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To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014.We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion.Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years.The decline in abortion was not uniform across all population groups.

Thrombocytopenia is, after anemia, the most frequent hematological problem among sick neonates. In this population, thrombocytopenia has traditionally been defined as a platelet count 9 /L, and has been classified as mild (100–150 × 10 9 /L), moderate (50–99 × 10 9 /L), and severe ( 9 /L). However, large population-based studies have shown that platelet counts increase with advancing gestational age, and platelet counts between 100 and 150 × 10 9 /L are more frequent among otherwise healthy extremely preterm infants than among full term neonates or older children. This suggests that different definitions of thrombocytopenia and thrombocytosis should be applied to preterm infants. The diagnostic approach to a thrombocytopenic neonate is facilitated if the thrombocytopenia is categorized as “early onset” (within the first 72 hours of life, usually secondary to congenital or intrauterine abnormalities) or “late onset” (after 72 hours, usually due to acquired conditions). Importantly, infection/sepsis should always be considered near the top of the differential diagnosis, as any delay in diagnosis and treatment can have life-threatening consequences. While in vitro studies have clearly shown that neonatal platelets are hyporesponsive to most agonists, this platelet hyporeactivity is well compensated by factors in neonatal blood that increase clotting (i.e. high hematocrit, high VWF concentrations), resulting in adequate primary hemostasis. The risk of bleeding in thrombocytopenic neonates is poorly predicted by the platelet count; gestational age

PurposeStudies on the association between peripheral neuropathy (PN) and patient-reported outcomes have mostly overlooked sleep quality. Therefore, we aimed to assess the association between PN and sleep quality in a population-based sample of colorectal cancer (CRC) patients up two years after diagnosis. MethodsAll newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N=340) completed questionnaires about PN (EORTC QLQ-CIPN20) and sleep (PSQI) before initial treatment (baseline) and one and two years after diagnosis. ResultsPatients who developed sensory PN (n=76) or motor PN (n=79) after treatment more often reported poor sleeping scores (PSQI>5) compared with those who did not develop SPN or MPN at 1-year (SPN: 38% vs. 261%, MPN: 37% vs. 14%) and 2-year follow-up (SPN: 38 vs. 23%, MPN: 37% vs. 18%) (all pConclusionsBoth SPN and MPN were significantly associated with the course of sleep quality among CRC patients up to two years after diagnosis. Clinicians should be encouraged to discuss sleep quality with their patients who either report PN or are at risk of developing PN. Implications for survivors: Improving sleep quality among survivors with PN is important, either by reducing PN symptoms, or directly targeting sleep

Background: We aimed to develop census-linked longitudinal mortality data for Japan and assess their validity as a new resource for estimating socioeconomic inequalities in health. Methods: Using deterministic linkage, we identified, from national censuses for 2000 and 2010 and national death records, persons and deceased persons who had unique personal identifiers (generated using sex, birth year/month, address, and marital status). For the period 2010–2015, 1,537,337 Japanese men and women aged 30–79 years (1.9% in national census) were extracted to represent the sample population. This population was weighted to adjust for confounding factors. We estimated age-standardized mortality rates (ASMRs) by education level and occupational class. The slope index of inequality (SII) and relative index inequality (RII) by educational level were calculated as inequality measures. Results: The reweighted sample population’s mortality rates were somewhat higher than those of the complete registry, especially in younger age-groups and for external causes. All-cause ASMRs (per 100,000 person-years) for individuals aged 40–79 years with high, middle, and low education levels were 1,078 (95% confidence interval [CI], 1,051–1,105), 1,299 (95% CI, 1,279–1,320), and 1,670 (95% CI, 1,634–1,707) for men, and 561 (95% CI, 536–587), 601 (95% CI, 589–613), and 777 (95% CI, 745–808) for women, respectively, during 2010–2015. SII and RII by educational level increased among both sexes between 2000–2005 and 2010–2015, which indicates that mortality inequalities increased. Conclusion: The developed census-linked longitudinal mortality data provide new estimates of socioeconomic inequalities in Japan that can be triangulated with estimates obtained with other methods.

Millimeter wave (mmWave) spectrum promises unprecedented data rates in 5G New Radio (NR). However, mmWave links are susceptible to severe path and propagation losses. Implementation of directional antennas that can manifest multiple beams becomes necessary at 5G base stations (gNBs) and User Equipments (UEs). Random access procedure (RAP), which is the first stage to establish connections to gNB, in its current state would be inadequate for such systems. To support RAP, 5G NR introduced mapping of different subsets of preambles in Physical Random Access Channel (PRACH) to different beams. We explore changes in RAP due to preamble-beam mapping and present a novel online algorithm to dynamically distribute preambles amongst beams to achieve fair access opportunities. The proposed algorithm can also eliminate overload problem of the beams with large UE population especially for high arrival rates. We extend the proposed algorithm to be applicable for RAP with access class barring mechanism which enables UEs to transmit a preamble with an optimal probability and, therefore, reduce access congestion. Through extensive simulations, we validate the efficiency of our proposed algorithms in providing fair channel access opportunities, improving throughput (or stability region), and reducing access delay when the system has high rate of UE arrivals and has unbalanced UE arrivals over different beams.

The United States population is aging and increasing in comorbidity, and patient care is accordingly growing increasingly complex. Complexity impacts patterns of resource consumption, adverse event and medical error rates, health-related quality of life, physician burnout, and more. Tools capturing complexity can be of benefit in the modern value-based reimbursement landscape and have been well-studied in specialties other than dermatology. In this paper, we describe the validation of a tool specific to outpatient dermatologic care that captures the complexity of clinical visit medical decision-making. We performed a cross-sectional retrospective study to determine the inter-rater reliability and face validity of the tool. By objectively grading a clinical encounter based on clinical complexity, there is increased awareness of opportunities to improve clinical care and the allocation of healthcare costs and resources within the dermatologic community can be better assessed.

BACKGROUND Lacrosse is one of the fastest-growing sports in the United States. Its rules regarding permitted contact differ by sex and age. There are no known studies using a nationally representative data set to analyze lacrosse injury patterns over several years by sex and age in the youth population. METHODS A retrospective analysis was performed using data from the National Electronic Injury Surveillance System for youth aged 11-18 years who were treated for lacrosse-related injuries in U.S. emergency departments from 2000 to 2016. Based on our review of the case narratives, we created and coded a new injury-mechanism variable. We generated national estimates from 6406 cases. RESULTS An estimated 206,274 lacrosse-related injuries to youths aged 11-18 years were treated in U.S. emergency departments from 2000 to 2016. The rate of injuries per 10,000 significantly increased from 1.9 in 2000 to a peak of 5.3 in 2012 (p < 0.0001), followed by a significant decrease to 3.4 in 2016 (p = 0.020). Injury mechanism, body part injured, and diagnosis differed by sex. Boys were 1.62 times (95%CI: 1.25-2.09) more likely than girls to be injured by player-to-player contact. Girls were 2.21 times (95%CI: 1.96-2.49) more likely than boys to have non-contact injuries. Overall, as age increased, the percentage of injuries from lacrosse sticks decreased and player-to-player contact increased. CONCLUSION Despite additional protective regulations in the sport, lacrosse is an important source of injury where we continue to see differences by sex and age. This study supports the continuation, modification, and addition of rules aimed at reducing lacrosse injury risk.

To determine the prevalence of abnormal laryngeal findings during videostroboscopy in performers presenting to clinic or when having an acute vocal emergency.Retrospective study of professional singers and actors who presented for a vocal evaluation.A chart review of singers or professional actors who presented in a private otorhinolaryngology clinic between 2014 and 2016. The prevalence of laryngeal lesions noted on stroboscopy were reviewed. The RFS (reflux finding score) was calculated and the exams that presented RFS greater than or equal to seven were considered suspicious of laryngopharyngeal reflux (LPR).A total of 140 records of actors and singers were evaluated either for routine evaluation or for an acute emergency. Sulcus vocalis was the most prevalent lesion 36% (n = 33), followed by cyst 27% (n = 25) and acute laryngitis, 14% (n = 13). Thirty-seven (26.4%) performers were treated for emergence due to dysphonia, Emergency dysphonia, mostly due to viral infection, was treated with steroids and speech therapy, with improvement of symptoms after treatment. Of these professionals, 83.8% (31) presented with a structural lesion or infection in the vocal folds, while 16.2% presented with dysphonia, which required emergency care without a structural lesion in the vocal folds. (P0.05) Eighty-nine percent (33) of the professionals presenting with a voice emergency with dysphonia (37) were treated with corticosteroids. Thirty-three percent (n = 47) of the professionals presented with RFS scores ≥7. Nineteen professionals (40%) with signs of LPR were treated for emergency due to dysphonia. The professionals with signs of LPR had more emergency dysphonia than those who did not suspect LPR. (19.4%) (P = 0.008).Vocal emergencies in professionals are common in a private laryngology practice and require specialized assessment. The most prevalent lesions in the study were vocal sulcus. LPR is common in this group as noted both by findings with videostroboscopy and the RFS.

Absract Background Obstetrics as a speciality has a very long association with the transfusion services and poses its own set of immunohematological (IHL) challenges. A study was carried out to evaluate the spectrum of IHL issues in obstetrics in our setup and to suggest a way forward. Methods This study was carried out in a transfusion services setup catering to antenatal care (ANC) clientele in two tertiary-level health care setups. Samples were collected from all ANC patients requiring transfusion and patients reporting for Indirect Coombs Test (ICT). Data included ICT positive cases with implicated alloantibodies, those requiring specialised procedures and the foetal outcome. The results were described using descriptive statistics by frequencies and percentages. Results A total of 4683 eligible samples were included in the study, out of 21,893 antenatal patients visiting our setup during study period. One hundred thirty-six ANC patient samples were found to be ICT positive. The most common single alloantibody was anti-D (n = 77, 57.5%). Double antibody positivity was found in 28 patients. Multiple alloantibodies were found in 1 patient. Up to 48% of these allo-anti D cases necessitated specialised procedures. Conclusion The IHL issues of obstetrics faced in our setup are no less than that in Indian population. We have much higher frequency of double alloantibody in our ANC population. The authors propose that all multiparous ANC patients, especially with a history of transfusion, irrespective of Rh D status should be screened for irregular alloantibodies to circumvent these issues and the last-minute rush for provision of compatible units.

This paper provides causal evidence that greater minority representation on school boards translates into greater investment in minority students. Focusing on California school boards, I obtain causal effects by instrumenting for minority (specifically, Hispanic) school board representation using the random order in which candidates appear on election ballots. Given the dearth of school-level expenditure data, I introduce detailed records from California’s School Facility Program (SFP), a capital investment program for which I observe how school boards allocate the marginal dollar within district. Instrumental variables estimates show that an additional Hispanic school board member increases SFP-funded investments at high-Hispanic schools within the district by 69 percent, with significantly lower effects at low-Hispanic schools. High-Hispanic schools also exhibit gains in student achievement of 0.08 standard deviations. I attribute this improved performance broadly to increased investment in these schools: new instructor hiring at high-Hispanic schools decreases by 23 percent. These results provide the first causal evidence that school board politics—and, specifically, school board ethnic composition—shapes education finance policy at the local level. I conclude that enhancing minority representation on school boards could help combat disparities in education finance and achievement.

Prevalence of testosterone deficiency is increasing in the adolescent and young adult male population. As the average paternal age rises, there is a significant population of men with hypogonadism seeking testosterone therapy wishing to achieve or maintain fertility potential. Identification of potential lifestyle modifications that may improve the testosterone deficiency is one of the initial interventions of the holistic strategy in treatment. This is followed by drug therapy; however, traditional testosterone therapy acts as a contraceptive by suppressing the hypothalamus-pituitary-gonadal (HPG) axis and therefore cannot be used as a treatment strategy. A solution has been the off-label use of selective estrogen receptor modulators, human chorionic gonadotropin (hCG), and anastrozole inhibitors to treat hypogonadal symptoms while increasing intratesticular testosterone, a necessity for spermatogenesis. Recently, a novel therapy, Natesto intranasal testosterone gel, has been shown to increase serum testosterone levels while maintaining semen parameters. This is hypothesized to be because of its short-acting properties having lesser effect on the HPG axis, in contrast to the long-acting properties of traditional testosterone therapy. It is important to differentiate hypogonadal men between those seeking to achieve or maintain fertility status because the drug therapy of choice differs. This can be accomplished by determining the levels of 17-hydroxyprogesterone (17-OHP), because it is a biomarker for intratesticular testosterone. Those with low 17-OHP may wish to initiate treatment with alternative therapies, whereas those with high 17-OHP may trial short-acting testosterone therapies. As the urologist's armamentarium continues to increase, better strategies to increase testosterone levels in men seeking fertility can be achieved.

Non-obstructive azoospermia is reported to affect 1 in 100 men, and despite advances in surgical practice, the succesful sperm retrieval rate for microdissection testicular sperm extraction surgery (mTESE) is only 46%. This article reviews the potential causes for mTESE failure and provides a management strategy to guide the clinicians on how to treat this challenging cohort of patients.

Background: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the treatment strategy for non-infarct-related artery (non-IRA) remains controversial. Quantitative flow ratio (QFR) is a new angiography-based physiological assessment index. However, there is little evidence on the practical clinical application of QFR. Methods: Two hundred and twenty-nine patients with STEMI and MVD were recruited for this study. Patients were randomly assigned to either receive QFR-guided complete revascularization (QFR-G-CR) of non-IRA or receive no further invasive treatment. The primary (1o) endpoint analyzed included death due to all causes, non-fatal myocardial infarction (MI), and ischemia-induced revascularization at 12 months post-surgery. Secondary (2o) endpoints included cardiovascular death, unstable angina, stent thrombosis, New York Heart Association (NYHA) class IV heart failure (HF), and stroke at 1 year post surgery. Massive bleeding and contrast-associated acute kidney injury (CAKI) were used as safety endpoints. Results: Around the 12 month follow up, the 1o outcome was recorded in 11/115 patients (9.6%) in the QFR-G-CR population, relative to 23/114 patients (20.1%) in the IRA-only PCI population (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.22–0.92; p = 0.025). Unstable angina in 6 (5.2%) and 16 (14.0%) patients (HR: 0.36; 95% CI: 0.14–0.92; p = 0.026), respectively. No marked alterations were found in the massive bleeding and CAKI categories. Conclusions: In conclusion, STEMI and MVD patients can benefit from QFR-G-CR of non-IRA lesions in the initial stages of acute MI. This can help reduce incidences of major adverse cardiovascular events and unstable angina, relative to IRA treatment only. Chinese Clinical Trial Registration number: ChiCTR2100044120.

BACKROUND AND OBJECTIVE: Lower limb strength after stroke, particularly of the more paretic side, is known to correlate with comfortable gait speed. This meta-analysis sought to determine the relative value of 6 muscle group strengths as explanators of comfortable gait speed. METHODS: Relevant literature was sought using PubMed, CINAHL Scopus, and a hand search. Information on samples, measurements, and correlations were extracted. Correlational data were subjected to meta-analysis. RESULTS: Results from 6 studies were consolidated. The summary correlations between paretic lower limb strength and comfortable gait speed ranged from 0.45 to 0.61. Data were highly heterogeneous but did not show publication bias. CONCLUSIONS: The correlation between the lower limb strength and comfortable gait speed strength was moderate. However, it does not provide an adequate explanation to guide clinical practice.

Learning-to-learn, a progressive speedup of learning while solving a series of similar problems, represents a core process of knowledge acquisition that draws attention in both neuroscience and artificial intelligence. To investigate its underlying brain mechanism, we trained a recurrent neural network model on arbitrary sensorimotor mappings known to depend on the prefrontal cortex. The network displayed an exponential time course of accelerated learning. The neural substrate of a schema emerges within a low-dimensional subspace of population activity; its reuse in new problems facilitates learning by limiting connection weight changes. Our work highlights the weight-driven modifications of the vector field, which determines the population trajectory of a recurrent network and behavior. Such plasticity is especially important for preserving and reusing the learnt schema in spite of undesirable changes of the vector field due to the transition to learning a new problem; the accumulated changes across problems account for the learning-to-learn dynamics.

BACKGROUND White rice is a staple food for Japanese, a population at high risk for colorectal cancer (CRC). We investigated the association between white rice intake and CRC among Japanese Americans in the Multiethnic Cohort (MEC) study. METHODS The Multiethnic Cohort Study is a prospective study established in Hawaii and California in 1993-1996. Usual dietary intake was assessed by a validated quantitative food frequency questionnaire at baseline. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) for quartiles of intake and to perform trend tests across sex-specific quartiles with adjustment for relevant confounders. RESULTS We identified 1,553 invasive CRC cases among 49,136 Japanese Americans (23,595 men and 25,541 women) during a mean follow-up of 19 years. White rice consumption was not associated with overall CRC incidence in men (p-trend = 0.11) or women (p-trend = 0.56). After excluding participants with a history of diabetes, the inverse associations were significant for CRC (p-trend = 0.03, HR for quartile 4 (Q4) vs. 1 = 0.81; 95% CI: 0.64-1.03) and tumors of the distal colon (p-trend = 0.006, HR for Q4 vs. Q1: 0.66; 0.44-0.99) among men but not women. CONCLUSIONS White rice consumption was not associated with an increased risk of overall CRC among Japanese Americans. An inverse association was observed with risk of CRC and distal colon cancer in men without a history of diabetes.

BACKGROUND Environmental and genetic factors are suggested to exhibit factor-based association with HDL-cholesterol (HDL-C) levels. However, the population-based effects of environmental and genetic factors have not been compared clearly. We conducted a cross-sectional study using data from the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study to evaluate the population-based impact of smoking, drinking, and genetic factors on low HDL-C. METHODS Data from 11,498 men and women aged 35-69 years were collected for a genome-wide association study (GWAS). Sixty-five HDL-C-related SNPs with genome-wide significance (P < 5 × 10-8) were selected from the GWAS catalog, and seven representative SNPs were defined, and the population-based impact was estimated using population attributable fraction (PAF). RESULTS We found that smoking, drinking, daily activity, habitual exercise, egg intake, BMI, age, sex and the SNPs CETP rs3764261, APOA5 rs662799, LIPC rs1800588, LPL rs328, ABCA1 rs2575876, LIPG rs3786247, and APOE rs429358 were associated with HDL-C levels. The gene-environmental interactions on smoking and drinking were not statistically significant. The PAF for low HDL-C was the highest in men (63.2%) and in rs3764261 (31.5%) of the genetic factors, and the PAFs of smoking and drinking were 23.1% and 41.8%, respectively. CONCLUSIONS The present study showed that the population-based impact of genomic factor CETP rs3764261 for low HDL-C was higher than that of smoking and lower than that of drinking.

Teacher performance scores inform education leaders’ management of teacher human resources. However, prior research has implied that different interpretations of performance criteria between teachers and their evaluators suppress teacher development. Although research has examined teacher perceptions of performance scores and compared teacher self-scores with researcher-generated scores, no work has estimated the statistical differences between self-scores and field-based evaluator scores. I applied structural equation modeling to a unique dataset of over 4,000 teacher self-scores and 4,000 evaluator scores of teacher performance to examine the extent to which teachers and evaluators applied a standards-based teaching performance rubric similarly. Consistent with prior work, some average self-scores exceeded average evaluator scores; however, evaluator-assigned scores exceeded self-scores on one indicator. The evidence also suggested that teachers and evaluators interpreted the meaning of two performance indicators differently. The findings imply that there are opportunities to strengthen evaluators’ and teachers’ shared understanding of teacher performance criteria. Teachers and evaluators might develop shared understandings by viewing videorecorded lessons and collaboratively interpreting teaching episodes using the performance criteria. Education leaders might also emphasize that preobservation conferences are an opportunity for evaluators and teachers to discuss performance criterion interpretations. As some selfscores exceeded evaluator scores, education leaders could introduce a consider-the-opposite scoring strategy, where evaluators consider two reasons that the score they want to give could be inaccurate, prompting stronger scoring justification, potentially leading to more accurate scoring.

Introduction The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Since emerging more than a century ago, petroleum engineering (PE) education has increasingly kept its popularity despite significant downturns in the industry. During these downturn periods, observed at least four times since the 1973 oil crisis, structural changes in university programs have been considered. On the other hand, during the "heyday" periods, institutions have had to tackle enormous demand from industry, severely increased enrollments, and reestablish resources to provide a proper service. In light of these observations and while experiencing the fifth downturn period over the last five decades, it is time again to ask the same question: "Shall we continue with the same PE education model or radically shift to a new model?" In this paper, after reviewing more than fifty articles published over the last 85 years reporting the attempts made towards reshaping PE education, an option of restructuring PE programs is discussed. This option is less oil industry (and oil prices) dependent and more of a "general" engineering education program with an emphasis on the "geoscience" or "subsurface" engineering aspects of the PE discipline. Detailed discussions focus on curriculum updates to address the industry practice of "subsurface" related engineering applications. Viability of this option was discussed from industry, academia, and students’ perspective. This restructuring option requires substantial changes to curricula, skill development, and teaching and learning styles. Fundamentals are essential to include in PE education similar to other general (or major) engineering disciplines such as mechanical, civil, chemical, and electrical engineering. The essential elements of engineering skills such as creative design, decision making, problem description and solving, management under high degree of uncertainty, and data collection and processing for optimization are to be included in the new model. Finally, the model proposed is critically discussed and analyzed from different perspectives (industry, academia, and students) considering current and prospected subsurface engineering applications.

Surrogate-assisted evolutionary algorithms (SAEAs) have been widely used for solving complex and computationally expensive optimization problems. However, most of the existing algorithms converge slowly in the later stage. This article proposes a novel two-stage data-driven evolutionary optimization (TS-DDEO) that meets the requirements of early exploration and later exploitation. In the first stage, a surrogate-assisted hierarchical particle swarm optimization method is used to find a promising area from the entire search space. In the second stage, we propose a best-data-driven optimization (BDDO) method with a strong exploitation ability to accelerate the optimization process. BDDO has a real-time update mechanism for the surrogate model and population and uses a predefined number of ranking-top solutions to update population and surrogates. BDDO combines three surrogate-assisted evolutionary sampling strategies: 1) surrogate-assisted differential evolution sampling; 2) surrogate-assisted local search; and 3) a surrogate-assisted full-crossover (FC) strategy which is proposed to integrate existing best genotypes in the population. Experiments and analysis have validated the effectiveness of the two-stage framework, the BDDO method, and the FC strategy. Moreover, the proposed algorithm is compared with five state-of-the-art SAEAs on high-dimensional benchmark functions. The result shows that TS-DDEO performs better both in effectiveness and robustness.

Purpose: Top surgery, or masculinization of the chest, is often the first and sometimes only procedure in gender-affirming surgery for transgender- and gender-diverse persons assigned female at bir...

Objective Homeless and marginally housed populations experience a higher prevalence of visual impairment relative to the general population. The aim of this pilot study is to present a novel model for conducting ocular screening clinics for homeless individuals during a pandemic and to describe the status of ocular health in this population during this time. Methods In this cross-sectional study, 3 outdoor tent-based ocular screening clinics were held in a park in Toronto. Most participants were recruited from local shelters, but additional spots were allocated for homeless individuals on a drop-in basis. Prior to enrolment, each participant underwent COVID-19 screening via a questionnaire and temperature measurement. Those who screened negative received a comprehensive eye examination, including vision testing, dilated fundus examination, and autorefraction. Results Eleven individuals completed all assessments. The mean age of participants was 54.5 years, and 11 of the participants were male. Visual impairment was found in 5 individuals. Refractive error via pinhole testing was found in 1 patient. Ocular pathology in this sample was found in 4 participants. Two patients required a referral to an ophthalmologist. From a psychosocial perspective, 4 participants reported significant difficulties. Conclusions This novel tent-based ocular screening program provides a viable option for screening in a pandemic.

Lately lawyers and medical professionals pay more attention too the process of minor patient healthcare. The research shall address the issues of legal relationship between minor patients and medical professionals, consent to treatment of minor patients and communication problems including the scope of information which the doctor can provide to the minor patient’s relatives to protect themselves and patients. Legislation prescribes that the information provided by the medical professional to the minor patient must be not only easy-to-understand, but also be consistent with the patient’s age maturity. However, in Latvia, for example, there are no guidelines that specify how medical professionals can determine the patient’s maturity. In the course of provision of medical services to the minor persons legal disputes involving communiucation failures between the minor patients, their relatives, legal representatives and the doctors arise increasingly frequently. The research will look into issue of communication problems in healthcare. The aim of the research is to provide insight into challenges of legal relations betweem minor patients and medical professionals and communication problems in healthcare.

An expensive multimodal optimization problem (EMMOP) is that the computation of the objective function is time consuming and it has multiple global optima. This article proposes a decomposition differential evolution (DE) based on the radial basis function (RBF) for EMMOPs, called D/REM. It mainly consists of two phases: the promising subregions detection (PSD) and the local search phase (LSP). In PSD, a population update strategy is designed and the mean-shift clustering is employed to predict the promising subregions of EMMOP. In LSP, a local RBF surrogate model is constructed for each promising subregion and each local RBF surrogate model tracks a global optimum of EMMOP. In this way, an EMMOP is decomposed into many expensive global optimization subproblems. To handle these subproblems, a popular DE variant, JADE, acts as the search engine to deal with these subproblems. A large number of numerical experiments unambiguously validate that D/REM can solve EMMOPs effectively and efficiently.

Objectives To assess people's level of recognition of rheumatic disease symptoms and their awareness that the rheumatologist is the main effector when it comes to these disorders. Materials and methods Survey performed in 8 towns in the Buenos Aires Province. Every town had at least one rheumatologist. Three clinical cases were presented: (1) inflammatory low back pain, (2) systemic disease, and (3) chronic polyarthritis. The population was asked whether (a) a physician should be immediately consulted, or (b) they could wait. They were asked whether they would advocate any initial treatment. They were also asked which physician should be consulted. Results Out of 150 surveys, 68% were female, the average age was 51.7 years old. Most people asserted that treatment with anti-inflammatory drugs should come first: 83% in inflammatory low back pain, 70% in systemic disease, and 70% in chronic polyarthritis (p = 0.02). The number of men that suggested waiting was higher (47% vs. 28% of women; p = 0.04). A rheumatologist was recommended by 51% for chronic polyarthritis, 15% for systemic disease, and 8% for inflammatory low back pain (p Conclusions Chronic polyarthritis was the disease people identified best as within the rheumatologist's field of expertise. Men tended to delay consultation more than women. Consultation is less likely when the level of education is lower.

Introduction Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. Methods Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. Results There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p Conclusions IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.

Introduction: Chronic kidney disease of uncertain etiology (CKDu) has been found at high frequency in several lowland agricultural areas including Meso-America and Sri Lanka. Whether CKDu also occurs in other countries with large agricultural populations remains uncertain, primarily due to lack of systematic data on kidney function. Hemoglobin (Hgb) levels could be an ancillary marker for presence of kidney dysfunction. Our goal is to estimate the causal effect of agricultural work on Hgb level in men. A causal effect may indicate the presence of CKDu. Methods: We use Demographic and Health Surveys (DHS) data from seven African and Asian countries (Ethiopia, Lesotho, Namibia, Senegal, Uganda, Zimbabwe, and India). We use optimal full matching and permutation inference to estimate the causal effect of agricultural work on altitude-adjusted Hgb levels after adjusting for six known confounders. To assess potential bias due to unmeasured socioeconomic differences, we use multiple control groups that differ in non-agricultural occupation. We then conduct sensitivity analyses to assess the robustness of our causal conclusions to unmeasured confounding. Results: Data were available for 41,180 agricultural workers and 55,705 non-agricultural workers in seven countries. On average, Hgb levels were 0.09 g/dL (95% CI [-0.12, -0.07]) lower among agricultural workers compared to matched controls. Significant effects were observed in Ethiopia, India, Lesotho, Senegal, and Uganda, with effects from 0.10 to 0.32 g/dL lower hemoglobin among agricultural workers. The effect was not attenuated in sensitivity analyses involving both better-off and worse-off occupational controls. Discussion: We find evidence that men engaged in agricultural work in five of the seven countries studied have modestly lower Hgb levels compared with other men living in rural areas. Since underlying kidney disease could be a potential explanation for this finding, our data support consideration to integrating kidney function assessments within DHS surveys and other population-based surveys.

PURPOSE To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) codes for identifying infantile eye diagnoses. METHODS Population-based retrospective cohort study of all residents of Olmsted County, Minnesota diagnosed at ≤1 year of age with an ocular disorder. The medical records of all infants diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were identified. To assess ICD-9 code accuracy, the medical records of all diagnoses with ≥20 cases were individually reviewed and compared to their corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. RESULTS In a cohort of 5,109 infants with ≥1 eye-related ICD-9 code, 10 ocular diagnoses met study criteria. The most frequent diagnoses were conjunctivitis (N = 1,695) and congenital nasolacrimal duct obstruction (N = 1,250), while the least common was physiologic anisocoria (N = 23). The PPVs ranged from 8.3% to 88.0%, NPVs from 96.3% to 100%, sensitivity from 3.0% to 98.7%, and specificity from 72.6% to 99.9%. ICD-9 codes were most accurate at identifying physiologic anisocoria (PPV: 88.0%) and least accurate at identifying preseptal cellulitis (PPV: 8.3%). In eye specialists versus non-eye specialists, there was a significant difference in PPV of ICD-9 codes for conjunctivitis (26.8% vs. 63.9%, p

OBJECTIVE Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time. DESIGN A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility - disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity. RESULTS Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09-1.68] and mobility (OR = 1.34, 95% CI = 1.18-1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value

Objectives. To describe health-related behaviors or indicators associated with overall health and well-being using the Global Assessment Tool (GAT), a health behavior and psychosocial questionnaire completed annually by US Army personnel. Methods. We analyzed GAT responses from 2014 to 2018, consisting of 367 000 to 449 000 respondents per year. We used generalized estimating equations to predict the presence of each health behavior or indicator, aggregated by year and stratified on various demographics. Results. Key findings included decreases from 2014 to 2018 in risky health behaviors such as hazardous drinking (7.5% decrease) and tobacco use (7.9% decrease), dietary supplement use (5.0% to 10.6% decrease, depending on type), self-reported musculoskeletal injury (5.1% decrease), and pain interference (3.6% decrease). Physical activity, sleep, and nutritional habits largely remained consistent over time. Conclusions. In the Army, tobacco, alcohol, and risky dietary supplement usage appears to be declining, whereas lifestyle health behaviors have been stable. Whether these trends reflect responses to health education is unknown. The GAT provides useful insights into the health of the Army, which can be leveraged when developing health-related educational programs and policies. Public Health Implications. Health behaviors that have changed less over time (e.g., nutrition, sleep) may require novel approaches compared with those that changed more (e.g., dietary supplement use, drinking). (Am J Public Health. 2021;111(11):2064–2074. https://doi.org/10.2105/AJPH.2021.306456 )

Objectives. To assess the impact of the COVID-19 pandemic on immunization services across the life course. Methods. In this retrospective study, we used Michigan immunization registry data from 2018 through September 2020 to assess the number of vaccine doses administered, number of sites providing immunization services to the Vaccines for Children population, provider location types that administer adult vaccines, and vaccination coverage for children. Results. Of 12 004 384 individual vaccine doses assessed, 48.6%, 15.6%, and 35.8% were administered to children (aged 0–8 years), adolescents (aged 9–18 years), and adults (aged 19‒105 years), respectively. Doses administered overall decreased beginning in February 2020, with peak declines observed in April 2020 (63.3%). Overall decreases in adult doses were observed in all settings except obstetrics and gynecology provider offices and pharmacies. Local health departments reported a 66.4% decrease in doses reported. For children, the total number of sites administering pediatric vaccines decreased while childhood vaccination coverage decreased 4.4% overall and 5.8% in Medicaid-enrolled children. Conclusions. The critical challenge is to return to prepandemic levels of vaccine doses administered as well as to catch up individuals for vaccinations missed. (Am J Public Health. 2021;111(11):2027–2035. https://doi.org/10.2105/AJPH.2021.306474 )

Human brain is a complex yet economically organized system, where a small portion of critical hub regions support the majority of brain functions. The identification of common hub nodes in a population of networks is often simplified as a voting procedure on the set of identified hub nodes across individual brain networks, which ignores the intrinsic data geometry and partially lacks the reproducible findings in neuroscience. Hence, we propose a first-ever group-wise hub identification method to identify hub nodes that are common across a population of individual brain networks. Specifically, the backbone of our method is to learn common graph embedding that can represent the majority of local topological profiles. By requiring orthogonality among the graph embedding vectors, each graph embedding as a data element is residing on the Grassmannian manifold. We present a novel Grassmannian manifold optimization scheme that allows us to find the common graph embeddings, which not only identify the most reliable hub nodes in each network but also yield a population-based common hub node map. Results of the accuracy and replicability on both synthetic and real network data show that the proposed manifold learning approach outperforms all hub identification methods employed in this evaluation.

Objective Overall trends in rates of fully alcohol-attributable mortality may mask disparities among demographic groups. We investigated overall, demographic, and geographic trends in fully alcohol-attributable mortality rates in Minnesota. Methods We obtained mortality data from Minnesota death certificates and defined fully alcohol-attributable deaths as deaths that would not occur in the absence of alcohol. We calculated age-adjusted death rates during 2000-2018 using 5-year moving averages stratified by decedents’ characteristics and geographic location. Results Chronic conditions accounted for most of the alcohol-attributable deaths in Minnesota (89% during 2014-2018). Alcohol-attributable mortality rates per 100 000 population increased from an average rate of 8.0 during 2000-2004 to 12.6 during 2014-2018. During 2000-2018, alcohol-attributable mortality rates were highest among males (vs females), adults aged 55-64 (vs other ages), and American Indian/Alaska Native people (vs other racial and ethnic groups) and lowest among people aged ≤24 years and Asian or Pacific Islander people. During 2014-2018, the alcohol-attributable mortality rate among American Indian/Alaska Native people was more than 5 times higher than the overall mortality rate in Minnesota. Conclusions Results from this study may increase awareness of racial and ethnic disparities and continuing health inequities and inform public health prevention efforts, such as those recommended by the Community Preventive Services Task Force, including regulating alcohol outlet density and increasing alcohol taxes.

A teenage high school student underwent an X-ray of the chest during a routine physical examination at the time of admission to school, which revealed marked tracheal stenosis ([figure 1A][1]). The boy was diagnosed with Graves’ disease a year before due to goitre and easy fatigability and was

There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries.We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies.Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach.This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.

In 1961, K Merendino ‘in pure curiosity’, while tracking the murmur of mitral regurgitation, placed his stethoscope ‘on the vertex of the head’, and ultimately led to a medical curiosity and exam finding that not only bears his name, but awes medical learners at all stages of their careers. Merendino and colleagues collected seven such cases of the ‘Murmur on Top of the Head’ building on the work of others who provided a detailed description of mitral regurgitation and noted murmur radiation to the neck and cervical/lumbosacral spine. The majority of patients suffered from rheumatic heart disease or subacute bacterial endocarditis in native heart valves. Here, we report on a case of the ‘Murmur on Top of the Head’ and provide the reader/listener with a direct recording of the ‘Merendino murmur’ (as well as its spinal correlate) in an elderly woman with a bioprosthetic mitral valve.

A latent variable modeling-based procedure is discussed that permits to readily point and interval estimate the design effect index in multilevel settings using widely circulated software. The method provides useful information about the relationship of important parameter standard errors when accounting for clustering effects relative to conducting single-level analyses. The approach can also be employed as an addendum to point and interval estimation of the intraclass correlation coefficient in empirical research. The discussed procedure makes it easily possible to evaluate the design effect in two-level studies by utilizing the popular latent variable modeling methodology and is illustrated with an example.

The current population-based study examines the association between county-level ambient air pollution and childhood asthma. Data from the nationally representative 2010–2015 National Health Interview Survey were linked to nationwide fine particulate matter (PM2.5) air pollution data at the county-level from the National Environmental Public Health Tracking Network which utilizes air quality monitoring stations and modeled PM2.5 measurements (Downscaler model data) and adjusted by county-level socioeconomic characteristics data from the 2010–2015 American Community Survey. Multilevel modeling techniques were used to assess the association between PM2.5 annual concentrations (quartiles < 8.11, 8.11–9.50, 9.51–10.59, ≥ 10.60 µg/m3) and current childhood asthma along with two asthma outcomes (episode in the past year, emergency room (ER) visit due to asthma). From 2010 to 2015, there were significant declines in PM2.5 concentrations and asthma outcomes. In unadjusted models, children living in areas with higher PM2.5 concentrations were more likely to have current asthma, ≥1 asthma episode in the past year, and ≥1 ER visit due to asthma compared with children living in areas with the lowest quartile (< 8.11 µg/m3). After adjusting for characteristics at the county, geographic, and child and family-level, significant associations remained for asthma episode, and ER visit among children living in areas with PM2.5 annual concentrations between 9.51 and 10.59 µg/m3 (3rd quartile) compared with children living in areas with the lowest quartile. This study adds to the limited literature by incorporating nationally representative county-, child-, and family-level data to provide a multi-level analysis of the associations between air pollution and childhood asthma in the U.S.

Hepatitis C virus (HCV) infection is common among people living with HIV. HIV and HCV coinfected patients have higher overall mortality rates compared with HIV mono-infected patients. With its high cure rate of HCV infection, direct-acting antiviral (DAA) treatment provides an opportunity to improve the survival of the HIV/HCV coinfected population. The objective of this study is to investigate the association between DAA treatment and all-cause mortality among HIV/HCV coinfected people. The study included 7103 Medicare beneficiaries in the United States who were infected with both HIV and HCV between 2014 and 2017. Cox proportional hazards regression model was used to estimate adjusted hazard ratios (aHRs) of death for patients with and without DAA treatment while controlling for patient characteristics. During the study period, 1675 patients initiated DAA treatment (23.6%). The adjusted hazard ratio (aHR) of all-cause mortality between patients with and without DAA treatment was 0.37 (95% CI, 0.29-0.48), regardless of cirrhosis status. DAA treatment was associated with a smaller reduction in all-cause mortality for females (aHR, 0.50 [95% CI, 0.30-0.85]) compared with males (aHR, 0.34 [95% CI, 0.25-0.46]). DAA treatment was associated with improved survival among all HIV/HCV coinfected patients regardless of sex or HCV disease progression.

Мета дослідження – розробити і обгрунтувати комплексну методику розвитку витривалості школярів середніх класів засобами велотуризму. Матеріал і методи. В даному дослідженні приймали участь велотуристи 12-13 років Липкуватіської загально–освітньої школи l-lll ступенів (9 спортсменів склали експериментальну групу, 9 – контрольну). Для визначення функціональних можливостей школярів середніх класів застосовувались наступні проби і тести: Гарвардський степ-тест, проба Штанге, проба Генчі, проба Серкіна. Розроблено методику розвитку витривалості, яка передбачає застосовування комплексу засобів велотуризму. Комплекс складається з 2-х частин: комплексна дистанція «тріал і фігурне водіння велосипеда» і велопохід. Тріал являє собою дистанцію довжиною 100-200 м. з природними та штучними перешкодами (крутий схил; яр; піщані; заболочені та інші важкопрохідні дільниці; струмки; калюжі; стовбури дерев, що лежать, тощо) по вузькому коридору (до 1,5м), утвореному природними і штучними обмеженнями (стрічки між деревами або стійками тощо). Фігурне водіння велосипеда передбачає застосування наступних перешкод: «Щілина», «Змійка між стійками», «Коридор», «Колія», «Коло», «Вісімка», «Ворота», «Кільце», «Перенесення предмету», «Зигзаг», «Гойдалка», «Змійка між фішками», «Стоп-лінія. Фініш». Особливістю походу є те, що окрем розвитку витривалості, він вирішував завдання виховного та освтнього характеру шляхом ознайомлення з цікавими місцями Слобожанщини, зустрічами з цікавими людьми тощо. Результати. Показано, що авторська методика комплексного розвитку витривалості, що поєднує засоби фігурного вождіння та велопоходу, є більш ефективною у порівнянні з традиційною методикою розвитку витривалості школярів середніх класів, яка містить виключно подолання дистанцій; виявлено, що застосування комплексної методики розвитку витривалості школярів середніх класів сприяє підвищенню часу затримки дихання за пробами Штанге, Генчі, Серкіна, а також зменшенню ЧСС спокою, ЧСС після стандартного навантаження та підвищенню якості відновлення працездатності. Висновок. Розроблена методика може застосовуватись в підготовці юних велотуристів.

PURPOSE Overexpression of the HER2 protein occurs in 25% to 30% of human breast cancers and leads to a particularly aggressive form of the disease. Efficacy and safety of recombinant humanized anti-HER2 monoclonal antibody as a single agent was evaluated in women with HER2-overexpressing metastatic breast cancer that had progressed after chemotherapy for metastatic disease. PATIENTS AND METHODS Two hundred twenty-two women, with HER2-overexpressing metastatic breast cancer that had progressed after one or two chemotherapy regimens, were enrolled. Patients received a loading dose of 4 mg/kg intravenously, followed by a 2-mg/kg maintenance dose at weekly intervals. RESULTS Study patients had advanced metastatic disease and had received extensive prior therapy. A blinded, independent response evaluation committee identified eight complete and 26 partial responses, for an objective response rate of 15% in the intent-to-treat population (95% confidence interval, 11% to 21%). The median duration of response was 9.1 months; the median duration of survival was 13 months. The most common adverse events, which occurred in approximately 40% of patients, were infusion-associated fever and/or chills that usually occurred only during the first infusion, and were of mild to moderate severity. These symptoms were treated successfully with acetaminophen and/or diphenhydramine. The most clinically significant adverse event was cardiac dysfunction, which occurred in 4.7% of patients. Only 1% of patients discontinued the study because of treatment-related adverse events. CONCLUSION Recombinant humanized anti-HER2 monoclonal antibody, administered as a single agent, produces durable objective responses and is well tolerated by women with HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease. Side effects that are commonly observed with chemotherapy, such as alopecia, mucositis, and neutropenia, are rarely seen.

The purpose of the study is to analyze changes of the cardiopulmonary system indicators of hospitalized patients with respiratory diseases and underwent physical therapy. Materials and methods. The study was performed as a prospective case series study design. The study involved patients hospitalized with pneumonia, exacerbation of COPD and asthma, who had no contraindications to undergoing physical therapy. A total number of patients were 273 persons; 140 of them with pneumonia, 96 persons with exacerbation of COPD, 37 persons with asthma. Conducted surveys, anthropometric studies, clinical tests and instrumental studies. Results. COPD patients with acute exacerbation had a lower level of functional status of the cardio-respiratory system than patients with pneumonia or exacerbation of asthma. We found the lowest rates of excursion of the chest, blood saturation, VC, FEV1, PEF and higher than normal inhale rate. In addition, COPD patients did not experience statistically significant improvement during the assessment period in the majority of the analyzed parameters, except excursion of the chest and inhale rate. Conclusions. Acute exacerbation of COPD has a significant impact on the health of patients and significantly reduces the functional state of the respiratory system. The hospitalization period is not sufficient for full recovery. The rehabilitation of such patients should continue after discharge from the hospital.

Background Children and adolescents with fragile X syndrome (FXS) manifest significant symptoms of anxiety, particularly in response to face-to-face social interaction. In this study we used functional near-infrared spectroscopy (fNIRS) to reveal a specific pattern of brain activation and habituation in response to face stimuli in young girls with FXS, an important but understudied clinical population. Methods Participants were 32 girls with FXS (age: 11.8 ± 2.9 years) and a control group of 28 girls without FXS (age: 10.5 ± 2.3 years) matched for age, general cognitive function and autism symptoms. Functional NIRS was used to assess brain activation during a face habituation task including repeated upright/inverted faces and greeble (nonface) objects. Results Compared to the control group, girls with FXS showed significant hyper-activation in the frontopolar and dorsal lateral prefrontal cortices in response to all face stimuli (upright + inverted). Lack of neural habituation (and significant sensitization) was also observed in the FXS group in the frontopolar cortex in response to upright face stimuli. Finally, aberrant frontopolar sensitization in response to upright faces in girls with FXS was significantly correlated with notable cognitive-behavioral and social-emotional outcomes relevant to this condition including executive function, autism symptoms, depression and anxiety. Conclusions These findings strongly support a hypothesis of neural hyper-activation and accentuated sensitization during face processing in FXS, a phenomenon that could be developed as a biomarker endpoint for improving treatment trial evaluation in girls with this condition.