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State and federal agencies regulate fecal indicator bacteria (FIB), such as E. coli or Enterococcus, in order to manage public health risks at swimming beaches. Despite these goals, watershed managers are challenged in terms of how to best clean up sources of FIB because concentrations frequently exceed water quality objectives, and sources—both human and nonhuman sources of FIB—appear to be everywhere. Since most nonhuman fecal sources represent substantially lower public health risks than human sources do, this study utilizes the human fecal source marker HF183 to better define watershed managers’ riskiest sites and times in order to prioritize remediation actions. A total of 117 samples were collected and analyzed for both FIB and HF183 from 26 sites during multiple sampling campaigns between 2019 and 2021 along the mainstem in addition to major tributaries in a highly urbanized watershed. The results indicated that the vast majority of samples (96%) quantified HF183 during wet weather, ranging from 99 to 44,768 gene copies/100 mL. Similar to HF183, the FIB results exceeded water quality objectives for 100% of the samples in wet weather; however, HF183 was rarely quantified in dry weather, with 3 of 72 samples (4%) exceeding 500 gene copies/100 mL, while two-thirds of samples (67%) exceeded FIB water quality objectives during dry weather. Where HF183 was detected in dry weather, isolated and unpredictable events explained human fecal pollution. It is more challenging in wet weather to identify and quantify the source(s) of human fecal pollution.

Social support is closely linked to health, but little is known about United States (U.S.) veterans' social support over time and factors that may influence their support trajectories. This study investigates social support over time for U.S. men and women Post-9/11 veterans in relation to trauma history and gender. A secondary analysis of longitudinal cohort data from the Survey of Experiences of Returning Veterans (SERV), which employed a repeated-measures longitudinal design using five waves of data (baseline, 3, 6, 9, 12 months) with 672 combat veterans. Results from random intercept multilevel models found no significant gender differences in social support over time. Veterans with complex trauma histories were at risk for lower social support across waves. A stability trend was also observed; specifically, at baseline, veterans who started with high support maintained their level over time whereas veterans who started with deficits in social support remained low over time. Veterans identifying as African American or Latinx, and those with lower annual incomes, reported lower support compared to White and higher-income veterans. Furthermore, low social support was significantly associated with severe posttraumatic stress symptoms and active suicidal ideation across 12 months. SERV utilized a nonrandom sampling method that may reduce generalizability of findings. There is also potential for residual confounding by factors related to both social support levels and time since discharge that were not available in this data set. Findings have implications for developing clinical and community interventions intended to support veterans as they transition back to the community. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This article reports the development of a “course trailer” video series that communicates the professional and academic value of general education courses' core competencies and describes the results of a survey measuring the impact of those videos on student perception. Although general education programs represent a staple of U.S. undergraduate education, enrolled students frequently misunderstand the nature and value of the programs' core goals and or competencies. Universities are making increasing use of devices such as catalog descriptions, mission statements, course websites or blogs, and course trailer videos to communicate and clarify their general education competencies and values; however, little empirical research exists demonstrating the efficacy of such devices. This study's results provide statistically significant evidence that the course trailer video series improved students' understanding of how general education course fit into both their academic and professional plans.

Summary Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding Cancer Research UK.

Summary Background Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding National Institute for Health Research Health Services and Delivery Research Programme.

R ESPONSE TO WEATHER WARNINGS. The National Weather Service (NWS) is responsible for issuing public warnings for all hazardous weather events across the United States. Advances in technology and basic scientific research over the years have allowed for significant improvements in this assignment. But while the NWS continues to focus much of its strategic planning toward improved warnings, most of those associated with the process are aware that there are a number of steps beyond increased accuracy to make their warnings effective. These include assuring that the target audience hears their message, understands it, believes it, and responds to it properly. One useful means of addressing these issues involves working directly with community response organizations, whose job it is to direct and allocate emergency services during catastrophic events. Often, the primary responsibility for identifying risks and managing vulnerabilities within a community is entrusted to a local emergency manager. With an emergency management system in place, disaster response can be more coordinated, flexible, and professional. However, one crucial factor in effectively managing emergencies is collaboration with organizational partners, and breakdowns in collaboration can adversely impact outcomes. In recent weather-related incidents, communications between the NWS and emergency managers have become confused. For example, in the case of the 2008 Windsor, Colorado, tornado, NWS forecasters tried to convey the urgency of a developing situation, while emergency managers awaited confirmation that a damaging event was actually underway. In that situation, it appears that emergency managers didn’t entirely understand how strongly forecasters felt about the potential threat, and NWS forecasters didn’t understand why emergency managers were not implementing emergency response immediately. The premise of the present study is that NWS forecasters can benefit from knowing more about their emergency management counterparts, including a general overview of the nature of that community, along with characteristics that might influence collaboration. To this end, a nationwide survey was conducted to learn more about the diversity of individual emergency managers and of the communities they serve.

Decentralized partially observable Markov decision processes (Dec-POMDPs) provide a general framework for multiagent sequential decision-making under uncertainty. Although Dec-POMDPs are typically intractable to solve for real-world problems, recent research on macro-actions (i.e., temporally-extended actions) has significantly increased the size of problems that can be solved. However, current methods assume the underlying Dec-POMDP model is known a priori or a full simulator is available during planning time. To accommodate more realistic scenarios, when such information is not available, this paper presents a policy-based reinforcement learning approach, which learns the agent policies based solely on trajectories generated by previous interaction with the environment (e.g., demonstrations). We show that our approach is able to generate valid macro-action controllers and develop an expectationmaximization (EM) algorithm (called Policy-based EM or PoEM), which has convergence guarantees for batch learning. Our experiments show PoEM is a scalable learning method that can learn optimal policies and improve upon hand-coded “expert” solutions.

Background The “RoPE Score” is a predictive model created to stratify patients by the likelihood that a patent foramen ovale (PFO) is incidental or pathogenic using clinical variables. We hypothesized that the predictors of recurrent stroke differ between patients with pathogenic and incidental PFOs. Methods Patients in the Risk of Paradoxical Embolism (RoPE) database with cryptogenic stroke (CS) and PFO were classified as having a probable pathogenic PFO (RoPE Score of >6, estimated PFO attributable fraction 72-99%, n=646) and others (RoPE Score of Results Follow-up was available for 91%, 80%, and 58% at 1, 2, and 3 years. Overall, a higher recurrence risk was associated with an index TIA, not being on a statin at baseline, and having a prior radiological stroke. For the low RoPE score group, older age, male sex, high cholesterol and antiplatelet (vs warfarin) treatment predicted recurrence. For those with high RoPE scores, predictors were prior (clinical) stroke/TIA and 2 echo features: septal hypermobility and a small shunt ( Conclusions Predictors of recurrence differ when PFO relatedness is classified by the RoPE Score. The hypothesis that patients with CS and PFO form a heterogenous group with different stroke mechanisms is supported. Conventional stroke risk factors were strong predictors among patients with lower RoPE scores. Echocardiographic features - including a counterintuitive association between smaller shunts and increased recurrence risk - were uniquely predictive in the high RoPE score group (likely pathogenic PFO).

Background Stroke databanks have consistently found a high ratio of anterior circulation (AC) to posterior circulation (PC) strokes without significant differences when compared for vascular risk factors, stroke etiology, treatments and outcome. One study suggested that there was a deviation from this consistent observation when comparing men and women with cryptogenic stroke (CS) and patent foramen ovale (PFO). We tested these associations using the RoPE database. Methods The Risk of Paradoxical Embolism (RoPE) Study is an international collaboration of 12 merged cohort studies of patients with CS and known PFO status (n=3674). This analysis was restricted to those subjects in the RoPE database with index strokes in the AC or PC (excluding both or unknown) from the 7 databases that had data for CS with, and without, PFO. We compared the effect of sex on infarct location among patients with versus without PFO. We used generalized linear mixed models to examine whether PFO status modified the gender effect on infarct location adjusting for study cohort as a random effect. Results Among cryptogenic stroke patients both with and without PFO, AC strokes were more common (61%) than PC overall (n=1535). Among patients with PFO, PC stroke was higher in men than in women (50% vs. 33%, OR 2.23, 95% CI: 1.58-3.13). This gender effect was attenuated in those without PFO (38% vs. 31%; OR 1.32, 95% CI: 0.98-1.77). The gender-by-PFO-status interaction was significant (p= 0.0224) and was highly consistent across study cohorts. Conclusions These data confirm that males with CS and PFO contravene the otherwise consistent pattern that AC strokes are more commonly observed than PC strokes in stroke populations. The potential mechanisms underlying this interaction between gender and PFO-status remain to be elucidated.

Background Enzymes involved in carbohydrate metabolism include Carbohydrate esterases (CE), Glycoside hydrolases (GH), Glycosyl transferases (GT), and Polysaccharide lyases (PL), commonly referred to as carbohydrate-active enzymes (CAZymes). The CE, GH, and PL superfamilies are also known as cell wall degrading enzymes (CWDE) due to their role in the disintegration of the plant cell wall by bacterial and fungal pathogens. In Phytophthora infestans, penetration of the plant cells occurs through a specialized hyphal structure called appressorium; however, it is likely that members of the genus Phytophthora also use CWDE for invasive growth because hyphal forces are below the level of tensile strength exhibited by the plant cell wall. Because information regarding the frequency and distribution of CAZyme coding genes in Phytophthora is currently unknown, we have scanned the genomes of P. infestans, P. sojae, and P. ramorum for the presence of CAZyme-coding genes using a homology-based approach and compared the gene collinearity in the three genomes. In addition, we have tested the expression of several genes coding for CE in cultures grown in vitro. Results We have found that P. infestans, P. sojae and P. ramorum contain a total of 435, 379, and 310 CAZy homologs; in each genome, most homologs belong to the GH superfamily. Most GH and PL homologs code for enzymes that hydrolyze substances present in the pectin layer forming the middle lamella of the plant cells. In addition, a significant number of CE homologs catalyzing the deacetylation of compounds characteristic of the plant cell cuticle were found. In general, a high degree of gene location conservation was observed, as indicated by the presence of sequential orthologous pairs in the three genomes. Such collinearity was frequently observed among members of the GH superfamily. On the other hand, the CE and PL superfamilies showed less collinearity for some of their putative members. Quantitative PCR experiments revealed that all genes are expressed in P. infestans when this pathogen grown in vitro. However, the levels of expression vary considerably and are lower than the expression levels observed for the constitutive control. Conclusions In conclusion, we have identified a highly complex set of CAZy homologs in the genomes of P. infestans, P. sojae, and P. ramorum, a significant number of which could play roles critical for pathogenicity, by participating in the degradation of the plant cell wall.

Culture-independent fecal source tracking methods have many potential advantages over library-dependent, isolate-culture methods, but they have been subjected to limited testing. The purpose of this study was to compare culture-independent, library-independent methods of fecal source tracking. Five laboratories analysed identical sets of aqueous samples that contained one or more of the following sources: sewage, human feces, dog feces, cattle feces and gull feces. Two investigators used methods based on PCR amplification of Bacteroidetes marker genes and both successfully discriminated between samples that did or did not contain human fecal material. One of these investigators was also able to identify the remaining sources, except for gull, with a low rate of false positives. A method based on E. coli toxin genes successfully identified samples containing sewage and cattle feces, but missed some samples with human feces because of low marker prevalence in individual human fecal samples. Researchers who used community terminal restriction fragment length polymorphism (T-RFLP) were limited by the amount of DNA recovered from samples, but they correctly identified human and cattle fecal contamination when sufficient DNA was obtained. Culture independent methods show considerable promise; further research is needed to develop markers for additional fecal sources and to understand the correlation of these source-tracking indicators to measures of human and environmental health.

The cytochrome P450 family of enzymes is involved in the Phase I metabolism of a wide variety of compounds. Although generally involved with detoxification, overexpression of one family member, cytochrome P450 1B1 (CYP1B1), has been associated with human epithelial tumors. As such, CYP1B1 was hypothesized to be a novel target for the development of anticancer therapies. We investigated expression of CYP1B1 protein in 61 human colorectal adenocarcinomas and compared this to that observed in 14 histologically normal human large bowel samples removed from patients undergoing surgery for large bowel tumors. Although we confirmed that CYP1B1 was expressed at high levels in human colorectal tumor epithelia, we also found that CYP1B1 was not absent from normal colonic epithelia but was expressed at low levels. The expression of CYP1B1 in colon tumors does not correlate with tumor stage or degree of lymph node invasion in this study. Furthermore, in addition to expression in colon epithelia, CYP1B1 is also observed in blood vessels within the colon. As with the epithelia, levels of CYP1B1 were higher in tumor vasculature than that of the normal colon. Although these observations greatly support the development of CYP1B1 targeted anticancer therapies, they also indicate the caution that should be observed when developing such drugs.

As part of MITRE's work under the DARPA TIDES (Translingual Information Detection, Extraction and Summarization) program, we are preparing a series of demonstrations to showcase the TIDES Integrated Feasibility Experiment on Bio-Security (IFE-Bio). The current demonstration illustrates some of the resources that can be made available to analysts tasked with monitoring infectious disease outbreaks and other biological threats.

By the East German authorities’ account, the “Anti-Fascist Wall of Protection,” or Berlin Wall, was built to thwart hordes of anti-communist commandos poised to invade the socialist republic. If the Party acknowledged the stream of refugees from East to West at all, it was only to decry the efforts of paid agitators luring or coercing skilled East German workers over the border. These paranoid scenarios, I will argue, represented more than just hard-line propaganda and political expediency; they arose from fundamental assumptions about the psyche and society. Through an exploration of East German cultural responses to the construction of the Wall, my paper outlines the ideological fantasies of the individual and social body that precipitated this drastic measure.

This paper describes a method for compiling a constraint-based grammar into a potentially more efficient form for processing. This method takes dependent disjunctions within a constraint formula and factors them into non-interacting groups whenever possible by determining their independence. When a group of dependent disjunctions is split into smaller groups, an exponential amount of redundant information is reduced. At runtime, this means that an exponential amount of processing can be saved as well. Since the performance of an algorithm for processing constraints with dependent disjunctions is highly determined by its input, the transformation presented in this paper should prove beneficial for all such algorithms., Comment: 6 pages LaTeX (uses colap.sty)D; To appear in the proceedings of COLING 1996

One of the major problems with surface-mounted or embedded induced strain actuator (ISA) patches are the considerably high stress gradients introduced at the edges of the actuator patches when an electric field is applied. These excessive stress gradients initiate debonding of the actuators from the substrate, thus affecting the mechanical reliability of the structure. This thesis is begun by investigating existing theoretical models of induced strain actuated structures, and will later use these to compare with the finite element analysis. The finite element analysis is used to explore the stress concentrations located at the edges of the actuators and begins by refining the mesh areas of the same structure focusing in on the ends of the ISA’s. This preliminary analysis is conducted on a structural configuration with a perfectly bonded actuator and proceeds to one with a finite bonding layer. After completion of the mesh refinement investigation several modifications in the design and implementation of the induced strain actuators are examined to reduce the stress concentrations at the edges of the actuators. In the finite element analysis two separate modeling considerations are examined: 1) The actuator is perfectly-bonded to the substrate. 2) A finite adhesive layer is incorporated between the actuator and the substrate. With each modeling consideration several design modifications are considered in this thesis including employing partial electrodes on the induced strain actuator surface regions instead of fully electroded surfaces, examining an actuator with a chamfered end, and using caps to reduce the stress concentrations and possibly increase the performance of the structure by allowing the induced strain actuators to utilize their piezoelectric strain coefficient in the thickness direction, d₃₃. The design modifications and different modeling techniques help to alleviate the critical stresses in the structure while gaining a better understanding of causes them. Master of Science