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Background Individuals with autism spectrum disorder (ASD) exhibit frequent behavioral deficits in facial emotion recognition (FER). It remains unknown whether these deficits arise because facial emotion information is not encoded in their neural signal or because it is encodes but fails to translate to FER behavior (deployment). This distinction has functional implications, including constraining when differences in social information processing occur in ASD, and guiding interventions (i.e., developing prosthetic FER vs. reinforcing existing skills). Methods We utilized a discriminative and contemporary machine learning approach—deep convolutional neural networks—to classify facial emotions viewed by individuals with and without ASD (N = 88) from concurrently recorded electroencephalography signals. Results The convolutional neural network classified facial emotions with high accuracy for both ASD and non-ASD groups, even though individuals with ASD performed more poorly on the concurrent FER task. In fact, convolutional neural network accuracy was greater in the ASD group and was not related to behavioral performance. This pattern of results replicated across three independent participant samples. Moreover, feature importance analyses suggested that a late temporal window of neural activity (1000–1500 ms) may be uniquely important in facial emotion classification for individuals with ASD. Conclusions Our results reveal for the first time that facial emotion information is encoded in the neural signal of individuals with (and without) ASD. Thus, observed difficulties in behavioral FER associated with ASD likely arise from difficulties in decoding or deployment of facial emotion information within the neural signal. Interventions should focus on capitalizing on this intact encoding rather than promoting compensation or FER prostheses.

Drawing on public opinion and empirical research, one may advise people to participate in voluntary organizations because voluntary participation can improve their mental health and social well-being. However, do such benefits apply across different types of participation and across the life course? In this study, we investigated whether benefits to mental health and social well-being differ between nonpolitical and political participation and across age groups (preregistration is accessible at https://osf.io/kqcbe). Using 25 waves of data from the British Household Panel Survey and the Understanding Society (1991–2016), we conducted multilevel analyses with observations nested within participants in younger (14–29, n = 10,536), middle-aged (40–50, n = 4,955), and older (65–75, n = 3,059) adults. We used life satisfaction and GHQ-12 scores as measures of mental health, and social support and neighborhood belonging as measures of social well-being. We found only few and small significant effects at the within-person level: On occasions when younger adults reported political participation, they reported slightly higher neighborhood belonging than when they did not. On occasions when older adults reported nonpolitical or political participation, they reported slightly higher life satisfaction than when they did not. However, we found no significant differences between nonpolitical and political participation and among age groups. In sum, our findings qualify the opinion that voluntary participation yields significant benefits to engaged individuals. We discuss potential explanations, including characteristics of political participation in the United Kingdom.

Optical measurement systems are increasingly used for underwater measurement tasks. Whilst 3D object reconstruction based on image-matching methods is established in air and high-quality results can be obtained, accuracy investigations for industrial applications underwater are yet to be carried out. This is because no sufficient reference objects are available. In this master thesis, a new type of textured dumbbell artefact was used as a reference object for the first time to carry out a high-precision verification of an optical measurement system in accordance with VDI Guideline 2634 Part 3 above and underwater. A comparison of the results above and underwater is thus possible, whereby no significant differences in accuracy were found. The distance between measured and calibrated sphere spacing is less than 30 µm in both cases.

PROMIS is becoming the most commonly utilized patient-reported outcome measure (PROM) in adult orthopaedics, but its adoption has lagged in pediatrics. Limited baseline data exists in pediatric-specific orthopaedic diagnoses. The objective of this study was to determine baseline PROMIS scores in patients with idiopathic scoliosis and to evaluate for correlations with the SRS-22. This was a retrospective analysis of prospectively collected data from six tertiary care pediatric hospitals between July 2016 and July 2018. Patients with a diagnosis of idiopathic scoliosis, adequate radiographs for measurement and completion of PROMIS and SRS-22 questionnaires from the same visit were included. Only the first visit during the study period was included for each subject. Post-operative patients were excluded. Spearman correlations were performed between four PROMIS domains (Pain interference [PI], Mobility [M], Peer Relationships [PR] and Upper Extremity [UE]) and SRS-22 domains. PROMIS scores are calibrated such that 50 is the median value in a population and 10 points is equivalent to one standard deviation. 986 patients with a mean age of 14.6 years were included, 79.8% of which were female. The mean major curve was 33.0° (range: 10–102). The major curve was thoracic in 56.5%, thoracolumbar in 24.4% and lumbar in 19.1% of subjects. The mean PROMIS domain scores were: Pain Interference 44.5 (IQR 17.7); Mobility 52.7 (IQR 12.5); Peer Relationships 55.7 (IQR 15.0); Upper Extremity 53.4 (IQR 7.7). Correlations existed between PROMIS Pain Interference and SRS-22 pain (r = 0.704, p

The current situation, namely the Corona crisis in 2020, has demonstrated that digitalization of teaching is not only an option, but also the indispensable necessity of present reality. The pandemic has particularly affected those academic programs where classroom teaching is unavoidable, for example, in practical courses with surveying equipment. Within the project VirScan3D, a terrestrial laser scanner simulator has been developed as educational tool for teaching and learning practical laser scanning processes. This article describes the functionality of the newly developed software and simulator, the evaluation of the simulator by qualitative testing as well as usability testing results conducted by independent users recruited in university courses.

For optical 3D measurements in close-range and UAV applications, the modelling of interior orientation is of superior importance in order to subsequently allow for high precision and accuracy in geometric 3D reconstruction. Nowadays, modern camera systems are often used for optical 3D measurements due to UAV payloads and economic purposes. They are constructed of aspheric and spherical lens combinations and include image pre-processing like low-pass filtering or internal distortion corrections that may lead to effects in image space not being considered with the standard interior orientation models. With a variety of structure-from-motion (SfM) data sets, four typical systematic patterns of residuals could be observed. These investigations focus on the evaluation of interior orientation modelling with respect to minimising systematics given in image space after bundle adjustment. The influences are evaluated with respect to interior and exterior orientation parameter changes and their correlations as well as the impact in object space. With the variety of data sets, camera/lens/platform configurations and pre-processing influences, these investigations indicate a number of different behaviours. Some specific advices in the usage of extended interior orientation models, like Fourier series, could be derived for a selection of the data sets. Significant reductions of image space systematics are achieved. Even though increasing standard deviations and correlations for the interior orientation parameters are a consequence, improvements in object space precision and image space reliability could be reached.

Review of 216 consecutive idiopathic scoliosis (IS) patients undergoing posterior spinal fusion (PSF) demonstrated 94.9% having abnormal lab values, but only 3.9% were referred for further evaluation. A limited set of preoperative laboratory testing costing $234/patient, and thorough, adjunct review of patient/family history could identify potentially significant comorbidities preoperatively in this study. A savings of $1556/patient from current laboratory testing was identified. The laboratory tests routinely obtained preoperatively were investigated: abnormal preoperative laboratory outcomes were identified and further documented if additional action was taken defined as a referral to another medical provider, performance of additional lab testing or counseling, or if there was alteration of the surgical plan. Overall, 94.9% (n = 205) of patients had one or more abnormal pre-operative lab values. Further actions occurred in 11.7% (n = 24) of all abnormal lab values with 3.9% (n = 8) of these being referred to other healthcare providers. Sixteen abnormal lab values underwent further testing or treatment: 11 nicotine tests, two UCx, one UA, one PT/PTT, and one bovine gelatin RAST. Eight abnormal tests prompted referral to another provider: three CBC, three platelet function tests, one UCx, and one UA. Based on these data, standard preoperative Hgb/Hct, platelet function tests, and bovine RAST (If the surgical plan involves use of bovine gelatin products) appear to be adequate to identify potential significant comorbidities in IS patients undergoing PSF for only $234/patient, a cost savings of $1556/patient from current protocol. Based on this study of 216 patients, a limited preoperative laboratory testing and thorough, adjunct review of patient/family history appears to be adequate to identify potential comorbidities preoperatively in this study. II.

Summary Background WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. Methods We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. Findings Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8–4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5–10·4) and South-East Asia (5·0%, 0·0–16·6). Globally, HCV prevalence was 1·5% (1·0–2·1) in HIV-negative MSM and 6·3% (5·3–7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14–2·01) and markedly higher (6·22, 5·14–7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0–39·0) or currently injected drugs (45·6%, 21·6–70·7) than in those who never injected drugs (2·7%, 2·0–3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00–0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65–20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78–10·32). Interpretation HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. Funding World Health Organization.

BACKGROUND This study aimed to assess the accuracy of the external remote control (ERC) digital readout to the radiographic measurement of magnetically controlled growing rod (MCGR) actuators undergoing lengthenings/expansions and to analyze the impact of patient and spinal deformity factors on the accuracy of the ERC digital readout. METHODS Single-surgeon database at 2 tertiary-care pediatric hospitals identified early-onset scoliosis patients with MCGR constructs. There were 14 males and 16 females with a minimum of 2 lengthenings included in the analysis. ERC readouts at each lengthening were recorded. RESULTS Sixty-six MCGR actuators were assessed in 30 patients which underwent 280 lengthenings (mean of 5.7 lengthenings). At individual lengthening sessions the ERC and radiographic measurements were correlated (r = 0.69, P

Since 2011 an intensive international cooperation has been in place between the Institute for Applied Photogrammetry and Geoinformatics (IAPG) at the Jade University of Applied Sciences in Oldenburg, Germany, and various Ukrainian universities. Following an initial contact by Prof. Gottfried Konecny, the first visit was organized, and was followed by many more. In subsequent years an intensive cooperation was established particularly with the National University for Construction and Architecture (KNUCA) in Kiev. In addition to architects and civil engineers, KNUCA also trains geodesists, geo-information scientists and landscape planners. The cooperation today includes the reciprocal exchange of scientists and students, research projects, courses and cooperation at many other levels. In addition, a commercial company has been established, SPM3D LLC, which now employs more than 14 engineers in the field of 3D acquisition, point cloud processing and modeling. This article summarizes the history of the cooperation and presents the results of associated student projects. In addition, results of joint work on the development of a virtual laser scanner are presented, part of a German-Ukrainian initiative to digitize teaching.

In this article, the design, characterization, and manufacture of a circuit for a ${W}$ -band, ultracompact continuous wave sheet beam klystron are described. This klystron, aiming to produce more than 1.5-kW output power, operates at a comparatively low voltage benefiting the device size and extending its application space. However, a lower operation voltage adversely affects the beam-gap interaction efficiency. Two multigap output cavities have been employed to achieve a higher beam interaction efficiency without introducing additional competing modes or shrinking the interval between the operation mode and competing mode. Inspired by the resynchronization technology, the second output cavity can be optimized for the spent beam from the first output cavity. Comprising a single cavity output structure, the circuit efficiency of this double output cavity circuit is increased from 2.37% to 4.96%. In this circuit, electromagnetic modeling and design have been optimized to avoid complicated structures which are constrained by current mechanical design and manufacturing techniques. The MAGIC simulation shows that, driven by a 1-W RF signal, this circuit can extract more than 1.7-kW output power from a 35-kV, 1-A beam. A prototype single output cavity circuit has been designed and manufactured to determine the required machining tolerances for the final double output cavity circuit.

Multicenter retrospective cohort study. To compare pre-operative and post-operative EOSQ-24 scores in magnetically controlled growing rods (MCGR) and traditional growing rod (TGR) patients. Since the introduction of MCGR, early-onset scoliosis patients have been afforded a reduction in the number of surgeries compared to the TGR technique. However, little is known about (health-related quality of life) and burden of care outcomes between these surgical techniques. This is a retrospective cohort study using a multicenter registry on patients with EOS undergoing MCGR or TGR between 2008 and 2017. The EOSQ-24 was administered at preoperative and postoperative 2-year assessments. The EOSQ-24 scores were compared between MCGR and TGR as well as preoperatively and postoperatively within each procedure. 110 patients were analyzed in this study (TGR, N = 32; MCGR, N = 78). There were no significant differences in preoperative age, gender, etiology, main coronal curve or maximum kyphosis between TGR and MCGR groups. Patients with TGR had averaged 3.9 surgical lengthenings and MCGR had averaged 7.7 non-invasive lengthenings by the 2-year follow-up. When changes in preoperative to postoperative scores were compared, MCGR had more improvements in pain, emotion, child satisfaction and parent satisfaction than TGR although there were no statistical significance. When analyzed separately, MCGR cohort had improvement in scores for all four domains and four sub-domains; while, TGR cohort only had improvement in financial burden domain and pulmonary function sub-domain. Although there was no statistical significance, the improvement in pain, emotion and satisfaction scores was larger in MCGR than TGR. Since these areas can be influenced more by mental well-being than other sub-domains, the results may prove our hypothesis that compared to TGR, MCGR with reduced number of surgeries have better psychosocial effects. III.

Investigations in associations between subjective health-related quality of life (HRQoL) measures and objective clinical assessments in patients with early-onset scoliosis (EOS) are limited. The purpose of this study is to investigate the association between pulmonary function rated by parents and pulmonary function testing (PFT) in patients with EOS. In this cross-sectional study, patients with EOS at any stage of treatment from 2011 to 2018 were identified in 2 registries including 33 centers. Parents’ perception of pulmonary function was evaluated using pulmonary function (PF) domain in the Early-Onset Scoliosis 24 item Questionnaire (EOSQ-24). PFT measures included FVC% predicted, FEV1/FVC, and TLC% predicted. All PFT predicted values utilized arm span. PFT and EOSQ-24 questionnaire were completed within 180 days of each other with an average day difference of 26 days. 176 patients (mean age: 10.4 years old, female: 56%) were identified. 33% of patients were of congenital/structural etiology, 27% neuromuscular, 26% syndromic, and 14% idiopathic. Wide variance and lower scores of PF domain were reported by parents at lower FVC% predicted values (

Aims Current American Academy of Orthopaedic Surgeons (AAOS) guidelines for treating femoral fractures in children aged two to six years recommend early spica casting although some individuals have recommended intramedullary stabilization in this age group. The purpose of this study was to compare the treatment and family burden of care of spica casting and flexible intramedullary nailing in this age group. Methods Patients aged two to six years old with acute, non-pathological femur fractures were prospectively enrolled at one of three tertiary children’s hospitals. Either early closed reduction with spica cast application or flexible intramedullary nailing was accomplished under general anaesthesia. The treatment method was selected after discussion of the options by the surgeon with the family. Data were prospectively collected on patient demographics, fracture characteristics, complications, pain medication, and union. The Impact on Family Scale was obtained at the six-week follow-up visit. In all, 75 patients were included in the study: 39 in the spica group and 36 in the nailing group. The mean age of the spica group was 2.71 (2.0 to 6.9) years and the mean age of the nailing group was 3.16 (2.0 to 6.9) years. Results All fractures healed without evidence of malunion or more than 2.0 cm of shortening. The mean Impact on Family score was 70.2 for the spica group and 63.2 (55 to 99) for the nailing group, a statistically significant difference (p = 0.024) in a univariate analysis suggesting less impairment of the family in the intramedullary nailing group. There was no significant difference between pain medication requirements in the first 24 hours postoperatively. Two patients in the spica group and one patient in the intramedullary nailing group required additional treatment under anaesthesia. Conclusion Both early spica casting and intramedullary nailing were effective methods for treating femoral fractures in children two to six years of age. Intramedullary stabilization provides an option in this age group that may be advantageous in some social situations that depend on the child’s mobility. Fracture treatment should be individualized based on factors that extend beyond anatomical and biological factors. Cite this article: Bone Joint J 2020;102-B(8):1056–1061.

Unmanned Aerial Vehicles (UAV) are enjoying increasing popularity in the photogrammetric community. The Chinese supplier DJI is the market leader with about 70% of the global consumer UAV market. The Phantom model has been available for more than 10 years and its current version "RTK" is equipped with a 2-frequency GNSS receiver, as a basis for direct georeferencing of image flights, using RTK or PPK technologies.In the context of the paper, different case studies are investigated, which allow statements on the geometric accuracy of UAV image flights as well as on the self-calibration of the camera systems.In the first example, four DJI Phantom 4 RTK systems are examined, which were flown in a cross flight pattern configuration on the area of the UAV test field "Zeche Zollern" in Dortmund, Germany. The second example analyses the results of an open moorland area where the establishment of GCPs is extremely difficult and expensive, hence direct georeferencing offers a promising way to evaluate deformations, soil movements or mass calculations. In this example a DJI Matrice 210 v2 RTK drone has been used and the results of two different software packages (Agisoft Metashape and RealityCapture) are analysed. The third example presents a reference building that has been established by the Lower Saxony administration for geoinformation in order to evaluate UAV photogrammetry for cadastral purposes. Here again a DJI Phantom 4 RTK has been tested in a variety of flight configurations and a large number of high precision ground control and check points.The case studies show that the RTK option leads to sufficient results if at least 1 GCP is introduced. Flights without any GCPs lead to a significant height error in the order of up to 30 GSD.

The complete design process of a high-frequency circuit for a 263 GHz staggered double grating, sheet beam traveling wave tube is presented in this article. This device, for use in a pulsed electron paramagnetic resonance spectrometer instrument, requires >30 dB gain and a 20 GHz bandwidth centered at 263 GHz. In addition to the standard Pierce gain analysis and point by point particle in cell (PIC) simulation, a novel fast pulse response analysis technique was utilized to determine the accurate synchronization voltage and test the ``hot” feature of the high-frequency circuit. Since this new method can evaluate the entire bandwidth in a single simulation, it can significantly reduce the computational resources normally required for the conventional PIC analysis while also illustrating the potential instabilities near the band edge. Good agreement between the fast pulse response and PIC simulation results validate the accuracy of this novel method. According to the analysis results and given the manufacturing limits of nano/micro-computer numerical control (CNC) machining, an appropriate SWS, coupler, and sever designs were chosen to complement the simulated design. Finally, a prototype circuit was manufactured and cold tested to verify the design and inspect the machining tolerances.

Few risk factors for fracture in magnetically controlled growing rods (MCGR) have been identified. We hypothesize an increased rate of rod fracture in small diameter rods compared to large diameter rods in patients with early-onset scoliosis (EOS). The purpose of this study was to determine the association between the diameter of MCGR constructs and the rate of rod fracture. Patients with EOS who underwent MCGR implantation—primary or conversion—from 2013 to 2018 were identified from two registries including 40 centers. Rod diameter sizes greater than 5.0 mm or less than or equal to 5.0 mm were defined as “Large” and “Small” rods, respectively. Only dual-rod constructs were included. The primary outcome measure collected was rod fracture at any point in treatment up to the most recent follow-up. Cox regression was utilized for unequal follow-up to compare rate of breakage at the last follow-up between cohorts. 527 patients with 1,054 rods were included. 552 (52.4%) rods had a diameter of less than or equal to 5.0 mm and 461 (43.7%) rods had a diameter of greater than 5.0 mm. 41 (3.9%) rods were missing a recorded rod diameter and were not included in the analysis to determine the association between the rate of fracture and rod diameter. 20 (1.9%) total rod fractures occurred: 9 (1.6%) rods with diameters of ≤ 5.0 mm, 10 (2.2%) rods with diameters of > 5.0 mm, and 1 uncategorized rod (p = 0.529). No difference in the rate of rod fracture or survival distribution was found between rod diameters of > 5.0 mm and ≤ 5.0 mm even after stratification by ambulatory status, major coronal curve, weight, or location of anchors. Rod fracture appears to be a rare event in dual MCGR constructs and rod diameter does not seem to be associated with the incidence or rate of rod fracture. Surgeons may consider other criteria for selecting rod diameter in their patients such as patient size, amount of surgical correction, single vs. dual constructs, and risk of hardware prominence.

To estimate the prevalence and factors associated with HIV and five other STIs among outdoor female sex workers (OSFW) and indoor FSW (IFSW).MethodsCross-sectional survey using respondent-driven sampling methodology. Participants answered a bio-behavioural questionnaire and were tested for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), syphilis (lifetime contact) and Mycoplasma genitalium (MG). Weighted HIV and other STIs prevalence and 95% CIs were calculated. Weighted multivariate logistic regression was performed to identify factors associated with having at least one STI (including HIV).ResultsBetween October 2017 and July 2018, 385 FSW participants were recruited, among whom 206 (53.5%) were IFSW and 179 (46.5%) were OFSW. The mean age was 31.4 years. Weighted HIV prevalence was 3.1% (95% CI 1.5 to 7.0). Weighted prevalence of other STIs was: 4.1% (95% CI 2.2 to 8.0) for NG, 8.8% (95% CI 5.9 to 13.0) for CT, 12.7% (95% CI 8.6 to 18.0) for TV, 13.9% (95% CI 9.9 to 19.0) for syphilis (lifetime contact) and 14.9% (95% CI 10.5 to 21.0) for MG. STI prevalence was significantly higher among OFSW for CT, TV and MG (pConclusionPrevalence of HIV and STIs was high among FSW in Moscow. OFSW were more vulnerable to STIs. There is an urgent need to tailor programmes for sexual and reproductive health for FSW in Russia.

BACKGROUND Pediatric orthopaedic surgery fellowships in North America have been organized, assigned, and administered through the San Francisco Match Program since 2011. However, trends in application numbers and match rates have not been assessed to this point. The purpose of this study is to describe these trends and applicants' perspective of the fellowship match. METHODS The San Francisco Match databank was queried for program and applicant data from 2011 to 2018. Specifically, we obtained data regarding the number of applicants, programs, match rates, and match results. Each year, applicants also completed an anonymous post-match survey administered by the Pediatric Orthopaedic Society of North America fellowship committee, which included information on the number of applications, interview process, estimated costs, and suggested changes. Descriptive statistics were used to summarize the data, and univariate statistics were used to assess differences in categorical and continuous variables. RESULTS From 2011 to 2018, 524 applicants participated in the pediatric orthopaedic fellowship match, and the mean number of annual applicants was 66 (range, 55 to 76). The mean number of fellowship programs and available positions during the same time period was 43 (range, 40 to 47) and 69 (range, 63 to 74), respectively. Each fellowship interview was estimated by the applicant to cost a mean of $458 (range, $372 to $566), and annual application costs across all applicants were extrapolated to be over $200,000/year. The mean overall match rate was 81% (range, 74% to 91%). The mean match rate for North American applicants was 98.7% and international applicants were 40.9% (P

Inflammation and endothelial activation play a pivotal role in development and progression of diabetic retinopathy (DR), a vision-threatening complication of diabetes mellitus (DM) and the leading cause of blindness in the working age population. Easily accessible and validated biomarkers for DR early diagnosis and progression are required for use in clinical trials: here, we reviewed the available literature to understand the association of circulating levels of selected markers of inflammation and endothelial activation with the presence of nonproliferative and proliferative DR (NPDR and PDR) and investigate the relationship between their systemic and ocular levels. We additionally provide data synthesis and perform statistical analysis for interpretation of the collected evidence. CRP, IL-1β, IL-6, TNFα, sICAM1, and sVCAM1 circulating levels were increased in subjects with DM compared to healthy individuals. Moreover, TNFα and sVCAM1 showed increasing systemic levels with DR presence and severity; circulating CRP increased with the transition from no DR to NPDR, whereas IL-6 was increased in PDR compared to NDPR stages. The relationship between ocular and systemic concentrations of these proteins remained unclear due to the low number of studies with matched sampling. In conclusion, the available data supports the use of systemic biomarkers of inflammation and endothelial activation to identify DM status and DR severity. These systemic biomarkers are likely reflecting an overall state of inflammation and vascular activation in different tissues of the body, including the eyes. Prospective, longitudinal datasets are required to validate these biomarkers as predictors of early DR presence, of DR progression, or for disease monitoring.

STUDY DESIGN Retrospective review of prospective data from multicenter registry. OBJECTIVE Compare outcomes of posterior spinal fusion (PSF) versus magnetically controlled growing rods (MCGR) versus vertebral body tethers (VBT) in 8- to 11-year-old idiopathic early onset scoliosis (EOS) patients. SUMMARY OF BACKGROUND DATA In EOS, it is unclear at what age the benefit of growth-sparing strategies outweighs increased risks of surgical complications, compared with PSF. METHODS One hundred thirty idiopathic EOS patients, 81% female, aged 8-11 at index surgery (mean 10.5 yrs), underwent PSF, MCGR, or VBT. Scoliosis curve, kyphosis, thoracic and spinal height, complications, and Quality of Life (QoL) were assessed preoperatively and at most recent follow-up (prior to final fusion for VBT/MCGR). RESULTS Of 130 patients, 28.5% received VBT, 39.2% MCGR, and 32.3% PSF. The VBT cohort included more females (P

Introduction: People who inject drugs (PWID) in Dar es Salaam, Tanzania, have a high prevalence of HIV and hepatitis C virus (HCV). While needle and syringe programmes (NSP), opioid agonist therapy (OAT) and anti-retroviral therapy (ART) are available in Tanzania, their coverage is sub-optimal. We assess the impact of existing and scaled up harm reduction (HR) interventions on HIV and HCV transmission among PWID in Dar es Salaam.Methods: An HIV and HCV transmission model among PWID in Tanzania was calibrated to data over 2006-2018 on HIV (~30% and ~67% prevalence in males and females in 2011) and HCV prevalence (~16% in 2017), numbers on HR interventions (5254 ever on OAT in 2018, 766-1479 accessing NSP in 2017) and ART coverage (63.1% in 2015). We evaluated the impact of existing interventions in 2019 and impact by 2030 of scaling-up the coverage of OAT (to 50% of PWID), NSP (75%, both combined termed ‘full HR’), and ART (81% with 90% virally suppressed) from 2019, reducing sexual HIV transmission by 50%, and/or HCV-treating 10% of PWID infected with HCV annually. Results: The model projects HIV and HCV prevalence of 19.0% (95% credibility interval: 16.4–21.2%) and 41.0% (24.4–49.0%) in 2019, respectively. For HIV, 24.6% (13.6–32.6%) and 70.3% (59.3–77.1%) of incident infections amongst male and female PWID are sexually transmitted, respectively. Due to their low coverage (22.8% for OAT, 16.3% for NSP in 2019), OAT and NSP averted 20.4% (12.9-24.7%) of HIV infections and 21.7% (17.0-25.2%) of HCV infections in 2019. Existing ART (68.5% coverage by 2019) averted 48.1% (29.7–64.3%) of HIV infections in 2019. Scaling up to full HR will reduce HIV and HCV incidence by 62.6% (52.5–74.0%) and 81.4% (56.7–81.4%), respectively, over 2019-2030; scaled up ART alongside full HR will decrease HIV incidence by 66.8% (55.6–77.5%), increasing to 81.5% (73.7–87.5%) when sexual risk is also reduced. HCV-treatment alongside full HR will decrease HCV incidence by 92.4% (80.7–95.8%) by 2030. Conclusions: Combination interventions including sexual risk reduction and HCV treatment are needed to eliminate HCV and HIV among PWID in Tanzania.

System-on-chip (SoC) millimeter wave integrated circuit technology has been developed and employed in chip heterodyne radiometers in Electron Cyclotron Emission Imaging (ECEI) and Microwave Imaging Reflectometer (MIR) on the DIII-D tokamak for 2D electron temperature and density fluctuation diagnostics. The W-band (75-110 GHz) ECEI system has been employed with 20 poloidal horn receiver modules with customized monolithic integrated circuit chips and internal local oscillator coupling path. The new SoC approach demonstrates > 30 dB additional gain on the receiver and 95% electronics noise suppression compared to the previous Schottky diode mixer array 1 . An F-band (110-140 GHz) receiver chip has been developed to measure MHD and turbulence behavior on the DIII-D high-field side, such as Alfven eigenmodes. Furthermore, it can image pedestal structure evolution on fusion facilities with stronger magnetic fields, such as ASDEX-U, EAST, HL-2M, and LHD. The F-band chip performance has been tested in the laboratory. Also, V-band (55-75 GHz) transmitter and receiver modules (55-75 GHz) have been developed for DIII-D and NSTX-U Microwave Imaging Reflectometer (MIR) application suitability for 2D density fluctuation imaging on the pedestal region 2 .

BACKGROUND In pediatric patients, the presentation of the nontraumatic acutely painful joint/limb poses a diagnostic dilemma due to the similarity of presentations of the most likely diagnoses [septic arthritis (SA), transient synovitis (TS), osteomyelitis]. Current tools employed to differentiate these diagnoses rely on nonspecific inflammatory markers, radiologic imaging, and arthrocentesis. Diagnostic algorithms utilizing these clinical, radiographic, and biochemical parameters have produced conflicting results. The purpose of this study was to identify a serum-based inflammatory signature which can differentiate SA from TS in pediatric patients. METHODS Serum samples were collected from 22 pediatric patients presenting with joint/extremity pain whose working diagnosis included SA or TS. Each sample was analyzed for serum abundance of 72 distinct biomarkers and cytokines using enzyme linked immunosorbent assay based arrays. Linear discriminant analysis was performed to identify a combinatorial biomarker panel to predict a diagnosis of SA or TS. Efficacy of the biomarker panel was compared with definitive diagnoses as based on laboratory tests, arthrocentesis results, and clinical scenario. RESULTS At the time of presentation: (1) mean erythrocyte sedimentation rate in the SA group was 56.6 mm/h and 12.4 mm/h in the TS group (P

Wind turbines face harsh inflow conditions when operating in the atmospheric boundary layer or in the wake of other wind turbines. The incoming velocity field can change within seconds due to the turbulent structures it contains, resulting in a rapid change of several degrees in the angle of attack for the rotating blade. Aerodynamics are hence rapidly altered, leading to changes of the occurring forces on the rotor. Such dynamic forces cause the blades to twist and bend, accelerating fatigue and reducing the lifetime of a turbine Spinato et al. (2009).

The prediction of a difficult cholecystectomy has traditionally been based on certain pre-operative clinical and imaging factors. Most of the previous literature reported small patient cohorts and have not used an objective measure of operative difficulty. The aim of this study was to develop a pre-operative score to predict difficult cholecystectomy, as defined by a validated intra-operative difficulty grading scale. Two cohorts from prospectively maintained databases of patients who underwent laparoscopic cholecystectomy were analysed: the CholeS Study (8755 patients) and a single surgeon series (4089 patients). Factors potentially predictive of difficulty were correlated to the Nassar intra-operative difficulty scale. A multivariable binary logistic regression analysis was then used to identify factors that were independently associated with difficult laparoscopic cholecystectomy, defined as operative difficulty grades 3 to 5. The resulting model was then converted to a risk score, and validated on both internal and external datasets. Increasing age and ASA classification, male gender, diagnosis of CBD stone or cholecystitis, thick-walled gallbladders, CBD dilation, use of pre-operative ERCP and non-elective operations were found to be significant independent predictors of difficult cases. A risk score based on these factors returned an area under the ROC curve of 0.789 (95% CI 0.773–0.806, p

The retinal vasculature is tightly organized in a structure that provides for the high metabolic demand of neurons while minimizing interference with incident light. The adverse impact of retinal vascular insufficiency is mitigated by adaptive vascular regeneration but exacerbated by pathological neovascularization. Aberrant growth of neovessels in the retina is responsible for impairment of sight in common blinding disorders including retinopathy of prematurity, proliferative diabetic retinopathy, and age-related macular degeneration. Myeloid cells are key players in this process, with diverse roles that can either promote or protect against ocular neovascularization. We have previously demonstrated that myeloid-derived VEGF, HIF1, and HIF2 are not essential for pathological retinal neovascularization. Here, however, we show by cell-specific depletion of Vhl in a mouse model of retinal ischemia (oxygen-induced retinopathy, OIR) that myeloid-derived HIFs promote VEGF and bFGF expression and enhance vascular regeneration in association with improved density and organization of the astrocytic network. Electronic supplementary material The online version of this article (10.1007/s10456-019-09681-1) contains supplementary material, which is available to authorized users.

Study design Multicenter retrospective review. Objectives To compare the radiographic outcomes and complication rates in patients with primary and conversion magnetically controlled growing rod (MCGR) implants at one and two years after surgery. Summary of background data Many initial early-onset scoliosis (MCGR) implantations in the United States were conversions from other types of growth-friendly systems, and the outcome similarities and differences between primary and conversion MCGR implantation procedures are still relatively unknown. Methods Multicenter retrospective review of EOS patients from two multicenter EOS registries identified consecutive EOS patients treated from 2014 to 2017 with a minimum of one-year follow-up. In addition, a subset of these patients who had two-year follow-up were further analyzed. Results In total, 383 MCGR patients were identified, of which 272 (71%) were primary (P) and 111 (29%) were conversion (C). Group P patients had significantly greater coronal curves at the time of MCGR implantation and greater initial coronal correction. There was no statistically significant difference in Cobb correction at one year or between follow-up at one and two years. The preimplantation thoracic spine height was identical in both groups, with statistically greater improvement at initial implantation in P than in C patients. Significantly greater height gains were seen in P than in C patients in the one-year follow-up cohort. There was a higher rate of complications in the C group than in the P group; however, the difference was not statistically significant. Overall, most complications were implant-related. No loss of curve correction occurred in either group. Conclusions Patients with primary MCGR insertion can be expected to have greater radiographic correction and spine length gain than those with conversion from growth-friendly instrumentation to MCGR, most likely because of increased spine stiffness in conversion patients. The rate of complications, primarily implant-related, remains higher in conversion than in primary insertion patients. Level of Evidence Level III.

In September 2018, photogrammetric images and terrestrial laser scans were carried out as part of a measurement campaign for the three-dimensional recording of several historic churches in Tbilisi (Georgia). The aim was the complete spatial reconstruction with a spatial resolution and accuracy of approx. 1cm under partly difficult external conditions, which required the use of different measurement techniques.The local measurement data were collected by two laser scanning campaigns (Leica BLK360 and Faro Focus 3D X330), two UAV flights and two terrestrial image sets. The photogrammetric point clouds were calculated with the SfM programs AgiSoft PhotoScan and RealityCapture taking into account the control points from the Faro laser scan. The mean residual errors from the registrations or photogrammetric evaluations are 4-12mm, depending on the selected software. The best completeness and quality of the resulting 3D model was achieved by using laserscan data and images simultaneously.

Background Modern treatment of early onset scoliosis (EOS) includes implantation of traditional growing rods (TGR) or magnetically controlled growing rods (MCGR) for posterior-based distraction if nonoperative treatment plans failed. The recent MCGR innovation has largely been expected to improve patient and family burden by avoiding frequent return to the operating room. At least one study has shown no HRQoL difference between TGR and MCGR, but none have specifically investigated a cohort of conversion patients whose families have experienced both. Methods An EOS database was queried for all patients treated with TGR, MCGR, and those converted from TGR to MCGR who had at least 1 pretreatment and 1 posttreatment HRQoL assessment (EOSQ-24). Data on demographics, diagnoses, and major curve size, as well as EOSQ-24 domain scores were studied. Results There were 156 TGR, 114 MCGR, and 32 conversion patients, with an average of 2.0 years between first and final EOSQ-24 surveys. There was no significant difference in outcome in any EOSQ-24 domain between the converts and the other 2 treatment groups. There was a significant post-op improvement in MCGR versus TGR in transfers and energy level (P=0.01; P=0.01). Conclusions Although patient families and their surgeons may subjectively report improved HRQoL after conversion from TGR lengthenings to in-office MCGR lengthenings, these improvements were seen in transfer and fatigue domains, not burden or satisfaction. Although the EOSQ-24 is a well-validated EOS metric, it may not be sensitive enough to overcome the QoL floor-effect associated with the diagnosis itself, or perhaps the improvement in QoL must be assessed over a longer interval to assess meaningful change. Level of evidence Level III-retrospective comparative study.

Design Retrospective analyses of congenital scoliosis patients at 2 tertiary care pediatric hospitals. Objective This study objectives were (1) to report the rates of anomalies of 10 organ systems in congenital scoliosis patients and (2) to determine whether the presence of a single organ system anomaly increases the rate of nonspinal organ system defects. Summary of background data Intraspinal, cardiac, renal, and gastrointestinal anomalies have been reported to occur at higher rates in congenital scoliosis than the normal population. It is unknown whether the presence of 1 organ system defect increases the risk of nonspinal organ system anomalies. Methods All patients diagnosed, evaluated in the outpatient setting, with congenital scoliosis who were below 18 years of age at time of presentation with available cardiac echo, renal ultrasound, or magnetic resonance imaging were included in this study. Results There were 305 patients (161 females, 53%) whose mean age was 7+3 years. In total, 84% of patients were observed to have at least 1 organ defect. Overall, 22% of patients had 1 organ defect, 19% had 2, 18% had 3, and 18% had ≥4 organ defects. There was an average of 2.2 anomalies per patient (range=0 to 8). Intraspinal anomalies were documented in 43% of patients; syrinx occurred most frequently. Urogenital anomalies were documented in 39% of patients; solitary kidney was most prevalent. Cardiac anomalies were documented in 54% of patients; ventricular septal defect was most common. In 12% of patients, the triad of spinal, urogenital, and cardiac defects was observed. Multiple organ systems were found to have significant associations (P Conclusions Cardiac anomalies were the most common defect (54%), and occurred at a rate >2 times higher than previously reported. The high rate of intraspinal, cardiac, and urogenital defects makes magnetic resonance imaging, echocardiography, and renal ultrasound a critical part of evaluation for all congenital scoliosis patients. Level of evidence Level II.

Background Radiographic characterization of Chiari malformation (CM) has historically focused on caudal tonsillar herniation (CH) below the foramen magnum. Previously, we published evidence linking ventral tonsillar herniation (VH) and medullary symptoms in very young children. We sought to extend that investigation by studying the radiographic and clinical significance of VH in adults diagnosed with CM. Methods We retrospectively reviewed adults with cerebellar ectopia who underwent posterior fossa decompression with or without duraplasty (PFD/D) at our institution. VH was defined as tonsils crossing a line bisecting the caudal medulla at the level of the foramen magnum on axial MRI. Degree of VH was measured as distance between this bisecting line and the ventral tip of the herniated tonsil. Dorsal brainstem compression was qualitatively determined by assessing for obliteration of CSF space between the dorsal brainstem and the tonsils. Results Out of 89 cases reviewed, 54 had some degree of VH. Compared with those without VH, the VH group was significantly older in age and more likely to also present with dorsal brainstem compression and headaches. No correlation was observed between degrees of CH and VH in the VH group. The degree of VH significantly decreased 3 months after PFD/D. Conclusions VH is relatively common in CM patients and might be an important independent radiographic metric to evaluate and consider as part of the decision-making process, especially in those presenting with Chiari-like symptomatology referable to the medulla but who do not meet the traditional criteria of cerebellar ectopia greater than 5 mm.

We regret that this article is behind a paywall. For more information, please visit the article page: https://onlinelibrary.wiley.com/doi/10.1111/add.15630, Background and aims: Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya. Design: We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a life-time horizon from the health-care provider's perspective. One-way and probabilistic sensitivity analyses were performed. Setting: Nairobi, Kenya. Population: PWID. Measurements: Treatment costs, incremental cost-effectiveness ratio (cost per disability-adjusted life year averted). Findings: The cost per disability-adjusted life-year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509; commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability-adjusted life-year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs. Conclusions: The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with currently available cheaper drug prices, if directly-observed therapy is not used and HCV disease care costs are accounted for.

BackgroundThe purpose of this study was to compare cervical cancer screening by pap smear (PS) versus preliminary HPV testing based on self-collected samples (SC-HPV).MethodsInterventional study among underprivileged women from 25 to 65 years old in four French cities. The control group (CG) was referred for a PS. The experimental group (EG) conducted a SC-HPV test followed by a PS in case of positivity. Differences on screening completion and cytological abnormalities were analysed by logistic and Cox regression.Results383 women were assigned to the EG and 304 to the CG. The screening completion proportion was 39.5% in the CG compared to 71.3% in the EG (HR = 2.48 (CI 95% [1.99–3.08];p p = 0.18).ConclusionProviding an SC-HPV-test increased the participation of underprivileged women in CCS. Nevertheless, the significant number of lost to follow-up in both groups can undermine the initial benefits of the strategy for HPV positive women.Registration: Clinicaltrials.gov: NCT03118258.

To assess if the preservation of preoperative kyphosis within the cephalad two motion segments of instrumented posterior spinal fusions (PSF), for idiopathic scoliosis (IS), would be associated with lower frequency of proximal junctional kyphosis (PJK) at 2 years postoperatively. Previous studies on PJK in IS have reported conflicting findings; none has evaluated the relationship between segmental kyphosis within the cephalad instrumented construct and PJK. One hundred consecutive patients undergoing PSF for IS by a single surgeon with minimum 2-year follow-up were evaluated. Radiographic evaluation focused on sagittal alignment of the upper instrumented vertebrae (UIV), the 1 and 2 vertebrae cephalad (UIV + 1, UIV + 2) and caudal (UIV − 1, UIV − 2). This was measured between the inferior endplate of the UIV and the superior endplate of the UIV + 1 and UIV + 2 or between the superior endplate of the UIV and the inferior endplate of the UIV − 1 and UIV − 2. PJK was defined as present if the final UIV + 2 ≥ 10° and final UIV + 2—preop UIV + 2 ≥ 10°. There were 78 females and 22 males whose mean age was 14.6 (± 2.1) years at surgery; mean follow-up was 3.9 (2–9.3) years. The overall frequency of PJK was 25% (25/100) at final follow-up. Preoperative mean coronal curve measured 63° (40°–107°) with a mean 66% correction at final follow-up. UIV was T2 (n = 15), T3 (n = 47) or T4 (n = 38). More caudal UIVs were associated with PJK development (p = 0.04): T2 (13%), T3 (21%) and T4 (34%). Greater preoperative T5–T12 thoracic kyphosis and UIV − 2, and lower major curve apex (below T12) were more likely to develop PJK (p = 0.019, p = 0.004 and p = 0.007, respectively). Post-operatively, larger values for UIV − 1 (p ≤ 0.001) and UIV − 2 (p = 0.002) were associated with PJK at final follow-up. Longer fusion lengths (10–13 vs. 6–9 segments, p = 0.02) and the presence of thoracolumbar/lumbar structural curves (Lenke 3–6 vs. 1–2, p = 0.032) had higher rates of PJK (32% vs 10% and 37% vs 18%, respectively). Changes in UIV − 1 and UIV − 2 (preoperatively to immediately post-op) did not influence the development of PJK. At final follow-up, no patient required revision surgery for symptomatic proximal junctional kyphosis. In this study, changes in UIV − 1 and UIV − 2 at surgery were not related to PJK. Greater preoperative T5–T12 thoracic kyphosis and UIV − 2, lower major curve apex (T12 and below), and greater post-operative UIV − 1 and UIV − 2 were associated with higher frequencies of PJK. Higher UIV (T2 vs. T4) and LIV levels had a protective effect against PJK. Based on this study, the preservation of segmental kyphosis within the instrumented cephalad two levels of the PSF did not minimize the occurrence of radiographic PJK. Level IV.

Research on major life events and personality change often focuses on the occurrence of specific life events such as childbirth, unemployment, or divorce. However, this typical approach has three important limitations: (1) Life events are typically measured categorically, (2) it is often assumed that people experience and change from the same event in the same way, and (3) external ratings of life events have unknown levels of validity. To address these limitations, we examined how common life events are typically perceived, how much perceptions of life events vary within events, and how well external ratings of events correspond to subjective ratings from people who experienced the events. We analyzed ratings of nine psychologically relevant characteristics of 10 common major life events from three different types of raters ( N = 2,210). Each life event had a distinct subjectively rated profile that corresponded well to external ratings. Collectively, this study demonstrates that life events can be meaningfully described and differentiated with event characteristics. However, people’s individual perceptions of life events varied considerably even within events. Therefore, research on major life events and their associations with personality change should incorporate individual perceptions of the events to advance the understanding of these associations.

Recently, virtual reality technologies are increasingly being introduced into our lives. The focus of their use is shifting from the entertainment industry to design, healthcare, tourism, architecture, education and more. The advantages of virtual reality technology are especially noticeable in the field of archaeology, as many historical objects have not survived to our time, and their appearance can be reproduced only on the basis of historical sources and archaeological excavations. Most platforms for implementing virtual reality programs are based on game engines that can provide the required level of performance for VR. Such platforms show very good results for architectural objects, which often have many similar elements of simple shapes. Integrating complex objects with unique shapes is usually a problem. In this article, we consider the use of photogrammetric methods to create 3D models of historical objects and the aspects of their integration into a virtual environment based on a game engine. Specifically, aspects such as object resolution and suitable level of detail are discussed. As a case study, such a virtual environment was created for the ancient Trypillia settlement in the territory of Ukraine.

BACKGROUND CONTEXT Since the study of Thompson, et al in 2005, use of dual-growing rod constructs have become the gold standard for operative treatment in early-onset scoliosis. However, use of dual-growing rod constructs may not be possible, due to patient size and the type, location and severity of the spinal deformity. PURPOSE The purpose of this study is to: (1) describe the deformities treated with single-growing rod constructs, and (2) report the outcomes of single-growing rods since 2005. STUDY DESIGN Observational, descriptive case series METHODS A prospective, multi-center, international database of early-onset scoliosis patients were queried to identify all patients with single traditional growing rods (sTGR) or magnetically-controlled growing rods (sMCGR) since the 2005. Patients were excluded if there were greater than 1 rod or if there was less than 2 years of follow-up postoperatively. Twenty-five patients (13 female, 12 male) were identified from the database query, which satisfied the inclusion and exclusion criteria. RESULTS Mean age at index surgery was 4.7 years (1.3 to 9.3 years) and mean follow-up was 4.3 years (2.0 to 10.6 years). Eleven patients were classified as congenital (all mixed-type), six neuromuscular, five idiopathic and three syndromic. Proximal foundations were ribs in 23 patients and pedicle screws in two patients. The distal foundations were the spine in 25 patients and three pelvic S-hooks. All single rods were on the concave side of the deformity. Interpretation of preoperative radiographs determined in 72% (18/25) of cases dual growing rods would be difficult and/or suboptimal due to patient size (longitudinal a/o weight) and/or kyphosis/kyphoscoliosis with severe rotation. Maximal coronal deformity improved 30% (83.9 degrees to 58.6 degrees) at latest follow-up. Maximal kyphosis increased 17% (45.6 degrees to 57.4 degrees). Postoperative length increase: T1-T12, 17.0 mm (4.6 mm/year); T1-S1, 34 mm (9.4 mm/year). Total secondary surgeries for TGRs were 100: 66 lengthenings, 32 revisions, two unknown. 10 MCGRs secondary surgeries occurred in nine patients (seven for maximized actuators and three for foundation migration). At latest follow-up 20 continued with lengthenings (five TGR & 15 MCGR), four underwent definitive fusions, and one completed lengthening (implants retained). CONCLUSIONS Treatment of severe EOS with single rods demonstrated a 30% coronal correction. T1-S1 length increased at 9.4 mm/year and T1-T12 length at 4.6 mm/year, which are comparable to published reports on dual MCGRs. Single TGRs and MCGRs in EOS can provide acceptable short-term outcomes when dual rods are not deemed appropriate. CLINICAL SIGNIFICANCE The use of single growing rod constructs, in the 4-8 years old patient with EOS, can achieve reasonable short-term radiographic outcomes.

INTRODUCTION The impact of posterior spinal fusion (PSF) on physical function and pain and mental health in pediatric patients as quantified by the Patient-Reported Outcomes Measurement Information System (PROMIS), developed by the National Institute of Health, is largely unknown. The purpose of this study is to report the changes of PROMIS scores for upper extremity (UE), pain interference (PI), mobility (MOB), and peer relationships (PR) after PSF in patients with idiopathic scoliosis (IS), compare postoperative changes in PROMIS PI and Scoliosis Research Society-30 pain scores, and evaluate associations between curve characteristics and PROMIS scores. METHODS A retrospective cohort of 122 patients (

Introduction Seizures are one of the most common neurological reasons for emergency department (ED) visits. The benefit of ED-initiated, short-course outpatient benzodiazepine (BZD) treatment to prevent early recurrent seizure is unknown. This study assesses the risk of early seizure recurrence in patients who were or were not started with outpatient BZD in the ED. Methods This was a multicenter retrospective study conducted in eight French EDs between January 1 and December 31, 2019. All patients admitted for seizure were retrospectively screened and those discharged home from the ED were included. Patients with a history of chronic alcohol intoxication or chronic BZD therapy were excluded. Baseline characteristics, type of seizure, and 30-day outcome were retrospectively collected from the electronic health records. The primary endpoint was a return visit for seizure recurrence within 30 days. Independent factors associated with a seizure recurrence were identified using a multivariable binary logistic regression. Results A total of 2,218 patients were included and 1,820 were analyzed. The median age was 39 years and 60% were men. Among them 82% of patients had a generalized tonic-clonic seizure and 47% of seizures were idiopathic. BZD treatment was started in 773 (42%) patients. A total of 154 (8%) patients had an early recurrence at 30 days: 68 (9%) in patients who were treated with BZD versus 86 (8%) in patients who were not (odds ratio [OR] = 1.07, 95% confidence interval [CI] = 0.71 to 1.43). In multivariable analysis, two factors were independently associated with the primary endpoint: chronic epileptic treatment (adjusted OR = 2.58, 95% CI = 1.55 to 4.37) and having had a focal seizure (adjusted OR = 2.16, 95% CI = 1.56 to 4.37). Conclusion BZD therapy was started in 42% of patients who were discharged home after ED visit for a seizure. This treatment was not an independent factor associated with the risk of return visit for seizure recurrence at 30 days.

BackgroundPeople who inject drugs (PWID) in Kenya have a high prevalence of HIV (14-26%) and HCV (11-36%). Needle and syringe programmes (NSP) and antiretroviral therapy (ART) have high coverage among PWID, while HCV treatment and opioid substitution therapy (OST) access is low.MethodsA dynamic model of HIV (sexual and injecting-related) and HCV (injecting-related) transmission among PWID was calibrated using Bayesian methods to data from Nairobi and the Coastal region. We projected the impact of existing coverage levels of interventions (ART: 64-66%; OST: 4-7%; NSP: 54-56%) in each setting, and the impact over 2020-2030 of increasing the coverage of OST (50%) and NSP (75%; ‘full HR’), ART (UNAIDS 90-90-90 target), HCV treatment (1000 over 5 years), and reducing HIV sexual risk by 75%. We estimated HCV treatment levels needed to reduce HCV incidence by 90% with or without full HR.FindingsSince 2013, HR has averted 15.1-20.6% (range in medians across settings) of HIV infections and 29.0-31.6% of HCV infections across Nairobi and the Coastal region, with most impact being due to NSP. Conversely, ART has only averted InterpretationExisting interventions have had moderate impact on HIV and HCV transmission in Kenya, but may have substantial impact if scaled-up. However, to achieve HIV and HCV elimination, reductions in sexual risk are needed and a scale-up in HCV treatment.FundingGlobal Fund, MDM

Purpose Spine surgeons have increasingly used intraoperative application of topical vancomycin powder (TVP) to prevent surgical site infections (SSIs). The goals of this study were to define the rate of pharmacological adverse reaction to TVP in young patients undergoing posterior spinal surgery and to summarise institutional variation in TVP dosing. Methods This retrospective observational study included ten spine centres in the United States and one in Europe. Patients with early onset scoliosis who underwent posterior spine surgery were eligible for inclusion. Age, weight, TVP dose and surgery type were recorded. Surgeries where patient age was > 12 years were excluded. Pharmacological adverse reactions were defined as clinical instances of Red Man Syndrome, rash, nephrotoxicity, proteinuria, hepatotoxicity or ototoxicity. The rate of pharmacological adverse reaction to TVP was calculated. Dosing practices were summarised. Results Patient age was in the range of seven months to 12 years (median ten years). Of 1398 observations, there was one possible pharmacological adverse reaction. This was in a ten-year-old, 20.4-kg female patient with neuromuscular sco-liosis undergoing growing rod implantation. She was dosed with 1500 mg of TVP and immediately developed a transient rash without systemic symptoms. This abated over minutes without any medical intervention. There were no other adverse reactions in the sample. The population rate of pharmacological adverse reaction was 0.072% (95% confidence interval 0 to 0.4). Significant variability in dosing practices existed between centres. Conclusion Pharmacological adverse reactions to TVP are rare. Future work may establish evidence-based guidelines for TVP dosing based on patient weight and other variables.