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Purpose: To analyze post-vitrectomy cataract formation in the pediatric population to elucidate the number of phakic children requiring cataract surgery following vitreous surgery and the perioperative factors affecting cataract development in these patients. Methods: Eyes of pediatric patients that underwent phakic pars plana vitrectomy (PPV) with no prior cataract in a 10-year period were included. Analyses evaluated relationships between patient age and time to cataract surgery, as well as contributing factors for cataract formation. Final visual outcomes were also examined. Outcomes were collected for patient age at first vitrectomy, indication for vitrectomy, use of tamponade agents, history of ocular trauma, cataract status, and time to cataract surgery from first vitrectomy. Results: Of 44 eyes analyzed, 27 (61%) were noted to have some degree of cataract formation. Of these, 15 (56%; 34% of total eyes) underwent cataract surgery. Use of octafluoropropane ( P = .04) or silicone oil ( P = .03) positively correlated with the need for cataract surgery in the total study group. Patients requiring cataract surgery had worse endpoint visual acuities than those who did not undergo surgery ( P = .02), although this difference becomes less significant in follow-up over 2 years ( P = .30). Patients who had cataracts but did not need cataract surgery showed an improvement in visual acuity ( P = .04), but this was not demonstrated in patients who did need cataract surgery ( P = .90). Conclusions: Pediatric eye care providers should be aware of the significant risk of cataract formation following a phakic PPV. [ J Pediatr Ophthalmol Strabismus . 20XX;X(X):XX–XX.]

Background Falls are the leading cause of morbidity and mortality in the elderly. Non-valvular Atrial fibrillation (AF) is present in up to 9% of this group and often requires oral anticoagulation (OAC). The CHA2DS2-VASc and HAS-BLED scores are validated tools assessing risk of ischemic stroke from AF and major bleeding (MB) from OAC. It is unclear if these predictions remain accurate in post-fall patients. This study seeks to determine the stroke and major bleeding rate in atrial fibrillation patients after a ground level fall and identify if validated risk scoring systems accurately stratify risk in this cohort. Methods Retrospective review of patients with AF presented to the emergency department after a fall. CHA2DS2-VASc and HAS-BLED scores were calculated. Follow up information was reviewed to 1 year. Patients were grouped according to discharge thromboprophylaxis plan (DTP): no treatment, Anti-platelet (AP), OAC, and AP + OAC. Outcomes were ischemic stroke, MB, or death at 1 year. Ischemic stroke and MB rates were calculated. Kruskal-Wallis, Χ2, Fisher's exact, and multivariable logistic regression were used to evaluate for clinical associations. Results 192 patients were included. MB rate was 14.5 bleeds/100 person-years, and ischemic stroke rate was 10.9/100 person-years. There were no observed differences between DTPs. Overall, one-year mortality was 22.1%. On unadjusted analysis, CHA2DS2-VASc did associate with ischemic stroke (p = 0.03); HAS-BLED did not associate with MB (p = 0.17). After logistic regression accounting for known risk factors, neither system associated with ischemic stroke or MB. Conclusions Fall patients are at higher risk for both ischemic stroke and MB compared to previously published reports. Current risk assessment tools should be used with caution. Further study of risk factors is warranted to guide medication decisions in these patients.

Languages are teeming with statistical cues for the cognitive system to capitalize on, and at least some aspects of language processing might be explained by sensitivity to such cues via general-purpose cognitive machinery. One cue relevant to the task of reading is the way in which information about word identity is typically distributed within a given lexicon. Previous research on visual word recognition has struggled to disentangle information distribution from perceptual factors because they are unavoidably interconnected in the processing of language. We construct a formal model that explicitly teases the two apart and use a novel experimental paradigm with artificial lexicons to test whether humans are sensitive to this cue. Our results provide a causal demonstration that the way in which the lexicon distributes information affects how readers visually explore words, thus revealing the use of another probabilistic cue that is based simply on efficient information gathering.

Identifying and assessing adaptation options are key pre-requisite steps to adaptation prioritization and effective adaptation planning. In this paper, we presented a systematic approach for adaptation stocktaking, combining a systematic mapping and an outcome-oriented and evidence-based assessment, illustrated using the case of The Gambia. This study systematically mapped 24 adaptation options that can potentially inform adaptation planning in The Gambia agriculture and food systems and assessed how the identified options contribute to the pillars of Climate-Smart Agriculture. Because of the paucity of evidence sources from The Gambia, we collated evidence from both The Gambia and the West Africa region. We found that many of the documented options, such as climate-resilient crop varieties, crop diversification, climate information use, and weather indexed-based insurance have the potential to increase agricultural productivity and income while building resilience to climate change. While several options, such as soil and water conservation practices can positively contribute to climate change mitigation, others such as manure and inorganic fertilizers can have no or negative impacts on mitigation. Agroforestry practices and System of Rice Intensification have the potential to make a triple impact. The paucity of evidence from The Gambia and the highly contextual and differential impacts of the identified adaptation options underscore the importance of careful consideration of barriers and enablers when developing and deploying policy and interventions to sustainably increase productivity and income while building resilience to climate risks and reducing GHGs emissions. Stakeholder engagement and participatory research action are crucial in selecting and testing the priority adaptation options which can maximize their potentials in specific agricultural and food system contexts, such as in The Gambia. Because of the heterogeneity in household vulnerability and socioecological circumstances, targeting options to the right contexts will also be crucial to avoid maladaptation. We highlighted key knowledge gaps in the understanding of the effectiveness and feasibility of the identified adaptation options in The Gambia. Beyond The Gambia, the approach can also be useful for and replicated in other least developed countries in the West African region, that are currently developing their National Adaptation Plan.

KEY POINTS GABA depolarized sural nerve axons and increased the electrical excitability of C-fibres via GABAA receptor. Axonal excitability responses to GABA increased monotonically with the rate of action potential firing. Action potential activity in unmyelinated C-fibres is coupled to Na-K-Cl cotransporter type 1 (NKCC1) loading of axonal chloride. Activation of axonal GABAA receptor stabilized C-fibre excitability during prolonged low frequency (2.5 Hz) firing. NKCC1 maintains intra-axonal chloride to provide feed-forward stabilization of C-fibre excitability and thus support sustained firing. ABSTRACT GABAA receptor (GABAA R)-mediated depolarization of dorsal root ganglia (DRG) axonal projections in the spinal dorsal horn is implicated in pre-synaptic inhibition. Inhibition, in this case, is predicated on an elevated intra-axonal chloride concentration and a depolarizing GABA response. In the present study, we report that the peripheral axons of DRG neurons are also depolarized by GABA and this results in an increase in the electrical excitability of unmyelinated C-fibre axons. GABAA R agonists increased axonal excitability, whereas GABA excitability responses were blocked by GABAA R antagonists and were absent in mice lacking the GABAA R β3 subunit selectively in DRG neurons (AdvillinCre or snsCre ). Under control conditions, excitability responses to GABA became larger at higher rates of electrical stimulation (0.5-2.5 Hz). However, during Na-K-Cl cotransporter type 1 (NKCC1) blockade, the electrical stimulation rate did not affect GABA response size, suggesting that NKCC1 regulation of axonal chloride is coupled to action potential firing. To examine this, activity-dependent conduction velocity slowing (activity-dependent slowing; ADS) was used to quantify C-fibre excitability loss during a 2.5 Hz challenge. ADS was reduced by GABAA R agonists and exacerbated by either GABAA R antagonists, β3 deletion or NKCC1 blockade. This illustrates that activation of GABAA R stabilizes C-fibre excitability during sustained firing. We posit that NKCC1 acts in a feed-forward manner to maintain an elevated intra-axonal chloride in C-fibres during ongoing firing. The resulting chloride gradient can be utilized by GABAA R to stabilize axonal excitability. The data imply that therapeutic strategies targeting axonal chloride regulation at peripheral loci of pain and itch may curtail aberrant firing in C-fibres.

A common problem in eye-tracking research is vertical drift—the progressive displacement of fixation registrations on the vertical axis that results from a gradual loss of eye-tracker calibration over time. This is particularly problematic in experiments that involve the reading of multiline passages, where it is critical that fixations on one line are not erroneously recorded on an adjacent line. Correction is often performed manually by the researcher, but this process is tedious, time-consuming, and prone to error and inconsistency. Various methods have previously been proposed for the automated, post hoc correction of vertical drift in reading data, but these methods vary greatly, not just in terms of the algorithmic principles on which they are based, but also in terms of their availability, documentation, implementation languages, and so forth. Furthermore, these methods have largely been developed in isolation with little attempt to systematically evaluate them, meaning that drift correction techniques are moving forward blindly. We document ten major algorithms, including two that are novel to this paper, and evaluate them using both simulated and natural eye-tracking data. Our results suggest that a method based on dynamic time warping offers great promise, but we also find that some algorithms are better suited than others to particular types of drift phenomena and reading behavior, allowing us to offer evidence-based advice on algorithm selection.

Numerous studies show that bodily states shape affect and cognition. Here, we investigated whether incidental physiological arousal impacted perceived familiarity for novel images depicting real-world scenes. Participants provided familiarity ratings for a series of high- and low-arousal emotional images, once after a cycling session (to increase heart rate) and once after a relaxation session (to reduce heart rate). We observed a novel match-effect between internal (physiological) and external (stimulus) arousal sources, where participants rated highly arousing images as more familiar when bodily arousal was also high. Interestingly, the match-effect was greater in participants that scored low on self-report measures of interoception, suggesting that these individuals are less able to correctly perceive bodily changes, and thus are more likely to confuse their physiological arousal with an external source. Overall, our findings underscore the importance of interactions between the mind, body, and stimulus, especially when it comes to subjective judgments of familiarity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives This study investigates a unique case of multiple osteochondromas (MO) comorbid with enlarged parietal foramina and correlates the findings with the existing literature. The aim of this study is to provide a deeper understanding of anatomic variation for physicians. Methods A 66-year-old White male donor was examined during a routine cadaveric dissection performed by medical students in an anatomy laboratory. Detailed exploration of the skeleton and organs was performed, and photographs were taken. Tissue samples were obtained from multiple outgrowths, and histopathologic examination was done. Results Bilateral bony growths were noted rising from the long bones of the upper and lower extremities (femur, tibia, fibula, and radius). An accessory muscle was found to be associated with the left radial bony growth. Histopathologic examination was positive for osteochondroma. Inspection of the skull revealed enlarged parietal foramina. Other findings included tibiofibular synostosis, abnormally shaped vertebral bodies and ribs, and elongated styloid processes of the skull. Conclusions In combination with the histopathologic examination, the case report and literature review elucidate a more precise clinical picture for those affected with MO or similar disorders. This report also emphasizes the necessity of further investigation of the pathogenesis of MO and Potocki-Shaffer syndrome.

The King’s Quarry site (36LH2), located in the Reading Prong region of eastern Pennsylvania, is one of six remaining jasper quarries mapped by the late James Hatch and reported in 1994. Several archaeological investigations were conducted there in preparation for a housing development. These investigations included controlled surface collections, hand excavated test units, and extensive mechanical investigations of mining pits. Pre-Contact era quarry pits were profiled in what appeared to be the most intensively mined area of the site. Several charcoal samples were collected from the profile which documented a prehistoric excavation over 7 m deep. A Paleoindian fluted preform along with other typical Paleoindian tools were recovered from the perimeter of the quarry pit. We present the results of the field testing and an extensive analysis of the artifacts. Despite the jumble of overlapping mining pits and historic farming activities, the site retains both horizontal and vertical integrity.

Extensive soft tissue loss or injury of the hand and upper extremity is a challenging reconstructive problem traditionally treated with abdominal-based pedicled flaps. Options for coverage included the groin flap based on the superficial circumflex iliac artery, the Scarpa's fascia flap based on the superficial inferior epigastric artery, and the paraumbilical perforator flap from the deep inferior epigastric artery perforators. Despite the ability to provide consistent and pliable soft tissue coverage with ease of elevation, these flaps have several disadvantages including restriction of mobility, requirement for multiple procedures, bulkiness and patient discomfort. With the advent of microsurgery, pedicled regional flaps, and off-the-shelf skin substitutes, the applications for these flaps have narrowed. However several indications still remain. These include: patient and facility factors which deter microsurgery, the absence of recipient vessels after injury, prior surgical use of recipient vessels, the need to preserve major vessels for future reconstruction, and large multi-surface wounds requiring coverage. In this review we detail these indications and provide case examples for each.

The distal radioulnar joint is inherently unstable, relying primarily on ligaments for stability. Disruption of the joint-stabilizing structures can occur in isolation or concomitantly with osseous trauma. Instability can result from dislocations, fractures, ligament injuries, or malunions. Untreated instability alters wrist and forearm kinematics, leading to pain, weakness, and possibly arthritis. In chronic instability, the native ligaments may not be reparable, necessitating a reconstructive procedure.

Annual wetland hydroperiods, defined here as the number of days per calendar year that water levels exceed a specified depth, were assessed at various depths for 41 cypress dome wetlands in west-central Florida lacking substantial anthropogenic impacts on hydrology. The effects of data sampling frequency and length of data on hydroperiod calculations were also evaluated. On average, the cypress domes had at least some surface water present for approximately 215 to 325 days per year and were fully inundated for approximately 5 to 20 days. We find that approximately twice monthly water level data collection for ten years represents a minimum data sampling frequency and data length target for characterizing cypress dome hydroperiods. The results provide insights into how hydroperiods can vary in time and space while delineating typical baseline hydroperiod ranges for cypress domes in the west-central Florida study area. More broadly, and applicable to wetlands worldwide, the work underscores the need to contextualize hydroperiods relative to depth threshold and data collection characteristics in order to better understand hydroperiods within and between wetlands.

SummarySeabirds are one of the most threatened avian taxa and are hence a high conservation priority. Managing seabirds is challenging, requiring conservation actions at sea (e.g. Marine Protected Areas - MPAs) and on land (e.g. protection of breeding sites). Important Bird and Biodiversity Areas (IBAs) have been successfully used to identify sites of global importance for the conservation of bird populations, including breeding seabirds. The challenge of identifying suitable IBAs for tropical seabirds is exacerbated by high levels of dispersal, aseasonal and asynchronous breeding. The western Indian Ocean supports ~19 million breeding seabirds of 30 species, making it one of the most significant tropical seabird assemblages in the world. Within this is the British Indian Ocean Territory (BIOT), encompassing 55 islands of the Chagos Archipelago, which supports 18 species of breeding seabird and one of the world’s largest no-take MPAs. Between January and March in 1975 and 1996, eight and 45 islands respectively were surveyed for seabirds and the data used to designate 10 islands as IBAs. A further two were proposed following an expedition to 26 islands in February/March 2006. Due to the historic and restricted temporal and spatial nature of these surveys, the current IBA recommendations may not accurately represent the archipelago’s present seabird status and distribution. To update estimates of the BIOT breeding seabird assemblage and reassess the current IBA recommendations, we used seabird census data collected in every month except September from every island, gathered during 2008–2018. The maximum number of breeding seabirds for a nominal year was 281,596 pairs of 18 species, with three species making up 96%: Sooty Tern Onychoprion fuscatus - 70%, Lesser Noddy Anous tenuirostris - 18% and Red-footed Booby Sula sula - 8%. Phenology was a complex species-specific mix of synchronous and asynchronous breeding, as well as seasonal and aseasonal breeding. Nine of the 10 designated IBAs and the two proposed IBAs qualified for IBA status based on breeding seabirds. However, not every IBA qualified each year because Sooty Terns periodically abandoned breeding islands and Tropical Shearwater Puffinus bailloni breeding numbers dropped below IBA qualifying criteria in some years. Further, one survey per year does not always capture the periodic breeding of some tropical seabirds. We propose therefore, that IBAs in BIOT are better designated at the island cluster level rather than by specific island and require two surveys six months apart per year. This work highlights the merits of long-term, systematic, versus incidental surveys for breeding tropical seabirds and the subsequent associated designation of IBAs.

Background Approximately 5-10% of patients with asthma have severe disease. High-quality real-world studies are needed to identify areas for improved management. Objective Aligned with the International Severe Asthma Registry, the CHRONICLE study (ClinicalTrials.gov: NCT03373045) was developed to address this need in the US. Study design Learnings from prior studies were applied to develop a real-world, prospective, noninterventional study of US patients with confirmed severe asthma who are treated by subspecialist physicians and require biologic or maintenance systemic immunosuppressant therapy or who are uncontrolled by high-dosage inhaled corticosteroids and additional controllers. Target enrollment is 4000 patients, with patient observation for ≥3 years. A geographically diverse sample of allergist/immunologist and pulmonologist sites approach all eligible patients under their care and report patient characteristics, treatment, and health outcomes every 6 months. Patients complete online surveys every 1-6 months. Initial results From February 2018 to February 2019, 102 sites screened 1428 eligible patients; 936 patients enrolled. Study sites (40% allergist/immunologist, 42% pulmonologist, 18% both) were similar to other US asthma subspecialist samples. Enrolled patients were 67% female with median ages at enrollment and diagnosis of 55 (range: 18-89) and 26 (0-80) years, respectively. Median body mass index was 31 kg/m2; 3% and 29% were current or former smokers, respectively, and >60% reported ≥1 exacerbation in the prior year and suboptimal symptom control. Conclusion CHRONICLE will provide high-quality provider- and patient-reported data from a large, real-world cohort of US adults with subspecialist-treated severe asthma.

Botulinum neurotoxins (BoNTs) are proteins produced by bacteria of the Clostridium family. Upon oral ingestion, BoNT causes the neuroparalytic syndrome botulism. There are seven serotypes of BoNT (serotypes A-G); BoNT-A and BoNT-B are the botulinum toxin serotypes utilized for therapeutic applications. Treatment with BoNT injections is used to manage chronic medical conditions across multiple indications. As with other biologic drugs, immunogenicity after long-term treatment with BoNT formulations may occur, and repeated use can elicit antibody formation leading to clinical nonresponsiveness. Thus, approaching BoNT treatment of chronic conditions with therapeutic formulations that minimize stimulating the host immune response while balancing patient responsiveness to therapy is ideal. Immunogenicity is a clinical limitation in many settings that use biologic drugs for treatment, and clinically relevant immunogenicity reduction has been achieved through engineering smaller protein constructs and reducing unnecessary formulation components. A similar approach has influenced the evolution of BoNT formulations. Three BoNT-A products and one BoNT-B product have been approved by the Food and Drug Administration (FDA) for therapeutic use: onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, and rimabotulinumtoxinB; a fourth BoNT-A product, daxibotulinumtoxinA, is currently under regulatory review. Additionally, prabotulinumtoxinA is a BoNT-A product that has been approved for aesthetic indications but not therapeutic use. Here, we discuss the preclinical and clinical immunogenicity data that exist within the scientific literature and provide a perspective for considering immunogenicity as a key factor in choice of BoNT formulation.

Water erosion removes soil nutrients, soil carbon, and in extreme cases can remove topsoil altogether. Previous studies have quantified crop yield losses from water erosion using a range of methods, applied mostly to single plots or fields, and cannot be systematically compared. This study assesses the worldwide impact of water erosion on maize and wheat production using a global gridded modeling approach for the first time. The EPIC crop model is used to simulate the global impact of water erosion on maize and wheat yields, from 1980 to 2010, for a range of field management strategies. Maize and wheat yields were reduced by a median of 3% annually in grid cells affected by water erosion, which represent approximately half of global maize and wheat cultivation areas. Water erosion reduces the annual global production of maize and wheat by 8.9 million tonnes and 5.6 million tonnes, with a value of $3.3bn globally. Nitrogen fertilizer necessary to reduce losses is valued at $0.9bn. As cropland most affected by water erosion is outside major maize and wheat production regions, the production losses account for less than 1% of the annual global production by volume. Countries with heavy rainfall, hilly agricultural regions and low fertilizer use are most vulnerable to water erosion. These characteristics are most common in South and Southeast Asia, sub-Saharan Africa and South and Central America. Notable uncertainties remain around large-scale water erosion estimates that will need to be addressed by better integration of models and observations. Yet, an integrated bio-physical modeling framework – considering plant growth, soil processes and input requirements – as presented herein can provide a link between robust water erosion estimates, economics and policy-making so far lacking in global agricultural assessments.

The recent development utilizing automatic microscopy to identify damage sites on an optic for damage mitigation at the National Ignition Facility (NIF) has resulted in a large set of damage dataset for growth analysis. In this work we will examine how the pre and post installation damage sizes are used to analyze the cumulative probability of growth for damage sites that have been exposed to multiple laser shots. The analysis can form the basis to derive single-shot probability growth behavior of fused silica damage site as a function of size.

We present the development of large aperture fabricated input surface sites (~1-2 mm size) designed to “shadow” damage sites on the exit surface and arrest their further growth. The inherent expanding wave which leads to exit surface damage, motivates our diversion from a conic shape and development of more intricate geometries. We discuss the design considerations, the fabrication and resulting geometries, the optical modeling of light propagation through these geometries, the imaging of the shadowed region as well as the damage-inducing expanding wave intensification they lead to, and the large beam damage testing and their analysis.

BackgroundThe coexistence of under- and overnutrition is of increasing public health concern in The Gambia. Fruits, vegetables and pulses are essential to healthy and sustainable diets, preventing micronutrient deficiencies and non-communicable diseases, while cereals significantly contribute to energy intake. However, environmental changes are predicted to intensify, reducing future yields of these crops if agricultural productivity and resilience are not improved. The Gambia is highly climate-vulnerable and import-dependent, but the extent of its reliance on other climate-vulnerable countries for its supply of nutritionally important crops is currently unknown.MethodsWe used United Nations Food and Agriculture Organization data, with novel origin-tracing algorithms applied, to analyse The Gambia's supply of cereals, fruits, vegetables and pulses between 1988 and 2018. The climate vulnerability of countries was assessed using Notre Dame Global Adaptation Initiative (ND-GAIN) index scores, and projected water stress (2040) assessed using World Resources Institute (WRI) scores. Multilevel generalized linear mixed-effects models were used to identify changes in the overall climate vulnerability and projected water stress of supply.ResultsBetween 1988 and 2018, The Gambia's supply of cereals, fruits, vegetables and pulses diversified, with the proportion domestically produced falling (Cereals: 61.4%–27.7%; Fruits: 93.0%–55.7%; Vegetables: 24.6%–16.3%; Pulses: 100.0%–76.0%). The weighted-average ND-GAIN scores improved (indicating less climate vulnerability) for supply of all crops except cereals, but the weighted-average WRI score for supply deteriorated (indicating increased projected water stress) for all crops except vegetables. When just considering imports, weighted-average ND-GAIN scores deteriorated for fruits and cereals while showing no significant change for other food groups, and the WRI score deteriorated for cereals only.ConclusionsDespite some notable improvements in the environmental vulnerability of The Gambia's supply of nutritionally important crops (particularly vegetables), considerable, and in some cases increasing, proportions of their supply are produced in countries that are vulnerable to climate change and future water stress. This may have implications for the availability, affordability, and hence consumption of these crops in The Gambia, ultimately exacerbating existing nutritional challenges. Exploring the options to strengthen supply resilience—such as altering trade patterns, agricultural techniques and diets—should be prioritized.