Shifting Spatial Patterns Of A Monocentric Metropolitan Area: The Evolution Of An Employment Cluster In The Buffalo-Niagara Falls, New York Metropolitan Statistical Area (MSA): 1990-2000

These findings are contrary to the established economic and geography literature that strongly suggests employment suburbanization has and will continue to create employment centers beyond the central city in metropolitan areas

Generation and delivery device for ozone gas and ozone dissolved in water

The present invention provides an ozone generation and delivery system that lends itself to small scale applications and requires very low maintenance. The system includes an anode reservoir and a cathode phase separator each having a hydrophobic membrane to allow phase separation of produced gases from water. The system may be configured to operate passively with no moving parts or in a self-pressurizing manner with the inclusion of a pressure controlling device or valve in the gas outlet of the anode reservoir. The hydrogen gas, ozone gas and water containing ozone may be delivered under pressure

Robotic partial nephrectomy for posterior tumors through a retroperitoneal approach offers decreased length of stay compared with the transperitoneal approach: A propensity-matched analysis

INTRODUCTION: We sought to compare surgical outcomes between transperitoneal and retroperitoneal robotic partial nephrectomy (RPN) for posterior tumors. PATIENTS AND METHODS: Using our multi-institutional RPN database, we reviewed 610 consecutive cases for posterior renal masses treated between 2007 and 2015. Primary outcomes were complications, operative time, length of stay (LOS), surgical margin status, and estimated glomerular filtration rate (eGFR) preservation. Secondary outcomes were estimated blood loss, warm ischemia time (WIT), disease recurrence, and disease-specific mortality. Due to significant differences in treatment year and tumor size between approaches, retroperitoneal cases were matched 1:4 to transperitoneal cases based on propensity scores using the greedy algorithm. Outcomes were compared between approaches using the chi-square and Mann-Whitney U tests. RESULTS: After matching, 296 transperitoneal and 74 retroperitoneal cases were available for analysis, and matched groups were well balanced in terms of treatment year, age, gender, race, American Society of Anesthesiologists physical status classification (ASA) score, body mass index, tumor laterality, tumor size, R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus, anterior/posterior, location relative to polar lines) score, and hilar location. Compared with transperitoneal, the retroperitoneal approach was associated with significantly shorter mean LOS (2.2 vs 2.6 days, p = 0.01), but longer mean WIT (21 vs 19 minutes, p = 0.01). Intraoperative (p = 0.35) and postoperative complications (p = 0.65), operative time (p = 0.93), positive margins (p = 1.0), and latest eGFR preservation (p = 0.25) were not significantly different between approaches. No differences were detected in the other outcomes. CONCLUSIONS: Among high-volume surgeons, transperitoneal and retroperitoneal RPN achieved similar outcomes for posterior renal masses, although with slight differences in LOS and WIT. Retroperitoneal RPN may be an effective option for the treatment of certain small posterior renal masses

Expressiveness of real-time motion captured avatars influences perceived animation realism and perceived quality of social interaction in virtual reality

Using motion capture to enhance the realism of social interaction in virtual reality (VR) is growing in popularity. However, the impact of different levels of avatar expressiveness on the user experience is not well understood. In the present study we manipulated levels of face and body expressiveness of avatars while investigating participant perceptions of animation realism and interaction quality when disclosing positive and negative experiences in VR. Moderate positive associations were observed between perceptions of animation realism and interaction quality. Post-experiment questions revealed that many of our participants (approximately 40 %) indicated the avatar with the highest face and body expressiveness as having the most realistic face and body expressions. The same proportion also indicated the avatar with the highest face and body expressiveness as being the most comforting and enjoyable avatar to interact with. Our results suggest that higher levels of face and body expressiveness are important for enhancing perceptions of realism and interaction quality within a social interaction in VR using motion capture

Low connectivity between shallow, mesophotic and rariphotic zone benthos

© 2019 Massachussetts Medical Society. All rights reserved. Worldwide coral reefs face catastrophic damage due to a series of anthropogenic stressors. Investigating how coral reefs ecosystems are connected, in particular across depth, will help us understand if deeper reefs harbour distinct communities. Here, we explore changes in benthic community structure across 15-300 m depths using technical divers and submersibles around Bermuda. We report high levels of floral and faunal differentiation across depth, with distinct assemblages occupying each depth surveyed, except 200-300 m, corresponding to the lower rariphotic zone. Community turnover was highest at the boundary depths of mesophotic coral ecosystems (30-150 m) driven largely by taxonomic turnover and to a lesser degree by ordered species loss (nestedness). Our work highlights the biologically unique nature of benthic communities in the mesophotic and rariphotic zones, and their limited connectivity to shallow reefs, thus emphasizing the need to manage and protect deeper reefs as distinct entities

Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients The ROADMAP Study 2-Year Results

OBJECTIVES The authors sought to provide the pre-specified primary endpoint of the ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) trial at 2 years. BACKGROUND The ROADMAP trial was a prospective nonrandomized observational study of 200 patients (97 with a left ventricular assist device [LVAD], 103 on optimal medical management [OMM]) that showed that survival with improved functional status at 1 year was better with LVADs compared with OMM in a patient population of ambulatory New York Heart Association functional class IIIb/IV patients. METHODS The primary composite endpoint was survival on original therapy with improvement in 6-min walk distance \u3e= 75 m. RESULTS Patients receiving LVAD versus OMM had lower baseline health-related quality of life, reduced Seattle Heart Failure Model 1-year survival (78% vs. 84%; p = 0.012), and were predominantly INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 4 (65% vs. 34%; p \u3c 0.001) versus profiles 5 to 7. More LVAD patients met the primary endpoint at 2 years: 30% LVAD versus 12% OMM (odds ratio: 3.2 [95% confidence interval: 1.3 to 7.7]; p = 0.012). Survival as treated on original therapy at 2 years was greater for LVAD versus OMM (70 +/- 5% vs. 41 +/- 5%; p \u3c 0.001), but there was no difference in intent-to-treat survival (70 +/- 5% vs. 63 +/- 5%; p = 0.307). In the OMM arm, 23 of 103 (22%) received delayed LVADs (18 within 12 months; 5 from 12 to 24 months). LVAD adverse events declined after year 1 for bleeding (primarily gastrointestinal) and arrhythmias. CONCLUSIONS Survival on original therapy with improvement in 6-min walk distance was superior with LVAD compared with OMM at 2 years. Reduction in key adverse events beyond 1 year was observed in the LVAD group. The ROADMAP trial provides risk-benefit information to guide patient- and physician-shared decision making for elective LVAD therapy as a treatment for heart failure. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients [ROADMAP]; NCT01452802

Barriers to integrating direct oral anticoagulants into anticoagulation clinic care: A mixedâ methods study

BackgroundOutpatient anticoagulation clinics were initially developed to care for patients taking vitamin K antagonists such as warfarin. There has not been a systematic evaluation of the barriers and facilitators to integrating direct oral anticoagulant (DOAC) care into outpatient anticoagulation clinics.MethodsWe performed a mixed methods study consisting of an online survey of anticoagulation clinic providers and semiâ structured interviews with anticoagulation clinic leaders and managers between March and May of 2017. Interviews were transcribed and coded, exploring for themes around barriers and facilitators to DOAC care within anticoagulation clinics. Survey questions pertaining to the specific themes identified in the interviews were analyzed using summary statistics.ResultsSurvey responses were collected from 159 unique anticoagulation clinics and 20 semiâ structured interviews were conducted. Three primary barriers to DOAC care in the anticoagulation clinic were described by the interviewees: (a) a lack of provider awareness for ongoing monitoring and services provided by the anticoagulation clinic; (b) financial challenges to providing care to DOAC patients in an anticoagulation clinic model; and (c) clinical knowledge versus scope of care by the anticoagulation staff. These themes linked to three key areas of variation, including: (a) the size and hospital affiliation of the anticoagulation clinic; (b) the use of faceâ toâ face versus telephoneâ based care; and (c) the use of nurses or pharmacists in the anticoagulation clinic.ConclusionsAnticoagulation clinics in the United States experience important barriers to integrating DOAC care. These barriers vary based on the clinic size, model for warfarin care, and staff credentials (nursing or pharmacy).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/1/rth212157.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/2/rth212157_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/3/rth212157-sup-0001-Supinfo.pd

Selecting Grassland Species for Saline Environments

In Australia, around 5.7 million hectares of agricultural land are currently affected by dryland salinity or at risk from shallow water tables and this figure is expected to increase over the next 50 years (LWRA, 2001). Most improved grassland species cannot tolerate the combined effects of salt and waterlogging and, therefore, the productivity of sown grasslands in salt-affected areas is low. However, there is potential to overcome the lack of suitably adapted fodder species by introducing new, salt and waterlogging-tolerant species and by diversifying the gene pool of proven species. Potential species include exotic, naturalised and native Australian grass, legumes, herb and shrub species that are halophytes and non-halophytes. A collaborative national project in southern Australia commenced in 2004 with the objective of evaluating a range of forage species for saline environments