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Purpose Statins are the most widely prescribed cholesterol lowering medications and have been associated with both improved and unchanged breast cancer outcomes in previous studies. This study examines the association between the post-diagnostic use of statins and breast cancer outcomes (death and recurrence) in a large, representative sample of New Zealand (NZ) women with breast cancer. Methods Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to national pharmaceutical data, hospital discharges, and death records. Cox proportional hazard models were used to estimate the hazard of breast cancer-specific death (BCD) associated with any post-diagnostic statin use. Results Of the 14,976 women included in analyses, 27% used a statin after diagnosis and the median follow up time was 4.51 years. Statin use (vs non-use) was associated with a statistically significant decreased risk of BCD (adjusted hazard ratio: 0.74; 0.63–0.86). The association was attenuated when considering a subgroup of ‘new’ statin users (HR: 0.91; 0.69–1.19), however other analyses revealed that the protective effect of statins was more pronounced in estrogen receptor positive patients (HR: 0.77; 0.63–0.94), postmenopausal women (HR: 0.74; 0.63–0.88), and in women with advanced stage disease (HR: 0.65; 0.49–0.84). Conclusion In this study, statin use was associated with a statistically significant decreased risk of breast cancer death, with subgroup analyses revealing a more protective effect in ER+ patients, postmenopausal women, and in women with advanced stage disease. Further research is warranted to determine if these associations are replicated in other clinical settings.

There is a tremendous increase in the development of alternative food packaging materials which are functional, environment-friendly, and can improve the shelf-life of food products. One such possible approach is to develop biopolymer-based active films loaded with antimicrobial essential oils. In the present study, pearl millet starch (PMS) films reinforced with kudzu cellulose nanocrystals (CNCs) stabilized Pickering emulsions of clove bud oil (CBO) were developed as active and sustainable packaging material. Active nanocomposite films were prepared by blending PMS with Pickering emulsions of CBO at 0.5, 1, 1.5, and 2 wt% conc. Using the solution casting method. Overall, active nanocomposite films displayed improved thermal, mechanical, and water barrier properties, with an optimum CBO-Pickering emulsion concentration of 1.5 %. CBO and PMS films showed strong chemical interactions, which significantly improved the mechanical resistance of the film. Further, SEM showed the appearance of micro-porous holes in the films because of partial evaporation on the cryo-fractured surface due to the vacuum condition. In addition, films exhibited antimicrobial activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), with a rate response from increasing CBO Pickering emulsion concentration from 0.5 to 2 %. E. coli and S. aureus exhibited an inhibition zone ranging from 10.5 to 2.15 mm and 11.2 to 22.1 mm. This study suggests that PMS starch and kudzu CNCs-based active nanocomposite films loaded with CBO-Pickering emulsions have good potential to develop active and sustainable packaging materials.

The early evolution of the Misty Creek embayment (MCE), a prominent, northwest-trending sub-basin of the economically important Selwyn basin, is poorly understood. The abrupt contact between Cambrian Stage 4 (traditional lower Cambrian) carbonate ramp strata of the Sekwi Formation and overlying Miaolingian (traditional middle Cambrian) deep-water, calciturbiditic strata of the Hess River Formation has been regarded as diachronous. This important transition, which marks the onset of long-lived, deep-water conditions in the MCE, remains unexplained. This study uses biostratigraphic data from a previously undescribed location in the MCE, existing biostratigraphic and lithostratigraphic data from the 1970s, and regional thickness patterns to characterise the sharp yet diachronous transition from lithofacies typical of the Sekwi Formation to those typical of the Hess River Formation. The dramatic change in depositional environments was diachronous yet non-gradational, precluding a eustatic cause. The change was geologically abrupt, probably through two extension-related subsidence events, with different geographic extents, which heralded the MCE’s long life as a deep-water basin. The onset of deep-water conditions in the MCE occurred semi-contemporaneously with other extension-related events that are recorded in the northern Canadian Cordillera, demonstrating that Cambrian Series 2 – Miaolingian was a time of widespread extension and subsidence along the western margin of Laurentia.

Presentation at the Congress for Clinical Neuroscience with Advanced Training Academy (DGKN23) of the German Society for Clinical Neurophysiology and Functional Neuroimaging (DGKN) e.V., Hamburg, Germany, March 2-4, 2023.

Presentation at SfN 2022, San Diego, CA. Program No. 272.08.

IntroductionFor people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors.MethodsA Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible.ResultsMean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation).DiscussionThese results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.

Primary sclerosing cholangitis (PSC) is associated with hepatobiliary and colorectal cancers, but it remains uncertain if PSC increases the risk for pancreatic cancer. While some European studies have suggested an increased risk of pancreatic cancer in PSC patients, other studies have not. And these studies did not well account for presence or absence of concomitant inflammatory bowel disease (IBD). The purpose of this study is to investigate the prevalence of pancreatic cancer in United States veterans with PSC both with and without IBD.MethodsThis retrospective study used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients with PSC, IBD, and pancreatic cancer from the Veterans Affairs (VA) Corporate Data Warehouse. The prevalence of pancreatic cancer in patients with PSC only, IBD only, PSC with IBD, and neither PSC nor IBD were compared. Logistic regression was used to control for age, gender, chronic pancreatitis, diabetes mellitus, and tobacco and alcohol use.ResultsA total of 946 patients with PSC were identified from a population of over 9 million veterans. 486 (51.4%) of these had concurrent IBD. Additionally 112,653 patients with IBD without PSC were identified. When adjusted for confounding factors, patients with PSC had a significantly higher prevalence of pancreatic cancer compared to the general population and those with IBD without PSC (2.4% vs. 0.2% and 0.5%, respectively).ConclusionsVeterans with PSC, particularly those without concomitant IBD, have a high prevalence of pancreatic cancer compared to the general veteran population. Our findings support the need for multicenter prospective studies investigating the benefits of screening for pancreatic cancer in patients with PSC.

Differences in dentin microstructure have been used as a tool for dietary reconstruction; however, the extent that diet is associated with this aspect of dental morphology has yet to be empirically tested. We conducted microhardness tests of mammalian dentin sections, hypothesizing that species with adaptations to particularly hard diets would have softer dentin, owing to a higher proportion of soft intertubular dentin. Species adapted to abrasive diets, in contrast, should have harder dentin, resulting from a higher proportion of hypermineralized peritubular dentin. We examined molar dentin hardness in ten mammalian taxa with durophagous diets, abrasive diets, and a comparative "control" group of mechanical generalists. Samples included six primate taxa and four non-primate species representing various dietary regimes. Our results reveal significant variation among taxa in overall hardness, but the data do not distinguish between hard and abrasive diets. Several taxa with generalized (i.e., mechanically diverse) diets resemble each other in exhibiting large variance in hardness measurements and comparably soft dentin. The high variation in these species appears to be either a functional signal supporting the niche variation hypothesis or indicate the absence of sustained unidirectional selective pressure. A possible phylogenetic signal of dentin hardness in the data also holds promise for future systematic investigations.

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Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about the potential clustering of these symptoms and risk factors that may predispose patients to certain clusters. In this study, an electronic survey was sent to patients in the UC San Diego Health (UCSDH) system who tested positive for COVID-19, querying if patients were experiencing symptoms consistent with Long COVID. Based on survey results, along with patient demographics reported in the electronic health record (EHR), linear and logistic regression models were used to examine putative risk factors, and exploratory factor analysis was performed to determine symptom clusters. Among 999 survey respondents, increased odds of Long COVID (n = 421; 42%) and greater Long COVID symptom burden were associated with female sex (OR = 1.73, 99% CI: 1.16–2.58; β = 0.48, 0.22–0.75), COVID-19 hospitalization (OR = 4.51, 2.50–8.43; β = 0.48, 0.17–0.78), and poorer pre-COVID self-rated health (OR = 0.75, 0.57–0.97; β = −0.19, −0.32–−0.07). Over one-fifth of Long COVID patients screened positive for depression and/or anxiety, the latter of which was associated with younger age (OR = 0.96, 0.94–0.99). Factor analysis of 16 self-reported symptoms suggested five symptom clusters—gastrointestinal (GI), musculoskeletal (MSK), neurocognitive (NC), airway (AW), and cardiopulmonary (CP), with older age (β = 0.21, 0.11–0.30) and mixed race (β = 0.27, 0.04–0.51) being associated with greater MSK symptom burden. Greater NC symptom burden was associated with increased odds of depression (OR = 5.86, 2.71–13.8) and anxiety (OR = 2.83, 1.36–6.14). These results can inform clinicians in identifying patients at increased risk for Long COVID-related medical issues, particularly neurocognitive symptoms and symptom clusters, as well as informing health systems to manage operational expectations on a population-health level.

Three guenon species in Taï National Park frequently form and maintain stable polyspecific associations despite significant feeding competition. This dietary overlap provides an opportunity to examine how closely related and anatomically similar taxa process the same foods. Our research examines whether the oral-processing behaviors of these guenons differ when they consume the same foods. Methods: Data on oral-processing behavior were collected on one habituated group each of Cercopithecus campbelli, C. diana, and C. petaurista in Taï National Park, Côte d’Ivoire from January 2016 to December 2018. We recorded the frequency with which foods were introduced to the mouth (ingestive action) and the frequency with which foods were processed using incisors, canines, and postcanine teeth. Oral-processing profiles for species-specific plant foods, fungi, and invertebrates were compared using Monte Carlo resampling. We quantified oral-processing behavior during a total of 2316 five-minute focal periods. Diana monkeys use their incisors significantly more per ingestive action than Campbell’s monkeys or Lesser spot-nosed guenons. Lesser spot-nosed guenons use their incisors more than Campbell’s monkeys. Diana monkeys also use significantly more post-canine chews per ingestive action than Campbell’s monkeys and Lesser spot-nosed guenons. Lesser spot-nosed guenons generally use fewer post-canine chews than Diana monkeys but more than Campbell’s monkeys. Canine use during feeding was rare in all three taxa. The three study species use different oral-processing profiles when consuming the same foods. These results are intriguing given the overall similarity in dental and cranial anatomy in these taxa. The oral-processing profiles we report do not encompass the full dietary breadth of all species; however, the behavioral diversity demonstrated during consumption of the same foods suggests that insight into feeding behavior is more likely obtained by examining oral processing of individual foods rather than broad food categories. Furthermore, these results underscore that important variation in feeding behavior is not necessarily associated with morphological differences in dental or craniofacial anatomy.

Plastic-based food packaging is generating a serious environmental problem by accumulating large amounts of plastic in the surroundings. Ecological and health concerns are driving research efforts for developing biodegradable films. There are few alternatives that could reduce the environmental impact; one of them is to substitute petroleum-based plastic with starch-based film. Starch has remarkable properties, including biodegradability, sustainability, abundancy, and capable of being modified or blended with other polymers. However, low mechanical strength and low water resistance restrict its application in food packaging. Nanocellulose isolated from lignocellulosic fibers has attracted tremendous interest in the field of science due to high crystallinity and mechanical strength, unique morphology along with abundancy, renewability, and biodegradability. Therefore, nano cellulose as a reinforcer proved to be a good option for fabricating biocomposites for food packaging. The current review will give a critical snapshot of the potential application of nanocellulose in food packaging and discuss new challenges and opportunities for starch biocomposites enriched with nano cellulose.

During processing of mango (Mangifera indica) into beverages, squashes and jellies, by-products such as peel and kernel are generated. The higher generation volume of mango-seed makes it cheaper and readily available material for extraction of starch. The current article addresses the mango-seed as potential source of starch over the conventional sources. The starch isolation, its composition structural morphology along with the various physicochemical properties are well discussed. Various modifications for improving the functionality of mango-seed starch (MSS) are comprehensively investigated based on the previous findings. Digestibility profile and glycaemic index of MSS reflected the presence of more resistant starch compared to other conventional starches; making it suitable ingredient for managing diabetes. The structure of mango seed starch can be easily manipulated using biological, chemical and physical methods for improving its application in the foods. Possible utilization of the MSS at large scale will improve the economic viability of the mango processing industries.

Short text is a popular avenue of sharing feedback, opinions and reviews on social media, e-commerce platforms, etc. Many companies need to extract meaningful information (which may include thematic content as well as semantic polarity) out of such short texts to understand users' behaviour. However, obtaining high quality sentiment-associated and human interpretable themes still remains a challenge for short texts. In this paper we develop ELJST, an embedding enhanced generative joint sentiment-topic model that can discover more coherent and diverse topics from short texts. It uses Markov Random Field Regularizer that can be seen as a generalisation of skip-gram based models. Further, it can leverage higher-order semantic information appearing in word embedding, such as self-attention weights in graphical models. Our results show an average improvement of 10% in topic coherence and 5% in topic diversification over baselines. Finally, ELJST helps understand users' behaviour at more granular levels which can be explained. All these can bring significant values to the service and healthcare industries often dealing with customers., Accepted in International AAAI Conference on Web and Social Media (ICWSM), 2021

Statins are the most widely prescribed cholesterol lowering medications and have been associated with both improved and unchanged breast cancer outcomes in previous studies. This study examines the association between the post-diagnostic use of statins and breast cancer outcomes (death and recurrence) in a large, representative sample of New Zealand (NZ) women with breast cancer. Methods Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to national pharmaceutical data, hospital discharges, and death records. Cox proportional hazard models were used to estimate the hazard of breast cancer-specific death (BCD) associated with any post-diagnostic statin use. Results Of the 14,976 women included in analyses, 27% used a statin after diagnosis and the median follow up time was 4.51 years. Statin use (vs non-use) was associated with a statistically significant decreased risk of BCD (adjusted hazard ratio: 0.74; 0.63-0.86). The association was attenuated when considering a subgroup of ‘new’ statin users (HR: 0.91; 0.69-1.19), however other analyses revealed that the protective effect of statins was more pronounced in estrogen receptor positive patients (HR: 0.77; 0.63-0.94), postmenopausal women (HR: 0.74; 0.63-0.88), and in women with advanced stage disease (HR: 0.65; 0.49-0.84). Conclusion In this study, statin use was associated with a statistically significant decreased risk of breast cancer death, with subgroup analyses revealing a more protective effect in ER+ patients, postmenopausal women, and in women with advanced stage disease. Further research is warranted to determine if these associations are replicated in other clinical settings.

This is a personal reflection on the first 25 years of the journal, Environmental Education Research. It begins in the 1990s with the ideas behind the need for a new journal and explores the journa...

Tropomyosins are structurally conserved α-helical coiled-coil proteins that bind along the length of filamentous actin (F-actin) in fungi and animals. Tropomyosins play essential roles in the stability of actin filaments and in regulating myosin II contractility. Despite the crucial role of tropomyosin in actin cytoskeletal regulation, in vivo investigations of tropomyosin are limited, mainly due to the suboptimal live-cell imaging tools currently available. Here, we report on an mNeonGreen (mNG)-tagged tropomyosin, with native promoter and linker length configuration, that clearly reports tropomyosin dynamics in Schizosaccharomyces pombe (Cdc8), Schizosaccharomyces japonicus (Cdc8) and Saccharomyces cerevisiae (Tpm1 and Tpm2). We also describe a fluorescent probe to visualize mammalian tropomyosin (TPM2 isoform). Finally, we generated a camelid nanobody against S. pombe Cdc8, which mimics the localization of mNG–Cdc8 in vivo. Using these tools, we report the presence of tropomyosin in previously unappreciated patch-like structures in fission and budding yeasts, show flow of tropomyosin (F-actin) cables to the cytokinetic actomyosin ring and identify rearrangements of the actin cytoskeleton during mating. These powerful tools and strategies will aid better analyses of tropomyosin and F-actin cables in vivo.

Tropomyosins are structurally conserved α-helical coiled-coil dimeric proteins that bind along the length of filamentous actin (F-actin) in fungi and animals. Tropomyosins play essential roles in the stability of actin filaments in non-muscle cells and are essential for calcium regulation of myosin II contractility in the muscle. Despite the crucial role of tropomyosin in actin cytoskeletal regulation, in vivo investigations of tropomyosin are limited, mainly due to the suboptimal live cell imaging tools currently available in many organisms. Here, we report mNeon-Green (mNG) tagged tropomyosin, with native promoter and linker length configuration, that clearly reports tropomyosin localization and dynamics in Schizosaccharomyces pombe (Cdc8), Schizosaccharomyces japonicus (Cdc8), and Saccharomyces cerevisiae (Tpm1 and Tpm2), in vivo and in isolated S. pombe cell division apparatuses. We extended this approach to also visualize the mammalian TPM2 isoform. Finally, we generated a camelid-nanobody against S. pombe Cdc8, which mimics the localization of mNG-Cdc8 in vivo without significantly influencing cell growth and dynamics of actin cytoskeleton. Using these tools, we report the presence of tropomyosin in previously unappreciated patch-like structures in fission and budding yeasts, show flow of tropomyosin (F-actin) cables to the cytokinetic actomyosin ring, and identify rearrangements of the actin cytoskeleton during mating. These powerful tools and strategies will aid better analyses of tropomyosin and actin cables in vivo.

Maternal autoantibody related complete heart block in the fetus is considered irreversible. During prenatal care for a 25 year old nulliparous Hispanic woman with newly diagnosed nephrotic range proteinuria and positive anti-nuclear antigen antibody, complete fetal heart block with a ventricular rate of 60 beats per minute was detected on a fetal echocardiogram at 28 weeks gestation. A small pericardial effusion and ascites were noted consistent with fetal hydrops. Dexamethasone and hydroxychloroquine were initiated. Fetal rhythm improved to Mobitz type 1 second-degree heart block, with a ventricular rate of 91 beats per minute. The fetus was born prematurely at 34 weeks gestation with second-degree heart block which improved to first-degree heart block prior to hospital discharge. First-degree heart block persisted at 2 years of age with a P-R interval of 185 milliseconds. Transplacental treatment with dexamethasone and hydroxychloroquine were associated with sustained reversal of complete heart block to sinus rhythm.

Accurate modelling of basal melting beneath ice shelves is key to reducing the uncertainty in forecasts of ice-shelf stability and, thus, the Antarctic contribution to sea level rise. However, the lack of flexibility inherent to traditional ocean models can pose problems. Obtaining accurate melt estimates requires capturing the turbulent exchange of momentum, heat and salt at the ice-ocean interface, which may be modulated by the competing effects of stratification and basal slope. There are still significant uncertainties surrounding the trade-off between the simplicity of the melt parameterisation and the processes that need to be resolved by the numerical ocean model near the boundary.Real ice-shelf cavity geometries are complicated. Bathymetric valleys are common and provide pathways for warm circumpolar deep water. The ice base is marked by channels, crevasses and terraces. These features will affect the boundary flow, with an added complication that melting plays a role in their formation. It is very difficult to model such flow regimes using a traditional ocean model not only because of the resolution constraints imposed by inflexible grids, but also due to the inbuilt assumptions of large aspect ratio processes and domains that may be violated when flow occurs past these features.Ice flow models are very sensitive to how they are forced by melting at the grounding line, where the ice starts to float. The grounding line is precisely the region where ocean models are most questionable due to insufficient resolution imposed by limitations on the grid. Subglacial outflow into the cavity will likely break the inherent physical assumptions of hydrostatic, non-negligible vertical accelerations in large aspect ratio domains.To model these effects requires the use of an ocean model that contains a flexible, unstructured mesh, is applicable at a range of length scales and, crucially, is still valid when the vertical-to-horizontal grid aspect ratio approaches order one. We are developing such a model for simulating flow under ice shelf cavities using the Firedrake finite element framework, primarily because it enables adjoint sensitivities to be calculated automatically. We present our 3d simulations of ISOMIP+ experiments alongside simulations using the MITgcm ocean model, a commonly used z-layer (constant vertical resolution) model. We have found that the ability to vary the mesh resolution flexibly in the horizontal and vertical, even in a relatively simple ISOMIP+ domain (i.e., no channels or crevasses) is very useful to investigate how melt rate depends on grid resolution, which ultimately must be the first aim of any study using a numerical model.

Examine the link between youth sports specialization and long-term lower extremity joint health after sports by comparing lower extremity function, pain, and history of sport-related injuries between young adults that were highly, moderately, and low specialized in youth sports. We used a cross-sectional design, and all data was collected using an electronic survey. Our sample included N = 356 young adults who participated in a primary sport during youth and high school sports but were no longer participating in that sport as a young adult. Participants were stratified into high (n = 111), moderate (n = 119), and low (n = 126) specialization groups using a 3-criteria sport specialization questionnaire based on youth sports participation prior to high school. We compared participants current Lower Extremity Functional Scale (LEFS) score (0–80), the proportion of participants with clinically important deficits in LEFS score (≤71/80), current lower extremity (foot/ankle, knee, hip) pain scores (0–10), and history of lower extremity (foot/ankle, knee, hip) injuries between the high, moderate, and low specialization groups. The high specialization group reported significantly lower overall LEFS scores, and a greater proportion (40%) reported clinically important deficits in LEFS scores compared to the low specialization group (20%). The high specialization group also reported greater foot/ankle and knee pain and a greater proportion of sport-related knee injuries than the low specialization group (49% vs 25%). Our findings suggest that even after discontinuing sports, young adults who were highly specialized in youth sports before high school reported clinically important deficits in lower extremity function, greater foot/ankle and knee pain, and a greater history of knee injuries than young adults who were not specialized in youth sports, suggesting a possible link between youth sports specialization and long-term lower extremity health after sports.

The basal ganglia play a central role in regulating behavior, yet the organization of their outputs to other brain areas is incompletely understood. We investigate the largest output nucleus, the substantia nigra pars reticulata (SNr), and delineate the organization and physiology of its projection populations in mice. Using genetically-targeted viral tracing and whole-brain anatomical analysis, we identify over forty SNr targets, which encompass a roughly 50-fold range of axonal densities. Retrograde tracing from the volumetrically largest targets indicates that SNr contains segregated subpopulations that differentially project to functionally distinct brainstem regions. These subpopulations are electrophysiologically specialized, topographically organized, and collateralize to common diencephalon targets, including motor and intralaminar thalamus, as well as the pedunculopontine nucleus and the midbrain reticular formation. These findings establish that SNr signaling is organized as dense, parallel outputs to specific brainstem targets, concurrent with extensive collateral branches that encompass the majority of SNr axonal boutons.

Purpose Beta blockers (BB) have been associated with improved, worsened, or unchanged breast cancer outcomes in previous studies. This study examines the association between the post-diagnostic use of BBs and death from breast cancer in a large, representative sample of New Zealand (NZ) women with breast cancer. Methods Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to national pharmaceutical data, hospital discharges, and death records. The median follow-up time was 4.51 years. Cox proportional hazard models were used to estimate the hazard of breast cancer-specific death (BCD) associated with any post-diagnostic BB use. Results Of the 14,976 women included in analyses, 21% used a BB after diagnosis. BB use (vs non-use) was associated with a small and nonstatistically significant increased risk of BCD (adjusted hazard ratio: 1.11; 95% CI 0.95–1.29). A statistically significant increased risk confined to short-term use (0–3 months) was seen (HR = 1.40; 1.14–1.73), and this risk steadily decreased with increasing duration of use and became a statistically significant protective effect at 3 + years of use (HR = 0.55; 0.34–0.88). Conclusion Our findings suggest that any increased risk associated with BB use may be driven by risk in the initial few months of use. Long-term BB use may be associated with a reduction in BCD.

Native starches are modified to overcome the shortcoming, including retrogradation, syneresis, and low water-holding potential, which limit their industrial applications. The enzymatic modification includes designing a starch with a new structure. The molecular mass, branch chain-length distribution, and amylose/amylopectin ratio can be altered by enzymatic reactions when the enzymes react with gelatinized starch. The enzymatic modification directly affects the properties of the modified starch, including in freeze-thaw stability of gels and retardation of retrogradation during storage. Various enzymatic modifications of starch have been attempted for novel applications to the food industry as food ingredients, the enhancement of product quality, and the improvement of the efficiency of food processing. This review article addresses the key enzymes used for starch modifications, their mechanism of action, functionality and discusses new challenges and opportunities for effective modification. Also, the current review will give a critical snapshot of the applications for starch modifications in food industries.

SIGNIFICANCE Retinal migraine and migrainous infarction are distinct clinical entities delineated by the International Headache Society. Presented is a novel case report demonstrating unique optical coherence tomography evidence of retinal ischemia experienced during a migraine with effects across retinal vascular territories. This may represent evidence of migrainous infarction within the retina. PURPOSE The purpose of this study is to present clinical and quasi-histologic optical coherence tomography features of retinal ischemia associated with migraine. CASE REPORT Presented is a case of profound monocular vision loss coincident with a migraine episode. Optical coherence tomography with novel features of acute inner retinal thinning, increased delineation of the inner plexiform and outer plexiform layers, and increased signal intensity of the photoreceptor layer is reported. These discriminating characteristics contrast those of retinal artery occlusions and other primary ocular vasculopathies such as Susac syndrome and acute macular neuroretinopathies. CONCLUSIONS A case of permanent vision loss with retinal thinning and ischemic hyperreflectivity of retinal layers on optical coherence tomography in different vascular territories is shown to be associated with migraine. These features may provide clinical evidence of migrainous pathophysiology within the retina.

Enterprise systems modelling requires integrated views of both technical systems as well as organisational systems that together will deliver the anticipated capabilities. A major challenge in such...

The American Academy of Pediatrics recommends an emergency information form (EIF) for children with medical complexity (CMC) to facilitate emergency care. We sought to increase the EIF completion rate at our children's hospital's CMC clinic and to evaluate the effect on caregiver and emergency department (ED) provider opinion of preparation, comfort, and communication.We used a pre/post-quality improvement design. The main outcomes were (1) the proportion of completed EIFs and (2) caregiver and ED provider opinion of preparation, comfort, and communication, using a Likert scale survey (1, low; 5, high).Emergency information form completion increased from 3.1% (4/133) before the intervention to 47.0% (78/166) after (P0.001). Twenty-three providers completed presurveys, and 8 completed postsurveys. Seventy-two caregivers completed presurveys, and 38 completed postsurveys (25 with ED visit and 13 without). There were no changes in preparation, comfort, or communication for caregivers who had an ED visit after the intervention. For those without a postintervention ED visit, caregiver median scores rose for preparation (4 [interquartile range {IQR}, 3-5] vs 5 [IQR, 4-5], P = 0.02) and comfort (4 [IQR, 2.25-5] vs 5 [IQR, 4-5], P = 0.05). After the intervention, ED providers had increased median communication scores (3 [IQR, 2.75-4.25] vs 5 [IQR, 4-5], P = 0.02), whereas scores of preparation and comfort were unchanged.A quality improvement project at a CMC clinic increased EIF completion, caregiver preparation and comfort, and ED provider communication in emergencies.