Fundamental Biological Features of Spaceflight: Advancing the Field to Enable Deep-Space Exploration.

Research on astronaut health and model organisms have revealed six features of spaceflight biology that guide our current understanding of fundamental molecular changes that occur during space travel. The features include oxidative stress, DNA damage, mitochondrial dysregulation, epigenetic changes (including gene regulation), telomere length alterations, and microbiome shifts. Here we review the known hazards of human spaceflight, how spaceflight affects living systems through these six fundamental features, and the associated health risks of space exploration. We also discuss the essential issues related to the health and safety of astronauts involved in future missions, especially planned long-duration and Martian missions.

Community-developed checklists for publishing images and image analyses.

Images document scientific discoveries and are prevalent in modern biomedical research. Microscopy imaging in particular is currently undergoing rapid technological advancements. However, for scientists wishing to publish obtained images and image-analysis results, there are currently no unified guidelines for best practices. Consequently, microscopy images and image data in publications may be unclear or difficult to interpret. Here, we present community-developed checklists for preparing light microscopy images and describing image analyses for publications. These checklists offer authors, readers and publishers key recommendations for image formatting and annotation, color selection, data availability and reporting image-analysis workflows. The goal of our guidelines is to increase the clarity and reproducibility of image figures and thereby to heighten the quality and explanatory power of microscopy data.

A comparison of foot fractures relative to other fragility fractures: a review and analysis of the American Orthopaedic Association's Own the Bone Database.

Evidence regarding the risk factors and characteristics of those with foot fragility fractures compared to non-foot fragility fractures is limited. Foot fragility fracture patients are more likely to be younger female with a higher BMI. A foot fragility fracture is strongly predictive of a subsequent foot fragility fracture. PURPOSE: Osteoporosis can clinically result in fragility fractures. Evidence regarding the risk factors and characteristics of foot fragility fractures compared to non-foot fragility fractures is limited. The American Orthopaedic Association's Own the Bone (OTB) is a bone health initiative with a substantial dataset. The purpose of this study was to examine and compare characteristics of patients presenting with isolated foot fragility fracture to those with a non-foot fragility fracture. METHODS: Between January 2009 and March of 2022, 58,001 fragility fractures occurred that were included in this cohort. A total of 750 patients had foot fragility fracture(s) and 57,251 patients had a non-foot fragility fracture that included shoulder, arm, elbow, forearm, wrist, spine, ribs, pelvis, hip, thigh, knee, tibia/fibula, and ankle. Demographics, fracture history, bone health factors, medication history, and medication use for each patient were reported in the OTB database. This data was utilized in our secondary cohort comparative analysis of characteristics and the risk of future fractures between foot fragility fracture and non-foot fragility fracture groups. RESULTS: Foot fragility fracture patients have a significantly higher probability to be younger (66.9 years old), female (91.5%), and have a higher BMI (28.3 kg/m2) compared to non-foot fragility fracture (p < 0.0001) patients. Patients with a foot fragility fracture are nine times (OR = 9.119, CI = 7.44-11.18, p < 0.001) more likely to have had a prior foot fragility fracture. Young, female patients with a prior foot fragility fracture are at higher risk of a future foot fragility fracture, and this risk increased as BMI increased. CONCLUSIONS: Foot fragility fracture patients are more likely to be female and younger compared to patients with a non-foot fragility fracture. A foot fragility fracture is a sentinel event considering that a prior foot fragility fracture is strongly predictive of a subsequent foot fragility fracture. LEVEL OF EVIDENCE: 3 (retrospective cohort).

Concise or comprehensive? Predictors of impact assessment choices for electric transmission line projects.

Environmental impact assessment (EIA) procedures required in the United States and many other countries are often highlighted as a major hindrance to timely and efficient deployment of critical infrastructure projects. Under the U.S. National Environmental Policy Act, a more extensive environmental impact statement (EIS) review can take several more years and cost much more than a succinct environmental assessment (EA). This not only affects the project in question, but also likely informs how-or whether-additional projects are pursued. Thus, understanding key predictors of the EA versus EIS choice sheds light on supply-side considerations affecting infrastructure deficits. Using the case of NEPA reviews conducted for 244 transmission line projects between 2005 and 2018 by two U.S. federal agencies in the western United States, the Bureau of Land Management (BLM) and Department of Energy (DOE), this addresses the following question: What project features most predict whether EA or an EIS is used to assess a transmission line project? Drawing upon NEPA assessment guidance and agency NEPA records, we use a regression classification tree to analyze how protocols and project attributes relate to assessment choice. The result is essentially a null finding: transmission line length is by far the most important predictor of whether a project receives an extensive EIS or a shorter EA, with little predictive value provided by other attributes. While absolute project size undoubtedly influences impacts, the lack of further differentiation in what predicts use of EISs versus EAs suggests assessment does not simply respond to project details but also shapes proposal and design choices beforehand.

EUS-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing metal stents in patients with malignant distal biliary obstruction: multicenter collaboration from the United Kingdom and Ireland.

BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CDD) with an electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has emerged as a viable method of establishing biliary drainage in patients with malignant distal biliary obstruction (MDBO). Our aim was to assess the efficacy, safety, and outcomes in patients with MDBO who underwent EUS-CDD with an EC-LAMS. METHODS: A retrospective review of consecutive patients with MDBO who underwent EUS-CDD with EC-LAMSs at 8 tertiary institutions across the United Kingdom and Ireland between September 2016 and November 2020 was undertaken. RESULTS: One hundred twenty patients (55% men) with a median age of 73 years (interquartile range, 17; range, 43-94) were included. The median follow-up period in 117 patients was 70 days (interquartile range, 169; range, 3-869), and 23 patients (19.2%) were alive at the end of the follow-up. Three patients were lost to follow-up. Technical success was achieved in 109 patients (90.8%). Clinical success (reduction of serum bilirubin to ≤50% of original value within 14 days) was achieved in 94.8% of patients (92/97). The adverse event rate was 17.5% (n = 21). Biliary reintervention after initial technical success was required in 9 patients (8.3%). CONCLUSIONS: EUS-CDD with EC-LAMSs at tertiary institutions within a regional hepatopancreatobiliary network for treatment of MDBO was effective in those where ERCP was not possible or was unsuccessful. When technical failures or adverse events occur, most patients can be managed with conservative or endoscopic therapy.

Postoperative Infection Rates After Total Ankle Arthroplasty: A Comparison With and Without the Use of a Surgical Helmet System.

Following total joint arthroplasty, surgical site infections (SSI) and periprosthetic joint infections (PJI) are associated with increased patient morbidity and healthcare utilization. Current positive-pressure surgical sterile helmet system (SHS) were developed as a feasible, useful version of the body exhaust system.The use of SHS has not yet been proven to decrease infection rates in the orthopedic literature. The primary purpose of this study is to compare the infection rates between patients who underwent total ankle arthroplasty (TAA) with a surgical team wearing SHS versus without SHS.A retrospective chart review in patients undergoing primary TAA with the surgeon wearing SHS (Group 1) or standard surgical attire (Group 2) was conducted. The primary outcome was postoperative SSI and PJI. The rate of wound complications, revision rates, and associated procedures were also analyzed. We identified 109 patients in Group 1 and 151 patients in Group 2. The rate of SSI was 12.8% in Group 1 and 14.6% in Group 2 (p = .411). The rate of PJI was 0.92% in Group 1 and 2.6% in Group 2 (p = .411). There was no difference in revision rates between the two groups. This study suggests that SHS does not appear to protect against postoperative SSI or PJI after TAA. Conversely, we did not find a higher infection rate compared to standard surgical attire despite recent in-vitro studies suggesting SHS as a source of wound contamination. The utility of SHS does not appear to influence the prevalence of postoperative SSI or PJI.

Disease Surveillance Investments and Administration: Limits to Information Value in Pakistan Polio Eradication.

In Pakistan, annual poliovirus investment decisions drive quantities of supplemental immunization campaigns districts receive. In this article, we assess whether increased spending on poliovirus surveillance is associated with greater likelihood of correctly identifying districts at high risk of polio with assignment of an elevated "risk ranking." We reviewed programmatic documents from Pakistan for the period from 2012-2017, recording whether districts had been classified as "high risk" or "low risk" in each year. Through document review, we developed a decision tree to describe the ranking decisions. Then, integrating data from the World Health Organization and Global Polio Eradication Initiative, we constructed a Bayesian decision network reflecting investments in polio surveillance and immunization campaigns, surveillance metrics, disease incidence, immunization rates, and occurrence of polio cases. We test these factors for statistical association with the outcome of interest-a change in risk rank between the beginning and the end of the one-year time period. We simulate different spending scenarios and predict their impact on district risk ranking in future time periods. We find that per district spending increases are associated with increased identification of cases of acute flaccid paralysis (AFP). However, the low specificity of AFP investment and the largely invariant ranking of district risk means that even large increases in surveillance spending are unlikely to promote major changes in risk rankings at the current stage of the Pakistan polio eradication campaign.

Using machine learning to automate ultrasound-based classification of butt-fused joints in medium-density polyethylene gas pipes.

Polyethylene (PE) pipes are widely used in gas distribution. Their joints are prone to various flaws and are the most problematic part of the pipeline, so the infrastructure industry requires an effective inspection technique. Butt-fusion (BF) is the most common method of joining PE pipes. In this research, we investigated the applicability of machine learning (ML) to automate the ultrasonic inspection of PE pipe BF joints. Flawless and defective joints were fabricated. A-scan signals were collected from each group of samples using a customized chord transducer, with the aim of developing and assessing the viability of ML approaches to the problem of joint classification. We compared several ML approaches to the problem and found that convolutional neural networks were most performant, classifying signals with an F1 score of 0.874 in a four-class problem (identifying defect presence and type) and of 0.912 in binary classification (defect presence/absence only). Our results show that an ultrasonic chord-type transducer approach can effectively resolve flawless samples versus those with coarse contaminants or cold fusions and that an ML approach can be used to effectively assess these ultrasonic signals. Our findings can be used to develop a portable, efficient, user-friendly, and inexpensive device for in-field joint inspections.

Knowledge about the predictive value of reward conditioned stimuli modulates their interference with cognitive processes.

Stimuli conditioned with a substance can generate drug-approach behaviors due to their acquired motivational properties. According to implicit theories of addiction, these stimuli can decrease cognitive control automatically. The present study (n = 49) examined whether reward-associated stimuli can interfere with cognitive processes in the absence of knowledge about stimulus-outcome contingencies. Conditioned stimuli (CS) were paired with high-reward (HR) or low-reward (LR) probabilities of monetary reward using a Pavlovian learning task. Participants were categorized as Aware or Unaware of contingencies using a Bayesian analysis. CS were then used as task-irrelevant distractors in modified flanker and N-back tasks. Results show HR CS can generate increased interference in the flanker task for participants Unaware of contingencies, contributing further evidence for the existence of implicit Pavlovian conditioning. For the N-back task, working memory performance was affected by HR CS, albeit only for Aware participants. These results suggest that CS can interfere implicitly with cognitive processes in a similar way to drug-related stimuli. Such an effect could occur in a stimulus-driven fashion, devoid of top-down goal-directedness. These findings have implications for the conceptualization and study of implicit processes in addiction and highlights the necessity to reconsider the measurement of such phenomena.

A Comparison of Outcomes of Revision Surgical Options for the Treatment of Failed Bulk Talar Allograft Transfer: A Systematic Review.

Talar bulk osteochondral allograft transplantation is a useful treatment strategy for large, uncontained osteochondral lesions of talus. Complications and high revision rates from osteochondral talar allograft transfer can be common. Talar graft failure is a devastating complication that results from failure of allograft incorporation within the host bone and subsequent resorption and sometimes subsidence can occur. Treatment options and outcomes for graft failure have rarely been reported. The purpose of this study is to evaluate treatment options and their outcomes for treating talar allograft failure. A systematic review was completed to find all reports of salvage treatments for talar graft failure and outcomes of these reports were analyzed. Eleven studies involving a total of 522 ankles, in 520 patients, met the inclusion criteria. The allograft failure rate was 11.5% in these studies with a reoperation rate of 18.9%. With limited reports, satisfactory outcomes for treatment of graft failure with ankle arthrodesis were 77.3%, 50% for revision allograft procedures, and 50% for total ankle arthroplasty. Considering the large failure rate and reoperation rate for bulk talar allograft transplantations, superior revision, and salvage options are needed. More prospective cohort studies focusing on consistent and standard outcome measures are needed to further assess revision options for failed talar allograft procedures.

Complications of En Bloc Osteochondral Talar Allografts and Treatment of Failures: Literature Review and Case Report.

Reoperation rates and complication rates can be high for patients receiving an osteochondral talar allograft transplant. Complications can include graft failure, delamination of the graft, arthrofibrosis, advancing osteoarthritis, nonunion of malleolar osteotomies, and partial or complete osteonecrosis of the talus. Graft failure refers to failure of graft incorporation with subsequent necrosis and subsidence. Treatment options for talar graft failure are limited, and outcomes for these treatments have rarely been reported. We present a review of the published data on the complications and treatments for failed talar allograft transplantation. A case report is presented on a young woman who experienced graft failure and osteonecrosis of her talar allograft transplant. Because of the size of the present osteonecrosis, an ankle arthrodesis was performed as the initial revision procedure. Talar necrosis was removed and revascularized from the ankle fusion with solid fusion was confirmed with computed tomography. Symptomatic adjacent joint pain quickly developed in the hindfoot after the ankle fusion, and 12 months later an ankle fusion conversion to total ankle arthroplasty was performed. The patient has returned to normal activity with significant reduction in pain at most recent follow-up visit. This patient was followed for 7 years from initial osteochondral talar allograft transplantation and for 2 years from conversion of ankle fusion to total ankle arthroplasty. It is important to understand the techniques, indications, and outcomes for the various revision options for talar allograft failure. This case report illustrates how multiple revision options can be used to provide the best outcome for the patient.

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Appropriate Clinical Management of Adult-Acquired Flatfoot Deformity.

This clinical consensus statement of the American College of Foot and Ankle Surgeons focuses on the highly debated subject of the management of adult flatfoot (AAFD). In developing this statement, the AAFD consensus statement panel attempted to address the most relevant issues facing the foot and ankle surgeon today, using the best evidence-based literature available. The panel created and researched 16 statements and generated opinions on the appropriateness of the statements. The results of the research on this topic and the opinions of the panel are presented here.

State of the Art: the Not-So-Great Wall of America.

PURPOSE OF REVIEW: This paper aims to review the literature regarding the impact of Donald Trump's candidacy and presidency on the health of immigrants in America. RECENT FINDINGS: The increase in detentions of alleged undocumented immigrants under the Trump presidency, especially his administration's attempts to detain children apart from their families, have placed thousands into conditions that can have long-lasting physical and mental health effects. Similarly, the Trump administration's efforts to increase deportations and restrict legal immigration has lead to immigrants' seeking fewer health-care resources for fear of jeopardizing their or their loved ones' chances of remaining in this country. The rhetoric used and policies pursued by Donald Trump have had a measurable adverse impact on the health of documented and undocumented immigrants in America.

THE ENVIRONMENTAL AND SAFETY PERFORMANCE OF GAS UTILITIES IN THE UNITED STATES.

The performance of energy service providers has important environmental and safety consequences in local communities. This paper uses a novel dataset compiled from operator reports and infrastructure monitoring data obtained from three different US federal agencies to assess the performance of retail gas utilities nationwide in terms of addressing gas leaks and minimizing leak volumes. Our panel data set includes yearly observations for 727 retail gas utilities from 2009 to 2017. We show that safety hazards and environmental costs of gas leaks are widespread across providers that vary in terms of ownership, size, and region. We then use series of Bayesian hierarchical models to regress four outcome variables--hazardous leaks, end-year unfixed leaks, total gas volume leaked, and significant incidents--on infrastructure conditions, regional service context, and socio-economic service population characteristics. Unlike what is observed in other critical infrastructure cases such as drinking water, socioeconomic conditions are not strongly predictive of service outcomes. Public utilities exhibit better environmental performance on average, and no difference in maintenance backlogs. Because the environmental costs of poor performance--primarily in terms of methane greenhouse gas emissions--are predominantly social, policy tools such as consolidation and privatization are unlikely to improve environmental outcomes.

A comparison of stable and fluctuating resources with respect to evolutionary adaptation and life-history traits using individual-based modeling and machine learning.

There are three non-mutually-exclusive key strategies evolved by gene pools to cope with fluctuating food resource availability, including evolutionary adaptation, phenotypic plasticity, and migration. We focus primarily on evolutionary adaptation and behavioral plasticity, which is a type of phenotypic plasticity, resulting in life-history changes as ways of dealing with fluctuations in food resource availability. Using EcoSim, a predator-prey individual-based model, we compare individuals with stable food resources with those in environments where there are fluctuating food resources in terms of adaptation through behavioral plasticity and evolution. The purpose of our study is to determine whether evolution and behavioral plasticity truly play a role in adapting to an environment with fluctuating food resources, as well as to determine whether there are specific gene divergences between gene pools in fluctuating food resource environments versus gene pools where food resources are relatively stable. An important result of our study is that individuals in environments that are unstable with respect to food resource availability exhibited significant differences in behaviors versus those in environments with stable food resources. Although behavioral plasticity facilitates a rapid response to unstable food conditions, our study revealed the evolution of perceptual traits such as vision range in reaction to fluctuating food resources, indicating the importance of evolution in adapting to unstable resource environments in the long run. Moreover, using decision trees, we found that there were significant behavioral gene divergences between individuals in environments with fluctuating food resources as opposed to individuals in environments with stable food resources.

Susceptibility to unconscious influences is unaffected by a challenging inhibitory task or mental exhaustion.

Unconscious influences have been demonstrated in a variety of behavioural contexts, however, a key question remains - to what extent do such influences vary with our changing mental states? We examine whether a prior inhibitory challenge increases susceptibility to subliminal priming in a stem completion task employing neutral (Experiment 1) and reward salient terms (Experiment 2). Results show stem completions to be significantly influenced by unconscious priming, and the challenging inhibitory task (the Stroop) to be significantly more mentally exhausting than the control task. However, neither the degree of inhibitory challenge, trait self-control, nor task-related mental exhaustion significantly influenced unconscious priming. Bayesian analysis provides strong evidence that prior inhibitory challenge does not affect susceptibility to unconscious priming. The study supports the conclusion that unconscious processing can be independent of consciously experienced mental states and provides reassurance that inhibitory impairment, common to mood disorders, should not increase susceptibility to unconscious influences.

Professional Pragmatism and Abortion Stigma: Assessing the Performance of the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) among Ethiopian Midwives.

This study assessed the applicability to medical professionals in Ethiopia of an abortion stigma assessment tool developed for community members, and examined the relationship between stigma and willingness to provide safe abortion care (SAC). The Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) was fielded to a convenience sample of 397 Ethiopian midwives. Scale reliability and validity were assessed, and associations were examined using multivariate linear and logistic regression. Levels of stigma were low compared to those reported elsewhere, and 49% of midwives were willing to provide SAC. The revised SABAS was reliable (alpha = 0.82), but items did not group into SABAS' conceptual categories, and some had limited face validity. SABAS scores had a small but significant negative association with willingness to provide SAC (OR=0.95, p < 0.05), with negative stereotyping subscale items most predictive. SABAS' limitations found here suggest the need for an adapted scale for medical professionals.

Experimental demonstration of interferometric imaging using photonic integrated circuits.

This paper reports design, fabrication, and demonstration of a silica photonic integrated circuit (PIC) capable of conducting interferometric imaging with multiple baselines around λ = 1550 nm. The PIC consists of four sets of five waveguides (total of twenty waveguides), each leading to a three-band spectrometer (total of sixty waveguides), after which a tunable Mach-Zehnder interferometer (MZI) constructs interferograms from each pair of the waveguides. A total of thirty sets of interferograms (ten pairs of three spectral bands) is collected by the detector array at the output of the PIC. The optical path difference (OPD) of each interferometer baseline is kept to within 1 µm to maximize the visibility of the interference measurement. We constructed an experiment to utilize the two baselines for complex visibility measurement on a point source and a variable width slit. We used the point source to demonstrate near unity value of the PIC instrumental visibility, and used the variable slit to demonstrate visibility measurement for a simple extended object. The experimental result demonstrates the visibility of baseline 5 and 20 mm for a slit width of 0 to 500 µm in good agreement with theoretical predictions.

Rapidly reconfigurable high-fidelity optical arbitrary waveform generation in heterogeneous photonic integrated circuits.

This paper demonstrates rapidly reconfigurable, high-fidelity optical arbitrary waveform generation (OAWG) in a heterogeneous photonic integrated circuit (PIC). The heterogeneous PIC combines advantages of high-speed indium phosphide (InP) modulators and low-loss, high-contrast silicon nitride (Si3N4) arrayed waveguide gratings (AWGs) so that high-fidelity optical waveform syntheses with rapid waveform updates are possible. The generated optical waveforms spanned a 160 GHz spectral bandwidth starting from an optical frequency comb consisting of eight comb lines separated by 20 GHz channel spacing. The Error Vector Magnitude (EVM) values of the generated waveforms were approximately 16.4%. The OAWG module can rapidly and arbitrarily reconfigure waveforms upon every pulse arriving at 2 ns repetition time. The result of this work indicates the feasibility of truly dynamic optical arbitrary waveform generation where the reconfiguration rate or the modulator bandwidth must exceed the channel spacing of the AWG and the optical frequency comb.