Stereoselective synthesis of an advanced trans-decalin intermediate towards the total synthesis of anthracimycin.

Progress towards the total synthesis of the macrolide natural product anthracimycin is described. This new approach utilises an intermolecular Diels-Alder strategy followed by epimeirsation to form the key trans-decalin framework. The route culminates in the stereoselective synthesis of an advanced tricyclic lactone intermediate, containing five contiguous sterogenic centres with the correct relative and absolute stereochemistry required for the anthracimycin core motif.

A Structural Study on Absorption of Lysozyme in Amorphous Starch Microspheres.

The potential of using proteins as drugs is held back by their low stability in the human body and challenge of delivering them to the site of function. Extensive research is focused on drug delivery systems that can protect, carry, and release proteins in a controlled manner. Of high potential are cross-linked degradable starch microspheres (DSMs), as production of these is low-cost and environmentally friendly, and the products are degradable by the human body. Here, we demonstrate that DSMs can absorb the model protein lysozyme from an aqueous solution. At low amounts of lysozyme, its concentration in starch microspheres strongly exceeds the bulk concentration in water. However, at higher protein contents, the difference between concentrations in the two phases becomes small. This indicates that, at lower lysozyme contents, the absorption is driven by protein-starch interactions, which are counteracted by protein-protein electrostatic repulsion at high concentrations. By applying small-angle X-ray scattering (SAXS) to the DSM-lysozyme system, we show that lysozyme molecules are largely unaltered by the absorption in DSM. In the same process, the starch network is slightly perturbed, as demonstrated by a decrease in the characteristic chain to chain distance. The SAXS data modeling suggests an uneven distribution of the protein within the DSM particles, which can be dependent on the internal DSM structure and on the physical interactions between the components. The results presented here show that lysozyme can be incorporated into degradable starch microspheres without any dependence on electrostatic or specific interactions, suggesting that similar absorption would be possible for pharmaceutical proteins.

Development of a curricular thread to foster medical students' critical reflection and promote action on climate change, health, and equity.

INTRODUCTION: Due to the health consequences arising from climate change, medical students will inevitably interact with affected patients during their training and careers. Accordingly, medical schools must incorporate education on the impacts of climate change on health and equity into their curricula. We created a curricular thread called "Climate Change, Health, and Equity" in the first-year preclinical medical program to teach foundational concepts and foster self-reflection and critical consciousness. METHODS: The authors developed a continuum of practice including administrators, educators and faculty members, students, and community partners to plan and design curricular activities. First-year medical students at Duke University School of Medicine participated in seven mandatory foundational lectures and two experiential learning opportunities in the local community. Following completion of activities, students wrote a critical reflection essay and completed a self-directed learning exercise. Essays were evaluated using the REFLECT rubric to assess if students achieved critical reflection and for thematic analysis by Bloom's Taxonomy. RESULTS: All students (118) submitted essays. A random sample of 30 (25%) essays underwent analysis. Evaluation by the REFLECT rubric underscored that all students were reflecting or critically reflecting on thread content. Thematic analysis highlighted that all students (30/30, 100%) were adept at identifying new areas of medical knowledge and connecting concepts to individual experiences, institutional practices, and public health and policy. Most students (27/30; 90%) used emotionally laden words, expressing negative feelings like frustration and fear but also positive sentiments of solidarity and hope regarding climate change and effects on health. Many students (24/30; 80%) expressed actionable items at every level including continuing self-directed learning and conversing with patients, minimizing healthcare waste, and advocating for climate-friendly policies. CONCLUSION: After participating in the curricular thread, most medical students reflected on cognitive, affective, and actionable aspects relating to climate change, health, and equity.

WellNest: A Medical Student-Run Housing Support Program.

PROBLEM: Being unhoused and facing housing insecurity contribute to poor health outcomes. Medical school curricula may include social determinants of health (SDOH) topics. However, experiential learning opportunities allow students to better contextualize how SDOH impact patients. The WellNest Housing Support Program (WellNest) was conceived and developed by Duke University medical students to learn from and support community members with a history of housing insecurity. APPROACH: Under the supervision of community organizations providing housing assistance services, WellNest was created in April 2020. Medical student-volunteers (MSVs) call clients, who are referred to WellNest by the community organizations, to plan move-ins. Local experts provide trainings on topics relevant to health care for individuals experiencing loss of housing. MSVs source and move furniture and clients' belongings into the new homes. Following move-in, MSVs are paired with clients to provide longitudinal tenancy support for at least 1 year. Student-volunteers contemplate their experiences and learning takeaways through debriefing sessions and an optional online survey. OUTCOMES: From fall 2021 to spring 2023, 83 student-volunteers from across the university participated in WellNest. Student-volunteers were generally medical students (37, 45%), and 16 MSVs served on the leadership team. WellNest facilitated 29 move-ins, and 26 clients requested to be paired with MSVs for longitudinal tenancy support. Following participation in WellNest, student-volunteers reported increased comfort, awareness, knowledge, and motivation related to caring for, discussing, and advocating for individuals experiencing housing insecurity. NEXT STEPS: As students from other programs are also interested in WellNest, there is potential for interprofessional education. Student-volunteers will be encouraged to participate in additional opportunities for reflection and advocacy activities. The impact of WellNest on clients will be explored through a questionnaire and narrative interviews. Long-term financial support was secured from community donations and partnering community organizations.

High-throughput screening of respiratory hazards: Exploring lung surfactant inhibition with 20 benchmark chemicals.

As environmental air quality worsens and respiratory health injuries and diseases increase, it is essential to enhance our ability to develop better methods to identify potential hazards. One promising approach in emerging toxicology involves the utilization of lung surfactant as a model that addresses the limitations of conventional in vitro toxicology methods by incorporating the biophysical aspect of inhalation. This study employed a constrained drop surfactometer to assess 20 chemicals for potential surfactant inhibition. Of these, eight were identified as inhibiting lung surfactant function: 1-aminoethanol, bovine serum albumin, maleic anhydride, propylene glycol, sodium glycocholate, sodium taurocholate, sodium taurodeoxycholate, and Triton X-100. These results are consistent with previously reported chemical-induced acute lung dysfunction in vivo. The study provides information on each chemical's minimum and maximum surface tension conditions and corresponding relative area and contact angle values. Isotherms and box plots are reported for selected chemicals across doses, and vector plots are used to summarize and compare the results concisely. This lung surfactant bioassay is a promising non-animal model for hazard identification, with broader implications for developing predictive modeling and decision-making tools.

Obesity Predisposes Anthracycline-Treated Survivors of Childhood and Adolescent Cancers to Subclinical Cardiac Dysfunction.

Anthracyclines are effective chemotherapeutics used in approximately 60% of pediatric cancer cases but have a well-documented risk of cardiotoxicity. Existing cardiotoxicity risk calculators do not include cardiovascular risk factors present at the time of diagnosis. The goal of this study is to leverage the advanced sensitivity of strain echocardiography to identify pre-existing risk factors for early subclinical cardiac dysfunction among anthracycline-exposed pediatric patients. We identified 115 pediatric patients with cancer who were treated with an anthracycline between 2013 and 2019. Peak longitudinal left ventricular strain was retroactively calculated on 495 surveillance echocardiograms via the TOMTEC AutoSTRAIN software. Cox proportional hazards models were employed to identify risk factors for abnormal longitudinal strain (> - 16%) following anthracycline treatment. High anthracycline dose (≥ 250 mg/m2 doxorubicin equivalents) and obesity at the time of diagnosis (BMI > 95th percentile-for-age) were both significant predictors of abnormal strain with hazard ratios of 2.79, 95% CI (1.07-7.25), and 3.85, 95% CI (1.42-10.48), respectively. Among pediatric cancer survivors, patients who are obese at the time of diagnosis are at an increased risk of sub-clinical cardiac dysfunction following anthracycline exposure. Future studies should explore the incidence of symptomatic cardiomyopathy 10-15 years post-treatment among patients with early subclinical cardiac dysfunction.

Differential host responses within the upper respiratory tract and peripheral blood of children and adults with SARS-CoV-2 infection.

Age is among the strongest risk factors for severe outcomes from SARS-CoV-2 infection. We sought to evaluate associations between age and both mucosal and systemic host responses to SARS-CoV-2 infection. We profiled the upper respiratory tract (URT) and peripheral blood transcriptomes of 201 participants (age range of 1 week to 83 years), including 137 non-hospitalized individuals with mild SARS-CoV-2 infection and 64 uninfected individuals. Among uninfected children and adolescents, young age was associated with upregulation of innate and adaptive immune pathways within the URT, suggesting that young children are primed to mount robust mucosal immune responses to exogeneous respiratory pathogens. SARS-CoV-2 infection was associated with broad induction of innate and adaptive immune responses within the URT of children and adolescents. Peripheral blood responses among SARS-CoV-2-infected children and adolescents were dominated by interferon pathways, while upregulation of myeloid activation, inflammatory, and coagulation pathways was observed only in adults. Systemic symptoms among SARS-CoV-2-infected subjects were associated with blunted innate and adaptive immune responses in the URT and upregulation of many of these same pathways within peripheral blood. Finally, within individuals, robust URT immune responses were correlated with decreased peripheral immune activation, suggesting that effective immune responses in the URT may promote local viral control and limit systemic immune activation and symptoms. These findings demonstrate that there are differences in immune responses to SARS-CoV-2 across the lifespan, including between young children and adolescents, and suggest that these varied host responses contribute to observed differences in the clinical presentation of SARS-CoV-2 infection by age. One Sentence Summary: Age is associated with distinct upper respiratory and peripheral blood transcriptional responses among children and adults with SARS-CoV-2 infection.

Metaboverse enables automated discovery and visualization of diverse metabolic regulatory patterns.

Metabolism is intertwined with various cellular processes, including controlling cell fate, influencing tumorigenesis, participating in stress responses and more. Metabolism is a complex, interdependent network, and local perturbations can have indirect effects that are pervasive across the metabolic network. Current analytical and technical limitations have long created a bottleneck in metabolic data interpretation. To address these shortcomings, we developed Metaboverse, a user-friendly tool to facilitate data exploration and hypothesis generation. Here we introduce algorithms that leverage the metabolic network to extract complex reaction patterns from data. To minimize the impact of missing measurements within the network, we introduce methods that enable pattern recognition across multiple reactions. Using Metaboverse, we identify a previously undescribed metabolite signature that correlated with survival outcomes in early stage lung adenocarcinoma patients. Using a yeast model, we identify metabolic responses suggesting an adaptive role of citrate homeostasis during mitochondrial dysfunction facilitated by the citrate transporter, Ctp1. We demonstrate that Metaboverse augments the user's ability to extract meaningful patterns from multi-omics datasets to develop actionable hypotheses.

A Unifying Bioinspired Synthesis of (-)-Asperaculin A and (-)-Penifulvin D.

The first syntheses of the isomeric dioxafenestrene natural products (-)-asperaculin A and (-)-penifulvin D are reported. Each target is formed selectively by choice of oxidant in a final divergent bioinspired Baeyer-Villiger (BV) reaction. Density functional theory calculations reveal that electrostatic interactions between the oxidant leaving group and the lactone motif accounts for a reversal of selectivity with H2O2/H3O+ compared to peracids. Synthetic features include forging the polycyclic carbon framework with a diastereoselective meta-photocycloaddition biased by an ether substituent at the aryl α-position. The encumbered tertiary alcohol was installed by cyanation of a ketone intermediate followed by nonaqueous hydrolysis of the resulting delicate cyanohydrin.

Interface-exfoliated graphene-based conductive screen-printing inks: low-loading, low-cost, and additive-free.

Paper diagnostics are of growing interest due to their low cost and easy accessibility. Conductive inks, necessary for manufacturing the next generation diagnostic devices, currently face challenges such as high cost, high sintering temperatures, or harsh conditions required to remove stabilizers. Here we report an effective, inexpensive, and environmentally friendly approach to graphene ink that is suitable for screen printing onto paper substrates. The ink formulation contains only pristine graphite, water, and non-toxic alkanes formed by an interfacial trapping method in which graphite spontaneously exfoliates to graphene. The result is a viscous graphene stabilized water-in-oil emulsion-based ink. This ink does not require sintering, but drying at 90 °C or brief microwaving can improve the conductivity. The production requires only 40 s of shaking to form the emulsion. The sheet resistance of the ink is approximately 600 Ω/sq at a thickness of less than 6 µm, and the ink can be stabilized by as little as 1 wt% graphite.

High Modulus, Thermally Stable, and Self-Extinguishing Aramid Nanofiber Separators.

Mechanically and thermally robust separators offer an alternative approach for preventing battery failure under extreme conditions such as high loads and temperatures. However, the trade-off between electrochemical performance and mechanical and thermal stability remains an ongoing challenge. Here, we investigate aramid nanofiber (ANF) separators that possess high moduli and self-extinguishing characteristics. The ANF separators are formed from the dissolution of bulk Kevlar fibers and their subsequent vacuum-assisted self-assembly. Thermogravimetric analysis shows a high 5 wt % decomposition temperature of 447 °C, which is over ∼175 °C higher than commercial Celgard separators. The ANF separator also possesses a high Young's modulus of 8.8 GPa, which is ∼1000% higher than commercial separators. Even when dry or when soaked in battery electrolyte, the ANF separators self-extinguish upon exposure to flame, whereas commercial separators melt or drip. We show that these features, although adventitious, present a trade-off with electrochemical performance in which a lithium nickel manganse cobalt (NMC) oxide-based battery possessed a reduced capacity of 123.4 mA h g-1. Considering the separator holistically, we propose that the ANF separator shows an excellent balance of the combined properties of high modulus, flame-resistance, thermal stability, and electrochemical stability and might be suitable for extreme environment applications with further testing.

Comparison of KBr and NaCl effects on the glass transition temperature of hydrated layer-by-layer assemblies.

The influence of assembly and post-assembly conditions on the glass transition temperature of free-standing poly(diallyldimethyl ammonium) (PDADMA)/poly(4-styrene sulfonate) (PSS) layer-by-layer (LbL) films assembled in 0.5M NaCl and 0.5M KBr are explored using modulated differential scanning calorimetry. Upon completion, PDADMA/PSS LbL assemblies are hydrated using solutions containing various concentrations of KBr. The data indicate that water provides the primary driving force for changes in the glass transition temperature of completed films rather than the post-assembly salt type. However, upon changing the assembly salt conditions from NaCl to KBr, the glass transition temperature shows a decrease of nearly 20 °C. Additionally, the composition of the films upon analysis with 1H NMR spectroscopy and neutron activation analysis indicates an elevated number of extrinsic binding sites within the film structure when KBr is the assembly salt. This shows a clear link between the assembly conditions and the internal structure and, therefore, the thermal properties of PDADMA/PSS LbL assemblies.

A pressure-tuned Fabry Pérot interferometer for laser frequency stabilization and tuning.

We present a simple, inexpensive pressure-tuned Fabry Pérot interferometer which can be used to frequency stabilize and tune a laser when no suitable atomic reference is available. Our design, made largely from off-the-shelf parts, yields a tuning range of about 4 GHz and offers an absolute tuning accuracy of better than 1 MHz. The interferometer, which uses air as its working medium, is characterized by a low thermal drift rate of order 1 MHz per hour.

QCM-D Investigation of Swelling Behavior of Layer-by-Layer Thin Films upon Exposure to Monovalent Ions.

Polyelectrolyte multilayers and layer-by-layer assemblies are susceptible to structural changes in response to ionic environment. By altering the salt type and ionic strength, structural changes can be induced by disruption of intrinsically bound ion pairs within the multilayer network via electrostatic screening. Notably, high salt concentrations have been used for the purposes of salt-annealing and self-healing of LbL assemblies with KBr, in particular, yielding a remarkably rapid response. However, to date, the structural and swelling effects of various monovalent ion species on the behavior of LbL assemblies remain unclear, including a quantitative view of ion content in the LbL assembly and thickness changes over a wide concentration window. Here, we investigate the effects of various concentrations of KBr (0 to 1.6 M) on the swelling and de-swelling of LbL assemblies formed from poly(diallyldimethylammonium) polycation (PDADMA) and poly(styrene sulfonate) polyanion (PSS) in 0.5 M NaCl using quartz-crystal microbalance with dissipation (QCM-D) monitoring as compared to KCl, NaBr, and NaCl. The ion content after salt exchange is quantified using neutron activation analysis (NAA). Our results demonstrate that Br- ions have a much greater effect on the structure of as-prepared thin films than Cl- at ionic strengths above assembly conditions, which is possibly caused by the more chaotropic nature of Br-. It is also found that the anion in general dominates the swelling response as compared to the cation because of the excess PDADMA in the multilayer. Four response regimes are identified that delineate swelling due to electrostatic repulsion, slight contraction, swelling due to doping, and film destruction as ionic strength increases. This understanding is critical if such materials are to be used in applications requiring submersion in chemically dynamic environments such as sensors, coatings on biomedical implants, and filtration membranes.

Solitary fibrous tumour of the pleura presenting as a spontaneous massive haemothorax.

Solitary fibrous tumours of the pleura are rare neoplasms. These tumours are generally asymptomatic and incidentally diagnosed. Symptoms, if present, are nonspecific such as cough, dyspnea, and chest pain. This report describes the case of a 38-year-old woman admitted to our department after the onset of a right massive spontaneous haemothorax requiring emergency surgical treatment. Intraoperatively a bleeding pleural mass was found to be the cause of the haemothorax. The tumour was successfully resected and the patient made an uneventful recovery. Histological examination revealed the mass to be a solitary fibrous tumour of the pleura.

A 3D interactive model and atlas of the jaw musculature of Alligator mississippiensis.

Modern imaging and dissemination methods enable morphologists to share complex, three-dimensional (3D) data in ways not previously possible. Here we present a 3D interactive model of the jaw musculature of the American Alligator (Alligator mississippiensis). Alligator and crocodylian jaw musculature is notoriously challenging to inspect and interpret because of the derived nature of the feeding apparatus. Using Iodine-contrast enhanced microCT imaging, a segmented model of jaw muscles, trigeminal nerve, brain and skull are presented as a cross-sectional atlas and 3D, interactive pdf of the rendered model. Modern 3D dissemination methods like this 3D Alligator hold great potential for morphologists to share anatomical information to scientists, educators, and the public in an easily downloadable format.

Trigeminal nerve morphology in Alligator mississippiensis and its significance for crocodyliform facial sensation and evolution.

Modern crocodylians possess a derived sense of face touch, in which numerous trigeminal nerve-innervated dome pressure receptors speckle the face and mandible and sense mechanical stimuli. However, the morphological features of this system are not well known, and it remains unclear how the trigeminal system changes during ontogeny and how it scales with other cranial structures. Finally, when this system evolved within crocodyliforms remains a mystery. Thus, new morphological insights into the trigeminal system of extant crocodylians may offer new paleontological tools to investigate this evolutionary transformation. A cross-sectional study integrating histological, morphometric, and 3D imaging analyses was conducted to identify patterns in cranial nervous and bony structures of Alligator mississippiensis. Nine individuals from a broad size range were CT-scanned followed by histomorphometric sampling of mandibular and maxillary nerve divisions of the trigeminal nerve. Endocast volume, trigeminal fossa volume, and maxillomandibular foramen size were compared with axon counts from proximal and distal regions of the trigeminal nerves to identify scaling properties of the structures. The trigeminal fossa has a significant positive correlation with skull length and endocast volume. We also found that axon density is greater in smaller alligators and total axon count has a significant negative correlation with skull size. Six additional extant and fossil crocodyliforms were included in a supplementary scaling analysis, which found that size was not an accurate predictor of trigeminal anatomy. This suggests that phylogeny or somatosensory adaptations may be responsible for the variation in trigeminal ganglion and nerve size in crocodyliforms.

Men calling healthline.

OBJECTIVE: To compare data for men who call Healthline for themselves with data from women callers and to use those pilot data to inform strategies to encourage men to use Healthline. SUBJECTS AND METHODS: This was a study examining retrospective data for people calling Healthline in a week in October 2010. Calls from 487 men were compared with those from 487 women. Geocoded data provided deprivation levels. RESULTS: There were fewer men calling than women in all age groups, although younger men were overrepresented. Young men were more acutely unwell than young women or older men. Men called at all times of the day, and call duration was similar to that of women callers. Most men callers were European; men of other ethnic groups were underrepresented compared with women and compared with their representation in the New Zealand population. Men from higher deprivation areas were more likely to call than those from lower deprivation areas. CONCLUSIONS: Compared with women, men underuse Healthline as they do other primary care services. Overall, men are more symptomatic than women; of interest is our observation that among men, the users are likely to be younger, of lower socioeconomic status, and European. Healthline may be an acceptable source of health advice for these men, and it should be considered central in any future initiative addressing men's health.

Facial phenotypes in subgroups of prepubertal boys with autism spectrum disorders are correlated with clinical phenotypes.

BACKGROUND: The brain develops in concert and in coordination with the developing facial tissues, with each influencing the development of the other and sharing genetic signaling pathways. Autism spectrum disorders (ASDs) result from alterations in the embryological brain, suggesting that the development of the faces of children with ASD may result in subtle facial differences compared to typically developing children. In this study, we tested two hypotheses. First, we asked whether children with ASD display a subtle but distinct facial phenotype compared to typically developing children. Second, we sought to determine whether there are subgroups of facial phenotypes within the population of children with ASD that denote biologically discrete subgroups. METHODS: The 3dMD cranial System was used to acquire three-dimensional stereophotogrammetric images for our study sample of 8- to 12-year-old boys diagnosed with essential ASD (n = 65) and typically developing boys (n = 41) following approved Institutional Review Board protocols. Three-dimensional coordinates were recorded for 17 facial anthropometric landmarks using the 3dMD Patient software. Statistical comparisons of facial phenotypes were completed using Euclidean Distance Matrix Analysis and Principal Coordinates Analysis. Data representing clinical and behavioral traits were statistically compared among groups by using χ2 tests, Fisher's exact tests, Kolmogorov-Smirnov tests and Student's t-tests where appropriate. RESULTS: First, we found that there are significant differences in facial morphology in boys with ASD compared to typically developing boys. Second, we also found two subgroups of boys with ASD with facial morphology that differed from the majority of the boys with ASD and the typically developing boys. Furthermore, membership in each of these distinct subgroups was correlated with particular clinical and behavioral traits. CONCLUSIONS: Boys with ASD display a facial phenotype distinct from that of typically developing boys, which may reflect alterations in the prenatal development of the brain. Subgroups of boys with ASD defined by distinct facial morphologies correlated with clinical and behavioral traits, suggesting potentially different etiologies and genetic differences compared to the larger group of boys with ASD. Further investigations into genes involved in neurodevelopment and craniofacial development of these subgroups will help to elucidate the causes and significance of these subtle facial differences.

N-heterocyclic carbene tethered amido complexes of palladium and platinum.

With a view to applications in bifunctional catalysis, a modular cross-coupling strategy has been used to prepare amine bis(imidazolium) salts (3a and 3b) and an amine mono(imidazolium) salt (6) as precursors to chelating amido-NHC ligands. Treating the pro-ligands 3 with 3 equivalents of the bulky base KHMDS and Pd(OAc)(2) or PtCl(2)(COD) gave the four amido bis(N-heterocyclic carbene) pincer complexes [CNC-R]M-I [M = Pd (7) or Pt (8); R = i-Pr (a) or n-Bu (b)], including the first examples of platinum complexes of a CNC ligand. The reaction of 7a with AgOTf in pyridine gave the cationic complex {[CNC-i-Pr]Pd-py}OTf (9a). Heating a mixture of amine mono(imidazolium) salt 6 with PdCl(2) or K(2)PtCl(4), K(2)CO(3) and KI in pyridine at 100 °C gave the complexes [C,NH]MI(2)py [M = Pd (10) or Pt (11)], in which the amine arm of the NHC ligand is not deprotonated and does not coordinate to the metal. For a solution of 10 in 1,4-dioxane, deprotonation of the amine occurred in a biphasic reaction with aqueous KOH at 40 °C, giving the dimeric amido complex {[C,N]Pd(µ-OH)}(2) (12). The more inert Pt analogue 11 was unreactive under the same conditions. Solid-state structures of the complexes 7a, 7b, 9a, 10, 11 and 12 have been determined by single crystal X-ray diffraction.