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Open source communities hosted in large foundations operate in a complex socio-technical ecosystem, which includes a heterogeneous mix of projects and stakeholders. Previous work has thus far investigated the challenges faced in OSS communities from the point of view of specific stakeholders, primarily at the level of individual projects. None have yet studied the challenges faced within a large, federated open source organization. In this paper, we aim to bridge this gap to identify ongoing challenges contributors face in a mature OSS organization. To do so, we surveyed 624 contributors at the Apache Software Foundation (ASF) and ran 11 semi-structured follow up interviews. We validated our findings through member checking with the interviewees as well as the ASF Diversity and Inclusion (D&I) committee. The contributions of this paper include: (1) an empirically-evidenced conceptual model of the 88 challenges that contributors face in a mature OSS foundation and (2) a set of 48 community-recommended strategies for alleviating these challenges. Our results show that even well-established and mature organizations still face a variety of individual and project-specific challenges and that it is difficult to design a comprehensive set of processes and guidelines to match the needs and expectations of a diverse and large federated community. Our conceptual challenges model and associated strategies to mitigate them can provide guidance to other OSS foundations and projects helping them in building better support processes and tools to create a successful, thriving community of contributors.

Extraintestinal disease manifestations of inflammatory bowel disease (IBD), such as arthritis and uveitis, have been well described in the medical literature. However, there has been growing evidence suggesting an association between IBD and both coronary artery disease (CAD) and acute myocardial infarctions (AMI). In this critical review, the pathogenesis of proatherogenic inflammatory markers (CD40-CD40L, IL-6, and TNF-α) are summarised along with clinical evidence that supports the association of these makers with CAD. Moreover, clinical data are examined that suggest an increased risk of AMI and CAD in IBD patients along with recent analyses of in-hospital and post-MI outcomes of AMI in IBD patients. This comprehensive review summarises and expands upon our understanding of the growing association between both CAD and AMI in IBD patients that potentially identifies IBD as a risk factor for developing CAD.

In considering how tuberculosis (TB) affects cattle across the UK, the British Veterinary Association (BVA) has coordinated with representatives of the farming, veterinary and scientific communities from throughout the UK to bring out a new policy position on bovine TB. In it BVA seeks to draw on the social science of behavioural change, as well as the best available evidence to support each of the recommendations. By advocating strengthening the team of farmer, private veterinary surgeon and government at a single farm unit level, BVA believes that engagement with control and prevention strategies can be improved. Access to local, current data will be a powerful tool in motivating the conversations between veterinary surgeons and farmers on appropriate measures to be taken over and above the statutory minimum on each farm. Increasing knowledge of when and how to apply different testing modalities, as well as government support for their use, will enable ownership of both the disease and its solutions farm by farm.

Background In 2017 the healthcare cost in the United States accounted for 17.9% of the Gross Domestic Product (GDP). Furthermore, healthcare facilities produce more than 4 billion pounds of waste annually. Interhospital and intersurgeon variabilities in surgical procedures are some of the drivers of high healthcare cost and waste. We sought to determine the effect of a monthly surgeon report card detailing the utilization and cost of disposable and reusable surgical supplies on cost and waste reduction for pediatric laparoscopic procedures. Methods Starting in July 2017, surgeons were provided with an individual report with supply cost per case, high cost, and disposable supply utilization, and clinical outcomes. Cost, utilization, and clinical outcomes six quarters before and after the intervention were compared. Results A total of 998 pediatric laparoscopic procedures were analyzed. We reduced the median supply cost per case by 43% after the intervention with total cost savings of $71,035 for the first four quarters. We also reduced the use of disposable trocars by 56% and the use of disposable harmonics and staplers by 33%. Conclusions Using a periodic surgeon report card, we significantly reduced supply cost and utilization of disposable items for all pediatric laparoscopic procedures performed at the University of Wisconsin American Family Children's Hospital. Type of study Cost effectiveness study. Level of evidence Level III.

Funder: Cancer Research UK (CRUK); doi: https://doi.org/10.13039/501100000289, Funder: DH | National Institute for Health Research (NIHR); doi: https://doi.org/10.13039/501100000272

Background Bipolar percutaneous radiofrequency (RF) is an established method for ablation of distal peripheral branches of the facial nerve to produce weakness of the corrugator muscle. Recent developments to the Serene RF system (Serene Medical, Inc., Pleasanton, CA) allowing for safer and more predictable results highlighted a need for prospective clinical data. Objectives The authors sought to assess the ability of percutaneous RF to safely improve the appearance of dynamic glabellar lines for a minimum of 3 months and up to 1 year. Methods This prospective study enrolled 78 patients across 5 centers in the United States. The most distal branches of the medial and lateral facial nerve innervation to the brow depressor/corrugator complex were treated. Follow-up was at 3 days by telephone and in-office at 7 days and 3, 6, 9, and 12 months posttreatment. Patients were evaluated employing the Merz scale for dynamic glabellar lines. Results At 3 months, 93.6% of patients had a ≥1-point Merz scale improvement in dynamic glabellar lines based on independent, blinded review. Sustained ≥2-point improvement was present in 60% and 20% of patients at 3 and 12 months, respectively. Overall satisfaction remained >60% through 6 months and >50% at 12 months. All device- or procedure-related adverse events were mild (90%) or moderate (10%) and resolved without medical intervention. Conclusions Bipolar percutaneous RF may be adopted in conjunction with surgery or as an office-based procedure where it can serve as a minimally invasive alternative to, or in concert with, Botulinum Toxin A therapy. Level of Evidence: 4

A culture of innovation is an attribute in business, which can be measured both qualitatively and quantitatively. The measurement of innovation empirically correlates with other measures of the corporate brand, such as overall reputation, perception of management, and investment potential. It seems logical then that the process of innovation may be a more strategic tool that is akin to corporate branding, rather than being a tactical component of product development. Whether developing innovative products or strategically building a culture of innovation in a company both require a commitment of a corporation’s management to provide resources, which means innovation should be financially accountable. Accountability requires measuring the return on innovation investment despite it being an internally grown intangible asset, which according to accounting standards cannot appear on the balance sheet. This paper is one of a series that will examine the culture of innovation as it relates to marketing and branding measures in a quantitative research survey known as the CoreBrand Index® (CBI). This purpose of this paper is to examine what came before the CBI. It will be a prequel to the primary work, which will evaluate the feasibility of measuring innovation as an indicator of business health and financial vitality, which may ultimately become a predictor of future revenue and cash flow. Ultimately, we would like to see internally grown intangible assets on the balance sheet, but at the very least we would like to see that they have some financial accountability. We hope to better understand what drives intangible assets like innovation, and how can it be measured, valued, and managed. To that end, we begin by examining areas we have not explored previously even after 25 years of measuring corporate brands.

Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated(e)-BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) remains the international standard of care for advanced-stage classical Hodgkin lymphoma (HL). We performed a retrospective, multicentre analysis of 221 non-trial (“real-world”) patients, aged 16–59 years, diagnosed with advanced-stage HL in the Anglia Cancer Network between 2004 and 2014, treated with ABVD or eBEACOPP, and compared outcomes with 1088 patients in the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma (RATHL) trial, aged 18–59 years, with median follow-up of 87.0 and 69.5 months, respectively. Real-world ABVD patients (n=177) had highly similar 5-year progression-free survival (PFS) and overall survival (OS) compared with RATHL (PFS 79.2% vs 81.4%; OS 92.9% vs 95.2%), despite interim positron-emission tomography-computed tomography (PET/CT)-guided dose-escalation being predominantly restricted to trial patients. Real-world eBEACOPP patients (n=44) had superior PFS (95.5%) compared with real-world ABVD (HR 0.20, p=0.027) and RATHL (HR 0.21, p=0.015), and superior OS for higher-risk (international prognostic score ≥3 [IPS 3+]) patients compared with real-world IPS 3+ ABVD (100% vs 84.5%, p=0.045), but not IPS 3+ RATHL patients. Our data support a PFS, but not OS, advantage for patients with advanced-stage HL treated with eBEACOPP compared with ABVD and suggest higher-risk patients may benefit disproportionately from more intensive therapy. However, increased access to effective salvage therapies might minimise any OS benefit from reduced relapse rates after frontline therapy.

Background Heart failure (HF), the dominant form of cardiovascular disease in Africans, is mainly due to hypertension, rheumatic heart disease and cardiomyopathy. Cardiomyopathies pose a great challenge because of poor prognosis and high prevalence in low- and middle-income countries (LMICs). Little is known about the etiology and outcome of cardiomyopathy in Africa. Specifically, the role of myocarditis and the genetic causes of cardiomyopathy are largely unidentified in Africans. Method The Afr i can Cardio m yopat h y and My o cardi t is R e gistry P rogram (the IMHOTEP study) is a pan-African multi-centre, hospital-based cohort study, designed with the primary aim of describing the clinical characteristics, genetic causes, prevalence, management and outcome of cardiomyopathy and myocarditis in children and adults. The secondary aim is to identify barriers to the implementation of evidence-based care and provide a platform for trials and other intervention studies to reduce morbidity and mortality in cardiomyopathy. The registry consists of a prospective cohort of newly diagnosed (i.e., incident) cases and a retrospective (i.e., prevalent) cohort of existing cases from participating centres. Patients with cardiomyopathy and myocarditis will be subjected to a standardized 3-stage diagnostic process. To date, 750 patients have been recruited into the multi-centre pilot phase of the study. Conclusion The IMHOTEP study will provide comprehensive and novel data on clinical features, genetic causes, prevalence and outcome of African children and adults with all forms of cardiomyopathy and myocarditis in Africa. Based on these findings, appropriate strategies for management and prevention of the cardiomyopathies in LMICs are likely to emerge.

INTRODUCTION: As adolescent tobacco use shifts from traditional cigarettes to alternative products, it is important to understand the influence of point-of-sale (POS) advertising on product use. This research investigated whether the percentage of POS advertising for a particular product, known as the share of advertising voice (SAV), moderated the relationship between exposure to POS tobacco advertisements and tobacco use among at-risk youth. METHODS: Longitudinal self-report data from 746 students attending 20 alternative high schools in southern California was merged with observational data cataloging 2101 advertisements for cigarettes, e-cigarettes, cigars, and smokeless tobacco from 87 tobacco retail outlets within a half mile of the schools. Four multilevel Poisson regression models examined whether SAV interacted with POS tobacco advertising exposure to influence the use of tobacco products 1 year later. RESULTS: Adolescent exposure to POS tobacco advertisements was significantly associated with increased use of all four tobacco products (p < .02). When SAV was added to the model as a moderator, the results showed a significant interaction, such that increasing the SAV for e-cigarettes was associated with greater use of that product (β = 0.27, SE = 0.07, p < .001). The same moderating effect was found for smokeless tobacco (β = 0.56, SE = 0.19, p = .004) but no moderating effect was observed for cigarettes or cigars. CONCLUSION: POS SAV has the potential to influence at-risk students’ use of alternative tobacco products and may be a contributing factor to recent nationwide shifts in youth tobacco use. IMPLICATIONS: Future studies should monitor changes in SAV to gain insight into POS marketing trends that may be impacting youth tobacco use. In addition, state and local governments should consider implementing policies that limit the volume and proportion of POS tobacco advertising for all nicotine and tobacco products available in retail environments near schools. Restrictions placed on a single product may cause unintended shifts in product selection rather than a reduction in youth tobacco use.

Despite increasing rates of cancer, biospecimen donations for cancer research remains low among Pacific Islanders (PIs). To address this disparity, researchers partnered with PI community organizations to develop and test a theory-based culturally tailored educational intervention designed to raise awareness about the issues surrounding biospecimen research. A total of 219 self-identified PI adults in Southern California were recruited to participate in a one-group pre-post design study. Participants completed questionnaires that assessed their knowledge and attitude regarding biospecimen research before and after viewing an educational video and receiving print materials. Results showed that participants' overall knowledge and attitude increased significantly from pre-test to post-test (p

BVA president James Russell tells Josh Loeb about his affinity for farming life, managing to live with dyslexia and the plans for his presidential year.

Background: There are currently no approved targeted therapies for KRAS-mutant non-small cell lung cancers (NSCLC), which represent 25-30% of lung adenocarcinomas. The development of mutant-specific covalent inhibitors of KRAS G12C has invigorated hope that clinically effective KRAS-targeted therapies are within reach. While these agents have shown activity in early phase clinical trials, identification of specific vulnerabilities conferred by common co-occurring mutations in KRAS-mutant NSCLC may enable development of combination therapies with enhanced activity in distinct subsets of patients. Results: We screened a panel of KRAS-mutant NSCLC cell lines and observed that loss of the tumor suppressor STK11/LKB1 is associated with increased MCL-1 dependence and sensitivity to combined MAPK (either MEK inhibitor or KRAS G12C inhibitor AMG 510) and MCL-1 inhibition (AMG 176). Restoration of LKB1 expression in LKB1-deficient cell lines and mouse xenograft tumors blunted the apoptotic response to MAPK + MCL-1 inhibition; conversely, deletion of LKB1 in LKB1 wild-type models restored the sensitivity. Mechanistically, LKB1 deficiency is associated with an altered phosphoproteome and increased MCL-1-dependent apoptotic priming. LKB1 loss increased cellular stress leading to hyperactivation of JNK1, phosphorylation and stabilization of MCL-1 protein, and increased BIM sequestration by MCL-1. Upon suppression of MAPK signaling, LKB1-deficient cells exhibited greater levels of BIM bound to MCL-1 that could be liberated by AMG 176 to induce apoptosis. Consistent with these results, ex vivo treatment of tumor tissue from a KRAS-LKB1 mutant NSCLC patient with MEK inhibitor or AMG 510 increased MCL-1 dependent priming. Conclusion: These results uncover a novel link between LKB1, cellular stress, and the regulation of MCL-1. LKB1 loss confers a dependency on MCL-1 that can be exploited therapeutically. Moreover, our study provides preclinical rationale for the exploration of combined KRAS G12C + MCL-1 inhibitors, particularly for KRAS-LKB1 mutant patients who respond poorly to standard-of-care checkpoint inhibitor therapy. Citation Format: Chendi Li, Yi Shen, Mohammed Usman Syed, Audris Oh, Cameron Fraser, Johannes Kreuzer, Kaitlyn Webster, Robert Morris, Sean Caenepeel, Anne Y. Saiki, Karen Rex, James Lipford, Wilhelm Hass, Kristopher Sarosiek, Paul E. Hughes, Aaron N. Hata. LKB1 loss rewires stress signaling-induced apoptotic protein dynamics and sensitizes KRAS-mutant non-small cell lung cancers to combined MAPK + MCL-1 blockade [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 982.

Purpose–This research project seeks to design,develop, and test the acceptabilityinnovative e-learning management system totransform traditional methodsinto Information Communication and Technology (ICT)based approach, to improvethe quality of education, enhance teachers’ teaching strategies,and to meet the demands of the 21stcentury teachers and learners as a result of the implementation oftheK to12 ICT integration in Araling Panlipunan(AP).Method–The researchers conducted a series of surveys and interviews with the ICT heads, AP department heads, master teachers,and districtsupervisor. Questionnaires and literature were also employed to gather relevant information vital to planning, designing and development of a prototype. The design of the system is responsive tomobile and another portable device. The system development was divided in four phases: requirement planning, user design, construction or development and cutover.The developers usedsoftware developmentlanguages,suchasHTML5 and PHP. The programmers employedMySQL database. In addition, other necessary softwarerequirements were also used like internet browser, Notepad++, Adobe Dreamweaver, TinyMCE and XAMPP. Alpha and Beta testing were used to minimize the errors experienced by respondents. The result of system testing was analyzed descriptively using frequency, rank,and weighted mean. Results–The system was tested and evaluated using the ISO 9126 Evaluation Model to determine the acceptance level of the proposed system. The overall acceptance rating in terms of functionality, reliability, usability, efficiency, maintainability and portability ishighly acceptable.It was a good indication that the developers met the necessary requirement of a learning management system by incorporating additional features.Conclusion–The goal of creating this alternativeapproach of teaching and evaluation process is to support teachers and students’ adaptation to e-learning and e-assessment.The study also achieved itsgoals to meet the demands of 21stcentury teachers and learners as a result ofthe implementation of K-12 curriculum through customized online-based responsive e-learning and e-assessment tool. These trends for Philippine education systems will empower the teachers and students to become more confident and competent in the use of technologies, shared resources,and collaborative learning.Recommendations–The system will bring new educational experiences to the young generationsofboth elementary teachers and students in particular to the DepEd-Division of Laguna. The system may be presented to theDepartment of Education for implementation as basis for creating e-learning tool not only for Araling Panlipunan but for all courses with more interactive and collaborative features in the system.Implications–The implementation of the said system is highly recommended to cope with the emerging trends of ICT in Education as a result of the implementation of the K to 12 programs.Furthermore, learning and assessment process can become more exciting and productive when ICT is being applied in public schools which can be a new student-centered assessment means to gauge learners and likewise recognize diverse learning styles.

Background: Pacific Islanders (PIs) have one of the highest rates of cigarette use, but evidence-based smoking cessation programs designed specifically for PIs are practically nonexistent. Objectives: This paper reports on the development of a culturally tailored smoking cessation curriculum designed specifically for young adult PIs using a community-based participatory research (CBPR) approach. This paper demonstrates the shared leadership and equal contribution of community and academic partnerships. Methods: Together community and academic partners conceptualized and developed a smoking cessation curriculum. Data from formative studies shaped the various components of the educational modules. Results: Eight educational modules were developed through CBPR. Information on the dangers of cigarettes, benefits to cessation, and ways to cope with cravings and stress through cognitive behavioral therapy were offered in both narrative and non-narrative formats. Conclusions: Use of CBPR is critical in the development of the curriculum because it allowed for the sharing of ideas and knowledge between academics and community members.

This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption.

Intangible assets are growing exponentially as a component of company value, but these assets are often unmanaged due to generally accepted accounting principles (GAAP), which provide no accountability. This research paper reaffirms and expands a proven alternative approach, which utilizes the CoreBrand Index® to measure, value, and manage intangible assets, and their financial impact on the corporation’s cash flow multiple.

Introduction Despite the high burden of tobacco-related diseases experienced by Samoans and Tongans, there is relatively little understanding of the factors that influence their smoking behaviors which could inform effective smoking cessation strategies. This study examined several psychosocial characteristics that intertwine to predict smoking patterns in these Pacific Islander subgroups. Methods Samoans and Tongans between the ages of 18 and 33, who consumed at least 100 cigarettes in their lifetime and were current smokers, were categorized as light, moderate, or heavy smokers. Baseline data from a randomized controlled smoking cessation trial were analyzed. Participants (n = 278) were measured on self-efficacy, perceived stress, sensation seeking, hostility, depression, and impulsivity. Least square means estimated from General Linear Models were used to compare psychosocial characteristics across smoking groups, as well as by gender and ethnicity. Results Samoan male heavy smokers reported higher levels of self-efficacy compared to light smokers, and greater stress, hostility, depression, and urgency over moderate smokers. Samoan female heavy smokers demonstrated greater stress and hostility than moderate and light smokers. Tongan female heavy and light smokers had significantly elevated levels of sensation seeking compared to moderate smokers. Tongan male smokers did not display any meaningful associations with these psychosocial constructs. Conclusions This study underscores the important distinctions between smoking patterns, gender, and ethnic subgroups. Interventions that rely on aggregated smoking profiles or general Pacific Islander data may not adequately address the complex array of mental health factors that contribute to tobacco use., Highlights • Heavy smokers had greater levels of stress, hostility, depression, and urgency compared to light or moderate smoking • Light smokers had the lowest level of self-efficacy • Female moderate smokers had the lowest level of sensation seeking • Male Tongan psychosocial characteristics did not vary across smoking patterns

Heparin-induced thrombocytopaenia (HIT) is a life and limb-threatening acquired autoimmune complication of heparin-based treatment, characterised by thrombocytopaenia and thrombosis. We present a case of a 77-year-old female with concomitant metastatic ovarian and breast cancer who presented to our institution with worsening shortness of breath. She had been diagnosed with acute pulmonary embolism 1 month earlier that was treated with therapeutic low molecular weight heparin (LMWH). In view of her worsening symptoms, CT imaging was performed. This demonstrated significant progression of the bilateral pulmonary emboli and new mural thrombosis of the thoracic aorta, despite being compliant with therapeutic anticoagulation. She had also developed thrombocytopaenia since commencing LMWH, which raised the clinical suspicion of HIT syndrome. The HIT pre-test probability score was intermediate and LMWH was immediately discontinued pending further investigation. She was commenced on rivaroxaban, a direct oral anticoagulant, and her platelet count soon recovered. Laboratory testing was strongly positive on both immunological and functional assays, thus confirming a diagnosis of HIT syndrome. A repeat CT scan 3 weeks later showed a reduction in the overall thrombus load. Whilst venous thrombosis is observed in as many as half of patients with HIT, arterial thrombosis is a far less common event. Furthermore, arterial involvement usually affects the distal vessels with significant atherosclerotic burden and typically presents as acute limb ischaemia or ischaemic stroke. Aortic thrombosis, as in this case, is a rare complication of HIT syndrome.

Universities around the world require project-based subjects and effective team allocation. Team allocation is a very time-consuming task in complex project-based coursework subjects. This gives rise to the need of automated team allocation software, which can help the subject coordinator quickly allocate students into optimal or sub-optimal teams based on a set of predetermined criteria. This paper details our team allocation software, which was developed in Java in 2012 for the project-based engineering projects and was actually implemented in two annual project-based subjects in the University of Wollongong in the years 2013 through 2017. The actual use of our developed team allocation software shows that this software is able to find, in a very short time, the solutions highly compliant to the team allocation criteria selected using a simple algorithm. Our developed software reduces significantly the time required to form student teams, compared to manual allocations.

Recent changes to NHS charging regulations undermine child health and represent an unprecedented departure from the founding principles of the NHS. Justified by the narrative of ‘health tourism’,1 NHS ‘overseas visitors’ charging regulations now restrict access to NHS care for undocumented migrants living in the UK. This includes an estimated 600 000 people, including 120 000 children, of whom 65 000 were born in the UK.2 Regulations include a charge of 150% of the NHS tariff for those unable to prove a regular status and sharing of personal data with the Home Office if debts are unpaid, effectively discouraging healthcare seeking with the threat of immigration enforcement. As such, the UK has abandoned universal health coverage, in conflict with the Sustainable Development Goals.3 We write this editorial in the context of growing concerns in the health community about the effects of these policies on child and public health, demonstrated most recently by a joint statement by the Royal College of Paediatrics and Child Health (RCPCH) and other medical colleges calling for suspension of this charging regime,4 as well as increasing recognition that ‘migration and global health are defining issues of our time’.5 ‘Undocumented’ (or ‘irregular’) refers to children lacking documentation proving a regular immigration status which, unless they are unaccompanied, is usually dependent on the status of, or applications made by, their parents.2 A child born in the UK to undocumented migrant parents may be considered an undocumented migrant, even without having ever left the UK. ‘Undocumented’ also includes unrecognised victims of trafficking and modern slavery, or children who have fled their countries of origin but are yet to seek—or have been refused—asylum. Recent changes to healthcare access have been implemented as part of the government’s ‘hostile environment’ policy for undocumented migrants living in the UK. The …

We are a mixture of volunteers and paid professionals who give our time to lead and support the veterinary professions, and we are extremely honoured to be able to do so. But we are increasingly concerned about the tone of some of the debates that are taking place in the veterinary world, particularly by the disparaging and demeaning language used against us or our colleagues. As leaders in the professions, representing various …

Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time. There was no significant difference in bile duct complications, graft survival or survival of the patient. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality. ispartof: NATURE vol:557 issue:7703 pages:50-+ ispartof: location:England status: published

This paper reflects my experiences developing a course within the Criminal Justice Technology Associates of Science degree program at Valencia College that fuses topics unique to peace and police studies. The key challenge in developing this course was in confronting the paradox of the police as instruments of both peace and conflict. In dealing with this paradox, students examine the role of the police in a democratic society and the authority of the police to use coercive force. Key topics covered in this course include defining peace, the police role in peace movements, the history, structure and strategies affecting the police, causes of violence, conflict analysis and conflict intervention, and ethical foundations for peace. In addition, this course examines occupational, organizational, institutional factors that contribute to the development of a unique police subculture that values crime fighting as its core responsibility and the impact of that orientation on police attitudes and behaviors toward...

Cricket is a sport in which hand injuries occur commonly, and yet the only players allowed to wear protective gloves are the batsman and wicketkeeper. This study aims to analyse the pattern of hand injuries occurring at the amateur level of the game. A prospective analysis was performed of all cricket hand injuries presenting to a specialist plastic surgery unit over the course of 3 months. Data was collected on the types, mechanisms and sites of injury, as well as their distribution amongst different playing positions. There were a total of 28 injuries, the majority of which were sustained whilst fielding (n = 22), with only five injuries occurring in batsmen or wicketkeepers. Twenty-three injuries were sustained by way of a direct blow or axial load to the fingers, with the ulnar digits and thumb most commonly affected. There were 20 fractures and eight dislocations, and 25 were associated with soft tissue injury. The distal phalanx was the most frequently injured site (n = 11), followed by the distal interphalangeal (DIP) joint. Most of the injuries were suitable for conservative management with only three patients requiring bony fixation. Only 15 of the 27 players stopped playing at the time of their injury, with significant delay to presentation to our unit in ten cases. Our survey highlights that hand injuries are common amongst amateur cricket players, and that a lack of protective gloves, improper catching technique and delay in seeking treatment may be important factors. Level of Evidence: Level IV, diagnostic study.

Heart diseases are one of the most common ailments that subtly kill its victim within seconds. The lack of knowledge about one's heart rate is one of the common reasons why it successfully penetrates the victim's heart at stealth. Portable monitoring device became a trend in the field of medicine for various benefits and ease for the user; it avoids the hassle in going to hospitals, coping up with check-up schedules, and paying huge amount of money just to have a close monitoring of one's heart activity. The portable heart rate monitoring device was created to give the patient the ease in monitoring their heart rate with the use of their smartphones, which are connected via live Bluetooth connection, using Bluetooth Shield 4.0. The monitoring sessions' output is accurately and reliably aligns with the heart rate monitoring devices used in hospitals, which are proven through a series of (1) accuracy test, (2])reliability test, and for the SMS feature, (3)the accuracy of SMS notification upon reaching the threshold, and (4) the Bluetooth range between the device and the smartphone. The sessions can be stored and retrieved from the memory of the smartphone itself. It can also be used to closely monitor the heart rate at a real time basis on a certain period of time. The device can be used within 10 m. radius away from the smartphone and can utilize the SMS notification feature using the regular load of the phone's SIM card.

This study examines the point-of-sale marketing practices used to promote electronic cigarettes at stores near schools that serve at-risk youth. One hundred stores selling tobacco products within a half mile of alternative high schools in Southern California were assessed for this study. Seventy percent of stores in the sample sold electronic cigarettes. Convenience stores heavily frequented by youth had the highest number of interior ads for e-cigarettes and were the most likely to employ in-store product placement strategies. Increased exposure to the promotion of these products at the point-of-sale poses a challenge for anti-smoking efforts directed toward vulnerable populations.

Triptans are a class of medication that act as serotonin agonists to abort migraines. While efficacious, they can rarely trigger vasospastic angina and ventricular tachyarrhythmias. A 61-year-old female was referred for stress testing after having several episodes of chest pain. She successfully

Syncope due to polymorphic ventricular tachycardia (PVT) in congenital long QT syndrome (LQTS) has many triggers including sudden sounds and sleep disturbances. A 64 year old female with LQTS on Atenolol presented as an out-of-hospital ventricular fibrillation arrest resuscitated with

Flecainide is a class 1C antiarrhythmic agent blocking sodium channels with use dependent prolongation of phase 0 in the fast response cardiac myocyte, a favorable property when managing supraventricular tachycardias (SVT) including atrial fibrillation (afib). While thought to be safe in a patient

Emission of neutrons in a given event is modeled by the DioramaEmitterNeutron object, a subclass of the abstract DioramaEmitterModule object. The GenerateEmission method of this object is the entry point for generation of a neutron population for a given event. Shown in table 1, this method requires a number of parameters to be defined in the event definition.

To examine the association between characteristics of Stargardt disease and visual acuity (VA), to estimate the longitudinal rate of VA loss, and to identify risk factors for VA loss.Retrospective, multicenter cohort study.A total of 176 patients (332 eyes) with molecularly and clinically confirmed Stargardt disease enrolled from the United States and Europe.Standardized data report forms were used to collect retrospective data on participants' characteristics and best-corrected or presenting VA from medical charts. Linear models with generalized estimating equations were used to estimate the cross-sectional associations, and linear mixed effects models were used to estimate the longitudinal VA loss.Yearly change in VA.The median duration of observation was 3.6 years. At baseline, older age of symptom onset was associated with better VA, and a longer duration of symptoms was associated with worse VA. Longitudinal analysis estimated an average of 0.3 lines loss (P0.0001) per year overall, but the rate varied according to baseline VA: (1) eyes with baseline VA ≥20/25 (N = 53) declined at a rate of approximately 1.0 line per year; (2) eyes with VA between 20/25 and 20/70 (N = 65) declined at a rate of approximately 0.9 lines per year; (3) eyes with VA between 20/70 and 20/200 (N = 163) declined at a rate of 0.2 lines per year; and (4) eyes with VA worse than 20/200 (n = 49) improved at a rate of 0.5 lines per year. Older age of onset was associated with slower VA loss: Patients with onset age30 years showed 0.4 lines slower change of VA per year (P = 0.01) compared with patients with onset age ≤14 years.Given the overall slow rate of VA loss, VA is unlikely to be a sensitive outcome measure for treatment trials of Stargardt disease. However, given the faster decline in younger patients and those with no or mild visual impairment, VA may be a potential outcome measure for trials targeting such subgroups of patients. These observations will need to be assessed in a prospective study bearing in mind the inherent limitations of retrospective datasets.

Background: Recent prevalence data indicates that Pacific Islanders living in the United States have disproportionately high smoking rates when compared to the general populace. However, little is known about the factors contributing to tobacco use in this at-risk population. Moreover, few studies have attempted to determine these factors utilizing technology-based assessment techniques. Objective: The objective was to develop a customized Internet-based Ecological Momentary Assessment (EMA) system capable of measuring cigarette use among Pacific Islanders in Southern California. This system integrated the ubiquity of text messaging, the ease of use associated with mobile phone apps, the enhanced functionality offered by Internet-based Cell phone-optimized Assessment Techniques (ICAT), and the high survey completion rates exhibited by EMA studies that used electronic diaries. These features were tested in a feasibility study designed to assess whether Pacific Islanders would respond to this method of measurement and whether the data gathered would lead to novel insights regarding the intrapersonal, social, and ecological factors associated with cigarette use. Methods: 20 young adult smokers in Southern California who self-identified as Pacific Islanders were recruited by 5 community-based organizations to take part in a 7-day EMA study. Participants selected six consecutive two-hour time blocks per day during which they would be willing to receive a text message linking them to an online survey formatted for Web-enabled mobile phones. Both automated reminders and community coaches were used to facilitate survey completion. Results: 720 surveys were completed from 840 survey time blocks, representing a completion rate of 86%. After adjusting for gender, age, and nicotine dependence, feeling happy (P=

Introduction: The majority of young patients presenting with advanced-stage Hodgkin lymphoma (HL) in the UK are managed with ABVD. However, from 2009, escalated BEACOPP (escBEACOPP) was introduced as a treatment option in certain UK cancer centres. Within the East of England Cancer Network (EECN), 6 hospitals introduced escBEACOPP as a treatment option, while 2 hospitals continued to use ABVD as standard first-line therapy for all patients. During this time period, recruitment to the RATHL (Response Adjusted Therapy for Hodgkin Lymphoma) trial was also a first-line treatment option across the UK and 4 of the EECN centres. Analysing data from all patients treated in the EECN centres and the RATHL trial has therefore enabled outcomes of patients treated with either escBEACOPP or ABVD within a non-trial setting to be compared to patients treated with ABVD in a clinical trial. Methods: We performed a retrospective multicentre analysis of patients treated for advanced-stage HL, aged 16-59 years, diagnosed between 2004-2014 in the EECN and compared outcomes with age and international prognostic score (IPS)-matched patients in the RATHL trial. Results: Over this 10-year period, 250 patients were diagnosed with advanced-stage HL in the EECN; 202 commenced treatment with ABVD (23 within RATHL), 44 escBEACOPP, 3 other regimens, and 1 died before treatment. Five-year progression-free survival (PFS) for all patients was 82% and overall survival (OS) was 93%. In RATHL, 1088 patients aged 18-59 years commenced treatment with ABVD, with 5-year PFS of 81% and OS of 95%. Within the EECN, there was a clinician-patient preference to treat higher-risk patients (IPS 3+) with more intensive therapy; a higher proportion of escBEACOPP patients were IPS 3+ (IPS 3+: escBEACOPP 75% vs. ABVD 39%, p ABVD-treated EECN patients had highly similar 5-year PFS and OS rates compared with age-matched RATHL patients (PFS 80% vs 81%; HR: 1.1 (95% CI: 0.8-1.5), p=0.60: OS 93% vs 95%; HR: 1.5 (95% CI: 0.8-2.7), p=0.21; Figure 1A-B). Despite being enriched with higher-risk patients, the 5-year PFS for all escBEACOPP-treated EECN patients was superior to ABVD in both the EECN and RATHL cohorts (PFS 95% vs 80% (EECN); HR 0.2 (95% CI: 0.1-0.9), p=0.04; Figure 1C; Table 1), but there was no significant OS advantage (5-year OS 97% vs. 93% (EECN); HR 0.4 (95% CI: 0.0-2.8), p=0.34; Figure 1D; Table 1). However, subgroup analysis of higher-risk (IPS 3+) patients found that escBEACOPP-treated EECN patients had both a 5-year PFS and OS advantage when compared with IPS 3+ ABVD-treated EECN patients (PFS 97% vs 74%; HR 0.1 (95% CI: 0.0-0.8), p=0.03; OS 100% vs 85%; p=0.03). However, when these higher-risk escBEACOPP patients were compared with IPS 3+ patients from RATHL, the significance of the OS advantage was lost (Table 1). Despite similar relapse/refractory rates for IPS 3+ ABVD-treated patients in the EECN and RATHL datasets, the OS for relapsed/refractory patients was inferior in the EECN. One explanation could be the time period over which the EECN data was collected, as the majority (7/9) of higher-risk ABVD-treated EECN patients who died from progressive disease died prior to 2011, when brentuximab vedotin was unavailable to treat relapsed HL in the UK. Conclusion: Our data support recently published European data showing that first-line HL patients treated in the non-trial setting achieve similar outcomes to those treated in contemporary clinical trials. Our data also reflect prospective trial results which show a first-remission PFS, but not OS, advantage for advanced-stage HL patients treated with escBEACOPP compared with ABVD, but suggest that higher-risk patients might benefit disproportionately from more intensive first-line therapy with escBEACOPP. However, improved access to more effective salvage treatments for relapsed/refractory patients may have diminished any OS benefit from the use of first-line escBEACOPP in higher-risk patients. Disclosures Follows: Abbvie: Other: advisory board and lecturing; Janssen: Other: advisory board and lecturing; Gilead: Other: advisory board and lecturing; Roche: Other: advisory board and lecturing.

Complex systems study, defined as an understanding of interrelationships between engineered, technical, and non-technical (e.g., social or environmental) systems, has been identified as a critical component of undergraduate engineering education. This paper assesses the extent to which complex systems study has been integrated into undergraduate mechanical engineering programs in the southeastern United States. Engineering administrators and faculty were surveyed and university websites associated with engineering education were examined. The results suggest engineering administrators and faculty believe that undergraduate engineering education remains focused on traditional engineering topics. However, the review of university websites indicates a significant level of activity in complex systems study integration at the university level, although less so at college and department levels.

Transplant recipients are at higher risk for a wide variety of severe infections, including skin and disseminated disease, due to immunosuppression. Fungal infections are especially common and can range from slight scale on the feet to life-threatening multisystem disease. Fungal infections in humans can be divided into three main groups based on tissue invasion and host characteristics: superficial cutaneous, subcutaneous, and opportunistic. Each has the potential to complicate the management of a renal transplant patient. A high index of suspicion is required to identify potential fungal infections in these patients. With proper awareness, the vast majority of fungal infections can be identified and successfully treated. This chapter primarily reviews the common fungal infections, their clinical characteristics, strategies for diagnosing fungal infections, and treatment of the more common infections. Other opportunistic infections are included for completeness but will not be covered in depth.

As a result of globalization, fossil fuels are being depleted at an alarming rate. Singapore, ranked 9th in the world as net importer of fuels [1], will have to find a more efficient way to utilize them. Over the years, Singapore has been switching its energy dependency on the cheaper natural gas [2]. However, its transportation still depends heavily of petroleum. One of the options to reduce the dependency is to switch to the electric vehicles (EV). However, the impacts and implications of introducing EV into Singapore to its energy distribution system is highly desired before actual deployment, which is very challenging primarily due to lacks of high quality data from real-life scenarios. In this paper, we propose to overcome this issue by using multi-agent system (MAS) based simulation technology to quantify the impacts of EV charging to the electricity system of Singapore.