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Objective: Vocal fold paralysis impairs quality of life, and no curative injectable therapy exists. We evaluated injection of a novel in situ polymerizing (scaffold‐forming) collagen in the presence and absence of muscle‐derived motor‐endplate expressing cells (MEEs) to promote medialization and recurrent laryngeal nerve (RLN) regeneration in a porcine model of unilateral vocal fold paralysis. Methods: Twelve Yucatan minipigs underwent right RLN transection. Autologous muscle progenitor cells were isolated from muscle biopsies, differentiated, and induced to MEEs. Three weeks after RLN injury, animals received injections of collagen, collagen containing MEEs, or saline into the paralyzed right vocal fold. Stimulated laryngeal electromyography and acoustic vocalization were used for function assessments. Larynges were harvested and underwent histologic, gene expression, and further quantitative analyses. Results: Injections were well‐tolerated, with the collagen scaffold showing immunotolerance and collagen‐encapsulated MEEs remaining viable. Collagen‐treated paralyzed vocal folds showed increased laryngeal adductor muscle volumes relative to that of the uninjured side, with those receiving MEEs and collagen showing the highest volumes. Muscles injected with MEEs and collagen demonstrated increased expression of select neurotrophic (BDNF and NTN1), motor‐endplate (DOK7, CHRNA1, and MUSK), and myogenic (MYOG and MYOD) related genes relative to saline controls. Conclusion: In a porcine model of unilateral vocal fold paralysis, injection of in situ polymerizing collagen in the absence and presence of MEEs enhanced laryngeal adductor muscle volume, modulated expression of neurotrophic and myogenic factors, and avoided adverse material‐mediated immune responses. Further study is needed to determine long‐term functional outcomes with this novel therapeutic approach. Level of Evidence: NA Laryngoscope, 134:4988–4997, 2024 [ABSTRACT FROM AUTHOR]

Evidence suggests that low cobalt (Co) may limit heterocyst frequency (HF) in filamentous diazotrophic cyanobacteria. Therefore, the effect of three Co concentrations on HF in four species in the genera Aphanizomenon and Dolichospermum was examined in N‐depleted (N was not added) culture. Long‐term HF data were also analysed in experimentally fertilised N‐limited Lake 227.HF ranges and means at 0.17, 17, and 170 nmol Co/L were 4.1%–5.7% (4.6%), 5.4%–7.4% (6.4%), and 5.9%–9.3% (7.4%), respectively, after 11 days of growth in batch cultures suggesting that Co plays a role in regulating HF. HF at 0.17 nmol/L was significantly different from HF at the two higher concentrations in all species implicating Co in heterocyst differentiation. However, growth rates and final biovolume yields were not significantly affected by Co in any of the species.Applying the ratio of total phosphorus (TP)/Co in culture media (106) at 0.17 nmol Co/L to an N‐limited system implies that dissolved Co would have to be less than 1 pmol/L to severely limit HF at 1 μmol TP/L. This Co concentration is much lower than dissolved Co in Lake 227 during an Aphanizomenon skujae bloom with 1 μmol TP/L in 2017. Furthermore, Co increased from 0.7 to 2.0 nmol/L simultaneously increasing with HF and cyanobacteria biomass suggesting that Co probably did not limit HF and bloom biomass in Lake 227.Mean summer HFs in Lake 227 during 2000–2020 were 3.4% (epilimnion) and 4.0% (metalimnion), similar to HF at the lowest Co in the cultures. However, HF was significantly higher after 2015 following a shift in dominant bloom species from A. schindlerii to the smaller A. skujae. Calculations suggest that the decrease in cell size may have prompted a higher HF in A. skujae in order to fix an amount of N per unit biomass similar to that fixed by the larger A. schindlerii. Thus, two previously unidentified factors, Co and cell size, can be added to the list of factors that affect HF. [ABSTRACT FROM AUTHOR]

The multi‐to hyperspectral evolution of satellite ocean color sensors is anticipated to enable satellite‐based identification of phytoplankton biodiversity, a key factor in aquatic ecosystem functioning and upper ocean biogeochemistry. In this work the bio‐optical Phytoplankton Detection with Optics (PHYDOTax) approach for deriving taxonomic (class‐level) phytoplankton community composition (PCC, e.g. diatoms, dinoflagellates) from hyperspectral information is evaluated in the Chesapeake Bay estuary on the U.S. East Coast. PHYDOTax is among relatively few optical‐based PCC differentiation approaches available for optically complex waters, but it has not yet been evaluated beyond the California coastal regime where it was developed. Study goals include: (a) testing the approach in a turbid estuary including novel incorporation of colored dissolved organic matter (CDOM) and non‐algal particles (NAP), and (b) performance assessment with both synthetic mixture and field data sets. Algorithm skill was robust on synthetic mixtures. Using field data, cryptophyte and/or cyanophyte phytoplankton groups were predicted, but diatom and dinoflagellate detection was not conclusive. For one field data set, small but significant improvements were observed in predicted PCC groups when tested with incorporation of CDOM and NAP into the algorithm, but not for the second field data set. Sensitivity to three hyperspectral‐relevant spectral resolutions (1, 5, 10 nm) was low for all field and synthetic data. PHYDOTax can identify some phytoplankton groups in the estuary using hyperspectral, field‐collected measurements, but validation‐quality data with broad temporospatial coverage are needed to determine whether the approach is robust enough for science applications. Key Points: A hyperspectral, bio‐optical approach to identifying phytoplankton types from remote sensing reflectance is tested in a turbid estuaryIn field data, cyanophytes and cryptophytes were typically detected but diatom and dinoflagellate detection was not conclusiveWork adds support to further testing this approach in optically complex waters to assess its potential for science applications [ABSTRACT FROM AUTHOR]

Introduction: International Classification of Diseases (ICD) codes recorded in administrative data are often used to identify congenital heart defects (CHD). However, these codes may inaccurately identify true positive (TP) CHD individuals. CHD surveillance could be strengthened by accurate CHD identification in administrative records using machine learning (ML) algorithms. Methods: To identify features relevant to accurate CHD identification, traditional ML models were applied to a validated dataset of 779 patients; encounter level data, including ICD‐9‐CM and CPT codes, from 2011 to 2013 at four US sites were utilized. Five‐fold cross‐validation determined overlapping important features that best predicted TP CHD individuals. Median values and 95% confidence intervals (CIs) of area under the receiver operating curve, positive predictive value (PPV), negative predictive value, sensitivity, specificity, and F1‐score were compared across four ML models: Logistic Regression, Gaussian Naive Bayes, Random Forest, and eXtreme Gradient Boosting (XGBoost). Results: Baseline PPV was 76.5% from expert clinician validation of ICD‐9‐CM CHD‐related codes. Feature selection for ML decreased 7138 features to 10 that best predicted TP CHD cases. During training and testing, XGBoost performed the best in median accuracy (F1‐score) and PPV, 0.84 (95% CI: 0.76, 0.91) and 0.94 (95% CI: 0.91, 0.96), respectively. When applied to the entire dataset, XGBoost revealed a median PPV of 0.94 (95% CI: 0.94, 0.95). Conclusions: Applying ML algorithms improved the accuracy of identifying TP CHD cases in comparison to ICD codes alone. Use of this technique to identify CHD cases would improve generalizability of results obtained from large datasets to the CHD patient population, enhancing public health surveillance efforts. [ABSTRACT FROM AUTHOR]

Background: Research on the association between neighborhood social deprivation and health among adults with congenital heart defects (CHD) is sparse. Methods: We evaluated the associations between neighborhood social deprivation and health care utilization, disability, and comorbidities using the population‐based 2016–2019 Congenital Heart Survey To Recognize Outcomes, Needs, and well‐beinG (CH STRONG) of young adults. Participants were identified from active birth defect surveillance systems in three U.S. sites and born with CHD between 1980 and 1997. We linked census tract‐level 2017 American Community Survey information on median household income, percent of ≥25‐year‐old with greater than a high school degree, percent of ≥16‐year‐olds who are unemployed, and percent of families with children <18 years old living in poverty to survey data and used these variables to calculate a summary neighborhood social deprivation z‐score, divided into tertiles. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) derived from a log‐linear regression model with a Poisson distribution estimated the association between tertile of neighborhood social deprivation and healthcare utilization in previous year (no encounters, 1 and ≥2 emergency room [ER] visits, and hospital admission), ≥1 disability, and ≥1 comorbidities. We accounted for age, place of birth, sex at birth, presence of chromosomal anomalies, and CHD severity in all models, and, additionally educational attainment and work status in all models except disability. Results: Of the 1435 adults with CHD, 43.8% were 19–24 years old, 54.4% were female, 69.8% were non‐Hispanic White, and 33.7% had a severe CHD. Compared to the least deprived tertile, respondents in the most deprived tertile were more likely to have no healthcare visit (aPR: 1.5 [95% CI: 1.1, 2.1]), ≥2 ER visits (1.6 [1.1, 2.3]), or hospitalization (1.6 [1.1, 2.3]) in the previous 12 months, a disability (1.2 [1.0, 1.5]), and ≥1 cardiac comorbidities (1.8 [1.2, 2.7]). Conclusions: Neighborhood social deprivation may be a useful metric to identify patients needing additional resources and referrals. [ABSTRACT FROM AUTHOR]

Objective: Accumulated evidence indicates both stable and malleable parts of inter‐individual differences in the broad Big Five domains. Less is known, however, about stability and change at the more diversified facet level. With the current study, we fill this gap by investigating personality stability and change across midlife and old age. Method: We apply local structural equation measurement models and second‐order growth curve models to four waves of data obtained with the full NEO Personality Inventory (NEO‐PI‐R) collected over 11 years from 1667 adults (Mage = 62.69 years, SDage = 15.62, 55% female) who participated in the Seattle Longitudinal Study. Results: Measurement invariance analyses indicated that the psychometric properties of the NEO‐PI‐R facets are comparable across time and age. Results revealed substantial rank‐order stabilities across all facets, yet the exact pattern varied strongly between facets of the same trait and across traits. Mean‐level change of facets from midlife to old age largely mirrored the mean‐level change observed for the broader traits. Conclusion: We discuss conceptual implications and argue that in the face of overall stability across midlife and old age, changes in the rank‐ordering of people reveals a much more complex and diverse pattern of development than analyses at the trait level suggest. [ABSTRACT FROM AUTHOR]

Background: While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS‐CoV‐2 infection by occupation and industry among non‐healthcare workers in six states. Methods: We analyzed data on occupation and industry of employment from a six‐state callback survey of adult non‐healthcare workers with confirmed SARS‐CoV‐2 infection and population‐based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS‐CoV‐2 infection by occupation and industry using the proportionate morbidity ratio (PMR). Results: Among a sample of 1111 workers with confirmed SARS‐CoV‐2 infection, significantly higher‐than‐expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1–1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1–1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2–1.9). Conclusions: We found evidence of significant differences in the proportionate distribution of SARS‐CoV‐2 infection by occupation and industry among respondents in a multistate, population‐based survey, highlighting the excess risk of SARS‐CoV‐2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people. [ABSTRACT FROM AUTHOR]

Monitoring of a seasonal‐use, on‐site wastewater disposal system (septic system) in Canada, over a 33‐year period from 1988 to 2021, showed that during recent sampling the groundwater plume had TIN (total inorganic nitrogen) averaging 12.2 mg/L that was not significantly different than early values, representing 80% removal, whereas SRP (soluble reactive phosphate), although higher than early values averaging 0.08 mg/L, was still 99% lower than the effluent concentration. Evidence suggests that the anammox reaction and possibly also denitrification contribute to TIN removal, whereas SRP removal is primarily the result of mineral precipitation. Most of the removal occurs in close proximity to the drainfield infiltration pipes (within about 1 m) demonstrating that reaction rates are relatively fast in the context of typical groundwater plume residence times. This long‐term consistency demonstrates that sustainable nutrient treatment can be achieved with conventional on‐site wastewater disposal systems that have low capital costs and require minimal energy input and maintenance. [ABSTRACT FROM AUTHOR]

Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower‐resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology‐based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart‐health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle‐income country. Following a pilot study, a single‐center, single‐blinded, 2 parallel‐arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre‐intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6‐month intervention comprises an app, website, SMS texts with generic heart‐health management advice, and bi‐weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent‐to‐treat. If results of this novel trial of women‐focused eCR in a middle‐income country demonstrate clinically‐significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality. [ABSTRACT FROM AUTHOR]

Northern high-latitude lakes are hotspots for cycling dissolved organic carbon (DOC) inputs from allochthonous sources to the atmosphere. However, the spatial distribution of lake dissolved organic matter (DOM) is largely unknown across Arctic-boreal regions with respect to the surrounding landscape. We expand on regional studies of northern high-latitude DOM composition by integrating DOC concentrations, optical properties, and molecular-level characterization from lakes spanning the Canadian Taiga to the Alaskan Tundra. Lakes were sampled during the summer from July to early September to capture the growing season. DOM became more optically processed and molecular-level aromaticity increased northward across the Canadian Shield to the southern Arctic and from interior Alaska to the Tundra, suggesting relatively greater DOM incorporation from allochthonous sources. Using water isotopes (δ18O-H2O), we report a weak overall trend of increasing DOC and decreasing aromaticity in lakes that were hydrologically isolated from the landscape and enriched in δ18O-H2O, while within-region trends were stronger and varied depending on the landscape. Finally, DOC correlated weakly with chromophoric dissolved organic matter (CDOM) across the study sites, suggesting that autochthonous and photobleached DOM were a major component of the DOC in these regions; however, some of the northernmost and wetland-dominated lakes followed pan-Arctic riverine DOC-CDOM relationships, indicating strong contributions from allochthonous inputs. As many lakes across the North American Arctic are experiencing changes in temperature and precipitation, we expect the proportions of allochthonous and autochthonous DOM to respond with aquatic optical browning with greater landscape connectivity and more internally produced DOM in hydrologically isolated lakes. [ABSTRACT FROM AUTHOR]

Concentrations of dissolved organic carbon (DOC) are increasing in many parts of the world and vary considerably among lakes. As a result, it is important to understand the effects of DOC on zooplankton, which are a key component of freshwater food webs. Deep chlorophyll maxima (DCMs) also are common in many lakes and numerous studies suggest that they may be an important resource for zooplankton.In a survey of eight boreal lakes spanning a gradient of DOC (3.5–9.2 mg/L), we assessed variations in the occurrence of DCMs, zooplankton biomass and their use of basal resources using stable isotopes of carbon (C), nitrogen (N) and hydrogen (H).DCMs occurred only in lakes with lower DOC concentrations and Bayesian stable isotope mixing models indicated that they contributed between 22% and 72% of the assimilated diet of zooplankton. Food quality as indicated by C:P and chlorophyll a: C ratios increased with depth and in DCMs.The proportion of C ultimately derived by zooplankton from terrestrial sources increased from 6% to 27% with DOC. Zooplankton biomass among lakes declined with increasing DOC concentrations, the absence of DCMs and with increasing allochthony.Our results suggest that increasing inputs of DOC may suppress zooplankton in many lakes by affecting both resource quality and the availability of metalimnetic phytoplankton resources. Because zooplankton occupy a central position in freshwater food webs, declines in their biomass may further affect phytoplankton dynamics and fish productivity. [ABSTRACT FROM AUTHOR]

Background: Due to invasive treatments and stressors related to heart health, adults with congenital heart defects (CHDs) may have an increased risk of post‐traumatic stress disorder (PTSD), anxiety, and/or depressive disorders. Our objectives were to estimate the prevalence of these disorders among individuals with CHDs. Methods: Using IBM® MarketScan® Databases, we identified adults age 18–49 years with ≥2 outpatient anxiety/depressive disorder claims on separate dates or ≥1 inpatient anxiety/depressive disorder claim in 2017. CHDs were defined as ≥2 outpatient CHD claims ≥30 days apart or ≥1 inpatient CHD claim documented in 2007–2017. We used log‐binomial regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between CHDs and anxiety/depressive disorders. Results: Of 13,807 adults with CHDs, 12.4% were diagnosed with an anxiety or depressive disorder. Adults with CHDs, compared to the 5,408,094 without CHDs, had higher prevalence of PTSD (0.8% vs. 0.5%; aPR: 1.5 [CI: 1.2–1.8]), anxiety disorders (9.9% vs. 7.5%; aPR: 1.3 [CI: 1.3–1.4]), and depressive disorders (6.3% vs. 4.9%; aPR: 1.3 [CI: 1.2–1.4]). Among individuals with CHDs, female sex (aPR range: 1.6–3.3) and inpatient admission (aPR range 1.1–1.9) were associated with anxiety/depressive disorders. Conclusion: Over 1 in 8 adults with CHDs had diagnosed PTSD and/or other anxiety/depressive disorders, 30–50% higher than adults without CHDs. PTSD was rare, but three times more common in women with CHDs than men. Screening and referral for services for these conditions in people with CHDs may be beneficial. [ABSTRACT FROM AUTHOR]

Phytoplankton blooms are a global water quality issue, and successful management depends on understanding their responses to multiple and interacting drivers, including nutrient loading and climate change. Here, we examine a long‐term dataset from Lake 227, a site subject to a fertilization experiment (1969–present) with changing nitrogen:phosphorus (N:P) ratios. We applied a process‐oriented model, MyLake, and updated the model structure with nutrient uptake kinetics that incorporated shifting N:P and competition among phytoplankton functional groups. We also tested different temperature and P‐loading scenarios to examine the interacting effects of climate change and nutrient loading on phytoplankton blooms. The model successfully reproduced lake physics over 48 yr and the timing, overall magnitude, and shifting community structure (diazotrophs vs. non‐diazotrophs) of phytoplankton blooms. Intra‐ and interannual variability was captured more accurately for the P‐only fertilization period than for the high N:P and low N:P fertilization periods, highlighting the difficulty of modeling complex blooms even in well‐studied systems. A model scenario was also run which removed climate‐driven temperature trends, allowing us to disentangle concurrent drivers of blooms. Results showed that increases in water temperature in the spring led to earlier and larger phytoplankton blooms under climate change than under the effects of nutrient fertilization alone. These findings suggest that successful lake management efforts should incorporate the effects of climate change in addition to nutrient reductions, including intensifying and/or expanding monitoring periods and incorporating climate change into uncertainty estimates around future conditions. [ABSTRACT FROM AUTHOR]

Background: Transit workers have jobs requiring close public contact for extended periods of time, placing them at increased risk for severe acute respiratory syndrome coronavirus 2 infection and more likely to have risk factors for coronavirus disease 2019 (COVID‐19)‐related complications. Collecting timely occupational data can help inform public health guidance for transit workers; however, it is difficult to collect during a public health emergency. We used nontraditional epidemiological surveillance methods to report demographics and job characteristics of transit workers reported to have died from COVID‐19. Methods: We abstracted demographic and job characteristics from media scans on COVID‐19 related deaths and reviewed COVID‐19 memorial pages for the Amalgamated Transit Union (ATU) and Transport Workers Union (TWU). ATU and TWU provided a list of union members who died from COVID‐19 between March 1–July 7, 2020 and a total count of NYC metro area union members. Peer‐reviewed publications identified through a scientific literature search were used to compile comparison demographic statistics of NYC metro area transit workers. We analyzed and reported characteristics of ATU and TWU NYC metro area decedents. Results: We identified 118 ATU and TWU NYC metro area transit worker COVID‐19 decedents with an incidence proportion of 0.3%. Most decedents were male (83%); median age was 58 years (range: 39–71). Median professional tenure was 20 years (range: 2–41 years). Operator (46%) was the most reported job classification. More than half of the decedents (57%) worked in positions associated with close public contact. Conclusion: Data gathered through nontraditional epidemiological surveillance methods provided insight into risk factors among this workforce, demonstrating the need for mitigation plans for this workforce and informing transit worker COVID‐19 guidance as the pandemic progressed. [ABSTRACT FROM AUTHOR]

The stable isotope ratios of groundwater sulfate (34S/32S, 18O/16O) are often used as tracers to help determine the origin of groundwater or groundwater contaminants. In agricultural watersheds, little is known about how the increased use of sulfur as a soil amendment to optimize crop production is affecting the isotopic composition of groundwater sulfate, especially in shallow aquifers. We investigated the isotopic composition of synthetic agricultural fertilizers and groundwater sulfate in an area of intensive agricultural activity, in Ontario, Canada. Groundwater samples from an unconfined surficial sand aquifer (Lake Algonquin Sand Aquifer) were analyzed from multi‐level monitoring wells, riverbank seeps, and private domestic wells. Fertilizers used in the area were analyzed for sulfur/sulfate content and stable isotopic composition (δ18O and/or δ34S). Fertilizers were isotopically distinct from geological sources of groundwater sulfate in the watershed and groundwater sulfate exhibited a wide range of δ34S (−6.9 to +20.0‰) and δ18O (−5.0 to +13.7‰) values. Quantitative apportionment of sulfate sources based on stable isotope data alone was not possible, largely because two of the potential fertilizer sulfate sources had an isotopic composition on the mixing line between two natural geological sources of sulfate in the aquifer. This study demonstrates that, when sulfate isotope analysis is being used as a tracer or co‐tracer of the origin of groundwater or of contaminants in groundwater, sulfate derived from synthetic fertilizer needs to be considered as a potential source, especially when other parameters such as nitrate independently indicate fertilizer impacts to groundwater quality. [ABSTRACT FROM AUTHOR]

Rationale, aim, and objectives: Heart failure (HF) clinics are highly effective, yet not optimally utilized. A realist review was performed to identify contexts (eg, health system characteristics, clinic capacity, and siting) and underlying mechanisms (eg, referring provider knowledge of clinics and referral criteria, barriers in disadvantaged patients) that influence utilization (provider referral [ie, of all appropriate and no inappropriate patients] and access [ie, patient attends ≥1 visit]) of HF clinics. Methods: Following an initial scoping search and field observation in a HF clinic, we developed an initial program theory in conjunction with our expert panel, which included patient partners. Then, a literature search of seven databases was searched from inception to December 2019, including Medline; Grey literature was also searched. Studies of any design or editorials were included; studies regarding access to cardiac rehabilitation, or a single specialist for example, were excluded. Two independent reviewers screened the abstracts, and then full‐texts. Relevant data from included articles were used to refine the program theory. Results: A total of 29 papers from five countries (three regions) were included. There was limited information to support or refute many elements of our initial program theory (eg, referring provider knowledge/beliefs, clinic inclusion/exclusion criteria), but refinements were made (eg, specialized care provided in each clinic, lack of patient encouragement). Lack of capacity, geography, and funding arrangements were identified as contextual factors, explaining a range of mechanistic processes, including patient clinical characteristics and social determinants of health as well as clinic characteristics that help to explain inappropriate and low use of HF clinics (outcome). Conclusion: Given the burden of HF and benefit of HF clinics, more research is needed to understand, and hence overcome sub‐optimal use of HF clinics. In particular, an understanding from the perspective of referring providers is needed. [ABSTRACT FROM AUTHOR]

Objective. Cardiovascular diseases are among the leading causes of morbidity in China and around the world. Cardiac rehabilitation (CR) effectively mitigates this burden; however, utilization is low. CR barriers in China have not been well characterized; this study sought to translate, cross-culturally adapt, and psychometrically validate the CR Barriers Scale in Chinese/Mandarin (CRBS-C/M). Methods. Independent translations of the 21-item CRBS were conducted by two bilingual health professionals, followed by back-translation. A Delphi process was undertaken with five experts to consider the semantics and cross-cultural relevance of the items. Following finalization, 380 cardiac patients from 11 hospitals in Shanghai were administered a validation survey including the translated CRBS. Following exploratory and confirmatory factor analysis, internal consistency was assessed. Validity was tested through assessing the association of the CRBS-C/M with the CR Information Awareness Questionnaire. Results. Items were refined and finalized. Factor analysis of CRBS-C/M (Kaiser Meyer Olkin = 0.867 , Bartlett's test p < 0.001) revealed five factors: perceived CR need, external logistical factors, time conflicts, program and health system-level factors, and comorbidities/lack of vitality; Cronbach's alpha (α) of the subscales ranged from 0.67 to 0.82. The mean total CRBS score was significantly lower in patients who participated in CR compared with those who did not, demonstrating criterion validity (2.35 ± 0.71 vs. 3.08 ± 0.55 ; p < 0.001). Construct validity was supported by the significant associations between total CRBS scores and CR awareness, sex, living situation, city size, income, diagnosis/procedure, disease severity, and several risk factors (all p < 0.05). Conclusions. CRBS-C/M is reliable and valid, so barriers can be identified and mitigated in Mandarin-speaking patients. [ABSTRACT FROM AUTHOR]

Background: Although emerging data suggest a direct link between sleep duration, aging, and cognitive performance, the impact of longitudinal sleep patterns have on Alzheimer's disease‐associated pathology and cognitive decline remains unclear. Method: Utilizing longitudinal data on self‐reported sleep duration collected within the Seattle Longitudinal Study, we used a Cox proportional hazard (CPH) regression to evaluate the relationship between longitudinal sleep factors on the development of cognitive decline. Additional analysis in a sub‐cohort utilized multivariate linear regression prediction analyses to evaluate the predictive value of these longitudinal sleep factors on the incidence of developing cognitive impairment over an interval of 10 years. A cohort within the study received MRI and FLAIR neuroimaging, enabling the assessment of the impact these longitudinal sleep factors have on subcortical white matter MRI‐visible perivascular space burden (PVS). A semi‐automated segmentation algorithm accounted for PVS total burden and volume, as well as average PVS width, length, and median volume across participants, blinded by group. Result: CPH analysis found years of education (HR 1.12, 95% CI 1.02, 1.22), APOE4 status (HR 2.18, 95% CI 1.37, 3.49), higher depression scores (HR 1.08, 95% CI 1.04, 1.13), short sleep phenotype (HR 1.78, 95% CI 1.03, 3.08) and increased sleep variability (HR 3.10, 95% CI 1.66, 5.80) were significantly associated with cognitive impairment. Further, when including these factors into our linear regression prediction analyses, age (p<0.0001), depression (p = 0.01) and sleep variability (p = 0.042) were significant predictors of cognitive impairment over a 10‐year period. Preliminary analysis showed significant association between high sleep variability and increased whole‐brain PVS volume (p = 0.04) and length (p = 0.03), with a significant correlation between sleep variability and median PVS volume (p = 0.04). Follow‐up analysis evaluated PVS features within the wider cohort. Conclusion: These findings suggest that variability in longitudinal self‐reported sleep duration exerts a previously unappreciated influence on downstream cognitive performance and pathological processes, potentially including glymphatic dysfunction. These findings elaborate the link between sleep instability, aging, cognitive decline and neuropathologic disease state. Future studies should evaluate these findings on an independent cohort to assess whether sleep variability of different time scales (weeks, years, decades) exerts similar effects on these outcomes. [ABSTRACT FROM AUTHOR]

The persistence of inorganic nitrogen is assessed in a set of 21 septic system plumes located in Ontario, Canada, that were studied over a 31‐year period from 1988 to 2019. In the plume zones underlying the drainfields, site mean NO3− values averaged 34 ± 27 mg N/L and exceeded the nitrate drinking water limit (DWL) of 10 mg N/L at 16 of 21 sites. In plume zones extending up to 30 m downgradient from the drainfields, site mean NO3− values averaged 24 ± 20 mg N/L and exceeded the DWL at 9 of 13 sites. Site mean total inorganic nitrogen (TIN; NH4+ + NO3− − N) removal averaged 34 ± 26% in the drainfield zones and 36 ± 44% in the downgradient plume zones, indicating that much of the removal occurred within the drainfields. Removal was much higher at nine sites where drainfield TIN included >10% NH4+ (62 ± 25% removal). TIN removal was not correlated with wastewater loading rate, system age, or sediment carbonate mineral content, but was correlated with water table depth, where shallower water table sites had generally less complete wastewater oxidation. At many of these sites, both NO3− and NH4+ were present together in the plumes and were lost concomitantly, suggesting that the anammox reaction was making an important contribution to the observed TIN loss. When groundwater nitrate contamination is a concern, considering on‐site treatment system designs that lead to a lesser degree of wastewater oxidation, could be a useful approach for enhancing N removal. [ABSTRACT FROM AUTHOR]

Dissolved organic matter (DOM) represents a mixture of organic molecules that vary due to different source materials and degree of processing. Characterizing how DOM composition evolves along the aquatic continuum can be difficult. Using a size‐exclusion chromatography technique (liquid chromatography‐organic carbon detection [LC‐OCD]), we assessed the variability in DOM composition from both surface and groundwaters across a number of Canadian ecozones (mean annual temperature spanning −10°C to +6°C). A wide range in DOM concentration was found from 0.2 to 120 mg C L−1. Proportions of different size‐based groupings across ecozones were variable, yet similarities between specific waterbody types, regardless of location, suggest commonality in the processes dictating DOM composition. A principal component analysis identified 70% of the variation in LC‐OCD derived DOM compositions could be explained by the waterbody type. We find that DOM composition within a specific waterbody type is similar regardless of the differences in climate or surrounding vegetation where the sample originated from. [ABSTRACT FROM AUTHOR]

Objectives: Most individuals born with congenital heart defects (CHDs) survive to adulthood, but healthcare utilization patterns for adolescents and adults with CHDs have not been well described. We sought to characterize the healthcare utilization patterns and associated costs for adolescents and young adults with CHDs. Methods: We examined 2009–2013 New York State inpatient admissions of individuals ages 11–30 years with ≥1 CHD diagnosis codes recorded during any admission. We conducted multivariate linear regression using generalized estimating equations to examine associations between inpatient costs and sociodemographic and clinical variables. Results: We identified 5,100 unique individuals with 9,593 corresponding hospitalizations over the study period. Median inpatient cost and length of stay (LOS) were $10,720 and 3.0 days per admission, respectively; 55.1% were emergency admissions. Admission volume increased 48.7% from 2009 (1,538 admissions) to 2013 (2,287 admissions), while total inpatient costs increased 91.8% from 2009 ($27.2 million) to 2013 ($52.2 million). Inpatient admissions and costs rose more sharply over the study period for those with nonsevere CHDs compared to severe CHDs. Characteristics associated with higher costs were longer LOS, severe CHD, cardiac/vascular hospitalization classification, surgical procedures, greater severity of illness, and admission in New York City. Conclusion: This study provides an informative baseline of health care utilization patterns and associated costs among adolescents and young adults with CHDs in New York State. Structured transition programs may aid in keeping this population in appropriate cardiac care as they move to adulthood. [ABSTRACT FROM AUTHOR]

Background: Platelet transfusion is associated with logistical problems with the national storage guidelines of platelets. This results in decreased function in vivo as a result of the platelet storage lesion, and complications such as allergic or hemolytic reactions and thrombosis. We evaluated a new, freshly prepared platelet modified lysate (PML) product designed to be more procoagulant than fresh and stored platelets.Methods: Fresh platelets were concentrated, sonicated, and centrifuged to produce PML. Samples of both washed and unwashed PML were evaluated for particle size, concentration, and activity, and then tested for clot kinetics and thrombin generation. PML samples were also stored at various temperatures for durations up to 6 months and evaluated for clot kinetics and thrombin generation throughout.Results: PML showed significantly higher concentration of platelet microparticles, increased procoagulant properties, and increased thrombin generation as compared to fresh and stored platelets. In addition, PML maintained its clot kinetics over a 6-month storage period with variable storage conditions.Conclusions: The newly proposed PML product is more procoagulant, stable, and has additional potential applications than currently available platelet products. Further studies will be performed to assess its functions in vivo and to assess thrombotic potential. [ABSTRACT FROM AUTHOR]

Energy retrofits can reduce air exchange, raising the concern of whether indoor radon and moisture levels could increase. This pre/post‐intervention study explored whether simple radon interventions implemented in conjunction with energy retrofits can prevent increases in radon and moisture levels. Treatment homes (n = 98) were matched with control (no energy retrofits or radon intervention) homes (n = 12). Control homes were matched by geographic location and foundation type. t‐tests were used to determine whether post‐energy retrofit radon and moisture level changes in treatment homes significantly differed from those in control homes. The radon interventions succeeded in preventing statistically significant increases in first floor radon using arithmetic (p = 0.749) and geometric means (p = 0.120). In basements, arithmetic (p = 0.060) and geometric (p = 0.092) mean radon levels statistically significantly increased, consistent with previous studies which found that basement radon levels may increase even if first floor levels remain unchanged. Changes in infiltration were related to changes in radon (p = 0.057 in basements; p = 0.066 on first floors). Only 58% of the change in infiltration was due to air sealing, with the rest due to weather changes. There was no statistically significant association between air sealing itself and radon levels on the first floor (p = 0.664). Moisture levels also did not significantly increase. [ABSTRACT FROM AUTHOR]

Background: Relationships between red blood cell (RBC) transfusion, circulating cell-free heme, and clinical outcomes in critically ill transfusion recipients are incompletely understood. The goal of this study was to determine whether total plasma heme increases after RBC transfusion and predicts mortality in critically ill patients.Study Design and Methods: This was a prospective cohort study of 111 consecutive medical intensive care patients requiring RBC transfusion. Cell-free heme was measured in RBC units before transfusion and in the patients' plasma before and after transfusion.Results: Total plasma heme levels increased in response to transfusion, from a median (interquartile range [IQR]) of 35 (26-76) μmol/L to 47 (35-73) μmol/L (p < 0.001). Posttransfusion total plasma heme was higher in nonsurvivors (54 [35-136] μmol/L) versus survivors (44 [31-65] μmol/L, p = 0.03). Posttransfusion total plasma heme predicted hospital mortality (odds ratio [95% confidence interval] per quartile increase in posttransfusion plasma heme, 1.76 [1.17-2.66]; p = 0.007). Posttransfusion total plasma heme was not correlated with RBC unit storage duration and weakly correlated with RBC unit cell-free heme concentration.Conclusions: Total plasma heme concentration increases in critically ill patients after RBC transfusion and is independently associated with mortality. This transfusion-associated increase in total plasma heme is not fully explained by RBC unit storage age or cell-free heme content. Additional studies are warranted to define mechanisms of transfusion-related plasma heme accumulation and test prevention strategies. [ABSTRACT FROM AUTHOR]

Phenotypic polymorphisms often differ in multiple correlated traits including morphology, behavior, and physiology, all of which can affect performance. How selection acts on these suites of traits can be complex and difficult to discern. Starry flounder (Platichthys stellatus) is a pleuronectid flatfish that exhibits rare polymorphism for the direction of eye migration and resulting whole‐body asymmetry. P. stellatus asymmetry morphs differ subtly in several anatomical traits, foraging behavior, and stable isotope signatures, suggesting they may be ecologically segregated, yet performance and metabolic differences are unknown.Here we tested the hypothesis that sinistral and dextral P. stellatus asymmetry morphs diverge in performance and routine metabolic rate (RMR) by comparing prolonged swimming endurance (time to exhaustion at a constant swimming speed), fast‐start swimming velocity and acceleration, and rate of oxygen consumption. Based on subtle morphological differences in caudal tail size, we expected sinistral P. stellatus to have superior prolonged swimming endurance relative to dextral fish, but inferior fast‐start performance.Sinistral P. stellatus exhibited both significantly greater prolonged swimming performance and fast‐start swimming performance. However, sinistral P. stellatus also exhibited greater RMR, suggesting that their general swimming performance could be enhanced by an elevated metabolic rate.Divergence between P. stellatus asymmetry morphs in swimming performance and metabolic rates contributes to growing evidence of ecological segregation between them, as well as our understanding of possible ecological consequences of asymmetry direction in flatfishes. These data provide an example of the complexity of polymorphisms associated with multiple correlated traits in a rare case of asymmetry polymorphism in a marine flatfish species. [ABSTRACT FROM AUTHOR]

Hydrologic models partition flows into surface and subsurface pathways, but their calibration is typically conducted only against streamflow. Here we argue that unless model outcomes are constrained using flow pathway data, multiple partitioning schemes can lead to the same streamflow. This point becomes critical for biogeochemical modeling as individual flow paths may yield unique chemical signatures. We show how information on flow pathways can be used to constrain hydrologic flow partitioning and how improved partitioning can lead to better water quality predictions. As a case study, an agricultural basin in Ontario is used to demonstrate that using tile discharge data could increase the performance of both the hydrology and the nitrogen transport models. Watershed‐scale tile discharge was estimated based on sparse tile data collected at some tiles using a novel regression‐based approach. Through a series of calibration experiments, we show that utilizing tile flow signatures as calibration criteria improves model performance in the prediction of nitrate loads in both the calibration and validation periods. Predictability of nitrate loads is improved even with no tile flow data and by model calibration only against an approximate understanding of annual tile flow percent. However, despite high values of goodness‐of‐fit metrics in this case, temporal dynamics of predictions are inconsistent with reality. For instance, the model predicts significant tile discharge in summer with no tile flow occurrence in the field. Hence, the proposed tile flow upscaling approach and the partitioning‐constrained model calibration are vital steps toward improving the predictability of biogeochemical models in tiled landscapes. Key Points: Tile flow data were used to constrain flow partitioning in hydrologic modelsNovel methodology developed to upscale from single tile to watershed scaleConstraining tile flow resulted in better performance of the nitrogen model [ABSTRACT FROM AUTHOR]

The effects of manure application in agriculture on surface water quality has become a local to global problem because of the adverse consequences on public health and food security. This study evaluated (i) the spatial distribution of bovine (cow) and porcine (pig) genetic fecal markers, (ii) how hydrologic factors influenced these genetic markers, and (iii) their variations as a function of land use, nutrients, and other physiochemical factors. We collected 189 samples from 63 watersheds in Michigan's Lower Peninsula during baseflow, spring melt, and summer rain conditions. For each sample, we quantified the concentrations of bovine and porcine genetic markers by digital droplet polymerase chain reaction and measured Escherichia coli, dissolved oxygen, pH, temperature, total phosphorus, total nitrogen, nitrate-nitrite (NOX), ammonia (NH3), soluble reactive phosphorus, streamflow, and watershed specific precipitation. Bovine and porcine manure markers were ubiquitous in rivers that drain agricultural and natural fields across the study region. This study provides baseline conditions on the state of watershed impairment, which can be used to develop best management practices that could improve water quality. Similar studies should be performed with higher spatial sampling density to elucidate detailed factors that influence the transport of manure constituents. [ABSTRACT FROM AUTHOR]

Cenderitide is a novel designer natriuretic peptide (NP) composed of C‐type natriuretic peptide (CNP) fused to the C‐terminus of Dendroaspis natriuretic peptide (DNP). Cenderitide was engineered to coactivate the two NP receptors, particulate guanylyl cyclase (pGC)‐A and ‐B. The rationale for its design was to achieve the renal‐enhancing and antifibrotic properties of dual receptor activation, but without clinically significant hypotension. Here we report the first clinical trial on the safety, tolerability, and cyclic guanosine monophosphate (cGMP) activating properties of Cenderitide in subjects with stable heart failure (HF). Four‐hour infusion of Cenderitide was safe, well‐tolerated, and significantly increased plasma cGMP levels and urinary cGMP excretion without adverse effects with no change in blood pressure. Thus, Cenderitide has a favorable safety profile and expected pharmacological effects in stable human HF. Our results support further investigations of Cenderitide in HF as a potential future cGMP‐enhancing therapeutic strategy. [ABSTRACT FROM AUTHOR]

Background: There are data suggesting that free hemoglobin (Hb), heme, and iron contribute to infection, thrombosis, multiorgan failure, and death in critically ill patients. These outcomes may be mitigated by haptoglobin.Study Design and Methods: 164 consecutively treated children undergoing surgery for congenital heart disease were evaluated for associations between free Hb and haptoglobin and clinical outcomes, physiologic metrics, and biomarkers of inflammation RESULTS: Higher perioperative free Hb levels (and lower haptoglobin levels) were associated with mortality, nosocomial infection, thrombosis, hours of intubation and inotropes, increased interleukin-6, peak serum lactate levels, and lower nadir mean arterial pressures. The median free Hb in patients without infection (30 mg/dL; 29 interquartile range [IQR], 24-52 mg/dL) was lower than in those who became infected (39 mg/dL; IQR, 33-88 mg/ 31 dL; p = 0.0046). The median mechanical ventilation requirements were 19 (IQR, 7-72) hours in patients with higher levels of haptoglobin versus 48 (IQR, 18-144) hours in patients with lower levels (p = 0.0047). Transfusion dose, bypass duration, and complexity of surgery were all significantly correlated with Hb levels and haptoglobin levels. Multivariate analyses demonstrated that these variables were independently and significantly associated with outcomes.Conclusions: Elevated pre- and postoperative levels of free Hb and decreased levels of haptoglobin were associated with adverse clinical outcomes, inflammation, and unfavorable physiologic metrics. Transfusion, RACHS score, and duration of bypass were associated with increased free Hb and decreased haptoglobin. Further investigation of the role of hemolysis and haptoglobin as potential mediators or markers of outcomes is warranted. [ABSTRACT FROM AUTHOR]

Summary: Background/Purpose: Research suggests that youth proximity to tanning salons may promote use; however, little is known about tanning salon proximity to schools. We assessed the proximity of tanning salons to schools in urban versus rural/suburban communities across Worcester County, Massachusetts (population > 800K). To put findings in context, we compared school proximity to tanning salons to school proximity to McDonald's restaurants, a large franchise that also caters to young people. Materials & Methods: Accessibility was measured by ArcGIS 10.2 Network Analyzer (ESRI, Redlands, CA, USA) and the most current road network data layer from Massachusetts Department of Transportation (MassDOT). Results: A total of 145 schools were observed in the study area, of which about 39% of schools were within 1 mile from a tanning salon. Urban schools (53.41%) had a higher proportion within 1 mile of a tanning salon than rural/suburban schools (17.54%; P < .001). More schools (39.31%) were within 1 mile of a tanning salon than schools within 1 mile of a McDonald's (22.70%; P < .001). Conclusions: Schools may be particularly impactful for implementing skin cancer prevention programing. [ABSTRACT FROM AUTHOR]

Abstract: Rationale and objectives: One way to understand medical overuse at the clinician level is in terms of clinical decision‐making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision‐making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics. De‐implementation strategies directed at clinicians may be conceptualized as corresponding to cognition: (1) a process of unlearning based on reflective cognition and (2) a process of substitution based on automatic cognition. Results: We define unlearning as a process in which clinicians consciously change their knowledge, beliefs, and intentions about an ineffective practice and alter their behaviour accordingly. Unlearning has been described as “the questioning of established knowledge, habits, beliefs and assumptions as a prerequisite to identifying inappropriate or obsolete knowledge underpinning and/or embedded in existing practices and routines.” We hypothesize that as an unintended consequence of unlearning strategies clinicians may experience “reactance,” ie, feel their professional prerogative is being violated and, consequently, increase their commitment to the ineffective practice. We define substitution as replacing the ineffective practice with one or more alternatives. A substitute is a specific alternative action or decision that either precludes the ineffective practice or makes it less likely to occur. Both approaches may work independently, eg, a substitute could displace an ineffective practice without changing clinicians' knowledge, and unlearning could occur even if no alternative exists. For some clinical practice, unlearning and substitution strategies may be most effectively used together. Conclusions: By taking into account the dual process model of cognition, we may be able to design de‐implementation strategies matched to clinicians' decision‐making processes and avoid unintended consequence. [ABSTRACT FROM AUTHOR]