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Purpose: To evaluate and quantify potential sociodemographic disparities in breast cancer screening, diagnosis, and treatment due to the COVID-19 pandemic, and the use of telemedicine. Methods: We fielded a 52-item web-based questionnaire from 14 May 2020 to 1 July 2020 in partnership with several U.S.-based breast cancer advocacy groups. Individuals aged 18 or older were eligible for this study if they: (1) received routine breast cancer screening; OR (2) were undergoing diagnostic evaluation for breast cancer; OR (3) had ever been diagnosed with breast cancer. We used descriptive statistics to understand the extent of cancer care delay and telemedicine adoption and used multivariable logistic regression models to estimate the association of sociodemographic factors with odds of COVID-19-related delays in care and telemedicine use. Results: Of 554 eligible survey participants, 493 provided complete data on demographic and socioeconomic factors and were included in the analysis. Approximately half (n = 248, 50.3%) had a personal history of breast cancer. Overall, 188 (38.1%) participants had experienced any COVID-19-related delay in care including screening, diagnosis, or treatment, and 339 (68.8) reported having at least one virtual appointment during the study period. Compared to other insurance types, participants with Medicaid insurance were 2.58 times more likely to report a COVID-19-related delay in care (OR 2.58, 95% Cl: 1.05, 6.32; p = 0.039). Compared to participants with a household income of less than USD 50,000, those with a household income of USD 150,000 or more were 2.38 (OR 2.38, 95% Cl: 1.09, 5.17; p = 0.029) times more likely to adopt virtual appointments. Self-insured participants were 70% less likely to use virtual appointment compared to those in other insurance categories (OR 0.28, 95% Cl: 0.11, 0.73; p = 0.009). Conclusions: The COVID-19 pandemic has had a significant impact on breast cancer screening, diagnosis, and treatment, and accelerated the delivery of virtual care. Lower-income groups and patients with certain insurance categories such as Medicaid or self-insured could be more likely to experience care delay or less likely to use telemedicine. Careful attention must be paid to vulnerable groups to insure equity in breast cancer-related service utilization and telemedicine access during and beyond the COVID-19 pandemic.

Objectives: Pyogenic vertebral osteomyelitis (PVO) is a rare disease with possible severe complications (e.g. sepsis and spinal cord injury). In the 1990s, diagnostic delay (DD) was often extensive as PVO has a non-specific clinical spectrum, mostly afebrile with back pain, and access to magnetic resonance imaging (MRI) was not straightforward. Our aim was to perform a new study focusing on the clinical spectrum and DD of PVO and its associated factors.Method: This study examined a prospective cohort of 88 patients having PVO with microbiological identification between 15 November 2006 and 15 November 2010.Results: The 88 patients included in the study (female:male ratio 1:8) had a mean age of 64.1 years. The mean (sd) DD was 45.5 (50.4) days (range 2-280), and 46 patients (52.2%) were febrile at diagnosis. The main microorganism involved was Staphylococcus (n = 45; 51.1%). In univariate and multivariate analyses, age > 75 years, antecedent back pain, involvement of bacteria, topography of PVO, and anti-inflammatory drug intake did not affect the DD, unlike a C-reactive protein (CRP) value > 63 mg/L or a positive blood culture (DD lowered from 73 to 17 days and from 90 to 30 days, respectively). Conversely, X-ray investigation was associated with a longer DD (from 14 to 34.7 days). Severity at diagnosis was not significantly different depending on the intake of anti-inflammatory drugs.Conclusions: Despite easier access to MRI, the DD for PVO remains long. One shortening factor is a high CRP value, which could be a useful diagnostic tool in case of back pain. Anti-inflammatory drugs seem to have no impact on DD and severity at diagnosis. [ABSTRACT FROM AUTHOR]

C-reactive protein (CRP) has been proposed as an independent risk factor for cardiovascular disease. In this study we sought to investigate the association between several nutritional and lifestyle factors and serum CRP concentration in a population-based study. We studied 359 individuals (172 women, 187 men; age range 18-75 years) randomly selected from the town hall's registers and assessed their daily dietary intake using a 3-day estimated-food record. The median serum CRP concentration was 1.40 mg/I (range <0.10-47.48 mg/L; geometric mean 1.20 mg/L). We noted significant and independent direct associations between CRP and age, body-mass index, female sex, and serum triglyceride concentration. Bivariate analysis showed a significant inverse association between CRP and many nutrients (e.g., carbohydrates, proteins, lipids, thiamine, pyridoxine, tocopherol, and folate), but multiple-regression analysis indicated that only the effect of dietary folate intake was not dependent on other factors. Differences in folate intake did not produce changes in plasma homocysteine concentration, and we detected no negative correlation between dietary folate intake and log homocysteine (r = .02, P = .711). Strong positive correlations between the intake of folate and numerous other nutrients were found. This population-based study shows that a higher folate intake, in addition to other known constitutive and lifestyle factors, is significantly associated with a lower serum CRP concentration. [ABSTRACT FROM AUTHOR]

With the increasing rate of wind power installed capacity, voltage state assessment with large-scale wind power integration is of great significance. In this paper, a vine-copula based voltage state assessment method with large-scale wind power integration is proposed. Firstly, the nonparametric kernel density estimation is used to fit the wind speed distribution, and vine-copula is used to construct the wind speed joint distribution model of multiple regions. In order to obtain voltage distribution characteristics, probabilistic load flow based on the semi-invariant method and wind speed independent transformation based on the Rosenblatt transformation are described. On this basis, a voltage state assessment index is established for the more comprehensive evaluation of voltage characteristics, and a voltage state assessment procedure is proposed. Taking actual wind speed as an example, the case study of the IEEE 24-node power system and the east Inner Mongolia power system for voltage state assessment with large-scale wind power integration are studied. The simulation results verify the effectiveness of the proposed voltage state assessment method.

The electromagnetic transient simulation of a power system with nonlinear characteristics is very time-consuming due to numerous inversion calculations of the admittance matrix. To speed up the simulation of the power system with nonlinear characteristics, a multi-rate and parallel electromagnetic transient simulation method is proposed. Firstly, a Multi-Area Thevenin Equivalents (MATE)-based parallel algorithm considering nonlinear characteristics of the power system is proposed. This method guarantees the admittance matrix is constant by considering changing branches as link current without dividing the subnet again. Secondly, considering the differences of the time constant of the AC/DC subnet, different simulation steps are used for these subnets. The Lagrange interpolation method is used for calculating the Thevenin voltage of the AC subnet in non-synchronous time. Calculation methods of the DC subnet Thevenin voltage is proposed by considering the simulation results during the entire large simulation step. Finally, the simulation process is optimized for improving the simulation efficiency further. The simulation results show that the proposed method could greatly improve the simulation efficiency without losing simulation accuracy too much compared with the traditional method.

Abstract Struma ovarii (SO) is a slow-growing ovarian neoplasm with thyroid tissue as its predominant component. It is an uncommon neoplasm, usually asymptomatic with an unknown risk of malignant transformation. Due to difficulties in assessing the rare biological nature and the discrepancies in the reported cases, a consensus on the appropriate treatment has not been definitively reached. A 50-year-old female was subjected to upper gut endoscopy which showed a 30-mm mass located in the gastric antrum, suggestive of mesenchimal tumor. Incidentally, a pelvic CT scan also documented a solid mass in the right adnexa, with morphological characteristics of ovarian neoplasm. The patient underwent gastrectomy, total hysterectomy, bilateral salpingo-oophorectomy with lymph node dissection, and omentectomy. Histology documented the presence of gastric cavernous angioma, and, in the right adnexa, foci of follicular thyroid-type carcinoma arising in SO with a well-differentiated neuroendocrine component. Here we report and discuss the clinical and morphological presentation of follicular thyroid-type carcinoma arising in SO. The neoplasm was discovered incidentally and had a favorable clinical outcome at 1-year follow-up.

The crisis of modernity as the crisis of the political is seen by the author primarily as a crisis of the "measure" of the criterion of political decision making and action. This crisis is understood in the first place as a crisis of self-awareness and practice of the ethos. Machiavelli was the first to attempt a solution to this problem by introducing the concept of virtus, which became the fundamental principle of modern political philosophy. However, many modern and contemporary interpreters of Machiavelli's thought often ignore the social and political context in which the political doctrine of the Florentine thinker arose. Namely, Machiavelli's effort to find an authentic form of the political act that would make possible a harmonization and stabilization of the dramatic political circumstances then prevailing in Italian cities required a reliable diagnosis and adequate means for a successful therapy of the sick organism of the community. The epochal novelty in Machiavelli's political theory was the shift from the ancient theorization of virtue to its modern operationalization. Nevertheless, this shift is often interpreted as a radical opposing of the Greek concept of arete to the Roman virtus, which is crudely and simplistically reduced to bravery and strength necessary for taking and keeping political power. Hegel in his political philosophy travels an important part of the road - unconsciously rather than consciously - along with Machiavelli and Shelling. This particularly holds for his understanding of the necessity of strength and bravery in the process of operationalizing the spirit of freedom in history through the mediation of "negation" as "the power of evil". The mediation of subjectivity and substantiality, according to Hegel, takes place in the state by the brutal bridling of the world spirit where not just individuals but whole peoples are sacrificed - toward freedom, i.e. its realization in the community of the ethos. The "trouble of the times" is a consequence of the separation between I and the world (Entzeiung) and stems from a reduced political reason which lacks the criterion of the ethical totality for political action and decision making. By the separation of the ethos this reason get routinized and political action is reduced to naked technique of winning and keeping political power. In the concluding segment of the paper the author points to some global consequences of the crisis of political decision making in the historical reality at the end of 20th century.

Young people in vulnerable situations tend to have more difficulties realizing successful formal education trajectories. It is extremely important to conduct studies that explore the key dimensions that can help young people overcome the conditioning of vulnerable situations, assisting in the achievement of academic success. According to the existing literature, one of these key dimensions is psychosocial well-being. Thus, this qualitative research aims to identify and analyze psychosocial factors that favor successful school pathways among young people in vulnerable situations. Through a case study approach, 12 in-depth interviews were carried out with 12 young Spanish people who not only have a vulnerable background but also successful formal education trajectories. The data were explored through qualitative content analysis-NVivo11. The results revealed that young people generally associate their successful educational trajectory with the positive impact of psychosocial factors, such as the following: positive caregivers' valuation of formal education and positive school experiences and support networks. Young people also point to many negative school experiences that have been overcome via positive attitudes and individual protective factors. The youngsters suggest changes in the educational system and teachers' skills in order to improve the levels of psychosocial support in formal education contexts. The study's implications and limitations and recommendations for future research are discussed.

Background: The process of transition to adult life of youth with a record of protection is crucial to overcome the difficulties to achieve an independent life., Objective: This research aims to analyze the conditions under which protected youth are emancipated, as well as the factors that facilitate emancipation., Method: A qualitative study was performed with three samples: longitudinal follow-ups with youths when they exit the system and during 12 months ( N  = 24); life stories of youths who have exited the child welfare system at least 2 years ago and a maximum of 5 years ago ( N  = 22); interviews with professionals conducting their intervention in adolescent protection resources ( N  = 18)., Results: The results indicate that protective action is not enabling youths' learning in normalized contexts, which negatively affects the conditions under which emancipation occurs. The experience of the protective action conditions the tendency to benefit from the post-majority socio-educational accompaniment., Conclusions: The importance of socio-educational intervention continuing during the first moments of emancipation, providing professional accompaniment to the entire collective, is highlighted., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Background: Duration of treatment for patients with vertebral osteomyelitis is mainly based on expert recommendation rather than evidence. We aimed to establish whether 6 weeks of antibiotic treatment is non-inferior to 12 weeks in patients with pyogenic vertebral osteomyelitis., Methods: In this open-label, non-inferiority, randomised controlled trial, we enrolled patients aged 18 years or older with microbiologically confirmed pyogenic vertebral osteomyelitis and typical radiological features from 71 medical care centres across France. Patients were randomly assigned to either 6 weeks or 12 weeks of antibiotic treatment (physician's choice in accordance with French guidelines) by a computer-generated randomisation list of permuted blocks, stratified by centre. The primary endpoint was the proportion of patients who were classified as cured at 1 year by a masked independent validation committee, analysed by intention to treat. Non-inferiority would be declared if the proportion of cured patients assigned to 6 weeks of treatment was not less than the proportion of cured patients assigned to 12 weeks of treatment, within statistical variability, by an absolute margin of 10%. This trial is registered with EudraCT, number 2006-000951-18, and Clinical Trials.gov, number NCT00764114., Findings: Between Nov 15, 2006, and March 15, 2011, 359 patients were randomly assigned, of whom six in the 6-week group and two in the 12-week group were excluded after randomisation. 176 patients assigned to the 6-week treatment regimen and 175 to the 12-week treatment regimen were analysed by intention to treat. 160 (90·9%) of 176 patients in the 6-week group and 159 (90·9%) of 175 of those in the 12-week group met the criteria for clinical cure. The difference between the groups (0·05%, 95% CI -6·2 to 6·3) showed the non-inferiority of the 6-week regimen when compared with the 12-week regimen. 50 patients in the 6-week group and 51 in the 12-week group had adverse events, the most common being death (14 [8%] in the 6-week group vs 12 [7%] in the 12-week group), antibiotic intolerance (12 [7%] vs 9 [5%]), cardiorespiratory failure (7 [4%] vs 12 [7%]), and neurological complications (7 [4%] vs 3 [2%])., Interpretation: 6 weeks of antibiotic treatment is not inferior to 12 weeks of antibiotic treatment with respect to the proportion of patients with pyogenic vertebral osteomyelitis cured at 1 year, which suggests that the standard antibiotic treatment duration for patients with this disease could be reduced to 6 weeks., Funding: French Ministry of Health., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aim: The finding of a neck nodular lesion provides strong suspicion of primary thyroid malignancy. Direct extension into the thyroid parenchyma of carcinomas arising from pharynx, larynx, trachea or esophagus, nervous structures has been also observed in the minority of cases. The intent of our study is to present and discuss rare conditions presenting asymptomatic neck masses, with particular emphasis on pre-operative characteristics and diagnostic criteria., Material of Study: In our retrospective analysis, we present three cases of nodular neck lesions that have mimicked primitive thyroid pathologies at the first diagnosis., Results: A 53-mm nodular mass in the right thyroid lobe was observed in one patient. The definitive diagnosis was Castleman's disease. The second case presented a 20-mm hypoechoic lesion in the contest of a multinodular goiter. The pre-operative suspect was thyroid carcinoma with lymphnode metastases but the definitive histology documented an 'ancient schwannoma'. A further patient presented bilateral supra-clavear and cervical lymphnodes in a multinodular goiter, initially interpreted as thyroid carcinoma with loco-regional spread. After a total thyroidectomy and cervical lymphadenectomy, the definitive histology documented foci of poorly differentiated carcinoma in cervical lymphnodes and a multinodular goiter without atypical cellularity. The patient is considered to have an occult tumor, probably arising from the breast, and she was scheduled in an oncological program., Conclusions: Nodular neck lesions are frequently misdiagnosed as primitive thyroid nodules in the common clinical practice. In these rare conditions, surgical exploration is advocated to reach the definitive diagnosis, to indicate the most appropriate treatment and to avoid unnecessary thyroidectomy., Key Words: Ancient Schwannoma, Castleman's disease, Nodular neck lesion, Thyroid nodule.

While endemic malaria has been eliminated in the United States, approximately 1200 mostly imported cases are reported annually in the country, with fewer than 20 recorded deaths. Because of the rarity of this disease in the United States, clinicians are often unfamiliar with its diagnosis and presentation. In a review of all malaria deaths in the United States from 1963 to 2001, failure to diagnose malaria on initial presentation, promptly initiate treatment, and/or prescribe appropriate antimalarial drugs were identified as contributing factors to death. Plasmodium falciparum can lead to a particularly severe type of malaria complicated by acute respiratory distress syndrome (ARDS), and physicians must be alert to the possibility of this diagnosis in immigrants and returning travelers. We report a case of successfully treated acute respiratory distress syndrome complicating imported P falciparum malaria at a large teaching hospital in Washington, DC.