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Aims Shoulder replacement is increasingly performed for end-stage arthritis. Information on the long-term survival and patient outcomes is very limited. This study aimed to quantify the survival and clinical outcome at a minimum of 20-yr follow-up. Methods A single-center, single-surgeon, consecutive cohort study was performed. Forty-four shoulder replacements in 40 patients (age at surgery 68.5 years, 82.5% female, preoperative visual analog scale [VAS] pain score 5.1/10, standard deviation [SD] 2.7) implanted between 1996 and 2000 were assessed. All-cause construct survival, radiographic glenoid and humeral stem loosening, radiographic humeral head migration, and patient-reported outcome measures were assessed. Results Survival with all-cause revision as an endpoint was 84.1% (95% confidence interval [CI] 60.7, 94.1) at 20 years, glenoid loosening was seen in all patients who survived to the 20-year follow-up. Survival of rotator cuff integrity was 16.8% (95% CI 3.5, 38.5) at 20 years. VAS pain scores demonstrated improvement at 10 years (mean change –4/10) but not at 20 years (effect size –0.15, mean change 0.4/10, SD 2.7). At 20 years, 72% of patients had died with the prosthesis in situ. Conclusion Older patients undergoing total shoulder arthroplasty are unlikely to require revision in their lifetime. However, beyond 10 years, a large proportion of implants demonstrate glenoid loosening, humeral head migration, and declining patient outcomes. This information will be of use to patients and clinicians when discussing the potential outcomes of surgery.

Brassicaceae crops, including Brassica, Camelina and Raphanus species, are among the most economically important crops globally; however, their production is affected by several diseases. To predict cloned disease resistance (R) gene homologs (CDRHs), we used the protein sequences of 49 cloned R genes against fungal and bacterial diseases in Brassicaceae species. In this study, using 20 Brassicaceae genomes (17 wild and 3 domesticated species), 3172 resistance gene analogs (RGAs) (2062 nucleotide binding-site leucine-rich repeats (NLRs), 497 receptor-like protein kinases (RLKs) and 613 receptor-like proteins (RLPs)) were identified. CDRH clusters were also observed in Arabis alpina, Camelina sativa and Cardamine hirsuta with assigned chromosomes, consisting of 62 homogeneous (38 NLR, 17 RLK and 7 RLP clusters) and 10 heterogeneous RGA clusters. This study highlights the prevalence of CDRHs in the wild relatives of the Brassicaceae family, which may lay the foundation for rapid identification of functional genes and genomics-assisted breeding to develop improved disease-resistant Brassicaceae crop cultivars.

21 Pags.- 4 Figs.- 3 Tabls. © 2022 Bretani, Shaaf, Tondelli, Cattivelli, Delbono, Waugh, Thomas, Russell, Bull, Igartua, Casas, Gracia, Rossi, Schulman and Rossini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY)., In cereals with hollow internodes, lodging resistance is influenced by morphological characteristics such as internode diameter and culm wall thickness. Despite their relevance, knowledge of the genetic control of these traits and their relationship with lodging is lacking in temperate cereals such as barley. To fill this gap, we developed an image analysis–based protocol to accurately phenotype culm diameters and culm wall thickness across 261 barley accessions. Analysis of culm trait data collected from field trials in seven different environments revealed high heritability values (>50%) for most traits except thickness and stiffness, as well as genotype-by-environment interactions. The collection was structured mainly according to row-type, which had a confounding effect on culm traits as evidenced by phenotypic correlations. Within both row-type subsets, outer diameter and section modulus showed significant negative correlations with lodging (, This work was supported by grant ClimBar (FACCE on Climate Smart Agriculture, Italian Ministry of Agriculture MIPAAF DM 9556/7303/15 dated 12/05/2015). This project also received funding from the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement No 771134: the project BARISTA was carried out under the ERA-NET Cofund SusCrop (Grant No. 771134), being part of the Joint Programming Initiative on Agriculture, Food Security and Climate Change (FACCE-JPI project ID: 77, Italian Ministry of Research MUR DM 2521 dated 12.12.2019). SS was in part supported by a post-doctoral fellowship (assegno di tipo A) from University of Milan.

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Chest pain is one of the most common presentations to emergency departments. However, only 5.1% will be diagnosed with an acute coronary syndrome, representing considerable time and expense in the diagnosis and investigation of the patients eventually found not to be suffering from an acute coronary syndrome. PubMed and Medline databases were searched with variations of the terms "chest pain", "emergency department", "computed tomography coronary angiography". After review, 52 articles were included. Computed tomography coronary angiography (CTCA) is a class I endorsement for investigating chest pain in major international societal guidelines. CTCA offers excellent sensitivity and negative predictive value in identifying patients with coronary disease, with prognostic data impacting patient management. If CTCA is to be applied to all comers, it is pertinent to discuss the advantages and potential pitfalls if use in the Australian system is to be increased.

Introduction: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission. Methodology: All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year. Results: We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively). Conclusion: We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.

This paper explores the growing need for integrated arts education at the college level. Specifically, the authors describe the need for an arts program which incorporates multiple disciplines and connects them to other, non-creative disciplines. Arts education affords students invaluable lessons in critical thinking, creativity, and communication, all of which are essential for the successful navigation of 21st-century challenges. The authors conclude that, contrary to current trends wherein arts education is being marginalized at the post-secondary level, an integrated approach to college arts education offers indispensable skill and enlargement of perspective for the general education of successful balanced individuals.

American mathematicians’ contributions to the engineering and production of equipment in World War II included the exploration of ways to improve choices between competing designs and maximize the value of experimental testing of prototypes. After the war, these contributions were extended, particularly at the RAND Corporation. Working on such matters, Kenneth Arrow took a keen interest in testing as a paradigm for information gathering in economic decision-making and in encouraging investment in R&D as an information-gathering exercise essential to making informed choices in military systems acquisition. He later extended insights about the shortcomings of information gathering as a market activity to his touchstone analysis of disparities of information between physician and patient as a crucial aspect of the economics of medical care. While it is difficult to trace the precise influence of the work of Arrow and others around him on engineering and R&D management, the issues they grappled with have remained relevant for more than half a century.

This essay examines the abbreviated fiction-writing career of an unlikely author, Central of Georgia Railway agricultural agent Jesse Frisbie Jackson. In the process, the essay explores the central...

Natural products (NPs) have long been a source of insecticidal crop protection products. Like many macrolide NPs, the spinosyns originated from a soil inhibiting microorganism (Saccharopolyspora spinosa). More than 20 years after initial registration, the spinosyns remain a unique class of NP-based insect control products that presently encompass two insecticidal active ingredients, spinosad, a naturally occurring mixture of spinosyns, and spinetoram, a semi-synthetic spinosyn product. The exploration and exploitation of the spinosyns has, unusually, been tied to an array of computational tools including artificial intelligence (AI)-based quantitative structure activity relationship (QSAR) and most recently computer-aided modeling and design (CAMD). The AI-based QSAR directly lead to the discovery of spinetoram, while the CAMD studies have recently resulted in the discovery and building of a series of synthetic spinosyn mimics. The most recent of these synthetic spinosyn mimics show promise as insecticides targeting lepidopteran insect pests as demonstrated by field studies wherein the efficacy has been shown to be comparable to spinosad and spinetoram. These and a range of other aspects related to the exploration of the spinosyns over the past 30 years are reviewed herein. © 2020 Society of Chemical Industry.

Study design Observational Study. Objective The primary objective was to determine if there were differences in spine structure measures between experimental postures and standard supine posture MRIs. Methods Thirty-four low back pain patients were included. MRI was taken in 6 experimental postures. The dependent measures includes sagittal view anterior (ADH), middle and posterior disc heights, thecal sac width, left/right foraminal height (FH). In the axial view: disc width, left and right foraminal height. Measures were done L3/L4, L4/L5 and L5/S1. Each subject served as their own control. Spine measurements in the experimental posture were compared to the same measures in the standard supine posture. Results 94% inter-observer reliability was seen. In the sagittal and axial view, 55 of the 108 and 11 of the 18 measures were significantly different. In sagittal view: a) ADH was significantly smaller in the sitting flexed posture by 2.50 mm ± 0.63 compared to the supine posture; b) ADH in sitting neutral posture was significantly smaller than the standard posture by 1.97 mm ± 0.86; c) sitting flexed posture showed that bilateral FH measures were significantly different; d) Bilateral FH was larger in the sitting neutral posture compared to the standard supine posture by 0.87 mm ± 0.17. Conclusions This research quantifies the differences in spine structure measures that occur in various experimental postures. The additional information gathered from an upright MRI may correlate with symptoms leading to an accurate diagnosis and assist in future spine research.

Unique in the Western world, the Court Challenges Program was an undertaking funded entirely by the Federal Government of Canada, without regard to jurisdiction, to subsidize legal test cases of national importance regarding the clarification and interpretation of language and equality rights guaranteed under Canada’s Constitution. This paper reviews the literature on the cancellation of the Court Challenges Program of Canada. Except from 1992 to 1994, when Brian Mulroney’s Conservative government withdrew all financial support for the program, it existed in its various institutional forms from 1978 to 2006, until Stephen Harper’s Conservative government cancelled it on September 25, 2006. In June 2008, the program was somewhat resurrected under the name of the Language Rights Support Program. This program, despite its questionable aspects, helped change the landscape of Canadian law in regards to access to services for Aboriginals, differently-abled people, the rights of women and sexual minorities, and access to education, health and the courts for those speaking minority languages. This paper examines the stormy history of the Court Challenges Program, explores criticisms of its administration, and considers the political motivations that led to the program’s demise in 2006 and subsequent resurrection in 2019.

Background Direct oral anticoagulants (DOACs) are prescribed for atrial fibrillation (AF) and venous thromboembolism (VTE) and both occur more frequently in obese patients. Outcomes from DOAC trials included few individuals ≥ 120 kg leading to uncertainty whether high body weight (BW) reduces DOAC concentrations. Objectives This article investigates the relationship between factor Xa (FXa) inhibitor concentrations, BW, and renal function, and compares them in high BW patients with unselected populations. Methods Consecutive patients in two United Kingdom centers, weighing ≥ 120 kg receiving 5 mg twice daily apixaban or 20 mg once daily rivaroxaban for AF or VTE were prospectively included. Peak or trough concentrations were measured using specific chromogenic assays, expressed in mean or median (5th–95th percentiles). On-therapy range was the interval from the 5th percentile trough concentration to the 95th percentile peak concentration. Results One hundred patients were included; age range: 23 to 78 years, 31% were women, 58% had AF, creatinine clearance range: 67 to 474 mL/min. Median BW was 139 kg, and 84% had body mass index (BMI) ≥ 40 kg/m2. DOAC peak and trough concentrations varied from 44 to 727 and 14 to 299 ng/mL, respectively. There was no linear relationship between FXa inhibitor concentrations at peak or trough and BW or BMI, and creatinine clearance. Apixaban troughs in AF and rivaroxaban peaks in VTE were lower than in unselected populations. However, only two trough concentrations were below the expected range, and 109/116 were within the on-therapy range. Conclusion These data indicated that obese or high BW patients generally achieve therapeutic FXa inhibitor concentrations. However, further investigations assessing clinical outcomes are required.

CSF (Cerebrospinal Fluid) xanthochromia by spectroscopy should not be dismissed in the context of hyperbilirubinemia in a patient with sickle cell anemia. Xanthochromia detected by spectrophotometry offers a vital clue that further invasive diagnosis is required., CSF xanthochromia by spectroscopy should not be dismissed in the context of hyperbilirubinemia in a patient with sickle cell anemia. Xanthochromia detected by spectrophotometry offers a vital clue that further invasive diagnosis is required.

Environmental DNA (eDNA) is emerging as a potentially powerful tool to assess aquatic ecosystems, and to monitor fish assemblages. We conducted a pilot eDNA water sampling program at 5 Reserves within the National Estuarine Research Reserve System from temperate and tropical estuaries to better understand how eDNA data can support detection of fish species within an standardized monitoring network. Samples were collected in coordination with an existing long term monitoring program, and the sampling plan was designed to minimize additional work for field teams. We found that results varied; in some estuaries the number and type of fish species was consistent with expected occurrence, and eDNA analysis detected fish that often eluded traditional sampling methods. In warm turbid waters, however, we detected fewer species than expected, suggesting that additional processing is required at these sites. Managers interested in applying standardized eDNA monitoring across a range of sites may want to consider a decision tree protocol, where a baseline methodology is developed for all sites, enhanced by additional laboratory or analysis steps when specific conditions are present.

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