Changes in groundwater recharge in areas where irrigated agriculture has increased despite low precipitation and surface water allocation are a big concern. The increasing water demand has raised global drought intensities by 10-500%, worsening hydrological drought. Agriculture accounts for 69% of total groundwater abstraction worldwide, and South America expects to face unprecedented hydrological drought conditions within the next 30 years with uncertain impacts (UNESCO 2022, Wada 2016, Wanders & Wada 2015, Siebert et al. 2015). This study compares coupled and non-coupled versions of PCR-GLOBWB2.0 with MODFLOW regarding model selection and scenario comparison. Natural and human scenarios are presented to understand the effects of groundwater depletion and drought recovery. The scenario comparison evaluation of groundwater fluxes, drought characteristics, and recovery reveals changes in the water cycle due to anthropogenic impacts. This is valuable for identifying drought vulnerability in regions where water management is critical for human consumption and ecosystems.

Background Despite several publications covering patients from multiple centers, no international registry covered all patients with red blood cell diseases (RBCD) affected by COVID-19. The ERN-EuroBloodNet’s registry provided real-time registration of SARS-CoV-2 patients with RBCD, promoting timely disease-specific knowledge sharing during the pandemic’s early stages. Procedures The study evaluated patient distribution, the infection across different RBBDs, and severity risk factors across similar healthcare systems, using data collected from the ERN-EuroBloodNet’s REDCap platform. Results From April 2020 to April 2023, 681 infections were recorded among 663 patients, of which 373 had transfusion-dependent thalassemia or non-transfusion-dependent thalassemia (TDT/NTDT), and 269 had sickle cell disease (SCD). SCD patients had a higher incidence of COVID-19 than those with TDT/NTDT (10.5 vs. 4.8 COVID/100 patients). Notably, 92% of the cases were mild, with neither age nor the specific RBCD affecting severity. The number of comorbidities, notably obesity and hypertension, that patients had prior to infection was associated with more severe COVID-19. During the infection, the presence of vaso-occlusive crises, acute chest syndrome, kidney failure, and ground-glass opacities on chest tomography scans were associated with a more severe clinical picture. The vaccination rate (32%) mirrored that of the general population and showed a protective effect against severe COVID-19. The observed mortality rate was 0.7%, aligning with Europe’s general population. Conclusion: SARS-CoV-2 infection in SCD and TDT/NTDT patients is mild and without higher mortality than the general population. The ERN-Eurobloodnet’s registry collaborative structure exemplifies the power of international cooperation in tackling rare diseases, especially during health emergencies

The cortical somatostatin interneuron population includes several diverse cell types, among them the Martinotti cells. Layer-specific differences in connectivity and function between different subtypes of Martinotti cells are becoming apparent, which require contemporary studies to investigate cortical interneurons in a layer and subtype specific manner. In this study, we investigate the connectivity of a subtype of Chrna2+ layer 5 Martinotti cells in the primary motor cortex, using a monosynaptic retrograde rabies viral tracer. We found direct input from pyramidal cells and local parvalbumin interneurons. In addition, we found long-range direct inputs from the motor thalamus, substantia innominata of the basal forebrain and globus pallidus. Based on the observed input pattern, we tested and found an increased number of falls in the hanging wire test upon temporary overexcitation of Chrna2+ layer 5 Martinotti cells. These results suggest that Chrna2+ Martinotti cells in the motor cortex are involved in sensorimotor integration.

Introduction: The aim of the study was to assess the predicting value of neuromarkers for psychomotor performances of congenital heart defect (CHD) patients. Methods: This cross-sectional study included children with CHD who did not receive treatment (interventional or cardiac surgery). Psychomotor development was evaluated using Denver II Screening Test. Blood samples were collected for neuromarkers analysis: neuron-specific enolase (NSE), protein S100 (pS100), brain-derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP). Results: We enrolled 77 children. Patients with CHD experienced more frequent developmental delays compared to healthy children (12-34% in the non-cyanotic group and 26-74% in the cyanotic group). The association between type of CHD and psychomotor impairment was statistically significant (p<0.0001, RR=2.604, CI=2.07-3.26). Neuromarkers value was compared between cyanotic and non-cyanotic groups: NSE and BDNF values were higher in the cyanotic group, respectively, pS100 and GFAP had slightly higher values in the non-cyanotic group. A correlation coefficient of 0.35 (p=0.023) was obtained between psychomotor development and BDNF level. An AUC of 0.72 was obtained for psychomotor development and BDNF in ROC analysis with the cut-off value of 5895 pg/ml. Conclusion: BDNF is showing moderate discriminative ability in predicting psychomotor development outcomes in pediatric patients with CHD.

This paper addresses the distributed recursive filtering problem for a class of time-varying multi-rate nonlinear systems which are subject to fading channels, sensor resolutions and quantization effects. For the purpose of prolonging the transmission distance, the amplify-and-forward (AaF) relay is deployed in wireless communication channel. The iterative method is employed to convert the underlying multi-rate system into a single-rate one. Before entering communication networks to transmission, measurement outputs are quantized by using the logarithmic quantizer. Moreover, a new equivalent delay-free measurement sequence is defined by the measurement reorganization technology to tackle random transmission delays. Our mainly aim is to design a distributed recursive filter such that an upper bound for the filtering error covariance is determined and subsequently minimized by properly choosing the filtering gains. Next, the performance of the proposed filtering algorithm is analyzed through establishing a sufficient condition for the boundedness of the filtering error covariance. Finally, a numerical simulation is used to testify the applicability and effectiveness of the developed filtering algorithm.

Actions are rarely devoid of emotional content. Thus, a more complete picture of the neural mechanisms underlying mental simulation of observed actions requires more research using emotion information. The present study used high-density electroencephalography to investigate mental simulation associated with facial emotion categorisation. Alpha-mu rhythm modulation was measured at each frequency, from 8 Hz to 13 Hz, to infer the degree of sensorimotor simulation. Results suggest the sensitivity of the sensorimotor activity to emotional information, because (1) categorising static images of neutral faces as happy or sad was associated with stronger suppression in the central region than categorising clearly happy faces, (2) there was preliminary evidence indicating that the strongest suppression in the central region was in response to neutral faces, followed by sad and then happy faces, and (3) in the control task, which required categorising images with the head oriented right, left, or forward as right or left, differences between conditions showed a pattern more indicative of task difficulty rather than sensorimotor engagement. Dissociable processing of emotional information in facial expressions and directionality information in head orientations was further captured in beta band activity (14-20 Hz). Stronger mu suppression to neutral faces indicates that sensorimotor simulation extends beyond crude motor mimicry. We propose that mu rhythm responses to facial expressions may serve as a biomarker for empathy circuit activation. Future research should investigate whether atypical or inconsistent mu rhythm responses to facial expressions indicate difficulties in understanding or sharing emotions.

This article assesses the reliability and readiness level of the open-pit drilling rigs used by the ”Erdenet Mining Corporation” in Mongolia. The assessment is based on a dynamic system model that predicts the reliable operation of the drilling rigs from 2010 to 2030. The model incorporates quantitative data on rig breakdowns and repairs from 2006 to 2019, using mathematical formulas based on Markov chain and Weibull distribution laws. The model’s unique feature lies in its use of ordinary differential equations, random process theory, distribution laws, and system dynamic modeling methods, allowing for easy performance of experiments and simulations. The certainty of drill-rig breakdowns necessitates minimizing damage and ensuring continuous and reliable mine operation. To enhance the drilling rig’s reliability, two methods are proposed: improving maintenance or purchasing new equipment. The article aims to calculate how these methods will impact the reliable operation of the drilling rig and determine the most economically beneficial option.

Epitaxial growth technology has drew widespread attention in the field of perovskites because of its notable success to produce high-quality crystals with preferred orientations and superior photoelectric properties, which enables the material combinations with a coherent interfacial lattice as well as combined complementary functionalities. Besides, the minimized structural defects benefited from the lattice coherent and the adjustable residual strain level could profoundly impact the energy conversion performance of perovskite epitaxial structures and their assembled devices. In this review, we summarized the lattice-matched epitaxial structures of perovskite solids categorized by the combined materials and demonstrated their lattice-matched schemes as well as the performance in various devices. Finally, we outline future directions for perovskite epitaxy, focusing on precise interfacial structure characterization and scaling up fabrications. These advancements have the potential to further enhance the performance and applications of perovskite-based devices.

The main antigens in the Rh blood group system are D, C, c, E and e 1. D– is a rare type that lacks C,c,E,e antigens, elevating D on RBC surface 2. Alloimmunization to anti-Rh17 causes severe HDFN 4. We report a case of Rh17 alloimmunization, treated with incompatible blood. Prenatal therapies included plasma exchange, intravenous immunoglobulin (IVIG) and intrauterine transfusions (IUTs). The infant, delivered at 32 weeks, experienced hyperbilirubinemia and anemia, managed with transfusions and medications. Due to the rarity of the condition, finding compatible blood is challenging, necessitating management with incompatible blood in severe HDFN cases, as exemplified in our case.

Aim: During the last decades mussels have shown a poleward shift in the distribution along the Atlantic coast conceivably driven by elevated sea-surface temperatures. We aimed to determine the baseline for the Northeast Atlantic (58 – 70° N) Mytilus species complex, and to compare the present distribution to surveys conducted 60 years ago. Location: Northeast Atlantic Methodology: Baseline was obtained by investigating a total of 509 stations in the intertidal zone, in four regions comprising the environmental gradient from head of fjord to coast, and distributed over the latitudinal gradient from 58 – 70° N. Results: The baseline shows a range in continuous abundance of mussels from 12 to 36 %, patchy abundance from 26 to 57 % and no or very limited mussel abundance from 26 to 46 % between the four regions. The presence of mussels in the southeast and west region was compared to previous surveys conducted 60 years ago. The data points to similar past and present presence of mussels in both regions, yet past major mussel fields in the inner section of region Southeast was not detected in this study. Main conclusions: The baseline of Mytilus spp. in the Northeast Atlantic (58 – 70° N) is now available for future reference. The baseline, compared to surveys conducted 60 years ago, points to awareness of the population situated in the southeast section of the investigated region. Continued monitoring and modelling are needed to clarify drivers of temporal and spatial variation in the mussel populations along the Northeastern Atlantic coast.

Endocrine disrupting chemicals (EDCs) are chemicals that interfere with the normal functioning of the endocrine (hormone) system in humans or other organisms. EDCs can exist in the environment in various ways. Exposure of organisms (including humans) to EDCs in the environment has been associated with various health problems, including feminization of fish, reproductive problems in alligators, decreased sperm count in humans, and childhood obesity. The aim of this study is to develop an environmentally friendly liquid-liquid extraction method for the determination of bisphenol A (BPA) and estradiol (E2) due to their frequency of occurrence, environmental importance, and chemical similarity to other EDCs, and to determine them using the LC-MS/MS method. A green LC-MS/MS method has been developed for the simultaneous determination of BPA and estradiol, which are important EDCs. The solvents used in the liquid-liquid extraction method developed and optimized in this study have environmentally friendly, easy degradability, and low toxicity properties. Ethyl acetate-acetone (4/1, v/v) was selected as the extraction solvent pair in the optimized extraction method. The best responses were obtained with a 10% NaCl concentration and 10 seconds of vortex time. The linear range of the developed method was found to be between 12 pg/mL and 100 ng/mL for BPA and between 48 pg/mL and 100 ng/mL for estradiol (E2). The intra-day and inter-day repeatability of the method is within an acceptable range at the internal level. The percent recovery values for both analytes were found to be between 75-98%. BPA and E-2 were successfully determined in drinking and environmental waters using the developed method.

Background: Subcutaneous immunotherapy has emerged as an effective option for treating allergic diseases. Here, we assessed the clinical impact of the mannan-conjugated birch pollen polallergoid T502 in birch pollen-induced allergic rhinoconjunctivitis. Methods: In this prospective, randomized, double-blind placebo-controlled phase III trial, 298 birch pollen–allergic adult patients were treated across 28 trial sites in Germany. Patients received either placebo or 23,000 mTU T502 subcutaneously over five pre-seasonal visits. Efficacy was assessed by comparing the combined symptom and medication score (CSMS) between placebo and T502 during the peak birch pollen season 2022. Safety, tolerability and immunologic effects were also analysed. Results: During the peak birch pollen season, the median CSMS of the T502 group was reduced by 33.00% (p=0.002) compared to placebo. The median daily symptom score and daily medication score were reduced by 30.43% (p<0.001) and 56.25% (p=0.045), respectively. Health related quality of life improved as reflected by reduction of RQLQ values by 31.54% (p<0.0001). Production of Bet v 1 sIgG4 and sIgG increased up to 6.2-fold and 3-fold respectively in the T502 group (p<0.0001). The sIgE/sIgG4 ratio was strongly reduced in the T502 group at V7 (-62.90%, p<0.0001). No fatalities nor serious adverse events were reported. In total, 16 systemic allergic reactions occurred (Grade I/II). Conclusions: Treatment with T502 significantly reduced symptoms and medication need in rhinoconjunctivitis patients. The treatment is well tolerated and safe.

Due to the escalating global warming, drought has significantly impacted the development and productivity of crops. This study identified a specific strain of Trichoderma harzianum from the soil surrounding healthy Nicotiana tabacum plants and examined its effect on the plants’ ability to withstand drought conditions. It was proved that the isolated T. harzianum can colonize in the roots of plants and promote the growth of N. tabacum. Therefore, studies were carried out to evaluate the growth-stimulating effects and improvement of drought resistance in N. tabacum by inoculating T. harzianum under different levels of drought. The investigation of agronomic parameters, physiological indicators, enzyme activity, photosynthetic ability, osmoprotectants, and membrane lipid peroxidation index demonstrated that the inoculation of T. harzianum (LDTh, MDTh, and SDTh) systematically regulates plant development and improves resistance to drought. This study offers substantial theoretical groundwork and potential applications for the development of innovative biofertilizers and enhancement of crop drought tolerance.

The research aims to characterize ethnomedicinal mushroom Lentinus squarrosulus isolates through morphological and molecular approaches. The nutritional requirements and cultural preferences required for the growth of L. squarrosulus were studied in order to maximize the production and its potential values. Morphological features of Lentinus sp. isolates were observed, and molecular methods were performed using DNA sequencing techniques to identify at species level. Culturing the isolates was carried out on potato dextrose agar for assessing cultural traits, colony diameter, mycelial dry weight, in addition to assess the impact of various growth factors like carbon and nitrogen sources, pH, and temperature on mycelial growth. Five isolates of L. squarrosulus were studied in that LS3 demonstrated best growth parameters, with potato dextrose agar as most conducive medium amended with 4% sorbitol and 4% mannitol as optimal carbon sources. Furthermore, maintaining pH levels between 6.0 to 7.0 and temperatures ranging from 25°C to 30°C optimized mycelial growth. The results highlight the crucial significance of comprehending the growth requirements of this mushroom species to maximize its cultivation potential effectively. Further exploration of these findings may unveil behavioral aspects of L. squarrosulus, including alterations in enzyme profiles and phenolic content, potentially fostering applications in biotechnology.

Spinal cord stimulation is a functional neurosurgery proposed for treating motor symptoms in patients with Parkinson’s disease, yet the mechanisms underlying motor symptom relief have not been elucidated. While preclinical studies suggest that long-term motor improvements may be due to neuroprotection of the nigrostriatal pathway, this evidence is limited to neurotoxic models. To evaluate the effect of spinal cord stimulation on nigrostriatal pathway neuroprotection in a genetic model of Parkinson’s disease, male Sprague-Dawley rats were unilaterally injected into the substantia nigra with empty or α-synuclein-coding adeno-associated viruses. Thirty-two days later, the rats were treated with 300 Hz spinal cord stimulation for ten weeks (two sessions/week). Ninety-one days post-injection treated α-synuclein rats had better motor performance than the untreated group, and no differences compared to the control group. However, spinal cord stimulation could not counteract the loss of dopaminergic neurons in the nigrostriatal pathway and did not cause changes in the total dopamine levels in the striatum, dopamine transporter, or tyrosine hydroxylase expression in the substantia nigra. The current study suggests that spinal cord stimulation prevents motor impairment in a genetic model of PD through a mechanism independent of the nigrostriatal pathway degeneration induced by α-synuclein overexpression.

Note: One of the catalyst systems is nano-reactors. One of the applications of nano-reactors is the electronic conductivity of porous materials smaller than  011 nm.Nano-reactors are very diverse. Simple or complex, organic and inorganic materials with electrical conductivity, volume, and tissue cavity are used as nano-reactors. Unlike micro-reactors, the reaction space inside the nanoreactors greatly affects the mobility and interactions between the molecules inside it. So the nano-reactor is not just a simple storage container and plays an important role in  the electrochemical process. Nano-reactors are relatively new materials, but in nature, nano-reactors have long been used in processes. Electrochemical reactions in confined spaces with nanometer dimensions and micrometer volumes result in changes in the kinetics and direction of the whole  process. To such confined spaces used for specific electrochemical reactions, a nano-reactor they say . Nano-reactors are very small nanometer-sized chambers that have the potential to improve electrochemical conversions by protecting catalysts from environmental impacts  as well as encapsulating reactors and catalysts in a small space for a long time  . In fact, nanoreactors are porous materials, one of which is nanoscale.

Microorganisms play a key role in maintaining the stability of vegetation-soil-microbial systems and terrestrial geochemical processes in alpine meadows. To investigate the effects of different management practices on the structure and function of microbial communities, the present study used metagenomic sequencing to investigate the structure and function of soil microbial communities in the southern Qilian Mountains of the Qinghai-Xizang Plateau in response to the management practices of fenestration (FE), winter grazing (WG), transition zone between natural and artificial grasslands (TZ), and artificial unicast oats (AU). The management measures significantly changed vegetation diversity and soil physicochemical properties. The prokaryotic community structure was considerably similar in FE and WG, as well as in TZ and AU. Near-natural (FE) and artificial establishment (AU) disturbances changed the fungal community structure. Enzymes related to carbon metabolism did not respond significantly to the management measures, whereas those related to nitrogen metabolism did not respond significantly in TZ and AU. The relative abundance of enzymes involved in nitrogen metabolism was higher under TZ and AU than under FE and WG. We concluded that grassland management measures altered the structure of aboveground graminoid and leguminous vegetation communities and belowground biomass allocation, resulting in changes in K uptake, causing significant changes in the structure of fungal communities and nitrogen-metabolizing enzymes; moderate disturbance (WG) was beneficial for maintaining the stability of microbial communities in alpine grasslands.

The spread of multidrug-resistant (MDR) Klebsiella pneumoniae, especially carbapenems and aminoglycosides, is a global public health challenge. Studying the genetic relatedness of bacteria from various sources, such as humans, animals, food, and the environment, can help identify potential routes of transmission and the extent of dissemination. In this study, we examined the phenotypes and genetic features of MDR K. pneumoniae isolates. Seventy K. pneumoniae strains were selected from different sources (clinics (n=55), environmental (n=7), and animals (n=8)), 43 of which were identified as carrying the blaKPC resistance gene, with a subset featuring both blaKPC-2 and blaKPC-3 variants, with different susceptibility profiles to aminoglycosides, and whole genome sequencing was used for phylogenetic analyses. Among them, 84% (n=59/70) and 53% (n=37/70) were resistant to amikacin and gentamicin, respectively. In addition, 93% (n=65/70) of the isolates harbored resistance genes, such as aminoglycoside-modifying enzymes (AMEs) and different plasmid types. Phylogenetic tree analyses showed two main clusters (A and B), and the multilocus sequence type (ST) 11 was the most frequently found among Brazilian isolates. Our findings showed a heterogeneous distribution of STs profiles in the two clusters, and a close relationship between human and animal or environmental K. pneumoniae strains.

Note:  In aerospace, carbon nanotubes can be used in the formation of airplane wings and projectiles.  Nanotubes are used in combination to bend in response to the application of electrical voltage.

The present study investigated whether the interaction of resting RSA (respiratory sinus arrhythmia) and RSA reactivity was associated with mobile phone addiction in adolescents. Physiological and psychological data were collected from 165 Chinese adolescents (80 boys; Mage = 12.68, Sage = 0.69). The results revealed that (1) resting RSA and RSA reactivity were both significantly negatively correlated with adolescents’ mobile phone addiction; and (2) resting RSA and RSA reactivity interactively to predict adolescents’ mobile phone addiction. Specifically, adolescents with higher resting RSA and higher RSA reactivity showed the lowest level of mobile phone addiction. The findings suggest the importance of considering the combined indices of respiratory sinus arrhythmia in predicting adolescent problem behaviors.

Rituximab is used for several indications including primary glomerulopathies; however, the optimal schedule in those diseases remains to be established. The aim of this study is to characterize rituximab pharmacokinetics in a population affected with glomerular diseases. A single-center, open-labelled, uncontrolled clinical trial was performed including adults affected by glomerular diseases who required rituximab (NEFRTX, EudraCT: 2020-000484-23). Patients received 1g or 0.5g of rituximab on day 1 (and 14 in some cases); blood and urine samples were collected. Rituximab and anti-rituximab concentrations were measured and the gene encoding the neonatal fragment crystallizable receptor (FcRn) was characterized. Win-Nonlin 1.1, was used for pharamacokinetic analysis. Thirty-five cases (30 patients) were included. Pharmacokinetic parameters (mean ± standard deviation): maximum plasma concentration 179.4±71.8µg/ml, volume of distribution 78.9±31.4ml/kg, clearance 0.30±0.27ml/h/kg, half-life (t1/2) 11.6±5.8d, elimination rate constant 0.0036±0.0030h⁻¹, area under the curve 117,756.1±88,228.1µg·h/ml. Anti-rituximab was detected on d1 in 3(8.6%) cases, they were negative by d28. No infusion reactions occurred. Rituximab t1/2 was characterized by the formula: t1/2=A-B·Log (Proteinuria)+C·Albuminemia; where A=515.0 (128.8, 901.3), B=182.1 (-108.6, -35.4), C=39.5 (-10.9, 89.9). There were differences in rituximab t1/2 depending on the presence of 24-hours proteinuria>2.4 g/24h (p<0.001), early treatment (p=0.008), diagnosis (p=0.025) and IgG<650 mg/dL (p=0.048). Our study confirms that albuminemia and especially proteinuria affect rituximab t1/2 and drug exposure in patients with primary glomerulopathies. Patients affected by membranous nephropathy and/or nephrotic syndrome and/or proteinuria >2.4 g/24h and/or IgG <650 mg/dl could need more frequent dosing. Further research is needed to establish an optimal dosing strategy in this population.

The test data of smooth specimens is expanded, by integrating Bayesian theory and the Monte Carlo method, and a probabilistic fatigue model considering size effect under different loading conditions is established. Furthermore, the influence of non-uniform stress fields and notch characteristics on fatigue crack initiation is defined, considering critical distance, with a correction to the stress field damage parameter. The relationship between fatigue life and damage variables under various loading conditions is explored, the virtual sub-sample augmentation method and the weakest link theory are combined, leading to the establishment of a multiaxial fatigue life prediction model, suitable for notched specimens. Finally, the prediction life using proposed method and other models are compared with the experimental life of three materials, the compared results show that the proposed method exhibits a notably heightened level of accuracy, and the fatigue life of notched specimens can be predicted by small samples of smooth specimens.

One of the scarcely explored subjects in automotive development is the reduction of software variants for attaining engineering simplicity. On the one hand, variants of functionality allow automakers to explore the customers' needs and tastes. On the other hand, adding software variants increase engineering complexity and production defects. From practice, this paper presents sensible ways for reducing automotive software variants.

BACKGROUND In pediatric patients with central nervous system (CNS) tumors, survival is associated with World Heatlh Organization (WHO) grade and location but the impact of social determinants of health is less clear. Many publications utilize the Surveillance, Epidemiology, and End Results (SEER) databases to assess social determinants of health. While this is a comprehensive resource, there is a paucity of data from geographic regions, like Ohio. PROCEDURE The relationships between race and socioeconomic status (SES) on the 5-year overall survival (OS) and event free survival (EFS) of pediatric patients with primary CNS tumors treated at a single, tertiary institution from 2009-2017 (n=184) were analyzed. Race and SES were determined through self-designation and an index-based county economic classification system respectively. Kaplan-Meier Survival Analyses were performed for OS and EFS. Cox Proportional Hazards models evaluated the association of race, SES, WHO tumor classification and grade, and tumor location, both individually and in combination, with OS and EFS. RESULTS Grade and location of tumor impacted OS and EFS with high-grade tumors yielding worse outcomes (p-values <0.001) and tumors in the midbrain experiencing worse OS compared to spinal and supratentorial tumors (p-values 0.001 and 0.047). Race and SES did not impact OS or EFS (p-values >0.2). Comparison of models showed OS and EFS were not impacted by race or SES, but rather a combination of tumor classification, grade, and location. CONCLUSION There was no association between race or SES on outcomes in our population at a single, tertiary institution, which deviates from previous data.