Search

Recurrent anterior shoulder instability remains the most common complication from a prior shoulder dislocation, especially among young and active individuals who engage in athletic activities. This instability can lead to repeated subluxation or dislocations of the humeral head from the glenoid fossa. The purpose of this study is to compare postoperative recurrence rates, instability-related revision and return to sport (RTS) rates between isolated arthroscopic Bankart repair (ABR) and ABR with remplissage (ABR + R) for anterior shoulder instability with subcritical glenoid bone loss (GBL) and a Hill-Sachs lesion (HSL). PubMed, Embase, and Web of Science were searched on June 2022. Studies sought were those comparing postoperative outcomes of ABR + R versus isolated ABR for subcritical GBL and an HSL. Study quality was evaluated using the revised Cochrane tool. Redislocations, instability-related revisions, and RTS rates were extracted and pooled estimates were calculated using the random-effect model. Twelve studies were included with a mean follow-up of 48.2 months for isolated ABR and 43.2 months for ABR + R. The meta-analytic comparison demonstrated that ABR + R resulted in statistically significant improvement in Rowe and American Shoulder and Elbow Surgeons scores by 6.5 and 2.2 points, respectively; however, the improvements in patient-reported outcomes were not clinically meaningful. ABR + R resulted in reduced external rotation at the side by 1° which was not clinically meaningful and there was no significant difference in terms of forward elevation. ABR + R resulted in a statistically significant reduction of overall postoperative recurrences (odds ratio [OR]: 9.36), postoperative dislocations (OR: 6.28), instability-related revision (OR: 3.46), and RTS to any level (OR: 2.85). The addition of remplissage to ABR for recurrent anterior shoulder instability with subcritical GBL and HSL results in significantly lower postoperative instability recurrence, lower instability-related revisions, and higher RTS to any level. [ABSTRACT FROM AUTHOR]

Factor XII (FXII) is a multifunctional protease capable of activating thrombotic and inflammatory pathways. FXII has been linked to thrombosis in extracorporeal membrane oxygenation (ECMO), but the role of FXII in ECMO-induced inflammatory complications has not been studied. We used novel gene-targeted FXII- deficient rats to evaluate the role of FXII in ECMO-induced thromboinflammation. FXII-deficient (FXII−/−) Sprague–Dawley rats were generated using CRISPR/Cas9. A minimally invasive venoarterial (VA) ECMO model was used to compare wild-type (WT) and FXII−/− rats in 2 separate experimental cohorts: rats placed on ECMO without pharmacologic anticoagulation and rats anticoagulated with argatroban. Rats were maintained on ECMO for 1 hour or until circuit failure occurred. Comparisons were made with unchallenged rats and rats that underwent a sham surgical procedure without ECMO. FXII−/− rats were maintained on ECMO without pharmacologic anticoagulation with low resistance throughout the 1-hour experiment. In contrast, WT rats placed on ECMO without anticoagulation developed thrombotic circuit failure within 10 minutes. Argatroban provided a means to maintain WT and FXII−/− rats on ECMO for the 1-hour time frame without thrombotic complications. Analyses of these rats demonstrated that ECMO resulted in increased neutrophil migration into the liver that was significantly blunted by FXII deficiency. ECMO also resulted in increases in high molecular weight kininogen cleavage and complement activation that were abrogated by genetic deletion of FXII. FXII initiates hemostatic system activation and key inflammatory sequelae in ECMO, suggesting that therapies targeting FXII could limit both thromboembolism and inopportune inflammatory complications in this setting. [Display omitted] [ABSTRACT FROM AUTHOR]

We previously found that cardioplegic arrest and cardiopulmonary bypass are associated with altered coronary arteriolar response to serotonin in patients undergoing cardiac surgery. In this study, we investigated the effects of hypertension on coronary microvascular vasomotor tone in response to serotonin and alterations in serotonin receptor protein expression in the setting of cardioplegic arrest and cardiopulmonary bypass. Coronary arterioles were dissected from harvested pre– and post–cardioplegic arrest and cardiopulmonary bypass right atrial tissue samples of patients undergoing cardiac surgery with normotension, well-controlled hypertension, and uncontrolled hypertension. Vasomotor tone was assessed by video-myography, and protein expression was measured with immunoblotting. Pre–cardioplegic arrest and cardiopulmonary bypass, serotonin induced moderate relaxation responses of coronary arterioles in normotension and well-controlled hypertension patients, whereas serotonin caused moderate contractile responses in uncontrolled hypertension patients. Post–cardioplegic arrest and cardiopulmonary bypass, serotonin caused contractile responses of coronary arterioles in all 3 groups. The post–cardioplegic arrest and cardiopulmonary bypass contractile response to serotonin was significantly higher in the uncontrolled hypertension group compared with the normotension or well-controlled hypertension groups (P <.05). Pre–cardioplegic arrest and cardiopulmonary bypass, expression of the serotonin 1A receptor was significantly lower in the uncontrolled hypertension group compared with the well-controlled hypertension and normotension groups (P =.01 and P <.001). Serotonin 1B receptor expression was higher in the uncontrolled hypertension group compared with the normotension or well-controlled hypertension groups post–cardioplegic arrest and cardiopulmonary bypass (P =.03 and P =.046). Uncontrolled hypertension is associated with an increased coronary contractile response of coronary microvessels to serotonin and altered serotonin receptor protein expression after cardioplegic arrest and cardiopulmonary bypass. These findings may contribute to a worse postoperative coronary spasm and worsened recovery of coronary perfusion in patients with uncontrolled hypertension after cardioplegic arrest and cardiopulmonary bypass and cardiac surgery. [ABSTRACT FROM AUTHOR]

• Children with epilepsy had significantly more mental health problems than controls. • Caregivers of children with epilepsy had significantly more problems than controls. • There was a significant association between child and caregiver difficulties. To describe the prevalence and associated factors of mental health problems in secondary school-aged (11–16 years) children with epilepsy and their primary caregivers compared to a control group without epilepsy. Children with epilepsy (n = 60), controls (n = 49), and caregivers (n = 60 epilepsy and n = 49 control group) completed a measure of the child's mental health (Strengths and Difficulties Questionnaire; SDQ). Primary caregivers in both groups completed a measure of their own mental health (Depression, Anxiety, and Stress Scale-21; DASS-21). Factors associated with child and caregiver mental health in the epilepsy group were explored using linear regression. There were no significant differences between the epilepsy and control group regarding age, gender, ethnicity and socioeconomic status. A higher proportion of children with epilepsy scored in the at-risk range on the SDQ indicating more mental health problems than the control group, as reported by the children (45% vs. 24 %) (p = 0.026) and caregivers (52% vs. 14 %) (p < 0.001). Primary caregivers of children with epilepsy had more symptoms of depression (p = 0.001), anxiety (p = 0.028) and stress (p = 0.019) than caregivers in the control group. Children with epilepsy with greater motor coordination problems had greater mental health difficulties. Children with epilepsy with more mental health difficulties had caregivers with more difficulties and caregivers of children with earlier onset of seizures had more mental health difficulties. Epilepsy confers a high risk for mental health problems in adolescents and their primary caregivers. There is a need to better understand the relationship between caregiver and child mental health difficulties in epilepsy. [ABSTRACT FROM AUTHOR]

[Display omitted] There are increasing numbers of metabolomic studies in food allergy (FA) and asthma, which, however, are predominantly limited by cross-sectional designs, small sample size, and being conducted in European populations. We sought to identify metabolites unique to and shared by children with FA and/or asthma in a racially diverse prospective birth cohort, the Boston Birth Cohort. Mass spectrometry–based untargeted metabolomic profiling was performed using venous plasma collected in early childhood (n = 811). FA was diagnosed according to clinical symptoms consistent with an acute hypersensitivity reaction at food ingestion and food specific-IgE > 0.35 kU/L. Asthma was defined on the basis of physician diagnosis. Generalized estimating equations were applied to analyze metabolomic associations with FA and asthma, adjusting for potential confounders. During a mean ± standard deviation follow-up of 11.8 ± 5.2 years from birth, 78 children developed FA and 171 developed asthma. Androgenic and pregnenolone steroids were significantly associated with a lower risk of FA, especially for egg allergy. N,N,N -trimethyl-5-aminovalerate (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.48-0.87), and 1-oleoyl-2-arachidonoyl-sn-glycero-3-phosphoinositol (OR = 0.77; 95% CI = 0.66-0.90) were inversely associated with FA risk. Orotidine (OR = 4.73; 95% CI = 2.2-10.2) and 4-cholesten-3-one (OR = 0.52; 95% CI = 0.35-0.77) were the top 2 metabolites associated with risk of asthma, although they had no association with FA. In comparison, children with both FA and asthma exhibited an altered metabolomic profile that aligned with that of FA, including altered levels of lipids and steroids. In this US multiethnic prospective birth cohort, unique and shared alterations in plasma metabolites during early childhood were associated with risk of developing FA and/or asthma. These findings await further validation. [ABSTRACT FROM AUTHOR]

[Display omitted] • In bivalves with asymmetric shells, DEGs are more abundant in the flat valve mantle. • LncRNA are new members of the bivalve biomineralization toolbox. • Biomineralization-related genes in the mantle are under cis regulation by lnRNAs. • Asymmetric Ostreidae family members share conserved regulatory gene modules. • Gene modules regulate calcium carbonate crystal growth and spatial orientation. Bivalve molluscs are abundant in marine and freshwater systems and contribute essential ecosystem services. They are characterized by an exuberant diversity of biomineralized shells and typically have two symmetric valves (a.k.a shells), but oysters (Ostreidae), some clams (Anomiidae and Chamidae) and scallops (Pectinida) have two asymmetrical valves. Predicting and modelling the likely consequences of ocean acidification on bivalve survival, biodiversity and aquaculture makes understanding shell biomineralization and its regulation a priority. This study aimed to a) exploit the atypical asymmetric shell growth of some bivalves and through comparative analysis of the genome and transcriptome pinpoint candidate biomineralization-related genes and regulatory long non-coding RNAs (LncRNAs) and b) demonstrate their roles in regulating shell biomineralization/growth. Meta-analysis of genomes, de novo generated mantle transcriptomes or transcriptomes and proteomes from public databases for six asymmetric to symmetric bivalve species was used to identify biomineralization-related genes. Bioinformatics filtering uncovered genes and regulatory modules characteristic of bivalves with asymmetric shells and identified candidate biomineralization-related genes and lncRNAs with a biased expression in asymmetric valves. A shell regrowth model in oyster and gene silencing experiments, were used to characterize candidate gene function. Shell matrix genes with asymmetric expression in the mantle of the two valves were identified and unique cis -regulatory lncRNA modules characterized in Ostreidae. LncRNAs that regulate the expression of the tissue inhibitor of metalloproteinases gene family (TIMPDR) and of the shell matrix protein domain family (SMPDR) were identified. In vitro and in vivo silencing experiments revealed the candidate genes and lncRNA were associated with divergent shell growth rates and modified the microstructure of calcium carbonate (CaCO 3) crystals. LncRNAs are putative regulatory factors of the bivalve biomineralization toolbox. In the Ostreidae family of bivalves biomineralization-related genes are cis -regulated by lncRNA and modify the planar growth rate and spatial orientation of crystals in the shell. [ABSTRACT FROM AUTHOR]

[Display omitted] • We present new zircon U-Pb, Hf, O isotopes from the Paleoproterozoic Karrat Group. • With provenance analysis of Karrat Group and Rinkian fold belt supracrustal rocks. • Zircon Hf isotopes identify new, abundant ca. 2.15–1.9 Ga juvenile magmatism. • Karrat Group sourced dominantly from orogenies involving the Rae craton. We use zircon U-Pb, Hf and O isotopes to constrain the depositional ages and provenance of metasedimentary rocks of the Paleoproterozoic Karrat Group of West Greenland and to understand the tectonic processes leading to basin development on the eastern Rae craton. An older supracrustal assemblage (Qeqertarssuaq complex) deposited after ca. 2.6 Ga is separated by an unconformity with a younger supracrustal assemblage (the Karrat Group). The Qaarsukassak Formation at the base of the Karrat Group was deposited after ca. 2.0 Ga, with dominantly Archean age modes. The youngest siliciclastic rocks (Nûkavsak and Mârmorilik formations) in the Karrat Group have maximum depositional ages ranging from ca. 1980 to 1950 to 1900 Ma and contain dominant detrital zircon age modes between ca. 2.50 and 1.93 Ga. A ca. 1.92 Ga supracrustal assemblage referred to as the northern domain (Karrat Group, sensu lato) is geographically separated from the Karrat Group (sensu stricto) by the Prøven igneous complex. The stratigraphy and detrital zircon profiles are compared to broadly coeval sedimentary units on the Rae craton and a unifying model of their deposition is presented. The Rae craton is the dominant detritus source; initially these sources were mostly local, changing to a mix of local and distal sources including the western Rae craton. The tectonic setting of the Karrat basin transitioned from extensional to convergent to collisional during its basin evolution, reflecting Wilson cycle phases within an epeiric sea. Accordingly, zircon Hf isotopes in our dataset track the evolution of the opening and closing of the Manikewan Ocean. Detrital zircon Hf isotopes in our dataset reveal a greater proportion of juvenile detritus (especially ca. 2.15–1.95 Ga) than is known from the currently exposed crustal record, pointing to the importance of the detrital zircon record for understanding Paleoproterozoic crustal and tectonic evolution. [ABSTRACT FROM AUTHOR]

Orthopedic surgeons are the third most frequent prescribers of opioid medications. Given the current opioid addiction crisis, it is critical to limit opioid prescriptions to the lowest effective dose. In this study, we investigated how the initial opioid prescription after shoulder surgery affects maximum possible opioid consumption. We hypothesized that fewer pills in the initial opioid prescription would lead to less opioid consumption, a lower refill request rate, and fewer post-surgery office contacts for pain. In this single-center, prospective, randomized controlled clinical trial, 74 adults who underwent shoulder arthroplasty, rotator cuff repair, or other arthroscopic shoulder procedures were enrolled from December 2020 to July 2022. Follow-up was completed by February 2023. Participants were randomly assigned to receive postoperative prescriptions of seven 5-mg oxycodone pills (n = 20), 15 pills (n = 29), or 23 pills (n = 25). The primary outcome was maximum possible opioid consumption within 2 weeks after surgery, calculated by assuming consumption of all pills in the initial prescription, as well as any refills. Secondary outcomes were the opioid prescription refill request rates, post-surgery pain-related telephone calls or messages to the provider's office ("office contacts") within 2 weeks after surgery, and American Shoulder and Elbow Surgeons pain scores 2 weeks after surgery. Baseline characteristics did not differ among groups except for mean age, which was younger in the 7-pill group (P =.047). Maximum possible opioid consumption increased with the number of pills initially prescribed, with means of 78 morphine milligram equivalents (MME) for the 7-pill group, 118 MME for the 15-pill group, and 199 MME for the 23-pill group (P <.001). None of the secondary outcome measures differed among groups. Refill request rates were 20% for the 7-pill group, 3.4% for the 15-pill group, and 12% for the 23-pill group (P =.20). The proportions of patients with at least 1 office contact were 35% in the 7-pill group, 45% in the 15-pill group, and 28% in the 23-pill group (P =.43). Mean American Shoulder and Elbow Surgeons pain scores were 49 in the 7-pill group, 44 in the 15-pill group, and 40 in the 23-pill group (P =.20). After shoulder surgery, an initial prescription of fewer opioid pills was associated with less maximum possible opioid consumption without an increase in the percentage of patients requesting opioid refills or contacting the provider's office for pain-related concerns. An initial postoperative prescription of fewer 5-mg oxycodone pills may be equally or more effective compared with larger quantities for most patients. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) is a modifiable risk factor for medical and infectious complications following total shoulder arthroplasty (TSA). Previous studies investigating BMI were limited to the conventional classification system, which may be outdated for modern day patients. Therefore, the purpose of this study was to identify BMI thresholds that are associated with varying risk of 90-day medical complications and 2-year prosthetic joint infection (PJI) following TSA. A national database was utilized to identify 10,901 patients who underwent primary elective TSA from 2013 to 2022. Patients were only included if they had a BMI value recorded within 1 month prior to TSA. Separate stratum-specific likelihood ratio analyses, an adaptive technique to identify data-driven thresholds, were performed to determine data-driven BMI strata associated with varying risk of 90-day medical complications and 2-year PJI. The incidence rates of these complications were recorded for each stratum. To control for confounders, each BMI strata was propensity-score matched based on age, sex, hypertension, heart failure, chronic obstructive pulmonary disease, and diabetes mellitus to the lowest identified BMI strata for both outcomes of interest. The risk ratio (RR) and 95% confidence interval (CI) were recorded for each matched analysis. The average age and BMI of patients was 70.5 years (standard deviation ±9.8) and 30.7 (standard deviation ±6.2), respectively. Stratum-specific likelihood ratio analysis identified two BMI strata associated with differences in the rate of 2-year PJI: 19-39 and 40+. The same strata were identified for 90-day major complications. When compared to the matched BMI 19-39 cohort, the risk of 2-year PJI was higher in the BMI 40+ cohort (RR: 2.7; 95% CI 1.39-5.29; P =.020). After matching, there was no significant difference in the risk of 90-day major complications between identified strata (RR: 1.19, 95% CI: 0.86-1.64; P =.288). A data-driven BMI threshold of 40 was associated with a significantly increased risk of 2-year PJI following TSA. This is the first TSA study to observe BMI on a continuum and observe at what point BMI is associated with increased risk of 2-year PJI following TSA. Our identified BMI strata can be incorporated into risk-stratifying models for predicting both PJI and 90-day major complications to minimize both. [ABSTRACT FROM AUTHOR]

The administration of tranexamic acid (TXA) in patients undergoing shoulder arthroplasty is a safe and effective means of reducing blood loss and blood transfusions. Due to its low cost and ability to prevent costly complications, TXA's use is thought to be a cost-saving practice. The purpose of this study was to determine the cost-effectiveness of TXA in preventing blood transfusions in patients undergoing reverse shoulder arthroplasty (RSA). The cost of TXA ($5.22) and the cost of a blood transfusion ($299.31) from our institution, as well as baseline published blood transfusion rates following RSA (14.3%) without the administration of TXA, were included in a break-even model to calculate the absolute risk reduction (ARR) that the routine use of TXA would need to be considered economically justifiable. To account for variance in baseline transfusion rates, the cost of TXA, and the cost of blood transfusion across institutions, sensitivity analyses were conducted in which the break-even transfusion rate and ARR were calculated across a wide range for each variable. TXA is deemed cost-effective if it prevents one blood transfusion out of 57 RSAs (ARR = 1.74%). It is economically viable at varying drug costs ($1-$25), blood transfusion costs ($50-$5000), and baseline transfusion rates (2.00%-50.00%). Using the cost parameters at a single institution, the current study found that TXA would be cost-effective in preventing blood transfusion if its routine use achieves an ARR greater than 1.74% following RSA. As the ARR has been demonstrated in the literature to be greater than 1.74%, TXA can be considered cost-effective in preventing blood transfusion following RSA. [ABSTRACT FROM AUTHOR]

Understanding the role of social determinants of health disparities (SDHDs) in surgical outcomes can better prepare providers to improve postoperative care. In this study, we use International Classification of Diseases (ICD) codes to identify SDHDs and investigate the risk of postoperative complication rates among patients undergoing total shoulder arthroplasty (TSA). A retrospective cohort analysis was conducted using a national insurance claims database. Using ICD and Current Procedural Terminology (CPT) codes, patients who underwent primary TSA with at least 2 years of follow-up in the database were identified. Patients with a history of SDHDs were identified using appropriate ICD-9 and ICD-10 codes. Patients were grouped in one of 2 cohorts: (1) patients with no history of SDHDs (control) and (2) patients with a history of SDHDs (SDHD group) prior to TSA. The SDHD and control groups were matched 1:1 for comorbidities and demographics prior to conducting multivariable analysis for 90-day medical complications and 2-year surgical complications. After matching, there were 8023 patients in the SDHD group and 8023 patients in the control group. The SDHD group had significantly higher odds for 90-day medical complications including heart failure, cerebrovascular accident, renal failure, deep vein thrombosis, pneumonia, sepsis, and urinary tract infection. Additionally, the SDHD group had significantly higher odds for revision surgery within 2 years following TSA. Patients in the SDHD group also had a significantly longer length of hospital stay following TSA. This study highlights the association between SDHDs and postoperative complications following TSA. Quantifying the risk of complications and differences in length of stay for TSA patients with a history of SDHDs is important in determining value-based payment models and risk stratifying to optimize patient care. [ABSTRACT FROM AUTHOR]

The incidence of liver disease continues to increase and is now one of the leading causes of death in the UK. The increasing prevalence of viral hepatitis combined with a surge in the incidence of both alcohol- and obesity-related liver disease mean that critical care units are increasingly being called upon to assist in managing those with life-threatening complications or end-stage liver disease. Decompensated cirrhosis is not a single-organ illness but a complex multi-system disorder typified by impaired immunity, malnutrition and multi-organ failure and presents a significant challenge to the critical care physician. In this article we describe the epidemiology, aetiology and pathophysiology of decompensated liver disease and describe the management strategies of a range of resulting clinical complications. [ABSTRACT FROM AUTHOR]

A large increase in hospital-onset and intensive-care-unit-onset Staphylococcus aureus bacteraemia rates in English acute trusts was observed between 2020 and 2021, coinciding with reported increases in coronavirus disease (COVID-19) cases and associated hospitalizations. Many of these S. aureus bacteraemia cases were defined as co-/secondary infections to COVID-19. Over the same period, increases in the percentage of ventilator-associated pneumonia-related bacteraemia were also found. The COVID-19 pandemic appears to have contributed to the increase in hospital-onset S. aureus bacteraemia in England; further studies are needed to better understand the impacts on patient outcomes. [ABSTRACT FROM AUTHOR]

Stroke is a major cause of mortality and disability, highlighting the importance of prevention. Clinical trials play an important role in evaluating interventions that can maximize stroke prevention. Traditional composite endpoints (TCE) used in clinical trials have limitations, as they pool together events of varying clinical importance. Weighted composite endpoints (WCE) have emerged as a solution to address these limitations and provide more accurate assessments of outcomes. In this study, we investigate the use of WCE in a previously reported negative clinical trial for stroke prevention. We analyzed data from the Vitamin Intervention for Stroke Prevention (VISP) trial, which compared high dose and low dose multivitamin therapy. We utilized weighted methods to analyze time-to-event outcomes with censoring. The primary outcomes of interest were time to nonfatal stroke, nonfatal coronary events, and death. We calculated modified Kaplan-Meier (KM) curves for each intervention group. We also performed a modified log-rank test to assess significant differences based on the weighted KM curves. The analysis included 3668 VISP trial participants, and most remained event-free throughout the study period. The TCE KM curve showed no significant difference in outcomes between high dose and low dose groups. Similarly, the WCE KM curves, with different weights assigned to each outcome, did not reveal significant differences in outcomes between the studied groups. This post-hoc analysis confirms the negative trial results of VISP and demonstrates the feasibility of using WCE in assessing nutrition-based interventions for stroke prevention. • Most cardiovascular trials use composite endpoints to determine efficacy of an outcome. • This traditional form of composite endpoint analysis is limited by pooling events of varying clinical importance. • Weighted composite outcome endpoints have emerged as a solution to provide more accurate assessments of outcomes. [ABSTRACT FROM AUTHOR]

Osteonecrosis of the humeral head is an uncommon condition, and treatment options are controversial. The shoulder is the second most common location for osteonecrosis, typically presenting between the second and fifth decades of life. Early diagnosis and treatment are essential because osteonecrosis may progress and lead to significant pain and loss of function. Nonoperative options are limited and are based on addressing the cause of the osteonecrosis. Multiple surgical treatments have been described, and these techniques continue to evolve. Open core decompression of the humeral head has been found to be an effective surgical option to restore blood supply and stimulate new bone formation. The evolution of arthroscopic techniques combined with biological adjuncts allows a minimally invasive approach with potential to accelerate revascularization and bone growth. We describe our technique for arthroscopic-assisted intraosseous bioplasty of the humeral head for the treatment of osteonecrosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Domesticated horses are often housed in individual stables for long periods where physical contact with conspecifics is not possible. Although common, this form of stable design is known to be detrimental to horse welfare. This study investigated the impact of short-term stabling (1-hour bouts) on behavioral expression using three stable conditions: a full wall, a barred window wall, and a half wall between paired horses in a within-subjects design study (N = 18). A mixed model (restricted maximum likelihood) was used to account for both stable condition and individual horse within the model. Behaviors influenced by stable design were those relating to vigilance and social affiliation. Horses spent a greater proportion of the observation time standing alert when in the full wall stable compared to the half wall stable (P = 0.009). The opposite is true of time spent standing and resting (P < 0.001). Compared to the window wall alone, horses in the half wall stable performed significantly more contact-seeking behaviors (P = 0.021). Horse owners often perceive stable design unimportant if only used for short periods of time, with the majority of their time budget spent at pasture with conspecifics. These results indicate that, even during short bouts of stabling, horses were more relaxed when stable design allowed them to engage in social behaviors with conspecifics and more vigilant when stable design left them physically isolated from conspecifics. [Display omitted] • Vigilance behavior in horses is influenced by stable design even when stabling duration is short. • Horses expressed more alert behaviors when isolated from conspecifics. • In contrast they performed more affiliative and relaxation behaviors when contact was possible. • Horses chose to actively engage in social behaviors when physical contact was possible in a stable. • This was despite being at pasture together for the other 23hrs of the day. [ABSTRACT FROM AUTHOR]

Total elbow arthroplasty (TEA) is often used to manage advanced arthropathies of the elbow caused by inflammatory conditions such as rheumatoid arthritis (RA). Recent literature has shown that use of TEA is decreasing in patients with RA, part of which can be attributed to early medical management involving disease-modifying antirheumatic drugs (DMARDs). However, there is a significant economic barrier to accessing DMARD therapy. The purpose of this study was to compare the use of TEA between patients with and without DMARD therapy from 2010 to 2020. A retrospective cohort analysis was performed using a national insurance claim database to investigate the trends of patients with RA undergoing TEA from 2010-2020. Patients who underwent TEA and had a diagnosis of RA were identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD)- 9 and ICD-10 codes between 2010 and 2020. These patients were then stratified into 2 cohorts: those with DMARD prescription claims and those without. A linear regression, compound annual growth rate (CAGR) analysis, and χ2 analysis were conducted to compare trends and demographic variables, including insurance type, between cohorts. Additionally, a multivariable logistic regression was subsequently performed to observe odds ratios (ORs) and 95% confidence intervals. From 2010 to 2020, there has been no significant change in the incidence of TEA in RA patients without DMARD prescriptions, whereas there has been a statistically significantly decreasing rate of TEA observed in RA patients with DMARD prescription claims. The analysis showed that there was a CAGR of −4%. For patients with a diagnosis of RA and DMARD prescription claims, the highest incidence of undergoing TEA was seen in the age group of 60-69 years, whereas patients with a diagnosis of RA and no DMARD prescription claims had the highest incidence of undergoing TEA in the age group of 70-79 years. The incidence of patients undergoing TEA with a diagnosis of RA and DMARD prescription claims has shown a statistically significant decrease from 2010 to 2020, whereas no significant difference was observed for patients without DMARD prescription claims. There were no statistically significant differences in the insurance plans between cohorts. [ABSTRACT FROM AUTHOR]

Magnetic Resonance (MR)-only radiotherapy for prostate cancer has previously been reported using fiducial markers for on-treatment verification. MR-Cone Beam Computed Tomography (CBCT) soft-tissue matching does not require invasive fiducial markers and enables MR-only treatments to other pelvic cancers. This study evaluated the first clinical implementation of MR-only prostate radiotherapy using MR-CBCT soft-tissue matching. Twenty prostate patients were treated with MR-only radiotherapy using a synthetic (s)CT-optimised plan with MR-CBCT soft-tissue matching. Two MR sequences were acquired: small Field Of View (FOV) for target delineation and large FOV for organs at risk delineation, sCT generation and on-treatment verification. Patients also received a CT for validation. The prostate was independently contoured on the small FOV MR, copied to the registered CT and modified if there were MR-CT soft-tissue alignment differences (MR-CT volume). This was compared to the MR-only volume with a paired t-test. The treatment plan was recalculated on CT and the doses compared. Independent offline CT-CBCT matches for 5/20 fractions were performed by three therapeutic radiographers using the MR-only contours and compared to the online MR-CBCT matches using two one-sided paired t-tests for equivalence within ±1 mm. The MR-only volumes were significantly smaller than MR-CT (p = 0.003), with a volume ratio 0.92 ± 0.02 (mean ± standard error). The sCT isocentre dose difference to CT was 0.2 ± 0.1%. MR-CBCT soft-tissue matching was equivalent to CT-CBCT (p < 0.001), with differences of 0.1 ± 0.2 mm (vertical), −0.1 ± 0.2 mm (longitudinal) and 0.0 ± 0.1 mm (lateral). MR-only radiotherapy with soft-tissue matching has been successfully clinically implemented. It produced significantly smaller target volumes with high dosimetric and on-treatment matching accuracy. MR-only prostate radiotherapy can be safely delivered without using invasive fiducial markers. This enables MR-only radiotherapy to be extended to other pelvic cancers where fiducial markers cannot be used. [ABSTRACT FROM AUTHOR]

Monetary rewards and punishments enhance motor performance and are associated with corticospinal excitability (CSE) increases within the motor cortex (M1) during movement preparation. However, such CSE changes have unclear origins. Based on converging evidence, one possibility is that they stem from increased glutamatergic (GLUTergic) facilitation and/or decreased type A gamma-aminobutyric acid (GABA A)-mediated inhibition within M1. To investigate this, paired-pulse transcranial magnetic stimulation was used over the left M1 to evaluate intracortical facilitation (ICF) and short intracortical inhibition (SICI), indirect assays of GLUTergic activity and GABA A -mediated inhibition, in an index finger muscle during the preparation of sequences initiated by either the right index or little finger. Behaviourally, rewards and punishments enhanced both reaction and movement time. During movement preparation, regardless of rewards or punishments, ICF increased when the index finger initiated sequences, whereas SICI decreased when both the index and little fingers initiated sequences. This finding suggests that GLUTergic activity increases in a finger -specific manner whilst GABA A -mediated inhibition decreases in a finger -unspecific manner during preparation. In parallel, both rewards and punishments non-specifically increased ICF, but only rewards non-specifically decreased SICI as compared to neutral. This suggests that to enhance performance rewards both increase GLUTergic activity and decrease GABA A -mediated inhibition, whereas punishments selectively increase GLUTergic activity. A control experiment revealed that such changes were not observed post-movement as participants processed reward and punishment feedback, indicating they were selective to movement preparation. Collectively, these results map the intracortical excitability changes in M1 by which incentives enhance motor performance. • Using ppTMS, ICF and SICI were assessed whilst participants prepared to initiate sequences under reward, neutral, and punishment conditions. • As compared to neutral, rewards and punishments enhanced both reaction and movement times, confirming that incentives enhanced performance. • During movement preparation, ICF increased in a finger -specific , whereas SICI decreased in a finger -unspecific , manner. • As compared to neutral, both rewards and punishments increased ICF but only rewards decreased SICI during preparation. • A control feedback processing experiment revealed that incentives altered ICF and SICI selectively during preparation. [ABSTRACT FROM AUTHOR]

The present study aims to quantify clinicians' perceptions of oral potentially malignant disorders (OPMDs) when evaluating, classifying, and manually annotating clinical images, as well as to understand the source of inter-observer variability when assessing these lesions. The hypothesis was that different interpretations could affect the quality of the annotations used to train a Supervised Learning model. Forty-six clinical images from 37 patients were reviewed, classified, and manually annotated at the pixel level by 3 labelers. We compared the inter-examiner assessment based on clinical criteria through the κ statistics (Fleiss's kappa). The segmentations were also compared using the mean pixel-wise intersection over union (IoU). The inter-observer agreement for homogeneous/non-homogeneous criteria was substantial (κ = 63, 95% CI: 0.47-0.80). For the subclassification of non-homogeneous lesions, the inter-observer agreement was moderate (κ = 43, 95% CI: 0.34-0.53) (P <.001). The mean IoU of 0.53 (±0.22) was considered low. The subjective clinical assessment (based on human visual observation, variable criteria that have suffered adjustments over the years, different educational backgrounds, and personal experience) may explain the source of inter-observer discordance for the classification and annotation of OPMD. Therefore, there is a strong probability of transferring the subjectivity of human analysis to artificial intelligence models. The use of large data sets and segmentation based on the union of all labelers' annotations holds the potential to overcome this limitation. [ABSTRACT FROM AUTHOR]

While soft tissues are commonly damaged by mechanical loading, the manifestation of this damage at the microstructural level is not fully understood. Specifically, while rate-induced stiffening has been previously observed in cerebral arteries, associated changes in microstructural damage patterns following high-rate loading are largely undefined. In this study, we stretched porcine middle cerebral arteries to failure at 0.01 and >150 s−1, both axially and circumferentially, followed by probing for denatured tropocollagen using collagen hybridizing peptide (CHP). We found that collagen fibrils aligned with the loading direction experienced less denaturation following failure tests at high than low rates. Others have demonstrated similar rate dependence in tropocollagen denaturation during soft tissue failure, but this is the first study to quantify this behavior using CHP and to report it for cerebral arteries. These findings may have significant implications for traumatic brain injury and intracranial balloon angioplasty. We additionally observed possible tropocollagen denaturation in vessel layers primarily composed of fibrils transversely aligned to the loading axis. To our knowledge, this is the first observation of collagen denaturation due to transverse loading, but further research is needed to confirm this finding. Previous work shows that collagen hybridizing peptide (CHP) can be used to identify collagen molecule unfolding and denaturation in mechanically overloaded soft tissues, including the cerebral arteries. But experiments have not explored collagen damage at rates relevant to traumatic brain injury. In this work, we quantified collagen damage in cerebral arteries stretched to failure at both high and low rates. We found that the collagen molecule is less damaged at high than at low rates, suggesting that damage mechanisms of either the collagen molecule or other elements of the collagen superstructure are rate dependent. This work implies that arteries failed at high rates, such as in traumatic brain injury, will have different molecular-level damage patterns than arteries failed at low rates. Consequently, improved understanding of damage characteristics may be expanded in the future to better inform clinically relevant cases of collagen damage such as angioplasty and injury healing. [Display omitted] [ABSTRACT FROM AUTHOR]

Many organizations have used pre-established body mass index (BMI) cut-offs to guide surgical decision-making. As there have been many improvements in patient optimization, surgical technique, and perioperative care over time, it is important to reassess these thresholds and contextualize them to total knee arthroplasty (TKA). The purpose of this study was to calculate data-driven BMI thresholds that predict significant differences in risk of 30-day major complications following TKA. Patients who underwent primary TKA from 2010 to 2020 were identified in a national database. Stratum-specific likelihood ratio (SSLR) methodology was used to determine data-driven BMI thresholds at which the risk of 30-day major complications increased significantly. These BMI thresholds were tested using multivariable logistic regression analyses. A total of 443,157 patients were included, who had a mean age of 67 years (range, 18 to 89 years), mean BMI of 33 (range 19 to 59), and 11,766 (2.7%) patients had a 30-day major complication. SSLR analysis identified four BMI thresholds that were associated with significant differences in 30-day major complications: 19 to 33, 34 to 38, 39 to 50, and 51+. When compared to those who had a BMI between 19 and 33, the odds of sustaining a major complication sequentially and significantly increased by 1.1, 1.3, and 2.1 times (P <.05 for all) for the other thresholds. This study identified four data-driven BMI strata using SSLR analysis that were associated with significant differences in the risk of 30-day major complications following TKA. These strata can be used to guide shared decision-making in patients undergoing TKA. [ABSTRACT FROM AUTHOR]

The Altmetric Attention Score (AAS) was developed to assess the impact a publication has on various social and mainstream media platforms. In this study, we examine the relationship between AAS and traditional bibliometric measures in peer-reviewed publications discussing total shoulder arthroplasty (TSA). The Altmetric database was utilized to identify the top 50 TSA articles with the highest AAS. The Clarivative Analytics Web of Knowledge database was utilized to obtain various metrics for each article. Linear regression analysis was performed to investigate significant relationship between the variables measured. Among the top 50 studies, the AAS ranged from 19 to 110 with a median of 26. The number of citations for each article ranged from zero to 147 with a median of 15.5. The average impact factor (IF) for journals was 3.45. AAS and number of citations showed a nonsignificant negligible correlation (r = −0.115, P =.425). AAS and IF of the journal of publication had a nonsignificant negligible correlation as well (r = 0.179, P =.215). The most common type of studies were retrospective cohort (32%), case series (20%), and systematic review (18%). In the current TSA literature, AAS is not a predictor for number of citations a manuscript receives and is not related to a journal's IF. Therefore, AAS should not be used in lieu of traditional bibliometric measures, although it could be used as a supplement by authors and journals to appraise their social media presence. [ABSTRACT FROM AUTHOR]

The use of tranexamic acid (TXA) has become widespread in orthopedics to promote hemostasis and has been successfully used to reduce blood loss and infection risk in joint arthroplasty. However, the cost effectiveness of routine TXA use for the prevention of periprosthetic infections in total shoulder arthroplasty remains unknown. The acquisition cost of TXA ($5.22) for our institution, along with values from the literature for the average cost of infection-related care ($55,243) and the baseline infection rates for patients without TXA use (0.70%),were used to perform a break-even analysis. The absolute risk reduction (ARR) of infection necessary to justify the prophylactic use of TXA in shoulder arthroplasty was calculated from the nontreated and break-even infection rates. TXA is considered cost-effective if it prevents one infection out of 10,583 total shoulder arthroplasty's (ARR = 0.009%). It is economically justifiable with an ARR range of 0.001% at a cost of $0.50/g to 0.181% at $100/g. At varying costs of infection-related care ($10,000-$100,000) and varying baseline infection rates (0.50%-8.00%) and routine use of TXA remained cost-effective. The use of TXA is an economically viable practice for infection prevention following shoulder arthroplasty if it reduces the infection rate by 0.009%. Future, prospective studies should be conducted to observe whether TXA reduces the infection rate by more than 0.009%, showing cost effectiveness. [ABSTRACT FROM AUTHOR]

This quality improvement project implemented job-related education for registered nurses (RNs) completing preoperative anesthesia interviews (PAIs) to increase their knowledge and confidence, improve completeness of documented preoperative interviews, and decrease day of surgery (DOS) cancellations. Pre/post implementation design and retrospective chart review. An educational module on PAIs was created and RNs working in the pre-admission testing (PAT) clinic were asked to complete the module. Pre and post implementation data was collected on RN knowledge and confidence, assessment completeness, and DOS cancellations. Knowledge and confidence increases were not statistically significant, although several interview components within PAI documentation improved with statistical significance. Overall DOS cancellations, although not statistically significant, were found to decrease, 1.3% to 1.2%. Registered nurses' knowledge, confidence and PAI completeness improved after completing the educational module with anesthetic considerations. Patients seen at the PAT clinic for PAIs before the DOS allowed for patient optimization and education leading to decreased preventable DOS cancellations. [ABSTRACT FROM AUTHOR]

The B.1.167.2 (Delta) variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. To describe COVID-19 outbreaks that occurred in Missouri LTCFs impacting staff and residents during the surge of the Delta variant. Outbreaks of COVID-19 in 178 LTCFs were identified by the Missouri Department of Health and Senior Services. Case data from LTCFs with the highest burden of disease were analysed to assess disease transmission, vaccination status, and outcomes among residents and staff. Additional investigational measures included onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. During April 22nd to July 29th, 2021, 159 COVID-19 cases among 72 staff members and 87 residents were identified in 10 LTCFs. More than 74.7% of resident cases were vaccinated compared to 23.6% of staff cases. Vaccinated residents had a lower proportion of hospitalizations and deaths reported compared to unvaccinated residents. Data analysis and contact-tracing efforts from a sample of the facilities suggest that staff members were likely a major factor in introducing SARS-CoV-2 virus into the facilities. Adherence to COVID-19 mitigation measures varied at the visited facilities. Data showed that vaccination rates varied between staff cases and resident cases in facilities with high-burden outbreaks. Differences were identified in mitigation practices in at least two facilities. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the feasibility of conducting a full-scale study investigating the influence of patient-related factors on rehabilitation outcomes in Achilles tendinopathy (AT). A secondary aim was to investigate preliminary relationships between patient-related factors and clinical outcomes at 12- and 26- weeks. feasibility cohort. Australian healthcare settings. Participants with AT receiving physiotherapy in Australia were recruited via treating physiotherapists and online. Data were collected online at baseline, 12- and 26-weeks. Progression criteria for a full-scale study were recruitment rate of ≥10 per month, conversion rate ≥20%, and response rate to questionnaires ≥80%. The relationship between patient-related factors and clinical outcomes was investigated using Spearman's rho correlation coefficient. The average recruitment rate was 5/month, conversion rate was 97%, and response rate to questionnaires was ≥97% at all timepoints. There was a fair to moderate correlation (rho = 0.225 to 0.683) between patient-related factors and clinical outcomes at the 12-week, but no to weak correlation at the 26-week (rho = 0.002 to 0.284). Feasibility outcomes suggest a future full-scale cohort study is feasible with the caveat of utilizing strategies to improve recruitment rate. Preliminary bivariate correlations at 12-weeks warrant further investigations in larger studies. • Full-scale cohort study investigating the influence of patients-related factors on AT rehabilitation is feasible. • Patient-related factors might affect AT rehabilitation outcomes at 12-week. • Patient-related factors may need to be considered when rehabilitating patients with AT. [ABSTRACT FROM AUTHOR]

Osteochondral defects of the shoulder due to posterior instability are less frequent than those caused by anterior instability. Although uncommon, locked posterior dislocations can create sizable osteochondral lesions of the anterior humeral head known as reverse Hill-Sachs lesions. Treatment of these defects to restore the congruent contour of the glenohumeral joint is essential to reduce recurrence of instability and prevent long-term sequelae of arthritis. Historically, nonanatomic options, such as transposition of the subscapularis tendon or lesser tuberosity into the defect and humeral rotational osteotomy, have been endorsed to treat reverse Hill-Sachs lesions. More contemporary techniques have focused on restoring not only the bony architecture but also the chondral surface using fresh osteochondral allografts. The evolution of this approach has been challenging because of the large impacted wedge-shaped defect typically encountered with a locked posterior dislocation. Many surgeons employ techniques using multiple circular grafts or customizing a nonanatomic graft to fill these defects. Given the unstable nature of these grafts, metallic screws are often placed through the chondral surface for fixation. The evolution of the "BioHumi" technique has made treatment of large reverse Hill-Sachs lesions technically simpler and more reproducible using innovative instrumentation to transplant an elliptical osteochondral allograft. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Dual energy X-ray absorptiometry (DXA) is widely used for the assessment of lean mass (LM), fat mass (FM) and bone mineral content (BMC). When observing standardised protocols, DXA has a high level of precision for the assessment of total body composition, including the head region. However, including the head region may have limited relevance in athletes and can be problematic when positioning taller athletes who exceed scan boundaries. This study investigated the precision of a new total-body-less-head (TBLH) DXA scan for three-compartment body composition measurement in athletes, with outcomes compared to the standard total-body DXA scan. Methods: Precision errors were calculated from two consecutive scans with re-positioning (Lunar iDXA, GE Healthcare, Madison, WI), in male and female athletes from a range of sports. TBLH precision was determined from repeat scans in 95 athletes (male n = 55; female n = 40; age: 26.0 ± 8.5 y; body mass: 81.2 ± 20.5 kg; stature: 1.77 ± 0.11 m), and standard total-body scan precision was derived from a sub-sample of 58 athletes (male n = 19; female n = 39; age: 27.6 ± 9.9 y; body mass: 69.6 ± 14.8 kg; stature: 1.72 ± 0.94 m). Data from the sub-sample were also used to compare precision error and 3-compartment body composition outcomes between the standard total-body scan and the TBLH scan. Results: : TBLH precision errors [root mean squared-standard deviation, RMS-SD (coefficient of variation, %CV)] were bone mineral content (BMC): 15.6 g (0.5%), lean mass (LM): 254.3 g (0.4%) and fat mass (FM): 199.4 g (1.3%). These outcomes compared favourably to the precision errors derived from the standard total-body scan [BMC: 12.4 g (0.4%), LM: 202.2 g (0.4%), and FM: 160.8 g (1.1%)]. The TBLH scan resulted in lower BMC (-19.5%), LM (-6.6%), and FM (-4.5%) compared to the total-body scan (BMC: 2,308 vs. 2,865 g; LM: 46,954 vs. 50,276 g; FM: 15,183 vs. 15,888 g, all p<0.005). Conclusion The TBLH scan demonstrates high in-vivo precision comparable to that of the standard total-body scan in a heterogeneous cohort of athletes. Given the impact of head exclusion on total body composition outcomes, TBLH scans should not be used interchangeably with the standard total-body scan. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate if administration of iodinated contrast during endovascular interventions in arteriovenous fistula (AVF) in patients not requiring dialysis (predialysis patients) (1) negatively affects their renal function and (2) if oral hydration has a protective effect. All pre-dialysis patients who underwent endovascular interventions in AVF between August 2010 and April 2019 were included in the study. During the procedures, 35 to 50 mL of Iodixanol were administered. A pre-hydration protocol was introduced in March 2015. Data were grouped before and after this date. The difference between pre- and post-contrast estimated glomerular filtration rate (eGFR) and the difference between the eGFR of hydrated and non-hydrated groups were calculated. Eighty-four patients who underwent 151 procedures were included in the study. In 60.3% of procedures, a mean decrease of 1.35 mL/min/1.73 m2 in eGFR was noted (95% confidence interval [CI], 1.02-1.69 mL/min/1.73 m2), whereas in 35.1% of procedures, there was a mean increase of 1.06 mL/min/1.73 m2 (95% CI, 0.84-1.28 mL/min/1.73 m2). The mean difference between pre- and post-procedure eGFR was −0.44 mL/min/1.73 m2 (95% CI, −0.72 to −0.16 mL/min/1.73 m2; P =.002). Oral hydration was associated with a smaller mean change in eGFR of −0.32 mL/min/1.73 m2 (95% CI, −0.62 to −0.03 mL/min/1.73 m2) compared with the non-hydrated group, with mean change of −0.47 mL/min/1.73 m2 (95% CI, −0.91 to −0.03 mL/min/1.73 m2), but this was not statistically significant (P =.586). This study demonstrates that administration of up to 50 mL of iodinated contrast for endovascular interventions in AVF in predialysis patients has minimal adverse effect on the eGFR with questionable clinical significance. In addition, oral hydration before and after the procedure has only a mild protective effect against a decrease in eGFR. [ABSTRACT FROM AUTHOR]

• Critical thinking instruction correlates with higher relative gains on writing tests. • Instruction in critical thinking has transferable benefits to literacy areas. • Explicitly teaching argumentation and the values of inquiry may assist students to navigate the cognitive demands of writing. Critical thinking is an international educational and economic priority, as are writing and effective communication skills. Little is known, however, about how these skills interact or whether instruction in one skillset has transferable benefits to the other. Given declining performance in writing skills in the Australian context, evidence that critical thinking instruction improves students' writing performance should be of interest to policy makers and school leaders. In this quasi-experimental retrospective cohort study, we utilised multilevel modelling to examine the effects of direct online critical thinking instruction on writing performance by Queensland state school students as measured by results from the Australian standardised testing scheme (NAPLAN) assessing writing structure, grammar, and spelling. Receiving critical thinking instruction correlated with significantly higher relative gains in academic performance across literacy domains and year levels compared to a comparable numeracy instruction control. We argue that these findings indicate a transfer of cognitive skills developed through critical thinking instruction to literacy domains and discuss the potential mechanisms underlying these effects. We summarily hypothesise that improving students' ability to identify, analyse, construct, and evaluate arguments empowers them to navigate the cognitive and metacognitive demands of academic writing with greater ease, leading to improved outcomes in standardised test settings and on writing tasks more generally. [ABSTRACT FROM AUTHOR]

Oil sands activities in the Athabasca Oil Sands Region in Alberta, Canada, are large sources of atmospheric NO x and SO 2. This study investigated the impact of oil sands emissions on the atmospheric deposition of nitrogen and sulfur species at a downwind site, about 350 km from the oil sands facilities. Measurement data are from the Canadian Air and Precipitation Monitoring Network (CAPMoN) from 2015 to 2019, including ambient concentrations of HNO 3 , pNO 3 -, NO 2 , pNH 4 +, NH 3 , SO 2 , pSO 4 2− and base cations, as well as concentrations of NO 3 −, SO 4 2−, NH 4 +, and base cations in precipitation. Sector analysis of air mass back trajectories was conducted to distinguish measurements with different air mass origins. Median atmospheric concentrations and dry deposition fluxes of HNO 3 , pNO 3 -, NO 2 , pNH 4 +, pSO 4 2−, and SO 2 on days when the air masses came from the oil sands sector were significantly greater than those with the "Clean" sector by 34–67%, whereas the difference in NH 3 concentration was not significant. Contributions of the oil sands emissions to dry deposition fluxes of these species ranged from 3.8 to 13.1%. The precipitation-weighted mean concentrations of NO 3 −, SO 4 2−, and NH 4 + in samples with the oil sands sector were 76 %, 65 % and 81 % greater than those with the "Clean" sector, respectively. Contributions of the oil sands emissions to wet deposition of NO 3 −, SO 4 2−, and NH 4 + were 12.5 ± 8.9 %, 8.7 ± 4.4 %, and 6.0 ± 3.3 %, respectively. The annual total deposition of nitrogen and sulfur were 1.9 kg-N ha−1 and 0.74 kg-S ha−1, respectively, of which 8.0 ± 3.5 % and 8.7 ± 3.6 % were from oil sands emissions. The total deposition of sulfur and nitrogen did not exceed the critical loads (CL) of acidity, but nitrogen deposition exceeded the CLs of nutrient nitrogen in the region. [Display omitted] • Oil sands emissions contributed to 9% of S and 8% of N deposition at a remote site. • Contributions from urban (∼500 km away) areas were significant. • Wet deposition dominated total deposition of S and N at this site. • Average total annual deposition was 1.9 kg-N ha−1 and 0.74 kg-S ha−1. • N total deposition exceeded critical loads of nutrient N in this region. [ABSTRACT FROM AUTHOR]

[Display omitted] • Two stages of magmatism are identified in the Gangou section of the Chinese Tianshan. • The Late Carboniferous and Permian magmatism recorded tectonic transition. • The Carboniferous intermediate rocks were derived from melting of mantle wedge. • The Permian magmatic rocks show a genetic link with upwelling of asthenosphere mantle. Multiple arc systems were developed in response to Neoproterozoic to Mesozoic consumption of the Paleo-Asian Ocean and their magmatic evolution is crucial for understanding the arc-arc amalgamation in the Central Asian Orogenic Belt. Here, we report whole-rock geochemical data as well as simultaneous in situ zircon U-Pb and Lu-Hf isotope results for the late Paleozoic magmatic rocks associated with the shear zones in the Gangou section of the Eastern Tianshan to constrain their petrogenesis and arc-arc amalgamation processes. We obtained ∼307 Ma and ∼270 Ma zircon U-Pb ages for the Late Carboniferous diorites and Middle Permian andesites, respectively. These rocks have high Mg# (∼65 and ∼47, respectively) values, and are enriched in large ion lithophile elements (LILEs) and depleted in high field strength elements (HFSEs), with depleted zircon ε Hf (t) values (+12.1 to +18.1), suggesting an origin from partial melting of the depleted mantle with various degree of differentiation. Furthermore, our results also provided ∼276 Ma zircon U-Pb ages for the Middle Permian granitic porphyries and ∼256 Ma zircon U-Pb ages for the Late Permian diabase rocks. The granitic porphyries are geochemically similar to A 2 -type granites, i.e., high K 2 O + Na 2 O, FeOT/MgO, Ga/Al and low CaO, Sr and Ba. They have high zircon ε Hf (t) (+9.0 to +13.7) values, indicating a possible derivation from juvenile lower crust. The diabase rocks show depletion of light rare earth elements (LREEs), resembling normal mid-ocean ridge basalt. These rocks have depleted zircon Hf isotopic compositions (ε Hf (t) = +8.9 to +15.8), demonstrating a possible derivation from partial melting of the depleted mantle. The available geochemical data from the Eastern Tianshan show that the Permian mafic rocks along the shear zones possess higher Nb/La and lower Ba/La ratios than their counterparts in the Carboniferous. These contrasting features imply that the Carboniferous mafic rocks originated from a metasomatic mantle wedge, while the Permian mafic rocks were likely derived from the depleted mantle with addition of enriched asthenosphere components. The high zircon saturation temperatures (mostly > 800 °C) of the Permian A-type granitoids and diverse magma sources of coeval mafic rocks also imply possible asthenosphere upwelling. Therefore, we propose that the Late Carboniferous magmatic rocks were likely resulted from subduction of the North Tianshan oceanic plate, while the spatial and temporal evolution of the Permian magmatic rocks were probably attributed to large-scale dextral transcurrent tectonics associated with arc-arc amalgamation. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Pediatric emergencies pose a challenge to primary care practices due to irregular frequency and complexity. Simulation-based assessment can improve skills and comfort in emergencies. Our aim was improving pediatric office emergency preparedness, as measured by adherence to the existing American Academy of Pediatrics policy statement, and quality of emergency care in a simulated setting, as measured by performance checklists. METHODS: This was a single center study nested in a multi-center, prospective study measuring emergency preparedness and quality of care in 16 pediatric primary care practices and consisted of 3 phases: baseline assessment, intervention, and follow-up assessment. Baseline emergency preparedness was measured by checklist based on AAP guidelines, and quality of care was assessed using in-situ simulation. A report-out was provided along with resources addressing potential areas for improvement after baseline assessment. A repeat preparedness and simulation assessment was performed after a 6 to 10 month intervention period to measure improvement from baseline. RESULTS: Sixteen offices were recruited with 13 completing baseline and follow-up preparedness assessment. Eight of these sites also completed baseline and follow-up simulation assessment. Median baseline preparedness score was 70% and follow-up was 75.9%. Median baseline simulation performance scores were 37.4% and 35.5% for respiratory distress and seizure scenarios, respectively. Follow-up simulation assessment scores were 73% and 76.9% respectively (P = .001). CONCLUSIONS: Our collaborative was able to successfully improve the quality of care in a simulated setting in a group of pediatric primary care offices over 6 to 10 months. Future work will focus on expansion and improving emergency preparedness. [ABSTRACT FROM AUTHOR]

In response to advice from The National Institute for Health and Care Excellence (1) to reduce hospital visits during COVID-19, standard headrests were introduced for head and neck radiotherapy within Northern Centre for Cancer Care (NCCC). The standard headrest requires one mould room appointment compared to 3 appointments with customised headrests. Two groups of 10 patients treated between December 2019 and June 2020 were retrospectively analysed by 1 observer. Groups were stratified according to age, sex and tumour site. One group had customised headrest and the other had standard headrest. Five hundred and forty seven cone beam computed tomography images were reviewed. A 6 Degree of Freedom match was performed then chin, shoulder and spine position were assessed using dosimetrist drawn structures. Structures out of the tolerance were recorded. A chi-squared test was used for statistical analysis. The out of tolerance chin position count recorded was 21 for customised headrest and 36 for standard headrest, p-value 0.046. The shoulder position count was 13 for customised headrest and 77 for standard headrest p-value <0.001. The spine position count was 3 for CHR and 21 for standard headrest, p-value <0.001. This means the headrests compared are not equivalent in terms of set up reproducibility. Overall the standard headrest group had 10 set-up re-scans and no set up re-scans were recorded in the customised headrest group. Fewer hospital visits with SHR reduce patient exposure to COVID-19. However, CHR provided a more reliable level of immobilisation in this study. The radiotherapy service will be reviewed in line with these findings. [ABSTRACT FROM AUTHOR]

Masculine facial morphology (e.g., larger jaw, prominent cheekbones) have been linked to a suite of social outcomes—including greater wealth, career progress, romantic desirability, and even greater political success. A leading explanation for these links is that dominant facial structures represent honest cues of physical dominance and fighting ability. Třebický et al. (2013) published the first study to demonstrate that masculine facial cues (e.g., large nose, deep-set eyes) similarly predict both dominance judgments and real-world fighting success, but no studies have replicated these popular findings that a large and specific assortment of masculine facial structures are implicated in both fighting ability and dominance perception. Thus, we conducted a pre-registered direct replication and extension of Třebický et al. (2013). Two separate samples of United States MTurk participants rated 516 UFC fighters' facial photographs on perceived aggressiveness (N = 500) and fighting ability (N = 500). Results showed that perceived aggressiveness was associated with masculine facial morphology (e.g., large nose, deep-set eyes) independent of bodily size. There was also some evidence that perceived fighting ability was associated with masculine facial morphology, which disappeared after controlling for bodily size. There was no support for the relation between facial structure and fighting success, and there were often negative relations between perceived aggressiveness and fighting ability on fighting success (i.e., more successful fighters were perceived as less successful and aggressive). We argue that our evolved psychology differentially processes the distinct avenues to victory that constitute overall fighting success (e.g., knockout versus submission wins). [ABSTRACT FROM AUTHOR]

The objective of this study was to determine whether state-level policies that restrict minors' access to confidential HIV testing without parental consent may suppress HIV testing in young men who have sex with men (YMSM) in the United States. Secondary data from a national HIV prevention trial among YMSM aged 13–17 years (N= 612) were analyzed to evaluate the association between living in a state with restrictive HIV testing policies for minors and HIV testing behavior, awareness of home-based HIV testing, and confidential interactions with a physician. Multilevel logistic regression models were adjusted for age, parents' education level, race, ethnicity, sexual orientation, being sexually experienced, and health literacy of medical forms and controlled for clustering by state. Age-stratified models by state-level age of consent for HIV testing and a subanalysis (including only sexually experienced participants) were also conducted. Residing in a state with restrictive HIV testing policies was associated with the lack of awareness of home-based HIV testing (adjusted odds ratio [aOR]: 3.06; 95% confidence intervals [CI]: 1.49, 6.28). No significant associations were found for HIV testing behavior (aOR: 1.81; 95% CI: 0.85, 3.84), speaking privately with a physician (aOR: 1.00; 95% CI: 0.56, 1.79), or discussing confidentiality with a physician (aOR: 0.95; 95% CI: 0.52, 1.71) and HIV testing policies for minors. These results were consistent in both the age-stratified models and subanalysis. HIV testing proportions among YMSM did not differ by state-level minor consent laws. However, YMSM living in states with restrictive policies on HIV testing for minors were less likely to be aware of home-based HIV testing. [ABSTRACT FROM AUTHOR]

• This review assessed Indigenous Peoples and Local Communities' (IPLC) values of nature through a gender lens. • IPLC hold plural values of nature, particularly nature's contributions to their subsistence and livelihoods. • Values differed between women and men due to gendered responsibilities (e.g. resource use and household duties). • More research on relational values is needed, particularly regarding cultural, spiritual, and aesthetic values. • Applying a gender lens to IPLC values of nature can foster equitable and just conservation decision making. Values of nature have different forms and are expressed through a variety of ways, depending on the culture and people in focus. Such values influence decisions and policies made about nature, especially regarding conservation and management. Current decision-making predominately focuses on instrumental and economic values of nature, often neglecting diverse and plural values, including intrinsic and relational ones. Additionally, the voice of marginalized communities such as Indigenous People and Local Communities (IPLC), and more so, Indigenous women, is often not recognized, leading to inequitable outcomes. Even though gender has been shown to influence value perceptions, no comprehensive review exists of how it affects values of nature within IPLC. This review aims to close this gap. Through a systematic literature review and thematic analysis, this paper highlights the values of nature and Nature's Contributions to People held by IPLC and insights of applying a gender lens to existing research in this field. The results indicate a focus on study areas in Asia, South America and Africa, as well as toward forests as ecosystems. The predominant valuation methods include preference assessments and semi-structured interviews. This review shows that IPLC hold diverse values, including instrumental, intrinsic, and relational values. Gendered insights were found to be connected to gendered responsibilities within communities. For example, domestic food products, homegardens, and wild edible plants are often of higher importance to female IPLC, due to their prominent role in household and family care. Research gaps on gendered values have also been shown, especially for religious, spiritual, and cultural heritage values. [ABSTRACT FROM AUTHOR]

Our aim was to assess the impact of COVID-19 pandemic on mortality in patients hospitalised with Gram-negative bloodstream infections (GNBSIs). A retrospective cohort study including cases of Escherichia coli , Klebsiella species and Pseudomonas aeruginosa in England (January 2015–December 2021) reported to UKHSA's Second Generation Surveillance System. The outcome was 30-day all-cause mortality. Multivariable logistic regression models were built, and adjusted Odds Ratios (ORs) with 95% confidence intervals were reported. Total E. coli , Klebsiella spp. and P. aeruginosa infections were 206,030, 53,819 and 21,129, respectively. Compared to the pre-pandemic period, odds of death during the pandemic (March 2020 onwards) in E. coli , Klebsiella spp. and P. aeruginosa infections with no COVID-19 infection within 28-days of onset were 1.13 (1.08–1.18), 1.15 (1.07–1.25) and 1.09 (0.97–1.22), while odds in GNBSIs with an associated COVID-19 infection were 2.45 (2.26–2.66), 2.96 (2.62–3.34) and 3.15 (2.61–3.80), respectively. Asian patients with an associated COVID-19 infection were more likely to die during the pandemic compared to White patients (E. coli : OR 1.28 (0.95–1.71); Klebsiella spp. OR 1.59 (1.20–2.11); P. aeruginosa : OR 2.02 (1.23–3.31)). Patients suffering from a GNBSI had increased risk of death during the pandemic, with the risk higher in patients with an associated COVID-19 infection. • Patients with GNBSIs in England had higher mortality during the COVID-19 pandemic. • Risk of death was higher in GNBSIs with an associated COVID-19 infection. • Asian ethnic GNBSI patients had disproportionately higher mortality during the pandemic. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) is a poisonous gas produced by incomplete combustion of carbon-based fuels that is linked to mortality and morbidity. Household air pollution from burning fuels on poorly ventilated stoves can lead to high concentrations of CO in homes. There are few datasets available on household concentrations of CO in urban areas of sub-Saharan African countries. CO was measured every minute over 24 h in a sample of homes in Nairobi, Kenya. Data on household characteristics were gathered by questionnaire. Metrics of exposure were summarised and analysis of temporal changes in concentration was performed. Continuous 24-h data were available from 138 homes. The mean (SD), median (IQR) and maximum 24-h CO concentration was 4.9 (6.4), 2.8 (1.0–6.3) and 44 ppm, respectively. 50% of homes had detectable CO concentrations for 847 min (14h07m) or longer during the 24-h period, and 9% of homes would have activated a CO-alarm operating to European specifications. An association between a metric of total CO exposure and self-reported exposure to vapours >15 h per week was identified, however this were not statistically significant after adjustment for the multiple comparisons performed. Mean concentrations were broadly similar in homes from a more affluent area and an informal settlement. A model of typical exposure suggests that cooking is likely to be responsible for approximately 60% of the CO exposure of Nairobi schoolchildren. Household CO concentrations are substantial in Nairobi, Kenya, despite most homes using gas or liquid fuels. Concentrations tend to be highest during the evening, probably associated with periods of cooking. Household air pollution from cooking is the main source of CO exposure of Nairobi schoolchildren. The public health impacts of long-term CO exposure in cities in sub-Saharan Africa may be considerable and should be studied further. [Display omitted] • Carbon monoxide concentrations in homes in a large African city are substantial. • Exposure to CO is likely to adversely affect the health of many urban dwellers in Africa. • CO levels were similar in homes in an informal settlement and a more affluent area. • Children receive most of their CO exposure during the evening when dinner is prepared. [ABSTRACT FROM AUTHOR]