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A falling particle receiver (FPR) has been designed to integrate with the G3P3-USA pilot plant currently being constructed at the National Solar Thermal Test Facility (NSTTF) at Sandia National Laboratories. This receiver integrates several innovative design features including a converging tunnel (SNOUT), an optimized cavity geometry, and a multistage “catch-and-release” trough. Details about the integration of these features and the final G3P3-USA FPR design and construction are described. Ray-tracing models of the FPR utilizing the NSTTF heliostat field are developed leveraging previous modeling efforts using SolTrace. Models demonstrate that at least 1.5 MWth of incident radiative energy can be provided to the FPR on a clear day throughout a typical year in Albuquerque, NM. Spillage fluxes around the periphery of the aperture are within acceptable bounds for the majority of the year. Intercept factors are computed for each utilized heliostat at the Vernal equinox to provide guidance to heliostat operators during operation of the system.

Objective: The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia. Methods: Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non–small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site. Results: New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy; P = .047). The median size of new hernias was 21 mm, and the most commonly associated resection site was the left lower lobe (24.2%; P = .04). In patients with preexisting hernias, 53.5% demonstrated a small but significant increase in size from 21 to 22 mm (P

BackgroundUnkept outpatient hospital appointments cost the National Health Service £1 billion each year. Given the associated costs and morbidity of unkept appointments, this is an issue requiring urgent attention. We aimed to determine rates of unkept outpatient clinic appointments across hospital trusts in the England. In addition, we aimed to examine the predictors of unkept outpatient clinic appointments across specialties at Imperial College Healthcare NHS Trust (ICHT). Our final aim was to train machine learning models to determine the effectiveness of a potential intervention in reducing unkept appointments.Methods and findingsUK Hospital Episode Statistics outpatient data from 2016 to 2018 were used for this study. Machine learning models were trained to determine predictors of unkept appointments and their relative importance. These models were gradient boosting machines. In 2017-2018 there were approximately 85 million outpatient appointments, with an unkept appointment rate of 5.7%. Within ICHT, there were almost 1 million appointments, with an unkept appointment rate of 11.2%. Hepatology had the highest rate of unkept appointments (17%), and medical oncology had the lowest (6%). The most important predictors of unkept appointments included the recency (25%) and frequency (13%) of previous unkept appointments and age at appointment (10%). A sensitivity of 0.287 was calculated overall for specialties with at least 10,000 appointments in 2016-2017 (after data cleaning). This suggests that 28.7% of patients who do miss their appointment would be successfully targeted if the top 10% least likely to attend received an intervention. As a result, an intervention targeting the top 10% of likely non-attenders, in the full population of patients, would be able to capture 28.7% of unkept appointments if successful. Study limitations include that some unkept appointments may have been missed from the analysis because recording of unkept appointments is not mandatory in England. Furthermore, results here are based on a single trust in England, hence may not be generalisable to other locations.ConclusionsUnkept appointments remain an ongoing concern for healthcare systems internationally. Using machine learning, we can identify those most likely to miss their appointment and implement more targeted interventions to reduce unkept appointment rates.

Technological innovations such as artificial intelligence and robotics may be of potential use in telemedicine and in building capacity to respond to future pandemics beyond the current COVID-19 era. Our international consortium of interdisciplinary experts in clinical medicine, health policy, and telemedicine have identified gaps in uptake and implementation of telemedicine or telehealth across geographics and medical specialties. This paper discusses various artificial intelligence and robotics-assisted telemedicine or telehealth applications during COVID-19 and presents an alternative artificial intelligence assisted telemedicine framework to accelerate the rapid deployment of telemedicine and improve access to quality and cost-effective healthcare. We postulate that the artificial intelligence assisted telemedicine framework would be indispensable in creating futuristic and resilient health systems that can support communities amidst pandemics.

Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the “safety-net” of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.

Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.

With the rapid pace and scale of the emerging coronavirus 2019 (COVID-19) pandemic, a growing body of evidence has shown a strong association of COVID-19 with pre- and post- neurological complications. This has necessitated the need to incorporate targeted neurological care for this subgroup of patients which warrants further reorganization of services, healthcare workforce, and ongoing management of chronic neurological cases. The social distancing and the shutdown imposed by several nations in the midst of COVID-19 have severely impacted the ongoing care, access and support of patients with chronic neurological conditions such as Multiple Sclerosis, Epilepsy, Neuromuscular Disorders, Migraine, Dementia, and Parkinson disease. There is a pressing need for governing bodies including national and international professional associations, health ministries and health institutions to harmonize policies, guidelines, and recommendations relating to the management of chronic neurological conditions. These harmonized guidelines should ensure patient continuity across the spectrum of hospital and community care including the well-being, safety, and mental health of the patients, their care partners and the health professionals involved. This article provides an in-depth analysis of the impact of COVID-19 on chronic neurological conditions and specific recommendations to minimize the potential harm to those at high risk.

Background Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. We sought to explore clinical outcomes in women and men undergoing CRT‐defibrillation or CRT‐pacing in real‐world clinical practice. Methods and Results A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43 730 patients (women: 10 890 [24.9%]; men: 32 840 [75.1%]) undergoing CRT over 7.6 years, (median follow‐up 2.2 years, interquartile range, 1–4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.69–0.76) and the secondary end point of total mortality or heart failure hospitalization (aHR, 0.79, 95% CI 0.75–0.82) were lower in women, independent of known confounders. Total mortality (aHR, 0.73; 95% CI, 0.70–0.76) and total mortality or heart failure hospitalization (aHR, 0.79; 95% CI, 0.75–0.82) were lower for CRT‐defibrillation than for CRT‐pacing. In analyses of patients with (aHR, 0.89; 95% CI, 0.80–0.98) or without (aHR, 0.70; 95% CI, 0.66–0.73) a myocardial infarction, women had a lower total mortality. In sex‐specific analyses, total mortality was lower after CRT‐defibrillation in women (aHR, 0.83; P=0.013) and men (aHR, 0.69; P

Roselle (Hibiscus sabdariffa L.) is a widely consumed edible flower, often utilized as a natural coloring agent. The bright red color of roselle is due to its anthocyanin content. Beyond their role as colorants, anthocyanins are known for their potent antioxidant properties, which have drawn significant interest for their potential health benefits. To fully harness the advantages of roselle's anthocyanins, developing a reliable extraction method is crucial. This study aimed to establish a fast, efficient, and environmentally friendly extraction technique using microwave-assisted extraction (MAE). Key factors, such as temperature (30, 65, and 100 °C), solvent concentration (30 %, 50 %, and 70 % ethanol in water), and solvent-to-solid ratio (10:1, 25:1, 40:1), were optimized using the Box-Behnken design combined with response surface methodology. The extraction time (5–30 min) was also evaluated to maximize anthocyanin recovery. Two major anthocyanins, delphinidin-3-sambubioside and cyanidin-3-sambubioside, were identified using UHPLC-PDA-QToF-MS and quantified using a cyanidin-3-glucoside calibration curve. The optimal extraction conditions were found to be 72 °C, using 70 % ethanol in water with a 40:1 solvent-to-solid ratio for 15 min. This method was validated with high accuracy (>98 % recovery) and precision (CV

Lung cancer remains the leading cause of cancer deaths in the US with >150,000 deaths per year. In order to more effectively reduce lung cancer mortality, more sophisticated screening paradigms are needed. Previously, our group demonstrated the use of low-coherence enhanced backscattering (LEBS) spectroscopy to detect and quantify the micro/nano-architectural correlates of colorectal and pancreatic field carcinogenesis. In the lung, the buccal (cheek) mucosa has been suggested as an excellent surrogate site in the "field of injury". We, therefore, wanted to assess whether LEBS could similarly sense the presence of lung. To this end, we applied a fiber-optic LEBS probe to a dataset of 27 smokers without diagnosed lung cancer (controls) and 46 with lung cancer (cases), which was divided into a training and a blinded validation set (32 and 41 subjects, respectively). LEBS readings of the buccal mucosa were taken from the oral cavity applying gentle contact. The diagnostic LEBS marker was notably altered in patients harboring lung cancer compared to smoking controls. The prediction rule developed on training set data provided excellent diagnostics with 94% sensitivity, 80% specificity, and 95% accuracy. Applying the same threshold to the blinded validation set yielded 79% sensitivity and 83% specificity. These results were not confounded by patient demographics or impacted by cancer type or location. Moreover, the prediction rule was robust across all stages of cancer including stage I. We envision the use of LEBS as the first part of a two-step paradigm shift in lung cancer screening in which patients with high LEBS risk markers are funnelled into more invasive screening for confirmation.

The bird leaf bird leaf bird turns out to be a leaf perched motionless at trailside. What might have been a dove is hickory detritus, curled up from its earthward [...]

'What we call poems being merely pictures ...'--Walt Whitman, 'Spontaneous Me' I've never been spontaneous. Just ask my friends, who've sometimes taken me to task for holding feelings in, or [...]

Little is known about government policies that regulate economic transfers between separated parents (child support) outside of high-income countries. This paper provides the first broad overview of child support policy and its outcomes in 37 middle- and low-income countries. Using a systematic literature review, we provide information on child support policies in these countries, considering institutional arrangements, procedures for determining how much child support is due and how obligations are enforced. Using descriptive statistics on individual-level data from the Luxembourg Income Study Database, we show that poverty rates are high among lone-mother families and that fewer than one-third of lone mothers receive child support. Among those who receive, however, amounts average over $3,600 US$/year, making child support an important income source for some. We discuss how current policies and their estimated outcomes are similar to (or differ from) the previous work that focused on high-income countries. [ABSTRACT FROM AUTHOR]

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-induced disease (COVID-19) and Gaucher disease (GD) exhibit upregulation of complement 5a (C5a) and its C5aR1 receptor, and excess synthesis of glycosphingolipids that lead to increased infiltration and activation of innate and adaptive immune cells, resulting in massive generation of pro-inflammatory cytokines, chemokines and growth factors. This C5a–C5aR1–glycosphingolipid pathway- induced pro-inflammatory environment causes the tissue damage in COVID-19 and GD. Strikingly, pharmaceutically targeting the C5a–C5aR1 axis or the glycosphingolipid synthesis pathway led to a reduction in glycosphingolipid synthesis and innate and adaptive immune inflammation, and protection from the tissue destruction in both COVID-19 and GD. These results reveal a common involvement of the complement and glycosphingolipid systems driving immune inflammation and tissue damage in COVID-19 and GD, respectively. It is therefore expected that combined targeting of the complement and sphingolipid pathways could ameliorate the tissue destruction, organ failure, and death in patients at high-risk of developing severe cases of COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: It remains unclear whether patients with HER2-negative, low-estrogen receptor (ER-low)-positive early breast cancer (BC) benefit from Oncotype DX® (ODX) testing. Methods: We conducted a retrospective review of cases referred for ODX testing over a seven-year period from a breast biomarker testing referral center (n = 854). For each case, we recorded the ODX Recurrence Score (RS) along with percentage of ER nuclear positivity and staining intensity on immunohistochemistry. Our criteria for ER-low was defined as ≤10% cells with nuclear positivity and/or weak intensity of staining. Slides from all ER-low cases were reviewed and the reported ODX ER gene scores were recorded. We randomly selected a comparator group of 56 patients with ER > 10% positivity and non-weak staining intensity (ER-high). Results: We identified 27 cases (3.2%) that met our criteria for ER-low. Of these, 92.6% had a high RS (>25), and 7.4% had a RS of 25. All cases with ≤10% ER nuclear positivity had a high RS. Most ER-low cases (85.2%) had ODX quantitative ER gene scores in the negative range, whereas all (100%) ER-high cases had positive ER gene scores. Conclusion: ODX does not appear to add significant additional information to inform treatment decisions for most patients with ER-low BC. Incorporating weak ER staining intensity in addition to low percentage of nuclear positivity identifies about twice as many ER-low patients, although with reduced specificity for high RS. Our study supports the contention that most ER-low early BC should be regarded similarly to ER-negative BC.

Reseña de: García Funes, Juan Carlos: Desafectos. Batallones de trabajo forzado durante el franquismo, Granada, Comares, 2022, 360 pp., ISBN: 9788413692890.

Introduction: Patients infected with covid-19 coronavirus and even influenza can die because of an overreaction of the immune system called cytokine storms. Previous research has said that turmeric (curcumin) has the ability to suppress viral infection condition where cytokine increase and continuing by increased of cytokine storm. This condition showed that curcumin potentially to using for healing Ebola patients. Curcumin seems to have very low bioavailability on our human body. In order to increase absorption, nanocurcumin which has smaller particle substrate was used. Our previous research has said that nanocurcumin increase mitochondrial biogenesis in skeletal muscles. This study aims to look at the effect of nanocurcumin administration on Il-6 and TNF-a which increase on high intensity endurance exercise. Methods: Wistar rats 10 weeks old used on this experiment and entered into non-exercise and exercise groups. Furthermore, every group divided with control and nanocurcumin. Curcumin doses was one hundred mg/kilogram/day peroral on both groups for 28 days to known effect of nanocurcumin itself and nanocurcumin together with exercise. Two hours swimming exercise per-day used to determine effect of endurance training. Western blotting (WB) was used to detect of proteins expression IL-6 and TNF-a. Results: Compared to non-exercise group, exercise group showed enhance IL-6 and TNF-a protein expression and interested that nanocurcumin significant abolish this effect. Conclusion: Taken together, these results suggest that nanocurcumin treatment ability decreased inflammation involved on endurance training induced cytokine storm and potentially to be one of candidate drugs to decrease cytokine storm condition. [ABSTRACT FROM AUTHOR]

Ongoing advances in precision cancer therapy have increased the number of molecularly targeted and immuno-oncology agents for a variety of cancers, many of which have been associated with a risk of pulmonary complications, among the most concerning being drug-induced interstitial lung disease/pneumonitis (DI-ILD). As the number of patients undergoing treatment with novel anticancer agents continues to grow, DI-ILD is expected to become an increasingly significant clinical challenge. Trastuzumab deruxtecan (T-DXd) is an antibody–drug conjugate targeting human epidermal growth factor receptor 2 that is gaining widespread use in the metastatic breast cancer setting and is undergoing exploration for other oncologic indications. ILD/pneumonitis is an adverse event of special interest associated with T-DXd, which has potentially fatal consequences if left untreated and allowed to progress. When identified in the asymptomatic stage (grade 1), T-DXd-related ILD can be monitored and treated effectively with the possibility of treatment continuation. Delayed diagnosis and/or treatment, however, results in progression to grade 2 or higher toxicity and necessitates immediate and permanent discontinuation of this active agent. Strategies are, therefore, needed to optimize careful monitoring during treatment to ensure patient safety and optimize outcomes. Several guidance documents have been developed regarding strategies for the early identification and management of T-DXd-related ILD, although none have been within the context of the Canadian health care environment. A Canadian multidisciplinary steering committee was, therefore, convened to evaluate existing recommendations and adapt them for application in Canada. A multidisciplinary approach involving collaboration among medical oncologists, radiologists, respirologists, and allied health care professionals is needed to ensure the proactive identification and management of T-DXd-related ILD and DI-ILD associated with other agents with a similar toxicity profile.

With current imaging, discriminating tumor progression from treatment effect following immunotherapy or oncolytic virotherapy of glioblastoma (GBM) is challenging. A blood based diagnostic biomarker would therefore be helpful. Axl is a receptor tyrosine kinase that is highly expressed by many cancers including GBM. Axl expression is regulated through enzymatic cleavage of its extracellular domain. The resulting fragment can be detected in serum as soluble Axl (sAxl). sAxl levels can distinguish patients with melanoma, hepatocellular carcinoma, and pancreatic ductal adenocarcinoma from healthy controls. This is a pilot study to determine if sAxl is a candidate biomarker for GBM. The sAxl levels in the serum of 40 healthy volunteers and 20 GBM patients were determined using an enzyme-linked immunosorbent assay (ELISA). Pre- and post- operative sAxl levels were obtained. Volumetric MRI evaluation provided GBM tumor volume metrics. There was no significant difference in the sAxl levels of the volunteers (30.16±1.88 ng/ml) and GBM patients (30.74±1.96 ng/ml) p = 0.27. The postoperative sAxl levels were significantly higher than preoperative levels (32.32±2.26 ng/ml vs 30.74±1.96 ng/ml, p = 0.03). We found no correlation between tumor volume and sAxl levels. Axl expression was low or absent in 6 of 11 (55%) patient derived GBM cell lines. Given the wide range of Axl expression by GBM tumors, sAxl may not be a reliable indicator of GBM. However, given the small sample size in this study, a larger study may be considered.

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(1) Background: Cancer is the leading cause of death in Canada, with significant resource limitation impacting the delivery of cancer care nationwide. The onset of the COVID-19 pandemic forced additional resource restriction and diversion, further impacting care delivery. Our intention is to analyze the impact COVID-19 on a provincial medical oncology workload and bring attention to the limitations of the current workload metric for oncologists. (2) Methods: All medical oncology patient encounters were extracted and compared, collected by year and encounter type, from April 2014 through March 2022. (3) Results: There was an increase in all patient encounters by an average of 9.5% per year, including during the strictest COVID-19 restrictions. There was an increase in virtual care encounters from 37.9% to 52.1%. (4) Conclusions: Medical Oncology workloads have increased over time and estimates suggest growing demand. Little data exist to inform workforce requirements and actual workload is not captured by the current metric. Though volume of new consults continues to increase, COVID-19 has highlighted additional changes in the delivery of care, likely with lasting impact, little of which are included in the current workload metric.

The addition of pertuzumab to neoadjuvant trastuzumab and chemotherapy for women with early-stage, high-risk, HER2+ breast cancer has been observed to lead to higher pathologic complete response rates (pCR), and improved event-free survival compared to trastuzumab and chemotherapy alone. Based on available data, neoadjuvant pertuzumab is recommended by ESMO, ASCO, and NICE as well as by a Canadian Consensus Guideline Group. We discuss the implications for Canadian patients with HER2+ early breast cancer due to a second and final negative funding decision by the Canadian Agency for Drugs and Technologies in Health (CADTH) related to neoadjuvant pertuzumab. This decision will have adverse impacts for up to 1 in 6 women receiving neoadjuvant therapy for high-risk HER2+ breast cancer, due to suboptimal pCR rates and higher risks of invasive breast cancer recurrent events, resulting in the need for more toxic adjuvant therapy.

OBJECTIVES: To describe a clinical case of pulmonary thromboembolism (PE) in a child with Duchenne muscular dystrophy. METHODS: A detailed description of the clinical picture and a review of the patients medical record were carried out, in addition to a discussion based on a literature review. DISCUSSION: PTE is not common in children and in 95% of cases it is secondary to an underlying cause or disease, with Duchennes disease being a predisposing condition due to the hypercoagulable state. Diagnosis in the pediatric population is not supported by tests validated as for adults; in this case, CT angiography was the exam of choice with sensitivity and specificity above 90%. In addition to diagnosis, a risk classification is essential, and supports the therapeutic choice. Therefore, low-risk patients receive anticoagulation, while high-risk patients receive thrombolytic therapy; in patients with contraindications to these drugs, surgical intervention may be necessary. Correct identification and early management are essential to delay disease progression and prevent sequelae, as well as avoid unnecessary invasive approaches. CONCLUSION: Due to the difficulty in diagnosing pulmonary thromboembolism in children, a detailed clinical investigation is essential, through the discussion of differential diagnoses and assessment of risk factors, since other diseases can mimic this clinical condition, which can present with signs and nonspecific symptoms.

Este artículo tiene como principales objetivos presentar la trayectoria de la experiencia bélica en tanto que cuestión historiográfica, centrándose sobre todo en el recorrido que ha tenido en la academia española, y problematizar esta línea de estudio a través del análisis crítico de sus fuentes primarias. Para ello, se propondrán tres tipos distintos de fuentes que se creen idóneas para la investigación de la experiencia de guerra de los combatientes republicanos (los egodocumentos, las publicaciones del frente y la documentación militar), y se valorarán sus potencialidades interpretativas, así como las trampas consecuentes de su naturaleza. A partir de estos planteamientos, se ilustrará la importancia de usar adecuadamente una fuente para sacarle el máximo partido interpretativo, así como lo vital que resulta encontrar otras fuentes con las que se las pueda contrastar.

Dominique Rivoal, "The Shared Space of Hackney Marshes" (9:04). My aim as the filmmaker is to develop a somatically informed film-making practice, investigating how attending to soma while operating my camera, can further reveal aspects of relationality within the filmmaker and mover dyad and environment that contains us. // Daniel Portelli, "What the River Doesn't Say About Itself" (9:55). Along a river surrounded by branches and root systems of a mangrove forest, musicians drift on a boat performing music and engaging in eco-acoustical awareness, sensory activation, and perceptual openness. This video essay inquiries into the relationship between cinematic art and how we experience ecology. // Florian Goeschke, "Of Speeds and Slownesses: Co-composing with a Giant Snail" (6:18). The video essay reflects the process of co-composing with a giant snail. What began as a lecture in the context of an online conference for Artistic Research turned out to be a multi-layered phenomenon in dealing with the question of one's own time and temporality and that of another species. // Fani Kostourou and Takako Hasegawa with Theatrum Mundi and Dancing Architects, "Embodied Understanding of Spatial Transformation" (8:55). This is an excerpt montage from a longer film work documenting the choreographic movement research and spatial observation experiments that took place during Theatrum Mundi’s Movement Lisbon Lab in October 2021, to address Lisbon’s uneven and seemingly inaccessible urban landscape.

Introduction: Evidence supports the addition of immunotherapy to definitive chemoradiation for unresectable stage IIIA NSCLC. Adding pembrolizumab to neoadjuvant chemoradiation in patients with resectable stage IIIA NSCLC requires study for safety and feasibility. Methods: Patients with resectable stage IIIA NSCLC received neoadjuvant cisplatin, etoposide, and pembrolizumab concurrently with thoracic radiotherapy of 45 Gy in 25 fractions. Patients without progression underwent resection followed by 6 months of consolidation pembrolizumab. Safety and feasibility were defined as less than or equal to 30% grade 3 or higher pulmonary toxicity or any grade 4 or 5 nonhematologic toxicity. A total of 10 patients were to be enrolled initially. If less than or equal to two patients had events, another 10 were to be enrolled. Results: The study closed after enrolling nine patients. The median age was 66 (range: 49–76) years. A total of 67% were female. Median follow-up was 38.3 months. Serious adverse events occurred in seven patients, including two grade 5 events: one sudden cardiac arrest in the neoadjuvant phase and one fatal pneumocystis pneumonia after resection. Eight patients were assessable for response. The overall response rate was 67%. Six underwent complete resection. Four achieved pathologic complete response, whereas one additional patient had complete nodal clearance. Median progression-free survival has not been reached. The 3-year overall survival was 64%. Conclusions: Adding pembrolizumab to neoadjuvant concurrent cisplatin, etoposide, and radiotherapy in resectable stage IIIA NSCLC resulted in an encouraging pathologic complete response rate. Higher-than-expected toxicities necessitated trial closure after meeting the rule for infeasibility. The relationship of grade 5 events to the addition of pembrolizumab is unclear.

Abstract Background Surgical intervention for spontaneous pneumothorax typically includes mechanical pleurodesis that frequently utilizes a Bovie scratch pad given its universal presence, low cost and ease of use. The pad is folded on itself after dividing it in half, allowing easier passage through the smaller incisions. However, unintentional foreign body retention may occur during the course of an operation leading to reoperations or even worse complications. This case is reported to raise awareness that dividing the scratch pad may allow the embedded radio-opaque marker to fall out and become retained as a foreign body. Case presentation The patient is a 41 year-old female who presented with shortness of breath secondary to spontaneous pneumothorax. Chest CT scan showed apical blebs. The patient underwent video assisted thorascopic surgery (VATS) with bleb resection and mechanical pleurodesis using a divided and folded bovie scratch pad. Postoperative chest x-ray showed a retained foreign body. Reoperation confirmed this to be the radio-opaque marker of the scratch pad and was removed. The patient did well and was discharged the following day. Conclusion Dividing the bovie scratch pad may damage and “weaken” the product allowing the radio- opaque marker to fall out during its use for pleurodesis and should be discouraged. Recommendation is made of using the scratch pad as a whole and not dividing it. Graphical abstract Retained radio-opaque marker of bovie scratch pad during VATS mechanical pleurodesis.

# Background The quality assessment provides information on the overall strength of evidence and methodological quality of a research design, highlighting the level of confidence the reader should place on the findings for decision making. This paper aimed to assess the quality (methodology and quality of reporting) of ageing studies in Sub-Saharan Africa (SSA). # Method This paper is the second of a Four-Part Series paper of a previous systematic mapping review of peer-reviewed literature on ageing studies conducted in SSA. We updated the literature search to include additional 32 articles, a total of 544 articles included in this paper. Downs & Black checklist, Case Report guidelines checklist, the 45-items Lundgren et al. checklist, and the Mixed Method Appraisal Tool were used to assess the methodological quality of quantitative, case reports, qualitative, and mixed-method studies. Quality assessment was piloted and conducted in pairs for each study type. Depending on the checklist, each study was classified as excellent, good, fair, or poor. # Result Of the 544 articles, we performed the quality assessment of a total of 451 quantitative studies \[Randomized control trials (RCTs) and pre-post (n=15), longitudinal (n=122), case-control (n=15) and cross-sectional (n=300); 4 case reports, 74 qualitative and 15 mixed-method studies. Only 20.4% (n=111) articles were of high quality \[one RCT, 27 longitudinal, 4 case-control, 48 cross-sectional studies, 19 qualitative, and 12 mixed-method studies\]. The remaining 433 were rated as moderate quality (n=292, 53.7%), fair quality (n = 96, 17.7%) and poor quality (n = 45, 8.2%). Most (80%) quantitative articles' sample size is small, resulting in insufficient power to detect a clinically or significant important effect. Three-quarter (75%) of the qualitative studies did not report their research team characteristics and a reflexivity component of the 45-items Lundgren et al. checklist. Mixed-method studies with low quality did not report the qualitative studies properly. # Conclusion We conclude that the methodological and quality reporting of published studies on ageing in SSA show variable quality, albeit primarily moderate quality, against high quality. Studies with a large sample size are recommended, and qualitative researchers should provide a section on research team members' characteristics and reflexivity in their paper or as an appendix.

Thymomas are derived from the epithelial component of the thymus and constitute the most common tumor of the anterior mediastinum. These neoplasms are considered malignant for their potential for invasion and metastases. Several histopathologic subclassification schemes have been proposed over the years, however, correlation of histotypes with prognosis remains controversial. In contrast, studies invariably have shown that staging and resection status correlate with oncologic behavior and disease outcomes. In this regard, several staging systems have been presented, though transcapsular invasion and degree of involvement of adjacent anatomic structures are common denominators of all schemes. Involvement of the great vessels and heart most commonly results from direct invasion, which may lead to unusual clinical presentations such as superior vena cava syndrome. Moreover, intravascular and intracardiac growth with or without direct mural invasion rarely occurs. We provide an overview of thymomas with intravascular and intracardiac involvement.

A series of 4-nitrobenzodiazoles with atomic substitution through the chalcogen group were synthesised and their photophysical properties analysed with a view for use in single-molecule localisation microscopy. Sub-diffraction resolution imaging was achieved for silica nanoparticles coated with each dye. Those containing larger atoms were favoured for super-resolution microscopy due to a reduced blink rate (required for stochastic events to be localised). The sulfur-containing molecule was deemed most amenable for widespread use due to the ease of synthetic manipulation compared to the selenium-containing derivative. [ABSTRACT FROM AUTHOR]

In this paper we describe the synthesis of a new carbohydrate-based building block functionalized with azido or amino groups on the 2 and 4 positions. The building block can be synthesized in anomerically pure form in only five scalable steps starting from commercially available levoglucosan. It was shown that the building block could undergo alkylations under strongly basic conditions. The building block with azido groups could furthermore take part in CuAAC reactions, generating derivatives with ester or carboxylic acid functionalities. In addition, the anomeric mixture of the building block was used for the synthesis of a molecule that could act as an emulsifier only in the presence of Zn2+ ions.

Efficient strategies to optimize metamaterial design for specific applications are urgently needed despite the rapid progress in this area. Here the authors propose a computational method combining an optimization algorithm with discrete element simulations for the automatic design of mechanical metamaterial actuators.

Background: Evidence to date supports continued human epidermal growth factor receptor 2 (HER2) suppression beyond progression on HER2-directed therapy for advanced HER2-positive breast cancer. Data from several phase II and III trials evaluating HER2-directed therapy following second-line T-DM1 have recently become available. Methods: We performed a systematic search of the published and presented literature to identify phase II and phase III trials assessing novel HER2-targeted agents as third-line therapy or beyond for HER2-positive advanced breast cancer using search terms ‘breast cancer’ AND ‘HER2’ AND ‘advanced’ AND (‘phase II’ OR ‘phase III’). Results: Eight clinical trials reporting efficacy outcomes on third-line or greater HER2-directed therapy for HER2-positive advanced breast cancer were identified. In phase III trials, margetuximab and neratinib combinations demonstrated significant 1.3-month (hazard ratio, HR = 0.71, p

Objective: To provide data describing the head impact exposure of 7- to 8-year-old football players. Design: Head impact data were collected from 19 players over the course of 2 seasons using helmet-mounted accelerometer arrays. Setting: Data were collected from 2 youth football teams in Blacksburg, VA, spanning 2 seasons. Participants: A total of 19 youth football players aged 7-8 years. Independent Variables: Type of session (practice or game) and the player’s experience. Main Outcome Measures: Head impact frequency, acceleration magnitude, and impact location for games, practices, and the season as a whole were measured. Results: The average instrumented player sustained 9 ± 6 impacts per practice, 11 ± 11 impacts per game, and 161 ± 111 impacts per season. The average instrumented player had a median impact of 16 ± 2 g and 686 ± 169 rad/s2 and a 95th percentile impact of 38 ± 13 g and 2052 ± 664 rad/s2 throughout a season. Impacts of 40 g or greater tended to occur more frequently in practices than in games, and practices had a significantly higher 95th percentile impact magnitude than games (P = 0.023). Returning players had significantly more impacts than first time players (P = 0.007). Conclusions: These data are a further step toward developing effective strategies to reduce the incidence of concussion in youth football and have applications toward youth-specific football helmet designs. [ABSTRACT FROM AUTHOR]

The head impact exposure experienced by football players at the college and high school levels has been well documented; however, there are limited data regarding youth football despite its dramatically larger population. The objective of this study was to investigate head impact exposure in middle school football. Impacts were monitored using a commercially available accelerometer array installed inside the helmets of 17 players aged 12-14 years. A total of 4678 impacts were measured, with an average (±standard deviation) of 275 ± 190 impacts per player. The average o f impact distributions for each player had a median impact of 22 ± 2 g and 954 ± 122 rad/s², and a 95th percentile impact of 54 ± 9 g and 2525 ± 450 rad/s². Similar to the head impact exposure experienced by high school and collegiate players, these data show that middle school football players experience a greater number of head impacts during games than practices. There were no significant differences between median and 95th percentile head acceleration magnitudes experienced during games and practices; however, a larger number of impacts greater than 80 g occurred during games than during practices. Impacts to the front and back of the helmet were most common. Overall, these data are similar to high school and college data that have been collected using similar methods. These data have applications toward youth football helmet design, the development of strategies designed to limit head impact exposure, and child specific brain injury criteria. [ABSTRACT FROM AUTHOR]

The isolation and analysis of circulating tumor cells (CTC) has the potential to provide minimally invasive diagnostic, prognostic and predictive information. Widespread clinical implementation of CTC analysis has been hampered by a lack of comparative investigation between different analytic methodologies in clinically relevant settings. The objective of this study was to evaluate four different CTC isolation techniques-those that rely on surface antigen expression (EpCAM or CD45 using DynaBeads® or EasySep™ systems) or the biophysical properties (RosetteSep™ or ScreenCell®) of CTCs. These were evaluated using cultured cells in order to calculate isolation efficiency at various levels including; inter-assay and inter-operator variability, protocol complexity and turn-around time. All four techniques were adequate at levels above 100 cells/mL which is commonly used for the evaluation of new isolation techniques. Only the RosetteSep™ and ScreenCell® techniques were found to provide adequate sensitivity at a level of 10 cells/mL. These techniques were then applied to the isolation and analysis of circulating tumor cells blood drawn from metastatic breast cancer patients where CTCs were detected in 54% (15/28) of MBC patients using the RosetteSep™ and 75% (6/8) with ScreenCell®. Overall, the ScreenCell® method had better sensitivity.