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We provide high-resolution in situ observations of wave-induced sea ice breakup in the natural environment. In order to obtain such data, a drone was deployed from the Canadian Coast Guard ship Amundsen as it sailed in the vicinity of large ice floes in Baffin Bay and in the St. Lawrence Estuary, Canada. The footage recorded during these experiments was used to obtain the floe size distribution (FSD) and the temporal evolution of the breakup. Floe-area-weighted FSDs exhibit a modal shape, indicating that a preferential size is generated by wave-induced breakup. Furthermore, the increase of the mode of the distribution with greater thickness indicates that ice thickness plays a defined role in determining the preferential size. Comparison with relevant theory suggests that the maximum floe size is dictated not only by the ice rigidity but also by the incident wavelength. It was also observed that the in-ice wavelength is smaller than the estimated incident wavelength, suggesting that waves responsible for the breakup obey mass loading dispersion. The fact that the breakup advances almost as fast as the wave energy suggests that fatigue might not have been an important physical component during the experiments. Moreover, the observed breakup extents show that thicker ice can attenuate waves less than thinner ice. Overall, this dataset provides key information on wave-induced sea ice breakup and highlights the potential for better understanding the physics of natural sea ice in response to waves.

The Green Edge project was designed to investigate the onset, life, and fate of a phytoplankton spring bloom (PSB) in the Arctic Ocean. The lengthening of the ice-free period and the warming of seawater, amongst other factors, have induced major changes in Arctic Ocean biology over the last decades. Because the PSB is at the base of the Arctic Ocean food chain, it is crucial to understand how changes in the Arctic environment will affect it. Green Edge was a large multidisciplinary, collaborative project bringing researchers and technicians from 28 different institutions in seven countries together, aiming at understanding these changes and their impacts on the future. The fieldwork for the Green Edge project took place over two years (2015 and 2016) and was carried out from both an ice camp and a research vessel in Baffin Bay, in the Canadian Arctic. This paper describes the sampling strategy and the dataset obtained from the research cruise, which took place aboard the Canadian Coast Guard ship (CCGS) Amundsen in late spring and early summer 2016. The sampling strategy was designed around the repetitive, perpendicular crossing of the marginal ice zone (MIZ), using not only ship-based station discrete sampling but also high-resolution measurements from autonomous platforms (Gliders, BGC-Argo floats …) and under-way monitoring systems. The dataset is available at https://doi.org/10.17882/86417 (Bruyant et al., 2022).

Landfast ice is a common coastal feature in the Arctic Ocean and around the Antarctic continent. One contributing and stabilizing mechanism is the grounding of sea ice ridges in shallow water. Recently, a grounding scheme representing this effect on sea ice dynamics was developed in order to improve the simulation of landfast ice by continuum-based sea ice models. This parameterization assumes that the ridged keel thickness is proportional to the mean thickness. Results demonstrated that this simple parameterization notably improves the simulation of landfast ice in many regions such as in the East Siberian Sea, the Laptev Sea and along the Alaskan coast. Nevertheless, a weakness of this approach is that it is based solely on the mean properties of sea ice. Here, we extend the parameterization by taking into account subgrid-scale ice thickness distribution and bathymetry distribution, which are generally non-normal, and by computing the maximum seabed stress as a joint probability interaction between the sea ice and the seabed. The probabilistic approach shows a reasonably good agreement with observations and with the previously proposed grounding scheme while potentially offering more physical insights into the formation of landfast ice.

A simplified model, representing the dynamics of marine organic particles in a given size range experiencing coagulation and fragmentation reactions, is developed. The framework is based on a discrete size spectrum on which reactions act to exchange properties between different particle sizes. The reactions are prescribed according to triplet interactions. Coagulation combines two particle sizes to yield a third one, while fragmentation breaks a given particle size into two (i.e. the inverse of the coagulation reaction). The complete set of reactions is given by all the permutations of two particle sizes associated with a third one. Since, by design, some reactions yield particle sizes that are outside the resolved size range of the spectrum, a closure is developed to take into account this unresolved range and satisfy global constraints such as mass conservation. In order to minimize the number of tracers required to apply this model to an ocean general circulation model, focus is placed on the robustness of the model to the particle size resolution. Thus, numerical experiments were designed to study the dependence of the results on (i) the number of particle size bins used to discretize a given size range (i.e. the resolution) and (ii) the type of discretization (i.e. linear vs. nonlinear). The results demonstrate that in a linearly size-discretized configuration, the model is independent of the resolution. However, important biases are observed in a nonlinear discretization. A first attempt to mitigate the effect of nonlinearity of the size spectrum is then presented and shows significant improvement in reducing the observed biases.

A 130 km2 tabular iceberg calved from Petermann Glacier in northwestern Greenland on 5 August 2012. Subsequent fracturing generated many individual large “ice islands”, including Petermann ice island (PII)-A-1-f, which drifted between Nares Strait and the North Atlantic. Thinning caused by basal and surface ablation increases the likelihood that these ice islands will fracture and disperse further, thereby increasing the risk to marine transport and infrastructure as well as affecting the distribution of freshwater from the polar ice sheets. We use a unique stationary and mobile ice-penetrating radar dataset collected over four campaigns to PII-A-1-f to quantify and contextualize ice island surface and basal ablation rates and calibrate a forced convection basal ablation model. The ice island thinned by 4.7 m over 11 months. The majority of thinning (73 %) resulted from basal ablation, but the volume loss associated with basal ablation was ∼12 times less than that caused by areal reduction (e.g. wave erosion, calving, and fracture). However, localized thinning may have influenced a large fracture event that occurred along a section of ice that was ∼40 m thinner than the remainder of the ice island. The calibration of the basal ablation model, the first known to be conducted with field data, supports assigning the theoretically derived value of 1.2×10−5 m2∕5 s-1/5 ∘C−1 to the model's bulk heat transfer coefficient with the use of an empirically estimated ice–ocean interface temperature. Overall, this work highlights the value of systematically collecting ice island field data for analyzing deterioration processes, assessing their connections to ice island morphology, and adequately developing models for operational and research purposes.

The Green Edge initiative was developed to investigate the processes controlling the primary productivity and fate of organic matter produced during the Arctic phytoplankton spring bloom (PSB) and to determine its role in the ecosystem. Two field campaigns were conducted in 2015 and 2016 at an ice camp located on landfast sea ice southeast of Qikiqtarjuaq Island in Baffin Bay (67.4797∘ N, 63.7895∘ W). During both expeditions, a large suite of physical, chemical and biological variables was measured beneath a consolidated sea-ice cover from the surface to the bottom (at 360 m depth) to better understand the factors driving the PSB. Key variables, such as conservative temperature, absolute salinity, radiance, irradiance, nutrient concentrations, chlorophyll a concentration, bacteria, phytoplankton and zooplankton abundance and taxonomy, and carbon stocks and fluxes were routinely measured at the ice camp. Meteorological and snow-relevant variables were also monitored. Here, we present the results of a joint effort to tidy and standardize the collected datasets, which will facilitate their reuse in other Arctic studies. The dataset is available at https://doi.org/10.17882/59892 (Massicotte et al., 2019a).

Arctic sea ice is experiencing a shorter growth season and an earlier ice melt onset. The significance of spring microalgal blooms taking place prior to sea ice breakup is the subject of ongoing scientific debate. During the Green Edge project, unique time-series data were collected during two field campaigns held in spring 2015 and 2016, which documented for the first time the concomitant temporal evolution of the sea ice algal and phytoplankton blooms in and beneath the landfast sea ice in western Baffin Bay. Sea ice algal and phytoplankton blooms were negatively correlated and respectively reached 26 (6) and 152 (182) mg of chlorophyll 'a' per m2 in 2015 (2016). Here, we describe and compare the seasonal evolutions of a wide variety of physical forcings, particularly key components of the atmosphere–snow–ice–ocean system, that influenced microalgal growth during both years. Ice algal growth was observed under low-light conditions before the snow melt period and was much higher in 2015 due to less snowfall. By increasing light availability and water column stratification, the snow melt onset marked the initiation of the phytoplankton bloom and, concomitantly, the termination of the ice algal bloom. This study therefore underlines the major role of snow on the seasonal dynamics of microalgae in western Baffin Bay. The under-ice water column was dominated by Arctic Waters. Just before the sea ice broke up, phytoplankton had consumed most of the nutrients in the surface layer. A subsurface chlorophyll maximum appeared and deepened, favored by spring tide-induced mixing, reaching the best compromise between light and nutrient availability. This deepening evidenced the importance of upper ocean tidal dynamics for shaping vertical development of the under-ice phytoplankton bloom, a major biological event along the western coast of Baffin Bay, which reached similar magnitude to the offshore ice-edge bloom.

Passive flow control valves are usually intended to deliver or drain a fluid at a constant rate independently of pressure variations. Microfluidic devices made of a stack of two plates are considered here: the first plate comprises a flexible silicon membrane having through holes while the second plate is a rigid substrate with a cavity, an outlet hole and pillars aligned with the through holes of the membrane. The liquid flows through the holes etched in the membrane and through the gap between the membrane and the pillars. Each gap can be considered as a valve which progressively closes as the pressure increases. Numerical modelling of the fluid dynamics inside the device associated with FEM simulations of the membrane distortion have been performed to design a device that exhibits a constant flow rate in a specified range of pressure. To make the design more reliable, the device characteristics have been optimized using a genetic algorithm, the fitness function taking notably into account machining and alignment tolerances. This algorithm has been finally used to design flow control valves for wearable injectors dedicated to the infusion of viscous drug formulations (hyaluronic acid, adalimumab, golimumab …) at high pressure. Prototypes have been characterized using solutions of 12 and 24 cP. It has been demonstrated experimentally that this technology is suitable to passively infuse biological products at flow rates up to 1 mL/min. The numerical model has then been refined further so as to obtain a good correlation with experimental data.

Numerical simulations based on the classical Marmarou’s model have been carried out to analyse the dynamics of hydrocephalus valves. The evolution of the intracranial pressure in various case studies has been determined with a specific focus on flow control valves. It has been shown that their capability to prevent postural under- and over-drainage may be significantly altered by non-idealities of their hydrodynamic characteristics and by the inter-individual variability of the cerebrospinal fluid production rate. The use of microtechnology to improve the flow rate accuracy also enables the possibility to get original designs that are desirable to address specific restrictions of use associated with flow-control valves, in particular for patients exhibiting very high resistance to cerebrospinal fluid reabsorption. A new hybrid hydrodynamic characteristic of a hydrocephalus valve is proposed to stabilize the intracranial pressure. This new passive valve is equivalent to two pressure regulators at high and low relative pressures, corresponding respectively to upright and decubitus positions. The device is able to automatically switch from one configuration to the other as a function of the postural change. Numerical simulations suggest that this new hybrid valve should combine the advantages of both differential and flow control valves.

We consider the estimation of the grazing preferences parameters of zooplankton in ocean ecosystem models with ensemble-based Kalman filters. These parameters are introduced to model the relative diet composition of zooplankton that consists of phytoplankton, small size-classes of zooplankton and detritus. They are positive values and their sum is equal to one. However, the sum-to-one constraint cannot be guaranteed by ensemble-based Kalman filters when parameters are bounded. Therefore, a reformulation of the parameterization is proposed. We investigate two types of variable transformations for the estimation of positive sum-to-one constrained parameters that lead to the estimation of a new set of parameters with normal or bounded distributions. These transformations are illustrated and discussed with twin experiments performed with the 1-D coupled model GOTM-NORWECOM with Gaussian anamorphosis extensions of the deterministic ensemble Kalman filter (DEnKF).

Abdominal compartment syndrome (ACS) is a rare but potentially fatal complication that can occur during hip arthroscopy. This usually occurs as a result of arthroscopic fluid passing into the retroperitoneal space through the psoas tunnel. From the retroperitoneal space, the fluid can then enter the intraperitoneal space through defects in the peritoneum. Previous studies have identified female sex, iliopsoas tenotomy, pump pressure, and operative time as potential risk factors for fluid extravasation. We present a method to measure intraoperative fluid deficit during hip arthroscopy to alert surgeons to possible ACS. Our proposed technique requires diligent intraoperative monitoring of fluid output through various suction devices, including suction canisters, puddle vacuums, and suction mats. The difference is then calculated from the fluid intake from the arthroscopic fluid bags. If the difference is greater than 1500 mL, then the anesthesiologist and circulating nurse are instructed to examine the abdomen for distension every 15 minutes. This, combined with other common symptoms such as hypotension and hypothermia, should alert the surgical team to the development of ACS. Despite limitations to this technique, this approach offers an objective method to calculate intra-abdominal fluid extravasation.

Purpose: The purpose of this study was to determine if the Single-Assessment Numeric Evaluation (SANE) score correlates with existing validated hip-specific patient-reported outcome measures (PROMs), including the Modified Harris Hip Score (mHHS), the International Hip Outcome Tool (IHOT-33), the Hip Outcome Score, Activities of Daily Living subscale (HOS-ADL), and the Hip Outcome Score, Sport-Specific subscale (HOS-SS), for patients preparing to undergo hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS). Methods: A single surgeon’s operative database was retrospectively reviewed to identify patients undergoing primary hip arthroscopy for treatment of FAIS from April 2018 to October 2019. Patient-specific factors including age, sex, body mass index (BMI), and duration of symptoms were collected. Preoperative SANE, mHHS, IHOT-33, HOS-ADL, and HOS-SS scores were analyzed. Statistical analysis using Pearson correlation was performed to identify the relationship between the SANE score and the mHHS, IHOT-33, HOS-ADL, and HOS-SS, preoperatively. Results: 154 patients were included in the study. The mean mHHS was 54.4 ± 11.7; mean IHOT-33 score was 32.7 ± 15.0; mean HOS-SS 42.9 ± 23.7; and mean HOS-ADL was 63.3 ± 1. The mean SANE score was 36.7 ± 19.9. The Simple Hip Score was directly correlated with the mHHS (P < .01), the IHOT-33 (P 1 year. Conclusion: The SANE score was strongly correlated with mHHS, IHOT-33, HOS-ADL, and HOS-SS in the preoperative setting for patients undergoing hip arthroscopy for treatment of FAIS. Given its simplicity, SANE may be a valuable tool for rapid assessment of joint function and pain in this patient population. Level of Evidence: IV, therapeutic case series.

Chronic groin pain in the athlete can be a difficult problem to manage. Adductor dysfunction is the most common cause of groin pain in athletes, with the adductor longus being the tendon most commonly involved. The most reproducible finding for adductor longus tendinopathy is tenderness along the tendon with passive abduction and resisted hip adduction in extension. Magnetic resonance imaging and injection of a corticosteroid and anesthetic into the proximal muscle-tendon junction are both helpful in confirming the diagnosis. Nonoperative treatment may consist of protected weight bearing, ice application, ultrasonography, electrical stimulation, and gentle stretching with progressive strengthening. However, nonoperative management is not always successful. In these instances, surgical treatment can be quite effective. We present the indications, surgical technique, and rehabilitation protocol of adductor tenotomy for chronic tendinopathy. This can prove a useful tool for the treatment of recalcitrant groin pain attributable to the adductor longus.

Objectives: The purpose of our research was to understand intersections between health, spirituality and well-being in the Métis Nation of Alberta (MNA) Region 3., Design: This Métis-guided, community-based, participatory research builds on our previous patient-oriented community-based study where we co-developed a qualitative structured survey with leaders, Elders and community members to explore health, spirituality and well-being in the MNA Region 3., Setting: Métis people are affected by historical and contemporary impacts of colonisation. This includes the residential school experience, impacting how Métis people relate to themselves, to others and to their culture. Alberta has the highest Métis population in Canada, and our research is based in the most densely populated region., Participants: 101 surveys were completed between September and November 2021, via Qualtrics. Twenty-five participants who completed surveys participated in community-based participatory research sharing circle data analysis groups in January 2022, via Zoom., Results: Six overarching themes were developed in our participatory data analysis: (1) searching, (2) interconnectedness, (3) colonisation and systems, (4) traditional practices and teachings, (5) spiritual and religious practices and (6) relationship with Métis identity., Conclusions: We discovered multiple intersections between health, spirituality and well-being within the MNA Region 3. Our results indicate that the impacts of colonisation for Métis people are poorly understood. More research is needed to understand the ongoing impacts of colonisation, including increased understanding about Métis identity, health, spirituality, religion and well-being. In particular, more research is needed about the effects of intergenerational trauma in the broader MNA, and across Canada., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Optimizing plant nitrogen (N) usage and inhibiting N leaching loss in the soil-crop system is crucial to maintaining crop yield and reducing environmental pollution. This study aimed at identifying quantitative trait loci (QTLs) and differentially expressed genes (DEGs) between two N treatments in order to list candidate genes related to nitrogen-related contrasting traits in tomato varieties. We characterized a genetic diversity core-collection (CC) and a multi-parental advanced generation intercross (MAGIC) tomato population grown in a greenhouse under two nitrogen levels and assessed several N-related traits and mapped QTLs. Transcriptome response under the two N conditions was also investigated through RNA sequencing of fruit and leaves in four parents of the MAGIC population. Significant differences in response to N input reduction were observed at the phenotypic level for biomass and N-related traits. Twenty-seven QTLs were detected for three target traits (leaf N content, leaf nitrogen balance index, and petiole NO3- content), 10 and six in the low and high N condition, respectively, while 19 QTLs were identified for plasticity traits. At the transcriptome level, 4752 and 2405 DEGs were detected between the two N conditions in leaves and fruits, respectively, among which 3628 (50.6%) in leaves and 1717 (71.4%) in fruit were genotype specific. When considering all the genotypes, 1677 DEGs were shared between organs or tissues. Finally, we integrated DEG and QTL analyses to identify the most promising candidate genes. The results highlighted a complex genetic architecture of N homeostasis in tomato and novel putative genes useful for breeding tomato varieties requiring less N input., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The data presented in this paper include the original and processed MRI images acquired with a 1.5 T whole-body MRI scanner, describing the growth kinetics, spatialization and appearance of internal defaults of individual tubers of potato plants (Rosanna cultivar of Solanum tuberosum ) grown in pots in a semi-controlled environment and exposed to two water regimes. The 2 conditions were a well-watered regime, in which soil moisture was maintained at 70 % of field capacity, and a variable water deficit regime, in which soil moisture was reduced to 20 % of field capacity several times during tuber growth, followed each time by a few-day period of rehydration to 70 % of field capacity. These data are supplemented by physiological, biochemical and gene expression data obtained from the leaves and tubers of additional potato plants grown under the same conditions. All these data contribute to highlight the long-term effects of water stress on plant functioning with a particular focus on the growth kinetics, spatialization and quality of potato tubers. The dataset presented here is related to the research article entitled "Growth kinetics, spatialization and quality of potato tubers monitored in situ by MRI - long-term effects of water stress". It is made publicly available to enable extended analyzes. It is a useful resource for biologists, agronomists and breeders interested in the potato crop, as well as for researchers interested in developing new imaging methods. All data can be used to improve databases on development and quality of tubers and to feed and validate mathematical models., (© 2024 The Author(s).)

Among plant pathogens, the necrotrophic fungus Botrytis cinerea is one of the most prevalent, leading to severe crop damage. Studies related to its colonization of different plant species have reported variable host metabolic responses to infection. In tomato, high N availability leads to decreased susceptibility. Metabolic flux analysis can be used as an integrated method to better understand which metabolic adaptations lead to effective host defence and resistance. Here, we investigated the metabolic response of tomato infected by B. cinerea in symptomless stem tissues proximal to the lesions for 7 d post-inoculation, using a reconstructed metabolic model constrained by a large and consistent metabolic dataset acquired under four different N supplies. An overall comparison of 48 flux solution vectors of Botrytis- and mock-inoculated plants showed that fluxes were higher in Botrytis-inoculated plants, and the difference increased with a reduction in available N, accompanying an unexpected increase in radial growth. Despite higher fluxes, such as those involved in cell wall synthesis and other pathways, fluxes related to glycolysis, the tricarboxylic acid cycle, and amino acid and protein synthesis were limited under very low N, which might explain the enhanced susceptibility. Limiting starch synthesis and enhancing fluxes towards redox and specialized metabolism also contributed to defence independent of N supply., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Experimental Biology.)

Drought is a persistent challenge for horticulture, affecting various aspects of fruit development and ultimately fruit quality, but the effect on nutritional value has been under-investigated. Here, fruit quality was studied on six tomato genotypes and one goji cultivar under deficit irrigation (DI), from fruit composition to in vitro bioaccessibility of carotenoids. For both species, DI concentrated most health-related metabolites in fresh fruit. On a dry mass basis, DI increased total phenolic and sugar concentration, but had a negative or insignificant impact on fruit ascorbic acid, organic acid, and alcohol-insoluble matter contents. DI also reduced total carotenoids content in tomato (-18.7% on average), especially β-carotene (-32%), but not in goji berry DW (+15.5% and +19.6%, respectively). DI reduced the overall in vitro bioaccessibility of carotenoids to varying degrees depending on the compound and plant species. Consequently, mixed micelles produced by digestion of fruits subjected to DI contained either the same or lesser quantities of carotenoids, even though fresh fruits could contain similar or higher quantities. Thus, DI effects on fruit composition were species and genotype dependent, but an increase in the metabolite concentration did not necessarily translate into greater bioaccessibility potentially due to interactions with the fruit matrix., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Breniere, Fanciullino, Dumont, Le Bourvellec, Riva, Borel, Landrier and Bertin.)

Purpose: Defining dosimetric rules to automatically detect patients requiring adaptive radiotherapy (ART) is not straightforward, and most centres perform ad-hoc ART with no specific protocol. This study aims to propose and analyse different steps to design a protocol for dosimetrically triggered ART of head and neck (H&N) cancer. As a proof-of-concept, the designed protocol was applied to patients treated in TomoTherapy units, using their available software for daily MVCT image and dose accumulation., Methods: An initial protocol was designed by a multidisciplinary team, with a set of flagging criteria based only on dose-volume metrics, including two action levels: (1) surveillance (orange flag), and (2) immediate verification (red flag). This protocol was adapted to the clinical needs following an iterative process. First, the protocol was applied to 38 H&N patients with daily imaging. Automatic software generated the daily contours, recomputed the daily dose and flagged the dosimetric differences with respect to the planning dose. Second, these results were compared, by a sensitivity/specificity test, to the answers of a physician. Third, the physician, supported by the multidisciplinary team, performed a self-analysis of the provided answers and translated them into mathematical rules in order to upgrade the protocol. The upgraded protocol was applied to different definitions of the target volume (i.e. deformed CTV + 0, 2 and 4 mm), in order to quantify how the number of flags decreases when reducing the CTV-to-PTV margin., Results: The sensitivity of the initial protocol was very low, specifically for the orange flags. The best values were 0.84 for red and 0.15 for orange flags. After the review and upgrade process, the sensitivity of the upgraded protocol increased to 0.96 for red and 0.84 for orange flags. The number of patients flagged per week with the final (upgraded) protocol decreased in median by 26% and 18% for red and orange flags, respectively, when reducing the CTV-to-PTV margin from 4 to 2 mm. This resulted in only one patient flagged at the last fraction for both red and orange flags., Conclusion: Our results demonstrate the value of iterative protocol design with retrospective data, and shows the feasibility of automatically-triggered ART using simple dosimetric rules to mimic the physician's decisions. Using a proper target volume definition is important and influences the flagging rate, particularly when decreasing the CTV-to-PTV margin., (© 2023 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

We report the case of a medically inoperable patient with localised colon cancer. Due to symptomatic bleeding, definitive radiotherapy (5 daily fractions of 5 Gy) has been performed using cone-beam computed tomography-based online-adaptive radiotherapy (ART). Online-ART enables compensation of interfraction motion of abdominal organs by performing daily delineation of organs at risk (OARs) and target volumes. Daily treatment replanning maximised target volume coverage while lowering the dose to OARs. Intrafraction variation of the tumour was still significant and had to be incorporated in the planning target volume margin computation. After the treatment, the patient did not develop any acute radiotherapy-induced adverse events and had no further rectal bleeding either at the end of the radiotherapy or at oncological follow-up 4 months later. Online-ART for colon cancer is feasible and is a valuable alternative when surgery is not an option., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Background: Using data from the Rhode Island immunization registry from January 2019 through September 2022, we assessed whether adolescent routine vaccination rates are catching up on losses experienced early in the pandemic., Methods: For Q1 2020-Q3 2022, we calculated the number of adolescents ages 11-18 receiving a routine vaccine as a percentage of the same quarter in 2019 along with the cumulative difference through Q3 2022. Human papillomavirus (HPV) vaccine trends were further stratified by racial/ethnic identity and by sex., Results: Except for Q1 2021, the number of adolescents receiving each vaccine in each calendar quarter since Q1 2020 was below 100% of the same quarter in 2019, resulting in cumulative "losses" or "deficits" relative to pre-pandemic numbers., Conclusions: We describe ways Rhode Island can expand on its existing partnerships between primary care providers, public health, and schools to address the decline in adolescent routine vaccination.

Main Conclusion: Severe N stress allows an accumulation of C-based compounds but impedes that of N-based compounds required to lower the susceptibility of tomato stem to Botrytis cinerea. Botrytis cinerea, a necrotrophic filamentous fungus, forms potentially lethal lesions on the stems of infected plants. Contrasted levels of susceptibility to B. cinerea were obtained in a tomato cultivar grown on a range of nitrate concentration: low N supply resulted in high susceptibility while high N supply conferred a strong resistance. Metabolic deviations and physiological traits resulting from both infection and nitrogen limitation were investigated in the symptomless stem tissue surrounding the necrotic lesion. Prior to infection, nitrogen-deficient plants showed reduced levels of nitrogen-based compounds such as amino acids, proteins, and glutathione and elevated levels of carbon-based and defence compounds such as α-tomatine and chlorogenic acid. After B. cinerea inoculation, all plants displayed a few common responses, mainly alanine accumulation and galactinol depletion. The metabolome of resistant plants grown under high N supply showed no significant change after inoculation. On the contrary, the metabolome of susceptible plants grown under low N supply showed massive metabolic adjustments, including changes in central metabolism around glutamate and respiratory pathways, suggesting active resource mobilization and production of energy and reducing power. Redox and defence metabolisms were also stimulated by the infection in plants grown under low N supply; glutathione and chlorogenic acid accumulated, as well as metabolites with more controversial defensive roles, such as polyamines, GABA, branched-chain amino acids and phytosterols. Taken together, the results showed that nitrogen deficiency, although leading to an increase in secondary metabolites even before the pathogen attack, must have compromised the constitutive levels of defence proteins and delayed or attenuated the induced responses. The involvement of galactinol, alanine, cycloartenol and citramalate in the tomato stem response to B. cinerea is reported here for the first time., (© 2023. The Author(s).)

With the increasing resolution of operational forecasting models, the marginal ice zone (MIZ), the area where waves and sea ice interact, can now be better represented. However, the proper mechanics of wave propagation and attenuation in ice, and especially their influence on sea ice dynamics, still remain poorly understood and constrained in models. Observations have shown exponential wave energy decrease with distance in sea ice, particularly strong at higher frequencies. Some of this energy is transferred to the ice, breaking it into smaller floes and weakening it, as well as exerting a stress on the ice similar to winds and currents. In this article, we present a one-dimensional, fully integrated wave and ice model that has been developed to test different parameterizations of wave-ice interactions. The response of the ice cover to the wind and wave radiative stresses is investigated for a variety of wind, wave and ice conditions at different scales. Results of sensitivity analyses reveal the complex interplay between wave attenuation and rheological parameters and suggest that the compressive strength of the MIZ may be better represented by a Mohr-Coulomb parameterization with a nonlinear dependence on thickness. This article is part of the theme issue 'Theory, modelling and observations of marginal ice zone dynamics: multidisciplinary perspectives and outlooks'.

Despite enormous scientific and technological progress in numerical weather and climate prediction, sea ice still remains unreliably predicted by models, both in short-term forecasting and climate projection applications. The total ice extent in both hemispheres is tied to the location of the ice edge, and consequently to what happens in the portion of the ice cover immediately adjacent to the open ocean that is called the marginal ice zone (MIZ). There is mounting evidence that processes occurring in the MIZ might play an important role in the polar climate of both hemispheres, yet some key physical processes are still missing in models. As sea ice models developed for climate studies are increasingly used for operational forecasting, the missing physics also impede short-term sea ice prediction skills. This paper is a mini-review that provides a historical perspective on how MIZ research has progressed since the 1970s, with a focus on the fundamental importance of the interactions between sea ice and surface gravity waves on sea ice dynamics. Completeness is not achieved, as the body of literature is huge, scattered and rapidly growing, but the intention is to inform future collaborative research efforts to improve our understanding and predictive capabilities of sea ice dynamics in the MIZ. This article is part of the theme issue 'Theory, modelling and observations of marginal ice zone dynamics: multidisciplinary perspectives and outlooks'.

Rhodamine water tracer (RWT) released during the 2021 Tracer Release Experiment in the St. Lawrence Estuary provides a proxy for the water-soluble fractions of contaminant spills. Measurements of total and size-resolved aerosols were taken onboard a research vessel throughout the experiment. Size-resolved aerosol measurements show airborne transmission of water-soluble RWT in a bimodal distribution peaking at 5.2 μm and 0.9 μm. Highest aerosol RWT (30.5 pg m -3 ) was observed in the 12-hour daytime period following the first dye release (Sept. 5), while the lowest (8.8 pg m -3 ) was observed in the subsequent nighttime sample. Available wind and RWT patch information were used to identify factors contributing to the factor-of-three variation in aerosol RWT concentrations. Negligible correlations were found between aerosol RWT and wind speed and sample time-of-day. Wind direction is isolated as the key variable for consideration in identifying the impact of contaminant spills on coastal and inland communities., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background. Despite the abundance and proximity of edible marine resources, coastal communities along the St. Lawrence in Eastern Québec rarely consume these resources. Within a community-based food sovereignty project, Manger notre Saint-Laurent ("Sustenance from our St. Lawrence"), members of participating communities (3 non-Indigenous, 1 Indigenous) identified a need for a web-based decision tool to help make informed consumption choices. Methods. We thus aimed to co-design a prototype website that facilitates informed choices about consuming local edible marine resources based on seasonal and regional availability, food safety, nutrition, and sustainability, with community members, regional stakeholders, and experts in user experience design and web development. We conducted 48 interviews with a variety of people over 3 iterative cycles, assessing the prototype's ease of use with a validated measure, the System Usability Scale. Results. Community members, regional stakeholders, and other experts identified problematic elements in initial versions of the website (e.g., confusing symbols). We resolved issues and added features people identified as useful. Usability scores reached "best imaginable" for both the second and the third versions and did not differ significantly between sociodemographic groups. The final prototype includes a tool to explore each species and index cards to regroup accurate evidence relevant to each species. Conclusions. Engaging co-designers with different sociodemographic characteristics brought together a variety of perspectives. Several components would not have been included without co-designers' input; other components were greatly improved thanks to their feedback. Co-design approaches in research and intervention development are preferable to foster the inclusion of a variety of people. Once the prototype is programmed and available online, we hope to evaluate the website to determine its effects on food choices., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided entirely by the Sustenance from our St. Lawrence project, which was funded by Réseau Québec Maritime (principal investigator Lemire), by the Littoral Research Chair (Sentinel North Partnership Research Chair in Ecosystem Approaches to Health funded by Sentinel North and the Northern Contaminant Program of the Crown-Indigenous Relations and Northern Affairs Canada [CIRNAC], chairholder Lemire), and the Canadian Institutes of Health Research Foundation grant FDN-148426 (principal investigator Witteman). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. ML receives salary support from the Fonds de recherche en santé du Québec. HOW receives salary support from a Tier 2 Canada Research Chair in Human-Centred Digital Health., (© The Author(s) 2022.)

Gravity-driven flows of granular matter are involved in a wide variety of situations, ranging from industrial processes to geophysical phenomena, such as avalanches or landslides. These flows are characterized by the coexistence of solid and fluid phases, whose stability is directly related to the erosion and sedimentation occurring at the solid-fluid interface. To describe these mechanisms, we build a microscopic model involving friction, geometry, and a nonlocal cooperativity emerging from the propagation of collisions. This new picture enables us to obtain a detailed description of the exchanges between the fluid and solid phases. The model predicts a phase diagram including the limits of erosion and sedimentation, in quantitative agreement with experiments and discrete-element-method simulations.

Metabolic profile is a key component of fruit quality, which is a challenge to study due to great compound diversity, especially in species with high nutritional value. This study presents optimized analytical methods for metabolic profiling in the fruits of three Solanaceae species: Lycium barbarum , Lycium chinense and Solanum lycopersicum . It includes the most important chemical classes involved in nutrition and taste, i.e., carotenoids, phenolic compounds and primary compounds. Emphasis has been placed on the systematic achievement of good extraction yields, sample stability, and high response linearity using common LC-ESI-TQ-MS and GC-EI-MS apparatuses. A set of 13 carotenoids, 46 phenolic compounds and 67 primary compounds were profiled in fruit samples. Chemometrics revealed metabolic markers discriminating Lycium and Solanum fruits but also Lycium barbarum and Lycium chinense fruits and the effect of the crop environment. Typical tomato markers were found to be lycopene, carotene, glutamate and GABA, while lycibarbarphenylpropanoids and zeaxanthin esters characterized goji ( Lycium spp.) fruits. Among the compounds discriminating the Lycium species, reported here for the first time to our knowledge, chlorogenic acids, asparagine and quinic acid were more abundant in Lycium chinense , whereas Lycium barbarum accumulated more lycibarbarphenylpropanoids A-B, coumaric acid, fructose and glucose.

Climate changes in the Arctic may weaken the currently tight pelagic-benthic coupling. In response to decreasing sea ice cover, arctic marine systems are expected to shift from a 'sea-ice algae-benthos' to a 'phytoplankton-zooplankton' dominance. We used mollusc shells as bioarchives and fatty acid trophic markers to estimate the effects of the reduction of sea ice cover on the food exported to the seafloor. Bathyal bivalve Astarte moerchi living at 600 m depth in northern Baffin Bay reveals a clear shift in growth variations and Ba/Ca ratios since the late 1970s, which we relate to a change in food availability. Tissue fatty acid compositions show that this species feeds mainly on microalgae exported from the euphotic zone to the seabed. We, therefore, suggest that changes in pelagic-benthic coupling are likely due either to local changes in sea ice dynamics, mediated through bottom-up regulation exerted by sea ice on phytoplankton production, or to a mismatch between phytoplankton bloom and zooplankton grazing due to phenological change. Both possibilities allow a more regular and increased transfer of food to the seabed. This article is part of the theme issue 'The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.

Objectives: Rates of unintended pregnancies in women with a history of incarceration are high and access to contraception before and after arrest can be limited. Individualized counseling can better prepare women for healthy pregnancy or provide an opportunity for contraceptive education and access within correctional facilities. In this study, we assessed the efficacy of motivational interviewing as an individualized intervention to increase the initiation of contraceptive methods while incarcerated and continuation after release in female inmates who wanted to avoid pregnancy for at least one year after release., Study Design: We performed an RCT in a population of incarcerated women who wanted to avoid pregnancy. Women were randomized to either a computer-assisted motivational interviewing intervention group (n = 119) or an educational video with counseling control group. (n = 113). The primary outcome was initiation of a method of birth control prior to release from the correctional facility., Results: Initiation of contraception was higher in the intervention group (56% vs. 42%, p = 0.03), but this difference was not significant after controlling for number of male partners within the year prior to incarceration. There was no difference between the groups in the rates of pregnancies or STIs or continuation of contraception after release, which was generally low (21%)., Conclusion: Computer-assisted motivational interviewing did not improve uptake or continuation of contraception in this study., Implications: Periods of incarceration provide an opportunity to offer contraceptive services to women who want to avoid a pregnancy. Motivational interviewing may not be an effective method to affect contraceptive behaviors in this population. Future research should explore the family planning values and preferences of women who become involved with the correctional system., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Overdrainage in upright position is one of the most prevalent issues in treating hydrocephalus with a cerebrospinal fluid (CSF) shunt. Anti-siphon devices (ASDs) are employed to reduce this problem. A novel microelectromechanical system (MEMS)-based valve, termed Chronoflow device, aims to regulate CSF drainage indifferently of the body posture. With this study, the suitability of this MEMS-based valve is evaluated regarding its use for the treatment of hydrocephalus, particularly for the prevention of overdrainage and blockage. In total, four Chronoflow devices were tested. An established in-vitro hardware-in-the-loop (HIL) test bed was used to investigate the valves regarding their pressure-flow characteristics, their behaviors towards CSF dynamics, and their capabilities to prevent CSF overdrainage in upright position. Additionally, a contamination test was conducted to evaluate the susceptibility of the device to blockage due to particles. All valves tested regulated the drainage rate at similar nominal flows and independently of posture. The pressure-flow relation measured, however, was notably higher than numerically calculated. Regarding the CSF dynamics, the first three valves tested led to a decreased steady-state intracranial pressure in supine position and showed stable drainage rate in upright position. During the transitional phase from supine to upright and vice versa, the valves continuously adjusted the outflow resistance, which resulted in a stable transitional phase preventing overdrainage. Yet, the fourth valve showed continuous overdrainage in upright position due to an increased nominal flow. However, after several test iterations the nominal flow decreased and stabilized at a level similar to that of the first three valves tested. The contamination test showed that most particles initially adhere to the pillars and spread throughout the cavity of the valve as the concentration of particles increases, thereby affecting the displacement of the membrane. The devices generally provide a stable flow regulation and prevent overdrainage in upright position. Specifically, their drainage behaviors during the posture changes are very effective. However, they also showed high hysteresis and sensitivity towards particle contamination, which resulted in initial increased and altering nominal flows after many test iterations. This result suggests that the MEMS design presented lacks robustness. Yet, an upstream filter and specific coatings on the fluid pathway may increase significantly its reliability.

Purpose: Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy are standard treatments for brain metastases when they are small in size (at the most 3cm in diameter) and limited in number, in patients with controlled extracerebral disease and a good performance status. Large inoperable brain metastases usually undergo hypofractionated stereotactic radiotherapy while haemorrhagic brain metastases have often been contraindicated for both stereotactic radiosurgery or hypofractionated stereotactic radiotherapy. The objective of this retrospective study was to assess a six 6Gy-fractions hypofractionated stereotactic radiotherapy scheme in use at our institution for haemorrhagic brain metastases, large brain metastases (size greater than 15cm 3 ) or brain metastases located next to critical structures., Material and Methods: Patients with brain metastases treated with the 6×6Gy scheme since 2012 to 2016 were included. Haemorrhagic brain metastases were defined by usual criteria on CT scan and MRI. Efficacy, acute and late toxicity were evaluated., Results: Sixty-two patients presenting 92 brain metastases were included (32 haemorrhagic brain metastases). Median follow up was 10.1 months. One-year local control rate for haemorrhagic brain metastases, large brain metastases, or brain metastases next to critical structures were 90.7%, 73% and 86.7% respectively. Corresponding overall survival rates were 61.2%, 32% and 37.8%, respectively. Haemorrhagic complications occurred in 5.3% of patients (N=5), including two cases of brain metastases with pretreatment haemorrhagic signal. Tolerance was good with only one grade 3 acute toxicity., Conclusion: The 6×6Gy hypofractionated stereotactic radiotherapy scheme seems to yield quite good results in patients with haemorrhagic brain metastases, which must be confirmed in a prospective way., (Copyright © 2019 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Background: The Transcatheter Valve Therapy (TVT) Coordinated Registry Network (CRN) supported 23 regulatory decisions and ensured evidence-based evaluation of the application of TVT technology. However, there are cost concerns that require value assessment of the TVT CRN compared with traditional study designs., Objectives: We aimed to determine the value created by the TVT CRN based on (1) Return on investment (ROI), (2) Time saved (TS) in conducting necessary regulatory studies., Methods: For both ROI and TS analyses, we compared studies that used the TVT CRN with those that would have been required if the registry did not exist (counterfactual studies). To estimate ROI, we accounted for the costs of investment and gain from investment. Both the counterfactual costs and length of studies were projected using design specifications determined by US Food and Drug Administration (FDA) reviewers., Results: We identified 21 studies using the TVT CRN (supporting 23 FDA decisions) that generated evidence on TVT for three device manufacturers. ROI is estimated to be greater than 550%. TS by using the CRN ranged from months to years., Conclusions: The CRN method to evidence generation creates value for manufacturers and the broader device ecosystem, demonstrated with this example of the TVT CRN. The public health benefits of evidence created by this CRN outweighs the difference in data quality between traditional clinical studies and the CRN method., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (<6 years old). There is a need for multicentre research on vertebral radiotherapy dose distributions for children, but until more valid data become available, these recommendations can provide a basis for daily practice for radiation oncologists who have patients that require vertebral radiotherapy., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Angiopoietin-1 (Ang1) mediates vascular maturation and immune response. Diabetes decreases Ang1 expression and disrupts Ang1/Tie2 signaling activity. Vasculotide is an Ang1 mimetic peptide, and has anti-inflammatory effects. In this study, we test the hypothesis that vasculotide treatment induces neuroprotection and decreases inflammation after stroke in type 1 diabetic (T1DM) rats. T1DM rats were subjected to embolic middle cerebral artery occlusion (MCAo) and treated with: 1) phosphate buffered saline (PBS); 2) vasculotide (3µg/kg, i.p. injection) administered half an hour prior to MCAo and at 8 and 24 hours after MCAo. Rats were sacrificed at 48 h after MCAo. Neurological function, infarct volume, hemorrhage, blood brain barrier (BBB) permeability and neuroinflammation were measured. Vasculotide treatment of T1DM-MCAo rats significantly improves functional outcome, decreases infarct volume and BBB permeability, but does not decrease brain hemorrhagic transformation compared with PBS-treated T1DM-MCAo rats. In the ischemic brain, Vasculotide treatment significantly decreases apoptosis, number of cleaved-caspase-3 positive cells, the expression of monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor (TNF-α). Western blot analysis shows that vasculotide significantly decreases expression of receptor for advanced glycation end products (RAGE), MCP-1 and TNF-α in the ischemic brain compared with T1DM-MCAo rats. Vasculotide treatment in cultured primary cortical neurons (PCN) significantly decreases TLR4 expression compared with control. Decreased neuroinflammation and reduced BBB leakage may contribute, at least in part, to vasculotide-induced neuroprotective effects after stroke in T1DM rats.

Granular chain packings exhibit a striking emergent strain-stiffening behavior despite the individual looseness of the constitutive chains. Using indentation experiments on such assemblies, we measure an exponential increase in the collective resistance force F with the indentation depth z and with the square root of the number N of beads per chain. These two observations are, respectively, reminiscent of the self-amplification of friction in a capstan or in interleaved books, as well as the physics of polymers. The experimental data are well captured by a novel model based on these two ingredients. Specifically, the resistance force is found to vary according to the universal relation logF∼μsqrt[N]Φ^{11/8}z/b, where μ is the friction coefficient between two elementary beads, b is their size, and Φ is the volume fraction of chain beads when semidiluted in a surrounding medium of unconnected beads. Our study suggests that theories normally confined to the realm of polymer physics at a molecular level can be used to explain phenomena at a macroscopic level. This class of systems enables the study of friction in complex assemblies, with practical implications for the design of new materials, the textile industry, and biology.

BACKGROUND The treatment of locally advanced non-small cell lung cancer involves a combination of chemotherapy, surgery, and radiotherapy. Each case is discussed and the best strategy is chosen individually, following international guidelines. CASE REPORT A 37-year-old man was diagnosed with locally advanced broncho-pulmonary adenocarcinoma (stage IIIA). The disease was stable after 2 cycles of cisplatin plus Navelbine used as neoadjuvant therapy. FISH analysis revealed an ALK rearrangement. The patient then received unlicensed crizotinib as second-line neoadjuvant treatment, which led to an almost complete radiological and metabolic response. A left upper lobectomy was performed, followed by post-operative chemotherapy and radiotherapy. At 18 months post-surgery, the patient is still disease-free according to the last CT scan. CONCLUSIONS Targeted therapy was an alternative solution when chemotherapy was not helping. Randomized studies are needed to define its precise role in the neoadjuvant scheme.

This study was initiated following conclusions from earlier experimental work, performed in a low-energy carbon ion beam, indicating a significant LET dependence of the response of a PTW-60019 microDiamond detector. The purpose of this paper is to present a comparison between the response of the same PTW-60019 microDiamond detector and an IBA Roos-type ionization chamber as a function of depth in a 62MeV proton beam. Even though proton beams are considered as low linear energy transfer (LET) beams, the LET value increases slightly in the Bragg peak region. Contrary to the observations made in the carbon ion beam, in the 62MeV proton beam good agreement is found between both detectors in both the plateau and the distal edge region. No significant LET dependent response of the PTW-60019 microDiamond detector is observed consistent with other findings for proton beams in the literature, despite this particular detector exhibiting a substantial LET dependence in a carbon ion beam., (Copyright © 2016 Associazione Italiana di Fisica Medica. All rights reserved.)

Acoustic clutter produced by off-axis and multipath scattering is known to cause image degradation, and in some cases these sources may be the prime determinants of in vivo image quality. We have previously shown some success addressing these sources of image degradation by modeling the aperture domain signal from different sources of clutter, and then decomposing aperture domain data using the modeled sources. Our previous model had some shortcomings including model mismatch and failure to recover B-Mode speckle statistics. These shortcomings are addressed here by developing a better model and by using a general regularization approach appropriate for the model and data. We present results with L1 (lasso), L2 (ridge), and L1/L2 combined (elastic-net) regularization methods. We call our new method aperture domain model image reconstruction (ADMIRE). Our results demonstrate that ADMIRE with L1 regularization, or weighted toward L1 in the case of elastic-net regularization, have improved image quality. L1 by itself works well, but additional improvements are seen with elastic-net regularization over the pure L1 constraint. On in vivo example cases, L1 regularization showed mean contrast improvements of 4.6 and 6.8 dB on fundamental and harmonic images, respectively. Elastic net regularization (α = 0.9) showed mean contrast improvements of 17.8 dB on fundamental images and 11.8 dB on harmonic images. We also demonstrate that in uncluttered Field II simulations the decluttering algorithm produces the same contrast, contrast-tonoise ratio, and speckle SNR as normal B-mode imaging, demonstrating that ADMIRE preserves typical image features.

Background: Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement., Methods: The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care. Socio-demographic variables, reason for referral, and psychiatric diagnosis were compiled for patients assessed from 1998 to 2010. GP-psychiatrist agreement was established for BD type, gender, and age group (18-25, 26-35, 36-45, >45) using Cohen׳s Kappa coefficient (Κ)., Results: From 1998 to 2010, MEL psychiatrists received 18,111 requests and carried out 10,492 (58%) assessments. There were 583 referrals for BD suspicion, while 640 assessments (6.1%) received a BD diagnosis (40.3% type I, 40.5% type II). The overall K was 0.35 (95% CI [0.31, 0.38]), and was significantly higher for type I than type II (I=0.35, 95% CI [0.30, 0.39]; II=0.25, 95% CI [0.21, 0.30]), though age group and gender had no impact., Limitations: Reasons for referral were converted into keywords and categories to facilitate agreement analyses. Only the main psychiatric diagnosis was available., Conclusions: Our study suggests diagnosing BD remains strenuous, regardless of age and gender, though BD type I seems better understood by primary care GPs. The true measure of BD diagnosis remains a critical issue in clinical practice., (Copyright © 2014 Elsevier B.V. All rights reserved.)

We summarized and appraised evidence regarding HIV prevention interventions for adults with criminal justice involvement. We included randomized and quasi-randomized controlled trials that evaluated an HIV prevention intervention, enrolled participants with histories of criminal justice involvement, and reported biological or behavioral outcomes. We used Cochrane methods to screen 32,271 citations from 16 databases and gray literature. We included 37 trials enrolling n = 12,629 participants. Interventions were 27 psychosocial, 7 opioid substitution therapy, and 3 HIV-testing programs. Eleven programs significantly reduced sexual risk taking, 4 reduced injection drug risks, and 4 increased testing. Numerous interventions may reduce HIV-related risks among adults with criminal justice involvement. Future research should consider process evaluations, programs involving partners or families, and interventions integrating biomedical, psychosocial, and structural approaches.

Background and Purpose: The "spot sign" or contrast extravasation is strongly associated with hematoma formation and growth. An animal model of contrast extravasation is important to test existing and novel therapeutic interventions to inform present and future clinical studies. The purpose of this study was to create an animal model of contrast extravasation in acute intracerebral hemorrhage., Materials and Methods: Twenty-eight hemispheres of Yorkshire male swine were insonated with an MR imaging-guided focused sonography system following lipid microsphere infusion and mean arterial pressure elevation. The rate of contrast leakage was quantified by using dynamic contrast-enhanced MR imaging and was classified as contrast extravasation or postcontrast leakage by using postcontrast T1. Hematoma volume was measured on gradient recalled-echo MR imaging performed 2 hours postprocedure. Following this procedure, sacrificed brain was subjected to histopathologic examination. Power level, burst length, and blood pressure elevation were correlated with leakage rate, hematoma size, and vessel abnormality extent., Results: Median (intracerebral hemorrhage) contrast extravasation leakage was higher than postcontrast leakage (11.3; 6.3-23.2 versus 2.4; 1.1-3.1 mL/min/100 g; P<.001). Increasing burst length, gradient recalled-echo hematoma (ρ=0.54; 95% CI, 0.2-0.8; P=.007), and permeability were correlated (ρ=0.55; 95% CI, 0.1-0.8; P=.02). Median permeability (P=.02), gradient recalled-echo hematoma (P=.02), and dynamic contrast-enhanced volumes (P=.02) were greater at 1000 ms than at 10 ms. Within each burst-length subgroup, incremental contrast leakage was seen with mean arterial pressure elevation (ρ=0.2-0.8)., Conclusions: We describe a novel MR imaging-integrated real-time swine intracerebral hemorrhage model of acute hematoma growth and contrast extravasation., (© 2014 by American Journal of Neuroradiology.)

Provisions of the Affordable Care Act offer new opportunities to apply a public health and medical perspective to the complex relationship between involvement in the criminal justice system and the existence of fundamental health disparities. Incarceration can cause harm to individual and community health, but prisons and jails also hold enormous potential to play an active and beneficial role in the health care system and, ultimately, to improving health. Traditionally, incarcerated populations have been incorrectly viewed as isolated and self-contained communities with only peripheral importance to the public health at large. This misconception has resulted in missed opportunities to positively affect the health of both the individuals and the imprisoned community as a whole and potentially to mitigate risk behaviors that may contribute to incarceration. Both community and correctional health care professionals can capitalize on these opportunities by working together to advocate for the health of the criminal justice-involved population and their communities. We present a set of recommendations for the improvement of both correctional health care, such as improving systems of external oversight and quality management, and access to community-based care, including establishing strategies for postrelease care and medical record transfers.

Early diagnosis of HIV and effective antiretroviral treatment are key elements in efforts to reduce the morbidity and mortality associated with HIV. Incarcerated populations are disproportionately affected by HIV, with the disease's prevalence among inmates estimated to be three to five times higher than among the general population. Correctional institutions offer important opportunities to test for HIV and link infected people to postrelease treatment services. To examine HIV testing and policies that help HIV-positive people obtain treatment in the community after release, we administered a survey to the medical directors of the fifty state prison systems and of forty of the largest jails in the United States. We found that 19 percent of prison systems and 35 percent of jails provide opt-out HIV testing, which is recommended by the Centers for Disease Control and Prevention (CDC). Additionally, fewer than 20 percent of prisons and jails conform to the CDC's recommendations regarding discharge planning services for inmates transitioning to the community: making an appointment with a community health care provider, assisting with enrollment in an entitlement program, and providing a copy of the medical record and a supply of HIV medications. These findings suggest that opportunities for HIV diagnosis and linking HIV-positive inmates to community care after release are being missed in the majority of prison systems and jails.

Introduction: As a result of transnational migration, health institutions are faced with growing demand for "restoration" of virginity. The practice of hymen reconstruction constitutes a challenge for health care providers in medical, ethical, judicial, social, and cultural dimensions, for which they are not well prepared., Aim: The aim of the presented nationwide survey was to investigate the experience of Swiss gynecologists with women requesting hymen reconstruction., Methods: A questionnaire specifically designed for this purpose was sent to 100 public hospitals., Main Outcome Measures: Main outcome measures included demands for (number of requests, origin of women) and attitudes toward hymen reconstruction (requests granted, decision-making for or against intervention, surgical technique applied, problems associated with the requests for hymen repair, cost coverage, need for further information) in Switzerland., Results: The response rate was 68%. Of the 43 clinics (63.2%) confronted with requests for hymen reconstruction, 38 (90.5%) claimed to see up to five patients per year. The predominantly mentioned countries of origin were Turkey in the German-speaking part and Arab countries in the French-speaking part. More than half of the clinics (27/64.3%) reported that they always (12/28.6%) or mostly (15/35.7%) granted the request. Decision for surgery was made after intensive counseling in 44.2% and on demand of the patient after brief counseling in 32.7%. The so-called approximation method was the most frequently applied surgical technique. A third of the participants (19/35.2%) reported problems with confidentiality. More than half of the clinics expressed their need for further information on this topic., Conclusions: Hymen reconstruction is rarely performed in Switzerland, even though two-thirds of the responding hospitals are confronted with this issue several times per year. No guidelines exist on how health professionals should deal with these requests. Interdisciplinary research on how to meet the needs of women and health care providers in such cross-cultural encounters is needed., (© 2013 International Society for Sexual Medicine.)

The United States now has the highest incarceration rate in the world. The majority of prison and jail inmates come from predominantly nonwhite and medically underserved communities. Although incarceration has adverse effects on both individual and community health, prisons and jails have also been used successfully as venues to provide health services to people with HIV who frequently lack stable health care. We review demographic trends shaping the difficulties in providing care to incarcerated people with HIV and recommend the Centers for AIDS Research Collaboration on HIV in Corrections as a model of interdisciplinary collaboration in addressing those difficulties.

Background: Screening for latent tuberculosis infection (LTBI) using a protocol comprising chest X-ray and tuberculin skin test (TST) interpreted with medical history, Sc1, reduces LTBI reactivation on treatment with anti-tumour necrosis factor-alpha (anti-TNF-α). In the district of Seine-Saint-Denis, France, where tuberculosis (TB) incidence ranges from 30 to >100/100 000 person-years, however, Sc1 might be insensitive as a screening tool. We adopted another protocol, Sc2, comprising Sc1 plus two additional tests: the QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) and chest computed tomography (CT)., Methods: We screened 123 consecutive patients with inflammatory rheumatic diseases (IRDs), candidates for anti-TNF-α treatment, and evaluated the impact of Sc2 vs. Sc1 on the prescription of prophylactic anti-tuberculosis treatment., Results: Sc2 led to a diagnosis of LTBI in 69 patients vs. 59 when using Sc1: eight were QFT-GIT-positive. Diagnosis was based on CT findings in two patients. QFT-GIT had higher diagnostic accuracy than TST, but no single diagnostic test could detect all patients at high risk for LTBI reactivation (respectively 30.2% and 37.5% of patients positive with only TST or QFT-GIT). CT detected TB sequelae in 3/46 rheumatoid arthritis patients who were negative to all tests., Conclusions: Testing with both TST and QFT-GIT seems the safest strategy for detecting LTBI in patients with IRD from populations with high incidence of TB. Systematic screening with CT warrants further evaluation.

A more detailed insight into disease mechanisms of multiple sclerosis (MS) is crucial for the development of new and more effective therapies. MS is a chronic inflammatory autoimmune disease of the central nervous system. The aim of this study is to identify novel disease associated proteins involved in the development of inflammatory brain lesions, to help unravel underlying disease processes. Brainstem proteins were obtained from rats with MBP induced acute experimental autoimmune encephalomyelitis (EAE), a well characterized disease model of MS. Samples were collected at different time points: just before onset of symptoms, at the top of the disease and following recovery. To analyze changes in the brainstem proteome during the disease course, a quantitative proteomics study was performed using two-dimensional difference in-gel electrophoresis (2D-DIGE) followed by mass spectrometry. We identified 75 unique proteins in 92 spots with a significant abundance difference between the experimental groups. To find disease-related networks, these regulated proteins were mapped to existing biological networks by Ingenuity Pathway Analysis (IPA). The analysis revealed that 70% of these proteins have been described to take part in neurological disease. Furthermore, some focus networks were created by IPA. These networks suggest an integrated regulation of the identified proteins with the addition of some putative regulators. Post-synaptic density protein 95 (DLG4), a key player in neuronal signalling and calcium-activated potassium channel alpha 1 (KCNMA1), involved in neurotransmitter release, are 2 putative regulators connecting 64% of the identified proteins. Functional blocking of the KCNMA1 in macrophages was able to alter myelin phagocytosis, a disease mechanism highly involved in EAE and MS pathology. Quantitative analysis of differentially expressed brainstem proteins in an animal model of MS is a first step to identify disease-associated proteins and networks that warrant further research to study their actual contribution to disease pathology.