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AbstractThe air–sea exchange of heat and carbon in the Southern Ocean (SO) plays an important role in mediating the climate state. The dominant role the SO plays in storing anthropogenic heat and carbon is a direct consequence of the unique and complex ocean circulation that exists there. Previous generations of climate models have struggled to accurately represent key SO properties and processes that influence the large-scale ocean circulation. This has resulted in low confidence ascribed to twenty-first-century projections of the state of the SO from previous generations of models. This analysis provides a detailed assessment of the ability of models contributed to the sixth phase of the Coupled Model Intercomparison Project (CMIP6) to represent important observationally based SO properties. Additionally, a comprehensive overview of CMIP6 performance relative to CMIP3 and CMIP5 is presented. CMIP6 models show improved performance in the surface wind stress forcing, simulating stronger and less equatorward-biased wind fields, translating into an improved representation of the Ekman upwelling over the Drake Passage latitudes. An increased number of models simulate an Antarctic Circumpolar Current (ACC) transport within observational uncertainty relative to previous generations; however, several models exhibit extremely weak transports. Generally, the upper SO remains biased warm and fresh relative to observations, and Antarctic sea ice extent remains poorly represented. While generational improvement is found in many metrics, persistent systematic biases are highlighted that should be a priority during model development. These biases need to be considered when interpreting projected trends or biogeochemical properties in this region.

Earth system models are complex and represent a large number of processes, resulting in a persistent spread across climate projections for a given future scenario. Owing to different model performances against observations and the lack of independence among models, there is now evidence that giving equal weight to each available model projection is suboptimal. This Perspective discusses newly developed tools that facilitate a more rapid and comprehensive evaluation of model simulations with observations, process-based emergent constraints that are a promising way to focus evaluation on the observations most relevant to climate projections, and advanced methods for model weighting. These approaches are needed to distil the most credible information on regional climate changes, impacts, and risks for stakeholders and policy-makers.

Objective: The effectiveness of the intraosseous (IO) route for fluid resuscitation remains uncertain. This study compares IO infusion rates and estimated volume expansion using clinically relevant infusion pressures with lactated Ringer's (LR) and hetastarch (HES).Methods: IO needles were placed in the sternum or tibia for infusion of HES and LR in 8 Yorkshire pigs. Pressures were recorded at variable flow rates and linear regression used to identify flow rates at 100 and 400 mm Hg. Volume expansion was calculated for a 10-minute infusion.Results: Mean LR flow rates (mL x min(-1)) were 24/111 (tibia--100/400 mm Hg) and 8/34 (sternum--100/400 mm Hg). The HES flow rates (mL x min(-1)) of 10/44 (tibia--100/400 mm Hg) and 6/26 (sternum--100/400 mm Hg) were significantly lower or -40% (p < 0.01) of the LR flow rates into the tibia and -70% (p < 0.05) into the sternum. Mean volume expansion (mL) for a 10-min infusion of LR was estimated to be 80/369 (tibia--100/400 mm Hg) and 27/112 (sternum--100/400 mm Hg). In comparison, HES volume expansion was -20% higher for the tibia (p > 0.05) and 110% to 120% higher for the sternum (p < 0.05).Conclusion: HES flow rates are lower than LR flow rates in the sternum and tibia of swine. Sternal infusion of HES is likely to provide greater estimated intravascular volume expansion than LR despite the lower infusion rates. [ABSTRACT FROM AUTHOR]

Russell, JL, Baker, BS, Mercer, RA, and McLean, BD. Examining the influence of season phase, age, and anthropometrics on body composition trends in NBA athletes. J Strength Cond Res 39(2): 227-233, 2025-This study aimed to describe seasonal body composition changes in NBA athletes using Dual-energy X-ray Absorptiometry (DXA) and to explore the relationship between these changes and factors such as age and anthropometrics. A retrospective analysis was conducted using 402 DXA scans from 62 professional male basketball players, obtained from one NBA team between 2012 and 2023. Seasonal phases were defined as preseason, pre all-star, post all-star, and offseason. A custom region of interest (ROI) method was used to ensure consistent scan areas for taller athletes who exceeded the DXA bed length. Linear mixed models analyzed the influence of seasonal phases, age, and height on lean mass (LM), fat mass (FM), and bone mineral content (BMC). In-season phases (pre all-star and post all-star) showed small increases in LM and decreases in FM compared with the preseason, with no significant BMC changes. Chronological age was associated with increases in LM but not FM. Taller athletes exhibited increases in LM, FM, and BMC. Significant random variance across players and seasons indicated that additional unmeasured factors might influence body composition. NBA athletes generally gain LM and lose FM during the season, with older players showing increased LM gain. The study's novel ROI method provide reliable data for athletes exceeding standard DXA limits, highlighting the importance of tailored body composition assessments in professional basketball. These findings can inform strength and conditioning, nutrition, and player development strategies across different seasonal phases and ages., (Copyright © 2024 National Strength and Conditioning Association.)

Background: Although acute kidney injury (AKI) has been established as an independent risk factor for in-hospital mortality for patients on veno-arterial (V-A) extracorporeal membranous oxygenation (ECMO), the impact of Kidney Disease Improving Global Outcomes (KDIGO) stages of AKI has yet to be elucidated as a risk factor., Methods: We conducted a retrospective analysis of patient outcomes based on KDIGO stages of AKI at a single institution. The analysis was a cohort of 179 patients; 66 without AKI, 19 with stage 1 AKI, 18 with stage 2 AKI, and 76 with stage 3 AKI., Results: Every 1-year increase in age was associated with 4% increased odds of mortality at 30 days (95% confidence interval [CI] 1.01, 1.07; p = 0.004). The presence of AKI at any stage was associated with 59% increased odds of 30-day mortality (95% CI 0.81, 3.10; p = 0.176). The presence of stage 1 AKI was associated with a 5% decreased odds of 30-day mortality (95% CI 0.32, 2.89). The presence of stage 2 AKI (odds ratio [OR] 2.29, 95% CI 0.69, 7.55; p = 0.173) and stage 3 AKI (OR 1.68, 95% CI 0.81, 3.46; p = 0.164) was associated with increased odds of 30-day mortality., Conclusion: Based on our single-center study, higher KDIGO stages of AKI likely have increased odds of mortality at 30 days. Larger studies are needed to confirm these findings., (© 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Abstract: Redinger, AL, Russell, JL, Allen, SMF, and Baker, BS. Height restrictions for dual-energy X-ray absorptiometry: what are our options for body composition and bone health precision? J Strength Cond Res 38(7): e359-e365, 2024-Dual-energy X-ray absorptiometry (DXA) is commonly used for testing athlete's body composition, but many athletes are too tall. The first aim was to assess the viability of combining upper- and lower-body regions of interest (ROI), creating a combined scan for tall athletes who do not fit on the table and second, to provide practical solutions to DXA users who routinely scan tall athletes. Sixty subjects (34.8 ± 11.9 years; 171 ± 9 cm) completed 2 total-body DXA scans for baseline precision testing, using GE Lunar Prodigy (LP) or Hologic Horizon A (HA) models. Next, an upper body ROI from the skull to the distal femoral condyles was combined with a flipped scan (feet-to-head) ROI encompassing the proximal tibial plateau to the distal foot. Soft and bone tissue coefficient of variance (CV%) were calculated between the baseline scans and for the newly combined ROI scan. The combined ROI scan added 0.25-0.63% and 0.01-4.35% error rates for the LP and HA, respectively. An exploratory assessment of a GE Lunar iDXA demonstrated results similar to the HA with 4%+ error. The combined ROI scan is a user-friendly and precise method for older LP systems adding less than 1% error; however, newer DXA systems cannot use the stitched scan technique. Coaches and practitioners who use newer DXAs must prioritize consistently using the same boney landmarks (head, jaw, or feet) and ROI heights to provide precise longitudinal assessments of tall athletes' bone and body composition, until larger DXA tables become available., (Copyright © 2024 National Strength and Conditioning Association.)

Abstract: Kutson, CW, Russell, JL, Strack, D, Coutts, AJ, and McLean, BD. External load fluctuations across an Amateur Athletic Union basketball season. J Strength Cond Res 38(3): 592-598, 2024-Amateur Athletic Union (AAU) competitions are an important component of the developmental pathway for youth basketball athletes. Despite its relative importance, there is currently a paucity of research investigating the physical demands in AAU basketball. Therefore, the purpose of this study was to examine the physical demands encountered over the course of an AAU basketball season. External training load was quantified using inertial sensors (Catapult T6) from one male AAU basketball team (age: 17.5 ± 0.5 years, height: 197.3 ± 10.0 cm, and mass: 89.4 ± 11.6 kg) over the course of the 2021 AAU season and categorized post hoc into high-, medium-, and low-minute groups based on mean playing minutes. After player categorization, 2 linear mixed models were constructed, one for PlayerLoad (PL) and one for duration, to examine the differences across player category, month of the season, and activity types (practices or games). The results show that the highest training loads were encountered by high-minute players, who had total PLs of 9,766 ± 1,516 AU, 13,207 ± 2,561 AU, and 7,071 ± 2,122 AU during April, May, and June, respectively. Highly variable training loads were also evident over the course of a season, with peak PL values as high as 4,921 AU per week. Practitioners should be aware that AAU basketball players experience variable loads throughout the season, which peak around congested competition/tournament periods. In addition, players with high game minutes accumulate the most load over the course of a season. This information may be used to better inform planning and periodizing strategies during developmental phases., (Copyright © 2023 National Strength and Conditioning Association.)

Objectives: Stroke after thoracic aortic surgery is a complication that is associated with poor outcomes. The aim is to characterize the intraoperative risk factors for stroke development., Design: A retrospective analysis., Setting: Tertiary, high-volume cardiac surgery center., Participants: Patients who had surgical repair of thoracic aortic diseases from January 1, 2017, through December 31, 2021., Interventions: None., Measurements and Main Results: A total of 704 patients were included, of whom 533 had ascending aortic aneurysms, and 171 had type A aortic dissection. The incidence of postoperative stroke was 4.5% (95% CI 2.9%-6.6%) for ascending aortic aneurysms compared with 12.3% (95% CI 7.8%-18.16%) in type-A aortic dissections. Patients who developed postoperative strokes had significantly lower intraoperative hemoglobin median (7.5 gm/dL [IQR 6.8-8.6] v 8.55 gm/dL [IQR 7.3-10.0]; p < 0.001). The median cardiopulmonary bypass time was 185 minutes (IQR 136-328) in the stroke group versus 156 minutes (IQR 113-206) in the nonstroke group (p = 0.014). Circulatory arrest was used in 57.8% versus 38.5% of the nonstroke patients (p = 0.017). The initial temperature after leaving the operating room was lower, with a median of 35.0°C (IQR 34-35.92) in the stroke group versus 35.5°C (IQR 35-36) in the nonstroke cohort (p = 0.021)., Conclusions: This single-center study highlighted the potential importance of intra-operative factors in preventing stroke. Lower hemoglobin, longer duration of cardiopulmonary bypass, deep hypothermic circulatory arrest, and postoperative hypothermia are potential risk factors for postoperative stroke. Further studies are needed to prevent this significant complication in patients with thoracic aortic diseases., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Sexual health is a necessary component of human wellbeing. Nurses espouse holistic care but in practice often overlook a person's sexual health. Disparities linked to sexual health persist nationally and globally, including those among gender and sexual minorities. Inconsistent sexual health curriculum in nurse education in the United States has led to gaps in learning. This study aimed to understand nursing students' attitudes toward addressing sexual health issues in their future profession during an Associate of Science in Nursing program in the United States., Methods: A convenience sample of Associate of Science in Nursing students from a university voluntarily participated in this longitudinal quantitative study. All eligible students enrolled in the first semester completed the Students' Attitudes Toward Addressing Sexual Health instrument. Summary statistics and Pearson r correlation were used to analyze the data., Results: The 159 students were relatively young, female, and White, non-Hispanic. The total score of students' attitudes toward addressing sexual health was 83.48, ranging from 41 to 109. Regarding the positively loaded items of the Students' Attitudes Toward Addressing Sexual Health, the results showed students believed they would have too much to do for handling sexual issues (M = 4.44), need to get basic knowledge about sexual health (M = 4.31), and take time to deal with patients' sexual issues (M = 4.24)., Conclusion: In this study, nursing students reported positive attitudes toward addressing sexual health in their future profession but acknowledged they would need basic education. Due to the homogeneity of participants' backgrounds, the generalizability of study results might be limited. It is suggested that nurse educators should develop an innovative curriculum for building students' competence and prepare graduates to deliver sexual health care for meeting a person's health needs., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Despite a significant growth of women trainees in cardiothoracic surgery recently, women remain a minority of cardiothoracic surgeons and hold a minority of leadership positions. This study evaluates differences in cardiothoracic surgeon subspecialty choices, academic rank, and academic productivity between men and women., Methods: The Accreditation Council for Graduate Medical Education database was used to identify 78 cardiothoracic surgery academic programs in the United States, including integrated, 4+3, and traditional fellowships, as of June 2020. A total of 1179 faculty members were identified within these programs, 585 adult cardiac surgeons (50%), 386 thoracic surgeons (33%), and 168 congenital surgeons (14%), and other, 40 (3%). Data were collected using institutional websites, ctsnet.org, doximity.com, linkedin.com, and Scopus., Results: Of the 1179 surgeons, only 9.6% were women. Overall, women composed 6.7% of adult cardiac, 15% of thoracic, and 7.7% of congenital surgeons. Among subspecialties, women represent 4.5% (17 of 376) of full professors and 5% (11 of 195) of division chiefs in cardiothoracic surgery in the United States, have shorter career durations, and lower h-indices compared with men. However, women had similar m-indices, which factors in career length, compared with men in adult cardiac (0.63 vs 0.73), thoracic (0.77 vs 0.90), and congenital (0.67 vs 0.78) surgeons., Conclusions: Career duration, including cumulative research productivity, appears to be the most important factors predicting full professor rank, potentially contributing to persistent sex-based disparities in academic cardiothoracic surgery., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Hospitalised children have become more medically complex and increasingly require specialised teams and units properly equipped to care for them. Within paediatric cardiology, this trend, which is well demonstrated by the expansion of cardiology-specific ICUs, has more recently led to the development of acute care cardiology units to deliver team-based and condition-focused inpatient care. These care teams are now led by paediatric cardiologists with particular investment in the acute care cardiology environment. Herein, we describe the foundation and development of an Acute Care Cardiology Advanced Training Fellowship to meet the clinical, scholarly, and leadership training needs of this emerging care environment.

Abstract: Mercer, RAJ, Russell, JL, McGuigan, LC, Coutts, AJ, Strack, DS, and McLean, BD. Finding the signal in the noise-interday reliability and seasonal sensitivity of 84 countermovement jump variables in professional basketball players. J Strength Cond Res 37(2): 394-402, 2023-This study examined the measurement characteristics of countermovement jump (CMJ) variables in basketball athletes using different variable selection criteria. Test-retest reliability (noise) and seasonal variability (signal) CMJ data were collected from 13 professional basketball athletes playing for the same club throughout 1 competitive season. Interday reliability (coefficient of variation [CV] and intraclass correlation coefficients) were calculated over 3 preseason tests conducted on 3 consecutive days. To evaluate sensitivity, signal-to-noise ratio (SNR) was calculated by dividing seasonal variability (CV) from 8 in-season CMJ tests (collected from November to February) by preseason reliability (CV). Players performed 3 CMJs each testing day, and 3 data analysis techniques were applied: a single variable from the trial with either the best jump height (BestJH; calculated by flight time) or the best flight time to contraction time (BestFT:CT) and mean output across 3 jumps (Mean3). Mean3 was the most reliable data analysis technique, with 79 and 82 of 84 variables displaying lower interday CVs compared with BestJH and BestFT:CT, respectively. Overall, many CMJ measures display seasonal changes that are greater than the inherent noise, with 77 variables producing SNR of >1.00 for Mean3 compared with 65 and 58 variables for BestJH and BestFT:CT, respectively. To improve reliability and sensitivity, it is recommended that practitioners use the average of multiple CMJ trials and regularly reassess measurement characteristics specific to their cohort and environment., (Copyright © 2022 National Strength and Conditioning Association.)

The diprovocims, a new class of toll-like receptor (TLR) agonists, bear no similarity to prior TLR agonists, act through a well-defined mechanism (TLR1/TLR2 agonist), exhibit exquisite structure-activity relationships, and display in vivo adjuvant activity. They possess potent and efficacious agonist activity toward human TLR1/TLR2 but modest agonism toward the murine receptor. A manner by which diprovocims can be functionalized without impacting hTLR1/TLR2 activity is detailed, permitting future linkage to antigenic, targeting, or delivery moieties. Improvements in both potency and its low efficacy in the murine system were also achieved, permitting more effective use in animal models while maintaining the hTLR1/TLR2 activity. The prototypical member diprovocim-X exhibits the excellent potency/efficacy of diprovocim-1 in human cells, displays substantially improved potency/efficacy in mouse macrophages, and serves as an adjuvant in mice when coadministered with a nonimmunogenic antigen, indicating stimulation of the adaptive as well as innate immune response.

This study examined associations between cumulative training load, travel demands and recovery days with athlete-reported outcome measures (AROMs) and countermovement jump (CMJ) performance in professional basketball. Retrospective analysis was performed on data collected from 23 players (mean±SD: age = 24.7±2.5 years, height = 198.3±7.6 cm, body mass = 98.1±9.0 kg, wingspan = 206.8±8.4 cm) from 2018-2020 in the National Basketball Association G-League. Linear mixed models were used to describe variation in AROMs and CMJ data in relation to cumulative training load (previous 3- and 10-days), hours travelled (previous 3- and 10-day), days away from the team's home city, recovery days (i.e., no travel/minimal on-court activity) and individual factors (e.g., age, fatigue, soreness). Cumulative 3-day training load had negative associations with fatigue, soreness, and sleep, while increased recovery days were associated with improved soreness scores. Increases in hours travelled and days spent away from home over 10 days were associated with increased sleep quality and duration. Cumulative training load over 3 and 10 days, hours travelled and days away from home city were all associated with changes in CMJ performance during the eccentric phase. The interaction of on-court and travel related stressors combined with individual factors is complex, meaning that multiple athletes response measures are needed to understand fatigue and recovery cycles. Our findings support the utility of the response measures presented (i.e., CMJ and AROMs), but this is not an exhaustive battery and practitioners should consider what measures may best inform training periodization within the context of their environment/sport., Competing Interests: The authors have declared that no competing interests exist.

Background: The purpose of this study was to test whether cryotherapy is superior to a sham procedure for reducing symptoms of chronic rhinitis., Methods: This study was a prospective, multicenter, 1:1 randomized, sham-controlled, patient-blinded trial. The predetermined sample size was 61 participants per arm. Adults with moderate/severe symptoms of chronic rhinitis who were candidates for cryotherapy under local anesthesia were enrolled. Participants were required to have minimum reflective Total Nasal Symptom Scores (rTNSSs) of 4 for total, 2 for rhinorrhea, and 1 for nasal congestion. Follow-up visits occurred at 30 and 90 days postprocedure. Patient-reported outcome measures included the rTNSS, standardized Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ(S)], and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires. Adverse events were also recorded. The primary endpoint was the comparison between the treatment and sham arms for the percentage of responders at 90 days. Responders were defined as participants with a 30% or greater reduction in rTNSS relative to baseline., Results: Twelve US investigational centers enrolled 133 participants. The primary endpoint analysis included 127 participants (64 active, 63 sham) with 90-day results. The treatment arm was superior at the 90-day follow-up with 73.4% (47 of 64) responders compared with 36.5% (23 of 63) in the sham arm (p < 0.001). There were greater improvements in the rTNSS, RQLQ(S), and NOSE scores for the active arm over the sham arm at the 90-day follow-up (p < 0.001). One serious procedure-related adverse event of anxiety/panic attack was reported., Conclusion: Cryotherapy is superior to a sham procedure for improving chronic rhinitis symptoms and patient quality of life., (© 2021 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.)

Purpose : There are currently no data describing combined practice and game load demands throughout a National Basketball Association (NBA) season. The primary objective of this study was to integrate external load data garnered from all on-court activity throughout an NBA season, according to different activity and player characteristics. Methods : Data from 14 professional male basketball players (mean ± SD; age, 27.3 ± 4.8 years; height, 201.0 ± 7.2 cm; body mass, 104.9 ± 10.6 kg) playing for the same club during the 2017-2018 NBA season were retrospectively analyzed. Game and training data were integrated to create a consolidated external load measure, which was termed integrated load . Players were categorized by years of NBA experience (1-2y, 3-5y, 6-9y, and 10 + y), position (frontcourt and backcourt), and playing rotation status (starter, rotation, and bench). Results : Total weekly duration was significantly different ( p  < 0.001) between years of NBA playing experience, with duration highest in 3-5 year players, compared with 6-9 ( d  = 0.46) and 10+ ( d  = 0.78) year players. Starters experienced the highest integrated load, compared with bench ( d  = 0.77) players. There were no significant differences in integrated load or duration between positions. Conclusion : This is the first study to describe the seasonal training loads of NBA players for an entire season and shows that a most training load is accumulated in non-game activities. This study highlights the need for integrated and unobtrusive training load monitoring, with engagement of all stakeholders to develop well-informed individualized training prescription to optimize preparation of NBA players., Competing Interests: BM, JR and DS involved in this work are NBA affiliated practitioners/researchers. As such, the study design and methods have been required to comply with the NBA Health-Related Research policy. This work has been reviewed by the NBA, NBA Physicians Association, NBA Players Association. As part of this process, this manuscript was made available for comment from the NBA and NBA Research Committee prior to publication (these contributors are not listed as authors). The authors declare an absence of any other commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Russell, McLean, Stolp, Strack and Coutts.)

Background Congenital heart disease practices and outcomes vary significantly across centers, including postoperative chest tube (CT) management, which may impact postoperative length of stay (LOS). We used collaborative learning methods to determine whether centers could adapt and safely implement best practices for CT management, resulting in reduced postoperative CT duration and LOS. Methods and Results Nine pediatric heart centers partnered together through 2 learning networks. Patients undergoing 1 of 9 benchmark congenital heart operations were included. Baseline data were collected from June 2017 to June 2018, and intervention-phase data were collected from July 2018 to December 2019. Collaborative learning methods included review of best practices from a model center, regular data feedback, and quality improvement coaching. Center teams adapted CT removal practices (eg, timing, volume criteria) from the model center to their local resources, practices, and setting. Postoperative CT duration in hours and LOS in days were analyzed using statistical process control methodology. Overall, 2309 patients were included. Patient characteristics did not differ between the study and intervention phases. Statistical process control analysis showed an aggregate 15.6% decrease in geometric mean CT duration (72.6 hours at baseline to 61.3 hours during intervention) and a 9.8% reduction in geometric mean LOS (9.2 days at baseline to 8.3 days during intervention). Adverse events did not increase when comparing the baseline and intervention phases: CT replacement (1.8% versus 2.0%, P =0.56) and readmission for pleural effusion (0.4% versus 0.5%, P =0.29). Conclusions We successfully lowered postoperative CT duration and observed an associated reduction in LOS across 9 centers using collaborative learning methodology.

Objective: To collect real-world data on the safety and effectiveness of balloon dilation of the Eustachian tube using a seeker-based device in patients with persistent/chronic symptoms of Eustachian tube dysfunction., Methods: A multicenter, prospective, single-arm registry was conducted from June 2018 through August 2020 at 10 US centers, including tertiary care and private practices. Primary endpoints included mean change from baseline in the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and the serious related adverse event rate. Secondary endpoints include changes in middle ear assessments, surgical intervention rate, and changes in Sino-Nasal Outcome Test and Work and Activity Impairment (WPAI) questionnaires., Results: A total of 169 participants were treated with balloon dilation of the Eustachian tube, with 166 and 154 participants completing the 6-week and 6-month follow-ups, respectively. Repeated measures analysis of the change in ETDQ-7 scores indicated statistically significant improvement (-2.1; 95% CI -2.40, -1.84; P  < .0001) at 6-month follow-up. The minimum clinically important difference of improvement was achieved by 85% of participants at 6 months. Four nonserious adverse events were reported. Middle ear functional assessments were improved in the majority of participants with abnormal baseline findings. There were no statistically significant differences in the change from baseline ETDQ-7 scores between participants who had concurrent procedures and those who did not. WPAI scores demonstrated significant improvement., Conclusion: Real-world evidence supports the clinical studies demonstrating that balloon dilation of the Eustachian tube with a seeker-based device is a safe and effective procedure to treat ETD symptoms., Level of Evidence: 3., Competing Interests: Ellen M. O'Malley is an employee of Stryker ENT. Robert T. Standring, Joshua B. Greene, and Edward D. McCoul are consultants for Stryker. Joseph L. Russell has no conflicts to disclose., (© 2021 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: Many critical care interventions that require teamwork are adopted slowly and variably despite strong evidence supporting their use. We hypothesize that educational interventions that target the entire interprofessional team (rather than professions in isolation) are one effective way to enhance implementation of complex interventions in the intensive care unit (ICU). Objective: As a first step toward testing this hypothesis, we sought to qualitatively solicit opinions about team dynamics, evidence translation, and interprofessional education as well as current knowledge, attitudes, and practices surrounding the use of one example of a team-based practice in the ICU-preventive postextubation noninvasive ventilation (NIV). Methods: We conducted a qualitative evaluation using semistructured interviews and focus groups with nurses, respiratory therapists, and physicians working in four ICUs in four hospitals within an integrated health system. ICUs were selected based on variation in academic versus community status. We iteratively analyzed transcripts using a thematic content analysis approach. Results: From December 2018 to January 2019, we conducted 32 interviews (34 people) and 3 focus groups (20 people). Participants included 31 nurses, 15 respiratory therapists, and 8 physicians. Participants had favorable views of how their teams work together but discussed ways team dynamics (e.g., leader inclusiveness) impact care coordination. Participants viewed interprofessional education favorably and shared suggestions regarding preferred content and delivery (e.g., include both profession-specific and team-oriented content). Though participants reported frequently using NIV as a treatment, they described rarely using NIV as a preventive strategy, and nurses and respiratory therapists described challenges to use such as perceived patient discomfort. There were ICU-specific differences in management of patients at a high risk for respiratory failure after extubation, with some preferring to delay extubation. Conclusion: Participants reported optimism that interprofessional education can be an acceptable and effective way to improve translation of evidence into practice. Participants also detailed patient-specific and ICU-wide barriers to the implementation of preventive postextubation NIV. This information about teamwork in the ICU, suggestions for interprofessional education, and barriers and facilitators to use of a target evidence-based practice can inform the development of novel educational strategies in ways that increase acceptability, appropriateness, and feasibility of the intervention., (Copyright © 2021 by the American Thoracic Society.)

Background: In children, chylothorax post cardiac surgery can be difficult to treat, may run a protracted course, and remains a source of morbidity and mortality., Objective: To analyze the experience with percutaneous image-guided chest-tube drainage in the management of post-cardiac-surgery chylothoraces in children., Materials and Methods: We conducted a single-center retrospective case series of 37 post-cardiac-surgery chylothoraces in 34 children (20 boys; 59%), requiring 48 drainage procedures with placement of 53 image-guided chest tubes over the time period 2004 to 2015. We analyzed clinical and procedural details, adverse events and outcomes. Median age was 0.6 years, median weight 7.2 kg., Results: Attempted treatments of chylothoraces prior to image-guided chest tubes included dietary restrictions (32/37, 86%), octreotide (12/37, 32%), steroids (7/37, 19%) and thoracic duct ligation (5/37, 14%). Image-guided chest tubes (n=43/53, 81%) were single unilateral in 29 children, bilateral in 4 (n=8/53, 15%), and there were two ipsilateral tubes in one (2/53, 4%). Effusions were isolated, walled-off, in 33/53 (62%). In 20/48 procedures (42%) effusions were septated/complex. The mean drainage through image-guided chest tubes was 17.3 mL/kg in the first 24 h, and 13.4 mL/kg/day from diagnosis to chest tube removal; total mean drainage from all chest tubes was 19.6 mL/kg/day. Nine major and 27 minor maintenance procedures were required during 1,207 tube-days (rate: 30 maintenance/1,000 tube-days). Median tube dwell time was 21 days (range 4-57 days). There were eight mild adverse events, three moderate adverse events and no severe adverse events related to image-guided chest tubes. Radiologic resolution was achieved in 26/37 (70%). Twenty-three children (68%) survived to discharge; 11 children (32%) died from underlying cardiac disease., Conclusion: Management of chylothorax post-cardiac-surgery in children is multidisciplinary, requiring concomitant multipronged approaches, often through a protracted course. Multiple image-guided chest tube drainages can help achieve resolution with few complications. Interventional radiology involvement in tube care and maintenance is required. Overall, mortality remains high.

Background: Measuring the physical work and resultant acute psychobiological responses of basketball can help to better understand and inform physical preparation models and improve overall athlete health and performance. Recent advancements in training load monitoring solutions have coincided with increases in the literature describing the physical demands of basketball, but there are currently no reviews that summarize all the available basketball research. Additionally, a thorough appraisal of the load monitoring methodologies and measures used in basketball is lacking in the current literature. This type of critical analysis would allow for consistent comparison between studies to better understand physical demands across the sport., Objectives: The objective of this systematic review was to assess and critically evaluate the methods and technologies used for monitoring physical demands in competitive basketball athletes. We used the term 'training load' to encompass the physical demands of both training and game activities, with the latter assumed to provide a training stimulus as well. This review aimed to critique methodological inconsistencies, establish operational definitions specific to the sport, and make recommendations for basketball training load monitoring practice and reporting within the literature., Methods: A systematic review of the literature was performed using EBSCO, PubMed, SCOPUS, and Web of Science to identify studies through March 2020. Electronic databases were searched using terms related to basketball and training load. Records were included if they used a competitive basketball population and incorporated a measure of training load. This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO Registration # CRD42019123603), and approved under the National Basketball Association (NBA) Health Related Research Policy., Results: Electronic and manual searches identified 122 papers that met the inclusion criteria. These studies reported the physical demands of basketball during training (n = 56), competition (n = 36), and both training and competition (n = 30). Physical demands were quantified with a measure of internal training load (n = 52), external training load (n = 29), or both internal and external measures (n = 41). These studies examined males (n = 76), females (n = 34), both male and female (n = 9), and a combination of youth (i.e. under 18 years, n = 37), adults (i.e. 18 years or older, n = 77), and both adults and youth (n = 4). Inconsistencies related to the reporting of competition level, methodology for recording duration, participant inclusion criteria, and validity of measurement systems were identified as key factors relating to the reporting of physical demands in basketball and summarized for each study., Conclusions: This review comprehensively evaluated the current body of literature related to training load monitoring in basketball. Within this literature, there is a clear lack of alignment in applied practices and methodological framework, and with only small data sets and short study periods available at this time, it is not possible to draw definitive conclusions about the true physical demands of basketball. A detailed understanding of modern technologies in basketball is also lacking, and we provide specific guidelines for defining and applying duration measurement methodologies, vetting the validity and reliability of measurement tools, and classifying competition level in basketball to address some of the identified knowledge gaps. Creating alignment in best-practice basketball research methodology, terminology and reporting may lead to a more robust understanding of the physical demands associated with the sport, thereby allowing for exploration of other research areas (e.g. injury, performance), and improved understanding and decision making in applying these methods directly with basketball athletes.

Background: Nearly every child undergoing congenital heart surgery has chest tubes placed intraoperatively. Center variation in removal practices and impact on outcomes has not been well described. This study evaluated variation in chest tube management practices and outcomes across centers., Methods: The study included patients undergoing any of 10 benchmark operations from June 2017 to May 2018 at participating Pediatric Acute Care Cardiology Collaborative (PAC 3 ) and Pediatric Cardiac Critical Care Consortium (PC 4 ) centers. Clinical data from PC 4 centers were merged with chest tube data from PAC 3 centers. Practices and outcomes were compared across centers in univariate and multivariable analysis., Results: The cohort included 1029 patients (N = 9 centers). Median chest tube duration varied significantly across centers for 9 of 10 benchmark operations (all P ≤ .03), with a "model" center noted to have the shortest duration for 9 of 10 operations (range, 27.9% to 87.4% shorter duration vs other centers across operations). This effect persisted in multivariable analysis (P < .0001). The model center had higher volumes of chest tube output before removal (median, 8.5 mL/kg/24 h [model] vs 2.2 mL/kg/24 h [other centers]; P < .001], but it did not have higher rates of chest tube reinsertion (model center 1.3% vs 2.1%; P = .59) or readmission for pleural effusion (model center 4.4% vs 3.0%; P = .31), and had the shortest length of stay for 7 of 10 operations., Conclusions: This study suggests significant center variation in chest tube removal practices and associated outcomes after congenital heart surgery. Best practices used at the model center have informed the design of an ongoing collaborative learning project aimed at reducing chest tube duration and length of stay., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: We describe our technique of using reverse frontal bone graft for FOAR for patients with metopic or coronal synostosis and present our complications using the Leeds classification system for complications in craniosynostosis surgery., Methods: Since April 2015, seventeen patients have been operated using this technique. We perform a frontal bone graft that is then reversed, and supraorbital margins are drilled out. The orbital bar is then removed and drilled down to make bone dust and on-lay bone grafts which are then used to fill gaps on exposed dura and fill in around the temporal region., Results: All 17 patients who underwent this technique have good cosmetic results. We report 5 (29%) complications and 8 (47%) blood transfusions (7 exposures, 1 cell salvage).

Controlling the thermal conductivity of semiconductors is of practical interest in optimizing the performance of thermoelectric and phononic devices. The insertion of inclusions of nanometer size in a semiconductor is an effective means of achieving such control; it has been proposed that the thermal conductivity of silicon could be reduced to 1 W/m/K using this approach and that a minimum in the heat conductivity would be reached for some optimal size of the inclusions. Yet the experimental verification of this design rule has been limited. In this work, we address this question by studying the thermal properties of silicon metalattices that consist of a periodic distribution of spherical inclusions with radii from 7 to 30 nm, embedded into silicon. Experimental measurements confirm that the thermal conductivity of silicon metalattices is as low as 1 W/m/K for silica inclusions and that this value can be further reduced to 0.16 W/m/K for silicon metalattices with empty pores. A detailed model of ballistic phonon transport suggests that this thermal conductivity is close to the lowest achievable by tuning the radius and spacing of the periodic inhomogeneities. This study is a significant step in elucidating the scaling laws that dictate ballistic heat transport at the nanoscale in silicon and other semiconductors.

Background: Sub-superficial musculo-aponeurotic system (SMAS) rhytidectomy techniques are considered to have a higher complication profile, especially for facial nerve injury, compared with less invasive SMAS techniques. This results in surgeons avoiding sub-SMAS dissection., Objectives: The authors sought to aggregate and summarize data on complications among different SMAS facelift techniques., Methods: A broad systematic search was performed. All included studies: (1) described a SMAS facelifting technique categorized as SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines., Results: A total 183 studies were included. High lateral SMAS (1.85%) and composite rhytidectomy (1.52%) had the highest rates of temporary nerve injury and were the only techniques to show a statistically significant difference compared with SMAS plication (odds ratio [OR] = 2.71 and 2.22, respectively, P < 0.05). Risk of permanent injury did not differ among techniques. An increase in major hematoma was found for the deep plane (1.22%, OR = 1.67, P < 0.05) and SMAS imbrication (1.92%, OR = 2.65, P < 0.01). Skin necrosis was higher with the SMAS flap (1.57%, OR = 2.29, P < 0.01)., Conclusions: There are statistically significant differences in complication rates between SMAS facelifting techniques for temporary facial nerve injury, hematoma, seroma, necrosis, and infection. Technique should be selected based on quality of results and not the complication profile., (© 2019 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Games derived from experimental economics can be used to directly compare decision-making behavior across primate species, including humans. For example, the use of coordination games, such as the Assurance game, has shown that a variety of primate species can coordinate; however, the mechanism by which they do so appears to differ across species. Recently, these games have been extended to explore anti-coordination and cooperation in monkeys, with evidence that they play the Nash equilibria in sequential games in these other contexts. In the current paper, we use the same methods to explore chimpanzees' behavior in the Assurance Game; an anti-coordination game, the Hawk Dove game; and a cooperation game with a temptation to defect, the Prisoner's Dilemma game. We predicted that they would consistently play the Nash equilibria, as do the monkeys, and that, as in previous work, the subjects' level of experience with cognitive experiments would impact performance. Surprisingly, few of our pairs consistently played the same outcome (i.e., no statistically significant preferences), although those who did showed evidence consistent with Nash equilibria play, the same pattern seen more consistently in the monkeys. We consider reasons for their inconsistent performance; for instance, perhaps it was due to lack of interest in a task that rewarded them almost every trial no matter what option they chose, although this does not explain why they were inconsistent when the monkeys were not. A second goal of our study was to ascertain the effects of exogenous oxytocin in their decision making in one population. In line with recent work showing complex effects of oxytocin on social behavior, we found no effect on subjects' outcomes. We consider possible explanations for this as well.

During evaporative self-assembly of colloidal crystal films, spherical l-arginine-stabilized silica colloids adapt to different close-packed geometries by faceting and forming bridge connections with their nearest neighbors. We systematically studied the morphological changes of 37 and 138 nm diameter colloids during evaporative assembly and compared them to 65 nm Stöber silica colloids prepared without l-arginine. Colloidal crystal films were grown from particles that had been dialyzed against water or l-arginine, and tetraethyl orthosilicate (TEOS) and/or l-arginine were added to solutions during colloidal film growth. Solid-state 29 Si NMR spectra showed the presence of l-arginine and incompletely condensed silica in colloids grown from silica seeds in l-arginine solutions. These colloids were especially susceptible to chemical ripening during the colloidal assembly process, adopting faceted shapes that reflected the packing symmetry of the colloidal crystal films. The addition of l-arginine and TEOS accelerated these shape changes by catalyzing the hydrolysis and olation of silica and by adding a source of silica to the solution, respectively. This chemistry provides a route to single-component and binary colloidal crystals composed of nonspherical silica building blocks.

Meltwater from the Antarctic Ice Sheet is projected to cause up to one metre of sea-level rise by 2100 under the highest greenhouse gas concentration trajectory (RCP8.5) considered by the Intergovernmental Panel on Climate Change (IPCC). However, the effects of meltwater from the ice sheets and ice shelves of Antarctica are not included in the widely used CMIP5 climate models, which introduces bias into IPCC climate projections. Here we assess a large ensemble simulation of the CMIP5 model 'GFDL ESM2M' that accounts for RCP8.5-projected Antarctic Ice Sheet meltwater. We find that, relative to the standard RCP8.5 scenario, accounting for meltwater delays the exceedance of the maximum global-mean atmospheric warming targets of 1.5 and 2 degrees Celsius by more than a decade, enhances drying of the Southern Hemisphere and reduces drying of the Northern Hemisphere, increases the formation of Antarctic sea ice (consistent with recent observations of increasing Antarctic sea-ice area) and warms the subsurface ocean around the Antarctic coast. Moreover, the meltwater-induced subsurface ocean warming could lead to further ice-sheet and ice-shelf melting through a positive feedback mechanism, highlighting the importance of including meltwater effects in simulations of future climate.

Background: We hypothesized that chylothorax could be a sign of intolerance to the Fontan physiology, and thus patients who develop chylothorax or pleural effusion have worse medium-term to long-term survival., Methods: A total of 324 patients who underwent the Fontan operation between 2000 and 2013 were included. Chylothorax was defined as ≥5 mL/kg/day of chylomicron-positive chest drainage fluid no earlier than postoperative day 5 or drainage with >80% lymphocytes. Outcomes were compared between the chylothorax and non-chylothorax groups by the Kaplan-Meier method and log-rank test. Independent predictors of chylothorax and number of days of any chest drainage were analyzed with multivariable logistic regression and multivariable generalized negative binomial regression for count data, respectively., Results: Chylothorax occurred in 78 patients (24%). Compared with the non-chylothorax group, the chylothorax group had a longer duration of chest tube requirement (median, 18 days vs 9 days; P < .000) and a longer length of hospital stay (median, 19 days vs 10 days; P < .000). Eight patients (10.3%) required thoracic duct ligation. The chylothorax group had lower freedom from death (P = .013) and from composite adverse events (P = .021). No predictor was found for chylothorax. Pulmonary atresia (P = .031) and pre-Fontan pulmonary artery pressure (P = .01) were predictive of prolonged pleural effusion (>14 days)., Conclusions: Occurrence of chylothorax following the Fontan operation can be a marker of poorer medium-term clinical outcomes. It is difficult to predict occurrence of chylothorax owing to its multifactorial nature and involvement of lymphatic compensatory capacity that is unmasked only after the Fontan operation., (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

We investigated the potential toxic effects of Oxyfluorfen (OXY), an herbicide used in agriculture, on the embryo-larval development of Japanese medaka fish (Oryzias latipes). Embryos (1-day postfertilization) and larvae (2-day posthatch) were exposed to OXY (0.5-8 mg/L) for 96 h and evaluated for mortality and hatching on embryos, and the mortality and growth on larvae during depuration. It was observed that the embryo-mortality was inconsistently altered by OXY; only the 2 mg/L group showed significant reduction on embryo survivability. However, larval-mortality was concentration-dependent and OXY exposure induced scoliosis-like phenotypic features in the surviving larvae; the calculated LC 50 was 5.238 mg/L. Our data further indicated that larval skeleton, both axial and appendicular, was the potential target site of OXY. Skeletal growth in larvae exposed to 2 mg/L was inhibited significantly until 1 week of depuration with regard to the linear lengths of neurocranium, Meckel's cartilage, caudal vertebrae (first 10) in the axial skeletons, and pectoral fin and urostyle in the appendicular skeletons. Moreover, the total protein content remained unaltered by OXY after 96 h exposure; while the RNA concentration was reduced significantly in larvae exposed to 2 mg/L. Expression analysis of several genes by quantitative real-time RT-PCR (RT-qPCR) showed significant upregulation of zic5, a zinc-finger type transcription regulator, at the transcription level. This study indicated that the scoliosis induced by OXY in Japanese medaka larvae was the result of stunted skeletal growth, probably because of deregulation of zinc-finger type transcription regulators, at the genomic level., (© 2018 Wiley Periodicals, Inc.)

Colloidal crystals with specific electronic, optical, magnetic, vibrational properties, can be rationally designed by controlling fundamental parameters such as chemical composition, scale, periodicity and lattice symmetry. In particular, silica nanospheres -which assemble to form colloidal crystals- are ideal for this purpose, because of the ability to infiltrate their templates with semiconductors or metals. However characterization of these crystals is often limited to techniques such as grazing incidence small-angle scattering that provide only global structural information and also often require synchrotron sources. Here we demonstrate small-angle Bragg scattering from nanostructured materials using a tabletop-scale setup based on high-harmonic generation, to reveal important information about the local order of nanosphere grains, separated by grain boundaries and discontinuities. We also apply full-field quantitative ptychographic imaging to visualize the extended structure of a silica close-packed nanosphere multilayer, with thickness information encoded in the phase. These combined techniques allow us to simultaneously characterize the silica nanospheres size, their symmetry and distribution within single colloidal crystal grains, the local arrangement of nearest-neighbor grains, as well as to quantitatively determine the number of layers within the sample. Key to this advance is the good match between the high harmonic wavelength used (13.5nm) and the high transmission, high scattering efficiency, and low sample damage of the silica colloidal crystal at this wavelength. As a result, the relevant distances in the sample - namely, the interparticle distance (≈124nm) and the colloidal grains local arrangement (≈1μm) - can be investigated with Bragg coherent EUV scatterometry and ptychographic imaging within the same experiment simply by tuning the EUV spot size at the sample plane (5μm and 15μm respectively). In addition, the high spatial coherence of high harmonics light, combined with advances in imaging techniques, makes it possible to image near-periodic structures quantitatively and nondestructively, and enables the observation of the extended order of quasi-periodic colloidal crystals, with a spatial resolution better than 20nm. In the future, by harnessing the high time-resolution of tabletop high harmonics, this technique can be extended to dynamically image the three-dimensional electronic, magnetic, and transport properties of functional nanosystems.

Background: Pediatric infective endocarditis (IE) has been associated with high morbidity and mortality, mostly related to thromboembolic complications (TEC). The objective of our study was to describe the experience in children with IE and to review the changes over a thirty-year period, regarding origin of IE, incidence of vegetations, TEC and their respective morbidity and mortality rates., Methods: A retrospective chart review of children aged 0-18years with IE defined by the Duke Criteria and admitted to The Hospital for Sick Children, was conducted. Data were divided into three periods (P); P1 (1979-1988); P2 (1989-1998); and P3 (1999-2008)., Results: The study included 113 patients, median age 7yrs.; females: 46 (41%), congenital heart defects 95 (84%), comparable in all periods. Overall, cardiac vegetations were found in 68/113 patients (60%); large vegetations (≥1cm) in 32 patients (28%). Fourty-five (45/133 [40%]) TEC were documented, 22 patients (20%) developed cerebrovascular events (CVE) and 23 patients (20%) had non-CVE. Patients diagnosed during P3 were older, had more vegetations (p<0.05), and a higher incidence of community acquired-IE (p<0.05). Overall, mortality was 15%, comparable in all periods. Significant risk factors for mortality were vegetations (HR 6.44; 95% CI: 2.07-20.01, p=0.002) and heart failure (HR 28.39; 95% CI: 10.49-76.85, p<0.001)., Conclusions: Over the study period, we report a growing incidence of community acquired pediatric IE in older children accompanied by an increasing rate of TEC. Heart failure and vegetations were associated with an increased mortality. These preliminary data need to be confirmed by prospective data., (Copyright © 2017 Elsevier B.V. All rights reserved.)