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Landscape connectivity operates at a variety of scales, depending on the geography of the area in question and the focal species or ecological process under consideration.Most connectivity studies, however, are typically focused on a single scale, which in the case of resistance‐based connectivity modelling, is often the entire landscape or protected area (PA) network. This large, single‐scale focus may miss areas that are important for connectivity at smaller scales and that can be documented via observed animal movements without resorting to landscape‐wide statistical modelling and extrapolation approaches.Here, we characterize landscape connectivity at three different scales (local/micro, inter‐PA, and landscape‐wide/macro), using observed animal movements rather than conventional resistance surface models, to produce a connectivity conservation blueprint for African elephants (Loxodonta africana) in the Kavango‐Zambezi transfrontier conservation area (KAZA) in southern Africa. This analysis is based on an extensive, high‐resolution GPS tracking database comprising approximately 4 million GPS locations from nearly 300 tagged elephants and their associated herds.Our results show that high‐fidelity elephant use of micro‐corridors is typically—though not exclusively—related to directed movements towards water, often amidst heavy anthropogenic presence. Movement pathways that connected KAZA's core protected areas were longer and variable, with some channelled into narrow areas of use and others more dispersed across larger sub‐landscapes. At the largest scale, a network analysis incorporating all used landscape grid cells revealed several clusters of large‐scale movement corridors that connected distant parts of KAZA.Synthesis and applications: Our three scales of analyses reveal disparate geographical priorities for connectivity conservation that collectively could help ensure the functional connectivity of KAZA for its largest inhabitants. Each scale will require its own set of inter‐related conservation interventions, while further research into areas with sparse data collection, and other species of conservation concern, could reveal additional connectivity priorities at each scale. [ABSTRACT FROM AUTHOR]

The hydrodynamic forces of nonlinear deep water gravity waves acting on cylindrical offshore structures are studied. Thereby, the waves are excited by random wind and the corresponding effect on the particle paths and hydrodynamic forces is investigated. This is done for the Peregrine breather solution of the nonlinear Schrödinger equation, which is nowadays considered as a prototype of extreme waves in open seas. Using this theory, the loads on mechanical structures can be calculated efficiently. It is shown that the Peregrine breather can exist under strong and gusty wind conditions and the water particles experience a horizontal drift. This leads to a force with randomly increasing amplitude in time, whereby a mean wind velocity of 50 km/h results in an increase of about 3%. The increase of hydrodynamic forces caused by the wind should therefore be considered for the construction of mechanical structures operating in the ocean. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to perform a biomechanical investigation on the effect of ulnar variance (UV) on the stability of the distal radioulnar joint (DRUJ) prior to and after DRUJ sectioning. Methods: Ten cadaveric forearm specimens were included in the study and baseline UV was assessed radiographically. Radial motion relative to the ulna was evaluated using Intel real sense cameras and a custom developed program. The forearms were dissected, and a radial osteotomy was performed. Using a custom-made plate, radial stability was assessed with an UV of + 4, 0, and −4 mm by measuring the maximum and minimum radial position relative to the ulna during a simulated Shuck test. The volar radioulnar ligaments and triangular fibrocartilage complex (TFCC) were then sectioned, and testing was repeated at each UV state. Results: Sectioning significantly increased radial translation at neutral (P =.008), +4 mm UV (P =.008), and −4 mm UV (P =.018). There were no significant differences in translation between the 3 UV groups with the DRUJ intact (P =.124). The ulnar negative (−4 mm) state had significantly lower translation compared to the positive (+4 mm) (P <.001) and the neutral (0 mm) (P =.026) UV states. There were no significant differences between the positive and neutral UV groups with the DRUJ sectioned. Conclusions: Fixating the radius in −4 mm of ulnar negativity significantly decreased radial translation after sectioning the volar radioulnar ligament and TFCC. Ulnar variance had no effect on stability with an intact DRUJ. Study Type: Biomechanical Study [ABSTRACT FROM AUTHOR]

The Whitham equation is a model for the evolution of small‐amplitude, unidirectional waves of all wavelengths in shallow water. It has been shown to accurately model the evolution of waves in laboratory experiments. We compute 2π$2\pi$‐periodic traveling wave solutions of the Whitham equation and numerically study their stability with a focus on solutions with large steepness. We show that the Hamiltonian oscillates at least twice as a function of wave steepness when the solutions are sufficiently steep. We show that a superharmonic instability is created at each extremum of the Hamiltonian and that between each extremum the stability spectra undergo similar bifurcations. Finally, we compare these results with those from the Euler equations. [ABSTRACT FROM AUTHOR]

Objective: Rheumatologic disease-associated hemophagocytic lymphohistiocytosis (HLH), a rare, life-threatening, systemic hyperinflammatory syndrome, occurs as a complication of underlying rheumatologic disease. Real-world evidence is lacking on emapalumab, a fully human monoclonal antibody that neutralizes the proinflammatory cytokine interferon-gamma, approved for treating patients with primary HLH., Methods: REAL-HLH, a retrospective medical chart review study conducted across 33 US hospitals, assessed real-world treatment patterns and outcomes in patients with HLH treated with ≥1 dose of emapalumab between November 20, 2018, and October 31, 2021. Data are presented for the subset of patients with rheumatologic disease-associated HLH., Results: Fifteen of 105 patients (14.3%) had rheumatologic disease-associated HLH. Of these, 9 (60.0%) had systemic juvenile idiopathic arthritis, and 1 (6.7%) had adult-onset Still's disease. Median (range) age at HLH diagnosis was 5 (0.9-39) years. Most (9/15; 60.0%) patients initiated emapalumab in an intensive care unit. Emapalumab was most frequently initiated for treating refractory or recurrent (10/15; 66.7%) disease. Most patients received HLH-related therapies prior to (10/15; 66.7%) and concurrently (15/15; 100.0%) with emapalumab. Emapalumab-containing regimens stabilized or achieved physician-determined normalization of most laboratory parameters including fibrinogen (11/13; 84.6%), chemokine ligand 9 (7/8; 87.5%), and absolute neutrophil count (6/10; 60%), and reduced glucocorticoid dose by 80%. Overall survival and 12-month survival probability from emapalumab initiation were 86.7%., Conclusion: Emapalumab-containing regimens stabilized or normalized most key laboratory parameters, reduced glucocorticoid dose, and were associated with low disease-related mortality, thereby demonstrating potential benefits in patients with rheumatologic disease-associated HLH., (This article is protected by copyright. All rights reserved.)

The growing use of frontline lenalidomide treatment in multiple myeloma (MM) is increasing the proportion of lenalidomide-refractory patients, which may limit the efficacy of subsequent lines of treatment (LOT). This systematic literature review (January 2008-October 2023) of clinical trials (CT) and real-world studies (RW) assessed treatment outcomes in adults with relapsed/refractory MM (RRMM) who were previously treated with ≥1 LOT, progressed and were lenalidomide-refractory. Medline, EMBASE and additional electronic databases were searched for articles published in English. Primary outcomes included progression-free survival (PFS), overall survival (OS) and overall/objective response rate (ORR); 24 CT and 19 RW were included. For CT, the population-weighted mean of median PFS (CT = 14) and OS (CT = 6) were shorter in the lenalidomide-refractory cohort (months: 8.8 [n = 2699] and 21.7 [n = 1066], respectively) than the intent-to-treat population (months: 13.8 [n = 5380] and 35.9 [n = 2264], respectively); the population-weighted (N = 2142) mean ORR for lenalidomide-refractory patients (CT = 18) was 56.0%. RW reported considerable variation in PFS (RW = 7), OS (RW = 8) and ORR (RW = 8); and median PFS (RW = 2; months) was lower in lenalidomide/bortezomib-refractory (5.5/5.5; n = 81/n = 25) versus lenalidomide-refractory (7.3/8.0; n = 81/n = 61) patients. These data provide evidence that clinical trials and real-world outcomes are suboptimal in lenalidomide-refractory patients with RRMM, highlighting the need to improve treatment options for this population., (© 2024 GSK and The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

The American Academy of Sleep Medicine commissioned a task force of clinical experts in pediatric sleep medicine to review published literature on performing the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test for diagnosis and management of central disorders of hypersomnolence among children and adolescents. This paper follows a format similar to that of the paper "Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine" that was published in 2021. Since there is insufficient evidence to specify a recommended protocol for the Maintenance of Wakefulness Test in children and adolescents, this paper focuses only on the MSLT protocol. This protocol paper provides guidance to health care providers who order, sleep specialists who interpret, and technical staff who administer the MSLT to pediatric patients. Similar to the adult protocol paper, this document provides guidance based on pediatric expert consensus and evidence-based data when available. Topics include patient preparation, evaluation of medication and substance use, sleep needs before testing, scheduling considerations, optimal test conditions for youth, and documentation. Specific changes recommended for pediatric MSLT protocols include (1) provision of a minimum of 7 hours of sleep (with a minimum 8-hour recording time) on polysomnography the night before the MSLT, ideally meeting age-based needs; (2) use of clinical judgment to guide the need for sleep-disordered breathing treatments before polysomnography-MSLT testing; and (3) shared patient-health care provider decision-making regarding modifications in the protocol for children and adolescents with neurodevelopmental/neurological disorders, young age, and/or delayed sleep phase., Citation: Maski KP, Amos LB, Carter JC, Koch EE, Kazmi U, Rosen CL. Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in children: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med . 2024;20(4):631-641., (© 2024 American Academy of Sleep Medicine.)