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The combination of radiotherapy/chemoradiotherapy and immune checkpoint blockade can result in poor outcomes in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Here, we show that combining ATR inhibition (ATRi) with radiotherapy (RT) increases the frequency of activated NKG2A+PD-1+ T cells in animal models of HNSCC. Compared with the ATRi/RT treatment regimen alone, the addition of simultaneous NKG2A and PD-L1 blockade to ATRi/RT, in the adjuvant, post-radiotherapy setting induces a robust antitumour response driven by higher infiltration and activation of cytotoxic T cells in the tumour microenvironment. The efficacy of this combination relies on CD40/CD40L costimulation and infiltration of activated, proliferating memory CD8+ and CD4+ T cells with persistent or new T cell receptor (TCR) signalling, respectively. We also observe increased richness in the TCR repertoire and emergence of numerous and large TCR clonotypes that cluster based on antigen specificity in response to NKG2A/PD-L1/ATRi/RT. Collectively, our data point towards potential combination approaches for the treatment of HNSCC. Immune checkpoint blockade can result in good outcomes in patients with metastatic head and neck squamous cell carcinoma (HNSCC), but not those with locally advanced disease. Here, the authors demonstrate that the addition of anti-NKG2A and anti-PD-L1 blockade to ATR inhibition and radiotherapy in the adjuvant setting can induce a robust antitumour immune response in mice. [ABSTRACT FROM AUTHOR]

Existing recommended first-line antibiotic agents for MRSA pneumonia have several shortcomings. We reviewed 29 cases of community- and hospital-acquired MRSA pneumonia managed at our hospital. Lincosamide monotherapy was administered to 21/29 (72%) and was the predominant antibiotic regimen (> 50% course duration) in 19/29 (66%). Patients receiving lincosamide-predominant monotherapy were no more likely to die or require intensive care unit admission than patients receiving vancomycin-predominant monotherapy (5/19 (26%) versus 4/7 (57%), p = 0.19); 5/7 (71%) patients admitted to ICU and 4/5 (80%) bacteraemic patients received lincosamide-predominant monotherapy. MRSA pneumonia can be safely treated with lincosamide monotherapy if the isolate is susceptible. [ABSTRACT FROM AUTHOR]

Purpose: Using a discrete dataset from the Women's Wellness after Cancer Program (WWACP), we examine the prevalence and predictors of self-reported sleep problems in women previously treated for cancer. Methods: Participants were 351 women (Mage = 53.2, SD = 8.8) from the WWACP who had completed surgery, chemotherapy and/or radiotherapy for breast, gynaecological or blood cancers within the previous 24 months. Sleep problems were measured using the Pittsburgh Sleep Quality Index (PSQI). Baseline data (i.e. prior to intervention randomisation) were analysed. Results: Most women (59%) reported clinically significant sleep disturbance (PSQI > 5), 40% reported insufficient sleep duration (< 7 h), 38% self-reported poor sleep quality and 28% reported poor habitual sleep efficiency (sleep efficiency < 75%). Fewer psychological and vasomotor climacteric symptoms, age < 45 years and having a partner were associated with reduced odds (AOR < 1) of sleep problems. Higher levels of pain-related disability, and an intermediate compared to 'high' level of education, were associated with increased odds (AOR > 1) of sleep problems. Conclusions: These findings confirm previous studies that have found a high prevalence of sleep problems in women previously treated for cancer. A range of sociodemographic, climacteric and pain-related factors were associated with sleep problems in this study. Implications for Cancer Survivors: Targeted interventions to improve sleep quality after cancer treatment should be explored in this population. Predictors identified in this study could inform intervention targeting and development. [ABSTRACT FROM AUTHOR]

Background: The prevalence of age-related hearing loss (ARHL) significantly increases in people aged 60 and older. Medical errors are frequently reported because of communication breakdown, especially for patients with ARHL. Aims: This qualitative study focuses on identifying the communication challenges faced by people aged over 65 with ARHL and potential ameliorative strategies based on the participants' personal experiences. Methods: Thirteen participants, attending a support service for older adults with hearing loss in the South of Ireland, were recruited using convenience sampling. Semi-structured interviews were conducted with participants. Interviews were audio-recorded and transcribed using NVivo 12 software. Braun and Clarke's thematic analysis methodology was used to identify themes arising from two main study domains: difficulties faced during the most recent healthcare interaction and suggestions for improving overall healthcare communication. Results: Older adults with hearing loss identified general mishearing, lack of awareness and use of medical terminology to be the cause of ineffective communication. Raising awareness of the impact of presbycusis on clinical interaction among healthcare professionals was cited as being of crucial importance. Other helpful strategies include repeat and rephrase, use of written information, providing context, minimizing ambient noise, continuity of care, longer consultation length and good body language. Conclusion: Effective clinical communication can be achieved through a clear understanding of the patient's perspective. Healthcare providers should be made aware of the hearing issues and associated communication difficulties posed, within the context of the development of patient-centred strategies to improve patient safety. [ABSTRACT FROM AUTHOR]

Aortitis is a life-threatening, manifestation of chronic Q fever. We report a series of 5 patients with Q fever aortitis who have presented to our hospital in tropical Australia since 2019. All diagnoses were confirmed with polymerase chain reaction (PCR) testing of aortic tissue. Only one had a previous diagnosis of acute Q fever, and none had classical high-risk exposures that might increase clinical suspicion for the infection. All patients underwent surgery: one died and 3 had significant complications. Q fever aortitis may be underdiagnosed; clinicians should consider testing for Coxiella burnetii in people with aortic pathology in endemic areas. [ABSTRACT FROM AUTHOR]

Purpose: To define the incidence and microbiological aetiology of infective endocarditis (IE) in patients with rheumatic heart disease (RHD) in tropical Australia. Methods: A retrospective study that examined all episodes of IE between January 1998 and June 2021 among individuals on the RHD register in Far North Queensland, Australia. Results: There were 1135 individuals with a diagnosis of RHD on the register during the study period, representing 10962 patient-years at risk. Overall, there were 18 episodes of definite IE occurring in 16 individuals, although only 7 episodes occurred in native valves (11 occurred in prosthetic valves) equating to 0.7 episodes of native valve IE/1000 patient-years. No patient with mild RHD - and only one child with RHD - developed IE during the study period. Despite the study's tropical location, the causative organism was usually typical skin or oral flora. Among individuals with an indication for benzathine penicillin G (BPG) prophylaxis, only 1/6 episodes of IE due to a penicillin-susceptible organism received BPG in the month before presentation. Conclusion: Although RHD predisposes individuals to IE, the absolute risk of IE in native valve disease in tropical Australia is low and might be reduced further by improved adherence to secondary BPG prophylaxis. [ABSTRACT FROM AUTHOR]

Purpose: Sleep disturbance after cancer treatment could compromise recovery. This paper examined the associations between post-treatment sleep problems and health-related quality of life (HRQoL), and the effectiveness of an e-enabled lifestyle intervention on sleep outcomes. Methods: The Women's Wellness after Cancer Program (WWACP) was examined in a single blinded, multi-centre randomised controlled trial. Data were collected from 351 women (Mage = 53.2, SD = 8.8; intervention n = 175, control group n = 176) who had completed surgery, chemotherapy and/or radiotherapy for breast, gynaecological or blood cancers within the previous 24 months. Participants completed the Pittsburgh Sleep Quality Index (PSQI) at baseline (prior to intervention randomisation), and at 12 and 24 weeks later. Sociodemographic information, menopausal symptoms (Greene Climacteric Scale) and HRQoL (36-Item Short Form Health Survey; SF-36) were also collected. Linear panel regression was used to examine the association between sleep variables and SF36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. A difference-in-difference regression model approach was used to examine the intervention effect on the sleep outcomes. Results: After adjustment for potential confounders, the sleep variables (except sleep duration) significantly predicted physical, but not mental, HRQoL. There was no statistically significant effect of the intervention on sleep outcomes at 12 or 24 weeks. Conclusion: Women who have completed treatment for cancer experience sleep problems that are associated with decreased physical HRQoL. Improving sleep through targeted interventions should improve their physical HRQoL. Improved targeting of the sleep components of the WWACP should be explored. [ABSTRACT FROM AUTHOR]

Inland fisheries make substantial contributions to food security and livelihoods locally, regionally, and globally but their conservation and management have been largely overlooked by policy makers. In an effort to remedy this limited recognition, a cross-sectoral community of scientists, practitioners, and policy makers from around the world convened a high-level meeting in 2015 at the Food and Agriculture Organization of the United Nations headquarters in Rome, Italy to develop recommendations for sustainable inland fisheries management. This meeting resulted in the production of the Rome Declaration, outlining ten key steps needed to achieve responsible inland fisheries. When the Ten Steps were conceived, they were framed in a global context because inland fisheries around the world face similar challenges, and it was hoped that these large-scale and ambitious steps would draw the attention of regional or international bodies for greater investment in their proper management. Most inland fisheries, however, are managed at a local (often community, watershed, or waterbody) scale with the "on-the-ground" practitioners, managers, assessment biologists, and stewardship officers responsible for achieving the promise of the Ten Steps. Here, we reflect on the relevance of the Ten Steps to practitioners using six regional case studies from around the globe (North America, South America, Europe, Asia, Australia, and Africa) to identify the extent to which existing efforts align with the Ten Steps and where there are opportunities to do more. Learning what is effective from local/regional actions should better inform a more global "action plan" and provide tangible guidance for implementation recognizing that global guidance needs to be informed by and acted upon by local practitioners. We conclude by considering the common challenges, synergies, and other emergent properties that arise from these case studies, and use these as a path forward to advancing responsible management of inland fisheries through the Rome Declaration. Of particular importance is the need to balance the high-level aspirational goals of the Ten Steps with the local cultural, socio-economic, and institutional realities that ultimately influence how humans interact with fisheries resources and aquatic ecosystems. This assessment provides valuable information on how to refine and implement the Ten Steps recognizing that success will require coordinated efforts among on-the-ground practitioners, scientists, stakeholders, rightsholders and international decision makers. [ABSTRACT FROM AUTHOR]

The clinical needs of young people with gender dysphoria (GD) have outpaced the capacity of health services to provide appropriate care. The study aimed to explore the interface of Paediatric Endocrinology and young people with GD, detailing the clinical characteristics and the clinical care provided, in order to inform future service development. Medical records of all young people with GD (n=91, 59 (65%) birth-assigned females and 32 (35%) birth-assigned males) referred to Paediatric Endocrinology during 2011–2019 for puberty suppression were reviewed. Median age at initial assessment was 14.6 years (range 8.8–17.6 years). There was a threefold increase from 2016 (n=22) to 2019 (n=73). Mental health disorders were present in 34 (37%) and autistic spectrum disorder in 21 (23%), while 54 (59%) had at least one comorbidity. Sixty-four (70%) young people fulfilled the criteria for consideration of fertility preservation, with 6 (9%) of them preserving their gametes. Seventy-nine (87%) young people commenced treatment with gonadotrophin-releasing hormone analogue, at a median age of 14.8 years (range 9.7–18.0 years). Six (8%) of those discontinued treatment, following a median duration of 6 months (range 6–18 months). Forty-one young people commenced gender-affirming hormones. One (2%) of those who started gender-affirming hormones discontinued treatment. Conclusions: We have witnessed increasing numbers of young people with GD attending Paediatric Endocrinology, with an over-representation of comorbidities, necessitating provision of an individualised approach to treatment. Addressing young people's acceptability of fertility services and ongoing close collaboration between endocrinology and mental health professionals require innovative models of multidisciplinary care. What is Known: • A worldwide increase in presentation of gender dysphoria has been mirrored in our service, with majority assigned female at birth and post-pubertal. • An over-representation of comorbidities exists, notably mental health disorders and autistic spectrum disorder. What is New: • Coordination of interprofessional care to meet complex needs, at an individual level, while improving efficiency of working, at a systemic level, can be met by the development of specialist centres. • The reasons for low uptake of fertility services demand further exploration. [ABSTRACT FROM AUTHOR]

Inland fisheries and their freshwater habitats face intensifying effects from multiple natural and anthropogenic pressures. Fish harvest and biodiversity data remain largely disparate and severely deficient in many areas, which makes assessing and managing inland fisheries difficult. Expert knowledge is increasingly used to improve and inform biological or vulnerability assessments, especially in data-poor areas. Integrating expert knowledge on the distribution, intensity, and relative influence of human activities can guide natural resource management strategies and institutional resource allocation and prioritization. This paper introduces a dataset summarizing the expert-perceived state of inland fisheries at the basin (fishery) level. An electronic survey distributed to professional networks (June-September 2020) captured expert perceptions (n = 536) of threats, successes, and adaptive capacity to fisheries across 93 hydrological basins, 79 countries, and all major freshwater habitat types. This dataset can be used to address research questions with conservation relevance, including: demographic influences on perceptions of threat, adaptive capacities for climate change, external factors driving multi-stressor interactions, and geospatial threat assessments. Measurement(s) Perception • Threats • Adaptive capacity Technology Type(s) Survey Factor Type(s) Fishery location • Demographics Sample Characteristic - Organism Homo sapiens • fish Sample Characteristic - Environment freshwater environment • lake • stream • wetland ecosystem Sample Characteristic - Location Europe • Asia • Oceania • Africa • South America • North America • Australia Machine-accessible metadata file describing the reported data: https://doi.org/10.6084/m9.figshare.14749161 [ABSTRACT FROM AUTHOR]

Purpose: Determine the incidence of metallosis around MAGEC rods. Methods: A multicentre explant database was searched to identify cases with complete intraoperative findings at rod removal. Surgeons removing rods detailed the presence or absence of tissue metallosis associated with rods. More recently surgeons measured the 'length' of tissue metallosis. Prior to rod disassembly, the majority underwent testing with an external remote controller (ERC). The impact of clinical and explant variables on metallosis was assessed. Results: Sixty-six cases were identified. Mean age at insertion was 8.1 ± 2.3 years with mean duration of implantation 37.6 ± 15.1 months. Tissue metallosis was noted at revision surgery in 52/66 cases (79%). Metallosis was noted more commonly when rods were removed during fusion surgery than rod removal/exchange (97% vs. 58% (p = < 0.01)). The mass at insertion was greater in cases with metallosis (25.9 ± 7.8 kg vs. 21.1 ± 6.2 kg, p = 0.04). Length of tissue metallosis was reported for 45 rods, median 9 cm (range 1–25). Metallosis was noted in 43/59 (73%) rods that produced no force and 22/30 (73%) rods that produced some force on ERC activation (p = 0.96). Wear debris was found within the actuator in all rods, and all but 3 rods had damaged O-rings. Conclusion: MAGEC rods are associated with tissue metallosis in the majority of cases. It is seen with functional rods as well as failed rods and appears related to wear debris within the actuator and high rates of O-ring failure. Until the implications of metal debris in children are known, we urge caution with the use of this implant. [ABSTRACT FROM AUTHOR]

A fleet of connected vehicles easily produces many gigabytes of data per hour, making centralized (off-board) data processing impractical. In addition, there is the issue of distributing tasks to on-board units in vehicles and processing them efficiently. Our solution to this problem is On-board/Off-board Distributed Data Analytics (OODIDA), which is a platform that tackles both task distribution to connected vehicles as well as concurrent execution of tasks on arbitrary subsets of edge clients. Its message-passing infrastructure has been implemented in Erlang/OTP, while the end points use a language-independent JSON interface. Computations can be carried out in arbitrary programming languages. The message-passing infrastructure of OODIDA is highly scalable, facilitating the execution of large numbers of concurrent tasks. [ABSTRACT FROM AUTHOR]

Key summary points: Objectives: This review quantified the extent to which hearing loss is cited and/or accounted for in studies of older adult interactions with medical, nursing, and allied health professionals Results: Only 28 (25.7%) papers of the 109 papers reviewed, which focused on health professional-older patient communication, mentioned hearing loss. Message: Across the health professions, few studies which have focused on clinical communication involving older adults have incorporated hearing loss as a variable in their study design or analyses. Purpose: Age-related hearing loss increases significantly in people aged 60 years and older. An ageing population with impaired hearing presents an additional burden to the multiple comorbidities found among older patients, who are high users of medical services. We sought to quantify the extent to which hearing loss is cited and/or accounted for in studies of older adult interactions with health professionals. Method: We conducted a systematic review focusing on clinical communication with older adults, based on a literature search within two databases, PubMed and SCOPUS. Thematic analysis was used to classify studies based on type of health communication. Results: The following health communication categories were identified: quality of clinical communication; enhancement of patient-centred care; information exchange between patient and health professionals; informed consent and shared decision-making. The health profession category 'Physician'/'Doctor' contributed most of the articles (N = 81), and the remaining articles (N = 28) belonged to the other health professions. Twenty-eight papers of 109 (25.7%) mentioned hearing loss; 18 only referred to hearing loss within the context of the text, five referred to hearing loss as an exclusion criterion, three were associational findings, and only two studies included an intervention. Conclusions: Despite the high prevalence of age-related hearing loss, we demonstrate that across the health professions, very few studies on health professional–older patient communication have incorporated hearing loss as a variable in their study design or analyses. Additionally, there is a lack of research focusing specifically on interventions designed to mitigate the effects of hearing loss on clinical communication. [ABSTRACT FROM AUTHOR]

Contraction Clustering (RASTER) is a single-pass algorithm for density-based clustering of 2D data. It can process arbitrary amounts of data in linear time and in constant memory, quickly identifying approximate clusters. It also exhibits good scalability in the presence of multiple CPU cores. RASTER exhibits very competitive performance compared to standard clustering algorithms, but at the cost of decreased precision. Yet, RASTER is limited to batch processing and unable to identify clusters that only exist temporarily. In contrast, S-RASTER is an adaptation of RASTER to the stream processing paradigm that is able to identify clusters in evolving data streams. This algorithm retains the main benefits of its parent algorithm, i.e. single-pass linear time cost and constant memory requirements for each discrete time step within a sliding window. The sliding window is efficiently pruned, and clustering is still performed in linear time. Like RASTER, S-RASTER trades off an often negligible amount of precision for speed. Our evaluation shows that competing algorithms are at least 50% slower. Furthermore, S-RASTER shows good qualitative results, based on standard metrics. It is very well suited to real-world scenarios where clustering does not happen continually but only periodically. [ABSTRACT FROM AUTHOR]

While data parallelism aspects of OpenCL have been of primary interest due to the massively data parallel GPUs being on focus, OpenCL also provides powerful capabilities to describe task parallelism. In this article we study the task parallel concepts available in OpenCL and find out how well the different vendor-specific implementations can exploit task parallelism when the parallelism is described in various ways utilizing the command queues. We show that the vendor implementations are not yet capable of extracting kernel-level task parallelism from in-order queues automatically. To assess the potential performance benefits of in-order queue parallelization, we implemented such capabilities to an open source implementation of OpenCL. The evaluation was conducted by means of a case study of an advanced noise reduction algorithm described as a multi-kernel OpenCL application. [ABSTRACT FROM AUTHOR]

Background: An institutional review board-approved, multicenter clinical trial was designed to determine the efficacy and outcome of percutaneous laser ablation (PLA) in the treatment of invasive ductal breast carcinoma (IDC). Post-ablation magnetic resonance imaging (MRI) was compared with surgical pathology in evaluation of residual post-ablation IDC and ductal carcinoma in situ.Methods: Patients with a single focus of IDC 20 mm or smaller by pre-ablation MRI were treated with PLA. The patients underwent a 28-day post-ablation MRI, followed by surgical resection. Cell viability criteria were applied to pre- and post-ablation pathology specimens, which evaluated hematoxylin-eosin (H&E), cytokeratin (CK) 8/18, estrogen receptor, and Ki67 staining patterns.Results: In this study, 61 patients were reported as the intention-to-treat cohort for determination of PLA efficacy. Of these 61 patients, 51 (84%) had complete tumor ablation confirmed by pathology analysis. One subject’s MRI imaging was not performed per protocol, which left 60 subjects evaluable for MRI pathology correlation. Five patients (8.3%) had residual IDC shown by both MRI and pathology. Post-ablation discordance was noted between MRI and pathology, with four patients (6.7%) false-positive and four patients (6.7%) false-negative. The negative predictive value (NPV) of MRI for all the patients was 92.2% (95% confidence interval [CI], 71.9-91.9%). Of the 47 patients (97.9%) with tumors 15 mm or smaller, 46 were completely ablated, with an MRI NPV of 97.7% (95% CI, 86.2-99.9%).Conclusions: Percutaneous laser ablation is a potential alternative to surgery for treatment of early-stage IDC. Strong correlations exist between post-ablation MRI and pathologic alterations in CK8/18, ER, and Ki67 staining. [ABSTRACT FROM AUTHOR]

This note presents a new, elementary proof of a generalization of a theorem of Halin to graphs with unbounded degrees, which is then applied to show that every connected, countably infinite graph G, with $$\aleph _0 \le |{\text {Aut}}(G)| < 2^{\aleph _0}$$ and subdegree-finite automorphism group, has a finite set F of vertices that is setwise stabilized only by the identity automorphism. A bound on the size of such sets, which are called distinguishing, is also provided. To put this theorem of Halin and its generalization into perspective, we also discuss several related non-elementary, independent results and their methods of proof. [ABSTRACT FROM AUTHOR]

A group $$A$$ acting faithfully on a set $$X$$ is $$2$$ - distinguishable if there is a $$2$$ -coloring of $$X$$ that is not preserved by any nonidentity element of $$A$$ , equivalently, if there is a proper subset of $$X$$ with trivial setwise stabilizer. The motion of an element $$a \in A$$ is the number of points of $$X$$ that are moved by $$a$$ , and the motion of the group $$A$$ is the minimal motion of its nonidentity elements. When $$A$$ is finite, the Motion Lemma says that if the motion of $$A$$ is large enough (specifically at least $$2\log _2 |A|$$ ), then the action is $$2$$ -distinguishable. For many situations where $$X$$ has a combinatorial or algebraic structure, the Motion Lemma implies that the action of $$\mathrm{Aut }(X)$$ on $$X$$ is 2-distinguishable in all but finitely many instances. We prove an infinitary version of the Motion Lemma for countably infinite permutation groups, which states that infinite motion is large enough to guarantee $$2$$ -distinguishability. From this, we deduce a number of results, including the fact that every locally finite, connected graph whose automorphism group is countably infinite is $$2$$ -distinguishable. One cannot extend the Motion Lemma to uncountable permutation groups, but nonetheless we prove that (under the permutation topology) every closed permutation group with infinite motion has a dense subgroup which is $$2$$ -distinguishable. We conjecture an extension of the Motion Lemma which we expect holds for a restricted class of uncountable permutation groups, and we conclude with a list of open questions. The consequences of our results are drawn for orbit equivalence of infinite permutation groups. [ABSTRACT FROM AUTHOR]

The emergence of a novel H7N9 avian influenza that infects humans is a serious cause for concern. Of the genome sequences of H7N9 neuraminidase available, one contains a substitution of arginine to lysine at position 292, suggesting a potential for reduced drug binding efficacy. We have performed molecular dynamics simulations of oseltamivir, zanamivir and peramivir bound to H7N9, H7N9-R292K, and a structurally related H11N9 neuraminidase. They show that H7N9 neuraminidase is structurally homologous to H11N9, binding the drugs in identical modes. The simulations reveal that the R292K mutation disrupts drug binding in H7N9 in a comparable manner to that observed experimentally for H11N9-R292K. Absolute binding free energy calculations with the WaterSwap method confirm a reduction in binding affinity. This indicates that the efficacy of antiviral drugs against H7N9-R292K will be reduced. Simulations can assist in predicting disruption of binding caused by mutations in neuraminidase, thereby providing a computational 'assay.' [ABSTRACT FROM AUTHOR]

The sleep-wake cycle is a major determinant of locomotor activity in humans, and the neural and physiological processes necessary for optimum postural control may be impaired by an extension of the wake period into habitual sleep time. There is growing evidence for such a contribution from sleep-related factors, but great inconsistency in the methods used to assess this contribution, particularly in control for circadian phase position. Postural control was assessed at hourly intervals across 14 h of extended wake in nine young adult participants. Force plate parameters of medio-lateral and anterior-posterior sway, centre of pressure (CoP) trace length, area, and velocity were assessed with eyes open and eyes closed over 3-min periods. A standard measure of psychomotor vigilance was assessed concurrently under constant routine conditions. After controlling for individual differences in circadian phase position, a significant effect of extended wake was found for anterior-posterior sway and for psychomotor vigilance. These data suggest that extended wake may increase the risk of a fall or other consequences of impaired postural control. [ABSTRACT FROM AUTHOR]

Nightshift is a common work schedule in health environments, and is associated with decreased alertness and increased adverse events at work. This decrease in alertness can be predicted from biological models of sleep homeostasis and circadian influences. Naps can provide a short-term alleviation of sleep need, and the benefits of naps have been demonstrated in laboratory-based studies, and in specific controlled work environments. The efficacy of brief naps has not been demonstrated in health workers in their usual work environment. The current study examined the effects of a 30-min nap break during the nightshift in a cohort of nursing staff and scientists in their usual work environment. Measures of both subjective sleepiness and objective alertness were taken at hourly intervals throughout the nightshift, on nights where a scheduled nap was taken and nights where there was no nap. Following a nap, psychomotor performance metrics (response speed and fastest 10% reactions times) improved and self-reported sleepiness was reduced compared to nights without a nap. These improvements persisted to the end of the nightshift. Effect size estimates suggested that 20–50% of variance in these measures was explained by the interaction of time on shift and the nap intervention. Differences were found in the timing of increases in subjective and objective alertness after the nap. These findings support the effectiveness of a scheduled nap break during a nightshift to maintain alertness in health workers. [ABSTRACT FROM AUTHOR]

Dear Editor, We read with interest 'Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs' by Miailhe et al I . i [[1]] and agree with their conclusion that the identification in their population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis. It is important to note that while earlier recognition of patients at risk of severe leptospirosis would be expected to reduce the case-fatality rate in well-resourced settings, the benefits for patients in the poorly resourced low- and middle-income tropical countries that bear a disproportionate burden of the disease are likely to be even greater [[4]]. [Extracted from the article]

Following carotid endarterectomy (CEA), patch angioplasty provides a significant reduction in that risk of perioperative complications. The expanded polytetrafluoroethylene (ePTFE) patch is strong, is resistant to infection, and has low thrombogenicity; but it remains unpopular because of its tendency of prolonged bleeding at the suture line. We aimed to investigate whether the application of Quixil sealant to the suture line could improve the time to achieve hemostasis and reduce local blood loss when compared to a standard topical hemostat Kaltoslat. A prospective, randomized trial of 20 patients undergoing CEA was undertaken. Patients were randomized to receive either Quixil sealant (treatment group) or topical Kaltostat (controls) as a hemostatic agent to the patch suture line. Hemostasis was defined as no bleeding at the suture line for 1 minute. Statistical analysis was performed using the Mann-Whitney test. The two groups had a similar age and sex distribution. The mean age was 71 years, and there were seven men and three women in each group. The time to achieve hemostasis was significantly lower in the Quixil group (median 2.5 minutes, range 1–4 minutes) compared to the controls (median 17 minutes, range 7–59 minutes) (p < 0.001). Blood loss after clamp release was also significantly reduced in the Quixil group: median 24.5 ml (range 5.5–105.0 ml) versus 203 ml (range 54.5–817.0 ml) (p < 0.001). This study has demonstrated that Quixil human surgical sealant is an effective sealant of ePTFE patch suture holes and does not compromise the patch repair. It could be used during other vascular procedures involving ePTFE. [ABSTRACT FROM AUTHOR]

The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; however, both biological and psychological factors have been implicated in establishing or maintaining this condition. People with CFS report significant and disabling cognitive difficulties such as impaired concentration that in some cases are exacerbated by exposure to chemical triggers. The aim of this study was to determine if neuropsychological deficits in CFS are triggered by exposure to chemicals, or perceptions about the properties of these substances. Participants were 36 people with a primary diagnosis of CFS, defined according to Centers for Disease Control (CDC) criteria. A randomized, double-blind, placebo-controlled, crossover design was used, with objective assessment of neuropsychological function and participant rating of substance type, before and after exposure to placebo or chemical trigger. Results showed decrements in neuropsychological tests scores on three out of four outcome measures when participants rated the substance they had been exposed to as "chemical." No change in performance was found based on actual substance type. These results suggest that cognitive attributions about exposure substances in people with CFS may be associated with worse performance on neuropsychological tasks. In addition, these findings suggest that psychological interventions aimed at modifying substance-related cognitions may reduce some symptoms of CFS. [ABSTRACT FROM AUTHOR]

Bright light is a known zeitgeber for the human circadian system, however, the phase shifting effects of natural sunlight are less well demonstrated. Eight male participants were exposed to 2-h periods of bright sunlight (in the morning or in the evening) over a week, following a week of restricted sunlight exposure in a repeated measures crossover design. A novel‘usual routine’ methodology was used to control possible daily zeitgebers. Bright sunlight in the morning induced an advance of the acrophase of the body temperature rhythm. This study supports the salience of sunlight as an everyday zeitgeber under naturalistic conditions. [ABSTRACT FROM AUTHOR]

A gene for early-onset familial breast cancer has recently been mapped to the chromosome 17q12-23 region. In order to confirm the gene location, we have tested an extensive early-onset breast cancer family with 4 markers in this chromosome region. Linkage was negative with all 4 markers. This study suggests that there is genetic heterogeneity among early-onset breast cancer families. [ABSTRACT FROM AUTHOR]

The article "Phase 2 Open-Label Trial Investigating Percutaneous Laser Ablation for Treatment of Early-Stage Breast Cancer: MRI, Pathology, and Outcome Correlations", written by Barbara Schwartzberg et al., was originally published electronically on the publisher's internet portal (currently SpringerLink) on July 9, 2018, without open access. [ABSTRACT FROM AUTHOR]

A patient was referred for superior vena cava (SVC) stenting prior to surgical biopsy of a mediastinal mass. A technically satisfactory insertion was followed 6 months later by cardiac tamponade with two legs of the Wallstent having perforated the wall of the SVC. [ABSTRACT FROM AUTHOR]