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Most studies on technology integration in mathematics education are focused on teachers' perceptions or students' academic achievement. However, it is necessary to learn how students perceive their learning in this environment. This basic qualitative study focuses on students' experiences with 1:1 computer-supported collaborative learning (CSCL) in an Algebraic Reasoning classroom. One hundred high school students were invited to participate in this study, nine primarily male students volunteered to share their experiences. We found that students perceived the environment to (1) be user-friendly, (2) provide a enjoyable experience, (3) support their learning, (4) provide multiple ways to learn, (5) allow them to "see" the concepts, (6) make previous interactions accessible, and (7) provide passive feedback

El trauma del hombro es una de las patologías más comunes en traumatología, se pueden presentar desde trauma de tejidos blandos hasta fracturas. Las luxaciones son comunes y generan daños de estructuras internas que predisponen a nuevos eventos de luxación y dolor crónico. En este trabajo se realizará una revisión por imagen de las diferentes patologías que pueden ocurrir en las luxaciones traumáticas y no traumáticas. La inestabilidad glenohumeral tiene muchas formas de presentación y el radiólogo juega un papel importante en el diagnóstico.

Essential oils (EO) affect performance, intestinal integrity, bone mineralization, and meat quality in broiler chickens subjected to cyclic heat stress (HS). Day-of-hatch Cobb 500 male broiler chicks (n = 475) were randomly divided into four groups. Group 1: No heat stress (Thermoneutral) + control diets with no antibiotics; Group 2: heat stress control + control diets; Group 3: heat stress + control diets supplemented with thymol chemotype (45 ppm) and herbal betaine (150 ppm) formulation EO1; Group 4: heat stress + control diets supplemented with phellandrene (45 ppm) and herbal betaine (150 ppm) formulation EO2. From day 10–42, the heat stress groups were exposed to cyclic HS at 35°C for 12 h (8:00–20:00). BW, BWG, FI, and FCRc were measured at d 0, 10, 28, and 42. Chickens were orally gavaged with FITC-d on days 10 (before heat stress) and 42. Morphometric analysis of duodenum and ileum samples and bone mineralization of tibias were done. Meat quality was assessed on day 43 with ten chickens per pen per treatment. Heat stress reduced BW by day 28 (p < 0.05) compared to thermoneutral chickens. At the end of the trial, chickens that received both formulations of EO1 and EO2 had significantly higher BW than HS control chickens. A similar trend was observed for BWG. FCRc was impaired by EO2 supplementation. There was a significant increase in total mortality in EO2 compared with EO1 EO1 chickens had lower FITC-d concentrations at day 42 than the HS control. In addition, EO1 treatment is not statistically different if compared to EO2 and thermoneutral. Control HS broilers had significantly lower tibia breaking strength and total ash at day 42 than heat-stressed chickens supplemented with EO1 and EO2. Heat stress affected intestinal morphology more than thermoneutral chickens. EO1 and EO2 improved intestinal morphology in heat-stressed chickens. Woody breast and white striping were more common in thermoneutral chickens than heat stress chickens. In conclusion, the EO-containing diet could improve broiler chicken growth during cyclic heat stress, becoming increasingly relevant in antibiotic-free production in harsh climates.

Antecedentes: La esperanza de vida es un indicador relacionado con condiciones médicas, demográficas, sociales y geográficas. Objetivos: Analizar el efecto de la pandemia de COVID-19 en la esperanza de vida y de su distribución según variables sociodemográficas en municipios de México. Material y métodos: Se recabó información sobre mortalidad de la Secretaría de Salud, así como información demográfica del Censo de Población y Vivienda de 2020. La esperanza de vida se calculó conforme el método actuarial estándar. Se realizó análisis de riesgo entre la pérdida de la esperanza de vida en años y el tamaño de la población, población económicamente activa, años de escolaridad y población de habla indígena. Resultados: En 2020 se registró una caída promedio de 4.7 años en la esperanza de vida a nivel nacional, pero su distribución fue heterogénea en los municipios, con valores extremos de −2.8 años y 12.6 años. El análisis de riesgo mostró una relación inversa entre las variables sociodemográficas y la pérdida de años de esperanza de vida, con excepción de la población de habla indígena. Conclusiones: El impacto de la pandemia de COVID-19 en la esperanza de vida en México fue significativo, matizado por las variables sociodemográficas analizadas, particularmente por el tamaño de la población de los municipios.

Entropy density behavior poses many problems when we study non-equilibrium situations. In particular, the local equilibrium hypothesis (LEH) has played a very important role and is taken for granted in non-equilibrium problems, no matter how extreme they are. In this paper we would like to calculate the Boltzmann entropy balance equation for a plane shock wave and show its performance for Grad’s 13-moment approximation and the Navier–Stokes–Fourier equations. In fact, we calculate the correction for the LEH in Grad’s case and discuss its properties.

Background: Despite enhanced recovery programmes, length of stay is variable following robotic assisted radical cystectomy (RARC). The aim of this study was to assess the impact socioeconomic deprivation on recovery following RARC. Methods: The prospectively maintained RARC databases at two tertiary referral hospitals were reviewed from 2015 to 2017. Demographic, histological, and outcome data including length of stay (LOS), operation time and blood loss were recorded. The Index of Multiple Deprivation, was chosen as a deprivation index as this is used by the UK government to direct funding and resources to regions, towns and postal codes by assessing a number of indicators. Results: During the study period, 340 consecutive patients underwent RARC. Deprivation deciles were significantly higher in site 1 patients (7.9 in site 1 vs 6.6 in site 2, p < 0.001) implying that these patients are more likely to have higher incomes, levels of education and improved living environments. The mean operating time was longer in the site 1 cohort (397 vs 366 min, p > 0.001) with a reduced mean blood loss volume (252 and 484 mL, p < 0.001). There was a significant difference in mean LOS (6.2 days in site 1 vs 10.6 days in site 2, p < 0.001). On multivariable analysis, a higher deprivation decile did not predict LOS (OR = 1, 95% CI = 0.9–1.1, p = 0.407). Sex and operation site were however significantly associated with LOS (p = 0.006 and <0.001). Conclusion: Recovery following RARC was independent of socioeconomic status when comparing two hospitals with diverse catchment areas in the UK. [ABSTRACT FROM AUTHOR]

Background: The updated Sydney system biopsy protocol (USSBP) standardizes the sampling of gastric biopsies for the detection of preneoplastic conditions (e.g., gastric intestinal metaplasia [GIM]), but the real-world diagnostic yield is not well-described., Aim: To determine whether regular application of USSBP is associated with higher detection of chronic atrophic gastritis (CAG), GIM and autoimmune gastritis (AIG)., Methods: We performed a real-world retrospective study at an academic urban tertiary hospital in Chile. We manually reviewed medical records from consecutive patients undergoing esophagogastroduodenoscopy (EGD) from January to December 2017. Seven endoscopists who performed EGDs were categorized into two groups (USSBP 'regular' and USSBP 'infrequent') based on USSBP adherence, using minimum 20% adherence as the prespecified threshold. Multivariable logistic regression models were used to estimate the odds ratios (aOR) and 95% confidence intervals (CI) for the association between endoscopist groups and the likelihood of diagnosing CAG, GIM or AIG., Results: 1206 patients were included in the study (mean age: 58.5; 65.3% female). The USSBP regular group demonstrated a higher likelihood of detecting CAG (20% vs. 5.3%; aOR 4.03, 95%CI: 2.69-6.03), GIM (12.2% vs. 3.4%; aOR 3.91, 95%CI: 2.39-6.42) and AIG (2.9% vs. 0.8%; aOR 6.52, 95%CI: 1.87-22.74) compared to infrequent group. Detection of advanced-stage CAG (Operative Link for Gastritis Assessment stage III/IV) was significantly higher in the USSBP regular vs. infrequent group (aOR 5.84, 95%CI: 2.23-15.31)., Conclusions: Routine adherence to USSBP increases the detection rates of preneoplastic conditions, including CAG, GIM and AIG. Standardized implementation of USSBP should be considered in high gastric cancer risk populations., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Background: Y-TZP zirconia heads were recalled by the Food and Drug Administration (FDA) in 2001 and zirconia alone was no longer used in orthopedics. Tunnel furnace sintering was suspected of producing defects responsible for early material failure. As Zirconia Toughened Alumina (ZTA) matrices are widely used as bearing material and contain zirconia grains, there remains a need to better understand the in vivo ageing process of zirconia and its clinical implications when the material is produced by batch furnace sintering, the validated sintering process., Questions/objectives: Is there an association between the ageing of batch furnace produced zirconia and THA revision?, Methods: 45 retrieved femoral heads, batch furnace sintered only, were analyzed. Roughness was measured by 3D profilometry, phase transfer by μRaman spectroscopy. Clinical data were compared with material characteristics., Results: Irrespective of the cause of revision, all heads showed a crystallographic phase transition from tetragonal to monoclinic over 19.5%. A correlation was found between the phase change, roughness increase and aseptic loosening, with a threshold set at 24.5% of monoclinic phase., Conclusions: The ageing process of zirconia may lead to aseptic loosening, which, in the absence of contrary evidence, prohibits its use as the sole component of orthopedic materials. ZTA matrices should be clinically monitored, especially in young patients, and better in vitro modelling needs to be performed., Level of Evidence: IV; Case series., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Organic electrochemical transistors have emerged as a promising alternative to traditional 2/3 electrode setups for sensing applications, offering in-situ transduction, electrochemical amplification, and noise reduction. Several of these devices are designed to detect potentiometric-derived signals. However, potentiometric sensing should be performed under open circuit potential conditions, allowing the system to reach thermodynamic equilibrium. This criterion is not met by conventional organic electrochemical transistors, where voltages or currents are directly applied to the sensing interface, that is, the gate electrode. In this work, we introduce an organic electrochemical transistor sensing configuration called the potentiometric‑OECT (pOECT), which maintains the sensing electrode under open circuit potential conditions. The pOECT exhibits a higher response than the 2-electrode setup and offers greater accuracy, response, and stability compared to conventional organic electrochemical transistors. Additionally, it allows for the implementation of high-impedance electrodes as gate/sensing surfaces, all without compromising the overall device size., (© 2024. The Author(s).)

Metabolic Dysfunction-Associated Fatty Liver Disease and Diabetes Mellitus are two prevalent metabolic disorders that often coexist and synergistically contribute to the progression of each other. Several pathophysiological pathways are involved in the association, including insulin resistance, inflammation, and lipotoxicity, providing a foundation for understanding the complex interrelationships between these conditions. The presence of MASLD has a significant impact on diabetes risk and the development of microvascular and macrovascular complications, and diabetes significantly contributes to an increased risk of liver fibrosis progression in MASLD and the development of hepatocellular carcinoma. Moreover, both pathologies have a synergistic effect on cardiovascular events and mortality. Therapeutic interventions targeting MASLD and diabetes are discussed, considering lifestyle modifications, pharmacological agents, and emerging treatment modalities. The review also addresses the challenges in managing these comorbidities, such as the need for personalized approaches and the potential impact on cardiovascular health. The insights gleaned from this analysis can inform clinicians, researchers, and policymakers in developing integrated strategies for preventing, diagnosing, and managing these metabolic disorders., Competing Interests: Conflicts of interest None., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Direct composite restorations are among the most common and useful in dentistry, but shade matching can present challenges. Shade matching with direct composites is often labor intensive and technique sensitive. Utilizing a single-shade composite can simplify the process, reducing the time spent and skill required as well as overall stress on the clinician. In the case presented, which involved multiple restorations in all four quadrants, a single-shade composite was utilized to streamline the workflow and achieve an excellent outcome.

Background and Objectives: For patients with surgical adult spinal deformity (ASD), our understanding of alignment has evolved, especially in the last 20 years. Determination of optimal restoration of alignment and spinal shape has been increasingly studied, yet the assessment of how these alignment schematics have incrementally added benefit to outcomes remains to be evaluated., Methods: Patients with ASD with baseline and 2-year were included, classified by 4 alignment measures: Scoliosis Research Society (SRS)-Schwab, Age-Adjusted, Roussouly, and Global Alignment and Proportion (GAP). The incremental benefits of alignment schemas were assessed in chronological order as our understanding of optimal alignment progressed. Alignment was considered improved from baseline based on SRS-Schwab 0 or decrease in severity, Age-Adjusted ideal match, Roussouly current (based on sacral slope) matching theoretical (pelvic incidence-based), and decrease in proportion. Patients separated into 4 first improving in SRS-Schwab at 2-year, second Schwab improvement and matching Age-Adjusted, third two prior with Roussouly, and fourth improvement in all four. Comparison was accomplished with means comparison tests and χ2 analyses., Results: Sevenhundredthirty-two. patients met inclusion. SRS-Schwab BL: pelvic incidence-lumbar lordosis mismatch (++:32.9%), sagittal vertical axis (++: 23%), pelvic tilt (++:24.6%). 640 (87.4%) met criteria for first, 517 (70.6%) second, 176 (24%) third, and 55 (7.5%) fourth. The addition of Roussouly (third) resulted in lower rates of mechanical complications and proximal junctional kyphosis (48.3%) and higher rates of meeting minimal clinically important difference (MCID) for physical component summary and SRS-Mental (P < .05) compared with the second. Fourth compared with the third had higher rates of MCID for ODI (44.2% vs third: 28.3%, P = .011) and SRS-Appearance (70.6% vs 44.8%, P < .001). Mechanical complications and proximal junctional kyphosis were lower with the addition of Roussouly (P = .024), while the addition of GAP had higher rates of meeting MCID for SRS-22 Appearance (P = .002) and Oswestry Disability Index (P = .085)., Conclusion: Our evaluation of the incremental benefit that alignment schemas have provided in ASD corrective surgery suggests that the addition of Roussouly provided the greatest reduction in mechanical complications, while the incorporation of GAP provided the most significant improvement in patient-reported outcomes., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America., Aim: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs., Methods: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile., Results: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1-99.2), 82.2% (95%CI: 57.6-93.3), 40.0% (95%CI: 16.5-82.8) and 25.9% (95%CI: 4.5-55.7%), respectively. NET (HR 6.1; 95%CI: 2.1-17.2) and GIST (HR 24.4; 95%CI: 3.0-19.8) were independently associated with higher survival compared to AC, adjusted for age and sex., Conclusions: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Objectives: To compare survival of patients who received LDR prostate brachytherapy relative to that of peers in the general population of England, UK., Patients and Methods: Net survival was estimated for 2472 cases treated between 2002 and 2016 using population-based analysis guidelines. Life tables adjusted for social deprivation in England from the Office for National Statistics were used to match patients by affluence based on their postcode., Results: The median (range) age at time of brachytherapy was 66 (55-84) years, 84% resided in Southeast England, 51% under an index of deprivation quintile 5 (most affluent), 55% were clinical stage T1 and the remainder T2. Death from any cause occurred in 270 patients at a median (range) of 7 (1-17) years postimplant. Five and 10-year estimates (95% CI) of overall survival were 96% (95-97) and 90% (89-92), and net survival 103% (102-104) and 109% (107-110) respectively. The net survival remained above 100% in all age-at-treatment and clinical stage groups., Conclusion: Net survival above 100% indicates patients survive longer than the matched general population. The study shows for the first time the net survival of patients treated with a radical therapy for localized prostate cancer in England. The impact of treatment choice on the long-term net survival advantage requires further investigation., (Copyright © 2024 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

The surge in 'Big data' has significantly influenced biomaterials research and development, with vast data volumes emerging from clinical trials, scientific literature, electronic health records, and other sources. Biocompatibility is essential in developing safe medical devices and biomaterials to perform as intended without provoking adverse reactions. Therefore, establishing an artificial intelligence (AI)-driven biocompatibility definition has become decisive for automating data extraction and profiling safety effectiveness. This definition should both reflect the attributes related to biocompatibility and be compatible with computational data-mining methods. Here, we discuss the need for a comprehensive and contemporary definition of biocompatibility and the challenges in developing one. We also identify the key elements that comprise biocompatibility, and propose an integrated biocompatibility definition that enables data-mining approaches., Competing Interests: Declaration of Interests The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Biocomposites were fabricated utilizing polylactic acid (PLA) combined with native starch sourced from mountain's yam ( Dioscorea remotiflora Knuth), an underexplored tuber variety. Different starch compositions (7.5, 15.0, 22.5, and 30.0 wt.%) were blended with PLA in a batch mixer at 160 °C to produce PLA/starch biocomposites. The biocomposites were characterized by analyzing their morphology, particle size distribution, thermal, X-ray diffraction (XDR), mechanical, and dynamic mechanical (DMA) properties, water absorption behavior, and color. The results showed that the amylose content of Dioscorea remotiflora starch was 48.43 ± 1.4%, which corresponds to a high-amylose starch (>30% of amylose). Particle size analysis showed large z-average particle diameters ( D z0 ) of the starch granules (30.59 ± 3.44 μm). Scanning electron microscopy (SEM) images showed oval-shaped granules evenly distributed throughout the structure of the biocomposite, without observable agglomeration or damage to its structure. XDR and DMA analyses revealed an increase in the crystallinity of the biocomposites as the proportion of the starch increased. The tensile modulus (E) underwent a reduction, whereas the flexural modulus (E flex ) increased with the amount of starch incorporated. The biocomposites with the highest E flex were those with a starch content of 22.5 wt.%, which increased by 8.7% compared to the neat PLA. The water absorption of the biocomposites demonstrated a higher uptake capacity as the starch content increased. The rate of water absorption in the biocomposites followed the principles of Fick's Law. The novelty of this work lies in its offering an alternative for the use of high-amylose mountain's yam starch to produce low-cost bioplastics for different applications.

A method using dispersive liquid-liquid microextraction (DLLME) prior to high performance liquid chromatography-diode array detection (HPLC-DAD) was developed to determine seven additives from the plastics industry (butylated hydroxytoluene, diisodecyl phthalate, irgafos 168, lawsone, quercetin, triclosan and vitamin E) in seawater samples. These compounds can reach seawater due to direct discharge from wastewater treatment plants and leaching from plastics and microplastics. The extraction was performed using 25 mL of seawater, 500 μL of 1-octanol (extraction solvent) and a stirring step instead of dispersive solvent. Additive concentrations were determined by LC-DAD on a C18 column with a mobile phase of acetonitrile and phosphoric acid aqueous solution (pH 3.5) by gradient elution. The analytical recoveries ranged from 82 to 93% for all compounds, except for lawsone (60%). Repeatability and intermediate precision were adequate with RSD < calculated values following the Horwitz equation at the concentration levels evaluated (0.06 and 0.24 mg L -1 ). All additives exhibited linear matrix calibration curves ( R 2 > 0.99). Detection limits ranged from 0.009 to 0.028 mg L -1 and quantification limits ranged from 0.027 to 0.084 mg L -1 . Finally, the application of the method to real samples verified the method as accurate and applicable to seawater.

Alzheimer's disease (AD) is a progressive degenerative disorder that results in a severe loss of brain cells and irreversible cognitive decline. Memory problems are the most recognized symptoms of AD. However, approximately 90% of patients diagnosed with AD suffer from behavioral symptoms, including mood changes and social impairment years before cognitive dysfunction. Recent evidence indicates that the dorsal raphe nucleus (DRN) is among the initial regions that show tau pathology, which is a hallmark feature of AD. The DRN harbors serotonin (5-HT) neurons, which are critically involved in mood, social, and cognitive regulation. Serotonergic impairment early in the disease process may contribute to behavioral symptoms in AD. However, the mechanisms underlying vulnerability and contribution of the 5-HT system to AD progression remain unknown. Here, we performed behavioral and electrophysiological characterizations in mice expressing a phosphorylation-prone form of human tau (hTauP301L) in 5-HT neurons. We found that pathological tau expression in 5-HT neurons induces anxiety-like behavior and alterations in stress-coping strategies in female and male mice. Female mice also exhibited social disinhibition and mild cognitive impairment in response to 5-HT neuron-specific hTauP301L expression. Behavioral alterations were accompanied by disrupted 5-HT neuron physiology in female and male hTauP301L expressing mice with exacerbated excitability disruption in females only. These data provide mechanistic insights into the brain systems and symptoms impaired early in AD progression, which is critical for disease intervention.

Latin America presents a high prevalence of Helicobacter pylori(Hp) infection. Between1996-2003, the prevalence in Santiago, Chile, was 70%; recent studies indicate a decreasein this infection. Updating the frequency of Hp is crucial due to its associated health impact., Objective: Our objective was to describe the trend in Hp infection in patients undergoingambulatory esophagogastroduodenoscopy (EGD) in a Chilean population., Materials and Methods: A retrospective observational study was conducted on patients over 18 years old who attended a first EGD with a rapid urease test between 2010-2020. Time trendswere described through time series analysis. A Poisson model was constructed to estimatethe risk of infection, adjusted for age and gender., Results: 11,355 patients were included[66.9% females; mean age 52 years; Hp 41.6%]. Male gender presented a higher frequencyof Hp infection [RR 1.13; (95% CI: 1.08-1.18)].Hp frequency infection decreased significantlyfrom 45.1% in 2010 to 29% in 2020, with a 36% lower probability of Hp infection in 2020 compared to 2010 [RR 0.64;(95% CI: 0.55-0.74)]. A progressive decline in Hp infectiontrend was projected, reaching values close to 25% by year 2025., Conclusion: A significantreduction in Hpinfection was observed between 2010-2020. This decrease could be explained by the implementation of public health policies in the last decade associated with socio-sanitary changes.

Improving health and safety in our communities requires deliberate focus and commitment to equity. Inequities are differences in access, treatment, and outcomes between individuals and across populations that are systemic, avoidable, and unjust. Within health care in general, and Emergency Medical Services (EMS) in particular, there are demonstrated inequities in the quality of care provided to patients based on a number of characteristics linked to discrimination, exclusion, or bias. Given the critical role that EMS plays within the health care system, it is imperative that EMS systems reduce inequities by delivering evidence-based, high-quality care for the communities and patients we serve. To achieve equity in EMS care delivery and patient outcomes, the National Association of EMS Physicians recommends that EMS systems and agencies:make health equity a strategic priority and commit to improving equity at all levels.assess and monitor clinical and safety quality measures through the lens of inequities as an integrated part of the quality management process.ensure that data elements are structured to enable equity analysis at every level and routinely evaluate data for limitations hindering equity analysis and improvement.involve patients and community stakeholders in determining data ownership and stewardship to ensure its ongoing evolution and fitness for use for measuring care inequities.address biases as they translate into the quality of care and standards of respect for patients.pursue equity through a framework rooted in the principles of improvement science.

Pericardiocentesis (PC) in patients with pulmonary hypertension (PH) and pericardial effusions has unclear benefits because it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population are limited. The National Inpatient Sample database was used to identify adult patients who underwent PC during hospitalizations between 2016 and 2020. Data were stratified by the presence or absence of PH. A multivariate regression model and case-control matching was used to estimate the association of PH with PC in-hospital outcomes. A total of 95,665 adults with a procedure diagnosis of PC were included, of whom 7,770 had PH. Patients with PH tended to be older (aged 67 ± 15.7 years) and female (56%) and less frequently presented with tamponade (44.9% vs 52.4%). Patients with PH had significantly higher rates of chronic kidney disease, coronary artery disease, heart failure, and chronic lung disease, among other co-morbidities. In the multivariate analysis, PC in PH was associated with higher all-cause mortality (adjusted odds ratio [aOR] 1.40, confidence interval [CI] 1.30 to 1.51) and higher rates of postprocedure shock (aOR 1.53, CI 1.30 to 1.81) than patients without PH. Mortality was higher in those with pulmonary arterial hypertension than other nonpulmonary arterial hypertension PH groups (aOR 2.35, 95% CI 1.46 to 3.80, p <0.001). The rates of cardiogenic shock (aOR 1.49, 95% CI 1.38 to 1.61), acute respiratory failure (aOR 1.56, 95% CI 1.48 to 1.64), and mechanical circulatory support use (aOR 1.86, 95% CI 1.63 to 2.12) were also higher in patients with PH. There was no significant volume-outcome relation between hospitals with a high per-annum pericardiocentesis volume compared with low-volume hospitals in these patients. In conclusion, PC is associated with increased in-hospital mortality and higher rates of cardiovascular complications in patients with PH, regardless of the World Health Organization PH group., Competing Interests: Declaration of Competing Interest The authors have no competing interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The current binary understanding of membership in international organizations (IOs), especially regional organizations (ROs), creates blind spots and biases in our understanding of who matters in IOs, as well as why and how they matter. Existing scholarship primarily looks at full member-states or non-state actors to capture who influences such organizations. Associated states are often portrayed as passive receivers of IO rules instead of active contributors. We address this blind spot and resulting analytical bias by exploring what types of association relationships exist and how they impact IOs. We propose a novel conceptualization of membership that we call member ness . On the level of IOs, memberness is based on the relative openness of organizational boundaries and stratified access via material and ideational contributions. On the level of states, memberness captures associated states' individual choices to contribute materially and/or ideationally to an IO. Memberness moves away from a purely rights-based understanding of membership (or who you are in an IO) to include a capacity-based understanding (or what you do in an IO). This shift in focus uncovers new channels of influence on IOs. Associated states' material and ideational contributions to IOs constitute three memberness types: payroller, sponsor , and advisor . We argue that these memberness types impact IOs' vitality, design, and performance in previously unrecognized ways. We illustrate these types with empirical examples from ROs across the globe and discuss the implications of memberness for IO research programs., (© The Author(s) 2023.)

Study Design: Retrospective review of a prospectively enrolled adult spinal deformity (ASD) database., Objective: To investigate what patient factors elevate the risk of sub-optimal outcomes after deformity correction., Background: Currently, it is unknown what factors predict a poor outcome after adult spinal deformity surgery, which may require increased preoperative consideration and counseling., Materials and Methods: Patients >18 yrs undergoing surgery for ASD(scoliosis≥20°, SVA≥5 cm, PT≥25°, or TK≥60°). An unsatisfactory outcome was defined by the following categories met at two years: (1) clinical: deteriorating in ODI at two years follow-up (2) complications/reoperation: having a reoperation and major complication were deemed high risk for poor outcomes postoperatively (HR). Multivariate analyses assessed predictive factors of HR patients in adult spinal deformity patients., Results: In all, 633 adult spinal deformity (59.9 yrs, 79% F, 27.7 kg/m 2, CCI: 1.74) were included. Baseline severe Schwab modifier incidence (++): 39.2% pelvic incidence and lumbar lordosis, 28.8% sagittal vertical axis, 28.9% PT. Overall, 15.5% of patients deteriorated in ODI by two years, while 7.6% underwent reoperation and had a major complication. This categorized 11 (1.7%) as HR. HR were more comorbid in terms of arthritis (73%), heart disease (36%), and kidney disease (18%), P <0.001. Surgically, HR had greater EBL (4431ccs) and underwent more osteotomies (91%), specifically Ponte(36%) and Three Column Osteotomies(55%), which occurred more at L2(91%). HR underwent more PLIFs (45%) and had more blood transfusion units (2641ccs), all P <0.050. The multivariate regression determined a combination of a baseline Distress and Risk Assessment Method score in the 75th percentile, having arthritis and kidney disease, a baseline right lower extremity motor score ≤3, cSVA >65 mm, C2 slope >30.2°, CTPA >5.5° for an R2 value of 0.535 ( P <0.001)., Conclusions: When addressing adult spine deformities, poor outcomes tend to occur in severely comorbid patients with major baseline psychological distress scores, poor neurologic function, and concomitant cervical malalignment., Competing Interests: P.G.P.: Cerapedics: Other financial or material support; Cervical Scoliosis Research Society: Research support; Globus Medical: Paid presenter or speaker; Medtronic: Paid consultant; Royal Biologics: Paid consultant; Spine: Editorial or governing board; Spinevision: Other financial or material support; SpineWave: Paid consultant; Terumo: Paid consultant; The remaining authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)