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This is the first case report in which patients with severe intestinal symptoms presented a marked SARS-CoV-2 positivity in the resected tissues, without any usual clinical manifestations of COVID-19. These results suggest that the patients might be infected with SARS-CoV-2 presenting acute abdominal distress but without respiratory or constitutional symptoms. This article is protected by copyright. All rights reserved.

Preventive nutritional management of frailty, a multidimensional intermediate status in the ageing process, may reduce the risk of adverse health-related outcomes. We investigated the ability of a measure combining physical frailty with nutritional imbalance, defined as nutritional frailty, to predict all-cause mortality over a period of up to 8 years.

We analysed data on 1,943 older adults from the population-based 'Salus in Apulia Study’. Physical frailty was operationalized using Cardiovascular Health Study criteria and cognitive frailty by combining physical frailty with cognitive impairment. A novel five-item construct was built to assess the extent of nutritional imbalance identified with a machine learning algorithm. Cox models and Kaplan-Meier survival probability analyses of physical frailty, nutritional imbalance (two or more of the following low body mass index, low skeletal muscle index, ≥2.3 g/day sodium intake, <3.35 g/day potassium intake and <9.9 g/day iron intake), cognitive frailtyealth trajectories in older adults.

The purpose was to evaluate an innovative Prospective Hiring Equation to determine registered nurse hiring needs.

The American Organization for Nursing Leadership identifies human resource management as a competency for nurse managers, yet calculations to determine when and how many registered nurses to hire are not readily available.

We implemented an educational intervention to teach nurse mangers the Prospective Hiring Equation. We evaluated the processes (adoption and confidence) and outcomes (vacancy rates) using a pre-evaluation/postevaluation design in a single cohort of nurse managers (n = 9). We used a statistical process control chart to depict mean differences in vacancy rate at baseline and 6-month postimplementation.

Participants (n = 9) were on average 43 years’ old, female, and had 2.94 (SD = 2.66) years’ of nurse manager experience. Following implementation of the intervention, the combined vacancy rates of the intensive care units improved by 11.8% (SD = 7), and use of agency nurses decreased by 42.5% (premedian = 7.2, interquartile ratio = 3.6, 10.8; postmedian = 1.8, interquartile ratio 0.9, 8.55).

The Prospective Hiring Equation may be a useful tool to improve nurse managers human resource management competencies.

The Prospective Hiring Equation may help nurse managers improve accuracy when evaluating hiring needs.

The Prospective Hiring Equation may help nurse managers improve accuracy when evaluating hiring needs.The prediction that telomere length (TL) shortens with increasing age is a major element in considering the role of telomeres as a key player in evolution. While telomere attrition is found in humans both in vitro and in vivo, the increasing number of studies reporting diverse age-specific patterns of TL challenges the hypothesis of a universal decline of TL with increasing age. Here, we performed a meta-analysis to estimate the relationship between TL and age across 175 estimates encompassing 98 species of vertebrates. We found that, on average, TL does decline with increasing age during adulthood. However, this decline was weak and variable across vertebrate classes, and we also found evidence for a publication bias that might weaken our current evidence of decreasing TL with increasing age. We found no evidence for a faster decline in TL with increasing age when considering the juvenile stage (from birth to age at first reproduction) compared to the adult stage. Heterogeneity in TL ageing rates was explained by the method used to measure telomeres detectable TL declines with increasing age were found only among studies using TRF with in-gel hybridisation and qFISH methods, but not in studies using qPCR and Southern blot-based TRF methods. While we confirmed that TL declines with increasing age in most adult vertebrates, our results identify an influence of telomere measurement methodology, which highlights the need to examine more thoroughly the effect of the method of measurement on TL estimates.Northern peatlands with large organic nitrogen (N) storage have the potential to be N2 O hotspots under climate warming, elevated N deposition, and vegetation composition change caused by climate change. However, the interactions of these three factors and the primary controls on N2 O fluxes in peatlands are not well-known. Here, the three factors were manipulated in a boreal bog in western Newfoundland, Canada for 5 years. We found that warming mitigated the positive N effect on N2 O fluxes in the mid-growing season under intact vegetation owing to the increase of available N uptake by vegetation and less N for N2 O production. In contrast, warming strengthened the N effect on N2 O fluxes in the early growing season under the absence of graminoids or shrubs, which could be attributed to the increase of available carbon and nitrogen for N2 O production. It should be noted that these effects were not observed under the condition of low carbon availability. In addition, gross primary production was found as a critical control on N2 O fluxes under N addition. Our findings emphasize that the interaction of abiotic (warming and elevated nitrogen deposition) and biotic factors (vegetation composition change) on N2 O fluxes should be taken into account in order to project N2 O fluxes in peatland ecosystems accurately.

Measurement of the macroscopic visible core (MVC) length during macroscopic on-site quality evaluation (MOSE) may allow estimation of sample adequacy for next-generation sequencing (NGS), and prediction of correct diagnosis in endoscopic ultrasound-guided tissue acquisition (EUS-TA) of pancreatic masses.

This multicenter prospective study included consecutive patients who underwent EUS-TA for pancreatic masses using a 22-G Franseen needle. MVC length and pathological samples obtained from two needle passes were analyzed on a per-pass basis. Outcome measures included respective correlations of MVC length with histological sample quantity and diagnostic yields.

The analysis included 204 passes from 102 EUS-TAs. MVC length correlated positively with histological sample quantity (P<0.01). On the receiver operating characteristic curve for MVC length, the cut-off value and area under the curve for obtaining a candidate sample for NGS were 30mm and 0.74 (95% confidence interval [CI] 0.65-0.83), respectively. On multivariate analysis, MVC length ≥30mm was a significant factor affecting suitability for NGS (odds ratio 6.19; 95% CI 2.72-14.10). Histologic diagnostic yield correlated positively with MVC length (P=0.01); however, there was no positive correlation between MVC length and overall (histology plus cytology) diagnostic yield.

Measuring MVC length to predict histological sample quantity on MOSE may be of clinical significance during EUS-TA using a 22-G Franseen needle. It may be an effective method, particularly while submitting samples for NGS. Registration University Hospital Medical Information Network Trials Registry (UMIN000036528).

Measuring MVC length to predict histological sample quantity on MOSE may be of clinical significance during EUS-TA using a 22-G Franseen needle. It may be an effective method, particularly while submitting samples for NGS. Registration University Hospital Medical Information Network Trials Registry (UMIN000036528).Although CAMKK2 is overexpressed in several cancers, its role and relevant downstream signaling pathways in gastric cancer (GC) are poorly understood. Treatment of AGS GC cells with a CAMKK2 inhibitor, STO-609, resulted in decreased cell proliferation, cell migration, invasion, colony-forming ability, and G1/S-phase arrest. Quantitative phosphoproteomics in AGS cells with the CAMKK2 inhibitor led to the identification of 9603 unique phosphosites mapping to 3120 proteins. We observed decreased phosphorylation of 1101 phosphopeptides (1.5-fold) corresponding to 752 proteins upon CAMKK2 inhibition. Bioinformatics analysis of hypo-phosphorylated proteins revealed enrichment of MAPK1/MAPK3 signaling. Kinase enrichment analysis of hypo-phosphorylated proteins using the X2K Web tool identified ERK1, cyclin-dependant kinase 1 (CDK1), and CDK2 as downstream substrates of CAMKK2. Moreover, inhibition of CAMKK2 and MEK1 resulted in decreased phosphorylation of ERK1, CDK1, MCM2, and MCM3. Immunofluorescence results were in concordance with our mass spectroscopy data and Western blot analysis results. Taken together, our data reveal the essential role of CAMKK2 in the pathobiology of GC through the activation of the MEK/ERK1 signaling cascade.The objective of this study was to investigate the impact of male age, semen quality and days of ejaculatory abstinence on embryo morphokinetics. A total of 1,220 zygotes obtained from 139 couples in a private in vitro fertilisation centre were analysed. The timing of specific events from the point of insemination, such as timings to pronuclei appearance and fading, to two, three, four, five, six, seven and eight cells and to blastulation were recorded. Multivariate linear regression analysis was used to evaluate the influence of paternal factors on embryo morphokinetic events. Paternal age was positively correlated with delayed cell cleavage and blastulation, and negatively associated with implantation rate, and clinical pregnancy and live-birth chances. The ejaculatory abstinence was inversely correlated with the implantation rate. Inverse relationships were observed between semen parameters (sperm count, progressive sperm motility, total motile sperm count and morphology) and the timing of specific events during embryo development. Sperm morphology was also positively associated with implantation rate and pregnancy and live-birth chances. Increased paternal age and ejaculatory abstinence, and poor semen quality correlate with delayed cell cleavage and blastulation and negatively impact intracytoplasmic sperm injection outcomes.

Professionalism lapses have high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, remediation for unprofessional behaviour is particularly challenging-and understudied. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether a learner has met expectations. We aimed to understand why and how postgraduate medical educators use reflective writing as an educational intervention to remediate professionalism.

In this constructivist grounded theory study, we interviewed 13 medical education professionals with experience using reflective writing to remediate professionalism across five Canadian medical schools. Data collection and analysis occurred iteratively using constant comate professionalism.

Educators express ambivalence about using reflective writing to remediate professionalism in residency. Understanding the potential and pitfalls of reflective writing may inform more tailored and effective approaches to remediate professionalism.

Myocardial bridging (MB) is a common and usually benign inborn coronary abnormality that may lead to anginal symptoms, acute coronary syndrome, arrhythmias, and rarely sudden cardiac death. MB are most commonly localized in the middle segment of the left anterior descending coronary artery (LAD). The treatment of LAD-MB is still challenging. Our objective was to assess the short- and long-term results of surgical procedures in patients with LAD-MB who had chest pain refractory to medical therapy.

Between March 2005 and January 2020, 26 patients (19 males and 7 females; mean 55.8 ± 12.4 years) with MB underwent surgery. All MB was located in the mid-segment of the LAD with a mean length of 4.2 ± 1.7 cm. Coronary angiography before surgery demonstrated LAD-MB with systolic compression more than or equal to 70% in all patients.

Twenty-five patients underwent myotomy and one patient underwent coronary artery bypass grafting (CABG). All patients survived and recovered uneventfully. Neither hospital or late death nor major complications occurred. Follow-up time was 3-173 months (mean 55.7 months). Follow-up of coronary angiography or computed tomography scan performed in 16 patients demonstrated restoration of coronary blood flow and myocardial perfusion without significant residual compression of the artery. All patients were symptom-free and are currently in NYHA Class I.

The symptomatic LAD-MB patients who are refractory to medication should actively undergo the surgical intervention such as myotomy and CABG to eliminate the clinical symptoms and achieve satisfactory results by follow-up findings. Myotomy is a preferred procedure because of its safety and satisfactory results.

The symptomatic LAD-MB patients who are refractory to medication should actively undergo the surgical intervention such as myotomy and CABG to eliminate the clinical symptoms and achieve satisfactory results by follow-up findings. Myotomy is a preferred procedure because of its safety and satisfactory results.Honeybee symbionts, predominantly bacteria, play important roles in honeybee health, nutrition, and pathogen protection, thereby supporting colony health. On the other hand, fungi are often considered indicators of poor bee health, and honeybee microbiome studies generally exclude fungi and yeasts. We hypothesized that yeasts may be an important aspect of early honeybee biology, and if yeasts provide a mutual benefit to their hosts, then honeybees could provide a refuge during metamorphosis to ensure the presence of yeasts at emergence. We surveyed for yeast and fungi during pupal development and metamorphosis in worker bees using fungal-specific quantitative polymerase chain reaction (qPCR), next-generation sequencing, and standard microbiological culturing. On the basis of yeast presence in three distinct apiaries and multiple developmental stages, we conclude that yeasts can survive through metamorphosis and in naïve worker bees, albeit at relatively low levels. In comparison, known bacterial mutualists, like Gilliamella and Snodgrassella, were generally not found in pre-eclosed adult bees. Whether yeasts are actively retained as an important part of the bee microbiota or are passively propagating in the colony remains unknown. Our demonstration of the constancy of yeasts throughout development provides a framework to further understand the honeybee microbiota.

Lin28A and its paralog Lin28B are RNA binding proteins expressed in stem and progenitor cells, regulating the balance between their proliferation and differentiation. In-vivo and in-vitro experiments have shown that overexpression of these genes leads to abnormal cell proliferation, which results in many cases in cell transformation and tumor formation.

Here we show, for the first time, that Lin28A overexpression can also lead to the opposite effect, i.e. apoptosis induction. We further demonstrate that this effect is specific to Lin28A but not to Lin28B and that it is mediated via the Let-7 independent pathway in a complex mechanism that involves at least several proteins.

This unexpected observation suggests that cell fate regulation by Lin28 is dependent on a specific cellular/genetic context. Unraveling the cellular and molecular mechanisms underlying this Lin28A overexpression effect may pave the way for novel tumor therapeutic strategies, as Lin28 is commonly expressed in many types of tumors but not in most normal adult cells.

This unexpected observation suggests that cell fate regulation by Lin28 is dependent on a specific cellular/genetic context. Unraveling the cellular and molecular mechanisms underlying this Lin28A overexpression effect may pave the way for novel tumor therapeutic strategies, as Lin28 is commonly expressed in many types of tumors but not in most normal adult cells.

Hair has traditionally been removed from the surgical site before surgery; however, some studies claim that this increases surgical site infections (SSIs) and should be avoided. This is the second update of a review published in 2006 and first updated in 2011.

To determine whether routine preoperative hair removal (compared with no removal) and the method, timing, or setting of hair removal effect SSI rates.

In November 2019, for this second update we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase; and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies, and scanned the reference lists of included studies plus reviews to identify additional studies. We applied no date or language restrictions.

We included randomised controlled trials or quasi-randomised trials that compared · hair removacompared with shaving using a razor. There may be a small reduction in SSIs when hair is removed on the day of, rather than the day before, surgery.

To evaluate left myocardial performance index (MPI) and its time intervals in monochorionic diamniotic (MCDA) twin pairs complicated by selective fetal growth restriction (sFGR) with abnormal (persistent -type II- or intermittent -type III- absent or reversed end-diastolic flow) umbilical artery Doppler.

Retrospective study including 16 MCDA twin pairs with sFGR type II, 26 MCDA twin pairs with sFGR type III and 42 gestational age-matched uncomplicated MCDA twin pairs in a single tertiary center. Left isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured and MPI calculated by conventional Doppler at diagnosis of sFGR.

In sFGR type II, the smaller twin had shorter ET and prolonged IRT and MPI, while the larger twin showed prolonged ICT and MPI as compared to uncomplicated MCDA twins. In sFGR type III, the smaller twin had shorter ICT and ET, while the larger twin showed prolonged ICT, IRT, and MPI in comparison to controls.

A differential pattern of MPI time intervals could be observed in MCDA twins with sFGR type II and III. All twins had echocardiographic signs of pressure/volume overload, except the smaller twin type III with shorter systolic times probably reflecting reduced volume load.

A differential pattern of MPI time intervals could be observed in MCDA twins with sFGR type II and III. All twins had echocardiographic signs of pressure/volume overload, except the smaller twin type III with shorter systolic times probably reflecting reduced volume load.

Self-assessment is an essential skill for dental professionals. Understanding global trends in self-assessment can highlight the learning needs of students across a diversity of cultural backgrounds. The aim of this study is to compare the self-assessment ability of dental students in the United States and Japan, where cultural backgrounds may differ.

Students in the United States (n=176) completed a typodont premolar and anterior Class II and Class III preparation and restoration. Students in Japan (n=175) completed a typodont premolar crown preparation. Students and faculty then evaluated the student performance using rubrics for each respective procedure. The difference between the student’s self-assessment score and the average faculty score (S-F gap) was calculated and the data were analyzed.

The mean S-F gap was 2.8% in Japan and 7.6% in the United States. This indicates that Japanese students tended to assess themselves closer to their faculty graders than students in the United States. On average, students in both countries scored themselves higher than their faculty graders. Students in the United States more frequently overestimated their performance and students in Japan more frequently underestimated their performance. For students in the lower quartile, the mean S-F gap was 5.1% in Japan and 14.6% in the United States, indicating a large cultural discrepancy in the lower quartile groups.

Although different preclinical procedures were compared, our findings demonstrated that Japanese students may score themselves more closely to their faculty assessors than students in the United States. Further investigation with more students completing the same preclinical activity will be needed.

Although different preclinical procedures were compared, our findings demonstrated that Japanese students may score themselves more closely to their faculty assessors than students in the United States. Further investigation with more students completing the same preclinical activity will be needed.

The 22-item Sinonasal Outcome Test (SNOT-22) is a validated chronic rhinosinusitis health-related quality-of-life outcome (HRQoL) measure; however, SNOT-22 domains have not been validated specifically for chronic rhinosinusitis with nasal polyps (CRSwNP).

Validation of SNOT-22 domain structure, using data from 3 randomized, placebo-controlled, double-blinded, multicenter clinical trials of dupilumab in adults with moderate-to-severe CRSwNP.

Preliminary dimensional structure was derived by exploratory factor analyses of SNOT-22 data from a phase 2 trial (NCT01920893) of dupilumab for the treatment of CRSwNP. Data from 2 phase 3 clinical trials (NCT02912468 and NCT02898454) were then used for confirmatory factor analysis, and evaluated for reliability, construct validity, and responsiveness. In all three trials, the SNOT-22 was administered electronically on a tablet and trial participants were required to answer all items.

Factor analysis supported five domains Nasal, Ear/Facial, Sleep, Function, and Eve domains of SNOT-22 (Nasal, Ear/Facial, Sleep, Function, and Emotion) for assessing symptoms and impact on HRQoL in patients with CRSwNP. Laryngoscope, 2021.Environmental heterogeneity has led to the widespread evolution of phenotypic plasticity in all taxonomic groups. Although phenotypic plasticity has been examined from multiple perspectives, few studies have examined evolutionary patterns of plasticity within a phylogeny. We conducted common-garden experiments on 20 species of tadpoles, spanning three families, exposed for 4 weeks to a control, predator cues, or reduced food (i.e., increased intraspecific competition). We quantified tadpole activity, growth, and relative morphology and found widespread differences in species responses to predator cues and reduced food. We detected pervasive phylogenetic signals in traits within each environment, but the phylogenetic signal was much less common in the trait plasticities. Among different models of continuous character evolution, Brownian Motion and Ornstein Uhlenbeck models provided better fits to the data than the Early Burst model. Tadpole activity level in predator environments had much higher evolutionary rates than in the control and reduced-food environments; we did not see this pattern in the other traits. In comparing traits versus trait plasticities, activity evolved much faster than the plasticity of activity whereas morphological traits evolved much slower than morphological plasticities. Collectively, these results suggest that traits and trait plasticities can exhibit dramatically different evolutionary patterns.We examined the replicability and generality of a previously reported training sequence effect on emergent conditional discriminations in the intraverbal naming task. In Experiment 1, a tact-intraverbal (TI) group learned first to vocally label 6 visual patterns and then to intraverbally relate pairs of verbal labels, whereas an intraverbal-tact (IT) group received the same training in the opposite sequence. Emergent conditional discriminations among pattern stimuli were assessed in match-to-sample (MTS) format. Experiment 2 was identical, except vocal tact and intraverbal training were replaced with selection-based training in which the verbal labels were text stimuli. Compared to the IT sequence, the TI sequence resulted in greater mean accuracy at test (Experiment 1), higher yields (Experiment 2), and shorter reaction times (Experiment 2). Experiment 2 data suggested the TI group’s performance might be less dependent on intact intraverbal relations relative to the IT group, but related to participants’ reports of visualization during intraverbal training. The results suggest the sequence effect is replicable and occurs in experimental preparations commonly used to study derived stimulus relations. They also provide novel support for the hypothesis that participant behavior during training alters sources of stimulus control available at test.Acceptance is a term used by healthcare professionals regarding patients’ psychosocial adjustment to chronic conditions. This paper describes a triangulation approach, applied over 25 years, to develop and evaluate a theory of adolescent acceptance of asthma. The theory was used to guide the development and evaluation of an education and counseling program focused on fostering acceptance. The approach was effective in (a) defining acceptance and isolating its attributes; (b) identifying its antecedents and consequences, and specifying relationships among them; (c) revealing overlooked variables and augmenting theory; and (d) using theory to guide development and evaluation of the self-management program.

Amyotrophic lateral sclerosis (ALS) symptoms mimic those of other conditions and often require multiple physician and healthcare contacts for investigation and accurate diagnosis. We examined the type and frequency of healthcare service utilization prior to ALS diagnosis and tracheostomy-free survival by sex and rurality among individuals treated with riluzole in Ontario, Canada.

This population-based cohort study used administrative databases to identify patients aged 18+ years diagnosed with ALS and started on riluzole between April 2002-March 2018. Using Poisson regression, rate ratios of healthcare utilization and atypical diagnostic tests and unnecessary therapeutic interventions five years prior to ALS diagnosis were compared by sex and rurality. Tracheostomy-free survival after diagnosis was compared between groups using Kaplan-Meier estimators and proportional hazards models.

1071 patients with ALS were identified with a mean age of 70 years; 563 (52.6%) were men and 134 (12.5%) were rural residnd clinical trials. This article is protected by copyright. All rights reserved.

Glaucoma is one of the leading largely preventable causes of blindness in the world. It is usually addressed first medically with topical intraocular pressure-lowering drops or by laser trabeculoplasty. In cases where such treatment fails, glaucoma-filtering surgery such as trabeculectomy, is commonly considered. Surgeons can differ in their technique when performing trabeculectomy, for example, the choice of the type of the conjunctival flap (fornix- or limbal-based). In a fornix-based flap, the surgical wound is performed at the corneal limbus; while in a limbal-based flap, the incision is further away. Many studies in the literature compare fornix- and limbal-based trabeculectomy with respect to outcomes and complications.

To assess the comparative effectiveness of fornix- versus limbal-based conjunctival flaps in trabeculectomy for adult glaucoma, with a specific focus on intraocular pressure (IOP) control and complication rates (adverse effects).

We searched the Cochrane Central Register of Controlct on long-term failure rate between the two surgical techniques.

The main result of this review was that there was uncertainty as to the difference between fornix- and limbal-based trabeculectomy surgeries due to the small number of events and confidence intervals that cross the null. This also applied to postoperative complications, but without any impact on long-term failure rate between the two surgical techniques.Use of historical data and real-world evidence holds great potential to improve the efficiency of clinical trials. One major challenge is to effectively borrow information from historical data while maintaining a reasonable type I error and minimal bias. We propose the elastic prior approach to address this challenge. Unlike existing approaches, this approach proactively controls the behavior of information borrowing and type I errors by incorporating a well-known concept of clinically significant difference through an elastic function, defined as a monotonic function of a congruence measure between historical data and trial data. The elastic function is constructed to satisfy a set of prespecified criteria such that the resulting prior will strongly borrow information when historical and trial data are congruent, but refrain from information borrowing when historical and trial data are incongruent. The elastic prior approach has a desirable property of being information borrowing consistent, that is, asymptotically controls type I error at the nominal value, no matter that historical data are congruent or not to the trial data. Our simulation study that evaluates the finite sample characteristic confirms that, compared to existing methods, the elastic prior has better type I error control and yields competitive or higher power. The proposed approach is applicable to binary, continuous, and survival endpoints.Biomedical research is increasingly data rich, with studies comprising ever growing numbers of features. The larger a study, the higher the likelihood that a substantial portion of the features may be redundant and/or contain contamination (outlying values). This poses serious challenges, which are exacerbated in cases where the sample sizes are relatively small. Effective and efficient approaches to perform sparse estimation in the presence of outliers are critical for these studies, and have received considerable attention in the last decade. We contribute to this area considering high-dimensional regressions contaminated by multiple mean-shift outliers affecting both the response and the design matrix. We develop a general framework and use mixed-integer programming to simultaneously perform feature selection and outlier detection with provably optimal guarantees. We prove theoretical properties for our approach, that is, a necessary and sufficient condition for the robustly strong oracle property, where the number of features can increase exponentially with the sample size; the optimal estimation of parameters; and the breakdown point of the resulting estimates. Moreover, we provide computationally efficient procedures to tune integer constraints and warm-start the algorithm. We show the superior performance of our proposal compared to existing heuristic methods through simulations and use it to study the relationships between childhood obesity and the human microbiome.In this study, we aimed to investigate the relationship between the genetic variant of rs696217-ghrelin and fasted lipid profile, indices of obesity, and environmental parameters. Amplification refractory mutation system-polymerase chain reaction (ARMs-PCR) was used for genotyping 1118 individuals recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. The interaction between the presence of the genetic variant of rs696217-ghrelin and nutritional intake and other major determinants of obesity and lipid profile was examined in the MASHAD study population. Individuals with the TT genotype at the locus had the lowest prevalence of obesity compared to other genotypes among the individuals. No significant relationship was found between the two groups regarding the lipid profile and TT genotype. Furthermore, no significant association was found between dietary intake and the genetic variant of rs696217-ghrelin in the population under study. Individuals with a TT or GT genotype appear to be at a higher risk of obesity, compared to those with a GG genotype. The results of the current study revealed a significant association between the genetic variant of rs696217-ghrelin and obesity; however, this gene did not correlate with the risk factors of cardiovascular diseases and dyslipidemia in the Iranian population.The SBO4-DZ(d,p)-3G basis sets introduced in a previous paper have been modified to improve their performance in the calculation of the atomization energies of organic molecules (pure or substituted hydrocarbons). The first step was to explore the possibility of improving those basis sets by adding a second D shell. The scale factor for an additional „D-3G” shell was first studied by minimizing the total energies. In a second step, the scale factor was calculated by optimizing atomization energies directly (instead total energies). This way the results obtained were very similar to those of the cc-pV5Z basis sets. Finally, we optimized simplified box orbital (SBO) basis sets for different methods obtaining optimal SBO basis sets for HF, DFTs, and MP2.

Conflicting results exist on the association between Helicobacter pylori infection and gastro-oesophageal reflux (GOR), and its complications, such as erosive oesophagitis (EO) and Barrett’s oesophagus (BO).

To explore the association of H. pylori infection with GOR symptoms and their complications METHODS We searched Embase, PubMed, Web of Science and Scopus databases through December 2020 for relevant articles. Regarding the association between H. pylori and GOR symptoms (heartburn, regurgitation or reflux), we included observational studies comparing the prevalence of GOR symptoms between H. pylori-positive and -negative individuals. Concerning the association between H. pylori and complications of GOR, we included studies comparing the prevalence of EO or BO between H. pylori-positive and -negative individuals.

In total, 36 papers were eligible. Based on seven cross-sectional surveys, H. pylori infection was associated with a lower odds of GOR symptoms (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.61-0.90). However, in four case-control studies, H. pylori infection was not associated with odds of GOR symptoms (OR 1.10, 95% CI 0.85-0.1.43). In 26 cross-sectional studies in patients with GOR symptoms, the OR for EO was 0.70 (95% CI 0.58-0.84) in H. pylori-positive vs -negative cases. Based on nine cross-sectional studies in subjects with GOR complications, no significant association was found between H. pylori infection and either endoscopically-diagnosed (OR 1.84, 95% CI 0.67-5.02) or histologically confirmed (OR 0.85, 95% CI 0.60-1.20) BO.

Helicobacter pylori infection appears to be associated with a decreased odds of GOR symptoms and EO. In contrast, H. pylori infection did not seem to affect the odds of BO in patients with GER complications.

Helicobacter pylori infection appears to be associated with a decreased odds of GOR symptoms and EO. In contrast, H. pylori infection did not seem to affect the odds of BO in patients with GER complications.Body condition is an important concept in behaviour, evolution and conservation, commonly used as a proxy of an individual’s performance, for example in the assessment of environmental impacts. Although body condition potentially encompasses a wide range of health state dimensions (nutritional, immune or hormonal status), in practice most studies operationalize body condition using a single (univariate) measure, such as fat storage. One reason for excluding additional axes of variation may be that multivariate descriptors of body condition impose statistical and analytical challenges. Structural equation modelling (SEM) is used in many fields to study questions relating multidimensional concepts, and we here explain how SEM is a useful analytical tool to describe the multivariate nature of body condition. In this 'Research Methods Guide’ paper, we show how SEM can be used to resolve different challenges in analysing the multivariate nature of body condition, such as (a) variable reduction and conceptualizatiooncepts as well, such as immunocompetence, oxidative stress and environmental conditions.Breastfeeding self-efficacy is a relevant predictor of exclusive breastfeeding during the first six months of life. The Prenatal Breastfeeding Self-Efficacy Scale (PBSES) is a 20-item tool developed to determine breastfeeding self-efficacy during pregnancy. Our study aimed to assess the structural validity and psychometric characteristics of the PBSES and to explore item reduction according to the statistical criteria for parsimony and incremental validity. In this study, conducted in six hospitals in eastern Spain, we recruited 1183 women with healthy, full-term, single-birth newborns. Data on sociodemographic, breastfeeding-related variables, and the PBSES, were obtained from self-administered questionnaires during the third trimester of pregnancy, at postpartum discharge, and 5 months postpartum, and from a phone survey 12 months postpartum. Item reduction was conducted after revising the PBSES item floor and ceiling effects, interitem correlations, and item-score relationships with breastfeeding-status variables during follow-up. The factorial structure of the short form of the PBSES (PBSES-SF) was tested using both exploratory and confirmatory approaches. After item reduction, the confirmatory factor analysis of the 12 remaining items of the PBSES-SF revealed adequate fit statistics for a three-factor structure and a second-order factor. Internal consistency was measured using the Cronbach’s α coefficient of the PBSES-SF (0.86). We provided evidence on the discriminant validity of the PBSES-SF by comparing its scores between known groups, convergent validity by examining its correlations with other variables, and predictive validity by assessing the association of PBSES-SF scores with breastfeeding behavior at critical points in time during the first postpartum year.Adequate removal of residual bonded materials from the enamel surface after orthodontic bracket debonding is critical, since any remaining composite may compromise enamel surface morphology and esthetics. The following clinical case reports present the association of at-home dental bleaching using 10% carbamide peroxide and the removal of residual bonded material using a super fine, tapered diamond bur followed by the use of an enamel microabrasion product after orthodontic bracket debonding. The proposed treatment considerably improved the esthetics and successfully removed the grooves created during the removal of the bonding composite, resulting in a smooth enamel surface.

To correlate the radiant power (mW), radiant exitance (or tip irradiance in mW/cm2), emission spectrum (mW/cm2/nm), and beam irradiance profile of 12 light-curing units (LCUs) available in the Brazilian market with their market cost.

Six LCUs that cost more than US$900 (Bluephase G4,VALO Grand, VALO Cordless, Radii Xpert, Elipar DeepCure-S, and Radii plus) and six low-cost LCUs costing less than US$500 (Radii Cal, Optilight Max, High Power LED 3M, Emitter D, Emitter C, and LED B) were examined. Radiant power (mW) and emission spectrum (mW/nm) were measured using an integrating sphere connected to a fiber-optic spectroradiometer. The internal tip diameter (mm) of each LCU was measured using a digital caliper and was used to calculate the average radiant exitance (mW/cm2). Irradiance profiles at the light tip were measured using a commercial laser beam profiler. The cost of each LCU in Brazil was correlated with internal tip diameter, radiant power, and tip irradiance.

None of the low-cost LCUs were broadlower radiant power and had a smaller tip diameter.Among 20 681 students and 4282 staff, the in-school transmission of SARS-CoV-2 appeared low during highest community spread and at 3- to 6-foot distancing. Nine of 820 school cases (1.1%) resulted in spread, with only one student-to-staff transmission. A school epidemiologist and mitigation audit teams were useful.

Place-based inequalities, such as exposure to violence and access to nutritious food and clean water, may contribute to human immunodeficiency virus (HIV)-associated cognitive impairment. In this study, we investigated neighborhood effects on cognition in children and adolescents with HIV in Lusaka, Zambia.

We conducted a prospective cohort study of 208 children with perinatally acquired HIV (ages 8-17) and 208 HIV-exposed uninfected controls. Participants underwent neuropsychological testing and interviews assessing socioeconomic status. Geographic regions with clusters of participants with HIV and cognitive impairment were identified using quantitative geographic information systems (QGIS) and SaTScan. Associations between location of residence and cognitive function were evaluated in bivariable and multivariable regression models. Mediation analysis was performed to assess direct and indirect effects of location of the residence on cognitive impairment.

Residence in Chawama, one of the poorest neighbt may be potentially modifiable.

Acquiring objective, timely, and comprehensive feedback on resident diagnostic performance is notoriously difficult.

To implement a custom software application (Resident Case Tracker) to improve evaluative diagnostic analysis for residency programs.

Residents and faculty use a graphical user interface with restricted access to their own cases and evaluations. For each sign-out, residents enter their diagnoses and comments for each case. Faculty are provided a sign-out queue to review the resident diagnosis and select their level of agreement alongside optional comments. After sign-out, residents can review the agreement level and comments for each case, overall sign-out statistics, and organ-specific performance, and they have the option of opening and reviewing groups of cases by agreement status. A sign-out evaluation is automatically generated and stored alongside additional reports. Administrative access allows privileged users to readily review data analytics at both an individual and residency-wider time. Faculty are able to assess resident milestones much more effectively while more readily identifying residents who would benefit from targeted study.The ability to adequately ventilate a patient is critical and sometimes a challenge in the emergency, intensive care, and anesthesiology settings. Commonly, initial ventilation is achieved through the use of a face mask in conjunction with a bag that is manually squeezed by the clinician to generate positive pressure and flow of air or oxygen through the patient’s airway. Large or small erroneous openings in the breathing circuit can lead to leaks that compromise ventilation ability. Standard procedure in anesthesiology is to check the circuit apparatus and oxygen delivery system prior to every case. Because the face mask itself is not a piece of equipment that is associated with a source of leak, some common anesthesia machine designs are constructed such that the circuit is tested without the mask component. We present an example of a leak that resulted from complete failure of the face mask due to a tiny tear in its cuff by the patient’s sharp teeth edges. This subsequently prevented formation of a seal between the face mask and the patient’s face and rendered the device incapable of generating the positive pressure it is designed to deliver. This instance depicts the broader lesson that deviation from clinical routines can reveal unappreciated sources of vulnerability in device design.

In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

To evaluate the impact of the number of comorbidities on virologic suppression in HIV-positive patients.

This study included patients 18 years or older who were on antiretroviral therapy (ART) with at least 2 visits to an HIV primary care clinic in the past year. The primary outcome was the percentage of patients with an undetectable viral load (a blood HIV RNA level of <20 copies/mL) among groups of patients with 0, 1 or 2, 3 or 4, and 5 comorbidities, respectively. The secondary outcome was the percentage of patients with undetectable viral loads per each comorbidity, as listedlowest viral suppression rates amongst all of the comorbidity subgroups.

Improved viral suppression was seen among HIV-positive patients with an increased number of comorbidities. Patients with psychiatric disorders had the lowest viral suppression rates amongst all of the comorbidity subgroups.Antimicrobial resistance (AMR) is increasing worldwide. We analyzed AMR rates for bacterial species identified from pediatric blood cultures between 2005 and 2019 at a single institution in Guatemala. We found significantly increased rates in Gram-negative resistance, with a high prevalence of carbapenem-resistant Acinetobacter and Klebsiella harboring the New Delhi metallo-beta-lactamase gene.Aging is a multifaceted process regulated by multiple cellular pathways, including the proteostasis network. Pharmacological or genetic enhancement of the intracellular proteostasis network extends lifespan and prevents age-related diseases. However, how proteostasis is regulated in different tissues throughout the aging process remains unclear. Here, we show that Drosophila homologs of Cubilin- and Amnionless (dCubilin and dAMN, respectively)-mediated protein reabsorption (CAMPR) from hemolymph insect blood by nephrocytes modulate longevity through regulating proteostasis in muscle and brain tissues. We find that overexpression of dAMN receptor in nephrocytes extends lifespan, whereas nephrocyte-specific dCubilin or dAMN RNAi knockdown shortens lifespan. We also show that CAMPR in nephrocytes regulates proteostasis in hemolymph and improves healthspan. In addition, we show that enhanced CAMPR in nephrocytes slows down the aging process in muscle and brain by maintaining the proteostasis network in these tissues. Altogether, our work has revealed an inter-organ communication network across nephrocytes and muscle/neuronal tissue that is essential for maintaining proteostasis, and to delay senescence in these organs. These findings provide insight into the role of renal protein reabsorption in the aging process via this tele-proteostasis network.Epstein-Barr virus (EBV) is a ubiquitous human tumor virus, which contributes to the development of lymphoproliferative disease, most notably in patients with impaired immunity. EBV associated lymphoproliferation is characterized by expression of latent EBV proteins and ranges in severity from a relatively benign proliferative response to aggressive malignant lymphomas. The presence of EBV can also serve as a unique target for directed therapies for the treatment of EBV lymphoproliferative diseases, including T cell based immune therapies. In this review, we will describe the EBV-associated lymphoproliferative diseases and will particularly focus on the therapies that target EBV.The Amazon region is an important region for biodiversity, and many new species are described for this region each year. However, the diversity of parasites infecting Amazonian reptiles is still poorly known, and there are few studies about how parasite communities of these hosts are structured. Our study was designed to elucidate the parasite community structure of Thecadactylus rapicauda, one of the largest species of gekkonid lizards in the world, and to discover the relative utility of size, sex, and body mass of Thecadactylus rapicauda as predictive factors of the abundance of helminth parasites. We analyzed 40 individuals of T. rapicauda, of which 34 had parasites (85% of prevalence), with 269 specimens allocated to 10 species. Body size of the host showed a positive influence on the abundance of helminths. Host sex is another important factor related to the abundance of nematodes females were usually heavily infected. We conclude that T. rapicauda has a high richness of the helminth species and that most of the species found infecting this host were nematodes with a direct life cycle. Additionally, we found new helminth species, which should be described formally in the future.Altered composition or function of the human micro- biome, termed dysbiosis, has been associated with a variety of immune-mediated diseases. Antibiotic use is a well-studied cause of dysbiosis. We conducted an electronic survey of 351 antibiotic-prescribing clinicians in Rhode Island to evaluate antibiotic prescription patterns, knowledge and opinions regarding the importance of the human microbiome and its relation to antibiotics and the immune system. We found that clinicians view the health of the human microbiome as important when prescribing antibiotics; however, they do not feel well-informed or confident in their knowledge about the microbiome or its relevance to patient health. A higher level of self- reported knowledge about the microbiome was associated with increased importance placed on the microbiome and its relevance to medical practice. Our results indicate that clinicians may benefit from continuing medical education on the link between antibiotic-induced dysbiosis and immune-mediated disease.

Concern about the decline in physician scientists has generated interest in promoting research participation among medical students. This study aimed to examine perceptions of research and research-oriented careers among college-level baccalaureate-MD (BA/MD) students at one institution in the United States.

A cross-sectional survey was distributed to a sample of 241 BA/MD students. Descriptive statistics were used to examine research perceptions of participants.

The response rate was 52% (126/241). Most respondents conducted scientific research in high school and were interested in research-oriented careers. Most students participated in a research program (research course, faculty mentorship, or research grant), disseminated their research, and believed that research programs would be helpful for their research participation. The most common perceived barriers were a lack of time, interest, and prior research experience.

College-level BA/MD students had positive perception of research-oriented careers and found student research programs helpful.