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Rationale South African adolescents carry a high tuberculosis disease burden. It is not known if schools are high-risk settings for Mycobacterium tuberculosis (MTB) transmission. Objectives To detect airborne MTB genomic DNA in classrooms. Methods We studied 72 classrooms occupied by 1,836 students in two South African schools. High-volume air filtration was performed for median 40 minutes (interquartile range 35-54) and assayed by droplet digital PCR (ddPCR) targeting MTB Region of Difference 9 (RD9), with concurrent CO2 concentration measurement. Classroom data were benchmarked against public health clinics. Students who consented to individual TB screening completed a questionnaire and sputum collection (Xpert MTB/RIF Ultra) if symptom-positive. Poisson statistics were used for MTB RD9 copy quantification. Measurements and Main Results ddPCR assays were positive in 13/72 (18.1%) classroom and 4/39 (10.3%) clinic measurements (p=0.276). Median ambient CO2 concentration was 886 ppm (IQR 747-1223) in classrooms vs. 490 ppm (IQR 405-587) in clinics (p

PURPOSE The Malaysian Ministry of Health had launched free opportunistic screening for colorectal cancer using immunochemical fecal occult blood test (iFOBT) targeting the average-risk individuals since 2014. This study aims to determine factors associated with colorectal cancer screening using iFOBT among the average-risk Malaysian population. METHODS A cross-sectional study was conducted at five government-run health clinics in the state of Selangor. Adults with an average risk of colorectal cancer (age > 50 years, asymptomatic, and no family history of colorectal cancer) were recruited using systematic random sampling. An interviewer-administered questionnaire adapted from the Cancer Awareness Measure and Health Belief Model was used. RESULTS The median age of participants was 61 years (interquartile range, 56 to 66). Almost 60% of participants indicated their willingness to be screened. However, only 7.5% had undergone iFOBT. Good knowledge of risk factors of colorectal cancer, perceived susceptibility to the disease, and the doctor's recommendation were associated with increased willingness to be screened: adjusted odds ratio (aOR), 1.66 (95% CI, 1.12 to 2.46); aOR, 1.70 (95% CI, 1.08 to 2.70); and aOR, 5.76 (95% CI, 2.13 to 15.57), respectively. Nevertheless, being elderly (aOR, 0.67; 95% CI, 0.45 to 0.99) and high negative perception toward the testing method (iFOBT) (aOR, 0.12; 95% CI, 0.05 to 0.30) were independently associated with lower willingness to be screened. Multivariable analysis within the average-risk individuals who were willing to be screened for colorectal cancer showed that the doctor’s recommendations remained as an important cue for positive action, whereas negative perception toward the test was a significant barrier to the actual uptake of iFOBT. CONCLUSION The present findings must be factored in when tailoring colorectal cancer screening promotion activities in multiethnic, middle-income settings.

The problem of finding the optimal solution in a self-organizing autonomous group robotic system under conditions of uncertainty is considered. A method for assessing the quality of group management based on a statistical and probabilistic decision-making criterion under uncertainty conditions has been developed. A distinctive feature of the method is the use of trust metrics. This approach allows us to identify and reduce the influence of destabilizing factors in the process of information interaction in an autonomous group of cyber-physical objects. The results can be used in the development of algorithms for group control of swarms of autonomous robotic complexes.

The objective of this study is to identify the dimension of the personality that has the greatest influence on the risk of exposure to HIV infection. The models used to fulfill the scientific objective are the empirical method of information gathering and the theoretical deductive method. The 16-FP test and the HIV infection exposure assessment test applied to homosexual adolescents between 18 and 24 years old allowed us to measure the association of the study variables. The non-association between personality and the risk of HIV infection is concluded. The predominant personality dimension is the category called toughness. The prevailing risk level of exposure to HIV is the medium risk. The average age with minimal risk of infection is 20 years, the average risk is 20.9 years, and the high risk of infection is 21.9 years. Keywords: Personality, homosexuality, HIV, risk of infection. References [1]T. Santa Cruz y M. Antezana, «Impact on corporate image in the face of inclusion of LGBT communities in retail stores in Peru,» Correspondencias & Análisis, vol. 13, nº 1, pp. 101 - 126, 2021. [2]R. Muñoz, «Estigma estructural, adherencia al tratamiento antirretroviral y cultura organizacional de cuidados en la atención hospitalaria en VIH y Sida enGuayaquil, Ecuador,» Andamios, vol. 15, nº 36, pp. 311- 341, 2018. [3]L. Brito, D. Jiménez, E. Sinche y A. Angulo, «KNOWLEDGE AND PERCEPTIONS LINKED TO HIV/AIDS IN SHUAR COMMUNITIES OF ECUADOR, » Ciencia y enfermería, vol. 25, nº 1, 2019. [4]J. Rausch, A. Gäbel, K. Nagy y N. Kleindienst, «El aumento de los niveles de testosterona y cortisol al despertar respuestas en pacientes con trastorno límite de la personalidad: Género y el rasgo de agresividad cuestión, » Psiconeuroendocrinologí, vol. 55, nº 1, pp. 116-127, 2015. [5]D. Mosquera, A. Gonzalez, y Van der Hart, O., «Trastorno límite de personalidad, trauma en la infancia y disociación estructural de la personalidad,» INTRA-TP, pp. 1 - 18, 2013. [6]V. Caballo, Manual de trastornos de la personalidad: Descripción, evaluación y tratamiento, Madrid: Síntesis, 2004. [7]O. González, N. Pérez y M. Redondo, «Procesos básicos en una aproximación cognitivo-conductual a los trastornos de personalidad,» Clínica y salud, pp. 401-423, 2007. [8]P. Fernández y A. Morales, «“No quiero que me rechacen”: Experiencias sobre la revelación del estado serológico a las parejas sexuales en hombres,» Escritos de Psicología, vol. 7, pp. 44 - 55, 2014. [9]B. Buenrostro, H. González, I. Delgado, A. Mora, J. Cadenas y S. Montero, «Frecuencia de infección por VIH/sida en usuarios de preservativo,» Revista Cubanade Investigaciones Biomédica, vol. 31, pp. 480 - 489, 2012.

Using the criterion of the minimum average risk, the statistically optimal algorithm for identifying objects by the same type of parameters is synthesized for the structural and system monitoring of the situation. In order to reduce computational costs, its quasi-optimal modification is performed, based on the exclusion of significantly different parameter values from the compared arrays. An identification simulation model is developed in the Qt Creator software environment in the object-oriented C++ programming language. Based on the statistical tests of the model, the probabilities of correctly identifying objects and false alarms are investigated according to estimates of the maximum likelihood of angular coordinates. The dependences of the indicators of identification efficiency on the root mean square errors (RMSEs) of the parameter estimates, the number of objects, and their density in the monitoring area are analyzed.

The purpose of the research. The optimization of the method electrocardiogram’s interpretation (ECG) for diagnosis and prognosis of fatal cardiogenic situations among children and teenagers depending on the severity of myocardial electrical instability.Materials and methods. The authors propose to use a modified method for assessing the “electrical quality of the heart”, proposed by A. N. Volobuev and co-authors in order to assess the electrical instability of the myocardium among children and teenagers. There is a formula which helps to estimate the index of “electrical quality factor of the heart” among children and teenagers: D=(aR/aT):(QT/QRS), where D is the index of “electrical quality factor of the heart”, aT and aR is the amplitude of R wave and T, QT — QT interval, QRS — interval, QRS. ECG was recorded in 12 leads, ECG assessment was carried out according to generally accepted rules.Results. Based on the analysis of 234 ECG of children and teenagers from the neonatal period to 18 years, the criteria of the average value of the index of “electrical quality factor of the heart” (D) were defined, D =1,09 +/- 0,03. It is proved that the value of the index “electrical quality factor of the heart” does not depend on the sex and age of the child. There was a decrease in the index of “electrical quality factor of the heart” was revealed among children with the lengthening of the QT interval.Conclusion. The index of “electrical quality factor of the heart” in pediatric practice allows to predict the risk of fatal cardiogenic conditions, to develop tactics of dynamic monitoring of patients, to evaluate the efficiency of treatment. When D

Background After breast cancer treatment, follow-up consists of physical examination and mammography for at least 5 years, to detect local and regional recurrence. The risk of recurrence may decrease after event-free time. This study aims to determine the risk of local recurrence (LR) as a first event until 5 years after diagnosis, conditional on being event-free for 1, 2, 3 and 4 years. Methods From the Netherlands Cancer Registry, all M0 breast cancers diagnosed between 2005 and 2008 were included. LR risk was calculated with Kaplan–Meier analysis, overall and for different subtypes. Conditional LR (assuming x event-free years) was determined by selecting event-free patients at x years, and calculating their LR risk within 5 years after diagnosis. Results Five-year follow-up was available for 34,453 patients. Overall, five-year LR as a first event occurred in 3.0%. This risk varied for different subtypes and was highest for triple negative (6.8%) and lowest for ER+PR+Her2− (2.2%) tumors. After 1, 2, 3 and 4 event-free years, the average risk of LR before 5 years after diagnosis decreased from 3.0 to 2.4, 1.6, 1.0, and 0.6%. The risk decreased in all subtypes, the effect was most pronounced in subtypes with the highest baseline risk (ER−Her2+ and triple negative breast cancer). After three event-free years, LR risk in the next 2 years was 1% or less in all subtypes except triple negative (1.6%). Conclusion The risk of 5-year LR as a first event was low and decreased with the number of event-free years. After three event-free years, the overall risk was 1%. This is reassuring to patients and also suggests that follow-up beyond 3 years may produce low yield of LR, both for individual patients and studies using LR as primary outcome. This can be used as a starting point to tailor follow-up to individual needs.

The incidence of early onset colorectal cancer, or colorectal cancer (CRC) diagnosed before age 50, is increasing.

GOALS We investigated if increasing the colonoscopy screening interval from 10 to 15 years would increase provider preferences for colonoscopy as a screening test. We further examined whether having colonoscopy performed at a 15-year interval by an endoscopist with a high adenoma detection rate would influence preferences. BACKGROUND Colonoscopy is recommended every 10 years in average risk individuals without polyps for colorectal cancer (CRC) screening. The use of a 15-year interval offers substantial protection, increases cost-effectiveness, and might make colonoscopy more attractive to patients and health care providers who order CRC screening tests. STUDY An anonymous online survey of health care providers across a health care system that serves a single US state and encompasses both academic and community physicians was conducted. Physicians and nurse practitioners in family medicine, obstetrics-gynecology, and internal medicine were included. Providers were asked to indicate their preference for CRC screening tests as a proportion of tests they prescribe among 5 common screening tools. Responses were compared for current colonoscopy screening intervals and if the screening intervals are increased to 15 years. RESULTS One hundred and twelve (34%) responded of 326 providers. Colonoscopy was the most frequently ordered test for CRC screening. Increasing screening interval from 10 to 15 years increased the choice of colonoscopy from 75.2% to 78.6% (P=0.003). CONCLUSIONS Expanding colonoscopy screening interval to 15 years could produce an increase in physicians and nurse practitioners choice of using colonoscopy for CRC screening, but the clinical impact appears minor. Additional surveys of patients and providers are needed.

Background and study aims Serrated lesions are precursors of approximately one-third of colorectal cancers (CRCs). Information on their detection rate was lacking as an important reference for CRC screening. This study was a systematic review and meta-analysis to determine the overall detection rate for serrated lesions and their subtypes in average-risk populations undergoing CRC screening with colonoscopy. Patient and methods MEDLINE and Embase were searched to identify population-based studies that reported the detection rate for serrated lesions. Studies on average-risk populations using colonoscopy as a screening tool were included. Metaprop was applied to model within-study variability by binomial distribution, and Freeman-Tukey Double Arcsine Transformation was adopted to stabilise the variances. The detection rate was presented in proportions using random-effects models. Results In total, 17 studies involving 129,001 average-risk individuals were included. The overall detection rates for serrated lesions (19.0 %, 95 % CI = 15.3 %–23.0 %), sessile serrated polyps (2.5 %, 95 % CI = 1.5 %–3.8 %), and traditional serrated adenomas (0.3 %, 95 % CI = 0.1 %–0.8 %) were estimated. Subgroup analysis indicated a higher detection rate for serrated lesions among males (22.0 %) than females (14.0 %), and Caucasians (25.9 %) than Asians (14.6 %). The detection rate for sessile serrated polyps was also higher among Caucasians (2.9 %) than Asians (0.7 %). Conclusions This study determined the overall detection rate for serrated lesions and their different subtypes. The pooled detection rate estimates can be used as a reference for establishing CRC screening programs. Future studies may evaluate the independent factors associated with the presence of serrated lesions during colonoscopy to enhance their rate of detection.

Colorectal cancer (CRC) is a common and preventable malignancy, and routine CRC screening is recommended for average risk individuals between the ages of 50 and 75 years. Screening has been shown to decrease CRC incidence and mortality. Once patients are older than 75 years, the risk to benefit ratio of ongoing screening begins to shift. As comorbidities increase and life expectancy decreases, the future potential benefits of CRC prevention become less robust, and risk for screening-related complications grows. However, firm age cutoffs are not sufficient to guide these decisions, as there is substantial physiologic heterogeneity among individuals of the same age.

The World Health Organization reports reveal that the average risk of dying from pregnancy-related causes in sub-Saharan Africa is about 1 in 45 compared to 1 in 5,400 in high-income countries. In Ethiopia, maternal mortality remains a tremendous problem. Several studies associate the high maternal mortality ratio to the widespread practice of home birth, household income, and lack of transportation. Absent from the findings of these studies is any discussion of the sociocultural contexts that might influence maternal health service utilization. Birthing bears cultural significance accompanied by rituals. Thus, any solution to maternal health problems must consider the sociocultural and grassroots context. It is important to learn the needs and priorities of the mothers who are targets of maternal health policies. Using Indigenous approaches, this study examines the gaps in Ethiopian maternal health policies and programs. The study also identifies culturally relevant solutions that address the needs of communities.

Background and aim The reported prevalence and risk factors for sessile serrated lesions (SSLs) show significant variation. We aimed to specifically study the prevalence and potential risk factors of SSLs in an average risk colorectal cancer (CRC) screening population of Chinese subjects. Methods This is a case-control study of prospectively collected data from a territory-wide colorectal screening program in Hong Kong. Information on risk factors was obtained from questionnaires completed prior to screening colonoscopy. We compared subjects with SSLs against controls without these lesions to identify potential risk factors using multivariable logistic regression. Results Of 12 039 asymptomatic screening subjects, 6011 subjects received a screening colonoscopy with 2214 subjects (36.8%) having conventional adenomas, 486 subjects (8.1%) having hyperplastic polyps, and 85 subjects (1.4%) having SSLs only. Of these subjects, three had synchronous advanced adenomas and were excluded from the analysis. More than 60% of these lesions were in the proximal colon. We compared these 82 subjects with SSLs only and 3226 controls without any polyps. After multivariable logistic regression, age ≥ 66 years, smoking, and diabetes mellitus (DM) were significant independent risk factors for SSLs. Conclusion In this study, we report the prevalence of SSLs to be 1.4%. Age ≥ 66 years, smoking, and DM were independent risk factors for these lesions. Our findings provide relevant new data that should be taken into consideration when designing region-specific surveillance programs for SSLs with the ultimate goal of reducing the risk of CRC.

ObjectiveColon capsule endoscopy (CCE) has shown promise for colorectal neoplasia detection compared with optical colonoscopy (OC), but has not been compared with other screening tests in average risk screening patients.DesignPatients 50 to 75 years of age (African Americans, 45–75 years) were randomised to CCE or CT colonography (CTC) and subsequent blinded OC. The primary endpoint was diagnostic yield of polyps ≥6 mm with CCE or CTC. Secondary endpoints included accuracy for size and histology, examination completeness, number/proportion of subjects with polyps and adenomas ≥6 mm and ≥10 mm, subject satisfaction and safety.ResultsFrom 320 enrolled subjects, data from 286 (89.4%) were evaluable. The proportion of subjects with any polyp ≥6 mm confirmed by OC was 31.6% for CCE versus 8.6% for CTC (pPr non-inferiority and superiority=0.999). The diagnostic yield of polyps ≥10 mm was 13.5% with CCE versus 6.3% with CTC (pPr non-inferiority=0.9954). The sensitivity and specificity of CCE for polyps ≥6 mm was 79.2% and 96.3% while that of CTC was 26.8% and 98.9%. The sensitivity and specificity of CCE for polyps ≥10 mm was 85.7% and 98.2% compared with 50% and 99.1% for CTC. Both tests were well tolerated/safe.ConclusionCCE was superior to CTC for detection of polyps ≥6 mm and non-inferior for identification of polyps ≥10 mm. CCE should be considered comparable or superior to CTC as a colorectal neoplasia screening test, although neither test is as effective as OC.Trial registration numberClinicalTrials.gov no: NCT02754661.

During the current COVID pandemic, there is growing interest to identify subsets of the population that may be at a higher than average risk of infection. One such group includes people living with HIV.

Short selling is measured in the literature as both constraint (e.g., lending fees) and activity (e.g., trades). We show that these two measures capture separate effects, which we characterize into two different strategies. The first strategy, “short trading,” has minimal constraints, weekly scale return predictability and average risk. The second strategy, “short investing,” has high constraints, multi-month return predictability and higher risk. Moreover, each strategy incorporates different types of information. Short trading includes short-lived information while short investing includes more long-lived, fundamental information. This diversity in short sellers has implications for both theoretical and empirical research.

Objective: The objective of this study was to assess the ability of the American College of Surgeons (ACS) NSQIP surgical risk calculator to accurately identify patients at increased risk of perioperative complication following surgery for gynaecological malignancy. Methods: A retrospective review of 142 patients who underwent major surgery under the gynae-oncology team between 06/08/2018-16/04/2019 at the University Hospital of Wales. Pre-operative factors combined with a procedure-specific code generated the predicted risk of 13 post-operative complications for each patient. Brier scores assessed calibration and receiver operated curves (AUC) evaluated the discriminative power of NSQIP. Results: Complications were experienced by 50/142 (35.2%) patients. The calculator displayed adequate calibration when used to predict serious complications (Brier = 0.070), readmission (Brier = 0.058), return to OR (Brier = 0.000) and UTI (Brier = 0.001). It had the greatest discriminative power when predicting the risk of serious complications (AUC = 0.672; 95% CI, 0.481-0.863). The calculator successfully identified a majority of patients who had a complication as being of ‘above average risk’ for all complications, apart from return to OR, based on their pre-operative factors. Discussion: NSQIP has previously been demonstrated to be a useful pre-operative tool for evaluating the risk of post-operative complications in colorectal surgery. This study suggests that in the setting of gynaeoncology surgery the calculator does not have adequate discriminative power to be an absolute predictor of all complications, however, it may be useful in identifying patients who are likely to develop serious complications and those at above average risk of complications.

Cancer is the leading cause of death among men and women aged 60-79 years. Colorectal cancer is the third most common cancer in males and the second most common in females, with about 0.8 million deaths worldwide per year. Individuals older than 50 years account for 20-50% of colonic adenomas. Several measures have been proposed to decrease colorectal cancer risks, such as an increase in dietary fiber, use of aspirin, and physical activity. Nonsteroidal anti-inflammatory drugs have been proposed as protective agents against the development of colorectal cancer and colorectal adenomas. Aspirin was the first pharmacological agent endorsed by the United States Preventive Services Task Force screening for colorectal cancer chemoprevention. Although studies have shown up to 40% colorectal cancer risk reduction in individuals at average risk, data regarding this benefit are inconsistent. Several recent studies show that prophylactic use of aspirin in elderly subjects may not be beneficial in preventing the occurrence of colorectal cancers. Given the risks associated with aspirin, such as non-fatal and fatal bleeding events, aspirin's role should be redefined, especially in individuals at risk of bleeding. This review provides a discussion of the recent studies on the role of aspirin use in elderly individuals at risk of colorectal cancer.

BACKGROUND In resource-limited countries, risk stratification can be used to optimize colorectal cancer screening. Few prospective risk prediction models exist for advanced neoplasia (AN) in true average-risk individuals. AIM To create and internally validate a risk prediction model for detection of AN in average-risk individuals. METHODS Prospective study of asymptomatic individuals undergoing first screening colonoscopy. Detailed characteristics including diet, exercise and medications were collected. Multivariate logistic regression was used to elucidate risk factors for AN (adenoma ≥1 cm, villous histology, high-grade dysplasia or carcinoma). The model was validated through bootstrapping, and discrimination and calibration of the model were assessed. RESULTS 980 consecutive individuals (51% F; 49% M) were enrolled. Adenoma and AN detection rates were 36.6% (F 29%: M 45%; P < 0.001) and 5.1% (F 3.8%; M 6.5%) respectively. On multivariate analysis, predictors of AN [OR (95%CI)] were age [1.036 (1.00-1.07); P = 0.048], BMI [overweight 2.21 (0.98-5.00); obese 3.54 (1.48-8.50); P = 0.018], smoking [< 40 pack-years 2.01 (1.01-4.01); ≥ 40 pack-years 3.96 (1.86-8.42); P = 0.002], and daily red meat consumption [2.02 (0.92-4.42) P = 0.079]. Nomograms of AN risk were developed in terms of risk factors and age separately for normal, overweight and obese individuals. The model had good discrimination and calibration. CONCLUSION The prevalence of adenoma and AN in average-risk Lebanese individuals is similar to the West. Age, smoking, and BMI are important predictors of AN, with obesity being particularly powerful. Though external validation is needed, this model provides an important platform for improved risk-stratification for screening programs in regions where universal screening is not currently employed.

The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel’s recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.

Purpose To describe the favorable procedural profile of CT colonography (CTC) during the COVID-19 pandemic. Conclusion Postponement of cancer screening due to COVID-19 has resulted in a backlog of individuals needing to undergo structural examination of the colon. The experience during the initial COVID-19 surge with urgent evaluation of the colon for transplant patients prior to transplant suggests that CTC can be done in a lower risk manner as compared to other structural examinations. The procedural profile of CTC is advantageous during this pandemic as maintaining social distancing and preserving healthcare supplies including PPE are of paramount importance. CTC is an important option to utilize in the screening armamentarium to allow effective screening of average risk asymptomatic individuals in the COVID-19 era.

Multiple large-scale, randomized controlled trials throughout the world have demonstrated screening mammography significantly reduces a woman's risk of dying from breast cancer. Despite the known mortality reduction, the perceived harms of mammography are weighed against the known value. Multiple national guidelines have moved away from recommending all women have annual screening mammograms beginning at age 40. Instead, many now encourage women at average risk for developing breast cancer to engage in shared decision-making with their providers, carefully weighing the perceived harms against the known benefits of mammography. These factors should be incorporated into the decision about when to begin and how often to screen. This paradigm shift has been particularly controversial as it relates to women in the 40-49-year age group, considering their incidence of breast cancer and therefore derived benefit of screening is lower, yet the breast cancers that do occur tend to be more aggressive and often require intensive therapy. Thus, debates ensue over the appropriate age at which to begin screening for breast cancer, how often screening should occur, and when to stop.

After 2 screen-setting studies showing high sensitivity for colorectal cancer and advanced precancerous lesions, multitarget stool DNA testing was endorsed by the US Preventative Services Task Force as a first-line colorectal cancer screening test. Uptake has increased exponentially since approval by the US Food and Drug Administration and Centers for Medicare and Medicaid Services. Adherence to testing is approximately 70%. Patients with positive results have high diagnostic colonoscopy completion rates in single-center studies. The positive predictive value for colorectal neoplasia in postapproval studies is high. Next-generation test prototypes show promise to extend specificity gains while maintaining high sensitivity.

Aim. To evaluate basic clinicopathologicalcharacteristics of patients with atrial fibrillationand pharmacological anamnesis at the time of cardioembolicstroke.Material and Methods. Study included 99 patientswith atrial fibrillation admitted to SeredavinSamara Regional Clinical Hospital due to cardioembolicstroke. The follow-up duration was 1year.Results. The average age of the patients was69.1 ± 8.7 years. Patients with atrial fibrillationand acute cardioembolic stroke were characterizedby multimorbidity. Arterial hypertension, chronickidney disease, and diabetes mellitus were diagnosedin 96/99 (97.0%), 60/99 (60.6%), and 22/99(22.2%) patients, respectively. Average risk scoreaccording to the CHA2DS2-VASc scale before admissionwas 4.51 ± 1.2 points; therefore, 96 patientshad indications for anticoagulant therapy (≥2 points on the CHA2DS2-VASc scale). However,adequate prevention of thromboembolic complicationsbefore admission was carried out only in16/99 (16.2%) patients.Conclusion. These results demonstrate a lowquality of outpatient care in patients with atrialfibrillation. Most likely, this can be explained bythe lack of awareness about the risks of potentialcomplications and low compliance.

Objective To compare the performance of abbreviated screening breast MRI (ABMR) versus full protocol MRI (FPMR) in women at higher-than-average risk for breast cancer with a prior normal FPMR. Methods ABMR was performed on higher-than-average-risk women who had a prior normal FPMR. ABMR protocol consisted of short inversion time inversion recovery imaging, precontrast, and two early postcontrast sequences acquired in under 10 minutes. Retrospective review of ABMR examinations performed from July 2016 to July 2018 was compared with a control group who underwent routine screening with FPMR who had a prior normal FPMR performed from July 2014 to June 2016. Screening outcome metrics were calculated and compared, adjusting for differences in patient demographics. Results The study cohort included 481 ABMR examinations, while the control group included 440 FPMR studies. There was no significant difference in the abnormal interpretation rate (AIR) or cancer detection rate (CDR) for the ABMR versus the FPMR group (AIR 6.0% vs 6.8% respectively, odds ratio (OR) 0.91, 95% confidence interval (CI): 0.53–1.5, P = 0.73; CDR 8.3 vs 11 cancers detected per 1000 examinations respectively, OR 0.73, 95% CI: 0.20–2.7, P = 0.64). The PPV2 and PPV3 for the ABMR group was 19% and 21% versus 16% and 16% for the FPMR group, with no statistical difference. Sensitivity was 100% in each group with no interval cancers. There was no difference in specificity between the ABMR and FPMR groups, 93% versus 94%, respectively (P = 0.73). Conclusion ABMR may be used to screen higher-than-average-risk women with a prior normal FPMR as outcome metrics are equivalent to FPMR.

Background: Early puberty is associated with higher than average risk of antisocial behaviour, both in girls and boys. Most studies of such association, however, have focused on psychosocial mediating and moderating factors. Few refer to coterminous hormonal measures. Aim: The aim of this review is to consider the role of hormonal markers as potential mediating or moderating factors between puberty timing and antisocial behaviour. Method: A systematic literature search was conducted searching Medline, Embase, Web of Science, Scopus, Psycinfo, Cochrane and Google Scholar. Results: Just eight studies were found to fit criteria, all cross-sectional. Measurements were too heterogeneous to allow meta-analysis. The most consistent associations found were between adrenal hormones—both androgens and cortisol—which were associated with early adrenarche and antisocial behaviours in girls and later adrenarche and antisocial behaviour in boys. Conclusions: The findings from our review suggest that longitudinal studies to test bidirectional hormone–behaviour associations with early or late puberty would be worthwhile. In view of the interactive processes between hypothalamic–pituitary–adrenal and hypothalamic–pituitary–gonadal axes, integrated consideration of the hormonal end products is recommended.

Intracranial venous sinus stenting is gaining acceptance as an effective treatment for idiopathic intracranial hypertension (IIH). The typical approach is via femoral venous and arterial access for transvenous stenting with simultaneous angiography. These patients are at an above average risk for groin complications considering obesity is typically associated with IIH and the need for heparinization and dual antiplatelet therapy. Here, we describe cerebral venography, angiography, and venous sinus stenting via a single upper extremity. We utilize a transradial approach for angiography and a venous access via the brachial or basilic vein. Over a series of 28 consecutive procedures, we were able to successfully access the intracranial venous sinuses via the arm without access site complications. This method offers the advantages of immediate patient mobilization after the procedure and more easily monitored and compressible access sites for easier post-procedural care.

Background Ambient environmental factors have been associated with respiratory infections in ecological studies, but few studies have explored the impact of indoor environmental factors in detail. The current study aimed to investigate the impact of indoor environment on the risk of acute respiratory illness (ARI) in a subtropical city. Method A prospective cohort study was conducted in 285 community-dwelling older adults from December 2016 through May 2019. Individual household indoor environment data and ARI incidence were continuously collected. A time-stratified case-crossover analysis was conducted to estimate the excess risk of ARI associated with per-unit increase of daily mean indoor temperature, relative humidity, and absolute humidity (AH). Result In total, 168 episodes of ARI were reported with an average risk of 36.8% per year. We observed a negative association of ARI with indoor AH up to 5 lag days in cool seasons, with a 6-day cumulative excess risk estimate of −9.0% (95% confidence interval, −15.9% to −1.5%). Negative associations between household temperature or relative humidity and ARI were less consistent across warm and cool seasons. Conclusions Lower indoor AH in household was associated with a higher risk of ARI in the community-dwelling older adults in Hong Kong during cold seasons.

HFRS is a relevant threat to the sanitary-epidemiological welfare of the population of the Russian Federation. It takes a leading position in the structure of natural-focal ifections of viral etiology incidence around the country. The most unfavorable situation on HFRS morbidity rates (more than 80% of the overall incidence) is observed in the constituent entities of the Volga Federal District (VFD). The purpose of the work is to differentiate the territory of the Volga Federal District in terms of the potential epidemic hazard (PEH) of HFRS infection. Materials and methods. We used information on the HFRS incidence contained in the statistical reporting form No. 1 “Information on infectious and parasitic diseases” and the data on epizootic activity of natural HFRS foci from the established forms of surveys and forecasts of the state of population and the numbers of small mammals over the period of 2014-2018. The assessment of the PEH level of HFRS infection was carried out according to the original method developed with the participation of the authors. The software used was the analytical platform Deductor Professional and the geo-information system Arc GIS. Results and discussion. Among the constituent entities of the Volga Federal District an extremely high level of risk of HFRS infection (6 points), the first type of territories, was established for the Udmurt Republic, the Republics of Bashkortostan, Tatarstan, Mordovia, and Chuvash Republic. The second type of territories characterized by high level of risk, where the PEH was 5 points – Samara, Ulyanovsk, Nizhny Novgorod, Kirov, Saratov, Orenburg regions and the Republic of Mari El. The territories in which there is an increased risk of HFRS infection cover the territory of the Penza Region (PEH – 4 points). The average risk of infection was noted only in the Perm Region (PEH – 3 points). Prompt implementation of a complex of nonspecific preventive measures at sites with a pronounced increase in the potential epidemic hazard of HFRS infection will significantly reduce the incidence rate in the VFD and the Russian Federation as a whole.

For a particular subgroup of individuals with severe paraphilic disorders and a high risk of sexual recidivism, the combination of sex drive–reducing medications and psychotherapy is a promising treatment approach. The present quasi-experimental study aims at comparing differences in clinical characteristics and dynamic risk factors between persons receiving (+TLM, n = 38) versus not receiving (−TLM, n = 22) testosterone-lowering medications (TLMs). Individuals receiving TLM were more frequently diagnosed with paraphilic disorders. Neither the criminal history nor average risk scores differed between the two groups. In the +TLM, Stable-2007 scores showed a stronger decrease after TLM treatment was started. This accounted especially for the general and sexual self-regulation subscales. Individual variations in risk, however, were not predicted by TLM but were significantly related to treatment duration and Psychopathy Checklist–Revised (PCL-R) Factor I. Paraphilic patients with problems in self-regulatory abilities seem to profit most from pharmacological sex drive–reducing treatment. Furthermore, therapists seem to underestimate deviant sexual fantasies in medicated patients.

BACKGROUND AND AIMS: National guidelines for colonoscopy screening and surveillance assume adequate bowel preparation. We used New Hampshire Colonoscopy Registry (NHCR) data to investigate the influence of bowel preparation quality on endoscopist recommendations for follow-up intervals in average-risk patients following normal screening colonoscopies. METHODS: The analysis included 9170 normal screening colonoscopies performed on average risk individuals aged 50 and above between February 2005 and September 2013. The NHCR Procedure Form instructs endoscopists to score based on the worst prepped segment after clearing all colon segments, using the following categories: excellent (essentially 100% visualization), good (very unlikely to impair visualization), fair (possibly impairing visualization), and poor (definitely impairing visualization). We categorized examinations into 3 preparation groups: optimal (excellent/good) (n = 8453), fair (n = 598), and poor (n = 119). Recommendations other than 10 years for examinations with optimal preparation, and > 1 year for examinations with poor preparation, were considered nonadherent. RESULTS: Of all examinations, 6.2% overall received nonadherent recommendations, including 5% of examinations with optimal preparation and 89.9% of examinations with poor preparation. Of normal examinations with fair preparation, 20.7% of recommendations were for an interval

We investigate whether and how a “critical audit matter” (CAM) disclosure affects managers' real operating decisions in two contexts (issuing a loan that decreases versus increases the average risk profile of loan portfolios, or choosing to hedge versus speculate on commodity risk). We expect that a CAM disclosure increases disclosure costs and implies expanded auditor support for both types of activities, but we expect implied auditor support to be valued more highly for risk-increasing than for risk-decreasing activities. As a result, we predict that a CAM disclosure decreases managers' risk-decreasing activities (due to increased disclosure costs) more than managers' risk-increasing activities (as the implied auditor support counteracts the increased disclosure costs). We find evidence consistent with our prediction across multiple experiments. Our study sheds light on the unintended consequences of a CAM disclosure and provides insight to relevant parties as the new standard goes into effect.