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Purpose: To uncover the barriers, facilitators, and adaptations that affected home care workers' care practices for their clients with dementia during the coronavirus disease 2019 (COVID-19) pandemic., Method: Semi-structured interviews were conducted with home care workers employed during the COVID-19 pandemic in Southeast Michigan. Respondent-driven sampling was used to recruit participants who were interviewed using a guide informed by the Theoretical Domains Framework. To identify themes across interviews, the research team combined content analysis with coding software for qualitative data., Results: Participants ( N = 34) were predominantly female and ranged in age from 19 to 79 years. From the analyzed transcripts, five themes emerged: (1) Challenges in Complying With Pandemic Precautions ; (2) Personal Protective Equipment-Related Disruption in Communication ; (3) Client Fear and Agitation Exacerbated by Isolation ; (4) Difficulties Necessitating Increased Patience ; and (5) Continuation of Pre-Pandemic Holistic Care Practices Facilitating Well-Being ., Conclusion: Home care workers adapted to meet their clients' health and well-being needs in the face of the demands of the pandemic. This study's findings are critical to informing the development of strategies to support home care workers and people living with dementia during future pandemics. [ Journal of Gerontological Nursing, 51 (3), 29-36.]., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Background: Postoperative patients' risk for developing venous thromboembolism (VTE) can be predicted using the adapted Caprini risk assessment model which informs administration of postoperative VTE prophylaxis. The study aimed to assess the appropriateness of postoperative VTE prophylaxis of patients according to the adapted Caprini scores and investigate whether a patient's HIV status influenced postoperative VTE prophylaxis administration., Methods: This cohort study included patients who had elective or urgent surgery at a tertiary hospital, Bloemfontein. Data from patient files were captured on datasheets that comprised the adapted Caprini risk assessment model. The type of prophylaxis received was noted. The appropriateness of the prophylaxis prescribed was compared with the patient's score., Results: Details of 147 patients were included. Three of the 16 patients who did not qualify for prophylaxis, were on VTE prophylaxis on day-one post-surgery. Only 24 (18.3%) of the 131 patients who qualified for prophylaxis were on prophylaxis one day post-surgery. Of the prophylaxis prescribed, 88.5% was enoxaparin, and 11.5% "other", mainly aspirin. Twenty-three (17.6%) patients who qualified for prophylaxis were discharged on prophylaxis. Of the 147 patients, 24 patients were HIV positive, and eight of these patients received postoperative VTE prophylaxis., Conclusion: The majority of postoperative patients at the various surgical departments of the hospital did not receive appropriate postoperative VTE prophylaxis compared to the adapted Caprini scores obtained from their medical information. A patient's HIV status alone did not influence the decision of administering postoperative VTE prophylaxis., (Copyright© Authors.)

Despite advances in gut health research, the variability of important gut markers within individuals over time remains underexplored. We investigated the intra-individual variation of various faecal gut health markers using an optimised processing protocol aimed at reducing variability. Faecal samples from ten healthy adults over three consecutive days demonstrated marker-specific intra-individual coefficients of variation (CV%), namely: stool consistency (16.5%), water content (5.7%), pH (3.9%), total SCFAs (17.2%), total BCFAs (27.4%), total bacteria and fungi copies (40.6% and 66.7%), calprotectin and myeloperoxidase (63.8% and 106.5%), and untargeted metabolites (on average 40%). For thirteen microbiota genera, including Bifidobacterium and Akkermansia, variability exceeded 30%, whereas microbiota diversity was less variable (Phylogenetic Diversity 3.3%, Inverse Simpson 17.2%). Mill-homogenisation of frozen faeces significantly reduced the replicates CV% for total SCFAs (20.4-7.5%) and total BCFAs (15.9-7.8%), and untargeted metabolites compared to faecal hammering only, without altering mean concentrations. Our results show the potential need for repeated sampling to accurately represent specific gut health markers. We also demonstrated the effectiveness of optimised preprocessing of human stool samples in reducing overall analytical variability., (© 2024. The Author(s).)

The home care workforce provides supportive healthcare services to older adults. The COVID-19 pandemic heightened the need for knowledge that can better support this high-risk and understudied group of essential workers. The study aimed to understand decision-making about safety and well-being during the COVID-19 pandemic. The study design used a descriptive qualitative study approach, and 34 participants completed individual video or phone interviews. The results were organized into three themes specific to decision-making around safety and well-being for home care workers (HCWs) during the pandemic: 1) Responsibility, commitment, and dedication to their clients led HCWs to continue to provide essential services, 2) Safety concerns did not prevent HCWs from reporting to work, and 3) HCWs expressed more concern about clients than their own safety. Understanding the experiences of HCWs can offer important insights for developing strategies and policies to address the safety of these essential yet often overlooked healthcare professionals., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Healthcare faces challenges due to the advancements of Industry 4.0 as large volumes of data are generated within healthcare facilities that, combined with the complex nature of healthcare environments, make it difficult to utilise and interpret this data effectively., Purpose: A novel holonic approach to clinical pathway data analysis is presented and implemented as a clinical pathway digital twin. A holon is here taken to be an autonomous and co-operative building block of a software system for transforming, transporting, storing and/or validating information. The digital twin's aim is to ingest, structure and analyse the information associated with a clinical pathway to support healthcare professionals in making informed decisions, for example monitoring and predicting the duration from admission to discharge for individual patients., Method: Real world observations and a review of literature led to the identification of a generic set of clinical pathway analysis needs and, derived therefrom, a set of design requirements. A proof-of-concept clinical pathway analysis digital twin was implemented using a holonic approach derived from the ARTI reference architecture. The holonic approach is evaluated in a hip and knee replacement pathway case study. The evaluation includes automated statistical analyses and machine learning predictions., Results: The evaluation demonstrates that the holonic approach provides an intuitive and extensible means to aggregate and disaggregate information tactically, and to derive context-tailored analysis features. The holonic approach enhances checking for data completion and handling data anomalies. The evaluation also demonstrates on-demand report generation, which reduces repetitive manual tasks for healthcare professionals., Conclusion: The novel holonic data analysis approach facilitates context-rich analyses tailored to specific clinical pathway activities, with effective tailoring of data ingestion and analysis. Healthcare professionals can use the data analysis approach to extract valuable insights for decision-making related to clinical pathways., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pharmacogenomic (PGx) biomarkers integrated using machine learning can be embedded within the electronic health record (EHR) to provide clinicians with individualized predictions of drug treatment outcomes. Currently, however, drug alerts in the EHR are largely generic (not patient-specific) and contribute to increased clinician stress and burnout. Improving the usability of PGx alerts is an urgent need. Therefore, this work aimed to identify principles for optimal PGx alert design through a health-system-wide, mixed-methods study. Clinicians representing multiple practices and care settings (N = 1062) in urban, rural, and underserved regions were invited to complete an electronic survey comparing the usability of three drug alerts for citalopram, as a case study. Alert 1 contained a generic warning of pharmacogenomic effects on citalopram metabolism. Alerts 2 and 3 provided patient-specific predictions of citalopram efficacy with varying depth of information. Primary outcomes included the System's Usability Scale score (0-100 points) of each alert, the perceived impact of each alert on stress and decision-making, and clinicians' suggestions for alert improvement. Secondary outcomes included the assessment of alert preference by clinician age, practice type, and geographic setting. Qualitative information was captured to provide context to quantitative information. The final cohort comprised 305 geographically and clinically diverse clinicians. A simplified, individualized alert (Alert 2) was perceived as beneficial for decision-making and stress compared with a more detailed version (Alert 3) and the generic alert (Alert 1) regardless of age, practice type, or geographic setting. Findings emphasize the need for clinician-guided design of PGx alerts in the era of digital medicine., (© 2024 The Author(s). Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Thresholds that guide diagnoses of probable and acceptable seasickness levels on board ships are scarcely reported in literature. Motion sickness incidence and motion sickness dose value thresholds exist, but are defined for specific environments, such as naval, or offered merely as optional criteria for ship performance metrics. The presented work communicates a novel means of developing seasickness diagnostic criteria during ship operation, based on observations from shipboard measurement systems and seafarers using an innovative platform. The innovative platform provides personalised seasickness criteria that are accessible during ship operation to estimate the probable level of seasickness on board. Results are compared to that from a traditional method of data acquisition and analyses, post operation, revealing a similar trend in diagnostic threshold magnitudes (13-85 m/s 1.5 ) that can be applicable to voyages with different durations (0.5-6 hr) considering desired levels of seasickness (10-50 %). The seasickness criteria are envisioned to be pertinent for the prediction of probable seasickness levels based on sea state forecasts and ship motion estimation., Competing Interests: Declaration of competing interest 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. s., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The radiological protection has the purpose of safeguarding the physical well-being of the user, preventing exposure to detrimental levels of ionizing radiation. This study introduces a novel, cost-effective category of lead-free elastomeric material designed for radiation shielding. The filler compounds utilized are notably lighter than conventional lead-based materials, enhancing user ergonomics during application. They comprise of a blend of barium sulfate combined or not with magnesium oxide with addition-cure liquid silicone rubber. To ensure the effectiveness of the radiation shielding, X-ray transmission measurements were performed for the different thicknesses of the materials and the results compared with Monte Carlo simulations. Additionally, the physical properties of the new materials, such as density, homogeneity, tensile strength, viscosity, and wettability, were also evaluated. The findings indicate that both materials fulfill the requirement for application in radiation protection garments.

Feeding pattern is related to health status or chronic diseases, and this depends on the individual's eating habits. Feeding organized with the right time to start and end during the day, promotes an internal biological rhythm, favoring molecular synchronization of the clock genes, which impose an effect on metabolism and immune cells, creating a physiological response related to a healthy profile. On the other hand, a feeding pattern disorganized, without the right time to start and end eating during the day, might lead to nonsynchronization of the clock genes, a disruption condition, which is related to chronic diseases, such as obesity and diabetes type 2. A strategy that should be adopted to favor molecular synchronization is time-restricted eating (TRE), which can organize the initial and end of the eating patterns during the day. Our review points out some cues that suggest TRE as an efficient strategy for healthy profile and can be a good intervention for the treatment of chronic diseases., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Owing to increasing remission rates, the management of patients with rheumatoid arthritis in sustained remission is of growing interest. The Rheumatoid Arthritis in Ongoing Remission (RETRO) study investigated tapering and withdrawal of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis in stable remission to test whether remission could be retained without the need to take DMARD therapy despite an absence of symptoms., Methods: RETRO was an investigator-initiated, multicentre, prospective, randomised, controlled, open-label, parallel-group phase 3 trial in patients aged at least 18 years with rheumatoid arthritis for at least 12 months before randomisation who were in sustained Disease Activity Score using 28 joints with erythrocyte sedimentation rate (ESR) remission (score <2·6 units). Eligible patients were recruited consecutively from 14 German hospitals or rheumatology practices and randomly assigned (1:1:1) without stratification and regardless of baseline treatment, using a sequence that was computer-generated by the study statistician, to continue 100% dose DMARD (continue group), taper to 50% dose DMARD (taper group), or 50% dose DMARD for 6 months before stopping DMARDs (stop group). Neither patients nor investigators were masked to the treatment assignment. Patients were assessed every 3 months and screened for disease activity and relapse. The primary endpoint was the proportion of patients in sustained DAS28-ESR remission without relapse at 12 months, analysed using a log-rank test of trend and Cox regression. Analysis by a trained statistician of the primary outcome and safety was done in a modified intention-to-treat population that included participants with non-missing baseline data. This study is completed and closed to new participants and is registered with ClinicalTrials.gov (NCT02779114)., Findings: Between May 26, 2010, and May 29, 2018, 303 patients were enrolled and allocated to continue (n=100), taper (n=102), or stop DMARDs (n=101). 282 (93%) of 303 patients were analysed (93 [93%] of 100 for continue, 93 [91%] of 102 for taper, and 96 [95%] of 101 for stop). Remission was maintained at 12 months by 81·2% (95% CI 73·3-90·0) in the continue group, 58·6% (49·2-70·0) in the taper group, and 43·3% (34·6-55·5) in the stop group (p=0·0005 with log-rank test for trend). Hazard ratios for relapse were 3·02 (1·69-5·40; p=0.0003) for the taper group and 4·34 (2·48-7·60; p<0.0001)) for the stop group, in comparison with the continue group. The majority of patients who relapsed regained remission after reintroduction of 100% dose DMARDs. Serious adverse events occurred in ten of 93 (11%) patients in the continue group, seven of 93 (8%) patients in taper group, and 13 of 96 (14%) patients in the stop group. None were considered to be related to the intervention. The most frequent type of serious adverse event was injuries or procedural complications (n=9)., Interpretation: Reducing antirheumatic drugs in patients with rheumatoid arthritis in stable remission is feasible, with maintenance of remission occurring in about half of the patients. Because relapse rates were significantly higher in patients who tapered or stopped antirheumatic drugs than in patients who continued with a 100% dose, such approaches will require tight monitoring of disease activity. However, remission was regained after reintroduction of antirheumatic treatments in most of those who relapsed in this study. These results might help to prevent overtreatment in a substantial number of patients with rheumatoid arthritis., Funding: None., Competing Interests: Declaration of interests KT reports payments for lectures from Gilead and Union Chimique Belge. BM reports consulting fees from MSD and Novartis and payments for lectures from AbbVie, Roche, Pfizer, MSD, Janssen, and Sanofi. SF reports payments for lectures from Amgen, Lilly, Novartis, Pfizer, Roche, and Union Chimique Belge; support for attending meetings from AbbVie, Amgen, Novartis, Pfizer, Roche, and Union Chimique Belge; and Advisory Board participation for Novartis and Amgen. SK reports payments for lectures from Celgene and AbbVie. MFl reports payments for lectures from Actelion, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Chugai Pharmaceutical, Janssen, Medac, Novartis, Pfizer, and Roche. RA reports grants from AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and Roche; payments for lectures from AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and Roche; and Advisory Board participation for AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and Roche. JH reports payments for lectures from AbbVie, Actelion, Bristol Myers Squibb, Boehringer Ingelheim, Janssen, Lilly, Novartis, Pfizer, Roche, Swedish Orphan Biovitrum, and Union Chimique Belge; support for attending meetings from AbbVie, Boehringer Ingelheim, Janssen, Lilly, Novartis, and Union Chimique Belge; and Advisory Board participation for AbbVie, Actelion, Boehringer Ingelheim, Janssen, Novartis Pfizer, and Swedish Orphan Biovitrum. GS reports consulting fees from Lilly, Janssen, and Novartis and payments for lectures from AbbVie, Bristol Myers Squibb, Lilly, Gilead, Janssen, Novartis, Pfizer, and Union Chimique Belge. JR reports consulting fees from AbbVie, Biogen, Bristol Myers Squibb, Chugai Pharmaceutical, Lilly, GlaxoSmithKline, Jannsen, MSD, Novartis, Roche, Sanofi, and Union Chimique Belge and payments for lectures from AbbVie, Biogen, Bristol Myers Squibb, Chugai Pharmaceutical, Lilly, GlaxoSmithKline, Jannsen, MSD, Novartis, Roche, Sanofi, and Union Chimique Belge. All other authors declare no conflicts of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the accuracy of six depth gauges used in three tibial plateau leveling osteotomy (TPLO) plate holes., Study Design: Ex vivo experimental study., Animals and Sample Population: Cadaveric canine limbs (n = 10), one 25-mm-thick wood board, and one 33.8-mm-diameter polyvinyl chloride (PVC) pipe., Methods: A TPLO was performed on 10 canine cadaveric pelvic limbs. Three 3.5-mm plate holes were filled with screws. The remaining three plate holes: a compression hole, a combination compression-locking hole, and a stacked combination compression-locking hole were measured by three observers using six commercial depth gauges and using a micrometer as gold standard. The process was repeated on one wood board and one PVC pipe., Results: Bone measurements collected using two depth gauges with base diameter < 5 mm were smaller than measurements collected using the four depth gauges with base diameter > 5.5 mm (p ranging from < .001 to .038). Mean depth gauge measurements were smaller than micrometer measurements by 2.20 mm for the compression hole, 0.82 mm for the combination hole, and 3.57 mm for the stacked combination hole. Measurement differences among depth gauges were also present for wood board and PVC pipe measurements. Bone measurement variability between depth gauges was less for the combination and compression holes than for the stacked combination hole., Conclusion: Depth gauges lacked accuracy. Measurements differed among gauges and measurement variability varied based on plate hole geometry., Clinical Relevance: Depth gauge measurement accuracy varies based on measuring devices and on 3.5-mm plate hole geometry., (© 2021 American College of Veterinary Surgeons.)

The African citrus psyllid Trioza erytreae is one of the major threats to citrus industry as the vector of the incurable disease known as huanglongbing (HLB) or citrus greening. The psyllid invaded the northwest of the Iberian Peninsula 6 years ago. The invasion alarmed citrus growers in the Mediterranean basin, the largest citrus producing area in Europe, which is still free of HLB. Before our study, no research had been carried out on the genetic diversity of T. erytreae populations that have invaded the Iberian Peninsula and the archipelagos of the Macaronesia (Madeira and the Canary Islands). In this study, combining microsatellites markers and mtDNA barcoding analysis, we characterize the genetic diversity, structure and maternal relationship of these new invasive populations of T. erytreae and those from Africa. Our results suggest that the outbreaks of T. erytreae in the Iberian Peninsula may have derived from the Canary Islands. The populations of T. erytreae that invaded Macaronesia and the Iberian Peninsula are likely to have originated from southern Africa. We anticipate our results to be a starting point for tracking the spread of this invasive pest outside of Africa and to be important for optimizing contingency and eradication plans in newly invaded and free areas., (© 2021. The Author(s).)

Increasing evidence suggests that probiotic supplementation may be efficacious in counteracting age-related shifts in gut microbiota composition and diversity, thereby impacting health outcomes and promoting healthy aging. However, randomized controlled trials (RCTs) with probiotics in healthy older adults have utilized a wide variety of strains and focused on several different outcomes with conflicting results. Therefore, a systematic review was conducted to determine which outcomes have been investigated in randomized controlled trials with probiotic supplementation in healthy older adults and what has been the effect of these interventions. For inclusion, studies reporting on randomized controlled trials with probiotic and synbiotic supplements in healthy older adults (defined as minimum age of 60 years) were considered. Studies reporting clinical trials in specific patient groups or unhealthy participants were excluded. In addition to assessment of eligibility and data extraction, each study was examined for risk of bias and quality assessment was performed by two independent reviewers. Due to the heterogeneity of outcomes, strains, study design, duration, and methodology, we did not perform any meta-analyses and instead provided a narrative overview of the outcomes examined. Of 1997 potentially eligible publications, 17 studies were included in this review. The risk of bias was low, although several studies failed to adequately describe random sequence generation, allocation concealment, and blinding. The overall study quality was high; however, many studies did not include sample calculations, and the majority of studies had a small sample size. The main outcomes examined in the trials included microbiota composition, immune-related measurements, digestive health, general well-being, cognitive function, and lipid and other biomarkers. The most commonly assessed outcome with the most consistent effect was microbiota composition; all but one study with this outcome showed significant effects on gut microbiota composition in healthy older adults. Overall, probiotic supplementation had modest effects on markers of humoral immunity, immune cell population levels and activity, as well as the incidence and duration of the common cold and other infections with some conflicting results. Digestive health, general-well-being, cognitive function, and lipid and other biomarkers were investigated in a very small number of studies; therefore, the impact on these outcomes remains inconclusive. Probiotics appear to be efficacious in modifying gut microbiota composition in healthy older adults and have moderate effects on immune function. However, the effect of probiotic supplementation on other health outcomes remains inconclusive, highlighting the need for more well-designed, sufficiently-powered studies to investigate if and the mechanisms by which probiotics impact healthy aging.

Duckweed has been recognized for its potential of producing biomass on nutrients from waste streams. Our research has shown that strains of duckweed can be successfully cultivated on anaerobically digested (AD) dairy manure under controlled levels of nitrogen (N) and phosphorus (P). The objective of this study was to explore the maximization of starch accumulation in Landoltia punctata (Mey.) Les & Crawford strain 0128 under different cultivation conditions using AD dairy manure as the nutrient source. Experimental results have shown that the most influential factors for starch accumulation in L. punctata were the nutrient concentration and the appropriate scheduling of nutrient starvation at the right growth stages. In our study, nutrient starvation for starch accumulation in L. punctata was achieved by incorporating nutrient addition of appropriately diluted AD dairy manure sequentially in a controlled manner under a constant light intensity of 3,000 lx. It was observed that a starch concentration of 30% (w/w) within the L. punctata biomass was achieved with an initial total N of 57.1 mg L -1 and a total P of 6.7 mg L -1 after a 30-d cultivation. Under the abovementioned cultivation conditions, the duckweed L. punctata recovered 16.3% (±4.0%) of total N and 25.9% (±6.6%) of total P from AD manure into its biomass. It is concluded that L. punctata can be successfully cultivated on nutrients from dairy manure for starch production, which would achieve well-being for dairy farmers by producing a feedstock for biofuels while treating dairy wastewater in an environmentally friendly manner., (© 2020 The Authors. Journal of Environmental Quality © 2020 American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.)

Purpose: Since evidence of an association between vitamin B12 (B12) deficiency and anemia in older people is limited and inconclusive, we wanted to investigate this association in old, frail nursing home patients., Methods: The study includes patients admitted to short-term, post-acute care (n = 765) and residents in long-term care (LTC) (n = 1665), in the municipality of Bergen. Anemia was defined according to the WHO criteria: Hb < 13 g/dL in men and < 12 g/dL in women, and as Hb < 11 g/dL, in both sex (moderate/severe anemia). The presence of anemia was analyzed in patients with subnormal (< 250 pmol/L), normal (250-650 pmol/L) and high (> 650 pmol/L) B12, and the association between anemia and clinical parameters, and including B12, was analyzed using logistic regression models. The use of B12 supplementation was investigated in the LTC patients., Results: Mean age of the 2430 patients was 86 ± 7 years. WHO-defined anemia was seen in 1023 (42%), and moderate/severe anemia in 384 (16%) of the patients. In multiple logistic regression analyses, we found no statistically significant associations of subnormal B12 with WHO-defined anemia or moderate/severe anemia. Renal insufficiency, iron deficiency and CRP > 10 mg/L were significantly associated with both types of anemia, (p < 0.001). Among the LTC residents, 405 (24%) received B12 supplements, 112 (7%) of them had elevated B12 > 650 pmol/L., Conclusion: In older nursing home patients, no association was observed between subnormal B12 and anemia. Older patients in Western societies with mild/moderate anemia should not be treated with B12 supplements without further investigation.

De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.

The curved planes of the human dentition seen in the sagittal view, the mandibular curve of Spee and the maxillary compensating curve, have clinical importance to modern dentistry and potential relevance to the craniofacial evolution of hominins. However, the mechanism providing the formation of these curved planes is poorly understood. To explore this further, we use a simplified finite element model, consisting of maxillary and mandibular "blocks", developed to simulate tooth eruption, and forces opposing eruption, during simplified masticatory function. We test our hypothesis that curved occlusal planes develop from interplay between tooth eruption, occlusal load, and mandibular movement. Our results indicate that our simulation of rhythmic chewing movement, tooth eruption, and tooth eruption inhibition, applied concurrently, results in a transformation of the contacting maxillary and mandibular block surfaces from flat to curved. The depth of the curvature appears to be dependent on the radius length of the rotating (chewing) movement of the mandibular block. Our results suggest mandibular function and maxillo-mandibular spatial relationship may contribute to the development of human occlusal curvature., Competing Interests: The authors have declared that no competing interests exist.

Conventional radiation therapy of brain tumors often produces cognitive deficits, particularly in children. We investigated the potential efficacy of merging Orthovoltage X-ray Minibeams (OXM). It segments the beam into an array of parallel, thin (~0.3 mm), planar beams, called minibeams, which are known from synchrotron x-ray experiments to spare tissues. Furthermore, the slight divergence of the OXM array make the individual minibeams gradually broaden, thus merging with their neighbors at a given tissue depth to produce a solid beam. In this way the proximal tissues, including the cerebral cortex, can be spared. Here we present experimental results with radiochromic films to characterize the method's dosimetry. Furthermore, we present our Monte Carlo simulation results for physical absorbed dose, and a first-order biologic model to predict tissue tolerance. In particular, a 220-kVp orthovoltage beam provides a 5-fold sharper lateral penumbra than a 6-MV x-ray beam. The method can be implemented in arc-scan, which may include volumetric-modulated arc therapy (VMAT). Finally, OXM's low beam energy makes it ideal for tumor-dose enhancement with contrast agents such as iodine or gold nanoparticles, and its low cost, portability, and small room-shielding requirements make it ideal for use in the low-and-middle-income countries.

Despite recommendations suggesting that biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) should be used in combination with methotrexate in the treatment of rheumatoid arthritis (RA), up to one-third of patients with RA are treated with monotherapy. The objective of the systematic literature review reported here was to evaluate the clinical evidence regarding the efficacy of b/tsDMARDs as monotherapy in the treatment of RA. MEDLINE ® , Embase ® , and the Cochrane Central Trials Register (to April 11, 2017) and the American College of Rheumatology and European League Against Rheumatism conference proceedings (2010-2016) were searched for randomized controlled trials evaluating the efficacy of b/tsDMARDs as monotherapy for RA in adults. Forty-four monotherapy studies of abatacept, adalimumab, baricitinib, certolizumab pegol, etanercept, sarilumab, sirukumab, tocilizumab, and tofacitinib reported in 71 publications were identified. Tocilizumab had the most studies (14), followed by etanercept (10) and adalimumab (9). These b/tsDMARDs were consistently shown to be efficacious treatments, regardless of whether patients were intolerant of or had never used conventional synthetic (cs) DMARDs. However, better treatment outcomes were usually achieved with combination therapy, and this was observed for all b/tsDMARDs assessed by this review. Only a few studies provided a head-to-head comparison between b/tsDMARD treatments or between b/tsDMARD monotherapy and combination therapy, and as many were initial RA treatments they were not generalizable to usual care. In conclusion, evidence from randomized trials suggests that the b/tsDMARDs studied are effective as monotherapy. In general, some patient responses seem better with combination therapy and the durability of monotherapy is less than combination therapy. There is, however, a need for longer-term head-to-head trials to establish positioning of these interventions in the treatment algorithm for RA., Funding: Pfizer.Plain Language Summary: Plain language summary available on the journal website.

The effectiveness of biologic therapies now means that remission or low disease activity are realistic targets for treatment. However, after achieving remission/low disease activity, the next steps remain unclear. The aim of this publication was to conduct a broad systematic literature review to evaluate dosing down of biologics. After screening papers and abstracts for relevance and application of inclusion/exclusion criteria, a structured extraction process was used to collect information on the included studies. Fifty-two papers were included in the analysis across rheumatic disease. In patients who discontinue therapy, remission is not typically sustained, with reported rates of relapse and flare across early RA (48-54%), established RA (2-84%), axial spondyloarthritis (11-53%) and PsA (44.9%). In many cases, an acceptable disease activity can be regained upon retreatment. More research is needed to understand the long-term impacts of these strategies on efficacy, safety and cost., (© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: To determine whether there is a measureable change in neurologic function after cranioplasty., Methods: This is a prospective single-surgeon, single-center study. Fifty patients who required a cranioplasty procedure were assessed neurologically within 72 hours before and 7 days after surgery. The assessment tools were the Functional Independence Measure (FIM) and the Cognitive assessment report (Cognistat). The scores for both assessments were calculated and then compared before and after surgery., Results: FIM assessment was performed on all fifty patients, and a Cognistat assessment was performed on 47 patients. Most improvements were seen in the Cognistat scores; however, there appeared to be no specific areas in which there was consistent improvement. There were substantial improvements in the Cognistat assessment in 9 patients. One patient had a much-improved FIM assessment (improved from 18 to 34), but a Cognistat assessment was not possible because of poor neurologic function. These results suggested that improvements after cranioplasty were more likely to occur in the domain of cognitive function than motor function, although overall these results did not reach statistically significance. Bifrontal (vs. unilateral) cranioplasty, timing between decompression and cranioplasty, and age of the patients did not appear to affect the postoperative FIM scores, after we adjusted for preoperative FIM scores and surgical complications., Conclusions: A small but significant number of patients appear to improve clinically after cranioplasty. Neurologic susceptibility to a skull defect may be more common than had been appreciated previously., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the issue of 'retrospective consent' among a cohort of patients who had survived with unfavourable outcome and to assess attitudes among next of kin regarding their role as surrogate decision makers., Methods: Twenty patients who had survived for at least 3 years with an unfavourable outcome following a decompressive craniectomy for severe traumatic brain injury were assessed with their next of kin. During the course of a semistructured interview, participants were asked whether they would have provided consent if they had known their eventual outcome. They were also asked for general comments regarding all aspects of the clinical journey. Eighteen patients had next of kin who were available for interview. For two patients, there was no longer any family involvement., Results: Of the 20 patients, 13 were able to provide a response and 11 felt that they would have provided consent even if they had known their eventual outcome. Of the 18 next of kin who were able to express an opinion, 10 felt that they would have provided retrospective consent., Conclusions: Many patients appeared to have adapted to a level of disability that competent individuals might deem unacceptable. This does not necessarily mean that such outcomes should be regarded as 'favourable', nor that decompressive craniectomy must be performed for patients with predicted poor outcome. Nevertheless, those burdened with the initial clinical decisions and thereafter the long-term care of these patients may draw some support from the knowledge that unfavourable may not necessarily be unacceptable., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)