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The aim of this study was to evaluate the filling ability of 2 obturation techniques in 3-dimensional (3D) printed teeth with perforating internal resorption (PIR). A maxillary central incisor was instrumented and scanned by micro–computed tomographic (micro-CT) imaging. The 3D model was exported in the stereolithographic format and, with the aid of OrtogOnBlender software (Cícero Moraes, Sinop, SP, Brazil), a PIR in the middle third of the root canal was designed. Thirty-two replicas were printed in surgical resin and distributed into 4 groups (n = 8) according to the obturation technique and the material used: 2 groups used the hybrid technique, 1 with Bio-C Sealer (BCS; Angelus, Londrina, PR, Brazil)/gutta-percha (GP; VDW GmbH, Munich, Germany) + Bio-C Repair (BCR; Angelus, Londrina, PR, Brazil) and the other with BioRoot (BR; Septodont, Saint Maur des Fosses, France)/gutta-percha (GP) + Biodentine (BD; Septodont, Saint Maur des Fosses, France), and 2 groups used the incremental technique, 1 with BCR and the other with BD. Postobturation micro-CT imaging was performed to measure the percentage volume of voids and laser confocal microscopy to measure the surface roughness (μm) of the repair cements. Data were compared using analysis of variance and Kruskal-Wallis tests. Regarding the filling volume in the apical third, the BCS/GP + BCR (89.70 ± 5.15), BR/GP + BD (87.70 ± 8.43), and BCR (84.20 ± 9.00) groups showed the highest percentages compared with the BD group (69.70 ± 6.88) (P <.05). In the area of internal resorption, the BCS/GP + BCR (96.00 ± 2.64) and BCR (95.30 ± 2.93) groups showed the highest percentages compared with the BR/GP + BD group (91.50 ± 1.35) (P <.05). The BD group showed intermediate values that were sometimes similar to the BCS/GP + BCR and BCR groups and similar to the BR/GP + BD group (P >.05). Regarding the quality of the filling in the perforation area, the BCR group showed better results compared with the BD group (P <.001). Regarding roughness, the BCR group (1.66 ± 0.65) showed lower surface roughness compared with the BD group (2.51 ± 0.89) (P <.05). The capacity and quality of the filling in teeth with PIR were superior with the incremental technique with BCR and the hybrid technique with BCS/GP + BCR. [ABSTRACT FROM AUTHOR]

The main objective of this paper is to propose a novel SEIR stochastic epidemic model. A distinguishing feature of this new model is that it allows us to consider a setup under general latency and infectious period distributions. To some extent, queuing systems with infinitely many servers and a Markov chain with time-varying transition rate comprise the very technical underpinning of the paper. Although more general, the Markov chain is as tractable as previous models for exponentially distributed latency and infection periods. It is also significantly more straightforward and tractable than semi-Markov models with a similar level of generality. Based on stochastic stability, we derive a sufficient condition for a shrinking epidemic regarding the queuing system's occupation rate that drives the dynamics. Relying on this condition, we propose a class of ad-hoc stabilising mitigation strategies that seek to keep a balanced occupation rate after a prescribed mitigation-free period. We validate the approach in the light of the COVID-19 epidemic in England and in the state of Amazonas, Brazil, and assess the effect of different stabilising strategies in the latter setting. Results suggest that the proposed approach can curb the epidemic with various occupation rate levels if the mitigation is timely. • We propose queue-based stochastic epidemic model for viral epidemics. • The model is tractable yet general and applicable to large populations. • It describes epidemics with general latency and infectious periods. • We derive a control rule that ensure a shrinking epidemic. • Our experiments illustrate the effectiveness of the proposed control rule. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested that symptomatic cancer patients often experience delays in diagnosis (DD). However, DD of gastric cancer within the USA and etiology of those delays are not understood. Our study quantifies the proportion of gastric cancer patients experiencing DD and contributing barriers of care. Methods: We conducted a single institution retrospective review of 256 gastric cancer patients treated between 2015 and 2020. Patients with an interval from symptom onset to diagnosis of > 90 days were classified as having DD and categorized into one of the following barriers of care: access, provider knowledge/skills, and patient factors. Chi-square tests were used to analyze categorical group differences. Non-pooled t-tests and ANOVA were used to compare differences in group means. Results: A total of 59 patients (23%) had DD. Among patients with DD, the mean time from symptom onset to diagnosis was 229 days vs 30 days in the non-delayed group (p < 0.0001). The most common barrier of care was provider knowledge/skills gaps (44%), followed by access (36%) and patient-related factors (20%). Only 5% of patients who experienced delays reported abdominal pain alone, with the remaining 95% of patients reporting more than one symptom including obstruction, gastrointestinal bleeding, or weight loss. Conclusion: Patients often face lengthy delays in gastric cancer diagnosis which arise from healthcare system factors such as access barriers or gaps in provider knowledge/skills. Understanding concerning alarm symptoms and addressing identified barriers will expedite patient diagnosis and are prime opportunities to improve outcomes for gastric cancer patients. [ABSTRACT FROM AUTHOR]

AAC-8 and AAC-24 are two widely used scales to evaluate abdominal aortic calcification (AAC) on X-ray images. Levels of ≥3 (AAC-8) and ≥5 points (AAC-24) are of high relevance since they are associated with greater risk of cardiovascular events. Given that it is unknown, our aim was to determine the reliability of both scales at those levels of atherosclerotic burden. The sample (93 subjects, 67.3 ± 9.7 years, BMI 28.8 ± 3.8, 57.6% smokers, 64.1% with hypertension) was classified according to quartiles of calcification. Six clinicians evaluated AAC independently with both scales on lateral lumbar spine X-ray images. We analyzed inter-rater agreement with the intraclass correlation coefficient (ICC) and the Bland-Altman scatterplots. We assessed 15 pairs of raters. Scores in both scales were significantly correlated with cardiovascular risk (r = 0.31 and r = 0.32; p < 0.005). Agreement was very high in the first quartile and moderate in the rest (p < 0.05). At cut-off points, ICC = 0.70 (95%CI, 0.54–0.86) and ICC = 0.68 (95%CI, 0.60–0.85) with AAC-8 and AAC-24. With the Bland-Altman method, mean of the differences ranged between 0 and 0.4 (AAC-8), and between 0.2 and 1 (AAC-24), while 95% limits of agreement showed values between 2.9 and 4.4 (AAC-8), and between 6 and 11.2 (AAC-24). Analyzing entire scales, ICC = 0.97 (95%CI, 0.97–0.98) and ICC = 0.98 (95%CI, 0.97–0.98) for AAC-8 and AAC-24, respectively. Both scales presented only moderate reliability at levels of atherosclerotic burden. Analyzing quartiles with ICC and the Bland-Altman plot showed concordant results. High global ICC values traditionally reported with both scales are likely biased. AAC predicts subsequent vascular morbidity and mortality and should implicate evaluation of cardiovascular risk. Optimal visualisation of AAC and its correct assessment are mandatory in order to maximize patient care. [ABSTRACT FROM AUTHOR]

Background In the United States, the 13-valent pneumococcal conjugate vaccine has been recommended for children since 2010 and for adults aged ≥65 years since 2014. We assessed S. pneumoniae antimicrobial nonsusceptibility among adults with suspected pneumonia from hospital settings. Methods Isolates were collected from 105 US sites between 2009 and 2017 in the SENTRY Antimicrobial Surveillance Program. Clinical and Laboratory Standards Institute methods were used for susceptibility testing. Serotypes were determined by cpsB sequence obtained by PCR or whole genome sequencing, plus multiplex PCR and/or Neufeld Quellung reactions as needed. Findings Of 7254 S. pneumoniae isolates analyzed, 63.6% and 36.4% were from patients aged 18‒64 and ≥65 years, respectively. Among all isolates, penicillin and ceftriaxone nonsusceptibility declined by 72.3% and 73.8%, respectively, with smaller changes observed for other antibiotics. Nonsusceptibility patterns were serotype-specific; for example, nonsusceptibility was relatively stable for serotype 19A but declined for 19F. Simultaneously, the percentage of serotype 19A isolates decreased from 17.4% to 3.9%, whereas for serotype 19F this percentage increased from 2.8% to 5.0%. The percentage of serotype 3 isolates that were nonsusceptible increased for select antibiotic classes, and the percentage of serotype 3 among all isolates increased minimally from 10.2% to 11.8%. Interpretation Overall pneumococcal nonsusceptibility patterns were influenced by distinct patterns within serotypes, indicating the likelihood of serotype-specific resistance mechanisms. Serotype 19A observations were consistent with vaccine-induced reductions in circulation with no change in the organism susceptibility, whereas the nonsusceptibility increases for serotypes 3 and 19F may indicate circulation of more antibiotic-resistant clones. [ABSTRACT FROM AUTHOR]

A standard treatment protocol for medial tibial stress syndrome (MTSS) has not been identified. Clinical practice focuses on local evaluation and treatment neglecting a global approach. The MyoKinesthetic™ (MYK) System includes a full-body postural assessment to identify compensatory patterns that may lead to MTSS. The purpose of this study was to assess the effects of the MYK System in treating patients diagnosed with MTSS. A multi-site exploratory study was used to assess the effects of the MYK System on perceived pain and disability in patients diagnosed with MTSS. Eighteen physically active patients (6 female, 12 male), ages 18–25 years (19.89 ± 1.32) were treated with the MYK System. Paired T-tests were utilized to assess change. The change in patient reported pain was statistically significant (t (17) = 10.48, p <.001, Cohen's d = 2.48) and represented an average decrease of 96% in patient reported pain. The change in disablement was statistically significant (t (17) = 7.39, p <.001, Cohen's d = 1.74) and represented an average decrease of 88.2% in patient reported disablement. Participants treated with the MYK System experienced significant improvements and appear to surpass traditional interventions without the need of rest. Implementation of the MYK System to treat MTSS led to significant decreases in patient reported pain and dysfunction. A full-scale clinical investigation of the MYK System is warranted to determine its effects compared to traditional treatment options. [ABSTRACT FROM AUTHOR]

Abstract Staphylococcus lugdunensis and Staphylococcus haemolyticus are unique among CoNS in that the former often causes aggressive disease, while the latter consistently exhibits high rates of multidrug resistance. We evaluated the in vitro susceptibility of contemporary (2012–2013) isolates from both pathogens to tedizolid and comparators, using standard methodology. Results were interpreted using CLSI and EUCAST breakpoints. Overall, 106 S. lugdunensis and 103 S. haemolyticus isolates were collected from 51 medical centers in the United States and 30 centers in 18 European countries. Tedizolid showed good activity against S. lugdunensis (MIC 50 /MIC 90 : 0.12/0.12 mg/L) and S. haemolyticus (MIC 50 /MIC 90 : 0.12/0.12 mg/L), inhibiting all isolates at MIC ≤0.25 mg/L. Based on the EUCAST breakpoint for staphylococci and when substituting the CLSI breakpoint for Staphylococcus aureus , all isolates were tedizolid susceptible. All isolates were also susceptible to linezolid, but the in vitro potency of tedizolid was 4-fold greater than that of linezolid against both S. lugdunensis and S. haemolyticus , based on MIC 90 values. S. lugdunensis exhibited ≥99% susceptibility to vancomycin, teicoplanin, gentamicin, levofloxacin, and trimethoprim-sulfamethoxazole; 7% of isolates were resistant to tetracycline, 11% to clindamycin, and 2% were methicillin-resistant. S. haemolyticus exhibited high rates of resistance to commonly used anti-staphylococcal agents: 71% of isolates were resistant to methicillin, 36%–37% to clindamycin, and 30%–50% to gentamicin. These in vitro findings suggest that tedizolid could be an alternative treatment option for infections due to these medically important CoNS pathogens. Additional clinical evaluation and continued surveillance of tedizolid in vitro activity against S. lugdunensis and S. haemolyticus are warranted. Highlights • Data on the antibacterial susceptibility of Staphylococcus lugdunensis and Staphylococcus haemolyticus remain limited. • The in vitro susceptibility of contemporary isolates of both pathogens, obtained from a large surveillance study, to tedizolid and comparators was evaluated. • Only a small proportion (2%) of S. lugdunensis was found to be methicillin-resistant, while 71% of S. haemolyticus exhibited this phenotype. • Tedizolid showed potent in vitro activity (MIC 90 : 0.12 mg/L) against surveillance isolates of S. lugdunensis and S. haemolyticus. [ABSTRACT FROM AUTHOR]

• Light use related well to growth among clones within sites, but not across sites. • Light use accounted for only one-fourth of growth differences across sites. • Light use efficiency accounted for three-fourths of growth differences across sites. • Water deficits lowered light use efficiencies. • Patterns of light use efficiency need to be informed by more work on C allocation. Eucalyptus plantations in Brazil are among the world's most productive forests. We examined how differences in growth across an 1100 km environmental gradient related to light use and light use efficiency for 11 tropical Eucalyptus plantations, with the same 11 clones planted at each site. The long geographic gradient led to differences in precipitation, temperature, and soils, giving annual water deficits ranging from 40 to 500 mm yr−1. Mean annual increment (MAI) declined by about 2.2 Mg ha−1 yr−1 for each 100 mm yr−1 increase in water deficit. Across sites, about one-fourth of the differences in MAI related to light use (absorbed photosynthetically active radiation, APAR), and three-fourths to light use efficiency (LUE, wood growth per unit of light absorbed),. Light use did not relate to water deficit, so the decline in MAI resulted from a 0.1 g MJ−1 decline in LUE for each 100 mm yr−1 increase in water deficit. Though APAR accounted for a minor part of the decline in growth across sites, differences in both APAR and LUE among clones were important within each site. The pattern in wood growth per unit of light use likely includes the effects of water deficit on both total carbon (C) gain per unit of light use and partitioning of C belowground. A next step in harnessing production ecology insights for silviculture and breeding may be direct assessments of belowground partitioning (and perhaps respiration), and how opportunities vary with site conditions. [ABSTRACT FROM AUTHOR]