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BACKGROUND: Acupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers. MATERIALS AND METHODS: We conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics. RESULTS: In unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191). CONCLUSIONS: Acupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.

The objective of the presented research was to create an average image of a harvester operator in Poland and to identify factors influencing the degree of mental workload. We used a survey of environmental assessments of workload. The creation of an electronic survey and the support of a company that indirectly employs operators (State Forests) made it possible to reach a large group of surveyed people. The respondents indicated the occurrence of ailments typical of sedentary work at the researched workstation. These included mainly monotony, back pain and numbness in the upper limbs. Stress at work was felt by the majority of respondents; hence the analyses of mental stress, which also translates into other diseases, should indicate key responses to questions regarding comprehensive ergonomic assessments at the researched workstation.

Abstract Background Somatic embryogenesis (SE) exemplifies the unique developmental plasticity of plant cells. The regulatory processes, including epigenetic modifications controlling embryogenic reprogramming of cell transcriptome, have just started to be revealed. Results To identify the genes of histone acetylation-regulated expression in SE, we analyzed global transcriptomes of Arabidopsis explants undergoing embryogenic induction in response to treatment with histone deacetylase inhibitor, trichostatin A (TSA). The TSA-induced and auxin (2,4-dichlorophenoxyacetic acid; 2,4-D)-induced transcriptomes were compared. RNA-seq results revealed the similarities of the TSA- and auxin-induced transcriptomic responses that involve extensive deregulation, mostly repression, of the majority of genes. Within the differentially expressed genes (DEGs), we identified the master regulators (transcription factors - TFs) of SE, genes involved in biosynthesis, signaling, and polar transport of auxin and NITRILASE-encoding genes of the function in indole-3-acetic acid (IAA) biosynthesis. TSA-upregulated TF genes of essential functions in auxin-induced SE, included LEC1/LEC2, FUS3, AGL15, MYB118, PHB, PHV, PLTs, and WUS/WOXs. The TSA-induced transcriptome revealed also extensive upregulation of stress-related genes, including those related to stress hormone biosynthesis. In line with transcriptomic data, TSA-induced explants accumulated salicylic acid (SA) and abscisic acid (ABA), suggesting the role of histone acetylation (Hac) in regulating stress hormone-related responses during SE induction. Since mostly the adaxial side of cotyledon explant contributes to SE induction, we also identified organ polarity-related genes responding to TSA treatment, including AIL7/PLT7, RGE1, LBD18, 40, HB32, CBF1, and ULT2. Analysis of the relevant mutants supported the role of polarity-related genes in SE induction. Conclusion The study results provide a step forward in deciphering the epigenetic network controlling embryogenic transition in somatic cells of plants.

W artykule podjęto problematykę namysłu o charakterze literaturoznawczym i kulturoznawczym nad tekstami patrologicznymi i teologicznymi. Zarys możliwej analizy tekstów związanych z historią doktryny i upowszechnianiem się chrześcijaństwa za pomocą metod innych niż wypracowane w patrystyce i teologii ukazuje sposoby wzbogacenia zarówno spektrum interpretacji tekstów wywodzących się z antyku chrześcijańskiego lub jego recepcji, jak i możliwości upowszechniania wiedzy na ich temat. Dla egzemplifikacji wybrano teksty trzech autorów antyku chrześcijańskiego z IV w.: Damazego I, Firmicusa Maternusa, Filastra z Brescii oraz rodzime teksty recepcyjne z terenu Polski (Walenty z Warty, Andreas Stredonius), nawiązujące zarówno do dorobku literatury antycznej, chrześcijańskiej apologetyki, jak i tendencji literackiej epoki (wieki XVI i XVII).

OBJECTIVE: To evaluate whether the deep learning (DL) segmentation methods from the six teams that participated in the IWOAI 2019 Knee Cartilage Segmentation Challenge are appropriate for quantifying cartilage loss in longitudinal clinical trials. DESIGN: We included 556 subjects from the Osteoarthritis Initiative study with manually read cartilage volume scores for the baseline and 1-year visits. The teams used their methods originally trained for the IWOAI 2019 challenge to segment the 1130 knee MRIs. These scans were anonymized and the teams were blinded to any subject or visit identifiers. Two teams also submitted updated methods. The resulting 9,040 segmentations are available online.The segmentations included tibial, femoral, and patellar compartments. In post-processing, we extracted medial and lateral tibial compartments and geometrically defined central medial and lateral femoral sub-compartments. The primary study outcome was the sensitivity to measure cartilage loss as defined by the standardized response mean (SRM). RESULTS: For the tibial compartments, several of the DL segmentation methods had SRMs similar to the gold standard manual method. The highest DL SRM was for the lateral tibial compartment at 0.38 (the gold standard had 0.34). For the femoral compartments, the gold standard had higher SRMs than the automatic methods at 0.31/0.30 for medial/lateral compartments. CONCLUSION: The lower SRMs for the DL methods in the femoral compartments at 0.2 were possibly due to the simple sub-compartment extraction done during post-processing. The study demonstrated that state-of-the-art DL segmentation methods may be used in standardized longitudinal single-scanner clinical trials for well-defined cartilage compartments.

Following the twentieth-century’s spatial turn in literary and cultural studies, this paper examines spaces and spatiality in Don DeLillo’s novel Falling Man, a seminal fictional response to the most traumatic (spatial) event in the USA at the turn of the century. Starting from Robert T. Tally Jr.’s thesis that authors are cartographers, I analyze how DeLillo acts as a mapper of the post-9/11 space. By exploring the depictions of the altered spatial landscape DeLillo creates, and the world he thrusts his characters into, I examine the intricate relationship between space and identity. Ultimately, I argue that the loss of a familiar and dependable space creates unfamiliar spaces the characters struggle to navigate.Keywords: space, spatiality, DeLillo, Falling Man, 9/11, post-9/11 literatureIn the introduction to his 2013 book Spatiality, Robert T. Tally Jr. claims that “over the past few decades, spatiality has become a key concept for literary and critical studies” (3). Exploring the different disciplinary takes on spatiality – literary cartography, geography, and geocriticism – Tally asserts that if the nineteenth century’s major obsession was dominated by the discourses of time and history, in the post-war period of the twentieth century, “space began to reassert itself in critical theory, rivaling if not overtaking time in significance” (3). The author reiterates numerous writers, philosophers, and thinkers who came before him to suggest there has been the so-called spatial turn. Bertrand Westphal, the founder of geocriticism, a literary theory that incorporates the study of geographic space, claims that “cataclysmic restructuring of societies during, and in the immediate aftermath of, Second World War, led to the decline in the obsession with time” (Tally 6). In the essay “Of Other Spaces,” French philosopher Michel Foucault argues that we live in the world “when our experience of the world is less that of a long life developing through time than that of a network that connects points and intersects with its own skein” (22). He argues that the twentieth-century era is the epoch of space and that “we are in the epoch of juxtaposition, the epoch of the near and far, of the side-by-side, of the dispersed” (Foucault and Miskowiec 22).

Objective.To establish an open framework for developing plan optimization models for knowledge-based planning (KBP).Approach.Our framework includes radiotherapy treatment data (i.e. reference plans) for 100 patients with head-and-neck cancer who were treated with intensity-modulated radiotherapy. That data also includes high-quality dose predictions from 19 KBP models that were developed by different research groups using out-of-sample data during the OpenKBP Grand Challenge. The dose predictions were input to four fluence-based dose mimicking models to form 76 unique KBP pipelines that generated 7600 plans (76 pipelines × 100 patients). The predictions and KBP-generated plans were compared to the reference plans via: the dose score, which is the average mean absolute voxel-by-voxel difference in dose; the deviation in dose-volume histogram (DVH) points; and the frequency of clinical planning criteria satisfaction. We also performed a theoretical investigation to justify our dose mimicking models.Main results.The range in rank order correlation of the dose score between predictions and their KBP pipelines was 0.50-0.62, which indicates that the quality of the predictions was generally positively correlated with the quality of the plans. Additionally, compared to the input predictions, the KBP-generated plans performed significantly better (P< 0.05; one-sided Wilcoxon test) on 18 of 23 DVH points. Similarly, each optimization model generated plans that satisfied a higher percentage of criteria than the reference plans, which satisfied 3.5% more criteria than the set of all dose predictions. Lastly, our theoretical investigation demonstrated that the dose mimicking models generated plans that are also optimal for an inverse planning model.Significance.This was the largest international effort to date for evaluating the combination of KBP prediction and optimization models. We found that the best performing models significantly outperformed the reference dose and dose predictions. In the interest of reproducibility, our data and code is freely available.

ObjectiveTo describe how a partnered evaluation of the Whole Health (WH) system of care-comprised of the WH pathway, clinical care, and well-being programs-produced patient outcomes findings, which informed Veterans Health Administration (VA) policy and system change.Data sourcesElectronic health records (EHR)-based cohort of 1,368,413 patients and a longitudinal survey of Veterans receiving care at 18 WH pilot medical centers.Study designIn partnership with VA operations, we focused the evaluation on the impact of WH services utilization on Veterans' (1) use of opioids and (2) care experiences, care engagement, and well-being. Outcomes were compared between Veterans who did and did not use WH services identified from the EHR.Data collectionPharmacy records and WH service data were obtained from the VA EHR, including WH coaching, peer-led groups, personal health planning, and complementary, integrative health therapies. We surveyed veterans at baseline and 6 months to measure patient-reported outcomes.Principal findingsOpioid use decreased 23% (31.5-6.5) to 38% (60.3-14.4) among WH users depending on level of WH use compared to a secular 11% (12.0-9.9) decrease among Veterans using Conventional Care. Compared to Conventional Care users, WH users reported greater improvements in perceptions of care (SMD = 0.138), engagement in health care (SMD = 0.118) and self-care (SMD = 0.1), life meaning and purpose (SMD = 0.152), pain (SMD = 0.025), and perceived stress (SMD = 0.191).ConclusionsEvidence developed through this partnership yielded key VA policy changes to increase Veteran access to WH services. Findings formed the foundation of a congressionally mandated report in response to the Comprehensive Addiction and Recovery Act, highlighting the value of WH and complementary, integrative health and well-being programs for Veterans with pain. Findings subsequently informed issuance of an Executive Decision Memo mandating the integration of WH into mental health and primary care across VA, now one lane of modernization for VA.

Abstract The TDP-43 proteinopathies, which include amyotrophic lateral sclerosis and frontotemporal dementia, are a devastating group of neurodegenerative disorders that are characterized by the mislocalization and aggregation of TDP-43. Here we demonstrate that RNA-targeting CRISPR effector proteins, a programmable class of gene silencing agents that includes the Cas13 family of enzymes and Cas7–11, can be used to mitigate TDP-43 pathology when programmed to target ataxin-2, a modifier of TDP-43-associated toxicity. In addition to inhibiting the aggregation and transit of TDP-43 to stress granules, we find that the in vivo delivery of an ataxin-2-targeting Cas13 system to a mouse model of TDP-43 proteinopathy improved functional deficits, extended survival, and reduced the severity of neuropathological hallmarks. Further, we benchmark RNA-targeting CRISPR platforms against ataxin-2 and find that high-fidelity forms of Cas13 possess improved transcriptome-wide specificity compared to Cas7–11 and a first-generation effector. Our results demonstrate the potential of CRISPR technology for TDP-43 proteinopathies.

Methylene blue (MB) and malachite green (MG) are pharmaceuticals which were used in aquaculture to treat fish diseases for many years. Nowadays, they are prohibited in many countries, but illegal use is still reported. The aim of the present study was to evaluate the effects of these agents on blood parameters of juvenile common carp (Cyprinus carpio L.). The fish were exposed for 7 or 14 days to therapeutic concentrations of the drugs (2 mg/l in the case of MB and 0.2 mg/l for MG). The results indicate that fish treated with MB or MG showed inflammation and an anaemic response (minor in the case of MG). Moreover, increased erythropoiesis was observed in MB-treated fish. The results of the study indicate that these pharmaceuticals at therapeutic concentrations are toxic to juvenile common carp. MB proved to be more toxic than MG. Therefore, we advise against the use of these pharmaceuticals at the concentrations tested (even if permitted by the legislation of a given country). In our opinion, a ban on their use in fish intended for human consumption is justified.

The embryogenic transition of plant somatic cells to produce somatic embryos requires extensive reprogramming of the cell transcriptome. The prominent role of transcription factors (TFs) and miRNAs in controlling somatic embryogenesis (SE) induction in plants was documented. The profiling of MIRNA expression in the embryogenic culture of Arabidopsis implied the contribution of the miR156 and miR169 to the embryogenic induction. In the present study, the function of miR156 and miR169 and the candidate targets, SPL and NF-YA genes, were investigated in Arabidopsis SE. The results showed that misexpression of MIRNA156 and candidate SPL target genes (SPL2, 3, 4, 5, 9, 10, 11, 13, 15) negatively affected the embryogenic potential of transgenic explants, suggesting that specific fine-tuning of the miR156 and target genes expression levels seems essential for efficient SE induction. The results revealed that SPL11 under the control of miR156 might contribute to SE induction by regulating the master regulators of SE, the LEC (LEAFY COTYLEDON) genes (LEC1, LEC2, FUS3). Moreover, the role of miR169 and its candidate NF-YA targets in SE induction was demonstrated. The results showed that several miR169 targets, including NF-YA1, 3, 5, 8, and 10, positively regulated SE. We found, that miR169 via NF-YA5 seems to modulate the expression of a master SE regulator LEC1/NF-YA and other auxin-related genes: YUCCA (YUC4, 10) and PIN1 in SE induction. The study provided new insights into miR156-SPL and miR169-NF-YA functions in the auxin-related and LEC-controlled regulatory network of SE.

Izhodišča: Trenutno ni veliko znanega o možnih potekih razvoja kronične bolečine, še posebej v odnosu do spremljajočih simptomov (utrudljivost, motnje spanja). Iz klinične prakse in nekaterih raziskav vemo, da bolniki z dolgoletno kronično bolečino poročajo še o drugih težavah, predvsem na področjih spanja in splošne vitalnosti, kar poleg bolečin pomembno vpliva na celostno življenjsko delovanje. V klinični praksi je anamneza glavno orodje opredeljevanja kroničnega bolečinskega sindroma. Z raziskavo smo želeli analizirati podatke, ki se rutinsko zbirajo neposredno ob kliničnem delu, predvsem pa ugotoviti obstoj morebitnih vzorcev glede na anamnezo razvoja časovnega sosledja omenjenih težav in raziskati morebitne razlike med tako nastalimi skupinami. Metode: Vključili smo 487 zaporedno pregledanih polnoletnih bolnikov, napotenih v subspecialistično ambulanto za rehabilitacijo oseb s kronično nerakavo bolečino od februarja do novembra 2019. Za opredelitev načina nastanka in časovnega poteka razvoja težav smo uporabili 16 dvojiških opisovalcev. Udeleženci so izpolnili tudi vprašalnika o bolečini. Uporabili smo še podatke, ki jih rutinsko pridobivamo v sklopu timskega triažno ocenjevalnega pregleda: o predhodnih in pridruženih boleznih, testiranjih gibalnih sposobnosti, indeksu telesne mase, prejemanju zdravil in socialnoekonomskem statusu. Rezultati: O pojavu prvih trajnih bolečin so udeleženci največkrat poročali v predelu ledvene hrbtenice. Tretjina udeležencev je navajala oceno trajanja bolečine vsak dan do 5 let, kar 16 % pa preko 20 let. Le tretjina udeležencev ni poročala o sočasnem glavobolu. Za večino udeležencev v raziskavi je bila bolečina glavna zdravstvena težava. S hierarhičnim združevanjem v skupine na podlagi opisovalcev smo prepoznali 3 izrazite skupine: 1. bolečina se je razvila praviloma postopno, v odrasli dobi se je iz iz t.i. področne bolečine razvila v razširjeno, utrudljivost in motnje spanja pa so se pojavili s širjenjem bolečinskih simptomov; 2. bolečina se je razvila že v otroštvu ali t.i. nenadno po poškodbi, spremljajoče težave pa so se razvile po nastopu simptoma bolečine; 3. telesna utrudljivost se je razvila pred pojavom telesnih bolečin, ki so se razvile praviloma postopno, iz področne oz. regionalne bolečine v razširjeno. Glede pojavljanja glavobolov izstopa le skupina 2, kjer se le-ti praviloma pojavijo kasneje. V 4. skupini so bili udeleženci z nejasno anamnezo. Podatki o pridruženih boleznih so razkrili širok nabor bolezenskih stanj, ki jih navadno neposredno ne povezujemo z bolečinskimi sindromi. Med pridruženimi boleznimi poleg motenj razpoloženja izstopajo še bolezni ščitnice in ginekološke bolezni. Med skupinami smo na podlagi zbranih kliničnih podatkov zaznali nekatere pomembne razlike. Zaključek: Razkrili smo možne vzorce za razvoj kroničnega bolečinskega sindroma glede na anamnezo časovnega sosledja razvoja temeljnih simptomov (bolečina po telesu, glavobol, telesna ali umska utrudljivost, motnje spanja), kar bi bilo v prihodnosti smiselno raziskovati z vidika posebnosti patofizioloških mehanizmov v ozadju opisanih vzorcev in za ukrepe primarne ali sekundarne preventive ter zdravstvene oskrbe najbolj prizadetih.

BackgroundAcupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers.Materials and methodsWe conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics.ResultsIn unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191).ConclusionsAcupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.

PurposeTo organize a multi-institute knee MRI segmentation challenge for characterizing the semantic and clinical efficacy of automatic segmentation methods relevant for monitoring osteoarthritis progression.Materials and methodsA dataset partition consisting of three-dimensional knee MRI from 88 retrospective patients at two time points (baseline and 1-year follow-up) with ground truth articular (femoral, tibial, and patellar) cartilage and meniscus segmentations was standardized. Challenge submissions and a majority-vote ensemble were evaluated against ground truth segmentations using Dice score, average symmetric surface distance, volumetric overlap error, and coefficient of variation on a holdout test set. Similarities in automated segmentations were measured using pairwise Dice coefficient correlations. Articular cartilage thickness was computed longitudinally and with scans. Correlation between thickness error and segmentation metrics was measured using the Pearson correlation coefficient. Two empirical upper bounds for ensemble performance were computed using combinations of model outputs that consolidated true positives and true negatives.ResultsSix teams (T 1-T 6) submitted entries for the challenge. No differences were observed across any segmentation metrics for any tissues (P = .99) among the four top-performing networks (T 2, T 3, T 4, T 6). Dice coefficient correlations between network pairs were high (> 0.85). Per-scan thickness errors were negligible among networks T 1-T 4 (P = .99), and longitudinal changes showed minimal bias (< 0.03 mm). Low correlations (ρ < 0.41) were observed between segmentation metrics and thickness error. The majority-vote ensemble was comparable to top-performing networks (P = .99). Empirical upper-bound performances were similar for both combinations (P = .99).ConclusionDiverse networks learned to segment the knee similarly, where high segmentation accuracy did not correlate with cartilage thickness accuracy and voting ensembles did not exceed individual network performance.See also the commentary by Elhalawani and Mak in this issue.Keywords: Cartilage, Knee, MR-Imaging, Segmentation © RSNA, 2020Supplemental material is available for this article.

The need for sustainable development in the context of pesticide use has been recognized by the European Union. The “Farm to Fork Strategy” indicates a goal of 50% reduction in pesticide use by 2030. To address this challenge, we used the concept of ionic liquids to modify known resistance inducers, i.e., a group of substances whose action is indicated as an alternative to fungicides. A new, patented substance developed by us, which is a choline 3,5-dichlorosalicylate, has been tested in the context of its use in sugar beet cultivation with the aim of controlling Cercospora leaf spot (CLS). The results suggest that the use of this substance in combination with one fungicide treatment reduces disease infection and produces yields very similar to the use of a standard protection program assuming the use of two fungicides. Such results provide the basis for further development of 3,5-dichlorosalicylate in terms of its use in agriculture. Thanks to its use, it was possible to resign from one fungicide treatment, while maintaining protection against CLS and yields at the same level as for the full fungicide protection program. Such an approach is in line with European Union policies.

Gestational diabetes (GDM) is one of the most common complications in pregnancy, with a prevalence that continues to rise. At the time of the COVID-19 epidemic, immediate reorganisation and adjustment of the system was needed. Telemedicine support was offered in order to provide high-quality treatment to pregnant women. However, the success of the treatment is unknown. We therefore aimed to evaluate COVID-19 epidemic effects on pregnancy outcomes in GDM.