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• Networks containing covalent crosslinks and supramolecular metal-ligand motifs. • Mechanics dictated by how energy is dissipated during deformation. • Shift in energy dissipation and mechanics driven by morphology. • Chemical gradients are applied through the diffusion of a competitive ligand. Polychaete worms display a remarkable jaw structure, where a gradient in metal-ligand coordination down the length of the jaw results in a shift from hard to soft mechanics. To mimic these gradient structures, a Zn-coordinated supramolecular polymer is crosslinked into a covalent matrix to afford supramolecular semi-interpenetrating networks (SIPNs). These SIPN materials exhibit improved mechanics with a lower supramolecular content (30 wt%), allowing for energy dissipation through cavitation to increase material toughness. The shift in mechanical behavior is further attributed to the morphology, where the size of the phase-separated droplets and nature of the continuous phase in these SIPNs contributes to the material mechanics. Furthermore, chemical gradients are applied to these systems through exposure to a competitive ligand, offering control over the localization of supramolecular interactions. These materials offer a framework to mediate mechanics while maintaining the ability to program gradient supramolecular interactions. [ABSTRACT FROM AUTHOR]

The trend amongst many parties toward the inclusion of rank-and-file members in the leadership selection process has often been attributed to opposition status and electoral defeat. However, these explanations are typical events for parties and hardly seem sufficient for party elites to willingly cede their authority over the selection of party leaders. This paper proposes that the electoral regionalization of the party contributes to the decision to expand the leadership selectorate. In the event a party is defeated to an extent in which their support is reduced to its regional base, this situation necessitates the bringing in of new voices to avoid further marginalization. This paper finds that regionalization plays a significant role in the decision of parties to expand leadership selectorates and that the role of opposition status and electoral setbacks have been overstated. [ABSTRACT FROM AUTHOR]

Retinal bipolar cells are second-order neurons that transmit basic features of the visual scene to postsynaptic partners. However, their contribution to motion detection has not been fully appreciated. Here, we demonstrate that cholinergic feedback from starburst amacrine cells (SACs) to certain presynaptic bipolar cells via alpha-7 nicotinic acetylcholine receptors (α7-nAChRs) promotes direction-selective signaling. Patch clamp recordings reveal that distinct bipolar cell types making synapses at proximal SAC dendrites also express α7-nAChRs, producing directionally skewed excitatory inputs. Asymmetric SAC excitation contributes to motion detection in On-Off direction-selective ganglion cells (On-Off DSGCs), predicted by computational modeling of SAC dendrites and supported by patch clamp recordings from On-Off DSGCs when bipolar cell α7-nAChRs is eliminated pharmacologically or by conditional knockout. Altogether, these results show that cholinergic feedback to bipolar cells enhances direction-selective signaling in postsynaptic SACs and DSGCs, illustrating how bipolar cells provide a scaffold for postsynaptic microcircuits to cooperatively enhance retinal motion detection. [Display omitted] • Retinal bipolar cells express α7 or non-α7-nAChRs in a type-dependent manner • Cholinergic feedback to bipolar cell α7-nAChRs boosts SAC direction selectivity • Bipolar cell α7-nAChRs boost asymmetric inhibition to motion-sensing ganglion cells • Conditional α7-knockout from bipolar cells impairs retinal motion detection Moving objects are sensed by the retina, which depends on neural circuits for visual motion detection. Hellmer et al. demonstrate that specific second-order retinal bipolar cells receive cholinergic feedback via nicotinic acetylcholine receptors, which enhances directional signaling of postsynaptic neurons in motion detection circuits. [ABSTRACT FROM AUTHOR]

Catatonia is a neuropsychiatric syndrome involving a complex mixture of motor, behavioral, and systemic manifestations. Approximately 70-90% of patients with anti-NMDAR encephalitis develop neuropsychiatric symptoms, including altered mental status, seizure, autonomic instability, catatonia, and dyskinesia and have a 4% mortality. Another form of mental health emergency called malignant catatonia, with 10-20% mortality when untreated, can also present in children with profound motor and mental illness symptoms. [Extracted from the article]

Background: Women with a gynecologic cancer tend to be older, obese, and postmenopausal, characteristics that are associated with an increased risk for obstructive sleep apnea. However, there is limited investigation regarding the condition's prevalence in this population or its impact on postoperative outcomes. In other surgical populations, patients with obstructive sleep apnea have been observed to be at increased risk for adverse postoperative events.Objective: We sought to estimate the prevalence of obstructive sleep apnea among gynecologic oncology patients undergoing elective surgery and to investigate for a relationship between obstructive sleep apnea and postoperative outcomes.Study Design: Patients referred to an academic gynecologic oncology practice were approached for enrollment in this prospective, observational study. Patients were considered eligible for study enrollment if they were scheduled for a nonemergent inpatient surgery and could provide informed consent. Enrolled patients were evaluated for a preexisting diagnosis of obstructive sleep apnea. Those without a prior diagnosis were screened using the validated, 4-item STOP questionnaire (ie, Snore loudly, daytime Tiredness, Observed apnea, elevated blood Pressure). All patients who screened positive for obstructive sleep apnea were referred for polysomnography. The primary outcome was the prevalence of women with obstructive sleep apnea or those who screened at high risk for the condition. Secondary outcomes examined the correlation between body mass index (kg/m2) with obstructive sleep apnea and assessed for a relationship between obstructive sleep apnea and postoperative outcomes.Results: Over a 22-month accrual period, 383 eligible patients were consecutively approached to participate in the study. A cohort of 260 patients were enrolled. A total of 33/260 patients (13%) were identified as having a previous diagnosis of obstructive sleep apnea. An additional 66/260 (25%) screened at risk for the condition using the STOP questionnaire. Of the patients who screened positive, 8/66 (12%) completed polysomnography, all of whom (8/8 [100%]) were found to have obstructive sleep apnea. The prevalence of previously diagnosed obstructive sleep apnea or screening at risk for the condition increased as body mass index increased (P < .001). Women with untreated obstructive sleep apnea and those who screened at risk for the condition were found to have an increased risk for postoperative hypoxemia (odds ratio, 3.5; 95% confidence interval, 1.8-4.7; P = .011) and delayed return of bowel function (odds ratio, 2.1; 95% confidence interval, 1.3-4.5; P = .009).Conclusion: The prevalence of obstructive sleep apnea or screening at risk for the condition is high among women presenting for surgery with a gynecologic oncologist. Providers should consider evaluating a patient's risk for obstructive sleep apnea in the preoperative setting, especially when risk factors for the condition are present. [ABSTRACT FROM AUTHOR]

Psychedelic compounds have potentially rapid, long-lasting anxiolytic, antidepressive and anti-inflammatory effects. We investigated whether the psychedelic compound (R)-2,5-dimethoxy-4-iodoamphetamine [(R)-DOI], a selective 5-HT 2A receptor partial agonist, decreases stress-related behavior in male mice exposed to repeated social aggression. Additionally, we explored the likelihood that these behavioral changes are related to anti-inflammatory properties of [(R)-DOI]. Animals were subjected to the Stress Alternatives Model (SAM), an escapable social stress paradigm in which animals develop reactive coping strategies - remaining in the SAM arena (Stay) with a social aggressor, or dynamically initiated stress coping strategies that involve utilizing the escape holes (Escape) to avoid aggression. Mice expressing these behavioral phenotypes display behaviors like those in other social aggression models that separate animals into stress-vulnerable (as for Stay) or stress-resilient (as for Escape) groups, which have been shown to have distinct inflammatory responses to social stress. These results show that Stay animals have heightened cytokine gene expression, and both Stay and Escape mice exhibit plasma and neural concentrations of the inflammatory cytokine tumor necrosis factor-α (TNF α) compared to unstressed control mice. Additionally, these results suggest that a single administration of (R)-DOI to Stay animals in low doses, can increase stress coping strategies such as increasing attention to the escape route, promoting escape behavior, and reducing freezing during socially aggressive interaction in the SAM. Lower single doses of (R)-DOI, in addition to shifting behavior to suggest anxiolytic effects, also concomitantly reduce plasma and limbic brain levels of the inflammatory cytokine TNF α. • A single dose of psychedelic [(R)-DOI] promotes Escape in stress-susceptible mice. • A low dose of [(R)-DOI] improves stress resilient behavior. • Social stress in the Stress Alternatives model increases plasma and neural TNF α. • Stress-induced elevation of cytokine expression in BLA in Stay susceptible phenotype. • A low dose of [(R)-DOI] reduces social stress-induced TNF α in BLA. [ABSTRACT FROM AUTHOR]

Background Context: The neck disability index (NDI) was the first patient-reported outcome (PRO) instrument specific to patients with neck pain, and it remains one of the most widely used PROs for the neck population. The NDI is an appealing measure as it is a short and well-known PRO measure. Currently, there are conflicting data on the performance and applicability of the NDI in patients undergoing either operative or nonoperative treatment for neck-related conditions.Purpose: This study investigates the psychometric properties, performance, and applicability of the NDI in the spine patient population.Study Design: A total of 865 patients visiting a university-based spine clinic with neck complaints, with or without radiating upper extremity pain, numbness, or weakness were enrolled in the study. Visit types included new and follow-up visits to both operative and nonoperative treatments. Questionnaires were administered electronically on a tablet computer, and all patients answered all 10 questions of the NDI.Methods: Standard descriptive statistics were performed to describe the demographic characteristics of the patients. Rasch modeling was applied to examine the psychometric properties of the NDI.Results: The NDI demonstrated insufficient unidimensionality (ie, unexplained variance after accounting for the first dimension=9.4%). Person reliability was 0.85 and item reliability was 1.00 for the NDI. The overall item fit for the NDI was good with an outfit mean square of 1.03. The NDI had a floor effect of 35.5% and ceiling effect of 4.6%. The raw score to measure correlation of the NDI was 0.019.Conclusions: Although the NDI had good person and item reliability, it did not demonstrate strong evidence of unidimensionality. The NDI exhibited a very large floor effect. Because of the poor raw score to measure correlation, the sum score should not be used in interpretation of findings. Despite great investment by physicians and other stakeholders in the NDI, this evaluation and previous research have demonstrated that the NDI needs further investigation and refinement. [ABSTRACT FROM AUTHOR]

Improving value in surgical care requires a detailed understanding of the true costs of surgical and operating room resources. In this study, we sought to identify predictors of health care costs and operating room resource use for patients undergoing initial single-level discectomies using a unique institutional cost dataset from the value driven outcomes (VDO) program developed by the University of Utah. A retrospective cost analysis of primary single-level lumbar discectomies. A total of 622 patients undergoing initial single-level lumbar discectomy between January 2014 to April 2016 at the University of Utah Orthopaedic Center. Health care costs, clinical length of stay, and operating room time. Univariate and multivariate generalized linear models (GLM) performed to identify predictors of health care costs, clinical length of stay (LOS, days) and operating room time (OR, minutes) using a unique costing tool. Modified park test procedure was implemented to determine GLM error distribution specifications and standard errors were clustered by provider. Cost outcomes were normalized using mean costs for a patient with normal body mass index (BMI) and a healthy American Society of Anesthesiologists (ASA) classification system. Average marginal effects in multivariate analysis were reported as percentage of normalized costs. Advanced age, male gender, Hispanic, Black, unemployment, and being retired were significant positive predictors of costs in univariate analysis. Asian, Native American, outpatient procedures, and being a student were significant negative predictors of costs. Univariate analysis also showed that obesity, higher ASA class and insurance status were also positive and significant predictors of costs. In multivariate analysis, we found that obesity led to higher average marginal total direct (9%), total facility (15%), and facility OR costs (22%), as well as an average marginal effect of 24 more OR minutes per surgery. Conversely, being underweight was associated with lower average marginal total direct (-23%), total non-facility (-54%), total facility (-8%), facility OR costs (-15%), as well as lower clinical LOS (-.42 days), and 18 less OR minutes. While being overweight was not significantly associated with greater total direct costs, it was associated with higher total facility (8%), and facility OR costs (12%), with an average marginal effect of 11 more OR minutes per surgery. Age was associated with a longer LOS but not with OR costs in multivariate analysis. As expected, outpatient surgical costs, LOS and OR time were significantly lower than inpatient procedures. Patients with incapacitating disease ASA Class had the highest predicted OR time in GLM estimates with an average marginal effect of 28 minutes, while severe systematic disease was associated with greater total and nonfacility costs. In addition, Medicare patients had higher facility costs (14%) compared to privately insured patients. Although many of our observed variables were significant predictors of costs in univariate analysis, multivariate GLM estimates showed that the main variables determining cost and operating room time and resource use were obesity (BMI), general health (ASA class), Medicare status and advanced age, and whether the surgery was an outpatient or inpatient procedure. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]