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Background: Enhanced recovery protocols (ERPs) after metabolic and bariatric surgery (MBS) may help decrease length of stay (LOS) and postoperative nausea/vomiting but implementation is often fraught with challenges. The primary aim of this pilot study was to standardize a MBS ERP with a real-time data support dashboard and checklist and assess impact on global and individual element compliance. The secondary aim was to evaluate 30 day outcomes including LOS, hospital readmissions, and re-operations. Methods and procedures: An ERP, paper checklist, and virtual dashboard aligned on MBS patient care elements for pre-, intra-, and post-operative phases of care were developed and sequentially deployed. The dashboard includes surgical volumes, operative times, ERP compliance, and 30 day outcomes over a rolling 18 month period. Overall and individual element ERP compliance and outcomes were compared pre- and post-implementation via two-tailed Student's t-tests. Results: Overall, 471 patients were identified (pre-implementation: 193; post-implementation: 278). Baseline monthly average compliance rates for all patient care elements were 1.7%, 3.7%, and 6.2% for pre-, intra-, and post-operative phases, respectively. Following ERP integration with dashboard and checklist, the intra-operative phase achieved the highest overall monthly average compliance at 31.3% (P < 0.01). Following the intervention, pre-operative acetaminophen administration had the highest monthly mean compliance at ≥ 99.1%. Overall TAP block use increased 3.2-fold from a baseline mean rate of 25.4–80.8% post-implementation (P < 0.01). A significant decrease in average intra-operative monthly morphine milligram equivalents use was noted with a 56% drop pre- vs. post-implementation. Average LOS decreased from 2.0 to 1.7 days post-implementation with no impact on post-operative outcomes. Conclusion: Implementation of a checklist and dashboard facilitated ERP integration and adoption of process measures with many improvements in compliance but no impact on 30 day outcomes. Further research is required to understand how clinical support tools can impact ERP adoption among MBS patients. [ABSTRACT FROM AUTHOR]

When compared to tide-dominated shelves, shelves swept by geostrophic flows are relatively understudied, yet geostrophic currents have the potential to construct substantial current-generated shelf bedforms. This paper examines the evolution of a series of bedforms encountered along the narrow Agulhas Current-swept northern KwaZulu-Natal shelf. Their evolution is placed in the context of progressive current impingement and variation in flows associated with the postglacial transgression and culminating in the present-day highstand. Ultra-high resolution seismic reflection, multibeam, side-scan sonar and single beam data sets reveal several bedform scales and morphologies; wave ripples and shoreface-connected ridges are associated only with the inner shelf, and 2D and 3D very large dunes are more cosmopolitan and span the entire shelf sector. The inner shelf is marked by rock outcrop (aeolianite), surrounded by sandy sediment, grading seaward into sediment starved bedforms associated with bioclastic gravels. Where sufficient sediment exists in local depocenters, very large dunes form discontinuous fields along the outer shelf. The seismic stratigraphy of the outer shelf reflects the effects of postglacial flooding by rising sea levels and increasing current impingement by the Agulhas Current. The Holocene wave ravinement surface is overlain by flat-lying strata (early dune development and dune amalgamation with first current exposure), in turn covered by hummocky, sub-horizontal aggrading beds (amalgamation), overlain by inclined cross-bedded packages (lee faces of the bedforms formed during migration and full current interaction). Morphometric analyses show that for both the inner and outer shelf, no relationships exist between water depth, wavelength and spacing. Height to spacing (H/L) relationships are weak but nevertheless show a broadly positive trend. Bedform heights are lower on the inner shelf compared to the outer shelf, but bedform spacing is greater on the inner shelf, with a 40% overlap in H/L indices observed between the two areas. The departures in overlap can be linked to the competing offshore Agulhas Current and the inshore wave-dominated processes. Bedforms of the inner shelf plot below the global H/L mean and can be related to the more infrequent incursions of the Agulhas Current core. At the time of survey, the Agulhas Current was likely situated well offshore, resulting in reduced current activity in the survey area resulting in rounding of the dune crests, degradation of the dune crests and trough infilling. On the outer shelf, the H/L values plot above the mean global trend, suggesting vertical accretion due to the faster currents. Crest rounding and downlapping of the upstream lee faces onto the downstream stoss faces indicate dune degradation, which is related to a seaward location of the Agulhas Current at the time of survey. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is the fourth most common neurodevelopmental disorder, with a prevalence of 1 in 160 children. Accurate diagnosis relies on experts, but such individuals are scarce. This has led to increasing interest in the development of machine learning (ML) models that can integrate neuroimaging features from functional and structural MRI (fMRI and sMRI) to help reveal central nervous system alterations characteristic of ASD. We optimized and compared the performance of 12 of the most popular and powerful ML models. Each was separately trained using 15 different combinations of fMRI and sMRI features and optimized with an unbiased model search. Deep learning models predicted ASD with the highest diagnostic accuracy and generalized well to other MRI datasets. Our model achieves state-of-the-art 80% area under the ROC curve (AUROC) in diagnosis on test data from the IMPAC dataset; and 86% and 79% AUROC on the external ABIDE I and ABIDE II datasets (with further improvement to 93% and 90% after supervised domain adaptation). The highest performing models identified reproducible putative biomarkers for accurate ASD diagnosis in accord with known ASD markers as well as novel cerebellar biomarkers. Such reproducibility lends credence to their tremendous potential for defining and using a set of truly generalizable ASD biomarkers that will advance scientific understanding of neuronal changes in ASD. [ABSTRACT FROM AUTHOR]

Hall effect and quantum oscillation measurements on high temperature cuprate superconductors show that underdoped compositions have small Fermi surface pockets whereas when heavily overdoped, a single much larger pocket is found. The origin of this change in electronic structure has been unclear, but may be related to the high temperature superconductivity. Here we show that the clean overdoped single-layer cuprate Tl2Ba2CuO6+δ (Tl2201) displays CDW order with a remarkably long correlation length ξ ≈ 200 Å which disappears above a hole doping of pCDW ≈ 0.265. We show that the evolution of the electronic properties of Tl2201 as the doping is lowered may be explained by a Fermi surface reconstruction which accompanies the emergence of the CDW below pCDW. Our results demonstrate importance of CDW correlations in understanding the electronic properties of overdoped cuprates. The origin of the Fermi surface reconstruction that occurs in cuprate superconductors as hole doping increases remains unclear. Here, the authors observe long range charge density wave (CDW) order in the overdoped single-layer cuprate Tl2Ba2CuO6+δ, which then disappears above a hole concentration 0.265, suggesting a correlation between Fermi surface reconstruction and the emergence of the CDW. [ABSTRACT FROM AUTHOR]

Strange metals possess highly unconventional electrical properties, such as a linear-in-temperature resistivity1–6, an inverse Hall angle that varies as temperature squared7–9 and a linear-in-field magnetoresistance10–13. Identifying the origin of these collective anomalies has proved fundamentally challenging, even in materials such as the hole-doped cuprates that possess a simple bandstructure. The prevailing consensus is that strange metallicity in the cuprates is tied to a quantum critical point at a doping p* inside the superconducting dome14,15. Here we study the high-field in-plane magnetoresistance of two superconducting cuprate families at doping levels beyond p*. At all dopings, the magnetoresistance exhibits quadrature scaling and becomes linear at high values of the ratio of the field and the temperature, indicating that the strange-metal regime extends well beyond p*. Moreover, the magnitude of the magnetoresistance is found to be much larger than predicted by conventional theory and is insensitive to both impurity scattering and magnetic field orientation. These observations, coupled with analysis of the zero-field and Hall resistivities, suggest that despite having a single band, the cuprate strange-metal region hosts two charge sectors, one containing coherent quasiparticles, the other scale-invariant ‘Planckian’ dissipators.Measurements of high-field magnetotransport in overdoped cuprates indicate that the strange-metal regime exists beyond the critical doping, and that it has both coherent and incoherent contributions. [ABSTRACT FROM AUTHOR]