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Determine the safety and initial efficacy of a novel biofeedback intervention to improve landing mechanics in patients following anterior cruciate ligament reconstruction (ACLR).Forty patients post-ACLR (age: 16.9 ± 2.0 years) were randomly allocated to a biofeedback intervention or an attention control group. Patients in the biofeedback group completed 12 sessions over six-weeks that included bilateral unweighted squats with visual and tactile biofeedback. Patients in the control group completed a six-week educational program. Lower extremity mechanics were collected during a bilateral stop jump at baseline, six-weeks, and 12-weeks post-intervention. Linear mixed-effects models adjusted for sex and graft type determined the main effects of and interactions between group and time.No group by time interaction existed for peak knee extension moment symmetry. A group by time interaction existed for peak vertical ground reaction force symmetry (p = 0.012), where patients in the biofeedback group had greater improvements in symmetry between baseline and post-intervention that were not maintained through the retention assessments.This novel biofeedback program did not reduce risk factors for second ACL injuries. Future work could develop and test multidisciplinary interventions for reducing second ACL injury risk factors.GOV IDENTIFIER: (NCT03273673).

The stable isotopic composition of methane (CH4) is commonly used to fingerprint natural gas origins. Over the past 50 years, there have been numerous proposals that both microbial and thermogenic CH4 can form in or later attain hydrogen isotopic equilibrium with water (H2O) and carbon isotopic equilibrium with carbon dioxide (CO2). Evaluation of such proposals requires knowledge of the equilibrium fractionation factors between CH4 and H2O or CO2 at the temperatures where microbial and thermogenic CH4 form in or are found in the environment, which is generally less than 200 °C. Experimental determinations of these fractionation factors are only available above 200 °C, requiring extrapolation of these results beyond the calibrated range or the use of theoretical calculations at lower temperatures. Here, we provide a calibration of the equilibrium hydrogen isotopic fractionation factor for CH4 and hydrogen gas (H2) (DαCH4(g)–H2(g)) based on experiments using γ-Al2O3 and Ni catalysts from 3 to 200 °C. Results were regressed as a 2nd order polynomial of 1000 × lnDαCH4(g)–H2(g) vs. 1/T (K−1) yielding: 1000 × l n D α C H 4 ( g ) - H 2 ( g ) = 3.5317 × 10 7 T 2 + 2.7749 × 10 5 T - 179.48 We combine this calibration with previous experimental determinations of hydrogen isotope equilibrium between H2, H2O(g), and H2O(l) and we provide an interpolatable experimental calibration of 1000 × lnDαCH4(g)–H2O(l) from 3 to 200 °C. Our resulting 4th order polynomial is the following equation: 1000 × l n D α C H 4 ( g ) - H 2 O l = - 7.9443 × 10 12 T 4 + 8.7772 × 10 10 T 3 - 3.4973 × 10 8 T 2 + 5.4398 × 10 5 T - 382.05 At 3 °C, the value from our calibration differs by 93‰ relative to what would be calculated based on the extrapolation of the only experimental calibration currently available to temperatures below its calibrated range (lowest temperature of 200 °C; Horibe and Craig, 1995). We additionally provide new theoretical estimates of hydrogen isotopic equilibrium between CH4(g), H2(g), and H2O(g) and carbon isotopic equilibrium between CH4(g) and CO2(g) using Path Integral Monte Carlo (PIMC) calculations. Our PIMC calculations for hydrogen isotopic equilibrium between CH4 and H2 agree 1:1 with our experiments. Finally, we compile carbon and hydrogen isotopic measurements of CH4, CO2, and H2O from various environmental systems and compare observed differences between carbon and hydrogen isotopes to those expected based on isotopic equilibrium. We find that isotopic compositions of some microbial gases from marine sedimentary, coalbed, and shale environments are consistent with those expected for CH4 H2O(l) hydrogen and CH4 CO2 carbon isotopic equilibrium. In contrast, microbial terrestrial and pure culture gases are not consistent with both CH4 H2O(l) hydrogen and CH4 CO2 carbon isotopic equilibrium. These results are explained qualitatively using previously developed conceptual models that link free energy gradients available to microorganisms to the degree that their enzymes can promote isotope-exchange reactions between CH4, CO2, and H2O.

Introduction Compressive ulnar neuropathy at the elbow is the second most common compressive neuropathy. Nerve transfers are used for severe ulnar neuropathies as a means of facilitating recovery. Hand therapy and rehabilitation after nerve transfers have not been extensively explored. Purpose of the Study The aim of this repeated case study was to describe the responses, functional outcome, and neuromuscular health of three participants after the supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar motor nerve transfer do describe the hand therapy and recovery of 3 cases reflecting different recovery potential mediators, trajectories, and outcomes. Study Design Repeated case study. Methods Three participants of similar age (76-80 years) that had severe ulnar neuropathy who underwent surgical treatment including a SETS AIN to ulnar motor nerve surgery were purposively selected from an ongoing clinical trial, based on their response to the surgical and the rehabilitation intervention (large, moderate, and small improvements). Clinical evaluations included measuring range of motion, strength testing, and clinical tests (ie, Egawa's sign) and, subjective assessment of rehabilitation adherence., Quick Disability of Arm, Shoulder and Hand and decomposition-based quantitative electromyography were performed at >23 months to evaluate patients. Results All the three participants completed the surgical and hand therapy interventions, demonstrating a variable course of recovery and functional outcomes. The Quick Disability of Arm, Shoulder and Hand scores (>23 months) for participants A, B, and C were 68, 30, and 18, respectively. The person with the least improvement had idiopathic Parkinson's disease, dyslipidemia, history of depression, and gout. Comparison across cases suggested that the comorbidities, longer time from neuropathy to the surgical intervention, and psychosocial barriers to exercise and rehabilitation adherence influenced the recovery process. The participants with the best outcomes demonstrated improvements in his lower motor neurons or motor unit counts (109 and 18 motor units in the abductor digiti minimi (ADM) and first dorsal interosseous, respectively) and motor unit stability (39.5% and 37.6% near-fiber jiggle in the ADM and first dorsal interosseous, respectively). The participant with moderate response to the interventions had a motor unit count of 93 for the ADM muscle. We were unable to determine motor unit counts and measurements from the participant with the poorest outcomes due to his physical limitations. Conclusions SETS AIN to ulnar motor nerve followed by multimodal hand therapy provides measurable improvements in neurophysiology and function, although engagement in hand therapy and outcomes appear to be mediated by comorbid physical and psychosocial health.

Purpose Oxygen delivery by high flow nasal cannula (HFNC) is effective in providing respiratory support. HFNC has utility in clearing the extra-thoracic dead space, making it potentially beneficial in the treatment of hypercapnic respiratory failure. This study compares high velocity nasal insufflation (HVNI), a form of HFNC, to non-invasive positive pressure ventilation (NIPPV) in their abilities to provide ventilatory support for patients with hypercapnic respiratory failure. Methods This is a pre-defined subgroup analysis from a larger randomized clinical trial of Emergency Department (ED) patients with respiratory failure requiring NIPPV support. Patients were randomized to HVNI or NIPPV. Subgroup selection was done for patients with discharge diagnoses of acute hypercapnic respiratory failure or acute exacerbation of chronic obstructive pulmonary disease. The primary outcomes were change in pCO2 and pH over time. Secondary outcomes were treatment failure and intubation rate. Results 65 patients with hypercapnic respiratory failure were compared. 34 were randomized to HVNI and 31 to NIPPV. The therapeutic impact on PCO2 and pH over time was similar in each group. The intubation rate was 5.9% in the HVNI group and 16.1% in the NIPPV group (p = 0.244). The rate of treatment failure was 23.5% in the HVNI group and 25.8% in the NIPPV group (p = 1.0). Conclusion HVNI may provide ventilatory support similar to NIPPV in patients presenting with acute hypercapnic respiratory failure, but further study is needed to corroborate these findings.

Growth is often impaired in infants with congenital heart disease. Poor growth has been associated with worse neurodevelopment, abnormal behavioral state, and longer time to hospital discharge. Nutritional interventions, drug therapy, and surgical palliation have varying degrees of success enhancing growth. Passive range of motion (PROM) improves somatic growth in preterm infants and is safe and feasible in infants with hypoplastic left heart syndrome (HLHS), after their first palliative surgery (Norwood procedure).This multicenter, Phase III randomized control trial of a 21-day PROM exercise or standard of care evaluates growth in infants with HLHS after the Norwood procedure. Growth (weight-, height- and head circumference-for-age z-scores) will be compared at 4 months of age or at the pre-superior cavopulmonary connection evaluation visit, whichever comes first. Secondary outcomes include neonatal neurobehavioral patterns, neurodevelopmental assessment, and bone mineral density. Eligibility include diagnosis of HLHS or other single right ventricle anomaly, birth at ≥37 weeks gestation and Norwood procedure at30 days of age, and family consent. Infants with known chromosomal or recognizable phenotypic syndromes associated with growth failure, listed for transplant, or expected to be discharged within 14 days of screening are excluded.The TEAM 4 Growth trial will make an important contribution to understanding the role of PROM on growth, neurobehavior, neurodevelopment, and BMD in infants with complex cardiac anomalies, who are at high risk for growth failure and developmental concerns.

Managing respiratory failure (RF) secondary to acute decompensated heart failure (ADHF) with non-invasive positive-pressure ventilation (NIPPV) has been shown to significantly improve morbidity and mortality in patients presenting to the emergency department (ED). This subgroup analysis compares high-velocity nasal insufflation (HVNI), a form of high-flow nasal cannula, with NIPPV in the treatment of RF secondary to ADHF with respect to therapy failure, as indicated by the requirement for intubation or all-cause arm failure including subjective crossover to the alternate therapy.The subgroup analysis is from a larger randomized control trial of adults presenting to the ED with RF requiring NIPPV support. Patients were randomly selected to therapy, and subgroup selection was established a priori in the original study as a discharge diagnosis. The primary outcome was therapy failure at 72 h after enrolment.Subgroup analysis included a total of 22 HVNI and 20 NIPPV patients which fit discharge diagnosis ADHF. Baseline patient characteristics were not statistically significant. Primary outcomes were not statistically significant: intubation rate (p = 1.000), therapy success (p = 1.000). Repeated measures (vitals, dyspnea, blood gases) showed comparable differences over initial 4 h. Physicians scored HVNI superior on patient comfort/tolerance (p 0.001), ease of use (p = 0.004), and monitoring (p = 0.036). Limitations were technical inability to blind the clinician team and lack of power of the subgroup analysis.In conclusion, this subgroup analysis suggests HVNI may be non-inferior to NIPPV in patients with respiratory failure secondary to ADHF that do not need emergent intubation.

Multiple classes of environmental contaminants have been found in aquatic environments, globally. Understanding internalised concentrations in the organism could further improve the risk assessment process. The present study is concerned with the determination of several contaminant classes (107 compounds) in Gammarus pulex collected from 15 sites covering 5 river catchments across Suffolk, UK. Quantitative method performance was acceptable for 67 compounds including pharmaceuticals, pesticides, illicit drugs and drugs of abuse. A total of 56 compounds were detectable and ranged from, Graphical abstract Unlabelled Image, Highlights • A method is presented to quantify pesticides, pharmaceuticals and drugs of abuse. • Cocaine was the most frequently determined compound found in 100% of samples. • Several pesticides no longer approved for use in the EU were determined. • Estimates of toxic pressure for detected pesticides was low. • Effect pressure of drugs showed good potential to prioritise compounds of concern.

Regulated small-dollar installment lenders do not operate within Arkansas, but they do in all six bordering states. We can measure the effects of Arkansas' 17 percent interest rate cap because Arkansas residents obtain installment loans only from out-state lenders. On average, Arkansas residents borrow \$1,051 at an APR of 93 percent, when incorporating travel costs. Perimeter county residents hold 96.8 percent of out-state supplied small-dollar installment loans and interior county residents hold 3.2 percent. Robustness checks show that nonprime borrowers in the interior counties have less access to all sources of credit than do prime borrowers in the perimeter counties.

Cannabis sativa L., a low-cost, fast-growing herbaceous plant, is seeing a resurgence in widespread cultivation as a result of new policies and product drive. Its biodegradable and environmentally benign nature coupled with its high specific surface area and three-dimensional hierarchal structure makes it an excellent candidate for use as a biomass-derived carbon material for electrochemical power sources. It is proposed that this ‘wonder crop’ could have an important role in the energy transition by providing high-functioning carbon-based materials for electrochemistry. In this article, all instances of C. sativa usage in batteries, fuel cells and supercapacitors are discussed with a focus on highlighting the high capacity, rate capability, capacitance, current density and half-wave potential that can be achieved with its utilisation in the field.

Monotonic and cyclic tests were carried out to determine strength and stiffness characteristics of 2.44 m (8 ft) long shear connections with 8 mm and 10 mm diameter self-tapping screws. The goal of this research is to compare test values of cross-laminated timber (CLT) diaphragm connections in seismic force-resisting systems to the design values calculated from formulas in the National Design Specification for Wood Construction (USA) and the Eurocode. Understanding and quantifying the behavior of these shear connections will provide structural engineers with increased confidence in designing these components, especially with regard to the seismic force-resisting systems. Ratios of the experimental yield strength (from the yield point on the load-deflection curve) to factored design strength were in the range of 2.1–6.1. In the ASCE 41-13 acceptance criteria analysis, the m-factors for the Life Safety performance level in cyclic tests ranged from 1.6 to 1.8 for surface spline connections and from 0.9 to 1.7 for cyclic half-lap connections. The half-lap connections with a unique combination of angled and vertical screws performed exceptionally well with both high, linear elastic initial stiffness and ductile, post-peak behavior.

The data presented in this study were obtained from a novel approach to estimate a comprehensive loan acquisition cost. The latter includes commute costs and wage losses in addition to the monthly installment payments. These cost estimates represent the monetary value (in U.S. dollars) of the costs of driving to and from the installment lender storefront and that of the potential hourly wage losses, that is, wage loss from the driving time and the time spent at the loan office filling out the required paperwork to obtain the loan. Borrowers only get the net loan proceeds, that is, the original loan amount minus the comprehensive loan acquisition costs. The study area has 160 counties. It was created from the ESRI ArcGIS Map (a mapping software) using the spatial data from the U.S. Census, Topologically Integrated Geographic Encoding and Referencing (TIGER) Cartographic boundary files representing the geographies of states and counties. Using the U.S. road networks, the origin of the trip is a county seat in Arkansas and the destination of the trip is a county seat in a surrounding state of Tennessee, Mississippi, Louisiana, Texas, Oklahoma, and Missouri. The transportation networks were established using Google Earth/Directions to efficiently measure the travel time (distance). The average cost of a trip of 17 cents (U.S. dollar) was calculated based on the U.S. Department of Transportation Survey data, which identify important attributes of a typical vehicle used in a county such as model make, age of the vehicle, fuel consumption, etc. There are 10 occupational industry sectors where a typical borrower has a job. To estimate wage loss, the data were gathered from the U.S. Department of Labor, Bureau of Labor Statistics, namely, the Occupational Employment Statistics. Putting the missing pieces together, the data contain in this study improve our understanding of extra costs borne by borrowers located in the “loan desert” area. As expected, interior counties post high loan acquisition costs compared with border counties. The data from this study are useful to the public, businesses, policymakers, and researchers working on consumer finance. JEL classification: G20, G29, L51, Keywords: Data, Loan acquisition costs, Loan desert, Interest rate cap, Arkansas

Patients who present for anterior cruciate ligament (ACL) revision with a high-grade pivot shift at the time of an index ACL revision procedure and subsequent reconstruction failure or a high-grade pivot shift at revision surgery, patients with generalized joint laxity, and those requiring softs tissue grafts should be considered candidates for lateral tenodesis to supplement intraarticular graft revision. Although there is no consensus regarding the optimal lateral tenodesis technique, due to the tibial positioning associated with tensioning and fixation of extra-articular procedures, a lateral tenodesis should not be used in patients with posterolateral corner injuries or lateral compartment articular disease.

Exoskeletons are central to the physiology and survival of marine invertebrates, but future increases in the temperature and pCO2 of the marine environment may alter the biomineralization processes involved in their formation. Thus, it is important to consider the impacts of a changing climate on the functionality of invertebrate exoskeletons. In this study, juvenile blue crab, Callinectes sapidus, from the Chesapeake Bay were exposed to increased temperature and pCO2 in a 2 × 2 factorial design for a period of two molts (approximately 30 days). Treatment levels were chosen to represent current (26 °C and 800 μatm CO2) and predicted future conditions in the year 2100 (32 °C and 8000 μatm CO2) in the Chesapeake Bay. Thickness was determined by light microscopy and carapace calcium (Ca) and magnesium (Mg) content were determined by Inductively Coupled Plasma – Atomic Emission Spectrometry. All Ca and Mg in the carapace were assumed to be present in the form of high‑magnesium calcite (HMC). Increased temperature decreased the thickness of juvenile blue crab carapaces by 8.5% and significantly reduced weight percent HMC by 2.0% (P

Climate warming has been found to increase forest insect herbivory with potentially important consequences for the performance and distribution of plant species. Dioecious species often show sex-specific responses to abiotic drivers leading to spatial segregation of the sexes. However, little is known about sexual differences in defense against herbivorous insects in response to warming. We used a field survey and glasshouse experiment to test how sex-specific defenses of Populus cathayana against insect herbivory respond to warming. Consumed leaf area in females was greater than in males at +4 ℃ experimental warming or lower altitude. The warming treatment did not strongly affect differences in constitutive levels of leaf salicortin, condensed tannins (CT), salicylic acid (SA) and jasmonic acid (JA) between the two sexes. However, warming decreased herbivore-induced responses in salicortin, CT, SA, JA and defensive-related enzyme activities (e.g., superoxide dismutase, peroxidase, polyphenol oxidase and lipoxygenase) more in females than in males. Moreover, consumed leaf area in females showed more negative relationships with feeding-induced chemical defense traits than in males. These results show that sex-specific leaf defense against insect herbivory can be mediated by climate warming, and that higher leaf herbivory in females under warming is mainly influenced by decreases in induced defense responses rather than constitutive defense responses.

Background The inability to standardize footwear is a potential issue when measuring landing kinetics in non-laboratory settings. This study determined the impact of not standardizing footwear on load and load symmetry during landing. A secondary purpose of this study was to introduce the Load Analysis Program, an open-source MATLAB® user-interface for computing kinetic and kinetic symmetry from data collected using loadsol® sensors. Methods Forty uninjured participants completed bilateral and unilateral landing tasks in their own preferred athletic footwear and in laboratory-standardized footwear. Peak impact force, impulse, and a limb symmetry index of both kinetic outcomes were computed using loadsol® sensors (200 Hz) for both footwear conditions, and compared between footwear conditions using intraclass correlation coefficients and Bland-Altman plots. Findings The agreement between the preferred and standardized conditions was good to excellent for peak impact force, peak impact force limb symmetry index, and impulse limb symmetry index during the bilateral task (intraclass correlation coefficient = 0.870–0.951). The agreement was moderate to poor for unilateral limb symmetry index measures (intraclass correlation coefficient = 0.399–0.516). During the preferred footwear condition, impulse was greater for the left limb during bilateral landing, and peak impact force during unilateral landing on the right limb was decreased, when compared to the standardized footwear condition (p Interpretation These results suggest that while not standardizing footwear can alter the results of certain load metrics, laboratory-relevant landing mechanics information can be obtained with participants wearing their own footwear.

Recent sea ice retreat and seawater warming in the Pacific Arctic are physical changes that are impacting arctic biological communities. Recently, ocean acidification from increases in anthropogenic CO 2 has been identified as an additional stressor, particularly to calcifying organisms like bivalves. These bivalves are common prey items for benthivorous predators such as Pacific walruses ( Odobenus rosmarus divergens ), bearded seals ( Erignathus barbatus ), and diving seaducks, such as Spectacled Eiders ( Somateria fischeri ). We investigated the effects of decreased pH and food availability on growth (% change in length and wet weight and allometric growth characterizations) and oxygen consumption (mg/L/hour) of three common Arctic bivalves, Macoma calcarea, Astarte montagui, and Astarte borealis. Two sets of experiments were run for seven and eleven weeks, exposing the bivalves to control (8.05 ± 0.02 and 8.19 ± 0.003, respectively) and acidified (7.76 ± 0.01 and 7.86 ± 0.01, respectively) pH treatments. Length, weight, and oxygen consumption were not significantly different among the varying treatments after the seven-week exposure and only one significant effect of decreased pH and one significant effect of decreased food availability were observed after the end of the eleven-week exposure. Specifically, shells of A. borealis displayed a decrease in length in response to decreased pH and M. calcarea showed a decrease in length in response to limited food. The negative effects of pH observed in the experiments on growth and oxygen consumption were small, suggesting that at least two of these species are generally resilient to decreasing pH.

Nearly 1 in 60 adolescent athletes will suffer anterior cruciate ligament (ACL) injuries with 90% of these athletes electing to undergo an ACL reconstruction (ACLR) at an estimated annual cost of $3 billion. While ACLR and subsequent rehabilitation allow these athletes to return to sports, they have a 15-fold increased risk of second ACL injuries. The modification of post-operative rehabilitation to improve movement and loading symmetry using visual and tactile biofeedback could decrease the risk factors for sustaining a second ACL injury. Participants included 40 adolescent ACLR patients who were intending to return to full sport participation. This preliminary randomized controlled trial (RCT) examined the changes in knee extension moment symmetry, a known risk factor for second ACL injuries, during landing from a stop-jump task between the following time-points: pre-intervention, immediate post-intervention, and subsequent follow-up 6-weeks post-intervention. Participants met twice per week for six-weeks (12-session). The intervention included bilateral squat biofeedback (visual and tactile); the attention control group attended weekly educational sessions. This RCT enrolled and randomize 40 participants over a two-and-a-half-year period. All participants were greater than 4.5 months post-op from a primary, unilateral ACLR and were released to participate by their treating physician. The findings from this pilot biofeedback RCT will provide critical effect size estimates for use in subsequent larger clinical trials.

Cross-laminated timber (CLT) rocking walls limit internal building forces and dissipate seismic energy mostly through severe connection damage and related wood crushing. While collapse-prevention and life-safety performance can be achieved, the connections and CLT walls are permanently damaged and may be unreliable for resisting aftershocks. Slip-friction connections (SFCs), also known as slotted-bolted connections, are highly resilient passive dampers originally developed for steel structures. As part of a thorough research program to apply SFCs to CLT rocking walls, connection tests were conducted to better understand a novel application of multiple modern timber technologies. The research objectives were to design and test a slip-friction connection connected to cross-laminated timber with inclined self-tapping screws (STS) to determine the stiffness and passive damping properties of the assembly. The SFC system was designed for use as a slip-friction hold-down in a self-centering CLT rocking wall system. A series of quasi-static, cyclic axial tests with slip-friction connections was shown to impart ductile and elastic–plastic characteristics to an otherwise non-ductile CLT connection. Because the timber connection forces were limited below the STS yield strength by the slip-friction connectors, no wood damage was observed during SFC sliding. Compared to other sources, passive damping was found to be excellent and close to typical idealized friction hysteresis models. The slip-friction connections are a unique design using an efficient CLT to SFC connection, with no slack, that performs consistently after consecutive tests. Additionally, cursory equivalent-viscous-damping ratios were extracted for the elastic range of the STS to steel connection for small amplitude excitations below the slip force threshold.

Study Objective To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. Design A projection model was used to apply estimates of costs and health outcomes associated with the excess risk of unexpected disposition for NAs reported in a recent study. Setting Ambulatory and inpatient surgery. Patients Base-case model parameters were based on estimates taken from peer-reviewed publications when available, or from other sources including data for all hospital stays in the United States in 2013 from the Healthcare Cost and Utilization Project Web site. The impact of parameter uncertainty was assessed using 1-way and 2-way sensitivity analyses. Interventions Not applicable. Measurements Major complication rates, relative risks of complications, anesthesia costs, costs of complications, and cost-effectiveness ratios. Main Results In the base-case model, there were on average 2.3 fewer unexpected dispositions for physician anesthesiologists compared with NAs. Overall, anesthesia-related costs (including the cost of managing unexpected dispositions) were estimated to be about $31 higher per procedure for physician anesthesiologists compared with NAs. Alternative model scenarios in the sensitivity analysis produced estimates of smaller additional costs associated with physician anesthesia administration, to the point of cost savings in some scenarios. Conclusions Provision of anesthesia for ambulatory knee and shoulder procedures by physician anesthesiologists results in better health outcomes, at a reasonable additional cost, compared with procedures with NA-administered anesthesia, at least when using updated cost-effectiveness willingness-to-pay benchmarks.

SummaryIntegral membrane proteins (IMPs) control the flow of information and nutrients across cell membranes, yet IMP mechanistic studies are hindered by difficulties in expression. We investigate this issue by addressing the connection between IMP sequence and observed expression levels. For homologs of the IMP TatC, observed expression levels vary widely and are affected by small changes in protein sequence. The effect of sequence changes on experimentally observed expression levels strongly correlates with the simulated integration efficiency obtained from coarse-grained modeling, which is directly confirmed using an in vivo assay. Furthermore, mutations that improve the simulated integration efficiency likewise increase the experimentally observed expression levels. Demonstration of these trends in both Escherichia coli and Mycobacterium smegmatis suggests that the results are general to other expression systems. This work suggests that IMP integration is a determinant for successful expression, raising the possibility of controlling IMP expression via rational design.

The Great Lakes Fishery Commission sponsored a 2-day workshop that sought to enhance the ability of Great Lakes agencies to understand, predict, and ideally manage fisheries production in the face of changes in natural and anthropogenic forcings (e.g., climate, invasive species, and nutrients). The workshop brought together 18 marine and freshwater researchers with collective expertise in aquatic ecology, physical oceanography, limnology, climate modeling, and ecosystem modeling, and two individuals with fisheries management expertise. We report on the outcome of a writing exercise undertaken as part of this workshop that challenged each participant to identify three needs, which if addressed, could most improve the ability of Great Lakes agencies to manage their fisheries in the face of ecosystem change. Participant responses fell into two categories. The first identified gaps in ecological understanding, including how physical and biological processes can regulate early life growth and survival, how life-history strategies vary across species and within populations, and how anthropogenic stressors (e.g., nutrient runoff, climate change) can interact to influence fish populations. The second category pointed to the need for improved approaches to research (e.g., meta-analytic, comparative, spatial translation) and management (e.g., mechanistic management models, consideration of multi-stock management), and also identified the need for improved predictive models of the physical environment and associated ecosystem monitoring programs. While some progress has been made toward addressing these needs, we believe that a continued focus will be necessary to enable optimal fisheries management responses to forthcoming ecosystem change.

Bipolar disorder is a chronic mental health disorder that is frequently encountered in primary care. Many patients with depression may actually have bipolar disorder. The management of bipolar disorder requires proper diagnosis and awareness or referral for appropriate pharmacologic therapy. Patients with bipolar disorder require primary care management for comorbidities such as cardiovascular and metabolic disorders.

An orthogonally accelerated time-of-flight mass spectrometer has been added to a flowing afterglow–Langmuir probe apparatus, coupled by a rectilinear ion guide. The TOF has improved the signal-to-noise (S/N) ratio by about an order of magnitude over a quadrupole mass filter/electron multiplier detection typical for flow tube instruments of this type and used previously. The improved S/N reduces our data acquisition time commensurately. Additionally, mass discrimination is low enough that it is minimal for ions heavier than ∼10 amu. The lack of mass discrimination not only reduces experiment time but also leads to greater accuracy in the measurement of reaction rate coefficients. Finally, simultaneous detection of both heavy and light ions is improved. H + can now be detected and WF 5 + isotopes can be separated without reducing sensitivity. We have found that discrimination against low-mass ions can occur when certain electron-attaching reactants are used (e.g. SF 6 ), and possibly due to radicals formed after certain other reactants attach electrons. Evidence points to adsorption of these species on surfaces of the ion guide immediately behind the flowing afterglow sampling orifice, which separates the flow tube and TOF region. The adsorption follows a Langmuir isotherm profile and is greatly reduced by heating the gas in the flow tube.

We present 300 K rate constants for the ion-ion reactions of O + a n d N + with the atomic halide anions: C l - , B r - , a n d I - measured using a flowing afterglow – Langmuir probe apparatus. All six rate constants were > 1 × 10 - 8 c m 3 s - 1 , larger than those typical for atomic ion – atomic ion reactions, approaching the rate constants of more complex ion-ion systems. Evaluation of literature atomic ion – atomic ion rate constants shows variation over orders of magnitude, but limited to below the expected value for a polyatomic ion-ion reaction of the same reduced mass, fitting into an expected physical picture. Unlike for polyatomic systems, estimation of rate constant for atomic ion – atomic ion reaction rates by simple means does not seem effective.

Construction of tall-wood buildings is increasing in North America. Cross-laminated timber (CLT) is one of the dominant structural mass-timber products and is a high strength, lightweight, value-added, wood-composite panel suited for shear walls. The advent of tall-wood buildings necessitates further connection development for increased seismic resiliency to meet life-safety and performance-based design objectives. A novel slip-friction connection (SFC) was tested on six 1.52 m by 3.04 m CLT walls subject to static and pseudo-static cyclic loading. The SFC used Belleville springs and brass shims to provide stable slip forces and equivalent-viscous damping ratios between 0.28 and 0.63. Half of the wall tests included a short post-tensioned restoring rod with Belleville washers. Inclined self-tapping screws (STS) were used to connect the SFCs to the CLT walls, and the SFCs were designed to reliably dissipate energy while protecting the rocking walls from damage. The wall’s response followed the idealized parallelogram, or flag shaped, hysteretic models observed in other slip friction systems. Results indicate repeatable performance and structural protection at least 2.5 times STS design loads. Self-centering and partially-centering wall conditions were tested by changing the SFC slip forces, while maintaining an initial 23 kN restoring force. Based on these experiments designers will be able to apply SFCs to CLT rocking walls.

Study objective The perioperative surgical home (PSH) is a recent innovation in perioperative care delivery that coordinates the pre-, intra-, and post-operative elements of surgical care under one organizational umbrella. Although significant research supports the efficacy of individual elements of the PSH in improving outcomes, there is not a published systematic review of the efficacy of entire PSH programs in improving patient outcomes. This article summarizes descriptions of PSH programs available in the literature and examines outcomes of original studies of PSH implementation. Design We conducted a systematic literature review to identify relevant articles on PSH implementation and synthesize our findings. Setting The studies included in our review took place at multiple academic and community hospitals in the United States. Patients Patients involved in the PSH studies included surgical patients of various ages and ASA classifications in various surgical specialties. Interventions All studies included in our review involved the implementation of a PSH program. Measurements Outcomes examined include length of stay, postoperative recovery, readmission rates, and patient discharge destination, among others. Main results We identified 11 studies of PSH implementation that met our inclusion and exclusion criteria. Most PSH programs described in these studies included an emphasis on preoperative education, standardization of care protocols in all phases of surgery, use of opioid-sparing multimodal analgesia, and collaborative staffing models. PSH program implementation was often associated with decreased length of stay, decreased utilization of postoperative opioids, decreased utilization of the ICU, and increased probability of discharge to home. PSH implementation was not meaningfully associated with reductions in readmission rates. Findings for cost reductions following PSH implementation were mixed. Conclusions Early evidence indicates that through elements that emphasize care coordination, standardization, and patient-centeredness, PSH programs can improve patient postoperative recovery outcomes and decrease hospital utilization.

Background Asthma exacerbation risk increases with worsening asthma control. Prevailing numerical control tools evaluate only current symptom impairment despite the importance of also assessing risk based on exacerbation history. An easy-to-use questionnaire addressing impairment and risk domains of control is needed. Objective To validate a composite asthma control tool that includes impairment and risk assessments (Asthma Impairment and Risk Questionnaire [AIRQ]). Methods Four-hundred forty-two patients aged ≥12 years with physician-diagnosed asthma who were followed in specialty practices completed 15 impairment and risk questions with dichotomized yes/no responses. Patients spanned all Global Initiative for Asthma severities and were classified as well-controlled, not well-controlled, or very poorly controlled according to a standard of Asthma Control Test (ACT) score plus prior-year exacerbations. Logistic regression analyses identified questions with the greatest predictive validity to discriminate among patients and determine cut points for these 3 classifications. Results The final AIRQ comprises 10 equally weighted yes/no impairment and risk questions. The final 10-item models yielded receiver operating characteristic curves of 0.94 to identify well-controlled versus not well-/very poorly controlled and 0.93 to identify well-/not well-controlled versus very poorly controlled asthma, as reflected by the ACT plus prior-year exacerbations standard. Cut points of 0-1, 2-4, and 5-10 best represented well-, not well-, and very poorly controlled asthma. Conclusions AIRQ is a rigorously validated composite measure designed to identify adults and adolescents with varying degrees of asthma control. Ongoing investigations will determine test-retest reliability, responsiveness to change, and predictive ability for future exacerbations.

Millions of Americans rely on small-dollar, non-bank-supplied credit products: payday, pawn, vehicle title, and personal installment loans from finance companies. Many features of these vital products, however, are not well understood. This book contains explanations of how these loans work, what features they share, and how they differ. Readers seeking to understand these products might learn something surprising. For example, pawn transactions are not loans in the traditional sense; interest rate caps influence the size of installment loans; and the length of a payday loan affects its annualized interest rate. This objective guide is a must-read resource for legislators, regulators, journalists, and anyone else who cares about access to, and regulation of, small-dollar credit.

The hippocampus plays a critical role in sleep-related memory processes [1, 2, 3], but it is unclear which specific sleep features are dependent upon this brain structure. The examination of sleep physiology in patients with focal bilateral hippocampal damage and amnesia could supply important evidence regarding these links. However, there is a dearth of such studies, despite these patients providing compelling insights into awake cognition [4, 5]. Here, we sought to identify the contribution of the hippocampus to the sleep phenotype by characterizing sleep via comprehensive qualitative and quantitative analyses in memory-impaired patients with selective bilateral hippocampal damage and matched control participants using in-home polysomnography on 4 nights. We found that, compared to control participants, patients had significantly reduced slow-wave sleep—likely due to decreased density of slow waves—as well as slow-wave activity. In contrast, slow and fast spindles were indistinguishable from those of control participants. Moreover, patients expressed slow oscillations (SOs), and SO-fast spindle coupling was observed. However, on closer scrutiny, we noted that the timing of spindles within the SO cycle was delayed in the patients. The shift of patients’ spindles into the later phase of the up-state within the SO cycle may indicate a mismatch in timing across the SO-spindle-ripple events that are associated with memory consolidation [6, 7]. The substantial effect of selective bilateral hippocampal damage on large-scale oscillatory activity in the cortex suggests that, as with awake cognition, the hippocampus plays a significant role in sleep physiology, which may, in turn, be necessary for efficacious episodic memory.

Management strategy evaluation (MSE) is often used in fisheries science to evaluate the effects of different management options. MSE models typically include a stock assessment component to estimate population size and management reference points based on data generated using the model, but including a full assessment within an MSE can be computationally intensive. A commonly used alternative to the full assessment approach is to simulate the error about the stock assessment outcomes as a stochastic process with an assumed level of autocorrelated estimation error. There is little guidance on what might be a reasonable assumed amount of autocorrelation, and what factors might influence this amount. We estimate the amount of temporal autocorrelation in errors of estimated biomass and recruitment from statistical catch at age stock assessment models over a series of scenarios spanning life histories, exploitation levels, recruitment variability, and data quality. Autocorrelation in the error in biomass estimates ( ϕ S ) was positive and relatively high, with median estimates ranging between 0.7 and 0.9. Estimates were highest for the long-lived life history and lowest for the short-lived life history. Exploitation level also affected the amount of autocorrelation, with higher values for lightly exploited populations. On average, however, estimates of ϕ S did not change over time as more data were included in the assessment, and were independent of whether or not a harvest policy was applied. Recruitment variability and data quality had relatively minor effects on autocorrelation of errors.

The primary fish gill cell culture system (FIGCS) is an in vitro technique which has the potential to replace animals in whole effluent toxicity tests. In the current study FIGCS were transported into the field and exposed to filtered (0.2μm) river water for 24h from 4 sites, on 2 different sampling dates. Sites 1 and 2 are situated in an urban catchment (River Wandle, London, UK) with site 1 downstream of a sewage treatment work; site 3 is located in a suburban park (River Cray, Kent, UK), and site 4 is more rural (River Darent, Kent, UK). The change in transepithelial electrical resistance (TER), the expression of the metal responsive genes metallothionein A (mta) and B (mtb), cytochrome P450 1A1 (cyp1a1) and 3A27 (cyp3a27), involved in phase 1 metabolism, were assessed following exposure to sample water for 24h. TER was comparable between FIGCS exposed to 0.2μm filtered river water and those exposed to synthetic moderately soft water for 24h. During the first sampling time, there was an increase in mta, cyp1a1 and cyp3a27 gene expression in epithelium exposed to water from sites 1 and 2, and during the second sampling period an increase in cyp3a27 gene expression at sites 1 and 4. Urban river water is a complex mixture of contaminants (e.g., metals, pesticides, pharmaceuticals and polyaromatic hydrocarbons) and the increase in the expression of genes encoding mta, cyp1a1 and cyp3a27 in FIGCS is indicative of the presence of biologically active pollutants.

Modulating tissue responses to stress is an important therapeutic objective. Oxidative and genotoxic stresses caused by ionizing radiation are detrimental to healthy tissues but beneficial for treatment of cancer. CD47 is a signaling receptor for thrombospondin-1 and an attractive therapeutic target because blocking CD47 signaling protects normal tissues while sensitizing tumors to ionizing radiation. Here we utilized a metabolomic approach to define molecular mechanisms underlying this radioprotective activity. CD47-deficient cells and cd47-null mice exhibited global advantages in preserving metabolite levels after irradiation. Metabolic pathways required for controlling oxidative stress and mediating DNA repair were enhanced. Some cellular energetics pathways differed basally in CD47-deficient cells, and the global declines in the glycolytic and tricarboxylic acid cycle metabolites characteristic of normal cell and tissue responses to irradiation were prevented in the absence of CD47. Thus, CD47 mediates signaling from the extracellular matrix that coordinately regulates basal metabolism and cytoprotective responses to radiation injury.

a b s t r a c t Bottom-up control within ecosystems is characterized, in part, by predator populations exhibiting growth and recruitment changes in response to variability in prey density or production. Annual prey availability can vary more than 10-fold in marine ecosystems, with prey experiencing a dramatic increase or pulse in production within some years. To assess the bottom-up effects of such pulses on predator growth, produc- tion, and fisheries management, we developed an age-specific, predator-prey simulation model (param- eterized for summer flounder, Paralichthys dentatus) based on simple hypothesized mechanisms for consumption, growth, and population dynamics. Pulses in each of the three modeled prey groups (small crustaceans, forage fish, larger fish prey) generated different magnitudes of change in predator weight-at- age (w), spawning stock biomass (S), fishery yield (Y), and recruitment (R), due to ontogenetic differences in growth potential and dietary composition across predator age classes. Increases in productivity of small forage fishes generated the greatest gains in predator w, S, Y, and R, relative to pulses of the other prey groups. Median increases in R following a prey pulse were minimal (

The triazolyl amide γ-secretase modulators are potent alternatives to the cinnamyl amides that have entered the clinic for the treatment of Alzheimer's disease. Herein we build on the lead benzoazepinones described in our prior communication with imidazomethoxyarene moiety alternatives that offer opportunities to fine tune physical properties as well as address hERG binding and PK. Both half-life and bioavailability were significantly improved, especially in dog, with robust brain Aβ42 lowering maintained in both transgenic mouse and rat.

The Rashba effect plays an important role in various spin-related phenomena in two-dimensional electronic systems. In this work we present a theoretical analysis of the Rashba effect both analytically and numerically for the prototypical Rashba system Bi/Ag surface alloy, which shows a giant Rashba spin splitting. The results reveal the critical influence of atomic spin-orbit coupling and structural inversion asymmetry. In addition, we demonstrate a theoretical route to interpret the prominent circular dichroic patterns observed by angle-resolved photoemission spectroscopy in this system. The results reveal a close connection between the experimentally observed dichroic patterns and the Rashba spin texture.

In this paper, we examine the impact of adopting macroprudential policies on bank risk taking and systemic risk. Using a difference-in-differences (DiD) design and a sample of 3,342 banks from 77 countries over the period 1997-2016, we find that macroprudential policy instruments mitigate bank risk taking and lower systemic risk. The mitigation depends on the policy target. We find borrower-targeted policies are effective, while policies targeting financial institutions’ assets or liabilities are not effective. We find the impact of borrower-targeted macroprudential policies on systemic risk is stronger in countries with more closed economies and those with tighter restrictions on bank activities. We find some evidence of a reduction in the effectiveness of policies adopted after the global financial crisis (GFC). Our results are robust to a battery of tests.

Before development of a new field steam applicator, this study was done to determine whether the application of steam from a source that is mixed with the soil is more efficient than application from a source that does not mix the soil, to aid in the machines' design. A cement mixer, either in motion or still, was used to contain soil or sand as it was treated with steam, and the heat profile of the soil or sand after the steam application was measured. The results indicated that the soil and sand were heated more thoroughly and rapidly from surface to deeper layers when steam was mixed compared to steam applied to the surface of still soil or sand.

The meniscus-based microcapillary electrochemical method (MCEM) allows electrochemical measurements to be made quickly and easily at a wide range of materials, simply by connecting up the sample of interest as a working electrode and bringing a capillary containing an electrolyte solution and quasi-reference/counter electrode into meniscus contact. In this work, microcapillary-based electrochemical methodology is advanced by introducing a very high aspect ratio carbon fibre ultramicroelectrode (CF-UME) allowing generation/collection and shielding (redox competition) measurements to be made. The experimental concept is demonstrated with the outer sphere (ferrocenylmethyl) trimethylammonium ion (FcTMA+/2+) redox mediator on a single walled carbon nanotube (SWNT) network. It is then used to investigate electrochemical reactions on a complex electrode, i.e. a SWNT forest, which is not easily investigated using traditional techniques that would require the electrode material to be physically encapsulated. The technique is most powerful when used to probe the different mechanistic pathways of the oxygen reduction reaction (ORR). This aspect is illustrated through studies on platinum, glassy carbon and SWNT forest electrodes. By platinising the CF-UME, the electrode can be used as a local sensor for the intermediate H2O2 and the O2 reactant, and it is possible to track the evolving consumption of these species near the working electrode during voltammetric measurements.

Thermal electron attachment to CH 3 Br has been studied over the temperature range 303–1100 K using two flowing-afterglow Langmuir-probe apparatuses. The reaction yielded only Br − product over this temperature range. The rate coefficient for electron attachment to CH 3 Br was measured to be 8 ± 4 × 10 −12 cm 3 s −1 at 303 K, and was observed to increase strongly with gas temperature. Rate coefficients for the reaction show Arrhenius behavior over the entire temperature range with an activation energy of 260 ± 20 meV. The results are in substantial agreement with earlier data covering a smaller temperature range. Kinetic modeling implies that this behavior and the small rate coefficient at room temperature are due to a barrier in the crossing from the neutral to the anionic potential surfaces of ∼280 meV that dominates other factors in the attachment reaction. There is a hint of the Arrhenius plot reaching saturation at the highest temperatures. While examining an electron-cation recombination correction, the rate coefficient (1.8 ± 0.4 × 10 −9 cm 3 s −1 ) of the reaction Ar + + CH 3 Br was measured at 302 K, and the ion products identified (80% CH 3 + and 20% CH 2 Br + ). A secondary reaction forming the adduct (CH 3 Br)CH 3 + was seen to occur with a rate coefficient of 2.8 ± 1.0 × 10 −9 cm 3 s −1 .

The Chukchi Sea shelf off the northern coast of Alaska is rich with infauna and epibenthic macroinvertebrates used by foraging Pacific walrus (Odobenus rosmarus divergens) and other benthic-feeding consumers. Recent seasonal sea-ice retreat on the Chukchi Sea shelf has resulted in walrus hauling out in late summer on beaches of the Chukchi Sea in Russia and Alaska rather than on sea ice. Additional energetic costs may be imposed upon walruses traveling from these haul-outs to more productive foraging areas. Here, we provide an energetic assessment of prey items that could be relevant to the foraging energetics of walruses in haul-out locations. Caloric values for 171 potential walrus prey items (comprising 11 classes of benthic fauna) were obtained over 15 southeastern Chukchi Sea stations in 2010. There were statistically significant relationships between caloric content and increasing latitude (R=0.661) and bottom temperature (R=−0.560). Linear modeling indicated that taxon and latitude were the most important explanatory variables for caloric content in the study area, whereas a second model with taxon dependencies removed returned significant coefficients for the explanatory variables of latitude, depth, bottom water temperature, and sediment total organic carbon and nitrogen. K-means cluster analysis identified 6 clusters based mainly upon environmental variables such as bottom temperature, bottom salinity, and other water-column and sediment parameters that explained 86% of the variation in the data. The finding that caloric content varies strongly with latitude, which is a proxy for both water-mass type and associated water-mass productivity in the study area, may have implications for Pacific walrus, whose historical foraging patterns well offshore on sea ice have been disrupted by sea-ice decline.

OBJECTIVE: To evaluate the association between neonatal neurobehavioral state and oral feeding outcomes following congenital heart disease (CHD) surgery. STUDY DESIGN: This single center retrospective cohort study described neonates undergoing cardiac surgery evaluated peri-operatively with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). We compared NNNS attention scores, which evaluates neonates’ ability to orient and fixate on stimuli, with the feeding outcomes percentage of feeds taken orally at discharge and time to reach full oral feeds using regression analyses. Models were constructed for both pre-operative and post-operative NNNS evaluations. RESULTS: Between August 2015 and October 2017, 124 neonates underwent 89 pre-operative and 97 post-operative NNNS evaluations. In multivariable Cox regression, higher pre-operative NNNS attention scores were associated with a shorter time to achieve full oral feeds (hazard ratio 1.4; 95% confidence interval: 1.0–2.0; P = .047). This relationship was not seen for post-operative NNNS attention scores or percentage of oral feeds at discharge. Depending on the model, younger age at surgery, increased ventilator days, increased length of stay, and single or two ventricle anatomy with aortic arch obstruction were associated with lower percentage of oral feeds at discharge and/or delay in full oral feeds. CONCLUSIONS: Higher neonatal attention before cardiac surgery is associated with improved feeding outcomes. Prospective assessment of neonatal neurobehavioral state may be a novel approach to predict and target interventions to improve feeding outcomes in CHD. Future studies should examine the impact of intrinsic neurodevelopmental delay versus environmental adaptation on the neurobehavioral state of neonates with CHD.

Background The Affordable Care Act’s Readmission Reduction Program (RRP) and ongoing transparency efforts to promote consumer-driven competition place significant institutional focus on improving 30-day readmission rates. It remains unclear whether the reduction in readmission rates subsequent to the RRP occurred due to improved quality and/or partly due to increased use of observation status in conditions that may have been classified as readmissions prior to the RRP. We hypothesize that a significant percentage of our institution’s 30-day readmissions after elective total knee and hip arthroplasty (TKA/THA) overestimate the needs, duration, and complexity of the hospital-based intervention and inaccurately reflect the quality of service provided. Methods We performed a retrospective review of prospectively collected quality control data for 30-day returns to hospital after elective TKA/THA at our institution over a 2-year period. After stratification of the readmissions to under 48-hour and over 48-hour length of stay, we calculated the financial implications to our institution if the under 48-hour length of stay admissions were reclassified as an observation by applying discharge-weighted and payment-weighted analyses to the 2017 RRP report. We then calculated the out-of-pocket expenses for the under 48-hour Medicare subpopulation. Results We found that 16.7% of the 30-day readmissions after elective TKA/THA required a length of stay under 48 hours. If the short length of stay TKA/THA readmissions were reclassified as observations, our institution’s 2018 RRP penalty would have been reduced to 39% or $334,512.28. However, this reclassification would result in an increase in out-of-pocket expenses by $540.25 (range $291.56-$1105.08) per patient. Conclusion A subpopulation of 30-day readmissions does not require a level of care consistent with inpatient admission services. Classification of this short length of stay subpopulation as an observation vs an admission per Centers for Medicare and Medicaid Services guidelines would have removed our institution from the TKA/THA-specific RRP penalty. However, this would result in the unintended consequence of shifting costs, particularly self-administered drug costs, to patients.