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The ability for individuals to adapt to local food sources likely allows for regional persistence of aquatic populations. In the Laurentian Great Lakes, invasive species and changing physical conditions have vastly altered local and regional food webs, leading to the potential for variation in energy flow up to large predators. To assess the potential that prey fish condition varies spatially, we examined patterns in proportion dry weight of prey fishes collected from Lake Michigan nearshore areas (

We present reverberation mapping measurements for the prominent ultraviolet broad emission lines of the active galactic nucleus Mrk817 using 165 spectra obtained with the Cosmic Origins Spectrograph on the Hubble Space Telescope. Our ultraviolet observations are accompanied by X-ray, optical, and near-infrared observations as part of the AGN Space Telescope and Optical Reverberation Mapping Program 2 (AGN STORM 2). Using the cross-correlation lag analysis method, we find significant correlated variations in the continuum and emission-line light curves. We measure rest-frame delayed responses between the far-ultraviolet continuum at 1180 A and Ly$\alpha$ $\lambda1215$ A ($10.4_{-1.4}^{+1.6}$ days), N V $\lambda1240$ A ($15.5_{-4.8}^{+1.0}$days), SiIV + OIV] $\lambda1397$ A ($8.2_{-1.4}^{+1.4}$ days), CIV $\lambda1549$ A ($11.8_{-2.8}^{+3.0}$ days), and HeII $\lambda1640$ A ($9.0_{-1.9}^{+4.5}$ days) using segments of the emission-line profile that are unaffected by absorption and blending, which results in sampling different velocity ranges for each line. However, we find that the emission-line responses to continuum variations are more complex than a simple smoothed, shifted, and scaled version of the continuum light curve. We also measure velocity-resolved lags for the Ly$\alpha$, and CIV emission lines. The lag profile in the blue wing of Ly$\alpha$ is consistent with virial motion, with longer lags dominating at lower velocities, and shorter lags at higher velocities. The CIV lag profile shows the signature of a thick rotating disk, with the shortest lags in the wings, local peaks at $\pm$ 1500 $\rm km\,s^{-1}$, and a local minimum at line center. The other emission lines are dominated by broad absorption lines and blending with adjacent emission lines. These require detailed models, and will be presented in future work., Comment: Submitted to ApJ. 25 pages, 8 figures, and 6 tables

Background #OrthoTwitter has evolved to disseminate findings and engage the public. However, the academic impact of Twitter utilization in orthopaedic surgery is unknown. Questions/purposes The purpose of the study was to evaluate relationships between the author and manuscript Twitter activity and citations. Methods Manuscripts in 17 orthopaedic journals from 2018 were identified. Citations, online mentions, impact factors, and subspecialties were obtained. H-index and Twitter account details for authors were obtained for a subset of manuscripts. Relationships between Twitter activity and citations were evaluated. Results 2,473/4,224 (58.5%) manuscripts were mentioned on Twitter (n=29,958 mentions), with Twitter manuscripts cited more frequently (median 10 vs. 7, p

Uranium tetrafluoride hydrate (UFH) is formed by immersing anhydrous UF4 under water for 12 h. UFH is therefore clearly a chemical species of environmental concern, as anhydrous UF4 is an intermedi...

SUMMARY Stagnant-lid convection, where subduction and surface plate motion is absent, is common among the rocky planets and moons in our solar system, and likely among rocky exoplanets as well. How stagnant-lid planets thermally evolve is an important issue, dictating not just their interior evolution but also the evolution of their atmospheres via volcanic degassing. On stagnant-lid planets, the crust is not recycled by subduction and can potentially grow thick enough to significantly impact convection beneath the stagnant lid. We perform numerical models of stagnant-lid convection to determine new scaling laws for convective heat flux that specifically account for the presence of a buoyant crustal layer. We systematically vary the crustal layer thickness, crustal layer density, Rayleigh number and Frank–Kamenetskii parameter for viscosity to map out system behaviour and determine the new scaling laws. We find two end-member regimes of behaviour: a ‘thin crust limit’, where convection is largely unaffected by the presence of the crust, and the thickness of the lithosphere is approximately the same as it would be if the crust were absent; and a ‘thick crust limit’, where the crustal thickness itself determines the lithospheric thickness and heat flux. Scaling laws for both limits are developed and fit the numerical model results well. Applying these scaling laws to rocky stagnant-lid planets, we find that the crustal thickness needed for convection to enter the thick crust limit decreases with increasing mantle temperature and decreasing mantle reference viscosity. Moreover, if crustal thickness is limited by the formation of dense eclogite, and foundering of this dense lower crust, then smaller planets are more likely to enter the thick crust limit because their crusts can grow thicker before reaching the pressure where eclogite forms. When convection is in the thick crust limit, mantle heat flux is suppressed. As a result, mantle temperatures can be elevated by 100 s of degrees K for up to a few Gyr in comparison to a planet with a thin crust. Whether convection enters the thick crust limit during a planet’s thermal evolution also depends on the initial mantle temperature, so a thick, buoyant crust additionally acts to preserve the influence of initial conditions on stagnant-lid planets for far longer than previous thermal evolution models, which ignore the effects of a thick crust, have found.

We present JWST near- and mid-infrared spectroscopic observations of the nearby normal Type Ia supernova SN 2021aefx in the nebular phase at $+255$ days past maximum light. Our Near Infrared Spectrograph (NIRSpec) and Mid Infrared Instrument (MIRI) observations, combined with ground-based optical data from the South African Large Telescope (SALT), constitute the first complete optical $+$ NIR $+$ MIR nebular SN Ia spectrum covering 0.3$-$14 $\mu$m. This spectrum unveils the previously unobserved 2.5$-$5 $\mu$m region, revealing strong nebular iron and stable nickel emission, indicative of high-density burning that can constrain the progenitor mass. The data show a significant improvement in sensitivity and resolution compared to previous Spitzer MIR data. We identify numerous NIR and MIR nebular emission lines from iron-group elements and as well as lines from the intermediate-mass element argon. The argon lines extend to higher velocities than the iron-group elements, suggesting stratified ejecta that are a hallmark of delayed-detonation or double-detonation SN Ia models. We present fits to simple geometric line profiles to features beyond 1.2 $\mu$m and find that most lines are consistent with Gaussian or spherical emission distributions, while the [Ar III] 8.99 $\mu$m line has a distinctively flat-topped profile indicating a thick spherical shell of emission. Using our line profile fits, we investigate the emissivity structure of SN 2021aefx and measure kinematic properties. Continued observations of SN 2021aefx and other SNe Ia with JWST will be transformative to the study of SN Ia composition, ionization structure, density, and temperature, and will provide important constraints on SN Ia progenitor and explosion models., Comment: published in ApJ Letters, 17 pages, 12 figures

Ultraviolet light from early galaxies is thought to have ionized gas in the intergalactic medium. However, there are few observational constraints on this epoch because of the faintness of those galaxies and the redshift of their optical light into the infrared. We report the observation, in JWST imaging, of a distant galaxy that is magnified by gravitational lensing. JWST spectroscopy of the galaxy, at rest-frame optical wavelengths, detects strong nebular emission lines that are attributable to oxygen and hydrogen. The measured redshift is z = 9.51 ± 0.01, corresponding to 510 million years after the Big Bang. The galaxy has a radius of 16.2 − 7.2 + 4.6 parsecs, which is substantially more compact than galaxies with equivalent luminosity at z ~ 6 to 8, leading to a high star formation rate surface density.

The paleomagnetic record is an archive of Earth’s geophysical history, informing reconstructions of ancient plate motions and probing the core via the geodynamo. We report a robust 3.25-billion-year-old (Ga) paleomagnetic pole from the East Pilbara Craton, Western Australia. Together with previous results from the East Pilbara between 3.34 and 3.18 Ga, this pole enables the oldest reconstruction of time-resolved lithospheric motions, documenting 160 My of both latitudinal drift and rotation at rates of at least 0.55°/My. Motions of this style, rate, and duration are difficult to reconcile with true polar wander or stagnant-lid geodynamics, arguing strongly for mobile-lid geodynamics by 3.25 Ga. Additionally, this pole includes the oldest documented geomagnetic reversal, reflecting a stably dipolar, core-generated Archean dynamo.

Plants use a wide array of secondary metabolites including terpenes as defense against herbivore and pathogen attack, which can be constitutively expressed or induced. Here, we investigated aspects of the chemical and molecular basis of resistance against the exotic rust fungus Austropuccinia psidii in Melaleuca quinquenervia, with a focus on terpenes. Foliar terpenes of resistant and susceptible plants were quantified, and we assessed whether chemotypic variation contributed to resistance to infection by A. psidii. We found that chemotypes did not contribute to the resistance and susceptibility of M. quinquenervia. However, in one of the chemotypes (Chemotype 2), susceptible plants showed higher concentrations of several terpenes including α‐pinene, limonene, 1,8‐cineole, and viridiflorol compared with resistant plants. Transcriptome profiling of these plants showed that several TPS genes were strongly induced in response to infection by A. psidii. Functional characterization of these TPS showed them to be mono‐ and sesquiterpene synthases producing compounds including 1,8‐cineole, β‐caryophyllene, viridiflorol and nerolidol. The expression of these TPS genes correlated with metabolite data in a susceptible plant. These results suggest the complexity of resistance mechanism regulated by M. quinquenervia and that modulation of terpenes may be one of the components that contribute to resistance against A. psidii.

Purpose of review This review outlines recent research in the application of low carbohydrate diets (LCD) for insulin resistance (IR) and metabolic syndrome (MetS). Recent findings Studies included in this review explore how a LCD can be used in the management of patients with IR and MetS. LCDs have been shown to result in Type 2 Diabetes Mellitus (T2DM) remission, improve lipid profiles and dramatically reduce intrahepatic fat. Summary The field of nutritional science is notoriously complex. The LCD has a simple narrative, which can easily and safely be applied in clinical practice. Current guidelines recognise and encourage the use of LCD as a valid option for patients with T2DM and obesity. Structured, evidence-based education should be available for all clinicians to increase confidence and ensure consistency and quality control. Further real-world evidence into the application and scalability of a LCD are required. The use of digital health solutions and improved health technology should see significant advances in this field, with dietary habit being driven by patient-derived health data in response to food, and not population-based food guidelines. The narrative around MetS and IR needs to change from progression to remission, with a LCD being a valid option for this.

This article seeks to use Dewey's interpretation of pragmatism and education as a model for how dominant notions of school exemplify a colonizing theory of nature. The article argues that Dewey sought to commodify nature as a tool for human progress. This aspect of Dewey's beliefs is further demonstrated in the kind of schooling that is being implemented through globalization. The article draws on Indigenous concepts of the nature and the Earth, for decolonizing science instruction in an elementary classroom.

We present Hubble Space Telescope imaging of a pre-explosion counterpart to SN 2019yvr obtained 2.6 years before its explosion as a type Ib supernova (SN Ib). Aligning to a post-explosion Gemini-S/GSAOI image, we demonstrate that there is a single source consistent with being the SN 2019yvr progenitor system, the second SN Ib progenitor candidate after iPTF13bvn. We also analyzed pre-explosion Spitzer/IRAC imaging, but we do not detect any counterparts at the SN location. SN 2019yvr was highly reddened, and comparing its spectra and photometry to those of other, less extinguished SNe Ib we derive $E(B-V)=0.51\substack{+0.27\\-0.16}$ mag for SN 2019yvr. Correcting photometry of the pre-explosion source for dust reddening, we determine that this source is consistent with a $\log(L/L_{\odot}) = 5.3 \pm 0.2$ and $T_{\mathrm{eff}} = 6800\substack{+400\\-200}$ K star. This relatively cool photospheric temperature implies a radius of 320$\substack{+30\\-50} R_{\odot}$, much larger than expectations for SN Ib progenitor stars with trace amounts of hydrogen but in agreement with previously identified SN IIb progenitor systems. The photometry of the system is also consistent with binary star models that undergo common envelope evolution, leading to a primary star hydrogen envelope mass that is mostly depleted but seemingly in conflict with the SN Ib classification of SN 2019yvr. SN 2019yvr had signatures of strong circumstellar interaction in late-time ($>$150 day) spectra and imaging, and so we consider eruptive mass loss and common envelope evolution scenarios that explain the SN Ib spectroscopic class, pre-explosion counterpart, and dense circumstellar material. We also hypothesize that the apparent inflation could be caused by a quasi-photosphere formed in an extended, low-density envelope or circumstellar matter around the primary star., 22 pages, 9 figures, submitted to MNRAS

The psychoactive substance cannabis is the most-commonly used drug around the world, and its use is becoming more prevalent globally. Additionally, it is becoming available in an increasing variety of forms. As such, it is imperative that perioperative practitioners have an understanding of the drug, its effects, and its implications in perioperative care. There is currently a lack of a standardised approach to a patient who uses cannabis, and prospective studies prove difficult given the current legal status of cannabis. This literature review seeks to provide information regarding cannabis and its use. Specifically, we explore the systemic effects of marijuana as well as perioperative and anaesthetic implications so that safer, more effective care may be administered.

Dietary protein is often considered a factor that limits the growth of primate populations. The ratio of crude protein (CP) to fiber in common mature leaves in a forest reliably predicts colobine biomass across Africa and Asia. This relationship is puzzling because CP of mature leaves is notably high in some forests, including Kibale National Park, Uganda, where mature leaves have a higher protein concentration (ca. 18% CP on a dry matter basis) than what is required for primate growth, maintenance, and reproduction. We used an in vitro assay that incorporates the role of fiber and tannins to assess the biological relevance of CP in the leaves that comprise the diets of colobines (Colobus guereza, Piliocolobus tephrosceles) in Kibale (N = 37 spp. mature leaves, 39 spp. young leaves). Relative to CP, available (digestible) protein (AP) concentrations were 50% lower in mature leaves and 38% lower in young leaves, and protein-to-fiber ratios were lower when incorporating AP. Surprisingly, leaf AP did not differ among sites within Kibale, and AP at all sites exceeded primate protein requirements. Future research, particularly in protein-rich forests like Kibale, should consider focusing on fiber, energy, and other nutritional factors to assess the relationship between colobine biomass and leaf nutritional quality. Our study expands on the way that primate ecologists measure protein, integrates several traits into a single currency of AP, and contributes to conservation management plans.

The coronavirus disease 2019 (COVID-19) disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often results in severe hypoxemia requiring airway management. Because SARS-CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue, the Society for Airway Management (SAM) created a task force to review existing literature and current practice guidelines for difficult airway management by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. The SAM task force created recommendations for the management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in the COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of Appraisal of Guidelines Research and Evaluation (AGREE) Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. Difficult airway management often takes longer and may involve multiple procedures with aerosolization potential, and strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When a patient's airway risk assessment suggests that awake tracheal intubation is an appropriate choice of technique, and procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with a tight seal facemask may be performed to reduce the risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as a first-line strategy for airway management. If emergent invasive airway access is indicated, then we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by the SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.

Pseudo‐natural products (PNPs) combine natural product (NP) fragments in novel arrangements not accessible by current biosynthesis pathways. As such they can be regarded as non‐biogenic fusions of NP‐derived fragments. They inherit key biological characteristics of the guiding natural product, such as chemical and physiological properties, yet define small molecule chemotypes with unprecedented or unexpected bioactivity. We iterate the design principles underpinning PNP scaffolds and highlight their syntheses and biological investigations. We provide a cheminformatic analysis of PNP collections assessing their molecular properties and shape diversity. We propose and discuss how the iterative analysis of NP structure, design, synthesis, and biological evaluation of PNPs can be regarded as a human‐driven branch of the evolution of natural products, that is, a chemical evolution of natural product structure., Pseudo‐natural products provide new opportunities in the discovery of bioactive small molecules and can be regarded as a human‐driven chemical evolution of natural product structure.

Natural product structure and fragment-based compound development inspire pseudo-natural product design through different combinations of a given natural product fragment set to compound classes expected to be chemically and biologically diverse. We describe the synthetic combination of the fragment-sized natural products quinine, quinidine, sinomenine, and griseofulvin with chromanone or indole-containing fragments to provide a 244-member pseudo-natural product collection. Cheminformatic analyses reveal that the resulting eight pseudo-natural product classes are chemically diverse and share both drug- and natural product-like properties. Unbiased biological evaluation by cell painting demonstrates that bioactivity of pseudo-natural products, guiding natural products, and fragments differ and that combination of different fragments dominates establishment of unique bioactivity. Identification of phenotypic fragment dominance enables design of compound classes with correctly predicted bioactivity. The results demonstrate that fusion of natural product fragments in different combinations and arrangements can provide chemically and biologically diverse pseudo-natural product classes for wider exploration of biologically relevant chemical space., Natural products inspire the development of pseudo-natural products through combinations of fragments of compound classes that are chemically and biologically distinct. Here, the authors report a library of 244 pseudo-natural products, evaluate them in the cell painting essays and identify the phenotypic role of individual fragments.

Unscheduled interruptions to radiotherapy treatments lead to decreased tumor control probability (TCP). Rapid cell repopulation in the tumor increases due to the absence of radiation dose, resulting in the loss of TCP. Compensation for this loss is required to prevent or reduce an extension of the patient's overall treatment time and regain the original TCP. The cyberattack on the Irish public health service in May 2021 prevented radiotherapy treatment delivery resulting in treatment interruptions of up to 12 days. Current standards for treatment gap calculations are performed using the Royal College of Radiologists (RCR) methodology, using a point-dose for planning target volume (PTV) and the organs at risk (OAR). An in-house tool, named EQD

To investigate the impact of combining the high-resolution (Hi-res) scan mode with deep learning image reconstruction (DLIR) algorithm in CT. Two phantoms (Catphan600® and Lungman, small, medium, large size) were CT scanned using combinations of Hi-res/standard mode and high-definition (HD)/standard kernels. Images were reconstructed with ASiR-V and three levels of DLIR. Spatial resolution, noise and contrast-to-noise ratio (CNR) were assessed. The radiation dose was recorded. The spatial resolution increased using Hi-res & HD. Image noise in the Catphan600® (69%) and the Lungman (10–70%) significantly increased when Hi-res & HD was applied. DLIR reduced the mean noise (54%). The CNR was reduced (64%) for Hi-res & HD. The radiation dose increased for both small (+70%) and medium (+43%) Lungman phantoms but decreased slightly for the large ones (−3%) when Hi-res was applied. In conclusion, the Hi-res scan mode improved the spatial resolution. The HD kernel significantly increased the image noise. DLIR improved the image noise and CNR and did not affect the spatial resolution.

We present panchromatic observations and modeling of calcium-strong supernovae (SNe) 2021gno in the star-forming host-galaxy NGC 4165 and 2021inl in the outskirts of elliptical galaxy NGC 4923, both monitored through the Young Supernova Experiment transient survey. The light curves of both, SNe show two peaks, the former peak being derived from shock cooling emission (SCE) and/or shock interaction with circumstellar material (CSM). The primary peak in SN 2021gno is coincident with luminous, rapidly decaying X-ray emission (L x = 5 × 1041 erg s−1) detected by Swift-XRT at δ t = 1 day after explosion, this observation being the second-ever detection of X-rays from a calcium-strong transient. We interpret the X-ray emission in the context of shock interaction with CSM that extends to r < 3 × 1014 cm. Based on X-ray modeling, we calculate a CSM mass M CSM = (0.3−1.6) × 10−3 M ⊙ and density n = (1−4) × 1010 cm−3. Radio nondetections indicate a low-density environment at larger radii (r > 1016 cm) and mass-loss rate of M ̇ < 10 − 4 M ⊙ yr−1. SCE modeling of both primary light-curve peaks indicates an extended-progenitor envelope mass M e = 0.02−0.05 M ⊙ and radius R e = 30−230 R ⊙. The explosion properties suggest progenitor systems containing either a low-mass massive star or a white dwarf (WD), the former being unlikely given the lack of local star formation. Furthermore, the environments of both SNe are consistent with low-mass hybrid He/C/O WD + C/O WD mergers.

Cuvier’s beaked whales Ziphius cavirostris are wide-ranging, deep-diving cetaceans that are particularly sensitive to anthropogenic noise. Current stock assessments assume a single population in the western North Atlantic Ocean, but knowledge of the residency patterns and distribution of the species is currently lacking in the region. Here we describe the spatial ecology of 20 Cuvier’s beaked whales equipped with satellite-linked tags off Cape Hatteras, North Carolina, USA, between 2014 and 2017. We applied a hierarchical switching state-space model to filter location estimates and define behavioral states of area-restricted search (ARS) and transit. We used kernel density estimation to identify high use areas, and net squared displacement analyses to assess residency. The vast majority (96%) of locations were classified as ARS behavior, suggesting that tagged whales allocated much of their time to foraging. Maximum net displacement had a sample median of 50 km, and 81% of individual whales were classified as demonstrating a resident, or ‘home range,’ movement pattern. Overall, our research indicates a localized population of Cuvier’s beaked whales occupying the area off Cape Hatteras. The tagged animals demonstrated a small, defined core use area and exhibited little displacement from the region. These patterns of movement and spatial use can inform future conservation and management of this species, which is vulnerable to anthropogenic disturbances caused by several sources, including mid-frequency active sonar and seismic exploration.

Introduction: Oncotype DX is a 21 gene assay which has been shown to be useful in predicting the risk of breast cancer recurrence. TAILORx trial compared survival with the use of hormonal therapy (HT) vs. chemo-hormonal therapy (CHT) in early-stage, Hormone receptor-positive, HER2-negative, axillary lymphnode-negative breast cancer who had an Oncotype DX recurrence score in the intermediate range (11-25), The study found HT to be non-inferior to CHT in that group, especially in women older than 50. Materials and methods: We studied 1084 patients with hormone receptor-positive, HER-2 negative early stage breast cancer at a multi-center setting in South Dakota and North Dakota who were diagnosed one year before and after the results of the TAILORx trial were presented. We aimed to identify any change in practice after the trial was published as compared to the year prior. Chi-square analysis was used to compare demographics of patients and management practices before and after the TAILORx trial publication. Results: We did not find any statistically significant change in Oncotype DX testing frequency across various age groups, tumor sizes, tumor grades or amongst patients who had lymphnode negative or one axillary lymph node positive disease (Table-1).We also did not find any statistically significant difference in management of early stage breast cancer patients (Table-2) that matched our inclusion criteria and had an intermediate risk Oncotype Dx score of 11-25(n=266). Conclusion: Our results indicate that management of early stage breast cancer at our center was not significantly impacted by the results of TAILORx. Rare use of CHT prior to TAILORx reporting suggests that practice prior to this trial was largely based on earlier trials suggesting minimal benefit for CHT in the intermediate risk group. Larger studies may be able to identify smaller changes in practice resulting from this study and should be pursued. Table-1: Frequency of Oncotype Dx testing one year before and after the TAILORx trial was released overall and in various sub-categories based on age of the patient, tumor size and tumor grade. Last row indicates the frequency comparison in patients who had one axillary lymph node positive status.Before TAILORx (N=512)After TAILORx (N=572)p-valuen (%)n (%)Overall204 (40)234 (41)0.7212Age< 5044 (46)31 (37)0.225450 - 69121 (46)146 (49)0.4519Equal or > 7039 (26)57 (30)0.3986Tumor Size< 1 cm41 (25)50 (28)0.53881 - 1.9 cm97 (51)122 (53)0.60552 - 2.9 cm40 (44)44 (42)0.77283+ cm24 (39)18 (32)0.4161Tumor Grade156 (39)63 (42)0.62002113 (48)135 (47)0.8542334 (26)35 (27)0.9768LN Positive31 (33)36 (32)0.9403 Table-2: Comparison of treatment received by patients in the intermediate risk group (score:11-25) based on Oncotype Dx test before and after the release of TAILORx trial , Chi sq p-value=0.5635, HT (Hormonal Therapy), CT (Chemotherapy).Before TAILORxAfter TAILORxHT + CTn=15n=135.91%5.12%HT Alonen=108n=11842.52%46.46% Citation Format: Mahum Shahid, Moataz Ellithi, Mohamed Abdallah, Arsalan Arshad, Mansi Oberoi, Mckenna L Eisenbeisz, Christopher M VanHove, Ty A Moody, Isaak N Ailts, Andrew J Foley, Morgan Nelson, Jonathan Bleeker. Real life impact of TAILORx trial in a multi-center healthcare system: A comparison of management practice one year before and after the release of the trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-34.

In recent years, advancements in photocatalysis have allowed for a plethora of chemical transformations under milder conditions. Many of these photochemical reactions utilize hydrogen atom transfer processes to obtain desired products. Hydrogen atom transfer processes can follow one of two unique pathways: the first, a direct path and the second, an indirect path. In this paper, we highlight the ability of eosin Y to act as a direct hydrogen atom transfer catalyst from both synthetic and computational chemistry perspectives.

Uranium tetrafluoride (UF4) is an important intermediate in the production of UF6 and uranium metal. Room temperature hydrolysis of UF4 was investigated using a combination of Fluorine-19 nuclear magnetic resonance spectroscopy (19F NMR), Raman and infrared spectroscopy, powder X-ray diffraction, and microscopy measurements. UF4(H2O)2.5 was identified as the primary solid hydrolysis product when anhydrous UF4 was stirred in deionized water. Static NMR and 19F magic angle spinning NMR measurements revealed that a small amount of uranyl fluoride can also form when anhydrous UF4 is left in water, although this species comprises less than 5% of the total sample with the remaining parts being UF4(H2O)2.5. Since UF4 is generally considered to be stable under ambient conditions, these findings mark the first time that a room temperature reaction between UF4 and water has been detected and analyzed without interference from additional chemical reagents. The Raman characterization of UF4(H2O)2.5 presented herein is the first on record. Since UF4 is one of the most used intermediates during chemical conversion of uranium ore to uranium metal for nuclear fuel and weapons, the results presented herein are applicable to numerous nuclear science fields where solid state detection of uranium is of value, including nuclear nonproliferation, nuclear forensics, and environmental remediation.

Background Definitive treatment of Paget-Schroetter syndrome (PSS) involves first rib resection (FRR), division of the anterior scalene muscle, and resection of the subclavius muscle. This is a single-institution experience with PSS, according to a treatment algorithm of preoperative venogram (accompanied by lysis and percutaneous mechanical thrombectomy as needed) followed by transaxillary FRR. In the later period of this experience, patients have often been discharged on aspirin only, with no plan for anticoagulation postoperatively. We sought to evaluate outcomes in light of this experience and these practice patterns. Methods Between 2007 and 2018, 125 transaxillary FRRs were performed in 123 patients. All patients presented with documented venous thrombosis, underwent diagnostic venography and—if indicated—lysis and percutaneous mechanical thrombectomy (VPT) before FRR. The patient was not offered FRR if the vein could not be crossed with a wire and patency was not re-established during percutaneous treatment. The experience was divided into early (before 2012, n = 50) and late (n = 75) periods. Results Mean patient age was 28.4 (12–64 years) years. Of the cohort, 33 were high-level competitive athletes, 13 presented with documented pulmonary embolism in addition to local symptoms, and 3 had a cervical rib fused to the first rib. Patients underwent FRR a median of 50 (4 days to 18 years) days after their initial symptoms, and a median of 22 (1 day to 9 months) days after their percutaneous intervention. Postoperative VPT was required in 23 patients and performed a median of 5 (1–137 days) days postoperatively; in 19 of these patients, postoperative VPT was required for postoperative re-thrombosis, whereas in 4 patients, postoperative VPT was planned before FRR due to vein stenosis or residual thrombus. All these patients were prescribed postoperative anticoagulation. No operative venous reconstruction or bypass was performed. Median follow-up time after FRR was 242 days; at last follow-up, 98.4% (123/125) of axillosubclavian veins were patent by duplex ultrasound (and all those patients were asymptomatic). Postoperative anticoagulation was less frequently prescribed in the late experience, with no difference in the rate of early re-thrombosis or follow-up patency. Conclusions This experience demonstrates 98.4% patency at last follow-up with standard preoperative percutaneous venography and intervention, transaxillary FRR, and postoperative endovascular re-intervention only in cases with persistent symptoms, stenosis, or re-thrombosis. Patients presenting with both acute and chronic PSS did not require surgical venous reconstruction. In the later experience, patients frequently have not been anticoagulated postoperatively. Advantages of this algorithm include the following: (1) the cosmetic benefits of the transaxillary approach, (2) the preoperative assessment of the ability to recanalize the vein to determine which patients will benefit from surgery, (3) the capacity to use thrombolysis preoperatively, and (4) potential elimination of the risk and inconvenience of postoperative anticoagulation.

Multiple international airway societies have created guidelines for the management of the difficult airway. In critically ill patients, there are physiologic derangements beyond inadequate airway protection or hypoxemia. These risk factors contribute to the "physiologically difficult airway" and are associated with complications including cardiac arrest and death. Importantly, they are largely absent from international guidelines. Thus, we created management recommendations for the physiologically difficult airway to provide practical guidance for intubation in the critically ill. Through multiple rounds of in-person and telephone conferences, a multidisciplinary working group of 12 airway specialists (Society for Airway Management's Special Projects Committee) over a time period of 3 years (2016-2019) reviewed airway physiology topics in a modified Delphi fashion. Consensus agreement with the following recommendations among working group members was generally high with 80% of statements showing agreement within a 10% range on a sliding scale from 0% to 100%. We limited the scope of this analysis to reflect the resources and systems of care available to out-of-operating room adult airway providers. These recommendations reflect the practical application of physiologic principles to airway management available during the analysis time period.

BACKGROUND The age of patients with pulmonary arterial hypertension (PAH) has increased, with registries now reporting mean ages of 50 to 65 years old. Limited data exist on age-related differences in hemodynamic and functional assessments in PAH. METHODS Adults with PAH in the Pulmonary Hypertension Association Registry were divided into 3 groups (18–50, 51–65, and >65 years old). Analysis of variance and chi-square testing were used to assess for baseline differences. Linear regression was used to examine the association of age with continuous hemodynamic and functional variables. RESULTS A total of 769 patients with mean age of 56 ± 16 years were included. Older patients had more connective tissue disease–associated PAH and less drug-associated PAH. In linear regression models, each year of increased age was associated with shorter 6-minute walk distance (−3.37 meters; 95% CI, −3.97 to −2.76), lower mean pulmonary arterial pressure (−0.21 mm Hg; 95% CI, −0.27 to −0.15), and lower pulmonary vascular resistance (−0.06 Wood units; 95% CI, −0.09 to −0.04). Pulmonary arterial compliance, cardiac index, right ventricular stroke work index, and percent predicted 6-minute walk distance were unrelated to age; resistance-compliance time was negatively related to age (−3 milliseconds per year; 95% CI, −4 to −2). CONCLUSIONS Relative to their pulmonary vascular resistance, older patients have lower pulmonary artery compliance and worse right ventricular performance. Based on these findings, we suspect that age influences right ventricular loading conditions and the response of the right ventricle to increased afterload.

Intravascular ultrasound (IVUS) examination is an integral technique used for treating type B aortic dissection (TBAD) because it verifies true lumen access. The purpose of this study was to evaluate the use of IVUS, to determine factors associated with IVUS use, and to investigate the potential survival benefit associated with IVUS in the treatment of TBAD.A retrospective review of TEVARs performed for TBAD in the national Vascular Quality Initiative was performed from January 2010 to August 2018. Data collected included demographics, intraoperative and postoperative variables, and long-term mortality. Multivariable logistic regression evaluated variables associated with IVUS the use and mortality, and Cox regression was performed for adjusted survival analysis.In this study of 2686 patients, the average age was 60.4 years, 69.3% were male, and IVUS examination was used in 74.6% of cases. IVUS patients were younger (60.0 years vs 61.7 years; P = .004), more often male (72.1% vs 61.3%; P .001), exhibited less coronary disease, but had higher preoperative creatinine (1.27 ± 0.89 mg/dL vs 1.14 ± 0.68 mg/dL; P .001) and were more often treated in the acute setting (55.2% vs 49.7%; P = .03). Interestingly, there were no differences in contrast use (117.4 ± 77.6 mL vs 123.0 ± 81.90.1 mL; P = .11) or fluoroscopy time (20.3 ± 16.5 minutes vs 19.0 ± 22.1 minutes; P = .10). However, IVUS cases had a greater number of devices implanted (1.84 vs 1.65; P .001), higher rates of Zone 0 to 2 proximal seal (43.9% vs 30.7%; P .001), higher rates of distal seal zones beyond the diaphragm (53.9% vs 37.4%; P = .001), and larger proximal and distal graft diameters, with no differences in postoperative renal function. IVUS patients notably also had higher rates of follow-up imaging (61.3% vs 54.8%; P = .003), larger maximum aortic diameters at follow-up, and more reinterventions over time. The number of aortic devices (odds ratio [OR] 1.56; 95% confidence interval [CI], 1.24-1.97; P .001), malperfusion indication (OR, 1.68; 95% CI, 1.17-2.42; P = .005) and distal seal zone beyond the diaphragm (OR, 1.64; 95% CI, 1.30-2.07; P .001) were independently associated with IVUS use, whereas female gender showed a trend towards less IVUS use (OR, 0.79; 95% CI, 0.62-1.01; P = .063). Even after controlling for age, preoperative comorbidities, and postoperative complications like spinal cord ischemia, IVUS was associated with a 61% decrease in the odds of mortality (OR, 0.39; 95% CI, 0.20-0.78; P = .008), with a clear survival advantage shown in adjusted survival curves.IVUS examination was used in the majority of TBAD, although not universally. IVUS examination was used more often in acute TBAD and more complex aortic repairs, and was independently associated with improved long-term survival. Further study is needed to understand these patterns.

Background Intralesional injection of sodium thiosulfate has emerged as a promising therapy for calcinosis cutis, but to our knowledge there are no randomized controlled trials evaluating its efficacy as a treatment. Objective Conduct a prospective, double-blinded investigation of intralesional sodium thiosulfate versus normal saline in the treatment of dystrophic calcinosis cutis. Methods This prospective pilot study injected normal saline or sodium thiosulfate at 0.1 mL/cm2 into lesions at baseline and at 1- and 2-month follow-up. Subjects were followed for a total of 12 weeks. An in-person Physician Global Assessment score was assigned by the injecting physician at each visit and was repeated by an independent observer. Results Of 4 subjects who completed the study, only 1 experienced improvement in the size and Physician Global Assessment score of the lesion. By 3-month follow-up, there was no difference between the average size of the treatment and control lesions (P = .39). Limitations This was a small single-center study with limited demographic diversity and a short follow-up period. Only dystrophic calcinosis cutis subjects were included, and subjects received only 3 monthly injections of sodium thiosulfate. Conclusions With only 1 positive response, our results highlight the need for further study of sodium thiosulfate treatment for dystrophic calcinosis.