Pierce College

Low-titer group O whole blood (LTOWB) is increasingly used for prehospital hemorrhagic shock, yet real-world data from multi-agency EMS systems, particularly in medical hemorrhage, remain limited. This evaluation describes the first 11 months of a regional LTOWB program, focusing on operational timelines, physiologic response, protocol adherence, and product stewardship. In this quality-improvement evaluation, all prehospital blood activations in the Pierce County EMS (PCEMS) region of Washington State were reviewed. Operational metrics included dispatch-to-blood time, scene time, transfusion location, and dispatch-to-ED interval. Physiologic response was assessed using systolic blood pressure (SBP), heart rate, and shock index (SI), with shock resolution defined as SI <1 on ED arrival. Protocol adherence and stewardship (utilization and waste) were obtained from EMS documentation and transfusion-service logs. Eighty-nine activations occurred, and all patients received prehospital transfusion (47 trauma, 42 medical hemorrhage). Timelines demonstrated early initiation: median dispatch-to-blood 21.3 min, scene time 14.3 mins, and dispatch-to-ED 36.6 min. Protocol adherence was high, with frequent LTOWB-first transfusion, crystalloid avoidance, and TXA and calcium use. Among LTOWB recipients with serial vitals, SBP increased and SI decreased from initial assessment to post-transfusion and ED arrival. Across agencies, 189 units (LTOWB and components) were issued; of 182 with known disposition, 135 (74.2%) were transfused and 47 expired, yielding a utilization of 74% and waste rate of 26%. A regional multi-agency EMS system achieved early LTOWB initiation, high protocol adherence, and physiologic improvement across trauma and medical hemorrhage, with stewardship metrics characteristic of early implementation.

TIMP2 (Tissue Inhibitor of Metalloproteinase-2) plays a crucial role in hippocampal neuroplasticity and cognitive function through MMP-independent signaling. Despite its therapeutic promise, TIMP2 has long been considered 'undruggable' due to its cryptic surface topology and lack of canonical active sites. We present a comprehensive computational pipeline integrating CNS-filtered virtual screening, orthogonal ADMET/toxicity validation, and allosteric site targeting to identify small-molecule modulators of TIMP2. Screening ~600,000 CNS-filtered compounds from ZINC20 against a cryptic N-terminal allosteric site (Val6, Leu100, Phe103) identified 178 compounds with favorable drug-like properties. Orthogonal validation using ProTox-III refined this to 154 highest-confidence candidates (Tier 1A) validated across multiple computational toxicology platforms. Site selectivity analysis revealed 99.5% preference for the primary allosteric pocket, establishing it as the dominant binding site for therapeutic intervention. Chemical diversity analysis identified 15 distinct scaffold families spanning both halogenated (26.6%) and non-halogenated (73.4%) chemotypes, demonstrating multiple viable strategies for achieving CNS penetration with clean safety profiles. Our findings challenge the notion of TIMP2 as an undruggable protein and provide 154 experimentally-ready chemical starting points for therapeutic development targeting neuroplasticity and cognitive enhancement.

This paper presents a theoretical extension to special relativity by introducing acceleration-dependent modifications to time dilation. The Clock Hypothesis—an assumption that acceleration has no effect on the ticking of a clock—is upheld by all known experimental data but remains an unproven postulate. Here, we explore whether acceleration might play a role under extreme conditions by introducing a perturbation function ε(a)ε(a) to the Lorentz factor.We propose and compare three candidate models—quadratic, exponential, and logarithmic—to assess their mathematical behavior and physical plausibility. Using 2D and 3D simulations, we visualize their effects across a range of velocities and accelerations, identifying failure boundaries where classical assumptions may break down. Among the models, the exponential form demonstrates bounded, stable behavior consistent with saturation effects observed in other physical systems.This framework does not contradict special relativity, but invites deeper inquiry into its limits—particularly near regimes involving extreme acceleration, time saturation, and quantum gravity. We present this work as a tool for theoretical exploration and interdisciplinary modeling, with implications for relativistic physics, AI cognition under acceleration, and the philosophy of time.

This study explored whether the type of torticollis, amount of tummy time or container time, participant age at examination, and Alberta Infant Motor Scales score influence the length of physical therapy care for infants with torticollis. Data for 149 participants were extracted from medical records for infants with torticollis who received care between November 2018 and November 2021. Statistically significant correlations were found between length of care (LOC) and torticollis type, age at examination, active range of motion rotation deficit, and passive range of motion rotation deficit. A multiple regression model predicted LOC from age at examination in days, as well as passive and active rotation deficits. Higher passive and active rotation deficits lead to longer LOC. However, longer lengths of care were associated with younger ages at examination, different from earlier studies.

Pollen allergy is currently evolving into a major aspect regarding allergic bronchial asthma and allergic rhinitis, which are significant global health issues over the past decades. More pollen allergens are being recognized as the changing patterns of pollen exposures trigger increasing numbers of suffering patients. Impacting factors such as human-induced activities and climate change can lengthen pollen seasons as well as heighten pollen production in general. Allergen Immunotherapy (AIT) is an advancing therapeutic vaccine for pollen allergy that can modify the disease and the sensitization of allergens in patients which are less common than symptom-relieving drugs. Monitoring methods contribute greatly to the necessary observation of pollen exposure for treatment processes and the well-being of patients. Automatic monitors are being developed using technologies of different fields based on the traditional methods of pollen counting.

To evaluate the safety and efficacy of processed amniotic fluid (pAF) used postoperatively after photorefractive keratectomy (PRK). University of Utah, Moran Eye Center, Salt Lake City, Utah. Randomized, double-masked, placebo-controlled prospective study. 61 participants were randomized to receive either placebo or pAF drops, which were instilled 4 times per day for 1 week after PRK along with routine postoperative medications. The primary outcome measure was time to full re-epithelialization in days. Secondary measures included visual acuity at 30 days and postoperative pain scores during the first week. There was no significant difference in time to re-epithelialization, with a median of 5 days for both groups. There were no difference in pain indicator scores during the first week and no difference in corneal staining scores at day 30 between the 2 groups. There were no adverse events. This pilot study evaluating the safety and efficacy of pAF as an additional postoperative topical medication for PRK demonstrated that pAF did not improve the rate of epithelial healing after PRK. pAF may be safely studied in other ocular conditions to determine its effect on epithelial healing.

1East Pierce FMR, Puyallup, WA 2Valley Family Medicine Residency, Renton, WA 3FMRI Boise, Boise, ID The corresponding author is Eloi Hoopman, DO; [email protected]. The authors declare no conflicts of interest.

This article studied on whether transforming from a mono-hull vessel to a trimaran surface vessel increases the stability of the vessel. Based on testing results from different levels of waves, a system of algorithm was developed to maximize the speed and stability of the vessel. Automation of the width of the tamarin with respect to the strength of the wave was made possible with a program in Arduino. The data for this particular trimaran vessel have significant value to the optimization of speed and stability and can be generalized for other in trimaran vessels. The application of transformable trimaran can save energy and protect the environment.

Block models of rock mass strength have been developed at Cadia East mine to support forecasting of excavation performance. This paper describes four key aspects of the workflow that have enabled forecasting of rock mass strength throughout the entire orebody: 1) high density measurements of the spatial variability in intact and defected rock strength, derived from systematic point load testing of core from select boreholes; 2) continuous estimates of core-scale rock strength along all boreholes (including those with no or low density testing), enabled by application of machine learning to all available geological and geotechnical data, 3) estimation of tunnel-scale rock mass strength from the local statistical distribution of core-scale strengths, enabled by synthetic rock mass (SRM) testing, and 4) development of an integrated litho-structural model and the implementation of a structural trend to estimate block variables.

Workbench ANSYS, a software based on the finite element method, provides powerful ways for the modal and harmonic response analysis to evaluate the dynamic characteristics of structures. This research aims to determine the inherent natural frequencies as well as total deformation of Shanghai Tower through simplified models. The result demonstrates diagrams of the first six modes and the harmonic response of the simplified exterior model. In addition, a telescopic model and a simplified interior model are built. We hope that this research would provide a reliable reference for the maintenance and forecast risks for Shanghai Tower, and insights for future modeling of the tower.