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We introduce a fairness criterion that we call Spanning. Spanning i) is implied by Calibration, ii) retains interesting properties of Calibration that some other ways of relaxing that criterion do not, and iii) unlike Calibration and other prominent ways of weakening it, is consistent with Equalized Odds outside of trivial cases. [ABSTRACT FROM AUTHOR]

Editing services within academic health centers are uncommon, and few studies have reported on their impact. In this article, we describe our medical writing center's editing service for faculty and trainees at a pediatric teaching hospital and associated outcomes of scholarly products (e.g., manuscripts and grants) over an 8-year period. Data for manuscripts and grant proposals edited by the writing center from 2015 through 2022 were collected electronically from our service request database. Outcome data on publications and grant proposals were regularly collected up to 12 months post-submission. Users were also asked if the writing center edits were helpful, improved readability, and if they planned to use the service in the future. From 2015 through 2022, the writing center received 697 requests, 88.4% to edit a document. Of the documents edited, 81.3% of manuscripts and 44.4% of grant proposals were successfully published or funded. When rating their experience, 97.8% of respondents rated the edits "helpful," 96.7% indicated the edits "improved readability," and 99.3% stated they planned to use the writing center in the future. Our results showed steady use of the writing center and high satisfaction with services. A writing center can be an effective tool to support psychology faculty development. [ABSTRACT FROM AUTHOR]

Let (Σ T , σ) be a subshift of finite type with primitive adjacency matrix T , ψ : Σ T → R a Hölder continuous potential, and A : Σ T → GL d (R) a 1-typical, one-step cocycle. For t ∈ R consider the sequences of potentials Φ t = (φ t , n) n ∈ N defined by φ t , n (x) : = S n ψ (x) + t log ‖ A n (x) ‖ , ∀ n ∈ N. Using the family of transfer operators defined in this setting by Park and Piraino, for all t < 0 sufficiently close to 0 we prove the existence of Gibbs-type measures for the superadditive sequences of potentials Φ t . This extends the results of the well-understood subadditive case where t ≥ 0 . Prior to this, Gibbs-type measures were only known to exist for t < 0 in the conformal, the reducible, the positive, or the dominated, planar settings, in which case they are Gibbs measures in the classical sense. We further prove that the topological pressure function t ↦ P top (Φ t , σ) is analytic in an open neighbourhood of 0 and has derivative given by the Lyapunov exponents of these Gibbs-type measures. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). Materials and Methods: This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. Results: Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p < 0.001); QoL at baseline was 4.7 and decreased to 2.0, 2.1, and 2.3 at 3, 12, and 24 months, respectively (all p < 0.001). The mean SHIM score at baseline and 12 months following PAE was 13.8 and 13.9, respectively. Of the 73 patients treated for AUR, 48 (65.8%) had their indwelling catheter removed within 3 months of PAE and remained catheter free at 24 months. Fifty-five patients (11.5%) experienced ≥ 1 AE and 10 (2.1%) experienced a serious AE. Conclusion: PAE is a safe and effective treatment for symptomatic BPH and LUTS. Level of Evidence Level 3 Trial registration ClinicalTrials.gov NCT03527589. [ABSTRACT FROM AUTHOR]

Several recent studies have investigated the validity of precautionary practices for lymphedema risk reduction after breast cancer treatment, such as avoidance of blood pressure measurements, skin puncture, blood draws, and use of prophylactic compression during air travel. Other studies have elucidated risk factors for breast cancer-related lymphedema, such as axillary lymph node dissection and skin infection (cellulitis). Combining the current evidence base with the consensus opinion of lymphatic experts assembled at the American Cancer Society/Lymphology Association of North America Summit in October 2023, updated evidence-based risk reduction recommendations are presented for those with or at risk of breast cancer-related lymphedema. Recommendation topics include prospective surveillance, patient education, individual risk factors, exercise, blood pressure, skin care and hygiene, skin puncture and blood draws, surgical procedures, prophylactic compression, air travel, and hot climate and sauna. These recommendations will help inform education and medical choices for individuals treated for breast cancer who are at risk of or diagnosed with breast cancer-related lymphedema. More high-quality evidence is required to allow the development of risk reduction recommendations for other cancer types such as gynecological, melanoma, and head and neck. It is recommended that clinicians and organizations serving people at risk of or with lymphedema align risk reduction guidelines with the evidence-based recommendations provided within this consensus document and companion manuscripts from the American Cancer Society/Lymphology Association of North America Lymphedema Summit: Forward Momentum: Future Steps in Lymphedema Management. [ABSTRACT FROM AUTHOR]

Corporal punishment (e.g., spanking) remains a highly debated yet common form of discipline in the United States. A body of research exists investigating the prevalence and effects of corporal punishment; however, less attention has been devoted to factors influencing individual perceptions of corporal punishment. The current study explores college students' perceptions of corporal punishment with a specific focus on students' experiences with physical discipline and factors that may influence students' intentions to use physical discipline with their own children. Relying on a convenience sampling methodology, the current research is based on a sample of 318 students, who participated in a pen-and-paper survey. Findings reveal that most students experienced corporal punishment (86.8%) and roughly three-quarters intend to use physical discipline with their children. Moreover, positive attitudes towards physical forms of punishment were positively associated with intentions to use corporal punishment (OR = 1.494; ***p < 0.001). Despite most participants reporting experiences with corporal punishment and intending to use physical discipline with their children, many felt better disciplinary methods were available. Given that attitudes were correlated with intention to use, educational programs and curricular endeavors to inform individuals of the negative impact of corporal punishment, as well as alternative non-physical discipline strategies are recommended as ways to reduce reliance on physical forms of discipline. Highlights: Most college students sampled reported personal experience with physical discipline as children (86.8%). Most college students intend to use corporal punishment (75.2%) as a discipline strategy with their children. Most participants (71%) believed there were better ways to punish a child than using corporal punishment. Attitudes towards corporal punishment were the only variables associated with intention to use physical discipline in multivariate models. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors have transformed the treatment landscape of many cancers, including melanoma and renal cell carcinoma (RCC). Randomised trials are evaluating outcomes from reduced ICI treatment schedules with the aim of improving quality of life, tolerability, and cost-effectiveness. This study aims to provide insight into patient and carer's perspectives of these trials. Methods: Seven focus groups were conducted with 31 people with stage IV melanoma, RCC, or caregivers for people receiving ICI. Transcripts were analysed using reflexive thematic analysis. Results: Three themes were generated: 1) "Treatment and clinic visits provide reassurance": reducing hospital visits may not improve quality of life. 2) "Assessment of personal risk versus benefit": the decision to participate in an ICI optimisation trial is influenced by treatment response, experience of toxicity and perceived logistical benefits based on the individual's circumstances. 3) "Pre-existing experience and beliefs about how treatment and trials work", including the belief that more treatment is better, influence views around ICI optimisation trials. Conclusion: This study provides insight into recruitment challenges and recommends strategies to enhance recruitment for ongoing ICI optimisation trials. These findings will influence the design of future ICI optimisation trials ensuring they are acceptable to patients. [ABSTRACT FROM AUTHOR]

Secondary malignancies are rare but devastating complications of longstanding burn scars. Squamous cell carcinoma is the most common, followed by basal cell carcinoma and melanomas. There are fewer than 50 total reported cases of malignant melanomas arising in burn scars. We report a case of malignant melanoma arising within a longstanding burn scar confirmed by histology, FISH, and PRAME staining to further characterize melanomas arising in burn scars and to illustrate the diagnostic challenges they present. [ABSTRACT FROM AUTHOR]

Background: Little is known about how to best evaluate, diagnose, and treat long COVID, which presents challenges for patients as they seek care. Objective: Understand experiences of patients as they navigate care for long COVID. Design: Qualitative study involving interviews with patients about topics related to seeking and receiving care for long COVID. Participants: Eligible patients were at least 18 years of age, spoke English, self-identified as functioning well prior to COVID infection, and reported long COVID symptoms continued to impact their lives at 3 months or more after a COVID infection. Approach: Patients were recruited from a post-COVID recovery clinic at an academic medical center from August to September 2022. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Key Results: Participants (n=21) reported experiences related to elements of care coordination: access to care, evaluation, treatment, and ongoing care concerns. Some patients noted access to care was facilitated by having providers that listened to and validated their symptoms; other patients reported feeling their access to care was hindered by providers who did not believe or understand their symptoms. Patients reported confusion around how to communicate their symptoms when being evaluated for long COVID, and they expressed frustration with receiving test results that were normal or diagnoses that were not directly attributed to long COVID. Patients acknowledged that clinicians are still learning how to treat long COVID, and they voiced appreciation for providers who are willing to try new treatment approaches. Patients expressed ongoing care concerns, including feeling there is nothing more that can be done, and questioned long-term impacts on their aging and life expectancy. Conclusions: Our findings shed light on challenges faced by patients with long COVID as they seek care. Healthcare systems and providers should consider these challenges when developing strategies to improve care coordination for patients with long COVID. [ABSTRACT FROM AUTHOR]

Coastal marshes face increasing pressures from climate-related environmental stressors, adversely affecting their biota like plants and microbes. Understanding how marsh communities are influenced by their environment is critical in determining their ability to respond to environmental stressors. Plants harbor microbes that colonize and inhabit their tissues without causing apparent harm ('endosymbionts'). These endosymbionts provide benefits to host plants including mediation of salinity stress response, thus it is important to understand the factors influencing the diversity of endosymbiont communities. We examined the relative influences of biotic (host-related) and abiotic (local environment) factors on the endosymbiont communities associated with the dominant saltmarsh halophyte, Batis maritima. Using culture-based and genetic approaches, we characterized both fungal and bacterial endosymbionts from B. maritima roots in Oso Bay, Texas, along the Gulf of Mexico. Isolation frequency of endosymbionts significantly differed between fungi and bacteria, and the overall diversity was low. Belowground plant biomass and salinity correlated with decreased diversity in fungi, while shifts in fungal composition varied according to light availability. Overall, these findings highlight the relative influences of both biotic and abiotic factors in shaping the root endosymbionts and might differ between fungi and bacteria. Understanding these processes is fundamental to determining the resilience of both endosymbionts and host plants, with implications for ecosystem functions amidst environmental pressures. As anthropogenic-driven environmental changes continue to rise, insights gained from these results can inform future coastal restoration and management especially of at-risk coastal ecosystems. [ABSTRACT FROM AUTHOR]

Poor parental mental health and stress have been associated with children's mental disorders, including attention-deficit/hyperactivity disorder (ADHD), through social, genetic, and neurobiological pathways. To determine the strength of the associations between parental mental health and child ADHD, we conducted a set of meta-analyses to examine the association of parent mental health indicators (e.g., parental depression, antidepressant usage, antisocial personality disorder, and stress and anxiety) with subsequent ADHD outcomes in children. Eligible ADHD outcomes included diagnosis or symptoms. Fifty-eight articles published from 1980 to 2019 were included. We calculated pooled effect sizes, accounting for each study's conditional variance, separately for test statistics based on ADHD as a dichotomous (e.g., diagnosis or clinical cutoffs) or continuous measurement (e.g., symptoms of ADHD subtypes of inattentiveness and hyperactivity/impulsivity). Parental stress and parental depression were significantly associated with increased risk for ADHD overall and both symptoms and diagnosis. Specifically, maternal stress and anxiety, maternal prenatal stress, maternal depression, maternal post-partum depression, and paternal depression were positively associated with ADHD. In addition, parental depression was associated with symptoms of ADHD inattentive and hyperactive/impulsive subtypes. Parental antisocial personality disorder was also positively associated with ADHD overall and specifically ADHD diagnosis. Prenatal antidepressant usage was associated with ADHD when measured dichotomously only. These findings raise the possibility that prevention strategies promoting parental mental health and addressing parental stress could have the potential for positive long-term impacts on child health, well-being, and behavioral outcomes. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3–17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD. [ABSTRACT FROM AUTHOR]

Exposure to certain chemicals prenatally and in childhood can impact development and may increase risk for attention-deficit/hyperactivity disorder (ADHD). Leveraging a larger set of literature searches conducted to synthesize results from longitudinal studies of potentially modifiable risk factors for childhood ADHD, we present meta-analytic results from 66 studies that examined the associations between early chemical exposures and later ADHD diagnosis or symptoms. Studies were eligible for inclusion if the chemical exposure occurred at least 6 months prior to measurement of ADHD diagnosis or symptomatology. Included papers were published between 1975 and 2019 on exposure to anesthetics (n = 5), cadmium (n = 3), hexachlorobenzene (n = 4), lead (n = 22), mercury (n = 12), organophosphates (n = 7), and polychlorinated biphenyls (n = 13). Analyses are presented for each chemical exposure by type of ADHD outcome reported (categorical vs. continuous), type of ADHD measurement (overall measures of ADHD, ADHD symptoms only, ADHD diagnosis only, inattention only, hyperactivity/impulsivity only), and timing of exposure (prenatal vs. childhood vs. cumulative), whenever at least 3 relevant effect sizes were available. Childhood lead exposure was positively associated with ADHD diagnosis and symptoms in all analyses except for the prenatal analyses (odds ratios (ORs) ranging from 1.60 to 2.62, correlation coefficients (CCs) ranging from 0.14 to 0.16). Other statistically significant associations were limited to organophosphates (CC = 0.11, 95% confidence interval (CI): 0.03–0.19 for continuous measures of ADHD outcomes overall), polychlorinated biphenyls (CC = 0.08, 95% CI: 0.02–0.14 for continuous measures of inattention as the outcome), and both prenatal and childhood mercury exposure (CC = 0.02, 95% CI: 0.00–0.04 for continuous measures of ADHD outcomes overall for either exposure window). Our findings provide further support for negative impacts of prenatal and/or childhood exposure to certain chemicals and raise the possibility that primary prevention and targeted screening could prevent or mitigate ADHD symptomatology. Furthermore, these findings support the need for regular review of regulations as our scientific understanding of the risks posed by these chemicals evolves. [ABSTRACT FROM AUTHOR]

Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0–17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978–2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities. [ABSTRACT FROM AUTHOR]

Previous studies have shown mixed results on the relationship between prenatal, birth, and postnatal ("pregnancy-related") risk factors and attention-deficit/hyperactivity disorder (ADHD). We conducted meta-analyses to identify potentially modifiable pregnancy-related factors associated with ADHD. A comprehensive search of PubMed, Web of Science, and EMBASE in 2014, followed by an updated search in January 2021, identified 69 articles published in English on pregnancy-related risk factors and ADHD for inclusion. Risk factors were included in the meta-analysis if at least three effect sizes with clear pregnancy-related risk factor exposure were identified. Pooled effect sizes were calculated for ADHD overall, ADHD diagnosis, inattention, and hyperactivity/impulsivity. Odds ratios (OR) were calculated for dichotomous measures and correlation coefficients (CC) for continuous measures. Prenatal factors (pre-pregnancy weight, preeclampsia, pregnancy complications, elevated testosterone exposure), and postnatal factors (Apgar score, neonatal illness, no breastfeeding) were positively associated with ADHD overall; the findings for ADHD diagnosis were similar with the exception that there were too few effect sizes available to examine pre-pregnancy weight and lack of breastfeeding. Prenatal testosterone was significantly associated with inattention and hyperactivity/impulsivity. Effect sizes were generally small (range 1.1–1.6 ORs, -0.16–0.11 CCs). Risk factors occurring at the time of birth (perinatal asphyxia, labor complications, mode of delivery) were not significantly associated with ADHD. A better understanding of factors that are consistently associated with ADHD may inform future prevention strategies. The findings reported here suggest that prenatal and postnatal factors may serve as potential targets for preventing or mitigating the symptoms of ADHD. [ABSTRACT FROM AUTHOR]

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health. [ABSTRACT FROM AUTHOR]

Purpose: This review aimed to assess the measurement and reporting of time toxicity (i.e., time spent receiving care) within prospective oncologic studies. Methods: On July 23, 2023, PubMed, Scopus, and Embase were queried for prospective or randomized controlled trials (RCT) from 1984 to 2023 that reported time toxicity as a primary or secondary outcome for oncologic treatments or interventions. Secondary analyses of RCTs were included if they reported time toxicity. The included studies were then evaluated for how they reported and defined time toxicity. Results: The initial query identified 883 records, with 10 studies (3 RCTs, 2 prospective cohort studies, and 5 secondary analyses of RCTs) meeting the final inclusion criteria. Treatment interventions included surgery (n = 5), systemic therapies (n = 4), and specialized palliative care (n = 1). The metric “days alive and out of the hospital” was used by 80% (n = 4) of the surgical studies. Three of the surgical studies did not include time spent receiving ambulatory care within the calculation of time toxicity. “Time spent at home” was assessed by three studies (30%), each using different definitions. The five secondary analyses from RCTs used more comprehensive metrics that included time spent receiving both inpatient and ambulatory care. Conclusions: Time toxicity is infrequently reported within oncologic clinical trials, with no standardized definition, metric, or methodology. Further research is needed to identify best practices in the measurement and reporting of time toxicity to develop strategies that can be implemented to reduce its burden on patients seeking cancer care. [ABSTRACT FROM AUTHOR]

R-Oxo hydroformylation processes on rhodium phosphite complexes developed at LLC «RN-RD CENTER» are described – selective production of n-butyral from propylene (R-Oxo I), production of a mixture of n-butyral and isobutyral in equal parts (R-Oxo II), selective production of n-pentanal from a mixture of linear butenes (R-Oxo III). A scheme for the hydroformylation of propylene with membrane separation of the catalyst from the heavy reaction products is described.The analysis of the direction of using C3–C5 oxosynthesis products as raw materials for the production of ester lubricants is carried out. [ABSTRACT FROM AUTHOR]

Little is known about how people decide to use psychedelics to self-treat depression and anxiety, though the practice is growing. We explored online community discussions of members' decisions around self-treatment with psychedelics for depression or anxiety. We used constructivist grounded theory to select and analyze 98 members' posts across 95 discussion threads (99, 552 words) and identified a four-stage decision-making model. In stage one, decision-making began after dissatisfaction with standard mental health treatment. In stage two, members considered various psychedelic self-treatment options but explained that information was limited. In stage three, they engaged in trial and error when making decisions, despite uncertainties around safety. In stage four, they continued or discontinued self-treatment. Those who continued adapted their practice to their evolving treatment needs. Firsthand and peers' experiences informed decisions. Available scientific evidence initially validated the psychedelic self-treatment but were not instructive. Many avoided healthcare and official information sources due to stigma and legal concerns. Research and knowledge translation efforts are needed to identify general concerns with self-treatment and provide user-informed decisional support to reduce harm and maximize benefit. Services supporting psychedelic self-treatment decisions can leverage our findings to create resources based on people's lived experiences. [ABSTRACT FROM AUTHOR]

The field of psychedelics is in an important era, with a significant focus on the potential role of psychedelic compounds in the treatment of mental health and substance use disorders. In 2022, a scientific research conference was held in Toronto to bring together stakeholders from a variety of disciplines and to promote dialogue and collaboration. This Special Issue includes 8 papers based on presentations from the conference, which showcase the breadth of topics that were brought forward. Included are both quantitative and qualitative works, as well as two letters to the editors which further advance these important conversations. These articles not only present the current state of research into psychedelics, but also present viewpoints about their impacts on underrepresented communities, the need to recognize the history of these compounds that extends beyond this new Western "renaissance," and the complexities of integrating psychedelics into mainstream medicine. This Special Issue serves as both an exploration of a much-discussed topic and a reminder that collaboration can advance the field in order to harness its potential impact. [ABSTRACT FROM AUTHOR]

To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed. [ABSTRACT FROM AUTHOR]

The article discusses the Large Outdoor Fires and the Built Environment (LOF&BE) workshops held at the 14th International Symposium on Fire Safety Science. LOF&BE is a working group established by the International Association for Fire Safety Science (IAFSS) to address issues related to large outdoor fires, including wildland fires, urban fires, and informal settlement fires. The working group consists of three subgroups: Ignition Resistant Communities (IRC), Emergency Management and Evacuation (EME), and Large Outdoor Fire Fighting (LOFF). The workshops provided updates on the progress of each subgroup and included presentations and discussions. Participants from various countries attended the workshops, including the United States, Canada, Japan, China, Australia, and others. Supplementary materials, such as detailed minutes of discussions and presentations, are available for interested readers. The article acknowledges the support of Professor Patrick Van Hees and former subgroup leaders. [Extracted from the article]

Hypophosphatasia (HPP) is an inborn error of metabolism caused by reduced or absent activity of the tissue non-specific alkaline phosphatase (TNSALP) enzyme, resulting from pathogenic variants in the ALPL gene. Clinical presentation of HPP is highly variable, including lethal and severe forms in neonates and infants, a benign perinatal form, mild forms manifesting in adulthood, and odonto-HPP. Diagnosis of HPP remains a challenge in adults, as signs and symptoms may be mild and non-specific. Disease presentation varies widely; there are no universal signs or symptoms, and the disease often remains underdiagnosed or misdiagnosed, particularly by clinicians who are not familiar with this rare disorder. The absence of diagnosis or a delayed diagnosis may prevent optimal management for patients with this condition. Formal guidelines for the diagnosis of adults with HPP do not exist, complicating efforts for consistent diagnosis. To address this issue, the HPP International Working Group selected 119 papers that explicitly address the diagnosis of HPP in adults through a Medline, Medline In-Process, and Embase search for the terms "hypophosphatasia" and "HPP," and evaluated the pooled prevalence of 17 diagnostic characteristics, initially selected by a group of HPP clinical experts, in eligible studies and in patients included in these studies. Six diagnostic findings showed a pooled prevalence value over 50% and were considered for inclusion as major diagnostic criteria. Based on these results and according to discussion and consideration among members of the Working Group, we finally defined four major diagnostic criteria and five minor diagnostic criteria for HPP in adults. Authors suggested the integrated use of the identified major and minor diagnostic criteria, which either includes two major criteria, or one major criterion and two minor criteria, for the diagnosis of HPP in adults. [ABSTRACT FROM AUTHOR]

Background: This manuscript provides a summary of the current evidence to support the criteria for diagnosing a child or adult with hypophosphatasia (HPP). The diagnosis of HPP is made on the basis of integrating clinical features, laboratory profile, radiographic features of the condition, and DNA analysis identifying the presence of a pathogenic variant of the tissue nonspecific alkaline phosphatase gene (ALPL). Often, the diagnosis of HPP is significantly delayed in both adults and children, and updated diagnostic criteria are required to keep pace with our evolving understanding regarding the relationship between ALPL genotype and associated HPP clinical features. Methods: An International Working Group (IWG) on HPP was formed, comprised of a multidisciplinary team of experts from Europe and North America with expertise in the diagnosis and management of patients with HPP. Methodologists (Romina Brignardello-Petersen and Gordon Guyatt) and their team supported the IWG and conducted systematic reviews following the GRADE methodology, and this provided the basis for the recommendations. Results: The IWG completed systematic reviews of the literature, including case reports and expert opinion papers describing the phenotype of patients with HPP. The published data are largely retrospective and include a relatively small number of patients with this rare condition. It is anticipated that further knowledge will lead to improvement in the quality of genotype-phenotype reporting in this condition. Conclusion: Following consensus meetings, agreement was reached regarding the major and minor criteria that can assist in establishing a clinical diagnosis of HPP in adults and children. [ABSTRACT FROM AUTHOR]

Our objectives were to measure long-term adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and to identify patient factors associated with adherence. Using linked, population-based administrative data from British Columbia, Canada, an incident cohort of adults prescribed OACs for AF was identified. We calculated the proportion of days covered (PDC) as a time-dependent covariate for each 90-day window from OAC initiation until the end of follow-up. Associations between patient attributes and adherence were assessed using generalized mixed effect linear regression models. 30,264 patients were included. Mean PDC was 0.69 (SD 0.28) over a median follow-up of 6.7 years. 54% of patients were non-adherent (PDC < 0.8). After controlling for confounders, factors positively associated with adherence were number of drug class switches, history of stroke or transient ischemic attack, history of vascular disease, time since initiation, and age. Age > 75 years at initiation, polypharmacy (among VKA users only), and receiving DOAC (vs. VKA) were negatively associated with adherence. PDC decreased over time for VKA users and increased for DOAC users. Over half of AF patients studied were, on average, nonadherent to OAC therapy and missed 32% of their doses. Several patient factors were associated with higher or lower adherence, and adherence to VKA declined during therapy while DOAC adherence increased slightly over time. To min im ize the risk stroke, adherence-supporting interventions are needed for all patients with AF, particularly those aged > 75 years, those with prior stroke or vascular disease, VKA users with polypharmacy, and DOAC recipients. [ABSTRACT FROM AUTHOR]

Introduction: Anemia of chronic kidney disease (CKD) has a high incidence and is associated with many disease conditions. Iron dysmetabolism is an important contributor to anemia in CKD patients. Methods: ALTAI, a randomized, active-controlled, phase 4 trial, investigated the efficacy of roxadustat versus recombinant human erythropoietin (rHuEPO) on gastrointestinal iron absorption in patients with anemia of CKD (stage 4/5). The primary endpoint was change from baseline to day 15 in gastrointestinal iron absorption (serum iron area under the concentration-time curve; AUC0–3h) following single-dose oral iron. Results: Twenty-five patients with a mean age of 55.1 years were randomized 1:1 to roxadustat (n = 13) or rHuEPO (n = 12). Baseline iron profiles were similar between treatment groups. Change from baseline to day 15 in serum iron AUC0–3h was not statistically significantly different between the roxadustat and rHuEPO groups. Mean (SD) change from baseline in serum iron AUC0–3h was 11.3 (28.2) g × 3 h/dl in the roxadustat group and − 0.3 (9.7) g × 3 h/dl in the rHuEPO group. Roxadustat treatment was associated with decreased hepcidin and also increased transferrin, soluble transferrin receptor, and total iron-binding capacity (TIBC), with nominal significance. The proportion of patients experiencing one or more adverse events was 38.5% when treated with roxadustat and 16.7% with rHuEPO. Conclusions: The study showed no significant difference between roxadustat and rHuEPO in iron absorption but was underpowered because of recruitment challenges. Trial Registration: ClinicalTrials.gov Identifier NCT04655027. [ABSTRACT FROM AUTHOR]

Standardized client feedback surveys encourage a culture of continuous quality improvement, allow for comparison of results over time and across similar types of service providers, and encourage use of evidence-based practices. Recognizing the importance of family and other caregivers in supporting people accessing services for mental health and substance use challenges, a standardized perception-of-care tool (the Ontario Perception of Care Tool for Mental Health and Addictions, OPOC-MHA) was adapted to collect feedback specific to the caregiver experience with these services. A collaborative process engaged a broad range of mental health and/or addiction providers, family advisory networks, and family members and caregivers to identify themes, specific items, and implementation approaches. The final version of the tool evolved through an iterative process of pilot testing and stakeholder feedback. Family member and caregiver perceptions of care will identify service areas in need of improvement, contribute to quality improvement initiatives, and facilitate the comparison of findings over time. [ABSTRACT FROM AUTHOR]

Surgical reconstruction of the anterior cruciate ligament (ACL) and subsequent physical therapy can help athletes return to competition; however, re-injury rates remain disproportionately high due, in part, to lingering biomechanical and neurological factors that are not fully addressed during rehabilitation. Prior reports indicate that individuals exhibit altered electrical activity in both brain and muscle after ACL reconstruction (ACLR). In this investigation, we aimed to extend existing approaches by introducing a novel non-linear analysis of corticomuscular dynamics, which does not assume oscillatory coupling between brain and muscle: Corticomuscular cross-recurrence analysis (CM-cRQA). Our findings indicate that corticomuscular dynamics vary significantly between involved (injured) and uninvolved legs of participants with ACLR during voluntary isometric contractions between the brain and both the vastus medialis and lateralis. This finding points to a potential lingering neural deficit underlying re-injury for athletes after surgical reconstruction, namely the dynamical structure of neuromuscular (brain to quad muscle) coordination, which is significantly asymmetric, between limbs, in those who have ACLR. [ABSTRACT FROM AUTHOR]

Hypophosphatasia (HPP) is a rare inborn error of metabolism that presents variably in both age of onset and severity. HPP is caused by pathogenic variants in the ALPL gene, resulting in low activity of tissue nonspecific alkaline phosphatase (TNSALP). Patients with HPP tend have a similar pattern of elevation of natural substrates that can be used to aid in diagnosis. No formal diagnostic guidelines currently exist for the diagnosis of this condition in children, adolescents, or adults. The International HPP Working Group is a comprised of a multidisciplinary team of experts from Europe and North America who have expertise in the diagnosis and management of patients with HPP. This group reviewed 93 papers through a Medline, Medline In-Process, and Embase search for the terms "HPP" and "hypophosphatasia" between 2005 and 2020 and that explicitly address either the diagnosis of HPP in children, clinical manifestations of HPP in children, or both. Two reviewers independently evaluated each full-text publication for eligibility and studies were included if they were narrative reviews or case series/reports that concerned diagnosis of pediatric HPP or included clinical aspects of patients diagnosed with HPP. This review focused on 15 initial clinical manifestations that were selected by a group of clinical experts. The highest agreement in included literature was for pathogenic or likely pathogenic ALPL variant, elevation of natural substrates, and early loss of primary teeth. The highest prevalence was similar, including these same three parameters and including decreased bone mineral density. Additional parameters had less agreement and were less prevalent. These were organized into three major and six minor criteria, with diagnosis of HPP being made when two major or one major and two minor criteria are present. [ABSTRACT FROM AUTHOR]

Purpose: The rising cost of breast cancer treatment has increased patients’ financial burden, intensifying an already stressful treatment process. Although researchers increasingly recognize the harmful impact of medical and nonmedical costs associated with cancer treatment, understanding patients’ perspectives of financial toxicity is limited. We aimed to explore the topic of financial toxicity through the lived experiences of patients with breast cancer from groups at risk of social and economic marginalization. Methods: We conducted semi-structured interviews with 50 women with breast cancer from four specific groups: Black women, Medicaid enrollees, rural residents, and women age ≤ 40. We transcribed, coded, and analyzed the data using deductive and inductive approaches. Results: Two overarching themes captured patients’ experiences of financial toxicity: short-term and long-term impacts. Short-term stressors included direct medical (e.g., co-pays, premiums), nonmedical (e.g., transportation, lodging), and indirect (e.g., job loss, reduced work hours) costs. Early in their treatments, patients’ focus on survival took precedence over financial concerns. However, as the treatment course progressed, fear of consequences from compounding costs of care and financial distress negatively impacted patients’ lifestyles and outlooks for the future. Conclusion: Programs addressing financial toxicity that look beyond early-phase interventions are needed. Specifically, patients struggling with the accumulation of treatment costs and the resultant stress require ongoing support. Long-term support is especially needed for groups vulnerable to financial instability and social marginalization. [ABSTRACT FROM AUTHOR]

Purpose: Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT. Methods: In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive five weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the Inventory to Measure and Assess imaGe disturbancE–Head and Neck (IMAGE-HN). Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores. Results: Among 44 HNC survivors with BID allocated to BRIGHT (n = 20) or AC (n = 24), mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month resulted in decreases in IMAGE-HN scores from baseline to 3 months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3 months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039). Conclusions: This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors. Trial registration: ClinicalTrials.gov identifier . [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the impact of early versus late palliative care referral (PCR) following pancreatic cancer diagnosis. Methods: Patients diagnosed with PDAC who received a PCR between 2014 and 2020 at a major academic institution were identified. PCR was classified as early (< 30 days) or late (≥ 30 days) based on time from definitive diagnosis. Data were obtained on number of emergency department (ED) visits, intensive care unit (ICU) admissions, and hospital admissions. Results: Among 1458 patients with PDAC, 419 (28.7%) received PCR, among which 67.3% (n = 282) received a late PCR. Of those who received PCR, the majority were White (85%) and male (54.8%), with a median age of 62 years at time of diagnosis. Patients who received an early PCR more commonly presented with stage 4 disease at diagnosis (early: n = 91, 69% vs. late: n = 132, 47%), whereas patients who received a late PCR more commonly presented with stage 1, 2, or 3 disease (early: n = 40, 30.5% vs. late: n = 150, 53.2%) (p < 0.001). Patients who received early PCR had fewer median ED visits (1 vs. 2, p < 0.001) and hospital admissions (1 vs. 2, p < 0.001) compared with patients who received late PCR. However, after performing recurrent-event Cox-proportional hazards models, the timing of PCR did not impact hospital admission (HR 0.88, 95% CI 0.68, 1.14; p = 0.3). Conclusion: Timing of PCR for patients with PDAC was not associated with healthcare utilization. Further prospective trials are needed to study the patient-centered impact of early integration of palliative care services into multidisciplinary pancreatic cancer teams. [ABSTRACT FROM AUTHOR]

Approximately 1 billion people in the world still live in informal settlements with comparatively low living standards and outdated firefighting equipment. In recent years, informal settlement fires have occurred frequently and globally, however, research into informal settlement fires in the Far East remains underdeveloped. This work briefly summarizes informal settlement types and discusses their fire safety characteristics in China. It is shown that informal settlements in China include non-compliant buildings, non-standard altered buildings, non-permanent buildings, and traditional ethnic minority buildings. More relevant research is needed to promote equity of fire safety outcomes for all. [ABSTRACT FROM AUTHOR]

Self-efficacy to remain abstinent in high-risk situations is associated with better outcomes post-treatment among individuals with substance use disorders (SUD). It is therefore important for researchers and clinicians to have valid and reliable measures to assess this construct. In the present study, we evaluated the psychometric properties of the Brief Situational Confidence Questionnaire (BSCQ) within a large clinically mixed SUD treatment population. Participants were adult patients (N = 1384) who entered an inpatient SUD treatment program in Guelph, ON, Canada. As part of routine clinical assessment, participants completed the BSCQ, as well as measures of confidence to stay abstinent, craving, and frequency and severity of substance use. Confirmatory factor analysis indicated that a bifactor model was the best fit to the data, with the general factor accounting for the vast majority of the variance in scores. Bifactor indices also suggested that the BSCQ was best conceptualized as unidimensional despite the presence of some multidimensionality. Tests of measurement invariance demonstrated configural, metric, and scalar invariance across age, gender, ethno-racial identity, and substance use disorder subgroups. The BSCQ exhibited convergent and concurrent validity via associations with general confidence to remain abstinent, less frequent substance use, and fewer cravings. Scores on the BSCQ were also significantly lower among individuals with a severe SUD. The findings provide evidence that the BSCQ is a psychometrically sound measure for assessing situational self-efficacy in an SUD treatment population, supporting its clinical utility. [ABSTRACT FROM AUTHOR]

The analysis of the current state of fire statistics and data collection in Europe and other countries is needed to increase awareness of how fire incidents affect buildings and to support pan-European fire prevention and fire mitigation measures. The terminology and data collected regarding fire incidents in buildings in the EU Member States were mapped to obtain meaningful datasets to determine common terminology, collection methodology, and data interpretation system. An extensive literature review showed that fire data collection systems have been instrumental in informing firefighting strategies, evidence-based planning, prevention, and educational programmes. Differences and similarities between fire data collection systems were also investigated. The amount and quality of the information in fire statistical recording systems appear to be influenced by the complexity and structure with which the data are collected. The analysis also examined the existing fire statistics in the EU Member States and a few other countries. Finally, a detailed investigation of the number of fires, fire deaths, and injuries from 2009 to 2018 in several countries was examined based on data from a report by CTIF. The trends showed differences attributable to the existing fire statistical practices in terms of terminology and data collection, and interpretation. Part II proposes a common terminology for selected fire statistical variables. The results provide relevant information regarding fire safety at the European level and should be used to guide the development of more uniform fire statistics across Europe. [ABSTRACT FROM AUTHOR]

A well-defined terminology of fire-related variables is important for correct analyses and supporting knowledge-based decisions regarding the evaluation of building fires at the European level. After developing an overview of current practices for fire statistics in Part I, the terminology used and the data collected by the EU Member States and eight other countries regarding fire incidents, property damage and human losses were mapped to increase awareness of their practice and support a comprehensive assessment of several fire statistical datasets. A questionnaire was distributed to relevant authorities responsible for the collection, elaboration/analysis, and fire statistical data publications to define and select the essential variables for an appropriate fire assessment and fire incident description. Based on the results of the questionnaire able to identify the essential fire statistical variables and a detailed analysis of current definitions adopted in the fire statistics of the EU Member States and other countries, a common terminology is proposed to collect the necessary data in the EU Member States and obtain meaningful datasets based on standardised terms and definitions. The results will generate essential outputs to move towards harmonised fire statistics at the EU level and contribute to an appropriate analysis able to improve fire prevention and fire mitigation in building fires. [ABSTRACT FROM AUTHOR]

Purpose: To systematically synthesise evidence of exercise intervention efficacy for physical/psychosocial outcomes that matter to women during/following treatment for gynaecological cancer. Methods: Five databases were searched (PubMed, EMBASE, CINAHL, PsychInfo, Scopus). Exercise-only intervention studies that included women during/ following treatment for any gynaecological cancer, with/ without control comparison, on any physical or psychosocial outcome(s), were included and qualitatively appraised using the Revised Cochrane Risk of Bias tool and a modified Newcastle-Ottawa Scale. Results: Seven randomised controlled trials (RCTs), three single-arm pre-post studies, and one prospective cohort study satisfied were included (11 studies). Most studies were completed following treatment (91%), included combined (aerobic and resistance; 36%) and aerobic (36%) training, were fully/mostly (63%) unsupervised, and had a moderate-to-high risk of bias. Overall, 33 outcomes (64% objectively-measured) were assessed. Improvements were observed in aerobic capacity (V̇O2 Peak +1.6 mL/kg/min, 6-minute walk distance +20-27 m), lower- (30-second sit-to-stand +2-4 repetitions) and upper-limb strength (30-second arm curl +5 repetitions; 1RM grip strength/chest press +2.4-3.1 kg), and agility (timed up-and-go -0.6 seconds). However, changes in quality of life, anthropometry/body composition, balance and flexibility were inconsistent. There was no evidence to support worsening of outcomes. Conclusion: Preliminary research into the role of exercise post-gynaecological cancer suggests an improvement in exercise capacity, muscular strength, and agility which, in the absence of exercise, typically decline following gynaecological cancer. Future exercise trials involving larger and more diverse gynaecological cancer samples will improve understanding of the potential and magnitude of effect of guideline-recommended exercise on outcomes that matter to patients. [ABSTRACT FROM AUTHOR]

A review of scientific and patent data on the hydroformylation of lower C2–C4 olefins in the oxo synthesis of oxygen-containing products is presented. Industrial and prospective catalytic systems based on organometallic compounds of cobalt and rhodium modified with phosphine and phosphite ligands and also industrial technological schemes involving such catalytic systems are examined. [ABSTRACT FROM AUTHOR]

Background: Wildfire severity mediates key dynamics, such as nutrient pulses, that regulate the recovery of ecosystem functioning. Large shifts in vegetation communities associated with plant invasions are often coupled with changes in soil communities; thus, it's critical to understand how fire severity may interact with vegetation type and soil communities to mediate ecosystem recovery. Methods: Following a 2017 wildfire in southern California, soils from areas dominated by native coastal sage scrub or exotic annual grasses that experienced a low or high severity fire event were analyzed for nutrient concentrations and two proxies for ecosystem function—microbial respiration and enzymatic activity potentials over the first-year post-fire. Aims: We predicted that increasing fire severity would positively correlate with soil nutrient concentrations. Thus, higher severity burned soil would experience a greater downregulation of enzyme activity as potential microbial nutrient limitation was alleviated, a relationship that would be stronger in shrub dominated soil. Results: We observed a strong soil nitrogen (N) pulse post-fire, which was greatest in shrub dominated soil; however, dominant vegetation had a variable effect on microbial responses. Enzyme activities were downregulated in CSS soil, but the grass dominated soil response was inconsistent. After 1 year, soil N remained elevated in burned soil, suggesting that basal soil N concentrations were altered. Conclusions: Persistent, residual soil N concentrations are of particular concern in high fire risk ecosystems, which will likely experience increasing fire frequency associated with environmental change; thus, encouraging the regrowth of opportunistic vegetation in subsequent growing seasons will be key to minimize long-term changes to these ecosystems. [ABSTRACT FROM AUTHOR]

The cell wall of the human bacterial pathogen Group A Streptococcus (GAS) consists of peptidoglycan decorated with the Lancefield group A carbohydrate (GAC). GAC is a promising target for the development of GAS vaccines. In this study, employing chemical, compositional, and NMR methods, we show that GAC is attached to peptidoglycan via glucosamine 1-phosphate. This structural feature makes the GAC-peptidoglycan linkage highly sensitive to cleavage by nitrous acid and resistant to mild acid conditions. Using this characteristic of the GAS cell wall, we identify PplD as a protein required for deacetylation of linkage N-acetylglucosamine (GlcNAc). X-ray structural analysis indicates that PplD performs catalysis via a modified acid/base mechanism. Genetic surveys in silico together with functional analysis indicate that PplD homologs deacetylate the polysaccharide linkage in many streptococcal species. We further demonstrate that introduction of positive charges to the cell wall by GlcNAc deacetylation protects GAS against host cationic antimicrobial proteins. The cell wall of the bacterial pathogen Group A Streptococcus is decorated with a polysaccharide termed GAC, which is a target for vaccine development. Here, Rush et al. characterize the linkage between GAC and peptidoglycan, and identify a protein that deacetylates the linkage and thus protects the pathogen against host cationic antimicrobial proteins. [ABSTRACT FROM AUTHOR]

A model of population growth and dispersal is considered where the spatial habitat is a lattice and reproduction occurs generationally. The resulting discrete dynamical system exhibits velocity locking, where rational speed invasion fronts are observed to persist as parameters are varied. In this article, we construct locked fronts for a particular piecewise linear reproduction function. These fronts are shown to be linear combinations of exponentially decaying solutions to the linear system near the unstable state. Based upon these front solutions, we then derive expressions for the boundary of locking regions in parameter space. We obtain leading order expansions for the locking regions in the limit as the migration parameter tends to zero. Strict spectral stability in exponentially weighted spaces is also established. [ABSTRACT FROM AUTHOR]

A correction to the article "Hypophosphatasia diagnosis: current state of the art and proposed diagnostic criteria for children and adults," published online on March 18, 2024 is presented.

The chronology of the Paleocene-Eocene Thermal Maximum (PETM, ~56 Ma) remains disputed, hampering complete understanding of the possible trigger mechanisms of this event. Here we present an astrochronology for the PETM carbon isotope excursion from Howards Tract, Maryland a paleoshelf environment, on the mid-Atlantic Coastal Plain. Statistical evaluation of variations in calcium content and magnetic susceptibility indicates astronomical forcing was involved and the PETM onset lasted about 6 kyr. The astrochronology and Earth system modeling suggest that the PETM onset occurred at an extreme in precession during a maximum in eccentricity, thus favoring high temperatures, indicating that astronomical forcing could have played a role in triggering the event. Ca content data on the paleo-shelf, along with other marine records, support the notion that a carbonate saturation overshoot followed global ocean acidification during the PETM. Astrochronology of a core in Maryland suggests that the onset of the Paleocene-Eocene Thermal Maximum (PETM) warming lasted about 6 thousand years. These data are more consistent with astronomical forcing than an extraterrestial trigger for the PETM. [ABSTRACT FROM AUTHOR]

Bread is a commonly consumed staple and could be a viable medium to deliver plant-based ingredients that demonstrate health effects. This review brings together published evidence on the bioactive properties of bread formulated with plant-based ingredients. Health effects associated with the consumption of bread formulated with plant-based functional ingredients was also reviewed. Bioactive properties demonstrated by the functional ingredients fruits and vegetables, legumes, nuts and tea incorporated into bread include increased phenolic and polyphenolic content, increased antioxidant activity, and extension of bread shelf-life by impairment of lipid and protein oxidation. Acute health effects reported included appetite suppression, reduced diastolic blood pressure, improvements in glycaemia, insulinaemia and satiety effect. These metabolic effects are mainly short lived and not enough for a health claim. Longer term studies or comparison of those who consume and those who do not are needed. The incorporation of plant-based functional ingredients in bread could enhance the health-promoting effects of bread. [ABSTRACT FROM AUTHOR]

Introduction: Sacral and presacral schwannomas are rare, accounting for a minority of spinal schwannomas. We present our institution's experience surgically treating spinal schwannomas and compare it to the literature. Methods: Data were collected for 27 patients treated surgically for sacral or presacral schwannoma between 1997 and 2018 at all Mayo Clinic locations and 93 patients in the literature. Kaplan–Meier disease-free survival analysis was conducted. Unpaired two-sample t tests and Fisher's exact tests assessed statistical significance between groups. Results: Our patients and those in the literature experienced a similar age at diagnosis (49.9 y/o. vs 43.4 y/o., respectively). Most of our patients (59.3%) reported full recovery from symptoms, while a minority reported partial recovery (33.3%) and no recovery (11.1%). A smaller percentage in the literature experienced full recovery (31.9%) and partial recovery (29.8%) but also no recovery (1.1%). Our patients experienced fewer complications (14.8% versus 25.5%). Disease-free survival curves for all patients showed no significant variation in progression by extent of resection of schwannoma (log-rank P = 0.26). No lesion progression was associated with full or partial symptom improvement (p = 0.044), and female patients were more likely to undergo resection via a posterior approach (p = 0.042). Conclusion: Outcomes of patients with sacral or presacral schwannomas vary based on patient demographics, tumor characteristics, symptoms, and surgical treatment. Among the range of symptoms experienced by these patients, the most common is pain. Prognosis improves and overall survival is high when the surgical approach towards sacral schwannomas is prepared and executed appropriately. [ABSTRACT FROM AUTHOR]

Inflammasomes are intracellular protein complexes whose activation results in proinflammatory cytokines. Inflammasomes are implicated in Crohn´s disease (CD) pathogenesis, yet the contribution of inflammasomes in intestinal epithelial cells (IECs) versus lamina propria (LP) macrophages is poorly understood. Whether inflammasome expression in intestinal tissue reflects the serum inflammatory protein profile of patients is also not known. We aimed to determine the intestinal cell types where inflammasome expression is increased in CD and if they correlate with the serum protein profile. RT-PCR and NanoString nCounter technology were used to characterize inflammasome gene expression in CD patients and controls. The mucosa, LP and IEC cell fractions and FACS-sorted cells were analyzed. Proximity extension assay with a 92-protein panel was used to determine the serum inflammatory protein profile. Compositional analysis was used to correlate ileum inflammasome gene expression with intestinal mononuclear phagocyte populations. We show that NLRP3 and MEFV inflammasome sensors and downstream effector expression including IL-1β are increased in inflamed mucosa of IBD patients and correlate with disease activity. Inflammasome gene expression increased with the abundance of immature intestinal macrophages, and increased IL-1β released by CD LP cells correlated with immature macrophage frequency. Inflammasome gene expression was also increased in circulating monocytes, the precursors of immature intestinal macrophages. Finally, the serum inflammatory profile of CD patients correlates with ileal expression of genes related to NLRP3 and MEFV inflammasomes. Overall, we show that MEFV and NLRP3 inflammasome expression in CD intestine is attributed to the accumulation of immature macrophages and correlates with serum inflammatory proteins. [ABSTRACT FROM AUTHOR]

Purpose: The field of artificial intelligence is ever growing and the applications of machine learning in spine care are continuously advancing. Given the advent of the intelligence-based spine care model, understanding the evolution of computation as it applies to diagnosis, treatment, and adverse event prediction is of great importance. Therefore, the current review sought to synthesize findings from the literature at the interface of artificial intelligence and spine research. Methods: A narrative review was performed based on the literature of three databases (MEDLINE, CINAHL, and Scopus) from January 2015 to March 2021 that examined historical and recent advancements in the understanding of artificial intelligence and machine learning in spine research. Studies were appraised for their role in, or description of, advancements within image recognition and predictive modeling for spinal research. Only English articles that fulfilled inclusion criteria were ultimately incorporated in this review. Results: This review briefly summarizes the history and applications of artificial intelligence and machine learning in spine. Three basic machine learning training paradigms: supervised learning, unsupervised learning, and reinforced learning are also discussed. Artificial intelligence and machine learning have been utilized in almost every facet of spine ranging from localization and segmentation techniques in spinal imaging to pathology specific algorithms which include but not limited to; preoperative risk assessment of postoperative complications, screening algorithms for patients at risk of osteoporosis and clustering analysis to identify subgroups within adolescent idiopathic scoliosis. The future of artificial intelligence and machine learning in spine surgery is also discussed with focusing on novel algorithms, data collection techniques and increased utilization of automated systems. Conclusion: Improvements to modern-day computing and accessibility to various imaging modalities allow for innovative discoveries that may arise, for example, from management. Given the imminent future of AI in spine surgery, it is of great importance that practitioners continue to inform themselves regarding AI, its goals, use, and progression. In the future, it will be critical for the spine specialist to be able to discern the utility of novel AI research, particularly as it continues to pervade facets of everyday spine surgery. [ABSTRACT FROM AUTHOR]