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This review describes the clinical, radiographic and histologic characteristics of dentinogenesis imperfecta diagnosed in two unrelated young dogs without evidence of concurrent osteogenesis imperfecta. The dentition was noted to have generalized coronal discoloration ranging from grey-blue to golden brown. Clinical pulp exposure, coronal wear and fractures were observed as was radiographic evidence of endodontic disease, thin dentin walls or dystrophic obliteration of the pulp canal. The enamel was severely affected by attrition and abrasion despite histologically normal areas; loss was most likely due to poor adherence or support by the underlying abnormal dentin. Histologically, permanent and deciduous teeth examined showed thin, amorphous dentin without organized dentin tubules and odontoblasts had dysplastic cell morphology. Primary dentin disorders, including dentinogenesis imperfecta and dentin dysplasia, have been extensively studied and genetically characterized in humans but infrequently reported in dogs. Treatment in human patients is aimed at early recognition and multi-disciplinary intervention to restore and maintain normal occlusion, aesthetics, mastication and speech. Treatment in both humans and canine patients is discussed as is the documented genetic heritability of primary dentin disorders in humans.

Background: DPP4 (dipeptidyl peptidase-4) inhibitors comprise a class of oral diabetes medication that have the potential for off-target cardiovascular effects. We previously showed that DPP4 inhibition attenuates the hypotensive effect of acute ACE (angiotensin-converting enzyme) inhibition and increases norepinephrine. Here, we investigated the effects of DPP4 during sustained ACE inhibition compared with during therapy with an ARB (angiotensin receptor blocker) or calcium channel blocker (neutral comparator) in a randomized, double-blinded crossover study. Methods: We enrolled 106 adults with type 2 diabetes and hypertension and 100 received intervention. Subjects were randomized to one of 3 blood pressure arms: ramipril, valsartan, or amlodipine for a total of 15 weeks and received 3 one-week crossover therapies in random order: placebo + placebo, sitagliptin + placebo, and sitagliptin + aprepitant separated by 4-week washout. Results: We found that DPP4 inhibition increased norepinephrine during ramipril but did not increase blood pressure. Aprepitant, a NK1 (substance P) receptor blocker, lowered standing heart rate during renin-angiotensin-aldosterone system blockade with ramipril or valsartan. Conclusions: Increased catecholamines during concurrent ACE and DPP4 inhibition may contribute to cardiovascular complications in patients predisposed to heart failure.

Murray-Darling Freshwater Research CentreMDFRC item.The Serial Discontinuity Concept (SDC) proposes that dams have the potential to affect the downstream ecological condition of rivers. While the SDC was developed principally around changes to physical habitat or temperature, reservoirs also have the potential to impact on downstream water quality, including algal community structure. In the current study we examined the impacts of an extreme drawdown event on nutrient loads and algal community structure downstream of a large water storage reservoir in south-eastern Australia-Lake Hume. The lake was a net exporter of carbon, nitrogen, phosphorus and iron during the study period and was a net sink for manganese. Most of the carbon, nitrogen and phosphorus exported from the lake was in the form of algal biomass. Processes in the lake also influenced the downstream algal community structure. Upstream of the reservoir green algae were the most dominant species; within and downstream of the reservoir cyanobacteria dominated. Much of the algal biomass found at the downstream sites appeared to originate in Lake Hume and was physically transported downstream.

Murray-Darling Freshwater Research CentreMDFRC item.The release of nutrients on wetting ('the Birch effect') is well documented for terrestrial soils. The effect for aquatic sediments has received much less attention. An extreme drawdown event in a large reservoir during a period of drought presented an opportunity to test whether or not reflooding dried sediments would be a source of nutrients to the overlying water column. Wetting and drying history influences the release of ammonium, but not oxides of nitrogen, organic nitrogen, filterable reactive phosphorus or total phosphorus, from dried sediments following re-wetting. Dried reservoir sediments that have never, or have only rarely, been desiccated since the 1920s produced a pulse of ammonium on re-inundation. Conversely, dried sediments from parts of the reservoir that undergo frequent wetting and drying cycles do not release substantial amounts of ammonium on rewetting.

PURPOSE/OBJECTIVES To examine patient characteristics that predispose to higher opioid administration during tandem and ovoid (T&O) high-dose rate (HDR) brachytherapy. METHODS A single-institution retrospective review was performed on patients who underwent brachytherapy for cervical cancer. Patients were included if they received at least one fraction of HDR T&O brachytherapy with analgesia administration recorded in the Medication Administration Record. Fentanyl dose was dichotomized as "low" (mean

Introduction The 2016 Clinical Learning Environment Review established that experiential patient safety curricula for residents are uncommon. Moreover, these curricula do not incorporate non-technical skills linked to safety, such as situational awareness (SA). We developed an in-situ patient safety simulation exercise incorporating core SA concepts and subsequently assessed exercise feasibility and acceptability, and measured residents' safety SA. Methods A simulation scenario and mock chart were designed, incorporating 16 patient safety hazards. Residents at two institutions reviewed the chart and had 10 minutes in an emergency department room with the simulated scenario to document identified hazards, followed by a facilitated debriefing. Pre- and post-exercise surveys were completed. We used regression analyses to compare exercise performance and survey responses by training year, and measures of proportional difference and association for survey responses. Results This study included 76 of 104 eligible residents (73.1%). Around 56.5% initially reported being comfortable identifying hazards. During the exercise, hazards requiring higher SA were identified less frequently. Senior residents identified more hazards (OR 2.26; 95%CI 1.56-3.28) (mean 8.28, SD1.45); 93.4% expressed satisfaction with the session, and residents reporting comfort increased significantly (89.5%, p0.001). Conclusion In-situ simulation incorporating SA concepts feasibly provides experiential safety education and enhances resident comfort with safety issues. Visible hazards were often identified; those requiring information synthesis were usually missed, suggesting a need for developing more robust resident SA. While interns demonstrated the poorest performance, senior residents only identified 50% of errors, indicating that patient safety education enhancing SA should begin early and continue longitudinally.

Ventilation is regulated across many systems, with respiratory rhythm formation occurring in the brainstem but modulated in response to: chemoreception, respiratory muscle afferents, and volitional control. Alterations within any of these systems may result in disruptions of appropriate respiratory control and ultimately, disease. The apolipoprotein (APOE) gene has been studied due to its influence on Alzheimer’s disease (AD) development and work in an APOE mouse model recently demonstrated impaired respiratory motor plasticity following spinal cord injury (SCI). Additionally, individuals with AD may co-present with obstructive sleep apnea (OSA). Despite the prominence of APOE genotype and sex as factors in differing AD and OSA severity, little is known about the impact of these on respiratory control. Using mice expressing two different humanized APOE alleles, we characterized how sex and the presence of E3 or E4 alleles influenced ventilation during baseline (normoxia) and during respiratory challenge. We show that sex and genotype influence breathing under hypoxia, which may have clinical implications in the context of AD and OSA. Additionally, female mice, while responding robustly to hypoxia, were unable to recover to baseline respiratory levels, emphasizing sex differences in disordered breathing and potentially indicative of high metabolic cost.

Assessing the resilience level of nursing faculty during a time of unprecedented change in nursing education was the focus of this study. A descriptive cross-sectional survey that incorporated demographic data and the 10-item Connor-Davidson Resilience Scale was used. Participants ( n = 78) had an average resilience score of 32.6. No correlation was found between resilience and demographic variables such as age, years of teaching experience, and type of nursing program. Resilience is important because it helps faculty assimilate various protective factors and persist during times of rapid change.

Background: Students who are more satisfied and engaged in online courses have better learning experiences and outcomes. Method: Survey data were collected during a 4-month period in 2019. The research team created a survey to collect demographic information and assess student satisfaction. Student engagement was measured using the 19-item Online Student Engagement Scale. Results: Overall student engagement and satisfaction scores in online programs were moderately high. Generation Z participants and students from PhD programs were the most satisfied and engaged in their programs. Conclusion: Students who are more engaged in online coursework are more satisfied and thus are more likely to remain and successfully complete their respective programs. [ J Nurs Educ . 2021;60(5):259–264.]

Objectives To describe incidence, risk factors, and treatment of poststroke epilepsy (PSE) in Germany based on claims data. Methods Retrospective analysis of claims data from a German public sickness fund (AOK PLUS). Patients with acute stroke hospitalizations from January 01, 2011 and December 31, 2015 (index hospitalization) were followed for 12–72 months. Outcomes included incidence of PSE (patients with ≥2 seizure claims [during/after index hospitalization], or ≥1 seizure claim after index hospitalization), multivariate Cox‐regression analyses of time to seizure claim and death after index stroke hospitalization discharge, and antiepileptic drug (AED) treatment. Results Among 53 883 patients with stroke (mean follow‐up of 829.05 days [median 749]), 6054 (11.24%) had ≥1 seizure claim (mean age 73.95 years, 54.18% female). 2130 (35.18%) patients had a seizure claim during index hospitalization (indicative of acute symptomatic seizures). Estimated incidence of PSE (cases/1000 patient‐years) was 94.49 within 1 year. Risk of seizure claim following hospital discharge was higher in patients with hemorrhagic stroke (hazard ratio [HR] =1.13; p

A series of nickel(II) tris(2-pyridylmethyl)amine (TPA) complexes featuring appended hydrogen bonds (H-bonds) to halides (F, Cl, Br) was synthesized and charcterized. Reduction to the corresponding nickel(I) state provided access to an unusual nickel(I) fluoride complex stabilized by H-bonds, enabling structural and spectroscopic characterization.

The ability of a phosphine-appended-2,2′-bipyridine ligand ((Ph2P)2bpy) to serve as a platform for late-stage ligand modifications was evaluated using tetrahedral (Ph2P)2bpyFeCl2. We employed a post-metalation Staudinger reaction to install a series of functionalized arenes, including those containing Bronsted and Lewis acidic groups. This reaction sequence represents a versatile strategy to both tune the ligand donor properties as well as directly incorporate appended functionality.

Dipeptidyl peptidase-4 (DPP-4) inhibitors increase endogenous glucagon-like peptide-1 (GLP-1). We hypothesized that genetic variation in the gene encoding the GLP-1 receptor (GLP1R) could affect the metabolic response to DPP-4 inhibition. To evaluate the relationship between the GLP1R rs6923761 variant (G-to-A nucleic acid substitution) and metabolic responses, we performed mixed meal studies in individuals with type 2 diabetes mellitus and hypertension after 7-day treatment with placebo and the DPP-4 inhibitor sitagliptin. This analysis is a substudy of NCT02130687. The genotype frequency was 13:12:7 GG:GA:AA among individuals of European ancestry. Postprandial glucose excursion was significantly decreased in individuals carrying the rs6923761 variant (GA or AA) as compared with GG individuals during both placebo (P = 0.001) and sitagliptin treatment (P = 0.045), while intact GLP-1 levels were similar among the genotype groups. In contrast, sitagliptin lowered postprandial glucose to a greater degree in GG as compared with GA/AA individuals (P = 0.035). The relationship between GLP1R rs6923761 genotype and therapies that modulate GLP-1 signalling merits study in large populations.

In addition to crossing state lines, networks of natural gas transmission pipelines in the US cross multiple local jurisdictions, each potentially with its own local comprehensive plans and zoning ...

Persistent inward currents (PICs) are responsible for amplifying motoneuronal synaptic inputs and contribute to generating normal motoneuron activation. Delta-F (ΔF) is a well-established method that estimates PICs in humans indirectly from firing patterns of individual motor units. Traditionally, motor unit firing patterns are obtained by manually decomposing electromyography (EMG) signals recorded through intramuscular electrodes (iEMG). A previous iEMG study has shown that in humans the elbow extensors have higher ΔF than the elbow flexors. In this study, EMG signals were collected from the ankle extensors and flexors using high-density surface array electrodes during isometric sitting and standing at 10–30% maximum voluntary contraction. The signals were then decomposed into individual motor unit firings. We hypothesized that comparable to the upper limb, the lower limb extensor muscles (soleus) would have higher ΔF than the lower limb flexor muscles [tibialis anterior (TA)]. Contrary to our expectations, ΔF was higher in the TA than the soleus during sitting and standing despite the difference in cohort of participants and body positions. The TA also had significantly higher maximum discharge rate than the soleus while there was no difference in rate increase. When only the unit pairs with similar maximum discharge rates were compared, ∆F was still higher in the TA than the soleus. Future studies will focus on investigating the functional significance of the findings. NEW & NOTEWORTHY With the use of high-density surface array electrodes and convolutive blind source separation algorithm, thousands of motor units were decomposed from the soleus and tibialis anterior muscles. Persistent inward currents were estimated under seated and standing conditions via delta-F (∆F) calculation, and the results showed that unlike the upper limb, the flexor has higher ∆F than the extensor in the lower limb. Future studies will focus on functional significance of the findings.

Low-inflow estuaries (LIEs) in Mediterranean climates located within regions of wind-driven coastal upwelling have seasonally minimal freshwater inflow, are supplied by nutrient-rich upwelled water, and often used for sustainable shellfish mariculture supported by a rich pelagic food web. They likely support endemic estuarine phytoplankton supplemented during the upwelling season with phytoplankton supplied from the ocean. There are few descriptions of LIE algal assemblages. This study characterizes the spatio-temporal phytoplankton community dynamics in a low-inflow estuary located along the northern California coast with high frequency sampling to assess seasonal influences on functional groups, blooms, and endemic populations. Phytoplankton biomass and community composition were measured in Drakes Estero monthly from June 2016 to November 2017. We predicted blooms with diatoms in summer and dinoflagellates in fall but had no prediction for non-bloom situations and what phytoplankton would occur year-round. Flagellates were ubiquitous throughout the Estero at all times. Two summer blooms occurred with diatoms characteristic of upwelling (Chaetoceros, Skeletonema, Asterionellopsis, Thalassiosira) and two blooms in fall with dinoflagellates dominated by Prorocentrum and high densities of the raphidophyte Heterosigma. Harmful algal bloom (HAB) taxa were observed, some at levels reported to have negative effects. Non-metric multi-dimensional scaling analyses showed the diatoms to be associated with upwelling, cooler temperatures and high nitrate, and the dinoflagellates and flagellates associated with warmer temperatures and reduced upwelling. Dinoflagellate and flagellate communities, especially HAB taxa, might be promoted with warmer temperatures or longer warm seasons accompanying climate change; an important consideration for managers of LIEs, especially those containing mariculture facilities.

Introduction The global Guinea Worm Eradication Program has reduced numbers of human infections of Guinea worm disease (dracunculiasis) to 49 cases in four countries. However, infections of domestic animals (dogs and cats) have recently been recognized and are increasing. Typically, Guinea worm (Dracunculus medinensis) transmission occurs via the ingestion of copepods from water. Despite several interventions, including tethering of dogs while worms emerge, the number of infected dogs continue to increase. One hypothesis is that dogs could be infected through the ingestion of copepods in provisioned water. Objectives The purpose of this study was to determine whether copepods can survive in water containers under typical Chadian temperatures. Methods Four container types (plastic, glass, gourd, and metal) were seeded with copepods and exposed to simulated Chadian temperatures. Results All copepods in the metal containers died within 4 h. Conversely, after 8 h live copepods were still present in plastic, glass, and gourd containers. Conclusions If provisioned water is provided to potential hosts of D. medinensis, metal containers create the most inhospitable environment for copepods. Plastic containers have little effect on copepod mortality. The use of metal containers for water provisions could be a useful tool assisting with the interruption of D. medinensis transmission among dogs.

The da Vinci Single-Port (SP) platform (Intuitive Surgical Inc, Sunnyvale CA) is a recently approved robotic surgical platform which features several novel modifications from previously available single trocar models including a flexible camera, articulating instruments, and navigator guidance for real-time monitoring of instrument position. We sought to describe our clinical experience with this device as well as to review the current literature related to the use of the SP platform. We provide a narrative review of clinical data related to single-port robotic surgery within the field of urology. In addition, we report our initial clinical experience for surgical procedures performed with the SP platform between December 2018 and April 2019 following installation of the system at our institution. Currently, the presently available literature for single-port robotic urological surgery consists of single-center case reports and series. Most major robotic urologic operations appear technically feasible using the da Vinci SP platform; however, additional multi-center studies and randomized trials are needed to determine what role the SP platform will play. Rather than an iterative step or a niche system, the SP platform provides for a new approach to single-site laparoscopic or robotic techniques and is demonstrated as a feasible approach for several major robotic urological operations. While comparative studies will be required to evaluate perioperative and long-term outcomes between SP and multi-port platforms, further technological advances will continue to push surgeons towards less morbid and more minimally invasive approaches for surgery.

OBJECTIVES To assess the safety and feasibility of the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform for a consecutive series of patients who underwent single-port robot-assisted laparoscopic radical prostatectomy (SP-RALP). PATIENTS AND METHODS In all, 10 consecutive patients with biopsy confirmed prostate cancer underwent SP-RALP at our institution. Pre-, peri-, and postoperative data were prospectively collected for key outcomes including: estimated blood loss (EBL), operative time, postoperative pain requirements, duration of hospital stay, and complications. RESULTS The patients were aged 52-77 years with a body mass index of 24.4-36.7 kg/m2 . Prostate volumes ranged from 26 to 136 mL, with a mean (sd) PSA (prostate specific antigen) level of 11.0 (10.6) ng/mL. Lymph node dissection was performed in four patients and nerve sparing in five. No intraoperative complications occurred, and no patients required conversion to an open approach. Total EBL was 20-150 mL, with a median (interquartile range [IQR]) console time of 189 (171-207) min and operative time of 234 (216-247) min. No patients were readmitted or required intervention. Urethral catheters were removed at a median (IQR) of 10 (8-11) days after surgery. CONCLUSION SP-RALP appears to be a safe and feasible approach to performing robotic radical prostatectomy. Long-term follow-up will be necessary to assess initial oncological and functional results.

Context Dipeptidyl peptidase 4 (DPP4) inhibitors may increase the risk of heart failure. Decreased degradation of vasoactive peptides like substance P [also degraded by angiotensin-converting enzyme (ACE)] and Y1 agonists peptide YY (PYY 1-36) and neuropeptide Y (NPY 1-36) could contribute. Objective This study tested the hypothesis that there is an interactive effect of DPP4 inhibition and ACE inhibition (vs antihypertensive control subjects) on vasoactive peptides after a mixed meal. Participants and Design Fifty-three patients with type 2 diabetes and hypertension were randomized to double-blind treatment with ramipril, valsartan, or amlodipine for 15 weeks in parallel groups. During the 5th, 10th, and 15th weeks, participants also received placebo + placebo, sitagliptin 100 mg/d + placebo, and sitagliptin + aprepitant 80 mg/d in random order. On the last day of each crossover treatment, participants underwent a mixed-meal study. Results Sitagliptin increased postprandial glucagon-like peptide-1 and decreased glucose in all antihypertensive groups. Sitagliptin increased NPY 1-36 and decreased Y2 agonists NPY 3-36 and PYY 3-36 in all groups. During ramipril or valsartan, but not amlodipine, sitagliptin increased postprandial norepinephrine; substance P receptor blockade with aprepitant prevented this effect. Despite increased norepinephrine, sitagliptin decreased postprandial blood pressure during ACE inhibition. Conclusion DPP4 inhibition increases postprandial concentrations of the Y1 agonist NPY 1-36. During treatment with an ACE inhibitor or angiotensin receptor blocker, DPP4 inhibition increased postprandial norepinephrine through a substance P receptor–dependent mechanism. Increased NPY 1-36 and norepinephrine could increase risk of heart failure but did not result in higher postprandial blood pressure.