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To evaluate the mFI-5 as a predictor of postoperative outcomes following transurethral resection of bladder tumor (TURBT). The National Surgical Quality Improvement Program database was queried for TURBT cases from 2015-2019. mFI-5 scores were calculated by assigning a point to chronic obstructive pulmonary disease, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were stratified by mFI-5 scores. Demographics and 30-day outcomes including Clavien-Dindo (CD) complications, mortality, and increased healthcare resource utilization (HCRU) were compared. HCRU outcomes included prolonged length of stay, unplanned readmission, and discharge to continued care. Multivariate regression assessed the predictive value of mFI-5 scores on outcomes. 40,278 TURBT cases were identified (mFI-5 = 0: 12,400, mFI-5 = 1: 17,328, mFI-5 = 2: 9225, mFI-5 ≥ 3: 1416). Patients with higher mFI-5 scores were more likely to be older, male, White, and have larger tumors, all P <.05. Increasing mFI-5 scores resulted in increased frequency of all adverse outcomes, all P <.001. On multivariate analysis, mFI-5 ≥ 3 classification was a predictor of CD I/II (OR = 1.280), CD IV (OR = 2.539), mortality (OR = 2.202), HCRU (OR = 2.094), prolonged length of stay (OR = 2.136), discharge to continued care (OR = 3.401), and unplanned readmission (OR = 1.705), all P <.05. A mFI-5 ≥ 3 demonstrated a sensitivity ranging from 6.0%-13.5% and a specificity ranging from 96.6%-97.0% for all outcomes. The mFI-5 is an easily ascertainable preoperative risk assessment tool that is a predictor of adverse clinical and HCRU outcomes following TURBT. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF) analysis is underutilized in patients with glioblastoma (GBM), partly due to a lack of studies demonstrating the clinical utility of CSF biomarkers. While some studies show the utility of CSF cell-free DNA analysis, studies analyzing CSF metabolites in patients with glioblastoma are limited. Diffuse gliomas have altered cellular metabolism. For example, mutations in isocitrate dehydrogenase enzymes (e.g., IDH1 and IDH2) are common in diffuse gliomas and lead to increased levels of D-2-hydroxyglutarate in CSF. However, there is a poor understanding of changes CSF metabolites in GBM patients. In this study, we performed targeted metabolomic analysis of CSF from n = 31 patients with GBM and n = 13 individuals with non-neoplastic conditions (controls), by mass spectrometry. Hierarchical clustering and sparse partial least square-discriminant analysis (sPLS-DA) revealed differences in CSF metabolites between GBM and control CSF, including metabolites associated with fatty acid oxidation and the gut microbiome (i.e., carnitine, 2-methylbutyrylcarnitine, shikimate, aminobutanal, uridine, N-acetylputrescine, and farnesyl diphosphate). In addition, we identified differences in CSF metabolites in GBM patients based on the presence/absence of TP53 or PTEN mutations, consistent with the idea that different mutations have different effects on tumor metabolism. In summary, our results increase the understanding of CSF metabolites in patients with diffuse gliomas and highlight several metabolites that could be informative biomarkers in patients with GBM. [ABSTRACT FROM AUTHOR]

Distraction osteogenesis (DO) of the craniofacial skeleton has become an effective technique for the treatment of both nonsyndromic and syndromic conditions. The advent of craniofacial DO has allowed for earlier intervention in pediatric patients with less complication risk and morbidity compared to traditional techniques. In this review, we will discuss current application and technique for craniofacial DO by anatomical region and explore future applications in craniofacial surgery. [ABSTRACT FROM AUTHOR]

Rhegmatogenous retinal detachment (RRD) is a serious surgical condition with significant ocular morbidity if not managed properly. Once untreatable, approaches to the repair of RRD have greatly evolved over the years, leading to outstanding primary surgical success rates. The management of RRD is often a topic of great debate. Scleral buckling, vitrectomy and pneumatic retinopexy have been used successfully for the treatment of RRD. Several factors may affect surgical success and dictate a surgeon's preference for the technique employed. In this review, we provide an overview and supporting literature on the options for RRD repair and their respective preoperative and postoperative considerations in order to guide surgical management. [ABSTRACT FROM AUTHOR]

The article presents a study which showed that a binary oncolytic/helper-dependent adenovirus (CAdVEC) that boy lyses tumor cells and locally express the proinflammtory cytokine IL-12 and PDL1 blocking antibody has potent antitumor activity in humanized mouse models. Topics include cell lines and adenoviral vectors (HDAds and OAds), isolation of tumor-infiltrating immune cells, and quantification of vector genome DNA in CAdVEC-injected tumors of patients.

Introduction: Although emergency department (ED) discharge presents patient-safety challenges and opportunities, the ways in which EDs address discharge risk in the general ED population remains disparate and largely uncharacterized. In this study our goal was to conduct a review of how EDs identify and target patients at increased risk at time of discharge. Methods: We conducted a literature search to explore how EDs assess patient risk upon discharge, including a review of PubMed and gray literature. After independently screening articles for inclusion, we recorded study characteristics including outcome measures, patient risk factors, and tool descriptions. Based on this review and discussion among collaborators, major themes were identified. Results: PubMed search yielded 384 potentially eligible articles. After title and abstract review, we screened 235 for potential inclusion. After full text and reference review, supplemented by Google Scholar and gray literature reviews, we included 30 articles for full review. Three major themes were elucidated: 1) Multiple studies include retrospective risk assessment, whereas the use of pointof-care risk assessment tools appears limited; 2) of the point-of-care tools that exist, inputs and outcome measures varied, and few were applicable to the general ED population; and 3) while many studies describe initiatives to improve the discharge process, few describe assessment of postdischarge resource needs. Conclusion: Numerous studies describe factors associated with an increased risk of readmission and adverse events after ED discharge, but few describe point-of-care tools used by physicians for the general ED population. Future work is needed to investigate standardized tools that assess ED discharge risk and patients’ needs upon ED discharge. [ABSTRACT FROM AUTHOR]

Coarctation of the aorta is a form of congenital heart disease requiring surgical intervention. If is often associated with other forms of congenital heart disease. Anomalous origin of the left coronary artery (ALCA) from the opposite sinus of Valsalva is implicated in sudden cardiac death. We report the first case in the literature of coarctation of the aorta associated with ALCA from the opposite aortic sinus and describe surgical correction of these two lesions. [ABSTRACT FROM AUTHOR]

Objectives Risk factors for sudden infant death syndrome include premature birth, maternal smoking, prone or side sleeping position, sleeping with blankets, sharing a sleeping surface with an adult, and sleeping without an adult in the room. In this study, we compare parents' responses on sleep patterns in premature and term infants with medical complexity. Methods Parents of children enrolled in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab were phoned monthly regarding their child's health status until the end of each respiratory syncytial virus season. Baseline data were obtained on patient demographics, medical history, and neonatal course. Responses on adherence to safe sleep recommendations were recorded as part of the assessment. Results A total of 2,526 preterms and 670 term infants with medical complexity were enrolled. Statistically significant differences were found in maternal smoking rates between the two groups: 13.3% (preterm); 9.3% (term) infants (χ 2=8.1, df=1, P=0.004) and with respect to toys in the crib: 12.3% (term) versus 5.8% preterms (χ 2=24.5, df=1, P<0.0005). Preterm infants were also significantly more likely to be placed prone to sleep (8.8%), compared with term infants (3.3%), (χ 2=18.1, df=1, P<0.0005). Conclusion All the infants in this study had frequent medical contacts. There is a greater prevalence of some risk factors for sudden infant death syndrome in preterm infants compared to term infants with medical complexity. Specific educational interventions for vulnerable infants may be necessary. [ABSTRACT FROM AUTHOR]

Pain secondary to amputations is a current health problem with a worldwide incidence of 4-68/100.000 inhabitants, with a higher prevalence in diabetic patients, and with vascular disease. Of multifactorial etiology, differences have been postulated with theories of peripheral and central factors involved in its genesis. Phantom limb pain is experienced by 65-70% of patients who undergo amputations, it frequently appears during the first seven days after amputation, although its appearance has been described years after the episode, which highlights the importance of an effective treatment for it. In this review, 5 patients undergoing amputations at the Vall d'Hebron Hospital during a 3-month follow-up period are presented, as well as the results obtained from the pharmacological and interventional carried out following the protocol for the prevention of the phantom limb Pain Unit. The recommendations included in it address three key moments of intervention combining pharmacological treatment and regional anesthesia-analgesia. A first action prior to amputation, followed by regional anaesthesia-analgesia during the intervention and maintenance of regional analgesia together with the reintroduction of drug therapy early in the postoperative period. Despite the small volume of patients, the subjective impression obtained from the review of cases presented is that those patients in whom drug treatment is started prior to amputation have good control of phantom limb pain, despite presenting Demonstrated risk factors for its development and chronification. The evidence for the different treatments for the prevention and treatment of phantom limb pain is contradictory and, in many cases, based on trials with little evidence or case reports, which highlights the need for clinical trials to lay the foundations for standardization a multimodal treatment that allows a comprehensive approach to pain. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is a global pandemic. In the USA, the burden of mortality and morbidity has fallen on minority populations. The understanding of the impact of this pandemic has been limited in Asian-Americans and Pacific Islanders (AAPIs), though disaggregated data suggest disproportionately high mortality rates. AAPIs are at high risk for COVID-19 transmission, in part due to their over-representation in the essential workforce, but also due to cultural factors, such as intergenerational residency, and other social determinants of health, including poverty and lack of health insurance. Some AAPI subgroups also report a high comorbidity burden, which may increase their susceptibility to more severe COVID-19 infection. Furthermore, AAPIs have encountered rising xenophobia and racism across the country, and we fear such discrimination only serves to exacerbate these rapidly emerging disparities in this community. We recommend interventions including disaggregation of mortality and morbidity data, investment in community-based healthcare, advocacy against discrimination and the use of non-inflammatory language, and a continued emphasis on underlying comorbidities, to ensure the protection of vulnerable communities and the navigation of this current crisis. [ABSTRACT FROM AUTHOR]

COVID-19 has highlighted an opportunity for medical professionals to engage in online Public Engagement with Science (PES). Currently a popular platform for PES is Reddit. Reddit provides an Ask Me Anything (AMA) format for subject matter experts to answer questions asked by the public. On March 11, 2020, from 2:00 to 4:00pm EST, two Emergency Department physicians from Massachusetts General Hospital hosted an AMA session on coronavirus. We retroactively conducted an analysis of the questions and answers from this AMA session in order to better understand the public's concerns around coronavirus and identify future opportunities for medical experts to leverage the Reddit AMA format in communicating with the general public. Results suggested that participants sought not only to obtain information, but to engage in discussion, and did so with each other in the absence of expert responses. The majority of bi-directional discussion occurred between participants. Due to the volume of questions and ratio of experts to participants, not all questions were answered. More posts provided facts or opinions, than posts that providing resources or requesting resources. [ABSTRACT FROM AUTHOR]

The literature on public health in Brazil has criticized the idea of universal health coverage (uhc), arguing that uhc is incompatible with the universal health system and the right to health. This article assesses that criticism and concludes that it creates a "strawman" argument. The idea of uhc that is being criticized in Brazil bears little similarity to the concept of uhc promoted by international organizations and discussed in the international literature. [ABSTRACT FROM AUTHOR]

Acute retinal necrosis is a rare yet devastating disease, with significant ocular morbidity. Over the past several decades, initial treatment regimens have shifted from intravenous antivirals requiring hospital admission to the routine use of oral antivirals with intravitreal antivirals for immediate local control. Given the rarity of this disease process and a lack of large-scale research trials, debate continues over recommended practice guidelines. In this paper, we review current diagnostic criteria and recommend a treatment algorithm based on available evidence. [ABSTRACT FROM AUTHOR]

Purpose: Retinopathy of prematurity (ROP) is widely regarded worldwide as a major cause of childhood blindness, however until recently the disease has not been recognized in most of the African continent. As a result of changing economic conditions, there is growing evidence that the population at risk for ROP in Africa is increasing. This report aims to summarize the published literature on ROP from Africa. Methods: We performed a systematic literature review of the English and French online literature databases by applying a general search strategy initially on May 1, 2017 with repeat inquiry on May 20, 2018. Search phrases included multiple variants of terms including "ROP", "retinopathy of prematurity", in conjunction with each of the individual 54 recognized sovereign African states. Findings: A total of 25 individual studies from six African nations were identified: South Africa (10), Egypt (7), Nigeria (4), with the nations of Sudan, Rwanda, and Kenya each having one respective study. Two countries (South Africa and Kenya) have developed national ROP policies for primary and secondary prevention. Summary: Review of the published literature suggests that ROP is emerging in Africa, however, there are published data from 6/54 (11%) African nations. Blindness from ROP is often preventable with appropriate primary and secondary prevention. This report provides compelling evidence that these efforts should be undertaken to implement and evaluate regionally appropriate ROP prevention programs in a growing number of African countries. [ABSTRACT FROM AUTHOR]

• The development of efficacious ocular drug delivery systems to treat diseases of the back of the eye faces many challenges due to the unique anatomy and physiology of the eye. • Nanotechnology in ophthalmic formulations may improve the therapeutic efficacy of some drug therapies. • The development of minimally or noninvasive drug delivery systems shows positive preclinical outcomes in animal models. • For the successful clinical translation of any ocular drug delivery technology, the use of appropriate animal models is key. Drug delivery to the posterior segment of the eye remains challenging even though the eye is readily accessible. Its unique and complex anatomy and physiology contribute to the limited options for drug delivery via non-invasive topical treatment, which is the prevalent ophthalmic treatment. To treat the most common retinal diseases, intravitreal (IVT) injection has been a common and effective therapy. With the advancement of nanotechnologies, novel formulations and drug delivery systems are being developed to treat posterior segment diseases. Here, we discuss the recent advancement in ocular delivery systems, including-sustained release formulations, IVT implants, and preclinical topical formulations, and the challenges faced in their clinical translation. [ABSTRACT FROM AUTHOR]

A sampler for volatile organic compounds (VOCs) was developed for deployment on a multicopter unmanned aerial vehicle (UAV). The sampler was designed to collect gas- and aerosol-phase VOCs on up to four commercially available VOC-adsorbent cartridges for subsequent offline analysis by thermal-desorption gas chromatography. The sampler had a mass of 0.90 kg and dimensions of 19 cm ×20 cm ×5 cm. Power consumption was <10 kJ in a typical 30 min flight, representing <3 % of the total UAV battery capacity. Autonomous sampler operation and data collection in flight were accomplished with a microcontroller. Sampling flows of 100 to 400 sccm were possible, and a typical flow of 150 sccm was used to balance VOC capture efficiency with sample volume. The overall minimum detection limit of the analytical method for a 10 min sample was 3 ppt and the uncertainty was larger than 3 ppt or 20 % for isoprene and monoterpenes. The sampler was mounted to a commercially available UAV and flown in August 2017 over tropical forest in central Amazonia. Samples were collected sequentially for 10 min each at several different altitude–latitude–longitude collection points. The species identified, their concentrations, their uncertainties, and the possible effects of the UAV platform on the results are presented and discussed in the context of the sampler design and capabilities. Finally, design challenges and possibilities for next-generation samplers are addressed. [ABSTRACT FROM AUTHOR]

Renal oncocytomas and retroperitoneal schwannomas are rare and typically benign tumors with characteristic histopathologic features. Ideal management of both renal oncocytoma and retroperitoneal schwannoma is surgical resection. We present a rare case of a 63-year-old man with multifocal renal oncocytoma and retroperitoneal ancient schwannoma which, preoperatively, masqueraded as metastatic renal cell carcinoma. Both tumors were successfully resected surgically. Immunochemistry and histopathology confirmed each diagnosis. [ABSTRACT FROM AUTHOR]

Focuses on a study which measured dark current noise on a compressively strained p-type InGaAs/AlGaAs quantum-well infrared photodetector as a function of temperature and bias voltage. Measurement setup; Experimental results; Discussion.

Presents information on detailed noise measurements performed on three different quantum-well infrared photodetectors (QWIP) with donor-doped quantum wells. Composition of the buffer and cap layers of QWIP; Calculation of values of bound-state and miniband energy levels; Electron diffusion length and noise-gain.

Children aged <2 years with chronic lung disease (CLD) have a 10-fold higher risk for respiratory syncytial virus-positive hospitalization (RSVH) compared to healthy term infants. Based on the updated position statements, we compared respiratory-related illness hospitalization (RIH) and RSVH risks in CLD children who received palivizumab during the first year (FY) versus second year (SY) of life in the Canadian Registry of Palivizumab (CARESS). Demographic data were collected at enrolment and RIH events recorded monthly from 2005 to 2015. Eight hundred forty-seven FY and 450 SY children with CLD were identified. SY children had a lower gestational age (27 versus 29 weeks) and required more days of respiratory support (64 versus 43), oxygen therapy (108 versus 55), and length of stay (118 versus 73) during the neonatal course compared to FY children; all p < 0.0005. RIH rates were 12.2 (FY) and 18.2 (SY), and RSVH rates were 2.3 (FY) and 3.9 (SY). Cox regression showed similar hazards for both RIH (hazard ratio 0.9, 95% CI 0.6-1.6, p = 0.812) and RSVH (hazard ratio 1.1, 95% CI 0.4-2.9, p = 0.920).Conclusions: SY and FY children had similar risks for RIH and RSVH. The findings imply that SY children with CLD are correctly selected for palivizumab based on neonatal illness severity and merit prophylaxis. What is Known: • Children with chronic lung disease have a 10-fold higher risk for RSV-positive hospitalization in comparison to healthy term infants and commonly receive palivizumab prophylaxis as a preventative measure against serious RSV-related lower respiratory tract infections. • The American Academy of Pediatrics [ 2 ] and the Canadian Paediatric Society [ 30 ] have recently modified their recommendations for RSV prophylaxis in children with chronic lung disease, limiting palivizumab to either those <32 weeks gestation or those in the first year of life who are oxygen dependent or require medical therapy for the treatment of their condition. What is New: • Children with chronic lung disease receiving an additional course of palivizumab in their second year of life were determined to be at similar risk for both respiratory illness-related hospitalization and RSV-positive hospitalization as palivizumab-naïve children enrolled in the first year of life in the Canadian Registry for palivizumab (CARESS). • CARESS physicians are correctly identifying high-risk children with chronic lung disease in their second year of life, whom they believe will benefit from an additional year of palivizumab prophylaxis, based on neonatal illness severity. [ABSTRACT FROM AUTHOR]

A new noninvasive method was used to measure the impairment of pulmonary gas exchange in 34 patients with lung disease, and the results were compared with the traditional ideal alveolar-arterial PO2 difference (AaDO2) calculated from arterial blood gases. The end-tidal PO2 was measured from the expired gas during steady-state breathing, the arterial PO2 was derived from a pulse oximeter if the SpO2 was 95% or less, which was the case for 23 patients. The difference between the end-tidal and the calculated PO2 was defined as the oxygen deficit. Oxygen deficit was 42.7 mmHg (SE 4.0) in this group of patients, much higher than the means previously found in 20 young normal subjects measured under hypoxic conditions (2.0 mmHg, SE 0.8) and 11 older normal subjects (7.5 mmHg, SE 1.6) and emphasizes the sensitivity of the new method for detecting the presence of abnormal gas exchange. The oxygen deficit was correlated with AaDO2 (R2 0.72). The arterial PO2 that was calculated from the noninvasive technique was correlated with the results from the arterial blood gases (R2 0.76) and with a mean bias of +2.7 mmHg. The PCO2 was correlated with the results from the arterial blood gases (R2 0.67) with a mean bias of -3.6 mmHg. We conclude that the oxygen deficit as obtained from the noninvasive method is a very sensitive indicator of impaired pulmonary gas exchange. It has the advantage that it can be obtained within a few minutes by having the patient simply breathe through a tube. [ABSTRACT FROM AUTHOR]

A sampler for volatile organic compounds (VOCs) was developed for deployment on a copter-technology unmanned aerial vehicle (UAV). The sampler was designed to collect VOCs on up to five commercially available VOC-adsorbent cartridges for subsequent offline analysis by thermal-desorption gas chromatography. The sampler had a mass of 0.90 kg and dimensions of 19 cm × 20 cm × 5 cm. Power consumption was <3 Wh in a typical 30 min flight, representing <3 % of the total UAV battery capacity. Autonomous sampler operation and data collection in flight were accomplished with a microcontroller. Sampling flows of 100 to 400 sccm were possible, and a typical flow of 150 sccm was used to balance VOC capture efficiency with sample volume. The overall minimum detection limit for the sampling volumes and the analytical method was close to 2 ppt for isoprene and monoterpenes. The sampler was mounted to a commercially available UAV and flown in August 2017 over tropical forest in central Amazonia. Samples were collected sequentially for 10 min each at several different altitude-latitude-longitude collection points. The species identified, their concentrations, and their uncertainties are presented and discussed in the context of the sampler design and capabilities. Finally, design challenges and possibilities for next-generation samplers are addressed. [ABSTRACT FROM AUTHOR]

We are developing a novel, noninvasive method for measuring the efficiency of pulmonary gas exchange in patients with lung disease. The patient wears an oximeter, and we measure the partial pressures of oxygen and carbon dioxide in inspired and expired gas using miniature analyzers. The arterial Po2 is then calculated from the oximeter reading and the oxygen dissociation curve, using the end-tidal Pco2 to allow for the Bohr effect. This calculation is only accurate when the oxygen saturation is <94%, and therefore, these normal subjects breathed 12.5% oxygen. When the procedure is used in patients with hypoxemia, they breathe air. The Po2 difference between the end-tidal and arterial values is called the “oxygen deficit.” Preliminary data show that this index increases substantially in patients with lung disease. Here we report measurements of the oxygen deficit in 20 young normal subjects (age 19 to 31 yr) and 11 older normal subjects (47 to 88 yr). The mean value of the oxygen deficit in the young subjects was 2.02 ± 3.56 mmHg (means ± SD). This mean is remarkably small. The corresponding value in the older group was 7.53 ± 5.16 mmHg (means ± SD). The results are consistent with the age-related trend of the traditional alveolar-arterial difference, which is calculated from the calculated ideal alveolar Po2 minus the measured arterial Po2. That measurement requires an arterial blood sample. The present study suggests that this noninvasive procedure will be valuable in assessing the degree of impaired gas exchange in patients with lung disease. [ABSTRACT FROM AUTHOR]

Effective management of pediatric craniofacial tumors requires coordinated input from medical, oncologic, and surgical specialties. Reconstructive algorithms must consider limitations in pediatric donor tissue and account for future growth and development. Immediate reconstruction is often focused on filling dead space, protecting underlying structures, and ensuring skeletal symmetry. Staged reconstruction occurs after the patient has reached skeletal maturity and is focused on restoring permanent dentition. Reconstructive options vary depending on the location, size, and composition of resected tissue. Virtual surgical planning (VSP) reduces the complexity of pediatric craniofacial reconstruction and ensures more predictable outcomes. [ABSTRACT FROM AUTHOR]

Background: Pancreatic ductal adenocarcinoma (PDAC) is a devastating malignancy with a 5-year survival rate of 6% following a diagnosis, and novel therapeutic modalities are needed. Protease-activated receptor 1 (PAR1) is abundantly overexpressed by both tumor cells and multiple stroma cell subsets in the tumor microenvironment (TME), thereby offering a suitable immunotherapy target. Methods: A chimeric antigen receptor (CAR) strategy was applied to target PAR1 using a human anti-PAR1 scFv antibody fused to the transmembrane region with two co-stimulatory intracellular signaling domains of cluster of differentiation 28 (CD28) and CD137 (4-1BB), added to CD3ζ in tandem. Results: The engineered PAR1CAR-T cells eliminated PAR1 overexpression and transforming growth factor (TGF)-β-mediated PAR1-upregulated cancer cells by approximately 80% in vitro. The adoptive transfer of PAR1CAR-T cells was persistently enhanced and induced the specific regression of established MIA PaCa-2 cancer cells by > 80% in xenograft models. Accordingly, proinflammatory cytokines/chemokines increased in CAR-T-cell-treated mouse sera, whereas Ki67 expression in tumors decreased. Furthermore, the targeted elimination of PAR1-expressing tumors reduced matrix metalloproteinase 1 (MMP1) levels, suggesting that the blocking of the PAR1/MMP1 pathway constitutes a new therapeutic option for PDAC treatment. Conclusions: Third-generation PAR1CAR-T cells have antitumor activity in the TME, providing innovative CAR-T-cell immunotherapy against PDAC. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined the impact of emergency department (ED) social interventions on patient outcomes and revisits, especially in underserved populations. Our objective in this study was to characterize a volunteer initiative that provided community medical and social resources at ED discharge and its effect on ED revisit rates and adherence to follow-up appointments at a large, county hospital ED. Methods: We performed a cross-sectional analysis of ED patients who received medical and social resources and an educational intervention at discharge between September 2017-June 2018. Demographic information, the number of ED return visits, and outpatient follow-up appointment adherence within 30 and 90 days of ED discharge were obtained from electronic health records. We obtained data regarding patient utilization of resources via telephone follow-up communication. We used logistic regression analyses to evaluate associations between patient characteristics, reported resource utilization, and revisit outcomes. Results: Most patients (55.3% of 494 participants) identified as Latino/Hispanic, and 49.4% received healthcare assistance through a local governmental program. A majority of patients (83.6%) received at least one medical or social resource, with most requesting more than one. Patients provided with a medical or social resource were associated with a higher 90-day follow-up appointment adherence (odds ratio [OR] 2.56; 95% confidence interval [CI] 1.05-6.25, and OR 4.75; 95% CI 1.49-15.20], respectively), and the provision of both resources was associated with lower odds of ED revisit within 30 days (OR 0.50; 95% CI 0.27-0.95). Males and those enrolled in the healthcare assistance program had higher odds of ED revisits, while Hispanic/Latino and Spanish-speaking patients had lower odds of revisits. Conclusion: An ED discharge intervention providing medical and social resources may be associated with improved follow-up adherence and reduced ED revisit rates in underserved populations. [ABSTRACT FROM AUTHOR]

Simple Summary: Brain metastases from sarcomas are uncommon and lead to poor outcomes. This study examines 81 cases of patients with brain metastases from sarcomas to review their symptoms, treatments, and survival. Most patients were symptomatic, often experiencing headaches or focal neurological deficits. Overall, 31% of patients survived one year after their initial sarcoma diagnosis, and the median time from the diagnosis of brain metastasis to death was 6.0 months. Given the rarity and heterogeneity of this disease, there are no structured guidelines for treatment that include chemotherapy, radiation, and surgery. Patients who survived more than two years from the sarcoma diagnosis were significantly more likely to have received chemotherapy, and those who survived more than one year from the brain metastasis diagnosis were significantly more likely to have undergone surgery and chemotherapy. Our findings highlight the urgent need for further research into effective treatment strategies. Purpose: Brain metastases (BM) in sarcomas occur rarely and are associated with poor prognosis. This study is a large retrospective cohort describing the demographic and clinical characteristics of these patients, treatment strategies, and survival outcomes. Methods: In total, 81 patients with BM from sarcomas were identified across five sarcoma centers. Demographic data, clinical presentation, and treatment modalities were analyzed. Results: The most common histologies were leiomyosarcoma (12.3%) and undifferentiated pleomorphic sarcoma (12.3%). The median time from sarcoma diagnosis to brain metastases was 1.9 years. Upon presentation, 88.9% of patients with BM from sarcomas were symptomatic with the most common presenting symptom being focal neurological deficits (37.9%) and headaches (22.1%). Higher-grade sarcomas were more likely to metastasize and were usually preceded by metastases to other sites, most commonly the lungs. One-year overall survival was 31% from initial sarcoma diagnosis, and the median time from diagnosis of BM until death was 6.0 months. For treatment, 60 (74.1%) patients had radiation, 39 (48.1%) patients had systemic therapy, and 29 (35.8%) patients had surgery. In a multivariate analysis, surgery (HR 0.30) and chemotherapy (HR 0.23) were found to be significantly correlated with improved survival outcomes. Although radiation as a whole was not found to significantly correlate with survival, improved outcomes were seen with stereotactic radiosurgery (SRS, mOS 11.6 mo) as opposed to whole-brain radiation therapy (WBRT, mOS 8.3 mo). Additionally, patients with leptomeningeal disease were significantly less likely to survive more than one year compared to patients with brain metastases only. Conclusions: Our findings identify that patients with metastatic sarcoma to the brain have poor prognoses, often have concurrent metastasis, and have a median survival of only 6 months. Additionally, our study found that leptomeningeal metastases is a rare presentation with poor survival outcomes. There are various treatment modalities for sarcomas with BM; however, there are no guidelines, unlike in other malignancies. Further research is necessary to evaluate the role of therapeutic measures in terms of type, timing, and outcomes. [ABSTRACT FROM AUTHOR]

In clinical trials, continuous monitoring of event incidence rate plays a critical role in making timely decisions affecting trial outcome. For example, continuous monitoring of adverse events protects the safety of trial participants, while continuous monitoring of efficacy events helps identify early signals of efficacy or futility. Because the endpoint of interest is often the event incidence associated with a given length of treatment duration (e.g., incidence proportion of an adverse event with 2 years of dosing), assessing the event proportion before reaching the intended treatment duration becomes challenging, especially when the event onset profile evolves over time with accumulated exposure. In particular, in the earlier part of the study, ignoring censored subjects may result in significant bias in estimating the cumulative event incidence rate. Such a problem is addressed using a predictive approach in the Bayesian framework. In the proposed approach, experts' prior knowledge about both the frequency and timing of the event occurrence is combined with observed data. More specifically, during any interim look, each event-free subject will be counted with a probability that is derived using prior knowledge. The proposed approach is particularly useful in early stage studies for signal detection based on limited information. But it can also be used as a tool for safety monitoring (e.g., data monitoring committee) during later stage trials. Application of the approach is illustrated using a case study where the incidence rate of an adverse event is continuously monitored during an Alzheimer's disease clinical trial. The performance of the proposed approach is also assessed and compared with other Bayesian and frequentist methods via simulation. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study reports ambient concentrations of 63 air toxics that were measured in Canada by the National Air Pollution Surveillance (NAPS) program over the period 2009–2013. Measured concentrations are compared with ambient air quality guidelines from Canadian jurisdictions, and compounds that exceeded guidelines are identified and discussed. Although this study does not assess risk or cumulative effects, air toxics that approached guidelines are also identified so that their potential contribution to ambient air toxics pollution can be considered. Eleven air toxics exceeded at least one guideline, and an additional 16 approached guidelines during the study period. Four compounds were measured using methods whose detection limits exceeded a guideline value, three of which could not be compared with guidelines, since they were not detected in any samples. The assessment of several metal(loid) concentrations is tentative, since they were measured only in fine particulate matter (PM) but compared with guidelines based on coarse or total PM. Improvements to sampling and analysis techniques for the latter compounds as well as for those whose methods are subject to known uncertainties would improve confidence in reported concentrations and their relation to applicable guidelines. Analysis of sampling strategies for all compounds found to exceed or approach guidelines would contribute to ensuring that their spatiotemporal coverage is adequate. Examination of the air toxics not measured by NAPS but having guidelines in Canadian jurisdictions or being included in other programs such as the U.S. National-Scale Air Toxics Assessment (NATA) would contribute to ensuring that the full suite of pollutants relevant to ambient air quality in Canada is subject to adequate study. The results of this study can be applied to evaluating the effectiveness of toxic substances management in Canada. Implications: Recent measurements of 63 air toxics in Canada by the National Air Pollution Surveillance (NAPS) program showed that 11 compounds exceeded daily or annual ambient air quality guidelines and that an additional 16 compounds approached such guidelines within an order of magnitude. The results of this study can be applied to evaluating the effectiveness of toxic substances management in Canada and to identifying compounds that merit further investigation. [ABSTRACT FROM AUTHOR]

This paper analyzes the implications of the Brazilian Federal Supreme Court judgment that expanded the number of people eligible for a social benefit called Benefício de Prestação Continuada. This judgment has policy implications and opportunity costs that become clear when the expected impact of this decision is compared to the cost and effectiveness of other social policies such as Bolsa Família and Brasil Carinhoso. [ABSTRACT FROM AUTHOR]

BACKGROUND Health care providers often counsel prostate cancer patients about treatment options with medical terminology. However, studies have demonstrated a severe lack of comprehension of these terms, particularly in underserved populations. It was hypothesized that a video-based educational tool would significantly improve the understanding of key terms related to prostate health in a predominantly lower literacy population. METHODS A software application was developed by various experts, including urologists and human-computer interaction specialists, to serve as a video-based educational tool emphasizing narrated animations to promote understanding of terms related to urinary, bowel, and sexual function. This application was viewed by patients recruited from 2 low-income safety net clinics, where a previously developed survey was administered to assess pre- and postintervention levels of comprehension. RESULTS Fifty-six patients with a mean literacy level of 7th to 8th grade completed the study. Patients achieved statistically significant improvements in comprehension for the majority of the terms after the video intervention, with notable improvements including the terms incontinence (from 14% to 50%), bowels (from 14% to 46%), and impotence (from 58% to 84%). Patients demonstrated significant gains in their understanding of the function of the prostate (from 11% to 30%) and in their ability to locate the prostate on anatomic drawings (from 50% to 82%). CONCLUSIONS This video-based educational tool is an effective method for overcoming the severe lack of comprehension of prostate health terminology among patients. The improvements achieved have the potential to enhance patient participation in shared and informed decision making and to support combined visual-audio multimedia as a promising tool for prostate cancer education. Cancer 2015;121:733-740. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined the impact of emergency department (ED) social interventions on patient outcomes and revisits, especially in underserved populations. Our objective in this study was to characterize a volunteer initiative that provided community medical and social resources at ED discharge and its effect on ED revisit rates and adherence to follow-up appointments at a large, county hospital ED. Methods: We performed a cross-sectional analysis of ED patients who received medical and social resources and an educational intervention at discharge between September 2017-June 2018. Demographic information, the number of ED return visits, and outpatient follow-up appointment adherence within 30 and 90 days of ED discharge were obtained from electronic health records. We obtained data regarding patient utilization of resources via telephone follow-up communication. We used logistic regression analyses to evaluate associations between patient characteristics, reported resource utilization, and revisit outcomes. Results: Most patients (55.3% of 494 participants) identified as Latino/Hispanic, and 49.4% received healthcare assistance through a local governmental program. A majority of patients (83.6%) received at least one medical or social resource, with most requesting more than one. Patients provided with a medical or social resource were associated with a higher 90-day follow-up appointment adherence (odds ratio [OR] 2.56; 95% confidence interval [CI] 1.05-6.25, and OR 4.75; 95% CI 1.49-15.20], respectively), and the provision of both resources was associated with lower odds of ED revisit within 30 days (OR 0.50; 95% CI 0.27-0.95). Males and those enrolled in the healthcare assistance program had higher odds of ED revisits, while Hispanic/Latino and Spanish-speaking patients had lower odds of revisits. Conclusion: An ED discharge intervention providing medical and social resources may be associated with improved follow-up adherence and reduced ED revisit rates in underserved populations. [ABSTRACT FROM AUTHOR]

Material properties play a key rolein the cellular internalizationof polymeric particles. In the present study, we have investigatedthe effects of material characteristics such as water contact angle,zeta potential, melting temperature, and alternative activation ofcomplement on particle internalization for pro-inflammatory, pro-angiogenic,and naïve macrophages by using biopolymers (∼600 nm),functionalized with 13 different molecules. Understanding how materialparameters influence particle internalization for different macrophagephenotypes is important for targeted delivery to specific cell populations.Here, we demonstrate that material parameters affect the alternativepathway of complement activation as well as particle internalizationfor different macrophage phenotypes. Here, we show that the quantitativestructure–activity relationship method (QSAR) previously usedto predict physiochemical properties of materials can be applied totargeting different macrophage phenotypes. These findings demonstratedthat targeted drug delivery to macrophages could be achieved by exploitingmaterial parameters. [ABSTRACT FROM AUTHOR]

During the last years, the number of judicial decision ordering the provision of health treatments, equipment and surgeries by the public health system has increased. Judges tend to ignore their decisions' budgetary impact and to consider that the Federal Government entities can be considered equally responsible by the supply of any item ordered by the patient. This paper analyzes the impact of these judicial decisions for the budgetary management of health policy in the City of Sao Paulo. It was considered an estimate with the expenses on the judicialization for the year of 2011, taking into consideration the data made available by the city and the publications in the official gazette about the acquisition of medications without bidding by the Municipal Health Department. According to the estimate of this article, the expenses of the city with health judicialization in 2011 is equivalent to 6% of the amount that the city spent with its policy of pharmaceutical assistance, and 10% of the total amount spent with the supply of medications, and hospital, dental and outpatient care material. Moreover, around 55% of the total amount is spent with drugs supply which are responsibility from the states and the union, and around 45% is spent with treatments that are not included in the Unified Public System (known as SUS). [ABSTRACT FROM AUTHOR]

• LB and UPS impair microglia-mediated synaptic pruning in the developing hippocampus. • Abnormal synaptic pruning is associated with reduced microglial ramification, lower expression of TREM2 protein, and increased spine density in CA1 pyramidal neurons. • Increased spine density is seen at P17 and in P29 mice when spine density reaches adult levels and mice are no longer exposed to stress. • Abnormal synaptic pruning during a critical period of hippocampal development may contribute to the long-term hippocampal deficits and connectivity seen in mice exposed to LB and UPS. • Surprisingly, LB caused more significant reduction in microglial ramification and impaired synaptic engulfment compared to UPS. • We propose that LB is a more severe form of early deprivation compared to UPS and that appropriate level of hippocampal stimulation is necessary to guide normal microglial ramification and synaptic pruning. Early life adversity impairs normal hippocampal function and connectivity in various mammalian species, including humans and rodents. According to the ' cumulative model ' the number of early adversities can be summed up to determine the risk for developing psychopathology later in life. In contrast, the ' dimensional model' argues that ' Deprivation ' and ' Threat ' impact different developmental processes that should not be added in determining clinical outcomes. Here we examine these predictions in male and female mice exposed to a single adversity — limited bedding (LB) — versus mice exposed to multiple adversities — unpredictable postnatal stress (UPS) — focusing on microglia-mediated synaptic pruning in the developing hippocampus. Exposure to both LB and UPS reduced the ramification of microglia, impaired their ability to phagocytose synaptic material in vivo and ex vivo, and decreased expression of TREM2. Abnormal phagocytic activity was associated with increased spine density in CA1 pyramidal neurons that was seen in 17-day-old groups and persisted in peri-pubescent 29-day-old LB and UPS mice. Exposure to LB caused more severe impairment in microglial ramification and synaptic engulfment compared to UPS, outcomes that were accompanied by a UPS-specific increase in the expression of several genes implicated in synaptic pruning. We propose that despite being a single stressor, LB represents a more severe form of early deprivation, and that appropriate levels of hippocampal stimulation during the second and third weeks of life are necessary to support normal microglial ramification and synaptic pruning. Further, impaired synaptic pruning during this critical period of hippocampal development contributes to the abnormal hippocampal function and connectivity seen in UPS and LB later in life. [ABSTRACT FROM AUTHOR]

BACKGROUND Patients diagnosed with prostate cancer are often counseled about treatment options with the use of terms that are part of the 'core vocabulary' of prostate cancer. It is hypothesized that predominantly lower literacy patients would demonstrate a severe lack of comprehension of prostate cancer terms, thus validating the findings of a previous single-institution study. METHODS A previously developed survey was used to evaluate understanding of terms related to urinary, bowel, and sexual function. The survey was administered by trained evaluators at 2 safety net clinics that provide care for low-income, predominantly African American patients. Comprehension was assessed using semiqualitative methods coded by 2 independent investigators. Literacy and numeracy were also evaluated. RESULTS Among 109 patients who completed the study, only 5% understood the function of the prostate, and 15%, 29%, and 32% understood the terms 'incontinence,' 'urinary function,' and 'bowel habits,' respectively. Lower levels of comprehension were observed for compound words, such as 'vaginal intercourse' (58%), versus single words such as 'intercourse' (95%), validating previous work. Median school level was 13 years, yet median literacy level was only ninth grade, and reading level was significantly correlated with comprehension. Only 30% of patients correctly calculated both a fraction and a percent. CONCLUSIONS Lack of comprehension of prostate health terminology is pronounced in this patient population and may be widespread. This lack of comprehension potentially limits the ability of patients to participate in informed decision-making. These results validate the findings of previous studies and supports a continued need for refined methods of prostate cancer education. Cancer 2013;119:3204-3211. © 2013 American Cancer Society. [ABSTRACT FROM AUTHOR]

In selected patients undergoing cardiac surgery, our research group previously showed that optimized temporary biventricular pacing can increase cardiac output one hour after weaning from cardiopulmonary bypass. Whether pacing is effective after beating-heart surgery is unknown. Accordingly, in this study we examined the feasibility of temporary biventricular pacing after off-pump coronary artery bypass grafting. The effects of optimized pacing on cardiac output were measured with an electromagnetic aortic flow probe at the conclusion of surgery in 5 patients with a preoperative mean left ventricular ejection fraction of 0.26 (range, 0.15–0.35). Atrioventricular (7) and interventricular (9) delay settings were optimized in randomized order. Cardiac output with optimized biventricular pacing was 4.2 ± 0.7 L/min; in sinus rhythm, it was 3.8 ± 0.5 L/min. Atrial pacing at a matched heart rate resulted in cardiac output intermediate to that of sinus rhythm and biventricular pacing (4 ± 0.6 L/min). Optimization of atrioventricular and interventricular delay, in comparison with nominal settings, trended toward increased flow. This study shows that temporary biventricular pacing is feasible in patients with preoperative left ventricular dysfunction who are undergoing off-pump coronary artery bypass grafting. Further study of the possible clinical benefits of this intervention is warranted. [ABSTRACT FROM AUTHOR]

Right to health litigation in Brazil raises a debate regarding its distributive effects in a resource constrained setting. Several studies have found that a significant proportion of litigation features individual claimants who live in the most affluent states, cities and districts of Brazil and are usually represented by private lawyers, whose fees are beyond the reach of most of the poor population. For some, this is an indication that the distributive effects of litigation are very likely negative because litigation tends to benefit a privileged socio-economic group and may force health authorities to divert to them resources from comprehensive health programs that benefit the majority of the population. Others, however, argue that courts can nonetheless provide an important institutional voice for the poor and promote health equity when they manage to access them. The main problem for this *prolitigation camp* is thus to enhance access to Justice. Our aim is to analyze lawsuits in which litigants are represented by public attorneys in right to health litigation in the city of São Paulo to inquire if at least this type of litigation is reaching out to the neediest citizens. This study analyzes three indicators: the income of litigants, the Human Development Index and the Health Need Index of the areas where they live. Our conclusion is that although public attorneys seem to represent mostly low income people, other indicators suggest that there are still important obstacles for public attorneys to reach the neediest. [ABSTRACT FROM AUTHOR]

This paper discusses the post-trial access to drugs for patients who participated in clinical trials in Brazil. The ethical guidance for clinical trials in Brazil is arguably one of the clearest in the world in attributing to research sponsors the responsibility for providing post-trial drugs to patients who participated in their experiments. The Federal Constitution recognizes health as a fundamental right to be fulfilled by the State. Based on the Brazilian constitution and on the National Health Council resolutions, courts have been accepting patients' claims and ordering the State and the pharmaceutical companies to provide these patients with the tested treatment in the quantity and duration they need it. This generous interpretation of the duties of the pharmaceutical companies and the State makes the Brazilian model for post-trial access unique when compared to the experience of other countries and thus should be followed with attention by future research in order to assess its consequences for patients, research sponsors, and the public health system. [ABSTRACT FROM AUTHOR]

Abstract: Chronic lymphocytic leukemia (CLL) is a malignancy arising from immune cells (B-lymphocytes) endowed with intrinsic antigen-presenting capabilities. Such a function however is lost during malignant transformation and CLL cells are well known for their inability to process and present antigens to the T-cell arm of the immune system. Instead, malignant CLL cells elicit a vast array of immune regulatory mechanisms conducive to T-cell dysfunction and immunosuppression. Previously, we have shown that treatment of CLL cells with the demethylating agent 5-aza-2′-deoxycytidine unleashed target antigen expression. Here we show for the first time that combining two epigenetic modifiers, 5-aza-2′-deoxycytidine and the histone deacetylase inhibitor LAQ824 effectively restores the immunogenicity of CLL cell lines as well as primary cells obtained from CLL patients. Indeed, such a combination induces the expression of novel and highly antigenic cancer-testis antigens (CTAs) and costimulatory molecules. These changes facilitate the formation of robust supramolecular activation complexes (SMAC) between CLL cells and responder T-cells leading to intracellular signaling, lytic granule mobilization, and polarization of functional and relevant T-cell responses. This cascade of T-cell activating events triggered by CLL cells with restored APC function, points to combined epigenetic modifier treatment as a potential immunotherapeutic strategy for CLL patients. [Copyright &y& Elsevier]

Abstract: The 7-alkene-3-quinolinecarbonitrile 20, a potent inhibitor of Src enzymatic and cellular activity with IC50 values of 2.1 and 58nM, respectively, had comparable efficacy to bosutinib in a colon tumor xenograft study. [Copyright &y& Elsevier]

Abstract: We previously reported that a 3-pyridinecarbonitrile analog with a furan substituent at C-5 and a 4-methylindol-5-ylamino substituent at C-4, 1, was a potent inhibitor of PKCθ (IC50 =4.5nM). Replacement of the C-5 furan ring of 1 with bicyclic heteroaryl rings, led to compounds with significantly improved potency against PKCθ. Analog 6b with a 4-methylindol-5-ylamino group at C-4 and a 5-[(4-methylpiperazin-1-yl)methyl]-1-benzofuran-2-yl group at C-5 had an IC50 value of 0.28nM for the inhibition of PKCθ. [Copyright &y& Elsevier]

Abstract: The key intermediate, 4-chloro-5-iodo-3-pyridinecarbonitrile, allowed for ready optimization of the PKCθ inhibitory activity of a series of 3-pyridinecarbonitriles. Analog 13b with a 4-methylindol-5-ylamino group at C-4 and a 4-(2-(4-methylpiperazin-1-yl)ethoxy)phenyl group at C-5 had an IC50 value of 7.4nM for the inhibition of PKCθ. [Copyright &y& Elsevier]

Abstract: We have developed a systematic and generic way to improve recombinant protein productivities in stable transfections by applying mRNA and protein destabilizing elements to reduce selection marker expression strength. Interferon-gamma (IFNγ) expression vectors containing different combinations of AU-rich elements (ARE) and mouse ornithine decarboxylase (MODC) PEST region on the amplifiable dihydrofolate reductase (dhfr) selection marker were stably transfected into CHO-DG44 cells. Improvements in specific IFNγ productivities were 1.7-, 6.6- and 13.3-fold with the application of ARE, MODC PEST, and both ARE and MODC PEST, respectively. To further enhance productivities, compatibility of the destabilizing sequences with methotrexate (MTX) amplification was validated by amplifying the transfected cells to 50nM MTX. A 14- to 27-fold increase in specific IFNγ productivities were observed after amplification, indicating the compatibility of the two systems. A high specific IFNγ productivity of 1.05pg/cell/day was also attained by the amplified cell pool with both ARE and MODC PEST. [Copyright &y& Elsevier]

This study attempted to identify the crucial individuals in the help-seeking pathways of Chinese caregivers of relatives suffering from early psychosis in Hong Kong. In-depth interviews with 58 caregivers were conducted. The findings suggest that although the family caregivers usually initiated the help-seeking process, informal network members were instrumental in confirming the presence of mental illness and encouraged the caregivers to seek external help. School social workers acted as a bridge between the informal and formal networks and referred the adolescents for psychiatric consultations. However, it was found that some of the ill relatives did not recognize the severity of their mental health problems, which posed a major obstacle to help seeking. Contrary to the claims in overseas literature, the informal network members' accurate recognition of mental illness quickened the help-seeking process. Individual, cultural, and social institutional factors were identified and used to further explain these characteristics of help seeking. Implications for social work practice are highlighted. [ABSTRACT FROM AUTHOR]

This manuscript includes findings from field and numerical modeling investigations designed to quantify the degree and rates of biogenic hydrocarbon chemical processing within and above a mixed deciduous forest in the southeastern United States. The study site was under the influences of nitrogen oxide and hydrocarbon emissions from suburban automobile traffic. The most common ambient biogenic hydrocarbons measured within and above the forest included isoprene, α-pinene, and d-limonene. Isoprene was the most abundantly produced biogenic hydrocarbon, with maximum isoprene flux densities reaching 50 nmol m−2 s−1. Isoprene and its reaction products (methyl vinyl ketone and methacrolein) comprised over 75% of the measured hydrocarbon mass. Substantial nitrate (NO3) and hydroxyl (HO) radical formation occurred within the forest canopy, with maximum NO3 and HO levels approaching 1 part per trillion on a volume basis (pptv) and 0.05 pptv, respectively. These NO3 and HO levels, combined with within-canopy ozone (O3) mixing ratios of 60 parts per billion (ppbv), reacted with biogenic hydrocarbons and produced substantial amounts (0.6 ppbv) of peroxy radicals. The main conclusion from this investigation is that forested ecosystems capable of high rates (>50 nmol m−2 s−1) of biogenic hydrocarbon emissions, and in the vicinity of modest rates of nitrogen oxide emissions from suburban automobile traffic, can support a unique and active photochemistry within the forest canopy. In these areas it may not be valid to use biogenic emissions estimated from measurements made at the foliage level for regional-scale air quality modeling because the underlying processes are nonlinear. Regional-scale air quality models should include chemical preprocessing of biogenic hydrocarbons before they are emitted to the full regional modeling grid in order to accurately represent the photochemical production of pollutants on the wider scale. [ABSTRACT FROM AUTHOR]

The amino acid arginine is frequently used as a solution additive to stabilize proteins against aggregation, especially in the process of protein refolding. Despite arginine's prevalence, the mechanism by which it stabilizes proteins is not presently understood. We propose that arginine deters aggregation by slowing protein-protein association reactions, with only a small concomitant effect on protein folding. The associated rate effect was observed experimentally in association of globular proteins (insulin and a monoclonal anti-insulin) and in refolding of carbonic anhydrase. We suggest that this effect arises because arginine is preferentially excluded from protein-protein encounter complexes but not from dissociated protein molecules. Such an effect is predicted by our gap effect theory [Baynes and Trout (2004) Biophys. J. 87, 1631] for "neutral crowder" additives such as arginine which are significantly larger than water but have only a small effect on the free energies of isolated protein molecules. The effect of arginine on refolding of carbonic anhydrase was also shown to be consistent with this hypothesis. [ABSTRACT FROM AUTHOR]

Two experiments were conducted to determine the optimum dietary inclusion level of dehulled soybean meal (DHSM) as a fish meal (FM) replacement in diets for olive flounder Paralichthys olivaceus. All the experimental diets were formulated to be isonitrogenous and isoenergetic to contain 50% crude protein (CP) and 16.7 kJ energy g−1 diet. In the first experiment, eight diets were formulated to replace FM with DHSM at 0%, 10%, 20% without amino acid (AA) supplementation; 20%, 30%, 40% with AA supplementation and 30%, 40% with AA & attractant supplementation (DHSM0, DHSM10, DHSM20, DHSM20+AA, DHSM30+AA, DHSM30+AA+Att, DHSM40+AA, DHSM40+AA+Att respectively). Triplicate groups of 25 fish averaging 5.0±0.04 g (mean±SD) were fed one of eight experimental diets for 8 weeks. In the second experiment, six diets were formulated to replace FM with DHSM at 0%, 10%, 20%, 30% without attractant supplementation and 20%, 30% with attractant supplementation (DHSM0, DHSM10, DHSM20, DHSM30, DHSM20+Att, DHSM30+Att respectively). Triplicate groups of 15 fish averaging 45.5±0.08 g (mean±SD) were fed one of six experimental diets for 10 weeks. Based on growth performance, we concluded that DHSM could replace FM up to 20% without AAs (lysine and methionine) and attractant supplementation, and up to 30% with AAs and/or attractant supplementation in diets for fingerling and growing olive flounder. [ABSTRACT FROM AUTHOR]