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African lovegrass [Eragrostis curvula (Schrad.) Nees] is a highly invasive C4 perennial grass that threatens global biodiversity. Appropriate management of this species has been hampered by a lack of knowledge concerning its seed ecology, resulting in significant economic and environmental impacts within various environments. Consequently, this study explored the effects of a selection of environmental factors (photoperiod, alternating temperature, pH, and salinity) by analyzing several measures of germination on four geographically distinct populations of E. curvula to assist in its extirpation from infested sites. Seeds were collected in Australia from Maffra and Shepparton, VIC; Tenterfield, NSW; and Midvale, WA. Key results showed that seeds from Maffra (54% vs. 79%), Tenterfield (38% vs. 61%), and Shepparton (34% vs. 71%) had significantly reduced germination in complete darkness compared with an alternating 12-h light and 12-h dark photoperiod, whereas Midvale had consistent germination (91% vs. 99%). Temperatures between 17/7 C reduced germination for Maffra (42% vs. 73%), Tenterfield (34% vs. 55%), and Shepparton (33% vs. 59%) compared with the mean of all other temperature combinations, whereas Midvale had consistent germination. Furthermore, germination for all populations was consistent between pH 4 and 9. For salinity, germination was significantly reduced at ≥100 mM for Maffra (29% vs. 67%), ≥150 mM for Tenterfield (29% vs. 94%) and Shepparton (39.5% vs. 81.5%), and 250 mM for Midvale (39% vs. 82%) compared with the mean of all other concentrations. Although each trial was conducted independently, the data can be used to generate species-targeted management. Such strategies include maintaining high levels of quarantine and hygiene programs to avoid future spread; where practical, applying light-limiting strategies (mulching, tilling, or scraping) for the Maffra, Tenterfield, and Shepparton populations; and maintaining management efforts year-round, as the species can germinate under a wide range of conditions.

Most of the scholarship on far-right hooliganism in Europe and Russia mentions only marginally the Russian far-right MMA gear and tournament brand White Rex (WR). A few authors have discussed WR’s right-wing connections and activities. Yet both the structures that enabled WR and, now, other similar brands to exert ideological and political influence and the influence itself bear further examination. This paper presents a qualitative analysis of information from intelligence reports, social media, open media, and interviews to show how WR modeled and cultivated a professionalizing trend in several far-right combat sport tournaments. We argue that WR’s entrance into the Western European far-right combat sport scene was a key development in the emergence of professionally organized, fight-focused events with explicit political messaging targeted at a far-right, primarily trans-European audience and a surrounding infrastructure of far-right organizations shaping the character of this developing scene. The business model that WR developed in Russia proved to be something the emerging European far-right combat sport scene could adopt in order to grow. Finally, we elaborate on how WR’s founder, Denis Kapustin, was able to establish a Western European network that temporarily gave him influence over one of the far right’s most significant cultural scenes.

Accurate prediction of sea level rise requires detailed understanding of processes contributing to ice sheet mass loss. Antarctica’s ice shelves are thinning, resulting in enhanced flow of grounded ice due to weakened ice shelf buttressing. Glaciers feeding ice shelves with the highest melt rates are also experiencing some of the most rapid grounding zone retreat. However, these ice shelf melt rates reach values that cannot be explained by ocean forcing alone and are not reproduced in ocean models. We present subglacial hydrology model outputs for four major Antarctic glaciers (Pine Island, Thwaites, Totten and Denman), which flow through the deepest and most extensive Antarctic marine subglacial basins and feed rapidly thinning ice shelves. We show that the areas of high ice shelf melting rates and grounding line retreat coincide closely with areas of high subglacial discharge. We posit that the subglacial discharge provides the missing component driving the high melt rates, and identify positive feedbacks between ice dynamics, steepening of ice shelf basal slope, and subglacial outflow. If surface temperatures increase as expected in Antarctica over the coming decades, surface meltwater could flow to the ice sheet base, as observed in Greenland. The surface meltwater hydrological cycle could therefore contribute to seasonal variations in subglacial meltwater and ice shelf basal melt, leading to accelerated grounding line retreat into Antarctica’s deepest subglacial basins. Invoking these feedbacks could reconcile sea level records and ice sheet model simulations that remain overly stable in warmer periods.

Background SARS-CoV-2 infection is associated with a significant risk of hospitalisation, death, and prolonged impact on quality of life. Evaluation of new treatment options and optimising therapeutic management of people hospitalised with SARS-CoV-2 infection remains essential, but rapid changes in pandemic conditions and potential therapies have limited the utility of traditional approaches to randomised controlled trials. Methods ASCOT ADAPT is an international, investigator-initiated, adaptive platform, randomised controlled trial of therapeutics for non-critically ill patients hospitalised with COVID-19. The study design is open label and pragmatic. Potential participants are hospitalised adults with PCR confirmed, symptomatic, SARS-CoV-2 infection, within 14 days of symptom onset. Domains include antiviral, antibody and anticoagulant interventions, with a composite primary outcome of 28-day mortality or progression to intensive-care level respiratory or haemodynamic support. Initial interventions include intravenous nafamostat and variable dose anticoagulation. A range of secondary endpoints, and substudies for specific domains and interventions are outlined. Discussion This paper presents the trial protocol and management structure, including international governance, remote site monitoring and biobanking activities and provides commentary on ethical and pragmatic considerations in establishing the ASCOT ADAPT trial under pandemic conditions. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12620000445976) and ClinicalTrials.gov (NCT04483960).

Background: There is a growing body of recent literature regarding the occurrence of pseudotumors associated with modular junctions and various bearing surfaces after total hip arthroplasty (THA). Revision surgery is often technically challenging and high complication rates have been reported. The optimal management of these patients and outcomes after operative treatment remain poorly understood. Methods: We report the case of a 77-year-old male with progressive unilateral lower extremity swelling, pain, and neuropathy 9 years after revision THA for polyethylene liner wear. Imaging and biopsy confirmed a massive intrapelvic pseudotumor exerting compressive effects. Radiographs demonstrated extensive femoral and pelvic osteolysis without evidence of component loosening. Debulking of the intrapelvic portion of the pseudotumor was performed via the lateral window of the ilioinguinal approach with component retention. Results: Debulking of the intrapelvic mass resulted in resolution of symptoms. One year postoperatively the patient reported pain free ambulation using a walker and no recurrence of symptoms. Radiographs demonstrated stable THA components in comparison with preoperative films. Discussion and Conclusion: This case demonstrates a rare finding of intrapelvic pseudotumor causing neurovascular compression after revision THA. Clinicians should be aware of intrapelvic pseudotumor as a possible cause of limb swelling and neuropathy, and that debulking of the mass is a potential treatment option in the setting of well-fixed implants.

ObjectivesA multistakeholder expert group under the Women’s Health Technology Coordinated Registry Network (WHT-CRN) was organized to develop the foundation for national infrastructure capturing the performance of long-acting and permanent contraceptives. The group, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry and the patient community, was assembled to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess contraceptive medical product technologies.DesignWe applied a Delphi survey method approach to achieve consensus on a core minimum data set for the future CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated and analyzed by a study design team from Weill Cornell Medicine. After the first survey, questions for subsequent surveys were based on the analysis process and conference call discussions with group members. This process was repeated two times over a 6-month time period until consensus was achieved.ResultsTwenty-three experts participated in the Delphi process. Participation rates in the first and second round of the Delphi survey were 83% and 100%, respectively. The working group reached final consensus on 121 core data elements capturing reproductive/gynecological history, surgical history, general medical history, encounter information, long-acting/permanent contraceptive index procedures and follow-up, procedures performed in conjunction with the index procedure, product removal, medications, complications related to the long-acting and/or permanent contraceptive procedure, pregnancy and evaluation of safety and effectiveness outcomes.ConclusionsThe WHT-CRN expert group produced a consensus-based core set of data elements that allow the study of current and future contraceptives. These data elements influence patient and provider decisions about treatments and include important outcomes related to safety and effectiveness of these medical devices, which may benefit other women’s health stakeholders.

Middle to distal-third clavicular shaft fractures are commonly treated with precontoured anterior plating. Some surgeons use mini-fragment plate fixation and position these plates on the anterior clavicle. Recent studies demonstrated the advantages of anterior clavicle plating, including a possible biomechanical advantage with cantilever bending forces and less subsequent implant removal. The insertion and positioning of anteriorly based clavicle plates requires the release of a portion of the anterior deltoid origin from the lateral clavicle. The purpose of this study is to evaluate the anatomy of the deltoid in relation to the clavicle and to determine the percentage of the deltoid origin released to place modern anterior precontoured plates.Six right and 4 left cadaver shoulders were dissected, each from separate cadaveric specimens (6 male and 4 female). All measurements were made with digital calipers. The length of the clavicle was measured from the acromioclavicular joint to the sternoclavicular joint. The length of deltoid origin on the lateral clavicle was measured from the acromioclavicular joint to the most medial attachment of the deltoid on the clavicle. Percentage of clavicle with deltoid origin was subsequently calculated.The average length of the cadaveric clavicles was 164.4 mm with a range from 134.3 to 178.1 mm. The average amount of deltoid origin on the clavicle was 58.7 mm with a range from 43.4 to 69 mm. On average 35.5% of the clavicle had deltoid origin, with a range from 30.2% to 38.8%.On average, 35.5% of the clavicular osseous anatomy contains deltoid origin. This should be taken into consideration when performing anterior plating for clavicle fractures. With a significant portion of deltoid origin elevated, surgeons may consider altering postoperative protocols until some interval healing has occurred to this anterior head of the deltoid.

In patients undergoing emergent operation for trauma, surgeons must decide whether to perform a definitive or damage control (DC) procedure. DC surgery (abbreviated initial surgery followed by planned reoperation after a period of resuscitation in the intensive care unit) has been suggested to most benefit patients more likely to succumb from the “vicious cycle” of hypothermia, acidosis, and coagulopathy and/or postoperative abdominal compartment syndrome (ACS) than the failure to complete organ repairs. However, there currently exists no unbiased evidence to support that DC surgery benefits injured patients. Further, the procedure is associated with substantial morbidity, long lengths of intensive care unit and hospital stay, increased healthcare resource utilization, and possibly a reduced quality of life among survivors. Therefore, it is important to ensure that DC laparotomy is only utilized in situations where the expected procedural benefits are expected to outweigh the expected procedural harms. In this manuscript, we review the comparative effectiveness and safety of DC surgery when used for different procedural indications. We also review recent studies suggesting variation in use of DC surgery between trauma centers and the potential harms associated with overuse of the procedure. We also review published consensus indications for the appropriate use of DC surgery and specific abdominal, pelvic, and vascular DC interventions in civilian trauma patients. We conclude by providing recommendations as to how the above list of published appropriateness indications may be used to guide medical and surgical education, quality improvement, and surgical practice.

Non-compressible torso haemorrhage (NCTH) (i.e., bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this manuscript, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude the above by providing recommendations as to when each of these methods may be best when indicated to manage injured patients with NCTH.

In the late fourth- or early fifth-century bilingual Codex Bezae (D), Lk. 6.5 includes the following agraphon in Greek and Latin: ‘On the same day, when [Jesus] saw someone working on the Sabbath, he said to him, “Man, if you know what you are doing you are blessed, but if you do not know then you are cursed and a transgressor of the law”’. Although scholars generally agree that this passage did not originate with the author of Luke, its precise origin and meaning remain contested. Previous studies implicitly agreed that the agraphon’s origin must be sought in the texts and traditions of the earliest Christian era. Based on literary parallels between Lk. 6.5D and the writings of Church Fathers, especially from the fourth century ce, this article argues that the Sabbath-Worker agraphon originated in the throes of later Christian polemic against Jewish and Judaizing practices of Sabbath observance.

Antimicrobial Stewardship Program (ASP) is one of the recommended programs to optimize the prudent use of antimicrobials, particularly in the hospital settings. The successful ASP implementation is determined by numerous factors, including communication among healthcare workers, and the availability of human resources and facilities. There is limited evidence available regarding the ASP implementation in Asia, particularly in the low- and lower-middle income countries. This systematic review aimed to identify the type of ASP interventions implemented in Asian countries according to the income status and to describe the impact of ASP implementation on the clinical, microbiological, and financial outcomes. The search strategy was undertaken using PUBMED, and the search terms were “antimicrobial stewardship” and “Asia” which were combined with the use of a Boolean operator “AND”. In total, 28 articles from nine countries were included in the final review. No article from Indonesia could be found in this systematic review. There was only an article from a lower-middle income country that was conducted in a tertiary health institution. Most of the articles (22 articles) were from high-middle income countries and 18 of them were conducted either in the tertiary care or university affiliated hospitals. Prospective audit with intervention and feedback was the most frequent ASP used in which positive outcomes on the clinical, microbiological, and financial outcomes have been evidenced. The positive impact of ASP implementation should suggest the needs to initiate the program in the healthcare facilities in Indonesia while taking into account the available resources and the local cultures.

ObjectivesThe accumulation of data through a prospective, multicenter coordinated registry network (CRN) is a robust and cost-effective way to gather real-world evidence on the performance of uterine fibroids treatment technologies for device-based and intervention-based studies. To develop the CRN, a group of uterine fibroids experts, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry, and the patient community, was convened to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess uterine fibroid treatment technologies.DesignA Delphi method approach was employed to achieve consensus on a core minimum data set for the CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated, and analyzed by a study design team from Weill Cornell Medicine. Questions for the next round were based on the analysis process and discussed with group members via a conference call. This process was repeated twice over a 3-month time period until consensus was achieved.ResultsTwenty-nine experts participated in the Delphi surveys, which began with an initial list of 200 data elements. The working group reached final consensus on 97 data elements capturing patient medical history, imaging data, procedure-related data, post-procedure data, and long-term follow-up data.ConclusionsThe CRN successfully convened an expert panel on uterine fibroids treatment technologies and used the Delphi method to produce a consensus-based core set of data elements. These identified data elements include important outcomes related to efficacy and safety and thus, influence patient, provider, and regulatory decision-making about treatments for uterine fibroids. Finally, the core data elements provide the foundation of the infrastructure needed for the CRN that will allow for the comparative study of uterine fibroid treatment devices and technologies.

In this chapter we analyze the discursive strategies of right-wing website Breitbart, focusing on stories that criticized or attacked established news organizations. We identify the affectively charged strategies of victory, victimhood, and vilification used by Breitbart against opponents. Victories refer to stories which celebrate failure of political or journalistic opponents. Conversely, victimhood is expressed through feelings of loss associated with events including perceived threats to conservative values in American culture. Finally, a closely related strategy involves the vilification of opponents – frequently Democratic politicians, as well as journalists and media figures perceived as “left-wing.” Through their attacks, the news site claims the moral high ground as the defender of liberal democracy, giving voice to the concerns of “The People” in a public sphere dominated by elite and establishment voices. It highlights the emerging prominence of politically motivated media actors which do not follow conventional norms associated with journalistic professionalism.

Author(s): Stompe, Dylan K.; Roberts, Jason D.; Estrada, Carlos A.; Keller, David M.; Balfour, Nicholas M.; Banet, Amanda I. | Abstract: This study examined diets of two predatory fish species, the native Sacramento Pikeminnow (Ptychocheilus grandis) and the introduced Striped Bass (Morone saxatilis), in the Sacramento River, California, USA. Both species have been implicated in native species declines through predation, eliciting our investigation of their diets in the Sacramento River. Sampling occurred between March and November 2017, and was conducted via hook and line on a 35-km reach near Chico, California. Habitat types sampled include engineered structures (water diversions and beam bridges), rip-rapped channel edges, and natural riverbank. Stomach contents were collected via gastric lavage and later processed using visual, gravimetric, and genetic techniques. Diets of Sacramento Pikeminnow and Striped Bass were highly similar as determined through index of relative importance and PERMANOVA modeling. Water temperature was the only variable that significantly affected diet composition. Results reflect similar dietary niches for both species in the Sacramento River.

Fundamental aspects of SARS-CoV-2 biology remain to be described, having the potential to provide insight to the response effort for this high-priority pathogen. Here we describe the first native RNA sequence of SARS-CoV-2, detailing the coronaviral transcriptome and epitranscriptome, and share these data publicly. A data-driven inference of viral genetic features and evolutionary rate is also made. The rapid sharing of sequence information throughout the SARS-CoV-2 pandemic represents an inflection point for public health and genomic epidemiology, providing early insights into the biology and evolution of this emerging pathogen.

Upper extremity pathology is uncommon and generally involves the brachial artery in about 12% of the cases. Of chronic upper limb ischemia, trauma, fibromuscular dysplasia, giant cell arteritis, and atherosclerosis are among the most reported cases. After a thorough review of the literature, there is agreement with duplex ultrasound sensitivity and specificity for predicting >70% stenosis in the subclavian arteries with a sensitivity of >82% and specificity of >90%. This article not only correlates the relationship between duplex ultrasound and severe peripheral arterial disease, but it also proves with 100% accuracy the ability to detect latent and abnormal pathology of the upper extremities post endovascular intervention.

Admission to colleges of veterinary medicine has become increasingly more competitive through the years. The increased number of applicants require students and the programs they are attending to help students distinguish themselves in the applicant pool. Many students understand the importance of the science related coursework early on in their undergraduate career. The soft skills along with mentoring have been shown to be important for applicant success. Time management skills can be some of the most vital skills for undergraduate students to practice before matriculation to veterinary school. In addition, group skills and conflict resolution are perceived as important among veterinary alumni and students. Mentoring is critical throughout the education process. The personal aspects and professional guidance given by professors make for the most successful advising of undergraduate pre-veterinary students. Results indicated that students could benefit from communication skills being included throughout the curriculum, especially in context of veterinary science courses.

Augmented renal clearance (ARC) is known to influence β-lactam antibiotic pharmacokinetics. This substudy of the BLING-II trial aimed to explore the association between ARC and patient outcomes in a large randomised clinical trial. BLING-II enrolled 432 participants with severe sepsis randomised to receive β-lactam therapy by continuous or intermittent infusion. An 8-h creatinine clearance (CLCr) measured on Day 1 was used to identify ARC, defined as CLCr ≥ 130 mL/min. Patients receiving any form of renal replacement therapy were excluded. Primary outcome was alive ICU-free days at Day 28. Secondary outcomes included 90-day mortality and clinical cure at 14 days following antibiotic cessation. A total of 254 patients were included, among which 45 (17.7%) manifested ARC [median (IQR) CLCr 165 (144–198) mL/min]. ARC patients were younger (P