shallower reef slopes, parameters of fish growth and condition will be higher. Contrary to expectations, we found no association between fish growth rate and sites with higher mean chlorophyll-a values. There were no differences in fish δ 15 N or δ 13 C values between depths. The relationship between fish condition and primary production was influenced by depth, driven by increased fish condition at shallow depths within a primary production ‘hotspot’ site. Carbon δ 13 C was depleted with increasing primary production, and interacted with reef slope. Our results indicate that variable primary production did not influence growth rates in planktivorous Chromis fieldi within 10–17.5 m depth, but show site-specific variation in reef physical characteristics influencing fish carbon isotopic composition.

This study was undertaken to test whether lesions causing central poststroke pain (CPSP) are associated with a specific connectivity profile, whether these connections are associated with metabolic changes, and whether this network aligns with neuromodulation targets for pain.Two independent lesion datasets were utilized: (1) subcortical lesions from published case reports and (2) thalamic lesions with metabolic imaging using 18F- fluorodeoxyglucose positron emission tomography-computed tomography. Functional connectivity between each lesion location and the rest of the brain was assessed using a normative connectome (n = 1,000), and connections specific to CPSP were identified. Metabolic changes specific to CPSP were also identified and related to differences in lesion connectivity. Therapeutic relevance of the network was explored by testing for alignment with existing brain stimulation data and by prospectively targeting the network with repetitive transcranial magnetic stimulation (rTMS) in 7 patients with CPSP.Lesion locations causing CPSP showed a specific pattern of brain connectivity that was consistent across two independent lesion datasets (spatial r = 0.82, p 0.0001). Connectivity differences were correlated with postlesion metabolism (r = -0.48, p 0.001). The topography of this lesion-based pain network aligned with variability in pain improvement across 12 prior neuromodulation targets and across 32 patients who received rTMS to primary motor cortex (p 0.05). Prospectively targeting this network with rTMS improved CPSP in 6 of 7 patients.Lesions causing pain are connected to a specific brain network that shows metabolic abnormalities and promise as a neuromodulation target. ANN NEUROL 2022;92:834-845.

Exercise-induced increases in pulmonary blood flow normally increase pulmonary arterial pressure only minimally, largely due to a reserve of pulmonary capillaries that are available for recruitment to carry the flow. In pulmonary arterial hypertension, due to precapillary arteriolar obstruction, such recruitment is greatly reduced. In exercising pulmonary arterial hypertension patients, pulmonary arterial pressure remains high and may even increase further. Current pulmonary arterial hypertension therapies, acting principally as vasodilators, decrease calculated pulmonary vascular resistance by increasing pulmonary blood flow but have a minimal effect in lowering pulmonary arterial pressure and do not restore significant capillary recruitment. Novel pulmonary arterial hypertension therapies that have mainly antiproliferative properties are being developed to try and diminish proliferative cellular obstruction in precapillary arterioles. If effective, those agents should restore capillary recruitment and, during exercise testing, pulmonary arterial pressure should remain low despite increasing pulmonary blood flow. The effectiveness of every novel therapy for pulmonary arterial hypertension should be evaluated not only at rest, but with measurement of exercise pulmonary hemodynamics during clinical trials.

We encounter the results of category formation every day, from demographic categories like race and gender, to role-playing-game classes like "fighter" or "mage". Category membership is often not simply based on the possession of discrete properties but instead constructed from and reflect the highly nuanced relationships (gradience) between members and best-example individuals called "prototypes". In this paper, we present The Marginal, an artificial intelligence (AI)-driven game that (1) computationally models the cognitive categories that players develop when customizing videogame avatars and (2) generates challenges for players to use their perception of visual, textual, and numerical data to progress in a game created using these models. We use archetypal analysis, an AI clustering approach for identifying boundary points in data, to generate tasks in The Marginal for its gameplay. It shows how AI can be combined with games to model and evaluate cognitive categorization phenomena.