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The aim of this study was to describe the characteristics and outcomes of remote-dwelling pregnant women with threatened labor referred for air medical retrieval to a regional birthing center as well as factors associated with birth within 48 hours. This was a retrospective observational study of all pregnant women in the remote Central Australian region referred to the Medical Retrieval Consultation and Coordination Centre for labor > 23 weeks' gestation between February 12, 2018, and February 12, 2020. Univariate and multivariate statistical analyses were performed. There were 116 women referred for retrieval for labor. There were no births during transport, and less than half of the cases resulted in birth within 48 hours of retrieval. Tocolysis was frequently used. Predictors of birth within 48 hours were cervical dilatation ≥ 5 cm, preterm gestational age, and ruptured membranes in the univariate analysis. Nearly one third of this cohort required intervention or had complications during birth. Birth during transport for threatened labor did not occur in this cohort, and more than half of the retrievals did not result in birth within 48 hours; however, the high risk of birth complications may offset any benefit of avoiding air medical transport from remote regions. Retrieval clinicians should consider urgent transfer in cases of ruptured membranes, cervical dilatation of 5 cm or more, or gestational age less than 37 weeks. [ABSTRACT FROM AUTHOR]

Remote Australian women in labour often rely on retrieval services to allow birthing in specialist obstetric centres. However, there is currently debate over when not to transfer a woman in labour, for risk of an in-transit birth, associated with worse neonatal outcomes. A scoping review methodology was undertaken, to define the scope of published literature on the topic and identify gaps in the current knowledge. A total of seven full texts were deemed suitable for synthesis, which were all retrospective observational studies. Four themes from the studies' findings were identified: population features, predicting time-to-birth, use of tocolysis and birth during medical evacuation. The evidence identified in this review was of low methodological quality and heterogenous. The key findings were that births in-flight are rare, despite geographical distances and long transport times, with a knowledge gap on predictors of time-to-birth. [ABSTRACT FROM AUTHOR]

• Orientation and simulation training for medical staff are vital in air medical retrieval. • Opportunities to perform simulations in flight are often limited because of service requirements, fuel cost, and operational pilot hours. • Demonstrations of the clinical procedures by a medical crew during a real flight via prerecorded video highlight that these interventions are possible in a difficult environment. • Video demonstrations before hands-on simulation can improve clinician confidence in performance. In May 2022, the Royal Flying Doctor Service Western Operations in Western Australia pioneered the introduction of the first organizational helicopter emergency service with 2 Eurocopter EC145 helicopters. This article describes the pilot study undertaken, assessing the implementation and flight crew confidence outcomes of the supplementation of video simulation training to standard clinical training for helicopter air medical retrieval. Survey assessments using a 5-point Likert scale provided anonymous demographic data with summarized results of the means and standard deviations. Nonparametric tests were used to compare responses between the control and experimental groups from pretraining to postintervention to postpractical. The findings showed an increase in confidence rates after a classroom session and further increases after a practical session in the control group. The intervention group showed a small rise in overall confidence levels after being shown video simulations following the completion of their classroom session before commencing their practical session. This study established that regardless of the airframe, clinical staff, often with significant experience in air medical retrieval and critical care medicine, do not automatically have confidence in performing critical care procedures in a new aircraft type to which they have not previously been oriented. The results display a statistically significant increase in confidence levels in procedural performance after the classroom session compared with the pretraining questionnaire, with a subtle further rise when video simulations are included in the classroom session. When a classroom session is subsequently supplemented with a practical simulation session, confidence levels continue to rise. Implementing a comprehensive educational strategy including classroom and practical elements for clinical staff in their orientation to new aircraft improves their confidence in performing critical care procedures if required in flight. The addition of in-flight prerecorded videos demonstrating these critical care procedures is a useful adjunct to simulation training for flight crew in air medical retrieval, and further analytical studies may indeed show a statistically significant improvement in staff confidence. [ABSTRACT FROM AUTHOR]

• Women have different lived experiences with heart failure, and different experiences could influence patients' interpretations of patient-reported outcome (PRO) items. • A presumption in the use of PRO measures is that patients interpret PRO questions similarly, regardless of their race, ethnicity, gender, etc. • When 2 groups of patients (eg, men and women, older and younger patients, various racial groups) interpret and respond to a PRO item differently for reasons other than the outcome of interest, differential item functioning (DIF) is present. • Without formally testing for DIF, it is possible that conclusions drawn from studies using PRO measures are biased, either by revealing subgroup differences that do not actually exist or by masking subgroup differences that really do exist. • As we strive toward equity in health outcomes, it is important that the tools we use to measure outcomes are not biased, and DIF evaluations provide a tool for examining our patient-reported outcome measures in heart failure and beyond. Women diagnosed with heart failure report worse quality of life than men on patient-reported outcome (PRO) measures. An inherent assumption of PRO measures in heart failure is that women and men interpret questions about quality of life the same way. If this is not the case, the risk then becomes that the PRO scores cannot be used for valid comparison or to combine outcomes by subgroups of the population. Inability to compare subgroups validly is a broad issue and has implications for clinical trials, and it also has specific and important implications for identifying and beginning to address health inequities. We describe this threat to validity (the psychometric term is differential item functioning), why it is so important in heart-failure outcomes, the research that has been conducted thus far in this area, the gaps that remain, and what we can do to avoid this threat to validity. PROs bring unique information to clinical decision making, and the validity of PRO measures is key to interpreting differences in heart failure outcomes. [ABSTRACT FROM AUTHOR]

: Digital approaches are frequently described as an ideal way to engage young people with health interventions. However, uptake and adherence to these interventions is often poor. Identifying factors associated with engagement, and the best methods to encourage engagement, is a critical issue for the digital health field. This presentation will discuss young peoples' engagement with a healthy lifestyles app (the Health4Life app). : The Health4Life app is a self-monitoring app for adolescents targeting six key health risk behaviours. Participants were students (n=3610) and teachers randomized to the intervention condition of a cluster randomized controlled trial of the 'Health4Life Initiative'. Students completed an online baseline assessment assessing their health behaviours, mental health and socio-demographic factors and were provided with access to the Health4Life app to complement the in-class Health4Life module. Teachers were asked to complete a logbook documenting if they prompted students to download and use the app. The date and time users accessed the Health4Life app and any self-reported data were also automatically collected. A series of hierarchical regressions were performed to ascertain factors associated with the likelihood that students accessed the app (uptake) and factors associated with how much and for how long students used the app and how much information they entered (use). : Of the 3610 students provided access to the Health4Life app, 407 accessed it. Factors associated with increased likelihood to access the app included teacher prompts, living in a major city and being female. Psychological distress was not a significant predictor of likelihood to access the app. When investigating factors potentially associated with app use all models were found not to be significant. : Teachers are critical in the process of prompting at least initial engagement with health interventions within a school-based context and the need for targeted engagement strategies for a number of sub-groups of young people (e.g. males, those in regional communities). There is a need for more research investigating predictors of actual app use and engagement. : These findings indicate that many clinical factors (e.g., psychological distress) may not be significant barriers to adolescents engaging with digital health interventions. Researchers should carefully consider the implications of excluding participants experiencing mental illness or psychological distress, as is common in research. The results also highlight the importance of researchers establishing good relationships with teachers and clinicians working in a school-based context. [ABSTRACT FROM AUTHOR]

Women with threatened preterm labor in remote Australia often require tocolysis in the prevention of in-flight birth during air medical retrieval. However, debate exists over the tocolytic choice. A retrospective analysis was undertaken on data containing women who required air medical retrieval for threatened preterm labor within Western Australia between the years 2013 and 2018. A total number of 236 air medical retrievals were deemed suitable for inclusion; 141 received nifedipine, and 95 women received salbutamol + nifedipine. Tocolytic efficaciousness was reported in 151 cases, proportionally more (P <.05) from the women who received salbutamol + nifedipine (n = 68, 71.6%) compared with the women who received nifedipine only (n = 83, 58.9%). Those receiving salbutamol + nifedipine were more likely to suffer maternal tachycardia (n = 87 [91.6%] vs. n = 62 [44.0%]), fetal tachycardia (n = 26 [27.4%] vs. n = 13 [9.2%]), nausea (n = 17 [17.9] vs. n = 5 [3.55%]), and vomiting (n = 12 [12.6%] vs. n = 2 [1.4%]). Three women who received salbutamol + nifedipine had serious side effects including echocardiographic changes, chest pain, and metabolic and lactic acidosis. Salbutamol + nifedipine tocolysis was proven to be more effective than nifedipine only. Although salbutamol + nifedipine had increased temporary side effects, most were nonsevere and managed in-flight. [ABSTRACT FROM AUTHOR]

The incidence of liver failure continues to increase, and it is associated with increased perioperative morbidity and mortality. Liver failure is associated with multiorgan dysfunction, including central nervous, cardiac, respiratory, gastrointestinal, renal, and hematological systems. Preoperative identification, optimization, and tailored anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery. The coagulopathy of liver failure is a balanced coagulopathy better assessed by thromboelastography than conventional testing, and it is not directly associated with bleeding risk. [ABSTRACT FROM AUTHOR]

The location of the atrioventricular conduction axis in the setting of atrioventricular septal defect has previously been shown by histology and intraoperative recordings. We have now reassessed the arrangement using phase-contrast computed tomography, aiming to provide precise measurements so as to optimize future surgical repairs. We used the system based on an X-ray Talbot grating interferometer using the beamline BL20B2 in a SPring-8 synchrotron radiation facility available in Japan. We analyzed 18 specimens. The atrioventricular node was found within a nodal triangle 1.7 mm from the coronary sinus, with 95% confidence intervals from 1.45 to 2.0 millimeters. The depth of the node from the right atrial endocardium was 1.0 mm, with 95% confidence intervals from 0.73 to 1.34 mm. The overall length of the scooped-out ventricular septum was 30.8 mm, with 95% confidence intervals from 27.5 to 34.1 millimeters. The length from the inferior atrioventricular junction to the take-off of the right bundle branch was 12.8 mm, with 95% confidence intervals from 11.12 to 14.38 mm, giving a ratio of 0.43 for the extent of the axis along the inferior septum, with 95% confidence intervals of 0.38-0.48. The length of the non-branching bundle was 6.6 mm, with 95% confidence intervals from 5.57 to 7.7 mm. The proportion of septum occupied by the non-branching bundle was 0.22, with 95% confidence intervals from 0.18 to 0.26. Our findings confirm previous histological studies, extending them by providing precise measurements to guide placement of sutures during surgical repair. [ABSTRACT FROM AUTHOR]

• An exhibitor team is a temporary organization. • We identified two unique determining factors for high-performance exhibitor team. • Servant leadership has both direct and indirect effects on team performance. • Swift trust mediates the effect of servant leadership on team performance. • Servant leadership includes conceptual skills and commitment to the growth of people. Participation in business events such as meetings, conventions and exhibitions is costly, and building a high-performance team is vital. This study examines the key influential factors of team performance from the perspective of the "temporary organization". Using a sample of 516 individuals employed by exhibitors attending trade shows, we demonstrate that "servant leadership" and "swift trust" are the two crucial factors in improving an exhibitor team's performance. Specifically, two dimensions of servant leadership, namely conceptual skills and commitment to the growth of people, contribute directly to team performance. Swift trust not only has a positive direct influence on team performance but is also a partial mediator between servant leadership and team performance. The results have implications for managers seeking to create a high-performance temporary team. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the technical success and efficacy of mitral valve edge-to-edge repair using extended clip arms. A new iteration of the MitraClip system, the MitraClip XTR, was introduced in 2018 with the aim of addressing technical limitations observed with previous versions. Patients having received at least 1 new implant for the treatment of symptomatic mitral regurgitation (MR) were eligible for this study. Among the 107 patients (mean age 76 ± 9 years, 69% men) included in this study, the etiology of MR was balanced, with one-half (n = 53 [50%]) classified as secondary and the remaining 54 patients having either primary (n = 40 [37%]) or mixed (n = 14 [13%]) disease. The mean number of devices implanted was 1.5 ± 0.6. Multiple device implantation was required in 46 patients (43%). Single-leaflet device attachment occurred in 4 patients and leaflet injury in 2 additional patients, requiring surgical conversion in 4 patients. Among the 102 patients discharged alive without mitral valve surgery, 95 (93%) had MR ≤2+ and 79 (77%) had MR ≤1+. The mean transmitral gradient increased from 1.9 ± 1.0 mm Hg at baseline to 3.5 ± 1.8 mm Hg at discharge (p < 0.001). Technical success with the new mitral valve repair system with extended clip arm was achieved in 93% of the patients. MR ≤2+ was obtained in 95 patients (93%) and MR ≤1+ in 79 (77%). The main reasons for procedural failure were acute single-leaflet device attachment associated with leaflet damage or isolated leaflet injury and often required surgical correction. [ABSTRACT FROM AUTHOR]

Highlights • Examines how temporal distance influences tourist's destination preferences. • Integrates construal level theory (CLT) with mind-set theory for the first time. • Utilizes four choice experiments to examine and segment destination preferences. • Reveals the moderating role of "mind-set" on tourists' preference inconsistency. • Explores the reasons behind individual differences on preference change. Abstract Where a lengthy period is available for the choice of tourist destination, people's tendency to change their minds can be pronounced. This makes the investigation of preference (in)consistency of great interest. Here, we integrate construal level theory (CLT) with mind-set theory, for the first time, to explore the moderating effect of an internal factor (i.e. mind-set) on preference shifts from desirable to feasible attributes over time. The results of four choice experiments suggest that, compared with people with a satisficing mind-set, people with a maximizing mind-set are reluctant to sacrifice desirability for feasibility, which counters the inclination to alter preferences as the decision time approaches. Furthermore, we found that different preference patterns between maximizers and satisficers are not connected to desirability but result from maximizers' consistency in placing less importance on feasibility. Implications for future studies and destination marketers are outlined. [ABSTRACT FROM AUTHOR]

Abstract Purpose Hepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared with standard planning using functional dose-volume histograms. Thresholds predicting for decompensation during follow up are evaluated. Methods and materials We studied 17 patients who underwent HIDA scans before SBRT. All SBRT cases were replanned using FLIGHT. The following dosimetric endpoints were compared for FLIGHT versus standard SBRT planning: functional residual capacity <15 Gy (FRC 15 HIDA), mean liver dose (MLD), equivalent uniform dose (EUD), and functional EUD (FEUD). Receiver operating characteristics curves were used to evaluate whether baseline HIDA values, standard cirrhosis scoring, and/or dosimetric data predicted clinical decompensation. Results Compared with standard planning, FLIGHT significantly improved FRC 15 HIDA (mean improvement: 5.3%) as well as MLD, EUD, and FEUD (P <.05). Considerable interindividual variations in the extent of benefit were noted. Decompensation during follow-up was associated with baseline global HIDA <2.915%/min/m2, FRC 15 HIDA <2.11%/min/m2, and MELD ≥11 (P <.05). Conclusions FLIGHT with HIDA-based parameters may complement blood chemistry-based assessments of liver function and facilitate individualized, adaptive liver SBRT planning. [ABSTRACT FROM AUTHOR]

Abstract Background Most patients risk gaining weight in the years after knee replacement, adding further concern to a population that is mostly overweight/obese prior to surgery. Objective Via a randomised pilot study, we assessed changes in weight during a Patient Centered Weight Loss Program (PACE) initiated either before or after knee replacement, while simultaneously examining the feasibility of recruiting and retaining participants over 26 weeks. Methods Recruitment outreach was made to 133 patients scheduled for knee replacement. Sixteen participants were randomised to a 14-session weight loss program that started either ≤6 weeks before surgery (PACE) or at 12 weeks post-op (Delayed PACE). Repeated measures ANOVAs were used to examine preliminary changes in weight, function, patient-reported outcomes, and physical activity across time (baseline/pre-op, 12 and 26 weeks after surgery) and group. Results Retention was 75% and 69% at 12 and 26 weeks after surgery, respectively. Weight significantly decreased across the 26 weeks (P < 0.001). A group by time interaction (P = 0.03) demonstrated Delayed PACE [−7.6 ± 5.9 kg (−7.9 ± 5.9%)] lost significantly more weight than PACE [−2.5 ± 2.7 kg (−2.6 ± 2.6%)] participants at 26 weeks. Significant improvements across time were seen for all function and patient reported outcomes, however activity did not change. Conclusion Conducting a behavioural intervention was challenging but feasible in a knee replacement population, with preliminary evidence suggesting that initiating a program 12 weeks after surgery produces greater weight losses at 26 weeks compared to a program starting before knee replacement. [ABSTRACT FROM AUTHOR]

The 3rd Edition of API 579-1/ASME FFS-1 2016 Fitness-For-Service includes a new Part 14 dedicated to fatigue assessment. An important section in this part covers the fatigue assessment of welded joints. In this paper, an overview of the fatigue methods for welded joints is provided and extensions are recommended. First, an overview is given of the classical fatigue method used in the ASME B&PV Code based on smooth bar fatigue curves in conjunction with a fatigue strength reduction factor. In addition, the mesh insensitive structural stress method is outlined using an equivalent stress parameter based on fracture mechanics considerations in conjunction with a master S-N curve based on the analysis of over 2000 high and low cycle S-N test data. The resulting master S-N curve approach is applicable to high cycle fatigue and low cycle fatigue if a Neuber correction is introduced. In this paper, a new structural strain method is presented to extend the early structural stress based master S-N curve method to the low cycle fatigue regime in which plastic deformations can be significant while an elastic core is present. With this new method, some of the inconsistencies of the pseudo-elastic structural stress procedure can be eliminated, such as its use of Neuber’s rule in approximating structural strain beyond yield. The earlier mesh-insensitive structural stress based master S-N curve method can now be viewed as an application of the structural strain method in the high cycle regime, in which structural strains are linearly related to traction-based structural stresses according to Hooke’s law. Thus, both low cycle and high cycle fatigue behavior can now be treated in a unified manner. In the low-cycle regime, the structural strain method characterizes fatigue damage directly in terms of structural strains that satisfy a linear through-thickness deformation gradient assumption, material nonlinear behavior, and equilibrium conditions. A PVRC Joint Industry Project is currently sponsoring work on the structural strain method that will lead to its incorporation in the next edition of API 579-1/ASME FFS-1. [ABSTRACT FROM AUTHOR]

Background Vascular malformations manifest with pain, bleeding, disability, and disfigurement in a subset of children. There are scant data available on the utility and tolerability of laser surgery for symptomatic or disfiguring non–port-wine stain vascular malformations in children. Objective The objective of this study was to determine the utility and tolerability of the 1064-nm long-pulsed neodymium:yttrium-aluminum-garnet (LP Nd:YAG) laser for treatment of symptomatic or disfiguring vascular malformations in children. Methods We conducted a retrospective review of 29 pediatric patients with non–port-wine stain vascular malformations who were treated with the LP Nd:YAG laser at our institution. We report patient characteristics, treatment parameters, outcomes, and complications. Results Blinded assessment of clinical efficacy revealed good to excellent results in 66.7% of patients treated and poor to fair results in 25%. The overall rate of complications was 27%, with minor skin breakdown and blistering being the most common. Limitations Our conclusions are limited by small sample size, pretreatment and posttreatment photographs in only a subset of patients, and lack of long-term follow-up. Conclusion The LP Nd:YAG laser is a well-tolerated and effective treatment modality for a variety of non–port-wine stain vascular malformations in children. [ABSTRACT FROM AUTHOR]

A detailed understanding of tourists’ preferences is of great importance both for decision-making theory and destination marketing practice. This study investigates the use of consideration-set formation together with conjoint analysis to estimate the destination preferences of Chinese long-haul outbound tourists. Through the integration of choice-set and characteristic theories, the study demonstrates how to optimise the advantages of both approaches in order to obtain more comprehensive insights into destination choice processes. The findings show that preferences can be analysed effectively in a two-stage model, which can reveal detailed additional insights regarding tourists’ preferences towards destination attributes that cannot be gained through each approach independently, thus contributing to marketing insight on destination choice and selection. [ABSTRACT FROM AUTHOR]

Background: Atherosclerosis is an inflammatory disease that affects the arterial wall leading to myocardial, cerebral, and peripheral ischemic syndromes. The use of low doses of aspirin inhibits platelet aggregation and inflammation and prevents cardiovascular mortality. However, ASA may produce hemorrhagic events. Thus, several studies have sought new natural compounds to suppress platelet aggregation without causing serious adverse effects.Purpose: In this sense, this study aims to compare the effects of Campomanesia xanthocarpa plant extract with those of acetylsalicylic acid (ASA) on inflammatory parameters observed in homozygous mice knockout for the low-density lipoprotein receptor (LDLr-KO) treated with a hypercholesterolemic diet.Material and Methods: In this study, 28 male LDLr-KO mice were divided into three groups and fed a hypercholesterolemic diet for 4 weeks. Thereafter, the animals that received the hypercholesterolemic diet were treated for 5 days with (1) distilled water, (2) C. xanthocarpa extract, or (3) acetylsalicylic acid. The levels of inflammatory markers were assessed in the blood samples. The gastric tolerability of the animals after oral administration of the treatments was assessed through quantification of the lesions in the gastric mucosa.Results: The levels of proinflammatory cytokines IL-1, IL-6, TNF-α, and INF-γ were reduced to 19.2 ± 3%, 20.4 + 1.3%, 24.7 ± 1.2%, and 20.8 ± 1.7%, respectively, in the group treated with C. xanthocarpa, when compared to control group. Furthermore, treatment with plant extract significantly increased the levels of the anti-inflammatory cytokine IL-10 by 27.3 ± 5.9%, but ASA showed no significant effect on the same cytokines when compared to the control group, with the exception of IL-10, which presented an increase of 8.6 ± 3.5%. Treatments with C. xanthocarpa and ASA also caused significant reductions of 26.4 ± 3% and 38.4± 6% in the serum levels of oxLDL, respectively. However, only treatment with C. xanthocarpa reduced the levels of anti-oxLDL antibodies when compared with the control (25.8 ± 6%). In addition, the analyzed extract did not induce ulcerogenic activity, while ASA induced the formation of lesions.Conclusion: In conclusion, treatment with C. xanthocarpa causes anti-inflammatory activity in hypercholesterolemic animals, with results superior to those obtained with the use of ASA. [ABSTRACT FROM AUTHOR]

A lack of intracellular delivery systems has limited the use of biologics such as monoclonal antibodies (mAb) that abrogate molecular signaling pathways activated to promote escape from cancer treatment. We hypothesized that intracellular co-delivery of the photocytotoxic chromophore benzoporphyrin derivative monoacid A (BPD) and the anti-VEGF mAb bevacizumab in a nanophotoactivatable liposome (nanoPAL) might enhance the efficacy of photodynamic therapy (PDT) combined with suppression of VEGF-mediated signaling pathways. As a proof-of-concept we found that nanoPAL-PDT induced enhanced extra- and intracellular bevacizumab delivery and enhanced acute cytotoxicity in vitro . In an in vivo subcutaneous mouse model of pancreatic ductal adenocarcinoma, nanoPAL-PDT achieved significantly enhanced tumor reduction. We attribute this to the optimal incorporation of insoluble BPD into the lipid bilayer, enhancing photocytotoxicity, and the simultaneous spatiotemporal delivery of bevacizumab, ensuring efficient neutralization of the rapid but transient burst of VEGF following PDT. From the Clinical Editor Most patients with pancreatic ductal adenocarcinoma (PDAC) by the time present the disease it is very advanced, which unavoidably translates to poor survival. For these patients, use of traditional chemotherapy often becomes ineffective due to tumor resistance to drugs. Photodynamic therapy (PDT) can be an effective modality against chemo-resistant cancers. In this article, the authors investigated the co-delivery of a photocytotoxic agent and anti-VEGF mAb using liposomes. This combination was shown to results in enhanced tumor killing. This method should be applicable to other combination of treatments. [ABSTRACT FROM AUTHOR]

Background: A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section.Methods: One-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11 mg, morphine 100 μg and fentanyl 15 μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10 min.Results: Sensory block to T6 was achieved within 10 min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (P<0.05). Compared to the Control Group, patients in the Elevation Pillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, P<0.001) or conversion to general anaesthesia (9.3% vs 0%, P<0.04).Conclusions: Use of a ramped position with an head-elevation pillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min. [ABSTRACT FROM AUTHOR]

The decision to administer a radical course of radiotherapy (RT) is largely influenced by the dose-volume metrics of the treatment plan, but what are the patient-related and other factors that may independently increase the risk of radiation lung toxicity? Poor pulmonary function has been regarded as a risk factor and a relative contraindication for patients undergoing radical RT, but recent evidence suggests that patients with poor spirometry results may tolerate conventional or high-dose RT as well as, if not better than, patients with normal function. However, caution may need to be exercised in patients with underlying interstitial pulmonary fibrosis. Furthermore, there is emerging evidence of molecular markers of increased risk of toxicity. This review discusses patient-related risk factors other than dosimetry for radiation lung toxicity. [ABSTRACT FROM AUTHOR]

Background & Aims We investigated the prevalence of germline mutations in APC , ATM , BRCA1 , BRCA2 , CDKN2A , MLH1 , MSH2 , MSH6 , PALB2 , PMS2 , PRSS1 , STK11 , and TP53 in patients with pancreatic cancer. Methods The Ontario Pancreas Cancer Study enrolls consenting participants with pancreatic cancer from a province-wide electronic pathology database; 708 probands were enrolled from April 2003 through August 2012. To improve the precision of BRCA2 prevalence estimates, 290 probands were selected from 3 strata, based on family history of breast and/or ovarian cancer, pancreatic cancer, or neither. Germline DNA was analyzed by next-generation sequencing using a custom multiple-gene panel. Mutation prevalence estimates were calculated from the sample for the entire cohort. Results Eleven pathogenic mutations were identified: 3 in ATM , 1 in BRCA1 , 2 in BRCA2 , 1 in MLH1 , 2 in MSH2 , 1 in MSH6 , and 1 in TP53 . The prevalence of mutations in all 13 genes was 3.8% (95% confidence interval, 2.1%−5.6%). Carrier status was associated significantly with breast cancer in the proband or first-degree relative ( P < .01), and with colorectal cancer in the proband or first-degree relative ( P < .01), but not family history of pancreatic cancer, age at diagnosis, or stage at diagnosis. Of patients with a personal or family history of breast and colorectal cancer, 10.7% (95% confidence interval, 4.4%−17.0%) and 11.1% (95% confidence interval, 3.0%−19.1%) carried pathogenic mutations, respectively. Conclusions A small but clinically important proportion of pancreatic cancer is associated with mutations in known predisposition genes. The heterogeneity of mutations identified in this study shows the value of using a multiple-gene panel in pancreatic cancer. [ABSTRACT FROM AUTHOR]

There is accumulating evidence for circulating tumour cells (CTCs) and circulating tumour nucleic acids (ctNAs) as prognostic and predictive biomarkers in colorectal cancer. Their role in the perioperative setting is evolving. These blood-borne biomarkers can potentially demonstrate tumour dissemination at time of colorectal cancer surgery and estimate the completeness of a surgical resection. CTCs and circulating ctNA levels at time of surgery, and persistent levels post-surgery, may correlate with poorer patient outcomes. These biomarkers can be utilised to refine surgical techniques to minimise tumour dissemination and determine the need for adjuvant therapy. [ABSTRACT FROM AUTHOR]

White blister rust is an economically important emerging disease of sunflower caused by Pustula helianthicola . Knowledge on the host range of the pathogen particularly on different Helianthu s species and its relative cultivars is of high relevance for disease management. Natural infection in the field on 13 sunflower genotypes with differentiating resistance against sunflower downy mildew ( Plasmopara halstedii ) showed high susceptibility to P. helianthicola which was independent from the resistance against downy mildew. Similarly, numerous commercial sunflower lines used in Europe showed high susceptibility to white blister rust in the field. Leaf disk inoculation with sporangia of a single spore strain of P. helianthicola confirmed full susceptibility of these genotypes, whereas wild species of Helianthus could not be infected under the controlled conditions except for a single incident observed with Helianthus praecox . Investigation of pre and post penetration events on the leaf surface of selected Helianthus annuus cultivars and wild species revealed that zoospore discharge, encystment and germ tube development occurred similarly on cultivars and wild species. But in the latter no germ tube penetration of the stomata was found and no hyphal or haustoria development was observed after 72–96 hours post inoculation (hpi) in wild species. Studies on the effect of different fungicides showed that the phenylamide metalaxyl-M and the strobilurin azoxystrobin inhibited the infection of seedlings at 1 and 2 μg/mL concentration, respectively, whereas the carboxylic acid amide dimethomorph required ca. a 10 fold higher concentration. With the plant strengthener BABA more than 40% of the plants were infected even at 200 μg/mL treatments. These results corroborated with the effects on early developmental stages of the pathogen (zoospore discharge, encystment, and germ tube development) in host independent experiments. Our results suggest that fungicides provide an effective measure for controlling sunflower white blister rust. However, considering the residual effect of chemicals and the possibility of developing fungicide resistance, breeding for resistant genotypes appears to be a more promising way for long lasting and sustainable disease management. [ABSTRACT FROM AUTHOR]

Abstract: The lack of characterized isolates of Plasmopara viticola is a very limiting issue in the management of downy mildew of grapevine. Although molecular studies have previously confirmed a high diversity of this pathogen, there are still no phenotypically characterized pathotype strains or races available which could be used to study the mechanisms of interaction with host genotypes of different resistance. A leaf disk inoculation technique was used to assess the variability of reactions of six different Vitis genotypes infected with single sporangial clones of five field isolates of P. viticola from different geographical origins. The virulence of thirty P. viticola clones was characterized on grapevine cultivars (Müller-Thurgau, Regent and Cabernet Cortis) and wild species (Vitis vinifera ssp. sylvestris, Vitis rupestris and Vitis riparia) with different susceptibility to downy mildew. Five categories ranging from full susceptibility with profuse and not clearly restricted sporulation (type A) to complete resistance with no sporulation or necrotic reaction (type E) were defined to evaluate the pathogen phenotype. A high variation of pathotypes was found amongst the samples from different field accessions and an unexpected variability was observed even between the cloned strains from the same field. This also accounted for the fungicide tolerance against the two most common fungicides, metalaxyl-M (Phenyl Amide group) and dimethomorph (Carboxylic Acid Amide group), where clones showing high sensitivity and high tolerance to the one or both fungicides were found within the same field. The virulence patterns found within clones of single field isolates supports previous reports that numerous genotypes may be involved in the infection of a single plant or even a single leaf. Moreover, the study provides a methodology to identify and select specific host–pathogen combination suitable for future studies in mechanisms of grapevine downy mildew interaction. [Copyright &y& Elsevier]

Highlights: [•] Binding and diffusion affect the penetration of targeted nanoparticles in tumors. [•] Simulations show many nanoparticle formulations accumulate in cells near vessels. [•] Shielding prevents nanoparticles from binding until they diffuse deep in tissue. [•] Shielding strategy is generalizable to many nanoparticles and tumor scenarios. [•] Time or space-dependent binding enables engineered nanoparticle tissue distributions. [Copyright &y& Elsevier]

Blue mold of tobacco, caused by Peronospora tabacina, is a serious disease with severe commercial impact. Quarantine measures to reduce pathogen distribution affect commercial trade of tobacco even in processed stages, but survival of the pathogen after curing at high temperature or exposure to sunlight has not been investigated adequately. To assess the effect of heat and UV-light on viability and infectivity of P. tabacina, sporangia of two different strains and sporulating leaves were exposed to temperatures up to 70 °C and UV irradiation at 254 and 366 nm. Sporangial germination of both strains strongly decreased within 48 h at temperatures above 16 °C, but 1–3% of sporangia still survived 24 h treatment at 70 °C. When sporulating leaves were used to inoculate fresh tobacco, reinfection occurred with samples kept for 48 h at 50 °C, whereas no infection resulted when the inoculum had been stored at 70 °C for at least 24 h. Exposure to 254 nm UV-light was deleterious to sporangial germination and killed them within 30–40 min. In contrast, sporangia treated at 366 nm survived for more than 4 h. Similarly, sporulating leaves exposed to 254 nm were infective to fresh tobacco, when irradiation time remained below 40 min. The results suggest that thermal treatment of at least 70 °C in post-harvest processing is necessary to prevent infection risks from commercially used tobacco. Alternatively, short-term irradiation with 254 nm UV light could be used for quarantine management, if it does not affect the product quality. [ABSTRACT FROM AUTHOR]

Radiation therapy plays a potential curative role in the treatment of patients with non–small-cell lung cancer with locoregional disease who are not surgical candidates and a palliative role for patients with metastatic disease. Stereotactic body radiation therapy is a relatively new technique in patients with early-stage non–small-cell lung cancer. A trial from RTOG® reported >97% local control at 3 years. For patients with locally advanced disease, thoracic radiation to a dose of 60 Gy remains the standard of care. Sequential chemotherapy or radiation alone can be used for patients with poor performance status who cannot tolerate more aggressive approaches. Chemotherapy should be used for patients with metastatic disease. Radiation therapy is useful for palliation of symptomatic tumors, and a dose of approximately 30 Gy is commonly used. Endobronchial brachytherapy is useful for patients with symptomatic endobronchial tumors. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. [Copyright &y& Elsevier]

Abstract: Peronospora tabacina is a major disease in tobacco cultures in many countries. Fungicide treatment with phenylamides is often used to control the pathogen, but resistance occurs and continuous application may cause selection pressure which influences the pathogen''s population structure. Field isolates collected from blue mold incidences in Germany and other countries of the European Mediterranean zone over a period of 10 years were screened for the presence of the two currently recognized phenotypes of the pathogen, one of which is fully tolerant to mefenoxam (metalaxyl-M). Besides the geographical distribution of the fungicide-tolerant strain in France, Italy and Germany, the long-term monitoring revealed a significant phenotype shift in the population of P. tabacina in Germany. This coincided with the alteration of disease management with respect to the fungicides recommended for use. While between 2002 and 2004 only metalaxyl-M-tolerant isolates were found in field accessions from Germany, the metalaxyl-M-sensitive strain occurred in 2005 and its ratio in the population increased gradually. Vice versa, the tolerant strain was not found anymore in samples 2010 and 2011. Infection experiments under controlled conditions with genetically homogenous strains of the two phenotypes revealed a significant higher virulence of the sensitive strain which is expressed in a two day reduction of the time period required from inoculation to sporulation. The consequence of fitness differences between the two phenotypes was tested in dual infection experiments starting with a 1:1 mixture of sporangia. When propagating the offspring by using the early produced sporangia for the next infection, the sensitive strain dominated already in the F2 generation and no tolerant phenotype was detected with specific primers in PCR with DNA from sporangia after four infection cycles. In contrast, the tolerant strain could survive when late produced sporangia were used for the next round of infection. These results suggest that the dominance of the metalaxyl-M tolerant phenotype of P. tabacina in field samples is due to selection pressure caused by continuous intensive use of the fungicide rather than by natural selection criteria. [Copyright &y& Elsevier]

Abstract: High quality 16S ribosomal RNA (rRNA) gene sequences from the type strains of all species with validly published names, as defined by the International Code of Nomenclature of Bacteria, are a prerequisite for their accurate affiliations within the global genealogical classification and for the recognition of potential new taxa. During the last few years, the Living Tree Project (LTP) has taken care to create a high quality, aligned 16S and 23S rRNA gene sequence database of all type strains. However, the manual curation of the sequence dataset and type strain information revealed that a total of 552 “orphan” species (about 5.7% of the currently classified species) had to be excluded from the reference trees. Among them, 322 type strains were not represented by an SSU entry in the public sequence repositories. The remaining 230 type strains had to be discarded due to bad sequence quality. Since 2010, the LTP team has coordinated a network of researchers and culture collections in order to improve the situation by (re)-sequencing the type strains of these “orphan” species. As a result, we can now report 351 16S rRNA gene sequences of type strains. Nevertheless, 201 species could not be sequenced because cultivable type strains were not available (121), the cultures had either been lost or were never deposited in the first place (66), or it was not possible due to other constraints (14). The International Code of Nomenclature of Bacteria provides a number of mechanisms to deal with the problem of missing type strains and we recommend that due consideration be given to the appropriate mechanisms in order to help solve some of these issues. [Copyright &y& Elsevier]

In megacities water quantity and quality are threatened by complex and interrelated processes caused by population growth, land use change, unsustainable agricultural practices, deforestation, erosion, destruction of ecosystems, lack of planning, laissez-faire policies, unsustainable water management, political conflicts, and increasingly also by the impacts of climate change. In the Metropolitan Valley of Mexico City (MVMC) located in the high plateau of Mexico City and on former lakes, the dry out policies during the last 300 years have been counterproductive, causing scarcity, pollution, health and environmental problems, subsidence and water conflicts, particularly affecting social vulnerable people. Megacities require an integrated management of water and aquatic systems—integral water resource management, rainwater harvesting, maintenance and replacement of infrastructure, restoration of ecosystems and urban planning. This implies investments and a water culture including a transparent administration and peaceful negotiation of conflicts regarding concessions, access, and reuse of water allocation. Socio-political and environmental processes are complex; besides technical factors and ecosystem recovery, socio-cultural changes must transform human settlements and power structures. [ABSTRACT FROM AUTHOR]

Despite the assumption that health care providers work synergistically in practice, professions have tended to be more exclusive than inclusive when it comes to educating students in a collaborative approach to interdisciplinary evidence-based practice (EBP). This article explores the state of academic and clinical training regarding interdisciplinary EBP, describes efforts to foster interdisciplinary EBP, and suggests strategies to accelerate the translation of EBP across disciplines. Moving from silos to synergy in interdisciplinary EBP will require a paradigm shift. Changes can be leveraged professionally and politically using national initiatives currently in place on improving quality and health care reform. [Copyright &y& Elsevier]

A 2 × 2 factorial experiment was conducted to investigate the effects of cereal type (barley v. oat) and exogenous enzyme supplementation (with or without) on intestinal fermentation, and on indole and skatole levels in the intestinal content and the adipose tissue in finisher boars. The experimental treatments were as follows: (i) barley-based diet, (ii) barley-based diet with enzyme supplement, (iii) oat-based diet and (iv) oat-based diet with enzyme supplement. The enzyme supplement contained endo-1,3(4)-β-glucanase (EC 3.2.1.6) and endo-1,4-β-xylanase (EC 3.2.1.8). The animals were fed ad libitum for 45 days from 76.0 to 113.6 kg live weight. Feeding barley-based diets led to higher (P < 0.05) total volatile fatty acids concentrations in the large intestine. Proportions of propionic- and butyric-acids were higher and that of acetic acid lower in digesta from barley-based in comparison to oat-based diets (P < 0.001). Consequently, pH in the large intestine was higher after feeding oat-based in comparison to barley-based diets. Animals fed unsupplemented oat-based diet had higher (P < 0.01) indole concentrations in the digesta from the proximal colon than those fed barley-based diets. Feeding oat-based diets led to lower (P < 0.01) skatole and higher (P < 0.001) indole concentrations in the digesta from the terminal colon than barley-based diets. skatole concentrations in the adipose tissue did not differ (P > 0.05) between the experimental treatments. Pigs offered the barley-based diets had lower (P < 0.001) indole concentrations in the adipose tissue compared with those fed the oat-based diet. In conclusion, barley-based diets were more efficient than oat-based diets in limiting concentrations of indole in the adipose tissue. [ABSTRACT FROM AUTHOR]

Abstract: Ontology mapping seeks to find semantic correspondences between similar elements of different ontologies. It is a key challenge to achieve semantic interoperability in building the Semantic Web. This paper proposes a new generic and adaptive ontology mapping approach, called the PRIOR+, based on propagation theory, information retrieval techniques and artificial intelligence. The approach consists of three major modules, i.e., the IR-based similarity generator, the adaptive similarity filter and weighted similarity aggregator, and the neural network based constraint satisfaction solver. The approach first measures both linguistic and structural similarity of ontologies in a vector space model, and then aggregates them using an adaptive method based on their harmonies, which is defined as an estimator of performance of similarity. Finally to improve mapping accuracy the interactive activation and competition neural network is activated, if necessary, to search for a solution that can satisfy ontology constraints. The experimental results show that harmony is a good estimator of f-measure; the harmony based adaptive aggregation outperforms other aggregation methods; neural network approach significantly boosts the performance in most cases. Our approach is competitive with top-ranked systems on benchmark tests at OAEI campaign 2007, and performs the best on real cases in OAEI benchmark tests. [Copyright &y& Elsevier]