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Background The infrapatellar fat pad (IFP) is the largest adipose deposit in the knee; however, its contributions to the homeostasis of this organ remain undefined. To determine the influence of the IFP and its associated synovium (IFP/synovium complex or IFP/SC) on joint health, this study evaluated the progression of osteoarthritis (OA) following excision of this unit in a rodent model of naturally-occurring disease. Methods Male Dunkin-Hartley guinea pigs ( n =18) received surgical removal of the IFP in one knee at 3 months of age; contralateral knees received sham surgery as matched internal controls. Mobility and gait assessments were performed prior to IFP/SC removal and monthly thereafter. Animals were harvested at 7 months of age. Ten set of these knees were processed for microcomputed tomography (microCT), histopathology, transcript expression analyses, and immunohistochemistry (IHC); 8 sets of knees were dedicated to microCT and biomechanical testing (material properties of knee joints tissues and anterior drawer laxity). Results Fibrous connective tissue (FCT) developed in place of the native adipose depot. Gait demonstrated no significant differences between IFP/SC removal and contralateral hindlimbs. MicroCT OA scores were improved in knees containing the FCT. Quantitatively, IFP/SC-containing knees had more osteophyte development and increased trabecular volume bone mineral density (vBMD) in femora and tibiae. Histopathology confirmed maintenance of articular cartilage structure, proteoglycan content, and chondrocyte cellularity in FCT-containing knees. Transcript analyses revealed decreased expression of adipose-related molecules and select inflammatory mediators in FCTs compared to IFP/SCs. This was verified via IHC for two key inflammatory agents. The medial articular cartilage in knees with native IFP/SCs showed an increase in equilibrium modulus, which correlated with increased amounts of magnesium and phosphorus. Discussion/conclusion Formation of the FCT resulted in reduced OA-associated changes in both bone and cartilage. This benefit may be associated with: a decrease in inflammatory mediators at transcript and protein levels; and/or improved biomechanical properties. Thus, the IFP/SC may play a role in the pathogenesis of knee OA in this strain, with removal prior to disease onset appearing to have short-term benefits.

Background The goal of this study was to document the relationship between BMI and the components of bariatric surgical operating room (OR) time. Methods The Stanford Translational Research Integrated Database Environment identified all patients who underwent laparoscopic Roux-en-Y gastric bypass procedures at Stanford University Medical Center between May 2008 and November 2013. The 434 patients were divided into 3 groups: group 1 ( n  = 213) BMI ≥35 to <45 kg/m 2 , group 2 ( n  = 188) BMI ≥45.0 to <60 kg/m 2 , and group 3 ( n  = 33) BMI ≥60 kg/m 2 . The primary variable measured was total operating room time, defined as beginning when the patient entered the OR until the moment the patient physically left the OR. Secondary variables were anesthetic induction time, nursing preparation time, operation time, time for emergence from anesthesia, and total length of hospital stay. Results Increasing BMI was associated with increased total OR time (group 1 = 202 min, group 2 = 215 min, group 3 = 235 min), mainly due to longer operation time (group 1 = 147 min, group 2 = 154 min, group 3 = 163 min). Anesthetic induction (group 1 = 17 min, group 2 = 18 min, group 3 = 23 min) and emergence times (group 1 = 12 min, group 2 = 12 min, group 3 = 22 min) were also significantly longer in the largest patients. Conclusions Operating room schedules and plans for resource utilization should recognize that the same bariatric procedure will require more time for patients with BMI >60 kg/m 2 than for smaller bariatric patients.

Biochar soil amendment to agricultural systems can reduce nitrogen (N) leaching; however, application to agricultural nitrogen treatment systems has not been extensively explored. The objective of this study was to assess the impact on N leaching in soils receiving repeated N applications which may be observed in agricultural treatment systems. In this study, 400 °C, 700 °C, and oxidized 700 °C corncob biochar was amended to sandy loam soil columns at 5% (wt/wt) to assess the impacts to N cycling following repeated synthetic N applications. Columns received weekly applications of either organic N (ORG-N), ammonium (NH4+-N), or nitrate (NO3−-N) and the N effluent, gaseous emissions, and soil N retention was measured. Biochar produced at 400 °C significantly reduced N leaching compared to control columns by 19% and 15% for ORG-N and NH4+-N, respectively, with application concentrations similar to silage bunker runoff. For NO3−-N applications, 700 °C biochar significantly reduced leaching by 25% compared to the controls. The primary mechanism reducing N effluent for biochar amended columns was enhanced soil retention of ORG-N and NO3−-N. Biochar surface chemistry analysis measured an increase in oxygenated functional groups and cationic minerals on the biochar surface, which likely enhanced retention through cationic bridging or the development of an organomineral layer on the biochar surface. Results indicated biochar amendment to agricultural treatment systems receiving N runoff may reduce the risk of N leaching.

Modern Intensive Care Units (ICUs) provide continuous monitoring of critically ill patients susceptible to many complications affecting morbidity and mortality. ICU settings require a high staff-to-patient ratio and generates a sheer volume of data. For clinicians, the real-time interpretation of data and decision-making is a challenging task. Machine Learning (ML) techniques in ICUs are making headway in the early detection of high-risk events due to increased processing power and freely available datasets such as the Medical Information Mart for Intensive Care (MIMIC). We conducted a systematic literature review to evaluate the effectiveness of applying ML in the ICU settings using the MIMIC dataset. A total of 322 articles were reviewed and a quantitative descriptive analysis was performed on 61 qualified articles that applied ML techniques in ICU settings using MIMIC data. We assembled the qualified articles to provide insights into the areas of application, clinical variables used, and treatment outcomes that can pave the way for further adoption of this promising technology and possible use in routine clinical decision-making. The lessons learned from our review can provide guidance to researchers on application of ML techniques to increase their rate of adoption in healthcare.

Infusion-related iatrogenic retinal breaks (IRBs) are a significant complication in vitrectomies, particularly when smaller-gauge cannulas are used during fluid infusion. Using two-dimensional finite element analysis (FEA), we analyzed forces exerted on the retina from different cannulas: traditional 25-gauge, 20-gauge, 23-gauge, and 27-gauge, then investigated four alternative new cannula designs: (A) oblique orifices, (B) external obstruction, (C) side ports, and (D) perpendicular orifices. The analysis revealed that the standard 25-gauge cannula had a force of 0.546 milli-Newtons (mN). Optimized cannulas demonstrated decreased forces: 0.072 mN (A), 0.266 mN (B), 0.417 mN (C), and 0.117 mN (D). While all the designs decrease fluid jet force, each has unique challenges: Design A may complicate manufacturing, B requires unique attachment techniques, C could misdirect fluid toward the lens and peripheral retina, and D requires a sealed trocar/cannula design to prevent unwanted fluid ejection. These four innovative cannula designs, identified with detailed engineering simulations, provide promising strategies to reduce the risk of IRBs during vitrectomy, bridging the gap between engineering insights and clinical application.

Justifications for the widespread adoption and integration of an electronic health record (EHR) have long leaned on the purported benefits of the technology. However, the performance of the EHR has been underwhelming relative to the promises of immediate access to relevant patient information, clinical decision supports, computerized ordering, and transferable patient data. In this narrative review, we provide an overview of the historical problems and limitations of the EHR, detail the core principles that define agile processes that may overcome the barriers faced by the current EHR, and re-imagine what an integrated, seamless EHR that serves its users and patients might look like. Moving forward, the EHR should be redesigned using a middle-out framework and empowering dual-type champions to maintain the sustainable diffusion of future innovations.

OBJECTIVES/GOALS: To determine the utility of any standard, one must first evaluate whether or not the standard meets the needs of the use case it is meant to support. We aim to quantify data availability of the HL7 FHIR standard to support data collection for three state-based registries in a rural state and measure the potential effects on data quality and collection time. METHODS/STUDY POPULATION: FHIR mapping will be performed to assess the level of HL7 FHIR standard completeness (or data element coverage) in supporting data collection for the three registries. A systematic approach, previously developed and used by Garza and Zozus, will be used to map registry data elements to corresponding HL7 FHIR standard resources. FHIR coverage will be calculated as a percentage (total data elements “Available in FHIR” vs. total data elements overall) and will be observed across different domain areas (i.e., demographics vs. medications vs. vital signs, etc.) in order to identify the domains with the least and most coverage. RESULTS/ANTICIPATED RESULTS: Although there have been informatics solutions that relied on data exchange standards to improve data collection, none have actually evaluated the coverage of the standard for supporting the needs of clinical data registries. To address this gap, we aim to evaluate the availability of the HL7 FHIR standard to support data collection for three state-based registries. These results will provide insight into the generalizability of a FHIR-based solution to support data acquisition and processing across multiple registries and demonstrate the potential for seamless exchange of that data for secondary use in clinical and translational research. Quantifying the coverage will also be used to further advance its development in order to meet the data collection needs of state and national clinical data registries. DISCUSSION/SIGNIFICANCE: Registries often rely on manual abstraction of EHR data. These manual approaches have had a negative impact on data quality and cost, often due to the complexities associated with collection and mapping of the data to fit the registry model. HL7 FHIR has the potential to address these issues by automating part or all of the data collection process.

Biochar amendment to soil is a method used to mitigate losses of nitrogen leaching through agricultural soils. Multiple methods for extraction of nitrogen have been used, and recent studies have indicated that traditional soil extraction methods underestimate biochar nitrate. This study evaluated the nitrate extraction efficiency of a KCl extraction method under different temperature (20 and 50 °C) and duration (24 and 96 h) conditions. Increasing the duration of extraction from 24 to 96 h did not have a significant impact on extraction efficiency. However, increasing temperature resulted in nitrate extraction efficiencies above 90%. Rinsing the biochar once with deionized (DI) water following filtration after extraction increased the extraction efficiency significantly, but any subsequent rinses were not significant. This study recommends extracting nitrate from biochar using 2 M KCl at 50 °C for a period of 24 h with one additional rinse to increase nitrate recovery above 90%. However, future studies should evaluate this procedure for different types of biochar produced from alternative biomasses and at varying temperatures.

The reuse of waste residuals as reactive media is a sustainable solution to remove phosphorus (P) from wastewater and reduce eutrophication. Large reactive waste media filters incorporated in edge-of-field treatment systems could reduce P loading from agricultural fields. We measured the treatment potential of regionally available waste residuals (i.e., calcined quagga mussel shells (CSHELL), magnesium activated biochar (MGBC), pickled steel (PSTEEL), and steel slag (SLAG)) for dissolved P removal. CSHELL and MGBC had elevated sorption capacities (64,419 and 50,642 mg kg−1, respectively) in comparison to SLAG and PSTEEL (14,541 mg kg−1 and 736 mg kg−1, respectively). However, CSHELL requires long reaction times for removal (22% removal after 1.5 h) and P sorbed to MGBC is removed with DI, reducing treatment potential. SLAG and PSTEEL were the only media with significant reductions of agricultural runoff and had the greatest overall treatment potential. SLAG is recommended for removal and replacement systems while PSTEEL is suitable for larger systems designed for regeneration on site.