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Environmentalism and sustainability issues have been widely explored in recent decades. Green supply chain management helps to ensure that public and private policies aimed at improving the environment, increasing market share, enhancing a company's image and reputation, and boosting profits are actually effective. GSCM practises are well-known, but there is a lack of implementation due to a variety of factors. More research is needed to find a solution to these discrepancies.

Background Comprehensive and transparent reporting of clinical trial activity is important. The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 and Consolidated Standards of Reporting Trials (CONSORT) 2010 statements define the items to be reported in clinical trial protocols and randomized controlled trials, respectively. The aim of this methodological review was to assess the reporting quality of adult neuro-oncology trial protocols and trial result articles. Methods Adult primary and secondary brain tumor phase 3 trial protocols and result articles published after the introduction of the SPIRIT 2013 statement, were identified through searches of 4 electronic bibliographic databases. Following extraction of baseline demographic data, the reporting quality of independently included trial protocols and result articles was assessed against the SPIRIT and CONSORT statements respectively. The CONSORT-A checklist, an extension of the CONSORT 2010 statement, was used to specifically assess the abstract accompanying the trial results article. Percentage adherence (standard deviation [SD]) was calculated for each article. Results Seven trial protocols, and 36 trial result articles were included. Mean adherence of trial protocols to the SPIRIT statement was 79.4% (SD: 0.11). Mean adherence of trial abstracts to CONSORT-A was 75.3% (SD: 0.12) and trial result articles to CONSORT was 74.5% (SD: 0.10). Conclusion The reporting quality of adult neuro-oncology trial protocols and trial result articles requires improvement to ensure comprehensive and transparent communication of planned neuro-oncology clinical trials and results within the literature. Raising awareness by clinical triallists and implementing mandatory evidence of proof of adherence by journals should improve reporting quality.

Palisaded neutrophilic and granulomatous dermatitis (PNGD) represents a cutaneous histopathologic reaction spectrum associated with several underlying disorders. Few cases of PNGD have been associated with chronic myelomonocytic leukemia (CMML), a malignant hematopoietic disorder with features in between those of a myeloproliferative neoplasm and myelodysplastic syndrome. We present a patient with a generalized papular skin reaction involving the neck, chest, and shoulders with histomorphological features on the spectrum of PNGD. Subsequent laboratory workup demonstrated a persistent mild monocytosis, raising concern for CMML. The diagnosis was ultimately confirmed with a bone marrow biopsy and associated mutational analysis through next-generation sequencing which identified deleterious variants in SRSF2, IDH2, and ASXL1. The findings in this case strengthen the previously made association between PNGD and SRSF2-mutated CMML and may help better define a unique recognizable clinical-histopathological-molecular subtype for dermatopathologists.

Left-behind experience is a demographic issue caused by unbalanced distributions of social determinants that affect individuals’ wellbeing. While the number of adolescents with left-behind experiences has increased over the past decades, the understanding of the impacts of left-behind experiences on the sexual and reproductive health of Chinese adolescents is limited. To determine the associations between left-behind experience and sexual health, this study analyzed 54,485 responses in the 2022 China Family Planning Association National College Student Survey sponsored by the China Family Planning Association with descriptive analysis and multivariable regression modeling. Participants with left-behind experiences demonstrated a higher prevalence of sexually transmitted infections (OR: 2.11, 95% CI:1.78—2.49) and unintended pregnancies (OR: 1.51. 95%CI: 1.26—1.82) but a lower prevalence of reproductive health problems (OR: 0.95, 95% 0.91—0.99), induced abortion (OR: 0.5, 95% CI: 0.28—0.95), and contraception at their first sexual behavior (OR: 0.81, 95%CI: 0.72–0.9). The studying results indicate sexual health disparities between adolescents with left-behind experiences and their counterparts, suggesting that current sex education programs in China should be further implemented to promote adolescent sexual health and dimmish the gap of health inequities.

Objective The objective of this study was to determine the accuracy of fast brain magnetic resonance imaging (MRI) in the detection of intra- and extra-axial intracranial hemorrhage compared with standard-of-care computed tomography (CT) or MRI in pediatric patients. Unlike previous studies, we did not focus exclusively on patients with head trauma. We evaluated the fast brain MRI findings in a general pediatric population referred for indications other than evaluation of ventricular size. Methods We retrospectively reviewed 48 pediatric patients with indications other than hydrocephalus and shunt follow-up, who underwent a standard head CT or standard MRI within 15 days of the fast brain MRI. All fast brain MRI scans included half-Fourier acquisition with single-shot turbo spin echo (HASTE) sequences in the axial, coronal, and sagittal plane. Two neuroradiologists blinded to patient information and study indications reviewed the fast brain MRI studies independently and then concurrently. Results A total of 48 patients met the inclusion and exclusion criteria. The median and mean time interval between the standard and fast imaging were 2 and 3.9 days, respectively. The sensitivity and specificity of fast brain MRI to detect intraparenchymal hemorrhage were 100% and 97%, respectively. The sensitivity and specificity of fast brain MRI in the detection of extra-axial hemorrhage (subdural and/or epidural) were 86% and 96%, respectively. The sensitivity and specificity of fast brain MRI were, respectively, 10% and 100% for subarachnoid hemorrhage, 50% and 100% for intraventricular hemorrhage, and 47% and 97% for skull fracture, respectively. Conclusions Our results show that fast brain MRI with HASTE sequence is as sensitive as CT and standard MRI in the detection of intra-axial hemorrhage and has moderate sensitivity in the detection of extra-axial hemorrhage. Our preliminary results show that T2-weighted HASTE imaging may be suitable for the follow-up of intraparenchymal and extra-axial (subdural and/or epidural) hemorrhages.

The methyl-lysine readers plant homeodomain finger protein 20 (PHF20) and its homolog PHF20-like protein 1 (PHF20L1) are known components of the nonspecific lethal (NSL) complex that regulates gene expression through its histone acetyltransferase activity. In the current model, both PHF homologs coexist in the same NSL complex, although this was not formally tested; nor have the functions of PHF20 and PHF20L1 regarding NSL complex integrity and transcriptional regulation been investigated. Here, we perform an in-depth biochemical and functional characterization of PHF20 and PHF20L1 in the context of the NSL complex. Using mass spectrometry, genome-wide chromatin analysis, and protein-domain mapping, we identify the existence of two distinct NSL complexes that exclusively contain either PHF20 or PHF20L1. We show that the C-terminal domains of PHF20 and PHF20L1 are essential for complex formation with NSL, and the Tudor 2 domains are required for chromatin binding. The genome-wide chromatin landscape of PHF20-PHF20L1 shows that these proteins bind mostly to the same genomic regions, at promoters of highly expressed/housekeeping genes. Yet, deletion of PHF20 and PHF20L1 does not abrogate gene expression or impact the recruitment of the NSL complex to those target gene promoters, suggesting the existence of an alternative mechanism that compensates for the transcription of genes whose sustained expression is important for critical cellular functions. This work shifts the current paradigm and lays the foundation for studies on the differential roles of PHF20 and PHF20L1 in regulating NSL complex activity in physiological and diseases states.

OBJECTIVE: To investigate factors associated with delay in initiation of initial disease-modifying antirheumatic drug (DMARD) in patients newly diagnosed with rheumatoid arthritis (RA). METHODS: We performed a retrospective cohort descriptive study using administrative data from the US military’s TRICARE program (2007–2012). We identified incident RA cases using billing codes and initial DMARD receipt using prescription fill date. We quantified the time between RA presentation and initial DMARD receipt, evaluated temporal changes in delay over the study period, and investigated predictors of treatment delay (>90 days) using logistic regression. RESULTS: We identified 16,680 patients with incident RA that were prescribed DMARDs and mean age was 47.2 (SD 13.5) years. The mean time from initial RA presentation to first DMARD prescription receipt was 125.3 days (SD 175.4). Over one-third (35.6%) of incident RA patients initiated DMARD >90 days after presentation. There was less treatment delay in later years of the study (mean days to DMARD of 144.7 days in 2007; 109.7 days in 2012). Patients prescribed opioids had mean time to DMARD of 212.8 days (SD 207.4) compared to mean of 77.3 days (SD 132.3) for those who did not use opioids (p

Introduction Obesity and overweight, defined as body mass index (BMI) of 30.0 and above or 25.0–29.9, respectively, are of significant concern to the military population, due to their associated comorbidities and potential for impaired readiness. In 2016, the US Army reported a prevalence of 17.3% obesity and 52.9% overweight among soldiers, despite both physical demands of the job and Department of Defense (DoD) guidelines which recommend separation from service for those unable to meet body composition standards. This study examines the health service utilization of active duty, male Army soldiers in order to determine the prevalence of obesity and overweight and to estimate the effects of these conditions on readiness. Materials and Methods This was a cross-sectional study utilizing fiscal year (FY) 2015 TRICARE claims and military treatment facility (MTF) encounter data obtained from the Military Health System Data Repository (MDR), for 467,732 US Army male Soldiers on active duty. We obtained basic demographic information (age, race, and rank) from the Defense Enrollment Eligibility Reporting System (DEERS). Next, we calculated BMI for this cohort by matching patients to their vital statistics of height and weight measurements. Finally, we obtained their health service utilization by querying and matching patients to their healthcare claims in 2015 by major diagnostic category. Findings More than half (51.2%) of subjects had overweight, 28.9% had normal weight, 19.7% had obesity, and less than 1% had underweight. Soldiers with overweight and obesity were most common among the 25–34 years age range and enlisted ranks. Normal weight and underweight soldiers had a median of 7 healthcare visits in FY 2015, compared with 8 for soldiers with overweight and 12 for those with obesity. Soldiers with obesity, but not overweight, had a disproportionately greater number of healthcare encounters for diagnostic categories including musculoskeletal; mental health; ear, nose, and throat; and endocrine system. In contrast, soldiers with obesity had disproportionately fewer healthcare encounters for multiple significant trauma and for infectious and parasitic diseases. Conclusions More than 70% of soldiers had overweight or obesity in FY 2015, showing the highest prevalence yet measured for these conditions. Previous reports of lower prevalence may be due to the inclusion of circumference-based body fat assessments, which have been criticized for inaccuracy. In our study, disproportionately high health service use by soldiers with obesity suggests decreased readiness, as these soldiers may experience both poorer health and lose necessary training time due to increased provider visits. Proportional usage by soldiers with overweight suggests the protective effect of regular physical activity, though these soldiers should be monitored to ensure that they do not progress to obesity. Additional research should establish the burden of cost, absenteeism, and presenteeism of obesity on the MHS, as well as developing more appropriate field tests for body fat assessment and BMI standards to better support military readiness.

Centruroides is a common genus of bark scorpions in the United States with at least 21 species considered to be medically important, including the closely related Centruroides exilicauda and Centruroides sculpturatus. Stings from C exilicauda and C sculpturatus have been shown to cause fatality in children more often than in adults. More severe complications are caused by the neurotoxin released by Centruroides stings. Most stings can be managed at home, but for those patients who require treatment, antivenin has been shown to decrease time to symptom abatement.

Purpose To evaluate the impact of a medication to bedside delivery (meds-to-beds) service on hospital reutilization in an adult population. Methods A retrospective, single-center, observational cohort study was conducted within a regional academic medical center from January 2017 to July 2017. Adult patients discharged from an internal medicine unit with at least one maintenance medication were evaluated. The primary outcome was the incidence of 30-day hospital reutilization between two groups: discharged patients who received meds-to-beds versus those who did not. Additionally, the incidence of 30-day hospital reutilization between the two groups was compared within predefined subgroup patient populations: polypharmacy, high-risk medication use, and patients with a principal discharge diagnosis meeting the criteria set by the Centers for Medicare and Medicaid Services 30-day risk standardized readmission measures. Results A total of 600 patients were included in the study (300 patients in the meds-to-beds group and 300 patients in the control group). The 30-day hospital reutilization (emergency department visits and/or hospital readmissions) related to the index visit was lower in the meds-to-beds group, but the difference was not statistically significant between the two groups (8.0% in the meds-to-beds group versus 10.0% in the control group; odds ratio, 0.78; 95% confidence interval, 0.45–1.37). There was no significant difference in the 30-day hospital reutilization related to the index visit between the control and meds-to-beds groups within the three subgroups analyzed. Conclusion There was no difference in 30-day hospital reutilization related to the index visit with the implementation of meds-to-beds service in the absence of other transitions-of-care interventions.

PURPOSE: Assess systemic vascular endothelial growth factor-A (VEGF) levels after treatment with intravitreous aflibercept, bevacizumab or ranibizumab. DESIGN: Comparative-effectiveness trial with participants randomly assigned to 2-mg aflibercept, 1.25-mg bevacizumab, or 0.3-mg ranibizumab following a retreatment algorithm. PARTICIPANTS: Participants with available plasma samples (N=436) METHODS: Plasma samples were collected before injections at baseline, 4-week, 52-week and 104-week visits. In a pre-planned secondary analysis, systemic free-VEGF levels from an ELISA immunoassay were compared across anti-VEGF agents and correlated with systemic side effects. MAIN OUTCOME MEASURES: Changes in the natural log (ln) of plasma VEGF levels. RESULTS: Baseline free-VEGF levels were similar across all 3 groups. At 4 weeks, mean ln(VEGF) changes were −0.30±0.61, −0.31±0.54, −0.02±0.44 pg/ml for the aflibercept, bevacizumab, and ranibizumab groups, respectively. The adjusted differences between treatment groups (adjusted CI; P-value) were −0.01 (−0.12, +0.10; P=0.89), −0.31 (−0.44, −0.18; P

Background Targeted capture sequencing can potentially facilitate precision medicine, but the feasibility of this approach in gastrointestinal (GI) malignancies is unknown. Patients and methods The FOrMAT (Feasibility of a Molecular Characterisation Approach to Treatment) study was a feasibility study enrolling patients with advanced GI malignancies from February 2014 to November 2015. Targeted capture sequencing (mainly using archival formalin-fixed paraffin-embedded diagnostic/resection samples) was carried out to detect mutations, copy number variations and translocations in up to 46 genes which had prognostic/predictive significance or were targets in current/upcoming clinical trials. Results Of the 222 patients recruited, 215 patients (96.8%) had available tissue samples, 125 patients (56.3%) had ≥16 genes successfully sequenced and 136 patients (61.2%) had ≥1 genes successfully sequenced. Sample characteristics influenced the proportion of successfully sequenced samples, e.g. tumour type (colorectal 70.9%, biliary 52.6%, oesophagogastric 50.7%, pancreas 27.3%, P = 0.002), tumour cellularity (high versus low: 78.3% versus 13.3%, P ≤ 0.001), tumour content (high versus low: 78.6% versus 27.3%, P = 0.001) and type of sample (resection versus biopsy: 82.4% versus 47.6%, P ≤ 0.001). Currently, actionable alterations were detected in 90 (40.5%) of the 222 patients recruited (66% of the 136 patients sequenced) and 2 patients subsequently received a targeted therapy. The most frequently detected currently actionable alterations were mutations in KRAS, BRAF, TP53 and PIK3CA. For the 205 patients with archival samples, the median time to obtain sequencing results was 18.9 weeks, including a median of 4.9 weeks for sample retrieval and 5.1 weeks for sequencing. Conclusions Targeted sequencing detected actionable alterations in formalin-fixed paraffin-embedded samples, but tissue characteristics are of critical importance in determining sequencing success. Routine molecular profiling of GI tumours outside of clinical trials is not an effective use of healthcare resources unless more targeted drugs become available. ClinicalTrials.gov identifier NCT02112357

Background Atopic dermatitis (AD) is a common, chronic type 2 inflammatory skin disease, typically starting in infancy, with increased risk for subsequent extracutaneous atopic morbidities. Dupilumab is the first biologic agent targeting type 2 inflammation approved by the U.S. Food and Drug Administration (USFDA); it was licensed in 2017 for adults with moderate to severe AD and 2 years later for adolescents. Systemic treatment for pediatric AD remains a significant unmet medical need. Objective To analyze off-label use of dupilumab in children with AD. Methods Multicenter retrospective review that evaluated children who were prescribed dupilumab for moderate to severe AD. Results One hundred eleven of 124 patients (89.5%) gained access to dupilumab after a mean of 9 weeks. The dosing range was 4 to 15.5 mg/kg for the loading dose and 2.0 to 15.3 mg/kg every other week for maintenance. The range was widest for 6- to 11-year-olds and was related to use of either full or half of adult dosing. Associated morbidities, treatment response, and adverse events were comparable to those in previous adolescent and adult trials. Limitations The retrospective design of the study limited uniform data collection. Conclusion Access to dupilumab was achievable for the majority of children after a mean 9-week delay because of insurance payment denial. This review supports dupilumab response and tolerability in children. Optimal dosing for patients younger than 12 years has not been defined. Availability of the drug in 2 different concentrations is an important safety issue.

Background Prompt initiation of disease-modifying antirheumatic drugs (DMARDs) is recommended for patients diagnosed with rheumatoid arthritis (RA) to improve symptoms and prevent disease progression, but treatment delays may still occur. Objectives To investigate predictors and temporal trends for delay in DMARD initiation among patients with incident RA in the United States. Methods We performed a longitudinal cohort study using administrative data from the United States military’s TRICARE program (2007–2012). TRICARE beneficiaries, who are demographically similar to the US, include active/retired military members, spouses, and dependents and receive care in military or civilian settings. We identified incident RA cases using billing codes and initial DMARD receipt using prescription fill date. We quantified the time between RA presentation and initial DMARD receipt, temporal changes in time to treatment over the study period, and investigated predictors of treatment delay (>90 days) using logistic regression. Results We identified 16 680 patients with incident RA that were later prescribed DMARDs. Mean age was 47.2 (SD 13.5) years, 77.6% were female, and 76.5% were spouses/dependents of the military sponsor. The mean time from initial RA presentation to first DMARD prescription was 125.3 days (SD 175.4). Over one-third (35.6%) of incident RA patients experienced treatment delay (>90 days between presentation and DMARD receipt). Time to DMARD initiation was shorter in later years of the study (mean 144.7 days in 2007; 109.7 days in 2012). Patients prescribed opioids between RA presentation and initial DMARD receipt had 4-fold increased risk for delay in initial DMARD (OR 4.07, 95% CI 3.78–4.37). Patients prescribed opioids had mean time to DMARD of 212.8 days (SD 207.4) compared to mean of 77.3 days (SD 132.3) for those who did not use opioids (p Conclusions In this large US nationwide study, delays in initial DMARD receipt after incident RA were common but time to treatment improved in later years of the study. Avoiding opioid use may decrease delay in initiating DMARDs during this vulnerable period when pain and disease activity are often most pronounced. Disclosure of Interest None declared

Objectives: The Military Healthcare System (MHS) shows increasing interest in acupuncture as an alternative to opioids for pain control. However, specific factors associated with this procedure in the MHS are not well-described in literature. This study examines usage within the MHS to determine patterns among the diagnoses, provider types, and facilities associated with acupuncture. Materials and Methods: Acupuncture-treated patients were identified from TRICARE claims data in the MHS Data Repository as having at least one acupuncture treatment in fiscal year (FY) 2014. Bivariate analysis was performed to determine demographics, diagnoses, and number of visits, for both active-duty and nonactive-duty personnel. Descriptive statistics were used to show associated provider and facility types. Results: A total of 15,761 people received acupuncture in the MHS in FY 2014. Use of acupuncture was greater for Army service, white race, and senior enlisted rank overall, and for males ages 26-35 among active-duty and females ages 46-64 among nonactive-duty beneficiaries. A cumulative 76% of diagnoses were for musculoskeletal or nerve and system issues. Approximately 60% of patients received acupuncture from physicians, 16% from physical therapists or chiropractors, and 9.7% from physician extenders. Specific acupuncture techniques (traditional, auricular, etc.) could not be determined from the data set. Conclusions: The most common diagnoses associated with acupuncture are consistent with pain management. However, full analysis is hampered by inconsistent coding and lack of granularity regarding specific techniques. Given the popularity of acupuncture in the MHS, further research is necessary to explore the full scope of this intervention.

The application of three-dimensional (3D) printing enables the creation of material objects from digital images by depositing layers of plastic material into 3D structures and can be used for training, education, and surgical planning. We report two patients with large complex cardiac tumors where 3D technology was utilized to analyze the tumor size, location, and extension more precisely, allowing better preoperative planning and decision making.

Introduction Many non-battle injuries among deployed soldiers are due to occupational-related tasks. Given that non-battle injuries are a significant cause of morbidity and mortality, occupational safety and health are of great concern to the military. Some of the leading causes of non-battle injuries in the military are also common in non-military occupational settings. Nationally, falls and motor-vehicle accidents are leading causes of non-fatal occupational injuries in the civilian workforce. The objective of this research is to identify the leading causes, types, and anatomic locations of non-fatal non-battle injuries in Afghanistan and Iraq. Methods Non-battle injuries were identified from medical air evacuation records. Causes of air evacuated injuries were identified and coded using the diagnosis and narrative patient history in the air evacuation records. Descriptive statistics were used to report the air evacuated non-battle injury rates, causes, injury types, and anatomic locations. Results Between 2001 and 2013, there were 68,349 medical air evacuations from Afghanistan and Iraq. Non-battle injuries accounted for 31% of air evacuations from Afghanistan and 34% from Iraq. These injuries were the leading diagnosis category for air evacuations. The three leading causes of injury for Afghanistan and Iraq, respectively, were sports/physical training (23% and 24%), falls/jumps (19% and 16%), and military vehicle-related accidents (8% and 11%). The leading injury types were fractures (21%), overuse pain and inflammation (16%), and dislocations (11%). Practical applications Given that over 30% of medical evacuations of soldiers result from non-battle injuries, prevention of such conditions would substantially enhance military readiness during combat.

Prenatal lung development requires fetal breathing movements (FBM). To investigate the dependence of FBM on feedback originating from the lung, we hypothesized that pneumonectomy stimulates FBM. Time-dated fetal sheep underwent bilateral pneumonectomy, unilateral pneumonectomy, or sham surgery at 125–130 days gestation. The incidence of FBM decreased in sham-operated fetuses at 142 days versus 130 days (p = 0.013), but was unchanged across all gestational ages in bilaterally pneumonectomized fetuses (p ≥ 0.52). In unilaterally pneumonectomized fetuses, the incidence of FBM remained unchanged until 139 days and was higher than that of the bilaterally pneumonectomized fetuses at 130–136 days gestation (p ≤ 0.03). The amplitude of integrated diaphragmatic electromyographic activity (∫EMGdi) and total respiratory output (frequency of breathing × ∫EMGdi) were lower in pneumonectomized fetuses versus sham-operated fetuses at later gestational ages (p < 0.05). These decreases in ∫EMGdi and total respiratory output were most pronounced at 142 days in bilaterally pneumonectomized fetuses versus sham-operated fetuses (p = 0.006 and 0.016, respectively). Low-voltage electrocortical activity (ECoG) increased, and high-voltage ECoG decreased, in unilaterally pneumonectomized fetuses compared with sham-operated fetuses (p = 0.04). In conclusion, we provide new evidence that feedback from the fetal lung modulates the incidence and various components of phrenic nerve output, suggesting a positive feedback mechanism between FBM and lung development.

To compare visual field (VF) defects found by Swedish interactive thresholding Algorithm (SITA) perimetry and Matrix perimetry, a new VF device that utilizes frequency doubling technology in a 24-2 test pattern.Prospective cross-sectional study.Fifty eyes from 50 subjects with SITA field defects were recruited for an observational study.Swedish Interactive Threshold Algorithm and Matrix VF testing were performed on patients from a glaucoma practice. To evaluate the learning effect on the performance of the VF, we tested subsets of each group who had previous experience with standard automated perimetry (SAP).Test duration, mean threshold, mean deviation (MD), pattern standard deviation (PSD), glaucoma hemifield test, and number of abnormal points on the pattern deviation plot were evaluated for each device.Test duration was significantly shorter for Matrix (SITA, 357.0+/-85.6 seconds; Matrix, 319.5+/-16.5 seconds; P = 0.0002, paired t-test). Thirty-six percent of eyes with SITA VF defects showed a normal Matrix field. In 30 of 32 eyes (94%) where both devices showed VF defects, the defects were congruent. Mean threshold value was significantly lower with Matrix compared to SITA (P0.0001, paired t-test), as was MD (-5.34+/-5.42 dB, -4.14+/-5.29 dB, respectively; P = 0.03, paired t-test). There was no significant difference in PSD between the 2 devices (P = 0.78, paired t-test). Matrix delineated significantly smaller (P = 0.005, Wilcoxon's test) and deeper (P0.001, Wilcoxon's test) defects than those found with SITA. Similar results were observed in the subgroups with prior SAP experience.The Matrix examination did not detect 36% of abnormal SITA fields. Matrix field defects were smaller and deeper than those appearing in SITA perimetry.

Purpose: Matrix perimetry is a new iteration of frequency doubling technology (FDT) using a smaller target size in the standard achromatic perimetry presentation pattern. This study compared Matrix and Swedish interactive thresholding algorithm (SITA) perimetry performance in detecting glaucoma diagnosed by structural assessment. Design: Prospective cross-sectional study. Methods: Seventy-six eyes of 76 consecutive healthy subjects, glaucoma suspects and glaucoma patients were included. All patients underwent optic nerve head (ONH) photography, SITA and Matrix perimetry and optical coherence tomography (OCT; Stratus OCT) within a six month interval. Glaucoma diagnosis was established by either glaucomatous optic neuropathy or OCT retinal nerve fiber layer (RNFL) thickness. Mean deviation (MD), pattern standard deviation (PSD), glaucoma hemifield test (GHT) and cluster of abnormal testing locations were recorded from Matrix and SITA. Results: Similar correlations were observed with Matrix and SITA MD and PSD with either cup-to-disc ratio or OCT mean RNFL. The area under the receiver operating characteristic (AROC) curves of MD and PSD for discriminating between healthy and glaucomatous eyes ranged from 0.69 to 0.81 for Matrix and from 0.75 to 0.77 for SITA. There were no statistically significant differences among any corresponding Matrix and SITA AROCs. Conclusions: Matrix and SITA perimetry had similar capabilities for distinguishing between healthy and glaucomatous eyes regardless of whether the diagnosis was established by ONH or OCT RNFL assessment.

The goals of this report on injuries to Soldiers engaged in Operation Enduring Freedom are to: describe the relative impact of injuries (battle and non-battle) compared to diseases for calendar year (CY) 2012; document non-battle injury (NBI) rates and trends from 2003 to 2012; identify leading causes and diagnoses of NBI for CY 2012; summarize key U.S. Army Public Health Command (USAPHC) CY 2012 analytic deployment surveillance projects on injuries among deployed Soldiers; and make recommendations for the improvement of Army injury prevention based on data analyzed. Routinely collected air evacuation, in-theater hospitalizations, and casualty data provide the basis for deployment injury surveillance during Army deployments in support of OEF. NBI was notably the most significant cause of medical air evacuations. As in previous years, the proportion of air-evacuated NBIs was larger than that of battle injuries (BIs) and any other category of disease. NBI was the second leading cause of OEF hospitalizations while BI was the first leading cause. Similar to previous reports, the leading cause of these NBIs indicate that many are likely preventable.

Experiments were carried out to investigate the effects of endothelin-1 (ET-1) on renal vascular tone during development under physiological conditions in conscious lambs. Renal blood flow (RBF), renal vascular resistance (RVR), mean arterial pressure (MAP), and heart rate (HR) were measured in conscious, chronically instrumented lambs aged approximately 1 week and 6 weeks before and after intra-arterial (i.a.) injection of 0, 100, 200, and 400 ng/kg body weight of ET-1. In addition, plasma levels of ET-1 were measured in 39 sheep aged 5-85 days. In 6-week-old lambs, i.a. injection of ET-1 was associated with a rapid dose-dependent decrease in RBF that resulted from a dose-dependent increase in RVR. In 1-week-old lambs, there was no renal vasoconstriction observed after ET-1 administration, even at the highest dose tested. In response to i.a. injection of ET-1 to 1-week-old and 6-week-old lambs, MAP increased and there was a concomitant decrease in HR; these effects were dose dependent but not age dependent. Plasma levels of ET-1 were 10.7+/-4.2 pg/ml at 5-10 days, and remained constant throughout the first 3 months of life in conscious sheep. We conclude that ET-1 is not a renal vasoconstrictor agent in the immediate newborn period, and that the effects of ET-1 on renal vascular tone appear to be developmentally regulated.

To investigate the role of endogenously produced bradykinin in modulating renal function during postnatal maturation, various parameters of glomerular and tubular function were measured for 1 h before and after intravenous injection of 12.5 μg/kg of the specific B2-receptor antagonist icatibant to conscious, chronically instrumented lambs aged ∼1 ( n = 7) and ∼6 wk ( n = 7). In response to icatibant, and in the absence of any changes in renal hemodynamics, there was an ∼80% decrease in glomerular filtration rate (GFR) at 20 min in 1-wk-old lambs that was sustained for 60 min; in 6-wk-old lambs, there was an ∼70% decrease in GFR by 20 min, with control levels being reached by 40 min. Icatibant administration was also associated with significant decreases in urinary flow, Cl−, and K+excretion rates that were similar in both groups of lambs, whereas Na+excretion decreased only in 6-wk-old lambs. We conclude that bradykinin modulates glomerular and tubular function in an age-dependent manner.

Purpose: To report a case of prostate cancer metastatic to the orbit that was initially misdiagnosed as orbital cellulitis with a subperiosteal abscess.Method: Case report.Conclusion: Metastatic disease should be considered in the differential diagnosis of orbital cellulitis, especially when key clinical features such as sinusitis are absent.

The present study was designed to test the hypothesis that the high renal vascular resistance characteristic of the newborn results from age-dependent changes in the responsiveness of the renal vasculature to kinins. Two studies were carried out in conscious, chronically instrumented lambs aged 1 and 6 weeks. Firstly, we measured the renal blood flow response to intra-arterial injection of the B2 receptor agonist bradykinin over the range of doses 0-800 ng x kg(-1). The ED50 renal blood flow response to bradykinin was 50 ng x kg(-1) in both age groups of lambs. Secondly, we measured the effects of intravenous administration of 12.5 microg x kg(-1) of the specific B2 receptor antagonist HOE 140; this dose attenuated the renal blood flow response to 50 ng x kg(-1) of bradykinin in both age groups. HOE 140 administration was associated with an age-dependent increase in mean arterial pressure, with little effect on heart rate or renal vascular resistance. This study provides new information regarding the effects of kinins in modulating renal haemodynamics during postnatal maturation. We reject our hypothesis and conclude that the high renal vascular resistance of the newborn does not appear to result from age-dependent changes in the responsiveness of the renal vasculature to endogenous kinins.

TThe aims of this report on injuries to Soldiers engaged in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) are to: a. Describe the relative impact of injury compared to that of disease for calendar year (CY) 2010. b. Document non-battle injury (NBI) rates and trends from 2003 to 2010. c. Identify leading causes and diagnoses of non-battle injury for CY 2010. d. Summarize key U.S. Army Public Health Command (USAPHC) CY 2010 analytic deployment surveillance projects on injuries among deployed Soldiers. e. Make recommendations for the improvement of Army injury prevention based on data analyzed. Routinely collected air evacuation, inpatient hospitalization, and casualty data provide the basis for deployment injury surveillance during current Army deployments in support of OIF/OND and OEF. Non-battle injury was notably the most significant cause of medical evacuations. As in previous years, the proportion of air-evacuated NBIs is larger than that of BIs and any other single category of disease, and it greatly impacts readiness. As in CY 2009, NBI was second to digestive diseases for OIF/OND hospitalizations and second to battle injuries for OEF hospitalizations. Similar to previous reports, the leading causes of these NBIs indicate that many are likely preventable. Timely reporting of injury rates, types, and causes should allow commanders and Army leaders to focus their attention on prevention strategies and policies during ongoing operations.

The aims of this report on injuries to Soldiers engaged in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OI)/Operation New Dawn (OND) are to: a.) Describe the relative impact of injury compared to that of disease for calendar year (CY) 2011. b.) Document non-battle injury (NBI) rates and trends from 2003 to 2011. c.) Identify leading causes and diagnoses of NBI for CY 2011. d.) Summarize key U.S. Army Public Health Command (USAPHC) CY 2011 analytic deployment surveillance projects on injuries among deployed Soldiers. e.) Make recommendations for the improvement of Army injury prevention based on data analyzed. Routinely collected air evacuation, inpatient hospitalization, and casualty data provide the basis for deployment injury surveillance during current Army deployments in support of OIF/OND and OEF. NBI was notably the most significant cause of medical evacuations. As in previous years, the proportion of air-evacuated NBIs is larger than that of battle injuries (BIs) and any other single category of disease and it greatly impacts readiness. As in CY 2010, NBI was second to digestive diseases for OND hospitalizations and second to BIs for OEF hospitalizations. Similar to previous reports, the leading causes of these NBIs indicate that many are likely preventable. Timely reporting of injury rates, types, and causes should allow commanders and Army leaders to focus their attention on prevention strategies and policies during ongoing operations.

The purpose of this article is to assist pediatric neurologists in practice and in training to better understand and distinguish between several of the most commonly prescribed treatments for attention-deficit/hyperactivity disorder (ADHD) in school-aged children. Among the various pharmacotherapies available for ADHD, 4 specific medications will be reviewed: oral release osmotic system methylphenidate hydrochloride (CON; Concerta, McNeil Pharmaceuticals), lisdexamfetamine dimesylate (LDX; Vyvanse, Shire Pharmaceuticals), atomoxetine (ATX; Strattera, Eli Lilly), and guanfacine extended-release (GXR; Intuniv, Shire Pharmaceuticals). This article contains information including medication-release pattern, administration including available dosing, adverse reactions, and case studies to serve as a guide to help determine when a particular treatment might be more appropriate than another. Although ADHD is apparent across the lifespan, this article will focus on children with ADHD from ages 6 to 12 years old. Importantly, although a number of stimulant and nonstimulant treatment options are available for school-aged children diagnosed with ADHD, choosing the best treatment options is highly dependent on obtaining thorough family and medical histories.

Metallic nanoparticles such as nickel are used in catalytic sensing, and electronic applications, but health and environmental affects have not been fully investigated. While some metal nanoparticles result in toxicity, it is also important to determine whether nanoparticles of the same metal but of different size and shape changes toxicity. Three different size nickel nanoparticle (Ni NPs) of 30, 60, and 100 nm and larger particle clusters of aggregated 60 nm entities with a dendritic structure were synthesized and exposed to zebrafish embryos assessing mortality and developmental defects. Ni NPs exposure was compared to soluble nickel salts. All three 30, 60, and 100 nm Ni NPs are equal to or less toxic than soluble nickel while dendritic clusters were more toxic. With each Ni NP exposure, thinning of the intestinal epithelium first occurs around the LD10 continuing into the LD50. LD50 exposure also results in skeletal muscle fiber separation. Exposure to soluble nickel does not cause intestinal defects while skeletal muscle separation occurs at concentrations well over LD50. These results suggest that configuration of nanoparticles may affect toxicity more than size and defects from Ni NPs exposure occur by different biological mechanisms than soluble nickel.