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BACKGROUND: Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls. METHODS AND RESULTS: Consecutive HTx recipients between March 2015 and March 2021 who underwent routine surveillance CMR imaging were included. Cardiac mechanics were assessed using CMR feature tracking to compute global longitudinal strain, global circumferential strain, and right ventricular free-wall longitudinal myocardial strain. Fibrosis was assessed using late gadolinium enhancement imaging and estimation of extracellular volume. There were 82 (DBD n = 42, DCD n = 40) HTx recipients (aged 53 years, interquartile range 41-59 years, 24% female) who underwent CMR imaging at median of 9 months (interquartile range 6-14 months) after transplantation. HTx recipients had increased extracellular volume (29.7 ± 3.6%) compared with normal ranges (25.9%, interquartile range 25.4-26.5). Myocardial strain was impaired after transplantation compared with controls (global longitudinal strain -12.6 ± 3.1% vs -17.2 ± 1.8%, P < .0001; global circumferential strain -16.9 ± 3.1% vs -19.2 ± 2.0%, P = .002; right ventricular free-wall longitudinal strain -15.7 ± 4.5% vs -21.6 ± 4.7%, P < .0001). There were no differences in fibrosis burden (extracellular volume 30.6 ± 4.4% vs 29.2 ± 3.2%; P = .39) or cardiac mechanics (global longitudinal strain -13.1 ± 3.0% vs -12.1 ± 3.1%, P = .14; global circumferential strain -17.3 ± 2.9% vs -16.6 ± 3.1%, P = .27; right ventricular free-wall longitudinal strain -15.9 ± 4.9% vs -15.5 ± 4.1%, P = .71) between DCD and DBD HTx. CONCLUSIONS: HTx recipients have impaired cardiac mechanics compared with controls, with increased myocardial fibrosis. There were no differences in early CMR imaging characteristics between DBD and DCD heart transplants, providing further evidence that DCD and DBD HTx outcomes are comparable.

Assistive technology for older people promises much, but the research evidence suggests that it delivers little. One hypothesis to explain the lack of positive impact is that assistive technology is often implemented with little involvement of older people or other stakeholders, such as family members or care staff. The suggestion is that co-production may ensure that assistive technology solutions are better tailored to people's needs, capacities and living situations. In this article, we review existing studies to examine what works in co-production in relation to processes of design and implementation of assistive technology for older people. Our results show a growing interest in co-production as an approach in this field, with a wide range of approaches being employed. We highlight a number of key lessons from the research, including key issues around who needs to be engaged in the co-production, as well as essential elements of the process itself. Our review suggests that there is considerable potential in using co-production to improve effectiveness of technological solutions to the challenges of age-related impairments. However, we also emphasise the need for more longitudinal research in this area, to examine whether such collaborative approaches can truly deliver the promise of assistive technology for older people.

Purpose: To examine the construct validity and reliability of 2 single items for fatigue and recovery in dancers. The construct validity was assessed using reference instruments: the fatigue items of the Brunel Mood Scale (BRUMS) and the Short Recovery and Stress Scale (SRSS). A secondary aim was to explore the respondent interpretation of these 2 items using a concept identification approach. Methods: Two hundred forty-three (N = 243) dancers completed single-item fatigue and recovery (unipolar and bipolar), BRUMS, and SRSS once for construct validity. For reliability, 49 dancers completed the questionnaires twice, 1 week apart. Using a concept identification approach, 49 dancers were also asked comprehension and interpretation of fatigue and recovery. Results: The fatigue item correlated with SRSS stress items (rs = .37–.51) and BRUMs fatigue items (rs = .63–.66). The recovery item was only partially confirmed in terms of construct validity, when using the SRSS recovery items as reference (rs = .39–.43). Reliability was confirmed for the single items of fatigue (κ = .77–.78) and recovery (κ = .71–.78). Main responses for the concept of fatigue were tiredness (34.7%), muscle soreness (17.3%), and energy (13.0%). Main responses for the concept of recovery were muscle soreness (43.0%), tiredness (27.9%), and fatigue (24.0%). Conclusion: We provide preliminary confirmation of the validity and reliability of the single item fatigue in dancers. The recovery item was only partially confirmed in terms of construct validity, when using the SRSS recovery items as reference, but did display acceptable reliability and agreement. Further research is warranted further exploring other measurement properties.

Despite the many mistakes we make while speaking, people can effectively communicate because we monitor our speech errors. However, the cognitive abilities and brain structures that support speech error monitoring are unclear. There may be different abilities and brain regions that support monitoring phonological speech errors versus monitoring semantic speech errors. We investigated speech, language, and cognitive control abilities that relate to detecting phonological and semantic speech errors in 41 individuals with aphasia who underwent detailed cognitive testing. Then, we used support vector regression lesion symptom mapping to identify brain regions supporting detection of phonological versus semantic errors in a group of 76 individuals with aphasia. The results revealed that motor speech deficits as well as lesions to the ventral motor cortex were related to reduced detection of phonological errors relative to semantic errors. Detection of semantic errors selectively related to auditory word comprehension deficits. Across all error types, poor cognitive control related to reduced detection. We conclude that monitoring of phonological and semantic errors relies on distinct cognitive abilities and brain regions. Furthermore, we identified cognitive control as a shared cognitive basis for monitoring all types of speech errors. These findings refine and expand our understanding of the neurocognitive basis of speech error monitoring.

For years, Amazon, a widely known and popular e-commerce enterprise and online marketplace, has provided consumers with a stress-free, simple approach to online shopping. The company offers customers the option to order products online or on an app and have them delivered directly to their door in no time at all. For years, Amazon has allowed third-party vendors access to its site for marketing and selling products to consumers.In recent years, instances have arisen where defective products sold on Amazon by third-party vendors have led to the injury of consumers. Often, the third-party vendors are suspicious entities who are challenging to locate and even more difficult to pursue legal recourse against for damages. By arguing that it merely provides a platform for these vendors to market their products to a wider-reaching consumer base, the E-commerce giant argues it is exempt from liability for consumers’ injuries since it is not the seller of the product that caused harm.Recently, a landmark case decided by the Supreme Court of Texas determined that Amazon could not be held liable for a defective product for which it never had or relinquished the title. This Note discusses why Amazon should be considered the “owner” of all products delivered to consumers via Amazon packaging by reviewing persuasive authority from other jurisdictions that found Amazon could be held liable. Additionally, it discusses other potential options for Amazon to pursue to help its customers more clearly identify suspicious vendors before purchasing products that could be defective. This Note ultimately argues that the Supreme Court of Texas set a precedent in the recently decided case of Amazon Incorporated v. McMillan that leaves customers no option for recovery when the third-party vendor is unreachable.

Although some lab studies suggest older adults rely more on attentional deployment to regulate their emotions, little is known about age differences in specific attention deployment tactic use and how they relate to mood regulation in everyday life. The current longitudinal experience sampling study considered several different attention deployment tactics, such as shifting or focusing attention to positive and negative elements either internally or externally (thoughts and feelings vs. external environment). Younger, middle-aged, and older adults (

Objectives The relationship of degeneration to symptoms has been questioned. MRI detects apparently similar disc degeneration and degenerative changes in subjects both with and without back pain. We aimed to overcome these problems by re-annotating MRIs from asymptomatic and symptomatics groups onto the same grading system. Methods We analysed disc degeneration in pre-existing large MRI datasets. Their MRIs were all originally annotated on different scales. We re-annotated all MRIs independent of their initial grading system, using a verified, rapid automated MRI annotation system (SpineNet) which reported degeneration on the Pfirrmann (1–5) scale, and other degenerative features (herniation, endplate defects, marrow signs, spinal stenosis) as binary present/absent. We compared prevalence of degenerative features between symptomatics and asymptomatics. Results Pfirrmann degeneration grades in relation to age and spinal level were very similar for the two independent groups of symptomatics over all ages and spinal levels. Severe degenerative changes were significantly more prevalent in discs of symptomatics than asymptomatics in the caudal but not the rostral lumbar discs in subjects Conclusions We confirmed age and disc level are significant in determining imaging differences between asymptomatic and symptomatic populations and should not be ignored. Automated analysis, by rapidly combining and comparing data from existing groups with MRIs and information on LBP, provides a way in which epidemiological and ‘big data’ analysis could be advanced without the expense of collecting new groups. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Purpose: This study investigated the association between (1) time zone difference and (2) travel direction (east vs west) with posttravel changes in perceptual responses of national-team footballers. Methods: Travel schedules from 355 national-team trips (50 elite soccer players) were verified using an online flight database. All players provided perceptual ratings of fatigue, sleep quality, soreness, and stress to calculate changes in scores up to 2 days after travel. Trips were categorized as Results: For every time zone crossed, poorer ratings of perceptual fatigue (β = 0.068, P β = 0.095, P β = 0.0049, P β = 0.214, P P β = 0.52, P Conclusions: Perceptual ratings of fatigue and sleep become progressively worse as travel increases in national-team soccer players, especially after travel across 9+ time zones and eastward travel.

Background Athlete monitoring trends appear to be favouring objective over subjective measures. One reason of potentially several is that subjective monitoring affords athletes to give dishonest responses. Indeed, athletes have never been systematically researched to understand why they are honest or not. Objective Because we do not know what motivates professional athletes to be honest or not when responding to subjective monitoring, our objective is to explore the motives for why the athlete may or may not respond honestly. Methods A qualitative and phenomenological approach was used, interviewing 11 world-class team-sport athletes (five women, six men) about their experiences when asked to respond to subjective monitoring questionnaires. Interview transcripts were read in full and significant quotations/statements extracted. Meanings were formulated for each interviewees’ story and assigned codes. Codes were reflected upon and labelled as categories, with similar categories grouped into an overall theme. Themes were examined, articulated, re-interpreted, re-formulated, and written as a thematic story, drawing on elements reported from different athletes creating a blended story, allowing readers a feel for what it is like to live the experience. Results Overall, four key themes emerged: (i) pursuit of the ideal-self, (ii) individual barriers to athlete engagement, (iii) social facilitators to athlete engagement; and (iv) feeling compassion from performance staff. Conclusions Our main insight is that athletes’ emotions play a major role in whether they respond honestly or not, with these emotions being driven at least in part by the performance staff asking the questions.

Spinal cord stimulators (SCS) represent an effective treatment for patients with chronic pain issues. This study examines extremely obese patients (body mass index [BMI] ≥40) as appropriate surgical candidates for paddle lead SCS trial via partial thoracic laminectomy and whether obesity impacts implantation safety.A retrospective review of patients treated with partial thoracic laminectomy and paddle lead SCS trial between October 1, 2016 and September 30, 2019 was performed. The primary outcome was implantation safety (complication rate within minimum of 90 days) in patients with extreme obesity (BMI ≥40) compared with patients with BMI40 and secondary outcome was effectiveness (successful trial leading to final implantation). Seventy-three patients underwent SCS trial.Four (5.48%) patients developed complications with only 1 patient in the BMI ≥40 cohort (not statistically significant). Overall trial success rate was 82.2% (60/73) with statistically significant higher success rates among patients with a BMI ≥40 (93.3% vs. 74.4%, P = 0.0183).We conclude that paddle lead SCS trial in extremely obese patients is reasonable to offer with the expectation of similar safety concerns as those for patients with a lower BMI.

Solitary pulmonary nodules (SPNs) measuring 8 to 30 mm in diameter require further workup to determine the likelihood of malignancy.What is the diagnostic performance of a lung cancer prediction convolutional neural network (LCP-CNN) in SPNs using unenhanced and contrast-enhanced CT imaging compared with the current clinical workup?This was a post hoc analysis of the Single Pulmonary Nodule Investigation: Accuracy and Cost-Effectiveness of Dynamic Contrast Enhanced Computed Tomography in the Characterisation of Solitary Pulmonary Nodules trial, a prospective multicenter study comparing the diagnostic accuracy of dynamic contrast-enhanced (DCE) CT imaging with PET imaging in SPNs. The LCP-CNN was designed and validated in an external cohort. LCP-CNN-generated risk scores were created from the noncontrast and contrast-enhanced CT scan images from the DCE CT imaging. The gold standard was histologic analysis or 2 years of follow-up. The area under the receiver operating characteristic curves (AUC) were calculated using LCP-CNN score, maximum standardized uptake value, and DCE CT scan maximum enhancement and were compared using the DeLong test.Two hundred seventy participants (mean ± SD age, 68.3 ± 8.8 years; 49% women) underwent PET with CT scan imaging and DCE CT imaging with CT scan data available centrally for LCP-CNN analysis. The accuracy of the LCP-CNN on the noncontrast images (AUC, 0.83; 95% CI, 0.79-0.88) was superior to that of DCE CT imaging (AUC, 0.76; 95% CI, 0.69-0.82; P = .03) and equal to that of PET with CT scan imaging (AUC, 0.86; 95% CI, 0.81-0.90; P = .35). The presence of contrast resulted in a small reduction in diagnostic accuracy, with the AUC falling from 0.83 (95% CI, 0.79-0.88) on the noncontrast images to 0.80 to 0.83 after contrast (P .05 for 240 s after contrast only).An LCP-CNN algorithm provides an AUC equivalent to PET with CT scan imaging in the diagnosis of solitary pulmonary nodules.ClinicalTrials.gov Identifier; No.: NCT02013063.

To identify the similarities and differences in data-sharing policies for clinical trial data that are endorsed by biomedical journals, funding agencies, and other professional organizations. Additionally, to determine the beliefs, and opinions regarding data-sharing policies for clinical trials discussed in articles published in biomedical journals.Two searches were conducted, a bibliographic search for published articles that present beliefs, opinions, similarities, and differences regarding policies governing the sharing of clinical trial data. The second search analyzed the gray literature (non-peer-reviewed publications) to identify important data-sharing policies in selected biomedical journals, foundations, funding agencies, and other professional organizations.A total of 471 articles were included after database search and screening, with 45 from the bibliographic search and 426 from the gray literature search. A total of 424 data-sharing policies were included. Fourteen of the 45 published articles from the bibliographic search (31.1%) discussed only advantages specific to data-sharing policies, 27 (27/45; 60%) discussed both advantages and disadvantages, and 4 (4/45; 8.9%) discussed only disadvantages specific. A total of 216 journals (of 270; 80%) specified a data-sharing policy provided by the journal itself. One hundred industry data-sharing policies were included, and 32 (32%) referenced a data-sharing policy on their website. One hundred and thirty-six (42%) organizations (of 327) specified a data-sharing policy.We found many similarities listed as advantages to data-sharing and fewer disadvantages were discussed within the literature. Additionally, we found a wide variety of commonalities and differences-such as the lack of standardization between policies, and inadequately addressed details regarding the accessibility of research data-that exist in data-sharing policies endorsed by biomedical journals, funding agencies, and other professional organizations. Our study may not include information on all data sharing policies and our data is limited to the entities' descriptions of each policy.

Social media, particularly Twitter, has played an increasing role in networking and the dissemination of neurosurgical research. Despite extensive study on financial conflicts of interest (FCOI) influencing medical research, little is known about the function of conflicts of interest on social media and the influence they may have. In this study, we sought to evaluate the FCOI of physicians followed on Twitter by the top three neurosurgical journals.We analysed the FCOI of United States (US) physicians followed by the top three neurosurgical journals (Journal of Neurosurgery, World Neurosurgery, Neurosurgery) on Twitter. We determined the FCOIs of each physician using the Open Payments Search Tool located at https://openpaymentsdata.cms.gov and summed the data between 2014 and 2021.We examined 2651 Twitter accounts followed by the top three neurosurgical journals on Twitter and determined 705 (26.6%) belonged to US physicians. Of the 705 US physicians, 577 (81.8%) received general payments between 2014 and 2021. After excluding US physicians currently in residency or fellowship (n = 157), this percentage increased to 93.2% (n = 511/548). In total, nearly $70 million in general payments were made between 2014 and 2021.These findings raise questions regarding the interaction between neurosurgical journals and the medical community on Twitter. This study may serve as the basis for future work on best practices for medical journals navigating their affiliations on Twitter.

Although thoracic surgery is understood to confer a high risk of postoperative respiratory complications, the substantial haemodynamic challenges posed are less well appreciated. This review highlights the influence of cardiovascular comorbidity on outcome, reviews the complex pathophysiological changes inherent in one-lung ventilation and lung resection, and examines their influence on cardiovascular complications and postoperative functional limitation. There is now good evidence for the presence of right ventricular dysfunction postoperatively, a finding that persists to at least 3 months. This dysfunction results from increased right ventricular afterload occurring both intraoperatively and persisting postoperatively. Although many patients adapt well, those with reduced right ventricular contractile reserve and reduced pulmonary vascular flow reserve might struggle. Postoperative right ventricular dysfunction has been implicated in the aetiology of postoperative atrial fibrillation and perioperative myocardial injury, both common cardiovascular complications which are increasingly being appreciated to have impact long into the postoperative period. In response to the physiological demands of critical illness or exercise, contractile reserve, flow reserve, or both can be overwhelmed resulting in acute decompensation or impaired long-term functional capacity. Aiding adaptation to the unique perioperative physiology seen in patients undergoing thoracic surgery could provide a novel therapeutic avenue to prevent cardiovascular complications and improve long-term functional capacity after surgery.

Background and Context: Inspired by a photograph of the groundbreaking playwright Lorraine Hansberry that appeared in the New York Times following her unanticipated death in 1965, Nina Simone, pianist, singer-songwriter, and civil rights activist, carefully crafted “To Be Young, Gifted and Black,” a song that later became the anthem of the 1970s Black Power Movement. Like Hansberry, Simone sought to encourage cultural and ethnic pride among young African Americans who found themselves at the crossroads of an identity crisis and a national dismissal of their existence, both funded by racism. Today, African Americans attending predominantly White institutions (PWIs) continue to grapple with these challenges. Purpose/Objective/Research Question or Focus of Study: For this study, we aim to amplify the lived experiences and ontologies of Black music education doctoral students at predominantly White institutions (PWIs) and to identify and confront racialized structures, including dominant narratives that suggest Black folk and their epistemologies are inferior. We seek to add to current scholarship written by Black scholars about Black experiences, while also honoring Black music educators, music teacher educators, and scholars who have come before us and who will follow by speaking truth to power or rather “telling it like it is.” Research Design: We employ storytelling, a key tenet of critical race theory (CRT), to share our experiences of grappling with racialized encounters in four predominantly White doctoral music education programs, highlighting how these experiences impacted our Ph.D. journeys and how we wrestled with them. To examine our experiences, we use CRT in its entirety alongside musical renditions of “To Be Young, Gifted and Black” by Nina Simone, Donny Hathaway, The Heptones, and Aretha Franklin. Data detailing our experiences were collected through five 90-minute semistructured focus group conversations. Using CRT a priori codes and emergent codes, we delved into our narratives and how our intersectional identities along the lines of race and gender compounded the oppression we endured. Conclusions/Recommendations: Our research suggests that Black doctoral students in music education encounter a wealth of racialized structures along their journeys to degree completion. Not only did we grapple with identity politics, but we also wrestled with our White professors’ and peers’ “imagined cultural superiority” (Calmore, 1992, p. 2131). Among our efforts to realize our pathways forward, resistance and counterspace became salient for us in seizing our liberation and defying racism. Because PWIs continue to evade their responsibility in confronting their own racist social order, we fear that African Americans and other students of color will have no choice but to continue to negotiate spaces that are racially hostile and unjust. When PWIs decide to truly become antiracist, their agendas will include, but will not be limited to, reimagining admission and audition policies and practices, dismantling curricula that propagate the functions of Whiteness as property, and terminating racist social agents.

We analysed SARS-CoV-2 PCR Cq values from 3,183 healthcare workers who tested positive between January and August 2022. Median Cq values were lower in symptomatic than in asymptomatic HCW. The difference in Cq values between HCW with mild vs moderate/severe symptoms was statistically significant but negligibly small. To prevent nosocomial infections, all symptomatic HCW should be tested irrespective of symptom severity. This information can support decisions on testing and isolation, in the context of ongoing pressure on healthcare systems.

We thank Dr Renker and colleagues for their interest in our manuscript examining temporal trends in the utilisation of cardiovascular imaging and their association with costs and healthcare outcomes

Use of experimental cats and dogs in veterinary heartworm preclinical drug research is increasing. As a potential alternative primaryin vivoheartworm preventative drug screen, we assessed lymphopenic mice with ablation of the interleukin-2/7 common gamma chain (γc) as susceptible to the larval development phase ofD. immitis. Non-obese diabetic (NOD) Severe Combined ImmunoDeficient (SCID)γc-/-(NSG / NXG) mice consistently yielded viableD. immitislarvae at 2-4 weeks post-infection across multiple experiments, different batches of infectious larvae inoculates, different isolates ofD. immitisand at independent laboratories. Mice did not display any overt clinical signs associated with infection up to 4 weeks. Developing larvae were found in subcutaneous and muscle fascia tissues, the natural site of this stage of heartworm in dogs. Larvae retrieved from NSG / NXG mice were mid-L4 stage of development. Compared with 14-dayin vitropropagated larvae,in vivoderived L4 were significantly larger and contained expandedWolbachiaendobacteria titres, determined by QPCR and Fluorescentin situHybridisation (FISH). We established anex vivo6-day L4 paralytic screening system against nematodicidal agents (moxidectin, levamisole) which highlighted discrepancies in relative drug sensitivities in comparison within vitroreared L4D. immitis.We demonstrated effective depletion ofWolbachiaby 70-90% inD. immitisL4 following 2-7 day oralin vivoexposures of NSG / NXG infected mice with doxycycline or the rapid-acting investigational anti-Wolbachiadrug, AWZ1066S. We validated the NSG / NXG mouse model as a filaricide drug screen byin vivotreatments with single injections of moxidectin, which mediated 60-88% reduction in L4 larvae at 14-28 days. Future adoption of the mouse model as a first-line efficacy screen will benefit end-user laboratories conducting research and development of novel heartworm preventatives via increased access, rapid turnaround and reduced costs whilst simultaneously decreasing need for experimental cat or dog use.

Adalimumab is the only FDA-approved biologic for hidradenitis suppurativa (HS). In the setting of increasing obesity rates worldwide, the relationship between adalimumab efficacy for HS and BMI is essential to understand. We assessed this relationship through markers of disease severity and inflammation.Institutional review board-approved retrospective chart review of Montefiore/Einstein HS Center (HSC) patients (n = 57) treated with adalimumab. The relationship between BMI and adalimumab efficacy was assessed through disease severity (HS-Physician Global Assessment [HS-PGA] 0 and Numerical Rating Scale Pain [NRS-Pain]) and inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and interleukin-6 [IL-6]). A BMI ≥ 30 is defined as obese; BMI 30 is defined as non-obese.The mean age was 35.8 ± 13.0 years. After adalimumab therapy, those with BMI 30 experienced significant reductions in HS-PGA (-1.5 ± 0.9; P 0.0001) and NRS-Pain (-1.6 ± 2.1; P 0.0001), as well as mean decreases in inflammatory markers ESR, CRP, and IL-6 (-17.90 ± 23.6, -0.71 ± 1.4, -5.88 ± 7.9, respectively; P 0.05). Obese patients (BMI ≥ 30) experienced mean increases in HS-PGA (+0.22 ± 0.8; P 0.05) and NRS-Pain scores (+1.41 ± 3.5; P 0.05) as well as mean increases in ESR, CRP, and IL-6 (+2.62 ± 28.3, +0.44 ± 3.0, +2.35 ± 6.9, respectively; P 0.05). Comparing the cohorts, differences in changes in HS-PGA, NRS-Pain, ESR, and IL-6 after therapy are significantly different (P 0.05).We identified significantly lower efficacy of adalimumab in HS patients with BMI ≥ 30 compared to those with BMI 30. Those with BMI ≥ 30 demonstrated signs of both clinical and physiological deterioration while on adalimumab. Future studies are needed to examine adalimumab dosing for HS patients with high BMI, as well as a critical reconsideration of weight-based therapies.

To examine whether primary care physician (PCP) comprehensiveness is associated with Medicare beneficiaries' overall rating of care from their PCP and staff.We linked Medicare claims with survey data from Medicare beneficiaries attributed to Comprehensive Primary Care Plus (CPC+) physicians and practices.We performed regression analyses of the associations between two claims-based measures of PCP comprehensiveness in 2017 and beneficiaries' rating of care from their PCP and practice staff in 2018.The analytic sample included 6228 beneficiaries cared for by 3898 PCPs. Regressions controlled for beneficiary, physician, practice, and market characteristics.Beneficiaries with more comprehensive PCPs rated care from their PCP and practice staff higher than did those with less comprehensive PCPs. For each comprehensiveness measure, beneficiaries whose PCP was in the 75th percentile were more likely than beneficiaries whose PCP was in the 25th percentile to rate their care highly (2 percentage point difference, p = 0.02).Medicare beneficiaries with more comprehensive PCPs rate overall care from their PCPs and staff higher than those with less comprehensive PCPs.

Chronic thromboembolic pulmonary hypertension occurs in a proportion of patients with prior acute pulmonary embolism and is characterised by breathlessness, persistently raised pulmonary pressures and right heart failure. Surgical pulmonary endarterectomy (PEA) offers significant prognostic and symptomatic benefits for patients with proximal disease distribution. For those with inoperable disease, management options include balloon pulmonary angioplasty (BPA) and medical therapy. Current clinical practice relies on the evaluation of pulmonary haemodynamics to assess disease severity, timing of and response to treatment. However, pulmonary haemodynamics correlate poorly with patient symptoms, which are influenced by right ventricular tolerance of the increased afterload. How best to manage symptomatic patients with chronic thromboembolic pulmonary disease (CTEPD) in the absence of pulmonary hypertension is not resolved.Right ventricular–pulmonary artery coupling (RV-PAC) describes the energy transfer within the whole cardiopulmonary unit. Thus, it can identify the earliest signs of decompensation even before pulmonary hypertension is overt. Invasive measurement of coupling using pressure volume loop technology is well established in research settings. The development of efficient and less invasive measurement methods has revived interest in coupling as a viable clinical tool. Significant improvement in RV-PAC has been demonstrated after both PEA and BPA. Further studies are required to understand its clinical utility and prognostic value, in particular, its potential to guide management in patients with CTEPD. Finally, given the reported differences in coupling between sexes in pulmonary arterial hypertension, further work is required to understand the applicability of proposed thresholds for decoupling in therapeutic decision making.

While fine manual dexterity develops over time, the extent to which children show independent control of their digits in each hand and the impact of perinatal brain injury on this individuation have not been well quantified. Our goal in this study was to assess and compare finger force and movement individuation in 8–14 year old children with hemiplegic cerebral palsy (hCP; n = 4) and their typically developing peers (TD; n = 10). We evaluated finger force individuation with five independent load cells and captured joint movement individuation with video tracking. We observed no significant differences in individuation indices between the dominant and non-dominant hands of TD children, but individuated force and movement were substantially reduced in the paretic versus non paretic hands of children with hCP ( p < 0.001). In TD participants, the thumb tended to have the greatest level of independent control. This small sample of children with hCP showed substantial loss of individuation in the paretic hand and some deficits in the non-paretic hand, suggesting possible benefit from targeted training of digit independence in both hands for children with CP.

Vitamin D metabolites may be protective against prostate cancer (PCa). We conducted a cross-sectional analysis to evaluate associations between in vivo vitamin D status, genetic ancestry, and degree of apoptosis using prostatic epithelial terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining.Benign and tumor epithelial punch biopsies of participants with clinically localized PCa underwent indirect TUNEL staining. Serum levels of 25 hydroxyvitamin D [25(OH)D] and 1,25 dihydroxyvitamin D were assessed immediately before radical prostatectomy; levels of prostatic 25(OH)D were obtained from the specimen once the prostate was extracted. Ancestry informative markers were used to estimate the percentage of genetic West African, Native American, and European ancestry.One hundred twenty-one newly diagnosed men, age 40-79, were enrolled between 2013 and 2018. Serum 25(OH)D correlated positively with both tumor (ρ = 0.17, p = 0.03), and benign (ρ = 0.16, p = 0.04) prostatic epithelial TUNEL staining. Similarly, prostatic 25(OH)D correlated positively with both tumor (ρ = 0.31, p 0.001) and benign (ρ = 0.20, p = 0.03) epithelial TUNEL staining. Only Native American ancestry was positively correlated with tumor (ρ = 0.22, p = 0.05) and benign (ρ = 0.27, p = 0.02) TUNEL staining. In multivariate regression models, increasing quartiles of prostatic 25(OH)D (β = 0.25, p = 0.04) and Native American ancestry (β = 0.327, p = 0.004) were independently associated with tumor TUNEL staining.Physiologic serum and prostatic 25(OH)D levels and Native American ancestry are positively associated with the degree of apoptosis in tumor and benign prostatic epithelium in clinically localized PCa. Vitamin D may have secondary chemoprevention benefits in preventing PCa progression in localized disease.