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There is an urgent critical need for a patient-forward vaginal stent that can prevent debilitating vaginal stenosis that occurs after pelvic radiation treatments and vaginal reconstruction. To this end, we developed a self-fitting vaginal stent based on a shape-memory polymer (SMP) foam that can assume a secondary, compressed shape for ease of deployment. Upon insertion, the change in temperature and hydration initiates foam expansion to shape fit to the individual patient and restore the lumen of the stent to allow egress of vaginal secretions. To achieve rapid actuation at physiological temperature, we investigated the effect of architecture of two photocurable, polycaprolactone (PCL) macromers. Star -PCL-tetraacrylate displayed a reduced melting temperature as compared to a linear -PCL-diacrylate. Upon fabrication into high porosity foams with emulsion-templating, both compositions displayed shape fixity (>90 %) in a crimped, temporary shape. However, only the PCL star- foams displayed shape recovery (∼84 %) at 37 °C with expansion back to its permanent shape. A custom mold and curing system were then used to fabricate the PCL star- foams into hollow, cylindrical stents. The stent was crimped to its temporary insertion shape (50 % reduction in diameter, OD ∼ 11 mm) with a custom radial crimper and displayed excellent shape fixity for deployment (> 95 %) and shape recovery (∼ 100 %). To screen vaginal stents, we developed a custom benchtop pelvic model that simulated vaginal anatomy, temperatures, and pressures with an associated computational model. The crimped SMP vaginal stent was deployed in the model and expanded to walls of the canal (∼70 % increase in cross-sectional area) in less than 5 min after irrigation with warm water. The vaginal stent demonstrated retention of vaginal caliber with less than 10 % decrease in cross-sectional area under physiological pressures. Collectively, this work demonstrates the potential for SMP foams as self-fitting vaginal stents to prevent stenosis and provides new open-source tools for the iterative design of other gynecological devices. Vaginal stenosis, a painful narrowing of the vaginal canal, is a common complication after pelvic radiation therapy or reconstructive surgery. To address this clinical need, we have created a self-fitting vaginal stent from a shape-memory polymer foam. The stent compresses for easy insertion and then expands to adapt to each patient's anatomy to maintain an open vaginal canal and prevent stenosis. This innovative stent provides a patient-friendly solution that could make a significant difference for women undergoing pelvic treatments by reducing pain, aiding recovery, and improving quality of life. [Display omitted] [ABSTRACT FROM AUTHOR]

Recurrent ventricular tachycardia (VT) can be treated by substrate modification of the myocardial scar by catheter ablation during sinus rhythm without VT induction. Better defining this arrhythmic substrate could help improve outcome and reduce ablation burden. The study aimed to limit ablation within postinfarction scar to conduction channels within the scar to reduce VT recurrence. Patients undergoing catheter ablation for recurrent implantable cardioverter-defibrillator therapy for postinfarction VT were recruited at 5 centers. Left ventricular maps were collected on CARTO using a Pentaray catheter. Ripple mapping was used to categorize infarct scar potentials (SPs) by timing. Earliest SPs were ablated sequentially until there was loss of the terminal SPs without their direct ablation. The primary outcome measure was sustained VT episodes as documented by device interrogations at 1 year, which was compared with VT episodes in the year before ablation. The study recruited 50 patients (mean left ventricular ejection fraction, 33% ± 9%), and 37 patients (74%) met the channel ablation end point with successful loss of latest SPs without direct ablation. There were 16 recurrences during 1-year follow-up. There was a 90% reduction in VT burden from 30.2 ± 53.9 to 3.1 ± 7.5 (P <.01) per patient, with a concomitant 88% reduction in appropriate shocks from 2.1 ± 2.7 to 0.2 ± 0.9 (P <.01). There were 8 deaths during follow-up. Those who met the channel ablation end point had no significant difference in mortality, recurrence, or VT burden but had a significantly lower ablation burden of 25.7 ± 4.2 minutes vs 39.9 ± 6.1 minutes (P =.001). Scar channel ablation is feasible by ripple mapping and can be an alternative to more extensive substrate modification techniques. [Display omitted] [ABSTRACT FROM AUTHOR]

Three-dimensional (3D) mapping of the ventricular conduction system is challenging. The purpose of this study was to use ripple mapping to distinguish conduction system activation to that of adjacent myocardium in order to characterize the conduction system in the postinfarct left ventricle (LV). High-density mapping (PentaRay, CARTO) was performed during normal rhythm in patients undergoing ventricular tachycardia ablation. Ripple maps were viewed from the end of the P wave to QRS onset in 1-ms increments. Clusters of >3 ripple bars were interrogated for the presence of Purkinje potentials, which were tagged on the 3D geometry. Repeating this process allowed conduction system delineation. Maps were reviewed in 24 patients (mean 3112 ± 613 points). There were 150.9 ± 24.5 Purkinje potentials per map, at the left posterior fascicle (LPF) in 22 patients (92%) and at the left anterior fascicle (LAF) in 15 patients (63%). The LAF was shorter (41.4 vs 68.8 mm; P =.0005) and activated for a shorter duration (40.6 vs 64.9 ms; P =.002) than the LPF. Fourteen of 24 patients had left bundle branch block (LBBB), with 11 of 14 (78%) having Purkinje potential–associated breakout. There were fewer breakouts from the conduction system during LBBB (1.8 vs 3.4; 1.6 ± 0.6; P =.039) and an inverse correlation between breakout sites and QRS duration (P =.0035). We applied ripple mapping to present a detailed electroanatomic characterization of the conduction system in the postinfarct LV. Patients with broader QRS had fewer LV breakout sites from the conduction system. However, there was 3D mapping evidence of LV breakout from an intact conduction system in the majority of patients with LBBB. [Display omitted] [ABSTRACT FROM AUTHOR]

Permanent surgical orchiectomy with or without scrotal ablation has become the contraceptive method of choice in male macropods, as reversible chemical methods have found little success. Four cases of elective orchiectomy and scrotal ablation utilizing an electrothermal bipolar tissue sealing device (LigaSureTM), a novel technique, was described in 1 red kangaroo (Osphranter rufus), 1 parma wallaby (Notamacropus parma), and 2 red-necked wallabies (Notamacropus rufogriseus). The mean surgical time was 90 seconds. Two cases experienced incision dehiscence during routine postoperative hospitalization. In both cases, the incision was reapposed using skin staples (Case 1) or suture (Case 2), with no further complications noted. No long-term complications were noted following orchiectomy in any of the cases. While orchiectomy and scrotal ablation were rapid in the described cases with no long-term complications, barbering, and subsequent incisional dehiscence were noted within the first 24 hours postoperatively, requiring reapposition in 2 cases. The authors recommend utilizing appropriately sized vessel-sealing devices based on the size of the scrotal stalk, adequate analgesia, closure with suture, and use of a diaper or an Elizabethan collar to decrease the incidence of incisional dehiscence. [ABSTRACT FROM AUTHOR]

Bariatric surgery is an increasingly popular treatment for patients with severe obesity and related health issues (e.g., diabetes, cardiovascular disease). Studies have identified alterations in functional connectivity both in obesity and following surgical treatment for severe obesity. This study aimed to assess brain function via resting-state within-network connectivity in bariatric surgery patients with severe obesity. University hospital. Thirty-four bariatric surgery patients completed functional neuroimaging at baseline and postoperatively (goal, 12 weeks; actual, 16 weeks, on average). They also self-reported health information. Baseline resting-state functional connectivity (RSFC) was predicted by baseline age, body mass index (BMI), continuous positive airway pressure use, and reported history of rheumatoid arthritis and type 2 diabetes. Change in RSFC was assessed using the same predictors. This model was run with and without controlling for baseline RSFC. Higher baseline BMI predicted lower baseline RSFC in 3 networks. Lower baseline RSFC also was related to rheumatoid arthritis and type 2 diabetes. Difference between baseline and follow-up RSFC was strongly negatively associated with baseline RSFC. Controlling for baseline RSFC, type 2 diabetes negatively predicted RSFC difference. RSFC may reflect brain dysfunction in patients with obesity and related diseases. That less connectivity at baseline predicted greater positive change suggests that RSFC may be a biomarker of neurocognitive improvement following bariatric surgery. Diseases more prevalent in patients with obesity (e.g., rheumatoid arthritis and type 2 diabetes) along with elevated BMI negatively affect RSFC likely through inflammatory pathways. [ABSTRACT FROM AUTHOR]

[Display omitted] Aspirin-exacerbated respiratory disease (AERD) is a severe disease involving dysregulated type 2 inflammation. However, the role other inflammatory pathways play in AERD is poorly understood. We sought to broadly define the inflammatory milieu of the upper respiratory tract in AERD and to determine the effects of IL-4Rα inhibition on mediators of nasal inflammation. Twenty-two AERD patients treated with dupilumab for 3 months were followed over 3 visits and compared to 10 healthy controls. Nasal fluid was assessed for 45 cytokines and chemokines using Olink Target 48. Blood neutrophils and cultured human mast cells, monocytes/macrophages, and nasal fibroblasts were assessed for response to IL-4/13 stimulation in vitro. Of the nasal fluid cytokines measured, nearly one third were higher in AERD patients compared to healthy controls, including IL-6 and the IL-6 family–related cytokine oncostatin M (OSM), both of which correlated with nasal albumin levels, a marker of epithelial barrier dysregulation. Dupilumab significantly decreased many nasal mediators, including OSM and IL-6. IL-4 stimulation induced OSM production from mast cells and macrophages but not from neutrophils, and OSM and IL-13 stimulation induced IL-6 production from nasal fibroblasts. In addition to type 2 inflammation, innate and IL-6–related cytokines are also elevated in the respiratory tract in AERD. Both OSM and IL-6 are locally produced in nasal polyps and likely promote pathology by negatively affecting epithelial barrier function. IL-4Rα blockade, although seemingly directed at type 2 inflammation, also decreases mediators of innate inflammation and epithelial dysregulation, which may contribute to dupilumab's therapeutic efficacy in AERD. [ABSTRACT FROM AUTHOR]

• Scapular mobility is uniquely challenging to assess and currently there is no reliable goniometric technique described in the literature to measure scapular protraction and retraction. • The current study examined intra and inter-rater reliability of a goniometric technique using the superior angle and acromion as landmarks to measure the position of the scapula relative to the frontal plane. • SEM for repeat measures by the expert and novice raters was < 4.5° and < 3.9°respectively, and SEM between evaluators was < 5.0°, demonstrating absolute reliability similar to that of other goniometric assessments. • Minimum detectable change (MDC) values as a percentage of the mean (% MDC), reflecting the degree of measurement error as a percentage of the available motion, ranged between 15.9-43.7% for intra-rater reliability and 21.9-52.8% for inter-rater reliability. Observational, descriptive design. Despite scapular mobility being essential for the completion of activities of daily living (ADLs), there is currently no established, a reliable goniometric technique to measure scapular protraction and retraction. A proposed method has shown clinically significant inter-rater reliability for a goniometric technique for these measurements. This observational descriptive study examined the intra-rater reliability of a goniometric technique to assess scapular protraction and retraction among a sample of healthy adults. An occupational therapist who is a certified hand therapist (CHT) and an occupational therapy student used goniometry to measure the neutral (resting), protracted, and retracted positions of the right and left scapula for a sample of healthy young adults (n = 54; a total of 108 data points for each measurement). These measurements were compared to analyze intra-rater and inter-rater reliability. For measurements of the scapula in neutral, protraction, and retraction, the standard error of measure (SEM) for repeat measures by the expert and novice raters was < 4.5° and < 3.9° respectively and ICC values ranged from poor to moderate (0.37-0.63). The SEM for measures between evaluators was < 5.0° and the ICC was poor (0.16-0.35). Minimum detectable change (MDC) values as a percentage of the mean (% MDC) ranged between 15.9 and 43.7% for intra-rater reliability and 21.9-52.8% for inter-rater reliability. The results of the study were mixed; variance of less than 5° for repeat measures by the same rater and measures between raters suggest clinically acceptable reliability. However, variance as a proportion of available motion (%MDC) demonstrates a broader range both above and below the threshold of 30% suggested for rehabilitation assessments. There are few efficient, reliable techniques to measure scapular mobility in clinical practice. The absolute reliability of goniometry to measure scapular protraction and retraction is similar to measurements of other joints. However, additional research and possible refinement of the technique is recommended to further address relative reliability and validity. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether a standardized dietary supplementation can help to decrease postoperative muscle atrophy and/or improve rehabilitation outcomes in patients who underwent anterior cruciate ligament reconstruction (ACLR).Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). MEDLINE, Scopus, and Cochrane Library databases were searched, and articles that examined protein or amino acid, vitamin, or any other type of supplementation in ACLR were reviewed. Two independent reviewers conducted the search using pertinent Boolean operations.Results: A total of 1818 articles were found after our database search. Ten studies fulfilled our inclusion criteria and only assessed patients undergoing ACLR. Four studies assessed protein-based supplementation. One study assessed creatine as a supplement. Four studies assessed vitamin-based supplementation. One study assessed testosterone supplementation. Protein and amino acid supplementation showed potential benefits; multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, graft maturation, muscular hypertrophic response, and peak dynamic muscle strength. When we examined creatine, vitamin, or hormone-based protocols, none demonstrated results, suggesting these factors may attenuate muscle atrophy after surgery. Vitamin C and E demonstrated potentially increased local inflammation in skeletal muscle, which runs contrary to the belief that antioxidant vitamin-based supplementation may decrease the inflammatory response that plays a role in the post injury/operative period.Conclusions: Protein-based supplementation may play a role in mitigating muscle atrophy associated with ACLR, as multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, thigh hypertrophic response, and peak dynamic muscle strength. However, based on current literature, it is not possible to recommend a specific protein-based supplementation protocol at this time for patients undergoing ACLR. Limited evidence suggests no benefit for creatine, vitamin, or hormone-based protocols.Level Of Evidence: II, a systematic review of level I-II studies. [ABSTRACT FROM AUTHOR]

The physical layout of the emergency department affects the way in which patients and providers move within the space and can cause substantial changes in workflow and, therefore, affect communication patterns between providers. There is no 1 ED design that enables the best patient care, and quantitative studies looking at ED design are limited. The goal of this study was to examine how different ED designs, centralized and decentralized, are associated with communication patterns among health care professionals. A task performance, direct observation time study was used. By developing a novel tablet-based digital mapping tool using a cloud-based mapping platform (ArcGIS), data on provider actions and interactions were collected and mapped to a precise location within the emergency department throughout an entire nursing shift. The difference in the duration of nurse-physician interactions between the 2 ED designs was statistically significant. Within the centralized design, nurse-physician interactions totaled 14 minutes and 38 seconds compared with 30 minutes and 11 seconds in the decentralized design (t = 2.31, P = 0.02). More conversations between nurses and physicians occurred inside the patient's room in the decentralized design. Our findings suggest that the ED design affects communication patterns among health care providers and that the design has the potential to affect the quality of patient care. [ABSTRACT FROM AUTHOR]

A 2-year-old, intact female inland bearded dragon (Pogona vitticeps) presented with a history of hyperglycemia and nonspecific gastrointestinal signs including frequent regurgitation and diarrhea. Ultrasound and computed tomography revealed the presence of gastric and hepatic masses. A fine needle aspiration biopsy with cytology of the liver revealed neoplastic epithelial cells, which were present in variably sized, crowded, disorganized clusters, surrounded by abundant, intact, and bare nuclei suggesting a fragile cell population. Nuclear chromatin was stippled without prominent nucleoli and the cytoplasm was lightly basophilic and the cells had a high nuclear:cytoplasmic (N:C) ratio. The cytologic diagnosis was a malignant neoplasm of neuroendocrine origin. The diagnostic imaging (ultrasonography, computed tomography) and cytology of a hepatic mass led to the antemortem diagnosis of gastric neuroendocrine carcinoma (gNEC). The animal was euthanized due to poor prognosis and diagnosis of gNEC was confirmed with histopathology. Immunohistochemical stains were performed for several neuroendocrine markers, but only somatostatin exhibited mild immunoreactivity in this case. Therefore, fine needle aspiration biopsy with cytology should be considered as a minimally invasive, antemortem diagnostic technique for gNEC in bearded dragons. [ABSTRACT FROM AUTHOR]

Background: Natural infection with tetanus in rabbits is not well studied, despite the fact that rabbits have been used for more than 100 years as a laboratory model of tetanus infections. Case Description: An adult male intact domestic rabbit (Oryctolagus cuniculus) was presented for lethargy and bilateral crusting with purulent discharge from the external ear canals. Cytology of the aural crusts confirmed the presence of Psoroptes cuniculi and Gram stain of the purulent material confirmed concurrent mixed bacterial otitis with a large number of nonsporulating Gram positive rods. Eight hours after presentation, the animal progressed to full body rigidity and increased respiratory effort. Tetanus was suspected based on clinical appearance, but presumptive treatment with tetanus antitoxin was declined and the patient was euthanized. Necropsy and histopathology confirmed an intact tympanum bilaterally, and no evidence of otitis media/interna or intracranial disease. Anaerobic culture of the purulent aural debris was positive for Clostridium sp. 16S rRNA gene partial sequencing on the anaerobic bacterial isolate showed 87% homology to Clostridium tetani. PCR analysis confirmed the presence of the neurotoxin gene, TetX, and the bacteria's origin as C. tetani. Western blotting and ELISA analyses did not detect free neurotoxin. Conclusions and Case Relevance: This case is unique to veterinary medicine in its confirmation of association of a C. tetani infection with Psoroptes cuniculi and otitis externa rather than associated with a penetrating injury or otitis media. Furthermore, naturally occurring tetanus in rabbits is underreported. [ABSTRACT FROM AUTHOR]

Detection and identification of body fluids plays a crucial role in criminal investigation, as it provides information on the source of the DNA as well as corroborative evidence regarding the crime committed, scene, and/or association with persons of interest. Historically, forensic serological methods have been chemical, immunological, catalytic, spectroscopic, and/or microscopic in nature. However, most of these methods are presumptive, with few robust confirmatory exceptions. In recent years several new molecular methods (mRNA, miRNA, DNA methylation, etc.) have been proposed; although promising, these methods require high quality human DNA or RNA. Additional steps are required in RNA based methods. Additionally, RNA based methods cannot be used for old cases where only DNA extracts remain to sample from. In this study, a novel non-human DNA (microbiome) based method was developed for the identification of the majority of forensically relevant human biological samples. Eight hundred and twelve (n = 812) biological samples (semen, vaginal fluid, menstrual blood, saliva, feces, urine, and blood) were collected and preserved using methods commonly used in forensic laboratories for evidence collection. Variable region four (V4) of 16 S ribosomal DNA (16 S rDNA) was amplified using a dual-indexing strategy and then sequenced on the MiSeq FGx sequencing platform using the MiSeq Reagent Kit v2 (500 cycles) and following the manufacturer's protocol. Machine learning prediction models were used to assess the classification accuracy of the newly developed method. As there was no significant difference in bacterial communities between vaginal fluid, menstrual blood, and female urine, these were combined as female intimate samples. Except in urine, the bacterial structures associated with male and female body fluid samples were not significantly different from one another. The newly developed method accurately identified human body fluid samples with an overall accuracy of more than 88%. This newly developed bacterial signature-based method is fast (no additional steps are needed as the same DNA can be used for both body fluid identification and STR typing), efficient (consume less sample as a single test can identify all major body fluids), sensitive (needs only 5 pg of bacterial DNA), accurate, and can be easily added into a forensic high throughput sequencing (HTS) panel. • Bacteria from saliva, feces, blood, male urine, and semen differed significantly. • Bacteria from female intimate samples did not differ significantly from each other. • Venous blood and menstrual blood could be accurately differentiated. • Bacterial signatures in urine can be used to differentiate male and female samples. • This method identifies seven body fluids at once, with an overall accuracy of 89%. [ABSTRACT FROM AUTHOR]

• The Headless Compression Screw Fastener (HCSF) achieved adequate compression of simulated C3 slab fractures • HCSF were biomechanically similar to cortical screws when tested in shear • No glide hole is required to place the HCSF in lag fashion • The headless nature of the HCSF is likely beneficial for C3 slab fracture fixation Frontal plane slab fractures account for the majority of third carpal bone (C3) fractures in racing and performance horses. Recommended treatment is stabilization with a lagged AO cortical screw. Associated complications are fragment splitting, fragment spinning, and irritation of dorsal soft tissue structures. A novel, headless, cannulated screw with interlocking threads the Headless Compression Screw Fastener (HCSF) has been developed to resist multidirectional forces and bending moments; however, it has not been applied in the horse. Simulated C3 frontal plane slab fractures were created in nine paired carpi from equine cadaver limbs, fixed with either the HCSF or AO cortical bone screw, and loaded in shear to failure. The effect of screw type on stiffness, maximum load to failure, and yield load was assessed in separate linear mixed models. No significant (P <.05) difference between screw types was detected in terms of maximum load to failure (P =.084), stiffness (P =.26), or yield load (P =.088). Mode of failure was screw bending in all specimens. For some samples in both groups, failure was associated with the sagittal fracture at the screw-bone interface. The HCSF was successfully used to repair simulated third carpal bone fractures. The different head and thread pitches of the HCSF effectively compressed the fracture. The headless design eliminates the need for counter sinking. There was no significant difference in maximum load to failure, stiffness, nor yield load compared to the cortical screws. These results invite clinical application to be investigated. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to identify the effect of coronary autoregulation on myocardial perfusion during intra-aortic balloon pump (IABP) therapy. Background: IABP is the most commonly used circulatory support device, although its efficacy in certain scenarios has been questioned. The impact of alterations in microvascular function on IABP efficacy has not previously been evaluated in humans. Methods: Thirteen patients with ischemic cardiomyopathy (left ventricular ejection fraction: 34 ± 8%) undergoing percutaneous coronary intervention were recruited. Simultaneous intracoronary pressure and Doppler-flow measurements were undertaken in the target vessel following percutaneous coronary intervention, during unassisted and IABP-assisted conditions. Coronary autoregulation was modulated by the use of intracoronary adenosine, inducing maximal hyperemia. Wave intensity analysis characterized the coronary wave energies associated with balloon counterpulsation. Results: Two unique diastolic coronary waves were temporally associated with IABP device use; a forward compression wave and a forward expansion wave caused by inflation and deflation, respectively. During basal conditions, IABP therapy increased distal coronary pressure (82.4 ± 16.1 vs. 88.7 ± 17.8 mm Hg, p = 0.03), as well as microvascular resistance (2.32 ± 0.52 vs. 3.27 ± 0.41 mm Hg cm s–1, p = 0.001), with no change in average peak velocity (30.6 ± 12.0 vs. 26.6 ± 11.3 cm s–1, p = 0.59). When autoregulation was disabled, counterpulsation caused an increase in average peak velocity (39.4 ± 10.5 vs. 44.7 ± 17.5 cm s–1, p = 0.002) that was linearly related with IABP–forward compression wave energy (R2 = 0.71, p = 0.001). Conclusions: Autoregulation ameliorates the effect of IABP on coronary flow. However, during hyperemia, IABP augments myocardial perfusion, principally due to a diastolic forward compression wave caused by balloon inflation, suggesting IABP would be of greatest benefit when microcirculatory reserve is exhausted. [Copyright &y& Elsevier]

Background: Flight-related measles contact investigations in the United States are coordinated by the Centers for Disease Control and Prevention (CDC). To evaluate the efficiency of CDC's measles protocol, we analyzed data from contact investigations conducted December 2008-December 2011. Methods: Cases were defined as travelers diagnosed with measles that were infectious at the time of the flight. Passengers seated within 2 rows of the case-traveler and all babies-in-arms were defined as contacts. Contact information obtained from airlines was distributed to US health departments; reporting of outcomes was requested. We cross-referenced the National Notifiable Diseases Surveillance System and CDC's National Center for Immunization and Respiratory Diseases to identify unreported cases in passenger-contacts and in passengers not identified as contacts. Results: Our evaluation included 74 case-travelers on 108 flights. Information for 2673 (79%) of 3399 passenger-contacts was provided to health departments; 9 cases of secondary measles were reported. No additional cases were identified.Conclusion: Our evaluation provided evidence of measles transmission related to air travel. CDC's protocol efficiently identifies passengers most at risk of exposure and infection for flights into and within the United States. [ABSTRACT FROM AUTHOR]

Summary: Since November 2006, flight-related mumps contact investigations were conducted in the United States only for flights ≥5 h long after an investigation showed minimal risk of mumps transmission on flights <5 h. Because the transmission risk on longer flights had not been evaluated, we investigated whether there was evidence to support the guidelines. We examined data from mumps contact investigations that were initiated by the US Centers for Disease Control and Prevention (CDC) from November 2006 to October 2010. We also cross-referenced passenger-contact data with data on mumps cases in the National Notifiable Diseases Surveillance System (NNDSS). Twenty-seven cases met inclusion criteria. Of 246 passengers identified as contacts, 166 (67%) were distributed to a US health department for contact tracing. Outcomes were reported for 21 (13%) of those 166 passengers. No secondary cases of mumps among passenger contacts were reported or identified by cross-referencing NNDSS data. The findings suggested that in-flight risk of mumps transmission is not high. Furthermore, these investigations have low yield, are resource intensive, there is no post-exposure prophylaxis, and mumps transmission has not been eliminated in the United States. Therefore, CDC discontinued conducting flight-related mumps contact investigations in May 2011. [Copyright &y& Elsevier]

Abstract: We describe a child of Middle Eastern descent by first-cousin coupling with idiopathic neurogenic bladder and high-grade vesicoureteral reflux at 1 year of age, whose characteristic facial grimace led to the diagnosis of Ochoa (urofacial) syndrome at age 5 years. We used homozygosity mapping, exome capture and paired-end sequencing to identify the disease causing mutation in the proband. We reviewed the literature with respect to the urologic manifestations of Ochoa syndrome. A large region of marker homozygosity was observed at 10q24, consistent with known autosomal recessive inheritance, family consanguinity and previous genetic mapping in other families with Ochoa syndrome. A homozygous mutation was identified in the proband in HPSE2: c.1374_1378delTGTGC, a deletion of 5 nucleotides in exon 10 that is predicted to lead to a frameshift followed by replacement of 132 C-terminal amino acids with 153 novel amino acids (p.Ala458Alafsdel132ins153). This mutation is novel relative to very recently published mutations in HPSE2 in other families. Early intervention and recognition of Ochoa syndrome with control of risk factors and close surveillance will decrease complications and renal failure. [Copyright &y& Elsevier]

This paper examines whether level of analyst following affects firms' labor investment efficiency. Using a sample of US public companies from 2001 to 2015, we find that firms with greater analyst coverage make more efficient labor investment decisions. Increased efficiency of labor investment is ascribed to lower levels of firms' over-firing problems. Moreover, we find that analysts have a more positive influence on efficiency of labor investment when firms have higher cash holdings. This paper emphasizes the role of analysts in firms' labor investment decisions. [ABSTRACT FROM AUTHOR]