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The interplay of positive and negative species interactions controls species assembly in communities. Dryland plant communities, such as savannas, are important to global biodiversity and ecosystem functioning. Sandhill oaks in xeric savannas of the southeastern United States can facilitate longleaf pine by enhancing seedling survival, but the effects of oaks on recruitment and growth of longleaf pine have not been examined. We censused, mapped, and monitored nine contiguous hectares of longleaf pine in a xeric savanna to quantify oak-pine facilitation, and to examine other factors impacting recruitment, such as vegetation cover and longleaf pine tree density. We found that newly recruited seedlings and grass stage longleaf pines were more abundant in oak-dominated areas where densities were 230% (newly recruited seedlings) and 360% (grass stage) greater from lowest to highest oak neighborhood densities. Longleaf pine also grew faster under higher oak density. Longleaf pine recruitment was lowest under longleaf pine canopies. Mortality of grass stage and bolt stage longleaf pine was low (~1.0% yr−1) in the census interval without fire. Overall, our findings highlight the complex interactions between pines and oaks—two economically and ecologically important genera globally. Xeric oaks should be incorporated as a management option for conservation and restoration of longleaf pine ecosystems. [ABSTRACT FROM AUTHOR]

Portunid crabs are an iconic, high value species in NSW, but catches are highly variable in space and time. Substantial variation in biomass is observed in both exploited and unfished populations, and environmental effects on distribution and abundance are an important factor contributing to this variability. Predicting and responding to this variability is a challenge for management and sustainability of exploited populations. We examine spatial and temporal variation in Blue Swimmer Crab (Portunus armatus) populations, over a 2.5 year trapping survey in two temperate estuaries that differ in tidal flow and riverine input. Specifically, monthly catch rates and distribution throughout the estuary are examined alongside variation in temperature and conductivity. In Wallis Lake, the shallower estuary with a restricted entrance, both water temperature and conductivity impacted abundance and distribution of crabs but there was no evidence that pulses of freshwater flow had a major impact. For a 10 °C increase in temperature the population on average shifted ~ 700 m closer to the ocean. Males were consistently located slightly further into the estuary compared to females, but there was no convincing evidence of estuarine egression in response to lower salinity. In Port Stephens, the deeper, tidal estuary, water temperature and conductivity also impacted abundance, but while males were more dispersed than females, the distribution of crabs within the estuary did not appear to be influenced by temperature, conductivity or flow. These results highlight the links between nuanced environmental relationships and estuarine geomorphology for Blue Swimmer Crab. [ABSTRACT FROM AUTHOR]

The medical-legal partnership (MLP) model is emerging across the USA as a powerful tool to address the adverse social conditions underlying health injustice. MLPs embed legal experts into healthcare teams to address health-harming legal needs with civil legal remedies. We conducted a narrative review of peer-reviewed articles published between 2007 and 2022 to characterize the structure and impacts of US MLPs on patients, providers, and healthcare systems. We found that MLPs largely serve vulnerable patient populations by integrating legal experts into community-based clinical settings or children's hospitals, although patient populations and settings varied widely. In most models, healthcare providers were trained to screen patients for legal needs and refer them to legal experts. MLPs provided a wide range of services, such as assistance accessing public benefits (e.g., Social Security, Medicaid, cash assistance) and legal representation for immigration and family law matters. Patients and their families also benefited from increased knowledge about legal rights and systems. Though the evidence base remains nascent, available studies show MLPs to be associated with greater access to care, fewer hospitalizations, and improved physical and mental health outcomes. Medical and legal providers who were engaged in MLPs reported interdisciplinary learning, and healthcare systems often experienced high returns on investment through cost savings and increased Medicaid reimbursement. Many MLPs also conducted advocacy and education to effect broader policy changes related to population health and social needs. To optimize the MLP model, more rigorous research, systematic implementation practices, evaluation metrics, and sustainable funding mechanisms are recommended. Broader integration of MLPs into healthcare systems could help address root causes of health inequity among historically marginalized populations in the USA. [ABSTRACT FROM AUTHOR]

Background: Op-ed writing can be a powerful and accessible advocacy tool for physicians, but training is lacking in undergraduate medical education. Aim: To train and engage first-year medical students in op-ed writing. Setting: Midwestern research-intensive medical school. Participants: All students in a required first-year health policy course in 2021 and 2022. Program Description: For their health policy course's final assignment, students could opt to write an op-ed on a healthcare issue of their choice. All students received written instruction on op-ed writing. Additionally, they could access a seminar, coaching and editing by peers and faculty, and publication guidance. Program Evaluation: Of 179 students over 2 years, 105 chose to write op-eds. Fifty-one attended the seminar, 35 attended peer coaching sessions, 33 accessed structured peer editing, and 23 received faculty assistance. Thirty-eight students submitted a total of 42 op-eds for publication. Twenty-two pieces were published in major outlets and 17 in the university's health policy review. Of the 22 in major outlets, 21 received editing from either peers or faculty. Discussion: An op-ed writing curriculum can be integrated into an existing medical school health policy course, resulting in a high level of engagement and in published op-eds by medical students. [ABSTRACT FROM AUTHOR]

How the four major processes affecting community assembly—selection, dispersal, drift, and diversification—solely or jointly shape co-occurring assemblages of macro- and microorganisms at the same scales remains poorly understood. Here, we delved into the distance pattern of similarity (DPS) in tree and soil fungal communities in three c. 20-hectare forest plots spanning tropical to temperate climates in Yunnan province, Southwest China. Specifically, we decrypted the assembly contribution of individual-based random sampling, selection and/or dispersal using drift-inexplicit ordination and drift-explicit baseline models. Surprisingly, our findings demonstrated that most soil fungal realized distribution ranges (RDR) were shorter than most trees. Because of explicitly integrating drift and the range of DPS is broader than the RDR of most trees and fungi, selection baseline models overwhelmingly captured the DPS structures in trees and fungi across spatial scales in tropical, subtropical, and subalpine forest ecosystems and that for fungi across taxonomic levels and fungal guilds. Under the premise that modeling frameworks, ecosystems, spatial scales, sample intensities, selection variables, and dispersal variables are well unified, the ubiquitous dominance of selection elucidates no fundamental difference in the assembly mechanism between trees and soil fungi. [ABSTRACT FROM AUTHOR]

The United Nations Decade on Ecosystem Restoration spotlights the urgent need for global efforts to restore ecosystems and mitigate climate change. In the Brazilian Atlantic Forest, restoration plantations often lack diversity, prompting inquiries into the optimal species count for maximal ecosystem productivity and services. This study aimed to assess aboveground carbon storage in a high-diversity restoration, comparing carbon stocks across 70 native tree species. We examined differences in carbon storage among species groups, employed regression models to project carbon accumulation over time, and identified top-performing species for carbon-focused projects in the Brazilian Atlantic Forest. Our high-diversity plantation, comprising 70 species, stored 46.04 MgC ha−1 at 8.5 years. The simulation revealed that planting only the most effective species could more than double carbon storage to 114.82 MgC ha−1 at the same age. Notably, filling group species consistently stored more carbon than diversity group species across all ages. We pinpointed seven top-performing filling group species: Guazuma ulmifolia, Croton urucurana, Mimosa scabrella, Trema micrantha, Solanum mauritianum, Croton floribundus, and Piptadenia gonoacantha and six from the diversity group: Inga vera, Zanthoxylum rhoifolium, Peltophorum dubium, Ceiba speciosa, Albizia polycephala, and Ficus enormis, for their superior carbon storage. Prioritizing these species can heighten carbon sequestration rates and effectively address the ongoing climate crisis. An approach combining selected filling and diversity group species emerges as the optimal strategy to achieve short- and long-term goals. Further research on species interactions and carbon stocks in scenarios with fewer planted species is imperative. [ABSTRACT FROM AUTHOR]

In vitro biopanning platforms using synthetic phage display antibody libraries have enabled the identification of antibodies against antigens that were once thought to be beyond the scope of immunization. Applying these methods against challenging targets remains a critical challenge. Here, we present a new biopanning pipeline, RAPID (Rare Antibody Phage Isolation and Discrimination), for the identification of rare high-affinity antibodies against challenging targets. RAPID biopanning uses fluorescent labeled phage displayed fragment antigen-binding (Fab) antibody libraries for the isolation of high-affinity binders with fluorescent activated sorting. Subsequently, discriminatory hit screening is performed with a biolayer interferometry (BLI) method, BIAS (Biolayer Interferometry Antibody Screen), where candidate binders are ranked and prioritized according to their estimated kinetic off rates. Previously reported antibodies were used to develop the methodology, and the RAPID biopanning pipeline was applied to three challenging targets (CHIP, Gαq, and CS3D), enabling the identification of high-affinity antibodies. A FACS aided selection process combined with characterization of the selected clones facilitates phage display screening to obtain antibodies against a given target from libraries. [ABSTRACT FROM AUTHOR]

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Although universal biometrics have been broadly called for, and there are many validated technologies to recognize adults, these technologies have been ineffective in newborns and young children. The present work describes the development and clinical testing of a fingerprint capture system for longitudinal biometric recognition of newborns and young children to support vaccination and clinical follow-up. The reader consists of a high-resolution monochromatic imaging system with an ergonomic industrial design to comfortably support and align infant fingers for imaging without a platen. This imaging approach without a platen, also called free-space imaging, reduces fingerprint distortion and ensures a more consistent finger placement. This system was tested in a newborn ward and immunization clinic at an urban hospital in Baja, California, Mexico, from 2017 to 2019. Nearly five hundred children were enrolled and followed for up to 24 months. With a protocol of imaging all ten fingers, the failure to enroll (FTE) rate was < 1% when acquiring at least two fingers for all ages and < 2% when enrolling at least four fingers. The verification (1:1) true accept rate (TAR) was 77% for newborns enrolled at ≤ 3 days of age and 96% for those enrolled at ≥ 4 days of age, both at a time gap of 15–30 days after enrollment at a false accept rate (FAR) of 0.1%. Using the top-ranked match score, the identification rate (1:many) was 86% for the ≤ 3 days enrollment age and 97% for age ≥ 4 days for a single finger at 15–30 days after enrollment. The enrollment protocol and the frequency of updating will increase for infants compared to adults. However, these data suggest that a high-resolution, free space imaging technique may fill the final gap for universal biometrics across all populations called for by the United Nations Sustainable Development Goal 16.9. [ABSTRACT FROM AUTHOR]

In cytologically indeterminate thyroid nodules undergoing molecular testing, estimated risk of malignancy is variable. Identification of a non-cancer-specific mutation (RAS-like) confirms a neoplastic process but does not differentiate between benign, malignant, and low-risk neoplasms. This study aims to retrospectively evaluate institutional experience of Interpace (ThyGeNEXT® and ThyraMIR®; Pittsburgh, PA) testing and to determine the rate of malignancy in resected nodules, stratified by mutational analysis and microRNA profile. Of 1917 fine need aspirations, 140 (7.3%) underwent Interpace testing: 47 (33.6%) were molecular-not-benign (harbored mutation, fusion, and/or positive miRNA) and 93 (66.4%) were molecular-benign (no mutations or fusions and negative microRNA). Surgery was spared in 79.6% of molecular-benign and 61.4% of all tested patients. Fifty-four (38.6%) underwent resection. Seventeen (89.5%) of the resected molecular-benign were benign and 2 were malignant. Thirteen (37.1%) of the resected molecular-not-benign were benign, 7 (20%) were noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and 15 (42.9%) were malignant (p < 0.05, negative predictive value (NPV) 89.4–95.6%, positive predictive value (PPV) 22.3–42.8%). Most molecular-not-benign (72.3%) had RAS-like mutation. Twenty-three were resected: 3 were malignant and 7 were NIFTP. Nodules with non-RAS-like mutations (BRAF V600E-like, others) were more likely to be malignant than RAS-like (H/N/KRAS, BRAF K601E) (p < 0.05, NPV 86.9–96.5%, PPV 100%). Most nodules had RAS-like mutations and most were benign or low-risk neoplasms (NIFTP). This study supports the role of histologic examination in the distinction of malignancy in RAS-like thyroid neoplasms and underscores the role of molecular testing in risk stratification, patient counseling, and operative management. [ABSTRACT FROM AUTHOR]

Spawning is a key life history event for aquatic species that can be triggered by environmental signals. For estuarine-dependent species, the timing of such triggers can be important for determining future patterns in recruitment. Here, we used acoustic telemetry to identify the potential drivers of spawning migration in female Giant Mud Crabs (Scylla serrata). Eighty-nine mature female crabs were tagged in two subtropical south-east Australian estuaries, the Clarence River (~ 29.4°S) and Kalang River (~ 30.5°S), during the summer spawning season (November–June) over two years (2018/19 and 2020/21), and their movements were monitored for up to 68 d, alongside high-resolution environmental data. Crabs were considered to have 'successfully' migrated if they were detected at the mouth of the estuary, a behaviour exhibited by 52% of tagged crabs. The highest probability of migration was associated with relatively low temperatures (< 22 °C) and when conductivity rapidly declined (< -10 mS cm−1 d−1) following heavy rainfall. Furthermore, migration coincided with larger tides associated with the new and full moon, and following heavy rainfall, which may aid rapid downstream migration. Oceanic detections of 14 crabs (30% of 'successful' migrators) showed that once crabs left estuaries they migrated north. These patterns show that variability in environmental triggers for spawning migrations may contribute to interannual variation in spawning patterns, which may in turn impact fisheries productivity in this region. [ABSTRACT FROM AUTHOR]

An important mechanism promoting species coexistence is conspecific negative density dependence (CNDD), which inhibits conspecific neighbors by accumulating host-specific enemies near adult trees. Natural enemies may be genotype-specific and regulate offspring dynamics more strongly than non-offspring, which is often neglected due to the difficulty in ascertaining genetic relatedness. Here, we investigated whether offspring and non-offspring of a dominant species, Castanopsis eyrei, suffered from different strength of CNDD based on parentage assignment in a subtropical forest. We found decreased recruitment efficiency (proxy of survival probability) of offspring compared with non-offspring near adult trees during the seedling-sapling transition, suggesting genotype-dependent interactions drive tree demographic dynamics. Furthermore, the genetic similarity between individuals of same cohort decreased in late life history stages, indicating genetic-relatedness-dependent tree mortality throughout ontogeny. Our results demonstrate that within-species genetic relatedness significantly affects the strength of CNDD, implying genotype-specific natural enemies may contribute to population dynamics in natural forests. [ABSTRACT FROM AUTHOR]

The Synthetic Yeast Genome Project (Sc2.0) represents the first foray into eukaryotic genome engineering and a framework for designing and building the next generation of industrial microbes. However, the laboratory strain S288c used lacks many of the genes that provide phenotypic diversity to industrial and environmental isolates. To address this shortcoming, we have designed and constructed a neo-chromosome that contains many of these diverse pan-genomic elements and which is compatible with the Sc2.0 design and test framework. The presence of this neo-chromosome provides phenotypic plasticity to the Sc2.0 parent strain, including expanding the range of utilizable carbon sources. We also demonstrate that the induction of programmable structural variation (SCRaMbLE) provides genetic diversity on which further adaptive gains could be selected. The presence of this neo-chromosome within the Sc2.0 backbone may therefore provide the means to adapt synthetic strains to a wider variety of environments, a process which will be vital to transitioning Sc2.0 from the laboratory into industrial applications. The Sc2.0 consortia is reengineering the yeast genome. To expand the Sc2.0 genetic repertoire, the authors build a neo-chromosome comprising variable loci from diverse yeast isolates, providing phenotypic plasticity for use in synthetic backgrounds. [ABSTRACT FROM AUTHOR]

While the literature is quite clear on the association between trade and innovation, there has been little explicit study of the direction of causality. This study uses all patents granted in the USA between 1987 and 1999, assigns them to probable industries of origin and sectors of use, then tests causality with trade flows in those same economic sectors. We run robustness checks on various measures of trade (imports versus exports, volume versus value of trade), and on various measures of innovation (patent counts, patent claims, citation-weighted patents, and patent counts weighted for originality or generality). Results at the aggregate level support the literature's assumption that imports cause innovation which then leads to exports, but at the industry level, causality is more complicated, running in both directions from imports (or exports) to and from innovation. [ABSTRACT FROM AUTHOR]

Macroscopic frictional behavior of granular materials is of great importance for studying several complex problems associated with fault slip and landslides. The main objective of this study is to model the macroscale frictional behavior of granular soils under monotonic and cyclic loadings based upon micromechanical determination of dissipated energy at particle contacts. This study is built on the general observation that the externally computed energy dissipation should be equal to the total internal energy dissipation derived from inter-particle sliding and rolling, energy losses from inter-particle collisions, and damping. For this purpose, the discrete element method is used to model a granular soil and determine the stored, dissipated, and damping energies associated with shear loading for applied monotonic and cyclic velocities. These energies are then related to the friction by an application of the Taylor-critical state power balance relationship. Also, the contributions of the different modes of energy dissipation (normal, shear, and rolling) to the total frictional resistance were studied. By changing the inter-particle friction, the simulations showed that the macroscopic friction was nearly constant, the slip friction increased almost linearly with increasing inter-particle friction, and the difference between the two was attributed to the non-energy dissipating dilatancy component. By providing a clear relationship between energy dissipated by micro-scale mechanisms versus the traditional engineering definition based on macro-scale (continuum) parameters, this study provides a means to develop a better understanding for the frictional behavior of granular media. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic forced many surgeons to adopt "virtual medicine" practices, defined as telehealth services for patient care and online platforms for continuing medical education. The purpose of this study was to assess spine surgeon reliance on virtual medicine during the pandemic and to discuss the future of virtual medicine in spine surgery.Methods: A comprehensive survey addressing demographic data and virtual medicine practices was distributed to spine surgeons worldwide between March 27, 2020, and April 4, 2020.Results: 902 spine surgeons representing seven global regions responded. 35.6% of surgeons were identified as "high telehealth users," conducting more than half of clinic visits virtually. Predictors of high telehealth utilization included working in an academic practice (OR = 1.68, p = 0.0015) and practicing in Europe/North America (OR 3.42, p < 0.0001). 80.1% of all surgeons were interested in online education. Dedicating more than 25% of one's practice to teaching (OR = 1.89, p = 0.037) predicted increased interest in online education. 26.2% of respondents were identified as "virtual medicine surgeons," defined as surgeons with both high telehealth usage and increased interest in online education. Living in Europe/North America and practicing in an academic practice increased odds of being a virtual medicine surgeon by 2.28 (p = 0.002) and 1.15 (p = 0.0082), respectively. 93.8% of surgeons reported interest in a centralized platform facilitating surgeon-to-surgeon communication.Conclusion: COVID-19 has changed spine surgery by triggering rapid adoption of virtual medicine practices. The demonstrated global interest in virtual medicine suggests that it may become part of the "new normal" for surgeons in the post-pandemic era. [ABSTRACT FROM AUTHOR]

Purpose: Multi-ligament knee injuries are a serious consequence of knee dislocation with a poorly evaluated post-operative complication profile due to low incidence. The aim of this study is to assess the risk of adverse post-operative events associated with operative management of multi-ligament knee injuries. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing surgical procedures for multi-ligament knee injuries from 2006 to 2016 using Current Procedural Terminology codes. We evaluated data on patient demographics and used a propensity score algorithm to adjust for baseline differences in these patients and developed univariate and multivariate logistic regression models to assess effects on minor and severe 30-day post-operative complications. Results: We identified 444 patients in this database who underwent multi-ligament knee reconstructions between 2006 and 2016. After propensity matching, minor and major adverse post-operative events were more frequent in patients with multi-ligament knee injuries (1.4% vs 0.2%, p < 0.001 and 2.7% vs 1.1%, p = 0.002, respectively). Patients with multi-ligament knee injuries experienced a 55-fold increase risk of need for transfusion (p < 0.001) and a fivefold increased risk of pulmonary embolism (p = 0.025), with most occurring in bicruciate reconstructions (Schenck Classification KD-III and KD-IV injuries). Conclusion: The surgical management of multi-ligament knee injuries confers significant increased risk of 30-day post-operative minor or severe adverse event over arthroscopic ACL reconstruction. These patients are most at risk for post-operative blood transfusion requirement, and pulmonary embolism, with patient's undergoing surgery for bicruciate ligament injuries at particularly high risk of complication. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Coastal estuaries provide essential juvenile habitat for many commercially and recreationally important fish, which may move between estuarine and coastal environments throughout their life. Identifying the most important estuarine nurseries that contribute to the broader stock can support targeted management of juvenile and spawning populations. The objective of this study was to (1) compare chemical fingerprints within sagittal otoliths of juvenile Mulloway (Argyrosomus japonicus) sampled from putative south-eastern Australian nurseries, (2) assess their potential as natural tags to distinguish nursery grounds for the broader coastal Mulloway stock and (3) assess the viability of otolith chemistry as a fisheries management tool when limited to opportunistic, fisheries-dependant, otolith sample collection from by-catch. Otoliths from juvenile Mulloway (0 to 3 years, 4 to 44.8 cm total length) were obtained from 8 major estuaries and 2 inshore ocean locations along coastal south-eastern New South Wales, Australia, from April 2015 to July 2018. Concentrations of Sr, Ba, Mg, Mn and Li in the otolith region corresponding to the juvenile nursery stage were determined using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). The element to Ca ratios of fish from coastal estuaries differed significantly among collection areas, based upon multivariate elemental fingerprints, with some exceptions. When the otoliths of fish were analysed in a multinomial logistic regression (MLR) classifier, there was an overall mean allocation success of 59% to the estuary of capture. This study highlights the use of otolith 'fingerprints' as natural tags in Mulloway, and contributes to progressive research in environmental reconstruction applications of otolith chemistry. [ABSTRACT FROM AUTHOR]

Conspecific negative density dependence (CNDD) could be one of the most important local-scale mechanisms shaping plant species coexistence. However, the spatial and temporal changes in the strength CNDD and the implications for the plant diversity remain unknown. We used 10 years of seedling data, in a seasonal tropical rainforest, to discover how CNDD influences tree seedling survival across habitats and seasons. We also evaluated the relation between CNDD and species diversity. We found the strength of CNDD in the valley habitat was significantly stronger than in ridge habitat in rainy season, but not significantly different in dry season. Corresponding to expectations of CNDD as mechanism of diversity maintenance, seedling species diversity was significantly higher in valley habitat than in ridge habitat and significantly correlated with CNDD. Additionally, conspecific and heterospecific seedling neighbour densities positively affected the survival of tree seedlings, but heterospecific adult neighbour density had a weak effect. Our study finds that CNDD varied significantly across habitats and was correlated with local seedling diversity. Our results highlight the importance of CNDD in driving species diversity at the local scale. Recognizing the spatial and temporal variation in the strength of CNDD will aid efforts to model and understand species coexistence. [ABSTRACT FROM AUTHOR]

Purpose: Spine surgeons around the world have been universally impacted by COVID-19. The current study addressed whether prior experience with disease epidemics among the spine surgeon community had an impact on preparedness and response toward COVID-19. Methods: A 73-item survey was distributed to spine surgeons worldwide via AO Spine. Questions focused on: demographics, COVID-19 preparedness, response, and impact. Respondents with and without prior epidemic experience (e.g., SARS, H1NI, MERS) were assessed on preparedness and response via univariate and multivariate modeling. Results of the survey were compared against the Global Health Security Index. Results: Totally, 902 surgeons from 7 global regions completed the survey. 24.2% of respondents had prior experience with global health crises. Only 49.6% reported adequate access to personal protective equipment. There were no differences in preparedness reported by respondents with prior epidemic exposure. Government and hospital responses were fairly consistent around the world. Prior epidemic experience did not impact the presence of preparedness guidelines. There were subtle differences in sources of stress, coping strategies, performance of elective surgeries, and impact on income driven by prior epidemic exposure. 94.7% expressed a need for formal, international guidelines to help mitigate the impact of the current and future pandemics. Conclusions: This is the first study to note that prior experience with infectious disease crises did not appear to help spine surgeons prepare for the current COVID-19 pandemic. Based on survey results, the GHSI was not an effective measure of COVID-19 preparedness. Formal international guidelines for crisis preparedness are needed to mitigate future pandemics. [ABSTRACT FROM AUTHOR]

Objective: To determine the utility of intravenous contrast in magnetic resonance neurography (MRN).Materials and Methods: A search of our PACS for MRN studies performed in 2015 yielded 74 MRN exams, 57 of which included pre- and post-contrast images. All studies were independently reviewed by 3 musculoskeletal radiologists with peripheral nerve imaging experience for presence/absence of nerve pathology, presence/absence of muscle denervation, and contrast utility score based on a 4-point Likert scale. The medical record was reviewed for demographic and clinical data.Results: The mean contrast utility score across all readers and all cases was 1.65, where a score of 1 indicated no additional information and a score of 2 indicated mild additional information/supports interpretation. The mean contrast utility score was slightly higher in cases with a clinical indication of amputation/stump neuroma or mass (2.3 and 2.1 respectively) and lower in cases with a clinical indication of trauma (1.5). The mean contrast utility score was lowest in patients undergoing MRN for pain, numbness, and/or weakness (1.2).Conclusion: Intravenous contrast provides mild to no additional information for the majority of MRN exams. Given the invasive nature of contrast and recent concerns regarding previously unrecognized risks of repetitive contrast exposure, assessment of the necessity of intravenous contrast in MRN is important. Consensus evidence-based practice guidelines regarding intravenous contrast use in MRN are necessary. [ABSTRACT FROM AUTHOR]

Purpose: Hip arthroscopy is known to be safe with low rates of postoperative complications. The purpose of this study is to evaluate hip arthroscopy cases in a national surgical database to identify risk factors associated with readmission.Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2012 to 2016 for current procedural terminology billing codes related to hip arthroscopy. International Classification of Diseases diagnostic codes were used to exclude cases involving infection, fracture, or open procedures. Univariate and multivariate analyses were performed to identify risk factors associated with 30-day readmission.Results: 1493 patients were identified who had undergone hip arthroscopy. The most common procedures were labral resection or chondroplasty (n = 589, 39.5%) and femoroplasty (n = 527, 35.3%). The 30-day complication rate was 1.7% and the most common complications following the procedure were bleeding (n = 12, 0.8%) superficial infections (n = 5, 0.3%), and returning to the operating room (n = 4, 0.3%). The 30-day readmission rate was 1.3%. On multivariate analysis, hypertension requiring anti-hypertensive medication (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4-8.7) and chronic corticosteroid or immunosuppressant use (OR 7.2; 95% CI 1.9-26.7) were identified as independent risk factors for readmission. There was no difference in complication rates when hip arthroscopy was performed with isolated femoroplasty (n = 340), isolated acetabuloplasty (n = 103), both (n = 187) or neither (n = 863).Conclusion: These findings confirm that the 30-day readmission (1.3%) and complication rate (1.7%) are low for isolated hip arthroscopy procedures; however, hypertension and chronic steroid use are independent risk factors for readmission.Level Of Evidence: Retrospective comparative study, Level III. [ABSTRACT FROM AUTHOR]

The connection between atrial fibrillation (AF) and H. pylori (HP) infection is still matter of debate. We performed a systematic review and metanalysis of studies reporting the association between AF and HF. A systematic review of all available reports in literature of the incidence of HP infection in AF and comparing this incidence with subjects without AF were analysed. Risk ratio and 95% confidence interval (CI) and risk difference with standard error (SE) were the main statistics indexes. Six retrospective studies including a total of 2921 were included at the end of the selection process. Nine hundred-fifty-six patients (32.7%) were in AF, whereas 1965 (67.3%) were in normal sinus rhythm (NSR). Overall, 335 of 956 patients with AF were HP positive (35%), whereas 621 were HP negative (65%). In addition, 643 of 1965 NSR patients (32.7%) were HP positive while 1,322 were negative (67.3%; Chi-square 2.15, p = 0.21). The Cumulative Risk Ratio for AF patients for developing an HP infection was 1.19 (95% CI 1.08–1.41). In addition, a small difference risk towards AF was found (0.11 [SE = 0.04]). Moreover, neither RR nor risk difference were influenced by the geographic area at meta-regression analysis. Finally, there was a weak correlation between AF and HP (coefficient = 0.04 [95% CI −0.01–0.08]). We failed to find any significant correlation between H. pylori infection and AF and, based on our data, it seems unlikely than HP can be considered a risk factor for AF. Further larger research is warranted. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the study 'Provision of market research for value of time savings and reliability' undertaken by the Arup/ITS Leeds/Accent consortium for the UK Department for Transport (DfT). The paper summarises recommendations for revised national average values of in-vehicle travel time savings, reliability and time-related quality (e.g. crowding and congestion), which were developed using willingness-to-pay (WTP) methods, for a range of modes, and covering both business and non-work travel purposes. The paper examines variation in these values by characteristics of the traveller and trip, and offers insights into the uncertainties around the values, especially through the calculation of confidence intervals. With regards to non-work, our recommendations entail an increase of around 50% in values for commute, but a reduction of around 25% for other non-work—relative to previous DfT 'WebTAG' guidance. With regards to business, our recommendations are based on WTP, and thus represent a methodological shift away from the cost saving approach (CSA) traditionally used in WebTAG. These WTP-based business values show marked variation by distance; for trips of less than 20 miles, values are around 75% lower than previous WebTAG values; for trips of around 100 miles, WTP-based values are comparable to previous WebTAG; and for longer trips still, WTP-based values exceed those previously in WebTAG. [ABSTRACT FROM AUTHOR]

While research on the role of acceptance in psychological well-being and treatment of posttraumatic distress is promising, significant challenges remain in developing a workable conceptualization of acceptance. The current study contributes to a more measureable and functional conceptualization of acceptance in postdeployment soldiers using a latent variable approach. Participants were a large sample of active duty service members who had recently returned from deployment (n = 1, 524). Exploratory factor analysis identified substantial common variance among several facets of acceptance-related measures, including nonjudgmental awareness, acceptance of internal experiences, and not using worry and experiential avoidance to control internal experiences. These results, confirmed with CFA, suggest that acceptance in postdeployment adjustment may be best conceptualized as a combination of awareness, nonjudgment of experience, and the tendency to refrain from using strategies such as worry to avoid feelings and emotions. Additionally, results of structural regression indicated that the latent variable of acceptance was negatively associated with measures of postdeployment maladjustment. These results are discussed in the context of current conceptualizations of acceptance and related constructs, and the burgeoning literature supporting the development and implementation of acceptance-based interventions for potentially traumatized populations. [ABSTRACT FROM AUTHOR]

Accurate and precisess estimation of spatio-temporal variability of solar radiation is critical. Some commonly used models evaluate this variability using methods in which the data required for estimating atmospheric attenuation may not be easily accessible for some study areas. Here, a daily solar radiation estimation method which uses ambient air temperature, a Digital Elevation Model, time of year, and monthly radiation estimates from Solar Analyst model has been proposed. The objective was to use air temperature-based empirical models for atmospheric transmissivity and diffuse fractions to vary total monthly radiation estimation from Solar Analyst, and then calculate total daily radiation as a fraction of total monthly radiation by applying a daily transmissivity-based ratio, as air temperature data are readily available at most locations on the planet. Results revealed that daily solar radiation can be estimated very well, with Mean Absolute Bias Error of around 40-53 W m−2 or Mean Bias Error of ± 10%, under all sky conditions at seven sites in diverse climate regions, using significantly less input data. The presented method is an improvement over previously used methods with Mean Bias Error of under 10% but more input parameters. Furthermore, the hourly solar radiation values can be calculated using the presented method using the ratio between daily and hourly radiation, for example from literature values and estimated daily insolation. The result also showed that the method is more useful for those stations with substantially higher numbers of sunny days than cloudy or partly cloudy days because the uncertainty of the model decreased from cloudy to sunny sky conditions. The implemented Digital Elevation Models environment of this method makes it applicable in many studies that need spatial estimation of solar radiation, especially for solar energy generation projects. [ABSTRACT FROM AUTHOR]

Tree mortality from drought is anticipated to increase as climate change promotes more frequent or severe water limitation. Ecosystem impacts of woody mortality depend on both the number and sizes of trees that die, but a limited capacity to predict mortality risk for individual trees hinders the capacity to forecast drought effects on tree population demography and ecosystem processes. We remotely measured leaf area of living Ashe juniper trees at three savanna sites in central Texas, USA to characterize the frequency-size distribution (FSD) of juniper populations and evaluate mortality risk from drought as a function of tree size. Mortality risk of individuals was assessed from the deviation in leaf area per tree from that of a similarly sized individual with near maximal leaf area using correlations among leaf area, growth rate, and mortality measured during a prior drought. We found that the FSD of juniper trees is bell-shaped at each site. Mortality risk from drought exceeded 25% of emergent (> 4 m height) trees in savanna juniper populations, but was highest for largest trees. Mortality risk was greatest at a grazed savanna, exceeding 50% of trees with projected canopy area > 20 m2. Results imply that severe drought could kill a large fraction (18-85%) of intermediate- to large-sized Ashe juniper trees in central Texas savannas. Our analysis demonstrates a novel use of remote measurements of canopy foliation to link mortality risk from drought to the demography of Ashe juniper populations through properties of individual trees. [ABSTRACT FROM AUTHOR]

Lunar phase is regarded as a key driver of reproductive development and spawning activity in prawns, but across smaller-temporal scales, other processes may have a significant influence. Here, we examined the effects of lunar phase and other abiotic variables on the reproductive development of an estuarine-dependent prawn, Metapenaeus bennettae Racek & Dall. We found that turbidity, salinity, water temperature and lunar phase each had a significant independent influence on the likelihood of female prawns being ripe throughout the spawning period. The likelihood of catching a ripe female increased on the new moon and first quarter of the moon and also during conditions of low turbidity, high salinity and high water temperature. For male prawns, however, significant interactions between salinity and lunar phase and also between turbidity and lunar phase were detected. These interactions indicated that salinity and turbidity have variable effects among the different lunar phases. Such complex relationships of reproductive timing and spawning success of M. bennettae, and potentially other aquatic species, are most likely adaptive responses to the highly variable conditions of estuarine environments. [ABSTRACT FROM AUTHOR]

Plant-soil feedbacks are known to play a central role in species co-existence, but conceptual frameworks for predicting their magnitude and direction are lacking. We ask whether co-occurring trees that associate with different types of mycorrhizal fungi, which are hypothesized to differ in terms of nutrient use and plant-soil feedbacks, differ in sapling establishment densities and probability of co-occurrence. Given that ectomycorrhizal (ECM) trees typically have fungal structures that protect roots from pathogens whereas arbuscular mycorrhizal (AM) trees do not, we hypothesized that ECM saplings would be clustered around ECM trees, while AM saplings would be suppressed near AM trees. Most previous studies have focused on seedlings, but here we examine whether the spatial signal is evident in later life stages. We measured the spatial associations of ~ 28,000 trees using point pattern analysis in a 25-ha old-growth forest where ECM trees comprised 72% of total basal area and 42% of the total stems, while AM trees comprised the remainder. Supporting our hypothesis, AM saplings were more inhibited by AM trees, while ECM saplings were more clustered around ECM trees. The spatial patterns of AM and ECM trees on saplings of the alternate mycorrhizal type were inhibited. To the extent that similar types of feedbacks occur for other AM and ECM trees, our results suggest that fundamental differences in the nature of local-scale biotic interactions between trees and their fungal symbionts may influence forest community assembly and ecosystem dynamics. [ABSTRACT FROM AUTHOR]

Over 90% of head and neck cancers overexpress the epidermal growth factor receptor (EGFR). In diverse tumor types, EGFR overexpression has been associated with poorer prognosis and outcomes. Therapies targeting EGFR include monoclonal antibodies, tyrosine kinase inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, and antisense gene therapy. Few EGFR-targeted therapeutics are approved for clinical use. The monoclonal antibody cetuximab is a Food and Drug Administration (FDA)-approved EGFR-targeted therapy, yet has exhibited modest benefit in clinical trials. The humanized monoclonal antibody nimotuzumab is also approved for head and neck cancers in Cuba, Argentina, Colombia, Peru, India, Ukraine, Ivory Coast, and Gabon in addition to nasopharyngeal cancers in China. Few other EGFR-targeted therapeutics for head and neck cancers have led to as significant responses as seen in lung carcinomas, for instance. Recent genome sequencing of head and neck tumors has helped identify patient subgroups with improved response to EGFR inhibitors, for example, cetuximab in patients with the KRAS-variant and the tyrosine kinase inhibitor erlotinib for tumors harboring MAPK1 mutations. Genome sequencing has furthermore broadened our understanding of dysregulated pathways, holding the potential to enhance the benefit derived from therapies targeting EGFR. [ABSTRACT FROM AUTHOR]

Drought is killing an increasing number of trees globally, yet mortality risk remains difficult to predict at fine spatial scales. We sought to identify metrics of living individuals that could be used to estimate mortality risk of Ashe juniper ( Juniperus ashei) trees and eventually to estimate the fraction of juniper populations at risk from drought. Ashe juniper is a keystone species in the Edwards Plateau region in central Texas, USA. We analyzed tree rings from both living and dead trees to determine growth rate prior to an historic drought in 2011 and measured morphological, physiological, and stand-level variables hypothesized to link growth rate and mortality risk. Slowly growing trees were disproportionately vulnerable to mortality. Fractional mortality of sampled trees was correlated to the difference between the mean predrought basal area increment (BAI) per tree and the predrought BAI of minimally stressed trees growing on deep soil (=BAI − BAI). Slowly growing trees had sparsely foliated canopies. BAI − BAI was positively correlated to the difference between: (1) leaf area per unit of projected canopy area per tree (LA) and the LA of minimally stressed trees and (2) projected canopy area (CA) and the CA of comparably sized trees. By contrast, there was no correlation between growth of living trees and light interception by neighboring trees, soil depth, or two functional metrics, the stem-leaf Ψ gradient and leaf light use efficiency. Mortality risk in Ashe juniper populations can be estimated from nondestructive measurements of leaf and canopy area of individual trees using relationships among risk, growth, and leaf and canopy area. [ABSTRACT FROM AUTHOR]

Purpose: Perioperative blood transfusion (PBT) has been inconsistently associated with adverse outcomes. Bladder cancer patients are unique as they frequently undergo neoadjuvant chemotherapy (NAC) with resulting immunosuppression, which may be exacerbated by transfusion-related immunomodulation. We examined the effect of leukoreduced PBT on oncologic outcomes and perioperative morbidity in radical cystectomy (RC) patients who received NAC, quantifying exposure with a novel dose-index variable. Methods: The Johns Hopkins Radical Cystectomy database was queried for patients who had undergone NAC followed by RC from 2010 to 2013. Overall, 119 patients had available PBT and survival data. A multivariable Cox model evaluated risk factors, including pathologic stage, Charlson Comorbidity Index, age, race, year of surgery, surgical margin status, PBT, and preoperative hemoglobin for bladder cancer-specific survival (CSS) and overall survival (OS). Logistic regression models determined factors that were independently associated with perioperative morbidity. Results: Median follow-up was 7.8 months (range 0.2-41.8), and during follow-up there were 25 deaths and 21 cancer deaths. PBT significantly predicted OS (hazard ratio [HR] 1.26, 95 % confidence interval [CI] 1.07-1.49; p = 0.005), CSS (HR 1.32, 95 % CI 1.11-1.57; p = 0.002), and morbidity (odds ratio [OR] 1.67, 95 % CI 1.26-2.21; p = 0.004) in univariate analyses. In multivariable models, PBT was significantly associated with morbidity (OR 1.77, 95 % CI 1.30-2.39; p = 0.0002), but not OS or CSS. Intraoperative transfusion was associated with decreased OS and CSS, and increased morbidity, whereas postoperative transfusion was only associated with increased morbidity. Conclusions: Intraoperative blood transfusion was associated with increased perioperative morbidity and worsened OS and CSS in patients undergoing RC who had NAC. Although PBT may be life-saving in certain patients, a restrictive transfusion strategy may improve outcomes. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis involving the temporal bone region is uncommon and can resemble malignant neoplasms on imaging due to high cellularity. Although recognizing the presence of sharp margins with beveled-edges can be helpful, tissue sampling is often necessary for confirming the diagnosis. Cytology classically demonstrates kidney-bean shaped nuclei within the Langerhans cells and immunohistochemical staining is positive for S-100, peanut agglutinin (PNA), MHC class II, CD1a, and Langerin (CD 207). These features are exemplified in this sine qua non radiology-pathology correlation article. [ABSTRACT FROM AUTHOR]

Background: Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal.Objective: The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge.Design: Randomized, controlled trial with concealed allocation and blinded outcome assessorsSetting: Two tertiary care academic medical centersParticipants: Adults hospitalized with a diagnosis of ACS and/or ADHF.Intervention: Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after dischargeMain Measures: The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported.Key Results: A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition.Conclusion: A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous. [ABSTRACT FROM AUTHOR]