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Background: In England, the number of takeaway food outlets ('takeaways') has been increasing for over two decades. Takeaway management zones around schools are an effective way to restrict the growth of new takeaways but their impacts on population health have not been estimated. Methods: To model the impact of takeaway management zones on health, we used estimates of change in and exposure to takeaways (across home, work, and commuting buffers) based on a previous evaluation suggesting that 50% of new outlets were prevented from opening because of management zones. Based on previous cross-sectional findings, we estimated changes in body mass index (BMI) from changes in takeaway exposure, from 2018 to 2040. We used PRIMEtime, a proportional multistate lifetable model, and BMI change to estimate the impact of the intervention, in a closed-cohort of adults (25–64 years), on incidence of 12 non-communicable diseases, obesity prevalence, quality-adjusted life years (QALYs), and healthcare costs saved by 2040 in six local authorities (LAs) across the rural–urban spectrum in England (Wandsworth, Manchester, Blackburn with Darwen, Sheffield, North Somerset, and Fenland). Results: By 2031, compared to no intervention, reductions in outlet exposure ranged from 3 outlets/person in Fenland to 28 outlets/person in Manchester. This corresponded to mean per person reductions in BMI of 0.08 and 0.68 kg/m2, respectively. Relative to no intervention, obesity prevalence was estimated to be reduced in both sexes in all LAs, including by 2.3 percentage points (PP) (95% uncertainty interval:2.9PP, 1.7PP) to 1.5PP (95%UI:1.9PP, 1.1PP) in males living in Manchester and Wandsworth by 2040, respectively. Model estimates showed reductions in incidence of disease, including type II diabetes (e.g. 964 (95% UI: 1565, 870) fewer cases/100,000 population for males in Manchester)), cardiovascular diseases, asthma, certain cancers, and low back pain. Savings in healthcare costs (millions) ranged from £1.65 (95% UI: £1.17, £2.25)/100,000 population in North Somerset to £2.02 (95% UI: £1.39, £2.83)/100,000 population in Wandsworth. Gains in QALYs/100,000 person were broadly similar across LAs. Conclusions: Takeaway management zones in England have the potential to meaningfully contribute towards reducing obesity prevalence and associated healthcare burden in the adult population, at the local level and across the rural–urban spectrum. [ABSTRACT FROM AUTHOR]

The three striatins (STRN, STRN3, STRN4) form the core of STRiatin-/nteracting Phosphatase and Kinase (STRIPAK) complexes. These place protein phosphatase 2A (PP2A) in proximity to protein kinases thereby restraining kinase activity and regulating key cellular processes. Our aim was to establish if striatins play a significant role in cardiac remodelling associated with cardiac hypertrophy and heart failure. All striatins were expressed in control human hearts, with up-regulation of STRN and STRN3 in failing hearts. We used mice with global heterozygote gene deletion to assess the roles of STRN and STRN3 in cardiac remodelling induced by angiotensin II (AngII; 7 days). Using echocardiography, we detected no differences in baseline cardiac function or dimensions in STRN+/- or STRN3+/-male mice (8 weeks) compared with wild-type littermates. Heterozygous gene deletion did not affect cardiac function in mice treated with AngII, but the increase in left ventricle mass induced by AngII was inhibited in STRN+/- (but not STRN3+/-) mice. Histological staining indicated that cardiomyocyte hypertrophy was inhibited. To assess the role of STRN in car-diomyocytes, we converted the STRN knockout line for inducible cardiomyocyte-specific gene deletion. There was no effect of cardiomyocyte STRN knockout on cardiac function or dimensions, but the increase in left ventricle mass induced by AngII was inhibited. This resulted from inhibition of cardiomyocyte hypertrophy and cardiac fibrosis. The data indicate that cardiomyocyte striatin is required for early remodelling of the heart by AngII and identify the striatin-based STRIPAK system as a signalling paradigm in the development of pathological cardiac hypertrophy. [ABSTRACT FROM AUTHOR]

There have now been a few attempts in trans theory to give an account of trans epistemology (see Radi 2019; Meadow 2016; and Dickson 2021). I will suggest that despite an admirable goal—that of giving an epistemology that provides a methodologically radical and distinctively trans break from other contemporary epistemological theory—thus far no account has been successful. Instead, I suggest that, in the absence of a more satisfactory radical account of trans epistemology, we can think of trans epistemology as a methodologically moderate (though politically radical) extension of mainstream epistemology. [ABSTRACT FROM AUTHOR]

Low-dose radiotherapy (LDRT), defined in this study as 2 fractions of 4 Gy delivered on consecutive days, is an effective option for local palliation of mycosis fungoides (MF), but its efficacy for tumoral lesions (TL) needs investigation. We assessed response and local control (LC) rates for patients treated with LDRT for MF and compared these outcomes between TL and non-TL. A total of 73 lesions in 18 patients treated with LDRT between 2013-2020 were analyzed. Response was defined as complete response (CR), partial response (PR), or no response (NR). In the non-TL versus TL groups, CR was observed in 16.7% v. 4.0%, PR in 81.2% v. 80.0%, NR in 2.1% v. 16.0%, respectively. 2-year LC was 100% for non-TL and 61% for TLs (p < 0.01). LDRT yields excellent response and lesion control for non-TLs and is associated with lower response rates and LC for TLs. Low-dose radiation therapy yields excellent response and lesion control for non-tumoral lesions. [ABSTRACT FROM AUTHOR]

Background: Taxes on sugar-sweetened beverages (SSBs) have been implemented globally to reduce the burden of cardiometabolic diseases by disincentivizing consumption through increased prices (e.g., 1 peso/litre tax in Mexico) or incentivizing industry reformulation to reduce SSB sugar content (e.g., tiered structure of the United Kingdom [UK] Soft Drinks Industry Levy [SDIL]). In Germany, where no tax on SSBs is enacted, the health and economic impact of SSB taxation using the experience from internationally implemented tax designs has not been evaluated. The objective of this study was to estimate the health and economic impact of national SSBs taxation scenarios in Germany. Methods and findings: In this modelling study, we evaluated a 20% ad valorem SSB tax with/without taxation of fruit juice (based on implemented SSB taxes and recommendations) and a tiered tax (based on the UK SDIL) in the German adult population aged 30 to 90 years from 2023 to 2043. We developed a microsimulation model (IMPACTNCD Germany) that captures the demographics, risk factor profile and epidemiology of type 2 diabetes, coronary heart disease (CHD) and stroke in the German population using the best available evidence and national data. For each scenario, we estimated changes in sugar consumption and associated weight change. Resulting cases of cardiometabolic disease prevented/postponed and related quality-adjusted life years (QALYs) and economic impacts from healthcare (medical costs) and societal (medical, patient time, and productivity costs) perspectives were estimated using national cost and health utility data. Additionally, we assessed structural uncertainty regarding direct, body mass index (BMI)-independent cardiometabolic effects of SSBs and cross-validated results with an independently developed cohort model (PRIMEtime). We found that SSB taxation could reduce sugar intake in the German adult population by 1 g/day (95%-uncertainty interval [0.05, 1.65]) for a 20% ad valorem tax on SSBs leading to reduced consumption through increased prices (pass-through of 82%) and 2.34 g/day (95%-UI [2.32, 2.36]) for a tiered tax on SSBs leading to 30% reduction in SSB sugar content via reformulation. Through reductions in obesity, type 2 diabetes, and cardiovascular disease (CVD), 106,000 (95%-UI [57,200, 153,200]) QALYs could be gained with a 20% ad valorem tax and 192,300 (95%-UI [130,100, 254,200]) QALYs with a tiered tax. Respectively, €9.6 billion (95%-UI [4.7, 15.3]) and €16.0 billion (95%-UI [8.1, 25.5]) costs could be saved from a societal perspective over 20 years. Impacts of the 20% ad valorem tax were larger when additionally taxing fruit juice (252,400 QALYs gained, 95%-UI [176,700, 325,800]; €11.8 billion costs saved, 95%-UI [€6.7, €17.9]), but impacts of all scenarios were reduced when excluding direct health effects of SSBs. Cross-validation with PRIMEtime showed similar results. Limitations include remaining uncertainties in the economic and epidemiological evidence and a lack of product-level data. Conclusions: In this study, we found that SSB taxation in Germany could help to reduce the national burden of noncommunicable diseases and save a substantial amount of societal costs. A tiered tax designed to incentivize reformulation of SSBs towards less sugar might have a larger population-level health and economic impact than an ad valorem tax that incentivizes consumer behaviour change only through increased prices. In a modeling study, Karl MF Emmert-Fees and team estimate the health and economic impact of national sugar-sweetened beverages taxation scenarios in Germany. Author summary: Why was this study done?: Taxation of sugar-sweetened beverages (SSBs), recommended by the World Health Organization (WHO) and implemented in many jurisdictions globally, aims to reduce the noncommunicable disease burden by disincentivizing consumption through increased consumer prices or incentivizing industry reformulation to reduce SSB sugar content. No tax on SSBs is currently enacted in Germany and the national government is preparing a new national strategy on food seeking evidence-based recommendations to establish policy priorities until 2050. In Germany, the potential long-term health and economic impacts of SSB taxation have not been evaluated. What did the researchers do and find?: We developed and validated a microsimulation model based on national data and international evidence to model the impact of SSB taxation on dietary exposure of added sugar from beverages, body mass index (BMI), cardiometabolic diseases, and related economic costs. We evaluated 3 SSB taxation scenarios in Germany with the simulation model: (1) 20% ad valorem tax on SSBs; (2) extended 20% ad valorem tax on SSBs and fruit juice; (3) tiered tax leading to reformulation of SSBs towards 30% lower sugar content. Taxation of SSBs in Germany could prevent or postpone 132,100 to 244,100 cases of type 2 diabetes, gain 106,000 to 192,300 quality-adjusted life years (QALYs) and save €10.8 to €16.0 billion in societal cost from 2023 to 2043 with the highest impacts estimated for tiered taxation. The absolute long-term health impacts are largely dependent on the relevance of direct, BMI-independent cardiometabolic effects of SSBs. What do these findings mean?: All modelled SSB taxation scenarios are likely to improve population health and reduce societal costs in Germany by preventing cardiometabolic disease. Considering all sources of uncertainty, we find that modelled SSB taxation scenarios that lead to reformulation towards less sugar might have a larger population-level health and economic impact than those that incentivize consumer behaviour change only through increased prices. From a public health perspective, taxation of SSBs should be considered as a policy option for German decision-makers to reduce consumption of added sugar and improve population health. [ABSTRACT FROM AUTHOR]

Introduction: Sagittal craniosynostosis (SC) is associated with scaphocephaly, an elongated narrow head shape. Assessment of regional severity in the scaphocephalic head is limited by the use of serial computed tomographic (CT) imaging or complex computer programing. Three-dimensional measurements of cranial surface morphology provide a radiation-free alternative for assessing cranial shape. This study describes the creation of an occipital bulleting index (OBI), a novel tool using surface morphology to assess the regional severity in patients with SC. Methods: Surface imaging from CT scans or 3D photographs of 360 individuals with SC and 221 normocephalic individuals were compared to identify differences in morphology. Cartesian grids were created on each individual's surface mesh using equidistant axial and sagittal planes. Area under the curve (AUC) analyses were performed to identify trends in regional morphology and create measures capturing population differences. Results: The largest differences were located in the medial regions posteriorly. Using these population trends, a measure was created to maximize AUC. The OBI has an AUC of 0.72 with a sensitivity of 74% and a specificity of 61%. When the frontal bossing index is applied in tandem, the two have a sensitivity of 94.7% and a specificity of 93.1%. Correlation between the two scores in individuals with SC was found to be negligible with an intraclass correlation coefficient of 0.018. Severity was found to be independent of age under 24 months, sex, and imaging modality. Conclusions: This index creates a tool for differentiating control head shapes from those with SC and has the potential to allow for objective evaluation of the regional severity, outcomes of different surgical techniques, and tracking shape changes in individuals over time, without the need for radiation. [ABSTRACT FROM AUTHOR]

Background: Over a third of pregnant women (around 250,000) each year in the United Kingdom have experienced trauma such as domestic abuse, childhood trauma or sexual assault. These experiences can have a long-term impact on women's mental and physical health. This global qualitative evidence synthesis explores the views of women and maternity care professionals on routine discussion of previous trauma in the perinatal period. Methods: Systematic database searches (MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and Global Index Medicus) were conducted in July 2021 and updated in April 2022. The quality of each study was assessed using the Critical Appraisal Skills Programme. We thematically synthesised the data and assessed confidence in findings using GRADE-CERQual. Results: We included 25 papers, from five countries, published between 2001 and 2022. All the studies were conducted in high-income countries; therefore findings cannot be applied to low- or middle-income countries. Confidence in most of the review findings was moderate or high. The findings are presented in six themes. These themes described how women and clinicians felt trauma discussions were valuable and worthwhile, provided there was adequate time and appropriate referral pathways. However, women often found being asked about previous trauma to be unexpected and intrusive, and women with limited English faced additional challenges. Many pregnant women were unaware of the extent of the trauma they have suffered, or its impact on their lives. Before disclosing trauma, women needed to have a trusting relationship with a clinician; even so, some women chose not to share their histories. Hearing trauma disclosures could be distressing for clinicians. Conclusion: Discussions of previous trauma should be undertaken when women want to have the discussion, when there is time to understand and respond to the needs and concerns of each individual, and when there are effective resources available for follow up if needed. Continuity of carer should be considered a key feature of routine trauma discussion, as many women will not disclose their histories to a stranger. All women should be provided with information about the impact of trauma and how to independently access support in the event of non-disclosures. Care providers need support to carry out these discussions. [ABSTRACT FROM AUTHOR]

Persons experiencing homelessness (PEH) use emergency department and acute care medical services to a high degree as they commonly do not have a primary care provider and postpone needed medical care. Medical-surgical nurses caring for PEH during their hospitalization need to be aware of risk factors for disease in this population. Nurse-led community healthcare programs that have proven effective are described. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the effects of flunixin meglumine or meloxicam on behavioral response and performance characteristics associated with surgical castration in crossbred bulls. Intact male Bos taurus calves (n = 252; averaging 176 kg) were randomly allocated into one of three treatment groups within pen: control (CON), flunixin meglumine (FLU ; 2.2 mg/kg intravenous injection), or meloxicam (MEL ; 2.0 mg/kg per os). The individual animal was the experimental unit. Calves were individually weighed on days 0 and 14 of the trial to evaluate performance outcomes. On study day 0, treatments were administered, according to their random allocation, immediately prior to surgical castration using the Henderson tool method. Visual analog scale (VAS) assessment and categorical attitude score (CAS) were collected on days −1, 0 (6 h post-castration), 1, 2, 3, and 4 in the study. The VAS was assigned using a 100 mm horizontal line with "normal" labeled at one end of the line and "moribund" at the other end of the horizontal line. The masked observer assigned a mark on the horizontal line based upon the observed severity of pain exhibited by that individual animal. The CAS was assigned by the same observer using five different categories with a score of 0 being "normal". Average daily gain tended (P = 0.09) to be associated with the treatment group, and MEL had a greater (P = 0.04) average daily gain through day 14 compared with CON. A significant (P < 0.01) treatment by day interaction was indicated for VAS score, and MEL had lower VAS scores on days 0, 1, 2, and 3 post-castration compared with CON; FLU had lower VAS scores on days 0 and 1 compared with CON. A significant treatment by day interaction was not present (P = 0.25) for CAS. The FLU had lesser percent CAS ≥1 (17.5%; P = 0.05) compared with CON (29.4%); MEL has lesser percent CAS ≥1 observations (14.9%; P = 0.01) compared with CON. The median VAS increased as CAS was more severe. Results indicated MEL and FLU calves temporally improved behavioral responses following surgical castration with positive numerical trends for a 14 d average daily gain (ADG). The VAS system appeared to be an effective method of subjective evaluation of pain in beef calves in this study. Route of administration, duration of therapy, and low relative cost make oral meloxicam a reasonable analgesic treatment in calves when administered at the time of surgical castration. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the demographic, clinical characteristics, and service systems of patients with autism spectrum disorder (ASD) and/or intellectual disability presenting to a large paediatric hospital emergency department (ED) with behaviours of concern (BOC) over a two-year period. Retrospective audit of ED presentations with BOC in patients with ASD and/or intellectual disability from 1 January 2019 to 31 December 2020, at the Royal Children's Hospital, Melbourne, Australia. There were 124 presentations (84 patients) in 2019 and 129 presentations (82 patients) in 2020. The mean age was 11.7 years. 55% arrived by ambulance, 24% required physical restraint, and 26% required sedation. Re-presentation was predicted by single-parent household, child protection involvement, and requirement of an interpreter. Children and adolescents with ASD and/or intellectual disability regularly present to ED with BOC. New models of care are required to better support this highly vulnerable patient group. [ABSTRACT FROM AUTHOR]

How do researchers choose their study species? Some choices are based on ecological or economic importance, some on ease of study, some on tradition—but could the name of a species influence researcher decisions? We asked whether phytophagous arthropod species named after their host plants were more likely to be assayed for host-associated genetic differentiation (or 'HAD'; the evolution of cryptic, genetically isolated host specialists within an apparently more generalist lineage). We chose 30 arthropod species (from a Google Scholar search) for which a HAD hypothesis has been tested. We traced the etymologies of species names in the 30 corresponding genera, and asked whether HAD tests were more frequent among species whose etymologies were based on host-plant names (e.g. Eurosta solidaginis, which attacks Solidago) versus those with other etymologies (e.g. Eurosta fenestrata, from Latin fenestra, 'window'). Species with host-derived etymologies were more likely to feature in studies of HAD than those with other etymologies. We speculate that the etymology of a scientific name can draw a researcher's attention to aspects of life-history and thus influence the direction of our scientific gaze. [ABSTRACT FROM AUTHOR]

How do researchers choose their study species? Some choices are based on ecological or economic importance, some on ease of study, some on tradition—but could the name of a species influence researcher decisions? We asked whether phytophagous arthropod species named after their host plants were more likely to be assayed for host-associated genetic differentiation (or 'HAD'; the evolution of cryptic, genetically isolated host specialists within an apparently more generalist lineage). We chose 30 arthropod species (from a Google Scholar search) for which a HAD hypothesis has been tested. We traced the etymologies of species names in the 30 corresponding genera, and asked whether HAD tests were more frequent among species whose etymologies were based on host-plant names (e.g. Eurosta solidaginis, which attacks Solidago) versus those with other etymologies (e.g. Eurosta fenestrata, from Latin fenestra, 'window'). Species with host-derived etymologies were more likely to feature in studies of HAD than those with other etymologies. We speculate that the etymology of a scientific name can draw a researcher's attention to aspects of life-history and thus influence the direction of our scientific gaze. [ABSTRACT FROM AUTHOR]

Retinal vascular resistance is of interest in glaucoma research, as a potential link between retinal ganglion cell loss and observed phenomena including disrupted vascular autoregulation, altered biomechanical stiffness, and impaired neurovascular coupling. It can now be assessed in vivo, using laser speckle flowgraphy. However, continued progress in the field requires better understanding of its physiology. In this study, we test the hypothesis of homogeneity of vascular resistance indices between regions of the retina: specifically, between superior and inferior hemifields. The resistivity index (maximum flow minus minimum flow, as a proportion of the maximum) and pulsatility index (maximum minus minimum, as a proportion of the mean) were measured in major vessels within the optic nerve head, in the remaining tissue within the optic nerve head, and in peripapillary branch retinal arteries, separated in each case into superior and inferior quadrants. This was performed in 378 eyes of 189 participants with suspected, early or moderate glaucoma; and in 99 eyes of 50 participants without any ocular pathology. In the glaucoma cohort, the resistivity index was on average 9% higher superiorly than inferiorly in vessels within the optic nerve head; 8% higher superiorly in remaining tissue; and 8% higher superiorly in peripapillary vessels (all p < 0.001). The pulsatility index was on average 11% higher superiorly in all three locations (all p < 0.001). Average flow was slightly higher superiorly in major vessels in the nerve head, but higher inferiorly elsewhere. In the healthy control cohort, resistivity index was higher superiorly by 10% in vessels and 8% in tissue within the optic nerve head; pulsatility index was 12% and 10% higher superiorly respectively (all p < 0.001). The fact that these differences were similar between the two cohorts suggests that they are not caused by the disease process. However, it is notable that glaucomatous loss most frequently occurs first in the superior visual field, corresponding with the inferior retina. The finding that vascular resistance indices are consistently higher in the superior retina warrants further investigation, both for its causes and consequences. • Changes in vascular resistance may be associated with glaucoma. • Vascular resistance at the optic nerve head was higher superiorly than inferiorly. • This was consistent in major vessels, remaining tissue, and peripapillary arteries. • It was also consistent between normal and glaucomatous eyes. [ABSTRACT FROM AUTHOR]

• Prospective multicenter observational trial assessing damage control laparotomy (DCL) wounds closed with the addition of wicks or incisional wound vacs. • Although the wick group had a higher proportion of class III and IV wound types, patients primarily treated with wicks had a lower risk of wound infection compared to those treated with incisional wound VACs; however, this difference was not statistically significant. • Primary closure of incisions with addition of wicks or incisional wound vacs after DCL is feasible. Damage control laparotomy (DCL) has a high risk of SSI and as an attempt to mitigate this, surgeons often leave the skin open to heal by secondary intention. A recent retrospective study showed that DCL wounds could be closed with the addition of wicks or incisional wound vacs with acceptable rates of wound infection. The aim of this prospective trial was to corroborate these results. This is a prospective multicenter observational trial performed by 7 institutions from July 2020 to April 2022. Adult patients who underwent DCL and fascia/skin closure with the addition of wicks or an incisional wound vac were included. Patients who died within seven days of DCL were excluded. Demographics, mechanism of initial presentation, wound classification, antibiotics given, surgical site infections, procedures performed, and mortality data was collected. Fisher's Exact test was used for categorical data and Wilcoxon Rank Sum test for continuous data. Mean days to closure was assessed using Student's t -test for independent groups. P-values <0.05 were considered indicative of statistical significance. Over the 21-month period, a total of 119 patients analyzed. Most patients were male (n = 66, 63 %), and the average age was 51 years. The average number of days the abdomen was kept open was 2.6. A majority of the DCLs were performed on acute care patients (n = 76, 63.8 %) and 92 patients (77.3 %) had a wound classification of contaminated or dirty. Most of the patients' skin was closed with wicks in place (68.9 %). There was a 9.8 % infection rate in patient's skin closed with wicks versus 16.2 % closed with an incisional wound vac (p = 0.361). Although the wick group had a higher proportion of class III and IV wound types, patients primarily treated with wicks had a lower risk of wound infection compared to those treated with incisional wound VACs; however, this difference was not statistically significant. [ABSTRACT FROM AUTHOR]

The protein kinase PKN2 is required for embryonic development and PKN2 knockout mice die as a result of failure in the expansion of mesoderm, cardiac development and neural tube closure. In the adult, cardiomyocyte PKN2 and PKN1 (in combination) are required for cardiac adaptation to pressure-overload. The specific role of PKN2 in contractile cardiomyocytes during development and its role in the adult heart remain to be fully established. We used mice with cardiomyocyte-directed knockout of PKN2 or global PKN2 haploinsufficiency to assess cardiac development and function using high resolution episcopic microscopy, MRI, micro-CT and echocardiography. Biochemical and histological changes were also assessed. Cardiomyocyte-directed PKN2 knockout embryos displayed striking abnormalities in the compact myocardium, with frequent myocardial clefts and diverticula, ventricular septal defects and abnormal heart shape. The sub-Mendelian homozygous knockout survivors developed cardiac failure. RNASeq data showed up-regulation of PKN2 in patients with dilated cardiomyopathy, suggesting an involvement in adult heart disease. Given the rarity of homozygous survivors with cardiomyocyte-specific deletion of PKN2, the requirement for PKN2 in adult mice was explored using the constitutive heterozygous PKN2 knockout. Cardiac hypertrophy resulting from hypertension induced by angiotensin II was reduced in these haploinsufficient PKN2 mice relative to wild-type littermates, with suppression of cardiomyocyte hypertrophy and cardiac fibrosis. It is concluded that cardiomyocyte PKN2 is essential for heart development and the formation of compact myocardium and is also required for cardiac hypertrophy in hypertension. Thus, PKN signalling may offer therapeutic options for managing congenital and adult heart diseases. [ABSTRACT FROM AUTHOR]

Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates. [ABSTRACT FROM AUTHOR]

Despite the superior efficacy of topical therapies for the treatment of actinic keratoses in clinical trials, cryosurgery remains a frequent treatment modality in clinical practice. Little is known about patients' experience of real-world use of topical therapy. To determine the real-world effectiveness and tolerability of 5-fluorouracil and imiquimod in the treatment of actinic keratoses. A phone survey and chart review was conducted among 51 patients prescribed 5-fluorouracil (N = 27) or imiquimod (N = 24) for actinic keratoses. Six patients (22%) in the 5-fluorouracil group and five patients (21%) in the imiquimod group reported severe local skin reactions, and three patients in both groups (11% and 13%, respectively) were unwilling to use the respective topical therapies again. Patients in the 5-fluorouracil group had, on average, 3.3 fewer cryosurgery spot treatments following topical treatment. Patients in the imiquimod group averaged 2.0 fewer spot treatments. While this study provides information on real-world experiences, patients' responses were limited by the ability to recall treatment and potential adverse effects. High rates of skin reactions, prolonged discomfort, and the continued need for procedural treatments may make patients less willing to use topical 5-fluorouracil or imiquimod for actinic keratoses. [ABSTRACT FROM AUTHOR]

In this article I introduce constitutive norm accounts of assertion, and then give three arguments for giving up on the constitutive norm project. First I begin with an updated version of MacFarlane's Boogling argument. My second argument is that the 'overriding response' that constitutive norm theorists offer to putative counterexamples is unpersuasive and dialectically risky. Third and finally, I suggest that constitutive norm theorists, in appealing to the analogy of games, actually undermine their case that they can make sense of assertions that fail to follow their putative constitutive norm. These considerations, I suggest, together show that the constitutive norm project founders not because any single norm is not descriptively correct of our assertion practices, but rather, because giving a constitutive norm as the definition of assertion alone is insufficient. [ABSTRACT FROM AUTHOR]

Simple Summary: An increasing number of cases of tick-borne diseases are being reported across North America and in new areas. This has been linked to the spread of ticks, primarily the blacklegged tick Ixodes scapularis and the lone star tick Amblyomma americanum, into new geographical regions. Tick surveillance systems have played an important role in monitoring the changing distributions of these ticks and have benefitted greatly from including data collected by members of the public through citizen or community science projects. Enlisting the help of community scientists is an economical way to collect large amounts of data over a wide geographical area, and participants can also benefit by receiving information relevant to their tick encounter, for example regarding tick-borne disease symptoms. This study examined tick observations from the online image-based biological recording platform iNaturalist to evaluate its use as an extra tool to collect information on expanding tick distributions. The distribution and seasonality of iNaturalist tick observations were found to accurately represent those of the studied species and identified potential new areas of tick expansion. Free-to-access iNaturalist data is a highly cost-effective method to support existing tick surveillance strategies to aid preparedness and response in emerging areas of tick establishment. Recent increases in the incidence and geographic range of tick-borne diseases in North America are linked to the range expansion of medically important tick species, including Ixodes scapularis, Amblyomma americanum, and Amblyomma maculatum. Passive tick surveillance programs have been highly successful in collecting information on tick distribution, seasonality, host-biting activity, and pathogen infection prevalence. These have demonstrated the power of citizen or community science participation to collect country-wide, epidemiologically relevant data in a resource-efficient manner. This study examined tick observations from the online image-based biological recording platform iNaturalist to evaluate its use as an effective tool for monitoring the distributions of A. americanum, A. maculatum, I. scapularis, and Dermacentor in the United States and Canada. The distribution and seasonality of iNaturalist tick observations were found to accurately represent those of the studied species. County-level iNaturalist tick occurrence data showed good agreement with other data sources in documented areas of I. scapularis and A. americanum establishment, and highlighted numerous previously unreported counties with iNaturalist observations of these species. This study supports the use of iNaturalist data as a highly cost-effective passive tick surveillance method that can complement existing surveillance strategies to update tick distributions and identify new areas of tick establishment. [ABSTRACT FROM AUTHOR]

Summary: The phase I/II AU‐003 study in patients with treatment‐naïve (TN) or relapsed/refractory (R/R) chronic lymphocytic leukaemia/small lymphocytic lymphoma demonstrated that zanubrutinib therapy results in clinically meaningful and durable responses with acceptable safety and tolerability. We report updated safety and efficacy data for 123 patients with a median follow‐up of 47·2 months. Patients received zanubrutinib 160 mg twice daily (81 patients), 320 mg once daily (40), or 160 mg once daily (two). Discontinuations due to adverse events or disease progression were uncommon. The overall response rate (ORR) was 95·9% (TN, 100%; R/R, 95%) with 18·7% achieving complete response (CR). Ongoing response at 3 years was reported in 85·7%. The ORR in patients with del(17p)/tumour protein p53 mutation was 87·5% (CR 16·7%). The 2‐ and 3‐year progression‐free survival estimates were 90% (TN, 90%; R/R, 91%) and 83% (TN, 81%; R/R, 83%) respectively. The most reported Grade ≥3 adverse events were neutropenia (15·4%), pneumonia (9·8%), hypertension (8·9%) and anaemia (6·5%). The annual incidence of atrial fibrillation, major haemorrhage, Grade ≥3 neutropenia and Grade ≥3 infection decreased over time. With a median follow‐up of ~4 years, responses remain clinically meaningful and durable and long‐term tolerability to zanubrutinib therapy continues. [ABSTRACT FROM AUTHOR]

Cold War Frequencies: CIA Clandestine Radio Broadcasting to the Soviet Union and Eastern Europe. The early chapters discuss the role of the U.S. Central Intelligence Agency (CIA) in setting up RFE and its sister station, Radio Liberation (later Radio Liberty). [Extracted from the article]

The Safe Systems Improvement Tool (SSIT) is a retrospective critical incident review tool designed for use in child welfare systems, which centers on the systems-level influences that contributed to casework practice in critical incidents. The SSIT output is structured and standardized, allowing for data aggregation both within and across systems. The SSIT demonstrates reliability at the tool and item level, and it is being widely used to review critical incidents across the United States. Learnings from aggregated SSIT data can be leveraged into systems-level quality improvement to enhance the safety and care of children and families. [ABSTRACT FROM AUTHOR]

Understanding the variation in Borrelia burgdorferi s.l. infection rates in Ixodes ricinus ticks is important for assessing the potential for Lyme borreliosis transmission. This study aimed to investigate infection rates of B. burgdorferi s.l. bacteria in I. ricinus across 24 field sites in England and Wales, focussing on protected recreational areas in National Parks (NPs) and Areas of Outstanding Natural Beauty (AONBs), to provide comparable data across multiple years to assess spatio‐temporal changes in B. burgdorferi s.l. infection. Working with park rangers, questing ticks were collected each spring from 2014 to 2019. A subset of ticks, 4104 nymphs, were analysed using a pan‐Borrelia qPCR assay, as well as a Borrelia miyamotoi‐specific qPCR, and sequenced to determine Borrelia burgdorferi s.l. genospecies. Site‐specific B. burgdorferi s.l. infection rates in I. ricinus nymphs varied from 0% to 24%, with overall infection rates ranging from 2.5% to 5.1% across the years. Genospecies composition of sequenced samples was 62.5% B. garinii, 20.3% B. valaisiana and 17.2% B. afzelii. Borrelia miyamotoi was detected in 0.2% of ticks. This study increases our knowledge on B. burgdorferi s.l.. infection in areas used by the public for outdoor activity across England and Wales, highlighting the spatial and temporal variability which can impact the changing risk to humans from infected tick bites. [ABSTRACT FROM AUTHOR]

Raf kinases signal via extracellular signal-regulated kinases 1/2 (ERK1/2) to drive cell division. Since activating mutations in BRAF (B-Raf proto-oncogene, serine/threonine kinase) are highly oncogenic, BRAF inhibitors including dabrafenib have been developed for cancer. Inhibitors of ERK1/2 signalling used for cancer are cardiotoxic in some patients, raising the question of whether dabrafenib is cardiotoxic. In the heart, ERK1/2 signalling promotes not only cardiomyocyte hypertrophy and is cardioprotective but also promotes fibrosis. Our hypothesis is that ERK1/2 signalling is not required in a non-stressed heart but is required for cardiac remodelling. Thus, dabrafenib may affect the heart in the context of, for example, hypertension. In experiments with cardiomyocytes, cardiac fibroblasts and perfused rat hearts, dabrafenib inhibited ERK1/2 signalling. We assessed the effects of dabrafenib (3 mg/kg/d) on male C57BL/6J mouse hearts in vivo. Dabrafenib alone had no overt effects on cardiac function/dimensions (assessed by echocardiography) or cardiac architecture. In mice treated with 0.8 mg/kg/d angiotensin II (AngII) to induce hypertension, dabrafenib inhibited ERK1/2 signalling and suppressed cardiac hypertrophy in both acute (up to 7 d) and chronic (28 d) settings, preserving ejection fraction. At the cellular level, dabrafenib inhibited AngII-induced cardiomyocyte hypertrophy, reduced expression of hypertrophic gene markers and almost completely eliminated the increase in cardiac fibrosis both in interstitial and perivascular regions. Dabrafenib is not overtly cardiotoxic. Moreover, it inhibits maladaptive hypertrophy resulting from AngII-induced hypertension. Thus, Raf is a potential therapeutic target for hypertensive heart disease and drugs such as dabrafenib, developed for cancer, may be used for this purpose. [ABSTRACT FROM AUTHOR]

In his miscellany Para todos: Exemplos morales, hvmanos, y divinos. En qve se tratan diversas ciencias, materias y facvltades (1632), the Spanish dramatist Juan Pérez de Montalbán inserted a rather lengthy treatise with the title, "Discurso del predicador" (ff. 192r-215r), in which he elaborates a lengthy list of books useful to the preacher for the embellishment of his sermons. This exhaustive catalogue of books both secular and divine includes many Renaissance and Baroque collections of emblems and imprese. What is more, Pérez de Montalbán contributed a poem to Vincencio Carducho's Diálogos de la pintura (1633) that describes an emblematic engraving of La Pintura (f. 162r). In view of the dramatist's clear familiarity with this phenomenon of combining words and symbolic images, this study explores the presence and function of emblematic influence in the dramatic works of Juan Pérez de Montalbán, the friend and disciple of Lope de Vega. [ABSTRACT FROM AUTHOR]

AMPA receptors are tetrameric glutamate‐gated ion channels that mediate a majority of fast excitatory neurotransmission in the brain. They exist as calcium‐impermeable (CI‐) and calcium‐permeable (CP‐) subtypes, the latter of which lacks the GluA2 subunit. CP‐AMPARs display an array of distinctive biophysical and pharmacological properties that allow them to be functionally identified. This has revealed that they play crucial roles in diverse forms of central synaptic plasticity. Here we summarise the functional hallmarks of CP‐AMPARs and describe how these are modified by the presence of auxiliary subunits that have emerged as pivotal regulators of AMPARs. A lasting change in the prevalence of GluA2‐containing AMPARs, and hence in the fraction of CP‐AMPARs, is a feature in many maladaptive forms of synaptic plasticity and neurological disorders. These include modifications of glutamatergic transmission induced by inflammatory pain, fear conditioning, cocaine exposure, and anoxia‐induced damage in neurons and glia. Furthermore, defective RNA editing of GluA2 can cause altered expression of CP‐AMPARs and is implicated in motor neuron damage (amyotrophic lateral sclerosis) and the proliferation of cells in malignant gliomas. A number of the players involved in CP‐AMPAR regulation have been identified, providing useful insight into interventions that may prevent the aberrant CP‐AMPAR expression. Furthermore, recent molecular and pharmacological developments, particularly the discovery of TARP subtype‐selective drugs, offer the exciting potential to modify some of the harmful effects of increased CP‐AMPAR prevalence in a brain region‐specific manner. [ABSTRACT FROM AUTHOR]

A warming climate, as predicted under current climate change projections, is likely to influence the population dynamics of many forest insect species. Numerous bark beetle species in both Europe and North America have already responded to a warming climate by significantly expanding their geographical ranges.The aim of the current study was to investigate how populations of bark beetles within stands of Sitka spruce, a widely planted non‐native commercial plantation tree species in the U.K., were likely to respond to a warming climate. Experimental plots were established in stands of Sitka spruce over elevational gradients in two commercial forest plantations, and the abundance and emergence times of key bark beetle species were assessed over a 3‐year period using flight interception traps. The air temperature difference between the lowest and highest experimental plot in each forest was consistently >1°C throughout the 3‐year period.In general, the abundance of the most dominant bark beetle species (e.g. Trypodendron, Dryocoetes, Hylastes spp.) was higher, and emergence times tended to be earlier in the year at the lower elevation plots, where temperatures were higher, although not all bark beetle species responded in the same manner.The results of the study indicated that, under the projected future climate warming scenarios, monoculture Sitka spruce stands at low elevations may potentially be more vulnerable to significant outbreak events from existing or invasive bark beetle species. Hence, consideration of establishing more resilient forests of Sitka spruce by diversifying the species composition and structure of Sitka spruce stands is discussed. [ABSTRACT FROM AUTHOR]

Voluntary contributions by citizen scientists can gather large datasets covering wide geographical areas, and are increasingly utilized by researchers for multiple applications, including arthropod vector surveillance. Online platforms such as iNaturalist accumulate crowdsourced biological observations from around the world and these data could also be useful for monitoring vectors. The aim of this study was to explore the availability of observations of important vector taxa on the iNaturalist platform and examine the utility of these data to complement existing vector surveillance activities. Of ten vector taxa investigated, records were most numerous for mosquitoes (Culicidae; 23,018 records, 222 species) and ticks (Ixodida; 16,214 records, 87 species), with most data from 2019–2020. Case studies were performed to assess whether images associated with records were of sufficient quality to identify species and compare iNaturalist observations of vector species to the known situation at the state, national and regional level based on existing published data. Firstly, tick data collected at the national (United Kingdom) or state (Minnesota, USA) level were sufficient to determine seasonal occurrence and distribution patterns of important tick species, and were able to corroborate and complement known trends in tick distribution. Importantly, tick species with expanding distributions (Haemaphysalis punctata in the UK, and Amblyomma americanum in Minnesota) were also detected. Secondly, using iNaturalist data to monitor expanding tick species in Europe (Hyalomma spp.) and the USA (Haemaphysalis longicornis), and invasive Aedes mosquitoes in Europe, showed potential for tracking these species within their known range as well as identifying possible areas of expansion. Despite known limitations associated with crowdsourced data, this study shows that iNaturalist can be a valuable source of information on vector distribution and seasonality that could be used to supplement existing vector surveillance data, especially at a time when many surveillance programs may have been interrupted by COVID-19 restrictions. [ABSTRACT FROM AUTHOR]

Recent historical discussion of conceptual engineering by analytic philosophers has largely focused on precedents for contemporary conceptual engineering within the history of analytic philosophy. However, I suggest that we can and should look outside of the analytic tradition for further examples of conceptual engineering, and inspiration for further work in conceptual engineering. Here I will look to one such other tradition – American Black feminism. I do this by considering the work of Audre Lorde and Patricia Hill Collins in tandem with a tradition that is the more usual stomping ground of analytic philosophers: logical positivism. I draw out Rudolf Carnap and Otto Neurath's respective views on conceptual engineering, before turning to Collins and Lorde. I suggest that Collins on the power of self-definition provides a model of conceptual engineering that closely matches that given by Neurath, whilst we can read Lorde's work on poetry as giving a distinctively individualist spin on the conceptual engineering. I conclude with a comparative discussion of the various models on offer, suggesting that rather than being in competition, these various views of conceptual engineering are best seen as a toolbox of methods for conceptual engineering. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate an educational pamphlet that incorporates evidence-based pain mitigation strategies during adult vaccine injections and determine its effect on the knowledge, attitudes, and behaviors toward use of such strategies among adults in the community receiving immunizations. An evidence-based pamphlet about how to reduce pain during vaccination in adults was distributed to a convenience sample of community sites that administer vaccines, including family physician offices, travel clinics, and pharmacies. Providers at the community sites distributed a baseline (pre) questionnaire followed by the pamphlet to study participants. Then participants were vaccinated. Six weeks later, participants were contacted to complete a follow-up (post) questionnaire. Participants' knowledge, attitudes, and behaviors regarding pain mitigation strategies for vaccine injections were evaluated before and after access to the pamphlet. Seventy-four people receiving vaccines participated. Participants were predominantly university educated (69%) and female (66%), with a median age of 44.5 years (range, 18–71). Most participants received an injection at a travel or public health clinic (73%). Twenty-seven percent had prior accurate knowledge of pain mitigation strategies. Self-reported pain or fear of needle pain did not change from before access to the pamphlet to six weeks after. Twenty percent of participants used at least one strategy outlined in the pamphlet and found it helpful and 52% were interested in sharing the pamphlet with others. An educational pamphlet about vaccination pain mitigation resulted in a positive change in knowledge and attitudes around pain mitigation strategies. Further research is needed to explore long-term impact. [ABSTRACT FROM AUTHOR]

CO2 surgical laser for piglet castration to reduce pain and improve wound healing: a pilot study. surgical lasers are widely used for procedures in veterinary and human medicine. There is evidence to suggest surgery using a CO2 surgical laser for piglet castration to reduce pain and improve wound healing: a pilot study. laser reduces pain and swelling and improves healing time compared with surgery with a scalpel. Millions of piglets in North America are surgically castrated each year using a scalpel. Therefore, piglet welfare may be improved by making refinements to the surgical procedure. The objectives of this preliminary study were to determine the ability of a CO2 surgical laser for piglet castration to reduce pain and improve wound healing: a pilot study. surgical laser to (1) reduce pain and (2) improve wound healing of piglets undergoing surgical castration. Two-day-old male Yorkshire × Landrace piglets were used and randomly assigned to 1 of 3 treatments (n = 10 piglets/treatment group): surgical castration with the CO2 surgical laser for piglet castration to reduce pain and improve wound healing: a pilot study. laser, surgical castration with a scalpel, or sham (uncastrated control). Piglets were video recorded in their pens for 1 hr preprocedure and from 0 to 2, 6 to 8, and at 24 hr postprocedure for behavior scoring. Surgical site images were collected at baseline, 0, 8, 24, 48, 72, 96, 120, 144, and 168 hr postcastration for wound healing assessment. Infrared thermography images of the surgical site were also taken at baseline, 0, 0.5, 8, and 24 hr post procedure to assess inflammation. Finally, blood was collected from each piglet at baseline and 0.5 hr postcastration to assess cortisol levels, prostaglandin E metabolite and pig-major acute phase protein concentration. Laser-castrated piglets displayed more pain behaviors across the observation period than scalpel-castrated piglets (P = 0.05). Laser-castrated piglets also displayed significantly more agonistic behavior than both scalpel-castrated piglets (P = 0.005) and sham piglets (P = 0.036); yet, laser castrated piglets had significantly lower temperatures at the site of incision compared with scalpel-castrated piglets (P = 0.0211). There was no significant difference in wound healing or any of the blood parameters assessed between laser castrated and scalpel-castrated piglets. There was evidence of thermal tissue damage on the scrotum of piglets that were castrated using the CO2 laser. This may have resulted in the unremarkable healing time and the increased pain behavior observed in this study. The surgical laser technique should be refined before conclusions can be made regarding the utility of a CO2 surgical laser for piglet castration to reduce pain and improve wound healing: a pilot study. laser for piglet castration. [ABSTRACT FROM AUTHOR]

Background: To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States.Methods: The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs).Results: The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: -0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63).Discussion: Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges. [ABSTRACT FROM AUTHOR]

It is crucial that, at the point of registration, midwives can competently interpret intrapartum cardiotocographs (CTGs). It is therefore important that practice assessors are confident teaching the safe and accurate interpretation of CTGs to the students they support. This paper uses a case study to examine how CTG interpretation can be taught most effectively. Humanistic learning theories can be used to create a psychologically safe-learning environment which is enjoyable for both the student and the practice assessor. Using a taxonomy of learning enables midwives to help the student develop higher order thinking skills, while understanding the learning style of that individual student allows midwives to incorporate tailored teaching in their clinical work. In addition to providing feedback, it is beneficial to encourage self-reflection and the student midwife's newly learned skills can be solidified by peer teaching. [ABSTRACT FROM AUTHOR]

Both the opioid and gun violence epidemics are recurrent public health issues in the United States. We sought to determine the effect of opioid dependence on gunshot injury treatment outcomes. Using the 2016 National Readmission Database, patients were included if they had a principal diagnosis of firearm injury. Opioid dependence was identified using appropriate International Classification of Diseases, 10th Revision, Clinical Modification codes. The primary outcome was 30-day all-cause readmission. Secondary outcomes were in-hospital and 1-year mortality, resource utilization, and most common reasons for admission and readmission. Confounders were adjusted for using multivariate regression analysis. A total of 31,303 patients were included, 695 of whom were opioid dependent. Opioid-dependent patients were more likely to be young (35.1 y, range: 33.4-36.7 y) and male (89.9%) compared with patients without opioid dependence. Opioid dependence was associated with higher 30-day readmission rates (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.12-2.50, P = 0.01). However, opioid dependence was associated with lower in-hospital (aOR: 0.16, CI: 0.07-0.38, P < 0.01) and 1-year (aOR: 0.15, CI: 0.06-0.38, P < 0.01) mortality, longer mean length of stay (adjusted mean difference [aMD]: 2.09 d, CI: 0.43-3.76, P = 0.03), and total hospitalization costs (aMD: $6,318, CI: $ 257–$12,380, P = 0.04). Both groups had similar total hospitalization charges (aMD: $$10,491, CI: −$12,618-$33,600, P -value = 0.37). Opioid dependence leads to higher rates of 30-day readmission and resource utilization among patients with firearm injuries. However, the in-hospital and 1-year mortality rates are lower among patients with opioid dependence secondary to lower injury acuity. [ABSTRACT FROM AUTHOR]

Tick bites on humans can occur in a variety of habitats and may result in the transmission of tick‐borne pathogens, such as the causative agent of Lyme borreliosis (LB), Borrelia burgdorferi sensu lato. As the risk of transmission of this pathogen to the host increases with the duration of tick feeding, the recognition and removal of ticks as soon as possible following attachment is important for reducing the risk of infection. Performing a thorough body examination for ticks following potential exposure is recommended by tick awareness campaigns. Knowledge of where on the body feeding ticks are frequently found, and at which times of year peak tick exposure occurs, provides important information for public health messaging and may aid those bitten by ticks to engage more effectively with tick‐checking behaviour. This paper summarizes human tick bites in the United Kingdom (UK) during 2013–2018 reported to Public Health England's passive Tick Surveillance Scheme and further examines the anatomical location and seasonality of bites from the most commonly encountered tick and LB vector Ixodes ricinus. A total of 1,328 tick records from humans were received of which 93% were I. ricinus. Humans were most commonly bitten by I. ricinus nymphs (70% bites). Tick bites were recorded on all parts of the body, but there were significant differences in their anatomical location on adults and children. Most tick bites on adults occurred on the legs (50%), whereas on children tick bites were mostly on the head and neck (43%). Bites from I. ricinus were recorded throughout the year but were most numerous during May to August. This study adds to the body of research on the seasonality and anatomical location of human tick bites in temperate Europe and highlights the importance of data collected through passive surveillance in addition to research and epidemiological studies. [ABSTRACT FROM AUTHOR]

Case Presentation: A 59-year-old man presented to the ED with a chief complaint of shortness of breath. His past medical history was significant for end-stage renal disease secondary to lithium toxicity, immunosuppression subsequent to cadaveric renal transplantation, bipolar disorder, and hypertension. His shortness of breath had begun 6 months previously and was initially intermittent; it then progressed to constant shortness of breath over the few weeks before presentation. He had no fever, hemoptysis, or chest pain. The patient was admitted to hospital for further evaluation. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Children and adolescents with autism spectrum disorder and/or intellectual disability often present to emergency departments with behaviours of concern: irritability, aggression and self‐injurious behaviour. The objective of this study was to design, implement and evaluate a new model of care to support these patients and their families following presentation to reduce the need for re‐presentation.We designed and evaluated a new model of care for these patients, comprising consultations with a developmental paediatrician and a child psychiatrist, referral to a specialist behavioural service and 6 weeks of care coordination by a clinical nurse consultant. Using a quality improvement framework, iterative improvements were made to the model via a series of plan–do–study–act cycles. Re‐presentation rates were compared with a control group of patients who presented with behaviours of concern but were not recruited into the study. Participating families and treating clinicians were surveyed at 2 and 6 weeks post‐enrolment to gather qualitative feedback about their experience of the model.A total of 31 families participated in the study. Three‐ and 6‐month re‐presentation rates were 48.7% and 36.3% lower than the control group. Qualitative evaluation of the model by both families and clinicians was positive. The model was feasible and acceptable. Families reported feeling heard and understood, and that the intervention was helpful and provided a positive path forwards.The findings suggest that a simple model of care can be successfully implemented and provide meaningful benefits for families of children with behaviours of concern, including reduced crisis‐oriented help‐seeking. [ABSTRACT FROM AUTHOR]

Determining triage activation levels in geriatric patients who fall (GF), and patients with penetrating wounds can be difficult and inaccurate, resulting in excessive overtriage (OT) and undertriage (UT) rates. We developed trauma activation prediction models using field data to predict with greater accuracy trauma activation level and triage rates consistent with the ACS recommendations. Using data from the 2014 National Trauma Data Bank, we created binary regression equations for each type of injury (GF and penetrating wounds). The 2014 data were randomized and divided into two halves. The first half for each injury type was used to generate prediction models, whereas the second half of the 2014 data were combined with 2013 and 2015 National Trauma Data Bank data for model verification. Binary regression equations were generated from vital signs collected by EMS. A Cribari grid with ISS ≥ 15 was used to determine the appropriateness of activation level. Chi-square analysis was used to determine significant differences between OT, UT, and accuracy predictions. Using our triage models, we were able to obtain UT rates of less than 4 per cent for GF with OT rates of less than 40 per cent, UT rates less than 4.1 per cent and OT of less than 50 per cent for patients with gunshot wounds, and UT rates less than 4 per cent and OT rates less than 25 per cent for patients who had stab wounds. Our developed trauma level prediction models enable health providers to predict trauma activation levels that can result in OT and UT rates in the recommended ranges by the ACS. [ABSTRACT FROM AUTHOR]

This paper analyses a particular social phenomenon whereby a speaker purports ignorance of the meaning of another speaker's speech in order to undermine that other speaker: dismissive incomprehension. It develops a speech act theory of the phenomenon, and develops its distinctive, and sometimes problematic perlocutionary character. After taking a look at some of the issues surrounding the phenomenon, the paper compares it to more fully studied features of our social lives, including epistemic injustice and gaslighting. It ends with some thoughts on counteracting the problematic cases of dismissive incomprehension. [ABSTRACT FROM AUTHOR]

Spanish Golden Age theatre owed its commercial success in part to the formulaic repetition of popular conventions that resonated with the play-going public. The challenge for dramatists was to forge something new and innovative while at the same time respecting the conventions that the audience demanded. The refundición, or adaptation of an entire earlier play, presented a unique challenge to Golden Age dramatists. This study seeks to demonstrate that Juan de Matos Fragoso's El sabio en su retiro represents a successful and innovative imitation of his source text, Lope de Vega's El villano en su rincón. [ABSTRACT FROM AUTHOR]

Her new book returns to Lugar's question but this time it is the jumping off point for a wholesale rethinking of the implications of culture for diplomacy. On 28 October 2003 the Senate Foreign Relations Committee met to cross-examine the Bush White House's nominee for the post of Under Secretary for Public Diplomacy and Public Affairs, Margaret Tutwiler. His remark sparked Rhonda Zaharna's well-regarded first book on public diplomacy: I Battles to Bridges: US strategic communication and public diplomacy after 9/11 i (2010). [Extracted from the article]

The article presents a study which examined the national trends in pediatric COVID-19 infection in the U.S. based on data from health agencies like the Centers for Disease Control and Prevention (CDC). The research determined confirmed infected children, their hospitalization rate and mortality rate. Based on the results, children can be infected by COVID-19 but the infections do not result to severe cases.

The poem "AUTO EROTICA SERIES: CAR COMMERCIAL EKPHRASTICS," by Tom Cull is presented. First Line: On-board navigation cuts; Last Line: Looks like we made it.