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Hypothesis This study aimed to examine the reliability and diagnostic discriminative accuracy of 5 different methods that quantity the craniocaudal humeral position with respect to the scapula on conventional radiographs. Methods In this retrospective, cross-sectional diagnostic study, 2 observers randomly assessed the conventional anteroposterior shoulder radiographs of 280 subjects with rotator cuff imaging for the (1) acromiohumeral (AH) interval, (2) upward migration index (UMI), (3) glenohumeral center-to-center measurement (GHCC), (4) glenohumeral arc measurement (GHa), and (5) scapular spine–humeral head center method (SHC). Reliability was assessed by means of relative consistency (intraclass correlation coefficient) and absolute consistency. Discriminative accuracy for detecting a rotator cuff tear was calculated. Results Relative consistency (intraclass correlation coefficient) for the AH interval, UMI, GHCC, GHa, and SHC was 0.961, 0.913, 0.806, 0.924, and 0.726, respectively. The AH interval had the highest absolute consistency with a random residual measurement error of 0.58 mm compared with 1.0-3.2 mm for the other measurements. The discriminative accuracy of the AH interval did not significantly differ from that of the UMI (−0.010; 95% confidence interval [CI], −0.042 to 0.022; P = .545) but was significantly better than that of the GHCC (0.112; 95% CI, 0.043-0.181; P = .001), GHa (0.074; 95% CI, 0.009-0.139; P = .027), and SHC (0.178; 95% CI, 0.100-0.256; P Conclusion Assessment of the craniocaudal humeral position is performed with good to excellent intraobserver and interobserver reliability. The discriminative accuracy for detecting a rotator cuff tear on a single radiograph was highest for the AH interval and UMI. We recommend using the AH interval or UMI as an indirect measure of the presence of a rotator cuff tear on conventional radiographs.

Microbiomes are all around us in natural and cultivated ecosystems, for example, soils, plants, animals and our own body. Microbiomes are essential players of biotechnological applications, and their functions drive human, animal, plant and environmental health. The rapidly developing microbiome research landscape was studied by a global mapping excercise and bibliometric analysis. Although microbiome research is performed in many different science fields, using similar concepts within and across fields, microbiomes are mostly investigated one ecosystem at-a-time. In order to fully understand microbiome impacts and leverage microbial functions, research needs to adopt a systems approach connecting microbiomes and research initiatives in divergent fields to create understanding on how microbiomes can be modulated for desirable functions as a basis of sustainable, circular bioeconomy. This work was supported by the European Union’s Horizon 2020 R&I programme under grant agreement No. 818116 (MicrobiomeSupport).

Given the bioremediation potential of peat, natural capping of landfills in wetlands with a “peat cap” could provide a sustainable addition to regular capping methods using basal liners with limited life-spans and sand. It is unknown, however, which initial conditions optimise growth of this “peat cap” on top of a sand layer. Here, we tested the combined effects of topsoil addition (clay or organic soil) and vegetation type (Typha latifolia, T. angustifolia, Stratiotes aloides and submerged spp.) on net ecosystem C exchange and water quality in 18 sandy basins situated in a constructed wetland on top of a landfill. Although the highest net C sequestration rates occurred in Typha stands on sand, due to lower decomposition-related C losses as compared to clay and organic topsoils, vegetation development was slow and its cover was very low (15%) compared to clay (40%) and organic topsoils (70%). As this strongly impeded the build-up of a uniform peat layer, we conclude that, within a restricted time frame, the application of nutrient-rich topsoils is still necessary for sufficient biomass production to accumulate organic material. By recycling local soils, the accompanying initial C loss becomes negligible on a landscape scale.

Objective: Despite the frequent occurrence of depressive symptoms in obsessive-compulsive disorder (OCD), little is known about the reciprocal influence between depressive and obsessive-compulsive symptoms during the course of the disease. The aim of the present study is to investigate the longitudinal relationship between obsessive-compulsive and depressive symptoms in OCD patients. Method: We used the baseline and 1-year follow-up data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. In 276 patients with a lifetime diagnosis of obsessive-compulsive disorder, depressive and obsessive-compulsive symptoms were assessed at baseline and at one-year follow-up with the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Symptom (Y-BOCS) scale. Relations were investigated using a cross-lagged panel design. Results: The association between the severity of depressive symptoms at baseline and obsessive-compulsive symptoms at follow7up was significant (beta=0.244, p

Purpose The aim of this study was to determine the similarities and differences of type 2 diabetes mellitus (T2DM) treatment patterns in daily practice in 5 European countries and whether these reflect differences in guidelines. Methods Prescriptions for drugs used in diabetes treatment during a 5-year study period were obtained from electronic databases. Patients initiating T2DM treatment during the study period were included. An SAS analysis tool was developed to create episodes of use of drug classes, which resulted in treatment patterns. Findings A total of 253,530 patients initiating T2DM treatment during the study period were included; 52% to 55% were male, and the mean age ranged from 62 to 67 years. Metformin was the most common initial treatment in all countries. After initial therapy, most patients in the Netherlands, Spain, and the United Kingdom switched to a combination of metformin + a sulfonylurea derivative (SU). In Italy, metformin in combination with an SU was outnumbered by “other treatment,” mainly because of repaglinide use. In France, treatments including dipeptidyl peptidase-4 inhibitors were most frequent as second- and fourth-line treatment. Metformin monotherapy was again most commonly observed as the third line of treatment in all countries. Fourth treatment was a combination of metformin + an SU in the Netherlands and Spain; in the United Kingdom and France, dipeptidyl peptidase-4 inhibitors were the most frequently used fourth line of treatment. Implications This study provides a comprehensive overview of T2DM treatment patterns among patients initiating T2DM treatment in 5 European countries. There were differences, especially regarding the uptake of newer incretin-based treatments, which are usually prescribed as a second and/or third treatment in agreement with local guidelines. These variations reflect the differences between the national guidelines of these countries.

Background: Chronic mountain sickness (CMS) is characterized by a combination of excessive erythrocytosis,severe hypoxemia, and pulmonary hypertension, all of which affect exercise capacity. METHODS: Thirteen patients with CMS and 15 healthy highlander and 15 newcomer lowlander control subjects were investigated at an altitude of 4,350 m (Cerro de Pasco, Peru). All of them underwent measurements of diffusing capacity of lung for nitric oxide and carbon monoxide at rest, echocardiography for estimation of mean pulmonary arterial pressure and cardiac output at rest and at exercise, and an incremental cycle ergometer cardiopulmonary exercise test. RESULTS: The patients with CMS, the healthy highlanders, and the newcomer lowlanders reached a similar maximal oxygen uptake at 32 1, 32 2, and 33 2 mL/min/kg, respectively, mean SE( P 5 .8), with ventilatory equivalents for C O 2 vs end-tidal P CO 2 , measured at the anaerobic threshold,of 0.9 0.1, 1.2 0.1, and 1.4 0.1 mm Hg, respectively ( P , .001); arterial oxygen content of 26 1, 21 2, and 16 1 mL/dL, respectively ( P , .001); diffusing capacity for carbon monoxide corrected for alveolar volume of 155% 4%, 150% 5%, and 120% 3% predicted, respectively( P , .001), with diffusing capacity for nitric oxide and carbon monoxide ratios of 4.7 0.1 at sea level decreased to 3.6 0.1, 3.7 0.1, and 3.9 0.1, respectively ( P , .05) and a maximal exercise mean pulmonary arterial pressure at 56 4, 42 3, and 31 2 mm Hg, respectively ( P , .001). CONCLUSIONS: The aerobic exercise capacity of patients with CMS is preserved in spite of severe pulmonary hypertension and relative hypoventilation, probably by a combination of increased oxygen carrying capacity of the blood and lung diffusion, the latter being predominantly due to an increased capillary blood volume.

With the availability of thousands of sequenced genomes, the integration of sequence data and biochemical literature offers increased opportunities for studying the detailed variations of pathways. We describe the use of subsystems as a framework for creating such an integration, illustrating its use with examples from vitamin and cofactor metabolism. The work accomplished so far has led to a resource that is continually expanded and improved to reveal numerous open research problems, offering tools to support experimental advances that fill in these gaps in understanding.

Publisher Summary REACH is a European regulation on registration, evaluation, authorization, and restriction of chemicals (REACH), which was enforced on June 1, 2007. This chapter provides guidance on what typical requirements and responsibilities are under REACH, and what options companies have in addressing the REACH requirements and responsibilities, especially when dealing with the complexities of a supply chain. The main aims of REACH are to improve the protection of human health and the environment from the risks that can be posed by chemicals, the promotion of alternative test methods, the free circulation of substances in the internal market, and the enhancement of competitiveness and innovation. REACH is principally broken down into five stages: Material Safety Data Sheets (MSDSs), Preregistration, Registration, Authorization, and Restrictions. The first step in preparing for REACH is to assess products and define them as substances, preparations, or articles. Cosmetics generally fall under the definition of preparations; thus all ingredients require registration. Preregistration is free and only basic substance and company information needs to be submitted. Preregistration is required only for substances that could potentially be imported or manufactured in excess of 1 ton (per legal entity) in the following year. Registration is the largest, most important part of REACH. Complete substance identification (including compositional information of multiconstituent substances), testing data, and safety assessments must be submitted to the European Chemicals Agency (ECHA). The authorization and restriction requirements target known and suspected carcinogens, mutagens, and reproductive toxins as well as persistent bioaccumulative toxins and other chemicals of similar risk. Companies can use a two-phased approach to meet the requirements of REACH: phase 1 should address the identification of requirements, responsibilities, preregistration, and timelines, and phase 2 should focus on the execution of responsibilities including documentation, supply chain data gathering, and registration.

Publisher Summary Agencies are demanding that substances, either known to be (potentially) hazardous or expected to be harmful, will become regulated or restricted in everyday consumer products. New legislations are becoming more prominent and widespread and since environmental compliance has been enforced strongly. A strong strategic partnership with a global network of supply chain control and monitoring specialists will ensure an ongoing success of the quality, compliance, as well as safety processes, which are the key components of the overall business process enabling sustainable growth, currently and in the future. It is important to develop a solution that will cost effectively allow the proactive management of restricted substances throughout product lines taking into account changing global legislation and good practices/voluntary standards as well as the flow of information within the supply chain. The Intertek group, housed in Houston, has developed systems and solutions to optimize the assessment of compliance in vendor/supplier materials as well as information; while at the same time, achieving efficiency gains for the customers. It will allow the branded customers to transfer the responsibilities to their suppliers/vendors of assemblies, and materials and raw materials for entering the required compliance-related information while at the same time having the full ability to track and assess their performance and monitor compliance. This information should be complemented with brand or seller-initiated risk-based conformance verifications on vendors and suppliers, their products, assemblies, materials and raw materials, and/or on final products.