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To verify possible correlations between formant and cepstral parameters and oropharyngeal geometry in singers, stratified by sex. Voice records and oropharyngeal measures of 31 singers – 13 females and 18 males, mean age of 28 (±5.0) years – were retrieved from a database and analyzed. The oropharyngeal geometry measures were collected with acoustic pharyngometry, and the voice records consisted of sustained vowel /Ԑ/ phonation, which were exported to Praat software and edited to obtain the formant and cepstral parameters, stratified by sex. The Pearson linear correlation test was applied to relate voice parameters to oropharyngeal geometry, at the 5% significance level; the linear regression test was used to justify the variable related to the second formant. Differences between the sexes were identified only in the oral cavity length (greater in males) and pharyngeal cavity length (greater in females). There was a linear correlation between the third formant and the cepstrum in the female group. In the male group, there was a linear correlation between the cepstrum and the third and fourth formants. A positive linear correlation with up to 95% confidence was also identified between the pharyngeal cavity volume and the second formant in the female group, making it possible to estimate a regression model for the second formant (R2 = 0.70). There are correlations between the oropharyngeal geometry and formant and cepstral parameters in relation to sex. The pharyngeal cavity volume showed the greatest correlation between females and the second formant. [ABSTRACT FROM AUTHOR]

Prosthetic patches (patch) and muscle flaps (flap) are techniques used for repair of congenital diaphragmatic hernia (CDH) with a large defect unamenable to primary closure. We hypothesized that the flap technique for CDH repair while on extra-corporeal membrane oxygenation (on-ECMO) would have decreased bleeding complications compared to patch due to the hemostatic advantage of native tissue. A single-center retrospective comparative study of patients who underwent on-ECMO CDH repair between 2008 and 2022 was performed. Fifty-two patients met inclusion criteria: 18 patch (34.6%) and 34 flap (65.4%). There was no difference in CDH severity between groups. On univariate analysis, reoperation for surgical bleeding was lower following flap repair compared to patch (23.5% vs 55.6%, respectively; p = 0.045), 48-h postoperative blood product transfusion was lower after flap repair (132 mL/kg vs 273.5 mL/kg patch; p = 0.006), and two-year survival was increased in the flap repair group compared to patch (53.1% vs 17.7%, respectively; p = 0.036). On multivariate analysis adjusting for CDH side, day on ECMO repaired, and day of life CDH repaired, flap repair was significantly associated with lower five-day postoperative packed red blood cell transfusion amount, improved survival to hospital discharge, and improved two-year survival. Our experience suggests that the muscle flap technique for on-ECMO CDH repair is associated with reduced bleeding complications compared to prosthetic patch repair, which may in part be responsible for the improved survival seen in the flap repair group. These results support the flap repair technique as a favored method for on-ECMO CDH repair. Level III. • The abdominal wall muscle flap technique can be used to repair large CDH defects and is feasible to perform on-ECMO. • The muscle flap technique is safe to perform on-ECMO and is associated with decreased postoperative bleeding complications, potentially making it the favored technique for large CDH defects which require on-ECMO repair. [ABSTRACT FROM AUTHOR]

Fatty accumulation in rotator cuff muscles has been associated with shoulder dysfunction, risk of repair failure, and poor postoperative outcomes. This study sought to assess risk factors associated with true fatty accumulation based on histologic analysis and determine whether preoperative function directly correlated with this fatty rotator cuff accumulation. Supraspinatus muscle biopsy specimens obtained prospectively from patients undergoing arthroscopic rotator cuff repair were stained with LipidTOX to quantify lipid accumulation. Two-step cluster analysis with Goutallier classification was used to define the fatty and non-fatty rotator cuff groups. We further performed a receiver operating characteristic curve analysis to confirm the group cutoff values. In total, 51 patients (aged 60.1 ± 10.5 years) were included. There were 19 high-grade partial tears, 10 small tears, 7 medium tears, 10 large tears, and 5 massive tears. Both cluster and receiver operating characteristic curve analyses yielded a cutoff value of 30% LipidTOX/4',6-diamidino-2-phenylindole (DAPI) separating the fatty vs. non-fatty groups. In the univariate analysis, patients with fatty rotator cuffs were aged 63.2 years on average compared with 59.7 years in the non-fatty group (P =.038). Female patients made up 57.1% of the fatty cohort, which was statistically higher than the non-fatty group (P =.042). Massive and large tears were more likely to occur in the fatty group (P =.005). In the multivariate analysis, full tendon tears had the largest predictive status of falling into the fatty group (odds ratio, 15.4; P =.008), followed by female sex (odds ratio, 4.9; P =.036). Patients in the fatty group had significantly higher American Shoulder and Elbow Surgeons scores (P =.048) and lower visual analog scale scores (P =.002). This prospective histologic assessment revealed that full-thickness rotator cuff tears and female sex were the largest risk factors for intracellular lipid accumulation. Although tear size correlated with fatty accumulation, the sex disparity is a noteworthy finding that warrants further research. [ABSTRACT FROM AUTHOR]

Follow-up care of early breast cancer (EBC) patients usually includes routinely scheduled physical examinations. While ASCO guidelines recommend a physical exam every three to six months for the first three years, little evidence supports this schedule. We evaluated recurrence detection of patients transferred into a single centre survivorship program that follows ASCO recommendations. Patients with EBC referred to the Wellness Beyond Cancer Program (WBCP) who had breast cancer recurrence between February 1, 2013, and January 1, 2019 were reviewed. Descriptive analyses were used to present patient and disease characteristics stratified by type of recurrence and mode of cancer detection. Of 206 recurrences, 135 were distant recurrences (65.5%), 41 were ipsilateral breast recurrences (19.9%), and 30 were contralateral breast primaries (14.6%). Distant recurrences were primarily detected via patient-reported symptoms (125/135, 92.6%). 53.7% (22/41) of ipsilateral breast recurrences were detected by patients and 41.5% (17/41) by routine imaging. Contralateral breast primaries were primarily detected by imaging 83.3% (25/30) and patient-reported symptoms 16.7% (5/30). Only 2/206 (1.14%) recurrences/new primaries were detected by healthcare providers at routinely scheduled follow-up visits. Despite following ASCO guidelines, healthcare providers rarely detect recurrences at routinely scheduled follow-up appointments. Our data suggests that approximately 35, 000 follow-up visits were required for healthcare providers to detect these 2 recurrences. While reduced in-person visits may affect other aspects of follow-up care (e.g. toxicity management), it appears unlikely, provided patients attend regular screening tests, that less frequent in-person follow-up is associated with worse breast cancer-related outcomes. • Follow-up of patients with early breast cancer usually includes routinely scheduled physical examination. • Actual evidence to support follow-up guidelines is sparse. • Recurrences are rarely detected at routine follow-up. [ABSTRACT FROM AUTHOR]

• We compared the outcomes of immunocompetent patients, chronically immunosuppressed patients, and acutely immunosuppressed patients who were placed on ECMO at our institution. • There was no significant difference in ECMO, 30-day, 90-day, or one-year survival between immunocompetent patients, chronically immunosuppressed patients, and acutely immunosuppressed patients, suggesting that select immunosuppressed patients may be eligible for ECMO therapy. • Acutely immunosuppressed patients were at higher risk of developing new infections on ECMO, suggesting that infection control on ECMO is important in acutely immunosuppressed patients. Immunosuppressed hosts represent a growing group of patients who suffer acute respiratory failure and may be considered for therapies such as extracorporeal membrane oxygenation (ECMO). We conducted this retrospective study to determine whether acutely or chronically immunosuppressed patients placed on ECMO for cardiac and/or respiratory failure in our institution have different outcomes than immunocompetent patients placed on ECMO in our institution. Adult patients placed on ECMO between June 31, 2010 and July 7, 2021 were identified within an IRB-approved database. Data was retrospectively extracted from the database and patients' medical records. Patients who survived ECMO decannulation were sub-grouped by the presence of acute or chronic immunosuppression, defined by the use of high-dose steroids or immunosuppressive agents for greater than four weeks prior to ECMO initiation. We analyzed and compared baseline characteristics and clinical outcomes using chi-squared tests for categorical variables and a one-way analysis of variance (ANOVA) for continuous variables. 385 patients were included in this study, with 39 identified as chronically immunosuppressed, 49 as acutely immunosuppressed, and 297 as immunocompetent. There was no statistical difference in ECMO survival (respectively 54%, 59%, 65% p = 0.359) or 30-day survival (33%, 51%, 48% p = 0.149) for chronically immunosuppressed, acutely immunosuppressed, and immunocompetent, respectively. There were significant differences in rates of pre-ECMO COVID infection (p <0.001), coronary artery disease (p <0.001), smoking (p = 0.003), and acute kidney injury (p = 0.032). Acutely immunosuppressed patients had the highest rates of new infections during ECMO (p = 0.006). When compared to immunocompetent patients, both acutely and chronically immunosuppressed patients had no significant difference in ECMO survival or 30-day survival. Acutely immunosuppressed patients had less comorbidities than chronically immunosuppressed patients, but they were more commonly infected during ECMO. ECMO may still be a valuable tool in appropriately selected patients with refractory respiratory or cardiac failure. [ABSTRACT FROM AUTHOR]

Autistic children and adolescents have academic performance challenges and are often reluctant to participate in physical activities. Executive function (EF) abilities generally remain stable or worsen as autistic children get older and obesity and lack of physical fitness are frequent concerns experienced by these individuals. Finding ways to address these concerns has the potential to improve outcomes in autistic youth. We conducted a 12-month, repeated-measures study to examine the effectiveness of a mandatory 35-minute daily school physical activity intervention involving low to moderate exertion for autistic adolescents (n = 29). Changes in fitness, EF, social responsiveness, and restrictive and repetitive behaviors were examined. Significant improvements were seen in fitness, EF areas (specifically cognitive flexibility and planning/organizing), restrictive and repetitive behaviors and social responsiveness. Findings suggest that participation in a mandatory daily 35-minute physical activity program with low to moderate exertion is feasible and may contribute to improved EF, fitness, restricted and repetitive behavior, and social responsiveness in autistic adolescents. • Mandatory daily 35-minute physical activity program participation is feasible for autistic adolescents. • Daily 35-minute low to moderate exertion physical activity may improve fitness in autistic adolescents. • Daily 35-minute physical activity may reduce restrictive thinking and repetitive behaviors in autistic adolescents. • Daily 35-minute mandatory low to moderate exertion physical activity may improve social responsiveness in autistic adolescents. • Daily 35-minute low to moderate exertion physical activity may improve executive function in autistic adolescents. [ABSTRACT FROM AUTHOR]

Almost all preference-based measures (PBMs) have been developed in Western countries, with none having been formulated in Asian countries. In this study, we construct a new generic PBM based on concept elicitation using interview surveys in East and Southeast Asian countries and qualitative analysis. This cross-sectional study included 225 adults recruited from 9 East and Southeast Asian countries or regions (Indonesia, Japan, Korea, mainland China, Malaysia, the Philippines, Singapore, Taiwan, and Thailand). Trained interviewers conducted semistructured interviews with 25 participants from the general population of each country/region. Qualitative data were analyzed using a content analysis approach. The selection of items was determined based on interview surveys and team member discussions. The description of items was considered based on a detailed qualitative analysis of the interview survey. A new region-specific PBM—the Asia PBM 7 dimensions instrument—was designed. It reflects East and Southeast Asian values and comprises 7 items: pain, mental health, energy, mobility, work/school, interpersonal interactions, and burden to others. The new region-specific instrument is one of the first PBMs developed in the context of non-Western countries. The Asia PBM 7 dimensions contains 7 items that address the core concepts of health-related quality of life that are deemed important based on East and Southeast Asian health concepts. • Almost all preference-based measures (PBMs) were developed in Western countries. No major PBM has been developed in non-Western countries, including East and Southeast Asian countries. A new PBM, "Asia PBM 7 dimensions" (AP-7D), was designed by concept elicitation and item selection using interview surveys. The survey included a sample of 225 East and Southeast Asian people and qualitative analysis. • The AP-7D includes the following 7 items: pain, mental health, energy, mobility, work or school, interpersonal interactions, and burden to others, which are the most bothersome symptoms and the most important health-related impacts revealed by our interview surveys. • The scores measured using the AP-7D based on Asian people's concepts may reflect the truer preference of East and Southeast Asians. [ABSTRACT FROM AUTHOR]

Atrioventricular block is a frequent major complication after alcohol septal ablation (ASA). The aim of this study was to evaluate the outcomes of patients with implanted permanent pacemaker (PPM) related to a high-grade atrioventricular block after ASA for hypertrophic obstructive cardiomyopathy. We used a multinational registry (the Euro-ASA registry) to evaluate the outcome of patients with PPM after ASA. A total of 1,814 patients were enrolled and followed up for 5.0 ± 4.3 years (median = 4.0 years). A total of 170 (9.4%) patients underwent PPM implantation during the first 30 days after ASA. Using propensity score matching, 139 pairs (n = 278) constituted the matched PPM and non-PPM groups. Between the matched groups, there were no long-term differences in New York Heart Association functional class (1.5 ± 0.7 vs 1.5 ± 0.9, P = 0.99) and survival (log-rank P = 0.47). Patients in the matched PPM group had lower long-term left ventricular (LV) outflow gradient (12 ± 12 mm Hg vs 17 ± 19 mm Hg, P < 0.01), more pronounced LV outflow gradient decrease (81% ± 17% vs 72% ± 35%, P < 0.01), and lower LV ejection fraction (64% ± 8% vs 66% ± 8%, P = 0.02) and were less likely to undergo reintervention (re-ASA or myectomy) (log-rank P = 0.02). Patients with hypertrophic obstructive cardiomyopathy treated with ASA have a 9% probability of PPM implantation within 30 days after ASA. In long-term follow-up, patients with PPM had similar long-term survival and New York Heart Association functional class but lower LV outflow gradient, a more pronounced LV outflow gradient decrease, a lower LV ejection fraction, and a lower likelihood of reintervention compared with patients without PPM. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim of this study was to review systematically the literature and to investigate the effects of electrical stimulation in treating dysphonia. This is a systematic review. The publications indexed on the MEDLINE, LILACS, PubMed, Web of Science, and SciELO databases were searched. Original articles with experimental, clinical trial and randomized studies involving a control group and approaching dysphonia treatment with electrical stimulation in humans, regardless of age, gender, or race were included. Those excluded were theses, editorials, comments and opinions, reflexive articles, case studies, experimental studies with animals, models, projects, reports and technical reports, and review articles, as well as articles approaching other alterations, not related to dysphonia. Eleven articles were found and it evaluated the effects of neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation on dysphonia caused by vocal fold paralysis, spasmodic dysphonia, behavioral dysphonia, and in patients with vocal fold nodules. The methodological analysis of the articles through the PEDro scale resulted in a mean score of 5.18; the studies were classified as either high quality (N = 3) or fair quality (N = 8). The results indicated that electrical stimulation had a therapeutic effect on various aspects of dysphonia. However, due to the high risk of bias and the heterogeneity of the studies, it is not possible to state the effectiveness of electrical stimulation in treating dysphonia. Using electrical stimulation as an evidence-based conventional rehabilitation therapy in the treatment of dysphonia cannot yet be done. [ABSTRACT FROM AUTHOR]

A robust current control approach with disturbance cross-coupling compensation for permanent magnet synchronous motor drives (PMSM) is proposed in this paper. The proposed approach can enhance the reference tracking and provides a robust option for current control of PMSM drives. A discrete-time sliding mode current controller is proposed. The PMSM model includes the digital implementation delay, present due to the discrete-time algorithm execution. A discrete-time backstepping disturbance observer is developed, being combined to the sliding mode controller as a means to improve the robustness and tracking capability. The effects of coupling, parametric uncertainties and load disturbances are compensated by the backstepping disturbance observer. The stability analysis of the combined system is presented and the limits for overall system stability are discussed. Simulations and experimental results validate the combined scheme and demonstrate the good performance of the proposal. • The proposal includes the digital implementation delay in the problem formulation. • The proposed system is analyzed in the discrete-time domain. • Mitigation of the coupling effect in dq axes via the disturbance observer. • The proposed switching functions cross the sliding surface at each sampling period. • A simple structure suitable to nonlinear plants with mismatched uncertainties [ABSTRACT FROM AUTHOR]

Early recognition and prompt, appropriate management may reduce mortality in patients with sepsis. The Surviving Sepsis Campaign's guidelines suggest the use of dynamic measurements to guide fluid resuscitation in sepsis; although these methods are rarely employed to monitor cardiac output in response to fluid administration outside intensive care units. This service evaluation investigated the introduction of a nurse led protocolised goal-directed fluid management using a non-invasive cardiac output monitor to the standard assessment of hypotensive ward patients. We introduced the use of a goal-directed fluid management protocol into our critical care outreach teams' standard clinical assessment. Forty-nine sequential patients before and thirty-nine after its introduction were included in the assessment. Patients in the post-intervention cohort received less fluid in the 6 h following outreach assessment (750mls vs 1200mls). There were no differences in clinical background or rates of renal replacement therapy, but rates of invasive and non-invasive ventilation were reduced (0% vs 31%). Although the groups were similar, the post-intervention patients had lower recorded blood pressures. IV fluid therapy in the patient with hypotension complicating sepsis can be challenging. Excessive IV fluid administration is commonplace and associated with harm, and the use of advanced non-invasive haemodynamic monitoring by trained nurses can provide objective evaluation of individualised response to treatment. Avoiding excessive IV fluid and earlier institution of appropriate vasopressor therapy may improve patient outcomes. Adoption of dynamic measures of cardiac output outside of critical care by trained critical care nurses is feasible and may translate into improved patient outcomes. In hospitals with a nurse-led critical care outreach service, consideration should be given to such an approach. [ABSTRACT FROM AUTHOR]

Patients undergoing maxillectomies may present alterations in the stomatognathic functions involved in oral communication. Rehabilitative treatment should favor the rescue of these functions, through surgical flaps, obturator prostheses or both. The present study aims to present the impact of the use of the palatal obturator on the oropharyngeal geometry and on the voice of patients undergoing maxillectomies, after adaptation to trans-surgical palatine obturators (TPO). Twelve patients treated at a Cancer Hospital, submitted to maxillectomy and rehabilitated during surgery were evaluated. The oropharyngeal geometry was measured by acoustic pharyngometry and the vocal parameters were evaluated through auditory-perceptual and acoustic analyses. The comparison between the results with and without TPO was analyzed using the Wilcoxon test and the correlation between oropharyngeal measurements and acoustic parameters using Spearman's correlation coefficient, all with a significance level of 5%. There was a decrease in the following oropharyngeal measurements with the use of TPO: length of the pharyngeal cavity and vocal tract, volume of the oral cavity, pharyngeal and vocal tract and area of ​​the oropharyngeal junction. There was no difference in the length of the oral cavity and in the glottic area between situations with and without TPO. In the vocal evaluation, changes in intelligibility and resonance were observed in the situation without TPO and, in only one case, mild hypernasality was detected in the situation with TPO. It is concluded that the use of TPO brought the oropharyngeal measurements closer to normal values ​​and provided an improvement in speech intelligibility and vocal resonance in maxilectomized individuals. [ABSTRACT FROM AUTHOR]

[Display omitted] • Backdune morphology influences strongly the wind flow dynamics through the notch. • Wind speed through the notch increases when swale width increases and the slope of backdune topography decreases, and vice versa. • The length of flow recirculation in the lee of the notch decreases as swale width increases, and vice versa. • The height of flow recirculation increases when the slope increases, and vice versa. On many metropolitan and developed coasts foredunes are narrow, vegetated, highly stable and confined by hinterland development. Such foredunes are most likely to erode, rather than landward migration, in response to ongoing eustatic sea-level rise. Foredune notching may be undertaken on such coasts to facilitate sand transport through the foredune zone and accomplish degrees of foredune landward migration; however, the efficacy of this method has not been examined in relation to the backdune topography, which in many instances takes the form of a dyke or similar infrastructure. Computational Fluid Dynamics (CFD) is used to investigate how the space behind a notch, and the slope of the seaward face of the backdune topography, modifies near-surface wind through foredune notches. Incident winds are simulated parallel to the notch long axis and the effects of changing backdune morphology on the secondary winds through the notch are examined. Swale widths between 3 and 53 m and hinterland gradients between 0° and 90° are examined. Air flow through the notch is strongly influenced by the morphology of backdune infrastructure. Wind speed increases through the notch as the spacing behind the notch increases and the slope of the hinterland topography decreases. An increase in spacing reduces the landward extension of wind recirculation in the lee of the notch. To maximise notch efficiency and sediment accumulation in the lee of the foredune the minimum spacing should be 8 and 30 m when the slope of the backdune infrastructure is 20° and 90°, respectively. [ABSTRACT FROM AUTHOR]

Wild canids serve as reservoir for various vector-borne pathogens of veterinary and medical importance, including the canine heartworm, Dirofilaria immitis. In North and Central America, coyotes (Canis latrans) may be a relevant reservoir host for heartworm transmission. The objective of this study was to determine the occurrence of D. immitis in coyotes across Texas using integrated antigen detection test and molecular assays. Matching whole blood and serum samples were collected from 122 coyotes from different locations across the state of Texas, United States, encompassing nine counties. Collections occurred from February to April 2016, and December 2016. Samples were assessed serologically using a commercial microtiter plate ELISA (DiroCHEK®), and molecularly by conventional PCR targeting the cytochrome oxidase c subunit 1 (cox1) and NADH dehydrogenase subunit 5 (nad5) of the mitochondrial DNA, and via a TaqMan© probe-based real-time PCR protocol, also targeting a fragment of the cox1 gene. Overall, 12 (9.83%) samples tested positive when serological and molecular results were combined. Seven of 122 samples (5.73%) were antigen-positive, 8 (6.55%) were qPCR-positive, and 4 (3.27%) were positive using conventional PCR. Of 12 positive samples, 4 tested antigen-positive by DiroCHEK® but were negative in all molecular tests, another 4 tested positive by at least one of the molecular assays but tested negative by DiroCHEK®, and 3 samples tested positive by both antigen test and at least one of the molecular assays. Two samples (16.67%) tested positive on both the antigen test and both conventional PCR and qPCR. Our study confirmed the presence of D. immitis infection in coyotes from southern and northern Texas. The combination of serologic and molecular diagnostic tests was proven synergistic for the identification of D. immitis infections, including occult dirofilariosis, and revealed a more accurate picture of heartworm occurrence in the sampled coyotes. [Display omitted] • Coyotes are an important wild reservoir for Dirofilaria immitis in North America. • We collected 121 matching blood and serum samples of coyotes from Texas, USA. • Twelve samples (9.92%) tested positive combining serology and molecular tests data. • Probe-based qPCR was superior than conventional PCR for heartworm diagnosis. • Combined DiroCHEK® and qPCR data showed a higher prevalence than each test alone. [ABSTRACT FROM AUTHOR]

The aim of this study was to verify the immediate effect of a flexible resonance tube in water and of lip trill on oropharyngeal geometry and vocal acoustic parameters of singers without vocal symptoms. Twenty-two adult singers participated in the study. They had an average age of 27 (±4.8) years. Participants were split into two groups: a group composed of 12 singers who performed the flexible resonance tube (FRT) exercise and a group of 10 singers who performed the Lip Trill technique (LTT). Acoustic pharyngometry and acoustic analysis of the voice were used to assess oropharyngeal geometry before and after the exercises. After performing the techniques, the vocal tract length was longer in the group that performed the FRT, compared to the one that performed the LTT. In the acoustic evaluation, there was an improvement in the glottal to noise excitation ratio and a decrease in noise in the group of singers who performed the LTT. In the analysis by sex men had a longer oral cavity compared to women and after application of the techniques greater volume of the vocal tract. There was variation in the oropharyngeal geometry with the FRT, while the LTT had a positive effect on the vocal acoustic parameters related to glottal noise. [ABSTRACT FROM AUTHOR]

To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise. [ABSTRACT FROM AUTHOR]

Chronic lymphocytic leukaemia (CLL) is a common leukaemia in adults with potential to progress to more aggressive forms. We report a case of a 68-year old male with a previous history of CLL, who presented with an obstructing caecal mass. Microscopy revealed high grade features resembling Burkitt lymphoma; however, no MYC rearrangement was detected and subsequent FISH studies detected 11q aberration. Although this profile is now a recognized entity in the revised 4th edition of the WHO classification of Tumours of Haematopoietic neoplasms as "Burkitt-like lymphoma with aberration in 11q", this has not previously been reported in patients with previous or concurrent CLL. We discuss this case of possible transformation from CLL to Burkitt-like lymphoma with aberration in 11q. [ABSTRACT FROM AUTHOR]

Despite documented disparities with regard to treatment of skin of color (SOC) among dermatology trainees, a consensus has not yet been established as to how to improve trainee experiences with regard to SOC pathology. Our study objective was to systematically review the literature and assess interventions that have been implemented thus far to increase trainee competence and/or confidence in assessing SOC pathology. A systematic review of PubMed, Scopus, and Science Direct in January 2022 was performed, yielding a total of 1097 records. Inclusion of primary literature only resulted in 669 records. After assessing records for relevance to the objective, a total of 3 were included. Two studies assessed interventions among medical students and 1 among dermatology resident physicians. In general, the interventions assessed the effect of a specific SOC curriculum, but varied in how they came up with the curriculum. One study engaged with medical students of color to develop their curriculum, and 1 study retrospectively identified and included images of patients with SOC into a new database that was used for educational purposes. Interventions that engage with SOC communities may be most relevant, whether this is done by using patient data or by allowing leadership with medical students of color. We present a system for future future interventions to engage with medical students of color at their institution to improve trainee experiences with skin of color and long-term recruitment and support of a diverse medical student body to the field of dermatology. [ABSTRACT FROM AUTHOR]

The treatment of ganglion cysts of the wrist remains understudied in the pediatric population, with the literature showing variable recurrence rates following different interventions. This study sought to determine whether surgical and nonsurgical management of pediatric ganglion cysts was associated with improved resolution rates when compared to observation alone. We identified 654 cases of pediatric ganglion cysts treated across 5 institutions between 2012 and 2017. The mean age at presentation was 11.6 ± 5.2 years. Of the patients, 315 had >2 years (mean, 50.0 months) of follow-up, either via chart review or telephone callbacks. There were 4 different treatment groups: (1) observation, (2) cyst aspiration, (3) removable orthosis, and (4) surgical excision. For patients followed >2 years, the cyst resolved in 44% (72/163) of those observed. Only 18% (9/49) of those treated with aspiration resolved, and 55% (12/22) of those treated with an orthosis resolved. Surgical excision was associated with resolution of the cyst in 73% (59/81) of patients. Observation had higher rates of resolution compared to aspiration. Orthosis fabrication and observation had similar rates of cyst resolution. Surgery had the highest rates of resolution when compared to observation and aspiration. Patients older than 10 years were less likely to have the cyst resolve with observation (35%; 28/80) than those younger than 10 years (53%; 44/83) at >2 years of follow-up. This study did not find evidence that nonsurgical treatments were associated with improved rates of cyst resolution compared to observation alone in a large pediatric sample. Surgical excision had the overall highest rate of resolution. Despite the costs and increased clinic time of orthosis fabrication and aspiration, these treatments were not associated with improved rates of cyst resolution in pediatric ganglion cysts compared to observation, with aspiration having higher rates of recurrence compared to observation. Therapeutic IV. [ABSTRACT FROM AUTHOR]

The natural history of ductal carcinoma in situ (DCIS) is poorly understood. The aim of this cohort study was to determine the outcomes of women who had no surgery for screen-detected DCIS in the 6 months following diagnosis. English breast screening databases were retrospectively searched for women diagnosed with DCIS without invasive cancer at screening and who had no record of surgery within 6 months of diagnosis. These were cross-referenced with cancer registry data. Details of the potentially eligible women were sent to the relevant breast screening units for verification and for completion of data forms detailing clinical, radiological and pathological findings, non-surgical treatment and subsequent clinical course. Data for 311 eligible women (median age 62 years) were available. 60 women developed invasive cancer, 56 ipsilateral and 4 contralateral. Ipsilateral invasion risk increased approximately linearly with time for at least 10 years. The 10-year cumulative risk of ipsilateral invasion was 9% (95% CI 4–21%), 39% (24–58%) and 36% (24–50%) for low, intermediate and high grade DCIS respectively and was higher in younger women, in those with larger DCIS lesions and in those with microinvasion. Most invasive cancers that developed were grade 2 or 3. The findings suggest that active surveillance may be a reasonable alternative to surgery in patients with low grade DCIS but that women with intermediate or high grade disease should continue to be offered surgery. This highlights the importance of reproducible grading of DCIS to ensure patients receive appropriate treatment. • >1/3 women with intermediate/high grade DCIS developed invasive cancer within 10 years. • Approximately 10% of women with low grade DCIS developed invasion within 10 years. • Most invasive cancers that developed were grade 2 or 3. • The risk of invasion was age-dependent and higher in younger women. • Invasion risk was higher in larger DCIS lesions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the crowdsourcing platform Amazon Mechanical Turk (MTurk) with in-person recruitment and web-based surveys as a method to (1) recruit study participants and (2) obtain low-cost data quickly from chiropractic patients with chronic low back pain in the United States. In this 2-arm quasi-experimental study, we used in-person clinical sampling and web-based surveys from a separate study (RAND sample, n = 1677, data collected October 2016 to January 2017) compared with MTurk (n = 310, data collected November 2016) as a sampling and data collection tool. We gathered patient-reported health outcomes and other characteristics of adults with chronic low back pain receiving chiropractic care. Parametric and nonparametric tests were run. We assessed statistical and practical differences based on P values and effect sizes, respectively. Compared with the RAND sample, the MTurk sample was statistically significantly younger (mean age 35.4 years, SD 9.7 vs 48.9, SD 14.8), made less money (24% vs 17% reported less than $30,000 annual income), and reported worst mental health than the RAND sample. Other differences were that the MTurk sample had more men (37% vs 29%), fewer White patients (87% vs 92%), more Hispanic patients (9% vs 5%), fewer people with a college degree (59% vs 68%), and patients were more likely to be working full time (62% vs 58%). The MTurk sample was more likely to have chronic low back pain (78% vs 66%) that differed in pain frequency and duration. The MTurk sample had less disability and better global health scores. In terms of efficiency, the surveys cost $2.50 per participant in incentives for the MTurk sample. Survey development took 2 weeks and data collection took 1 month. Our results suggest that there may be differences between crowdsourcing and a clinic-based sample. These differences range from small to medium on demographics and self-reported health. The low incentive costs and rapid data collection of MTurk makes it an economically viable method of collecting data from chiropractic patients with low back pain. Further research is needed to explore the utility of MTurk for recruiting clinical samples, such as comparisons to nationally representative samples. [ABSTRACT FROM AUTHOR]

This phase 1 study aimed to develop a Type 1 diabetes (T1DM) educational resource for adolescents (10–19 years) in China, and to test its validity for improving diabetes knowledge, self-efficacy and adherence. This phase 1 study was carried out in four phases: preliminary development of the Type 1 diabetes educational resource in English based on the health belief model (HBM) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines 2014; translation of the resource into Chinese; readability testing of the resource; and face and content validity testing for scientific and clinical accuracy. Type 1 diabetes educational resource with 17 "topics" in four sections was developed for 10–19-years old adolescents in China. Cartoon story, images, stories, questions & answers, and quizzes were used to attract adolescents' interest. Furthermore, the educational resource was confirmed to be understandable among adolescents, clinically accurate, and consistent with its purpose. This resource with good readability and content validity is a potential facilitator for diabetes education and self-management in adolescents with T1DM in China. This type 1 diabetes resource can be used to educate adolescents with T1DM as a validated resource after further testing in an effectiveness study. • An educational resource was developed for adolescents with T1DM, which is a potential facilitator to diabetes self-management. • This resource was confirmed to be understandable among adolescents and clinically accurate. • The combination of validated education resource and new technology could provide a comprehensive support for adolescents with T1DM. [ABSTRACT FROM AUTHOR]

Cytogenetic techniques provide powerful insights on species-rich taxa–such as ants–allowing better understanding of their biodiversity. Some hints on evolutionary paths can be observed through comparative populational cytogenetics among different ant groups. In this study, the karyotype of Strumigenys louisianae Roger from the Amazon rainforest is described and showed diploid chromosome number of 26 chromosomes. This configuration intriguingly contrasts with the already described karyotype for this species from the Atlantic rainforest with only 2n = 4 chromosomes. 18S rDNA site were detected on the pericentromeric region of the long arm of a metacentric pair and co-localizing with GC-rich chromatin. Recurrent synonymizations of S. louisianae may not reflect the species status of this taxon. The karyotypic differences and the observable morphological variation between the populations of both localities corroborates the idea of a species complex within S. louisianae. The morphology of S. louisianae from the Amazonian region is similar to that from the United States, the type locality. On the other hand, specimens from the Atlantic rainforest are more similar to the junior synonym Strumigenys unidentata Mayr. This study reinforces the need of taxonomical revision in S. louisianae by means of integrative taxonomy approaches. • Strumigenys louisianae from the Amazon rainforest showed an intriguing karyotype: 2n = 26. • The karyotype of the Amazonian S. louisianae contrasts with an already described one. • Morphological and karyotype variations put to question the limits of the taxon. • Morphology of the Amazonian S. louisianae is similar to the type locality in the USA. [ABSTRACT FROM AUTHOR]

To verify whether the dimensions of different segments of the oropharyngeal cavity have different proportions between Parkinson's disease patients and vocally healthy subjects and investigate whether the measurements of these subjects' oropharyngeal geometry associate with their acoustic measurements of voice. Quantitative, descriptive, cross-sectional, and retrospective study with secondary data, approved by the Human Research Ethics Committee under no. 4.325.029. We used vocal samples and data from the oropharyngeal geometry of 40 subjects – 20 with Parkinson's disease stages I to III and 20 who formed the control group, matched for sex and age. Each group had 10 males and 10 females, mean age of 61 years (±6.0). Formant (F1, F2, and F3) and cepstral measures of the sustained vowel /ε/ were extracted and arranged in the database to determine their values using Praat software. The data were descriptively analyzed, with statistics generated with R software. The proportion of oropharyngeal geometry measurements was arranged by mean values and coefficients of variation. Pearson's linear correlation test was applied to relate voice parameters to oropharyngeal geometry, considering P < 0.05, and linear regression test, to justify F2. The Parkinson's disease group showed a linear relationship between oral cavity length and F1 in males (P = 0.04) and between glottal area and F2 in females (P = 0.00); linear relationships were established according to age in both groups, and a regression model for F2 was estimated (R2 = 0.61). There was no difference between pathological and healthy voices; there was a difference in the proportional relationship of oropharyngeal geometry between the groups. The proportional relationship of oropharyngeal geometry differs between the Parkinson's disease group and the control group, as well as the relationship between oropharyngeal geometry and formant and cepstral values of voice according to the subjects' sex and age. [ABSTRACT FROM AUTHOR]

There is a lack of information regarding the risk factors for medication-related osteonecrosis of the jaw (MRONJ) in oncological patients. This retrospective observational study evaluated the clinical factors related to the risk for MRONJ occurrence in a cohort of cancer patients using zoledronic acid (ZA). Cancer patients with a history of ZA use between June 2016 and February 2019 were included. Demographic data, comorbidities, oncological and medication information, and dental history were collected. Risk analysis was performed using multivariate logistic regression adjusted for variables with significance in the exploratory analysis. 354 patients were included, the median age was 73 years (23-99), 72% were male, 67.8% underwent dental treatment as preparation for ZA use, and 5% developed MRONJ. The analysis showed as independent risk factors the longer time of ZA use (Odds: 2.20-CI:1.11-4.59), and the presence of nutritional, metabolic, and endocrinological diseases (Odds: 5.16-CI:1.28-21.34). While the lowest frequency of drug use (Odds: 0.20-CI:0.05-0.71), and the dental treatment before starting ZA (Odds: 0.05-CI:0.01-0.23) were protective factors for MRONJ development. This was the first Brazilian study looking for risk factors in oncological ZA users. It was also the first study to demonstrate the importance of dental treatment as MRONJ prevention. [ABSTRACT FROM AUTHOR]

Increased public awareness of antimicrobial resistance (AMR) is a key component of effective antimicrobial stewardship strategies. Educational theatre combined with an expert panel was used to engage the public about AMR through delivery of a play entitled 'The drugs don't work'. Audience knowledge and understanding of AMR were measured by pre- and post-play questionnaires. Performance of the play and discussion with the expert panel significantly improved audience knowledge and understanding of AMR, including antibiotic misuse and prescribing. Educational theatre provides a positive learning experience and is an innovative method of public engagement to disseminate important public health messages. [ABSTRACT FROM AUTHOR]

Primary febrile neutropenia (FN) prophylaxis with ciprofloxacin or granulocyte-colony stimulating factors (G-CSF) is recommended with docetaxel-cyclophosphamide (TC) chemotherapy for early-stage breast cancer (EBC). A pragmatic randomised trial compared the superiority of G-CSF to ciprofloxacin and a cost-utility analysis were conducted. EBC patients receiving TC chemotherapy were randomised to ciprofloxacin or G-CSF. The primary outcome was a composite of FN and non-FN treatment-related hospitalisation. Secondary outcomes included; rates of FN, non-FN treatment-related hospitalisation, chemotherapy dose reductions/delays/discontinuations. Primary analysis was performed with the intention to treat population. Cost-utility analyses were conducted from the Canadian public payer perspective. 458 eligible patients were randomised: 228 to ciprofloxacin and 230 to G-CSF. For the primary endpoint there was non-statistically significant difference (Risk difference = −6.7%, 95%CI = −13.5%–0.1%, p = 0.061) between ciprofloxacin patients (46,20.2%) and G-CSF (31,13.5%). Patients receiving ciprofloxacin were more likely to experience FN (36/228, 15.8% vs 13/230, 5.7%) than patients receiving G-CSF (p < 0.001). Non-FN treatment-related hospitalisation occurred in 40/228 (17.5%) of ciprofloxacin patients vs 28/230 (12.2%) of G-CSF patients (p = 0.12). There were no differences in other secondary outcomes. G-CSF was associated with an incremental cost-effectiveness ratio of C$1,760,796 per one quality-adjusted life year gained. The primary endpoint of superiority of G-CSF over ciprofloxacin was not demonstrated. While there were reduced FN rates with G-CSF, there were no differences in chemotherapy dose delays/reductions or discontinuations. With the commonly used willingness to pay value of C$50,000/QALY, G-CSF use was not cost-effective compared to ciprofloxacin and deserves scrutiny from the payer perspective. • Primary febrile neutropenia (FN) prophylaxis is indicated for docetaxel-cyclophosphamide (TC) chemotherapy. • In this multicentre trial 458 breast cancer patients receiving TC chemotherapy were randomised to ciprofloxacin or to G-CSF. • For the primary endpoint of FN and non-FN treatment-related hospitalizations, G-CSF was not superior over ciprofloxacin. • While there were reduced FN rates with G-CSF, the incremental cost-effectiveness ratio was C$1,760,796 per one QALYWALY gained. [ABSTRACT FROM AUTHOR]

Critical care clinicians are central to the organ transplantation process and therefore should be aware of the myriad ethical issues it raises. Organ donation can transform the lives of transplant recipients. However, it also warrants particular ethical scrutiny. Organ procurement is a procedure that cannot physically benefit the patient upon whom it is performed. Moreover, the potential donor incapacitated by terminal illness is usually unable to actively consent to donation. This article reviews contemporary debates in vital organ transplantation, including the definition of death, perimortem interventions and research, and merits of 'opt-in' versus 'opt-out' donor registries. [ABSTRACT FROM AUTHOR]

The ant Acromyrmex ameliae is a social parasite of two leaf-cutting ant subspecies: Acromyrmex subterraneus subterraneus and A. subterraneus brunneus. Cytogenetic data are available for 14 species of Acromyrmex and all of them possess 2n = 38 chromosomes. In this study, chromosome number, heterochromatin detection, and detection of AT and GC-rich blocks of colonies of A. ameliae and its hosts were carried out. Additionally, the detection of nucleolus organizer regions and 18S rDNA clusters in chromosomes of the parasite and physical mapping of telomeres were undertaken. The same chromosome number and morphology were detected for the hosts 2n = 38 (10m + 14sm + 12st + 2a), while the females and males of the social parasite A. ameliae presented 2n = 36 (10m + 16sm + 8st + 2a) and n = 18 (5m + 8sm + 4st + 1a). In both A. ameliae and its hosts, the terminal region on the short arm of the largest subtelocentric pair is heterochromatic GC-rich, and this region corresponded to the 18S rDNA clusters in the parasite. The short arms of several chromosomes were heterochromatin-rich. The telomeric probe hybridized telomeres on all chromosomes of the parasite and was not detected in intrachromosomal regions. Through a comparative cytogenetic analysis, we hypothesize that the karyotype of A. ameliae (2n = 36) originated from a chromosomal rearrangement that reduced the number of chromosomes from 38 to 36; as available data on the genus Acromyrmex show that all other species possess 38 chromosomes, representing 45% of the 33 valid species in this genus. The mechanism of the chromosome rearrangement is discussed. Thus, the chromosome number observed in A. ameliae is a derivation from the genus. Our data show variation in the chromosomal number in Acromyrmex and suggest that analyses of the karyotypes of parasite species can yield novel insights with regards to the evolution of this genus. [ABSTRACT FROM AUTHOR]

To compare the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score with the established Society of Thoracic Surgeons (STS) and EuroSCORE II risk prediction models regarding mortality discrimination after aortic and mitral valve surgery. Retrospective cohort study. Single tertiary academic medical center. A total of 259 patients who underwent open aortic valve replacement or open mitral valve repair/replacement from 2009-2014. Retrospective chart review. MAGGIC, STS, and EuroSCORE II risk scores for each patient were studied using binary logistic regression and receiver operating characteristic analysis for the primary endpoint of one-year mortality and secondary endpoint of 30-day mortality. One-year mortality C-statistics were similar across risk scores (STS 0.709, 95% confidence interval [CI] 0.578-0.841; MAGGIC 0.673, 95% CI 0.547-0.799; EuroSCORE II 0.642, 95% CI 0.521-0.762; p = 0.56 between STS and MAGGIC; p = 0.20 between STS and EuroSCORE II; and p = 0.69 between MAGGIC and EuroSCORE II). Thirty-day mortality C-statistics also were similar between STS (0.797, 95% CI 0.655-0.939; p < 0.0001 v null hypothesis), MAGGIC (0.721, 95% CI 0.581-0.860; p = 0.33 v STS), and EuroSCORE II (0.688, 95% CI 0.557-0.818; p = 0.06 v STS; p = 0.68 v MAGGIC). The MAGGIC risk score performs similarly to STS and EuroSCORE II risk models in mortality discrimination after aortic and mitral valve surgery, albeit in a small sample size. This finding has important implications in establishing MAGGIC as a viable prognostic model in this population subset, with fewer variables and ease of use representing key advantages over STS and EuroSCORE II. [ABSTRACT FROM AUTHOR]

This paper introduces a novel concept of Digital Twinning of heat treatment and machining for predicting distortion. A set of physical experiments were conducted, and statistical models based on these trials were created. The experiments involved heat-treating AA7075 billets with multiple input conditions and measuring distortion during machining trials. This trained a Gaussian Process machining model to reproduce the real-life behaviour of a part, and to predict distortions. These predictions matched the shape and magnitude of data points of the trials. The paper suggests further refinements of the model. The developed statistical tool enables distortion prediction to produce right-first-time parts. [ABSTRACT FROM AUTHOR]

There are few surgical options available to manage complex talar pathology that result in predictably acceptable functional and patient satisfaction scores. Recently, total talar replacement has gained popularity as a viable option. This study presents the clinical outcomes of a case series of total talar replacements in South Africa. A review of data for 8 (N = 8) consecutive patients who underwent total talus replacement between July 2014 and August 2018 was performed. The American Orthopedic Foot and Ankle Society hindfoot score was used to assess clinical function and the Short Form-36 was used to assess patient satisfaction. Patient demographics as well as data on pathology, range of motion, gait analysis, and radiological outcomes were included. The mean age was 46 (range, 23-71) years. Pathologies included trauma, avascular necrosis, and tumors. The mean duration of follow-up was 23 (range, 12-49) months. The mean American Orthopedic Foot and Ankle Society score was 79.25 (range, 69-88) and the mean Short Form-36 satisfaction score was 83.25 (range, 60-93). No revision surgeries have been performed to date. Seven patients demonstrated a mildly abnormal gait and 1 revealed a moderately abnormal gait. The patient with the longest duration of follow-up showed radiological changes of tibial wear, although he remained symptom free. Our experience with the patients described in this report leads us to believe that total talar replacement is a viable surgical option in appropriately selected patients with end-stage talar pathology in the short to medium term, without compromising future salvage options. [ABSTRACT FROM AUTHOR]

Despite triple antiemetic therapy use for breast cancer patients receiving emetogenic chemotherapy, nausea remains a clinical challenge. We evaluated adding olanzapine (5 mg) to triple therapy on nausea control in patients at high personal risk of chemotherapy-induced nausea and vomiting (CINV). This multi-centre, placebo-controlled, double-blind trial randomized breast cancer patients scheduled to receive neo/adjuvant chemotherapy with anthracycline-cyclophosphamide or platinum-based chemotherapy to olanzapine (5 mg, days 1–4) or placebo. Primary endpoint was frequency of self-reported significant nausea, repeated for all cycles of chemotherapy. Secondary endpoints included: duration of nausea, overall total control of CINV, Health Related Quality of Life (HRQoL) using FLIE questionnaire, use of rescue mediation and treatment-related adverse events. 218 eligible patients were randomised to placebo (105) or olanzapine (113). From days 0–5 following each cycle of chemotherapy, 41.3% (95%CI: 36.1–46.7%) of patients in the placebo group reported significant nausea compared to 27.7% (95%CI: 23.2–32.4%) in the olanzapine group (p = 0.001). Across all cycles of chemotherapy, patients receiving olanzapine experienced a statistically significant improvement in HRQoL (p < 0.001). Grade 1/2 sedation was the most commonly side effect reported at 40.8% in the placebo group vs. 54.1% with olanzapine (p < 0.001). In patients at high personal risk of CINV, the addition of olanzapine 5 mg daily to standard antiemetic therapy significantly improves the control of nausea, HRQoL, with no unexpected toxicities. • Double-blind trial evaluated the addition of olanzapine to triple therapy in patients at high personal risk of CINV. • Adding 5 mg olanzapine was associated with significantly improved nausea control with no unexpected toxicities. • Olanzapine plus triple therapy should be considered standard of care for breast cancer patients at high risk of CINV. [ABSTRACT FROM AUTHOR]

• Intrinsically contaminated mouthwashes by B. cepacia complex caused 2 outbreaks. • Eleven patients in 72 days diagnosed with VAP by B. cepacia complex, 55% died. • B. cenocepacia and B. cepacia were 100% similar between patients and mouthwashes. • Multidisciplinary approach was crucial for success in controlling outbreaks. We report 2 consecutive outbreaks of the Burkholderia cepacia complex (Bcc) in an intensive care unit (ICU) and describe its characteristics and consequences. Over a 72-day period, a multidisciplinary ICU team detected 2 distinct periods of high and unusual incidence of Bcc isolates that were recovered from cultures of endotracheal aspirate. Cultures of tap water, ultrasound gel and mouthwash (opened and unopened bottles) were performed. Bcc was identified with the BD-Phoenix and MALDI-TOF MS systems, with molecular typing using the enterobacterial repetitive intergenic consensus-polymerase chain reaction technique. In both outbreak 1 (6 patients) and outbreak 2 (5 patients), the point sources of Bcc were chlorhexidine mouthwashes of 2 different brands, both of them intrinsically contaminated. All patients had a clinical diagnosis of ventilator-associated pneumonia (VAP), and 6 died. MALDI-TOF MS identified 2 species of Bcc (B. cenocepacia and B. cepacia). Enterobacterial repetitive intergenic consensus-polymerase chain reaction typing confirmed 100% genetic similarity between patient and mouthwash isolates from each period. The first outbreak was controlled in 20 days and the second in 6 days. The surveillance program for multidrug-resistant organisms, especially in high-risk patients, with the active participation of a multidisciplinary team, was crucial for success in controlling these outbreaks. [ABSTRACT FROM AUTHOR]

Calculations of risk from natural disasters may require ensembles of hundreds of thousands of simulations to accurately quantify the complex relationships between the outcome of a disaster and its contributing factors. Such large ensembles cannot typically be run on a single computer due to the limited computational resources available. Cloud Computing offers an attractive alternative, with an almost unlimited capacity for computation, storage, and network bandwidth. However, there are no clear mechanisms that define how to implement these complex natural disaster ensembles on the Cloud with minimal time and resources. As such, this paper proposes a system framework with two phases of cost optimization to run the ensembles as a service over Cloud. The cost is minimized through efficient distribution of the simulations among the cost-efficient instances and intelligent choice of the instances based on pricing models. We validate the proposed framework using real Cloud environment with real wildfire ensemble scenarios under different user requirements. The experimental results give an edge to the proposed system over the bag-of-task type execution on the Clouds with less cost and better flexibility. Image 1 [ABSTRACT FROM AUTHOR]

Gastroschisis is a congenital abdominal wall defect which results in herniation of abdominal contents. The objective of this study was to determine the maternal risk factors for gastroschisis in Colorado. A case–control study was performed using the Birth Registry database from 2007 to 2016. The outcome was gastroschisis, and the main variable was maternal age which was divided into < 21, 21–30, and > 30 years of age. Descriptive analysis, bivariate analysis, and logistic regression was performed. There were 236 cases of gastroschisis compared to 944 controls. Maternal age did vary significantly between groups (23.4 ± 5 years (cases) vs. 28.7 ± 5.9 years (controls); p < 0.0001). Unadjusted analysis demonstrated that those with young maternal age (< 21 years of age) had a 14.14 (95% CI 8.44–23.67) higher odds of gastroschisis compared to those > 30 years of age. Independent risk factors for gastroschisis were exposure to prenatal and first trimester cigarettes, prenatal and first trimester alcohol, and chlamydia infection. The odds (4.41, 95% CI 1.36–14.26) of gastroschisis were highest in those with first trimester cigarette exposure and young maternal age (p = 0.03). Young maternal age, cigarette exposure, alcohol exposure, and chlamydia infection increase the odds of gastroschisis. The interaction between young maternal age and first trimester cigarette exposure significantly increases the odds of gastroschisis. Prognosis Study. Level III. [ABSTRACT FROM AUTHOR]

Determining which wildlife hosts are involved in the enzootic cycles of tick-borne diseases (TBD) enables enhanced surveillance and risk assessment of potential transmission to humans and domestic species. Currently, there is limited data to indicate which tick-borne pathogens (TBP) can infect coyotes. Additionally, limited surveillance data for white-tailed deer (WTD) in south Texas is available. The purpose of this study was to detect current infections of common TBP in coyotes and WTD in south Texas, which represents a transboundary region and common site for animal migrations across the U.S.-Mexico border. A patent pending real-time PCR assay, the TickPath layerplex test, was used to screen whole-blood samples for species from Borrelia, Rickettsia, Ehrlichia, Anaplasma, and Babesia genera. Conventional PCR and subsequent sequencing of positive samples confirmed the pathogen species. Of 122 coyote samples, 11/122 (9.0%) were positive for Babesia vogeli and 1/122 (0.8%) was positive for Borrelia turicatae. Of 245 WTD samples, 1/245 (0.4%) was positive for Anaplasma platys , 4/245 (1.6%) were positive for Ehrlichia chaffeensis , and 18/245 (7.3%) were positive for Theileria cervi. All positive samples from both species, except for one coyote, were collected from counties located in south Texas along the U.S.Mexico border. One coyote positive for B. vogeli originated from a county in northern Texas. The results from this study depicts the first known molecular detection of B. turicatae in a coyote, and demonstrates that coyotes and WTDs can potentially serve as sentinels for several zoonotic TBD as well as TBD that affect domestic animals. Image 1 • Coyote samples positive for Babesia vogeli and Borrelia turicatae. • WTD samples positive for Anaplasma platys , Ehrlichia chaffeensis , Theileria cervi. • First PCR detection of B. turicatae in a coyote. • First PCR detection of A. platys in WTD within Texas. [ABSTRACT FROM AUTHOR]

Measles virus, a member of the genus Morbillivirus, is highly contagious and still shows considerable mortality with over 100 000 deaths annually, although efficient attenuated vaccines exist. Recent studies of measles virus haemagglutinin (MeV-H) and its receptor, including crystallographic and electron microscopic structural analyses combined with functional assays, have revealed how the MeV-H protein recognizes its cognate receptors, SLAM and Nectin-4, and how the glycan shield ensures effective vaccination. In addition, the crystal structure of the MeV-F protein indicated its similarity to those of other paramyxoviruses. Taking into account these data, several models of viral entry/membrane fusion of measles viruses and related paramyxoviruses have been proposed. Furthermore, anti-MeV-F inhibitors targeted to specific regions to inhibit MeV-F protein activation were reported, with potency for preventing MeV infection. The inhibitors targeted for entry events may potentially be applied to treatment of MeV-derived diseases, although escape mutations and drug profiles should be considered. [ABSTRACT FROM AUTHOR]

High levels of sociality in spiders interact with morphological traits that enhance dispersal and dispersal propensity. The social spider Anelosimus eximius occurs in tropical rainforests in South America, including in the north and mid-west Amazon, and we have recently found records of its presence in Atlantic Forest, even though the arid features of Cerrado apparently restrict contact between these two areas. In this study we investigated the population history of A. eximius using a spatiotemporal framework. Focusing on biogeographic history, we used sequences of the mitochondrial gene cytochrome oxidase subunit I (COI), to investigate population structure, diversity and time to the most recent common ancestor of the sampled individuals. We aimed to generate ecological niche models to estimate the distribution of the species from the last interglacial to the present. Our results revealed three major clusters in A. eximius (Trans-Andean, Cis-Andean, and French Guiana–Brazil) sharing common ancestors in the Late Pleistocene, c.a. 360 thousand years ago. The last interglacial period revealed a connection between A. eximius populations in Amazonia and the Atlantic forests, through the area currently occupied by the Cerrado. Dispersal over longer distances could be improved by higher rates of propagule production, growth and proliferation of new colonies. This increased dispersal capacity could be provided by wetter environments that promote prey with greater biomass, thus positively impacting the expansion of larger webs. [ABSTRACT FROM AUTHOR]

Green and sustainable food procurement has benefits for human health, the environment and economies. Public sector actors have purchasing power behind procurement decisions, and there is significant support for sustainably sourced food from consumers and the third sector. A sustainability transition in the public procurement of food would appear to be achievable, yet change remains incremental. This paper analyses supply chain stakeholder narratives about pathways to more localised public food procurement. Based on forty interviews with actors in the procurement supply chain in the South West of England, we examine the barriers and opportunities for more localised food supply and sourcing. Our findings indicate that if public food procurement is to become a viable, feasible and desirable market channel for operators of regional food businesses, we need to give greater attention to supply chain stakeholders' experiences of the interface between procurers and suppliers. Tensions exist between stakeholders' shared need for efficiency and logistical convenience, and their mutual desire for closer procurer-supplier relations and aspirations for a regional economic community. Results demonstrate that alongside the need for new physical and digital infrastructure, there is an urgent need to address socio-cultural barriers to change. • A sustainability transition in the public food procurement should be achievable. • Barriers persist despite social benefits, state buying power and policy ambitions. • Narratives of the interface between procurers and suppliers display tensions. • Change requires integration of low-cost food, convenience and economic community. • Closer procurer-supplier relationships are needed, not just new infrastructure. [ABSTRACT FROM AUTHOR]

Population aging longevity and advances in robotic surgery suggest that increasing numbers of older women having gynaeoncological surgery is likely. Postoperative morbidity and mortality are more common in older than younger women with the age-associated characteristics of multimorbidity and frailty being generally predictive of worse outcome. Priorities that inform treatment decisions change during the life course: older patients often place greater' value on quality-of-life-years gained than on life expectancy following cancer treatments. However, data on post-operative cognition, frailty, or functional independence is sparse and not routinely collected. This study aimed to describe the clinical characteristics and trajectory of functional change of older women in the 12 months following gynaeoncological surgery and to explore the associations between them. The prospective observational cohort study recruited consecutive women aged 65 or over scheduled for major gynaeoncologic surgery between July 2017 and April 2019. Baseline data on cancer stage, multimorbidity, and geriatric syndromes including cognition, frailty, and functional abilities were collected using standardised tools. Delirium and post-operative morbidity were recorded. Post hospital assessments were collected at 3-, 6-, and 12-months. Overall, of 103 eligible participants assessed pre-operatively, most (77, 70%) remained independent in personal care at all assessments from discharge to 12 months. Functional trajectories varied widely over the 12 months but overall there was no significant decline or improvement for the 85 survivors. Eleven experienced a clinically significant decline in function at six months. This was associated with baseline low mood (P < 0.05), albeit with small numbers (6 of 11). Cognitive impairment and frailty were associated with lower baseline function but not with subsequent functional decline. There was no clear clinical profile to identify the minority of older adults who experienced a clinically significant decline six months after surgery and for most, the decline was transient. This may be helpful in enabling informed patient consent. Assessment for geriatric syndromes and frailty may improve individual care but our findings do not indicate criteria for segmenting the patient population for selective attention. Future work should focus on causal pathways to potentially avoidable decline in those patients where this is not determined by the cancer itself. [ABSTRACT FROM AUTHOR]