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The cause of Crohn's disease (CD) is unknown, but the current hypothesis is that microbial or environmental factors induce gut inflammation in genetically susceptible individuals, leading to chronic intestinal inflammation. Case-control studies of patients with CD have cataloged alterations in the gut microbiome composition; however, these studies fail to distinguish whether the altered gut microbiome composition is associated with initiation of CD or is the result of inflammation or drug treatment. In this prospective cohort study, 3483 healthy first-degree relatives (FDRs) of patients with CD were recruited to identify the gut microbiome composition that precedes the onset of CD and to what extent this composition predicts the risk of developing CD. We applied a machine learning approach to the analysis of the gut microbiome composition (based on 16S ribosomal RNA sequencing) to define a microbial signature that associates with future development of CD. The performance of the model was assessed in an independent validation cohort. In the validation cohort, the microbiome risk score (MRS) model yielded a hazard ratio of 2.24 (95% confidence interval, 1.03-4.84; P =.04), using the median of the MRS from the discovery cohort as the threshold. The MRS demonstrated a temporal validity by capturing individuals that developed CD up to 5 years before disease onset (area under the curve > 0.65). The 5 most important taxa contributing to the MRS included Ruminococcus torques , Blautia , Colidextribacter , an uncultured genus-level group from Oscillospiraceae , and Roseburia. This study is the first to demonstrate that gut microbiome composition is associated with future onset of CD and suggests that gut microbiome is a contributor in the pathogenesis of CD. Gut microbiome composition, function, and stool metabolites can identify those more likely to develop Crohn's disease in a cohort of healthy first-degree relatives of patients with Crohn's disease. [ABSTRACT FROM AUTHOR]

• The utility of telehealth services for lipid management remains understudied. • Telehealth has had a positive to neutral impact on improving lipid metrics. • Facilitators to telehealth include multidisciplinary care and patient-centeredness. • Technology dexterity and clinician reimbursement remain major barriers to telehealth. • Future interventions should emphasize a hybrid model of patient-centered care. Telehealth services have been implemented to deliver care for patients living with many chronic conditions and have expanded greatly during the COVID-19 pandemic. Little is known about the current or future impacts of telehealth on lipid management practices. The PubMed database was searched from inception to June 25, 2021, with the keywords "lipids or cholesterol" and "telehealth," which yielded 376 published articles. Telehealth was defined as a synchronous visit between a patient and clinician that replaced an in-office appointment. Studies that solely used remote monitoring, mobile health technologies, or callbacks of results, were excluded. Articles must have measured lipid values. Review articles and protocol papers were not included. After evaluation, 128 abstracts were included for full text evaluation, with 55 full-text articles eventually included. Of the articles, 29 were randomized clinical trials, 15 were pre-post evaluations, and 11 were other study designs. Telehealth had positive to neutral impacts on lipid management. Reported facilitators include easier implementation of multidisciplinary approaches to care, and utilization of patient-centered programs. Reported barriers to telehealth services include technological barriers, such as various skill levels with technology; systems barriers, such as cost and reimbursement; patient-related barriers, including patient non-adherence; and clinician-related barriers, such as difficulty standardizing care. Clinicians reported improved satisfaction among patients but had mixed feelings regarding their ability to deliver quality care. Telemedicine use to provide care for individuals with lipid conditions has expanded during the COVID-19 pandemic, but more research is needed to determine its potential as a sustainable tool for lipid management. [ABSTRACT FROM AUTHOR]

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A scoping study was performed for chlorinating dross formed during uranium casting operations. The purpose is to minimize the losses of uranium to dross wastes. The dross is primarily a mixture of uranium metal and uranium oxide with a minor fraction of crucible and crucible coating materials. The reaction chemistries were performed in a carrier salt of LiCl-KCl eutectic at 500 °C. The addition of FeCl 2 chlorinated the uranium metal to UCl 3 , by reducing the FeCl 2 to iron metal. After the uranium metal was chlorinated, zirconium metal was added to the salt. The residual FeCl 2 chlorinated the zirconium metal to ZrCl 4 , by reducing the FeCl 2 to iron metal. In turn, the ZrCl 4 chlorinated the uranium oxide to UCl 3 , by converting the ZrCl 4 to zirconium oxide. The effectiveness of the chlorination reactions was qualitatively verified by cyclic voltammograms that indicated the presence or absence of FeCl 2 and UCl 3 in the salt. [ABSTRACT FROM AUTHOR]

The IMPROVE study describes a large perioperative quality improvement project with reporting of both compliance with improvement activities and patient outcomes. It highlights the importance of such projects, as well as the challenges in implementing change and proving benefit. Challenges identified include the importance of effective training in practice change, selection of trial design and relevant quality measures, and how the context of quality improvement initiatives may influence outcomes. Quality improvement programmes of this nature, despite the difficulties with implementation and trial design, remain a high priority because of their positive influence on improving clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the application of cost-effectiveness modeling to redesign of perioperative care pathways, from a hospital perspective.Methods: A Markov cost-effectiveness model of patient transition between care locations, each with different characteristics and cost, was developed. Inputs were derived from clinical trials piloting a preoperative call center and a postoperative medium-acuity care unit. The effect chosen was days at home (DAH) after surgery, reflecting quality of in-hospital care, acknowledged financially by fundholders, and relevant to consumers. Cost was from the hospital's perspective. A model cycle time of 4 hours for 30 days reflected relevant timelines and costs.Results: A Markov model was successfully created, accounting for the care locations in the 2 pathways as model states and accounting for consequences and costs. Cost-effectiveness analysis allowed the calculation of an incremental cost-effectiveness ratio comparing these pathways, providing a mean incremental cost-effectiveness ratio of -$427 per additional DAH, where incremental costs and DAH were -$644 and +1.51, respectively. Probabilistic sensitivity analysis suggested the new pathway had a 61% probability of reduced costs and a 74% probability of increased DAH and a 58% probability this pathway was dominant. Tornado analysis revealed the major contributor to increased costs as intensive care unit stay and the major contributor to decreased costs as ward stay. For the new pathway, the probability of transfer from ward to home and the probability of staying at home had the greatest impact on DAH.Conclusions: These data suggest Markov modeling may be a useful tool for the cost-effectiveness analysis of initiatives in perioperative care. [ABSTRACT FROM AUTHOR]

• Statins in HCV heart transplant recipients may be avoided due to drug interactions. • Nonstatin therapy for prevention of CAV has not been well studied. • PCSK9 inhibitors appear safe among recipients of hepatitis C virus positive donors. • Early PCSK9 inhibition may be beneficial for recipients of hepatitis C virus donors. Although statin therapy is a primary treatment to prevent cardiac allograft vasculopathy (CAV), its use may be delayed due to pharmacologic interactions in the early post-transplant period among heart transplant (HT) recipients with hepatitis C virus positive (HCV+) donors. Further examination of the possible benefits of early, nonstatin lipid-lowering therapies (LLT), such as PCSK9 inhibitors (PCSK9i), among this specific subset of transplant recipients is therefore becoming increasingly important. We report a 60-year-old man who received a HT from a HCV+ donor for end-stage ischemic cardiomyopathy. In the early post-transplant period, there was concern for drug-drug interactions between statin, immunosuppressant, and direct acting antiviral (DAA) therapy. In addition, prior to transplant, he reported statin-associated muscle symptoms in response to multiple statins, which persisted despite attempts to re-challenge and use an every-other-day dosing strategy. Therefore, the patient was started on PCSK9i therapy after transplantation and while receiving curative DAA therapy for HCV. As the number of HT recipients of HCV+ donors continue to rise, investigation into the safety and benefits of early use of PCSK9i for the reduction of CAV and improved cardiovascular and mortality outcomes should be pursued. [ABSTRACT FROM AUTHOR]

• Cardiometabolic disease is linked to the development of cardiovascular disease. • APOs, PCOS and NAFLD should be recognized as markers of cardiometabolic disease. • Risk identification and optimization should be targeted throughout a woman's lifespan. • Lifestyle modification can play a significant role in disease treatment and progression. A recent rise in atherosclerotic cardiovascular disease (ASCVD) mortality in women warrants a heightened focus on the cardiometabolic risk factors that are closely tied to increasing trends in obesity and suboptimal lifestyle. Polycystic ovarian syndrome (PCOS), adverse pregnancy outcomes (APOs) and nonalcoholic fatty liver disease (NAFLD) are often manifestations of cardiometabolic disease that convey cardiovascular risk requiring recognition foremost, as well as a targeted approach to treatment. Similarly, menopause is a time to reflect on a woman's cardiovascular risk as multiple cardiometabolic changes occur during this time. Contraceptives and menopausal replacement therapy (MRT) should be considered along with a woman's individual thrombotic and cardiovascular risk. Clinicians should be attuned to cardiometabolic risk factors throughout a woman's lifespan and familiar with strategies to reduce cardiovascular risk. [ABSTRACT FROM AUTHOR]

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Active warming during surgery prevents perioperative hypothermia but the effectiveness and postoperative infection rates may differ between warming technologies.Aim: To establish the recruitment and data management strategies needed for a full trial comparing postoperative infection rates associated with forced air warming (FAW) versus resistive fabric warming (RFW) in patients aged >65 years undergoing hemiarthroplasty following fractured neck of femur.Methods: Participants were randomized 1:1 in permuted blocks to FAW or RFW. Hypothermia was defined as a temperature of <36°C at the end of surgery. Primary outcomes were the number of participants recruited and the number with definitive deep surgical site infections.Findings: A total of 515 participants were randomized at six sites over a period of 18 months. Follow-up was completed for 70.1%. Thirty-seven participants were hypothermic (7.5% in the FAW group; 9.7% in the RFW group). The mean temperatures before anaesthesia and at the end of surgery were similar. For the primary clinical outcome, there were four deep surgical site infections in the FAW group and three in the RFW group. All participants who developed a postoperative infection had antibiotic prophylaxis, a cemented prosthesis, and were operated under laminar airflow; none was hypothermic. There were no serious adverse events related to warming.Conclusion: Surgical site infections were identified in both groups. Progression from the pilot to the full trial is possible but will need to take account of the high attrition rate. [ABSTRACT FROM AUTHOR]

This work examines the change in liquidus temperature of the salt used in the Mk-IV electrorefiner at the Idaho National Laboratory during processing campaigns of sodium-bonded driver fuels from Experimental Breeder Reactor II and the Fast Flux Test Facility reactor. Modeling and Simulation Tool for Electrochemical Recycling Systems (MASTERS), an INL proprietary pyroprocessing flowsheet simulation tool, was used to simulate the processing campaigns and determine the resulting composition changes of the Mark-IV electrorefiner salt. Surrogate salt samples simulating the Mk-IV electrorefiner salt during the fuel processing campaigns were prepared, and the thermal properties were measured via differential scanning calorimetry. Results from this study indicate that after processing approximately 2,150 kg of uranium metal from used fuel, the liquidus temperature of the molten salt exceeds 520 °C, which is a significant increase from 352 °C (the melting temperature of eutectic LiCl KCl). It was also found that the liquidus temperature is strongly dependent on the amount of NaCl accumulating in the Mk-IV electrorefiner salt. Thus, the assessment of the liquidus temperature during the subsequent fuel processing campaigns can be simplified by considering the ternary LiCl KCl NaCl system only. [ABSTRACT FROM AUTHOR]

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The incidence of inappropriate cardiac catheterization lab activation for treatment of a false ST-segment elevation myocardial infarction (STEMI) has been reported to be 2.6%-36%. Excessive inappropriate catheterization lab activation may be associated with risks to patients, provider fatigue and improper resource usage.Hypothesis: To derive and validate a prediction score to more accurately classify patients with STEMI.Methods and Results: We conducted a retrospective cohort analysis of 1144 consecutive patients initially diagnosed with STEMI between September 2008 and January 2013. The incidence of catheterization laboratory activation for false STEMI was 21.4%. Multiple logistic regression identified 8 factors as important for prediction of false STEMI. Using a prediction rule derived from these factors, the area under the curve for differentiating false from true STEMI patients was 0.80 (95% CI: 0.75-0.84). Using objective standards, criteria were defined that had 95% specificity for detecting patients with an incorrect diagnosis of STEMI.in Conclusion: A prediction rule has been derived and validated in a large, racially diverse group to identify false STEMI patients with an incorrect classification rate of 5%, which is an improvement over current clinical practice. Prediction rules may be particularly useful in patients with atypical presentations in which emergent catheterization cannot be achieved rapidly or carries significant patient risk. [ABSTRACT FROM AUTHOR]

A dissolution experiment is performed in order to examine the kinetics of uranium isotope equilibration in a molten salt and cadmium system. The salt contains a solute concentration of UCl 3 in LiCl-KCl eutectic and the cadmium contained dissolved uranium at 500 °C. A small piece of high enriched uranium is introduced to the cadmium, which perturbs the equilibrium with respect to the uranium enrichment of the salt and cadmium phases. The series of salt and cadmium samples trace how the enrichment of the two phases reach equilibrium (in the absence of a chemical driving force) over the course of approximately 24 h. A model linking dissolution and isotope exchange kinetics is developed to track the evolution of uranium isotope composition. With the assumption of unaccounted salt mass incurred from the dated sample reporting practice, the model explains the trend of the measured uranium isotope composition well. [ABSTRACT FROM AUTHOR]

In the field of pyroprocessing of used nuclear fuels, liquid cadmium is applied in different ways to recover transuranics from molten salt, while effecting some degree of separations between transuranics and lanthanides. A model of the separation performance between uranium and plutonium across the phase boundary between molten salt and liquid cadmium is presented. The salt is the LiCl-KCl eutectic with solute concentrations of UCl 3 and PuCl 3 . The cadmium is the liquid cadmium phase field from the Cd-U-Pu ternary alloy system. The model used to describe the behavior of uranium and plutonium in the salt/cadmium system is applied to describe the behavior of plutonium and lanthanide in the salt/cadmium system. [ABSTRACT FROM AUTHOR]

The article focuses on diagnosis along with treatment of facial soft tissue injuries in sports and mentions soft tissue injuries categorized as contusions, abrasions, and lacerations; and injury to collateral vital structures.

High sensitivity C-reactive protein (hsCRP) has been evaluated as a biomarker in stroke and relevant pathological diseases. While its predictive values in several pathological phenotypes have been confirmed, controversy exists among different studies. This review summarizes reports of the predictive values of hsCRP for the diagnosis, etiology, prognosis and mortality of stroke diseases. The current literature suggests that CRP expression is influenced by multiple factors, such as polymorphisms, the genomic backgrounds and gender. However, few reported studies analyzed data based on all these multiple factors. Future studies should focus on comprehensive analysis based on multiple factors. [ABSTRACT FROM AUTHOR]

Highlights: [•] Photoluminescence (PL) properties of sol–gel derived Tb3+ doped ZnO nanocrystals. [•] Dependence of PL intensity of Tb3+ doped ZnO on Tb3+concentration. [•] Energy transfer mechanism between Tb3+ and ZnO. [ABSTRACT FROM AUTHOR]

Abstract: Rheumatoid arthritis (RA) and osteoarthritis (OA) are prevalent chronic health conditions. However, despite recent advances in medical therapeutics, their treatment still represents an unmet medical need because of safety and efficacy concerns with currently prescribed drugs. Accordingly, there is an urgent need to develop and test new drugs for RA and OA that selectively target inflamed joints thereby mitigating damage to healthy tissues. Conceivably, biocompatible, biodegradable, disease-modifying antirheumatic nanomedicines (DMARNs) could represent a promising therapeutic approach for RA and OA. To this end, the unique physicochemical properties of drug-loaded nanocarriers coupled with pathophysiological characteristics of inflamed joints amplify bioavailability and bioactivity of DMARNs and promote their selective targeting to inflamed joints. This, in turn, minimizes the amount of drug required to control articular inflammation and circumvents collateral damage to healthy tissues. Thus, nanomedicine could provide selective control both in space and time of the inflammatory process in affected joints. However, bringing safe and efficacious DMARNs for RA and OA to the marketplace is challenging because regulatory agencies have no official definition of nanotechnology, and rules and definitions for nanomedicines are still being developed. Although existing toxicology tests may be adequate for most DMARNs, as new toxicity risks and adverse health effects derived from novel nanomaterials with intended use in humans are identified, additional toxicology tests would be required. Hence, we propose that detailed pre-clinical in vivo safety assessment of promising DMARNs leads for RA and OA, including risks to the general population, must be conducted before clinical trials begin. [Copyright &y& Elsevier]

Abstract: To optimize the reduction of the drag area coefficient of a speed skater, mannequins in static positions wearing suits were tested in the NRC 2m x 3m Wind Tunnel to find the lowest drag for a given range of speeds. The results obtained from this study can only be interpreted and applied to a speed skater if the aerodynamic drag coefficient is not affected significantly by the motion of the skater. It has been assumed that, for a representative cadence or frequency of oscillation of a speed skater lower than 1Hz which is representative of the motion in a race, the aerodynamics could be considered quasi-stationary. The quasi-steady state is defined by the flow that developed around the body and the wake both governing the aerodynamic drag compared to the contribution of the low frequency of oscillation of the body. To verify this hypothesis and to determine to what extent the quasi-steady assumption is valid for a human body in a speed skating position, a study was carried out in a wind tunnel using a moving life-size mannequin. A mechanism was devised so that a mannequin in a sidepush position could be oscillated to mimic the sinusoidal path of a speed skater. The amplitude of motion was kept constant and the frequencies of oscillation and wind speeds were changed to cover the equivalent of 500 m to 10,000 m races. The experiments have revealed that the variations of the drag area coefficient with wind speed were similar for static positions and for cases where the mannequin was oscillating at frequencies lower than 0.67Hz or for a period of rotation of 1.5s. The drag reduction occurred at the same wind speeds for the static and dynamic cases. This paper presents details of the experiments and a summary of the main findings. [Copyright &y& Elsevier]