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China is the most productive seaweed farming country in the world and her seaweed imports and exports have a significant impact on global seaweed trade commodities and food security. Nevertheless, few studies had delved into the main characteristics and development of China's seaweed farming industry. This paper aims to narrow this research gap by analyzing trade patterns in China's seaweed products and the international competitiveness of seaweed product by using the international market share index (IMS), the trade competitiveness index (TC), and revealed comparative advantage index (RCA) from 2002 to 2017. The results showed that Japan, the Association of Southeast Asian Nations (ASEAN), Chile, Peru, and the Republic of Korea are China's main trade partners, the total trade value of China's seaweed products has grown rapidly, its imports have gradually exceeded exports, the trade deficit continues to expand, and its competitiveness keeps decreasing. The reasons for this trend may include the changing seaweed trade commodity structure, product differentiation, increased government support in competing countries, and trade barriers among the trade partners. We propose actively expanding international trade markets, establishing a strong seaweed product processing industry to develop high value-added seaweed products, optimizing the trade commodity structure, and differentiating of seaweed products to improve the competitiveness of China's seaweed products.

Using a continuous-time model of litigation, we show that the increasingly popular practice of third-party litigation financing has ambiguous welfare implications. A defendant and a plaintiff bargain over a settlement payment. The defendant takes costly actions to avoid deadweight losses associated with large transfers to the plaintiff. Litigation financing bolsters the plaintiff, leading to larger deadweight losses. However, by endogenously deterring the defendant from taking costly actions, litigation financing can nonetheless improve the joint surplus of the plaintiff and the defendant. In contrast to popular opinion, litigation financing does not necessarily encourage high-risk frivolous lawsuits.

Given the alleged uniqueness of Islamic stocks, it is expected that they should provide insurance when faced with adverse market conditions. This expectation is tested by assessing contagion, using 25 Islamic indexes during the period 2007–2017, by employing contemporary econometric techniques. The results reveal robust contagion effects of the financial crisis on Islamic stock indexes. Furthermore, we find Baker and Wurgler’s investor sentiment can predict Islamic stock returns during the crisis period. Our findings indicate that Islamic stocks cannot be used as a haven asset during financial turmoil.

Shariah screening discards the firms that belong to impermissible business sectors (or sin industries) and follow capital structure with high debt and current assets. This study tests whether the firms passing Shariah screening have better (or worse) governance quality as compared to firms not subjected to Islamic screening. The screened firms may have lesser governance quality as they cannot use debt to discipline managers or achieve optimal capital structure. On the contrary, they may be better governed as these firms get higher presence of institutional investors and better analyst coverage. This paper provides comparison of governance quality of Shariah compliant (SC) firms in United States by using proprietary dataset of Dow Jones US Indices. The screened firms offer ground for a natural experiment as they pass negative ethical screening and meet financial criteria for the inclusion in the index. The findings suggest that the SC firms have lesser governance quality than Shariah Non-Compliant firms. The lower level of governance can be attributed to lower Size, lower Profitability, higher Dividend Payout, higher Total Risk and lower Free Cash Flow. Various robustness tests are performed to validate the findings and the results remained robust. These findings provide useful insights about the governance mechanism of SC firms that are emerging as an important alternative investment class in the last two decades.

Cultural dimensions have a significant impact on capital structure decisions, particularly in Islamic economies where unique personal, social and ethical values are closely integrated with culture. This study considers the relationship between four Hofstede cultural dimensions to explain their connection with the capital structure decisions of Shariah-compliant firms. Using a panel of 342 Shariah complaint companies from Malaysia, Saudi Arabia and Pakistan for the period 2013 to 2017, this study investigates the influence of cultural dimensions on short-term, long-term and total leverage in the presence of several firm- and country-specific variables. On average, Saudi Arabian firms witnessed comparatively higher percentages of all three debt classifications considered. Typically, determinants of debt do not otherwise differ significantly across the three countries. Firms also carefully consider asset structure and growth opportunities when raising debt capital. On the other hand, when tested alongside cultural dimensions, Islamic firms from countries with (a) higher power distance scores, (b) higher levels of individualism, (c) higher masculinity scores and (d) lower degrees of uncertainty avoidance exhibit a preference for long-term debt. This finding diverges from the existing literature on non-Islamic firms. Agency theory and pecking order theory predominate in explaining our findings.

Traditionally, equity mispricing has been documented as an important determinant of speed of adjustment to target leverage levels. More recently, the impact of Shari’ah compliance has been shown to significantly affect capital structure decisions. In this paper, we explore the effect of equity mispricing in Shari’ah compliant (vs. non-compliant) firms. We conduct our study on a comprehensive sample of Malaysian firms from year 1998–2016. We show that established findings in the dynamic trade-off theory do not hold for Shari’ah compliant firms. Shari’ah compliant firms increase their reliance on equity financing at greater levels than non-compliant firms when they are above target levels and equities are overpriced. In contrast, for Shari’ah compliant firms below target levels and where equity is under-priced, the rate of adjustment is slower than non-compliant firms. Our findings suggest that managers of Shari’ah compliant firms are inclined to time the equity market when above target levels to capture the impact of lower costs of equity during periods of over-valuation of equity. However, those managers tend to be reluctant to resort to debt financing when below target leverage even in the presence of equity under-pricing.

This paper analyses the effect of bank lending and fee income on Islamic and conventional bank's performance. The paper builds a theoretical model and provides empirical evidence to show that Islamic banks as compared to conventional banks can have a greater reliance on fee-based income than returns from loans to increase their profitability. Using data from a sample of 20 countries for the period from 2000 to 2015 for Islamic and conventional banks, we find that the bank fee is an important determinant of the profitability of an Islamic bank. Interestingly, many commonly used measures such as loan to deposit ratio do not affect the Islamic banks' profitability as much as they do for conventional banks. Our findings imply that Islamic banks' lower sensitivity to loan to deposit ratio may contribute to lower credit risk. However, an over-reliance on fee-based income may affect their growth, profitability and sustainability in the long run.

Mediterranean mussel farming in Greece developed considerably during the last 40 years reaching a gross commodity product up to the limits of the country's production capacity (35–40,000 tonnes/year). Despite the achievements in the sector's growth, little or no effort has been attributed yet to risk assessment and moreover to risk management of the activity. The present effort aims at developing a working framework for the shellfish aquaculture of Greece to be used as a tool by the sector's decision makers to advance strategies for risk elimination or avoidance. The work was based on a generic risk management standard tool, the Joint Australian and New Zealand Risk Management Standard AS/NZS ISO 31000:2009 that has been adapted to the specific national characteristics of all levels of the mussel farming business -activities and the industry function. The framework supported by data sets regarding development, production, profits and losses, retrieved by surveys through distributed questionnaires or interviews during site-visits, as well as by collecting data from national and international authorities. Data input covered technology, farm size, farmer risk-attitude, risk-management strategies, risk-perceptions and socioeconomic profiles. Major risks and risk management options were identified providing aid for remediation risk policies to the stakeholders.

To overcome the cost of competition resulting from close social proximity while foraging in a group, individuals may balance their use of private (i.e. acquired from personal sampling) and social (i.e. acquired by watching other individuals) information in order to adjust their foraging strategy accordingly. Reliability of private information about environmental characteristics, such as the spatial distribution of prey, is thus likely to affect individual movement and social interactions during foraging. Our aim was to investigate how movement characteristics of foraging individuals changed as they acquired reliable private information about the spatial occurrence of prey in a foraging context. We allowed guppies (Poecilia reticulata) to develop the reliability of their private knowledge about prey spatial occurrence by repeatedly testing shoals in a foraging task under three experimental distributions of prey: 1) aggregated prey forming three patches located in fixed locations, 2) scattered distribution of prey with random locations, or 3) no prey (used as control). We then applied tracking methods to obtain individual time series of spatial coordinates from which we computed a suite of movement variables reflecting search effort, social proximity and locomotion characteristics during foraging, in order to examine changes occurring over repeated trials and to investigate which best explained foraging success. We show that foraging shoals became more efficient at finding and consuming food over the first three days by increasing their time spent active. Over time, individuals foraging on either scattered or aggregated prey travelled greater distances, showed an increasing distance to their closest neighbour and became slightly more stochastic in their acceleration profile, compared to control individuals. We found that behaviour changed as private information increased over time. Social proximity was the major predictor of foraging success in the absence of prior foraging information, while stochasticity in acceleration and search effort became the most important predictors of foraging success as information increased. In conclusion, we show that individual movement patterns changed as they acquire private information. Contrary to our predictions, the spatial distribution of prey did not affect any of the movement variables of interest. Our results emphasise the importance of information, both private and social, in shaping movement behaviour in animals. Keywords: social foraging, movement, private information, prey spatial distribution, fish.

Objective The objective was to develop a novel scoring system that would be predictive of postoperative pulmonary complications in critically ill patients after cardiac and major vascular surgery. Methods A total of 17,433 postoperative patients after coronary artery bypass graft, valve, or thoracic aorta repair surgery admitted to the cardiovascular intensive care units at Cleveland Clinic Main Campus from 2009 to 2015. The primary outcome was the composite of postoperative pulmonary complications, including pneumonia, prolonged postoperative mechanical ventilation (>48 hours), or reintubation occurring during the hospital stay. Elastic net logistic regression was used on the training subset to build a prediction model that included perioperative predictors. Five-fold cross-validation was used to select an appropriate subset of the predictors. The predictive efficacy was assessed with calibration and discrimination statistics. Post hoc, of 13,353 adult patients, we tested the clinical usefulness of our risk prediction model on 12,956 patients who underwent surgery from 2015 to 2019. Results Postoperative pulmonary complications were observed in 1669 patients (9.6%). A prediction model that included baseline and demographic risk factors along with perioperative predictors had a C-statistic of 0.87 (95% confidence interval, 0.86-0.88), with a corrected Brier score of 0.06. Our prediction model maintains satisfactory discrimination (C-statistics of 0.87) and calibration (Brier score of 0.07) abilities when evaluated on an independent dataset of 12,843 recent adult patients who underwent cardiovascular surgery. Conclusions A novel prediction nomogram accurately predicted postoperative pulmonary complications after major cardiac and vascular surgery. Intensivists may use these predictors to allow for proactive and preventative interventions in this patient population.

The body responds to changing circumstances and environmental threats both consciously and subconsciously. The cognitive response to a physical threat normally involves movement mediated by skeletal muscle. There are a number of control mechanisms ‘hardwired’ into the nervous system which enable muscle systems to respond in an integrated fashion without involving a conscious decision, although the subject is usually conscious of what has happened. These include the stretch reflex, the withdrawal reflex and the crossed extensor reflexes. Muscle spindles, Golgi tendon organs and cutaneous nociceptors provide the sensory input to these reflexes, and muscle spindles also play a role in the control of voluntary movement. The autonomic nervous system controls the internal environment in response to environmental change. It consists of the parasympathetic division, which controls basal and vegetative mechanisms, and the sympathetic nervous system, which controls visceral adaptive responses to any sort of environmental change or threat.

OBJECTIVES: This study was conducted to assess poultry farmers’ knowledge and practices regarding antibiotics, antimicrobial usage (AMU), and antimicrobial resistance (AMR), and to identify the sociodemographic factors of inappropriate use of antibiotics in commercial poultry farms in Bangladesh. METHODS: A qualitative survey of 140 farmers in Bangladesh was conducted from March to May 2019. A logistic regression model was used to identify factors associated with the inappropriate use of antibiotics. RESULTS: 47.1% of farmers were unable to explain antibiotics, 42.9% used antibiotics for preventive purposes, 4.3% used them as growth promoters, 25.7% used them as suggested by veterinarians, 42.9% used leftover antibiotics, 50% did not maintain antibiotics residual withdrawal period, and 98.6% did not know about AMR. In bivariable regression analysis, sex and primary occupation of poultry farmers, their knowledge about withdrawal periods for antibiotics, and no contact with veterinary surgeons (VS) were found to be significantly associated with the inappropriate use of antibiotics, while only ‘no contact with VS’ was identified in multivariable regression analysis. CONCLUSIONS: The findings suggest an urgent need to improve understanding of antibiotics and AMR. Adequate supervision by veterinarians would ensure adherence to appropriate AMU patterns, and would limit the misuse of antibiotics and associated AMR development in farms.

Findley first proposed the presence of age-related dysfunction of the hypothalamic-neurohypophyseal-renal axis more than 60 years ago. More sophisticated studies have since corroborated his findings. As a result, it is now clear that multiple abnormalities in water homeostasis occur commonly with aging, and that the elderly are uniquely susceptible to disorders of body volume and osmolality. This article summarizes the distinct points along the hypothalamic-neurohypophyseal-renal axis where these changes have been characterized, as well as the clinical significance of these changes, with special attention to effects on cognition, gait instability, osteoporosis, fractures, and morbidity and mortality.

Background Neutrophilic dermatosis of the dorsal hands is an uncommon localised variant of Sweet syndrome first described in 1995. It is characterised by tender erythematous plaques, pustules and bullae on the dorsa of the hands. Literature Review A total of 123 cases of NDDH are included in this review. The mean patient age was 62.1 years and there was a slight female preponderance. 78.0% of cases had reported bilateral involvement and other sites were affected in almost a third of cases. Underlying disease was found in around 40% of patients, with the most common associations being haematological disorders (gammopathies, myelodysplasias or malignancies), recent infection, solid organ tumours and inflammatory bowel disease. Systemic and/or topical corticosteroids were employed in the treatment of 88.1% of cases while dapsone, colchicine and tetracyclines were the commonest steroid-sparing agents used. Improvement was often rapid and complete resolution the norm. Conclusions Whilst being uncommon, NDDH is frequently misdiagnosed and thus, its exact prevalence is probably underestimated. This may have significant implications including treatment delays or incorrect management. Moreover, recognition of NDDH is important since a correct diagnosis should trigger a search for underlying diseases and proper treatment with corticosteroids and/or steroid-sparing agents which is almost invariably curative.

Policy evaluation is central to economic data analysis, but economists mostly work with observational data in view of limited opportunities to carry out controlled experiments. In the potential outcome framework, the panel data approach (Hsiao, Ching and Wan, 2012) constructs the counterfactual by exploiting the correlation between cross-sectional units in panel data. The choice of cross-sectional control units, a key step in its implementation, is nevertheless unresolved in data-rich environment when many possible controls are at the researcher's disposal. We propose the forward selection method to choose control units, and establish validity of the post-selection inference. Our asymptotic framework allows the number of possible controls to grow much faster than the time dimension. The easy-to-implement algorithms and their theoretical guarantee extend the panel data approach to big data settings., Comment: accepted for publication at the Journal of Econometrics

Various strategies, including controls of morphology, oxidation state, defect, and doping, have been developed to improve the performance of Cu-based catalysts for CO2 reduction reaction (CO2RR), generating a large amount of data. However, a unified understanding of underlying mechanism for further optimization is still lacking. In this work, combining first-principles calculations and machine learning (ML) techniques, we elucidate critical factors influencing the catalytic properties, taking Cu-based single atom alloys (SAAs) as examples. Our method relies on high-throughput calculations of 2669 CO adsorption configurations on 43 types of Cu-based SAAs with various surfaces. Extensive ML analyses reveal that low generalized coordination numbers and valence electron number are key features to determine catalytic performance. Applying our ML model with cross-group learning scheme, we demonstrate the model generalizes well between Cu-based SAAs with different alloying elements. Further, electronic structure calculations suggest surface - negative center could enhance CO adsorption by back donating electrons to antibonding orbitals of CO. Finally, several SAAs, including PCu, AgCu, GaCu, ZnCu, SnCu, GeCu, InCu, and SiCu, are identified as promising CO2RR catalysts. Our work provides a paradigm for the rational design and fast screening of SAAs for various electrocatalytic reactions.

Las osteonecrosis epifisarias no traumaticas del adulto se relacionan con tres causas esenciales: la administracion de corticoides, la intoxicacion etilica y la anemia drepanocitica. Ademas de estas tres causas principales, hay muchas otras, como los trastornos del metabolismo lipidico, que tambien pueden causar necrosis epifisarias. Estas afectan sobre todo a la articulacion de la cadera. Algunas pueden producir osteonecrosis multifocales que entonces afectan preferentemente al hombro y la rodilla, despues de la cadera. Es raro observar otras zonas afectadas, salvo en el caso de algunas causas que producen afecciones de zonas especificas (como la columna en la anemia drepanocitica). El diagnostico en la fase precoz se basa esencialmente en la resonancia magnetica (RM) que, en la mayoria de los casos, permite establecer un diagnostico de certeza de la enfermedad. Las modalidades terapeuticas de las osteonecrosis epifisarias dependen fundamentalmente de la fase diagnostica. Se puede hacer un tratamiento conservador de la articulacion si el diagnostico se ha establecido precozmente, en particular mediante una RM.

Background Ibrutinib is an oral inhibitor of Bruton’s tyrosine kinase (BTK) that is FDA-approved for several lymphoproliferative disorders and chronic GVHD. Objective To characterize cutaneous eruptions arising from ibrutinib and highlight overlap with epidermal growth factor receptor inhibitor (EGFRi)-induced dermatologic adverse events (dAEs). Methods Single-center retrospective cohort of patients referred to the Skin Toxicities Program for management of cutaneous eruptions while taking ibrutinib. Results Among 19 patients, cutaneous eruptions manifested as facial-predominant papulopustular eruptions, petechiae or ecchymoses, photosensitivity, panniculitis, xerosis, and clinical staphylococcal overgrowth. The majority of patients were able to continue ibrutinib therapy with focused management of their cutaneous toxicities. Limitations This study represents cases at a single tertiary care center and is limited to patients referred for toxicity. Conclusions With the exception of petechiae, the cutaneous toxicities of ibrutinib overlap with those associated with selective EGFR inhibitors. We observed that these reactions can be successfully managed using approaches for EGFR inhibitor-induced cutaneous adverse events.

We examine how the trade shock from China influences the behavior and investment performance of overconfident CEOs in U.S. firms. We show that the rise of Chinese import competition curbs investments and improves investment value and acquisition performance for firms with overconfident CEOs. Intensified Chinese product competition also reduces the incentives for these firms to expand assets, invest out of cash flows, pursue aggressive financial policies, and increase risk exposure, and enhances their incentives to buy back shares. Overall, the evidence suggests that product market competition is an effective external governance mechanism for curbing the adverse effects of managerial overconfidence.

Statement of problem Bilateral balanced occlusion has been advocated over nonbalanced occlusion for improved removable complete denture stability and function. However, assessments of quality of life and patient satisfaction studies between the 2 occlusion schemes are lacking. Purpose The objective of this parallel randomized control trial was to determine the difference in quality of life and patient satisfaction between the nonbalanced and bilaterally balanced occlusal schemes. Material and methods Sixty participants were included in the parallel randomized control trial of nonbalanced and bilaterally balanced complete dentures. Thirty were recruited into each group with definitive inclusion and exclusion criteria as per the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Quality of life was estimated from the oral health quality of life (Oral Health Impact profile) for edentulous patients questionnaire, and patient satisfaction was analyzed from a visual analog scale. The estimation was made at 0, 3, and 6 months after denture insertion. The data were statistically analyzed with the Friedman, Mann-Whitney, and t test (α=.05). Results The mean ±standard deviation Oral Health Impact profile score was 60.81 ±8.87 for nonbalanced dentures and 64.12 ±8.98 for bilaterally balanced dentures. The mean ±standard deviation visual analog scale score was 2.84 ±0.28 for nonbalanced dentures and 2.90 ±0.31 for bilaterally balanced dentures. The Mann-Whitney and t test indicated nonsignificant differences between the 2 groups and at different time intervals for Oral Health Impact profile and visual analog scale scores (P>.05). Conclusions The study detected no significant differences between the 2 occlusal schemes in quality of life or patient satisfaction.

Resumen Introduccion La miastenia gravis ocular (MGo) es la forma de presentacion de la enfermedad mas frecuente. Un porcentaje variable de estos pacientes desarrollan una forma generalizada (MGg), siendo los factores de riesgo de conversion y el efecto protector del tratamiento inmunosupresor objeto de controversia en el momento actual. Pacientes y metodos Disenamos un estudio monocentrico retrospectivo, con el objetivo de describir las caracteristicas demograficas, clinicas y de laboratorio de una cohorte espanola de MGo, a partir de una serie de MG registrada en el Hospital Universitario de Albacete desde enero del 2008 hasta febrero de 2020. Resultados Seleccionamos 62 pacientes con MGo de una cohorte de 91 sujetos con MG (68,1%). La mediana de edad al diagnostico fue de 68 (RIQ 52-75,3), con predominio de MGo de inicio muy tardio (n = 34, 54,8%) y de varones (n = 38, 61,3%). La diplopia binocular fue el sintoma inicial mas frecuente (51,7%). La tasa de conversion a MGg fue del 50% (n = 31), con una mediana de tiempo de seis meses (RIQ 2-12,8). Encontramos asociacion significativa entre ser mujer (OR: 5,46, IC 95% 1,16-25-74, p = 0,03) y tener AcAchR (OR: 8,86, IC 95% 1,15-68,41, p = 0,04), con el riesgo de desarrollar una MGg. Conclusiones La tasa de conversion de MGo en nuestra serie es relativamente elevada. La generalizacion tiene lugar principalmente durante los primeros dos anos de evolucion y esta asociada al sexo femenino y, sobre todo, a la presencia de AcAchR.

Introduction GOLD 2017 report proposed that the combined COPD assessment should be done according only to symptom burden and exacerbation history in the previous year. Objective This study aims to investigate the change in the COPD groups after the GOLD 2017 revision and also to discuss the evaluation of group C and D as a single group after the GOLD 2019 report. Method The study was designed as a cross-sectional. 251 stable COPD patients admitted to our out-patient clinic; aged ≥40 years, at least one-year diagnosis of COPD and ≥10 pack-year smoking history were consecutively recruited for the study. Results In GOLD 2017, a significant difference was found between the distribution of all groups compared to GOLD 2011 (P = 0,001). 31 patients included in group C were reclassified into group A and 37 patients in group D were reclassified into group B. The FEV1 values of group A and B patients were significantly low and group C and D patients had had exacerbations in more frequently the previous year in GOLD 2017 compared to GOLD 2011. Conclusion After the GOLD 2017 revision, the rate of group C patients decreased even more compared to GOLD 2011 and the group C and D may be considered as a single group in terms of the treatment recommendations with the GOLD 2019 revision. We think that future prospective studies are needed to support this suggestion.

Background Early initiation of breastfeeding (EIBF) within 1 h of birth is crucial in preventing newborn deaths and plays a vital role in early infant nutrition. Promoting and supporting breastfeeding is an integral part of midwifery. The objective of the study was to improve the EIBF rate in neonates born through a Cesarean Section (CS) from 0% to 50% within six months through a quality improvement (QI) process and to assess the maternal experience of EIBF in operation theatre (OT). Methods Six Plan-Do-Study-Act (PDSA) cycles were conducted to test the change ideas proposed by the team members for a month to improve EIBF. Participants of the study were the stable term newborns delivered by CS under spinal anesthesia. Results The EIBF rate improved from 0% to 88% after the sixth PDSA cycle. The effect was sustained for six months. Mothers of 51 neonates (98%) who received EIBF reported that their newborns were breastfed successfully, and it was not physically tiring to feed immediately in the OT. Conclusions A quality improvement (QI) initiative was able to improve and sustain the improved EIBF rate after CS. Early skin-to-skin contact to be initiated with EIBF for better neonatal outcomes.

INTRODUCTION Advances in the treatment of myasthenia gravis (MG) have improved quality of life and prognosis for the majority of patients. However, 10%-20% of patients present refractory MG, with frequent relapses and significant functional limitations. PATIENTS AND METHODS Patients with refractory MG were selected from a cohort of patients diagnosed with MG between January 2008 and June 2019. Refractory MG was defined as lack of response to treatment with prednisone and at least 2 immunosuppressants, inability to withdraw treatment without relapse in the last 12 months, or intolerance to treatment with severe adverse reactions. RESULTS We identified 84 patients with MG, 11 of whom (13%) met criteria for refractory MG. Mean (standard deviation) age was 47 (18) years; 64% of patients with refractory MG had early-onset generalised myasthenia (as compared to 22% in the group of patients with MG; P

Resumen Introduccion La deteccion precoz del cancer de cervix requiere la implementacion de programas de cribado del virus del papiloma humano (VPH). Sin embargo, existen discrepancias en la optimizacion de esas estrategias. Se evalua el rendimiento de 10 protocolos basados en tecnicas moleculares, citologicas o combinadas en cribado primario. Material y metodos Se disena un estudio ciego, prospectivo e intervencionista en 1.977 mujeres de 35 anos. La determinacion molecular se realizo por la plataforma Cobas 4800 HPV. Los analisis citologicos se realizaron en las mismas muestras sin conocimiento del resultado molecular. Todas las mujeres en las que se detectaba VPH-16/VPH-18 o presentaban alteracion citologica y deteccion de otros genotipos de alto riesgo (VPHar) eran derivadas a colposcopia. Resultados El ensayo molecular detecto presencia de VPHar en el 12,5% de las mujeres, mientras solo el 8,1% de las citologias fueron patologicas. El 19,5% de las pacientes derivadas a colposcopia revelaron lesiones de alto grado, estando VPH-16 presente en el 65,3% de ellas. En 6 de esas ocasiones (VPH-16 siempre presente) la citologia habia sido informada como normal. El seguimiento al ano de las mujeres con citologia normal y deteccion de VPHar identifico una lesion HSIL/CIN2+ (asociada a VPH-33). En el estudio comparativo con otras estrategias el protocolo denominado CRYGEN 16/18 rindio el mejor equilibrio de sensibilidad y especificidad con la menor derivacion a colposcopia. Conclusiones La realizacion de deteccion molecular de VPH con genotipado parcial en primera linea, al menos VPH-16, con derivacion directa a colposcopia, aumenta la tasa de deteccion de lesiones HSIL/CIN2+.

We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; P = .004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.

Resumen En junio de 2019 se organizo en Sevilla el primer curso de resonancia magnetica (RM) fetal, con el aval de las sociedades espanolas de Radiologia Medica (SERAM) y Radiologia Pediatrica (SERPE), y se fundo el grupo espanol de RM fetal. Para establecer este grupo, se diseno un cuestionario para radiologos que se dediquen a la imagen prenatal en Espana que anuncio la Sociedad Espanola de Radiologia a sus socios. Las preguntas estaban relacionadas con el tipo de hospital, con los estudios de RM (campo magnetico, edad gestacional, uso de sedacion, numero de estudios por ano, proporcion de estudios de neuroimagen fetal) y con la docencia e investigacion de la RM fetal. Recogimos 41 respuestas de 25 provincias (88% hospitales publicos). Muy pocos radiologos realizan ecografia (7%) o tomografia computarizada prenatal en Espana. La RM se realiza en el segundo trimestre (34%) o tercer trimestre (44%). En el 95% de los centros predominan los estudios del cerebro fetal. El 41% de los centros tienen la posibilidad de realizar sus estudios en RM 3 Tesla. La sedacion materna se usa en el 17% de los centros. El numero de estudios de RM fetal por ano es muy variable, siendo mucho mayor en Barcelona y Madrid que en el resto de Espana.

Background Hospital administrators are often challenged with overcrowding at hospitals. The study hospital receives referred patients; however, they have to wait in long queues even for getting registered. This was a cause of concern for hospital administrators. The study was undertaken to find an amicable solution to the queues at registration using Queuing Theory. Method This observational and interventional study was carried out in a tertiary care ophthalmic hospital. In the first phase, data of service time and arrival rate was collected. The queuing model was built using the coefficient of variation (CoV) of the observed times. Server utilization for new patient registration was found to be 1.21 and was 0.63 for revisit patients. Scenario-based simulation carried out using free software for optimal utilization of both types of servers. Recommendations made to combine the registration process and to increase one server were implemented. In the second phase, after one year, patient registration data were collected and compared for the number of patients registered using SPSS 17. Results Number of patients registered within the registration timings increased whereas the number of patients registered after the registration timings decreased significantly at 95% CI with a p-value of less than 0.001. Queues finished early and more number of patients were registered in the same time. Conclusion Using queuing theory, the bottleneck of the systems can be identified. Scenario and software-based simulations provide solutions to the problem of queues. The study is an application of Queuing Theory with a focus on efficient resource utilization. It can be replicated in an organization with limited resources facing the challenge of queues.

Current research aims at improving early detection and treatment of cognitive impairment (CI), particularly in patients at high risk for progression to dementia. It is important to treat signs and symptoms as early as possible to normalize quality of life. In older cognitively impaired patients, dentists and physicians should consider polypharmacy, uncontrolled cardiovascular risk factors, depression, metabolic or endocrine derangements, delirium due to intercurrent illness, and dementia, all of which may increase risk for CI and other negative outcomes. An interdisciplinary team approach is a necessity for a responsible and safe treatment sequence.

In this report, we present a series of two unusual cases of elapid snakebite with acute neuroparalysis, that after initial response to standard anti-snake venom therapy, developed recurrence of disabling quadriparesis with dysautonomia, that on detailed evaluation turned out to be immune-mediated polyradiculoneuropathy (GB syndrome). Both the cases then responded to therapy with intravenous immunoglobulins. These cases bring out the rare immune-mediated late complication of snake venom, which if recognized and treated in time, can significantly reduce the morbidity and mortality.

Background The aim of this study was to review, systematically, evidence concerning the link between the ACTN3 R577X polymorphism and the rates and severity of non-contact injuries and exercise-induced muscle damage in athletes and individuals enrolled in exercise training programs. Methods A computerized literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus, from inception until November 2020. All included studies compared the epidemiological characteristics of non-contact injury between the different genotypes of the ACTN3 R577X polymorphism. Results Our search identified 492 records. After the screening of titles, abstracts, and full texts, 13 studies examining the association between the ACTN3 genotypes and the rate and severity of non-contact injury were included in the analysis. These studies were performed in 6 different countries (Spain, Japan, Brazil, China, Republic of Korea, and Italy) and involved a total participant pool of 1093 participants. Of the studies, 2 studies involved only women, 5 studies involved only men, and 6 studies involved both men and women. All the studies included were classified as high-quality studies (≥6 points in the Physiotherapy Evidence Database (PEDro) scale score). Overall, evidence suggests there is an association between the ACTN3 R577X genotype and non-contact injury in 12 investigations. Six studies observed a significant association between ACTN3 R577X polymorphism and exercise induced muscle damage: two with non-contact ankle injury, three with non-contact muscle injury, and one with overall non-contact injury. Conclusion The present findings support the premise that possessing the ACTN3 XX genotype may predispose athletes to a higher probability of some non-contact injuries, such as muscle injury, ankle sprains, and higher levels of exercise-induced muscle damage.

The prone position is extensively used to improve oxygenation in patients with severe acute respiratory distress syndrome caused by SARS-CoV-2 pneumonia. Occasionally, these patients exhibit cardiac and respiratory functions so severely compromised they cannot tolerate lying in the supine position, not even for the time required to insert a central venous catheter. The authors describe three cases of successful ultrasound-guided internal jugular vein cannulation in prone position. The alternative approach here described enables greater safety and well-being for the patient, reduces the number of episodes of decompensation, and risk of tracheal extubation and loss of in-situ vascular lines.

Background Early specialist evaluation during rapid proliferative growth of complicated infantile hemangiomas (IH) is crucial. Health disparities and barriers of access-to-care for children with IH have not been examined. Objective Investigate whether socioeconomic status (SES) is associated with age at subspecialist presentation for IH evaluation. Method Retrospective cohort study of 804 children presenting to a large academic hospital. Primary outcome was age at initial presentation. Covariates included demographic, socioeconomic, geographic, and clinical characteristics. Medicaid or Children's Health Insurance Program (CHIP) were proxies for lower SES. Analysis of covariance, χ2 tests, and generalized ordered logistic regressions were performed. Results Children with lower SES had higher odds of presenting after 3 months of age (OR 2.11, 95% CI 1.31-3.38). In the subset that qualified for institutional care management program (ICMP), no risk factors were associated with delayed presentation. Limitations Use of insurance and economic distress as proxies for SES; exclusion of uninsured children may underestimate racioethnic effects; single academic center study limiting generalizability. Conclusions Children with IH and lower SES were more likely to present later to specialists, but those enrolled in an ICMP did not, suggesting that integrated ICMPs may mitigate disparities and delayed access-to-care for IH among lower SES populations.

Statement of problem Different proportions of tooth width ratios have been evaluated, and the golden proportion is the best known. Although the prevalence of the golden proportion has been evaluated in different ethnic groups and populations, a meta-analysis of these studies is lacking. Purpose The purpose of this systematic review and meta-analysis was to investigate the existence and suitability of the golden proportion for tooth width ratios and to assess the prevalence of the golden proportion among populations. Material and methods A systematic search based on the Patient, Intervention, Comparison, Outcome (PICO) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in PubMed, Cochrane, Scopus, Web of Science, and Embase in January 2021 without any time limitations and included English and non-English-language articles. Additional studies were identified by searching the reference lists of the retrieved articles. Two reviewers independently performed the literature search and data extraction, selecting articles based on the inclusion and exclusion criteria. Eligible studies were selected based on the inclusion criteria, and quality assessments were conducted. Descriptive statistics were applied for a number of outcome measures. Using a meta-analysis software program, data extracted from each selected study were statistically combined by using weighted mean differences and 95% confidence intervals, and heterogeneity was calculated for each measurement. Results A total of 566 articles were retrieved based on the keyword search. After the articles were assessed based on the inclusion and exclusion criteria, only 6 articles were included in the meta-analysis. Conclusions The outcomes of the review and analyses demonstrate that evidence supporting the existence of the golden proportion in natural smiles is lacking and that the existence of the golden proportion in dentistry is a myth and not a fact. However, the golden percentage theory can be applied with modified percentages that consider critical aspects of esthetic dentistry.

Essential voice tremor (EVT) is a voice disorder resulting from dyscoordination within the laryngeal musculature. A low-frequency fluctuations of fundamental voice frequency or the strength of excitation amplitude is the main consequence of the disorder. The automatic classification of healthy control and EVT is useful tool for the clinicians. A typical automatic EVT classification involves three steps. The first step is to compute the pitch contour from the speech. The second step is to compute the features from the pitch contour, and the final step is to use a classifier to classify the features into healthy or EVT. It is shown that a high-resolution pitch contour estimated from the glottal closure instants (GCIs) is useful for EVT classification. The HPRC estimation can be very poor in the presence of noise. Hence, a probabilistic source filter model based noise robust GCI detection is used for HPRC estimation. The Empirical mode decomposition based feature extraction is used followed by a support vector machine classifier. The EVT classification performance is evaluated using recordings from 45 subjects. The proposed method is found to perform better than the baseline techniques in eight different additive noise conditions with six SNR levels.

In this study, I present a theoretical social learning model to investigate how confirmation bias affects opinions when agents exchange information over a social network. Hence, besides exchanging opinions with friends, agents observe a public sequence of potentially ambiguous signals and interpret it according to a rule that includes confirmation bias. First, this study shows that regardless of level of ambiguity both for people or networked society, only two types of opinions can be formed, and both are biased. However, one opinion type is less biased than the other depending on the state of the world. The size of both biases depends on the ambiguity level and relative magnitude of the state and confirmation biases. Hence, long-run learning is not attained even when people impartially interpret ambiguity. Finally, analytically confirming the probability of emergence of the less-biased consensus when people are connected and have different priors is difficult. Hence, I used simulations to analyze its determinants and found three main results: i) some network topologies are more conducive to consensus efficiency, ii) some degree of partisanship enhances consensus efficiency even under confirmation bias and iii) open-mindedness (i.e. when partisans agree to exchange opinions with opposing partisans) might inhibit efficiency in some cases., Status: Accepted (Mathematical Social Sciences, Elsevier)

Statement of problem Knowledge about the location and dimensions of the mental foramen is important for surgical planning and implant placement in the posterior mandibular region. Purpose The purpose of this clinical study was to assess the location and dimensions of the mental foramen in individuals of different facial type, skeletal class, and sex by means of cone beam computed tomography (CBCT) images. Material and methods CBCT images of 142 individuals (72 women and 70 men) were classified according to the facial type (dolichocephalic, mesocephalic, or brachycephalic) and skeletal class (I, II, or III). The vertical and horizontal locations of each mental foramen were evaluated on panoramic reconstructions, and the greatest height and width of the mental foramen were determined on multiplanar reconstructions. Also, the distances from the mental foramen to the alveolar crest and to the inferior cortex of the mandible were obtained. The data were compared by using the Kruskal-Wallis test and multiway analysis of variance (α=.05). Results The facial type, skeletal class, and sex did not influence the vertical (P=1.00) or the horizontal (P>.15) location of the mental foramen. The most frequent location of the mental foramen was between the first and second premolars and below their apices. The dimensions of the mental foramen were not influenced by the studied factors in men (P>.07); conversely, the mental foramen dimensions were influenced for women (P Conclusions The most frequent location of the mental foramen was between the first and second premolars and below their apices. An influence of the facial type and skeletal class was observed on the dimensions of the mental foramen in women.

Neurofibromatosis (NF) is an inherited neuroectodermal abnormality that primarily affects the growth of neural tissues, and Riccardi classified it into eight types. Segmental neurofibromatosis, which is a rare form of neurofibromatosis, is classified as type 5. We report a case for very unusual presentation of segmental NF with unilateral lisch nodules and uncommon sites involving the scalp. Moreover, we could find only one case report of segmental NF with lisch nodules in the literature and could not find any case report involving the scalp.

Kidney disease is frequent in HIV-patients. We present a case of a 44-year-old woman, with known uncontrolled HIV infection and chronic kidney disease due to HIV-associated nephropathy. After starting dolutegravir, the patient developed eosinophilia and worsening kidney function. A kidney biopsy confirmed the diagnosis of acute interstitial nephritis. Given the time relation with dolutegravir introduction, it was deemed the culprit medication. Dolutegravir was stopped, and corticosteroids were initiated, with moderate improvement in renal function. To our knowledge, this is the first reported case of acute interstitial nephritis to dolutegravir, which should raise awareness of previously undocumented renal effects of antiretroviral therapy.

Background and objectives Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare and social costs. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: (“regional anesthesia” OR “nerve block”) AND (“complications” OR “nerve lesion” OR “nerve damage” OR “nerve injury”). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed. Results Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000. Conclusions Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.

The United States population is aging and increasing in comorbidity, and patient care is accordingly growing increasingly complex. Complexity impacts patterns of resource consumption, adverse event and medical error rates, health-related quality of life, physician burnout, and more. Tools capturing complexity can be of benefit in the modern value-based reimbursement landscape and have been well-studied in specialties other than dermatology. In this paper, we describe the validation of a tool specific to outpatient dermatologic care that captures the complexity of clinical visit medical decision-making. We performed a cross-sectional retrospective study to determine the inter-rater reliability and face validity of the tool. By objectively grading a clinical encounter based on clinical complexity, there is increased awareness of opportunities to improve clinical care and the allocation of healthcare costs and resources within the dermatologic community can be better assessed.

How does information management and control affect bank stability? Following a national bank holiday in 1933, New York state bank regulators suspended the publication of balance sheets of state-charter banks for two years, whereas the national-charter bank regulator did not. We use this divergence in policies to examine how the suspension of bank-specific information affected depositors. We find that state-charter banks experienced significantly less deposit outflows than national-charter banks in 1933. However, the behavior of bank deposits across both types of banks converged in 1934 after the introduction of federal deposit insurance.

BACKGROUND Lacrosse is one of the fastest-growing sports in the United States. Its rules regarding permitted contact differ by sex and age. There are no known studies using a nationally representative data set to analyze lacrosse injury patterns over several years by sex and age in the youth population. METHODS A retrospective analysis was performed using data from the National Electronic Injury Surveillance System for youth aged 11-18 years who were treated for lacrosse-related injuries in U.S. emergency departments from 2000 to 2016. Based on our review of the case narratives, we created and coded a new injury-mechanism variable. We generated national estimates from 6406 cases. RESULTS An estimated 206,274 lacrosse-related injuries to youths aged 11-18 years were treated in U.S. emergency departments from 2000 to 2016. The rate of injuries per 10,000 significantly increased from 1.9 in 2000 to a peak of 5.3 in 2012 (p < 0.0001), followed by a significant decrease to 3.4 in 2016 (p = 0.020). Injury mechanism, body part injured, and diagnosis differed by sex. Boys were 1.62 times (95%CI: 1.25-2.09) more likely than girls to be injured by player-to-player contact. Girls were 2.21 times (95%CI: 1.96-2.49) more likely than boys to have non-contact injuries. Overall, as age increased, the percentage of injuries from lacrosse sticks decreased and player-to-player contact increased. CONCLUSION Despite additional protective regulations in the sport, lacrosse is an important source of injury where we continue to see differences by sex and age. This study supports the continuation, modification, and addition of rules aimed at reducing lacrosse injury risk.

To determine the prevalence of abnormal laryngeal findings during videostroboscopy in performers presenting to clinic or when having an acute vocal emergency.Retrospective study of professional singers and actors who presented for a vocal evaluation.A chart review of singers or professional actors who presented in a private otorhinolaryngology clinic between 2014 and 2016. The prevalence of laryngeal lesions noted on stroboscopy were reviewed. The RFS (reflux finding score) was calculated and the exams that presented RFS greater than or equal to seven were considered suspicious of laryngopharyngeal reflux (LPR).A total of 140 records of actors and singers were evaluated either for routine evaluation or for an acute emergency. Sulcus vocalis was the most prevalent lesion 36% (n = 33), followed by cyst 27% (n = 25) and acute laryngitis, 14% (n = 13). Thirty-seven (26.4%) performers were treated for emergence due to dysphonia, Emergency dysphonia, mostly due to viral infection, was treated with steroids and speech therapy, with improvement of symptoms after treatment. Of these professionals, 83.8% (31) presented with a structural lesion or infection in the vocal folds, while 16.2% presented with dysphonia, which required emergency care without a structural lesion in the vocal folds. (P0.05) Eighty-nine percent (33) of the professionals presenting with a voice emergency with dysphonia (37) were treated with corticosteroids. Thirty-three percent (n = 47) of the professionals presented with RFS scores ≥7. Nineteen professionals (40%) with signs of LPR were treated for emergency due to dysphonia. The professionals with signs of LPR had more emergency dysphonia than those who did not suspect LPR. (19.4%) (P = 0.008).Vocal emergencies in professionals are common in a private laryngology practice and require specialized assessment. The most prevalent lesions in the study were vocal sulcus. LPR is common in this group as noted both by findings with videostroboscopy and the RFS.

Resumen Introduccion Junto con el envejecimiento de la poblacion general, la prevalencia de ancianos con esclerosis multiple (EM) se encuentra en aumento. El sistema inmunologico sufre profundos cambios a lo largo de la vida, por lo que parece imprescindible conocer que diferencias presentan respecto a pacientes mas jovenes. Desarrollo La inmunosenescencia, definida como la alteracion del sistema inmunologico en relacion con el envejecimiento natural, juega un papel esencial en la tolerancia, efectos adversos y respuesta a los tratamientos modificadores de la enfermedad. Entre las principales caracteristicas de este fenomeno, la involucion que sufre el timo es la mas destacable. Este hecho genera una reduccion en la produccion de celulas T virgenes. Ademas, se observa una ratio de linfocitos CD4 + /CD8 + invertido, alteraciones severas en el funcionamiento de las celulas NK o una disminucion en la capacidad de reparacion tisular cerebral. Conclusiones El numero de personas de edad avanzada con EM se encuentra en aumento en coincidencia con el envejecimiento de la poblacion general y gracias al avance en los tratamientos modificadores de la enfermedad, asi como a la mejora en la asistencia sociosanitaria de estos pacientes. El envejecimiento del sistema inmunitario conlleva un mayor riesgo de infecciones, tumores y enfermedades autoinmunes en los ancianos. En la EM, ademas, tiene lugar una aceleracion en la neurodegeneracion por la perdida de capacidad de remielinizacion del sistema nervioso. Conocer los cambios que tienen lugar en el sistema inmunologico de la poblacion de edad avanzada es esencial para mejorar la atencion de este grupo de pacientes cada vez mas prevalente.