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Bird photography is often seen as a more representational genre rather than an interpretive one, so experimentation with different styles tends to be less common. Unlike many other genres of [...]

Technically, you can use any camera for bird photography, as long as you know your equipment and how to activate supporting features. A weather-sealed body and lens will make your [...]

Objective: To explore clinicians' perspectives regarding the Massachusetts 2017 law, 'An Act Relative to Advancing Contraceptive Coverage and Economic Security in Our State' (ACCESS), including awareness of the law, perceived barriers and facilitators to successful implementation, and recommendations to improve uptake. ACCESS requires all insurers, except self-insured businesses, to cover short-acting reversible contraceptives (SARCs) at no cost to patients and for a 12-month supply to be prescribed/dispensed if desired after the completion of a three-month trial. Data Sources and Study Setting: We collected primary data from clinicians in Massachusetts from February 1 to July 31, 2021. Study Design: Semi-structured interviews of a purposeful sample of Massachusetts clinicians who provide primary and/or women's health care were conducted via Zoom. Data Collection/Extraction Methods: Interview guide and codebook were created using the Theoretical Domains Framework. Interviews were analyzed using framework analysis, including deductive and inductive approaches. Major themes and sub-themes were organized by a four-level model of the health care system: patient, care team (clinician), organization, and environment. Principal Findings: Most (58.1%) of the 31 participants were not aware of the law. Perceived advantages of this law included decreasing burden on patients, unnecessary clinical visits, and administrative burden on staff for refill requests. Perceived disadvantages focused on concerns that patients would lose their medications or devices (patient-level) and decreased clinician contact with patients (provider-level). Perceived organization- and environmental-level barriers to implementation included lack of electronic medical record (EMR) prescription defaults and insurance coverage issues. Many felt EMR modifications and more training for clinicians and pharmacists could lead to a change in practice. Conclusion: Our study identifies potentially modifiable barriers to the implementation of the ACCESS law. Massachusetts clinicians' lack of awareness of the law demonstrates the need for statewide education, which may allow more eligible patients to obtain a 12-month SARC supply. KEYWORDS implementation, law, short-acting contraception methods, supply, 1 | BACKGROUND Limited access to contraception remains a major contributor to unintended pregnancy in the United States. (1) Short-acting reversible contraceptive methods (SARCs), including oral contraceptives, patches, vaginal rings, [...]

Objective: To examine services delivered during preventive care visits among reproductive-age women with and without chronic conditions by physician specialty. Data Sources: National Ambulatory Medical Care Surveys (2011-2018). Study Design: We examined provision of specific services during preventive care visits by physician specialty among reproductive-age female patients, overall and among women with five common chronic conditions (diabetes, hypertension, depression, hyperlipidemia, and asthma). Data Collection/Extraction Methods: The sample included preventive visits to OB/GYNs or generalist physicians where the patient was female, age 18-44, and not pregnant. Principal Findings: In OB/GYN preventive visits, reproductive health services were more likely to be provided, while non-reproductive health services were less likely to be provided, both among reproductive-age female patients overall and among those with chronic conditions. For example, pap tests were provided in 44.5% of OB/GYN preventive visits (95% CI: 40.6-48.4) and in 21.4% of generalist preventive visits (95% CI: 17.2-26.6). Lipid testing was provided in 2.8% of OB/GYN preventive visits (95% CI: 1.7-3.9) and in 30.3% of generalist preventive visits (95% CI: 26.1-34.6). Conclusions: Understanding the full range of care received in preventive visits across settings could guide recommendations to optimize where reproductive-age women with chronic conditions seek care. KEYWORDS chronic conditions, physician specialty, preventive care, reproductive health, women's health What is known on this topic * A substantial proportion of reproductive-age women receive preventive care from obstetrician-gynecologists * The prevalence of chronic conditions among US adults is high, including among reproductive-age women * Provision of specific services in preventive visits may vary by physician specialty and patient chronic condition status What this study adds * OB/GYN preventive care visits include more reproductive-related services and fewer other services relative to generalist physicians, including for patients with chronic conditions * Preventive visits with OB/GYNs were shorter on average than preventive visits with generalist physicians * Better understanding the full range of care received in preventive visits across settings by reproductive-age women with chronic conditions can help guide recommendations to optimize where this population seeks care, 1 | INTRODUCTION Preventive care is important for optimal health, (1) and the Affordable Care Act required that insurance plans cover certain preventive services with no cost sharing starting in [...]

Objective: To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive. Data Sources: Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018). Study Design: We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid. Data Collection/Extraction Methods: Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics. Principal Findings: Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers. Conclusions: Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health. KEYWORDS child health services, health care costs, health expenditures, oral health, pediatrics, preventive care What is known on this topic * Widespread variation in prices paid by insurers is well-documented, but less is known about the prices paid for pediatric office-based medical services. * Fluoride varnish application in medical offices is an evidence-based service recommended during well-child medical visits during early childhood and as of 2015 is covered by Medicaid and private medical insurers. * Given low fluoride varnish rates and the potential for widespread delivery in medical offices to address oral health disparities, this study examined variation in prices paid by private medical insurers. What this study adds * Prices paid for fluoride varnish varied within and across states, with prices paid ranging from less than $5 to $50. * Prior studies suggest Medicaid generally pays less than private insurers for the same service, but we found that median prices paid by private insurers for fluoride varnish closely followed Medicaid rates. * Among states covering a package of fluoride varnish plus additional preventive oral health services during pediatric medical visits, prices paid by private insurers were much lower than Medicaid rates., 1 | INTRODUCTION Variation in prices paid for health care services is well-documented across geography and payer. (1-6) Studies find higher prices among private insurers than Medicare and Medicaid. (3,6,10) [...]

Extreme mountain trail is an event like no other. But there are some key fundamentals a horse and rider must know so they can better tackle the obstacles they're faced [...]

Afew months into the pandemic, the talent development and culture team at CHRISTUS Health knew that to sustain the organization's culture, it needed to reinstate development opportunities for leaders and [...]

IMPORTANCE: Nearly 6 million children in the US have asthma, and over one-third of US children are insured by Medicaid. Although 23 state Medicaid programs have experimented with accountable care organizations (ACOs), little is known about ACOs’ effects on longstanding insurance-based disparities in pediatric asthma care and outcomes. OBJECTIVE: To determine associations between Massachusetts Medicaid ACO implementation in March 2018 and changes in care quality and use for children with asthma. DESIGN, SETTING, AND PARTICIPANTS: Using data from the Massachusetts All Payer Claims Database from January 1, 2014, to December 31, 2020, we determined child-years with asthma and used difference-in-differences (DiD) estimates to compare asthma quality of care and emergency department (ED) or hospital use for child-years with Medicaid vs private insurance for 3 year periods before and after ACO implementation for children aged 2 to 17 years. Regression models accounted for demographic and community characteristics and health status. Data analysis was conducted between January 2022 and June 2024. EXPOSURE: Massachusetts Medicaid ACO implementation. MAIN OUTCOMES AND MEASURES: Primary outcomes were binary measures in a calendar year of (1) any routine outpatient asthma visit, (2) asthma medication ratio (AMR) greater than 0.5, and (3) any ED or hospital use with asthma. To determine the statistical significance of differences in descriptive statistics between groups, χ2 and t tests were used. RESULTS: Among 376 509 child-year observations, 268 338 (71.27%) were insured by Medicaid and 73 633 (19.56%) had persistent asthma. There was no significant change in rates of routine asthma visits for Medicaid-insured child-years vs privately insured child-years post-ACO implementation (DiD, −0.4 percentage points [pp]; 95% CI, −1.4 to 0.6 pp). There was an increase in the proportion with AMR greater than 0.5 for Medicaid-insured child-years vs privately insured in the postimplementation period (DiD, 3.7 pp; 95% CI, 2.0-5.4 pp), with absolute declines in both groups postimplementation. There was an increase in any ED or hospital use for Medicaid-insured child-years vs privately insured postimplementation (DiD, 2.1 pp; 95% CI, 1.2-3.0 pp), an 8% increase from the preperiod Medicaid use rate. CONCLUSIONS AND RELEVANCE: Introduction of Massachusetts Medicaid ACOs was associated with persistent insurance-based disparities in routine asthma visit rates; a narrowing in disparities in appropriate AMR rates due to reductions in appropriate rates among those with private insurance; and worsening disparities in any ED or hospital use for Medicaid-insured children with asthma compared to children with private insurance. Continued study of changes in pediatric asthma care delivery is warranted in relation to major Medicaid financing and delivery system reforms.

The article reviews the retrospective exhibition "Oliviero Toscani: More Than Fifty Years of Magnificent Failures", by Oliviero Toscani, at the Museum für Gestaltung in Zurich, Switzerland, until January 5, 2025.

The article reflects on the 40th anniversary of BDDP, now known as TBWA, featuring insights from Jean-Marie Dru and Guillaume Pannaud. Topics include the significance of celebrating the anniversary as a bridge between the past and present of BDDP and TBWA, the enduring cultural values and legacy that connect the two agencies, and the evolution of the advertising industry over the past four decades, emphasizing concepts like "disruption" as a guiding principle for TBWA.

Despite the discovery of actinide borohydride complexes over 80 years ago, no plutonium borohydride complexes have been structurally validated using single-crystal X-ray diffraction (XRD). Here we describe Pu2(H3BPtBu2BH3)6, the first example of a Pu(III) borohydride complex authenticated by XRD and NMR spectroscopy. Theoretical calculations (DFT, EDA, and QTAIM) and experimental comparisons of metal–boron distances suggest that metal–borohydride covalency in M2(H3BPtBu2BH3)6complexes generally decreases in the order M = U(III) > Pu(III) > Ln(III).

Adoptive cell transfer (ACT) with neoantigen-reactive T lymphocytes can mediate cancer regression. Here we isolated unique, personalized, neoantigen-reactive T cell receptors (TCRs) from tumor-infiltrating lymphocytes of patients with metastatic gastrointestinal cancers and incorporated the TCR α and β chains into gamma retroviral vectors. We transduced autologous peripheral blood lymphocytes and adoptively transferred these cells into patients after lymphodepleting chemotherapy. In a phase 2 single-arm study, we treated seven patients with metastatic, mismatch repair-proficient colorectal cancers who had progressive disease following multiple previous therapies. The primary end point of the study was the objective response rate as measured using RECIST 1.1, and the secondary end points were safety and tolerability. There was no prespecified interim analysis defined in this study. Three patients had objective clinical responses by RECIST criteria including regressions of metastases to the liver, lungs and lymph nodes lasting 4 to 7 months. All patients received T cell populations containing ≥50% TCR-transduced cells, and all T cell populations were polyfunctional in that they secreted IFNγ, GM-CSF, IL-2 and granzyme B specifically in response to mutant peptides compared with wild-type counterparts. TCR-transduced cells were detected in the peripheral blood of five patients, including the three responders, at levels ≥10% of CD3+cells 1 month post-ACT. In one patient who responded to therapy, ~20% of CD3+peripheral blood lymphocytes expressed transduced TCRs more than 2 years after treatment. This study provides early results suggesting that ACT with T cells genetically modified to express personalized neoantigen-reactive TCRs can be tolerated and can mediate tumor regression in patients with metastatic colorectal cancers. ClinicalTrials.gov registration: NCT03412877.

Bushings are the most critical component of a power transformer. The voltage gradient between the ground flange and the high-voltage center conductor is much larger compared to the voltage gradients [...]

During a year filled with so much pain for so many, my mantra has been: 'Try not to complain.' After all, I'm healthy. My immediate loved ones are healthy, and [...]

Thick honeycomb-like electrospun scaffold with nanoparticles of hydroxyapatite (nHA) recently demonstrated its potential to promote proliferation and differentiation of a murine embryonic cell line (C3H10T1/2) to osteoblasts. In order to distinguish the respective effects of the structure and the composition on cell differentiation, beads-on-string fibers were used to manufacture thick honeycomb-like scaffolds without nHA. Mechanical and biological impacts of those beads-on string fibers were evaluated. Uniaxial tensile test showed that beads-on-string fibers decreased the Young Modulus and maximal stress but kept them appropriate for tissue engineering. C3H10T1/2 were seeded and cultured for 6 days on the scaffolds without any growth factors. Viability assays revealed the biocompatibility of the beads-on-string scaffolds, with adequate cells-materials interactions observed by confocal microscopy. Alkaline phosphatase staining was performed at day 6 in order to compare the early differentiation of cells to bone fate. The measure of stained area and intensity confirmed the beneficial effect of both honeycomb structure and nHA, independently. Finally, we showed that honeycomb-like electrospun scaffolds could be relevant candidates for promoting bone fate to cells in the absence of nHA. It offers an easier and faster manufacture process, in particular in bone-interface tissue engineering, permitting to avoid the dispersion of nHA and their interaction with the other cells.

Treating intraosseous lesions (IOLs) and interradicular bone lesions (IRLs) is an extremely technical dental procedure in periodontics. Instrumentation of these lesions is often perceived as difficult by students and inexperienced dentists before they perform a certain number of procedures on patients in the clinic. The aim of this article is to evaluate a cost‐effective three‐dimensional (3D)‐printed educational simulator for the periodontal treatment of IOLs/IRLs (including scaling, incisions and sutures). The simulators were first developed digitally, and then manufactured using printable resins and specific materials; finally, they were assembled using different bonding systems. To evaluate the simulators, assessments were gathered from two target populations: undergraduate students and periodontics experts. These individuals tested the simulator and completed a cross‐sectional questionnaire based on a Likert scale with comparative and pedagogical items scored from one to five. The purpose of the questionnaire was to compare our simulator to clinical reality (i.e., operation on human jaws) and to an animal simulator (i.e., simulation of porcine jaws). The results are expressed as the mean and standard deviation and were statistically analyzed with the Wilcoxon signed‐rank test. Overall, the results were satisfactory for both groups of testers (4.70 and 4.61 out of five for students and experts, respectively, for global satisfaction). The overall educational relevance of the simulator designed herein highlights the fact that 3D‐printed educational simulators could enable efficient cognitive‐functional learning for clinical IOL/IRL treatment.

Organometallic molecules are promising for molecular electronic devices due to their potential to improve electrical conductance through access to complex orbital covalency that is not available to light-element organic molecules. However, studies of the formation of organometallic monolayers and their charge transport properties are scarce. Here, we report the cluster formation and charge transport properties of gold–triarylbismuthane–gold molecular junctions. We found that triarylbismuthane molecules with −CN anchoring groups form clusters during the creation of self-assembled submonolayers. This clustering is attributed to strong interactions between the bismuth (Bi) center and the nitrogen atom in the −CN group of adjacent molecules. Examination of the influence of –NH2and −CN anchoring groups on junction conductance revealed that, despite a stronger binding energy between the –NH2group and gold, the conductance per molecular unit (i.e., molecule for the –NH2group and cluster for the −CN group) is higher with the −CN anchoring group. Further analysis showed that an increase in the number of −CN groups from one to three within the junctions leads to a decrease in conductance while increasing the size of the cluster. This demonstrates the significant effects of different anchoring groups and the impact of varying the number of −CN groups on both the charge transport and cluster formation. This study highlights the importance of selecting the appropriate anchoring group in the design of molecular junctions. Additionally, controlling the size and formation of clusters can be a strategic approach to engineering charge transport in molecular junctions.

The article focuses on the upcoming Paris 2024 Olympic Games against the backdrop of recent French political developments. It examines how the political landscape, including the surprise dissolution of parliament and the rise of the far-right, has overshadowed initial enthusiasm for the Olympics. It explores whether the Games can still serve as a showcase for Paris and France internationally, highlighting both opportunities and challenges posed by this unique global event.

RésuméÀ partir d’une étude de cas unique, cet article interroge la résilience du supply chain managementà l’échelle de l’action publique déconcentrée. L’analyse de la réaction de la Gendarmerie nationale lors de la survenue de la tempête Alex dans les Alpes-Maritimes à l’automne 2020 permet d’enrichir la compréhension des différentes dimensions de la résilience logistique (conception, collaboration, agilité, culture interne). Entre autres résultats, le cas révèle les difficultés de coordinations intra-organisationnelles et, a contrario, souligne les vertus de la formation et de la cohésion organisationnelle des individus et des équipes.

The almost unlimited design freedom of the laser-based powder bed fusion of metals (PBF-LB/M) makes this technology very attractive for industry. However, as a developing technology, it still faces some challenges when it comes to productivity and robustness, to name some. Whereas numerous studies covered the impact of laser-based parameters on material properties and robustness, the effect of the processing gas received limited attention. The objective of this study was to evaluate the effect of processing gas composition, containing helium (He) and hydrogen (H2), compared to conventionally used argon (Ar), during PBF-LB/M processing of virgin alloy 718 powder, on printing behavior and part properties. The four gases studied were Ar, Ar +30%He, Ar +30%He +2%H2, and Ar +70%He. Optical Tomography (OT) was used to monitor process stability, which unveiled a significant decrease in process-by products (spatters) between 51 % and 89 % using He and H2-containing gases. It was also found that the process gas decreased the bulk porosity from an average value of 0.08 % when processed with Ar to 0.04 % when using Ar + 70%He. The oxygen pickup by the spatter particles was reduced from 630 ppm (Ar) to 331 ppm (Ar +70%He). EBSD analysis revealed that there were no evident changes in microstructure with the processing gas. The samples processed also had similar tensile properties with yield and ultimate tensile strength of 1180 MPa and 1395 MPa, respectively. However, there was a slight increase in ductility from 16.5 % to 17.2 %, when processed with pure Ar and Ar + 70%He, respectively. This study shows that utilizing standard Ar processing atmosphere with He addition leads to a more stable process with reduced spatter, porosity and a marginal increase in ductility for Alloy 718.

The dynamics of cyclopentadiene (CP) following optical excitation at 243 nm was investigated by time-resolved pump–probe X-ray scattering using 16.2 keV X-rays at the Linac Coherent Light Source (LCLS). We present the first ultrafast structural evidence that the reaction leads directly to the formation of bicyclo[2.1.0]pentene (BP), a strained molecule with three- and four-membered rings. The bicyclic compound decays viaa thermal backreaction to the vibrationally hot CP with a time constant of 21 ± 3 ps. A minor channel leads to ring-opened structures on a subpicosecond time scale.

Desde hace unos 30 años, la ecografía musculoesquelética está ocupando un lugar destacado en la práctica diaria, tanto en el diagnóstico como en el tratamiento de muchas afecciones del aparato locomotor. Tras una breve y necesaria reseña histórica y fundamental de las bases físicas de los ultrasonidos, se abordará la semiología ecográfica normal y patológica de las distintas estructuras anatómicas. En pediatría, la ecografía osteoarticular se ha convertido en la herramienta más útil para evaluar las articulaciones. Un buen conocimiento del desarrollo normal del niño y de los cortes ecográficos de niños sanos en los distintos grupos de edad son la garantía de una correcta interpretación de las imágenes patológicas.

Background There are no validated waist circumference (WC) cut-offs to define metabolic syndrome in Black people with HIV.Methods Cross-sectional analyses within the CKD-AFRICA study. We used Pearson correlation coefficients and receiver operating characteristic (ROC) curves to describe the relationship between WC and cardiometabolic parameters including triglycerides, cholesterol, glucose, glycated haemoglobin (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR), and to identify optimal WC cut-offs for each of these outcomes.Results We included 383 participants (55% female, median age 52 years) with generally well controlled HIV. Female and male participants had similar WC (median 98 vs. 97 cm, p= .16). Generally weak correlations (r2< 0.2) between WC and other cardiometabolic parameters were observed, with low (<0.7) areas under the ROC curves. The optimal WC cut-offs for constituents of the metabolic syndrome, HbA1c and HOMA-IR ranged from 92 to 101 cm in women and 89-98 cm in men, respectively; these cut-offs had variable sensitivity (52%–100%) and generally poor specificity (28%–72%).Conclusions In this cohort of Black people with HIV, WC cut-offs for cardiometabolic risk factors in male participants were in line with the recommended value of 94 cm while in female participants they vastly exceeded the recommended 80 cm for white women.

Copyright of Stratégies is the property of S2C and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An interview with physical therapist Mike Horsfield is presented. Topics mentioned include Horsfield's reason for going into private practice, the use of the American Physical Therapy Association (APTA) Private Practice website to help physical therapy students find information about private practice and the benefit of private practice.

Abstract:This article details how the French army employed medical topography as a tool of military occupation throughout the Mediterranean world from the mid-eighteenth to mid-nineteenth century. It departs from other works by focusing exclusively on medical topography's military applications. Medical topographies charted the connections between health and the environment by observing a location's features, such as soil, air, and water quality, as well as elevation, prevailing winds, common local diseases, sources of potential contagion, and the cleanliness of urban environments. Because a medical-topographic study took time to write and implement, its findings provided little utility during active conflict. Only after the fighting ceased during a campaign could the army make use of a medical topography's findings by taking measures such as draining swamps, relocating hospitals in unhealthy environments, and issuing climate-appropriate gear.Résumé:Cet article examine la façon dont l'armée française utilisait la topographie médicale en tant qu'outil d'occupation militaire pendant les dix-huitième et dix-neuvième siècles dans le monde Méditerranéen. Il se détache des autres travaux en se concentrant exclusivement sur les applications militaires de l'étude. Les études topographiques-médicales analysaient des liens entre l'environnement et la santé. Ces études permettaient l'observation minutieuse et l'enregistrement des caractéristiques d'un lieu, comme par exemple : son élévation, les vents dominants, la qualité de terre, d'eaux, et d'air, la propreté des centres urbaines, et des maladies locales ainsi que leurs origines. Parce que ces études exigeaient du temps d'écrire et d'implémenter, elles n'ont pas eu une grande utilité pratique pendant une campagne. Cependant, après la cessation des hostilités, l'armée a mis en pratique les résultats de ces études. Elle a vidé des marais, déménagé des hôpitaux malsains, et distribué du matériel adapté à l'environnement.

This article provides a comprehensive overview of the skills and knowledge required to become a successful database developer. It covers various topics related to SQL Server and database development, including SQL syntax, index optimization, join types, and advanced SQL concepts. The text also discusses data management, normalization, denormalization, data warehousing, and slowly-changing dimensions. Practical examples and tips are provided throughout the article to improve database development skills. The author emphasizes the importance of understanding and implementing these concepts and provides recommended reading for further learning. [Extracted from the article]

Patients with unresectable hepatocellular carcinoma (HCC) represent a heterogeneous population - in terms of tumor burden and biology as well as underlying liver dysfunction - who require nuanced multidisciplinary management for both therapeutic and supportive aspects of care. In the past several years, there has been rapid and remarkable progress in the discovery of treatment options for unresectable HCC, with numerous new approved systemic therapies, continued progress with locoregional approaches, and implementation of multimodal treatment strategies. This review will discuss the importance of multidisciplinary management as well as the selective role of multimodal for intermediate and advanced-stage HCC phenotypes.

Hepatocellular carcinoma (HCC) is a commonly diagnosed cancer globally, often diagnosed in advanced stages, and carries an overall poor prognosis. HCC has traditionally been challenging to treat with conventional chemotherapy. However, in the past several years, there has been remarkable progress made in systemic treatment options for unresectable HCC. Treatment choice and sequencing of therapies remain challenging due the clinical heterogeneity of unresectable HCC, recent changes in standard of care and trials excluding of patients with more advanced cirrhosis. This has led to a complex treatment landscape which will be explored in depth in this review.

The article explores the rising trend of survivalism, which has transitioned from being associated with fringe groups to gaining popularity among more mainstream demographics, particularly those in higher socioeconomic categories. It discusses how individuals like Bertrand, a Parisian commercial worker, are increasingly embracing outdoor and self-sufficiency activities as a means of disconnecting from modern life.

An interview with Olivier Saguez, founder of Saguez & Partners, is presented. He discusses passing the agency's reins to a trio consisting of his son, Thibault Saguez, Boris Gentine, and Pierre-Olivier Pigeot. Saguez emphasizes the importance of team cohesion over individual presence, reflecting on the agency's evolution and future under new leadership while maintaining his involvement in guiding the agency's direction and fostering a culture of innovation.

Hospitals are risk environments for people who use drugs, and most hospitals are unprepared to deliver substance use disorder (SUD) care, including harm reduction (HR) interventions. HR philosophy clashes with traditional hospital hierarchy and norms, and staff may resist HR interventions due to stigma, fear of enabling substance use, legal and safety concerns. Nurses are central to hospital culture and care and could promote and deliver HR care. Our US hospital has an inter-professional addiction consult service (ACS) that includes medical providers, social workers, and peers. We developed and launched a hospital-based registered nurse-(RN) led HR intervention, including distributing safe-use supplies (eg, syringes). We describe model development and early experience, using an Exploration, Preparation, Implementation, and Sustainment framework. ACS experiences and community HR interventions informed our explorationphase. In the preparationphase we secured funding from Medicaid payers for a 2-year pilot, including full-time RN salary and HR supplies. We elicited buy-in from hospital executive leaders, partly by partnering with nurse champions who described unmet patient care and staff education needs. We consulted hospital lawyers and developed an institution-wide media campaign targeting staff, including in-person booths distributing naloxone and materials promoting international overdose awareness day (eg, “#EndOverdose” buttons). We collaborated with local and national experts to develop the intervention, which includes RN bedside HR education and staff trainings. The Implementationwas from September 2022 to March 2023. We trained 459 staff (over 15 trainings) and conducted 209 patient encounters. Generally, patients and staff embraced the HR RN role, including previously controversial safe-use supply distribution. Sustainmentefforts include engaging stakeholders in continuous improvement and evaluation efforts. A nurse-led hospital-based HR intervention can expand patient services, support staff, and bridge HR and medical models.

A high-dose formulation of intravitreal aflibercept (8 mg) could improve treatment outcomes in diabetic macular oedema (DMO) by requiring fewer injections than the standard comparator, aflibercept 2 mg. We report efficacy and safety results of aflibercept 8 mg versus 2 mg in patients with DMO.

AbstractBackgroundThe objective of this evaluation was to determine the analytical and clinical performance of the AFIAS point-of-care (POC) Tn-I Plus assay (Boditech Med Inc).Design and methodsLimit of detection (LOD), limit of quantification (LOQ), repeatability, reproducibility, inter- and intra-individual CV were evaluated using the CLSI guidelines. The study was also designed to estimate the 99thpercentile upper reference limit (URL) and to assess the diagnostic sensitivity and specificity.ResultsThe precision repeatability CVs were 6.7–8.5% and reproducibility was 7.5–7.6%. The LOD and LOQ were consistent with the manufacturer’s specified values of 0.010 ng/mL and 0.030 ng/mL, respectively. The 99thpercentile URLs for males (aged 18–75 years) and females (aged 17–65 years) in serum were 0.0300 ng/mL (7.8% CV) and 0.0239 ng/mL (9.4% CV) respectively. Overall 99thpercentile URL was 0.0296 ng/mL (8.2% CV). For the overall apparently healthy population, the percentage of measurable cardiac troponin I (cTn-I) values below the 99thpercentile (i.e. 0.0296 ng/mL) and above the assay’s LOD (= 0.010 ng/mL) was 47,68% (391/820 samples). The diagnostic sensitivity and specificity were 100% with 95% CI (97% − 100%) and 95.2% with 95% CI (93.6% − 96.5%), respectively. No significant differences were observed for the diagnosis of acute myocardial infarction (AMI) between AFIAS Tn-I plus and Abbott ARCHITECT High Sensitive Troponin-I.ConclusionThe clinical performance of AFIAS Tn-I Plus assay for AMI is comparable to the established Abbott ALINITY STAT High Sensitive Troponin-I. This assay is suitable for routine use in clinical laboratories.

Organ procurement organization (OPO) staff play an essential role in the facilitation of organ donation as they guide family members and loved ones of dying patients through the donation process. Throughout the donation process, OPO staff must assume the role of a dual advocate, considering both the interests of the donor (which often include the wishes of the donor’s family) and the interests of potential recipient(s). The benefits of this role are well established; however, minimal literature exists on the ways this role can cause moral distress in OPO staff, who frequently face scenarios in which adhering to the wishes of a donor family may compromise donation potential but failing to honor donor family requests may result in further emotional burden for the family. Given the frequency with which these ethically complex situations exist during donation, OPO staff are at heightened risk for experiencing moral distress and burnout, yet they are seldom acknowledged in the existing moral distress literature. As a result, it is unclear whether the current practices available to mitigate moral distress are beneficial for this population.

The Yucatan Peninsula is a biogeographic province of the Neotropical region which is mostly encompassed by the 3 Mexican states of Campeche, Quintana Roo, and Yucatán. During the development of the International Joint Laboratory ELDORADO (Ecosystem, bioLogical Diversity, habitat mOdifications and Risk of emerging PAthogens and Diseases in MexicO), a French–Mexican collaboration between the IRD (Institut de Recherche pour le Développement) and UNAM (Universidad Nacional Autónoma de México) in Mérida, it became evident that many putative mosquito species names recorded in the Mexican Yucatan Peninsula were misidentifications/misinterpretations or from the uncritical repetition of incorrect literature records. To provide a stronger foundation for future studies, the mosquito fauna of the Mexican Yucatan Peninsula is here comprehensively reviewed using current knowledge of taxonomy, ecology, and distribution of species through extensive bibliographic research, and examination of newly collected specimens. As a result, 90 mosquito species classified among 16 genera and 24 subgenera are recognized to occur in the Mexican Yucatan Peninsula, including 1 new peninsula record and 3 new state records.

Ovarian cancer is the https://www.cdc.gov/cancer/ovarian/statistics/index.htm of gynecologic tumors. Fewer than 40% of those diagnosed with ovarian cancer are cured, and approximately https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html in the US die from the disease every [...]