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A large amount of wasted mushroom stems are accumulated yearly by the mushroom industry. To reduce this waste, we have proposed a fractionation method to isolate several useful coproducts such as β-glucans, lipids, Vitamin D, polyphenols, and proteins before producing chitin from oyster mushrooms using reusable organic solvents. The extracted β-Glucans, polyphenols, and proteins were confirmed by 3,5-dinitrosalicylic acid (DNS), Folin-Ciocalteau, and bicinchoninic acid (BCA) assays respectively. Extracted lipids were analyzed by gas chromatography-mass spectrometry (GC-MS) and chitin was characterized by Fourier-transform infrared spectroscopy (FT-IR) and powder X-Ray diffraction (XRD). The crystallinity index of the extracted chitin was 71.2% when compared to 85% for crustacean chitin. The reduced crystallinity in mushroom chitin was due to the presence of some β-glucans. Overall, the reported fractionation method uses less solvent and provides a greener alternative to producing chitin when compared to the conventional methods of using a large quantity of harsh chemicals harmful to the environment. Further, fractionating several coproducts while producing chitin will reduce the total processing cost.

Delays in commencing post-operative radiation therapy (PORT) and prolongation of overall treatment times (OTT) are associated with reduced overall survival and higher recurrence rates in patients with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to evaluate treatment delays, factors contributing to those delays and to explore strategies to mitigate them.This retrospective study included patients with mucosal HNSCC at Townsville University Hospital treated with curative intent surgery and PORT between June 2011 and June 2019. The proportion of patients who experienced delays in commencing PORT (6 weeks) and OTT were evaluated and reasons for these delays were explored.The study included 94 patients of which 70% experienced PORT delay. Surgery at an external facility (81% vs 56%, P = 0.006) and longer post-operative length of stay (P = 0.011) were significantly associated with a higher incidence of PORT delay. Aboriginal and Torres Strait Islander patients had a higher rate of PORT delay (89% vs 68.2%, P = 0.198). Significant delays were noted from time of surgery to radiation oncology (RO) consult and from RO consult to commencement of radiation treatment.This study demonstrates that the prevalence of PORT delay for patients with HNSCC remains high with room for improvement. Potential strategies to improve delays include developing effective care coordination, addressing specific needs of Indigenous patients, implementing reliable automated tracking and communication systems between teams and harnessing existing electronic referral systems.

Xanthomas are benign cutaneous manifestations of extracellular lipid accumulation. Eruptive xanthoma is characterized by the acute, widespread presentation of a papular rash and usually involves the back, buttocks, and extremities. Eruptive xanthoma is associated with hyperlipidemia, hypertriglyceridemia, and an increased long-term risk of atherosclerotic cardiovascular disease. We present a case of eruptive xanthoma accompanied by severe hypertriglyceridemia (10,164 mg/dL) in which the course of the disease was reversed following implementation of lipid-lowering pharmacotherapy.

Reactive chemistry atomistic simulation has a broad range of applications from drug design to energy to materials discovery. Machine learning interatomic potentials (MLIPs) have become an efficient alternative to computationally expensive quantum chemistry simulations. In practice, developing reactive MLIPs requires prior knowledge of reaction networks to generate fitting data and refitting to extensive datasets for each new application. In this work, we develop a general reactive MLIP through unbiased active learning with an atomic configuration sampler inspired by nanoreactor molecular dynamics. The resulting potential (ANI-1xnr) is then applied to study five distinct condensed phase reactive chemistry systems: carbon solid-phase nucleation, graphene ring formation from acetylene, biofuel additives, combustion of methane and the spontaneous formation of glycine from early-earth small molecules. In all studies, ANI-1xnr closely matches experiment and/or previous studies using traditional model chemistry methods. As such, ANI-1xnr proves to be a highly general reactive MLIP that does not need to be refit for each application, enabling high-throughput in silico reactive chemistry experimentation.

Machine learning (ML) models, if trained to datasets of high-fidelity quantum simulations, produce accurate and efficient interatomic potentials. Active learning (AL) is a powerful tool to iteratively generate diverse datasets. In this approach, the ML model provides an uncertainty estimate along with its prediction for each new atomic configuration. If the uncertainty estimate passes a certain threshold, then the configuration is included in the dataset. A key challenge in this process is locating structures for which the model lacks underlying training data. Here, we develop a strategy to more rapidly discover configurations that meaningfully augment the training dataset. The approach, uncertainty driven dynamics for active learning (UDD-AL), modifies the potential energy surface used in molecular dynamics simulations to favor regions of configuration space for which there is large model uncertainty. Performance of UDD-AL is demonstrated for two challenging AL tasks: sampling the conformational space of glycine and sampling the promotion of proton transfer in acetylacetone. The method is shown to efficiently explore chemically relevant configuration space, which may be inaccessible using regular dynamical sampling at target temperature conditions.

Objective Patients may be considered at high risk for CEA due to either anatomical or physiologic factors and are often treated with TCAR. Patients with physiologic criteria are deemed to have higher overall surgical risk due to more significant comorbidities. Our aim is to study the incidence of stroke, myocardial infarction (MI), death, and combined endpoints in patients who underwent TCAR comparing ANAT vs. PHYS risk factors. Methods An analysis of the prospectively collected data from the ROADSTER (pivotal), ROADSTER2 (FDA indicated post-market), and ROADSTER Extended Access TCAR trials was performed. All patients (n=851) were considered to be at high risk for CEA and were included and stratified based on high risk ANAT criteria (contralateral occlusion, tandem stenosis, high cervical artery stenosis, restenosis after previous endarterectomy, bilateral carotid stent, hostile neck with previous neck irradiation, neck dissection, or cervical spine immobility) or high-risk PHYS criteria (age75 years, multi-vessel coronary artery disease, history of angina, congestive heart failure NYHA class III/IV, left ventricular ejection fraction30%, recent MI, severe chronic obstructive pulmonary disease (COPD), permanent contralateral cranial nerve injury, or chronic renal insufficiency). For trial inclusion, asymptomatic patients had80% carotid stenosis and symptomatic patients had50% stenosis. Primary outcome measures were stroke, death, and MI at 30 days. Data was statistically analyzed with the χ2 test as appropriate. Results There were 851 high surgical risk patients categorized into ANAT only risk factors (n = 372) or having at least one PHYS risk factor (n = 479). The ANAT subset had 74.5% asymptomatic patients, while the PHYS subset had 76.6%. General anesthesia was employed similarly in both groups (67.7% ANAT vs. 68.1% PHYS). MI occurred in 8 PHYS (1.7%) patients all of whom were asymptomatic and in no ANAT patients (p = .01). Combined stroke, death, and MI rate was 2.1% in the ANAT cohort, compared to 4.2% in the PHYS cohort (p = .10). Stratification of each group into asymptomatic and symptomatic patients did not yield any further differences. Conclusion Patients who underwent TCAR in this prospective, neurologically adjudicated trial based on high-risk PHYS factors had higher rates of MI compared to patients who qualified with ANAT criteria only. These patients experienced comparable rates of combined stroke/death/MI rates. ANAT patients represent a healthier and younger subset of patients, with notably low overall event rates.

Quantum dots that store large tensile strains represent an emerging research area. We combine experiments and computational modeling to investigate the self-assembly of Ge and GaAs tensile-strained...

Organ donation after medical assistance in dying (MAID) has only been possible for patients having the MAID procedure performed at a hospital facility due to prohibitive warm ischemic times. Herein, we describe a protocol for lung donation following MAID at home and demonstrate excellent postoperative outcomes. Lung donation following MAID at home is possible and should be considered by transplant programs.

Study Design Multicenter, prospective cohort Objectives Malalignment following adult spine deformity (ASD) surgery can impact outcomes and increase mechanical complications. We assess whether preoperative goals for sagittal alignment following ASD surgery are achieved. Methods ASD patients were prospectively enrolled based on 3 criteria: deformity severity (PI-LL ≥25°, TPA ≥30°, SVA ≥15 cm, TCobb≥70° or TLCobb≥50°), procedure complexity (≥12 levels fused, 3-CO or ACR) and/or age (>65 and ≥7 levels fused). The surgeon documented sagittal alignment goals prior to surgery. Goals were compared with achieved alignment on first follow-up standing radiographs. Results The 266 enrolled patients had a mean age of 61.0 years (SD = 14.6) and 68% were women. Mean instrumented levels was 13.6 (SD = 3.8), and 23.2% had a 3-CO. Mean (SD) offsets (achieved-goal) were: SVA = −8.5 mm (45.6 mm), PI-LL = −4.6° (14.6°), TK = 7.2° (14.7°), reflecting tendencies to undercorrect SVA and PI-LL and increase TK. Goals were achieved for SVA, PI-LL, and TK in 74.4%, 71.4%, and 68.8% of patients, respectively, and was achieved for all 3 parameters in 37.2% of patients. Three factors were independently associated with achievement of all 3 alignment goals: use of PACs/equivalent for surgical planning ( P < .001), lower baseline GCA ( P = .009), and surgery not including a 3-CO ( P = .037). Conclusions Surgeons failed to achieve goal alignment of each sagittal parameter in ∼25-30% of ASD patients. Goal alignment for all 3 parameters was only achieved in 37.2% of patients. Those at greatest risk were patients with more severe deformity. Advancements are needed to enable more consistent translation of preoperative alignment goals to the operating room.

Study Design Retrospective review of prospective database. Objectives Vertebral pelvic angles (VPAs) account for complexity in spine shape by assessing the relative position of each vertebra with regard to the pelvis. This study uses VPAs to investigate the shape of the fused spine after T10-pelvis fusion, in patients with adult spinal deformity (ASD), and then explores its association with proximal junctional kyphosis (PJK). Methods Included patients had radiographic evidence of ASD and underwent T10-pelvis realignment. VPAs were used to construct a virtual shape of the post-operative spine. VPA-predicted and actual shapes were then compared between patients with and without PJK. Logistic regression was used to identify components of the VPA-based model that were independent predictors of PJK occurrence and post-operative shape. Results 287 patients were included. VPA-predicted shape was representative of the true post-operative contour, with a mean point-to-point error of 1.6-2.9% of the T10-S1 spine length. At 6-weeks follow-up, 102 patients (35.5%) developed PJK. Comparison of the true post-operative shapes demonstrated that PJK patients had more posteriorly translated vertebrae from L3 to T7 ( P < .001). Logistic regression demonstrated that L3PA ( P = .047) and T11PA ( P < .001) were the best independent predictors of PJK and were, in conjunction with pelvic incidence, sufficient to reproduce the actual spinal contour (error Conclusions VPAs are reliable in reproducing the true, post-operative spine shape in patients undergoing T10-pelvis fusion for ASD. Because VPAs are independent of patient position, L3PA, T11PA, and PI measurements can be used for both pre- and intra-operative planning to ensure optimal alignment.

Introduction Cognitive behavior therapy for insomnia (CBT-I), a first-line therapy for patients with chronic insomnia disorder (ChID), is underutilized due to reduced access to trained providers and other barriers. We developed an interactive care plan (ICP) combining individual aspects of CBT-I. This ICP, which integrates with the electronic health record (EHR), is designed to deliver personalized and scalable CBT-I to patients with ChID. We report data from initial implementation and evaluation of a ChID ICP deployed at a tertiary sleep medicine clinic. Methods The ICP was developed following patient and provider interviews and focus groups. Patients diagnosed with ChID were offered enrollment and engaged in the ICP through an app. The ICP has embedded logic that may escalate care or offer an exit from the program, depending upon the patient’s response to questions. Key variables ascertained from the patient included sleep efficiency (SE), sleep timing and the Insomnia Severity Index (ISI), and how satisfied they were with their progress (Likert scale). We also measured In Basket messaging related to use of the ICP. Results A total of 222 patients [57% female, age=56.4±15.9 years (average ±SD), 92.7% white] were enrolled in the initial 120 days of ICP implementation. Most referrals were initiated by physicians or advanced practitioners (77.9%). ISI at initiation was 15±5.18 and SE was 74.55±16.65%. Patients spent 35.9±26.25 days engaging with the ICP. The ISI score at 28 days was 12.89±4.98 and SE was 78.9±13.4% with both showing significant improvement from baseline (p=0.013; p=0.002; respectively). Self-rated satisfaction with progress did not significantly correlate with actual improvement in ISI or SE (p>0.05). The ICP generated 3.89±2.3 In Basket messages per patient. Conclusion Patients who actively engaged with the ICP showed significant improvements in insomnia severity and sleep efficiency. While a majority of the patients were neutral towards the ICP and only a small minority expressed dissatisfaction, these data indicate that the ICP will have clinical utility in busy sleep medicine practices with reduced access to behavioral sleep specialists. Support (If Any)

INTRODUCTION Head and neck cancers (HNC) require high level multidisciplinary care to achieve optimal outcomes. Reporting of quality indicators (QIs) has been instigated by some health services in an effort to improve quality of care. The aim of this study was to determine the quality of care provided to patients with HNC at a single institution by analysing compliance with QIs and to explore the feasibility and utility of collecting this data. METHODS This was a single institution retrospective chart review of all patients with squamous cell HNC at Townsville Hospital who were treated with curative intent between June 2011 and June 2019. Data was entered into a RedCap database and then exported to Stata V16 for analysis. RESULTS A total of 537 patients were included in the overall study, with six patients who had a synchronous non-HNC and two patients who received previous radiotherapy (RT) to the head and neck region excluded from the outcome analysis. Overall, compliance with pre-treatment, treatment and post-treatment QIs was high, with the exception of smoking cessation support (66%), post-treatment dental review and time to post-operative RT (33% of patients within 6 weeks). The 5-year overall survival was 69.4% (CI; 64-73.2%). The cumulative incidence of locoregional relapse for the overall study cohort was 18% (CI; 14.8-21.4%). CONCLUSION Collecting and evaluating quality metrics is feasible and helps identify areas for improvement. Centres treating HNC patients should strive towards monitoring quality against benchmarks and demonstrate transparency in outcome data.

While using security tools to resolve security defects, software developers must apply considerable effort. Success depends on a developer's ability to interact with tools, ask the right questions, and make strategic decisions. To build better security tools and subsequently help developers resolve defects more accurately and efficiently, we studied the defect resolution process—from the questions developers ask to their strategies for answering them. In this paper, we report on an exploratory study with novice and experienced software developers. We equipped them with Find Security Bugs, a security-oriented static analysis tool, and observed their interactions with security vulnerabilities in an open-source system that they had previously contributed to. We found that they asked questions not only about security vulnerabilities, associated attacks, and fixes, but also questions about the software itself, the social ecosystem that built the software, and related resources and tools. We describe the strategic successes and failures we observed and how future tools can leverage our findings to encourage better strategies.

In 2018, as the trade wars between the United States and China reached new heights, John faced challenges as he needed to quickly execute a plan to mitigate any risks to his company. The imposed tariffs were putting significant pressure on John’s current business initiatives, financial goals, and could derail is customers’ satisfaction. John knew that he was in safe hands with the support of Jabil’s supply chain and compliance directors. As one of the worlds largest Electronic Manufacturing Service companies, Jabil prides itself with understanding logistics, compliance, and operations competencies to support the growth of current and future business, all while mitigating and avoiding potential risks in the market. With the impact of the imposed tariffs beginning to affect John’s business, he knew that he needed to make a quick decision; either move operations out of China to a non-sanctioned country, continue the operations in China with the hope that the sanctions would end but risk customer satisfaction, or continue manufacturing the products in China and shipping the incomplete goods to another non-sanctioned location for final assembly, ultimately avoiding the tariff impacts. How was John expected to make this decision without understanding the trade uncertainties in the future? John knew that he needed to make his business profitable for him and the customer, but what approach did he need to execute on to keep the business sustainable? All these questions were impactful on the success of the business and could ultimately impact any long-term financial gains and growth with his customer base. John was anxious to come to a resolution, and knew that his next decisions would be critical to his business.

Made available in DSpace on 2022-04-28T19:47:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-01 Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material. University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine the Ronald Reagan UCLA Medical Center University of California Los Angeles SSM Healthcare Semmelweis University Keck School of Medicine University of Southern California University of North Carolina School of Medicine University of Arizona the Indiana University Health Physicians Vascular Surgery Michigan Medicine University of Michigan University Heart Center Hamburg University Medical Center Hamburg-Eppendorf Penn State Heart and Vascular Institute Milton S. Hershey Medical Center Johns Hopkins Hospital The Heart Hospital Baylor Plano the Cardiovascular Surgery Clinic University of Messina National & Kapodistrian University of Athens University of Patras Keio University University of Pennsylvania Vancouver General Hospital & University of British Columbia Mayo Clinic Christiana Health System University of Chicago Harborview Medical Center University of Washington Washington University Stanford University CHU de Poitiers Baylor College of Medicine MedStar Georgetown University Hospital SSM Health St. Louis University Faculdade de Medicina de Botucatu-Unesp Beth Israel Deaconness Medical Center Brigham and Women's Hospital St. Joseph's Hospital Massachusetts General Hospital Robert Wood Johnson Medical School Rutgers University Vita-Salute University School of Medicine San Raffaele Scientific Institute Kaiser Permanente University Heart Center Freiburg-Bad Krozingen Freiburg University of Virginia Medical Center University of Siena Kyung Hee University Gustave Dron Hospital Centro Hospitalar de Lisboa Norte Wexner Medical Center Ohio State University Uppsala University University Hospital of Trieste University Hospital of Verona University Hospital of Padova University of Alabama University of California Davis University of Florida Michael E. DeBakey Department of Surgery Baylor College of Medicine University Hospital University of Missouri Faculdade de Medicina de Botucatu-Unesp

open access article This report reflects on a follow-on initiative from the AHRC-funded project “Fifty Years of British Music Video” designed to explore a collaboration between Cuba’s dance, film and music cultures to create non- performance-based dance videos. Facilitated by service company Island Pictures, we worked with a young director, Giselle García Castro, dancers at Danza Contemporánea de Cuba, and leading Cuban rap artist Telmary. The result was a single-shot video for Telmary’s “Soy el Verso” (2018), filmed in the dance studio, based on an improvisation guided by Giselle, and inspired by the José Martí poem in the song. The video fulfilled PI Caston’s ambition to break down the barrier between “dance film” and “music video” by building the choreography from the lyrics and making it the centre of the exercise. It endorsed Caston’s conceptual aim to encourage practitioners to identify and articulate their own narrative and iconography. The team also produced a fifteen-minute documentary of the process including interviews with filmmakers, teachers and students. The project demonstrated that academic collaboration with artistic communities can stimulate new creative practices and economic development. It also showed how creative industries researchers can use networks established by institutions such as the British Council and British Embassies to exchange media practice.

As human-rated missions like those in NASA's Artemis program continue to grow in both size and complexity, and the role of software in achieving mission objectives expands dramatically, NASA's Independent Verification and Validation (IV&V) Teams face evolving challenges in assuring the safety and performance of the safety- and mission-critical embedded software that is essential to landing astronauts on the surface of the Moon by 2024. Key among these challenges is IV&V's desire to present a cohesive, integrated assurance statement to its stakeholders that encapsulates and summarizes our assurance positions across the integrated Artemis systems and their combined role in support of a safe and successful flight. In order to meet this challenge, the IV&V Teams have begun a transition to using formal assurance case concepts and documentation in the Goal Structuring Notation (GSN) to build an argument in support of software assurance. IV&V recognizes significant benefits to the logical argumentation structure provided by assurance cases and GSN over our current practices for documenting and managing assurance claims. In order to reap these benefits, IV&V is integrating the use of assurance case concepts with our paradigm of follow-the-risk capability based assurance. Because of this, assurance cases created and used by IV&V are distinct from the sort of assurance case created by a development project or embedded software assurance organization. IV&V's assurance cases depend much less upon standards and regulations, and more on evidence captured by IV&V regarding the environment, requirements, design, and implementation. IV&V constructs an independent network of claims based on an independent decomposition of arguments. Based upon the risk posture of these claims and their associated software and software artifacts, IV&V then develops and executes engineering analyses and testing, which provide evidence to either support or refute the claim. This emerging risk-informed assurance case methodology is being put into practice as IV&V plans for support of the Artemis II mission, the first flight of the Orion capsule and Space Launch System with astronauts on board.

Objective Thoracic endovascular aortic repair (TEVAR) for blunt traumatic aortic injuries (BTAIs) can be complicated by inaccurate aortic measurements at the initial computed tomography angiography secondary to hypovolemic shock. The use of intravascular ultrasound (IVUS) has been proposed for more accurate aortic sizing, with prior data demonstrating larger aortic sizes measured by IVUS, potentially altering the vast majority of chosen endograft sizes. At present, and to the best of our knowledge, no studies have examined whether IVUS affects the clinical outcomes. The purpose of the present study was to examine the effect of IVUS on the clinical outcomes after TEVAR for BTAIs. Methods A retrospective cohort study was performed of patients who had undergone TEVAR for BTAIs in the VQI registry. The cohorts were defined by the use of IVUS. The primary outcomes were mortality and reintervention at 1 year. Results A total of 919 patients who had undergone TEVAR for BTAIs were included in the present analysis. The IVUS patients had presented with higher injury severity scores (36.2 vs 42; P = .0004) largely because of more extremity and external trauma. IVUS was more often used for patients with grade III injuries (49.1% vs 56.9%; P = .02) and less often for patients with rupture (21.1% vs 12.4%; P = .001). A trend toward a delay in TEVAR was seen for the patients for whom IVUS was used (1.8 vs 3.5 days; P = .38), with additional trends toward reduced intraoperative resuscitation and blood loss. The hemodynamic status of the patients and differences in aortic or endograft sizes could not be assessed with the available data. IVUS use was not associated with any differences in survival or reintervention rates in-hospital or at 1 year (Kaplan-Meier survival estimates: 0.91 no IVUS vs 0.92 IVUS; P = .46). Fifteen aortic-related reinterventions occurred across the entire patient cohort for all-available follow-up with comparable rates of type I endoleaks (1 no IVUS vs 2 IVUS), with no recorded cases of sizing-related complications such as device rupture, migration, or dissection. Conclusions IVUS usage during TEVAR for BTAIs was associated with clinical scenarios in which patients were more stable and interventions to address BTAIs can be delayed. Despite this, the overall clinical outcomes were similar between cases in which IVUS was used and for which it was not.

Consider the following higher order difference equation \begin{equation*} x(n+1)= f\big (n,x(n)\big )+ g\big (n, x(n-k)\big )\,, \quad n=0, 1, \dots \end{equation*} where $f(n,x)$ and $g(n,x)\colon \lbrace 0, 1, \dots \rbrace \times [0, \infty ) \rightarrow [0,\infty )$ are continuous functions in $x$ and periodic functions in $n$ with period $p$, and $k$ is a nonnegative integer. We show the existence of a periodic solution $\lbrace \tilde{x}(n)\rbrace $ under certain conditions, and then establish a sufficient condition for $\lbrace \tilde{x}(n)\rbrace $ to be a global attractor of all nonnegative solutions of the equation. Applications to Riccati difference equation and some other difference equations derived from mathematical biology are also given.

Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of an extraordinarily large reduction of anterograde and a somewhat milder reduction of retrograde episodic long-term memory. Additionally, executive functions are described as diminished. Although it is suggested that various factors, such as migraine, focal ischemia, venous flow abnormalities, and epileptic phenomena, are involved in the pathophysiology and differential diagnosis of TGA, the factors triggering the emergence of these lesions are still elusive. Recent data suggest that the vulnerability of CA1 neurons to metabolic stress plays a pivotal part in the pathophysiological cascade, leading to an impairment of hippocampal function during TGA. In this review, we discuss clinical aspects, new imaging findings, and recent clinical-epidemiological data with regard to the phenotype, functional anatomy, and putative cellular mechanisms of TGA.

Background Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) are common sexually transmitted infections (STIs) treated in the emergency department (ED). Objectives To assess the history, physical examination, and laboratory findings associated with NG and CT infection and the decision to administer empiric antibiotic treatment for the diseases in the ED. Methods A retrospective review of 566 clinical encounters of adult female patients tested for STIs between January 1, 2013 and December 31, 2014. An analysis of patient- and provider-level variables was assessed to determine the characteristics associated with empiric antibiotic treatment in the ED and post-discharge laboratory confirmed NG or CT. Results Younger age and the presence of TV on vaginal wet prep had a higher association with being infected with NG or CT (p < 0.05). Subjective exam findings, such as vaginal discharge, abdominal pain, urinary urgency, urinary frequency, dysuria, objective vaginal discharge, cervical motion tenderness, adnexal tenderness, vaginal bleeding, as well as positive leukocyte esterase and nitrites on urinalysis were all not associated with NG or CT infection (p > 0.05). ED providers were more likely to treat subjects in the ED for NG and CT when there was subjective and objective vaginal discharge, cervical motion tenderness, adnexal tenderness, and vaginal bleeding, TV on wet prep, and leukocyte esterase on urinalysis (p < 0.05). Conclusions Only younger age women and the presence of TV on vaginal wet prep were associated with NG or CT infection. ED providers empirically over-treated with antibiotics ~20 patients uninfected with NG and CT by laboratory confirmation, for every one patient with a laboratory confirmed infection.

Amyloidosis is a group of diseases characterized by extracellular deposition of amyloid fibril complexes. Fibril deposition results in organ dysfunction and possible failure. Amyloidosis is regarded as a rare disease, but in general is underdiagnosed. The two main types of systemic amyloidosis are immunoglobulin light chain and transthyretin amyloidosis. The increased availability of noninvasive cardiac imaging, genetic testing and improved laboratory assays and protein identification methods have led to increased diagnosis. However, in many cases, the diagnosis is not made until the patient develops organ impairment. Earlier diagnosis is required to prevent irreversible organ failure. Novel treatments for immunoglobulin light chain and transthyretin amyloidosis that halt disease progression, prolong and increase quality of life have recently become available.

The file attached to this record is the author's final peer reviewed version. Whilst there is a surprising critical consensus underpinning the myth that British music video began in the mid-1970s with Queen’s video for ‘Bohemian Rhapsody’, few scholars have pursued Mundy’s (1999) lead in locating its origins a decade earlier. Although the relationship between film and the popular song has a much longer history, this article seeks to establish that the international success of British beat groups in the first half of the 1960s encouraged television broadcasters to target the youth audience with new shows that presented their idols performing their latest hits (which normally meant miming to recorded playback). In the UK, from 1964, the BBC’s Top of the Pops created an enduring format specifically harnessed to popular music chart rankings. The argument follows that this format created a demand for the top British artists’ regular studio presence which their busy touring schedules could seldom accommodate; American artists achieving British pop chart success rarely appeared on the show in person. This frequent absence then, coupled with the desire by broadcasters elsewhere in Europe and America to present popular British acts, created a demand for pre-recorded or filmed inserts to be produced and shown in lieu of artists’ appearance. Drawing on records held at the BBC’s Written Archives and elsewhere, and interviews with a number of 1960s music video directors, this article evidences TV’s demand-driver and illustrates how the ‘pop promo’, in the hands of some, became a creative enterprise which exceeded television’s requirement to cover for an artist’s studio absence.

Background There is a paucity of literature regarding the implementation of enhanced recovery after surgery (ERAS) protocols for open lumbar spine fusions. We implemented an ERAS program for 1–2-level lumbar spine fusion surgery and identified areas that might benefit from perioperative interventions to improve patient satisfaction and outcomes. Methods This institutionally approved quality improvement (QI) ERAS program for lumbar spine fusion was designed for all neurosurgical patients 18 years and older scheduled for 1 or 2 level primary lumbar fusions. The ERAS bundle contained elements such as multimodal analgesia including preoperative oral acetaminophen and gabapentin, postoperative early mobilization and physical therapy, and a prophylactic multimodal antiemetic regimen to decrease postoperative nausea and vomiting. No fluid management or hemodynamic parameters were included. Pre-ERAS and post-ERAS data were compared with regard to potential confounders, compliance with the ERAS bundle, and postoperative outcomes. Results A total of 230 patients were included from October 2013 to May 2017. The pre-ERAS phase consisted of 123 patients, 11 patients during the transition period, and 96 serving as post-ERAS patients. The pre-ERAS and post-ERAS groups had comparable demographics and comorbidities. Compliance with preoperative and intraoperative medication interventions was relatively good (~ 80%). Compliance with postoperative elements such as early physical therapy, early mobilization, and early removal of the urinary catheter was poor with no significant improvement in post-ERAS patients. There was no significant change in the amount of short-acting opioids used, but there was a decrease in the use of long-acting opioids in the post-ERAS phase (14.6 to 5.2%, p = 0.025). Post-ERAS patients required fewer rescue antiemetic medications in the recovery room compared to pre-ERAS patients (40 to 24%). There was no significant difference in postoperative pain scores or hospital length of stay between the two groups. Conclusions Implementing an ERAS bundle for 1–2-level lumbar fusion had minimal effect in decreasing length of stay, but a significant decrease in postoperative opioid and rescue antiemetic use. This ERAS bundle showed mixed results likely secondary to poor ERAS protocol compliance. Going forward, this QI project will look to improve post-operative ERAS implementation to improve patient outcomes.