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Background: Right heart catheterization (RHC) is the gold standard for diagnosing pulmonary hypertension (PH) in patients with interstitial lung disease (ILD). However, discrepancies between pulmonary arterial wedge pressure (PAWP) and left ventricular end-diastolic pressure (LVEDP) remain understudied in this population. Methods: We conducted a retrospective analysis of data from ILD patients who underwent RHC and had concomitant LVEDP measurements. Pulmonary vascular resistance (PVR) was calculated using both PAWP and LVEDP. Patients were categorized based on PAWP and LVEDP values using a threshold of 15 mmHg and PVR values using a threshold of 2 or 3 Wood Units. After that patients were categorized as concordant or discordant if both values were on the same or opposite sides of these thresholds, respectively. A discordantly higher PAWP group (left atrial dysfunction, LAD) was defined as patients with a PAWP-LVEDP difference of more than 3 mmHg. Results: Among 87 ILD patients, 9 patients (10.3%) showed discordance between PAWP and LVEDP. LAD was observed in 12 patients (13.8%) and was associated with lower forced vital capacity (Odd ratio [OR]: 0.956, p = 0.049) and a larger left atrium diameter (OR: 3.205, p = 0.033). Discordance in PVR values was also noted, with potential treatment targets for PH-specific therapy differing in 9 patients (22.0%) depending on whether PAWP or LVEDP was used. Conclusions: This study highlights the clinical significance of PAWP-LVEDP discrepancies in suspected PH-ILD patients, emphasizing the need for comprehensive assessments incorporating LVEDP and clinical context for accurate diagnosis, risk stratification, and treatment decisions.

This study examines the photovoltaic (PV) energy output and levelized cost of energy (LCOE) in seven regions of Tanzania across five different tilt adjustments of 1 MW PV systems. The one-diode model equations and the PVsyst 7.2 software were used in the simulation. The results reveal variations in energy output and LCOE among the regions and tilt adjustments indicating a strong correlation between PV energy output and solar irradiance incident on the PV panel. For horizontal mounting, the annual energy output ranges from 1229 MWh/year in Kilimanjaro to 1977 MWh/year in Iringa. Among the three optimal tilt adjustments, annually, monthly and seasonal, the last two are predicted to yield larger energy outputs, whereas the two axis tracking configuration consistently provides the maximal energy output in all regions, ranging from 1533 MWh/year in Kilimanjaro to 2762 MWh/year in Iringa. The LCOE analysis demonstrates the cost-effectiveness of solar PV systems compared to grid-connected and isolated mini-grid tariffs. The LCOE values across the regions and tilt adjustments range from $0.07/kWh to $0.16/kWh. In comparison, the tariff for grid-connected solar PV is $0.165/kWh, while for isolated mini-grids; it is $0.181/kWh. The monthly optimal tilt configuration proves to be the most cost-effective option for energy generation in multiple regions, as it consistently exhibits the lowest energy cost compared to the other four configurations. The results provide valuable insights into the performance and economic feasibility of various system setups. Through meticulous simulation and data analysis, we have gained a comprehensive understanding of the factors influencing energy generation and costs in the context of solar photovoltaic systems.

Abstract This study explored the dynamics of students' knowledge co-construction in an asynchronous gamified environment in higher education, focusing on peer discussions in college business courses. Utilizing epistemic network analysis, sequence pattern mining, and automated coding, we analyzed the interactions of 1,319 business students. Our findings revealed that externalization and epistemic activity were prevalent, demonstrating a strong link between problem-solving and conceptual understanding. Three primary discussion types were observed: argumentative, epistemic, and social, each with unique patterns of engagement and idea integration. Effective knowledge co-construction patterns included open-ended questions with an epistemic focus, debates serving as intense knowledge co-construction arenas, and social interactions fostering a supportive and collaborative learning environment. The introduction of gamification elements led to increased student engagement and participation. Our findings emphasize the significance of structured analysis, collaboration, and argumentation in promoting effective knowledge co-construction in peer learning settings. This study offers insights into the temporal interplay of discourse dimensions and their potential for collaborative learning, enhancing our understanding of how learning analytics can be employed to discover ways in which students co-construct knowledge in asynchronous gamified environments.

This work presents ab initio calculations for the Kα spectrum of manganese (Z = 25, [Ar]3d54s2), a highly complex system due to the five open orbitals in the 3d shell. The spectrum is composed of the canonical diagram line [1s]→[2p] and shake-off satellite lines [1snl]→[2pnl] (nl∈{2s,2p,3s,3p,3d,4s}), where square brackets denote a hole state. The multiconfiguration Dirac–Hartree–Fock method with the active set approach provides the initial and final atomic wavefunctions. Results are presented as energy eigenvalue spectra for the diagram and satellite transitions. The calculated wavefunctions include over one hundred million configuration state functions and over 280,000 independent transition energies for the seven sets of spectra considered. Shake-off probabilities and Auger transition rates determine satellite intensities. The number of configuration state functions ensures highly-converged wavefunctions. Several measures of convergence demonstrate convergence in the calculated parameters. We obtain convergence of the transition energies in all eight transitions to within 0.06 eV and shake-off probabilities to within 4.5%.

Despite the existence of important floristic and forest inventories in the Paraná state, the montane and upper montane ecosystems still give rise to new species and new records of plants. Here, we report for the first time in the Paraná state Hydrocotyle itatiaiensis Brade (Araliaceae), a rare and poorly studied species endemic to montane and upper montane rainforests and highland grasslands of the South and Southeast regions of Brazil. The previously known geographic distribution had a 700 km gap between northern São Paulo and southern Santa Catarina states, which is now filled by the present record. We provide photographs from the field, a map of occurrences, a description, and comments on the morphology, taxonomy, and conservation status of the species. Our new records reinforce the conservation importance of these environments and the need for further floristic sur-veys in the region.

Abstract Pulmonary vascular dysfunction in the absence of pulmonary hypertension (PH) has been observed in patients with idiopathic pulmonary fibrosis (IPF). We describe the prevalence and etiology of elevated pulmonary vascular resistance (PVR) without PH among patients with IPF. Hemodynamic, echocardiographic, and functional respiratory imaging (FRI) data was compared between patients with IPF without PH with normal (

Background Fixed and dilated pupils (FDPs) have become synonymous with devastating neurological damage and brainstem injury commonly associated with mass effect and herniation. Infrequently, changes in pupillary light response have been described with seizures; however, the loss of pupillary response with documented Neurological Pupil index has not been well established in patients with seizures. Case Report We present a case report describing a middle-aged female patient with focal status epilepticus with intermittent FDPs. An abnormal pupillary response occurred with right hemispheric lateralized periodic discharges and resolution with anti-seizure medication escalation. To our knowledge, this is the first description of objective documentation of reversible FDP as a possible clinical correlate of lateralized periodic discharges. Conclusion The use of handheld automated pupillometry in conjunction with electroencephalogram (EEG) has provided the therapeutic direction. Further research is warranted to fully describe the mechanistic underpinnings of these observations.

Abstract Designing strategic areas for biodiversity protection should help prevent species extinction. However, these delimitations are rarely evaluated for their effectiveness. To determine whether the original design of the Strategic Areas for the Conservation and Restoration of Biodiversity in Paraná (AECR) adequately protected the species and identify the species most likely to become extinct in the region, we analyzed occurrence records for threatened flora in the state’s most degraded phytogeographic regions (Araucaria Forest, Cerrado, and grassland). We developed a list of threatened species for Paraná using herbarium records. We also compiled a threatened species occurrence list for the region by filtering through the herbarium records. Based on the main concepts defining threat status and gap species, we identified the species at an elevated risk of extinction in the study region. A total of 644 threatened species were detected in the regions studied, 86% of which have been recorded within the AECR, and 30% can be characterized as gap species. The species distribution polygons accounted for 98% of species within the AECR and 4% as gap species. A total of 54 species (8.38% of the total) are at a higher risk of extinction.

Rationale and objectives: Lung transplantation is a potentially life-saving treatment option for patients with idiopathic pulmonary fibrosis (IPF); however, not all eligible candidates get referred and listed for transplantation. Amongst IPF patients within the Pulmonary Fibrosis Foundation Patient Registry (PFF-R), we sought to determine the proportion of patients who undergo lung transplant listing and the characteristics associated with transplant listing. Methods: An analysis of IPF patients with at least six months of follow-up data was performed. Patients with well-established contraindications to lung transplantation were excluded. Two complementary analyses were performed. The “prevalent” population included all patients with IPF at time of enrollment into the registry. The “incident severe” population included all patients with IPF who progressed to GAP Stage 3. Results: Of the 2003 patients in the PFF-R, 475 patients were included in the “prevalent” population. Of this group, only 42 (8.8%) were either listed for or underwent lung transplant. Univariable analysis of the “prevalent” population found age (per 10 year increase, OR 0.531, p = 0.0025), percent predicted FVC (OR 0.572, p=

Abstract Aims Debate continues as to the optimal orientation of the acetabular component in total hip arthroplasty (THA) and how to reliably achieve this. The primary objective of this study was to compare functional CT-based planning and patient-specific instruments with conventional THA using 2D templating. Methods A pragmatic single-center, patient-assessor blinded, randomized control trial of patients undergoing THA was performed. 54 patients (aged 18–70) were recruited to either Corin Optimized Positioning System (OPS) or conventional THA. All patients received a cementless acetabular component. All patients underwent pre- and postoperative CT scans, and four functional X-rays. Patients in the OPS group had a 3D surgical plan and bespoke guides made. Patients in the conventional group had a surgical plan based on 2D templating X-rays. The primary outcome measure was the mean error in acetabular anteversion as determined by postoperative CT scan. Results There was no statistically significant difference in the mean error in angle of acetabular anteversion when comparing OPS and conventional THA. In the OPS group, the achieved acetabular anteversion was within 10° of the planned anteversion in 96% of cases, compared with only 76% in the conventional group. The clinical outcomes were comparable between the groups. Conclusion Large errors in acetabular orientation appear to be reduced when CT-based planning and patient-specific instruments are used compared to the standard technique but no significant differences were seen in the mean error.

Though many scholars have understood Tokugawa Japan's encounter with Christianity (1549-1650) to have ended in failure, an analysis of the period's religious literature demonstrates the considerable extent to which missionaries engaged with Japanese culture. This article examines several Kirishitan (Japanese Christian) texts printed between 1590 and 1620, devoting particular attention to the theological and philosophical terminology they employed. While sometimes borrowing directly from Latin and Portuguese, the new Catholic lexicon also drew from pre-existing Japanese vocabulary in the context of Buddhist and Neo-Confucian spirituality. Along with the education reforms introduced by the accommodationist Jesuit Alessandro Valignano, projects of Catholicism in translation complicate the picture of defeat and mutual misunderstanding that are often thought to characterize Japan’s Christian Century.

Understanding the mechanisms driving community assembly has been a major focus of ecological research for nearly a century, yet little is known about these mechanisms in commensal communities, particularly with respect to their historical/evolutionary components. Here, we use a large-scale dataset of 4,440 vascular plant species to explore the relationship between the evolutionary distinctiveness (ED) (as measured by the ’species evolutionary history’ (SEH)) of host species and the phylogenetic diversity (PD) of their associated epiphyte species. Although there was considerable variation across hosts and their associated epiphyte species, they were largely unrelated to host SEH. Our results mostly support the idea that the determinants of epiphyte colonization success might involve host characteristics that are unrelated to host SEH (e.g., architectural differences between hosts). While determinants of PD of epiphyte assemblages are poorly known, they do not appear to be related to the evolutionary history of host species. Instead, they might be better explained by neutral processes of colonization and extinction. However, the high level of phylogenetic signal in epiphyte PD (independent of SEH) suggests it might still be influenced by yet unrecognized evolutionary determinants. This study highlights how little is still known about the phylogenetic determinants of epiphyte communities.

On 29 March 2023 the United Kingdom (UK) government published its AI Regulation White Paper, a “proportionate and pro-innovation regulatory framework” for AI designed to support innovation, identify and address risks, and establish the UK as an “AI superpower”. In this article, we assess whether the approach outlined in this policy document is appropriate for meeting the country’s stated ambitions. We argue that the proposed continuation of a sector-led approach, which relies on existing regulators addressing risks that fall within their remits, could support contextually appropriate and novel AI governance initiatives. However, a growing emphasis from the central government on promoting innovation through weakening checks, combined with domestic tensions between Westminster and the UK’s devolved nations, will undermine the effectiveness and ethical permissibility of UK AI governance initiatives. At the same time, the likelihood of the UK’s initiatives proving successful is contingent on relationships with, and decisions from, other jurisdictions, particularly the European Union. If left unaddressed in subsequent policy, these factors risk transforming the UK into a reluctant follower, rather than a global leader, in AI governance. We conclude this paper by outlining a set of recommendations for UK policymakers to mitigate the domestic and international risks associated with the country’s current trajectory.

Abstract COVID‐19 related lung disease (CRLD) has emerged as an indication for lung transplantation (LT) in highly select patients. The prevalence and prognostic implication of coexisting pulmonary hypertension (PH) in patients with CRLD listed for LT is not known. Adult patients in the United Network for Organ Sharing database listed for LT for COVID‐19 related acute respiratory distress syndrome or fibrosis through March 2022 were identified. The prevalence and impact of precapillary PH on pre‐ and posttransplantation survival was determined. Time‐to‐event analysis was used to compare outcomes between those with and without precapillary PH. We identified 245 patients listed for LT for CRLD who had right heart catheterization data available at the time of registry listing. Median age of the cohort was 54 years (interquartile range [IQR]: 46, 60), 56 (22.9%) were female, and the median lung allocation score was 81.3 (IQR: 53.3, 89.4). The prevalence of precapillary PH at the time of transplant listing was 27.9%. There was no significant difference in pretransplant mortality in patients with and without precapillary PH (sHR: 0.5; 95% confidence interval [CI]: 0.1–1.7, p = 0.261). A total of 187 patients ultimately underwent LT; of those, 60 (31.0%) were identified as having precapillary PH during the waitlist period. Posttransplantation survival was similar between patients with and without pretransplant precapillary PH (hazard ratio: 0.96; 95% CI: 0.2–3.7, p = 0.953). We observed a high rate of concomitant precapillary PH in patients listed for LT for CRLD. Though common, coexisting precapillary PH was not associated with a significant difference in either pre‐ or post‐transplantation outcomes.

Abstract The study aimed to evaluate the degree of conservation, analyse the structural and floristic similarity of the woody and herbaceous layers of two ecotone forest communities and evaluate the indicator species of a Mixed Ombrophilous Forest (MOF) and Dense Ombrophilous Forest (DOF). We outlined 30 sampling units of 100 m2 in each area (West and East), where we measured three woody and one herbaceous layers. Each species was classified into ecological groups, phytogeographic distribution and conservation status. We selected other 13 studies performed on similar ecosystems to carry out cluster and indicator species analyses. We registered 213 species, arranged into 63 families. The richest families were Myrtaceae, Lauraceae and Fabaceae. In the woody layers Araucaria angustifolia, Allophylus edulis and Cupania vernalis highlighted in West area, while Casearia sylvestris, Cyathea phalerata and Ilex paraguariensis highlighted in East area. Ctenitis paranaensis predominates in herbaceous layer of both areas. Our cluster analysis has formed two groups (MOF; DOF), including both study areas in MOF group. The study areas are in a maturation process. Serra da Baitaca State Park presents high conservationist importance. We list indicator species of montane MOF and DOF forests in the Paraná State, which can be used for monitoring alterations in vegetation caused by environmental changes.

Visualization of viruses and their hosts has been paramount to their study and understanding. The direct observation of the morphological dynamics of infection is a highly desired capability and the focus of instrument development across a variety of microscopy technologies. This study demonstrates progress that has been made in exploiting the capabilities offered by HS-AFM to characterise the interactions between coccolithoviruses and their globally important coccolithophore hosts. We observe whole Emiliania huxleyi Virus capsids, transient binding to Emiliania huxleyi derived supported lipid bilayers, and host-virus binding in real-time in an environmentally relevant, aqueous environment.

Background and purpose: Knowledge-based radiotherapy planning models have been shown to reduce healthy tissue dose and optimisation times, with larger training databases delivering greater robustness. We propose a method of combining knowledge-based models from multiple centres to create a ‘super-model’ using their collective patient libraries, thereby increasing the breadth of training knowledge. Materials and methods: A head and neck super-model containing 207 patient datasets was created by merging the data libraries of three centres. Validation was performed on 30 independent datasets during which optimiser parameters were tuned to deliver the optimal set of model template objectives. The super-model was tested on a further 40 unseen patients from four radiotherapy centres, including one centre external to the training process. The generated plans were assessed using established plan evaluation criteria. Results: The super-model generated plans that surpassed the dose objectives for all patients with single optimisations in an average time of 10 min. Healthy tissue sparing was significantly improved over manual planning, with dose reductions to parotid of 4.7 ± 2.1 Gy, spinal cord of 3.3 ± 0.9 Gy and brainstem of 2.9 ± 1.7 Gy. Target coverage met the established constraints but was marginally reduced compared with clinical plans. Conclusions: Three centres successfully merged patient libraries to create a super-model capable of generating plans that met plan evaluation criteria for head and neck patients with improvements in healthy tissue sparing. The findings indicate that the super-model could improve head and neck planning quality, efficiency and consistency across radiotherapy centres.

Background and study aims N95-filtering facepiece respirators (FFR) use is associated with physiological changes and symptoms due to impaired nasal airflow and increased breathing resistance. We prospectively studied the effect of using an external nasal dilator (END) in gastroenterology laboratory (gastrointestinal lab) staff using N95FFR. Patients and methods N95FFR qualitative saccharine fit testing was performed on study participants with and without an END. Prospective data collection and comparisons included: 1) survey of perceived symptoms and difficulty of performing one day of gastrointestinal procedures with N95FFR and 1 day of gastrointestinal procedures with END plus N95FFR in random sequence; and 2) vitals and respiratory belt plethysmography in ten gastroenterologists performing simulated colonoscopy while wearing a surgical mask (SM), N95FFR plus SM, END plus N95FFR plus SM for 20 minutes each in random sequence and rapid succession. Results Twenty-nine of 31 participants passed the N95FFR and the END plus N95FFR fit test. Twenty-two participants (12 physicians; 11 males; mean age 44.1 years, range 31–61) performed 1 day of gastrointestinal procedures with an N95FFR and 1 day of gastrointestinal procedures with an END plus N95FFR. Significantly less difficulty with nasal breathing and severity of symptoms including breathing difficulty, headache, fatigue and frustration, occurred while using an END plus N95FFR. Respiratory plethysmography peak-to-trough measurement showed an increase during the N95FFR stage compared to the END plus N95FFR stage and the SM stage. Conclusions N95FFR related respiratory changes and symptom development may be mitigated by END use.

Securin inhibits the protease separase and must be removed before anaphase to ensure timely chromosome segregation. Here, the authors define a mechanism of securin destruction in prometaphase I in mouse oocytes and demonstrate its importance for successful meiotic progression.

ABSTRACT Background: The emergence of variants of concern (VOCs) requires an ongoing assessment of the performance of antigen lateral flow tests (Ag-RDTs). The limit of detection (LOD) of 32 Ag-RDTs was evaluated using the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant. Methods: Ag-RDTs were performed according to the manufacturer’s instructions with a clinical isolate of the Gamma variant. Results: Twenty-eight of the 32 Ag-RDTs exceeded the World Health Organization criteria. Conclusions: This comprehensive analytical evaluation of Ag-RDTs demonstrated that the test performance was maintained with Gamma VOC.

Aims: There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Methods: We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination. Results: In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001). Conclusion: This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected.

Introduction The first clinical interaction most patients have in the emergency department occurs during triage. An unstructured narrative is generated during triage and is the first source of in-hospital documentation. These narratives capture the patient’s reported reason for the visit and the initial assessment and offer significantly more nuanced descriptions of the patient’s complaints than fixed field data. Previous research demonstrated these data are useful for predicting important clinical outcomes. Previous reviews examined these narratives in combination or isolation with other free-text sources, but used restricted searches and are becoming outdated. Furthermore, there are no reviews focused solely on nurses’ (the primary collectors of these data) narratives.Methods and analysis Using the Arksey and O’Malley scoping review framework and PRISMA-ScR reporting guidelines, we will perform structured searches of CINAHL, Ovid MEDLINE, ProQuest Central, Ovid Embase and Cochrane Library (via Wiley). Additionally, we will forward citation searches of all included studies. No geographical or study design exclusion criteria will be used. Studies examining disaster triage, published before 1990, and non-English language literature will be excluded. Data will be managed using online management tools; extracted data will be independently confirmed by a separate reviewer using prepiloted extraction forms. Cohen’s kappa will be used to examine inter-rater agreement on pilot and final screening. Quantitative data will be expressed using measures of range and central tendency, counts, proportions and percentages, as appropriate. Qualitative data will be narrative summaries of the authors’ primary findings.Patient and public involvement No patients involved.Ethics and dissemination No ethics approval is required. Findings will be submitted to peer-reviewed conferences and journals. Results will be disseminated using individual and institutional social media platforms.

Abstract Oreopanax fulvus is a species endemic to the Brazilian Atlantic Forest, assessed as rare and vulnerable in the states of Paraná and Rio Grande do Sul, respectively. This adverse situation requires conservation actions that must be supported by the understanding of its autecology. We aimed to identify the phenological patterns of O. fulvus populations from two Araucaria Rainforest remnants in Paraná. Monthly phenology monitoring of 19 trees in each site was performed over 24 months. We quantified the vegetative (i.e., leaf flushing, mature leaves, and leaf-senescence) and reproductive phenophases (i.e., buds production, blooming, immature, and mature fruits). Circular statistics based on activity index were applied to identify the phenophases seasonality. Spearman correlations were performed among phenophases and meteorological parameters. Leaf flushing and mature leaves were recorded in all months, with a decrease of mature leaves during November and December. Leaf-senescence was seasonal, occurring from May to December. The reproductive phenophases were seasonal: blooming from January to May; and fruiting from March to November, with fruits starting to mature in September. Vegetative and reproductive phenophases were highly influenced by average temperature and photoperiod. Although there were dissimilarities in reproductive phenological patterns, the different populations studied had similar phenological performances.

Purpose: Radiotherapy planning based only on positron emission tomography/magnetic resonance imaging (PET/MRI) lacks computed tomography (CT) information required for dose calculations. In this study, a previously developed deep learning model for creating synthetic CT (sCT) from MRI in patients with head and neck cancer was evaluated in 2 scenarios: (1) using an independent external dataset, and (2) using a local dataset after an update of the model related to scanner software-induced changes to the input MRI. Methods and Materials: Six patients from an external site and 17 patients from a local cohort were analyzed separately. Each patient underwent a CT and a PET/MRI with a Dixon MRI sequence over either one (external) or 2 (local) bed positions. For the external cohort, a previously developed deep learning model for deriving sCT from Dixon MRI was directly applied. For the local cohort, we adapted the model for an upgraded MRI acquisition using transfer learning and evaluated it in a leave-one-out process. The sCT mean absolute error for each patient was assessed. Radiotherapy dose plans based on sCT and CT were compared by assessing relevant absorbed dose differences in target volumes and organs at risk. Results: The MAEs were 78 ± 13 HU and 76 ± 12 HU for the external and local cohort, respectively. For the external cohort, absorbed dose differences in target volumes were within ± 2.3% and within ± 1% in 95% of the cases. Differences in organs at risk were

Abstract Myrtaceae is a plant family with outstanding diversity in the neotropics, which species are of difficult identification. Thus, for the differentiation between species to be possible, targeted inventories and detailed descriptions are necessary, to develop accessible and reliable identification tools. The goal of this research is to quantify the species richness and describe vegetative characters of Myrtaceae species from a Araucaria Rainforest remnant, through identification of patterns and the elaboration of an dendrological key. For the characterization of trunk and bark, up to five healthy adult individuals of each species were selected, and for branches and leaves, up to three individuals. The voucher material was deposited at the Herbarium EFC. The vegetative morphology of each species was described and an identification key was prepared. 29 species, belonging to 11 genera, were documented: Blepharocalyx (1), Campomanesia (3), Eugenia (5), Myrceugenia (5), Myrcia (8), Myrcianthes (1), Myrciaria (1), Myrrhinium (1), Pimenta (1), Plinia (1) and Psidium (2). The main dendrological characteristics used for the species differentiation were: rhytidome aspect, appearance and colour of the internal bark, venation, punctuations, indumentum and dimensions of the leaf blade. Differentiation was possible using vegetative characters, with greater difficulty for two very similar species of Campomanesia.

Nonhuman primates (NHP’s) are self-motivated to perform cognitive tasks on touchscreens in their animal housing setting. To leverage this ability, fully integrated hardware and software solutions are needed that work within housing and husbandry routines while also spanning cognitive task constructs of the Research Domain Criteria (RDoC). Here, we detail such an integrated robust hardware and software solution for running cognitive tasks in cage-housed NHP’s with a cage-mounted Kiosk Station (KS-1). KS-1 consists of a frame for mounting flexibly on housing cages, a touchscreen animal interface with mounts for receptables, reward pumps, and cameras, and a compact computer cabinet with an interface for controlling behavior. Behavioral control is achieved with a Unity3D program that is virtual-reality capable, allowing semi-naturalistic visual tasks to assess multiple cognitive domains.KS-1 is fully integrated into the regular housing routines of monkeys. A single person can operate multiple KS-1’s. Monkeys engage with KS-1 at high motivation and cognitive performance levels at high intra-individual consistency. KS-1 is optimized for flexible mounting onto standard apartment cage systems and provides a new design variation complementing existing cage-mounted touchscreen systems. KS-1 has a robust animal interface with options for gaze/reach monitoring. It has an integrated user interface for controlling multiple cognitive tasks using a common naturalistic object space designed to enhance task engagement. All custom KS-1 components are open-sourced.In summary, KS-1 is a versatile new tool for cognitive profiling and cognitive enrichment of cage-housed monkeys. It reliably measures multiple cognitive domains which promises to advance our understanding of animal cognition, inter-individual differences, and underlying neurobiology in refined, ethologically meaningful behavioral foraging contexts.

Abstract Background Community pharmacies are important for health access by rural populations and those who do not have optimum access to the health system, because they provide myriad health services and are found in most communities. This includes the sale of non-prescription syringes, a practice that is legal in the USA in all but two states. However, people who inject drugs (PWID) face significant barriers accessing sterile syringes, particularly in states without laws allowing syringe services programming. To our knowledge, no recent studies of pharmacy-based syringe purchase experience have been conducted in communities that are both rural and urban, and none in the Southwestern US. This study seeks to understand the experience of retail pharmacy syringe purchase in Arizona by PWID. Methods An interview study was conducted between August and December 2018 with 37 people living in 3 rural and 2 urban Arizona counties who identified as current or former users of injection drugs. Coding was both a priori and emergent, focusing on syringe access through pharmacies, pharmacy experiences generally, experiences of stigma, and recommendations for harm reduction services delivered by pharmacies. Results All participants reported being refused syringe purchase at pharmacies. Six themes emerged about syringe purchase: (1) experience of stigma and judgment by pharmacy staff, (2) feelings of internalized stigma, (3) inconsistent sales outcomes at the same pharmacy or pharmacy chain, (4) pharmacies as last resort for syringes, (5) fear of arrest for syringe possession, and (6) health risks resulting from syringe refusal. Conclusions Non-prescription syringe sales in community pharmacies are a missed opportunity to improve the health of PWID by reducing syringe sharing and reuse. Yet, current pharmacy syringe sales refusal and stigmatization by staff suggest that pharmacy-level interventions will be necessary to impact pharmacy practice. Lack of access to sterile syringes reinforces health risk behaviors among PWID. Retail syringe sales at pharmacies remain an important, yet barrier-laden, element of a comprehensive public health response to reduce HIV and hepatitis C among PWID. Future studies should test multilevel evidence-based interventions to decrease staff discrimination and stigma and increase syringe sales.

Gymnosiphon tenellus (Bentham) Urban is recorded for the first time in the state of Paraná and in southern Brazil. Until now it has only been known to occur in Central America, the Amazonian Rainforest, and in the Atlantic Rainforest of the state of Rio de Janeiro in southeastern Brazil. An updated description is provided, along with original, detailed pictures of the species.

A avaliação dos padrões de crescimento das árvores pode resgatar informações e indicar características do comportamento ecológico das espécies, importantes tanto para a conservação quanto para o seu manejo. A hipótese deste estudo é que os ciclos de corte de florestas do Sul do país resultaram em eventos de liberação do crescimento nas árvores remanescentes. Os objetivos foram identificar os padrões de crescimento, compará-los com a autoecologia das espécies e verificar o sincronismo dos eventos de liberação ou supressão. Foram coletadas 3 amostras não destrutivas de lenho de cada uma das 30 árvores por espécie, com uso de trado de incremento. As amostras de lenho foram secas e polidas, para posterior delimitação e mensuração da largura dos anéis anuais de crescimento. Para verificar alterações no incremento, foram calculados os incrementos diamétricos relativos, buscando detectar padrões de liberação e/ou supressão do crescimento, bem como a sincronicidade destes eventos. Os resultados indicaram diferentes padrões de crescimento para ambas as espécies. Para A. angustifolia, a maioria das árvores não registrou eventos de liberação ou supressão. Para C. fissilis, a maioria das árvores passou por, pelo menos, um evento de supressão. A sincronicidade entre eventos de liberação e supressão foi baixa, indicando que eventos individuais, e não de grande escala, atuaram. Não foi possível identificar liberações do crescimento relacionadas ao ciclo histórico de corte seletivo ocorrido na região Sul do Brasil.

Resumo A família Lauraceae se destaca na composição florística das formações florestais paranaenses, sendo estimadas na Floresta Ombrófila Mista, 23 espécies. Entretanto, a identificação de amostras estéreis é prejudicada, visto que flores e frutos apresentam as melhores condições na determinação das espécies. Este trabalho tem por objetivo quantificar a riqueza florística da família em um fragmento de Floresta Ombrófila Mista e avaliar os caracteres macromorfológicos vegetativos das espécies, buscando padrões que permitam seu reconhecimento prático. Os indivíduos da família foram localizados em campo através de buscas periódicas. Amostras férteis foram coletadas para identificação das espécies através de comparações com materiais de referência e consulta à bibliografia específica. Na caracterização macromorfológica foram selecionados pelo menos dez indivíduos de porte e ambiente similares ou, quando em menor número, todos os indivíduos existentes. Foram identificadas nove espécies de Lauraceae. O trabalho apresenta uma chave dicotômica baseada em caracteres morfológicos vegetativos, descrições e fotografias das espécies encontradas. A diferenciação através de características de folhas mostrou-se mais efetiva para as espécies de Aiouea e Nectandra, enquanto caracteres de casca interna e ramos assumem função importante em Ocotea.

Portopulmonary hypertension (PoPH) is defined as pulmonary arterial hypertension (PAH) associated with portal hypertension and is a subset of Group 1 pulmonary hypertension (PH). PoPH is a cause of significant morbidity and mortality in patients with portal hypertension with or without liver disease. Significant strides in elucidating the pathogenesis, effective screening algorithms, accurate diagnoses, and treatment options have been made in past 20 years. Survival of PoPH has remained poor compared to IPAH and other forms of PAH. Recently, the first randomized controlled trial was done in this patient population and showed promising results with PAH specific therapy. Despite positive effects on hemodynamics and functional outcomes, it is unclear whether PAH specific therapy has a beneficial effect on long term survival or transplant outcomes. In this review, we will discuss the epidemiology, pathophysiology, clinical and hemodynamic characteristics of PoPH. Additionally, this review will highlight the lacunae in our current management strategy, challenges faced and will provide direction to potentially useful futuristic management strategies.

In the current investigation, we examined the association among emotional intelligence, emotional regulation tendencies, resilience, and perceived stress within a sample of undergraduate students. Participants (N = 277, 71% Female, 55% White) completed the Brief Emotional Intelligence Scale, Emotion Regulation Questionnaire, Brief Resilience Scale, and Perceived Stress Scale. Using path analysis techniques, we demonstrated that resilience was a negative predictor of perceived stress. Additionally, our results indicated that the use of cognitive reappraisal exerted an indirect influence on perceived stress through resilience. Finally, the current investigation provided evidence that emotional intelligence exerts an indirect influence on stress through both cognitive reappraisal and resilience. We believe the results of the current understanding expand our understanding of the determinants of effective emotional information processing and have implications for intervention efforts designed to reduce perceived stress within university-based samples.

Background ST‐segment–elevation myocardial infarction is associated with an intense acute inflammatory response and risk of heart failure. We tested whether interleukin‐1 blockade with anakinra significantly reduced the area under the curve for hsCRP (high sensitivity C‐reactive protein) levels during the first 14 days in patients with ST‐segment–elevation myocardial infarction (VCUART3 [Virginia Commonwealth University Anakinra Remodeling Trial 3]). Methods and Results We conducted a randomized, placebo‐controlled, double‐blind, clinical trial in 99 patients with ST‐segment–elevation myocardial infarction in which patients were assigned to 2 weeks treatment with anakinra once daily (N=33), anakinra twice daily (N=31), or placebo (N=35). hsCRP area under the curve was significantly lower in patients receiving anakinra versus placebo (median, 67 [interquartile range, 39–120] versus 214 [interquartile range, 131–394] mg·day/L; P

Drosera brevifolia Pursh é uma herbácea carnívora considerada ameaçada de extinção no município de Curitiba, Paraná. O objetivo do trabalho foi avaliar a influência das variáveis ambientais declividade, umidade do solo, temperatura e precipitação na sobrevivência de indivíduos de D. brevifolia realocados em Curitiba. Foi realizado o monitoramento mensal da sobrevivência pós-realocação e dos ingressos por regeneração natural ao longo de 12 meses. Foram implantados quatro tratamentos (T) com 50 indivíduos cada, diferenciados pelo relevo, orientação e insolação: T1 (íngreme / sudoeste / pleno sol); T2 (íngreme / leste / sombra parcial); T3 (suave ondulado / leste / sombra parcial) e T4 (suave ondulado / sudoeste / pleno sol). Foram amostrados os solos e coletados dados de declividade e umidade do solo. 178 (89%) das plantas morreram no primeiro mês após o plantio, devido às condições meteorológicas, com excesso de chuva nos primeiros dias (62 mm), seguido por ressecamento do solo causado pela forte insolação, com temperatura máxima de até 33,9 °C. A faixa de umidade do solo mais favorável ao estabelecimento de indivíduos realocados variou de 22% a 30%. Apenas para o T1 foi verificada correlação positiva significativa entre a sobrevivência de plantas e as temperaturas, indicando que esta variável pode ser importante para o seu estabelecimento. Em nenhum tratamento foi constatada correlação significativa entre a sobrevivência e as variáveis precipitação, declividade e umidade do solo. Pode-se afirmar que D. brevifolia é sensível a pequenas mudanças nas condições ambientais locais.

Listeria rhombencephalitis (LRE) is a rare encephalitis of the hindbrain that can present with a variety of neurological symptoms. It is a diagnostic challenge, but prompt antimicrobial therapy is important to prevent high rates of mortality and morbidity. We report two cases of LRE, with several contrasting clinical features and different disease courses. Despite being rare, it is important to consider listeria in patients with possible meningoencephalitis, even if cultures are negative. Empirical treatment of meningoencephalitis should provide coverage for listeria, especially if the patient is at risk of listeriosis or there is a potential history of listeria exposure.

Abstract The ability of pore-forming proteins to interact with various analytes has found vast applicability in single molecule sensing and characterization. In spite of their abundance in organisms from all kingdoms of life, only a few pore-forming proteins have been successfully reconstituted in artificial membrane systems for sensing purposes. Lysenin, a pore-forming toxin extracted from the earthworm E. fetida, inserts large conductance nanopores in lipid membranes containing sphingomyelin. Here we show that single lysenin channels may function as stochastic nanosensors by allowing the short cationic peptide angiotensin II to be electrophoretically driven through the conducting pathway. Long-term translocation experiments performed using large populations of lysenin channels allowed unequivocal identification of the unmodified analyte by Liquid Chromatography-Mass Spectrometry. However, application of reverse voltages or irreversible blockage of the macroscopic conductance of lysenin channels by chitosan addition prevented analyte translocation. This investigation demonstrates that lysenin channels have the potential to function as nano-sensing devices capable of single peptide molecule identification and characterization, which may be further extended to other macromolecular analytes.

Objective. Delusional parasitosis (DP) is a difficult-to-treat condition. It is prevalent in all cultures, societies, and countries. Previous case reports of DP have been published; however, the patient presented in this report is unique because of the co-occurrence of both primary and secondary types of DP. We aim to explore the two subtypes of DP. Conclusions. We discuss DP from a nosological perspective and also highlight the various theories at play in the pathogenesis of primary and secondary DP. The different subtypes of DP should be taken into consideration as they also have a bearing on the management.

Introduction. Osteochondromas represent one of the most common bone tumors accounting for 8% of all bone tumors. While most osteochondromas arise in the metaphysis of long bones, osteochondromas have been reported in atypical locations such as the scapula, metatarsals, and the pelvic region. Osteochondromas are capable of growing large enough to cause mass effects and can undergo malignant transformation, stressing the clinical importance of recognizing these tumors. Case Presentation. In this case, we present an 18-year-old skeletally mature Caucasian male with a symptomatic osteochondroma arising from the iliac wing. The osteochondroma increased in size since he reached skeletal maturity. This resulted in a mass effect that interfered with activities of daily living, including clothing wear and symptomatic impaction on hard surfaces. Conclusion. The majority of osteochondromas arise from the metaphysis of long bones, but case reports have shown that osteochondromas presenting in atypical locations such as the pelvis do occur. In the case of our patient, his asymptomatic pelvic tumor grew to the extent that it was causing interference with activities of daily living. Surgical excision of his tumor proved to be curative, and there was no recurrence at 6 months after excision. Osteochondromas in this region are capable of growing large enough to cause sexual dysfunction. Clinical suspicion must be high to properly diagnose osteochondromas in atypical locations. All providers, particularly those in primary care, should be aware of these locations as patients with symptomatic mass lesions will likely initially present here.

Resumo Este estudo teve o objetivo de avaliar o efeito de um povoamento de Pinus taeda sobre a composição florística e estrutura do banco de sementes de um remanescente de Floresta Ombrófila Mista (FOM). Para tanto foram coletadas 160 amostras do banco de sementes, 80 de um remanescente de FOM e 80 em um povoamento de P. taeda. As amostras foram colocadas para germinar em duas casas de vegetação distintas, sob 35% e 75% de níveis de sombreamento. Foram contabilizados ao todo 11.669 indivíduos lenhosos e herbáceos, distribuídos em 31 famílias botânicas e 84 espécies. As famílias Asteraceae e Poaceae foram as mais representativas em riqueza de espécies herbáceas. Dentre as lenhosas, Solanaceae e Asteraceae foram as mais representativas em ambas as áreas. A espécie P. taeda foi registrada apenas no banco de sementes do próprio povoamento. O banco de sementes do povoamento de pinus caracterizou-se principalmente pela baixa riqueza de espécies lenhosas, o que demonstra sua influência sobre o estoque de sementes. Por outro lado, o remanescente de FOM avaliado parece não sofrer influência da proximidade do povoamento de pinus no seu banco de sementes.

ABSTRACT We performed a phytosociological study on an altitudinal gradient in Lauráceas State Park (Parque Estadual das Lauráceas/PR), aiming to describe the Montane Atlantic Rain Forest, to verify the importance of Lauraceae, and to evaluate the communities’ successional stage. We distributed survey units (2,000 m2 quadrats) along an altitudinal gradient and surveyed all individuals with DBH ≥ 10 cm, which composed the arboreal component. In smaller quadrats (250 m2), we surveyed regeneration individuals. The community at 800 and 900 m a.s.l. shows typical characteristics of Montane forest in an advanced successional stage, and the abundance of Ocotea catharinensis is its main indicator. At 1,000 and 1,100 m a.s.l., the forest is characterized as Montane with short stature in an advanced successional stage, with the occurrence of typical upper montane species such as O. porosa and O. vaccinioides.

Students have traditionally held a singular role in medical education - the learner. This narrow view neglects students unique perspective and ability to shape the future of medical education. In recognizing the need for deliberate leadership skill development and networking opportunities for medical student leaders, the American Medical Association (AMA) supported the first AMA Accelerating Change in Medical Education Student-Led Conference on Leadership in Medical Education. A planning committee of 19 students from seven medical schools collaborated to develop this conference, which took place on August 4-5, 2017 at the University of Michigan, Ann Arbor. The primary goal of the conference was for students to learn about leadership skills, connect with other student leaders, feel empowered to lead change, and continue to lead from their roles as students. Attendees participated in a variety of workshops and presentations focused on developing practical leadership skills. In addition, students formed multi-institutional teams to participate on in the MedEd Impact Challenge, attempting to address issues in medical education such as leadership curriculum development, wellness, and culture change. Post-conference surveys showed an overwhelming majority of students connected with other student leaders, shared ideas, developed collaborations, and felt empowered to enact change. Looking forward, we believe that similar student-led conferences focused on broadening the medical student role would provide avenues for positive change in medical education.

Post-traumatic osteoarthritis (PTOA) is a degenerative joint disease, leading to articular cartilage breakdown, osteophyte formation, and synovitis, caused by an initial joint trauma. Pro-inflammatory cytokines increase catabolic activity and may perpetuate inflammation following joint trauma. Interleukin-15 (IL-15), a pro-inflammatory cytokine, is increased in OA patients, although its roles in PTOA pathophysiology are not well characterized. Here, we utilized Il15 deficient rats to examine the role of IL-15 in PTOA pathogenesis in an injury-induced model. OA was surgically induced in Il15 deficient Holtzman Sprague-Dawley rats and control wild-type rats to compare PTOA progression. Semi-quantitative scoring of the articular cartilage, subchondral bone, osteophyte size, and synovium was performed by two blinded observers. There was no significant difference between Il15 deficient rats and wild-type rats following PTOA-induction across articular cartilage damage, subchondral bone damage, and osteophyte scoring. Similarly, synovitis scoring across six parameters found no significant difference between genetic variants. Overall, IL-15 does not appear to play a key role in the development of structural changes in this surgically-induced rat model of PTOA.

This study aimed to examine the effects of change of direction (COD) speed and technique modification training on 180° turning performance (completion time, ground contact time [GCT], and exit velocity), kinetics, and kinematics. A non-randomised 6 week intervention study was administered. Thirteen male multidirectional sport athletes formed the intervention group (IG), participating in two COD speed and technique modification sessions per week. A total of 12 male multidirectional sport athletes formed the control group (CG). All subjects performed six modified 505 trials, whereby pre-to-post-intervention biomechanical changes were evaluated using three-dimensional motion analysis. Two-way mixed analysis of variances revealed significant interaction effects (group × time) for completion time, mean horizontal propulsive force (HPF), horizontal to vertical mean braking and propulsive force ratios for the penultimate (PFC) and final foot contact (FFC), FFC peak knee flexion and PFC hip flexion angle (p ≤ 0.040, η2 = 0.170–0.417). The IG displayed small to large improvements post-intervention in these aforementioned variables (p ≤ 0.058, g = 0.49–1.21). Turning performance improvements were largely to very largely (p ≤ 0.062, r or ρ = 0.527–0.851) associated with increased mean HPF, more horizontally orientated FFC propulsive force and PFC braking force, and greater pelvic rotation, PFC hip flexion, and PFC velocity reductions. COD speed and technique modification is a simple, effective training strategy that enhances turning performance.

Heatwaves have implications for human health and ecosystem function. Over cities, the impacts of a heatwave event may be compounded by urban heat, where temperatures over the urban area are higher than their rural surroundings. Coastal cities often rely upon sea breezes to provide temporary relief. However, topographic features contributing to the development of Foehn-like conditions can offset the cooling influence of sea breezes. Using convection-permitting simulations (⩽4 km) we examine the potential for both mechanisms to influence heatwave conditions over the large coastal city of Sydney, Australia that is bordered by mountains. Heatwave onset in the hot period of January–February 2017 often coincides with a hot continental flow over the mountains into the city. The temperature difference between the coast and the urban–rural interface can reach 15.79 °C. Further, the urban heat island contributes on average an additional 1 °C in the lowest 1 km of the atmosphere and this often extends beyond the city limits. The cumulative heat induced by the urban environment reaches 10 °C over the city and 3 °C over adjacent inland areas. Strong sea breezes are important for heat dispersion with city temperature gradients reducing to within 1 °C. The resolution permits a comparison between urban types and reveals that the diurnal cycle of temperature, moisture content and wind are sensitive to the urban type. Here we show that convection permitting simulations can resolve the interaction between local breezes and the urban environment that are not currently resolved in coarser resolution models.

This study examines undergraduates' research practices, as described in reflective essays submitted in applications to a library research award. Thematic analysis of 24 student award essays identified three strong themes in student reflections about their research experiences. Students experienced research as a social process, made meaning closely tied to disciplinary ways of knowing and practicing, and underwent a transformative process from beginner to apprentice researchers. Through a discussion of these themes, the authors highlight implications for information literacy instruction and suggest this instruction be closely connected to disciplinary practices.

Human ether-à-go-go-related gene (Kv11.1, or hERG) is a potassium channel that conducts the delayed rectifier potassium current (IKr) during the repolarization phase of cardiac action potentials. hERG channels have a larger pore than other K+channels and can trap many unintended drugs, often resulting in acquired LQTS (aLQTS). R-roscovitine is a cyclin-dependent kinase (CDK) inhibitor that induces apoptosis in colorectal, breast, prostate, multiple myeloma, other cancer cell lines, and tumor xenografts, in micromolar concentrations. It is well tolerated in phase II clinical trials. R-roscovitine inhibits open hERG channels but does not become trapped in the pore. Two-electrode voltage clamp recordings from Xenopus oocytes expressing wild-type (WT) or hERG pore mutant channels (T623A, S624A, Y652A, F656A) demonstrated that compared to WT hERG, T623A, Y652A, and F656A inhibition by 200 μM R-roscovitine was ~ 48%, 29%, and 73% weaker, respectively. In contrast, S624A hERG was inhibited more potently than WT hERG, with a ~ 34% stronger inhibition. These findings were further supported by the IC50 values, which were increased for T623A, Y652A and F656A (by ~5.5, 2.75, and 42 fold respectively) and reduced 1.3 fold for the S624A mutant. Our data suggest that while T623, Y652, and F656 are critical for R-roscovitine-mediated inhibition, S624 may not be. Docking studies further support our findings. Thus, R-roscovitine's relatively unique features, coupled with its tolerance in clinical trials, could guide future drug screens.

The following article examines the implementation and controversy that surround climate change education and the implementation of the Next Generation Science Standards (NGSS). In order to fully understand why NGSS and climate change education continue to generate significant public debate, one must examine the work of both climate advocates and detractors. Therefore, this paper first examines the manner in which climate change continues to remain a debatable topic of discussion throughout American classrooms despite overwhelming scientific consensus. After, it explores how the debate over climate change stems from differing ethical cornerstones. Moreover, it delves into the oppositional perspective on climate change implementation by exploring the work of Truth in Texas Textbooks (TTT). Subsequently, it introduces and analyzes the creation and implementation of NGSS and discusses how adoption of NGSS and stronger levels of opposition to TTT is responsive policy that remains a necessary step to challenging global issues created by climate change.