High-Fidelity Reproduction of Visual Signals by Electrical Stimulation in the Central Primate Retina.

Electrical stimulation of retinal ganglion cells (RGCs) with electronic implants provides rudimentary artificial vision to people blinded by retinal degeneration. However, current devices stimulate indiscriminately and therefore cannot reproduce the intricate neural code of the retina. Recent work has demonstrated more precise activation of RGCs using focal electrical stimulation with multielectrode arrays in the peripheral macaque retina, but it is unclear how effective this can be in the central retina, which is required for high-resolution vision. This work probes the neural code and effectiveness of focal epiretinal stimulation in the central macaque retina, using large-scale electrical recording and stimulation ex vivo The functional organization, light response properties, and electrical properties of the major RGC types in the central retina were mostly similar to the peripheral retina, with some notable differences in density, kinetics, linearity, spiking statistics, and correlations. The major RGC types could be distinguished by their intrinsic electrical properties. Electrical stimulation targeting parasol cells revealed similar activation thresholds and reduced axon bundle activation in the central retina, but lower stimulation selectivity. Quantitative evaluation of the potential for image reconstruction from electrically evoked parasol cell signals revealed higher overall expected image quality in the central retina. An exploration of inadvertent midget cell activation suggested that it could contribute high spatial frequency noise to the visual signal carried by parasol cells. These results support the possibility of reproducing high-acuity visual signals in the central retina with an epiretinal implant.SIGNIFICANCE STATEMENT Artificial restoration of vision with retinal implants is a major treatment for blindness. However, present-day implants do not provide high-resolution visual perception, in part because they do not reproduce the natural neural code of the retina. Here, we demonstrate the level of visual signal reproduction that is possible with a future implant by examining how accurately responses to electrical stimulation of parasol retinal ganglion cells can convey visual signals. Although the precision of electrical stimulation in the central retina was diminished relative to the peripheral retina, the quality of expected visual signal reconstruction in parasol cells was greater. These findings suggest that visual signals could be restored with high fidelity in the central retina using a future retinal implant.

Spalling-Induced Liftoff and Transfer of Electronic Films Using a van der Waals Release Layer.

Heterogeneous integration strategies are increasingly being employed to achieve more compact and capable electronics systems for multiple applications including space, electric vehicles, and wearable and medical devices. To enable new integration strategies, the growth and transfer of thin electronic films and devices, including III-nitrides, metal oxides, and 2D materials, using 2D boron nitride (BN)-on-sapphire templates are demonstrated. The van der Waals (vdW) BN layer, in this case, acts as a preferred mechanical release layer for precise separation at the substrate-film interface and leaves a smooth surface suitable for vdW bonding. A tensilely stressed Ni layer sputtered on top of the film induces controlled spalling fracture that propagates at the BN/sapphire interface. By incorporating controlled spalling, the process yield and sensitivity are greatly improved, owed to the greater fracture energy provided by the stressed metal layer relative to a soft tape or rubber stamp. With stress playing a critical role in this process, the influence of residual stress on detrimental cracking and bowing is investigated. Additionally, a back-end selected area lift-off technique is developed which allows for isolation and transfer of individual devices or arbitrary shapes.

A proposed approach to accelerate evidence generation for genomic-based technologies in the context of a learning health system.

Genomic technologies should demonstrate analytical and clinical validity and clinical utility prior to wider adoption in clinical practice. However, the question of clinical utility remains unanswered for many genomic technologies. In this paper, we propose three building blocks for rapid generation of evidence on clinical utility of promising genomic technologies that underpin clinical and policy decisions. We define promising genomic tests as those that have proven analytical and clinical validity. First, risk-sharing agreements could be implemented between payers and manufacturers to enable temporary coverage that would help incorporate promising technologies into routine clinical care. Second, existing data networks, such as the Sentinel Initiative and the National Patient-Centered Clinical Research Network (PCORnet) could be leveraged, augmented with genomic information to track the use of genomic technologies and monitor clinical outcomes in millions of people. Third, endorsement and engagement from key stakeholders will be needed to establish this collaborative model for rapid evidence generation; all stakeholders will benefit from better information regarding the clinical utility of these technologies. This collaborative model can create a multipurpose and reusable national resource that generates knowledge from data gathered as part of routine care to drive evidence-based clinical practice and health system changes.

ATR inhibition induces synthetic lethality and overcomes chemoresistance in TP53- or ATM-defective chronic lymphocytic leukemia cells.

TP53 and ataxia telangiectasia mutated (ATM) defects are associated with genomic instability, clonal evolution, and chemoresistance in chronic lymphocytic leukemia (CLL). Currently, therapies capable of providing durable remissions in relapsed/refractory TP53- or ATM-defective CLL are lacking. Ataxia telangiectasia and Rad3-related (ATR) mediates response to replication stress, the absence of which leads to collapse of stalled replication forks into chromatid fragments that require resolution through the ATM/p53 pathway. Here, using AZD6738, a novel ATR kinase inhibitor, we investigated ATR inhibition as a synthetically lethal strategy to target CLL cells with TP53 or ATM defects. Irrespective of TP53 or ATM status, induction of CLL cell proliferation upregulated ATR protein, which then became activated in response to replication stress. In TP53- or ATM-defective CLL cells, inhibition of ATR signaling by AZD6738 led to an accumulation of unrepaired DNA damage, which was carried through into mitosis because of defective cell cycle checkpoints, resulting in cell death by mitotic catastrophe. Consequently, AZD6738 was selectively cytotoxic to both TP53- and ATM-defective CLL cell lines and primary cells. This was confirmed in vivo using primary xenograft models of TP53- or ATM-defective CLL, where treatment with AZD6738 resulted in decreased tumor load and reduction in the proportion of CLL cells with such defects. Moreover, AZD6738 sensitized TP53- or ATM-defective primary CLL cells to chemotherapy and ibrutinib. Our findings suggest that ATR is a promising therapeutic target for TP53- or ATM-defective CLL that warrants clinical investigation.

The predictability of mosquito abundance from daily to monthly timescales.

The prediction of mosquito abundance is of central interest in addressing mosquito population dynamics and in forecasting the associated emerging and re-emerging diseases. However, little work has focused on the systematic evaluation of how well adult mosquito abundance can be predicted as a function of observational resolutions, aggregation scales, and prediction lead time. We use a state space reconstruction (SSR) approach to compare the predictability of mosquito population dynamics at weekly, biweekly, and monthly scales. We focus on the analysis of Aedes vexans and Culiseta melanura populations monitored in Brunswick County (North Carolina, USA) and find that prediction over a 7-d lead time is improved when daily observations are used, compared to the commonly used once-per-week sample. Our results demonstrate that daily observations of mosquito abundance contribute to improving mosquito predictability in two ways: (1) daily observations better capture fluctuations over short timescales, which are missed when sampling at coarser resolutions, and (2) the aggregation of daily abundance observations reduces the impact of noise, thereby increasing the predictability of mosquito population dynamics as the aggregation scale is increased. We show that the evaluation of population dynamical models based on observed and predicted abundance can lead to a spuriously high apparent performance, due to the high autocorrelation in the observations used to update the model state at each successive time step. We show that the comparison of predicted and observed population change, expressed through per capita growth rates, leads to a more informative performance measure.

TMS stimulus-response asymmetry in left- and right-handed individuals.

There have been inconsistencies in the literature regarding asymmetrical neural control and results of experiments using TMS techniques. Therefore, the aim of this study was to further our understanding of the neural relationships that may underlie performance asymmetry with respect to the distal muscles of the hand using a TMS stimulus-response curve technique. Twenty-four male subjects (12 right handed, 12 left handed) participated in a TMS stimulus-response (S-R) curve trial. Focal TMS was applied over the motor cortex to find the optimal position for the first dorsal interossei muscle and to determine rest threshold (RTh). Seven TMS intensities ranging from 90 to 150 % of RTh were delivered in 10 % increments. One single TMS block consisted of 16 stimuli at each intensity. Peak-to-peak amplitudes were measured and the S-R curve generated. In right-handed subjects, the mean difference in slopes between the right and left hand was -0.011 ± 0.03, while the mean difference between hands in left-handed subjects was -0.049 ± 0.08. Left-handed normalized data in right handers displayed a mean of 1.616 ± 1.019 (two-tailed t test p < 0.05). The left-handed group showed a significant change in the normalized slope as indicated by a mean of 1.693 ± 0.149 (two-tailed t test p < 0.00006). The results found in this study reinforce previous work which suggests that there is an asymmetry in neural drive that exists in both left- and right-handed individuals. However, the results show that the non-dominant motor hemisphere displays a greater amount of excitability than the dominant, which goes against the conventional dogma. This asymmetry indicates that the non-dominant hemisphere may have a higher level of excitation or a lower level of inhibition for both groups of participants.

Expiratory time constant for determinations of plateau pressure, respiratory system compliance, and total resistance.

INTRODUCTION: We hypothesized the expiratory time constant (ƬE) may be used to provide real time determinations of inspiratory plateau pressure (Pplt), respiratory system compliance (Crs), and total resistance (respiratory system resistance plus series resistance of endotracheal tube) (Rtot) of patients with respiratory failure using various modes of ventilatory support. METHODS: Adults (n = 92) with acute respiratory failure were categorized into four groups depending on the mode of ventilatory support ordered by attending physicians, i.e., volume controlled-continuous mandatory ventilation (VC-CMV), volume controlled-synchronized intermittent mandatory ventilation (VC-SIMV), volume control plus (VC+), and pressure support ventilation (PSV). Positive end expiratory pressure as ordered was combined with all aforementioned modes. Pplt, determined by the traditional end inspiratory pause (EIP) method, was combined in equations to determine Crs and Rtot. Following that, the ƬE method was employed, ƬE was estimated from point-by-point measurements of exhaled tidal volume and flow rate, it was then combined in equations to determine Pplt, Crs, and Rtot. Both methods were compared using regression analysis. RESULTS: ƬE, ranging from mean values of 0.54 sec to 0.66 sec, was not significantly different among ventilatory modes. The ƬE method was an excellent predictor of Pplt, Crs, and Rtot for various ventilatory modes; r2 values for the relationships of ƬE and EIP methods ranged from 0.94 to 0.99 for Pplt, 0.90 to 0.99 for Crs, and 0.88 to 0.94 for Rtot (P <0.001). Bias and precision values were negligible. CONCLUSIONS: We found the ƬE method was just as good as the EIP method for determining Pplt, Crs, and Rtot for various modes of ventilatory support for patients with acute respiratory failure. It is unclear if the ƬE method can be generalized to patients with chronic obstructive lung disease. ƬE is determined during passive deflation of the lungs without the need for changing the ventilatory mode and disrupting a patient's breathing. The ƬE method obviates the need to apply an EIP, allows for continuous and automatic surveillance of inspiratory Pplt so it can be maintained ≤ 30 cm H2O for lung protection and patient safety, and permits real time assessments of pulmonary mechanics.

Infrared surface plasmon resonance of AZO-Ag-AZO sandwich thin films.

Near-infrared surface plasmon resonance (SPR) spectra were collected of thin multilayer films of aluminum-doped zinc oxide (AZO) / silver (Ag) / AZO on BK-7 glass in the Kretschmann configuration in air, with the silver layer thickness varying from 5 nm to 50 nm. The SPR results were interpreted by modeling the reflectance with a five-layer transfer-matrix method, with the aid of a simplex algorithm. The model indicated that the Ag plasma frequency was significantly higher than the bulk value, possibly due to Schottky effect charge transfer from the AZO to the Ag layer. Continuous silver films were made as thin as 10 nm, indicating an inhibition of metal island formation for Ag deposited on AZO.

Convergence of Service Providers and Managers' Perspectives on Strengths, Gaps, and Priorities for Rural Health System Redesign: A Whole-Systems Qualitative Study in Washington County, Maine.

INTRODUCTION: Both rural residents and state government leaders describe a need to redesign rural health care systems. Community members should be at the center of this effort. METHODS: We conducted 46 in-depth interviews of direct service providers between September and November 2020 in Washington County, Maine. Data were analyzed using a thematic analysis approach. RESULTS: Existing strengths included collaboration between government and health systems, and community-based services. Gaps included insufficient workforce, restricted scope of licensing and poor reimbursement, lack of coordination between health systems, and limited paramedicine capacity. Strategies for health system redesign included addressing maldistribution of services and resource optimization, changing federal and state legislation around insurance and scope of practice, and moving toward value-based purchasing models. CONCLUSIONS: Participants provided pragmatic recommendations based on their deep understanding of the community context. Lessons learned are likely to be salient in areas with similar profiles regarding rurality and poverty.

Focal electrical stimulation of human retinal ganglion cells for vision restoration.

Objective. Vision restoration with retinal implants is limited by indiscriminate simultaneous activation of many cells and cell types, which is incompatible with reproducing the neural code of the retina. Recent work has shown that primate retinal ganglion cells (RGCs), which transmit visual information to the brain, can be directly electrically activated with single-cell, single-spike, cell-type precision - however, this possibility has never been tested in the human retina. In this study we aim to characterize, for the first time, direct in situ extracellular electrical stimulation of individual human RGCs.Approach. Extracellular electrical stimulation of individual human RGCs was conducted in three human retinas ex vivo using a custom large-scale, multi-electrode array capable of simultaneous recording and stimulation. Measured activation properties were compared directly to extensive results from macaque.Main results. Precise activation was in many cases possible without activating overlying axon bundles, at low stimulation current levels similar to those used in macaque. The major RGC types could be identified and targeted based on their distinctive electrical signatures. The measured electrical activation properties of RGCs, combined with a dynamic stimulation algorithm, was sufficient to produce an evoked visual signal that was nearly optimal given the constraints of the interface.Significance. These results suggest the possibility of high-fidelity vision restoration in humans using bi-directional epiretinal implants.

Choosing Among Common Data Models for Real-World Data Analyses Fit for Making Decisions About the Effectiveness of Medical Products.

Many real-world data analyses use common data models (CDMs) to standardize terminologies for medication use, medical events and procedures, data structures, and interpretations of data to facilitate analyses across data sources. For decision makers, key aspects that influence the choice of a CDM may include (i) adaptability to a specific question; (ii) transparency to reproduce findings, assess validity, and instill confidence in findings; and (iii) ease and speed of use. Organizing CDMs preserve the original information from a data source and have maximum adaptability. Full mapping data models, or preconfigured rules systems, are easy to use, since all raw codes are mapped to medical constructs. Adaptive rule systems grow libraries of reusable measures that can easily adjust to preserve adaptability, expedite analyses, and ensure study-specific transparency.

Transferrable AlGaN/GaN High-Electron Mobility Transistors to Arbitrary Substrates via a Two-Dimensional Boron Nitride Release Layer.

Mechanical transfer of high-performing thin-film devices onto arbitrary substrates represents an exciting opportunity to improve device performance, explore nontraditional manufacturing approaches, and paves the way for soft, conformal, and flexible electronics. Using a two-dimensional boron nitride release layer, we demonstrate the transfer of AlGaN/GaN high-electron mobility transistors (HEMTs) to arbitrary substrates through both direct van der Waals bonding and with a polymer adhesive interlayer. No device degradation was observed because of the transfer process, and a significant reduction in device temperature (327-132 °C at 600 mW) was observed when directly bonded to a silicon carbide (SiC) wafer relative to the starting wafer. With the use of a benzocyclobutene (BCB) adhesion interlayer, devices were easily transferred and characterized on Kapton and ceramic films, representing an exciting opportunity for integration onto arbitrary substrates. Upon reduction of this polymer adhesive layer thickness, the AlGaN/GaN HEMTs transferred onto a BCB/SiC substrate resulted in comparable peak temperatures during operation at powers as high as 600 mW to the as-grown wafer, revealing that by optimizing interlayer characteristics such as thickness and thermal conductivity, transferrable devices on polymer layers can still improve performance outputs.

Gas-phase hydrogen/deuterium exchange in a traveling wave ion guide for the examination of protein conformations.

Accumulating evidence suggests that solution-phase conformations of small globular proteins and large molecular protein assemblies can be preserved for milliseconds after electrospray ionization. Thus, the study of proteins in the gas phase on this time scale is highly desirable. Here we demonstrate that a traveling wave ion guide (TWIG) of a Synapt mass spectrometer offers a highly suitable environment for rapid and efficient gas-phase hydrogen/deuterium exchange (HDX). Gaseous ND(3) was introduced into either the source TWIG or the TWIG located just after the ion mobility cell, such that ions underwent HDX as they passed through the ND(3) on the way to the time-of-flight analyzer. The extent of deuterium labeling could be controlled by varying the quantity of ND(3) or the speed of the traveling wave. The gas-phase HDX of model peptides corresponded to labeling of primarily fast exchanging sites due to the short labeling times (ranging from 0.1 to 10 ms). In addition to peptides, gas-phase HDX of ubiquitin, cytochrome c, lysozyme, and apomyoglobin were examined. We conclude that HDX of protein ions in a TWIG is highly sensitive to protein conformation, enables the detection of conformers present on submilliseconds time scales, and can readily be combined with ion mobility spectrometry.

A quantitative assessment of institutions of higher education disaster preparedness and resilience.

OBJECTIVE: Assess levels of disaster preparedness in institutions of higher education (IHEs) in the United States. DESIGN: An anonymous, 57-question survey targeted individuals responsible for emergency management at IHEs across the US descriptive statistics and bivariate chi-square analysis were reported. Using the established threshold score of the initial Cities Readiness Initiative from the CDC, an individual respondent's composite score of 70 percent or higher across 23 specific questions within the 57-question survey was labeled as "prepared." RESULTS: Chi-square analysis identified variables associated with lower preparedness levels at IHEs not achieving the minimum 70 percent score. Having a campus law enforcement officer serve the additional role of emergency manager had a negative association with being prepared [χ2 (1) = 10.18, p < 0.001]. Having emergency management as a separate university function from campus law enforcement had a positive relationship with being prepared [χ2 (1) = 18.55, p < 0.001]. Staffing the emergency management function with a professional having less than 3 years of emergency management experience had a negative association with being prepared. CONCLUSIONS: Our results indicate that minimizing the mission of emergency management by simply tasking a campus law enforcement officer with the extra responsibility of emergency management or entertaining less professionally qualified personnel to lead emergency management's complex mission can lead to disastrous results. Not only is preparedness impacted, but also resilience when facing disaster situations. Our nation continues to strive to become more resilient when facing such adverse events, as formally embraced and emphasized in the 2017 National Security Strategy. Research continues to offer best practices and unfortunately continues to highlight gaps. While the higher education community is not one of the 16 federal critical infrastructure sectors, identified gaps such as those presented in our findings as well as those published by the National Academies of Sciences are cause for alarm. Not only are higher education campuses generating invaluable contributions to society in general, bio-innovation, public health, and medicine, to name a few, they are a core stakeholder in resilience research and implementation. Yet, research continues to indicate preparedness and therefore resilience gaps in this sector. The authors propose implications for practice, policy, and research to assist IHEs in achieving a more comprehensive, sustainable level of resilience.

High Variability in Cellular Stoichiometry of Carbon, Nitrogen, and Phosphorus Within Classes of Marine Eukaryotic Phytoplankton Under Sufficient Nutrient Conditions.

Current hypotheses suggest that cellular elemental stoichiometry of marine eukaryotic phytoplankton such as the ratios of cellular carbon:nitrogen:phosphorus (C:N:P) vary between phylogenetic groups. To investigate how phylogenetic structure, cell volume, growth rate, and temperature interact to affect the cellular elemental stoichiometry of marine eukaryotic phytoplankton, we examined the C:N:P composition in 30 isolates across 7 classes of marine phytoplankton that were grown with a sufficient supply of nutrients and nitrate as the nitrogen source. The isolates covered a wide range in cell volume (5 orders of magnitude), growth rate (<0.01-0.9 d-1), and habitat temperature (2-24°C). Our analysis indicates that C:N:P is highly variable, with statistical model residuals accounting for over half of the total variance and no relationship between phylogeny and elemental stoichiometry. Furthermore, our data indicated that variability in C:P, N:P, and C:N within Bacillariophyceae (diatoms) was as high as that among all of the isolates that we examined. In addition, a linear statistical model identified a positive relationship between diatom cell volume and C:P and N:P. Among all of the isolates that we examined, the statistical model identified temperature as a significant factor, consistent with the temperature-dependent translation efficiency model, but temperature only explained 5% of the total statistical model variance. While some of our results support data from previous field studies, the high variability of elemental ratios within Bacillariophyceae contradicts previous work that suggests that this cosmopolitan group of microalgae has consistently low C:P and N:P ratios in comparison with other groups.

Extent and magnitude of copper contamination in marinas of the San Diego region, California, USA.

Marinas are areas of special water quality concern because of the potential for pollutant accumulation within their protected waters. Perhaps the largest contaminant source to marinas is antifouling paints that leach copper to prevent the growth of encrusting organisms on vessel bottoms. Very little monitoring of marinas is typically conducted despite the potential environmental risk, particularly in the San Diego region of California, USA where as many as 17,000 recreational vessels are berthed. The objective of this study was twofold: (1) determine the extent and magnitude of dissolved copper concentrations in marinas throughout the San Diego region, and (2) determine if elevated copper concentrations in marinas of the San Diego region are resulting in adverse biological impacts. A probabilistic study design was used to sample water column copper concentrations and toxicity (using Mytilus galloprovincialis) at 30 stations. Results indicated that exceedence of state water quality objectives was widespread (86% of marina area), but that toxicity was much less prevalent (21% of marina area). Toxicity identification evaluations (TIEs) conducted at the most toxic sites indicated that toxicity was largely due to trace metals, most likely copper. Toxicity was reduced using TIE treatments that chelated trace metals such as cation exchange column, ethylenediaminetetraacetic acid (EDTA), and sodium thiosulfate (STS). Moreover, increasing dissolved copper concentrations correlated with increasing toxicity and these copper concentrations were high enough to account for virtually all of the observed toxicity.

Microcystin Prevalence throughout Lentic Waterbodies in Coastal Southern California.

Toxin producing cyanobacterial blooms have increased globally in recent decades in both frequency and intensity. Despite the recognition of this growing risk, the extent and magnitude of cyanobacterial blooms and cyanotoxin prevalence is poorly characterized in the heavily populated region of southern California. Recent assessments of lentic waterbodies (depressional wetlands, lakes, reservoirs and coastal lagoons) determined the prevalence of microcystins and, in some cases, additional cyanotoxins. Microcystins were present in all waterbody types surveyed although toxin concentrations were generally low across most habitats, as only a small number of sites exceeded California's recreational health thresholds for acute toxicity. Results from passive samplers (Solid Phase Adsorption Toxin Tracking (SPATT)) indicated microcystins were prevalent throughout lentic waterbodies and that traditional discrete samples underestimated the presence of microcystins. Multiple cyanotoxins were detected simultaneously in some systems, indicating multiple stressors, the risk of which is uncertain since health thresholds are based on exposures to single toxins. Anatoxin-a was detected for the first time from lakes in southern California. The persistence of detectable microcystins across years and seasons indicates a low-level, chronic risk through both direct and indirect exposure. The influence of toxic cyanobacterial blooms is a more complex stressor than presently recognized and should be included in water quality monitoring programs.

A Comparison of Data Quality Assessment Checks in Six Data Sharing Networks.

OBJECTIVE: To compare rule-based data quality (DQ) assessment approaches across multiple national clinical data sharing organizations. METHODS: Six organizations with established data quality assessment (DQA) programs provided documentation or source code describing current DQ checks. DQ checks were mapped to the categories within the data verification context of the harmonized DQA terminology. To ensure all DQ checks were consistently mapped, conventions were developed and four iterations of mapping performed. Difficult-to-map DQ checks were discussed with research team members until consensus was achieved. RESULTS: Participating organizations provided 11,026 DQ checks, of which 99.97 percent were successfully mapped to a DQA category. Of the mapped DQ checks (N=11,023), 214 (1.94 percent) mapped to multiple DQA categories. The majority of DQ checks mapped to Atemporal Plausibility (49.60 percent), Value Conformance (17.84 percent), and Atemporal Completeness (12.98 percent) categories. DISCUSSION: Using the common DQA terminology, near-complete (99.97 percent) coverage across a wide range of DQA programs and specifications was reached. Comparing the distributions of mapped DQ checks revealed important differences between participating organizations. This variation may be related to the organization's stakeholder requirements, primary analytical focus, or maturity of their DQA program. Not within scope, mapping checks within the data validation context of the terminology may provide additional insights into DQA practice differences. CONCLUSION: A common DQA terminology provides a means to help organizations and researchers understand the coverage of their current DQA efforts as well as highlight potential areas for additional DQA development. Sharing DQ checks between organizations could help expand the scope of DQA across clinical data networks.