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Objective: Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis. Materials and methods: An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors. Results: A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures. Conclusion: Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures. [ABSTRACT FROM AUTHOR]

X-ray Transient Absorption Spectroscopy (XTAS) is a powerful probe for ultrafast molecular dynamics. The evolution of XTAS signal is controlled by the shapes of potential energy surfaces of the associated core-excited states, which are difficult to directly measure. Here, we study the vibrational dynamics of Raman activated CCl4 with XTAS targeting the C 1s and Cl 2p electrons. The totally symmetric stretching mode leads to concerted elongation or contraction in bond lengths, which in turn induce an experimentally measurable red or blue shift in the X-ray absorption energies associated with inner-shell electron excitations to the valence antibonding levels. The ratios between slopes of different core-excited potential energy surfaces (CEPESs) thereby extracted agree very well with Restricted Open-Shell Kohn-Sham calculations. The other, asymmetric, modes do not measurably contribute to the XTAS signal. The results highlight the ability of XTAS to reveal coherent nuclear dynamics involving < 0.01 Å atomic displacements and also provide direct measurement of forces on CEPESs. The evolution of X-ray transient absorption signal in studies of ultrafast molecular dynamics is controlled by the shapes of potential energy surfaces of the associated core-excited states. The authors use experiment and theory to measure the slopes of potential energy surfaces for excitations out of the C 1s and Cl 2p shells to valence antibonding orbitals in CCl4 [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility of using large language models (LLMs), specifically ChatGPT-4, to generate concise and accurate layperson summaries of musculoskeletal radiology reports. Methods: Sixty radiology reports, comprising 20 MR shoulder, 20 MR knee, and 20 MR lumbar spine reports, were obtained via PACS. The reports were deidentified and then submitted to ChatGPT-4, with the prompt "Produce an organized and concise layperson summary of the findings of the following radiology report. Target a reading level of 8-9th grade and word count <300 words." Three (two primary and one later added for validation) independent readers evaluated the summaries for completeness and accuracy compared to the original reports. Summaries were rated on a scale of 1 to 3: 1) summaries that were incorrect or incomplete, potentially providing harmful or confusing information; 2) summaries that were mostly correct and complete, unlikely to cause confusion or harm; and 3) summaries that were entirely correct and complete. Results: All 60 responses met the criteria for word count and readability. Mean ratings for accuracy were 2.58 for reader 1, 2.71 for reader 2, and 2.77 for reader 3. Mean ratings for completeness were 2.87 for reader 1 and 2.73 for reader 2 and 2.87 for reader 3. For accuracy, reader 1 identified three summaries as a 1, reader 2 identified one, and reader 3 identified none. For the two primary readers, inter-reader agreement was low for accuracy (kappa 0.33) and completeness (kappa 0.29). There were no statistically significant changes in inter-reader agreement when the third reader's ratings were included in analysis. Conclusion: Overall ratings for accuracy and completeness of the AI-generated layperson report summaries were high with only a small minority likely to be confusing or inaccurate. This study illustrates the potential for leveraging generative AI, such as ChatGPT-4, to automate the production of patient-friendly summaries for musculoskeletal MR imaging. [ABSTRACT FROM AUTHOR]

Spine injections are commonly performed in the treatment of back pain. The purpose of this article is to review the current literature surrounding image guided spine injections focusing on scenarios where fluoroscopic guidance can be advantageous in addition to discussing similarities among the different modalities. [ABSTRACT FROM AUTHOR]

Recent research highlights the use of artificial boundaries between distinct types of adverse experiences, including forms of maltreatment. Commonly-utilized methods that isolate the impact of one maltreatment subtype over others and fail to consider the often co-occurring nature of maltreatment may not adequately capture the complex heterogeneous nature of maltreatment and may obscure understanding of developmental pathways. Moreover, childhood maltreatment is associated with the development of maladaptive peer relationships and psychopathology, with negative conceptions of relationships identified as a risk pathway. The current study utilizes structural equation modeling to examine the impact of an adapted threat versus deprivation framework for conceptualizing maltreatment via children's negative conceptions of relationships, which have not been previously tested as mechanisms in the context of this conceptual framework. Participants included 680 socioeconomically disadvantaged children who attended a week-long summer camp. Multi-informant methods were used to assess children's symptomatology and interpersonal functioning. Results did not support differences between threatening versus depriving maltreatment experiences, but indicated that all groups of children who experienced maltreatment, including those enduring both threatening and depriving experiences, showed more maladaptive functioning and more negative conceptions of relationships relative to non-maltreated peers. Results of the current study support the mediating role of children's appraisals of the self and peers in the effect of maltreatment on children's internalizing and externalizing symptomatology. [ABSTRACT FROM AUTHOR]

In 1908, Felix Klein suggested that to mend the discontinuity that prospective secondary teachers face, university instruction must account for teachers' needs. More than a century later, problems of discontinuity remain. Our project addresses the dilemma of discontinuity in university mathematics courses through simulating core teaching practices in mathematically intensive ways. In other words, we interpret teachers' needs to include integrating content and pedagogy. We argue that doing so has the potential to impact teachers' competence. To make this argument, we report findings from the Mathematics of Doing, Understanding, Learning, and Educating for Secondary Schools (MODULE(S2)) project. The results are based on data from 324 prospective secondary mathematics teachers (PSMTs) enrolled in courses using curricular materials developed by the project in four content areas (algebra, geometry, modeling, and statistics). We operationalized competence in terms of PSMTs' content knowledge for teaching and their motivation for enacting core teaching practices. We examined pre- and post-term data addressing these constructs. We found mean increases in PSMTs' outcomes in content knowledge for teaching and aspects of motivation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the safety and feasibility of ultrasound-guided nerve block prior to biopsy of potentially neurogenic tumors. Materials and methods: A retrospective review of the medical record from June 2017 to June 2022 identified ultrasound-guided biopsies of potentially neurogenic tumors that were performed with a pre-procedural nerve block. Patient demographics, biopsy site, number of passes, needle gauge, use of sedation, pathology results, and procedural complications were recorded and summarized. Results: The structured search found 16 patients that underwent biopsies of 18 potentially neurogenic tumors with the use of a pre-procedural nerve block at a variety of upper and lower extremity locations. Average patient age was 52 (range 18–78) and 9 patients (56%) were female. Of the 16 patients, 10 were performed without intravenous sedation. Three patients were unable to tolerate biopsy until a nerve block was used. All biopsies yielded a diagnostic sample with 13 of the tumors neurogenic in origin. One patient reported mild postprocedural pain which resolved with conservative treatment; no other complications were reported. Conclusion: Nerve block prior to ultrasound-guided biopsy of potentially neurogenic tumors is a safe and feasible technique. Further study is needed to determine the extent to which nerve block can decrease intra-procedural pain and reduce or eliminate the need for sedation during biopsy. [ABSTRACT FROM AUTHOR]

Runoff from glacierised Andean river basins is essential for sustaining the livelihoods of millions of people. By running a high-resolution climate model over the two most glacierised regions of Peru we unravel past climatic trends in precipitation and temperature. Future changes are determined from an ensemble of statistically downscaled global climate models. Projections under the high emissions scenario suggest substantial increases in temperature of 3.6 °C and 4.1 °C in the two regions, accompanied by a 12% precipitation increase by the late 21st century. Crucially, significant increases in precipitation extremes (around 75% for total precipitation on very wet days) occur together with an intensification of meteorological droughts caused by increased evapotranspiration. Despite higher precipitation, glacier mass losses are enhanced under both the highest emission and stabilization emission scenarios. Our modelling provides a new projection of combined and contrasting risks, in a region already experiencing rapid environmental change. [ABSTRACT FROM AUTHOR]

Background: Active citizen participation, especially as collective prosumers in energy communities or as individual prosumers, is vital for a sustainable energy transition. As such, it is explicitly supported by European Union policy. It is the aim of policy-makers that a large proportion of the residential energy demand will be met in this way. At present, there is limited analysis on the macroeconomic impacts of such an increase in prosumers. In this study, we develop and apply an approach for assessing the macroeconomic impacts of transformation pathways, which depict potential developments of individual and collective prosumers. Results: The paper methodologically demonstrates how to macroeconomically assess scenarios and transformation pathways originating from cross-impact balance analyses by means of an input–output analysis. In particular, it is shown how qualitative data on future developments can be transformed into financial flows so as to enable an input–output analysis. Based on the assessment of two transformation pathways, our main findings suggest that there might be positive regional and national effects on net value added and employment as well as reductions in CO2 emissions. We find that the scale of the effects strongly depends on the spatial distribution of heterogeneous households and the underlying economic structure. Conclusions: Our study represents a methodological advancement by showing how scenarios and transformation pathways can be assessed in terms of their macroeconomic consequences. This study shows that energy communities and individual prosumers might generate positive effects on value added and on employment. Given that households fix their energy supply options for decades, political decisions to support the energy transition in the residential sector should be taken as soon as possible. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to describe an ultrasound (US)-guided temporomandibular joint (TMJ) arthrocentesis technique and determine its microbial yield in the workup of suspected TMJ septic arthritis. Materials and methods: A retrospective review of US-guided TMJ arthrocentesis for the work-up of septic arthritis performed by radiologists at two institutions was performed. Patient demographics, risk factors for septic arthritis, blood culture results, and pre-procedural imaging findings were recorded. Procedural data included fluid aspirate quantity, needle gauge and length, and any immediate complications. Post-procedural data included synovial fluid analysis including culture, final diagnosis of TMJ disease, type of treatment, and any delayed complications from arthrocentesis. Results: A total of six US-guided TMJ arthrocenteses were identified, all of which yielded at least 1 mL of synovial fluid. Five patients were subsequently diagnosed with septic arthritis, and one patient was diagnosed with GVHD arthritis. The synovial fluid in four out of five patients with a final diagnosis of septic arthritis produced positive cultures. There were no immediate or delayed complications from arthrocentesis. Conclusion: Basic US-guided procedural skills are transferrable to TMJ arthrocentesis, which is a low-risk procedure with a high microbial yield in our small series of patients with septic arthritis. [ABSTRACT FROM AUTHOR]

Clearly communicating baselines for assessing ocean warming is essential for understanding extreme events and how they will affect marine ecosystems and livelihoods in the future. [ABSTRACT FROM AUTHOR]

Objective: To determine if MR neurography of the common peroneal nerve (CPN) predicts a residual motor deficit at 12-month clinical follow-up in patients presenting with foot drop. Materials and methods: A retrospective search for MR neurography cases evaluating the CPN at the knee was performed. Patients were included if they had electrodiagnostic testing (EDX) within 3 months of imaging, ankle and/or forefoot dorsiflexion weakness at presentation, and at least 12-month follow-up. Two radiologists individually evaluated nerve size (enlarged/normal), nerve signal (T2 hyperintense/normal), muscle signal (T2 hyperintense/normal), muscle bulk (normal/Goutallier 1/Goutallier > 1), and nerve and muscle enhancement. Discrepancies were resolved via consensus review. Multivariable logistical regression was used to evaluate for association between each imaging finding and a residual motor deficit at 12-month follow-up. Results: Twenty-three 3 T MRIs in 22 patients (1 bilateral, mean age 52 years, 16 male) met inclusion criteria. Eighteen cases demonstrated common peroneal neuropathy on EDX, and median duration of symptoms was 5 months. Six cases demonstrated a residual motor deficit at 12-month follow-up. Fourteen cases underwent CPN decompression (1 bilateral) within 1 year of presentation. Three cases demonstrated Goutallier > 1 anterior compartment muscle bulk. Multivariable logistical regression did not show a statistically significant association between any of the imaging findings and a residual motor deficit at 12-month follow-up. Conclusion: MR neurography did not predict a residual motor deficit at 12-month follow-up in patients presenting with foot drop, though few patients demonstrated muscle atrophy in this study. [ABSTRACT FROM AUTHOR]

Background: Necrotizing pancreatitis can be complicated by Necrotic Fluid Collections (NFC). Guidelines recommend waiting for 4 weeks from the onset of acute pancreatitis (AP) before considering endoscopic drainage. We aimed to compare outcomes and safety in patients undergoing early versus late drainage of NFC. Methods: We performed a retrospective review of all patients who underwent Dual Modality Drainage (DMD) [combined endoscopic and percutaneous drainage] for NFC from January 2007 to December 2020. Patients were stratified into the "early" group (DMD < 28 days from AP onset) and were matched to "late" (DMD ≥ 28 days) drainage group using propensity- core-matching. Primary outcomes of interest were technical success and adverse events. Secondary outcomes included clinical success, late complication rates, and mortality. Results: We identified 278 patients who underwent DMD for NFC. Thirty-nine belonged to the early group and were matched to 174 patients from the late group. Technical success was similar in both early and late groups (97.4% vs 99.4%: P = 0.244) as were the procedural and early post-procedural (< 14 days) adverse events rates (23.1% vs 27.6%: P = 0.565). Clinical success (92.3% vs 93.1%; P = 0.861) and late complication rates (23.1% vs 31.6%; P = 0.294) were similar. There were 2 deaths (5.7%) in the early vs. 9 (5.2%) in the late group, P = 0.991. Conclusions: When performed in a tertiary care center with expertise in therapeutic endoscopic ultrasound, early drainage of NFC appears to be feasible and safe. Further studies are needed to validate our results. [ABSTRACT FROM AUTHOR]

Background: Although released only for drainage of pseudocyst and walled-off necrosis (WON) with ≤ 30% solid debris, the utilization of lumen-apposing metal stent (LAMS) in "real-world" practice has deviated from approved indications. We evaluated the contemporary use of LAMS and associated clinical, procedural outcomes in the setting of a tertiary referral center in the USA.Methods: Data from 303 consecutive patients who underwent LAMS placement were analyzed. Outcomes included technical and clinical success rates and adverse events.Results: Of 303 patients, 190 (62.7%) received LAMS for off-label indications. The latter included gallbladder drainage (n = 56, 18.5%), gastroenterostomy (n = 52, 17.2%), treatment of gastrointestinal strictures (n = 37, 12.2%), biliary drainage (n = 20, 6.6%), temporary gastric access for endoscopy (n = 13, 4.3%), symptomatic WON with > 30% solid debris (n = 8, 2.6%), and miscellaneous (n = 4, 1.3%). Technical success rates in the on- and off-label arm were 98.2% and 95.8%, respectively (P = .331; 95% CI 0.08 to 1.96). Clinical success rates in the on- and off-label arm were 89.4% and 83.2%, respectively (P = .137; 95% CI 0.28 to 1.19). The rate of adverse events was 20.5% (n = 39) in the off-label arm and 16.8% (n = 19) in the on-label arm (P = .242; 95% CI 0.69 to 2.34).Conclusion: Off-label use of LAMS out-numbered on-label use in our practice. The safety profile between the groups was similar and with the exception of refractory stricture treatment, efficacy was comparable. [ABSTRACT FROM AUTHOR]

This document is a response to a comment regarding the use of ChatGPT-4 to translate musculoskeletal radiology reports into patient-friendly summaries. The authors acknowledge the variability in report summaries and agree that detailed instructions could minimize these variations. They also mention that ChatGPT has introduced features since the study was conducted that could enhance the consistency and content of the translations. The authors emphasize the importance of involving all stakeholders in establishing standardized best practices for patient communication in radiology reporting. [Extracted from the article]

Background: Fluoroscopy is often used for endoscopic balloon dilation (EBD) of Crohn's disease (CD)-related strictures. However, its benefit remains unclear. Aims: To compare EBD with (EBDF) and without (EBDNF) fluoroscopic guidance in CD patients with strictures. Methods: Single-center, nested, case–control retrospective study of EBD for CD-related strictures. Technical and clinical success and safety outcomes were compared between EBDF and EBDNF. Results: A total of 122 strictures in 114 CD patients who underwent EBD from 2010 to 2018 at a single institution were reviewed (44 patients EBDF vs. 70 EBDNF). Esophagogastroduodenoscopy was the approach in 8 strictures, colonoscopy in 86, and deep enteroscopy in 28. There were no significant differences in the rates of technical and clinical success, need for repeat dilation and surgery between the two groups, although the mean maximal endoscopic balloon diameter was larger in the EBDNF group (17.1 ± 1.9 vs. 14.1 ± 2.5; p < 0.001). There was one perforation in EBDF and no serious complications in EBDNF. In multivariate analysis, balloon size < 15 mm (odds ratio [OR] 6.388; 95% CI 1.96–20.79; p = 0.002) and multiple strictures (OR 3.897; 95% CI 1.09–14.01; p = 0.037) were associated with repeat EBD, and age < 50 years (OR 7.178; 95% CI 1.38–37.44; p = 0.019) and small bowel (vs. colon) location (OR 7.525; 95% CI 1.51–37.47; p = 0.014) were associated with the need for surgery after EBD. Conclusions: EBD for CD-related strictures can be performed safely and effectively without fluoroscopic guidance. Balloon size, patient age, stricture location, and multiplicity are associated with clinical success and avoidance of surgery. [ABSTRACT FROM AUTHOR]

Utilization of unexplored lignocellulolytic microbial resources is in demand due to its ability to degrade the waste-plant biomasses like water-hyacinth or noxious weeds for alternative second-generation biofuel production, i.e., biogas. One such "biotechnological treasure-box" is the herbivorous insect gut-system, as its' symbionts produce key hydrolytic enzymes like lignocellulases, cellulases, xylanases, and pectinases responsible for degradation of their host's diet plant-biomasses. In this context, this review revealed such lignocellulolytic gut bacterial populations inhabiting the gut-system of only eight orders viz., Blattodea, Lepidoptera, Isoptera, Coleoptera, Orthoptera, Hemiptera, Hymenoptera, and Diptera among 31 insect orders. Proteobacteria is the most predominant group found in every case. Regarding enhanced biogas production, gut bacteria from only three insect orders i.e., Blattodea, Coleoptera, and Diptera were explored so far. Therefore, deployment of such gut bacteria with immense lignocellulolytic potentialities can be harnessed as the sustainable bioresource technology for augmented biogas production utilizing waste-plant biomasses. [ABSTRACT FROM AUTHOR]

Objective: To examine the trends in CT utilization in the emergency department (ED) for different racial and ethnic groups, factors that may affect utilization, and the effects of increased insurance coverage since passage of the Affordable Care Act in 2010. Materials and methods: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 2009–2018 were used for the analysis. The NHAMCS is a cross-sectional survey which has random and systematical samples of more than 200,000 visits to over 250 hospital EDs in the USA. Patient demographic characteristics, source of payment/insurance, clinical presentation, and disposition from the ED were recorded. Descriptive statistics and multivariate logistic regression were performed. Results: Between 2009 and 2018, the rate of uninsured patients in the ED decreased from 18.1% to as low as 9.9%, but this was not associated with a decrease in the disparity in CT utilization between non-Hispanic Black and non-Hispanic White patients. CT use rate increased 38% over the study period. Factors strongly associated with CT utilization include age, source of payment, triage category, disposition from the ED, and residence. After controlling for these factors, non-Hispanic White patients were 21% more likely to undergo CT than non-Hispanic Black patients, though no disparity was seen for Hispanic or Asian/other groups. Conclusion: Despite increased insurance coverage over the sample period, racial disparities between non-Hispanic Black and non-Hispanic White patients persist in CT utilization, though no disparity was seen for Hispanic or Asian/other patients. The source of this disparity remains unclear and is likely multifactorial. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of intravenous (IV) contrast on sensitivity, specificity, and accuracy of magnetic resonance (MR) neurography of the knee with attention to the common peroneal nerve (CPN) in identifying nerve lesions and active muscle denervation changes. Materials and methods: A retrospective search for contrast-enhanced MR neurography cases evaluating the CPN at the knee was performed. Patients with electrodiagnostic testing (EDX) within 3 months of imaging were included and those with relevant prior surgery were excluded. Two radiologists independently reviewed non-contrast sequences and then 4 weeks later evaluated non-contrast and contrast sequences. McNemar's tests were performed to detect a difference between non-contrast only and combined non-contrast and contrast sequences in identifying nerve lesions and active muscle denervation changes using EDX as the reference standard. Results: Forty-four exams in 42 patients (2 bilateral) were included. Twenty-eight cases had common peroneal neuropathy and 29, 21, and 9 cases had active denervation changes in the anterior, lateral, and posterior compartment/proximal muscles respectively on EDX. Sensitivity, specificity, and accuracy of non-contrast versus combined non-contrast and contrast sequences for common peroneal neuropathy were 50.0%, 56.2%, and 52.3% versus 50.0%, 56.2%, and 52.3% for reader 1 and 57.1%, 50.0%, and 54.5% versus 64.3%, 56.2%, and 61.4% for reader 2. Sensitivity, specificity, and accuracy of non-contrast and combined non-contrast and contrast sequences in identifying active denervation changes for anterior, lateral, and posterior compartment muscles were not significantly different. McNemar's tests were all negative. Conclusion: IV contrast does not improve the ability of MR neurography to detect CPN lesions or active muscle denervation changes. [ABSTRACT FROM AUTHOR]

The Northern Patagonian Icefield (NPI) and the Southern Patagonian Icefield (SPI) have increased their ice mass loss in recent decades. In view of the impacts of glacier shrinkage in Patagonia, an assessment of the potential future surface mass balance (SMB) of the icefields is critical. We seek to provide this assessment by modelling the SMB between 1976 and 2050 for both icefields, using regional climate model data (RegCM4.6) and a range of emission scenarios. For the NPI, reductions between 1.5 m w.e. (RCP2.6) and 1.9 m w.e. (RCP8.5) were estimated in the mean SMB during the period 2005–2050 compared to the historical period (1976–2005). For the SPI, the estimated reductions were between 1.1 m w.e. (RCP2.6) and 1.5 m w.e. (RCP8.5). Recently frontal ablation estimates suggest that mean SMB in the SPI is positively biased by 1.5 m w.e., probably due to accumulation overestimation. If it is assumed that frontal ablation rates of the recent past will continue, ice loss and sea-level rise contribution will increase. The trend towards lower SMB is mostly explained by an increase in surface melt. Positive ice loss feedbacks linked to increasing in meltwater availability are expected for calving glaciers. [ABSTRACT FROM AUTHOR]

In response to the commentaries provided by Chu et al. (2020), Harmon et al. (2020), and McMahon & Maxwell (2020) on our longitudinal follow-up of Child-Parent Psychotherapy (CPP) with mothers with depression and their children, we focus on two domains: accessibility and scalability of CPP and identifying empirically supported mechanisms of change in attachment intervention research. In considering the accessibility and scalability of CPP, we discuss issues related to attrition, length of intervention, and implementation with caregivers with depression. Our discussion of mechanisms of change in attachment interventions explores active comparison conditions, theorized mediators, intervention modalities, assessment methods, and longitudinal research designs. This conversation is intended to highlight important areas for future research in the field of attachment interventions, with the goal of informing clinical and systems-level policies and practices. [ABSTRACT FROM AUTHOR]

Objective: To present our experience with contrast-enhanced ultrasound (CEUS)-guided musculoskeletal soft tissue biopsies in a busy interventional clinic. Materials and methods: After IRB approval was obtained and informed consent was waived, we retrospectively reviewed all CEUS-guided musculoskeletal biopsies performed from December 1, 2018 to March 2, 2020. Relevant pre-procedure imaging was reviewed. Number of samples, suspected necrosis on pre-procedure imaging, specimen adequacy for pathologic analysis, correlation with pathologic diagnosis of surgical resection specimens, and procedural complications were recorded. Results: Thirty-six CEUS-guided musculoskeletal biopsies were performed in 32 patients (mean age 57, range 26–88; 22 males, 10 females). All procedures were performed using 16-gauge biopsy needles, and all procedures provided adequate samples for pathologic analysis as per the final pathology report. Between two and seven core specimens were obtained (mean 3.7). In 30/36 cases (83%), a contrast-enhanced MRI was obtained prior to biopsy, and 10/30 (33%) of these cases showed imaging features suspicious for necrosis. In 15/36 cases, surgical resection was performed, and the core biopsy and surgical resection specimens were concordant in 14/15 cases (93%). One patient noted transient leg discomfort at the time of microbubble bursting. Otherwise, no adverse reactions or procedural complications were observed. Conclusion: CEUS is an accurate way to safely target representative areas of soft tissue lesions for biopsy and can be implemented in a busy interventional clinic. Our early experience has shown this to be a promising technique, especially in targeting representative areas of heterogeneous lesions and lesions with areas of suspected necrosis on prior imaging. [ABSTRACT FROM AUTHOR]

Numerical models are often used to simulate estuarine physics and water quality under scenarios of future climate conditions. However, representing the wide range of uncertainty about future climate often requires an infeasible number of computationally expensive model simulations. Here, we develop and test a computationally inexpensive statistical model, or metamodel, as a surrogate for numerical model simulations. We show that a metamodel fit using only 12 numerical model simulations of Chesapeake Bay can accurately predict the early summer mean salinity, stratification, and circulation simulated by the numerical model given the input sea level, winter–spring streamflow, and tidal amplitude along the shelf. We then use this metamodel to simulate summer salinity and circulation under sampled probability distributions of projected future mean sea level, streamflow, and tidal amplitudes. The simulations from the metamodel show that future salinity, stratification, and circulation are all likely to be higher than present-day averages. We also use the metamodel to quantify how uncertainty about the model inputs transfers to uncertainty in the output and find that the model projections of salinity and stratification are highly sensitive to uncertainty about future tidal amplitudes along the shelf. This study shows that metamodels are a promising approach for robustly estimating the impacts of future climate change on estuaries. [ABSTRACT FROM AUTHOR]

We review developments in the field of boundary-layer flow over complex topography, focussing on the period from 1970 to the present day. The review follows two parallel strands: the impact of hills on flow in the atmospheric boundary layer and gravity-driven flows on hill slopes initiated by heating or cooling of the surface. For each strand we consider the understanding that has resulted from analytic theory before moving to more realistic numerical computation, initially using turbulence closure models and, more recently, eddy-resolving schemes. Next we review the field experiments and the physical models that have contributed to present understanding in both strands. For the period 1970–2000 with hindsight we can link major advances in theory and modelling to the key papers that announced them, but for the last two decades we have cast the net wider to ensure that we have not missed steps that eventually will be seen as critical. Two important new themes are given prominence in the 2000–2020 period. The first is flow over hills covered with tall plant canopies. The presence of a canopy changes the flow in important ways both when the flow is nearly neutral and also when it is stably stratified, forming a link between our two main strands. The second is the use of eddy-resolving models as vehicles to bring together hill flows and gravity-driven flows in a unified description of complex terrain meteorology. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound-guided choledochoduodenostomy (CDD) is emerging as an alternative technique for biliary drainage in patients who fail conventional endoscopic retrograde cholangiopancreatography (ERCP). The lumen-apposing metal stents (LAMS) are being increasingly used for CDD. We performed a systematic review and meta-analysis to evaluate the effectiveness and safety of CDD using LAMS.Methods: We performed a systematic search of multiple databases through May 2019 to identify studies on CDD using covered self-expanding metal stents. Pooled rates of technical success, clinical success, adverse events, and recurrent jaundice associated with CDD using LAMS were estimated. A subgroup analysis was performed based on use of LAMS with electrocautery-enhanced delivery system (EC-LAMS).Results: Seven studies on CDD using LAMS (with 284 patients) were included in the meta-analysis. Pooled rates of technical and clinical success (per-protocol analysis) were 95.7% (95% CI 93.2-98.1) and 95.9% (95% CI 92.8-98.9), respectively. Pooled rate of post-procedure adverse events was 5.2% (95% CI 2.6-7.9). Pooled rate of recurrent jaundice was 8.7% (95% CI 4.5-12.8). On subgroup analysis of CDD using EC-LAMS (5 studies with 201 patients), the pooled rates of technical and clinical success (per-protocol analysis) were 93.8% (95% CI 90.4-97.1) and 95.9% (95% CI 91.9-99.9), respectively. Pooled rate of post-procedure adverse events was 5.6% (95% CI 1.7-9.5). Pooled rate of recurrent jaundice was 11.3% (95% CI 6.9-15.7). Heterogeneity (I2) was low to moderate in the analyses.Conclusion: CDD using LAMS/EC-LAMS is an effective and safe technique for biliary decompression in patients who failed ERCP. Further studies are needed to assess CDD using LAMS as primary treatment modality for biliary obstruction. [ABSTRACT FROM AUTHOR]

Background: In patients with acute cholecystitis who are deemed high risk for cholecystectomy, percutaneous cholecystostomy (PC) was historically performed for gallbladder drainage (GBD). There are several limitations associated with PC. Endoscopic GBD [Endoscopic transpapillary GBD (ET-GBD) and EUS-guided GBD (EUS-GBD)] is an alternative to PC. We performed a systematic review and meta-analysis to compare the effectiveness and safety of EUS-GBD versus ET-GBD.Methods: We performed a systematic search of multiple databases through May 2019 to identify studies that compared outcomes of EUS-GBD versus ET-GBD in the management of acute cholecystitis in high-risk surgical patients. Pooled odds ratios (OR) of technical success, clinical success and adverse events between EUS-GBD and ET-GBD groups were calculated.Results: Five studies with a total of 857 patients (EUS-GBD vs ET-GBD: 259 vs 598 patients) were included in the analysis. EUS-GBD was associated with higher technical [pooled OR 5.22 (95% CI 2.03-13.44; p = 0.0006; I2 = 20%)] and clinical success [pooled OR 4.16 (95% CI 2.00-8.66; p = 0.0001; I2 = 19%)] compared to ET-GBD. There was no statistically significant difference in the rate of overall adverse events [pooled OR 1.30 (95% CI 0.77-2.22; p = 0.33, I2 = 0%)]. EUS-GBD was associated with lower rate of recurrent cholecystitis [pooled OR 0.33 (95% CI 0.14-0.79; p = 0.01; I2 = 0%)]. There was low heterogeneity in the analyses.Conclusion: EUS-GBD has higher rate of technical and clinical success compared to ET-GBD. While the rates of overall adverse events are statistically similar, EUS-GBD has lower rate of recurrent cholecystitis. Hence, EUS-GBD is preferable to ET-GBD for endoscopic management of acute cholecystitis in select high-risk surgical patients. [ABSTRACT FROM AUTHOR]

We present a table-top beamline providing a soft X-ray supercontinuum extending up to 370 eV from high-order harmonic generation with sub-13 fs 1300 nm driving pulses and simultaneous production of sub-5 fs pulses centered at 800 nm. Optimization of high harmonic generation in a long and dense gas medium yields a photon flux of ~ 1.4 × 106 photons/s/1% bandwidth at 300 eV. The temporal resolution of X-ray transient absorption experiments with this beamline is measured to be 11 fs for 800 nm excitation. This dual-wavelength approach, combined with high flux and high spectral and temporal resolution soft X-ray absorption spectroscopy, is a new route to the study of ultrafast electronic dynamics in carbon-containing molecules and materials at the carbon K-edge. [ABSTRACT FROM AUTHOR]

Purpose: Congenital duodenal obstruction (CDO) is associated with trisomy 21 (T21), or Down's syndrome, in around a third of infants. The aim of this study was to explore the impact of T21 on the epidemiology, management, and outcomes of infants with CDO.Methods: Data were prospectively collected from specialist neonatal surgical centres in the United Kingdom over a 12 month period from March 2016 using established population-based methodology for all babies with CDO. Infants with T21 were compared to those without any chromosomal anomaly.Results: Of 102 infants with CDO that underwent operative repair, T21 was present in 33 [32% (95% CI 23-41%)] babies. Cardiac anomalies were more common in those with T21 compared to those without a chromosomal anomaly (91 vs 17%, p < 0.001), whereas associated gastrointestinal anomalies were less common in infants with T21 (3 vs 12%, p = 0.03). Surgical management was not influenced by T21. Time to achieve full enteral feed, need for repeat related surgery, and mortality were similar between groups. Infants with T21 had a longer median initial inpatient stay (23 vs 16.5 days, p = 0.02).Conclusions: Infants with T21 have a higher incidence of cardiac anomalies and a longer initial inpatient stay; however, it does not change CDO management or outcomes. This information is important for prenatal and postnatal counselling of parents of infants with CDO and T21. [ABSTRACT FROM AUTHOR]

Background and Aims: Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas and has mostly replaced surgical local resection. Recent data have discussed the role of endoscopic removal of laterally spreading adenomas associated with ampullary adenomas. We evaluated our long-term results of endoscopic papillectomy for ampullary adenomas.Methods: We retrospectively analyzed patients who underwent endoscopic papillectomy of biopsy-proven adenomas at our tertiary center between 1994 and 2017. Clinical success was defined as complete excision of an adenoma with no evidence of recurrence during follow-up, no evidence of cancer, and without the need for surgery.Results: A total of 161 patients (73M/88F) with a mean age of 61 (range 19-93) were included. Mean adenoma size was 20 mm (range 5-70). In total, 114/161 patients continued endoscopic surveillance for a minimum of 6 months with a median follow-up of 30 months (range 6-283). Recurrent adenomas were diagnosed in 8 patients (7%) after a median of 36 months (range 12-138). Clinical success was 83%; 35 laterally spreading adenomas were treated, which were larger than adenomas confined to the papilla (mean size 38 mm vs 15 mm, P < 0.05) and required more piecemeal resections (77% vs 15%, P < 0.05). However, no difference was found in recurrence rates between the two groups (8% vs 4%, P = 0.26); 24/161 (15%) of patients had adverse events including bleeding (6%) and pancreatitis (7%).Conclusions: Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas, including laterally spreading ones. Long-term surveillance demonstrates low recurrence rates at expert centers. [ABSTRACT FROM AUTHOR]

Considerable efforts are underway to restore watersheds and estuaries downstream impacted by urban development; however, climate change (CC) may be undermining them. Current methods are limited in their ability to predict hydrology and water quality with CC and assess its effect on the efficiency of stormwater control measures (SCMs). We developed a method using downscaled global climate models (GCMs) from the Coupled Model Intercomparison Project Phase 5 (CMIP5) to project precipitation and temperatures; these were used to force a Storm Water Management Model (SWMM). Three scenarios, a historical and two Representative Concentration Pathways (RCP 4.5 and 8.5) with five GCMs, were used to produce ensemble results. All GCMs in both RCP scenarios projected increases in precipitation and temperature compared to historical conditions. Both RCPs exhibited their largest increases in precipitation, streamflow, total suspended solids (TSS), total nitrogen (TN), and total phosphorous (TP) loads in the winter, summer exhibited the largest increase in temperature. Median loads of TSS, TN, and TP increased 3.1%, 2.5%, and 9.9%, respectively, for RCP 4.5, and increased 3.8%, 3.1%, and 10.4%, respectively, for RCP 8.5. Median reductions in TSS, TN, and TP SCM efficiency for RCP 4.5 were projected to be 6%, 7%, and 11%, respectively; and 11%, 12%, and 17% for RCP 8.5, respectively. Thus, it is likely that additional efforts will be needed to meet water quality goals in the future. Methods such as these can help create climate resilient watershed improvement strategies and guide urban stormwater planning against likely future changes as a result of CC. [ABSTRACT FROM AUTHOR]

Objective: To determine the pubic bone fracture incidence and associated injury patterns in patients with core muscle injury.Materials and Methods: Ninety-three consecutive patients with core muscle injury protocol MRI showing rectus abdominis-adductor longus aponeurotic plate injuries from June 2007 through August 2017 were independently analyzed in blinded fashion by two musculoskeletal radiologists for the presence or absence of pubic bone fracture. A variety of other osseous and soft tissue injury characteristics were recorded. Pain duration prior to MRI and return to play time were taken from the clinical record. Statistical analysis included fracture incidence as well as the association of fracture with other injury characteristics, duration of pain, and return to play time.Results: Eighty-seven men and six women with a mean age of 34.4 years (range, 16-66 years) were included in the study cohort. Overall fracture incidence was 18.3% (17/93) including 13 fatigue fractures of the pubic body and four elevated cortical fractures/fragments. After correction for multiple comparisons, no strong association was identified with osseous or soft tissue injury characteristics, pain duration, or return to play time.Conclusions: Pubic fractures-particularly fatigue fractures-are a common co-existing injury in patients with a wide range of core muscle injury patterns. The presence of fracture did not have a strong correlation with injury patterns, pain duration, or return to play time but may have implications for patient management. [ABSTRACT FROM AUTHOR]

Background and Aims: Computer-assisted propofol sedation (CAPS) allows non-anesthesiologists to administer propofol for gastrointestinal procedures in relatively healthy patients. As the first US medical center to adopt CAPS technology for routine clinical use, we report our 1-year experience with CAPS for esophagogastroduodenoscopy (EGD).Methods: Between September 2014 and August 2015, 926 outpatients underwent elective EGDs with CAPS at our center. All EGDs were performed by 1 of 17 gastroenterologists certified in the use of CAPS. Procedural success rates, procedure times, and recovery times were compared against corresponding historical controls done with midazolam and fentanyl sedation from September 2013 to August 2014. Adverse events in CAPS patients were recorded.Results: The mean age of the CAPS cohort was 56.7 years (45% male); 16.2% of the EGDs were for variceal screening or Barrett's surveillance and 83.8% for symptoms. The procedural success rates were similar to that of historical controls (99.0% vs. 99.3%; p = 0.532); procedure times were also similar (6.6 vs. 7.4 min; p = 0.280), but recovery time was markedly shorter (31.7 vs. 52.4 min; p < 0.001). There were 11 (1.2%) cases of mild transient oxygen desaturation (< 90%), 15 (1.6%) cases of marked agitation due to undersedation, and 1 case of asymptomatic hypotension. In addition, there were six (0.6%) patients with more pronounced desaturation episodes that required brief (< 1 min) mask ventilation. There were no other serious adverse events.Conclusions: CAPS appears to be a safe, effective, and efficient means of providing sedation for EGD in healthy patients. Recovery times were much shorter than historical controls. [ABSTRACT FROM AUTHOR]

A challenge for climate impact studies is the selection of a limited number of climate model projections among the dozens that are typically available. Here, we examine the impacts of methods for climate model selection on projections of runoff change for five different watersheds across the conterminous USA. The results from an ensemble of 29 global climate models and 29 corresponding hydrological model simulations are compared with the results that would have been obtained by applying six different selection methods to the climate model data and using only the selected models to drive the hydrological model. We evaluate each selection method based on whether the runoff projections produced by the method meet the method's objective and on whether the results are sensitive to the number of models chosen. The Katsavounidis–Kuo–Zhang (KKZ) method, which is intended to maximize the spread in the projected climate change, was the only method that met both criteria for suitability. Although the KKZ method generally performed well, the results from both it and the other methods varied somewhat unpredictably based on region and number of models chosen. This study shows that the methods and models used in similar top–down studies should be carefully chosen and that the results obtained should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Hexavalent chromium contamination of groundwater is a worldwide problem caused by anthropogenic and natural processes. We report the rate of Cr(VI) removal by two humic acids (extracted from Miocene age lignite and younger peat soil) in aqueous suspensions across a pH range likely to be encountered in terrestrial environments. Cr(VI) was reduced to Cr(III) in a first-order reaction with respect Cr(VI) concentration, but exhibited a partial order (~ 0.5) with respect to [H+]. This reaction was more rapid with the peat humic acid, where Cr(VI) reduction was observed at all pH values investigated (3.7 ≤ pH ≤ 10.5). 13C NMR and pyrolysis GC-MS spectroscopy indicate that the reaction results in loss of substituted phenolic moieties and hydroxyl groups from the humic acids. X-ray absorption spectroscopy indicated that at all pH values the resulting Cr(III) was associated with the partially degraded humic acid in an inner-sphere adsorption complex. The reaction mechanism is likely to be controlled by ester formation between Cr(VI) and phenolic/hydroxyl moieties, as this initial step is rapid in acidic systems but far less favourable in alkaline conditions. Our findings highlight the potential of humic acid to reduce and remove Cr(VI) from solution in a range of environmental conditions. [ABSTRACT FROM AUTHOR]

Background: The utility of the American Society for Gastrointestinal Endoscopy (ASGE) grading scale assessing complexity of endoscopic retrograde cholangiopancreatography (ERCP) has not been evaluated in clinical practice.Methods: Patients that underwent ERCP between January 2015 and December 2015 were included. Procedural difficulty was graded according to the grading system proposed by the ASGE workshop. Technical success rates and complications were recorded.Results: A total of 1355 ERCPs were performed on 934 patients. Patients were equally divided with respect to gender and had a mean age of 58 years (range 29-86). 391 cases were grade 1, 2 (29%), 695 were grade 3 (51%), and 269 were grade 4 (20%). Altered anatomy was observed in 88% of grade 4 patients. Cannulation was achieved in 98% of cases graded 1-3 and in 88% of cases graded 4 (p < 0.05). Complications were recorded in 10% of all cases with post-ERCP pancreatitis (5.4%) and procedure-related bleeding (1.5%) being the more common ones. No statistically significant difference was noted between the groups with regard to complications. Three perforations were seen in grade 1-3 cases (0.3%) compared to 4 cases in grade 4 cases (1.5%), (p = 0.01).Conclusion: The grading system proposed by the ASGE workshop can aid in predicting cannulation success and perforation rates in ERCP. Based on this retrospective study, the most complex ERCP procedures can be achieved with encouraging rates of success. There is a need to validate our study with prospective ones performed in other high-volume centers. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of an abbreviated, two-sequence MRI protocol using limited pulse sequences for the detection of radiographically occult hip and pelvis fractures in the elderly compared to the complete MRI examination.Materials and Methods: One hundred and eleven consecutive emergency department patients age 65 or older who had undergone MRI to evaluate for clinically suspected hip fracture after negative radiographs were included in the study. The large field-of-view coronal T1 and STIR sequences were isolated from the complete six-sequence MRI protocol and reviewed independently in a blinded fashion by two musculoskeletal fellowship-trained radiologists who recorded presence or absence of fractures of the proximal femora or pelvis, fracture type, and presence or absence of soft tissue injury. Test accuracy was calculated with 95% confidence intervals and accuracy of fracture classification for the abbreviated protocol was compared to that made on the basis of the full exam.Results: For proximal femoral fractures, the abbreviated protocol had a pooled sensitivity and specificity for the two readers of 100 and 97%, respectively. For pelvic fractures, sensitivity was 92% and specificity was 98%. The kappa coefficient for fracture classification was 0.90 for reader 1 and 0.88 for reader 2, indicating excellent agreement for both readers in fracture classification compared to the classification made based on the complete MRI protocol.Conclusions: An abbreviated MRI protocol that includes only coronal T1 and STIR sequences maintains high sensitivity and specificity for hip and pelvis fracture detection and fracture classification. [ABSTRACT FROM AUTHOR]

The names of two of my co-authors, Elizabeth D. Handley and Dante Cicchetti, are misspelled as Elizabeth D. "Ha" and Dante "Cicchett" respectively. The online version of the original article can be found at https://doi.org/10.1007/s10802-023-01083-8 B Correction to: Research on Child and Adolescent Psychopathology b https://doi.org/10.1007/s10802-023-01083-8 The original version of this article contained some mistakes. [Extracted from the article]

We aimed to determine the microbiology of infected walled-off pancreatic necrosis (WON) in an era of minimally invasive treatment, since current knowledge is based on surgical specimens performed over two decades ago. We retrospectively analyzed a prospectively maintained database of patients who were treated for symptomatic WON using combined endoscopic and percutaneous drainage between 2008 and 2017. Aspirates from WON at initial treatment were evaluated. One hundred eighty-two patients were included with a mean age of 56 of whom 67% were male. Culture results were obtained at a median of 45 days from onset of acute pancreatitis of which 41% were infected. Candida spp. accounted for 27%; yet, multidrug-resistant organisms were found in only five patients. Approximately 64% were transferred to our institution for continuation of care. Of those, 55% were infected, most frequently with Candida spp., Enterococcus spp., and coagulase-negative Staphylococcus. Patients seen and admitted initially at our institution had milder forms of pancreatitis, fewer comorbidities, and 85% had symptomatic sterile WON. Empiric antibiotic use successfully predicted infection 70% of the time. Multivariate analysis demonstrated that elderly age, severity of pancreatitis, and prior use of antibiotics were indicators of infection. Necrotic pancreatic tissue remains sterile in the majority of cases treated with minimally invasive therapy, enabling judicious selection of antibiotics. Candida and Enterococcus spp. were common. Patients at highest risk for infection were previously treated with antibiotics and those transferred from outside institutions. [ABSTRACT FROM AUTHOR]

Background: The role of EUS in managing asymptomatic pancreatic cystic lesions (PCLs) remains unresolved. We retrospectively evaluated EUS in risk stratification of PCLs when adhering to the most recent AGA guidelines.Methods: Asymptomatic PCLs that were evaluated by EUS from January 2014 to December 2014 were retrospectively reviewed including associated cytology, fluid analysis, and relevant surgical pathology. Cross-sectional imaging reports were reviewed blindly by an expert radiologist using AGA risk stratification terminology. Accepted imaging high-risk features (HRF) included cyst diameter > 3 cm, dilated upstream pancreatic ducts, and a solid component in the cyst.Results: We reviewed 125 patients who underwent EUS. Expert review of cross-sectional imaging resulted in a different interpretation 25% of the time including 1 malignant cyst. Ninety-three patients (75%) had no HRFs on cross-sectional imaging; 28 patients (22%) were diagnosed with 1 HRF and 4 patients (3%) had 2 HRFs. Adhering to AGA guidelines using 2 HRF as threshold for use of EUS, the diagnosis of malignant and high-risk premalignant lesions (including pancreatic adenocarcinoma, mucinous cystadenoma, neuroendocrine tumors, and IPMN with dysplasia) had a 40% sensitivity and 100% specificity. Had EUS been utilized based on a threshold of 1 HRF on imaging, malignant and high-risk premalignant lesions would have been identified with 80% sensitivity and 95% specificity. By adding EUS to radiographic imaging, the specificity for detecting carcinomas (p = 0.0009) and detection of all premalignant lesions (p = 0.003) statistically improved. Furthermore, EUS allowed 14 patients (11%) to avoid further surveillance by lowering their risk stratification.Conclusion: EUS remains an essential risk stratification modality for incidental PCLs. Current guideline suggestions of its utility may be too stringent. Our study justifies expert radiology review when managing PCLs. Further studies are required to identify the optimal approach to PCL management. [ABSTRACT FROM AUTHOR]

Purpose of review: Osteochondral lesions of the talus (OLT) are common injuries in athletes. The purpose of this study is to comprehensively review the clinical results and return to sport capacity in athletes following treatment for OLT. Recent findings: Reparative procedures, such as bone marrow stimulation, and replacement procedures, such as autologous osteochondral transplantation, provide good clinical outcomes in short- and mid-term follow-up in the athlete. Recently, biological augmentation and scaffold-based therapies have been shown to improve clinical and radiological outcomes in OLT in both the general population and athletes. Summary: Most studies are of a low level of evidence. Studies analyzing the return to sport capability in athletes are further lacking. High-level evidence and well-designed clinical trials are required to establish the most effective treatment protocol. [ABSTRACT FROM AUTHOR]

Recent studies of flow over forested hills have been motivated by a number of important applications including understanding CO $$_2$$ and other gaseous fluxes over forests in complex terrain, predicting wind damage to trees, and modelling wind energy potential at forested sites. Current modelling studies have focussed almost exclusively on highly idealized, and usually fully forested, hills. Here, we present model results for a site on the Isle of Arran, Scotland with complex terrain and heterogeneous forest canopy. The model uses an explicit representation of the canopy and a 1.5-order turbulence closure for flow within and above the canopy. The validity of the closure scheme is assessed using turbulence data from a field experiment before comparing predictions of the full model with field observations. For near-neutral stability, the results compare well with the observations, showing that such a relatively simple canopy model can accurately reproduce the flow patterns observed over complex terrain and realistic, variable forest cover, while at the same time remaining computationally feasible for real case studies. The model allows closer examination of the flow separation observed over complex forested terrain. Comparisons with model simulations using a roughness length parametrization show significant differences, particularly with respect to flow separation, highlighting the need to explicitly model the forest canopy if detailed predictions of near-surface flow around forests are required. [ABSTRACT FROM AUTHOR]

Background: Previous reports comparing endoscopic therapy (ET) and surgical therapy (ST) have predominantly assessed patients with high-grade dysplasia. The study aim was to compare ET to ST in physiologically fit patients with cT1a adenocarcinoma (EAC).Methods: Review of two prospective databases yielded 100 patients presenting with clinical cT1a EAC between 2000 and 2013. Only physiologically fit patients who were candidates for either treatment were analyzed.Results: Presenting patient characteristics were similar between ET (n = 36) and ST groups (n = 49). Surgical patients were less likely to be staged with EMR (43 vs 100 %) and were associated with mass lesions >1 cm at EGD (p = 0.01), multifocal EAC (p = 0.03), and positive margins for EAC on EMR (p < 0.05). On multivariate analysis, only multifocal HGD was an independent factor for surgery. Following esophagectomy, R0 resection rates for Barrett's esophagus and cancer were 100 %. Incidence of surgery decreased over the study period from 85 to 25 %. All ET patients had EMR, and 28 patients underwent additional ablative therapies for Barrett's esophagus. Following ET, eradication rates of EAC, dysplasia, and BE were 92, 81, and 53 %, respectively. Morbidity rates were comparable between groups (ST 51 % vs ET 39 %, p = 0.31). In-hospital mortality rate was zero in each group. Recurrence rates in ST and ET group were 2 and 11 % (p = 0.08). In the ET group, two patients with endoluminal cancer recurrence after complete eradication underwent esophagectomy. Age-adjusted overall survival was comparable.Conclusion: In high-volume esophageal centers, ST and ET provide equally safe and effective treatment for cT1a EAC in medically fit patients. While the results of this study provide a historical perspective and clearly demonstrate an evolution toward ET over time, the appropriate treatment modality is best selected in a multidisciplinary fashion with EMR providing the most accurate staging. In endoscopically treated patients, indefinite endoscopic follow-up required, however, standardized long-term follow-up protocols are needed. [ABSTRACT FROM AUTHOR]

Blackleg disease caused by the fungus Leptosphaeria maculans is one of the most devastating diseases of Brassica napus. Association mapping was used to evaluate the response of 139 B. napus accessions originated from 16 countries with 4 growth habit types to inoculation with L. maculans isolates from pathogenicity group 4. All accessions were inoculated at the seedling stage and 37,346 single nucleotide polymorphism markers based upon genotyping-by-sequencing were used for analysis. One major QTL associated with the blackleg disease was identified on chromosome A01 at 9.66 Mbp and explains about 14.7 % of phenotypic variation (p value <2.2E−05). Orthologs of Arabidopsis thaliana hydroxyproline-rich glycoprotein family protein, acyl-CoA oxidase 1 and cysteine-/histidine-rich C1 domain family protein that are involved in plant defense mechanism were identified in this QTL region. At a lower significance (p value <0.00139), thirty-five additional markers were identified which are located on 13 other chromosomes. Stepwise regression identified that these markers belong to ten QTL regions and together explain 51.04 % of phenotypic variations. Additional twenty orthologs of A. thaliana disease resistance genes, transcription factors, genes in phytohormone pathway and signaling in plant defense pathway have been identified to be associated with the blackleg disease. Based on the haplotype at the most significant QTL, a total of 22 genotypes were evaluated in the greenhouse. As expected with the haplotype, we had 100 % success in predicting the phenotype. These markers could further be used for identification of phenotype that can be used in the breeding program. [ABSTRACT FROM AUTHOR]

Physicians depend on the use of flexible endoscopes for delivery of vital care that is morbidity sparing compared to surgical alternatives. Iatrogenic infection is a well-documented complication of therapeutic endoscopy. Recent emergence of unique antimicrobial resistance patterns and molecular 'fingerprinting' of bacteria harken a new era in duodenoscope-related infections which occur in spite of compliance with device manufacturer-recommended protocols for high-level disinfection (HLD). Further studies suggest that these protocols are likely inadequate. Endoscopic retrograde cholangiopancreatography (ERCP) remains critical in the provision of minimally invasive diagnostic, therapeutic, and palliative care for patients with pancreaticobiliary disease. This manuscript reviews the history of duodenoscope-related infections, current challenges to scope reprocessing, and recommendations from regulatory agencies. [ABSTRACT FROM AUTHOR]