Post-traumatic DVTs present unique challenges in patient populations with specific high-risk injury patterns. Duplex ultrasound (US) can be used to assess evolution of DVTs and may guide treatment ...for high-risk patients. We hypothesized that many DVTs resolve during the initial admission. Weekly duplex US are ordered on all trauma inpatients regardless of prior DVT at our facility. We reviewed US and outcomes data on all patients with lower extremity DVTs at our Level I trauma center from January 2012-December 2021. 392 patients were diagnosed with lower extremity DVT by US. 261 (67%) patients received follow-up US with a mean time to repeat US of 6 days. Of these, 91 (35%) patients experienced DVT resolution prior to the first follow-up US, and 141 (54%) patients experienced resolution prior to discharge. Mean time to resolution was 10 days. Over 50% of DVTs resolve before discharge and are detected by US. Further studies and post-discharge follow-up are needed to determine if patients with resolved DVTs can be managed without therapeutic anticoagulation.
Dual-task studies assessed the effects of cellular-phone conversations on performance of a simulated driving task. Performance was not disrupted by listening to radio broadcasts or listening to a ...book on tape. Nor was it disrupted by a continuous shadowing task using a handheld phone, ruling out, in this case, dual-task interpretations associated with holding the phone, listening, or speaking. However, significant interference was observed in a word-generation variant of the shadowing task, and this deficit increased with the difficulty of driving. Moreover, unconstrained conversations using either a handheld or a hands-free cell phone resulted in a twofold increase in the failure to detect simulated traffic signals and slower reactions to those signals that were detected. We suggest that cellular-phone use disrupts performance by diverting attention to an engaging cognitive context other than the one immediately associated with driving.
Disciplinary differences in the development of scientific generalizations and explanations are reviewed in this article. The social and behavioral sciences have identified fewer laws, established ...fewer “paradigms,” and developed “worse” theories than the physical sciences. We argue that the variability in the theoretical attainments of disciplines is due primarily to differences in the complexity of the topics studied. Accounts suggesting that differences in the maturity of disciplines are responsible for the variability are dismissed. In the study of complex phenomena, there is an extreme trade-off between generality and precision in which basic theories do not make the precise predictions needed for the development of applications and in which applied models are lacking in generality. The examination of proximal determinants and the generation of context-specific mathematical models are essential for prediction and application in complex disciplines. The impossibility of developing exacting theories of complex phenomena suggests that we need to redefine our conceptions of “good” and “bad” theories and “real” and “fake” science.
Escherichia coli sequence type 131 (ST131) predominates globally among multidrug-resistant (MDR) E. coli strains. We used whole-genome sequencing (WGS) to investigate 63 MDR E. coli isolates from 7 ...North Carolina community hospitals (2010 to 2015). Of these, 39 (62%) represented ST131, including 37 (95%) from the ST131-H30R subclone: 10 (27%) from its H30R1 subset and 27 (69%) from its H30Rx subset. ST131 core genomes differed by a median of 15 (range, 0 to 490) single-nucleotide variants (SNVs) overall versus only 7 within H30R1 (range, 3 to 12 SNVs) and 11 within H30Rx (range, 0 to 21). The four isolates with identical core genomes were all H30Rx. Epidemiological and clinical characteristics did not vary significantly by strain type, but many patients with MDR E. coli or H30Rx infection were critically ill and had poor outcomes. H30Rx isolates characteristically exhibited fluoroquinolone resistance and CTX-M-15 production, had a high prevalence of trimethoprim-sulfamethoxazole resistance (89%), sul1 (89%), and dfrA17 (85%), and were enriched for specific virulence traits, and all qualified as extraintestinal pathogenic E. coli. The high overall prevalence of CTX-M-15 appeared to be possibly attributable to its association with the ST131-H30Rx subclone and IncFF2:A1:B− plasmids. Some phylogenetically clustered non-ST131 MDR E. coli isolates also had distinctive serotypes/fimH types, fluoroquinolone mutations, CTX-M variants, and IncF types. Thus, WGS analysis of our community hospital source MDR E. coli isolates suggested ongoing circulation and differentiation of E. coli ST131 subclones, with clonal segregation of CTX-M variants, other resistance genes, Inc-type plasmids, and virulence genes.
The composition of perovskite has been optimized combinatorially such that it often contains six components (A
B
C
PbX
Y
) in state-of-art perovskite solar cells. Questions remain regarding the ...precise role of each component, and the lack of a mechanistic explanation limits the practical exploration of the large and growing chemical space. Here, aided by transient photoluminescence microscopy, we find that, in perovskite single crystals, carrier diffusivity is in fact independent of composition. In polycrystalline thin films, the different compositions play a crucial role in carrier diffusion. We report that methylammonium (MA)-based films show a high carrier diffusivity of 0.047 cm
s
, while MA-free mixed caesium-formamidinium (CsFA) films exhibit an order of magnitude lower diffusivity. Elemental composition studies show that CsFA grains display a graded composition. This curtails electron diffusion in these films, as seen in both vertical carrier transport and surface potential studies. Incorporation of MA leads to a uniform grain core-to-edge composition, giving rise to a diffusivity of 0.034 cm
s
in CsMAFA films. A model that invokes competing crystallization processes allows us to account for this finding, and suggests further strategies to achieve homogeneous crystallization for the benefit of perovskite optoelectronics.
Humoral responses to coronavirus disease 2019 (COVID-19) vaccines are attenuated in solid organ transplant recipients (SOTRs), necessitating additional booster vaccinations. The Omicron variant ...demonstrates substantial immune evasion, and it is unknown whether additional vaccine doses increase neutralizing capacity versus this variant of concern (VOC) among SOTRs.
Within an observational cohort, 25 SOTRs with low seroresponse underwent anti-severe acute respiratory syndrome coronavirus 2 spike and receptor-binding domain immunoglobulin (Ig)G testing using a commercially available multiplex ELISA before and after a fourth COVID-19 vaccine dose (D4). Surrogate neutralization (percent angiotensin-converting enzyme 2 inhibition %ACE2i, range 0%-100% with >20% correlating with live virus neutralization) was measured against full-length spike proteins of the vaccine strain and 5 VOCs including Delta and Omicron. Changes in IgG level and %ACE2i were compared using the paired Wilcoxon signed-rank test.
Anti-receptor-binding domain and anti-spike seropositivity increased post-D4 from 56% to 84% and 68% to 88%, respectively. Median (interquartile range) anti-spike antibody significantly increased post-D4 from 42.3 (4.9-134.2) to 228.9 (1115.4-655.8) World Health Organization binding antibody units. %ACE2i (median interquartile range) also significantly increased against the vaccine strain (5.8% 0%-16.8% to 20.6% 5.8%-45.9%) and the Delta variant (9.1% 4.9%-12.8% to 17.1% 10.3%-31.7%), yet neutralization versus Omicron was poor, did not increase post-D4 (4.1% 0%-6.9% to 0.5% 0%-5.7%), and was significantly lower than boosted healthy controls.
Although a fourth vaccine dose increases anti-spike IgG and neutralizing capacity against many VOCs, some SOTRs may remain at high risk for Omicron infection despite boosting. Thus, additional protective interventions or alternative vaccination strategies should be urgently explored.
Electrochemical impedance spectroscopy (EIS) has been used to obtain insight into corrosion processes for three Pd-Ag alloys, and compare their behavior with an Au-Pd alloy. Five specimens of each ...alloy received clinically-appropriate simulated porcelain-firing heat treatment. EIS testing was performed at ambient temperature, using 0.09% NaCl, 0.9% NaCl and Fusayama solutions. EIS data are presented as Bode plots. At the open-circuit potential (OCP), the data fit a modified Randles equivalent electrical circuit with a constant phase element (CPE), and the charge-transfer resistance (R
) and the two CPE parameters (CPE-T and CPE-P) were determined. The area-normalized capacitance of the double layer (C
) was also calculated. The EIS data at two relevant elevated potentials in the passive range were also found to fit well a modified Randles equivalent circuit with different values for the charge transfer resistance and CPE parameters. At the OCP no significant effect on R
was found for the alloys and electrolytes, and both alloy and electrolyte significantly affected CPE-P. In vitro corrosion was controlled by charge transfer and charge accumulation processes, and the behavior differed at the elevated potentials compared to the OCP. Significant effects were found for alloy, electrolyte, and alloy/electrolyte interaction on C
at the OCP. The EIS parameters at elevated potentials indicate that the Pd-Ag alloys should have satisfactory clinical corrosion resistance. The EIS analyses yielded information about in vitro corrosion of these alloys that cannot be obtained from potentiodynamic polarization testing.
Kidney transplant recipients (KTRs) develop decreased antibody titers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination compared to healthy controls (HCs), but whether KTRs ...generate antibodies against key epitopes associated with neutralization is unknown. Plasma from 78 KTRs from a clinical trial of third doses of SARS-CoV-2 vaccines and 12 HCs underwent phage display immunoprecipitation and sequencing (PhIP-Seq) to map antibody responses against SARS-CoV-2. KTRs had lower antibody reactivity to SARS-CoV-2 than HCs, but KTRs and HCs recognized similar epitopes associated with neutralization. Thus, epitope gaps in antibody breadth of KTRs are unlikely responsible for decreased efficacy of SARS-CoV-2 vaccines in this immunosuppressed population. Clinical Trials Registration. NCT04969263.
Neutralizing antibody (nAb) responses are attenuated in solid organ transplant recipients (SOTRs) despite severe acute respiratory syndrome-coronavirus-2 vaccination. Preexposure prophylaxis (PrEP) ...with the antibody combination tixagevimab and cilgavimab (T+C) might augment immunoprotection, yet in vitro activity and durability against Omicron sublineages BA.4/5 in fully vaccinated SOTRs have not been delineated. Vaccinated SOTRs, who received 300 + 300 mg T+C (ie, full dose), within a prospective observational cohort submitted pre and postinjection samples between January 31, 2022, and July 6, 2022. The peak live virus nAb was measured against Omicron sublineages (BA.1, BA.2, BA.2.12.1, and BA.4), and surrogate neutralization (percent inhibition of angiotensin-converting enzyme 2 receptor binding to full length spike, validated vs live virus) was measured out to 3 months against sublineages, including BA.4/5. With live virus testing, the proportion of SOTRs with any nAb increased against BA.2 (47%-100%; P < .01), BA.2.12.1 (27%-80%; P < .01), and BA.4 (27%-93%; P < .01), but not against BA.1 (40%-33%; P = .6). The proportion of SOTRs with surrogate neutralizing inhibition against BA.5, however, fell to 15% by 3 months. Two participants developed mild severe acute respiratory syndrome-coronavirus-2 infection during follow-up. The majority of fully vaccinated SOTRs receiving T+C PrEP achieved BA.4/5 neutralization, yet nAb activity commonly waned by 3 months postinjection. It is critical to assess the optimal dose and interval of T+C PrEP to maximize protection in a changing variant climate.
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