Search

Background: Prolonged intubation following lung transplantation is thought to delay recovery, yet a paucity of data exists regarding risk factors and outcomes related to extubation failure. Methods: We performed a single-center, retrospective analysis of 238 lung transplant recipients between January 1, 2018, and December 31, 2022, to identify risk factors for extubation failure (intubation greater than 3 days, reintubation, and/or need for tracheostomy). We also assessed short-term outcomes relative to extubation success. Results: In this cohort, 144 patients (60%) were extubated successfully while 94 patients experienced extubation failure; 10 (11%) were intubated greater than 3 days, 9 (9%) were reintubated, 34 (36%) required tracheostomy after reintubation, and 41 (44%) underwent empiric tracheostomy. Recipient height and female sex, lung allocation score, 6-minute walk distance, donor ischemic time, ex-vivo perfusion, donor smoking history, intraoperative transfused red blood cells (packed red blood cells (PRBCs)), primary graft dysfunction at time zero, and comatose sedation state at day 2 were associated with extubation failure on univariate analysis (all p

Goal: The American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) held a one-hour “Virtual Think Tank” (VTT) interactive session in 2020 for pharmacy educators interested in leadership development. The purpose of this study was to evaluate the quantitative and qualitative outcomes of this VTT. Methods: VTT attendees worked together in small groups created based on pre-selected common interest areas related to leadership development to create collaborative leadership initiative plans (CLIPs), which were ideas for new collaborative scholarly or programmatic initiatives. Principal findings: Quantitative outcomes of this VTT included statistically significant increases in positive perceptions toward the organization hosting the VTT regarding networking, scholarly collaboration, educational collaboration, and professional service opportunities, as well as significant improvements in attitudes regarding engagement with the sponsoring organization. Additionally, 18.4% of VTT attendees continued communicating with CLIP groups post-VTT and 13.2% of respondents indicated that they successfully implemented the CLIP ideas that were generated during the VTT. Qualitative outcomes included findings that the two most commonly encountered barriers were insufficient traction of the initial idea and lack of time (41.9% (n = 13) for both). Other barriers included lack of alignment with priorities at 12.9% (n = 4). Practical applications: This leadership VTT for pharmacy academicians led to development and implementation of important scholarly and programmatic outcomes, and fostered cross-institutional partnerships. Findings from this study evaluating a VTT provide a framework of expectations for other organizations seeking to implement a similar initiative.

OBJECTIVES:. For patients with acute respiratory distress syndrome (ARDS) receiving venovenous extracorporeal membrane oxygenation (ECMO) who develop acute kidney injury (AKI) requiring kidney replacement therapy (KRT), the inability to renally compensate for respiratory acidosis could result in increased sweep gas flow to normalize arterial pH. Our objective was to examine the relationship of serum bicarbonate levels, arterial pH, sweep gas flow, and Paco2. DESIGN:. This is a retrospective cohort study. We compared patients who received KRT while undergoing venovenous ECMO to patients who did not. SETTING:. Vanderbilt University Medical Center, February 2019 to February 2022. PATIENTS:. We examined data from adult patients receiving venovenous ECMO for ARDS. INTERVENTIONS:. Values for serum bicarbonate, arterial pH, Paco2, and sweep gas flow were collected daily from time of cannulation until the earlier of decannulation, 30 days, or death. MEASUREMENTS AND MAIN RESULTS:. Of the 126 patients included, 53 (42.1%) received KRT and 73 (57.9%) did not. In patients who received KRT, mean serum bicarbonate levels remained between 22 and 28 mmol/L throughout the study period. Patients who did not receive KRT experienced an increase in mean serum bicarbonate levels over time up to 40 mmol/L (mean difference = –4.4 mmol/L [95% CI, –6.3 to –2.5 mmol/L]; p < 0.0001). Mean values for Paco2 (–5.2 [95% CI, –8.8 to –1.7]; p = 0.004) and pH (–0.03 [95% CI, –0.03 to –0.02]; p < 0.0001) were lower in patients who received KRT than in patients who did not, despite higher sweep gas flow rates in patients who received KRT than in patients who did not (mean difference = 1.5 [95% CI, 0.8–2.3]; p < 0.001). CONCLUSIONS:. ARDS patients on venovenous ECMO with preserved kidney function experience an increase in bicarbonate concentration over time, compared to patients with AKI on KRT. Whether this increase in bicarbonate concentration increases pH, decreases sweep gas flow requirements, and facilitate weaning from venovenous ECMO requires examination in future research.

Studies of reward effects on behavior in adolescence typically rely on performance metrics that confound myriad cognitive and non-cognitive processes, making it challenging to determine which process is impacted by reward. The present longitudinal study applied the diffusion decision model to a reward task to isolate the influence of reward on response caution from influences of processing and motor speed. Participants completed three annual assessments from early to middle adolescence (N = 387, 55% female, M[subscript age] = 12.1 at Wave 1; M[subscript age] = 13.1 at Wave 2, M[subscript age] = 14.1 at Wave 3) and three annual assessments in late adolescence (M[subscript ages] = 17.8, 18.9, 19.9). At each assessment, participants completed a two-choice reaction time task under conditions of no-reward and a block in which points were awarded for speeded accuracy. Reward reduced response caution at all waves, as expected, but had a greater impact as teens moved from early to middle adolescence. Simulations to identify optimal response caution showed that teens were overly cautious in early adolescence but became too focused on speed over accuracy by middle adolescence. By late adolescence, participants adopted response styles that maximized reward. Further, response style was associated with both internalizing and externalizing symptoms in early-to-middle adolescence, providing evidence for the construct validity of a diffusion model approach in this developmental period.

Background In March 2021, the United States Food and Drug Administration (FDA) safety communication cautioned against the use of acellular dermal matrix (ADM) products in breast reconstruction and reiterated that the FDA does not approve ADM use in breast surgery. This study aims to assess the safety of ADM use in breast reconstruction. Methods Women who underwent ADM and non-ADM assisted tissue expander (TE)-based breast reconstruction were identified using the National Surgical Quality Improvement Program database (2012–2019). Trends of ADM use over time, and 30-day outcomes of surgical site infection (SSI), dehiscence, and unplanned reoperation were assessed. Results Of the 49,049 TE-based breast reconstructive cases, 42.4% were ADM assisted and 57.6% non-ADM assisted. From 2012 to 2019, the use of ADM increased from 26.1 to 55.6% (relative risk [RR] =1.10; p

Background and aim: Epidemiological studies conducted mostly in low- and middle-income countries have found a positive association between household combustion of wood and lung cancer. However, most studies have been retrospective, and few have been conducted in the United States where indoor wood-burning usage patterns differ. We examined the association of exposure to indoor wood smoke from fireplaces and stoves with incident lung cancer in a U.S.-wide cohort of women. Methods: We included 50,226 women without prior lung cancer participating in the U.S.-based prospective Sister Study. At enrollment (2003–2009), women reported frequency of use of wood-burning stoves and/or fireplaces in their longest-lived adult residence. Cox regression was used to estimate adjusted hazard ratios (HRadj) and 95 % confidence intervals (CI) for the association between indoor wood-burning fireplace/stove use and incident lung cancer. Lung cancer was self-reported and confirmed with medical records. Results: During an average 11.3 years of follow-up, 347 medically confirmed lung cancer cases accrued. Overall, 62.3 % of the study population reported the presence of an indoor wood-burning fireplace/stove at their longest-lived adult residence and 20.6 % reported annual usage of ≥30 days/year. Compared to those without a wood-burning fireplace/stove, women who used their wood-burning fireplace/stove ≥30 days/year had an elevated rate of lung cancer (HRadj = 1.68; 95 % CI = 1.27, 2.20). In never smokers, positive associations were seen for use 1–29 days/year (HRadj = 1.64; 95 % CI = 0.87, 3.10) and ≥30 days/year (HRadj = 1.99; 95 % CI = 1.02, 3.89). Associations were also elevated across all income groups, in Northeastern, Western or Midwestern U.S. regions, and among those who lived in urban or rural/small town settings. Conclusions: Our prospective analysis of a cohort of U.S. women found that increasing frequency of wood-burning indoor fireplace/stove usage was associated with incident lung cancer, even among never smokers.

Background The coronavirus disease 2019 (COVID-19) global pandemic prompted an unprecedented contraction in surgical volume. This utilizes the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database to assess the impact of COVID-19 on breast reconstruction surgery volume and quality throughout 2020. Methods The NSQIP database was utilized to gather data from 2015 to 2020. We provide descriptive statistics in the form of mean (standard deviation), median (interquartile range), and range for continuous variables and counts (%) for categorical variables. A Kruskal–Wallis test was used to compare average age and a chi-squared test was used to compare other demographic categorical variables from 2019 to 2020. Results Breast reconstruction procedures decreased by 27% in Q2 2020 compared to Q2 of 2019. Immediate tissue-expander-based reconstruction was the only type of reconstruction that increased in comparison to Q2 2019 values (53.5 vs. 41.1%, p

Seed dormancy often hinders direct seeding efforts that are attempting to restore degraded landscapes. Gibberellic acid (GA3) can be applied to physiologically dormant seeds to induce germination, but this hormone is rarely effective, as it can degrade or be leached from the seed. We tested different polymer matrixes (polylactic acid, polyvinylpyrrolidone, and ethylcellulose) to apply and slowly release GA3 to the seed. These polymers were tested as seed coatings in either a powder, liquid, or a combination of powder and liquid forms. We found that a liquid ethylcellulose/GA3 coating generally outperformed the other polymers and applications methods using our test species Penstemon palmeri. With this top-performing treatment, seed germination was 3.0- and 3.9-fold higher at 15 °C and 25 °C, respectively. We also evaluated the liquid ethylcellulose/GA3 coating on P. comharrenus, P. strictus, P. pachyphyllus, and P. eatonii. Again, the coating had a strong treatment response, with the degree of difference related to the relative level of dormancy of the species. Growth studies were also performed in pots to ensure that the side effects of GA3 overdosing were not present. Here, we found minimal differences in root length, shoot length, or biomass between plants grown from untreated and GA3-coated seeds.

Introduction and objectiveSystematic review tools that provide guidance on evaluating epidemiology studies are receiving increasing attention and support because their application facilitates improved quality of the review, consistency across reviewers, and transparency for readers. The U.S. Environmental Protection Agency's Integrated Risk Information System (IRIS) Program has developed an approach for systematic review of evidence of health effects from chemical exposures that includes structured approaches for literature search and screening, study evaluation, data extraction, and evidence synthesis and integration. This approach recognizes the need for developing outcome-specific criteria for study evaluation. Because studies are assessed at the outcome level, a study could be considered high quality for one investigated outcome, and low quality for another, due to differences in the outcome measures, analytic strategies, how relevant a certain bias is to the outcome, and how the exposure measure relates to the outcome. The objective of this paper is to illustrate the need for outcome-specific criteria in study evaluation or risk of bias evaluation, describe the process we used to develop the criteria, and summarize the resulting criteria.MethodsWe used a process of expert consultation to develop several sets of outcome-specific criteria to guide study reviewers, improve consistency, and ensure consideration of critical issues specific to the outcomes. The criteria were developed using the following domains: outcome assessment, exposure measurement (specifically timing of exposure in relation to outcome; other exposure measurement issues would be addressed in exposure-specific criteria), participant selection, confounding, analysis, and sensitivity (the study's ability to detect a true effect or hazard).ResultsWe discuss the application of this process to pregnancy-related outcomes (preterm birth, spontaneous abortion), other reproductive-related outcomes (male reproductive hormones, sperm parameters, time to pregnancy, pubertal development), chronic disease (diabetes, insulin resistance), and acute or episodic conditions (asthma, allergies), and provide examples of the criteria developed. For each outcome the most influential methodological considerations are highlighted including biological sample collection and quality control, sensitivity and specificity of ascertainment tools, optimal timing for recruitment into the study (e.g., preconception, specific trimesters), the etiologically relevant window for exposure assessments, and important potential confounders.ConclusionsOutcome-specific criteria are an important part of a systematic review and will facilitate study evaluations by epidemiologists with experience in evaluating studies using systematic review methods who may not have extensive discipline-specific experience in the outcomes being reviewed.

Robust driver attention prediction for critical situations is a challenging computer vision problem, yet essential for autonomous driving. Because critical driving moments are so rare, collecting enough data for these situations is difficult with the conventional in-car data collection protocol—tracking eye movements during driving. Here, we first propose a new in-lab driver attention collection protocol and introduce a new driver attention dataset, Berkeley DeepDrive Attention (BDD-A) dataset, which is built upon braking event videos selected from a large-scale, crowd-sourced driving video dataset. We further propose Human Weighted Sampling (HWS) method, which uses human gaze behavior to identify crucial frames of a driving dataset and weights them heavily during model training. With our dataset and HWS, we built a driver attention prediction model that outperforms the state-of-the-art and demonstrates sophisticated behaviors, like attending to crossing pedestrians but not giving false alarms to pedestrians safely walking on the sidewalk. Its prediction results are nearly indistinguishable from ground-truth to humans. Although only being trained with our in-lab attention data, the model also predicts in-car driver attention data of routine driving with state-of-the-art accuracy. This result not only demonstrates the performance of our model but also proves the validity and usefulness of our dataset and data collection protocol.

IntroductionConcussion in children and adolescents is a public health concern with higher concussion incidence than adults and increased susceptibility to axonal injury. The corpus callosum is a vulnerable location of concussion-related white matter damage that can be associated with short- and long-term effects of concussion. Interhemispheric transfer time (IHTT) of visual information across the corpus callosum can be used as a direct measure of corpus callosum functioning that may be impacted by adolescent concussion with slower IHTT relative to matched controls. Longitudinal studies and studies testing physiological measures of IHTT following concussion in adolescents are lacking.MethodsWe used the N1 and P1 components of the scalp-recorded brain event-related potential (ERP) to measure IHTT in 20 adolescents (ages 12–19 years old) with confirmed concussion and 16 neurologically-healthy control participants within 3 weeks of concussion (subacute stage) and approximately 10 months after injury (longitudinal).ResultsSeparate two-group (concussion, control) by two-time (3 weeks, 10 months) repeated measures ANOVAs on difference response times and IHTT latencies of the P1 and N1 components showed no significant differences by group (ps ≥ 0.25) nor by time (ps ≥ 0.64), with no significant interactions (ps ≥ 0.15).DiscussionResults from the current sample suggest that measures of IHTT may not be strongly influenced at 3 weeks or longitudinally following adolescent concussion using the current IHTT paradigm.

This paper is a systematic replication of a previous study performed by Alber-Morgan et al. (2007) to examine the effects of repeated reading with systematic error correction (SEC) procedures to increase the reading fluency and comprehension skills of three elementary students with mild intellectual disability and other comorbid disorders. A multiple probe across participants design (Horner and Baer 1978) was used to determine the effectiveness of the repeated reading intervention. During the baseline phase, the students read a passage aloud and orally answered comprehension questions. In the intervention phase, the students first read a passage aloud and received SEC, then completed two timed oral readings of the same passage, and answered comprehension questions. Baseline procedures were reintroduced in the maintenance phase. Results indicated that the use of the repeated reading with SEC intervention was effective to increase students' reading fluency skills; however, no consistent gains were shown that suggested the strategy fostered the students' comprehension skills. Limitations of the study, implications for the classroom, and future research directions are provided.

The American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) created a Virtual Social Networking Hour (VSNH). The VSNH explored pharmacy leadership educators' connections through discussing topics of interest that influence current teaching and scholarship practices. The VSNH also served to connect members in the LD SIG through informal networking, which was vital during a time when in-person connection was heavily restricted due to the COVID-19 global pandemic. The VSNH functioned as both a space for members to connect with LD SIG leadership and other members of the LD SIG and a tool to areas of leadership development the SIG should explore in future programming. Each of the four sessions included a skeleton structure that grew organically based on the conversations of the attendees. Common themes of scholarship, adaptation to a virtual landscape, leadership, and student-focused endeavors were interwoven across all four sessions. The VSNHs have since become an integral component in LD SIG Programming.

BackgroundGlycolysis breakdowns glucose into essential building blocks and ATP/NAD(P)H for the cell, occupying a central role in its growth and bio-production. Among glycolytic pathways, the Entner Doudoroff pathway (EDP) is a more thermodynamically favorable pathway with fewer enzymatic steps than either the Embden-Meyerhof-Parnas pathway (EMPP) or the oxidative pentose phosphate pathway (OPPP). However, Escherichia coli do not use their native EDP for glucose metabolism.ResultsOverexpression of edd and eda in E. coli to enhance EDP activity resulted in only a small shift in the flux directed through the EDP (~20 % of glycolysis flux). Disrupting the EMPP by phosphofructokinase I (pfkA) knockout increased flux through OPPP (~60 % of glycolysis flux) and the native EDP (~14 % of glycolysis flux), while overexpressing edd and eda in this ΔpfkA mutant directed ~70 % of glycolytic flux through the EDP. The downregulation of EMPP via the pfkA deletion significantly decreased the growth rate, while EDP overexpression in the ΔpfkA mutant failed to improve its growth rates due to metabolic burden. However, the reorganization of E. coli glycolytic strategies did reduce glucose catabolite repression. The ΔpfkA mutant in glucose medium was able to cometabolize acetate via the citric acid cycle and gluconeogenesis, while EDP overexpression in the ΔpfkA mutant repressed acetate flux toward gluconeogenesis. Moreover, 13C-pulse experiments in the ΔpfkA mutants showed unsequential labeling dynamics in glycolysis intermediates, possibly suggesting metabolite channeling (metabolites in glycolysis are pass from enzyme to enzyme without fully equilibrating within the cytosol medium).ConclusionsWe engineered E. coli to redistribute its native glycolytic flux. The replacement of EMPP by EDP did not improve E. coli glucose utilization or biomass growth, but alleviated catabolite repression. More importantly, our results supported the hypothesis of channeling in the glycolytic pathways, a potentially overlooked mechanism for regulating glucose catabolism and coutilization of other substrates. The presence of channeling in native pathways, if proven true, would affect synthetic biology applications and metabolic modeling.

The AACP Leadership Development Special Interest Group (LD SIG) held a one-hour Virtual Networking Session during the American Association of Colleges of Pharmacy (AACP) 2020 Annual Meeting. The purpose of the session was to connect attendees with colleagues from other institutions sharing similar interests related to leadership development through an engaging “Virtual Think Tank” (VTT). The VTT included facilitated collaboration which enabled small groups to develop “Collaborative Leadership Initiative Plans” (CLIPs) based on shared leadership interest areas. A CLIP is an idea for a multi-institutional programmatic or scholarly initiative that is expected to lead to deliverables or outcomes mutually beneficial for all collaborators. Facilitators then assisted the CLIP groups with identifying specific deliverables and potential outcomes of successful implementation, as well as a plan for group follow-up. Seventy-two attendees from 55 unique institutions participated to form seven CLIP groups consisting of an average of ten individuals each. CLIP ideas generated included an initiative to align faculty tenure and promotion criteria to incentivize entrepreneurship and innovation among faculty, incorporation of a leadership project into Advanced Pharmacy Practice Experiences in the experiential pharmacy curriculum, and creation of a cross-institutional co-curricular program for students. An important legacy of the session was a leadership networking contact list, called the Leadership Networking Database, which will serve as an enduring leadership networking tool. This session offered an innovative solution to a canceled in-person professional meeting and replaced missed networking and collaboration opportunities resulting from cancellation of the in-person meeting.

Abstract Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1

Background: This study explored the way families support self-determination in young adults with intellectual and developmental disabilities (IDD) during life transitions. Method: Qualitative case studies were conducted with two Canadian families who participated in semi-structured interviews and ethnographic observations every quarter for one year. Analyses were informed by family systems theory and self-determination theory. Findings: Families considered the needs and preferences of the young adults with IDD, suggesting individualized approaches for balancing independence and protection. Families set short-term and long-term goals for increased independence, scaffolded the learning of new skills and collaborated on important choices. Collaboration occurred to the extent that all family members perceived agency in planning and implementing transitions. Conclusions: Families supported the young adults with IDD in their psychological needs for competence, relatedness and autonomy, which allowed them to experience self-determination. Findings have implications for supporting self-determination and transition planning in the family system.

Neonicotinoid insecticide seed treatments are commonly used in rice (Oryza sativa) production to control rice water weevil (Lisorhoptrus oryzophilus). With the use of neonicotinoid seed treatments, there is potential that honey bees (Apis mellifera) could be exposed to neonicotinoids through translocation to the pollen. Studies were conducted in 2015 and 2016 to determine the level of neonicotinoids present in flag leaves, pollen, and grain of rice. Thiamethoxam was applied as a seed treatment and foliar prior to flooding. Clothianidin was applied as a seed treatment and as a foliar at a preflood and postflood timing. Subsamples of flag leaves, pollen, and grain were analyzed for positive neonicotinoid detections and abundance. Thiamethoxam was detected in 8.9% of samples and clothianidin was detected in 1.4% of samples. For both thiamethoxam and clothianidin, more positive samples were observed in flag leaf samples than in pollen or grain. An average of 4.30 ng/g of thiamethoxam was detected in flag leaves from seed-applied thiamethoxam. An average of 1.25 ng/g of clothianidin was found in flag leaves from a preflood application of clothianidin. A survey of honey bees present in rice fields was conducted in Mississippi and Arkansas to determine the abundance of honey bees present in rice fields based on the time of day. Honey bee densities were low in rice, with less than 5% and 3% positive detections observed in Mississippi and Arkansas, respectively. More positive detections and higher densities of honey bees were observed for mid-day sampling than for morning or evening sampling. [ABSTRACT FROM AUTHOR]

Abstract Background Radiation-induced brain injury is a common concern for survivors of adult and pediatric brain cancer. Pre-clinically, rodent models are the standard approach to evaluate mechanisms of injury and test new therapeutics for this condition. However, these rodent models fail to recapitulate the radiological and histological characteristics of the clinical disease. Methods Here we describe a hemispheric mini-pig model of radiation-induced brain injury generated with a clinical 6 MV photon irradiator and evaluated with a clinical 3T MRI. Two pairs of Yucatan mini-pigs each received either 15 Gy or 25 Gy to the left brain hemisphere. Quality of intensity modulated radiation therapy treatment plans was evaluated retrospectively with parameters reported according to ICRU guidelines. The pigs were observed weekly to check for any outright signs of neurological impairment. The pigs underwent anatomical MRI examination before irradiation and up to 6 months post-irradiation. Immediately after the last imaging time point, the pigs were euthanized and their brains were collected for histopathological assessment. Results Analysis of the dose volume histograms showed that 93% of the prescribed dose was delivered to at least 93% of the target volume in the left hemisphere. Organs at risk excluded from the target volume received doses below clinical safety thresholds. For the pigs that received a 25 Gy dose, progressive neurological impairment was observed starting at 2 months post-irradiation leading to the need for euthanasia by 3–4 months. On MRI, these two animals presented with diffuse white matter pathology consistent with the human disease that progressed to outright radiation necrosis and severe brain swelling. Histology was consistent with the final MRI evaluation. The pigs that received a 15 Gy dose appeared normal all the way to 6 months post-irradiation with no obvious neurological impairment or lesions on MRI or histopathology. Conclusion Based on our results, a mini-pig model of radiation-induced brain injury is feasible though some optimization is still needed. The mini-pig model produced lesions on MRI that are consistent with the human disease and which are not seen in rodent models. Our data shows that the ideal radiation dose for this model likely lies between 15 and 25 Gy.