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The aim of this study is to evaluate risk factors for non-attendance to post-discharge, hospital follow-up appointments for traumatically injured patients who underwent exploratory laparotomy.This is a retrospective chart review of patients who underwent exploratory laparotomy for traumatic abdominal injury at an urban, Midwestern, level I trauma center with clinic follow-up scheduled after discharge. Clinically, relevant demographic characteristics, patients' distance from hospital, and the presence of staples, sutures, and drains requiring removal were collected. Descriptive statistics of categorical variables were calculated as totals and percentages and compared with a chi-squared test or Fisher's exact when appropriate.The sample included 183 patients who were largely assaultive trauma survivors (68%), male (80%), and black (53%) with a mean age of 35.4 ± 14.9 years. Overall, 18.5% no-showed for their follow-up appointment. On multivariate analysis for clinic no-show; length of stay (odds ratio = 0.92 [0.84-0.99], P = 0.04) and the need for suture, staple, or drain removal were protective for clinic attendance (odds ratio = 5.59 [1.07-7.01], P = 0.04). Overall, 12 patients (6.4%) were readmitted. Forty patients (18.3%) had their follow-up in the emergency department (ED). On multivariate regression of risk factors for ED visits, the only statistically significant factors (P 0.05) were clinic appointment no-show (OR = 2.81) and self-pay insurance (OR = 4.78).Abdominal trauma patients are at high risk of no-show for follow-up appointments and no-show visits are associated with ED visits. Future work is needed evaluating interventions to improve follow-up.

Raman optical activity (ROA) becomes a standard method to monitor peptide conformation. However, the signal in the CH-stretching region is particularly difficult to measure and interpret. In order to understand the structural information contained in this part of the spectrum, data obtained on a custom-made ROA spectrometer have been analyzed for the model Ala-Ala molecule, with the help of molecular dynamics (MD) and density functional theory computations. The Ala-Ala enantiomers provided the "mirror image" spectra, which proves that the signal can be reliably measured, in spite of a rather low ROA/Raman intensity ratio (∼2 × 10-5). The theoretical modeling indicated that the most intense ROA bands can be attributed to locally asymmetric CH3 and αCH vibrations, whereas symmetric methyl CH-stretching modes contribute less. A simplified model made it possible to estimate the contribution of local chirality of the two alanine residues to the resultant ROA pattern. In spite of a significant frequency shift (over 100 cm-1) because of the anharmonic corrections, the harmonic level was able to explain the main spectral features. The anharmonic corrections were treated by second-order perturbation and limited vibrational configuration interaction procedures. This allowed for assignment of some weaker spectral features because of the combination and overtone vibrations. The results show that the peptide CH-stretching ROA signal contains rich structural information, reflecting also the peptide environment. The experimental data, however, need to be deciphered by relatively complex and time-consuming spectral simulations.

In a small subset of type II superconductor films, the critical current is determined by a weakened Bean-Livingston barrier posed by the film surfaces to vortex penetration into the sample. A film property thus depends sensitively on the surface or interface to an adjacent material. We theoretically investigate the dependence of vortex barrier and critical current in such films on the Rashba spin-orbit coupling at their interfaces with adjacent materials. Considering an interface with a magnetic insulator, we find the spontaneous supercurrent resulting from the exchange field and interfacial spin-orbit coupling to substantially modify the vortex surface barrier, consistent with a previous prediction. Thus, we show that the critical currents in superconductor-magnet heterostructures can be controlled, and even enhanced, via the interfacial spin-orbit coupling. Since the latter can be controlled via a gate voltage, our analysis predicts a class of heterostructures amenable to gate-voltage modulation of superconducting critical currents. It also sheds light on the recently observed gate-voltage enhancement of critical current in NbN superconducting films.

Exosomes encapsulate genomic and proteomic biomarkers for non-invasive diagnosis and disease monitoring. However, exosome surface-markers heterogeneity is a major drawback of current isolation methods. Here, we report a direct, one-step exosome sampling technology, ExoPRIME, for selective capture of CD63+ exosome subpopulations using an immune-affinity protocol. Microneedles (300μm × 30 mm), functionalized with anti-CD63 antibodies, were incubated under various experimental conditions in conditioned astrocyte medium and astrocyte-derived exosome suspension. The probe's capture efficiency and specificity were validated using FluoroCet assay, immunofluorescent imaging, and OMICS analyses. Significantly higher exosomes were captured by probes incubated for 16 h at 4 0C in enriched exosomal suspension (23 × 10 6 exosomes per probe) vis-a-vis 2 h at 4 0 C (12 × 10 6) and 16 h at 22 0C (3 × 10 6) in conditioned cell media. Our results demonstrate the application of ExoPRIME over a broad dynamic range of temperature and incubation parameters, offering flexibility for any desired application. ExoPRIME permits the use and re-use of minimal sample volumes (≤200 μL), can be multiplexed in arrays, and integrated into a lab-on-a-chip platform to achieve parallel, high-throughput isolation of different exosome classes in a semi-automated workstation. This platform could provide direct exosomal analysis of biological fluids since it can elegantly interface with existing room-temperature, picomolar-range nucleic acid assays to provide a clinical diagnostic tool at the point of care.

The prevalence of super obesity (SO, BMI > 50.0 kg/m2) and super-super obesity (SSO, BMI > 60 kg/m2) is increasing. Current data are limited and discrepant on the relationship between SSO and post-bariatric surgery complication risk. We hypothesized there would be increased complications for both laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in SSO compared to SO, but the relative risk (RR) would support the use of LSG in SSO patients. Metabolic and Bariatric Surgery Accreditation and Quality Improvement 2016 data were queried for SO and SSO patients undergoing LRYGB or LSG. Thirty-day post-operative complications were calculated. Univariate analyses were performed with a χ2 or Student’s t test. Comparisons between multiple groups were performed using a one-way ANOVA. Statistical significance was defined as p

In 2018, Stephon “Zoe” Clark and Darell Richards were killed by the Sacramento Police Department as an act of state-sanctioned violence at the intersection of a historically Black and Southeast Asi...

The rapid detection and identification of microorganisms is one of the most important factors in many cases of ill health. The purpose of this study was to determine the fluorescence characteristics of seven oral bacteria using emission spectra with the aim of distinguishing between the bacteria, and to compare fluorescence imaging methods for the direct assessment of oral bacteria. Fluorescence images of each bacterium were obtained under a 405-nm light source using a two-filter system. The emissions of all samples were measured with a fluorescence spectrometer. The complete fluorescence data set collected for each sample employed a three-dimensional data cube. The differences in the autofluorescence characteristics of the seven oral bacteria were determined by principal components analysis (PCA). The fluorescence images of the oral bacteria varied with the genus and the filter system. The three-dimensional excitation-emission matrix fluorescence spectra exhibited distinctive fluorescence features associated with intracellular fluorophores. The seven bacteria could be clearly differentiated on the PCA score plot. The findings of this study indicate that oral bacteria can be identified based on their autofluorescence characteristics. Fluorescence spectroscopy coupled with PCA can be used to detect and classify oral bacteria.

This research investigated the behavior of a Manduca sexta inspired biomimetic wing as a function of Reynolds number by measuring the aerodynamic forces produced by varying the characteristic wing length and testing at air densities from atmospheric to near vacuum. A six degree of freedom balance was used to measure forces and moments, while high speed cameras were used to measure wing stroke angle. An in-house created graphical user interface was used to vary the voltage of the drive signal sent to the piezoelectric actuator which determined the wing stroke angle. The Air Force Institute of Technology baseline 50 mm wing was compared to wings manufactured with 55, 60, 65, and 70 mm spans, while maintaining a constant aspect ratio. Tests were conducted in a vacuum chamber at air densities between 0.5% and 100% of atmospheric pressure. Increasing the wingspan increased the wing’s weight, which reduced the first natural frequency; and did not result in an increase in vertical force over the baseline 50 mm wing. However, if the decrease in natural frequency corresponding to the increased wing span was counteracted by increasing the thickness of the joint material in the linkage mechanism, vertical force production increased over the baseline wing planform. Of the wings built with the more robust flapping mechanism, the 55 mm wing span produced 95% more vertical force at a 26% higher flapping frequency, while the 70 mm wing span produced 165% more vertical force at a 10% lower frequency than the Air Force Institute of Technology baseline wing. Negligible forces and moments were measured at vacuum, where the wing exhibited predominantly inertial motion, revealing flight forces measured in atmosphere are almost wholly limited to interaction with the surrounding air. Lastly, there was a rough correlation between Reynolds number and vertical force, indicating Reynolds number is a useful modelling parameter to predict lift and corresponding aerodynamic coefficients for a specific wing design.

Progress in the treatment of triple-negative breast cancer remains an important challenge. Given the aggressive biology and high risk of distant recurrence, systemic chemotherapy is warranted in most patients. Neaodjuvant chemotherapy benefits patients with locally advanced disease by downsizing the tumor and increasing the probability of breast-conserving surgery. Clinical and pathologic responses provide important prognostic information, which makes neoadjuvant therapy an attractive approach for all patients with triple-negative breast cancer. Clinical research in the neoadjuvant setting is focused on improvement in pathologic complete response rates and outcomes of patients with residual disease.

Background: Medulloblastoma (MB) is the most common solid malignant pediatric brain neoplasm. Group 3 (G3) MB, particularly MYC amplified G3 MB, is the most aggressive subgroup with the highest frequency of children presenting with metastatic disease, and is associated with a poor prognosis. To further our understanding of the role of MSI1 in MYC amplified G3 MB, we performed an unbiased integrative analysis of eCLIP binding sites, with changes observed at the transcriptome, the translatome, and the proteome after shMSI1 inhibition. Methods: Primary human pediatric MBs, SU_MB002 and HD-MB03 were kind gifts from Dr. Yoon-Jae Cho (Harvard, MS) and Dr. Till Milde (Heidelberg) and cultured for in vitro and in vivo experiments. eCLIP, RNA-seq, Polysome-seq, and TMT-MS were completed as previously described. Results:MSI1 is overexpressed in G3 MB. shRNA Msi1 interference resulted in a reduction in tumour burden conferring a survival advantage to mice injected with shMSI1 G3MB cells. Robust ranked multiomic analysis (RRA) identified an unconventional gene set directly perturbed by MSI1 in G3 MB. Conclusions: Our robust unbiased integrative analysis revealed a distinct role for MSI1 in the maintenance of the stem cell state in G3 MB through post-transcriptional modification of multiple pathways including identification of unconventional targets such as HIPK1.

The purpose of this study was to determine whether or not the dual constant-depth film fermenter (dCDFF) is able to produce caries-like enamel lesions and to ascertain further information regarding the performance of this fully functional biological caries model. Conditions were defined by the continuation (CF) or cessation (FF) of a saliva-type growth medium supply during 50-mM sucrose exposures (8 times daily). Hydroxyapatite (n = 3) and bovine enamel (n = 3) substrata were included within each condition and samples extracted after 2, 4, 8, and 16 days. Community profiles were generated for fastidious anaerobes, Lactobacillus spp., Streptococcus spp., mutans streptococci (MS), and Veillonella spp. using selective culture techniques and enamel demineralisation assessed by transverse microradiography. Results demonstrated that the dCDFF model is able to produce caries-like enamel lesions with a high degree of sensitivity where reduced ionic strength within the FF condition increased surface layer mineral deposition. Between conditions, biofilm communities did not differ significantly, although MS in the biofilms extracted from the FF condition rose to a higher proportion (by 1.5 log10 units), and Veillonella spp. were initially greater within the CF condition (by 2.5 log10 units), indicating an enhanced ability for the clearance of low-pKa acids following exposures to sucrose. However, both conditions retained the ability for caries-like lesion formation.

We present the rare case of a small bowel obstruction secondary to pelvic organ prolapse (POP). A 77-year-old female presented with four days of abdominal pain, nausea, and vomiting. She had a history of abdominal hysterectomy with bilateral salpingo-opherectomy and a mildly symptomatic cystocele. She was found to have an enterocele causing small bowel obstruction. The enterocele was manually reduced and subsequently managed non-operatively with a pessary. Prior case reports of small bowel obstructions secondary to POP required emergent surgical intervention. Post-menopausal women should be asked about symptoms or presence of pelvic organ prolapse and in the correct patient population, pelvic examination can be important for diagnosis and treatment of small bowel obstruction. If the enterocele is manually reduced non-operative management can be safe and effective.

This chapter begins by quoting Professor Wilcox noting that little had changed in schooling over the past 500 years. This chapter provides examples of how the world has changed due to globalization and e-learning becoming mainstream, the changing needs and aspirations of the current generation of learners, and the rapid development of new technologies to assist learning. All of the examples quoted suggest that traditional face-to-face schooling will change. The economic and social survival of nations depends on the quality of education of its people, so some form of compulsory schooling will be needed, be it virtual or not.

Introduction Valvular disease in pediatric donor hearts may be a relative contraindication to graft use. Outcomes following use of donor hearts with milder forms of valvular disease have not been previously reported. We describe 4 cases of pediatric heart transplantation (HTx) in which the donor heart had a bicuspid aortic valve (BAV). Case Report Of the 469 HTx performed at our center since 1985, 4 donor hearts had a BAV. All recipients were female; median age 11 years (range 0.3 to 19 years). In all cases, the BAV was not discovered until after HTx. All donors were less than 30 years old. The patients were followed for a median of 6 years (range 2 to 9 years) with all patients alive at last follow up. Two patients transferred to adult care and 2 patients are followed by our clinic. In follow up, no patient required an aortic valve intervention or had infective endocarditis. At last review, no patient had greater than mild aortic insufficiency or more than mild aortic stenosis. Three patients developed mild to moderate left ventricular hypertrophy in the first year post-transplant that improved over time. One patient experienced a peri-operative embolic stroke at time of transplant unrelated to the bicuspid aortic valve. Summary On short- and intermediate-term follow up, donor hearts with bicuspid aortic valve demonstrated acceptable graft longevity and valvular function. A functionally normal bicuspid aortic valve in a pediatric heart transplant donor should not be a contraindication to organ acceptance.

Purpose Graft failure after heart transplant (HTx) due to allograft rejection or coronary artery vasculopathy (CAV) can result in cardiogenic shock requiring mechanical circulatory support (MCS). We present our institutional experience with the Impella®, a percutaneous ventricular assist device (VAD), in HTx patients in cardiogenic shock due to graft failure. Methods This is a single center, retrospective review of HTx patients who underwent Impella implantation from 10/2014 to 4/2020. Demographics, device implant techniques, complications, and clinical outcomes were analyzed. Results There were 19 Impella implants in 11 HTx patients with median age and weight of 16 years (range 6-25) and 61 kg (range 23-124). Graft failure was due to rejection in 55% (6/11), CAV in 18% (2/11), and non-specific graft failure in 27% (3/11). Median time from HTx to Impella implant was 42 months (range 9-175). Impella devices included CP (n=11), 5.0 (n=5), 2.5 (n=1), and RP (n=2). Median length of support per implant was 5 days (range 3-21). Devices were placed via femoral (15/19) or axillary (4/19) arterial access. Seven patients received Impella support once with a single implant each. One patient required 3 distinct admissions for shock due to rejection and received Impella support each time. Three patients required 9 device implants during their course primarily for recurrence of heart failure (HF) after trial off device. Two of these received simultaneous support with CP and RP devices for biventricular HF. ECMO with Impella was required in 4 patients; 2 had Impella after ECMO for left heart decompression and 2 were placed on ECMO after Impella to augment cardiac support. Device related complications per patient included: device malfunction in 2, major bleeding requiring transfusion in 2, hemolysis in 5, extremity arterial thrombus in 2, intracardiac thrombus in 1, and transient foot drop in 3. There was no limb ischemia, stroke, infection, or increase in aortic insufficiency in the study cohort. Survival to hospital discharge was 91% (10/11). Six patients were explanted for recovery, 2 were transitioned to durable VAD, and 2 were bridged to HTx. Conclusion Impella is a promising temporary MCS option with an acceptable risk profile for adolescent and young adult HTx patients in cardiogenic shock due to graft failure with means to facilitate recovery or bridge to durable VAD or re-transplant.

Progress in the treatment of triple-negative breast cancer remains an important challenge. Given the aggressive biology and high risk of distant recurrence, systemic chemotherapy is warranted in most patients. Neaodjuvant chemotherapy benefits patients with locally advanced disease by downsizing the tumor and increasing the probability of breast-conserving surgery. Clinical and pathologic responses provide important prognostic information, which makes neoadjuvant therapy an attractive approach for all patients with triple-negative breast cancer. Clinical research in the neoadjuvant setting is focused on improvement in pathologic complete response rates and outcomes of patients with residual disease.

Despite data gaps and information shortfalls, government agencies in the United States are expected to produce timely and defensible decisions to regulate pesticide use under the Federal Insecticide, Fungicide, and Rodenticide Act and in compliance with the Endangered Species Act. The decision to register a pesticide is predicated on a conclusion that no unreasonable effects will accrue to the environment, including threatened and endangered species. We recognize that the definition of acceptable risk is a policy judgment stemming from legislative language and judicial interpretation. However, a common risk assessment approach with similar technical underpinnings and a high degree of transparency used by all the agencies would be cost effective and more likely to achieve consensus among interested parties. Quantitative probabilistic risk assessment (PRA) methods can be used to develop risk estimates and to describe the level of confidence in these estimates. PRA methods can also differentiate amon...

Protocols for terrestrial bioaccumulation assessments are far less-developed than for aquatic systems. This article reviews modeling approaches that can be used to assess the terrestrial bioaccumulation potential of commercial organic chemicals. Models exist for plant, invertebrate, mammal, and avian species and for entire terrestrial food webs, including some that consider spatial factors. Limitations and gaps in terrestrial bioaccumulation modeling include the lack of QSARs for biotransformation and dietary assimilation efficiencies for terrestrial species; the lack of models and QSARs for important terrestrial species such as insects, amphibians and reptiles; the lack of standardized testing protocols for plants with limited development of plant models; and the limited chemical domain of existing bioaccumulation models and QSARs (e.g., primarily applicable to nonionic organic chemicals). There is an urgent need for high-quality field data sets for validating models and assessing their performance. There is a need to improve coordination among laboratory, field, and modeling efforts on bioaccumulative substances in order to improve the state of the science for challenging substances.

Background Oxygen is generally considered essential for lethal photosensitisation by photodynamic processes. The oral anaerobes, Prevotella intermedia and P. nigrescens are known to be photosensitive, but are also extremely sensitive to the cytotoxic effects of oxygen. Methods The Prevotellaceae were exposed to two 405 nm light sources for different exposure times in an anaerobic chamber. Viable counts of the light exposed samples were compared to light-free controls to determine the proportion of bacteria killed. Results Lethal photosensitivity was demonstrated against P. intermedia and P. nigrescens. The proportions of bacteria killed by either the light-emitting diode or laser pointer were similar at a given energy density (J/cm2). Conclusions Lethal photosensitivity was demonstrated in two species of Prevotella under anaerobic conditions.

The plaque inhibiting properties of magnolia bark extract (MBE) were assessed in a volunteer trial following the consumption of various sugar-free chewing gum formulations over a period of 4-days. Paired t-tests demonstrated significant (p

We have, for some time now, managed legacy chemicals and those currently in use, or proposed, for consumer, commercial, and industrial purposes, with approaches termed “risk-based” and with “risk” ...

Mercury (Hg) has been entering the environment from both natural and anthropogenic sources for millennia, and humans have been influencing its environmental transport and fate from well before the Industrial Revolution. Exposure to Hg (as neurotoxic monomethylmercury [MeHg]) occurs primarily through consumption of finfish, shellfish, and marine mammals, and regulatory limits for MeHg concentrations in fish tissue have steadily decreased as information on its health impacts has become available. These facts prompted us to consider 2 questions: 1) What might the MeHg levels in fish tissue have been in the pre-Anthropocene, before significant human impacts on the environment? and 2) How would these pre-Anthropocene levels have compared with current regulatory criteria for MeHg residues in fish tissue? We addressed the first question by estimating pre-Anthropocene concentrations of MeHg in the tissues of prey and predatory fish with an integrated Hg speciation, transport, fate, and food web model (SERAFM), using estimated Hg concentrations in soil, sediment, and atmospheric deposition before the onset of significant human activity (i.e., ≤2000 BCE). Model results show MeHg residues in fish varying depending on the characteristics of the modeled water body, which suggests that Hg in fish tissue is best considered at the scale of individual watersheds or water bodies. We addressed the second question by comparing these model estimates with current regulatory criteria and found that MeHg residues in predatory (but not prey) fish could have approached or exceeded these criteria in some water bodies during the pre-Anthropocene. This suggests that the possibility of naturally occurring levels of Hg in fish below which it is not possible to descend, regardless of where those levels stand with respect to current regulatory limits. Risk management decisions made under these circumstances have the potential to be ineffectual, frustrating, and costly for decision makers and stakeholders alike, suggesting the need for regulatory flexibility when addressing the issue of Hg in fish. Integr Environ Assess Manag 2014;10:299–308. © 2013 SETAC