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Aims The atherosclerotic profile and advanced plaque subtype burden in symptomatic patients ≤45 years old have not been established. This study aimed to assess the prevalence and predictors of coronary artery calcium (CAC), plaque subtypes, and plaque burden by coronary computed tomography angiography (CCTA) in symptomatic young patients. Methods and results We included 907 symptomatic young patients (18–45 years) from Montefiore undergoing CCTA for chest pain evaluation. Prevalence and predictors of CAC, plaque subtypes, and burden were evaluated using semi-automated software. In the overall population (55% female and 44% Hispanic), 89% had CAC = 0. The likelihood of CAC or any plaque by CCTA increased with >3 risk factors {RFs, odds ratio [OR] 7.13 (2.14–23.7) and OR 10.26 (3.36–31.2), respectively}. Any plaque by CCTA was present in 137 (15%); the strongest independent predictors were age ≥35 years [OR 3.62 (2.05–6.41)] and family history of premature coronary artery disease (FHx) [OR 2.76 (1.67–4.58)]. Stenosis ≥50% was rare (1.8%), with 31% of those having CAC = 0. Significant non-calcified plaque (NCP, 37.2%) and low-attenuation plaque (LAP, 4.24%) burdens were seen, even in those with non-obstructive stenosis. Among patients with CAC = 0, 5% had plaque, and the only predictor of exclusively NCP was FHx [OR 2.29 (1.08–4.86)]. Conclusion In symptomatic young patients undergoing CCTA, the prevalence of CAC or any coronary atherosclerosis was not negligible, and the likelihood increased with RF burden. The presence of coronary stenosis ≥50% was rare and most often accompanied by CAC >0, but there was a significant burden of NCP and LAP even within the non-obstructive group. [ABSTRACT FROM AUTHOR]

Lack of attention to rural healthcare for livestock in the southeastern United States has led to a focus on small ruminant farming, mainly using sericea lespedeza [SL; Lespedeza cuneata (Dum-Cours) G. Don], a drought-resistant forage species with nutraceutical benefits. Climate change has increased land availability for SL cultivation, further expanding the potential of this bioactive (anti-parasitic) legume. This study aims to create a geospatial engineering and technology-assisted model for identifying suitable SL production areas for supporting profitable small ruminant farming. The cultivation of SL depends on specific weather conditions and soil properties, with minimum requirements for temperature and rainfall, non-clay soil with reduced bulk density, and open land cover. The main objective was to develop an automated geospatial model using ArcGIS Pro ModelBuilder to assess SL production suitability. This model also aimed to identify appropriate locations for small ruminant production in Georgia in the southeastern United States, characterized by increasing temperature fluctuations. A web-based geographic information system (webGIS) platform was developed using the ArcGIS Online dashboard interface, allowing agriculturalists to access decision support for SL production suitability tailored to their land. This forage production suitability analysis, conducted in the context of climate change, offers valuable guidance for pasture managers in other nations with similar environmental attributes, promoting global adaptability and resilience. [ABSTRACT FROM AUTHOR]

Age, gender, and cross-national differences of children ages 9 through 16 in Pakistan (n = 463) and the United States (n = 500) are examined on four bipolar temperament styles: Extroversion-introversion, practical-imaginative, thinking-feeling, and organized-flexible. In general, Pakistani children prefer extroverted over introverted, practical over imaginative, and organized over flexible styles. Although their preference for thinking and feeling styles is balanced, gender differences are significant. Males generally prefer a thinking style and females generally prefer a feeling style. Gender and age differences are found on practical-imaginative and organized-flexible styles. Cross-national differences are found on practical-imaginative and organized-flexible styles. In contrast to children in the US, children in Pakistan are more likely to prefer practical and organized styles. (Contains 2 tables.)

Aim: The American Academy of Pediatrics and the European Centre for Pediatric and Adolescent Medicine guideline define fever as a temperature >38.0°C for all ages and recommend use of rectal thermometers in children <3 years. Based on new literature, this definition of fever using a fixed threshold of 38.0°C needs to be re‐examined. Design: A multi‐site diagnostic accuracy study was conducted to compare an "age‐based" threshold model with a "fixed" threshold over 38.0°C on a total of 894 patients of which 373 were ill. Methods: The "age‐based" and "fixed" threshold fever determinations were then compared to a clinical categorization ("well" or "ill") conducted by a clinician through a comprehensive examination. Results: The sensitivity and accuracy for the age‐based thresholds were found to be superior to the fixed thresholds in all ages and current ear thermometers were found equivalent to rectal thermometers in infants <6 months. [ABSTRACT FROM AUTHOR]

There is a paucity of cross-national studies evaluating protective models for suicidal behaviors. Thus, using a behavioral framework, the purpose of this study was to examine whether higher levels of life-enhancing behaviors could mitigate or weaken the relation between depressive symptoms and suicidal behaviors in United States and Pakistani college students. A total of 811 students (449 Pakistani and 362 U.S. students) participated in the study. Results indicated that the strength of the relation between depressive symptoms and suicidal behaviors was stronger for U.S. students. In addition, the association between depressive symptoms and suicidal behaviors weakened in the presence of high engagement in life-enhancing behaviors. This effect was comparable in strength for American versus Pakistani students. The results offer preliminary evidence for life-enhancing behaviors as a protective factor for suicide across unique cultural settings and may serve as a valuable area of focus for secondary prevention programs. [ABSTRACT FROM AUTHOR]

How health care professionals conceptualize mental illness has received relatively little attention in existing literature. This survey explored how health care professionals, academic faculty, and trainees at a US academic medical center (departments of psychiatry, neurology, family medicine, and geriatric medicine, as well as medical students, nurses, and social workers) conceptualize the notion of mental disorder. Respondents (N = 209) were asked to rate their agreement or disagreement with a variety of conceptual statements. Overall, distress and impairment were seen as essential features of mental disorder, and the presence of a biological abnormality was not considered necessary. There was significant correlation between disease status and biological etiology attribution for all conditions except homosexuality. Psychology trainees and psychologists were significantly less likely to call a condition a disease compared with other groups. There was a general lack of consensus regarding conceptual issues fundamental to psychiatry. Conceptualizations of mental disorder held by respondents were complex and did not fit easily within the "biological psychiatry" paradigm. [ABSTRACT FROM AUTHOR]

We queried hospital patients about international travel in the previous 30 days to assess potential importation of emerging infections. We used 12 months of deidentified data to analyze patient demographics, travel destinations, and diagnoses for exposure to Zika virus. Our approach could be used to analyze potential infectious disease exposures. [ABSTRACT FROM AUTHOR]

We queried hospital patients about international travel in the previous 30 days to assess potential importation of emerging infections. We used 12 months of deidentified data to analyze patient demographics, travel destinations, and diagnoses for exposure to Zika virus. Our approach could be used to analyze potential infectious disease exposures. [ABSTRACT FROM AUTHOR]

Introduction. There is a paucity of information about risk behaviors in adolescents with chronic kidney disease (CKD). We designed this study to assess the prevalence of risk behaviors among teens with CKD in the United States and to investigate any associations between risk behavior and patient or disease characteristics. Methods. After informed consent, adolescents with CKD completed an anonymous, confidential, electronic web-based questionnaire to measure risk behaviors within five domains: sex, teen driving, alcohol and tobacco consumption, illicit drug use, and depression-related risk behavior. The reference group was composed of age-, gender-, and race-matched US high school students. Results. When compared with controls, teens with CKD showed significantly lower prevalence of risk behaviors, except for similar use of alcohol or illicit substances during sex (22.5% vs. 20.8%, p=0.71), feeling depressed for ≥2 weeks (24.3% vs. 29.1%, p=0.07), and suicide attempt resulting in injury needing medical attention (36.4% vs. 32.5%, p=0.78). Furthermore, the CKD group had low risk perception of cigarettes (28%), alcohol (34%), marijuana (50%), and illicit prescription drug (28%). Use of two or more substances was significantly associated with depression and suicidal attempts (p<0.05) among teens with CKD. Conclusions. Teens with CKD showed significantly lower prevalence of risk behaviors than controls. Certain patient characteristics were associated with increased risk behaviors among the CKD group. These data are somewhat reassuring, but children with CKD still need routine assessment of and counselling about risk behaviors. [ABSTRACT FROM AUTHOR]

Objectives: To characterize unmet treatment needs in a sample of Migraine in America Symptoms and Treatment (MAST) Study participants using oral, acute prescription migraine medications. Background: The MAST Study is a 2017 study of US adults with migraine that profiles current treatment patterns and identifies and quantifies unmet treatment needs. Methods: Cross‐sectional data from an online survey of US adults meeting ICHD‐3 beta criteria for migraine. For inclusion in this paper, respondents self‐reported a history of 3 or more monthly headache days (MHDs) in the past 3 months and at least 1 MHD in the past 30 days, and current use of orally administered acute prescription medication for headache. Three domains of unmet need were identified: inadequate treatment response (ie, inadequate 2‐hour pain freedom, recurrence within 24 hours of initial relief), demanding attack characteristics (rapid onset of attack, headache associated with sleep), and unique patient characteristics (opioid or barbiturate overuse, cardiovascular comorbidity). Sociodemographics, oral medication use, and coexisting conditions and symptoms (ie, level of treatment optimization, psychological symptoms, attack‐related cutaneous allodynia, and migraine symptom severity) were assessed for each domain and by the number of unmet need domains. Results: Overall, 15,133 respondents met inclusion criteria, 26.0% (3930/15,133) reported current use of oral acute prescription medication to treat headache. Eligible participants had a mean age of 45.0 years, 73.6% [2892/3930] were women and 81.1% [3186/3930]) were White. A total of 95.8% (3765/3930) of respondents had at least 1 unmet acute treatment need; 89.5% (3516/3930) reported demanding attack characteristics, 74.1% (2912/3930) reported inadequate treatment response, and 16.1% (634/3930) presented with unique patient characteristics. Common areas of unmet need were rapid headache onset (65.3% [2567/3930]), moderate to severe disability (55.6% [2187/3930]), inadequate 2‐hours pain freedom (49.0% [1892/3930]), and headache recurrence within 24 hours (38.0% [1493/3930]). An increasing number of unmet treatment need domains was associated with worsening psychological symptoms, attack‐related cutaneous allodynia and migraine symptom severity. Conclusion: Nearly all MAST Study respondents using acute oral prescription medications for migraine reported at least 1 unmet treatment need. As unmet needs increased, so did coexisting conditions and symptom severity. [ABSTRACT FROM AUTHOR]

Objectives. To examine the impact of state texting bans on motor vehicle crash (MVC)–related emergency department (ED) visits. Methods. We used ED data from 16 US states between 2007 and 2014. We employed a difference-in-difference approach and conditional Poisson regressions to estimate changes in counts of MVC-related ED visits in states with and without texting bans. We also constructed age cohorts to explore whether texting bans have differential impacts by age group. Results. On average, states with a texting ban saw a 4% reduction in MVC-related ED visits (incidence rate ratio = 0.96; 95% confidence interval = 0.96, 0.97). This equates to an average of 1632 traffic-related ED visits prevented per year in states with a ban. Both primary and secondary bans were associated with significant reductions in MVC-related visits to the ED regardless of whether they were on all drivers or young drivers only. Individuals aged 64 years and younger in states with a texting ban saw significantly fewer MVC-related ED visits following its implementation. Conclusions. Our findings suggest that states' efforts to curb distracted driving through texting bans and decrease its negative consequences are associated with significant decreases in the incidence of ED visits that follow an MVC. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the baseline methods for the Migraine in America Symptoms and Treatment (MAST) Study and evaluate gender differences in sociodemographics and headache features; consultation and diagnosis patterns; and patterns of acute and preventive treatment use for migraine among study participants. Background: The MAST Study is a longitudinal, internet‐based panel study of symptoms, approaches to management, and unmet treatment needs among US adults with migraine. This analysis focuses on the initial cross‐sectional survey, conducted beginning in 2016, and is intended to update results from earlier national epidemiologic surveys of people with migraine in the United States. Methods: Respondents to the MAST Study were recruited from a US nationwide online research panel. Stratified random sampling identified a representative cohort of adults (aged ≥18 years). We administered a validated diagnostic screener based on modified ICHD‐3 beta criteria to identify individuals with migraine averaging at least 1 monthly headache day (MHD) over the previous 3 months. A baseline assessment evaluated sociodemographic and headache features, patterns of consultation and diagnosis, and use of acute and preventive medications for migraine. Frequency data and chi‐square contrasts (P < .05) were used to compare respondents based on gender. Results: Baseline survey data (N = 95,821) identified 18,353 respondents who met criteria for migraine, including 15,133 (women n = 11,049, men n = 4084) reporting at least 1 MHD for the preceding 3 months. The mean age of the sample was 43.1 (13.6) years; 73.0% of respondents were women, and 81.0% were Caucasian. Compared with men, women were younger (46.1 vs 42.0 years; P < .001); had more MHDs (5.6 vs 5.3; P < .001); and were more likely to report moderate or severe headache‐related disability (45.9% vs 35.8%; P < .001) and cutaneous allodynia (43.7% vs 29.5%; P < .001). The lifetime rate of medical consultation for headache was 79.8% overall and slightly higher in women than in men. Women were more likely than men to have been diagnosed with migraine (48.3% vs 38.8%, P < .001). While 95.1% of people with migraine currently used acute treatment, the majority (58.9%) used over‐the‐counter (OTC) drugs to the exclusion of prescription drugs, while 11.3% used exclusively prescription drugs, and 20.5% used both. Among acute prescription medication users, women were more likely than men to take triptans (17.7% vs 14.3%, P < .001), while men were more likely than women to take opioids (14.5% vs 9.2%, P < .001). Oral formulations were used predominately (92.7% of the medication users), but men were more likely to use nasal sprays (13.6% vs 9.4%, P < .001) and injectables (7.9% vs 3.4%, P < .001). Men (14.5%) were also significantly more likely than women (10.4%) to be taking daily oral preventive medication (P < .001). Conclusions: The MAST Study identified a large sample of women and men with migraine from a sampling frame that broadly resembles the US population. Low participation rate increases the risk of response bias, however, comparisons with Census data and prior population studies for the demographic and headache characteristics of the current sample suggest that findings are generalizable to the population of people with migraine. Women had more MHDs than men, and they were more likely to report migraine‐related disability and cutaneous allodynia. The lifetime consultation rate for headache was relatively high, but many with migraine symptoms reported never having received a diagnosis of migraine from a healthcare professional. Acute prescription and preventive migraine treatments are underused. Migraine persists as an underdiagnosed and undertreated public health problem in 2018, and there are many opportunities to improve the diagnosis and treatment of people with this painful, disabling condition. [ABSTRACT FROM AUTHOR]

Cushman suggested that impact of exchange rate volatility declines after the inclusion of the third-country effect. Like Cushman, when we use a linear analysis, we confirm his results. However, when we engage in asymmetric effects of exchange rate volatility which requires including nonlinear adjustment of volatility measures, the findings show more support to both exchange rate volatility influence and the third-country effect. Therefore, we propose that in examining exchange rate volatility effect on trade, consideration must be given to not just asymmetric effects of exchange rate volatility but also asymmetric effects of the third-country effect. We demonstrate these findings using monthly data from 54 Malaysian industries that export to the US and 63 Malaysian industries that import from the US. [ABSTRACT FROM AUTHOR]

In August 2015, flibanserin (brand name Addyi) was approved by the Food and Drug Administration (FDA) for treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. This article summarizes and promotes discussion regarding the numerous controversies that have enclosed flibanserin since the very beginning. This includes questions related to flibanserin's safety and efficacy and the validity of the clinical trials. Also included are philosophical considerations surrounding the diagnosis of hypoactive sexual desire disorder and pharmacological treatment of low libido. Based on the review of literature, authors judge flibanserin to be modestly effective and reasonably safe, and discuss the differences in philosophical perspectives with less definitive answers. [ABSTRACT FROM AUTHOR]

This research paper highlights the implications of judicial attempts to control police behavior in the United States of America. The discussion in this paper revolves around the general nature of 'exclusionary rules' discerned by the judicial decisions viz: Mapp vs Ohio (1961) where by the discretionary behavior of the police is scrutinized in detail. The consequent conduct and control of the judiciary in determining the constitutional framework for the police force as a 'safety value' for the 'constitutional rights' of the individuals, soliciting the warrants and/or judicial custody. The paper traces the historical evolution of the police force over the years, the comparative analysis of different police forces, and gradual emergence of jury system in the United States of America. The behavioral and structural reforms of the police force through the gradual development of the judicial system to check the discretionary powers exercised by police in the United States have been at the forefront of making sure that the individual liberties are not violated, since it's the important constitutional requirement on the part of the executive, legislative and the judiciary to collectively share that burden. This research paper discusses the attempts on the part of the judiciary to confine the limits of the police behavior through constitutional means and within the context of its historical development. According to the constitution of the United States of America no branch of the state would have unbridled powers, and hence there ought to be effective mechanism of checks and balances. Although the Fourth Amendment provides that, "the right of the people to be secure against unreasonable searches and seizures, shall not be violated" defendants involved in criminal prosecutions in state courts have not always been able to exclude illegal obtained evidence. Hence having the judicial control on the unrestrained powers of police through Mapp vs Ohio decision, and Blazac vs Porto Rico decision to strengthen the jury system in the United States of America are the classis examples of ensuring individual liberty. Thus these notions are pivot of this research paper. [ABSTRACT FROM AUTHOR]

Age, gender, and cross-national differences of children ages 9 through 16 in Pakistan (n = 463) and the United States (n = 500) are examined on four bipolar temperament styles: Extroversion-introversion, practical-imaginative, thinking-feeling, and organized-flexible. In general, Pakistani children prefer extroverted over introverted, practical over imaginative, and organized over flexible styles. Although their preference for thinking and feeling styles is balanced, gender differences are significant. Males generally prefer a thinking style and females generally prefer a feeling style. Gender and age differences are found on practical-imaginative and organized-flexible styles. Cross-national differences are found on practical-imaginative and organized-flexible styles. In contrast to children in the US, children in Pakistan are more likely to prefer practical and organized styles. [ABSTRACT FROM AUTHOR]

The well-anticipated and well-documented demographic shift attributed to ageing of the baby boomer generation will place significant demands upon the health-care industry in the future. Significant resources such as the nurse workforce, will be needed to provide health-care services to this cohort. There is a looming shortage of professional and paraprofessional nurses. This paper evaluates strategies that can be utilized to decrease the rate of the nursing shortage, while retaining the current supply of nurses. Recommendations for solving the nursing shortage problem include enhancing the work environment through fostering open communication, improving technology, nurse empowerment, building longlasting and fulfilling partnerships, and efficient workplace organization. [ABSTRACT FROM AUTHOR]

Eagle Ford shale formations have great hydrocarbon potential to minimise the supply and demand problems of the overgrowing population. Whereas, due to reduced permeability and marginal porosity, it is very difficult to produce from these formations. Previously, hydraulic fracturing and acidizing techniques are used to produce the hydrocarbons from tight gas shale formations; however, due to technical difficulties and environmental problems have led to a ban on these techniques in many countries. Therefore, it is suggested to use water-less fracturing methods to avoid these problems. Recently, liquid nitrogen (LN 2) cooling have shown a great potential to mitigate technical and environmental flaws, which works on the principle of providing sudden thermal shocks in the pore matrix, thus inducing micro-cracks and enhancing the petro-physical potential. In this study, we have collected tight gas shale samples from the Eagle Ford shale's Upper Late Cretaceous geologic formation in the United States. Initially, these samples were exposed to LN 2 for various time intervals of 30, 60, and 90 min and were characterised based on their petro-physical, morphology, topography, and rock mechanical properties before and after LN 2 exposure. To accomplish that, various techniques were used such as core flooding, porosity determination, microstructural characterisation via field emission scanning electron spectroscopy (FESEM) and energy dispersive spectroscopy (EDS), topographic characterisation via atomic force microscopy (AFM), and rock mechanical characterisation via nano-indentation technique. It is evident from our results that LN 2 cooling has a substantive effect on petro-physical properties by increasing permeability from 12 nano-Darcy (nD) to 2.6 milli-Darcy (mD) and porosity from 2.32% to 4.46%. Similarly, topographic properties have shown an increase in surface roughness from 177 nm to 692 nm, and hardness (indentation moduli, GPa) was substantially reduced due to optimum exposure of LN 2 at 90 min. Further, thermal shocks of LN 2 cooling have induced vivid micro-cracks in the pore matrix up to 7 μm. In a nutshell, it is vital to augment the effects of LN 2 cooling on microstructural, petro-physical, topography, and rock mechanical properties for better understanding in the development of hydrocarbon potential in Eagle Ford shale formations. • Eagle Ford shale samples were acquired from upper late Cretaceous geologic formation in the United States. • Various time intervals (30, 60, and 90 min) were selected for liquid nitrogen (LN 2) cooling treatment. • Sudden thermal shocks induced by liquid nitrogen (LN 2) cooling were very effective in Eagle Ford shale development. • Topographical, rock mechanical, mineralogical, and petro-physical characteristics were argued before and after LN 2 cooling. [ABSTRACT FROM AUTHOR]

To examine the test-retest reliability and concurrent validity of a new self-report measure of mobility function by comparing it with observed mobility, self-reported activity of daily living (ADL) function, and performance-based measures of gait and balance.Cross-sectional study involving two groups of older adults.Community sites in Seattle, Washington, and Waterloo, Ontario, Canada.Fifty-four adults aged 70 and older, recruited.Subjects completed the Environmental Analysis of Mobility Questionnaire (EAMQ), reporting frequency of encounter and avoidance of 24 features of the physical environment, grouped into eight dimensions, on two occasions 1 week apart. Subjects were observed and videotaped during six trips into the community; frequency of encounters with environmental features within the eight dimensions was recorded. EAMQ encounter and avoidance scores were compared with observed environmental encounters, with disability in ADLs and instrumental ADLs (IADLs), and lower extremity functional measures including the Short Physical Performance Battery (SPPB) and the Berg Balance Test.EAMQ test-retest reliability was high for all eight dimensions (intraclass correlation coefficient range=0.81–1.0) and for summary encounter (0.98) and avoidance (0.96) scores. Observed mobility was significantly correlated (Spearman correlation= r) with EAMQ summary encounter (r=0.66) and avoidance (r=−0.58) scores. Moderate correlations were present between the EAMQ (encounter or avoidance) and observed mobility in the distance, temporal, terrain, posture, load, and density dimensions but not in the attention and ambient dimensions. EAMQ encounter/avoidance was significantly associated with ADL and IADL ability and performance on the SPPB and Berg Balance Test.Self-reported frequency of encounter and avoidance of specific environmental features appears to be a valid method for determining environmentally specific mobility disability but needs to be confirmed in a larger sample. [ABSTRACT FROM AUTHOR]

Background: To determine accuracy of ultrasound (US) kidney, ureter and bladder (KUB) compared to un-enhanced helical CT (UHCT) in patients with renal failure in the diagnosis of stone and obstruction. Methods: This is a case controlled study conducted in the period from June 2000 to July 2003 at a university hospital. All patients had both US and UHCT scan. Patients with serum creatinine ≥ 1.8 mg/dl were included in the study. Only direct visualization of stone was considered as confirmatory. In both the studies, UHCT and US, presence of stone and obstruction were noted. The relevant biochemicals, radiological and clinical records of all the patients were analyzed. Data was analyzed using commercially available software. Results: During the period of study 864 patients had UHCT for evaluation of the urinary tract in patients presenting with flank pain. Out of these 34 patients had both UHCT and US done within a span of one day and had serum creatinine of ≥ 1.8 mg/dl. Mean age was 48 ± 15.8 years and 59% of patients were males. UHCT identified renal stones in 21 (62%), whereas 17 of these were identified on US, with a sensitivity of 81%. Of the four patients with renal stones missed on US, three were identified on plain x-ray; the mean size of stones missed was 6.3 mm. Of the 22 (65%) patients with ureteric stone on UHCT, US could only identify 10; a further 7 were identified on x-ray KUB, giving a sensitivity of 45% (US alone) and 77% (US with x-ray KUB). Conclusions: US is sensitive and specific for renal stones, 81% and 100% and for hydronephrosis, 93% and 100%, respectively. Its sensitivity to pick ureteric stone (46%) and to identify hydroureter (50%) is low. Addition of x-ray KUB abdomen increases the sensitivity for ureteric stones to 77%. [ABSTRACT FROM AUTHOR]

Tall buildings, or skyscrapers, are icons of cities, symbols of corporate power, and a mark of national pride. Certain skyscrapers, such as the John Hancock Center and the Sears Tower in Chicago, are also marvels of engineering that have paved the way for ever increasing heights of structural systems. Since the 1960s, a series of new structural systems has been introduced with the objective of achieving economically-competitive and aesthetically-pleasing tall buildings without compromising safety. One of the great structural engineers responsible for the new structural systems was Dr. Fazlur Rahman Khan. This paper provides a biographical sketch of Dr. Khan and discusses some of his innovations pertaining to high-rise buildings. It shows that his contributions led to a new vertical scale for the modern day city.Key words: aesthetics, architecture, innovation, structural system, tall building.Les grands édifices, ou gratte-ciel, sont l'emblème des villes, la manifestation symbolique des puissances corporatives, et sont représentatifs de la fierté nationale. Certains gratte-ciel, comme le Centre John Hancock et la Tour Sears à Chicago, sont aussi des merveilles d'ingénierie qui ont pavé la voie à des systèmes structuraux atteignant des hauteurs toujours plus grandes. Depuis les années 60, une série de nouveaux systèmes structuraux a été introduite, avec pour objectif la réalisation de grands édifices compétitifs économiquement et plaisants esthétiquement, sans compromettre la sécurité. L'un des grands ingénieurs en structures responsables de ces nouveaux systèmes structuraux est Dr Fazlur Rahman Khan. Cet article présente un aperçu biographique de Dr Khan et discute quelques-unes de ces innovations se rattachant aux gratte-ciel. L'article montre que sa contribution a mené à une nouvelle échelle verticale pour nos villes modernes.Mots clés : esthétique, architecture, innovation, systèmes structuraux, grand édifice.[Traduit par la Rédaction] [ABSTRACT FROM AUTHOR]

Presents the review and recommendations of the National Heart, Lung, and Blood Institute and the Office of Rare Diseases of the United States National Institutes of Health workshop on Peripartum Cardiomyopathy (PPCM). Selection of participants in the workshop; Evidence of PPCM; Standardized medical definition; Diagnosis; Management; Prognosis; Need for a registry to provide structure for future research; Conclusions.

Focuses on the conference on Nutrition and Immunity, which was held in Atlanta, Georgia, 1997. Information on the sponsors of the conference; How the conference focused on the relationship between nutrition, health and immunity; Other topics discussed at the conference.

Background: Cutaneous allodynia is a common clinical feature of migraine that has been associated with reduced efficacy of acute migraine treatments and an increased risk of disease progression.Objective: Identify factors associated with allodynia in a sample of adults with migraine.Methods: An online survey panel was used to identify adults with migraine who averaged at least 1 monthly headache day over the previous 3 months. Data on sociodemographics, headache frequency, headache pain intensity, migraine symptom severity, medication use, depression and anxiety, and cutaneous allodynia (via the Allodynia Symptom Checklist) were obtained. Binary logistic modeling predicted the presence of allodynia. Odds ratios and 95% confidence intervals (CI) were calculated.Results: In total, 15,133 individuals with migraine met the eligibility criteria. Mean age was 43.1 years, 73.0% were female, and 81.0% were Caucasian. Allodynia was present in 39.9%. The fully adjusted model, controlling for sociodemographics and headache features, demonstrated that allodynia was significantly associated with a higher migraine symptom severity score (odds ratio 1.17, confidence interval 1.15, 1.19) and more severe pain intensity (odds ratio 1.11, confidence interval 1.08, 1.14); probable depression and/or anxiety (odds ratio 1.83, confidence interval 1.67, 2.00); and overuse of acute medication (odds ratio 1.23, confidence interval 1.09, 1.38). A higher number of monthly headache days increased the likelihood of allodynia, but the effect was attenuated in the fully adjusted model.Conclusion: In a representative sample of US adults with migraine, there were significant associations between allodynia and headache frequency and intensity, anxiety and/or depression, symptom severity, and acute medication overuse. [ABSTRACT FROM AUTHOR]

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students., (© 2023 American Association for Anatomy.)

The coronavirus disease 2019 (COVID-19) pandemic created a crisis that disproportionately affected populations already disadvantaged with respect to access to health care systems and adequate medical care and treatments. Understanding how and where health care disparities are most widespread is an important starting point for exploring opportunities to mitigate such disparities, especially within our patient population with liver disease. In a webinar in LiverLearning, we discussed the impact of the pandemic on the United States, United Kingdom and Canada, highlighting the disproportionate effects on infection rates and death for certain ethnic minorities, those socioeconomically disadvantaged and living in higher density areas, and those working in health care and other essential jobs. We set forth a "call to action" for members of the American Association for the Study of Liver Diseases and the larger community of providers of liver disease care to generate viable solutions to improve access to care and vaccination rates of our patients against COVID-19, and in general help reduce health care disparities and improve the health of disadvantaged populations within their communities. Solutions will likely involve personalized interventions and messaging for communities that honor local leaders and embrace the diverse needs and different cultural sensitivities of our unique patient populations., (© 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.)

The world has been facing the COVID-19 pandemic since December 2019. Timely and efficient diagnosis of COVID-19 suspected patients plays a significant role in medical treatment. The deep transfer learning-based automated COVID-19 diagnosis on chest X-ray is required to counter the COVID-19 outbreak. This work proposes a real-time Internet of Things (IoT) framework for early diagnosis of suspected COVID-19 patients by using ensemble deep transfer learning. The proposed framework offers real-time communication and diagnosis of COVID-19 suspected cases. The proposed IoT framework ensembles four deep learning models such as InceptionResNetV2, ResNet152V2, VGG16, and DenseNet201. The medical sensors are utilized to obtain the chest X-ray modalities and diagnose the infection by using the deep ensemble model stored on the cloud server. The proposed deep ensemble model is compared with six well-known transfer learning models over the chest X-ray dataset. Comparative analysis revealed that the proposed model can help radiologists to efficiently and timely diagnose the COVID-19 suspected patients., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Ahmed I. Iskanderani et al.)

Background/objectives: The Institute of Medicine (IOM) recommends gestational weight gain (GWG) of 5-9 kg in women with a body mass index (BMI) ≥ 30 kg/m 2 . Debate continues as to whether GWG less than that recommended is safe in women with gestational diabetes mellitus (GDM). The study objective was to examine maternal and infant outcomes for obese women with GDM who lost weight or gained 0-5 kg during pregnancy., Subjects/methods: A 7-year retrospective cohort study of pregnancy outcomes for obese women with GDM recorded in the Atlantic Diabetes in Pregnancy database was conducted. We examined pregnancy outcomes for mothers with GDM and a BMI ≥ 30 who either lost weight or gained 0-5 kg (Group 1, n = 237) and women who gained 5-9 kg (Group 2, n = 77). We further divided groups 1 and 2 into women treated by diet only (GDM-D) (n = 120) and those requiring additional treatment with insulin (GDM-I) (n = 194)., Results: GDM-D women in Group 1 were more likely to deliver earlier (38.9 vs 39.8 weeks, p < 0.01), to develop pregnancy induced hypertension (PIH) (15.4% v 0%; p = 0.02) or have a post-partum haemorrhage (PPH) (13.2% vs 0, p = 0.03) compared to women in Group 2. Rates of prematurity were higher in group 1 vs 2 (14.3% vs 0%, p = 0.03). However, further logistic regression analysis adjusted for smoking status, family history of diabetes, ethnicity and age determined no significant difference in maternal or infant outcomes for women in Group 1 compared to those in Group 2., Conclusion: In our population, weight gain less than IOM guideline appears safe and is not associated with any further increase in adverse outcomes. However, validation through a prospective study with a larger obese GDM cohort is required before the findings presented here could be recommended for routine clinical use.

Objectives: To better understand the role of nutrition in older adults (aged 50 years or older) with bipolar disorders (OABD), we conducted a systematic review of the literature and appraise existing evidence., Methods: Following PRISMA guidelines, we searched databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Register, FDA website, and clinical trial registries through 2019 for eligible reports. The search string combined MeSH terms for bipolar disorder, nutrition and older adults. This was supplemented by snowball searching of references in relevant studies and authors were contacted to request their work where necessary. All included studies were rated with the National Institutes of Health Study Quality Assessment Tools based on study designs., Results: Of 2280 papers screened, ten studies including eight observational and two interventional studies. The topic foci of the papers examined several nutrients, (including vitamin B12, vitamin D, coenzyme Q10, homocysteine, and folate), nutritional deficiencies and biochemical correlates. The prevalence rates of deficiencies varied with specific nutrients (3.7% to 71.6% for Vitamin B12 and 34.6% for Vitamin D), and between inpatient versus outpatient populations. While nutritional interventions appeared to be associated with improvement in both affective and cognitive outcomes, the sample sizes of OABD varied and were generally small., Conclusion: While there is evidence for the benefits of nutritional interventions on affective, cognitive and overall outcome in OABD, the quality of the evidence is limited. Our findings underscore the need for high quality studies to inform evidence-based guidelines for nutritional assessment and supplemention in OABD., Competing Interests: The authors declare no conflicts of interest to the content of the manuscript.

Objectives: Left atrial appendage thrombus (LAT) was an exclusion criterion in the seminal transcatheter aortic valve replacement (TAVR) trials; however, such patients do undergo TAVR in the 'real-world' setting. This study sought to analyse outcomes after TAVR in patients with LAT or spontaneous echo contrast (SEC)., Methods: All patients undergoing TAVR at our institution between March 2009 and December 2014 were prospectively analysed. The presence of LAT or SEC was determined via a retrospective chart review. Primary outcomes included 30-day and 1-year neurological events as well as mortality., Results: Of the 369 patients undergoing TAVR, 3.8% (14) were found to have LAT and 6.8% (25) were found to have SEC, and they were separately compared to patients who did not have LAT or SEC. Significant differences were noted between groups with regard to preoperative renal function, atrial fibrillation and ejection fraction. Preoperative atrial fibrillation was the only independent predictor of LAT. No perioperative complications were associated with the presence of LAT or SEC. Specifically, no patient with LAT or SEC experienced a postoperative neurological event. While neither LAT nor SEC was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality (odds ratio 3.573, 95% confidence interval 1.040-12.28; P = 0.042)., Conclusions: The current study suggests that TAVR may be performed in patients with LAT and SEC with a low risk of embolic complications. While neither was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality. Larger studies are needed to better study this phenomenon.

Background: Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults., Methods: Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared., Results: Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to .88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500)., Conclusions: Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a "survivorship tendency" to never give up, despite collectively higher mortality risk., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Once again, efforts are being made to overhaul the US health care system. Democrats and Republicans have conflicting views on how to repair this ailing system. However, this is not a new phenomenon. Reformers have long struggled to form a universal health care system only to find themselves in conflict with groups whose financial stake is threatened as well as numerous labor associations who are concerned about a loss of power. This struggle is also caused by differences in ideologies. This article surveys social movements for national health insurance (NHI) that occurred in the United States and will examine features that prevented NHI policy formation.

Wilson disease, a genetic disorder of copper metabolism, presents typically in the second and third decades of life with hepatic or neuropsychiatric disease. Clinical presentations often vary depending on age and degree of onset; although clinical and biochemical testing can usually establish a diagnosis, the data are difficult to interpret in some patients. Correctly identifying patients from nonaffected carriers is important because treatment is lifelong. Genetic testing has greatly improved the ability to diagnose Wilson disease in affected patients and in their siblings even without clear-cut clinical and biochemical data. Direct sequencing of ATP7B for disease-specific mutations is now the standard for molecular diagnosis. However, haplotype analysis is useful when only a single mutation can be found. In specific populations with a higher frequency of a specific mutation, direct testing for these mutations can simplify and expedite molecular diagnosis. The molecular genetic test is now available commercially and in specific research laboratories; however, barriers to its use include cost, understanding when to perform it, and interpretation. This test eventually will be incorporated into the diagnostic armamentarium, allowing timely diagnosis and perhaps reversal or even prevention of further copper-induced injury.

This article discusses the science of regenerative medicine and presents evidence that investments towards the development of this technology will reduce total health care output. Use of regenerative medicine will also be an important factor in eliminating chronic diseases such as diabetes, heart disease, and Parkinson's disease. Investment in regenerative medicine is a sound strategy for several reasons: human suffering will be reduced, if not eliminated; and the economy will be stimulated by creating employment opportunities, generating additional income and tax revenues, increasing worker productivity, creating new conglomerates, and reducing insurance costs. This article discusses some of the latest advances in regenerative medicine as well as the progress that has been made in the development of new stem cell therapies.

This article examines the factors that comprise long-term health care and the impact that the aging population will have in dramatically increasing the costs of long-term health care in the United States if current health policies are not amended. It further analyzes the reasons that will cause the health care expenditures to expand. It also discusses the economic challenges and the impact that absent reform can have on state and federal budgets, ultimately affecting the national economy. Aside from that, this article presents numerous options that communities across the nation can embark on to reduce health care costs and it briefly glances at the proposed legislation called America's Affordable Health Choices Act of 2009 that was submitted by the House Committee on Ways and Means and in summary discusses the key features of the bill.

This special edition of the Journal of Autoimmunity is dedicated to celebrate the enormous contributions of Dr. Noel Rose, a physician-scientist, someone that can be readily anointed as a gifted scientist who laid down the foundation and fundamental concepts of human autoimmunity. Dr. Rose performed a series of landmark studies that extend back more than 50 years and whose work is the cornerstone of the commonly used term "from the bench to the bedside." The studies included not only characterization of a normal immune response but, more importantly, defining the nature of not only the antigen, but also the aberrant response that results in organ, tissue specific reactions and immunopathology. These pioneering studies contributed to the biochemical nature of antigens, dissection of the immune repertoire, the recognition of the importance of genetics and environment, and the distinctions between a normal and an autoimmune response. Hence, this volume has been coined "Navigating the Passage Between Charybdis and Scylla: Recognizing the Achievements of Noel Rose."

Viremia is one of the features of dengue virus infection among the flaviviruses. Dengue virus infection results in a spectrum of clinical symptoms, ranging from undifferentiated flu-like illness, mild dengue fever, to dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS), a life-threatening illness. Several mechanisms have been hypothesized based primarily on data collected from post-acute clinical phase to account for DHF/DSS. Lack of a suitable animal model for DHF/DSS has hindered progress in defining the etiology of DHF/DSS. Levels of circulating dengue virus have been well-correlated to severe dengue disease. However, the cell lineage(s) serving as a primary target for the source of viremia are largely unknown. Results from in vivo and in vitro pilot studies using molecular and more advanced technologies reveal that dengue virus appears to be associated with platelets and the megakaryocytic lineage. The observation may partially explain the dysfunction of platelets observed in dengue affected patients.