Search

Leila Katabi,1 Erica Stevens,1 Mona Ascha,2 Kavita Arora3,4 1Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA; 2Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA; 3Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, 44109, USA; 4Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27514, USACorrespondence: Kavita Arora, Department of Obstetrics and Gynecology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA, Tel +1 919-843-8295, Email kavita.shah.arora@gmail.comPurpose: Etonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case–control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution.Patients and Methods: We identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest.Results: A total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [− 0.6, 14.7] kilograms versus 1.6 [− 1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified.Conclusion: We did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.Keywords: nexplanon, etonogestrel subdermal implant, upper extremity surgery, implantable contraception

ObjectiveThere is evidence of altered neural taste response in female adolescents who are obese (OB), and in adolescents who are at risk for obesity. To further understand risk factors for the development of overeating and obesity, we investigated response to tastes of sucrose and water in 23 OB and healthy weight (HW) children.Methods and designThirteen HW and 10 OB 8-12-year-old children underwent functional magnetic resonance imaging while tasting sucrose and water. Additionally, children completed an eating in the absence of hunger paradigm and a sucrose-liking task.ResultsA region of interest analysis revealed an elevated BOLD response to taste (sucrose and water) within the bilateral insula and amygdala in OB children relative to HW children. Whole-brain analyses revealed a group by condition interaction within the paracingulate, medial frontal, middle frontal gyri and right amygdala: post hoc analyses suggested an increased response to sucrose for OB relative to HW children, whereas HW children responded more strongly to water relative to sucrose. In addition, OB children, relative to HW, tended to recruit the right putamen as well as medial and lateral frontal and temporal regions bilaterally.ConclusionThis study showed increased reactivity in the amygdala and insula in the OB compared with HW children, but no functional differentiation in the striatum, despite differences in the striatum previously seen in older samples. These findings support the concept of the association between increased neural processing of food reward in the development of obesity, and raise the possibility that emotional and interoceptive sensitivity could be an early vulnerability in obesity.

Context. River regulation, coupled with climate change, has caused significant declines in global freshwater biodiversity. In Australia, water extraction within the Murray–Darling Basin (MDB) has reduced the frequency, extent and duration with which floodplains are inundated, resulting in widespread declines in wetland-dependent biodiversity, including reptiles. The endangered Ngabi (Hemiaspis damelii) is associated with floodplain systems in the MDB, yet its distribution and ecological requirements are poorly understood, hampering conservation actions. Aims. We sought to validate an assumption that Ngabi is associated with wetland vegetation communities before investigating factors affecting its probability of detection in the lower Murrumbidgee catchment in southern New South Wales. We predicted Ngabi occurrence patterns would relate to frog abundance, wetland hydrology, microhabitat attributes and meteorological variables. Methods. We compared Ngabi observations from 16 paired wetland and dryland vegetation transects to evaluate associations with vegetation type. We then used generalised linear mixed models to relate snake presence and absence to prey (frog abundance), microhabitat (logs and ground cover), wetland hydrology (water depth and inundation frequency) and meteorological conditions, using 12 repeat surveys between September 2018 and March 2021. Key results. Fiftyeight snakes were observed at five of eight wetlands during the study. Ngabi was exclusively recorded in river red gum/spike rush or lignum vegetation communities, and was absent from sandhill woodland or chenopod communities. The probability of detecting Ngabi increased with ambient temperature and weakly with wetland inundation frequency, but not frog abundance, microhabitat attributes or year. Conclusions. Ngabi is strongly associated with floodplain vegetation communities and, to some extent, frequently inundated wetlands in southern NSW, suggesting water management agencies should incorporate threatened floodplain snake species into future wetland management plans. The use of environmental water to restore aspects of flow regimes, improve wetland health and aquatic diversity is likely to benefit other wetlanddependent snake populations across the MDB. Implications. The positive relationship between Ngabi detections and ambient temperature will be important for designing an effective monitoring program for the species across the MDB. Furthermore, our findings provide insight into the benefits of using environmental water to create wetland refuges to maintain floodplain snake populations during droughts. [ABSTRACT FROM AUTHOR]

Neutron beta decay is one of the most fundamental processes in nuclear physics and provides sensitive means to uncover the details of the weak interaction. Neutron beta decay can evaluate the ratio of axial-vector to vector coupling constants in the standard model, λ = gA/gV, through multiple decay correlations. The Nab experiment will carry out measurements of the electron-neutrino correlation parameter a with a precision of δa/a = 10−3 and the Fierz interference term b to δb = 3 × 10−3 in unpolarized free neutron beta decay. These results, along with a more precise measurement of the neutron lifetime, aim to deliver an independent determination of the ratio λ with a precision of δλ/λ = 0.03% that will allow an evaluation of Vud and sensitively test CKM unitarity, independent of nuclear models. Nab utilizes a novel, long asymmetric spectrometer that guides the decay electron and proton to two large area silicon detectors in order to precisely determine the electron energy and an estimation of the proton momentum from the proton time of flight. The Nab spectrometer is being commissioned at the Fundamental Neutron Physics Beamline at the Spallation Neutron Source at Oak Ridge National Lab. We present an overview of the Nab experiment and recent updates on the spectrometer, analysis, and systematic effects.