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Nearly every glacier in Greenland has thinned or retreated over the past few decades1–4, leading to glacier acceleration, increased rates of sea-level rise and climate impacts around the globe5–9. To understand how calving-front retreat has affected the ice-mass balance of Greenland, we combine 236,328 manually derived and AI-derived observations of glacier terminus positions collected from 1985 to 2022 and generate a 120-m-resolution mask defining the ice-sheet extent every month for nearly four decades. Here we show that, since 1985, the Greenland Ice Sheet (GrIS) has lost 5,091 ± 72 km2 of area, corresponding to 1,034 ± 120 Gt of ice lost to retreat. Our results indicate that, by neglecting calving-front retreat, current consensus estimates of ice-sheet mass balance4,9 have underestimated recent mass loss from Greenland by as much as 20%. The mass loss we report has had minimal direct impact on global sea level but is sufficient to affect ocean circulation and the distribution of heat energy around the globe10–12. On seasonal timescales, Greenland loses 193 ± 25 km2 (63 ± 6 Gt) of ice to retreat each year from a maximum extent in May to a minimum between September and October. We find that multidecadal retreat is highly correlated with the magnitude of seasonal advance and retreat of each glacier, meaning that terminus-position variability on seasonal timescales can serve as an indicator of glacier sensitivity to longer-term climate change.Analysis of more than 236,000 observations of glacier terminus positions shows that accelerated calving reduced the ice area of Greenland by about 5,000 km2 since 1985, producing over 1,000 Gt of freshwater that could influence ocean salinity and circulation. [ABSTRACT FROM AUTHOR]

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

Background: Although patients with lower socioeconomic status are at higher risk of obesity, bariatric surgery utilization among patients with Medicaid is low and may be due to program-specific variation in access. Our goal was to compare bariatric surgery programs by percentage of Medicaid cases and to determine if variation in distribution of patients with Medicaid could be linked to adverse outcomes. Methods: Using a state-wide bariatric-specific data registry that included 43 programs performing 97,207 cases between 2006 and 2020, we identified all patients with Medicaid insurance (n = 4780, 4.9%). Bariatric surgery programs were stratified into quartiles according to the percentage of Medicaid cases performed and we compared program-specific characteristics as well as baseline patient characteristics, risk-adjusted complication rates and wait times between top and bottom quartiles. Results: Program-specific distribution of Medicaid cases varied between 0.69 and 22.4%. Programs in the top quartile (n = 11) performed 18,885 cases in total, with a mean of 13% for Medicaid patients, while programs in the bottom quartile (n = 11) performed 32,447 cases in total, with a mean of 1%. Patients undergoing surgery at programs in the top quartile were more likely to be Black (20.2% vs 13.5%, p < 0.0001), have diabetes (35.1% vs 29.5%, p < 0.0001), hypertension (55.1% vs 49.6%, p < 0.0001) and hyperlipidemia (47.6% vs 45.2%, p < 0.0001). Top quartile programs also had higher complication rates (8.4% vs 6.6%, p < 0.0001), extended length of stay (5.6% vs 4.0%, p < 0.0001), Emergency Department visits (8.1% vs 6.5%, p < 0.0001) and readmissions (4.7% vs 3.9%, p < 0.0001). Median time from initial evaluation to surgery date was also significantly longer among top quartile programs (200 vs 122 days, p < 0.0001). Conclusions: Bariatric surgery programs that perform a higher proportion of Medicaid cases tend to care for patients with greater disease severity who experience delays in care and also require more resource utilization. Improving bariatric surgery utilization among patients with lower socioeconomic status may benefit from insurance standardization and program-centered incentives to improve access and equitable distribution of care. [ABSTRACT FROM AUTHOR]

Defining social scientific concepts can contribute to scholarly advancement in many ways. Definitions, which we define as a description of a word or phrase using terms for which the meaning is well known in the community, can contribute to inclusive discussion by welcoming outsiders, mitigate misunderstandings among insiders, encourage theorists to commit to the (sometimes surprising) entailments of their theories, and provide starting points and new pathways for future research. A necessary feature of definitions is “boundaries” – to define is to bound. But, it is precisely in boundaries that definitions get us into problems: the meanings of words are inherently fuzzy and changing; exceptionless definitions are elusive. We elaborate a process of “definition work” which is inherently “community work.” The process recognizes that meaning is a dynamic and fuzzy community property and uses theory visualizations – specifically, property spaces, schematic networks, and dynamic spanning trees – as definition tools to explore this fuzziness, while also communicating definitions along with their indeterminacy. [ABSTRACT FROM AUTHOR]

A pandemic, like other disasters, changes how systems work. In order to support research on how the COVID-19 pandemic impacted the dynamics of a single metropolitan area and the communities therein, we developed and made publicly available a "data-support system" for the city of Boston. We actively gathered data from multiple administrative (e.g., 911 and 311 dispatches, building permits) and internet sources (e.g., Yelp, Craigslist), capturing aspects of housing and land use, crime and disorder, and commercial activity and institutions. All the data were linked spatially through BARI's Geographical Infrastructure, enabling conjoint analysis. We curated the base records and aggregated them to construct ecometric measures (i.e., descriptors of a place) at various geographic scales, all of which were also published as part of the database. The datasets were published in an open repository, each accompanied by a detailed documentation of methods and variables. We anticipate updating the database annually to maintain the tracking of the records and associated measures. Measurement(s) Neighborhood context Technology Type(s) Naturally-occurring data Sample Characteristic - Environment City neighborhoods Sample Characteristic - Location Boston, MA, USA [ABSTRACT FROM AUTHOR]

In this study of patients admitted with COVID-19, we examined differences between the two waves in patient characteristics and outcomes. Data were collected from the first COVID-19 admission to the end of study (01/03/2020–31/03/2021). Data were adjusted for age and sex and presented as odds ratios (OR) with 95% confidence intervals (CI). Among 12,471 admissions, 1452 (11.6%) patients were diagnosed with COVID-19. On admission, the mean (± SD) age of patients with other causes was 68.3 years (± 19.8) and those with COVID-19 in wave 1 was 69.4 years (± 18.0) and wave 2 was 66.2 years (± 18.4). Corresponding ages at discharge were 67.5 years (± 19.7), 63.9 years (± 18.0) and 62.4 years (± 18.0). The highest proportion of total admissions was among the oldest group (≥ 80 years) in wave 1 (35.0%). When compared with patients admitted with other causes, those admitted with COVID-19 in wave 1 and in wave 2 were more frequent in the 40–59 year band: 20.8, 24.6 and 30.0%; consisted of more male patients: 47.5, 57.6 and 58.8%; and a high LACE (Length of stay, Acuity of admission, Comorbidity and Emergency department visits) index (score ≥ 10): 39.4, 61.3 and 50.3%. Compared to wave-2 patients, those admitted in wave 1 had greater risk of death in hospital: OR = 1.58 (1.18–2.12) and within 30 days of discharge: OR = 2.91 (1.40–6.04). Survivors of COVID-19 in wave 1 stayed longer in hospital (median = 6.5 days; interquartile range = 2.9–12.0) as compared to survivors from wave 2 (4.5 days; interquartile range = 1.9–8.7). Patient characteristics differed significantly between the two waves of COVID-19 pandemic. There was an improvement in outcomes in wave 2, including shorter length of stay in hospital and reduction of mortality. [ABSTRACT FROM AUTHOR]

The use of cerebral autoregulation monitoring to identify patient-specific optimal mean arterial pressure (MAPOPT) has emerged as a technique to augment cerebral oxygen delivery in post-cardiac arrest patients. Our systematic review aims to determine (a) the average MAPOPT in these patients, (b) the feasibility of identifying MAPOPT, (c) the brain tissue oxygenation levels when MAP is within proximity to the MAPOPT and (d) the relationship between neurological outcome and MAPOPT-targeted resuscitation strategies. We carried out this review in accordance with the PRISMA guidelines. We included all studies that used cerebral autoregulation to determine MAPOPT in adult patients (> 16 years old) who achieved return of spontaneous circulation (ROSC) following cardiac arrest. All studies had to include our primary outcome of MAPOPT. We excluded studies where the patients had any history of traumatic brain injury, ischemic stroke or intracranial hemorrhage. We identified six studies with 181 patients. There was wide variability in cerebral autoregulation monitoring methods, length of monitoring, calculation and reporting of MAPOPT. Amongst all studies, the median or mean MAPOPT was consistently above 65 mmHg (range 70-114 mmHg). Definitions of feasibility varied among studies and were difficult to summarize. Only one study noted that brain tissue oxygenation increased as patients' MAP approached MAPOPT. There was no consistent association between targeting MAPOPT and improved neurological outcome. There is considerable heterogeneity in MAPOPT due to differences in monitoring methods of autoregulation. Further research is needed to assess the clinical utility of MAPOPT-guided strategies on decreasing secondary injury and improving neurological outcomes after ROSC. [ABSTRACT FROM AUTHOR]

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

Regulatory B cells restrict immune and inflammatory responses across a number of contexts. This capacity is mediated primarily through the production of IL-10. Here we demonstrate that the induction of a regulatory program in human B cells is dependent on a metabolic priming event driven by cholesterol metabolism. Synthesis of the metabolic intermediate geranylgeranyl pyrophosphate (GGPP) is required to specifically drive IL-10 production, and to attenuate Th1 responses. Furthermore, GGPP-dependent protein modifications control signaling through PI3Kδ-AKT-GSK3, which in turn promote BLIMP1-dependent IL-10 production. Inherited gene mutations in cholesterol metabolism result in a severe autoinflammatory syndrome termed mevalonate kinase deficiency (MKD). Consistent with our findings, B cells from MKD patients induce poor IL-10 responses and are functionally impaired. Moreover, metabolic supplementation with GGPP is able to reverse this defect. Collectively, our data define cholesterol metabolism as an integral metabolic pathway for the optimal functioning of human IL-10 producing regulatory B cells. IL-10 production by B cells is integral to regulation and resolution of inflammation. Here the authors show that cholesterol metabolism can control B cell IL-10 production via a geranylgeranyl pyrophosphate-dependent mechanism. [ABSTRACT FROM AUTHOR]

Based on prior research, there is evidence that suggests a relationship between flow, mindfulness, cognitive flexibility, and postformal thought. In Study 1, 46 undergraduates from Towson University, 12 male and 34 female, with an age range from 18 to 32 participated in this study. Materials consisted of a consent form, a demographic questionnaire, a postformal thought survey, the Short DFS, CAMS-R, CFS, and an additional flow questionnaire developed by Langer. Participants completed a consent form, the two demographic questions, and the remaining surveys. The research design was a correlational study testing the hypothesis that there would be positive linear relationships between flow, mindfulness, cognitive flexibility, and postformal thought. There was a significant relationship between flow, mindfulness, and postformal thought. There was also a significant relationship between mindfulness and cognitive flexibility. In Study 2, 51 undergraduates participated and completed all scales. The goal was to replicate the results of the first study using the same materials. Results were that, with the exception of one correlation, all of our scales were significantly positively inter-correlated. So the significant results of Study 1 were replicated and Study 2 found even stronger associations. Strategies for future research include developing a test that allows individuals to actually engage in flow, mindfulness, and cognitive flexibility rather than simply reflect on and report their propensity to do this. [ABSTRACT FROM AUTHOR]

APOE4 is the strongest genetic risk factor for late-onset Alzheimer disease. ApoE4 increases brain amyloid-β pathology relative to other ApoE isoforms. However, whether APOE independently influences tau pathology, the other major proteinopathy of Alzheimer disease and other tauopathies, or tau-mediated neurodegeneration, is not clear. By generating P301S tau transgenic mice on either a human ApoE knock-in (KI) or ApoE knockout (KO) background, here we show that P301S/E4 mice have significantly higher tau levels in the brain and a greater extent of somatodendritic tau redistribution by three months of age compared with P301S/E2, P301S/E3, and P301S/EKO mice. By nine months of age, P301S mice with different ApoE genotypes display distinct phosphorylated tau protein (p-tau) staining patterns. P301S/E4 mice develop markedly more brain atrophy and neuroinflammation than P301S/E2 and P301S/E3 mice, whereas P301S/EKO mice are largely protected from these changes. In vitro, E4-expressing microglia exhibit higher innate immune reactivity after lipopolysaccharide treatment. Co-culturing P301S tau-expressing neurons with E4-expressing mixed glia results in a significantly higher level of tumour-necrosis factor-α (TNF-α) secretion and markedly reduced neuronal viability compared with neuron/E2 and neuron/E3 co-cultures. Neurons co-cultured with EKO glia showed the greatest viability with the lowest level of secreted TNF-α. Treatment of P301S neurons with recombinant ApoE (E2, E3, E4) also leads to some neuronal damage and death compared with the absence of ApoE, with ApoE4 exacerbating the effect. In individuals with a sporadic primary tauopathy, the presence of an ε4 allele is associated with more severe regional neurodegeneration. In individuals who are positive for amyloid-β pathology with symptomatic Alzheimer disease who usually have tau pathology, ε4-carriers demonstrate greater rates of disease progression. Our results demonstrate that ApoE affects tau pathogenesis, neuroinflammation, and tau-mediated neurodegeneration independently of amyloid-β pathology. ApoE4 exerts a 'toxic' gain of function whereas the absence of ApoE is protective. [ABSTRACT FROM AUTHOR]

It has been suggested by some past research that there is a relationship between postformal thought and intelligence. Also, prior research suggests that motivated individuals tend to perform better on measured tasks, such as taking tests. The two distinct studies reported here first test the hypothesis that, supposing that IQ and postformal thought tap into some similar cognitive operations, individuals would use some similar patterns of responses in showing both intelligence and reported postformal operations. The participants in this research were two separate samples of 41 emerging adult undergraduate students from Towson University who chose to sign up through the research pool website. In the first study materials consisted of a consent form, demographic questionnaire, a use of postformal thought survey, and the WASI abbreviated test. In the second study a pretest and posttest reported motivation survey were added. In the first study no significant relations were found between the reported use of postformal thought and the WASI IQ scores. In the second study there was a significant correlation between motivation and intelligence and between motivation and an individual's reported level of postformal thought. However, there was no significant relationship found between postformal thought and intelligence, even with motivation controlled. Further studies of the cognitive mechanisms underlying IQ and postformal complex problem solving may help determine the cognitive skills needed to differentially succeed at each of these skills. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that selective M4 muscarinic acetylcholine receptor (mAChR) activators may offer a novel strategy for the treatment of psychosis. However, previous efforts to develop selective M4 activators were unsuccessful because of the lack of M4 mAChR subtype specificity and off-target muscarinic adverse effects. We recently developed VU0152100, a highly selective M4 positive allosteric modulator (PAM) that exerts central effects after systemic administration. We now report that VU0152100 dose-dependently reverses amphetamine-induced hyperlocomotion in rats and wild-type mice, but not in M4 KO mice. VU0152100 also blocks amphetamine-induced disruption of the acquisition of contextual fear conditioning and prepulse inhibition of the acoustic startle reflex. These effects were observed at doses that do not produce catalepsy or peripheral adverse effects associated with non-selective mAChR agonists. To further understand the effects of selective potentiation of M4 on region-specific brain activation, VU0152100 alone and in combination with amphetamine were evaluated using pharmacologic magnetic resonance imaging (phMRI). Key neural substrates of M4-mediated modulation of the amphetamine response included the nucleus accumbens (NAS), caudate-putamen (CP), hippocampus, and medial thalamus. Functional connectivity analysis of phMRI data, specifically assessing correlations in activation between regions, revealed several brain networks involved in the M4 modulation of amphetamine-induced brain activation, including the NAS and retrosplenial cortex with motor cortex, hippocampus, and medial thalamus. Using in vivo microdialysis, we found that VU0152100 reversed amphetamine-induced increases in extracellular dopamine levels in NAS and CP. The present data are consistent with an antipsychotic drug-like profile of activity for VU0152100. Taken together, these data support the development of selective M4 PAMs as a new approach to the treatment of psychosis and cognitive impairments associated with psychiatric disorders such as schizophrenia. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the relative efficacy in diabetes remission among predominantly African-American patients who have undergone one of the three different types of bariatric surgical procedures. Methods: A total of 597 morbidly obese patients underwent one of the three bariatric surgical procedures at Harper University Hospital, Detroit, Michigan from 2008 to 2011. Of the three procedures, 203 (34 %) patients had laparoscopic sleeve gastrectomy, 264 (44.2 %) patients had laparoscopic gastric bypass, and 130 (21.8 %) had laparoscopic adjustable gastric banding. The prevalence of diabetes prior to surgery was 20.7, 17.4, and 24 %, respectively. There was no statistical difference in the prevalence of diabetes among the three surgical groups. Results: Of the 119 patients with diabetes, 46 (38.7 %) were males and 73 (61.3 %) were females. The majority of patients were African-Americans (65 %). The average age of patients was 42.2 ± 8.3 years for sleeve gastrectomy, 44.8 ± 7.9 years for gastric banding, and 41.5 ± 7.7 years for gastric bypass surgery. Of all the study patients with a preoperative diagnosis of type 2 diabetes, 86 patients (72.3 %) had resolution of diabetes 1 year after surgery. The resolution of diabetes was reported in 89.1, 66.7, and 54.8 % of patients who underwent laparoscopic gastric bypass, sleeve gastrectomy, and gastric banding, respectively. Conclusions: This study, which was conducted among predominantly African-Americans, showed consistent results with other studies. Patients who underwent laparoscopic gastric bypass appeared to benefit the most in terms of achieving better remission of diabetes. [ABSTRACT FROM AUTHOR]

Background Roux-en-Y gastric bypass is considered to be the gold standard of bariatric procedures. Minimally invasive surgical techniques have been demonstrated to decrease recovery time and provide for favorable cosmetic outcomes. The drawback of traditional laparoscopic techniques for the surgeon comes in the form of 2D monitoring of not always intuitive instrument manipulation. The da Vinci Surgical System provides surgeons with a 3D view and more intuitive instrument manipulation. This study was conducted in order to compare the surgical outcomes and assess the learning curve of traditional laparoscopic Roux-en-Y gastric bypasses (LRYGB) to totally robotic Roux-en-Y gastric bypasses (TRRYGB). A single surgeon's 100 most recent patients who underwent traditional LRYGB and the first 100 patients who underwent TRRYGB were included in this study. Data was collected on patient age, gender, body mass index (BMI), co-morbidities, surgical time, length of admission, and complication rates. No significant differences were found between study groups with respect to age, gender, BMI or any recorded co-morbidities. The mean operative times for patients 1-50 in the TRRYGB and LRYGB groups were 204.34 ± 90.19 min and 151.16 ± 47.16 min, respectively ( P = 0.0004). Mean operative times were 159.60 ± 48.26 min and 166.66 ± 44.95 min for patients 51-100 in the TRRYGB and LRYGB groups, respectively ( P = 0.45). No significant differences were found between study groups with respect to post-surgical complications or 30-day outcomes. Our data shows that TRRYGB compares favorably to the traditional laparoscopic approach, while maintaining patient safety. [ABSTRACT FROM AUTHOR]

Why do otherwise well-intentioned managers make decisions that have negative social or environmental consequences? To answer this question, the authors combine the literature on construal level theory with the compromise effect to explore the circumstances that lead to seemingly unethical decision-making. The results of two studies suggest that the degree to which managers make high-risk tradeoffs is highly influenced by how they mentally represent the decision context. The authors find that managers are more likely to make seemingly unethical tradeoffs when psychological distance is high (rather than low) and when they are forced to choose between competing alternatives. However, when given the option not to choose, managers better reflect on the consequences of each alternative, and thus become more likely to choose options with less risk of negative consequences. The results suggest that simply offering managers the option not to choose may reduce psychological distance and help organizations avoid seemingly unethical decision-making. [ABSTRACT FROM AUTHOR]

Many theories of category learning incorporate mechanisms for selective attention, typically implemented as attention weights that change on a trial-by-trial basis. This is because there is relatively little data on within-trial changes in attention. We used eye tracking and mouse tracking as fine-grained measures of attention in three complex visual categorization tasks to investigate temporal patterns in overt attentional behavior within individual categorization decisions. In Experiments 1 and 2, we recorded participants' eye movements while they performed three different categorization tasks. We extended previous research by demonstrating that not only are participants less likely to fixate irrelevant features, but also, when they do, these fixations are shorter than fixations to relevant features. We also found that participants' fixation patterns show increasingly consistent temporal patterns. Participants were faster, although no more accurate, when their fixation sequences followed a consistent temporal structure. In Experiment 3, we replicated these findings in a task where participants used mouse movements to uncover features. Overall, we showed that there are important temporal regularities in information sampling during category learning that cannot be accounted for by existing models. These can be used to supplement extant models for richer predictions of how information is attended to during the buildup to a categorization decision. [ABSTRACT FROM AUTHOR]

This paper shows how the prospect of a forest carbon market in Papua New Guinea added a new element of instability to national forest policy and property processes that were already moving in contradictory directions. In particular we examine attempts by foreign investors to forge voluntary carbon agreements with customary landowners after the Bali climate change conference of 2007, and the mobilization of state institutions to counter these 'private dealings'. We highlight the connection between the ways that these processes played out at both national and local scales, with a focus on the highly contentious Kamula Doso forest area in Western Province. We conclude with some observations on the way that the constitutional protection of customary land rights inhibits the formalization of marketable rights in forest resources, including forest carbon, and creates an inconclusive circularity in the operation of forest policy and property processes at different levels of social and political organization. [ABSTRACT FROM AUTHOR]

Many current computational models of object categorization either include no explicit provisions for dealing with incomplete stimulus information (e.g. Kruschke, Psychological Review 99:22-44, ) or take approaches that are at odds with evidence from other fields (e.g. Verguts, Ameel, & Storms, Memory & Cognition 32:379-389, ). In two experiments centered around the inverse base-rate effect, we demonstrate that people not only make highly informed inferences about the values of unknown features, but also subsequently use the inferred values to come to a categorization decision. The inferences appear to be based on immediately available information about the particular stimulus under consideration, as well as on higher-level inferences about the stimulus class as a whole. Implications for future modeling efforts are discussed. [ABSTRACT FROM AUTHOR]

Reptiles are an important, and often protected, component of many ecosystems but have rarely been fully considered within ecological risk assessments (ERA) due to a paucity of data on contaminant uptake and effects. This paper presents a meta-analysis of literature-derived environmental media (soil and water) to whole-body concentration ratios (CRs) for predicting the transfer of 35 elements (Am, As, B, Ba, Ca, Cd, Ce, Cm, Co, Cr, Cs, Cu, Fe, Hg, K, La, Mg, Mn, Mo, Na, Ni, Pb, Po, Pu, Ra, Rb, Sb, Se, Sr, Th, U, V, Y, Zn, Zr) to reptiles in freshwater ecosystems and 15 elements (Am, C, Cs, Cu, K, Mn, Ni, Pb, Po, Pu, Sr, Tc, Th, U, Zn) to reptiles in terrestrial ecosystems. These reptile CRs are compared with CRs for other vertebrate groups. Tissue distribution data are also presented along with data on the fractional mass of bone, kidney, liver and muscle in reptiles. Although the data were originally collected for use in radiation dose assessments, many of the CR data presented in this paper will also be useful for chemical ERA and for the assessments of dietary transfer in humans for whom reptiles constitute an important component of the diet, such as in Australian aboriginal communities. [ABSTRACT FROM AUTHOR]

Environmental monitoring programs often measure contaminant concentrations in animal tissues consumed by humans (e.g., muscle). By comparison, demonstration of the protection of biota from the potential effects of radionuclides involves a comparison of whole-body doses to radiological dose benchmarks. Consequently, methods for deriving whole-body concentration ratios based on tissue-specific data are required to make best use of the available information. This paper provides a series of look-up tables with whole-body:tissue-specific concentration ratios for non-human biota. Focus was placed on relatively broad animal categories (including molluscs, crustaceans, freshwater fishes, marine fishes, amphibians, reptiles, birds and mammals) and commonly measured tissues (specifically, bone, muscle, liver and kidney). Depending upon organism, whole-body to tissue concentration ratios were derived for between 12 and 47 elements. The whole-body to tissue concentration ratios can be used to estimate whole-body concentrations from tissue-specific measurements. However, we recommend that any given whole-body to tissue concentration ratio should not be used if the value falls between 0.75 and 1.5. Instead, a value of one should be assumed. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Changes in mucosal serotonin (5-HT) signaling have been detected in a number of functional and inflammatory disorders of the gastrointestinal (GI) tract. This study was undertaken to determine whether chronic constipation (CC) is associated with disordered 5-HT signaling and to evaluate whether constipation caused by opiate use causes such changes.METHODS:Human rectal biopsy samples were obtained from healthy volunteers, individuals with idiopathic CC, and individuals taking opiate medication with or without occurrence of constipation. EC cells were identified by 5-HT immunohistochemistry. 5-HT content and release levels were determined by enzyme immunoassay, and mRNA levels for the synthetic enzyme tryptophan hydroxylase-1 (TpH-1) and serotonin-selective reuptake transporter (SERT) were assessed by quantitative real-time reverse transcription PCR.RESULTS:CC was associated with increases in TpH-1 transcript, 5-HT content, and 5-HT release under basal and stimulated conditions, whereas EC cell numbers and SERT transcript levels were not altered. No changes in these elements of 5-HT signaling were detected in opiate-induced constipation (OIC).CONCLUSIONS:These findings demonstrate that CC is associated with a pattern of altered 5-HT signaling that leads to increased 5-HT availability but does not involve a decrease in SERT expression. It is possible that increased 5-HT availability due to increased synthesis and release contributes to constipation due to receptor desensitization. Furthermore, the finding that elements of 5-HT signaling were not altered in the mucosa of individuals with OIC indicates that constipation as a condition does not lead to compensatory changes in 5-HT synthesis, release, or signal termination. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic bariatric surgery has experienced a rapid expansion of interest over the past 5 years, with a 470% increase. This rapid expansion has markedly increased overall cost, reducing surgical access. Many surgeons believe that the traditional open approach is a cheaper, safer, equally effective alternative. Methods: 16 highly experienced "open" bariatric surgeons with a combined total of 25,759 cases representing >200 surgeon years of experience, pooled their open Roux-en-Y gastric bypass (ORYGBP) data, and compared their results to the leading laparoscopic (LRYGBP) papers in the literature. Results: In the overall series, the incisional hernia rate was 6.4% using the standard midline incision. Utilizing the left subcostal incision (LSI), it was only 0.3%. Return to surgery in <30 days was 0.7%, deaths 0.25%, and leaks 0.4%. Average length of stay was 3.4 days, and return to usual activity 21 days. Small bowel obstruction was significantly higher with the LRYGBP. Surgical equipment costs averaged ∼$3,000 less for "open" cases. LRYGBP had an added expense for longer operative time. This more than made up for the shorter length of stay with the laparoscopic approach. Conclusions: The higher cost, higher leak rate, higher rate of small bowel obstruction, and similar long-term weight loss results make the "open" RYGBP our preferred operation. If the incision is taken out of the equation (i.e. use of the LSI), the significant advantages of the open technique become even more obvious. [ABSTRACT FROM AUTHOR]

Background: Excluding pulmonary embolism, anastomotic leak is the leading cause of death and major morbidity in patients undergoing open or laparoscopic gastric bypass operations. We observed a number of these leaks (11 out of 1,120 MicropouchSM gastric bypass [MGB] patients; 0.9%). The majority (80%) required emergency laparotomy and drainage, massive fluid resuscitation, and aggressive nutritional support. Therefore, we designed a 2-year, prospective study to determine the therapeutic efficacy of vapor-heated fibrin sealant to prevent anastomotic leaks at the gastro-jejunostomy (GJS) site. Methods: Between April, 2000 and March, 2002, 738 patients underwent a primary (n=671) or revisionary (n=67) MGB procedure.The gastric reservoir was limited to the cardia of the stomach. Vapor-heated fibrin glue 1 cc was applied circumferentially to a 12-mm, non-banded GJS anastomosis. Once activated, fibrin sealant polymerized into a soft, closely adherent gel. No omental patch was used to cover the fibrin-sealed anastomosis. Results: Of 738 patients, 2 required emergency laparotomy for leaks and 2 for adhesive bands that contributed to a distal small bowel obstruction.There were no anastomotic leaks at the fibrin-sealed GJS sites. No gastro-gastric or gastro-enteric fistulas were recorded. Conclusion. Fibrin sealant applied to the GJS site appears to have eliminated anastomotic leaks in our MicropouchSM gastric bypass patients. These results suggest that fibrin glue application may contribute to "leak prophylaxis" in patients undergoing open Rouxen-Y gastric bypass. Glue placements may also benefit patients undergoing a laparoscopic Roux-en-Y procedure, wherein anastomotic leaks have been reported early in the learning curve. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) is a leading cause of death following gastric bypass operations for morbid obesity. Although its incidence appears to be stable, the number of bariatric operations performed annually is increasing considerably; hence, the isolated fatal PE is no longer a rare occurrence. The records of patients undergoing bariatric surgical operations since 1979 were reviewed to determine specific factors that increased the risk of developing a fatal PE. Both recommended and optional indications for prophylactic inferior vena cava (IVC) filter placement in patients considered at high risk were also examined. Materials and Methods: Between September, 1979 and March, 2003, 5,554 operations were performed for clinically severe obesity. These operations included jejuno-ileal bypass, horizontal gastroplasty, Roux-en-Y gastric bypass with a 30-cc pouch, modified biliopancreatic diversion, the Sapala-Wood Micropouch® gastric bypass (MicropouchSM), Lap-Band®, and revisions. 12 fatal pulmonary emboli (0.21 %) were identified. All but 1 embolus occurred within 30 days following surgery. Results: In 11 of 12 patients, at least 1 co-morbidity known to increase the risk of postoperative venous thromboembolism (VTE) was identified. 4 co-morbidites were common to 4 patients (33%): venous stasis disease (VSD), BMI ≥ 60, truncal obesity, and obesity hypoventilation syndrome/sleep apnea syndrome (OHS/SAS). 6 of 12 patients (50%) had a BMI ≥ 60. Another 6 had chronic leg swelling with stasis dermatitis. 2 patients experienced a previous PE, and 1 patient reported a history of deep vein thrombosis (DVT). Conclusion: 4 patients (33%) demonstrated a combination of risk factors (VSD, BMI ≥ 60, truncal obesity, OHS/SAS) recognized as significant for the development of postoperative VTE. In such patients, prophylactic IVC filter placement is highly recommended. Filter placement for other factors, such as age, body build, hypercoagulable state, etc., should be considered on an individual basis. [ABSTRACT FROM AUTHOR]

Two model G-protein coupled membrane receptors (GPCRs), aserotonin (5HT) and a metabotropic glutamate (mGlu) receptor, stablyexpressed in CHO cells were used to characterize cultureconditions for maximum receptor expression and functionalactivity in membrane preparations. Expression levels of the5HT receptor were affected by the growth phase of the cellculture. Maximum receptor density, as measured by ligandbinding per mg membrane protein, was observed when cells wereharvested in late exponential growth phase. Expression couldbe increased further by addition of 10 mM sodium butyrate andincubation at 31 °C for 24 hours prior to cellharvest. In contrast, functional activity as determined byagonist-stimulated GTPγS binding was independent of the growthrate. For both receptors, butyrate treatment at decreasedtemperature negatively affected functional activity. The mGlureceptor membranes lost functional activity considerably whenthe cells were cultured in an agitated system either onmicrocarriers or as aggregates in suspension. Functionalactivity could be restored and further improved compared to acontrol grown in T-flasks when the cell culture was incubatedat 31 °C for 48 hours following a complete mediumexchange and omission of sodium butyrate. [ABSTRACT FROM AUTHOR]

An important aim of many surveys is to undertake prospecting research: the search for new possibilities and an understanding of the diversity in a population. This paper develops a method-the extrapolation of resampled possibilities (ERP)-for predicting how much new information will be revealed by extending a sample. This is useful for deciding whether it is likely to be worthwhile sampling more cases, bearing in mind the costs and the benefits. The method avoids making any assumptions about the nature of the underlying population, apart from the information implicit in the existing sample. [ABSTRACT FROM AUTHOR]

Background: Roux-en-Y gastric bypass is an effective procedure for the long-term control of morbid obesity. An eventual revisionary operation, however, is necessary for some patients (0.8-29%). Redo procedures are required for pouch enlargement, stapleline dehiscence, or marginal ulceration. In 1994, the micropouch gastric bypass (MBG) was developed to eliminate the need for a repeat operation. Its design was based on two anatomical principles: 1) The fundus is elastic, aperistaltic, and may significantly dilate over time; 2) The proximal magenstrasse contains a high concentration of parietal cells, which potentiates the risk for marginal ulceration or gastroesophageal reflux after vertical pouch restriction. Construction of a micropouch limited to the gastric cardia avoids using the fundus and proximal lesser curvature, but requires a greater mobilization of the stomach and its peritoneal attachments. Methods: Between February 1994 and February 2000, 1,120 patients underwent the MGB as a primary or revisionary operation.The fundus was mobilized completely, including transection of the left phreno-esophageal and gastrophrenic ligaments. The transected pouch was limited to the gastric cardia with 1 cm of fundus incorporated into the gastrojejunostomy stoma (GJS). Results: There were 10 anastomotic leaks at the GJS (0.9%). All leaks sealed following surgical drainage or parenteral nutrition. One patient required re-operation (0.09%) for a dilated pouch and marginal ulceration. An additional patient (0.09%) developed a gastrogastric fistula secondary to a pharmacobezoar and stomal stenosis. Conclusion: With an appreciation for the finer anatomy of the proximal stomach and intra-abdominal esophagus, the micropouch can be constructed safely in both primary and redo procedures. The MGB, now in its seventh year, is durable and has, with rare exception, eliminated pouch enlargement, staple-line separation, reflux esophagitis, and marginal ulceration. [ABSTRACT FROM AUTHOR]

Background: Since 1994 we have performed the "micropouch" gastric bypass (MGB) procedure for morbid obesity. In our MGB operation, the transected gastric reservoir is limited to the cardia of the stomach. The Roux and biliopancreatic limbs measure 200 and 150 cm, respectively; radiographic or endoscopic access to the bypassed stomach is therefore excluded. Methods: A retrospective analysis of 1,120 MGB operations revealed that 33 patients (2.9%) developed a potentially life-threatening postoperative complication requiring emergency re-operation or prolonged hospitalization. Complications included anastomotic leaks, fascial dehiscence, gastroenteric obstructions, peptic ulcers, and pancreatitis. Each complication was analyzed to determine if gastrostomy tube (G-tube) placement at the time of gastric bypass could have affected complication outcome or obviated the need for repeat laparotomy. Results: In 19 patients (1.6% of total cohort), G-tube placement would have significantly affected complication outcome. In four instances, it would have prevented emergency re-operation. Conclusions: Routine gastrostomy tube placement at the time of gastric bypass is not necessary in all patients. For patients who are at high risk for a gastro-enteric obstruction or an anastomotic leak, G-tube placement is recommended and is often therapeutic. [ABSTRACT FROM AUTHOR]

Background: Marginal ulceration (MU) after Roux-en-Y gastric bypass (RYGB) is a well-recognized complication. Its incidence varies between 1% and 16%. Factors associated with the development of MU include pouch size, pouch orientation, staple line integrity, and mucosal ischemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori may also contribute to MU, but their mechanism of action in the RYGB patient has not been studied. Methods: In 1994 a prospective 3-year study was designed to document the incidence of MU after near-total gastric bypass (NTGB). In this procedure the transected pouch was limited to the cardia, and the gastrojejunostomy was made along the greater curvature. A total of 173 patients entered the study. All patients who experienced postoperative nausea, vomiting, or abdominal pain underwent endoscopic examination of the pouch, stoma, and proximal Roux-en-Y limb. Gastrograffin studies were used within the first 2 weeks of operation. Results: One year after operation, MU was not identified in any patient. At 3 years follow-up, MU was documented in one patient (0.6%) with a dilated gastric reservoir (60 cc). Conclusion: This study reviews the etiology, diagnosis, and treatment of MU in the RYGB patient and offers specific recommendations to reduce its occurrence. It also confirms a preliminary impression that NTGB is an effective operation in preventing MU formation. [ABSTRACT FROM AUTHOR]

This paper views empirical research as a search for illustrations of interesting possibilities which have occurred, and the exploration of the variety of such possibilities in a sample or universe. This leads to a definition of "illustrative inference" (in contrast to statistical inference), which, we argue, is of considerable importance in many fields of inquiry - ranging from market research and qualitative research in social science, to cosmology. Sometimes, it may be helpful to model illustrative inference quantitatively, so that the size of a sample can be linked to its power (for illustrating possibilities): we outline one model based on probability theory, and another based on a resampling technique. [ABSTRACT FROM AUTHOR]

The present study analyzes the effect of theory group association on the evaluative content of book reviews in sociology. Analysis of 219 book reviews written on 79 major works over a 30 year period reveals no significant differences in the evaluative content of reviews written by reviewers associated with the same theory, when compared to those associated with a different theory group than that of a book's author. Some evidence is presented which indicates that member, of one's own theory group are the most critical of an author's work. The implications of these findings and general mode of inquiry are discussed within a sociology of science framework. [ABSTRACT FROM AUTHOR]

Background: Hypothermia during and after major abdominal surgery decreases host defenses, increases the incidence of coagulopathy and may alter blood pressure, cardiac contractility and myocardial stability. Methods: We designed a prospective randomized study to compare the benefits of a forced air warming system with warm blanket treatments in minimizing the effects of hypothermia on 64 morbidly obese patients undergoing Roux-en-Y gastric bypass. Results: Patients in the forced air warming group ( n = 32) had significantly higher perioperative body core temperature, lower central venous pressure and blood pressure readings, lower incidence of shivering, less blood loss intraoperatively and achieved a higher post anesthesia Aldrete Score than those patients in the warmed blanket group ( n = 32). Conclusion: The forced air warming system is safe, cost effective and beneficial in minimizing the undesirable consequences of hypothermia in morbidly obese patients undergoing Roux-en-Y gastric bypass. [ABSTRACT FROM AUTHOR]

Background: Roux-en-Y gastric bypass (RYGB) procedures can be technically demanding because of anatomical factors including fat distribution, organ fixation, and wound depth. We developed a technique using the Multifire Endo GIA 60 2.5 disposable surgical stapler which allows greater mobilization, less blood loss, and decreased operating time. Methods: A disposable stapler designed for laparoscopic surgery was used to transect the gastro-colic omentum and small bowel mesentery in 67 morbidly obese patients undergoing RYGB. Generally, five to six stapler cartridges were needed for the transections. Results: Stapler division of the gastro-colic omentum and small bowel mesentery decreased operating time by an average of 25 minutes. Conclusions: Applying principles of laparoscopic surgery to RYGB resulted in more efficient mobilization of the stomach and the small bowel mesentery, as well as decreased blood loss and operating time. [ABSTRACT FROM AUTHOR]

This participant observation study examines some of the definitional and dramaturgical work performed by basketball officials attempting to enforce formal rules in the presence of audiences (e.g., spectators, coaches, players and fellow officials). Our analysis begins with the discovery that officiating requires participation in both a real world of physical events and objects, and a social world of subjective identifications. Second, we explore the contexts of legitimation by which decisions are justified. Third, we identify dramaturgical strategies used by officials to enhance legitimacy in the lace of problematic decisions. Finally, we consider the assumptions officials make about the character of their work. The paper concludes with a discussion of indexical and interpretive features of organizational and bureaucratic use of formal rules, including the case of basketball officiating. [ABSTRACT FROM AUTHOR]

Optical polarizers encompass a class of anisotropic materials that pass-through discrete orientations of light and are found in wide-ranging technologies, from windows and glasses to cameras, digital displays and photonic devices. The wire-grids, ordered surfaces, and aligned nanomaterials used to make polarized films cannot be easily reconfigured once aligned, limiting their use to stationary cross-polarizers in, for example, liquid crystal displays. Here we describe a supramolecular material set and patterning approach where the polarization angle in stand-alone films can be precisely defined at the single pixel level and reconfigured following initial alignment. This capability enables new routes for non-binary information storage, retrieval, and intrinsic encryption, and it suggests future technologies such as photonic chips that can be reconfigured using non-contact patterning. [ABSTRACT FROM AUTHOR]

Background: To maintain adequate oxygen delivery to tissue, resuscitation of critically ill patients is guided by assessing surrogate markers of perfusion. As there is no direct indicator of cerebral perfusion used in routine critical care, identifying an accurate strategy to monitor brain perfusion is paramount. Near-infrared spectroscopy (NIRS) is a non-invasive technique to quantify regional cerebral oxygenation (rSO2) that has been used for decades during cardiac surgery which has led to targeted algorithms to optimize rSO2 being developed. However, these targeted algorithms do not exist during critical care, as the physiological determinants of rSO2 during critical illness remain poorly understood. Materials and methods: This prospective observational study was an exploratory analysis of a nested cohort of patients within the CONFOCAL study (NCT02344043) who received high-fidelity vital sign monitoring. Adult patients (≥ 18 years) admitted < 24 h to a medical/surgical intensive care unit were eligible if they had shock and/or required mechanical ventilation. Patients underwent rSO2 monitoring with the FORESIGHT oximeter for 24 h, vital signs were concurrently recorded, and clinically ordered arterial blood gas samples and hemoglobin concentration were also documented. Simultaneous multiple linear regression was performed using all available predictors, followed by model selection using the corrected Akaike information criterion (AICc). Results: Our simultaneous multivariate model included age, heart rate, arterial oxygen saturation, mean arterial pressure, pH, partial pressure of oxygen, partial pressure of carbon dioxide (PaCO2), and hemoglobin concentration. This model accounted for a significant proportion of variance in rSO2 (R2 = 0.58, p < 0.01) and was significantly associated with PaCO2 (p < 0.05) and hemoglobin concentration (p < 0.01). Our selected regression model using AICc accounted for a significant proportion of variance in rSO2 (R2 = 0.54, p < 0.01) and was significantly related to age (p < 0.05), PaCO2 (p < 0.01), hemoglobin (p < 0.01), and heart rate (p < 0.05). Conclusions: Known and established physiological determinants of oxygen delivery accounted for a significant proportion of the rSO2 signal, which provides evidence that NIRS is a viable modality to assess cerebral oxygenation in critically ill adults. Further elucidation of the determinants of rSO2 has the potential to develop a NIRS-guided resuscitation algorithm during critical illness. Trial registration: This trial is registered on clinicaltrials.gov (Identifier: NCT02344043), retrospectively registered January 8, 2015. [ABSTRACT FROM AUTHOR]