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Objective: This study examined how driving attention develops with age and driving., Methods: In this observational longitudinal study, 190 adolescents (53% female, 73% Black) were enrolled across four groups: 16- and 18-year olds with and without driving experience. They underwent driving simulation with eye-tracking technology seven times over 18 months. By using a combination of factorial and longitudinal designs, the study examined the individual and combined effects of age and driving experience on driving attention over time., Results: Licensed participants had higher odds of glancing at safety-critical events initially (OR = 15.01, 95% CI: 1.36-165.53), but these odds decreased at higher driving speeds (b = -0.17, p<.01). Average glance length decreased over time (b = -0.26, p=.01), but less so in licensed participants (b=0.14, p=.01). Several visual behaviors were influenced by environmental and driving factors., Conclusions: Motor vehicle crashes (MVCs) are burdensome and costly to society. This study focused on the role of inattention in MVCs, particularly during the risky period of adolescence. Findings indicated that driving experience, as determined by licensure, had a considerable impact on visual behavior in both the short term (within two weeks of obtaining a license) and over the first 18 months of independent driving. Overall, these findings suggest that licensed adolescents are more likely to identify potential hazards on the road and navigate safely. To ensure effective guidance, pediatric psychologists and other professionals should consider the unique circumstances, needs, and concerns of individual patients., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Electroencephalographs record the electrical activity of your brain through the scalp. Electroencephalography is difficult to obtain due to its sensitivity and variability. Applications of electroencephalography such as for diagnosis, education, brain-computer interfaces require large samples of electroencephalography recording, however, it is often difficult to obtain the required datasets. Generative adversarial networks are robust deep learning framework which have proven themselves to be capable of synthesizing data. The robust nature of a generative adversarial network was used to generate multi-channel electroencephalography data in order to see if generative adversarial networks could reconstruct the spatio-temporal aspects of multi-channel electroencephalography signals. We were able to find that the synthetic electroencephalography data was able to replicate fine details of electroencephalography data and could potentially help us to generate large sample synthetic resting-state electroencephalography data for use in simulation testing of neuroimaging analyses. Generative adversarial networks (GANs) are robust deep-learning frameworks that can be trained to be convincing replicants of real data GANs were capable of generating "fake" EEG data that replicated fine details and topographies of "real" resting-state EEG data., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Intuitively, experience playing against one mixture of opponents in a given domain should be relevant for a different mixture in the same domain. If the mixture changes, ideally we would not have to train from scratch, but rather could transfer what we have learned to construct a policy to play against the new mixture. We propose a transfer learning method, Q-Mixing , that starts by learning Q -values against each pure-strategy opponent. Then a Q -value for any distribution of opponent strategies is approximated by appropriately averaging the separately learned Q -values. From these components, we construct policies against all opponent mixtures without any further training. We empirically validate Q-Mixing in two environments: a simple grid-world soccer environment, and a social dilemma game. Our experiments find that Q-Mixing can successfully transfer knowledge across any mixture of opponents. Next, we consider the use of observations during play to update the believed distribution of opponents. We introduce an opponent policy classifier-trained reusing Q-learning data-and use the classifier results to refine the mixing of Q -values. Q-Mixing augmented with the opponent policy classifier performs better, with higher variance, than training directly against a mixed-strategy opponent., Competing Interests: TA was employed by the company DeepMind Technologies Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Smith, Anthony and Wellman.)

We propose a multi-agent learning approach for designing crowdsourcing contests and All-Pay auctions. Prizes in contests incentivise contestants to expend effort on their entries, with different prize allocations resulting in different incentives and bidding behaviors. In contrast to auctions designed manually by economists, our method searches the possible design space using a simulation of the multi-agent learning process, and can thus handle settings where a game-theoretic equilibrium analysis is not tractable. Our method simulates agent learning in contests and evaluates the utility of the resulting outcome for the auctioneer. Given a large contest design space, we assess through simulation many possible contest designs within the space, and fit a neural network to predict outcomes for previously untested contest designs. Finally, we apply mirror ascent to optimize the design so as to achieve more desirable outcomes. Our empirical analysis shows our approach closely matches the optimal outcomes in settings where the equilibrium is known, and can produce high quality designs in settings where the equilibrium strategies are not solvable analytically., (© 2022. The Author(s).)

Identification of individuals at high risk for rapid progression of motor and cognitive signs in Parkinson disease (PD) is clinically significant. Postural instability and gait dysfunction (PIGD) are associated with greater motor and cognitive deterioration. We examined the relationship between baseline clinical factors and the development of postural instability using 5-year longitudinal de-novo idiopathic data (n = 301) from the Parkinson's Progressive Markers Initiative (PPMI). Logistic regression analysis revealed baseline features associated with future postural instability, and we designated this cohort the emerging postural instability (ePI) phenotype. We evaluated the resulting ePI phenotype rating scale validity in two held-out populations which showed a significantly higher risk of postural instability. Emerging PI phenotype was identified before onset of postural instability in 289 of 301 paired comparisons, with a median progression time of 972 days. Baseline cognitive performance was similar but declined more rapidly in ePI phenotype. We provide an ePI phenotype rating scale (ePIRS) for evaluation of individual risk at baseline for progression to postural instability., (© 2022. The Author(s).)

It is becoming increasingly clear that longer duration of untreated psychosis (DUP) is associated with adverse clinical outcomes in patients with psychosis spectrum disorders. Because this association is often cited when justifying early intervention efforts, it is imperative to better understand underlying biological mechanisms. We enrolled 66 antipsychotic-naïve first-episode psychosis (FEP) patients and 45 matched healthy controls in this trial. At baseline, we used a human connectome style diffusion-weighted imaging (DWI) sequence to quantify white matter integrity in both groups. Patients then received 16 weeks of treatment with risperidone, 51 FEP completed the trial. We compared whole-brain fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), and radial diffusivity between groups. To test if structural white matter integrity mediates the relationship between longer DUP and poorer treatment response, we fit a mediator model and estimated indirect effects. We found decreased whole-brain FA and AD in medication-naive FEP compared with controls. In patients, lower FA was correlated with longer DUP (r = -0.32; p = 0.03) and poorer subsequent response to antipsychotic treatment (r = 0.40; p = 0.01). Importantly, we found a significant mediation effect for FA (indirect effect: -2.70; p = 0.03), indicating that DUP exerts its effects on treatment response through affecting white matter integrity. Our data provide empirical support to the idea the DUP may have fundamental pathogenic effects on the natural history of psychosis, suggest a biological mechanism underlying this phenomenon, and underscore the importance of early intervention efforts in this disabling neuropsychiatric syndrome., (© 2020. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: To characterize the trajectory of driving attention as a function of age and driving experience. Hypotheses. The rate of change in driving attention will be greater for 16- compared to 18-year-olds and those acquiring driving experience (vs. non-drivers). Age and driving experience will interact, with the effect of driving experience being stronger among 16- compared to 18-year-olds., Methods: In this longitudinal study, 190 adolescents were enrolled into 4 groups: (1) 16-year-olds and (2) 18-year-olds recruited within 2 weeks of obtaining a full driver's license; (3) 16-year-olds and (4) 18-year-olds with no driving experience (no permit/license, no intention to obtain either over study period). At seven time points over 18 months, participants drove in a high-fidelity driving simulator integrated with eye tracking. Participants completed three experimental drives with three safety critical events and varying cognitive load conditions. Driving attention was measured by vertical and horizontal eye movements, number of glances , and glance length . A multilevel model using SAS PROC MIXED (SAS 9.4) will estimate the baseline intercept and slope of driving attention over time, with baseline age, driving experience, and their interaction serving as predictors of intercept and slope., Results: Preliminary analyses suggest driving attention changes over time as a function of age, driving experience, and across cognitive load conditions., Conclusions: Inattention is the primary contributor to motor vehicle crashes. It is critical to gain a clear understanding of how driving attention changes during adolescence, the riskiest developmental period for drivers. Results will reveal how driving impacts attention development through practice, providing a target for intervention.

Despite our understanding of the impact of noise-induced damage to the auditory system, much less is known about the impact of noise exposure on the vestibular system. In this article, we review the anatomical, physiological, and functional evidence for noise-induced damage to peripheral and central vestibular structures. Morphological studies in several animal models have demonstrated cellular damage throughout the peripheral vestibular system and particularly in the otolith organs; however, there is a paucity of data on the effect of noise exposure on human vestibular end organs. Physiological studies have corroborated morphological studies by demonstrating disruption across vestibular pathways with otolith-mediated pathways impacted more than semicircular canal-mediated pathways. Similar to the temporary threshold shifts observed in the auditory system, physiological studies in animals have suggested a capacity for recovery following noise-induced vestibular damage. Human studies have demonstrated that diminished sacculo-collic responses are related to the severity of noise-induced hearing loss, and dose-dependent vestibular deficits following noise exposure have been corroborated in animal models. Further work is needed to better understand the physiological and functional consequences of noise-induced vestibular impairment in animals and humans., (Copyright © 2020 Stewart, Holt, Altschuler, Cacace, Hall, Murnane, King and Akin.)

This paper describes the methods that have been developed and implemented to process research participant data generated by a high fidelity driving simulator that has been integrated with eye tracking equipment. The driving simulator is used for experimental studies to understand driving behavior. Solutions are implemented to programmatically process the output of the simulator and transform the raw data from these research experiments to an analysis ready format. The algorithm is tested across the data for numerous participants with varying scenarios within the experiments and is further curated to meet the requirements and standards of the research studies that require the use of driving simulator to generate data.

Flexible endoscopes became generally available 50 years ago and created a revolution in the practice of gastroenterology. They improved diagnosis enormously, enabled quicker, less invasive, and more cost-effective surgical treatment, while endoscopic screening has prevented many cancer deaths. The new technology stimulated research leading to a better understanding of gastrointestinal pathology, identifying new diseases and clarifying the etiology of others. Better-controlled clinical trials accelerated the use of newer and more effective drugs. National and international endoscopy societies supported nursing input, encouraged research, stimulated specialist journals, and devised guidelines that encouraged audit and quality assurance. Advances in instrument design and the manufacture of new accessories enhanced endoscopic technique, diagnostic ability, patient comfort, and safety. The risk of cross-infection inherent in the use of complex labile equipment that cannot be autoclaved remains a challenge. Endoscopy societies working closely with industry have established rigid protocols for high-level disinfection that minimize the risks, but strict adherence to guidelines and continued vigilance is essential, especially with the increasing prevalence of antibiotic-resistant commensals that can give rise to opportunistic infection. Government health departments have a responsibility to encourage and support research in this area by endoscopists, instrument manufacturers, and the pharmaceutical industry. Current trends suggest that in the future, artificial intelligence will greatly improve endoscopic diagnosis, and that therapeutic endoscopy will expand, encouraging endoscopists to subspecialize., (© 2019 Japan Gastroenterological Endoscopy Society.)

Diffusion tensor imaging (DTI) studies show widespread white matter abnormalities in schizophrenia, but it is difficult to directly relate these parameters to biological processes. Neurite orientation dispersion and density imaging (NODDI) is geared toward biophysical characterization of white matter microstructure, but only few studies have leveraged this technique to study white matter alterations. We recruited 42 schizophrenia patients (30 antipsychotic-naïve and 12 currently untreated) and 42 matched controls in this prospective study. We assessed the orientation dispersion index (ODI) and extracellular free water (FW) using single-shell DTI data before and after a 6-week trial of risperidone. Longitudinal data were available for 27 patients. Voxelwise analyses showed significantly increased ODI in the posterior limb of the internal capsule in unmedicated patients (242 voxels; x = -24; y = 6; z = 6; p < 0.01; α < 0.04), but no alterations in FW. Whole brain measures did not reveal alterations in ODI but a 6.3% trend-level increase in FW in unmedicated SZ (t = -1.873; p = 0.07). Baseline ODI was negatively correlated with subsequent response to antipsychotic treatment (r = -0.38; p = 0.049). Here, we demonstrated altered fiber complexity in medication-naïve and unmedicated patients with a schizophrenia spectrum illness. Lesser whole brain fiber uniformity was predictive of poor response to treatment, suggesting this measure may be a clinically relevant biomarker. Interestingly, we found no significant changes in NODDI indices after short-term treatment with risperidone. Our data show that biophysical diffusion models have promise for the in vivo evaluation of brain microstructure in this devastating neuropsychiatric syndrome.

Background: Schizophrenia is associated with progressive white matter changes, but it is unclear whether antipsychotic medications contribute to these. Our objective was to characterize effects of short-term treatment with risperidone on white matter diffusion indices., Methods: We recruited 42 patients with schizophrenia (30 never treated and 12 currently untreated) and 42 matched healthy control subjects in this prospective case-control neuroimaging study. Patients received a 6-week trial of risperidone. Using diffusion tensor imaging, we assessed microstructural (fractional anisotropy, mean diffusivity, and radial diffusivity) and macrostructural (radial fiber trophy) white matter integrity deficits in unmedicated patients compared with control subjects and change in white matter integrity in patients before and after antipsychotic treatment (mean risperidone dose at end point was 3.73 ± 1.72 mg)., Results: At baseline, fractional anisotropy was decreased in the left medial temporal white matter (cluster extent: 123 voxels; Montreal Neurological Institute peak coordinates: x = -51, y = -44, z = -7; α < .05), and mean diffusivity was increased in the fusiform/lingual gyrus white matter extending to the hippocampal part of the cingulum (cluster extent: 185 voxels; peak coordinates: x = -27, y = -49, z = 2; α < .04) in patients compared with control subjects. Radial diffusivity and macrostructure were not abnormal. None of the diffusion indices showed a significant change after 6 weeks of treatment with both voxelwise and whole-brain white matter analyses., Conclusions: We demonstrate microstructural white matter integrity abnormalities in the absence of macrostructural impairment in unmedicated patients with primarily early-stage schizophrenia. In our data, we found no significant white matter changes after short-term treatment with risperidone., (Copyright © 2019 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: Recurrent dislocation of Total Hip Replacement (THR) is often multifactorial and remains a significant surgical challenge with a significant risk of further instability. Dual Mobility Cups (DMC) have been used widely with good long term results in France with few studies in the British literature, especially assessing their use for recurrent instability. We set out to assess whether recurrent instability can be successfully treated solely with revision of acetabular component to a dual mobility cup., Methods: We retrospectively reviewed a prospectively collected electronic database for all consecutive dual mobility cups implanted to address recurrently instability in THR. Radiological and clinical data have been analysed., Results: From September 2013 to September 2017 54 dual mobility cups have been implanted, mean age 78 (range 49-97). 47 were 1st time revision procedures, 7 were following previous revisions including 5 failed PLADs. Average time post primary was 10 years (range 8 months-23 years). Twenty cases are cement in cement revisions which has become our primary technique for revision of cemented cups. Mean follow up is 1.9 years (range 6 months-5 years), 37 cases have 2 year follow up available. 8 patients have died. There have been no episodes of further instability. One patient has had reoperation for infection (1st stage revision)., Conclusions: This series demonstrates satisfactory early to mid-term results for the use of dual mobility cups to treat recurrent instability. The technique is particularly useful when femoral components are well fixed and can be used with monoblock implants such as the Charnley stem. Cement in cement revision is a convenient technique and potentially reduces complications and cost. Further analysis of longer term data is required but these results suggests this could be a valid solution to a complex problem.

Alterations in the gene encoding for the FGFR and upregulation of the VEGFR are found often in cancer, which correlate with disease progression and unfavorable survival. In addition, FGFR and VEGFR signaling synergistically promote tumor angiogenesis, and activation of FGFR signaling has been described as functional compensatory angiogenic signal following development of resistance to VEGFR inhibition. Several selective small-molecule FGFR kinase inhibitors are currently in clinical development. ODM-203 is a novel, selective, and equipotent inhibitor of the FGFR and VEGFR families. In this report we show that ODM-203 inhibits FGFR and VEGFR family kinases selectively and with equal potency in the low nanomolar range (IC 50 6-35 nmol/L) in biochemical assays. In cellular assays, ODM-203 inhibits VEGFR-induced tube formation (IC 50 33 nmol/L) with similar potency as it inhibits proliferation in FGFR-dependent cell lines (IC 50 50-150 nmol/L). In vivo , ODM-203 shows strong antitumor activity in both FGFR-dependent xenograft models and in an angiogenic xenograft model at similar well-tolerated doses. In addition, ODM-203 inhibits metastatic tumor growth in a highly angiogenesis-dependent kidney capsule syngenic model. Interestingly, potent antitumor activity in the subcutaneous syngenic model correlated well with immune modulation in the tumor microenvironment as indicated by marked decrease in the expression of immune check points PD-1 and PD-L1 on CD8 T cells and NK cells, and increased activation of CD8 T cells. In summary, ODM-203 shows equipotent activity for both FGFR and VEGFR kinase families and antitumor activity in both FGFR and angigogenesis models., (©2018 American Association for Cancer Research.)

Background: A growing number of college students are experiencing personal circumstances or encountering situations that feel overwhelming and negatively affect their academic studies and other aspects of life on campus. To meet this growing demand for counseling services, US colleges and universities are offering a growing variety of mental health services that provide support and services to students in distress., Objective: In this study, we explore mental health issues impacting college students using a corpus of news articles, foundation reports, and media stories. Mental health concerns within this population have been on the rise. Uncovering the most salient themes articulated in current news and literature reports can better enable higher education institutions to provide health services to its students., Methods: We used SAS Text Miner to analyze 165 references that were published from 2010 to 2015 and focused on mental health among college students. Key clusters were identified to reveal the themes that were most significant to the topic., Results: The final cluster analysis yielded six themes in students' mental health experiences in higher education (ie, age, race, crime, student services, aftermath, victim). Two themes, increasing demand for student services provided by campus counseling centers (113/165, 68.5%) and the increased mental health risks faced by racial and ethnic minorities (30/165, 18.2%), dominated the discourse., Conclusions: Higher education institutions are actively engaged in extending mental health services and offering targeted outreach to students of color. Cluster analysis identified that institutions are devoting more and innovative resources in response to the growing number students who experience mental health concerns. However, there is a need to focus on proactive approaches to mitigate the causes of mental health and the aftermath of a negative experience, particularly violence and sexual assault. Such strategies can potentially influence how students navigate their health information seeking and how information and communication technologies, including mobile apps, can partially address the needs of college students., (©Fay Cobb Payton, Lynette Kvasny Yarger, Anthony Thomas Pinter. Originally published in JMIR Mental Health (http://mental.jmir.org), 23.10.2018.)

Emerging evidence indicates that skeletal muscle possesses endocrine function to secret myokines. Interleukin 6 (IL-6) is a well-characterized myokine that is involved in regulation of metabolism and muscle function. Metabolism type and contractile dynamics vary in different muscle types. It is not clear, however, if IL-6 secretion differs in different muscle types. In this study, we first established an ex vivo approach to test the inducible muscle secretion. Freshly isolated muscles were incubated in Krebs solution at 37 °C with oxygen supply. Secreted IL-6 in the incubation media was measure using Western blot and ELISA assay. We first confirmed that the IL-6 release was inducible by treating the incubated muscle with a cytokine stimulant. We demonstrated that physiological temperature (37 °C) and O 2 supply were essential for the induction of IL-6 release from the incubated muscle, suggesting it is a controlled secretion rather than a spontaneous leak. Using this approach, we found that IL-6 release was only inducible from soleus muscle but not EDL muscle. We further showed that IL-6 protein level was higher in slow oxidative muscle fibers. Moreover, we showed that EDL, although lacks of IL-6 release, surely has inducible secretory function that had different secretory pattern from soleus., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Despite being straightforward to collect and key to providing patient-centred, individualised care, the routine use of patient reported outcome measures (PROMs) remains limited in the National Health Service. Herein is described the case of a 69-year-old woman who presented to secondary care with osteoarthritis. Web-based PROMs were used to track the patient's symptoms and function. Lifestyle changes were recommended to manage the osteoarthritis. Monitoring enabled the patient to take control of her disease management. Two years later, she continues to manage her knee symptoms conservatively, recording progress by using a web-based system. This case illustrates how web-based PROMs can be used to support conservative management of knee osteoarthritis by both empowering patients and minimising the burden on secondary care outpatient services., Competing Interests: Competing interests: DHW is a cofounder of My Clinical Outcomes., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Patient-reported outcome measures (PROMs) are an important tool in measuring the benefit of a surgery for patients and for clinicians. The results of such assessment tools can be used to monitor patient progress or initiate intervention. The scores also provide a reproducible evaluation of functional recovery and well-being after surgery. We report the case of a 68-year-old woman who underwent left unicondylar knee replacement in November 2011 followed by right unicondylar knee replacement in April 2012. Prospective, web-based electronic PROMs were used preoperatively and every 6-12 months postoperatively to monitor the improvement in pain and function symptoms. These outcome measures were beneficial in helping to monitor an episode of new pain in her left knee, without requiring invasive or extensive investigation., Competing Interests: Competing interests: DHW is cofounder of myclinicaloutcomes.com, a web-based PROMs system., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

BACKGROUND Pathologic alterations in resting-state brain activity patterns exist among individuals with Parkinson's disease (PD). Since physical exercise alters resting-state brain activity in non-PD populations and improves PD symptoms, we assessed the acute effect of exercise on resting-state brain activity in exercise-trained individuals with PD. MATERIAL AND METHODS Resting-state functional magnetic resonance imaging (fMRI) was collected twice for 17 PD participants at the conclusion of an exercise intervention. The acute effect of exercise was examined for PD participants using the amplitude of low frequency fluctuation (ALFF) before and after a single bout of exercise. Correlations of clinical variables (i.e., PDQ-39 quality of life and MDS-UPDRS) with ALFF values were examined for the exercise-trained PD participants. RESULTS An effect of acute exercise was observed as an increased ALFF signal within the right ventromedial prefrontal cortex (PFC), left ventrolateral PFC, and bilaterally within the substantia nigra (SN). Quality of life was positively correlated with ALFF values within the vmPFC and vlPFC. CONCLUSIONS Given the role of the SN and PFC in motor and non-motor symptoms in PD, the acute increases in brain activity within these regions, if repeated frequently over time (i.e., exercise training), may serve as a potential mechanism underlying exercise-induced PD-specific clinical benefits.

The molecular actions of mitogen-activated protein kinases (MAPKs) are ultimately accomplished by the substrate proteins where phosphorylation affects their molecular properties and function(s), but knowledge regarding plant MAPK substrates is currently still fragmentary. Here, we uncovered a previously uncharacterized protein family consisting of three proline/serine-rich proteins (PRPs) that are substrates of stress-related MAPKs. We demonstrated the importance of a MAPK docking domain necessary for protein-protein interaction with MAPKs and consequently also for phosphorylation. The main phosphorylated site was mapped to a residue conserved between all three proteins, which when mutated to a non-phosphorylatable form, differentially affected their protein stability. Together with their distinct gene expression patterns, this differential accumulation of the three proteins upon phosphorylation probably contributes to their distinct function(s). Transgenic over-expression of PRP, the founding member, led to plants with enhanced resistance to Pseudomonas syringae pv. tomato DC3000. Older plants of the over-expressing lines have curly leaves and were generally smaller in stature. This growth phenotype was lost in plants expressing the phosphosite variant, suggesting a phosphorylation-dependent effect. Thus, this novel family of PRPs may be involved in MAPK regulation of plant development and / or pathogen resistance responses. As datamining associates PRP expression profiles with hypoxia or oxidative stress and PRP-overexpressing plants have elevated levels of reactive oxygen species, PRP may connect MAPK and oxidative stress signaling.

Although chronic hypertension is associated with long-term complications, few studies directly examine the effects of in-hospital acute hypertensive episodes in trauma patients. The aim was to determine whether there is an association between in-hospital acute hypertension and morbidity. We included trauma patients between 45 and 89 years who presented to a level I trauma center between January and September 2008. Patients were classified as either experiencing or not experiencing acute hypertensive episode(s) as defined by systolic blood pressure ≥180, or diastolic blood pressure ≥110 mmHg, or at least two readings of systolic blood pressure ≥160 or diastolic blood pressure ≥100 mmHg. The primary outcome was a composite endpoint of myocardial infarction, stroke, venous thromboembolism, new-onset atrial fibrillation, or acute kidney injury. At least one acute hypertensive episode occurred in 42.6% (69/162) of patients. A total of 10.5% patients developed the composite endpoint, 17.4% in the acute hypertensive episode group compared to 5.4% in the non-hypertensive group, p = 0.012. Patients in the acute hypertensive group were more likely to require an intensive care unit admission compared to the non-hypertensive group (33.3 versus 14.0%, p = 0.004). Of the 17 patients who developed an acute hypertensive episode and met the primary endpoint, 10 were on home antihypertensive medications. Of those, four were restarted on all medications initially, three on some, two were started on new medications, and one was not resumed on home medications. Development of acute hypertensive episode(s) in older trauma patients was associated with an increase in the composite endpoint. Prospective studies are needed.

A new microwave digestion/inductively coupled plasma mass spectrometry (ICP-MS) for simultaneous determination of 8 heavy metals including Zn, Cu, As, Pb, Cd, Cr, Hg and Ni in wastes of scale hoggery from livestock parks in Chongqing and its biogas slurry after anaerobic digestion, with which an all round, fast analysis of multiple heavy metals in biogas slurry was realized. From the experiment, Zn, Cu, As, Pb, Cd, Cr, Hg, and Ni were the dominating heavy metals in biogas slurry. The linear correlation coefficients for the heavy metals were between 0.999 89 and 0.999 98, indicating a good linear correlation. The determination limits were between 0.79 and 25.0 ng x L(-1), recovery adding standard between 96.5% and 107.6%, RSD between 1.06% and 4.35%. These parameters revealed that the method has good precision and accuracy, which could be applied to the heavy metals detection in biogas slurry, and provide reference for its post-use.

Background: The purpose of the current study was to identify clinical and kidney morphologic features that predict a favorable blood pressure (BP) response to renal artery stenting (RAS)., Methods: The study cohort consisted of 149 patients who underwent primary RAS over 9 years. Patients were categorized as "responders" based on modified American Heart Association guidelines: BP <160/90 mm Hg on fewer antihypertensive medications or diastolic BP <90 mm Hg on the same medications. All other patients were deemed "nonresponders." Renal volume was estimated as kidney length × width × depth/2 based on preoperative computed tomography or magnetic resonance scans. Median follow-up was 19 months (interquartile range [IQR] 10.0-29.5 months)., Results: The median age of the cohort was 68 years (IQR, 60-74 years). A favorable BP response was observed in 50 of 149 patients (34%). Multivariate analysis identified three independent predictors of a positive BP response: (1) requirement for four or more medications (odds ratio, 29.9; P = .0001), (2) preoperative diastolic BP >90 mm Hg (OR, 31.4; P = .0011), and (3) preoperative clonidine use (OR, 7.3; P = .029). The BP response rate varied significantly based on the number of predictors present per patient (P < .0001). Among patients with three-drug hypertension, a larger ipsilateral kidney (volume ≥150 cm(3)) increased the BP response rate more than threefold compared with patients with smaller kidneys (63% vs 18% BP response rate; P = .018)., Conclusions: The current study demonstrated that three clinical predictors (≥4 antihypertensive medications, diastolic BP ≥90 mm Hg, and clonidine use) are preoperative predictors of BP response to RAS. Kidney volume may help in discriminating responders from nonresponders among those patients with three-drug hypertension. These parameters may assist clinicians in patient selection and provide more concrete data with which to counsel patients on the likely outcomes for RAS., (Published by Mosby, Inc.)

Major advances in the testing of oral fluid (e.g., saliva) may lead to the diagnosis and treatment of previously undiagnosed conditions and may enable dentists to manage oral disease more effectively. Such use of another body fluid, blood, is already well established. Blood is a complex tissue that has been extensively researched and is now used for a wide variety of diagnostic tests. It is also regarded as a form of property with ethical and legal dimensions. If saliva is to fulfill a similar role, it should perhaps be granted those same protections. This paper advances the concept that saliva should be considered a form of property, possibly within personal biological materials law. The emerging potential for the development of marketable products from oral fluids raises the issue of protecting the research participant's ethical and legal rights. In particular, violation of privacy and genetic discrimination may arise from the testing of salivary DNA. Respect for autonomy requires that the clinician inform a patient or research participant about his or her rights to property and privacy as these may pertain to oral fluid.

Background: This study assessed whether preoperative weight loss resulted in favorable outcomes after open Roux-en Y gastric bypass (RYGB)., Methods: A retrospective review of all patients who underwent RYGB at the DVAMC was undertaken. Patients were divided into: patients who did not lose weight within 3 months preoperatively (n=25) and group II, those who did (n=15)., Results: Both groups had similar demographics, body mass index, comorbid conditions, and American Society of Anesthesiology class. Group II lost 28.2+/-6.5 lbs (8.3% of body weight) within 3 months before RYGB. Operative time was longer in group I compared to group II (180.0+/-0.0 vs 161.0+/-0.0 min; p=0.05). Both groups had the same rate of postoperative complications and the same long-term weight loss at a 2-year follow-up (n=6 both groups)., Conclusions: An 8% reduction of body weight is associated with a decrease in operative time. These preliminary data suggest that preoperative weight loss results in a technically less challenging operation in the super-obese patient.

The main goal in monitoring patients after the treatment of colorectal cancer is to improve survival through the early identification and treatment of metastatic or locally recurrent disease. Although the results of several randomized, controlled trials have identified a survival benefit associated with careful follow-up, specific testing strategies to maximize survival while minimizing cost and patient inconvenience have not been identified. There is, therefore, great variability in the types, number, and frequency of tests ordered to follow these patients. This article reviews the level-I data avail-able regarding the efficacy of follow-up, the specific tests commonly used, and issues of costs and patient satisfaction, and provides a summary of the available societal guidelines concerning colorectal cancer follow-up.

Background: The population genetic structure of Plasmodium falciparum differs between endemic regions, but the characteristics of a population recently fragmented by effective malaria control have been unknown., Methods: Genotypic analysis of 10 microsatellite loci widely separated in the parasite genome was conducted on 288 P. falciparum isolates from 8 foci in Malaysian Borneo, a region in which malaria incidence has been progressively reduced., Results: Within all P. falciparum foci, moderate levels of allelic diversity were found, but levels of multilocus linkage disequilibrium were extremely variable. The population with the highest proportion of mixed-clone infections also had the highest allelic diversity and nonsignificant linkage disequilibrium. In contrast, several populations showed evidence of clonal expansion, and one offshore island population had exceptionally high levels of linkage disequilibrium. Genetic differentiation between many populations was very high and strongly associated with the geographical distance between them., Conclusions: High levels of differentiation and contrasting population structure among P. falciparum populations in Malaysian Borneo indicate that they are genetically independent. This supports the feasibility of individually eradicating the remaining P. falciparum foci.