Search

Interval training has been found to lower glucose concentrations and increase insulin sensitivity in males but not in females, which may be due to inherent sex-based differences in metabolism. Twenty-four (12/sex) participants completed a bout of high-intensity interval exercise (HIIE, 10 × 1 min at 90% HRmax) to evaluate whether sex influenced the physiological effects of HIIE on postexercise glycemic control during an oral glucose tolerance test (OGTT). Given that body anthropometrics influence postprandial glucose, data were also expressed as a function of the normalized glucose dose. In addition, we examined whether sex differences in postexercise glycemic control were related to sex differences in muscle metabolism and/or insulin signaling proteins. HIIE increased insulin sensitivity in both sexes as characterized by the Matsuda ( P = 0.03, ηp2= 0.20) and HOMA-IR ( P = 0.047, ηp2 = 0.17) indices. HIIE also lowered insulin concentration during the OGTT ( P = 0.04, ηp2 = 0.18) as compared with control. When normalized for glucose dose relative to lean mass, glucose area under the curve (AUC) was lower in females than in males ( P ≤ 0.001, ηp2 = 0.47). TBC1D1 Ser237 phosphorylation increased in males, but not in females, postexercise ( P = 0.03, ηp2 = 0.19). There was no difference in total insulin signaling protein content, muscle glycogen utilization, or AMPK activation during exercise between the sexes. These findings indicate that when the glucose dose is normalized for differences in body composition glycemic handling is better in females and that an acute bout of HIIE improves insulin sensitivity equally in healthy males and females.

Occupational therapy is beneficial among adults with chronic pain; however, occupational therapy interventions addressing earlier phases of pain have not been clearly explicated. This systematic review characterized acute and subacute interventions billable by occupational therapy after hip or knee replacement to improve pain and function. Seven articles met inclusion criteria. Six articles had a low risk of bias. Three intervention types were found: task-oriented exercise, water-based, and modalities. Only task-oriented interventions improved both pain and function one-year after surgery. There are long-term benefits to early task-oriented exercise. Further research is needed to contextualize occupational therapy's role in early pain interventions.

Chemotherapy can result in toxic side effects in the brain. Intake of marine-based omega-3 polyunsaturated fatty acids (n-3 PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), alter brain fatty acids, potentially improving brain function. However, it is unclear if alpha-linolenic acid (ALA), the plant-based n-3, affects brain PUFAs during chemotherapy. The objective of this study was to examine the effects of dietary ALA, EPA and DHA, with high or low sucrose, on brain PUFAs in a mouse model of chemotherapy. Secondarily, the use of liver PUFAs as surrogate measures of brain PUFAs was examined. Lipid peroxidation (4-HNE) and neurotrophic markers (BDNF) were assessed. Female C57Bl/6 mice (n = 90) were randomized to 1 of 5 diets (high EPA + DHA/high or low sucrose, high ALA/high or low sucrose, or control with no EPA + DHA/low ALA/low sucrose) and injected with doxorubicin-based chemotherapy or saline. Brain EPA and DHA were greater (p < 0.0001) with high EPA + DHA diets, regardless of sucrose; there were no significant differences in brain PUFAs between high ALA diets and control. Chemotherapy-treated mice had higher brain and liver DHA (p < 0.05) and lower brain and liver linoleic acid (p < 0.0001). Brain n-3 and n-6 PUFAs were strongly correlated with liver n-3 (r = 0.8214, p < 0.0001) and n-6 PUFAs (r = 0.7568, p < 0.0001). BDNF was correlated with brain total PUFAs (r = 0.36; p < 0.05). In conclusion, dietary ALA in proportions approximately two times greater than consumed by humans did not appreciably increase brain n-3 PUFAs compared to low ALA intake. Liver PUFAs may be a useful surrogate marker of brain PUFAs in this mouse model.

Background: Co-curricular (CoC) activity tracking and assessment are required by the Accreditation Council for Pharmacy Education (ACPE) 2016 Standards. The purpose of this manuscript is to evaluate the student-perceived impact of the type of CoC activity chosen. Methods: First-year (P1) through third-year (P3) students in a 4-year Doctor of Pharmacy programme were required to complete two Professional Development Unit (PDUs) activities each semester and two Self-Selected Activities (SSAs) longitudinally through each academic year. PDUs include passive attendance at practitioner presentations, whereas SSAs require more active engagement, such as membership in professional organisations. Students completed surveys for each CoC activity. Survey responses for spring 2020, fall 2020, and spring 2021 were collected through ExamSoft and analysed with PowerBI (2021) and IntellectusStatisticsTM (2019). Results: Students reported positive perceptions for both PDUs and SSAs in the areas of being “different from prior experiences”, “complimenting the curriculum”, “increased my understanding of the profession”, and being of “high quality”. Professional organisation activities were the most commonly selected SSA. Those activities with lower perceived benefit were less clearly aligned with the professional role of a pharmacist, such as intramural sports. Conclusion: Overall, most CoC activities that closely aligned with the profession of pharmacy were perceived to complement the curriculum and enhance students’ understanding of the field. Students reported perceived value in both active and passive CoC activities.

To compare the efficacy and frequency of akathisia and dystonia between the dopamine antagonist headache medications olanzapine, metoclopramide and prochlorperazine.This was a retrospective observational cohort study of patients presenting to a large urban level one trauma center between 2010 and 2018. Inclusion criteria was age ≥ 18 who presented to the emergency department with a chief complaint of headache who received either olanzapine, metoclopramide or prochlorperazine. The primary outcome was need for rescue medication. Secondary outcomes were receiving medication for either akathisia or dystonia. Logistic regression was used to identify differences between the three cohorts up to 72 h from initial presentation.There were 5643 patients who met inclusion criteria. Olanzapine was the most commonly used drug (n = 2994, 53%) followed by prochlorperazine (n = 2100, 37%) and metoclopramide (n = 549, 10%). After adjusting for age and gender, there were no differences in risk for receiving rescue therapy or developing akathisia or dystonia.During initial ED visit and up to 72 h after receiving olanzapine, metoclopramide or prochlorperazine, we found no difference in risk for requiring rescue medication or developing akathisia or dystonia.

Tie-stalls are the most confining method of housing for dairy cows and remain commonly used to house cows in many countries. Finding methods to improve animal welfare through housing modifications and alternative management strategies are of increasing importance. Twelve tie-stall dairy farms in Ontario and Quebec, Canada were visited four times in a 12 month period. Visits were spread to observe the effects of pasture (visit 1), short-term effects of stall modifications (visit 2), effects of winter confinement (visit 3), and final measures after 1 year (visit 4). Lameness, injuries, cow cleanliness, lying and rising behaviors, and production parameters were assessed at each visit. Outdoor access had the largest effect: cows with access to pasture had a lower prevalence of various outcome measures throughout all four visits. Also, cows in modified stalls had a higher prevalence of dirty udders compared to cows in unmodified stalls, but only on farms that provided outdoor access. Although applying minor stall modifications to tie-stalls can help improve aspects of animal welfare, providing year-round outdoor access may represent a more effective method; the continued provision of time outside the stall helps maintain the positive impact of outdoor/pasture access on the welfare of tie-stall dairy cows.

OBJECTIVE To evaluate the effects of tirzepatide on body composition, appetite, and energy intake to address the potential mechanisms involved in body weight loss with tirzepatide. RESEARCH DESIGN AND METHODS In a secondary analysis of a randomized, double-blind, parallel-arm study, the effects of tirzepatide 15 mg (N = 45), semaglutide 1 mg (N = 44), and placebo (N = 28) on body weight and composition, appetite, and energy intake were assessed at baseline and week 28. RESULTS Tirzepatide treatment demonstrated significant reductions in body weight compared with placebo and semaglutide, resulting in greater fat mass reduction. Tirzepatide and semaglutide significantly reduced appetite versus placebo. Appetite scores and energy intake reductions did not differ between tirzepatide and semaglutide. CONCLUSIONS Differences in energy intake during ad libitum lunch were not sufficient to explain the different weight outcomes. Further evaluation is needed to assess mechanistic differences related to tirzepatide actions on 24-h energy intake, substrate utilization, and energy expenditure.

Glucose control in patients after total pancreatectomy is problematic because of the complete absence of α- and β-cells, leading to impaired quality of life. A novel, bihormonal artificial pancreas (BIHAP), using both insulin and glucagon, may improve glucose control, but studies in this setting are lacking.To assess the efficacy and safety of the BIHAP in patients after total pancreatectomy.This randomized crossover clinical trial compared the fully closed-loop BIHAP with current diabetes care (ie, insulin pump or pen therapy) in 12 adult outpatients after total pancreatectomy. Patients were recruited between August 21 and November 16, 2020. This first-in-patient study began with a feasibility phase in 2 patients. Subsequently, 12 patients were randomly assigned to 7-day treatment with the BIHAP (preceded by a 5-day training period) followed by 7-day treatment with current diabetes care, or the same treatments in reverse order. Statistical analysis was by Wilcoxon signed rank and Mann-Whitney U tests, with significance set at a 2-sided P.05.The primary outcome was the percentage of time spent in euglycemia (70-180 mg/dL [3.9-10 mmol/L]) as assessed by continuous glucose monitoring.In total, 12 patients (7 men and 3 women; median [IQR] age, 62.5 [43.1-74.0] years) were randomly assigned, of whom 3 did not complete the BIHAP phase and 1 was replaced. The time spent in euglycemia was significantly higher during treatment with the BIHAP (median, 78.30%; IQR, 71.05%-82.61%) than current diabetes care (median, 57.38%; IQR, 52.38%-81.35%; P = .03). In addition, the time spent in hypoglycemia (70 mg/dL [3.9 mmol/L]) was lower with the BIHAP (median, 0.00% [IQR, 0.00%-0.07%] vs 1.61% [IQR, 0.80%-3.81%]; P = .004). No serious adverse events occurred.Patients using the BIHAP after total pancreatectomy experienced an increased percentage of time in euglycemia and a reduced percentage of time in hypoglycemia compared with current diabetes care, without apparent safety risks. Larger randomized trials, including longer periods of treatment and an assessment of quality of life, should confirm these findings.trialregister.nl Identifier: NL8871.

The biological pump transports organic matter, created by phytoplankton productivity in the well-lit surface ocean, to the ocean's dark interior, where it is consumed by animals and heterotrophic microbes and remineralized back to inorganic forms. This downward transport of organic matter sequesters carbon dioxide from exchange with the atmosphere on timescales of months to millennia, depending on where in the water column the respiration occurs. There are three primary export pathways that link the upper ocean to the interior: the gravitational, migrant, and mixing pumps. These pathways are regulated by vastly different mechanisms, making it challenging to quantify the impacts of the biological pump on the global carbon cycle. In this review, we assess progress toward creating a global accounting of carbon export and sequestration via the biological pump and suggest a potential path toward achieving this goal. Expected final online publication date for the

Background The prevalence of genital chlamydia and gonorrhoea is higher in the 16–24 years age group than those in other age group. With users, we developed the theory-based safetxt intervention to reduce sexually transmitted infections. Objectives To establish the effect of the safetxt intervention on the incidence of chlamydia/gonorrhoea infection at 1 year. Design A parallel-group, individual-level, randomised superiority trial in which care providers and outcome assessors were blinded to allocation. Setting Recruitment was from 92 UK sexual health clinics. Participants Inclusion criteria were a positive chlamydia or gonorrhoea test result, diagnosis of non-specific urethritis or treatment started for chlamydia/gonorrhoea/non-specific urethritis in the last 2 weeks; owning a personal mobile phone; and being aged 16–24 years. Allocation Remote computer-based randomisation with an automated link to the messaging system delivering intervention or control group messages. Intervention The safetxt intervention was designed to reduce sexually transmitted infection by increasing partner notification, condom use and sexually transmitted infection testing before sex with new partners. It employed educational, enabling and incentivising content delivered by 42–79 text messages over 1 year, tailored according to type of infection, gender and sexuality. Comparator A monthly message regarding trial participation. Main outcomes The primary outcome was the incidence of chlamydia and gonorrhoea infection at 12 months, assessed using nucleic acid amplification tests. Secondary outcomes at 1 and 12 months included self-reported partner notification, condom use and sexually transmitted infection testing prior to sex with new partner(s). Results Between 1 April 2016 and 23 November 2018, we assessed 20,476 people for eligibility and consented and randomised 6248 participants, allocating 3123 to the safetxt intervention and 3125 to the control. Primary outcome data were available for 4675 (74.8%) participants. The incidence of chlamydia/gonorrhoea infection was 22.2% (693/3123) in the intervention group and 20.3% (633/3125) in the control group (odds ratio 1.13, 95% confidence interval 0.98 to 1.31). There was no evidence of heterogeneity in any of the prespecified subgroups. Partner notification was 85.6% in the intervention group and 84.0% in the control group (odds ratio 1.14, 95% confidence interval 0.99 to 1.33). At 12 months, condom use at last sex was 33.8% in the intervention group and 31.2% in the control group (odds ratio 1.14, 95% confidence interval 1.01 to 1.28) and condom use at first sex with most recent new partner was 54.4% in the intervention group and 48.7% in the control group (odds ratio 1.27, 95% confidence interval 1.11 to 1.45). Testing before sex with a new partner was 39.5% in the intervention group and 40.9% in the control group (odds ratio 0.95, 95% confidence interval 0.82 to 1.10). Having two or more partners since joining the trial was 56.9% in the intervention group and 54.8% in the control group (odds ratio 1.11, 95% confidence interval 1.00 to 1.24) and having sex with someone new since joining the trial was 69.7% in the intervention group and 67.4% in the control group (odds ratio 1.13, 95% confidence interval 1.00 to 1.28). There were no differences in safety outcomes. Additional sensitivity and per-protocol analyses showed similar results. Limitations Our understanding of the mechanism of action for the unanticipated effects is limited. Conclusions The safetxt intervention did not reduce chlamydia and gonorrhoea infections, with slightly more infections in the intervention group. The intervention increased condom use but also increased the number of partners and new partners. Randomised controlled trials are essential for evaluating health communication interventions, which can have unanticipated effects. Future work Randomised controlled trials evaluating novel interventions in this complex area are needed. Trial registration This trial is registered as ISRCTN64390461. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 1. See the NIHR Journals Library website for further project information.

OBJECTIVE Adjacent-segment disease (ASD) proximal to lumbosacral fusion is assumed to result from increased stress and motion that extends above or below the fusion construct. Sublaminar bands (SBs) have been shown to potentially mitigate stresses in deformity constructs. A similar application of SBs in lumbar fusions is not well described yet may potentially mitigate against ASD. METHODS Eight fresh-frozen human cadaveric spine specimens were instrumented with transforaminal lumbar interbody fusion (TLIF) cages at L3–4 and L4–5, and pedicle screws from L3 to S1. Bilateral SBs were applied at L2 and tightened around the rods extending above the L3 pedicle screws. After being mounted on a testing frame, the spines were loaded at L1 to 6 Nm in all 3 planes, i.e., flexion/extension, right and left lateral bending, and right and left axial rotation. Motion and intradiscal pressures (IDPs) at L2–3 were measured for 5 conditions: intact, instrumentation (L3–S1), band tension (BT) 30%, BT 50%, and BT 100%. RESULTS There was significant increase in motion at L2–3 with L3–S1 instrumentation compared with the intact spine in flexion/extension (median 8.78°, range 4.07°–10.81°, vs median 7.27°, range 1.63°–9.66°; p = 0.016). When compared with instrumentation, BT 100% reduced motion at L2–3 in flexion/extension (median 8.78°, range 4.07°–10.81°, vs median 3.61°, range 1.11°–9.39°; p < 0.001) and lateral bending (median 6.58°, range 3.67°–8.59°, vs median 5.62°, range 3.28°–6.74°; p = 0.001). BT 50% reduced motion at L2–3 only in flexion/extension when compared with instrumentation (median 8.78°, range 4.07°–10.81°, vs median 5.91°, range 2.54°–10.59°; p = 0.027). There was no significant increase of motion at L1–2 with banding when compared with instrumentation, although an increase was seen from the intact spine with BT 100% in flexion/extension (median 5.14°, range 2.47°–9.73°, vs median 7.34°, range 4.22°–9.89°; p = 0.005). BT 100% significantly reduced IDP at L2–3 from 25.07 psi (range 2.41–48.08 psi) before tensioning to 19.46 psi (range −2.35 to 29.55 psi) after tensioning (p = 0.016). CONCLUSIONS In this model, the addition of L2 SBs reduced motion and IDP at L2–3 after the L3–S1 instrumentation. There was no significant increase in motion at L1–2 in response to band tensioning compared with instrumentation alone. The application of SBs may have a clinical application in reducing the incidence of ASD.

Whole genome and transcriptome analysis of 213 Pseudomonas aeruginosa isolates resistant to antipseudomonal β-lactams collected in 30 countries was performed to evaluate resistance mechanisms against these agents.Isolates were susceptibility tested by reference broth microdilution. Whole genome and transcriptome sequencing were performed, and data were analysed using open-source tools. A statistical analysis of changes in the expression of5500 genes was compared to the expression of PAO1.The high-risk clones ST235 and ST111 were the most prevalent among90 sequence types (STs). Metallo-β-lactamase (MBLs) genes were detected in 40 isolates. AmpC and MexXY were the most common genes overexpressed in approximately 50% of the 173 isolates that did not carry MBLs. Isolates overexpressing pmrA and pmrB, the norspermidine production genes speD2 and speE2, and the operon arnBCADTEF-ugd were noted among strains resistant to ceftolozane-tazobactam and ceftazidime-avibactam, despite the lack of polymyxin resistance often associated to increased expression of these genes. Overexpression of MuxABC-OpmB, OprG, and OprE proteins were associated with resistance to ceftolozane-tazobactam in addition to the usual genes involved in cephalosporin, monobactam, and carbapenem resistance. Statistical analysis identified discrete mutations in ArmZ, OprD, and AmpC that correlated to antipseudomonal β-lactam resistance.P. aeruginosa resistance mechanisms are complex. This analysis suggests the role of multiple genes in resistance to antipseudomonal β-lactams, including some not commonly described.

Objectives. To describe the prevalence of and risk factors for workplace violence among Ugandan adolescents.Methods. The analysis focused on adolescents recruited at primary schools who participated in the endline survey of a trial in 2014 (at ages 11–14 years) and were followed up in 2018–2019 (at ages 17–19 years). The analysis was restricted to those engaged in past-year paid work (n = 1406). We estimated the prevalence of past-year workplace violence and used mixed-effects multivariable logistic regression to explore associations with characteristics measured in early adolescence, current life circumstances, and work-related factors.Methods. The analysis focused on adolescents recruited at primary schools who participated in a 2014 survey and were followed up in 2018–2019. The analysis was restricted to those engaged in past-year paid work (n = 1406). We estimated the prevalence of past-year workplace violence and used mixed-effects multivariable logistic regression to explore associations with characteristics measured in early adolescence, current life circumstances, and work-related factors.Results. Overall, 40% (95% confidence interval [CI] = 37%, 43%) of adolescents in paid work experienced past-year workplace violence; odds were doubled among female domestic workers (vs retail/trade workers; adjusted odds ratio [AOR] = 2.07; 95% CI = 1.28, 3.35). Experiences measured in early adolescence, including eating less than 3 meals the previous day, experiencing severe physical violence (male adolescents: AOR = 1.48; 95% CI = 1.11, 1.98; female adolescents: AOR = 1.69; 95% CI = 1.13, 2.53) and bullying, and having poor mental health (male adolescents: AOR = 2.32 95% CI = 1.37, 3.92; female adolescents: AOR = 2.27; 95% CI = 1.05, 4.89), were associated with increased odds of workplace violence. Current life circumstances (fewer household assets, more moves, functional difficulties, poorer mental health) were also associated with workplace violence.Conclusions. Interventions are needed to address the high prevalence of workplace violence across all sectors, with female domestic workers particularly vulnerable. Early prevention of violence and poor mental health may be promising. (Am J Public Health. 2022;112(11):1651–1661. https://doi.org/10.2105/AJPH.2022.306983 )

Management of fish populations for conservation in thermally variable systems requires an understanding of the fish's underlying physiology and responses to thermal stress. Physiological research at the organismal level provides information on the overall effects of stressors such as extreme temperature fluctuations. While experiments with whole organisms provide information as to the overall effects of temperature fluctuations, biochemical assays of thermal stress provide direct results of exposure that are both sensitive and specific. Electron transport system (ETS; Complex III) assays quantify a rate-limiting step of respiratory enzymes. Parameters that can be estimated via this approach include optimum thermal temperature (T

Circadian rhythms are endogenous biological cycles that regulate physiology and behavior for optimal adaptive function and survival; they are synchronized to precisely 24 hours by daily light exposure. Disruption of the daily light-dark (LD) cycle by exposure to artificial light at night (ALAN) dysregulates core clock genes and biological function. Exposure to ALAN has been associated with increased health risks in humans, and elderly individuals are at elevated risk for poor outcome from disease and often experience elevated exposure to ALAN due to increased care requirements. The role of disrupted circadian rhythms in healthy, aged animals remains unspecified; thus, we hypothesized that disrupted circadian rhythms via chronic exposure to dim ALAN (dLAN) impair immune response and survival in aged mice. Twenty-month-old C57BL/6 male and female mice were exposed to 24 weeks of LD conditions or dLAN (5 lux); then, cell-mediated immune response was assessed using a delayed-type hypersensitivity test. Aged female mice exposed to dLAN displayed dysregulated hypersensitivity and inflammation as a measure of cell-mediated immune response and decreased lifespan compared to females housed in dark nights. Nighttime lighting did not affect cell-mediated immune response or lifespan in males but dysregulated body mass and increased adrenal mass after immune challenge after chronic exposure to dLAN. Together, these data indicate that chronic exposure to dLAN affects lifespan in aged females and suggest that females are more susceptible to the detrimental consequences of disrupted circadian rhythms.

The ocean holds vast quantities of carbon that it continually exchanges with the atmosphere through the air-sea interface. Because of its enormous size and relatively rapid exchange of carbon with the atmosphere, the ocean controls atmospheric CO2 concentration and thereby Earth's climate on timescales of tens to thousands of years. This review examines the basic functions of the ocean's carbon cycle, demonstrating that the ocean carbon inventory is determined primarily by the mass of the ocean, by the chemical speciation of CO2 in seawater, and by the action of the solubility and biological pumps that draw carbon into the ocean's deeper layers, where it can be sequestered for decades to millennia. The ocean also plays a critical role in moderating the impacts of climate change by absorbing an amount of carbon equivalent to about 25% of anthropogenic CO2 emissions over the past several decades. However, this also leads to ocean acidification and reduces the chemical buffering capacity of the ocean and its future ability to take up CO2. This review closes with a look at the uncertain future of the ocean carbon cycle and the scientific challenges that this uncertainty brings.

Review of: Gender in Post-9/11 American Apocalyptic TV: Representations of Masculinity and Femininity at the End of the World, Eve Bennett (2019)New York: Bloomsbury Academic, 224 pp.,ISBN 978-1-50133-108-4, h/bk, £110.00, p/bk, £29.99

Leslie O’Dell,1 Damon S Dierker,2 Douglas K Devries,3 Jaclyn Garlich,4 Walter O Whitley,5 Mark Holdbrook,6 Stephanie N Baba,6 Elizabeth Yeu5 1Medical Optometry America, Shrewsbury, PA, USA; 2Eye Surgeons of Indiana, Indianapolis, IN, USA; 3Eye Care Associates of Nevada, Sparks, NV, USA; 4Envision Optometry, Boston, MA, USA; 5Virginia Eye Consultants, Norfolk, VA, USA; 6Tarsus Pharmaceuticals, Inc, Irvine, CA, USACorrespondence: Elizabeth Yeu, Virginia Eye Consultants, 241 Corporate Boulevard, Suite 210, Norfolk, VA, 23502, USA, Tel +1 757 793 4942, Fax +1 757 319 2493, Email eyeulin@gmail.comPurpose: To evaluate the impact of Demodex blepharitis on patients’ daily activities and quality of life.Patients and Methods: In this multicenter, observational, prospective, IRB-approved study, 311 Demodex blepharitis patients aged ≥ 18 years were included. Demodex blepharitis was diagnosed based on the presence of ≥ 1.0 mite per lash (upper and lower eyelids combined), > 10 collarettes on the upper lashes, and at least mild lid margin erythema of the upper eyelid in at least one eye. All patients were asked to complete a questionnaire about their symptoms, daily activities, quality of life, and management approaches, and descriptive statistics were used to analyze the responses.Results: More than half the patients had been experiencing symptoms of blepharitis for ≥ 4 years. The three most frequent and bothersome symptoms experienced by patients were dry eyes, itchiness, and irritation. Nearly half the patients (47%) responded that they were conscious of their eyes all day, and 23% said that they were constantly worrying about their eyes. Other activities that were negatively affected included difficulty driving at night (47%), additional time needed for daily hygiene routine (30%), and difficulty in wearing eye make-up (in 34% of females). While all subjects had objective signs of Demodex blepharitis confirmed by an eye care provider, 58% said they had never previously been diagnosed with blepharitis. The most commonly used management approaches for Demodex blepharitis were artificial tears (47%), warm compresses (32%), and lid wipes (14%).Conclusion: Demodex blepharitis has a significant negative impact on daily activities and the mental and physical well-being of afflicted patients.Keywords: Demodex blepharitis, dry eye disease, collarettes, cylindrical dandruff, Demodex mites, lid margin disease

Marfan syndrome is one of the most common inherited connective tissue disorders that affects the heart, eyes, blood vessels, and bones. It occurs in approximately 1-2 per 10,000 individuals annually. Many patients with Marfan syndrome eventually develop aortic wall abnormalities, often resulting in aortic dilatation, which increases the risk of acute aortic dissection. Recent studies involving SARS-CoV-2 propose that individuals with connective tissue disorders such as Marfan syndrome can have additional associated conditions that could impose a higher risk for morbidity and mortality from SARS-CoV-2. The purpose of this article is to discuss the interrelationship between Marfan Syndrome, Acute Type A Aortic Dissection in a patient with Sars-CoV-2 infection. Pertinent review of these conditions, diagnostic findings, treatment, and the patient's clinical course will be discussed. There is minimal research focused on the connection between this novel virus, Marfan Syndrome, and compounding risk for aortic dissection.

The ability to understand speech in complex environments depends on the brain's ability to preserve the precise timing characteristics of the speech signal. Age-related declines in temporal processing may contribute to the older adult's experience of communication difficulty in challenging listening conditions. This study's purpose was to evaluate the effects of rate discrimination training on auditory temporal processing. A double-blind, randomized control design assigned 77 young normal-hearing, older normal-hearing, and older hearing-impaired listeners to one of two treatment groups: experimental (rate discrimination for 100- and 300-Hz pulse trains) and active control (tone detection in noise). All listeners were evaluated during pre- and post-training sessions using perceptual rate discrimination of 100-, 200-, 300-, and 400-Hz band-limited pulse trains and auditory steady-state responses (ASSRs) to the same stimuli. Training generalization was evaluated using several temporal processing measures and sentence recognition tests that included time-compressed and reverberant speech stimuli. Results demonstrated a session × training group interaction for perceptual and ASSR testing to the trained frequencies (100 and 300 Hz), driven by greater improvements in the training group than in the active control group. Further, post-test rate discrimination of the older listeners reached levels that were equivalent to those of the younger listeners at pre-test. Generalization was observed in significant improvement in rate discrimination of untrained frequencies (200 and 400 Hz) and in correlations between performance changes in rate discrimination and sentence recognition of reverberant speech. Further, non-auditory inhibition/attention performance predicted training-related improvement in rate discrimination. Overall, the results demonstrate the potential for auditory training to partially restore temporal processing in older listeners and highlight the role of cognitive function in these gains.

This review synthesizes research findings on the pain and welfare of dairy calves undergoing disbudding procedures. We describe disbudding practices in North America as well as the use and perceptions of pain control for these procedures. Governing bodies across Canada and the United States, including each country's veterinary medical association and nationwide initiatives such as proAction and Farmers Assuring Responsible Management (FARM), recommend or require the use of a local anesthetic, a nonsteroidal anti-inflammatory drug (NSAID), and a sedative for disbudding procedures. Although the use of pain relief for disbudding has increased over the past decade or so, some in the dairy industry still do not believe that pain control for disbudding is necessary. As a painful procedure, disbudding has numerous welfare impacts on the calf both during and following the procedure that can be categorized under all 3 principles of animal welfare: natural living, biological functioning, and affective state. The use of pain control for disbudding; namely, a local anesthetic and NSAID, can improve welfare outcomes such as procedure-induced pain behavior, cortisol concentrations, mechanical nociceptive threshold, emotional states, and so on, compared with no pain control for the procedure. Although extensive research exists on pain control practices for disbudding, this review identified further gaps in knowledge and areas for future research. Mechanical nociceptive threshold can be evaluated around the disbudding wounds and is a reliable test in older calves; however, this outcome in very young calves after caustic paste disbudding has been reported to be inconclusive compared with that in older calves. As well, research evaluating xylazine sedation for disbudding has reported both potentially positive and negative results that are difficult to interpret or base suggestions on for the use of this drug. Finally, wounds caused by disbudding take a long time to heal (up to 13 wk) and have increased sensitivity for the entire healing process. Therefore, future research should aim to (1) determine accurate behavioral tests for calves under 1 wk of age undergoing disbudding to better understand their experience, (2) further attempt to understand the effects of xylazine sedation for disbudding and potential impacts of providing this medication, and (3) determine more ways to reduce the healing time and pain experienced by the calf after disbudding procedures.

In 2014, a large urban community hospital adopted protected clinical indication practices as a quality improvement project. It then undertook a research study to examine bedside practices with short peripheral catheters, which included direct observation at the bedside once weekly for 6 months. A total of 4305 catheters were observed and remained in place for a total of 23 423 days. Fifty six percent of devices remained in place beyond 96 hours. The overall rate of peripheral bloodstream infection in patients enrolled in the study was 0.12/1000 peripheral intravenous days. Significant differences were noted based on which department placed the catheter, as well as which department cared for the patient during hospitalization. Patients admitted to step-down critical care units had the highest completion of therapy rates; however, those being cared for in medical/surgical units had the best outcomes. Devices placed in the emergency department had a higher successful dwell rate than those placed in critical care units. Twenty-gauge catheters were found to have the highest successful dwell rate, as well as insertion sites that were observed to be within normal limits during the weekly observation. Dressings that were noted to be clean, dry, and intact had a stronger association with completion of therapy than those that were not fully intact. Emphasis was placed on ensuring consistent practices with insertion, care, and maintenance, which contributed to more consistent outcomes between settings that insert, care for, and maintain devices. Nonmodifiable risk factors may remain.

The primary objective of this study was to determine whether the level of concentrate allowance in an automated milking system (AMS) affects the feed intake, eating behavior, milking activity, and performance of lactating dairy cows. The secondary objective of this study was to describe how the response to concentrate allocation, specifically in feeding and milking behavior, varies with cow personality traits. Fifteen Holstein cows were used in a crossover design with two 28-d periods, each including 14 d of adaptation and 14 d of data collection. The cows were housed in a freestall pen with free-traffic access to the AMS. Treatments consisted of a basal partial mixed ration (PMR) common to both treatment groups, with a concentrate allowance (on dry matter basis) of (1) 3.0 kg/d in the AMS (L-AMS) or (2) 6.0 kg/d in the AMS (H-AMS). Between the 2 treatment periods, each cow was assessed for personality traits using a combined arena test consisting of exposure to a novel environment, novel object, and novel human. Principal component analysis of behaviors observed during the novel environment and object tests revealed 3 factors (interpreted as active, social, and alert-curious) that together explained 76% of the variance, whereas principal component analysis of the novel human test revealed 2 factors (interpreted as active-vocal and fearful of novel humans) that together explained 77% of the variance. When on the H-AMS treatment, PMR dry matter intake (DMI) was less (24.5 vs. 26.0 kg/d) and AMS concentrate delivery was greater (5.9 vs. 3.1 kg/d), as per design. Consequently, total DMI was greater on the H-AMS treatment (30.4 vs. 29.1 kg/d). When on the H-AMS treatment, cows who were more alert-curious consumed more PMR, whereas cows who were more fearful of the novel human were less likely to receive the maximum amount of AMS concentrate available, limiting their total DMI and increasing the day-to-day variability of that intake. Although this was a preliminary study, these data suggest an association between dairy cow personality traits and how cows respond to increased AMS concentrate allowance.

To assess the change in HbA1c after initiation of biosimilar follow-on insulin (Basaglar) or reference insulin (Lantus) among patients with type 2 diabetes. We also compared treatment adherence, safety events and costs at 1 year after initiation of insulin.Using claims data from a large US health plan during 2016-2020, we identified adults with type 2 diabetes who initiated either Basaglar or Lantus. Generalized linear regression modelling assessed the differences in outcomes between the two groups. A 0.4% margin was used to determine non-inferiority for HbA1c.The study included 1136 Basaglar users and 6304 Lantus users. Both Lantus and Basaglar groups showed more than 1% reduction in HbA1c over 6 months and over 12 months. Reduction in HbA1c with Basaglar was similar (non-inferior) to that with Lantus, with an adjusted difference of Basaglar to Lantus of 0.14% (95% CI -0.02 to 0.30) over 6 months and 0.17% (95% CI 0.02 to 0.32) over 12 months. Rates of adverse events were similar for both hypoglycaemia and vascular events. The Basaglar group showed higher adherence in terms of proportion of days covered (adjusted difference 0.06, 95% CI 0.04 to 0.08). Medical costs were similar, but the cost of Basaglar was lower (adjusted mean cost difference -$462, 95% CI -$556 to -$363) after adjustment.In patients with type 2 diabetes, Basaglar provided similar glycaemic control compared with Lantus, had a similar safety profile and lower drug costs, and showed more favourable adherence.

In cardiology clinic visits, the discussion of optimal dietary patterns for prevention and management of cardiovascular disease is usually very limited. Herein, we explore the benefits and risks of various dietary patterns, including intermittent fasting, low carbohydrate, Paleolithic, whole food plant-based diet, and Mediterranean dietary patterns within the context of cardiovascular disease to empower clinicians with the evidence and information they need to maximally benefit their patients.

Background MRI radiomic features and machine learning have been used to predict brain metastasis (BM) stereotactic radiosurgery (SRS) outcomes. Previous studies used only single centre datasets, representing a significant barrier to clinical translation and further research. This study therefore presents the first dual-centre validation of these techniques. Methods SRS datasets were acquired from two centres (n=123 BMs and n=117 BMs). Each dataset contained eight clinical features, 107 pre-treatment T1w contrast-enhanced MRI radiomic features, and post-SRS BM progression endpoints determined from follow-up MRI. Random decision forest models were used with clinical and/or radiomic features to predict progression. 250 bootstrap repetitions were used for single centre experiments. Results Training a model with one centre’s dataset and testing it with the other centre’s dataset required using a set of features important for outcome prediction at both centres, and achieved area under the receiver operating characteristic curve (AUC) values up to 0.70. A model training methodology developed using the first centre’s dataset was locked and externally validated with the second centre’s dataset, achieving a bootstrap-corrected AUC of 0.80. Lastly, models trained on pooled data from both centres offered balanced accuracy across centres with an overall bootstrap-corrected AUC of 0.78. Conclusions Using the presented validated methodology, radiomic models trained at a single centre can be used externally, though they must utilize features important across all centres. These models’ accuracies are inferior to those of models trained using each individual centre’s data. Pooling data across centres shows accurate and balanced performance, though further validation is required.

The ocean is a major carbon sink and takes up 25-30% of the anthropogenically emitted CO2. A state-of-the-art method to quantify this sink are global ocean biogeochemistry models (GOBMs) but their simulated CO2 uptake differs between models and is systematically lower than estimates based on statistical methods using surface ocean pCO2 and interior ocean measurements. Here, we provide an in-depth evaluation of ocean carbon sink estimates from 1980 to 2018 from a GOBM ensemble. As sources of inter-model differences and ensemble-mean biases our study identifies the (i) model set-up, such as the length of the spin-up, the starting date of the simulation, and carbon fluxes from rivers and into sediments, (ii) the ocean circulation, such as Atlantic Meridional Overturning Circulation and Southern Ocean mode and intermediate water formation, and (iii) the oceanic buffer capacity. Our analysis suggests that the late starting date and biases in the ocean circulation cause a too low anthropogenic CO2 uptake across the GOBM ensemble. Surface ocean biogeochemistry biases might also cause simulated anthropogenic fluxes to be too low but the current set-up prevents a robust assessment. For simulations of the ocean carbon sink, we recommend in the short-term to (1) start simulations in 1765, when atmospheric CO2 started to increase, (2) conduct a sufficiently long spin-up such that the GOBMs reach steady-state, and (3) provide key metrics for circulation, biogeochemistry, and the land-ocean interface. In the long-term, we recommend improving the representation of these metrics in the GOBMs.

In humans, disuse is known to result in muscle atrophy and metabolic dysfunction, including reduced mitochondrial content. Previous data from this cohort found that omega-3 polyunsaturated fatty acid (n-3) supplementation attenuated declines in muscle mass, myofibrillar protein synthesis and ADP-stimulated mitochondrial respiration. Disuse has also been shown to increase apoptosis and events linked to autophagy. We investigated the effects of n-3 fatty acid supplementation on content of proteins involved in autophagy, intrinsic apoptosis, mitochondrial fission and fusion and mitochondrial area density during 14 d of immobilization and 14 d of recovery. Twenty females (18-30y) received 20mL doses of n-3 fatty acid (2.97g EPA and 2.03g DHA) or an isoenergetic sunflower oil (oleic acid content: 75%) daily during the 28-d protocol. Biopsies were taken from the vastus lateralis pre-immobilization, post-immobilization, and post-recovery. Protein and mitochondrial content were determined using Western Blot and transmission electron microscopy at 5800X magnification, respectively. Mitochondrial area density (%AD) decreased in the subsarcolemmal (SS, p=0.006) and central intramyofibrillar (IMF) (p=0.001) regions after recovery. The change in the central IMF was driven by a decrease in the n-3 group (p=0.0133). There was no change in the peripheral IMF region. P62 increased during immobilization (p This study was supported with a Canadian Institutes of Health Research Award to S.M. Phillips and a Natural Sciences and Engineering Research Council of Canada Award to M.C Devries This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Background Androgen deprivation therapy (ADT) with radiotherapy can benefit patients with localized prostate cancer. However, ADT can negatively impact quality of life and there remain no validated predictive models to guide its use. Methods Digital pathology image and clinical data from pre-treatment prostate tissue from 5,727 patients enrolled on five phase III randomized trials treated with radiotherapy +/- ADT were used to develop and validate an artificial intelligence (AI)-derived predictive model to assess ADT benefit with the primary endpoint of distant metastasis. After the model was locked, validation was performed on NRG/RTOG 9408 (n = 1,594) that randomized men to radiotherapy +/- 4 months of ADT. Fine-Gray regression and restricted mean survival times were used to assess the interaction between treatment and predictive model and within predictive model positive and negative subgroup treatment effects. Results In the NRG/RTOG 9408 validation cohort (14.9 years of median follow-up), ADT significantly improved time to distant metastasis (subdistribution hazard ratio [sHR] = 0.64, 95%CI [0.45–0.90], p = 0.01). The predictive model-treatment interaction was significant (p-interaction = 0.01). In predictive model positive patients (n = 543, 34%), ADT significantly reduced the risk of distant metastasis compared to radiotherapy alone (sHR = 0.34, 95%CI [0.19–0.63], p