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The anatomically complex craniofacial skeleton demands special consideration when caring for cases of polytrauma or medically compromised patients with craniofacial fractures. This paper utilises a systematic review and multidisciplinary opinions to create an algorithm for the hospital-based care of patients with craniofacial fractures (base of skull, orbit, paranasal sinus, and mandible) who require non-invasive ventilation (NIV). Each fracture location has a unique predisposition to a different type of emphysema and associated morbidity. The risk of developing emphysema, combined with its potential severity, is stratified against the harm of not providing NIV for the holistic care of the patient. The aim of this paper is to synthesise evidence from a systematic review of existing literature with multidisciplinary opinions to develop a concise algorithm that outlines the optimal treatment of patients with craniofacial fractures who require NIV. [ABSTRACT FROM AUTHOR]

• Lack of policies to protect dogs in hot weather. • High number of client owned dogs being trained. • Limited number of organizations undertake training in risk of zoonotic disease. Assistance and therapy dogs play a key role in providing support to humans. There have been limited studies of the health, ethics, and welfare of the dogs involved in these programs. This study sought to identify the current practices relating to the care and management of assistance and therapy dogs within Australia. Online surveys with a focus on dog welfare, behavior, training, and education standards were developed for Australian organizations that train or provide assistance dogs or have an allied health professional working with a therapy dog. Responses were received from 29 assistance dog organizations surveys and 28 therapy dogs in allied health organizations. While there were areas of strong practice, such as requiring health clearances from veterinarians, providing vaccinations, and training in understanding dog body language, there were inconsistencies in requirements for rest times and regular behavioral and health checks. Just over half of the respondent assistance dog organizations have a policy for dogs working in hot weather. Few organizations recommended the avoidance of raw meat diets, and most did not require a negative fecal parasite result. This study identified a range of gaps in the current service provision in relation to dog welfare and highlighted the lack of consistency in current practice. The identified gaps can be used to develop best practice guidelines to ensure the sustainability of the assistance and therapy dog industry. [ABSTRACT FROM AUTHOR]

• Older adults with mild cognitive impairment and their romantic partners, who often assume the role of informal caregivers, are generally physically inactive. Yet, very few trials have been designed to promote physical activity among couples living with mild cognitive impairment. • Our mixed-method preliminary study indicated that a dyadic approach to promoting physical activity was feasible, and couples described physical activity together as "time well spent." • To reflect our dyads' suggestions, future studies are needed that seek resources to maintain physical activity. Mild cognitive impairment is a prodromal phase of Alzheimer's disease and related dementias. Cognitive and/or neuropsychiatric symptoms that could worsen over time cause challenges for patients and romantic partners, who often assume the role of informal caregivers. Although physical activity is beneficial, older adults with mild cognitive impairment and their romantic care partners are generally physically inactive. Our 16-week study was performed to see whether physical activity together is feasible to increase physical activity among four dyads (individuals with mild cognitive impairment and their spouses). Our dyadic intervention was feasible given more than 70 % of participants self-reported adherence to physical activity based on the guidelines for adults in the United States. In exit interviews, togetherness was highlighted as one of the biggest strengths of this study. Future studies with more representative samples are needed, as well as adopting a more tailored approach that accounts for individuals' levels of physical fitness. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of exchange and upsizing of malfunctioning small-caliber double-J (JJ) ureteral stents. Thirty-one patients with malfunctioning cystoscopically placed small-caliber (6 or 7 F) JJ stents underwent transurethral (n = 28) or transrenal (n = 3) exchange and upsizing to a large-caliber (10 F) JJ stent from 2013 to 2022. Ureteral obstruction was malignant in 20 patients (65%) and benign in 11 (35%). Fifteen patients (48%) presented with persistent hydroureteronephrosis and 16 patients (52%) with worsening hydronephrosis. Acute kidney injury (AKI) was present in 19 patients (61%) at the time of stent malfunction. Therapeutic success was defined as resolution of hydronephrosis and AKI, if present. JJ stent exchange and upsizing was technically successful in 31 patients (100%) with no immediate adverse events. Therapeutic success was achieved in 27 patients (87%). During follow-up (median, 97 days; IQR, 32–205 days), 2 patients who initially achieved therapeutic success had stent malfunction, requiring conversion to percutaneous nephrostomy drainage (2/27, 7%). Exchange and upsizing to large-caliber JJ stents can relieve urinary obstruction and resolve AKI in patients with malfunctioning small-caliber JJ stents. Large-caliber JJ stents should be considered as a salvage option for patients who wish to continue internal drainage and avoid percutaneous nephrostomy. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: To describe evolution and severity of radiographic findings and assess association with disease severity and outcomes in critically ill COVID-19 patients.Materials and Methods: This retrospective study included 62 COVID-19 patients admitted to the intensive care unit (ICU). Clinical data was obtained from electronic medical records. A total of 270 chest radiographs were reviewed and qualitatively scored (CXR score) using a severity scale of 0-30. Radiographic findings were correlated with clinical severity and outcome.Results: The CXR score increases from a median initial score of 10 at hospital presentation to the median peak CXR score of 18 within a median time of 4 days after hospitalization, and then slowly decreases to a median last CXR score of 15 in a median time of 12 days after hospitalization. The initial and peak CXR score was independently associated with invasive MV after adjusting for age, gender, body mass index, smoking, and comorbidities (Initial, odds ratio [OR]: 2.11 per 5-point increase, confidence interval [CI] 1.35-3.32, P= 0.001; Peak, OR: 2.50 per 5-point increase, CI 1.48-4.22, P= 0.001). Peak CXR scores were also independently associated with vasopressor usage (OR: 2.28 per 5-point increase, CI 1.30-3.98, P= 0.004). Peak CXR scores strongly correlated with the duration of invasive MV (Rho = 0.62, P< 0.001), while the initial CXR score (Rho = 0.26) and the peak CXR score (Rho = 0.27) correlated weakly with the sequential organ failure assessment score. No statistically significant associations were found between radiographic findings and mortality.Conclusions: Evolution of radiographic features indicates rapid disease progression and correlate with requirement for invasive MV or vasopressors but not mortality, which suggests potential nonpulmonary pathways to death in COVID-19. [ABSTRACT FROM AUTHOR]

Metamorphosis is a transition from growth to reproduction, through which an animal adopts adult behavior and metabolism. Yet the neural mechanisms underlying the switch are unclear. Here we report that neuronal E93 , a transcription factor essential for metamorphosis, regulates the adult metabolism, physiology, and behavior in Drosophila melanogaster. To find new neuronal regulators of metabolism, we performed a targeted RNAi-based screen of 70 Drosophila orthologs of the mammalian genes enriched in ventromedial hypothalamus (VMH). Once E93 was identified from the screen, we characterized changes in physiology and behavior when neuronal expression of E93 is knocked down. To identify the neurons where E93 acts, we performed an additional screen targeting subsets of neurons or endocrine cells. E93 is required to control appetite, metabolism, exercise endurance, and circadian rhythms. The diverse phenotypes caused by pan-neuronal knockdown of E93 , including obesity, exercise intolerance and circadian disruption, can all be phenocopied by knockdown of E93 specifically in either GABA or MIP neurons, suggesting these neurons are key sites of E93 action. Knockdown of the Ecdysone Receptor specifically in MIP neurons partially phenocopies the MIP neuron-specific knockdown of E93 , suggesting the steroid signal coordinates adult metabolism via E93 and a neuropeptidergic signal. Finally, E93 expression in GABA and MIP neurons also serves as a key switch for the adaptation to adult behavior, as animals with reduced expression of E93 in the two subsets of neurons exhibit reduced reproductive activity. Our study reveals that E93 is a new monogenic factor essential for metabolic, physiological, and behavioral adaptation from larval behavior to adult behavior. • A screen of 70 Drosophila homologs enriched in mammalian VMH identified E93 , a homolog of mammalian LCOR and LCORL. • Neuron-specific reduction of E93 expression results inhyperphagia, obesity, and impaired exercise ability and circadian rhythm. • These defects were because of E93 action mainly in two types of neurons: GABA-ergic and MIP-producing neurons. • The systemic metabolic defects could be caused by the defects in brain rewiring during adolescence transition. [ABSTRACT FROM AUTHOR]

The present article reviews the growing literature on micro-level (daily or situation-specific) acculturation processes and provides new empirical evidence regarding the link between macro-level (general) and micro-level acculturation indices. The review covers the evolution of acculturation theory and research to focus on separate heritage and destination cultural dimensions and on specific domains (e.g., practices, values, identifications), to include longitudinal research designs, and to incorporate daily diary methodologies. The empirical study includes 824 Hispanic college students in Miami (76.1 % female) who participated in a 12-day diary study. General (macro-level) acculturation measures were administered on Days 1 and 12, and daily (micro-level) acculturation measures were administered on Days 2–11. Each of six acculturation components (dimension-domain pairings) – U.S. practices, Hispanic practices, individualist values, collectivist values, U.S. identity, and ethnic identity – was assessed using full scales on Days 1 and 12 and using single items on Days 2–11. Daily means and daily fluctuations, computed as the standard deviation of Day 2–11 scores, were included during the daily portion of the study. Analyses examined the extent to which earlier macro-level acculturation scores would predict daily means and fluctuations, as well as the extent to which these daily means and fluctuations would predict later macro-level acculturation scores. For each acculturation component, daily means were related to Day 1 and Day 12 scores, though the strengths of these associations varied across components. Daily fluctuations were negatively associated with Day 1 and 12 scores for U.S. and Hispanic practices, but these associations were less consistent for the values and identifications components. These results are discussed in terms of the overlap between micro and macro level acculturation processes, and in terms of the future of acculturation research. [ABSTRACT FROM AUTHOR]

In previous studies, an integrated process (flocculation, struvite precipitation, Chlorella vulgaris and bacteria co-treatment) was shown to be a potentially effective treatment for anaerobically digested swine manure (ADSM). To assess the feasibility of engineering application, the biological treatment (Chlorella vulgaris and bacteria) of this integrated process was scaled up and implemented in an open vertical runway treatment system in this study. With continuous analysis and improvement of natural conditions, equipment and environmental factors, the effect of biomass accumulation and pollutant removal were significantly improved in the second 100 L batch. After 7 days of treatment, the biomass accumulation reached 2.06 ± 0.11 g/L, and the removal rates of chemical oxygen demands (COD), NH 4 +-N, TN and TP reached 75.7 %, 99.3 %, 79.7 % and 76.9 %, respectively, in the second 100 L batch. Results showed that the integrated treatment process could become a reliable way in treating ADSM by optimizing operation conditions in scale-up system. [Display omitted] • C. vulgaris and bacteria co-treatment for PADSW was scaled up. • Conditions were adjusted along the gradual scaling-up process. • The gradual scaling-up process improved the system performance. • The gradual scaling-up process helped with the parameter optimization. • The process was implemented in an open vertical runway treatment system. [ABSTRACT FROM AUTHOR]

Surgical correction of a flatfoot deformity is controversial. The purpose of our study was to evaluate the structural radiographic changes of the flatfoot deformity while maintaining the mobile adapter of the foot. We conducted a retrospective analysis of 56 patients that underwent this procedure comparing their pre- to postoperative angular changes during a follow-up period. The mean age of our study cohort was 53.6 (range, 20-77) years and mean follow-up period was 23 (range, 4-73) months. Radiographic union was achieved in 48 patients (86%). Forty-six patients (82%) had all required radiographs completed through final follow-up visit. We illustrated statistically significant changes to the talonavicular, Meary, talocalcaneal, calcaneal inclination, and talar declination angles, and navicular height at 3 months and final follow-up. This study suggests surgical correction of the flatfoot deformity that fused the subtalar but spared the talonavicular joint appears to achieve and maintain radiographic angular changes and achieve union. [ABSTRACT FROM AUTHOR]

Objective: To assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly), we hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns, and controlling for violence factors would attenuate these associations.Study Design: Data from 27 513 US high-school youth were analyzed from the Centers for Disease Control and Prevention's Youth Risk Factor Surveillance System from 2015 and 2017. We fit sex-stratified, weighted, adjusted log-Poisson models to compare past 30-day exclusive combustible, exclusive e-cigarette, and poly-tobacco use in across sexual orientation. Then, models were adjusted for past-year experiences of physical fighting, bullying, attempting suicide, and physical and sexual dating violence.Results: Compared with heterosexual girls with other-sex partners, sexual minority girls were more likely to use exclusive combustible, exclusive e-cigarette, or poly-tobacco products. When adjusting for violence factors, most tobacco use associations were partially attenuated for all sexual minority girls, and completely attenuated for exclusive e-cigarette use among all sexual minority girls.Conclusions: Sexual minority girls have greater exclusive- and poly-tobacco use compared with heterosexual girls. Tobacco interventions for sexual minority youth should address the risks of poly-tobacco use as well as violence-based risk factors. [ABSTRACT FROM AUTHOR]

Objectives: For a population with knee osteoarthritis (OA), determine: 1) the prevalence of single compartmental, bicompartmental and tricompartmental OA, 2) the prevalence of isolated medial tibiofemoral, lateral tibiofemoral, or patellofemoral OA, and combinations thereof.Methods: PubMed and Web of Science databases, and reference lists of identified studies, were searched to find studies which reported on the compartmental distribution and prevalence of knee OA. Two independent reviewers assessed studies against pre-defined inclusion criteria and prevalence data were extracted along with subject characteristics. The methodological quality of each included study was assessed. A random-effects model meta-analysis was performed for each OA category to estimate the relative prevalence of OA in the knee compartments amongst people with knee OA.Results: 16 studies (3,786 knees) met the inclusion criteria. High heterogeneity was measured. Normalised for knees with OA, estimated prevalence rates (95% CI) were: single compartmental 50% (31.5-58.3%), bicompartmental 33% (23.1-37.2%) and tricompartmental only 17% (8.8-24.8%). Isolated medial tibiofemoral OA, isolated patellofemoral OA, and combined medial tibiofemoral and patellofemoral OA were more common than tricompartmental disease, occurring in 27% (15.2-31.1%), 18% (9.9-22.7%) and 23% (14.1-27.3%) of people respectively. Single/bicompartmental patterns of disease involving the lateral tibiofemoral compartment were less common, summing to 15% (8.5-18.7%).Conclusion: Three-quarters of people with knee OA do not have tricompartmental disease. This is not reflected in the frequency with which partial and combined partial knee arthroplasties are currently used.Trial Registration Number: PROSPERO systematic review protocol (CRD42019140345). [ABSTRACT FROM AUTHOR]

The present study was designed to examine acculturation trajectories of first-generation, Latino immigrant youth and their parents in an emerging immigrant context. We also examined whether acculturation trajectories differed between families with youth who migrated at different stages of development and who have spent differential amounts of time in the United States (US). A community sample of 217 immigrant families in western Oregon was purposely sampled according to youths' age at arrival and time in US residency (TR) and assessed three times over a 3-year period. Families were stratified into three TR groups: TR1 = 2–4 years spent in the US; TR2 = 6–8 years spent in the US; and TR3 = 10–12 years. Parents and youth in each TR group completed measures assessing their acculturation to US American and Latino culture. Results from multiple-group latent growth models showed that acculturation trajectories differed for both youth and parents depending on the TR group. Moreover, both youth and their parents within each TR group differed in their acculturation trajectories. Overall, although youth slowly gravitated toward biculturalism over time, their parents remained relatively separated such that they reported high endorsement of their heritage culture and low endorsement of US culture over time. Findings are discussed in terms of prior research and theory. [ABSTRACT FROM AUTHOR]

Whilst there have been great improvements in the management of elite and professional athletes with the formalisation of the clinical specialty of Sports and Exercise medicine, the management of facial injuries has perhaps lagged in this group. Professional athletic careers can be put in jeopardy due to unnecessarily long absences from training and competition after facial injuries. Professional and elite sports athletes can benefit from different approaches to the management of their facial injuries to reduce time away from competing but maximise their safety. On 6th December 2018, a consensus meeting of interested clinicians involved in the management of facial injuries of elite and professional athletes was held at the Royal Society of Medicine, London, UK to provide a contemporary review of the approaches to conservative, operative and recovery management of facial injuries. National experts with specialist experience of facial injuries presentation and athlete needs from a range of elite and professional sports led the day's programme and the discussions so that guidelines could be formulated. These are presented in this review paper. [ABSTRACT FROM AUTHOR]

Facial asymmetry secondary to unilateral condylar hyperplasia can be a diagnostic challenge to oral and maxillofacial surgeons. Single positron emission computed tomography (SPECT) scans provide a useful adjunct. We report a brief summary of the evidence describing the effectiveness of different methods of analysing SPECT scans and compare it with the results of a 10-year study at Sunderland Royal Hospital. Overall, both the evidence base and our study strongly favour use of the condyle:condyle ratio over the condyle:reference bone ratio, suggesting that no further comparisons are needed. [ABSTRACT FROM AUTHOR]

Despite profound advancements in arthroscopic rotator cuff repair (RCR) techniques, radiologic failure rates may be in excess of 60% with repairs of large and massive tears in the elderly population. One of the strategies to improve these healing rates has been "patch" augmentation of the cuff repair. At the same time, superior capsular reconstruction (SCR) has gained significant popularity as an option for irreparable rotator cuff (RC) tears. Some have also advocated performing SCR in addition to arthroscopic RCR to reinforce the repair and improve healing rates. Techniques involving the use of fascia lata, ECM patches, and long head of the biceps (LHB) for SCR to reinforce the cuff repair have all been elegantly described. In this article, we propose a technique that enables a combination of the aforementioned procedures and involves performing RCR with patch augmentation, as well as SCR using LHB. In doing so, the repaired RC is bordered by the patch over its bursal surface and the LHB on the articular surface (functioning as the superior capsule), thus giving us the name "Hamburger technique" (a 3-layered construct). [ABSTRACT FROM AUTHOR]

The aims of this study were to find out whether scoring in a rose-trellis pattern improved the stretch of mucoperiosteal flaps more than conventional scoring in the horizontal plane, and to consider its application in the closure of oroantral communications. Sixteen sections of cadaveric porcine buccal mucoperiosteum were removed from the molar region of the maxilla and mandible. A three-sided flap was raised in the subperiosteal plane, excised, and pinned to a cork board with the periosteal side facing upwards. Eight samples were scored in the horizontal plane (control) using lines perpendicular to the line of simulated advancement, and eight in a rose-trellis or criss-cross pattern. Scoring using a rose-trellis pattern yielded a mean increase in stretch of 24.3% (p = 0.0003) when compared with the conventional method. Buccal advancement flaps are widely used to close oroantral communications, and scoring of the mucoperiosteum facilitates the stretching of the tissue over the defect. To be successful, defects should be fully closed to prevent contamination, and closure should be tension-free. In this study, scoring in a rose-trellis pattern increased the stretch of the tissue sample more than scoring in the horizontal plane. The rose-trellis technique therefore could aid the effective closure of oroantral communications. [ABSTRACT FROM AUTHOR]

• Depressive symptoms contribute to men's and women's employment problems. • No evidence that employment problems contribute to men's depressive symptoms. • Limited evidence that employment problems contribute to women's depressive symptoms. • Analyze longitudinal survey data and employment measures drawn from job calendars. This paper analyzes the reciprocal lagged relationship between depressive symptoms and employment status. We find that severe depressive symptoms contribute to a 25.6% increase in subsequent non-employment rates, a 20.7% increase in non-participation rates and 34.2% increase in unemployment rates, for men. Similar, although weaker, marginal effects are found for women. However, we find no evidence for men and only limited evidence for women that unemployment, non-employment, or non-participation raises the risks of severe depressive symptoms. We observe an impact of labor market status on depressive symptoms only when using point-in-time measures. [ABSTRACT FROM AUTHOR]

• Effects of zeolite Brønsted acid site density and hierarchical pore system on catalytic performance are discussed. • A hierarchically micro– meso –macropore ZSM-5 shows better diffusion and higher stability. • The plastic-to-naphtha route can improve the environmental benefits of plastic recycling, with a great economic potential. Catalytic cracking of plastics into naphtha as a substitute for new plastic production has the potential to contribute to the plastic circular economy. However, mitigating catalyst deactivation in large-scale processes poses a significant challenge. Here, we demonstrate a remarkable improvement (4.3 × to 12.3 ×) in catalyst lifetime by utilizing hierarchical ZSM-5 catalysts compared to conventional analogues. Increasing the Brønsted acid concentration from 0 to 302 µmol/g enhances catalyst lifetime by over 46 × and boosts cumulative aromatic selectivity from 6 to 73%. Catalyst characterization reveals the development of significant voids after modification, enhancing molecular transport within the hierarchical ZSM-5. Economic analysis shows a pilot system with a 10 ton/day capacity yielding an annual profit of $344,999 and an 11.5% return on investment. Life cycle assessment indicates a reduction of 817.6 kg CO 2 eq compared to traditional plastic-to-fuels technology. These findings advance the plastic circular economy and bring us closer to commercial implementation. A hierarchically micro– meso –macropore zeolite is developed to improve catalyst lifetime during catalytic cracking of plastics. [Display omitted] [ABSTRACT FROM AUTHOR]

In this study, a tandem process that combines catalytic pyrolysis with catalytic chemical vapor deposition (CVD) was performed to investigate the conversion of waste plastics to carbon nanomaterials, oil, and for hydrogen production. This study primarily explored the effects of plastic types and the plastic feeding rate on the pyrolysis products and the quality and morphology of carbon nanomaterials. High-density polyethylene (HDPE), low-density polyethylene (LDPE), polypropylene (PP), polystyrene (PS), and polyethylene terephthalate (PET) were used as carbon precursors for the growth of carbon nanomaterials on nickel foams. Results showed that PS produced the highest liquid oil with just 2 % of predominantly amorphous structured carbon nanomaterials. PET had the lowest hydrogen yield and approximately 42 % amorphous carbon due to the formation of more CO 2 and CO. Most importantly, since HDPE, LDPE, and PP produced more graphitic carbon nanomaterial with fewer structural defects compared to PET and PS, they are more favorable for the production of hydrogen and carbon nanomaterials. Additionally, HDPE loading significantly affected the quality of the produced carbon nanomaterial, particularly higher or lower feedstock loading resulting in more defects. This proposed tandem process shows great potential for upcycling waste plastics for secondary use. [Display omitted] [ABSTRACT FROM AUTHOR]

Dust samples were collected from four indoor environments, including childcare facilities, houses, hair salons, and a research facility from the USA and were analyzed for brominated compounds using full scan liquid chromatography high-resolution mass spectrometry. A total of 240 brominated compounds were detected in these dust samples, and elemental formulas were predicted for 120 more abundant ions. In addition to commonly detected brominated flame retardants (BFRs), nitrogen-containing brominated azo dyes (BADs) were among the most frequently detected and abundant. Specifically, greater abundances of BADs were detected in indoor dusts from daycares and salons compared to houses and the research facility. Using authentic standards, a quantitative method was established for two BADs (DB373: Disperse Blue 373 and DV93: Disperse Violet 93) and 2-bromo-4,6-dinitroaniline, a commonly used precursor in azo dye production, in indoor dust. Generally, greater concentrations of DB373 (≤3850 ng/g) and DV93 (≤1190 ng/g) were observed in indoor dust from daycares highlighting children as a susceptible population to potential health risk from exposure to BADs. These data are important because, to date, targeted analysis of brominated compounds in indoor environments has focused mainly on BFRs and appears to underestimate the total amount of brominated compounds. Image 1 • Brominated azo dyes (BADs) were detected at relatively greater abundances than brominated fire retardants in indoor dusts from across USA. • BAD concentrations were determined, for the first time, in indoor dusts with maximum concentration of Disperse Blue, 3850 ng/g. • BAD concentrations in indoor dust from childcare were greater than in indoor dusts from houses, salons and a research facility. • Estimated BADs ingestion via dust was as much as 10-fold greater for infants compared to other age groups. Brominated azo dyes were detected at biologically significant concentrations in indoor dust using liquid chromatography ultrahigh-resolution mass spectrometry. [ABSTRACT FROM AUTHOR]

Sneddon syndrome (SS) is an episodic or chronic, slowly progressive disorder and characterized by generalized livedo racemosa (patchy, violaceous, skin discoloration) and recurrent cerebrovascular events. The histopathology of skin and brain is remarkable for a noninflammatory thrombotic vasculopathy involving medium- and small-sized dermal and cerebral arteries, respectively. Approximately 80% of the SS patients are women with a median age of diagnosis at 40 years. However, the onset of the disease during childhood have been reported. Etiopathogenesis of SS is unknown with 2 primary mechanisms proposed - autoimmune/inflammatory versus thrombophilia. SS is primarily classified as antiphospholipid positive or negative type. Neurological manifestations usually occur in 3 phases: (1) prodromal symptoms such as headaches, dizziness, and vertigo, (2) recurrent strokes, and (3) early onset dementia. Livedo racemosa precedes the onset of recurrent strokes by more than 10 years, but in many instances, the significance of the skin lesion is recognized only after the appearance of the stroke. The involvement of the heart valves, systolic labile hypertension, and retinal changes are also commonly associated with this syndrome. Treatment of SS is primarily based on anecdotal reports. Antiplatelet and antithrombotic agents are used for secondary stroke prophylaxis, and a recent study showed a relatively lower stroke recurrence rate with the universal use of antiplatelet/antithrombotic agents. Routine use of anti-inflammatory or immunosuppressive therapies is controversial. Neuropsychiatric prognosis of SS is relatively poor with predominant deficits in the concentration, attention, visual perception, and visuospatial skills. [ABSTRACT FROM AUTHOR]

To evaluate the impact of two standardized patient (SP) approaches on student communication skills and self-perceived confidence. Second professional year pharmacy students were assessed on overall and area of improvement (AOI) communication skills and self-perceived confidence. Students were invited to participate in a SP intervention activity, following a fall and before a spring class assessment, where they were randomized to an individualized or non-specific SP group. Communication skills were assessed using a four component 64-point rubric; confidence was assessed using an 11-question Likert-type survey. Nineteen students participated in the SP intervention activity; 11 students comprised the individualized group and eight students comprised the non-specific group. Students in the individualized group demonstrated a significantly higher median change in AOI communication scores compared to the non-specific group [five points vs. three points, respectively (p = 0.033)]. There was a significantly higher median change in overall communication skills in the individualized compared to the non-specific group of 12 points and 6.5 points, respectively (p = 0.017). Student self-perceived confidence in the individualized and non-specific group showed similar improvements overall from pre- to post assessment [seven points vs. eight points, respectively (p = 0.62)]. The use of SPs in pharmacy curricula can improve student communication skills. However, tailoring the activity to students' needs significantly improves their communication AOI and overall communication skill scores more than a non-specific activity. Student self-perceived confidence improved similarly in both groups, although no statistically significant differences were found between groups. [ABSTRACT FROM AUTHOR]

Concept born from the observation that 1) systematic conventional techniques for implanting hip components are still affected by some complications that technological improvements have not entirely solved, and 2) the increasing awareness that abnormal lumbo-pelvic kinematics are responsible for clinically detrimental poor functional cup orientation and components' interaction (edge loading and articular impingement) that occur during activities of daily living. Following on from this, the kinematic alignment (KA) technique for total hip replacement (THR) has been developed and consists of personalising the implantation of components, with the intention of restoring the pre-arthritic hip joint anatomy: centre of rotation, acetabular anteversion, and proximal femur anatomy. The acetabular component orientation will be adjusted from its native orientation (transverse acetabular ligament) for patients with poor functional acetabular orientation due to an abnormal spine-hip relationship (≍10 to 35% of patients). As the majority of conditions that lead to hip degeneration are automatically corrected when anatomically replacing a hip, there is little-to-no risk of reproducing the hip anatomy, with the exception of developmental disease. The cup adjustment aims, by reaching a compromise, to optimise the components' interaction between the standing and the sitting positions. The intended benefits of the KA technique for THR are primarily to reduce risk of prosthetic instability and failure as a result of the improved functional components' interaction, and secondarily to improve functional performances and patient satisfaction due to the anatomical implantation and subsequent physiological prosthetic hip kinematics. A parallel may be drawn between the KA technique for THR and the concept of "restricted KA technique for total knee replacement", as in both techniques component positioning primarily aims to reproduce the native joint anatomy, with only a fraction of patients requiring component orientation adjustment in order to compensate for a biomechanically sub-optimal pre-operative joint condition. Planning a KA-THR is simple (physical examination and radiographic measurements to distinguish between hip and spine users, in order to define the individual spine-hip relationship), and surgery can be reliably performed free hand. As the pre-operative individual spine-hip relationship is also influenced by the stiff osteoarthritic hip (hip-spine syndrome), further research is needed to refine the indication and the level of cup orientation adjustment. [ABSTRACT FROM AUTHOR]

Abstract Background Although there exists robust literature on mortality-associated factors in burn patients, it is not known how electronic medical records affect outcomes. Using burn injury as a surgical care model of information and communication, we hypothesized that functionality and interoperability of the electronic medical record could serve as determinants of outcome. Methods We used the state inpatient databases for New York, Washington, California, and Florida for the years 2009 and 2010 for all states, with the additional years of 2012 and 2013 for New York (n = 6,002), and the respective data from the American Hospital Association Information Technology survey. Using International Classification of Diseases, Ninth Revision, codes, we included burn patients and characterized total body surface area burned. We summed the binary answers to questions 1 and 2 and question 3 from the American Hospital Association Information Technology survey to make continuous functionality and interoperability scores. Mortality was predicted using extreme gradient boosting in Python. Results In each state in which our models had an accuracy and area under the curve of more than 0.90, electronic medical record functionality but not interoperability was a significant predictor in New York, California, and Florida. Important predictors in each state were, age, duration of stay, total body surface area burned/severity, and total charges. Electronic medical record functionality was more important than all comorbidities except for coagulopathies and electrolyte disorders. Higher functionality scores were associated with mortality (P <.01). Conclusion Our data support our hypothesis that electronic medical records may be associated with mortality in burn patients; however, electronic medical records are not having the intended impact on outcomes, and further research needs to elucidate exactly how electronic medical records are being used in clinical settings. [ABSTRACT FROM AUTHOR]

We examine the relationship between trait self-control and body weight. Data from a population representative household survey reveal that limited self-control is strongly associated with both unhealthy body weight and poorer subjective weight-related well-being. Those with limited self-control are characterized by reduced exercising, repeated dieting, unhealthier eating habits, and poorer nutrition. We propose an empirical method to isolate two facets of self-control limitations—high impulsivity and low restraint. Each has differential predictive power. Physical activity, dieting, and overall body weight are more strongly associated with restraint; impulsivity is relatively more predictive of when, where, and what people eat. • Low self-control is linked to higher body weight and lower weight-related wellbeing. • Potential mechanisms include reduced exercising and unhealthier eating. • We isolate two facets of self-control—impulsivity and restraint. • Restraint is more strongly associated with body weight, exercise, and dieting. • Impulsivity is relatively more predictive of when, where, and what people eat. [ABSTRACT FROM AUTHOR]

Background This study aimed to determine whether publicized hospital rankings can be used to predict surgical outcomes. Methods Patients undergoing one of nine surgical procedures were identified, using the Healthcare Cost and Utilization Project State Inpatient Database for Florida and New York 2011–2013 and merged with hospital data from the American Hospital Association Annual Survey. Nine quality designations were analyzed as possible predictors of inpatient mortality and postoperative complications, using logistic regression, decision trees, and support vector machines. Results We identified 229,657 patients within 177 hospitals. Decision trees were the highest performing machine learning algorithm for predicting inpatient mortality and postoperative complications (accuracy 0.83, P <.001). The top 3 variables associated with low surgical mortality (relative impact) were Hospital Compare (42), total procedure volume (16) and, Joint Commission (12). When analyzed separately for each individual procedure, hospital quality awards were not predictors of postoperative complications for 7 of the 9 studied procedures. However, when grouping together procedures with a volume-outcome relationship, hospital ranking becomes a significant predictor of postoperative complications. Conclusion Hospital quality rankings are not a reliable indicator of quality for all surgical procedures. Hospital and provider quality must be evaluated with an emphasis on creating consistent, reliable, and accurate measures of quality that translate to improved patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Deaths from drug intoxication have increased in the United States but outcomes of recipients of orthotopic heart transplantation (OHT) from these donors are not well characterized.Methods: We performed a retrospective analysis of the United Network for Organ Sharing's STAR database between January 2000 and March 2014 and assessed mortality and retransplantation using adjusted Cox models by mechanism of donor death.Results: Of the 31,660 OHTs from 2000 to 2014, 1233 (3.9%) were from drug intoxication. These donors were more likely to be female, white, with greater tobacco use and higher BMI compared to donors who died of other mechanisms. Drug intoxication accounted for 1.1% of OHT donors in 2000 and 6.2% in March 2014. No significant difference was observed in 10-year mortality (adjusted hazard ratio [HR], 95% confidence interval [CI]: 0.99, 0.87-1.13), 10-year retransplantation (adjusted HR 0.84, 0.49-1.41) or 1-year and 3-year rehospitalization with other mechanisms of death compared to drug intoxication.Conclusion: There has been a large increase in OHT donors who die of drug intoxication in the United States. OHT outcomes from these donors are similar to those dying from other mechanisms. These data have important implications for donor selection in context of the ongoing opioid epidemic. [ABSTRACT FROM AUTHOR]

Background Reversal of an enterostomy results in a high rate of incisional hernia at the ostomy site. Prophylactic mesh reinforcement of the fascial defect is typically not considered due to the contaminated nature of the case. We present the outcomes of a series of prophylactic mesh reinforcements with retromuscular, large-pore polypropylene at the time of enterostomy reversal. Methods Retrospective review of all ostomy reversals was performed. All cases with placement of synthetic mesh reinforcement were identified from a prospectively maintained, hernia database. Primary end points were surgical site occurrence, surgical site infection, and hernia occurrence. Results Ostomy reversal was performed in 359 patients; 91 were reinforced with mesh and 268 without mesh. Colostomy reversal was performed in 56.5% and ileostomy in 43.5%. The mesh group had a greater body mass index and a greater incidence of chronic obstructive pulmonary disease, but groups were otherwise similar. A midline incisional hernia was present in 45% of the mesh group vs 4.5% in the controls. Incidence of surgical site occurrence and surgical site infection were similar for mesh and control groups (21 vs 22.8%; P  = .82 and 20 vs 19.8%; P  = 1.000, respectively). Superficial surgical site infection was less with mesh (8 vs 16.4%; P  = .039). Incidence of a hernia developing at the stoma site was decreased markedly with mesh (1% vs 17.2%; P  < .001), as was the occurrence of a midline hernia (6% vs 19%; P  = .004). Mesh was placed across the midline prophylactically in 29.7% of cases, which decreased midline hernia formation from 24.1% to 4% ( P  = .019). Conclusion Retromuscular placement of permanent synthetic mesh at the time of enterostomy reversal is effective in preventing development of incisional hernia without increased risk of surgical site occurrence or surgical site infection. [ABSTRACT FROM AUTHOR]

Background: Core-to-peripheral redistribution of heat, secondary to sympathetic-mediated vasodilation, is the major mechanism leading to early perioperative hypothermia after neuraxial anesthesia. The study aim was to determine if preoperative anterior thigh (peripheral lower extremity) temperature predicted perioperative temporal (core) temperature decrease during cesarean delivery with spinal anesthesia.Methods: Secondary analysis of data derived from a prospective, randomized study of 46 healthy women undergoing scheduled cesarean delivery with spinal anesthesia was performed. Anterior thigh temperature was measured preoperatively prior to spinal anesthesia. The primary outcome was maximum perioperative temporal temperature decrease. Secondary outcomes included incidence of temporal hypothermia (temperature <36°C), shivering, and thermal comfort scores. This study ran concurrently with a previously published trial comparing no active intraoperative warming with active warming.Results: There was no correlation between preoperative anterior thigh temperature and maximum perioperative temporal temperature decrease (r=-0.049, P=0.751). The mean±standard deviation preoperative anterior thigh temperature of women who developed temporal hypothermia compared to those who did not was 32.4±0.8°C versus 32.4±0.70°C respectively (P=0.995). Preoperative anterior thigh temperature did not correlate with the incidence of shivering (r=0.267, P=0.080) or thermal comfort scores (r=0.233, P=0.129).Conclusion: Preoperative anterior thigh temperature does not correlate with the degree of perioperative temporal temperature decrease, likelihood of developing hypothermia, shivering, or thermal comfort during cesarean delivery with spinal anesthesia. Although core-to-peripheral redistribution of heat after neuraxial anesthesia is a major mechanism of perioperative heat loss, a lower extremity temperature prediction hypothesis was not confirmed in this population. [ABSTRACT FROM AUTHOR]

Introduction This article investigates a practical method of reducing the impact of scattered radiation during a lateral radiographic projection of the elbow. The light beam diaphragm (LBD) is generally accepted to limit ionising radiation using horizontal and longitudinal lead shutters, yet this article evidences further dose limitation by placing lead-rubber inferolateral to the LBD device. Methods Using an anthropomorphic phantom and arm construction scattered radiation was recorded at multiple radiosensitive organs. A 15 cc ionisation chamber (model 10100 AT TRIAD) was placed on each radiosensitive organ (eye, thyroid, breast, testes, spleen and ovaries) measuring exposure rate (μGy/s). Dose readings were recorded before and after the placement of lead-rubber inferolateral to the LBD. A paired two sample t- test was undertaken affirming how likely dose limitation was attributable to chance ( p < 0.05). Results Descriptive and inferential statistics demonstrate dose reduction to radiosensitive organs (right eye 53%, right breast 53%, left eye 39%, thyroid 13%, left ovary 9%, testes 6%, left breast 3% and spleen 2%) upon placement of the lead-rubber inferolateral to the LBD. The paired two sample t- test demonstrated statistically significant dose limitation ( t = 2.04, df = 7, p = 0.04) thus significant for radiographic practice. Conclusion Placement of lead-rubber inferolateral to the LBD limits dose to multiple radiosensitive organs. Right (53%) and left (39%) eye lens, right breast (53%), thyroid (13%), left ovary (9%), testes (6%), left breast (3%) and spleen (2%) statistically demonstrate dose limiting opportunities to patients. [ABSTRACT FROM AUTHOR]

Introduction The pathophysiology of heart failure involves activation of several neurohormonal systems including the renin-angiotensin-aldosterone system. The mineralocorticoid receptor antagonist spironolactone has been shown to be beneficial in humans and dogs with heart failure. The objective of this pilot study was to investigate the efficacy and safety of spironolactone in cats with heart failure secondary to cardiomyopathy already treated with furosemide and an angiotensin-converting enzyme inhibitor. Animals Twenty cats with heart failure due to cardiomyopathy. Methods The study was a double-blind, randomised, placebo-controlled, multicentre clinical study assessing the effect of spironolactone on survival and clinical parameters in cats with heart failure due to cardiomyopathy. The primary end point was mortality, defined as death (spontaneous or by euthanasia) due to cardiac causes. Results Twenty cats were enrolled: 9 in the spironolactone group and 11 in the placebo group of which 56% (5/9) and 0% (0/11) completed the 15-month period respectively. At inclusion, differences in systemic blood pressure, body condition score, electrocardiographic abnormalities and LA/Ao ratio suggested that disease may be less severe in the spironolactone group. Twenty-two percent (2/9) of cats in the spironolactone group and 82% (9/11) in the control group reached the primary end point (Fisher's exact test, p = 0.0216). No safety issues were identified in either group. Conclusions This study suggests that spironolactone is well tolerated, and preliminary results support further investigation to evaluate the efficacy of spironolactone in the treatment of cats with cardiac failure due to cardiomyopathy. [ABSTRACT FROM AUTHOR]

Reseeding yellow-flowered alfalfa (YFA) in degraded grasslands may require a vegetation-free microsite for germination and subsequent establishment. This study aimed to examine the role of microclimates of different-sized vegetation gaps on seedling performance and adult plant production of YFA. Field microsites were established in the meadow steppe of Hulunber, Inner Mongolia, China. Seedling performance, plant production, the microclimate within vegetation gaps, and soil nutrients (plant-available N, P, and K, total N concentration) were assessed at the end of each growing season from 2013 to 2015. Our results indicate light availability, and topsoil temperature of each gap were significantly increased as gap size increased, while topsoil moisture and air relative moisture were decreased in larger gaps. Small gaps (diameter ≤10 cm) improved seedling emergence, survival, biomass, and root nodulation, as compared with seedling performance associated with the larger gaps, presumably in response to increased shade and moisture. Additionally, large gaps (>20 or >40 cm) were characterized by significantly lower plant-available P, total N concentrations, plant-available K, and soil pH. However, root exclusion treatments did not improve overall seedling performance, plant production, or soil properties, as compared to corresponding microsites with root presence, regardless of gap size. Our results suggest that reseeding YFA into grasslands where disturbance, such as light grazing, has resulted in small gaps will be more effective than in highly degraded grasslands. [ABSTRACT FROM AUTHOR]

Recent diversity, equity, and inclusion (DEI) efforts have made some limited progress in addressing underrepresentation and unequal opportunities for minority members in the Information Systems (IS) academic community. The Association for Information Systems (AIS), as the preeminent global professional society for the IS discipline, is tasked with acting on behalf of its members and their colleagues to achieve equity and inclusion for its diverse membership. This editorial has two aims: (1) to share the extent to which positive changes have been made and also the extent to which underrepresentation still pervades the IS academic community, especially at the senior ranks and in positions of power, and (2) to propose a coordinated, strategic focus that our field, our journals and conferences, and our association (AIS) can take to further improve diversity and inclusion for both junior and senior minority colleagues. [ABSTRACT FROM AUTHOR]

There is growing recognition of the threat posed by toxic lead-based ammunition. One group of domestic animals known to be susceptible to harmful lead exposure via this route is hunting dogs. Scent-trailing dogs ('hounds') are used to hunt introduced sambar deer (Cervus unicolor) during a prescribed eight-month (April–November) annual hunting season, during which they are fed fresh venison, in Victoria, south-eastern Australia. We used this annual season as a natural experiment to undertake longitudinal sampling of dogs for lead exposure. Blood was collected from 27 dogs owned by four different deer hunters and comprising three different breeds just prior to the start of the hound hunting season (March 2022) and in the middle of the season (August 2022), and blood lead levels (BLLs) (μg/dL) were determined via inductively coupled plasma mass spectrometry (ICP-MS). Using Tobit regression, the expected BLLs across all dogs were significantly lower before the season (0.50 μg/dL, standard error [SE] = 0.32 μg/dL) than during the season (1.39 μg/dL, SE = 0.35 μg/dL) (p = 0.01). However, when the breed of dog was included in the analyses, this effect was only significant in beagles (P < 0.001), not bloodhounds (p = 0.73) or harriers (p = 0.43). For 32% of the dogs before the season, and 56% during the season, BLLs exceeded the established threshold concentration for developmental neurotoxicity in humans (1.2 μg/dL). Time since most recent venison feeding, sex of dog and owner were not associated with BLLs. The finding that BLLs more than doubled during the hunting season indicates that lead exposure is a risk in this context. These results expand the sphere of impact from environmental lead in Australia from wild animals and humans, to include some groups of domestic animals, a textbook example of a One Health issue. [Display omitted] • Lead from ammunition harms domestic as well as wild animals. • Hunting dogs are at particularly high risk of harmful lead exposure. • Blood lead levels in 27 dogs increased during an Australian deer hunting season. • Ammunition-derived lead is a One health issue requiring urgent mitigation. [ABSTRACT FROM AUTHOR]

Identifying modifiable risk factors is requisite for preventing stress-related psychopathology, but few prospective studies have examined their impact on the emergence of psychological dysfunction. Trait anxiety (TA), anxiety sensitivity (AS), and experiential avoidance (EA) were assessed in 161 soldiers awaiting deployment. Soldiers also completed repeated in-theater assessments of stressors, post-traumatic stress (PTSS), anxiety, and depression symptoms. Multilevel models tested predictions that each trait would independently and jointly amplify stressors’ impact on symptoms. TA increased risk for anxiety (r = .19, p = .020), but not stressors’ anxiogenic effects (r = .14, p = .080), whereas TA reduced stressors’ impact on depression (r = .18, p = .038) and PTSS (r = .28, p = .001). AS increased risk across symptoms (r's = .26–.31, p's ≤ .002), but did not moderate stressors’ anxiogenic effects (r = .15, p = .074). EA's stress-moderating effects depended on levels of TA and AS (r's = .22–.27, p's ≤ .010). Findings suggest TA and EA may interact in ways to enhance resilience, whereas AS may reliably potentiate the pathogenic effects of stress. Support is given for examining the contextualized influence of individual differences, and their dynamic interactions in predicting soldiers’ reactions to war-zone stressors. [ABSTRACT FROM AUTHOR]

Purpose To examine how cannabis use and polysubstance use among cannabis users relate to psychosis spectrum (PS) symptoms in a large community-based sample of U.S. youth. Methods Four thousand one hundred seventy-one youths (aged 14–21 years; mean = 16.90 years, SD = 1.85; 55% female) from the Philadelphia Neurodevelopmental Cohort completed assessments of substance use, PS symptoms, and confounding variables (e.g., demographics, comorbid psychopathology, and trauma exposure). Results After adjusting for confounds, cannabis use by itself was not associated with increased odds of being classified as “psychosis spectrum.” However, cannabis use in combination with tobacco or other substance use was associated with increased odds of PS classification (adjusted odds ratios [ORs] = 1.37–1.76). Follow-up symptom-level analyses revealed that cannabis use in combination with other substances was associated with subclinical positive symptoms (ORs = 1.95 and 2.24) and frequent cannabis use was associated with subclinical negative/disorganized symptoms (OR = 2.14). However, these symptom-level findings were reduced to trends after correction for multiple comparisons. Neither cannabis use nor polysubstance use was associated with threshold delusions or hallucinations. Conclusions After adjusting for important confounds, there was minimal evidence for associations between cannabis use by itself and PS symptoms. More compelling evidence emerged for associations between polysubstance use among cannabis users and PS symptoms. This study highlights the importance of considering polysubstance use and confounds when examining associations between cannabis use and PS symptoms. Further longitudinal research is necessary to determine whether these findings represent causal associations or shared genetic and/or environmental vulnerability for substance use and PS symptoms. [ABSTRACT FROM AUTHOR]

Intro: In light of the recent successful mechanical thrombectomy trials, the need for IV-tPA prior is under investigation. Few cases demonstrate angiographically the role of both mechanical and chemical strategies at achieving reperfusion. Case report: A 63 year-old male presented with an NIHSS 20. CTA demonstrated an acute occlusion of the left cervical and intracranial ICA and MCA. IV-tPA was administered, followed by immediate reperfusion of the cervical ICA with carotid stenting and mechanical thrombectomy. Within the next 10 min, the entire intracranial clot burden dissolved under angiographic control. TICI 3 reperfusion was achieved without any further intervention. Post-procedure, the patient recovered fully to an NIHSS of 0. Conclusion: This case underscores the importance of IV-tPA administration in conjunction to mechanical thrombectomy. The interventionalist should take advantage of the symbiotic effect of the IV-tPA administration, which remains the standard of care so far. [ABSTRACT FROM AUTHOR]

Measurement of the properties of bone as a material can happen in various length scales in its hierarchical and composite structure. The aim of this study was to test the tissue level properties of clinically-relevant human bone samples which were collected from donors belonging to three groups: ageing donors who suffered no fractures (Control); untreated fracture patients (Fx-Untreated) and patient who experienced hip fracture despite being treated with bisphosphonates (Fx-BisTreated). Tissue level properties were assessed by (a) nanoindentation and (b) synchrotron tensile tests (STT) where strains were measured at the 'tissue', 'fibril' and 'mineral' levels by using simultaneous Wide-angle - (WAXD) and Small angle- X-ray diffraction (SAXD). The composition was analysed by thermogravimetric analysis and material level endo- and exo-thermic reactions by differential scanning calorimetry (TGA/DSC3+). Irrespective of treatment fracture donors exhibited significantly lower tissue, fibril and mineral strain at the micro and nanoscale respectively and had a higher mineral content than controls. In nanoindentation only nanohardness was significantly greater for Controls and Fx-BisTreated versus Fx-Untreated. The other nanoindentation parameters did not vary significantly across the three groups. There was a highly significant positive correlation (p < 0.001) between organic content and tissue level strain behaviour. Overall hip-fractures were associated with lower STT nanostrains and it was behaviour measured by STT which proved to be a more effective approach for predicting fracture risk because evidently it was able to demonstrate the mechanical deficit for the bone tissue of the donors who had experienced fractures. [ABSTRACT FROM AUTHOR]