Abstract
We present photometric data for minor planets observed by the Transiting Exoplanet Survey Satellite during its Cycle 1 operations. In total, we extracted usable detections for 37,965 ...objects. We present an examination of the reliability of the rotation period and light-curve amplitudes derived from each object based upon the number of detections and the normalized Lomb–Scargle power of our period fitting and compare and contrast our results with previous similar works. We show that for objects with 200 or more photometric detections and a derived normalized, generalized Lomb–Scargle power greater than 0.2, we have an 85% confidence in that period; this encompasses 3492 rotation periods we consider to be highly reliable. We independently examine a series of periods first reported by Pál et al.; periods derived in both works found to have similar results should be considered reliable. Additionally, we demonstrate the need to properly account for the true proportion of slow rotators (
P
> 100 hr) when inferring shape distributions from sparse photometry.
Approximately one-half of all US surgical procedures, and one-third of orthopaedic procedures, are performed at teaching hospitals. However, the effect of resident participation and their level of ...training on patient care for TKA postoperative physical function, operative time, length of stay, and facility discharge are unclear.
(1) Are resident participation, postgraduate year (PGY) training level, and number of residents associated with absolute postoperative Patient-Reported Outcomes Measurement Information System (PROMIS®-10) global physical function score (PCS), and achieving minimum clinically important difference (MCID) PCS improvement, after TKA? (2) Are resident participation, PGY, and number of residents associated with increased TKA operative time? (3) Are resident participation, PGY, and number of residents associated with increased length of stay after TKA? (4) Are resident participation, PGY, and number of residents associated with higher odds of patients being discharged to another inpatient facility, rather than to their home (facility discharge)?
We performed a retrospective study using a longitudinally maintained institutional registry of TKAs that included 1626 patients at a single tertiary academic institution from April 2011 through July 2016. All patients who underwent primary, elective unilateral TKA were included with no exclusions. All patients were included in the operative time, length of stay, and facility discharge models. The PCS model required postoperative PCS score (n = 1417; 87%; mean, 46.4; SD, 8.5) and the MCID PCS model required pre- and postoperative PCS (n = 1333; 82%; 55% achieved MCID). Resident participation was defined as named residents being present in the operating room and documented in the operative notes, and resident PGY level was determined by the date of TKA and its duration since the resident entered the program and using the standard resident academic calendar (July - June). Multivariable regression was used to assess PCS scores, operative time, length of stay, and facility discharge in patients whose surgery was performed with and without intraoperative resident participation, accounting for PGY training level and number of residents. We defined the MCID PCS score improvement as 5 points on a 100-point scale. Adjusting variables included surgeon, academic year, age, sex, race-ethnicity, Charlson Comorbidity Index, preoperative PCS, and patient-reported mental function, BMI, tobacco use, alcohol use, and postoperative PCS time for the PCS models. We had postoperative PCS for 1417 (87%) surgeries.
Compared with attending-only TKAs (5% of procedures), no postgraduate year or number of residents was associated with either postoperative PCS or MCID PCS improvement (PCS: PGY-1 = -0.98, 95% CI, -6.14 to 4.17, p = 0.708; PGY-2 = -0.26, 95% CI, -2.01to 1.49, p = 0.768; PGY-3 = -0.32, 95% CI, -2.16 to 1.51, p = 0.730; PGY-4 = -0.28, 95% CI, -1.99 to 1.43, p = 0.746; PGY-5 = -0.47, 95% CI, -2.13 to 1.18, p = 0.575; two residents = 0.28, 95% CI, -1.05 to 1.62, p = 0.677) (MCID PCS: PGY-1 = odds ratio OR, 0.30, 95% CI, 0.07-1.30, p = 0.108; PGY-2 = OR, 0.86, 95% CI, 0.46-1.62, p = 0.641; PGY-3 = OR, 0.97, 95% CI, 0.49-1.89, p = 0.921; PGY-4 = OR, 0.73, 95% CI, 0.39-1.36, p = 0.325; PGY-5 = OR, 0.71, 95% CI, 0.39-1.29, p = 0.259; two residents = OR, 1.23, 95% CI, 0.80-1.89, p = 0.337). Longer operative times were associated with all PGY levels except for PGY-5 (attending surgeon only reference = 85.60 minutes, SD, 14.5 minutes; PGY-1 = 100. 13 minutes, SD, 21.22 minutes, +8.44 minutes, p = 0.015; PGY-2 = 103.40 minutes, SD, 23.01 minutes, +11.63 minutes, p < 0.001; PGY-3 = 97.82 minutes, SD, 18.24 minutes, +9.68 minutes, p < 0.001; PGY-4 = 96.39 minutes, SD, 18.94 minutes, +4.19 minutes, p = 0.011; PGY-5 = 88.91 minutes, SD, 19.81 minutes, -0.29 minutes, p = 0.853) or the presence of multiple residents (+4.39 minutes, p = 0.024). There were no associations with length of stay (PGY-1 = +0.04 days, 95% CI, -0.63 to 0.71 days, p = 0.912; PGY-2 = -0.08 days, 95% CI, -0.48 to 0.33 days, p = 0.711; PGY-3 = -0.29 days, 95% CI, -0.66 to 0.09 days, p = 0.131; PGY-4 = -0.30 days, 95% CI, -0.69 to 0.08 days, p = 0.120; PGY-5 = -0.28 days, 95% CI, -0.66 to 0.10 days, p = 0.145; two residents = -0.12 days, 95% CI, -0.29 to 0.06 days, p = 0.196) or facility discharge (PGY-1 = OR, 1.03, 95% CI, 0.26-4.08, p = 0.970; PGY-2 = OR, 0.61, 95% CI, 0.31-1.20, p = 0.154; PGY-3 = OR, 0.98, 95% CI, 0.48-2.02, p = 0.964; PGY-4 = OR, 0.83, 95% CI, 0.43-1.57, p = 0.599; PGY-5 = OR, 0.7, 95% CI, 0.41-1.40, p = 0.372; two residents = OR, 0.93, 95% CI, 0.56-1.54, p = 0.766) for any PGY or number of residents.
Our findings should help assure patients, residents, physicians, insurers, and hospital administrators that resident participation, after adjusting for numerous patient and clinical factors, does not have any association with key medical and financial metrics, including postoperative PCS, MCID PCS, length of stay, and facility discharge. Future research in this field should focus on whether residents affect knee-specific patient-reported outcomes such as the Knee Injury and Osteoarthritis Score and additional orthopaedic procedures, and determine how resident medical education can be further enhanced without compromising patient care and safety.Level of Evidence Level III, therapeutic study.
We sought to determine whether several preoperative socioeconomic status (SES) variables meaningfully improve predictive models for primary total knee arthroplasty (TKA) length of stay (LOS), ...facility discharge, and clinically significant Veterans RAND-12 physical component score (PCS) improvement.
We prospectively collected clinical data on 2198 TKAs at a high-volume rural tertiary academic hospital from April 2011 through March 2016. SES variables included race and/or ethnicity, living alone, education, employment, and household income, along with numerous adjusting variables. We determined individual SES predictors and whether the inclusion of all SES variables contributed to each 10-fold cross-validated area under the model's area under the receiver operating characteristic (AUC). We also used 1000-fold bootstrapping methods to determine whether the SES and non-SES models were statistically different from each other.
At least 1 SES predicted each outcome. Ethnic minority patients and those with incomes <$35,000 predicted longer LOS. Ethnic minority patients, the unemployed, and those living alone predicted facility discharge. Unemployed patients were less likely to achieve PCS improvement. Without the 5 SES variables, the AUC values of the LOS, discharge, and PCS models were 0.74 (95% confidence interval CI 0.72-0.77, “acceptable”); 0.86 (CI 0.84-0.87, “excellent”); and 0.80 (CI 0.78-0.82, “excellent”), respectively. Including the 5 SES variables, the 10-fold cross-validated and bootstrapped AUC values were 0.76 (CI 0.74-0.79); 0.87 (CI 0.85-0.88); and 0.81 (0.79-0.83), respectively.
We developed validated predictive models for outcomes after TKA. Although inclusion of multiple SES variables provided statistical predictive value in our models, the amount of improvement may not be clinically meaningful.
Newer implants for total knee arthroplasty (TKA) often gain market share at higher cost with little patient-reported and long-term clinical data. We compared outcomes after TKA using two different ...implants: DePuy PFC Sigma and Attune.
Using a prospective data repository from an academic tertiary medical center, we analyzed 2116 TKAs (1603 Sigma and 513 Attune) from April 2011 through July 2016. Outcomes included length of surgery, length of stay, facility discharge, 90-day reoperation, range of motion (ROM) change, and patient-reported physical function (PCS).
There was no difference in length of surgery (Attune −2.87 min, P = 0.143). Implant type was not associated with extended LOS (>3 days) (OR 0.80, P = 0.439). There was no difference in facility discharge (OR 0.65, P = 0.103). Unadjusted 90-day reoperations were 0.3% for Sigma and 1.0% for Attune cohorts (P = 0.158). Sigma implants were associated with more ROM improvement in unadjusted analyses (+2.1 degree improvement P = 0.031). Fifty nine percent of the Sigma cohort and 49% of the Attune cohort achieved the minimal clinically important (MCID) change for PCS improvement, although there was no adjusted difference in achieving MCID (Attune OR 0.84, P = 0.435). There was no adjusted difference in absolute PCS improvement (Attune +0.12 score, P = 0.864).
Our data show no difference in physical function and most outcomes between Sigma and Attune. Attune implants had shorter absolute LOS, but there were no differences in extended LOS.
The medical profession seeks to hire and train individuals who consistently meet and/or exceed both job and cultural expectations. Resident selection is often not structured to meet this goal. The ...objective of this quality improvement project was to evaluate a classic unscripted interview process (OI) in conjunction with a structured, scripted interview process (SI) developed using an established hiring methodology from industry not yet utilized in health care. Qualitative questions we sought to answer: (1) Can SI be practically applied to the selection of residents? (2) Is there a significant difference in the relative position of applicants between the OI and SI rank lists? (3) Qualitatively, does SI help the evaluation/discussion of the affective domain?
Design: Prospective qualitative comparison of OI versus SI.
Setting: Dartmouth Hitchcock Medical Center, Lebanon, NH.
Participants: Applicants were assessed by OI and SI. SI factors were selected based on a job profile. Interview scripts were created from validated behavioral and attitudinal questions. Online assessments assessed 2 important attributes - adaptability and values. Rank lists were compared for relative rank position of applicants. Feedback from faculty was obtained.
Fifty-two applicants. Critical attributes were self-management, integrator-synthesizer, versatility, communication, and achievement. Absolute mean difference in rank/applicant was 9.8 (standard deviation 8.9, Range 0-36) positions. Comparing the top 20 candidates of each rank list, 40% of those applicants were only on one list. Faculty felt that applicants were given a greater opportunity to show “who they are.”
In conjunction with OI, an industry proven methodology was practically applied to define and select for high performance for the authors’ specific institution. Comparing OI and SI resulted in substantial differences in rank lists. This initiative seemed to provide a structure to evaluate values and motivations that are inherently difficult to assess. Faculty felt SI in conjunction with OI gave a greater chance for applicants to show “who they are.”
Objective
The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many ...clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence‐based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework.
Method
Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive‐behavioral therapy for eating disorders (CBT‐ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians.
Results
A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT‐ED methods.
Discussion
Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence‐based practice. These are shared to assist clinicians over the period of changed practice.
The PI5P4Ks have been demonstrated to be important for cancer cell proliferation and other diseases. However, the therapeutic potential of targeting these kinases is understudied due to a lack of ...potent, specific small molecules available. Here, we present the discovery and characterization of a pan-PI5P4K inhibitor, THZ-P1-2, that covalently targets cysteines on a disordered loop in PI5P4Kα/β/γ. THZ-P1-2 demonstrates cellular on-target engagement with limited off-targets across the kinome. AML/ALL cell lines were sensitive to THZ-P1-2, consistent with PI5P4K's reported role in leukemogenesis. THZ-P1-2 causes autophagosome clearance defects and upregulation in TFEB nuclear localization and target genes, disrupting autophagy in a covalent-dependent manner and phenocopying the effects of PI5P4K genetic deletion. Our studies demonstrate that PI5P4Ks are tractable targets, with THZ-P1-2 as a useful tool to further interrogate the therapeutic potential of PI5P4K inhibition and inform drug discovery campaigns for these lipid kinases in cancer metabolism and other autophagy-dependent disorders.
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•Inhibitor THZ-P1-2 shows PI5P4K enzyme inhibition and target engagement in cells•THZ-P1-2 covalently targets unannotated cysteines outside the PI5P4K active site•AML/ALL cell lines are broadly sensitive to THZ-P1-2's covalent effects•PI5P4K inhibition causes autophagy disruption and upregulates TFEB signaling
PI5P4K, an understudied kinase family, is essential in various disease contexts. Sivakumaren et al. develop and characterize PI5P4K inhibitor THZ-P1-2, which targets unique cysteines, exhibits effects in biochemical and cellular assays, displays anticancer activity in leukemia cell lines, and causes defects in autophagy similar to PI5P4K gene knockdown or deletion.
Horizontal transmission of Helicoverpa armigera nucleopolyhedrovirus (HearNPV) has been found to occur through several pathways involving abiotic factors such as soil, wind, and rain, and biotic ...factors such as predators, parasitoids, and infected hosts. Previous studies examining horizontal transmission through certain biological carriers speculated they were likely not significant in increasing infection rates, however; these studies only focused on a relatively small number of arthropods present within a field setting. This study was conducted to evaluate the horizontal transmission potential of HearNPV by all potential biological carriers when applied as a foliar bioinsecticide or as virus-infected, nonmotile Helicoverpa zea (Boddie) (Lepidoptera: Noctuidae) larvae in a soybean field. Soybean plots were either sprayed with HearNPV or infested with late-stage HearNPV-infected larvae, and sample zones were sampled 3, 7, 10, 14, 17, and 21 days after the infestation, and analyzed for viral presence using PCR. We then identified HearNPV carriers through contamination from the application (involuntary) or through contact with a HearNPV-infected larva (voluntary). Both were confirmed through PCR analysis. Regardless of application technique, on average, HearNPV was capable of disseminating up to 61.0 m in 3 d after inoculation and was found within the sampled canopy 13–21 d after inoculation. Several arthropods were identified as novel carriers of HearNPV. Results from this study indicate that many novel HearNPV carriers are likely important in disseminating HearNPV.
Cardiogenic shock remains the leading cause of death in patients hospitalized with acute myocardial infarction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the ...treatment of infarct-related cardiogenic shock. However, there is limited evidence regarding its beneficial impact on mortality. The aim of this study was to systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock.
A comprehensive search of medical databases (Cochrane Register and PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included. The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomized controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared with standard medical therapy odds ratio (OR) 0.91; 95% confidence interval (CI) 0.65-1.27. Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31; 95% CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate, and successful revascularization are independent predictors of mortality.
Veno-arterial extracorporeal membrane oxygenation does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction; however, there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes.
The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023461740).
NASA's future Artemis missions to the Moon seek to explore areas around the Lunar South Pole. Though humans have previously set foot on the lunar surface, the proposed region provides unique and ...challenging environments that require insight and investigation prior to arrival. Several teams throughout the agency are performing this site and mission planning, design, and analysis to support areas like the Human Landing System (HLS), surface mobility, habitation elements, and scientific exploration. The NASA Exploration Systems Simulation (NExSyS) team at Johnson Space Center is developing a graphical environment of the Lunar South Pole region. Lunar terrain information collected from the Lunar Reconnaissance Orbiter (LRO) is compiled and made available through Johnson Space Center's Digital Lunar Exploration Sites (DLES) data sets. The DLES data is used to build this graphic environment. The process of ingesting and accurately modeling this information in a meaningful way for analysis creates its own challenges such as generating a performant model from the source data and the application of curvature. Additionally, the area around the Lunar South Pole experiences different lighting conditions than those observed from the Apollo missions. The need to use the lunar environmental data products provided by DLES combined with the capability to calculate date specific ephemerides in real-time has given rise to the development of the DLES Unreal Simulation Tool (DUST). DUST incorporates augmented terrain from the DLES product into a desktop application that allows exploration of the Lunar South Pole region and its complex lighting conditions. DUST leverages advanced capabilities in the recently released Unreal Engine 5 renderer by Epic Games such as double precision for positioning of planetary bodies and surface elements, multiple infinite light sources to represent the Sun and eventually Earthshine, high resolution shadow maps for dynamic shadow accuracy, real-time software ray-tracing for multi-surface bounce lighting to render sunlight reflected off surface elements and terrain features, and performance optimized level of detail shifting as the eyepoint changes in a scene. This paper details the DUST application, the technologies of the engine platform that enable scientific and engineering analysis, the unique techniques and processes developed to consume the DLES data sets, and how the tool is being used to support the Artemis program.
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