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Objective: To evaluate the effects of teprotumumab on ophthalmologic and biochemical findings and assess potential genetic markers for response to treatment., Methods: This is a retrospective study. Participants were 18-76 year old. All subjects were treated with teprotumumab. The primary outcome was the change in proptosis before and after teprotumumab treatment. Secondary outcomes include change in other ophthalmic measures and thyroid laboratory tests. Human leukocyte antigens (HLA) markers were analyzed for response to teprotumumab., Results: Twenty-six patients were included in the final analysis. There was a significant decrease in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and significant increases in glycated hemoglobin A1c, fasting glucose, and total T3 levels. There was also significant reduction in proptosis, clinical activity score, retinal nerve fiber layer thickness, ganglion cell analysis, and intraocular pressure. HLA haplotypes were distinct between responders and nonresponders, with HLA-DRB3 02:02:01G, HLA-DRB4 neg, and HLA-DQB1 02:01:01G demonstrating better response to teprotumumab and HLA-A 23:01:01G strongly correlating to nonresponse., Conclusions: Patients with both acute and chronic thyroid eye disease treated with teprotumumab had a significant reduction in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and improvement in proptosis, clinical activity score, retinal nerve fiber layer and ganglion cell analysis thickness, and intraocular pressure. HLA may predict responders vs nonresponders. Further studies with longer duration and larger population comparing teprotumumab with steroids or other immunomodulatory agents (tocilizumab, rituximab, etc) may be helpful., Competing Interests: Disclosure The authors have no conflicts of interest to disclose. The identification of specific products or scientific instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency. The views expressed in this manuscript are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense, the Uniformed Services University of the Health Sciences, nor the U.S. Government., (Published by Elsevier Inc.)

Southeast Asia is a major rice-producing region with a high level of internal consumption and accounting for 40% of global rice exports. Limited land resources, climate change and yield stagnation during recent years have once again raised concerns about the capacity of the region to remain as a large net exporter. Here we use a modelling approach to map rice yield gaps and assess production potential and net exports by 2040. We find that the average yield gap represents 48% of the yield potential estimate for the region, but there are substantial differences among countries. Exploitable yield gaps are relatively large in Cambodia, Myanmar, Philippines and Thailand but comparably smaller in Indonesia and Vietnam. Continuation of current yield trends will not allow Indonesia and Philippines to meet their domestic rice demand. In contrast, closing the exploitable yield gap by half would drastically reduce the need for rice imports with an aggregated annual rice surplus of 54 million tons available for export. Our study provides insights for increasing regional production on existing cropland by narrowing existing yield gaps., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Rice production is often associated with high pesticide input. To improve farmers' practice, sustainable management approaches are urgently needed, such as ecological engineering (EE), which aims at enhancing beneficial arthropods while reducing pesticides. Here, we implemented and tested EE in Cambodian rice fields by comparing: (i) fields not treated with pesticides (control); (ii) fields not treated with pesticides but with non-rice crops planted in the surrounding (EE); and (iii) conventionally farmed fields using pesticides (CR). Using benefit-cost analysis, we compared the economic value of each treatment. The non-rice crops preferred by men and women farmers as well as farmers' willingness to implement EE were assessed using surveys. We sampled arthropod abundance and richness in rice fields and bunds during two seasons. During the dry season, we compared EE and CR among three Cambodian provinces. During the wet season, we specifically assessed the differences in EE, control and CR in arthropod abundance and rice yield in one province. While withholding from using pesticides did not result in a decrease in yield in EE and control treatments, parasitoid abundance was higher in both treatments during the wet season. The benefit-cost ratio was highest for EE and control treatments. Pesticides were likely the main driver causing low arthropod abundance, without any benefit towards increased rice yield. The proper implementation of EE coupled with farmers' knowledge of ecologically based pest management is a promising solution towards sustainable rice production.

Background: Surgical debulking of primary neuroendocrine tumors (NETs) and hepatic resection of metastatic NET disease may each independently improve overall survival. However, evidence for combined primary site debulking and metastasectomy on survival and impact on short-term perioperative outcomes is limited., Methods: The 2014-2016 ACS-NSQIP targeted hepatectomy database was queried for all patients undergoing liver resection for metastatic NET. Secondary procedure codes were evaluated for major concurrent operations. Multivariable analysis was performed to determine risk factors for 30-day morbidity and mortality., Results: A total of 472 patients were identified, of whom 153 (32.4%) underwent ≥1 additional concurrent major operation. The most common concurrent procedures were small bowel resection (14.6%), partial colectomy (8.9%), and radical lymphadenectomy (7.4%). Among all patients, overall 30-day mortality and morbidity were 1.5% and 25.6%, respectively. Modifiable and treatment-related factors associated with increased major postoperative morbidity risk included >10% weight loss within six months of surgery (p = 0.05), increasing number of hepatic lesions treated (p = 0.05), and biliary reconstruction (p = 0.001). No major concurrent procedure was associated with increased 30-day morbidity (all p > 0.05)., Conclusions: Approximately one-third of patients with stage IV NET underwent combined hepatic and multi-organ resection. Although modifiable and treatment-related factors predictive of perioperative morbidity were identified, performance of concurrent major procedures did not increase perioperative morbidity. These results support consideration of multi-organ resection in carefully selected patients with metastatic NET.

Objective: Health care disparities have been described for children of limited English-proficient (LEP) families compared with children of English-proficient (EP) families. Poor communication with the medical team may contribute to these worse health outcomes. Previous studies exploring communication in the PICU have excluded LEP families. We aimed to understand communication experiences and preferences in the 3 primary communication settings in the PICU. We also explored LEP families' views on interpreter use in the PICU., Patients and Methods: EP and Spanish-speaking LEP families of children admitted to the PICU of a large tertiary pediatric hospital completed surveys between 24 hours and 7 days of admission., Results: A total of 161 of 184 families were surveyed (88% response rate); 52 were LEP and 109 EP. LEP families were less likely to understand the material discussed on rounds (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.11-0.90), to report that PICU nurses spent enough time speaking with them (OR 0.15, 95% CI 0.05-0.41), and to report they could rely on their nurses for medical updates (OR 0.07, 95% CI 0.02-0.25) controlling for covariates, such as education, insurance type, presence of a chronic condition, PICU length of stay, and mortality index. LEP families reported 53% of physicians and 41% of nurses used an interpreter "often.", Conclusions: Physician and nurse communication with LEP families is suboptimal. Communication with LEP families may be improved with regular use of interpreters and an increased awareness of the added barrier of language proficiency., (Copyright © 2017 by the American Academy of Pediatrics.)

Background: The study was done in three villages in Nueva Ecija, Philippines. It surveys farmers' belief system and pesticide practices relative to health and safety., Methods: Initially it used a simulated market study on willingness to pay for personal protective equipment in the form of gloves and masks. Then a combination of semi-structured, formal, informal, and key-informant interviews, as well as focus groups, and field observations was done intermittently in a span of approximately 12 years., Results: The farmers perceive illness in terms of inability to function. Pesticide to them may not be a threat because (i) they are immune, (ii) it is regarded as a medicine that is needed by the plants rather than poison, and (iii) exposure is only through inhalation and ingestion not through dermal contact. Added to that, they put value on pasma, and try to prevent it at the cost of exposure to pesticides. These perceptions lead to their practices showing inadequate protection., Conclusion: There is the need for more health education programs that tap farmers' belief system and cognitive categories to stress the need for precautions.

Treatment of patients with severe acute respiratory insufficiency included application of end-expiratory pressure to an optimal level, precise cardiovascular monitoring, and adaptation of conventional respirators to provide intermittent mandatory ventilation. Of 90 patients with acute respiratory insufficiency secondary to trauma, sepsis, or complicated surgery, 65% survived. Mortality appeared to be independent of the level of end-expiratory pressure required. The goal of therapy was maximal reduction of intrapulmonary shunt without significantly decreasing cardiac function. In the group requiring more than 20 cm H2O end-expiratory pressure, shunt decreased from 48% at 5 cm of positive end-expiratory pressure to 21% at the optimal level. In only 6% of the entire group was significant pulmonary dysfunction present at the time of death. Most deaths (75%) were deemed secondary to failure of multiple organ systems, occurring late in the hospital course. Pneumothorax was recorded in 10% of the entire group. Acute respiratory insufficiency should be rapidly reversible in most cases if aggressive measures are employed with the intent of reversing functional impairment rather than improving arterial oxygenation to "satisfactory levels."

Constant-positive airway pressure with spontaneous ventilation was successfully used in treatment of a patient who had suffered near-drowning in salt water. The patient was able to maintain adequate respiratory mechanics, although oxygenation without end-expiratory pressure was severely impaired. The rapid improvement in arterial oxygenation obviated the need for mechanical ventilation in this patient. It is suggested that the simplest modality of effective therapy should be used in such patients.