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Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors. OBJECTIVE: To determine factors that contribute to different clinical outcomes in racial populations. METHODS: We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences. RESULTS: Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival. CONCLUSION: Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.

Urban Heat Island (UHI) is a phenomenon that can cause hotspots in city areas due to dense, impervious infrastructure and minimal vegetation cover. UHI hotspots may become worse in extreme heat events that are already affecting many regions across the globe due to increased frequent hot extremes, human-induced warming in cities, and rapidly growing urbanization, as documented by the latest IPCC report 2021. In seeking to support designers, planners, and decision-makers in developing and implementing adaptation strategies and measures to make our cities sustainable and resilient, reliable projections and modelling are required. In this study, we modelled UHI vulnerability using high-resolution spatial data, advanced geospatial tools, and socio-demographic data. This modified vulnerability approach drew upon UHI index maps and 20 select customized indicators of heat exposure, population sensitivity, and mobility/adaptive capacity. The indicators were Delphi evaluated and weighted, and the methodology was applied against the City of Greater Geelong municipality in Australia. The resulting UHI index maps indicated significant hotspots in areas of high building density, commercial/industrial zones, newly constructed sites, and zones with low urban green infrastructure. These UHI maps, in combination with selected indicators, highlighted the areal concentration of heat risk areas and vulnerable locations for the sensitive human population. The highlighted areas were primarily concentrated in high building density and high population density areas, which was seen through correlation curves. However, the building density showed a weak correlation, and population per meshblock indicated a strong correlation with UHI measurements. This study provides a comprehensive analysis of risk mapping and vulnerability assessment using GIS geospatial data for the advancement of a major local government area and concludes that this methodology has replicability incomparable geographical regions.

Despite advances in molecular profiling, therapeutic development has been hindered by the inability to identify and target tumour-specific mechanisms without consequence to healthy tissue. Correspondingly, a computational framework capable of accurately distinguishing tumour from non-tumour cells has yet to be developed and cell annotation algorithms are unable to assign integrated genomic and transcriptional profiles to single cells on a cell-by-cell basis. To address these barriers, we developed the Single Cell Rule Association Mining (SCRAM) tool that integrates RNA-inferred genomic alterations with co-occurring cell type signatures for individual cells. Applying SCRAM to glioma, we identified tumour cell trajectories recapitulate temporally-restricted developmental paradigms and feature unique co-occurring identities. Specifically, we validated two previously unreported tumour cell populations with immune and neuronal signatures as hallmarks of human glioma subtypes.In vivomodeling revealed a rare immune-like tumour cell population resembling antigen presenting cells can direct CD8+ T cell responses. In parallel, Patch sequencing studies in human tumours confirmed that neuronal-like glioma cells fire action potentials and represent 40% ofIDH1mutant tumor cells. These studies identified new glioma cell types with functional properties similar to their non-tumour analogues and demonstrate the ability of SCRAM to identify these cell types in unprecedented detail.

BACKGROUND CONTEXT Improving value is an established point of emphasis to reduce the rapidly rising health care costs in the United States. Back pain is a major driver of costs with a substantial fraction caused by lumbar radiculopathy. The most common surgical treatment for lumbar radiculopathy is microdiscectomy. Research is sparse regarding variables driving cost in microdiscectomies and often limited by cost data derived from payer-based Medicare data. PURPOSE To identify targets for cost reduction by determining variables associated with significant cost variation in microdiscectomies, using cost data derived from the Value Driven Outcomes tool and actual system costs. STUDY DESIGN Single-center, retrospective study of prospectively collected registry data. PATIENT SAMPLE Six hundred twenty-two patients identified by CPT code and manually screened for initial, unilateral, single-level lumbar discectomy performed between 2014 and 2018 at a single institution. OUTCOME MEASURES Primary outcome measures include total direct cost, clinical length of stay, and OR minutes. Total Direct Cost was further differentiated into facility and nonfacility costs. METHODS Univariate and multivariate generalized linear models (GLM) were used to identify variables associated with variation in primary outcome measures. Costs were normalized by mean cost for patients with normal body mass index (BMI) and a healthy American Society of Anesthesiologists (ASA) classification. Average marginal effects were reported as percentage of normalized costs. RESULTS Advanced age, male gender, Hispanic, black, unemployment, obesity, higher ASA class, insurance status, and being retired were positively associated with costs in univariate analysis. Asian, Native American, outpatient procedures, and being a student were associated with decreases in costs. In multivariate analysis, we found that obesity led to higher average marginal total direct (9%), total facility (15%), and facility OR costs (22%), as well as 24 more OR minutes per surgery. While being overweight was not associated with greater total direct costs, it was associated with higher total facility (8%), and facility OR costs (12%), with 11 more OR minutes per surgery. Age was associated with a longer LOS but not with OR costs. As expected, outpatient surgical costs, LOS, and OR time were significantly lower than inpatient procedures. Severe systematic disease was associated with greater total and nonfacility costs. In addition, Medicare patients had higher facility costs (14%) compared to privately insured patients. CONCLUSIONS Significant drivers of total direct cost in multivariate GLM analysis were obesity, severe systemic disease and inpatient surgery. Average LOS was increased due to age and inpatient status, conversely it was decreased by unemployment and retirement. Significant variables in OR time were male sex, Hispanic race and both obese and overweight BMIs.

Hydrokinetic energy contains the major uncontrolled source of renewable marine energy. The highest level of converter technology readiness offered in the last three decades is TRL8–9, which is related to the first-generation horizontal axis converters. In low-depth calm waters, one of the best options to harvest tidal energy is vertical axis turbines. About 16% of the conceptual designs presented in the last 30 years apply this type of converter, which does not have a high level of technological readiness. In this study, a laboratory-designed vertical axis turbine has been introduced in which the effects of the number of blades, the blade profile, and attack angle on the performance of the turbine were analyzed. A 3D incompressible viscous turbulent computational finite volume approach is applied, with the spatial second-order and temporal first-order accuracies. The turbulent model k-ω SST was used to obtain the flow inside the turbine. Rotors include two, three, and six blades with three different profiles, including NACA2421, NACA16021, and NACA0020. Computational results reveal that the turbine with three blades and an angle of attack of +8 using the NACA2421 profile has a maximum generation capacity of about 4 kW, with a strength factor of 0.4 and a power factor of about 20%. The capacity, however, was lower for a higher number of blades.

To identify specific white matter tracts (WMTs) whose disruption is associated with the severity of neurogenic lower urinary tract dysfunction (NLUTD) in two independent cohorts of women with multiple sclerosis (MS) and NLUTD.Cohort 1 consisted of twenty-eight women with MS and NLUTD. The validation cohort consisted of 10 women with MS and NLUTD. Eleven healthy women served as controls. Participants of both MS cohorts had the same inclusion and exclusion criteria. Both MS cohorts and the healthy controls underwent the same clinical assessment and functional MRI (fMRI) protocol, except that the validation MS cohort underwent 7-Tesla fMRI scan. Fifteen WMTs (six coursing to relevant brainstem areas) involved in bladder control were a priori regions of interest (ROI). Spearman's correlation test was performed between each the Fractional Anisotropy (FA) and mean diffusivity (MD) of each WMT and the clinical parameters.Overall, we found a very high degree of overlap (100% of a priori ROI) in the tracts identified by our correlation analysis as having the greatest contribution to NLUTD symptoms in MS women. The right inferior cerebellar peduncle, left posterior limb of internal capsule, and left superior cerebellar peduncle displayed significant associations to the greatest number of clinical parameters.Our correlation analysis supports the role of specific WMT disruptions in the contribution of symptoms in women with MS and NLUTD, as confirmed in two independent MS cohorts.

Background and PurposeIn regard to the biosynthesis of conjugated linoleic acid (CLA) and eicosapentaenoic acid (EPA) by some bacteria, the objective of this study was to evaluate the efficiency of solid-state fermentation based on soybean pressed cake (SPC) to produce CLA and EPA by Bifidobacterium lactis. The objective of this study was to evaluate the efficiency of solid-state fermentation based on SPC to produce CLA and EPA by B. lactis.MethodsProcess conditions including humidity, inoculation level, and temperature parameters were optimized by adopting the response surface methodology (RSM) method (response surface method) and the design expert software. Accordingly, a homogeneous SPC paste substrate at 60, 70, and 80% humidity was prepared with different inoculation levels at 30, 37, and 44°C to assess the strain behavior. The introduced SPC consisted of 60% humidity, 2% inoculation level at 37°C, and 60% humidity, and 4% inoculation level at 30 and 44°C; it also included 6% inoculation level at 37°C, 70% humidity at 2% inoculation level, at 30 and 44°C, and 4% inoculation level at 37°C. Also, SPC with 80% humidity at 2% and 4% inoculation levels, and at 30 and 44°C was obtained. To confirm the accuracy of the conditions, an experiment was conducted according to the defined requirements.ResultsThe results were compared with the predicted data, which showed a significant difference. Under optimized conditions, with an inoculation level of 4% on the SPC medium with 70% humidity and at 37°C, B. lactis strains could yield 9cis-, 11 trans-linoleic and eicosapentaenoic at 0.18 and 0.39% of the total fatty acids.ConclusionSo, the potential benefits of using SPC as an inexpensive substrate for the commercial production of CLA and EPA should be noted.

ObjectivesTo inform national planning, six indicators posed by the Lancet Commission on Global Surgery were collected for the Mongolian surgical system. This situational analysis shows one lower middle-income country’s ability to collect the indicators aided by a well-developed health information system.DesignAn 11-year retrospective analysis of the Mongolian surgical system using data from the Health Development Center, National Statistics Office and Household Socio-Economic Survey. Access estimates were based on travel time to capable hospitals. Provider density, surgical volume and postoperative mortality were calculated at national and regional levels. Protection against impoverishing and catastrophic expenditures was assessed against standard out-of-pocket expenditure at government hospitals for individual operations.SettingMongolia’s 81 public hospitals with surgical capability, including tertiary, secondary and primary/secondary facilities.ParticipantsAll operative patients in Mongolia’s public hospitals, 2006–2016.Primary and secondary outcome measuresPrimary outcomes were national-level results of the indicators. Secondary outcomes include regional access; surgeons, anaesthesiologists and obstetricians (SAO) density; surgical volume; and perioperative mortality.ResultsIn 2016, 80.1% of the population had 2-hour access to essential surgery, including 60% of those outside the capital. SAO density was 47.4/100 000 population. A coding change increased surgical volume to 5784/100 000 population, and in-hospital mortality decreased from 0.27% to 0.14%. All households were financially protected from caesarean section. Appendectomy carried 99.4% and 98.4% protection, external femur fixation carried 75.4% and 50.7% protection from impoverishing and catastrophic expenditures, respectively. Laparoscopic cholecystectomy carried 42.9% protection from both.ConclusionsMongolia meets national benchmarks for access, provider density, surgical volume and postoperative mortality with notable limitations. Significant disparities exist between regions. Unequal access may be efficiently addressed by strengthening or building key district hospitals in population-dense areas. Increased financial protections are needed for operations involving hardware or technology. Ongoing monitoring and evaluation will support the development of context-specific interventions to improve surgical care in Mongolia.

BACKGROUND AND AIMS: In a United States randomized-effectiveness trial comparing extended-release naltrexone (XR-NTX) with buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse among participants recruited during inpatient detoxification (CTN-0051), the requirement to complete opioid detoxification prior to initiating XR-NTX resulted in lower rates of initiation of XR-NTX (72%-XR-NTX vs. 94%-BUP-NX). This led to higher relapse rates and average healthcare costs among XR-NTX participants. This study estimated the extent to which a more efficient model of XR-NTX induction would improve the economic value of XR-NTX relative to BUP-NX. DESIGN: This was a retrospective secondary analysis of CTN-0051 trial data, including follow up data over 24–36 weeks. SETTING: Eight community-based, inpatient-detoxification and follow-up outpatient treatment facilities in the USA. PARTICIPANTS: 283 participants randomized to receive XR-NTX. MEASUREMENTS: Efficiency was estimated using a multivariable generalized-structural-equation model to explore simultaneous determinants of XR-NTX induction and induction duration (detoxification + residential days). Cost-effectiveness was estimated from the healthcare sector perspective and included expected costs and quality-adjusted life-years (QALYs). FINDINGS: Treatment site was the only modifiable factor that simultaneously increased the likelihood of XR-NTX induction and decreased induction duration. Incorporating the higher predicted probability of XR-NTX induction, and fewer predicted days of detoxification and subsequent residential treatment into the cost-effectiveness framework, reduced the incremental average 24-week total cost of XR-NTX treatment from $5,317 more than that of BUP-NX (p=0.01) to a non-statistically-significant difference of $1,016 (p=0.63). QALYs gained remained similar across arms. CONCLUSION: Adopting an efficient model of extended-release naltrexone initiation could result in extended-release naltrexone and buprenorphine-naloxone being of comparable economic value from the healthcare sector perspective over 24–36 weeks for patients seeking treatment for opioid use disorder at an inpatient detoxification facility.

Patients with glioblastoma (GBM) need bold new approaches to their treatment, yet progress has been hindered by a relative inability to dynamically track treatment response, mechanisms of resistance, evolution of targetable mutations, and changes in mutational burden. We are writing on behalf of a multidisciplinary group of academic neuro-oncology professionals who met at the collaborative Christopher Davidson Forum at Washington University in St Louis in the fall of 2019. We propose a dramatic but necessary change to the routine management of patients with GBM to advance the field: to routinely biopsy recurrent GBM at the time of presumed recurrence. Data derived from these samples will identify true recurrence vs treatment effect, avoid treatments with little chance of success, enable clinical trial access, and aid in the scientific advancement of our understanding of GBM.

PurposeThis manuscript concentrates on addressing the success and failure factors to satisfy the small- and medium-sized enterprises (SMEs) need when facing challenges during the implementation of the quality management systems (QMSs) such as lack of both the financial and human resources and inadequate technical knowledge of quality management and employee indifference.Design/methodology/approachThis research employs a mixed-method research approach in three different steps. First, based on interviews and a review of previous research, a list of critical factors influencing the success and failure of QMS implementation in SMEs is provided. After conducting the interview and extracting the results, a quantitative questionnaire is recruited as a complementary tool to demonstrate the accuracy of the literature review and interview findings and to increase the validity and reliability of the data. By applying the exploratory factor analysis (EFA) method, the factors affecting the failure and success of QMS implementation are identified separately. In the third step, a focus group meeting is used to name the factors and identify the relationships among them. The relationships among the factors are also shown using the concept map. Finally, after conducting the focus group meeting, several key issues have been extracted from practice and literature to realize the critical success and failure factors.FindingsThe current study reveals that the factors supporting the SMEs during the implementation of the QMSs may be classified into nine groups. Of these, six factors are related to critical success factors (CSFs), and three factors are related to critical failure factors (CFFs).Originality/valueThere have been several studies developed and conducted to address the success factors supporting the QMSs in SMEs. However, the scope of these studies has only been set on either qualitative or quantitative approaches. Hence, the proposed method presented in this essay, which is, in turn, a new contribution, attempts to use a combined approach based on both the semistructured interviews and survey methods. The results of this study can be used as a reference by scholars and practitioners to identify the relevant issues of QMSs and their application in SMEs.

Evaluating the effect of convalescent plasma (CP) on some cytokine storm indices in severe COVID-19 patients. Totally, 62 patients were randomly assigned into two groups for this clinical trial. Patients in the intervention group received one unit (500 mL) plasma on the admission day plus standard drugs while the controls merely received standard treatments. Eventually, primary and secondary outcomes were evaluated. In the CP group, compared with controls, the mean levels of lymphocytes and IL-10 significantly increased while the levels of IL-6, TNF-α, and IFN-γ decreased (p 0.05) while WHO severity scores remarkably improved (p = 0.01), despite the higher frequency of underlying diseases among the CP group (66.7%) vs. controls (33.3%). Although CP has a remarkable immunomodulatory and antiviral potential to improve the cytokine storm and disease severity in COVID-19 patients, it did not considerably affect the mortality rate. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-021-02734-8.

Germline POT1 mutations are found in a spectrum of cancers and confer increased risk. Recently, we identified a series of novel germline POT1 mutations that predispose carrier families to the development of glioma. Despite these strong associations, how these glioma-associated POT1 mutations contribute to glioma tumorigenesis remains undefined. Here we show that POT1-G95C increases proliferation in glioma-initiating cells in vitro and in progenitor populations in the developing brain. In a native mouse model of glioma, loss of Pot1a/b resulted in decreased survival in females compared with males. These findings were corroborated in human glioma, where low POT1 expression correlated with decreased survival in females. Transcriptomic and IHC profiling of Pot1a/b-deficient glioma revealed that tumors in females exhibited decreased expression of immune markers and increased expression of cell-cycle signatures. Similar sex-dependent trends were observed in human gliomas that had low expression of POT1. Together, our studies demonstrate context-dependent functions for POT1 mutation or loss in driving progenitor proliferation in the developing brain and sexual dimorphism in glioma. Significance: This study shows that manipulation of POT1 expression in glioma has sex-specific effects on tumorigenesis and associated immune signatures.

A study was conducted to evaluate the effects of different plant extracts (common nettle, coriander, dill and thyme) at various dietary levels (0, 150, 300 and 450 mg/L) on growth performance, carcass traits, blood serum parameters, immune response and ileal microflora of 650 male Ross chickens (13 treatment groups; five replicates/treatment group; 10 birds/replicate) in a 42-day trial. Plant extracts were added to drinking water. Supplementation, except for coriander, increased feed intake (p

BACKGROUND No consensus germline testing guidelines currently exist for glioma patients. Hence such testing is not routinely performed. The prevalence and type of germline pathogenic variants in these brain tumors remains unknown. DESIGN/ METHODS A retrospective review of patients treated at Baylor College of Medicine with paired tumor/normal sequencing using the Tempus xT tumor/normal matched approach from August 2018- April 2022 was performed. Corresponding clinical data was collected for these patients. RESULTS We identified 152 glioma patients of which 15 (9.8%) had pathogenic germline variants. Pathogenic germline variants were seen in 11/84 (13.1%) of Glioblastoma, IDH wildtype, 3/42 (7.1%) of Astrocytoma, IDH mutant and 1/26 (3.8%) of Oligodendroglioma, IDH mutant and 1p/19q co-deleted patients. Pathogenic variants in BRCA2, MUTYH and CHEK2 were seen more commonly (3/15 or 20% each). BRCA1 variants were seen in 2/15 (13%) patients, with variants in NF1, ATM, MSH2, and MSH3 occurring in one patient (7%) each. Second hit somatic variants were seen in 3/15 patients (20%). A second somatic hit was seen in NF1, MUTYH and MSH2 in one patient (7%) each. Referral to genetics was performed in 6/15 (40%) patients with pathogenic germline variants. Median overall survival was 1.6 years for glioblastoma, IDH wildtype patients with a pathogenic germline variant compared to 1.79 years for glioblastoma, IDH wildtype patients without it (p = 0.67). CONCLUSIONS Although not routinely performed in glioma patients, pathogenic germline variants occurred in ~10% of our patients. Only 40% of these patients were referred to genetics. These findings suggest a possible overlooked opportunity for determination of hereditary cancer syndromes with impact on surveillance as well as potential broader treatment options. Further research to confirm the occurrence and types of pathogenic germline variants in patients with IDH wildtype compared to IDH mutant tumors is necessary.

Measurements of Pollution In The Troposphere (MOPITT) is an instrument on NASA's Terra satellite that has measured tropospheric carbon monoxide (CO) from early 2000 to the present day. Validation of data from satellite instruments like MOPITT is often conducted using ground-based measurements to ensure the continued accuracy of the space-based instrument's measurements and its scientific results. Previous MOPITT validation studies generally found a larger bias in the MOPITT data poleward of 60∘ N. In this study, we use data from 2006 to 2019 from the Bruker IFS 125HR Fourier Transform Infrared spectrometer (FTIR) located at the Polar Environment Atmospheric Research Laboratory (PEARL) in Eureka, Nunavut, Canada, to validate the MOPITT version 8 (V8) retrievals. These comparisons utilize mid- and near-infrared FTIR measurements made as part of the Network for the Detection for Atmospheric Composition Change (NDACC) and the Total Carbon Column Observing Network (TCCON), respectively. All MOPITT version 8 retrievals within a radius of 110 km (1∘) from the PEARL Ridge Laboratory and within a 24 h time interval are used in this validation study. MOPITT retrieval products include those from the near-infrared (NIR) channel, the thermal infrared (TIR) channel, and a joint product from the thermal and near-infrared (TIR–NIR) channels. Each channel's detector has 4 pixels. We calculated the MOPITT pixel-to-pixel biases for each pixel, which were found to vary based on the season and surface type (land or water). The systematic bias for pixel 1 over land is larger than that for other pixels, which can reach up to 20 ppb. We use a small-region approximation method to find filtering criteria. We then apply the filters to the MOPITT dataset to minimize the MOPITT pixel bias and the number of outliers in the dataset. The sensitivity of each MOPITT pixel and each product is examined over the Canadian high Arctic. We then follow the methodologies recommended by NDACC and TCCON for the comparison between the FTIR and satellite total column retrievals. MOPITT averaging kernels are used to weight the NDACC and TCCON retrievals and take into account the different vertical sensitivities between the satellite and PEARL FTIR measurements. We use a modified Taylor diagram to present the comparison results from each pixel for each product over land and water with NDACC and TCCON measurements. Our results show overall consistency between MOPITT and the NDACC and TCCON measurements. When compared to the FTIR, the NIR MOPITT retrievals have a positive bias of 3 %–10 % depending on the pixel. The bias values are negative for the TIR product, with values between −5 % and 0 %. The joint TIR–NIR products show differences of −4 % to 7 %. The drift in MOPITT biases (in units of % yr−1) relative to NDACC and TCCON varies by MOPITT data product. In the NIR, drifts vs. TCCON are smaller than those vs. NDACC; however, this scenario is reversed for the MOPITT TIR and joint TIR–NIR products. Overall, this study aims to provide detailed validation for MOPITT version 8 measurements in the Canadian high Arctic.