Search

We introduce a fairness criterion that we call Spanning. Spanning i) is implied by Calibration, ii) retains interesting properties of Calibration that some other ways of relaxing that criterion do not, and iii) unlike Calibration and other prominent ways of weakening it, is consistent with Equalized Odds outside of trivial cases. [ABSTRACT FROM AUTHOR]

Although the landing phases of the single-leg hop for distance (SLHD) are commonly assessed, limited work reflects how the take-off phase influences hop performance in patients with anterior cruciate ligament reconstruction (ACLR). To compare trunk and lower extremity biomechanics between individuals with ACLR and matched uninjured controls during take-off of the SLHD. Cross-sectional study design. Laboratory setting. Sixteen individuals with ACLR and 18 uninjured controls. Normalized quadriceps isokinetic torque, hop distance, and respective limb symmetry indices were collected for each participant. Sagittal and frontal kinematics and kinetics of the trunk, hip, knee, and ankle as well as vertical and horizontal ground reaction forces were recorded for loading and propulsion of the take-off phase of the SLHD. Those with ACLR had weaker quadriceps peak torque in the involved limb (P =.001) and greater strength asymmetry (P <.001) than control individuals. Normalized hop distance was not statistically different between limbs or between groups (P >.05), and hop distance symmetry was not different between groups (P >.05). During loading, the involved limb demonstrated lesser knee flexion angles (P =.030) and knee power (P =.007) than the uninvolved limb and lesser knee extension moments than the uninvolved limb (P =.001) and controls (P =.005). During propulsion, the involved limb demonstrated lesser knee extension moment (P =.027), knee power (P =.010), knee (P =.032) and ankle work (P =.032), and anterior-posterior ground reaction forces (P =.047) and greater knee (P =.016) abduction excursions than the uninvolved limb. Between-limb differences in SLHD take-off suggest a knee underloading strategy in the involved limb. These results provide further evidence that distance covered during SLHD assessment can overestimate function and fail to identify compensatory biomechanical strategies. [ABSTRACT FROM AUTHOR]

Let (Σ T , σ) be a subshift of finite type with primitive adjacency matrix T , ψ : Σ T → R a Hölder continuous potential, and A : Σ T → GL d (R) a 1-typical, one-step cocycle. For t ∈ R consider the sequences of potentials Φ t = (φ t , n) n ∈ N defined by φ t , n (x) : = S n ψ (x) + t log ‖ A n (x) ‖ , ∀ n ∈ N. Using the family of transfer operators defined in this setting by Park and Piraino, for all t < 0 sufficiently close to 0 we prove the existence of Gibbs-type measures for the superadditive sequences of potentials Φ t . This extends the results of the well-understood subadditive case where t ≥ 0 . Prior to this, Gibbs-type measures were only known to exist for t < 0 in the conformal, the reducible, the positive, or the dominated, planar settings, in which case they are Gibbs measures in the classical sense. We further prove that the topological pressure function t ↦ P top (Φ t , σ) is analytic in an open neighbourhood of 0 and has derivative given by the Lyapunov exponents of these Gibbs-type measures. [ABSTRACT FROM AUTHOR]

Corporal punishment (e.g., spanking) remains a highly debated yet common form of discipline in the United States. A body of research exists investigating the prevalence and effects of corporal punishment; however, less attention has been devoted to factors influencing individual perceptions of corporal punishment. The current study explores college students' perceptions of corporal punishment with a specific focus on students' experiences with physical discipline and factors that may influence students' intentions to use physical discipline with their own children. Relying on a convenience sampling methodology, the current research is based on a sample of 318 students, who participated in a pen-and-paper survey. Findings reveal that most students experienced corporal punishment (86.8%) and roughly three-quarters intend to use physical discipline with their children. Moreover, positive attitudes towards physical forms of punishment were positively associated with intentions to use corporal punishment (OR = 1.494; ***p < 0.001). Despite most participants reporting experiences with corporal punishment and intending to use physical discipline with their children, many felt better disciplinary methods were available. Given that attitudes were correlated with intention to use, educational programs and curricular endeavors to inform individuals of the negative impact of corporal punishment, as well as alternative non-physical discipline strategies are recommended as ways to reduce reliance on physical forms of discipline. Highlights: Most college students sampled reported personal experience with physical discipline as children (86.8%). Most college students intend to use corporal punishment (75.2%) as a discipline strategy with their children. Most participants (71%) believed there were better ways to punish a child than using corporal punishment. Attitudes towards corporal punishment were the only variables associated with intention to use physical discipline in multivariate models. [ABSTRACT FROM AUTHOR]

Objective: This article focuses on the outcomes at 1 year post-treatment of a naturalistic evaluation of services provided through the Takiwasi Centre, an accredited Peruvian therapeutic community offering an ayahuasca-assisted, integrative treatment program for addiction rehabilitation. Method: Participants (n = 52) completed structured interviews and a battery of validated instruments. Outcome measures included the Addiction Severity Index (Version 5), the Beck Anxiety and Depression Inventories, the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), and the World Health Organization Quality of Life Spiritual Religious and Personal Belief (WHOQOL-SRPB) scale. Likert rating scales were used to assess perceived importance and significance of different aspects of the program and overall participant satisfaction. Results: The group change from baseline to the 1-year follow-up was significant and in the anticipated direction for alcohol and drug use severity, depression and anxiety, and some dimensions of quality of life. There was considerable individual variation in outcomes and treatment duration. The majority of participants rated all aspects of the program as important, including the spiritual and therapeutic significance of the ayahuasca experience, which was rated as very significant. Conclusions: Based on the positive 1-year outcomes, and within the limitations of an uncontrolled observational study design, the findings suggest promise for the effectiveness of the use of ayahuasca in a multifactorial treatment context for individuals with significant treatment histories, high levels of comorbidity, and treatment motivation. Results highlight considerable variation in individual experience that merit in-depth qualitative analysis. Implications for ayahuasca-assisted and other psychedelic-assisted treatment alternatives are discussed. [ABSTRACT FROM AUTHOR]

Youth purpose was investigated using a two-phase embedded design with youth participating in Scouts BSA (N = 3,943), ages 9–20 (M = 14.0, SD = 1.9). Participating Scouts were mostly White (91%) and male (98%). In Phase 1, we conducted a two-step cluster analysis on Scouts' survey responses to three purpose dimensions (personal meaning, goal-directedness, beyond-the-self orientation). Four clusters emerged: Purposeful, Explorers, Dreamers, Nonpurposeful. In Phase 2, we explored qualities of purpose within each cluster and programmatic features and relationships within the scouting context fostering youth purpose with a Scout subsample (N = 30) who completed semi-structured interviews. Results demonstrated that adults supporting scouting, inspiration from older peers, and opportunities to help others and explore new activities supported youth purpose. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors have transformed the treatment landscape of many cancers, including melanoma and renal cell carcinoma (RCC). Randomised trials are evaluating outcomes from reduced ICI treatment schedules with the aim of improving quality of life, tolerability, and cost-effectiveness. This study aims to provide insight into patient and carer's perspectives of these trials. Methods: Seven focus groups were conducted with 31 people with stage IV melanoma, RCC, or caregivers for people receiving ICI. Transcripts were analysed using reflexive thematic analysis. Results: Three themes were generated: 1) "Treatment and clinic visits provide reassurance": reducing hospital visits may not improve quality of life. 2) "Assessment of personal risk versus benefit": the decision to participate in an ICI optimisation trial is influenced by treatment response, experience of toxicity and perceived logistical benefits based on the individual's circumstances. 3) "Pre-existing experience and beliefs about how treatment and trials work", including the belief that more treatment is better, influence views around ICI optimisation trials. Conclusion: This study provides insight into recruitment challenges and recommends strategies to enhance recruitment for ongoing ICI optimisation trials. These findings will influence the design of future ICI optimisation trials ensuring they are acceptable to patients. [ABSTRACT FROM AUTHOR]

Background: Anthracycline-taxane is the standard chemotherapy strategy for treating high-risk early breast cancer despite the potentially life-threatening adverse events caused by anthracyclines. Commonly, the combination of docetaxel and cyclophosphamide (TC) is considered an alternative option. However, the efficacy of TC compared to anthracycline-taxane chemotherapy is unclear. This study compares disease-free survival (DFS), overall survival (OS) and cardiotoxicity between adjuvant TC and anthracycline-taxane for stages I–III, HER2-negative breast cancer. Methods: A systematic search on MEDLINE, Embase and Cochrane CENTRAL for randomized-controlled trials published until 11 March 2024, yielded 203 studies with 11,803 patients, and seven trials were included. Results: TC results in little to no difference in DFS (HR 1.09, 95% CI 0.98–1.20; moderate-certainty of evidence); OS (1.02, 95% CI 0.89–1.16; high-certainty of evidence); and cardiotoxicity (RR 0.54, 95% CI 0.16–1.76; high-certainty of evidence), compared to anthracycline-taxane. In the subgroup analysis, patients with ≥4 lymph nodes had improved DFS from anthracycline-taxane over TC. Conclusions: Overall, there was no difference between TC and anthracycline-taxane in DFS, OS and cardiotoxicity. In women with ≥4 nodes, anthracycline-taxane was associated with a substantial reduction in relapse events, compared to TC. Our study supports the current standard of practice, which is to use anthracycline-taxane and TC chemotherapy as a reasonable option in select cases. [ABSTRACT FROM AUTHOR]

An ablation crater depth estimation model, founded on the concept of an ionizing bleaching wave, has been developed for metal targets irradiated by an extreme ultraviolet (EUV) laser. Two EUV capillary discharge lasers operating at a wavelength of 46.9 nm were focused onto targets of gold, aluminum, and copper using two different experimental setups to maximize the laser fluence range. The experimental ablation craters were measured using an atomic force microscope, and the depths were compared to the ionizing wave model. The model depends on the dominant ion charge of the ablated plasma, which was measured experimentally using the low fluence setup with a time-of-flight mass spectrometer. The measured ablation depths and ion charges at low fluences are in agreement with the model. The ablation crater depths in the higher fluence range confirmed the trends predicted by the model, showing potential to expand its use to other materials and fluence ranges. [ABSTRACT FROM AUTHOR]

This Article places the impact of the Voting Rights Act (“VRA”) in historical and futuristic context. There is no gainsaying that the VRA has had a tremendously positive impact in reversing or, at least, buffering the impact of discrimination throughout United States history. This is particularly—and sadly—manifest in the actions taken by some states to restrict access to the polls and voter registration in the wake of the Supreme Court’s Shelby County decision. A healthy democracy requires free and fair elections. Therefore, it is necessary to roll back such discriminatory laws. Yet, the battle over voting rights now takes place in a political universe that is vastly larger than it was at the time of the VRA’s passage. Accordingly, while measures such as the VRA have—and will continue to have—clear, positive impacts on the functioning of elections, it is important to note that elections play less of a governing role in an era in which the successful democratization of political power has led to its privatization and, correspondingly, to its lack of accountability [ABSTRACT FROM AUTHOR]

Objective: Body dissatisfaction elevates the risk for disordered eating behaviors. Excessive exercise is prevalent among college women and associated with harm. Risk theory posits a bidirectional relationship between risk factors for disordered eating behaviors and the behaviors themselves. This study investigated the longitudinal, reciprocal relationship between body dissatisfaction and excessive exercise. Participants and methods: College women (n = 302) assessed in August (baseline) and November (follow-up). Results: Baseline body dissatisfaction significantly predicted increases in excessive exercise endorsement at follow-up, controlling for baseline excessive exercise endorsement and body mass index (BMI). Baseline excessive exercise endorsement predicted increases in body dissatisfaction at follow-up, controlling for baseline body dissatisfaction and BMI. Conclusions: Findings support the presence of a positive feedback loop between body dissatisfaction and excessive exercise; both predict increases in risk for the other, regardless of weight status. Future research should test whether this process is ongoing and predicts further distress. [ABSTRACT FROM AUTHOR]

The 7th National Audit Project of the Royal College of Anaesthetists (NAP7) recommended that an emergency call system be immediately accessible in all anaesthesia locations. It is essential that all theatre team members can rapidly call for help to reduce the risk of patient harm. However, the ability of staff to activate this system in a timely manner can be affected by cluttered or unfamiliar environments and cognitive overload. One proposed strategy to enable rapid identification and activation of emergency call systems is to install a red vertical painted stripe on the wall from the ceiling to the activation button. We investigated the effect of introducing this vertical red line on activation times in operating theatres in the UK and Australia. Operating theatre team members, including anaesthetists, surgeons, anaesthetic nurses, surgical and theatre nurses, operating theatre practitioners, and technicians, were approached without prior warning and asked to simulate activation of an emergency call. Vertical red lines were installed, and data collection repeated in the same operating theatres 4–12 months later. After installation of vertical red lines, the proportion of activations taking >10 s decreased from 31.9% (30/94) to 13.6% (17/125, P =0.001), and >20 s decreased from 19.1% (18/94) to 4.8% (6/125, P <0.001). The longest duration pre-installation was 120 s, and post-installation 35 s. This simple, safe, and inexpensive design intervention should be considered as a design standard in all operating theatres to minimise delays in calling for help. [ABSTRACT FROM AUTHOR]

Background: To discover pharmacotherapy prescription patterns and their statistical associations with outcomes through a clinical pathway inference framework applied to real-world data. Methods: We apply machine learning steps in our framework using a 2006 to 2020 cohort of veterans with major depressive disorder (MDD). Outpatient antidepressant pharmacy fills, dispensed inpatient antidepressant medications, emergency department visits, self-harm, and all-cause mortality data were extracted from the Department of Veterans Affairs Corporate Data Warehouse. Results: Our MDD cohort consisted of 252,179 individuals. During the study period there were 98,417 emergency department visits, 1,016 cases of self-harm, and 1,507 deaths from all causes. The top ten prescription patterns accounted for 69.3% of the data for individuals starting antidepressants at the fluoxetine equivalent of 20-39 mg. Additionally, we found associations between outcomes and dosage change. Conclusions: For 252,179 Veterans who served in Iraq and Afghanistan with subsequent MDD noted in their electronic medical records, we documented and described the major pharmacotherapy prescription patterns implemented by Veterans Health Administration providers. Ten patterns accounted for almost 70% of the data. Associations between antidepressant usage and outcomes in observational data may be confounded. The low numbers of adverse events, especially those associated with all-cause mortality, make our calculations imprecise. Furthermore, our outcomes are also indications for both disease and treatment. Despite these limitations, we demonstrate the usefulness of our framework in providing operational insight into clinical practice, and our results underscore the need for increased monitoring during critical points of treatment. [ABSTRACT FROM AUTHOR]

Purpose: We assess the merits of pars plana vitrectomy (PPV) in subjects with good visual acuity (VA) and a chronic macula-involving tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). Methods: A retrospective review of medical records was undertaken. Subjects were divided into 1) a Study Group of subjects who underwent prompt PPV and 2) a Control Group of subjects in which PPV was deferred in favor of less invasive treatment options or observations. Both study and control subjects had a baseline Snellen VA of ≥ 20/50 and a PDR-associated macula-involving TRD of > 6 months duration with a minimum follow-up of 12-months. Results: There were 58 patients analyzed over an average follow-up period of 27.6 (± 7.1) months. The change in VA was similar in the Study Group compared to the Control Group (p=0.94) with both groups losing about three lines of VA during the study period (− 0.30 ± 0.52 logMAR). Although the rates of maintaining ≥ 20/200 Snellen VA and ≥ 20/50 Snellen VA were similar in the Study Group compared to the Control Group (p=0.55 and p=0.28, respectively), the Study Group had more subjects gaining ≥ 2 lines of VA during the study period (p=0.002). Conclusion: Patients presenting with good VA and a PDR-associated macula-involving TRD of > 6 months were more likely to gain ≥ 2 lines of VA when PPV was performed at baseline compared to PPV deferral until further deterioration occurred. [ABSTRACT FROM AUTHOR]

Introduction. Olecranon fractures are common injuries that require surgical intervention for optimal outcomes. Various fixation methods have been described in the literature, including the use of intramedullary proximal ulna screws in combination with tension band augmentation. Limited research has compared this hybrid technique to other established methods of fixation. This study compared complication and reoperation rates between multiple groups. Methods. A retrospective review was conducted on patients with olecranon fractures who underwent internal fixation at a level 1 trauma center between January 1st, 2013, and April 22nd, 2023. Data was collected using CPT codes, and patients were categorized into five groups based on the method of fixation received: no implant, tension band only, locking olecranon plate, intramedullary screw and tension band hybrid, and others. Variables such as patient demographics, Mayo fracture classification, open vs. closed injury, implant type, reoperation rates, and postoperative complications were recorded. Results. A total of 217 patients were included in the study. No difference was found with implant choice and reoperation rate (p = 0.461). There was a significant difference found with reoperation and fracture type (p = 0.027) and open fracture (p = 0.002). Conclusion. The primary findings of this study indicate no significant difference in implant choice and reoperation rates among the various fixation methods used for olecranon fractures. These findings suggest that the hybrid fixation technique, utilizing intramedullary proximal ulna screws in combination with tension band augmentation, is a viable and comparable treatment option when evaluated against other well‐documented methods of fixation. This study also reiterates that severity of initial injury is often the most important factor related to poorer outcomes. Further discussion and analysis of the data will provide a comprehensive understanding of implications and recommendations for olecranon fracture fixation. [ABSTRACT FROM AUTHOR]

Are resilient employees so tough that they neglect to rest? To answer this question, eleven extraordinarily resilient professional caregivers (positive deviants [PD]) were interviewed about their meanings and practices of rest. Additionally, five professionals who scored extremely low in resilience and four who were average were also interviewed. Analysis of interviews revealed that PD caregivers held multifaceted interpretive schema of rest. Namely, they embraced bounded physicality, the limited ability to engage in space and time. In turn, they viewed rest as a (a) strategic defense and (b) normal indispensable joy, and practiced rest through (c) multimodal care. Thus, findings implied that resilient employees make rest a priority. The paper contributes to the communicative theory of resilience and the meanings of work literatures. [ABSTRACT FROM AUTHOR]

Batrachochytrium dendrobatidis (Bd) is a lethal amphibian pathogen, partly due to its ability to evade the immune system of susceptible frog species. In many pathogenic fungi, the antioxidant glutathione is a virulence factor that helps neutralise oxidative stressors generated from host immune cells, as well as other environmental stressors such as heavy metals. The role of glutathione in stress tolerance in Bd has not been investigated. Here, we examine the changes in the glutathione pool after stress exposure and quantify the effect of glutathione depletion on cell growth and stress tolerance. Depletion of glutathione repressed growth and release of zoospores, suggesting that glutathione is essential for life cycle completion in Bd. Supplementation with <2 mM exogenous glutathione accelerated zoospore development, but concentrations >2 mM were strongly inhibitory to Bd cells. While hydrogen peroxide exposure lowered the total cellular glutathione levels by 42 %, glutathione depletion did not increase the sensitivity to hydrogen peroxide. Exposure to cadmium increased total cellular glutathione levels by 93 %. Glutathione-depleted cells were more sensitive to cadmium, and this effect was attenuated by glutathione supplementation, suggesting that glutathione plays an important role in cadmium tolerance. The effects of heat and salt were exacerbated by the addition of exogenous glutathione. The impact of glutathione levels on Bd stress sensitivity may help explain differences in host susceptibility to chytridiomycosis and may provide opportunities for synergistic therapeutics. • Buthionine sulfoximine (BSO) inhibits glutathione synthesis in chytrid fungi. • Zoospore production is affected by glutathione depletion and supplementation. • Glutathione concentration and ratio change in response to stress. • Cadmium tolerance is affected by glutathione availability. [ABSTRACT FROM AUTHOR]

This study examined volunteer coping and resilience processes in emotionally-taxing work. Based on the reflections of 34 client-facing volunteers with a nonprofit that supports people experiencing homelessness, survivors of human trafficking, and refugee children, we identified four primary processes of volunteer resilience: (a) preemptive support offered at an individual level, (b) promotion of periodic rest from volunteering, (c) reframing and transforming the struggle, and (d) invoking spiritual identity anchors. These findings contribute to resilience theorizing by underscoring the necessary role of both routine social support and rest from emotion work in resilience processes. [ABSTRACT FROM AUTHOR]

Introduction. Rice bodies (RBs) are pale and glossy appearing small fibrinous nodules that form due to synovial or tenosynovial joint inflammation. RBs are significant as they are common in orthopedic practices causing nonspecific symptoms such as pain, swelling, range of motion limitations, crepitus, and catching sensations. These loose bodies occur often within the bursa as a symptom of chronic bursitis and are commonly associated with rheumatoid, inflammatory, or tuberculous arthritis. Reports on RBs are present; however, few bilateral cases within the shoulder appear in the literature. Case Presentation. This case demonstrates an unusual bilateral, subacromial-subdeltoid presentation of rice bodies (RBs) in a 41-year-old Caucasian female patient with a history of rheumatoid arthritis. We describe treatment with right shoulder arthroscopy to remove the loose bodies. One-year postoperative patient-reported outcomes (PROMs) show improvement in symptoms, pain, and overall function. Conclusion. Formation of RBs occurs as a symptom of an inflammatory response in synovial joints. This provokes multiple small fibrin aggregates to collect within synovial bursae and occasionally tendon sheaths. RBs are rarely seen bilaterally. Arthroscopic removal of RBs is an appropriate treatment method for symptom improvement. [ABSTRACT FROM AUTHOR]

Context: Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice. Objectives: To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions. Evidence Acquisition: PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI. Evidence Synthesis: 122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect. Conclusion: AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury. [ABSTRACT FROM AUTHOR]

Context: Arthrogenic muscle inhibition (AMI) is a common neurophysiological response to joint injury. While athletic trainers (ATs) are constantly treating patients with AMI, it is unclear how clinicians are using the available evidence to treat the condition. Objective: To investigate ATs' general knowledge, clinical practice, and barriers for treating AMI. Methods: A cross-sectional web-based survey was utilized. The survey was distributed to a random sample of 3000 ATs from the National Athletic Trainers' Association and through social media. 143 board certified ATs (age: 34.6 [10.3] y; experience: 11.7 [9.8] y) from various clinical settings and educational backgrounds were included in the analysis. Results: One hundred one respondents were able to correctly identify the definition of AMI. The majority of these respondents correctly reported that joint effusion (n = 95, 94.1%) and abnormal activity from joint receptors (n = 91, 90.1%) resulted in AMI. Of the 101 respondents, only 58 (57.4%) reported using disinhibitory interventions to treat AMI. The most frequently used evidence supported interventions were transcutaneous electrical nerve stimulation (n = 38,65.5%), neuromuscular electrical stimulation (n = 33,56.9%), and focal joint cooling (n = 25, 43.1 %). The interventions used correctly most often based on current evidence were neuromuscular electrical stimulation (n = 29/33, 87.9%) and transcutaneous electrical nerve stimulation (n = 26/38, 68.4%). Overall, difficulty quantifying AMI (n = 62, 61.24%) and lack of education (n = 71, 76.2%) were most frequently perceived as barriers. Respondents that did not use disinhibitory interventions perceived lack of experience treating AMI, understanding the terminology, and access to therapeutic modalities more often than the respondents that reported using disinhibitory interventions. Conclusion: Further education about concepts and treatment about AMI is warranted for ATs. Continued understanding of ATs' clinical practice in regard to AMI may help identify gaps in athletic training clinical education. [ABSTRACT FROM AUTHOR]

Shared decision-making (SDM) aims to create a context in which patients and surgeons work together to explore treatment options and goals of care. The objective of the current study was to characterize demographic factors, behaviors, and perceptions of patient involvement among surgeons relative to SDM. Using a cross-sectional survey methodology, surgeon demographics, behaviors, and perceptions of patient involvement were assessed. Surgeon approaches to SDM were measured using a 100-point scale ranging from 'patient-led' (0) to 'surgeon-led' (100). Among 241 respondents, most were male (n = 123, 67.2%) and White (n = 124, 69.3%); roughly one-half of surgeons had been in practice ≥10 years (n = 120, 52.4%). Surgeon approaches to SDM ranged from 0 to 81.0, with a median rating of 50.0 (IQR: 35.5, 62.0). Reported approaches to SDM were associated with years in practice, sharing information, and perceptions of patient involvement. Surgeons in practice 10 + years most frequently utilized a 'Shared, Patient-led' approach to SDM (27.5%), while individuals with less experience more often employed a 'Shared, Surgeon-led' approach (33.3%, p = 0.031). Surgeons with a 'Patient-led' approach perceived patient involvement as most important (M = 3.82, SD = 0.16), while respondents who had a 'Surgeon-led' approach considered this less important (M = 3.57, SD = 0.38; p < 0.001). Surgeon factors including demographics, behaviors, and perceptions of patient involvement influenced SDM approaches. SDM between patients and surgeons should strive to be more dynamic and tailored to each specific patient's needs to promote optimal patient-centered care. [ABSTRACT FROM AUTHOR]

We sought to understand the perceptions of surgeons around patient preferred roles in decision-making and their approaches to patient-centered decision-making (PCDM). A concurrent embedded mixed-methods design was utilized among a cohort of surgeons performing complex surgical procedures. Data were collected through online surveys. Associations between perceptions and PCDM approaches were examined. Among 241 participants, most respondents were male (67.2%) with an average age of 47.6 y (standard deviation = 10.3); roughly half (52.4%) had practiced medicine for 10 or more years. Surgeons most frequently agreed (94.2%) with the statement, "Patients prefer to make health decisions on their own after seriously considering their physician's opinion." Conversely, surgeons most frequently disagreed (73.0%) with the statement, "Patients prefer that their physician make health decisions for them." Nearly one-third (30.4%) of surgeon qualitative responses (n = 115) indicated that clinical/biological information would help them tailor their approach to PCDM. Only 12.2% of respondents indicated that they assess patient preferences regarding both decision-making and information needs. Surgeons most frequently agree that patients want to make their own health decisions after seriously considering their physicians opinion. A greater focus on what information surgeons should know before treatment decision-making may help optimize patient experience and outcomes related to complex surgical procedures. [ABSTRACT FROM AUTHOR]

Objective: To critically review contemporary theoretical models, diagnostic approaches, clinical features, and assessment findings in Functional Cognitive Disorder (FCD), and make recommendations for neuropsychological evaluation of this condition. Method: Narrative review. Results: FCD is common in neuropsychological practice. It is characterized by cognitive symptoms that are not better explained by another medical or psychiatric disorder. The cognitive symptoms are associated with distress and/or limitations in daily functioning, but are potentially reversible with appropriate identification and treatment. Historically, a variety of diagnostic frameworks have attempted to capture this condition. A contemporary conceptualization of FCD positions it as a subtype of Functional Neurological Disorder, with shared and unique etiological factors. Patients with FCD tend to perform normally on neuropsychological testing or demonstrate relatively weak memory acquisition (e.g. list learning trials) in comparison to strong attention and delayed recall performance. Careful history-taking and behavioral observations are essential to support the diagnosis of FCD. Areas of ongoing controversy include operationalizing "internal inconsistencies" and the role of performance validity testing. Evidence for targeted interventions remains scarce. Conclusions: Neuropsychologists familiar with FCD can uniquely contribute to the care of patients with this condition by improving diagnostic clarity, richening case formulation, communicating effectively with referrers, and leading clinical management. Further research is needed to refine diagnosis, prognosis, and treatment. [ABSTRACT FROM AUTHOR]

Hypophosphatasia (HPP) is a rare inborn error of metabolism that presents variably in both age of onset and severity. HPP is caused by pathogenic variants in the ALPL gene, resulting in low activity of tissue nonspecific alkaline phosphatase (TNSALP). Patients with HPP tend have a similar pattern of elevation of natural substrates that can be used to aid in diagnosis. No formal diagnostic guidelines currently exist for the diagnosis of this condition in children, adolescents, or adults. The International HPP Working Group is a comprised of a multidisciplinary team of experts from Europe and North America who have expertise in the diagnosis and management of patients with HPP. This group reviewed 93 papers through a Medline, Medline In-Process, and Embase search for the terms "HPP" and "hypophosphatasia" between 2005 and 2020 and that explicitly address either the diagnosis of HPP in children, clinical manifestations of HPP in children, or both. Two reviewers independently evaluated each full-text publication for eligibility and studies were included if they were narrative reviews or case series/reports that concerned diagnosis of pediatric HPP or included clinical aspects of patients diagnosed with HPP. This review focused on 15 initial clinical manifestations that were selected by a group of clinical experts. The highest agreement in included literature was for pathogenic or likely pathogenic ALPL variant, elevation of natural substrates, and early loss of primary teeth. The highest prevalence was similar, including these same three parameters and including decreased bone mineral density. Additional parameters had less agreement and were less prevalent. These were organized into three major and six minor criteria, with diagnosis of HPP being made when two major or one major and two minor criteria are present. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate patient-reported outcomes with a validated patient questionnaire following topography-guided LASIK (TG-LASIK).Methods: Patients undergoing TG-LASIK using Phorcides analytic software were prospectively enrolled to receive an adapted Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL) questionnaire before and 26-weeks after treatment. The main study outcome was the change in the Global Vision Satisfaction Index from the PROWL questionnaire.Results: Forty-six patients underwent treatment and completed the modified PROWL questionnaire before and 26-weeks after TG-LASIK. The Global Vision Satisfaction Index from the modified PROWL questionnaire improved from 4.07 (3.87– 4.26) to 5.00 (4.81– 5.19) after the TG-LASIK treatment (p < 0.0001). The study population's binocular uncorrected distance visual acuity was 20/16, 20/12.5, and 20/10 or better in 100%, 87.0%, and 15.2% at 26 weeks post TG-LASIK, respectively.Conclusion: Patient satisfaction as assessed with the modified PROWL questionnaire is very high after undergoing TG-LASIK using Phorcides analytic software. Patient-reported outcomes add another dimension when assessing treatment efficacy beyond change in visual acuity and corneal architecture, and specialists may consider incorporating such assessments into the consenting process and patient education at large. [ABSTRACT FROM AUTHOR]

Objective dry eye measurement changes at 6 months. [ABSTRACT FROM AUTHOR]

Objective We aimed to describe hemoglobin (Hb) change after transfusion in the nonacute postpartum anemic population in order to provide clinicians with appropriate expectations regarding Hb rise posttransfusion. Study Design We performed a secondary analysis of a randomized controlled trial comparing initial transfusion with 1 unit of packed red blood cells (pRBCs) to 2 units pRBCs for postpartum women requiring nonacute transfusion (n = 66). Inclusion criteria were: age 18 years and older, Hb level either <7 g/dL or >7 g/dL with signs or symptoms of anemia, and > 6 hours postpartum without contraindication to transfusion. Hb assessment was performed 4 to 6 hours after initial transfusion. Hb change (ΔHb) was calculated as posttransfusion Hb minus randomization Hb. Our primary goal was to describe mean ΔHb per pRBC transfused at the 4- to 6-hour posttransfusion blood count. We also compared ΔHb per pRBC transfused by number of units transfused, body mass index (BMI), and symptoms (dizziness and/or fatigue) at time of posttransfusion assessment. Results Participants were mean age 29, mean BMI of 27, and over 70% self-identified as black, 12% identified as white, and 9% as Asian race. Mean Hb prior to transfusion was 6.9 ± 0.6 g/dL. Mean ΔHb per pRBC transfused was 0.9 ± 0.4g/dL. There was no difference in ΔHb per pRBC by BMI category (normal weight < 25 kg/m 2 : 1.1 ± 0.2 g/dL; overweight 25–29.9 kg/m 2 : 0.9 ± 0.5 g/dL; obese ≥ 30 kg/m 2 : 0.9 ± 0.5 g/dL; p = 0.12). Finally, there was also no significant difference in ΔHb per pRBC by whether or not symptoms of anemia persisted after initial transfusion (1.0 ± 0.7 vs. 0.9 ± 0.4 g/dL, p = 0.39). Conclusion Our data supports the classically accepted rise in Hb after pRBC of approximately 1 g/dL, regardless of BMI category or anemia symptomatology. The study population includes patients at highest risk of postpartum anemia. The results of our study provide important information for clinicians caring for postpartum patients with nonacute anemia. Key Points Postpartum anemia is a significant public health issue. Providers use hemoglobin change to assess response to blood transfusion. The established 1 g/dL change in Hb after transfusion is based on historic surgical populations. Our data suggests the 1 g/dL Hb change is applicable to postpartum patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate patient preferences in regards to the timing of the initial postoperative examination after undergoing cataract surgery. Methods: A retrospective, consecutive case series analysis from a single private practice institution was performed using a standardized phone survey on patients who underwent cataract surgery. Subjects were classified into one of two possible study groups according to the timing of their initial postoperative cataract surgery examination: Group A received the initial postoperative cataract surgery examination on the same day as the surgery, whereas Group B received the initial postoperative cataract surgery examination on the day following the operation. Results: There were 80 subjects contacted for the phone survey of which 70 (35 in each study group) completed the survey and therefore were included in the analysis. Group A subjects responded favorably in regards to preference and realizing reduced time and cost savings compared to Group B (p < 0.0001 for both). There were no subjects in Group A who would have preferred next-day initial postoperative care, whereas 31.4% of subjects in Group B would have preferred same-day care if given the opportunity. Conclusion: Patients undergoing cataract surgery both prefer and report time and cost savings with same-day initial postoperative care compared to next-day initial postoperative care. Patient preferences regarding their postoperative care should be one of the many factors that a surgeon ought to take into consideration when providing follow-up care after cataract surgery. [ABSTRACT FROM AUTHOR]

This article shows how Pope Francis's notion of "synodality" brings together central tenets of the comprehensive vision of the Second Vatican Council. The article proposes that the roots of synodality can be found, above all, in Vatican II's Dogmatic Constitution on Divine Revelation, Dei Verbum. [ABSTRACT FROM AUTHOR]

Data from 98 women recruited in the Metformin in Gestational Diabetes trial and dual‐energy X‐ray absorptiometry studies of their children at nine years were analysed to investigate associations between maternal measures during pregnancy and their children's size and adiposity. Mothers of boys (n = 56) and girls (n = 42) had been randomised to metformin or insulin treatment at 30.1 ± 2.8 and 29.3 ± 4.1 weeks gestation, respectively. In boys, fat‐free mass indexed to height squared was associated with maternal weight, body mass index, maternal glycaemia and metformin treatment. In boys and girls, fat mass indexed to height squared was associated with maternal glycaemia measures before gestational diabetes treatment. [ABSTRACT FROM AUTHOR]

Background: The most common operations performed for secondary hyperparathyroidism include subtotal parathyroidectomy (STPX) and total parathyroidectomy with autotransplantation (TPX + AT). We present a series of ESRD patients treated with total parathyroidectomy without autotransplantation (TPX). Methods: This is a retrospective cohort analysis of ESRD patients, age 18 years or older, with three or more glands resected on final pathology and follow-up parathyroid hormone levels obtained up to 1.5 years postoperatively. The primary endpoint was recurrence of hyperparathyroidism (defined as PTH > 500 pg/mL). Results: The incidence of recurrent hyperparathyroidism at 1.5 years was 5.9% (2/34). The incidence of persistent hyperparathyroidism at 1.5 years was 11.8% (4/34). In this series, no patients were hospitalized for symptomatic hypocalcemia or experienced pathologic bone fractures. Conclusions: Recurrence rates are low with TPX. The most common cause of recurrent and persistent disease is resection of three rather than four glands. The known complications of TPX, pathologic fractures, and severe hypocalcemia, were not seen in this study. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the effects of cardiac cachexia on the metabolomic profile in dogs with myxomatous mitral valve disease (MMVD). ANIMALS: 3 groups of dogs with MMVD enrolled between November 30, 2018, and April 7, 2022: (1) Dogs with congestive heart failure (CHF) and cachexia (CHF-cachexia group; n = 10); (2) dogs with CHF that had no cachexia (CHF-no cachexia group; n = 10); and (3) dogs with asymptomatic disease (American College of Veterinary Internal Medicine [ACVIM] Stage B2) with no cachexia (B2 group; n = 10). METHODS: Metabolomic profiles were analyzed from serum samples using ultra-high-performance liquid chromatographytandem mass spectroscopy. Dogs in the 3 groups were compared, with statistical significance defined as P < .05 with a low false discovery rate (q < .10) and nominal statistical significance defined as P < .05 but q > .10. RESULTS: Numerous metabolites were significantly (n = 201) or nominally significantly (n = 345) different between groups. For example, when comparing the CHF-cachexia vs CHF-no cachexia groups, lipids were the predominant metabolite differences, including many medium- and long-chain dicarboxylates and dicarboxylate acylcarnitines. For comparisons of the CHF-cachexia vs B2 groups and the CHF-no cachexia vs B2 groups, amino acids, nucleotides, and cofactors/vitamins were the predominant metabolite differences. CLINICAL RELEVANCE: Some significant metabolite differences were identified between dogs with and without cardiac cachexia. [ABSTRACT FROM AUTHOR]

Abstract Objectives. While oppositional defiance is often considered a childhood behavioural problem, the negative impact of symptoms on relationships and emotional wellbeing may endure well into young adulthood and can affect overall physical health. However, little is known about the co - occurrence of oppositional defiance symptoms (ODS) and changes in physical health functioning, particularly during the transition to young adulthood. This study examines the coupled change between ODS and physical health symptoms during this critical developmental period to inform the long - term somatic manifestations of ODS. Methods. Participants (N = 662; 52% female) from the Victoria Healthy Youth Survey (V-HYS) were assessed for ten years across six biennial occasions from ages 12–18 to ages 22–30. A multilevel time -varying covariation model, disaggregating within- and between - person variability, examined whether change in ODS was systematically associated with change in physical health symptoms. Results. On average, individuals with higher ODS reported more physical health symptoms. Moreover, ODS also shared a significant within - person time - varying association with physical health, suggesting that the two symptom domains fluctuated together within - individuals across time, irrespective of between - person differences. Conclusion. This study provides a novel within- and between - person demonstration of the link between ODS and physical health symptoms from youth to young adulthood. [ABSTRACT FROM AUTHOR]

Reporting new occurrence records of organisms is key to overcome the Wallacean shortfall. Here, we report the first sighting of a Burrowing Owl, Athene cunicularia (Molina, 1782), overwintering on a peninsula in the Tennessee River in Tennessee, USA, during boreal winters 2020-2022. Pellets from this bird showed combination of six species. This is the first record for the species in the Interior Plateau of the USA. Conditions supporting this bird and evidence of it overwintering bear to explore the environmental conditions that support this species in novel areas. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive weakness and eventual death, usually within 3-5 years. An ALS diagnosis is associated with substantial emotional distress for both the affected person and their family care-partners which impairs the ability to engage in important conversations about long term care planning, negatively impacts ALS symptoms for the patient, and quality of life for both patient and care-partner. Here we 1) discuss published works identified by the authors about psychosocial interventions for the ALS population, 2) identify a lack of early, dyadic interventions to support psychosocial needs of people with ALS and care-partners; 3) describe the Neurodegenerative Diseases (NDD) framework for early dyadic intervention development and 4) propose an adaptation of an evidence-based early dyadic psychosocial intervention, Recovering Together, for the unique needs of people with ALS and their care-partners (Resilient Together-ALS; RT-ALS) using the NDD framework. Future work will use stakeholder feedback to optimize the intervention for subsequent efficacy testing. [ABSTRACT FROM AUTHOR]

Background: In difficult-to-treat depression (DTD) the outcome metrics historically used to evaluate treatment effectiveness may be suboptimal. Metrics based on remission status and on single end-point (SEP) assessment may be problematic given infrequent symptom remission, temporal instability, and poor durability of benefit in DTD. Methods: Self-report and clinician assessment of depression symptom severity were regularly obtained over a 2-year period in a chronic and highly treatment-resistant registry sample (N = 406) receiving treatment as usual, with or without vagus nerve stimulation. Twenty alternative metrics for characterizing symptomatic improvement were evaluated, contrasting SEP metrics with integrative (INT) metrics that aggregated information over time. Metrics were compared in effect size and discriminating power when contrasting groups that did (N = 153) and did not (N = 253) achieve a threshold level of improvement in end-point quality-of-life (QoL) scores, and in their association with continuous QoL scores. Results: Metrics based on remission status had smaller effect size and poorer discrimination of the binary QoL outcome and weaker associations with the continuous end-point QoL scores than metrics based on partial response or response. The metrics with the strongest performance characteristics were the SEP measure of percentage change in symptom severity and the INT metric quantifying the proportion of the observation period in partial response or better. Both metrics contributed independent variance when predicting end-point QoL scores. Conclusions: Revision is needed in the metrics used to quantify symptomatic change in DTD with consideration of INT time-based measures as primary or secondary outcomes. Metrics based on remission status may not be useful. [ABSTRACT FROM AUTHOR]

Background: Patients with atrial fibrillation (AF) have significantly lower health-related quality of life (HRQoL) compared to the general population and patients with other heart diseases. The research emphasis on the influence of AF symptoms on HRQoL overshadows the role of individual characteristics. To address this gap, this study's purpose was to test an incremental predictive model for AF-related HRQoL following an adapted HRQoL conceptual model that incorporates both symptoms and individual characteristics. Methods: Patients attending an AF specialty clinic were invited to complete an online survey. Hierarchical regression analyses were conducted to examine whether individual characteristics (overall mental health, perceived stress, sex, age, AF knowledge, household and recreational physical activity) incremented prediction of HRQoL and AF treatment satisfaction beyond AF symptom recency and overall health. Results: Of 196 participants (mean age 65.3 years), 63% were male and 90% were Caucasian. Most reported 'excellent' or 'good' overall and mental health, had high overall AF knowledge scores, had low perceived stress scores, and had high household and recreation physical activity. The mean overall AF Effect On Quality-Of-Life Questionnaire (AFEQT) and AF treatment satisfaction scores were 70.62 and 73.84, respectively. Recency of AF symptoms and overall health accounted for 29.6% of the variance in overall HRQoL and 20.2% of the variance in AF treatment satisfaction. Individual characteristics explained an additional 13.6% of the variance in overall HRQoL and 7.6% of the variance in AF treatment satisfaction. Perceived stress and household physical activity were the largest contributors to overall HRQoL, whereas age and AF knowledge made significant contributions to AF treatment satisfaction. Conclusions: Along with AF symptoms and overall health, individual characteristics are important predictors of HRQoL and AF treatment satisfaction in AF patients. In particular, perceived stress and household physical activity could further be targeted as potential areas to improve HRQoL. [ABSTRACT FROM AUTHOR]

Purpose: This study compares responses of children who are deaf and hard of hearing (DHH) who use spoken language with responses of children who have typical hearing on a repeated word association task to evaluate lexical-- semantic organization. Method: This study included 109 participants in early kindergarten or who had completed first grade. The younger group included 30 children with typical hearing, 22 with hearing aids, and 21 with cochlear implants. The older group included 16 children with typical hearing, nine with hearing aids, and 11 with cochlear implants. Children were asked to give a word associated with 24 stimuli words. Responses were coded according to their relation to the target. Results: An analysis of variance revealed that older children, regardless of hearing status, produced more semantically related responses to prompts than younger children. Children in the younger DHH group differed from children with typical hearing in their production of non--semantically related responses: They produced errored responses at higher rates. Conclusion: This preliminary data may indicate an early deficit in recognition of semantic relations between words for children who are DHH and provides a basis for continued longitudinal study of changes in lexical--semantic organization. [ABSTRACT FROM AUTHOR]

Context: Altered quadriceps activation is common following anterior cruciate ligament reconstruction (ACLR), and can persist for years after surgery. These neural deficits are due, in part, to chronic central nervous system alterations. Transcranial direct current stimulation (tDCS) is a noninvasive modality, that is, believed to immediately increase motor neuron activity by stimulating the primary motor cortex, making it a promising modality to use improve outcomes in the ACLR population. Objective: To determine if a single treatment of tDCS would result in increased quadriceps activity and decreased levels of self-reported pain and dysfunction during exercise. Design: Randomized crossover design. Setting: Controlled laboratory. Patients: Ten participants with a history of ACLR (5 males/5 females, 22.9 [4.23] y, 176.57 [12.01] cm, 80.87 [16.86] kg, 68.1 [39.37] mo since ACLR). Interventions: Active tDCS and Sham tDCS. Main Outcome Measures: Percentage of maximum electromyographic data of vastus medialis and lateralis, voluntary isometric strength, percentage of voluntary activation, and self-reported pain and symptom scores were measured. The 2 × 2 repeated-measures analysis of variance by limb were performed to explain the differences between time points (pre and post) and condition (tDCS and sham). Results: There was a significant time main effect for quadriceps percentage of maximum electromyographic of vastus medialis (F9,1 = 11.931, P =.01) and vastus lateralis (F9,1 = 9.132, P =.01), isometric strength (F9,1 = 5.343, P =.046), and subjective scores for pain (F9,1 = 15.499, P =.04) and symptoms (F9,1 = 15.499, P =.04). Quadriceps percentage of maximum electromyographic, isometric strength, and voluntary activation showed an immediate decline from pre to post regardless of tDCS condition. Subjective scores improved slightly after each condition. Conclusions: One session of active tDCS did not have an immediate effect on quadriceps activity and subjective scores of pain and symptoms. To determine if tDCS is a valid modality for this patient population, a larger scale investigation with multiple treatments of active tDCS is warranted. [ABSTRACT FROM AUTHOR]

Our futures are always dying and there are futures always being born. There is a liminal space in which we stand and experience both those deaths and births which send ripples through our multiplex systems. Drawing upon fields and tools such as thanatology, neuroscience, and trauma-informed care may allow us frameworks with which to manage not just how we think about the future but also how we feel about the future. There is a hallowed ground where the births and deaths of our futures exist and it takes both courage and creativity to stand there. As futurists, our job is often to sit bedside with others as they nurse and hospice their futures - both imagined and unimagined. Recognizing the skill needed to serve as container for individuals, systems, and the world requires something new from the field of Foresight and its practitioners. With the shocking, global loss from the Covid-19 pandemic, related individual micro-loss, the continuing climate decline partnered with increasing disruption, the world stands on the precipice of new understanding around grief and hope. Thoughtful consideration here allows us to better anticipate futures death and the transitional grief that often accompanies change. [ABSTRACT FROM AUTHOR]

An unhelmeted 59-year-old male involved in a motorcycle accident presented with a right dorsal lunate dislocation in the context of a polytrauma evaluation. Soft-tissue attachments were minimal across the carpus, which allowed for an en bloc proximal row carpectomy. Two-year follow-up yielded a satisfactory outcome given the high energy injury mechanism. Proximal row carpectomy is a useful tool which preserves wrist range of motion in the acute trauma setting and is durable, as demonstrated by our patient's postoperative mobilization using a wheelchair. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the short-term effects of intravitreal faricimab (IVF) in treatment-resistant neovascular age-related macular degeneration (nAMD) subjects previously treated with intravitreal aflibercept (IVA). Methods: A retrospective review was conducted on nAMD patients undergoing IVA therapy at a single private practice institution. Subjects were divided into Study and Control groups. Both Study and Control subjects had undergone ≥ 6 IVA treatments during the previous 12 months, ≥ 4 IVA treatments during the previous 6 months, had a central macular thickness (CMT) on optical coherence tomography (OCT) of ≥ 300 microns, and had observable intraretinal and/or subretinal fluid on OCT prior to group assignment. Study subjects were switched from IVA to IVF and received 3 treatments within 4 months. Control subjects remained on IVA during the same time period and received 3 treatments within 4 months. Results: There were a total of 55 subjects analyzed. There were 39.3% (11/28) in the Study Group and 7.4% (2/27) in the Control Group attaining a CMT of less than 300 microns without retinal fluid on OCT at the end of the 4-month study period (p = 0.004). There were 35.7% (10/28) in the Study Group and 7.4% (2/27) in the Control Group gaining 2 or more lines of visual acuity at the end of the 4-month study period (p = 0.008). Conclusion: IVF can improve the visual and anatomic outcomes in a significant minority of treatment-resistant nAMD subjects previously managed with IVA. A greater follow-up period is needed to determine if such improvements can be maintained. [ABSTRACT FROM AUTHOR]

Patterns of larval food plant use and immature stage morphology help clarify Neotropical butterfly species diversity, and, in many cases, lineages identified with molecular data are corroborated by morphology and ecology of immature stages. Here, we investigate cryptic species in Adelpha butterflies (Nymphalidae), a group known for challenging adult wing similarity coupled with mimicry, and for its remarkably wide larval food plant breadth. We focus on the Adelpha serpa‐group and in particular Adelpha serpa celerio, whose immatures have been documented feeding on 11 plant families. Our analyses of A. serpa, and among serpa‐group species across the Neotropics, revealed evidence of cryptic species, but the pattern within A. serpa celerio showed relatively weak mtDNA and morphological differences, and no differentiation in food plant use. We conclude that A. serpa should be revised and recognize A. serpa to include the nominate subspecies and recognize A. celerio (revised status) as a geographically widespread species and a larval food plant generalist that contains A. c. celerio (revised status), A. c. duiliae (revised status) and A. c. diadochus (revised status). Four additional species within the serpa‐group show strong evidence of harbouring allopatric cryptic species, and further research should be done to clarify their species limits. [ABSTRACT FROM AUTHOR]