Search

Determination of the need for workshops for handicapped people, development of a new corporation, the adoption of bylaws, financial considerations, federal laws, workshop staff, resource material, state law, regulations, and forms, and procedures for establishing an extended employment workshop are mentioned and expanded in appendixes. Appendixes include the following: the sheltered workshop law, regulations for establishment and operation of extended employment workshops, procedure for incorporation, bylaws, a sample budget for the first quarter of a 15-man workshop, federal wage and hour contracts division regulations, a bibliography of 18 items, six applications or reports, and a copy of a shared business agreement. (RJ)

Skin injury is repaired through a multi-phase wound healing process of tissue granulation and re-epithelialization. Any failure in the healing process may lead to chronic non-healing wounds or abnormal scar formation. Although significant progress has been made in developing novel scaffolds and/or cell-based therapeutic strategies to promote wound healing, effective management of large chronic skin wounds remains a clinical challenge. Keratinocytes are critical to re-epithelialization and wound healing. Here, we investigated whether exogenous keratinocytes, in combination with a citrate-based scaffold, enhanced skin wound healing. We first established reversibly immortalized mouse keratinocytes (iKera), and confirmed that the iKera cells expressed keratinocyte markers, and were responsive to UVB treatment, and were non-tumorigenic. In a proof-of-principle experiment, we demonstrated that iKera cells embedded in citrate-based scaffold PPCN provided more effective re-epithelialization and cutaneous wound healing than that of either PPCN or iKera cells alone, in a mouse skin wound model. Thus, these results demonstrate that iKera cells may serve as a valuable skin epithelial source when, combining with appropriate biocompatible scaffolds, to investigate cutaneous wound healing and skin regeneration., Graphical abstract Image 1, Highlights • A reversibly immortalized mouse keratinocyte (i.e., iKera) line was established. • The iKera cells maintain the characteristics of keratinocytes without tumorigenecity. • A combination of thermoresponsive scaffold PPCN and iKera cells facilitates re-epithelization and cutaneous wound healing. • The iKera cells are a valuable cell source for skin tissue engineering studies.

The treatment of cancer mainly involves surgical excision supplemented by radiotherapy and chemotherapy. Chemotherapy drugs act by interfering with tumor growth and inducing the death of cancer cells. Anti-tumor drugs were developed to induce apoptosis, but some patient’s show apoptosis escape and chemotherapy resistance. Therefore, other forms of cell death that can overcome the resistance of tumor cells are important in the context of cancer treatment. Ferroptosis is a newly discovered iron-dependent, non-apoptotic type of cell death that is highly negatively correlated with cancer development. Ferroptosis is mainly caused by the abnormal increase in iron-dependent lipid reactive oxygen species and the imbalance of redox homeostasis. This review summarizes the progression and regulatory mechanism of ferroptosis in cancer and discusses its possible clinical applications in cancer diagnosis and treatment.

Background The safety and immunogenicity profile of COVID-19 vaccines when administered concomitantly with seasonal influenza vaccines have not yet been reported. We therefore aimed to report the results of a substudy within a phase 3 UK trial, by evaluating the safety, immunogenicity, and efficacy of NVX-CoV2373 when co-administered with licensed seasonal influenza vaccines. Methods We did a planned exploratory substudy as part of the randomised, observer-blinded, placebo-controlled, phase 3 trial of the safety and efficacy of the COVID-19 vaccine (NVX-CoV2373) by co-administrating the influenza vaccine at four study hospitals in the UK. Approximately, the first 400 participants meeting the main study entry criteria—with no contraindications to influenza vaccination—were invited to join the substudy. Participants of the main study were randomly assigned (1:1) to receive two intramuscular injections of either NVX-CoV2373 (5 μg) or placebo (normal saline) 21 days apart; participants enrolled into the substudy were co-vaccinated with a single (0·5 mL) intramuscular, age-appropriate (quadrivalent influenza cell-based vaccine [Flucelvax Quadrivalent; Seqirus UK, Maidenhead] for those aged 18–64 years and adjuvanted trivalent influenza vaccine [Fluad; Seqirus UK, Maidenhead] for those ≥65 years), licensed, influenza vaccine on the opposite deltoid to that of the first study vaccine dose or placebo. The influenza vaccine was administered in an open-label manner and at the same time as the first study injection. Reactogenicity was evaluated via an electronic diary for 7 days after vaccination in addition to monitoring for unsolicited adverse events, medically attended adverse events, and serious adverse events. Immunogenicity was assessed with influenza haemagglutination inhibition and SARS-CoV-2 anti-spike protein IgG assays. Vaccine efficacy against PCR-confirmed, symptomatic COVID-19 was assessed in participants who were seronegative at baseline, received both doses of study vaccine or placebo, had no major protocol deviations affecting the primary endpoint, and had no confirmed cases of symptomatic COVID-19 from the first dose until 6 days after the second dose (per-protocol efficacy population). Immunogenicity was assessed in participants who received scheduled two doses of study vaccine, had a baseline sample and at least one post-vaccination sample, and had no major protocol violations before unmasking (per-protocol immunogenicity population). Reactogenicity was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo and had data collected for reactogenicity events. Safety was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo. Comparisons were made between participants of the substudy and the main study (who were not co-vaccinated for influenza). This study is registered with ClinicalTrials.gov, number NCT04583995. Findings Between Sept 28, 2020, and Nov 28, 2020, a total of 15 187 participants were randomised into the main phase 3 trial, of whom 15 139 received treatment (7569 received dose one of NVX-CoV2373 and 7570 received dose one of placebo). 431 participants were co-vaccinated with a seasonal influenza vaccine in the substudy (217 received NVX-CoV2373 plus the influenza vaccine and 214 received placebo plus the influenza vaccine). In general, the substudy participants were younger, more racially diverse, and had fewer comorbid conditions than those in the main study. Reactogenicity events were more common in the co-administration group than in the NVX-CoV2373 alone group: tenderness (113 [64·9%] of 174 vs 592 [53·3%] of 1111) or pain (69 [39·7%] vs 325 [29·3%]) at injection site, fatigue (48 [27·7%] vs 215 [19·4%]), and muscle pain (49 [28·3%] vs 237 [21·4%]). Incidences of unsolicited adverse events, treatment-related medically attended adverse events, and serious adverse events were low and balanced between the co-administration group and the NVX-CoV2373 alone group. No episodes of anaphylaxis or deaths were reported within the substudy. Co-administration resulted in no change to influenza vaccine immune response although a reduction in antibody responses to the NVX-CoV2373 vaccine was noted. NVX-CoV2373 vaccine efficacy in the substudy (ie, participants aged 18 to

Objective The aim of this survey was to describe existing perioperative care standards and best practices in the Netherlands and Belgium. Design An online survey was followed up by an in-depth personal interview. The main outcomes were the existing standards of perioperative care for patients undergoing cardiac surgery. Setting The online survey and subsequent interviews were targeted to one representative in the intensive care unit (ICU), cardiac surgery, and anesthesiology department from each cardiac surgical center in the Netherlands and Belgium. Participants A representative intensive care physician, cardiac surgeon, and cardiac anesthesiologist. Interventions None. Measurements and Main Results The response rate was 60% (71% for the Netherlands, and 44% in Belgium). Agreement across centers was found for discontinuation of proton-pump inhibitors (80%) and avoiding intra- and postoperative (92%) nonsteroidal antiinflammatory drugs. Additionally, 98% of respondents stated that physiotherapy should be started immediately in the ICU. Major divergence was found for elements such as the discontinuation of angiotensin-converting enzyme inhibitors (55%) or the postoperative use of chest support vests (44%). Conclusions The authors demonstrated a wide range of different local protocols. Strategies differed among disciplines, hospitals, and countries. This emphasized the need for the implementation of a more universal protocol to further reduce variance and improve recovery practices. This nationwide survey was the first of its kind simultaneously studying best practices for cardiac surgery through the entire care pathway at the advent of Enhanced Recovery After Surgery (ERAS) Cardiac implementation. A multinational randomized controlled trial to test the implementation of an evidence-based ERAS Cardiac protocol is the next step to pave the way for further outcome improvements in this high-risk population.

Background & Aims Nonpedunculated colorectal polyps are normally endoscopically removed to prevent neoplastic progression. Delayed bleeding is the most common major adverse event. Clipping the resection defect has been suggested to reduce delayed bleedings. Our aim was to determine if prophylactic clipping reduces delayed bleedings and to analyze the contribution of polyp characteristics, extent of defect closure, and antithrombotic use. Methods An individual patient data meta-analysis was performed. Studies on prophylactic clipping in nonpedunculated colorectal polyps were selected from PubMed, Embase, Web of Science, and Cochrane database (last selection, April 2020). Authors were invited to share original study data. The primary outcome was delayed bleeding ≤30 days. Multivariable mixed models were used to determine the efficacy of prophylactic clipping in various subgroups adjusted for confounders. Results Data of 5380 patients with 8948 resected polyps were included from 3 randomized controlled trials, 2 prospective, and 8 retrospective studies. Prophylactic clipping reduced delayed bleeding in proximal polyps ≥20 mm (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.44–0.88; number needed to treat = 32), especially with antithrombotics (OR, 0.59; 95% CI, 0.35–0.99; number needed to treat = 23; subgroup of anticoagulants/double platelet inhibitors: n = 226; OR, 0.40; 95% CI, 0.16–1.01; number needed to treat = 12). Prophylactic clipping did not benefit distal polyps ≥20 mm with antithrombotics (OR, 1.41; 95% CI, 0.79–2.52). Conclusions Prophylactic clipping reduces delayed bleeding after resection of nonpedunculated, proximal colorectal polyps ≥20 mm, especially in patients using antithrombotics. No benefit was found for distal polyps. Based on this study, patients can be identified who may benefit from prophylactic clipping. (PROSPERO registration number CRD42020104317.)

Background/Objectives Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge. Design A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at 6 months. Setting Two cardiac care units of the University Hospitals Leuven. Participants One hundred and fifty-one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. Intervention A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications. MEASUREMENTS The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one-point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5, 95% CI = 9.2-9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6-month follow-up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. CONCLUSION This first nurse-led geriatric co-management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes. Onderzoeksraad, KU Leuven, Grant/Award Number: REF22/15/028 Deschodt, M (corresponding author), UZ, Dept Gerontol & Geriatr, AGSF, Herestr 49 Box 7003 35, B-3000 Leuven, Belgium. mieke.deschodt@kuleuven.be

Background: Despite advances in surgery and pharmacotherapy, there remains significant residual ischemic risk after coronary artery bypass grafting surgery. Methods: In REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, placebo-controlled, double-blind trial, statin-treated patients with controlled low-density lipoprotein cholesterol and mild to moderate hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or placebo. They experienced a 25% reduction in risk of a primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) and a 26% reduction in risk of a key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) when compared with placebo. The current analysis reports on the subgroup of patients from the trial with a history of coronary artery bypass grafting. Results: Of the 8179 patients randomized in REDUCE-IT, a total of 1837 (22.5%) had a history of coronary artery bypass grafting, with 897 patients randomized to icosapent ethyl and 940 to placebo. Baseline characteristics were similar between treatment groups. Randomization to icosapent ethyl was associated with a significant reduction in the primary end point (hazard ratio [HR], 0.76 [95% CI, 0.63–0.92]; P =0.004), in the key secondary end point (HR, 0.69 [95% CI, 0.56–0.87]; P =0.001), and in total (first plus subsequent or recurrent) ischemic events (rate ratio, 0.64 [95% CI, 0.50–0.81]; P =0.0002) compared with placebo. This yielded an absolute risk reduction of 6.2% (95% CI, 2.3%–10.2%) in first events, with a number needed to treat of 16 (95% CI, 10–44) during a median follow-up time of 4.8 years. Safety findings were similar to the overall study: beyond an increased rate of atrial fibrillation/flutter requiring hospitalization for at least 24 hours (5.0% vs 3.1%; P =0.03) and a nonsignificant increase in bleeding, occurrences of adverse events were comparable between groups. Conclusions: In REDUCE-IT patients with a history of coronary artery bypass grafting, treatment with icosapent ethyl was associated with significant reductions in first and recurrent ischemic events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01492361.

OBJECTIVES: To determine the extent of agreement between a handheld ultrasound (US) attached to an android tablet and the reference method dual energy x-ray absorptiometry (DXA) for the measurement of adiposity. METHODS: A whole-body DXA scan and abdominal adipose tissue thickness measurements using a handheld US were obtained from 104 adults (63 females, 41 males). Body fat percent (BF%), total fat mass (kg), and trunk fat mass (kg) were obtained from DXA. Subcutaneous adipose tissue (SAT), superficial subcutaneous adipose tissue (SSAT), and deep subcutaneous adipose tissue (DSAT) thickness were obtained from US. Sex-specific total fat mass, trunk fat mass, and BF% estimates by US were compared with DXA. Spearman’s correlations and Bland-Altman plots were used to assess agreement between the methods. RESULTS: US SAT correlated strongly with total fat mass for both females (r(s) = 0.74 ) and males (r(s) = 0.87) as did trunk fat mass (females, r(s) = 0.81; males, r(s) = 0.83); as did SSAT and DSAT (females: r(s) = 0.65 and r(s) = 0.66; males: r(s) = 0.63 and r(s) = 0.85, respectively, all p-values < 0.0001). Bland-Altman plots demonstrated strong agreement for total and trunk fat mass for both males and females. For BF%, acceptable limits of agreement were observed for males but not for females, substantial proportional bias as indicated by a negative slope was noted for BF% using SAT (r = −0.298, p=0.0177). CONCLUSION: The handheld US and technique to analyze abdominal adipose tissue thickness showed strong agreement with DXA results and generated highly comparable estimates for total and trunk fat mass for both sexes.

We aimed to compare the longitudinal changes in estimated glomerular filtration rate (eGFR) in chronic hepatitis B (CHB) patients treated with entecavir (ETV) vs. tenofovir disoproxil fumarate (TDF). This is a retrospective study of 6189 adult treatment-naive CHB patients initiated therapy with TDF (n = 2482) or ETV (n = 3707) at 25 international centers using multivariable generalized linear modeling (GLM) to determine mean eGFR (mL/min/1.73 m2) and Kaplan–Meier method to estimate incidence of renal impairment (≥ 1 chronic kidney disease [CKD] stage worsening). We also examined above renal changes in matched ETV and TDF patients (via propensity score matching [PSM] on age, sex, diabetes mellitus [DM], hypertension [HTN], cirrhosis, baseline eGFR, and follow-up duration). In the overall cohort (mean age 49.7 years, 66.2% male), the baseline eGFR was higher for TDF vs. ETV group (75.9 vs. 74.0, p = 0.009). PSM yielded 1871 pairs of ETV or TDF patients with baseline eGFR ≥ 60 and 520 pairs for the eGFR

There are few treatment options, including the use of natural phenolics-based combination therapy for mitigating male infertility conditions associated with chemotherapy. Busulfan is an anti-cancer drug that leads to testicular problems in humans. Here, we studied the effect of co-treatment of rutin and kolaviron against busulfan-induced testis damage. Young adult male Wistar rats were intraperitoneally injected busulfan (4 mg/kg b.w), and then orally administered rutin (30 mg/kg b.w), and kolaviron (50 mg/kg b.w) alone and combined for 60 days. Results revealed that rutin and kolaviron alone or in combination reversed busulfan-induced increase in oxidative stress along with sperm quality of treated animals. However, kolaviron and rutin separately improved the concentrations of MDA and GSH and sperm quality more than when they were combined. Similarly, rutin and kolaviron separately or in combination preserved spermatogenesis and relieved busulfan-induced increase in nitric oxide concentration, myeloperoxidase and 3β-hydroxysteroid dehydrogenase activities. Co-supplementation with kolaviron but not rutin nor when rutin was combined with kolaviron also improved the testicular level of tumor necrosis-alpha. Finally, the histological features in the testes caused by busulfan were reversed by rutin, whereas treatment with kolaviron alone or in combination with rutin partially protected the testis from busulfan-induced injury as demonstrated by the appearance of few germ cells, damaged tubules, loss of round spermatids and defoliation of the seminiferous epithelium. Thus, the combined treatment regimen of rutin and kolaviron sparingly prevented busulfan-induced testicular injuries in rats.

This paper proposes phase-shift-amplified optical fiber interferometry based on microwave photonics (MWP) for sensing applications with substantially-improved sensitivity. The principal idea of the system combines a destructive interference-based phase-shift amplification technique with optical carrier-based microwave interferometry (OCMI). The phase sensitivity of the OCMI system is significantly improved due to the phase amplifier, and more importantly, can be adjusted by simply varying the amplitude ratio of the two beams used in the interferometer. The amplification of the phase sensitivity is numerically investigated and experimentally demonstrated using a Mach-Zehnder interferometer for temperature and strain measurements. The measurement results accurately match theoretical predictions. Moreover, we demonstrate that light-scattering dots in the optical fiber core, created by tightly-focused femtosecond laser pulses, can be used to precisely tune the amplitude ratio of the two-beam interferometer. We postulate that amplification of several orders of magnitude in phase sensitivity can be achieved in the OCMI system by employing micromachining methods.

Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with respect to outcome. Features of the tumor microenvironment (TME) are associated with prognosis when assessed by gene expression profiling. However, it is uncertain whether assessment of the microenvironment can add prognostic information to the most relevant and clinically well-established molecular subgroups when analyzed by immunohistochemistry (IHC).We carried out a histopathologic analysis of biomarkers related to TME in a very large cohort (n = 455) of DLBCL treated in prospective trials and correlated with clinicopathologic and molecular data, including chromosomal rearrangements and gene expression profiles for cell-of-origin and TME.The content of PD1+, FoxP3+ and CD8+, as well as vessel density, was not associated with outcome. However, we found a low content of CD68+ macrophages to be associated with inferior progression-free survival (PFS) and overall survival (OS; P = 0.023 and 0.040, respectively) at both univariable and multivariable analyses, adjusted for the factors of the International Prognostic Index (IPI), MYC break and BCL2/MYC and BCL6/MYC double-hit status. The subgroup of PDL1+ macrophages was not associated with survival. Instead, secreted protein acidic and cysteine rich (SPARC)-positive macrophages were identified as the subtype of macrophages most associated with survival. SPARC-positive macrophages and stromal cells directly correlated with favorable PFS and OS (both, P[log rank]0.001, P[trend]0.001). The association of SPARC with prognosis was independent of the factors of the IPI, MYC double-/triple-hit status, Bcl2/c-myc double expression, cell-of-origin subtype and a recently published gene expression signature [lymphoma-associated macrophage interaction signature (LAMIS)].SPARC expression in the TME detected by a single IHC staining with fair-to-good interobserver reproducibility is a powerful prognostic parameter. Thus SPARC expression is a strong candidate for risk assessment in DLBCL in daily practice.

Background: Better water quality, improved sanitation and sound water resource management will improve public health and economic development in low-income countries. Water safety plan-based risk assessment and risk management from catchment to consumers are the modern and efficient approaches to safe drinking water supply established by World Health Organization. Thus, this paper aimed to assess risk from catchment level to consumers in the community of Brikama. Methods: This study report assessments of risk or hazards from catchment to consumers in Brikama Water Treatment Plant (BWTP), West Coast Region, The Gambia. The various means of data collection used include water quality monitoring, visual field inspection and questionnaire survey to explore data on where the water supply system goes wrong from catchment to consumers, so as to provide an improvement plan. Results: Overall, the day-to-day administration of services at BWTP was very impressive. The fencing of all the 17 boreholes at catchment sites has drastically reduced the risk of contamination including treatment systems and distribution lines. There are less risks observed and constant monitoring of the system was ensured. However, at the consumer end, there are some risks with poor practices associated with water handling, storage and hygiene measures at the household level. Some still use some unclean 20-liter containers to store water and indiscriminately kept drinking cups on the floor and unclean surfaces, and 50% lacked WASH knowledge related to water treatment, such as boiling and filtration at households. The overall perception of water storage, sanitation and hygiene practices could be rated moderately good. Conclusion: The overall findings of this study have shown tremendous achievement in the government's commitment to providing potable water to the people in Brikama Local Government Area. WASH education in the study area is recommended to avoid waterborne disease infections.

Genomic medicine holds great promise for improving health care, but integrating searchable and actionable genetic data into electronic health records (EHRs) remains a challenge. Here we describe Neptune, a system for managing the interaction between a clinical laboratory and an EHR system during the clinical reporting process. We developed Neptune and applied it to two clinical sequencing projects that required report customization, variant reanalysis, and EHR integration. Neptune has been applied for the generation and delivery of over 15,000 clinical genomic reports. This work spans two clinical tests based on targeted gene panels that contain 68 and 153 genes respectively. These projects demanded customizable clinical reports that contained a variety of genetic data types including single-nucleotide variants (SNVs), copy-number variants (CNVs), pharmacogenomics, and polygenic risk scores. Two variant reanalysis activities were also supported, highlighting this important workflow. Methods are needed for delivering structured genetic data to EHRs. This need extends beyond developing data formats to providing infrastructure that manages the reporting process itself. Neptune was successfully applied on two high-throughput clinical sequencing projects to build and deliver clinical reports to EHR systems. The software is open source and available at https://gitlab.com/bcm-hgsc/neptune .

Summary Background Computer-aided detection (CADe) techniques based on artificial intelligence algorithms can assist endoscopists in detecting colorectal neoplasia. CADe has been associated with an increased adenoma detection rate, a key quality indicator, but the utility of CADe compared with existing advanced imaging techniques and distal attachment devices is unclear. Methods For this systematic review and network meta-analysis, we did a comprehensive search of PubMed/Medline, Embase, and Scopus databases from inception to Nov 30, 2020, for randomised controlled trials investigating the effectiveness of the following endoscopic techniques in detecting colorectal neoplasia: CADe, high definition (HD) white-light endoscopy, chromoendoscopy, or add-on devices (ie, systems that increase mucosal visualisation, such as full spectrum endoscopy [FUSE] or G-EYE balloon endoscopy). We collected data on adenoma detection rates, sessile serrated lesion detection rates, the proportion of large adenomas detected per colonoscopy, and withdrawal times. A frequentist framework, random-effects network meta-analysis was done to compare artificial intelligence with chromoendoscopy, increased mucosal visualisation systems, and HD white-light endoscopy (the control group). We estimated odds ratios (ORs) for the adenoma detection rate, sessile serrated lesion detection rate, and proportion of large adenomas detected per colonoscopy, and calculated mean differences for withdrawal time, with 95% CIs. Risk of bias and certainty of evidence were assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings 50 randomised controlled trials, comprising 34 445 participants, were included in our main analysis (six trials of CADe, 18 of chromoendoscopy, and 26 of increased mucosal visualisation systems). HD white-light endoscopy was the control technique in all 50 studies. Compared with the control technique, the adenoma detection rate was 7·4% higher with CADe (OR 1·78 [95% CI 1·44–2·18]), 4·4% higher with chromoendoscopy (1·22 [1·08–1·39]), and 4·1% higher with increased mucosal visualisation systems (1·16 [1·04–1·28]). CADe ranked as the superior technique for adenoma detection (with moderate confidence in hierarchical ranking); cross-comparisons of CADe with other imaging techniques showed a significant increase in the adenoma detection rate with CADe versus increased mucosal visualisation systems (OR 1·54 [95% CI 1·22–1·94]; low certainty of evidence) and with CADe versus chromoendoscopy (1·45 [1·14–1·85]; moderate certainty of evidence). When focusing on large adenomas (≥10 mm) there was a significant increase in the detection of large adenomas only with CADe (OR 1·69 [95% CI 1·10–2·60], moderate certainty of evidence) when compared to HD white-light endoscopy; CADe ranked as the superior strategy for detection of large adenomas. CADe also seemed to be the superior strategy for detection of sessile serrated lesions (with moderate confidence in hierarchical ranking), although no significant increase in the sessile serrated lesion detection rate was shown (OR 1·37 [95% CI 0·65–2·88]). No significant difference in withdrawal time was reported for CADe compared with the other techniques. Interpretation Based on the published literature, detection rates of colorectal neoplasia are higher with CADe than with other techniques such as chromoendoscopy or tools that increase mucosal visualisation, supporting wider incorporation of CADe strategies into community endoscopy services. Funding None.

In this mixed-methods research, the relationship between four factors of individual online learners and their mathematics self-concept was explored. In addition, the challenges the students faced in learning mathematics online during the Coronavirus disease (COVID-19) pandemic were determined. The participant students were from two mathematics classes offered online during the summer of 2020. Pure online classes were first offered during this period because face-to-face learning sessions were suspended due to the COVID-19 pandemic. It was found that students owned the devices they were using for online classes. Internet connection and power interruption were the most problematic aspects of online learning. Students had positive as well as negative mathematics online learning self-concepts. Individual factors were partly related to mathematics self-concept. Qualitative data shows that students faced technological, personal, domestic, assessment, pedagogical, consultation, and test anxiety challenges. Implications and recommendations for teaching mathematics in an online environment are offered.

Background: Providing occupational health and safety (OHS) services to employees has been a global problem for an extended period. A safe workplace should pose no avoidable risk to employees' physical, psychological, or social wellbeing and should provide opportunities for employees to improve and support their health. This study aimed to assess the occupational health and safety risks and hazards among workers at the construction sites in Kombo North District of the Gambia. Methods: A mixed-method study design was conducted across construction workers in Kombo North District, West Coast Region of the Gambia. Data was generated using validated OHS risk assessment matrix, structured questionnaires, environmental and physical inspection and key informant interviews. Descriptive statistics, including a composite scoring system, were used to present the results of this study. Results: Of the 157 respondents in this study, 98.1% were males, and about one-third of these construction workers were 31-40 years of age. About 46% and 34.4% spent 1-5 and 6-10 years in the construction industry, while about 40.2% of the respondents never been to school. The study revealed that physical risks and hazards in the form of falling from a height, electric shock, etc. were the most common forms compared to other categories such as ergonomics, biological and chemical risks and hazards. There is no reporting system or registry in place across the study sites. Conclusion: This study provides evidence that physical hazards reported being the most common across other forms of ergonomics, biological and chemical risk and hazards. There is an urgent need for reactivation and implementation of OHS advocacies, health education, and other preventive strategies to control common workplace risks and hazards in their various forms.

Digital Voice Assistants (DVAs) like Google Home provide automated news, media and other content directly into the home. In this article, we outline how Google Home’s content delivery can support the wellbeing and independence of older people. We argue that automated media provided by DVAs enrols older people in a dialectic relationship with the automated content and feminised conversation they deliver, uniquely performed within people’s own everyday life circumstances. We demonstrate this by drawing on ethnographic insights generated during a trial of smart home technologies with older Australian households who are ‘ageing in place’ in regional New South Wales. For most participants, the trial was their first encounter with DVAs and the modes of media and content delivery including for music, news, weather, trivia, jokes, facts and images. While DVAs bring new experiences via content, communication and companionship, they are also subverted, ignored or transformed as people improvise to make them ‘fit’ within their homes and lives. These dynamics underpin how DVAs, automated content delivery and user’s interactions can support people’s sense of wellness and their independent daily practices at home.

We evaluated the disposable non-invasive SpotOn™ thermometer relying on the zero-heat-flux technology. We tested the hypothesis that this technology may accurately estimate the core temperature. The primary objective was to compare cutaneous temperature measurements from this device with blood temperatures measured with the pulmonary artery catheter. Secondary objective was to compare measurements from the zero-heat-flux thermometer indirectly with other routinely used thermometers (nasopharyngeal, bladder, rectal). We included 40 patients electively scheduled for either off-pump coronary artery bypass surgery or pulmonary thromboendarterectomy. Temperatures were measured using zero-heat-flux (SpotOn™), pulmonary artery catheter, nasopharyngeal, rectal, and bladder thermometers. Agreement was assessed using the Bland and Altman random effects method for repeated measures data, and Lin’s concordance correlation coefficient. Accuracy was estimated (defined as

Background and ObjectivesAndexanet alfa was recently approved as a reversal agent for the factor Xa inhibitors (FXais) apixaban and rivaroxaban, but its impact on long-term outcomes in FXai-associated intracerebral hemorrhage (ICH) is unknown. We aimed to explore potential clinical implications of andexanet alfa in FXai-associated ICH in this simulation study.MethodsWe simulated potential downstream implications of andexanet alfa across a range of possible hemostatic effects using data from a single center that treats FXai-associated ICH with prothrombin complex concentrate (PCC). We determined baseline probabilities of inadequate hemostasis across patients taking FXai and those not taking FXai via multivariable regression models and then determined the probabilities of unfavorable 3-month outcome (modified Rankin Scale score 4–6) using models comprising established predictors and each patient's calculated probability of inadequate hemostasis. We applied bootstrapping with model parameters from this derivation cohort to simulate a range of hemostatic improvements and corresponding outcomes and then calculated absolute risk reduction (relative to PCC) and projected number needed to treat (NNT) to prevent 1 unfavorable outcome.ResultsTraining models using real-world patients (n = 603 total, 55 on FXai) had good accuracy in predicting inadequate hemostasis (area under the curve [AUC] 0.78) and unfavorable outcome (AUC 0.78). Inadequate hemostasis was strongly associated with unfavorable outcome (odds ratio 4.5, 95% confidence interval [CI] 2.0–9.9) and occurred in 11.4% of patients taking FXai. Across simulated patients taking FXai comparable to those in A Study in Participants With Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors (ANNEXA-4) study, predicted absolute risk reduction of unfavorable outcome was 4.9% (95% CI 1.3%–7.8%) when the probability of inadequate hemostasis was reduced by 33% and 7.4% (95% CI 2.0%–11.9%) at 50% reduction, translating to projected NNT of 21 (cumulative cost $519,750) and 14 ($346,500), respectively.DiscussionEven optimistic simulated hemostatic effects suggest that the costs and potential benefits of andexanet alfa should be carefully considered. Placebo-controlled randomized trials are needed before its use can definitively be recommended.

Bean which is botanically called Phaseolus vulgaris L. belongs to the Fabaceae family. Unnecessary economic losses arise during bean disease identification due to a delay in treatment, inappropriate treatment, and a lack of understanding. The existing deep learning and machine learning techniques met few issues such as high computational complexity, higher cost associated with the training data, more execution time, noise, feature dimensionality, lower accuracy, low speed, etc. To tackle these problems, we have proposed a hybrid deep learning model with an Archimedes optimization algorithm (HDL-AOA) for bean disease classification. In this work, there are five bean classes of which one is a healthy class whereas the remaining four classes indicate different diseases such as Bean halo blight, Pythium diseases, Rhizoctonia root rot, and Anthracnose abnormalities acquired from the Soybean Data Set. The hybrid deep learning technique is the combination of wavelet packet decomposition (WPD) and long short-term memory (LSTM). Initially, the WPD decomposes the input images into four sub-series. For these sub-series, four LSTM networks were developed. During bean disease classification, an Archimedes optimization algorithm (AOA) enhances the classification accuracy for multiple single LSTM networks. To help the farmers in real-time, the proposed model is also deployed in a cloud-based collaboration framework. The proposed model accomplishes lower MAPE than other exiting methods. Finally, the proposed HDL-AOA model outperforms excellent classification results using different evaluation measures such as accuracy, specificity, sensitivity, precision, recall, and F-score.

Quantum dot solar cells are based on the concept of harvesting different parts of the solar light spectrum with a single, cheap semiconductor by simply changing the size of the nanoparticles. Of the many compositions explored, germanium is one of the most interesting as it has the major advantage of a large Bohr radius, which allows for the fabrication of larger particles. Moreover, germaniums possess very high optical absorption, and a small band gap give it free parameters to optimize the quantum dot solar cell. In a previous work, the germanium quantum dots were used in a Gratzel type solar cell containing an electrolyte, which is not desirable for applications. In this work instead, the n-doped germanium quantum dots were combined with a p-doped a-Si layer, making it the first all solid-state solar cell made from nanoparticles from a gas aggregation nanoparticle source. Remarkably, the effect of quantum confinement in both the germanium quantum dot assembled layer and a-Si was observed by peaks in the spectral response experiments. This work forms an important step toward realizing a germanium quantum dot based solar cell and studying quantum dot based solids.

Aim: To determine the opinion of patients on the use of operating theatre background music in tertiary health care facilities in Port Harcourt. Background: Music finds application in almost all spheres of society due to some beneficial effects. It has been used among patients in the intensive care setting, among hypertensives with associated lowering the systolic blood pressure, among endoscopy patients with significantly improved pain score and significantly reduced anxiety, for pain relief and relaxation, and also for expectant mothers in labour. Materials and Methods: The cross-sectional descriptive study was carried out among patients from March to June 2020 in two multispecialty tertiary healthcare facilities in Port Harcourt Nigeria. Using semi-structured questionnaires and convenience sampling method, 425 respondents were recruited. Data collected was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Four hundred and two (94.6%) respondents loved listening to music at home. Two hundred and seventy-three (64.2%) respondents preferred to listen to music in operating theatre. Preference for timing of music usage in theatre was variable: before, during and after surgery. One hundred and forty-four (33.9%) respondents asserted that they would love to listen to music in theatre during surgery. Two hundred and thirty-three (55.5%) respondents asserted that there was no background music during their last surgery. Conclusion: Majority of patients were desirous of the use of music in the operating theatre, while a few others thought otherwise.

Ocular repeated air blast injuries occur from low overpressure blast wave exposure, which are often repeated and in quick succession. We have shown that caspase-2 caused the death of retinal ganglion cells (RGC) after blunt ocular trauma. Here, we investigated if caspase-2 also mediates RGC apoptosis in a mouse model of air blast induced indirect traumatic optic neuropathy (b-ITON). C57BL/6 mice were exposed to repeated blasts of overpressure air (3 × 2 × 15 psi) and intravitreal injections of siRNA against caspase-2 (siCASP2) or against a control enhanced green fluorescent protein (siEGFP) at either 5 h after the first 2 × 15 psi (“post-blast”) or 48 h before the first blast exposure (“pre-blast”) and repeated every 7 days. RGC counts were unaffected by the b-ITON or intravitreal injections, despite increased degenerating ON axons, even in siCASP2 “post-blast” injection groups. Degenerating ON axons remained at sham levels after b-ITON and intravitreal siCASP2 “pre-blast” injections, but with less degenerating axons in siCASP2 compared to siEGFP-treated eyes. Intravitreal injections “post-blast” caused greater vitreous inflammation, potentiated by siCASP2, with less in “pre-blast” injected eyes, which was abrogated by siCASP2. We conclude that intravitreal injection timing after ocular trauma induced variable retinal and ON pathology, undermining our candidate neuroprotective therapy, siCASP2.

Aim: The aim of this study was to ascertain the opinion of patients on counselling of the surgical patient in tertiary healthcare facilities in Port Harcourt in the months of May and June 2020. Background: Counseling of the surgical patient is a dynamic process and its scope which is individualized should arm the patient with information on the purpose and nature of the disease and treatment, etc. Materials and Methods: Four hundred and twenty respondents were recruited for this cross-sectional descriptive study carried out in the wards and specialist surgical out-patient clinics of Teaching Hospitals in Port Harcourt, Nigeria between the months of May and June 2020 using semi-structured questionnaires. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Two hundred and twenty-five (53.6%) respondents asserted that they had counselling sessions for the surgical operation, 108 (25.7%) respondents opined that they did not have counselling session, while 87 (20.7%) were not sure if they had or not. Forty-five (10.7%) respondents asserted that the surgeons carried out the counselling. Only, 227 (54.0%) of the respondents affirmed that they were satisfied with the counselling sessions, while 104 (24.8%) respondents asserted that there was no counselling session at all. Conclusion: The opinion of patients on the counselling service experience is not entirely satisfactory. There is need for closer attention to be paid to issues of counselling of the surgical patient in order to ensure the full benefits of the services rendered.

Background Inaccessibility of medicines in low- and middle-income countries is a frequent challenge. Yet it is typically assumed that high-income countries have complete access to the full arsenal of medicines. This study tests this assumption for new antibacterials, which are saved as a last resort in order to prevent the development of resistance, resulting in insufficient revenues to offset costs. Prior studies report only regulatory approval, missing the important lag that occurs between approval and commercial launch, although some antibiotics never launch in some countries. Methods We identified all antibacterials approved and launched in the G7 and 7 other high-income countries in Europe for the decade beginning 1 January 2010, using quantitative methods to explore associations. Results Eighteen new antibacterials were identified. The majority were accessible in only 3 countries (United States, United Kingdom, and Sweden), with the remaining 11 high-income countries having access to less than half of them. European marketing authorization did not lead to automatic European access, as 14 of the antibacterials were approved by the European Medicines Agency but many fewer were commercially launched. There was no significant difference in access between “innovative” and “noninnovative” antibacterials. Median annual sales in the first launched market (generally the United States) for these 18 antibiotics were low, $16.2M. Conclusions Patient access to new antibacterials is limited in some high-income countries including Canada, Japan, France, Germany, Italy, and Spain. With low expected sales, companies may have decided to delay or forego commercialization due to expectations of insufficient profitability.

Introduction: Interfacility transport with helicopter from remote island clinics to urban hospitals account for a significant portion of the Hong Kong Government Flying Service missions. Currently, doctor and nurse escorts are deployed as volunteers only during the daytime from every Friday to Monday and on public holidays. While most transport runs smoothly, patient deterioration can occur during flight, warranting medical interventions on-board. Yet, little is known about the pattern and any clinical predictors of such interventions during helicopter interfacility transport missions. Methods: We collected Government Flying Service callout records from 1 January to 31 December 2016, and retrieved demographic, clinical and operational data. Interfacility transport mission was dispatched based on ‘Casualty Evacuation’ categories, which range from A+ (unstable), A (borderline) to B (stable). Univariate and multivariable logistic regression were used to identify independent predictors for in-flight medical interventions. Results: Of 1734 callout records, 386 interfacility transport missions escorted by volunteer doctors or nurses or both had complete flight medical records for analysis and 14.9% required in-flight medical interventions. Most interventions were related to oxygen therapy, intravenous fluid and administration of medications. Multivariable logistic regression showed that an age ⩾70 years, Casualty Evacuation A+ category, and any pre-flight emergency medical interventions were independent predictors for in-flight medical interventions. Conclusion: This study identified a few clinical predictors of in-flight medical interventions in an urban helicopter interfacility transport missions setting. Crewman training that focuses on the relevant procedural capabilities and clinical judgement is necessary to address the in-flight medical needs of interfacility transport missions.

This research is based on the thermodynamic performance of a gas turbine power plant. It considered the variation of operating conditions, i.e. the ambient temperature, the compressor outlet temperature, pressure ratio, etc. on the performance of the gas turbine thermal efficiency, turbine work, compressor work, etc. which were derived and analyzed. The Gross (higher) calorific values at constant pressure () heat of combustion in a flow process from state 1 to state 2 was considered and used to analyze our thermal efficiency. The results show that the ambient temperature and air to fuel ratio strongly influence the turbine work, compressor work and thermal efficiency. In addition, the thermal efficiency and power decreases linearly with increase of the ambient temperature. However, the efficiency analyzed when the calorific parameters were considered was higher than the efficiency when the basic thermodynamic theories (first and second law principles) were used. The first ranges between 31% to 33, while the second ranges between 28% to 32% under the same ambient temperature conditions

The COVID-19 pandemic has highlighted the inequitable access to resources, leading to a disproportionate burden of disease in vulnerable communities in the USA. However, these inequities in health outcomes are not limited to COVID-19. Approximately 18% of cancers are related to dietary behaviors and excess body weight. Underserved communities, such as minority racial/ethnic groups living in neighborhoods of low socioeconomic status, experience barriers to healthy eating including lack of access to high-quality healthy foods and higher availability of unhealthy foods and beverages in local retail food outlets. Strikingly, these same populations are more likely to die from cancers related to dietary intake and obesity like colorectal, liver, and pancreatic cancers. To reduce cancer inequities, policy makers can act by supporting programs that incentivize healthy food purchases and improve the local food environment in underserved communities., Graphical Abstract Graphical Abstract

Background: Choline supplementation (+Ch) improves cognitive function in impaired animals and humans. Chemotherapy-related cognitive deficits (CRCDs) occur in cancer patients, and these deficits persist following treatment, adversely impacting quality of life. To date, there are no approved treatments for this condition. Aim: Because +Ch improves impaired memory, it was of interest to determine whether +Ch can attenuate spatial memory deficits induced by the chemotherapeutic agents doxorubicin (DOX) and cyclophosphamide (CYP). Methods: Female BALB/C mice, 64 days of age, were trained in the Morris water maze and baseline performance determined on day 15. Following baseline assessment, mice were placed on +Ch diet (2.0% Ch) or remained on standard diet (0.12% Ch). Mice received intravenous injections of DOX (2.5 mg/kg) and CYP (25 mg/kg), or equivalent volumes of saline (0.9% NaCl), on days 16, 23, 30, and 37, and spatial memory was assessed weekly from day 22 to 71. Results: DOX and CYP produced a prolonged impairment in spatial memory as indicated by an increased latency to the correct zone ( p Conclusion: Although it remains to be determined whether this effect extends to other cognitive domains and whether +Ch is prophylactic or therapeutic, these findings suggest that +Ch may be an effective intervention for CRCDs.

Objective To discuss and summarise the background and recent advances in the approach to bronchoscopic ablative therapies for lung cancer, focusing on focal parenchymal lesions. Background This series focusses on the challenges highlighted by increasing recognition of the prognostically more favourable oligometastatic disease rather than the more frequent, but prognostically poor, high tumour burden metastatic disease. While surgery, stereotactic body radiation therapy (SBRT), and trans-thoracic percutaneous ablative techniques such as microwave (MWA) and radiofrequency ablation (RFA) are well recognised options for selected cases of pulmonary oligometastasis, bronchoscopic approaches to pulmonary tumour ablation are becoming realistic alternatives. An underlying tenet driving research and implementation in this domain is that percutaneous ablative techniques are obliged to traverse the pleura leading to a high rate of pneumothorax, and risks also goes up for peri-vascular lesions. Historically low yield bronchoscopic targeting of isolated peripheral tumors have significantly improved by incorporating multi-modality high resolution imaging and processing, including navigation planning and real-time image guidances (ultrasound, electromagnetic navigation, cone-beam CT). Combining advanced image guidance with ablative technology adaptations for bronchoscopic delivery opens up the options for high dose local ablative therapies that may reduce transthoracic complications and provide palliative to curative options for limited stage primary and oligometastatic diseases. Methods We conduct a narrative review of the literature summarizing the history of bronchoscopic tumor ablation approaches, technical details including biologic rational for their uses, and current evidence for each modality, as well as investigations into future applications. Because of the relative paucity of prospective studies, we have been very inclusive in our inclusion of experiences from the published clinical databases. Conclusions Whilst surgical resection and SBRT remain the current mainstay of curative therapies for peripheral cancers, in the foreseeable future, developments and further research will see bronchoscopic ablative therapies become viable lung sparing alternatives in those deemed suitable. The future is bright.

Ovarian cancer is the third most common cancer and the second most common cause of gynecologic cancer death in women. Its routine clinical management includes surgical resection and systemic therapy with chemotherapeutics. While the first-line systemic therapy requires the combined use of platinum-based agents and paclitaxel, many ovarian cancer patients have recurrence and eventually succumb to chemoresistance. Thus, it is imperative to develop new strategies to overcome recurrence and chemoresistance of ovarian cancer. Repurposing previously-approved drugs is a cost-effective strategy for cancer drug discovery. The antiparasitic drug mebendazole (MBZ) is one of the most promising drugs with repurposing potential. Here, we investigate whether MBZ can overcome cisplatin resistance and sensitize chemoresistant ovarian cancer cells to cisplatin. We first established and characterized two stable and robust cisplatin-resistant (CR) human ovarian cancer lines and demonstrated that MBZ markedly inhibited cell proliferation, suppressed cell wounding healing/migration, and induced apoptosis in both parental and CR cells at low micromole range. Mechanistically, MBZ was revealed to inhibit multiple cancer-related signal pathways including ELK/SRF, NFKB, MYC/MAX, and E2F/DP1 in cisplatin-resistant ovarian cancer cells. We further showed that MBZ synergized with cisplatin to suppress cell proliferation, induce cell apoptosis, and blunt tumor growth in xenograft tumor model of human cisplatin-resistant ovarian cancer cells. Collectively, our findings suggest that MBZ may be repurposed as a synergistic sensitizer of cisplatin in treating chemoresistant human ovarian cancer, which warrants further clinical studies.

It is important to evaluate the media's health coverage of Indigenous communities both because these communities have been hit very hard by health inequities, and because misinformation can negatively affect the future health of Indian Country. This study takes the unique angle of examining both Indigenous and non-Indigenous ("mainstream") news publications to evaluate information gaps in health, health policy, and health efficacy coverage. The Indigenous media examined, which covered 14 times more health stories than mainstream media, highlighted health issues in Indian Country through the lens of resilience by using framing to emphasize unequal power, while at the same time providing depth and specificity. Instead of putting Indigenous health stories into historical and cultural context, mainstream media focused on the lack of resources and the chronic struggle of Indigenous communities. Mainstream media often only covered the topic once per outlet; however, those outlets with connections to Indigenous communities did provide more balanced coverage. Instead of promoting change, most mainstream media stories blamed Indigenous people for their situation and offered a doom trajectory for tribes hit hardest by health disparities. This study reveals how embedded framing and mediatization direct non-Native readers' attention away from the systemic deprivation of support to U.S. Indigenous tribes that was guaranteed to them by the U.S. government in tribal agreements. The implications for journalism and policy are discussed.

A dynamic, physical model was created to predict soil erosion of Lagawe River Sub-watershed, a sub-watershed of Magat River Watershed, Philippines. Tipping-bucket rain gauge was installed to gather event-based rainfall data and a water-level recorder was installed on a straight segment of Lagawe River to gather water depth. Sediment samples were taken during rainstorm events and were used to calibrate the model. Manning’s equation was used to calculate surface runoff and stream flow velocity. Rose’ and Freebairn’s Equation was used to calculate sediment mass. Geographic Information System was utilized as a tool for modelling using PCRaster Software. The model estimated a total of 57,905,000 m3 of eroded sediments which was generated during Typhoon Koppu (local name, Lando) in year 2015. A Welch Two Sample t-value of -0.25 and a p-value of 0.81 was achieved on the statistical analysis between the measured sediment yield and the output of the model. Since the p-value is greater than 0.05 (5%), there is no significant difference between the output of the physical dynamic model and the measured value for sediment yield. Likewise, the correlation analysis supports this conclusion with a linearly positive R2 value of 0.74.

Introduction. The current management of advanced non-small cell lung cancer (NSCLC) includes the characterization of Programmed Death Ligand-1 (PD-L1) expression for potential immune checkpoint inhibitor treatment. There is currently no available data regarding the patterns of PD-L1 expression in NSCLC, as well as their association with clinicopathologic profile in Filipino patients. Methodology. Clinicopathologic characteristics of 187 consecutive NSCLC clinical samples with PD-L1 testing using the clone 22C3 pharmaDx kit were collected. The presence of stromal tumor-infiltrating lymphocytes (TILs) were assessed in hematoxylin and eosin-stained slides. PD-L1 expression on tumor cells (TC) and stromal TILs were evaluated. Results. Of the 187 cases, there were 112 males and 75 females. The mean age at diagnosis was 66.4 years old (32-92 years old). It is composed of 131 cases of Adenocarcinoma, 15 Squamous cell carcinoma, 4 Adenosquamous carcinoma, 32 Non-small cell carcinoma, not otherwise specified, 3 poorly differentiated malignancy, 1 Large cell carcinoma, and 1 Mucinous carcinoma. Specimen types included 17 pleural fluid cell blocks, 60 tumor cell block samples, and 110 tissue biopsies. Tumor cell PD-L1 expression was identified in 59.1% of the 110 tissue biopsies. PD-L1 TPS for histologic specimens are as follows: TPS >50%, TPS 1-49%, and TPS

OBJECTIVE To describe risk of recurrence and recurrence characteristics between ever- and never-smoking patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) when stratified by primary tumor subsite. STUDY DESIGN Retrospective observational study. SETTING Tertiary care center. METHODS Retrospective chart review of 171 patients with HPV+ OPSCC with primary treatment between 2008 and 2019. Five-year recurrence-free survival and risk of recurrence were evaluated through Kaplan-Meier curves with log-rank test and Cox proportional hazards models, respectively. RESULTS Of 171 patients with HPV+ OPSCC, 81.9% were male, and the average age was 63.9 years. Eighty patients (46.8%) had a smoking history (average, 17.7 pack-years), including 4 current smokers. Recurrence occurred in 31 patients (18.1%), 19 of whom were ever smokers. The recurrence rate for ever smokers with primary base of tongue (BOT) cancer was 41.7%, while 5.1% of never smokers with BOT primaries had recurrence. For primary tonsillar disease, 9.1% of ever smokers had recurrence versus 19.2% of never smokers. Five-year recurrence-free survival for BOT primaries was lower in ever smokers than never smokers (P = .001) but did not differ between ever and never smokers for tonsillar primaries (P = .215). In multivariable analysis across this period, ever-smoking status was associated with higher risk of recurrence than never-smoking status in BOT primaries (adjusted hazard ratio, 7.36; 95% CI, 1.61-33.68; P = .010) but with lower risk of recurrence after tonsillar primaries (adjusted hazard ratio, 0.23; 95% CI, 0.06-0.89; P = .033). CONCLUSION Smoking may uniquely interact with tumor subsites within the oropharynx to influence recurrence risk. Understanding the association between smoking and HPV+ OPSCC recurrence could lead to personalized, evidence-based treatments to improve oncologic outcomes.

BackgroundConcomitant chronic hepatitis B infection (CHB) and non-alcoholic fatty liver disease (NAFLD) is common, but the implications of NAFLD on clinical outcomes of CHB, including hepatocellular carcinoma (HCC), are not well-investigated. MethodsCHB patients were recruited for transient elastography assessment for liver stiffness (LS), and controlled attenuation parameter (CAP), a non-invasive quantification of hepatic steatosis, and were prospectively followed up for development of HCC. Steatosis and severe steatosis were diagnosed by CAP ≥248 dB/m and ≥280 dB/m respectively, and advanced fibrosis/ cirrhosis was diagnosed by LS ≥9 kPa. The independent effect of hepatic steatosis on HCC was examined via propensity score matching (PSM) of LS and other significant clinical variables.ResultsForty-eight patients developed HCC among 2403 CHB patients (55.6% male, median age 55.6 years, 57.1% antiviral-treated, median ALT 26 U/L) during a median follow-up of 46.4 months. Multivariate Cox regression analysis showed age (HR 1.063), male (HR 2.032), Albumin-Bilirubin score (HR 2.393) and CAP (HR 0.993) were associated with HCC development. The cumulative probability of HCC was 2.88%, 1.56% and 0.71%, respectively for patients with no steatosis, mild-to-moderate steatosis, and severe steatosis, respectively (p=0.01). The risk of HCC increased from 1.56% to 8.89% in patients without severe steatosis if advanced fibrosis/cirrhosis were present (p

Blue light imaging (BLI) has been shown to improve the characterization of colorectal polyps among the endoscopy experts. We aimed to determine if this technology could be taught to endoscopy trainees while maintaining high accuracy and interobserver agreement.Twenty-one gastroenterology trainees (fellows) from two academic institutions participated in this prospective study. Each trainee completed a web-based learning comprising four modules: pre-test, didactic videos explaining the BLI Adenoma Serrated International Classification (BASIC), interactive examples, and post-test assessment. The pre- and post-test modules consisted of reviewing video images of colon polyps in high definition white light imaging and BLI and then applying the BASIC classification to determine if the polyps were likely to be adenomatous. Confidence in adenoma identification (rated '1' to '5'), accuracy in polyp (adenoma vs. non-adenoma) identification, and agreement in characterization per BASIC criteria were derived.Trainee accuracy in the adenoma diagnosis improved from 74.7% (pre-test) to 85.4% (post-test) (P 0.01). There was a trend towards higher accuracy in polyp characterization with subsequent years of training (1st year fellows 77.4%, 2nd year 88.5%, and final year 94.0%) with consistent improvements after the e-learning across years of trainees. Overall, trainees were able to identify adenoma with a high sensitivity of 86.9%, specificity 83.9%, positive predictive value of 84.4%, and negative predictive value of 86.5%. However, their interobserver agreement in adenoma diagnosis was moderate (k = 0.52).The novel BLI classification can be easily taught to gastroenterology trainees using an online module and accuracy improves with years of training reaching90% for colorectal polyp characterization.

On 22 March 2014, a massive, catastrophic landslide occurred near Oso, Washington, USA, sweeping more than 1 km across the adjacent valley flats and killing 43 people. For the following 5 weeks, hundreds of workers engaged in an exhaustive search, rescue, and recovery effort directly in the landslide runout path. These workers could not avoid the risks posed by additional large-scale slope collapses. In an effort to ensure worker safety, multiple agencies cooperated to swiftly deploy a monitoring and alerting system consisting of sensors, automated data processing and web-based display, along with defined communication protocols and clear calls to action for emergency management and search personnel. Guided by the principle that an accelerating landslide poses a greater threat than a steadily moving or stationary mass, the system was designed to detect ground motion and vibration using complementary monitoring techniques. Near real-time information was provided by continuous GPS, seismometers/geophones, and extensometers. This information was augmented by repeat-assessment techniques such as terrestrial and aerial laser scanning and time-lapse photography. Fortunately, no major additional landsliding occurred. However, we did detect small headscarp failures as well as slow movement of the remaining landslide mass with the monitoring system. This was an exceptional response situation and the lessons learned are applicable to other landslide disaster crises. They underscore the need for cogent landslide expertise and ready-to-deploy monitoring equipment, the value of using redundant monitoring techniques with distinct goals, the benefit of clearly defined communication protocols, and the importance of continued research into forecasting landslide behavior to allow timely warning.

ObjectivesAtrial secondary mitral regurgitation (ASMR) is a clinically distinct form of Carpentier type I mitral regurgitation (MR), rooted in excessive atrial and mitral annular dilation in the absence of left ventricular dysfunction. Mitral valve annuloplasty (MVA) is expected to provide a more durable solution for ASMR than for ventricular secondary MR (VSMR). Yet data on MR recurrence and outcome after MVA for ASMR are scarce. This study sought to investigate surgical outcomes and repair durability in patients with ASMR, as compared with a contemporary group of patients with VSMR.MethodsClinical and echocardiographic data from consecutive patients who underwent MVA to treat ASMR or VSMR in an academic centre were retrospectively analysed. Patient characteristics, operative outcomes, time to recurrence of ≥moderate MR and all-cause mortality were compared between patients with ASMR versus VSMR.ResultsOf the 216 patients analysed, 97 had ASMR opposed to 119 with VSMR and subvalvular leaflet tethering. Patients with ASMR were typically female (68.0% vs 33.6% in VSMR, pConclusionPrognosis following MVA to treat ASMR is better, compared with VSMR as reflected by lower all-cause mortality and MR recurrence. Early distinction of secondary MR towards underlying ventricular versus atrial disease has important therapeutic implications.