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There is limited caregiver-reported evidence determining health care transition (HCT) outcomes for their adolescents/young adults with special health care needs (AYA-SHCN). A subcommittee of the International and Interdisciplinary Healthcare Transition Research Consortium aimed to identify multidimensional outcomes of a successful HCT among AYA-SHCN based on parents/caregivers' perspectives. After literature review and expert interviews, a three-stage Delphi process identified HCT outcomes based on parents/caregivers' perspectives. Participants were parents/caregivers of patients attending the Victory Junction Therapeutic Camp and a nationally representative sample from Cint Healthcare Digital Solutions Platform. The cumulative 272 responses collected on a Health Insurance Portability and Accountability Act-compliant web-based engine (Qualtrics) rated potential HCT outcomes by level of importance on a Likert scale from 1 (not important) to 9 (very important) and narrowed in subsequent iterations. The Delphi process included 127 (Stage 1), 82 (Stage 2), and 63 (Stage 3) parents/caregivers. The initial 25 HCT outcomes were narrowed to 13, across four major domains: coping/satisfaction, behavioral, structural, and HCT/healthcare-focused outcomes. The top outcome was "My child takes their medications as prescribed." Several traditionally considered important outcomes for HCT were eliminated. Thirteen HCT outcomes for AYA-SHCN were identified in four major domains: coping/satisfaction, behavioral, structural, and HCT/healthcare focused. Future research in larger samples would allow stratification to represent diverse patients and caregiver populations. Identifying international consensus-derived outcomes among parents/caregivers is imperative for the evaluation of HCT preparation strategies that ensure appropriate support for diverse AYA-SHCN and their families during this process and enable implementation of the most effective interventions. [ABSTRACT FROM AUTHOR]

Grainsize is among the most important parameters in aeolian research as it controls the sediment mobilization and the mode of transport. Therefore, it is a critical parameter for instance in wind erosion modeling studies which are used to analyze sand and dust storms in the Tarim Basin, an important natural hazard in this region. Spatially explicit parameterization of grain size is difficult, as the texture of the topsoil is not homogeneous across a landscape. Thus, a geomorphological classification of a Tugai landscape in the eastern Tarim Basin is developed and a stratified analysis of the grain-size distributions and the corresponding threshold friction velocities is presented. The results show that transversal dunes have the coarsest sediment in this landscape, while vegetated patches within the alluvial plain of the Tarim River are characterized by the finest sediments. The other landform classes open space, channel, and nebkha have properties between these two landform types. It is concluded that the surface sediment of a Tugai landscape in the eastern Tarim Basin shows a considerable heterogeneity. The landform-based stratification for grain-size analysis is an appropriate solution for an assessment of sediment grains. [ABSTRACT FROM AUTHOR]

Biliary brushing (BB) cytology has a sensitivity of 15%-65% and specificity approaching 100% for detecting malignancy. Fluorescence in-situ hybridization (FISH) using the UroVysion probe set has been advocated to enhance the detection of malignancies with reported sensitivity of 43%-84%. We sought to evaluate the performance of FISH in BB with equivocal cytology at our institution. Patients with atypical and suspicious BB with concurrent diagnostic FISH performed at our institution from 2014 to 2021 were identified through a query of our pathology database. FISH (using UroVysion probe set containing centromere enumeration probes to chromosomes 3, 7, and 17) was positive if at least 5 cells demonstrated polysomy. Electronic medical records were reviewed for pathology results and outcomes. Patients were classified malignant if they had positive pathology or documented clinical impression of malignancy and benign if they had negative pathology and/or documented benign clinical course for at least 12 months. We identified 254 equivocal BB (238 atypical/16 suspicious) with concurrent FISH results from 191 patients (105 benign, 86 malignant). 12% (22/191) of patients were FISH positive. Twenty-four percent (21/86) of patients with malignancy had positive FISH but were nonspecific for pancreaticobiliary/ampullary adenocarcinomas. Almost all positive FISH were associated with malignancy (21/22; 95%). There was 1 positive FISH in a patient with primary sclerosing cholangitis who had a benign outcome. The small number of positive FISH results in BB with equivocal cytology raises the question of the optimal criteria for malignancy. Using only polysomy could result in lower sensitivity. [Display omitted] • 9% of biliary brushings were FISH positive (22/254). • 24% (21/86) of patients with malignancy had positive FISH. • Almost all positive FISH results were associated with malignancy (21/22, 95%) but were nonspecific for pancreatobiliary/ampullary adenocarcinoma. One patient with PSC in the benign cohort had positive FISH. • The small number of positive FISH results in biliary brushings with equivocal cytology raises the question of the optimal criteria for malignancy. Using only polysomy could result in lower sensitivity. [ABSTRACT FROM AUTHOR]

• • Preeclampsia (PE) and depression (MDD) increase risk bi-directionally for each other. • • One potential intermediate mechanism is immunovascular dysfunction. • • Indoleamine 2,3 dioxygenase (IDO) regulates immunovascular function in PE and MDD. • • Vascular stiffness and depression symptoms increase with decreased IDO in pregnancy. • • Decreased IDO may be a target for improved psycho-obstetric health. Preeclampsia and depression in pregnancy are among the most prevalent obstetric disorders with no known cures. While depression and preeclampsia each increase risk for the other, shared mechansisms are unclear. One possibility is low levels of Indoleamine 2,3 dioxygenase (IDO), which links immune dysregulation and oxidative arterial damage resulting in poor vascular function in both preeclampsia and depression. We hypothesized low circulating IDO activity levels in pregnancy would correspond to poor vascular function and depression symptoms. In this nested case-control study, clinical, demographic, and biologic data from a cohort of pregnant women recruited to longitudinal studies measuring noninvasive vascular function and circulating factors were analyzed. IDO activity across all three trimesters of pregnancy was measured using a colorimetric assay. Carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, was also assessed throughout gestation by non-invasive applanation tonometry. Depression symptoms were assessed in pregnancy via the validated patient health questionnaire 9 (PHQ9). Participants with low second and third trimester IDO activity had significantly decreased cfPWV. This association remained statistically significant when controlled for confounders such as BMI and chronic hypertension in the third but not second trimester. While PHQ9 scores were not associated with cfPWV differences, IDO activity was lower in moderate and severely depressed relative to non-depressed pregnant individuals. Conclusion: These results implicate IDO in arterial stiffness and depression symptoms, suggesting that decreased IDO may be a central target for improved psycho-obstetric health. [ABSTRACT FROM AUTHOR]

Mobile Integrated Health Community Paramedicine (MIH-CP) programs are designed to increase access to care and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. Previous MIH-CP systematic reviews reported varied interventions, effect sizes, and a high prevalence of biased methods. We aimed to perform a meta-analysis on MIH-CP effect on ED visits, and to evaluate study designs' effect on reported effect sizes. We hypothesized biased methods would produce larger reported effect sizes. We searched Pubmed, Embase, CINAHL, and Scopus databases for peer-reviewed MIH-CP literature from January 1, 2000, to July 24, 2021. We included all full-text English studies whose program met the National Associations of Emergency Medical Technicians definition, reported ED visits, and had an MIH-CP related intervention and outcome. We established risk ratios for each included study through interpreting the reported data. We performed a random-effects and cumulative meta-analysis of ED visit data, tests of heterogeneity, and a moderator analysis to assess for factors influencing the magnitude of observed effect. We identified 16 studies that reported ED visit data and included 12 in our meta-analysis. All studies were observational; 3 used matched controls, 6 pre-post controls, and 3 without controls. 7 studies' intervention were diversion/triage while 5 studies intervened with health education/home primary care services. Pooled risk ratio for our data set was 0.56 (95% confidence interval 0.42–0.74). Cumulative meta-analysis revealed that as of 2018 MIH-CP programs began to show consistent reductions in ED visits. Significant heterogeneity was seen among studies, with I-squared >90%. Moderator analysis showed reduced heterogeneity for matched-control studies. Our data revealed MIH-CP programs were associated with a reduced risk of ED visits. Study design did not have a statistically significant influence on effect size, though it did influence heterogeneity. We would recommend future studies continue to use high levels of control to produce reliable data with lower heterogeneity. [ABSTRACT FROM AUTHOR]

Given the enormous symptom relief benefit seen with cardiac myosin inhibitors, there is renewed focus to correctly identify hypertrophic cardiomyopathy (HCM) patients as obstructive versus non-obstructive. Overall, two thirds of HCM patients have clinically significant obstruction of blood flow out of the left ventricular outflow tract (LVOTO). A third of HCM patients, however, will only experience obstruction during challenging provocative maneuvers such as Valsalva, during volume depletion, or with exercise. Patients with "masked obstruction" are frequently mislabeled and subsequently mismanaged as non-obstructive. This study aims to identify features seen on cardiac magnetic resonance imaging (CMR) and on transthoracic echocardiography (TTE) that should heighten awareness that occult obstruction may be present, potentially prompting physicians to obtain exercise stress echocardiography. This study utilized retrospective data analysis from a large, single-center cohort over a six-month period. Subjects were included if both stress echocardiography and CMR were available. LVOTO was defined as peak LV outflow tract gradient ≥30 mmHg. Subjects were divided in to 1) Absent, 2) Masked and 3) Overt LVOTO. CMR was used to assess anatomical differences between groups. Continuous data was compared using ANOVA analysis, with secondary multiple comparison tests. Sixty one patients (30:31 M:F)(Age = 57.1 ± 14.4 yrs.) were included; Absent (n = 27), Masked (n = 21), Overt (n = 13). CMR data with ANOVA analysis is provided in Table 1. Multiple comparison testing of the Zone of Coaptation Length was significant between the Absent v. Masked groups (mean = 7.8 v. 10.1, 95% CI: -4.6 to -0.1, p = 0.04). (Figure 1) The height of the zone of coaptation is best understood as the length of contact between the anterior and posterior mitral leaflets in the basal to apical axis during systole. In this cohort, longer zone of coaptation lengths were more likely to associate with masked LVOTO than overt or absent LVOTO. During hyperdynamic contractility, this highly mobile region of the sub-valvular apparatus is likely pushed into the LVOT due to the Venturi Effect and/or from apical displacement of the papillary heads. Once in the LVOT, drag force is exerted on the apparatus resulting in obstruction. Anterior mitral length, a feature thought to predict obstruction from the echocardiography literature, did not predict masked or overt obstruction. Further investigation is warranted to better understand how cardiac MRI could prompt physicians to look for masked obstruction, as stress echocardiography is commonly underutilized. [ABSTRACT FROM AUTHOR]

Many organizations are actively pursuing decarbonization goals to help mitigate the effects of climate change. This situation often requires capital replacement of building components with different fuel or higher efficiency variants to reduce emissions. However, this problem is complicated when an organization operates across a wide geographic area due to regional differences in weather, utility costs, and electrical grid emissions. This paper develops a framework for this problem by implementing energy, emissions, cost, and decision models that can scale across large organizations. The resulting decisions show the ability to reach decarbonization goals with lower costs and better rates of return. Compared to condition or unit-capacity ranking strategies, case studies show that the developed model reduces emissions by as much as 68.99 % or costs by as much as 47.08 %, depending on organizational goals. • Optimal large-scale decarbonization retrofit decisions when quality data is sparse. • Creating large-scale portfolio energy comparisons with open-source datasets. • Costing model for design alternative replacement costs from equipment capacity. • Decision frameworks to optimize goals like GHG reduction or simple payback. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is one of the most debilitating diseases, and a patient with a reconstructed knee could develop it early and lives with this condition for an average of 30-years. Furthermore, most studies focus on short-term results, not long-term. The purpose of this article is to show how a patient with reconstructed knees and OA improved clinical outcomes using the Pilates Method (PM) in the long term. The patient was treated with common medical treatment for 10 years and then treated with the PM for 15 years. Authors used the biomechanics-based approaches, radiographic examination of the knees, magnetic resonance imaging, the numeric pain rating scale, range of motion (ROM), the Polestar fitness screening test (PFST), the knee injury and osteoarthritis outcome score questionnaire (KOOS), and the physical function performance-based tests (PFPBT) recommended by Osteoarthritis Research Society International (OARSI). There was an improvement in the evaluated outcomes when using the PM in the long term: a decrease in pain-related scores (constant pain = - 4; worst pain = - 5), improved ROM in 15°, improved stability in both knees (right Lackman Test (LT) = −1; left LT = - 2). When comparing the patient with healthy women in the middle age through the PFPBT her scores are above average, with no restrictions in performing daily activities and a good quality of life according with the KOOS questionnaire. This case study suggests that long-term Pilates training may be useful for the treatment of pain, stiffness, and function in patients with reconstructed knees and OA. • There was a marked improvement in clinical outcomes obtained in the Pilates method (PM) compared with common medical treatments in the long term. • This case report was similar to some studies that found that PM was more effective than conventional therapy exercises in individuals with knee osteoarthritis (OA). • PM may help as long-term treatment and improve quality of life in patients with reconstructed knees and OA. [ABSTRACT FROM AUTHOR]

The purpose was to identify the educational needs of pediatric nurses and pediatric nurse practitioners providing direct care to transition-aged youth with chronic illness and disability and to identify strategies to develop health care transition planning (HCTP) expertise. Mixed-methods descriptive analyses were performed on survey data extracted from a larger national study exploring the provision of HCTP activities performed by nurses of two pediatric nursing professional organizations. Items querying educational needs were completed by 1,162 pediatric nurses serving in advanced practice and staff roles. Twenty percent reported having specialized HCTP education. Of which more than half received it outside of the workplace. Factor analysis revealed two constructs explaining 73.4% of the variance in nurses' reported level of knowledge. HCTP education and the development of nurse-led services to facilitate optimal health care transitions outcomes are necessitated. Academia and service have a shared responsibility in educating nurses. [ABSTRACT FROM AUTHOR]

Youth with special health care needs often experience significant difficulty transitioning into adult health care services and adult life. Services supporting youths' transition from pediatric to adult health care (Health Care Transition (HCT)) have been a priority for nearly 30 years to improve this transition process. The Health Resources and Service Administration, Maternal and Child Health Bureau have measured HCT service provision since 2001 but the longitudinal use of this measure has never been examined (Blumberg, 2003; Maternal and Child Health Bureau, n.d.). This manuscript highlights the consistent and inconsistent uses of HCT constructs in two prominent national surveys (the National Survey of Children with Special Health Care Needs (NS-CSHCN) and the National Survey of Children's Health (NSCH)) between 2001 and 2019. All studies utilizing an HCT measure within a national survey between the 18 years were included in this examination. Significant changes have been made to the measurement of HCT service provision resulting in inconsistencies over the last 18 years. Measurement criteria and survey questions have changed substantially from the NS-CSHCN and NSCH limiting one's ability to examine trends in HCT since 2001. Since 2016, few changes have been made, allowing for analysis of trends over time. Importantly, the NSCH includes added questions pertaining to HCT that are not included in the composite HCT outcome measure. Future work should include a validation study of the HCT outcome in the National Survey of Children's Health and inclusion of additional HCT questions to promote continued and extensive use of a measure that more fully represents the needs of youth and their families. • Maternal and Child Health Bureau have measured Health Care Transition service provision since 2001. • HCT measurement has undergone numerous changes in criteria and question format over the 20 years it has been assessed. • The National Survey of Children's Health HCT assessment includes important youth independence and skill-building questions. • Future works should validate the Health Care Transition measure in national surveys to promote consistency and more extensive use. [ABSTRACT FROM AUTHOR]

Internal wood damage poses a significant threat to tree health, impacting wood quality, mechanical stability, and wind resistance, therby challenging forest resource conservation and sustainable management efforts. The health of Populus euphratica , a keystone species, is crucial for the stability and sustainability of desert riparian forest ecosystems. Consequently, quantitatively diagnosing internal wood damage in living trees is essential for the conservation of existing forests. In this study, the degree of internal wood damage in the trunks of sample Populus euphratica trees of varying ages from the midstream of the Tarim River was quantified using Arbotom stress wave testing technology. The relationships among growth characteristics, soil physicochemical factors, and standing wood decay were analyzed. The results indicated that Arbotom stress wave testing technology achieved an accuracy of up to 92% in diagnosing internal wood damage in living P. euphratica trees. Healthy trees were more prevalent among middle-aged trees (65%), followed by mature (50%), near-mature (42%), and over-mature (30%) trees. The area of internal decay in over-mature and mature forests accounted for a significant proportion of decay, ranging from light to heavy decay levels. At the stand scale, increased in the level of trunk decay caused by increasing tree age. At the individual scale, light, moderate, and heavy decay were significantly positively correlated with diameter at breast height, tree height, and crown diameter, respectively (p < 0.01). Light decay was significantly negatively correlated with soil pH (p < 0.05). Moderate decay was significantly positively correlated (p < 0.05) with available-P and soil electrical conductivity and negatively correlated with Avail-K (p < 0.05). Heavy decay was significantly negatively correlated (p < 0.05) with available-K in both the 40–60 cm and 60–100 cm depth soil layers. The findings elucidate the causes and factors driving P. euphratica trunk decay in the Tarim River Basin, offering insights to aid in preventing and controlling standing tree decay and the sustainable management of natural desert riparian forest resources in arid areas. • Quantitative diagnosis of internal wood damage in living trees using non-destructive testing (NDT) methods can provide effective information. • At the stand scale, internal stem decay was age-related and increased with age. • At the individual scale, significant positive correlation between internal wood damage and diameter at breast height, tree height, and crown diameter. • Soil physicochemical properties affecting P. euphratica vary at different degrees of trunk internal decay. [ABSTRACT FROM AUTHOR]

Family-Centered care (FCC) is a model used in pediatric healthcare delivery wherein planning care for children incorporates the family, but questions remain whether there has been effective FCC implementation in practice. The purpose of this study was to examine the importance of FCC to pediatric nurses and their view of their organizations' support of FCC implementation. A survey with FCC descriptor statements was distributed electronically to the Society of Pediatric Nurses. Direct care nurses (N = 132) responded to demographic questions including their education level and organization size, and 26 items rating the importance of elements of FCC in their care (as it applies to themselves) and in their organizations (as it applies to their hospital or organization) using a 5-point Likert scale. Open ended questions supplemented the survey to yield narrative comments to triangulate the findings. The nurses' personal responses and their rating of their organizations were analyzed separately. The Cronbach alphas were 0.867 and 0.938, respectively. Factor analyses revealed the same three factors in the two foci of questions for (a) the nurse's own practice and (b) the organization's support of FCC: Philosophy of FCC, Implementation of FCC and Environment Variations of FCC. A qualitative process of narrative analysis added support to the factors with clarity in thematic triangulation. Additionally, there was a significant difference in the mean scores between nurses' personal responses and the mean scores for their organizations for all three factors (p =.000) and for self-reported FCC by nursing education to validate the utility of the tool. This instrument quantified the importance of FCC to pediatric nurses and their workplace support of FCC and can be used in future studies to evaluate FCC. [ABSTRACT FROM AUTHOR]

• Health care transition (HCT) is an emerging field of practice and research with unlimited opportunities for nursing involvement. • Past contributions of nurse clinicians, scholars, and researchers to the field of HCT have provided the foundation for future involvement and contributions. • Innovative avenues for practice include the development, implementation, and testing of nurse-led HCT models. • There is a considerable need for research generated using more rigorous designs and methodology. Health care transition (HCT) is an emerging field of practice and research with unlimited opportunities for nursing involvement. This article will highlight the unique contributions of nurse clinicians and researchers worldwide that have influenced HCT practice and research. The historical underpinnings of nursing practice will be discussed and feature the distinctive models and concepts of care that have and will continue to be contributed to HCT practice and research. Dimensions of prominent nursing contributions in collaboration with interdisciplinary partners as it pertains to scholarship, research, practice, and policymaking will be presented. The implications for future nursing involvement in this emerging field will be discussed. [ABSTRACT FROM AUTHOR]

Background: We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata.Objective: To report the results of the Alopecia Areata Consensus of Experts international expert opinion on diagnosis and laboratory evaluation for alopecia areata.Methods: Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Consensus threshold was set at greater than or equal to 66%.Results: Of 148 questions, expert consensus was achieved in 82 (55%). Round 1 consensus was achieved in 10 of 148 questions (7%). Round 2 achieved consensus in 47 of 77 questions (61%). The final face-to-face achieved consensus in 25 of 32 questions (78%). Consensus was greatest for laboratory evaluation (12 of 14 questions [86%]), followed by diagnosis (11 of 14 questions [79%]) of alopecia areata. Overall, etiopathogenesis achieved the least category consensus (31 of 68 questions [46%]).Limitations: The study had low representation from Africa, South America, and Asia.Conclusion: There is expert consensus on aspects of epidemiology, etiopathogenesis, clinical features, diagnosis, laboratory evaluation, and prognostic indicators of alopecia areata. The study also highlights areas where future clinical research could be directed to address unresolved hypotheses in alopecia areata patient care. [ABSTRACT FROM AUTHOR]

There is limited robust evidence on the course of pregnancy and its outcomes in women with psoriatic arthritis (PsA) on which to base recommendations for the management of these patients. The primary objective was to review available data on (I) disease activity during pregnancy and on (II) adverse pregnancy outcomes (APO) in women with PsA. Secondly, neonatal outcomes and treatment of the rheumatic disease were investigated. Systematic literature search within the databases Pubmed and Embase until 30 Nov 2020 was performed. Additionally, reference lists of included studies and of review articles revealed by the search were screened. All full text articles identified and published in English language were systematically evaluated by two reviewers. All studies that reported on one of the primary outcomes and included at least five pregnancies in women with PsA were considered. The review of 734 search results revealed 13 eligible publications reporting on a total of 2,332 pregnancies in women with PsA. Nine studies reported on PsA activity and showed an increase or worsening of disease activity after delivery compared to the pregnancy period. APOs were reported by nine studies. Adjusted analyses of APOs did not show an increased risk for gestational diabetes, small for gestational age and low birth weight in PsA patients in relation to the respective comparator groups. However, there were signals for a higher pre-eclampsia, elective caesarean section and preterm birth risk in PsA pregnancies. Meta-analysis was not performed due to study heterogeneity. This review showed a postpartum deterioration of disease activity in women with PsA and no risk elevation for gestational diabetes, small for gestational age and low birth weight. A higher risk for pre-eclampsia, elective caesarean section and preterm birth in PsA pregnancies cannot be ruled out. Differences in the studies investigated limit overall summary statements on disease activity and APOs in women with PsA. Harmonization of study approaches, instruments and outcome reporting is crucial to ensure informed counselling of patients with PsA before, during and after pregnancy that is based on robust data. CRD42020162242. [Display omitted] [ABSTRACT FROM AUTHOR]

• Health care transition nursing exemplars indicate need for more nursing-led research. • Diverse nursing research exemplars demonstrate need for varied study designs. • Health care transition research is needed for the provision of evidence-based care. This manuscript features exemplars of nursing science that contribute to the development of health care transition practice models and evidence-based care. These research exemplars demonstrate the need for diverse investigative approaches coupled with clinical acumen and expertise in health care transition. The focus of describing nurse-led and nurse-contributory research and quality improvement efforts in this emerging field is offered to foster nursing involvement.Also, research efforts are not limited to the pediatric populations; research is needed for the provision of evidence-based careand monitoring of health and psychosocial outcomes of adults with childhood acquired chronic conditions. [ABSTRACT FROM AUTHOR]

We asked readers of Science , Nature and Harvard Business Review about their expectations for advances in science, technology, and business over a 35-year time horizon. We asked further about their needs and dreams for technical products, and their forecasts of converging industries. A fourth survey, fielded later to experts in technology forecasting and science policy, yielded assessments of the earlier survey results as well as the experts' own views on the advances, needs, and convergence questions. A combined analysis of the four surveys leads to this paper's portrait of the expected scientific and business environments 35 years hence, and a description of the gaps between expected developments in science, technology and business on the one hand, and market and social needs on the other hand. Years between 2018 and 2053 will bring significant benefits from the convergence of biomedicine and computer science. They will bring challenges and changes to the agriculture and education sectors. Surveyed experts believe many of the areas of greatest social need, including dealing with climate change, are those that businesses are least prepared to respond to. • Four expert panels say convergence of biomedical science and artificial intelligence to shape the 35-year future. • Between-group differences in views of 2052 are substantial. • 82% strongly believed government should provide incentives for innovation solving human, social, environmental Problems. • Respondents believe that widespread perceptions about the future are instrumental in creating the future. [ABSTRACT FROM AUTHOR]

Background: A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high-quality randomized controlled trials.Objective: To produce an international consensus statement on the use and utility of various treatments for AA.Methods: Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Agreement of 66% or greater was considered consensus.Results: In the first round, consensus was achieved in 22 of 423 (5%) questions. After a face-to-face meeting in round 3, overall, consensus was achieved for only 130 (33%) treatment-specific questions. There was greater consensus for intralesional treatment of AA (19 [68%]) followed by topical treatment (25 [43%]). Consensus was achieved in 45 (36%) questions pertaining to systemic therapies in AA. The categories with the least consensus were phototherapy and nonprescription therapies.Limitations: The study included a comprehensive list of systemic treatments for AA but not all treatments used.Conclusion: Despite divergent opinions among experts, consensus was achieved on a number of pertinent questions. The concluding statement also highlights areas where expert consensus is lacking and where an international patient registry could enable further research. [ABSTRACT FROM AUTHOR]

Large scale manufacturing systems with a high degree in automation and the ability to produce several product variants in parallel meet current requirements of a highly flexible and at the same time productive manufacturing process. In practice, however, the non-transparency as well as the complexity of these systems overwhelm the maintenance department in the effective planning and implementation of maintenance tasks. As a result, major maintenance tasks are postponed to non-production times which causes increased maintenance cost as well as a decrease in system availability. This research explores a method that uses unsupervised learning algorithms to analyze type mixes and related process performances inside the system. The information is used to determine the optimal master production schedule prior to maintenance activities which leads to more frequent and extended time windows for maintenance activities during production time and thus to an increase in system availability. [ABSTRACT FROM AUTHOR]

Introduction: Caring for suicidal patients can be challenging, especially in emergency departments without easy access to mental health specialists. The American College of Emergency Physicians and the American Foundation for Suicide Prevention appointed a working group to create an easy-to-use suicide prevention tool for ED providers.Methods: The writing group created an easy-to-use mnemonic for the care of adult patients as a way of organizing sequential steps, accompanied by a systematic review of available ED-based suicide prevention literature. The systematic review was performed both to ensure that all relevant evidence was taken into account as well as to evaluate the strength of evidence for each recommendation. Levels of evidence were assigned utilizing the ACEP level of evidence classification.Results: The writing group created the mnemonic ICAR2E, which stands for Identify suicide risk; Communicate; Assess for life threats and ensure safety; Risk assessment (of suicide); Reduce the risk (of suicide); and Extend care beyond the ED. 31 articles were identified in the search, and were included in the systematic review.Conclusions: The ICAR2E mnemonic may be a feasible way for practicing ED clinicians to provide evidence-based care to suicidal patients. However, further research is needed. [ABSTRACT FROM AUTHOR]

Short- and mid-term outcomes after massive cuff tear repair are well reported, but there is no documentation of the clinical and structural outcomes at 20 years of follow-up. The hypothesis of the present study was that at 20 years, deterioration of the shoulder would have occurred and led to a substantial number of reoperations. The authors retrospectively recalled all 127 patients operated for massive rotator cuff tears in 1994 at 6 different centers. At the 20-year follow-up, 26 patients died and 35 were lost to follow-up. Thirteen (10.2%) had been reoperated. This left 53 patients for personal clinical assessment. Forty-nine consented to standardized radiographic evaluation for assessment of osteoarthritis, 36 patients underwent magnetic resonance imaging, allowing assessment of tendon healing, atrophy, and fatty infiltration (FI) of the cuff muscles. The final Constant-Murley score (CS) was 68 ± 17.7 (range, 8-91) vs. 44 ± 15.3 (range, 13-74) preoperatively (P <.05). The final Subjective Shoulder Value (SSV) was 73% ± 23% (range, 0-100). Retears (Sugaya IV and V) were found in 17 cases (47%). Nine patients (17%) had cuff tear arthropathy (Hamada stage 4). The CS and SSV for the shoulders with FI stages III or IV were significantly inferior (53 ± 19 points and 65% ± 14% respectively) than for those with FI stages 0-II (respectively, 71.6 ± 6 points and 73% ± 4%) (P <.05). Twenty years after surgical repair of massive rotator cuff tears, the functional scores remain satisfactory, and the rate of revision is low. [ABSTRACT FROM AUTHOR]

Youth and young adults (YYA) with chronic illness and/or disability (CID) face numerous challenges in transition from pediatric to adult health care. Established evidence supports interdisciplinary team approaches to preparing youth and families for transition and transfer. The purpose of this national survey was to address a gap in current knowledge specific to pediatric nursing professionals' roles and responsibilities in health care transition planning (HCTP). A quantitative descriptive study using a survey questionnaire validated by experts in the field investigated respondents' role in HCTP, inclusion of HCTP in job description, levels of HCTP knowledge, and ratings of importance of HCTP elements. A volunteer sample of 1814 respondents was drawn from two professional organizations. Over 64% of respondents performed HCTP activities related to complex chronic illness management. Only 18% reported specialized training in HCTP. The highest-ranking items in regard to perceived importance were educating and supporting disease self-management and speaking with families about complex needs. Predictors of perceived importance were role, inclusion of transition planning in a job description, percentage of time in direct care, caring for those aged 14 years and older, and level of knowledge about HCTP. The findings highlight key aspects of the pediatric nurse role in HCTP and identify specific elements that can be addressed to support future HCTP role development. Pediatric nurses perform a vital role in HCTP for YYA with CID that may be enhanced with the inclusion of HCTP activities in job descriptions and specialized interdisciplinary HCTP training related to this emerging and growing population. • The study findings address a knowledge gap on nursing roles in adult care transition. • Advocacy for complex needs and self-management are highly ranked in nurses' role. • Including transition planning in a job description enhances its importance. • Interdisciplinary education and training on health care transition elements are needed. [ABSTRACT FROM AUTHOR]

• 101 publications that cover the integration of ethical theories into the software of self-driving vehicles are synthesized. • Advantages and disadvantages of applying particular ethical theories to the decision-making of self-driving vehicles are identified. • No single theory is sufficient to meet all social, moral/legal, and functional considerations; instead, hybrid approaches are necessary to counteract tradeoffs. • A summarizing model of applying and integrating ethical theories to decision-making of self-driving vehicles is derived. [ABSTRACT FROM AUTHOR]

• Experiment compared effects of thin, athletic, and curvy ideals on women's body image. • All ideals increased state social comparison (SSC) compared to control condition. • SSC mediated ideals' negative effect on body appreciation and body surveillance. • SSC mediated negative effect of thin and curvy ideals only on esteem for body looks. • Curvy ideal did not harm body image for women very low in trait social comparison. Body dissatisfaction and self-objectification can arise when women view idealized thin bodies, as well as idealized athletic or curvy bodies. State-level social comparisons have been shown to mediate such effects, with mixed evidence for the moderating role of trait-level social comparison. An experiment tested the hypotheses that viewing messages idealizing thin, athletic, and curvy bodies would be associated with greater state social comparison as compared to a body acceptance condition, and that trait social comparison would moderate this association. Additionally, state social comparison was expected to mediate the association between viewing idealized images and negative body image. Data were collected online from 200 adult women. Regression analyses indicated that all three body ideals significantly increased state social comparison, which in turn predicted greater body surveillance, lower body appreciation, and, for thin and curvy conditions only, lower body esteem for looks. Further, trait social comparison moderated the association between viewing the curvy ideal and state social comparison. This study increases our knowledge of how state and trait social comparison function in relation to body ideals. Reducing social comparison to idealized images, as opposed to replacing the thin ideal with other body types, may be a superior approach to improving body image. [ABSTRACT FROM AUTHOR]

Abstract Background Remote iliac artery endarterectomy (RIAE) is a challenging technique in the treatment of arterial occlusive disease. The impact of proximal transection zone stenting on patency rates is still unclear. Methods This is a retrospective analysis of all patients who underwent RIAE in our hospital between March 2007 and October 2017. A stent was used in cases with a dissection flap or a stenosis at the proximal transection zone after RIAE. In all other cases, we did not use a stent. Study end points were patency rates, limb salvage, and survival after 5 years. Results There were 115 RIAEs performed in 108 patients. All lesions were TransAtlantic Inter-Society Consensus C (61.7%) or D (38.3%) lesions. The median follow-up time was 38.5 months (range, 0-117 months). The indications were claudication in 67.0% and critical limb ischemia in 33.0%. Group 1 (n = 56) included all patients without a stent; group 2 (n = 59) included all patients with stenting of the proximal dissection zone. Risk factors were similar between the groups. The 30-day morbidity and mortality rates between the groups were not significantly different. The primary patency rate was 81.6% (group 1, 76.2%; group 2, 87.6%; P =.286), the primary assisted patency rate was 91.9% (group 1, 94.0%; group 2, 90.0%; P =.512), and the secondary patency rate was 93.8% (group 1, 94.0%; group 2, 91.6%; P =.435) after 5 years. Limb salvage (97.2%; group 1, 100%; group 2, 94.5%; P =.084) and survival time (57.1%; group 1, 66.7%; group 2, 43.5%; P =.170) were also not significantly different between the groups. A restenosis at the transection zone occurred in 14.3% in group 1 and 1.7% in group 2 (P =.013) during follow-up. A newly formed occlusion of the hypogastric artery was seen in 5.2% of patients after RIAE. Conclusions RIAE is a safe procedure with excellent patency rates. However, the restenosis rate is higher in cases without stenting. [ABSTRACT FROM AUTHOR]

Background This study evaluated the clinical and structural outcome 20 years after repair of isolated supraspinatus tendon tears. We hypothesized that the results would deteriorate over time. Materials and Methods For this retrospective multicenter study, 137 patients were recalled for a clinical and imaging assessment. Six patients (4.3%) had died from unrelated causes, 52 (38.0%) were lost to follow-up, and 13 (9.5%) had undergone reoperations. This left 66 patients for clinical evaluation. Radiographs and magnetic resonance imaging were additionally performed for 45 patients, allowing assessment of osteoarthritis, tendon healing, fatty infiltration (FI), and muscle atrophy. Results The Constant Score (CS) improved from 51.5 ± 14.1 points preoperatively to 71 points (P <.05) with a mean Subjective Shoulder Value (SSV) of 77.2% ± 22%. Tendon discontinuity (Sugaya IV-V) was present in 19 of 45 patients (42 %), and there was advanced FI (Goutallier III-IV) of the supraspinatus in 12 (27%) and of the infraspinatus muscle in 16 (35%). Supraspinatus atrophy was present in 12 patients (28%), advanced arthritis in 6, and cuff tear arthropathy in 12 (30%). The CS and SSV were significantly inferior for shoulders with FI of stages III to IV (P <.05). The CS was lower in cuff tear arthropathy and correlated with infraspinatus FI. Conclusions At 20 years after surgical repair of isolated supraspinatus tears, the clinical outcome remains significantly above the preoperative state. FI of the infraspinatus is the most influential factor on long-term clinical outcome. [ABSTRACT FROM AUTHOR]

Abstract Purpose To develop an instrument to assess the nurse's role and responsibilities in healthcare transition planning (HCTP) for youth and young adults (YYA) with chronic illness and/or disability (CI/D) that will determine to what extent nurses are involved with providing HCTP services; and identify the specific activities that nurses engage in when providing HCTP services. Design and Methods A panel of seven experts in the field were used to determine content validity. Results The final NR-HCTP instrument contains a total of 68 items (17 main items, 5 containing sub items) representing activities that nurses engage in when providing HCTP services, their level and extent of involvement, and their level of knowledge in the areas of HCTP. Practice Implications An exploration of nurse's roles in HCTP for YYA with CI/D allows for discussion of current nursing practices in the transition process. The information obtained may be used to identify gaps in knowledge and practice guidelines, develop nursing core elements and educational materials to support nurses in their role, and inform nursing administrators in the development of appropriate HCTP position descriptions. Highlights • Increasing concern over the successful transition to adult healthcare • Nurses are an essential group of professionals who care for YYA with CI/D. • Development and validation of an instrument to evaluate nurses' roles in HCTP • Only instrument of its kind • Serve as a needs assessment for nurses and for quality improvement projects [ABSTRACT FROM AUTHOR]

The recent devastating pandemic has drastically reminded humanity of the importance of constant scientific and technological progress. A strong interdisciplinary dialogue between academic and industrial scientists of various specialties, entrepreneurs, managers and the public is paramount in triggering new breakthrough ideas which often emerge at the interface of disciplines. The following sections, compiled by a highly diverse group of authors, are summarizing recently achieved game-changing leaps in science and technology. The game-changers range from paradigm shifts in scientific theories to make impact over several decades to game-changers that have the potential to change our everyday lives tomorrow. The paper is an interdisciplinary dialogue of relevance for academic interdisciplinary thinkers, large corporations' strategic planners, and top executives alike; it provides a glimpse into what further breakthroughs the future may hold and thereby intends to spark new ideas with its readers. • A strong interdisciplinary dialogue involving academic and corporate scientists is required • Involving strategic thinkers and executives in this catalyzes further progress in science, technology & innovation • Breakthrough innovation is often happening when transferring key insights from one field to another • A good overview on recent game changers on a broad set of topics is highly valuable • A glimpse into what further breakthroughs the future might bring • AI technologies will lead to a renaissance of the generalist scientist [ABSTRACT FROM AUTHOR]

Abstract Introduction For ED patients at risk of suicide, counseling to reduce access to lethal means (including firearms) is recommended yet not routine. To enhance practice uptake, we sought to examine the attitudes and beliefs of emergency nurse leaders concerning the acceptability and effectiveness of lethal-means counseling. Methods We invited a nurse leader (ED nurse manager or Chief Nursing Officer [CNO]) at each hospital-based emergency department in the 8-state Mountain West region of the United States to complete a closed-ended telephone survey. Questions assessed current practices and leaders’ views on suicide prevention and lethal-means counseling. Reponses were weighted to all eligible hospitals to adjust for nonresponse. Results From 363 eligible hospitals, 190 emergency nurse leaders responded (overall response rate: 52%). Emergency nurse leaders thought providers at their emergency departments did an excellent job of safety counseling (74%) for suicidal patients. Most respondents believed that talking about firearms with suicidal patients is acceptable to patients (77%), supported by hospital administration (64%), effective in preventing suicide (69%), and something that providers should do (91%). However, the majority also had doubts about whether suicide is preventable (60%). Discussion Despite expressing high levels of support for the acceptability and effectiveness of lethal-means counseling, high proportions of emergency nurse leaders expressed skepticism regarding the preventability of suicide, a finding consistent with previous work. Our results support the need to address and modify misperceptions about prevention of suicide in any efforts for widespread implementation and dissemination of lethal-means counseling. Image 1 Contribution to Emergency Nursing Practice • Examination of ED nurse leaders across the United States Mountain West region found general support for lethal-means counseling for patients at risk of suicide. • Skepticism about the preventability of suicide highlights the need for better, focused suicide prevention training of nurses during training and through continuing education. • Efforts to implement, sustain, or improve lethal-means counseling practices in emergency departments can be more successful if they engage nurse leaders. [ABSTRACT FROM AUTHOR]

Global efforts are underway to develop, implement and test health care transition (HCT) models of care. Most studies have focused on the transfer of care models. In contrast, the nurse-led interdisciplinary HCT model, Movin' On Up , provides comprehensive HCT services beginning in early adolescence. A retrospective analysis was conducted of data extracted from HCT records of 146 adolescents and emerging adults with spina bifida (with a mean age of 13.91 years) who were provided services in the Movin' On Up HCT program. Data were categorized based on the Health Care Transition Research Consortium HCT model and the Omaha System framework and as to type of direct HCT services provided by the HCT Specialist and nurse-led interdisciplinary team conferences conducted. Findings revealed that the scope of services provided represented the scope of comprehensive needs beyond those associated with the transfer of care. [ABSTRACT FROM AUTHOR]

Scientific and technological progress over the centuries was very strong in some fields, much weaker in others and even virtually absent in a few so far. For the future, there are a series of areas where new breakthroughs can be expected to occur. However, there is some evidence that such breakthroughs seem to be increasingly difficult to achieve. The paper reviews these discussions, maps scientific and technological progress over the centuries and presents new ideas on how to foster and accelerate scientific and technological advancement. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether arthroscopic lateral acromioplasty reliably decreases the critical shoulder angle (CSA) and whether it is associated with damage to the deltoid or other complications.Methods: Patients undergoing arthroscopic rotator cuff repair (RCR) with lateral but without anterior acromioplasty for degenerative, full-thickness rotator cuff tears and a CSA of 34° or greater were retrospectively reviewed. Patients with traumatic or irreparable rotator cuff tears, osteoarthritis, or previous surgery were excluded. Clinical and radiographic outcomes were assessed at a minimum of 12 months' follow-up.Results: We reviewed 49 consecutive patients (mean age, 56 years; age range, 39-76 years) at a mean of 30 months (range, 12-47 months). There were 7 RCR failures (14%). The mean CSA was reduced from 37.5° preoperatively (95% confidence interval [CI], 36.7°-38.3°) to 33.9° postoperatively (95% CI, 33.3°-34.6°; P < .001). There were no cases of dehiscence, increases in fatty infiltration, or significant atrophy of the deltoid. Scarring at the deltoid origin was noted in 18 patients (37%). The mean absolute and relative Constant scores increased from 59 points (95% CI, 54-64 points) to 74 points (95% CI, 70-78 points) and from 66% (95% CI, 61%-71%) to 83% (95% CI, 79%-87%) respectively, and the Subjective Shoulder Value increased from 45% (95% CI, 39%-50%) to 80% (95% CI, 74%-86%) (P < .001 for all 3 improvements). The postoperative CSA was significantly larger in failed than in healed repairs (P = .026). Patients with a healed RCR and a CSA corrected to 33° or less (n = 22) had 25% more abduction strength than patients with a healed cuff and a CSA corrected to 35° or greater (n = 14, P = .04).Conclusions: Arthroscopic lateral acromioplasty performed in addition to arthroscopic RCR can reduce the CSA without significantly compromising the deltoid origin, deltoid muscle, or function. It is not associated with any additional complications of arthroscopic RCR. Insufficiently corrected, abnormally large CSAs are associated either with a higher retear rate or with inferior strength of abduction if the tears heal.Level Of Evidence: Level IV, case series, treatment study. [ABSTRACT FROM AUTHOR]

Rural America has a long relationship with the coal industry. Long-term shifts toward less labor intensive practices in the industry, coupled with policies aimed at reducing carbon emissions have resulted in substantial employment losses in coal communities. While the economic impacts of declining industries in rural America have been documented, less work has been done to investigate the impact of coal employment losses on social outcomes. We address this gap in the literature by assessing the association between county-level measures of coal employment and marriage, divorce, and cohabitation in nonmetro America. We use a novel proprietary data set to isolate the relationship between marital outcome and coal mining from all other types of mining that aggregated in publicly available data sets. Additionally, we compare these relationships across boom and bust periods. We find that after controlling for total employment growth, the presence of coal mining in a county is significantly associated with marital outcomes and these relationships differ across nonmetro and metro areas. We find some evidence that rural areas that typically have more experience with extraction industries display greater resilience to both positive and negative coal industry shocks compared to metropolitan counties. [ABSTRACT FROM AUTHOR]

Summary Some orthopaedic patients might be at risk for enterococcal infections and might benefit from adapted perioperative prophylaxis. Methods We performed a single-center cohort of adult patients with orthopaedic infections. Results Among 2740 infection episodes, 665 surgeries (24%) involved osteosynthesis material, including total joint arthroplasties. The recommended perioperative prophylaxis was cefuroxime (or vancomycin in case of documented MRSA body carriage). Patients had received antibiotic therapy before surgery in 1167 episodes (43%); among them with potential anti-enterococcal activity (penicillins, glycopeptides, imipenem, linezolid, daptomycin, aminoglycosids, tetracyclins) in 725 (62%) cases. Overall, enterococci were identified in intraoperative samples of 100 different infections (3.6%) ( Enterococcus faecalis , 95; Enterococcus faecium , 2; and other enterococci, 3). However, only 15/100 (15%) enterococcal infections were monomicrobial and 19 were nosocomial (19/2740; 0.7%), of which 15 had previous cephalosporin perioperative prophylaxis without other antibiotic exposure. This association to prior cephalosporin use was significant (Pearson-χ 2 -test; 148/2640 vs. 15/100, p < 0.01). By multivariate analysis, the presence of diabetic foot infection (odds ratio 1.9, 95% confidence interval 1.2–2.9), and polymicrobial infection (OR 6.0, 95%CI 3.9–9.4) were the main predictors of enterococcal infection, while sex, age, and type of material were not. Conclusions Community-acquired or nosocomial enterococcal infections in orthopaedic surgery are mostly polymicrobial, rare and very seldom attributed to a nosocomial origin. Thus, even if they are formally associated with prior cephalosporin use, we do not see a rational for changing our antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

While most body image research emphasizes the thin ideal, a wider variety of body-ideal messages pervade U.S. popular culture today, including those promoting athleticism or curves. Two studies assessed women’s reactions to messages conveying thin, athletic, and curvy ideals, compared to a control message that emphasized accepting all body types. Study 1 ( N = 192) surveyed women’s responses to these messages and found they perceived body-acceptance and athletic messages most favorably, curvy messages more negatively, and thin messages most negatively. Further, greatest liking within each message category came from women who identified with that body type. Study 2 ( N = 189) experimentally manipulated exposure to these messages, then measured self-objectification and body satisfaction. Messages promoting a body-ideal caused more self-objectification than body-acceptance messages. Also, athletic messages caused more body dissatisfaction than thin messages. Together, these findings reveal the complexity of women’s responses to diverse messages they receive about ideal bodies. [ABSTRACT FROM AUTHOR]

This paper reviews the present status and outlook of the building integrated photovoltaics (BIPV) market on a global and European scale. In particular, it provides a comprehensive review of the market situation and the future trends for Austria, Cyprus, France, Germany, Italy and the Netherlands until the year 2020. In addition, as education is seen as one of the barriers for BIPV deployment, results of a survey are presented that was conducted among BIPV stakeholders with the aim to identify major knowledge gaps in education and target audiences as well as teaching goals. From that potential courses dedicated to the needs of each target audience related to BIPV can be developed. [ABSTRACT FROM AUTHOR]

Citizen science has been gaining popularity in ecological research and resource management in general and in urban forestry specifically. As municipalities and nonprofits engage volunteers in tree data collection, it is critical to understand data quality. We investigated observation error by comparing street tree data collected by experts to data collected by less experienced field crews in Lombard, IL; Grand Rapids, MI; Philadelphia, PA; and Malmö, Sweden. Participants occasionally missed trees (1.2%) or counted extra trees (1.0%). Participants were approximately 90% consistent with experts for site type, land use, dieback, and genus identification. Within correct genera, participants recorded species consistent with experts for 84.8% of trees. Mortality status was highly consistent (99.8% of live trees correctly reported as such), however, there were few standing dead trees overall to evaluate this issue. Crown transparency and wood condition had the poorest performance and participants expressed concerns with these variables; we conclude that these variables should be dropped from future citizen science projects. In measuring diameter at breast height (DBH), participants had challenges with multi-stemmed trees. For single-stem trees, DBH measured by participants matched expert values exactly for 20.2% of trees, within 0.254 cm for 54.4%, and within 2.54 cm for 93.3%. Participants’ DBH values were slightly larger than expert DBH on average (+0.33 cm), indicating systematic bias. Volunteer data collection may be a viable option for some urban forest management and research needs, particularly if genus-level identification and DBH at coarse precision are acceptable. To promote greater consistency among field crews, we suggest techniques to encourage consistent population counts, using simpler methods for multi-stemmed trees, providing more resources for species identification, and more photo examples for other variables. Citizen science urban forest inventory and monitoring projects should use data validation and quality assurance procedures to enhance and document data quality. [ABSTRACT FROM AUTHOR]