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Most prior uses of mixed and augmented reality (MR/AR) in archaeology have focused on tourism, museums, and education, but we see bright potential for using 3D immersive technologies directly during active excavations. As a first step towards this vision, we ran four experiments with three different head-mounted hardware devices during our fieldwork in the South Caucasus. The devices are the Vuzix Blade 2 AR smart glasses, as well as the Microsoft HoloLens 2 and Meta Quest Pro MR headsets. Our first experiment aims to replace our smartphone data collection workflows with the hands-free AR and MR headsets using gesture interaction and voice recognition. Our second experiment used MR to allow us to view precisely placed 3D models of previously excavated remains in situ in the trench for stratigraphic comparisons. Our third experiment implemented a novel depth-guidance system in the HoloLens 2 to guide real excavation towards a precisely flat surface. In our fourth experiment, a user wearing the HoloLens 2 joined real and virtual pottery sherds in the excavation lab. Although the currently available hardware devices are not yet sufficient for regular use during fieldwork, our experiments demonstrate significant potential. Therefore, we plan to continue building towards our vision for the future where MR and AR immersive technologies provide enhanced vision and data interaction to working archaeologists in the field.

A growing body of critical care research draws on real-world data from electronic health records (EHRs). The bedside clinician has myriad data sources to aid in clinical decision-making, but the lack of data sharing and harmonization standards leaves much of this data out of reach for multi-institution critical care research. The Society of Critical Care Medicine (SCCM) Discovery Data Science Campaign convened a panel of critical care and data science experts to explore and document unique advantages and opportunities for leveraging EHR data in critical care research. This article reviews and illustrates six organizing topics (data domains and common data elements; data harmonization; data quality; data interoperability and digital infrastructure; data access, sharing, and governance; and ethics and equity) as a data science primer for critical care researchers, laying a foundation for future publications from the SCCM Discovery Data Harmonization and Sharing Guiding Principles Panel.

BackgroundIncreasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken toward sDHT usability evaluation have varied markedly. ObjectiveThis review aims to explore the current landscape of studies reporting data related to sDHT human factors, human-centered design, and usability, to inform our concurrent work on developing an evaluation framework for sDHT usability. MethodsWe conducted a scoping review of studies published between 2013 and 2023 and indexed in PubMed, in which data related to sDHT human factors, human-centered design, and usability were reported. Following a systematic screening process, we extracted the study design, participant sample, the sDHT or sDHTs used, the methods of data capture, and the types of usability-related data captured. ResultsOur literature search returned 442 papers, of which 85 papers were found to be eligible and 83 papers were available for data extraction and not under embargo. In total, 164 sDHTs were evaluated; 141 (86%) sDHTs were wearable tools while the remaining 23 (14%) sDHTs were ambient tools. The majority of studies (55/83, 66%) reported summative evaluations of final-design sDHTs. Almost all studies (82/83, 99%) captured data from targeted end users, but only 18 (22%) out of 83 studies captured data from additional users such as care partners or clinicians. User satisfaction and ease of use were evaluated for 83% (136/164) and 91% (150/164) of sDHTs, respectively; however, learnability, efficiency, and memorability were reported for only 11 (7%), 4 (2%), and 2 (1%) out of 164 sDHTs, respectively. A total of 14 (9%) out of 164 sDHTs were evaluated according to the extent to which users were able to understand the clinical data or other information presented to them (understandability) or the actions or tasks they should complete in response (actionability). Notable gaps in reporting included the absence of a sample size rationale (reported for 21/83, 25% of all studies and 17/55, 31% of summative studies) and incomplete sociodemographic descriptive data (complete age, sex/gender, and race/ethnicity reported for 14/83, 17% of studies). ConclusionsBased on our findings, we suggest four actionable recommendations for future studies that will help to advance the implementation of sDHTs: (1) consider an in-depth assessment of technology usability beyond user satisfaction and ease of use, (2) expand recruitment to include important user groups such as clinicians and care partners, (3) report the rationale for key study design considerations including the sample size, and (4) provide rich descriptive statistics regarding the study sample to allow a complete understanding of generalizability to other patient populations and contexts of use.

Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020 led to the implementation of nonpharmaceutical interventions (NPIs) to curb its spread. Studies have shown that adult asthma exacerbations and viral infections decreased during NPI use. However, few studies have shown the effects of NPIs on pediatric asthma exacerbations and infections during and after the pandemic. Objective: This study aimed to understand the impact of NPIs on asthma exacerbations and viral respiratory infections in pediatric patients at our institution from March 2018 to December 2022. Methods: The medical record numbers of children with asthma exacerbations seen at our institution between March 2018 and December 2022 were analyzed. Subjects were categorized on the basis of timing of their exacerbation in relation to NPI enforcement. We used the results from clinical testing with the BioFire Respiratory Panel (BRP) to detect up to 22 respiratory pathogens and then correlated these results with asthma exacerbation severity. Results: There were 5,758 asthma exacerbations recorded, with a 50% decline in average weekly exacerbations during NPI enforcement. Of the 70,682 BRP tests performed, 87% returned a positive result for at least 1 pathogen. Several viruses (respiratory syncytial virus, parainfluenza, and influenza) had a decrease in positivity rate with NPIs, whereas rhinovirus/enterovirus positivity rates were unchanged throughout the pandemic. Asthma exacerbations with a positive BRP result required higher clinical levels of care during the admission. Conclusion: NPIs were associated with significantly reduced numbers of asthma exacerbations and respiratory viral infections. The post-NPI period saw a return to prepandemic levels of asthma exacerbations and an unusual surge in respiratory syncytial virus infections, emphasizing the need for continuous monitoring and adaptive strategies in the postpandemic landscape.

IntroductionSeagrass sediments are important ‘blue carbon’ reservoirs which store climatically significant quantities of organic carbon (Corg) at the global scale. Seagrass meadows that overly these sediments also provide a range of critical ecosystem services including shoreline stabilization, storm surge protection, and fisheries nursery grounds. However, the controls over accumulation and the sources of organic C to these sediments beds are highly variable and poorly understood with the relative importance of hydrodynamic setting, species composition and canopy density being unclear.MethodsHere we address these questions using the first observation-based estimates of Corg stocks and provenance on Turneffe Atoll, Belize, made via remotely-sensed habitat extent, local Corg data and isotopic data. Sedimentary Corg was highest in sediments underlying the most sheltered meadows and decreased with increasing exposure to wind and wave energy with the seagrass meadows in the central lagoon containing an extensive deposit of mangrove derived organic carbon, stabilized and protected by the overlying seagrass meadow.ResultsThe influence of species composition appeared weak with the ubiquitous species T. testudinum occurring across a wide range of hydrodynamic regimes ranging from the most sheltered to the most energetic and being associated with a wide range of sedimentary organic C concentrations. Importantly from the perspective of remote sensing, org C concentrations were unrelated to canopy density. We hypothesize that this decoupling of organic C concentration from seagrass canopy cover reflects a much longer timescale for carbon storage in the sediments than the lifespan of the seagrass plants themselves and/or a substantial non seagrass derived organic C burden in seagrass sediments. Overall, we conservatively estimate that the top 30cm of sediments underlying the seagrass meadows overlying carbonate sediments on the atoll exterior store 0.58 x 106 Mg Corg, most of which is seagrass-derived, whilst the sediments underlying the meadows within the central lagoon store an additional 1.28 x 106 Mg Corg. When the maximum possible extent of seagrass is considered, this estimate increases to 3.54 x 106 Mg Corg. Substantial Corg stocks extending >1m depth were observed across all sites, and so these inventories are considered conservative.DiscussionA preliminary ‘cost of loss’ for sedimentary Corg in the top 30 cm of Turneffe Atoll’s seagrass meadows, based on a carbon trading value of €60 tCO2 (eq), is estimated at €42 million for the outer atoll, increasing to €136 million when the mangrove-derived sediments of the central atoll are considered and €260 million when turbid areas are assumed to contain seagrass.

Background: During a routine cadaver dissection, findings led to the recognition of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. MRKH is the second most common cause of primary amenorrhea in females. MRKH, also known as Müllerian aplasia, is a rare congenital disorder that is seen in 1 out of 5000 karyotypic females (46,XX). Patients with MRKH present with agenesis/aplasia of the uterus and the upper two thirds of the vagina. There are two different subtypes of MRKH. In Type I, only uterovaginal agenesis is seen. However, patients with MRKH Type II have uterovaginal agenesis including the absence of one or both fallopian tubes and ovaries, along with abnormalities of the kidney or skeleton. A subgroup of MRKH Type II is termed MURCS (Müllerian duct aplasia, renal aplasia, and cervicothoracic somite dysplasia) because of the severity of malformations seen in multiple extragenital organs including the kidney and skeleton. A patient with Type II is the rarest of the two subtypes occurring in 28–44 % of MRKH patients when compared to the occurrence of Type I, 56–72 %. Methods/results: Routine dissection of embalmed 63-year-old Caucasian female cadaver and inspection of various anatomical systems revealed this donor had MRKH type II with MURCS. Herein, reports the anatomical manifestations of MRKH type II with MURCS. Conclusion: Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a rare congenital disorder that is seen in 1 out of 5000 karyotypic females (46, XX). Patients with MRKH present with agenesis/aplasia of the uterus and the upper two thirds of the vagina. The discovery of MRKH in this cadaver was found upon routine dissection. Such findings provide insight into the anatomical implications and organ compensation that can occur over time with this pathology.

Background: Marital status has been shown to have protective effects for married patients with various cancers. We sought to determine effects of marital status on perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL). Methods: We retrospectively analyzed 709 consecutive patients who underwent RAPL between 2010 and 2022 by one surgeon. Patients were stratified by marital status at time of surgery. The Married group included married, domestically partnered, and co-habitating patients (N = 473). The Unmarried group included never married, divorced, and widowed individuals (N = 236). Demographics, preoperative comorbidities, intraoperative and postoperative complications, estimated blood loss (EBL), chest tube duration, hospital length of stay (LOS), tumor characteristics, and survival data were analyzed utilizing Student's t-test, Wilcoxon rank-sum test, Chi-square, or Fisher's exact test as appropriate, with significance at p≤0.05. Results: Unmarried patients were more likely to be female, while married patients were more likely to experience robotic-associated intraoperative complications and greater intraoperative estimated blood loss. Kaplan-Meier survival analysis revealed no difference in 5-year overall survival based on marital status. Other perioperative outcomes, intraoperative complications (except robotic-associated), postoperative complications, demographic history (except gender), and preoperative comorbidities did not significantly differ between the two groups. Conclusion: This study challenges the existing reports in the literature that marriage confers cancer treatment outcomes advantage and prolonged survival among cancer patients. Social support, in terms of a spouse or domestic partner, may be less protective in early-stage lung cancer and after minimally invasive pulmonary lobectomy compared to other cancer populations.

Objective:. To assess the accuracy, quality, and readability of patient-focused breast cancer websites using expert evaluation and validated tools. Background:. Ensuring access to accurate, high-quality, and readable online health information supports informed decision-making and health equity but has not been recently evaluated. Methods:. A qualitative analysis on 50 websites was conducted; the first 10 eligible websites for the following search terms were included: “breast cancer,” “breast surgery,” “breast reconstructive surgery,” “breast chemotherapy,” and “breast radiation therapy.” Websites were required to be in English and not intended for healthcare professionals. Accuracy was evaluated by 5 breast cancer specialists. Quality was evaluated through the DISCERN questionnaire. Readability was measured using 9 standardized tests. Mean readability was compared with the American Medical Association and National Institutes of Health 6th grade recommendation. Results:. Nonprofit hospital websites had the highest accuracy (mean = 4.06, SD = 0.42); however, no statistical differences were observed in accuracy by website affiliation (P = 0.08). The overall mean quality score was 50.8 (“fair”/“good” quality) with no significant differences among website affiliations (P = 0.10). Mean readability was at the 10th grade reading level, the lowest being for commercial websites with a mean 9th grade reading level (SD = 2.38). All websites exceeded the American Medical Association- and National Institutes of Health-recommended reading level by 4.4 levels (P < 0.001). Websites with higher accuracy tended to have lower readability levels, whereas those with lower accuracy had higher readability levels. Conclusion:. As breast cancer treatment has become increasingly complex, improving online quality and readability while maintaining high accuracy is essential to promote health equity and empower patients to make informed decisions about their care.

AbstractNeuroimaging is a powerful tool to investigate potential associations between chronic pain and brain structure. However, the proliferation of studies across diverse chronic pain syndromes and heterogeneous results challenges data integration and interpretation. We conducted a preregistered anatomical likelihood estimate meta-analysis on structural magnetic imaging studies comparing patients with chronic pain and healthy controls. Specifically, we investigated a broad range of measures of brain structure as well as specific alterations in gray matter and cortical thickness. A total of 7849 abstracts of experiments published between January 1, 1990, and April 26, 2021, were identified from 8 databases and evaluated by 2 independent reviewers. Overall, 103 experiments with a total of 5075 participants met the preregistered inclusion criteria. After correction for multiple comparisons using the gold-standard family-wise error correction ( P < 0.05), no significant differences associated with chronic pain were found. However, exploratory analyses using threshold-free cluster enhancement revealed several spatially distributed clusters showing structural alterations in chronic pain. Most of the clusters coincided with regions implicated in nociceptive processing including the amygdala, thalamus, hippocampus, insula, anterior cingulate cortex, and inferior frontal gyrus. Taken together, these results suggest that chronic pain is associated with subtle, spatially distributed alterations of brain structure.

Capsular polysaccharides are common virulence factors of extracellular, but not intracellular bacterial pathogens, due to the antiphagocytic properties of these surface structures. It is therefore paradoxical that Salmonella enterica subspecies enterica serovar Typhi, an intracellular pathogen, synthesizes a virulence-associated (Vi) capsule, which exhibits antiphagocytic properties. Here, we show that the Vi capsular polysaccharide has different functions when S. Typhi interacts with distinct subsets of host phagocytes. The Vi capsular polysaccharide allowed S. Typhi to selectively evade phagocytosis by human neutrophils while promoting human macrophage phagocytosis. A screen of C-type lectin receptors identified human DC-SIGN as the receptor involved in macrophage binding and phagocytosis of capsulated S. Typhi. Consistent with the anti-inflammatory activity of DC-SIGN, purified Vi capsular polysaccharide reduced inflammatory responses in macrophages. These data suggest that binding of the human C-type lectin receptor DC-SIGN by the Vi capsular polysaccharide contributes to the pathogenesis of typhoid fever. IMPORTANCE Salmonella enterica subspecies enterica serovar Typhi is the causative agent of typhoid fever. The recent emergence of S. Typhi strains which are resistant to antibiotic therapy highlights the importance of vaccination in managing typhoid fever. The virulence-associated (Vi) capsular polysaccharide is an effective vaccine against typhoid fever, but the role the capsule plays during pathogenesis remains incompletely understood. Here, we identify the human C-type lectin receptor DC-SIGN as the receptor for the Vi capsular polysaccharide. Binding of capsulated S. Typhi to DC-SIGN resulted in phagocytosis of the pathogen by macrophages and induction of an anti-inflammatory cytokine response. Thus, the interaction of the Vi capsular polysaccharide with human DC-SIGN contributes to the pathogenesis of typhoid fever and should be further investigated in the context of vaccine development.

Many coastal forests stretching from central California to southwest Oregon are threatened or have been impacted by the invasive forest pathogen Phytophthora ramorum, the cause of sudden oak death. We analyzed a set of stand-level forest treatments aimed at preventing or mitigating disease impacts on stand composition, biomass, and fuels using a before-after- control-intervention experiment with a re-evaluation after 5 years. We compared the effects of restorative management for invaded stands and preventative treatments for uninvaded forests with two stand-level experiments. The restorative treatments contrasted two approaches to mastication, hand-crew thinning, and thinning with pile burning with untreated controls replicated at three distinct sites (N = 30), while the preventative treatments were limited to hand-crew thinning (N = 10) conducted at a single site. Half of the restoration treatments had basal sprouts removed 2 and 4 years after treatment. All treatments significantly reduced stand density and increased average tree size without significantly decreasing total basal area, both immediately and 5 years after treatments. Preventative treatments did not reduce the basal area or density of timber species not susceptible to P. ramorum, suggesting the relative dominance of these species increased in accordance with host removal. Follow-up basal sprout removal in the restoration experiment appears to maintain treatment benefits for average tree size and may be associated with small decreases in stand density 5 years after initial treatment. Our study demonstrates that for at least 5 years, a range of common stand management practices can improve forest conditions threatened or impacted by sudden oak death. Key words: treatments, management, sudden oak death, Phytophthora, Introduction Emerging infectious forest diseases, often caused by the introduction of nonnative pathogens into naive and highly susceptible host populations, can generate severe population-to ecosystem-level impacts, including shifts in community [...]

Aims: Manual impaction, with a mallet and introducer, remains the standard method of installing cementless acetabular cups during total hip arthroplasty (THA). This study aims to quantify the accuracy and precision of manual impaction strikes during the seating of an acetabular component. This understanding aims to help improve impaction surgical techniques and inform the development of future technologies. Methods: Posterior approach THAs were carried out on three cadavers by an expert orthopaedic surgeon. An instrumented mallet and introducer were used to insert cementless acetabular cups. The motion of the mallet, relative to the introducer, was analyzed for a total of 110 strikes split into low-, medium-, and high-effort strikes. Three parameters were extracted from these data: strike vector, strike offset, and mallet face alignment. Results: The force vector of the mallet strike, relative to the introducer axis, was misaligned by an average of 18.1°, resulting in an average wasted strike energy of 6.1%. Furthermore, the mean strike offset was 19.8 mm from the centre of the introducer axis and the mallet face, relative to the introducer strike face, was misaligned by a mean angle of 15.2° from the introducer strike face. Conclusion: The direction of the impact vector in manual impaction lacks both accuracy and precision. There is an opportunity to improve this through more advanced impaction instruments or surgical training. Cite this article: Bone Joint Res 2024;13(4):193–200.

Motorists are required to interact with both roadway infrastructure and various users. The complexity of the driving task in certain scenarios can influence the frequency and severity of crashes. Turning vehicles at intersections, for example, pose a collision risk for both motorized and non-motorized road users. The primary goal of this paper is to investigate the underlying factors which contribute to right-turn crashes at signalized intersections. Five years of crash data across Oregon were collected. A random parameters binary logit model was developed to predict the likelihood of whether a crash resulted in an injury or fatality. It was found that 14 variables were statistically significant in contributing to crash severity. The results obtained show that dry conditions and a posted speed limit of 30 mi/hr or 35 mi/hr contributed to a higher percentage of severe crashes, while fixed-object crashes and snowy weather had a higher likelihood of resulting in no injury crashes. Time-of-day (9:00 p.m. to 6:00 a.m.), lighting conditions (dusk), gender (male driver), crash type (vehicle–pedestrian and rear-end), and driver-level crash cause (driver sped too fast for conditions, driver did not yield right-of-way, and driver disregarded the traffic control device) all led to an increase in probability of a fatal or injury crash. The vehicle–pedestrian conflict variable had the highest impact on increasing the probability of such a crash while turning right at a signalized intersection. This observation is important because right turns are often permitted during the pedestrian walk and clearance indications, and often drivers do not give right-of-way to pedestrians.