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Patients with lower educational attainment are underrepresented in inflammatory bowel disease (IBD) research. To increase our understanding of the health care perspectives of patients with less than a university degree, semi-structured interviews were conducted among 23 outpatients at the McGill University Health Centre IBD Centre (Montreal, Canada). Thematic analysis was used to analyze the qualitative data. Perspectives focused on communication with health care professionals, access to care, symptoms and treatment, and outside support. Access to an IBD specialist was the most important aspect of care. Good care, kind and receptive staff, and a lengthy delay to diagnosis were frequently reported experiences. IBD specialists, nurses, and family and friends were most helpful in managing disease. Physical and emotional symptoms, reduced social engagement, and medications were difficult aspects of living with IBD. An ideal IBD clinic would provide access to traditional and non-traditional services and assist with obtaining support to help patients engage in social activities, increase affordability of care, and maintain employment. Study findings may be helpful in designing equitable models of health care delivery.

Material flows between ecosystems, though the degree to which ecosystems are coupled is under investigation. Here Gounand et al. analyze cross-ecosystem carbon flows and relate them to in situ functions, and report different dependencies on spatial flows across numerous ecosystems.

Purpose: To examine the ability of surgeons to identify the osseous landmarks associated with the femoral anterior cruciate ligament (ACL) footprint and locate optimal tunnel placement on 3-dimensional (3D) printed models compared with intraoperative placement. Methods: Twelve sports fellowship-trained orthopaedic surgeons were asked to identify a femoral landmark and an ACL footprint on 10 different 3D printed knees. The 3D models were made based on 20 real patients with different anatomical morphology who later received ACL reconstructive surgery using independent drilling. ImageJ software was used to quantify the measurements, which were then analyzed using descriptive statistics. Results: Overall, none of the surgeons were able to consistently identify the junction of the bony ridges. The mean error per participant ranged from 2.81 to 7.34 mm in the proximal direction (P = 3.30e-05) and from 2.42 to 8.05 mm in the posterior direction (P =4.88e-12). None of the surgeons were able to appropriately identify the center of the femoral footprint on the anatomic 3D models. The difference between the center of the footprint surgeons identified on the 3D model and the tunnel graft location in surgery was significantly different (P = .0046). On average, the magnitude of the error when the surgeons performed the actual surgery was 3.72 ± 2.43 mm, whereas on the 3D models it was 5.82 ± 1.97 mm. Conclusions: Experienced sports fellowship-trained orthopaedic surgeons were unable to correctly identify the junction of the intercondylar and bifurcate ridges and the native ACL footprint on 3D models. Operatively placed tunnels were more accurate implying that looking either through a scope or soft-tissue landmarks play a significant role in surgeons ACL footprint localization. Clinical Relevance: The graft position for ACL reconstruction plays an important role on the kinematics of the knee. This paper shows that soft tissue landmarks are needed to provide reliable reference points for reconstruction.

Abstract Background Early screening for prostate cancer (PCA) remains controversial because of overdiagnosis and overtreatment of clinically insignificant cancers. Even though a number of diagnostic tests have been developed to improve on PSA testing, there remains a need for a more informative non-invasive test for PCA. The objective of this study is to identify a panel of DNA methylation markers suitable for a non-invasive diagnostic test from urine DNA collected following a digital rectal exam (DRE) and/or from first morning void (FV). A secondary objective is to determine if the cumulative methylation is indicative of biopsy findings. Methods DRE and FV urine samples were prospectively collected from 94 patients and analyzed using 24 methylation-specific quantitative PCR assays derived from 19 CpG islands. The methylation of individual markers and various combinations of markers was compared to biopsy results. A methylation threshold for cancer classification was determined using a target specificity of 70%. The average methylation and the number of positive markers were also compared to the result of the biopsy, and the area under the receiver operating characteristic curves (AUCs) were calculated. Results Methylation of all 19 markers was detected in FV and DRE DNAs. Combining the methylation of two or more markers improved on individual marker results. Using 6of19 methylated markers as the threshold for cancer classification yielded a specificity of 71% (95% CI, 0.57–0.86) from both DRE and FV and a sensitivity of 89% (95% CI, 0.79–0.97) from DRE and 94% (95% CI, 0.84–1.0) from FV. The negative predictive value at the 6of19 threshold was ≥ 90 for both DNA types. Conclusions PCA-specific methylation was detected in both FV and DRE DNA. There was no significant difference in diagnostic accuracy at the 6of19 threshold between DRE and FV urine DNA. The results support the development of a non-invasive diagnostic test to reduce unnecessary biopsies in men with elevated PSA. The test can also provide patients with personalized recommendations based on their own methylation profile.

Species richness patterns are driven by biotic and abiotic factors, the relative strengths of which are unclear. Here, the authors test how species interactions or environmental traits influence fish richness across over 700 Canadian lakes, showing a surprisingly small role of negative interactions.

We present spectrograph design details and initial radial velocity results from the PRL optical fiberfed high-resolution cross-dispersed echelle spectrograph (PARAS), which has recently been commissioned at the Mount Abu 1.2 m telescope in India. Data obtained as part of the postcommissioning tests with PARAS show velocity precision better than 2 ms-1 over a period of several months on bright RV standard stars. For observations of σ Dra, we report 1:7 ms-1 precision for a period of 7 months, and for HD 9407, we report 2:1 ms-1 over a period of 2 months. PARAS is capable of single-shot spectral coverage of 3800-9500 Å at a resolution of ~67; 000. The RV results were obtained between 3800 and 6900 Å using simultaneous wavelength calibration with a thorium-argon (ThAr) hollow cathode lamp. The spectrograph is maintained under stable conditions of temperature with a precision of 0.01-0.02° C (rms) at 25.55° C and is enclosed in a vacuum vessel at pressure of 0:1 ± 0:03 mbar. The blaze peak efficiency of the spectrograph between 5000 and 6500 Å, including the detector, is ~30%; it is ~25% with the fiber transmission. The total efficiency, including spectrograph, fiber transmission, focal ratio degradation (FRD), and telescope (with 81% reflectivity) is ~7% in the same wavelength region on a clear night with good seeing conditions. The stable point-spread function (PSF), environmental control, existence of a simultaneous calibration fiber, and availability of observing time make PARAS attractive for a variety of exoplanetary and stellar astrophysics projects. Future plans include testing of octagonal fibers for further scrambling of light and extensive calibration over the entire wavelength range up to 9500 Å using thorium-neon (ThNe) or uranium-neon (UNe) spectral lamps. Thus, we demonstrate how such highly stabilized instruments, even on small aperture telescopes, can contribute significantly to the ongoing radial velocity searches for low-mass planets around bright stars. [ABSTRACT FROM AUTHOR]