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IntroductionParticipatory research is a study method that engages patient partners in research programs from study design through to completion. It has seldom been used in diabetes health services research. Our objectives were to describe the process and challenges of conducting a patient-engagement project and to highlight the experiences of patient participants and academic researchers.Research Design & MethodsWe recruited PWLEH and diabetes in Toronto, Canada to be patient partners. Group members were asked to commit to attending biweekly meetings. We undertook two major research projects: Concept mapping to choose a research focus; and photovoice to explore accessing healthy food while homeless. We used a convergent mixed methods design to evaluate their experience.ResultsA diverse group of 8 PWLEH had an average attendance of 82% over 21 meetings – despite this success, we encountered a number of challenges to conducting this research. Group members reported that participation improved their ability to be self-advocates in their diabetes care and provided them with tangible skills and social benefits. Group members stated that they valued being involved in all aspects of the research, in particular knowledge translation activities, including advocating for nutritious food at shelters; presenting to stakeholders; and meeting with policy makers.ConclusionsThe use of participatory patient engagement research methods enables academic researchers to support community members in pursuing research that is pertinent to them and which has a positive impact. In our study, group members contributed in meaningful ways and also valued the experience.What is already known about this subject?Patient oriented research is important to public health research as it helps with the development of relevant interventions and knowledge translation.Participatory research is a form of research that maximally involves patients in all phases of the research.Participatory research has rarely been used in research on diabetes and diabetes-related interventions.What are the new findings?Patient engagement is important for studies involving socially disadvantaged populations with diabetes.Community members involved in research contribute substantially to research projects but also find the experience to be enriching and valuable.How might these results change the focus of research or clinical practice?Those who conduct research with and develop programs to provide diabetes care, especially to socially disadvantaged populations, should involve community members through all phases of the process to ensure the intervention is maximally useful for patients.

Agricultural greenhouse gas (GHG) emissions account for almost half of New Zealand’s total emissions, and therefore considerable attention has been given to identifying and testing mitigation options. At plot scale, plantain (Plantago lanceolate L.) in the pasture sward has been demonstrated to reduce nitrous oxide (N2O) emissions but has not been tested at paddock scale on an operating farm. Our aim was to test the efficacy of a pasture sward containing >30% plantain as a GHG mitigation option at paddock scale (2.5-3 ha) on a year-round rotationally grazed commercial dairy farm in the Waikato region of New Zealand. Utilising eddy covariance measurements of CO2, N2O and CH4 coupled to farm management records, N2O, carbon (C) and GHG balances (sign convention: positive value = emission to the atmosphere) were calculated for two adjacent paddocks – a control paddock containing an existing ryegrass/clover sward (RC), and a paddock that underwent renovation with the establishment of a ryegrass/clover/plantain sward (RCP). Establishment of RCP was via spraying and direct drilling and occurred in March 2018 (autumn). For the establishment period between initial herbicide application and the first grazing of the new RCP sward 66 days later, N2O emissions were 2.58 kg N ha-1 compared with 1.69 kg N ha-1 for the RC paddock. During the same period, C losses from the RCP paddock were greater than from the RC paddock (2.40 t C ha-1 for RCP and 1.29 t C ha-1 for RC) primarily due to reduced photosynthetic inputs associated with the herbicide application. The GHG budget (including enteric methane emissions from feed grown and eaten in the paddock) during the 66 day establishment period was an emission of 6.56 t CO2-eq ha-1 for RC and 9.85 t CO2-eq ha-1 for RCP. Unfortunately, the RCP sward establishment was poor, and after one year, total pasture production was unexpectedly lower than RC. Additionally, plantain accounted for 2O, C and GHG balances for RCP in the first year following (and including) establishment were 6.61 kg N ha-1 y-1, 3.25 t C ha-1 y-1 and 21.40 t CO2-eq ha-1 y-1 respectively, while for RC they were 7.21 kg N ha-1 y-1, 0.95 t C ha-1 y-1 and 13.29 t CO2-eq ha-1 y-1. Due to the poor establishment of plantain, any N2O and GHG benefits of this species were unable to be initially concluded, but additional plantain was sown and measurements are ongoing. However, we did identify several relevant findings: any N2O/GHG benefits of plantain must firstly offset emissions (including C losses) associated with the establishment of the sward (>3 t CO2-eq ha-1 in this study), and furthermore, there is a risk that should the establishment be poor, GHG emissions can be considerably greater (and pasture production lower) than an existing pasture.

Background Physical distancing, wearing face masks and hand hygiene are evidence-based methods to protect the public from coronavirus disease 2019 (COVID-19) infection. There has been a proliferation of research examining characteristics that can be targeted by public health interventions. This rapid review sought to identify predictors of attitudes toward and adherence to COVID-19 public health guidelines, and identify interventions aiming to improve adherence. Methods Articles were retrieved from multiple databases (e.g. MEDLINE, CINAHL and medRxiv) on 6 August 2020. Studies were limited to samples collected from Western countries. Studies were classified according to the types of factor (s) examined as independent variables. The consistency of evidence for each factor was scored by two reviewers. Results In total, 1323 unique articles were identified in the initial search, resulting in 29 studies in the final synthesis. The available evidence suggests individuals who are older, identify as women, trust governments, perceive COVID-19 as threatening and access information through traditional news media are more likely to adhere with COVID-19 public health guidelines. Interventions for improving adherence have not yet been investigated thoroughly, and this review identified only three experimental studies. Conclusions This review has identified several characteristics that impact attitudes and adherence to COVID-19 public health guidelines.

Understanding the secular population requires differentiating between people who are not religious (defined by what they are not) and those who are secular (defined by what they are). Non-religiosity is measured as the absence of the usual markers of religiosity—no religious affiliation, no religious attendance, and so on. Secularism is defined with new measures that reflect whether someone has a secular identity, receives guidance from secular sources, and has a secular worldview. Distinguishing between nonreligious and secular Americans reveals that they have very different levels of civic engagement. The former are civically disengaged, while the latter are often engaged in civic activity. Since both religionists and secularists share a high level of participation in civil society, it suggests the possibility of building bridges between them. But making such social connections will require conscious effort to overcome mutual suspicion.

High-throughput metabolomics can be used to optimize cell growth for enhanced production or for monitoring cell health in bioreactors. It has applications in cell and gene therapies, vaccines, biologics, and bioprocessing. NMR metabolomics is a method that allows for fast and reliable experimentation, requires only minimal sample preparation, and can be set up to take online measurements of cell media for bioreactor monitoring. This type of application requires a fully automated metabolite quantification method that can be linked with high-throughput measurements. In this review, we discuss the quantifier requirements in this type of application, the existing methods for NMR metabolomics quantification, and the performance of three existing quantifiers in the context of NMR metabolomics for bioreactor monitoring.

Introduction Tranexamic acid (TXA) has been shown to be effective in reducing post-operative blood loss after hip replacement surgery. Clinicians can be reluctant to administer intravenous (IV) TXA to high risk patients and intra-articular (IA) administration has been proposed as an alternative mode of delivery. This study was conducted to compare the efficacy of IV versus IA administration of TXA. Methods This prospective, double blinded, randomised non-inferiority trial, compared 69 patients undergoing primary total hip arthroplasty (THA) who received either 3 doses of 15mg/kg of IV TXA or 3 g of IA TXA after capsular closure. The primary outcomes were change in Hb and the rate of blood transfusion. The secondary outcome was the rate of VTE. Results The mean haemoglobin level change from pre-operative to day 1 post-operative for the IV group was 26.7g/L and for IA group was 27.3g/L. No statistically significant difference was detected between the two groups (p=0.82). No patients required a transfusion or developed a VTE. Conclusions IA administration of TXA can be equally effective as IV in the reduction of blood loss and the prevention of post-operative anaemia in primary THA.

Aims To summarize methods used to account for antihyperglycemic medication changes in randomized controlled trials evaluating the effect of dietary and physical activity interventions on glycemia among adults with diabetes. Methods Using studies included in two recently published systematic reviews of randomized controlled trials examining the glycemic effects of dietary and physical activity interventions, we evaluated how each study accounted for antihyperglycemic medication changes. Data were analyzed using summary statistics, stratified by the type of intervention studied, and each was assigned a score from 0 to 6 reflecting the strength of medication controls employed. Results We evaluated 22 physical activity focused and 27 dietary focused articles. Our scoring system yielded a mean concurrent medication adjustment score of 3.9/6 for the physical activity studies and a score of 1.7/6 ( p < 0.001) for the dietary studies. Conclusions We found that randomized controlled trials included in recent systematic reviews of physical activity and dietary interventions did not robustly account or control for changes in antihyperglycemic medications, with physical activity interventions doing so more robustly than dietary interventions. This is a threat to the validity of study findings, as observed glycemic changes may in fact be attributable to imbalances in concurrent medication adjustments between groups.

Background Patients with diabetes facing psychosocial challenges often struggle with diabetes self-management, and thereby are at risk of complications arising from hyperglycemia. Despite the Diabetes Canada Clinical Practice Guidelines’ recommendations for diabetes centres to offer psychosocial services for the screening and support of patients with psychosocial barriers, the extent to which these recommendations have been implemented in centres across Canada is unknown. Methods Tertiary adult diabetes centres affiliated with academic institutions were invited to participate in our quantitative survey (n=40). At each centre, a structured telephone interview was administered to a manager, as well as a social worker and psychologist (if employed at the centre) to inquire regarding the psychosocial services offered. Results 30 diabetes centres (75%) completed at least one questionnaire. Participating diabetes centres varied considerably in capacity, employing from 3 to >50 diabetes educators and 0 to 20 endocrinologists. Approximately 80% of centres reported providing patients with access to psychosocial services, but only about 50% had a dedicated, internal psychosocial team. Stratified results showed that centres which are the main centres affiliated with academic teaching hospitals were more likely to have embedded psychosocial services and to make referrals for psychosocial concerns than satellite centers. The majority of managers reported that their staffing and funding model provided inadequate psychosocial support and that increased funding for psychosocial care was either somewhat of a priority or a high priority. Conclusion Diabetes centres across Canada struggle to offer adequate psychosocial services; greater funding and training for staff is required to uphold the Diabetes Canada Clinical Practice Guidelines.

Initial stability of uncemented acetabular components in total hip arthroplasty (THA) is important for osseointegration and potentially enhanced by screw fixation. We used Australian Orthopaedic Association National Joint Replacement Registry data to determine whether screw usage influences uncemented acetabular component survival. Primary THA with uncemented acetabular components performed for osteoarthritis from 1999 to 2018 was included. Survivorship was calculated using Kaplan-Meier estimates of cumulative percent revision (CPR). Comparisons used Cox proportional hazards method. An instrumental variable analysis adjusted for surgeon preference for screws as a confounding factor was used. Three hundred thirty thousand one hundred ninety-two THAs were included (31.8% with screws, 68.2% without). Two hundred twenty thousand six hundred seven were included in the instrumental variable analysis. Revision rate of acetabular components (all causes) was higher with screws during the first six years (hazard ratio (HR) = 1.45 (95% CI 1.34, 1.57), p

The Casimir force, a quantum mechanical effect, has been observed in several microelectromechanical system (MEMS) platforms. Due to its extreme sensitivity to the separation of two objects, the Casimir force has been proposed as an excellent avenue for quantum metrology. Practical application, however, is challenging due to attractive forces leading to stiction and device failure, called Casimir pull-in. In this work, we design and simulate a Casimir-driven metrology platform, where a time-delay-based parametric amplification technique is developed to achieve a steady-state and avoid pull-in. We apply the design to the detection of weak, low-frequency, gradient magnetic fields similar to those emanating from ionic currents in the heart and brain. Simulation parameters are selected from recent experimental platforms developed for Casimir metrology and magnetic gradiometry, both on MEMS platforms. While a MEMS offers many advantages to such an application, the detected signal must typically be at the resonant frequency of the device, with diminished sensitivity in the low frequency regime of biomagnetic fields. Using a Casimir-driven parametric amplifier, we report a 10,000-fold improvement in the best-case resolution of MEMS single-point gradiometers, with a maximum sensitivity of 6 Hz/(pT/cm) at 1 Hz. Further development of the proposed design has the potential to revolutionize metrology and may specifically enable the unshielded monitoring of biomagnetic fields in ambient conditions.

Objective This study used cardiac magnetic resonance imaging to evaluate flow characteristics and ventricular hemodynamics for children with single right (hypoplastic left heart syndrome) and single left (hypoplastic right heart syndrome) systemic ventricle anatomy after Fontan palliation compared with normal biventricular controls. Methods Twenty children with single ventricle anatomy (hypoplastic left heart syndrome, n = 10; hypoplastic right heart syndrome, n = 10) underwent standardized 4-dimensional flow cardiac magnetic resonance and were compared with age-matched controls (n = 10). End-diastolic volume was partitioned into 4 defined components of variable kinetic energy (direct flow, retained inflow, delayed ejection, and residual volume) and compared between groups. Further, volumetric and functional parameters as defined by cardiac magnetic resonance were evaluated. Results Children with hypoplastic left heart syndrome had significantly increased indexed end-diastolic and end-systolic volumes compared with both hypoplastic right heart syndrome and control groups. Flow component analysis demonstrated diastolic inefficiency in both hypoplastic left heart syndrome and hypoplastic right heart syndrome groups compared with controls as defined by decreased direct flow and increased residual volumes. Decreased direct flow correlated with decreased ejection fraction and increased end-diastolic and end-systolic volume indices. Increased residual volume correlated with decreased ejection fraction and increased end-systolic volume index. Conclusions Fontan-palliated patients with single ventricle physiology (hypoplastic left heart syndrome and hypoplastic right heart syndrome) demonstrate altered and inefficient flow patterns in the systemic ventricle as defined by 4-dimensional flow cardiac magnetic resonance compared with normal biventricular controls. Decreased direct flow and increased residual volume indicate that diastolic ventricular dysfunction is prevalent after Fontan palliation. This study provides a foundation for future predictive modeling and cardiac magnetic resonance flow diagnostic studies in this high-risk patient population.

Studies published over the last decade have reached contrasting conclusions regarding the impact of climate change on conflict among the Classic Maya (ca. 250-900 CE). Some researchers have argued that rainfall declines exacerbated conflict in this civilisation. However, other researchers have found that the relevant climate variable was increasing summer temperatures and not decreasing rainfall. The goal of the study reported here was to test between these two hypotheses. To do so, we collated annually-resolved conflict and climate data, and then subjected them to a recently developed Bayesian method for analysing count-based times-series. The results indicated that increasing summer temperature exacerbated conflict while annual rainfall variation had no effect. This finding not only has important implications for our understanding of conflict in the Maya region during the Classic Period. It also contributes to the ongoing discussion about the likely impact of contemporary climate change on conflict levels. Specifically, when our finding is placed alongside the results of other studies that have examined temperature and conflict over the long term, it is clear that the impact of climate change on conflict is context dependent.

It is often useful to conduct inference for probability densities by constructing “plausible” sets in which the unknown density of given data may lie. Examples of such sets include pointwise intervals, simultaneous bands, or balls in a function space, and they may be frequentist or Bayesian in interpretation. For almost any density estimator, there are multiple approaches to inference available in the literature. Here we review such literature, providing a thorough overview of existing methods for density uncertainty quantification. The literature considered here comprises a spectrum from theoretical to practical ideas, and for some methods there is little commonality between these two extremes. After detailing some of the key concepts of nonparametric inference – the different types of “plausible” sets, and their interpretation and behaviour – we list the most prominent density estimators and the corresponding uncertainty quantification methods for each.

This paper describes an operational evaluation of the US Environmental Protection Agency’s (EPA) Air Pollution Exposure Model (APEX). APEX simulations for a multipollutant ambient air mixture, i.e. ozone (O3), carbon monoxide (CO), and particulate matter 2.5 microns in diameter or less (PM2.5), were performed for two seasons in three study areas in central Los Angeles. APEX predicted microenvironmental concentrations were compared with concentrations of these three pollutants monitored in the Exposure Classification Project (ECP) study during the same periods. The ECP was designed expressly for evaluating exposure models and measured concentrations inside and outside 40 microenvironments. This evaluation study identifies important uncertainties in APEX inputs and model predictions useful for guiding further exposure model input data and algorithm development efforts. This paper also presents summaries of the concentrations in the different microenvironments.

The nonlinear dimer obtained through the nonlinear Schrödinger equation has been a workhorse for the discovery the role nonlinearity plays in strongly interacting systems. While the analysis of the stationary states demonstrates the onset of a symmetry broken state for some degree of nonlinearity, the full dynamics maps the system into an effective [Formula: see text] model. In this later context, the self-trapping transition is an initial condition-dependent transfer of a classical particle over a barrier set by the nonlinear term. This transition that has been investigated analytically and mathematically is expressed through the hyperbolic limit of Jacobian elliptic functions. The aim of this work is to recapture this transition through the use of methods of Artificial Intelligence (AI). Specifically, we used a physics motivated machine learning model that is shown to be able to capture the original dynamic self-trapping transition and its dependence on initial conditions. Exploitation of this result in the case of the nondegenerate nonlinear dimer gives additional information on the more general dynamics and helps delineate linear from nonlinear localization. This work shows how AI methods may be embedded in physics and provide useful tools for discovery.

American society is rapidly secularizing–a radical departure from its historically high level of religiosity–and politics is a big part of the reason. Just as, forty years ago, the Religious Right arose as a new political movement, today secularism is gaining traction as a distinct and politically energized identity. This book examines the political causes and political consequences of this secular surge, drawing on a wealth of original data. The authors show that secular identity is in part a reaction to the Religious Right. However, while the political impact of secularism is profound, there may not yet be a Secular Left to counterbalance the Religious Right. Secularism has introduced new tensions within the Democratic Party while adding oxygen to political polarization between Democrats and Republicans. Still there may be opportunities to reach common ground if politicians seek to forge coalitions that encompass both secular and religious Americans.

We present the design and testing of a prototype in-plane echelle spectrograph based on an actively controlled fibre-fed double-pass design. This system aims to be small and efficient with the minimum number of optical surfaces - currently a collimator/camera lens, cross-dispersing prism, grating and a reflector to send light to the detector. It is built from catalogue optical components and has dimensions of approximately 20x30 cm. It works in the optical regime with a resolution of >70,000. The spectrograph is fed by a bifurcated fibre with one fibre to a telescope and the other used to provide simultaneous Thorium Argon light illumination for wavelength calibration. The positions of the arc lines on the detector are processed in real time and commercial auto-guiding software is used to treat the positions of the arc lines as guide stars. The guiding software sends any required adjustments to mechanical piezo-electric actuators which move the mirror sending light to the camera removing any drift in the position of the arc lines. The current configuration using an sCMOS detector provides a precision of 3.5 milli-pixels equivalent to 4 m/s in a standard laboratory environment., 21 pages, 9 figures, 2 tables, accepted PASP

ObjectiveThe objective of our study was to explore the perspectives of patients and general practitioners (GPs) regarding interventions to increase initiation of cholesterol lowering medication (or statins), including a proposed laboratory-based facilitated relay intervention.DesignQualitative descriptive study using interviews and focus groups for data collection, and thematic analysis for data analysis.SettingPrimary care providers and patients in Calgary, Alberta, Canada.Participants17 GPs with primarily community-based, non-academic practices with at least 1 year of practice experience participated in semistructured interviews. 14 patients at high risk of cardiovascular disease participated in focus groups.Main outcome measuresExploration of strategies that might be used to enhance the prescription of, and adherence to statin therapy for patients with statin-indicated conditions.ResultsGPs proposed a variety of interventions to improve statin prescription, including electronic record audit solutions, GP directed education, and patient-oriented campaigns. Patients expressed that they may benefit from being provided access to their laboratory test results, as well as targeted education. Both parties provided positive feedback on the proposed laboratory-based facilitated relay intervention, while pointing out areas for improvement. Notably, GPs were concerned that the patient-directed component of the intervention might jeopardise therapeutic relationships, and patients were concerned about accidental disclosure of personal health information. Important considerations for the design of facilitated relay messaging should include brevity, simplicity and the provision of contact information for inquiries.ConclusionsGPs and patients described several suggestions for increasing statin initiation and welcomed the proposal of a laboratory-based facilitated relay strategy. These findings support further testing of this intervention which may enhance GPs’ ability to successfully engage patients in cardiovascular risk reduction through statin therapy.

Data-Independent Acquisition (DIA) is a method to improve consistent identification and precise quantitation of peptides and proteins by mass spectrometry (MS). The targeted data analysis strategy in DIA relies on spectral assay libraries that are generally derived from a priori measurements of peptides for each species. Although Escherichia coli (E. coli) is among the best studied model organisms, so far there is no spectral assay library for the bacterium publicly available. Here, we generated a spectral assay library for 4,014 of the 4,389 annotated E. coli proteins using one- and two-dimensional fractionated samples, and ion mobility separation enabling deep proteome coverage. We demonstrate the utility of this high-quality library with robustness in quantitation of the E. coli proteome and with rapid-chromatography to enhance throughput by targeted DIA-MS. The spectral assay library supports the detection and quantification of 91.5% of all E. coli proteins at high-confidence with 56,182 proteotypic peptides, making it a valuable resource for the scientific community. Data and spectral libraries are available via ProteomeXchange (PXD020761, PXD020785) and SWATHAtlas (SAL00222-28)., Measurement(s) Proteome • database type spectral library Technology Type(s) SWATH MS protein profiling assay • mass spectrometry • Data-Independent Acquisition Sample Characteristic - Organism Escherichia coli Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.13078733

The development of fast-response analysers for the measurement of nitrous oxide (N2O) has resulted in exciting opportunities for new experimental techniques beyond commonly used static chambers and gas chromatography (GC) analysis. For example, quantum cascade laser (QCL) absorption spectrometers are now being used with eddy covariance (EC) or automated chambers. However, using a field-based QCL EC system to also quantify N2O concentrations in gas samples taken from static chambers has not yet been explored. Gas samples from static chambers are often analysed by GC, a method that requires labour and time-consuming procedures off-site. Here, we developed a novel field-based injection technique that allowed the use of a single QCL for (1) micrometeorological EC and (2) immediate manual injection of headspace samples taken from static chambers. To test this approach across a range of low to high N2O concentrations and fluxes, we applied ammonium nitrate (AN) at 0, 300, 600 and 900 kg N ha−1 (AN0, AN300, AN600, AN900) to plots on a pasture soil. After analysis, calculated N2O fluxes from QCL (FN2O_QCL) were compared with fluxes determined by a standard method, i.e. laboratory-based GC (FN2O_GC). Subsequently, the comparability of QCL and GC data was tested using orthogonal regression, Bland–Altman and bioequivalence statistics. For AN-treated plots, mean cumulative N2O emissions across the 7 d campaign were 0.97 (AN300), 1.26 (AN600) and 2.00 kg N2O-N ha−1 (AN900) for FN2O_QCL and 0.99 (AN300), 1.31 (AN600) and 2.03 kg N2O-N ha−1 (AN900) for FN2O_GC. These FN2O_QCL and FN2O_GC were highly correlated (r=0.996, n=81) based on orthogonal regression, in agreement following the Bland–Altman approach (i.e. within ±1.96 standard deviation of the mean difference) and shown to be for all intents and purposes the same (i.e. equivalent). The FN2O_QCL and FN2O_GC derived under near-zero flux conditions (AN0) were weakly correlated (r=0.306, n=27) and not found to agree or to be equivalent. This was likely caused by the calculation of small, but apparent positive and negative, FN2O when in fact the actual flux was below the detection limit of static chambers. Our study demonstrated (1) that the capability of using one QCL to measure N2O at different scales, including manual injections, offers great potential to advance field measurements of N2O (and other greenhouse gases) in the future and (2) that suitable statistics have to be adopted when formally assessing the agreement and difference (not only the correlation) between two methods of measurement.

Initial stability of uncemented acetabular components in total hip arthroplasty (THA) is important for osseointegration and potentially enhanced by screw fixation. We used Australian Orthopaedic Association National Joint Replacement Registry data to determine whether screw usage influences uncemented acetabular component survival.Primary THA with uncemented acetabular components performed for osteoarthritis from 1999 to 2018 was included. Survivorship was calculated using Kaplan-Meier estimates of cumulative percent revision (CPR). Comparisons used Cox proportional hazards method. An instrumental variable analysis adjusted for surgeon preference for screws as a confounding factor was used.Three hundred thirty thousand one hundred ninety-two THAs were included (31.8% with screws, 68.2% without). Two hundred twenty thousand six hundred seven were included in the instrumental variable analysis. Revision rate of acetabular components (all causes) was higher with screws during the first six years (hazard ratio (HR) = 1.45 (95% CI 1.34, 1.57), p 0.001) and lower thereafter (HR = 0.81 (95% CI 0.67, 0.98), p = 0.027). Revision rate of acetabular components for loosening was higher with screws over the entire study period (HR = 1.73 (95% CI 1.51, 1.98), p 0.001). Overall THA revision rate was higher with screws during the first six years (HR = 1.20 (95% CI 1.15, 1.26), p 0.001) but lower thereafter (HR = 0.89 (95% CI 0.81, 0.98), p = 0.020). Revision rate for dislocation was higher with screws over the entire period (HR = 1.16 (95% CI 1.06, 1.26), p 0.001). Instrumental variable analysis revealed higher revision rates with acetabular screws in the first six years. (HR = 1.18 (95% CI 1.09-1.29), p 0.001).Screws did not confer a protective effect against acetabular loosening and were not associated with long-term negative consequences.

Machine learning (ML) methods have recently been used as forward solvers to predict the mechanical properties of composite materials. Here, we use a supervised-autoencoder (sAE) to perform inverse design of graphene kirigami, where predicting the ultimate stress or strain under tensile loading is known to be difficult due to nonlinear effects arising from the out-of-plane buckling. Unlike the standard autoencoder, our sAE is able not only to reconstruct cut configurations but also to predict mechanical properties of graphene kirigami and classify the kirigami witheither parallel or orthogonal cuts. By interpolating in the latent space of kirigami structures, the sAE is able to generate novel designs that mix parallel and orthogonal cuts, despite being trained independently on parallel or orthogonal cuts. Our method allows us to both identify novel designs and predict, with reasonable accuracy, their mechanical properties, which is crucial for expanding the search space for materials design.

We derive an expansion of the functional renormalization (fRG) equations that treats the frequency and momentum dependencies of the vertices in a systematic manner. The scheme extends the channel-decomposed fRG equations to the frequency domain and reformulates them as a series of linear integral equations in the particle-particle, particle-hole and particle-hole exchange channels. We show that the linearity of the equations offers numerous computational advantages and leads to converged, stable solutions for a variety of Hamiltonians. As the expansion is in the coupling between channels, the truncations that are necessary to making the scheme computationally viable still lead to equations that treat contributions from all channels equally. As a first benchmark we apply the two-loop fRG equations to the single impurity Anderson model. We consider the sources of error within the fRG, the computational cost associated with each, and how the choice of regulator affects the flow of the fRG. We then use the optimal truncation scheme to study the Extended Hubbard Hamiltonian in one and two dimensions. We find that in many cases of interest the fRG flow converges to a stable vertex and self-energy from which we can extract the various correlation functions and susceptibilities of interest.

Background Although recruitment is a major challenge for most randomized controlled trials, few report on the difficulties of recruitment, or how it might be enhanced. The objective of our study was to qualitatively explore the experiences of both patients and pharmacists related to recruitment for ACCESS, a large trial involving low-income seniors, given that two of our most successful recruitment strategies were direct patient recruitment materials and use of community pharmacists. Methods Using qualitative descriptive methods, we collected data from pharmacists and study participants. Pharmacists were asked about their impressions of the study, as well as challenges they faced and methods they used to recruit potential participants. Focus groups with trial participants centered on the patient recruitment materials. Interviews and focus groups were recorded, transcribed and analyzed using thematic analysis. Results Pharmacists noted that their first impressions of the study were positive as they described being enticed to help the study team by the potential benefit of copayment elimination for their patients and the low time commitment. Pharmacists noted they were more likely to recruit if they were well informed on the study, as they could answer their patients’ questions. Participants noted that their primary motivations for participating were the tangible benefits of free medications and the intrinsic value of participating in research. Conclusions We noted that recruitment through pharmacies was an effective method as most patients have trusting relationships with their pharmacist. To optimize recruitment through pharmacies, study procedures should be straightforward, and pharmacists need to be equipped with good knowledge of the study. When promoting a study to potential participants, messaging should ensure the individuals are aware of the tangible benefits of participation while still presenting a full overview of the trial. Trial registration Trial Registration Number: NCT02579655 – initially registered Oct 19, 2015.

The use of roller compacted concrete (RCC) for new dam construction and for rehabilitation of existing dams has gained wide acceptance throughout the world. RCC is a zero slump concrete that is transported, spread and compacted using traditional earth moving equipment. The placement of horizontal to near-horizontal lifts typical of RCC construction lends itself to the forming of steps into the downstream edge of each lift. Recognition of the benefits of steps, coupled with ease of construction, has led to numerous downstream facing alternatives. A variety of alternative step treatments and approaches to forming have been developed to address a wide range of issues such as durability, aesthetics, constructability and cost. Facing alternatives include formed and unformed steps of exposed RCC, grout-enriched RCC, cast-in-place concrete, and precast concrete. Each of these alternative treatments brings with it its own unique benefits, limitations and design detailing. The development of RCC technology and the evolution of RCC materials science have indirectly led to a rebirth in the use of stepped spillways.

Drained peatlands are major sources of CO

Background The purpose of this study was to determine whether aortic biomechanical properties are abnormal in children with repaired truncus arteriosus (TA) and to concurrently evaluate left ventricular (LV) function post-repair utilizing a novel platform for regional ventricular function. Methods Cardiac magnetic resonance (CMR) studies from 26 children (mean age: 15.6 ± 7.2 years) post-TA repair were compared with 20 normal controls (mean age: 14.7 ± 2.6 years). Parameters of aortic stiffness (pulse wave velocity and relative area change) were measured. Flow hemodynamic metrics (aortic regurgitant fraction, peak systolic flow, and peak systolic velocity) and LV function (volumetric data, ejection fraction, regional wall strain) were also compared. Results Ascending aortic pulse wave velocity was elevated and relative area change was decreased in TA patients compared with controls. Patients post-TA repair demonstrated elevated end diastolic and end systolic volumes in addition to decreased regional wall strain and increased mechanical dyssynchrony. LV functional changes were independent of aortic biomechanical properties. Conclusions Children with repaired TA have increased ascending aortic stiffness and altered LV function as measured by CMR imaging. Longitudinal studies and advanced CMR assessments are warranted to better determine the long-term potential for late aortic complications and to optimize both the medical and surgical management of these patients after TA repair.

Small unmanned aircraft (SUA) have the potential to be used as platforms for the measurement of atmospheric particulates. The use of an SUA platform for these measurements provides benefits such as high manoeuvrability, re-usability, and low-cost when compared with traditional techniques. However, the complex aerodynamics of an SUA (particularly for multirotor airframes), combined with the miniaturisation of particle instruments poses difficulties for accurate and representative sampling of particulates. The work presented here relies on computational fluid dynamics with Lagrangian particle tracking (CFD-LPT) simulations to influence the design of a bespoke meteorological sampling system: the UH-AeroSAM. This consists of a custom built airframe, designed to reduce sampling artefacts due to the propellers, and a purpose built open-path optical particle counter–the Ruggedised Cloud and Aerosol Sounding System (RCASS). OPC size distribution measurements from the UH-AeroSAM are compared with the Cloud and Aerosol Precipitation Spectrometer (CAPS) for measurements of Stratus cloud during the Pallas Cloud Experiment (PaCE) in 2019. Good agreement is demonstrated between the two instruments. The integrated dN/dlog(Dp) is shown to have a coefficient of determination of 0.8, and a regression slope of 0.9 when plotted 1:1.

Objective Neonatal orthotopic heart transplantation was introduced in the 1980s as a treatment for complex congenital heart disease. Progress in single-ventricle palliation and biventricular correction has resulted in a decline in neonatal heart transplant volume. However, limited reports on neonatal heart transplants have demonstrated favorable outcomes. We report the long-term outcomes of patients with neonatal heart transplants at our institution spanning nearly 30 years. Methods A retrospective analysis of neonatal heart transplants and neonates listed for transplant was performed at Children's Hospital Colorado. Primary outcomes were early and late survival. Secondary outcomes were rejection episodes, retransplantation, and development of cardiac allograft vasculopathy or post-transplant lymphoproliferative disease. Results A total of 21 neonates underwent orthotopic heart transplantation at our institution. Among these, 10 neonates were transplanted from 1991 to 2000, 8 neonates were transplanted from 2001 to 2010, and 3 neonates were transplanted from 2011 to 2020. The average age of these patients was 17 days, and the average weight was 3.43 kg. Early survival was 95.2%. Survival at 1 and 5 years was 85.7% (confidence interval [CI], 61.9%-95.2%) and 75% (CI, 45.6%-85.5%), respectively. Of eligible patients, the 10-year and 20-year survival was 72.2% (CI, 45.1%-85.3%) and 50% (CI, 25.9%-70.1%), respectively. Conclusions Our institution reports favorable outcomes of neonatal heart transplantation. These results should be considered within the context of outcomes for patients awaiting transplant and the limited donor availability. However, the successful nature of these procedures suggest it may be necessary to reevaluate the indications for neonatal heart transplantation, particularly where risk of mortality and morbidity with palliative or corrective surgery is high.

In reverse shoulder arthroplasty, Inferior tilt was originally promoted to decrease rates of baseplate failure. However, the literature is conflicting regarding the effect of tilt on scapular neck impingement, which has been associated with an increased risk of notching, increased risk of impingement-related instability, and decreased range of motion. We hypothesized that inferior tilt of -10° would lead to increased medialization and increased scapular neck impingement compared with 0° of tilt.Twenty patients without glenoid bone loss undergoing reverse shoulder arthroplasty (RSA) at a single institution underwent computed tomography scans of the entire scapula and proximal humerus for preoperative planning. For each patient, we digitally implanted a 25-mm glenoid baseplate flush with the inferior rim of the glenoid. We then simulated impingement-free range of motion with 16 different implant configurations: glenoid tilt (0° vs. -10°), baseplate lateralization (0 mm vs. +6 mm), glenosphere size (36 mm vs. 42 mm), and neck-shaft angle (135° vs. 145°). The primary endpoint was external rotation with the arm at the side (ERS), which is the primary mode of both notching and impingement-related instability, and the secondary endpoint was adduction (ADD). We recorded the RSA angle, preoperative scapular neck length (SNL), and postoperative SNL. Data were compared by paired t tests and a multivariable regression analysis.In every simulation, inferior tilt led to more impingement on the scapular neck. Inferior tilt of the glenoid component was associated with a mean 27% decrease in impingement-free external rotation (P.01 in all cases) and a mean 32% decrease in impingement-free ADD (P.01 in all cases). Inferior tilt removed 3.2 mm of additional SNL (P.001). Multivariable regression analysis showed that lateralization had the most impact on impingement-free external rotation and ADD (P.001), followed by glenosphere size (P.001), neck-shaft angle (P.001), postoperative SNL (P.001), glenoid tilt (P = .001), inclination (P.001), and RSA angle (P = .023 for ERS and P = .025 for ADD).Relative to 0° of tilt of the baseplate, inferior tilt of -10° was associated with increased scapular neck impingement in ERS and ADD, likely a result of the increased medialization necessary to seat an inferiorly tilted implant, which shortens the scapular neck and brings the humerus closer to the scapula. This scapular neck impingement increases the risk of notching and impingement-related instability.

Optical systems typically use galvanometers (aka galvos) and scanners. Galvos move optical elements such as mirrors, quasi-statically, from one static position to another, and an important figure of merit is their step-settle relaxation time. Scanners move in an oscillatory fashion, typically at the device resonant frequency. MEMS devices, which have many advantages and are often used in such optical systems, are typically high Q devices. Moving from one position to another for a galvo or one frequency/amplitude to another for scanners, can take many periods to settle following the ring down. During these transitions, the optical system is inactive and the time is not being efficiently used. In this article we show how a novel class of open loop control algorithms can be used to rapidly change position, frequency and amplitude, typically in well under the period of the device. We show how the MEMS designer can excite, with complete, high-speed control, a vibrational mode of the system. We call this modal engineering, the ability to control the modes of the system in a practical, fast way. This control of the modes is accomplished with open loop control algorithms.

Background Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections. Methods The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation. Results We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and 30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%). Conclusions In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials., We enrolled 783 patients in a prospective, observational binational study of peri-prosthetic joint infection. Late, acute infections were the commonest mode of presentation. Microbiological causes differed according to affected joint and the timing of the infection. Management approaches were heterogeneous.

Historically there has been a relative dearth of social science research into civic education—even in political science, a discipline that had civic education as one of its founding objectives. Thi...