An Inhaled Galectin-3 Inhibitor in COVID-19 Pneumonitis: A Phase Ib/IIa Randomized Controlled Clinical Trial (DEFINE).

Rationale: High circulating galectin-3 is associated with poor outcomes in patients with coronavirus disease (COVID-19). We hypothesized that GB0139, a potent inhaled thiodigalactoside galectin-3 inhibitor with antiinflammatory and antifibrotic actions, would be safely and effectively delivered in COVID-19 pneumonitis. Objectives: Primary outcomes were safety and tolerability of inhaled GB0139 as an add-on therapy for patients hospitalized with COVID-19 pneumonitis. Methods: We present the findings of two arms of a phase Ib/IIa randomized controlled platform trial in hospitalized patients with confirmed COVID-19 pneumonitis. Patients received standard of care (SoC) or SoC plus 10 mg inhaled GB0139 twice daily for 48 hours, then once daily for up to 14 days or discharge. Measurements and Main Results: Data are reported from 41 patients, 20 of which were assigned randomly to receive GB0139. Primary outcomes: the GB0139 group experienced no treatment-related serious adverse events. Incidences of adverse events were similar between treatment arms (40 with GB0139 + SoC vs. 35 with SoC). Secondary outcomes: plasma GB0139 was measurable in all patients after inhaled exposure and demonstrated target engagement with decreased circulating galectin (overall treatment effect post-hoc analysis of covariance [ANCOVA] over days 2-7; P = 0.0099 vs. SoC). Plasma biomarkers associated with inflammation, fibrosis, coagulopathy, and major organ function were evaluated. Conclusions: In COVID-19 pneumonitis, inhaled GB0139 was well-tolerated and achieved clinically relevant plasma concentrations with target engagement. The data support larger clinical trials to determine clinical efficacy. Clinical trial registered with ClinicalTrials.gov (NCT04473053) and EudraCT (2020-002230-32).

Photoinduced absorption spectroscopy (PIAS) study of water and chloride oxidation by a WO3 photoanode in acidic solution.

The mechanisms of water and chloride oxidation by a WO3 photoanode are probed by photoinduced absorption spectroscopy (PIAS) coupled with transient photocurrent (TC) measurements. Linear sweep voltammograms (LSVs) and incident photon to current efficiencies (IPCEs) are obtained, in the water oxidation electrolyte (1 M HClO4) and chloride oxidation electrolyte (3.5 M NaCl in 1 M HClO4). Other work shows that the faradaic efficiency of water oxidation to O2 in 1 M HClO4 is ca. 1.0, and that for chloride oxidation to Cl2 in 3.5 M NaCl plus 1 M HClO4 is ca. 0.62. The PIAS/TC data reveals a 0.4 order dependency of the rate of water oxidation on the steady state concentration of photogenerated surface holes, [hs+]ss, and an approximately first order dependency of the rate of chloride oxidation on [hs+]ss. Associated mechanisms and rate determining steps for water and chloride oxidation at the photoanode surface that account for these reaction orders are proposed.

Kinetics of stearic acid destruction on TiO2 'self-cleaning' films revisited.

The photocatalytic oxidation of stearic acid, SA, by O2 is a common test method used to assess the activity of new materials and underpins a standard test for self-cleaning activity. The kinetics of this process have been well-studied and are often interpreted using one of two simple models, which are revisited here in this overview. The first model is based on the common scenario of a SA layer on top of an all-photocatalyst layer which yields zero order kinetics, for which it is suggested that all the reaction sites are occupied by SA during the bulk of the photocatalytic process. An important, but rarely noted feature of this system is that the rate of SA removal depends directly upon the fraction of absorbed ultra-bandgap radiation, which suggests that the photocatalyst particles are extensively networked, thereby allowing the photogenerated electrons and holes to move rapidly and efficiently to the surface to effect the destruction of SA. The second kinetic model has been used to describe the first order kinetics of SA removal observed for mesoporous photocatalytic films comprised of isolated photocatalyst particles, in which the SA is inside (rather than on top) of the photocatalytic film, and is developed further here. It is shown that, contrary to previous reports, this model is not appropriate for porous photocatalytic films in which the particles are extensively networked, such as ones based on powders or sol-gel films, even though they too may exhibit decay kinetics where the order is > 0. The reason for the latter kinetics appears to be a distribution of reactivities through such films, i.e. high and low activity sites.

3D printed, plastic photocatalytic flow reactors for water purification.

3D printing is known as a fast, inexpensive, reproducible method for producing prototypes but is also fast becoming recognised as a scalable, advanced manufacture process. Two types of lab-scale, 3D printed plastic, fixed-film, flow-through photocatalytic reactors are described, both of which are sinusoidal in shape, and only differ in that one has no baffles, reactor A, whereas the other has, reactor B. Both reactors are lined with a P25 TiO2/polylactic acid (PLA) coating, which, after UVA pre-conditioning, is used to photocatalyse the bleaching of circulating aqueous solutions of either methylene blue, MB, or phenol, PhOH, repeatably, without any obvious loss of activity. The rate of the photocatalysed bleaching of MB exhibited by reactor B shows a much lower dependence upon flow rate than reactor A, due to the greater lateral mixing of the laminar flow streams produced by the baffles. The photonic efficiencies of reactor A for the photocatalysed bleaching of MB and PhOH were determined to be 0.025% and 0.052%, respectively, and the photocatalytic space-time yields (PSTY) to be 0.98 × 10-4 and 1.49 × 10-4 m3 of reaction solution.m-3 reactor volume.day-1.kW-1, respectively. This is the first example of an all plastic, 3D printed photocatalytic reactor and demonstrates the advantages of 3D printing for prototyping. Given the 3D printing is a scalable process, possible potential areas of application are discussed briefly.

The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM.

PURPOSE: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. METHODS: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. RESULTS: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. CONCLUSION: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.

Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association.

Structural racism has been and remains a fundamental cause of persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic and the police killings of George Floyd, Breonna Taylor, and multiple others have been reminders that structural racism persists and restricts the opportunities for long, healthy lives of Black Americans and other historically disenfranchised groups. The American Heart Association has previously published statements addressing cardiovascular and cerebrovascular risk and disparities among racial and ethnic groups in the United States, but these statements have not adequately recognized structural racism as a fundamental cause of poor health and disparities in cardiovascular disease. This presidential advisory reviews the historical context, current state, and potential solutions to address structural racism in our country. Several principles emerge from our review: racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone. The path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups. Future research on racism must be accelerated and should investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, anti-Black). The American Heart Association must look internally to correct its own shortcomings and advance antiracist policies and practices regarding science, public and professional education, and advocacy. With this advisory, the American Heart Association declares its unequivocal support of antiracist principles.

The Medial Femoral Condyle Free Flap for Reconstruction of Recalcitrant Defects in the Head and Neck.

BACKGROUND: Small recalcitrant defects of the mandible and maxilla may be secondary to tumor, trauma, infection, and congenital origin. Vascularized bone grafting has been shown to effectively manage these defects; however, donor sites are limited. The vascularized medial femoral condyle (MFC) provides adequate cortical cancellous bone with the option of a skin island, consistent anatomy, and minimal donor site morbidity. This article outlines the use of the MFC flap for maxillomandibular reconstruction. METHODS: A retrospective chart review of patients who required segmental maxillomandibular reconstruction with the MFC flap was conducted. A total of 9 patients (5 men and 5 women) with an average age of 45.3 years were identified. The etiology of the defects, flap sizes, and postoperative outcomes were recorded. RESULTS: Three patients had osteoradionecrosis of the neomandible after irradiation of the free fibula reconstruction, 3 patients had defects after cancer extirpation (1 mandible, 2 maxillary), 1 patient had a maxillary defect from trauma, and 2 patients had a residual cleft palate defect. All defects failed initial treatment with nonvascularized bone grafts. The average dimensions of the MFC flaps were 1.2 × 2.5 × 4 cm. Two of 9 flaps included a skin island. Eight flaps survived completely, but 1 patient suffered from flap failure requiring debridement and resulted in an oroantral fistula. Four patients received endosseous dental implants. Average time to union was 6.7 months, and average time to implant was 6.75 months. The average follow-up time was 24.9 months. CONCLUSIONS: The MFC flap is useful in the reconstruction of small segmental maxillomandibular defects and for the salvage of a neomandible after osteoradionecrosis. The MFC flap provides a reliable platform for endosseous dental implants and serves as an alternative source of vascularized bone reconstruction in the head and neck.

3D printed O2 indicators.

A polymer filament, containing an O2-sensitive lumophore pigment, platinum(ii) (pentafluorophenyl) porphyrin coated onto nanoparticulate silica particles, i.e. PtTFPP/SiO2, is produced and used in a filament which is then 3D printed as O2-sensitive indicator dots (1 cm diameter, 30 µm thick) on a polyethylene terephthalate (PET) supporting film substrate. Two different filaments, prepared using the polymers, low density polyethylene (LDPE) and polylactic acid (PLA), respectively, are used to produce 3D printed PtTFPP/SiO2/LDPE and PtTFPP/SiO2/PLA O2-sensitive indicator dots, with dynamic ranges of 0-30% and 0-400% O2, respectively. The O2 response characteristics of these two, very different, indicator dots, such as sensitivity, response time and temperature sensitivity, are measured and compared with those of a commercial O2 indicator, FOSPOR (OceanInsight) and other commercial O2 indicators. The potential of this method for mass manufacture of O2 indicator dots and the likelihood that it can be extended to produce other optical indicators, such as those for ammonia or CO2, are discussed briefly.

Is Rural Plastic Surgery Feasible and Important?: A Survey and Review of the Literature.

BACKGROUND: There is little written about the scope of rural plastic surgery within the United States. Approximately 25 million people do not have immediate access to a plastic surgeon. Most areas are designated as rural, and this lack of specialty care can result in suboptimal care. Physicians are more likely to move to a rural area if they have prior life experience with rural areas, but exposure to rural plastic surgery in residency training is scarce. We attempted to examine the practice characteristics of rural plastic surgeons within the United States to (a) to better define the average rural plastic surgery practice and (b) to highlight the broad scope of practice of the rural plastic surgeon to educate both hospital administrators and our physician colleagues of the impact and benefit a plastic surgeon can have on a health system. METHODS: A survey was e-mailed to surgeons identified as rural plastic surgeons who practiced in communities with fewer than 50,000 people not located in a metropolitan area. Thirty-four surgeons were identified and 12 responded to the survey. RESULTS: Respondents on average were 56 years old and had practiced for 14.3 years. At the time of the survey, 33% practiced in a hospital-employed group practice, and 33% operated in a hospital that is part of a health system. Seventy-five percent did not complete fellowship training, but 67% believed that fellowship training would be beneficial to someone interested in rural plastic surgery. Seventy-five percent recommended hand surgery as the most beneficial fellowship. Eighty-three percent had prior experiences with rural surgery before starting their practice. Average case volume ranged from 150 to more than 1000 cases per year and spanned the spectrum of plastic surgery. Potential barriers to practicing rural plastic surgery included call responsibility and facility limitations. CONCLUSIONS: A career in rural plastic surgery offers great variety encompassing the spectrum of plastic surgery. Most agreed that hand fellowship would be the most beneficial fellowship. Most had prior experience with rural surgery before seeking a career in rural plastic surgery, highlighting the importance of increasing awareness of these opportunities.

A colourimetric vacuum air-pressure indicator.

A colourimetric vacuum air pressure indicator is described, based on the very low level of CO2 in air. The indicator uses the pH indicator dye, ortho-cresolphthalein, OCP, which is violet coloured in its deprotonated form and colourless when protonated. When the violet coloured OCP anion is ion-paired with the tetrabutylammonium cation, the product is readily dissolved in a non-aqueous solution containing the polymer ethyl cellulose to create an ink which, when cast and allowed to dry, responds to levels of CO2 well below that in air, i.e.≪0.041%; the indicator's halfway colour changing point is at 0.062 atm of air at 22 °C, which is interesting in that in food vacuum packaging the pressure in the pack is usually ca. 0.04 atm. The indicator can be used as a qualitative and quantitative indicator of vacuum air pressure. The latter requires the use of digital photography, coupled to RGB colour analysis, in the analysis of the indicator's colour. As with most CO2 indicators, the indicator's response is temperature sensitive, with ΔH = 78 ± 5 kJ mol-1. The indicator's 90% response and recovery times to a cycle of vacuum and air are 16.2 and 2.7 min, respectively. The efficacy of the indicator as a vacuum-package integrity indicator for food packaging is illustrated and other potential applications are discussed briefly. This is the first reported example of an ink-based, inexpensive, colourimetric vacuum air pressure indicator.

Fatigue, treatment satisfaction and health-related quality of life among patients receiving novel drugs suppressing androgen signalling for the treatment of metastatic castrate-resistant prostate cancer.

Clinical studies have demonstrated the benefits of abiraterone acetate + prednisone (AAP) and enzalutamide (ENZ) in significantly improving survival among metastatic castration-resistant prostate cancer (mCRPC) patients. However, evidence regarding patient's real-world experience, particularly with respect to fatigue, treatment satisfaction and health-related quality of life (HRQoL) is limited. Interviews were initially conducted with patients (n = 38) and carers (n = 12) to elicit qualitative data regarding their experiences. Findings informed the design of a quantitative, multinational online survey of mCRPC patients (n = 152) receiving AAP or ENZ. Participants completed validated questionnaires assessing fatigue (Brief Fatigue Inventory), treatment satisfaction (Cancer Therapy Satisfaction Questionnaire) and HRQoL (EuroQol-5-Dimensions). Results indicated that patients were generally satisfied with these therapies, more specifically with reductions in prostate-specific antigen levels and extended survival. Fatigue was commonly linked to poor HRQoL and responses indicated that significantly fewer patients in the AAP group reported feeling usually tired or fatigued in the last week compared to the ENZ group (33% vs. 55%, p = 0.006 respectively). Findings highlight the benefit of AAP and ENZ in promoting the "quality" of extended survival. That fatigue was lower among patients receiving AAP may be important for informing treatment decisions. Further research is needed to gain deeper insights.

Revision of the Failed Ankle Fusion.

A failed ankle fusion is a complicated and not-uncommon occurrence. Successful management requires a thorough preoperative evaluation to determine the cause of initial clinical failure and identify surgical strategies to maximize the likelihood of clinical success. Because revision ankle fusion is a risk factor for failed ankle fusion, a measured approach is required. Patients typically fall into one of three categories. In patients without infection or substantial malalignment, clinical success can be achieved with a broad scope of surgical interventions tailored to the specific clinical symptoms of the patient. Patients with malalignment may require osteotomy for correction. The final group, encompassing patients with infection or bone loss, often requires a more complex approach. A measured, meticulous approach increases the likelihood of successful revision surgery and can decrease the likelihood of further surgery. Although revision is often successful, limb salvage may not be possible in a small subset of patients.

Motivational Interviewing-Based Compliance/Adherence Therapy Interventions to Improve Psychiatric Symptoms of People With Severe Mental Illness: Meta-Analysis.

BACKGROUND: Nonadherence is the leading cause of relapse in mental illness. No quantitative synthesis of multiple studies has been conducted to determine the effect of motivational interviewing (MI)-based compliance/adherence therapy (CAT) interventions on people with severe mental illness. OBJECTIVE: To synthesize the studies that examined the effectiveness of MI-based CAT interventions to improve psychiatric symptoms. DESIGN: Quantitative meta-analysis. RESULTS: Sixteen primary studies were retrieved ( N =1267 participants). MI-based CAT interventions significantly improved psychiatric symptoms with a moderate effect size (ES) of .45. Longer sessions and higher intervention doses showed significantly greater ESs than shorter sessions and lower doses. ESs were significantly lower when participants were older and when there was a longer period between the intervention and outcome measurement. CONCLUSIONS: These findings support the effectiveness of MI-based CAT interventions. Session length and dose effect should be considered when tailoring MI to clients.

Action spectra in semiconductor photocatalysis.

Action spectra are an increasingly important part of semiconductor photocatalyst research, and comprise a plot of photonic efficiency, η, versus excitation wavelength, λ. The features and theory behind an ideal photocatalytic system are discussed, and used to identify: (i) the key aspect of an ideal action spectrum, namely: it is a plot of η vs. λ which has the same shape as that of the fraction of radiation absorbed by the semiconductor photocatalyst, f, versus λ and (ii) the key requirement when running an action spectrum, namely, that the initial rate of the photocatalytic process is directly proportional to incident photon flux, ρ, at wavelengths where η > 0. The Pt/TiO2/MeOH system is highlighted as an example of a photosystem that yields an ideal action spectrum. Most photocatalytic systems exhibit non-ideal action spectra, mostly due to one or more of the following: light intensity effects, crystal phase effects, dye-sensitisation, dye photolysis, charge transfer complex, CTC, formation and localized surface plasmon radiation, LSPR, absorption by a deposited noble metal catalyst. Each of these effects is illustrated using examples taken from the literatures and discussed. A suggested typical protocol for recording the action spectrum and absorption/diffuse reflectance spectrum of a photocatalytic system is described. The dangers of using a dye to probe the activity of a photocatalysts are also discussed, and a possible way to avoid this, via reductive photocatalysis, is suggested.

Principles of Quantitative MR Imaging with Illustrated Review of Applicable Modular Pulse Diagrams.

Continued improvements in diagnostic accuracy using magnetic resonance (MR) imaging will require development of methods for tissue analysis that complement traditional qualitative MR imaging studies. Quantitative MR imaging is based on measurement and interpretation of tissue-specific parameters independent of experimental design, compared with qualitative MR imaging, which relies on interpretation of tissue contrast that results from experimental pulse sequence parameters. Quantitative MR imaging represents a natural next step in the evolution of MR imaging practice, since quantitative MR imaging data can be acquired using currently available qualitative imaging pulse sequences without modifications to imaging equipment. The article presents a review of the basic physical concepts used in MR imaging and how quantitative MR imaging is distinct from qualitative MR imaging. Subsequently, the article reviews the hierarchical organization of major applicable pulse sequences used in this article, with the sequences organized into conventional, hybrid, and multispectral sequences capable of calculating the main tissue parameters of T1, T2, and proton density. While this new concept offers the potential for improved diagnostic accuracy and workflow, awareness of this extension to qualitative imaging is generally low. This article reviews the basic physical concepts in MR imaging, describes commonly measured tissue parameters in quantitative MR imaging, and presents the major available pulse sequences used for quantitative MR imaging, with a focus on the hierarchical organization of these sequences. ©RSNA, 2017.

Highly CO2 sensitive extruded fluorescent plastic indicator film based on HPTS.

Highly-sensitive optical fluorescent extruded plastic films are reported for the detection of gaseous and dissolved CO2. The pH-sensitive fluorescent dye used is 8-hydroxypyrene-1,3,6-trisulfonic acid trisodium salt (HPTS, PTS(-)) coated on the surface of hydrophilic fumed silica and the base is tetrabutylammonium hydroxide (TBAH). The above components are used to create an HPTS pigment (i.e. HPTS/SiO2/TBAH) with a high CO2 sensitivity (%CO2 (S = 1/2) = 0.16%) and fast 50% response (t50↓) = 2 s and recovery (t50↑) = 5 s times. Highly CO2-sensitive plastic films are then fabricated, via the extrusion of the HPTS pigment powder in low-density polyethylene (LDPE). As with the HPTS-pigment, the luminescence intensity (at 515 nm) and absorbance (at 475 nm) of the HPTS plastic film decreases as the %CO2 in the ambient gas phase increases. The HPTS plastic film exhibits a high CO2 sensitivity, %CO2 (S = 1/2), of 0.29%, but a response time <2 min and recovery time <40 min, which is slower than that of the HPTS pigment. The HPTS plastic film is very stable under ambient conditions, (with a shelf life >six month when stored in the dark but under otherwise ambient conditions). Moreover, the HPTS-LDPE film is stable in water, salt solution and even in acid (pH = 2), and in each of these media it can be used to detect dissolved CO2.

Reductive photocatalysis and smart inks.

Semiconductor-sensitised photocatalysis is a well-established and growing area of research, innovation and commercialisation; the latter being mostly limited to the use of TiO2 as the semiconductor. Most of the work on semiconductor photocatalytic systems uses oxygen as the electron acceptor and explores a wide range of electron donors; such systems can be considered to be examples of oxidative photocatalysis, OP. OP underpins most current examples of commercial self-cleaning materials, such as: glass, tiles, concrete, paint and fabrics. OP, and its myriad of applications, have been reviewed extensively over the years both in this journal and elsewhere. However, the ability of TiO2, and other semiconductor sensitisers, to promote reductive photocatalysis, RP, especially of dyes, is significant and, although less well-known, is of growing importance. In such systems, the source of the electrons is some easily oxidised species, such as glycerol. One recent, significant example of a RP process is with respect to photocatalyst activity indicator inks. paiis, which provide a measure of the activity of a photocatalytic film under test via the rate of change of colour of the dye in the ink coating due to irreversible RP. In contrast, by incorporating the semiconductor sensitiser in the ink, rather than outside it, it is possible to create an effective UV dosimeter, based on RP, which can be used as a sun-burn warning indicator. In the above examples the dye is reduced irreversibly, but when the photocatalyst in an ink is used to reversibly photoreduce a dye, a novel, colourimetric oxygen-sensitive indicator ink can be created, which has commercial potential in the food packaging industry. Finally, if no dye is present in the ink, and the semiconductor photocatalyst-loaded ink film coats an easily reduced substrate, such as a metal oxide film, then it can be used to reduce the latter and so, for example, clean up tarnished steel. The above are examples of smart inks, i.e. inks that are active and provide either dynamic information (such as UV dose or O2 level) or a useful function (such as tarnish removal), and all work via a RP process and are reviewed here.

Internalized Stigma of Mental Illness Scale - Thai Version: Translation and Assessment of Psychometric Properties Among Psychiatric Outpatients in Central Thailand.

This paper reports the translation of the English Internalized Stigma of Mental Illness scale into Thai and assessment of its psychometric properties. After forward- and backward-translation, Thai experts completed the content validity index with item agreements of .86 to 1.00. Data were collected from 390 psychiatric clinic patients in central Thailand using systematic random sampling. Unweighted least squares factor analysis with Promax rotation identified five subscales. Cronbach's alpha for scale reliability was .88, and correlations for construct validity ranged from r=.55 to .69. These findings support the validity and reliability of the Thai version of the scale.

In Situ, Simultaneous Irradiation and Monitoring of a Photocatalyzed Organic Oxidation Reaction in a TiO2-Coated NMR Tube.

The semiconductor photocatalyzed (SPC) oxidation of toluene is performed inside an NMR spectrometer and the reaction is monitored simultaneously in situ, using a fiber optic probe/diffuser to provide the UV light to activate the titania photocatalyst coating on the inside of the NMR tube. Such a system has great potential for the simple rapid screening of a wide range of SPC mediated organic reactions.