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Emerging infectious diseases with zoonotic potential often have complex socioecological dynamics and limited ecological data, requiring integration of epidemiological modeling with surveillance. Although our understanding of SARS-CoV-2 has advanced considerably since its detection in late 2019, the factors influencing its introduction and transmission in wildlife hosts, particularly white-tailed deer (Odocoileus virginianus), remain poorly understood. We use a Susceptible-Infected-Recovered-Susceptible epidemiological model to investigate the spillover risk and transmission dynamics of SARS-CoV-2 in wild and captive white-tailed deer populations across various simulated scenarios. We found that captive scenarios pose a higher risk of SARS-CoV-2 introduction from humans into deer herds and subsequent transmission among deer, compared to wild herds. However, even in wild herds, the transmission risk is often substantial enough to sustain infections. Furthermore, we demonstrate that the strength of introduction from humans influences outbreak characteristics only to a certain extent. Transmission among deer was frequently sufficient for widespread outbreaks in deer populations, regardless of the initial level of introduction. We also explore the potential for fence line interactions between captive and wild deer to elevate outbreak metrics in wild herds that have the lowest risk of introduction and sustained transmission. Our results indicate that SARS-CoV-2 could be introduced and maintained in deer herds across a range of circumstances based on testing a range of introduction and transmission risks in various captive and wild scenarios. Our approach and findings will aid One Health strategies that mitigate persistent SARS-CoV-2 outbreaks in white-tailed deer populations and potential spillback to humans. Author summary: Novel zoonotic diseases persist and evolve in both human and non-human hosts, posing challenges for human and animal health. SARS-CoV-2, the virus responsible for the COVID-19 pandemic in humans, has been detected in white-tailed deer (Odocoileus virginianus) yet we have limited understanding of its introduction and transmission within deer populations. Here, we use epidemiological models to describe SARS-CoV-2 introduction and transmission patterns within wild and captive white-tailed deer populations. We found that captive deer herds faced a higher risk of spillover of SARS-CoV-2 from humans and higher transmission rate compared to wild deer. Despite these differences in wild and captive contexts, we found that transmission in both wild and captive contexts often resulted in persisting circulation of SARS-CoV-2. This circulation was determined by deer-deer transmission in both wild and captive contexts, rather than by high rates of introduction from humans. Outbreaks in wild populations were greater when these animals could interact with captive deer populations circulating SARS-CoV-2. SARS-CoV-2 appears to circulate in both captive and wild deer across a range of circumstances. Our findings help to inform how to best mitigate the introduction and spread of SARS-CoV-2 in deer, with benefits to protecting human health. [ABSTRACT FROM AUTHOR]

BACKGROUND Reconstruction of lower lip defects is challenging because of the functional and aesthetic demands of the lower face. We review the functional and aesthetic outcomes of the Karapandzic-type flaps for reconstructing lower lip defects. METHODS A retrospective review of patients who underwent repair using Karapandzic-type flaps. RESULTS Fifty patients with lower lip defects ranging from 20% to 95% (mean 59.2% 6 20%) were included. Eighteen patients (36%) were repaired using a bilateral flap, and 32 (64%) were reconstructed using a unilateral flap design. All patients had preservation of oral competency and a satisfactory aesthetic result. No patient complained of microstomia. A complication rate of 8% was noted (n 5 4) with postoperative wound infection and small areas of dehiscence. There was no statistically significant difference in complication rates in patients older than 75 years, in patients with a history of head/neck radiation, or in defects greater than 70% of lower lip breadth. CONCLUSION Karapandzic-type flaps are versatile and reliable for the reconstruction of a broad range of lower lip defects. This one-stage procedure can produce superior functional and aesthetic results as compared with other local and distant flaps with minimal risk of functional microstomia. [ABSTRACT FROM AUTHOR]

The effect of the discretization of geothermal boreholes on the accuracy of g-function evaluations is studied. A data set of 557,056 bore field configurations covering a large range of geometrical parameters is generated using pygfunction. A nonuniform discretization of borehole segments geometrically expanding in length toward the middle of the borehole is proposed. A nonuniform discretization is shown to achieve better accuracy than a uniform discretization. The nonuniform discretization is optimized to minimize the maximum absolute percentage error over the entire data set. The discretization is optimized for each bore field configuration, and an artificial neural network (ANN) is trained to predict the optimal discretization given only geometrical and thermal parameters of the boreholes, excluding the borehole positions. Thermal parameters that quantify the bore field temperature distribution are introduced as inputs to the ANN. The maximum absolute percentage error using a uniform discretization is 99.0% in the worst studied case of a dense rectangular field of Nb = 1116 boreholes with lengths of 418.8 m and spacings of 3.14 m and 3.18 m along rows and columns, while only 1% of the cases feature an error above 26.7%. The error is reduced to 3.6% using the global optimal discretization and 3.3% using the ANN. [ABSTRACT FROM AUTHOR]

The document is a response to a letter from Wong regarding the determination of the target difference in sample size calculations for randomized controlled trials (RCTs). The authors agree with Wong on certain practical points, such as the challenges in estimation and the impact of the trial context. They argue that the importance of the target difference value should be considered when determining the sample size for a phase III RCT, but it does not always have to be the minimum important difference (MID). They also discuss the problematic nature of the "true benefit" approach and the potential biases in relying solely on prior evidence for sample size calculations. The authors suggest that consideration of both prior evidence and what is desirable to detect is relevant for a phase III trial. They propose a framework that can be implemented in both frequentist and Bayesian paradigms, emphasizing the importance of the target difference regardless of the chosen framework. [Extracted from the article]

We conducted a series of tests on the FORensic oUtcome Measure (FORUM), a novel tool for measuring outcomes in forensic mental health services, which consists of complementary patient-reported (FORUM-P) and clinician-reported instruments (FORUM-C). Inpatients and outpatients at a UK forensic psychiatric regional service completed the FORUM-P and members of their clinical teams completed the FORUM-C. Patients and clinicians also provided qualitative feedback on the instruments. We assessed test-retest and inter-rater reliability in standard ways. Sixty-two patients participated with a mean age of 41.0 years (standard deviation 11.3). Thirty-five clinicians provided information about these patients. For internal consistency, Cronbach's alpha for FORUM-P was 0.87 (95% confidence interval 0.80–0.93) and for FORUM-C was 0.93 (95% confidence interval 0.91–0.96). For test-retest reliability, weighted kappa for FORUM-P was 0.44 (95% confidence interval 0.24–0.63) and for FORUM-C was 0.78 (95% confidence interval 0.73–0.85). For inter-rater reliability, Spearman correlation coefficient for overall FORUM-C score between the first rating by clinician 1 and clinician 2 was 0.47 (95% confidence interval 0.18–0.69). For comprehensiveness, comprehensibility, and relevance FORUM-P and FORUM-C were both rated as good. FORUM-P and FORUM-C provide a novel, robust set of complementary instruments with promising psychometric properties for monitoring outcomes in forensic mental health. [ABSTRACT FROM AUTHOR]

Background: High participant retention enhances the validity of clinical trials. A monetary incentive can increase retention, but it is not known if when it is provided and if it is conditional matters. We aimed to determine whether there was a difference in the number of follow-up trial questionnaires returned when a monetary (gift voucher) incentive was given to participants at recruitment (non-conditional), compared to informing participants at recruitment that the incentive would be given only once their 14-day daily diary (questionnaire) had been returned (conditional). Method: A cluster randomised study within a trial embedded within the Antivirals for influenza-Like Illness, An rCt of Clinical and Cost effectiveness in primary CarE (ALIC4E) Trial. Matched site pairs (GP practices) were randomised using computer-generated random numbers, to either a non-conditional or conditional monetary voucher incentive (only once their 14-day daily diary (questionnaire) had been returned. Sites were matched on previous recruitment levels and practice list size. Analyses were conducted according to randomised groups irrespective of compliance with a two-sided 5% level statistical significance level. The main analysis of the primary outcome (site proportion of diaries returned) was linear regression accounting for site pair (using cluster-robust variance). Additional weighted, paired and non-parametric sensitivity analyses were conducted. Secondary outcomes were the site average number of completed pages, time to return diary, and cost related to the incentive (administration and postage). Results: Of the 42 randomised sites (21 for each intervention), only 28 recruited at least one participant with only 10 practice pairs recruiting participants at both constituent sites. Raw diaries return proportions were 0.58 (127/220) and 0.73 (91/125) for non-conditional and conditional incentive groups. Regression analysis adjusted for site pair showed no significant difference in returns, − 0.09, (95% CI, − 0.29, 0.10, p = 0.34); when weighted, there was still no clear difference: 0.15 (95% CI, − 0.02, 0.31, p = 0.07). There was no clear statistical evidence of a difference in time taken to return questionnaires, nor the proportion of pages completed, by the intervention group in the main analyses (all p > 0.05). The conditional incentive was approximately £23 cheaper per diary returned based upon observed data. Conclusion: There was no clear evidence of a statistically significant difference in the proportion of participant-completed diaries returned between conditional or non-conditional incentive groups. The time to questionnaire return and completeness of the returned questionnaires were similar in both groups. There was substantial statistical uncertainty in the findings. Some of the sensitivity analyses suggested that a meaningful benefit of a conditional incentive of a magnitude that would be meaningful was plausible. The conditional approach costs less in cash terms. [ABSTRACT FROM AUTHOR]

Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making. [ABSTRACT FROM AUTHOR]

Recently, it was argued that clinically important differences should play no role in sample size calculations. Instead, it was proposed that sample size calculations should focus on setting realistic estimates of treatment benefit. We disagree, and argue in this article that considering the importance of a target difference is necessary in the context of randomised controlled trials of effectiveness, particularly definitive phase III trials. Ignoring clinical importance could have serious ethical and practical consequences. [ABSTRACT FROM AUTHOR]

AmiA and AmiB are peptidoglycan-hydrolyzing enzymes from Escherichia coli that are required to break the peptidoglycan layer during bacterial cell division and maintain integrity of the cell envelope. In vivo, the activity of AmiA and AmiB is tightly controlled through their interactions with the membrane-bound FtsEX-EnvC complex. Activation of AmiA and AmiB requires access to a groove in the amidase-activating LytM domain of EnvC which is gated by ATP-driven conformational changes in FtsEX-EnvC complex. Here, we present a high-resolution structure of the isolated AmiA protein, confirming that it is autoinhibited in the same manner as AmiB and AmiC, and a complex of the AmiB enzymatic domain bound to the activating EnvC LytM domain. In isolation, the active site of AmiA is blocked by an autoinhibitory helix that binds directly to the catalytic zinc and fills the volume expected to accommodate peptidoglycan binding. In the complex, binding of the EnvC LytM domain induces a conformational change that displaces the amidase autoinhibitory helix and reorganizes the active site for activity. Our structures, together with complementary mutagenesis work, defines the conformational changes required to activate AmiA and/or AmiB through their interaction with their cognate activator EnvC. [ABSTRACT FROM AUTHOR]

David B. Diamond, Psychoanalytic Readings of Hawthorne's Romances: Narratives of Unconscious Crisis and Transformation Although the fiction of Nathaniel Hawthorne is known for the acuity of its psychological insights, surprisingly few critical studies have addressed this topic beyond exploring the pervasive presence of the Puritan doctrine of original sin and its varied psychological sources and consequences. As someone writing from outside the literary academy, Diamond is unburdened by the need to employ current critical jargon or to kowtow to established Hawthorne scholars, whose interpretations of Hawthorne's writings he carefully critiques and sometimes unabashedly rejects for their shortcomings. In the end, Hester's return to Boston allows her to provide advice and assistance to other women facing the emotional trials of their constricted social world; as Diamond notes, "every aspect of her life in Boston indicates that Hester has taken to heart the religious guidance Dimmesdale imparted to her on the scaffold" (p. 175). [Extracted from the article]

Forensic mental health services provide care to people in secure psychiatric hospitals and via specialised community teams. Such services are typically low volume and high cost, often highly restrictive and average duration of inpatient care prior to discharge is long. Measuring outcomes of care is important to safeguard patients and the public, monitor progress, inform treatment plans and assist in service evaluation and planning. We describe the development in England of a new outcome measure for forensic mental health services. Patient interviews and multi-stakeholder focus groups were held to elicit key concepts. Thematic analysis was used to develop an outcomes framework. Fifteen patients participated in the interviews and 48 stakeholders in the focus groups. Six domains were identified in thematic analysis: 'about me, my quality of life, my health, my safety and risk, my life skills and my progress'. Sixty-two stakeholders participated in the first round of the Delphi process, and 49 completed round two. Eight of the top fifteen outcomes were shared between patients/carers and professionals. Based on these results, a new outcome measure, the FORensic oUtcome Measure (FORUM), was developed including both a patient reported and clinician reported measure. Further assessment of the FORUM's use to track patients' progress over time, and facilitate shared decision-making and care planning, is required. [ABSTRACT FROM AUTHOR]

Diseases spread and persist according to complex interactions among hosts, pathogens, and their shared environments. In actively managed wildlife diseases, unanticipated disease spread and persistence can challenge mitigation efforts, necessitating modeling approaches that elucidate and integrate multiple mechanisms. Dynamic occupancy models (DOMs) can predict and forecast species occurrence patterns; however, they have not been extended to explain the complex spread and persistence patterns of chronic wasting disease (CWD). We used a DOM to predict and forecast the persistence, and localized and long‐distance spread of CWD in white‐tailed deer (Odocoileus virginianus) according to distinct ecological relationships that we hypothesized were important. We estimated large differences between the probabilities of disease persistence and localized and long‐distance CWD spread in Wisconsin, USA. Chronic wasting disease was more likely to persist in areas with low clay content in soils, to spread locally as the amount of localized disease increased, and to occur in areas far removed from prior positives in places with a higher proportion of agriculture. Across all landscape compositions, the probability of occurrence decayed by distance from prior positives in a manner consistent with transient movement distances of white‐tailed deer. Finally, a multi‐mechanism DOM was able to produce spatially accurate predictions and forecasts of disease occurrence using only data collected during the first 2 days of the firearm harvest season. Thus, our multi‐mechanism DOM offers advantages over simple linear models that can improve our understanding of the complex ecology driving CWD dynamics and lead to better surveillance and management strategies moving forward. [ABSTRACT FROM AUTHOR]

A literary criticism of Herman Melville's novel "Moby-Dick" examines the theme of blasphemy within the framework of Anglo-American legal history. Topics discussed include Melville's challenge to traditional religious beliefs, the potential legal implications of his narrative choices, and notable blasphemy cases in nineteenth-century America and England.

Preventing wildlife disease outbreaks is a priority for natural resource agencies, and management decisions can be urgent, especially in epidemic circumstances. With the emergence of SARS‐CoV‐2, wildlife agencies were concerned whether the activities they authorize might increase the risk of viral transmission from humans to North American bats, but had a limited amount of time in which to make decisions. We describe how decision analysis provides a powerful framework to analyze and reanalyze complex natural resource management problems as knowledge evolves. Coupled with expert judgment and avenues for the rapid release of information, risk assessment can provide timely scientific information for evolving decisions. In April 2020, the first rapid risk assessment was conducted to evaluate the risk of transmission of SARS‐CoV‐2 from humans to North American bats. Based on the best available information and relying heavily on expert judgment, the risk assessment found a small possibility of transmission during summer work activities. Following that assessment, additional knowledge and data emerged, such as bat viral challenge studies, that further elucidated the risks of human‐to‐bat transmission and culminated in a second risk assessment in the fall of 2020. We updated the first SARS‐CoV‐2 risk assessment with new management alternatives and new estimates of little brown bat (Myotis lucifugus) susceptibility, using findings from the fall 2020 assessment and other empirical studies. We found that new knowledge led to an 88% decrease in the median number of bats estimated to be infected per 1,000 encountered when compared to earlier results. The use of facemasks during, or a negative COVID‐19 test or vaccination prior to, bat encounters further reduced those risks. Using a combination of decision analysis, expert judgment, rapid risk assessment, and efficient modes of information distribution, we provided timely science‐based support to decision makers for summer bat work in North America. [ABSTRACT FROM AUTHOR]

The article analyzes the double standard of Western media in their coverage of the conflicts in Ukraine and Gaza. It highlights the media's hypocrisy in praising the Ukrainian resistance and supporting the sending of weapons, but not showing the same sympathy for the Palestinian resistance in Gaza. Furthermore, it criticizes the media's lack of impartiality in not questioning the ethics of sending weapons to Ukraine. The article also criticizes the BBC's lack of impartiality in its coverage of Ukraine and points out the tendency of Western media to amplify the claims of the United States, Europe, and Israel without questioning their veracity. The author argues that Western media is promoting war and criticizes the media's hypocrisy in not questioning political figures like Condoleezza Rice. The article also criticizes the hypocritical stance of the United States in labeling Vladimir Putin as a war criminal, while American politicians like Joe Biden do not accept responsibility for the war crimes committed by their country. [Extracted from the article]

One of the most rational and successful ways to mitigate the effects of wildlife disease is to perform proactive management efforts that can either prevent disease prior to first exposure or detect and eradicate disease prior to its establishment. However, estimating the risk of wildlife disease in new locations is often challenged by a lack of tractable linkages between known or presumed disease hazards and comprehensive risk of introduction and spread. In this study, we present a low‐cost approach that estimated comprehensive risk of chronic wasting disease (CWD) in Michigan, United States, based on the localized knowledge of experts and the use of existing datasets. We controlled for sources of expert bias, avoided group conflict that may challenge qualitative risk assessments, and generated estimates of risk that aligned with known positives and can be used in targeted surveillance and mitigation efforts. We found that 97% of CWD detections fell within high risk counties, with only 3 out of 117 cases (3%) falling in counties at low risk. Furthermore, we found coherence between indirect expert‐elicited risk estimates and direct hazard rankings, suggesting that an indirect approach maximized expert knowledge sharing while controlling for sources of potential bias. Lastly, our approach required limited time commitment from group participants and thus, represented a low‐cost decision‐making approach. Taken together, our study may provide an opportunity to mount proactive wildlife disease management in a way that has often been promoted but rarely accomplished. [ABSTRACT FROM AUTHOR]

The early humoral immune response to acute HIV-1 infection is largely non-neutralizing. The principal target of these antibodies is the primary immunodominant region (PID) on the gp41 fusion protein. The PID is a highly conserved 15-residue region displayed on the surface of HIV-1 virions. In this study, we analyzed the humoral determinants of HIV-1 gp41 PID binding using biophysical, structural, and computational methods. In complex with a patient-derived near-germline antibody fragment, the PID motif adopts an elongated random coil, whereas the PID bound to affinity-matured Fab adopts a strand-turn-helix conformation. Molecular dynamics simulations showed that the PID is structurally plastic suggesting that the PID can form an ensemble of structural states recognized by various non-neutralizing antibodies, facilitating HIV-1 immunodominance observed in acute and chronic HIV-1 infections. An improved understanding of how the HIV-1 gp41 PID misdirects the early humoral response should guide the development of an effective HIV-1 vaccine. The 15-amino-acid primary immunodominant (PID) region on HIV-1 gp41 adopts an ensemble of conformational states. This conformational plasticity is suggested to misdirect the early humoral immune response. [ABSTRACT FROM AUTHOR]

This essay examines Moby-Dick as a mid-nineteenth-century fictional response to the Christian tradition of theodicy, or the attempt to justify the goodness and justice of God in the face of evil and unmerited human suffering. Given Moby-Dick 's grounding in the traditions of theodicy going back to the book of Job, it is a potentially revealing exercise to compare Melville's novel to more recent examples of this form of discursive analysis, which have greatly proliferated over the last half-century. By examining a representative sample of early twenty-first century Christian theodicies by writers of varying denominational backgrounds, I seek to demonstrate that Moby-Dick dramatizes many of the same issues as discussed by these works, but by framing the issues in narrative and dramatic form, Melville's novel becomes significantly more compelling as an extended exhibition of the problem of evil than any discursive rationalization of its existence within the confines of Christian dogmatism. [ABSTRACT FROM AUTHOR]

In this article, we present commands to enable fixing the value of the correlation between the unobservables in Heckman models. These commands can solve two practical issues. First, for situations in which a valid exclusion restriction is not available, these commands enable exploring how the results could be affected by sample-selection bias. Second, stepping through values of this correlation can verify whether the global maximum of the likelihood function has been found. We provide several commands to fit these and related models with a fixed value of the correlation between the unobservables. [ABSTRACT FROM AUTHOR]

Background: Measurement of outcomes in forensic mental health services is essential to ensure that these services are delivering good quality care and treatment. Instruments for outcome measurement should cover all important domains, be easy to implement in a routine clinical context and facilitate transfer of relevant information between clinicians as the patient progresses along a recovery and rehabilitation pathway. Aims: We sought the views of clinicians on 10 common instruments used as outcome measures in forensic mental health services, especially on their perceived comprehensiveness and ease of use. Methods: An online survey was used to gather the views of clinicians from a range of professional backgrounds working in forensic mental health services in the United Kingdom. The selected instruments were identified from a previous systematic review of instruments for measuring outcomes in this context. Questions covered comprehensiveness, ease of use, patient involvement, relevance and use for progressing tracking and care planning. Results: Complete responses were received from 229 individuals. The range of respondents either agreeing or strongly agreeing that individual instruments were comprehensive was 6–39%; easy to use 19%–69%; relevant 31%–78%; useful to measure progress 7–70%; and useful for care planning 33–81%. Respondents reported that, for each of the 10 instruments, full involvement of patients varied between 3% and 22%; partial involvement 12–45%, patients informed, but not involved 11%–28%; and patients not involved or informed 21%‐64%. Conclusions: The Health of the Nation Outcome Scale Secure, the only instrument designed as an outcome measure, is not regarded by clinicians as useful in that respect and the majority of clinicians do not inform patients they are using it. Clinicians appear most familiar with the Historical Clinical Risk 20 (HCR‐20), which some respondents considered potentially useful as a progress measure but with limited patient involvement. Most respondents did not think that the HCR‐20 is comprehensive. There is a need for outcome measures that are comprehensive, easy to use and have adequate patient involvement in their development and rating. [ABSTRACT FROM AUTHOR]

Adolescence can be a tumultuous period with numerous threats to self‐integrity. A 3‐year field experiment tested whether repeated affirmations of self‐integrity can help lessen the impact of psychological threat on adolescent (11–14 years old) students' core course GPA over time. A diverse cohort of students (N = 163) was randomly assigned to a control condition or to an affirmation condition, in which teachers repeatedly administered classroom writing exercises that affirmed students' personal values. Results showed that affirmation lessened a downward trajectory of GPA over time. In contrast to previous research, this effect occurred among all ethnic groups rather than only among stereotype‐threatened ethnic minority groups. Affirmation did not reduce self‐reported psychological threat, but it severed its relationship with performance: Among control students, psychological threat predicted lower GPA. Among affirmed students, psychological threat was unrelated to performance. Beyond their practical implications, these results make two theoretical contributions. First, affirmation can have broader benefits than those previously documented among negatively stereotyped groups, if timed to co‐occur with different sources of threat that emerge over a long developmental window. Second, the effect of affirmation may not be so much to reduce threat as to disrupt its adverse cognitive and motivational effects. [ABSTRACT FROM AUTHOR]

Background: A rotator cuff tear is a common disabling shoulder problem. Symptoms include pain, weakness, lack of mobility and sleep disturbance. Many patients require surgery to repair the tear; however, there is a high failure rate. There is a pressing need to improve the outcome of rotator cuff surgery. The use of patch augmentation to provide support to the healing process and improve patient outcomes holds new promise. Different materials (e.g. human/animal skin or intestine tissue, and completely synthetic materials) and processes (e.g. woven or a mesh) have been used to produce patches. However, clinical evidence on their use is limited. The patch augmented rotator cuff surgery (PARCS) feasibility study aimed to determine the design of a definitive randomised controlled trial (RCT) assessing the effectiveness and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and feasible. Methods: A mixed methods feasibility study of conducing a subsequent RCT. The project involved six stages: a systematic review of clinical evidence; a survey of the British Elbow and Shoulder Society's (BESS) surgical membership; a survey of surgeon trialists; focus groups and interviews with stakeholders; a two-round Delphi study administered via online questionnaires and a 2-day consensus meeting. Results: The BESS surgeons' survey identified a variety of patches in use (105 (21%) responses received). Twenty-four surgeons (77%) completed the trialist survey relating to trial design. Four focus groups were conducted involving 24 stakeholders. Twenty-nine (67% of invited) individuals took part in the Delphi. Differing views were held on a number of aspects including the appropriate patient population for trial participation. Agreement on the key research questions and the outline of two potential RCTs were achieved through the Delphi study and the consensus meeting. Conclusions: Randomised comparisons of on-lay patch use for completed rotator cuff repairs, and bridging patch use for partial rotator cuff repairs were identified as areas for further research. The value of an observational study to assess safety concerns of patch use was also highlighted. The main limitation was that the findings were influenced by the participants, who might not necessarily reflect all stakeholders. [ABSTRACT FROM AUTHOR]

The virus that causes COVID‐19 likely evolved in a mammalian host, possibly Old‐World bats, before adapting to humans, raising the question of whether reverse zoonotic transmission to bats is possible. Wildlife management agencies in North America are concerned that the activities they authorize could lead to transmission of SARS‐CoV‐2 to bats from humans. A rapid risk assessment conducted in April 2020 suggested that there was a small but significant possibility that SARS‐CoV‐2 could be transmitted from humans to bats during summer fieldwork, absent precautions. Subsequent challenge studies in a laboratory setting have shed new information on these risks, as has more detailed information on human epidemiology and transmission. This inquiry focuses on the risk to bats from winter fieldwork, specifically surveys of winter roosts and handling of bats to test for white‐nose syndrome or other research needs. We use an aerosol transmission model, with parameter estimates both from the literature and from formal expert judgment, to estimate the risk to three species of North American bats, as a function of several factors. We find that risks of transmission are lower than in the previous assessment and are notably affected by chamber volume and local prevalence of COVID‐19. Use of facemasks with high filtration efficiency or a negative COVID‐19 test before field surveys can reduce zoonotic risk by 65 to 88%. [ABSTRACT FROM AUTHOR]

The increasing diabetes prevalence and advent of new treatments for its major visual-threatening complications (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]), which require frequent life-long follow-up, have increased hospital demands markedly. Subsequent delays in patient's evaluation and treatment are causing sight loss. Strategies to increase capacity are needed urgently. The retinopathy (EMERALD) study tested diagnostic accuracy, acceptability, and costs of a new health care pathway for people with previously treated DME or PDR. Prospective, multicenter, case-referent, cross-sectional, diagnostic accuracy study undertaken in 13 hospitals in the United Kingdom. Adults with type 1 or 2 diabetes previously successfully treated DME or PDR who, at the time of enrollment, had active or inactive disease. A new health care pathway entailing multimodal imaging (spectral-domain OCT for DME, and 7-field Early Treatment Diabetic Retinopathy Study [ETDRS] and ultra-widefield [UWF] fundus images for PDR) interpreted by trained nonmedical staff (ophthalmic graders) to detect reactivation of disease was compared with the current standard care (face-to-face examination by ophthalmologists). Primary outcome: sensitivity of the new pathway. Secondary outcomes: specificity; agreement between pathways; costs; acceptability; proportions requiring subsequent ophthalmologist assessment, unable to undergo imaging, and with inadequate images or indeterminate findings. The new pathway showed sensitivity of 97% (95% confidence interval [CI], 92%–99%) and specificity of 31% (95% CI, 23%–40%) to detect DME. For PDR, sensitivity and specificity using 7-field ETDRS images (85% [95% CI, 77%–91%] and 48% [95% CI, 41%–56%], respectively) or UWF images (83% [95% CI, 75%–89%] and 54% [95% CI, 46%–61%], respectively) were comparable. For detection of high-risk PDR, sensitivity and specificity were higher when using UWF images (87% [95% CI, 78%–93%] and 49% [95% CI, 42%–56%], respectively, for UWF versus 80% [95% CI, 69–88%] and 40% [95% CI, 34%–47%], respectively, for 7-field ETDRS images). Participants preferred ophthalmologists' assessments; in their absence, they preferred immediate feedback by graders, maintaining periodic ophthalmologist evaluations. When compared with the current standard of care, the new pathway could save £1390 per 100 DME visits and between £461 and £1189 per 100 PDR visits. The new pathway has acceptable sensitivity and would release resources. Users' suggestions should guide implementation. [ABSTRACT FROM AUTHOR]

FtsEX is a bacterial ABC transporter that regulates the activity of periplasmic peptidoglycan amidases via its interaction with the murein hydrolase activator, EnvC. In Escherichia coli, FtsEX is required to separate daughter cells after cell division and for viability in low-osmolarity media. Both the ATPase activity of FtsEX and its periplasmic interaction with EnvC are required for amidase activation, but the process itself is poorly understood. Here we present the 2.1 Å structure of the FtsX periplasmic domain in complex with its periplasmic partner, EnvC. The EnvC-FtsX periplasmic domain complex has a 1-to-2 stoichiometry with two distinct FtsXbinding sites located within an antiparallel coiled coil domain of EnvC. Residues involved in amidase activation map to a previously identified groove in the EnvC LytM domain that is here found to be occluded by a "restraining arm" suggesting a self-inhibition mechanism. Mutational analysis, combined with bacterial twohybrid screens and in vivo functional assays, verifies the FtsEX residues required for EnvC binding and experimentally test a proposed mechanism for amidase activation. We also define a predicted link between FtsEX and integrity of the outer membrane. Both the ATPase activity of FtsEX and its periplasmic interaction with EnvC are required for resistance to membrane-attacking antibiotics and detergents to which E. coli would usually be considered intrinsically resistant. These structural and functional data provide compelling mechanistic insight into FtsEX-mediated regulation of EnvC and its downstream control of periplasmic peptidoglycan amidases. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) rupture is a common knee injury that can lead to poor quality of life, decreased activity and increased risk of secondary osteoarthritis of the knee. Management of patients with a non-acute ACL injury can include a non-surgical (rehabilitation) or surgical (reconstruction) approach. However, insufficient evidence to guide treatment selection has led to high variation in treatment choice for patients with non-acute presentation of ACL injury. The objective of the ACL SNNAP trial is to determine in patients with non-acute anterior cruciate ligament deficiency (ACLD) whether a strategy of non-surgical management (rehabilitation) (with option for later ACL reconstruction only if required) is more clinically effective and cost effective than a strategy of surgical management (reconstruction) without prior rehabilitation with all patients followed up at 18 months.Methods: The study is a pragmatic, multi-centre, superiority, randomised controlled trial with two-arm parallel groups and 1:1 allocation. Patients with a symptomatic non-acute ACL deficient knee will be randomised to either non-surgical management (rehabilitation) or surgical management (reconstruction). We aim to recruit 320 patients from approximately 30 secondary care orthopaedic units from across the United Kingdom. Randomisation will occur using a web-based randomisation system. Blinding of patients and clinicians to treatment allocation will not be possible because of the nature of the interventions. Participants will be followed up via self-reported questionnaires at 6, 12 and 18 months. The primary outcome is the Knee injury and Osteoarthritis Outcome Score (KOOS) at 18 months post randomisation. Secondary outcomes will include a return to sport/activity, intervention-related complications, patient satisfaction, expectations of activity, generic health quality of life, knee specific quality of life and resource usage.Discussion: At present, no evidence-based treatment of non-acute ACL deficiency exists, particularly in the NHS. Moreover, little consensus exists on the management approach for these patients. The proposed trial will address this gap in knowledge regarding the clinical and cost effectiveness of ACL treatment and inform future standards of care for this condition.Trial Registration: ISRCTN: 10110685. Registered on 16 November 2016. ClinicalTrials.gov: NCT02980367. Registered in December 2016. [ABSTRACT FROM AUTHOR]

For policymakers, an important long-run question related to the development of renewable industries is how government policies affect decisions regarding the scrapping or upgrading of existing assets. This paper develops a dynamic structural econometric model of wind turbine owners' decisions about whether and when to add new turbines to a pre-existing stock, scrap an existing turbine, or replace old turbines with newer versions (i.e., upgrade). We apply our model to owner-level panel data for Denmark over the period 1980-2011 to estimate the underlying profit structure for small wind producers (who constitute the vast majority of turbine owners in the Danish wind industry during this time period), and evaluate the impact of technology and government policy on wind industry development. Our structural econometric model explicitly takes into account the dynamics and interdependence of shutdown and upgrade decisions, and generates parameter estimates with direct economic interpretations. Results from the model indicate that the growth and development of the Danish wind industry were driven primarily by government policies as opposed to technological improvements. We use the parameter estimates to simulate counterfactual policy scenarios in order to analyze the relative effectiveness and cost-effectiveness of the Danish feed-in-tariff and replacement certificate programs. Results show that both of these policies significantly impacted the timing of shutdown and upgrade decisions made by small wind producers and accelerated the development of the wind industry in Denmark. We also find that when compared with the feed-in-tariff; a declining feed-in-tariff; and the replacement certificate program and the feed-in-tariff combined, the replacement certificate program was the most cost-effective policy both for increasing payoffs of small wind producers and also for decreasing carbon emissions. [ABSTRACT FROM AUTHOR]

Receiver operating characteristic (ROC) curves are commonly used to evaluate predictions of binary outcomes. When there is a small percentage of items of interest (as would be the case with fraud detection, for example), ROC curves can provide an inflated view of performance. This can cause challenges in determining which set of predictions is better. In this article, we discuss the conditions under which precision-recall curves may be preferable to ROC curves. As an illustrative example, we compare two commonly used fraud predictors (Beneish's [1999, Financial Analysts Journal 55: 24–36] M score and Dechow et al.'s [2011, Contemporary Accounting Research 28: 17–82] F score) using both ROC and precision-recall curves. To aid the reader with using precision-recall curves, we also introduce the command prcurve to plot them. [ABSTRACT FROM AUTHOR]

The article discusses two cases of facial nerve injury during nasal reconstruction surgery, resulting in lagophthalmos (inability to close the eyelids completely). The patients experienced temporary upper eyelid dysfunction, which was managed conservatively with ophthalmic lubricants. The study highlights the importance of careful dissections around the medial canthal area to prevent facial nerve injuries during reconstructive procedures. The majority of patients undergoing nasal reconstruction do not develop lagophthalmos, and supportive care is recommended for those experiencing upper eyelid dysfunction. [Extracted from the article]

This essay examines "The Masque of the Read Death," one of Poe's most allusive tales, as a striking example of the aesthetics of the apocalyptic sublime. Combining several key ideas from Burke's Philosophical Enquiry into the Origins of our Ideas of the Sublime and Beautiful with numerous motifs from biblical apocalyptic symbolism, Poe's "Masque" was specifically designed to create an effect of sublime terror in the reader. Basing his image of mass death on the cholera pandemic of 1832, which killed thousands of individuals in Europe and America, Poe created a historically grounded parable of apocalyptic extinction with a myriad of connections with literary, biblical, and artistic tradition. Poe's tale echoes many of Burke's remarks on the nature and sources of sublime and beautiful effects while conveying a biblically based vision of human mortality. [ABSTRACT FROM AUTHOR]

Background: This study examined the relationship between prenatal exposure to alcohol, manifested through fetal alcohol syndrome (FAS) and pFAS, and hypertension in children and adolescents. Methods: This study was designed to analyze the association between fetal alcohol spectrum disorders (FASD) Status and hypertension status. FAS/pFAS‐diagnosed respondents (n = 125) were collected from a FASD Clinical database in Atlanta, Georgia. Non‐FAS/pFAS respondents (n = 500) were taken from the National Health and Nutrition Examination Survey (NHANES). Chi‐square analyses were used to examine the extent to which FASD status, sex, race/ethnicity, medication use, and obesity status each related to hypertension status. A logistic regression was performed analyzing the relationship between FASD status (y/n: independent) and hypertension status (y/n: dependent) while controlling for age, sex, race/ethnicity, medication use, and obesity status. Results: Univariate relationships between hypertension status and FASD status (OR = 8.46, p < 0.001), medication use (OR = 3.25, p < 0.001), and obesity status (OR = 3.03, p = 0.02) proved to be statistically significant (p < 0.05). FASD status significantly predicted hypertension status (β = 2.31, OR = 10.06, p < 0.001) after accounting for age, sex, race/ethnicity, medication use, and obesity status. Conclusions: The major findings of this study suggest a significant relationship between FASD and hypertension in youth. Race/ethnicity and obesity also proved important in predicting hypertensive blood pressure readings independent of FASD diagnosis. Further research is needed to isolate prenatal alcohol exposure (PAE) as a factor promoting increased hypertension and to assess the risk for hypertension in alcohol‐affected adults. The relationship between FASD and hypertension in clinically‐referred children and adolescents was investigated. Logistic regression indicated a significant predictive relationship between FASD and elevations in both systolic and diastolic blood pressure after controlling for age, sex, race/ethnicity, medication use, and obesity status. Race/ethnicity and obesity also proved significant in predicting hypertension independently of FASD diagnosis. Further research is needed to isolate prenatal alcohol exposure as a factor in youth hypertension and to assess the risk for hypertension in alcohol‐affected adults. [ABSTRACT FROM AUTHOR]

A three-year field experiment at an ethnically diverse middle school (N = 163) tested the hypothesis that periodic self-affirmation exercises delivered by classroom teachers bolsters students' school trust and improves their behavioral conduct. Students were randomly assigned to either a self-affirmation condition, where they wrote a series of in-class essays about personally important values, or a control condition, where they wrote essays about personally unimportant values. There were no behavioral effects of affirmation at the end of 6th grade, after students had completed four writing exercises. However, after four additional exercises in 7th grade, affirmed students had a significantly lower rate of discipline incidents than students in the control condition. The effect continued to grow and did not differ across ethnic groups, such that during 8th grade students in the affirmation condition on average received discipline at a 69% lower rate than students in the control condition. Analyses of student climate surveys revealed that affirmation was associated with higher school trust over time, a tendency that held across ethnic groups and partially mediated the affirmation effect on discipline. Repeated self-affirmation can bolster students' school trust and reduce the incidence of discipline in middle school, findings with both theoretical and practical implications. [ABSTRACT FROM AUTHOR]

Herman Melville's letters to Nathaniel Hawthorne during their joint residence in the Berkshires in 1850-51 have regularly drawn the close scrutiny of scholars interested in the literary, psychological, and cultural dynamics of this historic friendship, but they have seldom examined the religious language that infuses these missives. For just as Melville's writings are permeated by the influence of the Kingjames Bible, especially the whaling novel he was composing at this time, his letters to Hawthorne also bear the imprint of this key literary source. If Melville called his informal homilies to Hawthorne part of an "endless sermon," his major letters of April, May, and November 1851 each bear the moral weight of a series of biblical "texts" from Job, Ecclesiastes, and the Gospel of John, respectively, with the mystical language of John being of special importance for understanding Melville's creative and emotional identification with Hawthorne. [ABSTRACT FROM AUTHOR]

This paper argues that the United States has clear issues with its labor relations framework as it relates to its collective bargaining policy, and that several effective changes can be adopted by the United States from the Australian labor relations statutory scheme under the Fair Work Act 2009 to better effectuate its policy. [ABSTRACT FROM AUTHOR]

Nanostructured hollow carbon spheres (HCNSs), with either carbon nanotube (CNT) or metal oxide nanowire (MONW) decoration on their surface, were synthesized as building materials with a great potential for the next-generation advanced applications. A well-established, polymeric latex NS synthesis method and a simply modified version of a microwave (MW) energy-based carbonization approach, i.e., Poptube, were systematically combined to obtain these HCNSs. Through this simple, facile, affordable and easily scalable “combined synthesis method,” it was managed to successfully produce HCNSs with unique morphological, spectroscopic, thermal and elemental features, all of which were strongly supported by both various material characterization test results and the relevant previous literature data. Thus, it is believed that the as-synthesized CNT or MONW decorated HCNSs (CNT-MONW/HCNS) from the above-mentioned method would soon become the materials of preference for the next-generation advanced applications in various science and engineering fields. [ABSTRACT FROM AUTHOR]