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Introduction:. In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first 3 years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research. Methods:. ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the perioperative microsystem. The components were developed from available evidence, a detailed needs assessment of the hospitals, reviewing experiences from prior surgical and nonsurgical QI Collaboratives, and interviews with QI experts. The components comprise 5 domains: guided implementation (eg, mentors, coaches, statewide QI projects), education (eg, process improvement [PI] curriculum), hospital- and surgeon-level comparative performance reports (eg, process, outcomes, costs), networking (eg, forums to share QI experiences and best practices), and funding (eg, for the overall program, pilot grants, and bonus payments for improvement). Results:. Through implementation of the 21 novel ISQIC components, hospitals were equipped to use their data to successfully implement QI initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching were undertaken by the hospitals as they worked to implement solutions. Hospitals received funding for the program and were able to work together on statewide quality initiatives. Lessons learned at 1 hospital were shared with all participating hospitals through conferences, webinars, and toolkits to facilitate learning from each other with a common goal of making care better and safer for the surgical patient in Illinois. Over the first 3 years, surgical outcomes improved in Illinois. Discussion:. The first 3 years of ISQIC improved care for surgical patients across Illinois and allowed hospitals to see the value of participating in a surgical QI learning collaborative without having to make the initial financial investment themselves. Given the strong support and buy-in from the hospitals, ISQIC has continued beyond the initial 3 years and continues to support QI across Illinois hospitals.

Objectives: This study aims to characterize the association between the timing of MRI ordering and completion for pediatric knee injuries and Social Deprivation Index (SDI), which is a comprehensive, validated, county-level, measure of socioeconomic variation in health outcomes based upon combining geography, income, education, employment, housing, household characteristics, and access to transportation., Methods: A retrospective chart review was completed of patients 21 years old and younger from our institution with a history of knee sports injury (ligamentous/soft tissue injury, structural abnormality, instability, inflammation) evaluated with MRI between 5/26/2017 and 12/28/2020. Patients were from three states and attended to by physicians associated with an urban academic institution. Patients were assigned SDI scores based on their ZIP code. Excluded from the study were patients with a non-knee related diagnosis (hip, foot, or ankle), patients from ZIP codes with unknown SDI, and non-sports medicine diagnoses (tumor, infection, fracture)., Results: In a multivariate regression analysis of 355 patients, increased SDI was independently associated with increased time from clinic visit to MRI order ( p  = 0.044) and from clinic visit to MRI completion ( p  = 0.047). Each 10-point increase in SDI (0-100) was associated with a delay of 7.2 days on average. SDI itself was found to be associated with a patient's race ( p  < 0.001), ethnicity ( p  < 0.001), and insurance category ( p  < 0.001)., Conclusion: Increased SDI is independently associated with longer time from clinic visit to knee MRI order and longer time from clinic visit to knee MRI completion in our pediatric population. Recognizing potential barriers to orthopedic care can help create the change necessary to provide the best possible care for all individual patients.

Objective: To investigate whether a diagnosis of precancer poor bone mineral density (PBMD) is associated with higher risk of urological cancer bone metastasis., Methods: The PearlDiver Database was utilized to conduct a retrospective, propensity-matched cohort analysis of adult patients diagnosed with kidney, bladder, prostate, and testicular cancer with and without a prior diagnosis of PBMD, defined as osteopenia or osteoporosis. Unadjusted and adjusted odds ratios (OR) and 95% confidence intervals are used to compare the rate of newly diagnosed bone metastases between 6months and 3years of the initial cancer diagnosis between the experimental and control cohorts., Results: Among 685,066 patients with urological cancers, precancer PBMD was associated with increased odds of bone metastasis at various time periods (1week, 6months, 1, 2, and 3years). The strongest association was appreciated within 1week of cancer diagnosis (kidney: adjusted odds ratio [aOR], 2.37, P <.001; bladder: [aOR], 2.37, P <.001; prostate: [aOR], 2.84, P <.001; testicular: [aOR], 4.45, P <.001). Bisphosphonates were associated with reduced risk of kidney ([aOR], 0.46, P <.001), bladder ([aOR], 0.61, P <.001), and prostate ([aOR], 0.66, P <.001) cancer bone metastasis., Conclusion: Our findings suggest urology patients with PBMD may be predisposed to forming bone metastases as well as presenting with metastatic disease at time of cancer diagnosis. As such, further studies are needed to elucidate whether PBMD plays a role in bone tropism and whether bone health pertains to prolonging bone-free metastasis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Objectives: The goal of this study is to establish radiographic features and characteristics of patient injury in cases of femoral shaft fractures that predict the presence of ipsilateral femoral neck fractures (IFNFs)., Methods: Patient data was retrospectively assessed from a single level I trauma center through the electronic health record using (Current Procedural Terminology) CPT codes for both isolated and combined ipsilateral femoral shaft and neck fractures. Demographic information, injury characteristics, and independently reviewed radiographic features were collected and compared against the same information from a group of isolated femoral shaft fractures. Multivariable logistic regression was performed to identify risk factors for concomitant IFNFs and their respective odds ratios. A probability algorithm for assessing ipsilateral femoral neck fractures based on independent multivariate predictors was constructed and used., Results: A total of 113 patients with either isolated femoral shaft fractures or combined femoral shaft and IFNF (n = 33) met inclusion criteria and were identified for this study. Fracture displacement was most strongly associated with increased risk of combined injury with an aOR of 25.64 (95 %CI = 5.96-110.28) for every 100 % displacement. Motorcycle crash (MCC) was the mechanism associated with the highest risk of combined injury, with an aOR of 9.85 (95 % CI = 1.99-48.74). Combined injury was also correlated with lower Winquist score and presentation with a closed fracture, with aORs of 0.38 (95 %CI = 0.21 - 0.68) and 11.61 (95 %CI = 1.93-69.94), respectively. Presence of at least 3 of the statistically significant variables produced a positive predictive value (PPV) of ≥ 89 % for combined femoral shaft and IFNF., Conclusions: Identification of combined femoral shaft and IFNF is of critical importance when caring for orthopedic trauma patients. While diagnosis remains a challenging task, MCC mechanism, >100 % fracture displacement, and lower Winquist classification were found to be associated with combined injuries. The combination of these variables might assist in predicting the probability of combined injury and potentially guide decision making on the appropriateness of obtaining single sequence MRI or implementing prophylactic femoral neck fixation., Level of Evidence: Level III., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: Anabolic steroid therapy has been associated with tendon injury, but there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tenosynovitis of the hand, specifically trigger finger and de Quervain tenosynovitis. The purpose of this study was to evaluate the relationship between TRT and tenosynovitis of the hand., Methods: This was a one-to-one exact matched retrospective cohort study using a large nationwide claims database. Records were queried between 2010 and 2019 for adult patients who filled a prescription for TRT for 3 consecutive months. Rates of new onset trigger finger and de Quervain tenosynovitis and subsequent steroid injection or surgery were identified using ICD-9, ICD-10, and Current Procedural Terminology billing codes. Single-variable chi-square analyses and multivariable logistic regression were used to compare rates in the TRT and control cohorts while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison., Results: In the adjusted analysis, patients undergoing TRT were more than twice as likely to develop trigger finger compared to their matched controls. TRT was also associated with an increased likelihood of experiencing de Quervain tenosynovitis. Of the patients diagnosed with either trigger finger or de Quervain tenosynovitis over the 2-year period, patients with prior TRT were roughly twice as likely to undergo steroid injections or surgical release for both trigger finger and de Quervain tenosynovitis compared to the controls., Conclusions: TRT is associated with an increased likelihood of both trigger finger and de Quervain tenosynovitis, and an increased likelihood of requiring surgical release for both conditions., Type of Study/level of Evidence: Prognostic II., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: The cellular mechanisms underlying excess scar tissue formation in arthrofibrosis following total knee arthroplasty (TKA) are well-described. Angiotensin receptor blockers (ARB), particularly losartan, is a commonly prescribed antihypertensive with demonstrated antifibrotic properties. This retrospective study aimed to assess the rates of 1- and 2-year postoperative complications in patients who filled prescriptions for ARBs during the 90 days after TKA., Methods: Patients undergoing primary TKA were selected from a large national insurance database, and the impact of ARB use after TKA on complications was assessed. Of the 1,299,106 patients who underwent TKA, 82,065 had filled at least a 90-day prescription of losartan, valsartan, or olmesartan immediately following their TKA. The rates of manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (LOA), aseptic loosening, periprosthetic fracture, and revision at 1 and 2 years following TKA were analyzed using multivariable logistic regressions to control for various comorbidities., Results: ARB use was associated with decreased rates of MUA (odds ratio [OR] = 0.94, 95% confidence interval (CI), 0.90 to 0.99), arthroscopy/LOA (OR = 0.86, 95% CI, 0.77 to 0.95), aseptic loosening (OR = 0.71, 95% CI, 0.61 to 0.83), periprosthetic fracture (OR = 0.58, 95% CI, 0.46 to 0.71), and revision (OR = 0.79, 95% CI, 0.74 to 0.85) 2 years after TKA., Conclusions: ARB use throughout the 90 days after TKA is associated with a decreased risk of MUA, arthroscopy/LOA, aseptic loosening, periprosthetic fracture, and revision, demonstrating the potential protective abilities of ARBs. Prospective studies evaluating the use of ARBs in patients at risk for postoperative stiffness would be beneficial to further elucidate this association., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To characterize the association between a diagnosis of hypovitaminosis D and primary anterior cruciate ligament (ACL) tear, primary anterior cruciate ligament reconstruction (ACLR), and revision ACLR in different sex and age cohorts., Methods: In this retrospective cohort study of the PearlDiver claims database, records were queried between January 1, 2011, and October 31, 2018 for all patients aged 10 to 59 years who received a diagnosis of hypovitaminosis D. Rates of primary ACL tears, primary reconstruction, and revision reconstruction were calculated for sex- and age-specific cohorts and compared with a control of patients without a diagnosis of hypovitaminosis D. Incidence rates for primary ACL injuries were calculated, and multivariable logistic regression was used to compare rates of ACL injury, primary reconstruction, and revision reconstruction while controlling for age, sex, Charlson Comorbidity Index, and several other comorbidities., Results: Among the 328,011 patients (mean age 41.9 ± 12.6 years, 65.8% female) included in both the hypovitaminosis D and control cohorts, the incidence of ACL tears was 115.2 per 100,000 person-years (95% confidence interval [CI] 107.2-123.7) compared with 61.0 (95% CI 55.2-67.2) in the demographic- and comorbidity-matched control cohort. The study cohort was significantly more likely to suffer an ACL tear over a 1- (aOR 1.67, 95% CI 1.41-1.99, P < .001) and 2-year (aOR 1.81, 95% CI 1.59-2.06, P < .001) period. This trend remained for both male patients at the 1- (aOR 1.66, 95% CI 1.29-2.14, P < .001) and 2-year (aOR 1.68, 95% CI 1.37-2.06, P < .001) mark and female patients at the 1- (aOR 1.69, 95% CI 1.33-2.14, P < .001) and 2-year (aOR 1.80, 95% CI 1.51-2.14, P < .001) mark. Finally, patients with vitamin D deficiency had a significantly increased likelihood of undergoing a revision ACLR within 2 years of a primary reconstruction (aOR 1.28, 95% CI 1.05-1.55, P = .012)., Conclusions: This study reports an association between patients previously diagnosed with hypovitaminosis D and significantly increased rates of both index ACL tears (81% increase within 2 years of diagnosis) and revision ACLR (28% within 2 years). These results identify a population with increased odds of injury and provide valuable knowledge as we expand our understanding of the relationship between vitamin D and musculoskeletal health., Level of Evidence: Level III, retrospective database study., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Introduction: The rapid pace of research in the field of Artificial Intelligence in medicine has associated risks for near-term AI. Ethical considerations of the use of AI in medicine remain a subject of much debate. Concurrently, the Involvement of People living with disease and the Public (PPI) in research is becoming mandatory in the EU and UK. The goal of this research was to elucidate the important values for our relevant stakeholders: People with MS, Radiologists, neurologists, Registered Healthcare Practitioners and Computer Scientists concerning AI in radiology and synthesize these in an ethical matrix., Methods: An ethical matrix workshop co-designed with a patient expert. The workshop yielded a survey which was disseminated to the professional societies of the relevant stakeholders. Quantitative data were analysed using the Pingouin 0.53 python package. Qualitative data were examined with word frequency analysis and analysed for themes with grounded theory with a patient expert., Results: 184 participants were recruited, (54, 60, 17, 12, 41 respectively). There were significant (p < 0.00001) differences in age, gender and ethnicity between groups. Key themes emerging from our results were the importance fast and accurate results, explanations over model performance and the significance of maintaining personal connections and choice. These themes were used to construct the ethical matrix., Conclusion: The ethical matrix is a useful tool for PPI and stakeholder engagement with particular advantages for near-term AI in the pandemic era., Implications for Practice: We have produced an ethical matrix that allows for the inclusion of stakeholder opinion in medical AI research design., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Despite improving diagnostic and surgical techniques, some patients do not respond as well as others following hip arthroscopy. In most musculoskeletal studies, predictors for surgical outcomes focus solely on physical health prior to surgery. However, there likely exists a relationship between a patient's mental health and their postoperative patient-reported outcome measures (PROMs)., Methods: 40 patients who met indications for hip arthroscopy were enrolled in this prospective cohort study. All patients completed a baseline Brief Resilience Scale (BRS) and 4validated PROMs: modified Harris Hip Score (mHHS), visual analogue scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-Daily), and Hip Outcomes Score for Sports-Related Activities (HOS-Sport). For a secondary measure of psychometric evaluation, past medical histories of anxiety/depression were recorded. Patients were stratified into Low Resilience (LR < 21), Normal Resilience (NR 22-24), and High Resilience (HR > 25) by tertile to determine differences in PROMs. Comparisons and correlations of pre- and postoperative outcomes between resilience groups were performed., Results: In comparing the LR and HR groups, there was a significant relationship between resilience and all PROMs both preoperatively and 6 months postoperatively ( p  < 0.05), with the exception of the HOS-Sports. Pearson Correlation Coefficients confirmed this trend in the mHHS and the HOS-Daily. Additionally, there were sixteen patients who were discharged prior to 6-month follow-up with an average resilience above the mean of total population ( p  < 0.0001). Resilience was associated with return to activity ( p  = 0.017). A past history of anxiety/depression was associated with lower resilience ( p  = 0.039)., Conclusions: This study showed that HR hip arthroscopy patients had better PROMs than LR patients both preoperatively and postoperatively. HR patients were able to return to activity earlier and had lower rates of preoperative anxiety/depression. The BRS is a simple in-office screening tool, which may help guide patient and doctor communication and expectations.

With this article, we present a repository containing datasets, analysis code, and some outputs related to a paper in press at Cognition . The data were collected as part of a pre-test, pilot test, and main study all designed in SurveyGizmo and participants recruited via Prolific.co (combined N=303). Datasets consist of raw and annotated data, where participant responses are free-text entries about what unexpected events might occur after a series of events, presented them with based on everyday scenarios. The code consists of all computational additions to the data, and analysis carried out for the results presented in the article. This data is released for the purpose of transparency and to allow for reproducability of the work. This human-labelled data should also be of use to machine learning researchers researching text analytics, natural language processing and sources of common-sense knowledge., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s). Published by Elsevier Inc.)

Do people have specific "expectations about the unexpected" when they think about the future? Recent work supports a "negativity bias", that people expect future events to be disrupted by unexpected negative outcomes. However, when the current situation is negative, they report more positive unexpected outcomes (e.g., negative experiences lead many to imagine a future of unexpected positive outcomes). The present study (N = 219 Prolific.co participants; with a pre-test of N = 64) explored whether people also show an "uncontrollability bias"; best-laid plans are often disrupted by uncontrollable events. People thought of unexpected outcomes for 8 everyday scenarios, matched on valence and controllability, generating a total of 1752 distinct responses. Participants mainly report negative-uncontrollable unexpected events (34%). However, in contrast to prior work (i) negatively-valenced scenarios elicit more controllable unexpected outcomes, and (ii) uncontrollable scenarios elicit more positive unexpected outcomes. The implications of these results for everyday cognition and decision making are discussed., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: This report describes a minimally invasive lumbar foraminotomy technique that can be applied in patients who underwent complex spine decompression procedures or in patients with severe foraminal stenosis., Methods: Awake, endoscopic decompression surgery was performed in 538 patients over a 5-year period between 2014 and 2019. Transforaminal endoscopic foraminal decompression surgery using a high-speed endoscopic drill was performed in 34 patients who had previously undergone fusions at the treated level., Results: At 2-year follow-up, the mean (± SD) preoperative visual analog scale score for leg pain and the Oswestry Disability Index improved from 7.1 (± 1.5) and 40.1% (± 12.1%) to 2.1 (± 1.9) and 13.6% (± 11.1%)., Conclusions: A minimally invasive, awake procedure is presented for the treatment of severe lumbar foraminal stenosis in patients with lumbar radiculopathy after lumbar fusion.

(1) Background: Length of stay (LOS) is a commonly reported metric used to assess surgical success, patient outcomes, and economic impact. The focus of this study is to use a variety of machine learning algorithms to reliably predict whether a patient undergoing posterior spinal fusion surgery treatment for Adult Spine Deformity (ASD) will experience a prolonged LOS. (2) Methods: Patients undergoing treatment for ASD with posterior spinal fusion surgery were selected from the American College of Surgeon's NSQIP dataset. Prolonged LOS was defined as a LOS greater than or equal to 9 days. Data was analyzed with the Logistic Regression, Decision Tree, Random Forest, XGBoost, and Gradient Boosting functions in Python with the Sci-Kit learn package. Prediction accuracy and area under the curve (AUC) were calculated. (3) Results: 1281 posterior patients were analyzed. The five algorithms had prediction accuracies between 68% and 83% for posterior cases (AUC: 0.566-0.821). Multivariable regression indicated that increased Work Relative Value Units (RVU), elevated American Society of Anesthesiologists (ASA) class, and longer operating times were linked to longer LOS. (4) Conclusions: Machine learning algorithms can predict if patients will experience an increased LOS following ASD surgery. Therefore, medical resources can be more appropriately allocated towards patients who are at risk of prolonged LOS.

The three datasets described in this paper were collected from online experiments distributed via Prolific.co participant system. Together, the three datasets comprise 9720 text responses of unexpected events participants predicted for everyday scenarios such as going shopping or preparing breakfast. Each event was labelled by at least two independent, human raters on their topic or category (relative to their initial scenario), the valence or sentiment of the event, and whether or not the event mentions words related to the goal stated in the initial scenario. We also include summary data from a pre- and post-test conducted in the course of these experiments, as well as the analysis code in the form of Jupyter Notebooks. We provide this data and relevant code for transparency and reproducibility alongside our Cognition paper. The dataset could be useful in training machine learning models on valence/sentiment of everyday unexpected events., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships which have or could be perceived to have influenced the work reported in this article., (© 2021 The Authors. Published by Elsevier Inc.)

Though we often "fear the worst", worrying that unexpectedly bad things will happen, there are times when we "hope for the best", imagining that unexpectedly good things will happen, too. The paper explores how the valence of the current situation influences people's imagining of unexpected future events when participants were instructed to think of "something unexpected". In Experiment 1, participants (N = 127) were asked to report unexpected events to everyday scenarios under different instructional conditions (e.g., asked for "good" or "bad" unexpected events), and manifested a strong negativity bias in response to non-valenced instructions (i.e., being asked to "think of the unexpected" with no valence given). They mainly reported quite "predictable" unexpected outcomes that were negative; however, a post-test (N = 31) showed that the scenarios used were predominantly positive. In Experiment 2 (N = 257), when participants were instructed to think of "something unexpected and bizarre", under the same instructional manipulations as Experiment 1, this negativity bias was replicated. In Experiment 3, using a design in which positive/negative materials were matched (verified by a pre-test, N = 60), it was found that when participants (N = 102) were given negative scenarios, they reported more positive events than they do when they are given positive scenarios. Though responding still retained an overwhelming negative bias, this result provided some evidence for a weaker valence-countering strategy; that is, where a negative scenario can lead to positive unexpected events being mentioned, and a positive scenario leads to negative unexpected events being reported. The implications of these results for people's projections of unexpected futures in their everyday lives is discussed., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Since its discovery 16 years ago, roaming has become a ubiquitous mechanism in molecular photochemistry. Its general features are now understood, but little detail is known about how the potential energy surface (PES) determines reaction outcomes. We performed detailed experiments on formaldehyde (H 2 CO) photodissociation and determined fully correlated quantum state distributions of the molecular hydrogen and carbon monoxide products. These experiments reveal previously undetected bimodal carbon monoxide rotational distributions. Insights from classical trajectory calculations demonstrate that these features arise from resonances as the PES directs the reaction into cis and trans O-C-H···H critical geometries, which produce rebound and stripping mechanisms, respectively. These subtle and pervasive effects demonstrate additional complexity in this prototypical roaming reaction, which we expect to be general. They also provide detailed benchmarks for predictive theories of roaming., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Objective: This article reviews research on computerized and computer-assisted psychological assessment and psychotherapy for college and university students., Method: Published reviews of outcome research on the topic are reviewed, along with individual clinical trials and other relevant studies not covered by reviews, as well as reviews of closely-related research., Results: Computer-assisted assessment and psychotherapy have proven effective with collegians across samples, nations, and presenting concerns., Conclusions: Currently-available digital technologies can address these mental health service delivery challenges: cost, limited human resources, failure of students to seek help, stigmatization of collegians seeking help, premature termination, inadequate process and outcome data to assess and improve treatment effectiveness, and lack of real-time data-based treatment selection., (© 2019 Wiley Periodicals, Inc.)

Using a combination of velocity-map imaging and resonance-enhanced multiphoton ionization detection with crossed molecular beam scattering, the dynamics of rotational energy transfer have been examined for NO in collisions with CH 4 at a mean collision energy of 700 cm - 1 . The images of NO scattered into individual rotational ( j NO ' ) and spin-orbit (Ω) levels typically exhibit a single broad maximum that gradually shifts from the forward to the backward scattering direction with increasing rotational excitation (i.e., larger Δ j NO ). The rotational rainbow angles calculated with a two-dimensional hard ellipse model show reasonable agreement with the observed angles corresponding to the maxima in the differential cross sections extracted from the images for higher Δ j NO transitions, but there are clear discrepancies for lower Δ j NO (in particular, final rotational levels with j NO ' = 7.5 and 8.5). The sharply forward scattered angular distributions for these lower Δ j NO transitions better agree with the predictions of an L-type rainbow model. The more highly rotationally excited NO appears to coincide with low rotational excitation of the co-product CH 4 , indicating a degree of rotational product-pair anticorrelation in this bimolecular scattering.

The first experimental observation of the primary photochemical channel of acetaldehyde leading to the formation of ketene (CH 2 CO) and hydrogen (H 2 ) molecular products is reported. Acetaldehyde (CH 3 CHO) was photolysed in a molecular beam at 305.6 nm and the resulting H 2 product characterized using velocity-map ion (VMI) imaging. Resonance-enhanced multiphoton ionization (REMPI), via two-photon excitation to the double-well EF 1 Σ state, was used to state-selectively ionize the H 2 and determine angular momentum distributions for H 2 (ν = 0) and H 2 (ν = 1). Velocity-map ion images were obtained for H 2 (ν = 0 and 1, J = 5), allowing the total translational energy release of the photodissociation process to be determined. Following photolysis of CH 3 CHO in a gas cell, the CH 2 CO co-fragment was identified, using Fourier transform infrared spectroscopy, by its characteristic infrared absorption at 2150 cm -1 . The measured quantum yield of the CH 2 CO + H 2 product channel at 305.0 nm is φ = 0.0075 ± 0.0025 for both 15 Torr of neat CH 3 CHO and a mixture with 745 Torr of N 2 . Although small, this result has implications for the atmospheric photochemistry of carbonyls and this reaction represents a new tropospheric source of H 2 . Quasi-classical trajectory (QCT) simulations on a zero-point energy corrected reaction-path potential are also performed. The experimental REMPI and VMI image distributions are not consistent with the QCT simulations, indicating a non reaction-path mechanism should be considered.

Quasi-classical trajectory simulations examine the reaction of Cl with propene across a range of collision energies, from 7 to 28 kJ mol -1 . The majority (70% at 7 kJ mol -1 , 86% at 14 kJ mol -1 , and 93% at 28 kJ mol -1 ) of reactive trajectories produce HCl by direct abstraction of a hydrogen atom from the methyl group of propene, but the remainder involve a variety of delayed mechanisms. Among these longer-lived trajectories, transient formation of an energized 1-chloropropyl radical intermediate is predominant, with only a minor contribution from the 2-chloropropyl radical and roaming pathways. The branching ratios between these intermediate states are largely invariant to collision energy, although the overall proportion of indirect trajectories increases at lower collision energies. The greater role for longer-lived trajectories is reflected in the computed product scattering angle distributions, which become more isotropic at lower energies. However, the distributions of population over vibrational and rotational states of the product HCl do not change with collision energy because they are controlled by the dynamics late along the reaction path.

A new approach for preventing zero-point energy (ZPE) violation in quasi-classical trajectory (QCT) simulations is presented and applied to H 2 CO "roaming" reactions. Zero-point energy may be problematic in roaming reactions because they occur at or near bond dissociation thresholds and these channels may be incorrectly open or closed depending on if, or how, ZPE has been treated. Here we run QCT simulations on a "ZPE-corrected" potential energy surface defined as the sum of the molecular potential energy surface (PES) and the global harmonic ZPE surface. Five different harmonic ZPE estimates are examined with four, on average, giving values within 4 kJ/mol-chemical accuracy-for H 2 CO. The local harmonic ZPE, at arbitrary molecular configurations, is subsequently defined in terms of "projected" Cartesian coordinates and a global ZPE "surface" is constructed using Shepard interpolation. This, combined with a second-order modified Shepard interpolated PES, V , allows us to construct a proof-of-concept ZPE-corrected PES for H 2 CO, V eff , at no additional computational cost to the PES itself. Both V and V eff are used to model product state distributions from the H + HCO → H 2 + CO abstraction reaction, which are shown to reproduce the literature roaming product state distributions. Our ZPE-corrected PES allows all trajectories to be analysed, whereas, in previous simulations, a significant proportion was discarded because of ZPE violation. We find ZPE has little effect on product rotational distributions, validating previous QCT simulations. Running trajectories on V , however, shifts the product kinetic energy release to higher energy than on V eff and classical simulations of kinetic energy release should therefore be viewed with caution.

The photodissociation dynamics of roaming in formaldehyde are studied by comparing quasi-classical trajectory calculations performed on a new potential energy surface (PES) to new and detailed experimental results detailing the CO + H 2 product state distributions and their correlations. The new PES proves to be a significant improvement over the past one, now more than a decade old. The new experiments probe both the CO and H 2 products of the formaldehyde dissociation. The experimental and trajectory data offer unprecedented detail about the correlations between internal states of the CO and H 2 dissociation products as well as information on how these distributions are different for the roaming and transition-state pathways. The data investigated include, for dissociation on the formaldehyde 2 1 4 3 band, (a) the speed distributions for individual vibrational/rotational states of the CO products, providing information about the correlated internal energy distributions of the H 2 product, and (b) the rotational and vibrational distributions for the CO and H 2 products as well as the contributions to each from both the transition state and roaming channels. The agreement between the trajectory and experimental data is quite satisfactory, although minor differences are noted. The general agreement provides support for future use of the experimental techniques and the new PES in understanding the dynamics of photodissociative processes.

The dynamics of CO production from photolysis of H 2 CO have been explored over a 8000 cm -1 energy range (345 nm-266 nm). Two-dimensional ion imaging, which simultaneously measures the speed and angular momentum distribution of a photofragment, was used to characterise the distribution of rotational and translational energy and to quantify the branching fraction of roaming, transition state (TS), and triple fragmentation (3F) pathways. The rotational distribution for the TS channel broadens significantly with increasing energy, while the distribution is relatively constant for the roaming channel. The branching fraction from roaming is also relatively constant at 20% of the observed CO. Above the 3F threshold, roaming decreases in favour of triple fragmentation. Combining the present data with our previous study on the H-atom branching fractions and published quantum yields for radical and molecular channels, absolute quantum yields were determined for all five dissociation channels for the entire S 1 ←S 0 absorption band, covering almost 8000 cm -1 of excitation energy. The S 0 radical and TS molecular channels are the most important over this energy range. The absolute quantum yield of roaming is fairly constant ∼5% at all energies. The T 1 radical channel is important (20%-40%) between 1500 and 4000 cm -1 above the H + HCO threshold, but becomes unimportant at higher energy. Triple fragmentation increases rapidly above its threshold reaching a maximum of 5% of the total product yield at the highest energy.

Objective: To evaluate the efficacy of Parent Education Through Simulation-Diabetes (PETS-D; clinical trial registration NCT01517269) for parents of children <13 years old newly diagnosed with type 1 diabetes with 3 parent education vignette sessions using human patient simulation (HPS) as compared with formal parent-nurse education sessions (vignette only) regarding diabetes knowledge, problem-solving skills, hypoglycemia fear, anxiety, and self-efficacy., Design and Methods: Subjects were randomized to the HPS parent diabetes education or the vignette-only arm. Using linear mixed modeling, we compared HPS and vignette-only groups at 2, 6, and 14 weeks. Effect modification of treatment by dichotomized child's age (<6 and ≥ 6 years old) and parent education (≤ high school and >high school) was also tested. All analyses were intent to treat and adjusted for baseline outcome level and clustering within site., Results: We recruited 191 parents (116 children). Mean baseline A1C was 12%. Overall treatment-related differences were modest. There was a statistically significant effect modification of HPS by child's age, with a larger HPS benefit among parents of younger children for several outcomes: A1C (8.16% vs 9.48% in control; P = .006), lower state anxiety (P = .0094), and higher fear of hypoglycemia (P = .03) for parents of children <6 years old in the HPS group., Conclusions: Modest treatment-related differences may reflect ceiling/floor effects in many of the outcomes; we also compared HPS with another intervention rather than to usual education. Parents of younger children receiving the intervention may feel more comfortable with lower A1C levels because of management awareness gleaned from the HPS experience. Future research will include a retrospective case-control study of very young children., (© 2015 The Author(s).)

Citizen science programs that record wildlife observations on and along roads can help reduce the underreporting of wildlife-vehicle collisions and identify and prioritize road sections where mitigation measures may be required. It is important to evaluate potential biases in opportunistic citizen science data. We investigated whether the opportunistic observations of live animals by volunteers along a 46-km section of Highway 3 in the Crowsnest Pass area ("Road Watch in the Pass" data collection program) in Alberta, Canada, had a similar spatial pattern as systematically collected data by the researchers along the same road section. A permutation modeling process that compared the number of observations between the two datasets for each 1-km segment, a randomization method that tested for and compared hotspot observation locations, and a bivariate Ripley's L1.2-function analysis along a continuum of spatial scales all showed spatial agreement between the two datasets. There was spatial agreement at a scale between 1 and 4 km, and three clear hotspots of wildlife observation activity were identified for both processes. This suggests that the data collected by the volunteers are reliable and robust enough to be used to help identify road sections that may require mitigation measures. In addition, volunteers proved to be able to collect a sufficient number of observations relatively quickly. Within one year, 24 volunteers collected 640 wildlife observations, and we found that using only 150 or more of these observations always resulted in spatial similarity with the systematic observations collected by the researchers. We conclude with recommendations for other citizen science data collection programs and for further research., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Emerging evidence suggests that ecological heterogeneity across space can influence the genetic structure of populations, including that of long-distance dispersers such as large carnivores. On the central coast of British Columbia, Canada, wolf (Canis lupus L., 1758) dietary niche and parasite prevalence data indicate strong ecological divergence between marine-oriented wolves inhabiting islands and individuals on the coastal mainland that interact primarily with terrestrial prey. Local holders of traditional ecological knowledge, who distinguish between mainland and island wolf forms, also informed our hypothesis that genetic differentiation might occur between wolves from these adjacent environments., Results: We used microsatellite genetic markers to examine data obtained from wolf faecal samples. Our results from 116 individuals suggest the presence of a genetic cline between mainland and island wolves. This pattern occurs despite field observations that individuals easily traverse the 30 km wide study area and swim up to 13 km among landmasses in the region., Conclusions: Natal habitat-biased dispersal (i.e., the preference for dispersal into familiar ecological environments) might contribute to genetic differentiation. Accordingly, this working hypothesis presents an exciting avenue for future research where marine resources or other components of ecological heterogeneity are present.

The photodissociation dynamics of H2CO molecules at energies bracketing the triple fragmentation threshold were investigated using velocity map ion imaging of the H-atom fragments. An algorithm was developed to model the experimental results as a two-step process: initially barrierless C-H bond fission on the S0 potential energy surface to form H + HCO, followed by secondary fragmentation of those HCO radicals with sufficient internal energy to overcome the small exit channel barrier on the HCO surface to form H + CO. Our model treats the first step using phase space theory (PST) and the second using a combined PST-impulsive model, with a tunneling correction. Experimentally, triple fragmentation reaches 25% of the radical (H + HCO) channel photochemical yield at energies about 1500 cm(-1) above the barrier for breaking the second bond. In addition, the triplet (T1) channel appears to reduce in importance after the barrier on the T1 surface is exceeded, slowly decreasing to <10% of the total radical yield at higher energy. The double PST-impulsive model provides a good fit to the experimental H-atom speed and energy distributions for H2CO dissociation on S0 spanning >7000 cm(-1) of available energy.

The clearest dynamical signature of a roaming reaction is a very cold distribution of energy into the rotational and translational degrees of freedom of the roaming donor fragment (e.g. CO) and an exceptionally hot vibrational distribution in the roaming acceptor fragment (e.g. H2, CH4). These signatures were initially identified in joint experimental/theoretical investigations of roaming in H2CO and CH3CHO and are now used to infer the presence of roaming mechanisms in other photodissociation reactions. In this paper we construct a phase space theory (PST) model of triple fragmentation (3F) and show that the dynamical signature of 3F is similar to that of the roaming donor fragment. The PST model starts with a calculation of two-body fragmentation (2F) of a generic molecule, ABC into AB + C. Every AB fragment with sufficient energy to undergo subsequence spontaneous dissociation is allowed to dissociate and the PST distribution of energy into A + B products is calculated for every initial AB state. Using CH3CHO --> HCO + CH3 --> H + CO + CH3 as an example, we calculate that the energy disposal into the rotational and translational degrees of freedom of the 3F products is very low, and is similar to the dynamical signature expected for production of CO via a roaming mechanism. We compare the 3F PST model with published experimental data for photodissociation of CH3CHO and CH3OCHO at energies above the 3F threshold.

Depressed sinoaortic baroreflex control of heart rate following myocardial infarction (MI) is associated with increased morbidity and mortality. The etiology of this autonomic disturbance is unknown but could potentially occur at several levels of the reflex arc. The purpose of this study was to assess whether depressed baroreflex sensitivity (BRS) post-MI is associated with aortic baroreceptor dysfunction. BRS was measured before and 4-8 weeks after anterior MI in 17 chronically-instrumented, trained, conscious dogs. BRS (ms/mm Hg) was defined as the slope of the relationship between changes in systolic blood pressure (SBP) and heart period in response to a bolus dose of phenylephrine (PE). After the effects of MI on BRS were determined, the animals were anesthetized and the aortic depressor nerves (ADN) were isolated from the cervical vagi. Aortic baroreceptor function was measured by direct recording of ADN activity during gradual elevation of SBP induced by PE infusion. BRS was depressed following MI in 7 of these dogs and preserved in the remaining 10. Aortic baroreceptor sensitivity (ABS) defined as the slope of the relationship between changes in ADN activity and SBP was not significantly different between the dogs with depressed BRS compared to the dogs with preserved BRS post-MI. In conclusion, the response of the aortic baroreceptors to an increase in SBP is similar in dogs with and without depressed BRS post-MI. Based on these data, we conclude that depressed reflex control of heart rate following MI is not related to dysfunction of the afferent limb of the sinoaortic baroreflex.

Reflex control of heart rate is frequently impaired following myocardial infarction. This is referred to as depressed baroreflex sensitivity. The aim of these experiments was to assess the function of other autonomic reflexes in dogs with depressed baroreflex sensitivity. Comparisons were made to dogs in whom baroreflex sensitivity was preserved or unchanged after myocardial infarction. Under chloralose-barbiturate anesthesia, reflex control of sympathetic outflow by the sinoaortic baroreceptors was determined by measurement of changes in systolic arterial pressure and efferent renal sympathetic nerve activity during infusion of phenylephrine. Following sinoaortic denervation, reflex control of sympathetic outflow by cardiac receptors with vagal afferent fibers was determined by measurement of changes in pulmonary capillary wedge pressure and renal nerve activity during blood volume expansion. Reflex decreases in renal nerve activity in response to increases in arterial pressure were similar in the two groups of dogs. In contrast, elevation of pulmonary capillary wedge pressure elicited significantly greater reflex decreases in renal nerve activity in dogs with depressed baroreflex sensitivity following myocardial infarction compared to dogs with preserved baroreflex sensitivity. Hemodynamic parameters and infarct sizes were similar in each group. In conclusion, activation of cardiac receptors with vagal afferent fibers elicited greater reflex inhibition of sympathetic outflow in dogs with depressed baroreflex sensitivity following myocardial infarction. These data suggest that these receptors are "sensitized". These results provide additional support for the hypothesis that depressed reflex control of heart rate following myocardial infarction is related to augmented afferent input from the left ventricle.

The aim of this study was to assess the delayed effects of transmyocardial laser revascularization (TMLR) on cardiac nociceptors. Experiments were performed in anesthetized dogs 1 month after thoracotomy with either TMLR (n = 17) or sham laser procedure (n = 17). All dogs underwent sinoaortic denervation and vagotomy to isolate the sympathetic afferent system. Left ventricular sympathetic afferents were stimulated by intracoronary bradykinin and transmural myocardial ischemia. Efferent responses were measured by direct recording of renal sympathetic nerve activity. Renal nerve responses to intracoronary bradykinin administered to the laser-treated anterior ventricular wall were not significantly different from those observed from the unlased posterior wall. Anterior transmural ischemia elicited similar renal nerve responses in laser-treated and sham groups. Pathologic analysis showed intact neural structures in the subepicardial regions both near and remote from the lased channels. We conclude that reflexes mediated by left ventricular sympathetic afferents are preserved after chronic TMLR. These findings do not support the neural hypothesis for angina relief.

Objective: Depressed baroreflex sensitivity (BRS) has been observed following MI and has adverse prognostic implications. The mechanism for this finding is unknown. We tested the hypothesis that depressed BRS following myocardial infarction (MI) is related to augmented input from afferent receptors in the left ventricle., Methods: Conscious, chronically-instrumented dogs were trained to undergo BRS testing. This testing was performed before and 4 weeks after creation of experimental anterior MI. Animals were then randomized to undergo regional deafferentation or sham thoracotomy. One week later, BRS testing was repeated., Results: Animals with reduced BRS post-MI showed slight increases in sensitivity values after regional deafferentation. Following sham thoracotomy, animals with reduced BRS post-MI exhibited further decreases in sensitivity values. The differences in mean BRS values measured after regional or sham deafferentation were significant (17.4+/-2.0 ms/mmHg vs. 11.7+/-1.4 ms/mmHg; P<0.05)., Conclusions: In animals with reduced BRS post-MI, deafferentation of the infarcted region prevented the progressive decline in sensitivity values that was noted in the control group. These data suggest that depressed BRS following MI is related to augmented afferent input from left ventricular receptors.

Objective: The mechanism by which transmyocardial laser revascularization relieves angina is not understood. One theory is that laser-induced thermal damage to cardiac nerves results in cardiac denervation. This study examined the acute effects of transmyocardial laser revascularization on reflex responses mediated by cardiac nociceptors, the left ventricular receptors with sympathetic afferent fibers that are thought to mediate anginal chest pain., Methods: Experiments were performed in 13 chloralose-anesthetized dogs with sinoaortic denervation and vagotomy. Left ventricular receptors with sympathetic afferent fibers were activated by epicardial and intracoronary bradykinin before and 45 minutes after transmyocardial laser revascularization. Reflex responses elicited by bradykinin were quantitated by direct recording of efferent renal sympathetic nerve activity. Transmyocardial laser revascularization was performed in the open-chest model with a hand-held holmium:YAG laser (2.1-microm wavelength)., Results: An average of 44.5 +/- 1.0 channels were created. Before transmyocardial laser revascularization, reflex increases in renal sympathetic nerve activity were elicited by both epicardial and intracoronary bradykinin. After transmyocardial laser revascularization, there was no significant attenuation in the reflex responses to either epicardial (before, 66% +/- 8%; after, 100% +/- 24%; P =.19) or intracoronary (before, 124% +/- 37%; after, 108% +/- 25%; P =.44) bradykinin., Conclusions: Transmyocardial laser revascularization has no significant short-term effect on reflexes mediated by left ventricular receptors with sympathetic afferent fibers in anesthetized dogs. These results indicate that transmyocardial laser revascularization does not acutely interrupt the afferent nerves, which are believed to transmit the perception of anginal pain.

Complexity of biomedical data requires novel sophisticated analysis and presentation methods. Sonification is used as a new information display in augmented reality systems to overcome problems of existing human-computer interface (e.g., opaque or heavy head-mounted displays, slow computer graphics, etc.). A novel taxonomy of sonification methods and techniques is introduced. We present our experience with tactical audio and acoustic rendering in biomedical applications. Tactical audio as an audio feedback is used as support for precise manual positioning of a surgical instrument in the operating room. Acoustic rendering is applied as an additional information channel and/or warning signal in biomedical signal analysis and data presentation.