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Leg ulcers in adults are a major public health concern. Their incidence increases with age and many causes have been identified, predominantly associated with vascular diseases. Leg ulcers in children and teenagers are less frequent. The aim of our study was to identify the causes of leg ulcers in children and teenagers, and to evaluate their management.This retrospective multicenter study was conducted by members of the Angio-dermatology Group of the French Society of Dermatology and of the French Society of Pediatric Dermatology. Data from children and teenagers (18 years), seen between 2008 and 2020 in 12 French hospitals for chronic leg ulcer (disease course4 weeks), were included.We included 27 patients, aged from 2.3 to 17.0 years. The most frequent causes of leg ulcer were: general diseases (n=9: pyoderma gangrenosum, dermatomyositis, interferonopathy, sickle cell disease, prolidase deficiency, scleroderma, Ehlers-Danlos syndrome), vasculopathies (n=8: hemangioma, capillary malformation, arteriovenous malformation), trauma (n=4: bedsores, pressure ulcers under plaster cast), infectious diseases (n=4: pyoderma, tuberculosis, Buruli ulcer) and neuropathies (n=2). Comorbidities (59.3%) and chronic treatments (18.5%) identified as risk factors for delayed healing were frequent. The average time to healing was 9.1 months.Leg ulcers are less frequent in children and teenagers than in adults and their causes differ from those in adults. Comorbidities associated with delayed healing must be identified and managed. Children and teenagers tend to heal faster than adults, but a multidisciplinary management approach is necessary.

Item does not contain fulltext BACKGROUND: Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. In a previous phase 2 induction study, etrolizumab significantly improved clinical remission versus placebo in patients with moderately to severely active ulcerative colitis. We aimed to compare the safety and efficacy of etrolizumab with infliximab in patients with moderately to severely active ulcerative colitis. METHODS: We conducted a randomised, double-blind, double-dummy, parallel-group, phase 3 study (GARDENIA) across 114 treatment centres worldwide. We included adults (age 18-80 years) with moderately to severely active ulcerative colitis (Mayo Clinic total score [MCS] of 6-12 with an endoscopic subscore of ≥2, a rectal bleeding subscore of ≥1, and a stool frequency subscore of ≥1) who were naive to tumour necrosis factor inhibitors. Patients were required to have had an established diagnosis of ulcerative colitis for at least 3 months, corroborated by both clinical and endoscopic evidence, and evidence of disease extending at least 20 cm from the anal verge. Participants were randomly assigned (1:1) to receive subcutaneous etrolizumab 105 mg once every 4 weeks or intravenous infliximab 5 mg/kg at 0, 2, and 6 weeks and every 8 weeks thereafter for 52 weeks. Randomisation was stratified by baseline concomitant treatment with corticosteroids, concomitant treatment with immunosuppressants, and baseline disease activity. All participants and study site personnel were masked to treatment assignment. The primary endpoint was the proportion of patients who had both clinical response at week 10 (MCS ≥3-point decrease and ≥30% reduction from baseline, plus ≥1-point decrease in rectal bleeding subscore or absolute rectal bleeding score of 0 or 1) and clinical remission at week 54 (MCS ≤2, with individual subscores ≤1); efficacy was analysed using a modified intention-to-treat population (all randomised patients who received at least one dose of study drug). GARDENIA was designed to show superiority of etrolizumab over infliximab for the primary endpoint. This trial is registered with ClinicalTrials.gov, NCT02136069, and is now closed to recruitment. FINDINGS: Between Dec 24, 2014, and June 23, 2020, 730 patients were screened for eligibility and 397 were enrolled and randomly assigned to etrolizumab (n=199) or infliximab (n=198). 95 (48%) patients in the etrolizumab group and 103 (52%) in the infliximab group completed the study through week 54. At week 54, 37 (18·6%) of 199 patients in the etrolizumab group and 39 (19·7%) of 198 in the infliximab group met the primary endpoint (adjusted treatment difference -0·9% [95% CI -8·7 to 6·8]; p=0·81). The number of patients reporting one or more adverse events was similar between treatment groups (154 [77%] of 199 in the etrolizumab group and 151 [76%] of 198 in the infliximab group); the most common adverse event in both groups was ulcerative colitis (55 [28%] patients in the etrolizumab group and 43 [22%] in the infliximab group). More patients in the etrolizumab group reported serious adverse events (including serious infections) than did those in the infliximab group (32 [16%] vs 20 [10%]); the most common serious adverse event was ulcerative colitis (12 [6%] and 11 [6%]). There was one death during follow-up, in the infliximab group due to a pulmonary embolism, which was not considered to be related to study treatment. INTERPRETATION: To our knowledge, this trial is the first phase 3 maintenance study in moderately to severely active ulcerative colitis to use infliximab as an active comparator. Although the study did not show statistical superiority for the primary endpoint, etrolizumab performed similarly to infliximab from a clinical viewpoint. FUNDING: F Hoffmann-La Roche.

Scientific communities confer many forms of credit --- both implicit and explicit --- on their successful members, and it has long been argued that the motivation provided by these forms of credit helps to shape a community's collective attention toward different lines of research. The allocation of scientific credit, however, has also been the focus of long-documented pathologies: certain research questions are said to command too much credit, at the expense of other equally important questions; and certain researchers (in a version of Robert Merton's Matthew Effect) seem to receive a disproportionate share of the credit, even when the contributions of others are similar.Here we show that the presence of each of these pathologies can in fact increase the collective productivity of a community. We consider a model for the allocation of credit, in which individuals can choose among projects of varying levels of importance and difficulty, and they compete to receive credit with others who choose the same project. Under the most natural mechanism for allocating credit, in which it is divided among those who succeed at a project in proportion to the project's importance, the resulting selection of projects by self-interested, credit-maximizing individuals will in general be socially sub-optimal. However, we show that there exist ways of allocating credit out of proportion to the true importance of the projects, as well as mechanisms that assign credit out of proportion to the relative contributions of the individuals, that lead credit-maximizing individuals to collectively achieve social optimality. These results therefore suggest how well-known forms of misallocation of scientific credit can in fact serve to channel self-interested behavior into socially optimal outcomes.

OBJECTIVES Out-of-hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG. METHODS We conducted a multicenter retrospective cohort study among eight regional hospitals. Adult patients who experienced atraumatic OHCA with successful initial resuscitation and subsequent CAG between January 2015 and December 2019 were included. We collected data on prehospital documentation of potential ACS symptoms prior to OHCA as well as clinical factors readily available during postarrest care. The primary outcome in multivariable regression modeling was the presence of significant coronary lesions (defined as >50% stenosis of left main or >75% stenosis of other coronary arteries). RESULTS Four-hundred patients were included. Median (interquartile range) age was 59 (51-69) years; 31% were female. At least one significant stenosis was found in 62%, of whom 71% received PCI. Clinical factors independently associated with a significant lesion included a history of myocardial infarction (adjusted odds ratio [aOR] = 6.5, [95% confidence interval {CI} = 1.3 to 32.4], p = 0.02), prearrest chest discomfort (aOR = 4.8 [95% CI = 2.1 to 11.8], p ≤ 0.001), ST-segment elevations (aOR = 3.2 [95% CI = 1.7 to 6.3], p

Effective school-parent partnerships are in the child’s best interests. Nevertheless, the complexity of the parent-teacher relationship requires the teachers to be trained in parent communication s...

Objective This study aimed to develop predictive models of three aspects of psychotherapists' acceptance of telepsychotherapy (TPT) during the COVID-19 pandemic; attitudes towards TPT technology, concerns about using TPT technology and intention to use TPT technology in the future. Method Therapists (N = 795) responded to a survey about their TPT experiences during the pandemic, including quality of the therapeutic relationship, professional self-doubt, vicarious trauma, and TPT acceptance. Regression decision trees machine learning analyses were used to build prediction models for each of three aspects of TPT acceptance in a training subset of the data, and subsequently tested in the remaining subset of the total sample. Results Attitudes toward TPT were most positive for therapists who reported a neutral or strong online working alliance with their patients, especially if they experienced little professional self-doubt and were younger than 40 years old. Therapists who were most concerned about TPT, were those who reported higher levels of professional self-doubt, particularly if they also reported vicarious trauma experiences. Therapists who reported low working alliance with their patients were least likely to use TPT in the future. Performance metrics for the decision trees indicated that these three models held up well in an out-of-sample dataset. Conclusions Therapists' professional self-doubt and the quality of their working alliance with their online patients appear to be the most pertinent factors associated with therapists' acceptance of TPT technology during COVID-19, and should be addressed in future training and research.

The issue of cancer of the stump of a previously resected stomach is insufficiently covered in the literature, and operations on this matter are performed very rarely. So, according to A. V. Melnikov (1960), out of 22 operations performed by domestic surgeons in this regard, there were 18 extirpations of the stump. The nature of the 4 operations is not specified.

Over the past several years, family accommodation (FA) has gained increasing recognition for its role in child and adolescent anxiety disorders. Recent clinical trials highlight the importance of assessing and addressing FA within the context of treatment, with findings showing that FA is a significant predictor of treatment success. This clinical update was prompted by such findings, and specifically findings from a study by Zilcha-Mano and colleagues (2020) which suggest that the level of agreement between child- and parent-reports of FA has differential effects on outcomes for child- and parent-based treatments. In this article we aim to provide (1) a brief overview of the research pointing to the reduction of FA as a critical ingredient of youth anxiety treatment, and (2) a summary and in-depth discussion of the study by Zilcha-Mano et al. (2020) that speaks to the potential importance of leveraging multi-informant reports of FA. With regard to the latter aim, we offer preliminary suggestions for how clinicians might incorporate measures of FA into their practice to maximize benefits for anxious youth and their families. We also offer suggestions for how future research can build on these novel findings, advance methods of FA assessment, and promote its clinical utility.

Coronavirus disease 2019 (COVID-19) has affected tens of millions of people globally since it was declared a pandemic by the World Health Organization on 11 March 2020. Since its outbreak in December 2019, the ongoing coronavirus COVID-19 pandemic has led to global social, economic and healthcare crises affecting millions of people and causing the death of hundreds of thousands of people worldwide. As with other fields of healthcare, the pandemic with its heavy workload imposed on hospital services and personnel significantly affected solid organ transplantation. Concerns for potential exposure to the virus and its related severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) have profoundly altered the process of organ donation and recovery, acceptance of organ offers, management of potential recipients and living donors, and above all transplanted and immunosuppressed patients. All those issues required prompt implementation of new practice measures and guidelines as well as continuous adaptations to the fluid and rapidly changing situation. Herein we describe a single transplant center experience with kidney transplantation during the COVID-19 pandemic; we review the national and institutional measures and restrictions undertaken in different phases of the ongoing event as well as the outcomes.

Study Design This is an intrasubject cross-sectional study. Introduction Upper limb injuries often require wearing an orthosis. Today, orthoses are custom-made by the clinician or purchased as an off-shelf product. Although 3D printing is a popular solution, the design and adjustment of an orthosis model according to patient-specific anatomy requires technical expertise, often unavailable to the clinicians. Purpose of the Study The purposes of this study were (a) to create software that receives input of anatomic dimensions of the finger and automatically adjusts an orthosis model for patient-specific 3D printing and (b) to compare preparation time, product weight, and user satisfaction of occupational therapy students between the manual method and the automatic 3D printing method. Methods A custom code allows the user to measure five anatomic measurements of the finger. The code adjusts a swan-neck orthosis model according to the patient-specific measurements and a fitted resized 3D-printable file is produced. We recruited 36 occupational therapy students (age 25.4±1.9 years). They prepared two swan-neck orthoses for a finger of a rubber mannequin: one manually using a thermoplastic material and the other by 3D printing. The preparation time and orthosis weight were measured and the subjects filled out a user satisfaction questionnaire. Results The weight of the 3D-printed orthosis was significantly lower than that of the manual orthosis; however, the preparation time was longer. The subjects were more satisfied with the fit, esthetics, overall process, and product of the 3D-printed orthosis. Conclusion The creation of automated software for the patient-specific adjustment of orthoses for 3D printing can be the missing link for integration of 3D printing in the clinics.

To describe the use of wall painting as part of an intervention to control an outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB).An interrupted time-series analysis was performed analyzing an intervention in a neurosurgical intensive care unit (NSICU) and an inpatient hematology department in a tertiary level medical center in Israel. The intervention involved wall painting using a water based acrylic paint following patient discharge and terminal cleaning with sodium troclosene as part of an infection control bundle for an outbreak of CRAB in a NSICU and concurrent outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) colonization/infection in the same NSICU and the hematology department.Between January 2013 and December 2018, 122 patients hospitalized in the NSICU were identified with new CRAB colonization/infection. The median incidence in the periods prior to/post intervention were 2.24/1000 HD (interquartile range [IQR] 0.84-2.90/1000) vs. 0/1000 HD (IQR 0-0.49/1000), respectively. Poisson regression indicated a decrease of 92% in the CRAB incidence following the intervention onset (relative risk [RR] 0.080, 95% confidence interval [CI] 0.037-0.174, p 0.001). Forty-seven patients in the NSICU and 110 in the hematology department were colonized/infected with CRE in the same time period; a significant change was not observed following the start of the intervention in either department (for NSICU RR 1.236, 95% CI 0.370-4.125, p = 0.731; for hematology RR 0.658, 95% CI 0.314-1.378, p = 0.267).A. baumannii is able to survive on environmental surfaces despite decontamination efforts; wall-painting as part of a bundle may be a successful infection control measure.

AIM To examine the effect of a once-a-week group physiotherapy session in addition to a once-a-month individual physiotherapy treatment, in comparison to a monthly individual physiotherapy treatment. METHODS Fifty children and adolescents aged 10-18 years with poor back posture, some of whom had LBP, met individually with a physiotherapist once a month. The intervention group received an additional once-a-week group physiotherapy session for 12 weeks. Thorax curve angle, postural behavior, and low back pain (LBP) were measured before and after intervention. RESULTS The thorax curve angle decreased from 39.2 ± 9.3 to 28.2 ± 6.8 (p

Objective To describe the successful placement of an aortic stent graft in a dog suffering from aortic aneurysm and rupture. Case summary A 4-year-old neutered female mixed breed dog weighing 25 kg was presented with a chief complaint of acute onset of weakness and respiratory distress. On presentation, the dog was lateral and unresponsive, hypothermic, tachycardic, and tachypneic. Pleural effusion was identified in the right hemi-thorax on thoracic-focused sonographic scan for trauma. Thoracic radiographs showed a fluid/soft tissue opacity in the cranial mediastinum and pleural effusion on the right side. Thoracocentesis yielded noncoagulating blood. Hematology revealed normal PCV and total plasma protein that decreased within 24 hours to 20% and 50 g/L (20%/5.0 g/dL), respectively. The dog was treated with IV fluids, tranexamic acid, and fresh frozen plasma. An aortic aneurysm with irregular mineralization of the right ventrolateral aortic wall was identified on computed tomography examination, which also demonstrated a peri-aortic hematoma. A decision was made to attempt treatment with a stent graft. Under general anesthesia, a marker catheter was inserted into the esophagus. A 10-Fr sheath was inserted into the right femoral artery, and an angiography catheter was advanced over a wire. After angiography, a stent graft (12-mm × 50-mm) was placed over the guide wire and deployed under fluoroscopic guidance. The dog recovered uneventfully, with no evidence of recurrent bleeding, and was discharged 2 days after the procedure with antimicrobials, anthelmintic, and antithrombotic treatment. At 90-day follow-up, the dog was doing well, and stent position was radiographically confirmed. New or unique information provided This report describes successful management of aortic aneurysm and dissection, an uncommon and challenging pathology in the veterinary practice with few available treatment options. Stent graft placement is a minimally invasive procedure in which a covered stent is placed over the lesion to prevent rupture.

Laborious fruit thinning is required for attaining high-quality Medjoul dates. Thinning automation can significantly reduce labor and improve efficiency. An image processing apparatus developed for robotic Medjoul thinning is presented. Instance segmentation based on Mask R-CNN was applied to identify the fruit bunch components: spikelets and rachis. Motion planning parameters were extracted using the derived masks: rachis center point (RCP), rachis orientation angle, and spikelets remaining length. RCP and rachis orientation angle were computed geometrically, spikelets remaining length was estimated with a convolutional neural network (CNN) and a deep neural network (DNN). Instance segmentation results were accurate, especially for spikelets, for low intersection over union (IoU) (0.3 IoU, fruit determined for thinning identification, spikelets: 98%, rachises: 73%). However, only 66% of the rachises were correctly matched to spikelets. The segmentation of all spikelets and rachises in the images was of medium quality for low IoU (0.3 IoU, F1, spikelets: 0.67, rachis: 0.77), where both precision and recall dropped for higher IoUs. RCP and rachis orientation angle were accurately estimated (0.3 IoU, error, RCP: 2.2 cm, rachis orientation angle: 5.0°). Spikelets remaining length estimation using CNN resulted in better performance than DNN (0.3 IoU, error, CNN: 19.7%, DNN: 24.6%). Spikelets segmentation results are suitable for thinning automation. However, rachis segmentation and matching the rachis and spikelets may still require human intervention during run-time. RCP and rachis orientation angle estimation errors are acceptable, while spikelets remaining length estimation errors are acceptable only for preliminary motion planning and mandate additional tuning during motion execution.

Low levels of brain derived-neurotrophic factor (BDNF) and excessive screen exposure are risk factors for neurocognitive deficits and obesity in youth, but the relationship between screen time and BDNF remains unknown. This study examined whether duration and/or type of sedentary screen time behaviour (TV viewing, video games, recreational computer use) are associated with serum BDNF levels in youth with obesity. The sample consisted of 250 inactive, postpubertal adolescents with obesity (172 females/78 males, aged 15.5 ± 1.4 years) at the baseline assessment of the Healthy Eating, Aerobic, Resistance Training in Youth Study. After controlling for self-reported age, sex, race, parental education, puberty stage, physical activity, and diet, higher total screen exposure was significantly associated with lower serum BDNF levels (β = −0.21, p = 0.002). TV viewing was the only type of screen behaviour that was associated with BDNF levels (β = −0.22, p = 0.001). Higher exposure to traditional forms of screen time was independently associated with lower serum BDNF levels, and this association appears to be driven primarily by TV viewing. Future intervention research is needed to determine whether limiting screen time is an effective way to increase BDNF and associated health benefits in a high-risk population of youth with obesity. Trial Registration: ClinicalTrials.Gov NCT00195858. Novelty: This study is the first to show that recreational screen time is inversely associated with serum BDNF levels. The inverse association between screen time and BDNF is driven primarily by TV viewing, indicating the type of screen might matter.

Much of the research on the changing landscape of internet pornography (Porn 2.0) has neglected the societal implications of the distribution and consumption of pornography within homosocial male-o...

PurposeThe complex processes of global organizations poses significant challenges for the global quality management systems (QMSs) responsible for their coordination and effective management. This includes meeting local customers' needs, as well as being responsible for global operational effectiveness, aggregate capacity utilization, cost reduction and standardization. This study examines how all of these ends can be accomplished. Regulating local and global needs emerges as a key issue, but one that lacks clarity. Therefore, this article outlines an approach for developing a coherent, strategic approach.Design/methodology/approachA field study of eighteen multinational companies (MNCs) examined and mapped the activity of their QMS, defined representative profiles and compared these profiles to strategic, operational and marketing needs.FindingsThe data analysis shows several gaps in the approach to global quality management. The lack of coherence and considerable vagueness in addressing inter-organizational processes leads to behavior that fluctuates between absolute autonomy and specific initiatives aimed at reaching the necessary level of integration needed to achieve operational effectiveness.Originality/valueThe innovative mapping process and analysis of the current study provide a tool for differentiating between the local and global needs of MNCs' quality systems, identifying gaps and defining activities aimed at regulating responses while increasing global added value from the QMS. This provides deeper insight into the business needs of global and local QMSs to enhance the value derived from coordination and regulation.

Aim. To improve the results of the surgical component in the treatment of a nodular form of breast cancer with lateral and central localization by analyzing hemoglobin oxygen saturation of arterial blood in the foci of breast cancer, regional lymph nodes and resection line of the breast. Methods. The study involved 175 patients with a nodular form of breast cancer with lateral and central localization (T23N12M0), including 86 in the main group and 89 in the comparison group. In the main group, hemoglobin oxygen saturation in arterial blood of the foci of breast cancer, parenchyma, pectoral muscles and regional lymph nodes was examined for spread of cancer during surgery for nodular breast cancer by using a device developed by us (patent RU 2581266). This examination was not performed in the comparison group. Histopathological examination of resection specimens revealed confirmation of the main foci of breast cancer and the presence of metastases in the regional lymph nodes and pectoral muscles of the breast. Statistical analysis of the data was performed by using the Statistica 10 software. The arithmetic mean, the standard error of the mean and the standard deviation were calculated for the quantitative indicators. Results. In the main group, 86 patients had no recurrence and metastases in the follow-up, while in the comparison group, cancer recurrence was identified in 89 patients and metastases was found during cytological and histological studies in 9 patients. Conclusion. Determination of hemoglobin oxygen saturation of arterial blood during surgery in the subclavian, axillary and subscapular lymph nodes as well as in the pectoralis major and minor muscles allows clarifying the distribution of breast cancer, specifying the scope of the operation and improving the results of the surgical component of breast cancer treatment (T23N12M0).

BACKGROUND AND PURPOSE Falls are a major health concern after stroke. Spatial and temporal gait asymmetry and variability can contribute to instability and increased fall risk in persons with stroke (PwS). We aimed to quantify gait spatiotemporal symmetry and variability parameters in PwS undergoing rehabilitation in the subacute stage of the disease, by comparison to healthy participants, and to examine the associations between these parameters and patients' reactive and proactive balance capacity. METHODS Twenty-two PwS and 12 healthy adults walked over a computerized treadmill system at their self-selected walking speed. Symmetry and variability of gait parameters (step length, swing time, and stance time) as well as upper extremity and lower extremity angular range of motion in the sagittal plane were extracted. In addition, the Berg Balance Scale (BBS) and the fall threshold in response to sudden surface translations at increasing intensities were assessed. RESULTS PwS demonstrated significantly higher asymmetry in all gait parameters in comparison to controls. Also, PwS demonstrated increased stance time variability in comparison to healthy controls and increased swing time variability in the paretic lower extremity. Significant negative associations were found between fall threshold and stance time asymmetry in PwS (r = -0.48, P = 0.022), between the BBS and swing time asymmetry (r = -0.50, P = 0.018), and between the BBS and stance time variability of the paretic lower extremity (r = -0.56, P = 0.006). DISCUSSION AND CONCLUSIONS Findings highlight the importance of gait temporal symmetry and variability measures for dynamic balance control after stroke. These parameters should be considered when assessing gait recovery and safety in PwS.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A355).