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Atmospheric traces of radioactive xenon can be a strong indicator for underground nuclear fission reactions. 131mXe, 133Xe, 133mXe and 135Xe are the primary gaseous isotopes/isomers currently used to identify and classify nuclear events. During decay, each of these radioactive species produces a unique beta-gamma energy spectra, which can be measured using beta-gamma coincidence counting. Current operational Xe beta-gamma spectrum analysis software relies on Region of Interest (ROI) counting (Bowyer et al. in J Environ Radioact 59(2):139–151, 2002). This algorithm occasionally produces mismeasurements, especially when quantifying meta-stable isomers, due to overlapping ROIs and shifts in detector calibration in fielded systems over time (Ringbom and Axelsson in Appl Radiat Isot 156:108950, 2020). In an attempt to better de-convolve overlapping isotope spectra we have developed a technique that applies a supervised neural-network implemented in TensorFlow with Keras to classify and quantify the isotopes and mixtures of isomers based on their beta-gamma spectra—similar to image recognition. From this, we have improved upon the false-positive rate for classification and regression models, however challenges remain with dealing with differing detector energy calibrations and with estimating measurement uncertainty. [ABSTRACT FROM AUTHOR]

Handwashing is a vital skill for maintaining health and hygiene. For individuals with intellectual and developmental disabilities (IDD), such as autism spectrum disorder, evidence-based strategies, such as prompting and task analysis, may be effective in teaching these skills. Due to the shortage of experts who teach individuals with IDD skills such as handwashing, staff working with children need a means of ensuring these instructional strategies are implemented with fidelity. This study examined the effects of a tablet-based application that used artificial intelligence (GAINS®) on four behavior technicians' implementation of least-to-most prompting, total task chaining, and time delay during an acquisition of handwashing program with young children with autism. All four technicians increased fidelity immediately upon using GAINS and all four technicians reached mastery criteria within the shortest number of sessions possible. One child participant met mastery criteria, two showed some gains, and one demonstrated a high degree of variability across sessions. Limitations of the least-to-most prompting procedure, user design, considerations and directions for future research and practice are discussed. [ABSTRACT FROM AUTHOR]

The HIV treatment landscape in low- and middle-income countries (LMICs) is rapidly evolving, exemplified by the expansion of differentiated service delivery (DSD) during the coronavirus disease (COVID-19) pandemic. Long-acting products represent a new frontier that will require a significant redesign of health systems. It is critical to understand service delivery and product preferences of people living with HIV (PLHIV) and ensure evidence generation is guided by community priorities. We conducted a scoping review to identify gaps among preference studies and inform future research. Peer-reviewed articles published from January 2014-May 2022 reporting acceptability or preference data from PLHIV or caregivers for one or more service delivery or product attribute were eligible. Service delivery studies were restricted to LMIC populations while product studies had no geographical restrictions. Based on gaps identified, we consulted advocates to develop community-led research agenda recommendations. Of 6,493 studies identified, 225 studies on service delivery attributes and 47 studies on product preferences were eligible. The most frequently studied delivery models were integration (n = 59) and technology-based interventions (n = 55). Among product literature, only 15 studies included LMIC populations. Consultation with advocates highlighted the need for research on long-acting products, including among pediatric, pregnant, and breastfeeding PLHIV, PLHIV on second-line regimens, and key populations. Consultation also emphasized the need to understand preferences on clinic visit frequency, side effects, and choice. While the preference literature has expanded, gaps remain around long-acting regimens and their delivery. To fill these gaps, the research agenda must be guided by the priorities of communities of PLHIV. [ABSTRACT FROM AUTHOR]

To improve the motivation and enthusiasm of subjects during active rehabilitation training, this paper proposes a novel training task planning-based adaptive assist-as-needed (TTP-AAAN) control algorithm for an upper limb exoskeleton. The overall controller contains an outer control loop to determine the required assistive force, and an inner control loop to drive the exoskeleton to track subject motion and to provide desired assistive force obtained from the outer control loop. In the outer control loop, a motion intention and task performance evaluation (MITPE) strategy is established to learn the motor capability of the subject. Based on the obtained evaluation result, the radius and frequency of multi-periodic trajectory tracking task, and the gain of the assistive force are adaptively adjusted by using the adaptive central pattern generator (ACPG) algorithm. Then, in the inner control loop, an asymmetric barrier Lyapunov function-based adaptive output feedback (ABLF-AOF) controller, in combination with a neural network (NN) state observer, is developed. The exoskeleton tracking errors are constrained by the asymmetric barrier Lyapunov function, and the state variables and uncertainty terms of the exoskeleton are simultaneously estimated by the NN state observer. Experiments are carried out with an upper limb exoskeleton to demonstrate the effectiveness of the proposed control strategy. The experimental results show that the developed control scheme can provide assistance and achieve task parameter adaption for the subjects with different motion patterns. In addition, the proposed controller has better training performance than task performance-based adaptive velocity assist-as-needed (AAN) controller and minimal AAN controller. [ABSTRACT FROM AUTHOR]

Children under the age of 18 who are known to forensic child and adolescent mental health services often present with complex psychosocial and behavioural needs that are elevated compared with those in the general youth population. The Forensic Child and Adolescent Mental Health Service for Northern Ireland (FCAMHSNI) was commissioned in 2014 to support these children. Despite almost a decade of implementation, the profile and characteristics in the service remain under-analysed, impeding service improvement and making international comparisons more difficult. The primary aim of the current study was to address the regional gaps in how the needs of those accessing FCAMHSNI are understood. A secondary aim was to capture comparable data. Data on 107 accepted referrals are included in the analyses. The majority of cases within this time period were male (81.1%, n = 86) and the majority of presenting behaviours were related to violence and aggression 62.3% (n = 48). However, some forms of violence, such as harmful sexual behaviour, was relatively low when compared with other jurisdictions. Specific demographic characteristics such as gender and religious background appeared to be significant risk factors for referral to the service. Almost all of the sample are known to have experienced at least one potentially traumatic event (95.2%) and in more than one-third of cases, service users presented with co-morbid issues (35.6%, n = 37). These observations are discussed. This study adds to the growing international literature around the needs of forensically involved youth and helps to inform future service development and provision. [ABSTRACT FROM AUTHOR]

Childhood trauma exposure is prevalent among incarcerated youth and associated with antisocial traits and behavior. It has been proposed as a risk factor for the development of sadistic traits, which has been shown to predict future violence in youth. Using regression analyses, we examined the association between self-report and expert-rated measures of childhood trauma, sadistic traits (i.e., verbal, physical, vicarious sadism), and violence (i.e., homicide and non-homicide violent acts) in 54 incarcerated juveniles. Expert-rated (but not self-report) severity of physical abuse was associated with physical and vicarious sadistic traits. Other trauma types (e.g., emotional or sexual abuse) were not significantly associated with sadistic traits. Physical abuse coupled with vicarious sadistic traits conferred the highest risk of non-homicide violence. The findings support and clarify links between childhood trauma, sadistic traits, and violent behavior in youth, and are distinct from those found in other antisocial profiles. [ABSTRACT FROM AUTHOR]

The 15 January 2022 eruption of Hunga volcano, Tonga, significantly impacted the Kingdom of Tonga as well as the wider Pacific region. The eruption column attained a maximum height of 58 km whilst the umbrella cloud reached a diameter approaching 600 km within about 3 h. The frequency of volcanic lightning generated during the eruption was also unprecedented, with the Vaisala Global Lightning Database (GLD360) recording over 3 × 105 strikes over a 2-h period. We have combined Himawari-8 satellite imagery with the spatiotemporal distribution of lightning strikes to constrain the dynamics of umbrella spreading and infer a timeline of events for the climactic phase of the eruption. Lightning was initially concentrated directly above Hunga, with an areal extent that grew with the observed eruption cloud. However, about 20 min after the eruption onset, radial structure appeared in the lightning spatial distribution, with strikes clustered both directly above Hunga and in an annulus of radius ~ 50 km. Comparison with satellite imagery shows that this annulus coincided with the umbrella cloud front. The lightning annulus and umbrella front grew synchronously to a radius of ~ 150 km before the umbrella cloud growth rate decreased whilst the annulus itself contracted to a smaller radius of about 50 km again. We interpret that the lightning annulus resulted from an enhanced rate of particle collisions and subsequent triboelectrification due to enhanced vorticity in the umbrella cloud head. Our results demonstrate that volcanic lightning observations can provide insights into the internal dynamics of umbrella clouds and should motivate more quantitative models of umbrella spreading. [ABSTRACT FROM AUTHOR]

This exploratory study extends the literature on teachers' stress and self-efficacy in relation to behavior management. Sixty-six middle and high school teachers' use of praise and reprimand during a 20-min observation, in the general education setting, were examined. Following the observation, teachers completed stress and self-efficacy scales, related to student misbehavior. Teacher stress and teacher self-efficacy were significantly negatively related. Further, teachers who reported higher levels of stress used more reprimands, and teachers who reported higher levels of self-efficacy used fewer reprimands. Last, as teachers' behavioral difficulty ratings for their class increased, so did their use of reprimands. Implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Impact models are an important tool for golf equipment design as they allow for computer simulations to evaluate and optimize performance. There are several published driver impact models for this purpose. However, existing impact models have no or limited experimental validation to support their conclusions. The aim of this research was to extend several impact models from the literature to predict three-dimensional driver impacts and, for the first time, iron impacts. The accuracy of these models was evaluated using experimental data. Two impulse-momentum and three continuous contact models were applied to create dynamic models to predict driver and iron golf shots. While finite element models are used to design golf clubs, they were not considered here due to their high computational requirements. For modeling driver impacts, an adjusted IM model was the most accurate at predicting ball launch conditions. Ball speed was the most accurate launch condition with a mean absolute error of 1%. The error for vertical launch angle and backspin was less than 10%. However, the error for sidespin and horizontal launch angle (azimuth) was between 30 and 50%. For modeling 7-iron shots, a two-layer ball with a volumetric normal force model was the most accurate of the models considered. The experimental error for ball speed was 2%. The remaining errors were similar to the driver model. [ABSTRACT FROM AUTHOR]

Purpose: To highlight the utility of Colorectal Nurse Specialist (CNS) supervised parental administration of rectal washouts in the management of Hirschsprung's disease (HD). Methods: Retrospective case note review of HD patients treated at a tertiary children's hospital in United Kingdom from January 2011 to December 2022. Data collected included demographics, complications, enterocolitis, obstructive symptoms and stomas. Primary pull-through (PT) is done 8–12 weeks after birth. Parental expertise in performing rectal washouts at home is ensured by our CNS team before and after PT. Results: PT was completed in 69 of 74 HD patients. Rectal washouts were attempted on 63 patients before PT. Failure of rectal washout efficacy necessitated a stoma in four patients (6.4%). Of the 65 patients who had PT and stoma closed, three (4.5%) required a further stoma over a mean follow-up period of 57 months (Range 7–144 months). Two of these had intractable diarrhoea due to Total Colonic Aganglionosis (TCA). One patient (1.5%) had unmanageable obstructive symptoms requiring re-diversion. Hirschsprung-associated enterocolitis (HAEC) requiring hospital admission occurred in 14 patients (21%). Conclusion: Our stoma rates are lower compared to recent UK data. This could potentially be due to emphasis on parental ability to perform effective rectal washouts at home under CNS supervision. [ABSTRACT FROM AUTHOR]

Human cognition is incredibly flexible, allowing us to thrive within diverse environments. However, humans also tend to stick to familiar strategies, even when there are better solutions available. How do we exhibit flexibility in some contexts, yet inflexibility in others? The constrained flexibility framework (CFF) proposes that cognitive flexibility is shaped by variability, predictability, and harshness within decision-making environments. The CFF asserts that high elective switching (switching away from a working strategy) is maladaptive in stable or predictably variable environments, but adaptive in unpredictable environments, so long as harshness is low. Here we provide evidence for the CFF using a decision-making task completed across two studies with a total of 299 English-speaking adults. In line with the CFF, we found that elective switching was suppressed by harshness, using both within- and between-subjects harshness manipulations. Our results highlight the need to study how cognitive flexibility adapts to diverse contexts. [ABSTRACT FROM AUTHOR]

Polariton canalization is characterized by intrinsic collimation of energy flow along a single crystalline axis. This optical phenomenon has been experimentally demonstrated at the nanoscale by stacking and twisting van der Waals (vdW) layers of α-MoO3, by combining α-MoO3 and graphene, or by fabricating an h-BN metasurface. However, these material platforms have significant drawbacks, such as complex fabrication and high optical losses in the case of metasurfaces. Ideally, it would be possible to canalize polaritons "naturally" in a single pristine layer. Here, we theoretically predict and experimentally demonstrate naturally canalized phonon polaritons (PhPs) in a single thin layer of the vdW crystal LiV2O5. In addition to canalization, PhPs in LiV2O5 exhibit strong field confinement ( λ p ~ λ 0 27 ), slow group velocity (0.0015c), and ultra-low losses (lifetimes of 2 ps). Our findings are promising for the implementation of low-loss optical nanodevices where strongly directional light propagation is needed, such as waveguides or optical routers. Canalized polaritons are light-matter excitations characterized by intrinsic collimation of electromagnetic energy along a specific crystal axis. Here, the authors report the observation of intrinsically canalized phonon polaritons in a single thin layer of a van der Waals crystal, LiV2O5. [ABSTRACT FROM AUTHOR]

Parent–child and teacher–child relationship closeness have been shown to be crucial for children's development of socioemotional competencies from preschool to school-age stages. However, less is known about the importance of developing close relationships with young infants and toddlers attending childcare group settings for their early socioemotional development. The current study aimed to address this gap and to explore how child gender may influence the associations. Participants included 378 Hong Kong Chinese children (196 girls; Mage = 22.05 months, SD = 9.81 months) enrolled in childcare centres, along with their parents and teachers. Parents reported on children's socioemotional competencies as well as their relationship closeness with children; teachers reported on their relationship closeness with children. Multiple group structural equation modelling was used to analyse the results. The findings showed that both parent–child and teacher–child closeness were positively associated with children's social competence, while teacher–child closeness was negatively associated with children's anxiety behaviour. Parents of girls reported greater parent–child closeness, higher levels of social competence, and higher levels of anxiety behaviours compared to parents of boys. Furthermore, teacher–child closeness was significantly associated with social competence exclusively among girls, while parent–child closeness was significantly associated with anxiety behaviours solely among boys. Findings are discussed in terms of the role of child gender in influencing the associations between parent–child closeness, teacher–child closeness, and children's socioemotional competencies in the earliest years. [ABSTRACT FROM AUTHOR]

Rationale: Behavioral effects of testosterone depend on dose, acute versus sustained formulation, duration of administration, personality, genetics, and endogenous levels of testosterone. There are also considerable differences between effects of endogenous and exogenous testosterone. Objectives: This study was the secondary behavioral arm of a registered clinical trial designed to determine if testosterone protects against loss of lean body mass and lower-body muscle function induced by a severe energy deficit typical of sustained military operations. Methods: Behavioral effects of repeated doses of testosterone on healthy young men whose testosterone was reduced by severe energy deficit were examined. This was a double-blind, placebo-controlled, between-group study. Effects of four weekly intramuscular injections of testosterone enanthate (200 mg/week, N = 24) or matching placebo (N = 26) were evaluated. Determination of sample size was based on changes in lean body mass. Tasks assessing aggression, risk-taking, competition, social cognition, vigilance, memory, executive function, and mood were repeatedly administered. Results: During a period of artificially induced, low testosterone levels, consistent behavioral effects of administration of exogenous testosterone were not observed. Conclusions: Exogeneous testosterone enanthate (200 mg/week) during severe energy restriction did not reliably alter the measures of cognition. Study limitations include the relatively small sample size compared to many studies of acute testosterone administration. The findings are specific to healthy males experiencing severe energy deficit and should not be generalized to effects of other doses, formulations, or acute administration of endogenous testosterone or studies conducted with larger samples using tests of cognitive function designed to detect specific effects of testosterone. [ABSTRACT FROM AUTHOR]

Anthracnose of coffee fruits caused by Colletotrichum species is responsible for major losses in coffee production worldwide. In most coffee-producing countries, this disease has been present for many years. Recently coffee fruit rot (CFR), a disease complex of Colletotrichum spp. and Fusarium spp. as casual agents, was described in Puerto Rico but it has not yet been quantified. This study surveys incidence and severity of CFR, correlates it to elevation, cultivation methods (full sun, shade or intercalated with taller plants) and the presence of the coffee berry borer (CBB), and identifies rot-associated fungi. We found that CFR is present throughout Puerto Rico at varying levels and that environmental and cultivation factors are associated with CFR incidence and severity. Specifically, increased altitude and shade correlated with lower CFR incidence. In addition, fruits damaged by the CBB were found to have significantly more disease than undamaged fruits. Lastly, we isolated 7 fungal genera associated with CFR, the most prevalent being Colletotrichum and Fusarium. Overall, this study suggests that planting coffee at higher altitude under shade and controlling CBB can reduce CFR. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: There is a need for cost effective interventions that increase surgical preparedness in urogynecology. Methods: We performed an ancillary prospective economic evaluation of the Telehealth Intervention to Increase Patient Preparedness for Surgery (TIPPS) Trial, a randomized multicenter trial that evaluated the impact of a preoperative telehealth call on surgical preparedness in women undergoing urogynecologic surgery. A within-trial analysis from the health care sector and societal perspective was performed. Cost-effectiveness was computed from health care sector and societal perspectives, with an 8-week time horizon. Results: A total of 126 women were included in our analysis. QALYs gained were similar between groups (telehealth 0.1414 + 0.0249; usual care 0.1409 + 0.0179). The cumulative mean per-person costs at 8 weeks from the healthcare sector perspective were telehealth call: $8696 +/– 3341; usual care: $8473 +/– 3118 (p = 0.693) and from the societal perspective were telehealth call: $11,195 + 5191; usual care: $11,213 +/– 4869 (p = 0.944). The preoperative telehealth call intervention was not cost effective from the health care sector perspective with an ICER of $460,091/QALY (95%CI –$7,382,608/QALY, $7,673,961) using the generally accepted maximum willingness to pay threshold of $150,000/QALY (Neumann et al. N Engl J Med. 371(9):796–7, 2014). From the societal perspective, because incremental costs per QALY gained were negative $–35,925/QALY (95%CI, –$382,978/QALY, $317,226), results suggest that preoperative telehealth call dominated usual care. Conclusions: A preoperative telehealth call is cost effective from the society perspective. Clinical Trial Registration: Registered with http://ClinicalTrials.gov. Date of registration: March 26, 2019 Date of initial participant enrollment: June 5, 2019 URL: https://clinicaltrials.gov/ct2/show/record/NCT03890471 Clinical trial identification number: NCT03890471 [ABSTRACT FROM AUTHOR]

Background: The Tibialis Posterior tendon (TPT) is the only tendon to encounter the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle, they often have been missed and present late. Aim: Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF). Methods: A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site, this was denoted as a minor entrapment and if ≥ 50% of the tendon was present in the fracture site was denoted as major. Results: A total of 363 patients were identified for further analysis, 220 who had a PMF and 143 with PLM injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture line entered the TPT sheath, there was a 45% rate (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath (p <.001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353). Conclusion: In our assessment, we found significant prevalence of 22% of TPT entrapment in fractures involving the posterior tibia. PMF and PLF had no statistically significant difference in the rate of TPT entrapment. Additionally, we found that there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider taking care assessing pre-operative imaging to seek to identify the TPT and to assess intraoperatively where entrapment does occur. [ABSTRACT FROM AUTHOR]

Homozygosity for the ε4 allele of APOE increases the odds of developing Alzheimer's by 12 to 15 times relative to the most common ε3;ε3 genotype, and its association with higher plaque loads comports with evidence that APOEε4 compromises autophagy. The ApoE4 protein specifically binds a cis element ("CLEAR") in the promoters of several autophagy genes to block their transcription. We used a multifaceted approach to identify a druggable site in ApoE4, and virtual screening of lead-like compounds identified small molecules that specifically bind to this site to impede ApoE4::DNA binding. We validated these molecules both in vitro and in vivo with models expressing ApoE4, including ApoE4 targeted-replacement mice. One compound was able to significantly restore transcription of several autophagy genes and protected against amyloid-like aggregation in a C. elegans AD model. Together, these findings provide proof-of-principle evidence for pharmacological remediation of lysosomal autophagy by ApoE4 via ApoE4-targeted lead molecules that represent a novel tack on neurodegenerative disorders. In-silico based in vitro and in vivo validations identified a lead molecule that specifically targets: ApoE4 protein; inhibits ApoE4::CLEAR DNA binding; rescues thwarted lysosomal autophagy; and protects against Aβ aggregation. [ABSTRACT FROM AUTHOR]

The GERmanium Detector Array (Gerda) experiment operated enriched high-purity germanium detectors in a liquid argon cryostat, which contains 0.33% of 36 Ar, a candidate isotope for the two-neutrino double-electron capture (2 ν ECEC) and therefore for the neutrinoless double-electron capture (0 ν ECEC). If detected, this process would give evidence of lepton number violation and the Majorana nature of neutrinos. In the radiative 0 ν ECEC of 36 Ar, a monochromatic photon is emitted with an energy of 429.88 keV, which may be detected by the Gerda germanium detectors. We searched for the 36 Ar 0 ν ECEC with Gerda data, with a total live time of 4.34 year (3.08 year accumulated during Gerda Phase II and 1.26 year during Gerda Phase I). No signal was found and a 90% CL lower limit on the half-life of this process was established T 1 / 2 > 1.5 · 10 22 year. [ABSTRACT FROM AUTHOR]

Patients with myelodysplastic syndromes/neoplasms (MDS) or acute myeloid leukemia (AML) with hypomethylating agent failure have a poor prognosis. Myeloid-derived suppressor cells (MDSCs) can contribute to MDS progression and mediate resistance to anti-PD1 therapy. As histone deacetylase inhibitors (HDACi) decrease MDSCs in preclinical models, we conducted an investigator-initiated, NCI-Cancer Therapy Evaluation Program-sponsored, multicenter, dose escalation, and expansion phase Ib trial (NCT02936752) of the HDACi entinostat and the anti-PD1 antibody pembrolizumab. Twenty-eight patients (25 MDS and 3 AML) were enrolled. During dose escalation (n=13 patients), there was one dose-limiting toxicity (DLT) on dose level (DL) 1 (G5 pneumonia/bronchoalveolar hemorrhage) and two DLTs at DL 2 (G3 pharyngeal mucositis and G3 anorexia). Per the 3 + 3 dose escalation design, DL 1 (entinostat 8 mg PO days 1 and 15 + pembrolizumab 200 mg IV day 1 every 21 days) was expanded and another 15 patients were enrolled. Hematologic adverse events (AEs) were common. The most common non-hematologic ≥G3 AEs were infection (32%), hypoxia/respiratory failure (11%), and dyspnea (11%). There were no protocol-defined responses among the 28 patients enrolled. Two patients achieved a marrow complete remission (mCR). Using a systems immunology approach with mass cytometry and machine learning analysis, mCR patients had increased classical monocytes and macrophages but there was no significant change of MDSCs. In conclusion, combining entinostat with pembrolizumab in patients with advanced MDS and AML was associated with limited clinical efficacy and substantial toxicity. Absence of an effect on MDSCs could be a potential explanation for the limited efficacy of this combination. ClinicalTrial.gov Identifier: NCT02936752. [ABSTRACT FROM AUTHOR]

Increasing demand for bioenergy from intensively managed woody crops raises concerns of increased evapotranspiration and potential decreases in water yield. Pinus taeda (loblolly pine) is currently the most cultivated species in the southeastern USA, the country's wood basket. However, Eucalyptus species could achieve greater productivity but with unknown ramifications for water budgets. To address the knowledge gap, we determined annual water budgets of loblolly pine and Eucalyptus benthamii (eucalypt) from growing years 3 through 5 in a replicated (n = 3) two-factor design comparing species and groundwater depth. Paired plots were established across a depth-to-groundwater gradient from shallow (~ 2 m) to deep (~ 8 m). Hydrologic budgets were constructed by measuring precipitation, interception, soil evaporation, and transpiration. Eucalypt evapotranspiration and above-ground biomass production for growing years 3 through 5 were on average 25 and 14% greater than pine, respectively; however, evapotranspiration did not differ across groundwater depths. At the end of growing year 5, eucalypt had higher transpiration and evapotranspiration per unit area than pine. Soil evaporation was substantial in young plantations (nearly 500 mm) in growing year 3 but declined as the canopy closed. Partitioning of evapotranspiration components in developing bioenergy plantations was dynamic due to canopy development driven decreases in soil evaporation and increases in transpiration and interception; total evapotranspiration was less variable from year to year. Water use efficiency (WUE, kg biomass/m3 H2O) per unit evapotranspiration was similar between species, but WUE per unit transpiration was higher in pine. Considering total evapotranspiration in young plantations can affect WUE interpretations. [ABSTRACT FROM AUTHOR]

The communication between the nervous and immune systems plays a crucial role in regulating immune cell function and inflammatory responses. Sympathetic neurons, which innervate the spleen, have been implicated in modulating immune cell activity. The neurotransmitter norepinephrine (NE), released by sympathetic neurons, influences immune cell responses by binding to adrenergic receptors on their surface. The alpha-2 adrenergic receptor (α2AR), expressed predominantly on sympathetic neurons, has received attention due to its autoreceptor function and ability to modulate NE release. In this study, we used fast-scan cyclic voltammetry (FSCV) to provide the first subsecond measurements of NE released in the white pulp region of the spleen and validated it with yohimbine, a known antagonist of α2AR. For further application of FSCV in neuroimmunology, we investigated the extent to which subsecond NE from sympathetic neurons is important for immune cell physiology and cytokine production, focusing on tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), and interleukin-6 (IL-6). Our findings provide insights into the regulatory mechanisms underlying sympathetic-immune interactions and show the significance of using FSCV, a traditional neurochemistry technique, to study these neuroimmune mechanisms. [ABSTRACT FROM AUTHOR]

Background: Patient delays at the point of their discharge account for more than half a million additional bed days every year in Scotland, United Kingdom. Bottlenecks in discharge medication dispensing contribute to such delays. Aim: To test whether the discharge process could be made more time-efficient by utilising community pharmacy supply of medicines on the day of discharge, rather than hospital pharmacy supply. Setting: Glasgow Royal Infirmary, Scotland. Development: Local community pharmacy staff received training and communication about each patient discharge. Pharmacies could access an immediate discharge letter (IDL) on a shared electronic record. The existing pandemic law allowed medication dispensing from this IDL, without a prescription. Implementation: The programme was implemented from June to November 2020, across three Plan-Do-Study-Act (PDSA) cycles. Comparisons were made between the new community pharmacy model and standard hospital model. Evaluation: Across three PDSA cycles, in total 335 patients had community pharmacy supply compared to 376 patients eligible for hospital pharmacy supply. The median time taken from creation of the IDL to final completion was significantly lower in the new community pharmacy model compared to the hospital pharmacy model; 154 min (interquartile range (IQR) 82–272 min) vs 296 min (IQR 197–1281 min) p value < 0.000 Conclusion: A community pharmacy supply model compared to a standard hospital pharmacy model resulted in a median time saving of 142 min per patient. Such a time saving has the potential to deliver a transformational change in patient flow and free up hospital pharmacy staff to deliver other clinical interventions. [ABSTRACT FROM AUTHOR]

Surface waves can lead to intriguing transport phenomena. In particular, surface phonon polaritons (SPhPs), which result from coupling between infrared light and optical phonons, have been predicted to contribute to heat conduction along polar thin films and nanowires1. However, experimental efforts so far suggest only very limited SPhP contributions2–5. Through systematic measurements of thermal transport along the same 3C-SiC nanowires with and without a gold coating on the end(s) that serves to launch SPhPs, here we show that thermally excited SPhPs can substantially enhance the thermal conductivity of the uncoated portion of these wires. The extracted pre-decay SPhP thermal conductance is more than two orders of magnitude higher than the Landauer limit predicted on the basis of equilibrium Bose–Einstein distributions. We attribute the notable SPhP conductance to the efficient launching of non-equilibrium SPhPs from the gold-coated portion into the uncoated SiC nanowires, which is strongly supported by the observation that the SPhP-mediated thermal conductivity is proportional to the length of the gold coating(s). The reported discoveries open the door for modulating energy transport in solids by introducing SPhPs, which can effectively counteract the classical size effect in many technologically important films and improve the design of solid-state devices.Measurements of thermal transport along 3C-SiC nanowires with and without a gold coating on the end(s) suggest that thermally excited surface phonon polaritons can be used in nanostructures to substantially enhance thermal conductivity. [ABSTRACT FROM AUTHOR]

Oligodendrocyte progenitor cells (OPCs) receive synaptic innervation from glutamatergic and GABAergic axons and can be dynamically regulated by neural activity, resulting in activity-dependent changes in patterns of axon myelination. However, it remains unclear to what extent other types of neurons may innervate OPCs. Here, we provide evidence implicating midbrain dopamine neurons in the innervation of oligodendrocyte lineage cells in the anterior corpus callosum and nearby white matter tracts of male and female adult mice. Dopaminergic axon terminals were identified in the corpus callosum of DAT-Cre mice after injection of an eYFP reporter virus into the midbrain. Furthermore, fast-scan cyclic voltammetry revealed monoaminergic transients in the anterior corpus callosum, consistent with the anatomical findings. Using RNAscope, we further demonstrate that ~ 40% of Olig2 + /Pdfgra + cells and ~ 20% of Olig2 + /Pdgfra- cells in the anterior corpus callosum express Drd1 and Drd2 transcripts. These results suggest that oligodendrocyte lineage cells may respond to dopamine released from midbrain dopamine axons, which could affect myelination. Together, this work broadens our understanding of neuron-glia interactions with important implications for myelin plasticity by identifying midbrain dopamine axons as a potential regulator of corpus callosal oligodendrocyte lineage cells. [ABSTRACT FROM AUTHOR]

A new measurement of inclusive-jet cross sections in the Breit frame in neutral current deep inelastic scattering using the ZEUS detector at the HERA collider is presented. The data were taken in the years 2004–2007 at a centre-of-mass energy of 318 GeV and correspond to an integrated luminosity of 347 pb - 1 . The jets were reconstructed using the k t -algorithm in the Breit reference frame. They have been measured as a function of the squared momentum transfer, Q 2 , and the transverse momentum of the jets in the Breit frame, p ⊥ , Breit . The measured jet cross sections are compared to previous measurements and to perturbative QCD predictions. The measurement has been used in a next-to-next-to-leading-order QCD analysis to perform a simultaneous determination of parton distribution functions of the proton and the strong coupling, resulting in a value of α s (M Z 2) = 0.1142 ± 0.0017 (experimental/fit) - 0.0007 + 0.0006 (model/parameterisation) - 0.0004 + 0.0006 (scale) , whose accuracy is improved compared to similar measurements. In addition, the running of the strong coupling is demonstrated using data obtained at different scales. [ABSTRACT FROM AUTHOR]

Diversified crop rotation with an appropriate sequence may be a promising strategy for increasing crop productivity while reducing greenhouse gas emissions (GHGs) and lowering carbon (C) footprint for more sustainable agricultural systems. The objectives of this study were to (i) assess the agronomic performance and C footprint of canola (Brassica napus L.) production in different cropping systems, and (ii) better understand how canola could be adapted to existing cropping systems in eastern Canada. A four-year canola-based phase rotation study, including maize (Zea mays L.), wheat (Triticum aestivum L.), and soybean (Glycine max L.), started in 2011 and continued for two cycles in Ottawa, ON; Montreal, QC; and Canning, NS. It was found that, compared to continuous monoculture (canola, maize or wheat), diversified cropping systems increased crop yields by an average of 32% and reduced the C footprint of all rotations by 33%, except under severe heat and drought conditions. The effect of rotation on yield and C footprint of canola production varied significantly among site-years. At Ottawa, the canola following soybean (SC) had 12% higher canola yield than monoculture canola (CC), 5 and 8% higher canola yield than canola following wheat (WC) or maize (MC). At Montreal, canola yield ranked as MC > SC > WC > CC. At Canning, the highest canola yield was in WC (21%) and SC (13%). Overall, most SC rotations had the lowest C footprint, and CC cropping had the highest C footprint, with only a few exceptions. Regardless of the cropping system, canola required more N input and was high in oil and protein in the harvested product, and produced the highest C footprint, while soybean had the lowest C footprint at all three sites. Our findings indicate that a diversified cropping system with canola production following soybean significantly improved canola yield while lowering the C footprint. However, profitable and sustainable canola production in eastern Canada is threatened by climate change-induced drought and heat stress. [ABSTRACT FROM AUTHOR]

Hyperbolic phonon polaritons (HPhPs) can be supported in materials where the real parts of their permittivities along different directions are opposite in sign. HPhPs offer confinements of long-wavelength light to deeply subdiffractional scales, while the evanescent field allows for interactions with substrates, enabling the tuning of HPhPs by altering the underlying materials. Yet, conventionally used noble metal and dielectric substrates restrict the tunability of this approach. To overcome this challenge, here we show that doped semiconductor substrates, e.g., InAs and CdO, enable a significant tuning effect and dynamic modulations. We elucidated HPhP tuning with the InAs plasma frequency in the near-field, with a maximum difference of 8.3 times. Moreover, the system can be dynamically modulated by photo-injecting carriers into the InAs substrate, leading to a wavevector change of ~20%. Overall, the demonstrated hBN/doped semiconductor platform offers significant improvements towards manipulating HPhPs, and potential for engineered and modulated polaritonic systems.The photonic applications of hyperbolic phonon polaritons (HPhPs) in anisotropic van der Waals materials are currently limited by their low tunability. Here, the authors report the static and ultrafast wavevector modulation of HPhPs in hexagonal boron nitride by tuning the plasma frequency of doped semiconductor substrates. [ABSTRACT FROM AUTHOR]

We search for tri-nucleon decays of 76 Ge in the dataset from the GERmanium Detector Array (GERDA) experiment. Decays that populate excited levels of the daughter nucleus above the threshold for particle emission lead to disintegration and are not considered. The ppp-, ppn-, and pnn-decays lead to 73 Cu, 73 Zn, and 73 Ga nuclei, respectively. These nuclei are unstable and eventually proceed by the beta decay of 73 Ga to 73 Ge (stable). We search for the 73 Ga decay exploiting the fact that it dominantly populates the 66.7 keV 73 m Ga state with half-life of 0.5 s. The nnn-decays of 76 Ge that proceed via 73 m Ge are also included in our analysis. We find no signal candidate and place a limit on the sum of the decay widths of the inclusive tri-nucleon decays that corresponds to a lower lifetime limit of 1.2 × 10 26 yr (90% credible interval). This result improves previous limits for tri-nucleon decays by one to three orders of magnitude. [ABSTRACT FROM AUTHOR]

Primary sclerosing cholangitis (PSC) is notoriously challenging to manage given its heterogeneity with regard to diagnosis, management, and progression. The lack of disease-modifying therapy and variable rate of onset of cirrhosis, portal hypertension-related decompensating events, jaundice, pruritus, biliary complications, and need for liver transplantation is deeply unsettling to clinicians and patients alike. Recent updated practice guidance by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver endeavored to highlight some of these challenges. However, these references only briefly address clinical dilemmas that providers face on a daily basis. This review aims to further discuss these controversial topics, including providing insight into the utility of ursodeoxycolic acid, the significance of alkaline phosphatase normalization, when to consider PSC variants and mimickers, and the implications of continuous hepatobiliary malignancy screening. In particular, there has been a growing body of literature raising concern about repeat exposure to gadolinium-containing contrast. Patients with PSC are potentially at risk for large lifetime exposure to gadolinium related to frequent magnetic resonance imaging scans and whether this carries any negative long-term adverse effects remains unknown. [ABSTRACT FROM AUTHOR]

Structural anisotropy in crystals is crucial for controlling light propagation, particularly in the infrared spectral regime where optical frequencies overlap with crystalline lattice resonances, enabling light-matter coupled quasiparticles called phonon polaritons (PhPs). Exploring PhPs in anisotropic materials like hBN and MoO3 has led to advancements in light confinement and manipulation. In a recent study, PhPs in the monoclinic crystal β-Ga2O3 (bGO) were shown to exhibit strongly asymmetric propagation with a frequency dispersive optical axis. Here, using scanning near-field optical microscopy (s-SNOM), we directly image the symmetry-broken propagation of hyperbolic shear polaritons in bGO. Further, we demonstrate the control and enhancement of shear-induced propagation asymmetry by varying the incident laser orientation and polariton momentum using different sizes of nano-antennas. Finally, we observe significant rotation of the hyperbola axis by changing the frequency of incident light. Our findings lay the groundwork for the widespread utilization and implementation of polaritons in low-symmetry crystals. Hyperbolic phonon polaritons occurring in anisotropic materials exhibit strong light confinement and propagation directionality. Matson et al. report real-space imaging and control of recently discovered hyperbolic shear phonon-polaritons in beta-Ga2O3, arising from symmetry breaking in the dielectric response. [ABSTRACT FROM AUTHOR]

The readiness to interact with and explore novel stimuli—i.e., curiosity—is the cornerstone of innovation. Great apes show broad and complex innovation repertoires. However, little is known about the factors that affect curiosity in wild apes. To shed light on wild apes' curiosity, we measured the reactions of wild Sumatran orangutans (Pongo abelii) to an experiment apparatus. Overall, individuals were reluctant to touch the apparatus. However, compared to adults, immatures showed higher tendencies to explore (measured through looking durations and the probability of touching the apparatus) and to approach (measured through approach latencies and approach distances) the apparatus but were more likely to show behavioral signs of agitation. The presence of conspecifics who approached the apparatus increased visual exploration and approach tendencies. Prevailing habitat food availability positively affected visual exploration but had a negative effect on approach tendencies. These findings indicate that intrinsic, social, and ecological factors affect reactions to novelty in wild orangutans and suggest that exploration, neophobia and neophilia are independently regulated. Because reactions to novelty can be an essential pathway to innovation, our results suggest that factors acting on different elements of curiosity must be considered to understand the evolution of innovative tendencies. [ABSTRACT FROM AUTHOR]

10.1007/s10964-013-9941-5. 23532598 15 Valdez ES, Valdez L, Korchmaros J, Garcia DO, Stevens S, Sabo S, Carvajal S. Socioenvironmental risk factors for adolescent marijuana use in a United States-Mexico border community. Prevalence of youth substance use is increasing, including risky forms of use such as polysubstance (Zuckermann et al., [17]) and daily use (National Institute on Drug Abuse, [10]). Higher sum scores indicate lower overall support Analysis Descriptive statistics for demographic and socioenvironmental exposure variables were stratified by substance use frequency (daily use/non-daily use) and tested with t-tests or chi-squared tests as appropriate. Those who used daily were more likely to be older, male, and living with a single parent compared to those who did not use or used non-daily. [Extracted from the article]

Even though mechanization has dramatically decreased labor requirements, vineyard management costs are still affected by selective operations such as winter pruning. Robotic solutions are becoming more common in agriculture, however, few studies have focused on grapevines. This work aims at fine-tuning and testing two different deep neural networks for: (i) detecting pruning regions (PRs), and (ii) performing organ segmentation of spur-pruned dormant grapevines. The Faster R-CNN network was fine-tuned using 1215 RGB images collected in different vineyards and annotated through bounding boxes. The network was tested on 232 RGB images, PRs were categorized by wood type (W), orientation (Or) and visibility (V), and performance metrics were calculated. PR detection was dramatically affected by visibility. Highest detection was associated with visible intermediate complex spurs in Merlot (0.97), while most represented coplanar simple spurs allowed a 74% detection rate. The Mask R-CNN network was trained for grapevine organs (GOs) segmentation by using 119 RGB images annotated by distinguishing 5 classes (cordon, arm, spur, cane and node). The network was tested on 60 RGB images of light pruned (LP), shoot-thinned (ST) and unthinned control (C) grapevines. Nodes were the best segmented GOs (0.88) and general recall was higher for ST (0.85) compared to C (0.80) confirming the role of canopy management in improving performances of hi-tech solutions based on artificial intelligence. The two fine-tuned and tested networks are part of a larger control framework that is under development for autonomous winter pruning of grapevines. [ABSTRACT FROM AUTHOR]

In this work we present a keV-scale sterile-neutrino search with a low-tritium-activity data set of the KATRIN experiment, acquired in a commissioning run in 2018. KATRIN performs a spectroscopic measurement of the tritium β -decay spectrum with the main goal of directly determining the effective electron anti-neutrino mass. During this commissioning phase a lower tritium activity facilitated the measurement of a wider part of the tritium spectrum and thus the search for sterile neutrinos with a mass of up to 1.6 keV . We do not find a signal and set an exclusion limit on the sterile-to-active mixing amplitude of sin 2 θ < 5 × 10 - 4 ( 95 % C.L.) at a mass of 0.3 keV. This result improves current laboratory-based bounds in the sterile-neutrino mass range between 0.1 and 1.0 keV. [ABSTRACT FROM AUTHOR]

Introduction: Sternal fractures (SF) are uncommon injuries usually associated with a significant mechanism of injury. Concomitant injury is likely, and a risk of mortality is substantial. Aim: Our aim in this study was to identify the risk factors for mortality in patients who had sustained sternal fractures. Methods: We conducted a single centre retrospective review of the trust's Trauma Audit and Research Network Database, from May 2014 to July 2021. Our inclusion criteria were any patients who had sustained a sternal fracture. The regions of injury were defined using the Abbreviated Injury Score. Pearson Chi-Squared, Fisher Exact tests and multivariate regression analyses were performed using IBM SPSS. Results: A total of 249 patients were identified to have sustained a SF. There were 19 patients (7.63%) who had died. The most common concomitant injuries with SF were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%). There was a significant increase in age (59.93 vs 70.06, p =.037) and admission troponin (36.34 vs. 100.50, p =.003) in those who died. There was a significantly lower GCS in those who died (10.05 vs. 14.01, p <.001). On multi regression analysis, bilateral rib injury (p = 0.037, OR 1.104) was the only nominal variable which showed significance in mortality. Conclusion: Sternal Fractures are uncommon but serious injuries. Our review has identified that bilateral rib injuries, increase in age, low GCS, and high admission troponin in the context of SF, were associated with mortality. [ABSTRACT FROM AUTHOR]

Women with heart failure report worse health-related quality of life on average, than men. This may result from actual differences in care or differing interpretations of and responses to survey questions. We investigated potential gender-based differential item functioning on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Physical Limitations domain. Using data from the HF-ACTION trial, a multicenter, randomized controlled trial of exercise training in patients with chronic heart failure with reduced ejection fraction (661 women, 1670 men), we assessed gender-based differential item functioning using a Wald test based on item response theory and ordinal logistic regression. Both methods evaluated how men and women responded to each KCCQ item after adjusting for physical limitation status. No item exhibited statistically significant differential item functioning using the Wald method. Two items exhibited differential item functioning using the ordinal logistic regression method (KCCQ1e: Climbing a flight of stairs without stopping; KCCQ1f: Hurrying or jogging) (P < 0.01), but the magnitude of differential item functioning was negligible. To accurately measure patient-reported outcomes, it is important to evaluate potential biases that may influence the ability to compare patient subgroups. The magnitude of differential item functioning on a 5-item KCCQ Physical Limitation domain was negligible. [ABSTRACT FROM AUTHOR]

A person's place of residence is a strong risk factor for important diagnosed chronic diseases such as diabetes. It is unclear whether neighborhood-level risk factors also predict the probability of undiagnosed disease. The objective of this study was to identify neighborhood-level variables associated with severe hyperglycemia among emergency department (ED) patients without a history of diabetes. We analyzed patients without previously diagnosed diabetes for whom a random serum glucose value was obtained in the ED. We defined random glucose values ≥ 200 mg/dL as severe hyperglycemia, indicating probable undiagnosed diabetes. Patient addresses were geocoded and matched with neighborhood-level socioeconomic measures from the American Community Survey and claims-based surveillance estimates of diabetes prevalence. Neighborhood-level exposure variables were standardized based on z-scores, and a series of logistic regression models were used to assess the association of selected exposures and hyperglycemia adjusting for biological and social individual-level risk factors for diabetes. Of 77,882 ED patients without a history of diabetes presenting in 2021, 1,715 (2.2%) had severe hyperglycemia. Many geospatial exposures were associated with uncontrolled hyperglycemia, even after controlling for individual-level risk factors. The most strongly associated neighborhood-level variables included lower markers of educational attainment, higher percentage of households where limited English is spoken, lower rates of white-collar employment, and higher rates of Medicaid insurance. Including these geospatial factors in risk assessment models may help identify important subgroups of patients with undiagnosed disease. [ABSTRACT FROM AUTHOR]

Dynamic musculoskeletal ultrasound is an important diagnostic tool that allows the practitioner to observe soft tissue structures over a range of motion and identify pathology not diagnosed on other modalities. Familiarity with this modality allows health care practitioners to appropriately refer patients for this type of examination. This article will review several indications for dynamic ultrasound imaging, including slipping rib, muscle hernia, snapping hip, and peroneal tendon pathology. The examination technique and expected findings for common pathology in each location are discussed. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: We sought to further develop and validate the Surgical Preparedness Assessment (SPA) scale to evaluate patient preparedness for urogynecological surgery. Methods: This was a planned ancillary analysis of a randomized controlled trial (RCT) evaluating the impact of a preoperative telehealth call on patient preparedness for urogynecological surgery. Patients completed the Preoperative Preparedness Questionnaire (PPQ), the modified Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ), the Pelvic Floor Distress Inventory (PFDI-20), the Satisfaction Decision Scale (SDS), and the Decision Regret Scale (DRS). Content validity was established through expert opinion and patient cognitive interviews. Factor analysis identified item grouping into domains. Cronbach's alpha reported internal consistency. Known group validity was assessed by comparing intervention arms. External validity was evaluated by comparing intervention arms and correlations with SDS and DRS. Results: Eleven items and 3 domains met the criteria (information needs, satisfaction and pain, and catheterization). Cronbach's alpha values were acceptable for domains and ranged from 0.74 to 0.93. SPA scores did not correlate with other patient-reported outcomes. Mean SPA scores were lower among women who received a telehealth call vs those who did not (1.30 ± 0.31 vs 1.51 ± 0.44; p = 0.002). Conclusions: The content-valid SPA demonstrates high internal consistency and known group validity. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Microscopic hematuria (MH) has many etiologies in women and requires specific gynecologic evaluation. We created a standardized MH pathway to serve as an evidence-based decision aid for providers in our practice. Methods: Using a modified Delphi process, a multidisciplinary team reviewed existing guidelines for MH diagnosis and treatment to reach consensus on care pathway components. Results: Entry into the care pathway by an advanced practice provider is determined by the finding of ≥3 red blood cells per high-power field (RBC/HPF) on microscopic urinalysis. Initial evaluation includes history and physical exam. If there are signs of a gynecologic cause of MH, the conditions are treated and repeat urinalysis is performed in 6 months. If repeat urinalysis shows persistent MH or there are no other apparent causes for MH, we proceed with risk stratification. Through shared decision-making, low-risk patients may undergo repeat urinalysis in 6 months or cystoscopy with urinary tract ultrasound. For intermediate-risk patients, cystoscopy and urinary tract ultrasound are recommended. For high-risk patients, cystoscopy and axial upper urinary tract imaging are recommended. If evaluation is positive, urology referral is provided. If evaluation is negative, low-risk patients are released from care, but intermediate-risk or high-risk patients undergo repeat urinalysis in 12 months. If repeat urinalysis is positive, shared decision-making is used to determine a plan. Conclusions: We developed an MH care pathway to standardize care of women with MH across a multidisciplinary group. This pathway serves as a component of value-based care and supports evidence-based care by providers. [ABSTRACT FROM AUTHOR]

The combination of optical time transfer and optical clocks opens up the possibility of large-scale free-space networks that connect both ground-based optical clocks and future space-based optical clocks. Such networks promise better tests of general relativity1–3, dark-matter searches4 and gravitational-wave detection5. The ability to connect optical clocks to a distant satellite could enable space-based very long baseline interferometry6,7, advanced satellite navigation8, clock-based geodesy2,9,10 and thousandfold improvements in intercontinental time dissemination11,12. Thus far, only optical clocks have pushed towards quantum-limited performance13. By contrast, optical time transfer has not operated at the analogous quantum limit set by the number of received photons. Here we demonstrate time transfer with near quantum-limited acquisition and timing at 10,000 times lower received power than previous approaches14–24. Over 300 km between mountaintops in Hawaii with launched powers as low as 40 µW, distant sites are synchronized to 320 attoseconds. This nearly quantum-limited operation is critical for long-distance free-space links in which photons are few and amplification costly: at 4.0 mW transmit power, this approach can support 102 dB link loss, more than sufficient for future time transfer to geosynchronous orbits.Laser-based time transfer with near quantum-limited acquisition and timing is demonstrated that can support femtosecond precision over 102 dB link loss, more than sufficient for future time transfer to geosynchronous orbits for future optical clock networks. [ABSTRACT FROM AUTHOR]

Background & Aims: Cardiorespiratory fitness and liver fibrosis are independently associated with poor outcomes in patients with nonalcoholic steatohepatitis (NASH), however, conflicting reports exist about their relationship. We aimed to better characterize the relationship between cardiorespiratory fitness and liver histology in a cross-sectional study of patients with biopsy-proven NASH. Methods: Participants aged 18–75 years completed VO2peak fitness assessment using symptom-limited graded exercise testing. Participants were compared by liver fibrosis stage and NAFLD Activity Score (NAS). Multivariable models were constructed to assess factors related to relative VO2peak, including liver fibrosis and NAS. Results: Thirty-five participants with mean age 48 ± 12 years and body mass index 33.5 ± 7.6 kg/m2 were enrolled. Seventy-four percent of participants were female and 49% had diabetes. A dose-dependent relationship was found between relative VO2peak and liver fibrosis. Relative VO2peak was significantly lower in participants with advanced fibrosis (F3 disease- 15.7 ± 5.3 vs. ≤ F2 disease- 20.7 ± 5.9 mL/kg/min, p = 0.027). NAS > 5 was also associated with lower relative VO2peak (22.6 ± 5.7 vs. 16.5 ± 5.1 mL/kg/min, p = 0.012) compared to NAS ≤ 5. With multivariable modeling, advanced fibrosis remained independently predictive of relative VO2peak while NAS trended towards significance. Discussion and Conclusions: Advanced liver fibrosis is independently associated with cardiorespiratory fitness in patients with NASH. This may explain the incremental increase in mortality as liver fibrosis stage increases. Further research is needed to determine if exercise training can improve cardiorespiratory fitness across multiple stages of liver fibrosis and directly reduce morbidity and mortality in patients with NASH. [ABSTRACT FROM AUTHOR]