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Advanced driver assistance systems have been an active research topic for decades, for which many approaches have been developed not only to reduce the number of traffic accidents but also to increase the driver's comfort. Among the many different solutions proposed, learning-based prediction approaches have gained considerable attention in recent years. Within this scope, this work focuses on the implementation aspects of a linear learning-based regression model for detecting unintended lane-departures, where the goal is to achieve a prediction model with good predictive performance while keeping the computational complexity as low as possible. Aspects under consideration include input signal selection and down-sampling. The linear prediction model is analyzed using a real world data set, and benchmarked against a kinematic constant velocity model and a non-linear regression model. The results show that the linear regression model has a significantly higher prediction performance when compared to a kinematic model. It is also shown that the predictive performance remains comparable to the more complex nonlinear regression model, even though the computational complexity of the linear model is significantly lower.

Background Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients. Method Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method. Results Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. Conclusions Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.

Mammary gland and its secretion around parturition show different changes. The objective of the study conducted here was to examine the changes in the physical and chemical properties of the milk before, during, and after lambing. A total of 40 local Iraqi breed ewes, 2 to 4 years-old, confirmed pregnant by B-mode ultrasonography was used in this study. Milk was collected from each study ewe at 3 consecutive times, (i) on day 135 of pregnancy, (ii) at the time of lambing, and (iii) on day 5 postpartum. Milk examinations included colour, consistency, density, specific gravity, chloride contents, pH, light transmittance percentage, and light extinction coefficient. Results indicated changes of colour and consistency during different study periods. Milk density and specific gravity decreased as ewes approached lambing time and started lactation. Milk pH was low at the time of lambing. Mean of light transmittance percentage became zero at the time of lambing and later. The light extinction coefficient increased at the time of lambing and later. In conclusion, although signs of parturition could be simply observed, changes in milk properties can prompt owners to closely observe ewes whether they have already lambed or not.

In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was “very low” quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was “very low” quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved.

Economic inequality is associated with preferences for smaller, immediate gains over larger, delayed ones. Such temporal discounting may feed into rising global inequality, yet it is unclear whether it is a function of choice preferences or norms, or rather the absence of sufficient resources for immediate needs. It is also not clear whether these reflect true differences in choice patterns between income groups. We tested temporal discounting and five intertemporal choice anomalies using local currencies and value standards in 61 countries (N = 13,629). Across a diverse sample, we found consistent, robust rates of choice anomalies. Lower-income groups were not significantly different, but economic inequality and broader financial circumstances were clearly correlated with population choice patterns. Ruggeri et al. find in a study of 61 countries that temporal discounting patterns are globally generalizable. Worse financial environments, greater inequality and high inflation are associated with extreme or inconsistent long-term decisions.

Background and purpose — Knowing how to interpret values obtained with patient reported outcome measures (PROMs) is essential. We estimated the substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) for Forgotten Joint Score 12 (FJS) and explored differences depending on methods used for the estimates. Patients and methods — The study was based on 195 knee arthroplasties (KA) performed at a university hospital. We used 1 item from the Knee injury and Osteoarthritis Outcome Score domain quality of life and satisfaction with surgery, obtained 1-year postoperatively, to assess SCB and PASS thresholds of the FJS with anchor-based methods. We used different combinations of anchor questions for SCB and PASS (satisfied, satisfied with no or mild knee difficulties, and satisfied with no knee difficulties). A novel predictive approach and receiver-operating characteristics curve were applied for the estimates. Results — 70 and 113 KAs were available for the SCB and PASS estimates, respectively. Depending on method, SCB of the FJS (range 0–100) was 28 (95% CI 21–35) and 22 (12–45) respectively. PASS was 31 (2–39) and 20 (10–29) for satisfied patients, 40 (31–47) and 38 (32–43) for satisfied patients with no/mild difficulties, and 76 (39–80) and 64 (55–74) for satisfied patients with no difficulties. The areas under the curve ranged from 0.82 to 0.88. Interpretation — Both the SCB and PASS thresholds varied depending on methodology. This may indicate a problem using meaningful values from other studies defining outcomes after KA. This study supports the premise of the FJS as a PROM with good discriminatory ability in patients undergoing KA.

Transperineal (TP) prostate biopsy provides an effective approach to prostate cancer (PCa) detection. Although transrectal targeted biopsy has been well described, the specific advantage of the standard TP template or TP targeted biopsy using multiparametric (mp) magnetic resonance imaging (MRI)-ultrasound (US) fusion remains less understood and without consensus.We identified all men who underwent a transperineal standard 20-core template in addition to a targeted biopsy with mpMRI-US fusion-guided software from September 2019 to February 2021. We assessed and compared clinical, MRI and biopsy characteristics between standard TP template and fusion targeted biopsies.A total of 301 men underwent TP fusion biopsy during the study period. Target lesions on MRI were sampled with 3 targeted cores per patient (IQR 3-4). The overall cancer detection rate was 74.1% and 63.5% by standard template and targeted biopsy, respectively, of which 52.5% and 59.7% were clinically significant (cs) PCa. Combined csPCa detection rate was 62.2%. Of 176 cases with a cancer diagnosis by both biopsy methods, 18.8% were upgraded with targeted biopsies while 18.2% were upgraded with template biopsies.In men with suspicious lesions on mpMRI, TP MRI fusion-guided biopsies combined with standard template provide a higher overall cancer detection rate and higher detection rate of csPCa than the standard template or targeted biopsy alone. In the setting of a suspicious mpMRI prostate lesion, targeted plus standard template should be included as part of the TP biopsy procedure.

Background Enterococcal bacteraemia (EB) is common, particularly in the nosocomial setting, and its management poses a challenge for clinicians and microbiologists. Objectives The aim was to summarize the more relevant features of EB and to provide a practical state-of-the-art on the topics that more directly affect its management. Sources Pubmed articles from inception to 31 May 2020. Content The following topics are covered: epidemiological, clinical and microbiological characteristics and factors associated with prognosis of EB; diagnosis and work-up, including the use of echocardiography to rule out endocarditis; antibiotic management with special focus on antimicrobial resistance and complicated EB; and the role of infectious disease consultation and the use of bundles in EB. In addition, three clinical vignettes are presented to illustrate the practical application of the guidance provided, and major gaps in the current evidence supporting EB management are discussed. Implications EB is associated with large burdens of morbidity and mortality, particularly among fragile and immunosuppressed patients presenting complicated bacteraemia due to multidrug-resistant enterococci. Most cases of EB are caused by Enterococcus faecalis, followed by E. faecium. EB often presents as polymicrobial bacteraemia. Rapidly identifying patients at risk of EB is crucial for timely application of diagnostic techniques and empiric therapy. Early alert systems and rapid diagnostic techniques, such as matrix-assisted desorption ionization–time of flight mass spectrometry, especially if used together with infectious disease consultation within bundles, appear to improve management and prognosis of EB. Echocardiography is also key in the work-up of EB and should probably be more extensively used, although its exact indications in EB are still debated. Multidisciplinary approaches are warranted due to the complexity and severity of EB.

Background: We review the efficacy and safety of dexmedetomidine and clonidine as perineural or systemic adjuvants for brachial plexus blocks (BPB). Methods: We included randomised controlled trials on upper limb surgery with BPBs in adults, comparing dexmedetomidine with clonidine or either drug with placebo. The primary outcome was duration of analgesia. Secondary outcomes included adverse and serious adverse events. The review was conducted using Cochrane standards, trial sequential analyses (TSA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We included 101 trials with 6248 patients. Overall, duration of analgesia was prolonged with both clonidine (176 min [TSA adj. 95% CI: 118, 205, p

Background: The COVID-19 pandemic has had a huge impact on people’s lives and may influence mental health in the general population. In a unique representative Danish longitudinal study, we examined mental well-being measured just before and during the COVID-19 pandemic. Methods: The Danish Health and Wellbeing Survey is the Danish contribution to the European Health Interview Survey. In this study, we included the wave from autumn 2019, which we re-invited in the autumn 2020. The study population consisted of 4,234 persons. The main outcome was the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Linear and logistic regression models were conducted to evaluate change in SWEMWBS between 2019 and 2020. Outcomes: The SWEMWBS distribution was similar in 2019 and 2020, although the distribution moved to lower scores in 2020 compared to 2019. Mean SWEMWBS decreased significantly from 25·5 in 2019 to 24·6 in 2020 corresponding to a mean change of -1·0 (95%CI, -1·1. to -0·8). The proportion with low SWEMWBS increased from 16·5% in 2019 to 20·1% in 2020 (p

How information literate are students in higher education, and how accurate is their metacognition related to that ability? Are students’ perceived needs to learn more and their level of interest in becoming information literate related to their pursuit of information literacy (IL) skill development? First-year undergraduates, master’s, and PhD students ( N = 760) took an objective IL test and estimated their scores both before and after the test. IL ability, as well as students’ estimation of their IL ability, increased with higher education experience and IL test experience, though also varied notably within groups. Low-performers tended to overestimate their abilities, while high-performers tended to underestimate them—both evidence of the Dunning-Kruger effect. Furthermore, gender comparisons revealed that men tended to estimate higher, and more accurate, scores than women. Finally, PhD students reported greater interest in becoming information literate than undergraduates. Although undergraduates felt a greater need to learn more, PhD students were more inclined to pursue IL growth. For both groups, interest in becoming information literate correlated far more with their likelihood to invest effort into developing IL competencies than their perceived need to know more. What implications might these findings have for how we conceptualize the teaching of IL?

Purpose: We tested whether a single session of heavy-load resistance priming conducted in the morning improved double-poling (DP) performance in the afternoon. Methods: Eight national-level male cross-country skiers (mean [SD]: 23 [3] y, 184 [6] cm, 73 [7] kg, maximum oxygen consumption = 69 [6] mL·kg−1·min−1) carried out 2 days of afternoon performance tests. In the morning, 5 hours before tests, subjects were counterbalanced to either a session of 3 × 3 repetitions (approximately 85%–90% 1-repetition maximum) of squat and sitting pullover exercises or no exercise. The performance was evaluated in DP as time to exhaustion (TTE) (approximately 3 min) on a treadmill and 30-m indoor sprints before and after TTE (30-m DP pre/post). Furthermore, submaximal DP oxygen cost, countermovement jump, and isometric knee-extension force during electrical stimulation were conducted. Participants reported perceived readiness on test days. Results: Resistance exercise session versus no exercise did not differ for TTE (approximately 3 min above) (mean ± 95% confidence interval = 3.6% ± 6.0%; P = .29; effect size [ES], Cohen d = 0.27), 30-m DP pre (−0.56% ± 0.80%; P = .21; ES = 0.20), 30-m DP post (−0.18% ± 1.13%; P = .76; ES = 0.03), countermovement jump (−2.0% ± 2.8%; P = .21; ES = 0.12), DP oxygen cost (−0.13% ± 2.04%; P = .91; ES = 0.02), or perceived readiness (P ≥ .11). Electrical stimulation force was not different in contraction or relaxation time but revealed low-frequency fatigue in the afternoon for the resistance exercise session only (−12% [7%]; P = .01; ES = 1.3). Conclusion: A single session of heavy-load, low-volume resistance exercise in the morning did not increase afternoon DP performance of short duration in high-level skiers. However, leg low-frequency fatigue after resistance priming, together with the presence of small positive effects in 2 out of 3 DP tests, may indicate that the preconditioning was too strenuous.

Providers of complex business services often focus on creating positive experiences and emotions to manage their clients’ impressions and their consultants’ self-esteem. This, however, creates chal...

The catfish industry is the largest U.S. aquaculture sector and a major contributor to the rural economies of the Southern states of Alabama, Arkansas, and Mississippi. Economic contributions of th...

Objective: To identify risk factors of primary site necrosis (PSN) after definitive concurrent chemoradiation therapy (CCRT) in patients with nonoral cavity head and neck cancer (HNC). Methods: We retrospectively reviewed the records of 256 patients treated with CCRT for HNC during 2010–2018. Patient-related (age, sex, history of smoking, hypertension, diabetes mellitus, serum hemoglobin and albumin), tumor-related (tumor site, American Joint Committee on Cancer stage), and treatment-related (induction chemotherapy, maximum point dose and mean dose of planning target volume [PTV] of primary site, absolute volumes of the PTV receiving >50–75 Gy [V50–V75]) variables were analyzed. Critical dosimetric parameters of PSN were identified using receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analyses were used to select the significant variables for PSN development. Results: After median follow-up of 44 months (range, 5–127), 7 patients (2.7%) developed PSN with a median time to event of 10 months (range, 3–12). V70 ⩾79.8 mL was the most critical dosimetric parameter for PSN (area under the ROC curve 0.873, sensitivity 0.857, specificity 0.747). In univariate analyses, pretreatment serum hemoglobin 70 ⩾79.8 mL were significantly associated with higher risk of PSN occurrence. V70 ⩾79.8 mL (hazard ratio 5.960, 95% confidence interval 1.289–27.548; p = 0.022) remained significant predictors of PSN in multivariate analyses. Conclusions: V70 ⩾79.8 mL is significantly related to the risk of developing PSN. These findings offer valuable clues for clinicians to minimize PSN incidence in HNC treated with curative CCRT.

BACKGROUND: Long-term rhythm monitoring (LTRM) can detect undiagnosed atrial fibrillation (AF) in patients at high risk of AF and stroke. Biomarkers and echocardiographic parameters could, however, help identify patients benefitting most from LTRM. The aim of this study was to investigate, whether circulating biomarkers of cardiac and vascular function (brain natriuretic peptide (BNP), cardiac troponin I (cTnI), copeptin, and mid-regional proadrenomedullin (MR-proADM)) and echocardiographic parameters were associated with incident subclinical AF (SCAF) in a population at high risk of stroke in the presence of AF. For this purpose, we investigated individuals ≥65 years of age with hypertension and diabetes mellitus, but no history or symptoms of AF or other cardiovascular disease (CVD).METHODS: We included 82 consecutive patients (median age 71.3 years (IQR 67.4-75.1)). All patients received an insertable cardiac monitor (ICM) and were followed for a median of 588 days (IQR 453-712). On the day of ICM implantation, a comprehensive echocardiogram and blood samples were obtained.RESULTS: During a median follow-up of 588 days (IQR: 453 to 712 days), incident SCAF occurred in 17 patients (20.7%) with a median time to first-detected episode of 91 days (IQR 41-251 days). MR-proADM (median 0.87 nmol/L (IQR 0.76-1.02) vs 0.78 nmol/L (IQR 0.68-0.98)) and copeptin (median 13 pmol/L (IQR 9-17) vs 8 pmol/L (IQR 4-18)) levels were insignificantly higher in patients with incident SCAF. BNP and cTnI concentrations and echocardiographic parameters were similar in the two groups.CONCLUSIONS: MR-proADM, BNP, cTnI, copeptin, and several echocardiographic parameters were not associated with incident SCAF in this cohort of patients with hypertension and diabetes, but without any underlying CVD. This article is protected by copyright. All rights reserved.

Aims: New diastolic dysfunction (DD) guidelines were introduced in 2016 to replace the 2009 guidelines, but have not yet been evaluated in aortic stenosis (AS). We aimed to compare the 2009 and 2016 DD guidelines in severe AS patients in terms of association with left ventricular (LV) and left atrial (LA) remodeling, with pulmonary capillary wedge pressure (PCWP) at rest and exercise, and with prognosis. Methods and results: We included 212 patients with severe AS (112 undergoing AVR, 100 asymptomatic). Echocardiography, magnetic resonance imaging, and brain natriuretic peptides (BNP) were performed/measured. Thirty-nine asymptomatic patients had PCWP measured during rest and maximal exertion. Asymptomatic patients were followed for 3.1 years for the combined endpoint of death, AVR or admission with heart failure. The 2009 and 2016 DD guidelines agreed poorly with each other (Cohens’ κ =.15). 2009 guidelines showed many ambiguous DD findings. With the 2016 guidelines, 20% of patients had indeterminate DD. DD grade 2 according to 2016 guidelines showed stronger association with symptom status, BNP, global longitudinal strain (GLS) and peak exercise PCWP than 2009 guidelines. For indeterminate DD patients according to 2009 guidelines, GLS above the median was associated with event-free survival (HR.11 (95% CI.02–.53)). For neither guideline was DD associated with the combined endpoint in asymptomatic patients. Conclusion: The 2016 guidelines show a stronger association with BNP, GLS, and exercise PCWP than the 2009 guidelines. The 2016 guidelines result in 20% of patients with indeterminate DD; however, these patients may possibly be stratified according to GLS.

Summary Perineural invasion (PNI) on biopsy is associated with adverse features in prostate cancer (PCa). Transrectal multiparametric magnetic resonance imaging (MRI)–targeted biopsy (TBx) has shown to detect higher presence of PNI than standard template biopsy (SBx). Transperineal biopsy provides effective cancer detection with lower complications than the transrectal approach. We compared PNI detection efficiency between SBx and TBx through transperineal approach. We identified patients with PCa who underwent transperineal TBx and concomitant standard 20-core template SBx from September 2019 to February 2021. Clinical, MRI imaging and biopsy characteristics were evaluated and compared between TBx and SBx. Two hundred thirty-eight patients with PCa underwent concomitant transperineal SBx and TBx procedures. Combined PNI+ (SBxPNI+ and/or TBxPNI+) was identified in 77 of 238 (32.4%) patients. SBx detected 23.9% PNI-positive patients and TBx detected 19.3% PNI-positive patients of all patients with PCa. Patients with PNI were with significantly different clinicopathological characteristics than patients without PNI. Although significantly more positive PCa cores and higher positive PCa core rate were found in the SBx method, patients with SBxPNI+ only shared similar features as TBxPNI+only patients. Of 176 cases with both SBxPCa and TBxPCa, TBx could detect 19 (15.1%) more PNI cases than SBx while SBx could detect 24 (18.3%) more PNI cases than TBx. Multiparametric MRI fusion–targeted biopsy in combination with template biopsy through transperineal approach achieved PNI detection rate over 30% of PCa cases. The increased PNI detection may improve the model to select active surveillance candidates in clinical practice.

Comparing twins from same- and opposite-sex pairs can provide information on potential sex differences in a variety of outcomes, including socioeconomic-related outcomes such as educational attainment. It has been suggested that this design can be applied to examine the putative role of intrauterine exposure to testosterone for educational attainment, but the evidence is still disputed. Thus, we established an international database of twin data from 11 countries with 88,290 individual dizygotic twins born over 100 years and tested for differences between twins from same- and opposite-sex dizygotic pairs in educational attainment. Effect sizes with 95% confidence intervals (CI) were estimated by linear regression models after adjusting for birth year and twin study cohort. In contrast to the hypothesis, no difference was found in women (β = −0.05 educational years, 95% CI −0.11, 0.02). However, men with a same-sex co-twin were slightly more educated than men having an opposite-sex co-twin (β = 0.14 educational years, 95% CI 0.07, 0.21). No consistent differences in effect sizes were found between individual twin study cohorts representing Europe, the USA, and Australia or over the cohorts born during the 20th century, during which period the sex differences in education reversed favoring women in the latest birth cohorts. Further, no interaction was found with maternal or paternal education. Our results contradict the hypothesis that there would be differences in the intrauterine testosterone levels between same-sex and opposite-sex female twins affecting education. Our findings in men may point to social dynamics within same-sex twin pairs that may benefit men in their educational careers. CC BY 4.0Correspondence Address: Silventoinen, K.; University of Helsinki, P.O. Box 18, Finland; email: karri.silventoinen@helsinki.fi© 2021 The Authors

Dedicated breast CT is an emerging volumetric X-ray imaging modality for diagnosis that does not require any painful breast compression. To improve the detection rate of weakly enhanced lesions, an adaptive image rescaling (AIR) technique was proposed.Two disks containing five identical holes and five holes of different diameters were scanned using 60/100 kVp to obtain single-energy CT (SECT), dual-energy CT (DECT), and AIR images. A piece of pork was also scanned as a subclinical trial. The image quality was evaluated using image contrast and contrast-to-noise ratio (CNR). The difference of imaging performances was confirmed using student'sTotal mean image contrast of AIR (0.70) reached 74.5% of that of DECT (0.94) and was higher than that of SECT (0.22) by 318.2%. Total mean CNR of AIR (5.08) was 35.5% of that of SECT (14.30) and was higher than that of DECT (2.28) by 222.8%. A similar trend was observed in the subclinical study.The results demonstrated superior image contrast of AIR over SECT, and its higher overall image quality compared to DECT with half the exposure. Therefore, AIR seems to have the potential to improve the detectability of lesions with dedicated breast CT.Dedicated breast CT (이하 DBCT)는 유방 압박의 고통이 없는 영상 진단 기법으로 최근 주목받고 있다. 본 연구에서는 DBCT 영상에서 약하게 조영증강된 작은 병변의 검출률을 높이기 위해 피사체의 기하학적 정보를 이용하여 최적의 영상 문턱값을 제공하는 adaptive image rescaling (이하 AIR) 기법을 제안하였다.5개의 동일 크기의 구멍과 서로 다른 크기의 구멍을 가지는 두 개의 디스크를 각각 제작하고, 이를 60 kVp와 100 kVp로 스캔하여 single-energy CT (이하 SECT), dual-energy CT (이하 DECT), 그리고 AIR 영상을 생성하였다. 전임상 평가를 위해 돼지 조직 영상도 획득하였다. Image contrast (이하 IC)와 contrast-to-noise ratio (이하 CNR)로 화질을 평가하였으며, student'sAIR의 평균 IC (0.70)는 DECT (0.94)의 74.5%로 나타났으며, SECT (0.22) 보다 318.2% 높았다. 또한 AIR의 평균 CNR (5.08)은 SECT (14.30)의 35.5%로 나타났고 DECT (2.28) 보다 222.8% 높게 측정되었다. 돼지 조직의 전임상 평가 결과도 비슷한 양상을 보였다.AIR은 SECT보다 높은 영상 대조도를 가지며, 50% 선량만으로도 DECT에 비견할 만한 화질 성능을 제공할 수 있음을 확인하였다. 따라서 AIR은 DBCT 영상에서 약하게 조영증강된 병변의 검출률을 개선할 수 있을 것으로 생각된다.

Background Postpartum dysgalactia syndrome (PDS) is associated with a significantly higher activation of the inflammatory and stress response at parturition than in the healthy sow. Therefore, reliable and possibly non-invasive biomarkers for substantial increases of inflammation are searched to support the PDS diagnosis. This report studies the possible changes of the inflammatory marker enzyme adenosine deaminase (ADA) in serum and saliva of 38 PDS positive sows (PDS+) and 38 healthy sows (PDS-). Sampling was performed every 24 h from 60 h before to 36 h after parturition. Isoenzyme 1 (ADA1) and isoenzyme 2 (ADA2), as well as total ADA (tADA), were measured and their statistical association with several serum and saliva biomarkers of inflammation and stress was investigated. Results Compared to a baseline (60 to 36h prepartum), salivary activities of ADA1, ADA2 and tADA increased significantly over time in both PDS+ and PDS- sows, reaching their peaks after parturition. In serum from PDS- sows, no changes were observed over time in either ADA1, ADA2 or tADA. In PDS+ sows, serum ADA2 activity decreased temporarily after parturition followed by a significant increase compared to baseline. ADA1, ADA2 and tADA were all significantly associated with several inflammatory biomarkers and ADA1 in serum was associated with serum cortisol. Although serum activity was higher in PDS+ than in PDS- sows, the differences were not statistically significant. Further, no difference was noted between the groups in the analyses of saliva. Conclusions Salivary ADA1 and ADA2 increased in all sows after parturition, potentially as a response to the postpartum inflammation. However, no difference in the activity of ADA1, ADA2 and tADA were found between PDS+ and PDS- sows indicating inability to diagnose PDS under the conditions described in this report.

Background Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in organ transplant recipients that may be prevented by antibiotic prophylaxis. We aimed to investigate the incidence rate (IR) of PCP and the related hospitalization and mortality rates in liver transplant recipients in an era of routine prophylaxis. Methods We included all adult liver transplant recipients transplanted at Rigshospitalet between January 1, 2011 and October 1, 2019. Microbiology data were obtained from the Danish Microbiology Database (MiBa), a national database containing all data from all Departments of Clinical Microbiology in Denmark receiving samples from both hospitals and general practices. According to local guidelines, PCP prophylaxis was initiated 1 week posttransplantation and discontinued after 6 months or sooner in patients experiencing side effects. Results We included 343 liver transplant recipients with 1153 person‐years of follow‐up (PYFU), of which 269 (78%) received PCP prophylaxis during the first 6 months posttransplantation. Seven (2%) recipients were diagnosed with PCP during follow‐up. In the first 6 months posttransplantation and in 269 transplant recipients who received prophylaxis there were zero PCP events while the IR was 32 (95% confidence interval [CI] 2.9–148) per 1000 PYFU in 74 recipient who did not receive prophylaxis. During 7th to 12th month posttransplantation the IR was 20 (95% CI: 5.5–53) per 1000 PYFU. All seven (100%) recipients diagnosed with PCP were hospitalized, however none died. Conclusions PCP was not detected in liver transplant recipients while on prophylaxis. Though, it worth mentioning that two out of the seven PCP patients received high‐dose prednisolone before the PCP event. All liver transplant recipients with PCP were hospitalized, but none died. Randomized clinical trials to determine the optimal duration of prophylaxis are warranted., We investigated the incidence of Pneumocystis jirovecii pneumonia (PCP) in a cohort of liver transplant recipients in an era with the use of routine PCP prophylaxis. There were no cases of PCP in recipients while on prophylaxis. Furthermore, no case with PCP infection was reported after 15th month posttransplantation. This underlines the need for randomized clinical trials to determine the optimal duration of prophylaxis.

Background and purpose — The sacroiliac joint is increasingly recognized as a cause of pain in 15–30% of patients with low back pain. Nonoperative management is not always successful and surgical treatment with fusion of the joint is increasingly recommended. According to the literature, minimally invasive fusion reduces pain and improves function compared with nonoperative treatment. It is, however, unclear to what extent the placebo effect influences these results. Patients and methods — The trial is designed as a prospective multi-center, double-blind, randomized shamsurgery controlled trial with 2 parallel groups. 60 patients with a suspected diagnosis of sacroiliac joint pain confirmed with sacroiliac joint injection are included according to the trial inclusion criteria. Patients are randomized with a 1:1 allocation into 2 groups of 30 patients each. The primary end-point is group difference in sacroiliac joint pain intensity on the operated side at 6 months postoperatively, measured by the Numeric Rating Scale. The main objective is to examine whether there is a difference in pain reduction between patients treated with a minimally invasive fusion of the sacroiliac joint compared with patients undergoing a sham operation. Results — Unblinding occurs after the completed 6-month follow-up. The primary analysis will be performed when all patients have completed 6 months’ follow-up. Follow-ups are continued to at least 2 years postoperatively. Data from the different groups will be compared based on the “intention to treat” principle.

Charities are constantly looking for new and more effective ways to engage potential donors in order to secure the resources needed to deliver services. The current work demonstrates that creative activities are one way for marketers to meet this challenge. Field and lab studies find that engaging potential donors in creative activities positively influences their donation behaviors (i.e., the likelihood of donation and the monetary amount donated). Importantly, the observed effects are shown to be context independent: they hold even when potential donors engage in creative activities unrelated to the focal cause of the charity (or the charitable organization itself). The findings suggest that engaging in a creative activity enhances the felt autonomy of the participant, thus inducing a positive affective state, which in turn leads to higher donation behaviors. Positive affect is demonstrated to enhance donation behaviors due to perceptions of donation impact and a desire for mood maintenance. However, the identified effects emerge only when one engages in a creative activity—not when the activity is noncreative, or when only the concept of creativity itself is made salient.

Background Individuals who participate in outdoor sports are subject to an increased risk of developing skin cancer. To date, there has been no review examining skin cancer and sun protective behaviours specific to outdoor, water based sports. Therefore, this scoping reviews objectives were to (1) summarise volume and type of scientific literature available relating to skin cancer, (2) examine current sun protective behaviours and (3) identify knowledge gaps to inform future research. Method A scoping review was conducted to address the objectives following the PRISMA guidelines. Seven databases were searched; identified studies were screened based on title, abstract and full-text for outdoor water based sports which examined skin cancer and/or sun protective behaviours. Data was extracted, synthesised and critically appraised using a modified AXIS tool. Percentage frequencies were calculated, and key results were placed in tabular or graphical presentation. Results Nine cross sectional studies were identified, all defined as low level evidence. A combined sample of 4,377 participants across six countries and five water based sports showed BCC (71%) was the most common skin cancer, followed by melanoma (18%) and SCC (10%). The head (41%) and upper-limbs (27%) were the most common location. Conclusion This review highlights the minimal research available and demonstrates those in water based sports are at high risk of developing skin cancer. Due to difficulty adhering to sun protective behaviours, the most prevalent location is the upper body. Included studies were of low level evidence, providing opportunity for future research to expand upon the gaps in the current literature.

Objectives The aim of this study was to investigate if and to what extent small lateral wedges inserted under the ski boot, known as canting, could impact knee kinematics/kinetics, balance, and neuromuscular activity in recreational alpine skiers in the laboratory setting. Design Experimental, crossover study with repeated-measures analysis Methods Thirty-eight recreational skiers completed a single-leg postural balance test while wearing standardized ski boots in their unmodified state (control), and with medial and lateral canting wedges applied. Kinematics, kinetics, postural control measures, and neuromuscular activity of the lower extremity were assessed using optical motion capture, instrumented force plates, and electromyography. Results Canting modifications had significant impact on lower extremity kinematics and kinetics: canting wedges on the medial side of the foot significantly decreased knee valgus moments, hip internal rotation, and hip adduction. Medial canting also improved some postural control measures associated with balance quality, and reduced activation levels of the Vastus Lateralis, Biceps Femoris, and Tibialis Anterior. Conclusions In the laboratory setting, canting appears to be an appropriate option for improving balance in alpine skiers. Medial canting can alter skier kinematics and kinetics in ways which are consistent with mechanisms of ACL injury. Canting may also result in reduced neuromuscular effort. These changes in movement have potential to prevent lower limb injuries in alpine skiers. The findings of this study motivate future research to predict individual responses to canting treatment in a study setting more closely resembling the sports environment.

The coronavirus disease 2019 (COVID-19) pandemic is associated with delays in and barriers to accessing abortion, which are associated with higher gestational ages at the time of abortion.

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity.

Background: Bipolar disorder (BD) is associated with cortical and subcortical structural brain abnormalities. It is unclear whether such alterations progressively change over time, and how this is related to the number of mood episodes. To address this question, we analyzed a large and diverse international sample with longitudinal magnetic resonance imaging (MRI) and clinical data to examine structural brain changes over time in BD. Methods: Longitudinal structural MRI and clinical data from the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) BD Working Group, including 307 patients with BD and 925 healthy control subjects, were collected from 14 sites worldwide. Male and female participants, aged 40 ± 17 years, underwent MRI at 2 time points. Cortical thickness, surface area, and subcortical volumes were estimated using FreeSurfer. Annualized change rates for each imaging phenotype were compared between patients with BD and healthy control subjects. Within patients, we related brain change rates to the number of mood episodes between time points and tested for effects of demographic and clinical variables. Results: Compared with healthy control subjects, patients with BD showed faster enlargement of ventricular volumes and slower thinning of the fusiform and parahippocampal cortex (0.18 < d < 0.22). More (hypo)manic episodes were associated with faster cortical thinning, primarily in the prefrontal cortex. Conclusions: In the hitherto largest longitudinal MRI study on BD, we did not detect accelerated cortical thinning but noted faster ventricular enlargements in BD. However, abnormal frontocortical thinning was observed in association with frequent manic episodes. Our study yields insights into disease progression in BD and highlights the importance of mania prevention in BD treatment.

Objective: The reported incidence of complications and/or adverse events (AEs) following spine surgery varies greatly. A validated, systematic, reproducible reporting system to quantify AEs was used in 2 prospective cohorts, from 2 spine surgery centers, conducting either complex or purely degenerative spine surgery; in a comparative fashion. The aim was to highlight the differences between 2 distinctly different prospective cohorts with patients from the same background population.Methods: AEs were registered according to the predefined AE variables in the SAVES (Spine AdVerse Events Severity) system which was used to record all intra- and perioperative AEs. Additional outcomes, including mortality, length of stay, wound infection requiring revision, readmission, and unplanned revision surgery during the index admission, were also registered.Results: A total of 593 complex and 1,687 degenerative procedures were consecutively included with 100% data completion. There was a significant difference in morbidity when comparing the total number of AEs between the 2 groups (p < 0.001): with a mean number of 1.42 AEs per patient (n = 845) in the complex cohort, and 0.97 AEs per patient (n = 1,630) in the degenerative cohort.Conclusion: In this prospective study comparing 2 cohorts, we report the rates of AEs related to spine surgery using a validated reproducible grading system for registration. The rates of morbidity and mortality were significantly higher following complex spine surgery compared to surgery for degenerative spine disease.