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Introduction: Sulforaphane (SFN) is a naturally occurring isothiocyanate associated with various health benefits, including reduced cancer risk, and has been extensively explored as a potential therapeutic. However, its inherent instability presents challenges in formulation, storage, and administration as a medicinal product. SFX-01 (Sulforadex®) is a patented synthetic form of d,l-SFN stabilized within a biologically inert alpha-cyclodextrin complex. Methods: The safety, tolerability, and pharmacokinetics of an enteric-coated tablet formulation of SFX-01 were evaluated in a randomized, double-blind, placebo-controlled, dose-escalation study [300 mg once daily (46.2 mg SFN), 300 mg twice daily or 600 mg once daily (92.4 mg SFN)] over 7 days in healthy male participants. Results: Treatment-emergent adverse events (TEAEs) occurred in 94% of participants who received SFX-01 and were most commonly gastrointestinal events, which were mild in severity and related to treatment. Following ingestion of SFX-01 tablets, SFN was rapidly absorbed, with a timescale consistent with the enteric coating, and subsequently metabolized. The observed peak blood concentration (Cmax) for the sum of SFN and metabolites (total thiol) across all treatment cohorts ranged from 0.43 to 2.12 µmol/L in 3–6 h. Cmax data were considered inconclusive with respect to dose-proportionality and there was minimal evidence of accumulation of SFN and metabolites. Urinary excretion of SFN and individual metabolites ranged from < 1 to 41%, and the proportion excreted did not appear to be influenced by the dose. Conclusion: This study demonstrated the safety and tolerability of SFX-01 over 7 days and indicated that the pharmacokinetic behavior of SFX-01 enteric-coated tablets was in line with expectations. Trial Registration: European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) number: 2022-001601-43; ISRCTN Study Registration number: ISRCTN9628565. [ABSTRACT FROM AUTHOR]

Background: Bacterial infection of the intervertebral disc is difficult to treat because the tissue is usually not vascularized and systemic antibiotic therapy may not reach optimal antibacterial exposure. Here we characterize the safety, tolerability, and pharmacokinetics of PP353, a suspension of micronized linezolid, formulated for direct intervertebral disc administration. Methods: The safety, tolerability, and pharmacokinetics of an intradiscal administration of PP353, was assessed in Part A of a Phase 1b study and consisted of a single injection of study drug (3 mL of PP353 and 150 mg linezolid). Clinical assessment included initial safety and tolerability of PP353 with continued follow‐up for 12 months. Assessment of linezolid concentration in plasma samples enabled characterization of the pharmacokinetics. Deconvolution of systemic linezolid was used to estimate intervertebral disc linezolid concentration. Results: Intradiscal administration of 3 mL of PP353 (linezolid 50 mg/mL) to the nucleus pulposus was well tolerated with no reported study treatment‐related severe or serious adverse events and resulted in an average geometric mean linezolid plasma Cmax of 1300 ng/mL at 7.27 h post‐administration. The linezolid plasma Cmax observed with intradiscal PP353 is approximately 10% that observed with a standard oral or iv administration of 600 mg linezolid. Pharmacokinetic deconvolution estimated that a single dose of PP353 (150 mg linezolid) provided intradiscal bactericidal concentration of linezolid for 96 h and bacteriostatic exposure for up to 120 h after dosing. Conclusion: Intradiscal administration of 3 mL of PP353 is well‐tolerated and based on the pharmacokinetics following a single injection, a two‐dose regimen of PP353 (150 mg linezolid) on Day 1 and Day 5 ± 1 was selected to explore safety, tolerability, pharmacokinetics, and efficacy in Part B of the Persica 002 study. [ABSTRACT FROM AUTHOR]

In this essay I argue that Humphry Davy uses the figure of Proteus to illustrate his conception of a world in a state of perpetual change. Over the past four years, 11 417 pages of Davy's notebooks have been transcribed by more than 3500 volunteers from around the world. These have revealed the extent of Davy's poetic output and confirmed his world view that matter is constantly being made, unmade, and made again in new forms. For Davy, atoms are drawn dynamically towards and away from each other, forging new entities through the power of heat, cold, and other chemical interventions. Here, I look at specific instances where Davy's poetry and science are in close proximity to each other, on the same notebook page or in the same notebook, paying attention to Davy's interest in the so-called 'proteus' fish, which was thought to be able to adapt to life on land or sea at will. Davy saw the mythological figure Proteus as a symbol for chemical change and for the changes that all matter goes through. I will also use this trope to discuss the development of Davy's ideas from notebook to lecture and published page. [ABSTRACT FROM AUTHOR]

Little is known about risk management in homecare for people with dementia. We aimed to gain an understanding of the ways in which homecare workers assess and manage risk whilst caring for people with dementia in their own homes. We conducted a qualitative interview study with 17 homecare workers assisting people with dementia with their personal care. Interviews were face-to-face, semi-structured, recorded and transcribed verbatim. Analysis was inductive and thematic. A key theme of risk was identified, with three main sources: the client as a source of risk to the homecare worker, the clients' home and behaviours as a risk to the client, and the wider health and social care system as a risk to both clients and homecare workers. Three interrelated aspects of risk were found to influence homecare workers' decision making and actions: homecare workers' perception of the level of risk, their perceived ability to control the risk and their tolerability of risk. The higher the perceived risk, the stronger the action taken by the worker or agency to mitigate it and the greater the impact on the client. To support effective development of this workforce there is a need to devise training that incorporates the use of tacit knowledge and experiential learning. Risk management policies for homecare should acknowledge and utilise the expertise, experiences and values of homecare workers. [ABSTRACT FROM AUTHOR]

Neutralizing antibodies to Porcine Epidemic Diarrhea Virus (PEDV) can be detected by 3 weeks post-infection and remain detectable through at least 24 weeks post-infection. The objective of this study was to evaluate the levels of neutralizing antibodies in sow and piglet serum and sow milk to determine the duration of neutralizing antibodies following PEDV outbreaks. Two farms were selected for the study following outbreaks of PEDV. Monthly, cohorts of sows were sampled and followed through two farrowings. Following each farrowing, samples from piglets and milk were collected. Samples were evaluated for PEDV-neutralizing antibodies by a high-throughput fluorescent neutralization assay. Although neutralizing antibodies to PEDV can be detected throughout 15 months post-outbreak, a decrease in circulating neutralizing antibody levels is noted in farms beginning at six months post-outbreak. With decreasing levels, farms may become more vulnerable to PEDV outbreaks, and practitioners can focus on this time window to implement intervention strategies. [ABSTRACT FROM AUTHOR]

We assess a possibility to efficiently represent the strongly coupled increment in an ocean–atmosphere coupled data assimilation (DA) system by applying an iterative procedure involving uncoupled solvers and the weakly coupled analysis as a first guess approximation to the strongly coupled increment. Using the output of the ensemble‐based weakly coupled DA system, we explore convergence of the approximations to the strongly coupled DA solution by applying the uncoupled solver to a sequence of innovation vectors at various spacetime locations over the global ocean grid. The results demonstrate that, in general, fewer than two iterations are required to approximate the coupled increment in the majority of the locations tested with sufficient (3%) accuracy given the uncertainty of the background error covariance estimated from the limited number of the ensemble members. We assess the impact of data thinning and hybridization of the background error covariance model on the convergence of the iterative approximations to the strongly coupled increment. An empirical relationship between the spectral radius of the expansion matrix and convergence rate is obtained. [ABSTRACT FROM AUTHOR]

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A large body of research demonstrates that concussions are exceedingly common and extremely difficult to detect. Despite medical efforts to develop sophisticated tools to detect concussions, research continues to demonstrate that proper detection relies on prompt and thorough symptom reporting from the injured athlete. In the context of sports, such reporting requirements are complicated by systems that reward athletic performance. This study seeks to provide student athletes who play NCAA Division I high-contact sports with a theoretically driven intervention to improve their attitudes and behavior toward concussion reporting. Division I student athletes (N = 345) viewed one of three conditions: an NCAA handout consistent with current practices, the experimental video, or a non-treatment control video, then responded to questions regarding attitudes and behaviors toward concussion reporting. Overall, results support the video's effectiveness in changing perceptions of concussion injuries. Nuances of the findings lead to a discussion for practical implications to transform concussion-reporting attitudes and behaviors among athletes. [ABSTRACT FROM AUTHOR]

Rationale: Offering a primary care service that can provide good quality primary care at emergency departments may reduce pressure on usual emergency department (ED) services. Aims and Objectives: To evaluate the acceptability, satisfaction, and potential impacts of a co‐located primary care service at an emergency department. Methods: This is a prospective feasibility study and service evaluation comprising a narrative summary of activity, satisfaction, well‐being, and safety, and comparisons of wait times for ED services by patient category ('minor', 'majors', 'paediatric' or 'resus') before and during the service operation. Patients and staff were asked using semistructured interview topic guides about service perception, well‐being, representation within 48 h, safety concerns, and/or satisfaction. Wait times for patient categories in usual ED care service were in secondary care electronic records. Pathway changes were captured under primary care electronic records. Results: Approximately 96% of general practitioner streaming and treatment (GPST) patients were seen within 1 h. There was a statistically significant reduction in ED patients with minor injuries or illnesses waiting >4 h for admission or discharge 'breaches' during the 3 months that GPST was operating compared with the previous 3 months (p ≤ 0.005). Wait times for other ED services did not significantly improve. A total of 769 walk‐in patients received GPST consultation and 661 (86%) needed no further ED intervention. Fast discharge was a major determinant of patient satisfaction. No staff expressed dissatisfaction, but some suggested possible improvements in eligibility criteria and built environment design features. Conclusion: Provision of GPST correlated with shorter waits for discharge from ED. Patient and staff experiences of GPST were positive. [ABSTRACT FROM AUTHOR]

The assimilation of hyperspectral infrared sounders (HIS) observations aboard Earth-observing satellites has become vital to numerical weather prediction, yet this assimilation is predicated on the assumption of clear-sky observations. Using collocated assimilated observations from the Atmospheric Infrared Sounder (AIRS) and the Cloud–Aerosol Lidar with Orthogonal Polarization (CALIOP), it is found that nearly 7.7% of HIS observations assimilated by the Naval Research Laboratory Variational Data Assimilation System–Accelerated Representer (NAVDAS-AR) are contaminated by cirrus clouds. These contaminating clouds primarily exhibit visible cloud optical depths at 532 nm (COD532nm) below 0.10 and cloud-top temperatures between 240 and 185 K as expected for cirrus clouds. These contamination statistics are consistent with simulations from the Radiative Transfer for TOVS (RTTOV) model showing a cirrus cloud with a COD532nm of 0.10 imparts brightness temperature differences below typical innovation thresholds used by NAVDAS-AR. Using a one-dimensional variational (1DVar) assimilation system coupled with RTTOV for forward and gradient radiative transfer, the analysis temperature and moisture impact of assimilating cirrus-contaminated HIS observations is estimated. Large differences of 2.5 K in temperature and 11 K in dewpoint are possible for a cloud with COD532nm of 0.10 and cloud-top temperature of 210 K. When normalized by the contamination statistics, global differences of nearly 0.11 K in temperature and 0.34 K in dewpoint are possible, with temperature and dewpoint tropospheric root-mean-squared errors (RMSDs) as large as 0.06 and 0.11 K, respectively. While in isolation these global estimates are not particularly concerning, differences are likely much larger in regions with high cirrus frequency. [ABSTRACT FROM AUTHOR]

A new data source from ground‐based stations that track global navigation satellite system (GNSS) transmitters has been implemented in the Navy Global Environmental Model (NAVGEM) with the NRL Atmospheric Variational Data Assimilation System‐Accelerated Representer. The observable is the ground‐based zenith total delay (ZTD) at each ground station. This ground‐based GNSS ZTD represents the tropospheric delay of the propagation of GNSS radio L‐band signal between the transmitters and the ground stations after correcting for ionospheric effects. Here, we present the implementation procedure, quality control, single observation test, bias correction scheme, and data impact assessment. One of the critical elements in the quality control scheme is to correct for the difference between the observing ground station elevation and the numerical model terrain. A single observation test shows comparable impact from this new data source to a single radiosonde observation at a single level. The ZTD biases estimated from a 6‐month experiment run are generally small, but have a dependency on the processing center and are computed separately for each station. The forecast sensitivity to observation impact diagnosis from a 3‐month experiment demonstrates that a single ZTD observation shows similar impact as the average impact from a single tangent point of a GNSS Radio Occultation profile. The assimilation of ZTD observations also significantly improves the forecast skill by 0.25%–0.75% for wind, temperature, and precipitable water and by 1%–2% for geopotential height in the Southern Hemisphere beyond 3 days. Plain Language Summary: Adequate sampling of water vapor in meteorological and climate observing systems is critical to environmental characterization and climate monitoring. Currently, atmospheric humidity observations in both space and time are not adequately sampled. The ground‐based global navigation satellite system (GNSS) network offers a cost‐effective pathway to retrieve high‐quality humidity observations. Observations from the GNSS network can serve as anchoring observations for the data assimilation and numerical weather prediction. These observations complement other satellite measurements to further improve forecast quality. This study outlines the implementation procedure for the ground‐based GNSS zenith total delay and assesses its impact on Navy's global numerical weather forecasts. Our results indicate that the data can have a significant positive impact on the Southern Hemisphere's forecasts beyond 3 days. When evaluating each observation's impact on the 24‐hr model forecasts, the impact of a single zenith total delay measurement is comparable to that of the average impact of a single GNSS Radio Occultation data at a single tangent point. Key Points: Ground‐based global navigation satellite system (GNSS) provides an innovative and cost‐effective means to retrieve humidity observationsThe impact from the assimilation of a single zenith total delay and a single GNSS Radio Occultation tangent point are comparableAssimilation of zenith total delay significantly improves the model forecast skill in the Southern Hemisphere beyond 3 days [ABSTRACT FROM AUTHOR]

Integrative local health delivery models in the UK, under the framework of Enhanced Health in Care Homes (EHICH), have been developed to improve joint working between health and social care to benefit the patient. Despite this drive toward health and social care integration, research on the barriers, facilitators, and impact of partnership working on role of care home staff is underdeveloped. This study set out to explore views on how closer working between health and social care can impact on the role of care home staff and any barriers to effective integration. Staff from 25 care homes and GPs from their partnered practices were interviewed to explore the impact of the partnership. Homes receiving regular visits from the same health professional found the relationship between the two sectors had benefitted both residents and staff. The development of trusting relationships, access to support and information, and recognition and respect were all seen as facilitating the partnership and enhancing patient care. Regular and effective interactions with health-care professionals were key and had the potential to empower and increase confidence of care home staff in their role around health care. Factors negatively impacting on strength of relationship such as visits by inconsistent professional and high turnover of care home staff were a barrier to successful partnerships. Experiences of poor interactions with those from health-care services where there was an absence of a trusting relationship were disempowering to care home staff and remain a barrier to effective wider health and social care collaboration. [ABSTRACT FROM AUTHOR]

Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first‐order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second‐order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person‐centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks. [ABSTRACT FROM AUTHOR]

The task of quantifying spatial and temporal variations in terrestrial water, energy, and vegetation conditions is challenging due to the significant complexity and heterogeneity of these conditions, all of which are impacted by climate change and anthropogenic activities. To address this challenge, Earth Observations (EOs) of the land and their utilization within data assimilation (DA) systems are vital. Satellite EOs are particularly relevant, as they offer quasi‐global coverage, are non‐intrusive, and provide uniformity, rapid measurements, and continuity. The past three decades have seen unprecedented growth in the number and variety of land remote sensing technologies launched by space agencies and commercial companies around the world. There have also been significant developments in land modeling and DA systems to provide tools that can exploit these measurements. Despite these advances, several important gaps remain in current land DA research and applications. This paper discusses these gaps, particularly in the context of using DA to improve model states for short‐term numerical weather and sub‐seasonal to seasonal predictions. We outline an agenda for land DA priorities so that the next generation of land DA systems will be better poised to take advantage of the significant current and anticipated shifts and advancements in remote sensing, modeling, computational technologies, and hardware resources. Plain Language Summary: Satellite remote sensing measurements have enabled the monitoring of the Earth's land surface with unprecedented scale and frequency. These measurements allow us to monitor the changes on the land surface and understand the contribution of human activities toward them. The information from such observations is combined with the modeled estimates through data assimilation (DA) algorithms. This article discusses the progress made in the development of land DA systems and the major gaps that remain. The paper also outlines priorities that we need to consider in the development of next generation land DA systems so that the potential of land remote sensing measurements can be fully realized. Key Points: Land data assimilation has shown significant promise for short‐term forecasting applicationsSignificant gaps remain in the current land data assimilation systems related to observation utilization and modelsCoordinated development with the modeling and observational community and adoption of technological enhancements are needed in the future [ABSTRACT FROM AUTHOR]

Purpose: We identified associations between membership in seven group‐based trajectories based on supply of filled opioid prescriptions and potential opioid‐related adverse health events over a 720‐day window. Methods: We identified two veteran cohorts with chronic non‐cancer pain who initiated treatment with long‐term opioid therapy between 2008 and 2015, excluding those with prior substance use disorder (n = 373 941) or non‐SUD, opioid‐related adverse outcome (n = 405 631) diagnoses. Outcomes of interest included opioid use disorder, non‐opioid drug use disorder, and alcohol use disorder for the first cohort; or accidents resulting in wounds or injuries, self‐inflicted injuries, opioid‐related accidents and overdoses, alcohol and non‐opioid drug‐related accidents and overdoses, and violence‐related injuries for the second cohort. Using a cross‐sectional design, Veterans were followed until the specific outcome of interest was diagnosed, they died, the study ended, or they were lost to follow up. Accelerated failure time models were estimated for each outcome. Results: Membership in persistent moderate days covered and persistent modest days covered trajectories was associated with decreased risk of opioid use disorder (Moderate: θ = 0.59, 95%CI:0.54, 0.64; Modest: θ = 0.54, 95%CI:0.50, 0.59) and opioid overdose (Moderate: θ = 0.67,95%CI: 0.57, 0.79; Modest: θ = 0.72, 95%CI:0.61, 0.85) versus higher‐utilizing persistent users. Rapid discontinuation was associated with decreased risk of opioid use disorder (θ = 0.86, 95% CI:0.77, 0.95) and opioid overdose (θ = 0.54, 95%CI:0.41, 0.71), but increased risk of alcohol use disorder (θ = 1.07, 95%CI:1.00, 1.15) and other substance use disorders. Delayed discontinuation or delayed reduction was associated with increased risk for most opioid related adverse health events. Conclusion: Persistent use trajectories with low levels of opioid utilization were associated with lower risks of potential opioid‐related adverse health events. [ABSTRACT FROM AUTHOR]

We compare two seemingly different methods of estimating random error statistics (uncertainties) of observations, the three-cornered hat (3CH) method and Desroziers method, and show several examples of estimated uncertainties of COSMIC-2 (C2) radio occultation (RO) observations. The two methods yield similar results, attesting to the validity of both. The small differences provide insight into the sensitivity of the methods to the assumptions and computational details. These estimates of RO error statistics differ considerably from several RO error models used by operational weather forecast centers, suggesting that the impact of RO observations on forecasts can be improved by adjusting the RO error models to agree more closely with the RO error statistics. Both methods show RO uncertainty estimates that vary with latitude. In the troposphere, uncertainties are higher in the tropics than in the subtropics and middle latitudes. In the upper stratosphere–lower mesosphere, we find the reverse, with tropical uncertainties slightly less than in the subtropics and higher latitudes. The uncertainty estimates from the two techniques also show similar variations between a 31-day period during Northern Hemisphere tropical cyclone season (16 August–15 September 2020) and a month near the vernal equinox (April 2021). Finally, we find a relationship between the vertical variation of the C2 estimated uncertainties and atmospheric variability, as measured by the standard deviation of the C2 sample. The convergence of the error estimates and the standard deviations above 40 km indicates a lessening impact of assimilating RO above this level. Significance Statement: Uncertainties of observations are of general interest and their knowledge is important for assimilation in numerical weather prediction models. This paper compares two methods of estimating these uncertainties and shows that they give nearly identical results under certain conditions. The estimation of the COSMIC-2 bending angle uncertainties and how they compare to the assumed bending angle error models in several operational weather centers suggests that there is an opportunity for obtaining improved impact of RO observations in numerical model forecasts. Finally, the relationship between the COSMIC-2 bending angle errors and atmospheric variability provides insight into the sources of RO observational uncertainties. [ABSTRACT FROM AUTHOR]

Introduction: Accurate coding is essential to ensure correct remuneration for clinical procedures. However, coders are non-clinical, and use operative and discharge notes to infer what they think are appropriate codes. As plastic surgery encompasses a huge variety of procedures, the codes used may not reflect the procedures performed. Methods: Electronic records from July/August 2019 were consulted to identify commonly performed procedures on elective lists that were then reviewed retrospectively by a coding auditor and a clinician. Procedures were chosen to reflect a range of plastic surgery, including hand surgery, breast surgery and general plastic surgery. The changes to the clinical codes (procedural and diagnostic) and Healthcare Resource Group tariff implications were analysed. The audit loop was completed in July 2020 after the introduction of clinical coding improvement strategies. Results: A total of 65 relevant cases were included. Changes were made in 31 cases (24 changes to OPCS-4 codes and 7 changes to ICD-10 codes). Significant remunerative implications for the department were noted (£209 per patient on average). Conclusions: This study has demonstrated a clear need for collaboration between clinicians and coders. Increased surgeon awareness of clinical coding and clear documentation are essential. We have presented strategies to improve coding as part of a continued quality improvement. [ABSTRACT FROM AUTHOR]

Home‐care workers are increasingly caring for clients living with dementia. Workers usually have limited dementia training and are low paid and often lone working. Little is known about how home‐care workers assist people with dementia with their personal care. We aimed to explore the experiences of home‐care workers and the knowledge and skills they rely on when providing personal care to people with dementia. In 2020, we conducted 17 semi‐structured, face‐to‐face interviews with home‐care workers in the East of England. Analysis was inductive and thematic. Two key themes were present in the data: 'structural conditions' and 'clients' dementia‐related characteristics'. For each of these, we examined the challenges faced by home‐care workers and the strategies they used to manage these challenges. Challenges included time allocation for visits, completing care plan tasks, lone working, communication and understanding, refusals of care, and client behaviours. To mitigate these challenges, home‐care workers utilised system support, time management, training and experience and enacted a caring relationship, thought about their approach, and used distraction and communication skills. Workers relied on skills such as, relationship building, team working, observation, communication, decision making and interpersonal sensitivity. They drew on knowledge about the person, the person's needs, their own abilities, company policies and procedures and their role and responsibilities as a home‐care worker. Home‐care workers had more scope to mitigate client‐based challenges by adapting care within client interactions, than to manage structural challenges where there was a limit to what workers could do. Despite a commissioning focus on time‐ and task‐based care, when caring for people with dementia, home‐care workers used interaction as a way to bring the person along and complete care activities. Home‐care services should acknowledge the importance of interactions with people with dementia within home care and support their workers to develop interpersonal sensitivity. [ABSTRACT FROM AUTHOR]

Background: The radial forearm free flap (RFFF) is associated with troublesome donor site morbidity related to split thickness skin grafting (STSG). The radial forearm snake flap with primary closure of the donor site may reduce donor site complications. Methods: Single institution, retrospective cohort study comparing rates of delayed donor site wound healing and tendon exposure in 52 patients undergoing radial forearm snake flap and 95 patients undergoing conventional RFFF with STSG closure of the donor site. Results: Tendon exposure occurred in zero (0%) patients undergoing snake flap and four (4.2%) patients undergoing conventional RFFF (0/52 vs. 4/95; p = 0.297). Delayed wound healing occurred in zero (0%) patients undergoing snake flap and 19 (20.0%) patients undergoing conventional RFFF (0/52 vs. 19/95; p < 0.001). Conclusions: The radial forearm snake flap provides an alternative to conventional RFFF harvest, which enables primary donor site closure with reduced rates of delayed donor site healing. [ABSTRACT FROM AUTHOR]

The article focuses on the evolution of a life sentence served by the author, James Ruston, who reflects on his experiences during incarceration, struggles with parole, and the challenges of reintegration. Topics include the author's remorse for his past actions, positive changes during his sentence, the impact of social development delays among long-term prisoners, and the challenges of alcohol use and day parole conditions.

In 1624, Parliament passed An Act to Prevent the Destroying and Murdering of Bastard Children. The Virginia General Assembly enacted a similar law in 1710. Those statutes treated the concealment of a nonmarital newborn's death as presumptive murder. The essay argues that colonial Virginians' main objective in enforcing these acts was to scare pregnant servants into revealing their condition so that their masters could extract additional service without pay. Convictions for concealment alone, and not willful murder, rarely, if ever, resulted in execution. Deterrence was achieved through show trials and the criminal process, mitigated by a liberal pardon policy. [ABSTRACT FROM AUTHOR]

This paper describes the new global Navy Earth System Prediction Capability (Navy‐ESPC) coupled atmosphere‐ocean‐sea ice prediction system developed at the Naval Research Laboratory (NRL) for operational forecasting for timescales of days to the subseasonal. Two configurations of the system are validated: (1) a low‐resolution 16‐member ensemble system and (2) a high‐resolution deterministic system. The Navy‐ESPC ensemble system became operational in August 2020, and this is the first time the NRL operational partner, Fleet Numerical Meteorology and Oceanography Center, will provide global coupled atmosphere‐ocean‐sea ice forecasts, with atmospheric forecasts extending past 16 days, and ocean and sea ice ensemble forecasts. A unique aspect of the Navy‐ESPC is that the global ocean model is eddy resolving at 1/12° in the ensemble and at 1/25° in the deterministic configurations. The component models are current Navy operational systems: NAVy Global Environmental Model (NAVGEM) for the atmosphere, HYbrid Coordinate Ocean Model (HYCOM) for the ocean, and Community Ice CodE (CICE) for the sea ice. Physics updates to improve the simulation of equatorial phenomena, particularly the Madden‐Julian Oscillation (MJO), were introduced into NAVGEM. The low‐resolution ensemble configuration and high‐resolution deterministic configuration are evaluated based on analyses and forecasts from January 2017 to January 2018. Navy‐ESPC ensemble forecast skill for large‐scale atmospheric phenomena, such as the MJO, North Atlantic Oscillation (NAO), Antarctic Oscillation (AAO), and other indices, is comparable to that of other numerical weather prediction (NWP) centers. Ensemble forecasts of ocean sea surface temperatures perform better than climatology in the tropics and midlatitudes out to 60 days. In addition, the Navy‐ESPC Pan‐Arctic and Pan‐Antarctic sea ice extent predictions perform better than climatology out to about 45 days, although the skill is dependent on season. Key Points: Navy‐ESPC was run for a full year of weekly 60 day forecasts and compared to other models, observations, and climatologyNavy‐ESPC ensemble forecast skill for the MJO, NAO, AO, and AAO, and other indices, is comparable to that of other centersEnsemble forecasts of ocean sea surface temperatures perform better than climatology in the tropics and mid‐latitudes out to 60 days [ABSTRACT FROM AUTHOR]

The FORMOSAT‐7/COSMIC‐2 GNSS‐RO mission was launched on June 25, 2019, and it has provided a large increase in the number of GNSS‐RO observations available for operational numerical weather prediction (NWP) in the latitude band between ±40°. A key aim of this mission has been to improve the GNSS‐RO measurement quality in the lower and middle troposphere. In this study, we summarize the impact of the FORMOSAT‐7/COSMIC‐2 measurements in two independent NWP systems, which are now assimilating these measurements operationally. These are the United States Navy Global Environmental Model (NAVGEM) and the European Center for Medium‐Range Weather Forecasts (ECMWF) Integrated Forecasting System (IFS). Both systems employ a 4‐dimensional variational system (4D‐Var), and assimilate GNSS‐RO bending angles. The experiments cover the period January to March 2020. The impact of the FORMOSAT‐7/COSMIC‐2 measurements is assessed using improvements in short‐range forecast departures to other observations such as radiosonde and radiances, forecast error statistics against a verifying analysis, and adjoint based Forecast Sensitivity to Observation Impact (FSOI) estimates. The FORMOSAT‐7/COSMIC‐2 measurement has a clear impact on stratospheric temperatures and winds in the tropics. A novel finding is that the measurements also improve the tropical tropospheric humidity fit to radiosondes, and the fit to tropospheric radiances sensitive to humidity. To date, the impact of GNSS‐RO on humidity has been difficult to demonstrate in well constrained, operational NWP systems assimilating the full suite of observations. The results are achieved with a conservative assimilation approach which extended the quality control and observation error assignments used for the previous COSMIC receivers; further, possible improvements to the assimilation strategy are noted. [ABSTRACT FROM AUTHOR]

Numerical weather prediction systems depend on Hyperspectral Infrared Sounder (HIS) data, yet the impacts of dust-contaminated HIS radiances on weather forecasts has not been quantified. To determine the impact of dust aerosol on HIS radiance assimilation, we use a modified radiance assimilation system employing a one-dimensional variational assimilation system (1DVAR) developed under the European Organisation for the Exploitation of Meteorological Satellites (EUMETSAT) Numerical Weather Prediction--Satellite Application Facility (NWP-SAF) project, which uses the Radiative Transfer for TOVS (RTTOV). Dust aerosol impacts on analyzed temperature and moisture fields are quantified using synthetic HIS observations from rawinsonde, Micropulse Lidar Network (MPLNET), and Aerosol Robotic Network (AERONET). Specifically, a unit dust aerosol optical depth (AOD) contamination at 550 nm can introduce larger than 2.4 and 8.6 K peak biases in analyzed temperature and dewpoint, respectively, over our test domain. We hypothesize that aerosol observations, or even possibly forecasts from aerosol predication models, may be used operationally to mitigate dust induced temperature and moisture analysis biases through forward radiative transfer modeling. [ABSTRACT FROM AUTHOR]

This paper illustrates that analysis corrections, when applied as a model tendency term, can be used to improve nonlinear model forecasts and are consistent with the hypothesis that they represent an additive 6-h accumulation of model error. Comparison of mean analysis corrections with observational estimates of bias further illustrates the fidelity with which mean analysis corrections capture the model bias. While most previous implementations have explored the use of analysis corrections to correct forecast biases in shortrange forecasts, this is the first implementation of the correction method using both a seasonal mean and random analysis correction for medium-range forecasts (out to 10 days). Overall, the analysis correction– based perturbations are able to improve forecast skill in ensemble and deterministic systems, especially in the first 5 days of the forecast where bias and RMSE in both lower-tropospheric temperature and 500 hPa geopotential height are significantly improved across all experiments. However, while the method does provide some significant improvement to forecast skill, some degradation in bias can occur at later lead times when the average bias at analysis time trends toward zero over the length of the forecast, leading to an overcorrection by the analysis correction–based additive inflation (ACAI) method. Additionally, it is shown that both the mean and random component of the ACAI perturbations play a role in adjusting the model bias, and that the two components can have a complicated and sometimes nonlinear interaction. [ABSTRACT FROM AUTHOR]

This study documents how cultural sport narratives influence athletic team member sensemaking during concussion events. Analysis of macro-level sport culture narratives and interviews (N = 93) with collegiate athletes and athletic trainers from eleven large universities within the United States revealed that participants utilized five cultural sport narratives when making sense of a concussion event (i.e., Play-through-pain, Commodification, Big leagues, Masculine-Warrior, and Need-for-safety). These narratives functioned in two specific ways as athletic team members made sense of concussion events (i.e., as extracted cues and identity defenses). The study presents the concept of labeling avoidance (e.g., avoiding a formal concussion diagnosis) to describe how athletes retrospectively rationalized their non-disclosure of a severe head impact. Theoretical and practical implications of the study findings are discussed. [ABSTRACT FROM AUTHOR]

Coupled data assimilation (DA) provides a consistent framework for assimilating satellite observations that are sensitive to several components of the Earth system. In this paper, we focus on low-peaking infrared satellite channels that are sensitive to the lower atmosphere and Earth surface temperature (EST) over both ocean and land. Our atmospheric hybrid-4DVAR system [the Navy Global Environmental Model (NAVGEM)] is extended to include the following: 1) variability in the sea surface temperature (both diurnal variability and climatological perturbations to the ensemble members), 2) the coupled Jacobians of the radiative transfer model for the infrared sensors, and 3) the coupled covariances between the EST and the atmosphere. Our coupling approach is found to improve forecast accuracy and to provide corrections to the EST that are in balance with the atmospheric analysis. The largest impact of the coupling is found on near-surface atmospheric temperature and humidity in the tropics, but the impact extends all the way to the stratosphere. The role of each coupling element on the performance of the global atmospheric circulation model is investigated. Inclusion of variability in the sea surface temperature has the strongest positive impact on the forecast quality. Additional inclusion of the coupled Jacobian and ensemble-based coupled covariances led to further improvements in scores and to modification of the corrections to the ocean boundary layer. Coupled DA had significant impact on latent and sensible heat fluxes over land, locations of western boundary currents, and along the ice edge. [ABSTRACT FROM AUTHOR]

Rhinoplasty utilizes cartilage harvested from the nasal septum as autologous graft material. Traditional dogma espouses preservation of the "L-strut" of dorsal and caudal septum, which is less resistant to axial loading than virgin septum. Considering the 90° angle between dorsal and caudal limbs, the traditional L-strut also suffers from localized increases in internal stresses leading to premature septal "cracking," structural-scale deformation, or both. Deformation and failure of the L-strut leads to nasal deviation, saddle deformity, loss of tip support, or restriction of the nasal valve. The balance between cartilage yield and structural integrity is a topographical optimization problem. Guided by finite element (FE) modelling, recent efforts have yielded important modifications including the chamfering of right-angled corners to reduce stress concentrations and the preservation of a minimum width along the inferior portion of the caudal strut. However, all existing FE studies offer simplified assumptions to make the construct easier to model. This review article highlights advances in our understanding of septal engineering and identifies areas that require more work to further refine the balance between the competing interests of graft acquisition and the maintenance of nasal structural integrity. [ABSTRACT FROM AUTHOR]

Background: Adult acquired buried penis syndrome may be associated with an inability to void, sexual dysfunction, and recurrent infection. Previously published classification systems rely on intraoperative findings, such as penile skin quality.Objectives: The purpose of this study was to evaluate outcomes after adult acquired buried penis repair and to develop a classification system based on preoperative assessment.Methods: The authors reviewed data from patients who underwent buried penis reconstruction at a single institution. Patient history and physical examination guided the development of a classification system for surgical planning.Results: Of the 27 patients included, the mean age was 56 ± 15 years and mean body mass index was 49 ± 14 kg/m2. Patients were classified into 4 groups based on examination findings: (I) buried penis due to skin deficiency, iatrogenic scarring, and/or diseased penile skin (n = 3); (II) excess abdominal skin and fat (n = 6); (III) excess skin and fat with diseased penile skin (n = 16); and (IV) type III plus severe scrotal edema (n = 2). Surgical treatment (eg, excision and grafting, mons suspension, panniculectomy, translocation of testes, and/or scrotectomy) was tailored based on classification. Complications included wound breakdown (n = 3), cellulitis (n = 4), and hematoma (n = 1). Nearly all patients (96%) reported early satisfaction and improvement in their symptoms postoperatively.Conclusions: Classifying patients with buried penis according to preoperative examination findings may guide surgical decision-making and preoperative counseling and allow for optimized aesthetics to enhance self-esteem and sexual well-being.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Athlete safety and concussion injury have garnered considerable attention recently, and appropriate evaluation of athletes following head impacts depends, in part, on athletes' self-reporting of the symptoms. The National Collegiate Athletic Association has focused primarily on concussion injury education to encourage self-reporting; however, such efforts have not been especially effective and many potential injuries continue to go unreported. This research investigates cultural narratives, derived from sports media and popular culture, and how their narrative logics contribute to the context in which student-athletes make head injury reporting decisions and how these narratives offer templates for understanding potential consequences. We argue that performance-oriented narratives are more prevalent and showcase pathways to more immediate satisfaction of desires or goals. Ultimately, we argue that not only does analysis of prevailing cultural narratives illuminate the context in which athletes make reporting decisions but also that such understanding could inform narrative-based interventions in order to emphasize and model recommended behaviors, such as injury reporting, and values, such as long-term brain health and player wellness. [ABSTRACT FROM AUTHOR]

The article focuses on novel "Frankenstein" by Mary Shelley which argues that chemistry is the most important scientific discipline in the novel, refuting the commonly-held belief that Frankenstein is a medical doctor. It mentions fixity of identity and to encourage a new idea of the human as open and contemporary ideas of gender. It also mentions water cycle as a process is used to symbolise the transitory nature of human mood and emotion.

An introduction is presented in which editor discusses various articles within the issue on topics including historical and intellectual contexts of Mary Shelley, usual interpretation of "Frankenstein" and natural history of poetry.

Concussion among athletes is an issue of growing concern, with efforts underway to improve detection, diagnosis, and treatment. Success depends on communication by athletes, as brain-related symptoms are often not outwardly visible. Education programs to increase reporting behavior have not been successful to date. In accordance with the socioecological approach to health, we argue that multiple levels of influence on student athletes must be addressed, and report a multi-dimensional, mixed-methods research project conducted to identify possible points of intervention into changing the culture of concussion-injury reporting among collegiate athletes. Using quantitative, qualitative and interpretive methods, we examine the individual-level vested interests athletes have in reporting or not reporting concussion symptoms, and how these interests interact with community-level team culture and interpersonal relationships, and social-level cultural narratives to influence concussion-reporting behavior. Our findings confirm the viability of this approach, identifying immediacy, separation of responsibility and pain-enduring story systems as particularly salient elements. We conclude that competing performance versus safety value structures, reflected in cultural narratives and team culture, create mixed-messages for athletes, which are resolved in favor of performance because athletes perceive concussion injuries to be of low immediacy. [ABSTRACT FROM AUTHOR]

This special issue of Ambix brings together eight new studies on Humphry Davy together with an appreciation of the life and work of David Knight, much of whose scholarship was devoted to understanding Davy. Taken together they provide a much richer and more nuanced account of aspects of Davy's life, showing how he and his work fitted into the very complex and difficult social, cultural and political contexts of the opening decades of the nineteenth century. Taking as our starting point Thomas Carlyle's 1829 critique of modern science, in this introduction we weld together the themes that emerge from these papers, many of which ground their results in the project to publish Davy's Letters. This project has provided evidence that helps us critique the disciplinary boundaries that led to Davy becoming seen mostly as a chemist, while his friend Samuel Taylor Coleridge has generally been categorised as a poet. Such boundaries are now breaking down fruitfully as these essays all illustrate in their different ways. A consequence of the new understandings being produced, is that we need to consider anew what constitutes chemistry and chemists, how reputations and commemorations are constructed, the role of audiences (especially women) in developing knowledge and the use of language and literature, which, among other things, are key elements linking chemistry with other parts of society and culture. Davy provides an excellent location by which to address the historical issues involved, giving us an opportunity to balance carefully these and other components (such as human agency) in understanding how knowledge is constructed. [ABSTRACT FROM AUTHOR]

This essay explores how Davy fashioned himself as, what he called in his poetry, a "true philosopher." He defined the "true philosopher" as someone who eschewed monetary gain for his scientific work, preferring instead to give knowledge freely for the public good, and as someone working at a higher level than the mere experimentalist. Specifically, Davy presented himself as using the method of analogy to reach his discoveries and emphasised that he understood the "principle" behind his findings. He portrayed himself as one who perceived analogies because he had a wider perspective on the world than many others in his society. The poem in which he describes the "true philosopher" offers us Davy's private view of this character; the essay then demonstrates how Davy attempted to depict his own character in this way during critical moments in his career. [ABSTRACT FROM AUTHOR]

The Louisiana State University Community Playground Project (LSUCPP) employs community-based design techniques in which college students in biological engineering work with community constituents, especially children, to design and build playgrounds that reflect the unique aspects of the broader community that the playground will serve. In practicing a community-based design process, members of LSUCPP realized that there is a dearth of literature in this area. Therefore, members sought to develop an initial set of community-based design principles and best practices that engineering practitioners can use in their own community-based design endeavors. The team completed brainstorming and concept mapping exercises using a combination of individual and group techniques to create an initial set of 25 community-based design principles. Further discussion and concept mapping resulted in a framework for these 25 principles, which are organized into two major themes, Community-Based Design Principles of Practice, and Community-Based Design Principles of Conduct. The LSUCPP members believe that each of these principles supports the overall goal of community-based design: to express "the Soul of the Community" through co-created artifacts. [ABSTRACT FROM AUTHOR]

We conceptualize aerosol radiative transfer processes arising from the hypothetical coupling of a global aerosol transport model and a global numerical weather prediction model by applying the US Naval Research Laboratory Navy Aerosol Analysis and Prediction System (NAAPS) and the Navy Global Environmental Model (NAVGEM) meteorological and surface reflectance fields. A unique experimental design during the 2013 NASA Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC 4 RS) field mission allowed for collocated airborne sampling by the high spectral resolution Lidar (HSRL), the Airborne Multi-angle SpectroPolarimetric Imager (AirMSPI), up/down shortwave (SW) and infrared (IR) broadband radiometers, as well as NASA A-Train support from the Moderate Resolution Imaging Spectroradiometer (MODIS), to attempt direct aerosol forcing closure. The results demonstrate the sensitivity of modeled fields to aerosol radiative fluxes and heating rates, specifically in the SW, as induced in this event from transported smoke and regional urban aerosols. Limitations are identified with respect to aerosol attribution, vertical distribution, and the choice of optical and surface polarimetric properties, which are discussed within the context of their influence on numerical weather prediction output that is particularly important as the community propels forward towards inline aerosol modeling within global forecast systems. [ABSTRACT FROM AUTHOR]