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Purpose The aim of this study was to evaluate the efficacy of a 17-week, 3-component lifestyle intervention for enhancing health behaviors during the coronavirus disease-2019 (COVID-19) pandemic. Methods A parallel-group (intervention and control) study was conducted amongst 79 airline pilots over a 17-week period during the COVID-19 pandemic. The intervention group (n = 38) received a personalized sleep, dietary, and physical activity (PA) program. The control group (n = 41) received no intervention. Outcome measures for sleep, fruit and vegetable intake, PA, and subjective health were measured though an online survey before and after the 17-week period. The changes in outcome measures were used to determine the efficacy of the intervention. Results Significant main effects for Time × Group were found for International Physical Activity Questionnaire-Walk (p = 0.02) and for all other outcome measures (p < 0.01). The intervention group significantly improved in sleep duration (p < 0.01; d = 1.02), Pittsburgh Sleep Quality Index score (p < 0.01; d = –1.01), moderate-to-vigorous PA (p < 0.01; d = 1.32), fruit and vegetable intake (p < 0.01; d = 3.11), Short-Form-12v2 physical score (p < 0.01; d = 1.84), and Short-Form-12v2 mental score (p < 0.01; d = 2.69). The control group showed significant negative change for sleep duration (p < 0.01; d = –0.47), Pittsburgh Sleep Quality Index score (p < 0.01; d = 0.28), and Short-Form-12v2 mental score (p < 0.01; d = –0.64). Conclusion Results provide preliminary evidence that a 3-component healthy sleep, eating and PA intervention elicit improvements in health behaviors and perceived subjective health in pilots and may improve quality of life during an unprecedented global pandemic., Graphical abstract Image, graphical abstract

The aim of this study was to perform a 12-month follow-up of health parameters after a 17-week lifestyle intervention in overweight airline pilots. A parallel-group (intervention and control) study was conducted amongst 72 overweight airline pilots (body mass index > 25) over a 12-month period following the emergence of COVID-19. The intervention group (n = 35) received a personalized dietary, sleep, and physical activity program over a 17-week period. The control group (n = 37) received no intervention. Measurements for subjective health (physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) via an electronic survey, and objective measures of body mass and blood pressure were taken at baseline and at 12 months. Significant interactions for group × time from baseline to 12-months were found for all outcome measures (p < 0.001). Body mass and mean arterial pressure significantly decreased in the intervention group when compared to the control group (p < 0.001). Outcome measures for subjective health (physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) significantly increased in the intervention group when compared to the control group (p < 0.001). Results provide preliminary evidence that a brief three-component healthy sleep, diet and physical activity intervention can elicit and sustain long-term improvements in body mass and blood pressure management, health behaviors, and perceived subjective health in pilots and may support quality of life during an unprecedented global pandemic.

BackgroundAntiretroviral therapy (ART) during pregnancy is important for both maternal health and prevention of perinatal HIV-1 transmission; however adequate data on the safety and efficacy of different ART regimens that are likely to be used by pregnant women are scarce. In this trial we compared the safety and efficacy of three antiretroviral regimens started in pregnancy: dolutegravir, emtricitabine, and tenofovir alafenamide fumarate; dolutegravir, emtricitabine, and tenofovir disoproxil fumarate; and efavirenz, emtricitabine, and tenofovir disoproxil fumarate.MethodsThis multicentre, open-label, randomised controlled, phase 3 trial was done at 22 clinical research sites in nine countries (Botswana, Brazil, India, South Africa, Tanzania, Thailand, Uganda, the USA, and Zimbabwe). Pregnant women (aged ≥18 years) with confirmed HIV-1 infection and at 14-28 weeks' gestation were eligible. Women who had previously taken antiretrovirals in the past were excluded (up to 14 days of ART during the current pregnancy was permitted), as were women known to be pregnant with multiple fetuses, or those with known fetal anomaly or a history of psychiatric illness. Participants were randomly assigned (1:1:1) using a central computerised randomisation system. Randomisation was done using permuted blocks (size six) stratified by gestational age (14-18, 19-23, and 24-28 weeks' gestation) and country. Participants were randomly assigned to receive either once-daily oral dolutegravir 50 mg, and once-daily oral fixed-dose combination emtricitabine 200 mg and tenofovir alafenamide fumarate 25 mg; once-daily oral dolutegravir 50 mg, and once-daily oral fixed-dose combination emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg; or once-daily oral fixed-dose combination of efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil fumarate 300 mg. The primary efficacy outcome was the proportion of participants with viral suppression, defined as an HIV-1 RNA concentration of less than 200 copies per mL, at or within 14 days of delivery, assessed in all participants with an HIV-1 RNA result available from the delivery visit, with a prespecified non-inferiority margin of -10% in the combined dolutegravir-containing groups versus the efavirenz-containing group (superiority was tested in a pre-planned secondary analysis). Primary safety outcomes, compared pairwise among treatment groups, were the occurrence of a composite adverse pregnancy outcome (ie, either preterm delivery, the infant being born small for gestational age, stillbirth, or spontaneous abortion) in all participants with a pregnancy outcome, and the occurrence of grade 3 or higher maternal and infant adverse events in all randomised participants. This trial was registered with ClinicalTrials.gov, NCT03048422.FindingsBetween Jan 19, 2018, and Feb 8, 2019, we enrolled and randomly assigned 643 pregnant women: 217 to the dolutegravir, emtricitabine, and tenofovir alafenamide fumarate group, 215 to the dolutegravir, emtricitabine, and tenofovir disoproxil fumarate group, and 211 to the efavirenz, emtricitabine, and tenofovir disoproxil fumarate group. At enrolment, median gestational age was 21·9 weeks (IQR 18·3-25·3), the median HIV-1 RNA concentration among participants was 902·5 copies per mL (152·0-5182·5; 181 [28%] of 643 participants had HIV-1 RNA concentrations of

BACKGROUND CONTEXT Elderly patients are increasingly meeting the indications for spinal fusion and are more likely to have suboptimal bone quality. Patients with suboptimal bone quality who have undergone posterior cervical fusion have increased risk of fixation failure of up to 5.4% and may require stronger forms of fixation. Adding supplemental fixation to lateral mass screws (LMS) can increase fixation as measured by pullout strength. PURPOSE This work addresses the question: can supplemental screw fixation of lateral mass screws improve pullout strength? STUDY DESIGN/SETTING Biomechanical cadaveric study. PATIENT SAMPLE Fifteen C3-C6 vertebral bodies and 15 additional motion segments (C3-C4 or C5-C6) (age: 49-67). OUTCOME MEASURES Lateral mass screw construct peak pullout strength. METHODS All specimens were CT scanned with a phantom to obtain bone mineral density (BMD). The individual vertebral bodies and the cranial body of the motion segments were implanted with bilateral lateral mass screws. Supplemental fixation was added on one side of the vertebral body using two 2.4mm diameter unicortical screws (length 8-12mm). One side of the cranial vertebral body of the motion segments was supplemented with a single 2.4mm diameter transfacet tricortical screw (length 12-16mm). Screw constructs were subjected to posterior pullout coincident with the axis of the lateral mass screw at a rate of 5mm/min until failure. RESULTS A paired comparison was made of the peak pullout force of the LMS alone and LMS with supplemental fixation. Analysis was also made comparing BMD and pullout force.In the vertebral bodies with two supplemental unicortical screws, pullout force was significantly higher in the supplemented screw side. The average pullout force was 48.2% higher with supplemental screws (865±213N vs 637±206N; p=0.0038). There was moderate correlation between pullout force and bone mineral density for both the supplemented and LMS alone (correlation coefficients of 0.34 and 0.45 respectively). In the motion segments, peak pullout force was significantly higher in the side supplemented with a tricortical transfacet screw. The pullout force was 25.9% higher with supplemental transfacet screw fixation (1055±521N vs 912±508N; p=0.047). The pullout strength of the LMS with transfacet fixation was highly correlated with BMD (correlation coefficient of 0.71) while the LMS pullout strength was moderately correlated with BMD (correlation coefficient of 0.64). CONCLUSIONS Our data confirms the hypotheses that the pullout strength of C3-C6 LMS fixation using LMS supplemented with two unicortical screws or LMS supplemented with one-tricortical transfacet screw is superior to LMS fixation alone. FDA DEVICE/DRUG STATUS Cervical Fusion System (Approved for this indication)

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The following case of a retroperitoneal fibrolipoma is so typical of this rare form of abdominal tumor, at the present time receiving in general but indefinite recognition and differentiation, that it seems to justify a detailed presentation. On account of the necessity for anticipating the malignant degeneration to which all such connective tissue tumors are more or less prone, as well as preventing the serious involvement of various organs even by a benign overgrowth, an early diagnosis is of great importance. This, in view of the frequent paucity of symptoms and obscure local signs, is difficult and but infrequently made before the condition has rendered an operation impossible or extremely hazardous. In 1897 Adami 1 gave the immediate mortality from operation of the twenty-six instances he was able to collect at 53.9 per cent. One recurrence increased the mortality to 57.7 per cent. I have collected in addition to these three