Public Chronic Traumatic Encephalopathy Knowledge: Sources, Accuracy and Confidence

ABSTRACT

The goal of this study was to examine the general public's level of accuracy and confidence in knowledge of chronic traumatic encephalopathy (CTE), as well as information sources. This study also explored how these factors affected comfort in allowing children to play a high-contact sport. This study utilized online surveys and included 529 participants. Overall, CTE knowledge accuracy was 48.02% (standard deviation = 0.23). Inaccuracies regarding the etiology and diagnosis of CTE were most common, whereas the symptoms and lack of treatments for CTE were more widely known. Despite overall low CTE knowledge accuracy, CTE knowledge confidence was positively correlated with comfort in allowing children to play a high-contact sport (r = 0.199, P ≤ 0.001). Participants identified television/movies followed by web sites and social media as the most utilized CTE information sources. These results further support the need for clinicians and researchers to address misconceptions about CTE.

Vulnerable in the end - Longitudinal study among medical students on mental health and personal and work-related resources over a 5.5-year-period

BACKGROUND

Mental health problems are common in medical professionals and their development already starts at the undergraduate level. Studies on medical students can replicate higher prevalence for depression and burnout in this group, but they normally compare semester cohorts in an anonymized, cross-sectional approach and without a preventive perspective.

METHODS

We surveyed medical students at the beginning and end of their medical curriculum and collected data on burnout, depressivity, work related experience and salutogenesis parameters with validated self-administered questionnaires. Most remarkably we obtained the data from the same 58 individuals after 5.5 years, representing data of the highest quality in order to compare the mental health status at the beginning and the end of our students´ medical curriculum.

RESULTS

Our results not only show a severe exacerbation of physical, mental and emotional burnout in the participants at the end of their studies. The students also do not seem to have sufficient personal (resilience) or social resources (e.g. experience of social support) for coping with their mental health problems around the time of their graduation.

CONCLUSIONS

Our participants reflect a development of mental health during their medical studies at university that is paving the way to the devastating prevalence of mental disorders and suicide in health professionals. From our results we derive an urgent need to integrate self-care and active coping in the learning goals of medical curricula.

Safety of prolonged outpatient courses of intravenous antibiotics: a prospective cohort study

OBJECTIVES

The perceived need for prolonged intravenous antibiotic courses has become a major driver behind the growth of outpatient parenteral antimicrobial therapy (OPAT) services. Several recent randomised controlled trials demonstrate non-inferiority of early switch to oral therapy and highlight the need to accurately quantify harms associated with OPAT.

METHODS

We conducted a 10-year prospective cohort study in a tertiary hospital OPAT service. Adults admitted to the service between 1^st June 2009 and 30^th June 2019 who received an intravenous antimicrobial agent were included. Adverse events (AEs) attributable to intravenous antibiotics or intravenous access were recorded in a prospectively maintained database and analysed.

RESULTS

There were 4,160 admissions (median length of stay 20 days), and a total of 88,432 patient-days of observation. 135 (3.3% of admissions) experienced at least one major AE (1.54/1,000 patient days [95%CI: 1.29 to 1.82]). The risk of a major AE peaked in the second week of OPAT admission, with acute kidney injury (43/136, 32%) and severe cytopenia (42/136, 31%) being most common. At least one minor AE occurred in 38.3% (1,592/4,160) of admissions (26.4 per 1,000 patient days [95%CI: 25.4 to 27.5]), with central venous catheter related complications accounting for 71% (1658/2338).

CONCLUSIONS

The incidence of major adverse events during long courses of intravenous antibiotics is low, peaking in week two and tailing off thereafter. These results should inform decisions concerning the choice of intravenous versus oral antimicrobials.

Light assisted synthesis of poly-para-phenylene on Ag(001)

A detailed study of poly-para-phenylene (PPP) obtained by light-assisted on-surface-synthesis (OSS) on Ag(100) was carried out by scanning tunneling microscopy and spectroscopy together with density functional theory calculations. The use of light in combination with heat allows to lower by 50 K annealing temperature the each stage of the Ullmann coupling. Debromination of the 4,4″ dibromo-p-terphenyl precursors was thus realized at 300 K, the formation of the first oligomers from the organometallic intermediate by silver bridging atom release at 423 K and PPP by complete elimination of the silver at 473 K. This approach to lower the reaction temperature permits to enhance the Ag(100) surface reactivity to become comparable to that of Cu(111). The underlying mechanism of light effect was proposed to occur via surface mediated excitation, with the creation of photoexcited electrons known as hot electrons correlated with surface plasmon excitation. This original pathway combining both light and heat provides an additional parameter to control OSS by separating the precursor activation stage from the diffusion.

Growth-mode and interface structure of epitaxial ultrathin MgO/Ag(001) films

MgO ultrathin films are of great technological importance as electron tunneling barrier in electronics and spintronics, and as template for metallic clusters in catalysis and for molecular networks for 2D electronics. The wide band-gap of MgO allows for a very effective decoupling from the substrate. The films morphology and the detailed structure of the interface are crucial for applications, controlling the electronic transfer. Using surface x-ray diffraction, we studied the growth-mode and the structure of MgO/Ag(001) ultrathin films elaborated by reactive molecular beam epitaxy as function of the substrate temperature. We observed that deposition of about 1 monolayer results in an MgO(001) film in coherent epitaxy, with the oxygen atoms on top of silver as predicted by DFT calculations, and an interlayer distance at the interface of about 270 pm. Under well-defined conditions, a sharp MgO bilayer is formed covering a fraction of the substrate surface.

Software tools for practical application of human nutrient requirements in food-based social science research

This article focuses on the use of human nutrition requirements for applied social science research by non-nutrition experts.  Our motivation is to provide the data and default nutrient requirements to calculate the Cost of Nutrient Adequacy (CoNA) least-cost diet meeting specified nutrient requirements. The final format of the resulting datafile is ready for use in the CoNA protocol. However, we expect this article and associated software tools to be generally useful to social science researchers interested in nutrition-related research questions and the potential implications of food systems’ changes for nutrition. We provide readily usable data files (Supplement 1) containing the Dietary Reference Intakes (DRIs) and guide non-nutrition experts through appropriate use to establish the nutrient needs and assess the adequacy of diets for populations and groups. We complement the DRIs with companion data files (Supplement 2) containing the WHO Child Growth Standards and WHO Growth References for School-Aged Children and Adolescents percentiles tables of anthropometric measures, extract the median heights and weights, and calculate median reference values for the age-sex groups consistent with the DRIs nutrient requirements. We provide calculations of energy requirements using the DRIs Estimated Energy Requirement (EER) equation and WHO growth references for all age-sex groups and physical activity levels. We also calculate the protein Estimated Average Requirement (EAR) per kilogram body weight according to the WHO growth references. For children under two, we provide nutrient needs required from food in Supplement 3. We provide Stata code and R syntax (Supplements 4 and 5) to compile the single data files into usable datasets for statistical analysis. Finally, we also provide data files (Supplement 6) with the recently proposed harmonized average values and upper levels and briefly discuss their potential application.

The Cost of Nutritious Diets for Individuals and Households in Rural Malawi

Objectives

The affordability of healthy diets is a key concern for policymakers and an active area of research. To the best of our knowledge, ours is the first study to examine the cost of nutritionally adequate diets for all population age and sex subgroups at subnational disaggregation over a 10-year monthly time series as well as to extend the least-cost diet framework from individuals to household units who consume shared meals.

Methods

We use household survey panel data matched with local food composition data, human nutrient requirements (EARs, ULs and AMDRs), and monthly market food prices. The food price data include a standardized list of 51 items comprising those foods accounting for the vast majority of household food spending, covering all food groups. Household data are from the Integrated Household Panel Survey (IHPS) 3-round panel (2010–2017). Using linear programming, we identify the combination of available foods and quantities that meet the specified nutrient requirements at the lowest total cost.

Results

Local markets can supply an adequate diet most of the time for some groups but much less often for breastfeeding women and young children, and not at al for children 6–36 months. Where possible, we find that the least-cost individual diet costs 32% of current per capita food spending. For whole households, the local market can meet aggregate nutrient needs 30% of the time. Where possible, it costs 1.8 times household food spending or all total expenditure. Food group analysis reveals households spend more on cereals, meat and roots/tubers, compared to the least-cost adequate diet, but may be under-spending on legumes, milk, fats, and vitamin A-rich fruits.

Conclusions

Finding a healthy diet in Malawi's local markets is not always possible for all types of individuals or families of varying composition. Children 6–36 months require immediate attention, including increasing access to complete complementary foods. Guiding households to make smart shifts in their food spending could improve diet quality but is insufficient alone given that adequate shared meals are unaffordable for most families. Year-round access to nutritious, affordable diets will require an increase in availability and lower cost of nutrient-dense foods and economic growth to raise incomes.

Funding Sources

Bill & Melinda Gates Foundation, CANDASA project.

Salmonella in Foods: New Enrichment Procedure for TECRA Salmonella Visual Immunoassay Using a Single RV(R10) Only, TT Only, or Dual RV(R10) and TT Selective Enrichment Broths (AOAC Official Method 998.09): Collaborative Study

A collaborative study was conducted to compare a new enrichment procedure for the TECRA® Salmonella Visual Immunoassay (TSVIA) with the reference method given in the U.S. Food and Drug Administration's Bacteriological Analytical Manual (7th Ed.). Three food types (milk powder, pepper, and soy flour) were analyzed in Australia and 3 food types (milk chocolate, dried egg, and raw turkey) were analyzed in the United States. Thirty-eight collaborators participated in the study. The TECRA method was evaluated using both Rappaport-Vassiliadis R10 (RV(R10)) and tetrathionate (TT) broths for selective enrichment. M broth cultures arising from each of the 2 selective enrichment broths were tested in the TSVIA using 2 individual wells, one for each selective broth, and a single well to test the pooled selective enrichment broths. The results for the pooled enrichment broths were reported elsewhere. This study presents the results for the use of single enrichment broths, i.e., RV(R10) only or TT only, with the TSVIA. No significant differences (p > 0.05) were observed for the pairwise comparison of the proportion of positive samples for either RV(R10) or TT used as a single enrichment broth for the TSVIA with that for the reference method.

Nutrient Adequacy at the Household Level and the Cost of Nutritious Diets in Malawi (P10-055-19)

Objectives

Nutrient requirements are defined for individuals, but meals are often shared and food consumption is typically measured at the household level. Prior studies of nutrient adequacy using household data have estimated requirements in terms of adult equivalents. We introduced a nutrient-by-nutrient approach to capture differences in household composition, and used this measure to test whether a household's nutrient adequacy was associated with the market cost of nutritionally adequate diets.

Methods

We used panel data on food consumption from 1398 rural Malawian households from the Malawi Integrated Household Survey Panel with monthly prices for 53 foods at the nearest market. Both datasets are collected by the National Statistics Office (NSO), matched at the market-month level. We defined household nutrient needs as the highest density of each nutrient (quantity per kilocalorie) required by any household member over 6 months, summed over daily energy requirements for each individual in the household. From local prices and food composition data we calculated a least-cost, nutritionally adequate diet for the mean household, and computed its level at each location. From observed consumption and nutrient needs we calculated household nutrient adequacy ratios (HNARs) and mean adequacy ratios (HMAR), and tested their association with the local market cost of nutrient adequacy (CoNA), controlling for seasonality, volatility of diet cost, and household size.

Results

In each round of the survey, between 36% and 59% of households reached their nutrient requirements (HMAR = 1). We found no significant association with the level, seasonality or volatility in market costs, but found that greater household size is associated with lower odds of meeting nutrient adequacy.

Conclusions

Our novel approach recognizes food sharing at the household level, typical in developing countries, thereby advancing the potential to conduct nutrition-related analyses with existing household survey data. Our initial application found no association with market prices suggesting that other factors may be more important predictors of nutrient adequacy. Future analyses will investigate dietary patterns and cost of individual nutrients to further explain the odds of meeting household needs.

Funding Sources

Bill & Melinda Gates Foundation via the CANDASA project.

Supporting Tables, Images and/or Graphs

Orange Fanta versus orange fruit: A novel measure of nutrition knowledge in Malawi

This paper introduces a novel survey instrument to identify distinct components of nutrition knowledge and test for links between knowledge and dietary choices in Southern Malawi. Our first aim is to distinguish respondents' familiarity with recommended behaviours, such as when to start breastfeeding or introduce solid foods, from respondents' factual knowledge about mechanisms, such as whether biscuits or papaya and orange fruit or orange Fanta contribute more to future health. We find knowledge of nutrition behaviours to be strongly associated with more schooling, older age, and being female, whereas knowledge of mechanisms is associated only with training and employment as a health professional. We then test whether this expanded definition of nutrition knowledge is associated with dietary intake when controlling for other factors and find no significant links in these data. Results point to the need for knowledge surveys and public health behaviour-change campaigns to address the kinds of information that might have the most influence on actual behaviour, potentially including the mechanisms involved in food composition, food safety, and disease transmission.

[Specific characteristics of chest X‑ray in childhood : Basics for radiologists]

The radiographic technique of pediatric chest X‑rays is substantially different from that in adults. In nearly all cases ap/pa X‑rays are sufficient and lateral radiographs are rarely needed. In the first years of life the thymus may overshadow the heart, the great vessels and the lung hila. The most important anatomical structures essential for diagnosing pathological findings of the lungs and mediastinum are the trachea with the bifurcation and the main bronchi with the adjacent great vessels. For the assessment of distended lungs and intrathoracic consolidations, fundamental knowledge of the anatomy in childhood and malformations which can involve the airways, the lungs, the heart, as well as systemic and pulmonary vessels are indispensable. Diseases of the pleura and the chest wall should always be investigated by ultrasound. Malignant disorders are rare in children, except for lymphomas. Optimized computed tomography (CT) and/or magnetic resonance imaging (MRI) are crucial in the diagnostic workflow of complex congenital heart diseases, complex lung and airway malformations, pulmonary complications in cystic fibrosis and the diagnostics of all tumors in order to make the right treatment decisions.

Abstract P3-03-01: Clinical utility of finding pathogenic mutations beyond BRCA1/2 in breast cancer patients

Background

The clinical utility of germline genetic testing for BRCA1 and BRCA2 has long been established. However, management recommendations for pathogenic variants in other genes, typically included in multigene panels, have only recently been included in consensus guidelines for HBOC. The clinician actions implemented for findings in these genes, and patient follow-up, are not yet well studied. We report interim results from a multi-site study of clinical actions undertaken in patients presenting with HBOC and carrying a pathogenic germline mutation in cancer risk genes other than BRCA1/2.

Methods

We retrospectively examined a cohort of patients with a personal history of HBOC who had been referred for hereditary cancer multigene testing from three major academic medical centers. For patients with pathogenic findings in a non-BRCA1/2 cancer risk gene, ordering clinicians completed a short case report form describing the clinical actions taken in response to the genetic test result, and patient follow-up. Some patients were lost to follow-up and answers of “unknown” were permitted. Genes with positive findings included CHEK2, PALB2, ATM, MUTYH, RAD51C, TP53, MSH6, RAD50, APC, BARD1, BRIP1, MSH2, NF1, NBN, PMS2, and PTEN. Case report forms were available for 77 patients as of our cut off date, and these data were de-identified and summarized for this interim report. Additional cases continue to accrue in this ongoing study.

Results

In 57% (44/77) of cases, clinicians reported that counseling and/or clinical management recommendations were changed in response to the genetic test findings. Management changes included modification of imaging surveillance (38%), considered or recommended surgical prophylaxis (12%), modified surgical plan for an existing malignancy (5%), and for one patient each: inclusion in a research trial for PARP inhibitors, modification of colonoscopy schedule, and screening for cancers other than existing malignancy. Clinicians indicated that genetic test results changed management in 48% of patients, did not change management in 29%, and had unknown impact for 23%.

Clinicians also reported that counseling and/or management for the patients' family members was changed in 67% (52/77) of cases, including family variant testing. 27% (21/77) of the patient families had cascade genetic testing, and one or more new carriers were identified in 47% (10) of the tested families. In 58% of cases, the impact of management recommendations on family members was unknown as of the case report date.

Conclusions

Pathogenic variants in non-BRCA genes are present in about 3-11% of patients with a history of HBOC. This study suggests that genetic test results in cancer genes beyond BRCA1/2 changed clinical management for a majority of patients and their family members, led to identification of new carriers, and directly impacted treatment decisions. In almost half of these patients, genetic test results impacted their health outcome, including those reported to be disease free after undergoing interventional or prophylactic surgery informed by their genetic variant. More research is needed to improve the implementation of genetic testing based management recommendations for patients and their family members.

Citation Format: Esplin ED, Michalski S, Yang S, Hampel H, Jeter J, Sweet K, Pilarski R, Pearlman R, Shane K, Brock P, Westman J, Chittenden A, Stopfer J, Schneider K, Sacca R, Stickevers S, Kipnis L, Koeller D, Gaonkar S, Sotelo J, Vaccari E, Cochrane S, Champine M, Espinel W, Lincoln SE, Nussbaum RL. Clinical utility of finding pathogenic mutations beyond BRCA1/2 in breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-03-01.

Lebens- und Versorgungssituation von Schlaganfallpatienten

Trotz einer gut etablierten Dokumentation in der Qualitätssicherung der Akutbehandlung beim Krankheitsbild Schlaganfall sind Daten zur Lebensund Versorgungssituation betroffener Patienten im weiteren Verlauf nach Entlassung aus der Akuttherapie nur spärlich vorhanden. Im Qualitätssicherungsprojekt Schlaganfall Nordwestdeutschland wurde eine fragebogenbasierte Erhebung drei Monate nach Entlassung aus dem akut behandelnden Krankenhaus durchgeführt. Ziel der Studie war die Erhebung der Lebensund Versorgungssituation einschließlich der Re-Insulthäufigkeit, der Mortalität und der funktionellen Leistungsfähigkeit. 3 632 Patienten nahmen an der Follow-up-Untersuchung teil, davon hatten etwa zwei Drittel die Diagnose eines ischämischen Insultes und etwa 20% eine TIA. Die Mortalität im Zeitraum zwischen Entlassung und Follow-up lag bei 5,0% und die Re-Insulthäufigkeit bei 3,5%. Standardisierte Nachbefragung von Schlaganfallpatienten liefern wichtige Informationen zum weiteren Krankheitsverlauf, die auch für die akut behandelnde Klinik wertvolle Hinweise enthalten.

Impact of Endodontic Treatments on the Rigidity of the Root

The destabilizing effect of endodontic treatment upon teeth is still controversial. The purpose of this study was to investigate the effects of different steps of endodontic treatments upon the rigidity of teeth. Extracted untreated central maxillary anterior teeth were loaded (3.75 N), and deformations of the root were assessed by Speckle pattern interferometry. The following treatments (with subsequent determination of deformability) were conducted sequentially: access preparation, manual instrumentation (Kerr files ISO-40, ISO-60, ISO-80, ISO-110), and tapered and parallel-sided post preparation. It was found that the teeth were increasingly destabilized by any treatment. While the increased deformability was not significant with the manual enlargement (p > 0.05), we found a significant destabilization after access preparation and post preparation (p < 0.05). A corresponding difference was found after conversion of the post preparation from tapered to parallel-sided (p < 0.05). Both substance loss and modifications of the natural root canal geometry play an important role in tooth rigidity.

Bradykinin Mediates Phosphorylation of eNOS in Odontoblasts

While the activation of eNOS by Akt/PKB-dependent phosphorylation, leading to NO release, and the inhibition of enzyme activity by bradykinin (BK)-mediated phosphorylation of eNOS in endothelial cells are established, the phosphorylation of eNOS in odontoblasts is unknown. To clarify the regulation of eNOS in odontoblasts by BK, we examined the phosphorylation of eNOS, Akt/PKB, and ERK1/2 in odontoblasts of rat molars. BK (10−7 M) transiently induced the phosphorylation of eNOS at Ser1177, Akt/PKB in odontoblasts, while it induced the phosphorylation of eNOS at Thr495 throughout the entire period of BK treatment. BK receptor 2 antagonist HOE 140 (10−6 M) significantly reduced signal intensities of phosphorylated-eNOS at Ser1177, Thr495, and phosphorylated-Akt/PKB. These results suggest that BK has dual effects on the activation of eNOS in odontoblasts, the Akt/PKB-dependent up-regulation of eNOS by the transient phosphorylation at Ser1177, and the ERK1/2-independent down-regulation of eNOS by the phosphorylation at Thr495.

Synergistic Inhibition of R5 HIV-1 by the Fusion Protein (FLSC) IgG1 Fc and Maraviroc in Primary Cells: Implications for Prevention and Treatment

BACKGROUND

Antiretroviral (ARV) drugs targeting retroviral enzymes have been extensively employed to treat HIV-1 infection. Drawbacks of this approach include cost, toxicity, and the eventual emergence of resistant strains that threaten prophylactic and/or therapeutic efficacy. Accordingly, efforts to develop next-generation ARV approaches are warranted, particularly if they can offer a higher threshold of resistance. We have previously shown that FLSC, a fusion protein containing gp120(BAL) and the D1 and D2 domains of human CD4, specifically binds CCR5, an important cellular co-receptor, and inhibits the entry of R5 HIV isolates. (FLSC) IgG1, a fusion of FLSC and the hinge-C(H)2-C(H)3 region of human IgG1, has an increased antiviral activity, likely due to the resultant bivalency.

METHODS

In this study, we show CCR5 reduction upon (FLSC) IgG1 treatment both by standard flow cytometry and visualized using a novel nanoparticle method. A β-lactamase virus-cell fusion assay was used to quantify (FLSC) IgG1 inhibition of HIV-1 entry into both cell lines and primary cells. Synergistic anti-viral activities of (FLSC) IgG1 and MVC in primary cells were evaluated by measuring supernatant p24 levels via ELISA and calculated using the MacSynergy™ II program.

RESULTS

We previously reported that treatment with the CCR5 small molecule antagonist Maraviroc (MVC) increased the apparent exposure of the (FLSC) IgG1 binding sites on CCR5, leading us to wonder if the two compounds used in combination might synergize in their anti-viral activity. Here we show that this is indeed the case. We demonstrate that fusion protein (FLSC) IgG1, strongly synergizes with the CCR5 antagonist Maraviroc to successfully inhibit both MVC-sensitive and MVC-resistant R5 HIV-1.

CONCLUSION

Observed synergy between (FLSC) IgG1 and MVC was high in both, cell lines and primary PBMCs. This has relevance for future in vivo studies. In addition, synergy occurred both with MVC-sensitive viruses and MVC-resistant viruses, partially restoring the inhibitory effect of MVC. These findings suggest that a combinatorial treatment based on these two compounds has potential merit and that future in vivo studies are warranted.

[Aspects of radiation protection during chest X-radiography]

BACKGROUND

Radiation safety in conventional X-ray diagnostics is based on the concepts of justification, optimization of an X-ray examination and limitation of the radiation exposure achieved during the examination. Optimization of an X-ray examination has to be considered as a multimodal process in which all technical components of the X-ray equipment have to be adapted to each other and also have to be adapted to the anthropometric characteristics of patients and the clinical indications.

OBJECTIVES

In this article the technical components of a conventional pediatric chest X-radiograph are presented, and recommendations for optimizing chest X-rays in children are provided.

RESULTS AND DISCUSSION

The following measures are of prime importance: correct x-ray beam limitation, using the posteroanterior projection when possible and not using anti-scatter grids in children under approximately 8 years old. In pediatric radiology chest x-rays that are taken not at the peak of inspiration can also be of some diagnostic significance. Optimization of an X-ray examination inevitably results in the limitation of radiation exposure.

Full Length Single Chain Fc Protein (FLSC IgG1) as a Potent Antiviral Therapy Candidate: Implications for In Vivo Studies

We have previously shown that FLSC, a chimeric protein containing HIV-1BAL gp120 and the D1 and D2 domains of human CD4, blocks the binding and entry of HIV-1 into target cells by occluding CCR5, the major HIV-1 coreceptor. In an effort to improve the antiviral potential of FLSC, we fused it with the hinge-CH2-CH3 region of human IgG1. The IgG moiety should increase both the affinity and stability in vivo of FLSC, due to the resultant bivalency and an extended serum half-life, thereby increasing its antiviral potency. We previously showed that (FLSC) IgG1 indeed had greater antiviral activity against T cell infections. Here we extend these results to macrophages, for which (FLSC) IgG1 has a more potent antiviral activity than FLSC alone, due in part to its higher binding affinity for CCR5. We also test both compounds in a relevant humanized mouse model and show that, as anticipated, the IgG1 moiety confers a greatly extended half-life. These data, taken together with previous results, suggest potential clinical utility for (FLSC) IgG1 and support further developmental work toward eventual clinical trials.

Bumblebee Flight in Heavy Turbulence

High-resolution numerical simulations of a tethered model bumblebee in forward flight are performed superimposing homogeneous isotropic turbulent fluctuations to the uniform inflow. Despite tremendous variation in turbulence intensity, between 17% and 99% with respect to the mean flow, we do not find significant changes in cycle-averaged aerodynamic forces, moments, or flight power when averaged over realizations, compared to laminar inflow conditions. The variance of aerodynamic measures, however, significantly increases with increasing turbulence intensity, which may explain flight instabilities observed in freely flying bees.