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A fundamental question in the study of chemical reactions is how reactions proceed at a collision energy close to absolute zero. This question is no longer hypothetical: quantum degenerate gases of atoms and molecules can now be created at temperatures lower than a few tens of nanokelvin. Here we consider the benchmark ultracold reaction between, the most-celebrated ultracold molecule, KRb and K. We map out an accurate ab initio ground-state potential energy surface of the K 2 Rb complex in full dimensionality and report numerically-exact quantum-mechanical reaction dynamics. The distribution of rotationally resolved rates is shown to be Poissonian. An analysis of the hyperspherical adiabatic potential curves explains this statistical character revealing a chaotic distribution for the short-range collision complex that plays a key role in governing the reaction outcome. Studying chemical reactions near zero temperature in detail is challenging both in theory and practice. Here the authors report an explicit quantum mechanical study of the benchmark ultracold reaction between a K atom and a KRb molecule, important for future controlled chemistry experiments.

This book explores the use of the motif of hope within African American preaching during slavery (1803-1865) and the post-Civil War era (1865-1896). It discusses the presentation of the motif of hope from a historical perspective and how often this motif changed, though in some instances it remained the same despite the changing of its historical context. Futhermore, this discussion illuminates a realty that hope has been a theme of importance throughout the history of African American preaching.

Aim To determine the efficacy of 2.0 mg aflibercept in the management of patients with recalcitrant exudative age-related macular degeneration (AMD). Methods In this prospective, open-label, single-arm clinical trial, patients were seen monthly and given mandatory 2.0 mg aflibercept at baseline, months 1, 2 and 4. Pro re nata (PRN) retreatment at months 3 and 5 was performed upon evidence of disease on spectral domain-optical coherence tomography (SD-OCT). End point at month 6: mean change in Early Treatment Diabetic Retinopathy Study best corrected visual acuity (ETDRS BCVA) and central subfield thickness (CST), mean number of aflibercept injections, percentage of PRN injections required, patients with no fluid on SD-OCT and patients losing >15 letters. Results At baseline, 46 patients with a mean of 42 prior antivascular endothelial growth factor-A (anti-VEGF) intravitreal treatments had a mean of 74.2 letters (Snellen equivalent 20/32) and mean CST of 347 µm. ETDRS letters remained stable throughout the trial; at month 6, mean BCVA change was +0.2 letters (range −10 to +13, p=0.71). Anatomically, mean CST improved significantly from baseline at each study visit including −23.6 µm at month 1 and −27.3 µm at month 6 (p=0.018). Seventy-one of 90 (79%) possible PRN injections were required and a mean of 5.6 aflibercept injections out of the maximum six were administered. Ten of 45 (22%) patients had no retinal fluid on SD-OCT at month 6. No patient lost >15 letters. Conclusions Aflibercept 2.0 mg treatment maintained mean visual acuity improvements previously achieved with high-dose 2.0-mg ranibizumab injections in recalcitrant wet AMD patients. Aflibercept 2.0 mg treatment led to significant anatomic improvement and was required monthly in most patients. Clinical Trials Registration FDA IND#12462. NCT 01543568. Trial Details IND 12462, NCT 01543568 http://clinicaltrials.gov/show/NCT01543568.

The ability to identify wall motion abnormalities may be useful for emergency clinicians, but is not typically evaluated in point-of-care echocardiograms. We sought to determine if emergency physicians with basic training in emergency echocardiography could identify regional wall motion abnormalities (RWMA) in patients admitted with ST-elevation myocardial infarction (STEMI). We prospectively enrolled patients with admitted with STEMI. Resident physicians with basic training in emergency ultrasound, blinded to other patient data, performed a point-of-care echocardiogram to evaluate for RWMA. If present, they also recorded the suspected territory of the RWMA. We calculated test performance characteristics and compared the agreement between point-of-care and comprehensive echocardiogram for RWMA and territory. 75 patients with STEMI were enrolled, and 62% had a RMWA. RWMA were identified with excellent test performance characteristics (sensitivity 88% (95% CI 75–96); specificity 92% (95% CI 75–99)). There was substantial agreement between the point-of-care echocardiogram and reference standard (K = 0.79; 95% CI: 0.64–0.94). Emergency physicians with core training in point-of-care echocardiography can accurately identify RMWA.

Accurate quantification of retinal surface area from ultra-widefield (UWF) images is challenging due to warping produced when the retina is projected onto a two-dimensional plane for analysis. By accounting for this, the authors sought to precisely montage and accurately quantify retinal surface area in square millimeters. Montages were created using Optos 200Tx (Optos, Dunfermline, U.K.) images taken at different gaze angles. A transformation projected the images to their correct location on a three-dimensional model. Area was quantified with spherical trigonometry. Warping, precision, and accuracy were assessed. Uncorrected, posterior pixels represented up to 79% greater surface area than peripheral pixels. Assessing precision, a standard region was quantified across 10 montages of the same eye (RSD: 0.7%; mean: 408.97 mm(2); range: 405.34-413.87 mm(2)). Assessing accuracy, 50 patients' disc areas were quantified (mean: 2.21 mm(2); SE: 0.06 mm(2)), and the results fell within the normative range. By accounting for warping inherent in UWF images, precise montaging and accurate quantification of retinal surface area in square millimeters were achieved.

Background/AimsProspectively evaluate outcomes in the third year of neovascular age-related macular degeneration (AMD) management using ranibizumab with continued treat and extend (TREX) dosing compared with monthly visits with retreatment upon evidence of exudative disease activity (PRN, pro re nata).MethodsSubjects with treatment-naïve neovascular AMD were randomised 1:2 to Monthly or TREX and managed through 2 years. In the third year, subjects randomised to Monthly were managed PRN while subjects randomised to TREX were continued on TREX dosing or transitioned to PRN after achieving an interval of 12 weeks between visits.ResultsSixty subjects enrolled and 46 (77%) completed month 36 (M36). Transition from Monthly to PRN was associated with a decline in best corrected visual acuity (BCVA) (+10.5 letters (month 24) to +5.4 (M36, p=0.09)); three (15%) subjects required no dosing during year 3, and 47% (114/243) of possible PRN injections were delivered, yielding a mean of 6.1 injections during year 3. Among the 9 (23%) TREX subjects transitioned to PRN, the need for ongoing anti-vascular endothelial growth factor retreatments was small, with 4 (4%) intravitreal injections being delivered among 106 PRN visits; this subgroup displayed an inferior BCVA trajectory compared with the remainder of subjects. Outcomes among subjects continued on TREX were more favourable, with a mean gain of +5.0 letters at M36.ConclusionsUpon transition to PRN, subjects randomised to monthly dosing experienced a decline in BCVA. Among subjects initially randomised to TREX who transitioned to PRN after achieving a 12-week interval between visits, the overall need for additional treatment was low.Trial registration numberNCT01748292, Results.

Arthritis is a common chronic disease, affecting an estimated 53.2 million adults (21.2%) in the US. \"Arthritis\" is a general term, describing over 100 conditions with different etiologies, pathogeneses, symptoms, and treatments. Few studies have examined the prevalence and distribution of arthritis subtypes in the US. We used National Health and Nutrition Examination Survey data from 2017 to March 2020 to estimate the prevalence of arthritis subtypes overall and by sociodemographic characteristics. The overall prevalence of any type of diagnosed arthritis among US adults aged 20 years or older in this study was 27.9% (67.1 million). Among adults with diagnosed arthritis, osteoarthritis (49.6%, 33.2 million) was the most common arthritis subtype, followed by rheumatoid arthritis (15.8%, 10.6 million) and psoriatic arthritis (1.4%, 1.0 million). More than 1 in 10 reported some other type of unlisted arthritis (11.5%, 7.7 million), and 1 in 5 did not know their arthritis subtype (21.6%, 14.4 million). Prevalence of not knowing arthritis type was approximately 1 in 4 for adults identifying as non-Hispanic Black (26.7%) or other Hispanic (29.5%) and for adults who reported low family income (26.7%) and was approximately 1 in 3 for adults identifying as Mexican American (31.9%), having less than a high school education (31.8%), or not having health insurance (36.1%). Understanding arthritis type is important for improving treatment, self-management, and health outcomes associated with arthritis. Improving organizational and personal health literacy are potential strategies that may reduce the prevalence of not knowing arthritis type.

The first version of the UNCITRAL Arbitration Rules was endorsed by the General Assembly of the United Nations in December 1976. Now considered one of UNCITRAL's greatest successes, the rules have had an extraordinary impact on international arbitration as both instruments in their own right and as guides for others. The Iran-US Claims Tribunal, for example, employs a barely modified version of the rules for all claims, and many multilateral and bilateral foreign investment treaties adopt the UNCITRAL Rules as an arbitral procedure. The Rules are so pervasive and the consequences of the new version potentially so significant that they cannot be ignored. This commentary on the Rules brings the official documents together in one volume and includes the insights and experiences of the Working Group that are not included in the official reports.

IntroductionPatients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia are at a higher risk of acute exacerbations (AEs) compared to those without hypercapnia. Long-term non-invasive ventilation (LT-NIV) can reduce this risk, but its effectiveness may be diminished in patients with coexisting bronchiectasis. It remains unclear whether bronchiectasis independently increases the risk of AEs in patients with chronic hypercapnic COPD receiving LT-NIV.MethodsWe retrospectively identified 335 patients with chronic hypercapnic COPD who were initiated on LT-NIV at our tertiary ventilation centre between September 2011 and September 2023, with follow-up continuing until January 2025. Bronchiectasis was diagnosed based on chest CT findings, and severity was quantified using the Bronchiectasis Severity Index (BSI) and the FACED score. Clinical data at LT-NIV initiation and during follow-up were analysed and compared between patients with and without bronchiectasis. A Cox-regression analysis was conducted to evaluate the impact of bronchiectasis on AEs.ResultsThe median follow-up time was 26 months. Ninety-five patients (28.4%) were diagnosed with bronchiectasis. Prior to LT-NIV initiation, patients with bronchiectasis experienced more exacerbations than those without (median (IQR): 4 (2–4) vs. 3 (2–5); p=0.02). However, bronchiectasis was not associated with exacerbation-free survival after LT-NIV initiation (p=0.24). Notably, patients with bronchiectasis had significantly shorter infective exacerbation-free survival (p=0.04). A higher BSI score prior to LT-NIV initiation was significantly correlated with increased total exacerbations (ρ=0.51, p<0.01) and infective exacerbations (ρ=0.34, p<0.01), but not with exacerbation-free survival after LT-NIV initiation (both p>0.05). The FACED score showed no correlation with exacerbations before or after LT-NIV initiation.ConclusionCoexisting Bronchiectasis increases the risk of infective exacerbations in patients with chronic hypercapnic COPD receiving LT-NIV. This highlights the importance of actively screening for and managing bronchiectasis in this patient population.

Reduced male aggression towards different phenotypes generating negative frequency-dependent intrasexual selection has been suggested as a mechanism to facilitate the invasion and maintenance of novel phenotypes in a population. To date, the best empirical evidence for the phenomenon has been provided by laboratory studies on cichlid fish with different colour polymorphisms. Here we experimentally tested the hypothesis in a natural population of Lake Malawi cichlid fish, in which males build sand-castles (bowers) to attract females during seasonal leks. We predicted that if bower shape plays an important role in male aggressive interactions, aggression among conspecific males should decrease when their bower shape is altered. Accordingly, we allocated randomly chosen bowers in a Nyassachromis cf. microcephalus lek into three treatments: control, manipulated to a different shape, and simulated manipulation. We then measured male behaviours and bower shape before and after these treatments. We found that once bower shape was altered, males were involved in significantly fewer aggressive interactions with conspecific males than before manipulation. Mating success was not affected. Our results support the idea that an extended phenotype, such as bower shape, can be important in maintaining polymorphic populations. Specifically, reduced male conspecific aggression towards males with different extended phenotypes (here, bower shapes) may cause negative frequency-dependent selection, allowing the invasion and establishment of a new phenotype (bower builder). This could help our understanding of mechanisms of diversification within populations, and in particular, the overall diversification of bower shapes within Lake Malawi cichlids.