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Background:. Electrocautery has been a useful, fundamental instrument utilized for surgical procedures since its implementation in the 1920s. However, concerns exist regarding the health hazards of the by-product smoke associated with the use of electrocautery. Methods:. A comprehensive review of articles on the composition, mitigation, and effects of smoke was conducted using the PubMed search engine and excluding articles that did not meet the predetermined inclusion criteria. From January 1963 to December 2021, a total of 264 articles resulted, and a total of 69 articles were included in this narrative review. Results:. Surgical smoke contains volatile organic compounds, polycyclic aromatic compounds, viral particles, and ultrafine particles. There has been some evidence of mutagenicity to bacterial cells during animal in vivo studies, and one human survey study has shown similar mutagenic effects. We also discuss additional hemostatic techniques that can be used, including the use of hemostatic and antithrombolytic agents, epinephrine infiltration, and the use of tourniquet when appropriate. Conclusions:. Further studies should be conducted regarding human effects, but until the data are available, we recommend precautionary measures and actions to protect operating room staff from cautery smoke exposure.

Abstract Leucine-rich repeat containing 10 (LRRC10) is a cardiomyocyte-specific protein, but its role in cardiac biology is little understood. Recently Lrrc10 was identified as required for endogenous cardiac regeneration in zebrafish; however, whether LRRC10 plays a role in mammalian heart regeneration remains unclear. In this study, we demonstrate that Lrrc10 –/– knockout mice exhibit a loss of the neonatal mouse regenerative response, marked by reduced cardiomyocyte cytokinesis and increased cardiomyocyte binucleation. Interestingly, LRRC10 deletion disrupts the regenerative transcriptional landscape of the regenerating neonatal mouse heart. Remarkably, cardiac overexpression of LRRC10 restores cardiomyocyte cytokinesis, increases cardiomyocyte mononucleation, and the cardiac regenerative capacity of Lrrc10 –/– mice. Our results are consistent with a model in which LRRC10 is required for cardiomyocyte cytokinesis as well as regulation of the transcriptional landscape during mammalian heart regeneration.

Background:. Traumatic ballistic injury is an unfortunate and commonly encountered problem seen by surgeons. An estimated 85,694 nonfatal ballistic injuries occur annually, and in 2020 there were 45,222 firearm-related deaths in the United States. Surgeons of all subspecialties may provide necessary care. Acute care injuries are generally reported to authorities immediately; however, delayed presentation of ballistic injuries may go unreported despite regulations to do so. We present a case of a delayed ballistic injury and a comparative review of individual states’ reporting requirements to highlight statutory obligations and penalties as an educational reference for surgeons treating ballistic injuries. Methods:. Google and PubMed searches were performed utilizing keywords “ballistic,” “gunshot,” “physician,” and “reporting” as terms. Inclusion criteria included the English language, official state statute sites, legal and scientific articles, and websites. Exclusion criteria included nongovernmental sites and information sources. Data collected were analyzed to include statute numbers, time to report, infraction consequences, and monetary fines. The resultant data are reported by state and region. Results:. All but two state jurisdictions mandate healthcare providers to report knowledge and/or treatment of ballistic injuries, regardless of the timeline of injury. Violations of mandatory reporting may lead to fines or imprisonment, depending on the specific state. The timeline for reporting, fines, and subsequent legal action varies by state and region. Conclusions:. Requirements for reporting injuries exist in 48 of 50 states. The treating physician/surgeon should thoughtfully question patients with a chronic ballistic injury history and provide reports to local law enforcement.

Clean energy research and development (R and D) leading to commercial technologies is vital to economic development, technology competitiveness, and reduced environmental impact. Over the past 30 years, such efforts have advanced technology performance and reduced cost by leveraging network effects and economies of scale. After demonstrating promise in applied R and D, successful clean energy and energy efficiency technologies are incorporated into an initial product sold by the private sector. Despite its importance, processes by which first commercialization occurs are difficult to generalize while capturing specific insights from practitioners in markets and technologies. This paper presents a policy-focused qualitative assessment of the first commercialization of four diverse energy technologies: thin film photovoltaics, wind turbine blades, dual-stage refrigeration evaporators, and fuel cells for material handling equipment. Each technology presents distinct value propositions, markets, and regulatory drivers. The case studies indicate three common characteristics of successful first commercialization for new energy technologies: 1) good fit between the technology, R&D infrastructure, and public-private partnership models; 2) high degree of alignment of government regulations and R&D priorities with market forces; and 3) compatibility between time scales required for R&D, product development, and opportunities. These findings may inform energy investment decision-making, maximize benefits from R&D, and advance the transition to a low-emission future.

Heart failure is the leading cause of death worldwide. The inability of the adult mammalian heart to regenerate following injury results in the development of systolic heart failure. Thus, identifying novel approaches toward regenerating the adult heart has enormous therapeutic potential for adult heart failure. Mitochondrial metabolism is an essential homeostatic process for maintaining growth and survival. The emerging role of mitochondrial metabolism in controlling cell fate and function is beginning to be appreciated. Recent evidence suggests that metabolism controls biological processes including cell proliferation and differentiation, which has profound implications during development and regeneration. The regenerative potential of the mammalian heart is lost by the first week of postnatal development when cardiomyocytes exit the cell cycle and become terminally differentiated. This inability to regenerate following injury is correlated with the metabolic shift from glycolysis to fatty acid oxidation that occurs during heart maturation in the postnatal heart. Thus, understanding the mechanisms that regulate cardiac metabolism is key to unlocking metabolic interventions during development, disease, and regeneration. In this review, we will focus on the emerging role of metabolism in cardiac development and regeneration and discuss the potential of targeting metabolism for treatment of heart failure.

Measles is an important infectious disease system both for its burden on public health and as an opportunity for studying nonlinear spatio-temporal disease dynamics. Traditional mechanistic models often struggle to fully capture the complex nonlinear spatio-temporal dynamics inherent in measles outbreaks. In this paper, we first develop a high-dimensional feed-forward neural network model with spatial features (SFNN) to forecast endemic measles outbreaks and systematically compare its predictive power with that of a classical mechanistic model (TSIR). We illustrate the utility of our model using England and Wales measles data from 1944-1965. These data present multiple modeling challenges due to the interplay between metapopulations, seasonal trends, and nonlinear dynamics related to demographic changes. Our results show that while the TSIR model yields similarly performant short-term (1 to 2 biweeks ahead) forecasts for highly populous cities, our neural network model (SFNN) consistently achieves lower root mean squared error (RMSE) across other forecasting windows. Furthermore, we show that our spatial-feature neural network model, without imposing mechanistic assumptions a priori, can uncover gravity-model-like spatial hierarchy of measles spread in which major cities play an important role in driving regional outbreaks. We then turn our attention to integrative approaches that combine mechanistic and machine learning models. Specifically, we investigate how the TSIR can be utilized to improve a state-of-the-art approach known as Physics-Informed-Neural-Networks (PINN) which explicitly combines compartmental models and neural networks. Our results show that the TSIR can facilitate the reconstruction of latent susceptible dynamics, thereby enhancing both forecasts in terms of mean absolute error (MAE) and parameter inference of measles dynamics within the PINN. In summary, our results show that appropriately designed neural network-based models can outperform traditional mechanistic models for short to long-term forecasts, while simultaneously providing mechanistic interpretability. Our work also provides valuable insights into more effectively integrating machine learning models with mechanistic models to enhance public health responses to measles and similar infectious disease systems. Author summary: Mechanistic models have been foundational in developing an understanding of the transmission dynamics of infectious diseases including measles. In contrast to their mechanistic counterparts, machine learning techniques including neural networks have primarily focused on improving forecasting accuracy without explicitly inferring transmission dynamics. Effectively integrating these two modeling approaches remains a central challenge. In this paper, we first develop a high-dimensional neural network model to forecast spatiotemporal endemic measles outbreaks and systematically compare its predictive power with that of a classical mechanistic model (TSIR). We illustrate the utility of our model using a detailed dataset describing measles outbreaks in England and Wales from 1944–1965, one of the best-documented and most-studied nonlinear infectious disease systems. Our results show that overall, our neural network model outperforms the TSIR in all forecasting windows. Furthermore, we show that our neural network model can uncover the mechanism of hierarchical spread of measles where major cities drive regional outbreaks. We then develop an integrative approach that explicitly and effectively combines mechanistic and machine learning models, improving simultaneously both forecasting and inference. In summary, our work offers valuable insights into the effective utilization of machine learning models, and integration with mechanistic models, for enhancing outbreak responses to measles and similar infectious disease systems. [ABSTRACT FROM AUTHOR]

INTRODUCTION I. DECARBONIZATION'S PARTICIPATORY GAP A. Decarbonization's Transformative Potential B. Community Opposition, "NIMBYism," and NEPA Reform II. NEPA'S POTENTIAL AS A TOOL FOR COMMUNITY EMPOWERMENT A. NEPA's Structural Misfit B. [...], This Article addresses a potential tension between two ambitions for the transition to clean energy: reducing regulatory red-tape to quickly build out renewable energy, and leveraging that build-out to empower low-income communities and communities of color. Each ambition carries a different view of communities' role in decarbonization. To those focused on rapid build-out of renewable energy infrastructure, communities are a potential threat who could slow or derail renewable energy projects through opposition during the regulatory process. To those focused on leveraging the transition to clean energy to advance racial and economic justice, communities are necessary partners in the key decisions of the transition--including the development of renewable energy projects. The Biden Administration has committed to both ambitions, but there is a gap regarding what role communities will play in policies designed to implement decarbonization. This Article articulates this "participatory gap" in decarbonization policy and proposes changes to the regulations implementing the National Environmental Policy Act of 1969 (NEPA) that start bridging these ambitions. The Article offers proposals that would leverage NEPA's unique structure to empower communities in decarbonization. Specifically, it argues that NEPA's regulations should be reformed to require meaningful community engagement and enforce that commitment through a revitalized executive enforcement structure. Contrary to views that more community engagement will slow decarbonization, this Article argues that these reforms would support the rapid transition to renewable energy while also empowering communities and elevating justice as a central value in environmental policy.

We assessed the safety and efficacy of Formulated Collagen Gel (FCG) alone and with Ad5PDGF-B (GAM501) compared with Standard of Care (SOC) in patients with 1.5-10.0 cm(2) chronic diabetic neuropathic foot ulcers that healed

Abstract Introduction In emergency medicine, triage encompasses more than the initial prioritization of treatment; it also includes decisions about the most suitable level of care and disposition for each patient. However, the increasing use of mobile technology by patients in the emergency department (ED) introduces a new factor. This study aims to explore the relationship between patients’ cellphone use at the time of initial assessment and final disposition in the ED. Methods A prospective, cross-sectional study was conducted on 292 patients who presented to the ED between 9/1/2021 and 8/9/2022. Patients were stratified into two cohorts based on their behavior during the initial assessment: actively using a cell phone (n = 32) or not using a cell phone (n = 259). Final disposition was dichotomously recorded as admission or discharge. Hospital admission, hospital observation, and admission to the ED observation unit were consolidated into the combined category of admission. Results Patients not actively using their cell phone on initial assessment exhibited a discharge rate of 64%, while those engaged with their cellphones displayed notably higher dismissal rates at 94%. The calculated odds ratio (OR) of 8.4 (95% confidence interval: 1.96-36.0, p = 0.004) underscores a significantly heightened likelihood of dismissal among individuals actively using their cellphones, suggesting a potential association between cellphone use and a reduced probability of hospital admission. Conclusion The study suggests an association between cellphone use during initial ED assessment and higher discharge rates. While this introduces a novel concept, the study’s potential contribution to more informed and efficient triage decisions warrants careful consideration in future research and clinical applications.

To avoid the most catastrophic impacts of climate change, most of the world's oil and gas reserves must remain in the ground. In the United States, this would require a dramatic phaseout of oil and gas extraction nationwide over the coming decades. How could we accomplish this? While recent legal scholarship emphasizes the importance of a just transition away from oil and gas extraction, little work has been done to navigate the legal, political, and equity hurdles associated with phasing out oil and gas extraction. This Article seeks to start this conversation by offering one way to approach phaseouts of oil and gas extraction in the United States: prioritize phasing out extraction closest to people. This intuitive approach builds on the success of frontline communities in California and Colorado advocating for statewide setbacks that prioritize regulating oil and gas extraction closest to their communities. Among other virtues, this advocacy has successfully drawn the connection between the localized harms of oil and gas extraction on communities of color and low-income communities to the larger climate impacts of continued oil and gas extraction. This Article argues that phaseout policies should follow these communities' lead and articulates several priorities for doing so: (1) stopping new extraction closest to people, (2) monitoring continued extraction closest to people, (3) plugging and reclaiming wells closest to people, and (4) matching proximity-based phaseouts with decarbonization programs. This approach to managing the decline of oil and gas extraction in the United States places such policies on the strongest footing against legal challenges while also targeting the roots of political support for extraction by reducing local dependency and supporting communities that have borne the direct impacts of fossil fuel extraction. [ABSTRACT FROM AUTHOR]

Abstract Transportation accounts for one-quarter of all energy related greenhouse gas emissions. As it pertains to transport electrification, higher education institutions—such as universities—can model solutions that affect broader society. Despite this, higher education’s role in fleet electrification adoption has been understudied. We, therefore, modeled an archetypical higher education institution to analyze the carbon and economic payback periods of three electrification scenarios (Business-as-Usual, Targeted Electrification, and Full Electrification) using a cradle-to-grave lifecycle and technoeconomic approach. Given the archetypical higher education institution fleet of 368 vehicles, results show an economic ratio plateau point of about 8 years at 20 fuel-based cars replaced by electric vehicles and a carbon payback period peak of roughly 10 months at 50 fuel-based cars replaced. We then performed a multi-scalar analysis by leveraging implementation theory. We find that higher education institutions that adhere to the tenets of implementation theory are poised to be pro-environmental change agents in many regions and countries. The methods and findings herein can be adapted to other institutions, regardless of fleet size, and can bolster relevant decision-making outcomes now.

Introduction/Purpose: Avascular necrosis (AVN) is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is considered to be a strong predictor of preserved talus vascularity. The study sought to assess the accuracy of the Hawkins sign in a large, contemporary cohort and assess factors associated with inaccuracy. Methods: A retrospective review of all talar neck fractures from a single level I trauma center from 2008 to 2016 was performed. The presence of Hawkins sign and AVN were determined based on ankle radiographs 8 weeks after injury and at final follow-up, respectively. Patients with less than 6 months follow-up were excluded. Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (C.I.) and associations were examined with Fisher’s exact testing. Results: In total, 137 talar neck fractures were identified with 105 having adequate follow-up. Hawkins sign was observed in 21 tali, 3 (14%) of which later developed AVN (95% C.I., 3 – 36%). In the remaining 84 tali without Hawkins sign, 32 (38%) developed AVN (95% C.I., 28 – 49%). Of the 3 tali that developed AVN following observation of Hawkins sign, all patients were smokers. There were no cases of AVN in non-smokers with Hawkins sign (P=0.21), and smoking was not associated with AVN in patients without Hawkins sign (41% vs 36%, P=0.82). Conclusion: Hawkins sign may not be a reliable predictor of preserved talus vascularity in all patients. We identified three patients with positive Hawkins signs who developed AVN, all of whom were smokers. Factors impairing microvascular blood supply to the talus may lead to AVN even in the presence of preserved macrovascular blood flow and an observed Hawkins sign. Close monitoring of select patients with Hawkins sign should be considered and further research is needed to understand the factors limiting Hawkins sign accuracy. Prognostic accuracy of the Hawkins sign in predicting talar AVN

Abstract The morphogenetic process of apical constriction, which relies on non-muscle myosin II (NMII) generated constriction of apical domains of epithelial cells, is key to the development of complex cellular patterns. Apical constriction occurs in almost all multicellular organisms, but one of the most well-characterized systems is the Folded-gastrulation (Fog)-induced apical constriction that occurs in Drosophila. The binding of Fog to its cognizant receptors Mist/Smog results in a signaling cascade that leads to the activation of NMII-generated contractility. Despite our knowledge of key molecular players involved in Fog signaling, we sought to explore whether other proteins have an undiscovered role in its regulation. We developed a computational method to predict unidentified candidate NMII regulators using a network of pairwise protein–protein interactions called an interactome. We first constructed a Drosophila interactome of over 500,000 protein–protein interactions from several databases that curate high-throughput experiments. Next, we implemented several graph-based algorithms that predicted 14 proteins potentially involved in Fog signaling. To test these candidates, we used RNAi depletion in combination with a cellular contractility assay in Drosophila S2R + cells, which respond to Fog by contracting in a stereotypical manner. Of the candidates we screened using this assay, two proteins, the serine/threonine phosphatase Flapwing and the putative guanylate kinase CG11811 were demonstrated to inhibit cellular contractility when depleted, suggestive of their roles as novel regulators of the Fog pathway.

We investigate the vibrational predissociation dynamics of the hydrogen-bonded 3-aminophenolammonia cluster (3-AP-NH3) in the OH and NH stretching regions. Vibrational excitation provides enough energy to dissociate the cluster into its constituent 3-AP and NH3 monomers, and we detect the 3-AP fragments via (1 + 1) resonance-enhanced multiphoton ionization (REMPI). The distribution of vibrational states of the 3-AP fragment suggests the presence of two distinct dissociation pathways. The first dissociation channel produces a broad, unstructured feature in the REMPI-action spectrum after excitation of any of the OH or NH stretching vibrations, pointing to a nearly statistical dissociation pathway with extensive coupling among the vibrations in the cluster during the vibrational predissociation. The second dissociation channel produces distinct, resolved features on top of the broad feature but only following excitation of the OH or symmetric NH3 stretch in the cluster. This striking mode-specificity is consistent with strong coupling of these two modes to the dissociation coordinate (the O-H···N bond). The presence of clearly resolved transitions to the electronic origin and to the 10a² + 10b² state of the cis-3-AP isomer shows that vibrational excitation is driving the isomerization of the irans-3-AP-NH3 isomer to the cis-3-AP-NH3 isomer in the course of the dissociation. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Avascular necrosis (AVN) is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is considered to be a strong predictor of preserved talus vascularity. The study sought to assess the accuracy of the Hawkins sign in a large, contemporary cohort and assess factors associated with inaccuracy. Methods: A retrospective review of all talar neck fractures from a single level I trauma center from 2008 to 2016 was performed. The presence of Hawkins sign and AVN were determined based on ankle radiographs 8 weeks after injury and at final follow-up, respectively. Patients with less than 6 months follow-up were excluded. Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (C.I.) and associations were examined with Fisher's exact testing. Results: In total, 137 talar neck fractures were identified with 105 having adequate follow-up. Hawkins sign was observed in 21 tali, 3 (14%) of which later developed AVN (95% C.I., 3 - 36%). In the remaining 84 tali without Hawkins sign, 32 (38%) developed AVN (95% C.I., 28 - 49%). Of the 3 tali that developed AVN following observation of Hawkins sign, all patients were smokers. There were no cases of AVN in non-smokers with Hawkins sign (P=0.21), and smoking was not associated with AVN in patients without Hawkins sign (41% vs 36%, P=0.82). Conclusion: Hawkins sign may not be a reliable predictor of preserved talus vascularity in all patients. We identified three patients with positive Hawkins signs who developed AVN, all of whom were smokers. Factors impairing microvascular blood supply to the talus may lead to AVN even in the presence of preserved macrovascular blood flow and an observed Hawkins sign. Close monitoring of select patients with Hawkins sign should be considered and further research is needed to understand the factors limiting Hawkins sign accuracy. [ABSTRACT FROM AUTHOR]