Enhanced recovery after surgery (ERAS® ) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items.

INTRODUCTION: Worldwide, ERAS® Society guidelines have ushered in a new era of perioperative care. The purpose of this systematic review is to compare published core elements and pharmacotherapy recommendations embedded within ERAS® Society abdominal and thoracic surgery (ATS) guidelines. Determining whether a consensus exists for pharmacological core items would make future guideline preparation for similar surgeries more standardized and could improve patient care by reducing unnecessary protocol variations. METHODS: From the ERAS® Society website as of May 2023, 16 current ERAS® published ATS guidelines were included in the analysis to determine consensus and differing statements regarding each ERAS® perioperative and pharmacotherapy-related item. The aims were to (a) determine whether a consensus for each item could be derived, (b) identify gaps in ERAS® protocol development, and (c) propose potential research directions for addressing the identified gaps in the literature. RESULTS: Core items with consensus included: preoperative smoking and alcohol cessation; avoiding bowel reparation and fasting; multimodal preanesthetic, perioperative analgesia, and postoperative nausea and vomiting regimens; low molecular weight heparins for in-hospital and at-home venous thromboembolism prophylaxis; antibiotic prophylaxis; skin preparation; goal-directed perioperative fluid management with balanced crystalloids; perioperative nutrition care; ileus prevention with peripherally-acting mu receptor antagonists; and glucose control. CONCLUSION: While consensus was found for aspects of 21 current ERAS® guideline core items related to pharmacotherapy choice, details related to doses, regimen, timing of administration as well as unique aspects pertaining to specific surgeries remain to be researched and harmonized to promote guideline consistency and further optimize patient outcomes.

Rust (Puccinia emaculata) Management and Impact on Biomass Yield in Switchgrass.

Rust, putatively caused by Puccinia emaculata, is a widespread and potentially damaging disease of switchgrass, a crop produced as feedstock for livestock and bioenergy. Azoxystrobin, chlorothalonil, and myclobutanil were applied at 1-, 2-, 3-, or 4-week intervals for 12 to 14 weeks to the vegetatively propagated switchgrass cultivar Cloud Nine to assess fungicide selection and application interval for the control of rust as well as the impact of this disease on switchgrass biomass yield. Although rust severity significantly differed among study years, azoxystrobin and myclobutanil were often equally and more effective than chlorothalonil at controlling rust, with superior disease control coming at shorter application intervals compared with extended application intervals. Year, product, application interval, and product × interval significantly impacted dry biomass yield, which was greatest in 2016 and lowest in 2014. Dry biomass yield protection was significantly better with azoxystrobin and myclobutanil applications than with chlorothalonil or no fungicide. Linear regression models with the final disease rating, as well as with the area under disease progress curve in each year, were significant, but coefficients of determination were low to moderate (0.21 < R2 < 0.60), indicating that rust response and subsequent disease impact on dry biomass yield were impacted by other factors. From our models, an estimated 3 to 5% biomass decline was calculated for each 10% increment in rust-related leaf necrosis observed at the final September rating date. With rust-related leaf necrosis ≥80% by 1 September in each of 4 study years, biomass yield may be reduced by 24 to 40% if rust problems are not managed in switchgrass crops.

Developing a Greenhouse Protocol for Evaluating Resistance to Corynespora cassiicola in Cotton (Gossypium hirsutum).

Target spot, caused by Corynespora cassiicola, has reemerged as a disease of economic importance in cotton (Gossypium hirsutum L.) in the southeastern United States. Although this pathogen affects other economically important crops, relatively little is known about C. cassiicola on cotton, especially with regard to conditions conducive for disease development and sources of genetic resistance. Therefore, to more efficiently screen cotton genotypes for resistance, a greenhouse protocol is needed. Optimum temperature and conducive leaf wetness duration were determined in growth chamber trials. Temperature range for disease onset and greatest lesion counts occurred between 20 and 28°C. Generally, with ≥24 h of leaf wetness at these temperatures, disease onset was noted as rapidly as 1 day after inoculation on a cultivar that was previously determined to be susceptible to target spot. A mist irrigation system was used to maintain prolonged periods of leaf wetness in the greenhouse. In greenhouse trials, inoculation of cotyledons with 4 × 104 conidia/ml allowed differentiation of five selected genotypes with disease reactions that reflected their field rankings. The current protocol will be useful for evaluating cotton breeding lines for resistance to target spot.

Dynamics of the isotope exchange reaction of D with H3 +, H2D+, and D2H.

We have measured the merged-beams rate coefficient for the titular isotope exchange reactions as a function of the relative collision energy in the range of ∼3 meV-10 eV. The results appear to scale with the number of available sites for deuteration. We have performed extensive theoretical calculations to characterize the zero-point energy corrected reaction path. Vibrationally adiabatic minimum energy paths were obtained using a combination of unrestricted quadratic configuration interaction of single and double excitations and internally contracted multireference configuration interaction calculations. The resulting barrier height, ranging from 68 meV to 89 meV, together with the various asymptotes that may be reached in the collision, was used in a classical over-the-barrier model. All competing endoergic reaction channels were taken into account using a flux reduction factor. This model reproduces all three experimental sets quite satisfactorily. In order to generate thermal rate coefficients down to 10 K, the internal excitation energy distribution of each H3 + isotopologue is evaluated level by level using available line lists and accurate spectroscopic parameters. Tunneling is accounted for by a direct inclusion of the exact quantum tunneling probability in the evaluation of the cross section. We derive a thermal rate coefficient of <1×10-12 cm3 s-1 for temperatures below 44 K, 86 K, and 139 K for the reaction of D with H3 +, H2D+, and D2H+, respectively, with tunneling effects included. The derived thermal rate coefficients exceed the ring polymer molecular dynamics prediction of Bulut et al. [J. Phys. Chem. A 123, 8766 (2019)] at all temperatures.

Adaptive behavior in autism: Minimal clinically important differences on the Vineland-II.

Autism Spectrum Disorder (ASD) is associated with persistent impairments in adaptive abilities across multiple domains. These social, personal, and communicative impairments become increasingly pronounced with development, and are present regardless of IQ. The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) is the most commonly used instrument for quantifying these impairments, but minimal clinically important differences (MCIDs) on Vineland-II scores have not been rigorously established in ASD. We pooled data from several consortia/registries (EU-AIMS LEAP study, ABIDE-I, ABIDE-II, INFOR, Simons Simplex Collection and Autism Treatment Network [ATN]) and clinical investigations and trials (Stanford, Yale, Roche) resulting in a data set of over 9,000 individuals with ASD. Two approaches were used to estimate MCIDs: distribution-based methods and anchor-based methods. Distribution-based MCID [d-MCID] estimates included the standard error of the measurement, as well as one-fifth and one-half of the covariate-adjusted standard deviation (both cross-sectionally and longitudinally). Anchor-based MCID [a-MCID] estimates include the slope of linear regression of clinician ratings of severity on the Vineland-II score, the slope of linear regression of clinician ratings of longitudinal improvement category on Vineland-II change, the Vineland-II change score maximally differentiating clinical impressions of minimal versus no improvement, and equipercentile equating. Across strata, the Vineland-II Adaptive Behavior Composite standardized score MCID estimates range from 2.01 to 3.2 for distribution-based methods, and from 2.42 to 3.75 for sample-size-weighted anchor-based methods. Lower Vineland-II standardized score MCID estimates were observed for younger and more cognitively impaired populations. These MCID estimates enable users of Vineland-II to assess both the statistical and clinical significance of any observed change. Autism Res 2018, 11: 270-283. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Vineland Adaptive Behavior Scales (2nd edition; Vineland-II) is the most widely used scale for assessing day-to-day "adaptive" skills. Yet, it is unknown how much Vineland-II scores must change for those changes to be regarded as clinically significant. We pooled data from over 9,000 individuals with ASD to show that changes of 2-3.75 points on the Vineland-II Composite score represent the "minimal clinically-important difference." These estimates will help evaluate the benefits of potential new treatments for ASD.

SELECT-2: a phase II, double-blind, randomized, placebo-controlled study to assess the efficacy of selumetinib plus docetaxel as a second-line treatment of patients with advanced or metastatic non-small-cell lung cancer.

BACKGROUND: Combination of selumetinib plus docetaxel provided clinical benefit in a previous phase II trial for patients with KRAS-mutant advanced non-small-cell lung cancer (NSCLC). The phase II SELECT-2 trial investigated safety and efficacy of selumetinib plus docetaxel for patients with advanced or metastatic NSCLC. PATIENTS AND METHODS: Patients who had disease progression after first-line anti-cancer therapy were randomized (2 : 2 : 1) to selumetinib 75 mg b.i.d. plus docetaxel 60 or 75 mg/m2 (SEL + DOC 60; SEL + DOC 75), or placebo plus docetaxel 75 mg/m2 (PBO + DOC 75). Patients were initially enrolled independently of KRAS mutation status, but the protocol was amended to include only patients with centrally confirmed KRAS wild-type NSCLC. Primary end point was progression-free survival (PFS; RECIST 1.1); statistical analyses compared each selumetinib group with PBO + DOC 75 for KRAS wild-type and overall (KRAS mutant or wild-type) populations. RESULTS: A total of 212 patients were randomized; 69% were KRAS wild-type. There were no statistically significant improvements in PFS or overall survival for overall or KRAS wild-type populations in either selumetinib group compared with PBO + DOC 75. Overall population median PFS for SEL + DOC 60, SEL + DOC 75 compared with PBO + DOC 75 was 3.0, 4.2, and 4.3 months, HRs: 1.12 (90% CI: 0.8, 1.61) and 0.92 (90% CI: 0.65, 1.31), respectively. In the overall population, a higher objective response rate (ORR; investigator assessed) was observed for SEL + DOC 75 (33%) compared with PBO + DOC 75 (14%); odds ratio: 3.26 (90% CI: 1.47, 7.95). Overall the tolerability profile of SEL + DOC was consistent with historical data, without new or unexpected safety concerns identified. CONCLUSION: The primary end point (PFS) was not met. The higher ORR with SEL + DOC 75 did not translate into prolonged PFS for the overall or KRAS wild-type patient populations. No clinical benefit was observed with SEL + DOC in KRAS wild-type patients compared with docetaxel alone. No unexpected safety concerns were reported. TRIAL IDENTIFIER: Clinicaltrials.gov NCT01750281.

Enormous Hydrogen Bond Strength Enhancement through π-Conjugation Gain: Implications for Enzyme Catalysis.

Surprisingly large resonance-assistance effects may explain how some enzymes form extremely short, strong hydrogen bonds to stabilize reactive oxyanion intermediates and facilitate catalysis. Computational models for several enzymic residue-substrate interactions reveal that when a π-conjugated, hydrogen bond donor (XH) forms a hydrogen bond to a charged substrate (Y-), XH can become significantly more π-electron delocalized, and this "extra" stabilization may boost the [XH···Y-] hydrogen bond strength by ≥15 kcal/mol. This reciprocal relationship departs from the widespread pKa concept (i.e., the idea that short, strong hydrogen bonds form when the interacting moieties have matching pKa values), which has been the rationale for enzymic acid-base reactions. The findings presented here provide new insight into how short, strong hydrogen bonds could form in enzymes.

Computational and photoelectron spectroscopic study of the dipole-bound anions, indole(H2O)1,2 (.).

We report our joint computational and anion photoelectron spectroscopic study of indole-water cluster anions, indole(H2O)1,2 (-). The photoelectron spectra of both cluster anions show the characteristics of dipole-bound anions, and this is confirmed by our theoretical computations. The experimentally determined vertical electron detachment (VDE) energies for indole(H2O)1 (-) and indole(H2O)2 (-) are 144 meV and 251 meV, respectively. The corresponding theoretically determined VDE values for indole(H2O)1 (-) and indole(H2O)2 (-) are 124 meV and 255 meV, respectively. The vibrational features in the photoelectron spectra of these cluster anions are assigned as the vibrations of the water molecule.

Many Mg-Mg bonds form the core of the Mg16Cp*8Br4K cluster anion: the key to a reassessment of the Grignard reagent (GR) formation process?

It caused a sensation eight years ago, when the first room temperature stable molecular compound with a Mg-Mg bond (LMgMgL, L = chelating ligand) containing magnesium in the oxidation state +1 was prepared. Here, we report the preparation of a [Mg16Cp*8Br4K]- cluster anion (Cp* = pentamethylcyclopentadiene) with 27 Mg-Mg bonds. It has been obtained through the reaction of KCp* with a metastable solution of MgBr in toluene. A highly-resolved Fourier transform mass spectrum (FT-MS) of this cluster anion, brought into vacuum by electrospraying its solution in THF, provides the title cluster's stoichiometry. This Mg16 cluster together with experiments on the metastable solution of MgBr show that: during the formation process of GRs (Grignard reagents) which are involved in most of sophisticated syntheses of organic products, not the highly reactive MgBr radical as often presumed, but instead the metalloid Mg16Cp*8Br4 cluster anion and its related cousins that are the operative intermediates along the pathway from Mg metal to GRs (e.g. Cp*MgBr).

Anion Photoelectron Spectroscopy and CASSCF/CASPT2/RASSI Study of Lan(-) (n = 1, 3-7).

We present a combined experimental and theoretical study of small lanthanum clusters. The experimental photoelectron spectra of Lan(-) (n = 1, 3-7) were obtained using negative ion photoelectron spectroscopy. Electron affinities for these clusters were found to be in a range of 0.49 eV (La) to 1.5 eV (La7). Our computational tour de force in exploring the electronic structure and its consequences for the lanthanum atom and its anion as well as for lanthanum trimer and its anion shows the multiconfigurational method and large basis set with spin-orbit corrections: CASSCF/CASPT2/RASSI/ANO-RCC-L level of theory is needed to reproduce experimental accuracy. The most stable structure for La3(-) was established to be an equilateral triangle ((1)A1'). Chemical bonding analysis of the La3(-) global minimum reveals that this is the first experimentally observed species with d-AO double σ and π aromaticity.

Selecting core-hole localization or delocalization in CS2 by photofragmentation dynamics.

Electronic core levels in molecules are highly localized around one atomic site. However, in single-photon ionization of symmetric molecules, the question of core-hole localization versus delocalization over two equivalent atoms has long been debated as the answer lies at the heart of quantum mechanics. Here, using a joint experimental and theoretical study of core-ionized carbon disulfide (CS2), we demonstrate that it is possible to experimentally select distinct molecular-fragmentation pathways in which the core hole can be considered as either localized on one sulfur atom or delocalized between two indistinguishable sulfur atoms. This feat is accomplished by measuring photoelectron angular distributions within the frame of the molecule, directly probing entanglement or disentanglement of quantum pathways as a function of how the molecule dissociates.

Very small "window of opportunity" for generating CO oxidation-active Au(n) on TiO2.

Recent research in heterogeneous catalysis, especially on size-selected model systems under UHV conditions and also in realistic catalytic environments, has proved that it is necessary to think in terms of the exact number of atoms when it comes to catalyst design. This is of utmost importance if the amount of noble metal, gold in particular, is to be reduced for practical reactions like CO oxidation. Here it is shown that on TiO2 only Au6 and Au7 clusters are active for CO oxidation which holds for the single crystal, thin films, and titania clusters deposited on HOPG. Size-selected cluster deposition and TPD methods have been employed to investigate the CO oxidation activity of Aun/TiO2 systems which are compared to recent results reported by Lee et al. to form a consistent picture in which only two species can be regarded as "active". The efficiency of investigated Aun/(TiO2)93/HOPG composite materials is attributed to carbon-assisted oxygen spillover from gold to support particles and across grain boundaries.

Alanate anion, AlH4(-): photoelectron spectrum and computations.

The alanate anion, AlH4(-), was generated in the gas phase using a pulsed arc cluster ionization source. Its photoelectron spectrum was then measured with 193 nm photons. The spectrum consists of a broad feature, spanning electron binding energies from 3.8 eV to over 5.3 eV. This band reflects the photodetachment transitions between the ground state of the AlH4(-) anion and the ground state of its thermodynamically unstable neutral counterpart, AlH4. The vertical detachment energy (VDE) of AlH4(-) was measured to be 4.4 eV. Additionally, VDE values were also computed in a comprehensive theoretical study and compared both with the previously computed value and with our experimentally determined value.

Insect Damage, Aflatoxin Content, and Yield of Bt Corn in Alabama.

Isoline pairs of hybrid corn, similar except for presence or absence of a Bt trait, were planted at eight sites across Alabama over three years. This study evaluated insect damage, yield, and aflatoxin levels as affected by the Bt traits, YieldGard Corn Borer (expressing Cry1Ab), Herculex I (expressing Cry1F), Genuity VT Triple PRO (expressing Cry1A.105 and Cry2Ab2), Agrisure Viptera 3111 (expressing Vip3Aa20 and Cry1Ab), and Genuity SmartStax (expressing Cry1A.105, Cry2Ab2, and Cry1F). When examined over all sites and years, hybrids with any of the included Bt traits had lower insect damage and higher yields. However, insect damage was not consistently correlated to yield. Bt traits expressing multiple proteins provided greater protection from corn earworm feeding than did traits for single proteins. Yields and aflatoxin levels were highly variable among sites although irrigated sites had higher yields than nonirrigated sites. Aflatoxins commonly accumulate in corn in the southeastern United States because of prevailing high temperatures and frequent dry conditions. Aflatoxin levels were not consistently associated with any factors that were evaluated, including Bt traits.

Partial-ion-yield studies of SOCl2 following x-ray absorption around the S and Cl K edges.

We present a series of photoabsorption and partial-ion-yield experiments on thionyl chloride, SOCl(2), at both the sulfur and chlorine K edges. The photoabsorption results exhibit better resolution than previously published data, leading to alternate spectral assignments for some of the features, particularly in the Rydberg-series region. Based on measured fragmentation patterns, we suggest the LUMO, of a(') character, is delocalized over the entire molecular skeleton. Unusual behavior of the S(2 +) fragment hints at a relatively localized bond rupture (the S-O bond below the S K edge and the S-Cl bonds below the Cl K edge) following excitation to some of the higher lying intermediate states.

Al6H18: a baby crystal of γ-AlH3.

Using global-minima search methods based on the density functional theory calculations of (AlH(3))(n) (n = 1-8) clusters, we show that the growth pattern of alanes for n ≥ 4 is dominated by structures containing hexa-coordinated Al atoms. This is in contrast to the earlier studies where either linear or ring structures of AlH(3) were predicted to be the preferred structures in which the Al atoms can have a maximum of five-fold coordination. Our calculations also reveal that the Al(6)H(18) cluster, with its hexa-coordination of the Al atoms, resembles the unit-cell of γ-AlH(3), thus Al(6)H(18) is designated as the "baby crystal." The fragmentation energies of the (AlH(3))(n) (n = 2-8) along with the dimerization energies for even n clusters indicate an enhanced stability of the Al(6)H(18) cluster. Both covalent (hybridization) and ionic (charge) contribution to the bonding are the driving factors in stabilizing the isomers containing hexa-coordinated Al atoms.

Gas phase analogs of stable sodium-tin Zintl ions: anion photoelectron spectroscopy and electronic structure.

Mass spectrometry and photoelectron spectroscopy together with first principles theoretical calculations have been used to study the electronic and geometric properties of the following sodium-tin, cluster anion/neutral cluster combinations, (Na(n)Sn(4))(-)/(Na(n)Sn(4)), n = 0-4 and (NaSn(m))(-)/(NaSn(m)), m = 4-7. These synergistic studies found that specific Zintl anions, which are known to occur in condensed Zintl phases, also exist as stable moieties within free clusters. In particular, the cluster anion, (Na(3)Sn(4))(-) is very stable and is characterized as (Na(+))(3)(Sn(4))(-4); its moiety, (Sn(4))(-4) is a classic example of a Zintl anion. In addition, the cluster anion, (NaSn(5))(-) was the most abundant species to be observed in our mass spectrum, and it is characterized as Na(+)(Sn(5))(2-). Its moiety, (Sn(5))(2-) is also known to be present as a Zintl anion in condensed phases.

Climate change, noncommunicable diseases, and development: the relationships and common policy opportunities.

The rapid growth in noncommunicable diseases (NCDs), including injury and poor mental health, in low- and middle-income countries and the widening social gradients in NCDs within most countries worldwide pose major challenges to health and social systems and to development more generally. As Earth's surface temperature rises, a consequence of human-induced climate change, incidences of severe heat waves, droughts, storms, and floods will increase and become more severe. These changes will bring heightened risks to human survival and will likely exacerbate the incidence of some NCDs, including cardiovascular disease, some cancers, respiratory health, mental disorders, injuries, and malnutrition. These two great and urgent contemporary human challenges-to improve global health, especially the control of NCDs, and to protect people from the effects of climate change-would benefit from alignment of their policy agendas, offering synergistic opportunities to improve population and planetary health. Well-designed climate change policy can reduce the incidence of major NCDs in local populations.

Comparison of soil fungal community structure in different peanut rotation sequences using ribosomal intergenic spacer analysis in relation to aflatoxin-producing fungi.

The present study focuses on determining soil fungal community structure in different peanut-cropping sequences by using a high-resolution DNA fingerprinting technique: ribosomal intergenic spacer analysis (RISA). This study was initiated to determine fungal community profiles in four peanut-cropping sequences (continuous peanut, 4 years of continuous bahiagrass followed by peanut, peanut-corn-cotton, and peanut-cotton rotations), with a special focus to evaluate whether the profiles under investigation may have also indicated microbial differences that could affect Aspergillus flavus populations. Results indicated 75% similarities among fungal communities from the same cropping sequences as well as with similar times of sampling. Polymerase chain reaction (PCR)-based detection of A. flavus directly from these soils was carried out using A. flavus-specific primers (FLA1 and FLA2) and also through quantitative estimation on A. flavus and A. parasiticus agar medium. Population levels of A. flavus in soil samples ranged from zero to 1.2 × 10(3) CFU g(-1) of soil (based on culturable methods); however, the fungus was not detected with A. flavus-specific primers. The minimum threshold limit at which these aflatoxin-producing fungi could be detected from the total soil genomic DNA was determined through artificial inoculation of samples with 10-fold increases in concentrations. The results indicated that a minimum population density of 2.6 × 10(6) CFU g(-1) of soil is required for PCR detection in our conditions. These results are useful in further determining the relative population levels of these fungi in peanut soils with other soil fungi. This is a new approach to understanding soil fungal communities and how they might change over time and under different rotation systems.

Superhalogen properties of CumCln clusters: theory and experiment.

Using a combination of density functional theory and anion photoelectron spectroscopy experiment, we have studied the structure and electronic properties of CuCl(n)(-) (n = 1-5) and Cu(2)Cl(n)(-) (n = 2-5) clusters. Prominent peaks in the mass spectrum of these clusters occurring at n = 2, 3, and 4 in CuCl(n)(-) and at n = 3, 4, and 5 in Cu(2)Cl(n)(-) are shown to be associated with the large electron affinities of their neutral clusters that far exceed the value of Cl. While CuCl(n) (n ≥ 2) clusters are conventional superhalogens with a metal atom at the core surrounded by halogen atoms, Cu(2)Cl(n) (n ≥ 3) clusters are also superhalogens but with (CuCl)(2) forming the core. The good agreement between our calculated and measured electron affinities and vertical detachment energies confirm not only the calculated geometries of these superhalogens but also our interpretation of their electronic structure and relative stability.