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This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies., Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb293

Some U.S. cities are excellent for cycling, like Portland, and some cities are not so good. This observation raises the question: what are the characteristics of a city that make it good for cycling? This study investigates the characteristics of 119 cities to explore what factors help make a city good for cycling. What “good” means in terms of cycling cities is subjective and we use the popular Bicycling Magazine ranking of cities for this purpose. We collected a variety of data sources about our cities including geographic, meteorology, and socioeconomic data. These data were used to conduct cluster analyses and create multivariate generalized linear regression models. We hypothesized that geographic and meteorology factors were important in determining good cycling cities. However, our hypothesis was proved wrong because socio-economic factors, like house pricing and obesity rates, play a more important role. For example, hilly cities, like San Francisco, can have excellent cycling infrastructure. The analysis shows what cities are like each other, regarding our considered characteristics; thus, city planners might wish to look at similar cities to help determine forecasts of expected use and public benefit of cycling. We use a case study of the Hampton Roads region of Virginia to show the application of our regression models.

Accurately representing flow across the mesoscale to the microscale is a persistent roadblock for completing realistic microscale simulations. The science challenges that must be addressed to coupling at these scales include the following: 1) What is necessary to capture the variability of the mesoscale flow, and how do we avoid generating spurious rolls within the terra incognita between the scales? 2) Which methods effectively couple the mesoscale to the microscale and capture the correct nonstationary features at the microscale? 3) What are the best methods to initialize turbulence at the microscale? 4) What is the best way to handle the surface-layer parameterizations consistently at the mesoscale and the microscale? 5) How do we assess the impact of improvements in each of these aspects and quantify the uncertainty in the simulations? The U.S. Department of Energy Mesoscale-to-Microscale-Coupling project seeks to develop, verify, and validate physical models and modeling techniques that bridge the most important atmospheric scales determining wind plant performance and reliability, which impacts many meteorological applications. The approach begins with choosing case days that are interesting for wind energy for which there are observational data for validation. The team has focused on modeling nonstationary conditions for both flat and complex terrain. This paper describes the approaches taken to answer the science challenges, culminating in recommendations for best approaches for coupled modeling.

Pain is commonly reported among those in treatment for substance use disorders (SUD) and is associated with poorer SUD treatment outcomes. The current study examined the trajectory of pain over the course of SUD treatment and associations with substance use outcomes.This observational study included adults seeking treatment for alcohol, cannabis, or opioid use disorders (N = 811). Participants completed a battery of assessments at treatment admission, 30 days post admission, and at discharge, including measures of demographics, pain, quality of life, abstinence self-efficacy, and craving.Analyses indicated linear reductions in pain intensity and interference over time. Significant interactive effects were observed for opioid use disorder (OUD) and time, such that participants with OUD had greater reductions in pain intensity and interference over time compared to those without OUD. Elevated pain intensity was associated with negative treatment outcomes, including reduced quality of life and abstinence self-efficacy, and greater craving and negative affect.Reductions in pain occur over the course of SUD treatment, particularly for those with OUD. Greater pain was also associated with adverse SUD treatment outcomes. Results suggest that treatment and associated abstinence may be beneficial for those with co-occurring pain and SUD, highlighting an additional benefit of improving access to SUD treatment for patients and health care systems. Future research should replicate these findings among diverse samples and further characterize the trajectory of pain during and after SUD treatment.

Anemia is a commonly encountered finding either during the preoperative assessment or during the postoperative management of the patient. Anemia often gets overlooked while more emphasis is paid to cardiovascular and pulmonary evaluation. Evidence, however, suggests that the presence of anemia in the perioperative period can predispose patients to other complications. Awareness of the consequences of anemia in the perioperative period can lead to better recognition and early management of this potentially modifiable risk factor. In this review, we focus on the effects of anemia on the cardiac, pulmonary, neurologic, cognitive, and functional status outcomes of patients. We also review management strategies that could be employed, depending on the available time and resources.

A multicenter, phase 4, randomized, comparative-efficacy study in subjects with lower extremity wounds was carried out to compare wound closure rates, for a single-use negative pressure wound therapy (s-NPWT) versus traditional NPWT (t-NPWT) systems over a 12-week treatment period. From the initial population of patients with diabetic foot ulcers (DFU) and venous leg ulcers (VLU), we analyzed a subgroup of patients with diabetes mellitus and leg and foot ulcers (either DFUs or VLUs in diabetics), termed, the diabetic lower extremity ulcers (DLEU). In the DLEU group, there were 95 patients in intention-to-treat (ITT) and 61 patients in per protocol (PP) populations, respectively. We found a significant difference in favor of s-NPWT over t-NPWT in the confirmed wound closures at 12 weeks both in ITT (p 0.001) and PP populations (p = 0.017). Significantly higher wound closure rates in s-NPWT group suggest that s-NPWT should be preferred NPWT option for DLEU.

Concussions are frequent in sports and can contribute to significant and long-lasting neurological disability. Adolescents are particularly susceptible to concussions, with accurate determination of the injury challenging. Our previous study demonstrated that concussion diagnoses could be aided by metabolomics profiling and machine learning, with particular weighting on changes in plasma glycerophospholipids (PCs). Here, our aim was to report directional change of PCs after concussion and develop a diagnostic concussion panel utilizing a minimum number of plasma PCs. To this end, we enrolled 12 concussed male athletes at our academic Sport Medicine Concussion Clinic, as well as 17 sex-, age-, and activity-matched healthy controls. Blood was drawn and 71 plasma PCs were measured for statistically significant changes within 72 h of injury, and individual PCs were further analyzed with receiver operating characteristic (ROC) curves. Our data demonstrated that 26 of 71 PCs measured were significantly decreased after sports-related concussion (p < 0.01). None of the PCs increased in plasma after concussion. ROC curve analyses identified the top four PCs with areas under the curve (AUCs) ‡0.86 for concussion diagnosis: PCaeC36:0 (0.92; p < 0.001); PCaaC42:6 (0.90; p < 0.001); PCaeC36:2 (0.86; p = 0.001), and PCaaC32:0 (0.86; p = 0.001). Cut-off values in lM were £0.31, 0.22, 5.07, and 4.63, respectively. Importantly, combining these four PCs produced an AUC of 0.96 for concussion diagnoses (p < 0.001; 95% confidence interval, 0.89, 1.00). Our data suggest that as few as four circulating PCs may provide excellent diagnostic potential for adolescent concussion. External validation is required in larger cohorts.

This article develops a new theoretical basis for decomposing signals that are formed by the linear superposition of a finite number of modes. Each mode depends linearly on the weights within the superposition and nonlinearly upon several other parameters. The particular focus of this article is upon finding both the weights and the parameters when the number of modes is not known in advance. This article introduces a novel mathematical formalism, aggregation sheaves, and shows how they characterize the behavior of greedy algorithms that attempt to solve modal decomposition problems. It is shown that minimizing the local consistency radius within the aggregation sheaf is guaranteed to solve all modal decomposition problems. Since the modes may or may not be well-separated, a greedy algorithm that identifies the most distinct modes first may not work reliably.

The optimal treatment of complex proximal humeral fractures in adults remains controversial. We evaluated the risk of complications and the long-term outcomes in patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus treated with open reduction and plate fixation (ORIF).Between 1995 and 2012, 5,897 consecutive patients with a proximal humeral fracture were referred to a specialist shoulder clinic for surgical assessment. Indications for surgery included anterior or posterior fracture-dislocation, substantial tuberosity involvement with1 cm of displacement in a Neer 3 or 4-part fracture configuration, disengagement of the head from the shaft, or severe varus or valgus deformity of the head. All patients who met the surgical criteria and had been followed for 2 years were included, and standardized clinical and radiographic assessments of outcomes were performed. At a median of 10.8 years (range, 5 to 22 years) after ORIF, all surviving cognitively intact patients completed a patient-reported questionnaire assessing functional outcomes and satisfaction.Three hundred and sixty-eight patients (6.2%) met the inclusion criteria and had the appropriate follow-up. The study population had a high rate of complex fracture configurations; 77.2% had tuberosity involvement, 54.1% had complete head-shaft disengagement, and 44.0% had a dislocated head. Eighty-seven patients (23.6%) had postoperative stiffness, 25 (6.8%) had fixation failure/nonunion, and 16 (4.3%) had late osteonecrosis/posttraumatic osteoarthritis; these complications were the reason for the majority of the reoperations in the cohort. The survivorship until any reoperation was 74% at 10 years, but when reoperations for stiffness were excluded, the survivorship was 90% during the same time period. The patients' mean levels of pain, function, and satisfaction with treatment were good to excellent.Our results support the use of primary ORIF in medically fit patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus in centers where the expertise to carry out such treatment exists.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background This retrospective study aims to compare the outcome of the Latarjet procedure when used as a primary or revision procedure for recurrent anterior gleno-humeral instability. Methods One hundred and ninety-seven patients underwent 205 open Latarjet procedures during the period 2006–2015 (mean follow-up 5.6 years). Sixty shoulders had failure of a previous stabilisation requiring revision to the Latarjet procedure. Outcomes were measured using the Western Ontario Shoulder Instability Index and Quick Disabilities of the Arm, Shoulder and Hand score. Survival analyses were performed using Kaplan–Meier curves, and multiple linear regression modelling was utilised to identify predictors of functional outcome (p Results Two shoulders had recurrent dislocations in the cohort of 205 (1.0%). Six shoulders underwent further surgery for non-instability complications (2.9%). There were no significant differences in the clinical or functional outcome between patients undergoing a primary Latarjet procedure and those who required revision of a failed soft-tissue stabilisation. Ninety-two per cent of patients were satisfied with their shoulder following surgery. Patient-reported instability and satisfaction was significantly associated with poorer functional scores. Discussion The Latarjet procedure successfully prevents recurrent anterior instability and is associated with high levels of satisfaction. Patient-reported outcome measures suggest no difference between primary and revision procedures.

Study Design: Ambispective study with propensity matching. Objective: To assess the impact of cervical spondylolisthesis (CS) on clinical presentation and surgical outcome in patients with degenerative cervical myelopathy (DCM). Methods: A total of 458 magnetic resonance images (MRIs) from the AOSpine CSM-NA and CSM-I studies were reviewed and CS was identified. Patients with DCM were divided into 2 cohorts, those with CS and those without, and propensity matching was performed. Patient demographics, neurological and functional status at baseline and 2-year follow-up were compared. Results: Compared with nonspondylolisthesis (n = 404), CS patients (n = 54) were 8.8 years older ( P < .0001), presented with worse baseline neurological and functional status (mJOA [modified Japanese Orthopaedic Association Assessment Scale], P = .008; Nurick, P = .008; SF-36-PCS [Short Form–36 Physical Component Score], P = .01), more commonly presented with ligamentum flavum enlargement (81.5% vs 53.5%, P < .0001), and were less commonly from Asia ( P = .0002). Surgical approach varied between cohorts ( P = .0002), with posterior approaches favored in CS (61.1% vs 37.4%). CS patients had more operated levels (4.3 ± 1.4 vs 3.6 ± 1.2, P = .0002) and tended to undergo longer operations (196.6 ± 89.2 vs 177.2 ± 75.6 minutes, P = .087). Neurological functional recovery was lower with CS (mJOA [1.5 ± 3.6 vs 2.8 ± 2.7, P = .003]; Nurick [−0.8 ± 1.4 vs −1.5 ± 1.5, P = .002]), and CS was an independent predictor of worse mJOA recovery ratio at 2 years (B = −0.190, P < .0001). After propensity matching, improvement of neurological function was still lower in CS patients (mJOA [1.5 ± 3.6 vs 3.2 ± 2.8, P < .01]; Nurick [−0.8 ± 1.4 vs −1.4 ± 1.6, P = .02]). Conclusions: CS patients are older, present with worse neurological/functional impairment, and receive surgery on more levels and more commonly from the posterior. CS may indicate a more advanced state of DCM pathology and is more likely to result in a suboptimal surgical outcome.

Regulators and shareholders generally oppose any restriction on clients' rights to sue their auditors, believing that such restrictions would impair reporting quality. However, the evidence suggests that the opposition to limitation of liability agreements (LLAs) between clients and auditors is likely unwarranted. Specifically, the evidence indicates that LLAs are beneficial to clients by lowering their audit fees. More importantly, we find no evidence that they impair financial reporting quality in general. Hence, the extant contracts limiting clients' rights to sue their auditors appear to benefit auditors and their clients without any apparent detriment to the quality of financial reporting.

Cyber peacekeeping has quickly risen in prominence as a viable way to regulate the impact cyber warfare has upon civilian security. In this article, the concept of a cyber buffer zone is explored, and proposals are made on how it could be used to further the goals of a cyber peacekeeping operation. The article suggests what the goals of a cyber buffer zone could be, and translates the activities of a traditional UN buffer zone into a cyber warfare context. It is shown that many of the activities translate well, and that there is true value to be found in a cyber buffer zone. Whilst valuable, it is noted that many challenges await those tasked with implementing such an idea. However, by beginning the debate today the authors can give peacekeeping organisations and the international community as a whole the best opportunity to be prepared for what cyber warfare will bring.

This essay advances a version of the flicker of freedom defense of the Principle of Alternative Possibilities (PAP) and shows that it is invulnerable to the major objections facing other versions of this defense. Proponents of the flicker defense argue that Frankfurt-style cases fail to undermine PAP because agents in these cases continue to possess alternative possibilities. Critics of the flicker strategy contend that the alternatives that remain open to agents in these cases are unable to rebuff Frankfurt-style attack on the grounds that they are insufficiently robust (that is, morally significant in a way that could ground ascriptions of moral responsibility). Once we see that omissions are capable of constituting robust alternatives, even when they are not intentional, it becomes clear that agents in these cases do indeed possess robust alternative possibilities—alternatives that are ineliminable from cases of this sort. The upshot is that Frankfurt-style cases are theoretically incapable of providing us with good grounds for rejecting PAP.

Stand-alone (SA) zero-profile implants are an alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF). In this study, we investigate differences in surgical outcomes between SA and CP in ACDF. We conducted a retrospective analysis of 166 patients with myelopathy and/or radiculopathy who had ACDF with SA or CP from Jan 2013–Dec 2016. We measured surgical outcomes including Bazaz dysphagia score at 3 months, Nurick grade at last follow-up, and length of hospital stay. 166 patients (92F/74M) were reviewed. 92 presented with radiculopathy (55%), 37 with myelopathy (22%), and 37 with myeloradiculopathy (22%). The average operative time with CP was longer than SA (194 ± 69 vs. 126 ± 46 min) (p &lt, 0.001), as was the average length of hospital stay (2.1 ± 2 vs. 1.5 ± 1 days) (p = 0.006). At 3 months, 82 patients (49.4%) had a follow-up for dysphagia, with 3 patients reporting mild dysphagia and none reporting moderate or severe dysphagia. Nurick grade at last follow-up for the myelopathy and myeloradiculopathy cohorts improved in 63 patients (85%). Prolonged length of stay was associated with reduced odds of having an optimal outcome by 0.50 (CI = 0.35–0.85, p = 0.003). Overall, we demonstrate that there is no significant difference in neurological outcome or rates of dysphagia between SA and CP, and that both lead to overall improvement of symptoms based on Nurick grading. However, we also show that the SA group has shorter length of hospital stay and operative time compared to CP.

The longstanding dominant view is that health care practitioners should be permitted to refrain from participating in medical interventions when they have a conscientious objection to doing so in a broad range of cases. In recent years, a growing minority have been fervently advocating a sea change. In their view, medical professionals should not be permitted to refuse to participate in medical interventions merely because doing so conflicts with their own moral or religious views. One of the most commonly offered arguments in support of this position focuses on the fact that health care practitioners knew what they were getting into when they voluntarily chose to take on their professional roles; nobody forced them to do this. I will argue that, despite its popularity among opponents of conscientious refusal, this argument from voluntariness fails to provide us with a good reason to reject broad accommodationism in favour of non-accommodationism.

BACKGROUND The prevalence of nonunion after a proximal humeral fracture (PHF) and the risk factors for its occurrence are poorly defined. We aimed to estimate the rate of nonunion in nonoperatively treated patients and to produce a clinical model for its prediction. METHODS Two thousand two hundred and thirty adult patients (median age, 72 years [range, 18 to 103 years]; 75.5% were female) with a PHF underwent assessment of fracture union using standard clinical evaluation and conventional radiographs. We assessed the prevalence of nonunion and measured the effect of 19 parameters on healing. Best statistical practices were used to construct a multivariate logistic regression model. The PHF assessment of risk of nonunion model (PHARON) was externally validated in a subsequent prospectively collected population of 735 patients, treated by the same protocol in our institution. RESULTS Overall, 231 (10.4%) of 2,230 patients developed nonunion. Only 3 (0.8%) of 395 patients with a head-shaft angle (HSA) of >140° developed nonunion; in this cohort, none of the measured candidate variables were independently predictive of nonunion on multivariate logistic regression analysis. In the larger cohort of 1,835 patients with an HSA of ≤140°, 228 (12.4%) developed nonunion. Decreasing HSA, increasing head-shaft translation (HST), and smoking were independently predictive of nonunion on multivariate analysis. The prevalence of nonunion was very low (1%) in the majority with both an HSA of >90° and HST of

Objective: To identify and assess the criticality for infrastructure assets and better understand their dependencies, interdependencies, and supply chain reliance. Design: This study used a modified mission impact, symbolism, history, accessibility, recognizability, population, and proximity model combined with a deliberative process with regional subject matter experts. Setting: Hampton roads Virginia maritime area. Participants: Emergency managers, US Corps of Engineers, US Coast Guard, law enforcement, railroad industry, intelligence community, Virginia Department of Emergency Management, Virginia Department of Transportation, and Virginia Port. Main outcome: A prioritized list of one-to-n critical assets in the maritime area and identification of up and downstream dependencies. Results: The final most highly critical grouping included 26 out of 277 assets including especially important road bridges and tunnels, rail bridges and choke points, shipping channels, and marine terminals. Conclusions: Subject matter experts identified 277 critical infrastructure assets in the Hampton Roads Maritime Area (HRMA). From these, 26 assets that were deemed to be significantly more critical than others. From this reduced list, 12 were further assessed to be most important. The selection process provided significant support to those responsible for providing protection, mitigating potential damage, and planning recovery and allows informed, objective expenditures of limited funding. Additional key findings include the following: Proximity, or the potential for an asset that has been damaged or destroyed to cause direct harm to adjacent assets in the surrounding community, drives criticality in the HRMA more than any other factor in the model . A small group of 26 out of 277 assets exerts an outsized impact in the HRMA—nearly 20 percent of criticality—due to the potential consequences associated with their destruction or disruption . Road transportation, particularly tunnels, represents the primary dependency among critical assets. Major road and maritime transportation assets rely heavily on federal and state organizations to maintain their function . Supply chain: The critical asset group supports or supplies many missions and industries both nationally and internationally, including defense, manufacturing, commercial enterprise, and the movement of raw commodities .

For thousands of years, humankind has utilized star tracking to measure both time and geographical location. In the modern technological era, the problem of telling one's orientation and position from images of the stars has newfound importance when related to satellite communication systems. For example, developments in laser-based communication systems promise huge gains in data rates; however, they tend to require a much finer pointing accuracy in order to hit and track their target as compared to radio frequency due to having a more focused emission pattern. As such, satellites with laser-based communications systems require the ability to obtain their attitude with a much higher degree of accuracy than traditional radio-based communication. For example, in [1], the Mars-to-Earth optical communications system studied requires a pointing accuracy on the order of 2-5 microradians, with an estimated update clock of several hundred Hertz. For contrast, the high-gain antenna of the Mars Reconnaissance Orbiter (MRO) had a pointing accuracy requirement of 2.08 milliradians that could update at 10Hz-10kHz [2] (note that MRO did not use star trackers, but rather used the Electra radio; one can study its performance in [3]).

Rationale: The increased prevalence of obstructive sleep apnea (OSA) coincides with a severe shortage of sleep physicians. There is a need for widescale home-sleep-testing devices with accurate aut...

UNSTRUCTURED Anemia is a commonly encountered finding either during the preoperative assessment or during postoperative management of the patient. Anemia often gets overlooked while more emphasis is paid to cardiovascular and pulmonary evaluation. Evidence however suggests that presence of anemia in the perioperative period can predispose patients to other complications. Awareness of the consequences of anemia in the perioperative period can lead to better recognition and early management of this potentially modifiable risk factor. In this review we focus on the effects of anemia on the cardiac, pulmonary, neurologic, cognitive and functional status outcomes of patients. We also review management strategies that could be employed, depending on the available time and resources.

Whether a file is accepted by a single parser is not a reliable indication of whether a file complies with its stated format. Bugs within both the parser and the format specification mean that a compliant file may fail to parse, or that a non-compliant file might be read without any apparent trouble. The latter situation presents a significant security risk, and should be avoided. This article suggests that a better way to assess format specification compliance is to examine the set of error messages produced by a set of parsers rather than a single parser. If both a sample of compliant files and a sample of non-compliant files are available, then we show how a statistical test based on a pseudo-likelihood ratio can be very effective at determining a file's compliance. Our method is format agnostic, and does not directly rely upon a formal specification of the format. Although this article focuses upon the case of the PDF format (ISO 32000-2), we make no attempt to use any specific details of the format. Furthermore, we show how principal components analysis can be useful for a format specification designer to assess the quality and structure of these samples of files and parsers. While these tests are absolutely rudimentary, it appears that their use to measure file format variability and to identify non-compliant files is both novel and surprisingly effective., 15 pages, 8 figures

BACKGROUND: A minority of proximal humeral fractures extend into the diaphysis and their optimal treatment remains controversial. We evaluated the outcomes and risk of complications in patients with these injuries, treated by a protocol of open reduction and long locking plate fixation (LPF).METHODS: Between 2007 and 2014, all locally resident patients with a proximal humeral fracture extending into the diaphysis were referred to a specialist shoulder clinic. Operative treatment using a protocol of open reduction and LPF was offered to medically fit patients. Those with 2-year radiographic follow-up were included in the study, and standardized assessments of clinical and radiographic outcomes were performed during the first 2 years postoperatively. At a mean of 8.8 years (range, 5 to 12 years) after LPF, the functional outcomes and satisfaction of surviving, cognitively intact patients were assessed with a questionnaire study.RESULTS: One hundred and two patients met the inclusion criteria; the majority were older women who had incurred the injury during a simple fall. Fractures were divided into 2 types depending on the pattern of diaphyseal extension. The pain levels, functional scores, and satisfaction with treatment were satisfactory both at the 2-year follow-up and at the longer-term follow-up at a mean of 8.8 years postsurgery. Complications were predominantly due to postsurgical stiffness (in 7 patients, with 3 undergoing additional surgery) and nonunion or fixation failure (in 7 patients, with 6 undergoing additional surgery).CONCLUSIONS: Proximal humeral fractures with diaphyseal extension are rare. The results of our study support the use of LPF in medically stable patients in centers with the expertise to perform these procedures.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Honeycomb structures display extraordinary stiffness-to-weight ratio when loaded in the out-of-plane direction. When realized using thermoplastic polyurethane (TPU), the structures offer the potential for repeatable and high specific energy absorption. Varying the cell size and wall thickness of TPU honeycombs facilitates changes in stiffness magnitude, though affords only modest capacity to alter the shape of the stress-strain curve. 3D printing facilitates advanced design exploration, beyond that of straight walls. Origami fold patterns have demonstrated the ability to influence the buckling behavior of tubular structures. Here we demonstrate the incorporation of origami folds into square honeycombs. The fold parameters facilitate significant tailoring of the stress-strain curve, allowing a range of profiles from quasi-rectangular to quasi-linear to be achieved; such structures can find applications in situation-specific energy absorption scenarios.

Through a survey of 1,470 cadets at the U.S. Military Academy, we measure the strength of civil-military norms in the midst of their socialization to civil-military values. In addition, we use an embedded list experiment to measure true preferences to controversial questions in civil-military affairs, such as competing loyalties to democratic governance. To analyze cadet adherence to norms we first articulate a framework of various conceptions of professionalism. While cadets do not exhibit adherence to one particular framework, we find limited adherence to a purist Huntington model, and more of a conflicted reading of Huntington, as well as selectivity and superficiality in their commitment to norms, largely driven by their own partisan preferences. Lastly, we find concerning evidence that a significant number of cadets prioritize following orders over upholding democratic traditions, justifying Janowitz’s concerns that a military separate from society could breed attitudes among military personnel antithetical to democracy.

Background The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (≥3 month) and non-union (≥6 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation. Methods A consecutive series of patients over 10-years were retrospectively reviewed using the QuickDASH, Oxford Shoulder Score and EuroQol five-dimension summary index (EQ-5D). These patients were compared to a matched cohort that achieved union after non-operative management using propensity score matching. Results Sixty patients (follow-up 79%, n = 60/76) at 4.1 years post-operative (1.1–10.0 years) had a QuickDASH of 16.5 (95% CI 11.6–21.5), Oxford Shoulder Score 41.5 (39.0–44.1) and EQ-5D 0.7621 (0.6822–0.8421). One in five patients were dissatisfied with their final outcome ( n = 13/60). Functional outcome was inferior following fixation when compared to patients that united with non-operative management (QuickDASH 16.5 vs. 5.5, p Conclusions Clavicle fixation for delayed and non-union is a cost-effective intervention but outcomes are worse compared to patients that unite with non-operative management.

International standards ensure that equestrian helmets achieve high performance. Recently, one such standard (PAS 015) was revised to include a lateral deformation requirement, ensuring helmets can withstand the potential crushing forces associated with equestrian. This increased performance needs to be achieved against a minimal mass penalty, which is an important consumer consideration. This paper explores how shell design optimisation can improve crush resistance, validated using additive manufacturing and mechanical testing. This approach achieved a 73% increase in crush force, for only an 11% mass increase.

Additive Manufacturing of cellular lattice structures offers opportunities to fine-tune the mechanical response by altering geometric variables. It is known that heat treatment cycles provide an effective way of altering mechanical properties while relieving residual stress. By exploiting the combined influence of these two variables, this study demonstrates the possibility of optimising energy absorption in AlSi10Mg honeycomb lattice structures, manufactured using selective laser melting. This finding indicates that heat treatment and powder quality have a significant influence on the mechanical response of the honeycomb. Additionally, this highlights the opportunity to establish an energy absorption diagram, via mapping the relative performance of variable lattice geometries and heat treatment cycles. At the same time, the consistency of powder quality can be tightly controlled.

No treatment is available to address the unmet needs of mucopolysaccharidosis (MPS) IIIA patients. Targeting the root cause, we developed a new self-complementary adeno-associated virus 9 (scAAV9) vector to deliver the human N-sulfoglucosamine sulfohydrolase (hSGSH) gene driven by a miniature cytomegalovirus (mCMV) promoter. In pre-clinical studies, the vector was tested at varying doses by a single intravenous (i.v.) infusion into MPS IIIA mice at different ages. The vector treatments resulted in rapid and long-term expression of functional recombinant SGSH (rSGSH) enzyme and elimination of lysosomal storage pathology throughout the CNS and periphery in all tested animals. Importantly, MPS IIIA mice treated with the vector at up to 6 months of age showed significantly improved behavior performance in a hidden task in the Morris water maze, as well as extended lifespan, with most of the animals surviving within the normal range, indicating that the vector treatment can prevent and reverse MPS IIIA disease progression. Notably, 2.5 × 1012 vector genomes (vg)/kg was functionally effective. Furthermore, the vector treatment did not lead to detectable systemic toxicity or adverse events in MPS IIIA mice. These data demonstrate the development of a safe and effective new gene therapy product for treating MPS IIIA, which further support the extended clinical relevance of platform recombinant AAV9 (rAAV9 gene delivery for treating broad neurogenetic diseases., Graphical Abstract, This study developed a new effective scAAV9 gene therapy product via a systemic delivery to address the critical unmet medical needs of MPS IIIA. Data generated further support the extended clinical relevance of platform rAAV9 gene delivery for treating broad neurogenetic diseases.

The Federal Reserve Bank of Kansas City has been developing environments uniquely tailored for long-tail researchers in and around the field of economics. Due to the unique requirements of researchers in the Federal Reserve System, the Bear high performance computing environment was developed to meet our researchers’ computational and data needs, which have grown dramatically over the past few decades. In addition to increased accessibility, the environment meets an increasing number of usage modalities, demanding research cycles while decreasing the barrier of entry for researchers who have little to no experience using advanced research computing environments. We took the lessons learned from our previous environment, Bull, and improved on the pain points experienced with our diverse researcher base. We have found that Bear has improved user experience and has led to better usability while finding unique solutions to delivering resources. We have also updated and facilitated better training to give researchers in the Federal Reserve System the tools necessary to take advantage of not only Bear but also other cyberinfrastructure in the larger research ecosystem.