Association of glucose metabolism and insulin resistance with feed efficiency and production traits of finishing beef steers.

Increasing nutrient utilization efficiency is an important component of enhancing the sustainability of beef cattle production. The objective of this experiment was to determine the association of glucose metabolism and insulin resistance with dry matter intake (DMI), average daily gain (ADG), gain:feed ratio (G:F), and residual feed intake (RFI). Steers (n = 54; initial body weight = 518 ±â€…27.0 kg) were subjected to an intravenous glucose tolerance test (IVGTT) where glucose was dosed through a jugular catheter and serial blood samples were collected. Three days after the last group's IVGTT, steers began a 63-d DMI and ADG test. Body weight was measured on days 0, 1, 21, 42, 62, and 63, and DMI was measured using an Insentec Roughage Intake Control system (Hokofarm Group, Emmeloord, the Netherlands). To examine relationships between DMI, ADG, G:F, and RFI with IVGTT measurements, Pearson correlations were calculated using Proc Corr of SAS 9.4 (SAS Inst. Inc., Cary, NC). Additionally, cattle were classified based on DMI, ADG, RFI, and G:F, where the medium classification was set as mean ±â€…0.5 SD, the low classification was < 0.5 SD from the mean, and the high classification was > 0.5 SD from the mean. No associations between DMI and IVGTT parameters were observed, and no differences were detected when classifying cattle as having low, medium, or high DMI. Peak insulin concentration in response to the IVGTT tended to be correlated with ADG (r = 0.28; P = 0.07), indicating cattle with greater ADG tend to have a greater insulin release in response to glucose. Glucose nadir concentrations tended to be positively correlated with ADG (r = 0.26; P = 0.10). Additionally, the glucose nadir was greater in high-ADG steers (P = 0.003). The association of greater glucose nadir with high-ADG could indicate that high-ADG steers do not clear glucose as efficiently as low-ADG steers, potentially indicating increased insulin resistance. Further, RFI was not correlated with IVGTT measurements, but low RFI steers had a greater peak glucose concentration (P = 0.040) and tended to have a greater glucose area under the curve (P = 0.09). G:F was correlated with glucose area under the curve (r = 0.33; P = 0.050), glucose nadir (r = 0.35; P = 0.011), and insulin time to peak (r = 0.39; P = 0.010). These results indicate that glucose metabolism and insulin signaling are associated with growth and efficiency, but the molecular mechanisms that drive these effects need to be elucidated.

Feed efficiency is an important component of improving the sustainability of beef production. There is a need to understand how metabolism influences feed efficiency. This experiment aimed to explore the association of glucose metabolism and insulin resistance with feed intake, growth, and efficiency of finishing beef cattle. The results indicate that there is a relationship between insulin resistance and improved efficiency measured as the ratio of growth to feed intake. The findings of this experiment are novel as they show a relationship between insulin resistance and feed efficiency and indicate further research is needed to determine the mechanisms of insulin resistance in ruminants that contribute to improved feed efficiency.

COVID-19 and working from home-related changes in physical activity in Sydney, Australia.

ISSUES ADDRESSED: Evidence on how COVID-19 lockdowns impacted physical activity (PA) is mixed. This study explores changes in PA following initial mobility restrictions, and their subsequent relaxation, in a sample of Sydney (Australia) residents using a natural experiment methodology. METHODS: Participants' health and travel behaviours were collected pre-pandemic in late 2019 (n = 1937), with follow-up waves during the pandemic in 2020 (n = 1706) and 2021 (n = 1514). Linear mixed-effects models were used to analyse changes in weekly duration of PA between the three waves. RESULTS: Compared with pre-pandemic, average weekly PA increased in 2021 by 42.6 min total PA (p = .001), 16 min walking PA (p = .02), and 26.4 min moderate-vigorous PA (MVPA) (p = .003). However, average weekly sessions of PA decreased in 2020 and remained lower in 2021. For participants who were sufficiently active in 2019, weekly total PA (-66.3 min) MVPA (-43.8 min) decreased in 2020 compared to pre-pandemic. Conversely, among participants who were insufficiently active in 2019, average weekly PA increased in both 2020 (total PA, +99.1 min; walking PA, +46.4 min; MVPA +52.8 min) and 2021 (total PA, +117.8 min; walking PA, +58.4 min; MVPA +59.2 min), compared to 2019. Participants who did more work from home increased their average weekly total PA in 2021 compared to pre-pandemic (+45.3 min). CONCLUSION: These findings reveal the complex variability in PA behaviour brought about by the pandemic. SO WHAT?: Strategies to support the population in achieving sufficient PA must focus on maintaining an appetite for PA as we move out of the pandemic and on promoting more frequent PA sessions.

An Experimental Field Trial Investigating the Use of Bacteriophage and Manure Slurry Applications in Beef Cattle Feedlot Pens for Salmonella Mitigation.

Post-harvest Salmonella mitigation techniques are insufficient at addressing Salmonella harbored in cattle lymph nodes, necessitating the exploration of pre-harvest alternatives that reduce Salmonella prior to dissemination to the lymph nodes. A 2 × 2, unbalanced experiment was conducted to determine the effectiveness of pre-harvest treatments applied to the pen surface for Salmonella mitigation in cattle. Treatments included manure slurry intended to mimic pen run-off water (n = 4 pens), a bacteriophage cocktail (n = 4), a combination of both treatments (n = 5), and a control group (n = 5) that received no treatment. Environment samples from 18 feedlot pens and fecal grabs, hide swabs, and subiliac lymph nodes from 178 cattle were collected and selectively enriched for Salmonella, and Salmonella isolates were sequenced. The combination treatment was most effective at reducing Salmonella, and the prevalence was significantly lower compared with the control group for rump swabs on Days 14 and 21. The treatment impact on Salmonella in the lymph nodes could not be determined due to low prevalence. The reduction on cattle hides suggests that bacteriophage or water treatments applied to the feedlot pen surface may reduce Salmonella populations in cattle during the pre-harvest period, resulting in reduced contamination during slaughter and processing.

Protamine dose to neutralize heparin at the completion of cardiopulmonary bypass can be reduced significantly without affecting post-operative bleeding.

BACKGROUND: Systemic anticoagulation with heparin during cardiopulmonary bypass (CPB) should be neutralized by protamine administration to restore normal hemostasis. Our previous study showed the protamine-to-heparin ratio (P-to-H) of 1:1 (1 mg protamine:100 IU circulating heparin; 1.0 Ratio) is likely an overestimation. Thus, we reduced the P-to-H in the HMS Plus Hemostasis Management System to 0.9:1 (0.9 Ratio) for 5 months and then to 0.8:1 (0.8 Ratio). We monitored post-operative (post-op) bleeding in the setting of reduced protamine dose (PD). METHODS: We performed a retrospective study of 632 patients (209 for the 1.0 Ratio, 211 for 0.9 Ratio, 212 for 0.8 Ratio group) who underwent cardiac surgery to measure the reduction of PD and how it affects 24-hour (24 h) post-op chest tube output. We also analyzed the entire data set to explore whether further reduction of P-to-H is warranted. RESULTS: While there was no difference in the indexed heparin dose among the three groups, we achieved a significant reduction in the indexed actual protamine dose (APDi) by 24% (0.9 Ratio) and 31% (0.8 Ratio) reductions compared to the 1.0 Ratio group. On average, APDi was 88 ± 22, 67 ± 18, and 61 ± 15 mg/m2 in the 1.0, 0.9, and 0.8 Ratio groups, respectively. We found no significant difference in 24 h post-op bleeding among the three groups. CONCLUSION: 1.0 Ratio at the completion of CPB is likely an excessive administration of protamine. With the stepwise reduction of PD, we observed no increase in post-op bleeding, which may indicate that no meaningful increase in heparin rebound occurred. In addition, further analysis of the entire data set demonstrates that a 0.75 Ratio is likely sufficient to neutralize the heparin completely.

Mandibular condylar hyperplasia and its correlation with vascular endothelial growth factor.

BACKGROUND: Condylar hyperplasia (CH) is a rare condition characterised by excessive unilateral growth of the mandibular condyle after cessation of growth on the contralateral side causing facial asymmetry, being more prevalent in the second and third decades. OBJECTIVE: The aim of this study was to determine the utility of vascular endothelial growth factor (VEGF-A) as a diagnostic and prognostic factor in condylar hyperplasia, and to determine its potential viability as a therapeutic target. METHODS: This is a case-control study, where 17 mandibular condyles specimens were collected from 17 patients treated for active mandibular condyle hyperplasia and three unaffected human mandibular condyles from cadavers will serve as the control group. The samples were immunostained with VEGF-A antibody and evaluated on both quantity and intensity of staining. RESULTS: VEGF-A was qualitatively found to be greatly upregulated in patients with condylar hyperplasia. CONCLUSION: VEGF-A was qualitatively found to be upregulated in patients affected by CH, validating VEGF-A as a potential diagnostic, prognostic and therapeutic target.

Immunohistochemical Markers of Temporomandibular Disorders: A Review of the Literature.

Temporomandibular disorders (TMD) are a group of internal derangements encompassing dysfunction, displacement, degeneration of the temporomandibular joints and surroundings muscles of mastication, often accompanied by pain. Relationships between TMD and various chemical biomarkers have been examined throughout the years. This paper aims to gather evidence from the literature regarding other biomarkers and presenting them as one systematic review to investigate the potential links between TMD and different biochemical activity. To identify relevant papers, a comprehensive literature search was carried out in MEDLINE/PubMED, EMBASE, Web of Science and a manual search was performed in the International Journal of Oral and Maxillofacial Surgery, Journal of Oral and Maxillofacial surgery, and Journal of Cranio-Maxillo-Facial Surgery. The literature review produced extensive results relating to the biochemical and immunohistochemical markers of TMD. Many enzymes, inflammatory markers, proteoglycans, and hormones were identified and organized in tables, along with a brief description, study design, and conclusion of each study. Through this review, recurring evidence provides confidence in suggesting involvement of certain biomarkers that may be involved in this complex pathogenesis, in addition to pointing to differences in gender prevalence of TMD. However, more organized research on large human samples needs to be conducted to delve deeper into the understanding of how this disease develops and progresses.

Meta-Regression to Develop Predictive Equations for Urinary Nitrogen Excretion of Lactating Dairy Cows.

Dairy cows' urinary nitrogen (N) excretion (UN; g/d) represents a significant environmental concern due to their contribution to nitrate leaching, nitrous oxide (a potent greenhouse gas), and ammonia emissions (contributor to N deposition). The first objective of the current study was to determine the adequacy of existing models to predict UN from total mixed ration (TMR)-fed and fresh forage (FF)-fed cows. Next, we aimed to develop equations to predict UN based on animal factors [milk urea nitrogen (MUN; mg/dL) and body weight (BW, kg)] and to explore how these equations are improved when dietary factors, such as diet type, dry matter intake (DMI), or dietary characteristics [neutral detergent fiber (NDF) and crude protein (CP) content], are considered. A dataset was obtained from 51 published experiments composed of 174 treatment means. The whole dataset was used to evaluate the mean and linear biases of three existing equations including diet type as an interaction term; all models had significant linear and mean biases and two of the three models had poor predictive capabilities as indicated by their large relative prediction error (RPE; root mean square error of prediction as a percent of the observed mean). Next, the complete data set was split into training and test sets, which were used to develop and to evaluate new models, respectively. The first model included MUN and BW, and there was a significant interaction between diet type and the coefficients. This model had the worst 1:1 agreement [Lin's concordance correlation coefficient (CCC) = 0.50] and largest RPE (24.7%). Models that included both animal and dietary factors performed the best, and when included in the model, the effect of diet type was no longer significant (p > 0.10). These models all had very good agreement (CCC ≥ 0.86) and relatively low RPE (≤13.1%). This meta-analysis developed precise and accurate equations to predict UN from dairy cows in both confined and pasture-based systems.

Exploring how worthwhile the things that you do in life are during COVID-19 and links to well-being and working from home.

The COVID-19 pandemic has had a significant impact on the way we work and live, with working from home becoming more than the occasional desire but a regular feature of work and life. While an increasing number of research studies have promoted the virtues of what is often described as the positive unintended consequences of the pandemic, there are also downsides, especially during periods of imposed restrictions on the ability to get out and about, that have broadly been described as impacting mental health and life's worth. In this paper we use data collected in New South Wales during September 2020 and June 2021, seven and 16 months after the pandemic began, to obtain an understanding of the extent to which the pandemic has impacted on how worthwhile things done in life are for workers. We investigate whether there is a systematic behavioural link with working from home, reduced commuting linked to distance to work, and various socio-economic characteristics. The evidence suggests that the opportunity to have reduced commuting activity linked to working from home and increased perceived work-related productivity have contributed in a positive way to improving the worth status of life, offsetting some of the negative consequences of the pandemic.

Telomerase inhibition is an effective therapeutic strategy in TERT promoter-mutant glioblastoma models with low tumor volume.

BACKGROUND: Glioblastoma is one of the most lethal forms of cancer, with 5-year survival rates of only 6%. Glioblastoma-targeted therapeutics have been challenging to develop due to significant inter- and intra-tumoral heterogeneity. Telomerase reverse transcriptase gene (TERT) promoter mutations are the most common known clonal oncogenic mutations in glioblastoma. Telomerase is therefore considered to be a promising therapeutic target against this tumor. However, an important limitation of this strategy is that cell death does not occur immediately after telomerase ablation, but rather after several cell divisions required to reach critically short telomeres. We, therefore, hypothesize that telomerase inhibition would only be effective in glioblastomas with low tumor burden. METHODS: We used CRISPR interference to knock down TERT expression in TERT promoter-mutant glioblastoma cell lines and patient-derived models. We then measured viability using serial proliferation assays. We also assessed for features of telomere crisis by measuring telomere length and chromatin bridge formation. Finally, we used a doxycycline-inducible CRISPR interference system to knock down TERT expression in vivo early and late in tumor development. RESULTS: Upon TERT inactivation, glioblastoma cells lose their proliferative ability over time and exhibit telomere shortening and chromatin bridge formation. In vivo, survival is only prolonged when TERT knockdown is induced shortly after tumor implantation, but not when the tumor burden is high. CONCLUSIONS: Our results support the idea that telomerase inhibition would be most effective at treating glioblastomas with low tumor burden, for example in the adjuvant setting after surgical debulking and chemoradiation.

The impact of COVID-19 and working from home on the workspace retained at the main location office space and the future use of satellite offices.

There exists a substantial amount of research on the impact that the COVID-19 pandemic has had on significant changes in the location at which work takes place, especially working from home (WFH). There has been, however, very little systematic consideration given to the relationship between the substantial increase in WFH and the responses taken by organisations in reviewing their office (workspace) capacity needs in the future, including a switch of the mix of utilising workspace in the main office(s) and satellite office locations. The main aim of this paper is to explore the extent to which levels of working from home and increased use of rented satellite office space will be linked to changes in the amount of workspace required at the main office that was used pre-COVID-19. Using data from 459 businesses for three periods for pre-COVID-19, April 2022 (25 months after the outbreak of the pandemic) and stated intentions for 2023, we develop a random effects regression model for the Greater Sydney Metropolitan Area in which we identify some of the influences on the downsizing or not of the main office(s) work space, and comment on what we see as the most likely scenario for WFH and work space in the main office and rented satellite office space under the 'next normal'. The findings can be used to inform future commuting travel as well as changes in land use activity at specific locations, including possible reallocation of existing office space to other activity uses.

Working from home in Australia in 2020: Positives, negatives and the potential for future benefits to transport and society.

The year 2020 has been marked by the most extraordinary event we have witnessed since World War II. While other health threats and geographical disasters have occurred, none have been on the global scale of COVID-19. Although many countries have experienced more than one wave of the pandemic throughout 2020, Australia has been largely able to contain the impact of the virus. While there are many reasons for this, a key component of reducing transmission has been restrictions on movement, and the widespread adoption of working from home (WFH) by those who can. In describing the experience Australian's have had with working from home across 2020, via three waves of data collection, we find that WFH become a positive unintended consequence in contributing to the future management of the transport network, especially in larger metropolitan areas. Evidence suggests that support for WFH will be continuing in the form of a hybrid work model with more flexible working times and locations, linked to largely positive experiences of WFH during 2020, an improved wellbeing of employees, and no loss of productivity to the economy. We highlight potential future benefits of WFH to society, including significant implications for congestion and crowding, concluding that WFH is a formidable transport policy lever that must become embedded in the psyche of transport planners and decision makers so that we can gain some benefit from the pandemic.

Dietary and Animal Strategies to Reduce the Environmental Impact of Pastoral Dairy Systems Result in Altered Nutraceutical Profiles in Milk.

The objective of this study was to evaluate and provide further insights into how dairy cows genetically divergent for milk urea N breeding values [MUNBV, high (2.21 ± 0.21) vs. low (−1.16 ± 0.21); µ ± SEM], consuming either fresh cut Plantain (Plantago lanceolata L., PL) or Ryegrass (Lolium perenne L., RG) herbage, impacted the nutraceutical profile of whole milk by investigating amino and fatty acid composition and applying metabolomic profiling techniques. Both diet and MUNBV, and their interaction term, were found to affect the relative abundance of alanine, glycine, histidine, and phenylalanine in the milk (p < 0.05), but their minor absolute differences (up to ~0.13%) would not be considered biologically relevant. Differences were also detected in the fatty acid profile based on MUNBV and diet (p < 0.05) with low MUNBV cows having a greater content of total unsaturated fatty acids (+16%) compared to high MUNBV cows and cows consuming PL having greater content of polyunsaturated fatty acids (+92%), omega 3 (+101%) and 6 (+113%) compared to RG. Differences in the metabolomic profile of the milk were also detected for both MUNBV and dietary treatments. Low MUNBV cows were found to have greater abundances of choline phosphate, phosphorylethanolamine, N-acetylglucosamine 1-phosphate, and 2-dimethylaminoethanol (p < 0.05). High MUNBV cows had a greater abundance of methionine sulfoxide, malate, 1,5-anhydroglucitol (1,5-AG), glycerate, arabitol/xylitol, 3-hydroxy-3-methylglutarate, 5-hydroxylysine and cystine (p < 0.05). Large differences (p < 0.05) were also detected as a result of diet with PL diets having greater abundances of the phytochemicals 4-acetylcatechol sulfate, 4-methylcatechol sulfate, and p-cresol glucuronide whilst RG diets had greater abundances of 2,6-dihydroxybenzoic acid, 2-acetamidophenol sulfate, and 2-hydroxyhippurate. The results of this study indicate the potential to alter the nutraceutical value of milk from dietary and genetic strategies that have been previously demonstrated to reduce environmental impact.

Characterising public transport shifting to active and private modes in South American capitals during the COVID-19 pandemic.

During the year 2020, the COVID-19 pandemic affected mobility around the world, significantly reducing the number of trips by public transport. In this paper, we study its impact in five South American capitals (i.e., Bogotá, Buenos Aires, Lima, Quito and Santiago). A decline in public transport patronage could be very bad news for these cities in the long term, particularly if users change to less sustainable modes, such as cars or motorbikes. Notwithstanding, it could be even beneficial if users selected more sustainable modes, such as active transport (e.g., bicycles and walking). To better understand this phenomenon in the short term, we conducted surveys in these five cities looking for the main explanation for changes from public transport to active and private modes in terms of user perceptions, activity patterns and sociodemographic information. To forecast people's mode shifts in each city, we integrated both objective and subjective information collected in this study using a SEM-MIMIC model. We found five latent variables (i.e., COVID-19 impact, Entities response, Health risk, Life related activities comfort and Subjective well-being), two COVID-19 related attributes (i.e., new cases and deaths), two trip attributes (i.e., cost savings and time), and six socio-demographic attributes (i.e., age, civil status, household characteristics, income level, occupation and gender) influencing the shift from public transport to other modes. Furthermore, both the number of cases and the number of deaths caused by COVID-19 increased the probability of moving from public transport to other modes but, in general, we found a smaller probability of moving to active modes than to private modes. The paper proposes a novel way for understanding geographical and contextual similarities in the pandemic scenario for these metropolises from a transportation perspective.

Management of appendicitis in a De Garengeot hernia: Lockwood approach.

A De Garengeot hernia is a femoral hernia containing the vermiform appendix. This extremely rare hernia is associated with appendicitis and the risk of perforation and abscess formation. Given limited data, it poses both diagnostic and management difficulties. While management is generally surgical, questions remain about the best operative approach, indications for appendicectomy and optimum hernia repair technique. We describe a case of acute appendicitis within a De Garengeot hernia that was managed with an open appendicectomy via a Lockwood incision. This case helps to illustrate the management considerations present for this rare clinical pathology and describes a method to effectively identify the hernia and resect the appendix.

Stabilization of Vancouver B Periprosthetic Femur Fractures With Cerclage Wiring: A Retrospective Chart Review.

BACKGROUND: While biomechanical and clinical studies detailing the equivalence and, sometimes, the superiority of cerclage wiring fixation compared to plate fixation in select fractures (Vancouver B1 and C) exist, no studies exist detailing outcomes after cerclage wiring fixation in all Vancouver B fracture types. This study explores whether there is a difference in clinical outcomes between Vancouver B fractures fixed with cerclage wiring and those without. METHODS: This retrospective multicenter study reviewed 295 patients from 2007 to 2018 with periprosthetic femur fractures. Vancouver B periprosthetic fractures stabilized utilizing cerclage wiring were identified and compared against fractures stabilized without cerclage wiring, with 33% being B1, 48.4% B2, and 18.6% B3 fractures. Demographics, injury details, fracture classification, surgical details, fracture union, and postoperative complications were recorded for each patient. RESULTS: A majority of our patients were females (65.9%) and were older than 71 years of age (65.6%) without diabetes (63.3%) or smoking history (92.2%). Sixty-nine patients progressed to fracture union (76.7%), two (2.2%) to delayed union, and 19 (21.1%) to nonunion. There was no difference in the union rate (p = 0.98) or time to union (p = 0.91) between the fixation methods. Finally, there was no difference in the infection rate (p = 0.81), re-fracture rate (p = 0.87), or re-operation rate (p = 0.75) between the fixation methods. CONCLUSION: Periprosthetic femur fractures are common injuries, most commonly occurring after low-energy mechanisms in the elderly female population. While the Vancouver fracture pattern helps to guide the surgical construct used for fixation, the use of cerclage wires does not impact bony union in these injuries. Interestingly, increasing age and female gender were associated with increased union rates. Surgeons should individually consider each patient's demographic as well as fracture type when deciding which construct will achieve stable fixation that allows for fracture healing.

Australia 6 months after COVID-19 restrictions part 2: The impact of working from home.

This paper (Part 2 in the paper series), building on earlier studies examining the Australian response, extends on findings related to travel activity, commuting, and attitudes towards COVID-19 measures (Part 1 in the paper series). In this paper we focus in detail on the impact of, and experiences with, working from home (WFH), perhaps the largest of the positive unintended consequence of the pandemic, with respect to transport, and a key lens through which the changing patterns in travel activity and attitudes discussed in Part 1 need to be understood. We conclude that through the widespread adoption of WFH as a result of nationwide public health orders, there is evidence emerging that WFH is now seen as an appealing instrument of change by employees and employers, there is growing support to continue to support WFH into the future. This represents a significant potential contribution to the future management of the transport network, especially in larger metropolitan areas. We also discuss policy implications of this result and what the international community may take from the Australian experience.

Australia 6 months after COVID-19 restrictions- part 1: Changes to travel activity and attitude to measures.

While many countries have experienced more than one wave of the pandemic throughout 2020, Australia has been able to contain the virus in a way that makes it a stand out (with New Zealand) in the way that it has been contained, with an exception in Victoria linked to failed quarantine procedures for travellers returning from overseas. Through descriptive analysis, this paper builds on earlier papers by the authors on the Australian response, with a focus on the changing dynamics of travel activity, concern with public transport, and attitudes surrounding activity given the perception of risk of COVID-19 and the level of public support for regulatory intervention and restrictions on movement. We find that Australia continues to suppress travel, particularly that for commuting, that comfort in completing day-to-day activities continues to rise (with the exception of Victoria where confidence feel significantly), and while support for intervention measures remains high, there has been an erosion in sentiment. As with previous work, we discuss what this might mean for future transport policy, and attempt to draw lessons from the Australian experience.

Bilateral Pulmonary Embolism Masked by New-Onset Atrial Fibrillation with Rapid Ventricular Rate: The Role of Mechanical Thrombectomy.

BACKGROUND Management of atrial fibrillation (AF) with rapid ventricular rate in the setting of submassive pulmonary emboli (PE) has not been well defined in the literature. It is challenging as the hemodynamics caused by a PE can change the management of AF. We report a case of bilateral PE masked by new-onset AF with rapid ventricular rate that was treated pharmaceutically and mechanically, with thrombectomy. CASE REPORT An 85-year-old man presented with gradual dyspnea and was found to be in AF with rapid ventricular rate (~160-180 bpm). The patient had tachypnea and hypoxia requiring oxygen administration. On physical examination, he had euvolemia. Chest X-ray did not reveal pulmonary vascular congestion. He was started on standard AF management with atrioventricular nodal blockers. Laboratory tests revealed a normal troponin level but mildly elevated B-type natriuretic peptide and lactate. Because his dyspnea was out of proportion to the physical examination, radiographic, and laboratory findings, a D-dimer level was obtained and was elevated. Computed tomography with pulmonary angiogram showed extensive bilateral PE. An echocardiogram (TTE) showed evidence of right ventricular failure. The patient underwent mechanical thrombectomy with clot retrieval, deterring the risk of hemodynamic collapse that would have ensued with atrioventricular nodal blockers monotherapy. On repeat TTE, right ventricular dysfunction was completely resolved and the remaining hospitalization was uneventful. CONCLUSIONS In patients with concomitant AF with rapid ventricular rate and submassive PE, the use of mechanical thrombectomy, in addition to the standard AF management, could be beneficial in deterring the risk of hemodynamic collapse.

Advanced modelling of commuter choice model and work from home during COVID-19 restrictions in Australia.

The decision to work from home (WFH) or to commute during COVID-19 is having a major structural impact on individuals' travel, work and lifestyle. There are many possible factors influencing this non-marginal change, some of which are captured by objective variables while others are best represented by a number of underlying latent traits captured by attitudes towards WFH and the use of specific modes of transport for the commute that have a bio-security risk such as public transport (PT). We develop and implement a hybrid choice model to investigate the sources of influence, accounting for the endogenous nature of latent soft variables for workers in metropolitan areas in New South Wales and Queensland. The data was collected between September-October 2020, during a period of no lockdown and relatively minor restrictions on workplaces and public gatherings. The results show that one of the most important attributes defining the WFH loving attitude is the workplace policy towards WFH, with workers that can decide where to work having a higher probability of WFH, followed by those that are being directed to, relative to other workplace policies. The bio-security concern with using shared modes such as public transport is a key driver of WFH and choosing to commute via the safer environment of the private car.