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A term large-for-gestational-age neonate was born via an uncomplicated normal vaginal delivery at a peripheral hospital. The neonate was referred to our tertiary centre due to concerns regarding the appearance of the right hand. On examination at 6 hours of life there was cyanotic discolouration

Termination of microvascular hyperpermeability has been so far accepted to be a passive result of the removal of the applied proinflammatory agonists. We provide in vivo and in vitro evidence that 1) inactivation of hyperpermeability is an actively regulated process, 2) proinflammatory agonists (PAF and VEGF) stimulate microvascular hyperpermeability and initiate endothelial mechanisms that terminate hyperpermeability, and 3) eNOS location-translocation is critical in the activation-inactivation cascade of endothelial hyperpermeability.

There has been a renewed interest in developing environmentally friendly, economically viable, and technologically feasible supersonic transport aircraft and reduced order modeling methods can play an important contribution in accelerating the design process of these future aircraft. This paper reviews the use of the vortex lattice method (VLM) in modeling the general aerodynamics of subsonic and supersonic aircraft. The historical overview of the vortex lattice method is reviewed which indicates the use of this method for over a century for development and advancements in the aerodynamic analysis of subsonic and supersonic aircraft. The preference of VLM over other potential flow-solvers is because of its low order highly efficient computational analysis which is quick and efficient. Developments in VLM covering steady, unsteady state, linear and non-linear aerodynamic characteristics for different wing planform for the purpose of several different types of design optimisation is reviewed. For over a decade classical vortex lattice method has been used for multi-objective optimisation studies for commercial aircraft and unmanned aerial vehicle’s aerodynamic performance optimisation. VLM was one of the major potential flow solvers for studying the aerodynamic and aeroelastic characteristics of many wings and aircraft for NASA’s supersonic transport mission (SST). VLM is a preferred means for solving large numbers of computational design parameters in less time, more efficiently, and cheaper when compared to conventional CFD analysis which lends itself more to detailed study and solving the more challenging configuration and aerodynamic features of civil supersonic transport.

Objectives: Uterine leiomyoma/uterine fibroid is the benign tumor of the smooth muscle of the uterus. This study was conducted to identify the clinical features and the effects on their quality of life factors with the occurrence of uterine fibroids. Methods: A cross-sectional study research design was used. The sample constituted 370 patients diagnosed with uterine fibroids, starting from November 2021 to May 2022. Results: Heavy menstrual bleeding was found to be the most common clinical manifestation seen in women with uterine leiomyoma. Hypothyroidism was seen to be associated with uterine leiomyoma. Generalized fatigue was the main issue faced by many along with difficulty to do daily chores. All these issues caused mental stress in women to a large extent. Conclusion: The associated factors, clinical manifestations, and perceived impact on women’s health life of uterine leiomyoma were studied. Age (41–60), overweight, and family history were the associated factors of uterine leiomyoma. Uterine fibroids negatively impacted the quality of life in women.

The clinical features of cerebellar vermis hypoplasia, oligophrenia, ataxia, coloboma, and hepatic fibrosis (COACH) characterize the rare autosomal recessive multisystem disorder called COACH syndrome. COACH syndrome belongs to the spectrum of Joubert syndrome and related disorders (JSRDs) and liver involvement distinguishes COACH syndrome from the rest of the JSRD spectrum. Developmental delay and oculomotor apraxia occur early but with time, these can improve and may not be readily apparent or no longer need active medical management. Congenital hepatic fibrosis and renal disease, on the other hand, may develop late, and the temporal incongruity in organ system involvement may delay the recognition of COACH syndrome. We present a case of a young adult presenting late to a Renal Genetics Clinic for evaluation of renal cystic disease with congenital hepatic fibrosis, clinically suspected to have autosomal recessive polycystic kidney disease. Following genetic testing, a reevaluation of his medical records from infancy, together with reverse phenotyping and genetic phasing, led to a diagnosis of COACH syndrome.

We present a carboxylate-targeting reactive fragment screening platform using 2-aryl-5-carboxytetrazole (ACT) as the photoreactive functionality. This work will provide a simple accessible method to rapidly discover tool molecules to interrogate important biological targets.

The aim of this study was to use artificial intelligence (AI) to facilitate peer review for detection of missed suspicious liver lesions (SLLs) on CT pulmonary angiographic (CTPA) examinations.This retrospective study included 1 month of consecutive CTPA examinations from a multisite teleradiology practice. Visual classification (VC) software analyzed images for the presence (+) or absence (-) of SLLs (1 cm,20 Hounsfield units). Separately, a natural language processing (NLP) algorithm evaluated corresponding reports for description (+) of an SLL or lack thereof (-). Studies containing possible missed SLLs (VC+/NLP-) were reviewed by three abdominal radiologists in a two-step adjudication process to confirm if an SLL was missed by the interpreting radiologist. The number of VC+/NLP- cases, the number of images needing radiologist review, and the number of cases with confirmed missed SLLs were recorded. Interobserver agreement for SLLs was calculated for the radiologist readers.A total of 2,573 CTPA examinations were assessed, and 136 were classified as potentially containing missed SLLs (VC+/NLP-). After radiologist review, 13 cases with missed SLLs were confirmed, representing 0.5% of analyzed CT studies. Using AI, the ratio of CT studies requiring review to missed SLLs identified was 10:1; the ratio without the help of AI would be at least 66:1. Among the 136 cases reviewed by radiologists, interobserver agreement for SLLs was excellent (κ = 0.91).AI can accelerate meaningful peer review by rapidly assessing thousands of examinations to identify potentially clinically significant errors. Although radiologist involvement is necessary, the amount of effort required after initial AI screening is dramatically reduced.

We introduce a statistical methodology to evaluate the thermal performance of vertical opaque envelopes and provide the most adequate design of energy-efficient buildings located across extended regions. The analytical procedure was applied to the extensive Argentinian territory with a variety of climates and a limited number of networked meteorological stations. Although the study was conducted over a full year, results are presented for January and June, when the building energy demand for heating and cooling is most significant, taking into account the local climate, the thermal properties of the walls and the effects of the daily variation in the solar radiation. By using the Fourier series expansion of the sol-air temperature and multivariate analysis, we first correlated the weather data and the steady-state and time-dependent heat fluxes transmitted by conduction through five types of typical walls facing north and south in 10 climatically differentiated cities where full weather data were recorded. Then, the mean values of the sol-air temperature and the amplitude of its time variations were interpolated throughout the territory, thus yielding the spatial distributions of these parameters for a typical day in the months of interest. Finally, the calculation of the heat fluxes exchanged through building opaque envelopes was extended to the whole country.

This review highlights transborylation (controlled boron-boron exchange) and its applications as a turnover strategy in boron-catalysed methodologies. Catalytic applications of B–C, B–O, B–N, B–F, B–S, and B–Se transborylations are discussed in the context of transborylation-enabled catalysis, across a wide range of organic transformations including hydroboration, C–C bond formation, C–H borylation, chemoselective reduction, and asymmetric reduction.1 Introduction2 B–C Transborylation3 B–O Transborylation4 B–N Transborylation5 B–F Transborylation6 B–S Transborylation7 Conclusion

In many papers, random modulation of power electronic converters is described as an electromagnetic interference (EMI) mitigation technique, which contributes to the assurance of electromagnetic compatibility (EMC) of systems consisting of power electronic converters and serial transmission-based control and measuring devices. However, experimental results as well as theoretical analyses of physical phenomenon suggest that the EMI reduction is ostensible and results from the measuring procedure adopted in standards. This article presents the first known approach to compare the influence of deterministic and random modulation of transmission errors rate in serial communication systems. The comparison is based on the especially developed mathematical models, which are validated experimentally, using a simple setup with a dc/dc converter injecting a noise into the USB/RS232 converter representing a serial transmission scheme. The comparison reveals that for the studied switching frequency range from 10 kHz to 1 MHz, on average, there is no significant difference between random and deterministic modulations with respect to the probability of error rate in serial communication systems. Thus, in such systems, random modulation should not be considered as a valid EMC-assuring technique.

The reduction of nitriles to primary amines is a useful transformation in organic synthesis, however, it often relies upon stoichiometric reagents or transition-metal catalysis. Herein, a borane-catalysed hydroboration of nitriles to give primary amines is reported. Good yields (48–95%) and chemoselectivity (e.g., ester, nitro, sulfone) were observed. DFT calculations and mechanistic studies support the proposal of a double B–N/B–H transborylation mechanism.

Objective: Autism spectrum disorder (ASD) in very young children with significant cognitive impairment is difficult to diagnose, depriving them of the earliest opportunities for autism-specific intervention. This study delineated specific symptoms in this group, compared to symptoms in children with Global Developmental Delay (GDD) and in ASD with milder developmental delays.Method: Autism Diagnostic Observation Schedule, 2nd Edition, Toddler Module revealed symptoms in three groups of toddlers, with mean ages of 17-20 months: (1) ASD and cognitive/language functioning below the 12-month level (ASD-MA < 12 mos; n = 28), (2) GDD (n = 27), and (3) ASD and cognitive/language functioning at or above the 12-month level (ASD-MA ≥ 12 mos; n = 29). Logistic regression models were fit to control for developmental level. Results: Items in all domains (social interaction, communication, repetitive movements) discriminated ASD-MA < 12 mos from GDD. The two ASD groups, matched for age but differing on developmental level, showed strikingly similar ASD symptomatology. Conclusion: ADOS-2 symptoms differentiated ASD-MA < 12 mos from GDD, after controlling for cognitive impairment. Symptoms in the two ASD groups were minimally related to developmental level. The ADOS-2 Toddler Module successfully captured ASD symptomatology even in children whose developmental level was below the recommended ADOS-2 cutoff of 12 months, which may increase their access to early ASD-specific intervention.

Reducing the age of first autism diagnosis facilitates access to critical early intervention services. A current "waitlist crisis" for autism diagnostic evaluation thus demands that we consider novel use of available clinical resources. Previous work has found that expert autism clinicians can identify autism in young children with high specificity after only a brief observation; rapid identification by non-experts remains untested. In the current study, 252 children ages 12-53 months presented for a comprehensive autism diagnostic evaluation. We found that junior clinicians in training to become autism specialists (n = 29) accurately determined whether or not a young child would be diagnosed with autism in the first five minutes of the clinic visit in 75% of cases. Specificity of brief observations was high (0.92), suggesting that brief observations may be an effective tool for triaging young children toward autism-specific interventions. In contrast, the lower negative predictive value (0.71) of brief observations, suggest that they should not be used to rule out autism. When trainees expressed more confidence in their initial impression, their impression was more likely to match the final diagnosis. These findings add to a body of literature showing that clinical observations of suspected autism should be taken seriously, but lack of clinician concern should not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result.

The diastereo- and enantioselective allylation of ketones remains a synthetic challenge, with transition metal catalysis offering the most applied methods. Here, a boron-catalyzed allylation of ketones with allenes is presented. Excellent yield, regioselectivity, and diastereoselectivity were found across functionalized substrates. The reaction was further developed to accommodate an enantioenriched boron catalyst and thus gave asymmetric ketone allylation in good yield, diastereoselectivity, and enantioselectivity. Mechanistic studies supported a hydroboration–allylation–transborylation pathway. S.P.T. acknowledges the Royal Society for a University Research Fellowship (URF/R/191015). S.P.T. and K.N. thank AstraZeneca and EPSRC for an iCase PhD studentship.

This study evaluates an online ADOS-2 Module 4 administration. Adolescents and adults with (n = 24; 7 females) and without (n = 13; 5 females) a history of autism spectrum disorder (ASD) completed the ADOS-2 Module 4 via videoconference. Parents or caregivers completed the Parent/Caregiver Form of the Vineland Adaptive Behavior Scales and the Achenbach Adult Behavior Checklist. The ADOS-2 was reviewed and scored by five trained clinicians and supervised by a senior clinician with established research reliability. The autistic group's scores differed on ADOS total (Calibrated Severity Score, WPS instrument) and domain scores, KSADS domain scores, and Achenbach T-scores. Inter-rater reliability was "moderate" (κ = 0.732), and percentage item-wise agreement was r = 0.69. The online ADOS-2 showed significant convergence with parent-reported assessments of ASD-relevant symptoms and characteristics, suggesting it was a valid assessment. While any online assessments must be used with caution, results suggest that the approach described here could have sufficient validity and reliability to fill the urgent need to assess and evaluate ASD symptomatology, as one component of a thorough clinical evaluation of ASD-related behaviors. LAY SUMMARY: In this exploratory study, we asked whether it was possible to give the ADOS-2 to adolescents and adults in a completely online way. Results showed that expert clinicians agreed on 69% of ADOS-2 items; also, participants with autism had higher scores on all parts of the ADOS-2. The online ADOS-2 scores had strong and significant relationships with parents' reports of friendship and social skills. While we need more research that tests this method, this way of doing the ADOS-2 online may be useful for clinicians and researchers who have an urgent need to evaluate autism during the pandemic.

Objectives: The objectives of the study were (1) to compare the effectiveness of problem-based learning (PBL) in classroom and problem-based mobile learning (PBML) using a mobile application and (2) to study the perception of students to PBML and PBL in classroom. Methods: After getting clearance from institutional ethics committee, an interventional study was conducted for a period of 2 months among 250 Phase IMBBS students of Government Medical College Kozhikode, Kerala. Students who gave consent for the study were divided into two groups, namely, R-1 and R-2, and analyzed for the effectiveness of PBML as a teaching learning method in comparison with PBL in classroom. Perception of students toward use of PBML and PBL as teaching learning method was collected using validated questionnaire. Results: It was observed from the study that in all the sessions post-test mean scores were significantly higher than pre-test scores in both PBL and PBML. Before the intervention there was no significant difference in the pre-test mean scores in topics done by PBL and PBML. After intervention the only the post-test mean scores significantly improved. When the total post score scores of PBL and PBML compared, it was found that PBML mean score is significantly higher than PBL mean score. In the student’s perception analysis, it was found that both methods are effective in concept building, stimulating, helpful in passing exams, and development of problem-learning skills. Conclusion: From the study finding, we can conclude that both PBL and PBML are effective modes of teaching applied biochemistry for Phase I MBBS students. PBML is more effective than PBL in teaching applied biochemistry in Phase I MBBS students. Perception analysis shows that interaction with the students and doubt clearance is more effectuated with PBL than PBML.

The national otolaryngology-head and neck surgery (OHNS) landscape of transgender and nonbinary/gender-nonconforming (TNG) care education and gender-affirming surgical training is variable with limited availability. However, specialized and innovative training with breadth and depth is available at select training sites focusing on facial and/or vocal gender affirmation throughout the United States. With growing trainee interest, program and fellowship director-related efforts to expand training, and progressive arcs of social change focusing on protections and promotion of TNG health, the future of OHNS training opportunities to serve TNG patients is promising.

Focal segmental glomerulosclerosis (FSGS) is not a disease, rather a pattern of histological injury occurring from a variety of causes. The exact pathogenesis has yet to be fully elucidated but is likely varied based on the type of injury and the primary target of that injury. However, the approach to treatment is often based on the degree of podocyte foot process effacement and clinical presentation without sufficient attention paid to etiology. In this regard, there are many monogenic causes of FSGS with variable presentation from nephrotic syndrome with histological features of primary podocytopathy to more modest degrees of proteinuria with limited evidence of podocyte foot process injury. It is likely that genetic causes are largely underdiagnosed, as the role and the timing of genetic testing in FSGS is not established and genetic counseling, testing options, and interpretation of genotype in the context of phenotype may be outside the scope of practice for both nephrologists and geneticists. Yet most clinicians believe that a genetic diagnosis can lead to targeted therapy, limit the use of high-dose corticosteroids as a therapeutic trial, and allow the prediction of the natural history and risk for recurrence in the transplanted kidney. In this manuscript, we emphasize that genetic FSGS is not monolithic in its presentation, opine on the importance of genetic testing and provide an algorithmic approach to deployment of genetic testing in a timely fashion when faced with a patient with FSGS.

Strategies of balloon dilation during transfemoral carotid artery stenting include prestent dilation only (PRE), post-stent dilation only (POST), or both predilation and postdilation (PRE+POST). Concerns over higher neurological risk have been raised with POST and PRE+POST during transfemoral carotid artery stenting. Whether these concerns are applicable to transcarotid artery revascularization (TCAR), which uses proximal clamping and cerebral blood flow reversal during stent deployment and balloon angioplasty remains unknown. Our aim is to analyze outcomes of PRE, POST, or PRE+POST balloon dilation strategies during TCAR.We analyzed the prospectively collected data from the ROADSTER1 (pivotal), ROADSTER2 (US Food and Drug Administration indicated postmarket), and ROADSTER Extended Access TCAR trials. All trial patients had a high risk anatomic or clinical factors for carotid endarterectomy and were included, unless they did not undergo stent deployment or balloon dilation. For trial inclusion, asymptomatic patients had a carotid stenosis of more than 80%, and symptomatic patients had stenosis of more than 50%. Primary outcome measures were stroke, death, and myocardial infarction (MI) at 30 days. Data were statistically analyzed with χThere were 851 patients (566 male) who underwent dilation by PRE (n = 216), POST (n = 249), or PRE+POST (n = 386). Patients had carotid stenosis of greater than 70% (n = 828, 97%), and 207 (24%) were symptomatic. Flow reversal times were longer in the PRE+POST group (PRE 10.2 minutes, POST 9.8 minutes, and PRE+POST 13.3 minutes; P .001). The 30-day stroke rate for the whole cohort was 1.9%, mortality was 0.5%, and MI rate was 0.94%. Stroke rates for the PRE cohort (1.9%), POST cohort (2.0%), and PRE+POST cohort (1.8%; P = .98) were similar. Also, death rates at 30 days, and composite stroke, death, and MI rates were similar in the three cohorts. No significant differences in adverse outcomes were noted among the various dilation strategies for both symptomatic and asymptomatic patients.Based on these prospective trial data, there is no difference in neurological complications owing to balloon dilation strategy during TCAR. The balloon dilation technique best suited to the patient's specific lesion morphology should be used. Further studies are needed to evaluate the relationship of these dilation strategies to long-term outcomes, including stent patency, restenosis, and reintervention.

Purpose of ReviewThis review provides guidance for acute spinal cord injury (SCI) management through an analytical assessment of the most recent evidence on therapies available for treating SCI, including newer therapies under investigation. We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognostication, with additional emphasis on the pediatric population when evidence is available.Recent FindingsFurther studies since the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) demonstrated a potential functional outcome benefit with ultra-early surgical intervention ≤ 8 h post-SCI. Subsequent analysis of the National Acute Spinal Cord Injury Study (NASCIS) II and NASCIS III trials have demonstrated potentially serious complications from intravenous methylprednisolone with limited benefit. Newer therapies actively being studied have demonstrated limited or no benefit in preclinical and clinical trials with insufficient evidence to support use in acute SCI treatment.SummaryCare for SCI patients requires a multi-disciplinary team. Immediate evaluation and management are focused on preventing additional injury and restoring perfusion to the affected cord. Rapid assessment and intervention involve focused neurological examination, targeted imaging, and surgical intervention when indicated. There are currently no evidence-based recommendations for pathomechanistically targeted therapies.

Open bypass surgery remains a major tool for limb salvage in chronic limb-threatening ischemia (CLTI). Although rest pain and tissue loss both fall into the category of CLTI, goals of revascularization are markedly different for each context. Rest pain mandates long-term patency considerations. Tissue loss, however, requires consideration of infection risks and patency enough to heal the wound. Of the major conduit options, autologous saphenous vein graft continues to be the conduit of choice, given both superior patency and low risk of infection. When saphenous vein graft is not available or not available in appropriate length, arm vein, small saphenous vein, and spliced combinations of these have acceptable patency rates. Heparin-bonded polytetrafluoroethylene and Dacron grafts are prosthetic conduits with excellent patency rates when vein is not available. For infected wounds without other options, cryovein continues to provide acceptable patency for limb salvage. Creation of a bypass is only part of CLTI management. Appropriate postoperative surveillance with noninvasive studies, including ankle-brachial index and duplex ultrasound, can alert to impending graft failure, with a drop in ankle-brachial index of 0.15 and velocity ratios of 3 or more suggestive of significant stenoses. Anticoagulation has only been found in limited contexts (such as poor conduit or poor outflow) to offer some patency benefit, however, findings from the VOYAGER PAD (Vascular Outcomes Study of ASA [Acetylsalicylic Acid] Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) trial were a major breakthrough, showing a reduction in the composite outcome of major adverse limb, cardiac, and cerebrovascular events in revascularized patients taking low-dose rivaroxaban in conjunction with aspirin, without a substantial increase in bleeding risk.

Record-breaking heatwaves and wildfires immersed Siberia during the boreal spring of 2020 following an anomalously warm winter. Springtime heatwaves are becoming more common in the region, with statistically significant trends in the frequency, magnitude, and duration of heatwave events over the past four decades. Mechanisms by which the heatwaves occur and contributing factors differ by season. Winter heatwave frequency is correlated with the atmospheric circulation, particularly the Arctic Oscillation, while the frequency of heatwaves during the spring months is highly correlated with aspects of the land surface including snow cover, albedo, and latent heat flux. Idealized AMIP-style experiments are used to quantify the contribution of suppressed Arctic sea ice and snow cover over Siberia on the atmospheric circulation, surface energy budget, and surface air temperature in Siberia during the winter and spring of 2020. Sea ice concentration contributed to the strength of the stratospheric polar vortex and Arctic Oscillation during the winter months, thereby influencing the tropospheric circulation and surface air temperature over Siberia. Warm temperatures across the region resulted in an earlier-than-usual recession of the winter snowpack. The exposed land surface contributed to up to 20% of the temperature anomaly during the spring through the albedo feedback and changes in the ratio of the latent and sensible heat fluxes. This, in combination with favorable atmospheric circulation patterns, resulted in record-breaking heatwaves in Siberia in the spring of 2020.

Background and ObjectivesThe goal of this work was to determine whether locally acting ACE-083 is safe and well tolerated and increases muscle volume, motor function, and quality of life (QoL) in adults with Charcot-Marie-Tooth disease (CMT) type 1.MethodsThis phase 2 study enrolled adults with CMT1 or CMTX (N = 63). Part 1 was open label and evaluated the safety and tolerability of different dose levels of ACE-083 for use in part 2. Part 2 was a randomized, placebo-controlled, 6-month study of 240 mg/muscle ACE-083 injected bilaterally into the tibialis anterior muscle, followed by a 6-month, open-label extension in which all patients received ACE-083. Pharmacodynamic endpoints included total muscle volume (TMV; primary endpoint), contractile muscle volume (CMV), and fat fraction. Additional secondary endpoints included 6-minute walk test, 10-m walk/run, muscle strength, and QoL. Safety was assessed with treatment-emergent adverse events (TEAEs) and clinical laboratory tests.ResultsIn part 1 (n = 18), ACE-083 was generally safe and well tolerated at all dose levels, with no serious adverse events, TEAEs of grade 3 or greater, or death reported. In part 2 (n = 45 enrolled, n = 44 treated), there was significantly greater change in TMV with ACE-083 compared with placebo (least-squares mean difference 13.5%;p= 0.0096). There was significant difference between ACE-083 and placebo for CMV and change in ankle dorsiflexion strength. Fat fraction and all other functional outcomes were not significantly improved by ACE-083. Moderate to mild injection-site reactions were the most common TEAEs.DiscussionDespite significantly increased TMV and CMV, patients with CMT receiving ACE-083 in tibialis anterior muscles did not demonstrate greater functional improvement compared with those receiving placebo.Trial Registration InformationClinical Trials Registration:NCT03124459.Classification of EvidenceThis study provides Class II evidence that intramuscular ACE-083 is safe and well tolerated and increases total muscle volume after 6 months of treatment in adults with CMT1 or CMTX.

PURPOSE: MR Fingerprinting (MRF) Arterial Spin Labeling (ASL) is a non-contrast technique to estimate multiple brain hemodynamic and structural parameters in a single scan. The purpose of this study is to examine the feasibility and initial utility of MRF-ASL in Moyamoya disease. METHODS: MRF-ASL, conventional single-delay ASL, Time-of-flight (TOF) MR angiography, and contrast-based dynamic-susceptibility-contrast (DSC) MRI were prospectively collected from a group of Moyamoya patients in North America (N=21, 4 men and 17 women). Sixteen healthy subjects (7 men and 9 women) also underwent an MRF-ASL scan. Cerebral blood flow (CBF), bolus arrival time (BAT), and tissue T1 were compared between Moyamoya patients and healthy controls. Perfusion parameters from MRF-ASL were compared to those from other MRI sequences. Multi-linear regression was used for comparisons of parameter values between Moyamoya and control groups. Linear mixed-effects models was used when comparing MRF-ASL to PCASL and DSC parameters. Spearman’s Rank Correlation Coefficient was calculated when comparing MRF-ASL to and MRA grades. A P value of 0.05 or less was considered significant. RESULTS: BAT in stenotic internal carotid artery (ICA) territories was prolonged (P

We aim to compare Choose Your Own Adventure (CYOA) presentation format with linear case format as educational methods for teaching a radiology small group session to medical students.A radiology small group session was held for preclinical second-year medical students in the pulmonary course, whereby eight classrooms of students and eight radiology facilitators were each randomized to do either the linear case format or the nonlinear CYOA presentation format. All students in attendance were administered a survey at the end of the session, which assessed students' perceptions using five-point Likert-type questions. The survey also contained a four-question knowledge quiz on chest radiology. The facilitators were administered a qualitative survey as well. Between-group analyses were performed using Student's t-test.Of the 144 students who attended the small group sessions, 143 students completed the survey (99.3%). The CYOA format group reported significantly greater engagement in the cases (4.5 ± 0.7 vs. 3.8 ± 0.7, p0.001), satisfaction with the format (4.6 ± 0.6 vs. 3.7 ± 0.9, p0.001), and enhancement of clinical decision making skills (4.5 ± 0.6 vs. 3.5 ± 0.9, p0.001). The linear format group reported a greater role for the facilitator to add value (4.6 ± 0.5 vs. 4.3 ± 1.1, p = 0.033). There was no significant difference between groups in performance on the knowledge quiz.Medical students reported higher satisfaction, engagement, and enhanced clinical decision making skills with the CYOA presentation method compared to linear case format for radiology small group learning.

Neural-vascular coupling (NVC) is the process by which oxygen and nutrients are delivered to metabolically active neurons by blood vessels. Murine models of NVC disruption have revealed its critical role in healthy neural function. We hypothesized that, in humans, aging exerts detrimental effects upon the integrity of the neural-glial-vascular system that underlies NVC. To test this hypothesis, calibrated functional magnetic resonance imaging (cfMRI) was used to characterize age-related changes in cerebral blood flow (CBF) and oxygen metabolism during visual cortex stimulation. Thirty-three younger and 27 older participants underwent cfMRI scanning during both an attention-controlled visual stimulation task and a hypercapnia paradigm used to calibrate the blood-oxygen-level-dependent signal. Measurement of stimulus-evoked blood flow and oxygen metabolism permitted calculation of the NVC ratio to assess the integrity of neural-vascular communication. Consistent with our hypothesis, we observed monotonic NVC ratio increases with increasing visual stimulation frequency in younger adults but not in older adults. Age-related changes in stimulus-evoked cerebrovascular and neurometabolic signal could not fully explain this disruption; increases in stimulus-evoked neurometabolic activity elicited corresponding increases in stimulus-evoked CBF in younger but not in older adults. These results implicate age-related, demand-dependent failures of the neural-glial-vascular structures that comprise the NVC system.

Many mammals cross large rivers to access seasonal habitats, yet river crossing behavior is poorly acknowledged or understood. Crossing large rivers is inherently risky, with vessel traffic and flooding events increasing the risk of drowning. We investigated river crossing behavior by threatened bison (Bison bison) in the boreal forest, using data from 11 GPS-collared animals to identify when and where they cross a major river. We used kernel densities of GPS locations to identify crossing hotspots, and developed resource selection function (RSF) models that used habitat characteristics to explain crossing behavior based on a priori hypotheses. We then predicted high-probability crossing areas along a 400-km stretch of river using the best-supported RSF model. Bison regularly crossed the river (x¯ = 8.6 crossings/100 days), particularly during summer months. Model selection results suggested that bison may have chosen river crossing areas that maximized access to forage. Bison preferred to cross the river near islands and areas with high seismic line densities, both of which were likely preferred summer foraging habitats. In addition, islands may have been used as temporary stopovers while crossing the river, or for relief from biting insects. Bison crossed the river where the channel was relatively narrow (x¯ = 400 ± 213 m [SD]) and chose days when river discharge was low, likely to reduce the risk of drowning, exhaustion, or hypothermia. While based on a small sample of collared bison, predictions about high-probability crossing areas may be used to inform mitigation measures aimed at reducing bison drowning caused by vessel traffic, which is expected to increase as resource development expands in the region. Our approach may be informative for identifying river crossing hotspots for other mammals that cross major rivers.