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Objective: The efficacy of hypoglossal nerve stimulation (HGNS) therapy is limited by obstruction of the oropharyngeal lateral walls (OLWs). Our objective was to investigate the effect of palatine tonsillectomy on HGNS efficacy in obstructive sleep apnea (OSA) patients with OLW collapse. Study Design: Case‐control study of patients with moderate‐to‐severe OSA, complete‐or‐partial OLW collapse, and small tonsils (1 − 2+). Concomitant palatine tonsillectomy and HGNS (HGNS+T) were compared against a control group of patients who underwent HGNS alone. Setting: Single academic institution. Methods: Study outcomes were measures of HGNS efficacy defined as a %reduction in apnea‐hypopnea index (AHI) (primary) and successful treatment response (50% AHI reduction to <15/h, logistic regression), respectively. Regression analyses quantified the additional effect of tonsillectomy (HGNS+T vs HGNS alone, independent variable) on HGNS efficacy. Analyses were adjusted for OLW collapse severity (complete vs partial), tonsil size, age, sex, body mass index, and baseline AHI. Results: Nineteen patients underwent HGNS+T and had follow‐up sleep testing for the current analysis. The control group (HGNS alone) consisted of 78 patients. Baseline demographics and OSA severity were similar between the groups, except HGNS+T group had increased prevalence of complete OLW collapse. Linear regression demonstrated that adding tonsillectomy resulted in an additional 22.9% [7.5, 35.2] reduction in AHI [95% confidence interval, CI] (P =.006), and 8.6 [1.7,43.4] (P =.010) greater odds [95% CI] of a successful treatment response with HGNS. Conclusion: Compared to historically poorer outcomes of HGNS in patients with OLW collapse, these early results suggest combining tonsillectomy with HGNS may represent a promising strategy to improve success rates. [ABSTRACT FROM AUTHOR]

Archaeological bird remains from the Oregon coast provide important insight into local environments and the interactions between birds and people on the North American Pacific Coast. We contribute to this discussion with an analysis of bird remains from the Late Holocene Par‐Tee site (35CLT20) in Seaside, Oregon. We sampled the Par‐Tee avifaunal assemblage to near‐redundancy, generating the largest sample from a single site on the Oregon Coast to date (N = 7204). The Par‐Tee assemblage is dominated by nearshore or estuarine birds including scoters (Melanitta spp.) and Common Murres (Uria aalge), as well as pelagic Sooty Shearwaters (Ardenna grisea). Because of the large size of the sample, we identified unique species such as the California Condor (Gymnogyps californianus), which are currently endangered and face conservation challenges. Although the Par‐Tee avifaunal assemblage is diverse, site residents appear to have focused on acquiring the most accessible species in the nearshore habitat complemented by opportunistic pelagic hunting and/or scavenging of beached birds. Most birds appear to have been processed for dietary consumption, with possible preferential use of larger‐winged birds for tool manufacture. These findings underscore the value and challenges of using legacy collections for evaluating past human–environmental interactions in coastal and other aquatic regions. [ABSTRACT FROM AUTHOR]

Purpose: Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent childhood deaths due to disease. However, global coverage of childhood immunization has decreased throughout the world due to guardians' growing hesitancy towards immunizations. This study aims to describe how specialist nurses promote legal guardians to adhere to national childhood immunization programmes. Design and Methods: This study had a qualitative design. Semistructured interviews with 11 specialist nurses, who were paediatric primary care nurses or nurse practitioners, were conducted. Data were analysed using qualitative content analysis. Results: The findings, with four main categories including four subcategories, showed nurses using both local guidelines and national guidelines to promote guardians to adhere to the childhood immunization programme. The main intervention the nurses did to promote childhood immunization coverage was giving legal guardians general information about the programme. With hesitant guardians, adopting a person‐centred approach towards the legal guardian improved adherence. Practice Implications: Further research should focus on how specialist nurses can respond to guardians who decline immunization for their children, as this study identified difficulties in this area. Furthermore, research on guardians' perspectives towards childhood immunization may also help generate further effective guidance on how to promote immunization coverage among children. [ABSTRACT FROM AUTHOR]

A 6-year-old 21.5 kg castrated male Siberian Husky was presented for acute onset of lethargy, vomiting, hemorrhagic diarrhea, and inappetence. Physical examination revealed marked discomfort upon abdominal palpation and 5%–7% dehydration. The CBC and biochemical profile revealed changes consistent with mild to moderate inflammation, dehydration, and gastrointestinal (GI) disease. Despite aggressive gastrointestinal support, anorexia persisted, and an upper GI endoscopy was performed in conjunction with esophagostomy tube placement. Endoscopy revealed abnormal gastric mucosa characterized by moderately well-demarcated areas of blue-black discoloration. Impression smears of a gastric biopsy revealed abundant extracellular yeasts with morphology most consistent with Candida spp. and frequent extracellular cocci. Similar yeast and bacteria, in lower numbers, were observed on cytologic analysis of a direct smear of the rectal mucosa. A rectal swab submitted for fungal culture yielded pure growth of fungal yeasts identified as Diutina (formerly Candida) rugosa by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. The dog's clinical signs improved with fluconazole, and he was discharged. Follow-up fungal culture of a rectal swab showed no growth of D. rugosa. To the authors' knowledge, this is the first case report that describes the clinical, hematologic, cytologic, and gross findings of enteric colonization by D. rugosa in a dog. [ABSTRACT FROM AUTHOR]

A 15-year-old spayed female mixed-breed dog was presented to the Ohio State University Veterinary Medical Center with a gingival mass and progressive anorexia. The dog had a history of dental disease, liver issues, and urinary tract infections. Fine-needle aspirate preparations of the gingival mass were evaluated and diagnosed as carcinoma, concerning for metastatic urothelial cell carcinoma (UC). Additional abnormalities were found on computed tomography (CT), including a left dorsal intracranial mass, cavitated left hepatic mass, and urinary bladder trigonal nodule. The dog was eventually diagnosed with UC with maxillary metastasis and likely metastasis to the retropharyngeal lymph node. UC is a common form of canine urinary tract neoplasia and has a high metastatic rate. The presence of eosinophilic inclusions consistent with Melamed-Wolinska bodies in neoplastic cells should prompt an evaluation of the urinary tract for a primary UC. [Extracted from the article]

Acknowledging systemic racism, a key tenet of Critical Race Theory (CRT), may be threatening to many Americans but it can also reduce racial biases. However, anti‐CRT legislation prohibits learning about racism, thus highlighting the mutually reinforcing relationship between systemic racism and the production of ignorance. We assessed White Americans' knowledge about CRT through participant‐generated definitions (Study 1, N = 199) and via a true/false questionnaire (Study 2, N = 194), and its relation to opposition to CRT. Opposition to CRT was associated with a less accurate understanding of CRT, even when controlling for political orientation. Content analyses revealed that opponents of CRT deny anti‐Black racism, believe CRT harms Whites, and view discussing race as divisive. Based on these themes, we developed a meta‐cognitive corrective intervention in Study 3 (N = 289). Participants who received corrective feedback after taking a multiple‐choice test about CRT showed a larger decrease in their opposition to CRT than those in the control condition. [ABSTRACT FROM AUTHOR]

Species-specific length-weight relationships can inform researchers and managers about the growth patterns and health of fish populations. Few length-weight relationships exist for Appalachian stream fish species despite the high amount of biodiversity within the region. The main purpose of our study was to determine the length-weight relationships for stream fish species found in Central Appalachia. We sampled 16 streams and captured over 14,000 individual fish among 44 species. We identified each fish to species and recorded total length (mm) and weight (g) for each individual. These data were log10 transformed and analyzed using linear regression to calculate the length-weight parameters for each species. Relationships were calculated for 44 different stream fish species. Searches in FishBase.org revealed that of the 44 species in our data, 9 species have no current data in FishBase.org (Froese and Pauly, 2016), while 20 others have no previous representation from Central Appalachia. The relationships obtained in this study are some of the first published for these species in this region. Availability of species- and region-specific data on length-weight relationships could help inform future research and management of these species. [ABSTRACT FROM AUTHOR]

Claims of discrimination made by high‐status groups (e.g., White people, men) have become increasingly more common. To understand ingroup support for such claims, we examined perceivers' group identification (GID) and perceived social costs as contributing factors. In addition, we examined the impact of the claimant blaming 'diversity' as a source of discrimination to see if this may influence perceptions of social costs and ultimately support. Across three experiments, we found that GID predicted support for the claimant among Whites and men when the claim blamed diversity, which was mediated by perceptions of group‐level social costs, suggesting that mentioning diversity as part of their claim may influence support for the claimant. We found similar patterns of results for liking and behavioral intentions. Results suggest that it is important to examine aspects of the claim and perceivers' perceptions of social costs when examining support for discrimination claimants. [ABSTRACT FROM AUTHOR]

On March 11, 2020, the World Health Organization declared the coronavirus (COVID‐19) outbreak a global pandemic, spurring dramatic changes in public health policies, travel between countries, and (trans)national economies, as well as in religious and political institutions. In the United States, in particular, the pandemic provoked and revealed an increasingly fraught relationship between scientific, religious, and political sources of information and leadership—an American "crisis of authority" wherein many Americans distrusted scientific and medical establishments. This article explores how Shi'i Muslim institutions and leaders of metro Detroit navigated these competing authorities, even as their communities faced entrenched societal inequities, including anti‐Muslim racism (Islamophobia). Through interviews with Shi'i religious leaders in Dearborn, Dearborn Heights, and Detroit, supplemented by digital and in‐person ethnographic research at five major Shi'i mosques, we show how major Islamic centers and leaders argued for the efficacy, safety, religious value, and legality of COVID‐19 medical guidance and led extensive community outreach initiatives to help their struggling communities. Supported by religious scholars in Iran, Iraq, and Lebanon, their guidance offered messages of hope and resilience, as well as an emphasis on the community preservation and selflessness (caring for others) exemplified by the Family of the Prophet. They also emphasized how religious and scientific knowledge intersect, as per the sacred texts of Islam (the Qur'an and hadiths). Their approach compels us to better understand how sources of religious authority can tether vulnerable communities to forms of (legitimate) knowledge in times of upheaval, divisive politics, and misinformation. [ABSTRACT FROM AUTHOR]

Like many top consumers, parasites can regulate feeding of their prey via trait‐mediated means. If parasites modify the feeding behavior of ecologically important grazers, they may have cascading effects on the structure and functioning of whole plant communities. The extent to which parasites can influence plant communities in this way is largely dependent on the strength of their behavioral alteration, their prevalence in host grazers, and the density of those hosts. Recent experiments and comparative surveys in southeastern USA salt marshes revealed that common larval trematode parasites suppress the per capita grazing impacts of the marsh periwinkle Littoraria irrorata, generating a trophic cascade that protects foundational marsh plants from drought‐associated overgrazing. Here, we conducted a field manipulation wherein we modified grazer host density while holding infection prevalence constant at an ecologically relevant level (20%) to determine whether the indirect, facilitative effects of parasites on marsh plants varied with the density of grazers. We found that parasites had significant positive impacts on marsh net primary productivity at moderate densities of snails (≥50 snails/0.5 m2), but that the positive effects of parasites were negligible at lower densities. Our results confirm the findings of previous studies that parasites can protect marsh plants from overgrazing at sufficiently high prevalence, but show that their ability to do so depends on host density. [ABSTRACT FROM AUTHOR]

The wounding‐responsive KED gene, named for its coding for a lysine (K), glutamic acid (E), and aspartic acid (D)‐rich protein, is widely present among land plants. However, little is known about its regulation or function. In this study, we found that transcription of the tomato (Solanum lycopersicum) KED gene, SlKED, was rapidly and transiently elevated by wounding or ethephon treatment. Compared to the wild‐type plants, the CRISPR/Cas9‐mediated SlKED knockout plants did not exhibit altered expression patterns for genes involved in hormone biosynthesis or stress signaling, suggesting a lack of pleiotropic effect on other stress‐responsive genes. Conversely, jasmonic acid did not appear to directly regulate SlKED expression. Wounded leaves of the KED‐lacking plants exhibited higher binding of Evans blue dye than the wild‐type, indicating a possible role for KED in healing damaged tissues. The SlKED knockout plants showed a similar dietary effect as the wild‐type on the larval growth of tobacco hornworm. But a higher frequency of larval mandible (mouth) movement was recorded during the first 2 minutes of feeding on the wounded KED‐lacking SlKED knockout plants than on the wounded KED‐producing wild‐type plants, probably reflecting an initial differential response by the feeding larvae to the SlKED knockout plants. Our findings suggest that SlKED may be an ethylene‐mediated early responder to mechanical stress in tomato, acting downstream of the wound stress response pathways. Although its possible involvement in response to other biotic and abiotic stresses is still unclear, we propose that SlKED may play a role in plant's rapid, short‐term, early wounding responses, such as in cellular damage healing. [ABSTRACT FROM AUTHOR]

Background: While many studies have assessed and measured patient attitudes toward deprescribing, less quantitative research has addressed the provider perspective. We thus sought to describe provider knowledge, beliefs, and self‐efficacy to deprescribe, with a focus on opioids and sedative‐hypnotics. Methods: An electronic anonymous survey was distributed to primary care providers at Kaiser Permanente Washington. Two reminder emails were sent. The survey included 10 questions on general deprescribing, and six questions each specific to opioid and sedative‐hypnotic deprescribing. Knowledge questions used a multiple‐choice response option format. Questions addressing beliefs and self‐efficacy (i.e., confidence) used a 0–10 Likert scale. Scales were dichotomized at ≥7 to define agreement (belief questions) or confidence (self‐efficacy questions). We calculated descriptive statistics to summarize the responses. Results: Of 370 eligible primary care providers, 95 (26%) completed the survey. For general deprescribing questions, a majority believed that lack of patient willingness, withdrawal symptoms and fear of symptom return, and time constraints impeded deprescribing. Approximately half chose the correct answers about opioid deprescribing, 21% were confident that they could alleviate patient concerns about opioid tapering, and 32% were confident managing chronic non‐cancer pain without opioids. For sedative‐hypnotics, 64%–87% of respondents correctly answered questions about risks and the relative effectiveness of alternatives, but only one‐third correctly answered a question about sedative‐hypnotic tapering. Roughly half were confident in their ability to successfully engage patients in sedative deprescribing conversations and select alternatives. Only 54% and 34% were confident in writing a tapering protocol for opioids and sedative‐hypnotics, respectively. Conclusion: Results suggest that raising provider awareness of patient willingness to deprescribe, addressing knowledge gaps, and increasing self‐efficacy for deprescribing are important targets for improving deprescribing. Support for writing tapering protocols and prescribing evidence‐based drug and non‐drug alternatives may be important to improve care. [ABSTRACT FROM AUTHOR]

The introduction and spread of non‐native species restructure native ecosystems and can be particularly impactful when invaders are ecosystem engineers or habitat‐forming species. In coastal, estuarine, and marine systems, submerged aquatic vegetation (SAV), like macroalgae and seagrasses, form key habitats for nekton, serving as nurseries, foraging grounds, and reproduction sites. If non‐native ecosystem engineers can provide sufficient structure and/or resources, they may exert a neutral or positive effect on organisms occupying higher trophic positions. As such, we hypothesized that nekton response to non‐native SAV species may be neutral or positive. We performed a quantitative meta‐analysis to quantify impacts of non‐native SAV on native crabs, fishes, and shrimps. We extracted data from 35 studies and evaluated 11 response metrics related to facilitation (e.g., habitat use and foraging), restricting our analysis to studies that compared at least one of these metrics in nekton from co‐occurring native and non‐native SAV habitats in marine, coastal, or estuarine systems. We found that nekton abundance, species richness, and biomass were the most assessed metrics of nekton performance. Our pooled data revealed differential results among response metrics, with nekton growth and reproduction enhanced in non‐native habitats and species richness enhanced in a native setting. The mean effect sizes for all other nekton response metrics, including abundance, had 95% CIs that overlapped zero, indicating no difference in response between native and non‐native SAV. For many endpoints, limited sample sizes prevented robust inferences, but they also highlighted areas where more research is needed in future studies. Non‐native species have the potential to restructure the systems they invade. Our results lend support to the relative trophic position hypothesis, indicating that non‐native habitat formers may facilitate native organisms in higher trophic levels. We identify research gaps that may guide future studies and allow for a more comprehensive understanding of responses to non‐native ecosystem engineers. [ABSTRACT FROM AUTHOR]

But if the rights violations of slavery provide clear side-constraints against the slave-owner's coercion of slaves, why do the rights violations perpetrated by Norwegian officials not equally supply side-constraints against continuing to operate the government? The appropriate position to adopt would seem to be that legitimate regimes have moral powers that illegitimate regimes lack, but they are able to morally bind their constituents only when they are operating justly. After all, if one believes that only democratic regimes are legitimate (as many do), and that democratic states have a distinctive authority, this might explain why states can retain their legitimacy despite perpetrating injustices. As Michael Walzer puts it, "It is a feature of democratic government that the people have a right to act wrongly - in much the same way that they have a right to act stupidly.". [Extracted from the article]

Background and objective: The combination of the noradrenergic atomoxetine plus the anti‐muscarinic oxybutynin acutely increased genioglossus activity and reduced obstructive sleep apnoea (OSA) severity. However, oxybutynin has shorter half‐life than atomoxetine and side effects that might discourage long‐term usage. Accordingly, we aimed to test the combination of atomoxetine and fesoterodine (Ato‐Feso), a newer anti‐muscarinic with extended release formulation, on OSA severity and endotypes. Methods: Twelve subjects with OSA underwent a randomized, double‐blind, crossover trial comparing one night of atomoxetine plus fesoterodine (80–4 mg) to placebo. Parameters of OSA severity (e.g., apnoea–hypopnoea index [AHI], nadir oxygen desaturation and hypoxic burden) were calculated from two clinical, in‐lab polysomnographic studies. OSA endotypes (including collapsibility per VMIN and arousal threshold) were derived from validated algorithms. Results: Compared to placebo, Ato‐Feso did not reduce the AHI (34.2 ± 19.1 vs. 30.1 ± 28.2 events/h, p = 0.493), but reduced the apnoea index (12.9 [28.8] vs. 1.8 [9.1] events/h, median [interquartile range], p = 0.027) and increased nadir desaturation (76.8 [8.0] vs. 82.2 [8.8] %, p = 0.003); a non‐significant trend for improved hypoxic burden was observed (52.4 [50.5] vs. 29.7 [78.9] %min/h, p = 0.093). Ato‐Feso lowered collapsibility (raised VMIN; 43.7 [29.8–55.7] vs. 56.8 [43.8–69.8] %VEUPNOEA, mean [CI], p = 0.002), but reduced the arousal threshold (129.3 [120.1–138.6] vs. 116.7 [107.5–126] %VEUPNOEA, p = 0.038). In post hoc analysis, 6/6 patients with milder collapsibility (VMIN > 43%) exhibited OSA resolution (drop in AHI > 50% and residual AHI < 10 events/h) and improved hypoxaemia. Conclusion: While inefficacious in unselected patients, Ato‐Feso administered for one night suppressed OSA in patients with milder collapsibility. Ato‐Feso may hold some promise as an alternative OSA treatment in certain subgroups of individuals. We studied the combination of atomoxetine and fesoterodine (Ato‐Feso), an extended‐release anti‐muscarinic, on obstructive sleep apnoea (OSA) severity and endotypes. Despite the absence of an effect on OSA severity, Ato‐Feso led to improvements in OSA profile, reducing apnoea index and overnight hypoxaemia, especially in patients characterized by low‐to‐moderate pharyngeal collapsibility. [ABSTRACT FROM AUTHOR]

Maternal antibiotic (ABx) exposure can significantly perturb the transfer of microbiota from mother to offspring, resulting in dysbiosis of potential relevance to neurodevelopmental disorders such as autism spectrum disorder (ASD). Studies in rodent models have found long‐term neurobehavioral effects in offspring of ABx‐treated dams, but ASD‐relevant behavior during the early preweaning period has thus far been neglected. Here, we exposed C57BL/6J mouse dams to ABx (5 mg/ml neomycin, 1.25 μg/ml pimaricin,.075% v/v acetic acid) dissolved in drinking water from gestational day 12 through offspring postnatal day 14. A number of ASD‐relevant behaviors were assayed in offspring, including ultrasonic vocalization (USV) production during maternal separation, group huddling in response to cold challenge, and olfactory‐guided home orientation. In addition, we obtained measures of thermoregulatory competence in pups during and following behavioral testing. We found a number of behavioral differences in offspring of ABx‐treated dams (e.g., modulation of USVs by pup weight, activity while huddling) and provide evidence that some of these behavioral effects can be related to thermoregulatory deficiencies, particularly at younger ages. Our results suggest not only that ABx can disrupt microbiomes, thermoregulation, and behavior, but that metabolic effects may confound the interpretation of behavioral differences observed after early‐life ABx exposure. [ABSTRACT FROM AUTHOR]

Historically, the Monongahela, Tygart, and Cheat River watersheds in West Virginia were impaired by acidification from acid mine drainage and Walleye Sander vitreus were extirpated from these watersheds by the 1940s. Walleye were reestablished after water quality improvements following passage of environmental legislation and subsequent reintroduction efforts. We compared population characteristics, with emphasis on growth, of Walleye and used modeling to predict the potential effects of harvest regulations in the Monongahela River and two main‐stem reservoirs in the Cheat River and Tygart River watersheds. Statistical comparisons of von Bertalanffy growth curves and relative growth indices indicated that Walleye growth significantly differed across all water bodies. Relative growth index results suggested that Walleye growth was above average in Cheat Lake, average in the Monongahela River, and below average in Tygart Lake relative to other North American populations. Growth was negatively correlated with Walleye relative abundance and positively correlated with estimates of productivity (total phosphorus, chlorophyll a). Walleye diets significantly differed across all water bodies, with diets dominated by Yellow Perch Perca flavescens and Gizzard Shad Dorosoma cepedianum in Cheat Lake, where growth was fastest. Population modeling suggested that effects of exploitation on yield, spawning potential, and size structure were similar under regulations of no length limit and a minimum length limit (381 mm). Models suggested that removing length limits in Tygart Lake could increase angler harvest opportunities and pose minimal threat to the fishery. Models suggested that a protected slot limit could provide increased protection to the spawning potential of Cheat Lake and the Monongahela River populations. Additionally, models predicted that a protected slot limit could increase the number of large (>630‐mm) Walleye in these waters. Our findings demonstrate the different characteristics that Walleye populations can develop after reestablishment based on abiotic and biotic conditions and the need for watershed‐specific management. [ABSTRACT FROM AUTHOR]

There has been increasing interest in the use of a synthetic absorbable calcium sulfate (CaSO4) for local antibiotic delivery in orthopaedic infections. The purpose of this study was to quantify elution kinetics of six antibiotics (amikacin, meropenem, fosfomycin, minocycline, cefazolin, and dalbavancin) from a clinically relevant CaSO4 bead model and compare elution and antimicrobial activity to the current clinical gold standards: vancomycin and tobramycin. Antibiotic‐loaded synthetic CaSO4 beads were immersed in phosphate buffered saline and incubated at 37°C. Eluent was harvested at eight time points over 28 days. Antibiotic concentrations were measured by high performance liquid chromatography to quantify elution rates. CaSO4 beads demonstrated burst release kinetics. Dalbavancin, cefazolin, and minocycline all demonstrated similar elution profiles to vancomycin. Amikacin and meropenem demonstrated favorable elution profiles and durations of above‐minimum inhibitory concentration when compared to tobramycin. Clinical Significance: This study provides important novel data regarding the utility of amikacin, meropenem and dalbavancin as alternative choices to place in CaSO4 carriers when treating orthopaedic infections. [ABSTRACT FROM AUTHOR]

Lactating rats show changes in the secretion of hormones and brain signals that promote hyperphagia and facilitate the production of milk. Little is known, however, about the role of ghrelin in the mechanisms sustaining lactational hyperphagia. Here, we used Wistar female rats that underwent surgery to sever the galactophores to prevent milk delivery (GC rats) and decrease the energetic drain of milk delivery. We compared plasma acyl‐ghrelin concentrations and growth hormone secretagogue receptor (GHSR) mRNA expression in different brain regions of GC rats with those of sham operated lactating and nonlactating rats. Additional lactating and nonlactating rats were implanted with cannulae aimed at the lateral ventricles and were used to compare feeding responses to central ghrelin or GHSR antagonist infusions to those of nonlactating rats receiving similar infusions on day 14–16 postpartum (pp). Results show lower plasma acyl‐ghrelin concentrations on day 15 pp sham operated lactating rats compared to GC or nonlactating rats. These changes occur in association with increased GHSR mRNA expression in the hypothalamic arcuate nucleus (ARC) and ventral tegmental area (VTA) of sham operated lactating rats. Despite lactational hyperphagia, infusions of ghrelin (0.25 or 1 μg) resulted in similar increases in food intake in lactating and nonlactating rats. In addition, infusions of the GHSR antagonist JMV3002 (4 μg in 1 μl of vehicle) produced greater suppression of food intake in lactating rats than in nonlactating rats. These data suggest that, despite lower plasma ghrelin, the energetic drain of lactation increases sensitivity to the orexigenic effects of ghrelin in brain regions important for food intake and energy balance, and these events are associated with lactational hyperphagia. [ABSTRACT FROM AUTHOR]

The detrimental ecological impacts of engineered shoreline protection methods (e.g., seawalls) and the need to protect the coastal zone have prompted calls for greater use of natural and nature‐based infrastructure (NNBI). To balance competing needs of structural stability and ecological functioning, managers require assessments of NNBI designs and materials for differing environmental settings (e.g., among wave‐energy regimes). To examine the effects of setting and oyster‐based NNBI design on the provision of shoreline protection, we constructed reefs from two substrates: a novel, biodegradable material (Oyster Catcher, OC) and traditional oyster shell bags (SB) on low‐ and high‐energy eroding salt marsh shorelines, designated based on fetch and boat wake exposure. Both reef types buffered marsh elevation change on the high‐energy shoreline relative to unaltered controls, but only SB reefs were able to do so on the low‐energy shoreline. Additionally, both shorelines experienced high ambient rates of retreat and declines in marsh vegetation shoot density. Although constructed reefs did not mitigate marsh retreat on the low‐energy shoreline, novel OC reefs significantly reduced retreat relative to SB reefs and control sites (no reefs) on the high‐energy shoreline. Those SB reefs were severely damaged by storm events, increasing their areal footprints at the expense of vertical relief. Conversely, OC reefs on both shorelines exhibited steady oyster recruitment and growth and hosted higher densities of larger oysters. To successfully provide shoreline stabilization benefits, oyster‐based NNBI must be structurally stable and able to promote sustained oyster recruitment and growth. Our results indicate that deliberate decisions regarding NNBI substrate, siting, and configuration can produce resilient reefs, which reduce rates of erosion and, in some cases, enhance vertical accretion along salt marsh edges. The growth trajectory, structural stability, and co‐benefit provisioning of OC reefs demonstrate the potential of alternative restoration substrates to provide valuable oyster habitat along threatened marsh shorelines. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis‐related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone‐delivered cognitive behavioral therapy for insomnia (CBT‐I) improved sleep outcomes in this population. Using these data, we evaluated the incremental cost‐effectiveness of CBT‐I from a healthcare sector perspective. Methods: The study was based on 325 community‐dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality‐adjusted life years (QALYs) using the EuroQol 5‐dimension scale. Arthritis‐specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia‐specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia‐free nights"). Total healthcare costs included intervention and healthcare utilization costs. Results: Over the 12 months after randomization, CBT‐I improved ISI and WOMAC by −2.6 points (95% CI: −2.9 to −2.4) and −2.6 points (95% CI: −3.4 to −1.8), respectively. The ISI improvement translated into 89 additional insomnia‐free nights (95% CI: 79 to 98) over the 12 months. CBT‐I did not significantly reduce total healthcare costs (−$1072 [95% CI: −$1968 to $92]). Improvements in condition‐specific measures were not reflected in QALYs gained (−0.01 [95% CI: −0.01 to 0.01]); at a willingness‐to‐pay of $150,000 per QALY, CBT‐I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: −$1737 to $2270). Conclusion: CBT‐I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT‐I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite improved surgical approaches for chronic limb‐threatening ischemia (CLTI), amputation rates remain high and contributing tissue‐level factors remain unknown. The purpose of this study was twofold: (1) to identify differences between the healthy adult and CLTI limb muscle proteome, and (2) to identify differences in the limb muscle proteome of CLTI patients prior to surgical intervention or at the time of amputation. Methods and results: Gastrocnemius muscle was collected from non‐ischemic controls (n = 19) and either pre‐interventional surgery (n = 10) or at amputation outcome (n = 29) CLTI patients. All samples were subjected to isobaric tandem‐mass‐tag‐assisted proteomics. The mitochondrion was the primary classification of downregulated proteins (> 70%) in CLTI limb muscles and paralleled robust functional mitochondrial impairment. Upregulated proteins (> 38%) were largely from the extracellular matrix. Across the two independent sites, 39 proteins were downregulated and 12 upregulated uniformly. Pre‐interventional CLTI muscles revealed a robust upregulation of mitochondrial proteins but modest functional impairments in fatty acid oxidation as compared with controls. Comparison of pre‐intervention and amputation CLTI limb muscles revealed mitochondrial proteome and functional deficits similar to that between amputation and non‐ischemic controls. Interestingly, these observed changes occurred despite 62% of the amputation CLTI patients having undergone a prior surgical intervention. Conclusions: The CLTI proteome supports failing mitochondria as a phenotype that is unique to amputation outcomes. The signature of pre‐intervention CLTI muscle reveals stable mitochondrial protein abundance that is insufficient to uniformly prevent functional impairments. Taken together, these findings support the need for future longitudinal investigations aimed to determine whether mitochondrial failure is causally involved in amputation outcomes from CLTI. [ABSTRACT FROM AUTHOR]

Purpose: The study was to determine the effect of locking hole inserts and their insertion torque on the fatigue life of a large fragment Locking Compression Plate (LCP) under bending forces. Methods: Fatigue strength of the LCP was examined using cyclic three-point bend testing at 80% yield strength of the construct. Locking hole inserts were used in 2, 4, and 6-hole of a 12-hole plate to simulate three different working lengths. Within each working length, plates were tested without locking inserts serving as the control group. In the experimental groups, inserts were tightened to manufacturer recommendations (4 Nm) and using overtorque (8 Nm). Results: Significantly fewer cycles to failure were observed in control groups versus the locking hole insert groups for all working lengths (2-hole: 4 Nm p = 0.003, 8 Nm p = 0.003; 4-hole: 4 Nm p = 0.02, 8 Nm p < 0.001; 6-hole: 4 Nm p = 0.004, 8 Nm p < 0.001). There was a statistically significant increase in fatigue strength when using overtorque in the 4-hole (p = 0.04) and 6-hole (p = 0.01) defect groups. This was not shown in the 2-hole defect group (p = 0.99). Conclusions: By placing locking inserts in the empty locking regions of Combi holes along the working length, the number of cycles to failure was increased. Tightening inserts to twice the recommended insertion torque further increased cycles to failure in longer working length models. A longer fatigue life has the potential to decease the incidence of plate failure especially in the setting of delayed union due to poor intrinsic healing capacity, fractures in the geriatric population, osteoporosis and periprosthetic fractures. [ABSTRACT FROM AUTHOR]

Background: On a 20‐bed, mixed cardiac and general, UK pediatric intensive care unit (PICU), we aimed to determine if a physiologically based enteral feeding guideline for critically ill children, using feed frequency tailored to individual gastric emptying times, resulted in earlier establishment of full feeds (when 100% of fluid allowance (FA) available to be given as intravenous maintenance fluid or feed, defined as free FA [FFA], is given as enteral nutrition [EN]) and an increase in FFA given as EN. Methods: Four prospective audits (totaling 331 patients and 19,771 hours) were conducted at 1 year before guideline introduction and 1, 5, and 10 years after. Patient feeding data were collected from admission until day 4 or discharge, including reasons why feed was withheld. Results: The median time from admission to establishing full feeds decreased from 18 to 10 hours preguideline and postguideline and was sustained over 10 years. After adjustment for 5 confounders, this represented a reduction in the geometric mean time to full feeds of 30% (2009), 29% (2013), and 48% (2019) compared with 2007 (all P <.01). Nil‐per‐oral (NPO) hours were categorized as due to modifiable and nonmodifiable factors. Preguideline and postguideline NPO hours from modifiable factors decreased from 21 (2007) to 10 (2009) per 100 audit hours, which was sustained across 10 years (all P <.01). Conversely, NPO hours from nonmodifiable factors ranged from 27 to 36 per 100 audit hours throughout the audits, with no consistent trend over time. Similar inconsistency was shown in the proportion of FFA given as EN: 48% (2007), 71% (2009), 51% (2013), and 64% (2019). Continuous nasogastric and hourly bolus feeds decreased over time; they comprised 66% of feeds in 2007 but only 4%–11% in subsequent periods, being replaced with more 2–6 hour bolus, on‐demand, or continuous nasojejunal feeds. Conclusion: The guideline was associated with sustained reduction in the time to establishing full feeds and NPO hours due to modifiable factors and more or no less FFA being given as EN. [ABSTRACT FROM AUTHOR]

Rapid global degradation of coastal habitats can be attributed to anthropogenic activities associated with coastal development, aquaculture, and recreational surface water use. Restoration of degraded habitats has proven challenging and costly, and there is a clear need to develop novel approaches that promote resilience to human‐caused disturbances. Positive interactions between species can mitigate environmental stress and recent work suggests that incorporating positive interactions into restoration efforts may improve restoration outcomes. We hypothesized that the addition of a potential facultative mutualist, the native hard clam (Mercenaria mercenaria), could enhance seagrass bed recovery from disturbance. We conducted two experiments to examine the independent and interacting effects of hard clam addition and physical disturbance mimicking propeller scarring on mixed community Zostera marina and Halodule wrightii seagrass beds in North Carolina. Adding clams to seagrass beds exposed to experimental disturbance generally enhanced seagrass summer growth rates and autumn shoot densities. In contrast, clam addition to non‐disturbed seagrass beds did not result in any increase in seagrass growth rates or shoot densities. Clam enhancement of autumn percent cover relative to areas without clam addition was most prominent after Hurricane Dorian, suggesting that clams may also enhance seagrass resilience to repeated disturbances. By June of the next growing season, disturbed areas with clam additions had greater percent cover of seagrass than disturbed areas without clam additions. Beds that were disturbed in April had higher percent cover than areas disturbed in June of the previous growing season. Our results suggest that the timing and occurrence of physical disturbances may modify the ability of clams to facilitate seagrass resiliency and productivity. Understanding when and how to utilize positive, interspecific interactions in coastal restoration is key for improving restoration success rates. [ABSTRACT FROM AUTHOR]

Channel Catfish Ictalurus punctatus were collected during 2018 and 2019 from the Monongahela River in West Virginia using hoop nets to estimate population dynamics. Length, weight, sex, fecundity, and age data were obtained from collected individuals. Population characteristics (e.g., relative abundance, size structure, age structure, growth, etc.) were modeled under three proposed length limits of 300, 375, and 450 mm. Simulation results indicated that growth overfishing may occur when exploitation rates reach 36% under a 300‐mm minimum length limit. Furthermore, recruitment overfishing began to occur at 40% exploitation under a 300‐mm minimum length limit. Additionally, simulations suggest that no recruitment or growth overfishing occur at minimum length limits of 375 mm or 450 mm until extremely high exploitation levels (>90%) are reached. Thus, future consideration should be given for implementation of a 375‐mm minimum length limit of Channel Catfish in the Monongahela River to prevent growth and recruitment overfishing while also ensuring anglers are still able to harvest Channel Catfish. [ABSTRACT FROM AUTHOR]

The possibility and nature of bilingual advantage for theory of mind (ToM), that is, young bilingual children outperforming their monolingual peers, have been discussed increasingly since the first research on the topic was published in 2003. Because accumulating evidence demonstrates a ToM advantage for bilingual individuals, in this article, we focus on how this advantage arises. We consider how current theoretical positions, including executive function, metalinguistic awareness, and sociolinguistic awareness accounts, explain such an advantage in young bilingual children. These theoretical accounts receive some, but only partial, support, so further research and theory are needed to understand comprehensively the relationship between bilingualism and ToM. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) is characterized by impairments in decision-making that can exist as stable traits or transient states. Cognitive inflexibility reflects an inability to update information that guides decision-making and is thought to contribute to the inability to abstain from drinking. While several studies have reported evidence of impaired cognitive flexibility following chronic alcohol exposure, evidence that a pre-existing impairment in cognitive flexibility is a heritable risk factor for AUD is scarce. Here, we found that cognitive flexibility was impaired in rodents selectively bred for excessive alcohol consumption (alcohol preferring (P) rats), on the attentional set-shifting task (ASST). Further, the degree of impairment is predictive of future ethanol consumption, thus suggesting that cognitive inflexibility is a stable trait capable of predisposing one for drinking. In a second set of experiments, we observed an impairment in the ability of P rats to use a previously learned rule to guide foraging in a simple discrimination task. Convergence across several behavioral measures suggested that this impairment reflected a state of heightened urgency that interfered with decision-making. A similar impairment on a simple discrimination task was observed in Wistar rats with a history of alcohol consumption. These findings indicate how trait and state variables-in this case, impaired cognitive flexibility and heightened urgency, respectively-may influence the risk for excessive drinking. Furthermore, our results suggest that cognitive inflexibility and urgency can exist as both risk factors for and the result of alcohol exposure. [ABSTRACT FROM AUTHOR]

Animal personality is defined as behavioral tendencies that are consistent across time and contexts within an individual, but differ across individuals. Studies investigating personality typically examine individuals across short time periods or within a single life stage. Growing evidence suggests that personality may be less stable across life stages, highlighting the need to consider the effects of ontogeny on the expression of consistent behavioral traits. We investigated individual consistency in social and escape behaviors across developmental stages using Siberian hamsters (Phodopus sungorus). To determine whether individuals were consistent in these behaviors as juveniles and across developmental stages, we measured male and female social and escape behaviors twice as juveniles and once as adults. Individuals' social scores were significantly repeatable within the juvenile stage, but not across developmental stages. In contrast, escape scores were highly repeatable across developmental stages, with males' scores being more repeatable than females' scores. Our results support previous findings that personality traits, especially those associated with social behavior, are less stable across development, whereas behaviors associated with stress or coping may represent a more permanent feature of an individual's phenotype. Our results also indicate potential sex differences in long‐term repeatability of personality. Considering how ontogeny affects animal personality for males and females can provide insight into the evolution and mechanisms that maintain animal personality. Highlights: Individuals' social scores were repeatable within the juvenile stage, but not across developmental stagesIndividuals' escape scores were highly repeatable across developmental stagesMales' escape scores were more repeatable than females' escape scores [ABSTRACT FROM AUTHOR]

Urothelial carcinoma, also known as transitional cell carcinoma, is the most common primary bladder tumour in dogs, and can also involve the prostate gland. Cytology is a common diagnostic tool utilized for dogs with bladder or prostate gland lesions. The objectives of this retrospective study were to compare the sensitivity and specificity of cytologic evaluation for urothelial or prostatic carcinoma between two institutions with different cytology review protocols as well as determine if certain collection methods resulted in higher cytologic accuracy. A total of 298 cases met inclusion criteria. The overall sensitivity and specificity for institution 1 were 91.8% and 50%, respectively, compared to 31.1% and 97.4%, respectively, for institution 2. When the urine sample review protocol at institution 2 was matched to that of institution 1, sensitivity and specificity were more similar to institution 1 (71.2% and 88.9%, respectively). Our results show that the sensitivity and specificity of cytology are affected by screening and review protocols implemented by different institutions. The data also demonstrate that sensitivity and specificity vary by collection method. Diagnostic catheterization had the highest performance: of the 11 cases between two institutions, it had 100% sensitivity and specificity. In contrast, examination of urine sediment not collected via diagnostic catheterization had low sensitivity and specificity that varied greatly by institution. In summary, cytologic interpretation should be undertaken with consideration given to both processing and collection protocols. [ABSTRACT FROM AUTHOR]

Background and objective: Animal studies indicate that alpha‐1 adrenergic receptor agonists and antimuscarinic agents improve genioglossus muscle activity during sleep and may be candidates for the pharmacological treatment of OSA. On the other hand, noradrenergic stimulants may be wake‐promoting or cause insomnia symptoms if taken before bedtime, and the addition of a medication with sedative properties, such as an antihistaminic, may reduce these side effects. In this study, we aimed to determine the effects of the combination of an alpha‐1 adrenergic agonist (pseudoephedrine) and an antihistaminic‐antimuscarinic (diphenhydramine) on OSA severity (AHI), genioglossus responsiveness and other endotypic traits (Vpassive, muscle compensation, LG and arousal threshold). Methods: Ten OSA patients performed a randomized, placebo‐controlled, double‐blind, crossover trial comparing one night of pseudoephedrine 120 mg plus diphenhydramine 50 mg (DAW1033D) to placebo administered prior to sleep. The AHI, genioglossus muscle responsiveness to negative oesophageal pressure and the endotypic traits were measured via PSG. Results: The participants' median (interquartile range) age was 50 (46–53) years and body mass index (BMI) was 34.3 (30.6–39.2) kg/m2. The drug combination had no effect on AHI (21.6 (9.1–49.8) on placebo vs 37.9 (5.1–55.4) events/h on DAW1033D, P > 0.5) or genioglossus responsiveness (6.0 (2.6–9.2) on placebo vs 4.0 (3.5–7.3) %/cm H2O). Amongst the phenotypic traits, only Vpassive was improved by 29 (3–55) % eupnoea, P = 0.03 (mean (95% CI)). Conclusion: The combination of pseudoephedrine and diphenhydramine did not improve OSA severity or genioglossus responsiveness but induced a small improvement in upper airway collapsibility, possibly due to the decongestant effect of the medications. The results of this study do not support the use of these medications for OSA treatment. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea is associated with increased risk of car crashes; however, conventional measures of sleep apnea severity do not clearly identify those individuals who are at greatest risk. Here we tested whether, among individuals with sleep apnea, those with reduced interhemispheric sleep depth coherence, measured by correlation between right and left hemisphere odds ratio product, are at greater risk. The sample was derived from the Sleep Heart Health Study, a prospective observational cohort study, and included 1,378 adults with sleep apnea. The occurrence of a car crash was ascertained by a questionnaire administered 2 years after the sleep study, which asked about the occurrence of crashes during the year prior to questionnaire administration. We computed the sleep depth coherence from electroencephalograms recorded during baseline sleep studies and after 5 years. The weighted kappa coefficient and Bangdiwala's B were 0.34 and 0.59, respectively, indicating a fair to moderate stability over a 5‐year interval. Multivariate logistic regression, adjusted for age, sex, race, body mass index and miles driven per year, was used to assess the risk of a car crash. Compared to the lowest quartile of sleep depth coherence (<0.86), individuals in the highest quartile (>0.93) had a 62% (95% confidence interval, 22%‐81%) lower risk of an accident. Further adjustments for usual sleep duration and sleepiness did not meaningfully alter these findings. Higher interhemispheric sleep depth coherence is associated with significantly lower risk of motor vehicle crashes in individuals with sleep apnea. This suggests that high interhemispheric sleep depth coherence may be a marker of resistance to sleep apnea‐related adverse neurocognitive outcomes. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the physiological mechanism and spatial distribution of increased physiological dead-space, an early marker of ARDS mortality, in the initial stages of ARDS. We hypothesized that: increased dead-space results from the spatial redistribution of pulmonary perfusion, not ventilation; such redistribution is not related to thromboembolism (ie, areas with perfusion = 0 and infinite ventilation-perfusion ratio, V˙/Q˙ ), but rather to moderate shifts of perfusion increasing V˙/Q˙ in non-dependent regions.Methods: Five healthy anesthetized sheep received protective ventilation for 20 hours, while endotoxin was continuously infused. Maps of voxel-level lung ventilation, perfusion, V˙/Q˙ , CO2 partial pressures, and alveolar dead-space fraction were estimated from positron emission tomography at baseline and 20 hours.Results: Alveolar dead-space fraction increased during the 20 hours (+0.05, P = .031), mainly in non-dependent regions (+0.03, P = .031). This was mediated by perfusion redistribution away from non-dependent regions (-5.9%, P = .031), while the spatial distribution of ventilation did not change, resulting in increased V˙/Q˙ in non-dependent regions. The increased alveolar dead-space derived mostly from areas with intermediate V˙/Q˙ (0.5≤ V˙/Q˙ ≤10), not areas of nearly "complete" dead-space ( V˙/Q˙ >10).Conclusions: In this early ARDS model, increases in alveolar dead-space occur within 20 hours due to the regional redistribution of perfusion and not ventilation. This moderate redistribution suggests changes in the interplay between active and passive perfusion redistribution mechanisms (including hypoxic vasoconstriction and gravitational effects), not the appearance of thromboembolism. Hence, the association between mortality and increased dead-space possibly arises from the former, reflecting gas-exchange inefficiency due to perfusion heterogeneity. Such heterogeneity results from the injury and exhaustion of compensatory mechanisms for perfusion redistribution. [ABSTRACT FROM AUTHOR]

Charcot‐Marie‐Tooth disease (CMT) encompasses a set of genetically and clinically heterogeneous neuropathies characterized by length‐dependent dysfunction of the peripheral nervous system. Mutations in over 80 diverse genes are associated with CMT, and aminoacyl‐tRNA synthetases (ARS) constitute a large gene family implicated in the disease. Despite considerable efforts to elucidate the mechanistic link between ARS mutations and the CMT phenotype, the molecular basis of the pathology is unknown. In this work, we investigated the impact of three CMT‐associated substitutions (V155G, Y330C, and R137Q) in the cytoplasmic histidyl‐tRNA synthetase (HARS1) on neurite outgrowth and peripheral nervous system development. The model systems for this work included a nerve growth factor‐stimulated neurite outgrowth model in rat pheochromocytoma cells (PC12), and a zebrafish line with GFP/red fluorescent protein reporters of sensory and motor neuron development. The expression of CMT‐HARS1 mutations led to attenuation of protein synthesis and increased phosphorylation of eIF2α in PC12 cells and was accompanied by impaired neurite and axon outgrowth in both models. Notably, these effects were phenocopied by histidinol, a HARS1 inhibitor, and cycloheximide, a protein synthesis inhibitor. The mutant proteins also formed heterodimers with wild‐type HARS1, raising the possibility that CMT‐HARS1 mutations cause disease through a dominant‐negative mechanism. Overall, these findings support the hypothesis that CMT‐HARS1 alleles exert their toxic effect in a neuronal context, and lead to dysregulated protein synthesis. These studies demonstrate the value of zebrafish as a model for studying mutant alleles associated with CMT, and for characterizing the processes that lead to peripheral nervous system dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of immune cells and their effector cytokines in the pathogenesis and progression of knee osteoarthritis (OA) in matched OA synovial fluid (SF) and synovial tissue samples. Methods: Cells from matched samples of synovial tissue and SF acquired from individuals undergoing total knee replacement for OA (n = 39) were characterized for immune cell–associated surface markers and intracellular cytokine expression using polychromatic flow cytometry. Additional individuals with radiographic knee OA (Kellgren/Lawrence severity grades ≥1) who had available etarfolatide (inflammatory cell) imaging (n = 26) or baseline and 3‐year data on progression of radiographic knee OA (n = 85) were also assessed. SF cytokine concentrations in all cohorts were evaluated for associations with synovial tissue and SF cell phenotypes and severity of radiographic knee OA. Results: Macrophages (predominant in the synovial tissue, 53% of total cells) and neutrophils (predominant in the SF, 26% of total cells) were the major immune cell populations identified in the OA knee joints, exhibiting expression of or association with transforming growth factor β1 (TGFβ1) and elastase, respectively, in the SF. Expression levels of TGFβ1 and elastase were significantly associated with severity of radiographic knee OA. Baseline SF concentrations of TGFβ1 and elastase along with radiographic knee OA severity scores were predictive of knee OA progression, with areas under the receiver operating characteristic curves of 0.810 (for TGFβ1), 0.806 (for elastase), and 0.846 (for both TGFβ1 and elastase combined), with greater stability of prediction when both markers were utilized. Conclusion: Our findings demonstrate the hitherto underappreciated role of neutrophils in the sterile inflammatory process and progression of OA. Two soluble mediators, SF elastase and TGFβ1, are strong predictors of knee OA progression, reflecting a synergistic role of neutrophil and macrophage populations in the pathogenesis and worsening of OA that could potentially be utilized to identify patients who may have a greater risk of more rapid disease progression. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore the physiotherapists' lived experiences of providing pain education (PE), to people living with non‐specific low back pain (NSLBP). In previous studies, PE has been associated with positive clinical outcomes within the physiotherapeutic management of NSLBP. However, the meaning of providing PE, as experienced by physiotherapists, has not been specifically explored. Methods: This study adopted a hermeneutic phenomenological approach to explore PE experiences. Six semi‐structured interviews were conducted, interviews were transcribed and analysed in line with the 'interpretative phenomenological analysis' framework. Results: Five main thematic meaning structures emerged: Experienced significance of assessment in understanding NSLBP, PE as explaining the nature of NSLBP, Experienced challenges in providing PE, individualisation as key to PE for NSLBP and Reassurance as central to PE for people living with NSLBP. Conclusions: The significance of subjective assessment, was a key component of PE, as experienced by participants. However, differences were noted between participants in addressing the sense of assessment; in seeking a physiotherapeutic understanding of the NSLBP, and in seeking to understand the situation of those who are in pain. Within the participant experience, the significance of 'patient' reassurance was highlighted, related to the individualisation and outcome of PE. Reassurance, as described by participants, was emotive and practically grounded and linked with physical activity promotion. Individualisation in PE was meaningfully related to language modification and developing positive therapeutic relationships. Physiotherapists described PE particularly challenging related to pain chronicity and psychosocial factors, which may have significant implications to practice. [ABSTRACT FROM AUTHOR]

A 10‐year‐old intact male Golden Retriever was presented to The Ohio State University Veterinary Medical Center for acute, non‐painful facial swelling of the right mandibular region. On physical examination, the right mandibular swelling was found to represent marked lymphadenopathy of the submandibular lymph node. At this time, marked lymphadenopathy of the prescapular and popliteal lymph nodes was also appreciated. The CBC showed a moderate leukocytosis (38.4 × 109 cells/L, reference interval [RI] 4.8‐13.9 × 109 cells/L) characterized by a moderate lymphocytosis (28.4 × 109 cells/L, RI 1.0‐4.6 × 109 cells/L). Evaluation of peripheral blood and enlarged prescapular and popliteal lymph nodes revealed two morphologically different populations of homogeneous lymphocytes, with the lymphocyte population in the lymph nodes being distinct from that in the blood smear. Flow cytometry of peripheral blood revealed CD45‐, CD5+, CD4‐, CD8‐, variably CD21+ neoplastic lymphocytes compatible with T‐zone lymphocytes due to the absence of CD45 expression. Flow cytometry of the lymph node aspirate indicated a distinct population of CD21+ lymphocytes consistent with a B‐cell phenotype along with a smaller proportion of the T‐zone lymphocytes observed in the blood confirming the presence of two distinct populations of neoplastic lymphocytes, one involving T cells, and the other involving B cells. [ABSTRACT FROM AUTHOR]

Patient awareness of medical conditions may influence treatment seeking and monitoring of these conditions. Accurate awareness of hypertension reported to clinicians evaluating patients for whom clinical history is limited, such as in emergency care, can aid in diagnosis by revealing whether measured hypertension is typical or atypical. Measurement of blood pressure in a laboratory study was assessed at rest, immediately before phlebotomy, and within 10 minutes after. The resting measure was used to determine the accuracy of self-reported hypertension in 283 adults. Parametric analyses were conducted to identify potential variables influencing accuracy of self-reported hypertension. Sensitivity, specificity, and the kappa coefficient of agreement were calculated to determine the influence of alcohol dependence (AD), sex, age, and cigarette smoking on hypertension awareness. Self-report was mildly sensitive, correctly identifying individuals with hypertension in approximately 37% of the cases, but was highly specific (95%) in identifying individuals without hypertension. Similar sensitivities were found in analyses separated by sex. Sensitivity was greater in those over age 55 (53%) in comparison with those <54, as well as in those who were not smoking. Comparison of those with and without a history of AD revealed that both groups show similar accuracy in reporting hypertension. Absence of hypertension can be accurately determined with self-report data in those without hypertension. A significant proportion of those with measured hypertension report an absence of hypertension. [ABSTRACT FROM AUTHOR]

A 4‐year‐old male neutered domestic shorthair cat was presented to The Ohio State University College of Veterinary Medicine for a 2‐month history of severe weight loss, lethargy, anemia, and bilaterally hyperechoic kidneys with loss of corticomedullary distinction as reported by the referring veterinarian. Relevant initial laboratory results included severe non‐regenerative normocytic hypochromic anemia, increased blood urea nitrogen, minimally concentrated urine, proteinuria, and an increased urine protein:creatinine ratio. Cytologic evaluation of a bone marrow aspirate revealed a markedly hypocellular marrow with abundant mucinous material. Gelatinous marrow transformation (GMT) was confirmed histologically by the presence of mucinous material in the bone marrow that stained positive for Alcian blue but negative for periodic acid‐Schiff. The cat died despite repeated blood transfusions and supportive care. Gelatinous marrow transformation, immune complex‐mediated membranoproliferative glomerulonephritis, and gastrointestinal hemorrhage were observed on autopsy and histology. It is likely that the development of GMT was secondary to chronic kidney disease (CKD) and that CKD, GMT, and gastrointestinal hemorrhage contributed to the cat's non‐regenerative anemia. [ABSTRACT FROM AUTHOR]

A 6‐year‐old, spayed female, mixed shorthair cat presented to the emergency service at The Ohio State University Veterinary Medical Center for evaluation of hypercalcemia, a right eye mass, and multiple intrathoracic and intra‐abdominal masses. Cytologic evaluation of one of the abdominal masses revealed a uniform population of large, anaplastic mesenchymal cells found individually, in loose aggregates, and occasionally associated with pink, extracellular matrix. The cytology was consistent with a malignant mesenchymal neoplasm, with primary consideration given to fibrosarcoma and hemangiosarcoma. The cat was euthanized and histopathology confirmed disseminated fibrosarcoma. Fibrosarcoma comprises 12%‐41% of feline cutaneous tumors and affects cats at a mean age of 9.6 years. Three manifestations of fibrosarcoma predominate in cats: spontaneous solitary fibrosarcoma, vaccine‐induced/injection site fibrosarcoma, and oncogene‐induced (FSV) fibrosarcoma. The history, signalment, and results from diagnostics performed did not support solitary fibrosarcoma or injection‐induced sarcoma. Although some criteria fit with virally induced fibrosarcoma, such as age and the presence of multiple fibrosarcomas, the neoplastic population was negative for FeLV IHC. The presence of fibrosarcomas throughout the pleural and peritoneal cavity was most compatible with sarcomatosis and the distant metastasis of an unidentified primary neoplasm. To the authors' knowledge, this is the first reported case of sarcomatosis in a FeLV‐negative cat. [ABSTRACT FROM AUTHOR]