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Inflammatory pouch disorders exhibit a heterogeneous clinical spectrum and therapeutic requirements have not been properly studied. This retrospective, multicentre study included ulcerative colitis patients with ileal pouch construction and were later diagnosed with an inflammatory pouch disorder between 1995 and 2020. Classifications, behaviour and therapies applied were recorded and compared in the long-term. Overall, 338 patients were recruited. The most common disorders were pouchitis (n = 258, 76%), Crohn's disease of the pouch (n = 55, 16%) and cuffitis (n = 25, 7%). Pouchitis presented mainly as chronic (65.2%) and recurrent (87%) forms. Crohn's disease manifested as stricturing/penetrating in 53% of cases and perianal disease in 42%. Patients received multiple therapies: 86% antibiotics, 42% steroids, 27% immunosuppressants, 43% biologics and 27% surgery. Compared with pouchitis, Crohn's disease of the pouch was characterised by a later diagnosis (99 vs. 55 months, p < 0.001) and greater needs for immunosuppressants (OR 3.53, 1.79–6.94, p < 0.0001), biologics (OR 5.45, 2.78–10.6, p < 0.0001) and surgeries (OR 2.65, 1.43–4.89, p < 0.001). Chronic pouchitis is the most common pouch disorder presentation. These entities have diverse therapeutics requirements, particularly for Crohn's disease of the pouch. [ABSTRACT FROM AUTHOR]

This study proposes a scoring system for adjuvant irradiation for stage I/II oral squamous cell carcinoma (OSCC). Derivation cohort (119 patients, operated between 2011 and 2014) and a validation cohort (204 patients, operated between 2016 and 2019) were included. In derivation cohort, on univariate analysis, tumor size >2 cm [3-year Disease Free Survival (DFS) 72.5% vs 95.6%, P = 0.039], lymphovascular invasion (58.3% vs 83.6%, P = 0.024), perineural invasion (75% vs 85.6%, P = 0.013), and depth of invasion ≥0.5 cm (73.8% vs 97.5%, P = 0.017) predicted 3-year DFS. Tongue lesions and poor differentiation were added as poor prognosticators based on previously published reports. Patients were grouped as low risk (<3 risk factors) and high risk (≥3 risk factors), with only high-risk group receiving adjuvant irradiation in validation cohort. Overall, 47/119 (39.5%) patients in the derivation cohort and 50/204 (24.5%) patients in validation cohort received adjuvant irradiation. In derivation cohort, 3-year DFS was 93% and 72.5% in the low and high-risk group, respectively. 3-year DFS was 90.7% and 85.8% in the low and high-risk group, respectively for validation cohort. The proposed scoring system reduced the use of adjuvant irradiation by 38%, with similar DFS. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis is the most severe life-threatening acquired gastrointestinal disorder among preterm neonates. We describe here an outbreak of Clostridium butyricum- related necrotizing enterocolitis in preterm neonates that occurred in three different neonatal centres, in southeast France. We defined a confirmed case of C. butyricum -related necrotizing enterocolitis in preterm neonates by the presence of clinical signs according to modified Bell criteria and C. butyricum identified from stool samples using real-time polymerase chain reaction or culture. A phylogenetic analysis of the isolated strains by whole-genome sequencing was also performed. Between 5th and 27th January 2022, we identified 10 confirmed cases of C. butyricum- related necrotizing enterocolitis , including five from Neonatal Centre 1, four from Neonatal Centre 2, and one from Neonatal Centre 3. The attack rate of necrotizing enterocolitis in Neonatal Centre 1 was 7.1% (5/70). The positivity rate of C. butyricum detected from stool samples was higher during the outbreak period (37/276; 13.4%) than outside this period (7/369; 1.9%), while systematic screening was maintained (P <0.001). Phylogenetic analysis showed a clonality between strains inside four clusters. Two clusters included neonates hospitalized in different neonatal centres, suggesting the transmission of C. butyricum strains during the transfer of neonates between neonatal centres. This outbreak of C. butyricum- related necrotizing enterocolitis confirms a cross-transmission between preterm neonates, including twin or triplet siblings, and involving necrotizing enterocolitis cases together with asymptomatic carriers. After three months of follow-up, no further cases were identified following the implementation of contact precautions with sporicidal agents. [ABSTRACT FROM AUTHOR]

The genus Hydra (Cnidaria, Hydrozoa) comprises a group of aquatic organisms that inhabit freshwater bodies worldwide, except for Antarctica. Hydras are widely recognized for their significant regenerative capacity and simple body plan. Despite the importance of these organisms in freshwater environments and due to the abundance and diversity of freshwater bodies in the Brazilian territory, curiously, this genus and other freshwater cnidarians are understudied. To assess the diversity of hydra in Brazil, we collected specimens from eight freshwater bodies in the SE and S of the country and built a phylogeny using a COI marker and comparing the morphologies with endemic species. These analyzes have yielded encouraging results, mainly the discovery of the species Hydra sinensis originating in China, highlighting the need to expand studies in less explored areas to better understand the relationship between species represented in Brazil and those from other regions of the world. Molecular and phylogenetic inferences, as proxies for species identity are essential to advance our knowledge of the diversity and evolution of Hydra and its relationship with different freshwater ecosystems in Brazil. [ABSTRACT FROM AUTHOR]

While lumbar puncture (LP) remains gold standard for assessing intracranial pressure (ICP), LP can be difficult to perform and lead to complications. Noninvasive correlations for elevated ICP via ocular ultrasound (OUS) have shown mixed results. The primary objective of this study is to identify the frequency and test characteristics of the crescent sign on OUS for elevated ICP. Secondary objectives include comparison of test characteristics to optic nerve sheath diameter (ONSD) and optic disc elevation (ODE). Single center, prospective, observational cohort study enrolling adults (age ≥ 18 years) who presented to an outpatient Neurology LP clinic. An OUS protocol was performed prior to scheduled LP, with measurement of the opening pressure (OP) by manometry. Patients were excluded if LP was unable to be completed (for any reason) or if completed in the sitting position. Elevated OP was defined as ≥25cmH2O. In total, 68 patients were enrolled; seven were excluded due to no OP measured, leaving 61 patients for analysis. Forty-six patients had normal OP, while 15 had elevated OP. The crescent sign was observed in 19 patients (31 %). Overall sensitivity, specificity, and accuracy of the crescent sign was 67 %, 80 %, and 74 %, respectively. Comparison of accuracy between the six other OUS findings demonstrated no significant differences between test characteristics (p > 0.10 for each). The crescent sign was observed in 31 % of patients, with moderate sensitivity, specificity, and accuracy for elevated ICP. This study has several limitations and evaluations in the acute care setting are needed. [ABSTRACT FROM AUTHOR]

Understanding the structure of communities across multiple scales is useful for predicting impacts on biodiversity and ecosystem functioning. Scavenging, an important ecological function performed by scavenger assemblages, stands as a significant force shaping ecosystems. Using biodiversity partitioning, we assess the relative contribution of multiple scales (i.e., within and among individual carcasses, species and habitats) to the richness and Shannon diversity of vertebrate scavenger communities consuming anthropogenic food subsidies (i.e. livestock carrion) in central Argentina. We further evaluate the potential effect of carcass and habitat characteristics (including human impact) on the richness, abundance and diversity of vertebrate scavengers. A total of 31 carcasses, 22 of cow and nine of sheep, were monitored using remote cameras in cropland and natural habitats, recording consumption by 10 vertebrate species (four birds and six mammals). 50 % of scavenger species were observed at carcass level (α 1 = 4.94 species), a contribution lower than expected by chance. While the turnover of species among carcasses (β 1 diversity) significantly contributed (40 %) to regional richness (γ diversity), turnover of species between carrion types and habitats (β 2 diversity) contributed a smaller fraction (10 %). Partitioning of Shannon diversity showed similar patterns to richness. Scavenger abundance increased during spring and was positively influenced by carcass weight; furthermore, carcasses in croplands supported less abundance that those located in natural habitats. Aligning with the theory of carrion unpredictability in maintaining biodiversity, our results suggest that scavenger species replacement (turnover) at human-mediated carcasses scattered in the field plays a significant role in shaping vertebrate scavenger assemblages. [ABSTRACT FROM AUTHOR]

The ideal timing for surgery in asymptomatic chronic aortic regurgitation (AR) remains unclear. New thresholds for left ventricular ejection fraction (LVEF), left ventricular (LV) indexed end-systolic volume (iESV), and global longitudinal strain (GLS) have been associated with mortality in these patients. These represent markers of early LV dysfunction. The authors sought to assess the relationship between these markers (LVEF <60%, iESV ≥45 mL/m2, and GLS worse than −15%) and mortality, comparing them to Class I/IIa American College of Cardiology/American Heart Association guideline recommendations and absence of any of these. A total of 673 asymptomatic patients with chronic clinically significant (≥ moderate-severe) AR between 2004 and 2019 at a single referral center were retrospectively analyzed. The primary study outcome was all-cause mortality. Mean age was 57 ± 17 years, 97 (14%) were female, 293 (45%) had hypertension, and 273 (41%) had an abnormal number of valve cusps. Aortic valve replacement was performed in 281 (48%) patients, and 69 (10%) died while under surveillance (without aortic valve replacement). LVEF <60% was present in 296 (44%) patients, 122 (25%) of 482 had GLS worse than −15%, and 261 (39%) had iESV ≥45 mL/m2. Mortality under surveillance was highest when Class I/IIa recommendations were present (HR: 4.22; 95% CI: 2.15-8.29), followed by the presence of 1 or more markers of early LV dysfunction (HR: 2.18; 95% CI: 1.21-3.92); no markers was used as the reference (all, P < 0.05). LVEF showed the strongest association with mortality, statistically slightly better than GLS and iESV. In the absence of Class I/IIa recommendations, 1 marker of early LV dysfunction was associated with higher, although not statistically significant, mortality compared with no markers (P = 0.063), followed by 2 markers; highest mortality was when all 3 markers were present (HR: 5.46 [95% CI: 2.51-11.90]; P < 0.001). Patients with asymptomatic clinically significant chronic AR incur a survival penalty when Class I/IIa guideline recommendations are attained. In patients without these recommendations, at least 2 markers of early LV dysfunction identify those with higher mortality risk who may benefit from early surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

Targeting maximal ventricular resynchronization, with the shortest QRS duration (QRSd), is commonly implemented after cardiac resynchronization therapy (CRT). The purpose of this study was to compare optimization of ventricular resynchronization with optimization of left ventricular (LV) filling during CRT by measuring their acute hemodynamic effects. Patients with standard CRT indications, recruited from 2 centers, underwent biventricular pacing (BVP) and left bundle branch pacing (LBBP). We performed a within-patient comparison of acute hemodynamic response of systolic blood pressure (SBP) at the atrioventricular delay (AVD) with the shortest QRSd against the AVD with the most efficient LV filling. In a validation substudy, we also performed electrical assessment using QRS area (QRSa) and hemodynamic assessment with the maximum rate of LV pressure rise (dP/dt max). Thirty patients (age 65 ± 10 years; 53% male) were recruited. The AVD producing maximal ventricular resynchronization was associated with a significantly shorter QRSd (difference 15 ± 12 ms for BVP and 18 ± 13 ms for LBBP, both P <.01) and a significantly smaller improvement in SBP (difference −3 ± 4 mm Hg for BVP and −2 ± 2 mm Hg for LBBP, both P <.01) compared with the AVD that optimized filling. Similar findings were observed in the substudy, with a significantly smaller improvement in dP/dt max assessed with QRSd and QRSa (difference −9% ± 7% and −6% ± 4% during BVP, and −5% ± 6% and −3% ± 3% during LBBP, all P <.01). Targeting the maximal ventricular resynchronization results in suboptimal acute hemodynamic performance with both BVP and LBBP as CRT. These findings support prioritizing LV filling when programming AVD for CRT. [Display omitted] [ABSTRACT FROM AUTHOR]

Owing to the significant morbidity and mortality of open thoracoabdominal aortic aneurysm surgery, complex endovascular repairs have become increasingly common, but still carry substantial risk. These repairs require large-bore access, with resultant pelvic and lower extremity ischemia. We, therefore, hypothesized that operative timing would be associated with outcomes, because efficient surgery would limit the ischemic time as well as anesthesia time. We studied all thoracoabdominal aortic aneurysm surgerywith complex endovascular repairs (Crawford types 1, 2, 3, and 5) incorporating at least one branch vessel from 2014 to 2021 in the Vascular Quality Initiative and categorized them into quartiles of total operating time. To account for variations in case complexity and intraoperative events, we performed a subanalysis stratifying each surgeon by their median operating time. Multilevel logistic regression was used to compare perioperative outcomes including mortality, thoracoabdominal life-altering events (a composite of perioperative death, stroke, permanent paralysis and/or dialysis), spinal cord ischemia (SCI), acute kidney injury, major adverse cardiac events, myocardial infarction, and dialysis. There were 2925 thoracoabdominal aortic aneurysm surgery with complex endovascular repairs during the study period. Procedure times ranged from <204 minutes in the first quartile to >365 minutes in the fourth. Longer cases more commonly involved older patients who were more often female and higher rates of prior stroke and preoperative anemia. They involved larger, more extensive aneurysms, with higher rates of prior aortic surgery, and more commonly used physician-modified endografts or parallel grafting to incorporate more branch vessels. In addition, they were less often staged procedures, and used more spinal drains, femoral cutdowns, and upper extremity access. Operating time decreased as experience increased. In adjusted analyses, the odds of mortality and every morbidity studied increased stepwise with operating time, with 4- to 13-fold higher odds in the highest quartiles. SCI had the strongest association with procedure times, with seven-fold higher odds (odds ratio, 7.2; 95% confidence interval, 2.9-17.9; P <.001) of any SCI in the highest quartile compared to the lowest, and 13-fold higher odds of permanent SCI (OR, 13.1; 95% confidence interval, 3.9-44.7; P <.001). These results were consistent when surgeons were grouped into quartiles by their median operating times. Medium-term mortality was also higher in the upper quartile of operating time (hazard ratio, 2.7; 95% confidence interval, 1.4-5.1; P =.002). Longer operating times for complex thoracoabdominal aortic aneurysm surgerywith complex endovascular repairs were associated with markedly higher rates of morbidity and mortality, especially SCI. These results emphasize the importance of expeditious repairs by experienced teams. [ABSTRACT FROM AUTHOR]

Solid organ transplant (SOT) recipients are commonly prescribed immunosuppressive therapies which may predispose patients to higher infection and complication rates following total shoulder arthroplasty. This article aims to analyze the effects SOT and subsequent immunosuppressive regimens have on the functional and patient-reported outcomes of total shoulder arthroplasties. A single institution, multisurgeon retrospective case-control study investigating the functional and patient-reported outcomes of shoulder arthroplasty after SOT was conducted between the years of 2010 and 2020. To be included in the study, patients must have undergone SOT prior to primary total shoulder arthroplasty. A 4:1 match-paired control group lacking SOT prior to arthroplasty was then constructed. Thirty-four SOT patients (18 males and 16 females) and 136 control patients (77 male and 59 female) were included in the study. Patients were analyzed who underwent SOT prior to shoulder arthroplasty, with outcomes compared to controls that only underwent arthroplasty. The primary outcomes include range of motion and strength in forward elevation, external rotation, and internal rotation, and patient reported outcomes. There was no significant difference in improvement for range of motion and strength between the 2 cohorts, but within each cohort, improvement was statistically significant. In the SOT patients, forward elevation improved by 56° ± 52°, external rotation increased by 13° ± 20°, and internal rotation increased by 2 vertebral levels. In the non-SOT patients, forward elevation improved by 45° ± 51°, external rotation increased by 16° ± 25°, and internal rotation increased by 3 vertebral levels. SOT patients had equivocal visual analog scale pain and Simple Shoulder Test scores but lower American Shoulder and Elbow Surgeons (59 ± 13 vs. 79 ± 2; P =.002) and SANE (61 ± 30 vs. 84 ± 17; P <.001) scores than non-SOT patients. Complication rates were not significantly higher in the SOT group (15% vs. 6%; P =.05), but incidence of surgical revisions was not significantly different (SOT = 3%; non-SOT = 5%; P =.59). Shoulder arthroplasty is a safe, effective surgical intervention for improving shoulder function in patients with a history of SOT. Despite being on chronic immunosuppressive regimens, our solid organ transplants had comparable clinical outcomes and revision rates, but higher complication rates. [ABSTRACT FROM AUTHOR]

Information about outcomes after revision rotator cuff repair (RCR) is limited. A more thorough investigation of pain, range of motion (ROM), strength, and functional outcomes is needed. Comparing outcomes between primary and revision rotator cuff repair patients can help surgeons guide patient expectations of the revision procedure. The aim of this study was to compare the outcomes of a revision repair group to a control group of primary RCR patients. We expect revision RCR patients to have worse clinical outcomes than primary RCR patients. A retrospective review of patients who underwent primary or revision RCR between 2012 and 2020 was performed. The case group included 104 revision patients, and the control group included 414 primary RCR patients. Patient visual analog score for pain, ROM, strength, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at baseline, 12 months, 24 months, and final follow-up. The average final follow-up was 43.9 months for primary patients and 63.8 months for revision patients. Three hundred fifty-two primary patients and 55 revision patients had a final follow-up of 2 or more years. By the final follow-up, primary patients had less pain than revision patients (Δ of 2.11, P <.0001), but both groups improved overall. Primary patients had significant improvements in forward flexion, external rotation, internal rotation, and abduction at 2 years that were lost by final follow-up, but revision patients did not experience any long-term improvement in ROM. These differences in ROM between groups were not significant. Supraspinatus strength in the revision group did not improve nor decline by final follow-up. By final follow-up, both primary and revision patients had improved SST and ASES scores from baseline. Primary patient ASES scores were 17.9 points higher (P <.0001) than revision patients by final follow-up, and there was no difference between groups in SST scores at this time. Revision RCR significantly improves patient pain, SST score, and ASES score at 4 years. Revision patients should not expect to see the improvements in ROM that may occur after primary repair. [ABSTRACT FROM AUTHOR]

Knowledge of melanoma presentations among pediatric and adolescent and young adult (AYA) patients are limited because of studies with small sample sizes. The objective of this study was to determine the incidence trends and melanoma presentations based on age, sex, race, and ethnicity using a large cohort of diagnoses from 1997 to 2020. A retrospective cohort study was completed using the National Childhood Cancer Registry from 1997 to 2020. Incidence rates were 1.74 (95% CI: 1.64-1.84) and 62.05 (95% CI: 61.6-62.5) per 1-million-person years for pediatric and AYA patients, respectively. Women encompassed 62.3% of the cohort. Non-Hispanic White patients represented 87.5% of all diagnoses, with significantly higher incidence rates of melanoma compared with all other racial and ethnic groups in both age groups, respectively (P <.001; P <.001). Superficial spreading was the most common of the specified histologic subtypes. The most common location in pediatric patients was the lower extremity, compared with trunk in AYA. There were statistically significant differences in the distributions of primary tumor location by sex, as well as by race and ethnicity, in both pediatric and AYA groups. Limitations in this study include retrospective data, selection, and miscoding from individual registries. There are significant differences in tumor characteristics among pediatric and AYA patients with cutaneous melanoma. Trends in incidence rates are decreasing for young patients diagnosed with cutaneous melanoma. [ABSTRACT FROM AUTHOR]

To examine differences in unstable housing and health-risk behaviors and experiences by sexual identity among U.S. high school students. Using data from the 2021 Youth Risk Behavior Survey, a nationally representative survey of U.S. high school students, we calculated prevalence estimates and prevalence ratios of unstable housing by sexual identity (lesbian, gay, bisexual, questioning, and other-identifying [LGBQ+] vs. heterosexual). Among students experiencing unstable housing, we calculated prevalence estimates and prevalence ratios by sexual identity for substance use, violence victimization, mental health, and suicidal behaviors. LGBQ+ students were twice as likely to experience unstable housing, including sleeping in shelters or emergency housing, compared to heterosexual students. Among students experiencing unstable housing, LGBQ+ students were more likely to use substances and experience violence victimization, poor mental health, and suicide ideation and attempts. LGBQ+ youth experience a disproportionate burden of unstable housing and related health-risk behaviors and experiences. [ABSTRACT FROM AUTHOR]

To investigate differences in teen-reported and parent-reported lifetime prevalence estimates of traumatic brain injury (TBI) symptoms, TBI evaluation, and TBI diagnosis among a nationally representative sample of teenagers aged 12–17 years old and their parents. Parent-reported data from the 2021 to 2022 National Health Interview Survey linked with teen-reported data from the National Health Interview Survey-Teen July 2021-December 2022 (n = 1,153) were analyzed. Lifetime prevalence estimates for TBI symptoms (e.g., selected symptoms as a result of a blow or jolt to the head), history of evaluation by health professional for TBI (i.e., TBI evaluation), and TBI diagnosis stratified by sociodemographic characteristics and reporter type were produced, and z-tests were conducted to test for differences. Concordance measures were calculated to assess agreement between teen and parent survey responses to TBI measures. Lifetime prevalence of TBI symptoms varied by reporter type across all sociodemographic characteristics with teen-report consistently producing higher estimates. Estimates of TBI evaluation varied by reporter type only among older teens, non-Hispanic teens, and teens who participated in sports; there was no difference for TBI diagnosis. Percent agreement between the 2 reporters ranged from 73% to 95%, prevalence-adjusted bias-adjusted kappa ranged from 0.45 to 0.90, and Cohen's kappa ranged from 0.22 to 0.63. There was general agreement for observable outcomes TBI evaluation and TBI diagnosis, but discordance existed in reports of TBI symptoms. These findings suggest that youth self-report of TBI symptoms may enhance surveillance efforts. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What is the primary question addressed by this study? What was the uptake and impact of the American Association for Geriatric Psychiatry (AAGP) COVID-19 Online Trainee Curriculum, a free online resource consisting of 33 recorded lectures, during its first 3 years? • What is the main finding of this study? What is the main finding of this study? From May 2020 through April 2023, 860 individuals utilized the Curriculum. Of 251 survey respondents, the majority (54%) were psychiatry residents or medical students, and respondents to surveys on the two most-accessed lectures showed an increase in knowledge and confidence in clinical skills. • What is the meaning of the finding? What is the meaning of the finding? Postpandemic, the Curriculum may serve as a valuable resource to enhance geriatric psychiatry education and knowledge. The COVID-19 pandemic caused substantial disruptions in geriatric psychiatry education. In response, the AAGP created the "AAGP COVID-19 Online Trainee Curriculum" (Curriculum) a free online resource consisting of 33 recorded lectures. This study examined the uptake and impact of the Curriculum. Administrative data established the number of unique users. Surveys assessed demographics, prior AAGP engagement, prior experiences working with older adults, and each lecture's impact on participant knowledge, enthusiasm and confidence related to the module's topic area. From May 2020 through April 2023, 860 individuals utilized the Curriculum. Of 251 survey respondents, 54% were general psychiatry residents (37%, n = 91) or medical students (16%, n = 41). Surveys from the two most-accessed lectures showed an increase in knowledge and confidence in clinical skills. The Curriculum reached medical students and general psychiatry residents. Postpandemic, the Curriculum may serve as a valuable resource to enhance geriatric psychiatry education and knowledge. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) increase the risk of chronic diseases in adulthood and contribute to neurobehavioral challenges during childhood and adolescence. This retrospective study reviewed the medical records of 102 pediatric patients to describe interventions for children screening positive for ACEs in a pediatric primary care setting with integrated behavioral health services. It further assessed whether these interventions led to improvements in psychosocial functioning and mood. Immediate responses to positive ACE screenings included psychoeducation, crisis interventions, mental health referrals, and case management. Follow-up interventions involved skills training, cognitive-behavioral therapy, behavior management, motivation-based interventions, and symptom surveillance. Significant decreases in psychosocial problems and adolescent depression were observed. Integrated behavioral health interventions in pediatric primary care improved psychosocial functioning and mood in children with positive ACE screenings. These findings offer valuable insights for nurse practitioners implementing effective ACE screening and intervention programs in primary care. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty (THA) is a proven and effective treatment for end-stage osteoarthritis. The success of THA is due in part to highly crosslinked polyethylene (XL) implants. In 2007, a new generation of polyethylene liners entered clinical use. The new liners infused polyethylene with vitamin E and became vitamin E infused polyethylene (EP). The EP liner was hypothesized to prevent the loss of mechanical properties caused by oxidation, extending the lifetime of the implant. This international prospective study aimed to quantify the clinical outcomes of a 977 patient cohort receiving EP and XL liners 10 years after surgery. The prospective cohort study began in 2007, including eight countries and 17 centers. The final cohort included 977 patients (EP liner: n = 520; XL liner: n = 457). Patients were followed preoperatively, postoperatively, and at 1, 3, 5, 7, and 10 years. Each follow-up visit involved clinical evaluation, radiography, and survey collection. The demographics and revisions were also recorded. Mann–Whitney U tests were used to evaluate statistical differences. At 10 years following surgery, 534 patients were eligible for follow-up. Of those eligible, 352 patients returned for clinical evaluation (65.9% eligible; 36.0% overall). No statistical differences were found (P > 0.05) in the demographics of the followed-up cohort. The linear wear rates were 0.00338 mm/year for EP liners and 0.0236 mm/year for XL liners using individual regression (P < 0.0001). No significant difference was observed in wear rates using cohort regression. Similarly, surveys suggested no significant outcomes between the EP and XL liner cohorts. The overall incidence of revision was 2.3% for EP and 2.0% for XL liners. The EP liner demonstrated significantly lower wear than its XL counterparts at 10 years after implantation. Results are promising, as vitamin E polyethylene may improve the lifetime performance of THA implants and ensure that arthroplasty innovations reflect the changing patient population. [ABSTRACT FROM AUTHOR]

Ceramic–on–highly crosslinked polyethylene (HXLPE) has become the most common bearing surface utilized in primary total hip arthroplasty (THA). The purpose of this study was to determine the implant survivorship and clinical outcomes of THAs with ceramic-on-HXLPE in a large single-institutional series. We identified 5,536 primary THAs performed from 2007 to 2017 using a ceramic-on-HXLPE bearing through our total joint registry. The mean age was 60 years, 51% were women, and the mean body mass index was 30. A cementless femoral component was used in 98% of cases, and a head size of ≥ 36 was used in 75%. Kaplan-Meier survivorship analyses were completed to assess survivorship free of any revision or reoperation. Clinical outcomes were assessed via Harris Hip Score. The mean follow-up was four years. The 5-year survivorship free of any revision was 97%. The most common indications for revision were dislocation (41 hips), periprosthetic joint infection (39 hips), and periprosthetic femur fracture (18 hips). The 5-year survivorship free of any reoperation was 96%. There were an additional 70 reoperations, with the most common indications being wound dehiscence (32 hips), iliopsoas impingement (11 hips), and periprosthetic femur fracture (11 hips). There were only two bearing surface failures: one HXLPE liner fractured and one dissociated. There were no ceramic head fractures or failures. The mean Harris Hip Score increased from 57 to 92 (P < 0.0001). In over 5,500 THAs completed with modern ceramic-on-HXLPE bearings, failures of the bearing surface were nearly eliminated at midterm follow-up, and overall 5-year survivorship free of revision was excellent. Dislocation, periprosthetic joint infection, and periprosthetic femur fracture were the most common causes of failure. As bearing surfaces have evolved, traditional failure mechanisms such as polyethylene wear, corrosion and metal reactions, and ceramic fractures have become nearly extinct. III (Case-Control Study), Therapeutic. [ABSTRACT FROM AUTHOR]

To evaluate socioeconomic factors affecting whether a patient undergoes rotator cuff repair after a diagnosis of a rotator cuff tear. From 2009 through 2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary rotator cuff injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database via International Classification of Diseases (ICD)—9th Revision—Clinical Modification (CM) and ICD-10-CM diagnostic codes. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. ICD-9-CM and ICD-10-CM codes were used to identify the initial diagnosis for each patient. Current Procedural Terminology codes were used to identify subsequent rotator cuff surgery. The procedures identified were linked with the initial diagnosis, and patients were noted as either having or not having rotator cuff surgery. Logistic regression analysis was performed for variables including age, sex, race, Social Deprivation Index (SDI), Charlson Comorbidity Index, and primary insurance type to determine the effect of patient factors on the likelihood of having surgery after a diagnosis of rotator cuff injury. Of the 67,584 rotator cuff patients included in the analysis, 19,770 (29.3%) of the patients underwent surgical intervention. From the logistic regression, females relative to males (odds ratio [OR] = 0.798, P <.0001), increased SDI (OR = 0.994, p <.0001), African American compared with White race (OR = 0.694, P <.0001), Asian compared with White (OR = 0.832, P <.0001), Hispanic compared with White (OR = 0.693, P <.0001), other race (OR = 0.58, P <.0001), those with Medicare (OR = 0.601, P <.0001) or Medicaid (OR = 0.614, P <.0001) relative to private insurance, and self-pay relative to private insurance (OR = 0.727, P <.0001) were all associated with decreased odds of undergoing rotator cuff surgery. Older patients (OR = 1.012, P <.0001) and Workers' Compensation relative to private insurance (OR = 1.664, P <.0001) had increased odds of undergoing surgery. The results of the current study identified disparities in the likelihood of undergoing rotator cuff repair after a diagnosis of a rotator cuff tear based on patient demographic and socioeconomic factors. Individuals with higher SDI; African American, Asian, Hispanic, or other non-White races; and those with Medicare, Medicaid, or self-pay insurance had decreased odds of surgery, whereas older age and Workers' Compensation insurance were associated with increased odds of undergoing surgery. Level IV, retrospective case series [ABSTRACT FROM AUTHOR]

To assess clinical outcomes and return to sport (RTS) rates among patients who undergo osteochondral allograft (OCA) transplantation and autologous chondrocyte implantation (ACI) or matrix-induced autologous chondrocyte implantation (MACI), for patellofemoral articular cartilage defects. A retrospective review of patients who underwent an OCA or ACI/MACI from 2010 to 2020 was conducted. Patient-reported outcomes collected included visual analog scale for pain/satisfaction, Knee Injury and Osteoarthritis Outcome Score (KOOS), and RTS. The percentage of patients that met the patient acceptable symptom state for KOOS was recorded. Logistic regression was used to identify predictors of worse outcomes. A total of 95 patients were included (78% follow-up) with ACI or MACI performed in 55 cases (57.9%) and OCA in 40 (42.1%). A tibial tubercle osteotomy was the most common concomitant procedure for OCA (66%) and ACI/MACI (98%). Overall, KOOS pain was significantly poorer in OCA than ACI/MACI (74.7, 95% confidence interval 68.1-81.1 vs 83.6, 95% confidence interval 81.3, 88.4, P =.012), whereas the remaining KOOS subscores were nonsignificantly different (all P >.05). Overall, RTS rate was 54%, with no significant difference in return between OCA or ACI/MACI (52% vs 58%, P =.738). There were 26 (27%) reoperations and 5 (5%) graft failures in the entire group. Increasing age was associated with lower satisfaction in OCA and poorer outcomes in ACI/MACI, whereas larger lesion area was associated with lower satisfaction and poorer outcomes in ACI/MACI. Clinical and functional outcomes were similar in patients who underwent OCA or ACI/MACI for patellofemoral articular cartilage defects at a mean follow-up of 5 years. Patients who received OCA had a greater proportion of degenerative cartilage lesions and, among those with trochlear lesions, reported greater pain at final follow-up than their ACI/MACI counterparts. Overall, increasing age and a larger lesion size were associated with worse patient-reported outcomes. Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

• Coronary artery disease is highly prevalent in patients undergoing TAVI. • PCI before TAVI is recommended, but randomized controlled trials are warranted. • The PRO-TAVI trial investigates the non-inferiority of deferral of routine PCI. • The results of the PRO-TAVI trial are expected in early 2026. Concomitant coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The optimal treatment strategy for CAD is a topic of debate. An initial conservative strategy for CAD in patients undergoing TAVI may be favorable as multiple studies have failed to show an evident beneficial effect of percutaneous coronary intervention (PCI) on mortality after TAVI. However, more randomized, controlled trials are warranted. The PeRcutaneous cOronary Intervention before Transcatheter Aortic Valve Implantation (PRO-TAVI) trial is an investigator-initiated, multicenter, open-label, randomized controlled trial comparing TAVI with or without routine preprocedural PCI. A total of 466 patients undergoing TAVI will be randomized in a 1:1 ratio to PCI (reference group) or no PCI (index group). Concomitant CAD is defined as at least 1 stenosis of 70% to 99%, or at least 1 stenosis between 40% and 70% combined with positive physiological measurement in a coronary artery with a minimal diameter of 2.5 mm or bypass graft. The primary endpoint is a composite of all-cause mortality, myocardial infarction, stroke, or type 2 - 4 bleeding at 12 months after randomization, in accordance with Valve Academic Research Consortium-3 criteria. Key secondary endpoints include the individual components of the primary endpoint, revascularization, quality of life and cost-effectiveness. The primary endpoint will be analyzed to assess non-inferiority of deferral of routine PCI in patients undergoing TAVI against the prespecified margin of 11 percentage points. The PeRcutaneous cOronary intervention before Transcatheter Aortic Valve Implantation (PRO-TAVI) trial is designed to investigate the hypothesis that deferral of routine PCI in patients undergoing TAVI is non-inferior to TAVI with preceding PCI. clinicaltrials.gov. Unique identifier NCT05078619 Study flowchart. CAD, coronary artery disease; DAPT, dual antiplatelet therapy; PCI, percutaneous coronary intervention; TAVI, transcatheter aortic valve implantation; VARC, valve academic research consortium. [Display omitted] [ABSTRACT FROM AUTHOR]

Patients who undergo total shoulder arthroplasty typically have excellent clinical outcomes, though some patients require revision shoulder arthroplasty to address complications such as infection, instability, and persistent pain. The purpose of this study was to compare the rates and types of complications, as well as patient-reported outcomes, following primary and revision shoulder arthroplasty. Retrospective chart review was conducted for patients who underwent revision anatomic or reverse shoulder arthroplasty between January 2015 and May 2021 (N = 152). A cohort of patients who underwent primary shoulder arthroplasty in the same period was generated by matching 1:1 for implant type (anatomic/reverse), age, and surgery date. Demographic data, patient-reported outcomes, surgical details, surgical complications, and reoperations were collected for both cohorts (N = 304). Chi-square, t-test, Fisher's exact test, and Mann-Whitney test were used as appropriate. The revision cohort had a significantly higher rate of surgical complications than the primary cohort (N = 58, 38.2% vs. N = 22, 14.5%; P <.0001). The distribution of complication types differed significantly between the primary and revision cohorts (P =.018). Revision patients reported less improvement in Single-Assessment Numeric Evaluation score from baseline to 2-year follow-up compared to primary patients (postoperative and preoperative scores 33.9 ± 35.9 vs. 52.3 ± 32.5; P =.036). Patients in the primary cohort who underwent a previous shoulder surgery before their shoulder arthroplasty were more likely to experience complications than those who did not (P <.001). The most common surgical complications in the revision cohort were persistent pain (N = 20) and periprosthetic joint infection (N = 10), while the most common complications in the primary cohort were persistent pain (N = 6) and instability (N = 4). 63.6% of complications in primary patients and 55.2% of complications in revision patients necessitated reoperation. Total procedure time was higher on average in revision patients (120 ± 68 min) than primary patients (94 ± 31 min; P <.0001). Revision patients were more likely than primary patients to have had cemented humeral stems in their primary arthroplasty (P =.043). Patients undergoing revision shoulder arthroplasty are at an increased risk for subsequent surgical complications and worse clinical improvement compared to primary shoulder arthroplasty patients. The differing profiles of postoperative complication types following primary and revision shoulder arthroplasty should be considered when advising patients on the risks of surgery and creating preoperative surgical plans to minimize these risks. [ABSTRACT FROM AUTHOR]

• Proteomic analysis distinguishes LM from OED with KRT17, LYSC, CAL5, and CRNN as biomarkers. • Findings show OEDwithLF proteomic profiles resemble OED but differ notably from LM profiles. • Study validates proteomic profiling in distinguishing histopathological features in oral epithelium. This study investigates the proteomic profiles of oral epithelial dysplasia with lichenoid features (OEDwithLF) and evaluates its relevance as a histopathological feature for lichenoid mucositis (LM) through differential proteomic characterization. SWATH-MS proteomic profiling was conducted on FFPE samples from 6 OEDwithLF, 5 OED cases without associated lymphocytic infiltration, and 5 LM cases. Protein expression levels were quantified and compared. In silico analysis examined the biological and molecular functions of dysregulated proteins. A total of 460 proteins were identified. Unsupervised clustering revealed significant differences between LM and OEDwithLF, with fewer differences observed between OEDwithLF and OED. Bioinformatic analysis indicated dysregulated proteins are involved in nucleic acid binding, ribosome function, and developmental biology. Key potential biomarkers include KRT17, LYSC, CAL5, and CRNN. The proteomic profile of OEDwithLF is similar to OED without associated lymphocytic infiltration, but significantly different from LM. OED is relevant in lichenoid tissues, and its proteomic changes can be detected. Although OED may coexist with interface mucositis, it is not a defining feature of LM. This challenges the exclusion of epithelial dysplasia from lichenoid diagnoses. Based on this hypothesis-generating study, further investigation is warranted. [ABSTRACT FROM AUTHOR]

The purpose of this article is to review the staging systems for common malignant genitourinary and gynecological tumors, including renal cell carcinoma, urinary bladder carcinoma, as well as cervical, endometrial, and ovarian carcinoma, and to highlight the key imaging findings ("tipping points") that may alter patient management algorithms based on radiological staging. There are identifiable imaging features for the common genitourinary and gynecological malignancies, including the size of the primary tumor, tumor extension, invasion of adjacent structures, lymph node involvement, and distant metastasis, which provide important prognostic information and determine patient management. Radiologists must be aware of these imaging findings ("tipping points") when interpreting staging examinations. [ABSTRACT FROM AUTHOR]

There has been a growing interest in granting prescribing rights to pharmacists as a strategy to improve healthcare access. Researchers continue to explore the impact and implementation of pharmacist prescribing. Given the recent international changes in this field, an overview of current territories allowing pharmacist independent prescribing would provide a comprehensive understanding for researchers and policymakers. This scoping review aims to summarize the countries and specific jurisdictions where pharmacists can prescribe independently in community pharmacy, and map the conditions they can prescribe for, required training, and reimbursement policies. This scoping review was conducted in October 2024 and has been reported following the PRISMA-ScR guidelines. Searches were performed in Scopus, Web of Science, CINAHL, PubMed, and Cochrane databases, along with grey literature searches using Google. A total of 88 studies and reports were identified. The countries where pharmacist can prescribe independently include the United Kingdom, the United States, Canada, Australia, Poland, Switzerland, and Denmark. Pharmacists authorized as independent prescribers generally require post-registration training and are authorized to initiate, adapt, renew, or substitute prescriptions. For the payment and reimbursement, this service is publicly funded only in Canada, Denmark, France, and the United Kingdom. Pharmacist prescribing practices vary significantly worldwide, with differences in terminology, legislation, and training requirements. This scoping review provides the necessary information to visualize and conceptualize the current scope of pharmacist independent prescribers, offering a foundation for advancing this practice in new jurisdictions. Further research should address current models in under-studied regions, explore the scope for pharmacists to prescribe for undiagnosed conditions, and analyze payment structures in non-funded jurisdictions. • Independent prescribers' authority has expanded significantly in recent years. • Currently 8 countries allow independent prescribing in community pharmacy. • Common prescriptions are for contraception, smoking cessation, and urinary infections. [ABSTRACT FROM AUTHOR]

Dynamic tape™ (DT) is a biomechanical tape used to manage load directly, modify movement patterns, and assist functioning. Despite its increasing use in clinical practice, few studies have evaluated its effectiveness in improving postural stability, balance, and lower limb kinetics during jump landing tasks. This study aimed to investigate the acute effect of applying DT to the gluteus medius (GM) muscle on balance strategies during squatting, as well as on jump landing kinetics in asymptomatic active women. A randomized controlled clinical trial was performed with 32 healthy and recreationally active women randomly assigned to three groups: 1) submitted to the DT application in active form on the GM (BG; n = 9); 2) submitted to the DT application in placebo form on the GM (PG; n = 12), and 3) not submitted to any form of intervention (CG; n = 11). Center of pressure data was assessed using a force platform during the single-leg squat (SLS), and jump landing kinetics was assessed using the same platform during the drop landing (DL) and anterior jump (AJ) tasks under two conditions (with and without DT application). There was no significant effect of group or time factors, and no significant group × time interaction for any stabilometric outcome measure during the SLS and for any kinetic outcome measure during the DL and AJ (P > 0.05). DT functionally applied to the GM muscle had no acute effects on balance conditions and jump landing kinetics in asymptomatic active women. [ABSTRACT FROM AUTHOR]

The therapeutic armamentarium for management of inflammatory bowel diseases has expanded dramatically in the last 5 years, with the introduction of several medications with different mechanisms of action. These include the oral small molecule drugs Janus kinase inhibitors (including upadacitinib, approved for Crohn's disease and ulcerative colitis [UC], and tofacitinib, approved for UC) and sphingosphine 1-phosphate receptor modulators (ozanimod and etrasimod, both approved for UC), and biologic agents, such as selective interleukin-23 antagonists (risankizumab approved for Crohn's disease, and mirikizumab approved for UC). The efficacy and safety of these therapies vary. In this review, we discuss practical use of these newer advanced therapies focusing on real-world effectiveness and safety data, dosing and monitoring considerations, and special situations for their use, such as pregnancy, comorbid immune-mediated disease, use in hospitalized patients with acute severe UC, and in the perioperative setting. We also propose our approach to positioning these therapies in clinical practice, relying on careful integration of the medication's comparative effectiveness and safety in the context of an individual patient's risk of disease- and treatment-related complications and preferences. [ABSTRACT FROM AUTHOR]

Histoplasmosis is a rarely reported clinical disease of equids in North America and is historically attributed to Histoplasma capsulatum var. capsulatum. This report details a case of intestinal histoplasmosis with lymphadenitis in an American Mammoth Jackstock donkey from Mississippi. Clinically, the donkey had chronic wasting, poor appetite, diarrhoea and an intra-abdominal mass detected by ultrasound. Grossly, the distal small and proximal large intestines contained multifocal, raised, tan, nodular, button ulcers along the mucosal surface. The associated colonic and mesenteric lymph nodes were severely enlarged, mottled tan to red and firm, and formed a large multinodular mass within the mesentery. Microscopically, lesions consisted of nodular infiltrates of epithelioid macrophages and multinucleated giant cells laden with numerous yeasts, along with mucosal ulceration and necrosis. Fungal polymerase chain reaction from lesioned intestines and lymph nodes targeting the internal transcribed spacer region yielded a 585 bp sequence that matched identically to two human isolates of Histoplasma mississippiense , one of several cryptic species previously classified together as H. capsulatum var. capsulatum endemic to North America. This case represents the first molecular identification of a Histoplasma species infecting a North American equid and the second report of histoplasmosis in a donkey from North America. [ABSTRACT FROM AUTHOR]

In the UK Oral and Maxillofacial Surgery (OMFS) and Oral Surgery (OS) are distinct specialties governed respectively by the General Medical Council (GMC) and General Dental Council (GDC) respectively. There has always been overlap of training and care between both specialties. The OMFS curriculum was updated in 2021 and the Oral Surgery Curriculum in 2023. This paper quantitatively compares the two documents. The generic professional elements of both curricula are extensive and similar in content. The specialty specific elements of the OS and OMFS curricula, with focus on knowledge domains and competencies including index procedures and critical conditions, were compared with the level of coincidence colour coded: green (matching), amber (some overlap) and red (not present). OMFS curriculum contains all components of the new UK OS curriculum with the exception of formal documented competence in conscious sedation for dentistry. This overlap between OMFS and OS has been recognised by the General Dental Council who give OMFS specialists direct access to the Oral Surgery specialist list by Route 4. In contrast, the OS overlap with OMFS is limited, particularly in the important critical/emergency conditions where 'competence' has been replaced by 'experience of' in the 2023 OS curriculum in the domains of trauma and acute infections. This change will preclude OS specialists trained on the new curriculum being able to share on-call with OMFS specialists without significant additional training. We hope this comparison will be useful to those commissioning services and also for young dentists/doctors considering their future careers. [ABSTRACT FROM AUTHOR]

The characteristics of effective leaders in dentistry are unknown, especially as they relate to the perceptions of attributes associated with emotional intelligence. The purpose of this study was to survey dentists about their perceptions of the relative importance of emotional intelligence domains in effective leadership and in effective leaders with whom they have worked and to determine whether the differences were based on gender and age. A survey was sent to a list of over 50 000 dentists. The survey asked respondents to rate important qualities found in effective leaders in general and to identify important qualities found in the most effective leaders with whom they had worked or by whom they had been mentored. Additionally, demographic information such as the age and gender of the participants was captured in the survey. Descriptive statistics were created and statistical differences (α=.05) between genders were determined. A total of 256 respondents completed the survey. Self-management and relationship management were perceived to be more important than social awareness or self-awareness. Adaptability was the highest ranked personal competence skill, while conflict management was perceived as the least important personal competence skill. The social competence skills of empathy, organizational awareness, influence, and inspirational leadership were similarly ranked as highly important. When asked to identify the most important leadership skill of previous leaders, respondents noted that conflict management was most important and emotional self-awareness was least important. Women viewed the attributes of adaptability, organizational awareness, and conflict management as more important. Men viewed achievement orientation and coaching or mentoring as more important attributes of leaders. When answers were stratified for age group responses, younger respondents valued relationship management and adaptability, and whether their leader valued and exhibited conflict management more than older respondents. Older respondents were more likely to respond "yes" to valuing self-management and to whether their leader valued and exhibited inspirational leadership. Different genders and different age groups view leadership skills in effective leaders differently. The results of this study indicate that women may need different leadership skills to lead colleagues of different ages. [ABSTRACT FROM AUTHOR]

Alport syndrome (AS) is the second common monogenic cause of end-stage kidney disease (ESKD) worldwide and is caused by defective type 4 collagen due to pathogenic variants of COL4A3, COL4A4, or COL4A5. Type 4 collagen also exists in the eyes and ears, and thus ocular defects and hearing loss occur in AS. The understanding of AS has expanded over the past two decades due to greater availability of genetic testing and research on genotype-phenotype correlation. Patients previously diagnosed with idiopathic steroid resistant nephrotic syndrome or ESKD of unknown etiology may now be diagnosed as AS if pathogenic COL4A3-5 variants are identified. Some carriers of heterozygous COL4A3-5 variants may now be classified into females with X-linked AS or autosomal dominant AS, if there are typical pathologic changes in the glomerular basement membrane or if there is proteinuria and progression of kidney disease. Lastly, it has been recommended that renin-angiotensin-aldosterone system inhibition be started as soon as possible for selected AS patients for its long-term protective effect against kidney function deterioration. The purpose of this review is to introduce these important concepts to general pediatricians and pediatric nephrologists. [ABSTRACT FROM AUTHOR]

To demonstrate and test the capabilities of the ACR Connect and AI-LAB software platform by implementing multi-institutional artificial intelligence (AI) training and validation for breast density classification. In this proof-of-concept study, six US-based hospitals installed Connect and AI-LAB. A breast density algorithm was trained and tested on retrospective mammograms. We recorded time to receive institutional review board approval, to install software locally, and to complete the testing and training. We calculated the performance of the breast density algorithm at each participating hospital and compared it to the performance of a holdout multi-institutional clinical trial testing dataset and a retrospective multi-institutional dataset. We calculated the performance of the locally fine-tuned models on the holdout test datasets. The median time to receive institutional review board approval was 66 days, and the median time to successfully install Connect and AI-LAB locally was 157 days. The median time to complete breast density algorithm testing and training was 216 days. The breast density algorithm performed worse at each hospital than on the holdout test dataset, suggesting poor generalizability of the base model. The fine-tuned models had mixed performance locally and performed poorly on the test dataset. In this study, we demonstrate the successful installation and implementation of Connect and AI-LAB software platforms at six facilities using a breast density algorithm. Our results suggest poor generalizability of an algorithm trained on a single dataset and algorithms fine-tuned at individual institutions, emphasizing the hypothetical importance of multi-institutional testing and training. [ABSTRACT FROM AUTHOR]

Although bed baths are known to cause pain, the engendered pain frequency and intensity remain poorly studied. This prospective, observational study was undertaken to examine prospectively, on a given day, patients' bed bath-associated pain in the general in-hospital population. Eight external investigators observed 166 bed baths given in 23 units in 5 hospitals. Using validated assessment scales specific to the patients' clinical situations, they established pain scores. Expert observers rated bed bath-induced pain as moderate-to-severe for 48% of the patients, among whom 51.9% had not received prophylactic analgesia prior to the procedure. Only 7.2% benefited from evaluation with a validated pain scale. Astute attention-distraction techniques were applied to shift attention during 16.8% of the bed baths. Caregivers used verbal guidance for 85% of the procedures, and adapted touch and rhythm of the gestures for 84.3%. Bed baths generate moderate-to-severe pain intensity. Evaluation and recourse to analgesia remain insufficient despite caregivers' attention accorded to patient comfort and positioning. The results of this study could contribute to sensitizing professionals to preventing pain linked with routine nursing care. Four axes for improvement were highlighted: evaluation improvement, analgesia, nonpharmacological approaches, and adapted mobilization techniques. [ABSTRACT FROM AUTHOR]

We conducted an explanatory, sequential mixed-methods study to measure variation in the use of imaging and physical therapy (PT) for acute low back pain (LBP) and to identify implementation determinants that might explain variation in use across 22 EDs and 27 urgent cares in urban and rural locations within a community-based health system. We described the patient population and measured concordance with LBP guideline recommendations on imaging and PT referral from January–June 2023. We conducted key informant interviews with physicians and advanced practice providers (APPs), n = 30, from these 49 sites between July – September 2023 and performed content analysis to identify implementation determinants to guideline concordance. From January–June 30, 2023, 1047 Intermountain Health employed or affiliated physicians and APPs at the 22 adult EDs and 27 adult UCs cared for 8047 patient encounters involving acute LBP with no red flags. 29% of acute LBP patient encounters included an imaging order (ED: 43%; UC: 18%) and 5% included a PT order (ED: 7%; UC: 4%). 17 ED and 13 UC physicians and APPs participated in semi-structured interviews. Their patient encounters represent 6% of the overall study population (ED: 5%; UC: 7%) with order rates and patient population characteristics similar to the full study population. ED and UC clinicians were generally familiar with LBP guideline recommendations but varied significantly in their knowledge and beliefs of the appropriate application of guidelines in evaluation and treatment plans. Guideline concordance for use of imaging and PT varied substantially across physicians and advance practice providers providing care at EDs and UC centers within a community-based health system. Implementation strategies that address barriers identified by this study, including varied understanding of the PT discipline, complex workflows for placing PT referrals, the medico-legal assurance that imaging provides, and the lack of feedback loops in ED and UC centers should be tested in future hybrid implementation-effectiveness trials to increase concordance to LBP guidelines and minimize harm related to overuse of imaging and underuse of conservative first-line treatment approaches. [ABSTRACT FROM AUTHOR]

Respiratory diseases such as chronic obstructive pulmonary disease (COPD) and pulmonary diseases in general represent some of the most pervasive health threats globally, so there is a need to develop effective diagnostic systems. Therefore, identifying COPD at an early stage may help define early therapeutic approaches and individual patient care for this condition. The epidemiological data of COPD and its grave consequences for the health of patients show the importance of the development of effective diagnostic tools. The various conventional diagnostic approaches may not possess the detail needed to identify early-stage COPD or the difference between it and other respiratory diseases. This research seeks to create an adaptive and accurate model for assessing pulmonary audio data to diagnose COPD early. The objective is to increase diagnostic accuracy and employ modern approaches to machine learning algorithms and feature extraction. In this study, the feature extraction applied in Pulmonary sound recordings is Mel-frequency cepstral coefficients (MFCCs). Due to issues with dimensionality and computational complexity, the relevant features are selected using Forward Feature Selection (FFS). The classification approach synthesizes two methods, support vector machines, and k-nearest neighbors, to reveal intricate patterns and boundaries in the data. The COPD disease data set is the basis for all modeling and testing. The adopted SVM-KNN fusion model integrated in Python proved to deliver a high level of performance with an accuracy of 94 %. Again, this degree of accuracy attests to the model's effectiveness in distinguishing between healthy and COPD-affected lungs. The developed framework considerably improves the identification of patients' COPD and respiratory illness risk assessment. [ABSTRACT FROM AUTHOR]

Current adult cardiac surgery guidelines recommend against the routine use of prophylactic intravenous corticosteroids during cardiopulmonary bypass (CPB) due to concerns about myocardial injury, despite their potential to reduce postoperative atrial fibrillation. Traditionally, a high dose of 1,000 mg of methylprednisolone was used to attenuate the inflammatory response associated with CPB. Our institution aligned with guideline recommendations and gradually reduced methylprednisolone dosages; thus, we reevaluated the impact on postoperative clinical outcomes. Our study reviewed 1341 cases from a total of 1680 adult cardiac surgeries performed between June 2019 and May 2022 after excluding cases with off-pump procedures, ventricular assist device implantations, heart transplants, and aortic surgeries requiring systemic circulatory arrest. The study timely sorted periods including a baseline data from 2018, and other three periods since 2019 to analyze the effects of three different methylprednisolone dosage: 0 mg, 500 mg, and 1000 mg. We assessed the annual trends in methylprednisolone administration and compared morbidity and mortality rates across the groups. We observed a significant decline in steroid use, with no-steroid surgeries increasing from 23% to 66.5% by period 3. Despite the decreased use of steroids, our study showed no increase in mortality, new-onset atrial fibrillation, acute kidney injury, cerebrovascular event and prolonged ventilation when compared to baseline data. Notably, less surgical site infection rate was observed in the no-steroid group. The data indicates that a reduction or discontinuation of steroids during CPB can be performed without compromising patient outcomes. This could support a transition towards a more conservative use of steroids in adult cardiac surgery, aligning with current guidelines, and potentially reducing certain postoperative complications. [ABSTRACT FROM AUTHOR]

Previous research on the factors associated with surgical dose-response in strabismus surgery for exotropia has yielded inconsistent results. This study determined the factors influencing surgical dose-response in exotropia patients who underwent recession and resection (R&R). Exotropia patients who underwent unilateral R&R at the National Taiwan University Hospital between 2006 and 2021 were evaluated. Deviation-angle differences in prism diopters (PD) were measured preoperatively and at 1 month postoperatively. Surgical dose-response (PD/mm) was defined as the difference in deviation angle (in PD) divided by the surgical dose in millimeters. Linear and non-linear regression models were used to evaluate the influence of variables including age, sex, axial length, and preoperative deviation on surgical dose-response. Overall, 295 patients (162 children; 133 adults) were included. Average surgical dose-response in the pediatric and adult groups was 2.82 ± 0.60 PD/mm and 3.02 ± 0.62 PD/mm, respectively. Male sex was negatively correlated with surgical dose-response in children. The surgical dose-response was larger in adults with longer axial length (>25.64 mm) and patients with larger preoperative deviation (>42.6 PD and >38.7 PD in pediatric and adult groups, respectively). Surgical dose-responses peaked at 35.1 years. Age, axial length, and preoperative deviation have a nonlinear effect on surgical dose-responses in exotropia patients undergoing R&R. Surgical dose-responses were larger in patients in young adulthood, with longer axial length and larger preoperative deviation angle. A table with fitted values for surgical dose-response based on age, axial length, and preoperative deviation was established for clinical reference. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the supply and transfusion of blood components. This study aims to evaluate changes in blood collection and transfusions during the period following the nationwide Level 3 alert (May–July 2021). We retrieved usage data for red blood cells (RBC) from the Taiwan National Health Insurance (NHI) database 2019–2021. During the Level 3 alert period, approximately 85% of COVID-19 cases (11,455/13,624) were in Taipei. In Taipei, blood collection declined by 26.34% and RBC transfusions decreased by 17.14% compared to pre-pandemic levels. RBC usage decreased across all service types, with a significant decrease observed in hematology/oncology by 15.62% (-483 patients, -2,425 units). In non-Taipei regions, blood collection declined by 12.54%, rebounding around one month earlier than in Taipei. The decline in RBC transfusions occurred one month later than in Taipei, with a much lower magnitude (4.57%). Strain on the blood supply occurred in May and June in both Taipei and non-Taipei regions. Among 7,532 hospitalized COVID-19 patients, approximately 6.9% patients required a total of 1,873 RBC transfusions. The rapid increase in COVID-19 inpatients did not significantly increase the burden of blood demands. During the Level 3 alert, the most significant decline in both RBC collection and transfusions was observed in Taipei. In non-Taipei regions, the decrease in RBC use was only marginal. Notably, there was a significant decrease in RBC use in hematology/oncology in Taipei. This study supports transfusion specialists in seeking efficient ways to address similar future challenges. [ABSTRACT FROM AUTHOR]

Nose deviation deformities pose a complex cosmetic and functional problem. The most common surgical intervention to manage such deformities is septorhinoplasty, typically performed by a plastic surgeon or a rhinologist. This study investigated the effect of a combined operation by a plastic surgeon and rhinologist, comparing them with those operations performed singlehandedly by a plastic surgeon. From January 2017 to January 2022, 99 patients with deviated noses were treated. Fifty-nine underwent the combined operation, whereas 40 underwent surgery performed by a plastic surgeon. In the combined operation group, the rhinologist performed endonasal septoplasty and turbinoplasty, while the plastic surgeon performed open rhinoplasty, osteotomies, caudal septal deviation correction, camouflage procedure, esthetic enhancement, and dorsal augmentation. Subsequently, the rhinologist checked the airway and applied a nasal tamponade. Treatment outcomes were evaluated using the Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) questionnaire and incidence of postoperative complications. Of the 79 patients who responded to the RHINO questionnaire, 33 underwent an operation by a plastic surgeon, whereas 46 underwent the combined operation. All cases showed improved scores on the RHINO questionnaire postoperatively, with significantly higher scores in the combined group (p = 0.032). Furthermore, the combined group showed more significant improvements in function-related questions, despite longer total operation durations. The overall complication rate was 10.1%. A combined surgical correction for deviated nose by a plastic surgeon and rhinologist could provide better subjective outcomes, especially in functional outcomes. [ABSTRACT FROM AUTHOR]

Androgen deprivation therapy (ADT) leads to loss of lean mass (LM) and reduced strength and physical function. Resistance exercise alone can counteract these changes; however, it is unknown if the addition of creatine supplementation can further protect against these ADT-induced toxicities. We compared the effects of creatine supplementation with resistance exercise versus resistance exercise alone in patients with prostate cancer undergoing ADT on LM, muscle strength, and physical function. A 12-week randomized trial. Men with prostate cancer receiving ADT (n = 30) were randomized to either resistance exercise + placebo (PLA) or resistance exercise + creatine (SUPP), with both groups undertaking supervised exercise 3 days per week. Outcomes included whole body and appendicular LM and fat mass (FM) assessed by dual-energy X-ray absorptiometry, as well as muscle strength (chest press, seated low, leg press), and physical function (timed up-and-go, chair rise, 400-m walk) assessed at baseline and following the intervention. Patients were aged 59–84 years with a BMI of 28.6 kg·m−2. PLA completed a mean of 30 sessions (83 %) and SUPP a mean of 33 sessions (92 %). Despite similar within-group improvements (p < 0.05) in whole-body LM (PLA + 0.6 kg, SUPP + 1.3 kg), appendicular LM (PLA + 0.5 kg, SUPP + 0.6 kg), muscle strength (PLA + 8.8–49.3 kg, SUPP + 9.4–40.4 kg) and physical function, there were no between group differences (p = 0.078–0.951). No adverse events were reported due to creatine supplementation or resistance exercise. A short-term program of resistance exercise alone results in meaningful improvements in LM, muscle strength and physical function, with no additional effects of creatine supplementation. [ABSTRACT FROM AUTHOR]

Clinical features and outcomes in severe aortic stenosis (AS) have been described according to the hemodynamic phenotypes. The aim of this study was to investigate the clinical features and prognosis of patients with high-gradient (HG) AS with aortic valve area (AVA) >1.0 cm2. A total of 3,209 patients were identified according to AVA (cm2), peak velocity (m/s), systolic mean pressure gradient (MG) (mm Hg): HG-AVA >1 = >1.0, ≥4, and ≥40, HG-AVA ≤1 = ≤1.0, ≥4, and ≥40; LG-AVA ≤1 (low-gradient) = ≤1.0, <4, and <40; moderate AS = 1.0 1 accounted for 230 individuals (7.2%). Compared with others, patients with HG-AVA >1 were younger (70.2 ± 12.0 years), more frequently male (85.7%), had fewer comorbidities, larger body surface area and stroke volume (115 ± 19.3 mL), and had higher prevalence of bicuspid valve (39.6%). After a follow-up of 944 days (Q1-Q3: 27-2,212 days), 1,523 deaths occurred. Compared with the HG-AVA >1 group, all-cause mortality was higher in HG-AVA ≤1 (HR: 1.4; 95% CI: 1.1-1.7), LG-AVA ≤1 (HR: 2.8; 95% CI: 2.2-3.6), and moderate AS (HR: 1.4; 95% CI: 1.1-1.7). These differences were no longer significant after adjustment for age, comorbidities, bicuspid valve, and cardiac function. In the HG-AVA >1 group, patients with aortic valve replacement had better survival outcomes than those without aortic valve replacement (P < 0.001) after balancing the 2 groups. The underlying relative high-flow status is responsible for HG in patients with HG-AVA >1. This profile has better prognosis than others, being related to underlying younger age and better general and cardiac conditions, but aortic valve replacement may still benefit these patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Teen economic abuse (TEA) is an understudied form of adolescent relationship abuse with limited measures available to assess prevalence. The purpose of this article is to assess the underlying dimensions of survey items (developed with youth) to refine measurement of and validate the structures comprising TEA and examine differences in prevalence of TEA perpetration (Prp) and victimization (Vct) by demographic characteristics. This cross-sectional, online survey was conducted between July and September 2021. Youth ages 13–19 who read English and reside in the United States were eligible to complete this study. Recruitment occurred through a national violence prevention listserv with an emphasis on reaching organizations serving youth who are unhoused, juvenile justice and child welfare-system involved, identifying as sexual or gender minorities, or from communities of color. Based on exploratory and confirmatory factor analysis, negative binomial regression models were run to assess associations of demographic characteristics, with levels of TEA Vct and Prp. Adolescents who identify as White reported significantly more types of TEA exposures than their American Indian or Alaskan Native (adjusted incident rate ratios = 1.3; 95% CI = [1.1, 1.4]), Hispanic Latino (1.2 [1.1, 1.4]), and Multiracial peers (2.4 [1.8, 3.1]). Gender diverse adolescents (1.14 [1, 1.3]) and cisgender females (1.08 [1, 1.2]) had significantly more types of TEA exposures than cisgender males. Those with past-year physical or sexual violence in dating relationships reported more types of TEA exposures (4.1 [3.8, 4.4]) than those who had not experienced such violence. Adolescents with exposure to foster care or homelessness had more types of TEA (1.3 [1.2, 1.4]) than those without such experiences. Healthcare providers serving youth should be aware of how economic abuse manifests in adolescent relationships when providing support and resources for youth, especially those who are system-involved or experiencing housing instability. Findings also highlight the need for education about TEA and economic justice in violence prevention programs. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the patency of bridging covered stents (BCS) bridged to inner branches in custom-made thoracoabdominal endografts. This was a single-center retrospective study identifying all patients undergoing fenestrated or branched endovascular aortic repair (f/b EVAR) in whom the reno-visceral target vessels (TVs) were bridged with a BCS to an inner branch of a custom-made (CMD) endograft. Technical success and perioperative complications were noted. Follow-up BCS patencies were evaluated, and in patients with follow-up, two groups based on BCS were created, a group with BCS occlusion and a group with BCS patent. Univariable and multivariable analyses were performed to analyze factors related to visceral and renal bridging stent occlusion. From 2019 through 2022, 69 patients undergoing complex aortic repair had at least one TV bridged to an inner branch built into a CMD endograft. Eighty-six percent of the grafts had only inner branches, whereas 14% had a mix of fenestrations for the visceral TVs and inner branches for the renal arteries. Twenty-five percent of patients presented as urgent and received an endograft originally designed for another patient and available on our shelf at the time. A total of 245 TVs were connected to inner branches: celiac trunk (CT), 54; superior mesenteric artery (SMA), 59; and renal artery (RA), 132. Technical success was 99%. There was a 23% complication and 9% perioperative mortality rate. At follow-up, we identified 6% of visceral and 14% of renal BCS occlusions. The primary patency for RA BCS was 83% at 12 months and 58% at 24 months. For the CT-SMA BCS, Kaplan-Maier showed a patency of 99% and 96% at 12 and 24 months. In the univariate analysis, a misaligned TV ostium (P =.001), the postoperative BCS diameter on postoperative computed tomography angiography (P =.02), and the preoperative infrarenal aortic angle >60° (P =.007) were correlated with RA BCS occlusion. In the multivariate analysis, only the misaligned TV ostium (P =.002) and infrarenal angle >60° (P =.01) were significantly correlated. In our series of complex aortic repair, the incorporation of inner branches to bridge TVs is associated with a high renal BCS occlusion rate. Improper alignment of the branches with the TV ostium and acute aortic angles might play a significant role. Further research on this technology is needed. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (OA) affects 19% of American adults aged more than 45 years and costs $27+ billion annually. A wide range of nonoperative treatment options are available. This study compared 6 treatments: cryoneurolysis with deep genicular nerve block (Cryo-Deep/Both), cryoneurolysis with superficial nerve block (Cryo-Superficial), intra-articular hyaluronic acid (IA-HA) injections, nonsteroidal anti-inflammatory drug injections (IA-NSAIDs), IA-corticosteroids (IA-CS) injections, or IA-triamcinolone extended release (IA-TA-ER) injections over 4 months for: (1) pain severity and analgesic use; and (2) physical function (from Knee Injury and Osteoarthritis Outcome Score for Joint Replacement). Patients who had unilateral knee OA and received nonoperative intervention were enrolled in the Innovations in Genicular Outcomes Research registry, a novel, multicenter real-world registry, between September 2021 and February 2024. A total of 480 patients were enrolled. Both pain and functional outcomes were assessed at baseline, weekly, and monthly, which were analyzed by overall trend, magnitude changes pretreatment to post-treatment, and distribution-based minimally clinically important difference (MCID) score. Multivariate linear regressions with adjustments for 7 confounding factors were used to compare follow-up outcomes among 6 treatment groups. Use of IA-TA-ER injections was associated with the lowest pain, greatest pain reduction, and highest prevalence of patients achieving MCID relative to other treatments (P <.001). Deep/Both-Cryo and IA-CS were associated with a higher prevalence of achieving MCID than IA-HA, IA-NSAIDs, and Cryo-Superficial (P ≤.001). Use of IA-TA-ER was also associated with the greatest functional score, improvement from baseline, and highest prevalence of patients achieving MCID than other treatments (P ≤.003). The IA-TA-ER appears to outperform other treatments in terms of pain relief and functional improvement for up to 4 months following treatment. In addition, outcomes in the novel cryoneurolysis and conventional IA-CS were similar to one another and better than those in IA-HA and IA-NSAIDs. [ABSTRACT FROM AUTHOR]

Assessment of coronary artery disease (CAD) is critical in managing severe aortic stenosis. Unplanned coronary angiography after TAVR, with or without percutaneous coronary intervention, may present significant challenges. The aim of this study was to evaluate the incidence, predictors, and outcomes of unplanned coronary angiography after transcatheter aortic valve replacement (TAVR). All TAVR procedures between July 2015 and December 2021 were examined for the occurrence of unplanned angiography and for procedural success with percutaneous coronary intervention if attempted, and a machine learning prediction model was created. Among 1,444 patients (median age 81 years, 59% men), 6.7% had unplanned post-TAVR angiography, 45% within the first year. The most common indication was acute coronary syndrome, which occurred in 3.3% overall. Patients with preprocedural CAD (50.1%) had a significantly higher incidence of unplanned angiography (10.5% vs 2.9%; P < 0.001) in comparison with others. In multivariable analysis, factors associated with unplanned angiography were age (>75 years; HR: 0.46; 95% CI: 0.30-0.71; P < 0.001), mean aortic valve gradient (HR: 0.82; 95% CI: 0.68-0.98; P = 0.031), dialysis (HR: 2.68; 95% CI: 1.07-6.74; P = 0.036), and CAD (HR: 2.96; 95% CI: 1.76-4.98; P < 0.001). In multivariate models, these same variables had areas under the curve of 0.71 to 0.77 for 5-year prediction of unplanned angiography. Unplanned angiography post-TAVR occurs in about 1 in 15 patients, with about one-half occurring within the first year, about one-half due to acute coronary syndrome, and pre-existing CAD being the strongest predictor. For those considering TAVR and who have or are at risk for CAD, a comprehensive strategy to facilitate lifetime management is needed. [Display omitted] [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) harbors the risk of periprocedural complications that require emergent cardiac surgery, or "surgical bailout." Surgical bailout intends to be lifesaving but is associated with high mortality. This has given rise to discussion on the necessity of surgical backup during TAVR. Therefore, recent studies in contemporary TAVR patients are warranted. This study aimed to assess the incidence, trends, and clinical outcomes of surgical bailout in patients undergoing transfemoral TAVR. The CENTER2 (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves 2) study contains patient-level data from 10 clinical studies with patients undergoing TAVR between 2007 and 2022. A total of 24,010 patients undergoing transfemoral TAVR were included. The mean age was 81.5 ± 6.7 years, and 56% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality declined over time (2007-2014: 7.1% [Q1-Q3: 4.3%-14.8%] vs 2015-2022: 3.9% [Q1-Q3: 2.6%-6.0%]; P < 0.001). Surgical bailout was reported in 125 (0.52%) patients, and its incidence decreased over time, from 0.84% in 2007 to 2010 to 0.25% in 2019 to 2022 (P trend < 0.001). Surgical bailout was more frequently observed in women compared with men (0.61% vs 0.41%; P = 0.03). Ventricular perforation was the most prevalent reason for surgical bailout (28.0%). Patients who underwent surgical bailout reported higher mortality rates during the 1-year follow-up compared with patients without surgical bailout (68.3% vs 15.3%; HR: 8.60; 95% CI: 6.74-10.97; P < 0.001). Interestingly, patients surviving the first 90 days reported a similar mortality risk (HR: 2.19; 95% CI: 0.91-5.27; P = 0.08). The incidence of surgical bailout is very low in the contemporary TAVR population. Mortality rates remain high among patients requiring surgical bailout during transfemoral TAVR, but this risk diminishes in patients surviving the postprocedural period. (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves 2 [CENTER2]; NCT03588247) [Display omitted] [Display omitted] [ABSTRACT FROM AUTHOR]

Mid-term comparative data for the self-expanding ACURATE neo2 transcatheter heart valve and the balloon-expandable SAPIEN 3 Ultra are lacking. The aim of this study was to compare 1-year outcomes after transcatheter aortic valve replacement of these 2 valves. A total of 2,106 patients from 3 centers (neo2, n = 1,166; Ultra, n = 940) undergoing transfemoral transcatheter aortic valve replacement were analyzed retrospectively. The primary endpoint was the composite of all-cause mortality, stroke, and rehospitalization at 1 year. Secondary endpoints were the individual components of the primary endpoint at 1 year. To adjust for baseline differences, nearest neighbor propensity score matching was used. After matching (702 pairs), baseline characteristics were similar between groups. Device success was more common in the neo2 group (87.5% vs 82.3%; P = 0.007), irrespective of matching. DP mean after the procedure was higher for Ultra (13 mm Hg [Q1-Q3: 10-15 mm Hg] vs 8 mm Hg [Q1-Q3: 6-11] mm Hg; P < 0.001). Rates of paravalvular leakage, device embolization, and multiple valve implantations were more common in the neo2 arm, whereas major cardiac structural complications and major vascular complications occurred more frequently in the Ultra group. All other in-hospital complication rates were similar between the 2 groups. At 1 year, the cumulative incidence of the primary endpoint (14.1% for neo2 vs 14.5% for Ultra; P = 0.819) was similar between the groups. Likewise, the individual components showed no difference between the groups. Despite differing immediate results, the outcomes at 1 year, including the composite of all-cause mortality, stroke, or hospitalization, were similar for neo2 and Ultra transcatheter heart valves. [Display omitted] [ABSTRACT FROM AUTHOR]