Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) have been considered prevalent pathogens in foot infections. However, whether empiric therapy directed against these organisms is necessary, and in whom to consider treatment, is rather unclear. The aim of this study was to develop predictive algorithms for forecasting the probability of isolating these organisms in the infected wounds of patients in a population where the prevalence of resistant pathogens is low. This was a retrospective study of regression model-based risk factor analysis that included 140 patients who presented with infected, culture positive foot ulcers to two urban hospitals. A total of 307 bacteria were identified, most frequently MRSA (11.1%). P. aeruginosa prevalence was 6.5%. In the multivariable analysis, amputation (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.48–27.63), renal disease (OR 5.46, 95% CI 1.43–25.16) and gangrene (OR 2.78, 95% CI 0.82–9.59) were identified as risk factors associated with higher while diabetes (OR 0.07, 95% CI 0.01–0.34) and Infectious Diseases Society of America infection severity >3 (OR 0.18, 95% CI 0.03–0.65) were associated with lower odds of P. aeruginosa isolation (C statistic 0.81). Similar analysis for MRSA showed that amputation was associated with significantly lower (OR 0.29, 95% CI 0.09–0.79) risk, while history of MRSA infection (OR 5.63, 95% CI 1.56–20.63) and osteomyelitis (OR 2.523, 95% CI 1.00–6.79) was associated with higher odds of isolation (C statistic 0.69). We developed two predictive nomograms with reasonable to strong ability to discriminate between patients who were likely of being infected with P. aeruginosa or MRSA and those who were not. These analyses confirm the association of some, but also question the significance of other frequently described risk factors in predicting the isolation of these organisms.

Absolute K-shell ionization cross sections were measured for Ti, Co, Ge, Rb, and Sn for incident oxygen ions from 16-44 MeV. The x-rays were measured with a high resolution Si(Li) detector (166 eV at 5.9 keV). All of the data represents cross section measurements for thin targets. The measured cross sections for these elements are compared to the theoretical predictions of the Binary Encounter Approximation (BEA). Kα/Kβ ratios and energy shifts were also extracted from the data. The experimental data are compared to measured cross sections for other elements to give an overview of the systematics for oxygen ion induced x-ray production cross sections in this energy range. Some comment will also be given in regard to the use of oxygen ions to measure the parameters associated with ion implanted semiconductors.

Seismograms acquired on the McMurdo Ice Shelf, Antarctica, during an Austral summer melt season (November 2016–January 2017) reveal a diurnal cycle of seismicity, consisting of hundreds of thousands of small ice quakes limited to a 6–12 hour period during the evening, in an area where there is substantial subsurface melting. This cycle is explained by thermally induced bending and fracture of a frozen surface superimposed on a subsurface slush/water layer that is supported by solar radiation penetration and absorption. A simple, one-dimensional model of heat transfer driven by observed surface air temperature and shortwave absorption reproduces the presence and absence (as daily weather dictated) of the observed diurnal seismicity cycle. Seismic event statistics comparing event occurrence with amplitude suggest that the events are generated in a fractured medium featuring relatively low stresses, as is consistent with a frozen surface superimposed on subsurface slush. Waveforms of the icequakes are consistent with hydroacoustic phases at frequency $ {\bf \gt} \bf 75\,{\bf Hz}$ and flexural-gravity waves at frequency $ \bf {\bf \lt}25\,{\bf Hz}$ . Our results suggest that seismic observation may prove useful in monitoring subsurface melting in a manner that complements other ground-based methods as well as remote sensing.

Using an age-structured process-based simulation model for diamondback moth (DBM), we model the population dynamics of this major Brassica pest using the cropping practices and climate of Guangdong, China. The model simulates two interacting sub-populations (demes), each representing a short season crop. The simulated DBM abundance, and hence pest problems, depend on planting regime, crop hygiene and biological control. A continuous supply of hosts, a low proportion of crop harvested and long residue times between harvest and replanting each exacerbate pest levels. Biological control provided by a larval parasitoid can reduce pest problems, but not eliminate them when climate is suitable for DBM and under certain planting practices. The classic Integrated Pest Management (IPM) method of insecticide application, when pest threshold is reached, proved effective and halved the number of insecticide sprays when compared with the typical practice of weekly insecticide application.

OBJECTIVES/SPECIFIC AIMS: MDSCs are potent suppressors of T cell function, and have been recently found to be implicated in skin diseases driven by T cell dysregulation. However, the function of MDSCs in CLE is poorly understood. We sought to characterize the MDSC population in the peripheral blood of DLE patients and evaluate their ability to suppress autologous T cells. METHODS/STUDY POPULATION: All patients were recruited through the UT Southwestern Cutaneous Lupus Registry. PBMCs from 32 CLE patients and 16 age-matched and gender-matched controls were analyzed using flow cytometry. Monocytic MDSCs were identified by the phenotype of CD14+ HLA-DR neg/low. Furthermore, autologous MDSCs and T cells were purified from CLE PBMCs (n=4) and co-cultured at different ratios of these cells. T cell function was measured by secretion of IFN-γ by ELISA. RESULTS/ANTICIPATED RESULTS: Monocytic MDSCs in CLE PBMCs (median: 2.04%, IQR: 0.67%–5.07%) were significantly higher compared with healthy control PBMCs (median: 0.5%, IQR: 0.1%–1.07%, p=0.002). Although not significant on subset analysis, patients with CLE limited to the head and neck had the highest levels of MDSCs. CLE MDSCs (n=4) were found to suppress autologous activated T-cells in a dose-dependent manner. DISCUSSION/SIGNIFICANCE OF IMPACT: In this cross-sectional study of patients of the UT Southwestern Cutaneous Lupus Registry, we observed differences in the levels of MDSCs among PBMCs of CLE patients Versus healthy controls. CLE patients had significantly higher levels of MDSCs, which could be explained by the presence of an inflammatory state in this group. Furthermore, CLE MDSCs were able to suppress autologous T cells, showing that these cells are functionally patent in CLE blood. Their up-regulation in CLE blood may represent the body’s response to limiting disease severity, since most patients had mild disease activity.

The main goal of this paper is to provide insights into swash flow dynamics, generated by a non-breaking solitary wave on a steep slope. Both laboratory experiments and numerical simulations are conducted to investigate the details of runup and rundown processes. Special attention is given to the evolution of the bottom boundary layer over the slope in terms of flow separation, vortex formation and the development of a hydraulic jump during the rundown phase. Laboratory experiments were performed to measure the flow velocity fields by means of high-speed particle image velocimetry (HSPIV). Detailed pathline patterns of the swash flows and free-surface profiles were also visualized. Highly resolved computational fluid dynamics (CFD) simulations were carried out. Numerical results are compared with laboratory measurements with a focus on the velocities inside the boundary layer. The overall agreement is excellent during the initial stage of the runup process. However, discrepancies in the model/data comparison grow as time advances because the numerical model does not simulate the shoreline dynamics accurately. Introducing small temporal and spatial shifts in the comparison yields adequate agreement during the entire rundown process. Highly resolved numerical solutions are used to study physical variables that are not measured in laboratory experiments (e.g. pressure field and bottom shear stress). It is shown that the main mechanism for vortex shedding is correlated with the large pressure gradient along the slope as the rundown flow transitions from supercritical to subcritical, under the developing hydraulic jump. Furthermore, the bottom shear stress analysis indicates that the largest values occur at the shoreline and that the relatively large bottom shear stress also takes place within the supercritical flow region, being associated with the backwash vortex system rather than the plunging wave. It is clearly demonstrated that the combination of laboratory observations and numerical simulations have indeed provided significant insights into the swash flow processes.

Introduction: Mentorship is an essential component of professional development and benefits include increased career satisfaction, scholarship, and efficiency of academic promotion. The Mastermind group, a collaborative, network-based model for mentorship has gained popularity in the business world. It comprises of a group of colleagues that provide mentorship and career advice for each other through regularly scheduled meetings. The group benefits from the combined intelligence and accumulated experience of the participants, who may be at different career stages. Methods: Academic Life in Emergency Medicine (ALiEM; www.aliem.com), a digital health professions education organization, conducted two Mastermind groups for 14 team members in 2017. The groups included all levels of academic rank from full professor to instructors, and represented 14 different medical schools in North America. Each Mastermind group completed a self-assessment summarizing their professional strengths and weaknesses, two homework assignments, and two 90-minute videoconference meetings, using a structured, moderator-facilitated format. Meetings were conducted on Google Hangouts on Air© (Google Inc.). In the initial group meeting, participants discussed their self-assessments, current projects, and career challenges. The second meeting allowed discussion of suggested professional development resources for each participant, actionable next steps, and an accountability timeline for each participant. The free, cloud-based platforms and voluntary basis for the Mastermind groups resulted in a zero-cost innovation. Results: In a post-intervention survey, the 14 participants rated the experience as 9.4/10 (response rate 100%) using a Likert scale. In a quasi-experimental analysis participants cited the need for career advice or assistance with a project as their reason for participating. Participants received specific resource recommendations during the sessions, including books, training courses, or conferences. Contacts outside the group for additional mentorship were made possible given the breadth of networks among the participants. All participants had at least one identifiable next step with accountability to the group. Overall, the participants described a synergy of energy, commitment to one anothers longitudinal success, and benefit from the diverse range of talent and expertise in the group. Many of the members discussed plans to replicate this mentorship model at their own institutions. Conclusion: Our experiences suggest that the Mastermind conceptual framework is an easily replicated, feasible, zero-cost, and effective model for professional development. Though the model was originally proposed as a method for in-person discussions, we report a more modern, online experience for professional development in our diverse, globally-distributed team.

Introduction: The Emergency Medicine Chief Resident Incubator is a year-long curriculum for chief residents that aims to provide participants with a virtual community of practice, formal administrative training, mentorship, and opportunities for scholarship. Methods: The Chief Resident Incubator was designed by Academic Life in Emergency Medicine (ALiEM; www.aliem.com) a digital health professions education organization in 2015, following a needs assessment in emergency medicine. A 12-month curriculum was created using constructivist social learning theory, with specific learning objectives that reflected 11 key administrative or professional development domains deemed important to chief residents. The topics covered included interviewing skills, contract negotiations, leadership, coaching, branding, conflict resolution, and ended with a focus on wellness and career longevity. A Core Leadership Team and Virtual Mentors were recruited to lead each annual iteration of the curriculum. The Incubator was implemented as a virtual community of practice using Slack©, a messaging and digital communication platform. Ancillary technology such as Google Hangout on Air© and Mailchimp© were used to facilitate learner engagement with the curriculum. Three in person networking events were hosted at three large emergency medicine and education conferences with special medical education guests. Outcomes include chief resident participation rates, Slack© activity, Google Hangout© web analytics, newsletter email engagement, and scholarship. We also incorporated a hidden curriculum throughout the year with multiple online publications, competitions for guest grand round presentations, and incorporation of digital technologies in medical education. Results: A total of 584 chief residents have participated over the first 3 years of the Chief Resident Incubator; this includes chief residents from over 212 residency programs across North America. Over 27,000 messages have been shared on Slack© (median 214 per week). A total of 32 Google Hangouts© have occurred over the course of the inaugural Incubator including faculty mentorship from Dr. Rob Rogers, Dr. Dara Kass and Dr. Amal Mattu. A monthly newsletter was distributed to the participants with an opening rate of 59%. Scholarship included 26 published academic blog posts, 2 open access In-Training exam prepbooks, a senior level online curriculum with 9 published modules and 3 book club reviews. Conclusion: The Chief Resident Incubator is a virtual community of practice that provides longitudinal training and mentorship for chief residents. This Incubator framework may be used to design similar professional development curricula across various health professions using an online digital platform.

The worldwide population of the leatherback turtle (Dermochelys coriacea) encompasses seven subpopulations among the Pacific, Atlantic and Indian Oceans. It has experienced declines across parts of its distribution, with the subpopulation of the South-west Atlantic listed as critically endangered by the IUCN Red List. The main threats to this subpopulation include its interaction with fisheries, coastal development, pollution and climate change. In this study, we sequenced mitochondrial DNA from 52 leatherback turtles in Brazil and combined these with published data from other Atlantic Ocean rookeries. The haplotype diversities of the Atlantic population rookeries ranged from 0.112 to 0.533 and are not directly proportional to current rookery sizes. The Brazilian rookery, despite recording low nest numbers per year, had the second-highest haplotype diversity among all Atlantic rookeries (h = 0.532). A mixed-stock analysis revealed that the South American pelagic aggregate is primarily composed of individuals from West Africa (84%), with contributions from the North Atlantic rookeries (14%). Leatherback turtles appear to have a complex phylogeographic pattern, showing evidence of multiple colonization events and a lack of isolation by distance. Our novel dataset, based on DNA sequences of 695 base pairs, will provide baseline data needed to understand population dynamics in the region, building comprehensive population assessments to support and develop management strategies. Having both the only known regular rookery in the South-west Atlantic, and a mixed-origin foraging area for the species along its coast, Brazil has a key role in the conservation of the leatherback turtle.

Hepatitis C virus (HCV) infection is one of the leading causes of death and morbidity associated with liver disease. Risk factors identified for the transmission of HCV include contaminated blood products, intravenous drug use, body piercing, an infected mother at birth, sexual activity, and dental therapy, among others. However, the exact diversity of the HCV genotype and genetic variation among patients with low-risk factors is still unknown. In this study, we briefly described and analysed the genotype distribution and genetic variation of HCV infections with low-risk factors using molecular biology techniques. The results suggested that genotype 1b was predominant, followed by genotypes 2a and 1a. Genetic variations in the 5′ UTR sequences of HCV were identified, including point mutations, deletions, and insertions. The frequency of genetic variations in 1b was higher than in 2a. This study provides considerable value for the prevention and treatment of liver disease caused by HCV among patients with low-risk factors and for the development of HCV diagnostic reagents and vaccines.

The Yellow Sea region is of high global importance for waterbird populations, but recent systematic bird count data enabling identification of the most important sites are relatively sparse for some areas. Surveys of waterbirds at three sites on the coast of southern Jiangsu Province, China, in 2014 and 2015 produced peak counts of international importance for 24 species, including seven globally threatened and six Near Threatened species. The area is of particular global importance for the ‘Critically Endangered’ Spoon-billed Sandpiper Calidris pygmaea (peak count across all three study sites: 62 in spring [2015] and 225 in autumn [2014] and ‘Endangered’ Spotted Greenshank Tringa guttifer (peak count across all three study sites: 210 in spring [2014] and 1,110 in autumn [2015]). The southern Jiangsu coast is therefore currently the most important migratory stopover area in the world, in both spring and autumn, for both species. Several serious and acute threats to waterbirds were recorded at these study sites. Paramount is the threat of large-scale land claim which would completely destroy intertidal mudflats of critical importance to waterbirds. Degradation of intertidal mudflat habitats through the spread of invasive Spartina, and mortality of waterbirds by entrapment in nets or deliberate poisoning are also real and present serious threats here. Collisions with, and displacement by, wind turbines and other structures, and industrial chemical pollution may represent additional potential threats. We recommend the rapid establishment of effective protected areas for waterbirds in the study area, maintaining large areas of open intertidal mudflat, and the urgent removal of all serious threats currently faced by waterbirds here.

Higher carbohydrate intake, glycaemic index (GI), and glycaemic load (GL) are hypothesised to increase cancer risk through metabolic dysregulation of the glucose-insulin axis and adiposity-related mechanisms, but epidemiological evidence is inconsistent. This prospective cohort study investigates carbohydrate quantity and quality in relation to risk of adiposity-related cancers, which represent the most commonly diagnosed preventable cancers in the USA. In exploratory analyses, associations with three site-specific cancers: breast, prostate and colorectal cancers were also examined. The study sample consisted of 3184 adults from the Framingham Offspring cohort. Dietary data were collected in 1991–1995 using a FFQ along with lifestyle and medical information. From 1991 to 2013, 565 incident adiposity-related cancers, including 124 breast, 157 prostate and sixty-eight colorectal cancers, were identified. Cox proportional hazards models were used to evaluate the role of carbohydrate nutrition in cancer risk. GI and GL were not associated with risk of adiposity-related cancers or any of the site-specific cancers. Total carbohydrate intake was not associated with risk of adiposity-related cancers combined or prostate and colorectal cancers. However, carbohydrate consumption in the highest v. lowest quintile was associated with 41 % lower breast cancer risk (hazard ratio (HR) 0·59; 95 % CI 0·36, 0·97). High-, medium- and low-GI foods were not associated with risk of adiposity-related cancers or prostate and colorectal cancers. In exploratory analyses, low-GI foods, were associated with 49 % lower breast cancer risk (HR 0·51; 95 % CI 0·32, 0·83). In this cohort of Caucasian American adults, associations between carbohydrate nutrition and cancer varied by cancer site. Healthier low-GI carbohydrate foods may prevent adiposity-related cancers among women, but these findings require confirmation in a larger sample.

A new method, called Cloud of Points (COP) Reconstruction, is proposed in the present work to extend the meshfree method to simulate viscous flows. With the characters of viscous flows, the anisotropic COP structure is distributed in boundary layer. The proposed method can improve the anisotropic COP structure to isotropic COP structure and reduce the condition number of the least square coefficient matrix for conventional meshfree method. The values of the new reconstructed points are calculated by the Lagrange interpolation. The accuracy and the robustness of the presented meshfree solver are demonstrated on a number of standard test cases, including the functions with analytical gradients and the viscous flows past NACA0012 airfoil. The comparison of the simulation results with the experimental data and other numerical simulation data are also investigated.

Interfacial instabilities of immiscible radial displacements in homogeneous porous media are analysed in the case of sinusoidal injection flows. The analysis is carried out through numerical simulations based on the immersed interface and level set methods. Investigations of the effects of the period of the sinusoidal injection flows revealed a novel resonance effect where, for a critical period, the number of fingers as well as their structures are considerably changed. The resonance in the flow development is clearly identified through the abrupt changes in the Fourier spectrum of the interface as well as quantitative characteristics of the flow in the form of the minimum and maximum radii of the interface. For the range of parameters examined in this study that correspond to instabilities dominated by viscous forces, the resonance period was found to correlate with a characteristic time of the flow and the fluids mobility ratio. This new physical phenomenon offers new perspectives for using the flow instability to determine important physical properties such as the viscosity and the surface tension of fluids.

Lithium sulfur (Li–S) batteries have the potential to provide higher energy storage density at lower cost than conventional lithium ion batteries. A key challenge for Li–S batteries is the loss of sulfur to the electrolyte during cycling. This loss can be mitigated by sequestering the sulfur in nanostructured carbon–sulfur composites. The nanoscale characterization of the sulfur distribution within these complex nanostructured electrodes is normally performed by electron microscopy, but sulfur sublimates and redistributes in the high-vacuum conditions of conventional electron microscopes. The resulting sublimation artifacts render characterization of sulfur in conventional electron microscopes problematic and unreliable. Here, we demonstrate two techniques, cryogenic transmission electron microscopy (cryo-TEM) and scanning electron microscopy in air (airSEM), that enable the reliable characterization of sulfur across multiple length scales by suppressing sulfur sublimation. We use cryo-TEM and airSEM to examine carbon–sulfur composites synthesized for use as Li–S battery cathodes, noting several cases where the commonly employed sulfur melt infusion method is highly inefficient at infiltrating sulfur into porous carbon hosts.