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The article focuses on the dilemma of health insurance companies assuming an increasingly intrusive role in managing patients healthcare decisions, undermining doctors authority and eroding the doctor-patient relationship. Topics include the insurance companies attempts to manage healthcare, obtain confidential patient information, and create additional administrative burdens for doctors and their staff.

The author gives recognition to a woman in their community named Nila Martin, who delivered newspapers for 50 years on the same route and was honored for her service as a newspaper carrier. Several good deeds made by Martin while on her route included hauling garbage cans, helping free animals when stuck in blueberry bushes, and talking to children as they get off their school busses.

The author describes a personal observation on the interaction of a young woman stocking vegetables with an elderly gentleman using a walker. It shows the change in the woman's face and demeanor when she was approached with a friendly greeting by the man and how they engaged in a discussion with laughter between them.

We examined the pupping phenology and genetic variation between the currently defined stocks of harbor seals, Phoca vitulina richardsi (Gray, 1864), in Washington’s coastal and inland waters and looked in detail at genetic variation within the inland waters of Washington. We analyzed mtDNA variation in 552 harbor seals from nine areas in Washington State and the Canada-US transboundary waters. A total of 73 haplotypes were detected; 37 individuals had unique haplotypes. Pupping phenology and levels of genetic variation between the outer coastal stock (WA Coastal Estuaries, WA North Coast) and the inland waters stock (British Columbia, Boundary Bay, San Juan Islands, Smith/Minor Islands, Dungeness Spit, Hood Canal, Gertrude Island) corroborated the appropriateness of the present stock boundary. However, within the inland waters stock, Hood Canal and Gertrude Island were significantly different from the coastal stock, from the rest of the inland waters stock, and from each other. This indicates a total of four genetically distinct groups in Washington State, suggesting that managing the inland waters as a single stock may be erroneous. [ABSTRACT FROM AUTHOR]

Abstract: Humans and monkeys mislocalize targets flashed around the time of a saccade. Here, we present data from three monkeys on a double-step task with a 100ms target duration. All three subjects mislocalized targets that were flashed around the time of the first saccade, in spite of long intersaccadic intervals. The error was consistently in the direction opposite that of the saccade, and occurred in some cases when the target presentation was entirely presaccadic. This is inconsistent with a theory invoking a damped representation of eye position, but it is consistent with the hypothesis that it is due to an error in peri-saccadic remapping. [Copyright &y& Elsevier]

Persistent organic pollutants are environmental contaminants that, because of their lipophilic properties and long half-lives, bioaccumulate within aquatic food webs and often reach high concentrations in marine mammals, such as harbor seals (Phoca vitulina) . Exposure to these contaminants has been associated with developmental abnormalities, immunotoxicity, and reproductive impairment in marine mammals and other high-trophic-level wildlife, mediated via a disruption of endocrine processes. The highly conserved thyroid hormones (THs) represent one vulnerable endocrine end point that is critical for metabolism, growth, and development in vertebrates. We characterized the relationship between contaminants and specific TH receptor (TR) gene expression in skin/blubber biopsy samples, as well as serum THs, from free-ranging harbor seal pups (n = 39) in British Columbia, Canada, and Washington State, USA. We observed a contaminant-related increase in blubber TR-alpha gene expression [total polychlorinated biphenyls (capital sigmaPCBs) ; r = 0.679 ; p < 0.001] and a concomitant decrease in circulating total thyroxine concentrations (capital sigmaPCBs ; r = -0.711 ; p < 0.001) . Consistent with results observed in carefully controlled laboratory and captive feeding studies, our findings suggest that the TH system in harbor seals is highly sensitive to disruption by environmental contaminants. Such a disruption not only may lead to adverse effects on growth and development but also could have important ramifications for lipid metabolism and energetics in marine mammals. Key words: endocrine disruption, gene expression, marine mammal, PCBs, persistent organic pollutant, polychlorinated biphenyls, POP, seal, thyroid, thyroid hormone receptor. [ABSTRACT FROM AUTHOR]

This study examines regret and psychological well-being among 72 middle-aged and older women who are either voluntarily childless, involuntarily childless, or mothers. Group comparisons indicate that, when compared to involuntarily childless women, voluntarily childless women show higher levels of overall well-being, rate themselves as more autonomous with greater environmental mastery, and are less likely to have a child-related regret. An unexpected finding is that about one-third of women categorized by researchers as involuntarily childless indicate that they are 'childless by choice.' These women report making an active decision to accept the childless lifestyle and focus on the future, in essence exerting control over their situations. Results from this small and selective sample should be interpreted cautiously. However, they do suggest that researchers' definitions of childlessness may not map directly onto those of participants, and they emphasize the importance of ascertaining respondents' perceptions of control over their situations. [ABSTRACT FROM AUTHOR]

It is now widely acknowledged that autologous leucocytes are inappropriately activated during cardiopulmonary bypass (CPB). Removal of these activated leucocytes has been proposed as a clinical intervention. Several papers have recently reported benefits of systemic leucocyte depletion during CPB. There is also evidence that leucocyte-depleted blood cardioplegia is advantageous in the globally ischaemic human heart transplant setting. Recently, a new leucocyte-depleting filter for blood cardioplegia has been developed (Pall, BC1). In this paper, we report on the safety and efficiency of this device in the clinical situation. Fourteen patients undergoing routine cardiac surgery were recruited into this study. The BC1 blood cardioplegia filter was found to be an efficient leucocyte-depleting device, removing in excess of 70% (p = 0.001) of white blood cells, on average, from up to 5.3 litres of blood cardioplegia. The filter removed a small proportion of platelets (typically 11.3%), however, this was not statistically significant and no bleeding problems were encountered. Red cell removal was negligible and was not statistically significant, and no evidence of haemolysis was noted. The filter offered a very low resistance to flow with a mean pressure drop (deltaP) of 10.8 mmHg at a mean flow rate of 315 ml/min. We conclude that the Pall BC1 filter is a safe and efficient device for use with blood cardioplegia. [ABSTRACT FROM AUTHOR]

It is now widely acknowledged that autologous leucocytes are inappropriately activated during cardiopulmonary bypass (CPB). Removal of these activated leucocytes has been proposed as a clinical intervention. Several papers have recently reported benefits of systemic leucocyte depletion during CPB. There is also evidence that leucocyte-depleted blood cardioplegia is advantageous in the globally ischaemic human heart transplant setting. Recently, a new leucocyte-depleting filter for blood cardioplegia has been developed (Pall, BC1). In this paper, we report on the safety and efficiency of this device in the clinical situation. Fourteen patients undergoing routine cardiac surgery were recruited into this study. The BC1 blood cardioplegia filter was found to be an efficient leucocyte-depleting device, removing in excess of 70% (p = 0.001) of white blood cells, on average, from up to 5.3 litres of blood cardioplegia. The filter removed a small proportion of platelets (typically 11.3%), however, this was not statistically significant and no bleeding problems were encountered. Red cell removal was negligible and was not statistically significant, and no evidence of haemolysis was noted. The filter offered a very low resistance to flow with a mean pressure drop (DeltaP) of 10.8 mmHg at a mean flow rate of 315 ml/min. We conclude that the Pall BC1 filter is a safe and efficient device for use with blood cardioplegia. [ABSTRACT FROM AUTHOR]

Cereal cyst nematode (CCN) (Heterodera avenae Woll.) is an economically damaging pest of barley in many of the worlds cereal growing areas. The development of CCN-resistant cultivars may be accelerated with the application of molecular markers. Three resistance genes against the pest have been mapped previously to chromosome 2 (Ha1, Ha2 and Ha3). In this study, a third gene present in the Australian barley variety 'Galleon' derived from the landrace 'CI3576' was located. Segregation analysis of CCN resistance data derived from doubled haploid populations of the cross 'Haruna Nijo' x 'Galleon' identified a single major locus controlling CCN resistance in the variety 'Galleon'. This locus mapped to the long arm of chromosome 5H estimated to be 6.2 cM from the known function restriction fragment length polymorphism marker XYL (xylanase). While five genes for CCN resistance, including Ha2, have been mapped to group 2 chromosomes in the Triticeae, no gene other than Ha4 has been identified on group 5 chromosomes. [ABSTRACT FROM AUTHOR]

The article offers information on a disturbing incident in a waiting room where a young mother's harsh and fearful response to her curious and active child instilled fear in the child and stifled his natural curiosity and liveliness. It discusses that this interaction highlights the destructive effects of such parenting behaviors on a child's development; and leading to a loss of his natural liveliness and social interest.

Presents an abstract of the article "Hyperdiploid Acute Lymphoblastic Leukaemia in Identical Twins," by Mark Pomfret, M. D. Williams, R. G. Evans, J. Walker, S. J. Jeffries, S. Akiki, M. J. Griffiths, E. V. Davison.

Abstract: The potential benefits of epidural anesthesia on mortality, atrial fibrillation, and pulmonary complications must be weighed against the risk of epidural hematoma associated with intraoperative heparinization. This study aims to provide an updated assessment of the clinical risks of epidural anesthesia in cardiac surgery, focusing on the occurrence of epidural hematomas and subsequent paralysis. A systematic search of Embase, Medline, Ovid Central, Web of Science, and PubMed was conducted to identify relevant publications between 1966 and 2022. Two independent reviewers assessed the eligibility of the retrieved manuscripts. Studies reporting adult patients undergoing cardiac surgery with epidural catheterization were included. The incidence of hematomas was calculated by dividing the number of hematomas by the total number of patients in the included studies. Risk calculations utilized various denominators based on the rigor of trial designs, and the risks of hematoma and paralysis were compared to other commonly encountered risks. The analysis included a total of 33,089 patients who underwent cardiac surgery with epidural catheterization. No epidural hematomas were reported across all published RCTs, prospective, and retrospective trials. Four case reports associated epidural hematoma with epidural catheterization and perioperative heparinization. The risks of epidural hematoma and subsequent paralysis were estimated at 1:7643 (95% CI 1:3860 to 380,916) and 1:10,190 (95% CI 1:4781 to 0:1), respectively. The risk of hematoma is similar to the non-obstetric population (1:5405; 95% CI 1:4784 to 6134). The risk of hematoma in cardiac surgery patients receiving epidural anesthesia is therefore similar to that observed in some other surgical non-obstetric populations commonly exposed to epidural catheterization., (Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.)

Anesthesia objectives have evolved into combining hypnosis, amnesia, analgesia, paralysis, and suppression of the sympathetic autonomic nervous system. Technological improvements have led to new monitoring strategies, aimed at translating a qualitative physiological state into quantitative metrics, but the optimal strategies for depth of anesthesia (DoA) and analgesia monitoring continue to stimulate debate. Historically, DoA monitoring used patient's movement as a surrogate of awareness. Pharmacokinetic models and metrics, including minimum alveolar concentration for inhaled anesthetics and target-controlled infusion models for intravenous anesthesia, provided further insights to clinicians, but electroencephalography and its derivatives (processed EEG; pEEG) offer the potential for personalization of anesthesia care. Current studies appear to affirm that pEEG monitoring decreases the quantity of anesthetics administered, diminishes postanesthesia care unit duration, and may reduce the occurrence of postoperative delirium (notwithstanding the difficulties of defining this condition). Major trials are underway to further elucidate the impact on postoperative cognitive dysfunction. In this manuscript, we discuss the Bispectral (BIS) index, Narcotrend monitor, Patient State Index, entropy-based monitoring, and Neurosense monitor, as well as middle latency evoked auditory potential, before exploring how these technologies could evolve in the upcoming years. In contrast to developments in pEEG monitors, nociception monitors remain by comparison underdeveloped and underutilized. Just as with anesthetic agents, excessive analgesia can lead to harmful side effects, whereas inadequate analgesia is associated with increased stress response, poorer hemodynamic conditions and coagulation, metabolic, and immune system dysregulation. Broadly, 3 distinct monitoring strategies have emerged: motor reflex, central nervous system, and autonomic nervous system monitoring. Generally, nociceptive monitors outperform basic clinical vital sign monitoring in reducing perioperative opioid use. This manuscript describes pupillometry, surgical pleth index, analgesia nociception index, and nociception level index, and suggest how future developments could impact their use. The final section of this review explores the profound implications of future monitoring technologies on anesthesiology practice and envisages 3 transformative scenarios: helping in creation of an optimal analgesic drug, the advent of bidirectional neuron-microelectronic interfaces, and the synergistic combination of hypnosis and virtual reality., Competing Interests: Conflicts of Interest: See Disclosures at the end of the article., (Copyright © 2023 International Anesthesia Research Society.)

Proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are commonly used medications in neonates and infants for the treatment of gastroesophageal reflux disease (GERD), especially in neonatal intensive care units (NICUs). A literature review was conducted to evaluate the efficacy and safety of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) in preterm neonates, term neonates, and infants. A total of 27 studies were included in this review. Antacid medications in studies have consistently shown positive pharmacodynamic effects, including increasing gastric pH, reducing the reflux index, and reducing the number of acidic reflux events. The benefit found in placebo-controlled trials are limited exclusively to these surrogate outcomes. The actual clinically salient outcomes which H2RAs and PPIs are used for, such as reduction in GERD symptoms, especially irritability and improved feed tolerance and weight gain, have consistently shown no clinical benefit. H2RAs and PPIs appear to be extremely well tolerated by the neonatal and infant populations, which would mimic our experience with these medications in our unit. The available data from large, retrospective cohort and case-control studies paint a much more concerning picture regarding the potential for an increased risk in the development of allergies, anaphylactic reactions, necrotizing enterocolitis (NEC), other nosocomial infections, and lower respiratory tract infections. Given the risks associated with and lack of clinical effectiveness of both H2RAs and PPIs, use of these medications should be limited to specific clinical situations. Further studies are required to determine whether antacid pharmacologic therapy might benefit certain neonates and infants, such as those with complex medical issues., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Half of the myelodysplastic syndromes (MDS) have normal karyotype by conventional banding analysis. The percentage of true normal karyotype cases can be reduced by 20-30% with the complementary application of genomic microarrays. We here present a multicenter collaborative study of 163 MDS cases with a normal karyotype (≥10 metaphases) at diagnosis. All cases were analyzed with the ThermoFisher® microarray (either SNP 6.0 or CytoScan HD) for the identification of both copy number alteration(CNA) and regions of homozygosity (ROH). Our series supports that 25 Mb cut-off as having the most prognostic impact, even after adjustment by IPSS-R. This study highlights the importance of microarrays in MDS patients, to detect CNAs and especially to detect acquired ROH which has demonstrated a high prognostic impact., Competing Interests: The authors declare they have no conflicts of interest., (© 2023 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.)

Probody therapeutics (Pb-Txs) are conditionally activated antibody-drug conjugates (ADCs) designed to remain inactive until proteolytically activated in the tumor microenvironment, enabling safer targeting of antigens expressed in both tumor and normal tissue. Previous attempts to target CD71, a highly expressed tumor antigen, have failed to establish an acceptable therapeutic window due to widespread normal tissue expression. This study evaluated whether a probody-drug conjugate targeting CD71 can demonstrate a favorable efficacy and tolerability profile in preclinical studies for the treatment of cancer. CX-2029, a Pb-Tx conjugated to maleimido-caproyl-valine-citrulline-p-aminobenzyloxycarbonyl-monomethyl auristatin E, was developed as a novel cancer therapeutic targeting CD71. Preclinical studies were performed to evaluate the efficacy and safety of this anti-CD71 PDC in patient-derived xenograft (PDX) mouse models and cynomolgus monkeys, respectively. CD71 expression was detected at high levels by IHC across a broad range of tumor and normal tissues. In vitro, the masked Pb-Tx form of the anti-CD71 PDC displayed a >50-fold reduced affinity for binding to CD71 on cells compared with protease-activated, unmasked anti-CD71 PDC. Potent in vivo tumor growth inhibition (stasis or regression) was observed in >80% of PDX models (28/34) at 3 or 6 mg/kg. Anti-CD71 PDC remained mostly masked (>80%) in circulation throughout dosing in cynomolgus monkeys at 2, 6, and 12 mg/kg and displayed a 10-fold improvement in tolerability compared with an anti-CD71 ADC, which was lethal. Preclinically, anti-CD71 PDC exhibits a highly efficacious and acceptable safety profile that demonstrates the utility of the Pb-Tx platform to target CD71, an otherwise undruggable target. These data support further clinical development of the anti-CD71 PDC CX-2029 as a novel cancer therapeutic., (©2022 The Authors; Published by the American Association for Cancer Research.)

Background: Preterm infants receiving a diet of exclusive human milk compared to predominantly preterm formula have lower weight and non-adipose tissue mass by term. Human milk fortification is recommended. However, it is not known if the protein source affects body composition., Aims: To compare the effect of an exclusive human milk based diet (intervention) with a diet containing cow milk products (control) on body composition., Participants: Infants born below 30 weeks gestation., Study Design: Randomised multicentre, open label, controlled trial. Infants preferentially received their own mother's milk. Infants were randomised to either an exclusive human milk diet (human milk formula to make up a shortfall in own mother's milk and human milk derived fortifier) or cow milk-based supplementation (preterm formula to make up a shortfall in own mother's milk and cow milk-based fortifier). Fortification began at an enteral intake of 150 ml/kg/day. Infants underwent whole-body magnetic resonance imaging at term., Primary Outcome: Body composition (adipose tissue (ATM) and non-adipose tissue mass (N-ATM)) at term., Results: We randomly assigned 38 infants to intervention (n = 19) and control arms (n = 19). Primary outcomes were analysed in 15 infants in the intervention arm and 12 in the control arm. The estimates of the effect of the intervention following adjustment for length and sex, were non-significant (ATM (kg): 0.137, 95 % confidence interval (CI) -0.01, 0.29; N-ATM: -0.137; -0.01, 0.29)., Conclusions: We identified no clinically relevant differences in body composition in preterm babies <30 weeks gestation receiving a macronutrient-equivalent exclusive human milk diet compared with a diet containing cow milk products., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Bariatric surgery presents a specific challenge in surgical education; simulators need to take into account the specific technical difficulties related to the patient population but also to various types of surgery. We interviewed several leaders in the fields of bariatric and general surgery with experience in laparoscopic surgery and developed a bariatric-specific laparoscopic simulator. This novel simulator was constructed using a variety of silicone-based materials and 3D printing techniques to be reusable and adjustable for a variety of procedures, with no essential components being disposed of following each use. Expert surgeons (n=4) with knowledge on bariatric procedures were recruited and asked to perform a simple simulated laparoscopic procedure. Following testing, participants were asked to complete a survey and rate the simulator based on its physical attributes, global realism, usefulness in improving surgical skills, and overall surgical experience. Face and content validation outcomes based on the questionnaire evaluations completed by expert surgeons showed very good results, with an overall mean score of 4.3 out of 5 (86%). These preliminary results highlight the potential for the simulator's application as a tool to improve bariatric surgical education and patient outcomes.

Marine trophic ecology data are in high demand as natural resource agencies increasingly adopt ecosystem-based management strategies that account for complex species interactions. Harbour seal (Phoca vitulina) diet data are of particular interest because the species is an abundant predator in the northeast Pacific Ocean and Salish Sea ecosystem that consumes Pacific salmon (Oncorhynchus spp.). A multi-agency effort was therefore undertaken to produce harbour seal diet data on an ecosystem scale using, 1) a standardized set of scat collection and analysis methods, and 2) a newly developed DNA metabarcoding diet analysis technique designed to identify prey species and quantify their relative proportions in seal diets. The DNA-based dataset described herein contains records from 4,625 harbour seal scats representing 52 haulout sites, 7 years, 12 calendar months, and a total of 11,641 prey identifications. Prey morphological hard parts analyses were conducted alongside, resulting in corresponding hard parts data for 92% of the scat DNA samples. A custom-built prey DNA sequence database containing 201 species (192 fishes, 9 cephalopods) is also provided., (© 2022. The Author(s).)