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Preparedness to endure extreme situations such as natural disasters or military conflicts is not commonplace in healthcare training programs. Moreover, multidisciplinary teams in health services rarely (if ever) include experts in security. However, when emergency situations occur, prevailing healthcare demands do not cease to exist, and unexpected demands often surge due to the shortage of other services and supplies or as a consequence of the emergency condition itself. With services in 45 countries, AIDS Healthcare Foundation (AHF) has operated in several conflict zones, facing broad and challenging security demands. Since 2017 AHF has implemented the Global Department of Safety and Security (GDSS), a dedicated intelligence and safety program that had a key role in the security monitoring, preparedness, and defense responses, assisting staff members and clients during recent conflicts. In this manuscript, we describe the experience of AHF's GDSS in three recent military conflicts in Ethiopia, Myanmar, and Ukraine, and provide insights into steps that can be taken to assure staff safety and support the mission of caring for patients throughout catastrophic events. [ABSTRACT FROM AUTHOR]

Physiologically-based pharmacokinetic (PBPK) modeling is important for studying drug delivery in the central nervous system, including determining antibody exposure, predicting chemical concentrations at target locations, and ensuring accurate dosages. The complexity of PBPK models, involving many variables and parameters, requires a consideration of parameter identifiability; i.e., which parameters can be uniquely determined from data for a specified set of concentrations. We introduce the use of a local sensitivity-based parameter subset selection algorithm in the context of a minimal PBPK (mPBPK) model of the brain for antibody therapeutics. This algorithm is augmented by verification techniques, based on response distributions and energy statistics, to provide a systematic and robust technique to determine identifiable parameter subsets in a PBPK model across a specified time domain of interest. The accuracy of our approach is evaluated for three key concentrations in the mPBPK model for plasma, brain interstitial fluid and brain cerebrospinal fluid. The determination of accurate identifiable parameter subsets is important for model reduction and uncertainty quantification for PBPK models. [ABSTRACT FROM AUTHOR]

Paroling authorities should have a clear understanding of the empirical support for factors considered in suitability determinations. We presented a survey to paroling authorities across the United States and Canada to examine their purview and information considered in decision-making. We situated the findings among existing empirical research suggesting best practices for consideration of specific factors in parole decision-making. Paroling authorities claim to give equal consideration to all information available, regardless of its empirical relation to suitability for release. Probed further, they display a good understanding of the empirical support for and the weight to be applied to each factor. [ABSTRACT FROM AUTHOR]

The article focuses on writer G.K. Chesterton as a literary apologist for the Christian faith, delving into the darker and more complex aspects of his apologetics found in his works. Topics include Chesterton's exploration of the condition of joy in response to life's blessings, his profound crisis and near-suicidal thoughts during his early years at the Slade School of Art, and the transformative nature of his mid-twenties conversion to Christian faith.

Background While prior work examining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern focused on hospitalization and death, less is known about differences in clinical presentation. We compared the prevalence of acute symptoms across pre-Delta, Delta, and Omicron. Methods We conducted an analysis of the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a cohort study enrolling symptomatic SARS-CoV-2-positive participants. We determined the association between the pre-Delta, Delta, and Omicron time periods and the prevalence of 21 coronavirus disease 2019 (COVID-19) acute symptoms. Results We enrolled 4113 participants from December 2020 to June 2022. Pre-Delta vs Delta vs Omicron participants had increasing sore throat (40.9%, 54.6%, 70.6%; P <.001), cough (50.9%, 63.3%, 66.7%; P <.001), and runny noses (48.9%, 71.3%, 72.9%; P <.001). We observed reductions during Omicron in chest pain (31.1%, 24.2%, 20.9%; P <.001), shortness of breath (42.7%, 29.5%, 27.5%; P <.001), loss of taste (47.1%, 61.8%, 19.2%; P <.001), and loss of smell (47.5%, 55.6%, 20.0%; P <.001). After adjustment, those infected during Omicron had significantly higher odds of sore throat vs pre-Delta (odds ratio [OR], 2.76; 95% CI, 2.26–3.35) and Delta (OR, 1.96; 95% CI, 1.69–2.28). Conclusions Participants infected during Omicron were more likely to report symptoms of common respiratory viruses, such as sore throat, and less likely to report loss of smell and taste. Trial registration NCT04610515. [ABSTRACT FROM AUTHOR]

Decrease of .9 percent in the adult population of parolees or probationers in 2019, according to the Bureau of Justice Statistics, there remain just under 4.4 million adults under community supervision in the 50 states and Washington, D.C. (Oudekerk & Kaeble, 2021). Encouragingly, evidence-based supervision is associated with reductions in recidivism compared to the status quo training that is provided to community supervision officers (e.g., Robinson et al., 2012). The Council of State Governments (CSG) similarly highlighted the impact of supervision violation behavior on prison admissions, noting that on any given day there are 280,000 people in prison because of a supervision violation, which is nearly 1 in 4 (CSG, 2019). In addition, estimates indicate that approximately 48 percent of probation violations and 64 percent of parole violations are for technical reasons (e.g., breach of conditions and not necessarily new criminal behavior on its own), amounting to costs of $2.8 billion to the criminal justice system (CSG, 2019). [Extracted from the article]

Background Most research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants focuses on initial symptomatology with limited longer-term data. We characterized prevalences of prolonged symptoms 3 months post–SARS-CoV-2 infection across 3 variant time-periods (pre-Delta, Delta, and Omicron). Methods This multicenter prospective cohort study of adults with acute illness tested for SARS-CoV-2 compared fatigue severity, fatigue symptoms, organ system–based symptoms, and ≥3 symptoms across variants among participants with a positive ("COVID-positive") or negative SARS-CoV-2 test ("COVID-negative") at 3 months after SARS-CoV-2 testing. Variant periods were defined by dates with ≥50% dominant strain. We performed multivariable logistic regression modeling to estimate independent effects of variants adjusting for sociodemographics, baseline health, and vaccine status. Results The study included 2402 COVID-positive and 821 COVID-negative participants. Among COVID-positives, 463 (19.3%) were pre-Delta, 1198 (49.9%) Delta, and 741 (30.8%) Omicron. The pre-Delta COVID-positive cohort exhibited more prolonged severe fatigue (16.7% vs 11.5% vs 12.3%; P =.017) and presence of ≥3 prolonged symptoms (28.4% vs 21.7% vs 16.0%; P <.001) compared with the Delta and Omicron cohorts. No differences were seen in the COVID-negatives across time-periods. In multivariable models adjusted for vaccination, severe fatigue and odds of having ≥3 symptoms were no longer significant across variants. Conclusions Prolonged symptoms following SARS-CoV-2 infection were more common among participants infected during pre-Delta than with Delta and Omicron; however, these differences were no longer significant after adjusting for vaccination status, suggesting a beneficial effect of vaccination on risk of long-term symptoms. Clinical Trials Registration. NCT04610515. [ABSTRACT FROM AUTHOR]

The ability to acquire the landownership rights of another through adverse possession is a fundamental part of American property law. Yet to laypeople, the adverse possessor often seems hardly more than a thief. In contrast, scholars have justified the doctrine on a number of grounds: as punishment against original landowners who fail consistently to fly flags of ownership and protect their rights; as a reward to the adverse possessor, who presumably is making a higher and better use of the land than did its original owner; and as an acknowledgement that the adverse possessor's uninterrupted and continuous use over time--combined with a claim of ownership--leads to a psychological or emotional attachment held by the adverse possessor that far exceeds any such attachment held by the original owner. While each of these justifications has merit when applied to realty that is freely alienable and whose use may change over time, the justifications are less convincing when applied to certain kinds of realty. Real property interests exist in which we do not reasonably expect the holder to engage in routine inspection against trespass; in which there will be no higher and better use over the course of time; and in which the psychological and emotional attachments of an interloper are less, or no greater, than those of the original owner. In these instances, the trespasser who knowingly claims title through adverse possession indeed seems much like a thief. In such instances, should traditional property rules apply? What role do equitable considerations have to play? This Article examines these questions in a specific but illuminating instance: disputes among competing claimants to gravesites. Examining the unique attributes of burial lots in American property law, the Article demonstrates why traditional property rules are often an inappropriate mechanism for settling such disputes. The Article does not suggest a complete abandonment of adverse possession and traditional remedies for resolving disputes over burial sites. Instead, the Article argues for a more nuanced application of legal and equitable principles and invites further discussion of traditional property rules as currently applied to other forms of property that are not just unusual, but instead truly unique. [ABSTRACT FROM AUTHOR]

Introduction: Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain. Methods: Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probability of opioid analgesic use 3, 7, 30, and 90 days after ED discharge. We used multiple imputation to account for missing data and weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. We used weighted multivariable regression to compare longitudinal opioid analgesic use for those prescribed vs not prescribed an opioid analgesic at discharge, stratified by reported pain at ED discharge. Results: Among 892 adult ED patients with urolithiasis, 79% were prescribed an opioid analgesic at ED discharge. Regardless of reporting pain at ED discharge, those who were prescribed an opioid analgesic were significantly more likely to report using it one, three, and seven days after the visit in weighted multivariable analysis. Among those who were not prescribed an opioid analgesic, an estimated 21% (not reporting pain at ED discharge) and 30% (reporting pain at discharge) reported opioid analgesic use at day three. Among those prescribed an opioid analgesic, 49% (no pain at discharge) and 52% (with pain at discharge) reported using an opioid analgesic at day three. Conclusion: Urolithiasis patients who received an opioid analgesic at ED discharge were more likely to continue using an opioid analgesic than those who did not receive a prescription at the initial visit, despite the time-limited nature of urolithiasis. [ABSTRACT FROM AUTHOR]

Background: Transplant surgery fellowship has evolved over the years and today there are 66 accredited training programs in the US and Canada. There is growing concern, however, about the number of US-trained general surgery residents pursuing transplant surgery. In this study, we examined the transplant surgery pipeline, comparing it with other surgical subspecialty fellowships, and characterized the resident transplantation experience.Methods: Datasets were compiled and analyzed from surgical fellowship match data obtained from the National Resident Matching Program and ACGME reports and relative fellowship competitiveness was assessed. The surgical resident training experience in transplantation was evaluated.Results: From 2006 to 2018, a total of 1,094 applicants have applied for 946 transplant surgery fellowship positions; 299 (27.3%) were US graduates. During this period, there was a 0.8% decrease per year in US-trained surgical residents matching into transplant surgery (p = 0.042). In addition, transplant surgery was one of the least competitive fellowships compared with other National Resident Matching Program surgical subspeciality fellowships, as measured by the number of US applicants per available fellowship position, average number of fellowship programs listed on each applicant's rank list, and proportion of unfilled fellowship positions (each, p < 0.05). Finally, from 2015 to 2017, there were 57 general surgery residency programs that produced 77 transplant surgery fellows, but nearly one-half of the fellows (n = 36 [46.8%]) came from 16 (28.1%) programs.Conclusions: Transplant surgery is one of the least competitive and sought after surgical fellowships for US-trained residents. These findings highlight the need for dedicated efforts to increase exposure, mentorship, and interest in transplantation to recruit strong US graduates. [ABSTRACT FROM AUTHOR]

Aim: To evaluate nursing leaders' perception of communication and relationship management competencies while using digital platforms during the COVID‐19 pandemic. Background: Nursing leaders can achieve effective leadership by mastering these competencies leading to an overall improvement in the quality of nursing care. The COVID‐19 pandemic has brought numerous challenges in communication, and digital platforms have been widely used in healthcare settings to mitigate contagion. Design: Cross‐sectional. Methods: The study was conducted between February and March 2021. A survey was adopted from the American Organization of Nurse Executives (AONE) and was sent to nursing leaders in Qatar through email. Results: A total of 250 nurse leaders were invited to participate, but only 116 responded (RR 46.4%). The male participants represented a more significant proportion of 64.10%. Influencing behaviour, relationship management and effective communication had the lowest scores, which indicates low competency. Conclusions: Despite obtaining satisfying scores, nursing leaders in Qatar should strive for professional development and knowledge acquisition to improve their communications and relationship management competencies. Implications for Nursing Management: Healthcare organizations must understand that nursing leaders should strive for professional development and knowledge acquisition to improve their communication and management. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic performance of AI software in diagnosing intracranial arterial occlusions in the proximal anterior circulation at CT angiography (CTA) and to compare it to manual reading performed in clinical practice. Methods: Patients with acute ischemic stroke underwent CTA to detect arterial occlusion in the proximal anterior circulation. Retrospective review of CTA scans by two neuroradiologists served as reference standard. Sensitivity and specificity of AI software (StrokeViewer) were compared to those of manual reading using the McNemar test. The proportions of correctly detected occlusions in the distal internal carotid artery and/or M1 segment of the middle cerebral artery (large vessel occlusion [LVO]) and in the M2 segment of the middle cerebral artery (medium vessel occlusion [MeVO]) were calculated. Results: Of the 474 patients, 75 (15.8%) had an arterial occlusion in the proximal anterior circulation according to the reference standard. Sensitivity of StrokeViewer software was not significantly different compared to that of manual reading (77.3% vs. 78.7%, P = 1.000). Specificity of StrokeViewer software was significantly lower than that of manual reading (88.5% vs. 100%, P < 0.001). StrokeViewer software correctly identified 40 of 42 LVOs (95.2%) and 18 of 33 MeVOs (54.5%). StrokeViewer software detected 8 of 16 (50%) intracranial arterial occlusions which were missed by manual reading. Conclusion: The current AI software detected intracranial arterial occlusion with moderate sensitivity and fairly high specificity. The AI software may detect additional occlusions which are missed by manual reading. As such, the use of AI software may be of value in clinical stroke care. [ABSTRACT FROM AUTHOR]

A central theme of Peter Lawler's thought, and of his interpretation of Tocqueville in particular, is the tension between the classical, aristocratic idea of excellence and that of greatness understood as a kind of sublime anxiety, a restlessness that may characterize the democratic masses. His eloquent illustration of this connection is a permanent contribution, not only to Tocqueville studies, but to the task of political philosophy in the late modern world. To be sure, Lawler also brings to light the aristocratic, Aristotelian dimension of greatness in Tocqueville. Moreover, what I call Pascal's residual Platonism qualifies the notion of restlessness as the privileged expression of greatness. Still, I will here ask, employing a comparison between Pascal and Leo Strauss on the problem of parts and the whole, whether Lawler's emphasis on the Pascalian Christian dimension of modern democratic existence must not be balanced with an understanding of the dependence of liberal democracies on a more traditional and aristocratic conception of greatness and virtue. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is among the most common acts of violence against women worldwide, making it a major global threat to women's health and safety. The assessment and management of IPV offenders are therefore vital tasks in criminal justice systems. The current study examined whether the DRAOR, a general case management tool, was useful for supervising 112 male IPV offenders in Iowa, United States. Several risk factors emerged as potentially important treatment targets for partner-violent men, including poor attachment with others, substance abuse, anger/hostility, opportunity/access to victims, and problematic interpersonal relationships. While further research is needed to improve the utility of the DRAOR for predicting IPV recidivism, it assesses several factors that are relevant for supervising IPV cases (e.g., substance abuse, anger/hostility, victim access). This suggests the DRAOR could potentially be used to guide case management in the presence of a validated IPV tool that focuses on static risk factors, such as the ODARA. The use of the DRAOR with IPV offenders may also be warranted if they are found to be generally violent/antisocial rather than as family only offenders. [ABSTRACT FROM AUTHOR]

Estimates of the prevalence of drug-related out of hospital cardiac arrest (OHCA) vary, ranging from 1.8% to 10.0% of medical OHCA. However, studies conducted prior to the recent wave of fentanyl deaths likely underestimate the current prevalence of drug-related OHCA. We evaluated recent trends in drug-related OHCA, hypothesizing that the proportion of presumed drug-related OHCA treated by emergency medical services (EMS) has increased since 2015. We conducted a retrospective analysis of OHCA patients treated by EMS providers in San Francisco, California between 2015 and 2023. Participants included OHCA cases in which resuscitation was attempted by EMS. The study exposure was the year of arrest. Our primary outcome was the occurrence of drug-related OHCA, defined as the EMS impression of OHCA caused by a presumed or known overdose of medication(s) or drug(s). From 2015 to 2023, 5044 OHCA resuscitations attended by EMS (average 561 per year) met inclusion criteria. The median age was 65 (IQR 50–79); 3508 (69.6%) were male. The EMS impression of arrest etiology was drug-related in 446/5044 (8.8%) of OHCA. The prevalence of presumed drug-related OHCA increased significantly each year from 1% in 2015 to 17.6% in 2023 (p-value for trend = 0.0001). After adjustment, presumed drug-related OHCA increased by 30% each year from 2015-2023. Drug-related OHCA is an increasingly common etiology of OHCA. In 2023, one in six OHCA was presumed to be drug related. Among participants less than 60 years old, one in three OHCA was presumed to be drug related. [ABSTRACT FROM AUTHOR]

Significance: Numerous abnormalities in T cells have been described in patients with systemic lupus erythematosus (SLE), including lymphopenia, DNA demethylation, expression of endogenous retroviruses (ERVs), increased cell death, enlarged mitochondria, production of reactive oxygen species (ROS), and the appearance of unusual CD4−CD8− T cells. Our studies propose a model in which accelerated homeostatic proliferation of T cells promotes an epigenetic and metabolic program, leading to this cluster of abnormalities. Recent Advances: Growing knowledge of the innate immune disorders in SLE has included increased mitochondrial size and ROS production that induces oligomerization of the mitochondrial antiviral signaling (MAVS) protein and type I interferon production, as well as DNA demethylation, upregulation of inflammatory genes, and expression of certain ERVs in SLE peripheral blood mononuclear cells. All these events are part of the cellular program that occurs during homeostatic proliferation of T cells. Evidence from a murine model of SLE as well as in human SLE reveals that increased T cell homeostatic proliferation may be a driving factor in these processes. Critical Issues: Despite extensive knowledge of the myriad autoantibodies in SLE and other immune abnormalities, a cogent model has been lacking to link the numerous and seemingly disparate immune aberrations. This may partly explain the general lack of new drugs specifically for SLE in over 50 years. A more coherent model of SLE would not only unify the variety of immune abnormalities is SLE but would also suggest new therapies. Future Directions: The model of augmented homeostatic proliferation leading to increased mitochondrial mass, ROS, DNA demethylation, and upregulation of inflammatory genes suggests strategic new targets for SLE, including antioxidants and certain inhibitors of metabolism. Antioxid. Redox Signal. 36, 410–422. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to (1) estimate the effect of extended‐release naltrexone compared with placebo on alcohol consumption in patients with alcohol use disorder (AUD) and (2) conduct pre‐planned subgroup analyses to test whether being abstinent when initiating treatment (lead‐in abstinence) or the duration of treatment improves treatment efficacy. Design Systematic review and random‐effects meta‐analysis of blinded randomized placebo‐controlled trials reporting the effect extended‐release naltrexone on alcohol consumption. Setting: Outpatient clinics. Participants: Seven trials evaluating a total of 1500 adults with AUD receiving monthly injections of either placebo or extended‐release naltrexone at doses of 150–400 mg for 2–6 months and some form of behavioral therapy. Measurements Pooled weighted mean difference (WMD) in drinking days per month and heavy drinking days per month. Findings The WMD was −2.0 [95% confidence interval (CI) = −3.4, −0.6; P = 0.03] in favor of extended‐release naltrexone for drinking days per month and −1.2 (95% CI = −0.2, −2.1; P = 0.02) for heavy drinking days per month, indicating that treatment resulted in two fewer drinking days per month and 1.2 fewer heavy drinking days per month compared with placebo. Trials not requiring lead‐in abstinence and those lasting longer than 3 months reported larger reductions in heavy drinking days per month; WMD –2.0 (95% CI = −3.52, −0.48; P = 0.01) and −1.9 (95% CI = −3.2, −0.5; P = 0.01), respectively. In all cases, the I2 statistics (0–7.2%) did not suggest substantial heterogeneity. Conclusions: Extended‐release naltrexone reduces drinking days and heavy drinking days per month compared with placebo. Reductions are larger with a longer duration of treatment. [ABSTRACT FROM AUTHOR]

Background: Severe acute pain is still commonly treated with opioid analgesics in the United States, but this practice could prolong the duration of pain.Objectives: Estimate the risk of experiencing persistent pain after opioid analgesic use after emergency department (ED) discharge among patients with suspected urolithiasis.Methods: We analyzed data collected for a longitudinal, multicenter clinical trial of ED patients with suspected urolithiasis. We constructed multilevel models to estimate the odds ratios (ORs) of reporting pain at 3, 7, 30, or 90 days after ED discharge, using multiple imputation to account for missing outcome data. We controlled for clinical, demographic, and institutional factors and used weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge.Results: Among 2413 adult ED patients with suspected urolithiasis, 62% reported persistent pain 3 days after discharge. Participants prescribed an opioid analgesic at discharge were OR 2.51 (95% confidence interval [CI] 1.82-3.46) more likely to report persistent pain than those without a prescription. Those who reported using opioid analgesics 3 days after discharge were OR 2.24 (95% CI 1.77-2.84) more likely to report pain at day 7 than those not using opioid analgesics at day 3, and those using opioid analgesics at day 30 had OR 3.25 (95% CI 1.96-5.40) greater odds of pain at day 90.Conclusions: Opioid analgesic prescription doubled the odds of persistent pain among ED patients with suspected urolithiasis. Limiting opioid analgesic prescribing at ED discharge for these patients might prevent persistent pain in addition to limiting access to these medications. [ABSTRACT FROM AUTHOR]

The calamities of our dystopian time tempt teachers of literature either to a stiff defense of traditional Western civilization or else to a flaccid acceptance of post-modernist relativism. This essay argues that both strategies are mistaken. Since for post-modernists no tradition can be definitive, they are obliged to welcome Christians to voice our own history-laden tradition in a tournament of narratives. I buttress this claim by reference to the lessons that Flannery O'Connor learned, albeit imperfectly, about the intrinsic claims of art that must not be suborned to anything extrinsic, not even to unprecedented evils. [ABSTRACT FROM AUTHOR]

Introduction: In a digital early literacy intervention RCT, children born late preterm fell behind peers when in a control condition, but outperformed them when assigned to the intervention. Results did however not replicate previous findings. Replication is often complicated by resource quality. Gold Standard measures are generally time-intensive and costly, while they closely align with, and are more sensitive to changes in, early literacy and language performance. A planned missing data approach, leaving these gold standard measures incomplete, might aid in addressing the origin(s) of non-replication. Methods: Participants after consent were 695 p Dutch primary school pupils of normal and late preterm birth. The high-quality measures, in additional to simpler but complete measures, were intentionally administered to a random subsample of children. Five definitions of gold standard alignment were evaluated. Results: Two out of five gold standard levels improved precision compared to the original results. The lowest gold standard level did not lead to improvement: precision was actually diminished. In two gold standard definitions, an alphabetical factor and a writing-only factor the model estimates were comparable to the original results. Only the most precise definition of the gold standard level replicated the original results. Conclusion: Gold standard measures could only be used to improve model efficiency in RCT-designs under sufficiently high convergent validity. [ABSTRACT FROM AUTHOR]

Pierre Manent's Natural Law and Human Rights is a brilliant contribution to the critique of the contemporary ideology of universal and ever-expanding "human rights" and of its foundations in the modern natural rights doctrine authored by Hobbes and prepared by Machiavelli. But Manent does not answer modern rationalism in the way we tend to expect. To open up the possibility of substantive goodness, he does not propose a new or restored theory or theology of the good, or some unified, authoritative vision of the whole that might serve as an antidote to the acids of modernity. Instead, he directs our attention again and again to the inherent character of human action itself, to the very "grammar of action." This is the audacious modesty of Pierre Manent's practical natural law: his critique of the "hypertrophy of theory" invites us to recover our practical bearings by finding our starting point not in theory, but in a kind of phenomenology — a phenomenology of practice that must also be a practical phenomenology. Thus Pierre Manent judges it wise not to try to capture the élan of the noble in any determinate idea, but rather to keep it both tethered to the common goods of practice and open to a hope as much beyond human conception as it is beyond human power. [ABSTRACT FROM AUTHOR]

Context.--Granular cell change in melanocytic nevus is underrepresented in the literature with only 4 welldocumented cases, 1 described in the conjunctiva. Unfamiliarity with the clinical and pathologic features of these lesions contributes to the diagnostic difficulty. Objective.--To delineate the clinical and histopathologic features of conjunctival nevi with granular cell change. Design.--In a retrospective observational case series, the medical records of all patients with conjunctival nevi and granular cell change diagnosed between December 2016 and October 2018 were reviewed. Data collected included age, sex, clinical presentation, pathologic findings, and follow-up. Results.--Twelve patients, 6 males and 6 females, with a median age of 14 years (range, 8-82 years) were identified. The nevus manifested as a pigmented, well-circumscribed nodule (7 of 9; 78%) or patch (2 of 9; 22%) in the bulbar and limbal conjunctiva (7 of 9; 78%) or in the plica semilunaris/caruncle (2 of 9; 22%). Cysts were noted in 7 of 9 lesions (78%). Features prompting surgical excision included atypical pigmentation (8 of 9; 89%), growth (7 of 9; 78%), and atypical vascularity (4 of 9; 44%). Microscopically, all lesions comprised a conventional melanocytic nevus with focal granular cell change and immunoreactivity for Melan-A, SOX10, and HMB-45, with Ki-67 proliferative index of less than 2%. Of the 9 lesions with follow-up information, there were no recurrences over mean follow-up of 11.2 months (range, 1-23 months). Conclusions.--Granular cell change in melanocytic nevi is an underrecognized finding that can simulate melanoma clinically and histopathologically. Young age at diagnosis, lack of associated conjunctival melanosis, bulbar location, cysts, and the absence of mitotic figures with a low Ki-67 proliferative index are helpful clinical and pathologic diagnostic clues. [ABSTRACT FROM AUTHOR]

We study a motive for why individuals may hide wealth in offshore entities that has received scant attention in the academic literature and the public debate: the fear of expropriation. We use the Panama Papers and data on media reporting on expropriations and property confiscations. We document that such news reports increase the probability that offshore entities are incorporated by agents from the same country in the same month. This result is robust to the use of country-year- and month-fixed effects and the exclusion of tax havens. The effect is stronger in countries with well-functioning governments. We argue that individuals start hiding their proceeds from illegal activities in offshore entities when reasonably well-intended and well-functioning governments become more serious about law enforcement. [ABSTRACT FROM AUTHOR]

Source localization, such as detecting a nuclear source in an urban area or ascertaining the origin of a chemical plume, is generally regarded as a well‐documented inverse problem; however, optimally placing sensors to collect data for such problems is a more challenging task. In particular, optimal sensor placement—that is, measurement locations resulting in the least uncertainty in the estimated source parameters—depends on the location of the source, which is typically unknown a priori. Mobile sensors are advantageous because they have the flexibility to adapt to any given source position. While most mobile sensor strategies designate a trajectory for sensor movement, we instead employ mutual information, based on Shannon entropy, to choose the next measurement location from a discrete set of design conditions. [ABSTRACT FROM AUTHOR]

Purpose: The BRCA-associated protein1 (BAP1) immunohistochemical (IHC) stain has emerged as a powerful and inexpensive prognostic tool in uveal melanoma (UM), correlating with UM genetics and outcome. The data on the reliability of BAP1 immunohistochemistry in previously irradiated UM is scant. We aim to assess BAP1 IHC in post-Iodine-125 plaque brachytherapy-treated UM-enucleated eyes. Methods: In a case-control study, the medical records of all patients who underwent enucleation for UM at a major Ocular Oncology Service from December 1st, 2007 to December 31st, 2014 were reviewed. All cases with either chromosome 3 (ch3) status or sufficient follow-up (>5 years or metastasis) were selected. Nuclear BAP1 (nBAP1) immunoreactivity was interpreted as intact (positive in >90% of nuclei), lost (positive in <5% of nuclei), or heterogeneous (positive in 5-90% of nuclei). Retina and intratumoral blood vessels served as internal positive controls. Results: A comparison of 34 postbrachytherapy UM secondary-enucleated eyes with 47 nonbrachytherapy primary enucleated controls revealed no significant difference with respect to nBAP1 IHC (lost in 41% vs 51%, P = 0.19), ch3 status (ch3 monosomy in 59% vs 60%, P = 0.48), and outcome (metastatic disease in 44% vs 47%, P = 0.8). Association of nBAP1 IHC with ch3 status and outcome [intact nBAP1/(ch3 disomy and/or no metastasis) and lost nBAP1 (ch3 monosomy and/or metastasis)] in post-brachytherapy UM was significantly lower when compared with non-brachytherapy tumors [21/30 (70%) vs 41/44 (93%), P = 0.004*]. Conclusion: Although nBAP1 IHC stain is a strong prognostic tool in UM, its association with ch3 status, and outcome in postbrachytherapy UM was significantly lower compared with nonbrachytherapy tumors due to pitfalls in the interpretation of nBAP1 immunoreactivity in irradiated UM. This test should be used judiciously in the prognostication of postbrachytherapy-enucleated UM. [ABSTRACT FROM AUTHOR]

Clearly resolved hyperfine structure has been observed in the extreme ultraviolet (XUV) spectra of the C 1Π, v=0-X 1Σ+, v=0 transition of H19F obtained through 1 XUV+1 UV resonance enhanced multiphoton ionization spectroscopy. The hyperfine splitting within the R-branch lines shows significant perturbations, which we attribute to mixing with the rotational levels of the nearby v=29 level of the B 1Σ+ ion-pair state. A deperturbation analysis quantitatively explains the apparent variation of the fluorine magnetic hyperfine parameter aF, for which a value of 4034(83) MHz was obtained by averaging over the values derived from the R(0)–R(4) lines, after correcting for the effects of the perturbations. [ABSTRACT FROM AUTHOR]

This article addresses the development of a free energy model for magnetostrictive transducers operating in hysteretic and nonlinear regimes. Such models are required both for material and system characterization and for model-based control design. The model is constructed in two steps. In the first, Helmholtz and Gibbs free energy relations are constructed for homogeneous materials with constant internal fields. In the second step, the effects of material nonhomogeneities and nonconstant effective fields are incorporated through the construction of appropriate stochastic distributions. Properties of the model are illustrated through comparison and prediction of data collected from a typical Terfenol-D transducer. [ABSTRACT FROM AUTHOR]

Presents evidence from heat capacity, spectra, density and other properties for an equilibrium structural model of liquid water. Connection between quantum mechanics and thermodynamics; Relationship between pressure, temperature and density; Consideration of water properties for strong hydrogen bonds interaction.

Examines a perturbation molecular orbital approach in measuring the temperature and pressure dependence of hydrogen bond strength. Relevance of thermodynamics in the bond length and strength of hydrogen bonds; Variation of hydrogen bond length with temperature; Account on the perturbation molecular orbital treatment for bond formation.

Research involving administrative healthcare data to study patient outcomes requires the investigator to account for the patient's disease burden in order to reduce the potential for biased results. Here we develop a comorbidity summary score based on variable importance measures derived from several statistical and machine learning methods and show it has superior predictive performance to the Elixhauser and Charlson indices when used to predict 1-year, 5-year, and 10-year mortality. We used two large Veterans Administration cohorts to develop and validate the summary score and compared predictive performance using the area under ROC curve (AUC) and the Brier score. [ABSTRACT FROM AUTHOR]

The use of cell salvage during caesarean section has been increasing steadily, although there are concerns relating to cost, a perceived risk of amniotic fluid embolism, and fetal red cell sensitisation. We present observational data from almost a decade of use of intra-operative cell salvage in obstetrics. By the end of this period, we set up cell salvage collection for > 98% of all caesarean sections. From 2008 to 2017, 1170 women have had a re-infusion of cell salvaged blood with no clinical safety concerns; the median (IQR [range]) volume was 231 (154-306 [80-1690]) ml. During this time there has been a marked reduction in the number of women who were transfused allogeneic blood, as well as the amount of blood transfused. In total, 647 (55%) women have had alloimmunisation testing, with two positive cases. Quality control data indicate that the quality of blood processed from partial first bowls is no worse than that from full bowls. We discuss the costs of providing this service with regard to: staffing costs; single suction; leucodepletion filters; selectivity in the processing of collected blood; and the use of partial first bowls. [ABSTRACT FROM AUTHOR]

The article focuses on challanges surrounding exculpatory contracts in the U.S. It provides an analysis of the legislature's pronouncements on public policy and immunity from civil liability. It also informs on challanges faced by lawyers for fighting against recreational activities such as horseback riding, white-water rafting, and camping.

Spent fuel monitoring and characterization has been central to safeguards and nuclear facility monitoring for many years. The Digital Cerenkov Viewing Device (DCVD) has been used since the 1980s as a method of defect detection in spent fuel. In recent years, the accounting for large quantities of spent fuel before storage has renewed interest in this relatively quick and inexpensive method. This has an impact not only in safeguards, but also for nuclear power facilities, as accounting can be a long, arduous, and costly process. Additionally, the DCVD demonstrates limited accuracy in more complex cases such as substitution of a fuel rod with steel or a partial defect detection. A second method, gamma emission tomography (GET) has been explored as an improved defect detection method, but is much more expensive and invasive than DCVD. The present investigation identifies deficiencies in both methods and proposes a combination of data gathered from each method to address these deficiencies for improved spent fuel characterization. Initial results are promising, showing 97% detection of a single missing fuel rod when the data types are combined, versus approximately 50% and 70%, respectively, for DCVD and GET data on their own. These classification results are obtained with algorithms derived from facial recognition and applied to this problem, yielding unique accuracy in near real time while also maintaining the information barrier between output and measurement desired in safeguards. [ABSTRACT FROM AUTHOR]

Study Objective: Summary measures of medication adherence, such as the proportion of days covered (PDC), are often used to analyze the association between medication adherence and various health outcomes. We hypothesized that PDC and similar measures may lead to biased results in some situations when used to estimate the association between adherence and the outcome event (e.g., mortality). Thus, the objective was to determine the conditions under which PDC and similar measures might produce biased estimates of the association between adherence and mortality and to review methods to avoid such bias. Design: Simulation study and analysis of data from a large retrospective cohort study. Measurements and Main Results: We conducted a comprehensive simulation to compare how adherence estimates varied—using prescription‐based (end point was final date that medications were on hand or date of death) and interval‐based (end point based on fixed calendar interval or date of death) PDC denominators—when deaths occurred either during or after the adherence exposure period. We then made similar comparisons using data from a retrospective study that included comprehensive measures of medication refill activity and clinical outcomes of 207,841 patients with diabetes mellitus who were prescribed one or more oral antidiabetic medications. When deaths occurred within the adherence exposure period, substantial bias in adherence estimates was possible regardless of the PDC denominator type. Conclusion: Investigators using PDC or similar proxy measures should carefully consider the temporal relationship between adherence exposure and clinical outcomes when the outcome event affects the adherence measurement. [ABSTRACT FROM AUTHOR]

Discusses the approximation of the electronic matrix element in the semiclassical expression for the rate of nonadiabatic electron transfer using perturbation molecular orbital theory. Electron-transfer efficiency for the contribution of electron transfer to the observed kinetics of ion-molecule collisions followed by electron transfer.

The efficacy of empiric calcium for patients with undifferentiated cardiac arrest has come under increased scrutiny, including a randomized controlled trial that was stopped early due to a trend towards harm with calcium administration. However, small sample sizes and non-significant findings have hindered precise effect estimates. In this analysis we evaluate the association of calcium administration with survival in a large retrospective cohort of patients with cardiac arrest treated in the emergency department (ED). We conducted a retrospective review of medical records from two academic hospitals (one quaternary care center, one county trauma center) in San Francisco between 2011 and 2019. Inclusion criteria were patients aged greater than or equal to 18 years old who received treatment for cardiac arrest during their ED course. Our primary exposure was the administration of calcium while in the ED and the main outcome was survival to hospital admission. The association between calcium and survival to admission was estimated using a multivariable log-binomial regression, and also with two propensity score models. We examined 781 patients with cardiac arrest treated in San Francisco EDs between 2011 and 2019 and found that calcium administration was associated with decreased survival to hospital admission (RR 0.74; 95% CI 0.66–0.82). These findings remained significant after adjustment for patient age, sex, whether the cardiac arrest was witnessed, and including an interaction term for shockable cardiac rhythms (RR 0.60; 95% CI 0.50–0.72) and non-shockable cardiac rhythms (RR 0.87; 95% CI 0.76–0.99). Risk ratios for the association between calcium and survival to hospital admission were also similar between two propensity score-based models: nearest neighbor propensity matching model (RR 0.79; 95% CI 0.68–0.89) and inverse propensity weighted regression adjustment model (RR 0.75; 95% CI 0.67–0.84). Calcium administration as part of ED-directed treatment for cardiac arrest was associated with lower survival to hospital admission. Given the lack of statistically significant outcomes from smaller, more methodologically robust evaluations on this topic, we believe these findings have an important role to serve in confirming previous results and allowing for more precise effect estimates. Our data adds to the growing body evidence against the empiric use of calcium in cardiac arrest. [ABSTRACT FROM AUTHOR]

Background: The ACGME instituted duty hour restrictions in 2003. This presents a challenge for surgical residents who must acquire a medical and technical knowledge base during their training. Although the effect of work hour limitations on operative volume has been examined, no study has examined whether duty hour reform has had an effect on operative volume variability.Study Design: The ACGME operative log data of graduating general surgery residents from 1992 to 2015 were examined. Residents with the most and fewest total major cases were identified and case logs, learning styles, and evaluations were analyzed. Statistical analysis was performed using linear regression analysis, chi-square test, Student's t-test, and Wilcoxon rank sum test. Significance was defined as p < 0.05.Results: One hundred and thirty-five residents graduated from 1992 to 2015. No change in overall operative volume was seen after the 2003 duty hour reform, however, there was an increase in operative variability. In addition, there was an increase in the variability of total major cases between the resident completing the most and fewest cases per class (183.3; p = 0.02) after the start of work hour restrictions. The residents who graduated with the highest operative volume were more likely to be action-based learners (odds ratio = 6.81; 95% CI, 2.84-16.34; p < 0.001) and received superior evaluation scores.Conclusions: After the implementation of the 80-hour workweek, we found a significant increase in operative variability. This might suggest a growing disparity in the operative experience among surgical residents and, consequently, a varying quality of graduating residents. Programs should therefore consider using learning styles and developing competency-based training curricula to ensure equitable training among all trainees. [ABSTRACT FROM AUTHOR]

This cross-sectional study examines prevalence of fit test failure of 2 types of N95 mask (dome-shaped and duckbill) during extended use or reuse among health care workers over 2 days in April 2020 in the UCSF emergency department. [ABSTRACT FROM AUTHOR]

Highlights • We study the mechanism that drives the "rockets-and-feathers" phenomenon. • We use simple experimental markets with and without consumer search cost and either privately or publicly observed cost shocks. • We observe price dispersion and spontaneous asymmetric price adjustments to cost shocks in all treatments. • Neither search costs nor private information on cost shocks are indispensable for prices to adjust asymmetrically in the short term. • The initial asymmetry quickly disappears if the direction of the cost shocks is publicly known, while it persists in both treatments with private information. Abstract Prices usually adjust much faster when costs increase than when costs decrease. In spite of the many empirical studies confirming this "Rockets-and-Feathers" phenomenon for different industries, the mechanism driving it is not well understood. We use simple experimental markets with and without search frictions and either privately or publicly observed cost shocks to study how sensitive the "Rockets-and-Feathers" phenomenon is to changes in search costs and information conditions. In contrast to standard theoretical predictions we observe price dispersion and spontaneous asymmetric price adjustments in all treatments. Neither search costs nor private information on cost shocks are indispensable for prices to adjust asymmetrically in the short term. The initial asymmetry quickly disappears if the direction of the cost shocks are publicly known, while it persists in both treatments with private information. [ABSTRACT FROM AUTHOR]

A common characteristic of patients seen at the Veterans Health Administration (VHA) is a high number of concurrent comorbidities (i.e. multimorbidity). This study (i) examines the magnitude and patterns of multimorbidity by race/ethnicity and geography; (ii) compares the level of variation explained by these factors in three multimorbidity measures across three large cohorts. We created three national cohorts for Veterans with chronic kidney disease (CKD:n = 2,190,564), traumatic brain injury (TBI:n = 167,954) and diabetes-mellitus (DM:n = 1,263,906). Multimorbidity was measured by Charlson-Deyo, Elixhauser and Walraven-Elixhauser scores. Multimorbidity differences by race/ethnicity and geography were compared using generalized linear models (GLM). Latent class analysis (LCA) was used to identify groups of conditions that are highly associated with race/ethnic groups. Differences in age (CKD,74.5, TBI,49.7, DM, 66.9 years), race (CKD,80.9%, TBI,76.4%, DM, 63.8% NHW) and geography (CKD,64.4%, TBI,70%, DM, 70.9% urban) were observed among the three cohorts. Accounting for these differences, GLM results showed that risk of multimorbidity in non-Hispanic blacks (NHB) with CKD were 1.16 times higher in urban areas and 1.10 times higher in rural areas compared to non-Hispanic whites (NHW) with CKD. DM and TBI showed similar results with risk for NHB, 1.05 higher in urban areas and 0.97 lower in rural areas for both diseases. Overall, our results show that (i) multimorbidity risk was higher for NHB in urban areas compared to rural areas in all three cohorts; (ii) multimorbidity risk was higher for Hispanics in urban areas compared to rural areas in the DM and CKD cohorts; and (iii) the highest overall multimorbidity risk of any race group or location exists for Hispanics in insular islands for all three disease cohorts. These findings are consistent among the three multimorbidity measures. In fact, our LCA also showed that a three class LC model based on Elixhauser or Charlson provides good discrimination by type and extent of multimorbidity. [ABSTRACT FROM AUTHOR]

Decreasing soil productivity, despite improved crop genetics and soil technologies, signals a need for refined understanding of the interaction between soils and plants. For example, to what degree do improvements in soil structural stability and the number and type of plant species contribute to yield variability with extremes of weather? The role that soil aggregation and carbon play in the resilience of soil, and thus plant growth in extremes of moisture availability, is not well interpreted. Ultimately, improving soil organic carbon (SOC) also improves soil water retention and availability, which extends the limits of environmental variation for optimum plant growth. Not only is a significant amount of organic carbon a major element in soil resilience, but there may be interaction with the diversity of plants, which becomes evident with cover crop and crop rotation systems in agriculture. More diverse rotations including cover crops are being tested to explore the mechanisms and benefits of multispecies crop mixes. This review will explore the role of SOC and plant diversity for cropping system resilience with lessons from the temperate North American climate. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: The significance of fetal red blood cell (RBC) contamination in obstetric intra‐operative cell salvage is not fully known. It is unclear if we re‐infuse a larger volume of fetal RBCs into the maternal circulation than the amount that occurs secondary to transplacental haemorrhages is unclear. We also do not know if there is a critical volume required to cause alloimmunisation or if larger volumes increase the risk. Objectives: The aim of this study is to provide data on the level of fetal RBC contamination in the maternal circulation prior to delivery and immediately post‐partum and to compare these levels to those found in processed cell‐salvaged blood. Methods: In the first part of this study, we quantified the levels of fetal RBCs circulating in women immediately prior to delivery. This was then repeated with a separate group measuring the levels of fetal RBCs pre‐ and post‐delivery. Results: We found that 37% of women had fetal cells detected in their circulation, median 0·00 mL (IQR 0–0·24; average 0·3 mL, maximum 4·56 mL). Fetal RBCs were present pre‐delivery (maximum 0·66 mL) in 16% of women, increasing to 53% post‐delivery (median 0·66 mL; IQR 0·22–2·20, maximum 21·20 mL). Conclusions: We have shown that fetal RBCs are present in the maternal circulation throughout pregnancy and that the volumes are comparable to that obtained from intra‐operative salvage, with contamination amounts of up to 19 mL. At the Royal Cornwall Hospital, our experience and evidence supports offering intra‐operative salvage to all women, and we have not noted an increase in antibody formation, compared to allogeneic transfusion. [ABSTRACT FROM AUTHOR]

Abstract: Biliary complications are a common cause of morbidity after liver transplantation, with biliary stone formation being a known occurrence generally upstream of a stricture. A 12‐year‐old boy, who underwent an orthotopic liver transplantation at 11 months of age for biliary atresia, presented acutely with fever and abdominal pain. Cross‐sectional imaging revealed Roux‐en‐Y limb dilatation and thickening. He was explored and was found to have an ischemic Roux limb secondary to an obstructing enterolith. A segmental bowel resection and revision of his hepaticojejunostomy was performed. While rare, biliary enteroliths may present as either a bowel obstruction or cholangitis and should be considered in the differential diagnosis of a patient following biliary reconstruction. Additionally, anatomic etiologies should be considered and potentially surgically corrected. [ABSTRACT FROM AUTHOR]

As the population of elderly Americans swells in coming decades, growing numbers of citizens will experience some degree of cognitive incapacity and require the assistance of surrogate decision-makers. Consequently, the decisions of guardians, conservators, and agents will become increasingly important. Experts have frequently noted that, despite modern reforms, doctrines concerning surrogate decision-making are problematic and often do not result in outcomes that maximize autonomy and promote respect for the unique personhood of the adult with diminished capacity. Unlike other writings that seek to refashion or clarify surrogate decision-making statutes and standards, this Article suggests that a more fundamental problem lies in our inherent, if unwitting, tendency to infantilize the elderly and other adults with diminished capacity. Until we acknowledge and examine our biases and prejudices about age and incapacity, we as surrogate decision-makers will continue to make unfortunate choices for those whom we seek to assist, regardless of definitional changes in decision-making statutes and standards. [ABSTRACT FROM AUTHOR]

There are numerous endocrine (hormonal) responses during stress and these are often complex. This complexity makes the study of endocrine stress responses challenging and the challenges are intensified when attempts are made to use measures of hormones to assess the welfare of animals because so many endocrine systems are activated during stress and because there are countless stimuli that trigger these systems. Most research has concentrated on only a small number of these endocrine systems, particularly the hypothalamo-pituitary adrenal axis and the sympathoadrenal system, and there is a need to broaden the scope of endocrine systems that are studied. Furthermore, systematic approaches are required to establish when the actions of hormones associated with stress responses result in physiological and/or behavioural consequences that will have negative or positive effects on the welfare of animals. [ABSTRACT FROM AUTHOR]