At our cleft and craniofacial center, charges for a team care visit fall into one of three categories-hospital fees, professional fees, or external fees. There are four types of hospital fees depending on (1) whether the patient is new or returning, and (2) whether the patient saw ≤4 or ≥5 providers. To further elucidate the financial burden (out-of-pocket costs) directly borne by families of children with cleft lip and/or palate, we conducted a retrospective review of billing records of team care visits made between September 2019 and March 2020. Out-of-pocket costs for a single team care visit (on a commercial insurance plan) ranged from $4 to approximately $1220 and had a median (IQR) of $445 ($118, $749).

Drug-induced constipation (DIC) is a well-known comorbidity of cancer pain, however, data on its prevalence in nonmalignant pain (NMP) and its biopsychosocial effects are few.

To assess the prevalence and impact of DIC in patients with NMP.

Exploratory noninterventional, retrospective, cross-sectional analysis of depersonalized routine data of the German Pain e-Registry on 150,488 NMP patients (EUPAS identifier 42286).

DIC affects 33.5% of NMP patients. The most prevalent risk factors were the use of strong opioid analgesics and analgesic polymedication. Patients with DIC presented with significantly worse biopsychosocial scores as well as significantly higher percentages of individuals with severe deterioration of pain, daily life activities, physical and mental quality of life, mood, and overall wellbeing. Among patients with DIC, those who reported constipation as a clinical symptom and who documented bowel-function index (BFI) scores above the reference range were significantly more affected compared to those who either reported only constipation as an adverse event or elevated BFI scores. 55.9% of patients with DIC reported the use of laxatives, mostly over-the-counter preparations (43.6%), whereas prescription laxatives were taken by only 29.3%.

DIC is a frequent comorbidity of pain management and affects around one-third of patients with NMP. It interferes significantly with pain-related biopsychosocial effects and has to be addressed specifically to improve the overall burden in affected patients. However, the use of laxatives was significantly less frequent than recommended indicating significant room for improvement.

DIC is a frequent comorbidity of pain management and affects around one-third of patients with NMP. It interferes significantly with pain-related biopsychosocial effects and has to be addressed specifically to improve the overall burden in affected patients. However, the use of laxatives was significantly less frequent than recommended indicating significant room for improvement.

To assess clinical and biomolecular changes of the conjunctival epithelium in anophthalmic patients wearing an ocular prosthesis.

Thirty-five unilateral anophthalmic patients were enrolled. Patients with blepharitis, lid abnormalities, and topical/systemic medication affecting the ocular surface were excluded. Symptom Assessment in Dry Eye (SANDE) questionnaire and tear function test (Schirmer Test Type I) were recorded. Conjunctival inflammation and meibomian gland dysfunction (MGD) were graded in the anophthalmic side and fellow eye. Impression cytology sampling of the upper, lower tarsal, and posterior/bulbar conjunctiva from the anophthalmic socket were collected and compared to healthy controls.

Patients had significantly higher SANDE (

< 0.001), Schirmer

test (

= 0.004), conjunctival inflammation (

< 0.001), and MGD scores (

< 0.001) on the anophthalmic side compared to the fellow eye. Mucin 5AC, inflammatory markers (MMP-9, ICAM-1) expression (

< 0.001), and response to oon resembling dry eye disease.

The tricuspid valve (TV) and the right heart chambers are complex three-dimensional structures that are difficult to assess using tomographic imaging techniques. The progressive aging of the general population and the advancements in treating left-sided heart diseases by transcatheter procedures have contributed to the tricuspid regurgitation (TR) becoming a major public health problem associated with progression to refractory heart failure and poor outcome. Recent advances in multimodality cardiac imaging allow a better understanding of the pathophysiology of TR that may translate in better management of patients.

Three-dimensional echocardiography, cardiac magnetic resonance, and computed tomography provide complementary information to

. assess the TV complex;

. identify the etiology and the mechanisms of TR;

. evaluate its severity and hemodynamic consequences;

. explore the remodeling of the right heart chambers; and

. properly plan, guide, and monitor the transcatheter interventions aimed to reduce the severity of TR.

We need thorough understanding of both the TV and the right heart chamber geometry and function to understand the pathophysiology of TR. The integrated use of multimodality cardiac imaging is pivotal to assess patients with TR and to identify tailored and timely treatment of TR in properly selected patients.

We need thorough understanding of both the TV and the right heart chamber geometry and function to understand the pathophysiology of TR. The integrated use of multimodality cardiac imaging is pivotal to assess patients with TR and to identify tailored and timely treatment of TR in properly selected patients.Coronavirus disease 2019 (COVID-19) has created a global health emergency. Vaccine hesitancy and tremendous misinformation about the actual science are leaving the public with significant confusion. However, sound epidemiologic science is guiding us to a clear path toward mitigating this modern-day scourge. It is remarkable how putting an end to current COVID-19 outbreaks has such a simple solution-convincing the public to accept getting vaccinated. The dental research, dental education, and dental practice communities have a unique opportunity to act as trusted public exemplars as well as trusted interpreters of the science for the public.This article presents field experience in developing local waste management plans called Kebijakan Strategi Daerah (Jakstrada) in the Lake Toba region, one of the popular tourist destinations in Indonesia. It examines the current waste management status and discusses key priorities and actions identified in the Jakstradas to improve the waste management based on resource management and 3R (reduce, reuse and recycle) principles. In partnership with public, private, academic and citizen groups, the project activities supported the development of Jakstradas in all seven regencies and established a resource recovery centre (RRC) as a model to practice 3Rs in the region. The key lessons learned from these project activities are discussed and some practical recommendations are identified based on a literature review, interviews and workshops with local government officials and residents. Through those opportunities, it was found that remote regencies around Lake Toba do not have environmentally sound final disposal sites and do not have the financial or technical capacity to provide waste collection and handling services to residents, which often results in illegal dumping and open burning of waste. It was also revealed that lack of established markets for recycling value chains and citizens participation in waste separation at source had resulted in limited success for recycling and 3R activities in the region.

To study the influence of weight reduction after bariatric surgery on the intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, and blood flow of optic nerve head by optical coherence tomography angiography (OCTA).

This prospective observational cohort study included 60 obese patients. Body mass index (BMI), IOP, RNFL, and ganglion cell complex (GCC) thickness, rim area, and radial peripapillary capillary (RPC) vessel density were assessed before and 3 months after bariatric surgery.

The BMI and the IOP showed significant postoperative reduction to 40.45 ± 4.3 kg/m

and 14.83 ± 2.5 mmHg while the preoperative results were 51.13 ± 4.83 kg/m

and 16.95 ± 4.2 mm (

< 0.0001), respectively. No statistically significant change was detected in the RNFL, GCC thickness, rim area, or the RPC vessel density (

> 0.05). No statistically significant correlation was detected between the BMI changes and changes in the IOP, RNFL thickness, rim area, GCC thickness, or RPC vessel density.

No significant effect of bariatric surgery on the RNFL thickness and the optic nerve head blood flow measured by OCTA despite a significant IOP reduction 3 months post-surgical. OCTA can be a useful tool to assess the short-term influence of significant weight reduction on the retinal microcirculation.

Despite a significant BMI and IOP reduction following bariatric surgery in obese patients, the vascular flow of the ONH, measured by OCTA, and the RNFL thickness were not significantly affected. The former might be attributed to the complex autoregulatory mechanisms related to the ONH and its microcirculation.

Despite a significant BMI and IOP reduction following bariatric surgery in obese patients, the vascular flow of the ONH, measured by OCTA, and the RNFL thickness were not significantly affected. The former might be attributed to the complex autoregulatory mechanisms related to the ONH and its microcirculation.This study examined the typology of depressed mood trajectories and the associated factors over the first year postpartum among Taiwanese mothers. Data of 4332 mothers from a nationwide longitudinal study on child development and care were analyzed. Three classes of depressed mood trajectories were identified, two with lower initial scores and a decreasing trajectory and one with a higher initial score and an increasing trajectory. Subjective financial stress, perceived support, and marital satisfaction were significant in predicting mothers’ membership of the depressed mood trajectory classes. The results highlighted the individual susceptibility to the postpartum depressed mood among Taiwanese mothers.Mandarin-speaking children with speech sound disorders (SSD) often show difficulties in producing alveolar and velar plosives contrasts (e.g., /t/ vs. /k/). But it remains unclear whether such phonological disorder correlates with the perception of the contrast between alveolar and velar plosives. The present study assessed whether Mandarin-speaking children with SSD who substituted [t] for /k/ in production could perceptually distinguish between /t/ and /k/, and compared their results with those from typically developing children (TDC) and typically adults (TA). We adopted a categorical perception paradigm with a /ta/-/ka/ continuum. The continuum included nine stimuli, which were synthesized from a naturally-produced /ta/. The SSD, TDC, and TA groups completed both identification and discrimination tasks that required perceptual judgment of individual stimulus and pairs of stimuli from the continuum. The results showed that the TDC and TA groups showed typical patterns of categorical perception in the continuum. But the SSD group only reached or was slightly above the chance level in the identification task and did not show significant difference among pairs of stimuli in the discrimination task. Their performance was significantly different from that of the TDC and TA groups and lacked typical patterns of categorical perception. The results suggested that their perception of /t/ vs. /k/ may be impaired. Considering the SSD group’s speech errors, this perception defect may be a cause for their tendency of substituting [t] for /k/ in production.

Interventions tackling COVID-19 impact on health care workers’ mental health would benefit from being informed by validated and integrated assessment frameworks. This study aimed to explore the fitness of integrating the Job Demands-Resources (JD-R) model and the Individual-Group-Leader-Organization (IGLO) framework to investigate the pandemic’s impact on health care workers’ mental health.

Qualitative data were collected via 21 semi-structured interviews with senior and middle managers and four focus groups with employees (doctors, nurses, health care assistants) from three areas (Department of Emergency, Department of Medicine, Research Institute of Neuroscience) of a large health care institution facing the first wave of COVID-19. NVivo deductive content analysis of text data was performed.

Several COVID-19-related job demands and resources were found at IGLO levels. Individual-level demands included emotional load, while resources included resilience and motivation. Group-level demands included sociual, group, leader, and organization framework. The findings expand previous studies by filling the lack of knowledge on how job demands and resources might unfold at different workplace levels during a pandemic. Results provide unit-level evidence for designing and implementing multilevel interventions to manage health care workers’ mental health during COVID-19 and future pandemics. Our findings offer occupational health practitioners a suitable approach to perform workplace mental health assessment activities.Guidelines advocate a combined physical and psychological approach to managing non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). PIP is underpinned by patient-centered principles and skilled communication. Evidence suggests that a physiotherapist-focused style of communication prevails in physiotherapy. There is a recognized need for observational research to identify specific communication practices in physiotherapy interactions. This observational study explored the interactional negotiation of agenda setting following a PIP training intervention, by identifying and describing how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to primary care initial encounters. The research setting was primary care. Nineteen initial physiotherapy consultations were video-recorded, transcribed, and analyzed using conversation analysis, a qualitative observational method. These data revealed a patient-focused style of communication where trained physiotherapists demonstrated a collaborative and responsive style of verbal and nonverbal communication to solicit, explore, and validate patients’ concerns.Joseph John Thomson is best known for detecting two isotopes of neon within cathode ray tubes that lay the foundation of the field of mass spectrometry. He was awarded the 1906 Nobel Prize in Physics for the discovery of the electron and for his work on the conduction of electricity in gases in the same devices. He is less known for his strong religious beliefs and his interest in psychical research and the paranormal. Thomson served as a member of the Society for Psychical Research for over 50 years and even became its Vice President. During this time, he attended a number of séances and demonstrations by professed psychics and mediums. This article traces those who influenced his interest in the paranormal, from Balfour Stewart to Lord Rayleigh and William Crookes. It reports and illustrates his beliefs and experiences investigating the paranormal in his own words.It is widely accepted that the use of topical sunscreens has medical importance with potential to prevent skin damage by protecting from solar ultraviolet radiation (UVR) effects. Pharmaceutical emulsions require an optimal qualitative and quantitative combination of emollients, emulsifiers and others compounds such as softening agents and, for sunscreens, a combination of chemical and physical UV filters. Herein, we applied the quality by design (QbD) concept to achieve stable and effective compounded sunscreen emulsions. By using the statistical tool of design of experiments, it was possible to identify the influence of emulsifier type (with low and high Hydrophile-Lipophile Balance) and concentrations of emollient and softening agent on the achievement of formulations with suitable organoleptic and physicochemical features. Compounded emulsions with pleasant macroscopic aspects were obtained. Three formulations with physicochemical properties in targeted ranges were selected, namely pH ∼6.0, conductivity > 0.0 µS/cm2, spreadability factor ∼1-1.5 g/mm2, viscosity ∼12000 mPa.s and sunscreen protection factor ∼30. Freeze-thaw cycle and accelerated stability study under different storage conditions allowed selecting a stable emulsion that ensured photoprotection in biological assays. The QbD approach was essential to select the best, low-cost compounded sunscreen emulsion, with targeted physicochemical parameters.The ever-growing stream of waste production has become a critical issue for many metropolitan areas. An effective strategy to address this problem has been the concept of reverse logistics (RL). This paper seeks to develop an appropriate product recovery approach for electronic waste generated in an urban area. Consequently, we have proposed an integrated fuzzy RL model with buyback (BB) offers based on the condition of used-products (UPs) at the time of return. However, this strategy contains a significant challenge, which derives from unpredictability surrounding the return rate of UPs due to its dependency on multiple external factors. Hence, a novel fuzzy probability function is developed to approximate UPs’ chance of return. Besides that, the mathematical RL network’s inherent uncertainty prompted us to employ the fuzzy credibility-based method in the model. Afterward, the model’s objectives are locating and allocating collection centres to customer zones, determining flow between facilities and finding the optimal amount of gathered UPs and BB offers. Finally, we applied the model to a case study concerning product recovery in Mashhad city, Iran, and the results have proven its validity and utility.Background Caregiver frustration with inconsolable crying is a commonly cited antecedent factor of Abusive head trauma (AHT) in infants. Objective To assess the effectiveness of an educational intervention to improve patients’ knowledge of normal crying patterns in infants and the implications of AHT among women of Hispanic population. Methods The Period of PURPLE Crying program was piloted as part of Centering Prenatal Care at an outpatient clinic site in the Harris County Health Department system, which cares for a primarily underserved and Spanish speaking population. Educational material and direct counseling were delivered by the clinician. Demographic data was collected and a pre- and post-test survey was administrated to assess participant’s knowledge and behavior. Results Between April 2017 and April 2018, 63 Hispanic women were included in this study. Prior to implementation of the educational tool, most of the survey questions were answered incorrectly. After the intervention, knowledge regarding normal infant crying patterns was significantly improved in all questions. However, knowledge gaps persisted especially in relation to the adequacy of parents’ ability to soothe a crying infant and normalcy of excessive crying. Conclusions The educational curriculum was an effective tool for improving knowledge about normal infant crying patterns in Hispanic mothers.

Pregnancy and parturition reflect the complex interaction between physiologic conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We aimed to investigate the characteristics of the mother-infant dyad of term infants detected as having congenital hypothyroidism (CH).

A retrospective cohort study of 108,717 term infants delivered liveborn at Lis Maternity and Women’s Hospital between 2010 and 2017. Infants were detected by the National Newborn Screening Program as having congenital hypothyroidism (131, 0.12%). Three years of surveillance in the Pediatric Endocrine Clinic revealed that 65 had transient CH and 66 had permanent CH. Data on maternal, pregnancy, delivery, and perinatal characteristics of the mother-infant dyads were retrieved from the hospital’s electronic database.

Mode of delivery differed a higher proportion of deliveries of CH infants required vacuum assistance, and more infants with CH were born through a cesarean section compared to the general population (p<0.001). Medication during labor also differed, with higher rates of oxytocin (p<0.001) and antibiotics (p=0.008) administered to mothers of CH infants. A multivariate logistic regression model revealed an increased demand for oxytocin administration during the labor of a CH infant in a hypothyroidism severity-dependent manner, expressed as a threefold risk associated with permanent but not transient CH.

Our findings of increased utilization of medical interventions during the labor and delivery of CH infants suggest that the prenatal fetal thyroid function may affect the development and progress of labor and delivery, in response to oxytocin.

Our findings of increased utilization of medical interventions during the labor and delivery of CH infants suggest that the prenatal fetal thyroid function may affect the development and progress of labor and delivery, in response to oxytocin.Objective We tried to find the relationship between statin and diabetes retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods We searched the databases of PubMed, EMBASE, and the Cochrane Library for eligible studies reporting on the relationships between statin use and DR, from inception to September 25, 2020. The terms searched including Diabetes Mellitus, Type 2, Hydroxymethylglutaryl-CoA Reductase Inhibitors, and Diabetic Retinopathy. We expressed the results as the odds ratios (ORs) with 95% confidence intervals (CIs) which were calculated using a random-effects model. Results A total of 6 eligible studies, including 43 826 patients, were included in the meta-analysis. The meta-analysis showed that statin was not associated with elevated risk of DR [OR = 0.96 (95% CI 0.80-1.16), P = .68]. Similarly, no differences were found between statin and placebo in participants ≥500 [OR = 0.98 (95% CI 0.80-1.21)] or participants less then 500 [OR = 0.90 (95% CI 0.49-1.66)]. Further, we conducted a meta-analysis to study the effect of statin therapy on DR in people with type 2 diabetes according to age and found that statin use was associated with a decreased risk of DR in patients with type 2 diabetes 40 years of age or older [OR = 0.87 (95% CI 0.82-0.92)]. Conclusion Our meta-analysis revealed that statin was not associated with elevated risk of DR in patients with T2DM. Moreover, statin use was associated with a lower incidence of DR in patients with type 2 diabetes 40 years of age or older.

To evaluate the impact of otolaryngology programs’ social media on residency candidates in the 2020 to 2021 application cycle.

An anonymous survey was distributed via Otomatch, Headmirror, and word of mouth to otolaryngology residency applicants in the 2021 Match. Survey items included demographics, social media usage, and impact of programs’ social media on applicant perception and ranking. Descriptive statistics were performed, and responses based on demographic variables were compared using Fisher’s exact and Mann-Whitney

tests.

Of 64 included respondents, nearly all (61/64, 95%) used Facebook, Instagram, and/or Twitter for personal and/or professional purposes. Applicants (59/64, 92%) most commonly researched otolaryngology residency programs on Instagram (55/59, 93%) and Twitter (36/59, 61%), with younger (

 = .023) and female (

 = .043) applicants being more likely to engage with programs on Instagram. Program accounts were most helpful in showcasing program culture (50/59, 85%) and highlightse in the medical community, these findings can help otolaryngology residency programs craft a beneficial online presence that aids in recruitment, networking, and education.We designed and validated a test system that simulates a growth environment for Zea mays L. maize seedlings under conditions of low moisture gradient in darkness. This system allowed us to simultaneously measure mesocotyl elongation and the primary root hydrotropic response in seedlings before the emergence phase in a collection of maize hybrids. We found great variation in these two traits with statistically significant reduction of their elongations under the low moisture gradient condition that indicate the richness of maize genetic diversity. Hence, the objective of designing a new test system that evaluates the association between these underground traits with the potential use to measure other traits in maize seedlings related to early vigor was achieved.

To describe a case of idiopathic cricopharyngeal achalasia (CPA) in a pediatric patient with acute onset of dysphagia managed conservatively with supportive care.

Sixteen-month-old boy presented with acute onset of gagging and coughing with feeding. His exam was notable for a well-appearing child with pooling of oral secretions and coarse breath sounds. Plain film series did not show radio-opaque foreign body (FB) and an esophagram demonstrated an endoluminal filling defect of the cervical esophagus and aspiration of contrast. He was taken to the operating room for urgent endoscopy but no FB or food impaction was observed. He had persistent symptoms that required further evaluation and a multidisciplinary team approach. Bedside laryngoscopy did not reveal any abnormalities. Modified barium swallow (MBS) study revealed upper esophageal sphincter (UES) dysfunction, consistent with cricopharyngeal achalasia. Repeat upper endoscopy with biopsies demonstrated mucosal irritation overlying the UES but histologic studies were negative for infectious causes.

He was treated with supportive care, including nasogastric feedings for nutrition supplementation as he was unable to tolerate oral feedings without aspiration. Over the course of 3 months after discharge, his symptoms resolved and repeat MBS was normal.

CPA is a rare cause of dysphagia in the pediatric population. Conservative management with supportive care is a reasonable approach in cases with acute onset in otherwise healthy children without underlying medical problems.

CPA is a rare cause of dysphagia in the pediatric population. Conservative management with supportive care is a reasonable approach in cases with acute onset in otherwise healthy children without underlying medical problems.The sticky platelet syndrome (SPS) was described by Mammen in 1983. Since then, scientists in several countries have identified the condition and published cases or series of patients, thus enabling the description of the prevalence of the inherited condition, its salient clinical features, and the treatment of the disease. The diagnosis of the SPS phenotype requires fresh blood samples and special equipment which is not available in all coagulation laboratories. In the era of molecular biology, up to now it has not been possible to define a clear association of the SPS phenotype with a specific molecular marker. Some molecular changes which have been described in platelet proteins in some persons with the phenotype of the SPS are here discussed. Nowadays, the SPS phenotype may be considered as a risk factor for thrombosis and most cases of the SPS developing vaso-occlussive episodes are the result of its coexistence with other thrombosis-prone conditions, some of the inherited and some of them acquired, thus leading to the concept of multifactorial thrombophilia. Ignoring all these evidence-based concepts is inappropriate, same as stating that the SPS is a nonentity simply because not all laboratories are endowed with adequate equipment to support the diagnosis.The novel gambling disorder identification test (GDIT) was recently developed in an international Delphi and consensus process. In this first psychometric evaluation, gamblers (N = 603) were recruited from treatment- and support-seeking contexts (n = 79 and n = 185), self-help groups (n = 47), and a population sample (n = 292). Participants completed self-report measures, a GDIT retest (n = 499), as well as diagnostic semistructured interviews assessing gambling disorder (GD; n = 203). The GDIT showed excellent internal consistency reliability (α = .94) and test-retest reliability (6-16 days, intraclass correlation coefficient = 0.93). Confirmatory factor analysis yielded factor loadings supporting the three proposed GDIT domains of gambling behavior, gambling symptoms, and negative consequences. Receiver operator curves and clinical significance indicators were used to estimate GDIT cut-off scores in relation to recreational ( less then 15) and problem gambling (15-19), any GD (≥20), mild GD (20-24), moderate GD (25-29), and severe GD (≥30). The GDIT can be considered a valid and reliable measure to identify and predict GD severity, as well as problem gambling. In addition, the GDIT improves content validity in relation to an international research agreement concerning features of gambling outcome measures, known as the Banff Consensus Agreement.

Cigarette smoking is associated with primary spontaneous pneumothorax (PSP). Electronic cigarettes (E-cigarettes) are touted as a healthier alternative to cigarettes; however, the impact E-cigarette use has on PSP management is not known. The goal of this study was to determine if E-cigarette use is associated with inferior outcomes after PSP, compared to never smokers and cigarette smokers.

We conducted a retrospective cohort study of patients in a large tertiary care hospital system in an urban area who presented with PSP from September 2015 through February 2019. Primary spontaneous pneumothorax patients were identified from the institutional Society of Thoracic Surgeon (STS) database. Patients with pneumothoraces from traumatic, iatrogenic, and secondary etiologies were excluded. Baseline clinical and demographic data and outcomes including intervention(s) required, length of stay, and recurrence were evaluated.

Identified were 71 patients with PSP. Seventeen (24%) had unverifiable smoking history. Of the remaining, 7 (13%) currently vaped, 27(50%) currently smoked cigarettes, and 20(37%) were never smokers. Mean age was 33years; 80% male. All vapers required tube thoracostomy vs 74% of current smokers and 75% of never smokers. Vaping was associated with increased odds of recurrence compared to never smokers (OR 2.00, 95% CI 0.35,11.44). Vapers had the shortest median time to recurrence after initial hospitalization (10d[4,18] v 20d[5,13] cigarette smokers v 27d[13275] never smokers,

< .001).

Vaping may complicate PSP outcomes. As vaping use increases, especially among adolescents, it is imperative that the manner of tobacco use is documented and considered when caring for patients, especially those with pulmonary problems.

Vaping may complicate PSP outcomes. As vaping use increases, especially among adolescents, it is imperative that the manner of tobacco use is documented and considered when caring for patients, especially those with pulmonary problems.Men and women differ in outcomes following mild traumatic brain injury (TBI). In the CENTER-TBI study, we previously found that women had worse 6-month functional outcome (Glasgow Outcome Score Extended (GOSE)), health-related quality of life (HRQoL), and mental health following mild TBI. The aim of this study was to investigate whether those differences were mediated by psychiatric history, gender- related sociodemographic variables, or by care pathways. We analyzed sex/gender differences in 6-month GOSE, generic and TBI-specific HRQoL, post-concussion and mental health symptoms using three sets of mediators psychiatric history, sociodemographic variables (living alone, living with children, education and employment status/job category), and care-pathways (referral to study hospital and discharge destination after Emergency Room); while controlling for a substantial number of potential confounders (pre-injury health, and injury-related characteristics). We included 1842 men and 1022 women (16+) with a Glasgow Coma Score 13-15, amongst whom 83% had GOSE available and about 60% other 6-month outcomes. We used natural effects models to decompose the total effect of sex/gender on the outcomes into indirect effects that passed through the specified mediators, and the remaining direct effects. In our study population, women had worse outcomes and these were only partly explained by psychiatric history, and not considerably explained by sociodemographic variables nor by care pathways. Other factors than differences in specified variables seem to underlie observed differences between men and women in outcomes after mild TBI. Future studies should explore more aspects of gender roles and identity, and biological factors underpinning sex and gender differences in TBI outcomes.

Literature on radiologist-patient communication of musculoskeletal ultrasonography (US) results is currently lacking.

To investigate the patient’s view on receiving the results from a radiologist after a musculoskeletal US examination, and the additional time required to provide such a service.

This prospective study included 106 outpatients who underwent musculoskeletal US, and who were equally randomized to either receive or not receive the results from the radiologist directly after the examination.

In both randomization groups, all quality performance metrics (radiologist’s friendliness, explanation, skill, concern for comfort, concern for patient questions/worries, overall rating of the examination, and likelihood of recommending the examination) received median scores of good/high to very good/very high. Patients who had received their US results from the radiologist rated the radiologist’s explanation and concern for patient questions/worries as significantly higher (

 = 0.009 and

 = 0.002) ent experience can be further enhanced if a radiologist adds this communication to the examination. However, this increases total examination time and therefore costs.Finite element (FE) models of the human head are valuable instruments to explore the mechanobiological pathway from external loading, localized brain response, and resultant injury risks. The injury predictability of these models depends on the use of effective criteria as injury predictors. The FE-derived normal deformation along white matter (WM) fiber tracts (i.e., tract-oriented strain) has recently been suggested as an appropriate predictor for axonal injury. However, the tract-oriented strain only represents a partial depiction of the WM fiber tract deformation. A comprehensive delineation of tract-related deformation may improve the injury predictability of the FE head model by delivering new tract-related criteria as injury predictors. Thus, the present study performed a theoretical strain analysis to comprehensively characterize the WM fiber tract deformation by relating the strain tensor of the WM element to its embedded fiber tract. Three new tract-related strains with exact analytical solutions were proposed, measuring the normal deformation perpendicular to the fiber tracts (i.e., tract-perpendicular strain), and shear deformation along and perpendicular to the fiber tracts (i.e., axial-shear strain and lateral-shear strain, respectively). The injury predictability of these three newly-proposed strain peaks along with the previously-used tract-oriented strain peak and maximum principal strain (MPS) were evaluated by simulating 151 impacts with known outcome (concussion or non-concussion). The results preliminarily showed that four tract-related strain peaks exhibited superior performance than MPS in discriminating concussion and non-concussion cases. This study presents a comprehensive quantification of WM tract-related deformation and advocates the use of orientation-dependent strains as criteria for injury prediction, which may ultimately contribute to an advanced mechanobiological understanding and enhanced computational predictability of brain injury.We aimed to analyze the number and distribution of doping control tests in which a banned substance was reported (i.e., adverse analytical finding) in aquatics. The analysis was performed by using the data provided by the WADA Testing Figure Reports from 2015 to 2019. A total of 79,956 doping control tests were analyzed. Sprint swimming, middle-distance swimming and water polo were the disciplines with the highest number of doping control tests. However, there were no differences in the frequency of adverse findings among disciplines (overall, ∼0.56%, from 0.13 in artistic swimming to 0.76% in sprint swimming). Sprinters and long-distance swimmers presented a higher frequency of beta-2-agonists than the remaining aquatic disciplines (p less then 0.05). These results indicate that the type of prohibited substances employed is strongly influenced by the intrinsic characteristics of each aquatic discipline.Background The efficacy and safety of a house dust mite sublingual tablet (HDM-tab) have been demonstrated in clinical trials, but the findings must be confirmed in real-world use among more widespread patient populations. Materials & methods A postmarketing drug-use survey is assessing the drug’s safety and effectiveness during routine use for up to 4 years. This 2-year interim analysis reports data collected up to March 2020. Results Of 545 registered outpatients, 526 were evaluable for safety and 371 for effectiveness. Most common adverse drug reactions were local reactions. Mean rhinitis severity score decreased from 2.5 ± 0.8 at baseline to 1.4 ± 0.9, 1.1 ± 0.8 and 1.0 ± 0.8 at 6 months, 1 year and 2 years, respectively. Conclusion The HDM tab appears to be safe and effective in real-world conditions during 2 years of continuous use. Trial registration number University hospital Medical Information Network (UMIN) Clinical Trials Registry identifier UMIN000042840.Tweetable abstract The diagnostic application of genome-wide methylation signatures is increasing in various syndromic forms of autism, but further studies are warranted to clarify whether epigenetic biomarkers can be of diagnostic utility in idiopathic ASD.

The optimal serum thyroid-stimulating hormone (TSH) level for post-lobectomy papillary thyroid carcinoma (PTC) patients is unclear. The objective of this study was to examine the association of TSH and recurrence in post-lobectomy patients.

Patients who underwent lobectomy for PTC in a single tertiary hospital from January 2000 to December 2014 were enrolled. The mean TSH of a patient was calculated based on each serum TSH value during follow-up. The reference range of serum TSH was 0.5-4.0 mU/L. Univariate and multivariable analyses were performed with Cox proportional hazards models. Restricted cubic spline (RCS) functions were used to model relationships between mean TSH and recurrence-free survival (RFS).

A total of 2297 patients (median age, 42 years; 1750 (76.2%) female) were analyzed. Mean TSH below (≤0.5mU/L), in the lower half (0.6-2 mU/L), in the upper half (2.1-4 mU/L) and above (>4 mU/L) the reference range were observed in 668 (29.1%), 1162 (50.6%), 345 (15.0%), and 122 (5.3%) patients, respectively. According to the Cox model and RCS, no association was observed between mean TSH and RFS in the whole cohort, low-risk group and intermediate- to high-risk groups (adjusted P=0.4737, 0.9314, 0.1859, adjusted P for nonlinear=0.4589, 0.8622, 0.3010). The only RFS difference observed in the stratified univariate analysis was between patients with mean TSH in the lower half (0.6-2 mU/L, n=659) and above the reference range (>4 mU/L, n=68) in the intermediate- to high-risk group (10-year RFS by Kaplan-Meier 84.4% vs 69.4%, log rank p=0.011).

Mean serum TSH levels are not associated with recurrence. A normal TSH reference range is recommended for post-lobectomy PTC patients.

Mean serum TSH levels are not associated with recurrence. A normal TSH reference range is recommended for post-lobectomy PTC patients.Glucocorticoids have anti-inflammatory and immunosuppressive functions and have commonly been used for preventing liver toxicity after the systemic application of a high dose of adeno-associated virus (AAV) vector for gene therapy. Clinical studies have reported that glucocorticoids have rescued Factor IX (FIX) expression in hemophilia B patients who showed a reduced FIX expression at 6 to 10 weeks post-AAV vector administration. In this study, we explored whether glucocorticoids could affect transgene expression in AAV targeted livers in animal models. When dexamethasone was applied before AAV9/FIX vector administration in the wild-type C57BL/6 mice, FIX expression was much higher than that of the control mice at any time points. More importantly, FIX expression transiently increased after dexamethasone was administered at week 6 or later post-AAV injection regardless of the various dexamethasone treatments applied. The transient enhancement in transgene expression was observed once there were one to several consecutive dexamethasone treatments completed. A similar result was also achieved in another wild type BALB/c and hemophilia B mice that were treated with AAV9/FIX and dexamethasone. This mechanism study demonstrated that the administration of dexamethasone did not change either AAV genome copy number or transgene expression at the transcription level but transiently decreases IFN-β and TNF-α expression in the livers of mice at a later time after AAV injection. Next, we studied the effect of dexamethasone on late transgene expression in hemophilia B dogs. Dexamethasone was administered 1 year after AAV9/FIX injection. Inconsistent with the results in mice, no significant change of FIX expression was observed in hemophilia B dogs. In summary, the results from this study indicate that dexamethasone may have various effects on transgene expression in AAV transduced livers in different species, which provides valuable information about the rational application of dexamethasone in future clinical studies.The summer Olympic Games is the major mega sports event since the first modern era Olympiad, held in Athens, Greece in 1896. International Olympic Committee (IOC) has the responsibility of the organization of the summer and winter Games ensuring the broadcast in all corners of earth. The World Anti-Doping Agency (WADA) is the responsible organization of the fight against doping in sports. IOC and WADA support the event’s country WADA Accredited Laboratory to incorporate the maximum of the new analytical technologies to become applicable during the event’s antidoping testing. The current study reviewed the last 5 years progresses of the antidoping system with emphasis on the laboratory field.Antimicrobial photodynamic therapy (APDT) employs a photosensitizer, light, and molecular oxygen to treat infectious diseases via oxidative damage, with a low likelihood for the development of resistance. For optimal APDT efficacy, photosensitizers with cationic charges that can permeate bacteria cells and bind intracellular targets are desired to not limit oxidative damage to the outer bacterial structure. Here we report the application of brominated DAPI (Br-DAPI), a water-soluble, DNA-binding photosensitizer for the eradication of both Gram-negative and Gram-positive bacteria (as demonstrated on N99 Escherichia coli and Bacillus subtilis, respectively). We observe intracellular uptake of Br-DAPI, ROS-mediated bacterial cell death via one- and two-photon excitation, and selective photocytotoxicity of bacteria over mammalian cells. Photocytotoxicity of both N99 E. coli and B. subtilis occurred at submicromolar concentrations (IC50 = 0.2-0.4 μM) and low light doses (5 min irradiation times, 4.5 J cm-2 dose), making it superior to commonly employed APDT phenothiazinium photosensitizers such as methylene blue. Given its high potency and two-photon excitability, Br-DAPI is a promising novel photosensitizer for in vivo APDT applications.A series of new ternary lanthanide-based chlorides, Cs2EuCl5(H2O)10, Cs7LnCl10(H2O)8 (Ln = Gd or Ho), Cs10Tb2Cl17(H2O)14(H3O), Cs2DyCl5(H2O)6, Cs8Er3Cl17(H2O)25, and Cs5Ln2Cl11(H2O)17 (Ln = Y, Lu, or Yb), were prepared as single crystals via a facile solution route. The compounds with compositions of Cs7LnCl10(H2O)8 (Ln = Gd or Ho) and Cs5Ln2Cl11(H2O)17 (Ln = Y, Lu, or Yb) crystallize in a monoclinic crystal system in space groups C2 and P21/c, respectively, whereas Cs2EuCl5(H2O)10, Cs10Tb2Cl17(H2O)14(H3O), and Cs8Er3Cl17(H2O)25 crystallize in orthorhombic space groups Pbcm, Pnma, and P212121, respectively. Cs2DyCl5(H2O)6 crystallizes with triclinic symmetry in space group P1̅. All of these compounds exhibit complex three-dimensional structures built of isolated lanthanide polyhedral units that are linked together by extensive hydrogen bonds. Cs2EuCl5(H2O)10 and Cs10Tb2Cl17(H2O)14(H3O) luminesce upon irradiation with 375 nm ultraviolet light, emitting intense orange-red and green color, respectively, and Cs10Tb2Cl17(H2O)14(H3O) scintillates when exposed to X-rays. Radioluminescence (RL) measurement of Cs10Tb2Cl17(H2O)14(H3O) in powder form shows that the RL emission integrated in the range of 300-750 nm was ∼16% of BGO powder.We investigated the temperature-dependent phase behavior and interaction parameter of polyethylene-based multiblock copolymers with pendant ionic groups. These step-growth polymers contain short polyester blocks with a single Li+SO3- group strictly alternating with polyethylene blocks of x-carbons (PESxLi, x = 12, 18, 23). At room temperature, these polymers exhibit layered morphologies with semicrystalline polyethylene blocks. Upon heating above the melting point (∼130 °C), PES18Li shows two order-to-order transitions involving Ia3̅d gyroid and hexagonal morphologies. For PES12Li, an order-to-disorder transition accompanies the melting of the polyethylene blocks. Notably, a Flory-Huggins interaction parameter was determined from the disordered morphologies of PES12Li using mean-field theory χ(T) = 77.4/T + 2.95 (T in Kelvin) and χ(25 °C) ≈ 3.21. This ultrahigh χ indicates that the polar ionic and nonpolar polyethylene segments are highly incompatible and affords well-ordered morphologies even when the combined length of the alternating blocks is just 18-29 backbone atoms. This combination of ultrahigh χ and short multiblocks produces sub-3-nm domain spacings that facilitate the control of block copolymer self-assembly for various fields of study, including nanopatterning.Gas-phase hydrocarbon autoxidation is a rapid pathway for the production of in situ aerosol precursor compounds. It is a highway to molecular growth and lowering of vapor pressure, and it produces hydrogen-bonding functional groups that allow a molecule to bind into a substrate. It is the crucial process in the formation and growth of atmospheric secondary organic aerosol (SOA). Recently, the rapid gas-phase autoxidation of several volatile organic compounds (VOC) has been shown to yield highly oxygenated organic molecules (HOM). Most of the details on HOM formation have been obtained from biogenic monoterpenes and their surrogates, with cyclic structures and double bonds both found to strongly facilitate HOM formation, especially in ozonolysis reactions. Similar structural features in common aromatic compounds have been observed to facilitate high HOM formation yields, despite the lack of appreciable O3 reaction rates. Similarly, the recently observed autoxidation and subsequent HOM formation in the oxidation of saturated hydrocarbons cannot be initiated by O3 and require different mechanistic steps for initiating and propagating the autoxidation sequence. This Perspective reflects on these recent findings in the context of the direct aerosol precursor formation in urban atmospheres.Trehalose is widely assumed to be the most effective sugar for protein stabilization, but exactly how unique the structure is and the mechanism by which it works are still debated. Herein, we use a polyion complex micelle approach to control the position of trehalose relative to the surface of glucose oxidase within cross-linked and non-cross-linked single-enzyme nanoparticles (SENs). The distribution and density of trehalose molecules in the shell can be tuned by changing the structure of the underlying polymer, poly(N-[3-(dimethylamino)propyl] acrylamide (PDMAPA). SENs in which the trehalose is replaced with sucrose and acrylamide are prepared as well for comparison. Isothermal titration calorimetry, dynamic light scattering, and asymmetric flow field-flow fraction in combination with multiangle light scattering reveal that two to six polymers bind to the enzyme. Binding either trehalose or sucrose close to the enzyme surface has very little effect on the thermal stability of the enzyme. By contrast, encapsulation of the enzyme within a cross-linked polymer shell significantly enhances its thermal stability and increases the unfolding temperature from 70.3 °C to 84.8 °C. Further improvements (up to 92.8 °C) can be seen when trehalose is built into this shell. Our data indicate that the structural confinement of the enzyme is a far more important driver in its thermal stability than the location of any sugar.The lithium (Li)-metal anode is deemed as the „holy gray” of the next-generation Li-metal system because of its high theoretical specific capacity, minimal energy density, and lowest standard electrode potential. Nevertheless, its commercial application has been limited by the large volume variation during charge and discharge, the unstable interface between the Li metal and electrolyte, and uneven deposition of Li. Herein, we present a 3D host (Cu) with lithiophilic matrix (CuO and SnO2) in situ modification via a facile ammonia oxidation method to serve as a current collector for the Li-metal anode. The 3D Cu host embellished by CuO and SnO2 is abbreviated as 3D CSCC. By increasing interfacial activity, lowering the nucleation barrier, and accommodating changes in volume of the Li metal, the 3D CSCC electrode effectively demonstrates a homogeneous and dendrite-free deposition morphology with an excellent cycling performance up to 3000 h at a 1.0 mA cm-2 current density. Additionally, the full cells paired with Li@3D CSCC anodes and LiCoO2 cathodes show good capacity retention performance at 0.2 C.Phthalic acid esters (PAEs) are the most common plasticizers, approximately 90% of which are used in polyvinyl chloride (PVC) products, but they are also endocrine disruptors that have attracted considerable attention. The metabolism of PAEs in PVC products in China from 1958 to 2019 was studied using dynamic material flow analysis. The results showed that the total consumption of PAEs was 29.2 Mt in the past 60 years. By 2019, the in-use stocks of PAEs were 5.0 Mt. Construction materials were always in the leading position with respect to the consumption and in-use stocks of PAEs. A total PAE loss of 22.7 Mt was generated, of which 68.0% remained in waste distributed in landfills (50.1%), storage sites (5.5%), the environment (44.4%), 12.4% was eliminated during waste incineration and open burning, and 19.6% was emitted into the environment. From 1958 to 2019, 496.4, 55.6, and 3905.0 kt of PAEs were emitted into water, air, and soil, respectively. The use and waste treatment stages contributed 79.3 and 19.9% of the emissions of PAEs in the life cycle, respectively.