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The dysregulation of trace elements in the brain, which can be caused by genetic or environmental factors, has been associated with disease and compromised mobility. Research regarding trace elements and motor function has focused mainly on the basal ganglia, but few studies have examined the olfactory bulb in this context. Diets high in fat have been shown to have consequences of dysregulated iron and manganese in the brain and disrupted motor activity. The aim of our study was to examine the relationship between mobility and trace element disruption in the olfactory bulb in male and female C57BL/6J and DBA/2J mice fed a high-fat diet. Mobility was significantly reduced in male C57BL/6Js, but the correlation between iron and manganese in the olfactory bulb with velocity, distance travelled, and habituation was not statistically significant. However, there appears to be an overall pattern of a high-fat diet having a statistically significant impact individually on elevated iron and manganese in the olfactory bulb, reduced velocity, reduced distance travelled, and reduced habituation mainly in the male C57BL/6J strain. We found similar trends within the scientific literature to suggest that dysregulated trace element status in the olfactory bulb may be related to motor function in both humans and animals and that males may be more susceptible to the negative outcomes. Our findings contribute new information regarding the impact of diet on the brain, behavior, and potential connection between trace element dysregulation in the olfactory bulb with mobility. [ABSTRACT FROM AUTHOR]

Prostate artery embolisation (PAE) is a minimally invasive procedure commonly performed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. International Prostate Symptom Score (IPSS) is a validated patient questionnaire quantifying LUTS and is used for patient selection for PAE, but it is largely subjective. Prostate volume is an easily estimated objective parameter across multiple imaging modalities. No strict threshold of prostate volume is established as a selection criterion for PAE, but it is generally accepted that prostate volume should be over 40 to 50 mL. We looked at a sample of 65 cases performed at a large teaching hospital between 2017 and 2019 with a minimum of four years follow up. Embospheres between 100 to 500 microns were injected into the prostatic arteries bilaterally (if technically feasible). A 'bullet shape' model was used to estimate prostatic volume from initial CT. N = 13 had an estimated volume < 51 mL (range 31-50 mL). IPSS before and at 3 months post-procedure were collected. 80% of patients indicated a beneficial response to PAE (IPSS improvement > 5). 23% of patients required further PAE procedure or surgery. No major complications were recorded. The mean change in IPSS under 51 mL compared to over 51 mL cohort was 10.2 versus 11 (standard deviation 7.5 versus 7.3) (p = 0.44, 2 tailed Student's T-test). There was no statistically significant difference in the IPSS improvement or outcome of small volume prostates under 51 mL compared to large volume. Our results suggest that prostate volume should not be used to exclude patients for PAE. [ABSTRACT FROM AUTHOR]

An objective of a total knee arthroplasty (TKA) is to restore native (i.e. healthy) function, and a crucial step is determining the correct insert thickness for each patient. If the insert is too thick, then stiffness results, and if too thin, then instability results. Two methods to determine the insert thickness are by manually assessing the joint laxity and by using a trial insert with goniometric markings that measures the internal-external rotation of the trial with respect to a mark on the femoral component. The former is qualitative and depends on the surgeon's experience and 'feel' and while the latter is quantitative, it can be used only with an insert with medial ball-in-socket conformity. An unexplored method is to measure the force required to push a trial insert into position. To determine whether this method has merit, the push force was measured in 30 patients undergoing unrestricted kinematically aligned TKA using an insert with ball-in-socket medial conformity, a flat lateral surface, and retention of the posterior cruciate ligament. During surgery, the surgeon determined three appropriate thicknesses to test from a selection ranging from 10 mm to 14 mm in 1 mm increments. The peak push forces going from an insert 1 mm thinner than the correct thickness as determined by an insert goniometer and from the correct thickness to 1 mm thicker were measured. Mean peak forces for the different insert thicknesses were 127 ± 104 N, 127 ± 95 N, and 144 ± 96 N for 1 mm thinner, correct, and 1 mm thicker, respectively, and did not differ (p = 0.3210). As a result, measurement of peak force during trial positioning of a tibial insert cannot be used to identify the correct thickness for all insert designs. [ABSTRACT FROM AUTHOR]

The article discusses the concept of kinematically aligned total knee arthroplasty (TKA), which involves restoring the natural alignment and joint line obliquity of the knee. The authors argue that performing unrestricted kinematically aligned TKA, without imposing restrictions on alignment, can lead to positive outcomes such as high implant survival rates, improved joint scores, and restoration of native knee kinematics. They address concerns that limited the early adoption of this approach, including potential implant failure and regulatory approval. The authors conclude that unrestricted kinematically aligned TKA can be performed safely and effectively, and provide recommendations for surgeons implementing this technique. [Extracted from the article]

Background: Diagnostic errors cause significant patient harm. The clinician's ultimate goal is to achieve diagnostic excellence in order to serve patients safely. This can be accomplished by learning from both errors and successes in patient care. However, the extent to which clinicians grow and navigate diagnostic errors and successes in patient care is poorly understood. Clinically experienced hospitalists, who have cared for numerous acutely ill patients, should have great insights from their successes and mistakes to inform others striving for excellence in patient care. Objective: To identify and characterize clinical lessons learned by experienced hospitalists from diagnostic errors and successes. Design: A semi-structured interview guide was used to collect qualitative data from hospitalists at five independently administered hospitals in the Mid-Atlantic area from February to June 2022. Participants: 12 academic and 12 community-based hospitalists with ≥ 5 years of clinical experience. Approach: A constructivist qualitative approach was used and "reflexive thematic analysis" of interview transcripts was conducted to identify themes and patterns of meaning across the dataset. Results: Five themes were generated from the data based on clinical lessons learned by hospitalists from diagnostic errors and successes. The ideas included appreciating excellence in clinical reasoning as a core skill, connecting with patients and other members of the health care team to be able to tap into their insights, reflecting on the diagnostic process, committing to growth, and prioritizing self-care. Conclusions: The study identifies key lessons learned from the errors and successes encountered in patient care by clinically experienced hospitalists. These findings may prove helpful for individuals and groups that are authentically committed to moving along the continuum from diagnostic competence towards excellence. [ABSTRACT FROM AUTHOR]

The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy (RT) namely: reactive, proactive low- ("EAT-RT" only) and high-intensity ("EAT-RT + exercises"). Understanding the experiences of the trial Speech-Language Pathologists (SLPs) will be useful to inform clinical implementation. This study assessed SLP opinions of acceptability and clinical feasibility of the 3 trial therapies. 8 SLPs from 3 Canadian PRO-ACTIVE trial sites participated in individual interviews. Using a qualitative approach, data collection and thematic analysis were guided by the Theoretical Framework of Acceptability. Member checking was conducted through a follow-up focus group with willing participants. Seven themes were derived: intervention coherence, burden, barriers/facilitators, self-efficacy, attitude, ethicality, and perceived effectiveness. SLPs felt all 3 therapies had potential benefit yet perceived more advantages of proactive therapies compared to reactive. Compared to exercises, SLPs particularly endorsed the EAT-RT component. A major barrier was keeping patients motivated, which was impacted by acute toxicity and sometimes conflicting instructions from the healthcare team. Strategies utilized by to overcome barriers included: scaling exercises and/or diet up/down according to the changing patient needs and communicating therapy goals with healthcare team. A model was derived describing the perceived acceptability of the swallowing therapies according to SLPs, based on the interconnection of main themes. Proactive therapies were perceived as more acceptable to trial SLPs, for facilitating patient engagement. The perceived acceptability of the swallowing therapies was related to seven interconnected aspects of providers' experience. These findings will inform the implementation and potential uptake of the PRO-ACTIVE swallowing therapies in clinical practice. [ABSTRACT FROM AUTHOR]

The goal of NASA's Europa Clipper mission is to assess the habitability of Jupiter's moon Europa. After entering Jupiter orbit in 2030, the flight system will collect science data while flying past Europa 49 times at typical closest approach distances of 25–100 km. The mission's objectives are to investigate Europa's interior (ice shell and ocean), composition, and geology; the mission will also search for and characterize any current activity including possible plumes. The science objectives will be accomplished with a payload consisting of remote sensing and in-situ instruments. Remote sensing investigations cover the ultraviolet, visible, near infrared, and thermal infrared wavelength ranges of the electromagnetic spectrum, as well as an ice-penetrating radar. In-situ investigations measure the magnetic field, dust grains, neutral gas, and plasma surrounding Europa. Gravity science will be achieved using the telecommunication system, and a radiation monitoring engineering subsystem will provide complementary science data. The flight system is designed to enable all science instruments to operate and gather data simultaneously. Mission planning and operations are guided by scientific requirements and observation strategies, while appropriate updates to the plan will be made tactically as the instruments and Europa are characterized and discoveries emerge. Following collection and validation, all science data will be archived in NASA's Planetary Data System. Communication, data sharing, and publication policies promote visibility, collaboration, and mutual interdependence across the full Europa Clipper science team, to best achieve the interdisciplinary science necessary to understand Europa. [ABSTRACT FROM AUTHOR]

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program designated bariatric surgery as a clinical pathway. Among the tiers of the Masters Program, revisional bariatric surgery is the highest tier of "mastery" within the pathway. This article presents the top 10 seminal studies representing the current landscape of revisional bariatrics. Methods: The literature was systematically searched and seminal articles designated by consensus agreement of the SAGES Metabolic and Bariatric Surgery committee using multiple criteria, including impact on the field, citation frequency, and expert opinion. Articles were reviewed by committee members and presented in summarized fashion. Results: The top 10 papers are presented in grouped thematic categories covering the early evolution of revisional bariatrics, changing criteria for reoperative bariatric surgery, divergence of revision versus conversion bariatric surgery, and recent technologic innovations in revisional bariatric surgery. Each summary is presented with expert appraisal and commentary. Conclusion: These seminal papers represent a snapshot of the dynamic field of revisional bariatric surgery and emphasize the need to not only remain current with contemporary trends but also keep a patient-oriented perspective on patient and intervention selection for optimal success. [ABSTRACT FROM AUTHOR]

Background: Disadvantaged socioeconomic position (SEP) is an important predictor of poor health in children with chronic kidney disease (CKD). The time course over which SEP influences the health of children with CKD and their carers is unknown. Methods: This prospective longitudinal study included 377 children, aged 6–18 years with CKD (stages I–V, dialysis, and transplant), and their primary carers. Mixed effects ordinal regression was performed to assess the association between SEP and carer-rated child health and carer self-rated health over a 4-year follow-up. Results: Adjusted for CKD stage, higher family household income (adjusted odds ratio (OR) (95% CI) 3.3, 1.8–6.0), employed status of primary carers (1.7, 0.9–3.0), higher carer-perceived financial status (2.6, 1.4–4.8), and carer home ownership (2.2, 1.2–4.0) were associated with better carer-rated child health. Household income also had a differential effect on the carer's self-rated health over time (p = 0.005). The predicted probabilities for carers' overall health being 'very good' among lower income groups at 0, 2, and 4 years were 0.43 (0.28–0.60), 0.34 (0.20–0.51), and 0.25 (0.12–0.44), respectively, and 0.81 (0.69–0.88), 0.84 (0.74–0.91), and 0.88 (0.76–0.94) for carers within the higher income group. Conclusions: Carers and their children with CKD in higher SEP report better overall child and carer health compared with those in lower SEP. Carers of children with CKD in low-income households had poorer self-rated health compared with carers in higher-income households at baseline, and this worsened over time. These cumulative effects may contribute to health inequities between higher and lower SEP groups over time. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the impact of the implant's vertical location during Type 1 Thyroplasty (T1T) on acoustics and glottal aerodynamics using excised canine larynx model, providing insights into the optimal technique for treating unilateral vocal fold paralysis (UVFP). Methods: Measurements were conducted in six excised canine larynges using Silastic implants. Two implant locations, glottal and infraglottal, were tested for each larynx at low and high subglottal pressure levels. Acoustic and intraglottal flow velocity field measurements were taken to assess vocal efficiency (VE), cepstral peak prominence (CPP), and the development of intraglottal vortices. Results: The results indicated that the implant's vertical location significantly influenced vocal efficiency (p = 0.045), with the infraglottal implant generally yielding higher VE values. The effect on CPP was not statistically significant (p = 0.234). Intraglottal velocity field measurements demonstrated larger glottal divergence angles and stronger vortices with the infraglottal implant. Conclusion: The findings suggest that medializing the paralyzed fold at the infraglottal level rather than the glottal level can lead to improved vocal efficiency. The observed larger divergence angles and stronger intraglottal vortices with infraglottal medialization may enhance voice outcomes in UVFP patients. These findings have important implications for optimizing T1T procedures and improving voice quality in individuals with UVFP. Further research is warranted to validate these results in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Recent systematic reviews show varying methods for eliciting, modelling, and reporting preference-based values for child health-related quality-of-life (HRQoL) outcomes, thus producing value sets with different characteristics. Reporting in many of the reviewed studies was found to be incomplete and inconsistent, making them difficult to assess. Checklists can help to improve standards of reporting; however, existing checklists do not address methodological issues for valuing child HRQoL. Existing checklists also focus on reporting methods and processes used in developing HRQoL values, with less focus on reporting of the values' key characteristics and properties. We aimed to develop a checklist for studies generating values for child HRQoL, including for disease-specific states and value sets for generic child HRQoL instruments. Development: A conceptual model provided a structure for grouping items into five modules. Potential items were sourced from an adult HRQoL checklist review, with additional items specific to children developed using recent reviews. Checklist items were reduced by eliminating duplication and overlap, then refined for relevance and clarity via an iterative process. Long and short checklist versions were produced for different user needs. The resulting long RETRIEVE contains 83 items, with modules for reporting methods (A–D) and characteristics of values (E), for researchers planning and reporting child health valuation studies. The short RETRIEVE contains 14 items for decision makers or researchers choosing value sets. Conclusion: Applying the RETRIEVE checklists to relevant studies suggests feasibility. RETRIEVE has the potential to improve completeness in the reporting of preference-based values for child HRQOL outcomes and to improve assessment of preference-based value sets. [ABSTRACT FROM AUTHOR]

Background: Choledochal cysts are rare congenital anomalies of the biliary tree that may lead to obstruction, chronic inflammation, infection, and malignancy. There is wide variation in the timing of resection, operative approach, and reconstructive techniques. Outcomes have rarely been compared on a national level. Methods: We queried the Pediatric National Surgical Quality Improvement Program (NSQIP) to identify patients who underwent choledochal cyst excision from 2015 to 2020. Patients were stratified by hepaticoduodenostomy (HD) versus Roux‐en‐Y hepaticojejunostomy (RNYHJ), use of minimally invasive surgery (MIS), and age at surgery. We collected several outcomes, including length of stay (LOS), reoperation, complications, blood transfusions, and readmission rate. We compared outcomes between cohorts using nonparametric tests and multivariate regression. Results: Altogether, 407 patients met the study criteria, 150 (36.8%) underwent RNYHJ reconstruction, 100 (24.6%) underwent MIS only, and 111 (27.3%) were less than one year old. Patients who underwent open surgery were younger (median age 2.31 vs. 4.25 years, p = 0.002) and more likely underwent RNYHJ reconstruction (42.7% vs. 19%, p = 0.001). On adjusted analysis, the outcomes of LOS, reoperation, transfusion, and complications were similar between the type of reconstruction, operative approach, and age. Patients undergoing RNYHJ had lower rates of readmission than patients undergoing HD (4.0% vs. 10.5%, OR 0.34, CI [0.12, 0.79], p = 0.02). Conclusions: In children with choledochal cysts, most short‐term outcomes were similar between reconstructive techniques, operative approach, and age at resection, although HD reconstruction was associated with a higher readmission rate in this study. Clinical decision‐making should be driven by long‐term and biliary‐specific outcomes. [ABSTRACT FROM AUTHOR]

How could physicalism be true of a world in which there are no fundamental physical phenomena? A familiar answer, due to Barbara Gail Montero and others, is that physicalism could be true of such a world if that world does not contain an infinite descent of mentality. Christopher Devlin Brown has produced a counterexample to that solution. We show how to modify the solution to accommodate Brown's example: physicalism could be true of a world without fundamental physical phenomena if that world does not contain an infinite descent of mentally constituted mentality. This solution is independently plausible and is available to physicalists of virtually all significant varieties. [ABSTRACT FROM AUTHOR]

Background: School attendance and life participation, particularly sport, is a high priority for children with chronic kidney disease (CKD). This study is aimed at assessing the association between CKD stage, sports participation, and school absences in children with CKD. Methods: Using data from the binational Kids with CKD study (ages 6–18 years, n = 377), we performed multivariable regression to evaluate the association between CKD stage, school absences, and sports participation. Results: Overall, 62% of participants played sport with the most frequent sport activities engaged in being swimming (17%) and soccer (17%). Compared to children with CKD 1–2, the incidence rate ratios (IRR) (95% CI) for sports participation amongst children with CKD 3–5, dialysis, or transplant were 0.84 (0.64–1.09), 0.59 (0.39–0.90), and 0.75 (0.58–0.96), respectively. The median (IQR) days of school absences within a four-week period were 1 day (0–1), with children on dialysis reporting the highest number of school absences (9 days (5–15)), followed by transplant recipients (2 days (1–7)), children with CKD 3–5 (1 day (0–3)), and with CKD 1–2 (1 day (0–3)). Duration of CKD modified the association between CKD stage and school absences, with children with a transplant experiencing a higher number of missed school days with increasing duration of CKD, but not in children with CKD 1–5 or on dialysis (p-interaction < 0.01). Conclusions: Children receiving dialysis and with a kidney transplant had greater school absences and played fewer sports compared to children with CKD stages 1–2. Innovative strategies to improve school attendance and sport participation are needed to improve life participation of children with CKD. [ABSTRACT FROM AUTHOR]

Alter's The Matter of Consciousness is not only the most systematic defense of the knowledge argument, it is so crystal clear, so compelling, that it should be required reading not only for those interested in consciousness, but for those interested in clear philosophical writing. In some circles The Knowledge Argument (KA) gets a bad rap. Philosophers in those circles should read this book. Though I am someone who takes the argument quite seriously, I have argued that the metaphysical conclusions of the argument can be resisted. Alter has convinced me that in many cases my arguments have come up short, and at the very least require further clarification and defense. For the purpose of these comments, I'm going to focus on his criticism of "subjective physicalism" (Howell, 2013) and its acquaintance response to the knowledge argument. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to provide a comprehensive understanding of the need for continued development of symptom monitoring (SM) implementation, utilization, and data usage at the macro-, meso-, and micro-levels. Methods: Discussions from a patient-reported SM workshop at the MASCC/ISSO 2022 annual meeting were analyzed using a macro-meso-micro analytical framework of cancer care delivery. The workshop categories “initiation and implementation, barriers to adoption and utilization, and data usage” were integrated for each level. Results: At the macro-level, policy development could encourage data sharing and international collaboration, including the exchange of SM methods, supportive care models, and self-management modules. At the meso-level, institutions should adjust clinical workflow and service delivery and promote a thorough technical and clinical integration of SM. At the micro-level, SM should be individualized, with timely feedback for patients, and should foster trust and understanding of AI decision support tools amongst clinicians to improve supportive care. Conclusions: The workshop reached a consensus among international experts on providing guidance on SM implementation, utilization, and (big) data usage pathways in cancer survivors across the cancer continuum and on macro-meso-micro levels. [ABSTRACT FROM AUTHOR]

Purpose: Assessing the risk of tibial baseplate loosening in patients after unrestricted kinematically aligned (unKA) total knee arthroplasty (TKA) using a medially conforming insert is important because baseplates generally are aligned in varus which has been linked to an increased incidence of aseptic loosening following mechanically aligned TKA. Two limits that indicate long‐term stability in patients are a change in maximum total point motion between 1 and 2 years (ΔMTPM) < 0.2 mm and anterior tilt at 2 years < 0.8°. The purposes were to determine: (1) the number of patients with ΔMTPM > 0.2 mm, (2) the number of patients with anterior tilt > 0.8° and (3) whether increased varus baseplate and limb alignment were associated with increased migration. Methods: Thirty‐five patients underwent cemented, caliper‐verified, unKA TKA using a medially conforming tibial insert with posterior cruciate ligament (PCL) retention. Biplanar radiographs acquired on the day of surgery and at 1.5, 3, 6, 12 and 24 months were processed with model‐based radiostereometric analysis (RSA) software to determine migration and the number of patients with migration above the two stability limits. Medial proximal tibial angle (MPTA), hip‐knee‐ankle angle (HKAA) and posterior slope angle (PSA) were analyzed for an association with migration in six degrees of freedom and in MTPM. Results: Thirty‐two of 35 patients were available for analysis at 2 years. One patient exhibited ΔMTPM > 0.2 mm. The same patient exhibited anterior tilt > 0.8°. Varus rotation (p = 0.048, r ≤ 0.34) and medial translation (p = 0.0273, r ≤ 0.29) increased with increased varus baseplate alignment. Conclusion: The results indicate low risk of long‐term baseplate loosening in patients. Although varus rotation and medial translation increased with increased varus baseplate alignment, the magnitudes of the migrations were minimal and did not increase ΔMTPM and anterior tilt. Level of Evidence: Level II, therapeutic prospective cohort study. [ABSTRACT FROM AUTHOR]

In this paper we study the direct sums of subspaces and some constructions of quotient spaces of near-vector spaces, as defined by André. In particular, for near-vector spaces constructed by taking copies of finite fields, we characterise the quasi-kernels of their quotient spaces, find their cardinality and determine when they are regular. In the case of non-regular quotient spaces, we show how they decompose into maximal regular subspaces. We show how the theory of finite-dimensional near-vector spaces constructed from finite fields allows us to reconstruct near-vector spaces with certain quotient spaces. [ABSTRACT FROM AUTHOR]

Key message: The NIAB_WW_SHW_NAM population, a large nested association mapping panel, is a useful resource for mapping QTL from synthetic hexaploid wheat that can improve modern elite wheat cultivars. The allelic richness harbored in progenitors of hexaploid bread wheat (Triticum aestivum L.) is a useful resource for addressing the genetic diversity bottleneck in modern cultivars. Synthetic hexaploid wheat (SHW) is created through resynthesis of the hybridisation events between the tetraploid (Triticum turgidum subsp. durum Desf.) and diploid (Aegilops tauschii Coss.) bread wheat progenitors. We developed a large and diverse winter wheat nested association mapping (NAM) population (termed the NIAB_WW_SHW_NAM) consisting of 3241 genotypes derived from 54 nested back-cross 1 (BC1) populations, each formed via back-crossing a different primary SHW into the UK winter wheat cultivar ‘Robigus’. The primary SHW lines were created using 15 T. durum donors and 47 Ae. tauschii accessions that spanned the lineages and geographical range of the species. Primary SHW parents were typically earlier flowering, taller and showed better resistance to yellow rust infection (Yr) than ‘Robigus’. The NIAB_WW_SHW_NAM population was genotyped using a single nucleotide polymorphism (SNP) array and 27 quantitative trait loci (QTLs) were detected for flowering time, plant height and Yr resistance. Across multiple field trials, a QTL for Yr resistance was found on chromosome 4D that corresponded to the Yr28 resistance gene previously reported in other SHW lines. These results demonstrate the value of the NIAB_WW_SHW_NAM population for genetic mapping and provide the first evidence of Yr28 working in current UK environments and genetic backgrounds. These examples, coupled with the evidence of commercial wheat breeders selecting promising genotypes, highlight the potential value of the NIAB_WW_SHW_NAM to variety improvement. [ABSTRACT FROM AUTHOR]

Improved screening and treatment have decreased breast cancer mortality, although incidence continues to rise. Women at increased risk of breast cancer can be offered risk reducing treatments, such as tamoxifen, but this has not been shown to reduce breast cancer mortality. New, more efficacious, risk-reducing agents are needed. The identification of novel candidates for prevention is hampered by a lack of good preclinical models. Current patient derived in vitro and in vivo models cannot fully recapitulate the complexities of the human tissue, lacking human extracellular matrix, stroma, and immune cells, all of which are known to influence therapy response. Here we describe a normal breast explant model utilising a tuneable hydrogel which maintains epithelial proliferation, hormone receptor expression, and residency of T cells and macrophages over 7 days. Unlike other organotypic tissue cultures which are often limited by hyper-proliferation, loss of hormone signalling, and short treatment windows (< 48h), our model shows that tissue remains viable over 7 days with none of these early changes. This offers a powerful and unique opportunity to model the normal breast and study changes in response to various risk factors, such as breast density and hormone exposure. Further validation of the model, using samples from patients undergoing preventive therapies, will hopefully confirm this to be a valuable tool, allowing us to test novel agents for breast cancer risk reduction preclinically. [ABSTRACT FROM AUTHOR]

Associations between datasets can be discovered through multivariate methods like Canonical Correlation Analysis (CCA) or Partial Least Squares (PLS). A requisite property for interpretability and generalizability of CCA/PLS associations is stability of their feature patterns. However, stability of CCA/PLS in high-dimensional datasets is questionable, as found in empirical characterizations. To study these issues systematically, we developed a generative modeling framework to simulate synthetic datasets. We found that when sample size is relatively small, but comparable to typical studies, CCA/PLS associations are highly unstable and inaccurate; both in their magnitude and importantly in the feature pattern underlying the association. We confirmed these trends across two neuroimaging modalities and in independent datasets with n ≈ 1000 and n = 20,000, and found that only the latter comprised sufficient observations for stable mappings between imaging-derived and behavioral features. We further developed a power calculator to provide sample sizes required for stability and reliability of multivariate analyses. Collectively, we characterize how to limit detrimental effects of overfitting on CCA/PLS stability, and provide recommendations for future studies. Multivariate associations discovered by CCA/PLS can be highly unstable and inaccurate with relatively small but typical sample sizes, inspiring the development of a sample size calculator for stable associations. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to synthesise knowledge on the relative social value of child and adult health. Methods: Quantitative and qualitative studies that evaluated the willingness of the public to prioritise treatments for children over adults were included. A search to September 2023 was undertaken. Completeness of reporting was assessed using a checklist derived from Johnston et al. Findings were tabulated by study type (matching/person trade-off, discrete choice experiment, willingness to pay, opinion survey or qualitative). Evidence in favour of children was considered in total, by length or quality of life, methodology and respondent characteristics. Results: Eighty-eight studies were included; willingness to pay (n = 9), matching/person trade-off (n = 12), discrete choice experiments (n = 29), opinion surveys (n = 22) and qualitative (n = 16), with one study simultaneously included as an opinion survey. From 88 studies, 81 results could be ascertained. Across all studies irrespective of method or other characteristics, 42 findings supported prioritising children, while 12 provided evidence favouring adults in preference to children. The remainder supported equal prioritisation or found diverse or unclear views. Of those studies considering prioritisation within the under 18 years of age group, nine findings favoured older children over younger children (including for life saving interventions), six favoured younger children and five found diverse views. Conclusions: The balance of evidence suggests the general public favours prioritising children over adults, but this view was not found across all studies. There are research gaps in understanding the public's views on the value of health gains to very young children and the motivation behind the public's views on the value of child relative to adult health gains. Clinical Trial Registration: The review is registered at PROSPERO number: CRD42021244593. There were two amendments to the protocol: (1) some additional search terms were added to the search strategy prior to screening to ensure coverage and (2) a more formal quality assessment was added to the process at the data extraction stage. This assessment had not been identified at the protocol writing stage. [ABSTRACT FROM AUTHOR]

While the Circular Restricted Three-Body Problem (CR3BP) provides useful structures for various applications, transitioning the solutions from the CR3BP to a higher-fidelity ephemeris model while maintaining specific characteristics remains non-trivial. An analytical approach is leveraged to provide additional insight on the perturbations that are present in an ephemeris model. For the Earth–Moon CR3BP, pulsation of the Earth–Moon distance and solar gravity are identified as key components contributing to the additional accelerations, where patterns are illustrated through simplified mathematical relationships and graphics. Utilizing these findings, capabilities and limitations of two intermediate models, the Elliptic Restricted Three-Body Problem and the Bi-Circular Restricted Four-Body Problem, are assessed within the context of transitioning from the CR3BP to a realistic ephemeris model. A sample transition process for Earth–Moon L2 halo orbits is provided, leveraging the insight from the proposed analytical approach. [ABSTRACT FROM AUTHOR]

Background: Self-perception is an important internal resource, and violence exposure can negatively impact children's view of themselves. Although camp interventions can enhance self-perception, research has not yet examined whether camp interventions improve self-perception among children affected by family violence. Camp-based interventions promote health equity by addressing common barriers to service engagement. Objective: Using a non-masked, parallel randomized controlled design, this pilot study evaluated whether a camp-based intervention (i.e., Camp HOPE) enhanced self-perception among youth exposed to family violence. Method: Participants included 47 children aged 7–12 (M = 9.55, SD = 1.63; 79% Black/African American) and one of their adult caregivers seeking services from a Family Justice Center. Children were assigned to the camp (n = 23) or waitlist control (n = 24) condition using block randomization. Caregiver-child dyads completed evaluations at baseline, 2-month follow-up, and 5-month follow-up. Children reported on three self-perception domains: Social Competence, Behavioral Conduct, and Global Self-Worth (GSW). Piecewise latent growth curve models evaluated between-group differences in self-perception at 2- and 5-month follow-up. Results: Findings from intent-to-treat analyses indicated that Camp HOPE may have a temporary, negative impact on children's GSW (Diff. = − 2.65; SE = 1.22; p = 0.029; g = 0.63). Supplemental "as-treated" analyses revealed no significant differences between children who attended and did not attend the camp. Conclusions: Results are inconsistent with previous findings that camp interventions enhance self-perception, raising important questions about the unique experiences of youth exposed to family violence. Given these findings, Camp HOPE America might consider modifications to enhance effectiveness. [ABSTRACT FROM AUTHOR]

Geological investigations planned for the Europa Clipper mission will examine the formation, evolution, and expression of geomorphic structures found on the surface. Understanding geologic features, their formation, and any recent activity are key inputs in constraining Europa’s potential for habitability. In addition to providing information about the moon’s habitability, the geologic study of Europa is compelling in and of itself. Here we provide a high-level, cross-instrument, and cross-discipline overview of the geologic investigations planned within the Europa Clipper mission. Europa’s fascinating collection of ice-focused geology provides an unparalleled opportunity to investigate the dynamics of icy shells, ice-ocean exchange processes, and global-scale tectonic and tidal stresses. We present an overview of what is currently known about the geology of Europa, from global to local scales, highlighting outstanding issues and open questions, and detailing how the Europa Clipper mission will address them. We describe the mission’s strategy for searching for and characterizing current activity in the form of possible active plumes, thermal anomalies, evidence for surface changes, and extremely fresh surface exposures. The complementary and synergistic nature of the data sets from the various instruments and their integration will be key to significantly advancing our understanding of Europa’s geology. [ABSTRACT FROM AUTHOR]

Conspicuous coloration is often seen as the evolutionary consequence of either sexual selection or warning predators visually about prey defences, although not all conspicuous species fit this paradigm. Exceptions include several species of colobus monkeys whose black-and-white coloration, characteristic of larger colobines, has never been explained. Here, using photographs of black-and-white colobus (Colobus vellerosus) taken in the wild, quantitative image analysis, and vision modelling (acuity-corrected feline, chimpanzee, and raptor vision), we provide evidence that their coloration provides distance-dependent camouflage in natural forest environments. At all viewing distances, black-and-white colobus monkeys blend into their environment because of their high chromatic overlap with the background when viewed by ecologically relevant predator vision models which have low visual acuities. Additionally, for chimpanzee and felid vision, there was evidence of edge disruption at longer viewing distances. Our comparative analyses of different species of colobines do not support an association between black-and-white coloration and larger body mass or group size, but this may simply be due to the limited number of species within the family. We reason that black-and-white colobines gain visually protective coloration through background matching against felids, and also benefit through disruptive coloration against felids and chimpanzees but rely on these protective coloration mechanisms less against raptors. Significance statement: Conspicuous black-and-white coloration in colobus monkeys has long eluded an evolutionary explanation. Our research, employing photographs of colobus monkeys, image analysis, and vision modelling, unveils a novel approach to this coloration. We show that in their natural forest habitats, black-and-white colobus monkeys employ distance-dependent camouflage against ecologically relevant predators with low visual acuity, blending in with the background at increasing viewing distances. In summary, the evolution of black-and-white colobus coloration appears to be related to background matching against felids, with added benefits of disruptive camouflage against felids and chimpanzees, less so to raptors, offering fresh insights into the complex interplay of coloration and survival strategies in mammals. [ABSTRACT FROM AUTHOR]

Parent-child interactions, which substantially impact children’s psychosocial functioning, can be affected by caregiver adversity exposure. Considering that caregivers and their children often have divergent perspectives on their interactions, the current study included maternal- and child-reports of parenting practices and parent-child communication as indicators in a latent profile analysis. This study included 263 dyads comprised of children aged 8–17 (MAge = 12.13, SD = 2.77; 88.2% Black) and their female caregivers (MAge = 36.43, SD = 7.89; 82.9% Black) who were recruited based on caregivers’ differing experiences with the SAVA syndemic (i.e., potentially harmful substance use, intimate partner violence (IPV), HIV, or none of these adversities). After identifying empirically-derived profiles of maternal-child interactions, we examined associations between these established profiles and children’s external resilience resources. A three-class model emerged as the best fit: Concordant: Child/Mother Positive (C-PP; 73.4%), Discordant: Child Very Negative/Mother Slightly Negative (D-CN; 13.1%), and Discordant: Child Positive/Mother Negative (D-CP; 11.8%). Caregiver endorsement of SAVA syndemics did not predict class membership. Dyads with older children were more likely to be in the D-CN class, and dyads reporting lower SES were more likely to be in the D-CP class. Compared to children in the D-CN class, children in the C-PP class reported significantly higher resilience in school (Est. = −0.42, p = 0.006), community (Est. = −0.51, p = 0.001), and peer (Est. = −0.37, p = 0.004) contexts. No other class differences emerged. Findings highlight the importance of positive and consistent maternal-child interactions, which may help youth access a network of resilience resources that can promote healthy development and bolster well-being. [ABSTRACT FROM AUTHOR]

Purpose: Cricopharyngeus muscle dysfunction (CPMD) is a common clinical occurrence with very few clear diagnostic criteria and multiple pathways for treatment. Incidence of CPMD is not known, but some data suggest around 25% of people with dysphagia experience some degree of CPMD, which negatively impacts swallowing safety and efficiency. Workup and treatment of CPMD can require multidisciplinary collaboration across laryngologists, speech-language pathologists with training in dysphagia management, and gastroenterologists. The purpose of this paper is to review what is known about CPMD and identify areas of future research in CPMD diagnosis and treatment.An overview of CPMD, relative treatments and disorders, and a discussion of future areas of research needed to improve clinical care of CPMD.Details regarding historical background, pathophysiology and treatment practiced for CPMD are included.In summary, CPMD is a poorly defined disease due to a lack of understanding of its pathophysiology and the lack of consensus diagnostic criteria. Well-designed, prospective clinical trials are necessary to develop a better understanding of clinical incidence of CPMD, impact of the disorder on oropharyngeal swallowing, and how to approach treatment of the disorder surgically or in conjunction with therapy directed by a specialized speech-language pathologist.Methods: Cricopharyngeus muscle dysfunction (CPMD) is a common clinical occurrence with very few clear diagnostic criteria and multiple pathways for treatment. Incidence of CPMD is not known, but some data suggest around 25% of people with dysphagia experience some degree of CPMD, which negatively impacts swallowing safety and efficiency. Workup and treatment of CPMD can require multidisciplinary collaboration across laryngologists, speech-language pathologists with training in dysphagia management, and gastroenterologists. The purpose of this paper is to review what is known about CPMD and identify areas of future research in CPMD diagnosis and treatment.An overview of CPMD, relative treatments and disorders, and a discussion of future areas of research needed to improve clinical care of CPMD.Details regarding historical background, pathophysiology and treatment practiced for CPMD are included.In summary, CPMD is a poorly defined disease due to a lack of understanding of its pathophysiology and the lack of consensus diagnostic criteria. Well-designed, prospective clinical trials are necessary to develop a better understanding of clinical incidence of CPMD, impact of the disorder on oropharyngeal swallowing, and how to approach treatment of the disorder surgically or in conjunction with therapy directed by a specialized speech-language pathologist.Results: Cricopharyngeus muscle dysfunction (CPMD) is a common clinical occurrence with very few clear diagnostic criteria and multiple pathways for treatment. Incidence of CPMD is not known, but some data suggest around 25% of people with dysphagia experience some degree of CPMD, which negatively impacts swallowing safety and efficiency. Workup and treatment of CPMD can require multidisciplinary collaboration across laryngologists, speech-language pathologists with training in dysphagia management, and gastroenterologists. The purpose of this paper is to review what is known about CPMD and identify areas of future research in CPMD diagnosis and treatment.An overview of CPMD, relative treatments and disorders, and a discussion of future areas of research needed to improve clinical care of CPMD.Details regarding historical background, pathophysiology and treatment practiced for CPMD are included.In summary, CPMD is a poorly defined disease due to a lack of understanding of its pathophysiology and the lack of consensus diagnostic criteria. Well-designed, prospective clinical trials are necessary to develop a better understanding of clinical incidence of CPMD, impact of the disorder on oropharyngeal swallowing, and how to approach treatment of the disorder surgically or in conjunction with therapy directed by a specialized speech-language pathologist.Conclusion: Cricopharyngeus muscle dysfunction (CPMD) is a common clinical occurrence with very few clear diagnostic criteria and multiple pathways for treatment. Incidence of CPMD is not known, but some data suggest around 25% of people with dysphagia experience some degree of CPMD, which negatively impacts swallowing safety and efficiency. Workup and treatment of CPMD can require multidisciplinary collaboration across laryngologists, speech-language pathologists with training in dysphagia management, and gastroenterologists. The purpose of this paper is to review what is known about CPMD and identify areas of future research in CPMD diagnosis and treatment.An overview of CPMD, relative treatments and disorders, and a discussion of future areas of research needed to improve clinical care of CPMD.Details regarding historical background, pathophysiology and treatment practiced for CPMD are included.In summary, CPMD is a poorly defined disease due to a lack of understanding of its pathophysiology and the lack of consensus diagnostic criteria. Well-designed, prospective clinical trials are necessary to develop a better understanding of clinical incidence of CPMD, impact of the disorder on oropharyngeal swallowing, and how to approach treatment of the disorder surgically or in conjunction with therapy directed by a specialized speech-language pathologist. [ABSTRACT FROM AUTHOR]

Background: School engagement is a positive, malleable aspect of youth functioning that may be influenced by familial factors. Both risk and protective factors may affect youth’s school engagement.Utilizing an intergenerational transmission of risk framework, the current study examined how maternal factors (i.e., maternal psychopathology, maternal trauma history, maternal education) and youth factors (i.e., social support) relate to school engagement.Participants were 117 youth of color aged 8–13 years (Mage = 9.96, SD = 1.40), 51% female, 89% Black or African American and their female primary caregivers; all families had experienced adversity. Using a single-group, cross-sectional design, hierarchical linear regression models examined direct and interactive effects. The first block included maternal psychopathology (i.e., anxiety or depression), maternal trauma history, maternal education, and child social support. The second block added the interaction between maternal psychopathology and child social support.Results revealed a direct, positive relation between child social support and school engagement. Social support also moderated the association between maternal anxiety and school engagement; for individuals with extremely low social support, higher maternal anxiety was related to lower school engagement.Results illustrate the value of an intergenerational approach to exploring how maternal factors have implications for youth functioning. Findings also highlight the importance of social support among families of color exposed to adversity. Limitations include the cross-sectional design; thus, future research would benefit from longitudinal examination of maternal and child factors related to school engagement to assess temporal and directional effects.Objective: School engagement is a positive, malleable aspect of youth functioning that may be influenced by familial factors. Both risk and protective factors may affect youth’s school engagement.Utilizing an intergenerational transmission of risk framework, the current study examined how maternal factors (i.e., maternal psychopathology, maternal trauma history, maternal education) and youth factors (i.e., social support) relate to school engagement.Participants were 117 youth of color aged 8–13 years (Mage = 9.96, SD = 1.40), 51% female, 89% Black or African American and their female primary caregivers; all families had experienced adversity. Using a single-group, cross-sectional design, hierarchical linear regression models examined direct and interactive effects. The first block included maternal psychopathology (i.e., anxiety or depression), maternal trauma history, maternal education, and child social support. The second block added the interaction between maternal psychopathology and child social support.Results revealed a direct, positive relation between child social support and school engagement. Social support also moderated the association between maternal anxiety and school engagement; for individuals with extremely low social support, higher maternal anxiety was related to lower school engagement.Results illustrate the value of an intergenerational approach to exploring how maternal factors have implications for youth functioning. Findings also highlight the importance of social support among families of color exposed to adversity. Limitations include the cross-sectional design; thus, future research would benefit from longitudinal examination of maternal and child factors related to school engagement to assess temporal and directional effects.Methods: School engagement is a positive, malleable aspect of youth functioning that may be influenced by familial factors. Both risk and protective factors may affect youth’s school engagement.Utilizing an intergenerational transmission of risk framework, the current study examined how maternal factors (i.e., maternal psychopathology, maternal trauma history, maternal education) and youth factors (i.e., social support) relate to school engagement.Participants were 117 youth of color aged 8–13 years (Mage = 9.96, SD = 1.40), 51% female, 89% Black or African American and their female primary caregivers; all families had experienced adversity. Using a single-group, cross-sectional design, hierarchical linear regression models examined direct and interactive effects. The first block included maternal psychopathology (i.e., anxiety or depression), maternal trauma history, maternal education, and child social support. The second block added the interaction between maternal psychopathology and child social support.Results revealed a direct, positive relation between child social support and school engagement. Social support also moderated the association between maternal anxiety and school engagement; for individuals with extremely low social support, higher maternal anxiety was related to lower school engagement.Results illustrate the value of an intergenerational approach to exploring how maternal factors have implications for youth functioning. Findings also highlight the importance of social support among families of color exposed to adversity. Limitations include the cross-sectional design; thus, future research would benefit from longitudinal examination of maternal and child factors related to school engagement to assess temporal and directional effects.Results: School engagement is a positive, malleable aspect of youth functioning that may be influenced by familial factors. Both risk and protective factors may affect youth’s school engagement.Utilizing an intergenerational transmission of risk framework, the current study examined how maternal factors (i.e., maternal psychopathology, maternal trauma history, maternal education) and youth factors (i.e., social support) relate to school engagement.Participants were 117 youth of color aged 8–13 years (Mage = 9.96, SD = 1.40), 51% female, 89% Black or African American and their female primary caregivers; all families had experienced adversity. Using a single-group, cross-sectional design, hierarchical linear regression models examined direct and interactive effects. The first block included maternal psychopathology (i.e., anxiety or depression), maternal trauma history, maternal education, and child social support. The second block added the interaction between maternal psychopathology and child social support.Results revealed a direct, positive relation between child social support and school engagement. Social support also moderated the association between maternal anxiety and school engagement; for individuals with extremely low social support, higher maternal anxiety was related to lower school engagement.Results illustrate the value of an intergenerational approach to exploring how maternal factors have implications for youth functioning. Findings also highlight the importance of social support among families of color exposed to adversity. Limitations include the cross-sectional design; thus, future research would benefit from longitudinal examination of maternal and child factors related to school engagement to assess temporal and directional effects.Conclusions: School engagement is a positive, malleable aspect of youth functioning that may be influenced by familial factors. Both risk and protective factors may affect youth’s school engagement.Utilizing an intergenerational transmission of risk framework, the current study examined how maternal factors (i.e., maternal psychopathology, maternal trauma history, maternal education) and youth factors (i.e., social support) relate to school engagement.Participants were 117 youth of color aged 8–13 years (Mage = 9.96, SD = 1.40), 51% female, 89% Black or African American and their female primary caregivers; all families had experienced adversity. Using a single-group, cross-sectional design, hierarchical linear regression models examined direct and interactive effects. The first block included maternal psychopathology (i.e., anxiety or depression), maternal trauma history, maternal education, and child social support. The second block added the interaction between maternal psychopathology and child social support.Results revealed a direct, positive relation between child social support and school engagement. Social support also moderated the association between maternal anxiety and school engagement; for individuals with extremely low social support, higher maternal anxiety was related to lower school engagement.Results illustrate the value of an intergenerational approach to exploring how maternal factors have implications for youth functioning. Findings also highlight the importance of social support among families of color exposed to adversity. Limitations include the cross-sectional design; thus, future research would benefit from longitudinal examination of maternal and child factors related to school engagement to assess temporal and directional effects. [ABSTRACT FROM AUTHOR]

Introduction: Early cancer detection can significantly improve patient outcomes and reduce mortality rates. Novel cancer screening approaches, including multi-cancer early detection tests, have been developed. Cost-utility analyses will be needed to examine their value, and these models require health state utilities. The purpose of this study was to estimate the disutility (i.e., decrease in health state utility) associated with false-positive cancer screening results.In composite time trade-off interviews using a 1-year time horizon, UK general population participants valued 10 health state vignettes describing cancer screening with true-negative or false-positive results. Each false-positive vignette described a common diagnostic pathway following a false-positive result suggesting lung, colorectal, breast, or pancreatic cancer. Every pathway ended with a negative result (no cancer detected). The disutility of each false positive was calculated as the difference between the true-negative and each false-positive health state, and because of the 1-year time horizon, each disutility can be interpreted as a quality-adjusted life-year decrement associated with each type of false-positive experience.A total of 203 participants completed interviews (49.8% male; mean age = 42.0 years). The mean (SD) utility for the health state describing a true-negative result was 0.958 (0.065). Utilities for false-positive health states ranged from 0.847 (0.145) to 0.932 (0.059). Disutilities for false positives ranged from − 0.031 to − 0.111 (− 0.041 to − 0.111 for lung cancer; − 0.079 for colorectal cancer; − 0.031 to − 0.067 for breast cancer; − 0.048 to − 0.088 for pancreatic cancer).All false-positive results were associated with a disutility. Greater disutility was associated with more invasive follow-up diagnostic procedures, longer duration of uncertainty regarding the eventual diagnosis, and perceived severity of the suspected cancer type. Utility values estimated in this study would be useful for economic modeling examining the value of cancer screening procedures.Methods: Early cancer detection can significantly improve patient outcomes and reduce mortality rates. Novel cancer screening approaches, including multi-cancer early detection tests, have been developed. Cost-utility analyses will be needed to examine their value, and these models require health state utilities. The purpose of this study was to estimate the disutility (i.e., decrease in health state utility) associated with false-positive cancer screening results.In composite time trade-off interviews using a 1-year time horizon, UK general population participants valued 10 health state vignettes describing cancer screening with true-negative or false-positive results. Each false-positive vignette described a common diagnostic pathway following a false-positive result suggesting lung, colorectal, breast, or pancreatic cancer. Every pathway ended with a negative result (no cancer detected). The disutility of each false positive was calculated as the difference between the true-negative and each false-positive health state, and because of the 1-year time horizon, each disutility can be interpreted as a quality-adjusted life-year decrement associated with each type of false-positive experience.A total of 203 participants completed interviews (49.8% male; mean age = 42.0 years). The mean (SD) utility for the health state describing a true-negative result was 0.958 (0.065). Utilities for false-positive health states ranged from 0.847 (0.145) to 0.932 (0.059). Disutilities for false positives ranged from − 0.031 to − 0.111 (− 0.041 to − 0.111 for lung cancer; − 0.079 for colorectal cancer; − 0.031 to − 0.067 for breast cancer; − 0.048 to − 0.088 for pancreatic cancer).All false-positive results were associated with a disutility. Greater disutility was associated with more invasive follow-up diagnostic procedures, longer duration of uncertainty regarding the eventual diagnosis, and perceived severity of the suspected cancer type. Utility values estimated in this study would be useful for economic modeling examining the value of cancer screening procedures.Results: Early cancer detection can significantly improve patient outcomes and reduce mortality rates. Novel cancer screening approaches, including multi-cancer early detection tests, have been developed. Cost-utility analyses will be needed to examine their value, and these models require health state utilities. The purpose of this study was to estimate the disutility (i.e., decrease in health state utility) associated with false-positive cancer screening results.In composite time trade-off interviews using a 1-year time horizon, UK general population participants valued 10 health state vignettes describing cancer screening with true-negative or false-positive results. Each false-positive vignette described a common diagnostic pathway following a false-positive result suggesting lung, colorectal, breast, or pancreatic cancer. Every pathway ended with a negative result (no cancer detected). The disutility of each false positive was calculated as the difference between the true-negative and each false-positive health state, and because of the 1-year time horizon, each disutility can be interpreted as a quality-adjusted life-year decrement associated with each type of false-positive experience.A total of 203 participants completed interviews (49.8% male; mean age = 42.0 years). The mean (SD) utility for the health state describing a true-negative result was 0.958 (0.065). Utilities for false-positive health states ranged from 0.847 (0.145) to 0.932 (0.059). Disutilities for false positives ranged from − 0.031 to − 0.111 (− 0.041 to − 0.111 for lung cancer; − 0.079 for colorectal cancer; − 0.031 to − 0.067 for breast cancer; − 0.048 to − 0.088 for pancreatic cancer).All false-positive results were associated with a disutility. Greater disutility was associated with more invasive follow-up diagnostic procedures, longer duration of uncertainty regarding the eventual diagnosis, and perceived severity of the suspected cancer type. Utility values estimated in this study would be useful for economic modeling examining the value of cancer screening procedures.Conclusion: Early cancer detection can significantly improve patient outcomes and reduce mortality rates. Novel cancer screening approaches, including multi-cancer early detection tests, have been developed. Cost-utility analyses will be needed to examine their value, and these models require health state utilities. The purpose of this study was to estimate the disutility (i.e., decrease in health state utility) associated with false-positive cancer screening results.In composite time trade-off interviews using a 1-year time horizon, UK general population participants valued 10 health state vignettes describing cancer screening with true-negative or false-positive results. Each false-positive vignette described a common diagnostic pathway following a false-positive result suggesting lung, colorectal, breast, or pancreatic cancer. Every pathway ended with a negative result (no cancer detected). The disutility of each false positive was calculated as the difference between the true-negative and each false-positive health state, and because of the 1-year time horizon, each disutility can be interpreted as a quality-adjusted life-year decrement associated with each type of false-positive experience.A total of 203 participants completed interviews (49.8% male; mean age = 42.0 years). The mean (SD) utility for the health state describing a true-negative result was 0.958 (0.065). Utilities for false-positive health states ranged from 0.847 (0.145) to 0.932 (0.059). Disutilities for false positives ranged from − 0.031 to − 0.111 (− 0.041 to − 0.111 for lung cancer; − 0.079 for colorectal cancer; − 0.031 to − 0.067 for breast cancer; − 0.048 to − 0.088 for pancreatic cancer).All false-positive results were associated with a disutility. Greater disutility was associated with more invasive follow-up diagnostic procedures, longer duration of uncertainty regarding the eventual diagnosis, and perceived severity of the suspected cancer type. Utility values estimated in this study would be useful for economic modeling examining the value of cancer screening procedures. [ABSTRACT FROM AUTHOR]

Purpose: The prone transpsoas approach is a single-position alternative to traditional lateral lumbar interbody fusion (LLIF). Earlier prone LLIF studies have focused on technique, feasibility, perioperative efficiencies, and immediate postoperative radiographic alignment. This study was undertaken to report longer-term clinical and radiographic outcomes, and to identify learnings from experiential evolution of the prone LLIF procedure.All consecutive patients undergoing prone LLIF for any indication at one institution were included (n = 120). Demographic, diagnostic, treatment, and outcomes data were captured via prospective institutional registry. Retrospective analysis identified 31 ‘pre-proceduralization’ and 89 ‘post-proceduralization’ prone LLIF approaches, enabling comparison across early and later cohorts.187 instrumented LLIF levels were performed. Operative time, retraction time, LLIF blood loss, and hospital stay averaged 150 min, 17 min, 50 ml, and 2.2 days, respectively. 79% of cases were without complication. Postoperative hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. At last follow-up, back pain, worst-leg pain, Oswestry, and EQ-5D health state improved by 55%, 46%, 48%, and 51%, respectively. 99% improved or maintained sagittal alignment with an average 6.5° segmental lordosis gain at LLIF levels. Only intra-psoas retraction time differed between pre- and post-proceduralization; proceduralization saved an average 3.4 min/level (p = 0.0371).The largest single-center prone LLIF experience with the longest follow-up to-date shows that it results in few complications, quick recovery, improvements in pain and function, high patient satisfaction, and improved sagittal alignment at an average one year and up to four years postoperatively.Methods: The prone transpsoas approach is a single-position alternative to traditional lateral lumbar interbody fusion (LLIF). Earlier prone LLIF studies have focused on technique, feasibility, perioperative efficiencies, and immediate postoperative radiographic alignment. This study was undertaken to report longer-term clinical and radiographic outcomes, and to identify learnings from experiential evolution of the prone LLIF procedure.All consecutive patients undergoing prone LLIF for any indication at one institution were included (n = 120). Demographic, diagnostic, treatment, and outcomes data were captured via prospective institutional registry. Retrospective analysis identified 31 ‘pre-proceduralization’ and 89 ‘post-proceduralization’ prone LLIF approaches, enabling comparison across early and later cohorts.187 instrumented LLIF levels were performed. Operative time, retraction time, LLIF blood loss, and hospital stay averaged 150 min, 17 min, 50 ml, and 2.2 days, respectively. 79% of cases were without complication. Postoperative hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. At last follow-up, back pain, worst-leg pain, Oswestry, and EQ-5D health state improved by 55%, 46%, 48%, and 51%, respectively. 99% improved or maintained sagittal alignment with an average 6.5° segmental lordosis gain at LLIF levels. Only intra-psoas retraction time differed between pre- and post-proceduralization; proceduralization saved an average 3.4 min/level (p = 0.0371).The largest single-center prone LLIF experience with the longest follow-up to-date shows that it results in few complications, quick recovery, improvements in pain and function, high patient satisfaction, and improved sagittal alignment at an average one year and up to four years postoperatively.Results: The prone transpsoas approach is a single-position alternative to traditional lateral lumbar interbody fusion (LLIF). Earlier prone LLIF studies have focused on technique, feasibility, perioperative efficiencies, and immediate postoperative radiographic alignment. This study was undertaken to report longer-term clinical and radiographic outcomes, and to identify learnings from experiential evolution of the prone LLIF procedure.All consecutive patients undergoing prone LLIF for any indication at one institution were included (n = 120). Demographic, diagnostic, treatment, and outcomes data were captured via prospective institutional registry. Retrospective analysis identified 31 ‘pre-proceduralization’ and 89 ‘post-proceduralization’ prone LLIF approaches, enabling comparison across early and later cohorts.187 instrumented LLIF levels were performed. Operative time, retraction time, LLIF blood loss, and hospital stay averaged 150 min, 17 min, 50 ml, and 2.2 days, respectively. 79% of cases were without complication. Postoperative hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. At last follow-up, back pain, worst-leg pain, Oswestry, and EQ-5D health state improved by 55%, 46%, 48%, and 51%, respectively. 99% improved or maintained sagittal alignment with an average 6.5° segmental lordosis gain at LLIF levels. Only intra-psoas retraction time differed between pre- and post-proceduralization; proceduralization saved an average 3.4 min/level (p = 0.0371).The largest single-center prone LLIF experience with the longest follow-up to-date shows that it results in few complications, quick recovery, improvements in pain and function, high patient satisfaction, and improved sagittal alignment at an average one year and up to four years postoperatively.Conclusions: The prone transpsoas approach is a single-position alternative to traditional lateral lumbar interbody fusion (LLIF). Earlier prone LLIF studies have focused on technique, feasibility, perioperative efficiencies, and immediate postoperative radiographic alignment. This study was undertaken to report longer-term clinical and radiographic outcomes, and to identify learnings from experiential evolution of the prone LLIF procedure.All consecutive patients undergoing prone LLIF for any indication at one institution were included (n = 120). Demographic, diagnostic, treatment, and outcomes data were captured via prospective institutional registry. Retrospective analysis identified 31 ‘pre-proceduralization’ and 89 ‘post-proceduralization’ prone LLIF approaches, enabling comparison across early and later cohorts.187 instrumented LLIF levels were performed. Operative time, retraction time, LLIF blood loss, and hospital stay averaged 150 min, 17 min, 50 ml, and 2.2 days, respectively. 79% of cases were without complication. Postoperative hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. At last follow-up, back pain, worst-leg pain, Oswestry, and EQ-5D health state improved by 55%, 46%, 48%, and 51%, respectively. 99% improved or maintained sagittal alignment with an average 6.5° segmental lordosis gain at LLIF levels. Only intra-psoas retraction time differed between pre- and post-proceduralization; proceduralization saved an average 3.4 min/level (p = 0.0371).The largest single-center prone LLIF experience with the longest follow-up to-date shows that it results in few complications, quick recovery, improvements in pain and function, high patient satisfaction, and improved sagittal alignment at an average one year and up to four years postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: Resecting the posterior cruciate ligament (PCL) increases posterior laxity and increases the flexion gap more than the extension gap in the native (i.e. healthy) knee. These two effects could lead to significant anterior displacement of the medial femoral condyle in kneeling following total knee arthroplasty even when using a tibial insert with a high degree of medial conformity. Using an insert with ball-in-socket medial conformity and a flat lateral articular surface, the primary purpose was to determine whether the medial femoral condyle remained stable with and without PCL retention during kneeling.Two groups of patients were studied, one with PCL retention (22 patients) and the other with PCL resection (25 patients), while kneeling at 90º flexion. Following 3D model-to-2D image registration, A-P displacements of both femoral condyles were determined relative to the dwell point of the medial socket.With PCL resection versus PCL retention, the medial femoral condyle was 5.1 ± 3.7 mm versus 0.8 ± 2.1 mm anterior of the dwell point (p < 0.0001). Patient-reported function scores were comparable (p ≥ 0.1610) despite a significantly shorter follow-up of 7.8 ± 0.9 months with PCL retention than 19.6 ± 4.9 months with PCL resection (p < 0.0001). Range of motion was 126 ± 8° versus 122 ± 6° with and without PCL retention, respectively (p = 0.057).Surgeons that use a highly conforming tibial insert design can stabilize the medial femoral condyle during kneeling by retaining the PCL. In patients with PCL resection, the 9 mm high anterior lip of the insert with ball-in-socket medial conformity was insufficient to prevent significant anterior displacement of the medial femoral condyle when weight-bearing on the anterior tibia.Methods: Resecting the posterior cruciate ligament (PCL) increases posterior laxity and increases the flexion gap more than the extension gap in the native (i.e. healthy) knee. These two effects could lead to significant anterior displacement of the medial femoral condyle in kneeling following total knee arthroplasty even when using a tibial insert with a high degree of medial conformity. Using an insert with ball-in-socket medial conformity and a flat lateral articular surface, the primary purpose was to determine whether the medial femoral condyle remained stable with and without PCL retention during kneeling.Two groups of patients were studied, one with PCL retention (22 patients) and the other with PCL resection (25 patients), while kneeling at 90º flexion. Following 3D model-to-2D image registration, A-P displacements of both femoral condyles were determined relative to the dwell point of the medial socket.With PCL resection versus PCL retention, the medial femoral condyle was 5.1 ± 3.7 mm versus 0.8 ± 2.1 mm anterior of the dwell point (p < 0.0001). Patient-reported function scores were comparable (p ≥ 0.1610) despite a significantly shorter follow-up of 7.8 ± 0.9 months with PCL retention than 19.6 ± 4.9 months with PCL resection (p < 0.0001). Range of motion was 126 ± 8° versus 122 ± 6° with and without PCL retention, respectively (p = 0.057).Surgeons that use a highly conforming tibial insert design can stabilize the medial femoral condyle during kneeling by retaining the PCL. In patients with PCL resection, the 9 mm high anterior lip of the insert with ball-in-socket medial conformity was insufficient to prevent significant anterior displacement of the medial femoral condyle when weight-bearing on the anterior tibia.Results: Resecting the posterior cruciate ligament (PCL) increases posterior laxity and increases the flexion gap more than the extension gap in the native (i.e. healthy) knee. These two effects could lead to significant anterior displacement of the medial femoral condyle in kneeling following total knee arthroplasty even when using a tibial insert with a high degree of medial conformity. Using an insert with ball-in-socket medial conformity and a flat lateral articular surface, the primary purpose was to determine whether the medial femoral condyle remained stable with and without PCL retention during kneeling.Two groups of patients were studied, one with PCL retention (22 patients) and the other with PCL resection (25 patients), while kneeling at 90º flexion. Following 3D model-to-2D image registration, A-P displacements of both femoral condyles were determined relative to the dwell point of the medial socket.With PCL resection versus PCL retention, the medial femoral condyle was 5.1 ± 3.7 mm versus 0.8 ± 2.1 mm anterior of the dwell point (p < 0.0001). Patient-reported function scores were comparable (p ≥ 0.1610) despite a significantly shorter follow-up of 7.8 ± 0.9 months with PCL retention than 19.6 ± 4.9 months with PCL resection (p < 0.0001). Range of motion was 126 ± 8° versus 122 ± 6° with and without PCL retention, respectively (p = 0.057).Surgeons that use a highly conforming tibial insert design can stabilize the medial femoral condyle during kneeling by retaining the PCL. In patients with PCL resection, the 9 mm high anterior lip of the insert with ball-in-socket medial conformity was insufficient to prevent significant anterior displacement of the medial femoral condyle when weight-bearing on the anterior tibia.Conclusion: Resecting the posterior cruciate ligament (PCL) increases posterior laxity and increases the flexion gap more than the extension gap in the native (i.e. healthy) knee. These two effects could lead to significant anterior displacement of the medial femoral condyle in kneeling following total knee arthroplasty even when using a tibial insert with a high degree of medial conformity. Using an insert with ball-in-socket medial conformity and a flat lateral articular surface, the primary purpose was to determine whether the medial femoral condyle remained stable with and without PCL retention during kneeling.Two groups of patients were studied, one with PCL retention (22 patients) and the other with PCL resection (25 patients), while kneeling at 90º flexion. Following 3D model-to-2D image registration, A-P displacements of both femoral condyles were determined relative to the dwell point of the medial socket.With PCL resection versus PCL retention, the medial femoral condyle was 5.1 ± 3.7 mm versus 0.8 ± 2.1 mm anterior of the dwell point (p < 0.0001). Patient-reported function scores were comparable (p ≥ 0.1610) despite a significantly shorter follow-up of 7.8 ± 0.9 months with PCL retention than 19.6 ± 4.9 months with PCL resection (p < 0.0001). Range of motion was 126 ± 8° versus 122 ± 6° with and without PCL retention, respectively (p = 0.057).Surgeons that use a highly conforming tibial insert design can stabilize the medial femoral condyle during kneeling by retaining the PCL. In patients with PCL resection, the 9 mm high anterior lip of the insert with ball-in-socket medial conformity was insufficient to prevent significant anterior displacement of the medial femoral condyle when weight-bearing on the anterior tibia. [ABSTRACT FROM AUTHOR]