Search

The incidence of early-onset colorectal cancer has increased markedly over the past decade. Although established for older adults, there are limited data on socioeconomic and racial disparities in screening, treatment, and outcomes in this distinct group. Adults with primary colorectal cancer diagnosed at age <50 were identified from the Surveillance, Epidemiology, and End Results database. The exposure of interest was neighborhood socioeconomic status based on the Yost Index, a census-tract level composite score of neighborhood economic health. Univariate analysis was performed with χ2 analyses. Logistic regression models were created to evaluate the association of neighborhood socioeconomic status (Yost Index quintile) with metastasis at presentation and surgical intervention. Kaplan–Meier and Cox proportional hazards models were created. In total, 45,660 early-onset colorectal cancer patients were identified; 16.8% (7,679) were in the lowest quintile of neighborhood socioeconomic status. Patients with the lowest neighborhood socioeconomic status were 1.13 times (95% confidence interval 1.06–1.21) more likely to present with metastases and had lower survival (hazard ratio 1.45, 95% confidence interval 1.37–1.53) compared to those with the highest neighborhood socioeconomic status. Non-Hispanic Black patients were more likely to present with metastatic disease (odds ratio 1.11, 95% confidence interval 1.05–1.19), less likely to undergo surgery for localized or regional disease (odds ratio 0.48, 95% confidence interval 0.43–0.53), and had lower survival (hazard ratio 1.21, 95% confidence interval 1.15–1.27) than non-Hispanic White patients. Socioeconomic and racial disparities in early-onset colorectal cancer span diagnosis, treatment, and survival. As the disease burden of early-age onset colorectal cancer increases, interventions to boost early diagnosis and access to surgery are necessary to improve survival among minorities and patients with low neighborhood socioeconomic status. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disrupted routine health care, including many elective and non-cancer operations in the United States. Most hepato-pancreato-biliary malignancy patients require outpatient imaging, tissue sampling, and staging, and many undergo neoadjuvant therapy before operative intervention. The aims of this study were to evaluate the effect of the COVID-19 pandemic on hepato-pancreato-biliary oncologic operations and to determine whether trends in neoadjuvant therapy were altered by the pandemic. Adult patients in the United States undergoing oncologic operations for pancreatic, primary and secondary hepatic malignancies, with or without neoadjuvant therapy, were extracted from the Vizient Clinical Data Base. Control chart analysis was used to plot trends over time and to determine whether changes were statistically significant. Wilcoxon rank-sum tests also compared monthly operative volume from pre-pandemic (12 month) and pandemic (28 months) periods. A total of 36,553 patients were identified over 40 months. Mean monthly pancreatic oncologic operations were unaffected by the pandemic (P =.257). Operations for pancreatic oncologic operations with prior neoadjuvant therapy increased throughout the pandemic (P =.002). Oncologic operations for primary and secondary hepatic malignancies were significantly reduced for 4 and 2 months, respectively, at the beginning of the pandemic but returned to their pre-pandemic baseline within 4 months (P =.169 and P =.598). Pancreatic operation volumes for cancer did not change, but pancreatic operations after neoadjuvant therapy continued to increase during the pandemic. Operations for hepatic malignancy were transiently disrupted but quickly normalized. These observations suggest that surgery for hepato-pancreato-biliary malignancies was prioritized during the pandemic. [ABSTRACT FROM AUTHOR]

Racial and ethnic disparities have been observed in the multidisciplinary management of pancreatic ductal adenocarcinoma. Intraductal papillary mucinous neoplasm is the most common identifiable precursor to pancreatic ductal adenocarcinoma, where early surgical intervention before the development of an invasive intraductal papillary mucinous neoplasm improves survival. The association of race/ethnicity with the risk of identifying invasive intraductal papillary mucinous neoplasms during resection has not been previously defined. The American College of Surgeons National Quality Improvement Program targeted pancreatectomy database (2014–2021) was queried for patients with race/ethnicity data who underwent resection of an intraductal papillary mucinous neoplasm. Backward Wald logistic regression modeling (P ≤ 0.05 for entry; P >.10 for removal) was used to identify independent predictors of invasion. A total of 4,505 cases of resected intraductal papillary mucinous neoplasms were identified, with 923 (20.5%) demonstrating invasive intraductal papillary mucinous neoplasms. The cohort of individuals other than non-Hispanic Whites were significantly more likely to have invasive intraductal papillary mucinous neoplasms (White, 19.9%; Black, 24.2%; Asian, 23.7%; Hispanic, 22.6%; P =.026). Such disparity could not be explained by greater comorbidity, as non-White patients were significantly younger (age <65 years: 41.7% vs 33.2%, P <.001) and had better physical status (American Society of Anesthesiologists score ≤2: 28.8% vs 25.2%, P =.053). After controlling for clinicodemographic variables, being an individual of race/ethnicity other than White was independently associated with higher odds of invasive intraductal papillary mucinous neoplasms (odds ratio, 1.280; 95% confidence interval, 1.046–1.566; P =.017). No differences in postoperative morbidity were observed. In a national cohort of patients with resected intraductal papillary mucinous neoplasms, individuals who identified as being of race/ethnicity other than White were significantly more likely to have invasive intraductal papillary mucinous neoplasms during surgical resection. [Display omitted] [ABSTRACT FROM AUTHOR]

In image-guided adaptive brachytherapy (IGABT) a quantitative evaluation of the dosimetric changes between fractions due to anatomical variations, can be implemented via rigid registration of images from subsequent fractions based on the applicator as a reference structure. With available treatment planning systems (TPS), this is a manual and time-consuming process. The aim of this retrospective study was to automate this process. A neural network (NN) was trained to predict the applicator structure from MR images. The resulting segmentation was used to automatically register MR-volumes. DICOM images and plans of 56 patients treated for cervical cancer with high dose-rate (HDR) brachytherapy were used in the study. A 2D and a 3D NN were trained to segment applicator structures on clinical T2-weighted MRI datasets. Different rigid registration algorithms were investigated and compared. To evaluate a fully automatic registration workflow, the NN-predicted applicator segmentations (AS) were used for rigid image registration with the best performing algorithm. The DICE coefficient and mean distance error between dwell positions (MDE) were used to evaluate segmentation and registration performance. The mean DICE coefficient for the predicted AS was 0.70 ± 0.07 and 0.58 ± 0.04 for the 3D NN and 2D NN, respectively. Registration algorithms achieved MDE errors from 8.1 ± 3.7 mm (worst) to 0.7 ± 0.5 mm (best), using ground-truth AS. Using the predicted AS from the 3D NN together with the best registration algorithm, an MDE of 2.7 ± 1.4 mm was achieved. Using a combination of deep learning models and state of the art image registration techniques has been demonstrated to be a promising solution for automatic image registration in IGABT. In combination with auto-contouring of organs at risk, the auto-registration workflow from this study could become part of an online-dosimetric interfraction evaluation workflow in the future. [ABSTRACT FROM AUTHOR]

• Of the 208 CNA respondents, 80.1% reported having contact with a patient with a known or suspected case of COVID-19. • The majority of CNAs (80.6%) reported having enough access to PPE during the pandemic, though 32.6% indicated having to provide their own at one point. • Almost all CNAs (91.3%) experienced a death of a patient in their nursing home or unit at the time of the survey, which increased their mental health hardship. • Nearly half of CNAs reported it was "harder" or "a lot harder" to afford basic needs (e.g., food and housing) because of the pandemic. • CNAs reported a mixed impact of the pandemic on their long-term career choice with 17.9% indicating less likeliness of continue in the nursing home industry and 20.4% indicating more likeliness to do so. This study aimed to examine the challenges and needs of certified nursing assistants (CNAs) working in nursing homes during the COVID-19 pandemic in the greater New York City area. Between September and November of 2020, a telephone survey was administered to and completed by 208 CNAs in the study area about various aspects of their working experience during COVID-19. CNAs reported significant exposure to COVID-19 and experienced additional emotional and financial strain due to the pandemic. CNAs also expressed the influence of COVID-19 on their work schedules and intent to continue working as CNAs, and strong interest in financial support and further training. This study offers empirical insights into the experiences of CNAs working in nursing homes during the pandemic, which are of unique value to inform future efforts to support CNAs and other long-term care providers in general and during public health emergencies in New York and beyond. [ABSTRACT FROM AUTHOR]

Challenges arise when treatment to improve maternal health brings the possibility of risk to fetal health. The coronavirus disease 2019 (COVID-19) vaccine is the most recent, but hardly the only, example. Because pregnant patients are often specifically excluded from trials of new therapies, this is often the dilemma that patients and providers face when considering new treatments. In this study, we used the COVID-19 vaccine as an exemplar to question the broader issue of how society, in general, and obstetricians, in particular, should balance obligations to pregnant women's right of access to new therapeutic agents with the physician's desire to protect the fetus from potential risks. We will argue that in almost all circumstances (with few exceptions, as will also be discussed), maternal benefit and respect for autonomy create the uncertainty that absent safety data bring. Consequently, if pregnant women choose to try new interventions and treatments, such as the COVID-19 vaccination, they should be offered those new regimens and their decision supported. In addition, we will argue that the right solution to avoid the dilemma of absent data is to include pregnant individuals in clinical trials studying new treatments, drugs, and other therapies. We will also discuss the basis for our opinion, which are mainstream obstetrical ethics, precedents in law (supreme court ruling that forbids companies to exclude women from jobs that might pose a risk to the fetus), and historic events (thalidomide). The ethical framework includes the supposition that sacrifice to improve fetal outcome is a virtue and not a mandate. Denying a pregnant patient treatment because of threats to their life can create absurd and paradoxical consequences. Either requiring abortion or premature delivery before proceeding with treatments to optimize maternal health, or risking a patient's own life and ability to parent a child by delaying treatment brings clear and significant risks to fetal and/or neonatal outcomes. With rare exceptions, properly and ethically balancing such consequential actions cannot be undertaken without considering the values and goals of the pregnant patient. Therefore, active participation of both the pregnant patient and their physician in shared decision making is needed. [ABSTRACT FROM AUTHOR]

Weight change offers the simplest indication of a patient's recovery after an operation. There have been no studies that have thoroughly investigated postoperative weight dynamics after pancreatectomy. The aim of this study was to define postoperative weight change after a pancreatectomy and determine factors associated with optimal and poor weight trajectories. From 2004 to 2019, 1,090 proximal (65%) and distal (35%) pancreatectomies were performed in patients with adequate data in the medical records. Patient weights were acquired preoperatively and at postoperative months 1, 3, and 12. Optimal (top quartile, weight restoration) and poor (bottom quartile, persistent weight loss) postoperative weight cohorts were identified at 1 year postoperatively. The median percentage weight change 1 year postpancreatectomy was –6.6% (interquartile range: –1.4% to –12.5%), –7.8% for proximal pancreatectomy, and –4.2% for distal pancreatectomy. For most patients (interquartile range cohort), the median percentage weight change at 1, 3, and 12 months was –6.2%, –7.2%, and –6.6%. The independent factors associated with weight restoration were age <65, nonobesity (body mass index <30kg/m2), receiving total parenteral nutrition/total enteral nutrition preoperatively, experiencing preoperative weight loss >10%, distal pancreatectomy, not undergoing vascular resection, and no readmission within 30 days. Conversely, persistent weight loss was associated with American Society of Anesthesiologists classes III to IV, obesity, malignancy, proximal pancreatectomy, blood loss ≥350mL, and experiencing readmission within 30 days. Focusing on pancreatic ductal adenocarcinoma (n = 372) patients, the factors associated with persistent weight loss were obesity, proximal pancreatectomy, and experiencing recurrence within 1 year; however, weight cohorts were not associated with overall survival for pancreatic ductal adenocarcinoma patients. These data define weight kinetics after pancreatectomy. Ultimately, postoperative weight trajectories appear to be largely predetermined but may be mitigated by limiting readmissions and complications. Clinicians should use these data to identify patients who continue to lose weight between the first and third month postoperatively with a high suspicion for the requirement of nutritional monitoring or other interventions. [ABSTRACT FROM AUTHOR]

The last 2 decades have witnessed the development and broad adoption of image-guided adaptive brachytherapy (IGABT) combined with radiochemotherapy in patients with locally advanced cervical cancer. A variety of brachytherapy techniques and dose/fractionation schedules have been applied, and until recently, there was no strong evidence available for preferring one approach to another. However, large volumes of data have now provided high level clinical evidence for dose-effect relations for both disease and morbidity endpoints. It is therefore now possible to apply evidence based dose planning aims and dose prescription protocols in IGABT for locally advanced cervical cancer. This review gives an overview of targets/organs-at-risk and disease/morbidity endpoints which are relevant in the context of treatment planning and dose prescription in IGABT. The dosimetric and clinical evidence is summarized to support the implementation of dose prescription protocols which include hard and soft constraints for targets and organs at risk. [ABSTRACT FROM AUTHOR]

• Explains that bricolage is a key concept to uncover the "Why" and "How" of regional path-creation. • Finds that the technocratic approach in institutionalizing energy transition pathways is a barrier to community engagement. • Depicts how regional energy transition goes about in the peripheralized Austrian regions of Güssing, Hermagor and Murau. In the quest for energy transition pathways, energy regions have become the instrument of choice in peripheralized Austrian regions. This paper unveils why "locked-in" regions usually struggling with systemic change can still create alternative paths. Based on the bricolage concept and the ASID heuristic, we develop a framework to examine the transition processes of three Austrian energy regions (Güssing, Hermagor, Murau). The case studies illustrate the significance of bricolage in mobilizing agential, structural, institutional and discursive resources towards regional path-creation, and show how strategic agents skillfully assemble these resources to mold the transition process in their favor. We thus conclude that (1) the bricolage approach can be a valuable analytical lens for all aspects of regional development in "locked-in" regions, and (2) the energy regions instrument reinforces existing power structures, suggesting why inclusive energy transitions might still fail despite resourceful and robust plans. [ABSTRACT FROM AUTHOR]

Ampullary adenocarcinoma (AAC) is a rare malignancy with great morphological heterogeneity, which complicates the prediction of survival and, therefore, clinical decision-making. The aim of this study was to develop and externally validate a prediction model for survival after resection of AAC. An international multicenter cohort study was conducted, including patients who underwent pancreatoduodenectomy for AAC (2006–2017) from 27 centers in 10 countries spanning three continents. A derivation and validation cohort were separately collected. Predictors were selected from the derivation cohort using a LASSO Cox proportional hazards model. A nomogram was created based on shrunk coefficients. Model performance was assessed in the derivation cohort and subsequently in the validation cohort, by calibration plots and Uno's C-statistic. Four risk groups were created based on quartiles of the nomogram score. Overall, 1007 patients were available for development of the model. Predictors in the final Cox model included age, resection margin, tumor differentiation, pathological T stage and N stage (8th AJCC edition). Internal cross-validation demonstrated a C-statistic of 0.75 (95% CI 0.73–0.77). External validation in a cohort of 462 patients demonstrated a C-statistic of 0.77 (95% CI 0.73–0.81). A nomogram for the prediction of 3- and 5-year survival was created. The four risk groups showed significantly different 5-year survival rates (81%, 57%, 22% and 14%, p < 0.001). Only in the very-high risk group was adjuvant chemotherapy associated with an improved overall survival. A prediction model for survival after curative resection of AAC was developed and externally validated. The model is easily available online via www.pancreascalculator.com. • A prediction model for survival after resection of ampullary adenocarcinoma was created • The model was externally validated with a C-statistic of 0.77 • The model may be used to predict 3- and 5-year overall survival in individual patients • Four risk groups were created with statistically significant differences in survival • Only in the very high risk group was adjuvant chemotherapy associated with an improved overall survival [ABSTRACT FROM AUTHOR]

• First dosimetric results for 4He, 12C and 16O ions with anthropomorphic phantom. • MCTP and FRoG demonstrated superior agreement for clinical beams (1H, 12C). • Analytical calculation with point-of-interest has limits in handling heterogeneity. • MCTP and FRoG validated for clinical translation of novel ions e.g. 4He and 16O. With high-precision radiotherapy on the rise towards mainstream healthcare, comprehensive validation procedures are essential, especially as more sophisticated technologies emerge. In preparation for the upcoming translation of novel ions, case-/disease-specific ion-beam selection and advanced multi-particle treatment modalities at the Heidelberg Ion-beam Therapy Center (HIT), we quantify the accuracy limits in particle therapy treatment planning under complex heterogeneous conditions for the four ions (1H, 4He, 12C, 16O) using a Monte Carlo Treatment Planning platform (MCTP), an independent GPU-accelerated analytical dose engine developed in-house (FRoG) and the clinical treatment planning system (Syngo RT Planning). Attaching an anthropomorphic half-head Alderson RANDO phantom to entrance window of a dosimetric verification water tank, a cubic target spread-out Bragg peak (SOBP) was optimized using the MCTP to best resolve effects of anatomic heterogeneities on dose homogeneity. Subsequent forward calculations were executed in FRoG and Syngo. Absolute and relative dosimetry was performed in the experimental beam room using 1D and 2D array ionization chamber detectors. Mean absolute percent deviation in dose (|%Δ|) between predictions and PinPoint ionization chamber measurements were within ∼2% for all investigated ions for both MCTP and FRoG. For protons and carbon ions, |%Δ| values were ∼4% for Syngo. For the four ions, 3D-γ analysis (3%/3mm criteria) of FLUKA and FRoG presented mean passing rates of 97.0(±2.4)% and 93.6(±4.2)%. FRoG demonstrated satisfactory agreement with gold standard Monte Carlo simulation and measurement, superior to the commercial system. Our pre-clinical trial landmarks the first measurements taken in anthropomorphic settings for helium, carbon and oxygen ion-beam therapy. [ABSTRACT FROM AUTHOR]

Abstract The capacity of pharmaceutical pollution to alter behaviour in wildlife is of increasing environmental concern. A major pathway of these pollutants into the environment is the treatment of livestock with hormonal growth promotants (HGPs), which are highly potent veterinary pharmaceuticals that enter aquatic ecosystems via effluent runoff. Hormonal growth promotants are designed to exert biological effects at low doses, can act on physiological pathways that are evolutionarily conserved across taxa, and have been detected in ecosystems worldwide. However, despite being shown to alter key fitness-related processes (e.g., development, reproduction) in various non-target species, relatively little is known about the potential for HGPs to alter ecologically important behaviours, especially across multiple contexts. Here, we investigated the effects of exposure to a field-realistic level of the androgenic HGP metabolite 17β-trenbolone—an endocrine-disrupting chemical that has repeatedly been detected in freshwater systems—on a suite of ecologically important behaviours in wild-caught female eastern mosquitofish (Gambusia holbrooki). First, we found that 17β-trenbolone-exposed fish were more active and exploratory in a novel environment (i.e., maze arena), while boldness (i.e., refuge use) was not significantly affected. Second, when tested for sociability, exposed fish spent less time in close proximity to a shoal of stimulus (i.e., unexposed) conspecific females and were, again, found to be more active. Third, when assayed for foraging behaviour, exposed fish were faster to reach a foraging zone containing prey items (chironomid larvae), quicker to commence feeding, spent more time foraging, and consumed a greater number of prey items, although the effect of exposure on certain foraging behaviours was dependent on fish size. Taken together, these findings highlight the potential for exposure to sub-lethal levels of veterinary pharmaceuticals to alter sensitive behavioural processes in wildlife across multiple contexts, with potential ecological and evolutionary implications for exposed populations. Graphical abstract Image 1 Highlights • Use of growth-promoting veterinary pharmaceuticals is widespread in global beef production. • The androgenic growth promotant metabolite 17β-trenbolone (17β-TB) is present in aquatic systems. • Adult female mosquitofish were exposed to 17β-TB at an environmentally realistic level. • Exposed females were more active and exploratory, less social, showed increased foraging behaviour. • Androgenic contaminant disrupts key fitness-related behaviours in female fish. The androgenic endocrine disruptor 17β-trenbolone alters behaviour in female fish across multiple fitness-related contexts. [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract Introduction The incorporation of selenium in the structure of nucleosides is a promising strategy to develop novel therapeutic molecules. Objective To assess the toxic effects of three AZT derivatives containing organoselenium moieties on human erythrocytes. Methodology Freshly human erythrocytes were acutely treated with AZT and selenium derivatives SZ1 (chlorophenylseleno), SZ2 (phenylseleno) and SZ3 (methylphenylseleno) at concentrations ranging from 10 to 500 μM. Afterwards, parameters related to membrane damage, redox dyshomeostasis and eryptosis were determined in the cells. Results The effects of AZT and derivatives toward erythrocytes differed considerably. Overall, the SZ3 exhibited similar effect profiles to the prototypal AZT, without causing cytotoxicity. Contrary, the derivative SZ1 induced hemolysis and increased the membrane fragility of cells. Reactive species generation, lipid peroxidation and thiol depletion were also substantially increased in cells after exposure to SZ1. δ -ALA-D and Na+/K+-ATPase activities were inhibited by derivatives SZ1 and SZ2. Additionally, both derivatives caused eryptosis, promoting cell shrinkage and translocation of phosphatidylserine at the membrane surface. The size and granularity of erythrocytes were not modified by any compound. Conclusion The insertion of either chlorophenylseleno or, in a certain way, phenylseleno moietes in the structure of AZT molecule was harmful to erythrocytes and this effect seems to involve a pro-oxidant activity. This was not true for the derivative encompassing methylphenylseleno portion, making it a promising candidate for pharmacological studies. [ABSTRACT FROM AUTHOR]

Contamination of aquatic habitats with pharmaceuticals is a major environmental concern. Recent studies have detected pharmaceutical pollutants in a wide array of ecosystems and organisms, with many of these contaminants being highly resistant to biodegradation and capable of eliciting sub-lethal effects in non-target species. One such pollutant is fluoxetine, a widely prescribed antidepressant, which is frequently detected in surface waters globally and can alter physiology and behaviour in aquatic organisms. Despite this, relatively little is known about the potential for fluoxetine to disrupt mechanisms of sexual selection. Here, we investigate the impacts of 30-day exposure to two environmentally realistic levels of fluoxetine (low and high) on mechanisms of pre- and post-copulatory sexual selection in the eastern mosquitofish ( Gambusia holbrooki ). We tested 1) male mating behaviour in the absence or presence of a competitor male, and 2) sperm quality and quantity. We found that high-fluoxetine exposure increased male copulatory behaviour in the absence of a competitor, while no effect was detected under male-male competition. Further, fluoxetine exposure at both concentrations increased total sperm count relative to males from the control group, while no significant change in sperm quality was observed. Lastly, low-fluoxetine males showed a significant reduction in condition index (mass relative to length). Our study is the first to show altered mechanisms of both pre- and post-copulatory sexual selection in an aquatic species resulting from environmentally realistic fluoxetine exposure, highlighting the capacity of pharmaceutical pollution to interfere with sensitive reproductive processes in wildlife. [ABSTRACT FROM AUTHOR]

Purpose: To examine differences in outcome and response of cirrhotomimetic (CMM) hepatocellular carcinoma (HCC) to a combination of bridging transcatheter arterial chemoembolization and orthotopic liver transplantation (OLT) compared with non-CMM HCC.Materials and Methods: All patients with pathologically proven CMM HCC who underwent bridging transcatheter arterial chemoembolization before OLT between 2007 and 2013 (n = 23) were retrospectively compared with a control group of patients with pathologically proven non-CMM HCC (n = 46).Results: There were 29 tumors in the CMM HCC group and 64 tumors in the non-CMM group identified and treated. Objective response rate on MR imaging at 1 and 3 months after transcatheter arterial chemoembolization for CMM HCC tumors (including patients with complete and partial response) was 93.1% and 86.4% compared with 85.2% and 93.2% for non-CMM tumors without statistically significant difference (P = .54 and P = .09, respectively). Pathologic study of liver explants showed complete tumor necrosis in 62.3% of non-CMM tumors (38/61) compared with 10.3% of CMM tumors (3/29) (P < .0001). Overall 2-year survival after transcatheter arterial chemoembolization and OLT was significantly lower for patients with CMM HCC compared with patients non-CMM HCC (65.2% vs 87%, P = .03). Patients with CMM HCC with extranodular tumor extension involving > 50% of liver parenchyma had worse survival with mean 2-year survival of 402 days ± 102 vs 656 days ± 39 for the remaining patients with CMM HCC (P = .02).Conclusions: Despite similar early imaging response rates, CMM HCC tumors had markedly lower rates of complete pathologic necrosis on liver explants and were associated with reduced survival after OLT compared with conventional HCCs. [ABSTRACT FROM AUTHOR]

Study Objective: To determine if the addition of video coaching to an obstetrics and gynecology resident laparoscopic simulation curriculum improves acquisition of suturing skills.Design: Randomized controlled trial (Canadian Task Force classification I).Setting: Academic teaching hospital with a residency program in obstetrics and gynecology.Patients: Twenty obstetrics and gynecology residents undergoing a 4-week laparoscopic simulation curriculum were video recorded weekly performing a suturing task on a validated vaginal cuff model.Interventions: Residents were randomized to standard simulation curriculum or standard curriculum plus weekly video coaching by an expert laparoscopic surgeon. Primary outcome measure was comparison of weekly Global Operative Assessment of Laparoscopic Skills plus Vaginal Cuff Metrics (GOALS+) scores of the suturing task.Measurements and Main Results: Baseline GOALS+ scores did not differ across training groups (p = .406), although "senior" (postgraduate years 3 and 4) residents initially had significantly higher GOALS+ scores than "junior" (postgraduate years 1 and 2) residents (p < .001). GOALS+ scores significantly improved from week 1 to week 2 in the intervention group compared with the control group (p < .05). Junior coached residents had significantly higher GOALS+ scores at week 2 (mean, 28.06; standard deviation, 3.10) compared with the junior control residents (mean, 20.75; standard deviation, 6.38; p < .04). Over the 4-week period all residents showed significant improvement (p = .005), with novice residents improving more than experienced residents (p = .001). The junior coached residents exhibited a significant difference between weeks 1 and 2 when compared with the junior residents undergoing the standard curriculum.Conclusion: Video coaching during laparoscopic simulation training has the greatest impact early in junior learners' skill acquisition, thus providing another tool for simulation training curricula. [ABSTRACT FROM AUTHOR]

Suboptimal diets are the most important preventable risk factor for the global burden of non-communicable diseases. The EAT- Lancet reference diet was therefore developed as a benchmark for gauging divergence from healthy eating standards. However, no previous research has comprehensively explored how and why this divergence exists in poorer countries undergoing nutrition transitions. This study therefore analyzes dietary patterns and drivers of the demand for nutritious foods using nationally representative household surveys from Ethiopia, Kenya, Tanzania, and Uganda. We show how barriers to dietary convergence stem from combinations of poverty, high relative food prices and weak preferences for some specific healthy foods. The article concludes by discussing interventions for strengthening consumer demand for healthy diets in Africa. • Household data are used to compare diet patterns in Ethiopia, Kenya, Tanzania, and Uganda to the EAT- Lancet reference diet. • Consumption gaps for fruits, vegetables, and pulses and nuts/seeds are large for all consumer groups. • Food budgets of most households in these countries are far too low to afford the EAT-diet. • Consumer preferences for vegetables are weak, but preferences for fruits and animal-sourced foods are strong. • Income growth alone will not solve diet problems in sub-Saharan Africa; both supply and demand side interventions are needed. [ABSTRACT FROM AUTHOR]

A key requirement for future production facilities is to perform new production processes in a flexible and adaptive way with available and known resources. In this context, a comprehensive description (ontology) of involved components has a high significance. If certain technological aspects are missing during a production process, the production control should respond in a dynamic, versatile and adaptive (agile) manner to the overall value network. The possibility to describe the requirements of products for the necessary processes in the same namespace like the requirements of the necessary processes for the resources is a prerequisite to enable this behavior. Afterwards the different requirements will be placed in relation to the respective requirements. The aim is to define the necessary processes for the production based on the description of the product and the known resources in an agile way. Due to this a framework for a comprehensive description of automated production facilities, products and processes is described in this paper. The idea is that based on this framework a production facility can change the produced products without dedicated commissioning and ramp-up phases. [ABSTRACT FROM AUTHOR]

Background Psychiatric conditions, notably anxiety, commonly co-occur with autism spectrum disorders (ASD). Method This study investigated self-reported behavioural, cognitive and affective symptoms of social anxiety (SA) in 50 adult males with ASD. Associations between SA, core ASD symptoms and facets of neuropsychological functioning were also examined. Results Twenty-six participants (52%) endorsed levels of SA that exceeded the suggested caseness threshold for social anxiety disorder. Categorical and dimensional data analyses indicated that there were no relationships between SA symptoms, present-state or childhood ASD symptom-severity, or measures of socio-emotional processing in this sample. Conclusions Study findings suggest that severity of SA is not merely a reflection of ASD symptom-severity. Further research is needed to ascertain the prevalence of SA in adult ASD epidemiological samples, and identify causal and maintaining mechanisms for these co-morbid symptoms. [ABSTRACT FROM AUTHOR]

Background First detected in the United States in 1996, Klebsiella pneumoniae carbapenemase (KPC) has spread internationally among gram-negative bacteria, especially K pneumoniae . These microorganisms can cause serious infections in hospitalized patients, and there are few therapeutic options, culminating in increased mortality. The objective of this study was to describe the occurrence of outbreaks that were caused by KPC-producing K pneumoniae , emphasizing the interventions that were implemented to contain the outbreaks. Methods PubMed, Web of Knowledge, and Literatura Latino Americana em Ciências da Saúde databases were searched for articles that were published between 2001 and 2012 according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results Of the 586 studies identified, 13 were selected for the final sample. Most studies showed that the containment of KPC outbreaks is possible in hospital settings through several actions, particularly use of surveillance cultures and the establishment of contact precautions. Conclusions The results show that limiting the cross-transmission of these and other KPC-producing bacteria is possible in a hospital setting. However, such isolates need to be detected early with the aid of culture surveillance and contained early using appropriate actions immediately to prevent an outbreak. [ABSTRACT FROM AUTHOR]

To review the case of a second trimester cesarean scar ectopic pregnancy managed with laparoscopic resection in a patient with a history of renal transplant. Video demonstration of surgical technique with narrated description. Academic tertiary care site. 36yo G5P0221 found to have a 14-week cesarean scar ectopic pregnancy, desiring fertility sparing intervention. In this video, we demonstrate the case of a second trimester cesarean scar ectopic pregnancy resected laparoscopically. We illustrate several key points including: - Safe port placement in the setting of prior renal transplant - Preemptive hemostasis management with temporary uterine artery ligation - Intraoperative strategies for reducing blood loss - Considerations for management of gestational sac rupture and abdominal spill of fetal contents A 14-week cesarean scar ectopic pregnancy was successfully resected with minimal blood loss and excellent recovery. Laparoscopic resection can be safely and effectively utilized even for cesarean scar ectopic pregnancies of more advanced gestational ages. [ABSTRACT FROM AUTHOR]

This video seeks to educate both learners and educators on techniques for left-handed laparoscopic vaginal cuff closure through three different port configurations. It also aims to highlight disparities between right and left-handed trainees in surgical training and mentorship. Narrated surgical video. Two teaching hospitals (academic and community based). Three patients undergoing total laparoscopic hysterectomy for various indications. Left-handed laparoscopic vaginal cuff closure through three different port configurations. We illustrate several key points for educators and left-handed learners including: -Port placement options for the left-handed surgeon -Advantages and disadvantages of various port configurations -Recommended direction of suturing based on port placement -Techniques for assisting a left-handed surgeon -Direct comparison between right and left-handed suturing, demonstrating that they are mirror images of one another Left-handed laparoscopic vaginal cuff closure can be effectively accomplished through any port configuration. Educators and left-handed learners should be familiar with port placement options, techniques for assisting a left-handed surgeon, and direction of suturing for left-handed cuff closure to optimize surgical education and minimize patient time under anesthesia. [ABSTRACT FROM AUTHOR]

Although vaginal delivery has long been assumed to be the preferred route of delivery in women who have not had a prior cesarean delivery, some have recently advocated that women be offered the option of elective, primary cesarean delivery in all pregnancies. Available outcome data, however, do not permit ready comparison of these alternate plans for delivery. Important maternal outcomes include short-term complications such as death, bleeding, infection, and damage to pelvic organs as well as long-term effects on future pregnancies, fecal and urinary incontinence, and pelvic organ prolapse. Important neonatal outcomes include asphyxic and traumatic birth injury, infection, respiratory complications, and stillbirth. To weigh the relative merits of elective primary cesarean delivery and a trial of labor, a randomized controlled trial is needed. Such a trial would be both ethical and feasible. [ABSTRACT FROM AUTHOR]

Background Robotic technology is increasingly prevalent in bariatric surgery, yet there are national deficiencies in exposure of surgical residents to robotic techniques. Objectives The purpose of this study is to accurately characterize the perioperative outcomes of a resident teaching model using the robotic-assisted sleeve gastrectomy. Setting University Hospital. Methods We identified 411 consecutive patients who underwent robotic sleeve gastrectomy at our institution from a prospectively maintained administrative database. Perioperative morbidity, operative time, and supply cost of the procedure were analyzed. Results Mean operative time was 96.4±24.9 minutes; mean robot usage time was 63.9 minutes (range 30.0–122.0 min). Ninety-day morbidities included reoperation (0.72%), major bleeding complications (0.48%), staple line leak (0.24%), stricture (0.97%), need for blood transfusion (3.86%), surgical site infection (1.69%), deep vein thrombosis (0.48%), and pulmonary embolism (0.48%). Mortality was nil. The resident cohort achieved operative time plateaus after five consecutive cases. Subset analysis for fiscal year 2014 demonstrated significantly increased supply cost for robotic sleeve gastrectomy compared with its laparoscopic equivalent. Conclusion Robotic-assisted sleeve gastrectomy can be instituted as a model for resident robotic education with rates of morbidity and operative times equivalent to historical laparoscopic controls. The robot’s enhanced ergonomics and its opportunity for resident education must be weighed against its increased supply cost. [ABSTRACT FROM AUTHOR]

Purpose: To understand the frequency of use of Carnoy's solution, as a means of chemical curettage, for treating the keratocystic odontogenic tumor (KCOT).Materials and Methods: A Web-based survey was distributed by e-mail to 6,880 members listed in the 2013 American Association of Oral and Maxillofacial Surgeons directory.Results: Eight hundred nine participants across the United States responded to the survey (12% response rate). The most common procedures performed to definitively treat a KCOT were enucleation plus mechanical curettage (curette with or without peripheral ostectomy; 66%). Of the survey participants, 198 (25%) currently use Carnoy's solution, 111 (56%) of whom are using the solution with chloroform and 83 (42%) are using it without chloroform.Conclusion: Carnoy's solution remains a common method of chemical curettage for the definitive treatment of the KCOT. Carnoy's solution with and without chloroform is being used for chemical cautery. [ABSTRACT FROM AUTHOR]

Social learning studies emerged as part of the ecological economics research agenda rather recently. Questions of how human societies and organisations learn and transition on the basis of environmental knowledge relate to the core ideas of ecological economics with its pluralistic understanding of human behaviour in contrast to the limited focus on incentive-driven behaviour. Our study analyses the emergence and thematic foci of social learning studies within ecological economics over the past 15 years. We selected and analysed 54 articles published after peer review in established journals adhering to the epistemological tradition of ecological economics. This study is guided by the interest in how social learning is conceptualised, how this research is positioned in terms of process dynamics, causal factors and outcomes of learning. Results show, that the number of related papers grew substantially in recent years. Also the role of formal or informal institutions has been found to be a strong causal factor for social learning and change processes vis-à-vis technological, economic or political factors. In addition, there is a growing awareness of social learning processes in various environmental policy fields such as biodiversity governance, water and land management, fisheries, and climate adaptation. We conclude that these insights can give new impulses to research on socio-ecological transition and to the related debate on societal change and transformation processes as core topics for ecological economics. [ABSTRACT FROM AUTHOR]

Background Laparoscopic sleeve gastrectomy has become a stand-alone procedure in the treatment of morbid obesity. There are very few reports on the use of robotic approach in sleeve gastrectomy. Objectives The purpose of this retrospective study is to report our early experience of robotic-assisted laparoscopic sleeve gastrectomy (RALSG) using a proctored training model with comparison to an institutional cohort of patients who underwent laparoscopic hand-assisted sleeve gastrectomy (LASG). Settings University hospital. Methods The study included 108 patients who underwent sleeve gastrectomy either via the laparoscopic-assisted or robot-assisted approach during the study period. Of these 108 patients, 62 underwent LASG and 46 underwent RALSG. The console surgeon in the RALSG is a clinical year 4 (CY4) surgery resident. All CY4 surgery residents received targeted simulation training before their rotation. The console surgeon is proctored by the primary surgeon with assistance as needed by the second surgeon. Results The patients in the robotic and laparoscopic cohorts did not have a statistical difference in their demographic characteristics, preoperative co-morbidities, or complications. The mean operating time did not differ significantly between the 2 cohorts (121 min versus 110 min, P = .07). Patient follow-up in the LSG and RALSG were 91% and 90% at 3 months, 62% and 64% at 6 months, and 60% and 55% at 1 year, respectively. The mean percentage estimated weight loss (EWL%) at 3 months, 6 months, and 1 year was greater in the robotic group but not statistically significant (27 versus 22 at 3 mo [ P = .05] and 39 versus 34 at 6 mo [ P = .025], 57 versus 48 at 1 yr [ P = .09]). There was no mortality in either group. Conclusion Early results of our experience with RALSG indicate low perioperative complication rates and comparable weight loss with LASG. The concept of a stepwise education model needs further validation with larger studies. [ABSTRACT FROM AUTHOR]

Objective: In prior studies, mood disturbance has been associated with poor obstetric outcomes. The purpose of this study was to determine whether depression during pregnancy is associated with a higher frequency of cesarean or assisted vaginal delivery.Study Design: A mood disorders questionnaire, which included the standardized Center for Epidemiologic Studies Depression Scale (CES-D), was offered to all antenatal patients in their early third trimester from January 1996 to December 1999 at the Massachusetts General Hospital. Maternal demographics and pregnancy outcome data were collected from a computerized database on 1697 patients who completed the surveys. A CES-D score of 16 or higher was considered to indicate significant depressive symptoms. Rates of cesarean section and assisted vaginal delivery in women with and without scores of 16 or higher were compared by using the chi(2) test.Results: Of the study population, 264 women (15.6%) had CES-D scores of 16 or higher. Among all subjects, the cesarean section rate was 24.0%, and the assisted vaginal delivery rate was 10.0%. There was no statistically significant difference between the rate of cesarean section (26.5% vs 23.6%) or assisted vaginal delivery (8.0% vs 10.4%) in women with and without elevated CES-D scores (P =.34). These findings did not change when nulliparous and multiparous patients were analyzed separately, when the definition of patients at risk for depression was expanded to include women who indicated current or past use of antidepressants or when the cutoff CES-D score criteria was increased to 19 or 25. With our sample size, an alpha =.05 and a beta =.2, we had the power to detect a 7.5% difference between our two groups.Conclusion: Data from this study did not support a relationship between depressive symptoms during pregnancy and mode of delivery. [ABSTRACT FROM AUTHOR]

Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values. [ABSTRACT FROM AUTHOR]

Background: To identify opportunities to improve morbidity after hemorrhagic stroke, it is imperative to understand factors that are related to psychological outcome.Design/methods: We prospectively identified patients with non-traumatic hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) between January 2015 and February 2021 who were alive 3-months after discharge and telephonically assessed 1) psychological outcome using the Quality of Life in Neurological Disorders anxiety, depression, emotional and behavioral dyscontrol, fatigue and sleep disturbance inventories and 2) functional outcome using the modified Rankin Scale (mRS) and Barthel Index. We also identified discharge destination for all patients. We then evaluated the relationship between abnormal psychological outcomes (T-score >50) and discharge destination other than home, poor 3-month mRS score defined as 3-5 and poor 3-month Barthel Index defined as <100.Results: 73 patients were included; 41 (56%) had an abnormal psychological outcome on at least one inventory. There were 41 (56%) patients discharged to a destination other than home, 44 (63%) with poor mRS score and 28 (39%) with poor Barthel Index. Anxiety, depression, emotional and behavioral dyscontrol and sleep disturbance were all associated with a destination other than home, poor mRS score, and poor Barthel Index (all p<0.05). Fatigue was related to poor mRS score and poor Barthel Index (p=0.005 and p=0.006, respectively).Conclusion: Multiple psychological outcomes 3-months after hemorrhagic stroke are related to functional status. Interventions to improve psychological outcome and reduce morbidity in patients with poor functional status should be explored by the interdisciplinary team. [ABSTRACT FROM AUTHOR]

Objectives The authors hypothesized that, compared with conventional ultrasound (CUS), the use of a novel navigated ultrasound (NUS) technology would increase success rates and decrease performance times of vascular access procedures in a gel phantom model. Design A prospective, randomized, crossover study. Setting A university Hospital. Participants Participants were 44 anesthesiologists with varying clinical experience. Interventions Anesthesiologists performed in-plane and out-of-plane vascular access procedures using both NUS and CUS for needle visualization in a gel phantom model. Measurements and Main Results Procedure time was measured from needle insertion to verbalization of final needle positioning by the participants, and successful needle placement into the simulated vessel was verified by aspiration of simulated blood. By employing ultrasound navigation capabilities in addition to real-time ultrasound imaging during in-plane/long-axis vascular access procedures, median procedure time showed a nonsignificant decrease (7.5 seconds v 13.0 seconds; p = 0.028), and the observed increase in procedure success rate (90.9% v 100%; p = 0.125) did not reach statistical significance. For out-of-plane/short-axis vascular access procedures, a significant reduction in median procedure time (5.0 seconds v 11.5 seconds; p<0.001) and a significant increase in procedure success rate (75% v 100%; p<0.001) were achieved by using navigation technology combined with real-time ultrasound. Conclusions NUS technology improved the performance times and success rates of vascular access procedures conducted by anesthesiologists in a gel phantom model. [ABSTRACT FROM AUTHOR]

In the era of big data medicinal chemists are exposed to an enormous amount of bioactivity data. Numerous public data sources allow for querying across medium to large data sets mostly compiled from literature. However, the data available are still quite incomplete and of mixed quality. This mini review will focus on how medicinal chemists might use such resources and how valuable the current data sources are for guiding drug discovery. [ABSTRACT FROM AUTHOR]

Background Locked posterior glenohumeral dislocations with impaction fractures involving less than 30% to 35% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 35% to 40% are treated with humeral head arthroplasty. As an alternative, reconstruction of the defect with segmental femoral or humeral head allograft has been proposed, but the long-term outcome of this joint-preserving procedure is unknown. Methods Twenty-two shoulders in 21 patients with a locked posterior shoulder dislocation and an impaction of at least 30% (mean, 43%) of the humeral head were treated with segmental reconstruction of the humeral head defect. They were reviewed clinically and radiographically at a minimum follow-up of 5 years. Results Of the 22 shoulders, 19 could be followed up at 128 months (range, 60-294 months) postoperatively. Only 2 of the 19 patients needed a prosthesis more than 180 months after the index operation. Of the other 17, 4 had radiographically advanced osteoarthritis (OA), 4 had mild OA, and 9 had no or minimal OA. Eighteen shoulders were rated as subjectively excellent, none were rated as good, and one was rated as fair. The final Constant-Murley score averaged 77 points (range, 52-98 points), the Subjective Shoulder Value averaged 88% (range, 75%-100%), and only 2 patients had mild to moderate pain. Mean active anterior elevation was 145°, and mean external rotation with the arm at the side was 42°. Conclusion Segmental reconstruction of humeral head defects for large anteromedial impaction fractures caused by locked posterior dislocations durably restores stability and freedom from pain with an excellent subjective long-term outcome. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to evaluate the clinical utility of serum uric acid measurements in the hypertensive diseases of pregnancy.Study Design: We performed a nested case-control study to assess the clinical utility of serum uric acid measurements in women with hypertensive diseases of pregnancy. We identified 344 women who had serum uric acid measurements at term and categorized them into five diagnostic groups according to definitions of hypertensive diseases in pregnancy published by the National Working Group on Hypertension in Pregnancy: transient hypertension of pregnancy (n = 69), preeclampsia (n = 130), chronic hypertension (n = 23), chronic hypertension with superimposed preeclampsia (n = 29), and normal (n = 93). We compared the mean uric acid concentration for each group with use of a one-way analysis of variance and Scheffe's post hoc test and calculated the sensitivities and specificities in diagnosing preeclampsia as well as the likelihood ratios for serum uric acid values of 5.5, 6.0, and 6.5 mg/dl. We also examined the correlation between serum uric acid levels and several clinical outcome measures in women with hypertensive diseases of pregnancy.Results: The mean serum uric acid values for women with preeclampsia (6.2 +/- 1.4 mg/dl) and transient hypertension (5.6 +/- 1.7 mg/dl) were significantly higher than those of controls (4.3 +/- 0.8 mg/dl, p < 0.05). The difference in mean serum uric acid values between women with chronic hypertension (4.9 +/- 1.0 mg/dl) and superimposed preeclampsia (5.8 +/- 1.4 mg/dl) were not statistically significant. The likelihood ratio of having preeclampsia with a serum uric acid value of 5.5 mg/dl was 1.41 in gestational hypertension of pregnancy and 2.5 in chronic hypertension. With use of a receiver-operator characteristic curve, we were unable to identify a serum uric acid value that could be used to differentiate various hypertensive diseases of pregnancy. There was a weak correlation between serum uric acid values and several clinical outcome measures of preeclampsia (r = 0.06 to 0.26).Conclusion: Although mean serum uric acid values are elevated in women with preeclampsia, the clinical utility of serum uric acid values in differentiating various hypertensive diseases of pregnancy appears to be limited. In the setting of chronic hypertension, however, a serum uric acid level of > or = 5.5 mg/dl could identify women with an increased likelihood of having superimposed preeclampsia. [ABSTRACT FROM AUTHOR]

• Single layered forest with dense canopy is preferred foraging habitat of M. myotis. • LiDAR data proves to be powerful to predict the foraging habitat of M. myotis. • A nationwide map predicting foraging habitats informs conservation management. Habitat shift caused by human impact on vegetation structure poses a great threat to species which are specialized on unique habitats. Single layered beech forests, the main foraging habitat of Greater Mouse-eared Bats (Myotis myotis) , are threatened by recent changes in forest structure. After this species suffered considerable population losses until the 1970s, their roosts in buildings are strictly protected. However, some populations are still declining. Thus, the spatial identification of suitable foraging habitat would be essential to ensure conservation policy. The aim of this study was (a) to verify the relevance of forest structural variables for the activity of M. myotis and (b) to evaluate the potential of LiDAR (Light Detection and Ranging) in predicting suitable foraging habitat of the species. We systematically sampled bat activity in forests close to 18 maternity roosts in Switzerland and applied a generalized linear mixed model (GLMM) to fit the activity data to forest structure variables recorded in the field and derived from LiDAR. We found that suitable forest foraging habitat is defined by single layered forest, dense canopy, no shrub layer and a free flight space. Most importantly, this key foraging habitat can be well predicted by airborne LiDAR data. This allows for the first time to create nationwide prediction maps of potential foraging habitats of this species to inform conservation management. This method has a special significance for endangered species with large spatial use, whose key resources are hard to identify and widely distributed across the landscape. [ABSTRACT FROM AUTHOR]

Classical ATP-independent non-shivering thermogenesis enabled by uncoupling protein 1 (UCP1) in brown adipose tissue (BAT) is activated, but not essential for survival, in the cold. It has long been suspected that futile ATP-consuming substrate cycles also contribute to thermogenesis and can partially compensate for the genetic ablation of UCP1 in mouse models. Futile ATP-dependent thermogenesis could thereby enable survival in the cold even when brown fat is less abundant or missing. In this study, we explore different potential sources of UCP1-independent thermogenesis and identify a futile ATP-consuming triglyceride/fatty acid cycle as the main contributor to cellular heat production in brown adipocytes lacking UCP1. We uncover the mechanism on a molecular level and pinpoint the key enzymes involved using pharmacological and genetic interference. ATGL is the most important lipase in terms of releasing fatty acids from lipid droplets, while DGAT1 accounts for the majority of fatty acid re-esterification in UCP1-ablated brown adipocytes. Furthermore, we demonstrate that chronic cold exposure causes a pronounced remodeling of adipose tissues and leads to the recruitment of lipid cycling capacity specifically in BAT of UCP1-knockout mice, possibly fueled by fatty acids from white fat. Quantification of triglyceride/fatty acid cycling clearly shows that UCP1-ablated animals significantly increase turnover rates at room temperature and below. Our results suggest an important role for futile lipid cycling in adaptive thermogenesis and total energy expenditure. • A futile ATP-consuming triglyceride/fatty acid cycle is main contributor to heat production in brown adipocytes lacking UCP1. • During active lipolysis, ATGL releases fatty acids from lipid droplets and DGAT1 mediates fatty acid re-esterification. • UCP1-ablated animals significantly increase triglyceride/fatty acid cycling rates at room temperature and below. [ABSTRACT FROM AUTHOR]

Abstract: This study examined two main tenets of the Summerfeldt, Kloosterman, Antony, Richter, and Swinson (2004) model which posits incompleteness (INC) and harm avoidance (HA) as motivational core dimensions of obsessive–compulsive disorder (OCD): (1) INC is OCD-specific. (2) HA is common to OCD and other anxiety disorders. For this purpose, we assessed levels of INC and HA in 170 OCD patients, 38 anxiety, 45 depressive and 220 non-clinical controls. INC severity was more pronounced in OCD than in anxiety disorder, depressive disorder and non-clinical controls. HA was more pronounced in the OCD sample than in depressive disorder and non-clinical controls, and more pronounced in anxiety patients than in non-clinical controls, while HA severity did not differ significantly between OCD and anxiety disorders and between anxiety and depressive disorders. Moreover, regression analyses indicated (a) that the diagnosis of OCD and – to a much lesser degree – the diagnosis of a depressive disorder independently contributed to INC severity, whereas the diagnosis of an anxiety disorder did not, and (b) that OCD as well as anxiety disorder diagnoses, but also depressive disorder diagnoses (although to a lesser extent) independently contributed to HA severity. In sum, our results yielded preponderant, but only partial support for the Summerfeldt model. [Copyright &y& Elsevier]

Background: Social media is increasingly becoming a health resource for people suffering from complex and debilitating health conditions. A comprehensive understanding of how and why social media and the Internet are used among patients with chronic gynecologic pain will allow for the intentional development and incorporation of web-based tools into patient care plans.Objective: This study aimed to determine whether gynecologic patients with pain are more likely to use social media and the Internet to understand and manage their condition than those without pain. The survey was designed to explore how gynecologic patients with and without pain use and interact with social media and other web-based health resources and the clinical, personal, and demographic factors influencing these behaviors.Study Design: Patients presenting with a new complaint to a gynecologist at 1 of 6 Fellowship in Minimally Invasive Gynecologic Surgery-affiliated hospital systems were screened, consented, and assigned to pain and no-pain groups. Participants were surveyed about social media and Internet use, symptoms, bother, physician selection, motivation, trust, and demographic information. Survey responses were compared using the Fisher exact tests, odds ratios, and risk ratios from standard tabular analysis, univariate or multivariate tests of means, and regression analyses, as appropriate.Results: Of 517 participants included in the study, 475 (92%) completed the survey, 328 (69.1%) with pain and 147 (30.9%) without pain. Study participants in the pain group reported more than double the odds of using social media than those without pain (37.8% vs 19.7%; odds ratio, 2.47; 95% confidence interval, 1.54-3.96) and triple the odds of using the Internet (88.4% vs 69.4%; odds ratio, 3.37; 95% confidence, 2.04-5.56) to understand or manage their condition. Participants with pain were more likely than those without pain to engage in social media at a higher level (3.5 vs 1.7 on a scale of 0 to 10; P<.0001), be motivated by interpersonal elements of online engagement (Hotelling's T2=37.3; P<.0001), prefer an interactive component to their online health resource (35.6% vs 24.3%; risk ratio, 1.46; 95% confidence interval, 1.00-2.20; P=.0433), be influenced by others in their choice of a gynecologist (0.37 vs 0.32 on a scale of 0 to 1; P=.009), use social media as a coping tool (38.3% vs 17%; P=.0001), trust information found on social media (31.4% vs 16.7%; P=.0033), and trust other women with the same condition, informal health resources, and personal sources more and doctors and formal health resources less (P=.0083). Participants in both groups reported higher levels of social media engagement with higher levels of symptom bother (28% increase in engagement with every doubling of bother level (P<.0001).Conclusion: Patients with gynecologic pain were more likely than those without pain to use social media and the Internet to understand and manage their condition. Patients with pain engaged in and trusted social media at a higher level, with engagement rising directly with bother level. [ABSTRACT FROM AUTHOR]

Background: Women with gestational glucose intolerance, defined as an abnormal initial gestational diabetes mellitus screening test, are at risk of adverse pregnancy outcomes even if they do not have gestational diabetes mellitus. Previously, we defined the physiological subtypes of gestational diabetes mellitus based on the primary underlying physiology leading to hyperglycemia and found that women with different subtypes had differential risks of adverse outcomes. Physiological subclassification has not yet been applied to women with gestational glucose intolerance.Objective: We defined the physiological subtypes of gestational glucose intolerance based on the presence of insulin resistance, insulin deficiency, or mixed pathophysiology and aimed to determine whether these subtypes are at differential risks of adverse outcomes. We hypothesized that women with the insulin-resistant subtype of gestational glucose intolerance would have the greatest risk of adverse pregnancy outcomes.Study Design: In a hospital-based cohort study, we studied women with gestational glucose intolerance (glucose loading test 1-hour glucose, ≥140 mg/dL; n=236) and normal glucose tolerance (glucose loading test 1-hour glucose, <140 mg/dL; n=1472). We applied homeostasis model assessment to fasting glucose and insulin levels at 16 to 20 weeks' gestation to assess insulin resistance and deficiency and used these measures to classify women with gestational glucose intolerance into subtypes. We compared odds of adverse outcomes (large for gestational age birthweight, neonatal intensive care unit admission, pregnancy-related hypertension, and cesarean delivery) in each subtype to odds in women with normal glucose tolerance using logistic regression with adjustment for age, race and ethnicity, marital status, and body mass index.Results: Of women with gestational glucose intolerance (12% with gestational diabetes mellitus), 115 (49%) had the insulin-resistant subtype, 70 (27%) had the insulin-deficient subtype, 40 (17%) had the mixed pathophysiology subtype, and 11 (5%) were uncategorized. We found increased odds of large for gestational age birthweight (primary outcome) in women with the insulin-resistant subtype compared with women with normal glucose tolerance (odds ratio, 2.35; 95% confidence interval, 1.43-3.88; P=.001; adjusted odds ratio, 1.74; 95% confidence interval, 1.02-3.48; P=.04). The odds of large for gestational age birthweight in women with the insulin-deficient subtype were increased only after adjustment for covariates (odds ratio, 1.69; 95% confidence interval, 0.84-3.38; P=.14; adjusted odds ratio, 2.05; 95% confidence interval, 1.01-4.19; P=.048). Among secondary outcomes, there was a trend toward increased odds of neonatal intensive care unit admission in the insulin-resistant subtype in an unadjusted model (odds ratio, 2.09; 95% confidence interval, 0.99-4.40; P=.05); this finding was driven by an increased risk of neonatal intensive care unit admission in women with the insulin-resistant subtype and a body mass index of <25 kg/m2. Infants of women with other subtypes did not have increased odds of neonatal intensive care unit admission. The odds of pregnancy-related hypertension in women with the insulin-resistant subtype were increased (odds ratio, 2.09; 95% confidence interval, 1.31-3.33; P=.002; adjusted odds ratio, 1.77; 95% confidence interval, 1.07-2.92; P=.03) compared with women with normal glucose tolerance; other subtypes did not have increased odds of pregnancy-related hypertension. There was no difference in cesarean delivery rates in nulliparous women across subtypes.Conclusion: Insulin-resistant gestational glucose intolerance is a high-risk subtype for adverse pregnancy outcomes. Delineating physiological subtypes may provide opportunities for a more personalized approach to gestational glucose intolerance. [ABSTRACT FROM AUTHOR]