Assessing an online patient decision aid about upper extremity reconstructive surgery for cervical spinal cord injury: Pilot testing knowledge, decisional conflict, and acceptability

UNLABELLED: HIGHLIGHTS: People with cervical spinal cord injury prioritize gaining upper extremity function after injury, but few individuals receive information about treatment options.A newly created patient decision aid (PtDA) provides information about recovery after spinal cord injury and the role of traditional tendon and newer nerve transfer surgery to improve upper extremity upper extremity function.The PtDA improved knowledge and decreased decisional conflict in this pilot study.Future work should focus on studying dissemination and implementation of the ptDA into clinical practice

Stage-dependent transient storage of phosphorus in alluvial floodplains

Models for contaminant transport in streams commonly idealize transient storage as a well-mixed but immobile system. These transient storage models capture rapid (near-stream) hyporheic storage and transport, but do not account for large-scale, stage-dependent interaction with the alluvial aquifer. The objective of this research was to document transient storage of phosphorus (P) in coarse gravel alluvium potentially influenced by large-scale, stage-dependent preferential flow pathways (PFPs). Long-term monitoring was performed at floodplain sites adjacent to the Barren Fork Creek and Honey Creek in northeastern Oklahoma. Based on results from subsurface electrical resistivity mapping which was correlated to hydraulic conductivity data, observation wells were installed both in higher hydraulic conductivity and lower hydraulic conductivity subsoils. Water levels in the wells were monitored over time, and water samples were obtained from the observation wells and the stream to document P concentrations at multiple times during high flow events. Contour plots indicating direction of flow were developed using water table elevation data. Contour plots of total P concentrations showed the alluvial aquifer acting as a transient storage zone, with P-laden stream water heterogeneously entering the aquifer during the passage of a storm pulse, and subsequently re-entering the stream during baseflow conditions. Some groundwater in the alluvial floodplains had total P concentrations that mirrored the streams’ total P concentrations. A detailed analysis of P forms indicated that particulate P (i.e. P attached to particulates greater than 0·45 μm) was a significant portion of the P transport. This research suggests the need for more controlled studies on stage-dependent transient storage in alluvial systems

Stage-dependent transient storage of phosphorus in alluvial floodplains

Models for contaminant transport in streams commonly idealize transient storage as a well-mixed but immobile system. These transient storage models capture rapid (near-stream) hyporheic storage and transport, but do not account for large-scale, stage-dependent interaction with the alluvial aquifer. The objective of this research was to document transient storage of phosphorus (P) in coarse gravel alluvium potentially influenced by large-scale, stage-dependent preferential flow pathways (PFPs). Long-term monitoring was performed at floodplain sites adjacent to the Barren Fork Creek and Honey Creek in northeastern Oklahoma. Based on results from subsurface electrical resistivity mapping which was correlated to hydraulic conductivity data, observation wells were installed both in higher hydraulic conductivity and lower hydraulic conductivity subsoils. Water levels in the wells were monitored over time, and water samples were obtained from the observation wells and the stream to document P concentrations at multiple times during high flow events. Contour plots indicating direction of flow were developed using water table elevation data. Contour plots of total P concentrations showed the alluvial aquifer acting as a transient storage zone, with P-laden stream water heterogeneously entering the aquifer during the passage of a storm pulse, and subsequently re-entering the stream during baseflow conditions. Some groundwater in the alluvial floodplains had total P concentrations that mirrored the streams’ total P concentrations. A detailed analysis of P forms indicated that particulate P (i.e. P attached to particulates greater than 0·45 μm) was a significant portion of the P transport. This research suggests the need for more controlled studies on stage-dependent transient storage in alluvial systems

The COS-Dwarfs Survey: The Carbon Reservoir Around sub-L* Galaxies

We report new observations of circumgalactic gas from the COS-Dwarfs survey, a systematic investigation of the gaseous halos around 43 low-mass z $\leq$ 0.1 galaxies using background QSOs observed with the Cosmic Origins Spectrograph. From the projected 1D and 2D distribution of C IV absorption, we find that C IV absorption is detected out to ~ 0.5 R$_{vir}$ of the host galaxies. The C IV absorption strength falls off radially as a power law and beyond 0.5 R$_{vir}$, no C IV absorption is detected above our sensitivity limit of ~ 50-100 m$\AA$. We find a tentative correlation between detected C IV absorption strength and star formation, paralleling the strong correlation seen in highly ionized oxygen for L~L* galaxies by the COS-Halos survey. The data imply a large carbon reservoir in the CGM of these galaxies, corresponding to a minimum carbon mass of $\gtrsim$ 1.2$\times 10^6$ $M_\odot$ out to ~ 110 kpc. This mass is comparable to the carbon mass in the ISM and more than the carbon mass currently in stars of these galaxies. The C IV absorption seen around these sub-L* galaxies can account for almost two-thirds of all $W_r$> 100 m$\AA$ C IV absorption detected at low z. Comparing the C IV covering fraction with hydrodynamical simulations, we find that an energy-driven wind model is consistent with the observations whereas a wind model of constant velocity fails to reproduce the CGM or the galaxy properties.Comment: 18 Pages, 11 Figures, ApJ 796 13

C-Reactive Protein Gene Variants Are Associated with Postoperative C-reactive Protein Levels After Coronary Artery Bypass Surgery

Background: Elevated baseline C-reactive protein (CRP) levels are associated with increased risk for developing cardiovascular disease. Several CRP gene variants have been associated with altered baseline CRP levels in ambulatory populations. However, the influence of CRP gene variants on CRP levels during inflammatory states, such as surgery, is largely unexplored. We describe the association between candidate CRP gene variants and postoperative plasma CRP levels in patients undergoing primary, elective coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Methods: Using a multicenter candidate gene association study design, we examined the association between seventeen candidate CRP single nucleotide polymorphisms (SNPs) and inferred haplotypes, and altered postoperative CRP levels in 604 patients undergoing CABG surgery with CPB. Perioperative CRP levels were measured immediately prior to surgery, post-CPB and on postoperative days (POD) 1–4. Results: CRP levels were significantly elevated at all postoperative time points when compared with preoperative levels (P < 0.0001). After adjusting for clinical covariates, the minor allele of the synonymous coding SNP, rs1800947 was associated with lower peak postoperative CRP levels ($P = 2.4 × 10^{-4}$) and lower CRP levels across all postoperative time points ($P = 4.8 × 10^{-5}$). rs1800947 remained highly significant after Bonferroni adjustment for multiple comparisons. Conclusion: We identified a CRP gene SNP associated with lower postoperative CRP levels in patients undergoing CABG surgery with CPB. Further investigation is needed to clarify the significance of this association between CRP gene variants and the acute-phase rise in postoperative CRP levels with regard to the risk of adverse postoperative outcomes

The COS-Halos Survey: Physical Conditions and Baryonic Mass in the Low-Redshift Circumgalactic Medium

We analyze the physical conditions of the cool, photoionized (T $\sim 10^4$ K) circumgalactic medium (CGM) using the COS-Halos suite of gas column density measurements for 44 gaseous halos within 160 kpc of $L \sim L^*$ galaxies at $z \sim 0.2$. These data are well described by simple photoionization models, with the gas highly ionized (n$_{\rm HII}$/n$_{\rm H} \gtrsim 99\%$) by the extragalactic ultraviolet background (EUVB). Scaling by estimates for the virial radius, R$_{\rm vir}$, we show that the ionization state (tracked by the dimensionless ionization parameter, U) increases with distance from the host galaxy. The ionization parameters imply a decreasing volume density profile n$_{\rm H}$ = (10$^{-4.2 \pm 0.25}$)(R/R$_{\rm vir})^{-0.8\pm0.3}$. Our derived gas volume densities are several orders of magnitude lower than predictions from standard two-phase models with a cool medium in pressure equilibrium with a hot, coronal medium expected in virialized halos at this mass scale. Applying the ionization corrections to the HI column densities, we estimate a lower limit to the cool gas mass M$_{\rm CGM}^{\rm cool} > 6.5 \times 10^{10}$ M$_{\odot}$ for the volume within R $<$ R$_{\rm vir}$. Allowing for an additional warm-hot, OVI-traced phase, the CGM accounts for at least half of the baryons purported to be missing from dark matter halos at the 10$^{12}$ M$_{\odot}$ scale.Comment: 19 pages, 12 Figures, and a 37-page Appendix with 36 additional figures. Accepted to ApJ June 21 201

Visual search for basic emotional expressions in autism: impaired processing of anger, fear and sadness, but a typical happy face advantage

Facial expression recognition was investigated in 20 males with high functioning autism (HFA) or Asperger syndrome (AS), compared to typically developing individuals matched for chronological age (TD CA group) and verbal and non-verbal ability (TD V/NV group). This was the first study to employ a visual search, "face in the crowd" paradigm with a HFA/AS group, which explored responses to numerous facial expressions using real-face stimuli. Results showed slower response times for processing fear, anger and sad expressions in the HFA/AS group, relative to the TD CA group, but not the TD V/NV group. Reponses to happy, disgust and surprise expressions showed no group differences. Results are discussed with reference to the amygdala theory of autism. © 2011 Elsevier Ltd

Effectiveness of interventions to indirectly support food and drink intake in people with dementia : Eating and Drinking Well IN dementiA (EDWINA) systematic review

© 2016 Bunn et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). METHODS: We comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). The review was conducted with service user input in accordance with Cochrane Collaboration's guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively. RESULTS: We included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions. CONCLUSIONS: We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try. TRIAL REGISTRATION: The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611).Peer reviewedFinal Published versio

Packed Red Blood Cell Transfusion Associates with Acute Kidney Injury After Transcatheter Aortic Valve Replacement

Background: Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors. Methods: This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve replacement acute kidney injury was defined by Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Univariate comparisons between patients with and without post-transcatheter aortic valve replacement acute kidney injury were made for clinical characteristics. Multivariable logistic regression was used to assess independent association of packed red blood cell transfusion with post-transcatheter aortic valve replacement acute kidney injury (adjusting for pre-procedural renal function and other important clinical parameters). Results: Acute kidney injury occurred in 20 (17.2%) subjects. Total number of packed red blood cells transfused independently associated with post-procedure acute kidney injury (OR = 1.67 per unit, 95% CI 1.13–2.47, P = 0.01) after adjusting for pre-procedure estimated glomerular filtration rate (OR = 0.97 per ml/min/1.73m2, 95% CI 0.94–1.00, P = 0.05), nadir hemoglobin (OR = 0.88 per g/dL increase, CI 0.61–1.27, P = 0.50), and post-procedure maximum number of concurrent inotropes and vasopressors (OR = 2.09 per inotrope or vasopressor, 95% CI 1.19–3.67, P = 0.01). Conclusion: Packed red blood cell transfusion, along with post-procedure use of inotropes and vasopressors, independently associate with acute kidney injury after transcatheter aortic valve replacement. Further studies are needed to elucidate the pathobiology underlying these associations

GLASS FORMULATION DEVELOPMENT TO SUPPORT MELTER TESTING TO DEMONSTRATE ENHANCED HIGH LEVEL WASTE THROUGHPUT

The U.S. Department of Energy (DOE) is currently processing high-level waste (HLW) through a Joule-heated melter (JHM) at the Savannah River Site (SRS) and plans to vitrify HLW and Low activity waste (LAW) at the Hanford Site. Over the past few years at the DWPF, work has concentrated on increasing waste throughput. These efforts are continuing with an emphasis on high alumina content feeds. High alumina feeds have presented specific challenges for the JHM technology regarding the ability to increase waste loading yet still maintain product quality and adequate throughput. Alternatively, vitrification technology innovations are also being investigated as a means to increase waste throughput. The Cold Crucible Induction Melter (CCIM) technology affords the opportunity for higher vitrification process temperatures as compared to the current reference JHM technology. Higher process temperatures may allow for higher waste loading and higher melt rate. Glass formulation testing to support melter demonstration testing was recently completed. This testing was specifically aimed at high alumina concentration wastes. Glass composition property models were utilized as a guide for formulation development. Both CCIM and JHM testing will be conducted so glass formulation testing was targeted at both technologies with a goal to significantly increase waste loading without compromising product quality