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Background Childhood obesity is a complex multifaceted condition, which is influenced by genetics, environmental factors, and their interaction. However, these interactions have mainly been studied in twin studies and evidence from population-based cohorts is limited. Here, we analyze the interaction of an obesity-related genome-wide polygenic risk score (PRS) with sociodemographic and lifestyle factors for BMI and waist circumference (WC) in European children and adolescents. Methods The analyses are based on 8609 repeated observations from 3098 participants aged 2–16 years from the IDEFICS/I.Family cohort. A genome-wide polygenic risk score (PRS) was calculated using summary statistics from independent genome-wide association studies of BMI. Associations were estimated using generalized linear mixed models adjusted for sex, age, region of residence, parental education, dietary intake, relatedness, and population stratification. Results The PRS was associated with BMI (beta estimate [95% confidence interval (95%—CI)] = 0.33 [0.30, 0.37], r2 = 0.11, p value = 7.9 × 10−81) and WC (beta [95%—CI] = 0.36 [0.32, 0.40], r2 = 0.09, p value = 1.8 × 10−71). We observed significant interactions with demographic and lifestyle factors for BMI as well as WC. Children from Southern Europe showed increased genetic liability to obesity (BMI: beta [95%—CI] = 0.40 [0.34, 0.45]) in comparison to children from central Europe (beta [95%—CI] = 0.29 [0.23, 0.34]), p-interaction = 0.0066). Children of parents with a low level of education showed an increased genetic liability to obesity (BMI: beta [95%—CI] = 0.48 [0.38, 0.59]) in comparison to children of parents with a high level of education (beta [95%—CI] = 0.30 [0.26, 0.34]), p-interaction = 0.0012). Furthermore, the genetic liability to obesity was attenuated by a higher intake of fiber (BMI: beta [95%—CI] interaction = −0.02 [−0.04,−0.01]) and shorter screen times (beta [95%—CI] interaction = 0.02 [0.00, 0.03]). Conclusions Our results highlight that a healthy childhood environment might partly offset a genetic predisposition to obesity during childhood and adolescence.

Colorectal cancer survivors report pain and psychological distress to be burdensome long-term cancer consequences. Quality cancer survivorship care includes interventions for managing these symptoms. Yet, no studies have tested the efficacy of an accessible behavioral intervention for colorectal cancer survivors with pain and comorbid psychological distress. This paper reports on the feasibility (i.e., accrual, attrition, and adherence to study procedures), engagement, acceptability, and descriptive outcomes of a telephone-based coping skills training (CST) intervention. This randomized pilot trial assigned colorectal cancer patients (N=31) to 5 sessions of CST or standard care. CST sessions focused on cognitive-behavioral theory-based coping skills tailored to colorectal cancer symptoms of pain and psychological distress. Participants completed assessments of pain severity, self-efficacy for pain management, health-related quality of life, and psychological distress at baseline, post-treatment, and 3-month follow-up. Data indicated strong feasibility, evidenced by high completion rates for intervention sessions and assessments (93% completed all sessions; M=48.7 days; baseline=100%; post-treatment=97%; 3-month follow-up=94%). Participants demonstrated robust engagement with CST (M days per week with reported skills use=3.8) and reported high protocol satisfaction (M=3.6/4.0). Descriptive statistics showed self-efficacy for pain management and health-related quality of life improved for all participants. Findings suggest that a telephone-based CST intervention has strong feasibility, evidenced by accrual, low attrition, and adherence to intervention sessions and assessments. Likewise, participant engagement and acceptability with CST were high. These data provide a foundation for larger randomized efficacy trials of the telephone-based CST intervention.

Funding: A.N. Wright’s participation was through a program sponsored through the International Space Science Institute, and was partially funded by the Science and Technology Facilities Councils (STFC) Grant (ST/N000609/1). We present an example of one-to-one correspondence between poleward moving auroral arcs (PMAAs) and Pc5 oscillations observed at the Time History of Events and Macroscale Interactions during Substorms (THEMIS) Ground Based Observatory station Gillam. The PMAAs consisted of four successive intensifications (named PMAA1, PMAA2, PMAA3 and PMAA4) with a period of 3∼4 min over the magnetic latitudes from 68° to 70° in the auroral oval and varied coherently with the H-component of magnetic field Pc5 oscillations. PMAA1 and PMAA2 appeared clearly at the magnetic latitude ∼69°, and the following two PMAAs, which were dimmer, appeared at the magnetic latitude ∼68°. PMAA1 and PMAA2 exhibited features of field-line resonances (FLRs) with the maximum luminosity at the magnetic latitude ∼69.5° and ∼69.4°, respectively. The ground Pc5 oscillations were concurrent with toroidal mode Pc5 oscillation observed at the THEMIS-D, -E, and -A satellites at ∼4 MLT in the outer magnetosphere. The magnetic and electric field oscillations at THEMIS were synchronized with the PMAAs. The magnetic energy of the THEMIS Pc5 oscillations is estimated using a numerical model of damped toroidal oscillations and compared with the kinetic energy of precipitating electrons associated with the field aligned current (FAC) carried by the toroidal oscillations. The result reveals that the Pc5 magnetic energy is much larger than the kinetic energy, implying the magnetic energy is important for producing auroral emissions in the ionosphere. We also perform a simulation of the relationship between PMAAs and toroidal mode Pc5 oscillations. The simulation explains the observed spatial and temporal structures of the PMAAs. Publisher PDF

Telemedicine has been available for decades but has had minimal use in the USA prior to the COVID-19 pandemic. We aim to educate readers on the benefits of telemedicine and provide insight from our experience to optimize care in this setting.The COVID-19 pandemic ushered in a massive increase in use of telemedicine, offering several advantages with comparable clinical outcomes.This review summarizes the recent vast expansion of telemedicine, describes the benefits specific to minimally invasive gynecologic surgery, and offers practical suggestions for maintaining a successful practice that incorporates both in-person and virtual experiences for patients, anticipating continued use of telemedicine beyond the end of the current public health emergency.

Diffuse intrinsic pontine glioma (DIPG) remains a fatal brainstem tumor demanding innovative therapies. As B7-H3 (CD276) is expressed on central nervous system (CNS) tumors, we designed B7-H3–specific chimeric antigen receptor (CAR) T cells, confirmed their preclinical efficacy, and opened BrainChild-03 (NCT04185038), a first-in-human phase I trial administering repeated locoregional B7-H3 CAR T cells to children with recurrent/refractory CNS tumors and DIPG. Here, we report the results of the first three evaluable patients with DIPG (including two who enrolled after progression), who received 40 infusions with no dose-limiting toxicities. One patient had sustained clinical and radiographic improvement through 12 months on study. Patients exhibited correlative evidence of local immune activation and persistent cerebrospinal fluid (CSF) B7-H3 CAR T cells. Targeted mass spectrometry of CSF biospecimens revealed modulation of B7-H3 and critical immune analytes (CD14, CD163, CSF-1, CXCL13, and VCAM-1). Our data suggest the feasibility of repeated intracranial B7-H3 CAR T-cell dosing and that intracranial delivery may induce local immune activation. Significance: This is the first report of repeatedly dosed intracranial B7-H3 CAR T cells for patients with DIPG and includes preliminary tolerability, the detection of CAR T cells in the CSF, CSF cytokine elevations supporting locoregional immune activation, and the feasibility of serial mass spectrometry from both serum and CSF. This article is highlighted in the In This Issue feature, p. 1

Spin - the beautification of study results to emphasise benefits or minimise harms - is a deceptive reporting strategy with the potential to affect clinical decision-making adversely. Few studies have investigated the extent of spin in systematic reviews. Here, we sought to address this gap by evaluating the presence of the nine most severe forms of spin in the abstracts of systematic reviews on treatments for postoperative nausea and vomiting (PONV). PONV has the potential to increase hospital costs and patient burden, adversely affecting outcomes.We developed search strategies for MEDLINE and Embase to identify systematic reviews focused on PONV. Following title and abstract screening of the reviews identified during the initial search, those that met inclusion criteria were evaluated for the presence of spin and received a revised AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) appraisal by two investigators in a masked, duplicate manner. Study characteristics for each review were also extracted in duplicate.Our systematic search returned 3513 studies, of which 130 systematic reviews and meta-analyses were eligible for data extraction. We found that 29.2% of included systematic reviews contained spin (38/130). Eight of the nine types of spin were identified, with spin type 3 ('selective reporting of or overemphasis on efficacy outcomes or analysis favouring the beneficial effect of the experimental intervention') being the most common. Associations were found between spin and funding source. Spin was more likely in the abstracts of privately funded than nonfunded studies, odds ratio (OR) 2.81 [95% confidence interval (CI), 0.66 to 11.98]. In the abstracts of studies not mentioning funding spin was also more likely than in nonfunded studies, OR 2.30 (95% CI, 0.61 to 8.70). Neither of these results were statistically significant. Significance was found in the association between the presence of spin and AMSTAR-2 ratings: 'low' quality studies were less likely to contain spin than 'high' quality, OR 0.24 (95% CI, 0.07 to 0.88): 'critically low' studies were also less likely to contain spin than 'high' quality studies, OR 0.21 (95% CI, 0.07 to 0.65). There were no other associations between spin and the remaining extracted study characteristics or AMSTAR-2 ratings.Spin was present in greater than 29% of abstracts of systematic reviews and meta-analyses regarding PONV. Various stakeholders must take steps to improve the reporting quality of abstracts on PONV.

The ability of computed tomography (CT) to distinguish between benign congenital lung malformations and malignant cystic pleuropulmonary blastomas (PPBs) is unclear.To assess whether chest CT can detect malignant tumors among postnatally detected lung lesions in children.This retrospective multicenter case-control study used a consortium database of 521 pathologically confirmed primary lung lesions from January 1, 2009, through December 31, 2015, to assess diagnostic accuracy. Preoperative CT scans of children with cystic PPB (cases) were selected and age-matched with CT scans from patients with postnatally detected congenital lung malformations (controls). Statistical analysis was performed from January 18 to September 6, 2020. Preoperative CT scans were interpreted independently by 9 experienced pediatric radiologists in a blinded fashion and analyzed from January 24, 2019, to September 6, 2020.Accuracy, sensitivity, and specificity of CT in correctly identifying children with malignant tumors.Among 477 CT scans identified (282 boys [59%]; median age at CT, 3.6 months [IQR, 1.2-7.2 months]; median age at resection, 6.9 months [IQR, 4.2-12.8 months]), 40 cases were extensively reviewed; 9 cases (23%) had pathologically confirmed cystic PPB. The median age at CT was 7.3 months (IQR, 2.9-22.4 months), and median age at resection was 8.7 months (IQR, 5.0-24.4 months). The sensitivity of CT for detecting PPB was 58%, and the specificity was 83%. High suspicion for malignancy correlated with PPB pathology (odds ratio, 13.5; 95% CI, 2.7-67.3; P = .002). There was poor interrater reliability (κ = 0.36 [range, 0.06-0.64]; P .001) and no significant difference in specific imaging characteristics between PPB and benign cystic lesions. The overall accuracy rate for distinguishing benign vs malignant lesions was 81%.This study suggests that chest CT, the current criterion standard imaging modality to assess the lung parenchyma, may not accurately and reliably distinguish PPB from benign congenital lung malformations in children. In any cystic lung lesion without a prenatal diagnosis, operative management to confirm pathologic diagnosis is warranted.

We report results from a search for neutrino-induced neutral current (NC) resonant Δ(1232) baryon production followed by Δ radiative decay, with a ⟨0.8⟩ GeV neutrino beam. Data corresponding to MicroBooNE’s first three years of operations (6.80×1020 protons on target) are used to select single-photon events with one or zero protons and without charged leptons in the final state (1γ1p and 1γ0p, respectively). The background is constrained via an in situ high-purity measurement of NC π0 events, made possible via dedicated 2γ1p and 2γ0p selections. A total of 16 and 153 events are observed for the 1γ1p and 1γ0p selections, respectively, compared to a constrained background prediction of 20.5±3.65(syst) and 145.1±13.8(syst) events. The data lead to a bound on an anomalous enhancement of the normalization of NC Δ radiative decay of less than 2.3 times the predicted nominal rate for this process at the 90% confidence level (C.L.). The measurement disfavors a candidate photon interpretation of the MiniBooNE low-energy excess as a factor of 3.18 times the nominal NC Δ radiative decay rate at the 94.8% C.L., in favor of the nominal prediction, and represents a greater than 50-fold improvement over the world’s best limit on single-photon production in NC interactions in the sub-GeV neutrino energy range.

We present a measurement of νe interactions from the Fermilab Booster Neutrino Beam using the MicroBooNE liquid argon time projection chamber to address the nature of the excess of low energy interactions observed by the MiniBooNE Collaboration. Three independent νe searches are performed across multiple single electron final states, including an exclusive search for two-body scattering events with a single proton, a semi-inclusive search for pionless events, and a fully inclusive search for events containing all hadronic final states.With differing signal topologies, statistics, backgrounds, reconstruction algorithms, and analysis approaches, the results are found to be either consistent with or modestly lower than the nominal νe rate expectations from the Booster Neutrino Beam and no excess of νe events is observed., United States Department of Energy (DOE) DE-AC02-07CH11359 National Science Foundation (NSF), Swiss National Science Foundation (SNSF), European Commission, UK Research & Innovation (UKRI), Science & Technology Facilities Council (STFC), Royal Society of London

New tumor types are continuously being described with advances in molecular testing and genomic analysis resulting in better prognostics, new targeted therapy options and improved patient outcomes. As a result of these advances, pathological classification of tumors is periodically updated with new editions of the World Health Organization (WHO) Classification of Tumors books. In 2021, WHO Classification of Tumors of the Central Nervous System, 5

Background: The benefits of pimobendan in the treatment of congestive heart failure (CHF) in cats with hypertrophic cardiomyopathy (HCM) have not been evaluated prospectively. Hypothesis/objectives: To investigate the effects of pimobendan in cats with HCM and recent CHF and to identify possible endpoints for a pivotal study. We hypothesized that pimobendan would be well-tolerated and associated with improved outcome. Animals: Eighty-three cats with HCM and recently controlled CHF: 30 with and 53 without left ventricular outflow tract obstruction. Methods: Prospective randomized placebo-controlled double-blind multicenter nonpivotal field study. Cats received either pimobendan (0.30 mg/kg q12h, n = 43), placebo (n = 39), or no medication (n = 1) together with furosemide (

STUDY OBJECTIVE: Surgeons employ various methods for evaluating what is considered a common occurrence after gynecologic operations, postoperative urinary retention (POUR). Few have reported the incidence of POUR with a liberal voiding protocol (no requirement to void prior to discharge). The primary objective of this study is to evaluate the risk of POUR after benign gynecologic surgery, comparing a liberal voiding protocol to more strict voiding protocols. Secondary outcomes include length of hospital stay and urinary tract infection (UTI). DESIGN: Retrospective cohort study. SETTING: Quaternary-care academic hospital in the United States. PATIENTS: Patients undergoing hysterectomy or myomectomy at Cedars-Sinai Medical Center from August 2017 through July 2018 (n=652). Cases involving incontinence operations, correction of pelvic organ prolapse, malignancy, or peripartum hysterectomy were excluded. INTERVENTIONS: Hysterectomy, myomectomy MEASUREMENTS AND MAIN RESULTS: POUR, defined as the need for re-catheterization within 24 hours of catheter removal, along with UTI and length of stay, were compared between liberal and strict voiding protocols. Sub-group analysis was performed for those undergoing minimally invasive surgery (MIS). 303 (46.5%) women underwent surgery with a liberal postoperative voiding protocol and 349 (53.5%) with a strict voiding protocol. Overall, the incidence of POUR was low at 3.8% and not different among groups (2.6% liberal vs. 4.9% strict, p = 0.14). UTI also occurred infrequently (2.8% overall, 2.6% liberal vs. 2.9% strict, p= 0.86). Similar results were seen specifically among those that underwent MIS: POUR (3.7% overall, 2.8% liberal vs. 5.3% strict, p= 0.17) and UTI (3.3% overall, 2.4% liberal vs. 4.7% strict, p= 0.28). Median length of stay (IQR) was much shorter for MIS patients with a liberal voiding protocol (median 15 hours overall (IQR 15 hours), 9 (4) liberal vs. 36 (34) strict, p

Compare odds of postoperative urinary symptoms in women who had cystoscopy after benign laparoscopic hysterectomy with 50% dextrose and with normal saline solution with intravenous indigo carmine.Retrospective cohort study.Two tertiary care centers.All women who underwent benign laparoscopic hysterectomy and intraoperative cystoscopy carried out by a single surgeon.We compared postoperative urinary symptoms in patients who received 50% dextrose cystoscopy fluid (January 2016-June 2017) with those who received saline cystoscopy with intravenous indigo carmine (November 2013-April 2014).A total of 96 patients had cystoscopy with 50% dextrose and 104 with normal saline with intravenous indigo carmine. Differences in baseline characteristics of the two groups of participants mainly reflected institutional population diversity: age (45.2 vs 41.9, p = .01), body mass index (26.9 vs 33.4, p.01), race, current smoking status (1% vs 7.8%, p = .04), diabetes (2.1% vs 11.5%, p = .01), history of abdominal surgery (53.1% vs 74%, p.01), hysterectomy type, receipt of intraoperative antibiotics (92.7% vs 100%, p.01), recatheterization (10.4% vs 0%, p.01), and removal of catheter on postoperative day 0 (66.7% vs 12.5%, p.01). Urinary symptoms were similar for 50% dextrose and saline (12.5% vs 7.7%, p = .19). After adjusting for age, body mass index, race, diabetes, and day of catheter removal, there remained no significant differences in urinary symptoms between the groups (odds ratio 3.19 [95% confidence interval, 0.82-12.35], p = .09). One immediate bladder injury was detected in the saline group and 1 delayed lower urinary tract injury in the 50% dextrose group.Overall, most women experienced no urinary symptoms after benign laparoscopic hysterectomy. There were no significant differences in postoperative urinary symptoms or empiric treatment of urinary tract infection after the use of 50% dextrose cystoscopy fluid as compared with normal saline. The previous finding of increased odds of urinary tract infection after dextrose cystoscopy may be due to use in a high-risk population.

Non-contacting laser ultrasound is used to measure Young’s modulus, shear modulus, and Poisson’s ratio as functions of temperature for Alloys 617 and 709. These alloys are of interest for structural applications in advanced nuclear reactors. Design rules for the construction of elevated-temperature nuclear components are presented in Section III, Division 5 of the American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel (B&PV) Code. The ASME B&PV Code for each material provides Young’s modulus values tabulated as a function of temperature and a single, temperature-independent Poisson’s ratio value. Elastic properties characterized by laser ultrasonics for Alloy 617 are in good agreement with data collected using an American Society for Testing and Materials (ASTM) standard resonant frequency technique and values reported from literature, demonstrating its accuracy. The shear modulus and Poisson’s ratio as functions of temperature for Alloy 709 have not been reported previously. Laser ultrasonics is well suited for determining temperature-dependent elastic properties, and the method offers the ability to perform measurements on small irregularly shaped specimens.

Background Food pantries have the potential to improve the quality of clients’ diets. Objective This study evaluated the relationship between the quality of the mix of foods in pantry inventories and client food bags (separately), as assessed by the Healthy Eating Index-2010 (HEI-2010), with client diet quality and how these relationships varied by food security status. Design This cross-sectional, secondary analysis used baseline data from the Voices for Food intervention study (Clinical Trial Registry: NCT03566095 ). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Foods available in pantry inventories and distributed in client food bags were recorded at one time point during baseline data collection. Participants and setting A convenience sample of adult food pantry clients (N = 575) from 24 rural, food pantries in the US Midwest was recruited from August to November 2014. Main outcome measures Pantry inventories, client food bags, and client diets were scored using the HEI-2010. Main outcomes were client HEI-2010 scores. Statistical analyses performed Linear regression models estimated associations between HEI-2010 total and component scores for pantry inventories and client food bags (in separate models) and the corresponding scores for client dietary intake. The interaction of client food security status, and potential pantry- and client-level confounders, was considered. Results Client food bag HEI-2010 scores were positively associated with client diet scores for total vegetables, greens and beans, and total fruit components, whereas pantry inventory HEI-2010 scores were negatively associated with client diet scores for total fruit, total protein foods, and seafood and plant proteins components. Client food bag whole-grains scores were more strongly associated with very low food secure compared with food secure client diet scores (all P values Conclusions The quality of client food bags, but not of pantry inventories, was positively associated with client diet quality in a rural sample in the US Midwest.

Women, relative to men, are at particularly high risk for anxiety and depression, perhaps in part due to their heightened levels of anxiety sensitivity (AS). Physical activity (PA) is an accessible mental health intervention that may be particularly beneficial for women. Using a within-subjects pre-post mixed methods design, this study tested the acceptability, appropriateness, feasibility, and evidence-base of a community-based PA intervention for AS among women at high risk for anxiety and depression. Participants were 45 women with high AS who completed an 8-week group PA intervention. Data were collected via self-report questionnaires, interviews, and recruitment, participation, and retention rates. Results suggest the intervention is acceptable, appropriate, and feasible. Interviews reveal high intervention satisfaction and perceived benefits beyond AS reduction. There was a relatively high attrition rate that suggests room for improvement. The intervention significantly reduced AS, as well as panic, social anxiety, generalized anxiety, and depression symptoms. In the context of the preliminary nature of this study, results suggest the use of community-delivered, group-based PA as a mental health intervention strategy for women is worth further exploration. There is potential for collaboration between the health system, PA delivery professionals, and community organizations to improve access to care.

Background: To evaluate a multicomponent health promotion program targeting preschoolers’ physical activity (PA). Methods: PA of children from 23 German daycare facilities (DFs; 13 intervention DFs, 10 control DFs) was measured via accelerometry at baseline and after 12 months. Children’s sedentary time, light PA, and moderate to vigorous PA were estimated. Adherence was tracked with paper-and-pencil calendars. Mixed-model regression analyses were used to assess intervention effects. Results: PA data were analyzed from 183 (4.2 [0.8] y, 48.1% boys) children. At follow-up, children in DF groups with more than 50% adherence to PA intervention components showed an increase of 9 minutes of moderate to vigorous PA per day (β = 9.28; 95% confidence interval [CI], −0.16 to 18.72) and a 19-minute decrease in sedentary time (β = −19.25; 95% CI, −43.66 to 5.16) compared with the control group, whereas children’s PA of those who were exposed to no or less than 50% adherence remained unchanged (moderate to vigorous PA: β = 0.34; 95% CI, −13.73 to 14.41; sedentary time: β = 1.78; 95% CI, −26.54 to 30.09). Notable effects were found in children with migration background. Conclusions: Only small benefits in PA outcomes were observed after 1 year. A minimum of 50% adherence to the intervention seems to be crucial for facilitating intervention effects.

Background Heart chymase rather than angiotensin (Ang)-converting enzyme has higher specificity for Ang I conversion into Ang II in humans. A new pathway for direct cardiac Ang II generation has been revealed through the demonstration that Ang-(1-12) is cleaved by chymase to generate Ang II directly. Herein, we address whether Ang-(1-12), chymase messenger RNA (mRNA), and activity levels can be differentiated in human atrial tissue from normal and diseased hearts and if these measures associate with various pathologic heart conditions. Materials and methods Atrial appendages were collected from 11 nonfailing donor hearts and 111 patients undergoing heart surgery for the correction of valvular heart disease, resistant atrial fibrillation, or ischemic heart disease. Chymase mRNA was analyzed by real-time polymerase chain reaction and enzymatic activity by high-performance liquid chromatography using Ang-(1-12) as the substrate. Ang-(1-12) levels were determined by immunohistochemical staining. Results Chymase gene transcripts, chymase activity, and immunoreactive Ang-(1-12) expression levels were higher in left atrial tissue compared with right atrial tissue, irrespective of cardiac disease. In addition, left atrial chymase mRNA expression was significantly higher in stroke versus nonstroke patients and in cardiac surgery patients who had a history of postoperative atrial fibrillation versus nonatrial fibrillation. Correlation analysis showed that left atrial chymase mRNA was positively related to left atrial enlargement, as determined by echocardiography. Conclusions As Ang-(1-12) expression and chymase gene transcripts and enzymatic activity levels were positively linked to left atrial size in patients with left ventricular heart disease, an important alternate Ang II forming pathway, via Ang-(1-12) and chymase, in maladaptive atrial and ventricular remodeling in humans is uncovered.

Objective To report the outcomes of halo femoral traction (HFT) used for 1 week between anterior release and definitive posterior fusion in adolescents with severe rigid scoliosis. Methods A retrospective single-center review of 22 consecutive patients (mean age at surgery, 14.1 years; range, 10.5–18.2 years; 17 girls) with severe, rigid scoliosis treated with anterior release, followed by HFT for 7 days prior to posterior instrumented fusion. Cobb angles were measured preoperatively, 1 week after anterior release and traction, after posterior fusion, and at a minimum 2-year follow-up. Complications were recorded. Results Mean preoperative Cobb angle was 97° (range, 80°–118°), correcting to 52° with anterior release and HFT and 31° after posterior fusion. This equated to a 68% deformity correction and was maintained at final follow-up. Three traction-related complications were experienced, including 1 case of neck pain and 2 cases of brachial plexopathy that resolved with traction weight reduction. Conclusions Three-staged deformity correction using HFT for 1 week only offers gradual correction of the spine over sufficient time to optimize deformity correction yet minimizes neurologic dysfunction.

Study Objective To evaluate if there is a difference in hospital readmission when patients are required to void versus not required to void before discharge after a same-day gynecologic procedure. Design A retrospective cohort study. Setting An urban tertiary care hospital. Patients A total of 4743 patients undergoing same-day gynecologic surgery. Interventions The readmission rates of patients discharged home without an order to void were compared with those with an order to void. Chart review was performed for readmission within 30 days and time to discharge from the postanesthesia recovery unit. Measurements and Main Results There was no statistically significant difference in the readmission rate between patients with or without an order to void before discharge (0.4% vs 0.9%, p = .08). Only 3 patients were readmitted for urinary retention, all with an order to void before discharge. Compared with gynecologic surgeons treating benign conditions, gynecologic oncologists were 23% more likely to place an order to void before discharge. Patients without an order to void spent approximately 59 minutes more in the postanesthesia care unit compared with those required to void (p Conclusion Discharge without an order to void is a safe practice in patients undergoing same-day gynecologic procedures. The risk of postdischarge urinary retention is low, consistent with previously reported rates in the literature.

A collaboration between the third sector and a university in Southwest England, the Good from Woods project investigated wellbeing outcomes of time spent in woodland through action research by a ra...

Purpose of review This review aims to describe the influence of changes in obstetrics and gynecology on residency training and how tracking may help address emerging concerns around quality and safety in gynecologic surgery. Recent findings As has been shown in a variety of other surgical fields, recent evidence confirms that surgeries with higher volume gynecologists are associated with fewer complications, decreased cost, and an increase in use of minimally invasive surgery. Attending physicians and residents feel graduating obstetrics and gynecology (OB/GYN) trainees are unprepared to perform major surgery independently. Tracking has demonstrated tremendous success in general surgery, enriching trainee careers, allowing for increased operative and clinical experiences, enhancing autonomy, and improving mentorship, all while achieving equivalent or improved milestone achievement, case numbers, and board certification. A majority of medical students, residents, and OB/GYN residency program directors support tracking in OB/GYN. Currently, a single OB/GYN program provides tracking in the United States, with measurable success similar to that seen in general surgery. Summary Enhanced surgical volume results in better outcomes in gynecologic surgery, but current training models are insufficient to meet these volume demands. Tracking provides an attractive solution to create a more appropriate practicing model for physicians in women's health.

The J-5 unconformity was originally described as occurring in Wyoming at the base of the Upper Jurassic Windy Hill Sandstone, where it separates the underlying Redwater Shale from the overl...

The purpose of this study was to explore the relations between gendered racism (i.e., the simultaneous experience of racism and sexism) and anxiety among African American women. The study also tested the moderating role of physical activity in the link between gendered racism and anxiety. It was hypothesized that a subtle form of gendered racism (i.e., gendered racial microaggressions) would significantly predict anxious arousal. We also hypothesized that physical activity would buffer the relations between gendered racial microaggressions and anxiety. Participants were 249 African American women residing in the United States, who completed an online survey. Results from hierarchical multiple regression analyses indicated that a greater frequency and stress appraisal of gendered racial microaggressions significantly predicted greater anxious arousal. Results also suggested that physical activity did not buffer the association between gendered racial microaggressions and anxiety. This study has implications for highlighting the importance of exploring variables that might serve to buffer African American women against the stress of gendered racism experienced in their everyday lives.