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Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: With the COVID19 pandemic, virtual consultations are becoming a necessity. Clinicians are having to adapt consultations to determine where patients' symptoms are, and what the appropriate next line of investigation or treatment should be, without the benefit of traditional face-to-face contact. The aim of this project was therefore to use pain mapping in foot and ankle conditions, in order to see if there was a predictive correlation between certain symptomatic areas and the ultimate surgical treatment required by patients. Methods: Data was collected prospectively from patients attending foot and ankle clinics from 2014 to 2019, and this was cross- matched with operative data subsequently. Data included patient demographics, co-morbidities, smoking status and previous injuries or surgeries. In a structured questionnaire, patients also marked the regions of the foot and ankle that they thought were the most symptomatic. The foot and ankle was divided into 12 segments for the purpose of analysis. Results: A total of 2007 patients completed these questionnaires, from which operative data was available for 407 patients. In the first instance, data was analysed for 122 patients who underwent one of five specific procedures. Pain mapping was found to have a good predictive value for first MTP fusion and bunion surgery (n=20, 46), 1st metatarsal cheilectomy (n=10) and arthroscopic ankle arthrodesis (n=23). The least predictive pain mapping was seen for patients who had a triple arthrodesis (n=23), with those patients presenting with pain more globally in the foot and ankle. Conclusion: The results suggest that pain mapping can be used effectively as postal questionnaires, prior to a virtual consultation, as an aid to predict diagnosis and the ultimate treatment required in some specific foot and ankle conditions.

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: For integrated care and appropraite referral pathways, it is important to understand the patient demographics, pathologies and comorbidities of patients with foot and ankle pain. We are aware of the burden of foot and ankle problems in UK primary care, with a large number of referrals to outpatient orthopaedic clinics (Ferguson et al. Br J Gen Pract, e422, June 2019). With increasing demands on secondary and tertiary care settings, it is important to think of innovative solutions. To our knowledge there is no large patient case series looking at these aspects of care in foot and ankle patients attending outpatient clinics in the UK. Methods: Therefore the aims of this study were to: 1. To gain a better understanding of the demographics and pathologies of patients attending a specialist foot and ankle clinic. 2.To develop our existing knowledge of the types and prevalence of comorbidities within this population. Data was collected prospectively. All new patients attending a specialist foot and ankle clinic in one centre in the UK were asked to complete a proforma at their first assessment (figure 1). Information was collected on gender, age, occupation, hobbies, location of ankle pain, previous injuries, compensation issues, presence of comorbidities and medications. A descriptive analysis of the data was conducted using SPSS (version 19, IBM). Results: Data from 2001 patients was collected. The mean (SD) age was 52.9 (16.9) years with 76% being female. Nine percent of patients had diabetes (though others may have been seen in diabetic/ vascular clinics and not captured here) and 16% were current smokers. Thirty-three percent of patients had a previous history of injury to the foot and/or ankle. The right foot was affected in 49% and the left in 51%. Location of pain was in the forefoot (52%), midfoot (21%) and hindfoot (27%). Compensation issues were reported in 3%. The proportion of patients in work was 64.4% meaning 35.6% were unemployed (including those who had retired). Conclusion: This large study demonstrates that more women attend specialist foot/ ankle clinics in the UK. Both feet are equally affected; the forefoot was the most common site of pathology. The prevalence of diabetes and smoking are in line with the general UK population (reported as 9% and 15%). A small proportion of patients had compensation issues, with the majority of patients working. This data can be used to help streamline referral pathways and to establish innovative ways of working (e.g. virtual clinics). In turn, this may reduce the burden on outpatient clinics, the health economy and improve patient satisfaction.

Competing Interests: N.G. is a member of the Editorial Board of the Journal of Neurosurgical Anesthesiology. The remaining author has no conflicts of interest to declare.

The American Society of Anesthesiologists (ASA) opposes automatic reversal of do-not-resuscitate orders during the perioperative period, instead advocating for a goal-directed approach that aligns decision-making with patients' priorities and clinical circumstances. Implementation of ASA guidelines continues to face significant barriers including time constraints, lack of longitudinal relationships with patients, and difficulty translating goal-focused discussion into concrete clinical plans. These challenges mirror those of advance care planning more generally, suggesting a need for novel frameworks for serious illness communication and patient-centered decision-making. This review considers ASA guidelines in the context of ongoing transitions to serious illness communication and increasingly multidisciplinary perioperative care. It aims to provide practical guidance for the practicing anesthesiologist while also acknowledging the complexity of decision-making, considering limitations inherent to anesthesiologists' role, and outlining a need to conceptualize delivery of ethically informed care as a collaborative, multidisciplinary endeavor., (Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.)

Background: Frailty is associated with increased 30-day mortality and non-home discharge following perioperative cardiac arrest. We estimated the predictive accuracy of frailty when added to baseline risk prediction models., Methods: In this retrospective cohort study using 2015-2020 NSQIP data for 3048 patients aged 50+ undergoing non-cardiac surgery and resuscitation on post-operative day 0 (i.e., intraoperatively or postoperatively on the day of surgery), baseline models including age, sex, ASA physical status, preoperative sepsis or septic shock, and emergent surgery were compared to models that added frailty indices, either RAI or mFI-5, to predict 30-day mortality and non-home discharge. Predictive accuracy was characterized by area under the receiver operating characteristic curve (AUC-ROC), integrated calibration index (ICI), and continuous net reclassification index (NRI)., Results: 1786 patients (58.6%) died in the study cohort within 30 days, and 38.6% of eligible patients experienced non-home discharge. The baseline model showed good discrimination (AUC-ROC 0.77 for 30-day mortality and 0.74 for non-home discharge). AUC-ROC and ICI did not significantly change after adding frailty for 30-day mortality or non-home discharge. Adding RAI significantly improved NRI for 30-day mortality and non-home discharge; however, the magnitude was small and difficult to interpret, given other results including false positive and negative rates showing no difference in predictive accuracy., Conclusions: Incorporating frailty did not significantly improve predictive accuracy of models for 30-day mortality and non-home discharge following perioperative resuscitation. Thus, demonstrated associations between frailty and outcomes of perioperative resuscitation may not translate into improved predictive accuracy. When engaging patients in shared decision-making regarding do-not-resuscitate orders perioperatively, providers should acknowledge uncertainty in anticipating resuscitation outcomes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the program are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. Chen reports funding from T32AG51108 from the National Institute on Aging and T32GM007753 and T32GM144273 from the National Institute of General Medical Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, the National Institute of General Medical Sciences, or the National Institutes of Health. Allen reports as a source of support the Brigham and Women’s Hospital Department of Anesthesiology, Perioperative and Pain Medicine Eleanor and Miles Shore Fellowship. Justice and Bader do not report any conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Neurosurgeons treat nonfunctioning pituitary adenomas by surgical resection. Based on the adherence of the tumor to the normal pituitary gland, operative risks may include hormone replacement therapy for postoperative hypopituitarism with gross total resection that injures the gland or recurrent tumor with subtotal resection and purposeful avoidance of gland manipulation. None of the patients presented in this article had a preoperative preference regarding extent of resection. This study aimed to evaluate postoperative patient preferences regarding extent of resection., Methods: Adult patients who underwent resection of adenomas between 2015 and 2023 were retrospectively reviewed and surveyed. After surgery, participating patients were asked for their preference regarding 100% tumor resection with lifelong daily hormone replacement therapy versus 90% tumor resection with a chance of recurrence in the hypothetical situation where the neurosurgeon encounters tumor adherent to the normal gland., Results: Of the 73 patients included, 54 (74.0%) responded to the survey, with the majority (36 [66.7%]) preferring 90% resection with the chance of tumor recurrence. Tumor recurrence (odds ratio 2.3, 95% confidence interval 2.1-2.5, P = 0.03) and steroid avoidance (odds ratio 2.2, 95% confidence interval 2.0-2.4, P = 0.04) were the 2 variables that were significant predictors of patient preference in multivariate regression analysis., Conclusions: Although patients may not have the preoperative insight or experience to have a strong conviction regarding the extent of adenoma resection, the consequences following surgery clearly influence their preference. Most patients in our study, including patients with gross total resection and especially patients who experienced side effects of steroid therapy, preferred subtotal resection with the chance of tumor recurrence over hormone replacement therapy., (Published by Elsevier Inc.)

Objective: To characterize the perceptions of surgeons, anesthesiologists, and geriatricians regarding perioperative CPR in surgical patients with frailty., Summary Background Data: The population of patients undergoing surgery is growing older and more frail. Despite a growing focus on goal-concordant care, frailty assessment, and debate regarding the appropriateness of cardiopulmonary resuscitation (CPR) in patients with frailty, providers' views regarding frailty and perioperative CPR are unknown., Methods: We performed qualitative thematic analysis of transcripts from semi-structured interviews of anesthesiologists (8), surgeons (10), and geriatricians (9) who care for high-risk surgical patients at two academic medical centers in Boston, MA. The interview guide elicited clinicians' understanding of frailty, approach to decision-making regarding perioperative CPR, and perceptions of perioperative CPR in frail surgical patients., Results: We identified 5 themes: perceptions of perioperative CPR in patients with frailty vary by provider specialty; judgments regarding appropriateness of CPR in surgical patients with frailty are typically multifactorial and include patient goals, age, comorbidities, and arrest etiology; resuscitation in patients with frailty is sometimes associated with moral distress; biases such as ableism and ageism may skew clinicians' perceptions of appropriateness of perioperative CPR in patients with frailty; and evidence to guide risk stratification for patients with frailty undergoing perioperative CPR is inadequate., Conclusions: Anesthesiologists, surgeons, and geriatricians offer different accounts of frailty's relevance to judgments regarding CPR in surgical patients. Divergent views regarding frailty and perioperative CPR may impede efforts to deliver goal-concordant care and suggest a need for research to inform risk stratification, predict patient-centered outcomes, and understand the role of potential biases such as ageism and ableism., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Importance: Frailty is associated with mortality following surgery and cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest. Despite the growing focus on frailty as a basis for preoperative risk stratification and concern that CPR in patients with frailty may border on futility, the association between frailty and outcomes following perioperative CPR is unknown., Objective: To determine the association between frailty and outcomes following perioperative CPR., Design, Setting, and Participants: This longitudinal cohort study of patients used the American College of Surgeons National Surgical Quality Improvement Program, including more than 700 participating hospitals in the US, from January 1, 2015, through December 31, 2020. Follow-up duration was 30 days. Patients 50 years or older undergoing noncardiac surgery who received CPR on postoperative day 0 were included; patients were excluded if data required to determine frailty, establish outcome, or perform multivariable analyses were missing. Data were analyzed from September 1, 2022, through January 30, 2023., Exposures: Frailty defined as Risk Analysis Index (RAI) of 40 or greater vs less than 40., Outcomes and Measures: Thirty-day mortality and nonhome discharge., Results: Among the 3149 patients included in the analysis, the median age was 71 (IQR, 63-79) years, 1709 (55.9%) were men, and 2117 (69.2%) were White. Mean (SD) RAI was 37.73 (6.18), and 792 patients (25.9%) had an RAI of 40 or greater, of whom 534 (67.4%) died within 30 days of surgery. Multivariable logistic regression adjusting for race, American Society of Anesthesiologists physical status, sepsis, and emergency surgery demonstrated a positive association between frailty and mortality (adjusted odds ratio [AOR], 1.35 [95% CI, 1.11-1.65]; P = .003). Spline regression analysis demonstrated steadily increasing probability of mortality and nonhome discharge with increasing RAI above 37 and 36, respectively. Association between frailty and mortality following CPR varied by procedure urgency (AOR for nonemergent procedures, 1.55 [95% CI, 1.23-1.97]; AOR for emergent procedures, 0.97 [95% CI, 0.68-1.37]; P = .03 for interaction). An RAI of 40 or greater was associated with increased odds of nonhome discharge compared with an RAI of less than 40 (AOR, 1.85 [95% CI, 1.31-2.62]; P < .001)., Conclusions and Relevance: The findings of this cohort study suggest that although roughly 1 in 3 patients with an RAI of 40 or greater survived at least 30 days following perioperative CPR, higher frailty burden was associated with increased mortality and greater risk of nonhome discharge among survivors. Identifying patients who are undergoing surgery and have frailty may inform primary prevention strategies, guide shared decision-making regarding perioperative CPR, and promote goal-concordant surgical care.

Context: Discussion of perioperative code status is an important element of preoperative care and a component of the American College of Surgeons' Geriatric Surgery Verification (GSV) program. Evidence suggests code status discussions (CSDs) are not routinely performed and are inconsistently documented., Objectives: Because preoperative decision making is a complex process spanning multiple providers, this study aims to utilize process mapping to highlight challenges associated with CSDs and inform efforts to improve workflows and implement elements of the GSV program., Methods: Using process mapping, we detailed workflows relating to (CSDs) for patients undergoing thoracic surgery and a possible workflow for implementing GSV standards for goals and decision-making., Results: We generated process maps for outpatient and day-of-surgery workflows relating to CSDs. In addition, we generated a process map for a potential workflow to address limitations and integrate GSV Standards for Goals and Decision Making., Conclusion: Process mapping highlighted challenges associated with the implementation of multidisciplinary care pathways and indicated a need for centralization and consolidation of perioperative code status documentation., (Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Ethylene cross-bridged tetraazamacrocycles are known to produce kinetically stable transition metal complexes that can act as robust oxidation catalysts under harsh aqueous conditions. We have synthesized ligand analogs with single acetate pendant arms that act as pentadentate ligands to Mn, Fe, Co, Ni, Cu, and Zn. These complexes have been synthesized and characterized, including the structural characterization of four Co and Cu complexes. Cyclic voltammetry demonstrates that multiple oxidation states are stabilized by these rigid, bicyclic ligands. Yet, redox potentials of the metal complexes are modified compared to the "parent" ligands due to the pendant acetate arm. Similarly, gains in kinetic stability under harsh acidic conditions, compared to parent complexes without the pendant acetate arm, were demonstrated by a half-life seven times longer for the cyclam copper complex. Due to the reversible, high oxidation states available for the Mn and Fe complexes, the Mn and Fe complexes were examined as catalysts for the bleaching of three commonly used pollutant model dyes (methylene blue, methyl orange, and Rhodamine B) in water with hydrogen peroxide as oxidant. The efficient bleaching of these dyes was observed.

Background: Little is known about policies and practices for patients undergoing Transcatheter Aortic Valve Replacement (TAVR) who have a documented preference for Do Not Resuscitate (DNR) status at time of referral. We investigated how practices across TAVR programs align with goals of care for patients presenting with DNR status., Methods: Between June and September 2019, we conducted semi-structured interviews with TAVR coordinators from 52/73 invited programs (71%) in Washington and California (TAVR volume > 100/year:34%; 50-99:36%; 1-50:30%); 2 programs reported no TAVR in 2018. TAVR coordinators described peri-procedural code status policies and practices and how they accommodate patients' goals of care. We used data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, stratified by programs' DNR practice, to examine differences in program size, patient characteristics and risk status, and outcomes., Results: Nearly all TAVR programs (48/50: 96%) addressed peri-procedural code status, yet only 26% had established policies. Temporarily rescinding DNR status until after TAVR was the norm (78%), yet time frames for reinstatement varied (38% <48 h post-TAVR; 44% 48 h-to-discharge; 18% >30 days post-discharge). For patients with fluctuating code status, no routine practices for discharge documentation were well-described. No clinically substantial differences by code status practice were noted in Society of Thoracic Surgeons Predicted Risk of Mortality risk score, peri-procedural or in-hospital cardiac arrest, or hospice disposition. Six programs maintaining DNR status recognized TAVR as a palliative procedure. Among programs categorically reversing patients' DNR status, the rationale for differing lengths of time to reinstatement reflect divergent views on accountability and reporting requirements., Conclusions: Marked heterogeneity exists in management of peri-procedural code status across TAVR programs, including timeframe for reestablishing DNR status post-procedure. These findings call for standardization of DNR decisions at specific care points (before/during/after TAVR) to ensure consistent alignment with patients' health-related goals and values., (© 2022 The American Geriatrics Society.)

Spreading centre jumps are a common feature of oceanic back-arc basins. Jumps are conventionally suggested to be triggered by plate velocity changes, pre-existing weaknesses, or punctuated events such as the opening of slab windows. Here, we present 3D numerical models of back-arc spreading centre jumps evolving naturally in a homogeneous subduction system surrounded by continents without a trigger event. Spreading centres jump towards their subduction zone if the distance from trench to spreading centre becomes too long. In particular, jumps to a new spreading centre occur when the resistance on the boundary transform faults enabling relative motion of back-arc and neighbouring plates is larger than the resistance to break the overriding plate closer to trench. Time and distance of spreading centres jumps are, thus, controlled by the ratio between the transform fault and overriding plate strengths. Despite being less complex than natural systems, our models explain why narrow subducting plates (e.g. Calabrian slab), have more frequent and closely-spaced spreading jumps than wider subduction zones (e.g. Scotia). It also explains why wide back-arc basins undergo no spreading centre jumps in their life cycle., (© 2022. The Author(s).)

American Society of Anesthesiologists guidelines recommend that anesthesiologists revisit do-not-resuscitate orders preoperatively and revise them if necessary based on patient preferences. In patients without do-not-resuscitate orders or other directives limiting treatment however, "full code" is the default option irrespective of clinical circumstances and patient preferences. It is time to revisit this approach based on (1) increasing understanding of the power of default options in healthcare settings, (2) changing demographics and growing evidence suggesting that an expanding subset of patients is vulnerable to poor outcomes after perioperative cardiopulmonary resuscitation (CPR), and (3) recommendations from multiple societies promoting risk assessment and goal-concordant care in older surgical patients. The authors reconsider current guidelines in the context of these developments and advocate for an expanded approach to decision-making regarding CPR, which involves identifying high-risk elderly patients and eliciting their preferences regarding CPR irrespective of existing or presumed code status., (Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.)

Rigid and topologically constrained ethylene cross-bridged tetraazamacrocycles have been increasingly utilised for thirty years as they form remarkably stable transition metal complexes for catalysis, biomedical imaging, and inorganic drug molecule applications. Extending these benefits to pentaazamacrocycles has been achieved and a first transition metal complex prepared and structurally characterized.

COVID-19 is a rapidly evolving pandemic, which represents a multifaceted global threat. Given the economic consequences, most researchers agree that social distancing measures are an effective strategy relative to the cost. Previous studies indicate that community size as well as viral population risk groups should be considered in forming an effective targeted social distancing strategy. The resultant delay in the occurrence of infections in order to support vaccine development has been shown to be an effective policy. However, a return to normalcy from the current situation would require policy intervention that transforms the American economy along with continued targeted social distancing and the use of medical science as a tool to facilitate gradual personal interactions of low-risk individuals. We believe that the adoption of rapid IgG testing would be best suitable for widespread population-level screening as part of a comprehensive plan for incrementally rebuilding the in-person workforce. As such, this crisis represents an opportunity for the United States to increase automation of the manufacturing sector, shrink supply chains, and create higher-level jobs in order to reduce the dependency on other countries for critical supplies. This economic transition to better utilize technology along with reconstruction of the workforce could improve the standard of living for many Americans as well as better prepare the US for future pandemics., (Copyright © 2020 Allen and Mirsaeidi.)

During continental collision, considerable amounts of buoyant continental crust subduct to depth and subsequently exhume. Whether various exhumation paths contribute to contrasting styles of magmatism across modern collision zones is unclear. Here we present 2D thermomechanical models of continental collision combined with petrological databases to investigate the effect of the main contrasting buoyancy forces, in the form of continental crustal buoyancy versus oceanic slab age (i.e., its thickness). We specifically focus on the consequences for crustal exhumation mechanisms and magmatism. Results indicate that it is mainly crustal density that determines the degree of steepening of the subducting continent and separates the models' parameter space into two regimes. In the first regime, high buoyancy values ( ∆ρ > 500 kg/m 3 ) steepen the slab most rapidly (to 45-58°), leading to opening of a gap in the subduction channel through which the subducted crust exhumes ("subduction channel crustal exhumation"). A shift to a second regime ("underplating") occurs when the density contrast is reduced by 50 kg/m 3 . In this scenario, the slab steepens less (to 37-50°), forcing subducted crust to be placed below the overriding plate. Importantly, the magmatism changes in the two cases: Crustal exhumation through the subduction channel is mainly accompanied by a narrow band of mantle melts, while underplating leads to widespread melting of mixed sources. Finally, we suggest that the amount (or density) of subducted continental crust, and the resulting buoyancy forces, could contribute to contrasting collision styles and magmatism in the Alps and Himalayas/Tibet., (©2019. The Authors.)

Background: A better understanding of the consequences of being turned down for living kidney donation could help transplant professionals to counsel individuals considering donation., Methods: In this exploratory study, we used survey instruments and qualitative interviews to characterize nonmedical outcomes among individuals turned down for living kidney donation between July 1, 2010 and December 31, 2013. We assembled a comparator group of kidney donors., Results: Among 83 turned-down donors with contact information at a single center, 43 (52%) participated in the study (median age 53 years; 53% female; 19% black). Quality of life, depression, financial stress, and provider empathy scores were similar between individuals turned down for donation (n = 43) and donors (n = 128). Participants selected a discrete choice response to a statement about the overall quality of their lives; 32% of turned-down donors versus 7% of donors (P < 0.01) assessed that their lives were worse after the center's decision about whether they could donate a kidney. Among turned-down donors who reported that life had worsened, 77% had an intended recipient who was never transplanted, versus 36% among individuals who assessed life as the same or better (P = 0.02). In interviews, the majority of turned-down donors reported emotional impact, including empathy, stress, and other challenges, related to having someone in their lives with end-stage kidney disease., Conclusions: Generic instruments measuring quality of life, depression, financial stress, and provider empathy revealed no significant differences between kidney donors and turned-down donors. However, qualitative interviews revealed preliminary evidence that some turned-down donors experienced emotional consequences. These findings warrant confirmation in larger studies., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The 2016 WHO update changed the diagnostic criteria for myeloid neoplasms with erythroid predominance, limiting the diagnosis of acute myeloid leukemia to cases with ≥20% blasts in the bone marrow or peripheral blood. Although acute myeloid leukemia with ≥50% erythroid cells has historically been presumed to represent acute myeloid leukemia with myelodysplasia-related changes, this hypothesis has never been systematically examined. We sought to investigate the clinicopathologic, cytogenetic, and molecular features of acute myeloid leukemia with erythroid predominance to subclassify cases as defined by the 2016 WHO. We retrospectively identified patients with ≥50% erythroid precursors and either ≥20% bone marrow blasts or ≥20% peripheral blood blasts at the time of initial diagnosis at seven major academic centers. Laboratory and clinical data were obtained. Patients were then reclassified according to 2016 WHO guidelines. A matched control group was also obtained. We identified 146 patients with acute myeloid leukemia with erythroid predominance (62% M, average age: 62 y, range: 5-93 y). Of these, 91 were acute myeloid leukemia with myelodysplasia-related changes, 20 (14%) were therapy-related myeloid neoplasm, 23 (16%) acute myeloid leukemia, not otherwise specified, and ten acute myeloid leukemia with recurrent cytogenetic/molecular abnormalities. The bone marrow blast count ranged from 9-41%. There was no difference in survival for patients with erythroid predominance compared to patients with acute myeloid leukemia without erythroid proliferations. In a multivariable analysis, cytogenetic risk was the only significant predictor of survival. We find a significantly lower rate of FLT3 and RAS pathway alterations in acute myeloid leukemia with erythroid predominance compared to controls. Our study is one of the first to apply the 2016 WHO guidelines for classification of acute myeloid leukemia. We find acute myeloid leukemia with erythroid predominance is a heterogeneous group and that erythroid richness has no impact on overall survival.

Restoration of access to lost habitat for threatened and endangered fishes above currently impassable dams represents a major undertaking. Biological monitoring is critical to understand the dynamics and success of anadromous recolonization as, in the case of Oncorhynchus mykiss, anadromous steelhead populations are reconnected with their conspecific resident rainbow trout counterparts. We evaluate three river systems in the Lower Columbia River basin: the White Salmon, Sandy, and Lewis rivers that are in the process of removing and/or providing passage around existing human-made barriers in O. mykiss riverine habitat. In these instances, now isolated resident rainbow trout populations will be exposed to competition and/or genetic introgression with steelhead and vice versa. Our genetic analyses of 2,158 fish using 13 DNA microsatellite (mSAT) loci indicated that within each basin anadromous O. mykiss were genetically distinct from and significantly more diverse than their resident above-dam trout counterparts. Above long-standing natural impassable barriers, each of these watersheds also harbors unique rainbow trout gene pools with reduced levels of genetic diversity. Despite frequent releases of non-native steelhead and rainbow trout in each river, hatchery releases do not appear to have had a significant genetic effect on the population structure of O. mykiss in any of these watersheds. Simulation results suggest there is a high likelihood of identifying anadromous x resident individuals in the Lewis and White Salmon rivers, and slightly less so in the Sandy River. These genetic data are a prerequisite for informed monitoring, managing, and conserving the different life history forms during upstream recolonization when sympatry of life history forms of O. mykiss is restored., Competing Interests: We have the following interests: This study was funded in part by Portland General Electric and PacifiCorp. Erik Lesko and Frank Shrier are employed by PacifiCorp. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Large earthquakes occur in rocks undergoing high-pressure/low-temperature metamorphism during subduction. Rhythmic major-element zoning in garnet is a common product of such metamorphism, and one that must record a fundamental subduction process. We argue that rhythmic major-element zoning in subduction zone garnets from the Franciscan Complex, California, developed in response to growth-dissolution cycles driven by pressure pulses. Using electron probe microanalysis and novel techniques in Raman and synchrotron Fourier transform infrared microspectroscopy, we demonstrate that at least four such pressure pulses, of magnitude 100-350 MPa, occurred over less than 300,000 years. These pressure magnitude and time scale constraints are most consistent with the garnet zoning having resulted from periodic overpressure development-dissipation cycles, related to pore-fluid pressure fluctuations linked to earthquake cycles. This study demonstrates that some metamorphic reactions can track individual earthquake cycles and thereby opens new avenues to the study of seismicity.

Climate and tectonics have complex feedback systems which are difficult to resolve and remain controversial. Here we propose a new climate-independent approach to constrain regional Andean surface uplift. 87 Sr/ 86 Sr and 143 Nd/ 144 Nd ratios of Quaternary frontal-arc lavas from the Andean Plateau are distinctly crustal (>0.705 and <0.5125, respectively) compared to non-plateau arc lavas, which we identify as a plateau discriminant. Strong linear correlations exist between smoothed elevation and 87 Sr/ 86 Sr (R 2  = 0.858, n = 17) and 143 Nd/ 144 Nd (R 2  = 0.919, n = 16) ratios of non-plateau arc lavas. These relationships are used to constrain 200 Myr of surface uplift history for the Western Cordillera (present elevation 4200 ± 516 m). Between 16 and 26°S, Miocene to recent arc lavas have comparable isotopic signatures, which we infer indicates that current elevations were attained in the Western Cordillera from 23 Ma. From 23-10 Ma, surface uplift gradually propagated southwards by ~400 km.

Recommendations from the 2014 Consensus Conference on Best Practices in Living Kidney Donation reflect increasing attention to overcoming barriers to donation as a means of expanding access to living donor kidney transplantation. "High priority" initiatives include empowering transplant candidates and their loved ones in their search for a living kidney donor. Transplant programs are assuming an unprecedented role as facilitators of patients' solicitation for donors, and nonprofits are promoting living kidney donation (LKD) in the community. New strategies to promote LKD incorporate "nonargumentative" forms of influence (i.e. approaches to shaping behavior that do not attempt to persuade through reason) such as appeals to emotion, messenger effects and social norms. These approaches have raised ethical concerns in other settings but have received little attention in the transplantation literature despite their increasing relevance. Previous work on using nonargumentative influence to shape patient behavior has highlighted implications for (1) the relationship between influencer and influenced and (2) patient autonomy. We argue that using nonargumentative influence to promote LKD is a promising strategy that can be compatible with ethical standards. We also outline potential concerns and solutions to be implemented in practice., (© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Wilms tumor, the most common kidney tumor in children, is rarely seen in adults, making it a challenge for the adult oncologist to diagnose and treat. Unlike with renal cell carcinoma, patients with Wilms tumor should receive adjuvant chemotherapy with or without radiation therapy. Adult oncologists may not be familiar with pediatric oncology protocols, so it is important to consult with pediatric oncologists who have more experience in this disease. Multimodal therapy based on pediatric protocols improved the outcomes of adults with Wilms tumor worldwide. We report a rare case of a 24-year-old woman with a slow-growing mass of the left kidney during a 4-year period. The mass was surgically removed and final diagnosis confirmed by pathology to be Wilms tumor. The patient received adjuvant chemotherapy and has been free of disease since 2014.

Matthew Allen and Peter Reese argue that evidence-based efforts should be implemented to expand living kidney donation.