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OBJECTIVE To examine variations in timing of lower-limb amputation (LLA) across race/ethnicity and sex among older adults with a diabetic foot ulcer (DFU). It was hypothesized Black/African Americans were more likely to have LLA post-DFU earlier compared with non-Hispanic/Whites, and more men would receive LLA earlier post-DFU compared with women. RESEARCH DESIGN AND METHODS This was a retrospective cohort analysis of enrolled Medicare fee-for-service (FFS) beneficiaries with a diagnosis of DFU during the study period (2012–2017), allowing up to 5 years post-DFU. Final analytic sample contained 643,287 individuals; the subsample consisted of 68,633 individuals with LLA only. The primary outcome was mutually exclusive groups based on timing of LLA. Multinomial logistic regression was applied to assess likelihood of membership into a group post-DFU based on characteristics such as sex and race/ethnicity. RESULTS Black/African American beneficiaries had 1.98 (95% CI 1.93–2.03) times the odds of receiving an LLA within 1 year of DFU diagnosis compared with non-Hispanic/White beneficiaries relative to no amputation. Female beneficiaries had increased odds (odds ratio [OR] 1.07, 95% CI 1.02–1.11] between 1 and 3 years and OR 1.08 [95% CI 1.03–1.12] in ≥3 years) of a delayed LLA compared with men among those that underwent LLA. CONCLUSIONS Notably, these results present novel evidence on timing of LLA between racial groups and sex for Medicare FFS beneficiaries post-DFU. Results may be generalizable to individuals with Medicare FFS and DFU. Clinically more targeted, evidence-based decision making informs care decisions with opportunities to address inequities related to the social determinants of health that may lead to LLA.

This study develops a new thin cirrus detection algorithm applicable to overland scenes. The methodology builds from a previously developed overwater algorithm, which makes use of the Geostationary Operational Environmental Satellite 16 (GOES-16) Advanced Baseline Imager (ABI) channel 4 radiance (1.378-μm “cirrus” band). Calibration of this algorithm is based on coincident Cloud–Aerosol Lidar with Orthogonal Polarization (CALIOP) cloud profiles. Emphasis is placed on rejection of false detections that are more common in overland scenes. Clear-sky false alarm rates over land are examined as a function of precipitable water vapor (PWV), showing that nearly all pixels having a PWV of H removes significant land surface and low-/midlevel cloud false alarms from the overall sample while preserving over 80% of valid cirrus pixels. Additionally, the use of an aggressive PWV layer threshold preferentially removes noncirrus pixels such that the remaining sample is composed of nearly 70% cirrus pixels, at the cost of a much-reduced overall sample size. This study shows that lower-tropospheric clouds are a much more significant source of uncertainty in cirrus detection than the land surface.

We present an Arctic aerosol optical depth (AOD) climatology and trend analysis for 2003–2019 spring and summertime periods derived from a combination of multi-agency aerosol reanalyses, remote-sensing retrievals, and ground observations. This includes the U.S. Navy Aerosol Analysis and Prediction System ReAnalysis version 1 (NAAPS-RA v1), the NASA Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2), and the Copernicus Atmosphere Monitoring Service ReAnalysis (CAMSRA). Spaceborne remote-sensing retrievals of AOD are considered from the Moderate Resolution Imaging Spectroradiometer (MODIS), the Multi-angle Imaging SpectroRadiometer (MISR), and the Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP). Ground-based data include sun photometer data from AErosol RObotic NETwork (AERONET) sites and oceanic Maritime Aerosol Network (MAN) measurements. Aerosol reanalysis AODs and spaceborne retrievals show consistent climatological spatial patterns and trends for both spring and summer seasons over the lower Arctic (60–70∘ N). Consistent AOD trends are also found for the high Arctic (north of 70∘ N) from reanalyses. The aerosol reanalyses yield more consistent AOD results than climate models, can be verified well with AERONET, and corroborate complementary climatological and trend analysis. Speciated AODs are more variable than total AOD among the three reanalyses and a little more so for March–May (MAM) than for June–August (JJA). Black carbon (BC) AOD in the Arctic comes predominantly from biomass burning (BB) sources in both MAM and JJA, and BB overwhelms anthropogenic sources in JJA for the study period. AOD exhibits a multi-year negative MAM trend and a positive JJA trend in the Arctic during 2003–2019, due to an overall decrease in sulfate/anthropogenic pollution and a significant JJA increase in BB smoke. Interannual Arctic AOD variability is significantly large, driven by fine-mode and, specifically, BB smoke, with both smoke contribution and interannual variation larger in JJA than in MAM. It is recommended that climate models should account for BB emissions and BB interannual variabilities and trends in Arctic climate change studies.

Multiphase flows involving granular materials are complex and prone to pattern formation caused by competing mechanical and hydrodynamic interactions. Here we study the interplay between granular bulldozing and the stabilising effect of viscous pressure gradients in the invading fluid. Injection of aqueous solutions into layers of dry, hydrophobic grains represent a viscously stable scenario where we observe a transition from growth of a single frictional finger to simultaneous growth of multiple fingers as viscous forces are increased. The pattern is made more compact by the internal viscous pressure gradient, ultimately resulting in a fully stabilised front of frictional fingers advancing as a radial spoke pattern.

Climate change continues to have escalating effects worldwide. Multiple solutions are needed, one of which is carbon dioxide removal (CDR), where CO2 is removed directly from the atmosphere.One approach to CDR is ocean alkalinity enhancement (OAE), whereby finely ground alkaline minerals are added to the ocean, increasing pH and total alkalinity and enhancing the ocean’s ability to draw down CO2 from the air. This effect also helps counter ocean acidification, a phenomenon problematic to marine biodiversity and biogeochemistry.Here a similar process is investigated but using rivers or fjords settings instead of the coasts. Rivers are proposed to be used as conveyors of finely crushed olivine (10-30 μm) mixed in river water. The goal is for the river to have higher alkalinity and pH before entering the chosen ocean region.In this work, a closed mesoscale laboratory flume is used to study the feasibility of treating three different conditions, river, fjord, or saltwater, with finely crushed olivine, for alksalisation and CO2 absorption.During the experiments, we examined weathering of olivine (details on physical and chemical composition and mineralogy needed) in flowing freshwater, brackish water, and saltwater with a flow rate of 1.25 -1.4 m3/s and the solids-to-liquid ratio of 0,00015 kg. Preliminary results indicate that freshwater is an optimal candidate as a conveyor. Furthermore, using rivers as one of the long-term solutions as an output of alkaline and pH-rich water to targeted regions is suitable.

Preoperative dysphagia screening is rare. The purpose of this study was to assess the prevalence and potential risk factors of preoperative dysphagia risk in adults preparing for surgery.The Eating Assessment Tool (EAT-10), Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and Sarcopenia Screening Tool (SARC-F) were self-administered in adults preparing for surgery to identify dysphagia, malnutrition, and sarcopenia risk, respectively. Other variables collected include clinical demographics, fall risk, and surgical history associated with increased dysphagia risk. Descriptive summary statistics, univariate analysis, and logistic regression were performed as appropriate.The median age was 69 years and preoperative dysphagia risk was 9.6%. Among 357 patients completing both EAT-10 and PG-SGA SF or SARC-F, 7.3% had preoperative dysphagia and malnutrition risk and 7.2% had preoperative dysphagia and sarcopenia risk. Preoperative dysphagia risk was 2.7 times greater in those with prior surgical history associated with increased risk of dysphagia, 2.2 times higher in women, and almost twice as high in Black patients and patients with fall risk. Logistic regression revealed significant odds ratios (ORs) for prior surgical history associated with increased risk of dysphagia (OR, 2.95; 95% CI, 1.62-5.40) and male sex (OR, 0.52; 95% CI, 0.29-0.94), and a significant relationship between preoperative dysphagia and malnutrition risk (OR, 4.56; 95% CI, 2.02-10.28) when controlling for clinical variables.The high prevalence of dysphagia risk alone and in combination with malnutrition and sarcopenia risk in community-dwelling adults underscores the need for standardized preoperative screening and optimization prior to surgery.

Nuclear-penetrating anti-DNA autoantibodies have therapeutic potential as delivery agents and in targeting DNA and the DNA damage response (DDR). Derivatives of such Abs have advanced to human testing in genetic disease and are in preparation for oncology clinical trials. DNA release associated with neutrophil extracellular traps (NETs) contributes to immunity, inflammation, and the pathophysiology of multiple diseases. The DDR contributes to mechanisms of NETosis, and we hypothesize that anti-DNA autoantibodies that localize into live cell nuclei and inhibit DNA repair will suppress release of NETs by activated neutrophils. In the current study we evaluated the impact of a nuclear-penetrating anti-DNA autoantibody that interferes with the DDR on decondensation and release of DNA and NETs by activated human granulocyte-like differentiated PLB-985 cells and neutrophils isolated from C57BL/6 mice. The response of cells pretreated with control or autoantibody to subsequent stimulators of NETosis, including PMA and the calcium ionophore ionomycin, was evaluated by DAPI and SYTOX Green stains, measurement of DNA release, analysis of histone citrullination by Western blot, or visualization of NETs by immunostaining and confocal fluorescence microscopy. Autoantibody treatment of the cells yielded significant inhibition of NADPH oxidase–dependent and independent NETosis. These findings establish the concept of nuclear-penetrating anti-DNA autoantibodies as modulators of neutrophil biology with potential for use in strategies to suppress NETosis.

PDF file, 51K, CDC activity of h1567, 1-44 and 2-3 variants against Mac-1 cells.

PDF file, 209K, Epitope mapping of mAb1567.

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