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Ultrasound imaging has shown promise in assessing synovium inflammation associated early stages of rheumatoid arthritis (RA). The precise identification of the synovium and the quantification of inflammation-specific imaging biomarkers is a crucial aspect of accurately quantifying and grading RA. In this study, a deep learning-based approach is presented that automates the segmentation of the synovium in ultrasound images of finger joints affected by RA. Two convolutional neural network architectures for image segmentation were trained and validated in a limited number of 2-D images, extracted from N = 18 3-D ultrasound volumes acquired from N = 9 RA patients, with sparse ground truth annotations of the synovium. Various augmentation strategies were employed to enhance the diversity and size of the training dataset. The utilization of geometric and noise augmentation transforms resulted in the highest dice score (0.768 ± 0. 031 , N = 6) , and intersection over union (0. 624 ± 0.040, N = 6), as determined via six-fold cross-validation. In addition, the segmentation model is used to generate dense 3-D segmentation maps in the ultrasound volumes, based on the available sparse annotations. The developed technique shows promise in facilitating more efficient and standardized workflow for RA screening using ultrasound imaging. [ABSTRACT FROM AUTHOR]

Transverse skeletal changes involving maxilla occurs first, followed by vertical and horizontal changes. Transverse changes present as solitary or in significance to other change and are of either skeletal or dentoalveolar in origin, but mainly are the results of a slight or severe constriction of the maxilla that leads to either unilateral, bilateral or unilateral functional crossbite and may be associated with Class III malocclusion or Class II malocclusion. The article highlights the development, types, diagnosis and assessment, treatment and correction of transverse discrepancies. It is important for the practitioner to understand the diagnostic processes involved in evaluating a crossbite to arrive at a diagnosis for effective and efficient treatment. [ABSTRACT FROM AUTHOR]

When students who are confident in their abilities do not perform well in an important course, they are likely to experience surprise. This case study investigated engineering students' experiences of surprise caused by test scores in foundational courses. Students taking Engineering Statics reflected on their surprise after completing tests by following a template that asked questions about how surprised they were (experiential indicator of surprise), how much they liked their scores (affective indicator), and how much they expected such scores (cognitive indicator). An inductive analysis of the reflections showed that students were at least moderately unpleasantly surprised and moderately pleasantly surprised in 34.6% and 13.5% of the reflections, respectively. Among all reflections, 34.6% showed that students did not like their scores, and 25% showed that they did not expect such scores. A major cause of unpleasant surprise was the disparity between the students' high confidence in their understanding and their lower-than-expected scores. The other major cause was the disparity between the students' high effort in studying for the tests and their scores that were lower than expected. More than half of these students prepared for tests by reviewing materials. The emotions associated with unpleasant surprise included feelings of being disappointed, frustrated, and upset, and those associated with pleasant surprise were happiness and relief. [ABSTRACT FROM AUTHOR]

Background: Medial temporal lobe atrophy has been linked to decline in neuropsychological measures of explicit memory function. While the hippocampus has long been identified as a critical structure in learning and memory processes, less is known about contributions of the amygdala to these functions. We sought to investigate the relationship between amygdala volume and memory functioning in a clinical sample of older adults. Methods: A serial clinical sample of older adults that underwent neuropsychological assessment at an outpatient neurology clinic was selected for retrospective chart review. Patients were included in the study if they completed a comprehensive neuropsychological assessment within six months of a volumetric MRI scan. Each subject underwent scans conducted on a GE 3.0 Tesla scanner, and volumetric analyses were performed using imaging software which quantifies regional brain volumes. We used bilateral hippocampal and amygdala volumes in our analyses. Associations between these volumes and memory scores, derived from immediate and delayed recall conditions of a verbal story learning task and a nonverbal design reconstruction task [1], were examined using mixed‐effects general linear models, controlling for total intracranial volume, age, sex and education. Partial correlation coefficients, controlling for these covariates, were calculated to estimate the strength of the association between volumes and memory scores. Results: A total of 68 (38F, 29M) participants were included in the analyses, with a mean (SD) age of 80.1 (6.0) and educational level of 15.9 (2.5) years. Controlling for age, sex, education, and total intracranial volume, greater amygdala volumes were associated with better verbal and nonverbal memory performance (p<.001), comparable to hippocampal volume. The interaction term of hemisphere and memory was not significant for any of the models, indicating no lateralized effects. Partial correlation coefficients ranged from 0.45 to 0.31. Conclusion: These findings contribute to a growing body of knowledge highlighting the amygdala as a target for further research in memory functioning through the adult lifespan, supporting a holistic understanding of limbic system operations in which multiple subcortical structures contribute synergistically to memory processes and decline in older adults. References [1] Wechsler, D. (2009). Wechsler Memory Scale fourth edition. San Antonio, TX: Pearson. [ABSTRACT FROM AUTHOR]

Background The modified Rutgeerts' score [RS] differentiates i2a—lesions confined to the anastomosis—and i2b—more than five aphthous ulcers in the neoterminal ileum with normal intervening mucosa, with or without anastomotic lesions—categories. Its relevance for the therapeutic management of Crohn's disease [CD] patients after ileocolic resection is still debated. Our objective was to compare the postoperative recurrence risk in patients with an i2a or i2b score, using an individual patient data meta-analysis. Methods We conducted a systematic literature search until July 2020, to identify all relevant studies reporting the i2a/i2b status in the year following ileocolic resection and clinical and/or surgical postoperative CD recurrence in their follow-up. Individual patient-level data were obtained from the corresponding authors. The association between the modified RS and time-to-event was evaluated using a mixed Cox model with the centre as the random effect. Results Seven studies published between 2008 and 2019 were included, corresponding to 400 patients: 189 [47%] i2a and 211 [53%] i2b. Median [interquartile range, IQR] time from ileocolic resection to ileocolonoscopy was 6.2 [5.5, 7.9] months and median [IQR] follow-up time after ileocolonoscopy was 4.5 [2.9, 7.3] years. The risk of clinical postoperative recurrence at 1 and 3 years was 11% [6–15%], and 25% [18–32%] in the i2a group versus 9% [5–13%] and 33% [26–41%] in the i2b group [ p  = 0.63 and p  = 0.12, respectively]. No significant difference was observed in terms of time to clinical postoperative recurrence [ p  = 0.16] or surgical postoperative recurrence [ p  = 0.87]. Results did not change after excluding patients having initiated an immunosuppressant or a biologic in the 3 months after endoscopy [remaining cohort, n  = 361]. Conclusions In this individual patient data meta-analysis, no difference was observed between i2a and i2b subcategories with regards to clinical or surgical postoperative recurrence. As we wait for prospective trials, the same treatment strategy could be applied to all patients classified as i2 on the Rutgeerts score. [ABSTRACT FROM AUTHOR]

Skills form an integral part of an organization for its efficient functioning. This research study investigates mechanisms to actively persuade employees and organizations to change their attitudes and perspectives towards skills through the design and implementation of a skill-based system. The aim of the project is to know if we can create a skill-focused climate in a software organization through a software system proposed by the researcher and if such a system will help in utilizing in-house employees for new opportunities rather than hiring new employees. Feedback was collected on the proposed skill-based system from software professionals and human resource managers through an online survey. Findings reveal that the proposed skill-based system will create a skill-focused climate in a software organization and also help in better utilization of internal employees for new skill requirements rather than directly hiring external employees. [ABSTRACT FROM AUTHOR]

Background: Underlying inflammation is associated with an increased risk of depression in older adults. In this study, we examined the role of inflammatory biomarkers in antidepressant response in depressed older adults undergoing adjunct Tai Chi Chih (TCC) or Health education interventions.Methods: Older adults aged 60 years and above with a diagnosis of major depression were randomized to 12 weeks of TCC versus Health and Wellness Education (HEW) as an adjunct therapy to their stable antidepressant treatment regimen. A panel of 19 cytokine/chemokines was measured at baseline and 12 weeks. Five factors were derived using factor analysis. General linear models were estimated to examine the change in factor scores and the association of these changes on depression remission rates, controlling for age, sex, and body mass index.Results: Of the 170 randomized participants (TCC: n = 85 and HEW: n = 85), 55 TCC and 58 HEW completed the 3-month assessment. The groups did not differ at baseline in any measure. At follow-up, neither the changes in cytokine/chemokines scores nor the depression remission rate differed significantly between TCC and HEW. However, remitters and non-remitters differed significantly in changes in a factor composed of growth-regulated oncogene protein-alpha (GRO-alpha), epidermal growth factor (EGF), and soluble CD40 ligand (sCD40L). GRO-alpha and EGF levels (in both groups) were significantly increased in remitters compared to non-remitters.Conclusion: Changes in certain cytokines/chemokines may accompany improvement in depressive symptoms in older adults. Future studies will need to explore the role of these molecules in remission of late-life depression. [ABSTRACT FROM AUTHOR]

Fournier's gangrene is a rare and potentially fatal condition that affects the external genitalia and perineum as a necrotizing soft-tissue infection. It is equally prevalent in men and women and although there are many ways to manage the condition, it must be done so effectively because there is a chance that life-threatening complications could develop. This retrospective study set out to fill any knowledge gaps, compare reconstructive options to those described in the literature, and promote reflection on current management. Between January 2010 and January 2020, all perineal debridement operation notes were examined. The primary conclusions were that a large majority of defects could be repaired using split skin grafts to reduce surgical time and donor site morbidity. To avoid secondary contracture and the need for revision surgery, full-thickness skin grafts should be used whenever possible to treat penile defects. [ABSTRACT FROM AUTHOR]

Objectives: Geriatric depression is difficult to treat and frequently accompanied by treatment resistance, suicidal ideations and polypharmacy. New adjunctive mind-body treatment strategies can improve clinical outcomes in geriatric depression and reduce risk for side-effects of pharmacological treatments.Methods: We conducted a 3-month randomized controlled trial to assess the efficacy and tolerability of combining Tai Chi Chih (TCC) or Health Education and Wellness training (HEW) with the stable standard antidepressant treatment on mood and cognitive functioning in depressed older adults (NCT02460666). Primary outcome was change in depression as assessed by the Hamilton Rating Scale for Depression (HAM-D) post-treatment. Remission was defined as HAM-D ≤ 6; naturalistic follow-up continued for 6 months. We also assessed psychological resilience, health-related quality of life and cognition.Results: Of the 178 randomized participants, 125 completed the 3-month assessment and 117 completed the 6-month assessment. Dropout and tolerability did not differ between groups. Remission rate within TCC was 35.5% and 33.3%, compared to 27.0% and 45.8% in HEW, at 3 and 6 months respectively (χ2(1) = 1.0, p = 0.3; χ2(1) = 1.9, p =0.2). Both groups improved significantly on the HAM-D at 3 and 6 months. TCC demonstrated a greater improvement in general health compared to HEW.Conclusions: Both TCC and HEW combined with a standard antidepressant treatment improved symptoms of depression in older adults. While TCC was superior to HEW in improving general health, we did not find group differences in improvement in mood and cognition. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical outcomes following dorsal buccal mucosal graft urethroplasty (BMGU) in perimenopausal women (PMW) suffering from urethral stricture disease. Materials and Methods: PMW (40-65 years) presenting with urinary symptoms were evaluated with uroflowmetry, voiding cystourethrogram (VCUG), and urethral calibration. PMW with maximum flow rate (Qmax) less than 10 ml/s or postvoid residual (PVR) volume greater than 50 ml, VCUG showing evidence of urethral stricture, and failure to calibrate with 14 Fr Foley catheter were included in the study. Patients with underactive bladder, carcinoma cervix, pelvic trauma, and oral submucosal fibrosis were excluded from the study. Patients satisfying inclusion and exclusion criteria underwent dorsal BMGU. Outcomes of the surgery were assessed by uroflowmetry at 3-monthly intervals. Results: The number of patients satisfying the inclusion and exclusion criteria between March 2014 and March 2020 was eight. The mean age of the patients was 52.1 years. The mean stricture length was 1.9 cm. The mean preoperative Qmax and PVR were 4.2 ml/s and 110 ml, respectively. The mean postoperative Qmax and PVR at 6 months were 15.4 ml/s and 39.1 ml, respectively. One patient had a recurrent stricture and underwent dilatation. Donor site complications were minor. The overall success rate of the procedure was 87%. Conclusion: Dorsal BMGU in females for urethral stricture disease offers successful urethral reconstruction and the advantage of least disruption of continence mechanism and resilience to hormonal changes in PMW. [ABSTRACT FROM AUTHOR]

Hand hygiene is an essential component of infection prevention in the health care setting. Despite diligent efforts, clinicians can be susceptible to hand hygiene misses in fast-paced, complex environments such as the operating room due to systemic factors such as the physical environment, workflow, and sporadic interactions with other personnel. Through the use of human factors and resilience engineering concepts, work-as-done were studied to identify barriers to hand hygiene compliance in the operating rooms of a pediatric hospital in an urban area. The saliency, effort, expectancy, value model was applied to design a multifaceted intervention that resulted in a sustained 95% hand hygiene compliance. [ABSTRACT FROM AUTHOR]