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Higher cost of arthroplasty for hip fractures in patients transferred from outside hospitals vs primary emergency department presentation

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World Journal of Orthopedics 2022年第8期13卷 725-732页

作者： Emanuel C Haug Hakan Pehlivan J ryan Macdonell Wendy Novicoff James Browne thomas Brown Quanjun Cui Department of Orthopedic Surgery University of VirginiaCharlottesvilleVA 22908United States Department of Orthopedic Surgery Preferred Pediatric Orthopedic SurgeryRidgewoodNJ 07450United States Department of Orthopedic Surgery Asheville Orthopedic AssociatesAshevilleNC 28801United States

BACKGROUND In 2016 Centers for Medicare and Medicaid Services proposed bundled payments for hip fractures to improve the quality and decrease costs of *** transferred from other facilities may be imposing a financial risk on the hospitals that accept these *** To determine the costs associated with patients that either presented to the emergency department or were transferred from another hospital or skilled nursing facility(SNF)with the diagnosis of a hip fracture requiring operative *** A retrospective single institution review was conducted for all arthroplasty patients from 2010 to *** criteria included a total or partial hip replacement for a hip *** criteria included pathologic,periprosthetic,and fracture *** was collected to compare total observed costs for patients from the emergency department,patients from skilled nursing facilities,and patients from an outside *** A total of 223 patients met the inclusion criteria.135(60.54%)of these patients presented primarily to the emergency department,58 patients(26.01%)were transferred from an outside hospital,and 30 patients(13.43%)were transferred from a *** data analysis showed that outside hospital patients demonstrated significantly greater total cost for their hospitalization($43302)compared to emergency department patients($28875,P=0.000)and SNF patients($28282,P=0.000).CONCLUSION Patients transferred from an outside hospital incurred greater costs for their hospitalization than patients presenting from an emergency department or *** is a strong argument for riskadjustment models when bundling payments for the care of hip fracture patients.

关键词： Total hip arthroplasty Cost Transfer Outside hospital Hip fracture

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In-situ probing of thermal desorption of vapor molecules on a nanowire via work function variance

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Nano Research 2016年第11期9卷 3334-3345页

作者： Kovur Prashanthi John Eric Hawk ryan McGee Ravi Gaikwad thomas Thundat Ingenuity Lab Department of Chemical and Materials Engineering University of Alberta Edmonton AB T6G 2V4 Canada

Nanowire sensors based on variations of their electrical properties show great potential for real-time, in situ monitoring of molecular adsorption and desorption. Although the molecular adsorption-induced change in the electronic work function is very sensitive, it does not have any specificity. However, the temperature dependency of the adsorption-induced work function variation can provide limited selectivity based on the desorption temperature. In this study, we report the in situ probing of molecular desorption by monitoring the work function variations of a single Pt nanowire as a function of temperature. The work function of a clean Pt nanowire shows a significant variation due to vapor adsorption at room temperature. Increasing the temperature of the nanowire results in a variation of the work function due to molecular desorption. Experimentally measured differential work function as a function of temperature shows desorption peaks at 36 and 44 ℃ for methanol and ethanol molecules respectively. Adsorption-induced variation of the Pt nanowire work function was further confirmed using ultraviolet photoelectron spectroscopy before and after exposure to methanol vapor. These results show that the molecular adsorption/desorption-induced variation of the work function and its temperature dependency can be used for developing nanoscale electro-calorimetric sensors.

关键词： Kelvin probe microscopy nanowires thermal desorption work function

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Temperature and mass scaling affect cutaneous and pulmonary respiratory performance in a diving frog

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Integrative Zoology 2021年第5期16卷 712-728页

作者： ryan B.MCWHINNIE Jason P.SCKRABULIS thomas R.RAFFEL Department of Biological Sciences Oakland UniversityRochesterMichiganUSA

Global climate change is altering patterns of temperature variation,with unpredictable consequences for species and *** Metabolic Theory of Ecology(MTE)provides a powerful framework for predicting climate change impacts on ectotherm metabolic *** postulates that physiological and ecological processes are limited by organism metabolic rates,which scale predictably with body mass and *** purpose of this study was to determine if different metabolic proxies generate different empirical estimates of key MTE model parameters for the aquatic frog Xenopus laevis when allowed to exhibit normal diving *** used a novel methodological approach in combining a flow-through respirometry setup with the open-source Arduino platform to measure mass and temperature effects on 4 different proxies for whole-body metabolism(total O_(2) consumption,cutaneous O_(2) consumption,pulmonary O_(2) consumption,and ventilation frequency),following thermal acclimation to one of 3 temperatures(8℃,17℃,or 26℃).Different metabolic proxies generated different mass-scaling exponents(b)and activation energy(EA)estimates,highlighting the importance of metabolic proxy selection when parameterizing MTE-derived *** acclimated to 17℃ had higher O_(2) consumption across all temperatures,but thermal acclimation did not influence estimates of key MTE parameters EA and *** respiration generated lower MTE parameters than pulmonary respiration,consistent with temperature and mass constraints on dissolved oxygen availability,SA:V ratios,and diffusion distances across *** results show that the choice of metabolic proxy can have a big impact on empirical estimates for key MTE model parameters.

关键词： African clawed frog amphibian pneumotachography thermal biology

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Modelling Regional Land Change Scenarios to Assess Land Abandonment and Reforestation Dynamics in the Pyrenees(France)

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Journal of Mountain Science 2015年第4期12卷 905-920页

作者： Laure A.VACQUIE thomas HOUET Terry L.SOHL ryan REKER Kristi L.SAYLER GEODE Laboratory Toulouse Jean Jaurès University U.S.Geological Survey Earth Resources Observation and Science (EROS) Center ASRC Federal – Inu Teq Contractor to U.S.Geological Survey Earth Resources Observation and Science (EROS) Center

Over the last decades and centuries,European mountain landscapes have experienced substantial *** and anthropogenic LULC changes(land use and land cover changes), especially agro-pastoral activities,have directly influenced the spatial organization and composition of European mountain *** the past sixty years, natural reforestation has been occurring due to a decline in both agricultural production activities and rural ***, to better anticipate future changes,need spatially and temporally explicit models to identify areas at risk of land change and possible *** paper presents an integrated approach combining forecasting scenarios and a LULC changes simulation model to assess where LULC changes may occur in the Pyrenees Mountains,based on historical LULC trends and a range of future socio-economic *** proposed methodologyconsiders local specificities of the Pyrenean valleys,sub-regional climate and topographical properties,and regional economic *** indicate that some regions are projected to face strong abandonment, regardless of the scenario ***, high rates of change are associated with administrative regions where land productivity is highly dependent on socio-economic drivers and climatic and environmental conditions limit intensive(agricultural and/or pastoral) production and *** combination of the results for the four scenarios allows assessments of where encroachment(*** by shrublands) and reforestation are the most *** assessment intends to provide insight into the potential future development of the Pyrenees to help identify areas that are the most sensitive to change and to guide decision makers to help their management decisions.

关键词：土地利用变化评估退耕还林土地撂荒情景模拟农业生产活动气候环境条件牛

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In vivo radiometric analysis of glucose uptake and distribution in mouse bone

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Bone Research 2016年第1期4卷 31-38页

作者： Meredith L Zoch Diane S Abou thomas L Clemens Daniel LJ Thorek ryan C Riddle Department of Orthopaedic Surgery Johns Hopkins University School of Medicine Baltimore USA Division of Nuclear Medicine an Molecular Imaging Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore USA Baltimore Veterans Administration Medical Center Baltimore USA Department of Oncology Cancer Molecular and Functional Imaging Program Sidney Kimmel Comprehensive Cancer Center Johns Hopkins University School of Medicine Baltimore USA

Bone formation and remodeling occurs throughout life and requires the sustained activity of osteoblasts and osteoclasts, particularly during periods of rapid bone growth. Despite increasing evidence linking bone cell activity to global energy homeostasis, little is known about the relative energy requirements or substrate utilization of bone cells. In these studies, we measured the uptake and distribution of glucose in the skeleton in vivo using positron-emitting 18F-fluorodeoxyglucose （[lSF]-FDG） and non-invasive, high-resolution positron emission tomography/computed tomography （PE~/CT） imaging and ex vivo autoradiography. Assessment of [~SF]-FDG uptake demonstrated that relative to other tissues bone accumulated a significant fraction of the total dose of the glucose analog..Skeletal accumulation was greatest in young mice undergoing the rapid bone formation that characterizes early development. PET/CT imaging revealed that [lSF]-FDG uptake was greatest in the epiphyseal and metaphyseal regions of long bones, which accords with the increased osteoblast numbers and activity at this skeletal site. Insulin administration significantly increased skeletal accumulation of [lSF]-FDG, while uptake was reduced in mice lacking the insulin receptor specifically in osteoblasts or fed a high-fat diet. Our results indicated that the skeleton is a site of significant glucose uptake and that its consumption by bone cells is subject to regulation by insulin and disturbances in whole-body metabolism.

关键词： bone FDG

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Effect of interface on mid-infrared photothermal response of MoS2 thin film grown by pulsed laser deposition

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Nano Research 2017年第10期10卷 3571-3584页

作者： Ankur Goswami Priyesh Dhandaria Soupitak Pal ryan McGee Faheem Khan Zeljka Antic Ravi Gaikwad Kovur Prashanthi thomas Thundat Department of Chemical and Materials Engineering University of Alberta Edmonton T6G 1H9 Canada Department of Chemical Engineering University of California Santa Barbara 93106-5070 USA

This study reports on the mid-infrared （mid-IR） photothermal response of multilayer MoS2 thin films grown on crystalline （p-type silicon and c-axis- oriented single crystal sapphire） and amorphous （Si/SiO2 and Si/SiN） substrates by pulsed laser deposition （PLD）. The photothermal response of the MoS2 films is measured as the changes in the resistance of the MoS2 films when irradiated with a mid-IR （7 to 8.2 μm） source. We show that enhancing the temperature coefficient of resistance （TCR） of the MoS2 thin films is possible by controlling the film-substrate interface through a proper choice of substrate and growth conditions. The thin films grown by PLD are characterized using X-ray diffraction, Raman, atomic force microscopy, X-ray photoelectron microscopy, and transmission electron microscopy. The high-resolution transmission electron microscopy （HRTEM） images show that the MoS2 films grow on sapphire substrates in a layer-by-layer manner with misfit dislocations. The layer growth morphology is disrupted when the films are grown on substrates with a diamond cubic structure （e.g., silicon） because of twin growth formation. The growth morphology on amorphous substrates, such as Si/SiO2 or Si/SiN, is very different. The PLD-grown MoS2 films on silicon show higher TCR （-2.9% K^-1 at 296 K）, higher mid-IR sensitivity （△R/R = 5.2%）, and higher responsivity （8.7 V·W^-1） compared to both the PLD-grown films on other substrates and the mechanically exfoliated MoS2 flakes transferred to different substrates.

关键词： MoS2 pulsed laser deposition phototherrnal effect infrared (IR) detector interface

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Microstructural banding of directed energy deposition-additively manufactured 316L stainless steel

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Journal of Materials Science & Technology 2021年第10期69卷 96-105页

作者： Yoon Hwa Christopher S.Kumai thomas M.Devine Nancy Yang Joshua K.Yee ryan Hardwick Kai Burgmann Department of Materials Science and Engineering University of CaliforniaBerkeleyCA94720USA Sandia National Laboratory LivermoreCA.94551USA

The microstructures of 316L stainless steel created by rapid solidification are investigated by comparing the similar microstructures of individual hatches of directed energy deposition additive manufacturing(DED-AM)and those of single,laser surface-melted tracks formed on a solid *** recoil pressure,which is exponentially dependent on the laser beam power density,induces convection of the melt pool,which causes formation of microstructural bands in the as-solidified *** microstructural bands are associated with changes in the chromium concentration and are a significant component of the inhomogeneous microstructure of DED-AM.

关键词： Additive manufacturing Directed energy deposition Stainless steel Rapid solidification Recoil pressure Microstructure

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The hypoxia-inducible factor-1α activates ectopic production of fibroblast growth factor 23 in tumor-induced osteomalacia

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Bone Research 2016年第2期4卷 85-90页

作者： Qian Zhang Michele Doucet ryan E Tomlinson Xiaobin Han L Darryl Quarles Michael T Collins thomas L Clemens Department of Orthopaedic Surgery Johns Hopkins University Baltimore MD USA Department of Medicine University of Tennessee Health Science Center Memphis TN USA Skeletal Clinical Studies Unit craniofacial and Skeletal Diseases Branch National Institutes of HealthBethesda MD USA Baltimore Veterans Administration Medical Center Baltimore MD USA

Tumor-induced osteomalacia （TIO） is a rare paraneoplastic syndrome in which ectopic production of fibroblast growth factor 23 （FGF23） by non-malignant mesenchymal tumors causes phosphate wasting and bone fractures. Recent studies have implicated the hypoxia-inducible factor-la （HIF-la） in other phosphate wasting disorders caused by elevated FGF23, including X-linked hypophosphatemic rickets and autosomal dominant hypophosphatemia. Here we provide evidence that HIF-la mediates aberrant FGF23 in TIO by transcriptionally activating its promoter. Immunohistochemical studies in phosphaturic mesenchymal tumors resected from patients with documented TIO showed that HIF-la and FGF23 were co-localized in spindle- shaped cells adjacent to blood vessels. Cultured tumor tissue produced high levels of intact FGF23 and demonstrated increased expression of HIF-la protein. Transfection of MC3T3-E1 and Saos-2 cells with a HIF-la expression construct induced the activity of a FGF23 reporter construct. Prior treatment of tumor organ cultures with HIF-la inhibitors decreased HIF-la and FGF23 protein accumulation and inhibited HIF-la-induced luciferase reporter activity in transfected cells. Chromatin immunoprecipitation assays confirmed binding to a HIF-la consensus sequence within the proximal FGF23 promoter, which was eliminated by treatment with a HIF-la inhibitor. These results show for the first time that HIF-la is a direct transcriptional activator of FGF23 and suggest that upregulation of HIF-la activity in TIO contributes to the aberrant FGF23 production in these patients.

关键词： The hypoxia-inducible factor-1 activates ectopic production of fibroblast growth factor 23 in tumor-induced osteomalacia HIF

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Treatment strategies for chronic hepatitis C prior to andfollowing liver transplantation

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World Journal of Hepatology 2016年第1期8卷 69-73页

作者： ryan B Perumpail thomas A Hahambis Avin Aggarwal Zobair M Younossi Aijaz Ahmed Division of Gastroenterology and Hepatology Stanford University School of MedicinePalo AltoCA 94304United States Gilead Sciences Foster CityCA 94404United States Center for Liver Diseases Department of MedicineInova Fairfax HospitalFalls ChurchVA 22042United States Betty and Guy Beatty Center for Integrated Research Inova Health SystemFalls ChurchVA 22042United States

Hepatitis C virus(HCV)-related liver disease is the leading indication for liver transplantation(LT) worldwide. However, HCV is an independent predictor of lower survival following LT, and recurrence of HCV postLT is virtually universal. The historic standard of care during the interferon era of HCV therapy was expectant management-initiation of antiviral therapy in the setting of documented disease progression following LT. With the advent of new direct acting antiviral(DAA) therapies for HCV, the paradigm of expectant treatment for recurrent HCV infection post-LT is shifting. The safety, tolerability, and efficacy of DAAs, even among the sickest patients with advanced liver disease, enables treatment of HCV in the pre-transplant setting among LT waitlist registrants. Finally, emerging data are supportive of preemptive therapy with DAAs in liver transplant recipients as the preferred approach. Expectant management of HCV following LT can rarely be justified in the modern era of HCV therapy.

关键词： Hepatitis C virus Liver transplantation Direct acting antivirals Sustained virologic response

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CONVERGENCE AND OPTIMALITY OF ADAPTIVE MIXED METHODS FOR POISSON’S EQUATION IN THE FEEC FRAMEWORK

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Journal of Computational Mathematics 2020年第5期38卷 748-767页

作者： Michael Holst Yuwen Li Adam Mihalik ryan Szypowski Department of Mathematics University of CaliforniaSan DiegoCA 92123USA Department of Mathematics and Statistics Cal Poly PomonaUSA

Finite Element Exterior Calculus (FEEC) was developed by Arnold, Falk, Winther andothers over the last decade to exploit the observation that mixed variational problems canbe posed on a Hilbert complex, and Galerkin-type mixed methods can then be obtained bysolving finite-dimensional subcomplex problems. Chen, Holst, and Xu (Math. Comp. 78(2009) 35–53) established convergence and optimality of an adaptive mixed finite elementmethod using Raviart–thomas or Brezzi–Douglas–Marini elements for Poisson’s equationon contractible domains in R^2, which can be viewed as a boundary problem on the deRham complex. Recently Demlow and Hirani (Found. Math. Comput. 14 (2014) 1337–1371) developed fundamental tools for a posteriori analysis on the de Rham *** this paper, we use tools in FEEC to construct convergence and complexity resultson domains with general topology and spatial dimension. In particular, we construct areliable and efficient error estimator and a sharper quasi-orthogonality result using a noveltechnique. Without marking for data oscillation, our adaptive method is a contractionwith respect to a total error incorporating the error estimator and data oscillation.

关键词： Finite Element Exterior Calculus Adaptive finite element methods A posteriori error estimates,Convergence Quasi-optimality

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