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Human mesenchymal stromal cells (hMSCs) seeded on calcium phosphate (CaP) bioceramics are extensively explored in bone tissue engineering and have recently shown effective clinical outcomes. In previous pre-clinical studies, hMSCs-CaP-mediated bone formation was preceded by osteoclastogenesis at the implantation site. The current study evaluates to what extent phase composition of CaPs affects the osteoclast response and ultimately influence bone formation. To this end, four different CaP bioceramics were used, hydroxyapatite (HA), β-tricalcium phosphate (β-TCP) and two biphasic composites of HA/β-TCP ratios of 60/40 and 20/80 respectively, for in vitro osteoclast differentiation and correlation with in vivo osteoclastogenesis and bone formation. All ceramics allowed osteoclast formation in vitro from mouse and human precursors, except for pure HA, which significantly impaired their maturation. Ectopic implantation alongside hMSCs in subcutis sites of nude mice revealed new bone formation at 8 weeks in all conditions with relative amounts for β-TCP > biphasic CaPs > HA. Surprisingly, while hMSCs were essential for osteoinduction, their survival did not correlate with bone formation. By contrast, the degree of early osteoclastogenesis (2 weeks) seemed to define the extent of subsequent bone formation. Together, our findings suggest that the osteoclastic response could be used as a predictive marker in hMSC-CaP-based bone regeneration and strengthens the need to understand the underlying mechanisms for future biomaterial development. The combination of mesenchymal stromal cells (MSCs) and calcium phosphate (CaP) materials has demonstrated its safety and efficacy for bone regeneration in clinical trials, despite our insufficient understanding of the underlying biological mechanisms. Osteoclasts were previously suggested as key mediators between the early inflammatory phase following biomaterial implantation and the subsequent bone formation. Here we compared the affinity of osteoclasts for various CaP materials with different ratios of hydroxyapatite to β-tricalcium phosphate. We found that osteoclast formation, both in vitro and at early stages in vivo, correlates with bone formation when the materials were implanted alongside MSCs in mice. Surprisingly, MSC survival did not correlate with bone formation, suggesting that the number or phenotype of osteoclasts formed was more important. [Display omitted] [ABSTRACT FROM AUTHOR]

The impact of parathyroidectomy on bone mineral density in men with primary hyperparathyroidism is poorly known. This study aimed to evaluate the bone mineral density and bone remodeling biomarker changes in men with primary hyperparathyroidism 1 year after parathyroidectomy. Men operated for sporadic primary hyperparathyroidism between 2016 and 2022, enrolled in a monocentric prospective cohort, were analyzed. Patients with follow-up <1 year or missing data were excluded. Bone mineral density (dual X-ray absorptiometry) was measured before and 12 months after parathyroidectomy. Bone mineral density change ≥0.03g/cm2 was deemed significant. Bone remodeling biomarkers were serum cross-linked C-telopeptide, procollagen type 1 N-terminal propeptide, and bone-specific alkaline phosphatases. Forty-five men were included (mean age 58.8 ± 13.1 years). Before surgery, 49% had osteopenia, and 11% had osteoporosis. Mean serum calcium and median serum parathyroid hormone levels decreased significantly after surgery (P <.0001). One year after parathyroidectomy, the mean bone mineral density increased significantly at the lumbar spine (+0.04g/cm2 [0.01;0.70], P =.0054), femoral neck (+0.04g/cm2 [0.03;0.05], P <.0001) and total hip (+0.02g/cm2 [0.01;0.03], P =.0002). Considering significant bone mineral density gain (+1 point) and loss (–1 point) at each site, 29/45 patients (64% [95% CI 49;78]) improved. Bone remodeling biomarker concentrations significantly decreased (P <.001). Parathyroidectomy positively affects bone mineral density in men with primary hyperparathyroidism, supporting osteopenia as a surgical indication in these patients. [ABSTRACT FROM AUTHOR]

The degree to which culture and context contribute to variability in human behaviour is a critical scientific question. While most research in the human behavioural sciences is based on WEIRD samples, the last decade has seen a rise in research on traditionally under-represented populations, including small-scall societies, to demonstrate reproducibility of results. Considering this framework as a major objective, here we explore cross-cultural ubiquity in the production and perception of human baby cries, focusing on remote rural communities in the Democratic Republic of Congo, compared to analogous data from French and British samples. Through acoustic analysis of Congolese baby cries recorded in natural discomfort (bath) and pain (vaccine) contexts, combined with psychoacoustic experiments on Congolese adult listeners, we show that distress is reliably encoded in the acoustic cry signal, namely in nonlinear acoustic phenomena. Despite the absence of sexual dimorphism in cries, low-pitched cries are more often perceived as produced by boys than girls, and cries experimentally attributed to boys are perceived as expressing more distress than the same cries experimentally attributed to girls. Having obtained similar results in European samples, this study provides compelling evidence that these voice-based stereotypes are stable and robust, observed across extremely distinct human populations. • Acoustic analysis paired with perception studies tests for ubiquity in infant cries. • Cross-culturally, nonlinear phenomena encode distress levels in the baby cry signal. • Cross-culturally, adult listeners can recognize distress levels from babies' cries. • Sex stereotypes identified in WEIRD cultures exist in a distinct remote population. • The information encoded in human babies' cries and its perception is highly robust. [ABSTRACT FROM AUTHOR]

To advance pressure injury (PrI) research in individuals with spinal cord injury (SCI) by describing lessons learned and recommendations for future research, ultimately promoting PrI prevention and more effective wound care. This paper describes the detailed procedures undertaken to collect and reconcile PrI data and summarizes the types of discrepancies identified. Secondary analyses of PrI data collected between 2009 and 2014 in a randomized controlled trial (parent study). Participants in the parent study were recruited from a large rehabilitation center in the Los Angeles area that serves primarily individuals with limited resources. 232 participants with SCI and a history of 1 or more medically serious PrI (MSPrI) in the previous 5 years. Participants in the parent study were randomized to a 12-month PrI prevention intervention led by an occupational therapist, or to usual care. Relations among PrI characteristics, data sources (phone interviews, skin checks, paper and electronic medical records [MRs]), and treatment condition, and sensitivity of 6 different data sources in detecting MSPrIs. The majority (62%) of MSPrIs were in the pelvic region. MRs detected 82% of the MSPrIs overall, making it the most sensitive data source, and scheduled skin checks were the second-most sensitive data source, finding 37% of the MSPrIs. MR review is the preferred method for ascertaining MSPrIs in clinical trials of interventions designed to reduce the incidence of these injuries. When multiple sources of information are used, careful reconciliation of reports is necessary to ensure accuracy. [ABSTRACT FROM AUTHOR]

Several studies have reported negative results after total knee arthroplasty (TKA) in obese patients. This study aims to analyze the minimum 2-year outcomes in patients who have a body mass index (BMI) > 35 undergoing cemented TKA using an all-polyethylene tibial component (APTC) at a minimum of 2 years of follow-up. We retrospectively studied 163 obese patients (192 TKAs) who underwent a primary cemented TKA using an APTC comparing the outcomes of 96 TKA patients who had a BMI > 35 to 39.9 (group A) with 96 patients who a TKA and a BMI ≥40 (group B). Median follow-up of groups A and B were 3.8 years and 3.5 years respectively (P =.02). Multiple regression analyses were performed to evaluate independent risk factors associated with complications. Kaplan–Meier survival curves were estimated, defining failure as the need for any further femoral or tibial revision surgery with implant removal, irrespective of the reason. There was no significant difference at the latest follow-up patient-reported outcomes between both groups. Survivorship, as defined by revision for any reason, was 99% for group A and 99% for group B (P = 1.00). There was 1 aseptic tibial failure in group A, and 1 septic failure in group B. Multiple regression analyses showed no significant associations between age (odds ratio [OR] = 1.00; P =.98; 95% confidence interval (CI) = 0.93 to 1.08), sex (OR = 1.38; P =.70; 95% CI = 0.26 to 7.25), BMI (OR = 1.00; P =.95; 95% CI = 0.87 to 1.16), and complication rate. At a median 3.7-year follow-up, the use of an APTC provided excellent outcomes and survivorship in patients who had Class 2 and Class 3 obesity. Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

As a prerequisite of a multicentre study, we conducted a pilot study to assess the feasibility of a daily repositioning schedule in critically ill patients. The schedule was adapted to the patient's clinical condition, and the estimated risk for developing a pressure ulcer using the Braden scale. A single-center pre and post-intervention pilot study in a French Intensive Care Unit of a university teaching hospital. This study followed TREND guidelines. During the first period (March to May 2018), pressure ulcer prevention was performed according to usual care. During the second period (June to August 2018), the repositioning schedule was adapted to the estimated risk for developing a pressure ulcer according to the Braden scale. Eligible patients had no pressure ulcer at baseline, were intubated within 24 hours of admission and expected to receive mechanical ventilation for at least 24 hours. The primary outcome was the rate of pressure ulcer development at 28 days of hospitalization or at discharge or death, as compared with usual care. Secondary outcomes included the feasibility and safety of the schedule, as assessed by caregivers' adherence and workload, and the rate of adverse events. In the pre-intervention period 20 participants were included, and 14 patients were included in the post-intervention period. There was no decrease in the pressure ulcers incidence with the intervention (25% vs. 28.6%; P = 1). The number of daily repositioning performed increased from 3.3 [IQR 3.0; 3.9] during the pre-intervention period to 4.3 [IQR 3.8; 5.2] during the post-intervention period (P < 0.05), where it differed from the number scheduled by 0.6 [IQR 0.1; 1.4] per day, indicating satisfactory adherence of caregivers to the protocol. Adverse events rate did not differ between the two periods (55.9% vs. 57.1%; P = 0.90). A personalised daily repositioning schedule in critically ill patients is feasible and safe. The efficacy of such a strategy, together with its economic impact, need to be assessed in a multicentre randomized trial. • A repositioning schedule standardized and individualized is achievable in ICU. • The daily number of repositioning is increased by this schedule. • This schedule does not increase the rate of adverse events. • It also allows to increase the caregivers' adherence to practice of repositioning. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) is a surgical technique described in 1970 and performed laparoscopically since 1993. Occlusions are late complications that most often occur more than 6 months after surgery. Internal hernias and intussusception are the two clinical situations that can occur after RYGB. The presentation is that of an occlusion or chronic abdominal pain. Diagnosis can be made by imaging, including abdominal and pelvic CT scans, with ingestion and injection of contrast agents if possible. Treatment is based on surgical exploration. [ABSTRACT FROM AUTHOR]

Altered glomerular filtration rate is a controversial indication for parathyroidectomy in patients with primary hyperparathyroidism. The objective of this study was to evaluate the estimated glomerular filtration rate change 12 months after parathyroidectomy for primary hyperparathyroidism according to preoperative kidney function. Patients who underwent parathyroidectomy for primary hyperparathyroidism between 2016 and 2021 (n = 381) were enrolled in a monocentric prospective cohort. Patients without 1-year follow-up or with missing data were excluded (n = 135, 35%). Patients were dichotomized according to their baseline estimated glomerular filtration rate: <60 mL/min (group 1) and ≥60 mL/min (group 2). Parameters were measured before and then at 6 and 12 months after parathyroidectomy. Out of 246 included patients, 27 (11%) were assigned to group 1 and 219 (89%) to group 2. The mean baseline estimated glomerular filtration rate was 46.8 ± 11.5 and 87.3 ± 14.7 mL/min in groups 1 and 2, respectively. Group 1 patients were older (P =.0006) and had a higher median serum parathyroid hormone level (P =.021). At 6 months postoperative, 224 patients (91%) were normocalcemic. The estimated glomerular filtration rate raw change after parathyroidectomy was significantly higher in group 1 than in group 2 (4.2 ± 7.8 vs -2.2 ± 9.1 mL/min, P =.0004). In group 1, 13/27 patients (48%) improved their chronic kidney disease stage after parathyroidectomy, including 6/13 (46%) with postoperative estimated glomerular filtration rate ≥60 mL/min, whereas 2/27 (7%) worsened. The baseline estimated glomerular filtration rate <60 mL/min and elevated serum calcium level were associated with postoperative estimated glomerular filtration rate improvement in multivariable analysis (P =.0023 and.039, respectively). Parathyroidectomy for primary hyperparathyroidism is more likely to improve kidney function in patients with preoperative estimated glomerular filtration rate <60 mL/min. These results strengthen the current guidelines for surgery. [ABSTRACT FROM AUTHOR]

Background: The importance of preoperative urinary tract infection (UTI) in total hip and knee arthroplasty (THA and TKA) is controversial. The purpose of this study was to investigate the timing of preoperative UTI diagnosis and association with prosthetic joint infection (PJI) and determine if antibiotics impact this risk.Methods: A national database was used to analyze patients undergoing THA and TKA diagnosed with a preoperative UTI. Timing of diagnosis was categorized by 1-week intervals prior to surgery. Matched cohorts without UTI were collected, and PJI rates within 2 years of surgery were compared. Patients who received antibiotic prescriptions were identified and compared to no prescription.Results: Preoperative UTI within 1 week of TKA was associated with higher rates of PJI (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.26-1.43, P < .001). Preoperative UTI within 1 week of THA (OR 1.56, 95% CI 1.44-1.68, P < .001) and between 1-2 weeks prior to THA (OR 1.12, 95% CI 1.02-1.22, P = .022) was associated with significantly higher rates of PJI. UTI diagnosis at any other time interval did not reach statistical significance. Antibiotic prescription was not associated with lower rates of PJI.Conclusion: Patients with preoperative UTI within 1 week of TKA or within 2 weeks of THA have an increased risk of postoperative PJI. Antibiotics do not appear to mitigate risk.Level Of Evidence: Level III; Retrospective, database comparison. [ABSTRACT FROM AUTHOR]

Gastrointestinal diseases are associated with increased oxidative stress and inflammation. Pigmented cereal polyphenols are believed to have therapeutic potential. However, the impact of digestion on their bioactivity has not been fully elucidated. This study investigated the impact of digestion on the ability of purple rice extract (PRx) and purple barley (PBx) to alleviate oxidative stress-induced intestinal epithelial cell death and allergic inflammation. The study used a human colon adenocarcinoma (Caco-2) cell line to simulate intestinal oxidative stress for 4 h using 1 mM hydrogen peroxide. To evaluate the protective effects of digested and undigested cereal extracts, cells were first pre-treated with varying concentrations (50, 100, 200, and 500 μg/ml) of both purple rice (PRx) and purple barley (PBx) extracts. A rat basophilic leukemia (RBL-2H3) cell line was used to investigate the ability of the extracts to prevent calcium ionophore-induced histamine and cytokine release. The results demonstrated that both digested and undigested phenolic extracts prevented oxidative stress-induced cell death in Caco-2 cells and reduced Interleukin (IL)-8 secretion. PRx showed greater cytoprotective effects than PBx. Both digested and undigested extracts showed a time-dependent antihistamine effect, with the greatest inhibitory effects observed after 2 h and 4 h of treatment with PRx. Additionally, the extracts significantly attenuated the release of several cytokines including IL-2, IL-4, IL-13, monocyte chemoattractant protein-1, interferon-gamma, and tumour necrosis factor-alpha. Overall, the study demonstrates that both digested and undigested pigmented rice and barley extracts are potential sources of polyphenols which may promote intestinal health and alleviate allergic inflammation. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Monitoring the use of antimicrobials in hospitalized patients is critical owing to the risk of resistance selection. This study aimed to describe the patterns of antimicrobial prescription for the most frequent healthcare-associated infections (HAIs) in France, relating drugs and microbiological data.Methods: We used data from the 2017 point-prevalence survey of HAI and antimicrobial use in France, a large nationally representative sample survey of inpatients. We sought unambiguous correspondence between individual indications of antibiotic regimen and HAI sites to determine which molecules were directed towards which pathogen, considering its resistance profile.Results: Among 75,698 adult patients from 401 hospitals, 5.1% had an active HAI and 4.3% were being treated for an HAI. The two most frequent antibiotic indications were lower respiratory tract (LRTI, 27.7%) and urinary tract infections (UTI, 18.4%). For LRTI, the most prescribed antibiotic was amoxicillin-clavulanic acid (27.6%) and most frequently isolated pathogens (each accounting for around 17% of isolates) were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Meticillin-resistant S. aureus LRTI was more likely to be treated with linezolid. For UTI, ofloxacin, ceftriaxone, amoxicillin/co-amoxiclav were most-prescribed (∼13% each) and E. coli predominantly isolated (52.0%). Extended-spectrum beta-lactamase-producing E. coli UTI were more likely treated by fosfomycin, pivmecillinam or ertapenem.Conclusions: This study provides a baseline of antimicrobial use in relation to microbiological information in patients with the most common HAIs. These results can serve to direct future efforts in antimicrobial stewardship. Our work could be extended to a broader population, notably in Europe where similar surveys have been conducted. [ABSTRACT FROM AUTHOR]

This paper provides a standardised methodology to assess the suitability of using stand-alone solar photovoltaic (PV) systems for different productive uses of energy (PUE) at a country-wide level. The focus has been on the country of Tanzania, but the methodology is suitable for any location. This analysis has reviewed fourteen different PUE categories, with several sub-categories. The PUE were assessed for a wide range of factors, including cost of the system, potential income from the PUE, and potential market size. This report also highlights the PUE load profiles and energy requirements for comparison. Assessing a potential productive use is a complex process with multiple stakeholders and decision factors. The analysis here is not meant as a definitive answer, but to highlight the technical characteristics and economics of the potential productive uses for comparison. This methodology is a first pass method to assess the suitability of stand-alone PV systems for PUE applications at a country-wide level. For more detailed analysis of the PUE potential, the enabling environment, socio-cultural context and supporting services must be investigated in much greater detail. The quantitative methodology given here used computer-based simulation tools, including data processing (Excel & Python), geographical information systems (QGIS) and power system simulation (HOMER Pro). Input data from multiple sources, including in-country fieldwork, was used. This analysis has highlighted PUE with smaller energy requirements but low sensitivity to equipment or service cost to be the most suitable for more detailed analysis. Applying this methodology to Tanzania has shown stand-alone solar PV systems for barbershops, tailors, mobile carpenters, drip-feed irrigation systems and fishing lights as the lowest risk PUE for implementation. • Covers a standardised methodology for assessing and comparing productive uses of energy for remote rural applications. • Applies to remote stand-alone solar PV systems in Tanzania. • The methodology is a first pass assessment highlighting the most suitable productive uses of energy for future development. • Energy requirements, cost of system, potential market size and potential range of profit are compared for 25 use cases. • Drip-fed irrigations systems have the largest market potential and profitability in Tanzania. [ABSTRACT FROM AUTHOR]

To explore neurological factors affecting quality of life (QoL) in children and young people with ataxia-telangiectasia (A-T), from both child and parent perspective. 24 children/young people with A-T (mean age 11.2 ± 3.5 years; 13 males) and 20 parents were recruited, and 58% were reassessed after an average interval of 3.4 years. Participants completed the PedsQL QoL assessment. Participants with A-T underwent structured neurological examination. QoL data from 20 healthy controls and their parents was used for comparison. Children/young people with A-T rated their QoL higher than parental ratings across time points, with no longitudinal change. Higher age of the child participant correlated with lower parental (r = −0.43, p =.008) but not child ratings of QoL (r = −0.16, p =.380). Child and parent QoL ratings from the A-T group were lower than respective ratings from controls (η p 2 = 0.44 and η p 2 = 0.75 respectively, both p <.0005, controlled for socioeconomic status). Parental, but not child, ratings of QoL was predicted by a regression model based on neurological scores (R 2 = 0.44, p =<.001). Neurological disability does not determine child/young person QoL ratings in A-T. While certain aspects of neurological disability predict parent-proxy ratings, there is no decline in QoL over time. These results may reflect resilience in the face of a complex life-limiting disorder. [Display omitted] • Child ratings of QoL in A-T are significantly higher than parental ratings. • Age negatively correlated with parent QoL ratings, but there was no relationship between age and child QoL self-ratings. • Neurological function significantly predicts parental, but not the child's own ratings of their QoL. • Over time, QoL ratings did not decline with increasing disability reflecting high levels of resilience in this sample. [ABSTRACT FROM AUTHOR]

Multiple ocean sectors compete for space and resources, creating conflicts but also opportunities to plan for synergistic outcomes that benefit multiple sectors. Planning and management are increasingly informed by qualitative and quantitative methods for assessing multi-sector interactions to identify trade-offs and synergies among sectors and with the environment, but there is a need to critically review the alignment of these tools with the requirements of Blue Economy stakeholders. Through a systematic literature review, an operational maturity analysis, and a survey of Blue Economy stakeholders, we found that the most well-developed tools for assessing interactions between multiple Blue Economy industries, and with the environment, are spatial prioritization tools, such as Marxan and multi-criteria decision support tools; and spatial static tools, such as cumulative effect mapping. More complex process/dynamic tools such as ecosystem and oceanographic models are well developed for single sectors, particularly water quality assessments and commercial fisheries, but have been less commonly applied in multi-sector contexts. Our review and stakeholder survey highlighted that assessing the environmental and operational suitability of sites for Blue Economy infrastructure in conjunction with operational impacts, trade-offs and decommissioning considerations requires: 1) a toolbox of approaches that covers a range of spatial, temporal and ecological scales; 2) tools that capture interactions and feedbacks among sectors, and with the environment, without being unnecessarily complicated (i.e., tractable to use and allow for effective communication of findings); and 3) continued synthesis of approaches and tools used across sectors such as commercial fishing, aquaculture, offshore renewable energy, and offshore engineering. • Competition for ocean space and access to its resources is rapidly increasing. • We reviewed the tools to assess trade-offs between sectors and the environment. • Cumulative effect mapping and spatial prioritization are commonly used tools. • Ecosystem and dynamic models are less commonly applied in multi-sector contexts. • A toolbox of approaches can support the management of multi-sector interactions. [ABSTRACT FROM AUTHOR]

Operationalizing resilience in fisheries management is a challenging issue in the face of global changes. In this perspective, Grafton et al. (2019) propose a heuristic based on the '3Rs' of resilience, namely resistance, recovery, and robustness. The work presented here applies this generic framework to the coastal fishery of French Guiana, which is under pressure because of both climate change, energy costs and demographic growth. To this end, a dynamic multi-species, resource-based and multi-fleet model accounting for climate and socio-economic uncertainties is developed and calibrated using catch and effort time series. The search for a more resilient management leads us to compare different fishing management strategies and projections including 'Business as usual' (bau), 'Multispecies Maximum Sustainable Yield' (mmsy) and 'Multispecies Maximum Economic Yield' (mmey) strategies. The comparison between the strategies relies on ecological–economic viability goals and thresholds. The two normative strategies mmsy and mmey turn out to provide major gains in terms of the 3Rs and ecological–economic resilience as compared to bau. They both suggest major redistributions in the fishing effort of the different fleets. [ABSTRACT FROM AUTHOR]

The International Seabed Authority (ISA), established under the United Nations Convention on the Law of the Sea, is responsible for the governance of deep-sea mining in areas of the ocean beyond national jurisdiction (DSM), including the adoption of rules, regulations and procedures (RRPs) relating to DSM. As a result of actions by the Republic of Nauru, the ISA had been under pressure for the last two years to adopt RRPs for exploitation by July 2023 or face the possibility of evaluating a DSM application in the absence of such RRPs. In July 2023, the ISA was not able to finalize the RRPs but signaled its intent to continue working on them, with a view to their adoption by 2025. Negotiations on the timeline for the adoption of the RRPs were contentious with some member States wanting a binding target date and others expressing concern of being bound to arbitrary deadlines. This paper identifies major issues that remain outstanding in the draft RRPs relating to exploitation and discusses the underlying drivers for their lack of agreement with the aim of providing an indication of the amount of work ahead for the ISA. We find that over 30 major regulatory issues remain outstanding because of not receiving sufficient time for discussion, divergent views amongst member States, and due to a lack of information and inputs to progress negotiations. These findings suggest that member States and prospective contractors should expect negotiations on the adoption of RRPs to continue long into the foreseeable future. • Adoption of regulations is one prerequisite to deep-sea mining in international waters. • We determine that more than 30 major issues in the regulations remain outstanding. • Issues remain outstanding due to divergent views and lack of information and time. • We conclude that the 2025 target date set for the adoption of regulations is unrealistic. [ABSTRACT FROM AUTHOR]

• Superimposed preeclampsia led to higher blood pressures throughout pregnancy. • Superimposed preeclampsia led to earlier blood pressure nadirs. • Adverse secondary outcomes are more frequent with preeclampsia. • These findings may be useful in assessing preeclampsia risk during pregnancy. To assess physiologic blood pressure (BP) changes throughout pregnancy in patients with mild chronic hypertension (CHTN) who do and do not develop preeclampsia (PEC), compared to patients with normal BP. Retrospective cohort of singleton gestations with CHTN at a single tertiary center from 2000 to 2014 and a randomly selected cohort of patients without CHTN and normal pregnancy outcomes (NML) in the same time period with BP measurements available <12 weeks gestational age. The primary outcome was gestational age (GA) at nadir of systolic and diastolic BP. Secondary outcomes included perinatal death, umbilical cord pH, maternal and neonatal length of stay, GA at delivery, and mode of delivery. Quadratic mixed models were used to estimate SBP and DBP throughout gestation. Of 367 pregnancies with CHTN, 268 (73%) had CHTN without PEC and 99 (27%) had CHTN with PEC; 198 NML pregnancies were used as a comparison group. The median GA nadir for patients in the NML, CHTN without PEC, and CHTN with PEC for SBP were 20, 24, and 21, respectively. For DBP, the median GA nadir were 22, 24, and 21 for patients in the NML, CHTN without PEC, and CHTN with PEC cohorts, respectively. Adverse secondary outcomes were more frequent in patients with CHTN who developed PEC. BP trajectories in pregnancy are different between patients with CHTN with PEC, CHTN without PEC, and patients with normal BP. These findings may be useful in assessing patients' risks for developing preeclampsia during pregnancy. [ABSTRACT FROM AUTHOR]

Sorghum is a drought-resistant and polyphenol-rich staple food crop in many countries. Sorghum kernels contain bioactive compounds that have been found to synergistically slow or stop cancer development pathways in vitro and in vivo. Unhealthy dietary habits often lead to higher incidences of gastrointestinal cancers e.g. colorectal cancer. However, consuming pigmented wholegrain varieties of sorghum correlates with chemopreventative health benefits. Phenolic compounds, including 3-deoxyanthocyanidin, vanillic acid, ferulic acid and protocatechuic acid, have been shown to have specific cancer cell cytotoxicity. These compounds can bind or facilitate the binding of other compounds to the active sites of cellular proteins responsible for tumour inhibition. Incorporating optimally cooked sorghum into the human diet is a promising approach to preventing the onset and development of gastrointestinal cancers. Despite of the reported health benefits, sorghum is mainly used as animal feed in many developed nations. This review focuses on the chemopreventative properties of sorghum polyphenols and describes how incorporating sorghum into the human diet may improve health outcomes. Furthermore, the impact of processing by cooking, fermentation, and gastrointestinal digestion of sorghum, as well as the role sorghum polyphenols play in the mechanistic pathways involved in preventing cancer are elucidated. [ABSTRACT FROM AUTHOR]

Although literature describing the increased risk of postoperative infection for patients undergoing lower extremity arthroplasty with a preoperative urinary tract infection (UTI) is inconclusive, this relationship has yet to be adequately studied for shoulder arthroplasty. The goals of the present study were to examine the association between preoperative UTIs and their timing with periprosthetic joint infection (PJI) after shoulder arthroplasty. Patients undergoing primary shoulder arthroplasty diagnosed with a UTI in the preoperative period were identified in an insurance database and separated into mutually exclusive groups based on one-week intervals up to six weeks before surgery. A matched control cohort without a preoperative UTI was created for comparison. The incidence of PJI within two years after shoulder arthroplasty was then assessed for each cohort and compared using a logistic regression analysis. Compared with matched controls, patients with a UTI diagnosed within 1 week before shoulder arthroplasty (odds ratio, 2.73; 95% confidence interval, 1.67-4.46; P <.001) and within 1 to 2 weeks preoperatively (odds ratio, 1.77; 95% confidence interval, 1.24-2.52; P =.002) experienced significantly higher rates of PJI within 2 years postoperatively. There were no significant differences in the incidence of PJI between patients diagnosed with a UTI greater than 2 weeks before surgery and matched controls (P >.05). Patients diagnosed with a UTI within 2 weeks before shoulder arthroplasty may be at an increased risk of postoperative PJI. Level III [ABSTRACT FROM AUTHOR]

Good image segmentation produces objects that are internally homogeneous and distinct from their neighbors. Several approaches are used to assess the quality of segmentation parameters including visual observation of multiple segmentation results and techniques, which calculate measures of intra segment homogeneity and inter segment heterogeneity. Some of these techniques have been reported without considering under and over segmentation; occurrences and others exhibit some mathematical formulation instabilities when dealing with very heterogeneous areas. Moreover, the majority of segmentation assessment techniques focus on the evaluation of the scale parameter and give little attention to the influence of other parameters, such as compactness on the performance of the scale parameter. To the best of our knowledge, no existing approach can predict the optimal compactness thresholds that would enhance the performance of the scale parameters, or predict which scale parameter will perform best under certain compactness constraints. This paper proposes three spatial autocorrelation models, which identify the optimal parameters for single scale and multilevel segmentations of urban environments. Tested using a GeoEye satellite image of the City of Cape Town (South Africa), results reflect that the best combination of parameters to optimally segment the area and those that would poorly perform were successfully identified. [ABSTRACT FROM AUTHOR]

Background: Sub-optimal medication use results in significant avoidable morbidity, mortality, and costs. Programs, such as comprehensive medication management (CMM), can help to optimize medication use, improve outcomes, and reduce costs. However, implementing programs like CMM can be challenging and differences in how CMM has been implemented may be responsible for observed heterogeneity in the outcomes associated with CMM.Objective(s): Describe the implementation strategies utilized in implementing CMM telephonically within a team-based at-home care program and evaluate the implementation process.Methods: The implementation of CMM was facilitated using various implementation strategies including: develop educational material and conduct training, change record system, audit and feedback, learning collaborative, quality monitoring, readiness assessment, and implementation team formation. The impact of these strategies as well as pharmacist and team member perspectives on the implementation of CMM were examined using mixed methods and guided by Proctor's conceptual model for implementation.Results: The pharmacists felt that most of the implementation strategies used to facilitate consistent delivery of CMM were useful, but were unable to successfully implement all of them. Despite this, significant increases in fidelity to steps of the patient care process was achieved. The pharmacists felt that CMM was acceptable, appropriate for patient population, and feasible, but barriers (e.g., the telephonic and remote nature of the practice, the evolving nature of the program, and the difficulty in coordinating care between the patients primary care team and the care team affiliated with the program) affected the feasibility and organizational fit of CMM within this team-based, at-home care program. General pharmacy services, however, were seen as acceptable, appropriate, and feasible.Conclusion: Deliberately designing and utilizing a variety of implementation strategies can facilitate the implementation of CMM and significantly increase fidelity to the patient care process. To improve feasibility and organizational fit of CMM, additional barriers and challenges need to be addressed. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) and esophageal motor disorders (EMD) are frequent conditions among patients with obesity. The effects of sleeve gastrectomy (SG) on esophageal function can worsen GERD, but little is known about its effects on EMD and the consequences of preexisting EMD on GERD after SG. To study the postoperative outcomes of SG in a population of patients displaying preexisting EMD. University Hospital, France. Patients with EMD confirmed by high-resolution manometry who underwent a laparoscopic SG between 2010 and 2019 were retrospectively included in this monocenter study. GERD symptoms and high-resolution manometry results were recorded before surgery and during follow-up. Conversion to gastric bypass were also recorded. Thirty-seven patients were included. Mean age was 52.6 ± 12.9 years. Most patients were female (70%). EMD were achalasia (19% of patients), hypercontractile (22%), hypocontractile (30%) and nutcracker esophagus (22%), and ineffective esophageal motility (8%). GERD symptoms were present in 10 patients (27%) preoperatively and 18 (49%) postoperatively. Achalasia was not resolved after SG and was constantly associated with disabling food blockage or GERD symptoms after surgery, and 3 of 4 patients with nutcracker esophagus had postoperative GERD symptoms and underwent gastric bypass. This study is the largest to describe the course of GERD and EMD after SG in patients displaying preoperative EMD. Achalasia and nutcracker esophagus are associated with poorer postoperative outcomes, and another procedure such as a gastric bypass should be performed. 1 Sleeve gastrectomy worsens reflux and esophageal motor disorders symptoms 2 Achalasia and nutcracker esophagus lead to poorest post-operative outcomes 3 Achalasia and nutcracker esophagus should encourage to perform a gastric bypass [ABSTRACT FROM AUTHOR]

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To analyze the impact of bilateral cochlear implantation (CI) on perceptual and linguistic development in hearing-impaired children with congenital Cytomegalovirus (CMV) infection. A retrospective study was performed for the period 1991-2016 in a pediatric CI reference center. Closed Set Word (CSW) recognition scores, Categories of Auditory Performance (CAP) and linguistic level on the MT Lenormand scale (MTL) were compared between bilateral (Bi) and unilateral (Uni) groups 12, 24 and 36 months after first CI (CI-1). 84 patients with congenital CMV infection who underwent CI were included, in 2 groups: sequential or simultaneous bilateral CI (Bi) (N = 20), and unilateral CI (Uni) (N = 64). Twelve, 24 and 36 months after CI-1, CSW scores were 35.56%, 64.52% and 82.93% in Uni and 60.3%, 85% (P = 0.0084*), and 100% (P = 0.00085*) in Bi. CAP scores 12, 24 and 36 months after CI-1 were 2.57, 3.85 and 4.3 in Uni and 3.91 (P = 0.0068*), 5.00 (p = 0.029*) and 5.50 (P = 0.051*) in Bi. MTL linguistic level scores at 12, 24 and 36 months were 0.72, 1.25 and 1.65 in Uni, and 1.72, 3 (P = 0.033) and 3.11 (P = 0.045) in Bi. These significantly better scores in Bi at 24 and 36 months after CI-1 were also found on analysis of subgroups with no associated neurologic disorder (P = 0.046* and P = 0.032*), no associated psychiatric pathology (P = 0.0055* and P = 0.0073*), and no other associated disorder (P = 0.0018* and P = 0.035*), and for all subgroups together (P = 0.0036 and P = 0.037). Bilateral CI is a faster way than unilateral CI for patients with congenital CMV infection to achieve structured fluent oral language. 50% of the series showed cerebral abnormalities on MRI, without difference between groups. This was not in itself predictive of poor progression of oral communication, unless associated with major neurologic disorder. Some children made little or no use of their CI in the medium term. [ABSTRACT FROM AUTHOR]

• Few patients (3.1%) had severe anomaly on abdominal CT-scan before bariatric surgery. • No risk factor was found to predict appearance of severe anomaly on abdominal CT-scan. • Abdominal CT-scan could not be advocated to seek cancer before bariatric surgery. • Thoracic CT-scan may be interesting in patients with history of smoking. Scientific societies recommend to seek cancer prior to bariatric surgery. In our tertiary referral center, we aimed to study performance of abdominal CT-scan before bariatric surgery. We retrospectively included all patients who underwent bariatric surgery and a pre-operative abdominal CT-scan in our academic center, between January 2015 and December 2018. We included 521 patients (417 women and 104 men) with a mean age of 48.0 ± 11.5 years. Mean preoperative body mass index was 44.9 ± 7.0 kg/m2. Among the 392 patients with abnormal CT-scan, mean number of anomalies per patient was of 2.2 ± 1.2. Vast majority of anomalies (91.8%) were non-significant. Only 5 (1%) patients needed treatment prior to bariatric surgery. No factor predictive of abnormal CT-scan was found. Only few patients had severe anomaly on CT-scan before bariatric surgery. Abdominal CT-scan could not be advocated to seek cancer before bariatric surgery. [ABSTRACT FROM AUTHOR]

Neurologic injury after shoulder arthroplasty has been reported in previous outcome studies. However, the incidence and development of distal peripheral neuropathy (DPN) after shoulder arthroplasty requiring surgical intervention has not been previously described. The authors report on the incidence of DPN requiring surgical intervention following shoulder arthroplasty. A retrospective review was conducted of a prospectively collected shoulder arthroplasty registry at a single institution from a single surgeon from April 2006 to April 2017. Patients were included in the series if they had primary surgical intervention for ipsilateral or contralateral peripheral neuropathy following primary shoulder arthroplasty. Patients were excluded if they had known peripheral neuropathy or cervical radiculopathy prior to surgery. DPN was defined for the study as symptoms or diagnostic testing consistent with cubital tunnel or carpal tunnel syndrome. Demographics, patient reported outcome measures, and preoperative and postoperative shoulder range of motion were collected and analyzed with paired t-tests and multivariate regression models. One thousand three hundred eighty-seven total shoulder arthroplasties were performed in this period. During the study period, 16 patients (1.2%) underwent surgery for ipsilateral DPN while 6 patients (0.4%) underwent surgery for contralateral DPN. ASES scores, SANE scores, and shoulder flexion improved significantly from pre- to postoperatively for both groups. There was no significant difference in postoperative scores between groups. Finally, the multivariate linear analysis did not yield any statistically significant regression equations for ASES, SANE VAS, AFE, and AER. Shoulder arthroplasty resulted in increased ipsilateral distal peripheral neuropathy. Emergence of DPN symptoms following arthroplasty is multifactorial and may be related to a form of the double crush syndrome. Level IV; Case series [ABSTRACT FROM AUTHOR]

Background: Implementation outcomes serve as progress and success indicators of the implementation process. They are also key antecedents to achieving the more traditional clinical outcomes typically associated with a service. Despite their importance, there are few implementation outcomes measures with appropriate psychometric properties, none of which have yet been adapted for medication optimization services.Objectives: This study aims to develop and validate the Implementation Outcomes Questionnaire (IOQ) to assess implementation of medication optimization services, starting with Comprehensive Medication Management (CMM). The resulting IOQ is a 40-item self-report instrument for six implementation outcomes, including adoption, acceptability, feasibility, appropriateness, penetration, and sustainability.Methods: A three-phase approach was used to develop and validate the IOQ. Development of the instrument, Phase I, was informed by a targeted search of existing implementation outcomes measures in other fields, a review of suitableoptions options by an expert panel, and item adaptation. To assess content validity, Phase II, an internal vetting process was conducted using an adapted version of Rubio and colleagues' methodology. Evidence of reliability and construct validity, Phase III, was obtained through a pilot test with 167 pharmacists within 78 different care settings.Results: Overall, the results supported the reliability and validity (both content and construct) of the IOQ, with further psychometric testing needed for adoption. The items' relevance, clarity, and alignment with each implementation concept were high, except for Penetration. As a result, the Penetration items were refined for further use. Best-fit models were identified for each outcome based on the MCFA analyses, thereby providing insights into the factor structures and interpretation for each measure. Cronbach' alphas indicated good internal consistency.Conclusions: This questionnaire is the first of its kind tailored to medication optimization services, starting with CMM. Access to this survey should facilitate measurement of implementation outcomes, thereby increasing the likelihood of achieving the desired clinical outcomes. [ABSTRACT FROM AUTHOR]

Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). The choice of optimal drug for anticoagulation after TAVR remains debated. Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P < 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P < 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR. [Display omitted] [ABSTRACT FROM AUTHOR]

The tolerability and efficacy of targeted therapy in older adults with cancer has not been adequately studied. Neratinib is a novel HER1, HER2, HER4 tyrosine kinase inhibitor that has recently been granted FDA approval for treatment of breast cancer. The major toxicity of neratinib is diarrhea, which affects up to 90% of patients. This phase II trial evaluates the safety and tolerability of neratinib in adults ≥60. Patients aged 60 or older with histologically proven metastatic breast cancer and HER2 amplification (defined by ASCO/CAP guideline) or HER2/HER3 activating mutation were enrolled to receive neratinib at 240 mg daily in 28-day cycles. The association between tolerability, defined as dose reduction and number of completed courses, and log 2 Cancer and Aging Research Group (CARG) toxicity risk score was assessed using a Student's t -test and linear regression, respectively. Response rate, progression free survival, and overall survival were also evaluated. 25 patients were enrolled with median age of 66 (range 60–79). Seventy-six percent of patients were white, 16% Asian, and 8% African-American. Seventy-six percent were patients with hormone receptor (HR) positive metastatic breast cancer (MBC) and 24% were patients with HR negative MBC. Median number of prior lines of metastatic therapy were 3 (range 0–11). 20/25 (80%) had worst grade toxicities ≥2. A total of 9/25 (36%) had grade 3 toxicities including 5/20 (20%) diarrhea, 2/20 (8%) vomiting, and 2/20 (8%) abdominal pain. There were no grade 4 or 5 toxicities. A total of 9/25 (36%) had dose reduction, and 2/25 (8%) discontinued therapy due to toxicity. The association between dose reductions and CARG toxicity score reached borderline statistical significance suggesting a trend with participants with higher CARG toxicity risk scores being more likely to require a dose modification (p = 0.054). 1/25 (4%) had a partial response, 11/25 (44%) had stable disease, 12/25 (48%) had progression of disease, and 1/25 (4%) was not assessed. Median progression free survival (PFS) was 2.6 months (95% CI [2.56–5.26]), and median overall survival (OS) was 17.4 months (95% CI [10.3, NA]). Neratinib was safe in this population of older adults with HER2 amplified or HER2/3 mutated metastatic breast cancer (BC). Higher CARG toxicity risk score may be associated with greater need for dose adjustments. Future studies are needed to confirm this finding. [ABSTRACT FROM AUTHOR]

There are no recommendations for screening for thoracic aortic aneurysms (TAAs), even in patients with infrarenal abdominal aortic aneurysms (AAAs). The aims of this study were to determine the prevalence of TAAs in patients with AAAs and to analyse the risk factors for this association. This was a multicentre prospective study. The Aortic Concomitant Thoracic and Abdominal Aneurysm (ACTA) study included 331 patients with infrarenal AAAs > 40 mm between September 2012 and May 2016. These patients were prospectively enrolled in three French academic hospitals. Patients were classified as having a normal, aneurysmal, or ectatic (non-normal, non-aneurysmal) thoracic aorta according to their maximum aortic diameter indexed by sex, age, and body surface area. Thoracic aortic ectasia (TAE) was defined as above or equal to the 90th percentile of normal aortic diameters according to gender and body surface area. Descending TAA was defined as ≥ 150% of the mean normal value, and ascending TAA as > 47 mm in men and 42 mm in women; 7.6% (n = 25) had either an ascending (seven cases; 2.2%) or descending aortic TAA (18 cases; 5.4%), and 54.6% (n = 181) had a TAE. Among the 25 patients with TAAs, five required surgery; two patients had TAAs related to penetrating aortic ulcers < 60 mm in diameter, and three had a TAA > 60 mm. In the multinomial regression analysis, atrial fibrillation (AF) (odds ratio [OR] 11.36, 95% confidence interval [CI] 2.18 – 59.13; p =.004) and mild aortic valvulopathy (OR 2.89, 1.04–8.05; p =.042) were independent factors associated with TAAs. Age (OR 1.06, CI 1.02 – 1.09; p =.003) and AF (OR 4.36, 1.21 – 15.61; p =.024) were independently associated with ectasia. This study confirmed that TAAs coexisting with AAAs are not rare, and one fifth of these TAAs are treated surgically. Systematic screening by imaging the whole aorta in patients with AAAs is clinically relevant and should lead to an effective prevention policy. [Display omitted] [ABSTRACT FROM AUTHOR]

At the University of California, San Diego, routine coronary angiography has generally been performed in men 40 years of age and older and women 45 years of age and older before pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH). The prevalence of significant coronary artery disease (CAD) in this population has not been evaluated, however, and the optimal screening strategy has not been established. This study sought to evaluate whether the current approach may be better optimized on the basis of cardiac risk factors. This study included 462 consecutive patients with CTEPH who were undergoing preoperative coronary angiography for pulmonary thromboendarterectomy. Baseline demographic and medical information was recorded. Major cardiac risk factors included: diabetes, hypertension, hyperlipidemia, body mass index 25 kg/m2 or greater, tobacco use, and family history of CAD. Charts were then reviewed for presence of significant CAD and revascularization. Significant CAD was found in 13.4% of patients who underwent routine preoperative coronary angiography; it was present in only 5% of patients younger than 50 years of age, compared with 16% of patients 50 years old and older. No patient younger than 50 years of age without cardiac risk factors was found to have significant CAD. Furthermore, in patients younger than 50 years of age, significant CAD was found only among those with 3 or more major risk factors. In patients younger than 50 years of age with CTEPH, the prevalence of significant CAD was low. Omitting preoperative coronary angiography in this subset of patients is reasonable when no coronary risk factors are present. Preoperative coronary angiography is warranted in individuals 50 years of age and older, as well as in those younger than 50 years who have significant risk factors for CAD. [Display omitted] [ABSTRACT FROM AUTHOR]

Ixodes scapularis ticks are vectors of infectious agents that cause illness in humans, including Lyme disease. Recent years have seen a surge in tick-borne diseases (TBD) resulting in a high demand for tick management products. Plants offer a valuable source of active compounds for the development of novel, eco-friendly tick control products, reducing potential risks to human and animal health. Essential oils (EOs) have emerged as potential acaricides and repellents against ticks providing an alternative to synthetic chemicals and aiding in the prevention of TBD by lowering the risk of tick bites. We investigated the acaricidal activity of EOs from lemongrass (C ymbopogon citratus), geranium (Pelargonium x asperum), savory thyme (Thymus saturejoides), and white thyme (Thymus zygis) on I. scapularis. The interactions (i.e., synergistic, antagonistic, or additive) of their binary mixtures were also evaluated. EO samples were analyzed via gas chromatography-mass spectrometry to determine their chemical composition. The adult immersion test was used to determine the lethal concentration (LC 50) of each EO alone and in mixtures. Quantitative assessment of synergistic, additive, or antagonistic effect of the binary mixtures was performed by calculating the combination index. Strong acaricidal activity was recorded for savory thyme and white thyme EOs, with LC 50 values of 28.0 and 11.0 μg/μL, respectively. The LC 50 of lemongrass and geranium EOs were 49.0 and 39.7 μg/μL, respectively. Among the tested EOs, savory thyme and white thyme had a strong acaricidal effect on I. scapularis , which might be linked to the presence of carvacrol (26.05 % ± 0.38) and thymol (53.6 % ± 2.31), main components present in savory thyme and white thyme EOs, respectively. The tick killing efficacy of lemongrass and geranium EOs was lower when mixed than when used separately (LC 50 of 65.3 µg/µL). The same happened with savory thyme and white thyme EOs, except at 9.75 µg/µL where they had a synergistic effect (LC 50 of 58.3 µg/µL). Lemongrass and savory thyme EOs had a synergistic effect at low concentrations, and an antagonistic effect at higher concentrations (LC 50 of 95.4 µg/µL). Lemongrass and white thyme EOs had a synergistic effect against ticks from 15 to 120 µg/µL (LC 50 of 18.5 µg/µL) similar to white thyme EO. Geranium and savory thyme EOs had an antagonistic effect at all concentrations, with an LC 50 of 66.8 µg/µL. Geranium and white thyme EOs also had an antagonistic effect, except at 12.7 µg/µL where they had a synergistic effect (LC 50 of 66.8 µg/µL). The interaction observed when combining selected essential oils suggests promising potential for developing acaricidal formulations aimed at controlling ticks and curbing the transmission of tick-borne disease agents. [ABSTRACT FROM AUTHOR]

Floods pose significant threats to communities and homes, necessitating robust flood risk management to enhance community resilience. Plenty of research has confirmed that flood risk management and mitigation are often social and political issues where justice and equity must be examined (e.g. [1]). Onion Creek Neighbourhood (OCN) is a known flood-prone area and a high-income suburban neighbourhood in Austin, Texas. Through investigating the reasons behind the residents' continued habitation in or relocation to OCN, this research seeks to deepen our understanding about how affluence inland urban neighbourhoods respond to flood risk. Equipped with the 3-dimensional lens for examining behavior change in flood risk management [2], we argue that flood risk management and mitigation is as much a behavior change movement for these affluent urban communities as it is a justice and resource issue for some other communities. We collected data on OCN residents' perceptions, experiences, and behaviors related to flood risk, mitigation, and community resilience through an open-ended survey in 2021. The findings reveal diverse factors, such as lack of alternate akin housing options, attachment to the pleasant neighbourhood and environment, proximity to downtown Austin, and strong community ties, all of which create barriers for OCN residents to relocate out of the neighbourhood while sustaining their desires for comparable community and environment amenities. The study calls for tailored strategies and policies that account for residents' needs and preferences to mobilize communities for sustainable development and disaster preparedness in flood-prone areas like Onion Creek Neighbourhood. [ABSTRACT FROM AUTHOR]

Aims: Primary hyperparathyroidism (PHPT), one of the most frequent endocrine disorders, is not only associated with bone and kidney disorders but also with increased cardiovascular risk. This cardiovascular risk is not part of the indication for surgery owing to discordant evidence of the effects of parathyroidectomy (PTX), especially in mild PHPT which is the most common presentation of PHPT. This literature review focuses on the effects of PTX on the cardiovascular risk in PHPT. The MEDLINE database was searched via the PubMed interface, selecting relevant articles published after 1990 in English.Data Synthesis: In the most recent series, PTX appeared to have a positive impact on cardiovascular morbidity and mortality. Surgery improves arterial hypertension, markers of glucose homeostasis, vascular and cardiac remodeling and electrocardiographic impairments due to classical PHPT. However, the results of surgery on mild PHPT are conflicting.Conclusions: PTX seems to improve cardiovascular risk in patients presenting the classical form of PHPT. This improvement is correlated with preoperative serum calcium and/or PTH level, depending on the cardiovascular risk factor. However, many aspects of this improvement are not fully understood. Future studies should assess the effects of PTX on nocturnal hypertension, cardiac morphology and functions. The results for mild PHPT are conflicting owing to the limited size of the cohorts included in studies and the lack of randomized trials. Surgery is not currently recommended for patients presenting mild PHPT based on the cardiovascular risk and more studies are needed to better understand the interest of PTX on cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

To describe the characteristics and long-term outcomes of patients with granulomatosis with polyangiitis (GPA) from the French Vasculitis Study Group database. Patients' clinical and laboratory characteristics, Birmingham Vasculitis Activity Score (BVAS)-assessed disease activity, malignancies, opportunistic infections, and vital status were collected at diagnosis and each visit. Estimated probabilities and predictors of overall (OS) and relapse-free survival (RFS) were analyzed by Cox regression. We enrolled 795 newly diagnosed patients, followed for a median of 3.5 years. Initial clinical manifestations involved ear, nose & throat (ENT; 80%), lungs (68%) and kidneys (56%). Among the 728 available ELISA results, 75.0% were PR3-ANCA–positive, 16.5% MPO-ANCA–positive and 62 (8.5%) ANCA-negative. Relapses occurred in 394 (50%) patients, involving ≥1 organ(s) affected at onset in 179 (46%), mainly ENT, lungs and kidneys, with mean BVAS 10.2 points below that at diagnosis (p <0.001). Five- and 10-year RFS rates were 37% and 17%, respectively. PR3-ANCA-positivity independently predicted relapse (p = 0.05) and prolonged survival (p = 0.038). OS—but not RFS—improved significantly over time (p <0.001); 10-year OS reached 88.2% (95% CI 83.9 to 92.7) for the 660 patients diagnosed after 2000. Infections were the main causes of death. Malignancy or opportunistic infection each occurred in ≤5% of the patients. Survival has improved dramatically over the last decades but the high relapse rate remains a major concern for GPA patients, once again stressing the need for therapeutic strategy optimization to lower it. PR3-ANCA-positivity was associated with increased probability of relapse and survival. [ABSTRACT FROM AUTHOR]

Background: In 2016, the U.S. Food and Drug Administration expressed concern that neurodevelopment may be negatively affected by anesthesia or sedation exposure in pregnancy or before three years of age. We examined the association between general anesthesia at the time of cesarean delivery and early childhood neurodevelopment.Methods: A secondary analysis of a multicenter randomized controlled trial assessing magnesium for prevention of cerebral palsy in infants at risk for preterm delivery. Exposure was general compared to neuraxial anesthesia. The primary outcome was motor or mental delay at two years of age, assessed by Bayley Scales of Infant Development II (BSIDII). Secondary outcomes included BSIDII subdomains and perinatal outcomes. Multivariable logistic regression models were performed to control for confounders.Results: Of 557 women undergoing cesarean delivery, 119 (21%) received general anesthesia. There were no differences in the primary composite outcome of developmental delay (aOR 0.93, 95% CI 0.61 to 1.43) or the BSIDII subdomains of mild, moderate, or severe mental delay, or mild or moderate motor delay. Severe motor delay was more common among infants exposed to general anesthesia (aOR 1.98, 95% CI 1.06 to 3.69). Infants exposed to general anesthesia had longer neonatal intensive care stays (51 vs 37 days, P=0.010).Conclusions: General anesthesia for cesarean delivery was not associated with overall neurodevelopmental delay at two years of age, except for greater odds of severe motor delay. Future studies should evaluate this finding, as well as the impact on neurodevelopment of longer or multiple anesthetic exposures across all gestational ages. [ABSTRACT FROM AUTHOR]

Continuous intraoperative neuromonitoring may facilitate reversal of intraoperative injurious operative maneuvers in comparison with intermittent intraoperative neuromonitoring. The aim of this study was to evaluate the impact of the routine use of continuous intraoperative neuromonitoring on intraoperative injuries to the recurrent laryngeal nerve. This study was a prospective case series with retrospective analysis of consecutive patients undergoing total thyroidectomy from August 2013 to August 2019. During this period, intermittent intraoperative neuromonitoring (before Mar 2016) and continuous intraoperative neuromonitoring (after Mar 2016) were used in all patients. We reviewed the outcomes of 603 patients (466 female patients) comprising 236 who underwent intermittent intraoperative neuromonitoring and 367 who underwent continuous intraoperative neuromonitoring. Intraoperative adverse electromyography events (>50% decrease in amplitude between VN1 and VN2) were observed in 87 patients (14.5%) and were less frequent in the continuous intraoperative neuromonitoring group (10.6 vs 20.3%, P =.001). Intraoperative loss of signal (electromyography events with VN2 ≤100μV) were observed in 35 patients (5.8%) without any difference between the 2 groups of patients (5.2 vs 6.8%, P =.415). Postoperative recurrent laryngeal nerve palsies were observed in 36 patients (5.9%) without any difference between the 2 groups of patients (4.9 vs 7.6%, P =.168). The routine use of continuous intraoperative neuromonitoring improves the rate of intraoperative adverse electromyography events but does not impact significantly the rates of loss of signal and recurrent laryngeal nerve palsy. [ABSTRACT FROM AUTHOR]