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OBJECTIVE: To examine attachment to primary care and team-based primary care in the community for people who experienced imprisonment in Ontario, and to compare these attachment data with data for the general population. DESIGN: Population-based retrospective cohort study. SETTING: Ontario. PARTICIPANTS: All persons released from provincial prison in Ontario to the community in 2010 who were linked with provincial health administrative data, and an age- and sex-matched general population group. MAIN OUTCOME MEASURES: Primary care attachment and team-based primary care attachment in the 2 years before admission to provincial prison (baseline) and in the 2 years after release in 2010 (follow-up) for the prison release group, and for the corresponding periods for the general population group. RESULTS: People in the prison release group (n = 48 861) were less likely to be attached to primary care compared with the age- and sex-matched general population group (n = 195 444), at 58.9% versus 84.1% at baseline (P < .001) and 63.0% versus 84.4% during follow-up (P < .001), respectively. The difference in attachment to team-based primary care was small in magnitude but statistically significant, at 14.4% versus 16.1% at baseline (P < .001) and 19.9% versus 21.6% during follow-up (P < .001), respectively. CONCLUSION: People who experience imprisonment have lower primary care attachment compared with the general population. Efforts should be made to understand barriers and to facilitate access to high-quality primary care for this population, including through initiatives to link people while in prison with primary care in the community.

Background: Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. Methods: We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates. Findings: With complete cessation of LT, the projected 1-year overall survival (OS) decreased by 3•6%, 10•51% and 19•21% for a 1-, 3- and 6-month disruption respectively versus no limitation to LT, while 2-year OS decreased by 4•1%, 12•55%, and 23•43% respectively. When only urgent (acute-on-chronic liver failure [ACLF] or acute liver failure) LT was allowed, the projected 1-year OS decreased by a similar proportion: 3•1%, 8•41% and 15•20% respectively. When deceased donor LT (DDLT) and urgent living donor LT (LDLT) were allowed, 1-year projected OS decreased by 1•2%, 5•1% and 8•85% for a 1-, 3- and 6-month disruption respectively. OS was similar when only DDLT was allowed. Complete cessation of LT activities for 3-months resulted in an increased projected incidence of ACLF and hepatocellular carcinoma (HCC) dropout at 1-year by 49•1% and 107•96% respectively. When only urgent LT was allowed, HCC dropout and ACLF incidence were comparable to the rates seen in the scenario of complete LT cessation. Interpretation: A short and wide-ranging disruption to LT results in better outcomes compared with a longer duration of partial restrictions. Funding: None to disclose.

More than 80% of people in the United States who are older than 65 years have 1 or more chronic medical problems, and 50% have 2 or more. The cost of care for the elderly is at least 3 to 4 times that of younger populations and is rapidly growing, mostly because of a lack of preventive approaches and overly medicalized and fragmented care. This article summarizes the most up-to-date evidence for specific integrative modalities for common geriatric conditions, including falls, frailty, osteoporosis, and end-of-life palliative care.

Human natural killer (NK) cells develop in secondary lymphoid tissues (SLTs) through distinct stages. We identified two SLT lineage (Lin)(-)CD34(-)CD117(+/-)CD94(+)CD16(-) "stage 4" subsets according to expression of the C-type lectin-like surface-activating receptor, NKp80: NKp80(-) (stage "4a") and NKp80(+) (stage "4b"). Whereas stage 4b cells expressed more of the transcription factors T-BET and EOMES, produced interferon-gamma, and were cytotoxic, stage 4a cells expressed more of the transcription factors RORγt and AHR and produced interleukin-22, similar to SLT Lin(-)CD34(-)CD117(+)CD94(-)CD16(-) "stage 3" cells, whose phenotype overlaps with that of group 3 innate lymphoid cells (ILC3s). Co-culture with dendritic cells or transplantation into immunodeficient mice produced mature NK cells from stage 3 and stage 4a populations. These data identify NKp80 as a marker of NK cell maturity in SLTs and support a model of human NK cell development through a stage 4a intermediate with ILC3-associated features.

The current model of murine innate lymphoid cell (ILC) development holds that mouse ILCs are derived downstream of the common lymphoid progenitor through lineage-restricted progenitors. However, corresponding lineage-restricted progenitors in humans have yet to be discovered. Here we identified a progenitor population in human secondary lymphoid tissues (SLTs) that expressed the transcription factor, RORγt, and was unique in its ability to generate all known ILC subsets, including natural killer (NK) cells, but not other leukocyte populations. In contrast to murine fate-mapping data, which indicate that only ILC3 cells express Rorγt, these human progenitor cells as well as human peripheral blood NK cells and all mature ILC populations expressed RORγt. Thus, all human ILCs can be generated through an RORγt+ developmental pathway from a common progenitor in SLTs. These findings help establish the developmental signals and pathways involved in human ILC development.

PURPOSE The aim of the study was to assess the ability of chest digital tomosynthesis (DTS) for detection of interstitial lung disease (ILD) compared with conventional chest radiography. MATERIALS AND METHODS We retrospectively reviewed 78 patients (60 males, 18 females, mean age = 53.05 years, range, 19-83 years) who underwent chest DTS for a 5-year interval (January 1, 2009-December 31, 2014). Of the 78 patients, 33 (42.3%) carried a diagnosis of ILD and 45 (57.7%) were not ILD. All computed tomography reports and medical records were reviewed. The conventional chest radiography and DTS were separately reviewed by 2 radiologists for the presence of ILD and the confidence in diagnosis. RESULTS The diagnostic accuracy of DTS for the detection of ILD was better than conventional chest radiography (P < 0.05). Digital tomosynthesis had a sensitivity of 83.3% and negative predictive value of 89.0% that were statistically significantly better than conventional chest radiography (43.9% and 70.9%, respectively). Confidence in diagnosing ILD at DTS was higher than conventional chest radiography (P < 0.001) and had higher interobserver agreement than conventional chest radiography (P < 0.01). CONCLUSIONS Digital tomosynthesis improves diagnostic performance and confidence in diagnosing ILD compared with conventional chest radiography. Digital tomosynthesis can be suggested as the initial diagnostic technique for patients with suspected ILD.

Cancer risk increases with age, but a patient’s tolerance to conventional treatments may be reduced with aging and associated morbidities. The development and expansion of age-appropriate therapies and approaches will be crucial as the population of elderly patients with cancer grows in the upcoming years. Taking into account the unique needs of this population will be of great importance. This chapter introduces the field of integrative oncology, the practice of supporting the whole person before, during, and after conventional treatments for cancer. Current evidence recognizes the safe use of many integrative interventions, such as lifestyle and diet changes and supplement and botanical use, to prevent cancer; to reduce side effects and optimize wellness during treatments such as surgery, chemotherapy, and radiation; and to promote full recovery after treatment. Many of these same interventions act directly to optimally regulate pathways in the unique metabolism of the malignant cell process.

In this study, we experimentally investigate how performance risk and relational risk affect a principal’s willingness to offer gift, bonus, or penalty contracts and the subsequent motivational effect that these three contracts have on agents. Prior literature has not directly compared performance-contingent contracts to gift contracts, and extrapolation from existing empirical data is difficult because the literature has typically examined each in settings focused only on the mechanism through which each contract acts (i.e., interactive settings for gift exchange and settings with stochastic production and unobservable effort for performance-contingent contracts). We combine features of both settings and construct a willingness-to-pay (WTP) measure indicative of the principal’s propensity to offer a contract. Comparing the WTPs for the contracts, we find that gift exchange contracts are less attractive to principals than performance-contingent contracts. More importantly, we demonstrate that performance-contingent contracts evoke reciprocity concerns, suggesting that they function as both incentive compatible instruments, consistent with agency theory, and as behavioral instruments, consistent with models of gift exchange.

Integrative medicine and palliative medicine share many tenets. This chapter reviews integrative approaches to the most common symptoms needing palliation among geriatric patients at the end of life, including pain, nausea and vomiting, constipation, dyspnea, and fatigue. Several palliative care approaches to communication about patient goals and advance care planning for a time when the patient is unable to make decisions are described. Resources to support advance care planning are provided. Finally, issues that need to be addressed by either primary care geriatrics or in consultation with palliative care in the last weeks, days, and hours of life are described.

Themaincauses of smoking-related deaths are lung cancer, chronicobstructive pulmonary disease (COPD), and ischemic heartdisease.Smokinghasalsobeenstronglyassociatedwithseveralinterstitiallungdiseases(ILDs),namelypulmonaryLangerhanscell histiocytosis (PLCH), respiratory bronchiolitis (RB), RB-associated ILD (RB-ILD), and desquamative interstitialpneumonia (DIP).This article reviews the major diffuse pulmonary diseasesaffectingsmokers,includingemphysemaandsmoking-relatedILDs. We describe the histologic and radiologic features of thedifferent forms of emphysema (centrilobular, panlobular, andparaseptal). Finally, we then discuss the clinical, histopatho-logic, and radiologic characteristics of smoking-related ILDs,including PLCH, RB, RB-ILD, and DIP. Bronchogenic carci-noma is not covered in this article.

The recently discovered cytoprotective action of CO has raised interest in exogenous CO-releasing materials (CORMs) such as metal carbonyls (CO complexes of transition metals). To achieve control on CO delivery with metal carbonyls, we synthesized and characterized three Mn(I) carbonyls, namely, [Mn(tpa)(CO)(3)]ClO(4) [1, where tpa = tris(2-pyridyl)amine], [Mn(dpa)(CO)(3)]Br [2, where dpa = N,N-bis(2-pyridylmethyl)amine], and [Mn(pqa)(CO)(3)]ClO(4) [3, where pqa = (2-pyridylmethyl)(2-quinolylmethyl)amine], by crystallography and various spectroscopic techniques. All three carbonyls are sensitive to light and release CO when illuminated with low-power UV (5-10 mW) and visible (λ350 nm, ~100 mW) light. The sensitivity of 1-3 to light has been assessed with respect to the number of pyridine groups in their ligand frames. When a pyridine ring is replaced with quinoline, extended conjugation in the ligand frame increases the absorptivity and makes the resulting carbonyl 3 more sensitive to visible light. These photosensitive CORMs (photoCORMs) have been employed to deliver CO to myoglobin under the control of light. The superior stability of 3 in aqueous media makes it a photoCORM suitable for inducing vasorelaxation in mouse aortic muscle rings.

We have developed a rapid negative selection method to enrich rare mononuclear cells from human tissues. Unwanted and antibody-tethered cells are selectively depleted during a Ficoll separation step and there is no need for magnetic-based reagents and equipment. The new method is fast, customizable, inexpensive, remarkably efficient and easy to perform and per sample the overall cost is less than one-tenth the cost associated with a magnetic column-based method.

This is the 13th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for study online at http://www.aseronline.org/curriculum/toc.htm.

Background: There have been several reports in the literature of dermatofibromas with granular cells. Here we report a granular cell tumor with the architecture of a dermatofibroma. This is the first report of this histological variant of granular cell tumor. The lesion was a 2.5-cm oval, hyperpigmented plaque present for “years” on the back of a 60-year-old African-American woman. Methods: The specimen was processed using formalin fixation and paraffin embedding. Tissue sections were stained with hematoxylin and eosin. Immunohistochemical studies were performed with antibodies directed against S-100 protein, neuron-specific enolase, and factor XIIIa. Results: Histopathologic examination revealed granular cells, some of which were spindle shaped, distributed singly and in small groups between collagen bundles resembling a dermatofibroma. Immunohistochemical studies showed the tumor cells to be positive for S-100 and neuron-specific enolase and negative for factor XIIIa. Conclusion: The immunohistochemical findings support the diagnosis of a granular cell tumor with a dermatofibroma-like pattern.

The lungs are a common site for metastatic spread of malignancy. Approximately 20%-54% of patients with extrathoracic malignancy have pulmonary metastases at autopsy. The most common primary neoplasms with pulmonary metastases at autopsy include breast, colon, kidney, uterus, and head and neck. Less common primary malignancies including choriocarcinoma, osteosarcoma, testicular tumors, melanoma, and thyroid carcinoma also metastasize to the lungs. The detection of pulmonary metastases, as with other distant metastases, indicates a poor prognosis and directly affects treatment planning. For example, in a large retrospective study of patients with melanoma, median survival was only 7.3 months after development of pulmonary metastases. Evaluation is primarily performed with chest radiography and computerized tomography (CT), although other modalities such as fluorodeoxyglucose-positron emission tomography (FDG-PET) may also play a role. Pulmonary metastases can have a wide spectrum of appearances on imaging, reflecting the route of spread as well as the local behavior of the neoplastic cells.

We have demonstrated that cysteine and glutathione induced edge-to-edge coupling of gold nanocubes (Au NCs) caused a band-selective enhancement of two-photon photoluminescence (TPPL). The photoluminescence intensity of the X-band of Au NCs was found to be enhanced up to 60-fold and 46-fold upon addition of cysteine and glutathione, respectively, while the intensity of L-band remained almost unchanged. This band-selective enhancement behavior is totally different from the previously observed aggregation enhanced TPPL of spherical metal nanoparticles (NPs). The band-selective enhancement was ascribed to preferential enhancement of the X-band emission through resonant coupling with longitudinal surface plasmon resonance (SPR) band of the Au NCs assembly. This phenomenon was utilized to develop a new two-photon fluorescence turn-on sensing platform for detection of cysteine and glutathione. This method displayed high sensitivity and excellent selectivity over the other 19 amino acids. Together with the advantage of deep tissue penetration and localized excitation of two-photon near-infrared excitation, this strategy has promising applications in in vivo biosensing and imaging.

Introduction This resource is a part of a seven module curriculum intended to provide teaching faculty caring for well newborns with accessible, approachable, easily delivered, hands-on tools for bedside teaching in the newborn nursery. The seven modules are linked. Methods This module focuses on acquiring the skills to complete a newborn physical examination. Also included is a guide to newborn reflexes. This checklist has been used for third-year medical students, pediatric, medicine-pediatric and family medicine interns, and physician assistant students at three different institutions. Results This checklist was evaluated by randomizing 22 medical students into one of two groups: students who received feedback using this checklist and students who received routine feedback without using this checklist (control group). At the end of their one week newborn rotation, students' newborn physical exam skills were assessed by a blinded pediatrician. Using the checklist, students were given a score (0 = not done, 1 = needs improvement, 2 = done). Students who had received feedback using this checklist had a higher average score on individual items (average score 1.72 vs. 1.55 for control group, not significant). Discussion Attending physicians found the checklists easy to understand and easy to use. They felt that the checklists improved the quality of the feedback that the students received by covering more areas and by focusing on specific points. This checklist has been part of the University of Michigan student and intern curriculum since 2008.

One of the main requirements in the design and development of wireless sensor networks (WSN) is to minimize their power consumption. For this reason, this paper focuses on the energy efficiency improvement that can be achieved using new communication methods called cooperative communications. This cooperative communications is a diversity technique that is aiming to maximize the total network capacity for a given bandwidth and the defined bit error rate (BER) of the channel. Therefore, by using this method in a fading channel, a larger amount of information can be transmitted through the channel with less transmitting time and power. This paper presents one method for the channel capacity calculation in wireless sensor network with cooperative decode and forward communication.