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Transparency in animals is a complex form of camouflage involving mechanisms that reduce light scattering and absorption throughout the organism. In vertebrates, attaining transparency is difficult because their circulatory system is full of red blood cells (RBCs) that strongly attenuate light. Here, we document how glassfrogs overcome this challenge by concealing these cells from view. Using photoacoustic imaging to track RBCs in vivo, we show that resting glassfrogs increase transparency two- to threefold by removing ~89% of their RBCs from circulation and packing them within their liver. Vertebrate transparency thus requires both see-through tissues and active mechanisms that “clear” respiratory pigments from these tissues. Furthermore, glassfrogs’ ability to regulate the location, density, and packing of RBCs without clotting offers insight in metabolic, hemodynamic, and blood-clot research.

International audience; PurposeThe present study assessed the factors associated with the maintenance of a functional anastomosis in a large consecutive series of patients with anastomotic leakage (AL).MethodsAll consecutive patients presenting with AL after colorectal or coloanal anastomosis (2012–2019) were analyzed. The primary end point was a functional anastomosis without a stoma at 1 year.ResultsA total of 156 patients were included. AL was initially treated by antibiotics (38%), drainage (43%) or urgent surgery (19%). Initial treatment of AL was not adequate in 24.3%, and reintervention in the form of drainage or surgery was required. A total of 60.9% of patients had a functional anastomosis without a stoma 1 year after surgery. Factors associated with the risk of anastomotic failure at 1 year were diabetes (odds ratio [OR] = 4.24 [95% confidence interval {CI} 1.39–14.24] p = 0.014), neoadjuvant chemoradiotherapy (OR = 3.03 [95% CI 1.14–8.63] p = 0.03) and Grade B (OR = 6.49 [95% CI 2.23–21.74] p = 0.001) or C leak (OR = 35.35 [95% CI 9.36–168.21] p

A 31-year-old woman with a history of stillbirth due to placental abruption at 29 weeks’ gestation and one first trimester miscarriage documented a continuous record of her perceived fetal movements from 28 to 38 weeks’ gestation. Repeated ultrasound examinations confirmed a viable pregnancy, with normal growth, liquor volume and Doppler profile. She delivered a healthy male infant at 38 weeks and 3 days’ gestation. The data collected give a detailed record of fetal activity in a healthy pregnancy. Perceived fetal activity increased as pregnancy progressed and was greatest in the evenings. We also found that clusters of movements, which have previously been reported as protective against stillbirth, were felt earlier on in pregnancy.

Children in Flint, Michigan, have multiple risk factors for behavioural challenges, including exposure to lead during the Flint water crisis. However, their behavioural health status is largely unknown. Robust data from the Flint Registry can help understand the burden of behavioural outcomes and inform the allocation of resources.This population-level evaluation of Flint children's behavioural outcomes aims to answer the question: What is the burden of parent-reported child behaviour problems in Flint Registry enrolled children?This cross-sectional study describes parent-reported behavioural outcomes of children 2-17 years old who enrolled in the Flint Registry between December 2018 and December 2020. Parents/guardians completed behavioural assessments including the Behavior Assessment System for Children (BASC-3) Parent Rating Scale and Behavior Rating Inventory of Executive Function (BRIEF2) Screening Parent Form. Demographics of enrolees were compared with census data. Composite BASC-3 T scores were compared with national norms. Distributions for clinically relevant categories of BASC-3 and BRIEF2 scores were examined across age and sex groups.Of the 3579 children included in this study (mean age 9.73 ± 3.96 years), about half were female and 79.7% were eligible for free or reduced-price lunch. Almost half of the children were reported to have clinically concerning scores on the BASC-3 Parent Rating Scale (44.7%) and the BRIEF2 Screening Parent Form (46.7%). Across most age and sex groupings, the reported adaptive skills were relatively low and behaviour symptoms relatively high.Results reveal a substantial burden of parent-reported behavioural problems in Flint Registry children. This is clinically significant and indicates that a large number of children may require comprehensive neuropsychological evaluation and potential medical and/or educational services. Recognising the potential for long-term manifestations of childhood exposures to environmental hazards, longitudinal surveillance is critical to continue to identify and support participants.

COVID-19 has had a significant and measurable impact on individuals and families in economically deprived areas both in the United Kingdom and internationally. This article examines issues of community resilience and service adaptability and focuses on the period during the first lockdown in the United Kingdom (May to July 2020). Data were collected from members of the local community in Southend, with specific reference to the ‘A Better Start Southend’ programme of support. The evidence presented in this article uncovers the impact of the ‘first lockdown’ on families with young children, and local children’s and community services.

Background: The risk of conversion to open surgery is inevitably present during any minimally invasive colorectal surgical procedure. Conversions have been associated with adverse postoperative and oncologic outcomes. No previous study has evaluated the specific causes and consequences of conversion during a minimally invasive right colectomy (MIS-RC). Materials and Methods: We analyzed the Minimally invasivE surgery for oncologic Right ColectomY (MERCY) study database including patients who underwent laparoscopic or robotic RC because of colon cancer between 2014 and 2020. Descriptive analyses were performed to determine the different reasons for conversion. Uni- and multivariate logistic regressions were run to identify potential variables associated with this outcome. Cox regression analyses were used to evaluate the impact of conversion on tumor recurrence. Results: Over a total of 1574 MIS-RC, 120 (7.6%) were converted to open surgery. The main reasons for conversion were procedural difficulties related to adherences from previous abdominal surgical procedures (39.2%), or owing to large tumor size or infiltration of adjacent structures (26.7%). Only 16.7% of the conversions were caused by intraoperative medical or surgical complications. Converted patients required longer operative times and developed more postoperative complications, both overall (39.2% versus 27.5%; P = .006) and severe ones (13.3% versus 8.3%; P = .061). Male gender (odds ratio [OR] = 1.89 [95% confidence interval: 1.31-2.71]), obesity (OR = 1.99 [1.4-2.83]), prior abdominal surgery (OR = 1.68 [1.19-2.37]), and pT4 cancers (OR = 4.04 [2.86-5.69]) were independently associated with conversion. Conversion to open surgery was not significantly associated with tumor recurrence (hazard ratios = 1.395 [0.724-2.687]). Conclusions: Although conversion to open surgery during MIS-RC for cancer is associated with worsened postoperative outcomes, it seems not to impact on the oncologic prognosis.

C-reactive protein (CRP) is a useful predictive test to early detect abdominal complication after colorectal surgery. Inflammatory bowel disease (IBD) is responsible for chronic inflammation and abnormal basal CRP that could influence the interest of its management after abdominal surgery. The aim of this study is to evaluate CRP as an indicator of postoperative complication in a specific IBD population.Retrospective study of patients undergoing ileocolic resection or ileal pouch-anal anastomosis for IBD between 2012 and 2019.Ileocolic resection represents 242 patients and ileal pouch-anal anastomosis 105 patients. CRP was significantly higher at an early (105.2 ± 56.0 vs 128.1 ± 69.8; p = 0.008) and late stage (112.9 ± 72.8 vs 185.3 ± 111.5; p 0.0001) for patients having an intra-abdominal complication. A BMI 25 kg/mCRP is a useful predictive marker to detect abdominal complication after surgery in IBD population. Measurement of CRP can help to reduce hospitalization stay and orientate towards complementary examinations.

This autoethnography examines my experience of the diagnosis and treatment of anorexia nervosa. Drawing on memory and personal and medical documents relating to inpatient admissions in an adult specialist eating disorder unit, I narrate and analyse my experience in terms of my relationship to the diagnosis of anorexia and the constructions of it I encountered. I show how I came to value an identity based on anorexia and how I learned ways of ‘doing’ the diagnosis in treatment. This involved me valuing medical markers of illness, including signs of poor health, which became crucial to how I performed my diagnosis and retained the diagnostically-informed sense of self that I valued. I suggest that, ultimately, these diagnostic-dynamics, alongside other effects of long-term inpatient treatment such as detachment from ‘normal life’, prolonged my struggles with self-starvation. The insights from this autoethnography shed light on potential iatrogenic impacts of diagnosis and treatment for anorexia.

IMPORTANCE: Research has shown that early intervention programs can improve academic outcomes of children with developmental delays. It has been suggested that similar programs may combat the deleterious effects of lead on children’s neurodevelopment. However, to our knowledge, there are no published studies examining this possibility. OBJECTIVE: The objective of this study was to estimate the association between receipt of early intervention services and third-grade standardized test scores among children exposed to lead before age 3 years. DESIGN, SETTING, AND PARTICIPANTS: Cohort study including children born in New York City, New York, from 1994 to 1998 within an administrative data linkage of birth, lead monitoring, early intervention, and education data systems. Participants had a blood lead level of 4 μg/dL or greater at any point before age 3 years and later attended public school in New York City. EXPOSURES: Any use of early intervention services from birth through age 3 years. MAIN OUTCOMES AND MEASURES: Children who did or did not receive early intervention services were matched using propensity scores. Linear and log-binomial regression were used to estimate the association between receipt of early intervention services before age 3 years and standardized test scores in math and English-language arts in third grade. RESULTS: There were 2986 children exposed to lead who received early intervention services before age 36 months. Of these children, 2757 were propensity score–matched to 8160 children who did not receive services. Children who received early intervention services did 7% (95% CI, 3%-12%) of an SD better on math and 10% (95% CI, 5%-14%) of an SD better on English-language arts tests than children who did not receive services. In addition, children who received services were 14% (95% CI, 9%-19%) and 16% (95% CI, 9%-23%) more likely to meet test-based standards in math and English-language arts, respectively, than children who did not receive services. These associations became larger in magnitude when analyses were restricted to children with higher blood lead levels. CONCLUSIONS AND RELEVANCE: By leveraging existing public health data, this study found evidence that receipt of early intervention services may benefit the academic performance of children exposed to lead early in life.

Preclinical medical research has historically depended on either traditional two-dimensional in vitro cell culture or animal models for the purposes of disease modeling, including cancer pathophysiology, immunology studies, drug testing, and toxicity assays. However, both of these models have intrinsic flaws. Two-dimensional cell culture systems do not capture the heterogeneity of in vivo disease, being originally derived from a limited set of cell lines. They also differ from the physiology encountered in vivo, with the majority of pharmaceutical agents, including oncology drugs which are effective in vitro failing at clinical trials. Animal models have issues of cost, associated ethical concerns, and xenogeneity comparative to human systems. Organoids are three-dimensional (3D) cell culture models derived from human tissue, which have the potential to overcome the issues with the traditional models discussed above. They self-organize into 3D structures resembling their tissue of origin and recapitulate some of its functions. They have been shown to be excellent models for the purposes of disease modeling and high-throughput drug screening, among others. Despite these benefits, some challenges yet remain in organoid research. It is hoped that the combination of organoid culture with bioengineering approaches may successfully overcome these.

Many animals exhibit complex navigation over different scales and environments. Navigation studies in amphibians have largely focused on species with life histories that require accurate spatial movements, such as territorial poison frogs and migratory pond-breeding amphibians that show fidelity to mating sites. However, other amphibian species have remained relatively understudied, leaving open the possibility that well-developed navigational abilities are widespread. Here, we measured short-term space use in non-territorial, non-migratory cane toads (Rhinella marina) in their native range in French Guiana. After establishing site fidelity, we tested their ability to return home following translocations of 500 and 1000 m. Toads were able to travel in straight trajectories back to home areas, suggesting navigational abilities similar to those observed in amphibians with more complex spatial behavior. These observations break with the current paradigm of amphibian navigation and suggest that navigational abilities may be widely shared among amphibians.

In cases of anastomotic failure after colorectal (CRA) or coloanal anastomosis (CAA), revision of the anastomosis is an ambitious surgical option that can be proposed in order to maintain bowel continuity. Our aim was to assess postoperative morbidity, risk of failure and risk factor for failure in patients after CRA or CAA.All consecutive patients who underwent redo-CRA/CAA in our institution between 2007-2018 were retrospectively included. The success of redo-CRA/CAA was defined by the restoration of bowel continuity 12 months after the surgery.Two hundred patients (114 male: 57%) were analyzed. The indication for redo-CRA/CAA was chronic pelvic infection in 74 patients (37%), recto-vaginal or urinary fistula in 59 patients (30%), anastomotic stenosis in 36 patients (18%) and redo anastomosis after previous anastomosis takedown in 31 patients (15%). Twenty-three percent of the patients developed a severe postoperative complication. Anastomotic leakage was diagnosed in 39 patients (20%). One-year-success of the redo-CRA/CAA was obtained in 80% of patients. In multivariate analysis, only obesity was associated with redo-CRA/CAA failure (p = 0.042). We elaborated a pre-operative predictive score of success using the four variables: male sex, age 60 years, obesity and history of pelvic radiotherapy. The success of redo-CRA/CAA was 92%, 86%, 80% and 62% for a preoperative predictive score value of 0, 1, 2 and ≥3, respectively (p = 0.010).In case of failure of primary CRA/CAA, bowel continuity can be saved in 4 out of 5 patients by redo-CRA/CAA despite 23% suffering severe postoperative morbidity.

Understanding key trends within the penal field has become a core preoccupation of criminologists in recent decades. However, critical analyses of the emplotment of narratives, or how narratives themselves are constructed and move through the criminal justice system, can be overlooked, a gap that this article aims to address. Drawing on a range of case studies across the criminological literature, the article aims to build on this work by interrogating four key features of policy and practice narratives that have important implications for how we conceptualise, understand and employ narratives to understand policy and practice developments, namely that such narratives are (a) operating at multiple levels of analysis, (b) shaped by diverse and sometimes agonistic voices, (c) informed by vertical and horizontal influences and (d) fluid and dynamic, and as such can vary temporally and situationally. These features and their implications for understanding criminal justice policy and practice developments are explored next, illustrating that policy and practice can flow both into and from narratives.

Background While the use of robotic-assisted surgery is now mainstream for procedures such as robotic prostatectomy, its role in general surgery is less well established. Access to training in robotics for general surgery trainees in the Republic of Ireland is variable. Further, there is no data on attitudes of Irish trainees towards the role of robotics. We aimed to establish attitudes of Irish general surgery trainees towards the perceived utility of robotic surgery as well as access and satisfaction with training. Methods A survey was disseminated to trainees in the Republic of Ireland enrolled in a General Surgery training scheme via email and social media. Data collected included stage of training, intended subspecialty, interest in developing robotic skills, previous exposure to robotic surgery, satisfaction with current access to robotic training and opinion on formally incorporating training in robotics into the general surgery curriculum. Results The response rate was 44.8%. Of these, 83% reported interest in training in robotics and 69% anticipated using the technology regularly in consultant practice. Previous exposure to robotic-assisted surgery was significantly predictive of interest in developing the skillset (p = 0.014). Over 71% of trainees reported that they were not satisfied with access to robotic training. Of those satisfied with access, 40% felt there was a role for incorporating robotic training into the curriculum, compared to 68% of those dissatisfied. Conclusion Irish general surgery trainees perceive robotic-assisted surgery to be highly relevant to their future practice. There is an unmet need to provide additional training in the skillset.

Background Robotic-assisted minimally invasive surgery (MIS) for rectal cancer is a relatively new technique. Studies to date suggest that short term outcomes including TME quality, margin status, lymph node retrieval and 30-day morbidity and mortality are equivalent in robotic-assisted and laparoscopic MIS for rectal cancer. By contrast, there is a paucity of data on the medium and long-term oncologic safety of robotic-assisted comparative to laparoscopic surgery for rectal cancer. Methods A retrospective review was conducted of all robotic-assisted (n = 31) and laparoscopic (n = 23) rectal cancer cases performed at our institution between January 2016 to December 2018. Inclusion criteria were patients scheduled electively for a laparoscopic or robotic-assisted resection of rectal cancer (anterior resection or abdomino-perineal resection). Patients with distant metastases at presentation, those who proceeded to surgery as an emergency and those with a non-colorectal primary were excluded from analysis. Results A total of 54 (n = 54) cases met the inclusion criteria and were included in the final analysis. The median follow-up was 34 months. Of the 54, 21 patients received neoadjuvant chemoradiotherapy prior to definitive surgery. No significant difference was detected in local recurrence rates (p = 0.5), overall survival (p = 0.7) or disease-free survival (p = 0.8) between the robotic-assisted and laparoscopic cohorts. Conclusion In this series, robotic-assisted rectal cancer resections were associated with equivalent medium term oncological outcomes as laparoscopic procedures. However, given the small numbers in this cohort, outcomes from larger scale datasets will be required to confirm these results.

Laparoscopic Cholecystectomy (LC) is currently considered the gold standard for the management of symptomatic gallbladder stones disease. Specific complications remain challenging, particularly postoperative bleeding, bile leak, and bile duct injury. We report a rare case of a giant intrahepatic subcapsular haematoma (ISH) complicating LC. Case Presentation A 59-year-old female presented with symptomatic biliary colic. Her past medical history was noted for obesity (BMI>50). She underwent an elective LC with an uncomplicated intraoperative course; however, post-operatively she developed hypovolaemic shock with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. Emergency CT revealed a massive subcapsular haematoma measuring 21cm×3.1cm× 17cm at the right liver margin without evidence of ongoing bleeding. She was managed conservatively- as per a tertiary hepatobiliary surgery centre’s advice- with meticulous clinical observations, serial monitoring of haemoglobin, and repeat CT to assess for interval progressions. She progressed well with conservative management and did not require surgical or radiological intervention. A follow-up liver sonography performed eight weeks post-discharge confirmed a complete resolution. Conclusion Giant ISH is an exceedingly rare but life-threatening complication following LC which merits special attention. Our case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH in those who experience refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post-LC ISH.

A better understanding of pathological features and oncological survival in ypT0 rectal cancer after neoadjuvant chemoradiotherapy is required to improve patient selection criteria for rectal-preserving approach by local excision. Our aim was to define risk of lymph node metastasis and oncological outcomes in ypT0 rectal cancer after chemoradiotherapy and total mesorectal excision.All consecutive patients who underwent total mesorectal excision for a nonmetastatic rectal adenocarcinoma classified ypT0 after neoadjuvant chemoradiotherapy, with or without locoregional lymph node involvement (ypN+ or ypN-), in 14 French academic centers between 2002 and 2015 were included. Data were collected retrospectively. Overall and disease-free survival were explored.Among the 383 ypT0 patients, 6% were ypN+ (23/283). Before chemoradiotherapy, 86% (327/380) were staged cT3-T4 and 41% (156/378) were staged cN+. The risk of ypN+ did not differ between cT3-T4 and cT1-T2 patients (P = .345) or between cN+ and cN- patients (P = .384). After a median follow-up of 61.1 months, we observed 95% confidence interval (92%-97%) of 5-year overall survival and 93% confidence interval (91%-96%) of 5-year disease-free survival. In Cox multivariate analysis, overall survival was altered by intra-abdominal septic complications (hazard ratio = 2.53, confidence interval [1.11-5.78], P = .028). Regarding disease-free survival, ypN+ status and administration of adjuvant chemotherapy were associated with a reduced disease-free survival (P = .001 for both). cT3/T4 staging and cN+ staging did not modify overall survival (P = .332 and P = .450) nor disease-free survival (P = .862 and P = .124).The risk of lymph node metastasis and the oncological survival do not depend on the initial cT or cN staging in cases of ypT0 complete rectal tumor regression.

Background and objectives Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25–85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. Methods Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. Results Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. Conclusions Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.

We report on a 59-year-old female with symptomatic cholelithiasis on a background of morbid obesity who underwent an elective LC with an uncomplicated intraoperative course; however, she experienced a refractory hypotension within one hour postoperatively with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. A triphasic computed tomography scan revealed a large intrahepatic subcapsular haematoma (ISH) measuring 21 cm × 3.1 cm × 17 cm surrounding the lateral surface of the right hepatic lobe without active bleeding. She was managed conservatively with serial monitoring of haemoglobin and haematoma size. A follow-up ultrasound scan after eight weeks confirmed complete resolution of the haematoma. Giant ISH is a fairly rare, but life-threatening complication following LC which merits special attention. This case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH, although being rare event, in those who experience a refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post LC-ISH.

Introduction Tools for improving operative performance for surgical trainees are increasingly desirable, particularly in the context of EWTD and ‘run-through’ training programmes. In addition, positive direct trainer feedback to trainees can improve skill acquisition and motivation, whilst negative feedback may have the opposite effect.1 We aimed to examine the impact of targeted trainer feedback based on video analysis on trainee confidence and objective operative performance in laparoscopic cholecystectomy. Methods Selected procedures designated as training cases were recorded. These were assessed by the trainers using the Independence-Scaled Procedural Assessment Score for laparoscopic cholecystectomy. Targeted feedback based on video review of selected procedures was then delivered by the trainers to the trainees. Trainees completed a self-reported questionnaire based on their response to this feedback. Subsequent to the feedback intervention, further training procedures were recorded and assessed. Results A total of 6 trainees and 4 trainers participated in the study. For the pre-intervention assessment 15 cases were recorded, with a further 13 for the post-intervention assessment (total n = 28). The overall scores for the procedures performed post video feedback were improved, with a trend towards statistical significance (p = 0.08). However, there was a statistically significant improvement in the scores for performance of the triangle of Calot dissection after the feedback intervention (p = 0.009). The response rate to the questionnaire was 100%, with all trainees agreeing that they felt more confident and competent after the feedback intervention. Conclusion Targeted feedback to trainees based on post-procedure video review improves trainee confidence and may also improve performance. ACGME Core Competencies; Patient Care and Procedural Skills; Practice Based Learning and Improvement.

The term “École des Beaux-Arts” refers to a French arts institution and the building that housed it; the name also refers to its Curriculum and Pedagogy, and the impact of both on the teaching and practice of architecture—in its day and to the early 21st century. Originating in the royal academies established in the 17th century, the École des Beaux-Arts evolved through multiple iterations over the course of two centuries. Its architecture section, the focus of this bibliography, dates to 1671, the year of the founding of the Académie Royale d’Architecture. It was temporarily suppressed during the French Revolution (1793), resumed in altered form under the aegis of the Institut National in 1795, and definitively reestablished under Louis XVIII, who granted it permanent quarters on the Rue Bonaparte in 1816 and formally articulated its new mandate and structure in 1819. A major reform was attempted amid pitched debate in 1863 and a decree of 1903 decentralized the architectural education it purveyed by establishing a system of Écoles Régionales d’Architecture. The architecture section of the Paris École was ultimately dissolved by ministerial decree on 6 December 1968 in the wake of the revolutions in May of that year. The ensuing reorganization of architectural education created autonomous but coordinated unités pédagogiques, which are now gathered under the aegis of the Ministry of Culture and Communication, under the rubric École Nationale Supérieure d’Architecture (ENSA). Today’s École Nationale Supérieure des Beaux-Arts (ENSBA) at the Rue Bonaparte location is devoted to the nonarchitectural fine arts. Originally housed in an old regime convent reclaimed in the 1790s by arts aficionados to hold spolia of the Revolution, the École compound was expanded by one of its star progeny, Félix Duban, in the 1830s and became the center of an arts neighborhood, heartbeat of artistic production later in the century. The instructional core of the school, the so-called système des Beaux-Arts, featured an atelier structure, with students clustered in studios run by influential patrons; and a competition-based model of practice, with all exercises culminating in multiphased contests pitting students against one another for coveted prizes. The ultimate prize, the annual Grand Prix de Rome, won the laureate several years residency at the Villa Medici, headquarters of the French Academy in Rome. The Beaux-Arts education bore a distinctive relationship to drawing, to history, and to design values exemplified in antiquity. The stylistic impact of its architectural taste in France took a variety of forms, from a revivified classicism to eclectic recombinations of historical precedent and protomodern experimentations in space and light. In the United States, “Beaux-Arts” style came to be characterized by the sumptuous civic creations of a flush late-19th-century Gilded Age and, in the 20th century, by its opposition to modernism. The École’s most profound and wide-ranging influence lies in the particularities of its approach to the teaching of design—at once rigorously systematic and flexibly adaptable to circumstance.

Highlights • Synovial chrondroma is a rare condition of which the aetiology remains unclear. Large palpable lesions represent an atypical presentation. • The diagnosis is often not immediately apparent. However it is usually suggested by radiologic investigation and confirmed on histology. • Disease recurrence is not infrequent after excision (15–23%) and patients should be counselled regarding this. • Malignant transformation whilst uncommon has been described. At present no definite criteria exist in order to make the diagnosis of malignancy. • Due to the above risks of recurrence and malignancy, long term follow up of affected patients is advised., Introduction Synovial chrondomatosis is a rare disorder characterised by the development of hyaline cartilage from the synovial membrane. Large isolated lesions in the Hoffa's fat pad are an uncommon entity. Presentation of case A 33 year old gentleman presented complaining of progressive knee pain associated with an enlarging lesion on the anterior aspect of the right knee, with associated locking and giving way. Examination revealed a firm 4 × 5 cm lesion adjacent to the patellar tendon. Subsequent CT and MRI demonstrated a lesion in the inferior aspect of Hoffa’s fat pad, with a second lesion adjacent to the proximal tibiofibular joint, in addition to advanced degenerative changes and a meniscal tear. He proceeded to excisional biopsy. Histological analysis was consistent with a solitary synovial osteochondroma. There were no atypical features suggestive of malignancy. Discussion Synovial chondromatosis is a rare disorder affecting the synovial joints. The underlying pathophysiology is thought to be metaplastic change of the synovium to hyaline cartilaginous tissue. Transformation to malignancy has been described but is uncommon with an estimated risk of 5%. It is 1.5–2 times as prevalent in males versus females. Symptoms which patients may complain of include pain;locking and giving way; and palpable masses. The management usually entails removal of the mass lesion with or without accompanying synovectomy. Recurrence of disease may occur in up to 15–23% of patients. Conclusion Synovial chrondromatosis is a rare but well recognised condition. Long term follow up is advised in view of the risk of recurrence and malignant transformation.

Background The mucus gel layer (MGL) lining the colon is integral to exclusion of bacteria and maintaining intestinal homeostasis in health and disease. MGL defects allowing bacteria to directly contact the colonic surface are commonly observed in ulcerative colitis (UC). The major macromolecular component of the colonic MGL is the secreted gel-forming mucin, MUC2, whose expression is essential for homeostasis in health. In UC, another gel-forming mucin, MUC5AC is induced. In mice, Muc5ac is protective during intestinal helminth infection. Here, we tested the expression and functional role of MUC5AC/Muc5ac in colitis patient biopsies and murine colitis. Methods We measured MUC5AC/Muc5ac expression in UC patient biopsies and during acute dextran sulphate sodium (DSS) colitis. We performed DSS-colitis in mice deficient in Muc5ac (Muc5ac−/−) to model the potential functional role of Muc5ac in colitis. To assess MGL integrity, we quantified bacterial–epithelial interaction and translocation to mesenteric lymph nodes (MLNs). Antibiotic treatment was performed to directly investigate the role of colonic bacteria in our murine colitis studies. Results Colonic MUC5AC/Muc5ac mRNA expression increased significantly in active UC and murine colitis. Muc5ac−/− mice experienced worsened injury and inflammation in DSS-colitis compared with controls. This was associated with increased bacterial–epithelial contact and translocation to the MLN. Antibiotic treatment normalised colitis severity in Muc5ac−/− mice to that of antibiotic treated controls. Conclusion We demonstrate for the first time that MUC5AC/Muc5ac induction in acute colitis controls injury by reducing bacterial breach of the MGL. Therefore, developing strategies to induce MUC5AC expression may protect the intestinal barrier in UC.

This chapter reviews the effects of low-level lead exposure framed by the case of a 6-year-old with lead exposure via drinking water in the context of multiple neurodevelopmental and psychosocial considerations. Despite primary prevention efforts, lead exposure remains an important pediatric environmental health problem. Lead effects brain development and function through multiple mechanisms, primarily involving displacement of calcium and zinc in several cellular processes involved in neuronal growth, differentiation, development, and communication. Outcomes at low levels are idiosyncratic and span a variety of neurocognitive domains. Consequently, a tailored approach to evaluation and intervention are essential to maximizing outcomes for affected youth. Ongoing efforts to improve secondary and tertiary prevention while working toward primary prevention of newly recognized lead sources such as water are also imperative. This case highlights the capacity for lead exposure to complicate potentially underlying neurodevelopmental disabilities, cloud diagnostic clarity, and contribute to exacerbation of neuropsychiatric symptoms in addition to causing new-onset symptomatology.

Lauren O'Connell is a Bauer Fellow at Harvard University, USA, where she studies genetic and environmental contributions to behaviour and physiology in poison frogs. She received her Bachelor's degree in Biology from Cornell University, USA, before moving to the University of Texas at Austin, USA, for her PhD in the laboratory of Hans Hofmann, which she completed in 2011. O'Connell received a L'Oréal USA For Women in Science Fellowship in 2014 and was recognised for her outreach work by L'Oréal USA in 2016.

We describe a usability evaluation of a teleconsultation model for primary care physicians (PCPs) with patients with autism spectrum disorders and a developmental-behavioral pediatrician (DBP) with relevant expertise. Six PCPs participated in a total of 12 consultations with a DBP. Detailed observations and user ratings and comments were collected. Standard usability metrics were used, and the communication quality and interactions of the two participating parties (PCP and DBP) were examined. High post-task and post-study ratings (including System Usability Scale, Communication Quality, and attitudes toward teleconsultation process scores), as well as the positive comments from participants, indicated that the teleconsultations were successful, and demonstrated the effectiveness of this type of communication, particularly for validating PCPs’ ideas and strengthening their confidence in talking with families, providing new ideas and redirected their thinking, and connecting PCPs with location-sensitive resources. PCPs found value in the opportunity to connect with an ASD specialist in a timely and efficient manner. Most indicated that the video element of the consultation enhanced clarity and understanding, attention, engagement, and collegiality, while acknowledging drawbacks such as reduced ability to multitask compared to consultations by phone. Recommendations for enhancements of the teleconsultation process focus on supporting PCPs in getting started with Zoom; providing ground rules and establishing procedures; creating information sharing/summary templates for the teleconsultation process; and fostering communication quality in a mediated environment.