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Background COVID-19 causes hypercoagulability, but the association between coagulopathy and hypoxemia in critically ill patients has not been thoroughly explored. This study hypothesized that severity of coagulopathy would be associated with acute respiratory distress syndrome severity, major thrombotic events, and mortality in patients requiring intensive care unit–level care. Methods Viscoelastic testing by rotational thromboelastometry and coagulation factor biomarker analyses were performed in this prospective observational cohort study of critically ill COVID-19 patients from April 2020 to October 2020. Statistical analyses were performed to identify significant coagulopathic biomarkers such as fibrinolysis-inhibiting plasminogen activator inhibitor 1 and their associations with clinical outcomes such as mortality, extracorporeal membrane oxygenation requirement, occurrence of major thrombotic events, and severity of hypoxemia (arterial partial pressure of oxygen/fraction of inspired oxygen categorized into mild, moderate, and severe per the Berlin criteria). Results In total, 53 of 55 (96%) of the cohort required mechanical ventilation and 9 of 55 (16%) required extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation–naïve patients demonstrated lysis indices at 30 min indicative of fibrinolytic suppression on rotational thromboelastometry. Survivors demonstrated fewer procoagulate acute phase reactants, such as microparticle-bound tissue factor levels (odds ratio, 0.14 [0.02, 0.99]; P = 0.049). Those who did not experience significant bleeding events had smaller changes in ADAMTS13 levels compared to those who did (odds ratio, 0.05 [0, 0.7]; P = 0.026). Elevations in plasminogen activator inhibitor 1 (odds ratio, 1.95 [1.21, 3.14]; P = 0.006), d-dimer (odds ratio, 3.52 [0.99, 12.48]; P = 0.05), and factor VIII (no clot, 1.15 ± 0.28 vs. clot, 1.42 ± 0.31; P = 0.003) were also demonstrated in extracorporeal membrane oxygenation–naïve patients who experienced major thrombotic events. Plasminogen activator inhibitor 1 levels were significantly elevated during periods of severe compared to mild and moderate acute respiratory distress syndrome (severe, 44.2 ± 14.9 ng/ml vs. mild, 31.8 ± 14.7 ng/ml and moderate, 33.1 ± 15.9 ng/ml; P = 0.029 and 0.039, respectively). Conclusions Increased inflammatory and procoagulant markers such as plasminogen activator inhibitor 1, microparticle-bound tissue factor, and von Willebrand factor levels are associated with severe hypoxemia and major thrombotic events, implicating fibrinolytic suppression in the microcirculatory system and subsequent micro- and macrovascular thrombosis in severe COVID-19. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Our objective was to evaluate the effect of metabolizable protein (MP) supply on milk production, blood metabolites, and health in dairy cows during early lactation. Three experimental diets were formulated to contain 114, 107, 101 g of MP/kg of dry matter (DM; 114MP, 107MP, and 101MP, respectively) with crude protein contents of 17.0, 16.2, and 15.3% of DM, respectively. One hundred multiparous Holstein cows were fed 1 of these 3 diets during wk 1 to 3 and wk 4 to 13 of lactation in one of the following sequences: (1) 114MP and 107MP (114MP/107MP), (2) 114MP and 101MP (114MP/101MP), or (3) 101MP and 101MP (101MP/101MP). During wk 1 to 3, the 114MP and 101MP treatments were 20 and 27% deficient in estimated MP, respectively. From wk 4 to 13, the 114MP/107MP, 114MP/101MP, and 101MP/101MP treatments were 8, 12, and 13% deficient in estimated MP, respectively. Data were analyzed separately for wk 1 to 3, 4 to 13, and 1 to 13. Dry matter intake and energy-corrected milk (ECM) yield were not affected by treatment during wk 4 to 13 or wk 1 to 13; however, ECM yield decreased for 101MP versus 114MP from wk 1 to 3. Similarly, feed efficiency was not affected by treatment from wk 4 to 13 or wk 1 to 13, and was reduced with 101MP versus 114MP during wk 1 to 3. Milk N efficiency tended to increase for 101MP versus 114MP for wk 1 to 3 and increased with 101MP/101MP and 114MP/101MP relative to 114MP/107MP during wk 4 to 13 and wk 1 to 13. Treatment had no influence on yields and concentrations of milk components from wk 4 to 13 or wk 1 to 13; however, compared with 114MP, feeding 101MP tended to decrease milk fat yield and decreased yields of milk true protein and lactose for wk 1 to 3. Both milk and blood urea N concentrations decreased for 101MP/101MP and 114MP/101MP relative to 114MP/107MP during wk 4 to 13 and wk 1 to 13, and were reduced with feeding 101MP versus 114MP from wk 1 to 3. Treatment had no effect on the incidence of diseases in cows throughout the study. Serum concentrations of total fatty acids, albumin, and aspartate aminotransferase did not differ between 101MP and 114MP; however, serum β-hydroxybutyrate concentration was lower in cows receiving 101MP during the first 3 wk of lactation. Compared with 114MP, feeding 101MP during wk 1 to 3 increased plasma concentrations of creatinine and 3-methylhistidine (3-MHis) but did not change the ratio of plasma 3-MHis to creatinine. We found no differences in plasma creatinine or the ratio of 3-MHis-to-creatinine among treatments from wk 4 to 13; however, 101MP/101MP and 114MP/101MP had elevated plasma 3-MHis compared with 114MP/107MP. Treatment had no effect on body weight and body condition score over the duration of the study. Collectively, despite reduced milk production for the first 3 wk of lactation, feeding the 101MP/101MP treatment sustained lactational performance and improved milk N efficiency without negatively affecting the frequency of diseases in dairy cows during the first 13 wk postpartum.

The traumatic death of a significant person is an under-appreciated adverse life event. Unresolved grief from traumatic death is associated with complicated grief (CG) in adulthood and both contrib...

Millions of COVID-19 patients have succumbed to respiratory and systemic inflammation. Hyperstimulation of toll-like receptor (TLR) signaling has been shown to be a key driver of immunopathology following infection by viruses. We found that severely ill COVID-19 patients in the Intensive Care Unit (ICU) display hallmarks of such hyper-stimulation with abundant agonists of nucleic acid sensing TLRs present in their blood and lungs. These nucleic acid-containing Damage and Pathogen Associated Molecular Patterns (DAMPs/PAMPs) can be depleted using nucleic acid-binding microfibers to limit the patient samples’ ability to hyperactivate such innate immune receptors. Single-cell RNA-sequencing revealed that CD16+ monocytes from deceased but not recovered ICU patients exhibit a TLR-tolerant phenotype and a deficient anti-viral response after ex vivo TLR stimulation. Plasma proteomics confirmed such myeloid hyperactivation and revealed DAMP/PAMP carrier consumption in deceased patients. Treatment of these COVID-19 patient samples with MnO nanoparticles effectively neutralizes TLR activation by the abundant nucleic acid-containing DAMPs/PAMPs present in their lungs and blood. Finally, MnO nanoscavenger treatment limits the ability of DAMPs/PAMPs to induce TLR tolerance in monocytes. Thus, treatment with microfiber- or nanoparticle-based DAMP/PAMP scavengers may prove useful for limiting SARS-CoV-2 induced hyperinflammation, preventing monocytic TLR tolerance and improving outcomes in severely ill COVID-19 patients.

Consumption of polyphenols and dietary fiber as part of a normal diet is beneficial to human health. In this study, we examined whether different amounts of dietary soluble fiber (pectin) affect the absorption and metabolism of polyphenols from blackcurrant and green tea in rats. After 28 days, the rats fed blackcurrant and green tea with pectin (4 or 8%) had significantly lower body weight gain and food intake compared to the rats fed a control diet. Rats fed a blackcurrant and green tea diet with 8% pectin had significantly higher fecal nitrogen output and lower protein digestibility. No polyphenols were observed in the urine, feces and plasma of rats fed the control diet. Parent catechins and flavonols were absent in urine obtained from all diet groups. Gallocatechin glucuronide was only observed in the plasma of rats fed the blackcurrant and green tea diet without pectin. Meanwhile, epicatechin and catechin gallate were present in the feces of rats fed a blackcurrant and green tea diet with and without 4% pectin. Pectin (4 or 8%) added to the blackcurrant and green tea diet increased the plasma antioxidant capacity in rats. Inclusion of pectin in the diet altered the host absorption and metabolism of polyphenols from blackcurrant and green tea.

Exoplanet systems with multiple planets in mean motion resonances have often been hailed as a signpost of disk driven migration. Resonant chains like Kepler-223 and Kepler-80 consist of a trio of planets with the three-body resonant angle librating and/or with a two-body resonant angle librating for each pair. Here we investigate whether close-in super-Earths and mini-Neptunes forming in situ can lock into resonant chains due to dissipation from a depleted gas disk. We simulate the giant impact phase of planet formation, including eccentricity damping from a gaseous disk, followed by subsequent dynamical evolution over tens of millions of years. In a fraction of simulated systems, we find that planets naturally lock into resonant chains. These planets achieve a chain of near-integer period ratios during the gas disk stage, experience eccentricity damping that captures them into resonance, stay in resonance as the gas disk dissipates, and avoid subsequent giant impacts, eccentricity excitation, and chaotic diffusion that would dislodge the planets from resonance. Disk conditions that enable planets to complete their formation during the gas disk stage enable those planets to achieve tight period ratios, 13 pages, 3 tables, 9 figures, accepted for publication in the Astrophysical Journal on October 5, 2020

Super-Earths and mini-Neptunes exhibit great diversity in their compositional and orbital properties. Their bulk densities span a large range, from those dense enough to be purely rocky to those needing a substantial contribution from volatiles to their volumes. Their orbital configurations range from compact, circular multi-transiting systems like Kepler-11 to systems like our Solar System's terrestrial planets with wider spacings and modest but significant eccentricities and mutual inclinations. Here we investigate whether a continuum of formation conditions resulting from variation in the amount of solids available in the inner disk can account for the diversity of orbital and compositional properties observed for super Earths, including the apparent dichotomy between single transiting and multiple transiting system. We simulate in situ formation of super-Earths via giant impacts and compare to the observed Kepler sample. We find that intrinsic variations among disks in the amount of solids available for in situ formation can account for the orbital and compositional diversity observed among Kepler's transiting planets. Our simulations can account for the planets' distributions of orbital period ratios, transit duration ratios, and transit multiplicity; higher eccentricities for single than multi transiting planets; smaller eccentricities for larger planets; scatter in the mass-radius relation, including lower densities for planets with masses measured with TTVs than RVs; and similarity in planets' sizes and spacings within each system. Our findings support the theory that variation among super-Earth and mini-Neptune properties is primarily locked in by different in situ formation conditions, rather than arising stochastically through subsequent evolution., Comment: 18 pages, 9 figures. Submitted to ApJ; revised in response to referee report

While many observed debris disks are thought to have gaps suggestive of the presence of planets, direct imaging surveys do not find many high mass planets in these systems. We investigate if divergent migration is a viable mechanism for forming gaps in young debris disks with planets of low enough mass to currently elude detection. We perform numerical integrations of planet pairs embedded in planetesimal disks to assess the conditions for which divergent, planetesimal-driven migration occurs and gaps form within the disk. Gap widths and the migration rate of planets within a pair depend on both disk mass and the degree to which the planets share disk material. We find that planet pairs with planets more massive than Neptune can produce gaps with widths similar to their orbit distance within 10 Myr at orbit separations probed by direct imaging campaigns. Pairs of migrating super-Earths likely cannot form observable gaps on the same time and distance scales, however. Inferring the responsible planet masses from these gaps while neglecting migration could overestimate the mass of planets by more than an order of magnitude., Comment: 10 pages, 1 table, 8 figures. Accepted for publication in MNRAS on 2018 September 25

Brassicaceae is one of the few plant families with the ability to incorporate the essential trace element selenium (Se) into organic compounds, and the vegetables are claimed to have a number of human health benefits based on both Se and glucosinolate content. We investigated the effect of Se addition on the nutrient composition of broccoli, purple radish and green radish sprouts and develop an efficient growing method for producing high concentration Se radish sprouts that does not impact the glucosinolate content and has little seleniferous waste. The concentration of Se in sprouts increased exponentially with time in the presence of high Se supply (9.2 μmol Se g−1 seed). At lower rates of Se supply (≤2.5 μg Se g−1 seed) sprouts containing a target Se concentration were produced according to the linear relationship y = 0.91x, where y is the target Se concentration in μg Se g−1 FW, and x is the concentration of sodium selenate in water added at 8.3 mL of water g−1 dry seed. Glucosinolate profiles differed between broccoli and radish but the total glucosinolate concentration of the sprouts was unaffected by Se addition. Radish was more suitable than broccoli for producing sprouts high in both glucosinolates and Se.

Objective To determine the impact of long-term, body weight–supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers. Design Prospective observational cohort with longitudinal follow-up. Setting Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN). Participants Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1–45y after SCI) who completed at least 120 NRN physical therapy sessions. Interventions Manually assisted locomotor training (LT) in a body weight–supported treadmill environment, overground standing and stepping activities, and community integration tasks. Main Outcome Measures International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy. Results Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment. Conclusions Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs.

Sea angling has been shown to be a high value activity with significant expenditure by individuals on their sport. Deriving estimates of the economic contribution of recreational sea angling is important in a number of related policy contexts, from tourism management and economic development policy, to the sustainable management of inshore fish stocks. This paper reveals some of the challenges in understanding the economic effects associated with recreational sea angling, and provides estimates of the economic value of recreational sea angling in England. The results were derived from research undertaken in England in 2011- 13, which was conducted as part a wide ranging government-funded study, Sea Angling 2012, that estimated sea angler catches, spending and activity. Recreational sea angling made a significant contribution to the economy, supporting just over £2 billion of total spending, and 23,600 jobs in England in 2012-13. The implications of these results are discussed in the context of the management of recreational sea angling in England.

The role of concurrent illness in coronavirus disease 2019 (COVID-19) is unknown. Patients with leukemia may display altered thromboinflammatory responses. We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. Multiple analyses, including rotational thromboelastometry and flow cytometry on blood and bronchoalveolar lavage, are reported to characterize coagulation and immune profiles. The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leukemia and COVID-19.

This study evaluates and synthesizes qualitative evidence addressing factors affecting a child’s decision to disclose an experience of sexual abuse. Childhood sexual abuse is a devastating crime, with long-term negative impacts. Understanding the factors that affect a child’s decision to disclose is vital. Disclosure enables access to support and protection, both therapeutically and legally. A systematic review was conducted focusing on factors affecting a child’s decision to disclose an experience of sexual abuse. Seven studies were identified, quality appraisal undertaken, and meta-ethnography used to synthesize the studies. Six new super-ordinate themes were developed: Fear of what will happen; Others’ reactions: fear of disbelief; Emotions and impact of the abuse; An opportunity to tell; Concern for self and others; and Feelings toward the abuser. Themes indicated the importance of support, structure, and opportunity to facilitate disclosure and should be utilized by agencies to develop practices that facilitate disclosures.

The ecological success of social insects is frequently ascribed to improvements in task performance due to division of labour amongst workers. While much research has focused on improvements associated with lifetime task specialization, members of colonies can specialize on a given task over shorter time periods. Eusocial bees in particular must collect pollen and nectar rewards to survive, but most workers appear to mix collection of both rewards over their lifetimes. We asked whether bumblebees specialize over timescales shorter than their lifetime. We also explored factors that govern such patterns, and asked whether reward specialists made more foraging bouts than generalists. In particular, we described antennal morphology and size of all foragers in a single colony and related these factors to each forager’s complete foraging history, obtained using radio frequency identification (RFID). Only a small proportion of foragers were lifetime specialists; nevertheless, >50% of foragers specialized daily on a given reward. Contrary to expectations, daily and lifetime reward specialists were not better foragers (being neither larger nor making more bouts); larger bees with more antennal olfactory sensilla made more bouts, but were not more specialized. We discuss causes and functions of short and long-term patterns of specialization for bumblebee colonies.

The martian upper atmosphere could be strongly perturbed by the near collision with Comet C/2013 A1 (Siding Spring). Significant mass and energy will be deposited in the upper atmosphere of Mars if the comet coma is sufficiently dense. We predict that comet H 2 O production rates larger than 10 28 molecules/s would produce temperature increases exceeding 30 K and the H density in the upper atmosphere will approximately double. The temperature perturbation will persist for several hours and the increased H density for tens of hours. Drag on orbiting spacecraft may increase by substantial factors, depending upon comet activity, because of the thermal perturbation to the atmosphere. Observation of these perturbations may provide insight into the thermal and chemical balances of the atmosphere.

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Summary The ability to forage and return home is essential to the success of bees as both foragers and pollinators. Pesticide exposure may cause behavioural changes that interfere with these processes, with consequences for colony persistence and delivery of pollination services.We investigated the impact of chronic exposure (5–43 days) to field‐realistic levels of a neonicotinoid insecticide (2·4 ppb thiamethoxam) on foraging ability, homing success and colony size using radio frequency identification (RFID) technology in free‐flying bumblebee colonies.Individual foragers from pesticide‐exposed colonies carried out longer foraging bouts than untreated controls (68 vs. 55 min). Pesticide‐exposed bees also brought back pollen less frequently than controls indicating reduced foraging performance.A higher proportion of bees from pesticide‐exposed colonies returned when released 1 km from their nests; this is potentially related to increased orientation experience during longer foraging bouts. We measured no impact of pesticide exposure on homing ability for bees released from 2 km, or when data were analysed overall.Despite a trend for control colonies to produce more new workers earlier, we found no overall impacts of pesticide exposure on whole colony size. Synthesis and applications. This study shows that field‐realistic neonicotinoid exposure can have impacts on both foraging ability and homing success of bumblebees, with implications for the success of bumblebee colonies in agricultural landscapes and their ability to deliver crucial pollination services. Pesticide risk assessments should include bee species other than honeybees and assess a range of behaviours to elucidate the impact of sublethal effects. This has relevance for reviews of neonicotinoid risk assessment and usage policy world‐wide., This study shows that field‐realistic neonicotinoid exposure can have impacts on both foraging ability and homing success of bumblebees, with implications for the success of bumblebee colonies in agricultural landscapes and their ability to deliver crucial pollination services. Pesticide risk assessments should include bee species other than honeybees and assess a range of behaviours to elucidate the impact of sublethal effects. This has relevance for reviews of neonicotinoid risk assessment and usage policy world‐wide.

Morrison SA, Forrest GF, VanHiel LR, Dave M, D'Urso D. NeuroRecovery Network provides standardization of locomotor training for persons with incomplete spinal cord injury. Objective To illustrate the continuity of care afforded by a standardized locomotor training program across a multisite network setting within the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Design Single patient case study. Setting Two geographically different hospital-based outpatient facilities. Participants This case highlights a 25-year-old man diagnosed with C4 motor incomplete spinal cord injury with American Spinal Injury Association Impairment Scale grade D. Intervention Standardized locomotor training program 5 sessions per week for 1.5 hours per session, for a total of 100 treatment sessions, with 40 sessions at 1 center and 60 at another. Main Outcome Measures Ten-meter walk test and 6-minute walk test were assessed at admission and discharge across both facilities. For each of the 100 treatment sessions percent body weight support, average, and maximum treadmill speed were evaluated. Results Locomotor endurance, as measured by the 6-minute walk test, and overground gait speed showed consistent improvement from admission to discharge. Throughout training, the patient decreased the need for body weight support and was able to tolerate faster treadmill speeds. Conclusions Data indicate that the patient continued to improve on both treatment parameters and walking function. Standardization across the NRN centers provided a mechanism for delivering consistent and reproducible locomotor training programs across 2 facilities without disrupting training or recovery progression.

Background/purpose We present a retrospective case series of 2 individuals with motor-incomplete spinal cord injury (SCI) to examine differences in lifetime cost estimates before and after participation in an intensive locomotor training (LT) program. Sections of a life care plan (LCP) were used to determine the financial implications associated with equipment, home renovations, and transportation for patients who receive LT. An LCP is a viable method of quantifying outcomes following any therapeutic intervention. Case description The LCP cases analyzed were a 61-year-old woman and a 4½-year-old boy with motor-incomplete SCI and impairments classified by the American Spinal Injury Association Impairment Scale (AIS) as AIS D and AIS C, respectively. Interventions Each patient received an intensive outpatient LT program 3 to 5 days per week. The 61-year-old woman received 198 sessions over 57 weeks and the 4½-year-old boy received 76 sessions over 16 weeks. Outcomes The equipment, home renovation, and transportation costs of an LCP were calculated before and after LT. Prior to the implementation of LT, the 61-year-old woman had estimated lifetime costs between $150,247.00 and $199,654.00. Following LT, the estimated costs decreased to between $2010.00 and $2446.00 (a decrease of $148,237.00 and $197,208.00). Similarly, the 4-year-old boy had estimated lifetime costs for equipment, home renovation, and transportation between $535,050.00 and $771,665.00 prior to LT. However, the estimated costs decreased to between $97,260.00 and $200,047.00 (a decrease of $437,790.00 and $571,618.00) following LT. Discussion The lifetime financial costs associated with equipment, home renovations, and transportation following a motor-incomplete SCI were decreased following an intensive LT program for the 2 cases presented in this article. The LCP, including costs of rehabilitation and long-term medical and personal care costs, may be an effective tool to discern cost benefit of rehabilitation interventions.

Background: The primary barrier to obtaining robotic equipment is the cost of the device. Methods: A break-even analysis was performed for 2 robotic and 1 nonrobotic locomotor training (LT) devices. Results: The time for a clinic to break even after purchasing various LT devices ranged between 1.6 years for the nonrobotic device and 2.36 years for the robotic device. However, the 5-year projection showed that the most profitable LT device was a robotic device and the least profitable device was the nonrobotic device. Conclusion: Adding robotics to a hospital-based outpatient physical therapy clinic can be financially feasible.

High-resolution images from the Cassini Imaging Science Subsystem (ISS) show parallel sets of grooves on Epimetheus and Pandora. Grooves have previously been observed on other satellites and asteroids, including Phobos, Gaspra, Ida, Eros, and minor occurrences on Phoebe. Sets of parallel grooves are so far observed only on satellites known or likely to be subject to significant tidal stresses, such as forced librations. Grooves on asteroids and on satellites not subject to significant forced librations occur in more globally disorganized patterns that may reflect impacts, varying internal structures, or even thermal stresses. The patterns and individual morphologies of grooves on the tidally-affected satellites suggest fracturing in weak materials due to tidal stresses and forced librations.

Datta S, Lorenz DJ, Morrison S, Ardolino E, Harkema SJ. A multivariate examination of temporal changes in Berg Balance Scale items for patients with ASIA Impairment Scale C and D spinal cord injuries. Objective To provide a multivariate examination of the Berg Balance Scale (BBS) in patients with spinal cord injury (SCI) as a first step in developing a balance tool for the SCI population. Design Observational cohort. Setting The NeuroRecovery Network (NRN), a specialized network of treatment centers providing standardized, activity-based therapy for patients with SCI. Participants Patients (N=97) with American Spinal Injury Association Impairment Scale C or D SCI who were enrolled in the NRN between March 1, 2005, and June 12, 2007. Interventions All enrolled patients received 3 to 5 locomotor training sessions a week, according to NRN protocol, and were periodically evaluated for progress on functional outcome measurements. Main Outcome Measures Scores on the items of the BBS, six-minute walk test distances, ten-meter walk test speeds, and scores on the SCI Functional Ambulation Index. Temporal rates of change of the BBS items were examined with a principal components and correlation analysis. Results The first principal component accounted for nearly half of the overall variability in the BBS, correlated well with rates of change in functional mobility measures, and had good stability in its composition as verified by a resampling analysis. Further analysis showed that the composition of the first principal component varied with the patient's level of recovery. Conclusions The BBS captures a significant amount of information about balance recovery in persons with SCI and may be a good foundation for a balance tool. However, the utility of BBS items may be dependent on a patient's level of recovery. A dynamic balance instrument for the SCI population may be needed.

Paradise Lost , much more successfully than has been recognized, meets the challenge to make understandable the curse upon the Serpent while navigating tough theological terrain. As Milton was well aware, an inexplicable and special punishment inflicted upon an innocent animal threatens to impugn God’s goodness. The text goes beyond locating accommodated meaning in the curse to depict its pronouncement as an act of accommodation to Adam and Eve’s fallen consciousness, and in particular their now-tainted view of the Serpent. Milton presents the most troubling aspects of the Serpent’s role and punishment as key elements of God’s beneficent strategy of accommodation.

Trypsin inhibitor activity (TIA) of 17 spring-sown field pea cultivars grown in New Zealand ranged from 0.33 to 0.75 TIU/mg DM. These values were much lower than those reported for most European pea cultivars. After soaking and cooking, values fell by 42-91%, with an average reduction of 78% (0.07-0.19 TIU/mg DM). After heat treatment, the residual percentage of TIA was negatively correlated to the amount of TIA in the raw seed. Six to ten trypsin isoinhibitors were observed in each cultivar of the raw extracts, with isoelectric points ranging from 4.6 to 7.6. Only three of the isoinhibitors, with isoelectric points of 5.1, 5.9 and 7.6, remained after heat treatment. Pea cultivars with high TIA levels in the raw seed may be more suitable as processing peas because cooking substantially reduces TIA levels, suggesting that adverse effects of consuming TIA would be limited. Conversely, raw peas with low TIA levels would be more suitable for use as animal feed. Cultivars that contain more unstable isoforms may require less heat treatment, therefore retaining their nutritional value be more suitable for human consumption and use as animal feed, and have reduced processing costs.

Deficient perception and cognition in Alzheimer’s disease (AD) has been attributed to slow information processing and attentional disturbance, but an additional explanation may be reduced signal strength. In 21 individuals with probable AD, 29 healthy older and 54 younger adults, we enhanced the contrast level of rapidly-flashed masked letters. The AD group reached identification criterion (80% accuracy), but required significantly higher contrast than the control groups. A source of the prevalent masking deficit may be reduced signal strength arising from dysfunction of retina or visual cortex. Increasing stimulus contrast may be an effective means of enhancing cognitive performance in AD.

This study was conducted to determine the contribution of ion transport to restitution after injury in the gastric mucosa. For this, intact sheets of stomach from the bullfrog, Rana catesbeiana, were mounted in Ussing chambers. Restitution was evaluated in the presence or absence of ion transport inhibitors amiloride, DIDS, and bumetanide to block Na+/H+ exchange, [Formula: see text]/[Formula: see text] exchange and [Formula: see text]/[Formula: see text] co-transport, and Na+-K+-2Cl- cotransport, respectively. Ion substitution experiments with Na+-free, Cl--free, and [Formula: see text]-free solutions were also performed. Injury to the mucosa was produced with 1 M NaCl, and restitution was evaluated by recovery of transepithelial resistance (TER), mannitol flux, and morphology. Amiloride, bumetanide, Cl--free, or [Formula: see text]-free solutions did not affect restitution. In Na+-free solutions, recovery of TER and mannitol flux did not occur because surface cells did not attach to the underlying basement membrane. In contrast, all aspects of restitution were inhibited by DIDS, a compound that inhibits Na+-dependent [Formula: see text] transport. Because [Formula: see text]-free solutions did not inhibit restitution, it was concluded that DIDS must block a yet undefined pathway not involved in [Formula: see text] ion transport but essential for cell migration after injury and restitution in the gastric mucosa.

We investigate the orbital evolution of particles in a planet's chaotic zone to determine their final destinations and their timescales of clearing. There are four possible final states of chaotic particles: collision with the planet, collision with the star, escape, or bounded but non-collision orbits. In our investigations, within the framework of the planar circular restricted three body problem for planet-star mass ratio $\mu$ in the range $10^{-9}$ to $10^{-1.5}$, we find no particles hitting the star. The relative frequencies of escape and collision with the planet are not scale-free, as they depend upon the size of the planet. For planet radius $R_p\ge0.001R_H$ where $R_H$ is the planet's Hill radius, we find that most chaotic zone particles collide with the planet for $\mu\lesssim10^{-5}$; particle scattering to large distances is significant only for higher mass planets. For fixed ratio $R_p/R_H$, the particle clearing timescale, $T_{cl}$, has a broken power-law dependence on $\mu$. A shallower power-law, $T_{cl}\sim \mu^{-{1/3}}$, prevails at small $\mu$ where particles are cleared primarily by collisions with the planet; a steeper power law, $T_{cl}\sim\mu^{-{3/2}}$, prevails at larger $\mu$ where scattering dominates the particle loss. In the limit of vanishing planet radius, we find $T_{cl}\approx0.024\mu^{-{3\over2}}$. The interior and exterior boundaries of the annular zone in which chaotic particles are cleared are increasingly asymmetric about the planet's orbit for larger planet masses; the inner boundary coincides well with the classical first order resonance overlap zone, $\Delta a_{cl,int}\simeq1.2\mu^{0.28}a_p$; the outer boundary is better described by $\Delta a_{cl,ext}\simeq1.7\mu^{0.31}a_p$, where $a_p$ is the planet-star separation., Comment: 20 pages, 7 figures; accepted for publication in ApJ

To gain insight into who is likely to benefit from activity-based therapy (ABT), as assessed by secondary analysis of data obtained from a clinical trial.Secondary analysis of results from a randomized controlled trial with delayed treatment design.Outpatient program in a private, nonprofit rehabilitation hospital.Volunteer sample of adults (N=38; 27 men; 11 women; age, 22-63y) with chronic (≥12mo postinjury), motor-incomplete (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade C or D) spinal cord injury (SCI).A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.Walking speed and endurance (10-meter walk test and 6-minute walk test) and functional ambulation (timed Up and Go test).This secondary analysis identified likely responders to ABT on the basis of injury characteristics: AIS classification, time since injury, and initial walking ability. Training effects were the most clinically significant in AIS grade D participants with injuries3 years in duration. This information, along with information about preliminary responsiveness to therapy (gains after 12wk), can help predict the degree of recovery likely from participation in an ABT program.ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, not everyone with goals of walking recovery will benefit. Individuals with SCI should be advised of the time, effort, and resources required to undertake ABT. Practitioners are encouraged to use the findings from this trial to assist prospective participants in establishing realistic expectations for recovery.

HD 95086 is a young early-type star that hosts (1) a 5 MJ planet at the projected distance of 56 AU revealed by direct imaging, and (2) a prominent debris disk. Here we report the detection of 69 um crystalline olivine feature from the disk using the Spitzer/MIPS-SED data covering 55-95 um. Due to the low resolution of MIPS-SED mode, this feature is not spectrally resolved, but is consistent with the emission from crystalline forsterite contributing 5% of the total dust mass. We also present detailed analysis of the disk SED and re-analysis of resolved images obtained by Herschel. Our results suggest that the debris structure around HD 95086 consists of a warm (175 K) belt, a cold (55 K) disk, and an extended disk halo (up to 800 AU), and is very similar to that of HR 8799. We compare the properties of the three debris components, and suggest that HD 95086 is a young analog of HR 8799. We further investigate and constrain single-planet, two-planet, three-planet and four-planet architectures that can account for the observed debris structure and are compatible with dynamical stability constraints. We find that equal-mass four-planet configurations of geometrically spaced orbits, with each planet of mass 5 MJ, could maintain the gap between the warm and cold debris belts, and also be just marginally stable for timescales comparable to the age of the system., Comment: accepted for publication in ApJ

Rapid epithelial repair (restitution) after injury is required to maintain barrier function of the gastrointestinal mucosa and skin and is thought to be a highly ATP-dependent process that would be inhibited under hypoxic conditions. However, little is known about the metabolic pathways required for restitution. Thus, this study was undertaken to evaluate, in vitro, the role of oxidative respiration and glycolysis in restitution after injury. To this end, restitution of the bullfrog gastric mucosa was evaluated under the following conditions: 1) blockade of mitochondrial respiration; 2) blockade of glycolysis; or 3) absence of glucose. The extent of mucosal repair after injury was evaluated by electrophysiology and morphology. Cell migration, repolarization, and the formation of tight junctions after injury occurred during blockade of mitochondrial respiration, whereas the recovery of mucosal barrier function did not. In contrast, glycolytic inhibition completely blocked all aspects of restitution by inhibiting the migration of surface epithelial cells. Restitution occurred in tissues incubated with glucose-free solutions, suggesting that cells contain sufficient glucose (glycogen) to drive glycolysis for many hours. Our results demonstrate that the glycolytic pathway is essential for restitution after injury in the bullfrog gastric mucosa and that all but complete repair of barrier function occurs in the absence of mitochondrial respiration.

This study explores differences in length of stay (LOS) and functional status at time of discharge (DC) from inpatient rehabilitation and at 2 months post-DC (PDC) and examines complications PDC for patients admitted to a rehabilitation center in 1991 and 1995. Data were collected from 127 patients with motor complete spinal cord injury (SCI). Nineteen functional skills, medical complications, and employment status were collected. LOS was shorter in 1995 (54.2 days) than in 1991 (95.8 days). The 1991 patients with paraplegia were functioning more independently in 5 of the 19 skills, whereas in 1995 these patients functioned more independently in one skill PDC. Individuals with tetraplegia showed no difference in functional level at DC but did show functional improvement at PDC in 1995 for three skills. Urinary tract infections and pressure ulcers were not different between the groups, but pain complaints and unemployment status were greater in 1995 for individuals with paraplegia. Results indicate that LO...

In the coming years, high contrast imaging surveys are expected to reveal the characteristics of the population of wide-orbit, massive, exoplanets. To date, a handful of wide planetary mass companions are known, but only one such multi-planet system has been discovered: HR8799. For low mass planetary systems, multi-planet interactions play an important role in setting system architecture. In this paper, we explore the stability of these high mass, multi-planet systems. While empirical relationships exist that predict how system stability scales with planet spacing at low masses, we show that extrapolating to super-Jupiter masses can lead to up to an order of magnitude overestimate of stability for massive, tightly packed systems. We show that at both low and high planet masses, overlapping mean motion resonances trigger chaotic orbital evolution, which leads to system instability. We attribute some of the difference in behavior as a function of mass to the increasing importance of second order resonances at high planet-star mass ratios. We use our tailored high mass planet results to estimate the maximum number of planets that might reside in double component debris disk systems, whose gaps may indicate the presence of massive bodies., Accepted to ApJ

The existence of strong absorption bands of singly deuterated methane (CH3D) at wavelengths where normal methane (CH4) absorbs comparatively weakly could enable remote measurement of D/H ratios in methane ice on outer solar system bodies. We performed laboratory transmission spectroscopy experiments, recording spectra at wavelengths from 1 to 6 \mum to study CH3D bands at 2.47, 2.87, and 4.56 \mum, wavelengths where ordinary methane absorption is weak. We report temperature-dependent absorption coefficients of these bands when the CH3D is diluted in CH4 ice and also when it is dissolved in N2 ice, and describe how these absorption coefficients can be combined with data from the literature to simulate arbitrary D/H ratio absorption coefficients for CH4 ice and for CH4 in N2 ice. We anticipate these results motivating new telescopic observations to measure D/H ratios in CH4 ice on Triton, Pluto, Eris, and Makemake., Comment: 17 pages, 7 figures

Deficits in visual cognition in Alzheimer's disease (AD) arise from neuropathological changes in higher-order association areas of the cortex and from defective input from lower-level visual processing areas. We investigated whether enhanced signal strength may lead to improvement of visual cognition in AD. We tested 35 individuals with probable AD, 35 age-matched elderly control (EC) and 58 young control (YC) adults on letter identification, word reading, picture naming, discrimination of unfamiliar faces, and pattern completion. The contrast sensitivity step-difference across an independent sample of AD and EC groups was used in calculating an image filter, from which we produced stimulus-strength conditions of low-degraded, medium-normal, and high-enhanced. Using this filter we created a hypothetical proximal-strength equivalence between AD at medium strength and EC at low strength, and between AD at high strength and EC at medium strength. For letter identification, word reading, picture naming, and face discrimination, medium strength elicited AD accuracy levels and reaction times that were similar to those of EC at low strength. On picture naming, increased strength reduced perceptual-type errors for EC and AD and random errors for AD. For word reading, high strength elicited AD accuracy levels and reaction times that were equivalent to those of EC at medium strength. We saw no effect of signal-strength manipulation on performance of pattern completion, possibly owing to the complex cognitive demands of that task or to the inadequacy of the filter for its images. The results indicate that putative AD-EC differences in cognition directly reflect contrast sensitivity differences between the groups. Enhancement of stimulus strength can ameliorate vision-based deficits and lead to improvement in some aspects of cognitive performance. These results suggest new non-pharmacological avenues to explore in the attempt to improve cognition in elderly adults and especially in individuals with AD.

PURPOSE Several lines of evidence suggest that locomotor training (LT) modalities, such as body weight-supported treadmill training (BWSTT), improves gait in individuals with incomplete spinal cord injury (SCI). Yet, manual BWSTT has been criticized for being cost prohibitive due to the number of staff required to perform this treatment. This study examined the financial viability of a LT program using manual BWSTT. METHODS This retrospective study analyzed data from individuals with motor incomplete SCI who had participated in manual BWSTT in a hospital-based outpatient clinic between 2003 and 2005. Individuals were between 18 and 68 years of age and were medically stable. Descriptive statistics were performed to determine the mean for each of the following: date of injury, age, impairment, gender, total number of visits, total procedures billed, charges, basic reimbursement information, and costs associated with the treatment. RESULTS The majority of individuals were male, classified as ASIA C, and had private insurance. Physical therapy evaluation, gait training, and therapeutic exercise were the most commonly billed procedures for all individuals. It was found that this locomotor training program, using the delivery model of one physical therapist, two physical therapy technicians, and one volunteer, was profitable. CONCLUSIONS The findings from this study suggest that LT using manual BWSTT in a hospital-based outpatient clinic can be financially feasible when provided by one trained physical therapist, two technicians, and one well-trained volunteer.

Objective To examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. Design Randomized controlled trial with delayed treatment design. Setting Outpatient program in a private, nonprofit rehabilitation hospital. Participants Volunteer sample of adults (N=48; 37 men and 11 women; age, 18–66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI). Interventions A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. Main Outcome Measures Neurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check). Results Significant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P =.024] and lower extremity motor score [4.2±5.2 vs −0.6±4.2; P =.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P =.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P =.002). Conclusions ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.

This study was conducted to determine the contribution of ion transport to restitution after injury in the gastric mucosa. For this, intact sheets of stomach from the bullfrog, Rana catesbeiana, were mounted in Ussing chambers. Restitution was evaluated in the presence or absence of ion transport inhibitors amiloride, DIDS, and bumetanide to block Na(+)/H(+) exchange, Cl(-)/HCO(3)(-) exchange and Na(+)/HCO(3)(-) co-transport, and Na(+)-K(+)-2Cl(-) cotransport, respectively. Ion substitution experiments with Na(+)-free, Cl(-)-free, and HCO(3)(-)-free solutions were also performed. Injury to the mucosa was produced with 1 M NaCl, and restitution was evaluated by recovery of transepithelial resistance (TER), mannitol flux, and morphology. Amiloride, bumetanide, Cl(-)-free, or HCO(3)(-)-free solutions did not affect restitution. In Na(+)-free solutions, recovery of TER and mannitol flux did not occur because surface cells did not attach to the underlying basement membrane. In contrast, all aspects of restitution were inhibited by DIDS, a compound that inhibits Na(+)-dependent HCO(3)(-) transport. Because HCO(3)(-)-free solutions did not inhibit restitution, it was concluded that DIDS must block a yet undefined pathway not involved in HCO(3)(-) ion transport but essential for cell migration after injury and restitution in the gastric mucosa.

This study was undertaken to determine the mechanism by which ammonium chloride (NH4Cl) inhibits stimulated acid secretion in the bullfrog gastric mucosa. To this end, four possible pathways of inhibition were studied: 1) blockade of basolateral K+channel, 2) blockade of ion transport activity, 3) neutralization of secreted H+in the luminal solution, or 4) ATP depletion. Addition of nutrient 10 mM NH4Cl (calculated NH3concentration = 92.5 μM and NH4+concentration = 9.91 mM) inhibited acid secretion within 30 min. Inhibition of acid secretion did not occur by blockade of basolateral K+channel activity or ion transport activity or by neutralization of the luminal solution. Although ATP depletion occurred in the presence of NH4Cl, the magnitude of ATP depletion in 30 min was not sufficient to inhibit stimulated acid secretion. By comparing the effect of NH4Cl on the resistance of inhibited or stimulated tissues, we demonstrate that NH4Cl acts specifically on stimulated tissues. We propose that NH4Cl blocks activity of an apical K+channel present in stimulated oxyntic cells. Our data suggest that the activity of this channel is important for the regulation of acid secretion in bullfrog oxyntic cells.