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In an era marked by a growing demand for sustainable and high-performance materials, the convergence of additive manufacturing (AM), also known as 3D printing, and the thermal treatment, or pyrolysis, of polymers to form high surface area hierarchically structured carbon materials stands poised to catalyze transformative advancements across a spectrum of electrification and energy storage applications. Designing 3D printed polymers using low-cost resins specifically for conversion to high performance carbon structures via post-printing thermal treatments overcomes the challenges of 3D printing pure carbon directly due to the inability of pure carbon to be polymerized, melted, or sintered under ambient conditions. In this perspective, we outline the current state of AM methods that have been used in combination with pyrolysis to generate 3D carbon structures and highlight promising systems to explore further. As part of this endeavor, we discuss the effects of 3D printed polymer chemistry composition, additives, and pyrolysis conditions on resulting 3D pyrolytic carbon properties. Furthermore, we demonstrate the viability of combining continuous liquid interface production (CLIP) vat photopolymerization with pyrolysis as a promising avenue for producing 3D pyrolytic carbon lattice structures with 15 μm feature resolution, paving way for 3D carbon-based sustainable energy applications.

Persistent social inequities in the United States demand attention to culturally responsive (CR) teaching, which requires a specific disposition toward students and teaching. Using survey data of secondary teachers (N = 417) in seven urban districts across the country engaging in equity-oriented professional learning (PL) initiatives, we examine the relationship between teachers' beliefs about, self-efficacy for, and engagement in PL around CR teaching and their self-reported CR teaching practices. We find correlational evidence that teacher-reported self-efficacy with CR teaching and engagement in PL focused on CR teaching are associated with higher self-reported frequency of CR teaching. We also find that teachers who have beliefs aligned with CR teaching have a stronger relationship between their CR teaching self-efficacy and self-reported CR teaching practices. Finally, we find evidence that changes in CR teaching self-efficacy are associated with changes in self-reported CR teaching--suggesting that CR teaching self-efficacy may drive changes in CR teaching.

Abstract Background Intraoperative hemorrhage in cardiac surgery increases risk of morbidity and mortality. Low pre-operative and perioperative levels of fibrinogen, a key clotting factor, are associated with severity of hemorrhage and increased transfusion of blood components. The ability to supplement fibrinogen during hemorrhagic resuscitation is delayed 45–60 min because cryoprecipitated antihemophilic factor (cryo AHF) is stored frozen, due to a short post-thaw shelf life. Pathogen Reduced Cryoprecipitated Fibrinogen Complex (INTERCEPT Fibrinogen Complex, IFC) can be kept thawed, at room temperature, for up to 5 days, making it possible to be immediately available for hemorrhaging patients. This trial will investigate if earlier correction of acquired hypofibrinogenemia with IFC in hemorrhaging cardiac surgery patients reduces the total number of perioperatively transfused allogeneic blood products (red blood cells, plasma, and platelets) as compared to cryo AHF. Methods This is a single center, prospective, cluster randomized trial with an adaptive design. Acquired hypofibrinogenemia will be assessed by rotational thromboelastometry (ROTEM) and the threshold for cryo AHF/IFC transfusion defined as FIBTEM A10 ≤ 10 mm in bleeding patients. IFC/cryo AHF will be randomized by 1-month blocks. Cardiac surgery patients will be enrolled in the study if they have an eligible procedure and at least one dose of a cryo AHF/IFC product (approximately 2 g fibrinogen) is transfused. Data from the electronic health record, including the blood bank and lab information systems, will be prospectively collected from the health system’s data warehouse. Discussion This trial aims to provide evidence of the clinical efficacy of utilizing readily available thawed IFC during acute bleeding in the cardiac surgery setting compared to traditional cryo AHF. Trial registration ClinicalTrials.gov NCT05711524. Feb 3, 2023.

BACKGROUND: Anemia in very low birth weight (VLBW) infants is common and frequently managed with red blood cell (RBC) transfusions. We utilized a linked vein-to-vein database to assess the role of blood donors and component factors on measures of RBC transfusion effectiveness in VLBW infants. STUDY DESIGN AND METHODS: We linked blood donor and component manufacturing data with VLBW infants transfused RBCs between January 1, 2013 and December 31, 2016 in the Recipient Epidemiology Donor Evaluation Study-III (REDS III) database. Using multivariable regression, hemoglobin increments and subsequent transfusion events following single-unit RBC transfusion episodes were examined with consideration of donor, component, and recipient factors. RESULTS: Data on VLBW infants (n = 254) who received one or more single-unit RBC transfusions (n = 567 units) were linked to donor demographic and component manufacturing characteristics for analysis. Reduced post-transfusion hemoglobin increments were associated with RBC units donated by female donors (-0.24 g/dL [95% confidence interval (CI) -0.57, -0.02]; p = .04) and donors

Abstract Bleed‐off and shut‐in of injection have been implemented in different Enhanced Geothermal Systems (EGS) in an attempt to mitigate the induced seismicity at and after the injection stop. This article tackles the controversial discussion on the mitigation of the post‐injection induced seismicity through ending fluid injection by either a bleed‐off or a shut‐in. Both scenarios failed to mitigate the occurrence of large magnitude earthquake after stopping injection in numerous EGS. The two protocols are compared by using a seismological forecasting methodology coupled with a hydro‐mechanical model reproducing flow, poroelastic stress and fault failure in a domain including a discrete fault network based on Basel EGS (Switzerland, 2006). Unlike bleed‐off, shut‐in mitigates early post‐injection seismicity by smoothly reducing pressure, and consequently poroelastic stress changes in the modelled Basel EGS. Although post‐injection pore pressure diffusion eventually reaches distant faults and destabilizes them, seismicity is not initiated according to our simulation forecasting.

Summary: Low doses of general anesthetics like ketamine and dexmedetomidine have anxiolytic properties independent of their sedative effects, but the underlying mechanisms remain unclear. We discovered a population of GABAergic neurons in the oval division of the bed nucleus of the stria terminalis that are activated by multiple anesthetics and the anxiolytic drug diazepam (ovBNSTGA). The majority of ovBNSTGA neurons express neurotensin receptor 1 (Ntsr1) and form circuits with brain regions known to regulate anxiety and stress responses. Optogenetic activation of ovBNSTGA or ovBNSTNtsr1 neurons significantly attenuated anxiety-like behaviors in both naive animals and mice with inflammatory pain, while inhibition of these cells elevated anxiety. Activation of these neurons decreased heart rate and increased heart rate variability, suggesting that they reduce anxiety by modulating autonomic responses. Our study identifies ovBNSTGA/ovBNSTNtsr1 neurons as a common neural substrate mediating the anxiolytic effect of low-dose anesthetics and a potential therapeutic target for treating anxiety-related disorders.

Background and aimsColchicine is an anti-inflammatory drug that may prevent post-operative atrial fibrillation (POAF). The effect of this drug has been inconsistently shown in previous clinical trials. We aimed to compare the efficacy and safety of colchicine vs. placebo to prevent POAF in patients undergoing cardiac surgery.Methods and resultsA systematic search of EMBASE, MEDLINE, SCOPUS, ClinicalTrials.gov, and the Cochrane Library for randomized controlled trials (RCTs) was conducted from inception till April 2023. The primary outcome was the incidence of POAF after any cardiac surgery. The secondary outcome was the rate of drug discontinuation due to adverse events and adverse gastrointestinal events. Risk ratios (RR) were reported using the Mantel Haenszel method. A total of eight RCTs comprising 1885 patients were included. There was a statistically significant lower risk of developing POAF with colchicine vs. placebo (RR: 0.70; 95% CI: 0.59-0.82; P < 0.01, I2 = 0%), and this effect persisted across different subgroups. There was a significantly higher risk of adverse gastrointestinal events (RR: 2.20; 95% CI: 1.38-3.51; P < 0.01, I2 = 55%) with no difference in the risk of drug discontinuation in patients receiving colchicine vs. placebo (RR: 1.33; 95% CI: 0.93-1.89; P = 0.11, I2 = 0%).ConclusionThis meta-analysis of eight RCTs shows that colchicine is effective at preventing POAF, with a significantly higher risk of adverse gastrointestinal events but no difference in the rate of drug discontinuation. Future studies are required to define the optimal duration and dose of colchicine for the prevention of POAF.

AimsHaematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT.Methods and resultsThe National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001).ConclusionAmong patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.

The differentiation of wide complex tachycardias (WCTs) into ventricular tachycardia (VT) and supraventricular wide tachycardia (SWCT) via 12-lead ECG (electrocardiogram) interpretation is a crucial yet demanding clinical task. Decades of research have been dedicated to simplifying and improving this differentiation via manual algorithms. Despite such research, the effectiveness of such algorithms still remains limited, primarily due to reliance on user expertise. To combat this limitation, automated algorithms have been created that show promise as alternatives to manual ECG interpretation. However, direct comparison of the methods’ diagnostic performances has not been undertaken. A recent publication (LoCoco et al., 2024) compared the diagnostic performance between traditional manual ECG interpretation approaches (i.e. Brugada, Vereckei aVR, and VT Score) to novel automated wide QRS complex tachycardia differentiation algorithms (i.e. WCT Formula I, WCT Formula II, VT Prediction Model, Solo Model, and Paired Model). Two electrophysiologists independently applied the 3 manual WCT differentiation approaches to 213 ECGs. Simultaneously, computerized data from the same paired WCT with baseline ECGs were processed by the 5 automated WCT differentiation algorithms. Following these analyses, the diagnostic performance of automated algorithms was compared with manual ECG interpretation approaches. In this article, a summary of data components relating to diagnostic performance of the methods tested is presented.

The current context of standards-based reform has positioned regional service centers (RSCs), intermediary governmental agencies that support state policy implementation in local districts, as a critical source of professional development (PD). In this article, we ask how a governing body that districts often interact with during challenging reform processes manages maintain strong relationships with district and school staff, and thus maintain their image as trustworthy experts on standards implementation. We explore these questions using data from 108 interviews of state, district, and regional administrators in education agencies in Ohio, Texas, and California over a three-year period. We illustrate that by providing districts with (a) differentiated support specific to their unique needs, (b) materials and tools consistent with state content standards, and (c) expertise in supporting students with disabilities and English learners in standards-based environments, RSC staff become, in the words of one state leader, the state's trusted "boots on the ground." [For the corresponding grantee submission, see ED616594.]

* Context.--Substantial variability between different antibody titration methods has been identified since the development and introduction of the uniform procedure in 2008. Objective.--To determine whether more recent methods or techniques decrease interlaboratory and intralaboratory variation measured using proficiency testing. Design.--Proficiency test data for antibody titration between 2014 and 2018 were obtained from the College of American Pathologists. Interlaboratory and intralaboratory variations were compared by analyzing the distribution of titer results by method and phase, comparing the results against the supplier's quality control titer, and by evaluating the distribution of paired titer results when each laboratory received a sample with the same titer twice. Results.--A total of 1337 laboratories participated in the antibody titer proficiency test during the study period. Only 54.1 % (5874 of 10 852) of anti-D and 63.4% (3603 of 5680) of anti-A reported responses were within 1 titer of the supplier's intended result. Review of the agreement between laboratories of the same methodology found that 78.4% (3139 of 4004) for anti-A and 89.0% (9655 of 10 852) of laboratory responses for anti-D fell within 1 titer of the mode response. When provided with 2 consecutive samples of the same titer (anti-D titer: 16), 85% (367 of 434) of laboratories using the uniform procedure and 80% (458 of 576) using the other method reported a titer difference of 1 or less. Conclusions.--Despite advances, interlaboratory and intralaboratory variance for this assay remains high in comparison with the strong reliance on titer results in clinical practice. There needs to be a reevaluation of the role of this test in clinical decision-making. (Arch Pathol Lab Med. 2023;147:1351-1359; doi: 10.5858/arpa.2022-0248-CP), Antibody titration in transfusion medicine is a commonly used clinical assay to detect the strength of reactivity of red cell antibodies present in a patient's plasma. (1) There are a [...]

Spinal arachnoid web is a rare condition characterized by extramedullary bands of arachnoid tissue at the level of the dorsal thoracic spinal cord that may lead to progressive, permanent neurological deficits. To date, this condition has been radiographically characterized by a scalpel sign, which has been pathognomonic in all reported cases of spinal arachnoid webs. In this case, we report the first known patient with confirmed spinal arachnoid web without radiographic evidence of the scalpel sign. In reporting our finding, we encourage a higher clinical suspicion for spinal arachnoid web in patients presenting with progressive thoracic myelopathy following trauma, and radiographic evidence of ventrally displaced spinal cord and turbulent cerebrospinal fluid flow, even in the absence of a scalpel sign.

Abstract This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.

Though scholars agree that professional development (PD) is a key mechanism for implementing education policies that call for teacher change, and that PD generally needs to be content-focused, active, collaborative, coherent, and sustained, the application of this framework has yielded mixed results. In this qualitative study, we employed structured interviewing methods to explore how district leaders across five states are implementing college- and career- readiness (CCR) standards across the United States by creatively adapting and integrating the features of this PD framework in order to meet the demands of this mandated educational policy. We illustrate a revised model for how 70 district officials are conceptualizing these features of PD to support CCR standards-based learning.

Abstract INTRODUCTION Commercially available plasma p‐tau217 biomarker tests are not well studied in ethnically diverse samples. METHODS We evaluated associations between ALZPath plasma p‐tau217 and amyloid‐beta positron emission tomography (Aβ‐PET) in Hispanic/Latino (88% of Cuban or South American ancestry) and non‐Hispanic/Latino older adults. One‐ and two‐cutoff ranges were derived and evaluated to assess agreement with Aβ‐PET. RESULTS A total of 239 participants underwent blood draw and Aβ‐PET (age 70.8 ± 7.8, 55.2% female, education 15.6 ± 3.4 years, 48.9% Hispanic/Latino, 94.9% white). Plasma p‐tau217 showed excellent discrimination of Aβ‐PET positive and negative participants (visual read: AUC = 0.91 [0.87–0.95], p

Abstract Underwater organisms exhibit sophisticated propulsion mechanisms, enabling them to navigate fluid environments with exceptional dexterity. Recently, substantial efforts have focused on integrating these movements into soft robots using smart shape‐changing materials, particularly by using light for their propulsion and control. Nonetheless, challenges persist, including slow response times and the need of powerful light beams to actuate the robot. This last can result in unintended sample heating and potentially necessitate tracking specific actuation spots on the swimmer. To tackle these challenges, new azobenzene‐containing photopolymerizable inks are introduced, which can be processed by extrusion printing into liquid crystalline elastomer (LCE) elements of precise shape and morphology. These LCEs exhibit rapid and significant photomechanical response underwater, driven by moderate‐intensity ultraviolet (UV) and green light, being the actuation mechanism predominantly photochemical. Inspired by nature, a biomimetic four‐lapped ephyra‐like LCE swimmer is printed. The periodically illumination of the entire swimmer with moderate‐intensity UV and green light, induces synchronous lappet bending toward the light source and swimmer propulsion away from the light. The platform eliminates the need of localized laser beams and tracking systems to monitor the swimmer's motion through the fluid, making it a versatile tool for creating light‐fueled robotic LCE free‐swimmers.

Fewer than 26 case reports describe hypertrophic lichen planus (HLP) misdiagnosed as cutaneous squamous cell carcinoma (cSCC). It can be difficult to distinguish between HLP and cSCC, as these two conditions share many clinical and histopathological characteristics. Patients who are misdiagnosed with cSCC often undergo unnecessary medical and/or surgical interventions before receiving a diagnosis of HLP and improving on HLP-directed therapy. This case series highlights the course of three female patients, referred to a single tertiary institution between 2018 and 2022, who were initially misdiagnosed with cSCC before receiving a diagnosis of HLP. We have emphasized the clinical and histopathological distinguishing features between HLP and cSCC, the pathogenesis of HLP, and current and new HLP-directed therapy. We hope that this case series serves as a reminder to dermatologists, dermatologic surgeons, and dermatopathologists to be aware of this diagnostic challenge.

Coaching is a popular and high-leverage instrument for instructional reform. Coaching holds potential to accelerate teacher learning and school improvement. Linking results from current research, we portray how coaching benefits from robust infrastructure. This article offers three design recommendations that leaders can implement to optimize coaching: (1) identify infrastructural resources; (2) align coaching with instructional priorities and standards; and (3) ensure coaches have the knowledge they need, particularly in relation to the local context. We share insights on how educational reformers and leaders can re-set systems and optimize coaching to accelerate learning and change.

Serotonin reuptake inhibitors (SRIs), including selective SRIs (SSRIs) and other psychotropic medications, are used to treat a variety of psychiatric conditions, including many mood and anxiety disorders. They are among [...]

Serotonin reuptake inhibitors (SRIs), including selective SRIs (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are common treatments for many psychiatric conditions. SRIs are a first-line therapy for major depressive disorder (MDD), [...]

Abstract Facioscapulohumeral muscular dystrophy (FSHD) is among the most common of the muscular dystrophies, affecting nearly 1 in 8000 individuals, and is a cause of profound disability. Genetically, FSHD is linked to the contraction and/or epigenetic de-repression of the D4Z4 repeat array on chromosome 4, thereby allowing expression of the DUX4 gene in skeletal muscle. If the DUX4 transcript incorporates a stabilizing polyadenylation site the myotoxic DUX4 protein will be synthesized, resulting in muscle wasting. The mechanism of toxicity remains unclear, as many DUX4-induced cytopathologies have been described, however cell death does primarily occur through caspase 3/7-dependent apoptosis. To date, most FSHD therapeutic development has focused on molecular methods targeting DUX4 expression or the DUX4 transcript, while therapies targeting processes downstream of DUX4 activity have received less attention. Several studies have demonstrated that inhibition of multiple signal transduction pathways can ameliorate DUX4-induced toxicity, and thus compounds targeting these pathways have the potential to be developed into FSHD therapeutics. To this end, we have screened a group of small molecules curated based on their reported activity in relevant pathways and/or structural relationships with known toxicity-modulating molecules. We have identified a panel of five compounds that function downstream of DUX4 activity to inhibit DUX4-induced toxicity. Unexpectedly, this effect was mediated through an mTor-independent mechanism that preserved expression of ULK1 and correlated with an increase in a marker of active cellular autophagy. This identifies these flavones as compounds of interest for therapeutic development, and potentially identifies the autophagy pathway as a target for therapeutics.

The ambitious goals of standards-based reform call for both technical and adaptive leadership to address problems of practice involving the technical and adaptive alignment of teachers' instruction to the standards. Thus, standards-aligned curriculum implementation necessitates both types of strategies; otherwise, adaptive challenges will persist. In this study, we analyze case studies of four districts where new English Language Arts and math curricula were recently adopted to help align teachers' practice with their state's English Language Arts and math standards. We draw from interviews with district leaders, principals, instructional coaches, and teachers to illustrate how mostly technical strategies for curriculum implementation do little to address the adaptive challenges that prevent teachers from fundamentally shifting their practice to be more aligned to the standards and to meet the needs of all learners. We conclude with a set of insights and implications for educational leaders approaching curriculum implementation in both technical and adaptive ways.