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• Client experiences of virtual energy healing include embodied sensations, relaxation, release, sense of peace, and connection to self and others. • Clients reported increased relaxation, increased well-being, and decreased pain after virtual energy healing sessions via Zoom. • Clients reported they were surprised that virtual energy healing worked. During the COVID-19 pandemic medical and holistic health practitioners turned to utilizing virtual healthcare. As energy healing practitioners and educators who shifted to an online format, it seemed important to document descriptions of client experiences of virtual energy healing. To describe client experiences of virtual energy healing sessions. Descriptive pre-post intervention design. Two experienced and eclectic energy healing practitioners developed a protocol and conducted energy healing sessions via Zoom. A convenience sample of Sisters of St. Joseph of Carondelet (CSJ) Consociates, people of diverse life-styles and spiritual traditions who are committed to living the mission of the CSJs in the St. Paul Province. Pre-post 10-point Likert scale rating of relaxation, well-being, and pain. Pre-post primarily qualitative questionnaires. Results indicated significant pre-post differences: pre-session relaxation (M=5.036, SD = 2.9) and post-session relaxation (M=7.86, SD = 6.4): t(13)=2.16, p=.0017*; pre-session well-being (M=5.86, SD = 4.29); post-session well-being (M=8, SD = 2.31), t(13), p=.0001*; pre-session pain (M=4.0, SD = 6.15) and post-session pain (M=2.25, SD = 3.41), t(13)=2.16, p=.004*. Thematic analysis revealed six themes related to client experiences of virtual energy healing: 1) embodied sensations, 2) relaxation, 3) release - a letting go of tasks/anxieties/worries, 4) sense of peace/joy/calm, 5) connection to themselves, others, and something larger, and 6) surprise that virtual energy healing works. This was a descriptive study using a convenience sample, therefore, there was not a control group, a large sample size, and the sample might be more prone to report better results than the general population because of their spiritual perspectives. Results were not generalizable. Clients reported positive descriptions of virtual energy healing and say they would do it again. However more research is needed to understand the variables that influenced the results and the underlying mechanisms of action. [ABSTRACT FROM AUTHOR]

The care of critically ill neonates and pediatric patients can be particularly emotionally and ethically challenging. Emerging evidence suggests that we can improve the patient, family, and care team experience in the critical care setting through a better understanding and application of ethical frameworks and communication strategies. We conducted a multidisciplinary panel session at the American Academy of Pediatrics National Conference and Exhibition in the fall of 2022 wherein we explored a myriad of ethical and communication considerations in this unique patient population, with congenital diaphragmatic hernia (CDH) as the congenital anomaly/disease framework. In this review, we will cover state of the art topics in ethics, communication, and palliative care including basic terminology, communication strategies such as trauma-informed communication, establishing/evolving goals of care, futility, medically inappropriate treatment, ethical frameworks, parental discretion, establishing milestones, internal/external intentions, and re-direction of care. These topics will be helpful to many specialties who are involved in the care of critically ill neonates and children including maternal fetal medicine, pediatrics, neonatology, pediatric critical care, palliative care, and pediatric surgery, along with the pediatric surgical subspecialties. We use a theoretical CDH case as an example and include the live audience responses from the interactive session. This primer provides overarching educational principles, as well as practical communication concepts, that can cultivate compassionate multidisciplinary teams, equipped to optimize family-centered, evidence-based compassionate communication and care. [ABSTRACT FROM AUTHOR]

Recent United States Department of Energy (DOE) sponsored front-end engineering design (FEED) studies for retrofitting existing fossil-fueled power plants with state-of-the-art carbon capture technology contain previously overlooked real-world design considerations for near-term deployment of carbon capture. Insights from examining seven recently published FEED study reports are summarized in this paper. This includes a discussion of the design, performance, and cost implications associated with (1) location-specific considerations such as water availability, land availability, and accessibility; (2) host-plant-specific factors such as flue gas specifications, allowable degree of integration between the capture system and host plant, and operational mode; and (3) miscellaneous factors such as market conditions, permitting requirements, and business case incentives. This manuscript highlights (1) water availability as a key design and cost driver, with host plant steam extraction increasing capture system cooling water availability, (2) modularization and constructability impacts on the number of capture trains, (3) the impacts of host plant operational mode and capacity factor on the business case for installing capture, and (4) the merit of continued research, development, and demonstration efforts addressing steam extraction, host plant tie-in at the stack, solvent reclamation and air emissions control. [ABSTRACT FROM AUTHOR]

Anthropogenic pollutants are near-ubiquitous in aquatic systems. Aquatic animals such as fishes are subject to physiological stress induced by pollution present in aquatic systems, which can translate to changes in behaviour. Key adaptive behaviours such as shoaling and schooling may be subject to change as a result of physiological or metabolic stress or neurosensory impacts of pollution. This can result in fitness and ecological impacts such as increased predation risk and reduced foraging success. Here, we conducted a systematic metanalysis of the existing literature, comprising 165 studies, on the effects of anthropogenic pollution on sociability and group cohesion in fish species. Both organic (number of studies = 92, posterior mean (PM) = −0.483, p < 0.01) and inorganic (n = 24, PM = −1.453, p < 0.001) chemical pollutants, as well as light exposure (n = 21, PM = −3.038, p < 0.01) were found to reduce sociability. These pollutants did not reduce group cohesion, indicating that effects may be masked in group settings, though fewer studies were carried out on group cohesion and this is a key area for future research. Mixtures of chemical pollutants (n = 16) were found to reduce cohesion (PM = −43.71, p < 0.01), but increase sociability (PM = 44.27, p < 0.01). Evidence was found that fish may behaviourally acclimate to two forms of pollutant, namely mixed chemical pollutants (PM = −0.668, p < 0.01) and noise exposure (n = 22, PM = −4.043, p < 0.01). While aquatic systems are often subject to pollution from multiple sources and of multiple types, very few studies investigated the effects of multiple stressors concurrently. This review identifies trends in the existing literature, and highlights areas where further research is required in order to understand the behavioural and ecological impacts of anthropogenic pollutants in aquatic systems. [Display omitted] • Reduced sociability following exposure to individual chemical pollutants. • Reduced sociability in light compared with dark conditions. • Reduced cohesion following exposure to mixed organic and inorganic pollutants. • Evidence of acclimation to mixed organic and inorganic pollutants. • Evidence of acclimation to noise exposure. [ABSTRACT FROM AUTHOR]

Anthropogenic pollutants are near-ubiquitous in aquatic systems. Aquatic animals such as fishes are subject to physiological stress induced by pollution present in aquatic systems, which can translate to changes in behaviour. Key adaptive behaviours such as shoaling and schooling may be subject to change as a result of physiological or metabolic stress or neurosensory impacts of pollution. This can result in fitness and ecological impacts such as increased predation risk and reduced foraging success. Here, we conducted a systematic metanalysis of the existing literature, comprising 165 studies, on the effects of anthropogenic pollution on sociability and group cohesion in fish species. Both organic (number of studies = 92, posterior mean (PM) = −0.483, p < 0.01) and inorganic (n = 24, PM = −1.453, p < 0.001) chemical pollutants, as well as light exposure (n = 21, PM = −3.038, p < 0.01) were found to reduce sociability. These pollutants did not reduce group cohesion, indicating that effects may be masked in group settings, though fewer studies were carried out on group cohesion and this is a key area for future research. Mixtures of chemical pollutants (n = 16) were found to reduce cohesion (PM = −43.71, p < 0.01), but increase sociability (PM = 44.27, p < 0.01). Evidence was found that fish may behaviourally acclimate to two forms of pollutant, namely mixed chemical pollutants (PM = −0.668, p < 0.01) and noise exposure (n = 22, PM = −4.043, p < 0.01). While aquatic systems are often subject to pollution from multiple sources and of multiple types, very few studies investigated the effects of multiple stressors concurrently. This review identifies trends in the existing literature, and highlights areas where further research is required in order to understand the behavioural and ecological impacts of anthropogenic pollutants in aquatic systems. [Display omitted] • Reduced sociability following exposure to individual chemical pollutants. • Reduced sociability in light compared with dark conditions. • Reduced cohesion following exposure to mixed organic and inorganic pollutants. • Evidence of acclimation to mixed organic and inorganic pollutants. • Evidence of acclimation to noise exposure. [ABSTRACT FROM AUTHOR]

• Asymptomatic bacteriuria was highly prevalent (64%) in this Veteran population. • Twenty-eight percent of asymptomatic bacteriuria cases were inappropriately prescribed antimicrobials. • Abdominal pain, falls, decreased urine output and voiding issues were related to treatment. • Stewardship programs can incorporate these findings to reduce unnecessary treatment. Chart reviews often fall short of determining what drove antibiotic treatment of asymptomatic bacteriuria (ASB). To overcome this shortcoming, we searched providers' free-text for documentation of their decision-making and for misleading signs and symptoms that may trigger unnecessary treatment of ASB. We reviewed a random sample of 10 positive urine cultures per month, per facility, from patients in acute or long-term care wards at 8 Veterans Affairs facilities. Cultures were classified as urinary tract infection (UTI) or ASB, and as treated or untreated. Charts were searched for 13 potentially misleading symptoms, and free-text documentation of providers' decision-making was classified into 5 categories. We used generalized estimating equations logistic regression to identify factors associated with ASB treatment. One hundred fifty-eight (27.5%) of 575 ASB cases were inappropriately treated with antibiotics. Significant factors associated with inappropriate treatment included: abdominal pain, falls, decreased urine output, urine characteristics, abnormal vital signs, laboratory values, and voiding issues. Providers prescribed an average of 1.4 antimicrobials to patients with ASB, with cephalosporins (41%) and fluoroquinolones (21%) being the most common classes prescribed. Chart reviews of providers' decision-making highlighted new factors associated with inappropriate ASB treatment. These findings can help design antibiotic stewardship interventions for ASB. [ABSTRACT FROM AUTHOR]

• Mechanical ventilation with high tidal volumes during critical care transport is associated with high tidal volume ventilation in the receiving intensive care unit. • Women and men with shorter stature are at increased risk of high tidal volume ventilation during transport. • Mechanical ventilation tidal volume selection during transport has the potential to influence downstream ventilator management. High tidal volume ventilation is associated with ventilator-induced lung injury. Early introduction of lung protective ventilation improves patient outcomes. This study describes ventilator management during critical care transport and the association between transport ventilator settings and ventilator settings in the intensive care unit (ICU). This was a retrospective review of mechanically ventilated adult patients transported to an academic medical center via a critical care transport program between January 2018 and April 2019. Ventilator settings during transport were compared with the initial and 6- and 12-hour postadmission ventilator settings. Three hundred eighty patients were identified; 114 (30%) received tidal volumes > 8 mL/kg predicted body weight at the time of transfer. The transport handoff tidal volume strongly correlated with the ICU tidal volume (Pearson r = 0.7). Patients receiving high tidal volumes during transport were more likely to receive high tidal volumes initially upon transfer (relative risk [RR] = 4.6; 95% confidence interval [CI], 3.3-6.5) and at 6 and 12 hours after admission (RR = 2.6; 95% CI, 1.8-3.8 and RR = 2.7; 95% CI, 1.7-4.3, respectively). Exposure to high tidal volumes during transport is associated with high tidal volume ventilation in the ICU, even up to 12 hours after admission. This study identifies opportunities for improving patient care through the application of lung protective ventilation strategies during transport. [ABSTRACT FROM AUTHOR]

Background: Self-directed rehabilitation (SDR) after total knee arthroplasty (TKA) has not been traditionally recommended. The purpose of this study was to determine if there was an impact on postoperative outcomes with the use of an SDR program after primary TKA.Methods: In this prospective, randomized, multicenter, controlled trial, we paired a smartwatch with a mobile application, providing an SDR program after TKA. Three groups were examined in this level I study: (1) control group (formal physical therapy [PT]), (2) high exercise compliance group, and (3) low exercise compliance group. Patient-reported outcome measures (PROMs) of knee injury and osteoarthritis outcome scores, joint replacement (KOOS, JR), and EuroQol five-dimension five-level (EQ-5D-5L) along with range of motion (ROM) and manipulation rates were evaluated.Results: Three hundred thirty-seven patients were enrolled in two groups with 184 in the control group and 153 in the study groups (90 in the high-compliance group and 63 in the low-compliance group). The KOOS, JR score was statistically lower in the low-compliance group in net change from preoperative scores at 3 months (P = .046) and 6 months (P = .032) than that in the control group; difference was noted at 6 months for the high-compliance group, P = .036. However, these did not meet the threshold of 8.02 units for KOOS JR minimal clinically important difference. No differences were seen in PROMs at other time intervals and in manipulation rates or ROM.Conclusion: Postoperative outcomes including manipulation under anesthesia, ROM, and PROMs were not different when a smartwatch paired with a self-directed PT mobile application was compared with traditional formal PT. Surgeons can consider this an appropriate alternative to traditional PT programs after TKA. [ABSTRACT FROM AUTHOR]

The objective of this study was to conduct a preliminary evaluation of a new young adult–centered metaintervention to improve treatment engagement among those with serious mental illness. Young adults, clinic staff, and policy makers provided feedback on the intervention, which is a two-module engagement program provided by a clinician and person with lived experience (peer) during intake. A two-group pilot randomized explanatory trial design was conducted, comparing treatment as usual with treatment as usual plus the engagement program, Just Do You. The primary outcomes were treatment engagement and presumed mediators of program effects measured at 3 months after baseline. The randomized explanatory trial indicated that young adults in Just Do You were more engaged in treatment than treatment as usual and that changes in several mediators of engagement occurred. Mechanisms that demonstrated between-group differences were stigma, perceived expertise of providers, trust in providers, and beliefs about the benefits of treatment. Results also provide diagnostic information on mediators that the program failed to change, such as hope, self-efficacy, and emotional reactions to treatment. These results inform next steps in the development of this promising intervention. Just Do You illustrated feasibility, acceptability and preliminary impact. It represents an innovative metaintervention that has promise for improving treatment engagement in mental health services among young adults who have a history of poor engagement. [ABSTRACT FROM AUTHOR]

• First study to evaluate the gift of a bicycle on habits of overweight children. • Participants recruited from clinically settings where they were being seen for unhealthy weight. • Step-wedge randomized design, each child served as their own control (wait for bike was 0–6 months). • Majority of children reported riding their bike frequently. • BMI, eating, and activity initially improved but reverted to baseline. Treating pediatric obesity is challenging. The objective was to evaluate effect of receiving a bicycle on (a) physical activity, (b) sedentary activity, (c) Body Mass Index (BMI), and (d) eating habits. A stepped-wedge randomized controlled trial of 6- to 12-year-old patients with overweight/obesity was conducted April 2012–2018. Participants were randomized to wait 0, 2, 4, or 6 months for a bicycle. Outcomes on activity, BMI and eating were collected at 3, 6, 9- and 12-months after children received a bicycle. A total of 525 participants with 387 (74%) completed 3-month follow-up questionnaire, and 346 (66%) completed 12-month follow-up visit. Participants were mostly Latino/a (71%) and low income (58%), and 31% had never ridden a bicycle. Median baseline BMI was 98th percentile. At 3 months, 62% reported bicycle use last week, on average 3.6 days. Time spent on sedentary activities decreased by 48 min/day (p = 0.04), and time spent playing sports increased by 1.7 h/week (p < 0.01). No reduction in BMI was seen. Consumption of sugary drinks decreased (by 0.59 servings/week, p < 0.01), and consumption of vegetables increased (0.71 servings/week, p = 0.04). At 12 months, sedentary time, sugary drink and vegetable consumption remained significantly more favorable than at enrollment (p < 0.01, p < 0.01, p = 0.04 respectively), but not significantly different (p = 0.47 for sedentary, p = 0.73 for sugary drink) and significantly less favorable (p < 0.01 for vegetables) than at the time of intervention. Participants reported riding bicycle, improved activity and dietary habits, though reversion towards baseline behavior was seen by one year and no change in BMI from enrollment. [ABSTRACT FROM AUTHOR]

[Display omitted] Vaginal tearing at childbirth is extremely common yet understudied despite the long-term serious consequences on women's health. The mechanisms of vaginal tearing remain unknown, and their knowledge could lead to the development of transformative prevention and treatment techniques for maternal injury. In this study, whole rat vaginas with pre-imposed elliptical tears oriented along the axial direction of the organs were pressurized using a custom-built inflation setup, producing large tear propagation. Large deformations of tears through propagation were analyzed, and nonlinear strains around tears were calculated using the digital image correlation technique. Second harmonic generation microscopy was used to examine collagen fiber organization in mechanically untested and tested vaginal specimens. Tears became increasingly circular under pressure, propagating slowly up to the maximum pressure and then more rapidly. Hoop strains were significantly larger than axial strains and displayed a region- and orientation-dependent response with tear propagation. Imaging revealed initially disorganized collagen fibers that aligned along the axial direction with increasing pressure. Fibers in the near-regions of tear tips aligned toward the hoop direction, hampering tear propagation. Changes in tear geometry, regional strains, and fiber orientation revealed the inherent toughening mechanisms of the vaginal tissue. Women's reproductive health has historically been understudied despite alarming maternal injury and mortality rates in the world. Maternal injury and disability can be reduced by advancing our limited understanding of the large deformations experienced by women's reproductive organs. This manuscript presents, for the first time, the mechanics of tear propagation in vaginal tissue and changes to the underlying collagen microstructure near to and far from the tear. A novel inflation setup capable of maintaining the in vivo tubular geometry of the vagina while propagating a pre-imposed tear was developed. Toughening mechanisms of the vagina to propagation were examined through measurements of tear geometry, strain distributions, and reorientation of collagen fibers. This research draws from current advances in the engineering science and mechanics fields with the goal of improving maternal health care. [ABSTRACT FROM AUTHOR]

The aim of the study was to document mental health service use (counseling and medication) among youth in foster care, examine how prepared they feel to manage their mental health, and investigate predictors of service use and preparedness. The study includes a representative sample of youth in California foster care at age 17 years who participated in in-person, structured interviews (n = 727). Survey measures captured youth characteristics, their mental health service use, and their level of preparedness to manage their mental health. Data from a child welfare worker survey were used to capture county-level service availability, helpfulness, and coordination. Binary and ordered logistic regression were used to predict mental health service use and preparedness. Youth reported high rates of mental health service use and one-fifth of the sample reported feeling less than prepared to manage their mental health. Youth who screened positive for mental disorders were less prepared than their peers to manage their mental health. Physical (odds ratio [OR] = 1.44; p <.05) and sexual abuse (OR = 2.04; p <.001) predicted past year use of counseling. Sexual abuse also predicted medication use (OR = 1.97; p <.01). Youth who identified as 100% heterosexual were less likely than non-100% heterosexual peers to use counseling (OR =.58; p <.05). The results also suggest geographic variation in use. Finally, caseworkers' perception of greater helpfulness of services in the county they worked predicted greater mental health preparedness (OR = 1.23; p <.05). Mental health service use remains high among youth in foster care. Youth with particular characteristics may benefit from interventions aimed at preparing them for managing their mental health in adulthood. [ABSTRACT FROM AUTHOR]

Objectives: To determine which patients with congenital diaphragmatic hernia (CDH) and pulmonary hypertension (PH) benefit from inhaled nitric oxide (iNO) treatment by comparing characteristics and outcomes of iNO responders to nonresponders.Study Design: We performed a retrospective chart review of infants with CDH treated at our center between 2011 and 2016. In a subset of patients, iNO was initiated for hypoxemia or echocardiographic evidence of extrapulmonary right to left shunting. Initial post-treatment blood gases were reviewed, and patients were classified as responders (increased PaO2 >20 mm Hg) or nonresponders. Baseline characteristics, echocardiograms and outcomes were compared between groups with Fisher exact tests and Mann-Whitney t tests, as appropriate.Results: During the study period, 95 of 131 patients with CDH (73%) were treated with iNO. All patients with pretreatment echocardiograms (n = 90) had echocardiographic evidence of PH. Thirty-eight (40%) patients met treatment response criteria. Responders had significant improvements in PaO2 (51 ± 3 vs 123 ± 7 mm Hg, P < .01), alveolar-arterial gradient (422 ± 30 vs 327 ± 27 mm Hg, P < .01), and PaO2 to FiO2 ratio (82 ± 10 vs 199 ± 15 mm Hg, P < .01). Nonresponders were more likely to have left ventricular systolic dysfunction (27% vs 8%, P = .03) on echocardiogram. Responders were less likely to require extracorporeal membrane support (50 vs 24%, P = .02).Conclusions: iNO treatment is associated with improved oxygenation and reduced need for ECMO in a subpopulation of patients with CDH with PH and normal left ventricular systolic function. [ABSTRACT FROM AUTHOR]

Despite the need for climate change mitigation and altered forest management practices, little is known about the impacts of silvicultural practices such as partial-cuts and clear-cuts on forest ecosystem carbon (C) dynamics. Specifically, the effect of these two overstory treatments on C pools other than the aboveground biomass of trees remains poorly understood. Here, C stocks were estimated for a northern temperate mixed forest located in eastern Québec, Canada, five years after clear-cutting and partial-cutting, either with or without a brushing treatment to control the competing vegetation. The biomass of the aboveground vegetation (trees, saplings, understory), litter and woody debris (coarse, small, fine), as well as the roots (diameter ≤ 1.5 cm) was evaluated. Additionally, soil C pools up to a depth of 35 cm of the mineral soil were assessed. Total ecosystem C stocks were influenced by the overstory treatments reflecting harvest intensities. Although the belowground C pools were major contributors to total ecosystem C stocks, silvicultural treatments only influenced forest floor and aboveground C stocks. However, assessments like the one presented here capture contemporary C stocks, which highlights the need for monitoring to build suitable forest ecosystem C models and to understand long-term C dynamics. • Northern temperate mixed forests store large quantities of carbon. • Belowground carbon pools are major contributors to total ecosystem carbon stocks. • Total ecosystem carbon stocks are influenced by silvicultural overstory treatments reflecting harvest intensities. • Silvicultural treatments only influenced forest floor and aboveground carbon stocks. [ABSTRACT FROM AUTHOR]

Practice-embedded learning opportunities close the gap between professional development and practice. Side-by-side coaching can serve as such a learning opportunity by situating the teacher and coach in co-participation in the teacher's classroom. In this paper, we decompose side-by-side coaching drawing on Rogoff's (1995) constructs of guided participation and appropriation to demonstrate how co-participation can provide varied learning opportunities for teachers. We found that during side-by-side coaching teachers and coaches moved between seven forms of guided participation and opportunities for appropriation of practice. We discuss the adaptability of side-by-side coaching as a practice-embedded teacher learning opportunity and discuss implications for design. • Elementary mathematics teachers engaged in side-by-side coaching to develop productive teacher-student interactions. • Teacher and coach co-participation were decomposed using Rogoff's (1995) planes of sociocultural activity. • Seven forms of guided participation were found within side-by-side coaching. • Side-by-side coaching was found to include opportunities for teacher appropriation of practice. [ABSTRACT FROM AUTHOR]

Background: The risks and benefits of pharmacologic treatment and operative closure of patent ductus arteriosus (O-PDA) in premature infants remain controversial. Recent series have demonstrated the feasibility of transcatheter PDA closure (TC-PDA) in increasingly small infants. The effect of this change on practice has not been evaluated.Methods: A multicenter observational study of infants treated in neonatal intensive care units in hospitals contributing data to the Pediatric Health Information Systems Database from January 2007 to December 2017 was performed to study trends in the propensities for (1) mechanical closure of PDA and (2) TC-PDA versus O-PDA, as well as interhospital variation in practice.Results: A total of 6,214 subjects at 44 hospitals were studied (5% TC-PDA). Subject median gestational age was 25 weeks (interquartile range: 24-27 weeks). Median age at closure was 24 days (interquartile range: 14-36 days). The proportion of all neonatal intensive care unit patients undergoing either O-PDA or TC-PDA decreased (3.1% in 2007 and 0.7% in 2017, P < .001), whereas the proportion in which TC-PDA was used increased significantly (0.1% in 2007 to 29.0% in 2017). Case-mix-adjusted multivariable models similarly demonstrated increasing propensity to pursue TC-PDA (odds ratio [OR] 1.66 per year, P < .001) with acceleration of the trend after 2014 (OR 2.46 per year, P < .001) as well as significant practice variation (P < .001, median OR 4.6) across the study period.Conclusions: In the face of decreasing closure of PDA, the use of TC-PDA increased dramatically with significant practice variability. This demonstrates that there is equipoise for potential clinical trials. [ABSTRACT FROM AUTHOR]

Microplastics (plastic particles <5 mm) are an emerging concern in Arctic sea ice with measured concentrations orders of magnitude higher than in surface seawater. However, incorporation of microplastics into sea ice, and their impact on sea ice properties, is unknown. We added microplastic particles in a microcosm experiment to determine microplastic distributions and effects on sea ice properties. Microplastic additions did not affect sea ice growth, but high concentrations of microplastics at the ice surface resulted in high ice salinity and changes in sea ice albedo. Field studies in the Gulf of Bothnia (Baltic Sea) showed sea ice concentration of microplastics from 8 to 41 particles per liter of melted ice, wich were much lower than those found to impact sea ice properties in the microcosm experiments. However, should microplastic concentrations increase, microplastic incorporation in sea ice may impact sea ice albedo. • Microplastics are concentrated within sea ice compared from underlying seawater. • Microplastic within sea ice does not affect the sea ice growth. • High microplastics concentration seems to affect sea ice salinity and albedo. [ABSTRACT FROM AUTHOR]

• Structure links some archaeal viruses to bacteriophages and eukaryotic viruses. • Others display morphologies and capsid proteins found only in archaeal viruses. • Environmental conditions may promote unique structural adaptations. • Bioinformatic analysis indicates many structurally undetermined virus families. Archaeal viruses exhibit diverse morphologies whose structures are just beginning to be explored at high-resolution. In this review, we update recent findings on archaeal structural proteins and virion architectures and place them in the biological context in which these viruses replicate. We conclude that many of the unusual structural features and dynamics of archaeal viruses aid their replication and survival in the chemically harsh environments, in which they replicate. Furthermore, we should expect to find more novel features from examining the high-resolution structures of additional archaeal viruses. [ABSTRACT FROM AUTHOR]

Highlights • A framework to construct Bayesian networks for landscape aesthetic evaluation is proposed. • A simple participatory methodology to weight indicators was developed. • Visual blights have a more profound effect on landscape than beauty indicators. Abstract Landscape aesthetics provides humans with health and social benefits contributing to overall well-being, thus representing a cultural ecosystem service. Landscape biophysical and social attributes create information that is interpreted as either beauty or blight by the mind of the beholder. The ARtificial Intelligence for Ecosystem Services (ARIES) modelling platform is quite suited to the landscape aesthetics paradigm, since it is characterized by both a strong focus on the spatial connectivity between ecosystems and beneficiaries and by the employment of Bayesian networks to quantify and communicate uncertainty. A conceptual framework based on landscape aesthetic abstraction levels was proposed to build these Bayesian networks, progressively linking tangible indicators to abstract dimensions and concepts. As input to ARIES, a simple and rapid participatory methodology was designed to weight indicators according to stakeholder preferences, from which values the probabilities were derived for use in canonical probabilistic models. The participatory indicator identification methodology generated both abstract and concrete terms, suggesting that the process should be supervised to obtain clear and tangible indicators. A sensitivity analysis revealed that individual visual blight indicators had more profound impacts on landscape aesthetic while the effect of beauty indicators was more subtle and balanced. Although the methodology may require a relatively large number of participants to derive probabilities, the procedure was not overly challenging for the participants. This methodology has the potential to be implemented widely, in various contexts and for different periods, accounting for alternative spatiotemporal variations and land cover contexts. [ABSTRACT FROM AUTHOR]

Background and Purpose: Standardized electronic medical record tools provide an opportunity to efficiently provide care that conforms to Best Practices and supports quality improvement and practice-based research initiatives.Methods: We describe the development of a customized structured clinical documentation "toolkit" that standardizes patient data collection to conform to Best Practices for treating patients with stroke. The toolkit collects patients' demographic information, relevant score test measures, and captures information on disability, treatment, and outcomes.Results: We describe here our creation and implementation of the toolkits and provide example screenshots. As of August 1, 2018, we have evaluated 2332 patients at an initial visit for a possible stroke. We provide basic descriptive data gathered from the use of the toolkits, demonstrating their utility in collecting patient data in a manner that supports both quality clinical care and research initiatives.Conclusions: We have developed an EMR toolkit to support Best Practices in the care of patients with stroke. We discuss quality improvement projects and current research initiatives using the toolkit. This toolkit is being shared with other Departments of Neurology as part of the Neurology Practice-Based Research Network. [ABSTRACT FROM AUTHOR]

ECMO has proven to be a life-saving intervention for a variety of disease entities with a high rate of survival in the neonatal population. However, ECMO requires clinical teams to engage in many ethical considerations. Even with ongoing improvements in technology and expertise, some patients will not survive a course of ECMO. An unsuccessful course of ECMO can be difficult to accept and cause a great deal of angst. These questions can result in real conflict both within the care team, and between the care team and the family. Herein we explore a range of ethical considerations that may be encountered when caring for a patient on ECMO, with a particular focus on those courses where it appears likely that the patient will not survive. We then consider how a palliative care approach may provide a tool set to help engage the team and family in confronting the difficult decision to discontinue ECMO. [ABSTRACT FROM AUTHOR]

• Forest assisted migration (FAM) is a strategy to align tree composition with changing climate. • FAM is risky because migrated individuals may be misaligned with climatic and site conditions. • DREAM fuses modelling, physiology, and silviculture research to reduce FAM risk. • DREAM modeled data identifies future adapted seed and forecasts FAM planting outcomes. • DREAM lab and field data inform FAM responses to novel abiotic and biotic conditions. Global change is reshaping climatic conditions at a tempo that exceeds natural migration rates for most tree species. As climate change amplifies the disparity between species' adaptive capacity and local climates, tree populations risk becoming geographically stranded in increasingly unsuitable conditions. This mismatch may cause catastrophic losses of key forest ecosystem services such as carbon sequestration, habitat provisioning, and forest products. In response, forest managers and researchers are developing a suite of climate-adaptive strategies designed to sustain forest diversity and function. Among these, forest assisted migration (FAM) involves the movement of planting stock from source populations to locations either within or beyond their current ranges. The goal is to establish forests that can survive in today's climate and expected to thrive in future conditions, thereby sustaining ecosystem good and services. Because FAM is still in its infancy, implementation is limited by many uncertainties. Climatically derived seed sourcing is needed to ensure that planting stock possesses the ecophysiological amplitude to withstand both current and future climatic conditions at the destination site. Additionally, more knowledge about the impacts of local herbivores and intraspecific competition are needed because these drivers will co-regulate seedling success along with climate. Practically, these uncertainties must be addressed to instill in managers sufficient confidence that FAM investments will fulfill long-term management and societal goals relative to other silvicultural approaches. The Desired REgeneration through Assisted Migration (DREAM) framework is an international collaboration that uses basic and applied research to reduce these uncertainties and derive climate-informed planting approaches. DREAM is self-reinforcing in that each step in the process informs and strengthens subsequent phases. Namely, it sources seed in a climatically informed manner, experimentally tests this sourced stock to probe for physiological maladaptation under controlled settings, grows the stock in the field under a range of silvicultural scenarios, and finally forecasts long-term outcomes using models parameterized from the controlled- and field-tests. In this paper, we describe the DREAM framework and illustrate aspects of its implementation drawing from two experimental sites: one in Québec, Canada and one in Wisconsin, USA. Moreover, we place the DREAM study into the broader FAM context by briefly contrasting it with other operational examples throughout North America. Knowledge gained from this research-management collaboration will expand current reforestation paradigms to include future climate-adaptive ones that aim to use the right seed , planted in the right places , under the right conditions. [ABSTRACT FROM AUTHOR]

• We exposed seedlings of conifer species to three realistic simulated future climates. • Seedlings of conifer species experienced high mortality (75%) induced by drought. • Conifer species are highly vulnerable at the seedling stage to future drought. • Hydraulic safety margins are good indicators of mortality risk for conifer species. The future climate of northern temperate forests is projected to be drier and warmer by the end of this century. As a result, more drought-induced forest dieback events are anticipated in northeastern North America, and assessing the vulnerability of dominant tree species to drought is critical for understanding the future composition of these forests. In a greenhouse experiment, we exposed two-year-old seedlings of Picea glauca (Moench) Voss, Picea mariana (Mill.) B.S.P. and Pinus strobus L. to three future climate treatments for southern Quebec, Canada, and evaluated their mortality, growth, and foliage water status responses to soil water availability and atmospheric drought. Using a unique approach, climate treatments emulated droughts of different frequencies, durations, and intensities. Treatments closely simulated one growing season, with changes in air temperature and relative humidity every six hours and daily adjustment in the amount of water delivered to the seedlings. The three species experienced high mortality (75%) in all water-limited treatments compared to a control treatment that provided non-limiting soil moisture (0% mortality). The biomass of the seedlings that survived was 40% lower than that of control seedlings. Our results confirmed that the hydraulic safety margins, defined as the difference between seasonal minimum water potential and xylem water potential leading to 12, 50 and 88% of hydraulic conductivity loss, were good predictors of probability of tree mortality. Therefore, hydraulic safety margins are useful functional traits that can be used to compare the vulnerability of various species to drought and then provide crucial information to practitioners and policymakers to adjust forest management to climate change. We showed that three dominant conifer species of northern temperate forests were highly vulnerable to drought in future climates. Because drought is projected to be a significant threat to forests, understanding potentially adaptive physiological responses to drought, such as hydraulic safety margins of tree seedlings, is important for predicting the response of forest regeneration and composition in warmer and drier climates. [ABSTRACT FROM AUTHOR]

The durability assessment of a component or structure is often assessed using Finite Element Analysis (FEA)-based structural simulations. Fatigue is a progressive failure mode that is related to the stress cycle’s range in a power law such that the fatigue damage increases exponentially as the stress range increases. When the frequency content of the loading gets closer to the natural frequencies of the structure, resonance effects are activated. In this case, the dynamic properties of the structure must be included in the analysis in order to better account for the increased stress response. A dynamic FEA produces therefore more realistic results compared to a static analysis, but requires knowledge of additional characteristics such as mass and damping. In a dynamic FEA, whether transient or steady state frequency response, the damping property governs indeed the magnitude of the dynamic stress response and hence the durability of the component. Unfortunately a default damping value is sometimes erroneously assumed for all modes leading to errors in the stress response, which in turn leads to significant errors in the fatigue life estimates. The modal parameters – including damping ratios - for the structure’s modes of vibration can be extracted using experimental modal analysis techniques. The purpose of this article is first, to explain the critical role that damping plays in fatigue damage; and second, to recommend best practices for determining modal damping experimentally. A simple example of an automotive component will be used to illustrate the importance of using experimental modal analysis to adjust the properties of a FE-based dynamic structural analysis. An experimental modal test followed by a modal analysis will be described. The mode shapes obtained experimentally and analytically will be compared to validate the mass, stiffness and boundary conditions used in the modelling. Then, it will be shown that using realistic values for the damping ratios will help to obtain stress results that correlate with the measured stress. Finally, this example will illustrate the very high sensitivity of the fatigue life estimate to the damping ratios. [ABSTRACT FROM AUTHOR]

Background: We undertook this prospective, randomized, surgeon-blinded study to compare the accuracy of using of a magnification marker on preoperative radiographs for templating vs using a standard 21% magnification.Methods: One hundred consecutive total hip arthroplasties were randomized to preoperative templating using a 25-mm magnification marker (50 patients) or a standard 21% magnification (50 patients). Intraoperative data were collected regarding the actual and predicted size of the femoral and acetabular components.Results: The 2 groups were found to be comparable with respect to body mass index (28.9 vs 27.9, P = .26) and gender (P = .69). In the magnification marker group, we predicted the femoral size within 1 size in 80% of the cases and the acetabular component in 94%. In the group of a standard 21% magnification, we predicted the femoral size within 1 size in 90% of the cases and the acetabular component in 96%. These proportions did not statistically differ (femur: χ2P = .16, odds ratio = 2.3, 95% confidence interval = 0.7-7.1; acetabulum: χ2P = .65, odds ratio = 1.5, 95% confidence interval = 0.3-9.6).Conclusion: We did not detect a statistically significant difference in accuracy by using one method over the other when comparing the accuracy of component size selection. As the use of the magnification marker adds to the time and expense of preoperative radiographic acquisition, we feel using a standard 21% magnification is an equally accurate technique. [ABSTRACT FROM AUTHOR]

Addition of a CO 2 capture system to an existing power station has some impact on water consumption. CO 2 capture systems require additional water for cooling and process make-up. During the past decade, a number of relevant studies have been published that estimate the increase in water use when a capture system is added to Pulverized Coal (PC), Natural Gas Combined Cycle (NGCC) and Integrated Gasifier Combined Cycle (IGCC) power generation facilities. This paper provides a comprehensive analysis of these estimates available for post-, oxy- and pre-combustion CO 2 capture systems, making it possible to compare different technologies, and to better understand how adding a CO 2 capture system on a power plant impacts the volume of water withdrawn and consumed. The results of this study serve to dispel myths about the use of water in CCS systems. Specifically, they challenge the generic statement that CCS systems will double water consumption, which is often reported in papers and articles. Water use estimates cannot be generalized and are very dependent on the power plant type, the CO 2 capture technology and the cooling system used. The estimates indicate that for power plants served by wet-recirculating systems, the increase in actual water consumed varies approximately from 20 to 60 per cent, depending on the capture technology. For once through cooling systems the increase can be negligible, or even be negative when water recovery options are implemented. [ABSTRACT FROM AUTHOR]

This paper describes the world's largest carbon capture and storage project applied to a fluid catalytic cracking (FCC) process at a Sinopec oil refinery in He’Nan Province, China. FCC units emit a large amount of CO 2 in the process of regenerating catalysts deactivated by carbon deposits. There are few carbon capture pilots around the world targeting FCC regeneration flue gas. This project started construction in 2014 and was commissioned in June 2015. The pollutant removal process includes four major units: NO x removal; SO x and particulate removal; treatment of waste water associated with SO x removal; CO 2 capture and liquefaction. Since becoming operational more than one year ago, the project has generated significant economic and environmental benefits by reducing SO x , NO x , particulate and CO 2 emissions. The project provides valuable experience for whole chain CCS operation in China. [ABSTRACT FROM AUTHOR]

Over the last few decades, the fields of fetal surgery and maternal–fetal medicine have developed interventions aimed at modifying severe diseases in utero. Innovations in fetal approaches to congenital diaphragmatic hernia and myelomeningocele have shown considerable promise in modifying the clinical course with fetal intervention. Patients who present to fetal centers to be evaluated for these interventions face challenging decisions that directly relate to questions of mortality and quality of life. This article explores how clinicians might apply the tools and principles of fetal palliative care to supporting a woman and her family who are considering fetal surgery. [ABSTRACT FROM AUTHOR]

COVID-19 is caused by the SARS-CoV-2 virus and is associated with critical illness requiring hospitalization, maternal mortality, stillbirth, and preterm birth. SARS-CoV-2 has been shown to induce placental pathology. However, substantial gaps exist in our understanding of the pathophysiology of COVID-19 disease in pregnancy and the long-term impact of SARS-CoV-2 on the placenta and fetus. To what extent a SARS-CoV-2 infection of the placenta alters the placental antiviral innate immune response is not well understood. A dysregulated innate immune response in the setting of maternal COVID-19 disease may increase the risk of inflammatory tissue injury or placental compromise and may contribute to deleterious pregnancy outcomes. We sought to determine the impact of a maternal SARS-CoV-2 infection on placental immune response by evaluating gene expression of a panel of 6 antiviral innate immune mediators that act as biomarkers of the antiviral and interferon cytokine response. Our hypothesis was that a SARS-CoV-2 infection during pregnancy would result in an up-regulated placental antiviral innate immune response. We performed a case–control study on placental tissues (chorionic villous tissues and chorioamniotic membrane) collected from pregnant patients with (N=140) and without (N=24) COVID-19 disease. We performed real-time quantitative polymerase chain reaction and immunohistochemistry, and the placental histopathology was evaluated. Clinical data were abstracted. Fisher exact test, Pearson correlations, and linear regression models were used to examine proportions and continuous data between patients with active (<10 days since diagnosis) vs recovered COVID-19 (>10 days since diagnosis) at the time of delivery. Secondary regression models adjusted for labor status as a covariate and evaluated potential correlation between placental innate immune gene expression and other variables. SARS-CoV-2 viral RNA was detected in placental tissues from 5 women with COVID-19 and from no controls (0/24, 0%). Only 1 of 5 cases with detectable SARS-CoV-2 viral RNA in placental tissues was confirmed to express SARS-CoV-2 nucleocapsid and spike proteins in syncytiotrophoblast cells. We detected a considerably lower gene expression of 5 critical innate immune mediators (IFNB , IFIT1 , MXA , IL6 , IL1B) in the chorionic villi and chorioamniotic membranes from women with active or recovered COVID-19 than controls, which remained significant after adjustment for labor status. There were minimal correlations between placental gene expression and other studied variables including gestational age at diagnosis, time interval between COVID-19 diagnosis and delivery, prepregnancy body mass index, COVID-19 disease severity, or placental pathology. A maternal SARS-CoV-2 infection was associated with an impaired placental innate immune response in chorionic villous tissues and chorioamniotic membranes that was not correlated with gestational age at COVID-19 diagnosis, time interval from COVID-19 diagnosis to delivery, maternal obesity, disease severity, or placental pathology. [ABSTRACT FROM AUTHOR]

Mineral dusts can have profound effects on climate, clouds, ecosystem processes, and human health. Because regional dust emission and deposition in western North America are not well understood, measurements of total suspended particulate (TSP) from 2011 to 2013 were made along a 500-km transect of five remote sites in Utah and Colorado, USA. The TSP concentrations in μg m −3 adjusted to a 24-h period were relatively high at the two westernmost, dryland sites at Canyonlands National Park (mean = 135) and at Mesa Verde National Park (mean = 99), as well as at the easternmost site on the Great Plains (mean = 143). The TSP concentrations at the two intervening montane sites were less, with more loading on the western slope of the Rocky Mountains (Telluride, mean = 68) closest to the desert sites compared with the site on the eastern slope (Niwot Ridge, mean = 58). Dust concentrations were commonly highest during late winter-late spring, when Pacific frontal storms are the dominant causes of regional wind. Low concentrations (<7 wt%) of organic matter indicated that rock-derived mineral particles composed most TSP. Most TSP mass was carried by particle sizes larger than 10 μm (PM >10 ), as revealed by relatively low average daily concentrations of fine (<5 μg m −3 ; PM 2.5 ) and coarse (<10 μg m −3 ; PM 2.5–10 ) fractions monitored at or near four sites. Standard air-quality measurements for PM 2.5 and PM 10 apparently do not capture the large majority of mineral-particulate pollution in the remote western interior U.S. [ABSTRACT FROM AUTHOR]

Background: There is purported improvement in component positioning and hip stability with the use of direct anterior approach (DAA) total hip arthroplasty (THA). We sought to determine if there is a difference in acetabular component position or dislocation frequency between DAA and posterior THA.Methods: One arthroplasty fellowship-trained surgeon introduced DAA THA into his practice. From the initiation of DAA in 4/2012-8/2015, this comparative series resulted in 66 DAA THAs. A matched cohort (age, gender, body mass index [BMI], and comorbidities) was then created for posterior THA, 66 hips. DAA THA used fluoroscopy with anterior capsular excision; posterior group used no image guidance and had capsular repair. Posterior group BMI was 27.8 and DAA group BMI was 27.6 (P = .36). Minimum 3-month follow-up occurred in both groups.Results: Average acetabular abduction angle in the posterior group was 41.9° (range, 32°-60°; standard deviation [sdev], 6.24) and DAA group 43.8° (range, 30°-62°; sdev 6.9), P = .12. The percentage of outliers (outside Lewinnek safe zone, 30°-50°) was 9.1% (6 of 66) in posterior group and 13.6% (9 of 66) in DAA group. There were 2 anterior dislocations in the DAA THA group and 1 anterior dislocation in the posterior THA group, resulting in P = .56. The DAA dislocation frequency in this group was overall higher at 3.0% (2 of 66) compared with the matched posterior (1.5%, 1 of 66) and unmatched posterior larger series (.8%, 3 of 360).Conclusion: We demonstrated no observable difference in hip stability or acetabular abduction. This study provides realistic outcomes for surgeons implementing DAA THA into their practice. [ABSTRACT FROM AUTHOR]

The combined influence of silvicultural treatments and subsequent forest vegetation succession affects long-term soil organic C (SOC) and nutrient cycling in mineral soil in ways still poorly understood, possibly by influencing soil pH and microbial activity. We investigated how silvicultural disturbance and associated vegetation affected surface (0–15 cm) and subsurface (15–40 cm) mineral soil biogeochemistry, 25 years after establishment of white pine ( Pinus strobus ) plantations in Petawawa, Ontario, Canada. Three silvicultural treatments led to distinct communities, characterized by contrasting structure and functional composition. The control (CTR) was characterized by a Hardwood shrub-rich forest, blade-scarification treatment (S) by a Hardwood herb-rich forest, while blade-scarification combined with vegetation control (S + V) resulted in a Softwood monoculture. Increasing dominance of the hardwood canopy and herbaceous cover in CTR and S treatments was associated with higher surface mineral soil pH and exchangeable base cations, and dominance of net nitrate (NO 3 − -N) over ammonium (NH 4 + -N) production during incubation. In contrast, increased overstory softwood cover in the S + V treatment was associated with lower surface mineral soil pH and NH 4 + -N concentrations. Across all treatment-induced communities, surface mineral soil pH and exchangeable Ca and Mg were positively correlated with total N and SOC. The relation of Ca with SOC, total N and net nitrification was similarly observed in subsurface soil. Surprisingly, herb cover rather than overstory functional character (hardwood vs softwood) was related to subsurface N cycling; increasing cover in CTR and S treatments was related to higher NH 4 + -N availability and lower organic-to-inorganic N ratio, indicating accelerated cycling. We conclude that through effects on soil pH and base cations, silvicultural operations combined with subsequent hardwood and herbaceous species cover strongly regulate C and N cycling in the mineral soil of mixedwood forests. [ABSTRACT FROM AUTHOR]

Summary Novel oral anticoagulants (NOACs) have emerged as a good alternative to warfarin in the prevention of stroke for patients with atrial fibrillation. NOAC use is increasing rapidly; therefore, greater understanding of their use in the perioperative period is important for optimal care. Studies and reviews that reported on the use of NOACs were identified, with particular focus on the perioperative period. PubMed was searched for relevant articles published between January 2000 and August 2015. The inevitable rise in the use of NOACs such as rivaroxaban (Xarelto™), apixaban (Eliquis™), edoxaban (Lixiana™) and dabigatran (Pradaxa™) may present a simplified approach to perioperative anticoagulant management due to fewer drug interactions, rapidity of onset of action and relatively short half-lives. Coagulation status, however, cannot reliably be monitored and no antidotes are currently available. When planning for discontinuation of NOACs, special consideration of renal function is required. Advice regarding the management of bleeding complications is provided for consideration in emergency surgery. In extreme circumstances, haemodialysis may be considered for bleeding with the use of dabigatran. NOACs will increasingly affect operative planning in plastic surgery. In order to reduce the incidence of complications associated with anticoagulation, the management of NOACs in the perioperative period requires knowledge of the time of last dose, renal function and the bleeding risk of the planned procedure. Consideration of these factors will allow appropriate interpretation of the current guidelines. [ABSTRACT FROM AUTHOR]

In large areas of the boreal mixedwoods of eastern Canada, conventional forestry practices dominated by large-scale clearcutting have led to an increase in early-successional trembling aspen ( Populus tremuloides Michx.) stands and a decrease in late-successional mixedwood stands. Partial harvesting provides an alternative practice that could promote a return to mixedwood composition with greater potential economic returns. Our objective was to identify the stand attributes that have an effect on trembling aspen regeneration following industrial harvest operations. Ninety plots were surveyed immediately before and five years after partial harvesting, to collect information on harvested trees (stumps), residual cover and pre- and post-harvesting regeneration. Using zero-inflated beta regression models, we found that the transition probabilities (projected relative abundance) of trembling aspen were positively influenced by an increase in removal percentage and by an increase in initial basal area of trembling aspen in the overstory. Abundant balsam fir advance growth had a strong negative influence on trembling aspen transition probabilities. This information could be incorporated into silvicultural prescription decision tools to suggest optimal local basal area removal targets that would limit the regeneration success of trembling aspen. Using these results, we propose a new approach that consists of deliberately introducing heterogeneity within partial cutting prescriptions in order to limit deciduous encroachment and to promote the recruitment of coniferous regeneration in eastern Canadian boreal mixedwoods. [ABSTRACT FROM AUTHOR]

Coherent x-ray diffractive imaging is a novel imaging technique that utilizes phase retrieval and nonlinear optimization methods to image matter at nanometer scales. We explore how the convergence properties of a popular phase retrieval algorithm, Fienup's HIO, behave by introducing a reduced dimensionality problem allowing us to visualize and quantify convergence to local minima and the globally optimal solution. We then introduce generalizations of HIO that improve upon the original algorithm's ability to converge to the globally optimal solution. [ABSTRACT FROM AUTHOR]

Carbaryl is regarded among the most effective, economically viable, and ecologically-compatible insecticides available for protecting conifers from bark beetle attack in the western United States. Treatments are typically applied in spring prior to initiation of bark beetle flight for that year. We evaluated the efficacy of spring and fall applications for protecting individual lodgepole pine, Pinus contorta Dougl. ex Loud, from mortality attributed to mountain pine beetle, Dendroctonus ponderosae Hopkins, the most notable forest insect pest in western North America. Both spring and fall treatments of 2.0% a.i. carbaryl (Sevin ® SL) were efficacious for two field seasons, while results from a third field season were inconclusive due to insufficient beetle pressure. We discuss the implications of these and other results to the management of D . ponderosae . [ABSTRACT FROM AUTHOR]

Objective To describe the use of opioids and sedatives to pediatric patients dying in the hospital in the 2 weeks preceding death. Study design We conducted a retrospective study on opioid and sedation medication exposure among children who die in hospitals in the US by using large administrative data sources. We described patterns of exposure to these medications for deceased inpatients (<21 years of age) between 2007 and 2011 (n = 37?459) and factors associated with the exposure. Multivariable logistic regression models were used to estimate the ORs. Results Overall, 74% patients were exposed to opioids or sedatives in the 14 days before death. Among patients with 6 or more hospital days before death, the daily exposure rate ranged from 73% (the sixth day before death) to 89% (the day of death). The most commonly used medications were fentanyl (52%), midazolam (44%), and morphine (40%). Older age (ORs 1.6-3.7), black race (ORs 0.8), longer hospital stay (ORs 6.6-9.3), receiving medical interventions (including mechanical ventilation, surgery, and stay in the intensive care unit, ORs 1.7-2.6), having comorbidities (ORs 1.7-2.4), and being hospitalized in children's hospitals (ORs 4.0-4.5) were associated with exposure of opioid and sedation medication on adjusted analysis. Conclusion Although most pediatric patients terminally hospitalized are exposed to opioid and sedation medication, some patients do not receive such medications before death. Given that patient and hospital characteristics were associated with opioid/sedative exposure, these findings suggest areas of potential quality improvement and further research. [ABSTRACT FROM AUTHOR]

Purpose To assess the association between patients' pericoronitis pain symptoms and quality-of-life (QOL) outcomes for lifestyle and oral function. Patients and Methods Subjects (American Society of Anesthesiologists health risk assessment level I or II) with mild symptoms of pericoronitis were enrolled in a study approved by the institutional review board and asked to complete a QOL instrument specifically for third molar problems covering lifestyle, oral function, and pain. Subjects assessed lifestyle and oral function using a 5-point Likert-type scale, ranging from “no trouble” (score, 1) to “lots of trouble” (score, 5), and worst and average pain using a 7-point Likert-type scale, ranging from “no pain” (score, 1) to “worst pain imaginable” (score, 7). Pain levels reported at enrollment were compared with QOL outcomes for lifestyle and oral function using Spearman correlation coefficients. Correlations of at least 0.6 were considered clinically quite important, and correlations of at least 0.4 were considered clinically important. Associations between these outcome measurements were considered statistically significant at a P value less than .05. Results Most of the 113 subjects were Caucasian (51%), women (56%), 23 years old or younger (58%), and well educated (91% with at least some college). Mean pain levels ± standard deviation were low (worst pain, 3.3 ± 1.5; average pain, 2.4 ± 1.2). All pain outcomes were significantly associated with items in the lifestyle and oral function domains ( P < .01). Clinically important correlations were seen between pain outcomes and daily routine, social life, eating a regular diet, chewing food, and talking ( P < .0001). Conclusions Clinically important correlations existed between subjects' pericoronitis pain and lifestyle and oral function, associations not often considered by clinicians or policy makers. [ABSTRACT FROM AUTHOR]

Much of the world’s airborne sediment originates from dryland regions. Soil surface disturbances in these regions are ever-increasing due to human activities such as energy and mineral exploration and development, recreation, suburbanization, livestock grazing and cropping. Sediment production can have significant impacts to human health with particles potentially carrying viruses such as Valley Fever or causing asthma or other respiratory diseases. Dust storms can cause decreased visibility at the ground level, resulting in highway accidents, and reduced visual quality in park and wildland airsheds. Sediment production and deposition is also detrimental to ecosystem health, as production reduces soil fertility at its source and can bury plants and other organisms where it is deposited. Therefore, it is important to understand how we can predict what areas are prone to producing sediment emissions both before and after soil surface disturbance. We visited 87 sites in two deserts of the western U.S. that represented a range of soil texture and surface cover types. We used a portable wind tunnel to estimate the threshold friction velocity (TFV) required to initiate sediment transport and the amount of sediment produced by the tunnel at a set wind speed. Wind tunnel runs were done before and after soil surface disturbance with a four-wheel drive vehicle. Results show that most undisturbed desert soils are very stable, especially if covered by rocks or well-developed biological soil crusts, which make them virtually wind-erosion proof. Particles at disturbed sites, in contrast, moved at relatively low wind speeds and produced high amounts of sediment. Silt was an important predictor of TFV and sediment production across all sites, whereas the influence of rock cover and biological soil crusts was site-dependent. Understanding the vulnerability of a site after disturbance is important information for land managers as they plan land use activities and attempt to mitigate the harmful effects that sediment production can have on both human and ecosystem health. [ABSTRACT FROM AUTHOR]

Highlights: [•] Fourteen (14) different fires (burned 2005–2007) were studied in Quebec, Canada. [•] Organic and mineral (0–15 and 15–40cm depths) soil horizons were analyzed. [•] Fire reduced soil organic C (SOC) and total N stocks in the organic horizon. [•] Post-fire salvage logging increased SOC and total N stocks at 15–40cm depth. [•] Fire and post-fire salvage logging resulted in similar whole-soil SOC and total N stocks. [Copyright &y& Elsevier]

Abstract: Purpose: To describe experience with the use of ultrasound (US)–guided placement and tip position confirmation for direct saphenous and single-incision tunneled femoral noncuffed central venous catheters (CVCs) placed in neonates and infants at the bedside. Materials and Methods: A retrospective review of the interventional radiology (IR) database and electronic medical records was performed for 68 neonates and infants who received a CVC at the bedside and for 70 age- and weight-matched patients with CVCs placed in the IR suite between 2007 and 2012. Technical success, complications, and outcomes of CVCs placed at the bedside were compared with those in an age- and weight-matched sample of children with CVCs placed in the IR suite. Results: A total of 150 primary insertions were performed, with a technical success rate of 100%. Total catheter lives for CVCs placed at the bedside and in the IR suite were 2,030 catheter-days (mean, 27.1 d) and 2,043 catheter-days (mean, 27.2 d), respectively. No significant difference was appreciated between intraprocedural complications, mechanical complications (bedside, 1.53 per 100 catheter-days; IR, 1.76 per 100 catheter-days), or infectious complications (bedside, 0.39 per 100 catheter-days; IR, 0.34 per 100 catheter-days) between groups. Conclusions: US-guided placement and tip position confirmation of lower-extremity CVCs at bedside for critically ill neonates and infants is a safe and feasible method for central venous access, with similar complications and catheter outcomes in comparison with CVCs placed by using fluoroscopic guidance in the IR suite. [Copyright &y& Elsevier]

Summary: Introduction: Lymphoscintigraphy in melanoma provides important information on the dynamic drainage of the primary tumour and the location of the sentinel lymph node (SLN). Unfortunately these images lack anatomical detail. Single positron emission computed tomography/computed tomography (SPECT/CT) provides extremely detailed information on the location of the SLN and its relationship with surrounding structures and it is the aim of this study to report our initial experience with this technology. Methods: Thirty-two patients undergoing sentinel lymph node biopsy (SLNB) at our unit between October 2010 and October 2011 were included in this study. In each case, conventional planar lymphoscintigraphy (PL) was followed by SPECT/CT. Images of each patient were reviewed by the operating consultant plastic surgeon and a consultant radiologist. A joint opinion was issued on the number of lymph nodes identified by each imaging modality and whether SPECT/CT influenced surgical approach. Results: Both PL and SPECT/CT detected the SLN in 31/32 patients. There was no significant difference between the number of SLN identified by PL and SPECT (p = 0.69). In relation to the true number of SLNs identified intra-operatively by gamma probing and blue dye, there was no statistically significant difference in accuracy between SPECT/CT and PL (p = 0.50). SPECT/CT was judged to provide useful anatomical information in all cases. Surgical approach was altered in 12/32 patients and contributed to the detection of SLNs that were positive for metastases. Conclusions: In relation to true SLN number, SPECT/CT was not significantly more accurate than PL. The detailed anatomical information provided by SPECT/CT improved confidence and pre-operative planning in all patients. In select cases, particularly in the head and neck, SPECT/CT overcame the limitations of PL and facilitated the detection and sampling of metastatic nodes. [Copyright &y& Elsevier]

Abstract: Due to serious adverse effects and the limited effectiveness of currently available pharmacological therapies for obesity, many research efforts have focused on the development of drugs from natural products. Our previous studies demonstrated that berberine, an alkaloid originally isolated from traditional Chinese herbs, prevented fat accumulation in vitro and in vivo. In this pilot study, obese human subjects (Caucasian) were given 500mg berberine orally three times a day for twelve weeks. The efficacy and safety of berberine treatment was determined by measurements of body weight, comprehensive metabolic panel, blood lipid and hormone levels, expression levels of inflammatory factors, complete blood count, and electrocardiograph. A Sprague-Dawley rat experiment was also performed to identify the anti-obesity effects of berberine treatment. The results demonstrate that berberine treatment produced a mild weight loss (average 5lb/subject) in obese human subjects. But more interestingly, the treatment significantly reduced blood lipid levels (23% decrease of triglyceride and 12.2% decrease of cholesterol levels) in human subjects. The lipid-lowering effect of berberine treatment has also been replicated in the rat experiment (34.7% decrease of triglyceride and 9% decrease of cholesterol level). Cortisol, calcitriol, ACTH, TSH, FT4, and SHBG levels were not significantly changed following 12 weeks of berberine treatment. However, there was interestingly, an increase in calcitriol levels seen in all human subjects following berberine treatment (mean 59.5% increase, p =0.11). Blood inflammatory factors (CRP, IL-6, TNFα, COX-2) and erythrocyte sedimentation rate (ESR) were not significantly affected by treatment with berberine. Tests of hematological, cardiovascular, liver, and kidney function following berberine treatment showed no detrimental side effects to this natural compound. Collectively, this study demonstrates that berberine is a potent lipid-lowering compound with a moderate weight loss effect, and may have a possible potential role in osteoporosis treatment/prevention. [Copyright &y& Elsevier]

Abstract: The practice of careful logging has been mandated in northeastern Canada’s coniferous and mixedwood forests as a means of protecting natural regeneration while minimizing soil disturbance by machinery. This practice imposes evenly spaced, parallel trails for circulation of harvesting machinery, while most of the understory and soil is left intact in wide protection strips between the trails. The objective of this study was to examine soil physico-chemical and microbial properties, and ericaceous shrub performance (aboveground biomass) following careful logging and with or without subsequent scarification. By sampling 32 cutover forest sites (formerly black spruce-dominated) in the Abitibi-Temiscamingue region of boreal northwestern Quebec, we evaluated how (a) the presence of alternating bands of protection strips and skid trails (on non-scarified sites), and (b) a scarification treatment consisting of mixing the soil organic layer with the surface mineral soil, influenced soil and vegetation properties over time (4–15years after careful logging). On non-scarified sites, careful logging showed a differential compaction pattern consisting of bands of disturbed zones or trails alternating with protection zones. Both soil properties and ericaceous shrub biomass estimates tracked these alternating compacted and non-compacted areas on the cutover. Soil N (Nt), soil percentage microbial C to total C (Cmic/Ct), and Kalmia angustifolia (Kalmia) and Vaccinium spp. (Vaccinium) aboveground biomass differed on strips and trails 8 and 15years after harvest. The observed differences in ericaceous shrub biomass between strips and trails, and correlations between biomass and soil variables, suggest potential shrub interference with soil processes. These observations suggest that ericaceous species may promote differences in soil properties and plant communities that result in a long-term spatial signature perpetuating the trail pattern. Scarification reduced Kalmia and Vaccinium aboveground biomass and had a negative effect on Cmic/Nmic and Cmic/Ct, 15years after harvest. Forest understory plants, such as ericaceous shrubs, may play a key role in driving belowground properties, forest regeneration, and long-term succession on these sites. Understanding the ecology and spatial distribution of these species may thus have important implications for ecosystem structure and function as well as timber production. [Copyright &y& Elsevier]

Objective: To develop and pretest a decision-aid to help parents facing extreme premature delivery during antenatal counseling regarding delivery room resuscitation. Study design: Semistructured interviews with 31 clinicians and with 30 parents of children born <26 weeks’ gestation were conducted following standard methods of qualitative research. These characterized perceptions of prenatal counseling to identify information that parents value when making decisions regarding delivery room resuscitation. These parental needs were formatted into a decision-aid. We assessed the primary outcome of how effectively the decision-aid improved knowledge during a simulated counseling session. Two groups of women were studied: parents with a history of prematurity (“experienced”) and healthy women without prior knowledge of prematurity (“naïve”). Results: Interviewees thought that visual formats to present survival and short- and long-term outcome information facilitated their own preparation, recall, and understanding. Accordingly, we designed a decision-aid as a set of cards with pictures and pictographs to show survival rates and complications. There was significant improvement in knowledge in 13 “experienced” parents (P = .04) and 11 “naïve” women (P < .0001). Participants found the cards useful and easy to understand. Conclusions: A decision-aid for parents facing extreme premature delivery may improve their understanding of complicated information during antenatal counseling. [ABSTRACT FROM AUTHOR]