Search

Long viewed as a mostly noble, atmospheric species, recent work demonstrates that nitrogen in fact cycles throughout the Earth system, including the atmosphere, biosphere, oceans, and solid Earth. Despite this new-found behaviour, more thorough investigation of N in geologic materials is limited due to its low concentration (one to tens of parts per million) and difficulty in analysis. In addition, N can exist in multiple species (NO3−, NH4+, N2, organic N), and determining which species is actually quantified can be difficult. In rocks and minerals, NH4+ is the most stable form of N over geologic timescales. As such, techniques designed to measure NH4+ can be particularly useful.We measured a number of geochemical rock standards using three different techniques: elemental analyzer (EA) mass spectrometry, colorimetry, and fluorometry. The fluorometry approach is a novel adaptation of a technique commonly used in biologic science, applied herein to geologic NH4+. Briefly, NH4+ can be quantified by HF dissolution, neutralization, addition of a fluorescing reagent, and analysis on a standard fluorometer. We reproduce published values for several rock standards (BCR-2, BHVO-2, and G-2), especially if an additional distillation step is performed. While it is difficult to assess the quality of each method, due to lack of international geologic N standards, fluorometry appears better suited to analyzing mineral-bound NH4+ than EA mass spectrometry and is a simpler, quicker alternative to colorimetry.To demonstrate a potential application of fluorometry, we calculated a continental crust N budget based on new measurements. We used glacial tills as a proxy for upper crust and analyzed several poorly constrained rock types (volcanics, mid-crustal xenoliths) to determine that the continental crust contains ∼ 2 × 1018 kg N. This estimate is consistent with recent budget estimates and shows that fluorometry is appropriate for large-scale questions where high sample throughput is helpful.Lastly, we report the first δ15N values of six rock standards: BCR-2 (1. 05 ± 0. 4 ‰), BHVO-2 (−0. 3 ± 0. 2 ‰), G-2 (1. 23 ± 1. 32 ‰), LKSD-4 (3. 59 ± 0. 1 ‰), Till-4 (6. 33 ± 0. 1 ‰), and SY-4 (2. 13 ± 0. 5 ‰). The need for international geologic N standards is crucial for further investigation of the Earth system N cycle, and we suggest that existing rock standards may be suited to this need.

This study investigated reasons for lower-than-expected uptake of germline genetic testing compared to national guidelines amongst adult patients with cancer, self-reporting clinician recommendation for genetic testing. Cross-sectional survey of 596 patients with a personal history of cancer, responded about their cancer diagnosis, physician recommendation for and status of genetic testing and demographics. Adjusting for potential confounding factors (cancer type, education, income and insurance status) male sex significantly decreased odds of receiving a clinical recommendation for genetic testing (Odds Ratio: 0.06; 95% Confidence Interval: 0.04–0.10). Females, with a diagnosis of breast cancer, were more likely to receive a recommendation than other cancer types (64.8% vs. 90.9%, p < 0.001). Participants who received a physician recommendation were significantly more likely to receive genetic testing (p < 0.001). Clinician recommendation is an important driver of genetic testing, necessitating efforts to increase clinician recommendations, particularly for males and patients with cancers other than breast.

ABSTRACTAlthough severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. In addition, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 (“vax-plasma”). Thus, we report the clinical outcome of 386 immunocompromised outpatients who were diagnosed with COVID-19 and who received contemporary COVID-19-specific therapeutics (standard-of-care group) and a subgroup who also received concomitant treatment with very high titer COVID-19 convalescent plasma (vax-plasma group) with a specific focus on hospitalization rates. The overall hospitalization rate was 2.2% (5 of 225 patients) in the vax-plasma group and 6.2% (10 of 161 patients) in the standard-of-care group, which corresponded to a relative risk reduction of 65% (P = 0.046). Evidence of efficacy in nonvaccinated patients cannot be inferred from these data because 94% (361 of 386 patients) of patients were vaccinated. In vaccinated patients with immunosuppression and COVID-19, the addition of vax-plasma or very high titer COVID-19 convalescent plasma to COVID-19-specific therapies reduced the risk of disease progression leading to hospitalization.IMPORTANCEAs SARS-CoV-2 evolves, new variants of concern (VOCs) have emerged that evade available anti-spike monoclonal antibodies, particularly among immunosuppressed patients. However, high-titer COVID-19 convalescent plasma continues to be effective against VOCs because of its broad-spectrum immunomodulatory properties. Thus, we report clinical outcomes of 386 immunocompromised outpatients who were treated with COVID-19-specific therapeutics and a subgroup also treated with vaccine-boosted convalescent plasma. We found that the administration of vaccine-boosted convalescent plasma was associated with a significantly decreased incidence of hospitalization among immunocompromised COVID-19 outpatients. Our data add to the contemporary data providing evidence to support the clinical utility of high-titer convalescent plasma as antibody replacement therapy in immunocompromised patients.

We have created the immunodeficient SRG rat, a Sprague-Dawley Rag2/Il2rg double knockout that lacks mature B cells, T cells, and circulating NK cells. This model has been tested and validated for use in oncology (SRG OncoRat®). The SRG rat demonstrates efficient tumor take rates and growth kinetics with different human cancer cell lines and PDXs. Although multiple immunodeficient rodent strains are available, some important human cancer cell lines exhibit poor tumor growth and high variability in those models. The VCaP prostate cancer model is one such cell line that engrafts unreliably and grows irregularly in existing models but displays over 90% engraftment rate in the SRG rat with uniform growth kinetics. Since rats can support much larger tumors than mice, the SRG rat is an attractive host for PDX establishment. Surgically resected NSCLC tissue from nine patients were implanted in SRG rats, seven of which engrafted and grew for an overall success rate of 78%. These developed into a large tumor volume, over 20,000 mm3 in the first passage, which would provide an ample source of tissue for characterization and/or subsequent passage into NSG mice for drug efficacy studies. Molecular characterization and histological analyses were performed for three PDX lines and showed high concordance between passages 1, 2 and 3 (P1, P2, P3), and the original patient sample. Our data suggest the SRG OncoRat is a valuable tool for establishing PDX banks and thus serves as an alternative to current PDX mouse models hindered by low engraftment rates, slow tumor growth kinetics, and multiple passages to develop adequate tissue banks.

Facial width-to-height ratio (fWHR) has been proposed as a sexually dimorphic signal in humans that develops under the influence of pubertal testosterone (T); however, no studies have examined the association between fWHR and T during the phase in which facial growth is canalized--adolescence. In a sample of adolescent Tsimane males, we evaluate the relationship between T, known T-derived traits (i.e. strength and voice pitch), and craniofacial measurements. If fWHR variation derives from T's effect on craniofacial growth during adolescence, several predictions should be supported: 1) fWHR should increase with age as T increases, 2) fWHR should reflect adolescent T (rather than adult T per se), 3) fWHR should exhibit velocity changes during adolescence in parallel with the pubertal spurt in T, 4) fWHR should correlate with T after controlling for age and other potential confounds, and 5) fWHR should show strong associations with other T-derived traits. Only prediction 4 was observed. Additionally, we examined three alternative facial masculinity ratios: facial width/lower face height, cheekbone prominence, and facial width/full face height. In contrast to fWHR, all three alternative measures show a strong age-related trend and are associated with both T and T-dependent traits. Overall, our results question the status of fWHR as a sexually-selected signal of pubertal T and T-linked traits.

Nitrous oxide (N2O) has 265 times greater greenhouse potential than carbon dioxide and its atmospheric concentration has increased by about 20% since industrialization; however, N2O production and emissions from aquatic systems are poorly constrained. To evaluate N2O fluxes associated with meteoric groundwater discharge to coastal zones, we measured N2O concentrations in May and October 2011 from two discharge points of the Upper Glacial aquifer on Long Island, NY, USA. One coastal zone contains only fresh water and the other contains an upper saline zone. N2O concentrations decreased by around 40% for the fresh water and a factor of two for the salt water from May to October, 2011. Fluxes were around 100 to 200 times greater from the freshwater (246 to 448 µmol/m shoreline/day) than saltwater aquifer (26.1 to 26.5 µmol/m shoreline/day). N2O concentrations correlate positively with NO3− and dissolved oxygen concentrations and negatively with salinity, dissolved organic carbon (DOC) and N2 denitrification concentrations. The smaller saltwater N2O export resulted from DOC enrichment in the upper saline zone, which appears to have driven denitrification to completion, removed N2O, and increased N2 denitrification. DOC concentrations should be considered in global N2O flux estimates for coastal aquifers.

We explore textural cues as a mechanism for controlling neuronal process outgrowth in primary cultures of mammalian neurons. The work uses a form of decal transfer lithography to generate arrays of PDMS posts of various dimensions and spacings on glass substrates that are rendered growth-compliant by subsequent treatment with a protein activator. Hippocampal neurons plated on these substrates are used to determine how the posts direct process growth by acting as attachment points or guidance cues. Textural features varying over a large range, even as large as 100 µm in diameter, dramatically affect process growth. Indeed, two growth regimes are observed; at the smaller feature sizes considered, process branching strongly aligns (at right angles) along the post mesh, while neuronal outgrowth on the larger feature sizes elicits process wrapping. The latter behavior most strongly manifests in neurons plated initially at ∼100 cells/mm2, where the cells were able to form networks, while for isolated neurons, the cells exhibit poorer viability and development. Bag cell neurons from Aplysia californicaalso display regular growth patterns, but in this case are guided by contact avoidance of the posts, a behavior qualitatively different than that of the hippocampal neurons. [ABSTRACT FROM AUTHOR]

In this study we have introduced the 11-methoxy group, a substituent known to increase in vivopotency in other steroidal estrogens, into the (17,20E)-21-(trifluoromethylphenyl)-19-norpregna-1,3,5(10),20-tetraene-3,17-diols:  (trifluoromethylphenyl)vinyl estradiols. Receptor binding, using the ER-HBD, indicated that the 11-methoxy group had little effect on the relative binding affinity of the target compounds compared to the corresponding 11-unsubstituted analogs, however, the 11-methoxy derivatives were significantly more potent in stimulating uterotrophic growth in immature female rats. Molecular modeling studies suggest that while the 11-methoxy group does not contribute significantly to the overall binding energy of the ligand−ER-HBD complex, it stabilizes residues associated with the coregulator protein binding site. Such effects would influence the dynamics of subsequent events, such as transcription and biological responses. [ABSTRACT FROM AUTHOR]

This study investigated whether women track possible cues of paternal and genetic quality in men's faces and then map perception of those cues onto mate attractiveness judgments. Men's testosterone concentrations served as a proxy for genetic quality given evidence that this hormone signals immunocompetence, and men's scores on an interest in infants test were chosen as prima facie markers of paternal quality. Women's perceptions of facial photographs of these men were in fact sensitive to these two variables: men's scores on the interest in infants test significantly predicted women's ratings of the photos for how much the men like children, and men's testosterone concentrations significantly predicted women's ratings of the men's faces for masculinity. Furthermore, men's actual and perceived affinity for children predicted women's long-term mate attractiveness judgments, while men's testosterone and perceived masculinity predicted women's short-term mate attractiveness judgments. These results suggest that women can detect facial cues of men's hormone concentrations and affinity for children, and that women use perception of these cues to form mate attractiveness judgments. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that the Monoclonal Antibody Screening Score performs consistently better in identifying the need for monoclonal antibody infusion throughout each “wave” of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant predominance during the coronavirus disease 2019 (COVID-19) pandemic and that the infusion of contemporary monoclonal antibody treatments is associated with a lower risk of hospitalization. Patients and Methods: In this retrospective cohort study, we evaluated the efficacy of monoclonal antibody treatment compared with that of no monoclonal antibody treatment in symptomatic adults who tested positive for SARS-CoV-2 regardless of their risk factors for disease progression or vaccination status during different periods of SARS-CoV-2 variant predominance. The primary outcome was hospitalization within 28 days after COVID-19 diagnosis. The study was conducted on patients with a diagnosis of COVID-19 from November 19, 2020, through May 12, 2022. Results: Of the included 118,936 eligible patients, hospitalization within 28 days of COVID-19 diagnosis occurred in 2.52% (456/18,090) of patients who received monoclonal antibody treatment and 6.98% (7,037/100,846) of patients who did not. Treatment with monoclonal antibody therapies was associated with a lower risk of hospitalization when using stratified data analytics, propensity scoring, and regression and machine learning models with and without adjustments for putative confounding variables, such as advanced age and coexisting medical conditions (eg, relative risk, 0.15; 95% CI, 0.14-0.17). Conclusion: Among patients with mild to moderate COVID-19, including those who have been vaccinated, monoclonal antibody treatment was associated with a lower risk of hospital admission during each wave of the COVID-19 pandemic.

Abstract Background Only a small proportion of patients who qualify for clinical genetic testing for cancer susceptibility get testing. Many patient‐level barriers contribute to low uptake. In this study, we examined self‐reported patient barriers and motivators for cancer genetic testing. Methods A survey comprised of both new and existing measures related to barriers and motivators to genetic testing was emailed to patients with a diagnosis of cancer at a large academic medical center. Patients who self‐reported receiving a genetic test were included in these analyses (n = 376). Responses about emotions following testing as well as barriers and motivators prior to getting testing were examined. Group differences in barriers and motivators by patient demographic characteristics were examined. Results Being assigned female at birth was associated with increased emotional, insurance, and family concerns as well as increased health benefits compared to patients assigned male at birth. Younger respondents had significantly higher emotional and family concerns compared to older respondents. Recently diagnosed respondents expressed fewer concerns about insurance implications and emotional concerns. Those with a BRCA‐related cancer had higher scores on social and interpersonal concerns scale than those with other cancers. Participants with higher depression scores indicated increased emotional, social and interpersonal, and family concerns. Conclusions Self‐reported depression emerged as the most consistent factor influencing report of barriers to genetic testing. By incorporating mental health resources into clinical practice, oncologists may better identify those patients who might need more assistance following through with a referral for genetic testing and the response afterwards.

Abstract Background Although most cancers are sporadic, germline genetic variants are implicated in 5–10% of cancer cases. Clinical genetic testing identifies pathogenic germline genetic variants for hereditary cancers. The Michigan Genetic Hereditary Testing (MiGHT) study is a three-arm randomized clinical trial that aims to test the efficacy of two patient-level behavioral interventions on uptake of cancer genetic testing. Methods The two interventions being tested are (1) a virtual genetics navigator and (2) motivational interviewing by genetic health coaches. Eligible participants are adults with a diagnosis of breast, prostate, endometrial, ovarian, colorectal, or pancreatic cancer who meet the National Comprehensive Cancer Network (NCCN) criteria for genetic testing. Participants are recruited through community oncology practices affiliated with the Michigan Oncology Quality Consortium (MOQC) and have used the Family Health History Tool (FHHT) to determine testing eligibility. The recruitment goal is 759 participants, who will be randomized to usual care or to either the virtual genetics navigator or the motivational interviewing intervention arms. The primary outcome will be the proportion of individuals who complete germline genetic testing within 6 months. Discussion This study addresses patient-level factors which are associated with the uptake of genetic testing. The study will test two different intervention approaches, both of which can help address the shortage of genetic counselors and improve access to care. Trial registration This study has been approved by the Institutional Review Board of the University of Michigan Medical School (HUM00192898) and registered in ClinicalTrials.gov (NCT05162846).

Per- and polyfluoroalkyl substances (PFAS) are widespread and highly persistent organic chemicals with adverse health effects. The US Environmental Protection Agency has issued health advisory limits of 70 ng/L for aqueous concentrations of PFOA + PFOS. In the Colorado Springs, Colorado (USA), metro area, the Widefield Aquifer (groundwater) and Fountain Creek Watershed (surface water) have been contaminated by PFAS from aqueous film-forming foams. Here we present the concentrations of selected linear and branched isomers of legacy PFAS found in surface water (n = 95), soil (n = 83), and sediment (n = 34) samples collected from several creeks of the Fountain Creek Watershed. Collected samples were prepared for high-performance liquid chromatography tandem mass spectrometry (LC/MS/MS) analysis via liquid/liquid extraction and/or solid phase extraction (SPE). This dataset includes the geographic locations of sampled creeks, LC/MS/MS instrumental conditions, method verification data including percent recovery to assess method accuracy and background contamination of PFAS in laboratory reagents and supplies, and determined concentrations of PFAS in water, soil, and sediment samples. These locations were surveyed monthly for a full year and provide a rich dataset to assess influence of sampling location, temporal variability in concentration, and overall contaminant persistence.

Objective: To outline a consensus-designed process for triaging and managing patients with post-coronavirus disease (COVID-19) syndrome at Mayo Clinic. Patients and Methods: We convened a central multidisciplinary team including members from the departments of general internal medicine, occupational medicine, physical medicine and rehabilitation, psychology, allergy and immunology, infectious disease, pulmonology, neurology, cardiology, and pediatrics and otorhinolaryngology with membership from all Mayo Clinic sites in Arizona, Florida, Iowa, Minnesota, and Wisconsin. Results: Consensus recommendations were made for the best practice guidelines on triaging and managing patients. Several innovations were agreed upon, including a postacute sequelae of COVID-19-specific appointment request form for data collection, a bioregistry, a biorepository, and a postacute sequelae of COVID-19-specific treatment program. Conclusion: Given that each clinical site had individual clinical practices, these recommendations were implemented using different models, which may provide broad applicability to other clinical settings.

Background The clinical outcomes of patients who decline anti-spike monoclonal antibody therapies for coronavirus disease-2019 (COVID-19) is not known. Factors associated with the decision to accept or decline the offer for anti-spike monoclonal antibody therapies are not established. This study aimed to identify factors impacting the decision to consent for monoclonal antibody therapies and assess the differences in clinical outcomes of patients who accepted compared to those who declined these therapies. Methods This retrospective cohort study enrolled 2820 adult patients who were offered monoclonal antibody therapies, bamlanivimab and casirivimab-imdevimab, for COVID-19 at Mayo Clinic in the Midwest between 11/19/2020 and 12/31/2020. The primary endpoint is the decision to accept or decline monoclonal antibody treatment. Secondary endpoints were patient-level factors that could have impacted the decision to accept treatment (age, gender, race, ethnicity, primary language spoken, and medical comorbidities). The main clinical endpoint was hospitalization within 28 days of COVID-19 diagnosis. Results 59.1% (n = 1669) chose to accept monoclonal antibody therapy, and 40.9% (n = 1151) chose to decline the offer for treatment. Patients were more likely to accept treatment if they were non-Hispanic White, English speaking, identified a spouse or life partner, had a religious affiliation, and possessed more medical comorbidities. Overall, 28-day hospitalization rate was 2.6% (n = 72/2820) and was higher among those who declined (3.3%) than those who accepted monoclonal antibody therapy (2.0%; Rate Ratio = 0.62, 95% Confidence Interval, 0.39-0.98). Conclusions Despite having more comorbidities, patients who accepted monoclonal antibody treatments had a lower rate of hospitalization compared to patients who declined treatment. Several social and cultural factors were associated with the decision to decline therapy, including race, language, ethnicity, and lack of social support. These findings can inform public health efforts to reduce social disparities in the treatment of COVID-19 and increase utilization of monoclonal antibody therapies in high risk populations.

Clinical research coordinators are increasingly tasked with a multitude of complex study activities critical to scientific rigor and participant safety, though more than half report not receiving appropriate training. To determine the reproducibility of an established clinical research workforce orientation program, collaborative partners across Clinical and Translational Science Award institutions seeded core principles and structure from Mayo Clinic’s Clinical Research Orientation program within Penn State University and the University of Mississippi Medical Center from 2019 to 2021. Training concepts were established and tied to those domains deemed critical by the Joint Task Force for Clinical Trial Competency for the conduct of clinical research at the highest levels of safety and quality possible. Significant knowledge and confidence gains and high overall program satisfaction were reported across participants and partner sites, despite programs being required to pivot from traditional, in-person formats to entirely virtual platforms as a result of the COVID-19 pandemic. The successful standardization and translation of foundational clinical research training has important efficiency and efficacy implications for research enterprises across the USA.

Malignant proliferating trichilemmal tumors (MPTT) are rare skin lesions arising from the outer sheath of the hair follicle root. Because of their rarity and difficulty in pathologic identification, these skin lesions are often initially misdiagnosed. After a literature review, we found initial clinical or histopathological misdiagnosis has an associated 10.4-fold increase in recurrence and 2.18-fold increase in deaths., (© 2024 Wiley Periodicals LLC.)

We demonstrate proprioceptive feedback control of a one degree of freedom soft, pneumatically actuated origami robot and an assembly of two robots into a two degree of freedom system. The base unit of the robot is a 41 mm long, 3-D printed Kresling-inspired structure with six sets of sidewall folds and one degree of freedom. Pneumatic actuation, provided by negative fluidic pressure, causes the robot to contract. Capacitive sensors patterned onto the robot provide position estimation and serve as input to a feedback controller. Using a finite element approach, the electrode shapes are optimized for sensitivity at larger (more obtuse) fold angles to improve control across the actuation range. We demonstrate stable position control through discrete-time proportional-integral-derivative (PID) control on a single unit Kresling robot via a series of static set points to 17 mm, dynamic set point stepping, and sinusoidal signal following, with error under 3 mm up to 10 mm contraction. We also demonstrate a two-unit Kresling robot with two degree of freedom extension and rotation control, which has error of 1.7 mm and 6.1°. This work contributes optimized capacitive electrode design and the demonstration of closed-loop feedback position control without visual tracking as an input. This approach to capacitance sensing and modeling constitutes a major step towards proprioceptive state estimation and feedback control in soft origami robotics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hanson, Mensah, Roberts, Healey, Wu and Dorsey.)

Background: The Delta Oasis program was launched in New Brunswick in 2006 to offer patients from rural areas who were undergoing breast cancer surgery and their families 1 night of free accommodations and a postoperative consultation with an extramural nurse. We sought to investigate patient experiences with this program., Methods: This mixed-method retrospective study took place from 2020 to 2022 and compared the preoperative anxiety and quality of recovery of program participants and control patients who were discharged home over 100 km from hospital. We conducted 2 × 2 analysis of variance to evaluate the effects of intervention group and surgery type. We conducted semistructured interviews with intervention participants, which we then thematically analyzed. Two patient partners were engaged during data synthesis to support the interpretation of results., Results: We included 34 patients who participated in the program and 18 control patients. No statistically significant differences were found between treatment groups in preoperative anxiety and quality of recovery, regardless of surgery type. Thematic analysis of interviews with 17 intervention participants revealed that they were highly satisfied with the program and that the experience helped reduce stress and discomfort related to their surgery., Interpretation: The Delta Oasis program is a cost-effective alternative to inpatient care after breast cancer surgery and is highly regarded by rural patients; expansion to other regions with the inclusion of additional low-risk surgeries could help address hospital capacity issues. This study contributes to our understanding of the patient experience with the Delta Oasis program and informs the development of similar programs elsewhere., Competing Interests: Competing interests:: Sharon Chiu reports consulting fees from Merck and conference support from Allergan. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)

Background: Medication adherence is critical for optimal management of chronic obstructive pulmonary disease (COPD) and is influenced by patient, treatment and societal factors. Currently, little is known about the patient perspectives of older adult Canadians with COPD regarding medication adherence. Therefore, the purpose of this study was to explore the lived experiences of older Canadian adults with COPD regarding medication adherence and management., Methods: Semi-structured interviews were conducted with 20 community-dwelling older adults with COPD, and iterative thematic analysis was performed., Results: Six themes emerged from these data: (1) continuity of care, (2) importance of pharmacy for information and care, (3) medication self-management, (4) "there needs to be more information," (5) drug costs a concern and (6) "it's a lonely battle.", Conclusion: Findings suggested a need for improved continuity of care, disease-related information provision and means of addressing psychosocial needs. Holistic approaches to patient education and self-management, with consideration for varying health literacy, are needed., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s) 2022.)

Cluttered environments with partial object occlusions pose significant challenges to robot manipulation. In settings composed of one dominant object type and various undesirable contaminants, occlusions make it difficult to both recognize and isolate undesirable objects. Spatial features alone are not always sufficiently distinct to reliably identify anomalies under multiple layers of clutter, with only a fractional part of the object exposed. We create a multi-modal data representation of cluttered object scenes pairing depth data with a registered hyperspectral data cube. Hyperspectral imaging provides pixel-wise Visible Near-Infrared (VNIR) reflectance spectral curves which are invariant in similar material types. Spectral reflectance data is grounded in the chemical-physical properties of an object, making spectral curves an excellent modality to differentiate inter-class material types. Our approach proposes a new automated method to perform hyperspectral anomaly detection in cluttered workspaces with the goal of improving robot manipulation. We first assume the dominance of a single material class, and coarsely identify the dominant, non-anomalous class. Next these labels are used to train an unsupervised autoencoder to identify anomalous pixels through reconstruction error. To tie our anomaly detection to robot actions, we then apply a set of heuristically-evaluated motion primitives to perturb and further expose local areas containing anomalies. The utility of this approach is demonstrated in numerous cluttered environments including organic and inorganic materials. In each of our four constructed scenarios, our proposed anomaly detection method is able to consistently increase the exposed surface area of anomalies. Our work advances robot perception for cluttered environments by incorporating multi-modal anomaly detection aided by hyperspectral sensing into detecting fractional object presence without need for laboriously curated labels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hanson, Lvov and Padir.)

Introduction: The COVID-19 pandemic decreased in-person didactic sessions in our general surgery residency. We piloted a program to develop online tutorials posted to a YouTube channel designed to prepare our residents for the ABSITE examination., Methods: Study participants were General Surgery residents in our five-year ACGME accredited general surgery residency program who took the ABSITE in-service exam between 2019 and 2021. We compared raw scores and overall programmatic percentile scores for three academic years (2018-2019, 2019-2020, and 2020-2021)., Results: From academic year 2018-2019 to 2019-2020, before introducing the YouTube teaching platform, average raw scores and percentile scores among our general surgery residents remained unchanged (raw scores 64 - 65% ( p = ns), percentile scores 39 to 37% ( p = ns)). However, raw ABSITE scores increased significantly after introducing the YouTube teaching platform. A one-way ANOVA showed a statistically significant difference in raw ABSITE scores for AY 2020-2021 compared to the two prior years (F(2, 30) = [1.193], P < 0.01). Mean percentile ranking scores (program-wide) increased 15% from AY 2018-2019 to AY 2020-2021 (Figure1)., Conclusion: Teaching via an online platform such as YouTube allows residents to review material at their own pace and schedule. It is other our hypothesis is that the online YouTube material presented in the Ventura Surgery School channel contributed, in part, to this relative improvement compared to resident peers in other institutions. Teaching via an online platform could be a valuable tool to educate surgical learners in our ever-changing teaching environment.

Opioid therapy has been the mainstay therapy of post-operative pain management in thoracic surgery patients. With the high incidence of chronic pain in thoracic surgery patients and adverse effects of opioids, we examined the safety and efficacy of cryoneurolysis as an adjunct for narcotic-free pain management in robotic-assisted thoracoscopic lobectomies. Ten consecutive patients undergoing robotic-assisted (DaVinci) pulmonary resection and cryoneurolysis were compared to ten patients managed without intraoperative cryoneurolysis. All patients received multimodal pain regimen including paravertebral blocks as per our institutional enhanced recovery pathway. Patients with chronic pain and chronic opioid use were excluded. We compared inpatient and outpatient opioid consumption measured in morphine equivalents (mme), incidence of opioid-free outpatient recovery, and adverse events. The two groups did not differ significantly in terms of baseline demographics. Both inpatient (88.13 vs 26.92 mme) and outpatient (118.5 vs 34.5 mme) use of narcotics were significantly lower in the cryoneurolysis group (p < 0.05) with seven of ten patients receiving cryoneurolysis able to recover without the use of opioids in the outpatient setting, compared to two in the control group. One patient reported post-operative neuralgia in each cryoneurolysis and control group. There were no readmissions in either group and mean length of stay was identical at 1.7 days in control group and 1.1 days in experimental group (p = 0.33). The use of intraoperative intercostal cryoneurolysis may safely reduce the utilization of outpatient opioids in patients undergoing robotic-assisted thoracoscopic surgery. A randomized controlled trial is warranted to validate these findings in a larger cohort of patients., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: Length of stay (LOS) in the hospital following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has decreased over the past decade due to well-defined postoperative clinical pathways, earlier mobilization, and improved pain control methods. Historically, liberal use of parenteral and oral opioids for pain control caused side effects, resulting in delayed discharge. Intraoperative intrathecal morphine (ITM) has been posited to reduce the need for postoperative opioids and to expedite the discharge process. This study examines the relationship between the use of ITM with average required postoperative opioid usage and with average LOS., Methods: This IRB-approved retrospective cohort study examined 105 patients with AIS who received PSF with instrumentation split into two cohorts. One cohort underwent PSF via standard surgical protocol (n=40) while the other cohort received intraoperative ITM with the standard surgical protocol (n=65). Power analysis demonstrated a study power of 0.8. LOS and total postoperative opioid analgesic medication (morphine milligram equivalent, MME) data were collected. Age at surgery, gender, number of spinal levels fused, estimated intraoperative blood loss (EBL), preoperative Cobb angle, and any complications related to the use of ITM were also recorded. Continuous variables were analyzed with Student's t-test and categorical variables were analyzed with chi-square independent-sample tests using SAS 9.4 (α = 0.05)., Results: Patients who were treated with ITM displayed shorter LOS (p<0.0001) and reduced postoperative analgesic requirement (p<0.0001). Patients who received ITM spent an average of 1.8 fewer midnights in the hospital and received an average of 221.2 MME less than patients who received standard protocol (57% decrease). There were no significant differences between the two groups for any other variable., Conclusion: Intraoperative ITM is a simple and effective treatment for scoliosis surgeons to better control postoperative pain in patients, reduce the risk of dependency, and achieve earlier discharge from the hospital. Shortened LOS reduces the overall cost of care, benefitting patients, hospitals, and insurance companies. Based on the results of this study and several earlier studies, the authors recommended that scoliosis surgeons consider incorporating use of ITM into their standard operative protocols. Level of Evidence: IV ., (Copyright © The Iowa Orthopaedic Journal 2022.)

The purpose of this policy statement is to update the 2004 American Academy of Pediatrics clinical report and provide enhanced guidance for institutions, administrators, and providers in the development and operation of a pediatric intermediate care unit (IMCU). Since 2004, there have been significant advances in pediatric medical, surgical, and critical care that have resulted in an evolution in the acuity and complexity of children potentially requiring IMCU admission. A group of 9 clinical experts in pediatric critical care, hospital medicine, intermediate care, and surgery developed a consensus on priority topics requiring updates, reviewed the relevant evidence, and, through a series of virtual meetings, developed the document. The intended audience of this policy statement is broad and includes pediatric critical care professionals, pediatric hospitalists, pediatric surgeons, other pediatric medical and surgical subspecialists, general pediatricians, nurses, social workers, care coordinators, hospital administrators, health care funders, and policymakers, primarily in resource-rich settings. Key priority topics were delineation of core principles for an IMCU, clarification of target populations, staffing recommendations, and payment., (Copyright © 2022 by the American Academy of Pediatrics.)

Introduction: Adolescents with neuromuscular disease face significant challenges accessing social leisure activities. Assistive technology has provided new opportunities for those with neuromuscular disease to augment their social lives and leisure pursuits. However, there is limited research evaluating the impact of these technologies., Methods: This study employed mixed methods to evaluate the potential impact of simple robotics on psychosocial factors and quality of life for those adolescents living with neuromuscular diseases. Semi-structured qualitative interviews were performed, as well as the adult Psychosocial Impact of Assistive Technology Device (PIADS) with 9 adolescents, ranging in age from 13 to 19 years old., Results: Thematic analysis of the qualitative data resulted in five major themes: everyday lives and seasonality; socialization; leisure activities; robotics as a leisure activity; and ease of use of robotics. The PIADS found the individual scores demonstrated a range from very little yet positive perceived impact to maximum positive impact in each subscale (competence, adaptability, and self-esteem)., Conclusions: Simple mainstream robotics, paired with personalized access methods to control them, offer potential leisure and social integration opportunities to adolescents with neuromuscular diseases in a variety of settings, indoors and outdoors. The findings of this study suggest there are opportunities for this type of mainstream technology to be applied not just to adolescents, but potentially children of all ages with neuromuscular disease, across a variety of environments., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Paravertebral pain catheters have been shown to be equally effective as epidural pain catheters for postoperative analgesia after thoracic surgery with the possible additional benefit of less hemodynamic effect. However, a methodology for verifying correct paravertebral catheter placement has not been tested or objectively confirmed in previous studies. The aim of the current study was to describe a technique to confirm the correct position of a paravertebral pain catheter using a contrast-enhanced paravertebrogram., Methods: A retrospective cohort proof of concept study was performed including 10 consecutive patients undergoing elective thoracic surgery with radiographic contrast-enhanced confirmation of intraoperative paravertebral catheter placement (paravertebrogram)., Results: The results of the paravertebrograms, which were done in the operating room at the end of the procedure, verified correct paravertebral catheter placement in 10 of 10 patients. The radiographs documented dissemination of local anesthetic within the paravertebral space., Conclusion: This proof of concept study demonstrated that a contrast-enhanced paravertebrogram could be used in conjunction with standard postoperative chest radiography to add valuable information for the assessment of paravertebral catheter placement. This technique has the potential to increase the accuracy and efficiency of postoperative analgesia, and to set a quality standard for future studies of paravertebral pain catheters., (© 2020. The Author(s).)

Purpose: A regional task force of health-system pharmacy leaders was created to assist with successful adoption of United States Pharmacopeia (USP) general chapter <800>., Summary: A group of pharmacy leaders in the Kansas City region identified potential benefits to healthcare personnel and patients if hazardous drug handling procedures were standardized. A task force was created, a preimplementation survey was distributed, and meetings were held monthly to discuss sections of USP <800> identified as the most challenging to implement. The task force focused on an assessment of risk tool, hot topics, cleanroom design, and a detailed analysis of controversial medications. After the first year of meetings, a postimplementation survey was distributed, and the results were analyzed. The task force created significant value for the participants and achieved the goal of facilitating efficient USP <800> implementation resulting in greater compliance and consistency across the multiple health systems represented. Over 5,100 beds and 200 clinic sites were affected by this task force's efforts. Nearly three-fourths (73%) of respondents reported that the task force was "extremely helpful," and the majority (64%) of respondents adopted most or all (81%-100%) of the task force's assessment of risk choices. Prioritization of tasks, information sharing, and decision-making were areas where the individual leaders were most supported., Conclusion: Creating a structure to eliminate barriers and facilitate collaboration among regional pharmacy leaders provided a framework for successful implementation of USP <800> requirements. This interdependent leadership model produced innovative and standardized solutions and should be considered when addressing complicated initiatives that impact the profession., (© American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Sodium polystyrene sulfonate (SPS) is one of the most commonly used treatments for mild hyperkalemia. Other treatments include insulin, sodium bicarbonate, and salbutamol, which may be given alone or in combination. The results of research examining treatment effectiveness for mild hyperkalemia (e.g., the ability of SPS to achieve normokalemia) thus far have been inconsistent. Given that the effectiveness of treatment for mild hyperkalemia is debatable, new research is needed., Objective: To determine whether treatment of hospitalized patients with mild hyperkalemia (using SPS or another approach, relative to no treatment) was associated with achievement of normokalemia (serum potassium < 5.1 mmol/L)., Methods: For this retrospective, quasi-experimental study, hospitalized patients with index serum potassium level between 5.1 and 6.4 mmol/L were identified. Post-index serum potassium level within 24 hours was dichotomized (< 5.1 or ≥ 5.1 mmol/L). Pre-index serum creatinine and serum potassium levels were recorded as the average of the first 5 values immediately before the index potassium value. For each patient, treatment was categorized as no treatment, SPS treatment, or other treatment strategy., Results: Among the 1944 patients included in the analysis, the average age was 66.8 (standard deviation 13.5) years; 605 (31.1%) of the patients were women and 1339 (68.9%) were men. Logistic regression results indicated that patients who were female and/or had higher pre-index serum potassium were less likely to return to normokalemia within 24 hours after the time of the index serum potassium value. Treatment category was not a statistically significant predictor of the achievement of normokalemia. Most patients with mild hyperkalemia (> 74.5% in each treatment category) achieved normokalemia, whether or not they received treatment., Conclusions: The findings of this study suggest that although follow-up is required for mild hyperkalemia in hospitalized patients, active treatment may be unnecessary., Competing Interests: Competing interests: None declared., (2021 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.)

The main purpose of this study was to model and analyze hospital to home transition processes of frail older adults in order to identify the challenges within this process. A multi-phase, multi-sited and mixed methods design was utilized, in which, Phase 1 included collecting semi-structured interviews and focus group data, and Phase 2 consisted of six patient/caregiver dyad prospective case studies. This study was conducted in three hospitals in three cities in a single province in Canada. The Functional Resonance Analysis Method (FRAM) was employed to model daily operations of the transition process. The perspectives of both healthcare providers and patients/caregivers were used to build the FRAM model. The transition model was then tested using a customized version of the FRAM. The six patient/caregiver cases were used in the process of testing the FRAM model. The results of building the FRAM model showed that five categories of functions contributed to the transition model, including admission, assessment, synthesis, decision-making, and readmission. The outcomes of using the customized version of the FRAM revealed challenges affecting the transition process including waitlists for geriatric units, team-based care, lack of a discharge planner, financial concerns, and follow-up plans. The findings of this study could assist managers and other decision makers to improve the transition processes of frail older adults by addressing these challenges. The FRAM method employed in this study can be applied widely to identify work practices that are more or less successful, so that procedures and practices can be adapted to nudge healthcare processes towards paths that will yield better outcomes., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Functional Resonance Analysis Method (FRAM) is a function-based approach to model complex socio-technical systems and to manage variability. The current FRAM related tools are unable to capture qualitative and quantitative characteristics of variability as well as temporal variations. This study presents in detail a dynamic FRAM-based tool, which is called DynaFRAM. It is introduced to address the variability-related deficiencies of the FRAM related tools. It aims to capture variability in complex operations. It is a dynamic tool developed to capture time related variations in complex operations. This increases the attractiveness of the DynaFRAM for complex operations where specialists and practitioners make decisions in complicated situations. The ability of the DynaFRAM is demonstrated by examining a healthcare related case study. Although the ability of the DynaFRAM is assessed through capturing variations in healthcare operations, it can be applied to other domains in a similar manner.•The DynaFRAM is a dynamic FRAM-based tool.•It is able to captures different characteristics of variability.•It facilitates understanding and analysis of variability in complex operations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s). Published by Elsevier B.V.)