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Background: Current heart transplant health surveillance relies on frequent cardiac catheterization with endomyocardial biopsy (cath-EMB) to detect acute rejection (AR). Cardiac magnetic resonance imaging (MRI) is an emerging diagnostic tool to detect signs of AR. Consistent with “Value MRI,” we performed economic cost analysis modeling, if cardiac MRI is used for initial transplant surveillance rather than cath-EMB, while retaining the cath-EMB diagnostic “gold-standard.” Methods: With annual AR incidence of 2.5 - 5% (cath-EMB), clinical scenarios were modeled using pessimistic, realistic, and optimistic MRI positive test rate for parametric T1 and T2 mapping. Using probability theory, “expected cost” per patient and total Medicare savings per patient were calculated. Monte Carlo simulation was then performed 5000 times to estimate “per patient” cost with MRI as initial test. Longitudinal 20-year cost savings was modeled for 2 surveillance scenarios (lenient and intense), assuming 2.2% inflation rate and various discount rates. Results: Medicare cost savings were $689, $903, and $974 per patient (pessimistic, realistic, and optimistic MRI positivity) with confirmatory cath-EMB. Monte Carlo simulation median cost savings per patient was $795 (range $637 - $958). Inflation-adjusted, lifetime cost savings per patient (3% discount rate) ranged from $9,651 (pessimistic testing results/lenient surveillance plan) to $28,154 (optimistic/intense surveillance). Lifetime cost savings for 500 transplant recipients ranged from $4.8 million (M) (pessimistic/lenient) to $14.1M (optimistic/intense). Conclusion: At even the most pessimistic MRI positive test rate, modeling suggests substantial Medicare cost savings when using MRI parametric mapping as surveillance for AR. Longitudinal cost savings are notable too.

The paper describes an upper-division university course in Mars literature taught online since Fall 2013. The course readings comprise six novels relating to Mars. Authors include H.G. Wells, Edgar Rice Burroughs, Ray Bradbury, Phillip K. Dick, Greg Bear, and Kim Stanley Robinson. After an introduction, sections of the paper discuss course organization and syllabus, Americanist conceptual approaches, anti-colonialism, habitat sustainability, and pedagogical possibilities for future discussion of Mars literature. The paper argues for a fiction-based approach to understanding historical and potential future relationships with Mars and Mars science.

Purpose: College students with chronic illnesses are vulnerable to poor adjustment, but it remains unclear how these students differ from healthy peers. This study compares psychosocial adjustment and risky behavior between students with and without chronic illnesses. Participants: Participants (N = 629, 78% Caucasian, 77% Female) were recruited from universities. Methods: Participants completed measures of illness history, anxiety, depression, stressful life events, social support, and risky behavior. Results: College students with chronic illnesses demonstrated significantly greater symptoms of anxiety F(1,620) = 8.742, p < 0.003, depression F(1,614) = 26.947, p < 0.001, more stressful life events F(1,476) = 23.671, p < 0.001, and lower social support F(1,613) = 15.645, p < 0.001. No differences in risky behaviors between groups emerged F(1,601) = 3.432, p = 0.064. An indirect effect of health status on risk-taking behavior was observed [b = 0.677, 95% CI (0.351, 1.072)] partially mediated by depression. Conclusion: College students with chronic illnesses demonstrated worse psychosocial outcomes than healthy students, warranting programs to support these students. Depressive symptoms partially mediated risky behavior.

This study compared pre-treatment distress and the changes in that distress over the course of therapy between sexual trauma clients and non-sexual trauma clients. Reasons for therapy ending were also examined. Data for this study were collected at 139 university counseling centers. Psychological distress was measured using the Counseling Center Assessment of Psychological Symptoms; presenting concerns were determined using the Clinician Index of Client Concerns; and reason for end of treatment was measured using a standardized Termination Form. MANOVA was utilized to test differences in psychological distress at the start of therapy and a MANCOVA was used to examine psychological distress over the course of therapy. Chi-square tests were used to examine if different reasons existed for why treatment ended. Clients that experienced sexual trauma presented to treatment with significantly higher levels of distress but demonstrated greater distress change. No statistical differences in reasons associated with the end of treatment.

Abstract Large laser facilities have recently enabled material characterization at the pressures of Earth and Super-Earth cores. However, the temperature of the compressed materials has been largely unknown, or solely relied on models and simulations, due to lack of diagnostics under these challenging conditions. Here, we report on temperature, density, pressure, and local structure of copper determined from extended x-ray absorption fine structure and velocimetry up to 1 Terapascal. These results nearly double the highest pressure at which extended x-ray absorption fine structure has been reported in any material. In this work, the copper temperature is unexpectedly found to be much higher than predicted when adjacent to diamond layer(s), demonstrating the important influence of the sample environment on the thermal state of materials; this effect may introduce additional temperature uncertainties in some previous experiments using diamond and provides new guidance for future experimental design.

The role of resting state functional MRI (rsfMRI) is increasing in the field of epilepsy surgery because it is possible to interpolate network connectivity patterns across the brain with a high degree of spatial resolution. Prior studies have shown that by rsfMRI with scalp electroencephalography (EEG), an epileptogenic network can be modeled and visualized with characteristic patterns of connectivity that are relevant to both seizure-related and neuropsychological outcomes after surgery. The aim of this study is to show that a 5-min acquisition time provides reproducible results related to the relevant connectivity metrics when compared to a separately acquired 5-min scan. Fourteen separate rsfMRI sessions from ten different patients were used for comparison, comprised of patients with temporal lobe epilepsy both pre- and post-operation. Results showed that there was no significant difference in any of the connectivity metrics when comparing both 5-min scans to each other. These data support the continued use of a 5-min scan for epileptogenic network modeling in future studies because the inter-scan variability is sufficiently low as not to alter the output metrics characterizing the network connectivity.

This paper explores the representation and non-representation of slavery in US school textbooks from the late eighteenth century to the beginning of the US Civil War. It reviews the major readers, almost none of which mentioned slavery despite the anti-slavery sentiments of many textbook editors. The few readers that addressed slavery did so in limited terms and were not popular. Despite this, a myth arose in the US southern states that the treatment of slavery in school readers contributed significantly to the start of the Civil War and drove post-war textbook purchasing in those states. A concluding section considers the role of market censorship in shaping representation of slavery in early schoolbooks.

Leptomeningeal disease (LMD) is a rare, late complication of malignant cancers. In addition to causing significant neurosurgical morbidity, LMD can cause communicating hydrocephalus by disrupting the cerebrospinal fluid (CSF) outflow. We report an 18-year old female with a metastatic melanoma presenting with headaches, altered mental status, nausea, and vomiting three months following a craniotomy for a temporal melanoma brain metastasis that had extended into the lateral ventricle. A diagnosis of communicating hydrocephalus was made after brain MRI demonstrated ventriculomegaly, thus necessitating placement of a ventriculoperitoneal shunt. Despite an initial improvement in symptoms, the patient quickly deteriorated within six hours following shunt placement and expired following a diffuse subarachnoid hemorrhage. This represents an important complication to consider in patients with leptomeningeal metastases and warrants future exploration to determine incidence and etiology.

A muscle's architecture, defined as the geometric arrangement of its fibers with respect to its mechanical line of action, impacts its abilities to produce force and shorten or lengthen under load. Ultrasound and other noninvasive imaging methods have contributed significantly to our understanding of these structure–function relationships. The goal of this work was to develop a MATLAB toolbox for tracking and mathematically representing muscle architecture at the fascicle scale, based on brightness-mode ultrasound imaging data. The MuscleUS_Toolbox allows user-performed segmentation of a region of interest and automated modeling of local fascicle orientation; calculation of streamlines between aponeuroses of origin and insertion; and quantification of fascicle length, pennation angle, and curvature. A method is described for optimizing the fascicle orientation modeling process, and the capabilities of the toolbox for quantifying and visualizing fascicle architecture are illustrated in the human tibialis anterior muscle. The toolbox is freely available. [ABSTRACT FROM AUTHOR]

In 2019, the first cases of SARS-CoV-2 were detected in Wuhan, China, and by early 2020 the first cases were identified in the United States. SARS-CoV-2 infections increased in the US causing many states to implement stay-at-home orders and additional safety precautions to mitigate potential outbreaks. As policies changed throughout the pandemic and restrictions lifted, there was an increase in demand for COVID-19 testing which was costly, difficult to obtain, or had long turn-around times. Some academic institutions, including Boston University (BU), created an on-campus COVID-19 screening protocol as part of a plan for the safe return of students, faculty, and staff to campus with the option for in-person classes. At BU, we put together an automated high-throughput clinical testing laboratory with the capacity to run 45,000 individual tests weekly by Fall of 2020, with a purpose-built clinical testing laboratory, a multiplexed reverse transcription PCR (RT-qPCR) test, robotic instrumentation, and trained staff. There were many challenges including supply chain issues for personal protective equipment and testing materials in addition to equipment that were in high demand. The BU Clinical Testing Laboratory (CTL) was operational at the start of Fall 2020 and performed over 1 million SARS-CoV-2 PCR tests during the 2020-2021 academic year.

The immense neuroinflammation induced by multiple sclerosis (MS) promotes a favorable environment for ischemic stroke (IS) development, making IS a deadly complication of MS. The overlapping inflammation in MS and IS is a prelude to the vascular pathology, and an inherent cell death mechanism that exacerbates neurovascular unit (NVU) impairment in the disease progression. Despite this consequence, no therapies focus on reducing IS incidence in patients with MS. To this end, the preclinical and clinical evidence we review here argues for cell-based regenerative medicine that will augment the NVU dysfunction and inflammation to ameliorate IS risk.

This study explores the nature, dynamics, and reactivity of the photo-induced charge separated excited state in a Fe3+-doped titanium-based metal organic framework (MOF), xFeMIL125-NH2, as a function of iron concentration. The MOF is synthesized with doping levels x = 0.5, 1 and 2 Fe node sites per octameric Ti-oxo cluster and characterized by powder x-ray diffraction, UV-vis diffuse reflectance, atomic absorption, and steady state Fe K-edge X-ray absorption spectroscopy. For each doping level, time-resolved X-ray transient absorption spectroscopy studies confirm the electron trap site role of the Fe sites in the excited state. Time scan data reveal multiexponential decay kinetics for the charge recombination processes which extend into the microsecond range for all three concentrations. A series of dye photodegradation studies, based on the oxidative decomposition of Rhodamine B, demonstrates the reactivity of the charge separated excited state and the photocatalytic capacity of these MOF materials compared to traditional heterometal-doped semiconductor photocatalysts. [ABSTRACT FROM AUTHOR]

The field of stem cell therapy is growing rapidly and hopes to offer an alternative solution to diseases that are historically treated medically or surgically. One such focus of research is the treatment of medically refractory epilepsy, which is traditionally approached from a surgical or interventional standpoint. Research shows that stem cell transplantation has potential to offer significant benefits to the epilepsy patient by reducing seizure frequency, intensity, and neurological deficits that often result from the condition. This review explores the basic science progress made on the topic of stem cells and epilepsy by focusing on experiments using animal models and highlighting the most recent developments from the last 4 years.

Chronic illnesses are defined as any physiological condition that persists for at least 3 months and often does not resolve (Rosina et al., 2003). Growing numbers of young adults with chronic illnesses pursue higher education (Mullins et al., 2017), yet they arrive at college unprepared to manage their conditions (Gray et al., 2018; Schaefer et al., 2017). Many young adults matriculate without knowing how to refill prescriptions on time, navigate health insurance policies, identify providers, and advocate for their needs (Lemly et al., 2014). Medical transfer to a different geographic setting without parental support or self-management skills when beginning college can be a large stressor (Gray et al., 2018; Schaefer et al., 2017). Many universities also struggle to support the medical needs of students. This study aims to examine how students perceived their medical transfer to a new location, institutional support, and psychosocial functioning. The authors also specifically wanted to examine whether transfer and transition experiences were related to anxiety, depression, and social support, as these concerns have been noted in the literature as potential problem areas for this population.

Diffusion‐tensor (DT)‐MRI tractography provides information about properties relevant to muscle health and function, including estimates of architectural properties such as fascicle length, pennation angle, and curvature and diffusion properties such as mean diffusivity (MD) and fractional anisotropy (FA). Tractography settings, including integration algorithms, thresholds for early tract termination, and tract smoothing approaches, impact the accuracy of the muscle property estimates. However, muscle DT‐MRI tractography is performed using a variety of these settings, complicating comparisons between different studies. The effects of different tractography settings on muscle architecture estimates have not been fully explored, and optimized settings for muscle tractography have not yet been determined. We examined the influence of integration algorithm and termination check settings combined with a range of step sizes, termination criteria, and smoothing polynomial orders on tract characteristics, completion/reason for termination, and goodness of fit between fiber tracts and smoothing polynomials using 3‐T DT‐MR images of the lower leg muscles of seven healthy adults. We found that tract length and completion were highly sensitive to strict FA and intersegment angle thresholds (25%–69% reduction in complete fiber tracts from lowest to highest minimum FA threshold and 11%–36% reduction from highest to lowest intersegment angle threshold). Higher order polynomials (third and fourth order vs. second order) better fit the muscle fiber trajectories, but curvature estimates were highly sensitive to smoothing polynomial order (3.9–6.6 m−1 increase for second‐ vs. fourth‐order fitting polynomials). Step size impacted curvature estimates, albeit to a lesser degree. Integration algorithm had little impact, and mean pennation angle, and tract‐based FA and MD, were relatively insensitive to all parameters. The results demonstrate which muscle diffusion measures and architectural estimates are most sensitive to varying tractography settings and support the need for consistent reporting of tractography details to aid interpretation and comparison of results between studies. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) adherence remains a challenge among young men who have sex with men (MSM). We developed and tested a smartphone application ("app"), "DOT Diary", which combines automated directly observed therapy (DOT) with information about PrEP protection levels, pill-taking reminders, a sexual behavior diary, and a PrEP dosing calendar. To contextualize trial results, we qualitatively explored participants' app experiences. The trial enrolled 100 young MSM in San Francisco and Atlanta. Participants were randomized 2:1 to DOT Diary versus standard-of-care and followed for 24 weeks. Interviews were conducted with 24 intervention participants. Data were analyzed using a memo-writing approach. Most expressed overall satisfaction with the app ("it was good for its purpose"), despite concerns about technical glitches. The most popular app features were the monthly calendar showing days PrEP was taken and information about level of protection based on pills taken. The DOT component helped participants establish PrEP routines. The reminders were "annoying but effective" at motivating dosing. Opinions about the sexual behavior diary varied. Overall, DOT Diary was acceptable; participants were willing to use it daily to record pill-taking. Critical components included the information about PrEP protection levels and calendar, while others may be modified to improve future success. Trial registration: ClinicalTrials.gov identifier: NCT03771638. [ABSTRACT FROM AUTHOR]

Gymnastics is a popular sport that has potential strength, flexibility, and personal growth benefits for athletes. Both static and dynamic balance are developed from a young age and are fundamental to higher-level gymnastics. PURPOSE: To assess the efficacy of a balance training protocol in improving the dynamic balance of young female gymnasts. METHOD: 19 female Junior Olympic (JO) Level 3 gymnasts, ages 6-11, were randomly assigned to the Balance Training (BT) or control groups. The BT group completed a variety of balance exercises during each practice (2x/wk for eight weeks), including one-footed balance, hopping skills, and leaps onto surfaces of varying stability. Gymnasts in the control group continued with their normal gymnastics practices. Gymnasts were tested before training, after week 4, and after week 8 to assess improvements in the Balance Error Scoring System (BESS), Star Excursion Balance Test (SEBT), Center of Pressure Path length (COP Path length), and Joint Position Sense (JPS) scores. RESULTS: An improvement in SEBT for the gymnasts’ dominant foot reaching anteriorly (p=0.03) was observed. Otherwise, there were no significant differences between improvements in scores for the control group and the experimental group. CONCLUSION: JO Level 3 gymnasts, who are early in their training and development, demonstrated no additional benefit from twice weekly balance training beyond normally prescribed practice and skills training. While anecdotal evidence suggested a possible acute effect on balance performance immediately following balance exercises, further research is needed.

Seaweeds are macroalgae, which can be of many different morphologies, sizes, colors, and chemical profiles. They include brown, red, and green seaweeds. Brown seaweeds have been more investigated and exploited in comparison to other seaweed types for their use in animal feeding studies due to their large sizes and ease of harvesting. Recent in vitro and in vivo studies suggest that plant secondary compound-containing seaweeds (e.g., halogenated compounds, phlorotannins, etc.) have the potential to mitigate enteric methane (CH4) emissions from ruminants when added to the diets of beef and dairy cattle. Red seaweeds including Asparagopsis spp. are rich in crude protein and halogenated compounds compared to brown and green seaweeds. When halogenated-containing red seaweeds are used as the active ingredient in ruminant diets, bromoform concentration can be used as an indicator of anti-methanogenic properties. Phlorotannin-containing brown seaweed has also the potential to decrease CH4 production. However, numerous studies examined the possible anti-methanogenic effects of marine seaweeds with inconsistent results. This work reviews existing data associated with seaweeds and in vitro and in vivo rumen fermentation, animal performance, and enteric CH4 emissions in ruminants. Increased understanding of the seaweed supplementation related to rumen fermentation and its effect on animal performance and CH4 emissions in ruminants may lead to novel strategies aimed at reducing greenhouse gas emissions while improving animal productivity.

Competitive gymnasts in the Women’s Junior Olympic (JO) program are highly conditioned, typically training 8-20 hours per week. Training often consists of high-repetition body-weight activities with little variability. This method of training lacks progressive resistance exercise (PRE) training, a cornerstone for muscular adaptation. To investigate the benefits of 10 weeks of PRE training, 1 day/week, on muscular strength and power in women’s JO child and adolescent gymnasts. 50 females aged 7-17 years (mean 10.2±2.7 years), competing on JO levels 3-10 participated. Gymnasts in JO Levels 3 and 4 were divided into either the Control Group or the PRE group. The Control Group continued the standard non-PRE conditioning. The PRE Group underwent the prescribed PRE training. Level 5-10 gymnasts also underwent PRE training and were separately analyzed in a quasi-experimental repeated measures design. 15 exercises were completed. Tests for lower- and upper-body power included vertical leap and a modified Wingate arm-ergometer anaerobic test (Arm-WAnT). Compared to the Control Group, the PRE Group had a greater improvement in vertical power (p=0.003), and Arm-WAnT peak power and mean power (p=0.044 and 0.023), but no difference in Arm-WAnT fatigue index. Gymnasts in Levels 5 to 10 similarly improved vertical power (2224±756W to 2473±688W, p

Abstract Background Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study’s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. Methods We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017–2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. Results Stigma, a feature of IREF’s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID’s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. Conclusions Features of the social and healthcare environments operating at the meso-level, as well as PWID’s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.

This article addresses the histories of two Indigenous language immersion schools from the perspectives of teachers in the programs. The research questions, “What is the place of stories of our families, and communities? What does it mean to negotiate our place within the world of traditional stories told by our elders in the hogan and between worlds in the classroom?” draw on the histories of these programs to critique constructions of mainstream schooling and to frame the Dine epistemology as central to these narratives of teachers in the immersion classroom.

Despite a relatively developed understanding of the pathophysiology underlying primary and secondary mechanisms of cell death after ischemic injury, there are few established treatments to improve stroke prognoses. A major contributor to secondary cell death is mitochondrial dysfunction. Recent advancements in cell-based therapies suggest that stem cells may be revolutionary for treating stroke, and the reestablishment of mitochondrial integrity may underlie these therapeutic benefits. In fact, functioning mitochondria are imperative for reducing oxidative damage and neuroinflammation following stroke and reperfusion injury. In this review, we will discuss the role of mitochondria in establishing the anti-oxidative effects of stem cell therapies for stroke.

The Accreditation Council of Graduate Medical Education (ACGME) requires all residency training programs to 'provide instruction and experience in pain management if applicable for the specialty, including recognition of the [...]