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Objective: To investigate the oncological safety and potential cost savings of selective histopathological examination after appendectomy. Background: The necessity of routine histopathological examination after appendectomy has been questioned, but prospective studies investigating the safety of a selective policy are lacking. Methods: In this multicenter, prospective, cross-sectional study, inspection and palpation of the (meso)appendix was performed by the surgeon in patients with suspected appendicitis. The surgeon's opinion on additional value of histopathological examination was reported before sending all specimens to the pathologist. Main outcomes were the number of hypothetically missed appendiceal neoplasms with clinical consequences benefiting the patient (upper limit two-sided 95% confidence interval below 3:1000 considered oncologically safe) and potential cost savings after selective histopathological examination. Results: Seven thousand three hundred thirty-nine patients were included. After a selective policy, 4966/7339 (67.7%) specimens would have been refrained from histopathological examination. Appendiceal neoplasms with clinical consequences would have been missed in 22/4966 patients. In 5/22, residual disease was completely resected during additional surgery. Hence, an appendiceal neoplasm with clinical consequences benefiting the patient would have been missed in 1.01:1000 patients (upper limit 95% confidence interval 1.61:1000). In contrast, twice as many patients (10/22) would not have been exposed to potential harm due to re-resections without clear benefit, whereas consequences were neither beneficial nor harmful in the remaining seven. Estimated cost savings established by replacing routine for selective histopathological examination were 725,400 per 10,000 patients. Conclusions: Selective histopathological examination after appendectomy for suspected appendicitis is oncologically safe and will likely result in a reduction of pathologists' workload, less costs, and fewer re-resections without clear benefit.

Background Pneumomediastium is a rare complication of pregnancy or labor. Methods Here, we report our findings in a case report (gravid 5, para 2, gestational age 33 + 4 weeks) and narratively review the current literature on pneumomediastinum in pregnancy or labor. Results Our case is the first case that experienced pneumomediastinum after relatively limited exposure to barotrauma in the current pregnancy. Other reports describe pneumomediastinum after hyperemesis gravidarum or during labor. Treatment is usually conservatively due to the trauma mechanism of barotrauma to the alveoli. Conclusion Physicians should be aware of the possibility of pneumomediastinum in pregnant women with acute thoracic pain in cases of (previous) hyperemesis gravidarum or during labor.

1422 Purpose: Amyloid-beta imaging with 11C-PiB shows a robust increase in cortical binding in Alzheimer’s Disease (AD). Standardized uptake value ratio (SUVR) and distribution volume ratio (DVR) were shown to be effective quantitative measures in discriminating healthy and AD subjects (Klunk et al., 2004; Lopresti et al., 2005). However, these measures typically require long wait/scan time and optimal selection of the reference region. The aim of this study is to propose a novel measure, which could have superior diagnostic performance than conventional SUVR and DVR measures and less complicate workflow. Methods: We used 11C-PiB datasets that are publicly available from OASIS project (LaMontagne et al., 2019). A total number of 50 dynamic scans (0 to 60 mins, 24×5 sec; 9×20 sec; 10×1 min; 9×5 min) were included in this study, of which 25 are from AD and 25 are from healthy control (HC) subjects. For each subject, T1-weighted structural MRI was performed. The normalization process was performed with Statistical Parametric Mapping (SPM12). For all subjects, we first quantified standardized uptake value ratio (SUVR, 50-60 mins) and distribution volume ratio (DVR, T*=30 min) in posterior and anterior cingulate regions, which are known to be effective in AD staging (Lopresti et al., 2005). Reference region was selected as cerebellum cortex. We then defined a new measure, Peak-Clearance-Rate (PCR) which calculated the uptake decay rate at the early stage of the scan, which only requires the first 20-min scan. PCR was measured in posterior and anterior cingulate, by computing the ratio between the uptake at 20 mins and the uptake at the peak in those regions. The assumption is that a healthy subject typically has a faster drug clearance rate in certain brain regions than an AD subject has, and such trend is in accordance with the early tracer dynamics (Figure 1). Results: Kruskal-Wallis tests suggest that the new measure PCR, SUVR and DVR can all differentiate the HC and AD subjects (p

In this paper, we consider a real-life medical student scheduling problem in order to ensure students are able to complete the relevant training program to acquire the postulated medical proficiency. A training program includes mandatory and elective disciplines that students are able to select based on their interests and availability. These internship positions are offered by local hospitals that specify minimum and maximum staffing requirements. The curriculum manager tries to assign students to particular disciplines and hospitals while considering the objectives and the large number of requirements of different stakeholders, i.e. the educational requirements set by the medical school, the staffing requirements set by the involved hospitals and the student characteristics. We propose a heuristic solution methodology composed of a constructive heuristic and two local search heuristics to improve the initial solution. These heuristics embody different complementary neighbourhood structures derived based on the decomposition of the problem in order to find high-quality solutions very efficiently. In order to show the stable performance of the proposed solution methodology, we conducted computational experiments on a comprehensive synthetic dataset of smaller-sized instances and large-scale real-life instances. Results demonstrate that our approach can produce (near-)optimal solutions in a very short timespan. A comparison is made with the real-life approach, demonstrating significant improvements and the contribution to real-life decision-making.

Esophageal perforation after endoscopic ultrasound-guided fine-needle aspiration for mediastinal staging is a rare but severe complication. We report 2 cases of patients with esophageal perforation who were treated using video-assisted thoracoscopic surgery in combination with esophageal stenting. Through these cases, the feasibility of minimally invasive thoracic surgery was evaluated.

Nuclear imaging is used in the evaluation of painful arthroplasties for diagnosing loosening or periprosthetic joint infection (PJI). The purpose of this systematic review is to depict the reproducibility of the various nuclear imaging modalities used in the assessment of painful hip and knee arthroplasties. A systematic review of the literature was conducted with a comprehensive search of MEDLINE to identify clinical studies investigating the intra-and inter-observer agreement of nuclear imaging modalities in diagnosing PJI and mechanical loosening. A total of 3.000 studies, published between 2004 and 2020, were reviewed and 16 studies met the inclusion criteria. Quality assessment identified concerns with regard to the internal validity in approximately 40% of the included studies. A meta-analysis could not be performed because of insufficient available clinical data. The intra-observer agreement was poorly investigated. The included studies reported an inter-observer agreement of “slight” to “excellent” for bone scintigraphy, “moderate” to “substantial” for leukocyte scintigraphy, “substantial” to “almost perfect” for combined leukocyte and bone marrow scintigraphy, and “fair” to “substantial” for anti-granulocyte scintigraphy. Hybrid imaging with SPECT/CT and FDG-PET/CT demonstrated “substantial” and “almost perfect” inter-observer agreement for symptomatic hip prostheses, respectively. The reproducibility of nuclear imaging is underreported in clinical studies investigating painful knee and hip arthroplasties. Moreover, the included studies demonstrated methodological concerns with a high risk of bias. The available evidence demonstrated a wide range of inter-observer agreement using scintigraphy. Hybrid imaging with SPECT/CT and FDG-PET/CT may improve the accuracy of interpretation and reproducibility. However, literature provides limited data to support this assumption.

PSMA PET is increasingly used for localising biochemical recurrent prostate cancer (BCR) and is incorporated in European and national guidelines. Nevertheless, clinical implications of PSMA PET need to be clarified. In this report, the available literature on the clinical impact of PSMA PET in patients with BCR is reviewed. A comprehensive literature search was performed using the MEDLINE® database. All studies reporting data on PSMA PET directed patient management were considered relevant. In the review, 16 studies were included. Change of management was 45% for the pooled data (861/1899 patients), of which 50% changed from non-targeted to targeted approach. Change from targeted to non-targeted approaches was found in 17% of patients. High heterogeneity was found between presently available studies. It can be concluded that PSMA PET induces change of management in almost half of the patients with BCR. After PSMA PET more patients are selected for metastasis targeted therapies. Potential beneficial effects of metastasis directed therapies require further evaluation.

Prostate-specific membrane antigen (PSMA) PET/CT shows better diagnostic performance for detection of lymph node and bone metastases as compared to conventional imaging. Studies of PSMA PET/CT in primary staging comprise highly selected patient cohorts. This study evaluates 18F-DCFPyL PET/CT as first-line imaging modality for primary staging of high-risk prostate cancer. From February 2018 until April 2019, all patients with high-risk prostate cancer received 18F-DCFPyL PET/CT for staging of prostate cancer. Baseline characteristics, findings at 18F-DCFPyL PET/CT, number and type of required additional diagnostic procedures, findings at additional diagnostic procedures, and effects of therapy on PSA levels for all patients treated with curative intent were collected and evaluated. One hundred-sixty patients were included in the study of which 90 (56%) had evidence of metastasized disease (N1, M1a, M1b and, M1c in 49%, 28%, 31%, and 3% respectively). Additional diagnostic imaging was needed in 2/160 patients (1%) because of equivocal findings on 18F-DCFPyL PET/CT. Eighty-one patients had evidence of PSMA-positive lymph node metastases, of whom 39 (48%) had no enlarged lymph nodes on CT; 18F-DCFPyL PET detected additional metastatic lymph nodes in 41/42 patients that had evidence of lymph node metastases on CT. 18F-DCFPyL PET altered patients’ management in 17% of patients. 18F-DCFPyL PET/CT can be used as first-line imaging modality for therapy selection in patients with primary high-risk prostate cancer, without need for further diagnostic imaging procedures in the majority of patients.

Objective In the past few years,F-18-fluorocholine PET/CT has been established as a promising imaging technique for preoperative localization of parathyroid adenomas, but the optimal time point to start PET/CT acquisition after tracer injection is yet unknown. The aim of the present study was to assess the optimal time frame to acquire the PET/CT images and to evaluate the ability of dynamic imaging to differentiate parathyroid adenomas from active lymph nodes, a common cause for false-positive scan results. Patients and methods Patients with primary hyperparathyroidism who had undergone a dynamic(18)F-fluorocholine PET/CT positive for parathyroid disease and who subsequently underwent successful parathyroidectomy were retrospectively included in this study. On the 20 minutes dynamic images, standardized uptake value measurements were acquired per 1 minute frame for the parathyroid adenoma, the thyroid gland, blood pool activity, and, if present, lymph node activity. Results A total of 101 patients were included in this study. Time-activity curves showed a decrease of activity in parathyroid and thyroid glands, with faster wash-out from the thyroid gland and on average a stable, lower activity in lymph nodes. Blood pool activity was particularly present in the first 2 minutes. Differentiation of a parathyroid adenoma from active lymph nodes was best before 5 minutes, but no definitive cutoff value could be determined. Differentiation of a parathyroid adenoma from the thyroid gland was best after 10 minutes. Conclusion Dynamic imaging starting at the early time point of 2 minutes after injection of(18)F-fluorocholine is useful for characterization of hyperfunctioning parathyroid glands.

AIM Evaluation of major adverse cardiovascular events (MACE) in women referred for NH3-PET/CT in relation to scan outcome and pharmacological stress ECG (PxECG) results. PATIENTS AND METHODS Six hundred twenty-four women, referred for NH3-PET/CT between 2012 and 2016, were included. Demographic data and MACE during follow-up (407 ± 207 days) were retrieved from electronic patient charts. NH3-PET/CT was scored as either normal or abnormal. PxECG was scored as negative, non-diagnostic or positive. PxECG was compared with NH3-PET/CT and related to MACE. RESULTS The NH3-PET/CT was normal in 482/624 (77%) and abnormal in 142/624 (23%). PxECG was negative in 234/624 (38%), non-diagnostic in 365/624 (58%) and positive in 25/624 (4%). NH3-PET/CT was normal in 87, 71 and 72% with normal, nondiagnostic and positive PxECG, respectively. 41/624(7%) experienced a MACE, 38 with abnormal NH3-PET/CT versus three with normal NH3-PET/CT (P < 0.001). MACE occurred in 5/234 (0.9%), 31/365 (8%) and 5/25 (20%) with normal, non-diagnostic and positive PxECG, respectively (P < 0.001). No MACEs were seen in 204 with both normal PxECG and NH3-PET/CT versus 5/30(17%) with normal PxECG but abnormal NH3-PET/. No MACE occurred in 3/260(1%) with non-diagnostic PxECG and normal NH3-PET/CT versus 28/105(27%) with non-diagnostic PxECG and abnormal NH3-PET/CT. 0/18 with positive PxECG and normal NH3-PET/CT showed MACE versus 5/7(71%) with a positive PxECG and abnormal NH3-PET/CT. CONCLUSION Normal NH3-PET/CT is most prevalent in women with normal PxECG. The occurrence of MACE during follow-up is more frequently related to an abnormal NH3-PET/CT than to PxECG. Furthermore, in women with positive PxECG but normal NH3-PET/CT no MACE are to be expected.

Background: \ud The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes.\ud \ud Methods: \ud This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status.\ud \ud Findings: \ud Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low.\ud \ud Interpretation: \ud This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant.\ud \ud Funding: \ud Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research.

Significant treatment variation exists in the Netherlands between teams treating patients with cleft lip, alveolus, and/or palate, resulting in a confusing and undesirable situation for patients, parents, and practitioners. Therefore, to optimize cleft care, clinical practice guidelines (CPGs) were developed. The aim of this report is to describe CPG development, share the main recommendations, and indicate knowledge gaps regarding cleft care. Together with patients and parents, a multidisciplinary working group of representatives from all relevant disciplines assisted by two experienced epidemiologists identified the topics to be addressed in the CPGs. Searching the Medline, Embase, and Cochrane Library databases identified 5157 articles, 60 of which remained after applying inclusion and exclusion criteria. We rated the quality of the evidence from moderate to very low. The working group formulated 71 recommendations regarding genetic testing, feeding, lip and palate closure, hearing, hypernasality, bone grafting, orthodontics, psychosocial guidance, dentistry, osteotomy versus distraction, and rhinoplasty. The final CPGs were obtained after review by all stakeholders and allow cleft teams to base their treatment on current knowledge. With high-quality evidence lacking, the need for additional high-quality studies has become apparent.

An 81-year-old woman was evaluated for a stroke. CT showed no intracranial abnormalities but diffuse patchy aspect of the neurocranium. An MRI and F-NA PET/CT were performed to differentiate between metastases, Paget disease, hyperostosis frontalis interna, and primary malignancy. MRI yielded no additional findings. F-NA PET/CT showed diffusely increased uptake in the skull and 4 spots with intense uptake. No other suspicious skeletal foci were seen elsewhere. Low-dose CT showed no sign of malignancy elsewhere. Image findings together with elevated serum alkaline phosphatase levels, slightly increased calcium levels, and normal phosphorus levels were interpreted as pathognomic for monostotic Paget.

The decisions in the operating room scheduling process related to the case mix planning, the master surgery schedule and the nurse roster are based on the expected demand, predicted by historical data. Patients are only scheduled in the operational phase when the actual demand is known. However, the actual patient demand may differ from the expected demand. In this paper, we integrate the surgical case planning and scheduling problem and include the nurse re-rostering decision and nurse assignment to specific patients in order to utilise the operating room department as efficiently as possible and maximise the operating room profit. We propose a two-phase heuristic that uses the LP solution generated via column generation to construct a high-quality feasible solution. Computational experiments have been conducted on a diverse artificial data set generated in a controlled and structured manner and real-life data from the Sina Hospital (Tehran, Iran). We show that the presented approach is able to produce (near-)optimal solutions and benchmark the procedure with other optimisation strategies and solution methodologies.

Purpose: To analyze the results of endovascular repair of common iliac artery (CIA) aneurysms without preemptive coil embolization of the internal iliac artery (IIA). Materials and Methods: Between January 2010 and July 2016, 79 patients (mean age 74.3±8.4 years; 76 men) underwent endovascular repair extending into the external iliac artery owing to a CIA aneurysm. The procedure was performed for a ruptured aneurysm in 22 (28%) patients. Eighty-one IIAs were intentionally covered. The median CIA diameter was 37 mm (range 20–90). The primary outcomes were the occurrence of type II endoleaks and the incidence of buttock claudication. Results: Five (6%) patients died within 30 days (4 with ruptured aneurysms and 1 elective case). Two type II endoleaks originating from a covered IIA were recorded; one required an endovascular intervention because of aneurysm growth. The other patient died of a rupture based on an additional type III endoleak. Mean follow-up was 37.6±26.3 months. Nineteen (26%) patients required a secondary intervention. Buttock claudication was reported in 21 (28%) of 74 patients and persisted after 1 year in 7. No severe ischemic complications as a result of IIA coverage were recorded, and no revascularization was required during follow-up. Conclusion: Treatment of CIA aneurysms by overstenting the IIA without preemptive coil embolization is safe and has a low risk of type II endoleak and aneurysm growth. Persisting buttock claudication is rare.

V2X communication plays an important role in the transition towards connected, cooperative, automated driving. Wireless communication enables instant information exchange between vehicles (V2V) to support, e.g., platooning, and between the infrastructure and vehicles (I2V) to inform vehicles on, e.g., the local speed limit information or the approach of an accident location. In the Horizon 2020 HEADSTART project, we have shown how to test V2V communication in a scenario-based safety assessment framework. Safety assessment aims to determine the impact on safety in the case of potentially critical scenarios, e.g., due to, or in parallel to deterioration of communication. In this study, we extend this methodology with the incorporation of I2V communication. The developed method allows us to treat V2V and I2V communication independently. We demonstrate the method in the use case of an Intelligent Speed Adaptation I2V-functionality for platooning trucks. The practical implementation of test descriptions that consider the potential deterioration of communication signals in the standardized OpenSCENARIO format is shown. The study illustrates how tests are performed in a hardware-in-the-loop setup specifically developed for testing platooning functions. The availability of a test method that is capable of dealing with V2X communication is an important step towards the implementation of type approval methods for Cooperative, Connected and Automated Mobility (CCAM) systems.

A 58-year-old man presented with fever, erythema nodosum, and arthralgia of knee and ankle joints. Laboratory data showed signs of inflammation, and chest x-ray revealed bilateral hilar lymphadenopathy. 18F-FDG PET/CT was acquired to analyze the underlying causes and revealed FDG accumulation in thoracic lymphadenopathy and in subcutaneous lesions and periarticular uptake. This typical triad is known as Löfgren syndrome, an acute manifestation of sarcoidosis and which, as this case shows, can be visualized on 18F-FDG PET/CT. It is important to recognize this syndrome and to discriminate it from the classic presentation of sarcoidosis because of its different diagnostic and therapeutic consequences.

Objectives: We hypothesize that three-dimensional (3D) geometric analyses in weight bearing CT-images of the foot and ankle are more reproducible compared to two-dimensional (2D) analyses. Therefore, we compared 2D and 3D analyses on bones of weight-bearing and non weight-bearing cone-beam CT images of healthy volunteers. Methods: Twenty healthy volunteers (10 male, 10 female, mean age 37.5 years) underwent weight-bearing and non weight-bearing cone-beam CT imaging of both feet. Clinically relevant height and angle measurements were performed in 2D and 3D (for example: cuboid height, calcaneal pitch, talo-calcaneal angle, Meary's angle, intermetatarsal angle). Three-dimensional measurements were obtained using automated software. Intra-observer and inter-observer agreement were evaluated for all 2D measurements. Results: Overall intraclass correlation coefficients (ICC's) were higher than 0.750 for most 2D measurements, ranging from 0.352 to 0.995. Calcaneal pitch, angle between the first metatarsal (MT1) and proximal phalange 1, between the fifth metatarsal (MT5) and the calcaneus and heights of the sesamoid bones, navicular, cuboid and talus decreased during weight-bearing in both 2D and 3D results (p < 0.01). Meary's angle was not statistically different in 2D (p = 0.627) and 3D (p = 0.765). Higher coefficients of variation in 2D geometric analysis parameters (0.27 versus 0.16) indicate that 3D analyses are more precise compared to 2D (p < 0.01). Results of left and right feet are comparable for 2D and 3D analyses. Conclusion: Although 2D and 3D geometrical analyses are fundamentally different, automated 3D analyses are more reproducible and precise compared to 2D analyses. In addition, 3D evaluation better demonstrates differences in bone configurations between weight-bearing and non weight-bearing conditions, which may be of value to demonstrate pathology.

Background: The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. Methods: We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, R t, for the two incidence estimates. Findings: From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6–0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56–0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38–0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the R t of B.1.1.7 by a factor of 1·35 (95% CI 1·02–1·69) relative to pre-existing variants. However, R t fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. Interpretation: The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. Funding: Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society.

Purpose To investigate whether diabetes knowledge and health literacy impact glycemic control after 1 year of intermittently scanned continuous glucose monitoring (isCGM) in people with type 1 diabetes ≥ 16 years. Methods In this prospective real-world cohort study, we assessed diabetes knowledge using a new 10-item questionnaire [Patient Education and Knowledge (PEAK)] and health literacy using the validated 6-item Newest-Vital Sign-D (NVS-D) questionnaire. Primary endpoint was association between PEAK score and change in hemoglobin A1c (HbA1c). Secondary endpoints were link between NVS-D score and change in HbA1c and that between time spent in/above/below range and PEAK/NVS-D scores. Results 851 subjects were consecutively recruited between July 2016 and July 2018. Median PEAK score was 8 (range: 0-10), and median NVS-D score was 6 (range 0-6). HbA1c evolved from 7.9% (7.8%-8.0%), 63 (62-64) mmol/mol, at start to 7.7% (7.6%-7.7%), 61 (60-61) mmol/mol (P Conclusions isCGM reduced time in hypoglycemia, and HbA1c evolved favorably. Our findings suggest that diabetes and health literacy affect glucometrics, emphasizing the importance of education.

Identifying drivers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and quantifying population immunity is crucial to prepare for future epidemics. We performed a serial cross-sectional serosurvey throughout the first pandemic wave among patients from the largest health board in Scotland. Screening of 7480 patient serum samples showed a weekly seroprevalence ranging from 0.10% to 8.23% in primary and 0.21% to 17.44% in secondary care, respectively. Neutralization assays showed that highly neutralizing antibodies developed in about half of individuals who tested positive with enzyme-linked immunosorbent assay, mainly among secondary care patients. We estimated the individual probability of SARS-CoV-2 exposure and quantified associated risk factors. We show that secondary care patients, male patients, and 45–64-year-olds exhibit a higher probability of being seropositive. The identification of risk factors and the differences in virus neutralization activity between patient populations provided insights into the patterns of virus exposure during the first pandemic wave and shed light on what to expect in future waves.

In Latin American universities, Learning Analytics (LA) has been perceived as a promising opportunity to leverage data to meet the needs of a diverse student cohort. Although universities have been collecting educational data for years, the adoption of LA in this region is still limited due to the lack of expertise and policies for processing and using educational data. In order to get a better picture of how existing data-related practices and policies might affect the incorporation of LA in Latin American institutions, we conducted a mixed methods study in four Latin American universities (two Chilean and two Ecuadorian). In this paper, the qualitative data were based on 37 interviews with managers and 16 focus groups with 51 teaching staff and 45 students; the quantitative data were collected through two surveys answered by 1884 students and 368 teachers, respectively. The findings reveal opportunities to incorporate LA services into existing data practices in the four case studies. However, the lack of reliable information systems and policies to regulate the use of data imposes challenges that need to be overcome for future LA adoption. This work was funded by the LALA project (grant no. 586120-EPP-1-2017-1-ES-EPPKA2- CBHE-JP). This project has been funded with support from the European Commission. This publi- cation reflects only the views of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

18F-fluorocholine (18F-FCH) PET/CT is a promising and increasingly used scan technique in the preoperative imaging of parathyroid adenoma. Several acquisition methods have been evaluated in the literature, but the optimal image acquisition time point after administration of the tracer is still under debate. Methods: Patients who had hyperparathyroidism, underwent dual-time-point 18F-FCH PET/CT (image acquisition, 5 min; 60 min after injection), and had histologically proven pathologic parathyroid glands were retrospectively included in the study. Early and late images were compared both visually and quantitatively. Results: Sixty-four patients were included, and a total of 71 parathyroid glands were surgically removed. Visually, there were no differences between early and late images of hyperfunctioning parathyroid glands in 44 patients (69%); in 13 patients (20%), visualization on early images was better; in 6 patients (9%), visualization of hyperfunctioning glands was best on late images; and in 1 patient (2%), the lesion was exclusively visualized on late images. For the total cohort, there was a significant decrease in 18F-FCH uptake in the glands on late versus early time points (P = 0.001), but there was a significant increase in the ratio of parathyroid uptake to thyroid uptake (P = 0.037). The group of patients with better visualization on early images showed a decrease over time in both parathyroid uptake and the ratio of parathyroid uptake to thyroid uptake, significant in comparison to those in both the group with better visualization at later time points and the group in which visualization was similar at both time points (P values of 0.000-0.018). There were no significant differences in 18F-FCH uptake and the ratio of parathyroid uptake to thyroid uptake between the latter 2 groups (P values of 0.200-0.709). Conclusion: In most patients (89%), hyperfunctioning parathyroid glands were adequately visualized on early imaging; however, in a subset of patients (11%), such glands were best visualized at later time points. Therefore, we recommend the acquisition of dual-time-point images in parathyroid imaging with 18F-FCH PET/CT or the creation of an opportunity to acquire additional late images after review of early images when findings are inconclusive.

Despite the success of academic advising dashboards in several higher educational institutions (HEI), these dashboards are still under-explored in LatinAmerican HEI’s. To close this gap, three different Latin American universities adapted an existing advising dashboard, originally deployed at the KU Leuven to their own context. In all three cases, the context was the main ruling factor to these adaptations. In this paper, we describe these adaptions using a framework that focuses on four different elements of the context: Objectives, Stakeholders, Key moment, and Interactions. Evaluation of the adapted dashboards in the three different Latin American universities are conducted through pilots. This evaluation shows the value of the dashboard approach in different contexts in terms of satisfaction, usefulness, and impact in academic decision-making and advising tasks. The main contribution of this paper is the systematic reporting of the adaptations to an academic advising dashboard and showing the value of an academic advising dashboard on academic decision-making and advising tasks. ispartof: British Journal Of Educational Technology vol:51 issue:4 status: Published online

One of the most promising imaging techniques in primary hyperparathyroidism is PET/CT with choline-based tracers. To investigate the current evidence of these tracers in localizing parathyroid adenoma, a systematic review was performed. A comprehensive literature search was carried out and eligible studies were analyzed. Data were extracted, the level of evidence was scored, and performance data were pooled to calculate the weighted detection rate. Eleven articles were included in this study. The pooled detection rate was 97 and 94% on per patient-based and per lesion-based analysis, respectively. There was considerable heterogeneity between studies and the level of evidence was determined to be 3a-, following Oxford criteria. Choline PET/CT has shown favorable results in detection of hyperfunctioning parathyroid tissue and may replace conventional technetium-99m-sestamibi scintigraphy in preoperative planning of parathyroid surgery. However, the quality of current evidence is moderate, and additional high-quality studies are needed to confirm these numbers.

International audience; Many Latin-American institutions recognise the potential of learning analytics (LA). However, the number of actual LA implementations at scale remains limited, notwithstanding considerable effort made to formulate guidelines and frameworks to support the LA policy development. Guidance on how to coordinate the interaction between the LA policymaking and implementation is mostly missing, leaving a difficult challenge up to practitioners. In this study we propose a coordination model to support future LA initiatives at scale. We explore the problem by comparing two cases in Belgium and Ecuador. Following up we use the LA implementation timeline as a driver for planning the interaction between the policymaking and implementation. We continue by testing an application of the model with LA experts predominantly from Latin-American institutions, asking them to map low-level items of the SHEILA policy framework to four implementation phases. The results of this mapping support that LA policy building can be spread over time, that it can coincide with LA implementation at scale, and that both efforts can be coordinated. It is hoped that this study will provide additional guidance for future Latin-American and other LA initiatives.

The aim of the study was to determine the effect of α-actinin-3 (ACTN3) deficiency (XX) on muscle damage induced by an eccentric exercise bout. In this purpose, 4 RR and 4 XX individuals performed an intensive eccentric knee flexion exercise on an isokinetic dynamometer. Muscle biopsies, blood and pain scores were taken before and after the exercise to determine the extent of the exercise-induced damage and the effect of the ACTN3 R577X polymorphism. Maximal isometric strength of the quadriceps and single fibre properties were compared before and after the exercise. The drop in maximal isometric strength of the quadriceps at 45° knee flexion following the eccentric exercise bout was on average 37% 24 h post-exercise. The decrease in force was also apparent in isolated type IIa fibres (8%; P = 0.02), but not in type I fibres (P = 0.88). Creatine kinase and myoglobin plasma levels increased in all participants at least by 55% and 87%, respectively (P

Molecular imaging of the immune checkpoint receptor PD-1 and its ligand PD-L1 is increasingly investigated as a strategy to guide and monitor PD-1:PD-L1-targeted immune checkpoint therapy. We provide an overview of the current state-of-the-art on PD-1- and PD-L1-specific imaging agents for quantitative, real-time assessment of PD-1:PD-L1 expression in the tumor environment and discuss their potential for clinical translation.

Background The diagnosis of infected hip prosthesis is frequently not straightforward yet very important as it changes treatment. Purpose To retrospectively investigate the added value of 18F-FDG PET/CT to conventional tests including radiography, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) testing, and joint aspiration, in diagnosing infected hip prosthesis. Material and Methods Seventy-eight hip prostheses of 78 patients (55% men; mean age = 66.5 years; age range = 30–85 years) with non-specific clinical presentation, i.e. no abscess or sinus tract communicating with the joint space at clinical examination, were analyzed. Cultures of intra-articular fluid and peri-implant tissues after revision surgery or clinical follow-up ≥6 months served as gold standard. Areas under the receiver operating characteristic curves (AUCs) of radiography, ESR/CRP testing, aspiration culture, and white blood cell (WBC) count without and with the addition of 18F-FDG PET/CT were compared. Results The addition of 18F-FDG PET/CT increased AUCs: for radiography with 0.212, P = 0.001; for ESR/CRP testing with 0.076, P = 0.072; for aspiration culture with 0.126, P = 0.032; and for aspiration WBC count with 0.191, P = 0.035. Conclusion This study shows that 18F-FDG PET/CT adds to individual conventional tests in diagnosing infected hip prosthesis. It may improve the preoperative planning and should therefore be considered in the diagnostic work-up. Future studies should define the exact place of 18F-FDG PET/CT in the diagnostic work-up of periprosthetic joint infection.

Lenalidomide is a potent anti-myeloma drug with immunomodulatory properties. It is increasingly used in a low-dose maintenance setting to prolong remission duration after standard treatment. Data on the in vivo effects of lenalidomide are scarce and sometimes different from the well-described in vitro effects. We therefore evaluated the numerical, phenotypical and functional impact of lenalidomide maintenance on several immune cell types in a cohort of seventeen homogeneously treated myeloma patients achieving a low residual myeloma burden after a bortezomib based-induction followed by autologous stem cell transplantation. Lenalidomide maintenance: 1) increased the fraction of naïve CD8+ T cells and several memory T-cell subsets, 2) reduced the numbers of terminal effector CD8+ T cells, 3) resulted in a higher expression of co-stimulatory molecules on resting T cells and of the inhibitory checkpoint molecules LAG-3 on CD4+ T cells and TIM-3 on CD4+ and CD8+ T cells, 4) reduced the number of TIGIT+ CD8+ T cells, 5) increased the number of regulatory T cells with a phenotype associated with strong suppressive capacity. Purified CD8+ T cells showed increased and more polyfunctional recall viral responses. However, PBMC responses were not enhanced during lenalidomide maintenance and CD4+ T-cell responses specific for the myeloma-associated antigen MAGE-C1 even tended to become lower. We conclude that lenalidomide maintenance after autologous stem cell transplantation has complex pleotropic effects on the immune environment. Immune interventions such as anti-myeloma vaccination should include measures to tackle an expanded inhibitory Treg compartment., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective Determination of the accuracy of sodium fluorine-18-fluoride (F-NaF) PET/computed tomography (CT) for the evaluation of bone metastases, and the impact on patient management in breast cancer patients. Patients and methods Patients with breast cancer, referred for F-NaF PET/CT between February 2014 and June 2016, were included in a database. Baseline characteristics, clinical indication, definitive diagnosis according to follow-up data, as well as changes in patient management were recorded. Follow-up was performed during a period of at least 6 months using histopathologic, medical imaging, biochemical, and clinical data. Results A total of 118 patients were included in the study. Indications for F-NaF PET/CT included primary staging (12%), follow-up (31%), bone pain (52%), abnormal laboratory findings (5%), and evaluation of equivocal osseous lesions on other imaging modalities (3%). Bone metastases were found in 42%, whereas 53% of the scans were negative and 5% yielded equivocal results. Correlation with the reference standard yielded a sensitivity of 0.96, a specificity of 0.91, a positive predictive value of 0.89, a negative predictive value of 0.97, and an accuracy of 0.93. In 25% of the patients, the scan results led to alterations in patient management. F-NaF PET/CT for the evaluation of bone pain showed no explanation in 29%, benign pathology in 66%, and bone metastases in 5%. Conclusion In the present cohort of patients with breast cancer, F-NaF PET/CT detected bone metastases in 42% with an accuracy of 0.93. The scan results led to a change in patient management in 25%. In the evaluation of bone pain, an explanation for pain was found in 71% of the scans.

In this paper the Resource Renting Problem with Overtime (RRP/overtime) is presented. The RRP/overtime is a new problem in which the assumptions of the basic RRP are combined with the possibility to schedule (parts of) activities during overtime. The addition of this extension increases the applicability of the RRP to real world problems. This paper also presents a solution technique for this extension of the resource renting problem. The solution procedure uses a scatter search heuristic to optimize a priority list, which is then in turn used by a schedule generation scheme ( PatSGS ). A variation on this schedule generation scheme is also used in dedicated local search procedures. The third contribution of this research is a new lower bound for the RRP/overtime problem, which is used to evaluate the results of the proposed heuristic solution method.

Purpose The purpose of this paper is to draw attention to the potential of “small data” to complement research in learning analytics (LA) and to share some of the insights learned from this approach. Design/methodology/approach This study demonstrates an approach inspired by design science research, making a dashboard available to n=1,905 students in 11 study programs (used by n=887) to learn how it is being used and to gather student feedback. Findings Students react positively to the LA dashboard, but usage and feedback differ depending on study success. Research limitations/implications More research is needed to explore the expectations of a high-performing student with regards to LA dashboards. Originality/value This publication demonstrates how a small data approach to LA contributes to building a better understanding.

We analyze the incentives of internet service providers (ISPs) to break net neutrality by excluding competing one-way essential complements, i.e. internet applications competing with their own products. A typical example is the exclusion of VoIP applications by telecom companies offering internet and voice services. A monopoly ISP may want to exclude a competing internet app if it is of inferior quality and the ISP cannot ask for a surcharge for its use. Competition between ISPs never leads to full app exclusion but it may lead to a fragmented internet where only one ISP offers the application. We show that, both in monopoly and duopoly, prohibiting the exclusion of the app and surcharges for its use does not always improve welfare.

A 78-year-old woman with chest pain and a history of pacemaker implantation for arrhythmia underwent myocardial perfusion imaging by means of N-NH3 cardiac PET/CT. N-NH3 cardiac PET showed no signs of ischemia or infarction. Incidentally, a nodule with increased N-NH3 activity was observed in the right breast. Histopathologic examination revealed invasive ductal carcinoma.

A 75-year-old man, treated with curative intent for histopathologically proven prostate cancer (initial prostate-specific antigen, 27 ng/mL; Gleason 4 + 5 = 9) through external beam radiation therapy in 2010 in combination with 3 years of androgen deprivation therapy (leuprorelin), underwent 18F-DCFPyL PET/CT for biochemical recurrence with a prostate-specific antigen of 4.1 ng/mL in February 2019. Multiple pelvic and some para-aortic lymph nodes showed highly increased 18F-DCFPyL uptake, suspicious for metastases. Incidentally, a solid mesenteric mass and mesenteric lymph nodes with moderately increased 18F-DCFPyL uptake were found. Upon histopathological evaluation, this proved to be a low-grade follicular lymphoma.

OBJECTIVE In 2016, nationwide reimbursement of intermittently scanned continuous glucose monitoring (isCGM) for people living with type 1 diabetes treated in specialist diabetes centers was introduced in Belgium. We undertook a 12-month prospective observational multicenter real-world study to investigate impact of isCGM on quality of life and glycemic control. RESEARCH DESIGN AND METHODS Between July 2016 and July 2018, 1,913 adults with type 1 diabetes were consecutively recruited in three specialist diabetes centers. Demographic, metabolic, and quality of life data were collected at baseline, 6 months, and 12 months of standardized clinical follow-up. The primary end point was evolution of quality of life from baseline to 12 months. Secondary outcome measures were, among others, change in HbA1c, time spent in different glycemic ranges, occurrence of acute diabetes complications, and work absenteeism. RESULTS General and diabetes-specific quality of life was high at baseline and remained stable, whereas treatment satisfaction improved (P < 0.0001). Admissions for severe hypoglycemia and/or ketoacidosis were rare in the year before study (n = 63 out of 1,913; 3.3%), but decreased further to 2.2% (n = 37 out of 1,711; P = 0.031). During the study, fewer people reported severe hypoglycemic events (n = 280 out of 1,913 [14.6%] vs. n = 134 out of 1,711 [7.8%]; P < 0.0001) or hypoglycemic comas (n = 52 out of 1,913 [2.7%] vs. n = 18 out of 1,711 [1.1%]; P = 0.001) while maintaining HbA1c levels. Fewer people were absent from work (n = 111 out of 1,913 [5.8%] vs. n = 49 out of 1,711 [2.9%]; P < 0.0001). Time spent in hypoglycemia significantly decreased in parallel with less time in range and more time in hyperglycemia. Eleven percent (n = 210) of participants experienced skin reactions, leading to stopping of isCGM in 22 participants (1%). CONCLUSIONS Nationwide unrestricted reimbursement of isCGM in people with type 1 diabetes treated in specialist diabetes centers results in higher treatment satisfaction, less severe hypoglycemia, and less work absenteeism, while maintaining quality of life and HbA1c.

Producción Científica, Mobile and Ubiquitous Learning (m/u-learning) are finding an increasing adoption in education. They are often distinguished by hybrid learning environments that encompass elements of formal and informal learning, in activities that happen in distributed settings (indoors and outdoors), across physical and virtual spaces. Despite their purported benefits, these environments imply additional complexity in the design, monitoring and evaluation of learning activities. The research literature on learning design (LD) and learning analytics (LA) has started to deal with these issues. This paper presents a systematic literature review of LD and LA, in m/u-learning. Apart from providing an overview of the current research in the field, this review elicits elements of common ground between both communities, as shown by the similar learning contexts and complementary research contributions, and based on the research gaps, proposes to: address m/u-learning beyond higher education settings, reinforce the connection between physical and virtual learning spaces, and more systematically align LD and LA processes., Subvenciones de la UE (669074, 586120-EPP-1-2017-1-ES-EPPKA2- CBHE-JP), Ministerio de Ciencia, Innovación y Universidades (Project TIN2017-85179-C3-1-R, TIN2017-85179-C3-2-R, TIN2017- 85179-C3-3-R), Junta de Castilla y León (Project VA257P18)

Learning analytics (LA) can provide useful information for addressing the educational needs in Latin American universities, such as reducing program quality disparities and student dropout rates. Some researchers have suggested to build capacity in this region for institutional adoption of LA tools. Yet, there is still a long way to move from experimentation to actual integration of LA tools into institutional processes. With the objective of understanding how we could facilitate LA adoption in Latin American contexts, we present the cases of four Latin American universities adapting LA tools to meet institutional needs. Two questionnaires with open-ended questions were used to identify similarities and differences among the four cases in terms of two dimensions: (1) leadership processes to involve diverse stakeholders in the adoption of LA tools and (2) organizational maturity to analyze and act upon educational data. Findings indicate that leadership processes for LA adoption that engage middle managers, such as deans and directors of undergraduate studies, facilitated the involvement of intended users to receive feedback on the design and of senior managers to allocate resources for scaling up the LA initiative. Besides, a greater organizational maturity facilitated the incorporation of the LA tool into an existing academic process at a department or institutional level. Future work might explore how leadership processes and organizational maturity evolve in other Latin American universities, in order to provide guidelines and recommendations for scaling LA adoption in different contexts.

Background 18F-fluorocholine (FCH) PET/CT is a promising technique for visualizing hyperfunctioning parathyroid glands in hyperparathyroidism. It is still under debate whether to use this technique as a first-line imaging modality or to use it when conventional techniques such as 99mTc-sestamibi scintigraphy or ultrasonography are inconclusive. This study evaluates FCH PET/CT as a first-line modality. Methods Patients with primary hyperparathyroidism, referred between June 2015 and December 2018 for FCH PET/CT as a first-line imaging method, were included in this study. Baseline characteristics, clinical data, scan results, and type of treatment were recorded. The rate of correct detection was calculated on a per patient-based and a per lesion-based analysis. The reference standard comprised histopathological results, intraoperative response to parathyroidectomy, and clinical follow-up. Results Two hundred and seventy-one patients were included, of which 139 patients underwent parathyroidectomy, 48 were treated with calcimimetics, and 84 patients received further follow-up without active treatment. In the surgically treated group, a single adenoma was suspected in 127 scans, double adenoma in three scans, and one scan showed evidence of three hyperfunctioning glands. In eight scans, no lesions were visualized. A total of 154 parathyroid glands were surgically removed. The rate of correct detection was calculated at 96% and 90%, on a per patient-based and per lesion-based analysis, respectively. Conclusion This retrospective study in a large cohort shows high detection rates of FCH PET/CT in primary hyperparathyroidism, which is in accordance to literature. The use of FCH PET/CT as a first-line imaging modality in preoperative planning of parathyroid surgery may therefore be a suitable choice.

Literature shows that prostate-specific membrane antigen (PSMA) PET/CT may detect biochemical recurrence of prostate cancer at low prostate-specific antigen (PSA) levels, including detection of oligometastatic disease and hence direct metastasis-directed therapy. Although it is generally accepted that higher PSA values indicate higher disease burden, few data are available on the relation between PSA levels and number of detected metastases on PSMA PET/CT. This report demonstrates a patient with high PSA levels (856 ng/mL) at time of biochemical recurrence that showed only 1 metastasis on PSMA PET/CT. Combined androgen deprivation therapy and radiation therapy resulted in a complete biochemical response.

Radioisotope-labeled prostate-specific membrane antigen PET/CT is increasingly used for detection of prostate cancer most often in the setting of biochemical recurrence or in primary staging. This report shows increased PSMA expression in lymph node metastases 3 months after initiation of enzalutamide for castration-resistant prostate cancer, whereas lymph node volume and serum prostate-specific antigen decreases over time. This case demonstrates that increasing F-DCFPyL uptake after initiation of androgen deprivation therapy should not be confused with disease progression.

OBJECTIVE. Cannabis and alcohol use are correlated behaviors among youth. It is not known whether discontinuation of cannabis use is associated with changes in alcohol use. This study assessed alcohol use in youth before, during, and after four weeks of paid cannabis abstinence. METHODS. Healthy, non-treatment seeking, cannabis users (n=160), aged 14-25 years, 84% of whom used alcohol in the last month, were enrolled for a 4-week study with a 2-4 week follow-up. Participants were randomly assigned to four weeks of either biochemically-verified cannabis abstinence achieved through a contingency management framework (CB-Abst) or monitoring with no abstinence requirement (CB-Mon). Participants were assessed at baseline and approximately 4, 6, 10, 17, 24, and 31 days after enrollment. A follow-up visit with no cannabis abstinence requirement for CB-Abst was conducted after 2-4 weeks. RESULTS. Sixty percent of individuals assigned to the CB-Abst condition increased in frequency and quantity of alcohol consumption during the 4-week period of incentivized cannabis abstinence. As a whole, CB-Abst increased by a mean of 0.6 drinking days and 0.2 drinks per day in the initial week of abstinence (p’s0.53). There was no change in drinking frequency or quantity during the 4-week monitoring or follow-up periods among CB-Mon. CONCLUSIONS. On average, four weeks of incentivized (i.e., paid) cannabis abstinence among non-treatment seeking youth was associated with increased frequency and amount of alcohol use in week 1 that was sustained over 4 weeks and resolved with resumption of cannabis use. However, there was notable variability in individual-level response, with 60% increasing in alcohol use and 23% actually decreasing in alcohol use during cannabis abstinence. Findings suggest that increased alcohol use during cannabis abstinence among youth merits further study to determine whether this behavior occurs among treatment seeking youth and its clinical significance.

Purpose: To evaluate the differences in technical outcomes and secondary interventions between elective endovascular aneurysm repair (el-EVAR) procedures and those for ruptured aneurysms (r-EVAR). Methods: Of the 906 patients treated with primary EVAR from September 1998 until July 2012, 43 cases were excluded owing to the use of first-generation stent-grafts. Among the remaining 863 patients, 773 (89.6%) patients (mean age 72 years; 697 men) with asymptomatic or symptomatic abdominal aortic aneurysms (AAAs) were assigned to the el-EVAR group; 90 (10.4%) patients (mean age 73 years; 73 men) were assigned to the r-EVAR group based on blood outside the aortic wall on preoperative imaging. The primary study outcome was technical success; secondary endpoints, including freedom from secondary interventions and late survival, were examined with Kaplan-Meier analyses. Results: At baseline, r-EVAR patients had larger aneurysms on average (p

A 76-year-old man with histopathologically proven prostate cancer (initial prostate-specific antigen 110 ng/mL, Gleason 3 + 4 = 7) received F-DCFPyL PET/CT for initial staging. Both the primary tumor and pathologically enlarged pelvic lymph nodes showed no increased F-DCFPyL uptake. Subsequent histopathologic lymph node biopsy revealed prostate cancer metastasis. Prostate-specific membrane antigen tracers, such as F-DCFPyL, are promising radiopharmaceuticals for prostate cancer imaging. False-negative prostate-specific membrane antigen PET/CT findings have been reported earlier for prostate tumors with neuroendocrine differentiation. However, this report presents false-negative F-DCFPyL PET findings of an adenocarcinoma of the prostate without neuroendocrine differentiation.

Learning Analytics (LA) is perceived to be a promising strategy to tackle persisting educational challenges in Latin America, such as quality disparities and high dropout rates. However, Latin American universities have fallen behind in LA adoption compared to institutions in other regions. To understand stakeholders' needs for LA services, this study used mixed methods to collect data in four Latin American Universities. Qualitative data was obtained from 37 interviews with managers and 16 focus groups with 51 teaching staff and 45 students, whereas quantitative data was obtained from surveys answered by 1884 students and 368 teaching staff. According to the triangulation of both types of evidence, we found that (1) students need quality feedback and timely support, (2) teaching staff need timely alerts and meaningful performance evaluations, and (3) managers need quality information to implement support interventions. Thus, LA offers an opportunity to integrate data-driven decision-making in existing tasks. This work was funded by the EU LALA project (grant no. 586120-EPP-1-2017-1-ES-EPPKA2-CBHE-JP). This project has been funded with support from the European Commission. This publication reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein. The authors would like to thank the reviewers for their constructive suggestions, in addition to the Laspau fellowship program, organization affiliated to Harvard University that supported this work during its development.