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Abstract Defects in homologous recombination repair (HRR) in tumors correlate with poor prognosis and metastases development. Determining HRR deficiency (HRD) is of major clinical relevance as it is associated with therapeutic vulnerabilities and remains poorly investigated in sarcoma. Here, we show that specific sarcoma entities exhibit high levels of genomic instability signatures and molecular alterations in HRR genes, while harboring a complex pattern of chromosomal instability. Furthermore, sarcomas carrying HRDness traits exhibit a distinct SARC‐HRD transcriptional signature that predicts PARP inhibitor sensitivity in patient‐derived sarcoma cells. Concomitantly, HRDhigh sarcoma cells lack RAD51 nuclear foci formation upon DNA damage, further evidencing defects in HRR. We further identify the WEE1 kinase as a therapeutic vulnerability for sarcomas with HRDness and demonstrate the clinical benefit of combining DNA damaging agents and inhibitors of DNA repair pathways ex vivo and in the clinic. In summary, we provide a personalized oncological approach to treat sarcoma patients successfully.

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Introduction: Proactive tobacco treatment programs are an evidence-based strategy to recruit patients who smoke to make supported quit attempts. However, such programs are rarely implemented. We performed a qualitative assessment of clinicians to inform the creation of a proactive outreach program for patients with chronic obstructive pulmonary disease (COPD) who smoke. Methods: Informed by the Consolidated Framework for Implementation Research, we conducted semi-structured interviews to assess clinician views of proactive outreach, including barriers, program structure, and the use of technology. Clinicians included primary and specialty care physicians, nurses and advanced practice providers, pharmacists, respiratory therapists, a psychologist, and relevant members of leadership. Interviews were transcribed and analyzed using directed content analysis. Results: Clinicians in all roles identified that proactive outreach could be an effective use of resources to help patients with COPD who smoke quit with several advantages over the current state. Clinicians disagreed on the priority population (e.g., younger patients, sicker patients), and to some extent on whether proactive outreach is a clinical priority. Though they supported that technology could be part of the outreach program, most advocated for multiple avenues (phone calls, drop-in clinic, texting), as these patients were perceived to be low technology utilizers. The primary implementation barriers were competing priorities and cost, as well as unclear billing and staffing models. Conclusions: Clinicians support proactive outreach for patients with COPD, but the optimal way to structure, staff, and fund such programs remains unclear. Health systems should leverage implementation strategies to speed uptake of these potentially life-saving programs. [ABSTRACT FROM AUTHOR]

This note considers the momentum method by Polyak and the accelerated gradient method by Nesterov, both without line search but with fixed step length applied to strongly convex quadratic functions assuming that exact gradients are used and appropriate upper and lower bounds for the extreme eigenvalues of the Hessian matrix are known. Simple 2-d-examples show that the Euclidean distance of the iterates to the optimal solution is non-monotone. In this context, an explicit bound is derived on the number of iterations needed to guarantee a reduction of the Euclidean distance to the optimal solution by a factor ϵ . For both methods, the bound is optimal up to a constant factor, it complements earlier asymptotically optimal results for the momentum method, and it establishes another link of the momentum method and Nesterov's accelerated gradient method. [ABSTRACT FROM AUTHOR]

Additive manufacturing processes have progressed in years past from not only being prototyping methods to also being end-product manufacturing methods. However, there are many challenges hindering higher industrial adoption rates of additive manufacturing such as low surface quality of the manufactured parts. Post-process surface treatment methods can play a key role in addressing this challenge. In this work, three mechanical methods were applied to selective laser-sintered polyamide 12 (PA12) parts with the aim of improving the surface quality. The effects of the methods regarding the surface integrity characteristics were evaluated. The results show improved surface roughness across all three methods: from initial Ra of 7.09 μm to 0.055 μm Ra, 0.28 μm Ra and 0.45 μm Ra by grinding, diamond turning and milling on the surfaces oriented upwards during fabrication respectively. Across the three methods, surface hardness was slightly reduced: with a maximum reduction of 2.5% by diamond turning. [ABSTRACT FROM AUTHOR]

Suicide has been identified as the second leading cause of death among adolescents in the USA. Although neighborhood violence has also been identified as a major public health issue, few studies have examined the association between exposure to neighborhood violence and suicidal behaviors among adolescents using a large nationally representative sample. Guided by the Interpersonal Theory of Suicide, this study examined the cross-sectional association between exposure to neighborhood violence and suicidal behaviors among adolescents. Data for this study came from the 2021 Adolescent Behaviors and Experiences Survey (n = 7663, 52.1% Female). The outcome variables investigated in this study were suicidal ideation and suicide attempts, and the main explanatory variable was exposure to neighborhood violence. Data were analyzed using sequential hierarchical binary logistic regression. Of the 7663 adolescents examined, 20.1% experienced suicidal ideation and 8.9% attempted suicide at least once during the past 12 months. About 21% of the adolescents reported being exposed to neighborhood violence. Controlling for other factors, we found that exposure to neighborhood violence was associated with 1.38 times higher odds of making suicide attempts (AOR = 1.38, p =.029, 95% CI 1.04–1.84). The findings of this study could inform clinicians, practitioners, and school counselors on how to identify adolescents who may be particularly at risk of suicide attempts and focus efforts on prevention. [ABSTRACT FROM AUTHOR]

Long-term outcome after thoracic endovascular aortic repair (TEVAR) of acute type B aortic dissection (aTBAD) is still underreported in current literature. This case report shows persistence of aortic remodeling without secondary complication or need of reintervention 13 years after TEVAR. A 45-year-old woman was referred to the emergency room with aTBAD. Due to early diameter progression in combination with therapy-refractory pain and uncontrolled hypertension, TEVAR was performed. Hereafter, the patient showed complete remodeling of the descending thoracic aorta without persistent false lumen perfusion in this segment and with stable true and false lumen diameter in the untreated abdominal segment for a 13-year period. No aortic-related reintervention was needed. With contemporary devices and adapted therapy, TEVAR seems able to treat complex thoracic disease. Long-term follow-up (FU) is mandatory to monitor the efficacy and durability of endovascular treatment in aortic disease. [ABSTRACT FROM AUTHOR]

The Mathieu–Duffing equation represents a basic form for a parametrically excited system with cubic nonlinearities. In multi-degree-of-freedom systems, parametric resonances and the associated limit cycles take place at both principal and combination resonance frequencies. Furthermore, using asynchronous parametric excitation of coupling terms leads to a broadband destabilization of the trivial solution and the appearance of limit cycles at non-resonant frequencies. Regarding applications, the utilization of this excitation method has its significant importance in micro- and nanosystems. On the one hand, cubic nonlinearities are found to be abundant in these systems. On the other hand, parametric excitation is preferably utilized in these systems for better amplification leading to an enhanced sensitivity and for squeezing thermal noise, and thus, proved to be significantly useful in mechanical, optical and microwave systems. Therefore, this theoretical investigation should be of relevant importance to those small-scaled systems. Accordingly, a general two-degree-of-freedom Mathieu–Duffing system is studied. The non-trivial solutions are obtained at different parametric resonance conditions. A bifurcation analysis is carried out using the multiple scales method, followed by investigating the effect of the asynchronous parametric excitation on the existence of limit cycles at resonant and non-resonant frequencies. [ABSTRACT FROM AUTHOR]

Purpose: There is little investigation into the causes of food addiction. The aim of this study was to determine the impact of early life influences on the development of food addiction in college-attending young adults aged 18–29. Methods: This study utilized a sequential explanatory mixed-methods research design. College-attending young adults were invited to complete an online survey measuring Adverse Childhood Experiences (ACEs), food addiction, depression, anxiety, stress, and demographic information. Correlations between food addiction and the other variables were analyzed and significant variables were placed into a nominal logistic regression model to predict the development of food addiction. Participants who met the criteria for food addiction were invited to participate in interviews to examine their childhood eating environment and when their symptoms emerged. Interviews were transcribed and thematically analyzed. Quantitative analysis was conducted using JMP Pro Version 16.0 and qualitative analysis was conducted using NVIVO Software Version 12.0. Results: Survey respondents (n = 1645) had an overall 21.9% prevalence of food addiction. Significant correlations were observed between food addiction and ACEs, depression, anxiety, stress, and sex (p <.01 for all). Depression was the only significant predictor of the development of food addiction (OR = 3.33 95% CI 2.19, 5.05). The most common eating environment described by interview participants (n = 36) was an emphasis on diet culture, ideal body image, and restrictive environments. Symptoms frequently emerged after transitioning into college and having the ability to make their own food choices. Conclusion: These results show the impact of early life eating environments and young adulthood mental health on the development of food addiction. These findings contribute to the understanding of underlying causes of food addiction. Level of evidence: Level V, Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees. [ABSTRACT FROM AUTHOR]

Background: Healthcare agencies and perioperative professional organizations recommend avoiding preoperative screening tests for low-risk surgical procedures. However, low-value preoperative tests are still commonly ordered even for generally healthy patients and active strategies to reduce this testing have not been adequately described. Objective: We sought to learn from hospitals with either high levels of testing or that had recently reduced use of low-value screening tests (aka "delta sites") about reasons for testing and active deimplementation strategies they used to effectively improve practice. Design: Qualitative study of semi-structured telephone interviews. Participants: We identified facilities in the US Veterans Health Administration (VHA) with high or recently improved burden of potentially low-value preoperative testing for carpal tunnel release and cataract surgery. We recruited perioperative clinicians to participate. Approach: Questions focused on reasons to order preoperative screening tests for patients undergoing low-risk surgery and, more importantly, what strategies had been successfully used to reduce testing. A framework method was used to identify common improvement strategies and specific care delivery innovations. Key Results: Thirty-five perioperative clinicians (e.g., hand surgeons, ophthalmologists, anesthesiologists, primary care providers, directors of preoperative clinics, nurses) from 29 VHA facilities participated. Facilities that successfully reduced the burden of low-value testing shared many improvement strategies (e.g., building consensus among stakeholders; using evidence/norm-based education and persuasion; clarifying responsibility for ordering tests) to implement different care delivery innovations (e.g., pre-screening to decide if a preop clinic evaluation is necessary; establishing a dedicated preop clinic for low-risk procedures). Conclusions: We identified a menu of common improvement strategies and specific care delivery innovations that might be helpful for institutions trying to design their own quality improvement programs to reduce low-value preoperative testing given their unique structure, resources, and constraints. [ABSTRACT FROM AUTHOR]

Background and aims: Tree species worldwide suffer from extended periods of water limitation. These conditions not only affect the growth and vitality of trees but also feed back on the cycling of carbon (C) at the plant-soil interface. However, the impact of progressing water loss from soils on the transfer of assimilated C belowground remains unresolved. Methods: Using mesocosms, we assessed how increasing levels of water deficit affect the growth of Pinus sylvestris saplings and performed a 13C-CO2 pulse labelling experiment to trace the pathway of assimilated C into needles, fine roots, soil pore CO2, and phospholipid fatty acids of soil microbial groups. Results: With increasing water limitation, trees partitioned more biomass belowground at the expense of aboveground growth. Moderate levels of water limitation barely affected the uptake of 13C label and the transit time of C from needles to the soil pore CO2. Comparatively, more severe water limitation increased the fraction of 13C label that trees allocated to fine roots and soil fungi while a lower fraction of 13CO2 was readily respired from the soil. Conclusions: When soil water becomes largely unavailable, C cycling within trees becomes slower, and a fraction of C allocated belowground may accumulate in fine roots or be transferred to the soil and associated microorganisms without being metabolically used. [ABSTRACT FROM AUTHOR]

Background: Successful implementation can increase the availability of evidence-based treatments but continued patient access can be threatened if there is not deliberate focus on sustainment. Real-world examples are needed to elucidate contributors to sustainability. Objective: We examined sustainability of outcomes of a study which tested a 12-month external facilitation intervention. The study evaluated change in access to medications for opioid use disorder (MOUD) in Veterans Health Administration (VHA) facilities in the lowest quartile of MOUD prescribing. Design: Convergent mixed-methods design. Participants: Thirty-nine providers and leaders from eight VHA facilities. Approach: Thirty-minute post-implementation telephone interviews explored whether barriers identified pre-implementation were successfully addressed, the presence of any new challenges, helpfulness of external facilitation, and plans for sustaining MOUD access. Interviews were analyzed using a rapid turn-around approach. VHA administrative data were used to characterize the facilities and assess their ratio of patients with an OUD diagnosis receiving MOUD (MOUD/OUD ratio) at the end of a 9-month sustainability period. Key Results: Commonly reported contributors to sustained MOUD access included national attention on the opioid epidemic, accountability created by study participation, culture shift in MOUD acceptability, leadership support, and plans to build on initial progress. Frequently reported barriers included staffing issues and lack of MOUD-devoted time; the need to overhaul existing policies, practices, and/or processes; and fear and anxiety about MOUD prescribing. All facilities either maintained MOUD/OUD ratio improvement (n = 2) or further improved (n = 6) at the end of sustainability. Facilities with the highest and lowest ratio at the end of sustainability used a team-based approach to MOUD delivery; however, organizational setting differences may have impacted overall MOUD access. Conclusions: Ensuring stable and consistent staff, and sufficient time dedicated to MOUD are critical to sustaining access to evidence-based treatment in low-adopting facilities. This study highlights the importance of investing in local, system-level changes to improve and sustain access to effective treatments. [ABSTRACT FROM AUTHOR]

Corals are under siege by both local and global threats, creating a worldwide reef crisis. Cryopreservation is an important intervention measure and a vital component of the modern coral conservation toolkit, but preservation techniques are currently limited to sensitive reproductive materials that can only be obtained a few nights per year during spawning. Here, we report the successful cryopreservation and revival of cm-scale coral fragments via mL-scale isochoric vitrification. We demonstrate coral viability at 24 h post-thaw using a calibrated oxygen-uptake respirometry technique, and further show that the method can be applied in a passive, electronics-free configuration. Finally, we detail a complete prototype coral cryopreservation pipeline, which provides a platform for essential next steps in modulating post-thaw stress and initiating long-term growth. These findings pave the way towards an approach that can be rapidly deployed around the world to secure the biological genetic diversity of our vanishing coral reefs. Cryopreservation is one approach to conserving the genetic diversity of threatened coral reefs but has thus far been limited to difficult-to-obtain coral reproductive material. Using a new cytotechnology called isochoric vitrification, this study reports the successful cryopreservation and revival of whole mature coral fragments. [ABSTRACT FROM AUTHOR]

Purpose: To describe our experience in the management and outcomes of female patients with urethral or bladder neck (BN) injury at a high-volume Level 1 trauma center. Methods: A retrospective chart review of all female patients with urethral or BN injury by blunt trauma mechanism admitted to a Level 1 trauma center between 2005 and 2019 was performed. Results: Ten patients met study criteria with median age 36.5 years. All had concomitant pelvic fractures. All injuries were confirmed operatively, with no delayed diagnoses. Two patients were lost to follow up. One patient was not eligible for early repair of urethral injury and had two repairs of a urethrovaginal fistula. Two of seven (29%) patients who underwent early repair of their injury had an early Clavien grade > 2 complication, with none reporting long-term complications at median follow-up of 15.2 months. Conclusions: Intraoperative evaluation is critical in the diagnosis of female urethral and BN injury. In our experience, acute surgical complications are not uncommon after the management of such injuries. However, there were no reported long-term complications in those patients who had prompt management of their injury. This aggressive diagnostic and surgical strategy is instrumental in attaining excellent surgical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management. Methods: We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery). Results: Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25–50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found. Conclusion: Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) infection is a frequent event in patients undergoing allogeneic haematopoietic cell transplantation (HCT) and is associated with increased morbidity and mortality due to eventual progress to end-organ disease. Letermovir prophylaxis for CMV infections has become a standard of care in adult HCT recipients due to its efficacy and high tolerability. However, it is not yet approved for paediatric patients. Objective: In a retrospective single-centre observational study we evaluated the use of letermovir for prophylaxis or pre-emptive treatment of cytomegalovirus (CMV) infection in seropositive paediatric HCT recipients receiving the compound outside of clinical trials. The primary endpoint was CMV reactivation requiring a change of medication. Methods: A total of 17 patients (seven female/ten male; median age 12.2 [range 3.5–19] years, median body weight 39.5 [range 15–63] kg; median follow-up time 463.7 [range 41–1022] days) were identified who were started on oral (14) or intravenous (3) followed by oral (2) letermovir shortly after neutrophil engraftment at doses determined on the basis of age, weight, and concomitant cyclosporine use. Results: Five patients had no evidence of viral replication (prophylactic use), while 12 patients had varying extents of viral replication (pre-emptive therapy). A change of therapy was required in one patient due to a sustained increase in CMV viral load, and in two patients, letermovir was stopped without later reactivation after initiation of palliative care for recurrent leukaemia. Of the 14 patients who completed treatment, 3 had evidence of transient viral replication after end of treatment that required no further antiviral treatment. No patients (of 17) discontinued letermovir due to an adverse event. Conclusion: Letermovir was effective in controlling CMV infection in seropositive paediatric allogeneic HCT recipients and was overall well tolerated. Pending completion of the still ongoing paediatric investigation plans, letermovir will be an important adjunct to our options for control of infectious complications in this special population. [ABSTRACT FROM AUTHOR]

Background: Dystroglycanopathies are a heterogeneous group of membrane-related muscular dystrophies. The dystroglycanopathy phenotype includes a spectrum of severity ranging from severe congenital muscular dystrophy to adult-onset limb–girdle muscular dystrophy (LGMD). LGMDR9 is a dystroglycanopathy caused by mutations in the FKRP gene. Previous studies have characterized electroretinogram findings of dystroglycanopathy mouse models but have not been reported in humans. Purpose: This study set out to characterize the electroretinogram in eight participants with LGMDR9. Methods: Eight participants were recruited from an ongoing dystroglycanopathy natural history study at the University of Iowa (NCT00313677). Inclusion criteria for the current study were children and adults > 6 years old with confirmed LGMDR9. Age similar controls were identified from our electrophysiology service normative control database. Full-field electroretinograms were recorded using ISCEV standards. Six of the eight participants underwent light-adapted ON/OFF testing. Results: The electronegative electroretinogram was not seen in any participants with LGMDR9. An unusual sawtooth pattern in the 30 Hz flicker with faster rise than descent was noted in all 8 participants. Our cases showed a decreased b-wave amplitude in light-adapted ON responses (p = 0.011) and decreased d-wave amplitude in light-adapted OFF responses (p = 0.015). Decreased b-wave amplitude in light-adapted 3.0 testing (p = 0.015) and decreased flicker ERG amplitudes were also detected (p = 0.0018). Additionally, compared to controls, participants with LGMDR9 had decreased a-wave amplitudes on dark-adapted 10 testing (p = 0.026). Conclusions: Abnormal ON/OFF bipolar cell responses and sawtooth 30 Hz flicker waveforms on full-field electroretinogram may be specific for LGMDR9. If confirmed in a larger population and if related to disease stage, these tests are potential biomarkers which could be useful as endpoints in clinical treatment trials. [ABSTRACT FROM AUTHOR]

Coral reefs worldwide are at risk due to climate change. Coral bleaching is becoming increasingly common and corals that survive bleaching events can suffer from temporary reproductive failure for several years. While water temperature is a key driver in causing coral bleaching, other environmental factors are involved, such as solar radiation. We investigated the individual and combined effects of temperature, photosynthetically active radiation (PAR), and ultraviolet radiation (UVR) on the spawning patterns and reproductive physiology of the Hawaiian mushroom coral Lobactis scutaria, using long-term experiments in aquaria. We examined effects on spawning timing, fertilisation success, and gamete physiology. Both warmer temperatures and filtering UVR altered the timing of spawning. Warmer temperatures caused a drop in fertilisation success. Warmer temperatures and higher PAR both negatively affected sperm and egg physiology. These results are concerning for the mushroom coral L. scutaria and similar reproductive data are urgently needed to predict future reproductive trends in other species. Nonetheless, thermal stress from global climate change will need to be adequately addressed to ensure the survival of reef-building corals in their natural environment throughout the next century and beyond. Until then, reproduction is likely to be increasingly impaired in a growing number of coral species. [ABSTRACT FROM AUTHOR]

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant mesenchymal neoplasm of uncertain differentiation as classified by the WHO Classification of Tumours 2020. Although often associated with pronlonged survival, EMC has high rates of distant recurrences and disease-associated death. EMCs are translocation sarcomas and harbor in > 90% of the cases an NR4A3 rearrangement. The molecular consequences of the NR4A3 gene fusions are not yet fully elucidated as well-characterized ex vivo cell models for EMC are lacking. Patient-derived ex vivo models are important and essential tools for investigating disease mechanisms associated with diseases that are rare, that exhibit poor prognosis and for the identification of potential novel treatment options. We established two novel EMC ex vivo models (USZ20-EMC1 and USZ22-EMC2) for functional testing and research purposes. USZ20-EMC1 and USZ22-EMC2 were established and maintained as sarco-sphere cell models for several months in culture. The cells were molecularly characterized using DNA sequencing and methylation profiling. Both cell models represent their native tumor tissue as confirmed by histomorphology and their molecular profiles, suggesting that native tumor cell function can be recapitulated in the ex vivo models. Using a functional screening approach, novel anti-cancer drug sensitivities including potential synergistic combinations were identified. In conclusion, two novel EMC ex vivo cell models (USZ20-EMC1 and USZ22-EMC2) were successfully established and characterized from native tumor tissues. Both cell models will be useful tools for further investigating disease mechanisms and for answering basic and translational research questions. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD), a leading cause of disability and death in the U.S., disproportionately affects rural residents.[1] Rural counties experience more COPD-related exacerbations, hospitalizations, and deaths than urban counties.[1],[2] Furthermore, isolated rural veterans have a higher risk of mortality following hospitalization for an acute exacerbation compared to urban veterans.[3] Rural-urban disparities in COPD outcomes are multifactorial in origin with contributions from factors such as occupational exposures, tobacco use, and socioeconomic status.[4],[5] Lack of access to resources required to deliver evidence-based COPD management, such as outpatient pulmonary rehabilitation, likely also affects rural disparities in COPD.[6] To address this, we aimed to assess barriers to, facilitators of, and recommendations for improving evidence-based COPD management in rural clinics. This will improve delivery of evidence-based COPD care, while also increasing access to care for rural COPD patients. [Extracted from the article]

We consider a type-I seesaw framework endowed with a flavour symmetry, belonging to the series of non-abelian groups ∆(3 n2) and ∆(6 n2), and a CP symmetry. Breaking these symmetries in a non-trivial way results in the right-handed neutrinos being degenerate in mass up to possible (further symmetry-breaking) splittings κ and λ, while the neutrino Yukawa coupling matrix encodes the entire flavour structure in the neutrino sector. For a fixed combination of flavour and CP symmetry and residual groups, this matrix contains five real free parameters. Four of them are determined by the light neutrino mass spectrum and by accommodating experimental data on lepton mixing well, while the angle θR is related to right-handed neutrinos. We scrutinise for all four lepton mixing patterns, grouped into Case 1) through Case 3 b.1), the potential to generate the baryon asymmetry of the Universe through low-scale leptogenesis numerically and analytically. The main results are: a) the possible correlation of the baryon asymmetry and the Majorana phases, encoded in the Pontecorvo-Maki-Nakagawa-Sakata mixing matrix, in certain instances; b) the possibility to generate the correct amount of baryon asymmetry for vanishing splittings κ and λ among the right-handed neutrinos as well as for large κ, depending on the case and the specific choice of group theory parameters; c) the chance to produce sufficient baryon asymmetry for large active-sterile mixing angles, enabling direct experimental tests at current and future facilities, if θR is close to a special value, potentially protected by an enhanced residual symmetry. We elucidate these results with representative examples of flavour and CP symmetries, which all lead to a good agreement with the measured values of the lepton mixing angles and, possibly, the current indication of the CP phase δ. We identify the CP-violating combinations relevant for low-scale leptogenesis, and show that the parametric dependence of the baryon asymmetry found in the numerical study can be understood well with their help. [ABSTRACT FROM AUTHOR]

Background: Identifying effective strategies to improve access to medication treatments for opioid use disorder (MOUD) is imperative. Within the Veterans Health Administration (VHA), provision of MOUD varies significantly, requiring development and testing of implementation strategies that target facilities with low provision of MOUD. Objective: Determine the effectiveness of external facilitation in increasing the provision of MOUD among VHA facilities with low baseline provision of MOUD compared to matched controls. Design: Pre-post, block randomized study designed to compare facility-level outcomes in a stratified sample of eligible facilities. Four blocks (two intervention facilities in each) were defined by median splits of both the ratio of patients with OUD receiving MOUD and number of patients with OUD not currently receiving MOUD (i.e., number of actionable patients). Intervention facilities participated in a 12-month implementation intervention. Participants: VHA facilities in the lowest quartile of MOUD provision (35 facilities), eight of which were randomly assigned to participate in the intervention (two per block) with twenty-seven serving as matched controls by block. Intervention: External facilitation included assessment of local barriers/facilitators, formation of a local implementation team, a site visit for action planning and training/education, cross-facility quarterly calls, monthly coaching calls, and consultation. Main Measures: Pre- to post-change in the facility-level ratio of patients with an OUD diagnosis receiving MOUD compared to control facilities. Key Results: Intervention facilities significantly increased the ratio of patients with OUD receiving MOUD from an average of 18% at baseline to 30% 1 year later, with an absolute difference of 12% (95% confidence interval [CI]: 6.6%, 17.0%). The difference in differences between intervention and control facilities was 3.0% (95% CI: − 0.2%. 6.7%). The impact of the intervention varied by block, with smaller, less complex facilities more likely to outperform matched controls. Conclusions: Intensive external facilitation improved the adoption of MOUD in most low-performing facilities and may enhance adoption beyond other interventions less tailored to individual facility contexts. [ABSTRACT FROM AUTHOR]

In discrete manufacturing, the knowledge about causal relationships makes it possible to avoid unforeseen production downtimes by identifying their root causes. Learning causal structures from real-world settings remains challenging due to high-dimensional data, a mix of discrete and continuous variables, and requirements for preprocessing log data under the causal perspective. In our work, we address these challenges proposing a process for causal reasoning based on raw machine log data from production monitoring. Within this process, we define a set of transformation rules to extract independent and identically distributed observations. Further, we incorporate a variable selection step to handle high-dimensionality and a discretization step to include continuous variables. We enrich a commonly used causal structure learning algorithm with domain-related orientation rules, which provides a basis for causal reasoning. We demonstrate the process on a real-world dataset from a globally operating precision mechanical engineering company. The dataset contains over 40 million log data entries from production monitoring of a single machine. In this context, we determine the causal structures embedded in operational processes. Further, we examine causal effects to support machine operators in avoiding unforeseen production stops, i.e., by detaining machine operators from drawing false conclusions on impacting factors of unforeseen production stops based on experience. [ABSTRACT FROM AUTHOR]

The biodiversity of marine fishes is threatened globally by climate change and other anthropogenic activities, particularly in coral reef ecosystems. We present a simple, field-hardy method to cryopreserve marine fish gonads, targeting spermatogonial cells (undifferentiated diploid germ cells) with the ultimate goal of permitting recovery of threatened species and populations via gonadal diploid germ cell transplantation technologies. The use of a simplified cryopreservation extender based on L-15 medium resulted in minimal decline in spermatogonial cell viability post-thaw. Moreover, we compared post-cryopreservation viability of sperm and spermatogonial cells from gonads cryopreserved with freshly prepared cryoprotectant and with cryoprotectant prepared in advance and stored at −20 °C. We found no significant difference, suggesting that these solutions may be prepared in advance and frozen, ready for later use. We urge conservation, academic, and regulatory agencies to cryobank fish gonads as part of their sample collection processes to support the biodiversity and security of valuable marine fish resources, alongside other restoration efforts. [ABSTRACT FROM AUTHOR]

Animal models suggest that cochlear afferent nerve endings may be more vulnerable than sensory hair cells to damage from acoustic overexposure and aging. Because neural degeneration without hair-cell loss cannot be detected in standard clinical audiometry, whether such damage occurs in humans is hotly debated. Here, we address this debate through co-ordinated experiments in at-risk humans and a wild-type chinchilla model. Cochlear neuropathy leads to large and sustained reductions of the wideband middle-ear muscle reflex in chinchillas. Analogously, human wideband reflex measures revealed distinct damage patterns in middle age, and in young individuals with histories of high acoustic exposure. Analysis of an independent large public dataset and additional measurements using clinical equipment corroborated the patterns revealed by our targeted cross-species experiments. Taken together, our results suggest that cochlear neural damage is widespread even in populations with clinically normal hearing. Cross-species experiments on chinchillas and at-risk humans suggest cochlear synaptopathy from noise exposure and aging are widespread even among individuals with clinically normal hearing status. [ABSTRACT FROM AUTHOR]

Sessile invertebrates often engage in synchronized spawning events to increase likelihood of fertilization. Although coral reefs are well studied, the reproductive behavior of most species and the relative influence of various environmental cues that drive reproduction are not well understood. We conducted a comparative examination of the reproduction of the well-studied Hawaiian coral Montipora capitata and the relatively unknown reproduction of its congener, Montipora flabellata. Both are simultaneous hermaphroditic broadcast spawners that release egg-sperm bundles with external fertilization. Montipora capitata had a distinct reproductive pattern that resulted in coordinated gamete maturation and the synchronized release of thousands of egg-sperm bundles across two spawning pulses tightly coupled to consecutive new moon phases in June and July. Montipora flabellata exhibited a four month reproductive season with spawning that was four-fold less synchronous than M. capitata; its spawning was aperiodic with little linkage to moon phase, a broadly distributed release of only dozens or hundreds of bundles over multiple nights, and a spawning period that ranged from late June through September. The reproductive strategy of M. flabellata might prove detrimental under climate change if increased frequency and severity of bleaching events leave it sparsely populated and local stressors continue to degrade its habitat. [ABSTRACT FROM AUTHOR]

In previous studies of linear rotary systems with active magnetic bearings, parametric excitation was introduced as an open-loop control strategy. The parametric excitation was realized by a periodic, in-phase variation of the bearing stiffness. At the difference between two of the eigenfrequencies of the system, a stabilizing effect, called anti-resonance, was found numerically and validated in experiments. In this work, preliminary results of further exploration of the parametric excitation are shared. A Jeffcott rotor with two active magnetic bearings and a disk is investigated. Using Floquet theory, a deeper insight into the dynamic behavior of the system is obtained. Aiming at a further increase of stability, a phase difference between excitation terms is introduced. [ABSTRACT FROM AUTHOR]

Despite a wide array of applications, deep ultra-violet light emitting diodes offer relatively poor efficiencies compared to their optical counterparts. A contributing factor is the lower light extraction efficiency due to both highly absorbing p-contacts and total internal reflection. Here, we propose a structure consisting of a hexagonal periodic array of cylindrical nanoholes in the multi-layered p-contact which are filled with platinum. This nanostructure reduces the absorption of the p-contact layer, leading to a higher emission into the n-contact compared to a planar reference. An optimum geometry of the nanostructure allows a light extraction efficiency of 15.0%, much higher than the typical 4.6% of a planar reference. While the nanostructure strongly decreases the light absorption in the p-contact, it is still not able to considerably reduce the total internal reflection. Consequently, the nanostructured p-contact should be combined with other optical strategies, such as nanopatterned sapphire substrates to increase the efficiency even further. Despite this, the nanostructure described in this work provides a readily realizable path to enhancing the light extraction efficiency of state-of-the-art deep ultra-violet light emitting diodes. [ABSTRACT FROM AUTHOR]

Creatures with longer bodies in nature like snakes and eels moving in water commonly generate a large swaying of their bodies or tails, with the purpose of producing significant frictions and collisions between body and fluid to provide the power of consecutive forward force. This swaying can be idealized by considering oscillations of a soft beam immersed in water when waves of vibration travel down at a constant speed. The present study employs a kind of large deformations induced by nonlinear vibrations of a soft pipe conveying fluid to design an underwater bio-inspired snake robot that consists of a rigid head and a soft tail. When the head is fixed, experiments show that a second mode vibration of the tail in water occurs as the internal flow velocity is beyond a critical value. Then the corresponding theoretical model based on the absolute nodal coordinate formulation (ANCF) is established to describe nonlinear vibrations of the tail. As the head is free, the theoretical modeling is combined with the computational fluid dynamics (CFD) analysis to construct a fluid-structure interaction (FSI) simulation model. The swimming speed and swaying shape of the snake robot are obtained through the FSI simulation model. They are in good agreement with experimental results. Most importantly, it is demonstrated that the propulsion speed can be improved by 21% for the robot with vibrations of the tail compared with that without oscillations in the pure jet mode. This research provides a new thought to design driving devices by using nonlinear flow-induced vibrations. [ABSTRACT FROM AUTHOR]

Objectives: To describe a systematic method to quantify the severity of renal infarction injury and assess its association with post-traumatic renal function after blunt trauma. Methods: We retrospectively reviewed all patients who suffered an AAST grade IV renal infarction injury without active bleeding secondary to blunt trauma between 1/2010 and 10/2020. Only patients with a pre-traumatic eGFR within 12 months of injury and post-traumatic eGFR within 3–12 months were included. Percentage of renal ischemia was defined as: (ischemic volume/total volume) × 100%. Two radiologists reviewed computed tomography images to determine ischemic and overall cross-sectional areas using the polygon region of interest tool. These areas were multiplied by slice thickness to obtain ischemic and total volumes. Intraclass correlation coefficient was used to assess consistency between radiologists. Linear regression analyses were used to assess the association between percentage of renal ischemia and post-traumatic renal function. Results: Thirty-five of 140 (25.0%) patients met inclusion criteria. The median (IQR) pre-trauma eGFR was 107.7 ml/min/1.73m2 (90.6–121.8), percentage of renal ischemia was 8.4% (2.9–30.1), and decrease in eGFR after trauma was 12.9 ml/min/1.73m2 (0.4–32.6). There was excellent reliability in calculating ischemic volume (ICC = 0.987) and total kidney volume (ICC = 0.995) between two radiologists. When adjusting for pre-traumatic eGFR, patient age, and injury severity score, a 10% increase in ischemic volume was associated with a post-injury eGFR value that was 8.0 ml/min/1.73 m2 (95% CI − 11.2, − 4.7) lower. Conclusions: CT-based volume calculation of renal ischemia may be utilized to quantify kidney injury and be associated with post-traumatic renal function loss. [ABSTRACT FROM AUTHOR]

Variable filters are key components for compact spectral imagers. In this paper, we present a method for the fabrication of linearly variable filters based on Bühler HELIOS machine (plasma assisted reactive magnetron sputtering). These filters are obtained by producing a variation of the thickness of all the layers of the coating, using adapted masks placed in between the sputtering targets for the low and high refractive index materials and the substrates. Variable band pass filter from 550 up to 1000 nm is demonstrated. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disrupted normalcy for college attending young adults which resulted in a loss of the campus environment and classroom setting. This change in setting may interfere with a student's personal and academic wellbeing. This study used an online survey to evaluate college students' academic and psychosocial frustrations during the COVID-19 pandemic. Data were collected from March–April 2020 at a land-grant university in the Appalachian region. Data were available from 2643 undergraduate and graduate students. There was a 65.8% and 15.7% increase in the number of students who reported their learning and health as fair, poor, or very poor after the COVID-19 pandemic, respectively. Qualitative responses were coded and 8 themes and 24 subthemes emerged. College students expressed frustrations regarding technology, classwork, research, family, social, emotional, behavioral, and financial aspects of life. These results can be used by higher education administration, faculty, and staff when planning for online courses. Ensuring that student frustrations and barriers to success are recognized and considered may help prevent students departing from higher education during this time. [ABSTRACT FROM AUTHOR]

Maintaining genetic diversity and biodiversity is key to sustaining healthy ecosystems and their capacity for adaptation. Assisted Gene Flow (AGF) is a management approach to translocate adaptive genes among populations to restore faltering and at-risk habitats, especially on coral reefs. Cryopreserved sperm can facilitate AGF via selective breeding at a lower cost and with fewer risks than sourcing colonies from the wild or moving adult corals (translocation). Here, we present a proof-of-concept study demonstrating that cryopreserved sperm from northern and central Great Barrier Reef (GBR) locations can be used to make intrapopulation and interpopulation crosses to underpin AGF. The results of this study support the importance of assessing the concentration of motile sperm in post-thaw samples, with a minimum of approximately 30,000 motile cryopreserved sperm per egg required to achieve fertilisation. Mean per cent motility values post-collection and without artificial activation (northern colonies 14 ± 3.2%; central colonies 19 ± 3.6%) were considerably lower than previous observations of sperm from Acropora tenuis on the Great Barrier Reef, and may represent a lag effect from recent ocean warming events at the level of coral populations. Coral reefs with relatively high species and genetic diversity and coral cover are good places to preserve biodiversity through cryopreservation. Such cryo-collections build a genetic resource to optimise strategies available to reef managers to support natural recovery rates and reef restoration and adaptation efforts. [ABSTRACT FROM AUTHOR]

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We consider an inverse seesaw mechanism of neutrino mass generation in which the Standard Model is extended by 3 + 3 (heavy) sterile states, and endowed with a flavour symmetry G f , G f = Δ (3 n 2) or G f = Δ (6 n 2) , and a CP symmetry. These symmetries are broken in a peculiar way, so that in the charged lepton sector a residual symmetry G ℓ is preserved, while the neutral fermion sector remains invariant under the residual symmetry G ν = Z 2 × C P . We study the concrete setup, where the Majorana mass term for three of the sterile states conserves G ν , while the remaining mass terms (i.e. couplings of left-handed leptons and heavy sterile states, as well as the Dirac-type couplings among the latter) do not break the flavour or CP symmetry. We perform a comprehensive analysis of lepton mixing for different classes of residual symmetries, giving examples for each of these, and study in detail the impact of the additional sterile states on the predictions for lepton mixing. We further confront our results with those obtained in the model-independent scenario, in which the light neutrino mass matrix leaves the residual symmetry G ν intact. We consider the phenomenological impact of the inverse seesaw mechanism endowed with flavour and CP symmetries, in particular concerning effects of non-unitarity of the lepton mixing matrix (which strongly constrain the parameter space of the scenario), prospects for neutrinoless double beta decay and for charged lepton flavour violating processes. [ABSTRACT FROM AUTHOR]

Purpose: Structural failures after rotator cuff repair are well known, and despite advances and improved techniques in rotator cuff repair (RCR), retear rates remain high. The aim of this study was to (1) evaluate the midterm clinical and radiological outcomes after revision RCR and to (2) analyze whether preoperative ultrasound can predict outcome of open revision rotator cuff repair. Methods: Twenty-five patients who underwent revision RCR in a single institution between 2010 and 2012 were retrospectively reviewed at a minimum follow-up of 2 years. The Constant Score (CS) and the Disabilities of the Arm, Shoulder and Hand score were collected. Ultrasound examination was used both before revision surgery and at follow-up to determine tendon integrity. Results: At the final follow-up, 69.6% patients showed an intact rotator cuff and their CS had improved from 28.3 to 77. 30.4% patients had a persisting rotator cuff defect, and the CS had improved from 24 to 47.7. A preoperative tear size of more than 20 mm from an ultrasound examination could be identified as a factor that would risk structural failure of revision RCR. Conclusion: (1) Clinical outcomes after revision RCR improve in both patients with an intact RC and those with a retear at midterm follow-up. (2) Ultrasound seems to be a useful tool to predict whether reconstruction of recurrent rotator cuff tears is feasible. Level of evidence: IV, Case series. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

By adopting the absolute nodal coordinate formulation, a novel and general nonlinear theoretical model, which can be applied to solve the dynamics of combined straight-curved fluid-conveying pipes with arbitrary initially configurations and any boundary conditions, is developed in the current study. Based on this established model, the nonlinear behaviors of a cantilevered L-shaped pipe conveying fluid with and without base excitations are systematically investigated. Before starting the research, the developed theoretical model is verified by performing three validation examples. Then, with the aid of this model, the static deformations, linear stability and nonlinear self-excited vibrations of the L-shaped pipe without the base excitation are determined. It is found that the cantilevered L-shaped pipe suffers from the static deformations when the flow velocity is subcritical, and will undergo the limit-cycle motions as the flow velocity exceeds the critical value. Subsequently, the nonlinear forced vibrations of the pipe with a base excitation are explored. It is indicated that period-n, quasi-periodic and chaotic responses can be detected for the L-shaped pipe, which has a strong relationship with the flow velocity, excitation amplitude and frequency. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Intrathecal drug delivery is a well evidenced strategy for the treatment of many chronic pain syndromes. While opioids, anesthetics, and ziconotide are the most commonly used agents, intrathecal baclofen (ITB), which is indicated to treat spasticity, is also thought to have some analgesic properties that are poorly understood. These analgesic benefits have been reported with ITB use in treating patients with central neurological disorders who suffer from severe spasticity and chronic pain. Our review aims to characterize ITB's effects on pain, function, and quality of life in patients with severe spasticity. We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The primary outcome parameters were analgesic relief and functional improvements. Secondarily, quality of life and adverse effects were also recorded.Recent Findings: After an initial survey identified 393 studies, 20 studies met final inclusion criteria. Of these, 16 utilized ITB monotherapy and 4 utilized ITB polyanalgesia. Overall, there was a paucity of high-powered studies. Mean titrated ITB doses ranged from 140 to 627.9 μg daily. Nineteen studies reported improved pain and spasticity. Seven studies reported improved functional outcomes and quality of life. Our results show that ITB may be an effective agent in treatingfor the treatment of chronic pain in patients with severe spasticity independent of its spasmolytic effects. Although this evidence was largely derived from studies lacking clearly defined outcomes of pain relief, ITB is reasonable to consider for concurrent spasticity and pain management. Well-designed studies are still needed to characterize ITB's analgesic efficacy when used in patients with severe spasticity. [ABSTRACT FROM AUTHOR]

Muscular variants of the forearm are common and frequently cause neurovascular compression syndromes, especially when interfering with the compact topography of the carpal tunnel or the Canalis ulnaris. Here, we report on a male body donor with multiple muscular normal variations on both forearms. The two main findings are (1) an accessory variant muscle (AVM) on the right forearm originating from the M. brachioradialis, the distal radius, and the M. flexor pollicis longus. It spanned the wrist beneath the Fascia antebrachia and inserted at the proximal phalanx of the digitus minimus. (2) Moreover, we found a three-headed palmaris longus variant on the left arm with proximal origin tendon and a distal, trifurcated muscle belly, with separated insertions at the palmar aponeurosis, the flexor retinaculum, and, in analogy to the accessory muscle on the contralateral arm, at the base of the proximal phalanx of the digitus minimus. We found a considerable thickening of the left-hand median nerve right before entering the carpal tunnel indicative of a possible chronic compression syndrome adding clinical relevance to this anatomical case. We also discuss the notion that both, the AVM and the contralateral three-headed palmaris variant are developmental descendants of the M. palmaris longus. Additionally, we found a previously not recorded variant of the M. palmaris brevis on the left hand. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Chronic pain is highly prevalent in patients with rheumatoid arthritis (RA) and can cause various physical and psychological impairments. Unfortunately, the appropriate diagnosis of chronic pain syndromes in this population can be challenging because pain may be primary to RA-specific inflammation and/or secondary to other conditions, typically osteoarthritis (OA) and fibromyalgia (FM). This disparity further poses a clinical challenge, given that chronic pain can often be discordant or undetected with standard RA-specific surveillance strategies, including serological markers and imaging studies. In this review, we provide a robust exploration of chronic pain in the RA population with emphasis on epidemiology, mechanisms, and management strategies.Recent Findings: Chronic pain associated with RA typically occurs in patients with anxiety, female sex, and elevated inflammatory status. Up to 50% of these patients are thought to have chronic pain despite appropriate inflammatory suppression, typically due to peripheral and central sensitization as well as secondary OA and FM. In addition to the standard-of-care management for OA and FM, patients with RA and chronic pain benefit from behavioral and psychological treatment options. Moreover, early and multimodal therapies, including non-pharmacological, pharmacological, interventional, and surgical strategies, exist, albeit with varying efficacy, to help suppress inflammation, provide necessary analgesia, and optimize functional outcomes. Overall, chronic pain in RA is a difficult entity for both patients and providers. Early diagnosis, improved understanding of its mechanisms, and initiation of early, targeted approaches to pain control may help to improve outcomes in this population. [ABSTRACT FROM AUTHOR]

Multiresistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) cause serious postoperative infections. A skin tolerant far-UVC (< 240 nm) irradiation system for their inactivation is presented here. It uses UVC LEDs in combination with a spectral filter and provides a peak wavelength of 233 nm, with a full width at half maximum of 12 nm, and an irradiance of 44 µW/cm2. MRSA bacteria in different concentrations on blood agar plates were inactivated with irradiation doses in the range of 15–40 mJ/cm2. Porcine skin irradiated with a dose of 40 mJ/cm2 at 233 nm showed only 3.7% CPD and 2.3% 6-4PP DNA damage. Corresponding irradiation at 254 nm caused 15–30 times higher damage. Thus, the skin damage caused by the disinfectant doses is so small that it can be expected to be compensated by the skin's natural repair mechanisms. LED-based far-UVC lamps could therefore soon be used in everyday clinical practice to eradicate multiresistant pathogens directly on humans. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Pain is a prevalent symptom in the lives of patients with cancer. In light of the ongoing opioid epidemic and increasing awareness of the potential for opioid abuse and addiction, clinicians are progressively turning to interventional therapies. This article reviews the interventional techniques available to mitigate the debilitating effects that untreated or poorly treated pain have in this population.Recent Findings: A range of interventional therapies and technical approaches are available for the treatment of cancer-related pain. Many of the techniques described may offer effective analgesia with less systemic toxicity and dependency than first- and second-line oral and parenteral agents. Neuromodulatory techniques including dorsal root ganglion stimulation and peripheral nerve stimulation are increasingly finding roles in the management of oncologic pain. The goal of this pragmatic narrative review is to discuss interventional approaches to cancer-related pain and the potential of such therapies to improve the quality of life of cancer patients. [ABSTRACT FROM AUTHOR]

Ocean warming, fueled by climate change, is the primary cause of coral bleaching events which are predicted to increase in frequency. Bleaching is generally damaging to coral reproduction, can be exacerbated by concomitant stressors like ultraviolet radiation (UVR), and can have lasting impacts to successful reproduction and potential adaptation. We compared morphological and physiological reproductive metrics (e.g., sperm motility, mitochondrial membrane integrity, egg volume, gametes per bundle, and fertilization and settlement success) of two Hawaiian Montipora corals after consecutive bleaching events in 2014 and 2015. Between the species, sperm motility and mitochondrial membrane potential had the most disparate results. Percent sperm motility in M. capitata, which declined to ~ 40% during bleaching from a normal range of 70–90%, was still less than 50% motile in 2017 and 2018 and had not fully recovered in 2019 (63% motile). By contrast, percent sperm motility in Montipora spp. was 86% and 74% in 2018 and 2019, respectively. This reduction in motility was correlated with damage to mitochondria in M. capitata but not Montipora spp. A major difference between these species is the physiological foundation of their UVR protection, and we hypothesize that UVR protective mechanisms inherent in Montipora spp. mitigate this reproductive damage. [ABSTRACT FROM AUTHOR]

Initial COVID-19 containment in the United States focused on limiting mobility, including school and workplace closures. However, these interventions have had enormous societal and economic costs. Here, we demonstrate the feasibility of an alternative control strategy, test-trace-quarantine: routine testing of primarily symptomatic individuals, tracing and testing their known contacts, and placing their contacts in quarantine. We perform this analysis using Covasim, an open-source agent-based model, which has been calibrated to detailed demographic, mobility, and epidemiological data for the Seattle region from January through June 2020. With current levels of mask use and schools remaining closed, we find that high but achievable levels of testing and tracing are sufficient to maintain epidemic control even under a return to full workplace and community mobility and with low vaccine coverage. The easing of mobility restrictions in June 2020 and subsequent scale-up of testing and tracing programs through September provided real-world validation of our predictions. Although we show that test-trace-quarantine can control the epidemic in both theory and practice, its success is contingent on high testing and tracing rates, high quarantine compliance, relatively short testing and tracing delays, and moderate to high mask use. Thus, in order for test-trace-quarantine to control transmission with a return to high mobility, strong performance in all aspects of the program is required. Initial COVID-19 containment in the United States focused on limiting mobility, including school and workplace closures, with enormous societal and economic costs. Here, the authors demonstrate the feasibility of a test-trace-quarantine strategy using an agent-based model and detailed data on the Seattle region. [ABSTRACT FROM AUTHOR]

Background: Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods: The three-step training course included: (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results: Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions: This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety. [ABSTRACT FROM AUTHOR]