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Over the course of aging, there is an early degradation of cerebrovascular health, which may be attenuated with aerobic exercise training. Yet, the acute cerebrovascular response to a single bout of exercise remains elusive, particularly within key brain regions most affected by age-related disease processes. We investigated the acute global and region-specific cerebral blood flow (CBF) response to 15 minutes of moderate-intensity aerobic exercise in older adults (≥65 years; n = 60) using arterial spin labeling magnetic resonance imaging. Within 0–6 min post-exercise, CBF decreased across all regions, an effect that was attenuated in the hippocampus. The exercise-induced CBF drop was followed by a rebound effect over the 24-minute postexercise assessment period, an effect that was most robust in the hippocampus. Individuals with low baseline perfusion demonstrated the greatest hippocampal-specific CBF effect post-exercise, showing no immediate drop and a rapid increase in CBF that exceeded baseline levels within 6–12 minutes postexercise. Gains in domain-specific cognitive performance postexercise were not associated with changes in regional CBF, suggesting dissociable effects of exercise on acute neural and vascular plasticity. Together, the present findings support a precision-medicine framework for the use of exercise to target brain health that carefully considers age-related changes in the cerebrovascular system.

Background: Paediatric Crohn's disease (CD) has been associated with undernutrition. Accurate and accessible measures of body composition would provide data to personalise nutritional therapy. We assessed feasibility of MRI-derived measures of psoas cross-sectional area (PCSA) in paediatric CD and correlated with anthropometric and bioelectrical impedance spectroscopy (BIS) measures. Methods: MRI small bowel/pelvis images of patients with CD, aged

As the large-scale commercialization of proton exchange membrane fuel cells (PEMFC) for numerous applications, including heavy-duty trucks draws nearer, there is increasing interest in optimizing fuel cell membranes for both improved efficiency and durability. One of the major membrane attributes being considered for optimization is thickness. The current range of (perfluorosulfonic acid) PFSA membrane thicknesses employed for commercial applications range from 8 -25 µm. As with most adjustable materials parameters, there are a host of properties (cost, gas permeability, proton conductivity, etc.) that require co-optimization to provide the overall preferred position. For example, thin membranes will minimize proton resistance, facilitating high power densities, but will simultaneously allow increased gas crossover fluxes that can contribute to both reduced fuel efficiency and increased oxidative stress. On the other end of the spectrum, thick membranes will decrease gas crossover fluxes, offering improved fuel efficiency while simultaneously decreasing power density. A major question surrounding the tradeoffs of membrane thickness involves the chemical durability impact. Here, we report our investigations of PFSA membrane chemical durability as a function of thickness. For the studies reported here, a thickness series (8, 12 and 20 µm) of ePTFE reinforced Nafion®-like PFSA standalone membranes (SAMs) were prepared. A two-pronged approach was taken for this study. The first involves investigation of intrinsic chemical stability of the ionomer as a function of membrane thickness using an ex-situ H2O2 vapor test. The second investigative mode, which targets the oxidative stress generated by crossover gas flux, employs OCV durability tests of full MEAs. In addition to membrane thickness, gas crossover rates are known to be functions of membrane hydration and gas pressures.1,2 Accordingly, a 3(4-1) fractional factorial experimental design was executed to probe the role of membrane thickness as well as the other factors known to affect gas crossover. The fractional factorial design allows all main effects to be determined and further allows estimation of two factor interactions, if present. References T. Sakai, H. Tanenaka, E, Torikai, “Gas Diffusion in Dried and Hydrated Nations” J. Electrochem. Soc., 1986, 133, 88-92 R. Jiang, T. Fuller, S. Brawn, C. Gittleman, “Perfluorocyclobutane and poly(vinylidene fluoride) blend membranes for fuel cells” Electrochimica, Acta, 2013, 110, 306-315

Aim: We assessed growth in a paediatric inflammatory bowel disease (PIBD) cohort. Methods: Paediatric inflammatory bowel disease patients were eligible if they were diagnosed at Southampton Children's Hospital from 2011 to 2018. Weight and height standard deviation scores (SDS) were retrieved. Mean SDS values, SDS change and anti-TNF status were analysed at diagnosis and during follow-up. Results: Four hundred and ninety patients were included, 313 with Crohn's disease (CD). CD patients presented with mean height SDS −0.13, −0.1 at 1-year, −0.11 at 2-years and −0.03 at 5 years, reflecting preserved linear growth. There was no significant height-SDS change from diagnosis to 5-year follow-up, +0.12, 95%-CI: 0.48 to −0.24. Mean weight-SDS at diagnosis was −0.39, driven by CD patients (−0.65). Mean weight-SDS approached 0 after 1 year and remained at the 50th centile throughout follow-up. Growth in ulcerative colitis was maintained. In multivariable regression males had worse height growth from diagnosis to transition (P =.036). Anti-TNF treatment (P =.013) and surgical resection (P =.005) were also associated with poorer linear growth. Patients treated with anti-TNF therapy had lower height-SDS compared to those never treated with anti-TNF at 1 year (−0.2 vs −0.01, P =.22), 2-years (−0.27 vs −0.01, P =.07) and 5 years (−0.21 vs 0.25, P =.051). Conclusion: Height was generally maintained in Crohn's disease, and impaired linear growth was rare in this cohort.

Rezum is a new minimally invasive treatment for benign prostate enlargement using thermal transurethral water vapour therapy. We review the evidence with advantages and disadvantages of this technique. There are five studies reported including a randomised control trial looking at the outcomes of Rezum. The outcomes show an IPSS reduction by 45–60%, QoL improvement with a score reduction of 37–59%, the Qmax improvement by 44–72% and the PVR reduction by 20–38%. Convective water vapour therapy using the Rezum system has been shown to have successful outcomes in the treatment of LUTS resulting from BPH. The reported complications are infrequent and often minor, and it seems to be relatively cost-effective.

Background Training of emergency procedures is challenging and application is not routine in all health care settings. The debate over simulation as an alternative to live tissue training continues with legislation before Congress to banish live tissue training in the Department of Defense. Little evidence exists to objectify best practice. We sought to evaluate live tissue and simulation-based training practices in 12 life-saving emergency procedures. Methods In the study, 742 subjects were randomized to live tissue or simulation-training. Assessments of self-efficacy, cognitive knowledge, and psychomotor performance were completed pre- and post-training. Affective response to training was assessed through electrodermal activity. Subject matter experts gap analysis of live tissue versus simulation completed the data set. Results Subjects demonstrated pre- to post-training gains in self-efficacy, cognitive knowledge, psychomotor performance, and affective response regardless of training modality (P Conclusion Although simulation has made significant gains, no single modality can be identified definitively as superior. Wholesale abandonment of live tissue training is not warranted. We maintain that combined live tissue and simulation-based training add value and should be continued. Congressional mandates may accelerate simulation development and improve performance.

Introduction: Long-term, sustained, remission is the ultimate goal of contemporary inflammatory bowel disease (IBD) therapy. Avoiding complications, surgery and malignancy, alongside minimizing the side effects of medications are vital. However, the reality of treatment involves patients losing response to therapy, or developing complications requiring cessation of medication. The reasons underlying this are numerous and include medication and host-related influences. Underpinning the response to medication, long-term outcomes and loss of response are individual etiological factors including the molecular cause of disease and individual pharmacogenomic influences.Areas covered: In this review, we discuss the long-term outcome of IBD, with a focus on pediatric-onset illness and discuss the factors leading to loss of treatment response whilst briefly considering the future of personalized therapy as a strategy to improve long-term outcomes.Expert opinion: Research findings are now moving toward clinical translation, including application of novel medications targeting new pathways. The integration of biological and multiomic data to predict disease outcome will provide personalized therapeutic management.

War reminds us of our disconnection from one another. If we begin with acknowledging our common humanity, war comes when those small differences between us become amplified. We fail to see in the e...

What happens to a dream deferred? Does it dry up Like a raisin in the sun? Or fester like a sore— And then run? Does it stink like rotten meat? Or crust and sugar over— like a syrupy sweet? Maybe i...

Multiculturalism encourages the inclusion of the broad range of cultural differences that exist in society into our therapeutic dialogues. This paper examines multicultural group therapy through the perspective of social constructionism. Emphasis is given to the unacknowledged and unspoken imbalance of power that exists in psychotherapeutic contexts. The concepts of multiple individual identity and cultural representation are discussed and illustrated with case examples. Clinical considerations for the multicultural group therapist are provided.