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Les lésions traumatiques du front sont fréquentes et souvent associées à des traumatismes crâniens. Dans tous les cas, l'enjeu neurologique est au premier plan, mais ces lésions présentent également des enjeux fonctionnels (pour la ventilation sinusienne et la fonction motrice frontale) et des enjeux esthétiques. Les fractures de la voûte crânienne frontale nécessitent des traitements différents en fonction de la présence d'une rhinoliquorrhée associée, d'une atteinte sinusienne ou de leur extension à la base du crâne ou au massif facial. Elles nécessitent parfois, de ce fait, une collaboration pluridisciplinaire. Elles peuvent, dans certains cas, être responsables de complications à long terme qui justifie un suivi prolongé dans le temps. De par les séquelles dont peuvent être responsables l'ensemble des traumatismes de la région frontale, la minutie de la prise en charge initiale est capitale. Forehead traumatic injuries are frequently associated with head trauma. The primary concern in such cases is the neurological aspect, but these injuries also have significant functional (such as sinus ventilation and frontal movement) and aesthetic implications. Fractures of the frontal cranial vault differ based on the presence of associated rhinoliquorrhea, sinus involvement, or extension to the skull base or facial mass. Some cases could even require a multidisciplinary approach. Some fractures may lead to long-term complications, necessitating prolonged follow-up. Given the potential sequelae of all forehead injuries, meticulous initial management is crucial. [ABSTRACT FROM AUTHOR]

• The relationship between race and ethnicity and vaccine confidence is mediated by health literacy. • The relationship between education and vaccine confidence is mediated by health literacy. • Increasing health literacy may improve vaccine confidence, which in turn may improve vaccination rates. A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas. Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI). Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (−0.76, 95 % CI −1.00 to −0.50; −0.52, 95 % CI −0.80 to −0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, −0.73 for 12th grade or less, 95 % CI −0.93 to −0.47; −0.73 for some college/associate's/technical degree, 95 % CI −1.05 to −0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects −0.19 and −0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; −0.15 for some college/associate's/technical degree). Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity. Clinical Trials Number: NCT03584490. [ABSTRACT FROM AUTHOR]

The histone variant H2A.Z has been extensively studied to understand its manifold DNA-based functions. In the past years, researchers identified its specific binding partners, the 'H2A.Z interactome', that convey H2A.Z-dependent chromatin changes. Here, we summarize the latest findings regarding vertebrate H2A.Z-associated factors and focus on their roles in gene activation and repression, cell cycle regulation, (neuro)development, and tumorigenesis. Additionally, we demonstrate how protein–protein interactions and post-translational histone modifications can fine-tune the complex interplay of H2A.Z-regulated gene expression. Last, we review the most recent results on interactors of the two isoforms H2A.Z.1 and H2A.Z.2.1, which differ in only three amino acids, and focus on cancer-associated mutations of H2A and H2A.Z, which reveal fascinating insights into the functional importance of such minuscule changes. H2A.Z is involved in gene activation and repression, partly through interaction with post-translational modification (PTM) writer and eraser complexes (directly or through mediators). Focusing on PTMs with regard to the histone code hypothesis and the H2A.Z interactome will shed light on H2A.Z's multitude of functions. More studies display distinct functions for H2A.Z.1 and H2A.Z.2.1 partly through specific interactors, even though they only differ in three amino acids. Focusing on how their binding specificity is achieved will highlight the importance of every amino acid. H2A.Z and its interactors [e.g., PWWP Domain Containing 2A (PWWP2A) and ZNF512B] are emerging as novel regulators in early development and neurodevelopment, associate with diseases as well as cancer development, and offer new therapeutic potential. [ABSTRACT FROM AUTHOR]

International Classification of Disease, ninth/tenth revision codes are used to identify patients with appendicitis and classify severity of disease for research and hospital reimbursement. We sought to determine accuracy of International Classification of Disease, ninth/tenth revision codes in classifying appendicitis as uncomplicated versus complicated (defined as perforated, necrotic, or abscess) compared with the clinical gold standard: surgeon characterization of the appendix in the operative report. Retrospective review of operative reports and discharge International Classification of Disease, ninth/tenth revision codes for patients ≥18 years old who underwent noninterval, nonincidental appendectomy between January 2012 and December 2019 at a tertiary referral center. Sensitivity, specificity, and positive predictive value were calculated for International Classification of Disease, ninth/tenth revision codes to classify appendicitis accurately as complicated compared with surgeon description. ICD-9/10 codes and surgeon description were categorized into complicated/uncomplicated based on the American Association for the Surgery of Trauma grading system. In the study, 1,495 patients with acute appendicitis underwent appendectomy. Per surgeon description, 200 (13%) were complicated and 1,295 (87%) uncomplicated. Compared with surgeon description, discharge International Classification of Disease, ninth/tenth revision codes did not accurately identify complicated appendicitis: sensitivity = 0.68, positive predictive value = 0.77. As a sensitivity analysis, the cohort was stratified by public versus private payers, and the results did not change. International Classification of Disease, ninth/tenth revision codes do not accurately identify surgeon-described complicated appendicitis. Nearly one-third of the cases of complicated appendicitis were coded as uncomplicated. Such misclassification negatively impacts reimbursement for complicated appendicitis care and could lead to misleading results in research and quality improvement activities that rely on these codes. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is a highly morbid condition which requires long-term adherence to oral anticoagulation and may be associated with adverse quality of life and health care utilization. We developed a relational agent-an interactive smartphone-based intervention accessible regardless of digital or health literacy-to assist individuals residing in rural, Western Pennsylvania, with AF with chronic disease self-management.Methods: The "Mobile health intervention for rural atrial fibrillation" is a single center, parallel-arm randomized clinical trial for adults with AF funded by the National Institute of Health's National Heart, Lung, and Blood Institute to enroll 264 participants. All participants receive a smartphone with data plan: The intervention is a 4 month relational agent coupled with the AliveCor Kardia for heart rate and rhythm monitoring provided by smartphone, and the control a pre-installed, smartphone-based application for health-related information (WebMD). The study uses remote recruitment and engagement to enroll individuals who would otherwise be unlikely to participate in clinical research due to rurality. The primary outcome of the trial is adherence to oral anticoagulation, determined by proportion of days covered, as measured at 12 months. The secondary outcomes are quality of life, both AF-specific and general, and health care utilization. The study entails a baseline visit, a 4 month intervention phase, and 8 and 12 month follow-up visits.Conclusions: This mobile health trial tests the effectiveness of a smartphone-based relational agent to improve clinical and patient-reported outcomes in rural-dwelling individuals. [ABSTRACT FROM AUTHOR]

Preeclampsia is characterized by maternal endothelial activation and placental dysfunction. Imbalance in maternal angiogenic and vasoactive factors has been linked to the pathophysiology. The contribution of the placenta as a source of these factors remains unclear. Furthermore, little is known about fetal angiogenic and vasoactive proteins and the relation between maternal and fetal levels. We describe placental growth factor, soluble Fms-like tyrosine kinase 1, soluble endoglin, and endothelin 1–3 in 5 vessels in healthy pregnancies, early- and late-onset preeclampsia. Specifically, we aimed to (1) compare protein abundance in vessels at the maternal-fetal interface between early- and late-onset preeclampsia, and healthy pregnancies, (2) describe placental uptake and release of proteins, and (3) describe protein abundance in the maternal vs fetal circulations. Samples were collected from the maternal radial artery, uterine vein and antecubital vein, and fetal umbilical vein and artery in 75 healthy and 37 preeclamptic mother-fetus pairs (including 19 early-onset preeclampsia and 18 late-onset preeclampsia), during scheduled cesarean delivery. This method allows estimation of placental release and uptake of proteins by calculation of venoarterial differences on each side of the placenta. The microarray-based SomaScan assay quantified the proteins. The abundance of soluble Fms-like tyrosine kinase 1 and endothelin 1 was higher in the maternal vessels in preeclampsia than in healthy pregnancies, with the highest abundance in early-onset preeclampsia. Placental growth factor was lower in the maternal vessels in early-onset preeclampsia than in both healthy and late-onset preeclampsia. Maternal endothelin 2 was higher in preeclampsia, with late-onset preeclampsia having the highest abundance. Our model confirmed placental release of placental growth factor and soluble Fms-like tyrosine kinase 1 to the maternal circulation in all groups. The placenta released soluble Fms-like tyrosine kinase 1 into the fetal circulation in healthy and late-onset preeclampsia pregnancies. Fetal endothelin 1 and soluble Fms-like tyrosine kinase 1 were higher in early-onset preeclampsia, whereas soluble endoglin and endothelin 3 were lower in both preeclampsia groups than healthy controls. Across groups, abundances of placental growth factor, soluble Fms-like tyrosine kinase 1, and endothelin 3 were higher in the maternal artery than the fetal umbilical vein, whereas endothelin 2 was lower. An increasing abundance of maternal soluble Fms-like tyrosine kinase 1 and endothelin 1 across the groups healthy, late-onset preeclampsia and early-onset combined with a positive correlation may suggest that these proteins are associated with the pathophysiology and severity of the disease. Elevated endothelin 1 in the fetal circulation in early-onset preeclampsia represents a novel finding. The long-term effects of altered protein abundance in preeclampsia on fetal development and health remain unknown. Further investigation of these proteins' involvement in the pathophysiology and as treatment targets is warranted. [Display omitted] [ABSTRACT FROM AUTHOR]

The effect of a small shock to the production function in one country on another, even in the absence of any direct economic linkages, was studied based on the model developed by Kiyotaki and Moore. The results revealed that a shock was easily transmitted with a decline in the terms of trade in the presence of collateral based credit constraints and a high correlation was found between crises and terms of trade shocks due to financial frictions.

Introduction: Shared decision making (SDM) may result in treatment plans that best reflect the goals and wishes of patients, increasing patient satisfaction with the decision-making process. There is a knowledge gap to support the use of decision aids in SDM for anticoagulation therapy in patients with atrial fibrillation (AF). We describe the development and testing of a new decision aid, including a multicenter, randomized, controlled, 2-arm, open-label ENHANCE-AF clinical trial (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention) to evaluate its effectiveness in 1,200 participants.Methods: Participants will be randomized to either usual care or to a SDM pathway incorporating a digital tool designed to simplify the complex concepts surrounding AF in conjunction with a clinician tool and a non-clinician navigator to guide the participants through each step of the tool. The participant-determined primary outcome for this study is the Decisional Conflict Scale, measured at 1 month after the index visit during which a decision was made regarding anticoagulation use. Secondary outcomes at both 1 and 6 months will include other decision making related scales as well as participant and clinician satisfaction, oral anticoagulation adherence, and a composite rate of major bleeding, death, stroke, or transient ischemic attack. The study will be conducted at four sites selected for their ability to enroll participants of varying racial and ethnic backgrounds, health literacy, and language skills. Participants will be followed in the study for 6 months.Conclusions: The results of the ENHANCE-AF trial will determine whether a decision aid facilitates high quality shared decision making in anticoagulation discussions for stroke reduction in AF. An improved shared decision-making experience may allow patients to make decisions better aligned with their personal values and preferences, while improving overall AF care. [ABSTRACT FROM AUTHOR]

Background: Previous research shows that Black and Hispanic patients have longer ED wait times than White patients, but these data do not reflect recent changes such as the Affordable Care Act. In addition, previous research does not account for the non-normal distribution of wait times, wherein a sizable subgroup of patients seen promptly and those not seen promptly experience long wait times.Methods: We utilized National Hospital Ambulatory Medical Care Survey (NHAMCS) datasets (2013-2017) to examine mean ED wait time comparing visits by Black, Hispanic, and Asian patients to White patients. Using a two-part regression model, we adjusted for patient, hospital, and health system factors, and estimated differences, for each of five triage levels, in (a) likelihood of waiting at least 5 min and (b) difference in wait time among those not seen promptly.Results: Our cohort included 38,800 White, 14,838 Black, 10,619 Hispanic, and 1257 Asian patient visits. Black (triage level 3) and Hispanic (triage levels 3 and 4) patients had longer mean wait times than White patients. Adjusted likelihood of not being seen promptly was lower among Blacks (triage levels 3, 4 and 5), Hispanics (triage level 5) and Asians (triage level 5) compared to Whites. Among those waiting at least 5 min, adjusted wait time was longer among Blacks in triage level 3 (5.2 min, 95% CI, 1.3 to 9.0) and level 4 (2.5 min, 95% CI, 0.2 to 4.9), Hispanics in triage level 4 (4.7 min, 95% CI, 1.7 to 7.7) and Asians in triage level 5 (16.3 min, 95% CI, 0.6 to 31.9) compared to Whites.Conclusions: Minority patients were less likely to wait to be seen, but waited longer if not seen promptly. These data exhibit that ED wait time disparities persist for African American and Hispanic patients and extend this observation to Asian patients. [ABSTRACT FROM AUTHOR]

Study Objective: To characterize the short-term incidence of gynecologic cancer after undergoing uterine artery embolization (UAE).Design: Retrospective cohort study.Setting: Commercial insurance claims database.Patients: Total of 15 393 United States women aged 18 to 64 years who underwent UAE between 2007 and 2017.Interventions: We used the IBM MarketScan (Armonk, NY) claims to identify adult women without previous gynecologic cancer diagnoses undergoing UAE between 2007 and 2017. Database queries identified women with any diagnostic or procedure codes related to gynecologic malignancies occurring in the first 3 years after UAE. A malignancy diagnosis was suggested by recurrent malignancy-related claims not linked exclusively to diagnostic testing (e.g., transvaginal ultrasound) and malignancy codes linked to tissue pathology claims. Incidence of malignancy diagnosis was calculated. Rates of endometrial sampling in the year before UAE were identified.Measurements and Main Results: Thirty-one women undergoing UAE had gynecologic cancer diagnoses within 3 years of the procedure (22 of 31, 71% uterine cancers; 7 of 31, 23% ovarian cancers; and 2 of 31, 6% cervical cancers). On average, cancer diagnoses were made 1.1 ± 0.9 years after UAE. One in 497 women undergoing UAE was diagnosed with a gynecologic malignancy within 3 years, with an incidence of 1.1 malignancies per 1000 person-years. Cancer incidence increased with age at the time of UAE: short-term malignancy diagnoses were made in 1 in 377 women aged 45 to 54 years, and 1 in 79 women aged 55 to 64 years. In the year before UAE, 28% (4311 of 15 362) of women without cancer, and 23% (5 of 22) of women diagnosed with uterine cancer had preprocedural endometrial sampling.Conclusion: These data can inform risk/benefit counseling and shared decision-making regarding UAE and its alternatives. Short-term malignancies after UAE highlight the importance of preprocedure evaluation in symptomatic women and women with age-related risk. [ABSTRACT FROM AUTHOR]

Objectives: This study is a randomized controlled trial comparing the efficacy of a virtual counselor (VICKY) to the My Family Health Portrait (MFHP) tool for collecting family health history (FHx).Methods: A total of 279 participants were recruited from a large safety-net hospital and block randomized by health literacy to use one of the digital FHx tools, followed by a genetic counselor interview. A final sample of 273 participants were included for analyses of primary study aims pertaining to tool concordance, which assessed agreement between tool and genetic counselor.Results: Tool completion differed significantly between tools (VICKY = 97%, MFHP = 51%; p < .0001). Concordance between tool and genetic counselor was significantly greater for participants randomized to VICKY compared to MFHP for ascertaining first- and second-degree relatives (ps<.0001), and most health conditions examined. There was significant interaction by health literacy, with greater differences in concordance observed between tools among those with limited literacy.Conclusions: A virtual counselor overcomes many of the literacy-related barriers to using traditional digital tools and highlights an approach that may be important to consider when collecting health histories from vulnerable populations.Practice Implications: The usability of digital health history tools will have important implications for the quality of the data collected and its downstream clinical utility. [ABSTRACT FROM AUTHOR]

• The pathophysiology of impulsivity is a challenge for understanding the pathophysiology of addictive disorders. • Impulsive actions are realized faster than they should be in time. • It leads people to choose immediate gratification instead of preferred but delayed gratification. • Our review contributes to understanding the relationship between time perception and impulsivity. • Addictive behaviors are a good model for understanding the pathophysiology of impulsivity. Addictive disorders are characterized by impulsive behavior that leads to difficulties in preventing certain behaviors despite negative consequences. This symptom predisposes to a vulnerability in developing addictive disorders and is also aggravated by the addiction process itself. As such, understanding the underlying mechanisms of impulsivity is a challenge for understanding the pathophysiology of addiction. One common link between impulsivity and addiction is that both involve actions and decisions that are realized faster than they should be in time. Impulsive traits increase the tendency to choose immediate gratification instead of delayed gratification even when preferred. This observation suggests a relationship between impulsivity and time processing. To better understand this relationship, we reviewed the literature that describes the relationship between time processing and impulsivity in addictive disorders in humans. Despite a lack of literature concerning this question in alcohol, cannabis and gambling disorders, we highlight that addictive behaviors are a good model for understanding the pathophysiology of impulsivity, and could help us to better understand the relationship between time perception and impulsivity. [ABSTRACT FROM AUTHOR]

Objectives: The extent to which the human term fetus utilizes cholesterol released from the placenta has remained elusive. Our aims were to estimate the net mass of cholesterol taken up by the uteroplacental unit, released by the placenta and taken up by the fetus. Thereby we aimed to explore the maternal-fetal cholesterol transfer and hypothesized that maternal levels and uteroplacental uptake were correlated to the fetal uptake of cholesterol.Methods: A cross-sectional in vivo study of 179 fasting, healthy women with uncomplicated singleton pregnancies. Blood flow in the uterine artery (n = 70) and umbilical vein (n = 125) was measured by Doppler ultrasound. Blood samples from the maternal radial artery, antecubital vein and uterine vein, and the umbilical artery and vein were obtained during cesarean section. Cholesterol was determined enzymatically.Results: We found a significant uteroplacental uptake (median [Q1,Q3]) of total (3.50 [-36.8,61.1]) and HDL cholesterol (6.69 [-3.78,17.9]) μmol/min, and a fetal uptake of HDL (8.07 [4.48,12.59]), LDL (5.97 [2.77,8.92]) and total cholesterol (13.2 [8.06,21.58]) μmol/min. Maternal cholesterol levels were not correlated to fetal uptake of cholesterol. There was a correlation between uteroplacental uptake of total (rho 0.35, p 0.003) and LDL cholesterol (rho 0.25, p 0.03) and the fetal uptake of LDL cholesterol from the umbilical circulation. The fetal uptake of cholesterol from HDL was higher than from LDL (p < 0.001).Conclusion: Fetal cholesterol uptake is independent of maternal cholesterol levels, but related to the uteroplacental uptake of cholesterol from LDL. This suggests that the placenta influences maternal-fetal cholesterol transfer at term. [ABSTRACT FROM AUTHOR]

Introduction Alcohol, tobacco, and illegal drug usage is pervasive throughout the world, and abuse of these substances is a major contributor to the global disease burden. Many pharmacotherapies have been developed over the last 50 years to target addictive disorders. While the efficacy of these pharmacotherapies is largely recognized, their cognitive impact is less known. However, all substance abuse disorders are known to promote cognitive disorders like executive dysfunction and memory impairment. These impairments are critical for the maintenance of addictive behaviors and impede cognitive behavioral therapies that are regularly administered in association with pharmacotherapies. It is also unknown if addictolytic medications have an impact on preexisting cognitive disorders, and if this impact is modulated by the indication of prescription, i.e. abstinence, reduction or substitution, or by the specific action of the medication. Method We reviewed the cognitive effects of labeled medications for tobacco addiction (varenicline, bupropion, nicotine patch and nicotine gums), alcohol addiction (naltrexone, nalmefene, baclofen, disulfiram, sodium oxybate, acamprosate), and opioid addiction (methadone, buprenorphine) in human studies. Studies were selected following MOOSE guidelines for systematic reviews of observational studies, using the keywords [Cognition] and [Cognitive disorders] and [treatment] for each medication. Results 971 articles were screened and 77 studies met the inclusion criteria and were reported in this review (for alcohol abuse, n = 21, for tobacco n = 22, for opioid n = 34. However, very few comparative clinical trials have explored the chronic effects of addictolytic medications on cognition in addictive behaviors, and there are no clinical trials on the cognitive impact of nalmefene in patients suffering from alcohol use disorders. Discussion Although some medications seem to enhance cognition in patients suffering from cognitive disorders, others could promote cognitive impairments, and our work highlights a lack of literature on this subject. In conclusion, more comparative clinical trials are needed to better understand the cognitive impact of addictolytic medications. [ABSTRACT FROM AUTHOR]

Objective: To determine whether or not limited caregiver health literacy is associated with adherence to a daily multi-vitamin with iron regimen in infants.Methods: 110 caregiver/infant dyads were enrolled in a prospective study to assess the relationship between caregiver health literacy and adherence to a daily multi-vitamin with iron regimen for infants. Households were contacted biweekly over a 3-month period. Adherence was based upon caregiver report. High adherence, our primary outcome, was defined as the administration of the multi-vitamin with iron on 5-7 days over the past week.Results: As measured by the Short Test of Functional Health Literacy in Adults (S-TOFHLA), 18% of caregivers had limited health literacy skills. Caregivers with limited health literacy skills were more likely to have higher adherence than caregivers with adequate health literacy, after adjusting for a number of possible confounding variables (AOR=2.13; 95% 1.20-3.78).Conclusion: Caregivers with limited health literacy were twice as likely to report high adherence to a daily multi-vitamin with iron regimen in infants as caregivers with adequate health literacy in adjusted analysis.Practice Implications: Health literacy may exert a differential influence on adherence depending upon the complexity of the desired health behavior. [ABSTRACT FROM AUTHOR]

Background Adverse drug events (ADEs) affect millions of patients annually and place a significant burden on the healthcare system. The Food and Drug Administration (FDA) has developed patient safety information for high-risk medications that pose serious public health concerns. However, there are currently few assurances that patients receive this information or are able to identify or respond correctly to ADEs. Objective To evaluate the effectiveness of the Electronic Medication Complete Communication (EMC 2 ) Strategy to promote safe medication use and reporting of ADEs in comparison to usual care. Methods The automated EMC 2 Strategy consists of: 1) provider alerts to counsel patients on medication risks, 2) the delivery of patient-friendly medication information via the electronic health record, and 3) an automated telephone assessment to identify potential medication concerns or ADEs. The study will take place in two community health centers in Chicago, IL. Adult, English or Spanish-speaking patients (N = 1200) who have been prescribed a high-risk medication will be enrolled and randomized to the intervention arm or usual care based upon practice location. The primary outcomes of the study are medication knowledge, proper medication use, and reporting of ADEs; these will be measured at baseline, 4 weeks, and three months. Intervention fidelity as well as barriers and costs of implementation will be evaluated. Conclusions The EMC 2 Strategy automates a patient-friendly risk communication and surveillance process to promote safe medication use while minimizing clinic burden. This trial seeks to evaluate the effectiveness and feasibility of this strategy in comparison to usual care. [ABSTRACT FROM AUTHOR]

Usually, phase equilibrium measurements are performed with pure substances. On the other hand, in technical applications, technical grade substances are used. In this work, the differences in the phase behaviors of these two grades were investigated. The phase behavior of technical grade, nonionic surfactant Genapol X080+technical 1-dodecene+water was studied and compared to the phase behavior of the pure compound. First, binary subsystems (technical 1-dodecene+water; technical surfactant Genapol X080®+water; technical 1-dodecene+technical surfactant Genapol X080®) were studied. The solubility of water in technical 1-dodecene is slightly higher than the solubility of water in pure 1-dodecene. The cloud point curves of technical aqueous surfactant solutions and solutions made from pure surfactant show extreme differences in temperature and shape. The phase behavior of the ternary system was intensively studied visually by measuring Kahlweit's fish at a constant oil/water ratio ( =0.5). Tie lines were measured at temperatures between 30°C and 90°C at 10°C intervals. The results were compared to the measured tie lines in a system containing pure substances. The raw material's purity has an enormous influence on phase change temperatures. For the first time, a 4-phase liquid equilibrium was observed in a system containing technical grade substances. Furthermore, the solubility of the surfactant was compared at nearly constant feed concentrations in the aqueous and 1-dodecene-rich phases. [ABSTRACT FROM AUTHOR]

Activins are regulators of embryogenesis, osteogenesis, hormones and neuronal survival. Even though activin receptor type II has been detected in spiral ganglion neurons (SGN), little is known about the role of activins in the inner ear. An activin-mediated neuroprotection is of considerable clinical interest since SGN are targets of electrical stimulation with cochlear implants in hearing impaired patients. Thus, the presence of activin type-I and type-II receptors was demonstrated immunocytochemically and the individual and combined effects of activin A, erythropoietin (EPO) and brain-derived neurotrophic factor (BDNF) on SGN were examined in vitro. SGN isolated from neonatal rats (P 3–5) were cultured in serum-free medium supplemented with activin A, BDNF and EPO. Compared to the negative control, survival rates of SGN were significantly improved when cultivated individually with activin A (p < 0.001) and in combination with BDNF (p < 0.001). Neither neurite outgrowth nor neuronal survival was influenced by the addition of EPO to activin A-treated neurons. However, when all three factors were added, a significantly (p < 0.001) improved neuronal survival was observed (61.2 ± 3.6%) compared to activin A (25.4 ± 2.1%), BDNF (22.8 ± 3.3%) and BDNF + EPO (19.2 ± 1.5%). Under the influence of the EPO-inhibitors, this increase in neuronal survival was blocked. Acting with BDNF and EPO to promote neuronal survival in vitro, activin A presents an interesting factor for pharmacological intervention in the inner ear. The present study demonstrates a synergetic effect of a combined therapy with several trophic factors. [ABSTRACT FROM AUTHOR]

Abstract: Economic incentives to promote healthy behavior are becoming increasingly common and have been suggested as an approach to decreasing healthcare costs. Ethical concerns about programs with such incentives are that they may contribute to inequities, be coercive, interfere with therapeutic relationships, undermine personal responsibility for health, and decrease social solidarity. Additionally, they may be a source of stigma or discrimination, promote dependence, and be unfair for those already engaged in targeted health behaviors or those who cannot fulfill the incentivized behaviors. Incentive programs need to incorporate appropriate safeguards to monitor these risks and support fairness in offering economic incentives to promote healthy behavior. [Copyright &y& Elsevier]

Abstract: In the past, geographers have argued for a policing network that mainly consists of the police, private security companies and voluntary policing. This paper revises the idea of policing and social control by arguing for an extension of theorisations of the policing network to include social development agencies within certain governance arrangements. Although they are partially effective, private security companies and ‘hard policing’ strategies are limited when controlling targeted groups such as particular sectors of the urban poor. Acknowledging and responding to those limits, Improvement Districts have invested in social development programmes. Guided by statistics and the pressure to produce ‘success stories’, meaning fewer visible street people, social development actors are associated with the ‘softer side of security’. Being governed under the same auspices, private security and social development furthermore complement each other. If the urban poor refuse offers of social development assistance it is likely that those individuals will be referred to private security companies. In this set-up, participation in social development programmes is not entirely voluntary as it puts pressure on the urban poor. Thus the policing and social control strategy becomes more effective. This research is informed by extensive interviews and participant observations in Cape Town. The case study addresses wider questions on the control of sectors of the urban poor and suggests that policing landscapes can be more nuanced than often depicted. [Copyright &y& Elsevier]

Background: Limited health literacy may be a contributing factor to racial disparities in health care. This study examined the mediating effect of limited health literacy on the relationship between race and HIV-medication adherence. Methods: A total of 204 patients infected with HIV were recruited from two clinics in 2001. Structured in-person interviews were conducted to obtain information on patient demographics, medication adherence, and health literacy. Multivariate regression models were run in 2006 to examine the associations among race, literacy, and HIV-medication adherence after adjusting for relevant covariates. Results: In an adjusted analysis that excluded literacy, African Americans were 2.40 times more likely to be nonadherent to their HIV-medication regimen than whites (95% confidence interval [CI]=1.14–5.08). When literacy was included in the final model, the effect estimates of race diminished 25% to nonsignificance. Literacy remained a significant independent predictor of nonadherence (adjusted odds ratio [AOR]=2.12, 95% CI=1.93–2.32). Conclusions: In this study, limited health literacy mediated the relationship between race and HIV-medication adherence. Investigators need to consider the potential utility of responding to literacy and communication barriers in health care as part of interventions to reduce racial disparities. [Copyright &y& Elsevier]

Abstract: The environmental history of a talus-derived rockglacier located in northern Norway has been reconstructed through the Last Glacial–Interglacial transition based on two cores retrieved from an adjacent lake. The methods used to quantify sedimentary properties include rock magnetism, grain size analyses, loss-on-ignition (LOI) and bulk density, which when combined has enabled an unmixing of the various sediment components and their corresponding sources. Rockglaciers signify mean annual air temperatures (MAAT) of −4°C or colder, but little is known about their dynamical response to changing thermal regimes. We document here for the first time that a permafrost regime did exist in northern Norway during the lateglacial period, and that it required a lowering equivalent of at least 7°C compared to present-day MAAT. The lake sediments suggest that the rockglacier existed prior to the local deglaciation of the Fennoscandian Ice Sheet (>14800calyrBP), and continued its expansion until the end of the Younger Dryas whereupon it became fossil. The cool climate of the lateglacial was intersected by brief warming spells that caused a systematic release of sedimentladen meltwater from the rockglacier. During the Holocene the minerogenic influx to the lake was driven by spring snowmelting, which are related to the magnitude of winter precipitation. Three phases are recognised: (1) 9800–6500calyrBP when wet winters prevailed, (2) 6500–4000calyr BP with dry winters, and (3) the last 4000calyrBP with a return to wetter winters. [Copyright &y& Elsevier]

Abstract: In explaining the rapid transitions associated with the Younger Dryas cooling, a reduced meridional overturning circulation has traditionally been invoked, but such a scenario has been difficult to reproduce in model studies without adding excessive amounts of freshwater to the North Atlantic. More recent studies challenge this view and indicate that the role of an extensive sea ice cover may have been as important in promoting abrupt climate change as reorganisations of the North Atlantic Ocean [Gildor, H., Tziperman, E., 2003. Sea-ice switches and abrupt climate change. Philosophical Transactions Of The Royal Society Of London Series A—Mathematical Physical And Engineering Sciences 361, 1935–1942]. Based on glacier evidence from eastern Greenland [Denton, G.H., Alley, R.B., Comer, G.C., Broecker, W.S., 2005. The role of seasonality in abrupt climate change. Quaternary Science Reviews 24, 1159–1182] suggest that the seasonal temperature amplitude increased by about 20°C during the Younger Dryas. Such a ‘switching of seasonality’ lends support to the idea of a fast-expanding sea ice cover, because it allows for extremely cold winters that are balanced by relatively mild summers. However, climatic interpretations based on the geometry and length of glaciers under such conditions as in Scoresby Sund is not well understood, and equilibrium-line-altitude (ELA) estimates should, therefore, be regarded as tentative. Here, we discuss the absolute seasonal amplitude during the Younger Dryas by taking winter precipitation into account and show that the changes in seasonality may have been limited to 10°C. We propose that by reducing the seasonal response in Greenland compared with western Europe we better understand the hinged-door modus operandi [COHMAP, 1988. Climatic changes of the last 18,000 years: observations and model simulations. Science 241, 1043–1052] of the polar front and sea-ice cover, where the absolute southward migration of sea-ice is highest in the East Atlantic region. [Copyright &y& Elsevier]

Abstract: Several studies using animals have shown the protective effects of neurotrophic factors (NF) on spiral ganglion cells (SGC). This is of particular importance since the number of SGCs is considered to be among the factors defining the efficacy of cochlear implants. A device for local inner ear treatment is therefore of great interest. As described previously, we modified a ContourTM cochlear implant electrode, to examine the inbuilt canal to be used for fluid release [Paasche, G., Gibson, P., Averbeck, T., Becker, H., Lenarz, T., Stöver, T., 2003. Technical report: modification of a cochlear implant electrode for drug delivery to the inner ear. Otol. Neurotol. 24, 222–227]. In the present study, three different electrode prototypes with openings of the delivery channel at various locations along the electrode array were examined to determine distribution of dye in a cochlea model over time. We compared dye delivery with: (a) release of the dye at the tip, (b) release of the dye at the tip and the side of the electrode, and (c) release of the dye only at the side of the electrode (6mm from the tip). A mechanical pump was used to drive the system at pump rates of 100, 10, and 1μl/h. Dye concentration changes along the length of the whole cochlea were investigated. Mean values for all experimental conditions show that the distribution along the array is fastest with two outlets whereas the distribution via a single outlet at the side of the electrode array is not considered to be sufficient. The established experimental setup provides the possibility of investigating prototypes of a fluid based drug delivery system for the treatment of inner ear pathologies in combination with electrical stimulation. [Copyright &y& Elsevier]

Abstract: The aim was to determine plasma levels of sFlt-1 and sEng on the arterial and venous side of the uteroplacental circulation in preeclamptic patients and healthy controls. Preeclamptic patients had higher arterial concentrations than controls of sFlt-1 (17,450 vs 5055 pg/ml, p = 0.003) and sEng (68.7 vs 28.7 ng/ml, p = 0.003). In the preclampsia group sFlt-1 was higher in the uterine vein than in the radial artery (22,450 vs 17,450 pg/ml, p = 0.005). We found no gradient for sEng. Our results support the hypothesis that excess sFlt-1 at least partly originates in placenta, while excess sEng appears to have a different origin. [Copyright &y& Elsevier]

Gynecologic surgery has potential for adjunct vascular interventions, given the proximity of major intra-abdominal and pelvic blood vessels. Our goal was to determine contemporary incidence, associations, and outcomes of vascular repairs in gynecologic operations. The American College of Surgeons National Surgical Quality Improvement Program database (2005-2017) was queried for patients undergoing elective gynecologic operations. Vascular repairs were performed concurrently or during reoperation. Univariable and multivariable analyses evaluated associations with vascular repairs and 30-day morbidity. A total of 201,224 gynecologic operations were identified: hysterectomy (88.3%), myomectomy (5.9%), adnexal surgery (3.5%), vulvovaginectomy/other (1.1%), nonadnexal tumor or cyst excision (0.5%), ectopic pregnancy treatment (0.4%), and pelvic lymphadenectomy (0.3%). There were 187 vascular repairs in 176 (0.09%) patients. Repairs were typically concurrent (89.8%) and most commonly included open abdominal blood vessel repair (51.8%), major abdominal artery ligation (25%), vena cava reconstruction/ligation (6%), common iliac vein ligation (4.2%), and aorta/great vessel repair (4.2%). A minority were performed endovascularly (1.7%). Patients undergoing vascular repairs were older (56 vs 46 years), were more likely to have an open vs minimally invasive/vaginal operation (71.6% vs 28.4%), and were more likely to have a hysterectomy (85.2%; P <.001 for all). In multivariable analysis, vascular repairs were observed more often with hysterectomy (odds ratio [OR]; 7.63, 95% confidence interval [CI], 2.28-25.55; P =.001) and open vs minimally invasive/vaginal operations (OR, 5.24; 95% CI, 2.64-10.42; P <.001). Vascular repairs were also more common for patients with malignant disease (OR, 2.84; 95% CI, 1.78-4.53; P <.001), patients assigned to American Society of Anesthesiologists class 3 or class 4 (OR, 1.85; CI, 1.36-2.53; P =.002), and patients without obesity (OR, 1.45; 95% CI, 1.08-1.96; P =.014). Vascular repairs independently predicted major morbidity and mortality (OR, 7.26; 95% CI, 5.26-10.03; P <.001) after adjustment for open operative approach, American Society of Anesthesiologists class 3 or class 4, and hysterectomy. Whereas vascular repairs during gynecologic operations are rare, they are associated with morbidity and mortality. These findings provide an evidence base for risk assessment and informed consent. [ABSTRACT FROM AUTHOR]

De l'oracle de Delphe à l'imagerie par résonance magnétique, le regard disséquant de l'anatomiste s'est toujours accompagné d'une lecture connective, aliment de la subjectivité. Le visage offert à la vue a ainsi fait l'objet depuis Aristote (et probablement avant sans qu'on en ait gardé la trace écrite) d'interprétations multiples, faisant école au fil des époques. En émane tout un vocabulaire : métoposcopie, prosopologie, physiognomonie, phrénologie, organologie, morphopsychologie, amphibologie... qui a ponctué l'au-delà du regard porté. C'est cette histoire, focalisée sur la région frontale, dont il sera fait mention, avec les dérives qu'elle a pu engendrer. Invitation à éduquer le regard chirurgical. From the oracle of Delphi to magnetic resonance imaging, the anatomist's dissecting gaze has always been accompanied by a connective reading, nourishing subjectivity. The face offered to view has thus been the subject since Aristotle (and probably before without any written record of it being kept) of multiple interpretations, becoming a standard throughout the ages. A whole vocabulary emanates from it: metoposcopy, prosopology, physiognomony, phrenology, organology, morphopsychology, amphibology... which punctuated the beyond of the gaze. It is this story, focused on the frontal region, which will be mentioned, with the excesses it may have caused. Invitation to educate the surgical perspective. [ABSTRACT FROM AUTHOR]

To estimate the likelihood that patients who have undergone uterine fibroid embolization (UFE) for leiomyomata will go on to develop subsequent gynecologic cancer that may have been prevented with hysterectomy. We identified women over 18 years old without prior diagnosis of cancer who had undergone UFE for treatment of leiomyomata in the MarketScan database between 2007 and 2016. Records were then electronically queried for any diagnostic or procedure codes (ICD9, ICD10, and CPT) related to uterine, cervical, tubal, or ovarian malignancies occurring after the UFE procedure date through the end of data available. All charts identified through electronic query had all codes manually reviewed by a minimum of three coders to confirm diagnosis of cancer, and discrepancies were resolved by consensus. Diagnosis of cancer was defined as having at least two codes for gynecological malignancy submitted at least one week apart and/or with malignancy codes linked to tissue pathology results. Descriptive statistics were generated for the final study sample. N/A Patient data was obtained from MarketScan, a database of diagnostic and treatment data for over 60 million commercially insured individuals in the US. N/A Between 2007 and 2016, 20,575 women underwent UFE. Fifty-one women met criteria for exhibiting cancer after UFE (37/51, 73% uterine cancer; 13/51, 25% ovarian cancer; 1/51, 2% cervical cancer). One in 403 (95% CI: 1 in 354 to 1 in 469) women undergoing UFE developed a gynecologic malignancy. On average, women exhibited cancer within 2.3 years from the date of UFE with a standard deviation of ±2.14 years and a range of 17 days to 7.8 years. A small fraction of women undergoing UFE develop subsequent gynecologic malignancies. Women choosing uterine preservation with UFE should be counseled about the risk of developing gynecologic malignancies in the future, some of which may be preventable with hysterectomy. [ABSTRACT FROM AUTHOR]

This study aimed to examine changes in emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) among uninsured or Medicaid-covered Black, Hispanic, and White adults aged 26–64 in the first 5 years of the Affordable Care Act Medicaid expansion. Using 2010–2018 inpatient and ED discharge data from nine expansion and five nonexpansion states, an event study difference-in-differences regression model was used to estimate changes in number of annual ACSC ED visits per 100 adults ("ACSC ED rate") associated with the 2014 Medicaid expansion, overall and by race/ethnicity. A secondary outcome was the proportion of ACSC ED visits out of all ED visits ("ACSC ED share"). Analyses were conducted in 2022–2023. Medicaid expansion was associated with no change in ACSC ED rates among all, Black, Hispanic, or White adults. When excluding California, where most counties expanded Medicaid before 2014, expansion was associated with a decrease in ACSC ED rate among all, Black, Hispanic, and White adults. Expansion was also associated with a decrease in ACSC ED share among all, Black, and White adults. White adults experienced the largest reductions in ACSC ED rate and share. Medicaid expansion was associated with reductions in ACSC ED rates in some expansion states and reductions in ACSC ED share in all expansion states combined, with some heterogeneity by race/ethnicity. Expansion should be coupled with policy efforts to better link newly insured Black and Hispanic patients to non-ED outpatient care, alongside targeted outreach and expanded primary care capacity, which may reduce disparities in ACSC ED visits. [ABSTRACT FROM AUTHOR]

Context: Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care.Objectives: We conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics to guide future research.Methods: The scoping review followed methods from The Joanna Briggs Institute Reviewers' Manual (2015). We developed a priori a scoping review protocol outlining the population, concept, and context for study; data sources; search strategy; inclusion/exclusion criteria; and procedure for screening, extracting, and analyzing data.Results: The final sample consisted of 19 studies with the following themes: characterizing spiritual needs, preferences, and resources; characterizing palliative or spiritual care; predicting provision of spiritual care; and assessing spiritual care interventions. Eighteen studies were published in the past decade, and 11 studies were based in Europe. Most studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual care. Many studies were limited in sample size and generalizability/transferability and used less sophisticated research designs.Conclusion: Research across dementia, spirituality, and palliative care needs to examine settings beyond long-term care, distinct stages of dementia, and formal spiritual care interventions plus use rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide. [ABSTRACT FROM AUTHOR]

Study Objective: Evidence on variability in emergency medical services use is limited. We obtain national evidence on geographic variation in the use of ambulance transport to the emergency department (ED) among Medicare enrollees and assess the role of health status, socioeconomic status, and provider availability.Methods: We used 2010 Medicare claims data for a random sample of 999,999 enrollees aged 66 years and older, and identified ambulance transport and ED use. The main outcome measures were number of ambulance transports to the ED per 100 person-years (ambulance transport rate) and proportion (percentage) of ED visits by ambulance transport by hospital referral regions.Results: The national ambulance transport rate was 22.2 and the overall proportion of ED visits by ambulance was 36.7%. Relative to hospital referral regions in the lowest rate quartile, those in the highest quartile had a 75% higher ambulance transport rate (incidence rate ratio [IRR] 1.75; 95% confidence interval [CI] 1.69 to 1.81) and a 15.5% higher proportion of ED visits by ambulance (IRR 1.155; 95% CI 1.146 to 1.164). Adjusting for health status, socioeconomic status, and provider availability reduced quartile 1 versus quartile 4 difference in ambulance transport rate by 43% (IRR 1.43; 95% CI 1.38 to 1.48) and proportion of ED visits by ambulance by 7% (IRR 1.145; 95% CI 1.135 to 1.155). Among the 3 covariate domains, health status was associated with the largest variability in ambulance transport rate (30.1%), followed by socioeconomic status (12.8%) and provider availability (2.9%).Conclusion: Geographic variability in ambulance use is large and associated with variation in patient health status and socioeconomic status. [ABSTRACT FROM AUTHOR]