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Alcohol intoxication is a prevalent feature of university life and campus sexual assault cases. While previous research has examined how students perceive obvious cases of assault, less is known about how students evaluate more ambiguous sexual scenarios—such as those including two intoxicated individuals. In three survey experiments with college students (N = 990), we examined how manipulating the intoxication (sober vs. drunk) of a man accused of assault (the respondent) influenced perceptions of a hook-up scenario involving an intoxicated woman. Although university policies indicate that respondent intoxication should not influence evaluations of these scenarios, we hypothesized that students would be influenced by cues of respondent intoxication when making judgments of the hook-up and the individuals involved. Students reported that the hook-up was a sexual assault more often when the respondent was sober compared to when he was drunk, and they found sober respondents more responsible for the encounter than drunk respondents. Although effect sizes fluctuated across studies, an internal meta-analysis found evidence of significant (but modest) aggregate effects. Furthermore, perceptions of the respondent’s agency mediated the effects of intoxication on perceptions of respondent responsibility (Studies 2 & 3). We also manipulated whether the respondent should have reasonably known the complainant was drunk (Studies 1 & 2) and whether the complainant or the complainant’s friend reported the incident (Study 3), but these manipulations had little effect on students’ perceptions of the vignettes. We discuss how our findings can guide future research and consider implications of our results for university stakeholders.

We explore the utility of social media platforms as educational tools in dermatology, providing a summary of how these sites are used by the public and dermatologists alike, and demonstrating ways these findings may be applied for educational purposes.Over half of the world's population utilizes social media platforms. More recently, these platforms have increasingly been used for educational purposes. In the field of dermatology, a large portion of the educational content is coming from users with no formal medical or dermatologic training.Each of the top five social media platforms in the world (Twitter, Instagram, TikTok, YouTube, and Facebook) has unique qualities which people may utilize to educate fellow users. As more of the population seeks online health information and education, it is important that dermatologists, while taking ethical considerations into account, become more comfortable facilitating educational content on social media.

Tropical cyclones (TCs) pose a significant threat to human health, and research is needed to identify high-risk subpopulations. We investigated whether hospitalization risks from TCs in Florida (FL), United States, varied across individuals and communities. We modeled the associations between all storms in FL from 1999 to 2016 and over 3.5 million Medicare hospitalizations for respiratory (RD) and cardiovascular disease (CVD). We estimated the relative risk (RR), comparing hospitalizations during TC-periods (2 days before to 7 days after) to matched non-TC-periods. We then separately modeled the associations in relation to individual and community characteristics. TCs were associated with elevated risk of RD hospitalizations (RR: 4.37, 95% CI: 3.08, 6.19), but not CVD (RR: 1.04, 95% CI: 0.87, 1.24). There was limited evidence of modification by individual characteristics (age, sex, or Medicaid eligibility); however, risks were elevated in communities with higher poverty or lower homeownership (for CVD hospitalizations) and in denser or more urban communities (for RD hospitalizations). More research is needed to understand the potential mechanisms and causal pathways that might account for the observed differences in the association between tropical cyclones and hospitalizations across communities.

Accumulation of fat in the liver and skeletal muscle is associated with obesity and poor health outcomes. Liver steatosis is a characteristic of non-alcoholic fatty liver disease (NAFLD) and myosteatosis, of poor muscle quality in sarcopenia. In this study of 403 men (33–96 years), we investigated associations between the fatty liver index (FLI) and muscle density, as markers of fat accumulation in these organs. We also investigated associations between the FLI and parameters of sarcopenia, including DXA-derived appendicular lean mass (ALM) and handgrip strength by dynamometry. Muscle density was measured using pQCT at the radius and tibia. FLI was calculated from BMI, waist circumference, and levels of triglycerides and gamma-glutamyltransferase. There was a pattern of decreasing muscle density across increasing quartiles of FLI. After adjusting for age and lifestyle, mean radial muscle density in Q4 was 2.1% lower than Q1 (p p = 0.022 and

Socioeconomic status (SES) affects a range of health outcomes but has not been extensively explored in the single ventricle population. We investigate the impact of community-level deprivation on morbidity and mortality for infants with single ventricle heart disease in the first year of life. Retrospective cohort analysis of infants enrolled in the National Pediatric Cardiology Improvement Collaborative who underwent staged single ventricle palliation examining mortality and length of stay (LOS) using a community-level deprivation index (DI). 974 patients met inclusion criteria. Overall mortality was 20.5%, with 15.7% of deaths occurring between the first and second palliations. After adjusting for clinical risk factors, the DI was associated with death (log relative hazard $${\chi }_{3}^{2}$$ = 8.92, p = 0.030) and death or transplant (log relative hazard $${\chi }_{3}^{2}$$ = 8.62, p = 0.035) in a non-linear fashion, impacting those near the mean DI. Deprivation was associated with LOS following the first surgical palliation (S1P) (p = 0.031) and overall hospitalization during the first year of life (p = 0.018). For every 0.1 increase in the DI, LOS following S1P increased by 3.35 days (95% confidence interval 0.31–6.38) and total hospitalized days by 5.08 days (95% CI 0.88–9.27). Community deprivation is associated with mortality and LOS for patients with single ventricle congenital heart disease. While patients near the mean DI had a higher hazard of one year mortality compared to those at the extremes of the DI, LOS and DI were linearly associated, demonstrating the complex nature of SES factors.

Objective During the COVID-19 pandemic, limitations on in-person medical school clerkships created a deficit in urologic learning opportunities. We sought to develop and evaluate a blended curriculum of interactive online modules with small-group discussion to enhance the educational experience for medical students in urology. Materials and Methods We created a curriculum of four online case-based urology modules. Between July and October 2020, 14 fourth-year medical students completed the modules. Students answered questions on a discussion board and engaged in asynchronous dialogue with 16 physicians, in addition to a weekly live review session. Students and physicians completed anonymous surveys to assess satisfaction and perceived learning outcomes, with questions scored on a 5-point Likert scale. Results Thirteen students (93% response rate) and 12 physicians (75% response rate) completed the survey. Overall, 12/13 students and 11/12 physicians “strongly agree” or “somewhat agree” that the modules improved the rotation. Students and physicians perceived that the modules were effective for learning/teaching foundational knowledge (average ratings 4.8 and 4.5, respectively) and facilitating performance assessment (4.4 and 4.0). Students reported high learning scores across multiple Accreditation Council for Graduate Medical Education core competencies, and 12/13 students found the modules fun/engaging. The majority of students (12/13) and physicians (10/12) felt that the online modules should be incorporated into future urology electives. Conclusions A blended learning curriculum utilizing online modules is an effective tool for enhancing urologic education, improving perceived learning outcomes and facilitating performance assessment. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-021-01427-3.

Prior work by Michael R. Dougherty and colleagues (Yu et al., 2014) shows that when a scientist monitors the p value during data collection and uses a critical p as the signal to stop collecting data, the resulting p is distorted due to Type I error-rate inflation. They argued similarly that the use of a critical Bayes factor (BF(crit)) for stopping distorts the obtained Bayes factor (BF), a position that has met with controversy. The present paper clarified that when BF(crit) is used as a stopping criterion, the sample becomes biased in that data consistent with large effects have a greater chance to be included than do other data, thus biasing the input to Bayesian inference. We report simulations of yoked pairs of scientists in which Scientist A uses BF(crit) to optionally stop, while Scientist B, sampling from the same population, stops when A stops. Thus, optional stopping is compared not to a hypothetical in which no stopping occurs, but to a situation in which B stops for reasons unrelated to the characteristics of B's sample. The results indicated that optional stopping biased the input for Bayesian inference. We also simulated the use of effect-size stabilization as a stopping criterion and found no bias in that case.

The present research explored the influence of isochronous auditory rhythms on the timing of movement-related prediction in two experiments. In both experiments, participants observed a moving disc that was visible for a predetermined period before disappearing behind a small, medium, or large occluded area for the remainder of its movement. In Experiment 1, the disc was visible for 1 s. During this period, participants were exposed to either a fast or slow auditory rhythm, or they heard nothing. They were instructed to press a key to indicate when they believed the moving disc had reached a specified location on the other side of the occluded area. The procedure measured the (signed) error in participants’ estimate of the time it would take for a moving object to contact a stationary one. The principal results of Experiment 1 were main effects of the rate of the auditory rhythm and of the size of the occlusion on participants’ judgments. In Experiment 2, the period of visibility was varied with size of the occlusion area to keep the total movement time constant for all three levels of occlusion. The results replicated the main effect of rhythm found in Experiment 1 and showed a small, significant interaction, but indicated no main effect of occlusion size. Overall, the results indicate that exposure to fast isochronous auditory rhythms during an interval of inferred motion can influence the imagined rate of such motion and suggest a possible role of an internal rhythmicity in the maintenance of temporally accurate dynamic mental representations.

The basal forebrain (BF) is involved in arousal, attention, and reward processing but the role of individual BF neuronal subtypes is still being uncovered. Glutamatergic neurons are the least well-understood of the three main BF neurotransmitter phenotypes. Here we analyzed the distribution, size, calcium-binding protein content and projections of the major group of BF glutamatergic neurons expressing the vesicular glutamate transporter subtype 2 (vGluT2) and tested the functional effect of activating them. Mice expressing Cre recombinase under the control of the vGluT2 promoter were crossed with a reporter strain expressing the red fluorescent protein, tdTomato, to generate vGluT2-cre-tdTomato mice. Immunohistochemical staining for choline acetyltransferase and a cross with mice expressing green fluorescent protein selectively in GABAergic neurons confirmed that cholinergic, GABAergic and vGluT2+ neurons represent distinct BF subpopulations. Subsets of BF vGluT2+ neurons expressed the calcium-binding proteins calbindin or calretinin, suggesting that multiple subtypes of BF vGluT2+ neurons exist. Anterograde tracing using adeno-associated viral vectors expressing channelrhodopsin2-enhanced yellow fluorescent fusion proteins revealed major projections of BF vGluT2+ neurons to neighboring BF cholinergic and parvalbumin neurons, as well as to extra-BF areas involved in the control of arousal or aversive/rewarding behavior such as the lateral habenula and ventral tegmental area. Optogenetic activation of BF vGluT2+ neurons elicited a striking avoidance of the area where stimulation was given, whereas stimulation of BF parvalbumin or cholinergic neurons did not. Together with previous optogenetic findings suggesting an arousal-promoting role, our findings suggest that BF vGluT2 neurons play a dual role in promoting wakefulness and avoidance behavior.

We present analyses from focus group interviews with a geographically diverse set of experienced, urban teachers who point to systemic inequity as a major contributing factor to the problems they face in their schools and communities. To begin, we overview the literature relating to our development of this project, after which we outline the theoretical underpinnings of our analyses. Next, we outline our methods, process of analysis, and analytical approach. We then discuss our findings, highlighting how the teachers described the systemic nature of inequality, and the policy solutions they identified as potential avenues by which to address these inequalities.

Interstage mortality (IM) remains high for patients with single-ventricle congenital heart disease (SVCHD) in the period between Stage 1 Palliation (S1P) and Glenn operation. We sought to characterize IM. This was a descriptive analysis of 2184 patients with SVCHD discharged home after S1P from 60 National Pediatric Cardiology Quality Improvement Collaborative sites between 2008 and 2015. Patients underwent S1P with right ventricle-pulmonary artery conduit (RVPAC), modified Blalock–Taussig–Thomas shunt (BTT), or Hybrid; transplants were excluded. IM occurred in 153 (7%) patients (median gestational age 38 weeks, 54% male, 77% white), at 88 (IQR 60,136) days of life, and 39 (IQR 17,84) days after hospital discharge; 13 (8.6%) occurred ≤ 30 days after S1P. The mortality rate for RVPAC was lower (5.2%; 59/1138) than BTT (9.1%; 65/712) and Hybrid (20.1%; 27/134). More than half of deaths occurred at home (20%) or in the emergency department (33%). The remainder occurred while inpatient at center of S1P (cardiac intensive care unit 36%, inpatient ward 5%) or at a different center (5%). Fussiness and breathing problems were most often cited as harbingers of death; distance to surgical center was the biggest barrier cited to seeking care. Cause of death was unknown in 44% of cases overall; in the subset of patients who underwent post-mortem autopsy, the cause of death remained unknown in 30% of patients, with the most common diagnosis being low cardiac output. Most IM occurred in the outpatient setting, with non-specific preceding symptoms and unknown cause of death. These data indicate the need for research to identify occult causes of death, including arrhythmia.

Overweight/obesity, prevalent cardiovascular risk factors in children, can be associated with increased risk of adverse outcomes in children with heart disease. The American College of Cardiology (ACC) developed quality metrics including a BMI metric related to identifying and counseling overweight and obese children presenting to cardiology clinics. This metric was used for a multicenter collaborative learning Quality improvement (QI) Project through the ACC Quality Network (QNet). Our aim was to increase the percentage of children between ages 3 and 18 years presenting to cardiology clinics at participating centers with BMI > 85th percentile who received appropriate counseling. Participating centers submitted data quarterly to QNet for a sample of patients who received counseling. A Key Driver Diagram was created to help teams drive improvement. Individual centers customized interventions and participated in network-wide educational learning sessions about QI and shared experience. Statistical process control charts were used. From 04/01/2017 to 09/30/2019, 27,511 patient visits were included. Among 32 participating centers, overall counseling rate was 54%. The BMI counseling rate increased from 25% in 2017Q2 to 54% in 2019Q3. There was a wide variation from 10 to 100% in the performance of individual centers. The overall rate of identification and counseling of overweight and obese children presenting to ambulatory cardiology clinics in participating centers is low. There is wide variation in the performance of centers, providing an opportunity for improvement. Using this multicenter learning approach, individual centers have demonstrated improvement. This demonstrates that collaborative learning approaches in QI can increase implementation of the metric.

Pacemakers are a mainstay of therapy for patients with congenital and acquired heart block, but ventricular pacing is related to ventricular dysfunction. We sought to evaluate patient and device characteristics associated with ventricular dysfunction in pediatric patients with chronic ventricular pacing. This was a retrospective cohort of pediatric patients with heart block and chronic ventricular pacing. Patient, ECG, and device characteristics were analyzed to determine factors associated with ventricular dysfunction. Longitudinal ECG and echocardiogram parameters were obtained to track changes in QRS and systemic ventricular systolic function over time. In total, 82 patients were included (median age at implant 0.81 years). Over a follow-up time of 6.1 years, 18% developed ventricular dysfunction. Patients with dysfunction had greater current QRS duration (p = 0.002) compared to those with preserved function with a similar time from device implantation. There was no difference between lead location or age at device implantation. QRS duration increased with time from implant and the resultant ΔQRS was associated with ventricular dysfunction (p = 0.01). QRS duration >162 ms was associated with a 5.8 (2–9)-fold increased risk for dysfunction. Transvenous leads were associated with longer QRS duration with no difference compared to epicardial leads in development of ventricular dysfunction. This study demonstrated that the absolute paced QRS duration and Δpaced QRS were association with long-term ventricular dysfunction independent of how long a given patient was paced. Patients in high-risk categories may benefit from close echocardiographic monitoring. Whether permissive junctional rhythm or His bundle/biventricular pacing decreases the rate of dysfunction needs further study.

Although the imposter phenomenon (IP), characterized by fear of exposure as a fraud, is prevalent in higher education, studies disagree about its dimensionality, its relation to individual characteristics, and how IP relates to self-evaluation. Analyzing data from 959 graduate students and professionals in science, technology, engineering, mathematics (STEM), and medicine, we examined the psychometric properties of the Clance IP scale and evaluated IP’s conceptual clarity in relation to demographics and self-evaluation. Factor analyses yielded three factors: Self-Doubt, Fear of Evaluation, and Luck. Older age groups, people currently not in-training, and men had lower sub-scale IP scores. We created four IP groups using factor scores and found that “Fear IP” (low self-doubt/high fear) and “High IP” (high self-doubt/high fear) groups reported less positive self-evaluations than “Self-Doubt” IP (high self-doubt/low fear) and “Low IP” (low self-doubt/low fear) groups. Findings suggest different types of IP that includes more strategic self-presentations of ability, and the defining feature of IP may be fear rather than self-doubt, with implications on training in higher education.

We aimed to investigate cross-sectional associations between skeletal muscle density, a proxy measure for fatty infiltration into muscle, and cognition. Contributions from body fat mass, systemic inflammation and lifestyle were explored, as these factors have been identified in both muscle and cognitive deterioration. For 281 men (60–95 year) from the Geelong Osteoporosis Study, radial and tibial muscle density were measured using peripheral quantitative computed tomography. Body fat and appendicular lean mass were measured using dual-energy X-ray absorptiometry. Cognitive function was assessed for psychomotor function (DET), visual identification/attention (IDN), visual learning (OCL) and working memory (OBK) (CogState Brief Battery). Composite scores signified overall cognitive function (OCF). Higher scores represent poorer performance except for OCL and OCF. Regression analyses examined associations between muscle density and cognition; potential confounders included age, muscle cross-sectional area (CSA), body composition, lifestyle and serum markers of inflammation. Negative associations with age were evident for muscle density, all cognitive domains and OCF. Muscle density at both sites was positively associated with DET, OCL and OCF. After adjustment for age, the association persisted for DET (radius: B = − 0.006, p = 0.02; tibia: B = − 0.003, p = 0.04) and OCL (radius B = + 0.004, p = 0.02; tibia: B = + 0.005, p

This paper presents an adaptive control law for unknown nonlinear switched plants that must follow the trajectory of user-defined linear switched reference models. The effectiveness of the proposed control architecture is proven in two alternative frameworks, that is, analyzing Caratheodory and Filippov solutions of discontinuous differential equations. Numerical and experimental data verify the applicability of the theoretical results to problems of practical interest. The proposed numerical simulation involves the design of a model reference adaptive control law to regulate the roll dynamics of a reconfigurable delta-wing aircraft. The proposed flight tests involve an aerial robot tasked with autonomously mounting a camera of unknown inertial properties to a vertical surface.

Pediatric chest pain is common and though usually benign often leads to unnecessary diagnostic testing. There is limited evidence as to whether a local consensus guideline can decrease testing frequency without negatively affecting the overall yield. In addition, it is unknown whether the addition of pulmonary function testing to a cardiopulmonary exercise test increases the diagnostic yield in pediatric patients with chest pain. A retrospective chart review was performed on all new pediatric patients who presented with chest pain at our academic center’s pediatric cardiology clinic 18 months before and after the implementation of a standard management guideline. Data from the encounter-associated echocardiogram, cardiopulmonary exercise test, and pulmonary function test, when available, were analyzed. There were no significant differences in patient volume or demographic characteristics in the 18 months before (n = 768) and after (n = 778) guideline implementation. There were significant reductions in the number of ordered echocardiograms (n = 131; 17% vs. n = 75; 9.6%, p

Agricultural practices constitute both the greatest cause of biodiversity loss and the greatest opportunity for conservation1,2, given the shrinking scope of protected areas in many regions. Recent studies have documented the high levels of biodiversity-across many taxa and biomes-that agricultural landscapes can support over the short term1,3,4. However, little is known about the long-term effects of alternative agricultural practices on ecological communities4,5 Here we document changes in bird communities in intensive-agriculture, diversified-agriculture and natural-forest habitats in 4 regions of Costa Rica over a period of 18 years. Long-term directional shifts in bird communities were evident in intensive- and diversified-agricultural habitats, but were strongest in intensive-agricultural habitats, where the number of endemic and International Union for Conservation of Nature (IUCN) Red List species fell over time. All major guilds, including those involved in pest control, pollination and seed dispersal, were affected. Bird communities in intensive-agricultural habitats proved more susceptible to changes in climate, with hotter and drier periods associated with greater changes in community composition in these settings. These findings demonstrate that diversified agriculture can help to alleviate the long-term loss of biodiversity outside natural protected areas1.

Despite being remote, polar and sub-polar regions are increasingly threatened by global ecological change. For instance, South America’s sub-Antarctic forest ecoregion is considered one of the world’s last wilderness areas and a global reference site for pre-Industrial Revolution nutrient cycles. Nonetheless, the North American beaver (Castor canadensis) was introduced to Tierra del Fuego in 1946 and, as an invasive ecosystem engineer, has transformed the ecology of regional watersheds. Beavers’ engineering activities transform forested streams (FS) into beaver ponds (BP), where there is greater light and primary production (allochthonous organic matter) and, consequently, increased basal resource quality. To investigate this, we analyzed algal, diatom, fungal and bacterial fatty acid (FA) biomarkers in three basal resource categories (biofilm, very fine benthic organic matter, coarse benthic organic matter) and benthic consumers from four functional feeding groups (FFG). The amphipod Hyalella spp. was chosen as an indicator species due to its abundance and biomass in both habitats. Hyalella spp. had higher proportions of algal and bacterial FA in BP than FS. In FS, Hyalella spp. (gatherer) and Gigantodax spp. (filterer, Diptera) had greater contributions of higher quality FA (higher in polyunsaturated FA), while Rheochorema magallanicum (predator, Trichoptera) and Meridialaris spp. (scraper, Ephemeroptera) showed lower quality monounsaturated and saturated FA. All FFGs showed evidence of microbial FA and had higher levels of autochthonous FA biomarkers than their food resources. Scrapers had the greatest proportion of autochthonous FA. These data provide new insights into the utilization of basal resources by stream consumers in sub-Antarctic streams and how beavers modify these ecosystems. Fil: Anderson, Christopher Brian. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina. Universidad Nacional de Tierra del Fuego, Antártida e Islas del Atlántico Sur. Instituto de Ciencias Polares, Ambientales y Recursos Naturales; Argentina Fil: Tagliaferro, Marina Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina Fil: Fisk, Aaron. University of Guelph; Canadá Fil: Rosemond, Amy D.. University of Georgia; Estados Unidos Fil: Sanchez, Marisol. University of North Texas; Estados Unidos Fil: Arts, Michael T.. Ryerson University; Canadá

Peripheral quantitative computed tomography (pQCT) assesses bone quantity and quality, complementary to current standard practice, and has potential to improve prediction of fracture risk. This study explored whether pQCT parameters were associated with prior fracture in men and found a number of parameters to be associated, particularly at the radius. Peripheral quantitative computed tomography (pQCT) provides information about bone structure and density complementary to dual x-ray absorptiometry. This study aimed to determine which pQCT parameters are associated with prior fracture. Participants were men (n = 508, age 33–96 years) from the Geelong Osteoporosis Study. Parameters at 4% (n = 469) and 66% (n = 436) of radial length, and 4% (n = 449) and 66% (n = 437) of tibial length were acquired (pQCT XCT 2000, Stratec Medizintechnik, Pforzheim, Germany), and mean standardised. Low trauma prior fractures in adulthood (≥ age 20 years) were radiologically confirmed when possible. Cross-sectional associations between pQCT and fracture were tested using logistic regression adjusting for confounders. Prior low trauma fractures were identified for 106 participants. Fracture was negatively associated with parameters at the 4% radius site: bone mass (adjusted OR = 0.67; 95%CI = 0.52–0.86), total density (OR = 0.61; 95%CI = 0.47–0.78), trabecular density (OR = 0.62; 95%CI = 0.48–0.79) and cortical subdensity (OR = 0.61; 95%CI = 0.47–0.77). At the 66% radius site, fracture was associated with total density (OR = 0.69; 95%CI = 0.55–0.87) and cortical thickness (OR = 0.68; 95%CI = 0.54–0.86). Fracture was associated with the ratio of the cortical area at the 66% site to the total area at the 4% site (OR = 0.74; 95%CI = 0.58–0.94). Prior fracture was negatively associated with parameters at the 4% tibial site: total density (OR = 0.67; 95%CI = 0.52–0.86), trabecular density (OR = 0.64; 95%CI = 0.50–0.82) and cortical subdensity (OR = 0.72; 95%CI = 0.56–0.92). Fracture was negatively associated with cortical density at the 66% site (OR = 0.74; 95%CI = 0.58–0.94), and the ratio of the cortical area at the 66% site to the total area at the 4% site (OR = 0.65; 95%CI = 0.46–0.91), but were attenuated in adjusted models. No other associations were identified. Prior fracture was associated with parameters at both the radius and tibia. This study highlights key pQCT parameters that may aid in the prediction of fracture risk.

Angiotensin-converting enzyme inhibitor use in women was associated with lower femoral neck and lumbar spine bone mineral density as well as trabecular bone score compared to non-users. No differences were identified for men or for those who used ARB medications. Many individuals at high fracture risk use medications such as angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) that could affect bone; thus, this study aimed to investigate whether there are any differences in bone mineral density (BMD) and trabecular bone score (TBS) between ACEI users, ARB users, and non-users. Participants (685 men, 573 women) were from the Geelong Osteoporosis Study. Current medication use was self-reported. BMD at the femoral neck (FNBMD) and lumbar spine (LSBMD) were measured using DXA. TBS was calculated using TBS iNsight software. Linear regression models were used to investigate associations between ACEI or ARB use and bone measures, adjusting for other potential confounders. Due to interaction terms, data were stratified by age. There were 88 (12.8%) men and 41 (7.2%) women taking an ACEI medication, and 71 (10.4%) men and 76 (13.3%) women taking an ARB medication. Compared to non-users, ACEI use was associated with lower FNBMD (− 7.2%), LSBMD (− 12.2%), and TBS (− 9.0%) for women aged

This study reports that both FRAX and Garvan calculators underestimated fractures in Australian men and women, particularly in those with osteopenia or osteoporosis. Major osteoporotic fractures were poorly predicted, while both calculators performed acceptably well for hip fractures. This study assessed the ability of the FRAX (Australia) and Garvan calculators to predict fractures in Australian women and men. Women (n = 809) and men (n = 821) aged 50–90 years, enrolled in the Geelong Osteoporosis Study, were included. Fracture risk was estimated using FRAX and Garvan calculators with and without femoral neck bone mineral density (BMD) (FRAXBMD, FRAXnoBMD, GarvanBMD, GarvannoBMD). Incident major osteoporotic (MOF), fragility, and hip fractures over the following 10 years were verified radiologically. Differences between observed and predicted numbers of fractures were assessed using a chi-squared test. Diagnostics indexes were calculated. In women, 115 MOF, 184 fragility, and 42 hip fractures occurred. For men, there were 73, 109, and 17 fractures, respectively. FRAX underestimated MOFs, regardless of sex or inclusion of BMD. FRAX accurately predicted hip fractures, except in women with BMD (20 predicted, p = 0.004). Garvan underestimated fragility fractures except in men using BMD (88 predicted, p = 0.109). Garvan accurately predicted hip fractures except for women without BMD (12 predicted, p

The study of the genetic basis of sudden cardiac death has been impacted by advances in sequencing technology, gene variant interpretation, and additional evaluation into the ideal clinical approach to assessing cause of death and the medical and psychological risks of surviving family members. This short review aims to summarize recent publications as well as provide context for future directions for the care of families faced with sudden cardiac death. The molecular autopsy is a critical method in determining cause of death, particularly in autopsy-negative sudden cardiac death. Although the cost and availability of exome sequencing have improved in the past few years, its utility in the postmortem evaluation has not significantly improved yield. This is primarily due to the increase in genetic variants detected through this sequencing modality and the difficulty in interpreting these results. Medical examiners are essential in the proper identification and referral of surviving relatives to multidisciplinary clinics that include an expert cardiologist, cardiac genetic counselor, and clinical psychologist that can provide appropriate education, clinical evaluation, and psychological support. Future studies need to build on the improvement in variant interpretation and appropriate education and support of medical examiners. This will ensure family members are referred to appropriate providers such that they can receive medical and psychological care that will improve overall health outcomes and reduce the incidence of subsequent sudden cardiac death in the family.

Heterotic compactifications on Calabi-Yau threefolds frequently exhibit textures of vanishing Yukawa couplings in their low energy description. The vanishing of these couplings is often not enforced by any obvious symmetry and appears to be topological in nature. Recent results in the literature used differential geometric methods to explain the origin of some of this structure. A vanishing theorem was given which showed that the effect could be attributed, in part, to the embedding of the Calabi-Yau manifolds of interest inside higher dimensional ambient spaces, if the gauge bundles involved descended from vector bundles on those larger manifolds. In this paper, we utilize an algebro-geometric approach to provide an alternative derivation of some of these results, and are thus able to generalize them to a much wider arena than has been considered before. For example, we consider cases where the vector bundles of interest do not descend from bundles on the ambient space. In such a manner we are able to highlight the ubiquity with which textures of vanishing Yukawa couplings can be expected to arise in heterotic compactifications, with multiple different constraints arising from a plethora of different geometric features associated to the gauge bundle., Comment: 34 pages

Fresh snow and lichens (Cladonia rangiferina) were collected along two ~300-km transects in a regional survey around two smelter areas in Northern Ontario, i.e., the Sudbury and Timmins areas, in 2009–2010, as a part of a monitoring program. The samples were analyzed for Pb isotope ratios in snow from 47 sites, and in lichens from 28 sites, for background airborne lead and to determine the influence of distance versus local sources of Pb on a regional scale. Moreover, the lichen samples were split into two portions, the top portion, corresponding to recent growth (2–4 years), and the lower portion (up to 10+ years old) to determine the regime of recent versus old deposition. The study also investigated whether the isotopic signature in fresh snow (~1–2 weeks old) could correlate to the lichens’ recent growth. The Pb isotope signatures, reported as Pb isotope ratios 208Pb/206Pb and 207Pb/206Pb, in both snow and lichen recent growth were uniform over the region, except for localized influences near Sudbury and Timmins, suggesting that the background Pb represented remote sources for most of the region. Three-isotope plots 208Pb/206Pb versus 207Pb/206Pb of snow and lichens followed a linear model typical of mixing lines between two sources. As there are no statistical differences of Pb isotope ratios between fresh snow and recent lichen growth at neighboring stations, either type of sample may be used to describe the short-term record of airborne inputs. Finally, we found a strong relationship between the Pb isotope ratios of the recent growth (upper part) and old growth (lower part) of the lichens, with a slope of 0.9 between the lichen parts. This observation suggests either an isotopic segregation or the older parts of the lichens developed under different Pb source inputs in earlier times.

TBS is associated with age, weight, childhood physical activity, and BMD in men and age, height, BMD, and mobility in women. Trabecular bone score (TBS) indirectly assesses trabecular microarchitecture at the lumbar spine, providing complementary information to areal BMD. Many studies have investigated the relationships between BMD and lifestyle factors known to affect bone, but such research is limited for TBS. The aim of this study was to assess the relationship between TBS and lifestyle factors in Australian men and women. This cross-sectional study involved 894 men and 682 women (ages 24–98 years) enrolled in the Geelong Osteoporosis Study. TBS was assessed by analysis of lumbar spine DXA scans (Lunar Prodigy) using TBS iNsight software (Version 2.2). Bivariate and multivariable linear regression models were used to explore the associations between TBS and physical and lifestyle factors, including anthropometry, alcohol consumption, childhood physical activity, mobility, smoking status, prior low trauma fracture, medication use, and intakes of calcium and vitamin D. In bivariate regression modelling, low mobility and the use of antiresorptive medication were associated with lower TBS in both men and women. Low childhood physical activity was also associated with lower TBS in men. Prior fracture, use of glucocorticosteroids, and total calcium intake were also associated with lower TBS in women. The final adjusted model for men included age, weight, childhood physical activity, and BMD, and for women, age, height, BMD, and mobility. No interaction terms were identified in the models. Lower TBS is associated with older age, increased weight, low childhood physical activity, and lower BMD in men and older age, shorter stature, lower BMD, and low mobility in women.

BackgroundAmber has been reported from the Early Cretaceous Crato Formation, as isolated clasts or within plant tissues. Undescribed cones of uncertain gymnosperm affinity have also been recovered with amber preserved in situ. Here, we provide multiple lines of evidence to determine the botanical affinity of this enigmatic, conspicuous cone type, and to better understand the diversity of amber-source plants present in the Crato Formation and beyond.ResultsA new taxon of amber-bearing pollen coneAraripestrobus resinosusgen. nov. et sp. nov. is described here from complete cones and characteristic disarticulated portions. The best-preserved cone portion has both in situ amber infilling the resin canals inside the preserved microsporophyll tissues and pollen of theEucommiidites-type. This places this genus within the Erdtmanithecales, an incompletely known gymnosperm group from the Mesozoic.FTIR analysis of the in situ amber indicates a potential araucariacean conifer affinity, although affinity with cupressacean conifers cannot be definitely ruled out. Pyr-GC-MS analysis of theAraripestrobus resinosusgen. nov. et sp. nov. in situ fossil resin shows that it is a mature class Ib amber, thought to indicate affinities with araucariacean and cupressacean, but not pinaceous, conifers. This is the first confirmed occurrence of this class of amber in the Crato Formation flora and in South America, except for an archaeological sample from Laguna Guatavita, Colombia.ConclusionsThe combined results of the cones’ novel gross morphology and the analyses of the in situ amber and pollen clearly indicate that the new taxon of resinous gymnosperm pollen cones from the Crato Formation is affiliated with Erdtmanithecales. The cone morphology is very distinct from all known pollen cone types of this extinct plant group. We therefore assume that the plant group that producedEucommiidites-type pollen is much more diverse in habits than previously thought. Moreover, the diversity of potential amber source plants from the Crato Formation is now expanded beyond the Araucariaceae and the Cheirolepidiaceae to include this member of the Erdtmanithecales. Despite dispersedEucommiiditespollen being noted from the Crato Formation, this is the first time macrofossils of Erdtmanithecales have been recognized from the Early Cretaceous of South America.

In 2013, the Montana Department of Natural Resources and Conservation engaged twenty citizens with diverse water interests as the Yellowstone Basin Advisory Council (YBAC). The purpose of the YBAC was to provide basin-specific recommendations for an updated water plan. Our research group documented the degree to which the YBAC incorporated scientific and technical information into its deliberations and final recommendations. Based on empirical evidence, this study illuminated three dynamics that discouraged the group’s use of certain sets of scientific and technical information. However, we also found that the convening managers, technical experts, and YBAC members were operating as pragmatic participants who created deliberative spaces where tensions between conflicting goals and values did not need to be addressed head-on. We argue that because this pragmatism guided certain scientific issues to the sideline, it helped the group pre-empt conditions of intractability that would otherwise threaten the overall collaborative process. While the sidelining was important in terms of “getting things done,” it, nonetheless, marginalized some important scientific issues. To validate and advance our findings, we presented the YBAC case, the dynamics that sidelined science, and our corrective recommendations to water resources professionals. We then solicited their ideas for specific strategies they might employ to avoid sidelining essential scientific and technical information. As a research innovation, their inputs help close the loop between critical observations and practice.

Meeting the behavioral medicine research and clinical needs of an increasingly diverse United States population is an issue of national concern. We examine the trends in the demographic representation of the behavioral medicine scientific workforce through an analysis of the training grants funded by National Institutes of Health for the field of behavioral medicine from 1980 to 2018. We report the topics of these training grants, and we depict the demographic representation of the training leaders. We provide the demographic representation of the trainees, and of the first authors of publications reported within those training grants. Finally, we report the topics addressed in these behavioral medicine publications, to determine if topic diversity increased as the behavioral medicine scientific workforce diversified. Visualizations are presented that tell a story of how we have, and have not, advanced representation within the field of behavioral medicine. Best practices for launching future successful behavioral medicine scientists are then presented, to ensure optimal representation and diversification occurs in our workforce, our science, and our delivery of our clinical care.

Biofeedback following total knee arthroplasty (TKA) seems to be a feasible approach to improve rehabilitation, outcomes, mobility and reduce pain. This systematic review gives the practicing orthopedic surgeon a summary of what is available and how biofeedback affects clinical outcomes. We reviewed the current literature regarding methods, devices and effects of biofeedback in patients who underwent total knee arthroplasty. Embase, Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to May 2018 for the following keywords: Biofeedback OR Feedback AND Total Knee Arthroplasty OR TKA. Data were extracted according to a predefined setting (see Protocol for systematic review on PROSPEO). Devices used for biofeedback were recorded. Demographics, training methods and effects were also collected. The search resulted in 380 potentially eligible studies from which 11 met all inclusion criteria including 7 randomized controlled trials (RCTs), 3 cohort studies, and 1 cross-sectional study. A total of 416 patients with unilateral TKA were included, with an average of 37.8 patients per study. In patients with TKA, significant improvements in activity scores or pain were reported by 9 of 11 studies. Only two of the studies reported no significant influence of the feedback on the chosen outcome parameters. Devices for biofeedback varied between studies and included the use of a goniometer, force plate, balance board, treadmill, and/or electromyography (EMG). The most common type of feedback was visual followed by audio, with one study mentioning that the audio mode was preferred by the patients as it was easier to handle. Overall, 5 out of 6 different methods demonstrated a potential value for improving mobility and decreasing pain. This review suggests that biofeedback in early postoperative rehabilitation after TKA is effective in improving gait symmetry, reducing pain and increasing activity level. It should be noted that the great variety of devices used for feedback limits comparisons between studies. IIa.

Air pollution intake represents the amount of pollution inhaled into the body and may be calculated by multiplying an individual’s ventilation rate with the concentration of pollutant present in their breathing zone. Ventilation rate is difficult to measure directly, and methods for estimating ventilation rate (and intake) are lacking. Therefore, the goal of this work was to examine how well linear models using heart rate and other basic physiologic data can predict personal ventilation rate. We measured personal ventilation and heart rate among a panel of subjects (n = 36) while they conducted a series of specified routine tasks of varying exertion levels. From these data, 136 candidate models were identified using a series of variable transformation and selection algorithms. A second “free‑living” validation study (n = 26) served as an independent validation dataset for these candidate models. The top‑performing model, which included heart rate (Hr), resting heart rate (Hrest), age, sex, and hip circumference and interactions between sex with Hr, Hrest, age, and hip predicted ventilation rate (Ve) to within 11% and 33% for moderate (Ve = 45 L/min) and low (Ve = 15 L/min) intensity activities, respectively, based on the validation study. Many of the promising candidate models performed substantially worse under independent validation. Our results indicate that while measures of air pollution exposure and intake are highly correlated within tasks for a given individual, this correlation decreases substantially across tasks (i.e., as individuals go about a series of typical daily activities). This discordance between exposure and intake may influence exposure‑response estimates in epidemiological studies. New air pollution studies should consider the trade‑offs between the predictive ability of intake models and the error potentially introduced by not accounting for ventilation rate.

Item does not contain fulltext PURPOSE: To provide a summary of the Third International Consultation on Bladder Cancer recommendations for the management of non-muscle invasive bladder cancer (NMIBC). METHODS: A detailed review of the literature was performed focusing on original articles for the management of NMIBC. An international committee assessed and graded the articles based on the Oxford Centre for Evidence-based Medicine system. The entire spectrum of NMIBC was covered such as prognostic factors of recurrence and progression, risk stratification, staging, management of positive urine cytology with negative white light cystoscopy, indications of bladder and prostatic urethral biopsies, management of Ta low grade (LG) and high risk tumors (Ta high grade [HG], T1, carcinoma in situ [CIS]), impact of BCG strain and host on outcomes, management of complications of intravesical therapy, role of alternative therapies, indications for early cystectomy, surveillance strategies, and new treatments. The working group provides several recommendations on the management of NMIBC. RESULTS: Recommendations were summarized with regard to staging; management of primary and recurrent LG Ta and high risk disease, positive urine cytology with negative white light cystoscopy and prostatic urethral involvement; indications for timely cystectomy; and surveillance strategies. CONCLUSION: NMIBC remains a common and challenging malignancy to manage. Accurate staging, grading, and risk stratification are critical determinants of the management and outcomes of these patients. Current tools for risk stratification are limited but informative, and should be used in clinical practice when determining diagnosis, surveillance, and treatment of NMIBC.

Species functional behaviors amidst the food web, such as feeding ecology in ecosystems, are directly connected to their habitat preferences and use. In reef ecosystems, groupers and sea bass are considered key species, as top-down controllers, regulating the trophic levels on which they feed. Moreover, they are a diversified group of actinopterygian fishes, ranging from 7 to 250 cm of total length and inhabiting many types of reef habitats, from shallow waters up to 200 m deep. Due to the exceptional ecological and commercial importance of groupers and sea bass to the rocky reef systems of southwestern Atlantic and considering the small amount of information on their behavior and habitat use available for this particular region, three questions have emerged. First, how are the species spatially distributed considering the topography complexity of their environment? Second, do large Epinephelids and small Serranids have the same use of the water column, when foraging (e.g., position related to the substrate)? Third, do marine protected areas influence the distributional patterns of both families? To answer these questions, we assessed the spatial distribution and habitat use of two dominant species of groupers (Epinephelus marginatus, Mycteroperca acutirostris) and three species of sea bass (Diplectrum radiale and Serranus flaviventris and S. baldwini), using underwater visual census at Santa Catarina State, southern Brazil, during the austral summers of 2010 and 2011. All of the five sympatric species studied are directly associated with specific topographic characteristics that may be related to shelter as well as to reproduction and feeding. Except for M. acutirostris, which was mainly recorded foraging in the water column, all the remaining species are benthic dwellers. Significant evidences of effectiveness advocate that Arvoredo Marine Biological Reserve has critical importance as a refuge for heavily targeted reef species in southern Brazil, such as E. marginatus and M. acutirostris. The establishment of more protected marine areas that encompass the nursery areas near AR, along with proper enforcement, is critical to the protection of endangered and vulnerable marine species. The present work has contributed to the knowledge of habitat use and partitioning of some key reef fishes, especially target species, which is critical to effective conservation measures, including the design and management of MPAs.

The East Antarctic ice sheet was larger than present during past cold periods. Seafloor geophysical data show that in the Ross Sea, the extended ice sheet was underlain by an active hydrologic system during the glacial termination.

Evidence suggests that communication technology applications can improve treatment adherence.1 However, a recent Cochrane Review concluded insufficient evidence exists to determine the effects of automated communication on managing chronic conditions such as asthma.2 Because not all patients are receptive to communication technology interventions, defining factors associated with non-response to electronic outreach can inform tailoring future interventions to increase effectiveness. As part of a pragmatic trial targeting asthma patients with too frequent refills of inhaled beta-agonists (“overfill”),3 the objective of this work was to describe and compare patients who did versus did not respond to a communication technology outreach. A higher asthma medication ratio (AMR), defined as the ratio of asthma controller medications (numerator, e.g., inhaled corticosteroids) to total controller medications plus inhaled beta-agonists (denominator), is associated with better asthma outcomes.4 We hypothesized that patients who did not respond to outreach would have a lower AMR than patients who did respond.

In this work we consider quotients of elliptically fibered Calabi-Yau threefolds by freely acting discrete groups and the associated physics of F-theory compactifications on such backgrounds. The process of quotienting a Calabi-Yau geometry produces not only new genus one fibered manifolds, but also new effective 6-dimensional physics. These theories can be uniquely characterized by the much simpler covering space geometry and the symmetry action on it. We use this method to construct examples of F-theory models with an array of discrete gauge groups and non-trivial monodromies, including an example with Z6 discrete symmetry., 41 pages, 4 figures, 8 tables

The atrial transseptal procedure is used in catheter ablation of left-sided arrhythmias. Studies in adult patients have shown the SafeSept™ transseptal guidewire (SSTG) to be effective in atrial transseptal procedures. We analyzed our 5-year experience with SSTG use in pediatric and congenital heart disease patients undergoing catheter ablation. This is a single-center retrospective analysis of patients undergoing catheter ablation from 2009 to 2014. We identified all procedures where SSTG was used for atrial transseptal or trans-baffle access. Success of transseptal access and complications were recorded and compared to the standard transseptal approach without the SSTG. One hundred twenty-seven patients underwent 132 attempted atrial transseptal or trans-baffle procedures using SSTG. Median age was 14 (1.2–38) years. Arrhythmia substrates included AV reentrant tachycardia (90.2%), atrial tachycardia (4.5%), ventricular tachycardia (2.3%), and AV nodal reentrant tachycardia (2.3%). Transseptal or trans-baffle access was successful in 96.2% of the SSTG cases compared to 98.9% in the standard transseptal group without SSTG (p = NS). The youngest patient with successful atrial transseptal procedure using SSTG was 4 years old. SSTG was used to successfully cross a surgically created atrial baffle in a patient who had undergone the Mustard procedure. There was one major complication in both groups, 0.8% in the SSTG group compared to the standard transseptal group without SSTG, 1.1% (p = NS). The major complication in the SSTG group occurred when the SSTG crossed the aorta into the coronary artery system and mimicked placement in the left atrial appendage, with subsequent placement of a transseptal sheath into the aorta, requiring sternotomy and surgical intervention. SSTG is effective for use in atrial transseptal and surgical trans-baffle access in pediatric and congenital heart disease patients. Placement of the SSTG into the pulmonary vein is necessary to avoid major complications, and if not achieved requires additional methods to determine appropriate left atrial placement.

Understanding the amount of impact and distribution of invasive species is important for both basic ecological research and making management decisions. Because of their extensive impacts in southern Patagonia, invasive North American beavers (Castor canadensis) are considered both a scientific and conservation priority. However, little is known about the landscape-scale effects of these exotic ecosystem engineers. Using satellite imagery, we estimated the impact of beavers in the Argentine portion of Tierra del Fuego Island and determined the habitat factors (vegetation cover, forest type, stream presence and topography) related to their presence using both non-parametric statistical and information-theoretic approaches. Results indicated that more than 31,000 ha (1.6 % of the study area) were impacted by beavers and that the presence, but not the amount, of beaver impacts were spatially clustered. Impacts were greater in the Mountain ecoregion (2.8 % of the ecoregion) and lower in the Steppe (0.1 %). The best model for predicting beaver presence included variables related to water availability (presence of peatlands and streams), forage availability (forest type cover), and topography (slope and elevation). These findings support previous assertions that this invasion is the largest alteration to the sub-Antarctic forests in the Holocene. They also serve as a foundation for the development of maps based on habitat- and landscape-scale conditions to assist with the orientation of control, eradication, and restoration efforts currently being planned.

It has been established that degenerative-changes at the spine elevate bone mineral density at the lumbar spine. This study in men reports that trabecular bone score may be less affected by spinal degenerative-changes. A recent tool for assessing trabecular microarchitecture at the lumbar spine, trabecular bone score (TBS), provides information about bone health complementary to lumbar spine areal BMD (here referred to as BMD). In men, mean BMD increases with increasing age due to degenerative-changes at the spine including osteophytes and aortic calcification. The aim of this study was to investigate whether TBS is similarly affected by the presence of degenerative-changes in men. This study included 728 men aged 40–90 years enrolled in the Geelong Osteoporosis Study. Lumbar spine DXA scans (Lunar Prodigy) were used to determine TBS retrospectively (TBS iNsight software, Version 2.2), and for identification of degenerative-changes. Using multivariable regression techniques, the relationships between TBS or BMD and degenerative-changes were assessed, further adjusting for age and weight. The difference between each of the two methods was examined through testing interactions between method, degenerative-changes and age. Of 728 men, 439 (60.3%) were identified as having one or more degenerative-changes at the lumbar spine. Adjusted mean TBS was 1.219 (1.203–1.232) and 1.196 (1.179–1.212) for those with and without degenerative-changes, respectively. Adjusted mean BMD was 1.317 g/cm2 (1.297–1.336) and 1.198 g/cm2 (1.173–1.223) for those with and without degenerative-changes, respectively. Partial r2 for degenerative-changes in the model for TBS was 0.076 and for BMD, 0.257 (both p

We explore 6-dimensional compactifications of F-theory exhibiting (2,0) superconformal theories coupled to gravity that include discretely charged superconformal matter. Beginning with F-theory geometries with Abelian gauge fields and superconformal sectors, we provide examples of Higgsing transitions which break the $U(1)$ gauge symmetry to a discrete remnant in which the matter fields are also non-trivially coupled to a (2,0) SCFT. In the compactification background this corresponds to a geometric transition linking two fibered Calabi-Yau geometries defined over a singular base complex surface. An elliptically fibered Calabi-Yau threefold with non-zero Mordell-Weil rank can be connected to a smooth non-simply connected genus one fibered geometry constructed as a Calabi-Yau quotient. These hyperconifold transitions exhibit multiple fibers in co-dimension 2 over the base., 60 pages, 11 pages appendices, 18 Figures, 2 Tables, references added, typos corrected, extended introduction, extended discussion of Section 4.3, published version