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Negative-pressure wound therapy (NPWT) is commonly utilized to treat traumatic injuries sustained on the modern battlefield. However, NPWT has failed to decrease the incidence of deep tissue infections experienced by Wounded Warriors, despite attempts to integrate common antimicrobials, like Ag+ nanoparticles, into the wound dressing. The purpose of this study was to incorporate a unique antibiofilm compound (CZ-01179) into the polyurethane matrix of NPWT foam via lyophilized hydrogel scaffolding. Foam samples with 2.5%, 5.0%, and 10.0% w/w CZ-01179 were produced and antibiofilm efficacy was compared to the current standards of care: V.A.C.® GRANUFOAM SILVER™ and V.A.C.® GRANUFOAM™. Gravimetric analysis and elution kinetics testing confirmed that this loading technique was both repeatable and controllable. Furthermore, zone of inhibition and antibiofilm efficacy testing showed that foam loaded with CZ-01179 had significantly increased activity against planktonic and biofilm phenotypes of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii compared to the clinical standards. These findings motivate additional ex vivo and in vivo work with NPWT foam loaded with CZ-01179 with the overall objective of reducing NPWT-associated infections that complicate battlefield-related and other wounds.

Whole body CT in the setting of trauma has been shown to improve patient outcomes and decrease mortality in the emergency department (ED). Our institutional WBCT protocol allows for easy inclusion of the lower extremities, circumventing the need for diagnostic radiographs of the lower extremities. We hypothesized that this WBCT protocol would decrease time in the ED, reduce time to ED discharge, and decrease the number of lower extremity radiographs obtained in this patient population.To assess patient throughput in the ED by determining total time in the ED, number of lower extremity radiographs, cost of radiographs, and total cost of imaging before and after the implementation of a WBCT protocol for trauma.The trauma registry from an urban level 1 trauma center was searched for blunt trauma patients 6 months before and 6 months after the implementation of a WBCT protocol for trauma. Time between admission and discharge from the ED, total number of radiographs, total radiographs cost, total cost of ED imaging, and radiation dose estimations before and after WBCT implementation were calculated.There was a statistically significant decrease in time in the ED (76 min, p = 0.033) and number of lower extremity radiographs (decreased by 2 per patient, p 0.01) following the implementation of the WBCT for trauma protocol. The cost of radiographs was decreased by 28.5% (p = 0.013) but the total cost of ED imaging was increased by approximately 4 × (p 0.0001). Calculated effective radiation dose to the lower extremities increased by a factor of 1.9 × after implementation of WBCT for trauma.Implementation of a WBCT protocol for trauma resulted in statistically significant decreased time in the ED and decreased the number of radiographs at the expense of increased imaging costs and radiation exposure.

In Jewish Antiquities 14–17, Josephus draws extensively on Nicolaus of Damascus’s Universal History. Josephus and his immediate audience in Rome at the end of the first century would have seen Nicolaus’s work as a direct competitor for telling the history of the Jewish people in the Herodian period. This essay looks at Josephus’s use of conventional historiographical polemic to impugn the motivations of his predecessor and rival. By casting Nicolaus the historical actor as biased, Josephus casts doubt on the reliability of the Universal History. Ultimately, this opens up a new perspective on the Antiquities’s more censorious posture vis-à-vis Herod (relative to the more generous posture in his earlier work, the Jewish War): in a virtual competition with Nicolaus, Josephus seeks to win admiration for his own work as frank and impartial in its assessment of Herod while simultaneously fostering suspicion of Nicolaus’s work as obsequious and partisan.

The operational safety of Automated Driving System (ADS)-Operated Vehicles (AVs) are a rising concern with the deployment of AVs as prototypes being tested and also in commercial deployment. The robustness of safety evaluation systems is essential in determining the operational safety of AVs as they interact with human-driven vehicles. Extending upon earlier works of the Institute of Automated Mobility (IAM) that have explored the Operational Safety Assessment (OSA) metrics and infrastructure-based safety monitoring systems, in this work, we compare the performance of an infrastructure-based Light Detection And Ranging (LIDAR) system to an onboard vehicle-based LIDAR system in testing at the Maricopa County Department of Transportation SMARTDrive testbed in Anthem, Arizona. The sensor modalities are located in infrastructure and onboard the test vehicles, including LIDAR, cameras, a real-time differential GPS, and a drone with a camera. Bespoke localization and tracking algorithms are created for the LIDAR and cameras. In total, there are 26 different scenarios of the test vehicles navigating the testbed intersection; for this work, we are only considering car following scenarios. The LIDAR data collected from the infrastructure-based and onboard vehicle-based sensors system are used to perform object detection and multi-target tracking to estimate the velocity and position information of the test vehicles and use these values to compute OSA metrics. The comparison of the performance of the two systems involves the localization and tracking errors in calculating the position and the velocity of the subject vehicle, with the real-time differential GPS data serving as ground truth for velocity comparison and tracking results from the drone for OSA metrics comparison.

The interface between two-dimensional topological Dirac states and an s-wave superconductor is expected to support Majorana bound states that can be used for quantum computing applications. Realizing these novel states of matter and their applications requires control over superconductivity and spin-orbit coupling to achieve spin-momentum locked topological surface states which are simultaneously superconducting. While signatures of Majorana bound states have been observed in the magnetic vortex cores of bulk FeTe0.55Se0.45, inhomogeneity and disorder from doping makes these signatures unclear and inconsistent between vortices. Here we report superconductivity in monolayer FeTe1-ySey (Fe(Te,Se)) grown on Bi2Te3 by molecular beam epitaxy. Spin and angle resolved photoemission spectroscopy directly resolve the interfacial spin and electronic structure of Fe(Te,Se)/Bi2Te3 heterostructures. We find that for y = 0.25 the Fe(Te,Se) electronic structure overlaps with the topological Bi2Te3 interfacial states which disrupts the desired spin-momentum locking. In contrast, for y = 0.1 a smaller Fe(Te,Se) Fermi surface allows for clear spin-momentum locking observed in the topological states. Hence, we demonstrate the Fe(Te,Se)/Bi2Te3 system is a highly tunable platform for realizing Majorana bound states where reduced doping can improve characteristics important for Majorana interrogation and potential applications.

The purpose of this study was to develop and test a 3D multi-parameter MR fingerprinting (MRF) method for brain imaging applications. The subject cohort included 5 healthy volunteers, repeatability tests done on 2 healthy volunteers and tested on two multiple sclerosis (MS) patients. A 3D-MRF imaging technique capable of quantifying T1, T2 and T1ρ was used. The imaging sequence was tested in standardized phantoms and 3D-MRF brain imaging with multiple shots (1, 2 and 4) in healthy human volunteers and MS patients. Quantitative parametric maps for T1, T2, T1ρ, were generated. Mean gray matter (GM) and white matter (WM) ROIs were compared for each mapping technique, Bland-Altman plots and intra-class correlation coefficient (ICC) were used to assess repeatability and Student T-tests were used to compare results in MS patients. Standardized phantom studies demonstrated excellent agreement with reference T1/T2/T1ρ mapping techniques. This study demonstrates that the 3D-MRF technique is able to simultaneously quantify T1, T2 and T1ρ for tissue property characterization in a clinically feasible scan time. This multi-parametric approach offers increased potential to detect and differentiate brain lesions and to better test imaging biomarker hypotheses for several neurological diseases, including MS.

The immunosuppressive tumor microenvironment (TME) is a formidable barrier to the success of adoptive cell therapies for solid tumors. Oncolytic immunotherapy with engineered adenoviruses (OAd) may disrupt the TME by infecting tumor cells, as well as surrounding stroma, to improve the functionality of tumor-directed chimeric antigen receptor (CAR)-T cells, yet efficient delivery of OAds to solid tumors has been challenging. Here we describe how mesenchymal stromal cells (MSCs) can be used to systemically deliver a binary vector containing an OAd together with a helper-dependent Ad (HDAd; combinatorial Ad vector [CAd]) that expresses interleukin-12 (IL-12) and checkpoint PD-L1 (programmed death-ligand 1) blocker. CAd-infected MSCs deliver and produce functional virus to infect and lyse lung tumor cells while stimulating CAR-T cell anti-tumor activity by release of IL-12 and PD-L1 blocker. The combination of this approach with administration of HER.2-specific CAR-T cells eliminates 3D tumor spheroids in vitro and suppresses tumor growth in two orthotopic lung cancer models in vivo. Treatment with CAd MSCs increases the overall numbers of human T cells in vivo compared to CAR-T cell only treatment and enhances their polyfunctional cytokine secretion. These studies combine the predictable targeting of CAR-T cells with the advantages of cancer cell lysis and TME disruption by systemic MSC delivery of oncolytic virotherapy: incorporation of immunostimulation by cytokine and checkpoint inhibitor production through the HDAd further enhances anti-tumor activity.

PURPOSE This study evaluated risk factors predicting unplanned 30-day acute service utilization among adults subsequent to hospitalization for a new diagnosis of leukemia, lymphoma, or myeloma. This study explored the prevalence of medical complications (aligned with OP-35 measure specifications from the Centers for Medicare & Medicaid Services [CMS] Hospital Outpatient Quality Reporting Program) and the potential impact of psychosocial factors on unplanned acute care utilization. METHODS This study included 933 unique patients admitted to three acute care inpatient facilities within a nonprofit community-based health care system in southern California from 2012 to 2017. Integrated comprehensive data elements from electronic medical records and facility oncology registries were leveraged for univariate statistics, predictive models constructed using multivariable logistic regression, and further exploratory data mining, with predictive accuracy of the models measured with c-statistics. RESULTS The mean age of study participants was 65 years, and 55.1% were male. Specific diagnoses were lymphoma (48.7%), leukemia (35.2%), myeloma (14.0%), and mixed types (2.1%). Approximately one fifth of patients received unplanned acute care services within 30 days postdischarge, and over half of these patients presented with one or more symptoms associated with the CMS medical complication measure. The predictive models, with c-statistics ranging from 0.7 and above for each type of hematologic malignancy, indicated good predictive qualities with the impact of psychosocial functioning on the use of acute care services ( P values < .05), including lack of consult for social work during initial admission (lymphoma or myeloma), history of counseling or use of psychotropic medications (lymphoma), and past substance use (myeloma). CONCLUSION This study provides insights into patient-related factors that may inform a proactive approach to improve health outcomes, such as enhanced care transition, monitoring, and support interventions.