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To assess men's preferences for healthcare provider from whom they would obtain hormonal male contraceptive (HMC) methods.We asked participants from 3 clinical trials of investigational HMC methods-an oral pill (11β-Methyl-19-nortestosterone-17β-dodecylcarbonate, 11β-MNTDC), intramuscular or subcutaneous injection (Dimethandrolone undecanoate), and transdermal gel (Nestorone and testosterone)-to rank their top 3 preferred HMC providers from a list including: men's health doctor (urologist/andrologist), hormonal doctor (endocrinologist), reproductive health doctor (OB/GYN), family planning clinician (community health worker, midwife, nurse practitioner), regular doctor (family medicine/internal medicine), and community pharmacist. We examined preferences based on their rankings and conducted bivariate analyses. Collapsing the various specialists (men's health doctor, hormonal doctor, reproductive health doctor, and family planning clinician) into a single provider type, we examined participant demographics against provider preference (regular doctor, pharmacist, or specialist).Participants across the 3 trials (n = 124) ranked their regular doctor (44%) and community pharmacist (18%) as their most preferred HMC provider; these preferences did not differ significantly by trial and drug formulation. Specialists in family planning (13%), men's health (12%), reproductive health (10%), and hormones (4%) were least frequently ranked as their preferred provider. Older and higher educated participants more often preferred specialists over regular doctors and pharmacists (p = 0.02 and p = 0.01).Despite receiving contraceptive steroid hormones and care from endocrinologists and family planning specialists in a clinical trial, participants would prefer to obtain contraception from their regular doctor.As most men expect to obtain hormonal male contraceptives from their regular doctor when commercially available, primary care physicians should become familiar with HMCs and be prepared to provide counseling and options accordingly.

Palliative care (PC) and hospice services have experienced shortages before 2020, and during the initial phases of the current pandemic, more critical gaps are expected with future surges, much as scarcity in intensive care unit services may recur during the COVID-19 pandemic. Although ethical allocation of ventilators and intensive care unit care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care and ration these essential services to our communities.

Cutaneous papillomas (CPs) and cutaneous squamous cell carcinomas (CSCCs) are usual epidermal tumours in dogs. CPs and CSCCs probably arise from the neoplastic transformation of the keratinocytes within the stem cell compartment, since these cells are the only keratinocytes that would reside long enough to accumulate the number of molecular alterations to drive the progression towards a tumour cell phenotype. However, the role of these cells in common epidermal tumours in dogs is still unknown. Thus, the purpose of this study was to evaluate the immunohistochemical expression pattern of p63 together with CK5, molecular markers of epidermal stem cells, on sections of tissue microarrays constructed from canine samples of CP and CSCC to investigate the contribution of stem cells in those canine tumours. p63/CK5 coexpression was retained in most basal and some suprabasal cells in CPs and CSCCs. In addition, increased coexpression of these molecules was observed in a group of CPs and CSCCs, as a result of a higher p63 expression. These results suggest that the coexpression of p63/CK5 may mark epidermal keratinocytes that possess self-renewal capacity rather than only stem cells, and suggest that transit amplifying cells, and even differentiated keratinocytes, may also contribute to the pathogenesis of epidermal tumours in dogs.

Background Increasing hospice need, a growing shortage of hospice providers, and concerns about in-person services because of coronavirus disease 2019 (COVID-19) require hospices to innovate care delivery. Measures This project compared outcomes between hospice reauthorization visits conducted via telehealth and in person. After each visit, providers, patients, and caregivers completed telehealth acceptance surveys, and providers recorded reauthorization recommendations. Intervention Providers conducted 88 concurrent in-person and telehealth visits between June and November 2019. Outcomes No statistically significant differences in reauthorization recommendations were found between telehealth and in-person visits. Satisfaction with telehealth was high; 88% of patients/caregivers and 78% of providers found telehealth services as effective as in-person visits. Conclusions/Lessons Learned Results indicate that telehealth can successfully support clinical decision making for hospice reauthorization. These findings show telehealth to be reliable and acceptable for certain types of hospice care even before COVID-19, which emphasizes its importance both during and after the current public health emergency.

Cutaneous papilloma (CP) and cutaneous squamous cell carcinoma (CSCC) are frequent epidermal tumours in dogs. In this regard, the study of the deregulated activity of signalling molecules during the epidermal tumourigenesis process could be the basis for the development of novel molecular mechanism-based antitumour treatments for CP and CSCC canine patients. Recent evidence suggests that the development and progression of CP and CSCC involve the dysregulated activation of the Hippo signalling pathway effector YAP. Thus, in the present study, we evaluated the immunohistochemical expression pattern of YAP in sections of tissue microarrays constructed from canine samples of normal epidermis, CP, preneoplastic epidermis, and CSCC. In samples of CP, preneoplastic epidermis, and CSCC, YAP expression was significantly increased relative to normal epidermis. This emerging evidence suggests that the dysregulated activity of the Hippo signalling pathway effector YAP represents a frequent event during canine epidermal tumourigenesis, pointing to this protein as a potential therapeutic target for the treatment of CP and CSCC in dogs.

In this paper we present and assess human isotopic data (δ13C and δ15N) available for Southern Chile. We analyze 24 cases from six different geographical zones, dated 200-1800 AD. This new information allows us to characterize individuals who had different subsistence patterns, social organization and historical trajectories, vis-a-vis phenomena like the adoption of ceramics (150 BC), cultigens (600-1000 AD) and the arrival of Europeans (1550 AD). This is complemented by a regional baseline of 45 archaeological faunal and plant resources. Based on our results, three dietary patterns can be identified over time (from 1000 to 1800 AD): one oriented towards marine resources, another towards C3 plants and terrestrial protein, and the last focused on a mixed consumption of C3 and C4 plants, complemented by intake of terrestrial and marine protein. These cases show significant intra-zone consistency over time, and high inter-zone variability. This heterogeneous situation is evident even in synchronous individuals ascribed to the same cultural-historical unit or inhabiting the same geographical macro-zone (valley, coast, islands). It also contrasts with results from adjacent areas to Southern Chile. This highlights the complex diet variability that existed in societies which otherwise appear to be extremely alike in their archaeological record (burials, pottery) and ethnographic features (language, rituals).

Clinically relevant epidermal tumours in dogs include cutaneous papillomas (CPs) and cutaneous squamous cell carcinomas (CSCCs). The development of CPs and CSCCs involves dysregulation in expression of E-cadherin/β-catenin; however, knowledge about the contribution of these molecules to epidermal tumourigenesis in dogs is limited. This study examined the immunohistochemical expression pattern of E-cadherin/β-catenin in samples of normal canine epidermis, CPs, preneoplastic epidermis and CSCCs, using tissue microarrays, in order to elucidate whether the dysregulated expression of these molecules may contribute to the pathogenesis of clinically relevant epidermal tumours in dogs. We also investigated the correlation between the immunohistochemical expression pattern of E-cadherin/β-catenin in these tissue microarrays to further evaluate whether the disruption of the adherens junction interactions plays a relevant role in canine epidermal tumourigenesis. In samples of CP and preneoplastic epidermis, the membrane immunoreactivity of E-cadherin/β-catenin was conserved, while in CSCC, the immunoreactivity of these molecules was significantly reduced, independently of the tumour location. There was significant correlation between the membrane expression of E-cadherin/β-catenin in CSCC. β-catenin also showed cytoplasmic and nuclear expression in samples of CP, preneoplastic epidermis and CSCC. These results support the hypothesis that dysregulated expression of E-cadherin/β-catenin may play a critical role in the pathogenesis of relevant canine epidermal tumours, not only due to the disruption of the intercellular adherens junctions, but also due to the dysregulated activity of the signalling pathways in which these molecules are involved.

Diagnosis of early invasive breast cancer relies on radiology and clinical evaluation, supplemented by biopsy confirmation. At least three issues burden this approach: a) suboptimal sensitivity and suboptimal positive predictive power of radiology screening and diagnostic approaches, respectively; b) invasiveness of biopsy with discomfort for women undergoing diagnostic tests; c) long turnaround time for recall tests. In the screening setting, radiology sensitivity is suboptimal, and when a suspicious lesion is detected and a biopsy is recommended, the positive predictive value of radiology is modest. Recent technological advances in medical imaging, especially in the field of artificial intelligence applied to image analysis, hold promise in addressing clinical challenges in cancer detection, assessment of treatment response, and monitoring disease progression. Radiomics include feature extraction from clinical images; these features are related to tumor size, shape, intensity, and texture, collectively providing comprehensive tumor characterization, the so-called radiomics signature of the tumor. Radiomics is based on the hypothesis that extracted quantitative data derives from mechanisms occurring at genetic and molecular levels. In this article we focus on the role and potential of radiomics in breast cancer diagnosis and prognostication., Highlights • In the screening setting, radiology sensitivity is suboptimal. • Artificial intelligence hold promise in cancer diagnosis and prognostication. • Radiomics include feature extraction from clinical images.

This work studies the surface characteristics and, particularly, the rolling contact fatigue (RCF) behavior of austempered ductile iron (ADI) samples coated with TiN based coatings of about 1 μm in thickness. Films synthesized by cathodic arc deposition (CAD) at a fixed nitrogen flow, compositional gradient films synthesized by CAD at a variable nitrogen flow and plasma based ion implanted and deposited (PBIID) films were comparatively analyzed. The results indicated that CAD films showed a strong TiN (111) preferred orientation while PBIID films a more randomly orientation. The crystallite size of CAD films was more than the double of PBIID films. Residual stresses of the PBIID films were lower than those of CAD films, the lowest hardness and elastic modulus were obtained for CAD films grown at variable nitrogen flow, while no significant differences in roughness, H/E ratio and adhesion were observed among the different films. Regarding RCF tests, failures in samples coated with TiN at constant flow were characterized by a progressive coating delamination followed by the formation of fatigue spalls inside the delaminated areas. Failures in samples coated with PBIID and gradient TiN were characterized by the formation of fatigue spalls with slight coating delamination. There were no significant differences between the RCF resistance of uncoated ADI and the samples with CAD films while the samples with PBIID films had a noticeably higher resistance. The better performance could be associated with the low compressive residual stresses and the fine grained microstructure induced by the PBIID process. © 2018 Elsevier B.V.

International audience; A passive decay heat removal system is proposed that is actuated by the phase change heat transfer method(latent heat of fusion and evaporation) for an emergency draining tank system of molten salt reactors. Theemergency draining tank serves an evaporating tank, where the liquid fuel is mixed with an immiscible workingfluid and later to vaporize this working fluid. The top header of the vaporizing tank is connected by pipes to acondenser. The resulting vapor pressure of the working fluid drives the vapor through these pipes to condensers,The condensers are located above the reactor, where the vapor condenses, releasing its latent heat of vaporizationto a provided heat sink (air heat exchanger). The condensed working fluid flows at first in a Pythagoreancup type collector, which is located just below the condensers, the collected working fluid flows back, in batch,to the emergency draining tank by gravitational force. In this batch manner the working fluid can be stronglymixed with the liquid fuel to enhance the heat transfer between liquid fuel and working fluid without anymechanical or electrical assistance, i.e. a completely passive heat removal process. Therefore the system canpassively transport the latent heat of vaporization of the working fluid from the emergency draining tank to thecondenser section. This proposed decay heat removal system is described in more detail in this paper. Thepassive cooling of the liquid fuel to extract the residual heat has been studied.

After the 2010 Maule, Chile, earthquake (Mw 8.8), several reinforced concrete (RC) buildings presented damage in some walls (crushing of concrete, buckling and fracture of steel reinforcement). These buildings had been designed according to the up-to-date seismic standards in the country and were not expected to suffer damage as severe as what was observed. Common features of the damaged walls were: little or no confinement at the wall ends; relatively high axial load; narrow thicknesses (below 200 mm); and discontinuities in height. Slender RC walls are often used in Chile and commonly, due to architectural constraints, the length of the walls changes between floors designated for parking use and the upper floors, creating a setback in the lower levels. These types of walls are commonly called “flag walls”. The problem of discontinuity has not been investigated experimentally and therefore it is necessary to observe its impact in RC walls. Four structural wall specimens were designed, one with no discontinuity and the other three with different sizes of the setback. They were tested under a nominal constant axial load of 0.1f'cAg and cyclic lateral loads increasing at specific drift levels. Conventional instrumentation and photogrammetry were used to monitor the tests. The experimental results show that the impact of the setback, for the sizes tested, is not significant for the strength but it is relevant for the strength degradation and deformation capacity. Strains in the extreme fibers, curvature and principal strains are studied using photogrammetry. It is found that the plastic hinge length increases with drift, but it remains constrained to the setback region. Another discontinuity is found around the reinforcement of the setback where large concentration of strains can cause premature failure of the wall.