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Methodologies for identifying atmospheric oxidized mercury (HgII) compounds, including particulate-bound HgII (HgII(p)) and gaseous oxidized mercury (HgII(g)), by mass spectrometry are currently under development. This method requires preconcentration of HgII for analysis due to high instrument detection limits relative to ambient HgII concentrations. The objective of this work was to identify and test materials for quantitative capture of HgII from the gas phase and to suggest potential surfaces onto which HgII can be collected, thermally desorbed, and characterized using mass spectrometry methods. From the literature, several compounds were identified as potential sorbent materials and tested in the laboratory for uptake of gaseous elemental mercury (Hg0) and HgII(g) (permeated from a HgBr2 salt source). Chitosan, α - Al2O3 , and γ - Al2O3 demonstrated HgII(g) capture in ambient air laboratory tests, without sorbing Hg0 under the same conditions. When compared to cation exchange membranes (CEMs), chitosan captured a comparable quantity of HgII(g) , while ≤90 % of loaded HgII(g) was recovered from α - Al2O3 and γ - Al2O3. When deployed in the field, the capture efficiency of chitosan decreased compared to CEMs, indicating that environmental conditions impacted the sorption efficiency of this material. The poor recovery of HgII from the tested materials compared to CEMs in the field indicates that further identification and exploration of alternative sorbent materials are required to advance atmospheric mercury chemistry analysis by mass spectrometry methods. [ABSTRACT FROM AUTHOR]

High concentrations of ozone in the Uinta Basin, Utah, can occur after sufficient snowfall and a strong atmospheric anticyclone creates a persistent cold pool that traps emissions from oil and gas operations, where sustained photolysis of the precursors builds ozone to unhealthy concentrations. The basin's winter-ozone system is well understood by domain experts and supported by archives of atmospheric observations. Rules of the system can be formulated in natural language ("sufficient snowfall and high pressure leads to high ozone"), lending itself to analysis with a fuzzy-logic inference system. This method encodes human expertise as machine intelligence in a more prescribed manner than more complex, black-box inference methods such as neural networks, increasing user trustworthiness of our model prototype before further optimization. Herein, we develop an ozone forecasting system, Clyfar, informed by an archive of meteorological and air-chemistry measurements. This prototype successfully demonstrates proof-of-concept despite rudimentary tuning. We describe our framework for predicting future ozone concentrations if input values are drawn from numerical weather prediction forecasts rather than observations as Clyfar initial conditions. We evaluate inferred values for one winter, finding our prototype demonstrates mixed performance but promise after optimization to deliver useful forecast guidance for decision-makers when forecast data are used as input. This early version model is the basis of ongoing optimization through machine learning. [ABSTRACT FROM AUTHOR]

Mercury (Hg) is a global atmospheric pollutant. In its oxidized form (HgII), it can readily deposit to ecosystems, where it may bioaccumulate and cause severe health effects. High HgII concentrations are reported in the free troposphere, but spatiotemporal data coverage is limited. Underestimation of HgII by commercially available measurement systems hinders quantification of Hg cycling and fate. During spring–summer 2021 and 2022, we measured elemental (Hg0) and oxidized Hg using a calibrated dual-channel system alongside trace gases, aerosol properties, and meteorology at the high-elevation Storm Peak Laboratory (SPL) above Steamboat Springs, Colorado. Oxidized Hg concentrations displayed diel and episodic behavior similar to previous work at SPL but were approximately 3 times higher in magnitude due to improved measurement accuracy. We identified 18 multi-day events of elevated HgII (mean enhancement of 36 pgm-3) that occurred in dry air (mean ± SD of relative humidity = 32 ± 16 %). Lagrangian particle dispersion model (HYSPLIT–STILT, Hybrid Single-Particle Lagrangian Integrated Trajectory–Stochastic Time-Inverted Lagrangian Transport) 10 d back trajectories showed that the majority of transport prior to events occurred in the low to middle free troposphere. Oxidized Hg was anticorrelated with Hg0 during events, with an average (± SD) slope of - 0.39 ± 0.14. We posit that event HgII resulted from upwind oxidation followed by deposition or cloud uptake during transport. Meanwhile, sulfur dioxide measurements verified that three upwind coal-fired power plants did not influence ambient Hg at SPL. Principal component analysis showed HgII consistently inversely related to Hg0 and generally not associated with combustion tracers, confirming oxidation in the clean, dry free troposphere as its primary origin. [ABSTRACT FROM AUTHOR]

Mercury (Hg) is a global atmospheric pollutant. In its oxidized form (HgII), atmospheric Hg can readily deposit to ecosystems, where it may bioaccumulate and cause severe health effects. High HgII concentrations are reported in the free troposphere, but spatiotemporal data coverage is limited. Underestimation of HgII by commercially available measurement systems hinders quantification of Hg cycling and fate. During spring-summer 2021 and 2022, we measured elemental (Hg0) and oxidized Hg using a calibrated dual-channel system alongside trace gases, aerosol properties, and meteorology at the high-elevation Storm Peak Laboratory (SPL) above Steamboat Springs, Colorado. Oxidized Hg concentrations displayed temporal behavior similar to previous work at SPL, but were approximately three times higher in magnitude due to improved measurement accuracy. We identified 18 multi-day events of elevated HgII (mean enhancement: 36 pg m-3) that occurred in dry air (mean ± s.d. RH = 32 ± 16 %). Lagrangian particle dispersion model (HYSPLIT-STILT) 10-day back-trajectories showed that the majority of transport prior to events occurred in the low to mid-free troposphere. Oxidized Hg was anticorrelated with Hg0 during events, with an average (± s.d.) slope of -0.39 ± 0.14, suggestive of upwind oxidation followed by deposition during transport. Concurrent sulfur dioxide measurements verified that three upwind coal-fired power plants did not measurably contribute ambient Hg at SPL. Principal Components Analysis revealed HgII consistently inversely related with Hg0 and was generally not associated with combustion tracers, confirming oxidation in the clean, dry free troposphere as its primary origin. [ABSTRACT FROM AUTHOR]

Online healthcare information has the potential to improve health outcomes via the widespread, cost-effective translation of research evidence into practice by healthcare professionals and use by consumers. However, comparatively little is known about how healthcare professionals and consumers engage with healthcare websites, or whether the knowledge that is made available through digital platforms is translated into better health outcomes. To realise the potential of such resources, we argue that an evidence-based framework—grounded in a nuanced understanding of how audiences engage with and use information provided by healthcare websites—is needed. The goal of this paper is to outline a case for the development of a best-practice framework that can guide the development of websites that provide healthcare information to clinicians and consumers. In addition to supporting the design of more effective online resources, a common framework for understanding how better health outcomes can be achieved via digital knowledge translation has the potential to significantly improve patient outcomes in the face of a complex, rapidly changing and resource-constrained healthcare landscape.

A laboratory-based study was conducted to investigate the consumption and degradation of expanded polystyrene (EPS) by superworms (darkling beetle larvae, Zophobas morio; heterotypic synonym Zophobas atratus). Superworms fed on one of three diets (wheat bran control, EPS blocks, or EPS S-shaped chips) following a 60-second pretreatment with UV radiation or no UV radiation exposure. Loss-of-mass measurements were conducted every week for 4 weeks. Nutrients (nitrogen and phosphorus) and EPS degradation products in frass were determined as well as the superworm gut microbiome composition. The average loss of mass after 28 days was 34.7% for EPS blocks and 25.6% for S-shaped chips. Small quantities of nitrogen and phosphorus were found in the frass of superworms that fed on the EPS diet, but they were lower than those from wheat bran-fed superworms. Twenty-one EPS degradation products were identified in the frass of superworms on an EPS diet, including short-chain carboxylic acids, polyols, amino acids, metabolites of amino acids, and phosphoric acids. Pseudomonas aeruginosa (polystyrene degrader) and Stenotrophomonas sp. (nitrogen fixer and phosphorus solubilization promoter) were identified from the guts of superworms that fed on an EPS diet. Overall, superworms have the potential to deal with plastic waste degradation problems.

Abstract Examination of early phases of synucleinopathy when inclusions are present, but long before neurodegeneration occurs, is critical to both understanding disease progression and the development of disease modifying therapies. The rat alpha-synuclein (α-syn) preformed fibril (PFF) model induces synchronized synucleinopathy that recapitulates the pathological features of Parkinson’s disease (PD) and can be used to study synucleinopathy progression. In this model, phosphorylated α-syn (pSyn) inclusion-containing neurons and reactive microglia (major histocompatibility complex-II immunoreactive) peak in the substantia nigra pars compacta (SNpc) months before appreciable neurodegeneration. However, it remains unclear which specific genes are driving these phenotypic changes. To identify transcriptional changes associated with early synucleinopathy, we used laser capture microdissection of the SNpc paired with RNA sequencing (RNASeq). Precision collection of the SNpc allowed for the assessment of differential transcript expression in the nigral dopamine neurons and proximal glia. Transcripts upregulated in early synucleinopathy were mainly associated with an immune response, whereas transcripts downregulated were associated with neurotransmission and the dopamine pathway. A subset of 29 transcripts associated with neurotransmission/vesicular release and the dopamine pathway were verified in a separate cohort of males and females to confirm reproducibility. Within this subset, fluorescent in situ hybridization (FISH) was used to localize decreases in the Syt1 and Slc6a3 transcripts to pSyn inclusion-containing neurons. Identification of transcriptional changes in early synucleinopathy provides insight into the molecular mechanisms driving neurodegeneration.

Face detection and recognition play pivotal roles across various domains, spanning from personal authentication to forensic investigations, surveillance, entertainment, and social media. In our interconnected world, pinpointing an individual’s identity amidst millions remains a formidable challenge. While contemporary face recognition techniques now rival or even surpass human accuracy in critical scenarios like border identity control, they do so at the expense of poor explainability, leaving the underlying causes of errors largely unresolved. Moreover, they demand substantial computational resources and a plethora of labeled samples for training. Drawing inspiration from the remarkably efficient human visual system, particularly in localizing and recognizing faces, holds promise for developing more efficient and interpretable systems, with high gains in scenarios where misidentification can yield grave consequences. In this context, we introduce the Uniss-FGD dataset, which captures gaze data from observers presented with facial images depicting diverse expressions. In view of the potential uses of Uniss-FGD, we propose two baseline experiments on a subset of the dataset in which we perform a comparative analysis juxtaposing the attention mechanisms of ViTs, multi-scale handcrafted features, and human observers when viewing facial images. These preliminary comparisons pave the way to future investigation into the integration of human attention dynamics into advanced and diverse image analysis frameworks. Beyond the realms of Computer Science, numerous research disciplines stand to benefit from the rich gaze data encapsulated in this dataset.

Exploring the sugar and amino acid content variability and the influence of thermal processing on these in soybeans can help optimize their utilization in animal feed. This study examined 209 samples harvested in 2020 and 55 samples harvested in 2021 from across the U.S. to assess their sugar variability and amino acid variability. Harvest regions included the East Corn Belt, West Corn Belt, Mid-South, East Coast, and the Southeast of the U.S. In addition to the sugar and amino acid contents, protein, oil, and seed size were also analyzed. Samples from 2021 were evaluated for their sugar and amino acid contents before and after autoclaving the seeds at 105–110 °C for 15 min. For the samples harvested in 2020, sucrose (4.45 g 100 g−1) and stachyose (1.34 g 100 g−1) were the most prevalent sugars. For the samples harvested in 2021, L-arginine (9.82 g 100 g−1), leucine (5.29 g 100 g−1), and glutamate (4.90 g 100 g−1) were the most prevalent amino acids. Heat treatment resulted in an 8.47%, 20.88%, 11.18%, and 1.46% median loss of free lysine, sucrose, glucose, and fructose. This study’s insights into the variability in sugar and amino acid content and the heat-induced changes in the nutritional composition of soybeans provide a reference for improving soybean quality assessment and optimizing its use in animal feed formulations in the U.S.

Introduction: Multiple interventions have been designed to employ facilitators to address gaps in Advance Care Planning (ACP). Objective: To collect and review available evidence related to facilitated ACP interventions. Methods/Design: Narrative review using a previously described framework for scoping reviews. We searched PubMed using structured criteria and report synthesized themes detailing the design, target populations, methods, and outcome measurements for interventions in which a facilitator-who may or may not be clinical staff-engaged a patient and/or a patient's caregiver in some part of the ACP process. Results: Of 1492 articles discovered on our search, 28 met the inclusion criteria. Twelve (42.9%) studies utilized a nurse facilitator, two (7.1%) utilized trained social workers, and one (3.6%) embedded multiple facilitators. The remaining 13 (46.4%) utilized facilitators from other various professional and community backgrounds, such as lay navigators, care coordinators, and peer mentors. Twenty-five (89.2%) studies included patients with serious or chronic illness, at the end-of-life, or having a high risk of need for medical care. Four (14.3%) articles focused on marginalized populations. Intervention settings varied notably across studies. Eighteen (64.3%) integrated interventions into existing clinical workflows. Primary outcomes were measured in one of three ways: documentation in the Electronic Health Record (EHR) (25.0%); questionnaires, scales, patient reports, or non-EHR documentation (64.3%); or multiple measures (10.7%). Twenty-three (82.1%) of the studies were determined a success by study authors. Conclusion: We identified a variety of key characteristics that can be modified to target facilitated ACP interventions towards gaps in current applications of ACP., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Angelo Volandes has a financial interest in ACP Decisions, a non-profit organization developing advance care planning video decision support tools. Dr Volandes’ interests were reviewed and are managed by MGH and Mass General Brigham in accordance with their conflicts of interest policies. None of the other authors have any conflicts of interest to disclose.

Background: The trapeziometacarpal joint (TMCJ) is the most common hand joint affected by osteoarthritis (OA), and trapezium implant arthroplasty is a potential treatment for recalcitrant OA. This meta-analysis aimed to investigate the efficacy and safety of various trapezium implants as an interventional option for TMCJ OA. Methods: Web of Science, PubMed, Scopus, Google Scholar, and Cochrane library databases were searched for relevant studies up to May 28, 2022. Preferred Reported Items for Systematic Review and Meta-Analysis guidelines were adhered to, and the protocol was registered in PROSPERO. The methodological quality was assessed by National Heart, Lung, and Blood Institute tools for observational studies and the Cochrane risk of bias tool. Subgroup analyses were performed on different replacement implants; the analysis was done using Open Meta-Analyst software and P values <.05 were considered statistically significant. Results: A total of 123 studies comprising 5752 patients were included. Total joint replacement (TJR) implants demonstrate greater significant improvements in visual analogue scale pain scores postoperatively. Interposition with partial trapezial resection implants were associated with highest grip strength and highest reduction in the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Revision rates were highest in TJR (12.3%) and lowest in interposition with partial trapezial resection (6.2%). Conclusion: Total joint replacement and interposition with partial trapezial resection implants improve pain score, grip strength, and DASH scores more than other implant options. Future studies should focus on high-quality randomized clinical trials comparing different implants to accumulate higher quality evidence and more reliable conclusions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Optimal care for seriously ill and older patients often involves advance care planning (ACP), goals-of-care (GOC) conversations, and specialty palliative care consultation, three sometimes overlapping, yet distinct practices. Insufficient staffing and investment in these areas have limited their availability., Objectives: We explored the facilitators and barriers to successful implementation of the VIDEO-PCE trial. The intervention aimed to increase patient engagement in ACP, GOC, and by establishing Palliative Care Educators, a new clinical role integrated into existing hospital wards., Design: This qualitative interview study employed a semi-structured interview guide tailored to the interviewee's clinical role. The interviews elicited perceptions of the facilitators and barriers to integration of palliative care educators (PCEs) into existing workflows. We developed deductive codes a priori and inductive codes as we coded interview transcripts., Setting/subjects: Medical/surgical floor clinical colleagues, palliative care team members, and PCEs from both participating sites were interviewed., Results: Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role., Conclusion: The creation and implementation of a new role within existing clinical workflows posed some challenges but were felt to relieve staff from some work burden and allow more patients to engage in ACP and GOC conversations., Trial Registration: ClinicalTrials.gov Identifier: NCT04857060., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Angelo Volandes has a financial interest in ACP Decisions, a non-profit organization developing advance care planning video decision support tools. Dr Volandes’ interests were reviewed and are managed by MGH and Mass General Brigham in accordance with their conflicts of interest policies. Dr Aretha Delight Davis is the CEO of ACP Decisions, a nonprofit organization focused on strengthening shared decisions making through video decision aids, from which she receives a salary. None of the other authors have any conflicts of interest to disclose.

Objective: To quantify proportions of loss to follow-up in patients presenting with a pregnancy of unknown location and explore patients' perspectives on follow-up for pregnancy of unknown location. A pregnancy of unknown location is a scenario in which a patient has a positive pregnancy test but the pregnancy is not visualized on transvaginal ultrasound. Study Design: We conducted a retrospective cohort study of patients with pregnancy of unknown location who presented to an urban academic emergency department or complex family planning outpatient office. We sought to calculate the proportion of patients lost to follow-up, defined as inability to contact the patient within 2 weeks. We then conducted focus groups of patients diagnosed with a pregnancy of unknown location. We used thematic analysis to identify themes related to follow-up. Results: We reviewed 464 charts of patients diagnosed with pregnancy of unknown location. The median age in this cohort was 27 with most patients identifying as Black (80%, n = 370) and using public insurance (67%, n = 315). When looking at loss to follow-up rates, Black patients experienced loss to follow-up (20%, n = 72) more often than White patients (4%, n = 2; p = 0.003). Focus group participants had a mean age of 31.8+/-4.8, and the majority were of Black race ( n = 16, 72.7%). Participants identified barriers to follow-up including the long duration of management, general inconvenience, and poor communication with their health care team. Participants felt a burden of responsibility to learn about their condition and to self-advocate for their follow-up and communication of results. Conclusions: These data indicate that Black patients are more likely to experience loss to follow-up compared with White patients during monitoring for pregnancy of unknown location. Patients identified many barriers to follow-up and felt that successful follow-up required substantial self-efficacy.

Background: The Olin E. Teague Veterans' Center (OETVC) is a teaching hospital with a medical ward consisting of 189 beds, 3 teaching teams with 1 resident and 2 to 3 interns, and 3 nonteaching teams. Due to the complexity of hospitalization, there are concerns that patients may not follow up with primary care or fill their prescribed medication and may have postdischarge questions., Observations: A program was created at OETVC to bridge the gap between inpatient and outpatient care. Internal medicine residents call all teaching team patients a week following discharge. They discuss medications, changes in symptoms, follow-up plans, and address all questions. The residents also assist with missed orders and make treatment regimen changes if necessary., Conclusions: This new program has proven to be beneficial. Residents are developing a better understanding of illness scripts and are working on communication skills without time constraints. Patients now have access to a physician following discharge to discuss any concerns with their hospitalization, present condition, and follow-up. Data show a decreased 30-day readmission rate at 6% in the transition of care group compared to 10% in all patients who participated in the program. This program will continue to address barriers to care and adapt to improve the success of care transitions., Competing Interests: Author disclosures: The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article., (Copyright © 2024 Frontline Medical Communications Inc., Parsippany, NJ, USA.)

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects a substantial percentage of women, estimated at around 9-21%. This condition can lead to anovulatory infertility in women of childbearing age and is often accompanied by various metabolic disturbances, including hyperandrogenism, insulin resistance, obesity, type-2 diabetes, and elevated cholesterol levels. The development of PCOS is influenced by a combination of epigenetic alterations, genetic mutations, and changes in the expression of non-coding RNAs, particularly microRNAs (miRNAs). MicroRNAs, commonly referred to as non-coding RNAs, are approximately 22 nucleotides in length and primarily function in post-transcriptional gene regulation, facilitating mRNA degradation and repressing translation. Their dynamic expression in different cells and tissues contributes to the regulation of various biological and cellular pathways. As a result, they have become pivotal biomarkers for various diseases, including PCOS, demonstrating intricate associations with diverse health conditions. The aberrant expression of miRNAs has been detected in the serum of women with PCOS, with overexpression and dysregulation of these miRNAs playing a central role in the atypical expression of endocrine hormones linked to PCOS. This review takes a comprehensive approach to explore the upregulation and downregulation of various miRNAs present in ovarian follicular cells, granulosa cells, and theca cells of women diagnosed with PCOS. Furthermore, it discusses the potential for a theragnostic approach using miRNAs to better understand and manage PCOS., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The management of distal radius giant cell tumors (GCTs) remains challenging, and the optimal approach is still a matter of debate. This systematic review and meta-analysis aimed to compare the outcomes of extended curettage and wide resection, the mainstays of treatment., Methods: Medline (via PubMed), Cochrane Library, Web of Science, Google Scholar, ClinicalTrials.gov, and Embase databases were searched for comparative studies that assessed extended curettage with adjuvant therapy and wide resection with reconstruction in patients with GCTs of the distal radius up to April 2023. Data were collected and analyzed on rates of local recurrence, metastasis, overall complications, and functional outcomes. The Newcastle-Ottawa scale was used to appraise the risk of bias within each study., Results: Fifteen studies (n = 373 patients) were included and analyzed. Patients who underwent curettage were more likely to develop recurrence (risk ratio [RR] = 3.02 [95% confidence interval; CI, 1.87-4.89], P < .01), showed fewer complications (RR = 0.32 [95% CI, 0.21-0.49], P < .01), and showed greater improvement in Visual Analog Scale and lower Disabilities of the Arm, Shoulder, and Hand scores ( P < .00001) than those who underwent wide resection. No significant difference was found regarding metastasis (RR = 1.03 [95% CI, 0.38-2.78], P = .95)., Conclusions: Regarding the surgical approach to GCT of the distal radius, curettage with adjuvant therapy was associated with a higher likelihood of recurrence compared with wide resection with reconstruction. Nevertheless, the curettage approach resulted in significantly lower rates of operative complications, decreased pain scores, and better functional outcomes in comparison to the resection group., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Few studies have shown the effects of prompt outpatient follow-up in relation to reducing readmission rates in patients hospitalized with inflammatory bowel disease (IBD). Our study evaluated whether postdischarge follow-up was associated with fewer IBD-related readmissions., Methods: This single-center retrospective study included 477 patients with Crohn's disease (CD) or ulcerative colitis (UC) who were readmitted to our tertiary care hospital from January 1, 2016, to June 1, 2022. Rehospitalization admissions were defined as admissions that occurred within 90 days after discharge date. We used a chi-square or Fisher's exact test to test for bivariate comparisons to determine if there was an association in patients readmitted for IBD and primary care or gastroenterology follow-up at 1, 2, 3, and 4 weeks versus no follow-up., Results: In UC patients, there were 118 admissions from 2016 to 2022; 36/118 (31%) and 41/118 (34.7%) of the patients were readmitted at 30 days and 90 days, respectively. In the CD group, there were 101 (36.73%) readmissions among 277 patients, with 174 nonreadmissions (63.27%)., Conclusions: Gastroenterology follow-up within 1 month was associated with reduced rates of admission in both groups ( P  < 0.05). This study highlights the importance of close gastroenterology follow-up for IBD-related hospitalizations., Competing Interests: The authors report no funding or conflicts of interest., (Copyright © 2024 Baylor University Medical Center.)

Purpose: Preoperative prediction of postoperative complications (PCs) in inpatients with cancer is challenging. We developed an explainable machine learning (ML) model to predict PCs in a heterogenous population of inpatients with cancer undergoing same-hospitalization major operations., Methods: Consecutive inpatients who underwent same-hospitalization operations from December 2017 to June 2021 at a single institution were retrospectively reviewed. The ML model was developed and tested using electronic health record (EHR) data to predict 30-day PCs for patients with Clavien-Dindo grade 3 or higher (CD 3+) per the CD classification system. Model performance was assessed using area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), and calibration plots. Model explanation was performed using the Shapley additive explanations (SHAP) method at cohort and individual operation levels., Results: A total of 988 operations in 827 inpatients were included. The ML model was trained using 788 operations and tested using a holdout set of 200 operations. The CD 3+ complication rates were 28.6% and 27.5% in the training and holdout test sets, respectively. Training and holdout test sets' model performance in predicting CD 3+ complications yielded an AUROC of 0.77 and 0.73 and an AUPRC of 0.56 and 0.52, respectively. Calibration plots demonstrated good reliability. The SHAP method identified features and the contributions of the features to the risk of PCs., Conclusion: We trained and tested an explainable ML model to predict the risk of developing PCs in patients with cancer. Using patient-specific EHR data, the ML model accurately discriminated the risk of developing CD 3+ complications and displayed top features at the individual operation and cohort level.

The microbial community diversity in Constructed Wetland System (CWS) plays a key role in the removal of pollutants from waste water. An integrated functional CWS developed at Neela Hauz Biodiversity Park, Delhi was selected to assess the diversity in composition and structure of microbial community diversity of sludge and sediment of CWS, based on metagenomic approach using 16S rRNA genes. The sediment showed higher diversity than sludge and both formed distinct clusters. The taxonomic structure of the microbial community of CWS is represented by 6,731 OTUs distributed among 2 kingdoms, 103 phyla, 227 classes, 337 orders, 320 families, 295 identified genera, and 84 identified species. The relative abundance of top 5 dominant phyla of sludge and sediment varied from 3.77% ( Acidobacteria ) to 35.33% ( Proteobacteria ) and 4.07% ( Firmicutes ) to 28.20% ( Proteobacteria ), respectively. The range of variation in relative abundance of top 5 dominant genera of sludge and sediment was 2.58% ( Hyphomicrobium ) to 6.61% ( Planctomyces ) and 2.47% ( Clostridium ) to 4.22% ( Syntrophobacter ), respectively. The rich microbial diversity of CWS makes it perform better in pollutants removal (59.91-95.76%) than other CWs. Based on the abundance values of taxa, the taxa are grouped under four frequency distribution classes-abundant (>20), common (10-19), rare (5-9), and very rare (1-4). The unique structure of microbial communities of integrated CWS is that the number of abundant taxa decreases in descending order of taxonomic hierarchy, while the number of rare and very rare taxa increases. For example, the number of abundant phyla was 14 and 21 in sludge and sediment, respectively and both communities have only 3 abundant genera each. This is in contrast to 4 and 17 very rare phyla in sludge and sediment, respectively and both the communities have 114 and 91 very rare genera, respectively. The outcomes of the study is that the integrated CWS has much higher microbial community diversity than the diversity reported for other CWs, and the rich diversity can be used for optimizing the performance efficiency of CWS in the removal of pollutants from waste water. Such structural diversity might be an adaptation to heterogeneous environment of CWS., 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. The author(s) declared that SM-L was an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Seth, Vats, Lakhanpaul, Arafat, Mazumdar-Leighton, Bansal and Babu.)

Background: Autologous fat grafting (AFG) is a breast augmentation method for treating volume and contour abnormalities. This systematic review aims to summarize complications, radiologic safety, volume retention, and patient satisfaction associated with AFG., Methods: The PubMed, Embase, Google Scholar, Cochrane Central Register of Controlled Trials, Wiley library, clinical key/Elsevier, and EBSCO databases were searched for relevant studies from January of 2009 to March of 2022. Articles describing AFG for breast augmentation were selected based on predetermined inclusion and exclusion criteria. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to, and the study was registered on the International Prospective Register of Systematic Reviews. The Risk of Bias in Nonrandomized Studies of Interventions assessment was used to assess the quality of studies and the risk of bias was measured using the Cochrane Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions., Results: A total of 35 studies comprising 3757 women were included. The average follow-up duration was 24.5 months (range, 1 to 372 months). The overall complication rate was 27.8%, with fat necrosis making up 43.7% of all complications. Average fat volume injected was 300 mL (range, 134 to 610 mL), and average volume retention was 58% (range, 44% to 83%). Volume retention was greater with supplementation of fat with platelet-rich plasma and stromal vascular fraction. The most common radiologic changes were fat necrosis (9.4%) and calcification (1.2%). After 1 year of follow-up, patient satisfaction was, on average, 92% (range, 83.2% to 97.5%). The included studies were of good quality and consisted of a moderate risk of bias., Conclusions: AFG was associated with an overall complication rate of 27.8%. Additional supplementation of fat with platelet-rich plasma and stromal vascular fraction may improve graft survival. Despite poor volume retention being a persistent drawback, patient satisfaction remains high., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Background: Competency in paracentesis is an important procedural skill for health care practitioners caring for patients with decompensated cirrhosis. It is estimated that 97,577 paracentesis procedures were performed between 2010 and 2012 across 120 academic medical centers and 290 affiliated hospitals., Methods: Due to limitations of resources at the Central Texas Veterans Affairs Hospital, a paracentesis clinic was created to give patients improved access to this procedure which is staffed by a supervising physician and internal medicine residents. We evaluated resident competency via survey and change in the number of paracentesis procedures performed with the utilization of this clinic., Results: Thirty-three residents completed the survey. The total mean number of paracentesis sessions participated in was 4.8. It was found that during training, 79% met conditional independence in performing this procedure with a high level of comfort by rotating through this clinic. It was also found that the number of procedures performed by internal medicine residents significantly increased with the addition of this clinic., Conclusions: A dedicated paracentesis clinic with internal medicine resident involvement can increase resident paracentesis procedural independence, the number of procedures available and performed, and procedural comfort level by the end of training., Competing Interests: Author disclosures: The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article., (Copyright © 2024 Frontline Medical Communications Inc., Parsippany, NJ, USA.)

The salt-inducible kinases (SIK) 1-3 are key regulators of pro- versus anti-inflammatory cytokine responses during innate immune activation. The lack of highly SIK-family or SIK isoform-selective inhibitors suitable for repeat, oral dosing has limited the study of the optimal SIK isoform selectivity profile for suppressing inflammation in vivo. To overcome this challenge, we devised a structure-based design strategy for developing potent SIK inhibitors that are highly selective against other kinases by engaging two differentiating features of the SIK catalytic site. This effort resulted in SIK1/2-selective probes that inhibit key intracellular proximal signaling events including reducing phosphorylation of the SIK substrate cAMP response element binding protein (CREB) regulated transcription coactivator 3 (CRTC3) as detected with an internally generated phospho-Ser329-CRTC3-specific antibody. These inhibitors also suppress production of pro-inflammatory cytokines while inducing anti-inflammatory interleukin-10 in activated human and murine myeloid cells and in mice following a lipopolysaccharide challenge. Oral dosing of these compounds ameliorates disease in a murine colitis model. These findings define an approach to generate highly selective SIK1/2 inhibitors and establish that targeting these isoforms may be a useful strategy to suppress pathological inflammation., Competing Interests: Competing interests statement:The authors’ employment information at the time of data generation are marked in the “Author affiliations” section. H.B., T.B.S., M.T., M.S., G.B., W.C., L.C, De M.C., K.C., B.C., M.F., A.G., P.A.M., A.M., E.V.M.-M., M.-L.R., M.R., P.L.S., R. Smith, J. Smith, R. Steele, H.S., J. Suarez, G.T., N.M., L.P.V., J.W., P.T.D., L.L.O., T.K., S.D.G., G.H., T.O., N.S., S.P., J.D.V., J.E.T. are current or former employees of Janssen Research & Development, LLC, and employees may own stock/stock options in Johnson & Johnson, of which Janssen Research & Development, LLC is a subsidiary. R.J.X. is co-founder of Jnana Therapeutics and Celsius Therapeutics, scientific advisory board member at Nestlé and Magnet BioMedicine, board director at MoonLake Immunotherapeutics; these organizations had no roles in this study. G.B., W.C., De M.C., S.D.G., G.H., V.K.K., E.V.M.-M., D.D.R., H.S., M.S., R. Smith, T.B.S., M.T., J.D.V., J.W., and R.J.X. are named as inventors on the PCT patent application “Small Molecule Inhibitors of Salt Inducible Kinases”, published as WO 2022/165529, and N.M., R.J.X., T.B.S., G.T., and H.B. are named inventors on the PCT patent application “Materials and Methods for Differentiating CREB Regulated Transcription Coactivator 3”, published as WO 2022/260995.