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We report the serendipitous multiwavelength discovery of a candidate dual black hole system with a separation of ∼100 pc, in the gas-rich luminous infrared galaxy MCG-03-34-64 ( z = 0.016). Hubble Space Telescope/Advanced Camera for Surveys observations show three distinct optical centroids in the [O iii ] narrow-band and F814W images. Subsequent analysis of Chandra/ACIS data shows two spatially resolved peaks of equal intensity in the neutral Fe K α (6.2–6.6 keV) band, while high-resolution radio continuum observations with the Very Large Array at 8.46 GHz (3.6 cm band) show two spatially coincident radio peaks. Fast shocks as the ionizing source seem unlikely, given the energies required for the production of Fe K α . If confirmed, the separation of ∼100 pc would represent the closest dual active galactic nuclei reported to date with spatially resolved, multiwavelength observations.

This study uses the simplified patterns of temperature and effective precipitation approach from the Australian component of the international palaeoclimate synthesis effort (INTegration of Ice core, MArine and TErrestrial records – OZ-INTIMATE) to compare atmosphere–ocean general circulation model (AOGCM) simulations and proxy reconstructions. The approach is used in order to identify important properties (e.g. circulation and precipitation) of past climatic states from the models and proxies, which is a primary objective of the Southern Hemisphere Assessment of PalaeoEnvironment (SHAPE) initiative. The AOGCM data are taken from the Paleoclimate Modelling Intercomparison Project (PMIP) mid-Holocene (ca. 6000 years before present, 6 ka) and pre-industrial control (ca. 1750 CE, 0 ka) experiments. The synthesis presented here shows that the models and proxies agree on the differences in climate state for 6 ka relative to 0 ka, when they are insolation driven. The largest uncertainty between the models and the proxies occurs over the Indo-Pacific Warm Pool (IPWP). The analysis shows that the lower temperatures in the Pacific at around 6 ka in the models may be the result of an enhancement of an existing systematic error. It is therefore difficult to decipher which one of the proxies and/or the models is correct. This study also shows that a reduction in the Equator-to-pole temperature difference in the Southern Hemisphere causes the mid-latitude westerly wind strength to reduce in the models; however, the simulated rainfall actually increases over the southern temperate zone of Australia as a result of higher convective precipitation. Such a mechanism (increased convection) may be useful for resolving disparities between different regional proxy records and model simulations. Finally, after assessing the available datasets (model and proxy), opportunities for better model–proxy integrated research are discussed.

Background: The prevalence of mental health disorders calls for valid and reliable instruments that are easy to administer and assess for clinicians and researchers. The Depression Anxiety Stress Scale-21 (DASS-21) is a commonly used instrument to assess psychological distress; however, model fit and internal reliability issues have been reported. Our objective was to assess the factorial and structural validity of the DASS-21. Methods: A confirmatory factor analysis (CFA) was conducted on the full sample (n = 1036) to assess the proposed three-factor DASS-21 using a priori cut-off values. Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting three-factor structure (i.e., DASS-9) was then assessed using CFA and multigroup invariance testing procedures. Results: The proposed three-factor DASS-21 did not meet model fit criteria. The DASS-9 did meet recommended model fit criteria and was invariant between sex, injury status, mental health diagnosis, and activity level groups. Statistically different group means were found between mental health diagnosis and activity level groups, while no differences between sex or injury status groups were found. Conclusions: The current study provides support to use a condensed DASS-21 instrument, such as the DASS-9. Future research is necessary to establish the DASS-9 prior to its adoption in research and clinical practice. Additionally, there is a need to identify and review all condensed versions of the DASS-21, so individuals know which instrument can be used for clinical or research purposes.

Background: Researchers in the field of sport pedagogy have highlighted questioning as a behaviour that facilitates athletes' high-order thinking and problem-solving. However, previous studies have suggested that coaches ask a reduced number of questions during training that are typically convergent and lead players to predetermined responses. Formal coach development programmes (CDPs), intended to encourage the use of questioning, have been scrutinised for their limited impact on coaches' practice. These criticisms have been made without consideration of the instances and situations during training that might present a better opportunity for asking different question types. Purpose: The purpose of this study was to explore coaches' perceptions concerning potential 'teachable moments' to ask convergent and divergent questions during training at three data collection points, and to associate changes between knowledge and behaviour after a work-based CDP. Method: Six Spanish youth football coaches working for an elite academy were recruited to a longitudinal study. The study involved a six-week CDP delivered by a coach developer, in collaboration with the club's Academy Management Team, and an experienced research team. Data collection occurred throughout 24-months interspersed by a workshop and two directed tasks organised in several stages: (1) Pre-systematic observations (Sep-Dec 2018) and (2) pre-interviews (Jan 2019), to identify coaches' baseline behaviours and knowledge; (3) a workshop & directed task 1 (Feb 2019), encouraging coaches to experiment and self-discover how to implement questioning within their training contexts; (4) a directed task 2 (Feb-Mar 2019), facilitating coaches' video-based and dialogic reflections about their questions; (5) post-systematic observations (Mar-May 2019) and (6) post-interviews (May 2019), capturing changes in knowledge and questioning after the intervention; and (7) consolidation interviews (May 2020), recording coaches' knowledge stabilisation and further developments. Results and findings: Four coaches completed the full CDP, whilst the remaining two coaches did not participate in the second directed task. Qualitative data suggest that all coaches developed their understanding of which moments might be most appropriate to ask convergent or divergent questions. However, only the first group of coaches presented congruent changes between the timing in which they asked questions and their perceptions. This involved higher use of convergent questions (during practice) and divergent questions (in-between practices and when the coach stops practice). Conversely, coaches in the incomplete CDP, decreased or maintained their questioning values within most instances and suggested organisational and contextual factors hindering their engagement in this work-based CDP. Therefore, real opportunities to implement questioning techniques combined with reflective practice assisted by a coach developer are proposed to translate knowledge gained during CDPs into observable behaviours.

Flow in the wake of a coronary artery stenosis induces a bruit in the 300–1500 Hz range that can be heard at the chest wall. It has been hypothesised that this sound is caused by turbulence-induced shear waves which travel through the soft tissue of the thorax. This contribution describes a computational mathematical ‘forward solve’ method to simulate these shear waves in a virtual chest of tissue mimicking agarose gel. As the first stage in the development of a noninvasive diagnostic tool we also describe initial results towards the solution of the mathematical inverse problem. That is: to identify the source of the bruit given the surface measured signal. Objectives: To demonstrate proof-of-concept of a novel biotechnology that will use mathematical simulations to provide a non-invasive screening tool for coronary artery disease. Methods: Finite element based forward solvers for soft tissue response (given the source, generate the signal); optimisation-based inverse solver (given the signal, determine the source). Results: For a simple, small scale, and axisymmetric cylindrical gel configuration, and for a source at 500 Hz, the forward solve generates signals that agree with experimental data (using Kelvin-Voigt viscoelasticity). Also, with surface signals generated by simulated sources in this virtual environment the inverse algorithm is able to identify this source given only chest surface measurements, and an adequate initial datum from which to start the computation. Conclusions: While enormous challenges remain we have shown that this approach offers considerable promise in delivering a noninvasive diagnostic or screening tool.

Background: Turbulent flow downstream of atherosclerotic plaques produces low amplitude shear waves which travel through the chest and can be measured by skin sensors. This acoustic signature may provide a cheap non-invasive way to diagnose arterial disease. We report measurements of shearing oscillations and flow-induced turbulence in soft tissue-mimicking gels which provide input to a numerical model of soft tissue behaviour described in a companion presentation. Methods: Cylindrical specimens of 3% agarose gel were cast around an axial rod and bead connected to an electromechanical vibrator (figure 1), to generate shear-waves of known characteristics and location (frequency 250–750 Hz, amplitude 10–50 μm). Displacement was mapped optically by tracking the movement of carborundum particles on the surface. In the flow study (figure 2) a silicone rubber tube (i.d. 4.5mm) containing a stenosis was embedded in a cuboidal gel phantom and lateral displacement of the gel surface was mapped by a piezo-electric accelerometer. Results: Forced oscillations produced movement in the same direction at the gel surface, amplitude 10–50% of the bead’s movement. Amplitude modulation (≈5%) at around 40Hz, probably due to resonance in the gel, was also seen. Lateral movement (200–800Hz) of the gel surface caused by flow-induced turbulence increased monotonically with turbulence magnitude. Conclusions: The methods described above provide internally consistent and repeatable data, validating the numerical models. The next steps will compare computational results with measurements in progressively more realistic representations of the chest aiming ultimately to produce a device suitable for screening/diagnosis of coronary artery disease. Figure. 1. Forced vibration rig. Gels cast with bead in various positions. Laser measures bead movement; camera measures surface movement Figure 2. Steady flow rig. Measurements made at various flow rates, tube depths and stenosis severity. Accelerometer position varied.

# Background The International Knee Document Committee Subjective Knee Form (IKDC-SKF) is a patient-reported outcome measure used in orthopedics and sports medicine. Further psychometric assessment is necessary to confirm measurement properties in a large, heterogenous sample. # Purpose The purpose of the study was to assess the psychometric properties of the IKDC-SKF in a large, heterogenous sample. # Study Design Cross-Sectional Study # Methods An exploratory factor analysis (EFA) was conducted to identify a sound latent structure and to assess internal consistency in a large sample of patients who underwent knee arthroscopy. A confirmatory factor analysis (CFA) was conducted to confirm structural validity. Multi-group invariance was conducted to assess factorial stability across sex and age groups, while longitudinal invariance procedures were performed to assess stability over time. # Results A 3-factor, 9-item IKDC-SKF short form was identified with EFA procedures. The model was confirmed with CFA (CFI = 0.983; TLI = 0.975; IFI = 0.983; RMSEA = 0.057), while a sound 2-factor, 6-item model was also identified (CFI = 1.0; TLI = 0.999; IFI = 1.0; RMSEA = 0.11). The 9-item IKDC-SKF short form was invariant across groups but not time; removal of a single item (i.e., 8-item IKDC-SKF short form) resulted in longitudinal invariance. The 6-item IKDC-SKF short form was invariant across groups and time. # Conclusion The 6-item, 8-item, and 9-item short form versions of the IKDC-SKF exceed contemporary fit recommendations and present as plausible alternatives to the IKDC-SKF with improved measurement properties, reduced scale response burden, and evidence of multi-group and longitudinal invariance. Further, the 6- and 8-item IKDC-SKF short forms may be used to assess group differences or change across time. # Level of evidence here Level 3

# Background Instrument-assisted soft tissue mobilization (IASTM) is a commonly utilized intervention for musculoskeletal pain and dysfunction. However, little is known regarding the reliability of forces applied by clinicians of different experience levels during an IASTM intervention. # Purpose The purpose of this pilot study was to assess intra-clinician reliability of IASTM force (i.e., mean normal force) during a simulated, one-handed stroke IASTM intervention across different levels of IASTM clinical experience. # Design Descriptive laboratory study. # Methods The researchers conducted a repeated measures trial in a laboratory setting with a convenience sample of ten participants who had previously completed professional IASTM training. Participants performed 15 one-handed sweeping strokes with an IASTM instrument on a skin simulant attached to a force plate for a standardized hypothetical treatment scenario. The participants performed the treatment on two separate days, 24-48 hours apart. The researchers examined the intra-rater reliability for average (mean) normal forces using Bland-Altman (BA) plots and Coefficient of Variation (CV) values. # Results The BA plot results indicated all participants (professional athletic training students = 4, athletic trainers = 6; males = 5, females = 5; age = 32.60 ± 8.71 y; IASTM experience = 3.78 ± 4.10 y), except participant D (1.9N, 190g), were consistently reliable within 1N (100g) or less of force for mean differences and within the maximum limits of agreement around 3.7N (370g). Most participants' CV scores ranged between 8 to 20% supporting reliable force application within each treatment session. # Conclusion The data indicated that IASTM trained clinicians could produce consistent forces within and across treatment sessions irrespective of clinical experience. # Level of Evidence 3

Background Women have been reported to have worse health‐related quality of life (HRQoL) following stroke than men, but uncertainty exists over the reasons for the sex difference. Methods and Results We included all ischemic strokes registered with the BASIC (Brain Attack Surveillance in Corpus Christi) project (May 2010–December 2016), a population‐based stroke study, who completed a 90‐day outcome interview. Information on baseline characteristics was obtained from medical records and in‐person interviews. HRQoL was measured by the 12‐item short‐form Stroke Specific Quality of Life Scale. Multivariable Tobit regression was used to estimate the mean difference in overall HRQoL scores (range, 1–5; higher indicating better HRQoL) between sexes and to identify contributing factors to the differences. We included 1061 cases with complete data on HRQoL and covariates (median age, 67 years; 51% women). In unadjusted analyses, women had poorer overall HRQoL than men (mean difference, −0.26 [95% CI, −0.40 to −0.13]). Contributors to this difference included sociodemographic/prestroke factors (eg, age, race and ethnicity, prestroke function), risk factors/comorbidities (eg, history of stroke, Alzheimer disease/dementia), and initial stroke severity. Sociodemographic/prestroke factors explained 62% of the sex difference (mean difference, −0.08 [95% CI, −0.21 to 0.04]). In a fully adjusted model that included adjustment for all confounding factors, the sex difference was eliminated and became nonsignificant (mean difference, −0.03 [95% CI, −0.16 to 0.09]). Conclusions Poorer HRQoL in women compared with men was observed and explained by the combination of sociodemographic and prestroke factors, including physical function before stroke and stroke severity. The findings suggest potential subgroups of women who might benefit from more targeted interventions before and after stroke to improve HRQoL.

In the recent years, technology has been an important component in teaching and learning. The literature has highlighted many studies investigations on the students' intention to use technology in many Western, African and South East Asian countries. This article brings in the factors influencing students' adoption of ICT tools in higher education institutions in India. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used to determine the predictors of ICT adoption in learning their coursework in colleges. The results were obtained by structural equation modelling, using the data collected from 398 students doing their undergraduate engineering programs. The findings show that performance expectancy, effort expectancy and social influence has a positive significant relationship on behavioral intention to use ICT tools and facilitating conditions has a direct relationship with usage behaviour. The findings have led to relevant theoretical and practical implications and future researches are suggested.

Background We aimed to determine if there is an association between hospital quality and the likelihood of a given hospital being a preferred transfer destination for stroke patients. Methods and Results Data from Medicare claims identified acute ischemic stroke transferred between 394 northeast US hospitals from 2007 to 2011. Hospitals were categorized as transferring (n=136), retaining (n=241), or receiving (n=17) hospitals based on the proportion of acute ischemic stroke encounters transferred or received. We identified all 6409 potential dyads of sending and receiving hospitals, and categorized dyads as connected if ≥5 patients were transferred between the hospitals annually (n=82). We used logistic regression to identify hospital characteristics associated with establishing a connected dyad, exploring the effect of adjusting for different quality measures and outcomes. We also adjusted for driving distance between hospitals, receiving hospital stroke volume, and the number of hospitals in the receiving hospital referral region. The odds of establishing a transfer connection increased when rate of alteplase administration increased at the receiving hospital or decreased at the sending hospital, however this finding did not hold after applying a potential strategy to adjust for clustering. Receiving hospital performance on 90‐day home time was not associated with likelihood of transfer connection. Conclusions Among northeast US hospitals, we found that differences in hospital quality, specifically higher levels of alteplase administration, may be associated with increased likelihood of being a transfer destination. Further research is needed to better understand acute ischemic stroke transfer patterns to optimize stroke transfer systems.

The Regional Arctic System Model version 1 (RASM1) has been developed to provide high-resolution simulations of the Arctic atmosphere–ocean–sea ice–land system. Here, we provide a baseline for the capability of RASM to simulate interface processes by comparing retrospective simulations from RASM1 for 1990–2014 with the Community Earth System Model version 1 (CESM1) and the spread across three recent reanalyses. Evaluations of surface and 2 m air temperature, surface radiative and turbulent fluxes, precipitation, and snow depth in the various models and reanalyses are performed using global and regional datasets and a variety of in situ datasets, including flux towers over land, ship cruises over oceans, and a field experiment over sea ice. These evaluations reveal that RASM1 simulates precipitation that is similar to CESM1, reanalyses, and satellite gauge combined precipitation datasets over all river basins within the RASM domain. Snow depth in RASM is closer to upscaled surface observations over a flatter region than in more mountainous terrain in Alaska. The sea ice–atmosphere interface is well simulated in regards to radiation fluxes, which generally fall within observational uncertainty. RASM1 monthly mean surface temperature and radiation biases are shown to be due to biases in the simulated mean diurnal cycle. At some locations, a minimal monthly mean bias is shown to be due to the compensation of roughly equal but opposite biases between daytime and nighttime, whereas this is not the case at locations where the monthly mean bias is higher in magnitude. These biases are derived from errors in the diurnal cycle of the energy balance (radiative and turbulent flux) components. Therefore, the key to advancing the simulation of SAT and the surface energy budget would be to improve the representation of the diurnal cycle of radiative and turbulent fluxes. The development of RASM2 aims to address these biases. Still, an advantage of RASM1 is that it captures the interannual and interdecadal variability in the climate of the Arctic region, which global models like CESM cannot do.

Background Women have worse outcomes after stroke than men, and this may be partly explained by stroke severity. We examined factors contributing to sex differences in severity of acute stroke assessed by the National Institutes of Health Stroke Scale. Methods and Results We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population‐based stroke incidence studies (1996–2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke‐related clinical factors, comorbidities, and pre‐stroke function were obtained. Within each study, relative risk regression using log‐binominal modeling was used to estimate the female:male relative risk (RR) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study‐specific unadjusted and adjusted RRs, controlling for confounding variables, were pooled using random‐effects meta‐analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24–1.46). The sex difference in severity was attenuated after adjustment for age, pre‐stroke dependency, and atrial fibrillation but remained statistically significant (pooled RRadjusted 1.20, 95% CI 1.10–1.30). There was no sex difference in severity for intracerebral hemorrhage (RRcrude 1.08, 95% CI 0.97–1.21; RRadjusted 1.08, 95% CI 0.96–1.20). Conclusions Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre‐stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre‐stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.

Background Patients presenting to hospitals during non–weekday hours experience worse outcomes, often attributed to reduced staffing. The American Heart Association International Stroke Conference (ISC) is well attended by stroke clinicians. We sought to determine whether patients with acute ischemic stroke (AIS) admitted during the ISC receive less guideline‐adherent care and experience worse outcomes. Methods and Results We performed a retrospective cohort study of US hospitals participating in Get With The Guidelines–Stroke and assessed use of intravenous tissue plasminogen activator, other quality measures, and outcomes for patients with AIS admitted during the ISC compared with those admitted the weeks before and after the conference. A total of 69 738 patients with AIS were included: mean age, 72 years; 52% women; 29% nonwhite. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non‐ISC weeks (1984 versus 1997; P=0.95). Patient and hospital characteristics were similar between ISC and non‐ISC time periods. There were no significant differences in 14 quality metrics and 5 clinical outcomes between patients with AIS treated during the ISC versus non‐ISC weeks. Patients with AIS who presented within 2 hours of onset had no difference in the likelihood of receiving intravenous tissue plasminogen activator within 3 hours (adjusted odds ratio, 0.89; 95% confidence interval, 0.77–1.03; P=0.13) or the likelihood of receiving intravenous tissue plasminogen activator within 60 minutes of arrival (adjusted odds ratio, 0.92; 95% confidence interval, 0.83–1.02; P=0.13). Conclusions Patients with acute stroke admitted to Get With The Guidelines–Stroke hospitals during ISC received the same quality care and had similar outcomes as patients admitted at other times.

Background The prognostic value of shock index (SI), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood. Methods and Results We examined the Get With The Guidelines–Stroke (GWTG‐Stroke) data to explore the usefulness of SI in predicting in‐hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [CI], 1.92–2.08) for in‐hospital mortality, 1.46 (95% CI, 1.43–1.49) for longer length of hospital stay >4 days, 1.50 (95% CI, 1.47–1.54) for discharge destination other than home, 1.41 (95% CI, 1.38–1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI, 1.47–1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG‐Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS. Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.

The article focuses on the integration of workplace spirituality and emotional intelligence in organizations, presenting a framework that links the two concepts. Topics include the definition and benefits of workplace spirituality, the importance of recognizing employees' spirits at work, and the relevance of emotional intelligence in overcoming challenges in today's competitive work environments.

Purpose The purpose of the paper is to highlight the concept of workplace spirituality, its benefits, importance in organization, and the strategies to implement workplace spirituality to enhance employee engagement in the organization.Design/methodology/approach Viewpoint paper.Findings This paper suggests that workplace spirituality will improve the level of engagement of employees.Originality/value This paper provides various strategies of workplace spirituality. This will help the organization to implement it in the work setting. [ABSTRACT FROM AUTHOR]

Purpose This paper aims to lay a theoretical foundation favoring the use of social networking sites (SNS) in workplace and its implication on employee stress and well-being. Prescriptive policies are also formulated to control unintended negative consequences.Design/methodology/approach The authors have used an explorative design. Prescriptive data were drawn from extant literature, simple discussions with employees and employers. Discussions were centered on the consequences of SNS.Findings In recent years, SNS usage has skyrocketed and use in the workplace has been controversial. Use of SNS enables employees to communicate and connect not only with coworkers but also with family members and friends, and it also helps to minimize the stress and improve the well-being of employees. However, a comprehensive policy that controls negative consequences should be in place.Originality/value This paper sensitizes readers on the need for permitting SNS usage within a policy-controlled setting in organizations. It also throws light on social support, stress and well-being. [ABSTRACT FROM AUTHOR]

Originating in the grapes, anthocyanins and their derivatives are the crucial pigments responsible for the red wine color. During wine maturation and aging, the concentration of monomeric anthocyanins declines constantly, while numerous more complex and stable anthocyanin derived pigments are formed, mainly including pyranoanthocyanins, polymeric anthocyanins produced from condensation between anthocyanin and/or flavan-3-ols directly or mediated by aldehydes. Correspondingly, their structural modifications result in a characteristic variation of color, from purple-red color in young red wines to brick-red hue of the aged. Because of the extreme complexity of chemical compounds involved, many investigations have been made using model solutions of know composition rather than wine. Thus, there is a large amount of research still required to obtain an overall perspective of the anthocyanin composition and its change with time in red wines. Future findings may well greatly revise our current interpretation of the color in red wines. This paper summarizes the most recent advances in the studies of the anthocyanins derived pigments in red wines, as well as their color evolution. [ABSTRACT FROM AUTHOR]

The objectives of this study were 1) to evaluate the ability of trenbolone acetate (TBA) administered in tandem with LHRH immunization to suppress reproductive function in bulls and 2) to examine the effects of LHRH and androgen (TBA) signaling on pituitary gland function. Forty-four Angus × Hereford crossbred calves (BW = 225 ± 2 kg; age = 187 ± 6 d) received castration, LHRH immunization, or TBA administration in a 2 × 2 × 2 factorial design. Treatment groups receiving LHRH immunization contained 6 animals, whereas other treatment groups contained 5 animals. Animals immunized against LHRH received a primary injection and 2 booster injections of ovalbumin-LHRH-7 fusion protein on d 0, 42, and 196, respectively. Animals treated with TBA were implanted on d 224. Serum LHRH antibodies increased (P < 0.05) after each booster for immunized animals, but were negligible in nonimmunized animals throughout the experiment. Serum testosterone concentration (P < 0.001) and scrotal circumference (P < 0.05) were depressed in LHRH-immunized bulls compared with nonimmunized bulls by d 84 and 168 of the experiment, respectively. Treatment with TBA tended (P = 0.08) to decrease serum testosterone concentrations of nonimmunized bulls. Weights of testes at slaughter were decreased (P < 0.001) for LHRH-immunized (232 ± 41 g) compared with nonimmunized (752 ± 45 g) bulls, but did not differ (P = 0.80) between TBA-implanted (500 ± 49 g) and nonimplanted bulls (484 ± 36 g). Both LHRH immunization and castration decreased pituitary gland stores of LH and FSH (P < 0. 001). There was no effect (P > 0.10) of TBA on pituitary gland FSH content and only a tendency (P = 0.09) to increase pituitary gland LH content. Immunization against LHRH decreased expression of LH β-subunit and common α-subunit genes (P < 0.001). Castration increased expression of LH β-subunit and common α-subunit genes (P = 0.02). Treatment with TBA further suppressed (P = 0.04) α-subunit mRNA expression in LHRH-immunized steers. In summary, LHRH immunization decreased synthesis and storage of LH and decreased storage, but not synthesis of FSH in bulls. The increased synthesis of LH and FSH in nonimmunized, but not LHRH-immunized steers suggests that castration removes the negative feedback on gonadotropin synthesis but that LHRH is still needed for release of these hormones. Androgen replacement with TBA did not restore the negative feedback control of gonadotropin synthesis. [ABSTRACT FROM AUTHOR]

In seasonally breeding songbirds, brain nuclei of the song control system that act in song perception change in size between seasons. It has been hypothesized that seasonal regression of song nuclei may impair song discrimination. We tested this hypothesis in song sparrows (Melospiza melodia), a species in which males share song types with neighbors and must discriminate between similar songs in territorial interactions. We predicted that song sparrows with regressed song systems would have greater difficulty in discriminating between similar songs. Sparrows were housed either on short days (SD) and had regressed song circuits, or were exposed to long days and implanted with testosterone (LD+T) to induce full growth of the song circuits. We conducted two experiments using a GO/NO-GO operant conditioning paradigm to measure song discrimination ability of each group. Birds learned four (experiment 1) or three (experiment 2) pairs of song types sequentially, with each pair more similar in the number of shared song elements and thus more difficult to discriminate. Circulating T levels differed between the SD and LD+T groups. The telencephalic song nuclei HVc, RA, and area X were larger in the LD+T birds. The two groups of sparrows did not differ, however, in their ability to learn to discriminate between shared song types, regardless of the songs' similarity. These results suggest that seasonal changes in the song control system do not affect birds' ability to make difficult song discriminations. © 2003 Wiley Periodicals, Inc. J Neurobiol 57: 119–129, 2003 [ABSTRACT FROM AUTHOR]

Abstract Background A shortage of healthcare providers, particularly in primary care and mental health, exists in the predominately rural state of Idaho. There are also barriers to retaining healthcare providers to work in rural and remote communities. Limited research using U.S. samples has explored factors that may affect the retention of healthcare providers in rural areas. Additionally, due to differences between communities, it is important to conduct community-level investigations to better understand how these factors may affect retention in rural areas. Therefore, the purpose of this study was to explore factors affecting healthcare provider retention in a rural community in Northern Idaho. Methods A modified version of the Nursing Community Apgar Questionnaire (NCAQ) was completed by 30 healthcare providers in a rural and frontier community in Northern Idaho to assess factors influencing healthcare provider retention. Factors were classified into classes including geographic, economic, scope of practice, medical support, and facility and community support classes. Retention factors were assessed on their perceived importance to retention as well as whether they were perceived as an advantage or challenge to retention based on Likert scales. A “Community Apgar” score was also created by combining the importance and advantage/challenge factors. Results Overall, items in the medical support group had the highest importance of any other class and included factors such as nursing workforce. Additionally, the facility and community support class, which included factors such as televideo support, was rated the highest advantage class and had the highest Apgar score, indicating it contained the factor that healthcare providers identified as the most important advantage (i.e., medical reference resources). Conclusion Our study identified multiple factors that healthcare providers deemed as important advantages or disadvantages to retaining healthcare providers in rural areas. Overall, facility and community support factors were found to have the highest advantage in the retention of rural providers. Rural healthcare organizations looking to increase healthcare provider retention should target retention efforts towards these factors. Additional research should also be conducted on other rural samples across the U.S. to make comparisons of findings.

Background We performed a review of acute stroke trials to determine features associated with premature termination of trial enrollment, defined by the authors as not meeting preplanned sample size. Methods and Results MEDLINE was searched for randomized clinical stroke trials published in 9 major clinical journals between 2013 and 2022. We included randomized clinical trials that were phase 2 or 3 with a preplanned sample size ≥100 and a time‐to‐treatment within 24 hours of onset for transient ischemic attack, ischemic stroke, or intracerebral hemorrhage. Data were abstracted on trial features including trial design, inclusion criteria, imaging, location and number of sites, masking, treatment complexity, control group (standard therapy, placebo), industry involvement, and preplanned stopping rules (futility and efficacy). Least absolute shrinkage and selection operator regression was used to select the most important factors associated with premature termination; then, a multivariable logistic regression was fit including only the least absolute shrinkage and selection operator selected variables. Of 1475 studies assessed, 98 trials met eligibility criteria. Forty‐five (46%) trials were prematurely terminated, of which 27% were stopped for benefit/efficacy, 20% for lack of money/slow enrollment, 18% for futility, 16% for newly available evidence, 17% for other reasons, and 4% due to harm. Complex trials (adjusted odds ratio [aOR], 2.76 [95% CI, 1.13–7.49]), presence of a futility rule (aOR, 4.43 [95% CI, 1.62–17.91]), and exclusion of prestroke dependency (none/slight disability only; aOR, 2.19 [95% CI, 0.84–6.72] versus dependency allowed) were identified as the strongest predictors. Conclusions Nearly half of acute stroke trials were terminated prematurely. Broadening inclusion criteria and simplifying trial design may decrease the likelihood of unplanned termination, whereas planned futility analyses may appropriately terminate trials early, saving money and resources.

Background: Recent evidence in systems neuroscience suggests that lighting conditions affect the whole chain of brain processing, from retina to high-level cortical networks, for perceptual and cognitive function. Here, visual adaptation levels to three different environmental lighting conditions, (1) darkness, (2) daylight, and (3) prolonged exposure to very bright light akin to sunlight, were simulated in lab to investigate the effects of light adaptation levels on classic cases of subjective contrast, assimilation, and contrast-induced relative depth in achromatic, i.e., ON–OFF pathway mediated visual configurations. Methods: After adaptation/exposure to a given lighting condition, configurations were shown in grouped and ungrouped conditions in random order to healthy young humans in computer-controlled two-alternative forced-choice procedures that consisted of deciding, as quickly as possible, which of two background patterns in a given configuration of achromatic contrast appeared lighter, or which of two foreground patterns appeared to stand out in front, as if it were nearer to the observer. Results: We found a statistically significant effect of the adaptation levels on the consciously perceived subjective contrast (F(2,23) = 20.73; p < 0.001) and the relative depth (F(2,23) = 12.67; p < 0.001), a statistically significant interaction between the adaptation levels and the grouping factor (F(2,23) = 4.73; p < 0.05) on subjective contrast, and a statistically significant effect of the grouping factor on the relative depth (F(2,23) = 13.71; p < 0.01). Conclusions: Visual adaption to different lighting conditions significantly alters the conscious perception of contrast and assimilation, classically linked to non-linear functional synergies between ON and OFF processing channels in the visual brain, and modulates the repeatedly demonstrated effectiveness of luminance contrast as a depth cue; the physically brighter pattern regions in the configurations are no longer consistently perceived as nearer to a conscious observer under daylight and extreme bright light adapted (rod-saturated) conditions.

Silver oxide Schottky contacts (SCs), reactively sputtered using a low-power Ar:O2 rf-plasma on SnO2 films grown by mist-CVD, showed significantly improved figures-of-merit compared with plain-metal SCs, with barrier heights of 0.91 eV and ideality factors close to unity. These SCs were used to fabricate thin-film metal-semiconductor FETs with on/off ratios >106 on the same solution-processed material. It is proposed that the high quality of these SCs is due to the oxidized fabrication methodology, whereby reactive oxygen species are likely to be present during the formation of the Schottky interface, leading to the removal of the native surface electron accumulation layer. [ABSTRACT FROM AUTHOR]

Abstract Background Vitamin E has a positive effect in the management of osteoarthritis in humans, and in a previous study of dogs. It has been suggested to decrease C‐reactive protein concentrations and liver enzyme activities in humans and animals. Objective To assess the effect of vitamin E supplementation on lameness, pain, pain medication requirement, clinical pathology variables, and quality of life in large‐breed dogs with naturally occurring osteoarthritis. Animals Fifty‐seven client‐owned dogs with naturally occurring osteoarthritis. Methods Dogs received either vitamin E or placebo for 90 days in a randomized, placebo‐controlled, double‐blinded, prospective clinical trial. Clinical lameness scores, pain medication requirements, and owner questionnaires were used to assess response to treatment every 30 days. Blood samples were collected at enrollment and at the end of the study period. Results Vitamin E administration did not improve pain, lameness, or quality of life as assessed by owners and veterinarians. Vitamin E supplementation did not decrease the requirement for rescue pain relief. No changes in clinical pathology variables were observed after 90 days of vitamin E supplementation. Body weight was negatively associated with the lameness scores and requirement for rescue pain relief. Conclusion Vitamin E supplementation did not have any observable positive effects in dogs with naturally occurring osteoarthritis.

Summary: Background: BC2001 showed combining chemotherapy (5-FU + mitomycin-C) with radiotherapy improves loco-regional disease-free survival in patients with muscle-invasive bladder cancer (MIBC). We previously showed a 24-gene hypoxia-associated signature predicted benefit from hypoxia-modifying radiosensitisation in BCON and hypothesised that only patients with low hypoxia scores (HSs) would benefit from chemotherapy in BC2001. BC2001 allowed conventional (64Gy/32 fractions) or hypofractionated (55Gy/20 fractions) radiotherapy. An exploratory analysis tested an additional hypothesis that hypofractionation reduces reoxygenation and would be detrimental for patients with hypoxic tumours. Methods: RNA was extracted from pre-treatment biopsies (298 BC2001 patients), transcriptomic data generated (Affymetrix Clariom-S arrays), HSs calculated (median expression of 24-signature genes) and patients stratified as hypoxia-high or -low (cut-off: cohort median). Primary endpoint: invasive loco-regional control (ILRC); secondary overall survival. Findings: Hypoxia affected overall survival (HR = 1.30; 95% CI 0.99–1.70; p = 0.062): more uncertainty for ILRC (HR = 1.29; 95% CI 0.82–2.03; p = 0.264). Benefit from chemotherapy was similar for patients with high or low HSs, with no interaction between HS and treatment arm. High HS associated with poor ILRC following hypofractionated (n = 90, HR 1.69; 95% CI 0.99–2.89 p = 0.057) but not conventional (n = 207, HR 0.70; 95% CI 0.28–1.80, p = 0.461) radiotherapy. The finding was confirmed in an independent cohort (BCON) where hypoxia associated with a poor prognosis for patients receiving hypofractionated (n = 51; HR 14.2; 95% CI 1.7–119; p = 0.015) but not conventional (n = 24, HR 1.04; 95% CI 0.07–15.5, p = 0.978) radiotherapy. Interpretation: Tumour hypoxia status does not affect benefit from BC2001 chemotherapy. Hypoxia appears to affect fractionation sensitivity. Use of HSs to personalise treatment needs testing in a biomarker-stratified trial. Funding: Cancer Research UK, NIHR, MRC.

Background Patients with ischemic stroke and concomitant COVID‐19 infection have worse outcomes than those without this infection, but the impact of COVID‐19 on hemorrhagic stroke remains unclear. We aimed to assess if COVID‐19 worsens outcomes in intracerebral hemorrhage (ICH). Methods and Results We conducted an observational study of ICH outcomes using Get With The Guidelines Stroke data. We compared patients with ICH who were COVID‐19 positive and negative during the pandemic (March 2020–February 2021) and prepandemic (March 2019–February 2020). Main outcomes were poor functional outcome (defined as a modified Rankin scale score of 4 to 6 at discharge), mortality, and discharge to a skilled nursing facility or hospice. The first stage included 60 091 patients with ICH who were COVID‐19 negative and 1326 COVID‐19 positive. In multivariable analyses, patients with ICH with versus without COVID‐19 infection had 68% higher odds of poor outcome (odds ratio [OR], 1.68 [95% CI, 1.41–2.01]), 51% higher odds of mortality (OR, 1.51 [95% CI, 1.33–1.71]), and 66% higher odds of being discharged to a skilled nursing facility/hospice (OR, 1.66 [95% CI, 1.43–1.93]). The second stage included 62 743 prepandemic and 64 681 intrapandemic cases with ICH. In multivariable analyses, patients with ICH admitted during versus before the COVID‐19 pandemic had 10% higher odds of poor outcomes (OR, 1.10 [95% CI, 1.07–1.14]), 5% higher mortality (OR, 1.05 [95% CI, 1.02–1.08]), and no significant difference in the risk of being discharged to a skilled nursing facility/hospice (OR, 0.93 [95% CI, 0.90–0.95]). Conclusions The pathophysiology of the COVID‐19 infection and changes in health care delivery during the pandemic played a role in worsening outcomes in the patient population with ICH.

BackgroundFunctional abdominal pain disorders (FAPD) are the most common chronic pain conditions of childhood and are made worse by co-occurring anxiety. Our research team found that the Aim to Decrease Pain and Anxiety Treatment (ADAPT), a six-session coping skills program using cognitive behavioral therapy strategies, was effective in improving pain-related symptoms and anxiety symptoms compared to standard care. In follow-up, this current randomized clinical trial (RCT) aims to test potential neural mechanisms underlying the effect of ADAPT. Specifically, this two-arm RCT will explore changes in amygdalar functional connectivity (primary outcome) following the ADAPT protocol during the water loading symptom provocation task (WL-SPT). Secondary (e.g., changes in regional cerebral blood flow via pulsed arterial spin labeling MRI) and exploratory (e.g., the association between the changes in functional connectivity and clinical symptoms) outcomes will also be investigated.MethodsWe will include patients ages 11 to 16 years presenting to outpatient pediatric gastroenterology care at a midwestern children's hospital with a diagnosis of FAPD plus evidence of clinical anxiety based on a validated screening tool (the Generalized Anxiety Disorder-7 [GAD-7] measure). Eligible participants will undergo baseline neuroimaging involving the WL-SPT, and assessment of self-reported pain, anxiety, and additional symptoms, prior to being randomized to a six-week remotely delivered ADAPT program plus standard medical care or standard medical care alone (waitlist). Thereafter, subjects will complete a post assessment neuroimaging visit similar in nature to their first visit.ConclusionsThis small scale RCT aims to increase understanding of potential neural mechanisms of response to ADAPT.Trial registrationClinicalTrials.gov registration: NCT03518216.

Background: Idaho, a predominately rural state, has a high prevalence of mental illness with minimal access to care. Barriers in diagnosis and treatment of pediatric behavioral health disorders could be mitigated with an accessible and effective specialty training program. Methods: A 10-session Project Extension for Community Health Outcomes (ECHO) series was designed to expand provider knowledge about pediatric behavioral health conditions and improve perceived clinical practice skills. Pre- and postseries evaluation surveys and individual session evaluations were used to assess the program. Results: A total of 148 individuals attended at least 1 of the 10 sessions. Participants reported high satisfaction with individual sessions and indicated that attendance positively impacted their knowledge and competency. Participants also reported that the knowledge and skills gained from the series would benefit more than half of their patients or clients. Conclusion: The short ECHO series appears to be a viable and valuable option to provide Idaho providers with effective specialty training that is well attended and well received.

A 15-year-old female presented to the emergency department with a 1-day history of pain and swelling of her right eye following ocular contact with a caterpillar. Caterpillars of the white-marked tussock moth and other related species possess hairlike structures called setae, with angled barbs along their length, allowing them to travel linearly upon penetration of an enemy, resisting backward movement and becoming very difficult to extract once imbedded. When these fine, pointed hairs contact the surface of the eye, they can easily migrate in, eliciting movement of the globe, blinking, and rubbing of the eye in an attempt to remove the offending agent, potentially leading to ophthalmia nodosa. One of the most important aspects of ophthalmia nodosa diagnosis is a thorough history and prompt slit-lamp examination to identify the presence of foreign bodies and where they are located; this will help guide clinical management decisions. This case demonstrates that, depending on the number and location, more than one attempt may be required to remove all of the barbed setae. If ophthalmia nodosa is suspected, it is important to promptly refer to ophthalmology for a thorough eye exam, keep the eye clean, prescribe prophylactic topical antibiotics and/or steroids to reduce the potential for infection and inflammation, and emphasize the importance of keeping the eye protected during the healing process with an eye shield.

IntroductionThirty oral targeted antineoplastic agents are associated with prolongation of the QT interval. However, limited data exists regarding QTc prolongation and associated risk factors in the ambulatory oncology setting.MethodsThis retrospective study was completed to describe QTc prolongation incidence among patients receiving oral targeted tyrosine kinase inhibitors (TKI) and identify potential risk factors in the ambulatory community-based oncology clinic.ResultsOf the 341 patients identified as receiving oral TKI, 49 with a baseline and follow-up ECG were included. The incidence of QTc prolongation (QTc > 470 ms in males, QTc > 480 ms in females, or >20 ms increase in QTc from baseline) was 24%. Three patients developed significant QTc prolongation (QTc >500 ms or >60 ms increase in QTc from baseline). No patients discontinued therapy primarily due to QTc prolongation or experienced symptomatic torsades de pointes. Analysis of risk factors demonstrated that patients with QTc prolongation were more likely to receive concomitant therapy with a loop diuretic (41% vs 11%, respectively, p=0.029).DiscussionThe frequency of QTc prolongation may be higher in the real-world setting than that observed in clinical trials; however, continuation of therapy may be possible. Patients receiving concomitant loop diuretics should be monitored more closely for QTc prolongation and electrolyte abnormalities.