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Exercise training (EX) and weight loss (WL) improve lower extremity physical function (LEPF) in older overweight women; however, effects on rate of torque development (RTD) are unknown. This study aimed to determine the effects of WL + EX or WL alone on RTD, and relatedly LEPF, in overweight older women. Leg strength was assessed using isokinetic dynamometry, and RTD was calculated (RTD200 = RTD at 200 ms, RTDPeak = peak RTD, T2P = time to 1st peak). LEPF was determined via clinical functional tasks. Women (n = 44, 69.1 ± 3.6 years, 30.6 ± 4.3 kg/m2) completed a 6-month trial in EX + WL or WL groups with similar weight loss (−9.8 ± 4.2%, p > .95). EX + WL had greater improvements in (a) most LEPF tasks (p 200, compared with WL (36% vs. −16%, p = .031); no other RTD parameters differed. Changes in RTD parameters and LEPF were not related (all p > .05). RTD is responsive to EX but is not associated with LEPF in older women.

To develop and validate a prostate cancer (PCa) risk calculator (RC) incorporating multiparametric magnetic resonance imaging (mpMRI) and to compare its performance with that of the Prostate Biopsy Collaborative Group (PBCG) RC.Men without a PCa diagnosis receiving mpMRI before biopsy in the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (2015-2020) were included. Data from a separate institution were used for external validation. The primary outcome was diagnosis of no cancer, grade group (GG)1 PCa, and clinically significant (cs)PCa (≥GG2). Binary logistic regression was used to explore standard clinical and mpMRI variables (prostate volume, Prostate Imaging-Reporting Data System [PI-RADS] version 2.0 lesions) with the final PLUM RC, based on a multinomial logistic regression model. Receiver-operating characteristic curve, calibration curves, and decision-curve analysis were evaluated in the training and validation cohorts.A total of 1010 patients were included for development (N = 674 training [47.8% PCa, 30.9% csPCa], N = 336 internal validation) and 371 for external validation. The PLUM RC outperformed the PBCG RC in the training (area under the curve [AUC] 85.9% vs 66.0%; P 0.001), internal validation (AUC 88.2% vs 67.8%; P 0.001) and external validation (AUC 83.9% vs 69.4%; P 0.001) cohorts for csPCa detection. The PBCG RC was prone to overprediction while the PLUM RC was well calibrated. At a threshold probability of 15%, the PLUM RC vs the PBCG RC could avoid 13.8 vs 2.7 biopsies per 100 patients without missing any csPCa. At a cost level of missing 7.5% of csPCa, the PLUM RC could have avoided 41.0% (566/1381) of biopsies compared to 19.1% (264/1381) for the PBCG RC. The PLUM RC compared favourably with the Stanford Prostate Cancer Calculator (SPCC; AUC 84.1% vs 81.1%; P = 0.002) and the MRI-European Randomized Study of Screening for Prostate Cancer (ERSPC) RC (AUC 84.5% vs 82.6%; P = 0.05).The mpMRI-based PLUM RC significantly outperformed the PBCG RC and compared favourably with other mpMRI-based RCs. A large proportion of biopsies could be avoided using the PLUM RC in shared decision making while maintaining optimal detection of csPCa.

Objectives: Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life. Design: A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research. Setting: Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings. Participants: A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician. Results: Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent. Conclusions: Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.

DP915635 maize was genetically modified (GM) to express the IPD079Ea protein for corn rootworm (Diabrotica spp.) control. DP915635 maize also expresses the phosphinothricin acetyltransferase (PAT) protein for tolerance to glufosinate herbicide and the phosphomannose isomerase (PMI) protein that was used as a selectable marker. A field study was conducted at ten sites in the United States and Canada during the 2019 growing season. Of the 11 agronomic endpoints that were evaluated, two of them (early stand count and days to flowering) were statistically significant compared with the control maize based on unadjusted p-values; however, these differences were not significant after FDR-adjustment of p-values. Composition analytes from DP915635 maize grain and forage (proximates, fiber, minerals, amino acids, fatty acids, vitamins, anti-nutrients, and secondary metabolites) were compared to non-GM near-isoline control maize (control maize) and non-GM commercial maize (reference maize). Statistically significant differences were observed for 7 of the 79 compositional analytes (16:1 palmitoleic acid, 18:0 stearic acid, 18:1 oleic acid, 18:2 linoleic acid, 24:0 lignoceric acid, methionine, and α-tocopherol); however, these differences were not significant after FDR-adjustment. Additionally, all of the values for composition analytes fell within the range of natural variation established from the in-study reference range, literature range, and/or tolerance interval. These results demonstrate that DP915635 is agronomically and compositionally comparable to non-GM maize represented by non-GM near-isoline control maize and non-GM commercial maize.

Background: Optic nerve (or disc) drusen is the presence of hyaline bodies at the optic nerve head. The drusen may be visible upon funduscopic examination or may present as buried. Timely diagnosis and responsible imaging may help inform the patient of the potential for future concerns. The long-term prognosis is good for most patients, however, they may experience progressive peripheral vision loss that may reduce the patient’s quality of life. Neuroprotective options have previously been discussed with minimal clinical effectiveness, however, new medications may aid in future treatment. Case Report: A patient presenting with mild and slowly progressing vision loss was examined and found to have optic disc drusen. Visual fields were done to quantify the extent of vision loss and revealed the patient no longer met the criteria for his commercial driver’s license. Findings, imaging, and treatment options are discussed. Conclusion: While no effective treatments exist currently, the potential benefit of brimonidine as a neuroprotective agent is discussed along with other future potential options. An assessment of the viability of the patient’s cost benefit ratio is discussed.

Los pacientes con CPNM metastásico portadores de una fusión del gen ROS1 suelen experimentar un control prolongado de la enfermedad con inhibidores de la tirosina quinasa (TKI) dirigidos a ROS1, aunque hay una heterogeneidad clínica significativa, debida en parte a la presencia de alteraciones genómicas concurrentes. Presentamos el caso de un paciente con CPNM metastásico, con fusión de ROS1 acompañada de una mutación en KRAS p.G12C detectada durante el diagnóstico, quien mantuvo la enfermedad bajo control durante un breve periodo con entrectinib, un TKI de ROS1. Cuando se observó progresión, el paciente continuó con entrectinib y comenzó a recibir sotorasib, un inhibidor de KRAS p.G12C de bajo peso molecular. Una línea celular derivada del paciente generada durante la progresión mientras recibía entrectinib demostró una mejor capacidad de respuesta a los TKI cuando se trató con entrectinib y sotorasib. La dependencia del crecimiento de la línea celular tanto con respecto a ROS1 como a KRAS p.G12C se reflejó además en las distintas vías de señalización corriente abajo activadas por cada impulsor. No se observó beneficio clínico con la terapia combinada de entrectinib y sotorasib, posiblemente debido a una amplificación evolutiva de KRAS p.G12C identificada en pruebas moleculares repetidas. Este caso respalda la necesidad de establecer perfiles moleculares amplios en pacientes con CPNM metastásico para disponer de información con posible valor terapéutico y pronóstico.

Many business transactions and employment contracts are wrongfully exploitative despite being consensual and beneficial to both parties, compared with a nontransaction baseline. This form of exploitation can present governments with a dilemma. Legally permitting exploitation may send the message that the public condones it. In some economic conditions, coercively enforced antiexploitation law may harm the people it is intended to help. Under these conditions, a way out of the dilemma is to enact laws with provisions that lack coercive enforcement. Noncoercive law would convey the state’s condemnation of wrongful exploitation without risking the harmful effects of coercively enforced law. It would also give firms and their agents a way of explaining nonexploitative pricing decisions to investors, and it may help give precise content to the moral duty to set prices and wages fairly. Governments should thus consider noncoercive law a viable component of their responses to exploitation.

To address the challenge in urology in recruiting physicians from backgrounds racially and ethnically underrepresented in medicine (URiM), we sought to design, implement, and evaluate methods for recruiting URiM candidates to our urology residency program.We developed a three-pronged approach aimed at increasing the number of interviewed applicants, and subsequently number of URiM residents recruited to our program. The three facets included: (1) funded visiting student rotation, (2) holistic evaluation of applications, (3) implemented targeted outreach. Statistical analysis of the applicants interviewed and matched into our residency program, as well as traditional metrics used for residency recruitment, were performed from 2015 to 2022.The number of URiM interviewees significantly increased from 6.1% in 2015 to its peak, 40%, in 2020. In 2015, there were no URiM residents in our urology residency program. By 2022, the total URiM complement increased to 35%. In evaluating traditional metrics of residency recruitment, there was no significant difference in mean USMLE Step 1 score before compared with after the implementation of our recruitment approach. The maximum rank number reached to fill the urology residency positions also remained relatively stable throughout the study period, with a range from 5 to 38.We demonstrate that the implementation of our innovative and intentional three-pronged recruitment approach effectively increased the number of URiM interviewees and residents in our residency program. The diversification of our urology workforce depends on the implementation of such efforts, and we encourage urologists to lead the way on such initiatives.

Current guidelines recommend a target international normalized ratio (INR) range of 2.5 to 3.5 in patients with a mechanical mitral prosthesis. The Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) Mitral randomized controlled noninferiority trial assessed safety and efficacy of warfarin at doses lower than currently recommended, in patients with an On-X mechanical mitral valve.After On-X mechanical mitral valve replacement followed by at least 3 months of standard anticoagulation, 401 patients at 44 North American centers were randomized to low-dose warfarin (target INR 2.0 to 2.5) or standard-dose warfarin (target INR 2.5 to 3.5). All patients were prescribed aspirin 81 mg daily and encouraged to use home INR testing. The primary endpoint was the sum of the linearized rates of thromboembolism, valve thrombosis, and bleeding events. The design was based on an expected 7.3% event rate and 1.5% noninferiority margin.Mean patient follow-up was 4.1 years. Mean INR was 2.47 and 2.92 (P.001) in the low-dose and standard-dose warfarin groups, respectively. Primary endpoint rates were 11.9%/patient-year in the low-dose group and 12.0%/patient-year in the standard-dose group (difference -0.07, 95% confidence intervals: -3.40, 3.26). The confidence interval exceeded 1.5%, thus noninferiority was not achieved. Rates (%/patient-year) of the individual components of the primary endpoint were 2.3% vs 2.5% for thromboembolism, 0.5% vs 0.5% for valve thrombosis, and 9.13% vs 9.04% for bleeding.Compared to standard-dose warfarin, low-dose warfarin did not achieve noninferiority for the composite primary endpoint. (PROACT Clinicaltrials.gov number, NCT00291525).

Drawing on demands-resources theory, we develop and test a dual-path model to unpack the energizing and draining mechanisms, captured by leader need satisfaction and role conflict, through which servant leadership affects leader psychological strain and job performance. We further identify leader-leader exchange (LLX) as a critical resource moderator that can strengthen the energizing benefit and buffer against the draining cost of servant leadership behaviors. Using five-wave, multisource field data from 474 team leaders, 3,712 followers, and 97 superior leaders, we find support for the energizing benefit, in that servant leadership satisfied leader psychological needs, which subsequently reduced leader psychological strain. This energizing benefit was stronger when LLX was higher. In parallel, servant leaders experienced role conflict, which subsequently increased their psychological strain and deteriorated their job performance when LLX was lower. Overall, our research contributes to a fine-grained understanding of the double-edged effects of servant leadership on leaders and sheds light on how and when leaders can benefit from practicing servant leadership. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

T-cell–rich, large B-cell lymphoma (TCRLBCL) is the most commonly diagnosed type of lymphoma in horses. Here we describe the clinical signs, neuropathology, immunohistochemistry (IHC), and PCR for antigen receptor rearrangement (PARR) analysis results of a TCRLBCL in the brain of an 8-y-old male Quarter Horse that was euthanized after acute anorexia, tremors, head pressing, falling, blindness, incoordination, and seizures. Autopsy revealed a firm, smooth, pale-yellow mass that expanded both lateral ventricles and the adjacent subcortical white matter. Histologically, the mass consisted of a densely cellular neoplasm composed of large, CD79+ neoplastic B-lymphocytes admixed with sheets of small, CD3+ reactive T-lymphocytes, Iba1+ histiocytes, MUM1+ plasma cells, and rare eosinophils supported by a fine fibrovascular stroma. Formalin-fixed, paraffin-embedded tissue scrolls were retrieved and subjected to PARR analysis, which revealed a clonal reaction in the immunoglobulin gene and a polyclonal reaction for the T-lymphocyte receptor gene, consistent with a neoplastic B-lymphocyte and reactive T-lymphocyte proliferation. The diagnosis of TCRLBCL was suspected histologically and confirmed based on IHC and PARR analysis.

Phase correlation (PC) is a well-known method for estimating cloud motion vectors (CMVs) from infrared and visible spectrum images. Commonly, phase shift is computed in the small blocks of the images using the fast Fourier transform. In this study, we investigate the performance and the stability of the blockwise PC method by changing the block size, the frame interval, and combinations of red, green, and blue (RGB) channels from the total sky imager (TSI) at the United States Atmospheric Radiation Measurement user facility's Southern Great Plains site. We find that shorter frame intervals, followed by larger block sizes, are responsible for stable estimates of the CMV, as suggested by the higher autocorrelations. The choice of RGB channels has a limited effect on the quality of CMVs, and the red and the grayscale images are marginally more reliable than the other combinations during rapidly evolving low-level clouds. The stability of CMVs was tested at different image resolutions with an implementation of the optimized algorithm on the Sage cyberinfrastructure test bed. We find that doubling the frame rate outperforms quadrupling the image resolution in achieving CMV stability. The correlations of CMVs with the wind data are significant in the range of 0.38–0.59 with a 95 % confidence interval, despite the uncertainties and limitations of both datasets. A comparison of the PC method with constructed data and the optical flow method suggests that the post-processing of the vector field has a significant effect on the quality of the CMV. The raindrop-contaminated images can be identified by the rotation of the TSI mirror in the motion field. The results of this study are critical to optimizing algorithms for edge-computing sensor systems.

In recent years, applications of Blockchain technology (BCT) have been progressing at a galloping rate in miscellaneous fields, such as finance, education, travel, healthcare, and insurance. However, BCT has gained much popularity in the construction industry, especially in developed nations worldwide, as it can solve real-world problems, including poor payments, inadequate cooperation and collaboration, inappropriate data sharing among stakeholders, and poor efficiency. The current research employs a bibliometric and systematic literature review (SLR) on utilizing BCT in the construction industry. Using co-occurrence and co-citation studies, network visualization and other methodologies concerning the Web of Science (WOS) database and the research contacts’ patterns were investigated in 482 academic papers. Notable publications, conferences, significant writers, nations, organizations, and funding organizations have been acknowledged. Our research reveals that the primary study topics are BCT in the construction industry, supply chain management, smart contracts, sustainability, building information modeling (BIM), the Internet of Things (IoT) and energy efficiency. Several possible fields for further research are mentioned, including the use of BCT in: (i) circular economy, (ii) risk management, (iii) smart villages, and (iv) infrastructure construction projects.

Accurate cloud type identification and coverage analysis are crucial in understanding the Earth’s radiative budget. Traditional computer vision methods rely on low-level visual features of clouds for estimating cloud coverage or sky conditions. Several handcrafted approaches have been proposed; however, scope for improvement still exists. Newer deep neural networks (DNNs) have demonstrated superior performance for cloud segmentation and categorization. These methods, however, need expert engineering intervention in the preprocessing steps—in the traditional methods—or human assistance in assigning cloud or clear sky labels to a pixel for training DNNs. Such human mediation imposes considerable time and labor costs. We present the application of a new self-supervised learning approach to autonomously extract relevant features from sky images captured by ground-based cameras, for the classification and segmentation of clouds. We evaluate a joint embedding architecture that uses self-knowledge distillation plus regularization. We use two datasets to demonstrate the network’s ability to classify and segment sky images—one with ∼ 85,000 images collected from our ground-based camera and another with 400 labeled images from the WSISEG database. We find that this approach can discriminate full-sky images based on cloud coverage, diurnal variation, and cloud base height. Furthermore, it semantically segments the cloud areas without labels. The approach shows competitive performance in all tested tasks, suggesting a new alternative for cloud characterization.

River ecosystems have been altered by flow regulation and species introductions. Regulated flow regimes often include releases designed to benefit certain species or restore ecosystem processes, and invasive species suppression programs may include efforts to restrict access to spawning habitat. The impacts of these management interventions are often uncertain. Here, we assess hypotheses regarding introduced brown trout ( Salmo trutta) movement in a regulated river. We model mark–recapture data in a multistate framework to assess whether movement was affected by the operation of a tributary weir (restricting access to spawning habitat), experimental releases of fall-timed high flow experiments (Fall HFEs), or simply increased during the fall, spawning season. Our results suggest that the presence of the weir led to reduced tributary homing and the release of Fall HFEs stimulated upstream movement and straying. Both effects are of a similar magnitude, however the Fall HFE effect is more certain. Our results suggest the expansion of an invasive species was stimulated by management interventions, and demonstrate the potential for unanticipated outcomes of restoration in highly altered river ecosystems.