Use of Stroboscopic Goggles in Suture Training Improves Precision and Accuracy.

Background: This study aimed to quantify the impact of intermittent visual occlusion via stroboscopic goggles on suture accuracy and precision.

Methods: This crossover study recruited and randomized 72 graduate students to train with stroboscopic goggles early or late in structured suture practice. Participants completed assessments of 10 running sutures with 2 training sessions between baseline and follow-up assessments.

Impacts of longleaf pine (Pinus palustris Mill.) on long-term hydrology at the watershed scale.

Threats from climate change and growing populations require innovative solutions for restoring streamflow in many regions. In the arid western U.S.

Integration of Improvement and Implementation Science in Practice-Based Research Networks: a Longitudinal, Comparative Case Study.

Background: Implementation science (IS) and quality improvement (QI) inhabit distinct areas of scholarly literature, but are often blended in practice. Because practice-based research networks (PBRNs) draw from both traditions, their experience could inform opportunities for strategic IS-QI alignment.

Objective: To systematically examine IS, QI, and IS/QI projects conducted within a PBRN over time to identify similarities, differences, and synergies.

Warmer temperatures reduce net carbon uptake, but do not affect water use, in a mature southern Appalachian forest.

Increasing air temperature is expected to extend growing season length in temperate, broadleaf forests, leading to potential increases in evapotranspiration and net carbon uptake. However, other key processes affecting water and carbon cycles are also highly temperature-dependent. Warmer temperatures may result in higher ecosystem carbon loss through respiration and higher potential evapotranspiration through increased atmospheric demand for water.

Declining water yield from forested mountain watersheds in response to climate change and forest mesophication.

Climate change and forest disturbances are threatening the ability of forested mountain watersheds to provide the clean, reliable, and abundant fresh water necessary to support aquatic ecosystems and a growing human population. Here, we used 76 years of water yield, climate, and field plot vegetation measurements in six unmanaged, reference watersheds in the southern Appalachian Mountains of North Carolina, USA to determine whether water yield has changed over time, and to examine and attribute the causal mechanisms of change. We found that annual water yield increased in some watersheds from 1938 to the mid-1970s by as much as 55%, but this was followed by decreases up to 22% by 2013.

Two fixation methods for acromioclavicular joint reduction during coracoclavicular ligament reconstruction: a biomechanical analysis.

One specimen from each of six pairs of cadaveric shoulders underwent a semitendinosus coracoclavicular ligament reconstruction with a hook plate used for acromioclavicular joint reduction, while on the other specimen a polydioxanone (PDS) suture braid was utilized. Cyclical loading followed by maximal load-to-failure testing was performed. Displacement during cyclical loading, loads to 50% and 100% displacement, stiffness, and maximal load to failure were determined for all specimens.

Barrier island morphology and sediment characteristics affect the recovery of dune building grasses following storm-induced overwash.

Barrier islands are complex and dynamic systems that provide critical ecosystem services to coastal populations. Stability of these systems is threatened by rising sea level and the potential for coastal storms to increase in frequency and intensity. Recovery of dune-building grasses following storms is an important process that promotes topographic heterogeneity and long-term stability of barrier islands, yet factors that drive dune recovery are poorly understood.

Future species composition will affect forest water use after loss of eastern hemlock from southern Appalachian forests.

Infestation of eastern hemlock (Tsuga canadensis (L.) Carr.) with hemlock woolly adelgid (HWA, Adelges tsugae) has caused widespread mortality of this key canopy species throughout much of the southern Appalachian Mountains in the past decade.

Contribution of sunflecks is minimal in expanding shrub thickets compared to temperate forest.

Ecological consequences of shrub encroachment are emerging as a key issue in the study of global change. In mesic grasslands, shrub encroachment can result in a fivefold increase in ecosystem leaf area index (LAI) and a concurrent reduction in understory light and herbaceous diversity. LAI and light attenuation are often higher for shrub thickets than for forest communities in the same region, yet little is known about the contribution of sunflecks in shrub-dominated systems.

Shifts in litterfall and dominant nitrogen sources after expansion of shrub thickets.

Woody encroachment into herbaceous ecosystems is emerging as an important ecological response to global change. A primary concern is alterations in C and N cycling and associated variations across a variety of ecosystems. We quantified seasonal variation in litterfall and litter N concentration in Morella cerifera shrub thickets to assess changes in litterfall and associated N input after shrub expansion on an Atlantic coast barrier island.

Leaf-area index and light attenuation in rapidly expanding shrub thickets.

There is increasing interest in the changes in ecosystem services that accompany the conversion of grasslands to shrub-dominated communities. Shrub structure and associated effects on the light environment may be especially important in affecting productivity and diversity. Leaf-area index (LAI) and understory light levels of Morella cerifera shrub thickets were assessed on Hog Island, Virginia, USA, at four sites along a soil chronosequence.

Lung injury linked to etanercept therapy.

Etanercept is the first anticytokine drug approved to treat rheumatoid arthritis. Side effects are infrequent, the most common being local skin reactions, headaches, and upper respiratory tract symptoms. We report the first case of lung injury that occurred while receiving this agent.