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EDM is notorious for having copious genres and subgenres. There are many facets of EDM genre distinctions, but this article focuses on one musical aspect: the utilization of “continuous processes” such as crescendos, glissandi and filter sweeps of various lengths (Smith 2021). Some continuous processes signify belonging to certain subgenres. For example, acid house is known for a “squelching” sound, dubstep is known for its “wobble bass” and it is common to hear conversations about which subgenres have the most intense “risers”. In general, continuous processes are used more prominently in subgenres that are more intense, psychedelic and electronic than others. The article’s findings are based on analysis of production guides and fan discourse, as well as the author’s fieldwork and interviews with producers. Three analytical case studies are presented, comparing the use of continuous processes in multiple versions of a work (the original mix and remixes) from different subgenres.

Junior faculty are often called upon to deliver high-stakes large-group presentations. Training in the skills needed to do this effectively is often lacking. We devised a 1.25 h coaching program. The coach analyzed a practice run of the presentation using a locally developed assessment tool. Areas covered included public speaking skills, promoting learner understanding and retention, creating a dynamic learning climate, and optimal use of slides. COVID-19 necessitated a switch to virtual coaching, and we studied the impact of virtual vs. in-person coaching. We added two additional coaches and studied the transferability of the coaching component. There was high uptake of the offered coaching. Participant surveys showed improved comfort levels with large-group presentations; had a sense that their presentation skills had improved; showed an increased likelihood of volunteering for future speaking opportunities; and were likely to recommend the program. Comparisons between virtual and in-person coaching showed no statistical difference, and there was little difference between the original coach and the subsequent two coaches. Qualitative assessments revealed broad areas in which faculty felt the program had been most impactful. The coaching program was well-received and resulted in concrete positive changes in presenter behavior. Conducting the coaching in a virtual manner may increase the feasibility of the intervention, as would expanding the coach pool.

The advent of the Artificial Intelligent Internet of Things (AIoT) has sparked a revolution in the deployment of intelligent systems, driving the need for innovative data processing techniques. Due to escalating data privacy concerns and the immense volume of data produced by IoT devices, decentralized and distributed learning methods that are rapidly replacing traditional centralized learning play a pivotal role. As AIoT systems become increasingly ubiquitous, the accompanying computational and storage demands necessitate a departure from conventional paradigms towards more scalable, distributed, and decentralized architectures. This paper delves into the background of AIoT, with a particular focus on the evolution of distributed and decentralized learning mechanisms that operate without the need for centralized data collection, thus aligning with the General Data Protection Regulation (GDPR) for enhanced data privacy. The various distributed and decentralized learning strategies are the focus of this paper that facilitate collaborative model training across multiple AIoT nodes, thereby not only improving the performance of the AIoT system but also mitigating the risks of data concentration. The review further explores the adaptability of AI algorithms in these distributed settings, assessing their potential to optimize system performance and learning efficacy. The paper concludes with some use cases and lessons learned for decentralized and distributed learning in various AIoT areas.

Situation Awareness (SA) is a process of sensing, understanding and predicting the environment and is an important component in complex systems. The reception of information from the environment tends to be continuous and of a multimodal nature. AI technologies provide a more efficient and robust support by subdividing the different stages of SA objectives into tasks such as data fusion, representation, classification, and prediction. This paper provides an overview of AI and multimodal methods used to build, enhance and evaluate SA in a variety of environments and applications. Emphasis is placed on enhancing perceptual integrity and persistence. Research indicates that the integration of artificial intelligence and multimodal approaches has significantly enhanced perception and comprehension in complex systems. However, there remains a research gap in projecting future situations and effectively fusing multimodal information. This paper summarizes some of the use cases and lessons learned where AI and multimodal techniques have been used to deliver SA. Future perspectives and challenges are proposed, including more comprehensive predictions, greater interpretability, and more advanced visual information.

Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. We present the pathophysiology of ASIH through a literature review of hypothalamic–pituitary– testosterone axis recovery in supraphysiological testosterone exposure. This is followed by a scoping review of relevant observational and interventional studies published on PubMed and finally, a conclusion that is an easy reference for clinicians helping patients that are recovering from AAS abuse. Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 3–6 months. Further prospective studies are indicated to more closely describe patterns of recovery.

The evolution of super-resolution (SR) technology has seen significant advancements through the adoption of deep learning methods. However, the deployment of such models by resource-constrained devices necessitates models that not only perform efficiently, but also conserve computational resources. Binary neural networks (BNNs) offer a promising solution by minimizing the data precision to binary levels, thus reducing the computational complexity and memory requirements. However, for BNNs, an effective architecture is essential due to their inherent limitations in representing information. Designing such architectures traditionally requires extensive computational resources and time. With the advancement in neural architecture search (NAS), differentiable NAS has emerged as an attractive solution for efficiently crafting network structures. In this paper, we introduce a novel and efficient binary network search method tailored for image super-resolution tasks. We adapt the search space specifically for super resolution to ensure it is optimally suited for the requirements of such tasks. Furthermore, we incorporate Libra Parameter Binarization (Libra-PB) to maximize information retention during forward propagation. Our experimental results demonstrate that the network structures generated by our method require only a third of the parameters, compared to conventional methods, and yet deliver comparable performance.

Situational awareness (SA) is crucial in disaster response, enhancing the understanding of the environment. Social media, with its extensive user base, offers valuable real-time information for such scenarios. Although SA systems excel in extracting disaster-related details from user-generated content, a common limitation in prior approaches is their emphasis on single-modal extraction rather than embracing multi-modalities. This paper proposed a multimodal hierarchical graph-based situational awareness (MHGSA) system for comprehensive disaster event classification. Specifically, the proposed multimodal hierarchical graph contains nodes representing different disaster events and the features of the event nodes are extracted from the corresponding images and acoustic features. The proposed feature extraction modules with multi-branches for vision and audio features provide hierarchical node features for disaster events of different granularities, aiming to build a coarse-granularity classification task to constrain the model and enhance fine-granularity classification. The relationships between different disaster events in multi-modalities are learned by graph convolutional neural networks to enhance the system’s ability to recognize disaster events, thus enabling the system to fuse complex features of vision and audio. Experimental results illustrate the effectiveness of the proposed visual and audio feature extraction modules in single-modal scenarios. Furthermore, the MHGSA successfully fuses visual and audio features, yielding promising results in disaster event classification tasks.

Category: Other Introduction/Purpose: Musculoskeletal consultations constitute a growing portion of primary care physician (PCP) referrals. Optimization of communication between PCPs and orthopaedists can potentially reduce the time PCPs spend in the electronic medical record (EMR). This, in turn, may help reduce burnout. However, little is known about the preferences of PCPs regarding communication from orthopaedic specialists. The current study therefore investigated the preferences of PCPs across a large health network regarding communication from orthopaedists. Methods: One hundred and seventy-five PCPs across 15 practices within our health network were surveyed. These providers universally used the Epic Systems EMR. PCPs were asked to report their years in practice, panel size, typical number of electronic clinical messages received each day, time spent in the EMR after normal clinical hours, and burnout level. Likert scales and top-box scores were used to assess the PCPs’ perceived importance of communication from orthopedists in specific clinical scenarios. PCPs were further asked to report their preferred method of communication in each scenario and overall interest in communication from orthopaedists. Regression analyses were performed to determine if any PCP characteristics are associated with communication preferences and overall PCP interest in communication from orthopaedists. Results: A total of 107 (61%) PCPs completed the survey. PCPs most commonly rated communication from orthopaedists as highly important when the orthopaedist needed information from the PCP. In this scenario, PCPs preferred to receive an Epic Staff Message. Other scenarios rated as important included: the decision for surgery, hospitalization, and a major clinical change. In these scenarios, a CC’d Chart rather than Staff Message was preferred. Increased EMR use after-hours was associated with diminished odds of having high interest in communication from orthopaedists (odds ratio=0.65, 95% confidence interval: 0.48-0.88, P=0.005). Ninety-three PCPs (86.9%) reported spending at least 1 hour a day in Epic after normal clinical hours. Twenty-seven (25.2%) spent more than 3 hours. Forty-six PCPs (42.9%) reported experiencing at least one symptom of burnout. Conclusion: In the current study, there were distinct preferences among PCPs regarding clinical communication from orthopaedic surgeons. In addition, there was evidence of substantial burnout and after-hours work effort by PCPs. Our results may be helpful in optimizing communication between PCPs and orthopaedists, while also reducing time spent in the EMR by PCPs.

Category: Ankle; Trauma Introduction/Purpose: Although the medial clear space (MCS) is commonly used to assess talar alignment and ankle stability, its measurement is variable with multiple reported “normal” values. We have observed that the lateral tibial shaft is a reliable landmark to assess talar alignment. The objective of the current investigation was to determine the normal relationship of the lateral tibia to the superolateral talus using a tangent drawn inferiorly from the lateral tibial shaft, which we refer to as the “lateral tibial line” (LTL). Methods: The relationship of the LTL to the superolateral talus was assessed and characterized on ninety-nine standing ankle mortise radiographs in uninjured patients. This relationship was quantified by measuring the distance (in millimeters) between the LTL and the superolateral talus. Additionally, the inter-observer reliability of the LTL measurement, determined by three reviewers, was recorded and compared to medial clear space measurements. Results: The median value for the lateral tibial line was -0.50 mm with an interquartile range of -1.4mm - 0.0mm. The LTL was within 1mm of the lateral talus in 176 of 297 reviewer measurements (59.3%). Moreover, it was either lateral to or was at most 1mm medial to the lateral talus in 90.9% of cases. The LTL measurement also demonstrated good inter-observer reliability (0.764, 95% CI: 0.670-0.834), similar to the measurement of MCS (0.742, 95% CI: 0.539-0.846). Conclusion: The LTL is easily measured with good reliability for assessing the anatomic relationship of the tibia and talus. It uncommonly fell more than 1 mm medial to the superolateral talus. In other words, it was uncommon for the talus to shift lateral to this line, as might be seen with displaced ankle fractures. These findings will hopefully serve as a standard for future studies evaluating the role of the LTL in assessing lateral displacement and stability of isolated fibula fractures.

Category: Ankle Arthritis Introduction/Purpose: Despite advancements in surgical techniques, implants, and biologics, nonunion remains the most common major complication of ankle arthrodesis. While previous studies have reported delayed union or nonunion rates, few have elaborated on the clinical course of patients experiencing delayed union. We sought to better understand the trajectory of patients with delayed union by determining the rate of clinical success and failure and whether the extent of fusion on computed tomography (CT) was associated with outcomes. Methods: Delayed union was defined as incomplete ( < 75%) fusion seen on CT scan between 2 and 6 months postoperative. A total of 36 patients met inclusion criteria: isolated tibiotalar arthrodesis with delayed union. Patient-reported outcomes were obtained and patients were asked about satisfaction with their fusion. Success was defined as patients who were not revised and reported satisfaction with the procedure. Failure was defined as patients who progressed to revision or reported being not satisfied. Fusion was assessed by measuring the percent of osseous bridging across the joint on CT scan. The extent of bony bridging was categorized as absent (0%-24%), minimal (25%-49%), or moderate (50%-74%). Results: We determined the clinical outcome in 28 of the 36 eligible patients (78%) with mean follow-up of 5.6 years (range, 1.3 to 10.2 years). The majority (71%) of patients failed. A mean of 3.9 months (standard deviation, 1) elapsed between time of surgery and CT scan. Patients with minimal or moderate fusion on CT were more likely to succeed clinically than those with ‘absent’ fusion (X2 = 4.215, p = 0.040). Of those with absent ( < 25%) fusion, 11 of 12 (92%) failed. In patients with minimal or moderate fusion, 9 of 16 (56%) failed. Conclusion: We found that 71% of patients with a delayed union at roughly 4 months after ankle fusion required revision or were not satisfied. Patients with less than 25% osseous bridging on CT had an even lower rate of clinical success. These findings may help surgeons in counseling and managing patients experiencing a delayed union after ankle fusion.

ABSTRACT Little is known regarding the effectiveness of tixagevimab/cilgavimab in preventing SARS-CoV-2 infection in vaccinated immunocompromised patients, particularly after the emergence of the Omicron variant. In this retrospective cohort study with exact matching and propensity score adjustment within the U.S. Department of Veterans Affairs (VA) healthcare system, we selected immunocompromised veterans age ≥18 years as of 1 January 2022, receiving VA healthcare. We compared a cohort of 1,878 patients treated with at least one dose of intramuscular tixagevimab/cilgavimab to 7,014 matched controls selected from patients who met study criteria but were not treated. Patients were followed through 15 June 2022, or until death, whichever occurred earlier. The primary outcome was a composite of SARS-CoV-2 infection, COVID-19-related hospitalization, and all-cause mortality. We used Cox proportional hazards modeling to estimate the hazard ratios (HRs) and 95% CI for the association between receipt of tixagevimab/cilgavimab and outcomes. Most (73%) tixagevimab/cilgavimab recipients were ≥65 years old, and 80% had ≥3 mRNA vaccine doses or two doses of Ad26.COV2. Compared to matched controls, recipients had a lower incidence of the composite COVID-19 outcome (49/1,878 [2.6%] versus 312/7,014 [4.4%]; HR 0.35; 95% CI, 0.24–0.52), and individually SARS-CoV-2 infection (HR 0.44; 95% CI, 0.22–0.88), COVID-19 hospitalization (HR 0.24; 95% CI, 0.10–0.59), and all-cause mortality (HR 0.32; 95% CI, 0.19–0.55). In conclusion, tixagevimab/cilgavimab was associated with lower rates of SARS-CoV-2 infection and severe COVID-19 during the Omicron BA.1, BA.2, and BA.2.12.1 surge. IMPORTANCE SARS-CoV-2 remains an ongoing global health crisis that justifies continued efforts to validate and expand, when possible, knowledge on the efficacy of available vaccines and treatments. Clinical trials have been limited due to fast tracking of medications for mitigation of the COVID-19 pandemic for the general population. We present a real-world analysis, using electronic health record data, of the effectiveness of tixagevimab/cilgavimab for the prevention of COVID-19 infection in the unique population of U.S. veterans. Unlike those in the PROVENT clinical trial from which the emergency use authorization for tixagevimab/cilgavimab as a preventative treatment arose, the veterans population is highly immunocompromised and nearly 96% totally vaccinated. These demographics allowed us to analyze the effectiveness of tixagevimab/cilgavimab in preventing COVID-19 under different conditions in a more fragile population than that of the initial clinical trial.

In the context of smart cities, the integration of artificial intelligence (AI) and the Internet of Things (IoT) has led to the proliferation of AIoT systems, which handle vast amounts of data to enhance urban infrastructure and services. However, the collaborative training of deep learning models within these systems encounters significant challenges, chiefly due to data privacy concerns and dealing with communication latency from large-scale IoT devices. To address these issues, multi-level split federated learning (multi-level SFL) has been proposed, merging the benefits of split learning (SL) and federated learning (FL). This framework introduces a novel multi-level aggregation architecture that reduces communication delays, enhances scalability, and addresses system and statistical heterogeneity inherent in large AIoT systems with non-IID data distributions. The architecture leverages the Message Queuing Telemetry Transport (MQTT) protocol to cluster IoT devices geographically and employs edge and fog computing layers for initial model parameter aggregation. Simulation experiments validate that the multi-level SFL outperforms traditional SFL by improving model accuracy and convergence speed in large-scale, non-IID environments. This paper delineates the proposed architecture, its workflow, and its advantages in enhancing the robustness and scalability of AIoT systems in smart cities while preserving data privacy.

The most widespread statement of political philosophy is presented here in the simplified and trivialised form of “man is X; he must become Y. ” Man must do so at the same time for himself, for his own survival, but also for the good of all, of the Community, of the City: the plurality must absolutely, in any way whatsoever, give way to unity, subject to [sous peine] and under threat of chaos. The essential question found confronting political doctrines, moreover since the prominence of the idea of democracy is the following: how to bring about the existence of a united society across a heterogeneous social body? The response from philosophy articulates itself around three principle schemas: the theoretical construction of a unified community under the order of similar laws to those of nature (Platonic schema); the search for the best regime, which will have as its ultimate end the moderation and perpetual regulation of conflicts, by an optimal combination of freedom and stability (Aristotelian schema); and the theorisation of the “end of politics” by the locating of a “social wrong” inscribed in a structure doomed to collapse by the practical negation of its ideological foundations (Marxian schema and derivatives). The mode of thought which imposes itself here is decisional. Beyond the third schema which constitutes in some way a meta-political critique, and necessitates that it alone has a particular analysis, in the two preceding, man constitutes a kind of material – raw or primary, depending – that philosophy will work on, and sculpt to give it a form that harmonises fully with the Whole that it prescribes. In political philosophy, we always turn more or less around the “Let’s make man” of Hobbes, that is, around the technical transformation of a material given. Or to say it otherwise: the creation of an oeuvre from crude and imperfect elements, an oeuvre thought like a masterpiece – that is to say, one that contains within it an idea of perfection and permanence – but doomed here to serial reproduction.

Binary neural networks (BNNs) are variations of artificial/deep neural network (ANN/DNN) architectures that constrain the real values of weights to the binary set of numbers {−1,1}. By using binary values, BNNs can convert matrix multiplications into bitwise operations, which accelerates both training and inference and reduces hardware complexity and model sizes for implementation. Compared to traditional deep learning architectures, BNNs are a good choice for implementation in resource-constrained devices like FPGAs and ASICs. However, BNNs have the disadvantage of reduced performance and accuracy because of the tradeoff due to binarization. Over the years, this has attracted the attention of the research community to overcome the performance gap of BNNs, and several architectures have been proposed. In this paper, we provide a comprehensive review of BNNs for implementation in FPGA hardware. The survey covers different aspects, such as BNN architectures and variants, design and tool flows for FPGAs, and various applications for BNNs. The final part of the paper gives some benchmark works and design tools for implementing BNNs in FPGAs based on established datasets used by the research community.

The sex-based human brain structural variations alongside the necessity and development process for sex-specific brain templates were investigated in this study. Comparing magnetic resonance images of 500 female and 500 male subjects, no significant sex-based difference was observed for average cortical thickness, however, all the volumetric values, including the total brain volume (TBV) and major 19 brain regions, were found to be significantly different between females and males. Moreover, analyzing the fractional volume of the regions showed that these sex variations were not proportional to TBV for all regions. These findings underscore the importance of distinguishing the sex-based differences in human brain studies. While brain templates have been developed for general population and cohorts with the same characteristics such as race or age, there is a lack of sex-specific brain templates. To fill this gap and find a representative reference brain image for each sex, nonlinear templates were developed for female, male, and mixed population subjects. Next, a separate set of 109 female and 109 male brain images were used to evaluate the sex-specificity of the brain templates. It was observed that the female and male test subjects were registered to their sex-specific templates with the lowest amount of deformation/warping confirming better representativeness of the sex-specific templates for their target population. The findings of this study including the templates and the reported variations can be used in research involving sex dimorphic brain disorders, diseases, and/or injuries such as traumatic brain injury that is affected by the sex-based brain anatomical differences. Statement of significance: Human brain exhibits sex-based variation both in size and volumetric composition of different regions. Despite these differences, there is a paucity of sex-specific brain templates. Addressing this gap marks the significance of our study as briefly explained here. We have shown that differences in male and female brain go beyond simple scaling and the observation of regional differences that are not proportional to the sex-based total brain volume variations has motivated us to develop sex-specific templates. The representativeness and difference of these sex-specific templates were assessed by measuring the amount of required warping in nonlinear registration of test subjects to them. It was shown that registration of female and male subjects to their corresponding sex-specific template involved lower level of warping compared to their registration to their opposite sex or mixed population brain template.

The following is a review of the recently published translation of Theory of the Solitary Sailor by Gilles Grelet (trans. Amy Ireland and Robin Mackaye, Falmouth: Urbanomic, 2022). It highlights the significance of the work, its major stakes, and asks questions regarding the future of Grelet's methodical anti-philosophical invention. Author(s): Jeremy R. Smith Title (English): Freedom is a Point of Departure, Not a Horizon Journal Reference: Identities: Journal for Politics, Gender and Culture, Vol. 19, No. 1-2 (2022). Publisher: Institute of Social Sciences and Humanities - Skopje Page Range: 176-180 Page Count: 4 Citation (English): Jeremy R. Smith, "Freedom is a Point of Departure, Not a Horizon,” Identities: Journal for Politics, Gender and Culture, Vol. 19, No. 1-2 (2022): 176-80. Author Biography Jeremy R. Smith, Western University Jeremy R. Smith is a PhD Candidate at the Centre for the Study of Theory and Criticism at Western University. He is a co-founder and co-editor of Oraxiom: A Journal of Non-Philosophy.

MECP2 duplication syndrome (MDS) is a rare, X-linked, neurodevelopmental disorder resulting from the duplication of the methyl-CpG-binding protein 2 (MECP2) gene. The clinical features of MDS include severe intellectual disability, global developmental delay, seizures, recurrent respiratory infections, and gastrointestinal problems. The aim of this qualitative study was to explore how the parents of children with MDS manage their child’s seizures, recurrent respiratory infections, and gastrointestinal symptoms, and the impact on them as parents. The data were coded into three categories: (1) complex care needs in the home, (2) highly skilled caregivers, and (3) impact on caregivers and families. Complex 24 h care was required and parents developed complex skillsets to ensure that this was delivered well to their child. The provision of extensive complex medical care in the home had an impact on parent mental and physical health, family dynamics, and finances. This study captures the management of high-burden comorbidities in MDS at home. Investigations into how best to support caregiver wellbeing to reduce their stresses, whilst maintaining optimal child health and wellbeing, are needed.

State of health (SoH) imbalance causes capacity waste and cycle life reduction of the battery-based energy storage systems (BESS), which demands SoH balancing control of the parallel-connected packs and the series-connected cells of the BESS. This study proposed a multi-layer SoH balancing control to extend the cycle life of the BESS. For the series-connected battery cells, active equalization circuits based on the fly-back converter are used to exchange energy between cells and control the depth of discharge (DoD) of cells to achieve the SoH balance. For the parallel-connected packs, SoH is equalized by distributing the output power based on the SoH balancing principle and the minimum power distribution constraints of packs caused by the bidirectional balancing current among the series-connected cells are considered. Because the proposed method achieves the SoH balancing by utilizing the active equalization circuits to transfer the energy between the cells with different SoH, it can achieve higher capacity and energy utilization efficiency and lower heat release compared with the passive equalization typology that dissipates the energy. The effectiveness of the proposed method is verified by a case study based on a 3-packs-15-cells BESS. Simulation results show that this method can prolong the cycle life of BESS by about 52.9% compared with the active SoC balancing method using the same fly-back converter and 18.3% with a passive multi-layer SoH balancing method, respectively.

Objective To estimate the effectiveness of messenger RNA (mRNA) booster doses during the period of Delta and Omicron variant dominance.Design We conducted a matched test-negative case–control study to estimate the vaccine effectiveness (VE) of three and two doses of mRNA vaccines against infection (regardless of symptoms) and against COVID-19-related hospitalisation and death.Setting Veterans Health Administration.Participants We used electronic health record data from 114 640 veterans who had a SARS-CoV-2 test during November 2021–January 2022. Patients were largely 65 years or older (52%), male (88%) and non-Hispanic white (59%).Main outcome measures First positive result for a SARS-CoV-2 PCR or antigen test.Results Against infection, booster doses had higher estimated VE (64%, 95% CI 63 to 65) than two-dose vaccination (12%, 95% CI 10 to 15) during the Omicron period. For the Delta period, the VE against infection was 90% (95% CI 88 to 92) among boosted vaccinees, higher than the VE among two-dose vaccinees (54%, 95% CI 50 to 57). Against hospitalisation, booster dose VE was 89% (95% CI 88 to 91) during Omicron and 94% (95% CI 90 to 96) during Delta; two-dose VE was 63% (95% CI 58 to 67) during Omicron and 75% (95% CI 69 to 80) during Delta. Against death, the VE with a booster dose was 94% (95% CI 90 to 96) during Omicron and 96% (95% CI 87 to 99) during Delta.Conclusions Among an older, mostly male, population with comorbidities, we found that an mRNA vaccine booster was highly effective against infection, hospitalisation and death. Although the effectiveness of booster vaccination against infection was moderately higher against Delta than against the Omicron SARS-CoV-2 variant, effectiveness against severe disease and death was similarly high against both variants.

Abstract This paper addresses the recognitions of human actions in videos. Human action recognition can be seen as the automatic labeling of a video according to the actions occurring in it. It has become one of the most challenging and attractive problems in the pattern recognition and video classification fields. The problem itself is difficult to solve by traditional video processing methods because of several challenges such as the background noise, sizes of subjects in different videos, and the speed of actions. Derived from the progress of deep learning methods, several directions are developed to recognize a human action from a video, such as the long-short-term memory (LSTM)-based model, two-stream convolutional neural network (CNN) model, and the convolutional 3D model.In this paper, we focus on the two-stream structure. The traditional two-stream CNN network solves the problem that CNNs do not have satisfactory performance on temporal features. By training a temporal stream, which uses the optical flow as the input, a CNN can have the ability to extract temporal features. However, the optical flow only contains limited temporal information because it only records the movements of pixels on the x-axis and the y-axis. Therefore, we attempt to design and implement a new two-stream model by using an LSTM-based model in its spatial stream to extract both spatial and temporal features in RGB frames. In addition, we implement a DenseNet in the temporal stream to improve the recognition accuracy. This is in-contrast to traditional approaches which typically utilize the spatial stream for extracting only spatial features. The quantitative evaluation and experiments are conducted on the UCF-101 dataset, which is a well-developed public video dataset. For the temporal stream, we choose the optical flow of UCF-101. Images in the optical flow are provided by the Graz University of Technology. The experimental result shows that the proposed method outperforms the traditional two-stream CNN method with an accuracy of at least 3%. For both spatial and temporal streams, the proposed model also achieves higher recognition accuracies. In addition, compared with the state of the art methods, the new model can still have the best recognition performance.

Background Prior studies have established those elderly patients with chronic obstructive pulmonary disease (COPD) are at elevated risk for developing influenza-associated complications such as hospitalization, intensive-care admission, and death. This study sought to determine whether influenza vaccination could improve survival among elderly patients with COPD. Materials/Methods This study included Veterans (age ≥ 65 years) diagnosed with COPD that received care at the United States Veterans Health Administration (VHA) during four influenza seasons, from 2012–2013 to 2015–2016. We linked VHA electronic medical records and Medicare administrative files to Centers for Disease Control and Prevention National Death Index cause of death records as well as influenza surveillance data. A multivariable time-dependent Cox proportional hazards model was used to compare rates of mortality of recipients of influenza vaccination to those who did not have records of influenza vaccination. We estimated hazard ratios (HRs) adjusted for age, gender, race, socioeconomic status, comorbidities, and healthcare utilization. Results Over a span of four influenza seasons, we included 1,856,970 person-seasons of observation where 1,199,275 (65%) had a record of influenza vaccination and 657,695 (35%) did not have a record of influenza vaccination. After adjusting for comorbidities, demographic and socioeconomic characteristics, influenza vaccination was associated with reduced risk of death during the most severe periods of influenza seasons: 75% all-cause (HR = 0.25; 95% CI: 0.24–0.26), 76% respiratory causes (HR = 0.24; 95% CI: 0.21–0.26), and 82% pneumonia/influenza cause (HR = 0.18; 95% CI: 0.13–0.26). A significant part of the effect could be attributed to “healthy vaccinee” bias as reduced risk of mortality was also found during the periods when there was no influenza activity and before patients received vaccination: 30% all-cause (HR = 0.70; 95% CI: 0.65–0.75), 32% respiratory causes (HR = 0.68; 95% CI: 0.60–0.78), and 51% pneumonia/influenza cause (HR = 0.49; 95% CI: 0.31–0.78). However, as a falsification study, we found that influenza vaccination had no impact on hospitalization due to urinary tract infection (HR = 0.97; 95% CI: 0.80–1.18). Conclusions Among elderly patients with COPD, influenza vaccination was associated with reduced risk for all-cause and cause-specific mortality.

BackgroundPrior studies have established those elderly patients with chronic obstructive pulmonary disease (COPD) are at elevated risk for developing influenza-associated complications such as hospitalization, intensive-care admission, and death. This study sought to determine whether influenza vaccination could improve survival among elderly patients with COPD.Materials/methodsThis study included Veterans (age ≥ 65 years) diagnosed with COPD that received care at the United States Veterans Health Administration (VHA) during four influenza seasons, from 2012-2013 to 2015-2016. We linked VHA electronic medical records and Medicare administrative files to Centers for Disease Control and Prevention National Death Index cause of death records as well as influenza surveillance data. A multivariable time-dependent Cox proportional hazards model was used to compare rates of mortality of recipients of influenza vaccination to those who did not have records of influenza vaccination. We estimated hazard ratios (HRs) adjusted for age, gender, race, socioeconomic status, comorbidities, and healthcare utilization.ResultsOver a span of four influenza seasons, we included 1,856,970 person-seasons of observation where 1,199,275 (65%) had a record of influenza vaccination and 657,695 (35%) did not have a record of influenza vaccination. After adjusting for comorbidities, demographic and socioeconomic characteristics, influenza vaccination was associated with reduced risk of death during the most severe periods of influenza seasons: 75% all-cause (HR = 0.25; 95% CI: 0.24-0.26), 76% respiratory causes (HR = 0.24; 95% CI: 0.21-0.26), and 82% pneumonia/influenza cause (HR = 0.18; 95% CI: 0.13-0.26). A significant part of the effect could be attributed to "healthy vaccinee" bias as reduced risk of mortality was also found during the periods when there was no influenza activity and before patients received vaccination: 30% all-cause (HR = 0.70; 95% CI: 0.65-0.75), 32% respiratory causes (HR = 0.68; 95% CI: 0.60-0.78), and 51% pneumonia/influenza cause (HR = 0.49; 95% CI: 0.31-0.78). However, as a falsification study, we found that influenza vaccination had no impact on hospitalization due to urinary tract infection (HR = 0.97; 95% CI: 0.80-1.18).ConclusionsAmong elderly patients with COPD, influenza vaccination was associated with reduced risk for all-cause and cause-specific mortality.

Soundscapes represent an intrinsic aspect of a habitat which, particularly in protected areas, should be monitored and managed to mitigate human impacts. Soundscape ecology characterizes acoustic interactions within an environment, integrating biological, anthropogenic, climatological, and geological sound sources. Monitoring soundscapes in marine protected areas is particularly important due to the reliance of many marine species on sound for biological functions, including communication and reproduction. In this study we establish a baseline understanding of underwater soundscapes within two marine National Park Zones (NPZs) along the east coast of Australia: Cod Grounds Marine Park and an NPZ surrounding Pimpernel Rock within Solitary Islands Marine Park. In each of the NPZs, underwater recorders were deployed twice during the austral winter (33–35 days, 2018 and 60–69 days, 2019) and once during the austral summer (35–71 days, 2018–2019). We used the resulting acoustic recordings to determine hourly presence of anthropogenic and biological sounds between 20 Hz and 24 kHz and analyze their contributions to patterns of received sound levels. Sounds from vessels were recorded on most days throughout monitoring but were not found to influence long-term patterns of sound levels over their corresponding frequencies. Biological sources included dolphins, snapping shrimp, fish choruses, humpback whales, and dwarf minke whales. Dolphins, snapping shrimp, and fish choruses were present in all deployments. Median ambient sound levels showed a consistent diel pattern with increased levels resulting from crepuscular fish choruses combined with a higher intensity of snapping shrimp snaps during those times. Singing humpback whales strongly influenced the overall sound levels throughout the winter migration, while dwarf minke whales were consistently detected in the 2019 winter deployment but were only present in 2 h among the earlier deployments. Patterns of acoustic spectra were similar between the two NPZs, and patterns of soundscape measurements were observed to be driven by seasonal differences in biological contributions rather than anthropogenic sound sources, indicating that these NPZs are not yet heavily impacted by anthropogenic noise. These baseline measurements will prove invaluable in long-term monitoring of the biological health of NPZs.

In a wireless sensor network (WSN), reducing the energy consumption of battery-powered sensor nodes is key to extending their operating duration before battery replacement is required. Message bundling can save on the energy consumption of sensor nodes by reducing the number of message transmissions. However, bundling a large number of messages could increase not only the end-to-end delays and message transmission intervals, but also the packet error rate (PER). End-to-end delays are critical in delay-sensitive applications, such as factory monitoring and disaster prevention. Message transmission intervals affect time synchronization accuracy when bundling includes synchronization messages, while an increased PER results in more message retransmissions and, thereby, consumes more energy. To address these issues, this paper proposes an optimal message bundling scheme based on an objective function for the total energy consumption of a WSN, which also takes into account the effects of packet retransmissions and, thereby, strikes the optimal balance between the number of bundled messages and the number of retransmissions given a link quality. The proposed optimal bundling is formulated as an integer nonlinear programming problem and solved using a self-adaptive global-best harmony search (SGHS) algorithm. The experimental results, based on the Cooja emulator of Contiki-NG, demonstrate that the proposed optimal bundling scheme saves up to 51.8% and 8.8% of the total energy consumption with respect to the baseline of no bundling and the state-of-the-art integer linear programming model, respectively.

BackgroundPrevious studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier studies.MethodsWith data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the "risk interval" as the first 7 days after specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality.ResultsWe identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41).ConclusionWe confirmed a significant association between LCI and AMI. The risk was elevated among those with high WBC or platelet count, suggesting a potential role for inflammation and platelet activation in the underlying mechanism.

Category: Trauma Introduction/Purpose: Fractures of the talus are rare, but serious injuries to the hindfoot associated with high-energy mechanisms in often polytraumatized patients. The collective knowledge regarding talus injuries is lacking in many regards. Limited effort has been previously made to identify and characterize associated injuries ordinarily occurring in conjunction with fractures of the talus. The purpose of the current study was to [1] determine what associated injuries occur in high incidence in patients presenting with major fractures of the talus, and to [2] identify clinical injury patterns that warrant special attention in patients presenting with talus fractures. Methods: A retrospective review was conducted for patients with talar body or neck fractures at three level-1 academic trauma centers in Boston, MA between June 1, 2004 and June 30, 2018. Patient charts were reviewed for demographic details, injury mechanism, open versus closed injury status, and all associated orthopaedic and non-orthopaedic injuries identified during the initial patient encounter and hospitalization. Results: 253 patients met criteria for inclusion. The final study population included 158 (61%) talar neck fractures, 82 (32%) body fractures, and 18 (7%) head fractures. Falls from height, MVC/MCC, low energy falls and sports injuries were the most common mechanisms of injury in declining order. 64% of patients presenting with a talus fracture had at least one other concomitant injury. The table demonstrates the breakdown of associated injuries rates by body area. Conclusion: Talus fractures are commonly associated with injuries to different anatomic sites and systems. Trauma to the ipsilateral foot is most common necessitating complete imaging of the foot and ankle in all patients presenting with talus fractures. Trauma to the chest, abdomen, and pelvis occurred most commonly following motor vehicle trauma. Talar fractures and lumbar spine injuries was also observed frequently and underscores the importance of lumbar spine evaluation in patients presenting with major talus fractures, particularly those occurring after falls from height. This study presents valuable information to surgeons when evaluating and assessing injured patients to optimize care for patients.

In this study, novel spore pouches were developed using mashed potato as a food model inoculated with either Geobacillus stearothermophilus or Clostridium sporogenes spores. These spore pouches were used to evaluate the sterilization efficiency of Coaxially induced microwave pasteurization and sterilization (CiMPAS) as a case study. CiMPAS technology combines microwave energy (915 MHz) along with hot water immersion to sterilize food in polymeric packages. The spore pouches were placed at pre-determined specific locations, especially cold spots in each food tray before being processed using two regimes (R-121 and R-65), which consisted of 121 °C and 65 °C at 12 and 22 kW, respectively, followed by recovery and enumeration of the surviving spores. To identify cold spots or the location for inoculation, mashed potato was spiked with Maillard precursors and processed through CiMPAS, followed by measurement of lightness values (*L-values). Inactivation equivalent to of 1–2 Log CFU/g and >6 Log CFU/g for Geobacillus stearothermophilus and Clostridium sporogenes spores, respectively was obtained on the cold spots using R-121, which comprised of a total processing time of 64.2 min. Whereas, inactivation of G. stearothermophilus and C. sporogenes spores, respectively on the cold spots was obtained using R-65 (total processing time of 68.3 min), whereas inactivation of 1–3 Log CFU/g of C. sporogenes spores was obtained on the sides of the tray. The results were reproducible across three processing replicates for each regime and inactivation at the specific locations were clearly distinguishable. The study indicated a strong potential to use spore pouches as a tool for validation studies of microwave-induced sterilization.

The model food in this study known as mashed potato consisted of ribose (1.0%) and lysine (0.5%) to induce browning via Maillard reaction products. Mashed potato was processed by Coaxially Induced Microwave Pasteurization and Sterilization (CiMPAS) regime to generate an F0 of 6–8 min and analysis of the post-processed food was done in two ways, which included by measuring the color changes and using hyperspectral data acquisition. For visualizing the spectra of each tray in comparison with the control sample (raw mashed-potato), the mean spectrum (i.e., mean of region of interest) of each tray, as well as the control sample, was extracted and then fed to the fitted principal component analysis model and the results coincided with those post hoc analysis of the average reflectance values. Despite the presence of a visual difference in browning, the Lightness (L) values were not significantly (p < 0.05) different to detect a cold spot among a range of 12 processed samples. At the same time, hyperspectral imaging could identify the colder trays among the 12 samples from one batch of microwave sterilization.

Category: Trauma Introduction/Purpose: Prompt reduction and stabilization of displaced ankle fractures is important to protect soft tissues, restore potential neurovascular deficits and prevent cartilage injury. Many of these injuries do eventually require surgical fixation. The purpose of this study is to determine whether the initial quality of ankle closed reduction based on radiographic criteria would affect outcomes such as ankle osteoarthritis and complications after surgery. Furthermore, we sought to develop a classification system for the quality of closed reduction that would be easy to use and provide interrater reliability. Methods: A retrospective analysis of patients who sustained isolated, closed ankle fractures with at least 3 months follow up postoperatively at two level 1 trauma centers was performed. Patient demographics and history, ankle fracture characteristics and reduction information as well as surgical outcomes and complications were collected. A grading classification for the quality of the initial closed reduction before surgery was developed based on standard AP or mortise and lateral ankle x-rays. The factors considered for rating the reduction included the degree of talar shift on the AP/mortise view, malleoli displacement, as well the relationship of a central plumb line to the center of the talar dome on the lateral x-ray. For ankle osteoarthritis, the Takakura classification was utilized. Three reviewers (1 resident, 2 attendings) independently reviewed and rated all imaging. Results: 161 patients were analyzed. 65% female, average age 50, average 4 days between injury and surgery, mean follow up of 12 months (3-58 months), and 17% wound complications. Psychiatric history was the single comorbidity significantly associated with complications (p=0.009). There was no difference in wound or infection complication rates based on initial closed reduction quality (p=0.17). Neither number nor quality of reductions correlated with increased osteoarthritis (p=0.19, 0.39 respectively). Worst graded reductions had shorter time to surgery, mean 1.4 vs 4.7 days for best reductions (p=0.03), suggesting a protective factor that may account for no association between reduction quality and wound complications. Interclass correlation coefficients for multiple observers showed very high consistency for grading of reduction quality based on the classification system (ICC >0.85, p

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomies. Despite good correction, these procedures bear inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis (AVN). Suture button fixation has been used as another form of HV treatment that avoids the use of corrective osteotomies and maintains reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. Methods: Twenty-two patients underwent HV correction utilizing a distal soft tissue correction and proximal fixation with the Mini TightRope (Arthrex, Inc, Naples, Florida) device. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate post-operative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative Visual Analog Scale (VAS) scores, complications, and any additional surgical procedures performed were also recorded. Results: Mean follow-up was 27.7 months.The mean preoperative IMA and HVA were 16.9 and 32.6 degrees.The mean immediate postoperative IMA was 5.2 degrees(p20degrees.All components of the FAAM and SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant.The average final postoperative VAS was11.05.Of the 22 cases, three experienced complications, including an intra-operative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis(DVT). Conclusion: The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy and with minimal risk of complications.

INTRODUCTION An estimated 53% of the world’s population do not have Internet access. As a consequence, they lack information capital that could be key to bettering their lives. In this practice article, we introduce a sociotechnical system called “World Librarians.” This system, facilitated by a knowledge commons, provides educators, librarians, students, and medical professionals in remote Internet-poor areas of Malawi with access to digital content that they request. OBJECTIVE We describe the social and technical methods by which a team of educators, librarians, students, and information technology specialists in information-privileged environments share educational content to information-disadvantaged communities. METHODS After briefly discussing key foundational components and partnerships, we explain the mechanics of the sociotechnical system. We follow this with two proof-of-concept cases where offline requesters in remote school and library contexts in rural Malawi are assisted by an online librarian searcher team at the University of Massachusetts Amherst. RESULTS The proof of concept cases demonstrate that the relatively low-cost sociotechnical system accomplishes the goal of sharing open access educational content in remote areas with limited or no access to networked information. Moreover, the cases demonstrate that the content shared can be content global southerners offline want and need, rather than information global northerners think they should have. CONCLUSIONS The World Librarians system is ready to be scaled and replicated at other institutions with ready access to high-speed networked information. The authors welcome contact from readers who might be interested in establishing their library as a new “searcher node” in the growing World Librarians network.

Category: Sports Introduction/Purpose: Acute Achilles tendon ruptures have a 2.4-4.7% rate of infection and wound healing complications when treated operatively. The incidence doubles in those with risk factors such as diabetes, smoking or steroid use. To diminish complications minimally invasive approaches have received increasing interest. Meta-analyses have demonstrated equivalent rerupture rates, significantly lower risk of superficial infection, and higher patient satisfaction rates with minimally invasive repairs compared with traditional open Achilles repair techniques. We have previously published a novel technique for limited open Achilles repair using modified ring forceps. The objective of the present study is to review the clinical outcomes of this technique, and to analyze functional results using validated outcomes measures. Methods: Between 2009 and 2016, the clinical records of 29 consecutive patients (average age 45 years [range, 21-76 years], 24 males [83%]) who underwent limited-open repair of an acute Achilles tendon rupture with modified ring forceps were retrospectively reviewed. Through a 2.5-3 cm midline incision a pair of ring forceps bent 30 degrees were used to grasp the tendon stumps deep to paratenon. Three #2 non-absorbable sutures were placed in the proximal and distal segments and delivered out of the wound. The tendon ends were reapproximated and the sutures tied down to secure the tendon. At a minimum of 6 months follow-up the 10-cm Visual Analog Scale (VAS), the Foot and Ankle Ability Measure (FAAM), and the Victorian Institute of Sports Assessment – Achilles (VISA-A) were assessed. Results: At final follow-up (average 43.5 months[range, 5.7-90.1]) 28 of 29 patients reported no pain in their Achilles with an average Achilles VAS of 0.8 out of 100(SD±4.5). The average post-operative VISA-A score was 87.9 out of 100(SD±13.2). The average FAAM Activities of Daily Living and Sports subscales were 96.4%(SD±5.5) and 85.1%(SD±21.3), respectively. Post- operatively patients reported their overall functional level was 94.2% of their pre-injury level when performing ADLs, and 80.1% when participating in sports. Seventeen of 29 patients(58.6%) rated their current functional level as “normal,” nine(31.0%) as “nearly normal,” three(10.3%) as “abnormal,” and none as “severely abnormal.” There was one case of superficial wound infection that resolved with oral antibiotics and local wound care; there were no cases of deep infection, sural neuritis or rerupture. Conclusion: These results demonstrate that limited-open Achilles repair with modified ring forceps provides an economical repair with excellent pain relief and good functional outcomes at mid-term follow-up. Additionally, this is one of the first studies to report validated Achilles specific outcomes(VISA-A) in the setting of acute repair. The wide age range, and subsequent variability in elective sport involvement, may have differentially lowered the sports-related functional outcomes in this study. The complication rate was extremely low making it an attractive alternative to traditional open techniques. Furthermore, this technique is easy to learn and cost-effective without the requirement of commercially available single-use kits.

Category: Sports Introduction/Purpose: Peroneal tendinopathy is a common condition of the ankle and may lead to substantial pain and disability. Low lying peroneus brevis (PB) muscle belly, accessory tendons and bony abnormalities have been implicated in peroneal tendon pathology. To date, studies have reported the presence of these variants or the distal extent of a muscle belly with the presumption that this reflects an increased intra-sheath volume. The goal of this study was to perform volumetric measurements of MR images of peroneal tendons in patients with peroneal pathology requiring surgical intervention and those without. Methods: Two fellowship trained musculoskeletal radiologists evaluated MR images of patients with and without peroneal tendon pathology. The volume of the peroneal tendon sheath and its contents were measured from the level of the tibial plafond down to the peroneal tubercle. The volumes were measured using the Vital Images 3D Vitoria program. The program allows calculation of volumes based on selected area outlines on each axial slice and then compiles each slice into a stacked volume. The presence of a peroneus quartus (PQ), synovitis and peroneal tendon tears were also recorded. Results: Fifty-one patients with peroneal pathology and 15 control patients were included. The mean distance of the PB muscle belly to the tip of the fibula was 5.55 ± 2.5 mm and 11.79 ± 4.07 mm for the groups with and without pathology, respectively (p=0.017). The mean total sheath volume was 7.06 ± 0.95 cc and 5.12 ± 0.53 cc (p=0.001), respectively. The mean PB and PQ combined volume was 1.31 ± 0.29 and 0.86 ± 0.24 cc (p=0.023), respectively. In isolation, the peroneal muscle volume was 0.87 ± 0.25 cc and 0.80 ± 0.25 cc (p=0.733), respectively. Conclusion: The volume of the peroneal tendon sheath and its contents are greater in the patients with peroneal tendinopathy that required surgery compared to controls. Despite the lower position of the muscle belly in the peroneal tendinopathy group, which is similar to previous studies, this was not reflected in increased volumetric measurements. However, when the PQ tendon was included this combined volume was significantly greater. Volumetric measurements are a more accurate way to assess the peroneal sheath in patients with peroneal pathology.

Abstract Introduction Objective structured teaching exercises (OSTEs) are used to evaluate teaching skills and allow participants to practice new teaching behaviors. This resource contains a complete set of tools to conduct a three-station OSTE for a group of clinician-teachers and includes a novel method of multisource feedback delivery. Methods This OSTE was implemented as the culmination of a full-day faculty development workshop for the Division of Emergency Medicine at the University of Wisconsin in May 2012. Over the course of an hour and 15 minutes, a group of four participants rotated through each of three stations, which comprised two clinical teaching scenarios and one end-of-rotation feedback scenario. All three stations utilized a standardized learner, and two of the three stations included a standardized patient. Each member of the four-person participant group had a different role: teacher, copilot, verbal communication observer, or nonverbal communication observer. The last three roles observed the teacher and provided feedback on different aspects of the teacher's performance. The standardized learner also offered feedback. Materials included three cases featuring descriptions of all roles, the instructor's guide, an instrument to allow evaluation of the OSTE, and a take-home tip sheet. Results Twenty-four faculty completed the workshop and the OSTE. Quantitative and qualitative evaluation data were collected. Participants were asked on a written, anonymous evaluation form if the OSTE was useful, if they would recommend a similar experience to their colleagues, and whether they believed the OSTE would change the way they taught. Average scores for those three questions were 4.25, 4.06, and 4.00, respectively, on a 5-point Likert scale (1 = definitely no, 5 = definitely yes), suggesting that participants viewed the experience as useful and impactful. A self-assessment survey was also completed. Participants compared their own retrospective assessments of skills prior to and after the entire workshop. These self-assessments showed improvements across a range of 10 different teaching behaviors. In particular, on a 5-point Likert scale, participants' confidence in providing effective feedback rose from an average of 2.94 to 4.38, confidence in identifying teachable moments rose from 3.19 to 4.06, and confidence in overall teaching ability rose from 3.19 to 3.81 (all statistically significant, p < .05). Discussion These results suggest that the OSTE played a significant role in improving participants' attitudes. The same scale could be used to evaluate the module at one's home institution and serve as a basis for further improvements and modifications in the protocol.

The purpose of this paper is to provide a thorough discussion of the definitional and data issues associated with the measurement of aggregate labour productivity growth in Canada and the United States. The paper examines all data sources for output, employment and hours estimates in the two countries, and attempts to identify the series that are the most appropriate for the calculation of aggregate labour productivity – both from the perspective of the methodological merits of each series and of cross-country comparability. It also assesses the sensitivity of Canada-U.S. aggregate labour productivity growth comparisons to the choice of monitoring trends at the total economy or business sector level, investigates the sources of the differences between trends and comparisons assessed at each level, and discusses the advantages and disadvantages of making comparisons at each level. The paper finds compelling reasons to believe that the monitoring of total economy productivity trends is desirable in addition to the more common practice of focusing on the business sector. Canada has lagged the United States in terms of aggregate labour productivity growth over 1981-2003 to a much smaller degree according to total economy trends than according to business sector trends. This is caused by very high measured labour productivity growth in the non-business sector in Canada relative to the United States, which calls into question the reliability of productivity growth comparisons made at the total economy level. This also raises questions about the comparability of GDP growth between the two countries.

The efficiency of stem cell transplantation is limited by low cell retention. Intracoronary (IC) delivery is convenient and widely used but exhibits particularly low cell retention rates. We sought to improve IC cell retention by magnetic targeting. Rat cardiosphere-derived cells labeled with iron microspheres were injected into the left ventricular cavity of syngeneic rats during brief aortic clamping. Placement of a 1.3 Tesla magnet ~1 cm above the heart during and after cell injection enhanced cell retention at 24 h by 5.2–6.4-fold when 1, 3, or 5 × 10 5 cells were infused, without elevation of serum troponin I (sTnI) levels. Higher cell doses (1 or 2 × 10 6 cells) did raise sTnI levels, due to microvascular obstruction; in this range, magnetic enhancement did not improve cell retention. To assess efficacy, 5 × 10 5 iron-labeled, GFP-expressing cells were infused into rat hearts after 45 min ischemia/20 min reperfusion of the left anterior coronary artery, with and without a superimposed magnet. By quantitative PCR and optical imaging, magnetic targeting increased cardiac retention of transplanted cells at 24 h, and decreased migration into the lungs. The enhanced cell engraftment persisted for at least 3 weeks, at which time left ventricular remodeling was attenuated, and therapeutic benefit (ejection fraction) was higher, in the magnetic targeting group. Histology revealed more GFP + cardiomyocytes, Ki67 + cardiomyocytes and GFP - /ckit + cells, and fewer TUNEL + cells, in hearts from the magnetic targeting group. In a rat model of ischemia/reperfusion injury, magnetically enhanced intracoronary cell delivery is safe and improves cell therapy outcomes.

A continent-wide Convention to protect IDPs in Africa couldsoon be adopted by the African Union. If sufficiently robustand aligned closely with the Guiding Principles, it would senda powerful signal about Africa’s determination to addressIDP issues.

Using existing experimental data taken over a period of roughly 12 years that documents the concentrations of dieldrin levels in the environment and fatty tissue of the fish, we construct a model of the total dieldrin concentration decline. Comparisons between the experimental data and speculative data can be made using calculus and elements of statistics in order to better understand the movement of dieldrin in the reservoir. Because of the potentially harmful exposure effects of dieldrin to humans as well as the environment, it is important to be able to predict when stability has been restored to the ecosystem.