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· Differences in the clinical course of intensive care unit (ICU) admitted male and female patients with serve coronavirus disease 2019 (COVID-19) has not been investigated. · We aimed to investigate, in a large global population of ICU admitted COVID-19 patients, the impact of sex on ICU mortality and complications. · Males experienced critical illness that was protracted and required intervention more often than females. · Males had higher odds of developing cardiac arrest and pulmonary embolism, as a complication of COVID-19. · Future investigators ought to evaluate sex-differences in the long-term recovery of patients admitted to ICU with COVID-19. Sex differences in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) susceptibility, illness severity, and hospital course are widely acknowledged. The effects of sex on outcomes experienced by patients with severe Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) remains unknown. To determine the effects of sex on ICU mortality in patients with COVID-19 This retrospective analysis of an international multi-center prospective observational database included adults admitted to ICU for treatment of acute COVID-19 between 1st January 2020 and 30th June 2022. The primary outcome was ICU mortality. Multivariable Cox regression was used to ascertain the hazard of death (Hazard Ratio=HR) adjusted for pre-selected covariates. The secondary outcome was sex differences in complications of COVID-19 during hospital stay. Overall, 10,259 patients (3,314 females, 6,945 males) were included with a median age of 60 (interquartile range [IQR]=49–68) and 59 (IQR=49–67) years, respectively. Baseline characteristics were similar between sexes. More females were non-smokers (65% vs. 44 %, p < 0.01) and obese (39% vs. 30 %, p < 0.01), compared to males. Also, males received greater ICU intervention (mechanical ventilation, prone ventilation, vasopressors, and tracheostomy) than females. Males had a greater hazard of death (compared to females, HR=1.14; 95 % CI=1.02–1.26). Adjustment for complications during hospital stay did not alter the hazard of death (HR=1.16; 95 % CI=1.05–1.28). Males had a significantly elevated hazard of death among patients who received ECMO (HR=1.24; 95 % CI=1.01–1.53). Male sex was associated with cardiac arrest (adjusted OR [aOR]=1.37; 95 % CI=1.16–1.62) and PE (aOR=1.28; 95 % CI=1.06–1.55). Among patients admitted to ICU for severe COVID-19, males experienced higher severity of illness and more frequent intervention than females. Ultimately, the hazard of death was moderately elevated in males compared to females despite greater PE and cardiac arrest. [ABSTRACT FROM AUTHOR]

• Global income inequality and disparities of healthcare resources have been exacerbated by the pandemic. • Coronavirus disease-2019 (COVID-19) causes severe respiratory distress as well as a slew of additional systemic consequences that affect several organ systems, including neurological complications. Ischemic stroke represents the most common neurological complication of respiratory failure due to COVID-19. • Stroke incidence per admitted days in patients with respiratory failure due to COVID-19 was low in high income countries (HICs) and low-middle income countries (LMICs) although the stroke risk was higher in LMICs. • Both LMIC status and stroke increased the risk of death in patients with respiratory failure due to COVID-19. We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p < 0.001)]. Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. ACTRN12620000421932 registered on 30/03/2020. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic forced most colleges and universities to go online, student health centers rapidly shifted to telehealth platforms without frameworks for virtual care provision. An urban student health center implemented a needs assessment involving unannounced standardized patients (USPs) to evaluate the integration of a new telehealth workflow and clinicians' virtual communication skills. From April to May 2021, USPs conducted two video visits with 12 primary care and four women's health clinicians (N = 16 clinicians; 32 visits). Cases included (1) a 21-year-old female presenting for birth control with a positive Patient Health Questionaire-9 and (2) a 21-year-old male, who vapes regularly, with questions regarding safe sex with men. Clinicians were evaluated using a checklist completed by the USP immediately following the visit and a systematic chart review of the electronic health record. USP feedback indicates most clinicians received high ratings for general communication skills but may benefit from educational intervention in several key telemedicine skills. Clinicians struggled with using nonverbal signals to enrich communication (47% well done), acknowledging emotions (34% well done), and using video for information gathering (34% well done). Low rates of standard screenings (e.g., 63% administered the PHQ-2, <50% asked about alcohol use) suggested protocols for in-person care were not easily incorporated into telehealth practices, and clinicians may benefit from enhanced care team support. Performance reports were shared with clinicians and leadership postvisit. Results suggest project design and implementation is scalable and feasible for use at other institutions, offering a structured methodology that can improve general student health care. [ABSTRACT FROM AUTHOR]

Nitrous oxide is used as a recreational drug. Contact frostbite injury from compressed gas canisters has previously been described in the literature, but an increased number of such cases has been noted in our busy regional burns center in the UK. A single-center prospective case series of all patients referred and treated for frostbite injury secondary to misuse of nitrous oxide compressed gas canisters between January and December 2022 is presented. Data collection was performed through a referral database and patient case notes. Sixteen patients, of which 7 were male and 9 were female, satisfied the inclusion criteria. Mean patient age was 22.5 years. The median TBSA was 1%. In total, 50% of patients in the cohort had a delayed initial presentation to A&E of greater than 5 days. Eleven patients were reviewed at our burns center for further assessment and management. In total, 11 patients had bilateral inner thigh frostbite injuries, of which 8 had necrotic full-thickness injury, including subcutaneous fat. Seven patients were reviewed at our burns center and offered excision and split-thickness skin graft. Four patients presented with contact frostbite injury to the hand and one patient to the lower lip. This subgroup was managed successfully with conservative management alone. The reproducible pattern of frostbite injury secondary to the abuse of nitrous oxide compressed gas canisters is demonstrated in our case series. The distinct pattern of injury, patient cohort, and anatomical area affected presents an opportunity for targeted public health intervention in this group. [ABSTRACT FROM AUTHOR]

Posterolateral instability is the most frequent form of both acute and chronic elbow instability. Joint incongruity due to posterolateral unlocking leads to shear and compression stress of the internal aspect of the humeroulnar joint. We carried out long-term analysis of patients with posterolateral elbow instability in order to determine whether, in addition to improving their symptoms, reconstruction of the lateral collateral ligament complex may play a protective role against the development of post-traumatic osteoarthritis. We hypothesized that ligament reconstruction according to the technique of O'Driscoll stabilizes the elbow and also limits the development of osteoarthritis in the long term. Patients with symptomatic posterolateral instability of the elbow and who underwent ligament reconstruction according to the technique of O'Driscoll from January 1995 to December 2010 were identified and retrospectively included for 2 follow-up evaluations at a mean of 5 and 14 years. Fourteen elbows in 14 patients were included. All had a negative lateral pivot shift test and none reported a new episode of instability. Two patients (14%) had osteoarthritis. The 2 radiographic evaluations showed no progression of osteoarthritis. Osteoarthritis developed in 33% of patients with intra-articular fracture. In simple dislocations, pre-existing osteoarthritic lesions were stabilized and there were no new cases of osteoarthritis. Elbow ligament reconstruction according to the technique of O'Driscoll gives effective posterolateral stabilization and appears to protect against progression to osteoarthritic degeneration in the long term. In the absence of associated lesions, it prevents the development of osteoarthritis or the worsening of pre-existing osteoarthritis. [ABSTRACT FROM AUTHOR]

Peripheral nerve injury (PNI) is a significant health problem that confers lifelong impact on those injured. Current interventions are purely surgical; however, outcomes remain poor. There is a lack of high-quality epidemiological data that is needed to identify populations involved, current healthcare demands, and ensure resources are distributed to the greatest effect, to reduce the injury burden. Anonymized hospital episode statistical (HES) data on admitted patient care was obtained from NHS Digital for all National Health Service (NHS) patients sustaining PNI of all body regions between 2005 and 2020. Total numbers of finished consultant episodes (FCEs) or FCEs/100,000 population were used to demonstrate changes in demographic variables, anatomical locations of injury, mechanisms of injury, speciality, and main operation. There was a mean national incidence of 11.2 (95% CI 10.9, 11.6) events per 100,000 population per year. Males were at least twice as likely (p < 0.0001) to sustain a PNI. Upper limb nerves at or distal to the wrist were most commonly injured. Knife injuries increased (p < 0.0001), whereas glass injuries decreased (p < 0.0001). Plastic surgeons increasingly managed PNI (p = 0.002) as opposed to orthopaedic surgeons (p = 0.006) or neurosurgeons (p = 0.001). There was an increase in neurosynthesis (p = 0.022) and graft procedures (p < 0.0001) during the study period. PNI is a significant national healthcare problem predominantly affecting distal, upper limb nerves of men of working age. Injury prevention strategies, improved targeted funding and rehabilitation pathways are needed to reduce the injury burden and improve patient care. [ABSTRACT FROM AUTHOR]

Connectomics has been instrumental in advancing our understanding of the intricate neural networks that underpin neurological and psychiatric conditions. Resting state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) are critical imaging modalities that provide insights into the brain's functional and structural connectivity without the need for active patient participation. This presentation is designed to showcase the pivotal role of rs-fMRI and DTI in the burgeoning field of personalized functional imaging. It will highlight how these techniques can redefine the practice of radiological technologists by integrating connectomic insights into personalized patient care. The presentation will discuss the protocols for employing rs-fMRI and DTI in a clinical environment, including data collection, analysis, and interpretation strategies. It will illustrate the connectome's relevance in various neurological conditions and the ways in which these imaging techniques can contribute to the development of individualized treatment plans. Employing rs-fMRI and DTI for connectomic analysis has yielded promising results in pinpointing neurological disease biomarkers, deciphering psychiatric disorder pathways, and crafting tailored therapeutic interventions. These imaging modalities offer a refined perspective on brain disorders, shifting the diagnostic paradigm from a general to a more patient-centered approach. The integration of connectomics with personalized functional imaging marks a significant advancement in the field of medical imaging. Rs-fMRI and DTI not only enhance our visualization of brain networks but also support a transition toward treatments aimed at the underlying mechanisms of disease. Embracing these techniques is crucial for the progression of personalized medicine and the enhancement of patient care outcomes. The keynote will delve into the implications of these technologies for radiological technologists, stressing the necessity for a transition to a connectome-based imaging model. Additionally, it will touch upon the educational and skill development needed for practitioners to adeptly adopt and apply these sophisticated imaging techniques in a personalized healthcare setting. [ABSTRACT FROM AUTHOR]

A rare cause of scapular winging is rhomboid muscle paralysis secondary to dorsal scapular nerve (DSN) neuropathy. This paralysis causes winging of the medial border of the scapula with lateral rotation of its inferior angle. We report a series of 4 clinical cases of isolated DSN compression and the results of a specific rehabilitation protocol. A continuous clinical series of 4 patients with isolated rhomboid muscle deficiency was analyzed. Two patients were men and 2 were women, with a mean age of 40 years (range, 33-51 years). Three patients were right-handed and 1 was left-handed. Scapular winging always affected the dominant side. Two patients had occupations involving heavy physical work. The sports practiced involved exertion of the arms (dancing, boxing, gymnastics, muscle strengthening). A specific rehabilitation protocol was offered to the patients. In addition, 6 fresh cadaver dissections were performed to reveal possible DSN compression. Potential areas of compression were identified, in particular when the arm was raised. The 4 patients presented with isolated DSN neuropathy were confirmed by electroneuromyographic testing. Total correction of scapular winging was not obtained in any patient. Three patients experienced residual pain with a neuropathic pain by the questionnaire for a Diagnosis of Neuropathic Pain (DN4) score of 2. The mean Quick-Disabilities of the Arm, Shoulder and Hand (DASH) score after treatment was 31.8 of 100. The mean ASES score was 56.2. Only 1 patient agreed to rehabilitation in a specialized center and underwent follow-up electroneuromyography. Signs of rhomboid muscle denervation were no longer present and distal motor latencies had become normal. In all cadaver dissections, the DSN originated from the C5 nerve root and did not pass through the middle scalene muscle. We identified a site of dynamic compression of the DSN by the upper part of the medial border of the scapula when the arm was raised. DSN compression is conventionally attributed to the middle scalene muscle, but it is noteworthy that our study reveals the possibility of dynamic compression of the nerve by the proximal part of the medial border of the scapula, which occurs when the arm elevation is above 90°. Our study reveals the possibility of dynamic compression of the DSN by the proximal part of the medial border of the scapula, which occurs when the arm is raised above 90°. In the absence of a surgical solution, conservative treatment is fundamental and requires management in a rehabilitation center with intervention by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Transcranial direct current stimulation (tDCS) has shown potential as an effective aid to facilitate learning. A popular application of this technology has been in combination with working memory training (WMT) in order to enhance transfer effects to other cognitive measures after training. This meta-analytic review aims to synthesize the existing literature on tDCS-enhanced WMT to quantify the extent to which tDCS can improve performance on transfer tasks after training. Furthermore, we were interested to evaluate the moderating effects of assessment time point (immediate post-test vs. follow-up) and transfer distance, i.e., the degree of similarity between transfer and training tasks. Using robust variance estimation, we performed a systematic meta-analysis of all studies to date that compared WMT with tDCS to WMT with sham in healthy adults. All procedures conformed to PRISMA guidelines. Across 265 transfer measures in 18 studies, we found a small positive net effect of tDCS on improving overall performance on transfer measures after WMT. These effects were sustained at follow-up, which ranged from 1 week to one year after training, with a median of 1 month. Additionally, although there were no significant differences as a function of transfer distance, effects were most pronounced for non-trained working memory tasks. This review provides evidence that tDCS can be effective in promoting learning over and above WMT alone, and can durably improve performance on trained and untrained measures for weeks to months after the initial training and stimulation period. In particular, boosting performance on dissimilar working memory tasks may present the most promising target for tDCS-augmented WMT. • Across 19 studies, transcranial direct current stimulation significantly enhances working memory training benefits. • Effects at follow-up were even stronger than at immediate post-test. • The most pronounced transfer occurred in untrained working memory tasks. [ABSTRACT FROM AUTHOR]

Serratus anterior (SA) palsy following mechanical injury to the long thoracic nerve (LTN) is the most common cause of scapular winging. This study aimed to identify the factors influencing the outcome of neurolysis of the distal segment of the LTN. We hypothesized that poor results are due to duration before surgery and to persistent scapulothoracic dysfunction. A retrospective study was conducted. The inclusion criteria were partial or complete isolated noniatrogenic SA paralysis of at least 4-month duration with preoperative electrophysiologic assessment confirming the neurogenic origin without signs of reinnervation. Seventy-three patients were assessed at 45 days, 6 months, and 24 months after neurolysis of the distal segment of the LTN. At the last follow-up, improvement was excellent in 38 (52%), good in 22 cases (30%), moderate in 6 (8%), and poor in 7 (10%). No patient showed deterioration in outcomes since the beginning of follow-up. Scapular winging was no longer present in 46 cases (63%), while it was minimal in 23 (31.5%). In 4 cases (5.5%), winging was similar to the preoperative condition. The best outcomes occurred in patients who presented without compensatory muscle pain and who were treated within 12 months of paralysis. Beyond this time frame, neurolysis can still provide useful functional improvement and avoid palliative surgery. Neurolysis of the distal segment of the LTN is a safe and reliable procedure. This technique allows treatment of SA muscle palsy and corrects scapular winging with excellent or good outcomes in 82% of cases. [ABSTRACT FROM AUTHOR]

Objectives: We examined whether mild heat exposure alters performance, perceptual responses and neural drive to the quadriceps during two sets of repeated sprints matched for initial mechanical output.Design: Repeated measures.Methods: Twelve males performed 10 × 6-s sprints (recovery = 30 s), followed 6 min later by 5 × 6-s sprints (recovery = 30 s) in either COOL (24 °C/30% rH) or HOT (35 °C/40% rH) conditions. Subsequently, two sets of five consecutive sprints matched for initial mechanical output were compared.Results: On the basis of peak power, performance in sprint 2 was not significantly different to sprint 11 in both conditions (p ≥ 0.32). Average peak power across the five sprints compared (i.e., sprints 2-6 and 11-15, respectively) was 2.6 ± 3.4% higher in HOT compared to COOL (p = 0.025). Electromyographic activity (root mean square value) of the vastus lateralis muscle remained unchanged. Core (sprints 2-6: 37.85 ± 0.21 vs. 37.53 ± 0.19 °C, sprints 11-15: 38.26 ± 0.33 vs. 37.89 ± 0.24 °C; p < 0.001) and skin (sprints 2-6: 36.21 ± 0.29 vs. 30.72 ± 0.52 °C, sprints 11-15: 36.37 ± 0.28 vs. 30.99 ± 0.55 °C; p < 0.001) temperatures were overall higher in HOT compared to COOL. Heart rate, thermal sensation and comfort were significantly elevated in HOT compared to COOL (p ≤ 0.02), irrespective of sprint number.Conclusions: When two sets of repeated sprints were matched for initial mechanical output, performance was enhanced with mild heat exposure. This occurred despite higher thermal, cardiovascular, and perceptual strain, and without alterations in quadriceps neural drive. [ABSTRACT FROM AUTHOR]

• We saw no increase in child abuse at 9 pediatric trauma centers during the first 3 months of the COVID-19 pandemic. • It is possible that we have not seen the full impact of the COVID-19 pandemic on child abuse and this topic needs continued surveillance. Economic, social, and psychologic stressors are associated with an increased risk for abusive injuries in children. Prolonged physical proximity between adults and children under conditions of severe external stress, such as witnessed during the COVID-19 pandemic with "shelter-in-place orders", may be associated with additional increased risk for child physical abuse. We hypothesized that child physical abuse rates and associated severity of injury would increase during the early months of the pandemic as compared to the prior benchmark period. We conducted a nine-center retrospective review of suspected child physical abuse admissions across the Western Pediatric Surgery Research Consortium. Cases were identified for the period of April 1-June 30, 2020 (COVID-19) and compared to the identical period in 2019. We collected patient demographics, injury characteristics, and outcome data. There were no significant differences in child physical abuse cases between the time periods in the consortium as a whole or at individual hospitals. There were no differences between the study periods with regard to patient characteristics, injury types or severity, resource utilization, disposition, or mortality. Apparent rates of new injuries related to child physical abuse did not increase early in the COVID-19 pandemic. While this may suggest that pediatric physical abuse was not impacted by pandemic restrictions and stresses, it is possible that under-reporting, under-detection, or delays in presentation of abusive injuries increased during the pandemic. Long-term follow-up of subsequent rates and severity of child abuse is needed to assess for unrecognized injuries that may have occurred. [ABSTRACT FROM AUTHOR]

• Affiliation networks are integrated with molecular data to examine HIV transmission. • Core-peripheral structure in venue affiliation is associated with HIV transmission. • Popular social venues potentiate sexual affiliation network of minority young MSM. • Molecular and affiliation network approach informs effective network interventions. • A surveillance-research-community partnership is important to address ethical issues. This study investigates the two-mode core-periphery structures of venue affiliation networks of younger Black men who have sex with men (YBMSM). The study examined the association between these structures and HIV phylogenetic clusters, defined as members who share highly similar HIV strains that are regarded as a proxy for sexual affiliation networks. Using data from 114 YBMSM who are living with HIV in two large U.S. cities, our findings indicate that HIV phylogenetic clustering patterns were found to be associated with social clustering patterns whose members share affiliation with core venues that overlap with those of YBMSM. Distinct HIV transmission patterns were found in each city, a finding that can help to inform tailored venue-based and network intervention strategies. [ABSTRACT FROM AUTHOR]

Aortic arch pathologies have been a surgical challenge, involving cerebral, visceral and myocardial protection. Innovative techniques including total arch replacement and frozen elephant trunk had evolved over last decades with promising mid-term outcomes. We evaluate our mid-term outcomes on total arch replacement with frozen elephant trunk and the role of timely second staged interventions. Between August 2014 and April 2020, 41 patients with aortic arch pathologies underwent total arch replacement with frozen elephant trunk with Thoraflex-Hybrid-Plexus device (Vascutek, Inchinnan, Scotland). Patients' perioperative, clinical and radiological outcomes were reviewed. Post discharge survival (n = 37) at 3 year was 100%. Overall survival of 85.3% over a median follow up of 3.3 years, inpatient mortality of 9.8%. Distribution of aortic pathologies with acute type A dissection or intramural hematoma (n = 15, 36.6%), thoracic aortic aneurysm, including arch and descending aortic aneurysm (n = 9, 22%) and chronic aortic dissection including chronic type A and type B dissections (n = 13, 31.7%). Mean operative, circulatory arrest, and antegrade cerebral perfusion time were 417 ± 121 minutes, 89 ± 28 minutes, and 154 ± 43 minutes, respectively. Second stage procedures were performed in 32% and distal stent graft induced new entry was observed in 19% of patients. We reported an Asian series of Thoraflex with outstanding midterm clinical outcomes, given descending aortic pathologies were tackled with a timely second stage interventions. The observation of aortic remodeling and distal stent graft induced new entry requires further investigations. [ABSTRACT FROM AUTHOR]

Education is the most essential component for effective asthma control and is endorsed by guidelines worldwide. However, multiple caregivers are often jointly involved in child care, and educating them is often a challenging task. This study determines the effectiveness of a web-based asthma education program in enhancing knowledge, attitude and practice of caregivers and reducing unscheduled hospital visits of children for asthma. A two-arm, randomized controlled trial was carried out between November 2018 and December 2019. Child-parent dyads were recruited when the children (4–11 years of age) were admitted due to asthma exacerbations. A nurse-led web-based home asthma education program was developed and implemented before discharge. Outcomes included parents' knowledge, attitude and practice regarding asthma and frequency of unscheduled visits and readmissions in children. 112 child-parent dyads were enrolled. The parents' knowledge, attitude and practice and the number of unscheduled visits of the children were found to be significantly different between two groups at different time points (Ps < 0.001) with a large effect size (Cohen's d > 0.8). This intervention was shown to be an effective strategy to educate caregivers who are jointly involved in their child's asthma control after discharge from hospital. The Chinese Clinical Trial Registry, World Health Organization (ChiCTR1800019706). • This study provided evidence on what constitutes a good web-based education programme and what helps to maintain such practices on asthma control. • The programme is comprised of multimedia education materials, gamified teaching materials, tailored family-centered discussion sessions. • The proposed intervention (WB-HAEP) is effective in enhancing asthma knowledge, attitude and practice on asthma. • Unscheduled visits and readmissions due to asthma exacerbations can be reduced by the proposed WB-HAEP. • The components of this WB-HAEP may be introduced and adopted to other clinical areas in the future for other chronic diseases. [ABSTRACT FROM AUTHOR]

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Takayasu arteritis (TAK) is a chronic inflammatory vasculitis of unknown origin affecting large vessels, predominantly the aorta and its main branches. TAK usually affects young women and the management of pregnancy during this vasculitis may be a challenging situation. After a review of the literature, we analysed the data of 505 pregnancies in 373 TAK patients. We discuss main results to clarify if the pregnancy outcome is affected by TAK, especially during disease clinical onset or disease activity. We also discuss the potential impact of pregnancy on TAK prognosis. Disease activity of TAK appears independently associated with a poor pregnancy outcome. More than 5% of pregnant women with TAK develop a life-threatening maternal cardiovascular complication. A good control of TAK disease activity and arterial hypertension before conception and during pregnancy is critical to improve both maternal and foetal outcomes. Pregnancies in the setting of TAK should be considered high-risk, requiring a close collaboration between specialists involved in the care of TAK and obstetricians. [ABSTRACT FROM AUTHOR]

Patients with rheumatologic diseases might be more susceptible to COVID-19 and carry a poorer prognosis. The aim of this study is to examine the incidence and outcomes of all COVID-19 patients with rheumatologic conditions in Hong Kong. This is a population-based retrospective study. All patients tested positive for SARS-CoV-2 by PCR with a previous diagnosis of rheumatologic diseases were reviewed. The incidence of COVID-19 in patients with rheumatologic conditions was calculated and compared to the general population in Hong Kong. Descriptive data of those rheumatologic patients with COVID-19 and the clinical course of the index infection were presented. Up till 27 May 2020, there were 1067 cases of COVID-19 diagnosed in Hong Kong which had a population of 7.5 million. Out of the 39,835 patients with underlying rheumatologic diseases, we identified 5 PCR confirmed COVID-19 cases. The estimated incidence of COVID-19 was 0.0126% patients with rheumatologic diseases, compared to 0.0142% in the general population. All 5 patients had inflammatory arthropathies. One patient was on hydroxychloroquine and sulphasalazine, and one was on methotrexate. None of the 3534 patients on b/tsDMARDs was infected. Four patients had leucopenia/lymphopenia and stool viral PCR was positive in 3 patients. All patients made uneventful recovery without complications or flare of underlying diseases. We found no alarming signals of increased frequency or severity of COVID-19 in patients with rheumatologic diseases, although extrapolation of the results to other populations with different infection control strategies should be made with caution. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To measure the effect of visual hindsight bias on radiologists' perception during chest radiograph pulmonary nodule detection.Materials and Methods: This was a prospective multi-observer study to assess the effect of hindsight bias on radiologists' perception. Sixteen radiologists were asked to interpret 15 postero-anterior chest images containing a solitary lung nodule each consisting of 25 incremental levels of blur. Participants were requested initially to detect the nodule by reducing the blur of the images (foresight). They were then asked to increase the blur until the identified nodule was undetectable (hindsight). Participants then repeated the experiment, after being informed of the potential effects of hindsight bias and asked to counteract these effects. Participants were divided into two groups (experienced and less experienced) and the nodules were given different conspicuity ratings to determine the effect of expertise and task difficulty. Eye tracking technology was also utilised to capture visual search.Results: Wilcoxon analysis demonstrated significant differences between foresight and hindsight values of the radiologists (p = 0.02). However, after being informed of hindsight bias, these differences were no longer significant (p = 0.97). Friedman analysis also determined overall significance in the hindsight ratios between nodule conspicuities for both phases (phase 1: p = 0.02; phase 2: p = 0.02). There was no significance difference between the experienced and less experienced groups.Conclusion: This study demonstrated that radiologists exhibit hindsight bias but appeared to be able to compensate for this phenomenon once its effects were considered. Also, visual hindsight bias appears to be affected by task difficulty with a greater effect occurring with less conspicuous nodules. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of exercises for improving forearm bone mass. MEDLINE, EMBASE, CINAHL, AMED, Web of Science, and Cochrane CENTRAL were searched from their inception until December 2018. Eligibility included adults undertaking upper limb exercise interventions (≥12wk) to improve bone mass. Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using Cochrane risk of bias tool. Exercise interventions were classified into "resistance training" of high or low intensity (HIRT/LIRT, respectively) or "impact." Random-effects meta-analysis of the percentage change in forearm bone mass from baseline was conducted. Twenty-six studies were included in the review, of which 21 provided suitable data for meta-analysis. Methodological quality ranged from "low" to "unclear" risk of bias. Exercise generally led to increases (moderate-quality evidence) in forearm bone mass (standard mean difference [SMD], 1.27; 95% CI, 0.66-1.88; overall effect Z value=4.10; P <.001). HIRT (SMD, 1.00; 95% CI, 0.37-1.62; Z value=3.11; P =.002), and LIRT (SMD, 2.36; 95% CI, 0.37-4.36; Z value=2.33; P <.001) led to moderate increases in forearm bone mass. Improvements resulting from impact exercises (SMD, 1.12; 95% CI, −1.27 to 3.50; Z value=0.92; P =.36) were not statistically significant (low-quality evidence). There is moderate-quality evidence that exercise is effective for improving forearm bone mass. There is moderate-quality evidence that upper body resistance exercise (HIRT/LIRT) promotes forearm bone mass but low-quality evidence for impact exercise. Current evidence is equivocal regarding which exercise is most effective for improving forearm bone mass. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of vocal hygiene education with resonant voice therapy for school-aged children with vocal nodules. A pre-test/post-test control group design was employed. Seventeen children aged between 6 and 9 years old with vocal nodules were randomly assigned to three groups: a treatment group, a placebo group and a control group. Children in the treatment group (n = 7) received six consecutive, weekly, one-hour sessions of vocal hygiene education with resonant voice therapy. Children in the placebo group (n = 5) received six consecutive, weekly, one-hour sessions on presentation skills training. Children in the control group (n = 5) did not receive any form of treatment. Subjective outcome measures included auditory-perceptual evaluation of overall dysphonia severity, the Pediatric Voice Handicap Index (pVHI) and the Children's Voice Handicap Index-10 (CVHI-10). Objective outcome measures included acoustic analysis of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio. Significant improvements in perceptual ratings of overall dysphonia severity levels and pVHI scores were found in the treatment group. No significant changes in acoustic measures and CVHI-10 scores were noted in any of the three groups. Interestingly, an improvement in perceptual overall dysphonia severity levels at post-evaluation was observed in the no treatment control group. [ABSTRACT FROM AUTHOR]

The effect of computer-aided polyp detection (CADe) on adenoma detection rate (ADR) among endoscopists-in-training remains unknown. We performed a single-blind, parallel-group, randomized controlled trial in Hong Kong between April 2021 and July 2022 (NCT04838951). Eligible subjects undergoing screening/surveillance/diagnostic colonoscopies were randomized 1:1 to receive colonoscopies with CADe (ENDO-AID[OIP-1]) or not (control) during withdrawal. Procedures were performed by endoscopists-in-training with <500 procedures and <3 years' experience. Randomization was stratified by patient age, sex, and endoscopist experience (beginner vs intermediate level, <200 vs 200–500 procedures). Image enhancement and distal attachment devices were disallowed. Subjects with incomplete colonoscopies or inadequate bowel preparation were excluded. Treatment allocation was blinded to outcome assessors. The primary outcome was ADR. Secondary outcomes were ADR for different adenoma sizes and locations, mean number of adenomas, and non-neoplastic resection rate. A total of 386 and 380 subjects were randomized to CADe and control groups, respectively. The overall ADR was significantly higher in the CADe group than in the control group (57.5% vs 44.5%; adjusted relative risk, 1.41; 95% CI, 1.17–1.72; P <.001). The ADRs for <5 mm (40.4% vs 25.0%) and 5- to 10-mm adenomas (36.8% vs 29.2%) were higher in the CADe group. The ADRs were higher in the CADe group in both the right colon (42.0% vs 30.8%) and left colon (34.5% vs 27.6%), but there was no significant difference in advanced ADR. The ADRs were higher in the CADe group among beginner (60.0% vs 41.9%) and intermediate-level (56.5% vs 45.5%) endoscopists. Mean number of adenomas (1.48 vs 0.86) and non-neoplastic resection rate (52.1% vs 35.0%) were higher in the CADe group. Among endoscopists-in-training, the use of CADe during colonoscopies was associated with increased overall ADR. (ClinicalTrials.gov , Number: NCT04838951). [Display omitted] [ABSTRACT FROM AUTHOR]

• Induction of immunological cell death and activation of innate and adaptive immune responses are important therapeutic PDT mechanisms. • In addition to their primary tumor-killing effects, vitamin D and PDT when combined induce stronger activation of anti-tumor immunity. • Vitamin d and PDT together exert an additive effect upon anti-tumor immune responses, as compared to either treatment modality alone. Improved treatment outcomes for non-melanoma skin cancers can be achieved if Vitamin D (Vit D) is used as a neoadjuvant prior to photodynamic therapy (PDT). However, the mechanisms for this effect are unclear. Vit D elevates protoporphyrin (PpIX) levels within tumor cells, but also exerts immune-modulatory effects. Here, two murine models, UVB-induced actinic keratoses (AK) and human squamous cell carcinoma (A431) xenografts, were used to analyze the time course of local and systemic immune responses after PDT ± Vit D. Fluorescence immunohistochemistry of tissues and flow analysis (FACS) of blood were employed. In tissue, damage-associated molecular patterns (DAMPs) were increased, and infiltration of neutrophils (Ly6G+), macrophages (F4/80+), and dendritic cells (CD11c+) were observed. In most cases, Vit D alone or PDT alone increased cell recruitment, but Vit D + PDT showed even greater recruitment effects. Similarly for T cells, increased infiltration of total (CD3+), cytotoxic (CD8+) and regulatory (FoxP3+) T-cells was observed after Vit D or PDT, but the increase was even greater with the combination. FACS analysis revealed a variety of interesting changes in circulating immune cell levels. In particular, neutrophils decreased in the blood after Vit D, consistent with migration of neutrophils into AK lesions. Levels of cells expressing the PD-1+ checkpoint receptor were reduced in AKs following Vit D, potentially counteracting PD-1+ elevations seen after PDT alone. In summary, Vit D and ALA-PDT, two treatments with individual immunogenic effects, may be advantageous in combination to improve treatment efficacy and management of AK in the dermatology clinic. [ABSTRACT FROM AUTHOR]

Chest wall deformities in children encompass a broad spectrum of disorders but pectus excavatum and carinatum are by far the most common. Treatment varies substantially by center, and depends on patient symptoms, severity of disease, and surgeon preference. Historically, surgical approaches were the mainstay of treatment for these disease processes but new advances in non-surgical approaches have demonstrated reasonable results in select patients. These non-surgical approaches include vacuum bell therapy, autologous fat grafting and hyaluronic acid injections for pectus excavatum, and orthotic brace therapy for pectus carinatum. There is debate with regards to optimal patient selection for these non-surgical approaches, as well as other barriers including reimbursement issues. This paper will review the current non-surgical approaches to chest wall deformities available, including optimal patient selection, treatment protocols, indications, contraindications, and outcomes. [ABSTRACT FROM AUTHOR]

Renewal of healthcare registration or license to practise is becomingly increasingly common, worldwide. Evidence regarding the experience of nursing and midwifery revalidation in the United Kingdom is limited. Preparation of students for the process has not yet been considered in the literature. To explore registrants' experiences of undertaking or supporting colleagues through revalidation. To consider preparation of pre-registration students for this future professional requirement. A descriptive exploratory study comprising an on-line survey. A university in the southwest of England and associated clinical placements. Nursing and Midwifery Council registrants, comprising 40 university staff and 40 clinicians; 36 pre-registration nursing and midwifery students. Participation in an anonymous on-line survey was invited via university databases. Descriptive statistical analysis of quantitative data used a combination of software and manual methods. Qualitative data were manually coded and categorised into themes through inductive reasoning. Most experiences of revalidation were positive. Reflective discussions resulted in mutual learning, particularly if partners were chosen by the registrant. External scrutiny was welcomed. Some registrants questioned involvement of line managers and alignment with performance review, seeking to avoid a 'tick-box exercise' and conflicts of interest. University staff felt better prepared and more positive than clinicians. Pre-registration curriculum activities preparing students included writing reflections, maintaining portfolios, practice assessment and discussions about the revalidation process. Midwifery students seemed better prepared than nursing peers. Key themes of ' Professional values ', ' Preparation ', ' Process ' and ' Purpose ' and a range of positive influences and potential hazards informed development of a conceptual model. The purpose and process of revalidation is enhanced if confirmation is undertaken by a registered nurse or midwife of the individual's choice. Preparation of students for future revalidation is facilitated by role-modelling of positive attitudes and explicitly linking relevant pre-registration curriculum activities to this process and purpose. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to determine the optimal formula to estimate QT interval adjusting for QRS prolongation during right ventricular (RV) pacing.Methods: This observational study included individuals (n = 43) with a newly implanted permanent ventricular pacemaker, who had a narrow QRS complex before pacemaker insertion. QT interval with RV pacing was related to QT interval before pacemaker implantation. The validation cohort (n = 442) had permanent RV pacing in DDD mode.Results: A new QTc formula was derived utilizing the constants from the relationship between the spline heart rate QT correction (QTcRBK) before and after pacing; specifically, QTcRBKPACED = QTcRBK × 0.86. The JT interval from paced complexes was highly heart rate (HR) dependent and was not accurate for QT assessment. Previous, QTc formula for paced complexes were not highly correlated with QT before pacing unless a robust HR correction is added. Formulae subtracting a fixed amount from QTcPACED markedly overestimated QTc before pacing.Conclusion: We proposed a new, simple formula for QT estimation in RV pacing. JT interval in paced complexes is highly HR dependent and is not accurate for QT assessment. The new spline approach for HR correction for the QT, once incorporated into some previously proposed formulae, blunts HR dependency and improves prediction of QT before pacing. QTcRBKPACED*0.86 and QTcRBKPACED - (QRS*0.5) demonstrated the best balance of relatively strong correlation to QTc before pacing and accurate QTc prolongation identification. Abnormal QT for QTcRBKPACED*0.86 as defined by the 97.5th and 99th percentile are 469 and 479 ms respectively. [ABSTRACT FROM AUTHOR]

We evaluated the use and value of breast surgical excision biopsies for diagnostic purposes over the last decades in women undergoing mammographic screening, either as a primary procedure or following an inconclusive percutaneous biopsy. All women with an excision biopsy among 817,656 screens, obtained from January 1997 to January 2017, were included. Of 18,593 recalled women (recall rate, 2.3%) with screen-detected abnormalities, 908 (4.9%) underwent excision biopsy. Of these, 411 (45.3%) were performed as first diagnostic intervention, decreasing from 4.3 per 1000 screens in 1997–1998 to 0 per 1000 screens in 2015–2016. The remaining 497 (54.7%) excision biopsies were performed secondary to pathologic findings at percutaneous biopsy. During 1997–1998, 1.0 secondary biopsies per 1000 screens were performed, decreasing to 0.3 per 1000 in 2005–2006 and afterwards increased to 0.6 per 1000 in 2015–2016 (p = 0.003). Of all 487 secondary biopsies, 303 (61.0%) had a benign pathology outcome, increasing from 40.4% in 1997–1998 to 70.2% in 2015–2016. Of all 211 biopsies in the three most recent cohorts (2011–2016) the overall upgrade rate was 26.5%, consisting of 39 (18.5%) DCIS (27 low grade) and 17 (8.1%) invasive carcinomas. Although the use of excision biopsy significantly decreased over the past two decades, we observed a significant increased rate in more recent years. Since the vast majority of currently performed excision biopsies reveals a benign diagnosis or shows low grade DCIS, a secondary excision biopsy should only be considered if radiologic surveillance and repeated percutaneous biopsy continues to yield indeterminate results. • Primary excision biopsy were replaced by percutaneous biopsy in almost all patients. • An ongoing significant increase in secondary excision biopsies was observed. • The vast majority of all excision biopsies performed nowadays is benign. • The use of secondary excision biopsies should be considered carefully. [ABSTRACT FROM AUTHOR]

Abstract Ethnic food is largely chosen to be consumed by tourists in order to better appreciate the local culture. An ethnic food experience has increasingly become a popular food activity for many tourists. Although the Dayaks are the largest indigenous group in Malaysia, little has been done to explicate Dayak food consumption intention from the tourists' perspective. The present study uses the theory of planned behaviour to investigate tourists' intention to consume Dayak food when they visit Sarawak, Malaysia. Specifically, tourists from Peninsular Malaysia, Sabah, Singapore and Indonesia, are sampled to examine and compare consumption intention. A questionnaire-based survey was administered, and PLS-SEM was used to perform the path and multi-group analyses. While these tourists appear to share a lot in common in their consumption intention, they are different in terms of how they intend to consume Dayak food in Sarawak. The implications of the study are provided. Highlights • The study compares the consumption intention towards ethnic food using local and regional tourists (four regions). • The study investigates tourists' intention to consume Dayak food when they are on the tour in Sarawak. • The study uses rigorous statistical techniques - MICOM and Omnibus Test of Group - to provide more accurate estimates. • This cross-border study delves into food and destination tourism to provide a holistic view of the subject matter. [ABSTRACT FROM AUTHOR]

Abstract Nitrogen (N) deposition poses a severe risk to global terrestrial ecosystems, and managing this threat is an important focus for air pollution science and policy. To understand and manage the impacts of N deposition, we need metrics which accurately reflect N deposition pressure on the environment, and are responsive to changes in both N deposition and its impacts over time. In the UK, the metric typically used is a measure of total N deposition over 1–3 years, despite evidence that N accumulates in many ecosystems and impacts from low-level exposure can take considerable time to develop. Improvements in N deposition modelling now allow the development of metrics which incorporate the long-term history of pollution, as well as current exposure. Here we test the potential of alternative N deposition metrics to explain vegetation compositional variability in British semi-natural habitats. We assembled 36 individual datasets representing 48,332 occurrence records in 5479 quadrats from 1683 sites, and used redundancy analyses to test the explanatory power of 33 alternative N metrics based on national pollutant deposition models. We find convincing evidence for N deposition impacts across datasets and habitats, even when accounting for other large-scale drivers of vegetation change. Metrics that incorporate long-term N deposition trajectories consistently explain greater compositional variance than 1–3 year N deposition. There is considerable variability in results across habitats and between similar metrics, but overall we propose that a thirty-year moving window of cumulative deposition is optimal to represent impacts on plant communities for application in science, policy and management. Graphical abstract Image 1 Highlights • We present a large study of N deposition impacts on British vegetation. • N deposition consistently explains spatial variability in vegetation composition. • Metrics based on long-term pollution histories are superior to current deposition. • We propose thirty-year cumulative deposition as an optimum metric. Measures of nitrogen deposition which incorporate long-term pollution history explain more spatial variance in plant communities than those which do not. [ABSTRACT FROM AUTHOR]

Abstract Stratigraphic, sedimentologic, and micropaleontologic studies have been undertaken on the "Infra-Cenomanian" continental red beds (= Dekkar Group) located on the northern side of the Moroccan eastern High Atlas. Rich charophyte assemblages containing Sphaerochara magna, Ascidiella stellata, Hemiclavator sp. A, Globator trochiliscoides, Atopochara trivolvis , At. triquetra, and Flabellochara harrisii indicate a late Barremian age for the lower part of the series. Within the continental deposits we have discovered in the Middle Member of the Dekkar 2 Formation limestones and marls containing echinoderms, dasycladacean algae and foraminifera (miliolids, Ammobaculites sp., Choffatella decipiens). The existence of two littoral to lagoonal-marine intercalations within the continental sedimentation reveals marine transgressive events during the late Barremian–?early Aptian. The lateral extension of these marine sediments allows the erection of paleogeographic boundaries that define a « Marginal Folds Gulf » characterized mainly by restricted marine paleoenvironments. This E-W directed gulf is a relatively long depression, a few tens of kilometers wide and one hundred kilometers long, developed in an area which is now at the foot of the eastern High Atlas. The infilling deposits is dominantly controlled by the distance from the North High Atlas Fault. The gulf terminated westward and probably opened northeastward into the Tethyan domain. This narrow gulf was separated from both the Tethyan Gulf known in the Central Middle Atlas during the Aptian and the coeval Atlantic Gulf located on the northern side of the Marrakech and Central High Atlas. Thus, the « Marginal Folds Gulf » is a new paleogeographic feature that documents marine incursions within the Jurassic–Early Cretaceous continental areas of the NW Africa. [ABSTRACT FROM AUTHOR]

Abstract Though, Unified Modeling Language (UML), Ontology, and Text categorization approaches have been used to automate the classification and selection of design pattern(s). However, there are certain issues such as time and effort for formal specification of new patterns, system context-awareness, and lack of knowledge which needs to be addressed. We propose a framework (i.e. Three-phase method) to discuss these issues, which can aid novice developers to organize and select the correct design pattern(s) for a given design problem in a systematic way. Subsequently, we propose an evaluation model to gauge the efficacy of the proposed framework via certain unsupervised learning techniques. We performed three case studies to describe the working procedure of the proposed framework in the context of three widely used design pattern catalogs and 103 design problems. We find the significant results of Fuzzy c-means and Partition Around Medoids (PAM) as compared to other unsupervised learning techniques. The promising results encourage the applicability of the proposed framework in terms of design patterns organization and selection with respect to a given design problem. Highlights • Propose a framework to overcome the limitation of existing automation techniques. • Unsupervised learning techniques are used to exploit the proposed framework. • The aim of proposed framework is the classification and selection of the software design pattern(s). • Propose an evaluation model to assess the effectiveness of the proposed framework. • Present three case studies in different domains such as object-oriented development, real time and security based application. [ABSTRACT FROM AUTHOR]

Effort-Aware Defect Prediction (EADP) technique sorts software modules by the defect density and aims to find more bugs when testing a certain number of Lines of Code (LOC). The existing EADP methods ignore the number of required inspected modules and thus resulting in more testing cost. Therefore, we propose a multi-objective effort-aware defect prediction approach based on NSGA-II named MOOAC for EADP, which aims to maximize the Proportion of the found Bugs (PofB@20%) and minimize the Proportion of Module Inspected (PMI@20%) when inspecting the top 20% LOC. MOOAC firstly trains a random forest classification model. Then, it builds a logistic regression model, and utilizes the NSGA-II algorithm to generate the coefficient vector of the model by maximizing the PofB@20% value and minimizing the PMI@20% value simultaneously. In the model prediction phase, MOOAC firstly employs the built random forest classifier to decide whether modules are defective. Next, the predicted defective modules are first inspected based on the ratio between the predicted defect probability by the logistic regression model and LOC, which can make testers to find more bugs and test as fewer LOC as possible. The clean modules are then inspected to reduce the Initial False Alarms (IFA), if there is still the testing budget left. The results show that MOOAC exhibits the best overall performance on the PofB@20% and PMI@20%. In other words, MOOAC enables testers to identify more bugs per 1% module. • Propose a multi-objective effort-aware defect prediction approach based on NSGA-II. • The main objective of effort-aware defect prediction is finding more bugs and inspecting as fewer modules as possible, when testing a specific number of lines of code. • Conduct comprehensive experiments to evaluate MOOAC against five existing effort-aware defect prediction methods on 41 real datasets using seven evaluation metrics. [ABSTRACT FROM AUTHOR]

Objectives Pharmacodynamics suggests that levosimendan might be a valuable inotrope for weaning from extracorporeal life support (ECLS). As there is a paucity of evidence regarding the effectiveness and safety of such an approach, the aim was to report the authors' experiences in ECLS weaning before and after the implementation of levosimendan in clinical practice. Design Retrospective before-and-after study. Setting Cardiac intensive care unit of a university hospital. Participants A total of 64 patients under ECLS for postcardiotomy cardiac failure, who underwent an ECLS weaning trial. Intervention Group comparisons between patients treated with levosimendan and patients treated with milrinone were made with the Mann-Whitney U test or the Pearson chi-squared test. Results are given as median (interquartile range) or numbers (percentages). Measurements and Main Results Of 64 patients, 26 (41%) received levosimendan. Successful ECLS weaning was achieved in 24 (92%) and 30 patients (79%) in the levosimendan and milrinone group, respectively (p = 0.18). In the levosimendan group, fewer patients had an intra-aortic balloon pump for weaning (2 [7.7%] v 15 [40%], p = 0.008). The support with norepinephrine was similar in the levosimendan and milrinone groups at the time of ECLS removal (0.06 [0.01-0.11] v 0.07 [0.01-0.16] µg/kg/min, p = 0.64) and 24 hours later (0.06 [0.04-0.09] v 0.04 [0.00-0.09] µg/kg/min, p = 0.15). Twenty-eight days (9/26 (35%) v 14/35 (40%), p = 0.28) and 180 days (13/26 [50%] v 15/34 [44%], p = 0.80) mortalities after ECLS removal were similar in the levosimendan and the milrinone groups. Conclusion Levosimendan enabled ECLS weaning without increasing norepinephrine requirements when compared to a control group receiving milrinone. [ABSTRACT FROM AUTHOR]

Desmoid-type fibromatosis, also called desmoid tumor, is a locally aggressive myofibroblastic neoplasm that usually arises in deep soft tissue with significant potential for local recurrence. It displays an unpredictable clinical course. β-Catenin, the genetic key player of desmoid tumors shows nuclear accumulation due to mutations that prevent its degradation leading to activation of Wnt signaling and myofibroblastic cell proliferation. The corresponding hot spot mutations are located in exon 3 of the CTNNB1 gene or alternatively, in the APC tumor suppressor gene, most often as a germline mutation. Multifocal desmoid tumors are very rare and clinical characteristics are poorly understood. Here we present six sporadic and one familial case of multifocal desmoid tumors. Four female and three male patients, aged between 7 and 30 years (mean 18.4 years) were identified in a cohort of 1392 cases. Tumors were located in (distal) extremities, thorax, breast, abdominal wall, shoulder, and neck. Four cases showed a CTNNB1 mutation and one an APC germline mutation. In two sporadic cases no CTNNB1 mutation was identified. Four patients showed (multiple) recurrences and one patient was lost to follow-up. In conclusion, multifocal desmoid tumors are a very rare disease and may occur in sporadic cases that are characterized by recurrent CTNNB1 mutations. However, the underlying pathogenesis of multifocal desmoid tumors remains poorly understood with often aggressive clinical behavior and challenging therapeutical management. [ABSTRACT FROM AUTHOR]

Sediment runoff has been cited as a major contributor to the declining health of the Great Barrier Reef (GBR), however, climate and land use drivers have not been jointly evaluated. This study used alluvial archives from fluvial benches in two tributaries of the Upper Burdekin catchment together with the best available land use history and climate proxy records to provide insights into the timing of depositional events in this region over the past 500 years. This study suggests that mining and the increased runoff variability in the latter half of the nineteenth century are the likely sources of the original excess sediment that was used to build the bench features in these catchments. Grazing also contributed to increased bench sedimentation prior to 1900, however, the contribution of grazing was likely more significant in the second half of the 20th century, and continues to be a dominant land use contributor today. [ABSTRACT FROM AUTHOR]

Drawing on the concept of institutional logics, this study advances the coopetition research on tourism destinations. An inductive multi-case study approach is adopted to explore the evolution of coopetitive practices of four tour operators in Macau over the last decade. The findings indicate that actors in a tourism destination respond to the changes of institutional factors by adopting an institutional logic of coopetition, which include five key processes: exploiting, exploring, bridging, sharing and boundary spanning. This paper contributes to the nascent literature on coopetition in tourism destination studies by analyzing the dynamics of co-evolution between the multi-stakeholders’ changing logics of practice and the surrounding institutional environment. The implications of institutional logics and coopetition from a managerial perspective are also discussed. [ABSTRACT FROM AUTHOR]

Myositis ossificans is defined as a self-limiting pseudotumor composed of reactive hypercellular fibrous tissue and bone. USP6 rearrangements have been identified as a consistent genetic driving event in aneurysmal bone cyst and nodular fasciitis. It is therefore an integral part of the diagnostic workup when dealing with (myo)fibroblastic lesions of soft tissue and bone. Two cases of myositis ossificans with USP6 rearrangement were published so far. We determine herein the incidence of USP6 rearrangement in myositis ossificans using USP6 fluorescence in situ hybridization analysis (FISH). Of the 11 cases included, seven patients were female and four were male. Age ranged from 6 to 56 years (mean 27 years). Lesions were located in the thigh (n = 5), knee (n = 1), lower leg (n = 1), lower arm (n = 1), perineum (n = 1), gluteal (n = 1) and thoracic wall (n = 1). All assessable cases except one (8/9) showed rearrangement of USP6 providing evidence that myositis ossificans is genetically related to nodular fasciitis and aneurysmal bone cyst. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to describe young men's sexual and reproductive health care (SRHC) receipt by sexual behavior and factors associated with greater SRHC receipt. Methods There were 427 male patients aged 15–24 who were recruited from 3 primary care and 2 sexually transmitted disease (STD) clinics in 1 urban city. Immediately after the visit, the survey assessed receipt of 18 recommended SRHC services across four domains: screening history (sexual health, STD/HIV test, family planning); laboratories (STDs/HIV); condom products (condoms/lubrication); and counseling (STD/HIV risk reduction, family planning, condoms); in addition, demographic, sexual behavior, and visit characteristics were examined. Multivariable Poisson regressions examined factors associated with each SRHC subdomain adjusting for participant clustering within clinics. Results Of the participants, 90% were non-Hispanic black, 61% were aged 20–24, 90% were sexually active, 71% had female partners (FPs), and 20% had male or male and female partners (M/MFPs). Among sexually active males, 1 in 10 received all services. Half or more were asked about sexual health and STD/HIV tests, tested for STDs/HIV, and were counseled on STD/HIV risk reduction and correct condom use. Fewer were asked about family planning (23%), were provided condom products (32%), and were counseled about family planning (35%). Overall and for each subdomain, never sexually active males reported fewer services than sexually active males. Factors consistently associated with greater SRHC receipt across subdomains included having M/MFPs versus FPs, routine versus non–STD-acute visit, time alone with provider without parent, and seen at STD versus primary care clinic. Males having FPs versus M/MFPs reported greater family planning counseling. Conclusions Findings have implications for improving young men's SRHC delivery beyond the narrow scope of STD/HIV care. [ABSTRACT FROM AUTHOR]

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Bug localization is a software development and maintenance activity that aims to find relevant source code entities to be modified so that a specific bug can be fixed on the basis of the given bug report. Information retrieval (IR) techniques have been widely used to locate bugs in recent decades. These techniques mainly use the IR similarity between the bug report and source code entities. In addition to IR similarity, features that are extracted from version history, source code structure, dynamic analysis, and other resources are found to be beneficial for bug localization. The approaches utilizing extra features in IR-based bug localization are called hybrid bug localization. We conduct a short survey of the hybrid bug localization methods that use additional features in addition to IR similarity. We also use Learning to Rank (LtR) techniques to combine the beneficial features to improve bug localization. Learning to Rank is the application of machine learning in the ranking models for information retrieval. We compared eight LtR techniques in bug localization, and the experimental results show that coordinate ascent algorithms without normalization is a suitable LtR technique in bug localization for selected attributes, and it outperforms two state-of-the-art localization approaches for two large projects, Eclipse and SWT. [ABSTRACT FROM AUTHOR]

Following the establishment in 2006 of a representational standard for the computational handling of structures of argumentation, the Argument Interchange Format, it became possible to develop a vision for the coherent integration of multifarious services, components and tools that create, consume, navigate, analyse, evaluate and manipulate arguments and debates. This vision was the Argument Web with theoretical foundations laid by Rahwan et al. (2007), and practical engineering work described by Bex et al. (2013). Over the intervening period, the key challenge has been to demonstrate the practical and societal value of the Argument Web by taking its tools and applications to larger audiences. This paper lays out three approaches by which the Argument Web has been scaled up in this way, each in partnership with the BBC, and each with different kinds of evaluation and impact. Transitioning these technologies to large user groups paves the way for broader-scale uptake of the Argument Web and heralds the translation from lab to real-world application for a substantial research community working in argument technology. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) remains a major worldwide health problem and has caused millions of deaths in the past few years. Current diagnostic methods, such as sputum smear microscopy and sputum culture, are time-consuming and cannot prevent the rapid spreading of TB during the diagnostic period. In this connection, detecting biomarkers specific to TB at molecular level in plasma of patients will provide a rapid means for diagnosis. In this study, we first evaluated the differential expression of the long non-coding RNAs (lncRNAs) in the plasma from patients with TB (TB positive), community acquired pneumonia (CAP) and healthy individuals (CG) using lncRNA microarray scanning. It was found that there were 2116 specific lncRNAs differentially expressed in the TB positive samples (1102 up-regulated and 1014 down-regulated), which accounted for 6.96% of total lncRNAs. Twelve differentially expressed lncRNAs discovered in microarray were subsequently validated by using real-time quantitative PCR (RT-qPCR). Two lncRNAs (ENST00000354432 and ENST00000427151) were further validated with more Tuberculosis samples. These results suggested the expression level of lncRNAs and the two validated lncRNAs in plasma could be the potential molecular biomarkers for the rapid diagnosis of Tuberculosis. [ABSTRACT FROM AUTHOR]

Context Numerous software design patterns have been introduced and cataloged either as a canonical or a variant solution to solve a design problem. The existing automatic techniques for design pattern(s) selection aid novice software developers to select the more appropriate design pattern(s) from the list of applicable patterns to solve a design problem in the designing phase of software development life cycle. Goal However, the existing automatic techniques are limited to the semi-formal specification, multi-class problem, an adequate sample size to make precise learning and individual classifier training in order to determine a candidate design pattern class and suggest more appropriate pattern(s). Method To address these issues, we exploit a text categorization based approach via Fuzzy c-means (unsupervised learning technique) that targets to present a systematic way to group the similar design patterns and suggest the appropriate design pattern(s) to developers related to the specification of a given design problem. We also propose an evaluation model to assess the effectiveness of the proposed approach in the context of several real design problems and design pattern collections. Subsequently, we also propose a new feature selection method Ensemble-IG to overcome the multi-class problem and improve the classification performance of the proposed approach. Results The promising experimental results suggest the applicability of the proposed approach in the domain of classification and selection of appropriate design patterns. Subsequently, we also observed the significant improvement in learning precision of the proposed approach through Ensemble-IG. Conclusion The proposed approach has four advantages as compared to previous work. First, the semi-formal specification of design patterns is not required as a prerequisite; second, the ground reality of class label assignment is not mandatory; third, lack of classifier’s training for each design pattern class and fourth, an adequate sample size is not required to make precise learning. [ABSTRACT FROM AUTHOR]

Objective: To address the challenges for trialing with elderly and the lacking of valid sham/placebo control, a randomized crossover pilot study is designed and its feasibility on elderly subjects is evaluated.Design: A pilot randomized crossover study was conducted with hydrocollator-based hot pack therapy as active control. Pain intensity, physical disability, depression, general health status, and salivary biomarkers were assessed as outcome measures.Results: Despite there was no significant difference observed between any outcome measures attained by the two interventions, several important differences were noted during the one-week follow-up period. The magnitudes of pain reduction (21-25% versus 16-18%) and disability improvement (45-52% versus 39-42%) were greater in the Gua sha-treated group than the hot pack group. Both treatments were shown to improve flexion, extension and bending movements of the lower back, whereas areas of improvement varied between the two interventions. Decreasing trends were observed in both tumor necrosis factor-alpha (TNF-α) and heme-oxygenase-1 (HO-1) levels following Gua sha. However, rebounds of the biomarkers were observed one week following hot pack. Furthermore, in response to Gua sha, the decrease of TNF-α was strongly correlated with the improvement of physical disability, whereas the physical disability was correlated with the VAS pain intensity.Conclusion: It demonstrated a feasible clinical trial protocol for evaluating the effectiveness of Gua sha and other therapeutic modalities. Gua sha may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain. [ABSTRACT FROM AUTHOR]

Purpose To explore perceptions of facilitators/barriers to sexual and reproductive health (SRH) care use among an urban sample of African-American and Hispanic young men aged 15–24 years, including sexual minorities. Methods Focus groups were conducted between April 2013 and May 2014 in one mid-Atlantic U.S. city. Young men aged 15–24 years were recruited from eight community settings to participate in 12 groups. Moderator guide explored facilitators/barriers to SRH care use. A brief pregroup self-administered survey assessed participants' sociodemographics and SRH information sources. Content analysis was conducted, and three investigators independently verified the themes that emerged. Results Participants included 70 males: 70% were aged 15–19 years, 66% African-American, 34% Hispanic, 83% heterosexual, and 16% gay/bisexual. Results indicated young men's perceptions of facilitators/barriers to their SRH care use come from multiple levels of their socioecology, including cultural, structural, social, and personal contexts, and dynamic inter-relationships existed across contexts. A health care culture focused on women's health and traditional masculinity scripts provided an overall background. Structural level concerns included cost, long visits, and confidentiality; social level concerns included stigma of being seen by community members and needs regarding health care provider interactions; and personal level concerns included self-risk assessments on decisions to seek care and fears/anxieties about sexually transmitted infection/HIV testing. Young men also discussed SRH care help-seeking sometimes involved family and/or other social network members and needs related to patient-provider interactions about SRH care. Conclusions Study findings provide a foundation for better understanding young men's SRH care use and considering ways to engage them in care. [ABSTRACT FROM AUTHOR]