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Designing nasal prostheses can be challenging because of the unpaired nature of the facial feature, especially in patients lacking preoperative information. Various nose model databases have been developed as a helpful starting point for the computer-aided design of nasal prostheses, but these do not appear to be readily accessible. Therefore, an open-access digital database of nose models has been generated based on a 3-dimensional (3D) morphable face model approach. This article describes the generation of the database, highlights steps for designing a nasal prosthesis, and points readers to the database for future clinical application and research. [ABSTRACT FROM AUTHOR]

To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study, including localized BC patients aged 18–43 years, matched for age and parity to cancer-free volunteer controls in a 1:2 ratio. Data were collected through online questionnaires completed on the Seintinelles research platform. In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p = 0.97). Contrarily, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p < 0.001). For patients at risk of unintentional pregnancy, receiving information about chemotherapy-induced ovary damage at BC diagnosis (OR = 2.47 95%CI [ 1.39–4.37] and anti- HER2 treatment (OR = 2.46, 95% CI [ 1.14–6.16]) were significantly associated with the use of a contraception in multivariate analysis. In this large French study, BC survivors had a prevalence of contraception use similar to that for matched controls, though almost one in five women at risk of unintentional pregnancy did not use contraception. Dedicated consultations at cancer care centers could further improve access to information and contraception counseling. [ABSTRACT FROM AUTHOR]

It was aimed to determine the prevalence of Helicobacter in some reptilian and amphibian species in Türkiye and to describe the bacteria. For this purpose, 73 cloacal swab samples were used as material. The description of the isolates was performed by detailed phenotypic tests, whole genome analyses, and MALDI-TOF MS. As a result of the phenotypic analysis, two helical, curved Gram-negative, motile isolates were recovered. It was determined through the analysis of 16S rRNA gene sequences that two isolates belonged to the genus Helicobacter. These isolates were found to be in a distinct group from other Helicobacter species. However, the 16S rRNA sequence did not match any identified species, with the closest match being Helicobacter mustelae strain R85-13-6T, which had an identity level of 96.2 %. Additionally, it was found that strains faydin-H75T and faydin-H76 had a 99.3 % identity level for their 16S rRNA genes. After conducting dDDH and ANI analyses, it was found that strains faydin-H75T and their close neighbors H.anseris ATCC BAA-1299T shared 13.5 % and 68.8 % similarity, respectively. The genome size of the strains was 1.7 Mb while G + C contents were 33.5 %. Metagenomic analyses using IMNGS and Protologger tools revealed the presence of faydin-H75T in various lizard species with high similarity, confirming its broad distribution and host specificity. The results indicated that these two strains represent a novel species, for which we propose the name Helicobacter cappadocius with faydin-H75T (=NCTC014972 = LMG 33382 = DSM117062) as the respective type strain. The current novel species is the first Helicobacter species to exhibit a psychrotrophic feature. [ABSTRACT FROM AUTHOR]

Objective: Steady-State Visual Evoked Potentials based Brain-Computer Interfaces (SSVEP-based BCIs) systems have been shown as promising technology due to their short response time and ease of use. SSVEP-based BCIs use brain responses to a flickering visual stimulus as an input command to an external application or device, and it can be influenced by stimulus properties, signal recording, and signal processing. We aim to investigate the system performance varying the stimuli spatial proximity (a stimulus property). Material and methods: We performed a comparative analysis of two visual interface designs (named cross and square) for an SSVEP-based BCI. The power spectrum density (PSD) was used as feature extraction and the Support Machine Vector (SVM) as classification method. We also analyzed the effects of five flickering frequencies (6.67, 8.57, 10, 12 e 15 Hz) between and within interfaces. Results: We found higher accuracy rates for the flickering frequencies of 10, 12, and 15 Hz. The stimulus of 10 Hz presented the highest SSVEP amplitude response for both interfaces. The system presented the best performance (highest classification accuracy and information transfer rate) using the cross interface (lower visual angle). Conclusion: Our findings suggest that the system has the highest performance in the spatial proximity range from 4° to 13° (visual angle). In addition, we conclude that as the stimulus spatial proximity increases, the interference from other stimuli reduces, and the SSVEP amplitude response decreases, which reduces system accuracy. The inter-stimulus distance is a visual interface parameter that must be chosen carefully to increase the efficiency of an SSVEP-based BCI. • A spatial proximity from 4° to 13° visual angle results in higher BCI performance. • As inter-stimulus distance increases, the SSVEP amplitude response decreases. • A stimulus at 10 Hz presented the highest SSVEP amplitude response. • The BCI performance is higher when the cross interface is adopted. [ABSTRACT FROM AUTHOR]

Anorexia nervosa (AN) commonly begins in adolescence; however, detailed knowledge of symptom trajectories, including their temporal sequence, is less well elucidated. The purpose of the present study is to describe the onset and duration of disordered eating behaviors prior to a diagnosis of AN, examine concordance between child and parent report, and examine the relationships between timing of symptom onset and illness severity. Seventy-one adolescents (ages 12–18 years) and their parents were interviewed about dieting, restriction, loss of control/binge eating, purging, excessive/compulsive exercise, weight history, and amenorrhea. Body mass index percentiles were calculated, and adolescents completed the Eating Disorder Examination-Questionnaire. Restriction, being underweight, dieting, and excessive exercise were reported by most of the sample; purging, loss-of-control eating, and having been overweight were reported by less than a third. Dieting typically emerged first, on average around age 14; the remainder of behaviors tended to emerge between ages 14 and 14½; and average age of formal diagnosis was slightly over 15 years. Dyads had good agreement regarding presence and timing of all behaviors except for dieting, for which children reported about 6 months earlier onset/longer duration, compared to parents. Although older age at interview was associated with lower body mass index percentile and higher EDE-Q score, neither age of onset nor duration was associated with severity when controlling for current age. Teens and parents describe a similar sequence of behavior changes leading up to a diagnosis of AN that typically begins with dieting and occurs over an approximate 1- to 1½-year period. Querying teens and parents about eating behavior changes may aid in identification and early intervention in AN; adolescents with normal weight who engage in persistent dieting or restrictive eating may warrant more frequent weight monitoring. [ABSTRACT FROM AUTHOR]

• The world today is facing an increasing burden of AD, it is estimated that every 3 s one person is diagnosed as having AD. • Families provide care to 80% of older adults living with AD in the world, especially in developing countries. • Limited studies have been conducted about factors affecting the care of families of the older adults living with AD in Iran and the Middle East. • Empowerment programs in Iran and Middle Eastern countries should focus on women's empowerment as primary caregivers. This study investigates the barriers and promoters of caring for older adults living with Alzheimer's Dementia (AD) in families. This was a qualitative study through content analysis (based on the Granheim and Lundman method), and the participants were selected using purposive sampling from the families of older adults living with AD who were receiving care in the community. We used semi-structured interviews to collect data from 32 family members. The validity and reliability of the data were assessed using the Lincoln and Guba criteria. In this study, 70.58% of primary caregivers were women. Caregiving facilitators included "Efficient family," "Capable caregiver," and "Motivated caregiver." Caregiving barriers included "Lacking awareness and knowledge," "Vulnerable family," "Older person with complex/multiple needs," and "Lack of care infrastructures." Training families and caregivers and developing care infrastructures for older adults with AD can help reduce caring barriers in older adults. [ABSTRACT FROM AUTHOR]

Colorism, systematic intragroup discrimination based on skin color, plays a unique role in Chinese culture. In-group bias and aesthetic attitudes towards lighter skin prompt the consumption of skin-lightening products and daily sun avoidance/protection practices such as carrying parasols or wearing long-sleeved shirts. However, culturally grounded attitudes may be challenged when individuals move to a place where cultural values differ from their own. Drawing upon sociocultural perspectives and qualitative approaches, we explore the mechanisms by which individuals' attitudes towards skin color and associated behavior change when two cultures interact. We focus on 15 Chinese female young adults who lived in mainland China until they were at least 18 and now reside in the U.S. Results demonstrate that these women, who have a solid sense of Chinese culture, became more aware of cultural values towards skin color and associated behavior. Their increased understanding helped them adjust to their environment, provoking them to assess cultural values and aesthetics. Their attitudes thus evolved and became more situationally dependent. Reformed attitudes led to sun-related behavior modification. Such actions reflect attitudes towards skin color and a psychological need to conform to behavioral patterns considered appropriate in the host culture. Understanding how women reconcile conflicting aesthetic values highlights the complexity of acculturation, elucidates how colorism operates in intercultural contexts, and contributes to bicultural theories. Unpacking aesthetic attitudes around skin color, especially how they affect daily decisions, also illuminates the connection between body image and health in different sociocultural contexts. [ABSTRACT FROM AUTHOR]

Patients undergoing orthodontic treatment (OT) face an increased risk of developing external apical root resorption (EARR). A prognostic risk assessment prior to OT can potentially be conducted through anatomical features in panoramic radiography. This retrospective study aimed to assess the significance of Kjær's morphological characteristics in analyzing the risk of EARR. Panoramic radiographs of 1,156 patients (624 females, 532 males) were retrospectively analyzed. Anamnestic and treatment-related data were extracted from patient records. The mean age at the start of OT was 12.8 ± 2.2 years (min. 6.4 years, max. 22.3 years) and at the end of OT 15.9 years (min. 8.5 years, max. 24.1 years). The mean treatment duration was 3.1 ± 1.6 years. Panoramic radiographs with a minimum of two per patient were examined for the presence of Kjær's characteristics. The degree of EARR was registered defining resorption in four degrees of severity. Bivariate analysis and multivariate Poisson regression were performed to assess the association between Kjær's characteristics and EARR patient- and tooth- related (α = 0.05). In total, 72.8% of the patients showed EARR at the end of OT with lateral maxillary incisors most frequently affected. Short roots (p < 0.001) were significantly associated with EARR in patients. Tooth-related microdontia (#12, #22, lower second premolars), narrow crowns (#11, #21, lower incisors), short roots (upper incisors, lower first molars) and ectopia (#11, #21, #13), such as shorter distal roots of the mandibular first molar showed a significant association with EARR depending on severity degree. The type of orthodontic appliance (fixed: p < 0.001, fixed and removeable: p = 0.008), as well as treatment duration (p < 0.001) were also identified as risk factors for EARR. Although the risk assessment for EARR development through panoramic radiography analysis is limited, predisposition appears to be present in specific dental characteristics and treatment-related factors. [ABSTRACT FROM AUTHOR]

Facial prosthesis research uses a wide variety of outcome measures, which results in challenges when comparing the effectiveness of interventions among studies. Consensus is lacking regarding the most appropriate and meaningful outcome measures to use in facial prosthesis research to capture important perspectives. The purpose of the systematic review was to identify and synthesize outcome measures used in facial prosthesis research. Electronic searches were performed in 11 databases (including nonpeer-reviewed literature). The citations were searched, and expert societies were contacted to identify additional studies. Inclusion criteria comprised studies of participants with facial defects who required or had received prosthetic rehabilitation with an external facial prosthesis. Exclusion criteria comprised participants with ocular prostheses, case reports, case series with fewer than 5 participants, laboratory-based studies, and studies published before 1980. Study selection was performed independently by 2 reviewers. Discrepancies were resolved through discussion or by a third reviewer. Outcome measures were synthesized with a categorization approach based on the perspective, theme, and subtheme of the outcome measures. Quality assessment was performed with an appraisal tool that enabled evaluation of studies with diverse designs. Database searching identified 13 058 records, and 7406 remained after duplications were removed. After initial screening, 189 potentially relevant records remained, and 186 full texts were located (98% retrieval rate). After full-text screening, 124 records were excluded. Citation searches and contact with expert societies identified 4 further records. In total, 69 articles (grouped into 65 studies) were included. Studies were categorized as per the perspective of their outcome measures, with the following findings: patient-reported (74% of studies), clinical indicators (34%), clinician-reported (8%), multiple viewpoints (6%), and independent observer-reported (3%). Patient-reported outcome measures included tools to assess satisfaction, quality of life, and psychologic health. Variability in the choice of outcome measures was evident among the studies, with many self-designed, unvalidated, condition-specific questionnaires reported. A greater number of outcome measure themes emerged over time; themes such as service delivery and health state utility have recently been evaluated. Over the past 40 years, facial prosthesis research has focused on patient-reported outcome measures. Outcome measures relating to other perspectives have been used less frequently, although new themes appear to be emerging in the literature. Future research should use outcome measures with appropriate measurement properties for use with facial prosthetics. [ABSTRACT FROM AUTHOR]

Premenopausal women with early hormone-receptor positive (HR+) breast cancer receive 5–10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may wane. The POSITIVE study investigates the impact of temporary ET interruption to allow pregnancy. POSITIVE enrolled women with stage I-III HR + early breast cancer, ≤42 years, who had received 18–30 months of adjuvant ET and wished to interrupt ET for pregnancy. Treatment interruption for up to 2 years was permitted to allow pregnancy, delivery and breastfeeding, followed by ET resumption to complete the planned duration. From 12/2014 to 12/2019, 518 women were enrolled at 116 institutions/20 countries/4 continents. At enrolment, the median age was 37 years and 74.9 % were nulliparous. Fertility preservation was used by 51.5 % of women. 93.2 % of patients had stage I/II disease, 66.0 % were node-negative, 54.7 % had breast conserving surgery, 61.9 % had received neo/adjuvant chemotherapy. Tamoxifen alone was the most prescribed ET (41.8 %), followed by tamoxifen + ovarian function suppression (OFS) (35.4 %). A greater proportion of North American women were <35 years at enrolment (42.7 %), had mastectomy (59.0 %) and received tamoxifen alone (59.8 %). More Asian women were nulliparous (81.0 %), had node-negative disease (76.2%) and received tamoxifen + OFS (56.0 %). More European women had received chemotherapy (69.3 %). The characteristics of participants in the POSITIVE study provide insights to which patients and doctors considered it acceptable to interrupt ET to pursue pregnancy. Similarities and variations from a regional, sociodemographic, disease and treatment standpoint suggest specific sociocultural attitudes across the world. • Fertility and pregnancy are priority concerns for young breast cancer survivors. • POSITIVE explores a transient interruption of endocrine therapy to allow conception. • Patients' characteristics highlight features considered suitable to study enrolment. • Overall, patients enrolled had a relatively high median age and low-risk disease. • Variations emerged across continents suggesting specific sociocultural attitudes. [ABSTRACT FROM AUTHOR]

Some studies suggested a decreased ovarian reserve among BRCA1/2 pathogenic variant carriers, with conflicting results. We conducted a retrospective single-center observational study of ovarian reserve and spontaneous fertility comparing BRCA1/2 pathogenic variant carriers to controls (women who attended consultations to discuss fertility preservation before gonadotoxic treatment). Measures of associations between plasma AMH concentration, AFC and BRCA1/2 status were modelled by nonlinear generalized additive regression models and logistic regressions adjusted for age at plasma storage, oral contraceptive use, body mass index, cigarette smoking, and the AMH assay technique. The whole population comprised 119 BRCA 1/2 pathogenic variant carriers and 92 controls. A total of 110 women (42 carriers, among whom 30 were cancer-free, and 68 controls) underwent an ovarian reserve evaluation. Spontaneous fertility analysis included all women who previously attempted to become pregnant (134 women). We observed a tendency towards a premature decrease in ovarian reserve in BRCA1/2 pathogenic variant carriers, but no difference in mean AMH or AFC levels was found between BRCA1/2 pathogenic variant carriers and controls. An analysis of the extreme levels of AMH (≤5 pmol/l) and AFC (≤7 follicles) by logistic regression suggested a higher risk of low ovarian reserve among BRCA1/2 pathogenic variant carriers (adjusted odds ratio (OR) = 3.57, 95% CI = 1.00–12.8, p = 0.05; and adjusted OR = 4.99, 95% CI = 1.10–22.62, p = 0.04, respectively). Attention should be paid to BRCA1/2 pathogenic variant carriers' ovarian reserve, considering this potential risk of premature alteration. • A tendency towards a premature decrease in the ovarian reserve in BRCA 1/2 pathogenic variant carriers was found. • BRCA 1/2 pathogenic variant carriers presented a higher risk of a low ovarian reserve. • Information and education regarding reproduction is mandatory among BRCA 1/2 pathogenic variant carriers. [ABSTRACT FROM AUTHOR]

While the diversity of Scutiger is high in the central and eastern parts of the Himalaya-Tibet orogen, only a single species, Scutiger occidentalis Dubois, 1978, can be found in the westernmost regions, in Northwest India and Pakistan. Little is known about its genetic variation, ecology, and distribution and far less about its larval morphology. Here, we provide new records, detailed morphological data of tadpoles, and genetic data (mtDNA and nDNA) of the species from two, so far unknown localities in northern Pakistan. Molecular analysis confirmed the taxonomic identity of the tadpoles and indicated shallow intraspecific genetic differentiation. Tadpole characterizations were illustrated by detailed imagery of live and preserved specimens. Measurements and qualitative traits on oral apparatus provide relevant taxonomic characteristics to distinguish the tadpoles of this species from other lazy toads. [ABSTRACT FROM AUTHOR]

The genetic diversity of virus populations within their hosts is known to influence disease progression, treatment outcome, drug resistance, cell tropism, and transmission risk, and the study of dynamic changes of genetic heterogeneity can provide insights into the evolution of viruses. Several measures to quantify within-host genetic diversity capturing different aspects of diversity patterns in a sample or population are used, based on incidence, relative frequencies, pairwise distances, or phylogenetic trees. Here, we review and compare several of these measures. [ABSTRACT FROM AUTHOR]

Historically, nursing students have not been adequately prepared to provide end-of-life (EOL) care. The faculty of a university in the northwest recognized the curriculum was deficient in EOL content. In response to this deficit, the simulation team developed an evidenced-based EOL simulation in accordance to INASCL Standards of Best Practice℠. The End-of-Life Nursing Education Consortium undergraduate curriculum includes six modules presenting content considered essential to prepare students for EOL care. Students complete the modules in preparation for the simulation. The simulation begins with prebriefing and orientation to the simulation space. Immediately after the simulation, students participate in a debriefing session to process their thoughts and feelings about the experience. Students submit a reflection after they have had time to further explore the impact of the simulation, both personally and professionally. Student reflections indicated an increase in knowledge of their role in EOL care and the importance of creating a calm environment for the patient and family. Participants reported the profound impact of the simulation and the opportunity to experience emotions evoked by the simulation in a safe setting. Students reported both the presence of a "family member" and performing postmortem care contributed to the reality of the simulation. Based on the reflections and feedback received from students after they experience the death of a patient for the first time as a nurse, the simulation played a significant part in preparing them for EOL care. • Simulation is a pedagogy used to educate nursing students about end-of-life care. • The ELNEC Undergraduate Curriculum effectively prepares students for simulation. • Presence of a family member and postmortem care add to reality of the simulation. • Debriefing and reflection help process emotions evoked by the simulation. [ABSTRACT FROM AUTHOR]

• Delirium is a widespread condition in hospitalized older adults. • Delirium outcomes for older adults admitted to the surgical intensive care unit (SICU) are limited. • The incidence of delirium reported in the SICU was far lower than previous reports in the literature among other ICU settings. • Rates of delirium screening more than doubled following the delirium-informed care intervention. Delirium is prevalent in hospitalized older adults. Little is known about delirium among older adults admitted to the surgical intensive care unit (SICU). The purpose of this study was to describe the incidence of delirium, length of stay, 30-day readmission and mortality rates experienced by older adults in the SICU before and after a nurse-driven protocol for delirium-informed care. This study employed a retrospective observational cohort design. Consecutive patients 65 years or older admitted to the SICU over six-month periods were compared before (n = 101) and following (n = 172) a nurse-driven protocol for delirium-informed care. Patient-level outcomes included incidence delirium, SICU and hospital length of stay, 30-day readmission and mortality rates. All measures were collected using medical record review. In the pre- and post-intervention cohorts, 37% (37/101) and 33% (56/172) of patients screened positive for delirium, respectively. Following implementation of the delirium-informed care intervention, the number of days where no CAM-ICU assessment was performed significantly decreased (Pre 1.1 ± 1.4; Post 0.45 ± 0.65; p <0.001) and the number of negative assessments significantly increased (Pre 2.45 ± 1.66; Post 2.94 ± 1.69; p < 0.0178), indicating that nurses post-intervention were more consistently assessing for delirium. This study failed to show improvements in patient outcomes (SICU and hospital length of stay, 30-day readmission and mortality rates), before and following a delirium-informed care intervention. However, positive trends in the data suggest that delirium-informed care has the potential to increase rates of assessment and delirium identification, thereby providing the foundation for reducing the consequences of delirium and improve patient-level outcomes. Further better controlled prospective work is needed to validate this intervention. [ABSTRACT FROM AUTHOR]

This paper describes the participatory modeling experiences of five discrete teams across the U.S. working to develop models of food systems to identify leverage points and policies to induce food system transformation. Collaboration between academic and community partners within these individual modeling processes enables teams to address food systems complexity, integrate scientific evidence and local knowledge into models, while improving a model's credibility and accessibility for policymaking. While tools for facilitating participatory modeling are becoming more available, there is scant discussion on the practicalities of community engagement processes, including how teams respond to the needs of partners, navigate challenges that arise during projects, and communicate results. Synthesizing results from five independent teams in Albany, New York; Austin, Texas; Cleveland, Ohio; Denver, Colorado; and Flint, Michigan, this paper provides an overview of each team's approach to community engagement for participatory modeling of food systems. Analysis of engagement strategies across these five teams revealed four essential components to successful participatory modeling projects: 1) building research in collaboration with partners from the onset, 2) developing awareness of the challenges of community-researcher partnerships, 3) supporting transparent communication, and 4) promoting justice and trust through accessible dissemination processes. We emphasize that there is no single best approach to participatory modeling with community partners, rather that researchers need to understand and respond to various stakeholder needs. While each team faced challenges to the engagement process, including responding to the COVID-19 pandemic, our findings reveal important considerations for research in participatory modeling for food system policy. • Participatory modeling is useful to bridge academic knowledge and policy-making. • Immediate food access and lasting climate impacts of food systems challenges engaged modeling. • We synthesize lessons from five independent projects on participatory modeling of food systems. • Researchers must be responsive to community assets to produce policy relevant results. [ABSTRACT FROM AUTHOR]

Fabrication of conventional facial prostheses is a labor-intensive process which traditionally requires an impression of the facial defect and surrounding tissues. Inaccuracies occur during the facial moulage because of soft-tissue compression, the patient's reflex movements, or the lack of support for the impression material. A variety of 3D imaging techniques have been introduced during the production of facial prostheses. However, the accuracy of the different imaging techniques has not been evaluated sufficiently in this clinical context. The purpose of this in vitro study was to compare the difference in accuracy of capturing oncology facial defects with multimodal image fusion and laser scanning against a cone beam computed tomography (CBCT) reference scan. Ten gypsum casts of oncology facial defects were acquired. To produce reference models, a 3D volumetric scan was obtained using a CBCT scanner and converted into surface data using open-source medical segmentation software. This model was cropped to produce a CBCT mask using an open-source system for editing meshes. The multimodal image fusion model was created using stereophotogrammetry to capture the external facial features and a custom optical structured light scanner to record the defect. The gypsum casts were also scanned using a commercial 3D laser scanner to create the laser-scanned model. Analysis of the best fit of each experimental model to the CBCT mask was performed in MeshLab. The unsigned mean distance was used to measure the absolute deviation of each model from the CBCT mask. A paired-samples t test was conducted to compare the mean global deviation of the 2 imaging modalities from the CBCT masks (α=.05). A statistically significant difference was found in the mean global deviation between the multimodal imaging model (220 ±50 μm) and the laser-scanned model (170 ±70 μm); (t(9)=2.56, P =.031). The color error maps illustrated that the greatest error was located at sites distant to the prosthesis margins. The laser-scanned models were more accurate; however, the mean difference of 50 μm is unlikely to be clinically significant. The laser scanner had limited viewing angles and a longer scan time which may limit its transferability to maxillofacial practice. [ABSTRACT FROM AUTHOR]

Abstract Most of the vitamin D necessary for the maintenance of human health and successful reproduction is made in the skin under the influence of a narrow portion of the electromagnetic spectrum emitted from the sun, namely ultraviolet B radiation (UVB). During the course of human evolution, skin pigmentation has evolved to afford protection against high levels of UVR while still permitting cutaneous production of vitamin D. Similar pigmentation phenotypes evolved repeatedly as the result of independent genetic events when isolated human populations dispersed into habitats of extremely low or high UVB. The gradient of skin color seen in modern human populations is evidence of the operation of two clines, one favoring photoprotection near the equator, the other favoring vitamin D production nearer the poles. Through time, human adaptations to different solar regimes have become more cultural than biological. Rapid human migrations, increasing urbanization, and changes in lifestyle have created mismatches between skin pigmentation and environmental conditions leading to vitamin D deficiency. The prevalence and significance for health of vitamin D deficiencies, and the definition of optimal levels of vitamin D in the bloodstream are subjects of intense research and debate, but two of the causes of vitamin D deficiency – lack of sun exposure and abandonment of vitamin D rich foods in the diet – are traceable to changes in human lifestyles accompanying urbanization in prehistory. [ABSTRACT FROM AUTHOR]

Background Patients frequently remain in the hospital after bariatric surgery due to pain, nausea, and inability to tolerate oral intake. Enhanced recovery after surgery (ERAS) concepts address these perioperative complications and therefore improve length of stay for bariatric surgery patients. Objectives To determine if ERAS concepts increase the proportion of patients discharged on postoperative day 1. Secondary objectives included mean length of stay, perioperative opioid use, emergency department visits, and readmissions. Setting A large metropolitan university tertiary hospital. Methods A quantitative before and after study was conducted for patients undergoing bariatric surgical patients. Data were collected surrounding length of stay, perioperative opioid consumption, antiemetic therapy requirements postoperatively, multimodal analgesia compliance, emergency department visits, and hospital readmission rates. Wilcoxon rank-sum and χ 2 test were used to compare continuous and categorical variables, respectively. A secondary analysis was performed using Aligned Rank Transformation and Cochran-Mantel-Haenszel χ 2 tests to account for an increase in sleeve gastrectomies in the intervention group. Results The 2 groups had clinically similar baseline characteristics. Comparison group (N = 366) and ERAS group (N = 715) patients underwent a primary bariatric surgery procedure. There was an increase in the number of patients undergoing a laparoscopic sleeve gastrectomy in the intervention group. After accounting for this increase, the percentage of patients discharged on postoperative day 1 was unchanged (79.8% non-ERAS versus 83.1% ERAS, P = .52). ERAS length of stay was statistically significantly lower for gastric bypass ( P <.001) and robotic gastric bypass ( P = .01). P erioperative opioid consumption was reduced (41.0 versus 16.2 morphine equivalents, P <0.001), and fewer ERAS patients required postoperative antiemetics (68.8% versus 46.2%, P <.001). Emergency department visits at 7 days were reduced (6.0% versus 3.2%, P = .04), but hospital readmission rates were unchanged. Conclusions Implementing ERAS did not reduce the percentage of patients discharged on postoperative day 1 in a bariatric surgery program with historically low length of stay, but it led to significant reductions in perioperative opioid use, decreases in postoperative nausea, and early emergency room visits. [ABSTRACT FROM AUTHOR]

Development research and practice often use a capitals framework to study and encourage community improvement (Flora et al. 2015; Pender et al., 2014; Scoones 2009). This includes capitals such as human, social, natural, infrastructural, political, economic, and cultural. Despite robust scholarship on a variety of capital types, the conceptualization and use of cultural capital in community development remains unsettled and often underdeveloped. To help address this, we have conducted a systemic literature review of peer-reviewed community development scholarship in the United States employing the concept of cultural capital between 2001 and 2021. We find that the various ways cultural capital is understood and deployed are reflective of disciplinary and practitioner assumptions and norms. Though cultural capital is often not well defined, our review suggests that it tends to be viewed as creative industries and amenities; a distinct social group; knowledge, values, attitudes, norms, and beliefs; place-based characteristics; and/or an exercise of power. A number of methodological trade-offs are discussed as well as the symbolic foundation of the concept. We posit that cultural capital might be better understood as a meta-capital, as a resource that only registers through the other capitals as opposed to something separate from them. Reflexivity on the part of researchers and practitioners is vital to deploying cultural capital for community development due to the impact such characterization can have on determining which culture matters or not, and how this can shape how other assets are mobilized. Due its place-based, symbolic, and meta qualities, cultural capital may need to be understood differently from the other capitals which has important implications for research and practice - namely the importance of community participation in determining what matters. • Conducts a systematic literature review of how cultural capital is conceptualized and deployed in community development literature. • There is not consensus on the way cultural capital should be understood and deployed in community development. • Due to its symbolic nature, cultural capital might be best understood as a meta-capital that registers through other capitals. • Reflexivity in the way cultural capital is deployed is important to avoid symbolic violence. [ABSTRACT FROM AUTHOR]

Objectives Explore (1) the characteristics of the Maine population with delayed geographic access to interventional cardiology (IC) services and (2) the effect of delayed geographic IC access on coronary mortality. Background Acute coronary syndrome (ACS), ST-segment elevated myocardial infarction (STEMI), and non-ST segment elevated myocardial infarction (NSTEMI) are highly prevalent. Coronary mortality is minimized when victims have prompt IC access. Methods The study design was (1) an exploration of census data to investigate disparities in geographic IC access and (2) a secondary analysis of administrative claims data to investigate coronary mortality relative to delayed geographic IC access. Results Delayed access was associated in the Maine population with rural residence, advanced age, high school education, and lack of health insurance. Delayed access was associated with increased unadjusted coronary mortality, but not age-adjusted coronary mortality. Conclusion Delayed geographic IC access was associated with disparity but not with increased age-adjusted coronary mortality. [ABSTRACT FROM AUTHOR]

Aims Catecholamines have metabolic effects on blood pressure, insulin sensitivity and blood glucose. Genetic variation in catechol- O -methyltransferase ( COMT ), an enzyme that degrades catecholamines, is associated with cardiometabolic risk factors and incident cardiovascular disease (CVD). Here we examined COMT effects on glycemic function and type 2 diabetes. Methods We tested whether COMT polymorphisms were associated with baseline HbA 1c in the Women's Genome Health Study (WGHS), and Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC), and with susceptibility to type 2 diabetes in WGHS, DIAbetes Genetics Replication And Meta-analysis consortium (DIAGRAM), and the Diabetes Prevention Program (DPP). Given evidence that COMT modifies some drug responses, we examined association with type 2 diabetes and randomized metformin and aspirin treatment. Results COMT rs4680 high-activity G-allele was associated with lower HbA 1c in WGHS (β = − 0.032% [0.012], p = 0.008) and borderline significant in MAGIC (β = − 0.006% [0.003], p = 0.07). Combined COMT per val allele effects on type 2 diabetes were significant (OR = 0.98 [0.96–0.998], p = 0.03) in fixed-effects analyses across WGHS, DIAGRAM, and DPP. Similar results were obtained for 2 other COMT SNPs rs4818 and rs4633. In the DPP, the rs4680 val allele was borderline associated with lower diabetes incidence among participants randomized to metformin (HR = 0.81 [0.65–1.00], p = 0.05). Conclusions COMT rs4680 high-activity G-allele was associated with lower HbA 1c and modest protection from type 2 diabetes. The directionality of COMT associations was concordant with those previously observed for cardiometabolic risk factors and CVD. [ABSTRACT FROM AUTHOR]

Objectives To examine the significance of multimorbidity in breast cancer survivors, to explore multimorbidity in treatment decisions, and survivorship, and to consider multimorbidity assessment in clinical practice. Data Sources Literature review; clinical practice guidelines. Conclusion Multimorbidity influences treatment decisions. Breast cancer survivors report greater multimorbidity compared with other cancer survivors. Multimorbidity increases with age; there may be racial and ethnic differences. Multimorbidity is associated with symptom burden, functional decline, low adherence to surveillance, and early retirement. Implications for Nursing Practice Clinical practice guidelines do not refer to multimorbidity and patient outcomes. Comprehensive geriatric assessment combined with survivorship care plan may be considered. [ABSTRACT FROM AUTHOR]

Water striders use ripple signals in aggressive interactions between individuals for access to food. We asked whether water striders produce ripple signals more frequently when they are hungrier and when the value of food resources is higher. We also asked if and how the use of signals depends on the size difference between interacting individuals. We found that females used ripple signals more often than males did. The experiment suggested that use of aggressive ripple signals is affected by hunger in females – the sex with high demands for food resources. Among females, but not males, we found out that the probability of using signals in response to the approaching intruder depended both on the degree of hunger and on the size of the focal animal relative to the size of the intruder. Before starvation, the probability of a female using a signal in an interaction with an intruder was higher when the individual's size was larger relative to the intruder. After starvation, the focal individuals were more likely to signal when their size was smaller relative to the intruder. The results are consistent with the idea that these signals may reveal information about the signalers weight or hunger level, and specific hypotheses are suggested for the future studies. [ABSTRACT FROM AUTHOR]

Abstract: The delegation of low-risk breast cancer patients' follow-up to non-hospital practitionners (NHP), including gynaecologists and general practitioners, has been assessed prospectively within a care network in the Paris region. Patients with early stage breast cancer were eligible. The follow-up protocol was built according to international guidelines. By 2012, 289 NHPs were following 2266 patients treated in 11 centres. Median follow-up time was 7.4 years. The mean intervals between two consecutive consultations were 9.5 [9.2–9.8] months for women supposed to be monitored every 6 months and 12.5 [12.2–12.8] for those requiring annual monitoring. The relapse rate was 3.2% [2.1–4.3] at 5 years and 7.8% [5.9–9.7] at 10 years. Seventy one percent of relapses were diagnosed on a scheduled assessment. Only 6% were lost-to-follow-up. Delegating follow-up after low risk breast cancer to NHPs in a care network is feasible, well accepted and provides an alternative to follow-up in specialized centres. [Copyright &y& Elsevier]

Abstract: Understanding and supporting learning for different emerging low carbon energy supply technology fields is a key issue for policymakers, investors and researchers. A range of contrasting analytical approaches are available: energy system modelling using learning rates provides abstracted, quantitative and output oriented accounts, while innovation studies research offers contextualised, qualitative and process oriented accounts. Drawing on research literature and expert consultation on learning for several different emerging energy supply technologies, this paper introduces a ‘learning pathways’ matrix to help bridge between the rich contextualisation of innovation studies and the systematic comparability of learning rates. The learning pathways matrix characterises technology fields by their relative orientation to radical or incremental innovation, and to concentrated or distributed organisation. A number of archetypal learning pathways are outlined to help learning rates analyses draw on innovation studies research, so as to better acknowledge the different niche origins and learning dynamics of emerging energy supply technologies. Finally, a future research agenda is outlined, based on socio-technical learning scenarios for accelerated energy innovation. [Copyright &y& Elsevier]

Abstract: Background and aims: We sought to explore associations between serum 25-hydroxyvitamin D [25(OH)D] levels and non-alcoholic fatty liver disease [NAFLD] in an integrated healthcare delivery system in the U.S. Methods and results: Six hundred and seven NAFLD cases were randomly matched 1:1 with controls for age, sex, race and season of measurement. Conditional logistic regression was used to evaluate if serum 25(OH)D levels were associated with increased odds of NAFLD (diagnosed by ultrasound) after adjusting for body mass index and history of diabetes, renal, peripheral vascular and liver diseases (model 1) and also for hypertension (model 2). Mean (SD) serum 25(OH)D level was significantly lower in the group with NAFLD as compared with that in the matched control group (75±17 vs. 85±20nmol/L [30±7 vs. 34±8ng/mL], P <0.001). Inadequate 25(OH)D status progressively increased the odds of NAFLD when classified categorically as sufficient (25(OH)D 75nmol/L [>30ng/mL], reference group), insufficient (37–75nmol/L [15–30ng/mL]; adjusted odds ratio [OR]: 2.40, 95% confidence interval [CI]: 0.90–6.34) or deficient (<37nmol/L [<15ng/mL]; adjusted OR: 2.56, 95% CI: 1.27–5.19). When modeled as a continuous variable, increased log10 25(OH)D was inversely associated with the risk of prevalent NAFLD (adjusted OR: 0.25, 95% CI: 0.064–0.96, P =0.02). Conclusion: Compared with matched controls, patients with NAFLD have significantly decreased serum 25(OH)D levels, suggesting that low 25(OH)D status might play a role in the development and progression of NAFLD. [Copyright &y& Elsevier]

Summary: The fibroblast growth factor receptor 4 (FGFR4)-R388 single-nucleotide polymorphism has been associated with cancer risk and prognosis. Here we show that the FGFR4-R388 allele yields a receptor variant that preferentially promotes STAT3/5 signaling. This STAT activation transcriptionally induces Grb14 in pancreatic endocrine cells to promote insulin secretion. Knockin mice with the FGFR4 variant allele develop pancreatic islets that secrete more insulin, a feature that is reversed through Grb14 deletion and enhanced with FGF19 administration. We also show in humans that the FGFR4-R388 allele enhances islet function and may protect against type 2 diabetes. These data support a common genetic link underlying cancer and hyperinsulinemia. [Copyright &y& Elsevier]

Abstract: Proper joining of aluminum to carbon fiber reinforced plastics is one of the challenges in hybrid designs. With the objective to minimize or avoid some of the disadvantages of manufacturing technologies used today, like cut fibers or adhesion uncertainty, and to fulfill requirements for enhanced lightweight designs, novel transition structures are needed. Considering several manufacturing techniques, novel and integral joint concepts are researched. Three concepts are analyzed which consist of different materials (titanium and titanium-alloys, glass fiber), manufacturing methods (casting, welding, textile techniques) and geometries. The numerical methods and results for one of these concepts are presented in this work. Within the concept, various phase boundaries and materials have to be studied, which have effects on the structural behavior and failure. First, volume models are generated on a meso scale and two failure models are developed. These concern the debonding between epoxy matrix and included joint-components as well as bulk material failure. Both failure models are based on damage mechanics and include progressive damage that allows computation of fracture initiation and propagation. Simulations are carried out for testing routines in order to gain further understanding of fracture behavior. [Copyright &y& Elsevier]

The majority of nursing home residents require assistance with activities of daily living, including oral care. Poor oral health is common in the nursing home because residents are not given appropriate assistance to support this aspect of their care. The purpose of this study was to describe the demographic, functional, and behavioral profile of nursing home residents with dementia who require verbal or physical assistance with mouth care. Residents who required verbal support to complete mouth care exhibited higher levels of physical function, higher levels of cognitive functioning in the domains of language and executive function, lower levels of passivity, and higher scores for the personality trait of openness than residents who required physical assistance. Best practices for implementing verbal and physical assistance during mouth care to persons with dementia are presented on the basis of these profiles. [ABSTRACT FROM AUTHOR]

Background: Our aim was to study the clinical, surgical, and pathological characteristic of women with homolateral recurrence of pneumothorax despite previous surgery. Methods: This study is a retrospective analysis of the clinical and pathological records of all consecutive women of reproductive age hospitalized in a thoracic surgery department for surgical treatment of pneumothorax recurrence despite previous surgery between 2000 and 2009. Results: During the study period, 35 women were operated on. Their mean age was 37 years. Twenty-nine pneumothoraces (83%) were right sided. In 20 women, the recurrence occurred during the menstrual period. At initial surgery, 5 cases had been catamenial with evidence of thoracic endometriosis, 12 were catamenial with no evidence of endometriosis, 5 were noncatamenial with thoracic endometriosis, and 13 were idiopathic. At repeat surgery the figures were 18, 4, 5, and 8 cases, respectively. Repeat operation was carried out by video-assisted thoracoscopy in 13 cases, video-assisted minithoracotomy in 10, and standard thoracotomy in 12. Partial diaphragmatic resection was performed at repeat surgery in 16 patients (45.7%). Talc pleurodesis and pleural abrasion were carried out in 20 (57.1%) and 15 patients (42.9%), respectively. No major morbidity was observed. After repeat surgery, hormonal treatment was prescribed in 24 cases. Median follow-up was 40 months (range, 1.5 to 138 months). In 6 women, further homolateral recurrence of pneumothorax occurred (17.1%) and required surgery in 3 cases. Conclusions: Repeat surgery can be safely performed in women with recurrence of pneumothorax despite previous surgery, and frequently shows initially missed endometriosis. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of this study was to evaluate the bond strength of different adhesive sealers on Resilon and gutta-percha. Methods: Pellets of gutta-percha and Resilon were embedded into test tubes. Small eyelets were attached to those surfaces with a 0.5-mm film of different root canal sealers. Real Seal, Real Seal SE, Hybrid Root Seal (also known as Meta Seal), and AH Plus were used. AH Plus as a nonadhesive sealer served as a control group. In all groups (n = 10) shear bond strength was measured. Results: Shear bond strength was relatively low (0.1–3 MPa) and significantly higher in the groups with a single component adhesive sealer. No substantial bond strength was found in the control group. Overall bond strength to Resilon was higher than to gutta-percha but not significant compared with the Hybrid Root Seal group. Conclusions: With single component self-adhesive sealers, an adhesive connection might be formed to gutta-percha as well as to Resilon. [Copyright &y& Elsevier]

Summary: The natural selection hypothesis suggests that lighter skin colour evolved to optimise vitamin D production. Some authors question if vitamin D deficiency leads to sufficient health problems to act as a selection pressure. This paper reviews the numerous effects of vitamin D deficiency on human health and argues that vitamin D deficiency is sufficient to pose as a potent selection pressure for lighter skin colour. Vitamin D deficiency manifesting as rickets and osteomalacia are sufficient to impair reproductive success, but additionally, animal studies and some clinical observations suggest that vitamin D may have more direct impact on human fertility. Vitamin D deficiency may lead to a whole host of clinical conditions which impair health and increase mortality rates: increase susceptibility to bacterial and viral infections; rickets, osteomalacia and osteoporosis, with increased risk of falls and fractures; increased risk of cancers; hypertension and cardiovascular disease; maturity onset diabetes; autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease and Type 1 diabetes; and gum disease. We submit that at higher latitudes, lighter skin colour evolved to facilitate vitamin D production under conditions of low ultra-violet B radiation in order to avoid a plethora of ill health, reproductive difficulties and early mortality. [Copyright &y& Elsevier]

Introduction Geriatric trauma, mainly as a result of motor vehicle crashes (MVCs), has been a persistent and serious problem for those older than 65 years of age. Because of physiological changes and pre-existing disease, older adults present a unique clinical challenge to emergency nurses and staff. 'Are older adults involved in MVCs appropriately assessed and treated?' Methods A review of the research literature, including 17 articles from 2003 to 2009, on the topic of geriatric trauma, specifically trauma that resulted from MVCs will be explored. Results Four different areas were discussed: (1) the under-detection of geriatric trauma, (2) prehospital triage guidelines, (3)the injury severity score, and (4) common resultant injuries encountered by older adults. Discussion Understanding specific patterns of injury in older adults and the geriatric trauma outcomes data is essential to emergency nursing practice. Following this literature review, the emergency nurse will be more comfortable managing the next geriatric patient arriving in the emergency department. [ABSTRACT FROM AUTHOR]

Introduction: Geriatric trauma, mainly as a result of motor vehicle crashes (MVCs), has been a persistent and serious problem for those older than 65 years of age. Because of physiological changes and pre-existing disease, older adults present a unique clinical challenge to emergency nurses and staff. “Are older adults involved in MVCs appropriately assessed and treated?” Methods: A review of the research literature, including 17 articles from 2003 to 2009, on the topic of geriatric trauma, specifically trauma that resulted from MVCs will be explored. Results: Four different areas were discussed: (1) the under-detection of geriatric trauma, (2) prehospital triage guidelines, (3)the injury severity score, and (4) common resultant injuries encountered by older adults. Discussion: Understanding specific patterns of injury in older adults and the geriatric trauma outcomes data is essential to emergency nursing practice. Following this literature review, the emergency nurse will be more comfortable managing the next geriatric patient arriving in the emergency department. [Copyright &y& Elsevier]

The purpose of this study was to examine the knowledge, beliefs, and practices of nursing assistants (NAs) providing oral hygiene care to frail elders in nursing homes, with the intent of developing an educational program for NAs. Methods: The study occurred in two economically and geographically diverse nursing homes. From a sample size of 202 NAs, 106 returned the 19-item Oral Care Survey. Results: The NAs reported satisfactory knowledge regarding the tasks associated with providing mouth care. The NAs believed that tooth loss was a natural consequence of aging. They reported that they provided mouth care less frequently than is optimal but cited challenges such as caring for persons exhibiting care-resistive behaviors, fear of causing pain, and lack of supplies. Conclusion: Nurses are in a powerful position to support NAs in providing mouth care by ensuring that they have adequate supplies and knowledge to respond to resistive behaviors. [ABSTRACT FROM AUTHOR]

Abstract: The use of Yoga and other complementary healthcare interventions for both clinical and non-clinical populations has increased substantially in recent years. In this context, we describe the implementation of Hatha Yoga in the Mindfulness-Based Stress Reduction (MBSR) program of Kabat-Zinn and colleagues. This is embedded in a more general consideration of Yoga’s place in complementary healthcare. In providing this overview, we comment on the nature and quality of current research on Yoga, summarize current physiological and psychological explanations of its effects, and discuss practical issues related to teacher training and experience. [Copyright &y& Elsevier]

Abstract: Brazilian legislation defines coastal zone as a national patrimony – the geographic space of interaction of air, sea and land formed by the counties directly influenced, but not necessarily by those located in the coastline; also included are those distant until 50km from the coastline, holding activities of great impact for the coastal zone or its ecosystems. The definition includes also the territorial sea of 12 nautical miles. Coastal management is conducted by a national plan legally enforced, complemented by states and counties plans, and a coastal ecologic-economic zoning limited to small portions of the coastal zone. A resolution of the “Environmental National Council” defines as “permanent preservation areas”, of very restricted use, coastal ecosystems as mangroves, sand dunes, and reproduction sites of wild fauna. One could expect that the Brazilian coast should be more protected and properly managed than other countries where a national management plan is lacking (Argentina) or where the guidelines exist but are not yet legally enforced (South Africa). Notwithstanding, we note today in Brazil an intensification of conflicts opposing small-scale vs. industrial fishermen; shrimp farming vs. mangrove crab harvesting; resorts installation vs. native communities; oil and gas activities vs. NGOs; and conflicts on environmental permit between federal and state governmental agencies. This paper evaluates the possible reasons for the failure of the complex legal suite available in Brazil and suggests that participatory management and concerted actions with relevant stakeholders are the key elements for the successful cases. [Copyright &y& Elsevier]

The protein and activity levels of the non-receptor tyrosine kinase Src are elevated in many cancers. In addition, Src has been shown to be involved in the regulation of important cellular processes including migration, survival and proliferation. Given the participation of Src in many diverse cell functions and the data implicating Src in tumor formation, there has been significant effort to develop Src inhibitors. Here, we review the cell culture, animal and clinical studies that document the use and specificity of Src inhibitors. [Copyright &y& Elsevier]

Background: The premise of coronary revascularization without cardiopulmonary bypass (off-pump coronary artery bypass graft [CABG]) proposes that patient morbidity and, potentially, mortality can be reduced without compromising the excellent results of conventional revascularization techniques (on-pump CABG). High-risk patients may benefit the most from off-pump CABG. The aim of this study was to compare early and mid-term clinical outcomes after off-pump CABG with on-pump CABG in a subset of high-risk patients. Methods: Between January 1, 2000 and December 31, 2000, 513 high-risk patients with a Parsonnet''s risk scores of 20 or higher underwent CABG; 38.6% (n = 198) underwent on-pump CABG, and 61.4% (n = 315) had off-pump CABG. Logistic regression was used to calculate the probability of being selected for on-pump CABG given a set of preoperative risk factors. Propensity scores or the probability of being selected for on-pump CABG were computed. Relative risks, heterogeneity among strata, and interactions between surgery type and the propensity score were assessed by a multivariate Cox proportional-hazards regression for the outcomes mortality and major adverse cardiac events (death, acute myocardial infarction, stroke, reoperative CABG, percutaneous coronary intervention). Results: Operative mortality was lower after off-pump versus on-pump CABG between the two groups after controlling for preoperative risk factors using the propensity score (odds ratio = 2.10; 95% confidence intervals = 1.02 to 4.36, p = 0.04). In the Cox-regression analysis, off-pump CABG was associated with an improved survival rate compared with on-pump CABG (p = 0.03). Off-pump CABG was associated with a comparable event-free survival (p = 0.14) compared with on-pump CABG. Conclusions: Off-pump CABG can be performed with a reasonably low morbidity and lower early and late mortality in high-risk patients. Off-pump CABG may be a better operative strategy in this subset of patients. [Copyright &y& Elsevier]

: BackgroundAortic valve replacement (AVR) through a partial sternotomy (mini-AVR) has been suggested to significantly reduce postoperative morbidity compared with conventional AVR. This study sought to investigate whether mini-AVR patients require fewer transfusions than patients who had conventional AVR.: MethodsOf 511 patients who had AVR, 56 had mini-AVR and 455 had conventional AVR. A matched-case logistic regression analysis was used to adjust for these imbalances between groups.: ResultsNo patient in the mini-AVR cohort required conversion to a conventional AVR. Cardiopulmonary bypass time was longer in the mini-AVR group compared with the conventional AVR group, with a median of 102 minutes (range, 78 to 119 minutes) versus 75 minutes (range, 61 to 96 minutes; p < 0.01) in the conventional AVR group. A total of 31 patients (55%) in the mini-AVR group and 336 patients (74%) in the conventional sternotomy group required transfusions during their hospital stay (p < 0.01). After adjusting for differences in preoperative risk factors, year of operation, and surgeon, by matching on propensity score, the differences were not statistically significant (odds ratio = 0.84, 95% confidence interval = 0.40 to 1.75, p = 0.63).: ConclusionsMini-AVR produces better wound cosmesis and less surgical trauma but requires more time to perform. Matched-case analysis failed to show a significant difference in blood transfusion requirements after mini-AVR compared with the conventional AVR approach. [Copyright &y& Elsevier]

Reports that the thermodynamic water retention capacity (WRC) has been defined and applied to different heterogeneous phase equilibria. Discussion of some phase equilibria with respect to the capacity of water retention; Isobaric equilibria of vaporization and melting in a binary system; Heteregeneous equilibria with gels.

Background. Postoperative stroke is a serious complication after coronary artery bypass grafting with cardiopulmonary bypass (on-pump), and portends higher morbidity and mortality. It is unknown whether an off-pump cardiopulmonary bypass (OPCAB) approach may yield a lower stroke rate over conventional on-pump coronary artery bypass grafting.Methods. From June 1994 to December 2000, OPCAB was performed in 2,320 patients and compared with 8,069 patients who had on-pump coronary artery bypass grafting, during the same period of time. The patients undergoing OPCAB were randomly matched to on-pump patients by propensity score. A logistic regression model was used to test the difference in the postoperative stroke rate between OPCAB and on-pump procedures controlling for the correlation between matched sets. A multiple logistic regression model predicting the risk of stroke adjusted by stroke risk factors and operation type was also computed.Results. Matches by propensity score were found for 72% of the patients undergoing OPCAB. Patients undergoing on-pump coronary artery bypass grafting were 1.8 (95% confidence interval 1.0 to 3.1, p = 0.03) times more likely to suffer a stroke postoperatively than OPCAB patients after controlling for preoperative risk factors through matching. Independent predictors of stroke identified from the multiple logistic model included on-pump operation (versus OPCAB operation), female gender, 4 to 6 vessels grafted (versus <4 grafts), hypertension, history of previous cerebrovascular accident, carotid artery disease, chronic obstructive pulmonary disease, and depressed ejection fraction.Conclusions. Off-pump cardiopulmonary bypass avoids the risks of cardiopulmonary bypass and atrial trauma. A substantially lower stroke rate suggests that OPCAB is a neurologically safe treatment option for revascularization. [Copyright &y& Elsevier]

Background. Coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (CPB) is currently increasing in clinical practice. Decreased morbidity associated with off-pump (OP) CABG in selected risk groups examined in relatively small, single institution groups has been the focus of most recent studies. The purpose of this study was to determine the independent impact of CPB on early survival in all isolated multivessel CABG patients undergoing surgery in two large institutions with established experience in OPCABG techniques.Methods. A review of two large databases employed by multiple surgeons in the hospitals of two institutions identified 8,758 multivessel CABG procedures performed from January 1998 through July 2000. In all, 8,449 procedures were included in a multivariate logistic regression analysis to determine the relative impact of CPB on mortality independent of known risk factors for mortality. Procedures were also divided into two treatment groups based on the use of CPB: 6,466 had CABG with CPB (CABG-CPB), 1,983 had CABG without CPB (OPCABG). Disparities between groups were identified by univariate analysis of 17 preoperative risk factors and treatment groups were compared by Parsonnet’s risk stratification model. Finally, computer-matched groups based on propensity score for institution selection for OPCABG were combined and analyzed by a logistic regression model predicting risk for mortality.Results. CABG-CPB was associated with increased mortality compared with OPCABG by univariate analysis, 3.5% versus 1.8%, despite a lower predicted risk in the CABG-CPB group. CPB was associated with increased mortality by multiple logistic regression analysis with an odds ratio of 1.79 (95% confidence interval = 1.24 to 2.67). An increased risk of mortality associated with CPB was also determined by logistic regression analysis of the combined computer-matched groups based on OPCABG-selection propensity scores with an odds ratio of 1.9 (95% confidence interval = 1.2 to 3.1).Conclusions. Elimination of CPB improves early survival in multivessel CABG patients. Rigorous attempts to statistically account for selection bias maintained a clear association between CPB and increased mortality. Larger multiinstitutional studies are needed to confirm these findings and determine the most appropriate application of OPCABG. [Copyright &y& Elsevier]

• We sequenced 11.8 % of all SARS-CoV-2 cases in Switzerland from Dec 2020 to Mar 2021. • We estimate a transmission fitness advantage of 43–52 % for the B.1.1.7 variant. • We estimate the reproductive number of B.1.1.7. In December 2020, the United Kingdom (UK) reported a SARS-CoV-2 Variant of Concern (VoC) which is now named B.1.1.7. Based on initial data from the UK and later data from other countries, this variant was estimated to have a transmission fitness advantage of around 40–80 % (Volz et al., 2021; Leung et al., 2021; Davies et al., 2021). This study aims to estimate the transmission fitness advantage and the effective reproductive number of B.1.1.7 through time based on data from Switzerland. We generated whole genome sequences from 11.8 % of all confirmed SARS-CoV-2 cases in Switzerland between 14 December 2020 and 11 March 2021. Based on these data, we determine the daily frequency of the B.1.1.7 variant and quantify the variant's transmission fitness advantage on a national and a regional scale. We estimate B.1.1.7 had a transmission fitness advantage of 43–52 % compared to the other variants circulating in Switzerland during the study period. Further, we estimate B.1.1.7 had a reproductive number above 1 from 01 January 2021 until the end of the study period, compared to below 1 for the other variants. Specifically, we estimate the reproductive number for B.1.1.7 was 1.24 [1.07–1.41] from 01 January until 17 January 2021 and 1.18 [1.06–1.30] from 18 January until 01 March 2021 based on the whole genome sequencing data. From 10 March to 16 March 2021, once B.1.1.7 was dominant, we estimate the reproductive number was 1.14 [1.00–1.26] based on all confirmed cases. For reference, Switzerland applied more non-pharmaceutical interventions to combat SARS-CoV-2 on 18 January 2021 and lifted some measures again on 01 March 2021. The observed increase in B.1.1.7 frequency in Switzerland during the study period is as expected based on observations in the UK. In absolute numbers, B.1.1.7 increased exponentially with an estimated doubling time of around 2–3.5 weeks. To monitor the ongoing spread of B.1.1.7, our plots are available online. [ABSTRACT FROM AUTHOR]