Earworms-A Narrative Review of Infectious Music.

This Arts and Medicine feature reviews the clinical and neurophysiologic features of earworms, music fragments heard in the mind that repeat over and over as if jammed in playback mode.

Effects of Laser Bandwidth in Direct-Drive High-Performance DT-Layered Implosions on the OMEGA Laser.

In direct-drive inertial confinement fusion, the laser bandwidth reduces the laser imprinting seed of hydrodynamic instabilities. The impact of varying bandwidth on the performance of direct-drive DT-layered implosions was studied in targets with different hydrodynamic stability properties. The stability was controlled by changing the shell adiabat from (α_{F}≃5) (more stable) to (α_{F}≃3.5) (less stable). These experiments show that the performance of lower adiabat implosions improves considerably as the bandwidth is raised indicating that further bandwidth increases, beyond the current capabilities of OMEGA, would be greatly beneficial. These results suggest that the future generation of ultra-broadband lasers could enable achieving high convergence and possibly high gains in direct drive ICF.

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review.

PURPOSE: This study systematically reviews the uses of electronic health record (EHR) data to measure graduate medical education (GME) trainee competencies. METHOD: In January 2022, the authors conducted a systematic review of original research in MEDLINE from database start to December 31, 2021. The authors searched for articles that used the EHR as their data source and in which the individual GME trainee was the unit of observation and/or unit of analysis. The database query was intentionally broad because an initial survey of pertinent articles identified no unifying Medical Subject Heading terms. Articles were coded and clustered by theme and Accreditation Council for Graduate Medical Education (ACGME) core competency. RESULTS: The database search yielded 3,540 articles, of which 86 met the study inclusion criteria. Articles clustered into 16 themes, the largest of which were trainee condition experience (17 articles), work patterns (16 articles), and continuity of care (12 articles). Five of the ACGME core competencies were represented (patient care and procedural skills, practice-based learning and improvement, systems-based practice, medical knowledge, and professionalism). In addition, 25 articles assessed the clinical learning environment. CONCLUSIONS: This review identified 86 articles that used EHR data to measure individual GME trainee competencies, spanning 16 themes and 6 competencies and revealing marked between-trainee variation. The authors propose a digital learning cycle framework that arranges sequentially the uses of EHR data within the cycle of clinical experiential learning central to GME. Three technical components necessary to unlock the potential of EHR data to improve GME are described: measures, attribution, and visualization. Partnerships between GME programs and informatics departments will be pivotal in realizing this opportunity.

Effect of preoperative chemotherapy on the outcome of women with operable breast cancer.

PURPOSE: To determine, in women with primary operable breast cancer, if preoperative doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan; AC) therapy yields a better outcome than postoperative AC therapy, if a relationship exists between outcome and tumor response to preoperative chemotherapy, and if such therapy results in the performance of more lumpectomies. PATIENTS AND METHODS: Women (1,523) enrolled onto National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 were randomly assigned to preoperative or postoperative AC therapy. Clinical tumor response to preoperative therapy was graded as complete (cCR), partial (cPR), or no response (cNR). Tumors with a cCR were further categorized as either pathologic complete response (pCR) or invasive cells (pINV). Disease-free survival (DFS), distant disease-free survival (DDFS), and survival were estimated through 5 years and compared between treatment groups. In the preoperative arm, proportional-hazards models were used to investigate the relationship between outcome and tumor response. RESULTS: There was no significant difference in DFS, DDFS, or survival (P = .99, .70, and .83, respectively) among patients in either group. More patients treated preoperatively than postoperatively underwent lumpectomy and radiation therapy (67.8% v 59.8%, respectively). Rates of ipsilateral breast tumor recurrence (IBTR) after lumpectomy were similar in both groups (7.9% and 5.8%, respectively; P = .23). Outcome was better in women whose tumors showed a pCR than in those with a pINV, cPR, or cNR (relapse-free survival [RFS] rates, 85.7%, 76.9%, 68.1%, and 63.9%, respectively; P < .0001), even when baseline prognostic variables were controlled. When prognostic models were compared for each treatment group, the preoperative model, which included breast tumor response as a variable, discriminated outcome among patients to about the same degree as the postoperative model. CONCLUSION: Preoperative chemotherapy is as effective as postoperative chemotherapy, permits more lumpectomies, is appropriate for the treatment of certain patients with stages I and II disease, and can be used to study breast cancer biology. Tumor response to preoperative chemotherapy correlates with outcome and could be a surrogate for evaluating the effect of chemotherapy on micrometastases; however, knowledge of such a response provided little prognostic information beyond that which resulted from postoperative therapy.

Cognitive impairment in REM-sleep behaviour disorder and individuals at risk of Parkinson's disease.

BACKGROUND: Mild cognitive impairment (MCI) is commonly present at the time of Parkinson's Disease (PD) diagnosis, but its prevalence amongst individuals at increased risk of PD is unclear. METHODS: Cognition was assessed using the Montreal Cognitive Assessment (MoCA) in 208 participants in the PREDICT-PD study, and 25 participants with REM-sleep behaviour disorder (RBD). Prevalence of MCI level I was determined in all participants, and level II MCI in the RBD sub-group. RESULTS: Total MoCA scores were worse in the higher risk than the lower risk group defined as those below the 15th percentile of risk (p = 0.009), and in the RBD group compared to all healthy participants (p < 0.001). The prevalence of MCI level I was 12.8% in the lower-risk, 21.9% in the higher-risk (within the highest 15th percentile) and 64% in RBD participants; 66% of RBD participants had MCI level II with multi-domain MCI, but particularly attention and memory deficits. CONCLUSIONS: Cognitive impairment is increased in different groups at higher risk of PD, particularly in the subgroup formally diagnosed with RBD.

Predicting hot electron generation in inertial confinement fusion with particle-in-cell simulations.

A series of two-dimensional particle-in-cell simulations with speckled laser drivers was carried out to study hot electron generation in direct-drive inertial confinement fusion on OMEGA. Scaling laws were obtained for hot electron fraction and temperature as functions of laser/plasma conditions in the quarter-critical region. Using these scalings and conditions from hydro simulations, the temporal history of hot electron generation can be predicted. The scalings can be further improved to predict hard x-rays for a collection of OMEGA warm target implosions within experimental error bars. These scalings can be readily implemented into inertial confinement fusion design codes.

Bound on hot-spot mix in high-velocity, high-adiabat direct-drive cryogenic implosions based on comparison of absolute x-ray and neutron yields.

In laser-driven implosions for laboratory fusion, the comparison of hot-spot x-ray yield to neutron production can serve to infer hot-spot mix. For high-performance direct-drive implosions, this ratio depends sensitively on the degree of equilibration between the ion and electron fluids. A scaling for x-ray yield as a function of neutron yield and characteristic ion and electron hot-spot temperatures is developed on the basis of simulations with varying degrees of equilibration. We apply this model to hot-spot x-ray measurements of direct-drive cryogenic implosions typical of the direct-drive designs with best ignition metrics. The comparison of the measured x-ray and neutron yields indicates that hot-spot mix, if present, is below a sensitivity estimated as ∼2% by-atom mix of ablator plastic into the hot spot.

Thermoregulation of the bovine scrotum 2: simulated acute and chronic heat waves reduces the scrotal thermoregulatory capability of Wagyu bulls.

The objective of this study was to investigate the effect of acute and chronic heat load events on scrotal temperature (ST), body temperature (BT) and bull behaviour, and to examine the interrelationship between these parameters; the underlying hypothesis was that adverse heat treatments delivered in a temperature controlled environment will lead to thermoregulatory dysfunction of the bull scrotum. Six sexually mature Wagyu bulls were used in this study with data loggers surgically implanted into the abdominal cavity and scrotum. Body temperate and ST were recorded at 30-min intervals for the duration of the study. There were two housing locations used throughout the study, outdoor pens and climate control rooms. The study was designed as a four-phase crossover design with two heat treatments: (1) a 5-day acute challenge, and (2) a 14-day chronic challenge. The study was also blocked by phase to control for systematic change between phases with a thermoneutral (TN) phase in outdoor pens between each heat challenge. Observations within the climate rooms were conducted at 1-h intervals and data on panting scores (PS), respiration rate (RR), posture (standing or lying) and general behaviours (feeding, drinking, ruminating) recorded. Ambient temperature (AT, °C) and relative humidity (RH, %) were obtained at 10-min intervals and used to calculate the temperature humidity index (THI). Multiple models were conducted using a linear mixed effects model that contained different permutations of date and time factors and interactions as well as inclusion of an autoregressive parameter. The strongest model based on Akaike's information criterion (AIC) was selected and further analysed. Ambient conditions during heat treatments were consistent with heat load and bulls showed typical physiological symptoms of the same. Maximum ST for acute and chronic treatments occurred once AT had exceeded 34 °C for at least 3 h (acute 35.59 °C at 1500 h; chronic 35.18 °C at 1400 h), whereas during TN conditions, maximum ST was at 2100 h. All phases showed variation in ST throughout the day. There were strong cross correlations between ST and RR during the heat treatments (acute r = 0.918, P < 0.0001; chronic r = 0.916, P < 0.0001), but not during TN (r = 0.411, P < 0.05). Our results confirmed that the ST of the bulls used in this study was not held at a constant temperature and that there was a possible connection between ST and RR. We have shown that during a period of heat load, the thermoregulatory mechanisms thought responsible for maintaining bovine ST appear to breakdown.

The impact of weather on the incidence of dark cutting in Australian feedlot cattle.

This study conducted a retrospective analysis of historical Meat Standard Australia (MSA) carcass data in combination with Bureau of Meteorology (BOM) weather data, to evaluate the relationship between climatic conditions prior to feedlot departure on the incidence of dark cutting grain-fed beef. Data records for 2,795,754 carcasses from 17 commercial feedlots over a 6-year period were evaluated within this study. Carcasses were consigned to 16 abattoirs. Weather data from BOM were recorded at 30-min intervals and were obtained from weather stations with the closest proximity to each feedlot. These data were used to calculate the Temperature Humidity Index (THI). Climatic data were amalgamated into daily observations and a series of predictors including ambient temperature (TA, °C), relative humidity (RH, %), wind speed (WS, m/s), rainfall (mm) and THI. In addition, lag interactions from 24 h out to 28 days prior to exiting the feedlot were generated. The incidence of dark cutting was determined as percentage per cohort with an ultimate pH > 5.7. Data were analysed using three models: model 1 included feedlot, abattoir, hormone growth promotant status and sex as fixed effects. Model 2 incorporated the fixed effects within model 1 and minimum, maximum and standard deviation (SD) of TA and RH, daily range in TA, average WS and rainfall as random effects. Model 3 incorporated minimum, maximum, range and SD of THI, average WS and rainfall as random effects in addition to the fixed effects of model 1. The incidence of dark cutting within feedlot had a 10.1% range in estimated means with the lowest incidence was observed at feedlot 17 (0%) and highest incidence at feedlot 10 (10.1%). The inclusion of the climatic variables in model 2 and model 3 accounted for an additional 0.1 to 0.2% of the incidence of dark cutting carcasses. Higher maximum TA, RH and THI in the 3 to 28 days prior to consignment were all associated with an increased incidence of dark cutting (P < 0.05), but not in the 48 h preceding consignment (P > 0.05). Low minimum TA and low THI were also associated with an increase the incidence of dark cutting across all lag periods (P < 0.05). Increased variation in THI and TA in the 48 h prior to consignment increased dark cutting (P < 0.05) while increased standard deviation (SD) of temperature and THI range also increased dark cutting in the 14 and 28 day prior to feedlot exit (P < 0.05). Smaller minimum ranges in TA in the 28 days prior to consignment also reduced dark cutting (P < 0.05). Climatic conditions accounted for a further 0.1 to 0.2% of the incidence of dark cutting, whereas animal management factors, feedlot and abattoir were able to account for 21% of dark cutting. These data suggest that climatic conditions appear to have an inherent role in the incidence of dark cutting, albeit a small impact. Regardless, understanding the influence of climatic conditions on dark cutting allows for the implementation of management strategies within the supply chain to further reduce the impact of climatic conditions on grain-fed cattle.

The influence of shade availability on the effectiveness of the Dairy Heat Load Index (DHLI) to predict lactating cow behavior, physiology, and production traits.

Numerous climatic indices have been utilized to predict the effect of hot, and cold, climatic conditions on animal production and welfare. To date, the dairy industry has relied extensively on the Temperature Humidity Index (THI) to predict adverse climatic conditions; however, neither solar radiation nor air movement is accounted for in the THI equation. The Dairy Heat Load Index (DHLI) was initially developed as an alternative climate index. In its current format, the DHLI does not account for the effects of heat load mitigation strategies, such as shade, which decreases the negative effects of hot climatic conditions on lactating cows. Therefore, this experiment aimed to determine the effectiveness of the DHLI as a predictor of heat load responses in both shaded and unshaded cows, as compared with the THI. Forty lactating Holstein Friesian (n = 40) cows were selected and paired based on live weight, milk yield, and days in milk. One cow from each pair was randomly allocated to one of two treatments: shaded (n = 20) or unshaded (n = 20). Cows were given 7 days to acclimate prior to the commencement of data collection. After 28 days, cows were transitioned into the alternate treatment in a crossover design and given 7 days to acclimate prior to data collection. Behavioral observations (0800, 1200, 1400, and 1800 h daily), daily milk yield (kg), milk composition (various days), and vaginal temperature (TVAG, °C; 5 pairs/week, over a 4-week rotation) were recorded. Overall, data from this experiment indicated that the DHLI was a better predictor of standing and feeding behaviors in unshaded cows and drinking behaviors in shaded cows. Conversely, the THI was a better predictor of standing behavior and shade usage in shaded cows. Furthermore, the THI was a better predictor of mean panting score (MPS) in shaded cows, whereas the DHLI performed better in unshaded cows. Additionally the DHLI was a better predictor of TVAG in these cows. Finally, when evaluating the 7-day average of each climatic index, the DHLI was a better predictor of change in milk yield. Incorporation of additional animal and management factors is required if the DHLI is to become an effective heat load management tool.

Influence of feeding Saccharomyces cerevisiae on the heat load responses of lactating dairy cows during summer.

The objective of this study was to evaluate the influence of supplementing lactating dairy cows with Saccharomyces cerevisiae on milk production and composition, cow behavior, and physiological responses during summer. Twenty primiparous cows were used and two treatments were imposed: (1) control (CON); and (2) probiotic supplementation (PRO; S. cerevisiae, providing 1010 colony forming units (CFU) per day). Rumen temperature (TRUM, °C) and pH were obtained via rumen boluses. Rumen temperatures were obtained from all cows (n = 20) at 10-min intervals and ruminal pH were obtained from five cow pairs (n = 10) at 10-min intervals. Ambient temperature (TA; °C), relative humidity (RH; %), wind speed (WS; m/s), and solar radiation (SR; W/m2) were recorded at 10-min intervals. The temperature humidity index (THI) was calculated using TA and RH. Cows were milked twice daily. Milk fat (%), protein (%), lactose (%), and somatic cell count (SCC, '000) were evaluated on 16 occasions. Cows were observed three times (0800 h; 1200 h; and 1400 h) daily for panting score (PS); respiration rate (RR); posture (standing/lying); shade utilization; and cow activity (eating/drinking/ruminating). Individual PS were used to calculate a mean panting score (MPS) for CON and PRO treatments for each observation. S. cerevisiae did not influence milk yield (P = 0.87), fat (P = 0.82), protein (P = 0.26) or SCC (P = 0.19), although there was a tendency for PRO cows to have higher lactose (P = 0.06). Probiotics did not influence the proportion of cows utilizing shade (P = 0.42); standing (P = 0.41); ruminating (P = 0.72); or drinking (P = 0.40). All cows exhibited an increase in RR (> 24 bpm) at 1200 h and RR showed a steady increase as THI increased (P < 0.0001), regardless of treatment (P = 0.96). Both CON (35.8%) and PRO (40.2%) exhibited an increase in MPS as THI increased from thermoneutral (THI ≤ 74) to very hot (THI ≥ 84.1; P < 0.001). However, PRO cows had lower (2.19 ± 0.09; P < 0.0001) MPS compared with CON (2.54 ± 0.22) cows when THI was categorized as very hot (THI ≥ 84.1). Rumen pH were not influenced by treatment (P = 0.38), however TRUM of PRO cows were 0.2 °C lower across days (P < 0.0001) and hours (P < 0.0001). These results suggest that supplementing cows with S. cerevisiae may support thermoregulation via decreased TRUM and MPS; however, further studies are required.

Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study.

BACKGROUND: Hospital progress notes can serve as an important communication tool. However, they are criticized for their length, preserved content, and for the time physicians spend writing them. OBJECTIVE: We aimed to describe hospital progress note content, writing and reading practices, and the preferences of those who create and read them prior to the implementation of a new electronic health record system. METHODS: Using a sample of hospital progress notes from 1000 randomly selected admissions, we measured note length, similarity of content in successive daily notes for the same patient, the time notes were signed and read, and who read them. We conducted focus group sessions with note writers, readers, and clinical leaders to understand their preferences. RESULTS: We analyzed 4938 inpatient progress notes from 418 authors. The average length was 886 words, and most were in the Assessment & Plan note section. A total of 29% of notes (n=1432) were signed after 4 PM. Notes signed later in the day were read less often. Notes were highly similar from one day to the next, and 26% (23/88) had clinical risk associated with the preserved content. Note content of the highest value varied according to the reader's professional role. CONCLUSIONS: Progress note length varied widely. Notes were often signed late in the day when they were read less often and were highly similar to the note from the previous day. Measuring note length, signing time, when and by whom notes are read, and the amount and safety of preserved content will be useful metrics for measuring how the new electronic health record system is used, and can aid improvements.

Experimentally Inferred Fusion Yield Dependencies of OMEGA Inertial Confinement Fusion Implosions.

Statistical modeling of experimental and simulation databases has enabled the development of an accurate predictive capability for deuterium-tritium layered cryogenic implosions at the OMEGA laser [V. Gopalaswamy et al.,Nature 565, 581 (2019)10.1038/s41586-019-0877-0]. In this letter, a physics-based statistical mapping framework is described and used to uncover the dependencies of the fusion yield. This model is used to identify and quantify the degradation mechanisms of the fusion yield in direct-drive implosions on OMEGA. The yield is found to be reduced by the ratio of laser beam to target radius, the asymmetry in inferred ion temperatures from the ℓ=1 mode, the time span over which tritium fuel has decayed, and parameters related to the implosion hydrodynamic stability. When adjusted for tritium decay and ℓ=1 mode, the highest yield in OMEGA cryogenic implosions is predicted to exceed 2×10^{14} fusion reactions.

Visual hallucinations.

Visual hallucinations have intrigued neurologists and physicians for generations due to patients' vivid and fascinating descriptions. They are most commonly associated with Parkinson's disease and dementia with Lewy bodies, but also occur in people with visual loss, where they are known as Charles Bonnet syndrome. More rarely, they can develop in other neurological conditions, such as thalamic or midbrain lesions, when they are known as peduncular hallucinosis. This review considers the mechanisms underlying visual hallucinations across diagnoses, including visual loss, network dysfunction across the brain and changes in neurotransmitters. We propose a framework to explain why visual hallucinations occur most commonly in Parkinson's disease and dementia with Lewy bodies, and discuss treatment approaches to visual hallucinations in these conditions.

Heat stress and poultry production: impact and amelioration.

Globally, the poultry industry is gaining significant importance among the agricultural and its allied sectors. However, heat stress was found to negatively affect the poultry production particularly in the tropical regions. This review is therefore an attempt to generate information pertaining to the impacts of heat stress on poultry production and its amelioration. Heat stress reduces the growth, reproductive performance, and egg production in poultry birds. The reduction in productive potential of poultry birds on exposure to heat stress may be attributed to the deviation of energy resources from production to adaptation pathway. There are different approaches pertaining to relieving the adverse impacts of heat stress on poultry production. These approaches can be broadly categorized under genetic, management, and nutritional strategies. These approaches may reduce the negative effects of heat stress and enhance the productive performance of poultry birds. The management strategies include appropriate shelter design, providing shade, using sprinklers, implementing cooling devices, and using fans and ventilation systems. The recommended floor space for mature birds weighing 1.7 kg is 0.06 m2/bird while it is 0.13 m2/bird for the birds weighing 3.5 kg with 27.8 kg/m2 bird density in either case. The nutritional interventions comprise ration balancing and providing essential micronutrients to improve the productive and reproductive performance in poultry birds. Fat, antioxidants, yeast, and electrolyte supplementations are some of the most commonly used nutritional strategies to ensure optimum production in the poultry industry. Furthermore, providing adequate water supply and disease surveillance measures may help to ensure optimum meat and egg production in the birds. The advanced biotechnological tools may aid to identify suitable genetic markers in poultry birds which might help in developing new strains of higher thermo-tolerance by designing suitable breeding program involving marker-assisted selection. These strategies may help to optimize and sustain poultry production in the changing climate scenario.

The motor prodromes of parkinson's disease: from bedside observation to large-scale application.

There is sufficient evidence that the pathological process that causes Parkinson's disease begins years before the clinical diagnosis is made. Over the last 15 years, there has been much interest in the existence of a prodrome in some patients, with a particular focus on non-motor symptoms such as reduced sense of smell, REM-sleep disorder, depression, and constipation. Given that the diagnostic criteria for Parkinson's disease depends on the presence of bradykinesia, it is somewhat surprising that there has been much less research into the possibility of subtle motor dysfunction as a pre-diagnostic pointer. This review will focus on early motor features and provide some advice on how to detect and measure them.