Juno-UVS approach observations of Jupiter's auroras

Juno ultraviolet spectrograph (UVS) observations of Jupiter's aurora obtained during approach are presented. Prior to the bow shock crossing on 24 June 2016, the Juno approach provided a rare opportunity to correlate local solar wind conditions with Jovian auroral emissions. Some of Jupiter's auroral emissions are expected to be controlled or modified by local solar wind conditions. Here we compare synoptic Juno-UVS observations of Jupiter's auroral emissions, acquired during 3-29 June 2016, with in situ solar wind observations, and related Jupiter observations from Earth. Four large auroral brightening events are evident in the synoptic data, in which the total emitted auroral power increases by a factor of 3-4 for a few hours. Only one of these brightening events correlates well with large transient increases in solar wind ram pressure. The brightening events which are not associated with the solar wind generally have a risetime of ~2 h and a decay time of ~5 h.

Serum leptin levels in older patients with hip fracture--impact on peri-operative myocardial injury

To evaluate whether there is a relationship between admission serum leptin concentrations and peri-operative myocardial injury, 238 consecutive older patients (mean age 81.9+/-7.9 years; 172 women) with low-trauma hip fracture were assessed. Myocardial injury as defined by elevated serum cardiac troponin I was associated with lower leptin levels analyzed as continuous or categorical variables. Patients with serum leptin concentrations <12ng/ml (medium value) had a two-fold greater increased risk for such complications compared with those with higher leptin levels (odd ratio 2.13, 95% confidence interval 1.06-4.28; p=0.033). This association remained significant after adjustments for age, gender, clinical (history of coronary artery disease [CAD], stroke, hypertension, diabetes, dementia), hematological (red, white, and lymphocyte count, hemoglobin, hematocrit), metabolic (parathyroid hormone [PTH], albumin), renal(creatinine, urea, glomerular filtration rate [GFR]), and inflammatory (C-reactive protein [CRP], ferritin) factors. The predictive value of lower leptin levels increased significantly when used in combination with traditional risk factors for myocardial injury.

Trends in hip fracture epidemiology in Australia: possible impact of bisphosphonates and hormone replacement therapy

The purposes of this study were to analyse trends in hip fracture (HF) epidemiology over a 13-year period (1994-2007) in the Australian Capital Territory (ACT), to assess the potential impact of concurrent changes in hormone replacement therapy (HRT) and bisphosphonate use and to present a new prediction of HFs in Australia up to 2021. Annual sex- and age-specific incidence rates (per 100,000 population) were determined and standardized using the Australian 2006 population. The projected number of HFs was estimated by two models applying age- and sex-specific HF rates averaged for 2002-2006 (model 1) or continuously changing as observed in this period (model 2, Poisson regression) to the projected population. In 2006 compared to 2001, the population > or = 60 years in the ACT increased by 19.7%. Over the last 5 years the average annual incidence HF rate compared to the previous 3-year period decreased in females > or = 60 years of age by 28.3%. Between 2001 and 2006 the number of prescriptions for HRT dispensed in the ACT declined by 54.6, while the number of prescriptions for bisphosphonate increased by 245%, accompanied by a decline in standardized incidence of HF rates of 36.4%, mainly in women (42.1%). This represents an annual cost for bisphosphonates per one prevented HF, of $A45,250 or $A576 person/year. Compared to 2006 the total number of HFs in Australia according to model 1 will increase in 2011 by 20.1% and in 2021 by 58.8%, but according to model 2 will decrease by 15.5% in 2011 and 27.5% in 2021. Our data suggest that the previously predicted rising trend in HFs in elderly women reversed, but did not so for men. This was coincident with a significant fall in HRT use and increased prescribing of bisphosphonates, which is cost-effective. However caution should be used in attributing causation as this is an ecological study. If trends in HF observed in 2002-2006 continue, the absolute number of HFs in Australia in 2011-2021 will stabilise or decline (which is more likely), despite the rapid ageing of the population.

Elevated serum cardiac troponin I in older patients with hip fracture: incidence and prognostic significance

INTRODUCTION

Cardiovascular complications are the main causes of morbidity and mortality in patients with osteoporotic hip fracture (HF). The aim of this prospective study was to evaluate the incidence and prognostic significance of elevated cardiac troponin I (cTnI) in the early peri-operative period in older patients with HF.

MATERIALS AND METHODS

A blind evaluation of myocardial injury as detected by cTnI elevation in 238 consecutive older patients with low-trauma HF (mean age 81.9 +/- 7.8 (SD) years; 72% females). Data on demographic and clinical characteristics, in-hospital mortality, hospital length of stay and discharge destination were collected prospectively. Serum cTnI level was analysed from blood collected routinely in the first 72 h of hospital admission.

RESULTS

Sixty-nine (29%) patients had elevated cTnI (>0.06 microg/l) but myocardial injury was clinically recognised in only 23 (33%) and only 24 (34.8%) had a history of coronary artery disease (CAD). Patients with elevated cTnI were significantly older, more often had American Society of Anaesthesiologist status score >or=3, a history of CAD or stroke and more often were current smokers than the patients without cTnI elevation. In multivariate regression analysis only age was an independent predictor of cTnI elevation. Patients with cTnI release were twice as likely to have a length of stay >or=20 days (P = 0.047) and 2.7 times more likely to be discharged to a long-term residential care facility (RCF) (P = 0.013). cTnI level >or=1 microg/l was a strong independent predictor of all-cause mortality with 98.3% specificity and 89.1% negative predictive value.

CONCLUSION

Peri-operative myocardial injury is common in older HF patients but is frequently unrecognised clinically. Elevated blood cTnI level is an independent predictor of prolonged length of hospital stay (>or=20 days), need for long-term RCF and mortality (if cTnI >or=1 microg/l).

Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare

OBJECTIVES

To assess the impact of a specifically designed model of orthopedic-geriatric cocare on hip fracture (HF) outcomes.

SETTING

Tertiary teaching hospital (level I trauma center).

DESIGN

Prospective observational study with a retrospective (historical) control. Data on 951 consecutive patients 60 years of age or older admitted to the authors' institution with a nonpathologic HF over a 7-year period (1995 to 2002) were analyzed. Between 1995 and 1997, medical problems were managed by a geriatric medicine (GM) consultation-only service (retrospective audit). In 1998, a GM registrar began overseeing daily medical care with weekly geriatrician consultant review (prospective study). Outcomes for 2 time periods were compared: a 3-year period before (no GM; 504 patients) and a 4-year period after (GM; 447 patients) the introduction of GM cocare.

MAIN OUTCOME MEASUREMENTS

Postoperative medical complications, mortality, length of stay, discharge destination, use of thromboprophylaxis, and antiosteoporotic treatment.

RESULTS

While comparing 2 periods (GM and no GM), significant reductions in postoperative medical complications and comorbid conditions (in total 49.5% vs. 71.0%, P<0.001) and mortality (4.7% vs. 7.7%, P<0.01) occurred and rehospitalization to medical wards within 6 months decreased (28% vs. 7.6%). However, no differences were observed in median length of hospital stay (10.8 vs. 11.0 days) or in discharge destination. Antiosteoporotic treatment (12% to 69%) and specific thromboprophylaxis (63% to 94%) increased in the GM period.

CONCLUSIONS

Orthopedic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality, and increases in optimal postoperative care. Options for further improvement of orthopedic-GM cocare need to be investigated.

Drinking salt water enhances rehydration in horses dehydrated by frusemide administration and endurance exercise

Because the primary stimulus for thirst is an increase in plasma tonicity, we hypothesised that dehydrated horses would drink a greater total volume of fluid voluntarily during the first hour of recovery when they were initially offered salt water. To test this hypothesis, bodyweight (bwt), fluid intake (FI) and [Na+] were measured in 6 Arabian horses offered 3 rehydration solutions. After dehydration was induced by frusemide administration (1 mg/kg bwt, i.v.) followed by 45 km treadmill exercise, water (W), 0.45% NaCl and 0.9% NaCl were offered, in a randomised order, during the initial 5 min after completing exercise. Horses were subsequently placed in a stall and further intake of plain water during the first hour of recovery was measured. By the end of exercise, horses lost 5.2 +/- 0.2, 5.6 +/- 0.3 and 5.7 +/- 0.2% (P>0.05) bwt and FI during the first 5 min of recovery was 10.5 +/- 0.7, 11.6 +/- 0.8 and 11.6 +/- 1.5 l (P>0.05) for W, 0.45% NaCl and 0.9% NaCl, respectively. After 20 min of recovery, [Na+] had decreased with W but remained unchanged from the end exercise values for both saline solutions. During the initial hour of recovery, further water intake was 0.9 +/- 0.4, 5.0 +/- 0.5 and 6.9 +/- 0.7 l (P<0.05) for W, 0.45% NaCl and 0.9% NaCl, respectively. Therefore, total FI was 11.4 +/- 0.5, 16.6 +/- 0.7 and 18.5 +/- 1.7 l (P<0.05) for W, 0.45% NaCl and 0.9% NaCl, respectively, and persisting bwt loss after 60 min of recovery was greater (P<0.05) for W (3.5%) than for the 2 saline solutions (24% for 0.45% NaCl and 1.9% for 0.9% NaCl). In conclusion, providing salt water as the initial rehydration fluid maintained an elevated [Na+] and resulted in greater total FI and recovery of bwt loss during the first hour of recovery, in comparison to offering only plain water.

Mobilization of a Drosophila transposon in the Caenorhabditis elegans germ line

Transposons have been enormously useful for genetic analysis in both Drosophila and bacteria. Mutagenic insertions constitute molecular tags that are used to rapidly clone the mutated gene. Such techniques would be especially advantageous in the nematode Caenorhabditis elegans, as the entire sequence of the genome has been determined. Several different types of endogenous transposons are present in C. elegans, and these can be mobilized in mutator strains (reviewed in ref. 1). Unfortunately, use of these native transposons for regulated transposition in C. elegans is limited. First, all strains contain multiple copies of these transposons and thus new insertions do not provide unique tags. Second, mutator strains tend to activate the transposition of several classes of transposons, so that the type of transposon associated with a particular mutation is not known. Here we demonstrate that the Drosophila mariner element Mos1 can be mobilized in C. elegans. First, efficient mobilization of Mos1 is possible in somatic cells. Second, heritable insertions of the transposon can be generated in the germ line. Third, genes that have been mutated by insertion can be rapidly identified using inverse polymerase chain reaction. Fourth, these insertions can subsequently be remobilized to generate deletion and frameshift mutations by imperfect excision.

"It wasn't working. " Women's experiences with short-term breastfeeding

PURPOSE

To investigate the lived experiences of women who initiate breastfeeding but stop within the first 2 weeks after birth.

DESIGN

Phenomenology.

METHODS

Interviews were recorded on audio tape, transcribed verbatim, and analyzed for themes by an interdisciplinary group of researchers.

RESULTS

Women described a clash or incongruity between highly idealized expectations and early breastfeeding problems. This led to incremental disillusionment and cessation of breastfeeding attempts. Women spoke poignantly about a sense of failure, guilt, or shame and had lingering self-doubts about not continuing with breastfeeding.

CLINICAL IMPLICATIONS

Women need more accurate information about the process of initiating breastfeeding. Nurses should avoid teaching breastfeeding practices that can confuse infants and sabotage mothers and should work toward providing sensitive care that respects personal boundaries of mothers. Additionally, provisions need to be made for continued support and consultation after the mother's discharge from the hospital or birthing center. Finally, nurses and other health professionals should understand that women who stop breastfeeding at an early date may feel guilty about doing so, and may need assistance in resolving feelings about having made that choice.

Ultrafast inactivation causes inward rectification in a voltage-gated K(+) channel from Caenorhabditis elegans

The exp-2 gene in the nematode Caenorhabditis elegans influences the shape and duration of the action potential of pharyngeal muscle cells. Several loss-of-function mutations in exp-2 lead to broadening of the action potential and to a concomitant slowing of the pumping action of the pharynx. In contrast, a gain-of-function mutation leads to narrow action potentials and shallow pumping. We cloned and functionally characterized the exp-2 gene. The exp-2 gene is homologous to genes of the family of voltage-gated K(+) channels (Kv type). The Xenopus oocyte-expressed EXP-2 channel, although structurally closely related to Kv-type channels, is functionally distinct and very similar to the human ether-à-gogo-related gene (HERG) K(+) channel. In response to depolarization, EXP-2 activates slowly and inactivates very rapidly. On repolarization, recovery from inactivation is also rapid and strongly voltage-dependent. These kinetic properties make the Kv-type EXP-2 channel an inward rectifier that resembles the structurally unrelated HERG channel. Apart from many similarities to HERG, however, the molecular mechanism of fast inactivation appears to be different. Moreover, the single-channel conductance is 5- to 10-fold larger than that of HERG and most Kv-type K(+) channels. It appears that the inward rectification mechanism by rapid inactivation has evolved independently in two distinct classes of structurally unrelated, voltage-gated K(+) channels.

A mutation in the C. elegans EXP-2 potassium channel that alters feeding behavior

The nematode pharynx has a potassium channel with unusual properties, which allows the muscles to repolarize quickly and with the proper delay. Here, the Caenorhabditis elegans exp-2 gene is shown to encode this channel. EXP-2 is a Kv-type (voltage-activated) potassium channel that has inward-rectifying properties resembling those of the structurally dissimilar human ether-à-go-go-related gene (HERG) channel. Null and gain-of-function mutations affect pharyngeal muscle excitability in ways that are consistent with the electrophysiological behavior of the channel, and thereby demonstrate a direct link between the kinetics of this unusual channel and behavior.

Living with postpartum depression: the father's experience

PURPOSE

To derive a deeper understanding of postpartum depression (PPD) and its impact on the family through the experiences of fathers whose spouses suffered from this disorder.

DESIGN

Phenomenology.

METHODS

Eight men were interviewed. Interviews were recorded on audio tape and transcribed verbatim. Thematic analysis conducted within an interdisciplinary phenomenological research group led to a description of the experiences and emotions involved.

RESULTS

Respondents in this study revealed a major disruption in their lives and in their relationship with their wives as a result of PPD. The men experienced fear, confusion, and much concern for their spouses, and felt unable to help them in overcoming PPD. The inability to "fix the problem" created frustration and anger. The majority of the respondents reported that they made many sacrifices to hold the relationship and the family together. Even though the PPD improved over time, fathers were left to face an uncertain future with a spouse who seemed to be very different from the person they had previously known.

CLINICAL IMPLICATIONS

Health care professionals need to design interventions that are more supportive of men, for men also suffer when their spouses experience PPD.

A randomized phase 3 study of peripheral blood progenitor cell mobilization with stem cell factor and filgrastim in high-risk breast cancer patients

This randomized study compared the number of leukaphereses required to collect an optimal target yield of 5 x 10(6) CD34(+) peripheral blood progenitor cells/kg, using either stem cell factor (SCF) at 20 micrograms/kg/d in combination with Filgrastim at 10 micrograms/kg/d or Filgrastim alone at 10 micrograms/kg/d, from 203 patients with high-risk stage II, III, or IV breast cancer. Leukapheresis began on day 5 of cytokine administration and continued daily until the target yield of CD34(+) cells had been reached or a maximum of 5 leukaphereses performed. By day 5 of leukapheresis, 63% of the patients treated with SCF plus Filgrastim (n = 100) compared with 47% of those receiving Filgrastim alone (n = 103) reached the CD34(+) cell target yield. There was a clinically and statistically significant reduction (P <.05) in the number of leukaphereses required to reach the target yield for the patients receiving SCF plus Filgrastim (median, 4 leukaphereses) compared with patients receiving Filgrastim alone (median, 6 or more leukapherses; ie, <50% of patients reached the target in 5 leukaphereses). All patients receiving SCF were premedicated with antihistamines, albuterol, and pseudoephedrine. Treatment was safe, generally well tolerated, and not associated with life-threatening or fatal toxicity. In conclusion, SCF plus Filgrastim is a more effective peripheral blood progenitor cell (PBPC)-mobilization regimen than Filgrastim alone. In addition to the potential for reduced leukapheresis-related morbidity and costs, SCF offers additional options for obtaining cells for further graft manipulation.

Success with sealants

Specific clinical techniques and practice philosophies are suggested to facilitate success with sealants when used by the private practice restorative dentist. Although sealants have proven successful in academic and not-for-profit environments, this has not always transferred to the private sector. Methods and materials, together with economic realities, are all discussed and shortcuts that may lead to clinical failures are noted.

Techniques to enhance success in placement of tetracycline fibers as a periodontal therapy

This article proposes specific clinical techniques as a component of periodontal therapy which can be used to enhance successful placement and retention of fibers containing tetracycline. Potential problems that may lead to clinical failure are also addressed and modalities to overcome these obstacles are suggested. This treatment technique need not be limited to the periodontal specialist. The general dentist, with clinical experience in restorations, may possess superior skills needed for optimal clinical success.

avr-15 encodes a chloride channel subunit that mediates inhibitory glutamatergic neurotransmission and ivermectin sensitivity in Caenorhabditis elegans

Ivermectin is a widely used anthelmintic drug whose nematocidal mechanism is incompletely understood. We have used Caenorhabditis elegans as a model system to understand ivermectin's effects. We found that the M3 neurons of the C.elegans pharynx form fast inhibitory glutamatergic neuromuscular synapses. avr-15, a gene that confers ivermectin sensitivity on worms, is necessary postsynaptically for a functional M3 synapse and for the hyperpolarizing effect of glutamate on pharyngeal muscle. avr-15 encodes two alternatively spliced channel subunits that share ligand binding and transmembrane domains and are members of the family of glutamate-gated chloride channel subunits. An avr-15-encoded subunit forms a homomeric channel that is ivermectin-sensitive and glutamate-gated. These results indicate that: (i) an ivermectin-sensitive chloride channel mediates fast inhibitory glutamatergic neuromuscular transmission; and (ii) a nematocidal property of ivermectin derives from its activity as an agonist of glutamate-gated chloride channels in essential excitable cells such as those of the pharynx.

Biology and clinical potential of stem-cell factor

Stem-cell factor (SCF) is a hematopoietic growth factor that acts on both primitive and mature progenitor cells. Preclinical studies have shown that recombinant SCF can protect against lethal irradiation, elicit multilineage hematopoietic responses and increases in bone marrow cellularity, and increase the number of circulating peripheral blood progenitor cells (PBPCs) in a dose-dependent manner. Both preclinical and early clinical studies using recombinant methionyl human SCF plus recombinant methionyl human granulocyte colony-stimulating factor (Filgrastim) have demonstrated increased PBPC mobilization as compared with the use of either factor alone. These data suggest a clinical role for the combination.

Toward development of an implantable tissue engineered liver

Hepatocyte transplantation on implantable devices is a tissue engineering approach to improve the treatment of liver disease and the efficacy of ex vivo gene therapy. Diverse physiological functions and high metabolic activity of the liver represent significant challenges to engineering implantable devices that provide long-term hepatic support. Liver tissue engineering research has explored alternatives to direct hepatocyte injection that include hepatocyte attachment to microcarriers, encapsulation and transplantation on biodegradable polymer scaffolds. Successful function of hepatocytes transplanted on implantable devices in animal models has been documented by production of albumin and other liver-specific markers, and clearance of bilirubin and urea metabolites. Strategies used to achieve these successes are reviewed, with particular emphasis on biodegradable polymer scaffolds, and two areas of investigation that may improve the function of implantable tissue engineered liver devices are highlighted.

Mutations in the Caenorhabditis elegans Na,K-ATPase alpha-subunit gene, eat-6, disrupt excitable cell function

We have cloned a Na,K-ATPase alpha-subunit gene from Caenorhabditis elegans and discovered that it is identical to the gene eat-6, eat-6 mutations cause feeble contractions and slow, delayed relaxations of pharyngeal muscle. The resting membrane potential of eat-6 mutant pharynxes is consistently depolarized compared to wild-type. The action potentials are smaller, and the return to resting potential is slower. To explain these abnormalities, we propose that a reduction of Na,K-ATPase activity in eat-6 mutants leads to a reduction of the ion concentration gradients that power membrane potential changes.

Peptidyl alpha-ketoheterocyclic inhibitors of human neutrophil elastase. 2. Effect of varying the heterocyclic ring on in vitro potency

A series of peptidyl alpha-ketoheterocycles were synthesized and evaluated for their in vitro inhibition of human neutrophil elastase (HNE). Several heterocycles, including oxazoline and benzoxazole, afforded extremely potent inhibitors of HNE (1p-r) with nanomolar to subnanomolar Ki values. The structure-activity relationships revealed that for compounds with a Ki < 1000 nM potency tends to be positively correlated with the sigma I value of the heterocycle. Furthermore, the results in this study support the hypothesis that, in the covalent enzyme-inhibitor adduct, the azole nitrogen atom of the inhibitor heterocycle participates in a hydrogen-bonding interaction with the active-site His-57.

The use of light-cured composite resin on altered diagnostic casts

Light-cured composite resin as an alternative to wax for altered diagnostic casts is demonstrated. The value of altered diagnostic casts as a diagnostic tool is addressed. The benefits in the use of composite resin versus the traditional use of wax are emphasized.

A model for clinical teaching as a scholarly endeavor

The traditional ways that academia has approached documentation of scholarship are relatively narrow and best fit those disciplines whose practice is research and writing. In professional practice disciplines such as nursing, writing and research are critical, but they are not the only scholarly activities in which faculty are involved. A model resulting from work from the Carnegie Foundation for the Advancement of Teaching offers a broader view of scholarship in which clinical teaching has academic legitimacy. The components of scholarship included in the model are discovery, practice, integration, and teaching.

Functional dissection of a predicted class-defining motif in a class II tRNA synthetase of unknown structure

A core of eight beta-strands and three alpha-helices was recently predicted for the active site domain of Escherichia coli alanyl-tRNA synthetase, an enzyme of unknown structure [Ribas de Pouplana, L1., Buechter, D. D., Davis, M. W., & Schimmel, P. (1993) Protein Sci. 2, 2259-2262; Shi, J.-P., Musier-Forsyth, K., & Schimmel, P. (1994) Biochemistry 26, 5312-5318]. A critical part of this predicted structure is two antiparallel beta-strands and an intervening loop that make up the second of three highly degenerate sequence motifs that are characteristic of the class II aminoacyl-tRNA synthetases. We present here an in vivo and in vitro analysis of 21 rationally designed mutations in the predicted 34-amino acid motif 2 of E. coli alanyl-tRNA synthetase. Although this motif in E. coli alanyl-tRNA synthetase is of a different size than and has only two sequence identities with the analogous motif in yeast aspartyl- and Thermus thermophilus seryl-tRNA synthetases, whose structures are known, the functional consequences of the mutations are explainable in terms of those structures. In particular, the analysis demonstrates the importance of the predicted motif 2 in adenylate formation, distinguishes between two similar, but distinct, predicted models for this motif, and distinguishes between the functional importance of two adjacent phenylalanines in a way that strongly supports the predicted structure. The results suggest that similar analyses will be generally useful in testing models for active site regions of other class II aminoacyl-tRNA synthetases of unknown structure.

Reaping the benefits of electronic medical record systems

An electronic medical record system can provide benefits beyond the obvious functions of efficient and less labor-intensive scanning, archiving, retrieving, and printing of patient care information. The less tangible benefit of providing record access to several users simultaneously is difficult to quantify, but can enhance operations and improve the quality of patient care throughout a healthcare facility.

A randomized controlled phase III trial of recombinant human granulocyte colony-stimulating factor (filgrastim) for treatment of severe chronic neutropenia

Patients with idiopathic, cyclic, and congenital neutropenia have recurrent severe bacterial infections. One hundred twenty-three patients with recurrent infections and severe chronic neutropenia (absolute neutrophil count < 0.5 x 10(9)/L) due to these diseases were enrolled in this multicenter phase III trial. They were randomized to either immediately beginning recombinant human granulocyte colony-stimulating factor (filgrastim) (3.45 to 11.50 micrograms/kg/d, subcutaneously) or entering a 4-month observation period followed by filgrastim administration. Blood neutrophil counts, bone marrow (BM) cell histology, and incidence and duration of infection-related events were monitored. Of the 123 patients enrolled, 120 received filgrastim. On therapy, 108 patients had a median absolute neutrophil count of > or = 1.5 x 10(9)/L. Examination of BM aspirates showed increased proportions of maturing neutrophils. Infection-related events were significantly decreased (P < .05) with approximately 50% reduction in the incidence and duration of infection-related events and almost 70% reduction in duration of antibiotic use. Asymptomatic splenic enlargement occurred frequently; adverse events frequently reported were bone pain, headache, and rash, which were generally mild and easily manageable. These data indicate that treatment of patients with severe chronic neutropenia with filgrastim results in a stimulation of BM production and maturation of neutrophils, an increase in circulating neutrophils, and a reduction in infection-related events.