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Inflammation early in life can prime the local immune milieu of peripheral tissues, causing lasting changes in immunologic tone that confer disease protection or susceptibility. The cellular and molecular mechanisms that incite changes in immune tone in many nonlymphoid tissues remain largely unknown. We find that time-limited neonatal inflammation induced by transient reduction of neonatal regulatory T cells (Tregs) causes a dramatic dysregulation of subcutaneous tissue in murine skin, accompanied by the selective accumulation of Th2 cells within a distinct microanatomic niche. Th2 cells are maintained into adulthood through interactions with a fibroblast population in skin fascia that we refer to as Th2-interacting fascial fibroblasts (TIFFs), which expand in response to Th2 cytokines to form subcutaneous fibrous bands. Activation of the Th2-TIFF niche by neonatal inflammation primes skin for altered reparative responses to wounding. We further identify fibroblasts in healthy human skin expressing the TIFF transcriptional signature and find these cells at high levels in eosinophilic fasciitis, an orphan disease characterized by inflammation and fibrosis of the skin fascia. Taken together, these data define a novel Th2 niche in skin, functionally characterize a disease-associated fibroblast population, and suggest a mechanism of immunologic priming whereby inflammation early in life creates networks between adaptive immune cells and stromal cells, establishing an immunological set-point in tissues that is maintained throughout life.

Current Li-ion batteries have a low energy density mainly because of the low Li intercalation level in graphite anodes. The high-density packing of lithium atoms in electrode materials amplifies th...

Micelles immobilized in polymer materials are of emerging interest in drug delivery, water treatment and other applications. Immobilization removes the need for membrane-based separation to eliminate micelles from the medium, enabling facile extraction and delivery in diverse industries. This work lays out a coarse-grained molecular dynamics simulations framework for the rapid identification of surfactants for use in immobilized micelle systems. Micelles are immobilized by constraining one end of the constituent surfactants in space, mimicking what would occur in a copolymer system. We demonstrate that constraints affect how the micelles interact with small hydrophobic molecules, making it important to account for their effects in various drug-micelle and pollutant-micelle simulations. Our results show that in several systems there is stronger interaction between hydrophobic small molecules and micelles in immobilized systems compared to unconstrained systems. These strengthened interactions can have important implications for the design of new micelle-based extraction and delivery processes.

Despite the growing senior population within the United States, there is a lack of consensus regarding the safety and efficacy of performing lumbar spinal fusion for this population.To evaluate the clinical and radiographic outcomes in different age cohorts following lumbar spinal fusion.Retrospective cohort analysis.Analysis of 1,184 patients who underwent posterolateral lumbar fusion from 2011 to 2018. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, had a lumbar fracture, tumor, or infection, or had fusions involving the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. Of the 1,184 patients, 850 patients were included. Patients were divided into three roughly equal groups for analysis: young (18-54 years), middle-aged (55-69 years), and senior (≥70 years).Visual Analog Scale Back/Leg pain, and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were analyzed.Several radiographic parameters were measured using plain radiographs obtained at preoperative, immediately postoperative (standing radiographs performed on postoperative day 1), and most recent follow-up visits. Preoperative and final patient-reported outcomes, along with demographic information, were obtained all patients. Binary outcome variables were compared between groups with multivariate logistic regression, and continuous outcome variables were compared using multivariate linear regression, with age 18 to 54 years used as the reference. Multivariate regressions were used to compare outcomes between cohorts while controlling baseline characteristics.A total of 850 patients were included; 330 young (38.80%), 317 middle-aged (37.30%), and 203 senior (23.90%). Seniors had higher postoperative length of stay compared to younger patients (p.001). Younger patients had worse final ODI scores compared to middle-aged patients (p=.002). Seniors had higher rates of proximal ASD (p=.002) compared to young patients. There was no difference in achievement of minimal clinically important differences (MCID) between all three groups.Senior patients have significant improvement in patient-reported clinical outcomes, despite having greater comorbidities, and longer length of stay. However, given a general lack of achievement of MCID across all cohorts, these findings suggest the need for a critical re-evaluation of the role of lumbar spinal fusion in the management of patients with refractory radiculopathic and/or neurogenic claudication symptoms.

We demonstrated that joint delivery of human-derived endothelial progenitor cell (EPC) and smooth muscle cell (SMC) sheets mimics the native architecture of structurally mature blood vessels and contributes to limiting ventricular remodeling using a confluent SMC-EPC bi-level cell sheet engineered by cell-sheet technology and transplanted into an athymic rodent model of myocardial infarction. Enhanced vasculogenic potential was observed in vitro when EPCs were stimulated with SMC-conditioned culture medium, augmenting angiogenesis in vivo. Increased structurally mature vessel density, myocardial upregulation of biological adhesion, and vasculature developmental genes in the ischemic border zone myocardium showed interaction between cells and the extracellular matrix. Cell fate tracking experiments featuring xenogeneic transplantation showed transplanted EPCs and SMCs to have elements of the newly formed vasculature. Specialized magnetic resonance imaging of the cell-sheet-transplanted rodents suggested prolonged cell retention. The robust angiogenic effect of the transplanted cell sheets induced reverse ventricular remodeling of the ischemic heart. Bioinformatic analyses indicated that these cell sheets promote transcriptome-wide changes in the left ventricular response to acute ischemia, promote productive remodeling, and prevent pathological ventricular dilation. Thus, the human-derived, spatially arranged SMC-EPC bi-level cell sheet is a promising therapy for increasing myocardial viability and limiting adverse ventricular remodeling after myocardial infarction.

Mechanochemistry refers to unusual chemical reactions induced by mechanical energy at room temperatures. It has attracted increased attention because of advantages, such as being a solution-free, energy saving, high-productivity and low-temperature process. However, there is limited understanding of the mechanochemical process because mechanochemistry is often conducted using closed milling devices, which are often regarded as a black box. This feature article shows that mechanochemical reactions can be controlled by varying milling parameters, such as the mechanical force, milling intensity, time and atmosphere. New nanomaterials with doped and functionalized structures can be produced under controlled conditions, which provide a critical insight for understanding mechanochemistry. A fundamental mechanism investigation using force microscopy is discussed.

Flexible and high-performance batteries are urgently required for powering flexible/wearable electronics. Lithium-sulfur batteries with a very high energy density are a promising candidate for high-energy-density flexible power source. Here, we report flexible lithium-sulfur full cells consisting of ultrastable lithium cloth anodes, polysulfone-functionalized separators, and free-standing sulfur/graphene/boron nitride nanosheet cathodes. The carbon cloth decorated with lithiophilic three-dimensional MnO2 nanosheets not only provides the lithium anodes with an excellent flexibility but also limits the growth of the lithium dendrites during cycling, as revealed by theoretical calculations. Commercial separators are functionalized with polysulfone (PSU) via a phase inversion strategy, resulting in an improved thermal stability and smaller pore size. Due to the synergistic effect of the PSU-functionalized separators and boron nitride-graphene interlayers, the shuttle of the polysulfides is significantly inhibited. Because of successful control of the shuttle effect and dendrite formation, the flexible lithium-sulfur full cells exhibit excellent mechanical flexibility and outstanding electrochemical performance, which shows a superlong lifetime of 800 cycles in the folded state and a high areal capacity of 5.13 mAh cm-2. We envision that the flexible strategy presented herein holds promise as a versatile and scalable platform for large-scale development of high-performance flexible batteries.

Immunologic, physiologic, and behavioral responses to a combined viral-bacterial respiratory challenge were explored in beef steers (initial BW 293 kg). Steers (n = 24) were inoculated intranasally with bovine herpes virus-1 (2×108 PFU) and intratracheally with Mannheimia haemolytica (MH, 2.15×1010 CFU) on days -3 and 0, respectively, (n = 16; VB), or similarly inoculated with phosphate-buffered saline (n = 8; PBS). Venous and arterial blood were collected on -3, -1, 0, 2, 3, 5, 7, 10, and 14 relative to MH challenge for CBC, haptoglobin, and arterial blood oxygen saturation analysis. Continuously recorded variables included rumen temperature, activity, rumination, DMI, and feeding behavior. Data were analyzed with a repeated-measures mixed model (SAS 9.4) with fixed effects of day, inoculation, and the interaction. Bunk visit frequency and DMI were reduced (P < 0.01) in VB steers throughout the 14 d post-MH period compared to PBS steers. Rumination (days 1, 7) and activity (days 1, 2, 4–8, and 11–13) were reduced (P < 0.03) in VB steers vs PBS steers. Rumen temperature was elevated (P < 0.04) in VB steers until day 6 post MH inoculation. Neutrophil concentrations (days 2 and 3), platelets (days 7–14), fibrinogen (days 2–10), and haptoglobin (days 2–7) were elevated (P < 0.05) in VB vs PBS steers. Hematocrit was depressed (P < 0.05) in VB steers on days 3–10. The VB steers had decreased (P < 0.05) arterial SO2% and pO2 than PBS steers; however, the inoculation × day interaction was not significant. Results indicate that the experimental VB challenge substantially altered rumen temperature, DMI, feeding behavior, rumination and immunological response as expected. Arterial sO2% and pO2 concentrations were reduced minimally by VB challenge, indicating challenges in using blood gas to detect BRD in beef cattle.

Hydrogen is ideal for producing carbon-free and clean-green energy with which to save the world from climate change. Proton exchange membrane fuel cells use to hydrogen to produce 100% clean energy, with water the only by-product. Apart from generating electricity, hydrogen plays a crucial role in hydrogen-powered vehicles. Unfortunately, the practical uses of hydrogen energy face many technical and safety barriers. Research into hydrogen generation and storage and reversibility transportation are still in its very early stages. Ammonia (NH3) has several attractive attributes, with a high gravimetric hydrogen density of 17.8 wt% and theoretical hydrogen conversion efficiency of 89.3%. Ammonia storage and transport are well-established technologies, making the decomposition of ammonia to hydrogen the safest and most carbon-free option for using hydrogen in various real-time applications. However, several key challenges must be addressed to ensure its feasibility. Current ammonia decomposition technologies require high temperatures, pressures and non-recyclable catalysts, and a sustainable decomposition mechanism is urgently needed. This review article comprehensively summarises current knowledge about and challenges facing solid-state storage of ammonia and decomposition. It provides potential strategic solutions for developing a scalable process with which to produce clean hydrogen by eliminating possible economic and technical barriers.

Summary The interaction between tumor and immune system plays a crucial role in both cancer development and treatment response. To facilitate comprehensive investigation of tumor–immune interactions, we have designed a user-friendly web portal TISIDB, which integrated multiple types of data resources in oncoimmunology. First, we manually curated 4176 records from 2530 publications, which reported 988 genes related to anti-tumor immunity. Second, genes associated with the resistance or sensitivity of tumor cells to T cell-mediated killing and immunotherapy were identified by analyzing high-throughput screening and genomic profiling data. Third, associations between any gene and immune features, such as lymphocytes, immunomodulators and chemokines, were pre-calculated for 30 TCGA cancer types. In TISIDB, biologists can cross-check a gene of interest about its role in tumor–immune interactions through literature mining and high-throughput data analysis, and generate testable hypotheses and high quality figures for publication. Availability and implementation http://cis.hku.hk/TISIDB Supplementary information Supplementary data are available at Bioinformatics online.

There is a strong desire to design and synthesize catalysts that assemble at the oil-water interface to improve the efficiency of biphasic reactions. Anisotropic dumbbell-shaped bi-component mesoporous carbon-organosilica Janus particles with asymmetric wettability are synthesized through a one-step compartmentalized growth of a mesoporous organosilica sphere attached to a mesoporous resorcinol-formaldehyde (RF) sphere. A library was prepared of tunable Janus particles possessing diverse hollow structures with various functionalities. As a proof of concept, the Janus particle-derived catalyst can assemble at the oil-water interface to stabilize Pickering emulsions. Owing to the increased reaction interface area, the Janus catalyst exhibits a more than three-fold increase in catalytic efficiency compared to the Pt loaded carbon sphere catalyst in aqueous hydrogenation reactions.

Compared to the traditional approach of using virtual machines as the basis for the development and deployment of applications running in Cloud-based infrastructures, container technology provides developers with a higher degree of portability and availability, allowing developers to build and deploy their applications in a much more efficient and flexible manner. A number of tools have been proposed to orchestrate complex applications comprising multiple containers requiring continuous monitoring and management actions to meet application-oriented and non-functional requirements. Different container orchestration tools provide different features that incur different overheads. As such, it is not always easy for developers to choose the orchestration tool that will best suit their needs. In this paper we compare the benefits and overheads incurred by the most popular open source container orchestration tools currently available, namely: Kubernetes and Docker in Swarm mode. We undertake a number of benchmarking exercises from well-known benchmarking tools to evaluate the performance overheads of container orchestration tools and identify their pros and cons more generally. The results show that the overall performance of Kubernetes is slightly worse than that of Docker in Swarm mode. However, Docker in Swarm mode is not as flexible or powerful as Kubernetes in more complex situations.

When planning planetary rover missions it is useful to develop intuition and skills driving in, quite literally, alien environments before incurring the cost of reaching said locales. Simulators make it possible to operate in environments that have the physical characteristics of target locations without the expense and overhead of extensive physical tests. To that end, NASA Ames and Open Robotics collaborated on a Lunar rover driving simulator based on the open source Gazebo simulation platform and leveraging ROS (Robotic Operating System)components. The simulator was integrated with research and mission software for rover driving, system monitoring, and science instrument simulation to constitute an end-to-end Lunar mission simulation capability. Although we expect our simulator to be applicable to arbitrary Lunar regions, we designed to a reference mission of prospecting in polar regions. The harsh lighting and low illumination angles at the Lunar poles combine with the unique reflectance properties of Lunar regolith to present a challenging visual environment for both human and computer perception. Our simulator placed an emphasis on high fidelity visual simulation in order to produce synthetic imagery suitable for evaluating human rover drivers with navigation tasks, as well as providing test data for computer vision software development. In this paper, we describe the software used to construct the simulated Lunar environment and the components of the driving simulation. Our synthetic terrain generation software artificially increases the resolution of Lunar digital elevation maps by fractal synthesis and inserts craters and rocks based on Lunar size-frequency distribution models. We describe the necessary enhancements to import large scale, high resolution terrains into Gazebo, as well as our approach to modeling the visual environment of the Lunar surface. An overview of the mission software system is provided, along with how ROS was used to emulate flight software components that had not been developed yet. Finally, we discuss the effect of using the high-fidelity synthetic Lunar images for visual odometry. We also characterize the wheel slip model, and find some inconsistencies in the produced wheel slip behavior.

Introduction The purpose of this study was to investigate odontogenic and osteogenic cell adhesion, proliferation, and survival on the surface of a newly developed bioceramic material (EndoSequence Root Repair Material [RRM]; Brasseler USA, Savannah, GA) and compare it with mineral trioxide aggregate (gray MTA) (ProRoot MTA; Dentsply Tulsa Dental, Tulsa, OK). A potential role of extracellular signal-regulated kinase (ERK) signaling in the RRM/MTA-induced cellular activities was also investigated. Methods Human bone marrow mesenchymal stem cells, periodontal ligament stem cells, and dental pulp stem cells were cultured on RRM- or MTA-coated slides. Cell proliferation was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assays after 1, 3, and 5 days of growth. Cell survival was assessed under serum starvation (0.5% and 0.2% serum) using MTT assays. RRM and MTA surface characteristics and cell morphology were studied using a scanning electron microscope. The role of ERK signaling in RRM/MTA-induced cell proliferation/survival was studied using an ERK-specific inhibitor. Results All cell types firmly attached to RRM- and MTA-coated plates. The coated surfaces had a granular appearance under the scanning electron microscope. Compared with those grown on uncoated plates, the cells on MTA/RRM-coated plates appeared healthy and smaller. Cell proliferation was significantly higher on RRM/MTA-coated surfaces (2- to 3-fold in cell number). The mitogenic effect on periodontal ligament stem cells and dental pulp stem cells was more pronounced with RRM than MTA (49% and 26% higher, respectively), but human bone marrow mesenchymal stem cells responded to both materials similarly. In serum-deprived conditions, significantly more cells (2- to 3-fold) survived on RRM/MTA surfaces. The cells grown on RRM/MTA surfaces showed sustained up-regulation of ERK phosphorylation, and blocking ERK signaling with U0126 significantly reduced RRM- and MTA-dependent cell survival. Conclusions MTA and RRM are biocompatible and promote cell proliferation and survival in an ERK-dependent manner.

This paper presents the software framework established to facilitate cloud-hosted robot simulation. The framework addresses the challenges associated with conducting a task-oriented and real-time robot competition, the Defense Advanced Research Projects Agency (DARPA) Virtual Robotics Challenge (VRC), designed to mimic reality. The core of the framework is the Gazebo simulator, a platform to simulate robots, objects, and environments, as well as the enhancements made for the VRC to maintain a high fidelity simulation using a high degree of freedom and multisensor robot. The other major component used is the CloudSim tool, designed to enhance the automation of robotics simulation using existing cloud technologies. The results from the VRC and a discussion are also detailed in this work.

Background: Hydroxyurea (HU) therapy in sickle cell anemia (SCA) improves health care utilization, slows organ failure, and prolongs life. Implementation of evidence-based, comprehensive care has been shown to improve health-related quality of life (HRQOL). Case management by community health workers (CHWs) is an evidence-based health management strategy. We therefore hypothesized that HU-eligible SCA adults exposed to patient navigators (PN), CHWs specially trained as case managers for SCA, would have improved HRQOL compared with controls. Methods: We enrolled 224 patients eligible for HU into the Start Healing in Patients with Hydroxyurea (SHIP-HU) Randomized Controlled Trial. All patients received care from trained physicians who implemented use of a standardized HU prescribing protocol using NIH guidelines. Pateints were randomized to either PN intervention (which included case management and education through home, telephone, and/or other visits from PNs) plus standard care by their treating physician (Experimental, E), or standard care by their physician alone (Control, C). Study physicians were blinded to study arm. At baseline, 6 and 12 months we assessed 4 psychosocial HRQOL variables-- ASCQ-Me emotional impact (EMOT), social impact (SOCI), PROMIS global mental (GMENT) and satisfaction with social roles (ROLE); 6 Physical HRQOL variables-- ASCQ-Me Sleep impact (SLEP) and Stiffness (STIFF), PROMIS global physical (GPHYS), Physical health (PHYS), Fatigue (FATG), and sleep/Wake disturbance (WAKE), and 4 pain HRQOL variables-- PROMIS pain behavior (PAINB), and ASCQ-ME-Pain crisis frequency (PAINF), Pain crisis severity (PAINS), and Pain impact (PAIN). Main analyses consisted of mixed model analysis of variance of follow-up visits, controlling for site and baseline value of outcome variable. Any missing baseline values for subjects were imputed. Results: 181 of 224 randomized patients had at least one HRQOL measure at follow-up. Patients had mean age 30.3, 45.3% were male, 81.2% were on HU at baseline. No HRQOL measures were different between groups E and C in any domain (Table, variables grouped by domain). Conclusions: In our sample, there were no differences in HRQOL among patients who were exposed to PNs vs those who weren't. These findings require further analyes before firm conclusions can be made about the isolated effect of PNs on HRQOL. PN dose of intervention was likely variable. HU use and adherence has been associated with higher HRQOL, and we did not predict high baseline HU uptake and adherence which may have led to minimal improvement despite adequate PN intervention. PNs were not allowed to work with MDs, nor did they work with the remainder of the health care team to improve HRQOL. Analyses are underway to examine these and other possible influences on HRQOL. Table. Disclosures Smith: Novartis: Consultancy, Honoraria. Villella:Emmaus: Membership on an entity's Board of Directors or advisory committees; Pfizer: Other: Site PI for the Rivipansel Clinical Trial. Liles:Novartis: Other: PI on clinical trial Sickle cell ; Shire: Other: PI on clinical trial Sickle cell ; Imara: Other: PI on Clinical trial- Sickle cell .

Background: Hydroxyurea (HU) therapy in adults with sickle cell anemia (SCA) increases total hemoglobin (Hb) and percent fetal hemoglobin (HbF) levels, reduces total white cell (WBC) and neutrophil (ANC) count, and increases the mean corpuscular volume (MCV). Case management and community health workers are both evidence-based health management strategies. Patient navigators (PN) are community health workers trained specifically in case management for patients with SCA. We therefore hypothesized that HU-eligible patients exposed to patient navigators (PN) would have improved laboratory characteristics reflecting improved uptake and adherence to HU. Methods: We enrolled 224 adult patients eligible for HU into the Start Healing in Patients with Hydroxyurea (SHIP-HU) Randomized Controlled Trial. All patients received care from trained physicians who implemented use of a standardized HU prescribing protocol using NIH guidelines. Pateints were randomized to either PN intervention (which included case management and education through home, telephone, and/or other visits from PNs) plus standard care by their treating physician (Experimental, E), or standard care by their physician alone (Control, C). Study physicians were blinded to study arm. At baseline, 6 months and 12 months we assessed: Complete Blood Count including WBC, ANC, total hemoglobin (Hb), platelet count (plt), mean corpuscular volume (MCV), and; HbF via HPLC and electrophoresis. Main analyses consisted of comparisons of the hematological variables between arms. Mixed model analysis of variance was used to analyze follow-up visits, controlling for site and baseline value of outcome variable. Any missing baseline values for subjects were imputed. Results: 206 of 224 patients had at least one lab value at follow-up. Patients had mean age 30.1, 45.6% were male, 82.5% had been prescribed HU at baseline. HbF was higher at the 6 month visit for group E vs. group C when controlled for baseline values. Neither WBC, ANC, Hb, Hb F, Plt, nor MCV were different between groups E and C at any other time point (Table). Conclusions: In our sample, there were no differences in hematological variables among patients who were exposed to PNs vs those who weren't. Several factors may have impacted these outcomes. HU was prescribed to 82.5% of enrolled patients at baseline, with higher % HbF than anticipated in study design. The intention to study change in % HbF as a singular marker for HU uptake and adherence did not assume high utilization of HU at baseline. We are currently analyzing data to enable comparisons between patients who were on HU at baseline and those who were not, which we believe will be able to speak to the true impact of the PN intervention. Future analyses will examine these and other factors influencing outcomes. Table Disclosures Smith: Novartis: Consultancy, Honoraria. Villella:Pfizer: Other: Site PI for the Rivipansel Clinical Trial; Emmaus: Membership on an entity's Board of Directors or advisory committees. Liles:Novartis: Other: PI on clinical trial Sickle cell ; Shire: Other: PI on clinical trial Sickle cell ; Imara: Other: PI on Clinical trial- Sickle cell.

Background: Patient reported outcomes (PROs) for people with Sickle Cell Disease (SCD) have been shown to be associated with the degree of sickle cell organ system involvement using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) medical health checklist [Keller et al]. But since SCD is characterized mainly by vaso-occlusive pain, we explored how and how much various PRO measures correlated with the frequency and severity of painful crises, particularly the annual number of painful crises, which has been related to long-term mortality. Methods: All included patients had non-missing values (N=200, 52.5% female), age 15 or older and were enrolled in the Start Healing in Patients with Hydroxyurea (SHIP-HU, R18HL112737) randomized controlled trial. Patients completed various ASCQ-Me (A) and Patient Reported Outcomes Measurement Information System (PROMIS, or P) forms to assess PROs in the psychosocial domain (emotional impact, social impact, global mental health and satisfaction with social roles), physical domain (sleep impact, stiffness, global physical health, physical functioning, fatigue and wake disturbance) and pain domain (behavior and impact). Pain attack (crisis) frequency and severity were measured via the ASCQ-Me SCD pain episode frequency and severity short form. The frequency subscale assessed the number of crises in the past year and the timing of the most recent crisis. The severity subscale assessed the pain intensity rating (0-10) during the most recent crisis and the length of that crisis in days. Crises were defined solely by self-report. We tested PRO correlations with crisis frequency and crisis severity, controlling for possible confounding by age, sex, genotype, and education. Analysis used baseline data only. Results: At baseline, 81.5% of SHIP-HU enrollees were on HU and 87% were SS genotype. The mean age was 29.5 years and 48% had at least some college; 44.2% had a low ASCQ-Me medical health checklist value, 27.9% had a medium value and 27.9% had a high value. See Table for correlations. PRO correlations with crisis frequency and crisis severity were almost always statistically significant, regardless of PRO domain (except for correlations of crisis severity with either global mental health or satisfaction with social roles). Correlations were always higher with crisis frequency than severity. The strongest correlations were -0.43 and -0.42, relating global physical health and social impact, respectively, to crisis frequency. Conclusions: In SHIP-HU, PROs in the psychosocial, physical and pain domains were statistically correlated with painful crisis frequency and severity, although none were higher than 0.43. More frequent crises and greater crisis severity were correlated with worse psychosocial, physical function and pain behavior and impact, though the correlation was always higher with crisis frequency than with crisis severity. Whether reported painful crisis frequency and severity using PROs are also associated with mortality is not known. Table. Table. Disclosures No relevant conflicts of interest to declare.

This article surveyed attending physicians on their work hours, sleep schedule, daytime sleepiness, and the perceived relation of these factors to patient safety, quality of care, and personal well-being. Physicians answered demographic and workload questions and attitudinal questions regarding work-hour limitations; the Epworth Sleepiness Scale (ESS) was used to measure subjective sleepiness, and an 18-item Impact Questionnaire was also used. Of 180 participants, 41 (23%) attending physicians manifested abnormal ESS scores (11 or greater). Private practice- and surgically-based subspecialties had higher ESS scores. Reduced sleep, but not hours worked, was associated with increased sleepiness. Sleepy physicians were more likely to associate sleep loss with medical errors and driving impairment. Sleepiness may be attenuated by education regarding consequences of insufficient sleep and institution of effective countermeasures.

Introduction The purpose of this study was to compare healing after root-end surgery by using grey mineral trioxide aggregate (MTA) and EndoSequence Root Repair Material (RRM) as root-end filling material in an animal model. Methods Apical periodontitis was induced in 55 mandibular premolars of 4 healthy beagle dogs. After 6 weeks, root-end surgeries were performed by using modern microsurgical techniques. Two different root-end filling materials were used, grey MTA and RRM. Six months after surgery, healing of the periapical area was assessed by periapical radiographs, cone-beam computed tomography (CBCT), micro computed tomography (CT), and histology. Results Minimal or no inflammatory response was observed in the majority of periapical areas regardless of the material. The degree of inflammatory infiltration and cortical plate healing were not significantly different between the 2 materials. However, a significantly greater root-end surface area was covered by cementum-like, periodontal ligament–like tissue, and bone in RRM group than in MTA group. When evaluating with periapical radiographs, complete healing rate in RRM and MTA groups was 92.6% and 75%, respectively, and the difference was not statistically significant (P = .073). However, on CBCT and micro CT images, RRM group demonstrated significantly superior healing on the resected root-end surface and in the periapical area (P = .000 to .027). Conclusions Like MTA, RRM is a biocompatible material with good sealing ability. However, in this animal model RRM achieved a better tissue healing response adjacent to the resected root-end surface histologically. The superior healing tendency associated with RRM could be detected by CBCT and micro CT but not periapical radiography.