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Gender-affirming surgery is unequally distributed across the United States due to resource allocation, state-based regulations, and the availability of trained physicians. Many individuals seeking gender-affirming surgery travel vast distances to receive care. This study aims to quantify the distances that individuals travel to receive gender-affirming surgery based on procedure type and patient home-of-record location. Patients in the Optum Clinformatics Data Mart who underwent gender-affirming surgery were identified via Current Procedural Terminology codes. Data on patient demographics, procedural care, and location of patient and provider were collected. To be included, a patient had to meet diagnostic criteria to receive gender-affirming surgery and have a recorded surgical procedure reimbursed as part of gender-affirming surgery per the Centers for Medicare and Medicaid Services guidelines. Patients residing or receiving care outside the continental United States were excluded. Distances between the ZIP Code of each patient's home of record and the location where the gender-affirming surgery was performed were calculated via the Google Maps Distance Matrix API. Distance traveled for gender-affirming surgery by patient state and gender-affirming surgery procedure were determined. Multivariate linear regression analysis determined predictors of distance traveled for gender-affirming surgery, whereas multivariate logistic regression identified variables associated with an increased likelihood of out-of-state travel to gender-affirming surgery. Across 86 million longitudinal patient records, the study population included 2,743 records corresponding to 1,735 patients who received gender-affirming surgery between January 2003 and June 2020. The median distance traveled for gender-affirming surgery was 191 miles (mean: 391.5), and 36.0% of patients traveled out of their state of residence. Every patient from West Virginia, Wyoming, South Dakota, Mississippi, and Delaware traveled out of state for gender-affirming surgery. Patients with homes of record in California (18.4%), Massachusetts (20.7%), and Oregon (19.0%) were the least likely to travel out-of-state for gender-affirming surgery out of states with more than 10 gender-affirming surgery encounters. The main predictors for out-of-state travel included both feminizing and masculinizing genital surgery, as well as an insurance coverage with increased provider options. Additionally, patients traveled shorter distances for gender-affirming surgery after the post-2014 Affordable Care Act expansion compared to pre-2014. Patients receiving gender-affirming surgery in the United States travel great distances for their care, often receiving their care from out-of-state providers. Restrictive guidelines imposed by state laws on both the access to and provision of gender-affirming surgery compound the myriad of common difficulties that patients face. It is imperative to discuss potential factors that may mitigate these barriers for those who require gender-affirming surgery. [ABSTRACT FROM AUTHOR]

An approach to predict standard times for upcoming individual customer orders based on historical production orders is developed. The approach follows the CRISP-DM model with regard to the steps data preparation, modeling and evaluation. A precision steel tube straightening machine is provided as a validation example. Furthermore, the paper focuses on how the standard time prediction approach can be successfully integrated into the IT infrastructure of a production focused company. Especially data availability and accessibility in enterprise resource planning systems are discussed. The presented approach offers users the value of more precise scheduling in production than established approaches. [ABSTRACT FROM AUTHOR]

The objectives of this study were to evaluate the incidence and to identify risk factors for acute kidney injury (AKI) in neonates undergoing cardiopulmonary bypass (CPB) with a miniaturized bloodless primed extracorporeal circuit. A retrospective cohort study. A single-center, tertiary academic hospital. Data of 462 patients were analyzed. With a retrospective analysis of neonates undergoing CPB with bloodless priming between May 2007 and August 2019, the incidence of AKI was determined according to the neonatal Kidney Disease: Improving Global Outcomes classification. Multivariate logistic regression analyses were performed to determine risk factors for AKI. The incidence of AKI was 41.1% (190 of 462); 30.3% (n = 140) had mild stage 1, 6.5% (n = 30) reached stage 2, and 4.3% (n = 20) reached stage 3. Multivariate logistic regression showed that degree of hypothermia (p = 0.05), duration of CPB (p = 0.03), and lower baseline serum creatinine (p < 0.001) were associated independently with AKI. In the authors' patient population, patients without transfusion of donor-derived erythrocytes had a lower incidence of AKI (p = 0.003). AKI stages 2 and 3 were associated with longer duration of mechanical ventilation (p = 0.008) and increased length of stay in the intensive care unit (p = 0.03). With a miniaturized CPB circuit and bloodless priming, the AKI incidence was well within the range consistent with previously reported studies from other institutions. [ABSTRACT FROM AUTHOR]

In this manuscript we report the establishment and characterization of a three-dimensional in vitro , coculture engineered prostate cancer tissue (EPCaT) disease model based upon and informed by our characterization of in vivo prostate cancer (PCa) xenograft tumor stiffness. In prostate cancer, tissue stiffness is known to impact changes in gene and protein expression, alter therapeutic response, and be positively correlated with an aggressive clinical presentation. To inform an appropriate stiffness range for our in vitro model, PC-3 prostate tumor xenografts were established. Tissue stiffness ranged from 95 to 6,750 Pa. Notably, xenograft cell seeding density significantly impacted tumor stiffness; a two-fold increase in the number of seeded cells not only widened the tissue stiffness range throughout the tumor but also resulted in significant spatial heterogeneity. To fabricate our in vitro EPCaT model, PC-3 castration-resistant prostate cancer cells were co-encapsulated with BJ-5ta fibroblasts within a poly(ethylene glycol)-fibrinogen matrix augmented with excess poly(ethylene glycol)-diacrylate to modulate the matrix mechanical properties. Encapsulated cells temporally remodeled their in vitro microenvironment and enrichment of gene sets associated with tumorigenic progression was observed in response to increased matrix stiffness. Through variation of matrix composition and culture duration, EPCaTs were tuned to mimic the wide range of biomechanical cues provided to PCa cells in vivo ; collectively, a range of 50 to 10,000 Pa was achievable. Markedly, this also encompasses published clinical PCa stiffness data. Overall, this study serves to introduce our bioinspired, tunable EPCaT model and provide the foundation for future PCa progression and drug development studies. The development of cancer models that mimic the native tumor microenvironment (TME) complexities is critical to not only develop effective drugs but also enhance our understanding of disease progression. Here we establish and characterize our 3D in vitro engineered prostate cancer tissue model with tunable matrix stiffness, that is inspired by this study's spatial characterization of in vivo prostate tumor xenograft stiffness. Notably, our model's mimicry of the TME is further augmented by the inclusion of matrix remodeling fibroblasts to introduce cancer-stromal cell-cell interactions. This study addresses a critical unmet need in the field by elucidating the prostate tumor xenograft stiffness range and establishing a foundation for recapitulating the biomechanics of site-of-origin and soft tissue metastatic prostate tumors in vitro. [Display omitted] [ABSTRACT FROM AUTHOR]

Large, complex structures in the maritime sector are often engineered and built to order. Due to the complexity and enormous number of installed components, assemblies and outfitting parts, there is often an abandonment of the complete design of all elements. Especially smaller components such as cables, which complete the product in the outfit, are typical examples. This state of affairs leads to a deficient data situation. Against this background, the coordination and traceability of the installation processes is severely limited. Furthermore, completeness checks and the derivation of essential key figures involve a great deal of downstream effort and are in part not possible. The paper therefore takes up this specific problem and discusses possible solutions. Approaches, which enable an increase in transparency despite the lack of data, minimize these negative effects. Based on the use of Auto-ID, a tracking of the installed components takes place. The feedback of the collected data permits the generation of key figures. Furthermore, the comprehensible process design serves the superordinate coordination of peripheral processes and allows the derivation of necessary action measures. Above all, the expansion of communication between direct and indirect areas during installation is a focus and optimization compared to the status. Based on this, a consistent data stream is the prerequisite for this approach [ABSTRACT FROM AUTHOR]

• Interacting aquatic and terrestrial habitats are defined as turquoise infrastructure. • Multi-habitat graphs are used to measure connectivity. • The impacts of global change on turquoise species are assessed. • Useful information for planning and management is spatialized. Riparian and wetland ecosystems (RWEs) are home to many biphasic species, such as amphibians, whose life cycles require both terrestrial and aquatic habitats. This "turquoise infrastructure" has emerged only recently and, because it is complex, little is known to date about how to evaluate its functionality. This paper presents an innovative graph-based model for assessing the connectivity of composite habitats. The model is applied to amphibians at the migration and dispersal ranges in the Essonne department (France). We evaluate the impacts of recent and future (i.e., planned urbanization and drying-up of water bodies due to climate change) landscape transformations on multi-habitat connectivity for these species. Aquatic and terrestrial habitats jointly contribute significantly to the overall habitat connectivity of biphasic species, and changes in landscape configuration can significantly affect composite habitat networks. We find that past land-cover changes had greater negative impacts than those expected from future urbanization. Conversely, the potential future disappearance of ponds because of, for example, climate change could be far more devastating if more than one in four ponds is lost. Turquoise infrastructure supports species with a biphasic lifestyle and makes their multi-habitat networks resilient to urbanization and climate change. In this context, we argue the multi-habitat models can be used relevantly for enhancing and restoring breeding sites, planning, and designing ecological corridors, and/or establishing new protection areas at the landscape scale. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein (PV) stenosis is an important potential complication of PV isolation using thermal modalities such as radiofrequency ablation (RFA). Pulsed field ablation (PFA) is an alternative energy that causes nonthermal myocardial cell death.Objective: The purpose of this study was to compare the effect of PFA vs RFA on the incidence and severity of PV narrowing or stenosis.Methods: Data were analyzed from 4 paroxysmal atrial fibrillation ablation trials using either PFA or RFA; because of absent CT scans or poor computed tomography scan quality, 73 of 153 patients (47.7%) were excluded. Baseline and 3-month cardiac computed tomography scans were reconstructed into 3-dimensional images, and the long and short axes of the PV ostia were quantitatively and qualitatively assessed in a randomized blinded manner by 2 physicians.Results: A total of 299 PVs from 80 patients after either PFA (n = 37) or RFA (n = 43) were enrolled. PV ostial diameters decreased significantly less with PFA than with RFA (% change; long axis: 0.9% ± 8.5% vs -11.9% ± 16.3%; P < .001 and short axis: 3.4% ± 12.7% vs -12.9% ± 18.5%; P < .001). After a combined quantitative/qualitative analysis, mild (30%-49%), moderate (50%-69%), or severe (70%-100%) PV narrowing was observed, respectively, in 9.0% (15 of 166), 1.8% (3 of 166), and 1.2% (2 of 166) of PVs in the RFA cohort but in none of the PVs after PFA (P < .001). Overall, PV narrowing/stenosis was present in 0% and 0% vs 12.0% and 32.5% of PVs and patients who underwent PFA and RFA, respectively.Conclusion: This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA. [ABSTRACT FROM AUTHOR]

Current adaptation responses to sea-level rise tend to ignore the interplay of adaptation responses and city development, leading to unintended consequences with adverse impacts on citizens' welfare, institutional performance, and economic capacities. This study introduces a generic causal loop diagram (CLD) model, a novel approach exploring the dynamics of coastal adaptation and city development at a city scale. Unveiling key feedback mechanisms—flood risk perception, economic capacity, and trust—reveals their central role in driving negative repercussions, irrespective of the chosen strategy (protection, accommodation, planned relocation). Specifically, fiscal motivations to increase flood exposure and reinforcing dynamics between trust and institutional capacity can significantly impact socioeconomic vulnerabilities. Protection and accommodation may stimulate development in risk areas, while planned relocation faces challenges. However, well-planned relocation offer resource-effective adaptation, mitigating economic and political repercussions through long-term planning. Although the CLD lacks consideration for external drivers and spatial-temporal complexities, it provides crucial insights for coastal adaptation planning. Emphasizing holistic decision-making and multidimensional effects, this research supports informed policy formulation, fostering collaboration between urban planners and flood risk managers for robust and sustainable coastal adaptation pathways. • Development of a causal loop diagram (CLD) for coastal adaptation. • Critical socio-hydrological feedbacks of coastal adaptation and city development. • Unintended consequences of three generic coastal adaptation strategies. • Flood risk perception, economic capacity, and public trust are central. • Fiscal motivations to increase flood exposure notably impact adaptation outcomes. [ABSTRACT FROM AUTHOR]

This is an editorial note for the special issue: Strong User Rights in Fisheries (SURFs). SURFs are rights that constitute a subset of the wider category of rights in fisheries. Being held by the existing operators in the fishery, SURFs may be more acceptable than other fisheries rights. The special issue contains eight (8) papers addressing various issues concerning SURFs such as the theoretical and analytical properties of SURFs, empirical verification of SURF theory, case studies of the impacts of SURFs and challenges to achieve agreements in international fisheries required for the establishment of SURFs. [ABSTRACT FROM AUTHOR]

The manipulation of specific brain oscillations by applying transcranial electrical stimulation techniques in order to enhance memory processes during sleep has become an intriguing field of research. A seminal study found a positive effect of slow-oscillatory transcranial direct current stimulation (so-tDCS) on sleep-dependent consolidation of declarative memories. Since then several studies have tried to replicate this result with inconsistent findings. This study aimed to reexamine effects of so-tDCS on declarative memory observed in young participants based on a previously described stimulation protocol used in elderly subjects. 23 healthy participants (mean ± SD: 23.2 ± 1.9 years; 13 women) completed a word-pair test and a sequential finger tapping test before and after sleep. Participants received anodal so-tDCS bifrontaly at a frequency of 0.75 Hz or sham stimulation during NREM sleep N2, following a double-blind, placebo controlled, counterbalanced, randomized crossover design. Data were analyzed with respect to possible effects of stimulation on memory performances, sleep staging, spindle densities and EEG power in eight frequency bands. Stimulation had no significant effect on sleep dependent memory consolidation or on sleep macro- and microstructure. Independent of stimulation, procedural memory performances increased and declarative memory performances decreased overnight. This decline was less pronounced when participants had more than one learning opportunity. Fast parietal but not slow frontal spindle densities diminished from baseline to stimulation-free intervals under both stimulation conditions. The present study could not reproduce the results of the seminal study in young subjects, but it is consistent with results observed in elderly subjects using the same protocol. Irrespective of stimulation, re-encoding opportunities in the word-pair test had an impact on memory strength and retrieval performance. • So-tDCS has no effect on sleep-dependent memory consolidation, sleep stages, sleep EEG-power, and sleep spindle densities. • In the procedural task, performances showed an overnight increased independent of stimulation. • Word-pair retention decreased independent of stimulation. • Re-encoding opportunities seem to be critical for learning and retrieval performance in declarative memory tasks. • The non-significant results may be explained by a lack of entrainment. [ABSTRACT FROM AUTHOR]

Background: In patients with increased bleeding risk during dual antiplatelet therapy, the biolimus A9-coated BioFreedom, a stainless steel drug-coated stent devoid of polymer, has shown superiority compared to a bare-metal stent. The aim of this study was to investigate whether the polymer-free biolimus A9-coated BioFreedom is noninferior to a modern thin-strut biodegradable polymer cobalt-chromium sirolimus-eluting Orsiro stent in an all-comers patient population treated with percutaneous coronary intervention.Methods: The multicenter SORT OUT IX trial (NCT02623140) randomly assigned all-comers patients to treatment with the BioFreedom drug-coated stent or the biodegradable polymer Orsiro stent in 4 Danish University Hospitals. The primary end point target lesion failure is a composite of cardiac death, myocardial infarction (not related to other than index lesion), or target lesion revascularization within 12 months. Clinically driven event detection based on Danish registries will be used and continue through 5 years. Assuming an event rate of 4.2% in each stent group, 1,563 patients in each treatment arm will provide 90% power to detect noninferiority of the drug-coated BioFreedom stent with a noninferiority margin of 2.1%.Results: A total of 3,150 patients have been randomized and enrolled in the study.Conclusions: The SORT OUT IX trial will determine whether the drug-coated BioFreedom stent is noninferior to a modern biodegradable polymer Orsiro stent. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of this study was to compare the thin-strut biodegradable-polymer everolimus-eluting platinum-chromium stent (EES) with the biodegradable-polymer biolimus-eluting stainless-steel stent (BES). Background Currently available drug-eluting coronary stents have been refined to reduce the risk for coronary events following implantation. Methods This randomized, multicenter, all-comers, noninferiority trial was undertaken at 3 sites in western Denmark. Patients with clinical indications for percutaneous coronary intervention were eligible for inclusion. Patients were randomly assigned (1:1) to either EES or BES. The primary endpoint, target lesion failure, was a composite of safety (cardiac death and myocardial infarction not clearly attributable to a nontarget lesion) and efficacy (target lesion revascularization) at 12 months, analyzed using intention-to-treat principles. The trial was powered to assess target lesion failure noninferiority of the EES compared with the BES with a predetermined noninferiority margin of 3%. Results A total of 1,385 patients were assigned to treatment with EES and 1,369 patients to treatment with BES. The analysis showed that 55 patients (4.0%) assigned to the EES and 60 (4.4%) assigned to the BES met the primary endpoint (absolute risk difference 0.4%; upper limit of 1-sided 95% confidence interval: 1.7%; p < 0.001). Conclusions At 1-year follow-up, the EES was found to be noninferior to the BES with respect to target lesion failure. (Everolimus-eluting SYNERGY Stent Versus Biolimus-Eluting Biomatrix NeoFlex Stent—SORT-OUT VIII; NCT02093845) Central Illustration [ABSTRACT FROM AUTHOR]

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Background: Current guidelines on the use of β-blockers in post-acute myocardial infarction (MI) patients without reduced left ventricular ejection fraction (LVEF) are based on studies before the implementation of modern reperfusion and secondary prevention therapies. It remains unknown whether β-blockers will reduce mortality and recurrent MI in contemporary revascularized post-MI patients without reduced LVEF.Design: BETAMI is a prospective, randomized, open, blinded end point multicenter study in 10,000 MI patients designed to test the superiority of oral β-blocker therapy compared to no β-blocker therapy. Patients with LVEF ≥40% following treatment with percutaneous coronary intervention or thrombolysis and/or no clinical signs of heart failure are eligible to participate. The primary end point is a composite of all-cause mortality or recurrent MI obtained from national registries over a mean follow-up period of 3 years. Safety end points include rates of nonfatal MI, all-cause mortality, ventricular arrhythmias, and hospitalizations for heart failure obtained from hospital medical records 30 days after randomization, and from national registries after 6 and 18 months. Key secondary end points include recurrent MI, heart failure, cardiovascular and all-cause mortality, and clinical outcomes linked to β-blocker therapy including drug adherence, adverse effects, cardiovascular risk factors, psychosocial factors, and health economy. Statistical analyses will be conducted according to the intention-to-treat principle. A prespecified per-protocol analysis (patients truly on β-blockers or not) will also be conducted.Conclusions: The results from the BETAMI trial may have the potential of changing current clinical practice for treatment with β-blockers following MI in patients without reduced LVEF. EudraCT number 2018-000590-75. [ABSTRACT FROM AUTHOR]

Purpose: Purpose of this paper is to describe the project design for the development of a context-specific and patient-focused integrative care programme for an intensive care unit for paediatric oncology to ease the strain of the treatments for patients and their families. Integrative care interventions based on anthroposophical medicine such as wraps, compresses and rhythmic body oiling can be used to ease typical side effects such as nausea, pain and agitation.Methods: Conduct of a literature research on existing integrative care programmes in medical hospitals and biomedical settings and the identification of appropriate methods to achieve the research aim.Results: A project design was developed which can be used as a basis for developing, introducing and evaluating an integrative care programme for a paediatric oncological intensive care unit in a German university hospital. A qualitative study design was chosen to develop this programme. This included participant observations and interviews with all stakeholders at the respective oncology ward as well as in existing oncology wards that work with an integrative care programme. The primary emphasis was on the criteria appropriateness for the specific setting, sustainability and financial viability as well as on the development of an appropriate evaluation model.Conclusions: When developing an integrative care programme for use in the specific setting of a paediatric oncology ward and selecting the appropriate interventions for inclusion in the programme, particular attention should be paid to the needs of the patients as well as to the practicability for the nursing staff, particularly with regard to resources such as time and personnel. Both the nursing team and nursing management should be actively involved in the project design from the outset. In the evaluation particular importance is attached to feasibility. The challenge for the economic evaluation is to create a robust database for negotiation of financing possibilities. [ABSTRACT FROM AUTHOR]

Background: Anteroseptal ST elevation myocardial infarction (STEMI) is traditionally defined on the electrocardiogram (ECG) by ST elevation (STE) in leads V1-V3, with or without involvement of lead V4. It is commonly taught that such infarcts affect the basal anteroseptal myocardial segment. While there are suggestions in the literature that Q waves limited to V1-V4 represent predominantly apical infarction, none have evaluated anteroseptal ST elevation territories. We compared the distribution of the myocardium at risk (MaR) in STEMI patients presenting with STE limited to V1-V4 and those with more extensive STE (V1-V6).Methods: We identified patients in the MITOCARE study presenting with a first acute STEMI and new STE in at least two contiguous anterior leads from V1 to V6. Patients underwent cardiac magnetic resonance (CMR) imaging three to five days after acute infarction.Results: Thirty-two patients met inclusion criteria. In patients with STE in V1-V4 (n = 20), myocardium at risk (MaR) > 50% was seen in 0%, 85%, 75%, 100%, and 90% in the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. The group with STE in V1-V6 (n = 12), MaR > 50% was seen in 8%, 83%, 83%, 92%, and 83% of the same segments.Conclusions: Patients with acute STEMI and STE in leads V1-V4, exhibit MaR in predominantly apical territories and rarely in the basal anteroseptum. We found no evidence to support existence of isolated basal anteroseptal or septal STEMI. "Anteroapical" infarction is a more precise description than "anteroseptal" infarction for acute STEMI patients exhibiting STE in V1-V4. [ABSTRACT FROM AUTHOR]

The Coolidge effect is a well-known phenomenon in the behavioral sciences. It was first observed in several different mammals and refers to the decline in the sexual interest of males over the course of repeated encounters with the same female, coupled with renewed interest in a novel female introduced when the male no longer shows any desire to mate with the original female. Among a handful of other invertebrates, this effect has also been described for burying beetles ( Nicrophorus vespilloides Herbst) based on lab observations of males and females in small containers without access to carrion. In the field, the only repeat encounters between males and females occur on carcasses, which can be utilized as food or buried for reproduction. In the present study, we placed dead mice in the field to investigate how often natural breeding groups include males and several females. We found that many breeding groups in the field satisfy this condition necessary for a Coolidge effect. In addition, we used direct observations of undisturbed breeding assemblages in the lab to assess whether males really exhibit the Coolidge effect in a more natural context, when they are engaged in burying and preparing a carcass. Since males encounter dominant and subordinate females at different rates, we compared how often successive encounters and matings occurred with the same female, which revealed that males in these undisturbed breeding groups actively avoid mating with the same female twice in succession. This shows that the Coolidge effect is not a laboratory artefact, but is part of the natural repertoire of behaviors in male burying beetles. [ABSTRACT FROM AUTHOR]

Background: In traditional literature, it appears that "anteroseptal" MIs with Q waves in V1-V3 involve basal anteroseptal segments although studies have questioned this belief.Methods: We studied patients with first acute anterior Q-wave (>30ms) MI. All underwent late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI).Results: Those with Q waves in V1-V2 (n=7) evidenced LGE >50% in 0%, 43%, 43%, 57%, and 29% of the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. Patients with Q waves in V1-V3 (n=14), evidenced involvement was 14%, 43%, 43%, 50%, and 7% of the same respective segments. In those with extensive anterior Q waves (n=7), involvement was 0%, 71%, 57%, 86%, and 86%.Conclusions: Q-wave MI in V1-V2/V3 primarily involves mid- and apical anterior and anteroseptal segments rather than basal segments. Data do not support existence of isolated basal anteroseptal or septal infarction. "Anteroapical infarction" is a more appropriate term than "anteroseptal infarction." [ABSTRACT FROM AUTHOR]

Background: Terminal "QRS distortion" on the electrocardiogram (ECG) (based on Sclarovsky-Birnbaum's Grades of Ischemia Score) is a sign of severe ischemia, associated with adverse cardiovascular outcome in ST-segment elevation myocardial infarction (STEMI). In addition, ECG indices of the acuteness of ischemia (based on Anderson-Wilkins Acuteness Score) indicate myocardial salvage potential. We assessed whether severe ischemia with or without acute ischemia is predictive of infarct size (IS), myocardial salvage index (MSI) and left ventricular ejection fraction (LVEF) in anterior versus inferior infarct locations.Methods: In STEMI patients, the severity and acuteness scores were obtained from the admission ECG. Based on the ECG patients were assigned with severe or non-severe ischemia and acute or non-acute ischemia. Cardiac magnetic resonance (CMR) was performed 2-6days after primary percutaneous coronary intervention (pPCI). LVEF was measured by echocardiography 30days after pPCI.Results: ECG analysis of 85 patients with available CMR resulted in 20 (23%) cases with severe and non-acute ischemia, 43 (51%) with non-severe and non-acute ischemia, 17 (20%) with non-severe and acute ischemia, and 5 (6%) patients with severe and acute ischemia. In patients with anterior STEMI (n=35), ECG measures of severity and acuteness of ischemia identified significant and stepwise differences in myocardial damage and function. Patients with severe and non-acute ischemia had the largest IS, smallest MSI and lowest LVEF. In contrast, no difference was observed in patients with inferior STEMI (n=50).Conclusions: The applicability of ECG indices of severity and acuteness of myocardial ischemia to estimate myocardial damage and salvage potential in STEMI patients treated with pPCI, is confined to anterior myocardial infarction. [ABSTRACT FROM AUTHOR]

Introduction: The myocardium at risk (MaR) represents the quantitative ischemic area destined to myocardial infarction (MI) if no reperfusion therapy is initiated. Different ECG scores for MaR have been developed, but there is no consensus as to which should be preferred.Objective: Comparisons of ECG scores and Cardiac Magnetic Resonance (CMR) for determining MaR.Methods: MaR was determined by 3 different ECG scores, and by CMR in ST-segment elevation MI (STEMI) patients from the MITOCARE cardioprotection trial. The Aldrich score (AL) is based on the number of leads with ST-elevation for anterior MI and the sum of ST-segment elevation for inferior MI on the admission ECG. The van Hellemond score (VH) considers both the ischemic and infarcted component of the MaR by adding the AL and the QRS score, which is an estimate of final infarct size. The Hasche score is based on the maximal possible infarct size determined from the QRS score on the baseline ECG.Results: Ninety-eight patients (85% male, mean age 61years) met STEMI criteria on their admission ECG and underwent CMR within 3-5days after STEMI. Mean MaR by CMR was 41.2±10.2 and 30.3±7.2 for anterior and inferior infarcts, respectively. For both anterior and inferior infarcts the Aldrich (18.2±5.1 and 18.6±6.0) and Hasche (25.3±9.8 and 26.4±8.8) scores significantly underestimated MaR compared to MaR measured by CMR. In contrast, MaR by the van Hellemond score (37.0±14.2 and 31.7±12.8) was comparable to CMR.Conclusion: We tested the performance of the electrocardiographic estimation of myocardium area at risk by Aldrich, Hasche and van Hellemond ECG scores in comparison to MaR measured by CMR in STEMI patients. MaR by the van Hellemond score and CMR were comparable, while Aldrich and Hasche underestimated MaR. [ABSTRACT FROM AUTHOR]

Objective To review current risk factors for lung cancer, identify screening and early detection guidelines while describing new approaches that use genomic technologies. Data Sources Published scientific literature, clinical literature, and published lung cancer screening guidelines from the United States and Canada. Conclusion Nurses are caring for lung cancer patients who, historically, do not live for long periods after diagnosis. Research is revealing promising screening methodologies that can detect lung cancer 1 to 4 years earlier than the current approaches. Implications for Nursing Practice Current knowledge about screening for lung cancer is a vital tool for nurses working with persons at high risk for this potentially aggressive and life-threatening malignancy. While old methods remain the standard of care, new detection methods use a variety of genomic-based technologies. These developing approaches emphasize the need for nurses at all levels of practice to have a working knowledge of genetics to educate patients and conference with colleagues. [ABSTRACT FROM AUTHOR]

This paper explores the effect of the perceived risk of the Swedish people of Covid-19 on daily auctioned shrimp prices from the start of the pandemic to the end of the year 2021. This topic is of interest to see whether the government intervention in the shrimp market to aid fishers with possible losses was justified. The Swedish shrimp fishery was for a long time managed by Regulated Open Access, but in January 1, 2017, it was transformed to a Strong User Rights Fishery by the introduction of Individual Transferable Quotas (ITQs). We use empirical data from the period from 2018 to 2021. We find that auction prices were negatively affected by covid-19 cases by SEK 19.83/kg (−9.37%), and that fishers have suffered a loss of SEK 21.5 million. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of the Patient Education Programme Parkinson (PEPP) in patients with Parkinson’s disease (PD) in a randomized controlled trial and its sustainability after a 3-month follow-up. Methods Thirty-nine patients were allocated to the intervention group and participated in the 8-week PEPP. Thirty-four patients were assigned to the control group undergoing routine neurological care. Primary outcome was the Parkinson’s disease quality of life questionnaire (PDQ-39) measured at baseline, directly after the programme and at 3-month follow-up. Secondary outcomes assessed coping behavior, psychosocial strain, health-related quality of life (HrQoL), sense of coherence, self-efficacy, anxiety and depression. Results A significant effect for the intervention group on the PDQ-39 ( p = .001) and on the active problem-oriented coping subscale of the Freiburg Coping with disease questionnaire ( p = .027) was found at 3-month follow-up. Conclusion In this study the PEPP improved disease-specific HrQoL and helped patients to cope with the disease. [ABSTRACT FROM AUTHOR]

Sediment deposition changes the physical characteristics of river beds, and may alter the production and/or processing of allochthonous and autochthonous organic matter, with potential consequences for stream food webs. We conducted a comparative study of biofilm standing crop and metabolism in the Salmon Trout River, a tributary of Lake Superior where watershed disturbances have led to 3-fold increases in streambed fine sediments, predominately sand, in the past decade. We compared biofilm standing crop and metabolism rates using light–dark chambers in reaches where substrate consisted of predominately exposed rock or sand substrates. Biofilm chlorophyll a was 4.2-fold greater on rock substrates, but ash-free dry mass was 8-fold greater on sand substrates. Rates of gross primary production were 2 to 25-fold greater on rock versus sand substrates, and differences persisted whether rates were scaled for area or biofilm standing crop. In contrast, rates of respiration were similar on rock and sand substrates when scaled per unit area but 7–13 times lower on sand when scaled for biofilm standing crop. Together, these results suggest that sand aggradation in this river alters organic matter processing during the summer from net production to net consumption and storage of organic matter. Sand aggradation may alter the availability and processing of both allochthonous and autochthonous food resources in this forested river, with potential far-reaching impacts on the food web. [ABSTRACT FROM AUTHOR]

Background In elderly patients with HER2-positive breast cancer, few data on efficacy and toxicity of adjuvant trastuzumab treatment exists since older patients were in general excluded from large randomized studies. This prospective observational study aimed to confirm the beneficial findings from pivotal trials in age cohorts ≥ 65 years. Materials and Methods There were no restrictions for recruitment with respect to age or concomitant/sequential adjuvant medication. Long-term relapse/survival status of the patients was assessed once a year. Results Among the 3940 evaluable patients enrolled between 2006 and 2012 at 339 institutions, 507 were aged between 65 and 69 years, with another 507 patients ≥ 70 years. Elderly patients suffered from significantly more advanced primary tumors. Preceding or concomitant chemotherapy showed decreasing aggressiveness with patient's age. Trastuzumab treatment was stopped prematurely in only 11% of the elderly, but more often than in younger patients ( p = 0.0008). With 453 events hitherto reported, elderly patients did not exhibit an inferior relapse-free survival when adjusted for other relevant prognostic factors (hazard ratio: 1.01 per year; p = 0.24). Three-year overall survival was significantly lower in the population older than 64 years than in younger patients (94.2% vs. 96.8%, p = 0.0011). Conclusions To our knowledge, our population of elderly patients treated with adjuvant trastuzumab is the largest analyzed so far. The beneficial long-term results were comparable to those in the younger cohorts. Although the risk of cardiotoxicity increased significantly with age, it also remained manageable in older patients. Thus, chronological age alone should not preclude HER2 antibody treatment. [ABSTRACT FROM AUTHOR]

Background: Third-generation coronary drug-eluting stents (DES) with biodegradable polymers have been designed to improve safety and efficacy. We designed a large scale registry-based randomized clinical trial to compare 2 third-generation DES: a thin strut, cobalt-chromium DES with silicon carbide-coating releasing sirolimus from a biodegradable polymer (O-SES, Orsiro; Biotronik, Bülach, Switzerland) with the stainless steel biodegradable polymer biolimus-eluting Nobori stents (N-BES, Nobori; Terumo, Tokyo, Japan) in an all-comer patient population.Design: The multicenter SORT OUT VII trial (NCT01879358) randomly assigned 2,530 patients to treatment with biodegradable polymer O-SES or biodegradable polymer N-BES at 3 sites in Western Denmark. Patients were eligible, if they were ≥18 years old; had chronic stable coronary artery disease or acute coronary syndromes; and ≥1 coronary lesion with >50% diameter stenosis, requiring treatment with a DES. The primary end point target lesion failure is a composite of cardiac death, myocardial infarction (not related to other than index lesion), or target lesion revascularization within 12 months. Clinically, driven event detection based on Danish registries will be used. An event rate of 6.5% is assumed in each stent group. With a sample size of 1,157 patients in each treatment arm, a 2-group large-sample normal approximation test of proportions with a 1-sided 5% significance level will have 90% power to detect noninferiority of the O-SES compared with the N-BES with a predetermined noninferiority margin of 3.0%.Conclusion: The SORT OUT VII trial will determine whether the biodegradable polymers O-SES is noninferior to the N-BES with respect to driven event. [ABSTRACT FROM AUTHOR]

Background Third-generation coronary drug-eluting stents (DES) with biodegradable polymers have been designed to improve safety and efficacy. We designed a large scale registry-based randomized clinical trial to compare 2 third-generation DES: a thin strut, cobalt-chromium DES with silicon carbide-coating releasing sirolimus from a biodegradable polymer (O-SES, Orsiro; Biotronik, Bülach, Switzerland) with the stainless steel biodegradable polymer biolimus-eluting Nobori stents (N-BES, Nobori; Terumo, Tokyo, Japan) in an all-comer patient population. Design The multicenter SORT OUT VII trial (NCT01879358) randomly assigned 2,530 patients to treatment with biodegradable polymer O-SES or biodegradable polymer N-BES at 3 sites in Western Denmark. Patients were eligible, if they were ≥18 years old; had chronic stable coronary artery disease or acute coronary syndromes; and ≥1 coronary lesion with >50% diameter stenosis, requiring treatment with a DES. The primary end point target lesion failure is a composite of cardiac death, myocardial infarction (not related to other than index lesion), or target lesion revascularization within 12 months. Clinically, driven event detection based on Danish registries will be used. An event rate of 6.5% is assumed in each stent group. With a sample size of 1,157 patients in each treatment arm, a 2-group large-sample normal approximation test of proportions with a 1-sided 5% significance level will have 90% power to detect noninferiority of the O-SES compared with the N-BES with a predetermined noninferiority margin of 3.0%. Conclusion The SORT OUT VII trial will determine whether the biodegradable polymers O-SES is noninferior to the N-BES with respect to driven event. [ABSTRACT FROM AUTHOR]

Objective To analyze the prevalence of juvenile idiopathic arthritis (JIA) and diabetes end points in pediatric patients with type 1 diabetes. Study design Patients with type 1 diabetes, recorded from 1995 up to September 2013 in the Diabetes Patienten Verlaufsdokumentation database (n = 54?911, <16 years of age, 47% girls), were analyzed. The patients' height, weight, and body mass index SDS, glycosylated hemoglobin A1c (HbA1c); insulin dose; hypertension and dyslipidemia prevalence; rate of hypoglycemic events; and ketoacidosis were compared between patients with and without JIA. To adjust for age, sex, diabetes duration, and migration background, data were analyzed in hierarchic multivariable regression models. Results The prevalence of JIA in type 1 diabetes was 106 of 54?911 patients; 66% were girls. Diabetes onset was earlier in children with JIA (7.2 years vs 8.3 years, P = .04). Children with JIA were smaller (SDS: -0.22 vs 0.09, P = .004). Correspondingly, weight SDS was lower in patients with JIA (-0.02 vs 0.22, P = .01). Body mass index SDS did not differ. HbA1c was marginally lower in children with JIA (63 mmol/mol [8.0%] vs 67 mmol/mol [8.3%], P = .06). Insulin requirement was greater in patients with JIA (1.03 vs 0.93 insulin units/weight/day, P = .003). Hypertension and dyslipidemia were comparable in both groups. Conclusions The JIA-prevalence in patients with type 1 diabetes (0.19%) was considerably greater than in the general population (0.05%). Growth is influenced negatively by JIA. Surprisingly, HbA1c was somewhat lower in children with JIA, possibly because of a more intensive treatment or a latent hemolysis caused by the inflammation. [ABSTRACT FROM AUTHOR]

The present study aims at providing an improved understanding of the environmental factors affecting pro-environmental behavior. To this end, we introduce the economic concept of bounded rationality to the domain of recycling behavior, hypothesizing that the subjective costs of recycling are a better predictor of an individual's tendency to recycle than the objective costs. At the chosen study site, recyclables needed to be disposed of at collection centers distributed throughout the city, allowing for the analysis of recycling-related costs by assessing the distance between participants’ residence and the nearest collection center. Results from an online questionnaire completed by N = 306 citizens indicate that the perceived distance to the recycling facilities is more closely related to recycling behavior than the actual distance. By means of hierarchical regression analyses, we demonstrate that the perceived distance explains unique variance in recycling behavior while the actual distance conveys only redundant information. Surprisingly, the predictive potential of participants’ distance estimates appeared to be significantly larger for recycling behavior than for recycling intention. The implications of our results are discussed with regard to potential opportunities to promote recycling behavior by targeting individuals’ biased perception of recycling-related costs. [ABSTRACT FROM AUTHOR]

Abstract: A commonly observed intensity modulation or “beating” in laser velocimetry (VISAR) data is examined and explained. It is found that internal target reflections between two surfaces moving relative to one another produces this intensity modulation in the VISAR steak record. The two partially reflecting surfaces define a Fabry–Perot cavity that creates an intensity interference pattern that is superimposed upon VISAR measurements. Experiments are conducted that demonstrate this phenomenon. Previous VISAR experiments that observe this beating pattern are presented and explained. [Copyright &y& Elsevier]

Abstract: Background: Studies in young healthy volunteers provided evidence of a beneficial impact of an anodal time-varied transcranial direct current stimulation (tDCS) during early slow wave rich sleep on declarative memory but not on procedural memory. Objective/hypothesis: The present study investigated whether sleep-dependent memory consolidation can also be affected by slow oscillating tDCS in a population of elderly subjects. Methods: 26 subjects (69.1 years ± 7.7 years) received bi-frontal anodal stimulation (max. current density: 0.331 mA/cm2) during early NREM sleep in a double-blind placebo-controlled randomized crossover study. Stimulation effects on offline consolidation were tested by using a declarative and a procedural memory task. Furthermore, sleep stages were scored, EEG power was analyzed and spindle densities were assessed. Results: Independently from stimulation condition, performance in both memory tasks significantly decreased overnight. Stimulation revealed no significant effect on sleep-dependent memory consolidation. Verum tDCS was accompanied by significantly more time awake and significantly less NREM stage 3 sleep during five 1-min stimulation free intervals. Conclusions: The results of the present study are in line with other studies showing that offline consolidation during sleep varies with age and is less pronounced in the elderly than in young or middle-aged subjects. Contrary to an almost identical positive study in young adults, slow oscillatory tDCS applied to the elderly failed to show a beneficial effect on memory consolidation in the present study. [Copyright &y& Elsevier]

Objectives: To describe the impact of genetics and genomics on the biology of cancer and the implications for patient care. Data Sources: Pubmed; CINAHL. Conclusions: Cancer research in genetics/genomics has identified new mechanisms influencing personalized risk assessment/management, early detection, cancer treatment, and long-term screening/surveillance. Implications for Nursing Practice: Understanding the basics of genetics/genomics on the biology of cancer will facilitate patient education and care delivery, including the administration and monitoring of genetically targeted therapies whose toxicities may in part be mediated by the molecular pathways targeted by the specific agent. [Copyright &y& Elsevier]

Abstract: The potential emergence of an ocean mining industry to exploit seafloor massive sulfides could present opportunities for oceanographic science to facilitate seafloor mineral development in ways that lessen environmental harms. [Copyright &y& Elsevier]

Background: Imiquimod 5% cream is approved as a 16-week regimen for the treatment of actinic keratoses involving a 25-cm2 area of skin. Objective: We sought to evaluate imiquimod 2.5% and 3.75% creams for short-course treatment of the entire face and scalp. Methods: In two identical studies, adults with 5 to 20 lesions were randomized to placebo, or imiquimod 2.5% or 3.75% cream (1:1:1). Up to two packets (250 mg each) were applied per dose once daily for two 3-week treatment cycles, with a 3-week, no-treatment interval. Efficacy was assessed at 8 weeks posttreatment. Results: In all, 490 subjects were randomized to placebo, or imiquimod 2.5% or 3.75% cream. Median baseline lesion counts for the treatment groups were 9 to 10. Complete and partial clearance rates were 5.5% and 12.8% for placebo, 25.0% and 42.7% for imiquimod 2.5%, and 34.0% and 53.7% for imiquimod 3.75% (P < .001, each imiquimod vs placebo; P = .034, 3.75% vs 2.5% for partial clearance). Median reductions from baseline in lesion count were 23.6%, 66.7%, and 80.0% for the placebo, imiquimod 2.5%, and imiquimod 3.75% groups, respectively (P < .001 each imiquimod vs placebo). There were few treatment-related discontinuations. Temporary treatment interruption (rest) rates were 0%, 17.1%, and 27.2% for the placebo, imiquimod 2.5%, and imiquimod 3.75%, respectively. Limitations: Local effects of imiquimod, including erythema, may have led to investigator and subject bias. Conclusions: Both imiquimod 2.5% and 3.75% creams were more effective than placebo and had an acceptable safety profile when administered daily as a 3-week on/off/on regimen. [Copyright &y& Elsevier]

Abstract: The marine environment provides many goods and services that depend on the quality of coastal waters. In this paper, we represent water quality by three different attributes, coastal cod stock level, bathing water quality, and biodiversity level, and carry out a choice experiment among residents on the Swedish west coast to estimate the economic benefits of improved coastal water quality. We find that respondents have high levels of environmental concern and that substantial values are at stake. The highest values were placed on preventing further depletion of marine biodiversity and to improve Swedish cod stocks. [Copyright &y& Elsevier]

Abstract: Internationally, individual vessel quotas (IVQ) have become an increasingly popular management tool. The main attraction of IVQs is the incentives they create for cost savings, autonomous capacity adjustment and, subsequently, rent generation. In this paper, the extent to which different IVQ systems have facilitated resource rent generation and capacity adjustment in five European countries—Denmark, Iceland, Norway, Sweden and the UK—is examined. The potential economic rents and the capacity reduction necessary to achieve these rents in each of the fisheries are also estimated. Reasons why IVQs have not achieved their potential economic benefits in these fisheries are also examined. [Copyright &y& Elsevier]

Objective: To test the hypothesis that 1-desamino-8-D-arginine vasopressin (dDAVP) has an effect on prepulse inhibition (PPI) of startle in patients with primary monosymptomatic enuresis (PME), thus indicating a central effect. Study design: Patients with PME (n = 21, age 6 to 12 years) were enrolled in a prospective, randomized, double-blinded, cross-over study. Startle reflexes and PPI were measured under dDAVP treatment versus placebo. Results: The data show that dDAVP has a significant effect on PPI, raising it from 38.88% under placebo to the age-related normal level of 62.6% with dDAVP treatment (P = .0127). Conclusions: Our findings revive the concept of a central pathophysiology of PME and offer a different explanation for the effects of dDAVP, which not only acts on the kidney, but also is (as is AVP) a central neurotransmitter with a signal cascade on relevant reflex mechanisms. [Copyright &y& Elsevier]

Summary: Background & aim: Nutritional status frequently deteriorates during chemotherapy in cancer. This is associated with a poor outcome. Since creatine supplementation has shown promising results in various diseases, we investigated the effects of creatine on nutritional status in patients with colorectal cancer undergoing chemotherapy. Methods: Thirty patients with colorectal cancer undergoing chemotherapy were randomised to receive either creatine () or placebo () for 8 weeks. Body composition was determined with bioelectrical impedance analysis; muscle function by hand grip, hip flexion and knee extension strength and quality of life (QoL) was assessed by the QLQ30 questionnaire. Results: Neither muscle function, body cell mass (BCM) nor QoL improved, but phase angle, a marker of BCM and cell integrity, increased significantly in the intervention patients (5.3±0.3° to 5.4±0.2°, ). Evaluating patients with different chemotherapy regimens, however, only intervention patients undergoing less aggressive chemotherapy were shown to benefit, increasing phase angle (5.11±0.22° to 5.51±0.30°, ) as well as BCM (27.22±2.85 to 29.60±3.54kg, ). Conclusion: Creatine failed to improve muscle mass or function and QoL in colorectal cancer patients but improved bioimpedance parameters that are predictive of poor outcome. Creatine might therefore be useful in patients with milder chemotherapy in order to maintain or increase BCM whereas patients undergoing aggressive chemotherapy however are not likely to benefit. [Copyright &y& Elsevier]

The results from a survey of Swedish commercial fishers on regulation compliance and attitudes to control and restrictions are reported. According to the responding fishers, 90% of all Swedish catches are reported, in spite of limited control efforts. From an economic perspective we would expect substantially lower levels of compliance. The results also show that the majority of Swedish fishers are in favour of co-management on a regional basis. However, on this and other management issues opinions divert significantly between large vessel operators and small vessel operators, which reveals conflicting interests for such and similar changes in Swedish management of fisheries. [Copyright &y& Elsevier]

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: Rationale and ObjectivesNear-infrared diffuse optical imaging may offer enhanced contrast resolution over that of the existing technologies for detection and diagnosis of breast cancer. The authors report quantitative absorption and scattering images of the human breast with model-based reconstruction methods using near-infrared continuous-wave tomographic data.: Materials and MethodsAn automatic, multichannel optical imaging system was used to image the breasts of nine women: four with infiltrating ductal carcinomas, one with infiltrating lobular carcinoma, one with fibroadenoma, and three control subjects with no breast lesion. The image reconstruction methods are centered on the finite element solution of photon diffusion in breast tissue.: ResultsSubstantial contrast between tumor and adjacent parenchyma was observed. Images of the control subjects showed homogeneous optical features. In the six women with breast lesions, the locations and sizes of tumors imaged optically were accurate and consistent with the mammographic findings.: ConclusionThe results of this pilot study show that cancers as small as 5 mm can be quantitatively imaged. In addition, preliminary data from the scattering images suggest that benign and malignant tumors can be noninvasively differentiated with optical imaging. [Copyright &y& Elsevier]

Purpose: Children and adolescents undergoing treatment for cancer are exposed to a wide variety of stressors both physical and mental. Not only adults but also children and adolescents increasingly practice yoga in a health-promoting manner and to cope with stressful situations.Methods: A review of literature was conducted to present the current outcomes on yoga, meditation and mindfulness for children and adolescents who are affected by an oncological disease.Results: Eight studies were identified that examined yoga treatment for children and adolescents with oncological diseases. Three studies were found on mindfulness in pediatric oncology. The studies summarized here suggest that yoga and mindfulness could help to improve quality of life, reduce fatigue, improve activity and fitness levels, improve sleep quality, increase appetite and decrease anxiety in various stages of the disease and its treatment. The reviewed studies showed that yoga and mindfulness-based interventions for children and adolescents with oncological illnesses are feasible in different settings and are well received.Conclusions: The results of the studies suggest that yoga and mindfulness may help to support children and adolescents during and after oncological treatment. Based on the current body of evidence it is not possible to draw conclusions about the efficacy of yoga and mindfulness-based interventions in pediatric oncology patients. Research must meet this challenge to develop suitable designs to further and better investigate the effects of yoga and mindfulness in children and adolescents with oncological diseases. [ABSTRACT FROM AUTHOR]