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Solid Oxide Cell (SOC) technology is considered as an efficient electrolysis technology to produce hydrogen at large scale. It can also operate in fuel cell mode using different fuels (carbon-based or non-carbon based like ammonia), and in reversible mode. Though proofs-of concept have been achieved at different relevant scales for those operating modes, some R&D works still need to be performed to improve performance, durability and cost. Improved and upscaled cells and stacks need to be developed, with a methodology combining multiscale and multiphysics modelling, electrochemical characterization in relevant conditions and advanced post-test analysis. Their integration into modules made of several stacks is also a stepping stone in order to reach multi-MW electrolysers. CEA is working on the whole value chain of SOC technology, from cell development and optimisation to module design and operation through stack upscaling. Recent achievements on those aspects will be presented.

Purpose: Patients with metastatic or recurrent Ewing’s sarcoma family of tumors and alveolar rhabdomyosarcoma have Experimental Design: Fifty-two patients with translocation positive, recurrent, or metastatic Ewing’s sarcoma family of tumors or alveolar rhabdomyosarcoma underwent prechemotherapy cell harvest via apheresis for potential receipt of immunotherapy. Following completion of standard multimodal therapy, 30 patients ultimately initiated immunotherapy and were sequentially assigned to three cohorts. All cohorts received autologous T cells, influenza vaccinations, and dendritic cells pulsed with peptides derived from tumor-specific translocation breakpoints and E7, a peptide known to bind HLA-A2. Cohort 1 received moderate-dose recombinant human interleukin-2 (rhIL-2), cohort 2 received low-dose rhIL-2, and cohort 3 did not receive rhIL-2.Results: All immunotherapy recipients generated influenza-specific immune responses, whereas immune responses to the translocation breakpoint peptides occurred in 39%, and only 25% of HLA-A2+ patients developed E7-specific responses. Toxicity was minimal. Intention-to-treat analysis revealed a 31% 5-year overall survival for all patients apheresed (median potential follow-up 7.3 years) with a 43% 5-year overall survival for patients initiating immunotherapy.Conclusions: Consolidative immunotherapy is a scientifically based and clinically practical approach for integrating immunotherapy into a multimodal regimen for chemoresponsive cancer. Patients receiving immunotherapy experienced minimal toxicity and favorable survival. The robust influenza immune responses observed suggest that postchemotherapy immune incompetence will not fundamentally limit this approach. Future studies will seek to increase efficacy by using more immunogenic antigens and more potent dendritic cells.

Supplementary Tables S1-S3 from A Pilot Study of Consolidative Immunotherapy in Patients with High-Risk Pediatric Sarcomas

This study aimed at characterizing the effects of dietary l-carnitine supplementation on hepatic fatty acid (FA) metabolism during inflammation in mid-lactating cows. Fifty-three pluriparous Holstein dairy cows were randomly assigned to either a control (CON, n = 26) or an l-carnitine supplemented (CAR; n = 27) group. The CAR cows received 125 g of a rumen-protected l-carnitine product per cow per day (corresponding to 25 g of l-carnitine/cow per day) from d 42 antepartum (AP) until the end of the trial on d 126 postpartum (PP). Aside from the supplementation, the same basal diets were fed in the dry period and during lactation to all cows. In mid lactation, each cow was immune-challenged by a single intravenous injection of 0.5 μg of LPS/kg of BW at d 111 PP. Blood samples were collected before and after LPS administration. The mRNA abundance of in total 39 genes related to FA metabolism was assessed in liver biopsies taken at d -11, 1, and 14 relative to LPS (d 111 PP) and also on d 42 AP as an individual covariate using microfluidics integrated fluidic circuit chips (96.96 dynamic arrays). In addition to the concentrations of 3 selected proteins related to FA metabolism, acetyl-CoA carboxylase α (ACACA), 5' AMP-activated protein kinase (AMPK), and solute carrier family 25 member 20 (SLC25A20) were assessed by a capillary Western blot method in liver biopsies from d -11 and 1 relative to LPS from 11 cows each of CAR and CON. On d -11 relative to LPS, differences between the mRNA abundance in CON and CAR were limited to acyl-CoA dehydrogenase (ACAD) very-long-chain (ACADVL) with greater mRNA abundance in the CAR than in the CON group. The liver fat content decreased from d -11 to d 1 relative to the LPS injection and remained at the lower level until d 14 in both groups. One day after the LPS challenge, lower mRNA abundance of carnitine palmitoyltransferase 1 (CPT1), CPT2, ACADVL, ACAD short-chain (ACADS), and solute carrier family 22 member 5 (SLC22A5) were observed in the CAR group as compared with the CON group. However, the mRNA abundance of protein kinase AMP-activated noncatalytic subunit gamma 1 (PRKAG1), ACAD medium-chain (ACADM), ACACA, and FA binding protein 1 (FABP1) were greater in the CAR group than in the CON group on d 1 relative to LPS. Two weeks after the LPS challenge, differences between the groups were no longer detectable. The altered mRNA abundance before and 1 d after LPS pointed to increased transport of FA into hepatic mitochondria during systemic inflammation in both groups. The protein abundance of AMPK was lower in CAR than in CON before the LPS administration. The protein abundance of SLC25A20 was neither changing with time nor treatment and the ACACA protein abundance was only affected by time. In conclusion, l-carnitine supplementation temporally altered the hepatic mRNA abundance of some genes related to mitochondrial biogenesis and very-low-density lipoprotein export in response to an inflammatory challenge, but with largely lacking effects before and 2 wk after LPS.

Posttraumatic stress disorder commonly occurs among U.S. military veterans. Therapeutic horseback riding (THR) has emerged as an adjunct therapy. We explored 20 veterans’ perceived benefits, drawbacks and views of a 6-week THR program. Participants had confirmed diagnoses of posttraumatic stress disorder, traumatic brain injury, or both. Veterans rode the same horse weekly, the same day, at the same time. Data were collected as part of a randomized clinical trial testing the effects of THR on Post-Traumatic Stress Disorder. Veterans responded to an open-ended questionnaire. Content analysis was used for data analysis. Benefits were “Connection to the Horse,” “Relaxing,” “180 Degree Change,” and “Meeting New People.” Drawbacks were “None,” “Struggle to Get There,” “Pain,” “Too Short,” and “It is Structured.” Overall perceptions were “I Absolutely Loved It,” “Feel Again,” “The Horse,” “The People,” and “No Worries.” Participants viewed THR as positive. Findings may elucidate why THR may be clinically beneficial.

Liver transplantation has been underway for several decades, becoming a curative and life-prolonging treatment for individuals experiencing acute liver failure, end-stage liver disease, and/or hepatocellular carcinoma. Several trends have emerged to better select recipients and identify indicators for successful transplantation in light of the shortage of available organs relative to the number of people awaiting transplantation. In addition, different perfusion approaches have been studied to better understand how to achieve favorable outcomes during and after liver transplantation.

Asthma is a disease characterized by reversible bronchoconstriction, but some subjects develop fixed airflow obstruction (FAO). Subjects with FAO present more asthma symptoms and may have increased sedentary behavior; however, the effect of FAO on aerobic fitness and physical activity levels (PAL) remains poorly understood. AIM To compare adolescents with asthma and FAO and adolescents with asthma without FAO in terms of aerobic fitness, PAL, muscle strength, and health-related quality of life (HRQoL). METHODS This cross-sectional study included adolescents with asthma, both sexes, and aged 12-18 years. They were divided into two groups: FAO and non-FAO groups. The adolescents were diagnosed with asthma according to the Global Initiative for Asthma guidelines and underwent optimal pharmacological treatment for at least 12 months. FAO was diagnosed when the forced expiratory volume in the first second/forced vital capacity ratio was below the lower limit of the normal range after optimal treatment. Aerobic fitness, PAL, peripheral and respiratory muscle strength, and HRQoL were evaluated. RESULTS No significant differences were observed between FAO and non-FAO groups regarding the peak oxygen uptake (34.6 ± 8.5 vs. 36.0 ± 8.4 mLO2 /min/kg), sedentary time (578 ± 126 vs. 563 ± 90 min/day), upper limb muscle strength (29.1 ± 5.9 vs. 28.1 ± 5.7 kilograms of force [kgf]), lower limb muscle strength (42.8 ± 8.6 vs. 47.6 ± 9.6 kgf), or HRQoL (5.1 ± 1.3 vs. 4.7 ± 1.4 score; p > .05). However, the FAO group exhibited a higher maximal expiratory pressure than the non-FAO group (111.5 ± 15.5 vs. 101.5 ± 15.0 cmH2 O, respectively). CONCLUSION Our results suggest that FAO does not impair aerobic fitness, PAL, peripheral muscle strength, or HRQoL in adolescents with asthma. Furthermore, adolescents with asthma were physically deconditioned.

Additional file1: Table S1. List of metabolites measured bythe Absolute-IDQ p180 Kit.

Dairy cows respond individually to stressful situations, even under similar feeding and housing conditions. The phenotypic responsiveness might trace back to their microbiome and its interactions with the host. This long-term study investigated the effects of calving, lipopolysaccharide (LPS)-induced inflammation, and l-carnitine supplementation on fecal bacteria and metabolites, dairy cow milk production, health, energy metabolism, and blood metabolites. Fifty-four multiparous Holstein dairy cows were examined over a defined period of life (168 days). The obtained data allowed a holistic analysis combining microbiome data such as 16S rRNA amplicon sequencing and fecal targeted metabolome (188 metabolites) with host parameters. The conducted analyses allowed the definition of three enterotype-like microbiome clusters in dairy cows which could be linked to the community diversity and dynamics over time. The microbiome clusters were discovered to be treatment independent, governed by Bifidobacterium (C-Bifi), unclassified (uncl.) Clostridiales (C-Clos), and unclassified Spirochaetaceae (C-Spiro). Animals between the clusters varied significantly in terms of illnesses, body weight, microbiome composition, and milk and blood parameters. C-Bifi animals were healthier and leaner with a less diverse but dynamic microbiome. C-Spiro animals were heavier, but the diversity of the static microbiome was higher. This pioneering study uncovered microbiome clusters in dairy cows, each contributing differently to animal health and productive performance and with a crucial role of Bifidobacterium. IMPORTANCE The health of dairy cows has to be carefully considered for sustainable and efficient animal production. The microbiome of animals plays an important role in the host’s nutrient supply and regulation of immune functions. We show that a certain composition of the fecal microbiome, called microbiome clusters, can be linked to an animal’s health at challenging life events such as calving and inflammation. Cows with a specific set of bacteria have coped better under these stressors than have others. This novel information has great potential for implementing microbiome clusters as a trait for sustainable breeding strategies.

Lipopolysaccharides (LPS) challenge the metabolic integrity of high-yielding dairy cows, activating the immune system and altering energy metabolism. Fatty acid oxidation, a major energy-gaining pathway, can be improved by supplementary carnitine, facilitating the transport of fatty acids into mitochondria. The metabolic response to the LPS challenge could alter both the plasma and the milk metabolome. Plasma and milk samples collected from cows treated with ( n = 27) or without ( n = 27) dietary carnitine, before and after intravenous administration of LPS, were subjected to a targeted metabolomics analysis. Multivariate statistical analyses revealed that both plasma and milk metabolome changed in response to the LPS challenge in both the carnitine-supplemented and the control cows. Short-chain acylcarnitines (carbon chain length C2, C3, C4, and C5) and long-chain acylcarnitines (C14, C16, and C18) had the highest performance to indicate LPS response when testing the predictive power of single metabolites using receiver-operator characteristics (ROC) analysis. The maximum area under a ROC curve (AUC) was 0.93. Biogenic amines, including sarcosine, and amino acids such as glutamine and isoleucine had AUC > 0.80 indicating metabolic changes due to the LPS challenge. In summary, the metabolites involved in the LPS response were acylcarnitines C2 and C5, sarcosine, glutamine, and isoleucine in plasma, and acylcarnitines C4 and C5 in milk. The interrelationship of plasma and milk metabolome included correlation of acylcarnitines C2, C4, and C5 between plasma and milk.

Introduction: Epicardial fat (EF) is biologically active and, through its paracrine effect, interacts with the atrial myocardium and may be involved in the atrial remodeling observed in obese individuals. P-wave duration (PWD) is a non-invasive marker of atrial conduction time and reflects changes related to atrial remodeling. The effects of the reduction of EF induced by bariatric surgery on PWD have not yet been defined. Methods: We prospectively recruited 22 morbidly obese patients with no other comorbidities at the Unidade de Cirurgia Bariátrica (Bariatric Surgery Unit) of Unviversidade de São Paulo’s Hospital das Clínicas. The patients were submitted to clinical and laboratorial evaluations, 12-lead eletrocardiography (ECG), two-dimensional echocardiogram and 24 h Holter. The same evaluation was performed 12 months after bariatric surgery. In order to make a comparison of the continuous variables, we used the paired and Wilcoxon T tests. To evaluate the association between independent variables, a regression model was used for repeated measures. Results: A total of 20 patients completed the protocol (age: 36.35 ± 10.26 years, 18 women). There was a significant reduction of PWD, body mass index (BMI) and EF after bariatric surgery (p

Introduction: Epicardial fat (EF) is biologically active and, through its paracrine effect, interacts with the atrial myocardium and may be involved in the atrial remodeling observed in obese individuals. P-wave duration (PWD) is a non-invasive marker of atrial conduction time and reflects changes related to atrial remodeling. The effects of the reduction of EF induced by bariatric surgery on PWD have not yet been defined. Methods: We prospectively recruited 22 morbidly obese patients with no other comorbidities at the Unidade de Cirurgia Bariátrica (Bariatric Surgery Unit) of Unviversidade de São Paulo’s Hospital das Clínicas. The patients were submitted to clinical and laboratorial evaluations, 12-lead eletrocardiography (ECG), two-dimensional echocardiogram and 24 h Holter. The same evaluation was performed 12 months after bariatric surgery. In order to make a comparison of the continuous variables, we used the paired and Wilcoxon T tests. To evaluate the association between independent variables, a regression model was used for repeated measures. Results: A total of 20 patients completed the protocol (age: 36.35 ± 10.26 years, 18 women). There was a significant reduction of PWD, body mass index (BMI) and EF after bariatric surgery (p

Background Sickle cell disease (SCD) may cause several impacts to patients and the whole society. About 4% of the population has the sickle cell trait in Brazil, and 60,000 to 100,000 have SCD. However, despite recognizing the significant burden of disease, little is known about SCD costs. Objective To estimate SCD societal costs based on disease burden modelling, under Brazilian societal perspective. Methods A disease burden model was built considering the societal perspective and a one-year time horizon, including direct medical and indirect costs (morbidity and mortality). The sum of life lost and disability years was considered to estimate disability-adjusted life years (DALYs). Data from a public database (DATASUS) and the prevalence obtained from literature or medical experts were used to define complications prevalence and duration. Costs were defined using data from the Brazilian public healthcare system table of procedures and medications (SIGTAP) and the human capital method. Results Annual SCD cost was 413,639,180 USD. Indirect cost accounted for the majority of burden (70.1% of the total; 290,158,365 USD vs 123,480,816 USD). Standard of care and chronic complications were the main source of direct costs among adults, while acute conditions were the main source among children. Vaso-occlusive crisis represented the complication with the highest total cost per year in both populations, 11,400,410 USD among adults and 11,510,960 USD among children. Conclusions SCD management may impose an important economic burden on Brazilian society that may reach more than 400 million USD per year.

Supplemental material to the journal article: Xu, Grindler et al., 2021. Increased plasma and milk short-chain acylcarnitines concentrations reflect systemic LPS response in mid-lactation dairy cows

Simple Summary Dairy cows develop metabolic diseases especially in the transition period due to high energy requirements for the process of calving, beginning milk production and, simultaneously, restricted feed intake capacity. L-carnitine is endogenously synthesised as an obligatory, quaternary amine for the initial step of ß-oxidation, but with the onset of lactation it is also excreted with milk, whereby its availability for other metabolic pathways might be limited. Supplemental L-carnitine might be able to fill in this apparent gap and to enhance the efficiency of ß-oxidation, whereby the magnitude of negative energy balance would be decreased. The present experiment mainly focused on the energy-consuming process of calving itself and on the energy metabolism during the first weeks of lactation. Abstract Dairy cows are metabolically challenged during the transition period. Furthermore, the process of parturition represents an energy-consuming process. The degree of negative energy balance and recovery from calving also depends on the efficiency of mitochondrial energy generation. At this point, L-carnitine plays an important role for the transfer of fatty acids to the site of their mitochondrial utilisation. A control (n = 30) and an L-carnitine group (n = 29, 25 g rumen-protected L-carnitine per cow and day) were created and blood samples were taken from day 42 ante partum (ap) until day 110 post-partum (pp) to clarify the impact of L-carnitine supplementation on dairy cows, especially during the transition period and early puerperium. Blood and clinical parameters were recorded in high resolution from 0.5 h to 72 h pp. L-carnitine-supplemented cows had higher amounts of milk fat in early lactation and higher triacylglyceride concentrations in plasma ap, indicating increased efficiency of fat oxidation. However, neither recovery from calving nor energy balance and lipomobilisation were influenced by L-carnitine.

Phthalates are known endocrine disruptors and associated with decreased fecundity, pregnancy loss, and adverse obstetrical outcomes, however the underlying mechanisms remain to be established. Environmental factors can influence gene expression and cell function by modifying epigenetic marks, impacting the developing embryo as well as future generations of offspring. The impact of phthalates on placental gene methylation and expression is largely unknown. We studied the effect of maternal phthalate exposure on the human placental DNA methylome and transcriptome. We determined epigenome-wide DNA methylation marks (Illumina Infinium Human Methylation 850k BeadChip) and gene expression (Agilent whole human genome array) associated with phthalate exposure in first trimester placenta. Integrative genomic analysis of candidate genes was performed to define gene methylation-expression relationships. We identified 39 genes with significantly altered methylation and gene expression in the high phthalate exposure group. Most of these relationships were inversely correlated. This analysis identified epidermal growth factor receptor (EGFR) as a critical candidate gene mediating the effects of phthalates on early placental function. Although additional studies are needed to determine the functional consequences of these changes, our findings are consistent with the model that phthalates impact placental function by modulating the expression of critical placental genes through epigenetic regulation.

In order to determine horses' stress and ensure health and welfare of horses working with military veterans with posttraumatic stress disorder (PTSD) in a therapeutic horseback riding program, we measured the stress levels of the horses. Five horses worked in two 6-week therapeutic riding sessions: one 6-week session ridden by military veterans with PTSD (session 1) and one 6-week session ridden by experienced riders (session 2). Plasma adrenocorticotropic hormone (ACTH), glucose, and cortisol levels were determined on a resting day (baseline [BL]) and in weeks 1, 3, and 6 before each riding class (T1), after tacking (T2), and after each riding class (T3). Behavioral patterns for stress were determined before venipuncture at the same intervals. In session 1, cortisol level at BL was significantly lower than at T1 and T3, whereas in session 2, it was significantly higher than at T1 and T3. Cortisol level in session 1 was significantly higher than session 2 at T1 and T3. No significant differences were found between two sessions or over time for ACTH. Glucose level at BL was significantly higher than at T3 in session 1 and higher than at T1 in session 2. Glucose level in session 1 was significantly higher than session 2 at T1, T2, and T3. Stress behavior scores were significantly lower in session 1 than session 2. Although physiological and behavioral patterns for stress varied across experimental conditions, they remained within normal reference ranges. There was no evidence that horses carrying riders with a disability were unduly stressed.

The body’s own continuity is expressed in the word “implying”—any present bodily event is also an implying of the body’s next events. Body-events are always also environment-events. The implying of further body-process also implies the environmental aspects involved in those body-events, for example the food, and the ground. The food carries the body forward into its already implied next events. For example, the complexity of the body’s implying makes a food-object with the environment’s cooperation. The body’s implying is always more than what occurs. The body’s implicit organization is much more complex and capable of many more possible further events, than those that have ever occurred. A feeling comes in the body as we live in the situational space where a certain event might happen. We feel the heart pounding in the body, as we live in the situation. After any imagery one must, of course, check in the body if the physical easing has come.

l-carnitine plays an important role in energy metabolism through supporting the transport of activated fatty acids to the subcellular site of &beta, oxidation. An acute phase reaction (APR) is known as an energy consuming process. Lipopolysaccharides (LPS) are often used in animal models to study intervention measures during innate immune responses such as APR. Thus, the aim of the study was to investigate the effects of dietary l-carnitine supplementation during an LPS-induced APR in mid-lactating German Holstein cows. Animals were assigned to a control (CON, n = 26) or l-carnitine group (CAR, n = 27, 25 g rumen-protected l-carnitine/cow/d) and received an intravenous injection of LPS (0.5 &mu, g/kg body weight) at day 111 post-partum. Blood samples were collected from day 1 pre-injection until day 14 post-injection (pi). From 0.5 h pi until 72 h pi blood samplings and clinical examinations were performed in short intervals. Clinical signs of the APR were not altered in group CAR except rumen motility which increased at a lower level compared to the CON group after a period of atonia. Group CAR maintained a higher insulin level compared to group CON even up to 72 h pi which might support glucose utilization following an APR.

P-wave dispersion (PWD, Pd or Pdis) is a noninvasive electrocardiographic (ECG) marker for atrial remodeling and predictor for atrial fibrillation (AF). PWD is defined as the difference between the widest and the narrowest P-wave duration recorded from the 12 ECG leads. Increased P-wave duration and PWD reflect prolongation of intraatrial and interatrial conduction time with lack of a well-coordinated conduction system within the atrial muscles, with inhomogeneous, asynchronic, pro-inflammatory and anti-inflammatory effect mediated by interleukin-6 (IL-6) in patients with the CG + GG genotype IL-6 -634C/G polymorphism [1] and discontinuous propagation of sinus impulses mainly between the left and right atria, interstitial/extracellular fibroblast activation and collagen deposition with fibrosis (via TGF-β) in atrial tissue, insufficient blood supply, significant not isotropic myoelectric activity, and thin wall thickness and consequent expansion tendency all well-known electrophysiological characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation (PAF) [2].

"Pott's puffy tumor", rara condição descrita em 1768 por Sir Percival Pott, é a formação de abscesso subperiosteal com edema local, osteomielite subjacente e complicações intracranianas infecciosas. Infreqüente na era da antibióticoterapia, bem como em pré-adolescentes, devido í incompleta pneumatização dos seios paranasais. O objetivo deste trabalho é apresentar o caso de uma criança que desenvolveu uma complicação intracraniana de uma infecção sinogênica. Relato de Caso: Paciente de dez anos e três meses, sem antecedentes patológicos, após trauma leve evoluiu com edema periorbitário í direita e febre. Realizada hipótese diagnóstica de sinusopatia, fez uso irregular da antibioticoterapia. Após 15 dias apresentou crise convulsiva. A tomografia revelou empiema subdural, osteomielite do osso frontal e abscesso subjacente. Realizadas três drenagens cirúrgicas e antibioticoterapia endovenosa prolongada. Recebeu alta após dois meses e meio com hemiparesia incompleta e desproporcionada í esquerda. Segue acompanhamento ambulatorial. Discussão: "Pott's puffy tumor" é mecanismo não usual de causa de empiema subdural de origem sinogênica. Apesar de a tumoração relatada se revelar em região subjacente ao abscesso há dúvida de este ser realmente um "Pott's puffy tumor" pois não há evidente erosão óssea. Sabe-se que tal acometimento pode resultar de uma sinusite negligenciada ou então parcialmente tratada e que se deve suspeitar de empiema subdural em crianças e adolescentes com febre, sinais neurológicos e infecção otorrinológica recente. Dentre as causas de empiema subdural de origem sinogênica, deve-se atentar para a presença de tumor frontal que pode evidenciar o Pott's puffy tumor, um diagnóstico a ser lembrado.Descritores: Osteomielite, Sinusite, Empiema subdural, Osso frontal, Infecção do sistema nervoso central, Abscesso encefálico

Decoupling water electrolysis using mediator is an interesting way to produce pure hydrogen. The present work validates the proof of concept of decoupled electrolyser associated with a bioelectrochemical system (MFC-DES) through a redox flow mediator (potassium hexacyanoferrate (KHCF)). Low voltage (1 V) hydrogen production was achieved with a current density up to 25 mA cm−2. Regeneration of the mediator was performed by glucose fed microbial fuel cells. The oxidation rate of KHCF in the electrolyser is, at least, an order of magnitude higher than the reduction rate in MFC cascade fed system. MFC-DES is thus a promising set up as it desynchronizes limited microbial rate and hydrogen production, generate value from wastewater and reduce energetic cost of water electrolysis.

Background Large numbers of post-deployment U.S. veterans are diagnosed with post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI), leading to an urgent need for effective interventions to reduce symptoms and increase veterans’ coping. PTSD includes anxiety, flashbacks, and emotional numbing. The symptoms increase health care costs for stress-related illnesses and can make veterans’ civilian life difficult. Methods We used a randomized wait-list controlled design with repeated measures of U.S. military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding (THR) program for decreasing PTSD symptoms and increasing coping self-efficacy, emotion regulation, social and emotional loneliness. Fifty-seven participants were recruited and 29 enrolled in the randomized trial. They were randomly assigned to either the horse riding group (n = 15) or a wait-list control group (n = 14). The wait-list control group experienced a 6-week waiting period, while the horse riding group began THR. The wait-list control group began riding after 6 weeks of participating in the control group. Demographic and health history information was obtained from all the participants. PTSD symptoms were measured using the standardized PTSD Checklist-Military Version (PCL-M). The PCL-M as well as other instruments including, The Coping Self Efficacy Scale (CSES), The Difficulties in Emotion Regulation Scale (DERS) and The Social and Emotional Loneliness Scale for Adults-short version (SELSA) were used to access different aspects of individual well-being and the PTSD symptoms. Results Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR (P ≤ 0.01) as well as a statistically and clinically significant decrease after 6 weeks of THR (P ≤ 0.01). Logistic regression showed that participants had a 66.7% likelihood of having lower PTSD scores at 3 weeks and 87.5% likelihood at 6 weeks. Under the generalized linear model(GLM), our ANOVA findings for the coping self-efficacy, emotion regulation, and social and emotional loneliness did not reach statistical significance. The results for coping self-efficacy and emotion regulation trended in the predicted direction. Results for emotional loneliness were opposite the predicted direction. Logistic regression provided validation that outcome effects were caused by riding longer. Conclusion The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.

Menopause is defined as the permanent cessation of menses. In this article, we review the menopausal transition and its unique impact on the endocrine system. Vasomotor symptoms, or hot flashes, are sudden episodes of intense heat that are accompanied by sweating and flushing. We also review menopausal therapies including both hormonal and nonhormonal treatments. Menopausal hormone therapy (MHT) has multiple side effects including increased risk for breast cancer in the case of combination therapies, increased risk of stroke and deep venous thrombosis, and possible increased risk of cardiovascular disease depending on the time of initiation of therapy. The benefits of MHT include the prevention of osteoporosis and decreased incidence of colorectal cancer in combined estrogen and progestin users, and its short-term use for symptomatic patients for the relief of vasomotor symptoms and urogenital atrophy is indicated. Although there are two new Food and Drug Administration-approved, nonestrogenic treatments for menopausal symptoms (paroxetine mesylate and ospemifene), estrogen continues to be the most effective treatment available.

Microstructural evolution of a Solid Oxide Electrolyser Cell (SOEC) Ni–YSZ cermet cathode is investigated using three dimensional electrode characterisations. 3D reconstructions are obtained on a reference and two long-term tested cells, which were maintained at −0.5 and −0.8 A cm−2 for 1000 h at 800 °C. During the long term tests, air was fed at the anode and a mixture of 10% H2–90% H2O was fed at the cathode. In this framework, reconstructions have been obtained from synchrotron X-ray nano-tomography technique. Microstructural properties extracted from the 3D reconstructions exhibit an evolution during the tests. Triple Phase Boundary length is decreasing from 10.49 ± 1.18 μm−2 for the reference cell to 6.18 ± 0.6 μm−2 for the long term tested cell at −0.8 A cm−2. Evolutions of morphological parameters were introduced in an in-house multi-scale model to evaluate their impacts on the electrode degradation, and hence, on the global SOEC performance.

Supernormal conduction is defined as better-than-expected conduction in patients with depressed conduction during a short interval in the ventricular cycle. It is mainly observed in long-duration electrocardiogram (ECG) assessments. Its occurrence during 12-lead ECG is uncommon and its interpretation demands knowledge on electrophysiological alterations that are hard to understand. By reporting this case we aim to propose a rationale sequence that should be considered when facing an ECG with these same features, which would enable a greater accuracy to make a definitive diagnosis.

To determine the etiology, laterality, and time to presentation of unilateral vocal fold paralysis (UVFP) at a tertiary care institution over 10 years.Case series with chart review.Academic medical center.All patients seen between 2002 and 2012 by the Department of Otolaryngology at the Washington University School of Medicine (WUSM), with a diagnosis of unilateral vocal fold paralysis, were included. Medical records were reviewed for symptom onset date, presentation date(s), and etiology of UVFP.Of the patients, 938 met inclusion criteria and were included. In total, 522 patients (55.6%) had UVFP due to surgery; 158 (16.8%) were associated with thyroid/parathyroid surgery, while 364 (38.8%) were due to nonthyroid surgery. Of the patients, 416 (44.4%) had nonsurgical etiologies, 124 (13.2%) had idiopathic UVFP, and 621 (66.2%) had left-sided UVFP. The diagnosis was more common on the left side in cases of intrathoracic surgeries and malignancies, as expected, but also in idiopathic, carotid endarterectomy, intubation, and skull base tumors. In total, 9.8% of patients presented first to an outside otolaryngologist at a median time of 2.1 months after onset, but these patients presented to WUSM at a median time of 9.5 months. Overall, 70.6% of patients presented to a WUSM otolaryngologist within 3 months of onset.Iatrogenic injury remains the most common cause of UVFP. Thyroidectomy remains the leading cause of surgery-related UVFP. Patients are typically seen within 3-4 months of onset; however, a significant delay exists for those referred to WUSM.

Otitis media (OM) in children is the most frequent reason for physician visits in developed countries and burdens caregivers, society, and the child. Our objective was to describe the impact of OM severity on parent/caregiver quality of life (QoL).Multi-institutional prospective cross-sectional study.Otolaryngology, family, and pediatric practices.Children 6 to 24 months old with and without a primary diagnosis of recurrent OM and their caregivers. Physicians provided patient history, and parents/caregivers completed a Family Information Form, the PedsQL Family Impact survey, the Patient Reported Outcomes Measurement Information System (PROMIS) survey, and the OM 6-item severity survey (OM-6).A total of 2413 subjects were enrolled and data from 1208 patients and physician were analyzed. The average child age was 16 months, and 54% were male. The mean OM-6 score was 3.2. The mean PedsQL Family Impact score for parents was 66.9 from otolaryngology sites and 78.8 from pediatrics/family practice sites (P.001). Higher (worse) OM-6 scores correlated significantly with worse PedsQL Family Impact scores (Pearson r = -0.512, P.01). Similarly, increasing OM-6 scores strongly correlated with increased parental anxiety, depression, and fatigue, as well as decreased satisfaction (all P.01).Worse PedsQL Family Impact and PROMIS scores were highly correlated with elevated OM-6 scores, suggesting that severity of childhood OM significantly affects parent/caregiver QoL. Understanding the impact of a child's illness on parent/caregiver QoL can help physicians counsel patients and families and provide better family-centered, compassionate care.

Children with otitis media (OM) suffer sleep disturbances, loss of appetite, earache, and behavioral problems. Our objective was to quantitate the average burden of OM and to compare the associated impact of tympanostomy tubes on infant health related quality of life (HR-QoL).Multi-institutional prospective cross-sectional study.Otolaryngology, family practice, and pediatric clinics.Children ages 6 to 24 months of age with or without recurrent OM. Patient history, the PedsQL Infant QoL survey, and the 6-item child with OM survey (Otitis Media 6 [OM-6]) were collected from providers and parents.Data from 1208 patients were analyzed. Mean age was 14.7 months, and 54% were male. The mean OM-6 score of children with recurrent OM was 3.3, whereas similarly aged well-children had a mean OM-6 score of 2.5. The mean PedsQL Infant scores of recurrent OM patients were significantly worse than those of children from well-child visits. Worse OM-6 scores were correlated with poorer PedsQL Infant scores, Pearson r = -0.581 (1-12 months) and -0.558 (13-24 months), P.001. Otolaryngology patients who were recommended to undergo ear tube placement had significantly poorer OM-6 scores and worse PedsQL Infant scores, whereas patients with prior tube placement had significantly better OM-6 and PedsQL Infant scores.Children with recurrent OM had significantly worse HR-QoL than similarly aged healthy children. Increased burden of OM strongly affected HR-QoL, and recommendation for tube placement was associated with increased disease burden and poorer HR-QoL. The presence of tympanostomy tubes was associated with better OM-6 and PedsQL Infant scores.

Noncompliance with federal regulations, as monitored through institutional review boards for the ethical conduct of clinical research, can occur, even to seasoned investigators. The cause of this noncompliance can be that an investigator is overloaded, does not know the regulations, or does not take the time to pay attention to the details. Sometimes it happens just because of inevitable human error that can befall us all at any time. The authors begin by citing the inherent differences between clinical practice and clinical research. This is followed by an illustration of common noncompliance errors, with examples, followed by general and specific concepts and methods to minimize noncompliance events. The objective of this article is to condense the myriad details involved in conducting clinical research into a set of manageable recommendations that can be recalled easily before and during the research. The material supporting these recommendations comes from years of institutional review board work at several institutions and consultation with experienced principal investigators and their research coordinators.

Composite Ni–Y0.15Zr0.85O1.925 anodes were fabricated by axial-injection suspension plasma spraying in open atmosphere conditions. The composition of the anode is controllable by adjustment of the plasma gas composition, stand-off distance, and suspension feed rate. The total porosity is controllable through the addition of carbon black to the suspension as a sacrificial pore-forming material as well as by adjustment of the suspension feed rate. The size of the NiO particles in suspension affects both the composition and total porosity, with larger NiO particles leading to increased Ni content and porosity in the deposited coatings. The surface roughness increases with a decrease of the in-flight droplet momentum, which results from both smaller NiO particles in suspension and the addition of low density pore-forming materials. A solid oxide fuel cell was fabricated with both electrodes and electrolyte fabricated by axial-injection plasma spraying. Peak power densities of 0.718 W cm−2 and 1.13 W cm−2 at 750 °C and 850 °C, respectively, were achieved.

This study is an exploratory, qualitative investigation of breast cancer survivors' experiences of paradox, following psycho-spiritual integrative therapy (PSIT). Previous studies examined the role of paradox in spiritual development among women diagnosed with cancer; this study investigated a psycho-spiritual intervention for multicultural cancer survivors. Twelve multicultural breast cancer survivors, from a sample of 30 women participants in an 8-week PSIT group intervention, were recruited from oncologists, hospitals, support groups, outpatient oncology centers, surgeons, radiation therapy centers, cancer events, and websites. We conducted semi-structured, open-ended interviews lasting 1-2 h regarding participants' experiences coping with cancer and their experience of PSIT. We transcribed interviews and conducted blind searches for both new and previously identified paradoxes and themes. Two previously identified themes emerged: (1) attempting to maintain coherence in new and old ways and (2) letting go of ultimate control in life. Additionally, three novel themes emerged: (1) interconnection between helpers and hinderers, (2) spiritual edges and tensions, and (3) new paths to empowerment. Results of this qualitative analysis indicate participants experienced previously identified themes and experienced an expanded range of paradoxes. After learning compassionate acceptance through PSIT, breast cancer survivors develop greater access to the multidimensionality of paradoxes, which can go beyond a binary (either/or) construction to a more interdependent (both/and) relationship. Devoting greater attention to investigating and understanding how diverse participants engage with and move through paradoxical change processes could enhance the effectiveness of existential and spiritual interventions.

Microstructural evolution of a Solid Oxide Electrolyser Cell (SOEC) La0.6Sr0.4Co0.2Fe0.8O3 (LSCF) anode is investigated using 3D reconstruction techniques both on a reference and a long-term tested cell. In this framework, reconstructions have been obtained from focused ion beam-scanning electron microscopy and synchrotron X-ray nano-tomography techniques. Microstructural properties extracted from the 3D reconstructions exhibit a slight evolution during the test. Synchrotron X-ray Absorption Spectroscopy (XAS) was also performed, and a modification of the cobalt oxidation state is found. LSCF conductivity decrease due to the change in Co mixed valence has been discussed. Evolutions of both morphological parameters and electrical conductivity were introduced in an in-house micro model to evaluate their impacts on the electrode degradation.

"Comparative effectiveness research" (CER) is not a new concept; however, recently it has been popularized as a method to develop scientifically sound actionable data by which patients, physicians, payers, and policymakers may make informed health care decisions. Fundamental to CER is that the comparative data are derived from large diverse populations of patients assembled from point-of-care general primary care practices and that measured outcomes include patient value judgments. The challenge is to obtain scientifically valid data to be acted upon by decision-making stakeholders with potentially quite diversely different agenda. The process requires very thoughtful research designs modulated by complex statistical and analytic methods. This article is composed of a guiding narrative with an extensive set of tables outlining many of the details required in performing and understanding CER. It ends with short discussions of three example papers, limitations of the method, and how a practicing physician may view such reports.

Thermo-mechanical properties of SOFC/SOEC electrodes have been computed by homogenization from three-dimensional reconstructions of their microstructure. The support and the functional layer of a Ni/YSZ supported cell and the oxygen electrode made of La 0.6 Sr 0.4 Co 0.2 Fe 0.8 O 3−δ (LSCF) have been studied. Values of the effective Young's modulus obtained for the thick porous Ni/YSZ support are in good agreement with the experimental data ( E = 35 GPa). Besides, for thin functional layers, the methodology supplies original values that are difficult to obtain by conventional experimental methods ( E = 105 GPa for the Ni/YSZ Functional Layer and E = 55 GPa for the LSCF electrode). Furthermore, it has been shown that the effective elastic parameters are influenced by the following morphological parameters: the porosity and the formation factor that could also be related to the manufacturing process. Theses morphological parameters have however negligible effect on the effective thermal expansion.

An in-house micro model has been built to describe the electrochemical mechanisms governing both H2 and O2 electrodes operating in SOEC mode. A special attention has been paid to take into account the microstructure properties of the ionic, electronic and gas phases as well as the processes occurring therein. A commercial LSM–YSZ symmetrical cell has been tested at 700, 750 and 850 °C in air. Simulations have been carried out to interpret the experimental data. It is suggested that the kinetic of O2 formation is controlled by a single charge transfer. A sensitivity analysis has been performed using the micro model to quantify the role of the microstructure in the electrode behaviour. Transport of oxygen ions in the functional layer has a strong impact on the cell response since it governs the delocalization of the electrochemical reactions. The density of TPB length is also a key parameter controlling the electrode efficiency. Evolutions of the microstructural parameters in operation have been associated to the degradation of the electrochemical performances. The decrease in TPB length due to Ni agglomeration has a moderate impact whereas the decrease in ionic conductivities of 8YSZ or LSFC could explain a large amount of the cell degradation.

With recent changes in the landscape of health care, clinical practice guidelines (CPGs) have proliferated. Attitudes about guidelines differ considerably, forming 2 competing viewpoints with considerable tension between them. Some feel CPGs are unneeded or are efforts to create automated "cookie cutter" medical practice; at best, they are perceived as suggestions that may be altered by experience. Others feel they are mandates that must be followed to the letter. This article attempts to explain how and why we have arrived at this point and to explain the origins of the differing viewpoints. We begin by describing the 2 viewpoints and proceed to define the origin of medicine as a profession and to chronicle the evolution of health insurance, medical education, and scientific methods for evaluating evidence.

Obesity is associated with ovulatory disorders, decreased rates of conception, infertility, early pregnancy loss and congenital abnormalities. Poor oocyte quality and reduced IVF success have also been reported in obese women. Recent attempts to understand the mechanism by which these defects occur have focused on mitochondria, essential organelles that are critical for oocyte maturation and subsequent embryo development. The oocyte relies on maternally supplied mitochondria until the resumption of mitochondrial replication in the peri-implantation period. Here we review current literature addressing the roles of mitochondria in oocyte function and how mitochondrial dysfunction can lead to fertility problems. The relationship between mitochondrial dysfunction and oocyte function is evaluated by examining the following examples of environmental exposures: tobacco smoke, aging, caloric restriction and hyperglycemia. Finally, we present new data from a mouse model of obesity that has demonstrated that oocyte mitochondria play a key role in obesity-associated reproductive disorders.

Conjunctive consolidation, one method of multivariable analysis by arranging data into clusters, is intuitive and transparent. An unexpected consequence in writing this article was the discovery of just how useful it is in critically analyzing articles and in designing new projects. It has stimulated a fresh understanding as to the value of multivariable thinking in all clinical research. This article is organized into the sequential steps for performing conjunctive consolidation for critically analyzing an article of interest and for completing the process, pending all required data are available. Investigators, particularly those who perform clinical research, should consider conjunctive consolidation as a valuable method of multivariable analysis with which to report data.

Introduction: Cardiac involvement is frequent in inflammatory myopathies. Electrocardiogram (ECG) may show evidence of this involvement and its changes should be well-known and described. Objectives: Due to the lack of studies in the literature, we conducted an analysis of the ECG findings in patients with dermatomyositis (DM) and polymyositis (PM), comparing them with a control group. Methods: This cross-sectional study compared the ECG of 86 individuals with no rheumatic disorders (controls) with 112 patients (78 DM and 34 PM), during 2010 to 2013. The ECG findings between DM and PM were also compared. Results: Demographic characteristics, comorbidities and ECG abnormalities were similar between controls and patients (p > 0.05), except for a higher frequency of left ventricular hypertrophy (LVH) in patients (10.7% vs. 1.2%, p = 0.008). Demographic characteristics, comorbidities, clinical and laboratory manifestations, were also similar between the groups PM and DM, except for the presence of cutaneous lesions only in DM. One third of the patients had ECG abnormalities, which were more prevalent in PM than DM (50% vs. 24.4%, p = 0.008). LVH, left atrial enlargement, rhythm and conduction abnormalities were more frequent in PM than DM (p < 0.05 for all), especially the left anterior fascicular block. Conclusions: We showed distinct ECG changes between DM and PM and a higher frequency of LVH in patients compared to controls. Investigation of cardiac involvement should be considered even in asymptomatic patients, especially PM. Further studies are necessary in order to determine the correlation of ECG findings with other complementary tests, clinical manifestations, disease activity and progression to other cardiac diseases. RESUMO Introdução: Acometimento cardíaco nas miopatias inflamatórias é frequente. Eletrocardiograma (ECG) pode mostrar indícios desse acometimento e suas alterações devem ser bem conhecidas e descritas. Objetivos: Devido à escassez de trabalhos na literatura, analisamos as alterações de ECG em pacientes com dermatomiosite (DM) e polimiosite (PM) e as comparamos com um grupo controle. Métodos: Este estudo transversal comparou ECGs de 86 indivíduos sem doenças reumatológicas (controles) com 112 pacientes (78 DM e 34 PM), de 2010 a 2013. Também comparamos os ECGs entre DM e PM. Resultados: Características demográficas, comorbidades e alterações de ECG foram semelhantes entre controles e pacientes (p > 0,05), exceto pela maior frequência de sobrecarga de ventrículo esquerdo (SVE) nos pacientes (10,7% vs. 1,2%; p = 0,008). Características demográficas, comorbidades, manifestações clínicas e laboratoriais também foram semelhantes entre os grupos PM e DM, exceto por lesões cutâneas apenas em pacientes com DM. Um terço dos pacientes apresentou alterações de ECG, que foram mais prevalentes em PM do que em DM (50% vs. 24,4%, p = 0,008). Sobrecarga de câmaras esquerdas (SCE), distúrbios do ritmo e da condução foram mais encontrados em PM do que em DM (p < 0,05 para todos), sobretudo o bloqueio divisional do ramo anterossuperior. Conclusões: Encontramos alterações distintas de ECG entre PM e DM e frequência aumentada de SVE em pacientes quando comparados com controles. Investigação do acometimento cardíaco nessas doenças deve ser considerada mesmo em pacientes assintomáticos, especialmente em se tratando de PM. Mais estudos são necessários para correlacionar os achados de ECG com outros exames complementares, manifestações clínicas, atividade das miopatias e evolução para outras doenças cardíacas.

Clearing a space was first developed as a preparatory step for focusing. Since then this process has been expanded to include a direct engagement with the cleared space. Research results show its impact upon increased self-care and positive body image, recovery from trauma, and experiences of wholeness. Little attention has been paid to exploring its value within ongoing psychotherapy. This paper demonstrates how this expanded approach to clearing a space shifts one's relationship to particular issues towards a greater unification of the person and alignment with higher values and purpose. A summary of research and the presentation of six common characteristics of direct engagement with the cleared space are presented. Discussion of two philosophical concepts sheds light on the difference this process makes in psychotherapy. A final discussion examines how this expanded approach to clearing a space may contribute to a more spiritually informed change process.

Background Prenatal exposures have known adverse effects on maternal and neonatal outcomes. Professional societies recommend routine screening for environmental, occupational, and dietary exposures to reduce exposures and their associated sequelae. Objective Our objective was to determine the frequency of environmental exposure screening by obstetricians and gynecologists (OBGYNs) at initial patient visits. Study design Practicing OBGYNs were approached at the University of Colorado and by social media. The survey instrument queried demographics, environmental literacy, and screening practices. Statistical analysis was performed using Chi-square and two-sample t-test. Results We received 312 online survey responses (response rate of 12%). Responding OBGYNs were predominantly female (96%), board-certified (78%), generalists (65%) with a mean age of 37.1 years. Fewer than half of physicians screened for the following factors: occupational exposures, environmental chemicals, air pollution, pesticide use, personal care products, household cleaners, water source, use of plastics for food storage, and lead and mercury exposure. Eighty five percent of respondents reported that they did not feel comfortable obtaining an environmental history and 58% respondents reported that they performed no regular screening of environmental exposures. A higher frequency of screening was associated with > 4 years of practice (p = 0.001), and having read the environmental committee opinion (p = Conclusion The majority of OBGYNs did not incorporate screening for known environmental exposures into routine practice. Reading the environmental committee opinions was strongly and significantly associated with a higher rate of screening. Improving physician comfort in counseling patients may enhance screening for exposures that affect reproductive health.

Background Stenotrophomonas maltophilia is a multidrug-resistant Gram-negative bacillus that has been implicated in serious nosocomial infections. This microbe has also been isolated from sinus cultures in refractory chronic rhinosinusitis (CRS). The goal of this study was to elucidate the implications of S. maltophilia–positive cultures in the setting of CRS. The objectives of the study were (1) to define clinical and microbiological characteristics and (2) to assess management strategy and overall outcomes of S. maltophilia–positive sinus cultures in CRS patients. Methods A retrospective review was performed of 101 patients over a 5-year period. Results The mean age was 56.9 years with a female/male ratio of 1.1:1. Previous sinus surgery had been performed in 90.1% of patients. Greater than 97% of patients had been given antibiotics in the previous 6 months. The most common presenting symptom was discolored nasal drainage (76.2%) with endoscopic evidence of pus or crusting in 83.2% of cases. Monotherapy with trimethoprim sulfamethoxazole (TMX) or fluoroquinolones was used in 41 and 26%, respectively. This intervention resulted in overall symptom and endoscopic improvement in 70% of cases. Conclusion The presence of S. maltophilia isolates on culture are associated with clinically relevant symptoms and endoscopic findings in patients with refractory CRS. Despite its multidrug-resistant nature, monotherapy with TMX or fluoroquinolones appears to be effective in providing patients with bacterial infection with symptom relief in a majority of cases.