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Background: Despite advancements in critical care and coronary revascularization, cardiogenic shock (CS) outcomes remain poor. Implementing a shock team and use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have been associated with improved CS outcomes, but its feasibility in remote and rural areas remains unknown. Methods: This retrospective study included patients with CS who required mechanical circulatory support (MCS) at Health Sciences North, Sudbury, Ontario. The analysis aimed to accomplish 2 objectives: first, to review the outcomes associated with use of Impella (Abiomed, Danvers, MA) and, second, to assess the feasibility of establishing a shock team to facilitate the local implementation of VA-ECMO. The primary endpoint was in-hospital mortality. Results: The outcomes of 15 patients with CS who received Impella between 2015 and 2021 were reviewed. Their average age was 65 years (standard deviation [SD]: 13), and 8 patients (53%) were female. CS was ischemic in 12 patients (80%). Transfemoral Impella CP (cardiac power) was the most frequently used (93%). Thirteen patients (87%) died during the index hospital stay post-Impella because of progressive circulatory failure. The shock team was established following consultations with several Canadian MCS centres, leading to the development of a protocol to guide use of MCS. There have been 4 cases in which percutaneous VA-ECMO using Cardiohelp (Getinge/Maquet, Wayne, NJ) has been used; 3 (75%) survived beyond the index hospitalization. Conclusions: This analysis demonstrated the feasibility of implementing a shock team in remote Northern Ontario, enabling the use of VA-ECMO with success in a centre with a sizeable rural catchment area. This initiative helps address the gap in cardiac care outcomes between rural and urban areas in Ontario. Résumé: Introduction: En dépit des avancées des soins aux patients en phase critique et de la revascularisation coronarienne, les résultats du choc cardiogénique (CC) semblent mauvais. La mise en place d’une équipe de choc et l’utilisation de l’oxygénation extracorporelle (ECMO, de l’anglais extracorporeal membrane oxygenation) par voie veino-artérielle (VA) (VA-ECMO) ont été associées à de meilleurs résultats du CC, mais on ignore sa faisabilité dans les régions éloignées et rurales. Méthodes: La présente étude rétrospective portait sur des patients en CC qui ont eu besoin d’une assistance circulatoire mécanique (ACM) à Horizon Santé-Nord, à Sudbury, en Ontario. L’analyse visait 2 objectifs : le premier objectif était de passer en revue les résultats associés à l’utilisation de Impella (Abiomed, Danvers, MA) et, le deuxième était d’évaluer la faisabilité de la mise en place d’une équipe de choc pour faciliter la mise en œuvre locale de la VA-ECMO. Le principal critère d’évaluation était la mortalité intrahospitalière. Résultats: Nous avons passé en revue les résultats cliniques de 15 patients ayant subi un CC qui avaient reçu une Impella entre 2015 et 2021. L’âge moyen était de 65 ans (écart type [ET] : 13), et 8 patients (53 %) étaient des femmes. Le CC était d’origine ischémique chez 12 patients (80 %). L’Impella CP (cardiac power, soit la pompe cardiaque) par voie transfémorale était la plus fréquemment utilisée (93 %). Treize patients (87 %) sont morts durant le séjour de référence à l’hôpital après l’utilisation de l’Impella en raison d’insuffisance circulatoire progressive. La mise en place de l’équipe de choc à la suite des consultations dans plusieurs centres canadiens d’ACM a mené à l’élaboration d’un protocole d’utilisation de l’ACM. Il y a eu 4 cas chez lesquels la VA-ECMO par voie percutanée à l’aide de Cardiohelp (Getinge/Maquet, Wayne, New Jersey, É.-U.) a été utilisée ; 3 (75 %) ont survécu après l’hospitalisation de référence. Conclusions: Cette analyse a démontré la faisabilité de la mise en place d’une équipe de choc dans les régions éloignées du nord de l’Ontario, qui a permis d’utiliser efficacement la VA-ECMO dans un centre d’une circonscription hospitalière rurale non négligeable. Cette initiative aide à remédier à l’écart des résultats en soins cardiaques entre les régions rurales et urbaines de l’Ontario.

In this paper, we summarize findings from the Tenth International Workshop on Tropical Cyclones (IWTC-10) subgroup on forecasting wind hazards and impacts. We found that new approaches to TC wind hazard forecasts continue to be developed and are becoming an increasingly common product offered by operational centres. To add greater context to wind risk information for users, many operational and research centres are also working to develop impact-based forecasts that incorporate hazard, vulnerability, and exposure data. Efforts to develop tropical cyclone wind impact forecasts present resourcing challenges, and when compared to wind hazard forecasting, are generally still in their infancy. Overall, both operational and research centres are extending significant efforts to meet the strong public need for accurate predictions of TC wind hazards and impacts around the world.

All-solid-state batteries (ASSBs) that employ solid-state electrolytes (SSEs) have the potential to replace more conventional batteries that employ liquid electrolytes due to their inherent safety, compatibility with lithium metal and reputable ionic conductivity. Li7P3S11 is a promising SSE with reported ionic conductivities in the order of 10 mS/cm. However, its susceptibility to degradation through oxidation and hydrolysis limits its commercial viability. In this work, we demonstrate a laser-based processing method for SSEs to improve humidity stability. It was determined that laser power and scanning speed greatly affect surface morphology, as well as the resulting chemical composition of Li7P3S11 samples. Electrochemical impedance spectroscopy revealed that laser treatment can produce SSEs with higher ionic conductivities than pristine counterparts after air exposure. Further examination of chemical composition revealed an optimal laser processing condition that reduces the rate of P2S74− degradation. This work demonstrates the ability of laser-based processing to be used to improve the stability of SSEs.

Digging in the Crates: Hip Hop Studies at Virginia Tech, or VTDITC, is a pedagogical model that exists to foster a sense of community among artists, fans, and scholars. Based in our campus’ main library, we hope to model that students’ and community members’ personal interests are worthy of academic study and further establish Hip Hop Studies’ presence at Virginia Tech, the academy, and in the larger community. To that end, the VTDITC community has designed, taught, and assessed more than 150 community-based media literacy workshops over the past half decade. We have demonstrated, explained, and created opportunities for a wide variety of learners to experience the science, technology, engineering, art, and mathematics inherent to the hip hop culture. We have learned alongside a diversity of audiences—from elementary school children to adults. To name just a few of our partner organizations, we have worked with the 4H Virginia Congress, the Boys & Girls Clubs of Southwest Virginia, Higher Achievement, Inc., a variety of public libraries including our regular collaborator Roanoke Public Libraries, the Science Museum of Western Virginia, Virginia’s Summer Residential Governor's School for Humanities, and the West End Center for Youth. In our contribution to The Global Drumbeat: Permeations of Hip Hop across Diverse Information Worlds, we will outline and explain an example lesson plan from one of our workshops. We will provide our learning outcomes as well as our assessment plan. Additionally, we will detail the theoretical underpinnings and guiding principles that inform our pedagogical decision making. Our workshops take a hands-on, practitioner-minded, and co-creation approach to teaching media literacy. Inasmuch, this contribution will also provide a recommended list of music creation equipment and other appropriate classroom technology that will accommodate a variety of budgets. Furthermore, we will include several promising practices and recommendations gained from more than 50 years of collective experience creating hip hop music and 10 years of collective experience teaching the hip hop arts. Our hope is that this contribution will inspire other library workers and educators to remix our workshops to suit the needs of their communities.

Background The proportion of days covered (PDC) is used to estimate medication adherence by looking at the proportion of days in which a person has access to the medication, over a given period of interest. This study aimed to adapt the PDC algorithm to allow for plausible assumptions about prescription refill behaviour when applied to data from online pharmacy suppliers. Methods Three PDC algorithms, the conventional approach (PDC1) and two alternative approaches (PDC2 and PDC3), were used to estimate adherence in a real-world dataset from an online pharmacy. Each algorithm has different denominators and increasing levels of complexity. PDC1, the conventional approach, is the total number of days between first dispensation and a defined end date. PDC2 counts the days until the end of supply date. PDC3 removes from the denominator specifically defined large gaps between refills, which could indicate legitimate reasons for treatment discontinuation. The distribution of the three PDCs across four different follow-up lengths was compared. Results The dataset included people taking ACE inhibitors (n = 65,905), statins (n = 100,362), and/or thyroid hormones (n = 30,637). The proportion of people taking ACE inhibitors with PDC ≥ 0.8 was 50–74% for PDC1, 81–91% for PDC2, and 86–100% for PDC3 with values depending on drug and length of follow-up. Similar ranges were identified in people taking statins and thyroid hormones. Conclusion These algorithms enable researchers and healthcare providers to assess pharmacy services and individual levels of adherence in real-world databases, particularly in settings where people may switch between different suppliers of medicines, meaning an individual supplier’s data may show temporary but legitimate gaps in access to medication. Accurately identifying problems with adherence provides the foundation for opportunities to improve experience, adherence and outcomes and to reduce medicines wastage. Research with people taking medications and prescribers is required to validate the algorithms’ assumptions.

As additively manufactured radio frequency (RF) design expands towards higher frequencies, performance becomes ever more sensitive to print-induced dimensional variations. These slight deviations from design dimensions typically skew RF performance, resulting in low yields or poor device performance. In order to overcome this limitation, RF design paradigms must be developed for non-uniform process and material-specific variations. Therefore, a new generalized approach is developed to explore variation-tolerant designs for printed RF structures. This method evaluates the feature fidelity and S11 performance of micro-dispensed, X-band (8–12 GHz) patch antennas by evaluating the standard deviation in as-printed features, surface roughness, and thickness. It was found that the traditional designs based on optimal impedance matching values did not result in the most robust performance over multiple printing sessions. Rather, performance bounds determined by print deviation could be utilized to improve large-batch S11 results by up to 7 dB. This work demonstrates that establishing the average standard deviation of printed dimensions in any RF printing system and following the formulated design procedure could greatly improve performance over large datasets. As such, the method defined here can be applied to improve large-scale, printed RF yields and enable predictive performance metrics for any given printing method.

In treatments based on differential reinforcement of alternative behavior, applied researchers and clinicians often provide multiple, qualitatively different reinforcers (i.e., synthesized reinforcement) rather than a single reinforcer (i.e., isolated reinforcement) contingent on alternative behavior. Some research shows that providing synthesized reinforcement for alternative responses within such treatments produces more rapid and complete suppression of target behavior; however, there is limited research evaluating the durability of these effects during treatment disruptions. Conceptual explanations of resurgence (e.g., resurgence as choice, context theory) suggest that treatments that include synthesized alternative reinforcement may lead to more resurgence of target behavior when alternative reinforcement is disrupted relative to treatments using isolated reinforcement. We evaluated this hypothesis within a three-phase resurgence evaluation. We exposed rats to isolated or synthesized reinforcement for alternative responding in the second phase, and we exposed rats to extinction in the third phase. Synthesized alternative reinforcement produced more rapid and complete suppression of target behavior than did isolated reinforcement in the second phase; however, exposure to extinction following synthesized reinforcement produced more resurgence. We discuss these results in terms of their implications for applied research and their support for current conceptual explanations for resurgence., (© 2024 Society for the Experimental Analysis of Behavior.)

Resurgence is an increase in the rate of a previously suppressed behavior that occurs when an alternative source of reinforcement is made worse in some way. The Resurgence as Choice model offers a quantitative approach to understanding resurgence that may provide important insights into the variables that affect this form of relapse in the natural environment. Bringing this model to bear on relapse following reinforcement-based interventions for alcohol and other substance use disorders, however, may not be straightforward. Laboratory work on which the Resurgence as Choice model is based has almost exclusively focused on resurgence following extinction of target behavior, but abstinence from alcohol during intervention is often voluntary: Patients may drink alcohol and forfeit therapeutic reinforcers at any time. In this article, we first will review recent data from our group that demonstrate a method for studying resurgence following voluntary abstinence from alcohol seeking in rats. In a previous experiment, we reduced rats' alcohol-maintained lever pressing to low levels without placing it on extinction by arranging nondrug differential reinforcement of other behavior. Further, when we suspended nondrug reinforcement, resurgence of lever pressing occurred. Next, we will explore methods for modeling these outcomes using the Resurgence-as-Choice framework. We conclude that the data under consideration may not be sufficient to discriminate between candidate models of resurgence following voluntary abstinence and point to areas for future empirical and theoretical development. This work may provide a stronger bridge between preclinical and conceptual work on resurgence and clinical treatments for alcohol use disorder., Competing Interests: Conflicts of InterestThe authors declare no competing interests., (© Association for Behavior Analysis International 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Resurgence refers to the relapse of a target behavior following the worsening of a source of alternative reinforcement that was made available during response elimination. Most laboratory analyses of resurgence have used a combination of extinction and alternative reinforcement to reduce target behavior. In contingency-management treatments for alcohol use disorder, however, alcohol use is not placed on extinction. Instead, participants voluntarily abstain from alcohol use to access nondrug alternative reinforcers. Inasmuch, additional laboratory research on resurgence following voluntary abstinence is warranted. The present experiment evaluated resurgence of rats' ethanol seeking following voluntary abstinence produced by differential reinforcement of other behavior (DRO). Lever pressing produced ethanol reinforcers during baseline phases. During DRO phases, lever pressing continued to produce ethanol and food reinforcers were delivered according to resetting DRO schedules. Ethanol and food reinforcers were suspended during resurgence test phases to evaluate resurgence following voluntary abstinence. Lever pressing was elevated during baseline phases and occurred at near-zero rates during DRO phases. During the resurgence test phases, lever pressing increased, despite that it no longer produced ethanol. The procedure introduced here may help researchers better understand the variables that affect voluntary abstinence from ethanol seeking and resurgence following voluntary abstinence., (© 2024 Society for the Experimental Analysis of Behavior.)

Cognitive impairment is common in persons with spinal cord injury (SCI), impacting their daily functioning and rehabilitation. This study assesses the extent of self-reported cognitive failures in everyday life in persons with SCI and its relationships with objective neurocognitive measures and psychosocial factors, including depressive mood, anxiety, perceived control, and fatigue. The differences between forty-one adults with a chronic SCI and forty-one able-bodied controls were examined. The participants completed the Cognitive Failures Questionnaire (CFQ) to assess cognitive failure and neurocognitive tests assessing attention and executive functions, as well as a psychosocial assessment. The SCI group reported higher cognitive failure rates than the able-bodied group (31.7% versus 19%, p > 0.05). Objective neurocognitive tests did not significantly correlate with the CFQ scores in either group. However, the CFQ scores were positively associated with most psychosocial factors, even after controlling for covariates. The CFQ scores were significantly associated with depressive mood in persons with SCI. These findings highlight the importance of incorporating self-reported cognitive measures into neurocognitive assessments and rehabilitation planning for adults with SCI. Self-reports capture everyday cognitive challenges that objective tests may miss. Additionally, this study highlights the strong connections between cognitive failures and psychosocial issues, particularly mood disorders, emphasizing the need for comprehensive rehabilitation and psychosocial support post-SCI, addressing both cognitive and emotional wellbeing.

The persistence of operant behavior when disrupted tends to be positively related to how often reinforcers were delivered in the past. Behavioral momentum theory describes this finding as the outcome of Pavlovian processes. That is, the relation between discriminative stimuli and reinforcers that were delivered in their presence strengthens behavior, thereby making it more likely to persist. If only the story were that simple. A growing number of findings challenge the basic tenets of behavioral momentum theory. Some even call into question whether Pavlovian relations contribute to persistence in the first place. In this paper, I will review behavioral momentum theory and some of the data that have been problematic for the theory. I will argue that despite these very real challenges, the theory provides important utility not only to basic analyses of response persistence but also to clinical interventions directed at long-term reductions in problem behavior. It, for example, has set the stage for the development of alternative conceptual analyses of resistance to change, two of which will be highlighted for readers. Moreover, behavioral momentum theory may tell us something important about the reasons it continues to have an influence on the field, despite the challenging data that deter it., (© 2023 Society for the Experimental Analysis of Behavior.)

In patients with cytopenic myelofibrosis, treatment with the JAK2/IRAK1 inhibitor pacritinib was associated with anemia benefit in the phase 3 PERSIST-2 study. The impact of pacritinib on transfusion independence (TI) has not been previously described, nor has the mechanism by which pacritinib improves anemia been elucidated. Because it has been previously postulated that inhibition of activin A receptor, type 1 (ACVR1)/activin receptor-like kinase-2 improves anemia in patients with myelofibrosis via suppression of hepcidin production, we assessed the relative inhibitory potency of pacritinib compared with other JAK2 inhibitors against ACVR1. Pacritinib inhibited ACVR1 with greater potency (half-maximal inhibitory concentration [IC50] = 16.7 nM; Cmax:IC50 = 12.7) than momelotinib (IC50 = 52.5 nM; Cmax:IC50 = 3.2), fedratinib (IC50 = 273 nM; Cmax:IC50 = 1.0), or ruxolitinib (IC50 > 1000; Cmax:IC50 < 0.01). Pacritinib's inhibitory activity against ACVR1 was corroborated via inhibition of downstream SMAD signaling in conjunction with marked suppression of hepcidin production. Among patients on PERSIST-2 who were not transfusion independent at baseline based on Gale criteria, a significantly greater proportion achieved TI on pacritinib compared with those treated on best available therapy (37% vs 7%, P = .001), and significantly more had a ≥50% reduction in transfusion burden (49% vs 9%, P < .0001). These data indicate that the anemia benefit of the JAK2/IRAK1 inhibitor pacritinib may be a function of potent ACVR1 inhibition., (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

The effects of delivering nondrug alternative reinforcement on resistance to extinction and reinstatement of rats' ethanol-maintained lever pressing were evaluated in two experiments. In both, rats self-administered ethanol by lever pressing in a two-component multiple schedule during baseline. In the Rich component, alternative food reinforcement was made available for performing an alternative response (Experiment 1) or according to a differential-reinforcement-of-other-behavior schedule for lever pressing (Experiment 2). In the Lean component, only ethanol was available. Moreover, the frequency of alternative reinforcement was manipulated across conditions in Experiment 1. Following baseline, lever pressing was extinguished in both components by suspending ethanol reinforcement, and alternative food reinforcers were discontinued. Finally, to test for reinstatement, ethanol reinforcers were delivered independently of lever pressing in both components. In both experiments, proportion-of-baseline response rates were higher during extinction and reinstatement testing in the Rich component than in the Lean component (although differentiation was not observed at the lowest frequency of alternative reinforcement in Experiment 1). Thus, alternative nondrug reinforcers increased resistance to extinction and reinstatement of rats' ethanol-maintained lever pressing, even when those reinforcers were delivered contingently on an alternative response or on abstinence from lever pressing., (© 2022 Society for the Experimental Analysis of Behavior.)

Thrombocytopenia is common in patients with myelofibrosis (MF) and is a well-established adverse prognostic factor. Both of the approved Janus kinase (JAK) inhibitors, ruxolitinib and fedratinib, can worsen thrombocytopenia and have not been evaluated in patients with severe thrombocytopenia (platelet counts <50×109/L). Pacritinib, a novel JAK2/interleukin-1 receptor-associated kinase 1 inhibitor, has been studied in two phase III trials (PERSIST-1 and PERSIST- 2), both of which enrolled patients with MF and severe thrombocytopenia. In order to better characterize treatment outcomes for this population with advanced disease, we present a retrospective analysis of efficacy and safety data in the 189 patients with severe thrombocytopenia treated in the PERSIST studies. The proportion of patients in the pacritinib group meeting efficacy endpoints was greater than in the BAT group for ≥35% spleen volume reduction (23% vs. 2%, P=0.0007), ≥50% modified Total Symptom Score reduction (25% vs. 8%, P=0.044), and self-reported symptom benefit ("much" or "very much" improved; 25% vs. 8%, P=0.016) at the primary analysis time point (week 24). The adverse event profile of pacritinib was manageable, and dose modification was rarely required. There was no excess in bleeding or death in pacritinib-treated patients. These results indicate that pacritinib is a promising treatment for patients with MF who lack safe and effective therapeutic options due to severe thrombocytopenia.