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Injectable filler is one of the most common cosmetic procedures performed annually. An aging face shows a characteristic loss of volume in the deep fat pads of the midface. The goal of midfacial rejuvenation with injectable filler is to restore lost volume, with the suborbicularis fat pad and deep medial cheek fat being the most critical areas. Filler can be instilled here with a cannula or needle with successful outcomes. However, this procedure is not without complications if proper technique and underlying anatomy are not respected.

Background: The optimal vasopressor management for septic patients with left ventricular (LV) dysfunction has not been well established, and current evidence is conflicting regarding the optimal vasopressor discontinuation order. Objective: The objective was to evaluate the impact of LV dysfunction on the hemodynamic management of septic shock by assessing the incidence of clinically significant hypotension after vasopressor discontinuation. Methods: In this single-center, retrospective cohort study, adult patients were included if they met the Sepsis-3 definition of septic shock, had LV dysfunction (defined as an ejection fraction ≤40%), and received norepinephrine and vasopressin as the last vasopressors discontinued. The primary outcome was the incidence of clinically significant hypotension following discontinuation of vasopressin or norepinephrine. Clinically significant hypotension was defined as a MAP less than 60 mmHg and the need for either: 1) the reinstitution of the previously discontinued agent at any dosage, 2) the receipt of at least 500 mL of a crystalloid at a rate of at least 500 mL/hour, 3) or the receipt of at least 25 grams of albumin 5% at a rate of at least 25 gram/hour. Secondary outcomes included intensive care unit (ICU) and hospital lengths of stay, and ICU and hospital mortality. Results: A total of 78 patients met inclusion criteria, with 37 patients having vasopressin discontinued first and 41 having norepinephrine discontinued first. Clinically significant hypotension occurred in 28 patients (76%) following the discontinuation of vasopressin, compared to 28 patients (81%) following the discontinuation of norepinephrine (p = 0.61). ICU length of stay was 9 days in the vasopressin discontinued first cohort, compared to 15 days in the norepinephrine discontinued first cohort (p = 0.01). There was no statistically significant difference in mortality observed. Conclusion: The discontinuation order of norepinephrine and vasopressin did not impact the incidence of clinically significant hypotension in patients with septic shock and LV dysfunction, but may influence ICU length of stay, although other factors may have impacted this finding.

This paper discusses colorants found in Tumulus MM, the tomb of King Midas or his father, at Gordion, the capital of the Phrygian kingdom. Chromophores, colorants, and auxiliaries are preserved largely independent of the textiles they once colored. The Tumulus MM textiles are now fragmentary due to the degradation processes that occurred inside the tomb chamber. For DHA 26 (Vienna, Austria, 2007), we discussed a group of golden-yellow fragments from Tumulus MM that appeared to be tabby cloth but were skeletal lattices of goethite, αFeOOH (yellow ochre), as identified by FTIR, with SEM/EDS, XRD with molybdenum Kα radiation, NIR, and Raman spectroscopy. The “dyeing” has been replicated using a patented method; originally it may have involved a controlled redox reaction, based on our preliminary experiments. Amidst the goethite lattices, some skeletal fragments were green, with near-black lines within the yarn spiral, identified as indigo by FTIR at the time. Other masses with colorations of red, orange/brown, and purple with deep red veins did not yield identifiable inorganic coloration profiles with SEM/EDS. A purple fragment (2003-Tx-6 Front) was assayed by ICP-MS for mordants and for bromine, but neither could be found. Recently, direct analysis in real time mass spectrometry (DART-MS) enabled us to successfully detect organic colorants. For one fragment, indoxyl, isatin, indigo, and leuco-indigo were identified. One striated red-to-brown mass (2003-Tx-3) contained alizarin, purpurin, xanthopurpurin, lucidin, and other madder substituents; it also contained indigo/isatin but neither indoxyl nor leuco-indigo. Other beige-brown masses like 2003-Tx-5 sometimes contained alizarin, xanthopurpurin, rubiadin, and lucidin but rarely purpurin or indigo-related compounds. The purple (2003-Tx-6) shared the madder analogues with browner hues. The versatility appears related to that found in Anatolian pile carpets and flat weaves. Our new analyses confirm that the Phrygian textile colorists were indeed superb, versatile dyers.

Nasal surgery performed for the management of obstructive sleep apnea includes septoplasty with and without inferior turbinate reduction and functional rhinoplasty. There is controversy over the effectiveness of these techniques in terms of their ability to decrease apnea-hypopnea index. However, it is fairly accepted that nasal surgery can improve sleep-related quality of life measures. This review focuses on the recently published evidence surrounding the role of nasal surgery in obstructive sleep apnea. Findings suggest that functional rhinoplasty may improve apnea–hypopnea index (AHI) in patients with mild OSA. The effect of septoplasty on AHI is less consistent. Further studies are needed to better clarify the role for both septoplasty and functional rhinoplasty in the OSA treatment algorithm.

How do human communities integrate within food webs? Studies characterizing the historical flow of energy among people and local environments can yield important insights into managing sustainable ecosystems. Here, we combine zooarchaeological, bulk tissue, and compound-specific stable isotope data from late Holocene Santa Rosa Island to investigate the ecological role of people within a southern California nearshore marine ecosystem. We show people foraged in diverse marine habitats, including kelp forests and pelagic waters, and consumed a wide range of species. However, zooarchaeological results reveal >50% of recovered fish remains came from presumed kelp forest carnivores of mid-trophic level (3.0–4.0) such as surfperches and rockfishes. Local fishing strategies thus did not involve the preferential removal of large-bodied, high trophic level species – a pattern known as “fishing down the food web” which has been documented in modern commercial fisheries and results in the collapse of marine ecosystems. Essential amino acid δ13C analysis revealed that the historical fish community relied on basal resources from kelps and phytoplankton. This coupling of benthic and pelagic energy sources suggests late Holocene coastal food webs in the region were in a relatively stable configuration immediately prior to first European arrival. This stability likely contributed to sustaining densely populated Chumash settlements, intensive fisheries, and high local faunal diversity. Our findings provide important pre-industrial data for marine ecosystems and document some of the mechanisms behind the intensive, yet sustainable long-term fisheries of the Island Chumash.

We aimed to investigate the trends in surgical residents' salaries across the nation and by region from 2014-2015 to 2021-2022 to identify areas for improvement in resident benefits and compensation.This is a retrospective study investigating the trends in US medical resident salaries from 2014-2015 to 2021-2022. Residency salary was analyzed over time, by region, and between surgical specialties both unadjusted and adjusted for cost of living. Salary by surgical specialty was collected from available years 2014-2015 to 2019-2020. Trends in residency salaries were also compared to the trends in graduate medical education (GME) Medicare funding.The average resident salary/cost of living ratio did not significantly change over the study period (2014-2015: 0.96, 2020-2021, 0.96, P = 0.654). The South and Midwest had significantly higher average resident salaries than the Northeast (P 0.001) and West (P 0.001) after adjusting for the cost of living. The average total GME Medicare funding per resident increased significantly more than the average resident salary ($12,278 versus $4540, P 0.001). The average general surgery resident salary (2014-2015: $57,000, 2019-2020: $61,500, Δ = $4500) increased significantly less than the average salary of all specialties (2014-2015: $51,586, 2019-2020: $57,191, Δ = $5605, P = 0.001).Residency salaries have increased marginally from 2014-2015 to 2021-2022 and remain below the average US cost of living. Residency salaries vary significantly between surgical specialties and by region. Discussions aimed at reformulating GME compensation that takes into consideration regional differences in cost of living are needed.

The ability to flexibly categorize object concepts is essential to semantic cognition because the features that make two objects similar in one context may be irrelevant and even constitute interference in another. Thus, adaptive behavior in complex and dynamic environments requires the resolution of feature-based interference. In the current case study, we placed visual and functional semantic features in opposition across object concepts in two categorization tasks. Successful performance required the resolution of functional interference in a visual categorization task and the resolution of visual interference in a functional categorization task. In Experiment 1, we found that patient D. A., an individual with bilateral temporal lobe lesions, was unable to categorize object concepts in a context-dependent manner. His impairment was characterized by an increased tendency to incorrectly group objects that were similar on the task-irrelevant dimension, revealing an inability to resolve cross-modal semantic interference. In Experiment 2, D. A.'s categorization accuracy was comparable to controls when lures were removed, indicating that his impairment is unique to contexts that involve cross-modal interference. In Experiment 3, he again performed as well as controls when categorizing simple concepts, suggesting that his impairment is specific to categorization of complex object concepts. These results advance our understanding of the anterior temporal lobe as a system that represents object concepts in a manner that enables flexible semantic cognition. Specifically, they reveal a dissociation between semantic representations that contribute to the resolution of cross-modal interference and those that contribute to the resolution of interference within a given modality.

Scuba diving has now become a regular feature of coral reef tourism and Sri Lanka has the potential to become a popular destination for scuba divers. Scuba divers were interviewed at two main diving destinations on the southwest coast of Sri Lanka: Hikkaduwa and Unawatuna. Most respondents were "experienced" divers. Enjoyment, viewing marine life in their natural environments, and adventure were the main motives of divers at these destinations. In general, the perceptions of respondents on scuba diving as an ecotourism activity were positive across all experience levels. The self-rating experience positively influenced divers' responsible underwater behavior. As such, diving operators must be aware of the potential damage to coral due to loss of control/buoyancy underwater and intentional touching of coral reefs by less experienced/novice divers. Experienced divers with strong environmental consciousness supported conservation-oriented reef management actions. Conversely, experienced divers were resistant to management actions that directly or indirectly compromised their dive experience. Less experienced divers did not favor management actions that restrict them from accessing healthy coral reefs. Respondents expressed a general concern regarding the negative environmental impacts associated with an increase in visitors to sensitive marine habitats.

This article seeks to broaden the interpretative landscape concerning contemporary discourse on the theme of slavery within the book of Job. Written from the perspective of Africana critical theory vis-a-vis standard depictions of the character of Job, the author argues that the issue of slavery writ large, aside from its immediate social/cultural ANE context, poses more complex and relevant questions of marginalization with which the academy and more so, modern society, must wrestle. Arguing from the postulated hermeneutics of three contemporary writers, this article analyzes Job’s direct reference to slavery—and seeks to reframe Job through the lens of Africana critical scholarship as one of many options through which the text can be necessarily re-appropriated and re-deployed by marginalized communities.

Mass shootings pose a considerable threat to public safety and significantly cost the United States in terms of lives and expenses. The following are the specific aims of this study: (1) to assess US mass shootings, firearm-related sales, laws, and regional differences from 2015 to 2021 and (2) to investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 pandemic.A retrospective review was conducted of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the United States from 2015 to 2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015 to 2021 were selected for further analysis.Mass shootings correlated significantly with firearm sales from 2015 to 2021 nationwide (P 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared to the years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm.Firearm sales correlated significantly with mass shootings from 2015 to 2021. Mass shootings and gun sales increased at greater rates during the Coronavirus Disease 2019 pandemic compared to the years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.

The national kidney allocation system (KAS) implemented in December 2014 in the United States redefined the start of waiting time from the time of waitlisting to the time of kidney failure. Waitlisting has declined post-KAS, but it is unknown if this is due to transplant center practices or changes in dialysis facility referral and evaluation. The purpose of this study was to assess the impact of the 2014 KAS policy change on referral and evaluation for transplantation among a population of incident and prevalent patients with kidney failure.Cohort study.37,676 incident (2012-2016) patients in Georgia, North Carolina, and South Carolina identified within the US Renal Data System at 9 transplant centers and followed through December 2017. A prevalent population of 6,079 patients from the same centers receiving maintenance dialysis in 2012 but not referred for transplantation in 2012.KAS era (pre-KAS vs post-KAS).Referral for transplantation, start of transplant evaluation, and waitlisting.Multivariable time-dependent Cox models for the incident and prevalent population.Among incident patients, KAS was associated with increased referrals (adjusted HR, 1.16 [95% CI, 1.12-1.20]) and evaluation starts among those referred (adjusted HR, 1.16 [95% CI, 1.10-1.21]), decreased overall waitlisting (adjusted HR, 0.70 [95% CI, 0.65-0.76]), and lower rates of active waitlisting among those evaluated compared to the pre-KAS era (adjusted HR, 0.81 [95% CI, 0.74-0.90]). Among the prevalent population, KAS was associated with increases in overall waitlisting (adjusted HR, 1.74 [95% CI, 1.15-2.63]) and active waitlisting among those evaluated (adjusted HR, 2.01 [95% CI, 1.16-3.49]), but had no significant impact on referral or evaluation starts among those referred.Limited to 3 states, residual confounding.In the southeastern United States, the impact of KAS on steps to transplantation was different among incident and prevalent patients with kidney failure. Dialysis facilities referred more incident patients and transplant centers evaluated more incident patients after implementation of KAS, but fewer evaluated patients were placed onto the waitlist. Changes in dialysis facility and transplant center behaviors after KAS implementation may have influenced the observed changes in access to transplantation.

To determine relationships between prophylactic inferior vena cava filter (IVCF) insertion and pulmonary embolism (PE), deep venous thrombosis (DVT), and in-hospital mortality outcomes in patients with severe traumatic pelvic/lower extremity, intracranial, and spinal cord injuries.Adult patients with severe traumatic pelvic/lower extremity, intracranial, and spinal cord injuries admitted to level I-IV trauma centers were selected from the National Trauma Data Bank (NTDB). IVCFs that were inserted both ≤48 h after admission and before a lower extremity venous ultrasound were defined as prophylactic. Associations between prophylactic IVCF insertion and PE, DVT, and overall mortality outcomes during admission were estimated using logistic regression models after propensity score matching. Additionally, factors predictive of prophylactic IVCF insertion were estimated using multivariate logistic regression.Of 462,838 patients, 11,938 (2.6%) underwent prophylactic IVCF insertion. Prophylactic IVCF utilization decreased over time (6.3% in 2008 to 1.8% in 2015). Factors associated with prophylactic IVCF placement were injury pattern, trauma center level/region, Injury Severity Score, and race. Prophylactic IVCF placement was positively associated with PE (Odds Ratio (OR): 5.25, p 0.01) and DVT (OR: 5.55, p 0.01), but negatively associated with in-hospital mortality compared to the propensity score-matched control group (OR: 0.46, p 0.01).Prophylactic IVCF insertion in adult patients with severe pelvic/lower extremity fractures, intracranial injuries, and spinal cord injuries was negatively associated with in-hospital mortality, but positively associated with VTE. Further research evaluating the use of prophylactic IVCF placement in trauma patients with these specific severe injury types may be warranted.

Motor vehicle collisions remain a leading cause of trauma-related deaths. We aim to investigate the relationship between the proximity of trauma centers to the nearest highway exit and prehospital motor vehicle collision fatalities at the county level nationwide.This was a cross-sectional study evaluating the association between the distance of trauma centers to the nearest highway exit and prehospital motor vehicle collision fatalities between the years 2014 and 2019. Prehospital motor vehicle collision fatalities were obtained from National Highway Traffic Safety Administration. Mapping software was used to determine the distance of trauma center to the nearest highway exit and transport time. Linear regression analysis was performed.A total of 2,019 American College of Surgeons-verified and/or state-designated trauma centers were included (211 Level 1, 356 Level 2, 491 Level 3, and 961 Level 4 trauma centers). Prehospital motor vehicle collision fatalities were positively correlated with the distance of trauma center to the nearest highway exit for counties with trauma centers located ≤5 miles from the nearest highway exit (r = 0.328; Plt; .001). In the 612 counties with a 10% increase in prehospital motor vehicle collision fatalities from 2014 to 2019, prehospital motor vehicle collision fatalities were also positively correlated with distance to the nearest highway exit (r = 0.302; Plt; .001). The counties with more dispersed distributions of trauma centers were significantly associated with motor vehicle collision fatalities (Spearman's rank coefficient = 0.456; 95% confidence interval, 0.163-0.675; P = .003).Shorter distances between trauma centers and the nearest highway exit are associated with fewer prehospital motor vehicle collision fatalities for counties with trauma centers ≤5 miles of the nearest highway exit. Further enhancement of existing highway infrastructure and standardization of emergency medical services transport protocols are needed to address the burden of prehospital motor vehicle collision fatalities in the United States.

SummaryAnimal mass mortality events (MMEs) will increase with weather and climate extremes. MMEs can add significant stress to ecosystems through extraordinary nutrient pulses or contribute to potential disease transmission risks. Given their efficient removal of carrion biomass from landscapes, we argue here for the potential of scavenger guilds to be a key nature-based solution to mitigating MME effects. However, we caution that scavenger guilds alone will not be a silver bullet. It is critical for further research to identify how the composition of scavenger guilds and the magnitude of MMEs will determine when scavengers will buffer the impacts of such events on ecosystems and when intervention might be required. Some MMEs are too large for scavengers to remove efficiently, and there is a risk of MMEs subsidizing pest species, altering nutrient cycling or leading to disease spread. Prioritizing native scavenger taxa in conservation management policies may help to boost ecosystem resilience through preserving their key ecological services. This should be part of a multi-pronged approach to MME mitigation that combines scavenger conservation with practices such as carcass dispersal or removal when exceeding a threshold quantity. Policymakers are urged to identify such thresholds and to recognize both the insects and the vertebrate scavengers that could act as allies for mitigating the emerging problem of climate-driven MMEs.

Background: Critically ill patients are at increased risk for fluid overload, but objective prediction tools to guide clinical decision-making are lacking. The MRC-ICU scoring tool is an objective tool for measuring medication regimen complexity. Objective: To evaluate the relationship between MRC-ICU score and fluid overload in critically ill patients. Methods: In this multi-center, retrospective, observational study, the relationship between MRC-ICU and the risk of fluid overload was examined. Patient demographics, fluid balance at day 3 of ICU admission, MRC-ICU score at 24 hours, and clinical outcomes were collected from the medical record. The primary outcome was relationship between MRC-ICU and fluid overload. To analyze this, MRC-ICU scores were divided into tertiles (low, moderate, high), and binary logistic regression was performed. Linear regression was performed to determine variables associated with positive fluid balance. Results: A total of 125 patients were included. The median MRC-ICU score at 24 hours of ICU admission for low, moderate, and high tertiles were 9, 15, and 21, respectively. For each point increase in MRC-ICU, a 13% increase in the likelihood of fluid overload was observed (OR 1.128, 95% CI 1.028-1.238, p = 0.011). The MRC-ICU score was positively associated with fluid balance at day 3 (β-coefficient 218.455, 95% CI 94.693-342.217, p = 0.001) when controlling for age, gender, and SOFA score. Conclusions: Medication regimen complexity demonstrated a weakly positive correlation with fluid overload in critically ill patients. Future studies are necessary to establish the MRC-ICU as a predictor to identify patients at risk of fluid overload.

A growing percentage of the US population is over the age of 65, and geriatrics account for a large portion of trauma admissions, expected to reach nearly 40% by 2050. Cognitive status is important for operative management, especially in elderly populations. This study aims to investigate preoperative and postoperative cognitive function assessment tools in geriatric patients following acute trauma and associated outcomes, including functional status, postdischarge disposition, mortality, and hospital length of stay (H-LOS).A literature search was conducted using Medline/PubMed, Google Scholar, Embase, JAMA Networks, and Cochrane databases for studies investigating the use of cognitive assessment tools for geriatric patients with acute trauma. The last literature search was conducted on November 13, 2021.Ten studies were included in this review, of which five focused on preoperative cognitive assessment and five focused on postoperative. The evidence suggests patients with preoperative cognitive impairment had worse functional status, mortality, and postdischarge disposition along with increased LOS. Acute trauma patients with postoperative cognitive impairment also had worse functional status, mortality, and adverse postdischarge disposition.Preoperative and postoperative cognitive impairment is common in geriatric patients with acute trauma and is associated with worse outcomes, including decreased functional status, increased LOS, and adverse discharge disposition. Cognitive assessment tools such as MMSE, MoCA, and CAM are fast and effective at detecting cognitive impairment in the acute trauma setting and allow clinicians to address preoperative or postoperative cognitive impairments to improve patient outcomes.

Australia’s 2019–20 mega-fires burnt 79% of the Greater Blue Mountains World Heritage Area, prompting an urgent need for rapid on-ground post-fire assessments of flora and fauna to aid in post-fire recovery. This project aimed to determine spatial patterns in populations and assemblages of vertebrates, vertebrate temporal activity, and the diet of the invasive Red Fox Vulpes vulpes, across burnt and unburnt sites. Using remote camera traps we surveyed 12 unburnt and 10 burnt sites approximately 12 months after the fires. We detected 41 species (11 mammals, 28 birds and 2 reptiles), with different species composition, but similar vertebrate species richness across both unburnt and burnt sites. The relative abundance of the Eastern Grey Kangaroo Macropus giganteus, Common Wombat Vombatus ursinus and Australian Magpie Gymnorhina tibicen was higher in burnt sites, while small mammals (< 500 g) had higher relative abundance at unburnt sites. There was no difference in the relative abundance of the Superb Lyrebird Menura novaehollandiae across burnt and unburnt sites, and although 11 species of bird were only detected at unburnt sites, the numbers were too low for reliable estimates of differences. Red Fox scat analysis (n=23) revealed that invertebrates and plant material were the dominant prey items in both burnt and unburnt sites, but medium-sized mammals increased in Red Fox diets in burnt sites, and reptiles were consumed disproportionately more by Red Foxes in burnt compared to unburnt sites. Although the short-term nature of this study and low scat sample size limited detailed insights, our rapid survey was an effective tool to gain preliminary data on species responses to the 2019–20 megafires in the Blue Mountains and contribute to a baseline for understanding species recovery.

Traumatic brain injury (TBI) is one of the leading causes of fatal trauma, and patients often require prolonged ventilation and tracheostomy. There are currently no standardized guidelines regarding the optimal timing of tracheostomy placement for mechanically ventilated patients with severe TBI. This review aims to investigate the impact of tracheostomy timing on the clinical outcomes in patients with severe TBI.A literature search was conducted according to PRISMA 2020 guidelines. PubMed, Google Scholar, EMBASE, MedLine, Web of Science, Cochrane, and CINAHL were searched for studies evaluating the impact of early versus late tracheostomy on TBI patient outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Newcastle-Ottawa Scale (NOS) were used for quality of evidence and risk of bias assessment, respectively.A total of nine studies met eligibility criteria. All nine studies investigated tracheostomy timing in severe TBI patients and demonstrated that early tracheostomy is associated with decreased ICU length-of-stay (LOS) and increased ventilator free-days compared to late tracheostomy.Current evidence suggests that patients with severe TBI following traumatic injury may benefit from an early tracheostomy due to improved clinical outcomes, including decreased MV duration and ICU-LOS, compared to late tracheostomy. Further multi-institutional studies are needed to develop evidence-based guidelines.

Data for 'The effect of metal remediation on the virulence and antimicrobial resistance of the opportunistic pathogen Pseudomonas aeruginosa' published in Evolutionary Applications. This tests whether liming reduces selection by metals for antibiotic resistance and virulence. In all datasets, when lime = 0 the vial was not limed, when it =1 it was limed. This is the same for shaken coulmns. Copper resistance Optical density readings. Each column is a well of a 96-well plate; each row a reading. Use the deposited code to associate wells with the treatments and media Iron fe2 = the amount of Fe2+ in the samples. feT = the total amount of available iron (i.e. Fe2+ + Fe3+) Pa amr Control is the number of colonies on plain agar, antibiotic columns are the number of colonies on agar containing that antibiotic. tcontrol should be used for trimethoprim and ampicillin as they were done seperatly to cefotaxime. Pa density pseudo = the number of colonies. See code for how to convert these to per 1 mL. pH data pH is final pH Siderophores Sample shows well id from a 96-well plate; see code for how to split this into replicates. Pyoverdin is the measure of pyoverdine using the OD reader, od is the optical density at 600nm to give a proxy for population density, cas is the reading given by the cas assay and shows total siderophore production. Virulence Sample = a population, with each sample row showing one injected larave (20 per sample). stime is the time of death. censor shows status of larvae (1 = dead, 0 = alive). This dataset also contains the natural microbial community too (pseudo = 0).

Background: Propofol is a key component for the management of sedation and shivering during targeted temperature management (TTM) following cardiac arrest. The cardiac depressant effects of propofol have not been described during TTM and may be especially relevant given the stress to the myocardium following cardiac arrest. The purpose of this study is to describe hemodynamic changes associated with propofol administration during TTM. Methods: This single center, retrospective cohort study evaluated adult patients who received a propofol infusion for at least 30 minutes during TTM. The primary outcome was the change in cardiovascular Sequential Organ Failure Assessment (cvSOFA) score 30 minutes after propofol initiation. Secondary outcomes included change in systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), and vasopressor requirements (VR) expressed as norepinephrine equivalents at 30, 60, 120, 180, and 240 minutes after propofol initiation. A multivariate regression was performed to assess the influence of propofol and body temperature on MAP, while controlling for vasopressor dose and cardiac arrest hospital prognosis (CAHP) score. Results: The cohort included 40 patients with a median CAHP score of 197. The goal temperature of 33°C was achieved for all patients. The median cvSOFA score was 1 at baseline and 0.5 at 30 minutes, with a non-significant change after propofol initiation ( P = .96). SBP and MAP reductions were the greatest at 60 minutes (17 and 8 mmHg; P

Gene regulation is highly cell type-specific and understanding the function of non-coding genetic variants associated with complex traits requires molecular phenotyping at cell type resolution. In this study we performed single nucleus ATAC-seq (snATAC-seq) and genotyping in peripheral blood mononuclear cells from 13 individuals. Clustering chromatin accessibility profiles of 96,002 total nuclei identified 17 immune cell types and sub-types. We mapped chromatin accessibility QTLs (caQTLs) in each immune cell type and sub-type using individuals of European ancestry which identified 6,901 caQTLs at FDR < .10 and 4,220 caQTLs at FDR < .05, including those obscured from assays of bulk tissue such as with divergent effects on different cell types. For 3,941 caQTLs we further annotated putative target genes of variant activity using single cell co-accessibility, and caQTL variants were significantly correlated with the accessibility level of linked gene promoters. We fine-mapped loci associated with 16 complex immune traits and identified immune cell caQTLs at 622 candidate causal variants, including those with cell type-specific effects. At the 6q15 locus associated with type 1 diabetes, in line with previous reports, variant rs72928038 was a naïve CD4+ T cell caQTL linked to BACH2 and we validated the allelic effects of this variant on regulatory activity in Jurkat T cells. These results highlight the utility of snATAC-seq for mapping genetic effects on accessible chromatin in specific cell types.