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Myocardial fibrosis, as diagnosed on cardiac magnetic resonance imaging (cMRI) by late gadolinium enhancement (LGE), is associated with adverse outcomes in adults with hypertrophic cardiomyopathy (HCM), but its prevalence and magnitude in children with HCM have not been established. We investigated: (1) the prevalence and extent of myocardial fibrosis as detected by LGE cMRI; (2) the agreement between echocardiographic and cMRI measurements of cardiac structure; and (3) whether serum concentrations of N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) and cardiac troponin-T are associated with cMRI measurements. A cross-section of children with HCM from 9 tertiary-care pediatric heart centers in the U.S. and Canada were enrolled in this prospective NHLBI study of cardiac biomarkers in pediatric cardiomyopathy (ClinicalTrials.gov Identifier: NCT01873976). The median age of the 67 participants was 13.8 years (range 1-18 years). Core laboratories analyzed echocardiographic and cMRI measurements, and serum biomarker concentrations. In 52 children with non-obstructive HCM undergoing cMRI, overall low levels of myocardial fibrosis with LGE >2% of left ventricular (LV) mass were detected in 37 (71%) (median %LGE, 9.0%; IQR: 6.0%, 13.0%; range, 0% to 57%). Echocardiographic and cMRI measurements of LV dimensions, LV mass, and interventricular septal thickness showed good agreement using the Bland-Altman method. NT-proBNP concentrations were strongly and positively associated with LV mass and interventricular septal thickness (P <.001), but not LGE. Low levels of myocardial fibrosis are common in pediatric patients with HCM seen at referral centers. Longitudinal studies of myocardial fibrosis and serum biomarkers are warranted to determine their predictive value for adverse outcomes in pediatric patients with HCM. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the third most common cancer in the United States.1 Although CRC incidence has declined in individuals >50 years, incidence is rising in adults <50 years (early onset).1 By 2027, CRC is projected to become the leading cause of cancer mortality in US adults <50 years.2 To combat the rising incidence of early onset CRC (EOCRC), national guidelines recently lowered the screening age from 50 to 45 years for average-risk individuals.3 Understanding the risk profile of EOCRC can help combat the rising burden in young adults, especially in those ineligible for screening. [ABSTRACT FROM AUTHOR]

Allergic conjunctivitis (AC) is an ocular inflammatory disease with symptoms driven by eosinophils and mast cells. Allergic comorbidities are common. Current treatments are often ineffective in severe AC and limited by potential side effects. Lirentelimab is an anti–sialic acid–binding immunoglobulin-like lectin-8 mAb that depletes eosinophils and inhibits mast cells. We sought to determine safety and preliminary efficacy of lirentelimab in an open-label, phase 1b study. Patients with chronic, severely symptomatic atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC, and who had history of topical or systemic corticosteroid use, were enrolled to receive up to 6 monthly lirentelimab infusions (dose 1: 0.3 mg/kg, dose 2: 1 mg/kg, subsequent doses: 1 or 3 mg/kg). Changes from baseline in peripheral blood eosinophils, changes in patient-reported symptoms (measured by daily Allergic Conjunctivitis Symptom Questionnaire, including atopic comorbidities), changes in investigator-reported ocular signs and symptoms (Ocular Symptom Scores), changes in quality of life, and changes in tear cytokine and chemokine levels were assessed. Thirty patients were enrolled (atopic keratoconjunctivitis n = 13, vernal keratoconjunctivitis n = 1, perennial AC n = 16), 87% of whom had atopic comorbidities. After lirentelimab treatment, mean improvement was observed in Allergic Conjunctivitis Symptom Questionnaire score (−61%; 95% CI, −75% to −48%) and Ocular Symptom Scores (−53%; 95% CI, −76% to −31%), consistent across atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC groups. There was substantial improvement in atopic comorbidities, with −55% (95% CI, −78% to −31%), −50% (95% CI, −82% to −19%), and −63% (95% CI, −87% and −38%) reduction in symptoms of atopic dermatitis, asthma, and rhinitis, respectively. Levels of key mediators of inflammation were reduced in patient tears after lirentelimab treatment. The most common adverse effects were mild to moderate infusion-related reactions. Lirentelimab was well tolerated, improved severe AC and concomitant atopic symptoms, and reduced inflammatory mediators in patient tears. [ABSTRACT FROM AUTHOR]

Postoperative cardiac troponin I concentration is predictive of worsened outcomes in cardiac surgery. Lung transplantation (LT) surgery shares common features with cardiac surgery, but postoperative troponin has yet to be investigated. The authors aimed to evaluate the association between early postoperative troponin concentration and the 1-year mortality after transplantation. A retrospective, observational, single-center study. At a tertiary care, university hospital. Patients who underwent lung transplantation from January 2011 to December 2017 For each patient, preoperative, intraoperative, and postoperative data were collected, as well as the troponin I measurement at the moment of postoperative intensive care unit admission. Two hundred twenty LT procedures were analyzed. Troponin I was elevated in all LT patients, with a median of 3.82 ng/mL−1 (2-6.42) ng/mL−1 significantly higher in non-survivors than in survivors with 5.39 (2.88-7.44) v 3.50 ng/mL (1.74-5.76), p = 0.005. In the multivariate analysis, the authors found that only the Simplified Acute Physiology Score II score (hazard ratio [HR] 1.03; 95% confidence interval [CI] [1.001; 1.05]; p = 0.007) and the need to maintain extracorporeal life support at the end of surgery (HR 2.54; 95% CI [1.36; 4.73]; p = 0.003) were independently associated with the 1-year mortality. The multiple linear regression model found that troponin levels were associated with the need for extracorporeal life support (ECLS) (p = 0.014), the amount of transfused packed red blood cells (p = 0.008), and bilateral LT (p < 0.001). Early postoperative troponin serum levels were not independently associated with 1-year mortality. Early postoperative troponin I levels were correlated to bilateral LT, the need for ECLS, and intraoperative blood transfusion. [ABSTRACT FROM AUTHOR]

Cardiac surgery increasingly is being performed in patients with a history of or with active cancer. The aim of this study was to analyze the association between a history of cancer and 1-year mortality after cardiac surgery with cardiopulmonary bypass (CPB). An observational monocentric study, with data collected from a prospective institutional database was conducted. A single academic center. All consecutive patients undergoing cardiac surgery with CPB between 2005 and 2017. None. A history of cancer was preoperatively identified. Mortality rates were estimated by the Kaplan-Meier method. The 1-year mortality risk of patients with and without cancer was compared using a multivariate Cox model. During the study period, 12,143 patients underwent cardiac surgery with CPB, including 4,681 (39%) isolated coronary artery bypass surgeries. Their median EuroSCORE II was 3.1, interquartile range 1.5-to-6.4. Nine hundred thirty patients (8%) had a diagnosis of cancer, out of whom 469 (50%) were diagnosed ≤5 years before the index surgery; 103 (11%) patients had hemopathy, and 825 (89%) had solid cancers. The estimated unadjusted 1-year mortality was significantly higher among patients with cancer, 11% (95% confidence interval [CI] 10-14) versus 8% (95%CI 7-9) p < 0.01. After adjustment, a diagnosis of cancer was not associated with the risk of 1-year mortality (adjusted hazard ratio = 1.17 [95%CI 0.96-1.43]; p = 0.13). In a large cohort of patients undergoing cardiac surgery with CPB, cancer was not independently associated with 1-year mortality. An isolated cancer history should not lead to denial of cardiac surgery. The impact of cancer on complications and long-term survival after cardiac surgery requires further research. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: To compare the biomechanical effects of superior capsule reconstruction (SCR) graft fixation length determined at 20° and 40° of glenohumeral (GH) abduction.Methods: Humeral translation, rotational range of motion (ROM), and subacromial contact pressure were quantified at 0°, 30°, and 60° of GH abduction in the scapular plane in 6 cadaveric shoulders for the following states: intact, massive rotator cuff tear, SCR with dermal allograft fixed at 20° of GH abduction (SCR 20), and SCR with dermal allograft fixed at 40° of GH abduction (SCR 40). Statistical analysis was conducted using a repeated-measures analysis of variance and a paired t test (P < .05).Results: A massive cuff tear significantly increased total ROM compared with the intact state at 0° and 60° of abduction. SCR 20 or SCR 40 did not affect ROM. Compared with the intact state, the massive cuff tear model significantly increased superior translation by an average of 4.6 ± 0.5 mm in 9 of 12 positions (P ≤ .002). Both SCR 20 and SCR 40 reduced superior translation compared with the massive cuff tear model (P < .05); however, SCR 40 significantly decreased superior translation compared with SCR 20 at 0° of abduction (P ≤ .046). Peak subacromial pressure for the massive cuff tear model increased by an average of 486.8 ± 233.9 kPa relative to the intact state in 5 of 12 positions (P ≤ .037). SCR 20 reduced peak subacromial pressure in 2 of 12 positions (P ≤ .012), whereas SCR 40 achieved this in 6 of 12 positions (P ≤ .024).Conclusions: SCR with dermal allograft fixed at 20° or 40° of GH abduction decreases GH translation and subacromial pressure without decreasing ROM.Clinical Relevance: With an increasing abduction angle for graft fixation, the medial-to-lateral graft length is decreased and the graft tension is effectively increased. Surgeons may increase shoulder stability without restricting ROM by fixing the graft at higher abduction angles. However, surgeons should remain cognizant of potential graft failure due to increased tension. [ABSTRACT FROM AUTHOR]

Updated estimates of adolescents' receipt of sex education are needed to monitor trends and potential inequities. Using nationally representative data from the 2011–2015 and 2015–2019 National Survey of Family Growth, we use logistic regression to examine changes in the receipt of formal sex education by gender. For 2015–2019, we estimate patterns by gender and race/ethnicity for content, timing, and location of instruction. Between 2011–2015 and 2015–2019, there were few significant changes in adolescents' receipt of formal sex education. Between these periods, instruction on waiting until marriage to have sex declined (73%–67% female [F.], p =.005; 70%–58% males [M.], p <.001). In both the periods, about half of the adolescents received sex education that meets the minimum standard articulated in national goals. In 2015–2019, there were significant gender differences in the instruction about waiting until marriage to have sex (67% F., 58% M., p < 001) and condom skills (55% F., 60% M., p =.003). Non-Hispanic Black and Hispanic males were less likely than non-Hispanic White males to receive formal instruction before the first sex on sexually transmitted infection/HIV, birth control, or where to get birth control. Many adolescents reported religious settings as the sources of instruction about waiting until marriage to have sex (56% F. and 49% M.), but almost none received instruction about birth control from those settings. Differences in the receipt of sex education, by gender, race/ethnicity, and the location of instruction, leave many adolescents without critical information. Gaps in meeting national objectives indicate the need to expand the provision of sex education. [ABSTRACT FROM AUTHOR]

Background: Patient-Reported Outcomes Measurement Information System Global Health (PGH) was validated to assess health-related quality of life in several diseases. Little is known about its measurement properties in adult atopic dermatitis.Objective: Examine the measurement properties of PGH in adult atopic dermatitis.Methods: A prospective dermatology practice-based study of 994 atopic dermatitis patients (18-97 years).Results: PGH physical and mental health 4-item and abridged 2-item T scores, as well as mapped EuroQol-5D score, showed strong to very strong correlation with one another and moderate to strong Spearman correlations with Patient-Oriented Scoring Atopic Dermatitis, Patient-Health Questionnaire-9, Patient-Reported Outcomes Measurement Information System sleep disturbance and related impairment, Eczema Area and Severity Index, objective Scoring Atopic Dermatitis; and weak to moderate correlations with Patient Oriented Eczema Measure, numeric rating scale worst itch and average itch, and Scoring Atopic Dermatitis. The Dermatology Life Quality Index (DLQI) had stronger correlations with Patient Oriented Eczema Measure, Patient-Oriented Scoring Atopic Dermatitis, numeric rating scale worst itch and average itch, Eczema Area and Severity Index, and Scoring Atopic Dermatitis, but weaker correlations with Patient-Health Questionnaire-9 and Patient-Reported Outcomes Measurement Information System sleep disturbance and related impairment (convergent/divergent validity). PGH and DLQI scores had similarly poor ability to differentiate between levels of self-reported global atopic dermatitis severity (known-groups validity). No floor or ceiling effects were observed. No PGH or DLQI items had differential item functioning by demographics. PGH and DLQI scores showed fair to good responsiveness. Finally, PGH and DLQI showed similarly good test-retest reliability.Limitations: Single-center study.Conclusion: PGH scores had sufficient validity and reliability to assess health-related quality of life in atopic dermatitis. [ABSTRACT FROM AUTHOR]

Now, more than ever, enhancement of diversity and inclusion is significant to the nursing profession. One way that nursing institutions can enrich diversity in the workforce is through enrollment of students from diverse backgrounds. The overarching goal of this innovative admissions revision project was to implement and assess the process of holistic admissions in a BSN to DNP family nurse practitioner track. Using a step-by-step approach, the authors in this paper present five key steps to implementing a holistic review of doctoral nursing applicants. These five steps are: (1) assessing fit of admissions criteria, (2) utilizing shared governance, (3) measuring admissions criteria, (4) analyzing reliability, and (5) evaluating revision outcomes. The step-by-step approach to holistic admissions discussed in this paper was feasible and cost effective. The scoring tool developed for applicant videos demonstrated very good to excellent reliability among raters in two different scoring scenarios. Diversity enhancement among enrolled students was noted in gender, race, and ethnicity after a holistic review was implemented. Findings from this innovative admissions revision have implications for nursing education, advanced nursing practice, organizational policy, workforce diversity, and student/patient outcomes. • Holistic review is a unique process requiring state of the science appraisal. • Shared governance is key in developing balanced holistic admissions criteria. • Feasibility and inter-rater reliability were tested in an innovative video scoring tool. • One school's step-by-step approach to implementating holistic admissions is described. • Diversity enhancement outcomes were noted after holistic admissions implementation. [ABSTRACT FROM AUTHOR]

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice. [ABSTRACT FROM AUTHOR]

Ulnar collateral ligament (UCL) repair with single-strand suture augmentation has been introduced as a viable surgical option for throwers with acute UCL tears. For the original single-strand suture augmentation construct, revision UCL reconstructions can be challenging owing to the bone loss at the site of anchor insertion in the center of the sublime tubercle. This biomechanical study assessed a small-diameter (1.5-mm) ulnar bone tunnel technique for double-strand suture-augmented UCL repair that may be more easily converted to salvage UCL reconstruction if necessary, as well as a salvage UCL reconstruction with a docking technique after a failed primary suture-augmented UCL repair. In 7 fresh-frozen cadaveric upper extremities (mean age, 66.3 years), a custom shoulder testing system was used to simulate the late cocking phase of throwing. The elbow valgus opening angle was evaluated using a MicroScribe 3DLX device for sequentially increasing valgus torque (from 0.75 to 7.5 Nm in 0.75-Nm increments) at 90° of flexion. Valgus angular stiffness (in newton-meters per degree) was defined as the correlation of sequentially increasing valgus torque with the valgus opening angle through simple linear regression (slope of valgus torque - valgus opening angle curve). Four conditions were tested: intact elbow, distal UCL avulsion, primary UCL repair with double-strand suture augmentation using small-diameter bone tunnels, and subsequent docking UCL reconstruction in the same specimen. Load-to-failure tests were performed for primary UCL repair with double-strand suture augmentation and subsequent docking UCL reconstruction. With increasing elbow valgus torque, the valgus opening angle increased linearly in each condition (R 2 ≥ 0.98, P <.001). Distal UCL avulsion resulted in significantly decreased angular stiffness compared with the intact UCL (P <.001). Both UCL repair with double-strand suture augmentation and subsequent UCL reconstruction showed significantly increased angular stiffness values compared with distal UCL avulsion (P <.001 and P <.001, respectively). On load-to-failure testing, there was no significant difference in stiffness, yield torque, and ultimate torque between the primary suture-augmented UCL repair and the subsequent UCL reconstruction (P =.11, P =.77, and P =.38, respectively). In all specimens undergoing the small-diameter ulnar bone tunnel technique for double-strand suture-augmented UCL repair, failure occurred by retear of the repaired ligament without causing an ulnar bone bridge fracture. Primary UCL repair with double-strand suture augmentation using small-diameter bone tunnels was able to restore valgus stability. When failure occurs, this technique retains enough cortical bone to permit subsequent docking UCL reconstruction. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is associated with itch, pain, and sleep disturbance, all of which may contribute toward cognitive dysfunction.Objective: To determine the relationship of AD severity and cognitive function in adults.Methods: We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 386). Cognitive function was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function 8-item Short-Form.Results: At baseline, 118 patients (58.1%) reported ≥1 symptoms of cognitive dysfunction in the past 4 weeks, with 29 (14.3%) having mild, 11 (5.4%) moderate, and 4 (2.0%) severe PROMIS Cognitive Function T-scores. In propensity score-weighted regression models, PROMIS Cognitive Function T-scores were inversely associated with patient-reported global AD severity, Patient Oriented Eczema Measure (POEM), Numeric Rating Scale worst itch and skin pain, SCORing Atopic Dermatitis (SCORAD)-sleep, POEM-sleep, Eczema Area and Severity Index, and SCORAD, with stepwise decreases of cognitive function with worsening AD severity. At all AD severity levels, cognitive dysfunction was associated with increased Dermatology Life Quality Index and ItchyQoL scores. Changes from baseline in PROMIS Cognitive Function T-scores were weakly to moderately inversely correlated with changes from baseline in multiple AD outcomes.Limitations: Single-center study without non-AD controls.Conclusion: Cognitive dysfunction is associated with AD severity. Cognitive function may be an important end point for monitoring treatment response in AD. [ABSTRACT FROM AUTHOR]

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire (PIQ) was recently developed.Objective: To validate PIQ short forms in adults with AD.Methods: Self-administered questionnaires and skin examinations were performed in 239 adults with atopic dermatitis (AD) in a dermatology practice setting.Results: PIQ items had good content validity. PIQ item bank T-scores strongly correlated with each other, moderately correlated with numeric and verbal rating scales for worst or average itch and with itch frequency, moderately to strongly correlated with patient-oriented eczema measure, and weakly to moderately correlated with the Eczema Area and Severity Index and Objective-Scoring AD (Spearman correlations, P < .0001). There were significant and stepwise increases of T-scores for all item banks with increasing patient-reported global severity (Wilcoxon rank sum test, P < .0001). However, there was limited ability to discriminate between the lowest or highest 2 levels of AD or itch severity. Item banks showed good internal consistency (Cronbach α, 0.91-0.95). No differential item functioning was identified by age, sex, race/ethnicity, or educational level. There were floor effects for total scores, particularly in almost clear/mild AD or itch.Limitations: Single-center study.Conclusions: PIQ item bank short forms showed good content and construct validity and are feasible for potential use in clinical trials and practice. [ABSTRACT FROM AUTHOR]

As the first step in image interpretation is detection, an error in perception can prematurely end the diagnostic process leading to missed diagnoses. Because perceptual errors of this sort-"failure to detect"-are the most common interpretive error (and cause of litigation) in radiology, understanding the nature of perceptual expertise is essential in decreasing radiology's long-standing error rates. In this article, we review what constitutes a perceptual error, the existing models of radiologic image perception, the development of perceptual expertise and how it can be tested, perceptual learning methods in training radiologists, and why understanding perceptual expertise is still relevant in the era of artificial intelligence. Adding targeted interventions, such as perceptual learning, to existing teaching practices, has the potential to enhance expertise and reduce medical error. [ABSTRACT FROM AUTHOR]

This guideline describes the approach and expertise needed for the genetic evaluation of cardiomyopathy. First published in 2009 by the Heart Failure Society of America (HFSA), the guideline has now been updated in collaboration with the American College of Medical Genetics and Genomics (ACMG). The writing group, composed of cardiologists and genetics professionals with expertise in adult and pediatric cardiomyopathy, reflects the emergence and increased clinical activity devoted to cardiovascular genetic medicine. The genetic evaluation of cardiomyopathy is a rapidly emerging key clinical priority, because high-throughput sequencing is now feasible for clinical testing and conventional interventions can improve survival, reduce morbidity, and enhance quality of life. Moreover, specific interventions may be guided by genetic analysis. A systematic approach is recommended: always a comprehensive family history; an expert phenotypic evaluation of the proband and at-risk family members to confirm a diagnosis and guide genetic test selection and interpretation; referral to expert centers as needed; genetic testing, with pre- and post-test genetic counseling; and specific guidance as indicated for drug and device therapies. The evaluation of infants and children demands special expertise. The approach to managing secondary and incidental sequence findings as recommended by the ACMG is provided. [ABSTRACT FROM AUTHOR]

The management of plastic waste is a growing concern that can harm wildlife and ecosystems, and its end-of-life policies are key to mitigating plastic environmental impact. This work presents a decision-making methodology for the thermal and material valorization of plastic waste, coupling a supply chain model with multi-objective optimization and data analytics. It highlights the challenges and vulnerabilities of plastic waste management, the importance of system integration and holistic analysis, as well as the potential for carbon capture to reduce emissions. Our results suggest that efficient incineration, coupled with simplified waste logistics, can compete with existing mechanical recycling strategies in terms of emissions and costs. This study provides insights into municipal, regional, and European waste management, with the potential for a common EU platform and savings of 210 Mton of CO 2 by harvesting benefits from plastic recycling and incineration with carbon capture. [ABSTRACT FROM AUTHOR]

Knives are commonly-used weapons in criminal activities and interpersonal assaults worldwide. Injury reports have identified the upper body as the most frequent location of knife injuries, and that stabbing attacks are more fatal than slashing attacks. The first two aims of the study explore whether the type of attack and attack location could be predicted from age and sex group. The following aims compared attack times between sex and age groups and evaluated the influence of subject characteristics on attack duration. The exploratory aim surveyed subjects on attack location during the scenario if the target was not wearing body armor. A total of 74 subjects (male: n = 40; female: n = 34) participated. Subjects were video recorded during a 21-foot (ft) attack and participated in follow-up questions and completed a push-up test to determine physical strength. Attack time (AT), concealment location, attack type, and demographic information were correlated to age group and sex. Mean AT from 21 ft was 2.40 ± 0.47 s, with the fastest of 1.75 s. The most commonly observed concealment location, attack type, and attack location on the target included the right hip (n = 62), stab (n = 62), and the chest (n = 28), respectively. After controlling for push-up ability (p < 0.05), no differences were reported between any combination of sex and age group in AT from 21 ft. Push-up ability was the sole significant predictor of AT from 21 ft (p < 0.05). Twenty-eight subjects reported they purposely avoided the body armor vest during the 21 ft attack. Law enforcement officers are encouraged to train for quick defensive or offensive responses, such as hand-to-knife combat or rapid firearm skills that can be performed in under 1.75 s. Stronger people were predicted to complete the 21 ft attack faster. • The stab was the most common attack method, with the chest location most common. • The fastest attack time was 1.75 s, and average 2.23 s for males, and 2.61 s for females. • Differences in attack time were removed after controlling for push up ability. • Push-up ability explained 36.75 % of attack time from 21 ft. • Chest and abdomen are the common attack locations on a target without body armor. [ABSTRACT FROM AUTHOR]

Purpose: To compare the biomechanical effectiveness of human dermal allograft (HDA) anterior capsular reconstruction (ACR) and pectoralis major tendon transfer (PMTT) for treating irreparable subscapularis tears with capsular insufficiency in human cadaver shoulders.Methods: Glenohumeral rotational range of motion and translation were measured in 6 cadaveric shoulders under the following 5 conditions: intact, deficient subscapularis/anterior capsule, ACR using HDA, HDA ACR with concomitant PMTT, and PMTT alone.Results: The deficient subscapularis/anterior capsule condition significantly increased external and total rotational range of motion at 0° (P < .001, P < .001) and 30° (P = .005, P = .002) abduction as well as anterior-inferior translation (P ≤ .001 to .03). HDA ACR, both with and without PMTT, restored anterior-inferior stability to that of the intact condition; however, PMTT alone did not restore anterior-inferior translation or rotational range of motion.Conclusions: HDA ACR for treating irreparable subscapularis tears with capsular insufficiency restored anterior-inferior glenohumeral translation and rotational range of motion at time 0 in human cadaver shoulders.Clinical Relevance: Anterior capsule reconstruction may be a viable option for treating massive irreparable subscapularis tears with capsular insufficiency. [ABSTRACT FROM AUTHOR]

In a cadaveric irreparable rotator cuff tear model, patellar tendon allograft–superior capsule reconstruction (PT-SCR) will restore glenohumeral stability and reduce subacromial contact pressures without significant graft deformation during testing. Eight cadaveric shoulders were tested in a custom shoulder testing system. Rotational range of motion (ROM), superior translation, and subacromial contact pressure were measured in the following experimental conditions: intact rotator cuff, irreparable supraspinatus tear (massive cuff tear [MCT]), and PT-SCR. MCT and PT-SCR resulted in significantly increased total ROM at all degrees of abduction compared with the intact state (P <.001). In both 0° and 30° of glenohumeral abduction, MCT showed a significant increase in superior translation compared with the intact state (P <.001). Application of the PT-SCR resulted in a decrease of superior translation compared with MCT (P <.001). At 0° abduction/60° external rotation and 0° abduction/90° external rotation, MCT showed significantly greater peak subacromial contact pressure compared with the intact state (P <.006). At both of these positions, PT-SCR was able to reduce peak pressure to lower than or no significant difference from the intact state. There was no statistically significant change in graft thickness, length, or width after testing. PT-SCR was able to reduce superior translation of the humeral head and peak subacromial contact pressure without restricting ROM. Furthermore, there was no significant graft deformation during testing. PT-SCR in this validated cadaveric model demonstrates favorable biomechanical properties and is a viable source of graft material for SCR. [ABSTRACT FROM AUTHOR]

Long-term cooperation between individuals necessitates repairing damage arising from inevitable competing interests. How two members of a valuable relationship switch from competing to cooperating constitutes an important problem for any social species. Observations of non-human animals suggest that affiliative contact immediately following a contest facilitates continued cooperation. Behavioral studies further indicate that winners and losers frequently differ in hormonal changes following a competition. We tested the hypothesis that immediate contact with increases in cortisol (and testosterone for men) for winners following competition would facilitate subsequent cooperation between adult same-sex friends. Results show that contact (versus no contact) immediately following competition enhanced subsequent cooperation between female friends. During contact, increases in winner's cortisol for both sexes, and in testosterone for men, predicted future cooperation. Our results suggest two mechanisms that maintain social bonds following competition between established allies. [ABSTRACT FROM AUTHOR]

• Geant4 Standard EM option 4 and Livermore Physics Lists are in good agreement with EGSnrc in the energy range 20–100 keV. • We confirmed that breast dose in mammography screening can be minimised if a beam energy around 60 keV is used. • We confirmed that phase-contrast imaging is a promising technique for routine mammography screening. Breast cancer is the most frequent cancer in women. Early and accurate detection of the disease is a major factor in patient survival. To this end, phase-contrast imaging has gained significant interest in recent years. The aim of this work was to validate the physics models of a Geant4 mammography imaging simulation (in the context of the XPulse project) by comparing to EGSnrc results. We used three Geant4 electromagnetic physics lists of the version 10.4 of the toolkit: Standard, Livermore and Penelope. We calculated energy distributions in homogeneous and inhomogeneous phantoms and breast doses in DICOM images. The simulations used photon beams of energies 20–100 keV. The Geant4 calculations were compared with EGSnrc/DOSXYZnrc simulations. We found a very good agreement between the Standard Electromagnetic option 4 and Livermore Physics Lists (within 1% for all beam energies). Larger differences were found between Standard Electromagnetic option 4 and Penelope Physics Lists (about 4%). The agreement of longitudinal energy distributions between Geant4 Standard Electromagnetic option 4 and EGSnrc was good in water and light biological materials, but important discrepancies were found in heavy elements. We confirmed with both codes that dose to the breast is minimal at beam energy around 60 keV. Overall, we found good agreement between the option 4 of the Standard Electromagnetic physics list and Livermore physics lists of Geant4, as well as EGSnrc for materials relevant to mammography screening. Further investigations are needed for the case of heavier materials. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study presents a single-site experience of 5 patients with severe tricuspid regurgitation (TR) who underwent implantation of a novel transcatheter tricuspid valve replacement device. Background Functional TR is the most common etiology of severe TR in the developed world and is associated with unfavorable clinical outcomes. Although numerous transcatheter repair devices are currently in early clinical trials, most result in incomplete degrees of TR reduction and functional improvement. Methods Transcatheter tricuspid valve replacement was performed in 5 patients with compassionate use of the novel GATE System. All patients had symptomatic, massive and/or torrential TR at baseline. All patients had computed tomography, transthoracic and transesophageal echocardiographic assessment of the tricuspid valve and right heart anatomy. All patients had a surgical transatrial approach performed with valve implantation guided by fluoroscopy and intraprocedural transesophageal echocardiography. Results Baseline characteristics of the patients showed a substantial burden of comorbidities. All patients had successful implantation of the transcatheter valve, with significant reduction of TR to ≤2+. Baseline poor right ventricular (RV) function measured by global longitudinal strain and RV change in pressure divided by change in time were associated with post-implantation RV failure and poor clinical outcomes in this small group. Four of the 5 patients were followed for 3 to 6 months following the initial implantation and showed evidence of RV remodeling, increased cardiac output, and reduction in New York Heart Association functional class. Conclusions Implantation of a first-generation TTVR device was technically feasible in patients with more than severe TR. Transcatheter tricuspid valve replacement was associated with RV remodeling, increased cardiac output, and improvement in New York Heart Association functional class in most patients. Further studies are needed to refine patient population selection for this device and to determine long-term outcomes. Graphical abstract [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract Ixodes scapularis vectors several pathogens including Borrelia burgdorferi , the agent of Lyme disease. N ymphal and larval stages, and the pathogens transmitted by I. scapularis are maintained in a zoonotic cycle involving rodent reservoir hosts, predominantly Peromyscus leucopus. Humans are not reservoir hosts, however, accidental encounters of infected ticks with humans, results in pathogen transmission to the human host. Laboratory models of non-reservoir hosts such as guinea pigs develop a strong immune response to tick salivary proteins and reject ticks upon repeated tick infestations. Anecdotal and scientific evidence suggests that humans that get frequent tick bites might also develop resistance to ticks. Mus musculus , the laboratory model of natural host, does not develop resistance to I. scapularis upon repeated tick infestations. Addressing this dichotomy in vector-host interaction, we present data that suggest that the salivary transcriptome and proteome composition is different in mouse and guinea pig-fed I. scapularis, and that these differences might contribute to differences in host immune responses. These findings reveal a new insight into vector-host interactions and offer a functional paradigm to better understand the phenomenon of acquired tick-resistance. [ABSTRACT FROM AUTHOR]

Highlights • We investigated tourist attachment to souvenirs based on religion and place of purchase. • The willingness to pay for souvenirs was compared to the willingness to accept for souvenirs. • We found an endowment effect toward most of the souvenirs (Jewish, Christian and general). • The endowment effect was higher for Jewish tourists as compared to Christians tourists. • Souvenirs are perceived not only by their utility, but also by their meaningfulness. Abstract Souvenir purchases has emerged as an important area of research in tourism studies. We investigate tourists' attachment to souvenirs based on religion, type, and place of purchase, and analyze the endowment effect. We asked 3325 Jewish and Christian tourists visiting Israel to estimate the price they would pay/accept for three types of souvenir: Jewish, Christian, and general souvenirs. Overall, we found an endowment effect toward most of the souvenirs. The results demonstrated that religion, type, and place of purchase affected the valuation of the items. The endowment effect was higher for the Jewish group than for their non-Jewish counterparts. These results demonstrate that tourists' perceptions of souvenirs are shaped not only by their utility, but also by their meaningfulness. [ABSTRACT FROM AUTHOR]

Sacred cities are not only venerable focal point for tourists; they also mainly attract believers to take up residence in them, creating potential tension between residents and tourists. This study examines the role of religiosity as an influence on the attitudes of communities towards tourism. We examine Jerusalem as a case study, a city sacred to three religions: Judaism, Christianity, and Islam. We focus on the practical inevitability of Jewish resident interaction with a variety of tourists. A survey was used to gauge the impact of tourism on social, economic, and environmental conditions. Participants were asked to identify their level of religious observance. Of the 1776 Jewish residents who participated in the survey, 200 defined themselves as ultra-orthodox, 994 as orthodox or traditional, and the remaining 496 as secular. Socio-demographic variables were measured, including amount of financial benefit gained from tourism. Overall, subjects acknowledged tourism as a contributor to personal benefit and the prosperity of Jerusalem. As such, our findings indicate that religiosity exerts an important influence on community attitudes. Consistent with Social Distance Theory, we found that the more extreme the religious group, measured as self-segregation from external influence, the less affirmative they were towards tourism. The findings also suggest that individuals who profit financially from tourism were more affirmative towards tourism. This connection is explained according to Social Exchange Theory (SET). The latter variable interacts with religious characteristics, suggesting a more complex picture of Jerusalem residents. These results point to a major contribution of religiosity to perceptions of tourism, the implications of which should be considered when planning urban developments, especially those linked with sacred sites or landmarks. [ABSTRACT FROM AUTHOR]

Purpose: To assess an anterior cable reconstruction (ACR) using autologous proximal biceps tendon for large to massive rotator cuff tears.Methods: Nine cadaveric shoulders (mean age, 58 years) were tested with a custom testing system. Range of motion, superior translation of the humeral head, and subacromial contact pressure were measured at 0°, 30°, 60°, and 90° of external rotation (ER) with 0°, 20°, and 40° of glenohumeral abduction. Five conditions were tested: intact, stage II tear (supraspinatus), stage II tear + ACR, stage III tear (supraspinatus + anterior half of infraspinatus), and stage III tear + ACR. ACR involved a biceps tendon tenotomy at the transverse humeral ligament, preserving its labral attachment. ACR included nonpenetrating suture-loop fixation using 2 side-to-side sutures and an anchor at the articular margin to restore anatomy and secure the tendon along the anterior edge of the cuff defect. ACR was performed in 20° glenohumeral abduction and 60° ER.Results: ACR for both stage II and stage III showed significantly higher total range of motion compared with intact at all angles (P ≤ .001). ACR significantly decreased superior translation for stage II tears at 0°, 30°, and 60° ER for both 0° and 20° abduction (P ≤ .01) and for stage III tears at 0° and 30° ER for both 0° and 20° abduction (P ≤ .004). ACR for stage III tear significantly reduced peak subacromial contact pressure at 30° and 60° ER with 0° and 40° abduction and at 30° ER with 20° abduction (P ≤ .041).Conclusions: ACR using autologous biceps tendon biomechanically normalized superior migration and subacromial contact pressure, without limiting range of motion.Clinical Relevance: ACR may improve rotator cuff tendon repair longevity by providing basic static ligamentous support to the dynamic tendon while helping to limit superior migration without restricting glenohumeral kinematics. [ABSTRACT FROM AUTHOR]

Background Studies evaluating the efficacy of minimally invasive approaches to pancreatoduodenectomy (MIS-PD) compared to open pancreatioduodenectomy (OPD) have been limited by selection bias and mixed outcomes. Methods ACS-NSQIP 2014–2015 pancreas procedure-targeted data were used to identify patients undergoing PD. Intention-to-treat analysis was performed. Results Of 7907 PD patients, 1277 (16%) underwent MIS-PD: 776 (61%) robotic or laparoscopic PD, 304 (24%) hybrid, and 197 (15%) unplanned conversions. There were no differences in demographics or comorbidities. Patients undergoing MIS-PD were less likely to have pancreatic ductal adenocarcinoma (30.9% vs 53.9%, P  < 0.01) and less likely to have a dilated pancreatic duct (21.8% vs 46.7%, P  < 0.01). 30-day morbidity was less for MIS-PD (63.6% vs 76.9%, P  < 0.01), due to decreased delayed gastric emptying DGE) in the MIS-PD group (8.6% vs 15.5%, P  < 0.01). 30-day mortality, length-of-stay, and readmissions were not significantly different. Patients undergoing MIS-PD had greater rates of CR-POPF (15.3% vs 13.0%, P  = 0.03). On adjusted multivariable analysis, MIS-PD was not associated with CR-POPF (OR 1.05, 95% CI 0.87–1.26) but was associated with decreased DGE (OR 0.57, 95% CI 0.46–0.71). Conclusion MIS-PD has comparable short-term outcomes to open PD. While CR-POPF rates are greater for MIS-PD, this increased risk appears related to case-selection bias and not inherent to the MIS-approach. [ABSTRACT FROM AUTHOR]