Dynamic surface chemistry and interparticle interactions mediating chemically fueled dissipative assembly of colloids.

HYPOTHESIS: Dissipative assembly of colloids involves using a chemical fuel to temporarily activate organic colloid surface ligands to an assembly prone state. Colloids assemble into transient aggregates that disintegrate after the fuel is consumed. The underlying colloidal interactions controlling dissipative assembly have not been rigorously identified or quantified. We expect that fuel concentration dependent dissipative assembly behavior can be reconciled with measurements of dynamic colloid surface chemistry and colloidal interactions. EXPERIMENTS: Carbodiimide chemistry was utilized to induce dissipative assembly of carboxylic acid functionalized polystyrene colloids. We measured aggregation kinetics, colloid surface hydrophobicity, and zeta potential as a function of time, which established that colloids underwent dissipative assembly for fuel concentrations between 5 and 12.5 mM and irreversible aggregation at higher fuel concentrations due to transient changes in surface chemistry. FINDINGS: We formulated a pairwise colloidal interaction potential model including hydrophobic interactions quantified by fluorescence binding experiments. Fuel concentrations causing dissipative assembly displayed a transient increase in secondary minimum depth and a primary maximum much larger than the thermal potential. Fuel concentrations leading to irreversible aggregation displayed a primary maximum smaller than the thermal potential. This is the first study to quantify surface chemistry and interparticle interactions during dissipative colloid assembly and represents a foundational step in rationally designing more complex dissipative assembly systems.

HCV universal EHR prompt successfully increases screening, highlights potential disparities.

BACKGROUND & OBJECTIVES: Screening for hepatitis C virus is the first critical decision point for preventing morbidity and mortality from HCV cirrhosis and hepatocellular carcinoma and will ultimately contribute to global elimination of a curable disease. This study aims to portray the changes over time in HCV screening rates and the screened population characteristics following the 2020 implementation of an electronic health record (EHR) alert for universal screening in the outpatient setting in a large healthcare system in the US mid-Atlantic region. METHODS: Data was abstracted from the EHR on all outpatients from 1/1/2017 through 10/31/2021, including individual demographics and their HCV antibody (Ab) screening dates. For a limited period centered on the implementation of the HCV alert, mixed effects multivariable regression analyses were performed to compare the timeline and characteristics of those screened and un-screened. The final models included socio-demographic covariates of interest, time period (pre/post) and an interaction term between time period and sex. We also examined a model with time as a monthly variable to look at the potential impact of COVID-19 on screening for HCV. RESULTS: Absolute number of screens and screening rate increased by 103% and 62%, respectively, after adopting the universal EHR alert. Patients with Medicaid were more likely to be screened than private insurance (ORadj 1.10, 95% CI: 1.05, 1.15), while those with Medicare were less likely (ORadj 0.62, 95% CI: 0.62, 0.65); and Black (ORadj 1.59, 95% CI: 1.53, 1.64) race more than White. CONCLUSIONS: Implementation of universal EHR alerts could prove to be a critical next step in HCV elimination. Those with Medicare and Medicaid insurance were not screened proportionately to the national prevalence of HCV in these populations. Our findings support increased screening and re-testing efforts for those at high risk of HCV.

Spatially structured relationships between white banana prawn (Penaeus merguiensis) catch and riverine flow in the Northern Prawn Fishery, Australia.

Water resource development can lead to the significant alteration of natural flow regimes, which can have impacts on the many aquatic species that rely on both freshwater and estuarine environments to successfully complete their lifecycles. In tropical northern Australia, annual catches of commercially harvested white banana prawns (WBP) are highly variable in response to environmental conditions, namely rainfall and subsequent riverine flow. However, little is known about the spatial extent to which flow from individual rivers influences offshore WBP catch. In this study, we quantify how the relationship between WBP catch in the Gulf of Carpentaria is influenced by flow from the Mitchell River, Queensland Australia. We used a Bayesian framework to model both prawn presence and catch per unit effort, and found evidence that multiple components of the flow regime contribute to fishery catch. We also found evidence to suggest that the relationships between prawn presence and flow were spatially structured across the fishing ground. Our results suggest that attributing fishery catch to a single river remains challenging, though highlights the importance of maintaining natural flow regimes to support a highly valuable commercial fishery species in the face of potential water resource development.

Early Identification of Maternal Cardiovascular Risk Through Sourcing and Preparing Electronic Health Record Data: Machine Learning Study.

BACKGROUND: Health care data are fragmenting as patients seek care from diverse sources. Consequently, patient care is negatively impacted by disparate health records. Machine learning (ML) offers a disruptive force in its ability to inform and improve patient care and outcomes. However, the differences that exist in each individual's health records, combined with the lack of health data standards, in addition to systemic issues that render the data unreliable and that fail to create a single view of each patient, create challenges for ML. Although these problems exist throughout health care, they are especially prevalent within maternal health and exacerbate the maternal morbidity and mortality crisis in the United States. OBJECTIVE: This study aims to demonstrate that patient records extracted from the electronic health records (EHRs) of a large tertiary health care system can be made actionable for the goal of effectively using ML to identify maternal cardiovascular risk before evidence of diagnosis or intervention within the patient's record. Maternal patient records were extracted from the EHRs of a large tertiary health care system and made into patient-specific, complete data sets through a systematic method. METHODS: We outline the effort that was required to define the specifications of the computational systems, the data set, and access to relevant systems, while ensuring that data security, privacy laws, and policies were met. Data acquisition included the concatenation, anonymization, and normalization of health data across multiple EHRs in preparation for their use by a proprietary risk stratification algorithm designed to establish patient-specific baselines to identify and establish cardiovascular risk based on deviations from the patient's baselines to inform early interventions. RESULTS: Patient records can be made actionable for the goal of effectively using ML, specifically to identify cardiovascular risk in pregnant patients. CONCLUSIONS: Upon acquiring data, including their concatenation, anonymization, and normalization across multiple EHRs, the use of an ML-based tool can provide early identification of cardiovascular risk in pregnant patients.

Applying diagnosis support systems in electronic health records to identify wild-type transthyretin amyloid cardiomyopathy risk.

Aim: Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is frequently misdiagnosed, and delayed diagnosis is associated with substantial morbidity and mortality. At three large academic medical centers, combinations of phenotypic features were implemented in electronic health record (EHR) systems to identify patients with heart failure at risk for ATTRwt-CM. Methods: Phenotypes/phenotype combinations were selected based on strength of correlation with ATTRwt-CM versus non-amyloid heart failure; different clinical decision support and reporting approaches and data sources were evaluated on Cerner and Epic EHR platforms. Results: Multiple approaches/sources showed potential usefulness for incorporating predictive analytics into the EHR to identify at-risk patients. Conclusion: These preliminary findings may guide other medical centers in building and implementing similar systems to improve recognition of ATTRwt-CM in patients with heart failure.

Get Outside! Promoting Adolescent Health through Outdoor After-School Activity.

BACKGROUND: The Get Outside: After School Activity Program (GO-ASAP) exemplifies how a rural community can utilize its natural resources and community partnerships to promote adolescent health. METHODS: A qualitative descriptive inquiry was conducted using convenience sampling. Data were collected from students (n = 13/2018; n = 13/2019) via focus group and art-based method (2018 only) and parent (n = 6/2018) focus group. Data were analyzed via qualitative content analysis using the applied theoretical frameworks of Social Cognitive Theory and Social Determination Theory. RESULTS: (1) Increasing Health-Related Competencies. Students increased their physical activity, improved their sleep, perceived less stress, and reported changes in dietary habits and electronic use. (2) Increasing Social Relatedness. Students made new friends, felt more connected, and spent less time home alone after school. (3) Increasing Autonomy and Intrinsic Motivation. Students recognized their emerging capabilities, and their increased confidence stimulated more action-oriented behavior. Parent-perceived changes support and mirror student reports. CONCLUSION: Outdoor, nature-based, activity programs are a novel upstream approach to promote adolescent health, especially in rural communities where natural resources often exceed health-service resources and community partnerships are a way of life.

Two Cases of Isolated Ureteral Injury Secondary to Blunt Force Trauma.

Ureteral injuries although rare can cause serious issues. The mechanism of injury is most commonly penetrating but in some rare cases blunt forces can contribute. It is important to diagnose ureteral injuries as soon as possible because they can have significant morbidity and mortality. Here we present two cases of isolated ureteral injury secondary to blunt force trauma. Both patients had the ureteral injury diagnosed by computed tomography (CT) scan and confirmed by a ureterogram with extravasation of contrast. Both patients also had peripelvic cyst, which could have been a contributing risk factor for injury. In both cases, the ureteral injury was repaired using a stent and both patients had no complications. We present these cases along with presentation, diagnostic work-up, and treatment.

Elite and Professional sports facial injuries management - a consensus report.

Whilst there have been great improvements in the management of elite and professional athletes with the formalisation of the clinical specialty of Sports and Exercise medicine, the management of facial injuries has perhaps lagged in this group. Professional athletic careers can be put in jeopardy due to unnecessarily long absences from training and competition after facial injuries. Professional and elite sports athletes can benefit from different approaches to the management of their facial injuries to reduce time away from competing but maximise their safety. On 6th December 2018, a consensus meeting of interested clinicians involved in the management of facial injuries of elite and professional athletes was held at the Royal Society of Medicine, London, UK to provide a contemporary review of the approaches to conservative, operative and recovery management of facial injuries. National experts with specialist experience of facial injuries presentation and athlete needs from a range of elite and professional sports led the day's programme and the discussions so that guidelines could be formulated. These are presented in this review paper.

The Effects of Pre-treatment Depressive Symptoms on Quality of Life Across Cognitive Behavioral Therapy for Chronic Pain.

Recent studies suggest that chronic pain affects millions and carries significant physical, financial, and social burdens, and thus adversely affects quality of life (QOL). Cognitive behavioral therapy for chronic pain (CBTp) is a non-pharmacological treatment method which has been shown to reduce a sufferer's experience of chronic pain and improve overall QOL. These and other studies also indicate that affective symptoms likely impact the effectiveness of CBTp. The current study focused on the effects of depressive symptoms on changes in QOL ratings across a 12-session CBT for chronic pain. Participants in this study (n = 313; mean age = 46.83 years, SD = 10.99, range = 19.1-79.9, 63.9% female, 83.9% Caucasian) were current patients of a mid-sized tertiary multidisciplinary outpatient chronic pain treatment facility. Progress through CBTp was assessed using QOL as a dependent variable and analyzed using RMANOVAs. All participants showed improvements in QOL ratings across the CBTp period, but greater improvements were seen in participants in the low depression category than in the high or moderate depression category. This study also confirms the clinical utility of the BDI-II with chronic pain patients.

Virtual synthesis of thermally cross-linked copolymers from a novel implementation of polymatic.

Because of the complex connectivity of cross-linked polymers, generating structures for molecular simulations is a nontrivial task. In this work, a general methodology is presented for constructing post-cross-linked polymers by a new two-stage implementation of the Polymatic simulated polymerization algorithm, where linear polymers are first polymerized and then cross-linked. It is illustrated here for an example system of thermally cross-linked octene-styrene-divinylbenzene (OS-DVB) copolymers. In the molecular models, the degree of cross-linking is ranged from 0 to 100%, and the resulting structural and thermal properties are examined. The simulations reveal an increase in the free volume with higher cross-linking degrees. Shifts in the peaks of the structure factors, which are assigned to contributions from the backbone and side-chain atoms, correspond to the formation of larger free volume elements. Furthermore, the glass transition temperatures increase with higher degrees of cross-linking, while the thermal expansivity decreases. Comparisons with experimental results for similar systems are made when available. As demonstrated here, the presented methodology will provide an effective route to simulating post-cross-linked polymers for a variety of applications, which will enable an improved understanding of their structure-property relationships.

Burn injury by nuclear magnetic resonance imaging.

Nuclear magnetic resonance imaging has become a standard diagnostic procedure in clinical medicine and is well known to have hazards for patients with pacemaker or metallic foreign bodies. Compared to CT, the frequency of MRI examinations is increasing due to the missing exposure of the patients by X-rays. Furthermore, high-field magnetic resonance tomograph (MRT) with 3 T has entered clinical practice, and 7-T systems are installed in multiple scientific institutions. On the other hand, the possibility of burn injuries has been reported only in very few cases. Based on a clinical finding of a burn injury in a 31-year-old male patient during a routine MRI of the lumbar spine with standard protocol, the MR scanner was checked and the examination was simulated in an animal model. The patient received a third-degree burn injury of the skin of the right hand and pelvis in a small region of skin contact. The subsequent control of the MRI scanner indicated no abnormal values for radiofrequency (RF) and power. In the subsequent animal experiment, comparable injuries could only be obtained by high RF power in a microwave stove. It is concluded that 'tissue loops' resulting from a contact between hand and pelvis must be avoided. With regard to forensic aspects, the need to inform patients of such a minimal risk can be avoided if the patients are adequately positioned using an isolating material between the hands and pelvis. These facts must be emphasized more in the future, if high-field MRI with stronger RF gradients is available in routine imaging.

Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years.

STUDY DESIGN: Prospective case series. OBJECTIVE: To study the radiologic changes in the intervertebral disc after Dynesys dynamic stabilization. SUMMARY OF BACKGROUND DATA: Adjacent segment disc degeneration is one of the potential complications of fusion surgery. It has been proposed that nonfusion motion preservation surgery may prevent accelerated adjacent segment degeneration because of the protective effect of persisting segmental motion. METHODS: Thirty-two patients who underwent Dynesys procedure between November 2002 and June 2004 and have completed 2-year follow-up MRI scans were included in this study. Preoperative and 2 year postoperative lumbar MRI scans were evaluated by 2 independent observers. T2-weighted mid-sagittal images were used and disc degeneration classified according to the Woodend classification of disc degeneration. Anterior and posterior intervertebral disc heights were also measured. RESULTS: Of the 32 patients, 20 patients underwent Dynesys procedure alone and 12 underwent additional fusion at 1 or more levels. A total of 70 levels were operated on, of which 13 levels were fused.There was a statistically significant increase in the mean Woodend score at the operated levels in the Dynesys alone group, a change from 1.95 before surgery to 2.52 after surgery (P < 0.001). The mean Woodend scores changed from 1.27 preoperative to 1.55 postoperative (P = 0.066) at the proximal adjacent levels, and from 1.37 to 1.62 at the distal levels (P = 0.157). There was good interobserver agreement (weighted kappa score of 0.819). The anterior intervertebral disc height reduced by 2 mm from 9.25 to 7.17 (P < 0.001). The posterior disc height increased by 0.14 mm but this change was not significant. CONCLUSION: Disc degeneration at the bridged and adjacent segment seems to continue despite Dynesys dynamic stabilization. This continuing degeneration could be due to natural disease progression.

The Dynesys lumbar spinal stabilization system: a preliminary report on positional magnetic resonance imaging findings.

STUDY DESIGN: We present the positional magnetic resonance imaging findings of a prospective case series of patients undergoing surgery with the Dynesys spinal stabilization device (Zimmer, Inc., Warsaw, IN). OBJECTIVE: To explore the biomechanical impact of the Dynesys device in vivo. SUMMARY OF BACKGROUND DATA: Spinal fusion surgery is widely used for painful degenerative conditions of the lumbar spine that have not responded to conservative measures. It often produces good outcomes but can be associated with adjacent segment hypermobility that may lead to further degeneration and pain. Previous cadaveric biomechanical studies claim that the Dynesys Dynamic Spinal Stabilization System allows some lumbar movement, behaving similar to a normal spine in extension but similar to rigid fixation in flexion. METHODS: Twenty-four patients with dominant low back pain, with or without leg pain, were treated with the Dynesys. All patients underwent positional magnetic resonance imaging before surgery and 9 months after surgery. Measurements were made to assess the differences at the operated level, adjacent level, and whole lumbar spine. RESULTS: There was a statistically significant reduction in flexion-extension range of movement of both the whole lumbar spine by 13.37 degrees (P = 0.002) and at the instrumented segments by 4.08 degrees (P < 0.001) following surgery. There was an insignificant reduction in range of movement at the level above instrumentation (P = 0.807). Mean anterior disc height at the instrumented level reduced by 0.7 mm following insertion of the Dynesys (P < 0.027). Mean posterior disc height reduced by 0.3 mm (P = 0.453). In a neutral posture, the Dynesys had no significant impact on lordosis or inclination of operated or adjacent levels. Contrary to cadaveric study findings, the Dynesys appears to restrict extension more than flexion with respect to a neutral posture. CONCLUSIONS: In vivo, the Dynesys Stabilization System allows movement at the instrumented level, albeit reduced, with no significant increased mobility at the adjacent segments. There was reduction of the anterior disc height without a significant increase of the posterior disc height.