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The aim of this systematic review and meta-analysis was to conduct a thorough assessment of post-operative anti-mullerian hormone levels, a marker of ovarian reserve, after laparoscopic cystectomy for endometriomas. This was a systematic review and meta-analysis that assessed pre and post-operative anti-mullerian hormone levels after ovarian cystectomy for endometriomas. Anti-Mullerian hormone levels were reported up to 18 months after surgery categorized as short term (up to six weeks), medium term (seven weeks to six months) and long term (six months to 18 months). The setting included all countries where a laparoscopic cystectomy was performed in a hospital operating room. A total of 30 studies and 1,315 participants were included. Inclusion criteria included reproductive aged patients with known endometriomas, anti-mullerian hormone levels assessed within one month prior to surgery, and levels reported up to 18 months after surgery. Interventions included laparoscopic cystectomy, unilateral or bilateral, for endometriomas. Serum Anti-mullerian hormone levels were assessed at various time points post operatively as described above using an enzyme linked immunosorbent assay. Primary outcomes showed a statistically significant (P < 0.001) decrease in anti-mullerian hormone in the postoperative short-term period [-1.39 ng/mL, 95% CI, -2.01- (-0.76)], medium term period [-1.13 ng/mL (95% CI, -1.4- (-0.87)], and long term period [-2.12 ng/mL (95% CI, -2.61- (-1.63)]. There was no significant difference when comparing anti-mullerian hormone levels in the short term versus long term period across all groups. There was no significant difference when comparing long term unilateral and bilateral cystectomies on anti-mullerian hormone levels post operatively. This systematic review and meta-analysis highlight the decline in serum anti-mullerian hormone levels following laparoscopic cystectomy for endometriomas, suggesting a potential adverse impact on ovarian reserve. This outcome emphasizes the need to incorporate discussions about the implications of surgery on fertility into preoperative counseling. [ABSTRACT FROM AUTHOR]

Purpose: Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers., Methods: Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method., Results: Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified., Conclusions: This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.

Background: The sexual mistreatment of older adults is a significant public health issue; like other forms of sexual violence, it is more prevalent than officially reported. Survivors often hesitate to speak out due to feelings of embarrassment, fear, or potential cognitive impairments. Moreover, the concealment of such mistreatment, coupled with societal stigmas surrounding aging and sexuality, creates challenges in recognizing sexual mistreatment during routine or emergency room visits., Purpose: This paper provides a framework for informing physicians, psychiatrists, and other healthcare providers on best practices screening, detection, and management of sexual mistreatment in older adults., Methods: A literature review of older adult sexual mistreatment articles between 2005-2024 was conducted., Results: Medical professionals and psychiatrists are well-positioned to raise awareness and identify sexual mistreatment in older adults and manage such situations when suspected., Conclusion: Assessing suspected sexual mistreatment can improve detection, responsiveness, and patient safety for older adults through an interprofessional approach., 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.

Osteoporosis treatment following arthroplasty for femoral neck fracture (FNF) is associated with lower rates of periprosthetic fracture (PPF). Our study evaluated the economic viability of treatment in patients following arthroplasty and demonstrates that treatment with oral bisphosphonates can be cost-effective in preventing PPF., Introduction: Osteoporosis treatment following arthroplasty for femoral neck fracture (FNF) is associated with lower rates of periprosthetic fracture (PPF). Although cost-effective in reducing the rate of secondary fragility fracture, the economic viability of osteoporosis treatment in preventing PPF has not been evaluated. Therefore, the purpose of this study is to use a break-even analysis to determine whether and which current osteoporosis medications are cost-effective in preventing PPF following arthroplasty for FNFs., Methods: Three-year average cost of osteoporosis medication (oral bisphosphonates, estrogen hormonal therapy, intravenous (IV) bisphosphonates, denosumab, teriparatide, and abaloparatide), costs of PPF care, and PPF rates in patients who underwent hip arthroplasty for FNFs without osteoporosis treatment were used to perform a break-even analysis. The absolute risk reduction (ARR) related to osteoporosis treatment and sensitivity analyses were used to evaluate the cost-effectiveness of this intervention and break-even PPF rates., Results: Oral bisphosphonate therapy following arthroplasty for hip fractures would be economically justified if it prevents one out of 56 PPFs (ARR, 1.8%). Given the current cost and incidence of PPF, overall treatment can only be economically viable for PPF prophylaxis if the 3-year costs of these agents are less than $1500., Conclusion: The utilization of lower cost osteoporosis medications such as oral bisphosphonates and estrogen hormonal therapy as PPF prophylaxis in this patient population would be economically viable if they reduce the PPF rate by 1.8% and 1.5%, respectively. For IV bisphosphonates and newer agents to be economically viable as PPF prophylaxis in the USA, their costs need to be significantly reduced., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Objective: To determine the association between diuretic use and falls in community-dwelling older women with urinary incontinence (UI)., Methods: We conducted an analytic cross-sectional study using patients' electronic medical records. Patients were women with UI, 65 years or older seen at a urogynecology clinic between January 1, 2018 and September 30, 2019. We used logistic regression analysis to explore the associations between falls and diuretic use., Results: The study included 108 women, mean age of 75.2 ±7.5 years. Twenty-two (20%) reported one or more falls within the past year and 32 (30%) were diuretic users. Fall prevalence in diuretic users and non-users were 25% (8/32) and 18.4% (14/76), respectively. Diuretic use was not associated with falls (OR = 0.74, 95%CI = 0.22-2.52). Post-hoc analysis revealed inadequate sample size., Conclusions: Diuretics use may not be a risk factor for falls in ambulatory older women with UI. A larger sample will be needed to confirm., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Mosquito-borne disease presents a significant threat to urban populations, but risk can be uneven across a city due to underlying environmental patterns. Urban residents rely on social and economic processes to control the environment and mediate disease risk, a phenomenon known as everyday governance. We studied how households employed everyday governance of urban infrastructure relevant to mosquito-borne disease in Bengaluru, India to examine if and how inequalities in everyday governance manifest in differences in mosquito control. We found that governance mechanisms differed for water access and mosquitoes. Economic and social capital served different roles for each, influenced by global narratives of water and vector control., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

In comparison to classical shallow representation learning techniques, deep neural networks have achieved superior performance in nearly every application benchmark. But despite their clear empirical advantages, it is still not well understood what makes them so effective. To approach this question, we introduce deep frame approximation: a unifying framework for constrained representation learning with structured overcomplete frames. While exact inference requires iterative optimization, it may be approximated by the operations of a feed-forward deep neural network. We indirectly analyze how model capacity relates to frame structures induced by architectural hyperparameters such as depth, width, and skip connections. We quantify these structural differences with the deep frame potential, a data-independent measure of coherence linked to representation uniqueness and stability. As a criterion for model selection, we show correlation with generalization error on a variety of common deep network architectures and datasets. We also demonstrate how recurrent networks implementing iterative optimization algorithms can achieve performance comparable to their feed-forward approximations while improving adversarial robustness. This connection to the established theory of overcomplete representations suggests promising new directions for principled deep network architecture design with less reliance on ad-hoc engineering.