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Medication adherence and persistence patterns among patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) were analyzed. Electronic medical records of patients from the Reliant Medical Group were examined to evaluate adherence and persistence patterns. A total of 1,807 patients with LUTS/BPH were included in the study, and the number of patients at least 50 years of age was 1,748/1,807 (97%). Overall, 15.77% of patients were prescribed index prescription once, and no patients on combination alpha-blocker and 5-alpha reductase inhibitor therapies were prescribed their index prescriptions once. For all patients with LUTS/BPH, the mean number of prescriptions filled was 6.26, and the percentage of men persisting on index therapy for ≥4 years was 48%. Patients with LUTS/BPH showed a high proportion of both adherent and persistent treatment patterns, especially among patients taking combination therapy. The long follow-up time in our study provides evidence that patients are experiencing sufficient symptom relief to tolerate the challenges of remaining adherent and persistent.

The vast peat deposits in the Peruvian Amazon are crucial to the global climate. Palm swamp, the most extensive regional peatland ecosystem faces different threats, including deforestation and degradation due to felling of the dominant palm Mauritia flexuosa for fruit harvesting. While these activities convert this natural C sink into a source, the distribution of degradation and deforestation in this ecosystem and related C emissions remain unstudied. We used remote sensing data from Landsat, ALOS-PALSAR, and NASA's GEDI spaceborne LiDAR-derived products to map palm swamp degradation and deforestation within a 28 Mha area of the lowland Peruvian Amazon in 1990-2007 and 2007-2018. We combined this information with a regional peat map, C stock density data and peat emission factors to determine (1) peatland C stocks of peat-forming ecosystems (palm swamp, herbaceous swamp, pole forest), and (2) areas of palm swamp peatland degradation and deforestation and associated C emissions. In the 6.9 ± 0.1 Mha of predicted peat-forming ecosystems within the larger 28 Mha study area, 73% overlaid peat (5.1 ± 0.9 Mha) and stored 3.88 ± 0.12 Pg C. Degradation and deforestation in palm swamp peatlands totaled 535,423 ± 8,419 ha over 1990-2018, with a pronounced dominance for degradation (85%). The degradation rate increased 15% from 15,400 ha y -1 (1990-2007) to 17,650 ha y -1 (2007-2018) and the deforestation rate more than doubled from 1,900 ha y -1 to 4,200 ha y -1 . Over 1990-2018, emissions from degradation amounted to 26.3 ± 3.5 Tg C and emissions from deforestation were 12.9 ± 0.5 Tg C. The 2007-2018 emission rate from both biomass and peat loss of 1.9 Tg C yr -1 is four times the average biomass loss rate due to gross deforestation in 2010-2019 reported for the hydromorphic Peruvian Amazon. The magnitude of emissions calls for the country to account for deforestation and degradation of peatlands in national reporting., 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 © 2023 Elsevier Ltd. All rights reserved.)

Rationale: Cystic fibrosis (CF) newborn screening (NBS) algorithms in the United States vary by state. Differences in CF NBS algorithms could potentially affect the detection rate of CF newborns and lead to disparities in CF diagnosis amongst different racial and ethnic groups., Objectives: Generate a database of CF NBS algorithms in the United States and identify processes that may potentially lead to missed diagnoses or lead to healthcare disparities., Methods: We sent an online survey to state and regional CF and NBS leaders about the type and threshold of immunoreactive trypsinogen (IRT) cutoff used and methods used for CFTR  gene variant analysis. Follow-up by email and phone was done to ensure a response from every state, clarify responses, and resolve discordances., Results: There is wide variation in the NBS algorithms employed by different states. Approximately half the states use a floating IRT cutoff, and half use a fixed IRT cutoff. CFTR variant analysis also varies widely, with two states analyzing only for the F508del variant and four states incorporating CFTR gene sequencing. The other states use CFTR variant panels ranging from 23 to 365 CFTR variants., Conclusions: CF NBS algorithms vary widely amongst the different states in the United States, which affects the ability of CF NBS to diagnose newborn infants with CF consistently and uniformly across the country and potentially may miss more infants with CF from minority populations. Our results identify an important area for quality improvement in CF NBS., (© 2022 Wiley Periodicals LLC.)

Introduction: Concomitant plate fixation as an adjunct to intramedullary nailing (IMN) of proximal third tibia fractures is a proven technique. Benefits include its role as a minimally invasive reduction aid, allowing for minimal soft tissue disruption. Expanding its indications as adjunct fixation to IMN throughout the tibia, we aimed to study outcomes in a multi-centre initiative., Materials and Methods: From May 1999 to March 2010, a total of 1302 operatively treated tibial fractures (including plateau and pilon fractures) with complete medical records were identified for review. Of these, 376 cases were treated via IMN, of which 30 cases were treated via combined IMN and plating, meeting inclusion criteria. Primary outcome was union rates, time to union, and complication rates. Secondary outcomes included mean alignment from the immediate postoperative period to the time of final follow-up., Results: Twenty-seven out of 30 patients were available for follow-up. Twenty-five (93%) achieved bony union; the remaining two patients, sustained Type IIIA and B injuries respectively, went onto non-union secondary to deep infection and required multiple re-operations before achieving ultimate union. Mean time at final follow-up was 20 ± 10 months, 96% were ambulatory at full weight bearing status with no malunions. No significant changes in alignment in either the coronal or sagittal planes were noted at time of final follow-up., Conclusion: Combined IMN and plate fixation is a reliable tool not only in the treatment of fractures of the proximal tibia, but also for those fractures in the diaphysis and segmental fractures with proximal and/or distal metadiaphyseal extension with consistent ability to maintain high union rates and maintained alignment. However, longer-term follow-up and prospective trials will be necessary before coming to a definitive conclusion., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Computer-assisted anterior cruciate ligament (ACL) reconstruction in the United States has been used to help improve clinical outcomes and investigate tunnel placement and kinematic activity. Computer-assisted techniques were developed to improve accuracy of tunnel placement, because of concerns about the accuracy of manual tunnel placement causing revisions. Several authors have demonstrated improved tunnel location with computer assistance, although others have demonstrated little or no difference. More recently, American investigators have used computer assistance to evaluate the position and biomechanical behavior and kinematics of theoretical tunnel placement and also to assess in vitro and in vivo knee stability following ligament reconstruction. Computer assistance of anterior ligament reconstruction has demonstrated its value as a research and clinical tool in the United States.