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The late Paleozoic transition is well represented by the upper Pennsylvanian to lower Permian Conemaugh, Monongahela, and Dunkard groups of the western Appalachian Basin (U.S.A.). These units contain abundant paleosols possessing suites of ichnofossils that serve as indicators of soil moisture, soil organic content, water table level, precipitation, and landscape stability. Analysis of these units can, therefore, be used to refine the details of how late Paleozoic terrestrial landscapes changed through time. A study along a 50 km west-east and a 40 km north-south transect through southeast Ohio and southwest West Virginia resulted in the recognition of 24 pedotypes with distinct ichnofossil assemblages. Ichnofossils include rhizoliths, Planolites, Palaeophycus, Taenidium, Scoyenia, Macanopsis, Skolithos, Cylindricum, cf. Psilonichnus, Arenicolites, mottles, and coprolites produced by various plants, gastropods, and larval-to-adult soil arthropods. Soil-forming environments include palustrine, levee, proximal to distal floodplain, interfluve, backswamp, marsh, and fen settings. An up-section shift in pedotypes from Argillisols to Vertisols and Calcisols as well as an overall increase in the diversity of pedotypes recorded a change in soil-forming conditions, resulting in a diverse landscape that changed significantly as mean annual precipitation rose and fell. An up-section increase in ichnofossil diversity in the paleosols and changes in ichnocoenoses suggests an increased dependence on the soil as a refuge and as a food resource. Overall, growing instability of the climate during the Pennsylvanian–Permian transition led to a more heterogeneous landscape that helped to promote colonization of a more diverse assemblage of soil organisms.

Previous studies have suggested that frailty among older adults with cancer is associated with a variety of negative outcomes, including greater chemotherapy toxicity and worse survival. However, results often do not include patient-reported outcomes, such as quality of life (QOL). The objective of this study was to evaluate frailty prior to receipt of moderately- or highly-emetogenic chemotherapy and acute changes in QOL in patients at least 65 years of age. It was hypothesized that frail patients would report greater declines in QOL.Participants completed questionnaires before receiving their first infusion and again five days later. A 59-item deficit accumulation index score was created at baseline using a modified Rockwood frailty index. QOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The relationship between baseline frailty and QOL was evaluated using a dichotomized deficit accumulation index (frail vs. robust) in repeated measures ANOVA.Study participants (n = 151) had a mean age of 72 (SD = 4.5) and 62% were female. Nearly half (42%) were frail at baseline. Frail participants reported worse QOL at baseline compared to robust participants. Frail patients reported smaller declines in overall and physical (p 0.0001) and emotional (p = 0.006) QOL from baseline to five days after receiving chemotherapy. At five days, frail participants reported better emotional and physical QOL compared to robust participants.Contrary to expectations, frail patients reported smaller declines in QOL compared to robust patients using a deficit accumulation index. These results can be used to help educate frail patients on what to expect during treatment.

In patients with ulcerative colitis or familial adenomatous polyposis who develop neoplasia or fail medical therapy and require colectomy, restorative proctocolectomy with IPAA is often indicated. Although often well tolerated, IPAA can be complicated by cuffitis or inflammation of the remaining rectal cuff. Although much has been published on this subject, there is no clear and comprehensive synthesis of the literature regarding cuffitis.Our systematic literature review analyzes 34 articles to assess the frequency, cause, pathogenesis, diagnosis, classification, complications, and treatment of cuffitis.Cuffitis occurs in an estimated 10.2% to 30.1% of pouch patients. Purported risk factors include rectal cuff length2 cm, pouch-rectal anastomosis, stapled anastomosis, J-pouch configuration, 2- or 3-stage IPAA, preoperative Clostridium difficile infection, toxic megacolon, fulminant colitis, preoperative biologic use, medically refractory disease, immunomodulator/steroids use within 3 months of surgery, extraintestinal manifestations of IBD, and BMI18.5 kg/m2 at the time of colectomy. Adverse consequences associated with cuffitis include decreased quality-of-life scores, increased risk for pouchitis, pouch failure, pouch excision, and pouch neoplasia.Given the similarities between pouchitis and cuffitis, diagnosis and treatment of cuffitis should proceed according to the International Ileal Pouch Consortium guidelines. This review found that the majority of the current literature fails to distinguish between classic cuffitis (a form of reminant ulcerative proctitis) and nonclassic cuffitis (resulting from other causes). Further work is needed to distinguish the unique risk factors and endoscopic characteristics associated with each subtype, and further randomized clinical trials should be conducted to strengthen the evidence for treatment options.

BACKGROUND: Distinguishing men with aggressive from indolent prostate cancer is critical to decisions in the management of clinically localized prostate cancer. Molecular signatures of aggressive disease could help men overcome this major clinical challenge by reducing unnecessary treatment and allowing more appropriate treatment of aggressive disease. METHODS: We performed a mass spectrometry-based proteomic analysis of normal and malignant prostate tissues from 22 men who underwent surgery for prostate cancer. Prostate cancer samples included Grade Groups (3 to 5), with 8 patients experiencing recurrence and 14 without evidence of recurrence with a mean of 6.8 years of follow-up. To better understand the biological pathways underlying prostate cancer aggressiveness, we performed a systems biology analysis and gene enrichment analysis. Proteins that distinguished recurrent from non-recurrent cancer were chosen for validation by immunohistochemical analysis on tissue microarrays containing samples from a larger cohort of patients with recurrent and non-recurrent prostate cancer. RESULTS: 24,037 unique peptides (false discovery rate < 1%) corresponding to 3,313 distinct proteins were identified with absolute abundance ranges spanning seven orders of magnitude. Of these proteins, 115 showed significantly (P < 0.01) different levels in tissues from recurrent versus non-recurrent cancers. Analysis of all differentially expressed proteins in recurrent and non-recurrent cases identified several protein networks, most prominently one in which approximately 24% of the proteins in the network were regulated by the YY1 transcription factor (adjusted P < 0.001). Strong immunohistochemical staining levels of three differentially expressed proteins, POSTN, CALR, and CTSD, on a tissue microarray validated their association with shorter patient survival. CONCLUSIONS: The protein signatures identified could improve understanding of the molecular drivers of aggressive prostate cancer and be used as candidate prognostic biomarkers.

Objectives: Tricuspid valve surgery is associated with high rates of shock and in-hospital mortality. Early initiation of venoarterial extracorporeal membrane oxygenation after surgery may provide right ventricular support and improve survival. We evaluated mortality in patients undergoing tricuspid valve surgery based on the timing of venoarterial extracorporeal membrane oxygenation. Methods: All consecutive adult patients undergoing isolated or combined surgical tricuspid valve repair or replacement from 2010 to 2022 requiring venoarterial extracorporeal membrane oxygenation use were stratified by initiation in the operating room (Early) versus outside of the operating room (Late). Variables associated with in-hospital mortality were explored using logistic regression. Results: There were 47 patients who required venoarterial extracorporeal membrane oxygenation: 31 Early and 16 Late. Mean age was 55.6 years (standard deviation, 16.8), 25 (54.3%) were in New York Heart Association class III/IV, 30 (60.8%) had left-sided valve disease, and 11 (23.4%) had undergone prior cardiac surgery. Median left ventricular ejection fraction was 60.0% (interquartile range, 45-65), right ventricular size was moderately to severely increased in 26 patients (60.5%), and right ventricular function was moderately to severely reduced in 24 patients (51.1%). Concomitant left-sided valve surgery was performed in 25 patients (53.2%). There were no differences in baseline characteristics or invasive measurements immediately before surgery between the Early and Late groups. Venoarterial extracorporeal membrane oxygenation was initiated 194 (23.0-840.0) minutes after cardiopulmonary bypass in the Late venoarterial extracorporeal membrane oxygenation group. In-hospital mortality was 35.5% (n = 11) in the Early group versus 68.8% (n = 11) in the Late group (P = .037). Late venoarterial extracorporeal membrane oxygenation was associated with in-hospital mortality (odds ratio, 4.00; 1.10-14.50; P = .035). Conclusions: Early postoperative initiation of venoarterial extracorporeal membrane oxygenation after tricuspid valve surgery in high-risk patients may be associated with improvement in postoperative hemodynamics and in-hospital mortality.

No evidence-based prevention strategies currently exist for cancer-related cognitive decline (CRCD). Although patients are often advised to engage in healthy lifestyle activities (e.g., nutritious diet), little is known about the impact of diet on preventing CRCD. This secondary analysis evaluated the association of pre-treatment diet quality indices on change in self-reported cognition during chemotherapy.Study participants (n = 96) completed the Block Brief Food Frequency Questionnaire (FFQ) before receiving their first infusion and the PROMIS cognitive function and cognitive abilities questionnaires before infusion and again 5 days later (i.e., when symptoms were expected to be their worst). Diet quality indices included the Dietary Approaches to Stop Hypertension (DASH), Alternate Mediterranean Diet (aMED), and a low carbohydrate diet index and their components. Descriptive statistics were generated for demographic and clinical variables and diet indices. Residualized change models were computed to examine whether diet was associated with change in cognitive function and cognitive abilities, controlling for age, sex, cancer type, treatment type, depression, and fatigue.Study participants had a mean age of 59 ± 10.8 years and 69% were female. Although total diet index scores did not predict change in cognitive function or cognitive abilities, higher pre-treatment ratio of aMED monounsaturated/saturated fat was associated with less decline in cognitive function and cognitive abilities at 5-day post-infusion (P ≤ .001).Higher pre-treatment ratio of monounsaturated/saturated fat intake was associated with less CRCD early in chemotherapy. Results suggest greater monounsaturated fat and less saturated fat intake could be protective against CRCD during chemotherapy.

Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT). In this single-center, retrospective, case–control study, 25 patients (30 feet) with symptomatic HR and 30 controls were selected. WBCT parameters were measured by two independent investigators. Inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). MPE was evaluated by measuring the direct distance between 1st and 2nd metatarsals. Independent t tests were performed to compare the two groups. A threshold of MPE to diagnose HR was calculated using the Receiver Operating Characteristic (ROC) curve. HR groups had increased hallux valgus angle (HVA) (8.52° in control vs 11.98° in HR) and MPE (2.92 vs 5.09 mm), decreased 1st metatarsal declination angle (21.09° vs 19.07°) 1st/2nd metatarsal declination ratio (87.45 vs 79.71) indicating elevated first metatarsal compared to controls. Dorsal translation of the first metatarsal at the first tarsometatarsal joint was observed in 21 (70%) patients of the HR group when defined as a step-off or discontinuation of the curvature along the first TMT joint. The threshold of MPE for diagnosis of HR was 4.19 mm with 77% sensitivity and 77% specificity. Our results confirmed a significantly elevated first metatarsal in the HR group compared to controls on WBCT. A MPE greater than 4.19 mm was found to be diagnostic for symptomatic HR. Significant number of patients in the HR group (70%) had dorsal translation of the first metatarsal at the first TMT joint which can contribute to increased MPE. The present study demonstrated significantly increased MPE in HR on WBCT and MPE greater than 4.19 mm on WBCT can be used as a diagnostic threshold for HR.

Beetles (Coleoptera) are a critical component of terrestrial ecosystems filling numerous ecological roles. Soil-dwelling beetles play an important role in pedogenesis through the production of biog...

Evidence-based psychotherapies are efficacious at reducing posttraumatic stress disorder (PTSD) symptoms, but military and veteran samples improve less than civilians. The objective of this secondary analysis of two clinical trials of cognitive processing therapy (CPT) was to determine if hyperarousal symptoms were more resistant to change compared with other PTSD symptom clusters in active duty service members.Service members completed the PTSD Checklist for theAmong improved participants, the average hyperarousal symptom was present in 69% compared with 49% for symptoms in other clusters (Even among service members who recovered from PTSD after CPT, a significant minority continue to report hyperarousal symptoms while other symptoms remit. Hyperarousal symptoms may require additional treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ectopic ACTH (adrenocorticotropic hormone) syndrome, EAS, is extremely rare, accounting for only 10–20% of all ACTH-dependent Cushing’s syndromes, and only 5–10% of all types of Cushing’s syndromes. Given the extremely aggressive behavior of malignancies, EAS is typically associated with significantly higher levels of ACTH and cortisol, the difference being 100–1000-fold greater than in Cushing’s disease. Consequently, clinical symptoms and manifestations of EAS can be more severe and rapid in onset. In this case report, we describe the course of EAS-induced malignant hypertension in a 40-year-old patient who was subsequently diagnosed with high-grade poorly differentiated large cell neuroendocrine carcinoma (NEC).

Our study consisted of surveying undergraduate and graduate students at a historically black college and university (HBCU) about their knowledge of certain health disparities that affect African Americans. Approval from the Allen University Institutional Review Board was granted to administer an online anonymous health disparity questionnaire to undergraduate and graduate students at Allen University. The questionnaire was administered using the community based participatory research (CBPR) methodology. The sampling criteria consisted of undergraduates enrolled in the Biological Sciences course, Biology I course, Biology II course, or Freshman Seminar course during the spring 2020 semester. The sampling also consisted of graduate students that were currently enrolled in the Dickerson-Green Theological Seminary. The sample size consisted of 114 participants that completed the online questionnaire. The data from the metabolic syndrome questionnaire was analyzed using descriptive statistics, utilizing percentages from a cross-tabulation of individual responses. Most of the participants were African American (89.4%), female (54.9%) and between the ages of 18 and 21 (60.5%). Between 73% and 90.4% of the participants knew that each disease on the survey disproportionately affected African Americans. However, less than 50% knew the risk factors of breast cancer, risk factors of cervical cancer, risk factors of prostate cancer, symptoms of prostate cancer, symptoms of sickle cell anemia and treatments for sickle cell anemia. The next phase of our study will consist of conducting a metabolic syndrome (MetS) questionnaire with the graduate students. The data, along with data from the MetS questionnaire conducted with the undergraduates in a previous study, and the health disparity questionnaire data will be used to construct health disparity educational workshops at Allen University. Keywords: health disparities, historically black colleges and universities, African American college students

Background: Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures. Methods: Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles. Results: The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 [range 100-300] cycles vs 178.6 ± 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens. Conclusion: A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base. Clinical Relevance: Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.

Paleosols and ichnofossils of the Late Pennsylvanian to Early Permian Monongahela and Dunkard groups of southeastern Ohio provide significant paleoenvironmental and paleoclimatic data related to the Late Paleozoic climatic transition. Forty paleosol profiles from three outcrops in southeastern Ohio were investigated. Methods included the description of paleosol profiles in the field and the analysis of thin sections. Clay mineralogy and bulk geochemistry were used to assess weathering processes and paleoprecipitation. Results, such as the distribution, abundance, and size of physical features including slickensides, pedogenic carbonates, and rhizoliths suggest erratic fluctuations between mildly seasonal wet environments and strongly seasonal dry environments throughout the studied section which are supported by oscillations in calculated paleoprecipitation values. Paleosols of the Monongahela Group are interpreted as mildly to strongly seasonal, wet to wet-dry, sparsely to heavily vegetated fen, dry woodland, clastic marsh, early successional vegetation, and brakeland ecosystems forming on proximal to distal floodplain and shoreline lacustrine environments. Paleosols of the Lower Dunkard Group are interpreted as a mildly to strongly seasonal, wet to wet-dry, sparsely to heavily vegetated, clastic marsh, early successional vegetation, and brakeland ecosystems forming on proximal to distal floodplain and distal levee environments. Variability in climate has profound effects on paleolandscapes. By investigating changes in paleosols through episodes of climatic transition, we can better understand the impact these changes have on soils and soil ecosystems of the past and future.

Open peer review (OPR), where review reports and reviewers’ identities are published alongside the articles, represents one of the last aspects of the open science movement to be widely embraced, although its adoption has been growing since the turn of the century. This study provides the first comprehensive investigation of OPR adoption, its early adopters and the implementation approaches used. Current bibliographic databases do not systematically index OPR journals, nor do the OPR journals clearly state their policies on open identities and open reports. Using various methods, we identified 617 OPR journals that published at least one article with open identities or open reports as of 2019 and analyzed their wide-ranging implementations to derive emerging OPR practices. The findings suggest that: (1) there has been a steady growth in OPR adoption since 2001, when 38 journals initially adopted OPR, with more rapid growth since 2017; (2) OPR adoption is most prevalent in medical and scientific disciplines (79.9%); (3) five publishers are responsible for 81% of the identified OPR journals; (4) early adopter publishers have implemented OPR in different ways, resulting in different levels of transparency. Across the variations in OPR implementations, two important factors define the degree of transparency: open identities and open reports. Open identities may include reviewer names and affiliation as well as credentials; open reports may include timestamped review histories consisting of referee reports and author rebuttals or a letter from the editor integrating reviewers’ comments. When and where open reports can be accessed are also important factors indicating the OPR transparency level. Publishers of optional OPR journals should add metric data in their annual status reports.

Processing-tomato (Lycopersicon esculentum L.) cultivation in California has transitioned to the use of transplants, subsurface drip irrigation (SDI), and shallow tillage from direct-seeded, flood-...

Leukaemia stem cells (LSCs) underlie cancer therapy resistance but targeting these cells remains difficult. The Wnt-β-catenin and PI3K-Akt pathways cooperate to promote tumorigenesis and resistance to therapy. In a mouse model in which both pathways are activated in stem and progenitor cells, LSCs expanded under chemotherapy-induced stress. Since Akt can activate β-catenin, inhibiting this interaction might target therapy-resistant LSCs. High-throughput screening identified doxorubicin (DXR) as an inhibitor of the Akt-β-catenin interaction at low doses. Here we repurposed DXR as a targeted inhibitor rather than a broadly cytotoxic chemotherapy. Targeted DXR reduced Akt-activated β-catenin levels in chemoresistant LSCs and reduced LSC tumorigenic activity. Mechanistically, β-catenin binds multiple immune-checkpoint gene loci, and targeted DXR treatment inhibited expression of multiple immune checkpoints specifically in LSCs, including PD-L1, TIM3 and CD24. Overall, LSCs exhibit distinct properties of immune resistance that are reduced by inhibiting Akt-activated β-catenin. These findings suggest a strategy for overcoming cancer therapy resistance and immune escape.

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The purpose of this pilot study was to determine if the efficacy of imaginal exposure for symptoms of posttraumatic stress disorder (PTSD) could be improved by adding aerobic exercise. We hypothesized that aerobic exercise would enhance the efficacy of exposure therapy. Active duty service members with clinically significant symptoms of posttraumatic stress (PTSD Checklist-Stressor-Specific Version, [PCL-S], ≥25) were randomized into one of four conditions: exercise only; imaginal exposure only; imaginal exposure plus exercise; no exercise/no exposure therapy (control). Participants (

Robust evidence supports the use of prolonged exposure therapy (PE) as a first-line treatment for posttraumatic stress disorder (PTSD). However, Latinos have not benefitted equally from advancements in the treatment of PTSD and continue to face barriers to receiving care. There is consensus that it is necessary to support the expansion of high-quality culturally and linguistically appropriate treatment to address disparities experienced by racial and ethnic minorities in behavioral health care. The current study was a randomized controlled trial comparing a culturally adapted PE intervention with applied relaxation (AR) among Spanish-speaking Latinos with PTSD in Puerto Rico. Eligible participants (N = 98) were randomly assigned to PE (n = 49) or AR (n = 49). Both treatments included 12–15 weekly sessions each lasting 60–90 min. The primary outcome, clinician-rated PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 at baseline, posttreatment, and 3-month follow-up. Secondary outcomes were assessed using the Patient Health Questionnaire and State–Trait Anxiety Inventory. Results showed a large within-group effect of treatment on PTSD symptoms, PE: d = 1.29, 95% CI [1.12, 2.05]; AR: d = 1.38, 95% CI [1.21, 2.19]. The between-group effect on PTSD symptoms was small, d = −0.09, 95% CI [−0.48, 0.31]. Participants in both treatment conditions reported significant decreases in PTSD symptoms from baseline to follow-up; additionally, significant within-group reductions in depression and anxiety symptoms were observed. These findings underscore the potential benefit of PE and AR for the treatment of Spanish-speaking Latinos with PTSD.

Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT).In this single-center, retrospective, case-control study, 25 patients (30 feet) with symptomatic HR and 30 controls were selected. WBCT parameters were measured by two independent investigators. Inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). MPE was evaluated by measuring the direct distance between 1st and 2nd metatarsals. Independent t tests were performed to compare the two groups. A threshold of MPE to diagnose HR was calculated using the Receiver Operating Characteristic (ROC) curve.HR groups had increased hallux valgus angle (HVA) (8.52° in control vs 11.98° in HR) and MPE (2.92 vs 5.09 mm), decreased 1st metatarsal declination angle (21.09° vs 19.07°) 1st/2nd metatarsal declination ratio (87.45 vs 79.71) indicating elevated first metatarsal compared to controls. Dorsal translation of the first metatarsal at the first tarsometatarsal joint was observed in 21 (70%) patients of the HR group when defined as a step-off or discontinuation of the curvature along the first TMT joint. The threshold of MPE for diagnosis of HR was 4.19 mm with 77% sensitivity and 77% specificity.Our results confirmed a significantly elevated first metatarsal in the HR group compared to controls on WBCT. A MPE greater than 4.19 mm was found to be diagnostic for symptomatic HR. Significant number of patients in the HR group (70%) had dorsal translation of the first metatarsal at the first TMT joint which can contribute to increased MPE.The present study demonstrated significantly increased MPE in HR on WBCT and MPE greater than 4.19 mm on WBCT can be used as a diagnostic threshold for HR.

Centipedes extend to the Silurian yet have a relatively poor fossil record. Many species of extant centipedes are semi-fossorial to fossorial and contribute to soil processes, suggesting that their trace fossils should be common in paleosols. The goal of this project was to document the types of biogenic structures produced by two species of large, semi-fossorial centipedes, Hemiscolopendra marginata andScolopendra polymorpha, to aid in the recognition of fossil centipede burrows. Ten specimens of each species were placed in large, sediment-filled terrariums and observed over periods of 14 days. The centipedes burrowed via intrusion, compression, and excavation, moving throughout the enclosure both near the surface and deep within the sediment. Open burrows produced by the centipedes were cast with plaster and the ichnofabric produced was observed through the enclosure walls. The centipedes primarily produced J-, U-, and Y-shaped burrows as well as complexes of linked burrows. The burrows were elliptical in cross section and possessed thin, intermittent, compressional linings. The centipede burrows were compared to burrows of other extant soil arthropods including millipedes, spiders, and scorpions as well as Pennsylvanian to Permian ichnofossils. The centipede burrows were distinct from those of other soil arthropods and many aspects of the ichnofossils were similar to those produced by the centipedes. Description of burrows produced by centipedes can aid in the interpretation of continental ichnofossils and improve our understanding of the composition of ancient soil ecosystems. This knowledge is especially important given the poor preservation potential of centipedes in the environments they inhabit.

Background For cancer patients with an unplanned hospitalization, estimating survival has been limited. We examined factors predicting survival and investigated the concept of using a deficit‐accumulation survival index (DASI) in this population. Methods Data were abstracted from medical records of 145 patients who had an unplanned 30‐day readmission between 01/01/16 and 09/30/16. Comparison data were obtained for patients who were admitted as close in time to the date of index admission of a study patient, but who did not experience a readmission within 30 days of their discharge date. Our survival analysis compared those readmitted within 30 days versus those who were not. Scores from 23 medical record elements used in our DASI system categorized patients into low‐, moderate‐, and high‐score groups. Results Thirty‐day readmission was strongly associated with the survival (adjusted hazard ratio [HR] 2.39; 95% confidence interval [CI], 1.46‐3.92). Patients readmitted within 30 days of discharge from index admission had a median survival of 147 days (95% CI, 85‐207) versus patients not readmitted who had not reached median survival by the end of the study (P, Cancer patients readmitted within 30 days of an unplanned hospitalization are at a higher risk of mortality. A novel index developed from clinical documentation may help to predict survival in this population.

Camellia L., the most speciose member of the diverse tea family Theaceae, has a long and complex horticultural history. Extensive cultivation and hybridization have produced thousands of varieties of Camellia, including commercially important crops such as cultivated tea, oilseed, and iconic flowering shrubs. Cytogenetics of Camellia and related genera is complicated; chromosome number and ploidy can vary widely between species, and interspecific and interploid hybridization occurs. However, specific information regarding cytogenetics of many species, cultivars, and modern hybrids is lacking. The objectives of this study were to compile a consolidated literature review of the cytogenetics of Camellia and related genera and to determine chromosome numbers, ploidy, and genome sizes of specific accessions of selected species, cultivars, and interspecific and interploid hybrids. A review of the existing literature regarding Theaceae cytogenetics is presented as a consolidated reference comprising 362 taxa. Genome sizes were determined with flow cytometry using propidium iodide as a fluorochrome and Pisum sativum ‘Ctirad' and Magnolia virginiana ‘Jim Wilson’ as internal standards. Chromosome numbers of selected taxa were determined using traditional cytology and were used to calibrate genome sizes with ploidy level. Our results confirmed a base chromosome number of x = 15 for Theeae including Camellia, x = 17 for Stewartiae, and x = 18 for Gordoniae. Surveyed camellias ranged from 2n = 2x = 30 to 2n = 8x = 120, including diploids, triploids, tetraploids, pentaploids, hexaploids, and octoploids. Previously uncharacterized taxa such as Camellia azalea, C. amplexicaulis, C. chrysanthoides, C. cordifolia, C. cucphuongensis, C. flava, C. nanyongensis, and C. trichoclada were found to be diploid. Ploidy was also newly determined for Schima argentea, S. khasiana, S. remotiserrata, and S. sinensis (all diploids). Both diploid and triploid Stewartia ovata were found, and a ploidy series was discovered for Polyspora that ranged from diploid to octoploid. Ploidy determinations were used to confirm or challenge the validity of putative interploid hybrids. Monoploid genome sizes varied among subfamily and genera, with 1Cx values ranging from 0.80 pg for Franklinia to a mean of 3.13 pg for Camellia, demonstrating differential rates of genome expansion independent of ploidy. Within Camellia, monoploid genome sizes varied among subgenera, sections, and some species (range, 2.70–3.55 pg). This study provides a consolidated and expanded knowledgebase of ploidy, genome sizes, hybridity, and reproductive pathways for specific accessions of Camellia and related genera that will enhance opportunities and strategies for future breeding and improvement within Theaceae.

Objective This study aimed to determine whether youth access behavioral health (BH) care earlier (i.e., when problems are less severe) when receiving services in colocated pediatric primary care clinics. Methods Six primary care clinics in the Midwest with a colocated BH provider participated in this study. Data on number of sessions attended/not attended with the BH provider, BH symptom severity as measured by the Child Behavior Checklist, parent report of length of presenting problem, and improvement ratings were collected and compared for on-site referrals and off-site referrals. Descriptive, independent sample t tests and regression analyses compared those referred from on-site physicians versus off-site referral sources. Results Results demonstrated that youth receiving BH services at their primary care physician's office accessed services when problems were less severe and had been impacting their functioning for a shorter duration. Conclusion This study is among the first to explore whether youth receiving BH services in primary care are accessing those services earlier than those who are referred from outside sources, resulting in improved patient outcomes.

As of November 2020, the massively popular social media site Twitter boasts 1.3 billion accounts, 330 million monthly users, and 500 million tweets per day. The sheer volume of data shared on this platform has legitimized Twitter as a real-time information sharing monolith. Millions of people can share information via Twitter making it's power in this space undeniable. In this project, we'd like to use that power for good. Twitter's real-time information sharing prowess has become the platform of interest when attempting to learn information on events in progress. This paper identifies Tweets related to disasters, accidents, or emergencies and determines such statements' sincerity. We introduce a new model that can detect real emergency tweets with a high classification accuracy by using a transfer learning model BERT for emotion classification and behavior modeling approach to detect tweets in Twitter disaster datasets. In doing so, we hope to provide a great service in identifying relevant, real-time information to first responders.

Supplemental Material, sj-pdf-1-fao-10.1177_24730114211019371 for Previsit Patient Instructional Video for the Virtual Orthopedic Foot and Ankle Examination by Naudereh Noori, Bonnie Chien, Zijun Zhang, Jason Schon, Walter Hembree and Lew Schon in Foot & Ankle Orthopaedics

The purpose of the study was to explore the ways apparel and textile firms might think innovatively to address the cost and scarcity of a skilled, domestic workforce in order to facilitate the reshoring of their operations in the United States. In depth interviews were conducted with 24 individuals with knowledge of or experience in reshoring from a production or policy perspective. Three themes were identified: Direct Investments, Indirect Solutions, and Differentiating to Meet Demand. Data were interpreted through the lens of innovation theory. Results extend previous literature on the topic by highlighting the ways that industry stakeholders think firms can overcome the barriers to reshoring and make a successful return to domestic production.

Patient: Female, 28-year-old Final Diagnosis: Hepatic metastasis • metastatic breast cancer • sinusoidal occlusive syndrome Symptoms: Abdominal distension • abdominal pain • lower extremity edema • nausea • vomiting Medication:— Clinical Procedure: — Specialty: General and Internal Medicine • Oncology Objective: Challenging differential diagnosis Background: Hepatic metastasis is well known in breast cancer. Approximately 12–20% of breast cancer patients will develop liver metastasis, which usually presents as discrete mass lesions. Rarely, metastatic spread can be so diffuse that it is unidentifiable on imaging but can progress to fulminant hepatic failure. Our case report suggests that clinicians need to have a high index of suspicion when patients present with rapidly decompensating liver failure in the absence of discrete radiologic hepatic lesions, and that weekly Adriamycin should be considered as a first-line therapeutic option. Case Report: A 28-year-old African American woman with a history of locally advanced estrogen receptor-positive, progesterone receptor-negative, and HER2-negative breast cancer presented with right upper quadrant abdominal pain and bilateral lower extremity swelling. She had been treated 3 years prior with neoadjuvant Adriamycin/cyclophosphamide – Taxol, bilateral mastectomies, radiation therapy, and tamoxifen. Diagnostic imaging revealed massive hepatomegaly and extensive areas of liver ischemia/necrosis without discrete masses or arterial/venous thrombosis. Biopsy of the liver revealed metastatic carcinoma diffusely infiltrating the hepatic sinusoids. Extensive work up for other etiologies of liver disease was negative. The patient’s liver function quickly decompensated over several days. She was treated with weekly single-agent low-dose Adriamycin, and this resulted in successful reversal of her liver function tests back to baseline. Conclusions: In addition to having a high index of suspicion for diffuse intrasinusoidal hepatic metastasis, physicians should consider weekly low-dose Adriamycin as a first-line therapeutic option for patients with progressive liver failure and biopsy-confirmed metastatic carcinoma diffusely infiltrating the hepatic sinusoids.

Foundations of prolonged exposure (PE) include (1) education about common reactions to trauma, what maintains trauma-related symptoms, and how PE reduces posttraumatic stress disorder (PTSD) symptoms; (2) repeated in vivo confrontation with situations, people, or objects that the patient is avoiding because they are trauma-related and cause emotional distress such as anxiety, shame, or guilt; and (3) repeated, prolonged imaginal exposure to the trauma memories followed by processing the details of the event, the emotions, and the thoughts that the patient experienced during the trauma. The aim of in vivo and imaginal exposure is to enhance emotional processing of traumatic events by helping the patient face the trauma memories and reminders and process the emotions and thoughts, as well as the details of the trauma that emerge during revisiting experiences.

Urothelial malignancies are commonly treated with platinum-based therapies. Newer trials have tested antimitotic therapies such as enfortumab vedotin as viable treatment therapy for refractory malignany. Enfortumab vedotin targets nectin-4, a member of a family of calcium-dependent, immunoglobulin-like adhesion molecules found in adherens junctions and expressed in various epithelial malignancies, including bladder, breast, lung, ovarian, head/neck, and esophageal cancers. We present a case of a patient with symmetrical drug-related intertriginous and flexural exanthema secondary to enfortumab. He was successfully treated with topical corticosteroids. Cutaneous toxicity appears to be a common adverse reaction in this growing class of antibody-drug conjugates.

This chapter provides users of the ASME Boiler and Pressure Vessel Code Section V, Nondestructive Examination (NDE), an insight into the significant Section V requirements, the NDE methods addressed therein, and the applicability of the ASME Code NDE methodology to Section V and other sections of the ASME book. It explains when and how to use the American Society for Testing Materials (ASTM) Standards. The chapter traces the history of Section V and outlines its organization. It highlights the need for users to understand the relationship of Section V to other ASME Code sections to ensure that all contract requirements are satisfied. Section V is divided into two basic subsections. Subsection A contains Articles 1 through 19, including Mandatory and Nonmandatory appendices that address general requirements, test methods, and specific Code requirements. Subsection B contains the ASTM Standards (Articles 22 through 31 with Mandatory Appendix II – Standard Units Used in Equations and Nonmandatory Appendix A, Guidance for the Use of U.S. Customary and SI Units in the ASME). The chapter covers each of the 19 articles, including the various NDE techniques such as radiographic examination, ultrasonic examination for welds and materials, liquid penetrant examination, magnetic particle examination, eddy current examination, visual examination, and leak testing. Additional NDE techniques discussed in the chapter are acoustic emission examination for fiber-reinforced plastic vessels and metallic vessels, acoustic emission monitoring of pressure boundary components, alternating current field measurement, magnetic flux leakage examination, remote field testing examination, acoustic pulse reflectometry examination, and guide wave examination for pipe testing. Eddy current array examination methodology is being considered for incorporation into Section V.

Category: Midfoot/Forefoot Introduction/Purpose: The etiology of hallux rigidus has been unknown. Metatarsus primus elevates (MPE), elevated first metatarsal has been controversial. Recent studies have supported significantly elevated first metatarsal in hallux rigidus patients. Bouaicha reported MPE greater than 5 mm could be a predictive factor of hallux rigidus. Lateral weightbearing radiographs has been used to evaluate MPE, However, there are limitations of conventional radiography including variation in X-ray projection angle and foot position and superimposition of metatarsals. Cheung assessed foot alignment utilizing 3D reconstructions from WBCT and concluded that hallux rigidus patients had increased MPE. Our objective was to assess MPE and anatomical characteristics in foot alignment of hallux rigidus patients compared to a control group using WBCT. This is the first study measuring MPE on WBCT. Methods: This is a single-center, retrospective study from prospectively collected data. 20 patients with hallux rigidus and WBCT data were enrolled from October 2014 to December 2020. As a control group, 20 patients with various foot and ankle pathologies were selected. Measured WBCT parameters included 1st TMT joint version, HVA, IMA, DMAA, 1st and 2nd metatarsal lengths, Foot width, Sesamoid station and rotation angle, 1st-5th Metatarsal Angle, Metatarsus adductus angle, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel, 1st Metatarsal-Proximal Phalanx Angle, 1st and 2nd metatarsal declination angles and ratio, and MPE. MPE was measured as a direct distance between 1st and 2nd metatarsals using a line tangential to the first metatarsal and another perpendicular line at the metadiaphyseal junction to reach second metatarsal on parasagittal view. A Cut-off value of MPE was calculated using receiver operating characteristic curve. Two investigators independently assessed each WBCT. Results: Mean age was 43.3 in control group (45% male, 55% female) and 55.9 in HR group (60% male, 40% female). Significant differences were found in several facets of foot anatomy between HR and control groups including HVA (7.57 in control vs 14.05 in HR), DMAA (3.89 vs 8.06), forefoot width (92.96 vs 95.47), 1st MT declination angle (20.17 vs 17.82), 1st/2nd MT declination ratio (83.52 vs 76.02), and MPE (3.24 mm vs 5.40 mm). MPE was significantly higher in hallux rigidus group in all three parasagittal views (unmodified, parallel to 1st metatarsal and 2nd metatarsal). Dorsal subluxation/translation of the first metatarsal was observed at 1st TMT joint in the parasagittal view of WBCT in 9 (45%) patients of hallux rigidus group suggesting sagittal instability. No patient in control group had dorsal subluxation/translation. A cut-off value of MPE was 4.56 mm with 80% sensitivity and 90% specificity. Conclusion: To evaluate MPE on WBCT, we used a new direct measurement on parasagittal views. We found a significant difference in MPE in HR. Our WBCT results are consistent with other studies using conventional radiographs. A cut-off value of WBCT MPE for diagnosis of HR was 4.56 mm in our cohort. Considering 45% patients of the HR group had dorsal subluxation/translation of first metatarsal at 1st TMT and increased HVA, Hallux rigidus may be associated with first ray instability predominantly in sagittal plane with resultant MPE with varying degree of combined coronal plane instability resulting in increased HVA.

Category: Midfoot/Forefoot Introduction/Purpose: The etiology of hallux rigidus (HR) is not well understood and Its association with first-ray hypermobility, hallux valgus and metatarsus primus elevatus (MPE) has not been clearly proven. MPE, elevated first metatarsal has been a topic of debate since Lambrinudi`s first description. Recent studies have supported MPE in hallux rigidus by measuring with various methods on wightbearing lateral radiographs, but there are limitations of conventional radiography due to variation in X- ray projection and superimposed metatarsals regardless of the methods of measurement. Our objective was to assess MPE and other associated parameters with hallux rigidus via radiography and WBCT for convergent validity and to evaluate the use of classification system used in conventional radiography with WBCT. Methods: This is a single-center, retrospective study from prospectively collected data. 20 symptomatic hallux rigidus patient with weightbearing radiograph and WBCT were enrolled from October 2014 to December 2020. Measured parameters included hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux interphalangeal angle (HIPA), distal metatarsal articular angle (DMAA), 1st TMT joint version, First and second metatarsal lengths, Metatarsus adductus angle, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel, First and second metatarsal declination angles, and MPE. MPE was measured as the direct distance between 1st and 2nd metatarsals (modified Horton index). All patients were graded according to the radiographic criteria of Coughlin and Shurnas classification on radiographs and WBCT, separately. Paired T-test was performed to compare radiographic measurements with WBCT. Results: Mean age was 55.9, 12 males and 8 females. HVA (15.73 in X-ray vs 14.04 in WBCT), AP first TMT version (16.25 vs 16.47), 2nd cuneiform-2nd metatarsal angle (24.54 vs 26.60), Talus-1st Metatarsal Angel (-7.67 vs -7.89) were not different between radiograph and WBCT. MPE was measured higher in WBCT by 0.86 mm compared to radiograph. First metatarsal declination angle was lower in WBCT by 2.9° indicating increased MPE. When graded with radiographic findings, 5 (25%) patients were grade 1, 5 (25%) patients were grade 2 and 10 (50%) grade 3, when graded with WBCT, 1 (5%) patient had grade 1, 3 (15%) patients were grade 2 and 16 (80%) grade 3. Dorsal subluxation/translation of first metatarsal at first TMT joint was observed 3 (15%) in radiograph and 9 (45%) in WBCT. Conclusion: HVA, AP first TMT version, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel demonstrated consistent measurements in radiograph and WBCT. MPE was measured higher in WBCT when measured with direct distance (0.86 mm) between the first and second metatarsals using modified Horton index and first metatarsal declination angle (2.9°). When graded with WBCT, the subchondral cyst in the proximal phalanx and metatarsal head were better delineated leading to higher grade in WBCT. Further studies are needed for inter-rater reliability and discriminant validity of the measurements determined by differences between different groups (HR vs control).

The geospatial research and development team in the National and Homeland Security Division at Idaho National Laboratory was tasked with providing tools to derive insight from the substantial amount of data currently available – and continuously being produced – associated with the critical infrastructure of the US. This effort is in support of the Department of Homeland Security, whose mission includes the protection of this infrastructure and the enhancement of its resilience to hazards, both natural and human. We present geovisual-analytics-based approaches for analysis of vulnerabilities and resilience of critical infrastructure, designed so that decision makers, analysts, and infrastructure owners and managers can manage risk, prepare for hazards, and direct resources before and after an incident that might result in an interruption in service. Our designs are based on iterative discussions with DHS leadership and analysts, who in turn will use these tools to explore and communicate data in partnership with utility providers, law enforcement, and emergency response and recovery organizations, among others. In most cases these partners desire summaries of large amounts of data, but increasingly, our users seek the additional capability of focusing on, for example, a specific infrastructure sector, a particular geographic region, or time period, or of examining data in a variety of generalization or aggregation levels. These needs align well with tenets of in-formation-visualization design; in this paper, selected applications among those that we have designed are described and positioned within geovisualization, geovisual analytical, and information visualization frameworks.

The lower Washington Formation of the Lower Permian (Asselian) Dunkard Group in southeastern Ohio contains large burrows exposed in cross section in a laterally discontinuous sandstone bed. This study examined the morphology of the burrows and their associated lithofacies to interpret the environmental conditions under which they were produced as well as the behavior and identity of the trace maker. Mudstone facies below and above the burrow-bearing sandstone consist of reddish-brown to variegated paleosols containing rhizohaloes, argillans, and large-scale slickensides, as well as thinly laminated, organic-rich shales containing plant fossils. The sandstone facies is 94–147 cm thick, thinly bedded to massive, and fine- to medium-grained. The lithofacies are interpreted as deposits of crevasse splays, abandoned channels, and proximal to distal floodplains. Sixty burrows consist of vertical, subvertical, J-shaped, Y-shaped, and complex networks of branching shafts and tunnels. The burrows range from 5 to 180 cm in length and 0.8–3.6 cm in width. The main shaft's angles are typically ~ 90°, although are rarely 30–70°. Branching angles of subvertical and Y-shaped burrows vary from 0 to 90°. Many burrows extend to the top of the sandstone bed, but others turn into or out of the bed. The morphology of the burrows is most similar to Camborygma, known from continental deposits of the Permian to recent. While Camborygma has been previously reported from the Permian, this is the first occurrence in the Late Paleozoic Appalachian Basin extending its geographic range. The Dunkard burrows are similar to those of modern freshwater decapods, particularly crayfish. Decapod body fossils are not known from the Dunkard Group, yet these burrows are highly suggestive of their presence. Therefore, these fossil burrows contribute to the paleoecological interpretation of the Dunkard Group, helping to fill in gaps of the terrestrial fauna not otherwise preserved in the fossil record. Decapod burrow morphologies are highly variable depending on burrow function and environment. The Dunkard burrows are similar to secondary dwellings, with few open water attachments, multiple branches, and shafts likely extending to the water table.