Extreme Range Research Articles

Therapeutic Plasma Exchange for the Symptomatic Treatment of Scleromyxedema: A Case Report and Literature Review

ABSTRACTScleromyxedema is a rare skin mucinosis often associated with systemic involvement and monoclonal gammopathy (MG). No formal recommendation for management with therapeutic plasma exchange (TPE) has been published due to rarity. This paper reports a 42‐year‐old male with progressive scleromyxedema. The patient was treated with glucocorticoids, immunosuppressants, and intravenous immunoglobulin (IVIG) therapy, but the disease progressed. Ultimately, the patient was referred for TPE, which resulted in decreased skin stiffness, improved extremity range of motion, and decreased visibility of papules on the hands. The patient's debilitating dysphagia gradually improved. A review of the literature focusing on clinical response identified five cases of scleromyxedema patients treated with TPE. Three of the five cases reported significant improvement in cutaneous symptoms and range of motion for at least 12 months. Overall, we propose that TPE should be considered an effective supportive treatment for symptomatic relief in severe or refractory scleromyxedema.

Antarctic extreme seasons under 20th and 21st century climate change

In this study, available large ensemble datasets in the Coupled Model Intercomparison Phase 6 (CMIP6) archive were used to provide the first multi-variate overview of the evolution of extreme seasons over Antarctica and the Southern Ocean during the 20th and 21st centuries following medium-to-high radiative forcing scenarios. The results show significant differences between simulated changes in background mean climate and changes in low (10th percentile) and high (90th percentile) extreme seasons. Regional winter warming is most pronounced for cold extremes. In summer, there are more pronounced increases in high extremes in precipitation and westerly wind during the ozone hole formation period (late 20th century), affecting coastal regions and, in particular, the Antarctic Peninsula. At midlatitudes, there is a reduction in the range of summer season wind extremes. Suggested mechanisms for these differences are provided relating to sea ice retreat and westerly jet position.

Bremsstrahlung radiation power in fusion plasmas revisited: towards accurate analytical fitting

Abstract In fusion plasmas, where electron temperatures $T_e$ range from keV to hundreds of keV, Bremsstrahlung radiation constitutes a significant energy loss mechanism. While various thermal average fitting formulas exist in the literature, their accuracy is limited, particularly for $T_e \leq 20$ keV with error $>10\%$. Additionally, non-relativistic fitting formulas become invalid for $T_e \geq 50$ keV. The accurate calculation of Bremsstrahlung radiation is important for fusion gain study, especially of advanced fuels fusion. In this work, we develop new but still simple fitting formulas that are valid for electron temperatures ranging from small ($\lesssim0.1$ keV) to extreme relativistic range, with errors of less than 1\% even for high atomic number ions (e.g., $Z=30$), which could be sufficient for fusion plasma applications. Both electron-ion (e-i) and electron-electron (e-e) Bremsstrahlung radiations are considered. Both polynomial fitting with truncated ($t=k_BT_e/m_ec^2\leq10$) and one-fit-all formulas are provided. Additionally, we offer fitting formulas for e-i and e-e specifically for electron energies, which could prove useful in non-Maxwellian Bremsstrahlung radiation studies.

Sensor-Acquired Reachable Workspace (RWS) Correlates with Activities of Daily Living (ADL) Function in Stroke as Measured by Functional Independence Measure (FIM) Self-Care

Optimal upper extremity motor control and range of motion are necessary to achieve even the basic activities of daily living (ADL) function. Stroke, with resulting hemiparesis, can significantly and negatively impact an individual’s ADL function. Functional Independence Measure (FIM) self-care score can provide an assessment of what aspects and to what degree ADL functions are impaired. FIM self-care assessment can also track changes in ADL function during stroke recovery and rehabilitation. Recently, the sensor-acquired 3D motion analysis of stroke patients’ upper extremity has shown promise as a potential alternative to assess ADL function. This observational study evaluates whether the sensor-acquired upper extremity reachable workspace (RWS) measure correlates with clinician-evaluated FIM self-care score in stroke patients. Seventeen patients with stroke were enrolled in the study. FIM self-care, NeuroQoL upper extremity, and reachable workspace outcome measures (relative surface area, RSA) were collected upon rehabilitation hospital admission, at discharge, and at the 3-month visit. Pearson and Spearman’s rank correlation coefficients as well as multiple linear regression analyses were used to determine the relationships between FIM self-care, NeuroQoL, and reachable workspace RSAs. Moderately strong correlation between total reachable workspace RSA and total FIM self-care score at discharge and at 3 months were noted (r = 0.619, r = 0.661, p < 0.05), and similarly strong correlation was also noted with the upper extremity NeuroQoL total score (r = 0.690, r = 0.815, p < 0.05). Multiple linear regression analyses revealed a change in average bilateral total RSA of 0.1 unit from admission to the 3-month follow-up correlated with a respective change in the FIM self-care score of 2.011 points (95%CI: 0.663–3.360). Longitudinal improvement in ADL function during stroke rehabilitation and recovery process is correlated with improvement in reachable workspace.

Correlation Between Functional Ability and Great Toe Flexor Strength in Young Adults

Background: Functional ability refers to the capacity to perform daily tasks efficiently, which relies on maintaining balance and stability. Balance is essential for keeping the body’s center of gravity aligned over a stable base and is supported by the coordination of the vestibular, visual, proprioceptive, and musculoskeletal systems. Factors such as proprioception, muscle strength, and lower extremity range of motion significantly impact functional ability. Toe flexor muscles play a vital role in providing the necessary force for anterior-posterior stability, especially when leaning forward, and contribute to the proprioceptive feedback loop that is essential for maintaining balance. Objective: To find correlation between functional ability and great toe flexor strength in young adults. Methodology: 12 male and female young adults with normal BMI were selected for the study. functional ability was measured using Functional Reach Test, great toe flexor strength was assessed using Pinch Guage Dynamometer. Karl Pearson’s Correlation Coefficient was used for statistical analysis, with a p value < 0.05 considered as significant. Result: Statistically significant strong correlation was found between Functional Reach Test score and great toe flexor strength ( r = 0.887, p=0.035) suggesting that higher the great toe flexion strength higher the functional ability score. Conclusion: This study conluded that an increase in great toe flexor strength is associated With Improved Functional Ability In Young Adults.

Study in the Extreme UV Range of the Spectral Transmission of Nickel Plasma Created under the Effect of an X-Ray Pulse of the Z-Pinch

Spectral properties of the high-temperature plasma obtained by exposing a nickel layer to a source of high-power X-ray radiation (a power of 6–10 TW with a duration of 7–10 ns) based on a Z-pinch, formed during implosion of tungsten multi-wire arrays at the Angara-5-1 facility, are studied. In this case, the Z-pinch radiation heats the target and turns it into the hot plasma, and the same radiation probes the target plasma to determine the spectral dependence of the transmission of this plasma. An original scheme is proposed for measuring the incident, transmitted and self-emission of a target simultaneously in one experiment in the frame mode using a grazing incidence diffraction spectrograph. Using laser shadow imaging, experimental data are obtained on the velocity of the plasma expansion on the irradiated and back sides of the target, which reached 100 km/s. Targets made of thin Ni layers deposited on a mylar film are studied. An irradiationinduced multiple increase in the transmission of the target plasma in the EUV range is observed compared to the transmittance of the target in the cold state. The dependence of the absorption spectrum of the plasma and the accompanying self-radiation of the target on the power and shape of the heating pulse is studied. The measurement results are compared with numerical calculations performed using the RALEF-2D two-dimensional radiation code, which has been repeatedly used previously to simulate similar experiments. The shape of the spectral dependence of the transmission in the experiment and calculation is similar in the range of ∼30–200 Å, but the model plasma transmission (∼0.8–0.9) is higher than that obtained using a spectrograph and X-ray multi-frame photography (∼0.5–0.6).

Formation and Controlling of Optical Hopfions in High Harmonic Generation.

Toroidal vortex is a kind of novel and exotic structured light with potential applications in photonic topology and quantum information. Here, we present the study on high harmonic generation from the interaction of the intense toroidal vortices with atoms. We show that the spatial distribution of harmonic spectra reveal unique structures, which are kinds of high-order topological toroidal vortex because of the rotating of the driving fields with transverse orbital angular momentum. Then we show that, by synthesizing the toroidal vortices and optical vortices with longitudinal orbital angular momentum, it is able to generate the optical hopfions in the extreme ultraviolet range, which exhibit a completely different topological property compared with both the driving fields. Harnessing the spin angular momentum selection rules, we further show that one can control the topological texture and channel each harmonic into a single mode of controllable Hopf invariant.

Niche breadth specialisation impacts ecological and evolutionary adaptation following environmental change.

None declared.Conflicts of interestEcological theory predicts that organismal distribution and abundance depend on the ability to adapt to environmental change. It also predicts that eukaryotic specialists and generalists will dominate in extreme environments or following environmental change, respectively. This theory has attracted little attention in prokaryotes, especially in archaea, which drive major global biogeochemical cycles. We tested this concept in Thaumarchaeota using pH niche breadth as a specialisation factor. Responses of archaeal growth and activity to pH disturbance were determined empirically in manipulated, long-term, pH-maintained soil plots. The distribution of specialists and generalists was uneven over the pH range, with specialists being more limited to the extreme range. Nonetheless, adaptation of generalists to environmental change was greater than that of specialists, except for environmental changes leading to more extreme conditions. The balance of generalism and specialism over longer timescales was further investigated across evolutionary history. Specialists and generalists diversified at similar rates, reflecting balanced benefits of each strategy, but a higher transition rate from generalists to specialists than the reverse was demonstrated, suggesting that metabolic specialism is more easily gained than metabolic versatility. This study provides evidence for a crucial ecological concept in prokaryotes, significantly extending our understanding of archaeal adaptation to environmental change.

Effects of moderate physical activity on diabetic adhesive capsulitis: a randomized clinical trial.

Moderate physical activity (MPA) has proven advantages for glycemic control, cardiovascular health, and functional independence. However, physical activity is not part of routine conventional physical therapy (CPT) in managing diabetic adhesive capsulitis patients. To determine the effects of moderate MPA on diabetic adhesive capsulitis (AC). A randomized control trial was conducted at the Combined Military Hospital (CMH), Muzaffarabad, Pakistan from March 2022 to October 2022. A total of n = 44 patients with diabetic AC, aged 40 to 65 years, HbA1c > 6.5% were enrolled. Group A received MPA and CPT, while Group B only received CPT for six weeks. The upper extremity function, pain, and range of motion were assessed at baseline, third week, and sixth week through the disability of arm, shoulder, and hand (DASH) questionnaire, numeric pain rating scale (NPRSS), and goniometer respectively. The NPRS score and ROMs showed significant improvement (p < 0.05) in group A compared to group B with a large effect size. When comparing the mean difference of the DASH score (73 + 7.21 vs. 57.9 + 12.64, p < 0.001, Cohen's d = 1.46) was significantly improved with large effect size in group A as compared to group B. MPA along with CPT has positive effects on patient pain, range of motion, and disability in patients with diabetic adhesive capsulitis.

Shoulder Injury Incidence and Epidemiology in Youth, High School, and Collegiate Fastpitch Softball Players: A Systematic Review and Future Research Perspectives.

Fastpitch softball is one of the most popular sports in the United States among young female athletes. Softball players regularly subject their shoulders to extreme range of motion and high velocity movements. To date, no systematic review has reported on the epidemiology and incidence of shoulder injuries in softball players. To describe the incidence and epidemiology of softball-related shoulder injuries in youth, high school, and collegiate female softball players. PubMed, Web of Science, and Embase were searched for relevant English language articles from 1980 to 2023. Studies selected based on predefined inclusion criteria. Studies were required to be available full text, in English. Systematic review. Level 4. A preliminary screening was performed based on study title and abstract. In the subsequent screening, the full text versions of the remaining articles were evaluated by 2 reviewers for the fulfillment of the inclusion criteria. A total of 7 articles met criteria for inclusion. All studies evaluated injuries among softball players for at least 1 season. In total, there were 1107 softball-related shoulder injuries reported in the 7 studies included in this systematic review. Of the 3 studies that included a shoulder injury rate, a mean rate of 4.01 shoulder injuries per 10,000 athlete-exposures was calculated. The 2 most common shoulder injuries were shoulder muscle-tendon strains (297) and shoulder/biceps tendinitis (220). High-level prospective studies reporting injury incidence and risk factors among female softball players are extremely limited. Only 2 studies eligible for inclusion in this systematic review were prospective in nature, with neither of these reporting the specific injury rate for shoulder injuries among softball players.

In silico full-angle high-dynamic range scattering of microscopic objects exploiting holotomography.

Accurate optical characterization of microscopic objects is crucial in academic research, product development, and clinical diagnosis. We present a method for obtaining full and high-dynamic range, angle-resolved light scattering attributes of microparticles, enabling distinction of variations in both overall morphology and detailed internal structures. This method overcomes previous limitations in observable scattering angles and dynamic range of signals through computationally assisted three-dimensional holotomography. This advancement is significant for particles spanning tens of wavelengths, such as human erythrocytes, which have historically posed measurement challenges due to faint side-scattering signals indicative of their complex interiors. Our technique addresses three key challenges in optical side-scattering analysis: limited observational angular range, reliance on simplified computational models, and low signal-to-noise ratios in both experimental and computational evaluations. We incorporate three-dimensional tomographic complex refractive index data from Fourier-transform light scattering into a tailored finite-difference time-domain simulation space. This approach facilitates precise near-to-far-field transformations. The process yields complete full-angle scattering phase functions, crucial for particles like Plasmodium falciparum-parasitized erythrocytes, predominantly involved in forward scattering. The resultant scattering data exhibit an extreme dynamic range exceeding 100 dB at various incident angles of a He-Ne laser. These findings have the potential to develop point-of-care, cost-effective, and rapid malaria diagnostic tools, inspiring further clinical and research applications in microparticle scattering.

The relationship between lower extremity range of motion and dynamic balance

&lt;p&gt;目的：本研究欲探討，青少年運動員下肢關節活動度與動態平衡表現的相關性，以及兩者在測量表現上的差異。方法：招募 20 名國高中男性運動員，測量下肢髖關節及踝關節活動度、改良版星狀偏移平衡測試 (modified star excursion balance test, mSEBT) 和 Y 字平衡測試 (Y balance test, YBT)。以皮爾森積差相關係數，比較慣用腳 mSEBT、YBT 與下肢關節活動度之相關性。透過多元迴歸分析，分析下肢關節活動度對 mSEBT 和 YBT 的預測性，以成對樣本 t 檢定比較 mSEBT 和 YBT 之差異。結果：mSEBT 與踝背屈、髖外展和髖外轉活動度呈顯著正相關，前側以踝背屈活動度解釋力最大 (R2 ＝ .506)，後內側 (R2 ＝ .544) 和後外側 (R2 ＝ .399) 以髖外轉活動度解釋力最大。YBT 前側與踝背屈活動度 (r ＝ .519，p &lt; .05)；YBT後外側與髖外轉活動度 (r ＝ .561，p &lt; .05)；YBT後內側與髖外展活動度 (r ＝ .558，p &lt; .05) 呈顯著正相關。mSEBT 和 YBT 在 3 個方向上皆有中至高度相關 (r = .473 - .736，p &lt; .05)，測量距離在前側、後外側和總分達顯著差異。結論：mSEBT 受多關節活動度影響，而 YBT 僅和單一關節活動度有關。mSEBT 和 YBT 雖有中至高度相關，但測量距離表現上並不相同。日後實驗設計及臨床應用上，應考量測試之差異，針對受試者的動態平衡能力，選擇適合的評估方法。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purpose: To examine the relationships of lower extremity range of motion (ROM), modified star excursion balance test (mSEBT) and Y balance test (YBT) and to compare the differences between mSEBT and YBT. Methods: Twenty adolescent high school male athletes were recruited to measure hip ROM, ankle ROM, mSEBT, and YBT. Pearson&amp;rsquo;s product-moment correlation coefficient were used to analyze the relationship between lower extremity ROM and dynamic balance. Multiple regression analysis were used to determine the predictors in explaining the variance to dynamic balance outcomes. Paired t test was used to compare the differences between mSEBT and YBT. Results: mSEBT was significantly correlated with ankle dorsiflexion, hip abduction and hip external rotation ROM. Ankle dorsiflexion ROM was the strongest predictor for anterior direction (R2 ＝ .506). Hip external rotation ROM was the strongest predictor for posteromedial direction (R2 ＝ .544) and posterolateral direction (R2 ＝ .399). Anterior YBT was correlated with ankle dorsiflexion ROM (r ＝ .519, p &lt; .05). Posterolateral YBT was correlated with hip external rotation ROM (r ＝ .561, p &lt; .05), and posteromedial YBT was correlated with hip abduction ROM (r ＝ .558, p &lt; .05). There were significant correlations in all three directions between mSEBT and YBT (r = .473 - .736, p &lt; .05). Conclusion: There were significant differences in anterior, posterolateral and composite performance between YBT and mSEBT. mSEBT performance was affected by multi-joint ROM and YBT performance was affected by single-joint ROM. Even though mSEBT and YBT were highly correlated, the absolutely reach distances are different. Future works should consider the differences between two dynamic balance measures and select the proper tool while examining dynamic balance in different sports.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Alkaline range pH sensor based on chitosan hydrogel: A novel approach to pH sensing

Monitoring of pH under extreme alkaline range is still a challenge due to the lack of accuracy and validity. This research developed a novel pH sensor (hydrogel/BTB) based on the transition of bromothymol blue from the hydrogel matrix into the pH-examining sample solution. The hydrogel/BTB sensor was synthesized through the solvent casting of chitosan, citric acid as the crosslinker, and bromothymol blue as a pH-sensitive dye. The structure of hydrogel/BTB was characterized using Fourier-transform infrared spectroscopy (FT-IR), Energy-dispersive X-ray spectroscopy (EDS), Field emission scanning electron microscopy (FE-SEM), Brunauer-Emmett-Teller (BET) analysis, and thermogravimetric analysis (TGA). The effect of various parameters on pH determination was investigated. The developed pH sensor demonstrated a linear detection range validated from pH 10 to 14 using the gravimetric method, and from pH 11 to 14 using the colorimetric method. The sensor successfully detected pH in alkaline tap water, carbonate buffer, and ethanol amine buffer. The transition of bromothymol blue is described by the Peppas-Korsmeyer kinetic model. The activation and Gibbs free energy were obtained as 357.1 J/mol and 260 J/mol, respectively. This work furnished a new mechanism for pH detection, and it has excellent potential for developing novel sensors in this field.

Immediate effects of upper limb exercises with and without deep breathing on lung function after cardiac surgery – a randomized crossover trial

BackgroundOpen heart surgery, involving median sternotomy, may cause diminished chest wall motion and restrictive pulmonary function in the early postoperative period. Thoracic and upper extremity range of motion (ROM) exercises are often recommended after surgery but have not been evaluated regarding effect on lung volumes and oxygenation. The objective of this study was to evaluate the immediate effect of upper limb elevations, with or without simultaneous deep breathing, on lung function after cardiac surgery.MethodsIn a randomized 2 × 2 crossover trial, 22 adult patients (> 18 years old) were assessed during one of the first days after surgery in the spring of 2022 at Örebro University Hospital, Sweden. Exercises involving five bilateral upper limb elevations, performed either with simultaneous deep breathing (ROM-DB) or without (ROM), while sitting in an upright position at the edge of the bed, were evaluated. Peripheral oxygen saturation (Rad-5v; Masimo, Irvine, USA) was the primary outcome. Tidal volume and respiratory rate were recorded continuously during the exercises (Spiropalm; Cosmed, Rome, Italy). Heart rate, pain, exertion and dyspnoea were evaluated before and after the exercises.ResultsBoth ROM-DB and ROM momentarily increased peripheral oxygen saturation (+ 1% ± 1, p = 0.004 and + 1% ± 1, p < 0.001, respectively), with no significant differences between these exercises (p = 0.525). ROM-DB significantly increased the VT compared with ROM (798 ± 316 vs. 602 mL ± 176, p = 0.004). However, ROM-DB induced more pronounced pain (p = 0.012), exertion (p = 0.035) and dyspnoea (p = 0.013) than ROM.ConclusionsUpper limb elevations improved oxygenation momentarily, both performed with and without simultaneous deep breathing, with no significant differences between these exercises. The additive deep breathing improved tidal volume compared with upper limb elevations alone, but induced more pain, exertion and dyspnoea during the performance of exercise.Trial registrationClinicalTrials.gov (NCT05278819).

A NOVEL MAGNETIC SYSTEM TO TREAT TOTAL HIP ARTHROPLASTY INSTABILITY

Dislocation after total hip replacement (THR) is a devastating complication. Risk factors include patient and surgical factors. Mitigation of this complication has proven partially effective. This study investigated a new innovating technique to decrease this problem using rare earth magnets.Computer simulations with design and magnetic finite element analysis software were used to analyze and quantitate the forces around hip implants with embedded magnets into the components during hip range of motion. N52 Neodymium-Iron-Boron rare earth magnets were sized to fit within the existing acetabular shells and the taper of a hip system. Additionally, magnets placed within the existing screw holes were studied. A 50mm titanium acetabular shell and a 36mm ceramic liner utilizing a taper sleeve adapter were modeled which allowed for the use of a 12mm × 5mm magnet placed in the center hole, an 18mm × 15mm magnet within the femoral head, and 10mm × 5mm magnets in the screw holes.Biomechanical testing was also performed using in-vitro bone and implant models to determine retention forces through a range of hip motion.The novel system incorporating magnets generated retentive forces between the acetabular cup and femoral head of between 10 to 20 N through a range of hip motion. Retentive forces were stronger at the extreme position hip range of motion when additional magnets were placed in the acetabular screw holes. Greater retentive forces can be obtained with specially designed femoral head bores and acetabular shells specifically designed to incorporate larger magnets. Mechanical testing validated the loads obtained and demonstrated the feasibility of the magnet system to provide joint stability and prevent dislocations.Rare earth magnets provide exceptional attractive strength and can be used to impart stability and prevent dislocation in THR without the complications and limitations of conventional methods.

Extreme range in adult body size reveals hidden trade-offs among sexually selected traits.

Sexually selected weapons used to monopolize mating opportunities are predicted to trade-off with traits used in competition for fertilization. Yet, the limited size range typically found among adults of a species often precludes clear comparisons between population-level and individual-level relative trait investment. The jousting weevil, Brentus anchorago (Coleoptera: Brentidae), varies more than 26-fold in body mass, which is among the most extreme adult body size ranges of any solitary terrestrial species. We reveal a trade-off at a population level: hypermetric scaling in male weapons (slope = 1.59) and a closely mirrored reversal in allocation to postcopulatory traits (slope = 0.54). Yet, at the individual level, we find the opposite pattern; males that invest relatively more in weapons for their size class also invest more in postcopulatory traits. Across 36 dung beetle and 41 brentine weevil species, we find the allometric slope explains more trait variation at larger body size ranges; in brentines, population-level scaling patterns become more detectable in species with a larger range in adult body size. Our findings reveal that population-level allometries and individual-level trade-offs can both be important in shaping relative trait allocation; we highlight that the adult body size range is rarely examined but may be integral to gaining a deeper understanding of trade-offs in reproductive allocation.

Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study.

Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non-web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non-web-based outpatient management model. This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non-web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99%) patients reaching the follow-up end point, including 260 (50%) in the non-web-based management group and 259 (50%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non-web-based management group (82.4% vs 71.6%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2% vs 63.5%, P<.001). The incidence of minor bleeding events in the non-web-based management group was significantly higher than that in the web-based management group (12.1% vs 6.6%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non-web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6% vs 21.3%) and severe supertreatment range (0% vs 0.8%) and a higher proportion in the treatment range (50.4% vs 43.1%), with statistical significance. Compared with traditional non-web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution.

Harmonic Generation in Molecular Ag2S Plasma.

The molecular laser-induced plasma (LIP) produced during the ablation of silver sulfide (Ag2S) was used as a medium for high-order harmonic generation in the extreme ultraviolet range. The role of LIP formation, the plasma components, and the geometry of plasma in the harmonic conversion efficiency was analyzed. We also analyzed the influence of the driving pulses (chirp, single-color pump, two-color pump, and delay between heating and converting pulses) on the harmonic yield in Ag2S LIP. The application of molecular plasma was compared with the application of atomic plasma, which comprised similar metallic elements (Ag) as well as other metal LIPs. The harmonics from the Ag2S LIP were 4 to 10 times stronger than those from the Ag LIP. The harmonics up to the 59th order were achieved under the optimal conditions for the molecular plasma.

Stress Testing California's Hydroclimatic Whiplash: Potential Challenges, Trade‐Offs and Adaptations in Water Management and Hydropower Generation

AbstractInter‐annual precipitation in California is highly variable, and future projections indicate an increase in the intensity and frequency of hydroclimatic “whiplash.” Understanding the implications of these shocks on California's water system and its degree of resiliency is critical from a planning perspective. Therefore, we quantify the resilience of reservoir services provided by water and hydropower systems in four basins in the western Sierra Nevada. Using downscaled runoff from 10 climate model outputs, we generated 200 synthetic hydrologic whiplash sequences of alternating dry and wet years to represent a wide range of extremes and transitional conditions used as inputs to a water system simulation model. Sequences were derived from upper (wet) and lower (dry) quintiles of future streamflow projections (2030–2060). Results show that carryover storage was negatively affected in all basins, particularly in those with lower storage capacity. All basins experienced negative impacts on hydropower generation, with losses ranging from 5% to nearly 90%. Reservoir sizes and inflexible operating rules are a particular challenge for flood control, as in extremely wet years spillage averaged nearly the annual basins' total discharge. The reliability of environmental flows and agricultural deliveries varied depending on the basin, intensity, and duration of whiplash sequences. Overall, wet years temporarily rebound negative drought effects, and greater storage capacity results in higher reliability and resiliency, and lesser volatility in services. We highlight potential policy changes to improve flexibility, increase resilience, and better equip managers to face challenges posed by whiplash while meeting human and environmental needs.

Irrigation expansion shows potential for increased maize yield and reduced nitrogen leaching in the Midwest US

CONTEXTYield gaps in Midwest US rainfed maize (Zea mays L.) are likely to continue to increase as the frequency of extreme weather events associated with future climate change increase (i.e., high temperatures, precipitation variability). One solution to closing this gap is the expansion of irrigation in regions that currently do not utilize this practice. While irrigation expansion has the potential to increase maize yields and crop productivity, there is also the potential to see improvement in nitrogen loss. However, it remains unclear at what point irrigation should be triggered (i.e., plant available water content (AWC) thresholds) to obtain a balance between crop productivity and environmental improvements. OBJECTIVEThe objective of this study is to assess the effects of irrigation management on maize yield, nitrogen leaching, and water use efficiency under the expansion of irrigation across the entire Midwest US and to determine the optimal plant AWC threshold to trigger irrigation for achieving a substantial increase in maize yield and reduction in nitrogen leaching while using the minimal amount of required irrigation. METHODSWe use an agroecosystem model, Agro-IBIS, to simulate both rainfed and irrigated maize production and nitrogen leaching under likely future climate conditions (i.e., wet-warm, dry-warm). To determine the optimal plant AWC threshold for irrigation, irrigation scenarios were conducted for a range of plant AWC thresholds (0.2 to 0.8) across the entire Midwest US. RESULTS AND CONCLUSIONSOur results show that Midwest US regions that do not currently utilize irrigation could experience an 11–37% increase in maize yield and a 12–32% decrease in nitrogen leaching when irrigation (39.0 to 96.8 mm yr−1) is triggered at the lower end of the plant AWC threshold (e.g., 0.3). Maize grown under dry-warm and wet-warm climate conditions will likely experience increased yields and reduced nitrogen loss with minimal irrigation. While these findings suggest that the expansion of irrigation could help close yield gaps while improving other ecosystem services, future work should focus on simulating these conditions under a wider range of precipitation extremes and fertilizer management to better understand the potential interactions under a changing climate. SIGNIFICANCEThis study outlines the optimal plant AWC threshold for irrigation to maximize maize yields in the Midwest while minimizing nitrogen loss and can provide valuable insights for making informed decisions about landscape management under future conditions.