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Background: Neoadjuvant chemotherapy is available to women with locally advanced breast cancer where chemotherapy is given prior to surgery. By examining resected tissue following neoadjuvant chemotherapy pathological complete response (pCR) can be determined. pCR is a favorable prognostic factor associated with longer survival compared to residual disease after neoadjuvant chemotherapy. Physical activity and diet may improve some side effects during treatment, but less is known about their effect on chemotherapy completion and more specifically on pCR in the neoadjuvant setting. Utilizing data from a randomized trial of diet and physical activity with a primary endpoint of chemotherapy completion in women with newly diagnosed breast cancer initiating chemotherapy, we evaluated the effect of a lifestyle intervention on pCR among the subset of women in the trial who received neoadjuvant chemotherapy. Methods: The Lifestyle, Exercise and Nutrition Early after Diagnosis (LEANer) Study enrolled 173 women with Stage I-III breast cancer who were randomized to usual care (n = 86) or a yearlong, 16-session, in-person or telephone-administered diet and physical activity intervention (n = 87) delivered by registered dietitians. Among study participants, 73 women received neoadjuvant chemotherapy and of these, 72 (98.6%) had complete follow-up pCR data (intervention = 40; usual care = 32). pCR, dates, doses and reason for dose-adjustments/delays of chemotherapy were abstracted from electronic medical records and confirmed with treating oncologists. A Chi-square test was used to examine the effect of the intervention versus usual care on pCR. Results: The 72 women receiving neoadjuvant chemotherapy with complete follow-up pCR data in LEANer were 49.4±11.6 years old, had a body mass index of 30.0+6.7 kg/m2, and 37.0% and 49.3% had stage I or II breast cancer, respectively. Just over half (52.1%) of women had ER/PR positive cancers and 32.9% of tumors were HER2 positive, with no statistically significant differences in tumor type by study arm. 92.7% of the women randomized to intervention adhered to all of the counseling sessions during their neoadjuvant chemotherapy and had statistically significant improvements in mean physical activity (161 minute increase versus 40 minute increase, p-value = < 0.001) and fiber intake (0.21 gram/day increase versus -5.17 g/day decrease, p-value = 0.020), as well as median fruit and vegetable intake (0.6 serving/day increase versus -0.5 serving/day decrease, p-value = 0.041) compared to usual care. There was a benefit of the intervention on pCR compared to usual care (52.5% with pCR in the intervention arm versus 28.1% with pCR in the usual care arm, p-value = 0.037). The intervention effect on pCR did not appear to be impacted by chemotherapy completion (relative dose intensity of 92% in intervention versus 90% in usual care) or chemotherapy dose delays as these were similar in the two study arms. In mediation analyses, results suggested that the changes in physical activity mediated, at least partially, the intervention effect on pCR. Conclusions: A primarily telephone-based diet and physical activity intervention led to improved pCR compared to usual care among the subset of women with breast cancer in the LEANer Study who received neoadjuvant chemotherapy. As pCR is an important prognostic factor for breast cancer, additional lifestyle interventions focusing on the neoadjuvant treatment setting with pCR as the primary outcome are necessary to confirm the potential benefits of lifestyle changes on pCR. Citation Format: Leah Ferrucci, Tara B. Sanft, Maura Harrigan, Brenda Cartmel, Fangyong Li, Michelle Zupa, Courtney McGowan, Leah Puklin, Thai Hien Nguyen, Anna M. Tanasijevic, Marian L. Neuhouser, Dawn Hershman, Karen Basen-Engquist, Beth Jones, Tish Knobf, Anees B. Chagpar, Andrea L.M. Silber, Jennifer A. Ligibel, Melinda L. Irwin. PD12-08 Randomized trial of exercise and nutrition on pathological complete response among women with breast cancer receiving neoadjuvant chemotherapy: the Lifestyle, Exercise and Nutrition Early after Diagnosis (LEANer) Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD12-08.

Summary We present our management of urgent skin cancer referrals during the COVID-19 pandemic through the utilisation of an independent plastic surgery treatment centre (PSTC). During this pandemic, we have seen a worrying decline in the number of new urgent skin cancer referrals being received by our service. However, there are still a number of patients requiring treatment for high risk skin cancers, where delays could potentially lead to significant complications. Our PSTC has allowed us to continue with definitive skin cancer excisions and reconstructions in patients suitable for local anaesthetic day case procedures, with reduced waiting times for the most urgent, protecting other patients and healthcare staff, and minimising the burden on hospital resources.

Objectives Human papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state. Methods Using a mixed-methods design, we integrated quantitative analyses of Montana’s National Immunization Survey–Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake. Results In Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers’ recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%). Conclusions HPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents’ knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.

Understanding the patient's perspective of their care transition process from hospital or skilled nursing facility (SNF) to home may highlight gaps in care and inform system improvements.To gather data about patients' care transition experiences and factors associated with follow-up appointment completion.A survey tool was developed with input from patient advisors and organizations participating in a collaborative quality initiative. Seventeen hospitals, 12 practitioner organizations, and 6 SNFs in Michigan collaborated to identify shared patients who were aged 18 years and older, had a working telephone number, recently returned home or to an assisted living facility with a diagnosis of congestive heart failure or chronic obstructive pulmonary disease, or after an SNF stay. Using consecutive sampling, interviewers collected 5 telephone surveys per month. From October 2018 to December 2019, patients or caregivers were surveyed via telephone 8 to 12 days after discharge from a hospital or SNF. Data were analyzed from March 2020 to January 2022.Care transition experiences.The primary outcome was to identify patient-perceived gaps during care transition experiences, including postdischarge follow-up.On the basis of pilot data, the response rate was estimated at 34%, yielding 1257 surveys. Of 1257 survey respondents (mean [SD] age, 70 [12.94] years for 968 patients for whom age data was available), 654 (52%) were female; 829 (74%) were White, 250 (22%) were Black or African American, and 40 (4%) were another race. Eleven percent of patients reported not receiving a telephone number to call for postdischarge questions. Nearly 80% of patients (977 patients) received a follow-up telephone call, and most found it valuable. Twenty percent of patients (255 patients) reported at least 1 social determinant of health issue. Lack of transportation was associated with reduced likelihood of completing a follow-up visit, decreasing the odds of completing a follow-up by nearly 70% (odds ratio [OR], 0.31; 95% CI, 0.18-0.53; P .001). Compared with other patient groups, Black patients were less likely to report completing a postdischarge follow-up visit (OR, 0.49; 95% CI, 0.36-0.67; P .001) or to receive prescribed medical equipment (OR, 4.23; 95% CI, 1.30-13.83; P = .02).An examination of patient discharge experiences from a hospital or SNF identified inconsistencies in care transition processes, social determinants of health issues needing to be addressed after discharge, and racial disparities between patients who attend follow-up appointments. Physicians should be aware of these findings and their consequences for patient experiences.

PurposeCombining the mTOR inhibitor ridaforolimus and the anti-IGFR antibody dalotuzumab demonstrated antitumor activity, including partial responses, in estrogen receptor (ER)-positive advanced breast cancer, especially in high proliferation tumors (Ki67>15%).MethodsThis randomized, multicenter, international, phase II study enrolled postmenopausal women with advanced ER-positive breast cancer previously treated with a nonsteroidal aromatase inhibitor (NCT01234857). Patients were randomized to either oral ridaforolimus 30mg daily for 5 of 7days (once daily [qd]×5days/week) plus intravenous dalotuzumab 10mg/kg/week or oral exemestane 25mg/day, and stratified by Ki67 status. Due to a high incidence of stomatitis in the ridaforolimus-dalotuzumab group, two sequential, nonrandomized, reduced-dose cohorts were explored with ridaforolimus 20 and 10mg qd×5days/week. The primary endpoint was progression-free survival (PFS).ResultsMedian PFS was 21.4weeks for ridaforolimus 30mg qd×5days/week plus dalotuzumab 10mg/kg (n=29) and 24.3weeks for exemestane (n=33; hazard ratio=1.00; P=0.5). Overall survival and objective response rates were similar between treatment arms. The incidence of drug-related, nonserious, and serious adverse events was higher with ridaforolimus/dalotuzumab (any ridaforolimus dose) than with exemestane. Lowering the ridaforolimus dose reduced the incidence of grade 3 stomatitis, but overall toxicity remained higher than acceptable at all doses without improved efficacy.ConclusionsThe combination of ridaforolimus plus dalotuzumab was no more effective than exemestane in patients with advanced ER-positive breast cancer, and the incidence of adverse events was higher. Therefore, the combination is not being further pursued.

Heteroditopic receptors (4a–e) based on a thiacalix[4]arene in the 1,3-alternate conformation, which have two urea moieties linking various phenyl groups substituted with either electron-donating or -withdrawing groups at their m-, or p-positions with a crown-ether moiety at the opposite side of the thiacalix[4]arene cavity, have been synthesized. The two examples with p-CH3– (4b) and p-NO2-substituted (4e) phenyl groups have been characterized by X-ray crystallography. The binding properties of receptor 4e were investigated by means of 1H NMR spectroscopic and absorption titration experiments in CHCl3–DMSO (10 : 1, v/v) solution in the presence of K+ ions and various anions. Interestingly, it was found that receptor 4e, which possesses two p-nitrophenyl ureido moieties, can complex most efficiently in the urea cavity or the crown-ether moiety; and the plausible allosteric effect of receptor 4e was also studied.

To examine incidence of adverse health outcomes and associated factors among preschoolers (under age 6) who received antipsychotic treatment through the Florida Medicaid Prior Authorization (PA) program.Using Florida's PA registry linked to the state's Medicaid claims data, we ascertained incident outcomes during PA-approved antipsychotic use between April 2008 and September 2015 (7.5 years). Six outcomes associated with use of antipsychotics included: diabetes, obesity, hyperlipidemia, hyperprolactinemia, cardiovascular disease (CVD) (including hypertension, ventricular arrhythmia, and other CVDs), and extrapyramidal symptoms (EPS) (including dystonia, akathisia, parkinsonism, and tardive dyskinesia). Outcome-specific incidences were stratified by short-term (≤1 year) and long-term (1-7 years) antipsychotic use. We used multivariate modified Poisson regressions to determine factors associated with these outcomes among preschoolers.The overall crude incidence during PA-approved antipsychotic use was highest for EPS and obesity (57 and 19 cases/1000 children-years, respectively). The rate of these two outcomes differed by duration of antipsychotic use. We observed a higher obesity (23.8 vs. 9.6, p 0.001) and dystonia incidence (7.2 vs. 2.5, p 0.05), but lower akathisia incidence (44.4 vs. 60.6, p 0.05) among long-term antipsychotic users compared with short-term users. Five outcomes-ventricular arrhythmia, other cardiovascular side effects, hyperprolactinemia, parkinsonism, and tardive dyskinesia-occurred rarely (2.0/1000 children-years). Preschoolers who were younger at baseline (≤2 years old vs. 4-5 years old) and Black (vs. White) were at a higher risk of EPS.Risk for EPS and obesity deserves clinical attention during antipsychotic treatment among preschoolers. Controlled studies that allow interpretation of these incidence rates in the context of background risk and that formally quantify the incremental risk associated with antipsychotic initiation during early childhood are needed.

PurposeTo evaluate whether adding humanized monoclonal insulin growth factor-1 receptor (IGF-1R) antibody (dalotuzumab) to mammalian target of rapamycin (mTOR) inhibitor (ridaforolimus) plus aromatase inhibitor (exemestane) improves outcomes in patients with estrogen receptor (ER)-positive advanced/metastatic breast cancer.MethodsThis randomized, open-label, phase II trial enrolled 80 postmenopausal women with high-proliferation (Ki67 index staining≥15%), ER-positive breast cancer that progressed after a non-steroidal aromatase inhibitor (NCT01605396). Randomly assigned patients were given oral ridaforolimus 10mg QD 5×/week, intravenous dalotuzumab 10mg/kg/week, and oral exemestane 25mg/day (R/D/E, n=40), or ridaforolimus 30mg QD 5×/week and exemestane 25mg/day (R/E; n=40). Primary end point was progression-free survival (PFS).ResultsMedian PFS was 23.3weeks for R/D/E versus 31.9weeks for R/E (hazard ratio 1.18; 80% CI 0.81-1.72; P=0.565). Grade 3-5 adverse events were reported in 67.5% of patients in the R/E arm and 59.0% in the R/D/E arm. Stomatitis (95.0 vs. 76.9%; P=0.021) and pneumonitis (22.5 vs. 5.1%; P=0.027) occurred more frequently in the R/E than the R/D/E arm; hyperglycemia (27.5 vs. 28.2%) occurred at a similar rate.ConclusionsR/D/E did not improve PFS compared with R/E. Because the PFS reported for R/E was similar to that reported for everolimus plus exemestane in patients with advanced breast cancer, it is possible that lower-dose ridaforolimus in the R/D/E arm (from overlapping toxicities with IGF1R inhibitor) contributed to lack of improved PFS.

Background In-vitro gut fermentation systems provide suitable models for studying gut microbiota composition and functionality. However, such methods depend on the availability of donors and the assumption of reproducibility between microbial communities before experimental treatments commence. The aim of this study was to develop a frozen standardised inoculum (FSI) which minimizes inter-individual variation and to determine its stability over time using culture-dependent and culture-independent techniques. Results A method for the preparation difference of a FSI is described which involves pooling the faecal samples, centrifugation and pelleting of the cell biomass and finally homogenising the cell pellets with phosphate buffer and glycerol. Using this approach, no significant difference in total anaerobe cell viability was observed between the fresh standardised inoculum (before freezing) and the 12 days post freezing FSI. Moreover, Quantitative PCR revealed no significant alterations in the estimated bacterial numbers in the FSI preparations for any of the phyla. MiSeq sequencing revealed minute differences in the relative abundance at phylum, family and genus levels between the FSI preparations. Differences in the microbiota denoted as significant were limited between preparations in the majority of cases to changes in percentage relative abundance of ± 0.5%. The independently prepared FSIs revealed a high degree of reproducibility in terms of microbial composition between the three preparations. Conclusions This study provides a method to produce a standardised human faecal inoculum suitable for freezing. Based on culture-dependent and independent analysis, the method ensures a degree of reproducibility between preparations by lessening the effect of inter-individual variation among the donors, thereby making the system more suitable for the accurate interpretation of the effects of experimental treatments.

Objective Evaluate safety/tolerability/efficacy of MK-8242 in subjects with refractory/recurrent AML. Methods MK-8242 was dosed p.o. QD (30–250 mg) or BID (120–250 mg) for 7on/7off in 28-day cycle. Dosing was modified to 7on/14off, in 21-day cycle (210 or 300 mg BID). Results 26 subjects enrolled (24 evaluable for response); 5/26 discontinued due to AEs. There were 7 deaths; 1 (fungal pneumonia due to marrow aplasia) possibly drug-related. With the 7on/7off regimen, 2 subjects had DLTs in the 250 mg BID group (both bone marrow failure and prolonged cytopenia). With the 7on/14off, no DLTs were observed in 210 mg BID or 300 mg BID (doses >300 mg not tested). Best responses were: 1/24 PR (11 weeks;120 mg QD, 7on/7off); 1/24 CRi (2 weeks;210 mg BID, 7on/14off); 1/24 morphologic leukemia-free state (4 weeks; 250 mg BID, 7on/7off). PK on Day7 at 210 mg BID revealed AUC0–12 h 8.7 μM·h, Cmax 1.5 μM (n = 5, Tmax, 2–6 h), T1/2 7.9 h, CLss/F 28.8 L/h, and Vss/F 317 L. Conclusions The 7on/14off regimen showed a more favorable safety profile; no MTD was established. Efficacy was seen using both regimens providing impetus for further study of HDM2 inhibitors in subjects with AML.

Purpose This study aims the following: (i) to describe the exposure to antipsychotic medications over a 4‐year period experienced by a cohort of children who initiated antipsychotic treatment before their sixth birthday; and (ii) to identify variables associated with the risk of antipsychotic exposure. Methods Children were identified who initiated an index episode of antipsychotic treatment before their sixth birthday in Florida’s fee for service Medicaid program. With the use of claims data, the medication utilization of these children was tracked during the year before and the 4years following the start of their index episodes (pre‐index and four post‐index periods). Generalized estimating equations were used to identify variables associated with the risk of additional days of antipsychotic exposure. Results Five hundred twenty‐eight children were included in the cohort. The mean total number of days of exposure was 821.9 (±431.9), representing 56.3% of all days during the four post‐index periods. The mean days of exposure to combinations of antipsychotics and other classes of psychotherapeutic medications were 623.8±447.6days. Children with primary diagnoses of pervasive developmental disorders and affective disorders were at greater risk of additional days of exposure than children with attention deficit/hyperactivity disorder. Exposure tended to be greater among children with indicators of clinical complexity including the presence of secondary diagnoses and the use of other classes of psychotherapeutic medications in addition to antipsychotics. Conclusions Exposure to antipsychotic mediations was extensive. Although these children may have had complex and severe problems, additional research is urgently needed on the benefits and risks of long‐term antipsychotic exposure among very young children. Copyright © 2011 John Wiley & Sons, Ltd. key words—antipsychotic medication; long‐term exposure; children Received 1 March 2011; Revised 26 May 2011; Accepted 27 May 2011

Dielectric properties of glass–ceramics containing barium/lead-based sodium niobates and barium titanate-based silicates were evaluated for capacitor applications. The glasses were formed by melt-rolling the respective constituents which were then crystallized by reheating them at higher temperatures. Crystallization schedules were formulated based on differential thermal analysis results. X-ray diffractometer patterns indicated that the samples were highly crystallized. Microstructure and microchemistry of samples were studied by transmission electron micropscopy. Perovskite, tungsten–bronze and fresnoite phases developed during crystallization have a strong effect on the resulted dielectric properties with permittivities ranging from 20 to 700. Resistivity measurements were done to study conduction mechanisms in samples and the resistivity values for glass–ceramics were found to be between 1011 and 1013Ω·cm at 150°C. MnO2 additions were made to improve the electrical resistivity of glass–ceramics.

This chapter offers a critical paradigm for reading Ruth through the lens of “narrative desire.” An interdisciplinary method bringing together insights from narratology, psychoanalytic theory, philosophical studies, and queer theory, narrative desire provides a versatile approach to indeterminate texts, highlighting the erotic interplay between a narrative’s form and content and the reader’s response. By playing on readers’ desires for a fulfilling and resolute climax, Ruth often seduces readers into what Peter Brooks terms “the male plot of ambition.” From this perspective, women and other minority characters are rendered utilitarian disruptions in an otherwise male, Israelite story. An alternative strategy of “reading for the middle” encourages readers to reconsider the temporal and spatial dynamics of the narrative in order to resist restrictive forms of emplotment. As one lingers in the “dilatory” spaces of the middle, hidden desires are exposed and emancipatory possibilities are revealed.

Glass-ceramics in the Na 2 O–PbO–Nb 2 O 5 –SiO 2 system have been synthesized to produce bulk materials with nanometer-sized crystals grown in a glass phase via roll-quenching followed by controlled crystallization. X-ray diffraction studies indicate that Pb 2 Nb 2 O 7 , NaNbO 3 and PbNb 2 O 6 phases are formed from the as-quenched glass in temperature range from 750 to 900 °C. Pb 2 Nb 2 O 7 crystallizes at 750 °C and disappears at 850 °C, NaNbO 3 is the primary phase at 850 °C, while PbNb 2 O 6 is formed at a higher temperature of 900 °C. The dielectric properties of the glass-ceramics formed through controlled crystallization have a strong dependence on the phase assemblages that are developed during heat treatment. The highest dielectric constants (> 600) were found in samples annealed at 850 °C for 3 h. Microstructural observation shows that randomly oriented, nanometer-sized crystalline are found with residual glass concentrated at crystallite boundaries. Further studies by scanning tunneling electron microscopy (STEM) in conjunction with energy dispersive spectroscopy (EDS) reveals inhomogeneous distribution of NaNbO 3 and PbNb 2 O 6 in the sample annealed at 850 °C for 3 h and these phases contribute to the high dielectric constant.

The crystallization kinetics and phase developments of PbO–BaO–SrO–Nb2O5–B2O3–SiO2-based glass-ceramics was investigated. Lead strontium barium niobate, (Pb,Sr,Ba)Nb2O6, with a tetragonal tungsten-bronze structure formed as the major crystalline phase, which showed evidence of both surface and bulk crystallization. The results of the present study showed significant evidence of a change in crystallization mechanism between the as-heated surface and the interior of glass-ceramics. This effect could be attributed to a volatilization of PbO taken place readily on the surface region of sample during heating. The grain size of the bulk-nucleated (Pb,Sr,Ba)Nb2O6 crystals was substantially smaller than that of surface-nucleated crystals. This result facilitated meeting the capacitors as high energy density application due to the ultrafine grains (2 O6 phase.

(1−x)Bi(Mg1/2Ti1/2)O3–xPbTiO3 polycrystalline ceramics were investigated for potential as high-temperature piezoelectric materials. A morphotropic phase boundary (MPB) between tetragonal (T) and rhombohedral (R) ferroelectric (FE) phases, which exhibited enhanced piezoelectric activity and a ferroelectric–paraelectric phase transition at 478 °C was observed at x≈0.37. Electron diffraction patterns (x⩽0.37) contained discrete superlattice reflections at 12{hkl} positions arising from antiphase rotations of the O octahedra, consistent with R3c space group symmetry. These reflections were diffuse at the MPB (x=0.38) and absent in the T phase (x=0.5). In the unpoled state, FE R (x=0.35) ceramics revealed a polar microdomain structure whereas the T phase (x=0.5) contained classic {110} twin domain boundaries. However, poled R samples underwent a field-induced transformation to an aligned domain structure with {110} twin boundaries similar to those in the T phase. Correlations are made between structure and pro...

Single crystals of Ba(ZrxTi1−x)O3 were grown by templated grain growth (TGG). Millimeter size single crystals of Ba(ZrxTi1−x)O3 were produced by heating a BaTiO3 crystal in contact with a sintered polycrystalline matrix of 4.5, 5.0, or 8.5 mol % Zr-doped barium titanate for 30 h at 1350 °C. To facilitate boundary migration, the ceramic compact was made 3 mol % TiO2 excess. The 4.5 and 5.0 mol % Zr-doped crystals were orthorhombic at room temperature, and for a pseudocubic (001) orientation, they showed remanent polarizations of 13 μC/cm2 and a high field d33 of 340–355 pC/N. The 8.5 mol % Zr-doped crystal [again oriented along the pseudocubic (001)] was rhombohedral at room temperature with a remanent polarization of 10 μC/cm2. A k33 value of 0.74 from resonance measurements was observed for the 4.5 mol % Zr-doped crystal.

Summary Background Testicular torsion (TT) remains one of the most common urological emergencies. The length of time from onset of symptoms to detorsion and degree of spermatic cord twisting are usually the most important factors for testicular damage. Therefore early presentation, accurate diagnosis, and prompt treatment are important factors for optimizing the testicular salvage rate. While delay in seeking medical attention is a common cause of testicular loss in pediatric patients with testicular torsion, delays in diagnosis and treatment can be preventable causes of testicular loss. Objective In this study, we aimed to develop a standardized process to improve the patient flow from the Emergency Room (ER) to Operating Room (OR) for TT patients in an academic children's hospital. Study design Thirty consecutive pediatric patients with acute testicular torsion between November 2013 and July 2014 served as the control group. A scrotal pain checklist was implemented in July 2014, and 30 consecutive patients from July 2014 until April 2015 served as the study group. Perioperative parameters including times, ultrasound (US) findings, and surgical results were reviewed. Results The mean ages of the control group and the study group were similar (12.3 ± 4.9 years and 11.5 ± 5 years, respectively) ( p = 0.575). ER arrival to OR time, triage completion to OR time, and scrotal US to OR time were significantly decreased in the study group ( p p = 0.071, p = 0.112, respectively). Discussion Utilizing scoring tools during the triage of patients with scrotal pain can help identify high-risk patients earlier and prevent unnecessary use of resources in an ER serving a large pediatric population. Limitations of this pilot study include the limited number of patients and the potential for the Hawthorne effect (staff awareness of the study). Additionally, we did not examine scrotal pain checklist scores for other acute scrotal diseases. This study focused on a quality improvement process for TT patients, in order to reduce ER to OR times. Conclusion A standardized process with use of a scrotal pain checklist and prompt communication between the ER, Urology, and Radiology teams led to significantly reduced times from the ER to the OR. Standardized processes for pediatric patients with testicular torsion may help to improve testicular survival rates. Table . Patient demographics and time flow. Control group, mean ± SD (min–max) Study group, mean ± SD (min–max) * p Age (years) 12.3 ± 4.9 (0.1–17.9) 11.5 ± 5 (0.1–18) 0.575 Triage time (h:min) 0:14 ± 0:12 (0:02–0:55) 0:09 ± 0:07 (0:03–0:29) 0.071 ER arrival to OR Time (h:min) 3:18 ± 1:16 (1:03–7:23) 2:05 ± 0:45 (0:55–3:26) 0.001 Triage completion to OR time (h:min) 3:03 ± 1:16 (0:55–7:18) 1:55 ± 0:43 (0:50–3:12) 0.001 ER arrival to Scrotal Doppler US Time (h:min) 0:52 ± 0:36 (0:11–2:44) 0:39 ± 0:20 (0:13–1:33) 0.112 Scrotal Doppler US to OR time (h:min) 2:26 ± 1:04 (0:36–5:54) 1:26 ± 0:39 (0:19–3:01) 0.001 ER = Emergency Room; OR = Operating Room; US = ultrasonography. *Student t test. The bold p values are the statistically significant ones (

This study aims the following: (i) to describe the exposure to antipsychotic medications over a 4-year period experienced by a cohort of children who initiated antipsychotic treatment before their sixth birthday; and (ii) to identify variables associated with the risk of antipsychotic exposure.Children were identified who initiated an index episode of antipsychotic treatment before their sixth birthday in Florida's fee for service Medicaid program. With the use of claims data, the medication utilization of these children was tracked during the year before and the 4 years following the start of their index episodes (pre-index and four post-index periods). Generalized estimating equations were used to identify variables associated with the risk of additional days of antipsychotic exposure.Five hundred twenty-eight children were included in the cohort. The mean total number of days of exposure was 821.9 (± 431.9), representing 56.3% of all days during the four post-index periods. The mean days of exposure to combinations of antipsychotics and other classes of psychotherapeutic medications were 623.8 ± 447.6 days. Children with primary diagnoses of pervasive developmental disorders and affective disorders were at greater risk of additional days of exposure than children with attention deficit/hyperactivity disorder. Exposure tended to be greater among children with indicators of clinical complexity including the presence of secondary diagnoses and the use of other classes of psychotherapeutic medications in addition to antipsychotics.Exposure to antipsychotic mediations was extensive. Although these children may have had complex and severe problems, additional research is urgently needed on the benefits and risks of long-term antipsychotic exposure among very young children.

Venus is one of the many significant scientific targets for NASA. New rock sampling tools with the ability to be operated at high temperatures of the order of 460 deg C are required for surface in-situ sampling/analysis missions. Piezoelectric materials such as LiNbO? crystals and Bismuth Titanate are potentially operational at the temperature range found on the surface of Venus. A study of the feasibility of producing piezoelectric drills for a temperature up to 500 deg C was conducted. The study includes investigation of the high temperature properties of piezoelectric crystals and ceramics with different formulas and doping. Several prototypes of Ultrasonic/Sonic Drill/Corers (USDC) driven by transducers using the high temperate piezoelectric ceramics and single LiNbO? crystal were fabricated. The transducers were analyzed by scanning the impedance at room temperature and 500 deg C under both low and high voltages. The drilling performances were tested at temperature up to 500 deg C. Preliminary results were previously reported [Bao et al, 2009]. In this paper, the progress is presented and the future works for performance improvements are discussed.

Cigarette smoking is the most important preventable cause of illness and death in the United States, responsible for 390,000, or one sixth, of all deaths. Although smoking prevalence has decreased among adults, from 40% in 1965 to 29% in 1987, 49 million Americans continue to smoke. Smoking rates have declined at a slower rate among blacks, women, young people, and the less educated, groups that must be targeted for tobacco use prevention interventions. The clinician is uniquely positioned to reduce the enormous health toll from cigarette smoking. As a first step, physicians are urged to assess tobacco use during every patient visit by making smoking status a new vital sign. Although 85% of all smokers quit on their own, physicians can greatly facilitate this process. A brief intervention for physicians to help their smoking patients quit, based on a program of the National Cancer Institute, is presented. This program includes asking about smoking status during every clinic visit, advising all smoking patients to quit, assisting smokers by setting a quit date and using nicotine gum, if appropriate, and arranging follow-up with smokers who try to quit. Cessation rates of 5% to 25%, sustained for at least 1 year, are consistent with a successful, physician-mediated intervention program. Physicians are also urged to prevent smoking initiation among adolescents, particularly young girls and those not aspiring to attend college. Physicians can also reduce the enormous toll of tobacco use by acting at the public health and public policy levels. Recording tobacco use as a contributing or the underlying cause on death certificates, if appropriate, will assist in public health surveillance. Also, clinicians are urged to work at the organizational, community, and governmental levels to promote tobacco-free environments.