We examined the potential of conversational agents (CAs) to support older adults’ self-care related to chronic illness in light of lessons learned from decades of pedagogical agent research, which investigates the impact and efficacy of CAs for a wide range of learners.

The role of CAs in education (i.e., pedagogical agents) has been long studied, but their potential for supporting self-care has received less attention, especially for older adults.

We reviewed work on pedagogical agents and considered how it informs the design of CAs for older adults. We propose a framework for designing CAs to support older adult self-care, which organizes a review of work in this area and integration with the pedagogical agent literature.

Our review of the pedagogical agent literature revealed an evolution from teaching machines to interactive, social systems that influence student motivational as well as learning outcomes. To integrate this review with work on CAs and self-care, we developed a framework that specifies how self-care goals evolve with stages of an illness, communication goals that support self-care at each stage, patient needs, and requirements for CAs to support these needs. The review identified an agenda for future research on CA functions and features that help older adults accept need for self-care, establish self-care, and sustain self-care over time.

Integrating insights from the pedagogical agent literature with research on developing CAs for self-care defines an agenda for developing and evaluating CAs to help older adults manage illness.

Integrating insights from the pedagogical agent literature with research on developing CAs for self-care defines an agenda for developing and evaluating CAs to help older adults manage illness.The concept of „double jeopardy”-being both older and Black-describes how racism and ageism together shape higher risks for coronavirus exposure, COVID-19 disease, and poor health outcomes for older Black adults. Black people and older adults are the two groups most affected by COVID-19 morbidity and mortality. Double jeopardy, as a race- and age-informed analysis, demonstrates how Black race and older age are associated with practices and policies that shape key life circumstances (e.g., racial residential segregation, family and household composition) and resources in ways that embody elevated risk for COVID-19. The concept of double jeopardy underscores long-standing race- and age-based inequities and social vulnerabilities that produce devastating COVID-19 related deaths and injuries for older Black adults. Developing policies and actions that address race- and age-based inequities and social vulnerabilities can lower risks and enhance protective factors to ensure the health of older Black Americans during the COVID-19 pandemic.

COVID-19 is a worldwide pandemic that is mild in most patients but can result in a pneumonia like illness with progression to acute respiratory distress syndrome and death. Predicting the disease severity at time of diagnosis can be helpful in prioritizing hospital admission and resources.

We prospectively recruited 1096 consecutive patients of whom 643 met the inclusion criterion with COVID-19 from Jaber Hospital, a COVID-19 facility in Kuwait, between 24 February and 20 April 2020. The primary endpoint of interest was disease severity defined algorithmically. Predefined risk variables were collected at the time of PCR based diagnosis of the infection. Prognostic model development used 5-fold cross-validated regularized logit regression. The model was externally validated against data from Wuhan, China.

There were 643 patients with clinical course data of whom 94 developed severe COVID-19. In the final model, age, CRP, procalcitonin, lymphocyte percentage, monocyte percentages and serum albumin were independent predictors of a more severe illness course. The final prognostic model demonstrated good discrimination, and both discrimination and calibration were confirmed with an external dataset.

We developed and validated a simple score calculated at time of diagnosis that can predict patients with severe COVID-19 disease reliably and that has been validated externally. The KPI score calculator is now available online at covidkscore.com.

We developed and validated a simple score calculated at time of diagnosis that can predict patients with severe COVID-19 disease reliably and that has been validated externally. The KPI score calculator is now available online at covidkscore.com.A 76-year-old Caucasian male with a history of rheumatoid arthritis, Raynaud’s phenomenon, pulmonary embolism on warfarin, and a previous amputation of his left partial ring and fifth finger presented with acute onset of rash in bilateral lower extremities. He was recently started on trimethoprim-sulfamethoxazole due to concern for cellulitis. Differential diagnosis for acute-onset rash with the patient’s history presented as a challenge to the internist, as the differential is broad. Our case goes through the differential diagnosis to contrast the different presentations of rash in a patient with vasculitis. Ultimately skin biopsy in conjunction with a past positive cryoglobulinemic level helped confirm the diagnosis of cutaneous vasculitis, following which he was started on appropriate treatment and recovered.3D tooth models were virtually restored flowable composite resin + bulk-fill composite (A), glass ionomer cement + bulk-fill composite (B) or adhesive + bulk-fill composite (C). Polymerization shrinkage and masticatory loads were simulated. All models exhibited the highest stress concentration at the enamel-restoration interfaces. A and C showed similar pattern with lower magnitude in A in comparison to C. B showed lower stress in dentine and C the highest cusps displacement. The use of glass ionomer cement or flowable composite resin in combination with a bulk-fill composite improved the biomechanical behavior of deep class II MO cavities.Pu, Xiaoyan, Xue Lin, Xianglan Duan, Junjie Wang, Jun Shang, Haixia Yun, and Zhi Chen. Oxidative and endoplasmic reticulum stress responses to chronic high-altitude exposure during the development of high-altitude pulmonary hypertension. High Alt Med Biol. 21378-387, 2020. Objectives To investigate the effect of endoplasmic reticulum (ER) stress during the development of high-altitude pulmonary hypertension (HAPH) after chronic high-altitude exposure, as well as the association between oxidative stress and ER stress. Methods Forty male Sprague-Dawley rats were placed in a low-pressure chamber with a simulated altitude of 4,200 m for 0-28 days. Rats were chosen at random on days 0, 7, 14, and 28 of chronic high-altitude exposure and were examined for pulmonary arterial pressure, oxidative stress, apoptosis, and ER stress. Results Chronic high-altitude exposure caused a continuous deterioration of pulmonary hypertension, which was accompanied by obvious apoptosis of alveolar epithelial cells and remodeling of pulmonary vessels. From day 7 of high-altitude exposure, although the activities of glutathione peroxidase and superoxide dismutase were gradually decreased, the generation of both malondialdehyde and reactive oxygen species was increased in a time-dependent manner. The protein expression of ER stress-related GRP78, PERK, IRE1α, ATF6, ATF4, CHOP, and caspase-12 in lung tissue was significantly upregulated from day 14 of high-altitude exposure. Further, the expression of caspase-12 in alveolar epithelial cells and vascular smooth muscle cells was also increased from day 14 of high-altitude exposure. Conclusions Early high-altitude exposure first activates oxidative stress; then, it gradually activates ER stress. The activation of ER stress might promote the apoptosis of alveolar epithelial cells and the remodeling of pulmonary vessels by exacerbating the oxidative stress response during the development of HAPH after chronic high-altitude exposure.Green criminology allows for the study of environmental and criminal laws, environmental criminality which includes widespread environmental harm, and the abuse and exploitation of nonhuman animals. Yet many environmental crimes are not the core focus of criminal justice systems or public concern about crime and safety despite having the potential to cause far wider social harm and a large number of deaths. Instead much environmental enforcement is regulatory or administrative in nature, particularly in respect of corporate environmental wrongdoing, which is often categorized as accidental wrongdoing, largely considered to be the fault of „rogue” employees or the unintended consequences of governance failures. Unlike traditional street and property crimes, environmental crimes (and environmental harms) frequently have long-lasting and irreversible effects. This raises questions about the effectiveness of justice systems in dealing with environmental offenders and the damage they cause. This paper explores the effectiveness of contemporary environmental enforcement mechanisms. In particular, the paper explores the extent to which they such mechanism are equipped to deal with corporate environmental offending which in many cases is a consequence of the operation of neoliberal markets. This paper examines whether the drive for profits and anthropocentric attitudes toward the environment and exploitation of natural resources create a situation where corporate environmental crime is a foreseeable and even natural/inevitable consequence. Where that is the case and where corporations have the resources to continue paying fines and the expertise to navigate regulatory justice systems, an alternative to the law enforcement „detection apprehension and punishment” approach might be required.A robust stream of research has shown the detrimental influence of slurs and derogatory epithets on attitudes toward minority groups. Extending prior work, we explored the influence of positive labels ascribed to the majority group on the evaluation of the minority group. Specifically, three studies tested the possibility that the label „straight,” generally linked with the concept of morality, would promote a negative evaluation of gay men. Study 1 exposed English speakers to an individual person described as straight (vs. heterosexual) while Study 2 exposed English speakers to a target person described as straight (vs. heterosexual vs. no label). Study 3 considered a non-English sample (i.e., Italian adults) and experimentally induced the association between the straight label and the concept of heterosexuality. In each study, participants were asked to express their attitudes toward a gay target after the manipulation. Results showed that heterosexual participants exposed to the label „straight” reported more negative attitudes toward gay men than heterosexual participants exposed to the label „heterosexual” (or when they were not exposed to any label). Critically, such an effect emerged only among highly religious participants. Implications for policies and prejudice reduction are discussed.Layer-specific experimental data for human aortic tissue suggest that, in aged arteries and arteries with non-atherosclerotic intimal thickening, the innermost layer of the aorta increases significantly its stiffness and thickness, becoming load-bearing. However, there are very few computational studies of abdominal aortic aneurysms (AAAs) that take into account the mechanical contribution of the three layers that comprise the aneurysmal tissue. In this paper, a three-layered finite element model is proposed from the simplest uniaxial stress state to geometrically parametrized models of AAAs with different asymmetry values. Comparisons are made between a three-layered artery wall and a mono-layered intact artery, which represents the complex behavior of the aggregate adventitia-media-intima in a single layer with averaged mechanical properties. Likewise, the response of our idealized geometries is compared with similar experimental and numerical models. Finally, the mechanical contributions of adventitia, media and intima are analyzed for the three-layered aneurysms through the evaluation of the mean stress absorption percentage. Results show the relevance and necessity of considering the inclusion of tunica intima in multi-layered models of AAAs for getting accurate results in terms of peak wall stresses and displacements.

Lung transplantation outcomes are influenced by the intraoperative mechanical cardiopulmonary support strategy used. This surgery was historically done either on cardiopulmonary bypass (CPB) or off pump. Recently, there has been increased interest in intraoperative support with veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO). However, there is a lack of consensus on the relative risks, benefits and indications for each intraoperative support strategy.

This review includes information from cohort studies, case-control studies, and case series that compare morbidity and/or mortality of two or more intraoperative cardiopulmonary support strategies during lung transplantation.

The optimal strategy for intraoperative cardiopulmonary support during lung transplantation remains an area of debate. Current data suggest that off pump is associated with better outcomes and could be considered whenever feasible. ECMO is generally associated with preferable outcomes to CPB, but the data supporting this association is not robust. Interestingly, whether CPB is unplanned or prolonged might influence outcomes more than the use of CPB itself. These observations can help guide surgical teams in their approach for intraoperative mechanical support strategy during lung transplantation and should serve as the basis for further investigations.

The optimal strategy for intraoperative cardiopulmonary support during lung transplantation remains an area of debate. Current data suggest that off pump is associated with better outcomes and could be considered whenever feasible. ECMO is generally associated with preferable outcomes to CPB, but the data supporting this association is not robust. Interestingly, whether CPB is unplanned or prolonged might influence outcomes more than the use of CPB itself. These observations can help guide surgical teams in their approach for intraoperative mechanical support strategy during lung transplantation and should serve as the basis for further investigations.

The primary aims of the study were to replicate the vigilance decrement in the tactile modality, examine whether a decrease in sensitivity is associated with the decrement, and determine whether tactile vigilance is stressful and demanding.

When people monitor occasional and unpredictable signals for sustained durations, they experience a decline in performance known as the vigilance decrement, which has important practical consequences. Prior studies of the vigilance decrement focused primarily on visual vigilance and, to a lesser degree, on auditory vigilance. There are relatively few studies of tactile vigilance.

Participants monitored vibrotactile stimuli that were created from a tactor, for 40 min.

Sensitivity declined, self-report ratings of distress increased, and ratings of task engagement decreased, during the vigil, and perceived workload was moderately high.

Monitoring tactile signals is demanding and stressful and results in a decrement in signal detection.

Monitoring tactile signals may result in a decrement in tasks requiring discrimination, such as monitoring lane position with the use of rumble strips; these require discrimination between current road vibration and increased vibration when the car drifts out of its lane and crosses over the strip.

Monitoring tactile signals may result in a decrement in tasks requiring discrimination, such as monitoring lane position with the use of rumble strips; these require discrimination between current road vibration and increased vibration when the car drifts out of its lane and crosses over the strip.

Prior studies have examined how individuals may undermine their partner’s efforts to maintain a healthy diet, but gay couples have not been represented in this work. Additionally, research has not accounted for mixed-weight status [lighter partner (LP) and heavier partner] nor investigated the mechanisms through which undermining is associated with dietary outcomes.

Utilising dyadic data from 224 gay married couples across the United States, we tested associations between perceptions of partner’s diet undermining strategies and diet quality with couple food disagreements and depressive symptoms as putative, serial mediators in an actor-partner interdependence mediation model.

Results revealed that more severe diet undermining was associated with both partners’ poorer diet quality, which was explained by more frequent couple food disagreements and higher depressive symptoms for both heavier and LPs.

These findings suggest that undermining strategies are detrimental to both partners’ relational health (increased conflict), emotional health (depressive symptoms) and physical health (diet)-regardless of weight status-and provide valuable targets for prevention and intervention. Our study underscores the interdependence of couple relations in lifestyle changes and specifically highlight the need for health professionals to discuss the partner’s indirect or unintended disruptions to the patient’s plan.

These findings suggest that undermining strategies are detrimental to both partners’ relational health (increased conflict), emotional health (depressive symptoms) and physical health (diet)-regardless of weight status-and provide valuable targets for prevention and intervention. Our study underscores the interdependence of couple relations in lifestyle changes and specifically highlight the need for health professionals to discuss the partner’s indirect or unintended disruptions to the patient’s plan.

To investigate the effectiveness and safety of office hysteroscopic metroplasty by diode laser for the treatment of septate uteri.

We performed a prospective cohort study including 41 nulliparous women diagnosed with septate uterus and a history of primary infertility or recurrent miscarriage. All patients underwent hysteroscopic metroplasty for the treatment of the uterine septum, which was performed in-office setting using a 4.3 mm continuous-flow hysteroscope and a 15-watt diode laser at 1470 nm. Surgical and reproductive outcomes after 2 years of follow-up are reported.

The procedure was well tolerated by 93% of patients. No surgical complications were reported. Thirty women out of 38 (78.9%) became pregnant 17 (56.7%) pregnancies were spontaneously conceived, and 13 (43.3%) were obtained with assisted reproductive techniques. Twenty-four (80%) of the 30 pregnant women had a live birth, with a cumulative live birth of 63.2% among the 38 women (95% CI 45.9-78.2%). There were no cases of post-partum hemorrhage or uterine rupture among 14 (58.3%) women who had vaginal deliveries.

Office hysteroscopic metroplasty for septate uterus using diode laser appears to be a feasible and safe alternative to other available techniques and has sufficient efficacy in terms of reproductive outcomes to be considered for further investigations.

Office hysteroscopic metroplasty for septate uterus using diode laser appears to be a feasible and safe alternative to other available techniques and has sufficient efficacy in terms of reproductive outcomes to be considered for further investigations.

Calcaneal osteotomy are used to treat various pathologies in the correction of hindfoot deformities. But lateral plantar artery (LPA) pseudoaneurysms have been reported following calcaneal osteotomy, and LPA pseudoaneurysms may be at risk for rupture. Although the vascular structures in close proximity to calcaneal osteotomies have variable courses and branching patterns, there is little information on safe zone for LPA during calcaneal osteotomy. The aims of this study were to identify the safety zone to avoid the LPA injury during calcaneal osteotomy.

Enhanced computed tomography scans of 25 fresh cadaveric feet (male, n = 13; female, n = 12; mean age 79.0 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery. Line A is the landmark line and extends from the posterosuperior aspect of the calcaneal tuberosity to the plantar fascia origin, and the perpendicular distance between the LPA and line A at its closest point was measured on sagittal images.

The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 cases (8.0 %), the perpendicular distance between the LPA and line A at its closest point was very close, approximately 9 mm. In 18 of 25 feet (72.0%), the point where perpendicular distance from the line A to LPA is the closest was the bifurcation of one of the medial calcaneal branches from LPA, and in 7 feet in 25 feet (28.0%) feet the point where perpendicular distance from the line A to LPA is the closest was the trifurcation of LPA, medial plantar artery, and one of the medial calcaneal branches.

Calcaneal osteotomy approximately more than 9 mm from the line A could injure the LPA in overpenetration into the medial aspect of tcalcaneal osteotomy. Completion of the osteotomy on the medial side should be performed with caution to avoid iatrogenic injury of the LPA.

Level IV, Cadaveric study.

Level IV, Cadaveric study.Introduction Nosocomial pneumonias are the second most common healthcare-associated infections (HCAIs), often associated with the presence of Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Acinetobacter species, and Enterobacter species. Increasing use of carbapenems has led to an increase in the prevalence of carbapenem-resistant gram-negative organisms, such as carbapenem-resistant Enterobacterales (CRE), P. aeruginosa (CRPA), and Acinetobacter baumannii (CRAB), limiting treatment options for patients at high-risk of multi-drug resistant (MDR) gram-negative pathogens. Areas covered The purpose of this review is to discuss the role of meropenem/vaborbactam, a beta-lactam combined with a novel non-beta-lactam cyclic boronic acid beta-lactamase inhibitor (BLI), for the treatment of nosocomial pneumonia based on its chemistry, pharmacokinetics/dynamics, microbiological spectrum of activity, mechanisms of resistance, safety, and clinical efficacy. Expert opinion Currently, any utilization of meropenem/vaborbactam beyond its FDA-approved indication for complicated urinary tract infections is considered off-label use; however, based on the pulmonary penetration of meropenem/vaborbactam, it is highly likely to be a safe and effective alternative to more toxic agents, like aminoglycosides and polymixins, for targeted therapy in pulmonary infections due to CRE. Unfortunately, the multifactorial resistance pattern of CRPA and other non-lactose-fermenting gram-negative bacteria restricts activity against these organisms which are common pathogens implicated in nosocomial pneumonia.Wang, Juan, Jiahui Wang, Xin Li, Wanju Hou, Jie Cao, and Jing Feng. Endothelial dysfunction in a cell culture model exposed to various intermittent hypoxia modes. High Alt Med Biol. 21388-395, 2020. Objective To construct an in vitro model of endothelial cells exposed to various intermittent hypoxia (IH) modes, and determine whether different frequencies and degrees can cause different effects on endothelial cells. Methods EA.hy926 cells were used to set up the cell model. A program-controlled gas delivery system was designed to regulate the flow of premixed air into the cell culture chamber. The cells were divided into eight groups exposed to various IH modes standard cell culture group, intermittent normoxia (IN) group (21% O2 15 seconds/21% O2 3 minutes 45 seconds for 12 cycles/h), IH1 group (1.5% O2 15 seconds/21% O2 8 minutes 15 seconds for 6.32 cycles/h), IH2 group (1.5% O2 15 seconds/21% O2 5 minutes 15 seconds for 9.23 cycles/h), IH3 group (1.5% O2 15 seconds/21% O2 3 minutes 45 seconds for 12 cycles/n.

The purpose of this study was to gain a better understanding of

behaviors within interactive exercise groups.

Qualitative study.

Using semi-structured interviews, 16 individuals who exercise in small groups (e.g., workout partners, participants of interactive fitness classes) were recruited to (a) reflect on their experiences of collaboration within this context, and (b) identify behaviors that members demonstrate that help each other perform exercise tasks and achieve their exercise-related goals. Data were analyzed using thematic analysis.

We identified three overarching themes (and 14 subthemes) reflecting participants’ perceptions and experiences of collaboration in exercise groups including 'motivation building’, 'intragroup coaching’, and 'personal support’. These collaboration behaviors were noted by participants as important in shaping their continued exercise adherence, enjoyment, and relatedness.

This study advances knowledge of the specific ways in which individuals can work together effectively within interactive exercise groups and provides a novel means of understanding how the group environment might best be leveraged to support exercise behavior.

This study advances knowledge of the specific ways in which individuals can work together effectively within interactive exercise groups and provides a novel means of understanding how the group environment might best be leveraged to support exercise behavior.

We aimed to elucidate the correlation between expression patterns of aortic tissue microRNAs and the aortopathy formation in bicuspid aortic valve (BAV) disease.

All 65 patients who underwent elective aortic valve repair/replacement +/- proximal aortic replacement due to BAV disease with or without concomitant aortic aneurysm were identified from our BAV registry. Aortic tissue was collected intraoperatively from the ascending aorta at the greater and lesser curvature. Aortic tissue microRNAs analysis included 11 microRNAs (

). Furthermore, analysis of MMP2, TIMP1/2 mRNA and the protein expression was subsequently performed. The primary study endpoint was the correlation between microRNAs and MMP2, TIMP1/2 mRNA/protein expression.

We found a significant association between miR-133a and TIMP1 mRNA (

 = 0.870,

 < 0.001), an inverse correlation between miR-143a and MMP2 protein expression (

= -0.614,

 = 0.044) and a positive correlation between miR-133a and TIMP-2 protein expression (

 = 0.583,

 = 0.036) at the greater curvature.

Our findings indicate that aortic tissue microRNAs may reflect remodelling processes of the proximal aorta in BAV aortopathy. Specific aortic tissue microRNAs may exert their regulatory effects on the aortopathy through their impact on MMPs/TIMPs homeostasis at the level of the greater curvature.

Our findings indicate that aortic tissue microRNAs may reflect remodelling processes of the proximal aorta in BAV aortopathy. Specific aortic tissue microRNAs may exert their regulatory effects on the aortopathy through their impact on MMPs/TIMPs homeostasis at the level of the greater curvature.

To examine the expression and value of the smoothelin marker in control cases, to standardize the working method, and to analyze its application in pathologic staging process of problematic transurethral resection of bladder tumor (TURBT) cases.

Immunohistochemical (IHC) staining was performed on tumor-free bladder wall sections, tumor-free large bowel sections, TURBTs with unequivocal tumor stage, and TURBTs with equivocal stage. The IHC staining of muscularis mucosa (MM), muscularis propria (MP), and blood vessels was evaluated semiquantitatively.

Smoothelin IHC staining pattern ranged from negative (30% to 67% cases) to 2+ (0% to 15% cases) in MM and from 1+ (10% to 50% cases) to 3+ (9% to 48% cases) in MP. When compared on the same slide, the smoothelin expression of MP showed a stronger staining intensity than the one of the MM in all the analyzed cases. Blood vessel muscle cells stained in a constant intensity as the MM (

= 0.9808;

= 0.9604). Smoothelin determined restaging of 33% of the problematic TURBT cases.

Smoothelin is an IHC marker that shows differential staining between coexistent MM and MP; however, variations in staining intensity and pattern may occur, aspects that can be influenced by different technique variables. We recommend using this marker as a diagnostic tool in problematic TURBT cases only when there is sufficient experience in control cases with this antibody.

Smoothelin is an IHC marker that shows differential staining between coexistent MM and MP; however, variations in staining intensity and pattern may occur, aspects that can be influenced by different technique variables. We recommend using this marker as a diagnostic tool in problematic TURBT cases only when there is sufficient experience in control cases with this antibody.While biological warfare has classically been considered a threat requiring the presence of a distinct biological agent, we argue that in light of the rise of state-sponsored online disinformation campaigns we are approaching a fifth phase of biowarfare with a „cyber-bio” framing. By examining the rise of measles cases following disinformation campaigns connected to the US 2016 presidential elections, the rise of disinformation in the current novel coronavirus disease 2019 pandemic, and the impact of misinformation on public health interventions during the 2014-2016 West Africa and 2019-2020 Democratic Republic of the Congo Ebola outbreaks, we ask whether the potential impact of these campaigns-which includes the undermining of sociopolitical systems, the delegitimization of public health and scientific bodies, and the diversion of the public health response-can be characterized as analogous to the impacts of more traditional conceptions of biowarfare. In this paper, we look at these different impacts and the norms related to the use of biological weapons and cyber campaigns. By doing so, we anticipate the advent of a combined cyber and biological warfare. The latter is not dependent on the existence of a manufactured biological weapon; it manages to undermine sociopolitical systems and public health through the weaponization of naturally occurring outbreaks.

Little is known about the psychological experiences of individuals being investigated for cardiac inherited diseases (CID). This study aimed to assess the prevalence, trajectory and associated variables of anxiety and depression in this population.

This was a longitudinal study with 116 individuals being investigated for a CID; 85 (73%) completed follow-up.

Questionnaires were administered at the first appointment, post-disclosure of genetic results, and six-months later. Questionnaires measured demographic and psychological variables. The NZCID Registry provided clinical and genetic information.

Thirty-seven (43%) individuals reported clinical and subclinical levels of anxiety and/or depression at least once. Anxiety and depression at follow up were associated with anxiety (p < .001) and depression (

< .001) at baseline. Elevated anxiety and depression scores at any point were also associated with more reporting of somatic symptoms (

< .001), poorer social support (

< .01) and greater intolerance for uncertainty (

< .001). There were five different trajectories of anxiety and depression stable-low, stable-high, increasing, decreasing and fluctuating.

A significant minority of individuals being investigated for a CID experience anxiety and depression. Ongoing screening for anxiety, depression, social support and somatic symptoms could help identify those individuals.

A significant minority of individuals being investigated for a CID experience anxiety and depression. Ongoing screening for anxiety, depression, social support and somatic symptoms could help identify those individuals.

Positive fluid balance is common among critically ill patients and leads to worse outcomes, particularly in sepsis, acute respiratory distress syndrome, and acute kidney injury. Restrictive fluid infusion and active removal of accumulated fluid are being studied as approaches to prevent and treat fluid overload. Use of human albumin solutions has been investigated in different phases of restrictive fluid resuscitation, and this narrative literature review was undertaken to evaluate hypoalbuminemia and the roles of human serum albumin with respect to hypovolemia and its management.

PubMed/EMBASE search terms were „resuscitation,” „fluids,” „fluid therapy,” „fluid balance,” „plasma volume,” „colloids,” „crystalloids,” „albumin,” „hypoalbuminemia,” „starch,” „saline,” „balanced salt solution,” „gelatin,” „goal-directed therapy” (English-language, pre-January 2020). Additional papers were identified by manual searching of reference lists.

Restrictive fluid administration, plus early vasopressor use, may redcitative measures. Current evidence is mostly from observational studies, and more randomized trials are needed to better establish a personalized approach to fluid management.Many real-world graphs are temporal, for example, in a social network, persons only interact at specific points in time. This temporal information directs dissemination processes on the graph, such as the spread of rumors, fake news, or diseases. However, the current state-of-the-art methods for supervised graph classification are mainly designed for static graphs and may not capture temporal information. Hence, they are not powerful enough to distinguish between graphs modeling different dissemination processes. We introduce a framework to lift standard graph kernels and graph-based neural networks to the temporal domain to address this. We explore three different approaches and investigate the trade-offs between loss of temporal information and efficiency. Moreover, to handle large-scale graphs, we propose stochastic variants of our kernels with provable approximation guarantees. We evaluate our methods, both kernel and neural architectures, on various real-world social networks to validate our theoretical findings. Our methods beat static approaches by a large margin in terms of accuracy while still being scalable to large graphs and data sets. Moreover, we show that our framework reaches high classification accuracy in scenarios where most of the dissemination process information is incomplete.Shapelets are discriminative segments used to classify time-series instances. Shapelet methods that jointly learn both classifiers and shapelets have been studied in recent years because such methods provide both interpretable results and superior accuracy. The partial area under the receiver operating characteristic curve (pAUC) for a low range of false-positive rates (FPR) is an important performance measure for practical cases in industries such as medicine, manufacturing, and maintenance. In this article, we propose a method that jointly learns both shapelets and a classifier for pAUC optimization in any FPR range, including the full AUC. In addition, we propose the following two extensions for shapelet methods (1) reducing algorithmic complexity in time-series length to linear time and (2) explicitly determining the classes that shapelets tend to match. Comparing with state-of-the-art learning-based shapelet methods, we demonstrated the superiority of pAUC on UCR time-series data sets and its effectiveness in industrial case studies from medicine, manufacturing, and maintenance.Physics-based simulations are often used to model and understand complex physical systems in domains such as fluid dynamics. Such simulations, although used frequently, often suffer from inaccurate or incomplete representations either due to their high computational costs or due to lack of complete physical knowledge of the system. In such situations, it is useful to employ machine learning (ML) to fill the gap by learning a model of the complex physical process directly from simulation data. However, as data generation through simulations is costly, we need to develop models being cognizant of data paucity issues. In such scenarios, it is helpful if the rich physical knowledge of the application domain is incorporated in the architectural design of ML models. We can also use information from physics-based simulations to guide the learning process using aggregate supervision to favorably constrain the learning process. In this article, we propose PhyNet, a deep learning model using physics-guided structural priors and physics-guided aggregate supervision for modeling the drag forces acting on each particle in a computational fluid dynamics-discrete element method. We conduct extensive experiments in the context of drag force prediction and showcase the usefulness of including physics knowledge in our deep learning formulation. PhyNet has been compared with several state-of-the-art models and achieves a significant performance improvement of 7.09% on average. The source code has been made available*.Early diagnosis of autism spectrum disorder (ASD) is of paramount importance as it opens the road to early intervention, which is associated with better prognosis. However, early diagnosis is often delayed until preschool or school age. The purpose of the current retrospective study was to explore the age of recognition of first alarming symptoms in boys and girls as well as the age at diagnosis of different subtypes of ASD in a small sample. A total of 128 parents’ of children with ASDs were participated in the survey by completing a self-report questionnaire about early signs and symptoms that raised their concern. Parents of children with autism voiced concerns earlier and obtained diagnosis significantly earlier compared to parents of children with Asperger syndrome (p value less then 0.000). No significant difference (p value less then 0.05) has been detected between males and females in early manifestation of first signs and symptoms of ASD. The mean age at diagnosis was 3.8 years for autistic disorder, 6.2 years for children with Asperger syndrome and 6.4 years for other, e.g., PDD-NOS. The most commonly reported symptoms were speech and language problems (p value = 0.001) for children who were later diagnosed with autism, while behavior problems (p value = 0.046) as well as difficulties in education at school (p value = 0.013) for children with Asperger syndrome. The gap between early identification and diagnosis pinpoints the urgent need for national systematic early screening, the development of reliable and sensitive diagnostic instruments for infants and toddlers and heightened awareness of early signs of ASD among parents, teachers, and healthcare professionals and providers as well.Aim To explore the circular RNA (circRNA) profile in cumulus cells from endometriosis-associated infertility patients. Methods The expression of circRNAs was profiled by high-throughput sequencing. Sanger sequencing was performed to identify the backsplicing site. Six candidate circRNAs and their parental genes were measured in 30 samples by quantitative reverse transcription-polymerase chainreaction (qRT-PCR). Bioinformatics analysis was performed to predict the functions. Results A total of 55 upregulated and 41 downregulated differentially expressed circRNAs were detected. Kyoto Encyclopedia of Genes and Genomes data indicated that these target genes were mainly involved in cumulus cell growth- and differentiation-related pathways. Hsa_circ_0072391, hsa_circ_0007299 and hsa_circ_0057799 were significantly increased, and hsa_circ_001533 was significantly decreased in endometriosis-associated infertility patients. Conclusion The differentially expressed circRNAs might be potentially involved in pathophysiology of endometriosis-associated infertility.

Traditional Kirschner wire (K-wire) stabilization of first metatarsal distal chevron osteotomy involves 1 cortex of fixation; however, unicortical fixation is associated with a high complication rate, including pin migration. A method of K-wire fixation utilizing 3 cortices may be biomechanically superior and potentially equivalent to single-screw fixation.

Cadaveric specimens fixed with tricortical K-wires were tested in both the physiologic and cantilever conditions against specimens fixed with unicortical K-wires (N = 8) and single screws (N = 9) utilizing matched-pair comparison groups. Differences in physiologic and cantilever fixed/intact stiffness ratio and cantilever failure load were determined.

The tricortical fixation specimens had a significantly higher stiffness ratio in cantilever loading than the unicortical fixation specimens (60.50% tricortical, 34.17% unicortical,

= .02) but not in physiologic load (15.34% tricortical, 25.75% unicortical,

= .23). In cantilever failure loading, the tricortical fixation specimens had a significantly higher load to failure than the unicortical fixation specimens (132.81 N tricortical, 58.58 N unicortical,

< .01). Stiffness ratio under physiologic load, cantilever load, and ultimate load to failure were not significantly different between tricortical K-wire and screw-fixation groups.

Tricortical K-wire fixation for distal chevron osteotomies is biomechanically superior to traditional unicortical K-wire fixation, and equivalent to single-screw fixation.

Level V Cadaver study.

Level V Cadaver study.Aim An advanced proteomics platform for protein biomarker discovery in diabetic chronic kidney disease (DKD) was developed, validated and implemented. Materials & methods Three Type 2 diabetes mellitus patients and three control subjects were enrolled. Urinary peptides were extracted, samples were analyzed on a hybrid LTQ-Orbitrap Velos Pro instrument. Raw data were searched using the SEQUEST algorithm and integrated into Proteome Discoverer platform. Results & discussion Unique peptide sequences, resulted sequence coverage, scoring of peptide spectrum matches were reported to albuminuria and databases. Five proteins that can be associated with early DKD were found apolipoprotein AI, neutrophil gelatinase-associated lipocalin, cytidine deaminase, S100-A8 and hemoglobin subunit delta. Conclusion Urinary proteome analysis could be used to evaluate mechanisms of pathogenesis of DKD.This is a single-center randomized open label active-controlled crossover trial comparing efficacy and safety of fast acting insulin aspart (FA) (FIASP®) versus insulin aspart (IAsp) (NovoLog®) when used in the Medtronic 670G system in auto mode in patients with type 1 diabetes. Forty patients were randomized to either IAsp or FA. Each treatment period was 7 weeks and a standardized meal test was administered 6 weeks after the start of each treatment period. The primary endpoint was postprandial glucose (PPG) increment after the meal test at 1 h. Treatment with FA using the MiniMed 670G hybrid closed loop (HCL) led to a greater reduction in 1-h postprandial glucose increase compared with treatment with IAsp during the standardized mixed meal test. Change in glucose [estimated treatment difference (ETD ± standard deviation [SD]); 95% confidence interval] 70.27 (±17.36) mg/dL (3.9 ± 1.0 mmol/L) with FA versus 98.42 (±17.36) mg/dL (5.5 ± 1.0 mmol/L) with IAsp (P = 0.008). Patients spent 1.81% (P = 0.016) more time (equivalent to 26 min per day) in the 70-180 mg/dL (3.89-9.99 mmol/L) range with FA than with IAsp. The entire sample spent only 0.5% of time less then 54 mg/dL ( less then 3.0 mmol/L) range. The increment in the 1 h postmeal test glucose was significantly lower with FA versus IAsp. FA in a HCL setting is safe and effective with patients spending more time in the 70-180 mg/dL (3.89-9.99 mmol/L) target range than with IAsp. Trial registration Clinicaltrials.gov identifier NCT03977727.

To determine the impact coronavirus disease of 2019 (COVID-19) will have on the 2020-2021 otolaryngology (OTO-HNS) resident application cycle.

A cross-sectional survey targeting OTO-HNS program directors (PD) was created and disseminated via email to PDs on May 28th 2020. Descriptive analyses of the 19-question survey was performed, and free text responses for certain suitable questions were thematically categorized into groups determined to be relevant during analysis.

Twenty-nine of 123 solicited PDs (23.6%) completed the survey. Nineteen (65.5%) respondents indicated they would not host away rotations (AR) in 2020, and 9 (31.0%) reported that they would consider away rotators without home programs. Regarding the historical importance of AR, 21 (72.4%) PDs stated they were either „extremely” or „very” important in evaluating candidates. Sixteen (55.2%) PDs stated that virtual interviews would impact their ability to properly gauge candidates and 12 (41.4%) were unsure. Eight PDs (27.6%) stated their e is expected to change.Interleukin-22 (IL-22), secreted by tumor infiltrated lymphocytes, is identified as a tumor-promoting factor in certain cancers, which was secreted by tumor infiltrated lymphocytes. However, the role of IL-22 in breast cancer remains conflicting. In this study, we assessed the expression of IL-22, IL-22 receptor 1 (IL-22R1), CD4, CD8, FOXP3, and CD68 in breast cancer by immunohistochemistry. IL-22 expression was exhibited in 105 (69.1%) cases in tumor cells (tIL-22), whereas only 24 (15.8%) samples displayed IL-22 expression in stromal cells. Multivariate analysis showed that tIL-22 expression was a poor prognostic factor for overall survival (OS) (p = 0.04). Meanwhile, IL-22R1 was predominantly presented in tumor cells (84.9%), which was associated with tIL-22 expression. The CD68-positive tumor-associated macrophages (TAMs) displayed the highest infiltration rate (50.7%) compared with CD4-, CD8-, and FOXP3-positive cells. Kaplan-Meier analysis confirmed patients with high TAM infiltration displayed significantly worse relapse-free survival (RFS) compared with low TAMs group (p = 0.017). TAM infiltration was also positively associated with tIL-22 and IL-22R1 expression. Furthermore, tIL-22 expression together with high TAM infiltration displayed the worst prognosis outcomes both in OS (p = 0.039) and RFS (p = 0.008). Instead of lymphocytes, our data indicated that tumor cells express IL-22 in breast cancer that is associated with IL-22R1, high TAM infiltrating, and poor prognosis.

This retrospective cohort study uses endoscopic assessment of the pharyngeal phase of swallowing in infants with laryngomalacia, to ascertain the impact of infant positioning on airway compromise and fluid dynamics during breastfeeding. The study aims to identify whether modification of infant positioning at the breast may improve the possibility of safe, successful breastfeeding in infants with laryngomalacia and concurrent breastfeeding difficulty.

Twenty-three infants referred for noisy breathing and difficulty feeding were assessed with flexible endoscopic evaluation of swallowing (FEES) during breastfeeding. All had endoscopically confirmed laryngomalacia. During FEES, observations were made of clinical signs of airway compromise as well as endoscopically observable anatomical features and swallowing dynamics during breastfeeding, including tongue base position, view of laryngeal inlet and vocal folds, dynamic supraglottic soft tissue collapse, timing of milk flow into pyriform fossae/hypopharynx reltion of breastfeeding position to semi-prone may improve dynamic airway obstruction and reduce aspiration risk in infants with laryngomalacia.

This study has shown how alteration of breastfeeding position to semi-prone may improve dynamic airway obstruction and reduce aspiration risk in infants with laryngomalacia.Background Although postpartum sexual problems are common, the impact of the infant feeding method on sexual life is still unclear. The aim of this study was to investigate the effects of different infant feeding methods and other influencing factors on female sexual life 3 months postpartum. Materials and Methods Three hundred women from three obstetrical institutes were enrolled in this cross-sectional study. An online questionnaire was administered 3 months postpartum. Women were categorized into three groups exclusive breastfeeding (n = 180), mixed feeding (n = 75), and formula-feeding (n = 45) groups. The infant feeding method was assessed by self-constructed questions. Sexual dysfunctions were evaluated by the Hungarian version of the Female Sexual Function Index (FSFI). Results Of the women, 50.55% reported sexual dysfunction in the exclusive breastfeeding group, 42.66% in the mixed feeding group, and 31.11% in the formula-feeding group. Lack of sexual desire was the most prevalent dysfunction regardless of the infant feeding method. Significantly lower median scores were found in the exclusive breastfeeding group compared with the formula-feeding group for the total FSFI score (p = 0.002), arousal (p = 0.034), lubrication (p = 0.020), orgasm (p = 0.015), and pain (p = 0.021) subgroups. Breastfeeding (p = 0.032) and the quality of prepregnancy sexual life (p  less then  0.001) were significant factors, whereas prepregnancy dyspareunia, parity, age, income, and educational level did not predict women’s postpartum sexual function. Conclusions Our findings indicate that exclusive breastfeeding women have an increased likelihood of sexual problems 3 months postpartum. Extensive and professional counseling is needed for couples about postpartum sexuality and influencing factors such as breastfeeding to maintain sexual health and promote long-term breastfeeding.Chemokine-like factor (CKLF)-like MARVEL transmembrane domain containing protein 6 (CMTM6) is a ubiquitously expressed protein, which plays a critical role in the stability of programmed death-ligand 1. However, the expression of CMTM6 in a variety of cancer pathological tissues is not clear. Therefore, 109 patients who were diagnosed with nonsmall cell lung cancer (NSCLC) and underwent surgical resection were included in this retrospective study. The expression of CMTM6 in NSCLC patients’ tissue samples were measured by immunohistochemistry and the results showed that 60 cases (55.05%) had high CMTM6 expression. The chi-square test showed that the expression of CMTM6 in NSCLC was significantly related to smoking (p = 0.017) and differentiation (p = 0.029). The Kaplan-Meier survival analysis suggested that the high expression of CMTM6 was associated with better prognosis of NSCLC patients. The univariate analysis revealed that the prognosis of NSCLC patients was correlated with T stage (p = 0.042), lymph node metastasis (p = 0.007), metastasis (p = 0.009), pathological differentiation (p = 0.001), and CMTM6 expression level (p  less then  0.001). In addition, multivariate analysis indicated that CMTM6 was an independent prognostic factor for NSCLC patients (p = 0.002). CMTM6 expression may have the potential to be a biomarker assisting in disease monitoring and prognosis in NSCLC.