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The transport of energy through 1-dimensional (1D) waveguiding channels can be affected by sub-wavelength disorder, resulting in undesirable localization and backscattering phenomena. However, quantized disorder-resilient transport is observable in the edge currents of 2-dimensional (2D) topological band insulators with broken time-reversal symmetry. Topological pumps are able to reduce this higher-dimensional topological insulator phenomena to lower dimensionality by utilizing a pumping parameter (either space or time) as an artificial dimension. Here we demonstrate a temporal topological pump that produces on-demand, robust transport of mechanical energy using a 1D magneto-mechanical metamaterial. We experimentally demonstrate that the system is uniquely resilient to defects occurring in both space and time. Our findings open a path towards exploration of higher-dimensional topological physics with time as a synthetic dimension. A robust time-controlled energy pumping in a classical metamaterial remains to be achieved. Here, Grinberg et al. demonstrate a temporal topological pump that produces on-demand, robust transport of mechanical energy using a one-dimensional magneto-mechanical metamaterial.

Background and challenges Writing and publishing research is important in the fields of orthopaedic surgery, and medicine in general. In recent years, the number of orthopaedic publications has significantly increased, highlighting the value of possessing the ability to write and publish a paper. However, publishing research is not an easy task, especially if English is not a native language. Non-native English speakers have been reported to experience barriers to writing and publishing research in English, the dominant language of scientific publication. This affects not only individual researchers, but also the scientific community in general. To improve reporting in scientific manuscripts, many peer-reviewed guidelines have been published for a variety of study designs and study types. These guidelines are made available through the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network and have associated checklists that guide authors in the synthesis of their research manuscript. Purpose Whether you are a non-native English speaker or a novice research writer, these checklists can ameliorate the process of building your manuscript. The purpose of this paper is to empower orthopaedic researchers, and researchers in general, through an easy-to-follow framework for writing a research manuscript using available checklists and general research knowledge.

To measure the effect of snoring and obstructive sleep apnea (OSA) on the sleep of snorers' bed partners and to determine whether a bed partner's sleep improves when snoring and OSA are treated. We studied 10 married couples in which 1 member was undergoing polysomnography to evaluate suspected OSA. The patients and their spouses underwent simultaneous polysomnography. Midway through the 1-night study, the patients received nasal continuous positive airway pressure (CPAP) with the pressure adjusted to eliminate snoring and obstructive breathing events. Apnea-hypopnea index (episodes/hours of sleep time), arousal index (arousals/hours of sleep time), and sleep efficiency (percent time asleep) were calculated to measure sleep quality. The patients (all male) demonstrated a median (range) apnea-hypopnea index of 26 (3-75) that decreased to 7 (0-34) during the trial of nasal CPAP therapy (P < .05). During the CPAP trial, the median (range) arousal index of the spouses decreased from 21 (14-34) to 12 (4-27) (P < .01), and the spouses' median (range) sleep efficiency increased from 74% (56%-80%) to 87% (64%-95%) (P < .01). The elimination of snoring and OSA in these patients was associated with an improvement in the quality of their bed partners' sleep, as indicated by improved sleep efficiency and continuity, even when the spouses had been habitually exposed to snoring and OSA. Assuming that 480 minutes were spent in bed for sleep, a 13% improvement in sleep efficiency (i.e., from 74% to 87%) translates to an additional 62 minutes of sleep per night for the spouses of snorers with OSA.

Nerinetide is a neuroprotectant effective in preclinical models of acute ischaemic stroke when administered within 3 h of onset. However, the clinical evaluation of neuroprotectants in this short timeframe is challenging. We sought to establish the feasibility, safety, and effectiveness of nerinetide when given before hospital arrival within 3 h of symptom onset of suspected stroke. In this multicentre, randomised, double-blind, placebo-controlled study, paramedics enrolled participants aged 40–95 years within 3 h of suspected severe stroke onset, who were previously independent, and were being taken to one of seven stroke centres in Ontario or British Columbia, Canada. The primary hypothesis was that the administration of nerinetide would result in a higher rate of good functional outcomes. Participants were randomly assigned 1:1 to intravenous nerinetide (2·6 mg/kg) or placebo, each in visually identical vials. Paramedics, hospital care providers, and outcome evaluators were masked to treatment assignment. The primary outcome was good functional outcome on a sliding dichotomy of the modified Rankin Scale at 90 days. Participants were assessed on day 4, 30, and 90 by the stroke center research team, in person or over the telephone. Outcomes, adjusted for age and stroke severity, were evaluated in the modified intention-to-treat (mITT) population, and in the target population of those with acute ischaemic stroke. The safety population included all participants who received the study drug. This study is registered with ClinicalTrials.gov (NCT02315443), and trial enrolment has concluded. Between March 26, 2015, and March 27, 2023, 532 participants received nerinetide (n=265) or placebo (n=267). The mITT population of suspected stroke (n=507; 254 nerinetide and 253 placebo) included 321 (63%) with acute ischaemic stroke, 93 (18%) with intracranial haemorrhage, 44 (9%) with transient ischaemic attack, and 49 (10%) with stroke-mimicking conditions. Treatment began a median of 64 min (IQR 47–100) from symptom onset. Participants randomly assigned to nerinetide had more severe strokes compared with those receiving placebo (median National Institutes of Health Stroke Scale (NIHSS) 12, IQR 5–19 vs 10, 4–18 in mITT, and 14, 7–19 vs 10, 4–18 in the acute ischaemic stroke subgroup). Overall, 145 (57%) of 254 participants in the nerinetide group and 147 (58%) of 253 in the placebo group had the primary outcome of a favourable functional outcome using the prespecified sliding dichotomy at 90 days (adjusted odds ratio 1·05, 95% CI 0·73–1·51; adjusted risk ratio 1·04, 95% CI 0·85–1·25). In the 302 patients with ischaemic stroke, the favourable functional outcome adjusted for arrival NIHSS and age favoured nerinetide (odds ratio 1·53, 0·93–2·52 and risk ratio 1·21, 0·97–1·52). In those given reperfusion therapies (thrombolysis or endovascular thrombectomy, or both) nerinetide was associated with improved favourable functional outcomes (adjusted odds ratio 1·84, 1·03–3·28; adjusted risk ratio 1·29, 1·01–1·65). There was no apparent benefit in haemorrhagic stroke or acute ischaemic stroke without reperfusion. There were no safety concerns. Prehospital nerinetide did not improve neurological functional outcomes in all patients with suspected ischaemic stroke in the mITT population. Nerinetide might benefit patients with acute ischaemic stroke who are selected for reperfusion therapies within 3 h of symptom onset. This finding should be confirmed in a future trial. Brain Canada and NoNO.

In three neuroprotection trials of nerinetide for acute ischaemic stroke, inconclusive results have been reported with respect to the prespecified primary outcome. However, none of the trials faithfully replicated the inclusion criteria of the animal studies that provided the rationale for the clinical trials—ie, treatment within 3 h of stroke onset and selected for reperfusion without previous thrombolysis. We aimed to investigate whether a clinical benefit of nerinetide might be seen in the subgroup of patients enrolled in these three clinical trials who met the criteria used in the animal studies. In this post-hoc individual patient data meta-analysis, we pooled data from the ESCAPE-NA1, ESCAPE-NEXT, and FRONTIER trials, which were done at 135 stroke centres in 13 countries (Canada, Australia, Germany, Ireland, Italy, the Netherlands, Norway, Singapore, South Korea, Sweden, Switzerland, the UK, and the USA). We included all participants who were enrolled within 3 h of acute ischaemic stroke onset, treated with study drug (nerinetide or placebo; randomised 1:1), and selected for reperfusion with thrombolysis, endovascular thrombectomy, or both. The primary endpoint was the number of responders at day 90, which was defined as people with a favourable outcome as per the primary endpoint prespecified in their respective trial. The primary endpoint was analysed by logistic regression, adjusted for age, stroke severity, and trial. Between March 26, 2015, and Jan 31, 2023, 2487 participants were enrolled in the three trials, of whom 690 met criteria for this pooled analysis (389 participants in the nerinetide group and 301 participants in the placebo group). 364 (53%) of 690 participants were men and 326 (47%) were women. The median age of participants was 76 years (IQR 66–83) and median baseline National Institutes of Health Stroke Scale score was 17 (11–21). 216 (56%) of 389 participants were responders at day 90 in the nerinetide group compared with 144 (48%) of 301 in the placebo group (adjusted odds ratio [aOR] 1·48, 95% CI 1·07–2·06; p=0·017). 62 (16%) of 389 people in the nerinetide group died compared with 55 (18%) of 301 people in the placebo group (aOR 0·81, 95% CI 0·53–1·24; p=0·34). No safety concerns were identified in either group. Nerinetide showed a clinically significant benefit over several outcome measures, including the modified Rankin Scale score, the incidence of stroke worsening, and infarction volumes. Neuroprotection with nerinetide might, therefore, be indicated for patients within 3 h of stroke onset and who are selected for reperfusion. These inclusion criteria should be tested in a future trial. None.

When atoms are subjected to different environments in molecules or solid-state materials, the electronic energy levels and general structure of the mutual system are altered away from the pure atomic state. For metals that are bombarded with ion beams, this structure can be complicated and an interplay between theory and materials imaging is required to evaluate these complex materials effects. The Beryllium Electron capture in Superconducting Tunnel junctions (BeEST) experiment currently uses 7Be embedded in superconducting tunnel junction (STJ) sensors to search for physics beyond the Standard Model in the neutrino sector by measuring the eV-scale radiation from 7Li that is emitted in the electron capture (EC) decay of 7Be. Understanding the spatial distribution of the final state 7Li in these superconductors at the eV-scale is thus important for characterizing material effects in these precision experiments, and to-date, represents the first attempt at performing so-called “atomic scale sensor characterization” for subatomic physics detectors.The chemical shifts resulting from the location and distribution of these implanted species in the final state have been estimated to contribute to broadening in the STJ spectrum during Li core-hole relaxation by recent theoretical calculations. In this thesis, atom probe tomography (APT) and transmission electron microscopy (TEM) were used to explore the Li distribution in the Al and Ta columnar polycrystalline layers. The Li concentration and clustering were compared in both purpose-fabricated thin film wafers and STJs for this imaging. The maximum separation method was used to classify clusters at the unit cell scale, as Li-Li interactions at this distance cause shifts in the 1s binding energy. Li clustering was seen in the ultra-high-dose (UHD) thin film wafers. The low concentration of Li in the STJs suggests no clustering within the unit cell. The Li clustering and concentration profiles provide future implantation dose limits. These limits are greater than the projected total implantation dose for future phases of the BeEST experiment. The Li distribution along the grain boundary (GB) was also explored. Li appeared to segregate at GBs in the Al and Ta thin film wafers. Due to low Li concentrations, GB segregation determinations in the Al and Ta STJs were inconclusive. These insights are critical in understanding the specific environment for the Li core-hole and subsequent relaxation.

The BeEST experiment is a precision laboratory search for physics beyond the standard model that measures the electron capture decay of 7Be implanted into superconducting tunnel junction (STJ) detectors. For Phase-III of the experiment, we constructed a continuously sampling data acquisition system to extract pulse shape and timing information from 16 STJ pixels offline. Four additional pixels are read out with a fast list-mode digitizer, and one with a nuclear MCA already used in the earlier limit-setting phases of the experiment. Here, we present the performance of the data acquisition system and discuss the relative advantages of the different digitizers.

Introduction Follow-up care of patients with obstructive sleep apnea (OSA) on positive airway pressure (PAP) therapy has become increasingly complex due to regulatory requirements and primary care provider experience in this area may be limited. We present a project aimed to facilitate primary care management of stable PAP users at our institution. Methods A multidisciplinary workgroup of key stakeholders was formed with representation from sleep medicine and primary care, including physicians, a nurse manager, operations administrator, laboratory supervisor, appointment office manager and financial analysts. The group evaluated existing patient volumes and workflows for chronic management of OSA. Analyses reflected a very high rate of established patients returning for follow-up (76%); of these 64% were stable OSA patients on PAP treatment who were not receiving specialized or new interventions. As a tertiary sleep center practice, it seemed most practical to develop a care pathway for patients with established primary care services within our institution. Our group established criteria for identification of stable OSA patients on PAP therapy that could be transitioned back to primary care. A care process model was developed for provider reference. Relevant educational material relating to PAP download reports, PAP troubleshooting, prescription requirements/insurance visit guidelines and reasons for referral back to sleep medicine, were placed on the institutional website. Communication plans were developed and methodology for transfer of care implemented. Results Initial implementation of the project resulted in an increase of 6 new consultation appointments a week (312/year) at the sleep center and a 14% reduction in follow-up appointments with a projected financial improvement of $263,841/year. Primary care teams were hesitant about assuming responsibility for long-term care of OSA and patients accepted the transition. Conclusion With the growing number of patients requiring longitudinal care for OSA, it is imperative to explore how and when transitions from sleep specialty services to primary care should occur. This project proposes steps to standardize the process and collaborate effectively with primary care colleagues; thereby assuring patients achieve competent care in the transition. Support (If Any)

This study examined the socialization experiences of Black doctoral students in education with a focus on faculty career aspirations. While there are studies that have explored the completion of Black doctoral students, fewer examine the socialization experiences that contribute to the decision for Black doctoral students in education to seek faculty careers.Schools of education were chosen as the focal point of this study because they historically, and currently graduate more doctoral students than any other field or discipline. While they graduate more Black doctoral students than other schools or colleges, the representation among the faculty is not representative.Employing constructivist narrative inquiry methodology, semi-structured, in-depth interviews were conducted with ten Black doctoral students who had reached the milestone of qualifying exams in various doctoral programs. Findings include: the ways the range of predoctoral career aspirations influence career aspirations, limited perceptions of the professoriate and exposure to career options, program culture: lack of faculty engagement with research development and mentorship, and preparation as only half the battle: racism and sexism as barriers to faculty careers. While doctoral socialization literature is largely laudatory or focuses on factors that influence the socialization process, this study revealed negative components of socialization processes. Black doctoral students in this study were suspicious of peers and competitive for opportunities, socialization attributed to academic culture. This socialization had a negative influence on Black doctoral student’s degree aspirations. Not all participants career aspirations changed, though there was participant shifts in reasons for career aspirations and additional concern about their non-academic preparation. Additionally, Black doctoral students were committed to contributing to their community. Participant aspirations served as a unique framework to analyze student perspective, specifically because participants were soon to make career related decisions based on their socialization experiences. Implications provide reflection points for research and practice, including graduate programs within schools of education, faculty working with Black doctoral students and graduate schools preparing future faculty for traditional and non-traditional faculty roles.