A new setup for measurements of absolute saturation vapor pressures using a dynamical method: Experimental concept and validation.

We describe a new experimental system for direct measurements of the absolute saturation vapor pressures of liquid or solid samples. The setup allows the isolation of the sample under steady conditions in an ultra-high vacuum chamber, where the measurement of the sample's vapor pressure as a function of its temperature can be performed in a range around room temperature and in a pressure range defined only by the applied absolute pressure sensor. We characterize the setup and illustrate its capability to measure saturation vapor pressures as well as enthalpies of evaporation around room temperature with explicit measurements on four liquid compounds (diethyl phthalate, 1-decanol, 1-heptanol, and 1-hexanol) for which accurate vapor pressures have previously been reported.

Patient Interaction With the Health Care System Following a Nonopioid Discharge Strategy for Anterior Urethroplasty.

INTRODUCTION: Continued efforts have been made to minimize postoperative opioids following urologic interventions. Studies show that patient-reported pain outcomes are similar between those patients discharged with and without opioids following anterior urethroplasty, but we do not know what impact this has on health care utilization. We aim to show that a nonopioid discharge following anterior urethroplasty does not increase postoperative health care utilization. METHODS: Five hundred patients who underwent anterior urethroplasty from January 2016 to October 2022 were identified from retrospective chart review. Patient demographic information, surgical characteristics, and postoperative interactions with the health care system were extracted from the electronic medical record. We then compared these outcomes by discharge opioid prescription status. RESULTS: A total of 253 patients were discharged without an opioid prescription. Patients who received an opioid were more likely to have had a perineal incision (73% vs 64%, P = .02), more likely to have had an overnight hospital stay (30% vs 14%, P < .01), and were more likely to have been prescribed an opioid preoperatively (13% vs 7%, P = .03). There were overall low rates of interaction with the health system in both groups with no significant difference in 30-day unplanned office visits, emergency department visits, or office phone calls. Overall, by the end of our study period 97% were discharged without an opioid and 94% of patients were discharged the same day. CONCLUSIONS: Patients undergoing anterior urethroplasty can safely be discharged home without opioids following surgery without undue postoperative burden on the health care system.

Polyreactivity of antibodies from different B-cell subpopulations is determined by distinct sequence patterns of variable region.

An antibody molecule that can bind to multiple distinct antigens is defined as polyreactive. In the present study, we performed statistical analyses to assess sequence correlates of polyreactivity of >600 antibodies cloned from different B-cell types of healthy humans. The data revealed several sequence patterns of variable regions of heavy and light immunoglobulin chains that determine polyreactivity. The most prominent identified patterns were increased number of basic amino acid residues, reduced frequency of acidic residues, increased number of aromatic and hydrophobic residues, and longer length of CDR L1. Importantly, our study revealed that antibodies isolated from different B-cell populations used distinct sequence patterns (or combinations of them) for polyreactive antigen binding. Furthermore, we combined the data from sequence analyses with molecular modeling of selected polyreactive antibodies and demonstrated that human antibodies can use multiple pathways for achieving antigen-binding promiscuity. These data reconcile some contradictions in the literature regarding the determinants of antibody polyreactivity. Moreover, our study demonstrates that the mechanism of polyreactivity of antibodies evolves during immune response and might be tailored to specific functional properties of different B-cell compartments. Finally, these data can be of use for efforts in the development and engineering of therapeutic antibodies.

Surgical Outcomes and Prediction of Complications Following High-complexity Buried Penis Reconstruction.

PURPOSE: With uniform modern approaches to adult acquired buried penis reconstruction, this study provides updated results on surgical outcomes for complex cases while evaluating the relative influence of medical, surgical, and socioeconomic factors on these results. MATERIALS AND METHODS: Retrospective review was conducted of all patients undergoing initial buried penis reconstruction including escutcheonectomy and penile skin grafting at 1 tertiary center from 2015 through 2022. Summary scores for frailty and socioeconomic status were calculated with the Modified Frailty Index and Area Deprivation Index, respectively. RESULTS: The cohort included 103 patients. Median age was 51 years (IQR 44-65), and median BMI was 43 (IQR 38-49). Frail patients (≥2 Modified Frailty Index risk factors) accounted for 27% of the population while socioeconomic disadvantage (≥85th percentile on Area Deprivation Index) affected 33% of patients. Twenty-eight percent of repairs included a panniculectomy. Rate of revision for a poor outcome was 3.9% with median follow-up of 11 months. Complications were frequent (50%) with most being Clavien I or II (41%) and related to wound dehiscence (31%) or infection (30%). Frail patients had a higher rate of complication (71% vs 41%, P = .01) and were 6 times more likely to experience a complication on multivariable logistic regression (OR 6.41, 95% CI: 1.77-23.22, P = .005). CONCLUSIONS: The modern approach to complex buried penis reconstruction results in a low revision rate; however, low-grade complications are frequent. Patient frailty identifies those at highest risk for complication, offering an opportunity for counseling and preoperative preparation.

Patterns of understory invasion in invasive timber stands of a tropical sky island.

Current climate and land cover change threaten global mountaintops with increased spread of invasive species. Long-established plantations of invasive trees on these mountaintops can alter their surroundings, further increasing invader-facilitated invasion. Identifying the ecological conditions promoting such associations can help develop better management interventions. The Western Ghats's Shola Sky Islands (>1400 m MSL) host vast stretches of invasive tree plantations that sustain the colonization of other invasive woody, herbaceous, and fern species in their understories. Here, we analyzed vegetation and landscape variables from 232 systematically placed plots in randomly selected grids using non-metric multidimensional scaling and Phi coefficient approaches to examine patterns of association (positive interactions) between understory invasive species with specific invasive overstory species. We also conducted GLMM with zero inflation to determine the influence of environmental variables where such associations occur. We find that understory invasion of multiple species under the canopy of other invasives is widespread across the Shola Sky Islands. Stands of Eucalyptus host the colonization of 70% of non-native invasive species surveyed across the Shola Sky Islands. In particular, the Lantana camara invasion is strongly associated with Eucalyptus stands. We also found that climatic variables affect the colonization of understory woody invasive species, while invasion by exotic herbaceous species is associated with the density of road networks. Canopy cover impacts all invasives negatively, while fire incidence was negatively associated with invasion by Lantana spp. and the Pteridium spp. While the restoration of natural habitats primarily targets the highly invasive Acacia, less invasive Eucalyptus and Pinus are often not included. Our study suggests that retaining such invasive species in natural habitats, particularly protected areas, can hinder ongoing grassland restoration efforts by facilitating further invasions by multiple woody and herbaceous species.

The Evolution of Comparative Phylogeography: Putting the Geography (and More) into Comparative Population Genomics.

Comparative population genomics is an ascendant field using genomic comparisons between species to draw inferences about forces regulating genetic variation. Comparative phylogeography, by contrast, focuses on the shared lineage histories of species codistributed geographically and is decidedly organismal in perspective. Comparative phylogeography is approximately 35 years old, and, by some metrics, is showing signs of reduced growth. Here, we contrast the goals and methods of comparative population genomics and comparative phylogeography and argue that comparative phylogeography offers an important perspective on evolutionary history that succeeds in integrating genomics with landscape evolution in ways that complement the suprageographic perspective of comparative population genomics. Focusing primarily on terrestrial vertebrates, we review the history of comparative phylogeography, its milestones and ongoing conceptual innovations, its increasingly global focus, and its status as a bridge between landscape genomics and the process of speciation. We also argue that, as a science with a strong "sense of place," comparative phylogeography offers abundant "place-based" educational opportunities with its focus on geography and natural history, as well as opportunities for collaboration with local communities and indigenous peoples. Although comparative phylogeography does not yet require whole-genome sequencing for many of its goals, we conclude that it nonetheless plays an important role in grounding our interpretation of genetic variation in the fundamentals of geography and Earth history.

The Emerging Role of Telehealth for Concussion Clinical Care During the Coronavirus (COVID-19) Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has substantially altered the delivery of healthcare for providers and their patients. Patients have been reticent to seek care for many diseases and injuries including concussion due to fears of potential exposure to COVID-19. Moreover, because of social distancing recommendations and stay-at-home orders, patient screening, evaluation, and delivery of care have become less efficient or impossible to perform via in-person clinic visits. Consequently, there was a sudden need to shift healthcare delivery from primarily in-person visits to telehealth. This sudden shift in healthcare delivery brings with it both challenges and opportunities for clinical concussion care. This article is designed to discuss these challenges and opportunities and provide an experiential-based framework for providing concussion care via telehealth. We first provide an overview of a clinical concussion model utilized at concussion specialty clinics from 3 geographically disparate healthcare systems for in-person service delivery prior to COVID-19. We then discuss the creation of new clinical workflows to facilitate the continued provision of concussion specialty care using telehealth. Finally, we examine lessons learned during this healthcare delivery shift including limitations and potential barriers for telehealth for concussion care, as well as opportunities for expansion of concussion care in rural and underserved areas. We also discuss the need to empirically evaluate the comparative efficacy of telehealth and in-person concussion care moving forward.

Assessment of physician training and prediction of workforce needs in paediatric cardiac intensive care in the United States.

OBJECTIVE: To assess the training and the future workforce needs of paediatric cardiac critical care faculty. DESIGN: REDCap surveys were sent May-August 2019 to medical directors and faculty at the 120 US centres participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database. Faculty and directors were asked about personal training pathway and planned employment changes. Directors were additionally asked for current faculty numbers, expected job openings, presence of training programmes, and numbers of trainees. Predictive modelling of the workforce was performed using respondents' data. Patient volume was projected from US Census data and compared to projected provider availability. MEASUREMENTS AND MAIN RESULTS: Sixty-six per cent (79/120) of directors and 62% (294/477) of contacted faculty responded. Most respondents had training that incorporated critical care medicine with the majority completing training beyond categorical fellowship. Younger respondents and those in dedicated cardiac ICUs were more significantly likely to have advanced training or dual fellowships in cardiology and critical care medicine. An estimated 49-63 faculty enter the workforce annually from various training pathways. Based on modelling, these faculty will likely fill current and projected open positions over the next 5 years. CONCLUSIONS: Paediatric cardiac critical care training has evolved, such that the majority of faculty now have dual fellowship or advanced training. The projected number of incoming faculty will likely fill open positions within the next 5 years. Institutions with existing or anticipated training programmes should be cognisant of these data and prepare graduates for an increasingly competitive market.

Workforce demographics and unit structure in paediatric cardiac critical care in the United States.

OBJECTIVE: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. DESIGN: REDCap surveys were sent by email from May till August 2019 to medical directors ("directors") of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. MEASUREMENTS AND MAIN RESULTS: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). CONCLUSIONS: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

Postoperative Use of Blood Flow Restriction in Orthopedics.

Blood flow restriction (BFR) therapy is being used more frequently for rehabilitation from orthopedic injuries. Several physiologic mechanisms of action, at local and systemic levels, have been proposed. Numerous studies have investigated the effects of BFR training in healthy athletes; however, limited clinical data exist supporting the use of BFR after surgery. Given that BFR training may facilitate muscle development using low-load resistance exercises, it offers a unique advantage for the post-surgical patient who cannot tolerate traditional high resistance training. [Orthopedics. 2021;44(6):e694-e698.].

Anthropogenic disturbance favours generalist over specialist parasites in bird communities: Implications for risk of disease emergence.

Niche theory predicts specialists which will be more sensitive to environmental perturbation compared to generalists, a hypothesis receiving broad support in free-living species. Based on their niche breadth, parasites can also be classified as specialists and generalists, with specialists infecting only a few and generalists a diverse array of host species. Here, using avian haemosporidian parasites infecting wild bird populations inhabiting the Western Ghats, India as a model system, we elucidate how climate, habitat and human disturbance affects parasite prevalence both directly and indirectly via their effects on host diversity. Our data demonstrate that anthropogenic disturbance acts to reduce the prevalence of specialist parasite lineages, while increasing that of generalist lineages. Thus, as in free-living species, disturbance favours parasite communities dominated by generalist versus specialist species. Because generalist parasites are more likely to cause emerging infectious diseases, such biotic homogenisation of parasite communities could increase disease emergence risk in the Anthropocene.

Opportunities and challenges in using remote sensing for invasive tree species management, and in the identification of restoration sites in tropical montane grasslands.

Tropical montane grasslands (TMG) support biodiverse and endemic taxa and provide vital ecosystem services to downstream communities. Nevertheless, invasive alien tree species across the world have threatened tropical grasslands and grassland endemic species. In India, TMG in the Shola Sky Islands of the Western Ghats have been reduced due to exotic tree invasions (Acacias, Pines, and Eucalyptus species). The loss of grassland habitat has, in turn, reduced the range sizes of species endemic to grasslands (plants, birds, amphibians, and mammals), driving some populations to local extinction. Grassland conversion to exotic trees has also impacted ecosystem services in the Western Ghats. Conserving existing grassland and restoring invaded habitat is critical to reverse these losses. This research focused on identifying grassland restoration sites using satellite images with a high spatial resolution (RapidEye). We used an object-oriented Random Forest classification to map the area for grassland restoration. We identified an area of 254 sq. km. as suitable for grassland restoration and an area of 362 sq. km. for grassland conservation and preventing invasion by exotic tree species. For restoration, we recommend careful removal of young and isolated exotic trees at the invasion front and restoring grasslands, instead of removing dense stands of mature exotic trees. Although our limited data indicate that areas with low fire frequency tend to be invaded, and areas invaded by exotic trees tend to burn at higher intensities, we recommend a broader investigation of these patterns to critically examine a potential role for the use of fire in invasive species management. We assume that removing exotic tree species in the identified restoration sites and restoring the grassland will help recover lost habitat and ensure the viability of indigenous and endemic species and increase streamflow.

Host phylogeny matters: Examining sources of variation in infection risk by blood parasites across a tropical montane bird community in India.

BACKGROUND: Identifying patterns and drivers of infection risk among host communities is crucial to elucidate disease dynamics and predict infectious disease risk in wildlife populations. Blood parasites of the genera Plasmodium and Haemoproteus are a diverse group of vector-borne protozoan parasites that affect bird populations globally. Despite their widespread distribution and exceptional diversity, factors underlying haemosporidian infection risk in wild bird communities remain poorly understood. While some studies have examined variation in avian haemosporidian risk, researchers have primarily focused on host ecological traits without considering host phylogenetic relationships. In this study, we employ a phylogenetically informed approach to examine the association between host ecological traits and haemosporidian infection risk in endemic bird communities in the Western Ghats Sky Islands. METHODS: We used parasite sequence data based on partial mitochondrial cytochrome b gene, that was amplified from genomic DNA extracted from 1177 birds (28 species) across the Western Ghats to assess infection of birds with haemosporidian parasites. We employed a Bayesian phylogenetic mixed effect modelling approach to test whether haemosporidian infection risk was affected by seven species-specific and four individual-level ecological predictors. We also examined the effect of host phylogenetic relationships on the observed patterns of variation in haemosporidian infection risk by estimating phylogenetic signal. RESULTS: Our study shows that host ecological traits and host phylogeny differentially influence infection risk by Plasmodium (generalist parasite) and Haemoproteus (specialist parasite). For Plasmodium, we found that sociality, sexual dimorphism and foraging strata were important ecological predictors. For Haemoproteus, patterns of infection risk among host species were associated with sociality, species elevation and individual body condition. Interestingly, variance in infection risk explained by host phylogeny was higher for Haemoproteus parasites compared to Plasmodium. CONCLUSIONS: Our study highlights that while host ecological traits promoting parasite exposure and host susceptibility are important determinants of infection risk, host phylogeny also contributes substantially to predicting patterns of haemosporidian infection risk in multi-host communities. Importantly, infection risk is driven by joint contributions of host ecology and host phylogeny and studying these effects together could increase our ability to better understand the drivers of infection risk and predict future disease threats.

Rare Variant Double-Layered Lateral Meniscus Detected During Arthroscopy in a Young Gymnast After a Hyperextension Knee Injury: A Case Report.

CASE: A 15-year-old high-level gymnast sustained a hyperextension knee injury and was diagnosed with a lateral meniscus tear on advanced imaging. During arthroscopy, a redundant meniscus was encountered overlying an otherwise normal, intact lateral meniscus, consistent with a double-layer lateral meniscus. The redundant meniscus was resected, and the patient was able to return to gymnastics at her previous high level of competition. CONCLUSIONS: Abnormalities of the lateral meniscus may be poorly characterized or undetected on preoperative imaging studies. When the decision is made to proceed with surgery, a vigilant diagnostic arthroscopic examination can facilitate the detection and treatment of unanticipated pathology.

Pediatric Cardiac Intensive Care Distribution, Service Delivery, and Staffing in the United States in 2018.

OBJECTIVES: To assess the distribution, service delivery, and staffing of pediatric cardiac intensive care in the United States. DESIGN: Based on a 2016 national PICU survey, and verified through online searching and clinician networking, medical centers were identified with a separate cardiac ICU or mixed ICU. These centers were sent a structured web-based survey up to four times, with follow-up by mail and phone for nonresponders. SETTING: Cardiac ICUs were defined as specialized units, specifically for the treatment of children with life-threatening primary cardiac conditions. Mixed ICUs were defined as separate units, specifically for the treatment of children with life-threatening conditions, including primary cardiac disease. PARTICIPANTS: Cardiac ICU or mixed ICU physician medical directors or designees. MEASUREMENTS AND MAIN RESULTS: One-hundred twenty ICUs were identified: 61 (51%) were mixed ICUs and 59 (49%) were cardiac ICUs. Seventy five percent of institutions at least sometimes used a neonatal ICU prior to surgery. The most common temporary cardiac support beyond extracorporeal membrane oxygenation was a centrifugal pump such as Centrimag. Durable cardiac support devices were far more common in separate cardiac ICUs (84% vs 20%; p < 0.0001). Significantly less availability of electrophysiology, heart failure, and cardiac anesthesia consultation was available in mixed ICUs (p = 0.0003, p < 0.0001, p = 0.042 respectively). ICU attending physicians were in-house day and night 98% of the time in mixed ICUs and 87% of the time in cardiac ICUs. Nurse practitioners were consistent front-line providers in the ICUs caring for children with primary cardiac disease staffing 88% of cardiac ICUs and 56% of mixed ICUs. Mixed ICUs were more commonly staffed with pediatric residents, and critical care fellows were found in more cardiac ICUs (83% vs 77%; p < 0.0001). CONCLUSIONS: Mixed ICUs and cardiac ICUs have statistically different staffing models and available services. More evaluation is needed to understand how this may impact patient outcomes and training programs of physicians and nurses.