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(Completely regular) locales generalize (Tychonoff) spaces; indeed, the passage from a locale to its spatial sublocale is a well understood coreflection. But a locale also possesses an equally important pointless sublocale, and with morphisms suitably restricted, the passage from a locale to its pointless sublocale is also a coreflection. Our main theorem is that every locale can be uniquely represented as a subdirect product of its pointless and spatial parts, again with suitably restricted projections. We then exploit this representation by showing that any locale is determined by (what may be described as) the placement of its points in its pointless part. [ABSTRACT FROM AUTHOR]

Invertebrates account for over 90% of all described species and provide crucial ecosystem services. Land clearing, including the removal of abiotic habitat features, threatens invertebrate biodiversity, making environmental restoration crucial for conservation. However, little is known about the effects of abiotic restoration compared to the restoration of biotic features. To determine if rock addition increased invertebrate biodiversity, we introduced 120 t of rocks to 10 sites across five grassland reserves in the Australian Capital Territory in a before‐after‐control‐impact design. We sampled invertebrates using pitfall traps before treatment in 2016 and after rock addition in 2019 (during record‐breaking drought). We recorded 29,164 individual invertebrates from 19 orders and undertook a functional trait‐based analysis of rock effects on the invertebrate community. No effects of rock addition were observed on the probability of occurrence, richness, diversity, community similarity, or abundance of any taxonomic or functional group. The abundance of snare‐building spiders and large ants was higher in the control plots at the end of the experiment. These abundance responses in 2019 did not differ from the control or treatment plots in 2016. Thus, some combination of drought and rock addition appears to have neutralized a positive temporal change that was evident without rocks. Despite a regionwide, replicated restoration effort and an extensive functional analysis of invertebrate communities, very little positive response to rock addition was recorded. Rock addition did not have a negative effect on grassland invertebrate biodiversity and may still be beneficial to the long‐term conservation and restoration of vertebrate and invertebrate communities. [ABSTRACT FROM AUTHOR]

AbstractWe offer here a particularly simple and direct construction of the congruence frame of a given frame, aka its assembly, from the bounded meet semilattice of differences of frame elements. The construction enables economical proofs of two of the assembly’s known attributes, namely ultranormality and ultraparacompactness, as well as a proof that the assembly is an essential extension of the frame with the same essential closure as the frame. The major new result is that the assembly is free over its meet semilattice of differences. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Serious games enhance learner engagement and knowledge, yet few medical education games target older adults' healthcare. Addressing this gap, we developed Geri‐POP (Geriatrics Population Health), focusing on the Age‐Friendly Health System (AFHS) framework and Geriatric 4Ms.Geri‐POP, a healthcare game is aimed at educating health profession learners about the AFHS framework. Geri‐POP employs plan–do–study–act cycles of rapid improvement to apply AFHS principles and explore evidence‐based geriatric practices within the game environment while garnering points for insight, trust and outcomes. Faculty and medical students were surveyed for feedback on an alpha version of Geri‐POP.Players manage patient panels across three age groups (65–74, 75–84, and 85 years and older) while engaging in plan–do–study–act (PDSA) cycles, applying Geriatric 4Ms (What Matters, Medications, Mentation, and Mobility), and refining strategies based on resource utilization, health outcomes, and real‐time feedback. Alpha testing of the game received mixed perceptions on graphics, with faculty endorsing the game for training and integration into the curriculum, while students prioritize academic commitments. Suggestions include enhancing graphics and refining dialogue for a more professional tone.Geri‐POP demonstrates the potential of gamifying older adult population health and quality improvement around AFHS. Feedback on a prototype game revealed different attitudes between faculty and students, thus emphasizing the importance of game development as an iterative process that accounts for educator and learner‐centric needs. A future consideration is whether the game informs user's clinical practices and changes healthcare outcomes for older adults. [ABSTRACT FROM AUTHOR]

The first 2 years of life is a period of rapid learning and growth when humans acquire notable motor, perceptual, linguistic, and social capabilities. Because of challenges in measuring brain activity in human infants, many of the neural mechanisms underlying these capabilities have not been identified. Advances in neuroimaging technologies, task designs, and data analyses from studies of older children and adults are starting to be translated into studies of infants. These new methods include frequency tagging designs in electroencephalography (EEG), task-based functional magnetic resonance imaging (fMRI) studies in awake and behaving infants, multivariate analyses of EEG and functional near-infrared spectroscopy (fNIRS), and the emergence of infant-friendly optically pumped magnetometry (OPM). The resulting neural data provide rich new measures of infant cognition, supplementing the limited behavioral data that can be obtained from preverbal infants. The functional properties of the infant brain are poorly understood. Recent advances in cognitive neuroscience are opening new avenues for measuring brain activity in human infants. These include novel uses of existing technologies such as electroencephalography (EEG) and magnetoencephalography (MEG), the availability of newer technologies including functional near-infrared spectroscopy (fNIRS) and optically pumped magnetometry (OPM), and innovative applications of functional magnetic resonance imaging (fMRI) in awake infants during cognitive tasks. In this review article we catalog these available non-invasive methods, discuss the challenges and opportunities encountered when applying them to human infants, and highlight the potential they may ultimately hold for advancing our understanding of the youngest minds. [ABSTRACT FROM AUTHOR]

Lumbar interbody instrumentation techniques are common and effective surgical options for a variety of lumbar degenerative pathologies. Anterior lumbar interbody fusion (ALIF) has become a versatile and powerful means of decompression, stabilization, and reconstruction. As an anterior only technique, the integrity of the posterior muscle and ligaments remain intact. Adding posterior instrumentation to ALIF is common and may confer benefits in terms of higher fusion rate but could contribute to adjacent segment degeneration due to additional rigidity. Large clinical studies comparing stand-alone ALIF with and without posterior supplementary fixation (ALIF+PSF) are lacking. To compare rates of operative nonunion and adjacent segment disease (ASD) in ALIF with or without posterior instrumentation. Retrospective cohort study. Adult patients (≥18 years old) who underwent primary ALIF for lumbar degenerative pathology between levels L4 to S1 over a 12-year period. Exclusion criteria included trauma, cancer, infection, supplemental decompression, noncontiguous fusions, prior lumbar fusions, and other interbody devices. Reoperation for nonunion and ASD compared between ALIF only and ALIF+PSF. Reoperations were modeled as time-to-events where the follow-up time was defined as the difference between the primary ALIF procedure and the date of the outcome of interest. Crude cumulative reoperation probabilities were reported at 5-years follow-up. Multivariable Cox proportional hazard regression was used to evaluate risk of operative nonunion and for ASD adjusting for patient characteristics. The study consisted of 1,377 cases; 307 ALIF only and 1070 ALIF+PSF. Mean follow-up time was 5.6 years. The 5-year crude nonunion incidence was 2.4% for ALIF only and 0.5% for ALIF+PSF; after adjustment for covariates, a lower operative nonunion risk was observed for ALIF+PSF (HR=0.22, 95% CI=0.06–0.76). Of the patients who are deemed potentially suitable for ALIF alone, one would need to add posterior instrumentation in 53 patients to prevent one case of operative nonunion at a 5-year follow-up (number needed to treat). Five-year operative ASD incidence was 4.3% for ALIF only and 6.2% for ALIF+PSF; with adjustments, no difference was observed between the cohorts (HR=0.96, 95% CI=0.54–1.71). While the addition of posterior instrumentation in ALIFs is associated with lower risk of operative nonunion compared with ALIF alone, operative nonunion is rare in both techniques (<5%). Accordingly, surgeons should evaluate the added risks associated with the addition of posterior instrumentation and reserve the supplemental posterior fixation for patients that might be at higher risk for operative nonunion. Rates of operative ASD were not statistically higher with the addition of posterior instrumentation suggesting concern regarding future risk of ASD perhaps should not play a role in considering supplemental posterior instrumentation in ALIF. [ABSTRACT FROM AUTHOR]

We report examples of C(sp2)−N, C(sp2)−S, and C(sp2)−P bond‐forming transformations in water microdroplets at room temperature and atmospheric pressure using N2 as a nebulizing gas. When an aqueous solution of vinylic acid and amine is electrosprayed (+3 kV), the corresponding C(sp2)−N product is formed in a single step, which was characterized using mass spectrometry (MS) and tandem mass spectrometry (MS2). The scope of this reaction was extended to other amines and other unsaturated acids, including acrylic (CH2=CHCOOH) and crotonic (CH3CH=CHCOOH) acids. We also found that thiols and phosphines are viable nucleophiles, and the corresponding C(sp2)−S and C(sp2)−P products are observed in positive ion mode using MS and MS2. [ABSTRACT FROM AUTHOR]

We report examples of C(sp2)−N, C(sp2)−S, and C(sp2)−P bond‐forming transformations in water microdroplets at room temperature and atmospheric pressure using N2 as a nebulizing gas. When an aqueous solution of vinylic acid and amine is electrosprayed (+3 kV), the corresponding C(sp2)−N product is formed in a single step, which was characterized using mass spectrometry (MS) and tandem mass spectrometry (MS2). The scope of this reaction was extended to other amines and other unsaturated acids, including acrylic (CH2=CHCOOH) and crotonic (CH3CH=CHCOOH) acids. We also found that thiols and phosphines are viable nucleophiles, and the corresponding C(sp2)−S and C(sp2)−P products are observed in positive ion mode using MS and MS2. [ABSTRACT FROM AUTHOR]

The article discusses the historical context and scientific understanding of diabetes, focusing on the interplay between pancreatic β cell function and insulin resistance, as elucidated by the hyperbolic law of glucose tolerance. Topics include the distinction between type 1 and type 2 diabetes, the debate over the primary pathogenetic defect in type 2 diabetes, and the application of the hyperbolic curve in studying glucose regulation and predicting disease onset.

Monitoring is critical for detecting population trends, determining efficacy of management intervention, assessing species or community responses to ecological threats and informing conservation policies. While the intention of threatened species monitoring programmes is generally in the best interest of the target species, the sampling techniques used can often have negative impacts on individuals, populations, species or even the ecosystem. The Pink‐tailed Worm‐lizard Aprasia parapulchella, a threatened species, is a small fossorial, legless lizard found along the western slopes of the Great Dividing Range in south‐eastern Australia. The most commonly used survey method for the species is searching beneath shallowly embedded rocks. Like other active hand search methods, rock‐turning can have a detrimental effect on the target species and microhabitat. The aim of this study was to develop a low‐impact monitoring method for A. parapulchella, using artificial shelters (bricks), that would reduce monitoring impacts and allow monitoring to be undertaken more frequently. We found that annual artificial shelter surveys for A. parapulchella achieved similar detection rates to rock‐turning surveys. We also found that artificial shelters provided similar habitat attributes as natural habitat rocks and importantly, we showed that artificial shelter surveys did not negatively affect either A. parapulchella or habitat condition. The novel, low‐impact monitoring method allows monitoring for the species to be undertaken more frequently and thereby allows land managers and conservation practitioners an opportunity to respond faster to population change. [ABSTRACT FROM AUTHOR]

The article discusses the concept of the "gratitude paradox" in healthcare, using examples from the field of transplantation and other contexts. The authors argue that there is an expectation for disadvantaged and vulnerable populations to be grateful for minimal improvements in their lives, and that expressing a desire for more and better care options is often met with backlash. They call on healthcare professionals to validate the conflicting emotions that patients experience and strive to offer improved treatment options. The authors also emphasize the need for empathy, collaboration, and resistance against societal forces that hinder progress in healthcare. [Extracted from the article]

The article provides information on the Network for Investigation of Delirium: Unifying Scientists (NIDUS) which aims to develop the collaborative network and infrastructure to advance scientific research and train on the causes, mechanisms, outcomes, diagnosis, prevention, and treatment of delirium in older adults. Topics include the renewal of NIDUS as NIDUS II in 2020, structure of NIDUS, and summary of NIDUS-I and NIDUS-II accomplishments.

Objective: The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS). Method: The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery was used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data. Results: For the eight domains of cognitive functioning identified (orientation, memory [immediate, delayed, and recognition], set shifting, attention/speed, language/fluency, and visuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where fit must be perfect and is not informative. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94). Conclusions: The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used to operationalize notions of neurocognitive impairment, and as a starting point for prioritizing pre-statistical harmonization and evaluating configural invariance in cross-national research. [ABSTRACT FROM AUTHOR]

Background This study was performed to assess the impact of preaspiration antibiotics on synovial fluid analysis and timing of operative treatment in native-joint septic arthritis. Methods We performed a retrospective record review of adult patients from an urban level 1 trauma center with native joint septic arthritis in 2015–2019, identified by means of codes from the International Classification of Diseases (Ninth Revision and Tenth Revision). Univariate and multivariate analyses were performed to determine whether antibiotics were associated with lower synovial fluid white blood cell counts (WBCs), the percentage of polymorphonuclear neutrophil (PMNs), and rate of culture positivity. Secondary analysis included time elapsed from aspiration to surgery. Results Of the 126 patients with septic joints included, nearly two-thirds (n = 80 [63.5%]) received antibiotics before joint aspiration. The synovial fluid WBC count, percentage of PMNs, and rate of culture positivity were significantly lower in patients who received preaspiration antibiotics than in those who did not (mean WBC count, 51 379.1/μL [standard deviation, 52 576.3/μL] vs 92 162.7/μL [59 330.6/μL], respectively [ P <.001]; PMN percentage, 83.6% [20.5%] vs 91.9% [6.0%; P =.01]; and culture positivity, 32.5% vs 59.1% [ P =.008]). Multivariable analyses revealed that these associations remained after controlling for potential confounders (change in PMNs, −42 784.60/μL [95% confidence interval, −65 355/μL to −20 213.90/μL [ P <.001]; change in PMNs, −7.8% [−13.7% to −1.8%] [ P =.01]; odds ratio, 0.39 [.18–.87; P =.02). Patients with a synovial fluid WBC count ≤50 000/μL experienced significant delay in time from joint aspiration to operative intervention (mean [standard deviation], 10.5 [11.3] vs 17.9 [17.2] hours; P =.02). Conclusions The administration of antibiotics before joint aspiration for suspected septic arthritis appears to decrease the synovial fluid WBC count, the percentage of PMNs, and the rate of culture positivity. Efforts to limit antibiotic administration before joint aspiration are important to minimize diagnostic dilemmas and circumvent treatment delays. [ABSTRACT FROM AUTHOR]

Background: High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure. Purpose: To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs. Study Design: Systematic review; Level of evidence, 4. Methods: The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded. Results: A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%). Conclusion: Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure. [ABSTRACT FROM AUTHOR]

Recent literature focuses on the inherent challenges of food delivery work. Less is known about how these injustices impact workers and their lives more broadly, or how workers navigate them. This empirical article is based on a 12-month ethnographic theory-relevant case study and includes an innovative shadowing method focused on migrant food delivery workers in Brisbane, Australia. We found that temporary migrant workers face intersectional injustices, exacerbated by the COVID-19 crisis, both within and beyond the platform economy. Nevertheless, the workers agentically enacted their own justices to navigate their precarity, in the absence of institutional supports. This study’s theoretical contribution is the development of a model explaining the agentic and structural underpinnings of the injustices that migrant platform workers experience. Moreover, our contribution reveals that the unique attributes that migrants bring to bear on their platform work provide them with the affordances to navigate the injustices they experience. In so doing they mitigate some of the negative impacts of platform work, and indeed derive benefits that non-migrant platform workers might not. [ABSTRACT FROM AUTHOR]

Objective: The aim was to develop and test a novel screen of adult ADHD, with a specific focus on clinical use. We designed a series of three studies to accomplish this aim. Method: Study One (n = 155) and Study Two (n = 591) collected data via surveys to conduct exploratory and confirmatory factor analyses, respectively. Study Three analyzed the scale's psychometrics in a clinical sample (n = 151). Results: Study One and Study Two identified a 10-item scale with a two-factor structure. Study Three found good discriminant validity, sensitivity = 80.0%, specificity = 80.2%, and convergent validity with both the Brown Executive Function/Attention Scales, r (131) =.76, p <.001, and the Conner's Adult ADHD Rating Scales r (131) =.71, p <.001. Conclusion: The scale demonstrated effectiveness in screening for ADHD in a psychiatric outpatient population. Its results may be used to identify patients that may benefit from thorough ADHD diagnostic procedures. [ABSTRACT FROM AUTHOR]

A water microdroplet in air or oil typically possesses an electric double layer (EDL) from the preferential adsorption of surface-bound ions at the periphery. We present the calculations of the ion gradients within a microdroplet at equilibrium, including systems containing buffers and water autoionization. These ion gradients are used to calculate the potential energy stored within the microdroplet. We consider how this stored potential energy can be utilized to drive chemical reactions, much like an electrochemical cell. Effective voltages as high as 111 mV are found for microdroplets having a low surface charge density (0.01 ions per nm2). Two sources of potential energy are investigated: (1) the electrostatic energy of the EDL of the microdroplet and (2) shifts in other chemical equilibria coupled to the main reaction through the EDL. A particularly important example of the latter is water autoionization, wherein the reaction of interest causes a flattening of the [H+] gradient within the EDL, resulting in a net recombination of H+ and OH− throughout the microdroplet. Numerical calculations are performed using a continuum model consisting of a balance between the electromigration and diffusion of ions throughout the microdroplet. Our treatment accounts for the autoionization of water and any chemical equilibrium of buffers present. The results are presented for uncharged water microdroplets with low amounts of salts and simple buffers in them. However, the calculational method presented here can be applied to microdroplets of any net charge, composed of any solvent, containing ions of any valence, and containing complex mixtures of chemical equilibria. [ABSTRACT FROM AUTHOR]

Mercury has been described as been in daily household items such as soaps, skin-lightening creams (SLC), and topical disinfectants. Mercury exposure can reportedly cause damage to the optic nerve and retina. A 30-year-old Somali woman presented with decreased vision and was found to have bilateral optic atrophy. Neuroimaging and laboratory work-up for nutritional deficiencies, heavy metals, and syphilis were performed. Evaluation revealed normal neuroimaging and laboratory work-up except for elevated serum and urine mercury levels. Mercury levels at the initial blood test was 11.1 ug/L (normal limits < 10.0 ug/L) and was 15.7 ug/L on repeat testing. A 24-h urine test showed elevated mercury at 16 ug/24 h (normal limits < 2 ug/24 h). Evaluation of an unlabelled SLC that she was using showed the presence of mercury. It is worth testing for heavy metals in the work-up of bilateral optic atrophy. Clinicians should consider cosmetic products as a potential source of mercury exposure and recommend discontinuation if mercury is present. [ABSTRACT FROM AUTHOR]

Purpose: To assess the 3-month and 12-month postoperative visual performance and subjective quality of vision (QoV) after combined implantation of complementary continuous phase multifocal intraocular lenses (IOLs). Setting: Private practice, United Kingdom. Design: Case series. Methods: The study enrolled 44 patients undergoing phacoemulsification with implantation of an Artis Symbiose Mid in the dominant eye and an Artis Symbiose Plus in the nondominant eye. Refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity, uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), electronic reading desk, and a QoV questionnaire were evaluated at 3 months and 12 months postoperatively. Results: The mean binocular UDVA was -0.06 ± 0.08 logMAR and -0.07 ± 0.06 logMAR at 3 months and 12 months (P = .097), respectively. The mean binocular UIVA was 0.03 ± 0.13 logMAR and 0.03 ± 0.10 logMAR (P = 1.0), respectively. The mean binocular UNVA was 0.07 ± 0.10 logMAR and 0.07 ± 0.08 logMAR (P = .875), respectively. There was a significant improvement in QoV for both day and night between 3 and 12 months, with a significant reduction in halos at 12 months. Spectacle independence was reported in 93.2% of cases at 12 months. Conclusions: The Artis Symbiose Mid and Plus IOL combined implantation provided an excellent range of uncorrected vision at 3 and 12 months. There was a significant improvement in QoV and less halos at 12 months. This IOL combination provided very high rates of complete spectacle independence. [ABSTRACT FROM AUTHOR]

Introduction: GINA guidelines recommend increasing the dose of inhaled corticosteroids (ICS) as a step-up option for patients with inadequately controlled asthma at GINA step 4 [inadequately controlled asthma on medium-dose ICS/long-acting beta-2 agonist (LABA)]. The aim of this study was to compare the efficacy and safety of long-acting muscarinic antagonists (LAMA) add-on to medium-dose ICS/LABA in patients at GINA 2022 step 4. Methods: This post hoc analysis of the IRIDIUM study evaluated the change from baseline in trough forced expiratory volume (FEV1) in patients receiving medium-dose MF/IND/GLY versus high-dose MF/IND and high-dose FLU/SAL at Week 26. Other outcomes included improvement in lung functions [peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory flow between 25% and 75% of the FVC (FEF)25–75%)], asthma control [Asthma Control Questionnaire (ACQ-7)], responder analysis (≥ 0.5 unit improvement in ACQ-7), and reduction in asthma exacerbations at Weeks 26 and 52. Results: A total of 1930 patients were included in this analysis. Medium-dose MF/IND/GLY improved trough FEV1 versus high-dose MF/IND (Δ 41 mL; 95% CI – 7–90) and high-dose FLU/SAL (Δ 88 mL; 95% CI 39–137) at Week 26 which were sustained until Week 52. Exacerbation rates were 16% lower with medium-dose MF/IND/GLY versus high-dose MF/IND for all (mild, moderate, and severe) exacerbations and 21–30% lower versus high-dose FLU/SAL for all (mild, moderate, and severe), moderate or severe, and severe exacerbations over 52 weeks. Further improvements in other lung functions were observed with medium-dose MF/IND/GLY. No new safety signals were identified. Conclusion: Medium-dose MF/IND/GLY improved lung function and reduced asthma exacerbations compared to high-dose ICS/LABA and may be an undervalued option in patients at GINA 2022 step 4. Trial Registration: ClinicalTrials.gov Identifier: NCT02571777. [ABSTRACT FROM AUTHOR]

Purpose: Hamstring autograft (HA) is commonly used for primary anterior cruciate ligament reconstruction (ACLR). However, if the harvested HA is inadequate in diameter, it is often augmented with an allograft tendon, forming a hybrid graft (HY). This study sought to evaluate aseptic revision risk following HA versus HY ACLR. Methods: A retrospective cohort study was performed using data obtained from our healthcare system's ACLR registry. Patients ≤ 25 years of age who underwent primary isolated ACLR were identified (2005–2020). Graft type and diameter size was the primary exposure of interest: < 8 mm HA and ≥ 8 mm HY. A secondary analysis was performed to examine 7 mm HA and 7.5 mm HA vs ≥ 8 mm HY. Propensity score-weighted Cox proportional hazard regression was used to evaluate the risk of aseptic revision. Results: The study sample included 1,945 ACLR: 548 ≥ 8 mm HY, 651 7 mm HA, and 672 7.5 mm HA. The crude cumulative aseptic revision probability at 8-years for ≥ 8 mm HY was 9.1%, 11.1% for 7 mm HA, and 11.2% for 7.5 mm HA. In adjusted analysis, no difference in revision risk was observed for < 8 mm HA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.72–1.82), 7 mm HA (HR 1.23, 95% CI 0.71–2.11), or 7.5 mm HA (HR 1.16, 95% CI 0.74–1.82) compared to ≥ 8 mm HY. Conclusion: In a US-based cohort of ACLR patients aged ≤ 25 years, we failed to observe any differences in aseptic revision risk for HA < 8 mm compared to HY ≥ 8 mm. Augmentation of a HA as small as 7 mm is not necessary to prevent a revision surgery. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: To perform a predictive analysis to identify preoperative patient factors associated with failure to achieve a newly defined patient acceptable symptom state (PASS) for the International Knee Documentation Committee (IKDC) Score after anterior cruciate ligament reconstruction (ACLR) in patients aged ≥ 40 years with a minimum of 2-year follow-up. Methods: This was a secondary analysis of a retrospective review of all patients aged 40 years or older receiving a primary allograft ACLR at a single institution between the years of 2005 and 2016, with 2-year minimum follow-up. Using an updated PASS threshold of 66.7 for the International Knee Documentation Committee (IKDC) score previously established for this patient cohort, a univariate and multivariate analysis was performed to identify preoperative patient characteristics predictive of failure to achieve PASS. Results: A total of 197 patients with a mean follow-up of 6.2 ± 2.1 years (range 2.7 – 11.2) were included in the analysis (48.5 ± 5.6 years, 51.8% female, Body Mass Index (BMI) 25.9 ± 4.4). PASS was achieved by 162 patients (82.2%). Patients who failed to achieve PASS more often had lateral compartment cartilage defects (P = 0.001) and lateral meniscus tears (P = 0.004), higher BMIs (P = 0.004), and Workers' Compensation status (P = 0.043) on univariable analysis. Factors predictive of failure to achieve PASS on multivariable analysis included BMI and lateral compartment cartilage defect (OR 1.12 [1.03–1.23], P = 0.013; OR 5.1 [1.87–13.9], P = 0.001). Conclusion: Among patients ≥ 40 years who receive a primary allograft ACLR, patients who fail to achieve PASS more often had lateral compartment cartilage defects and higher BMIs. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

In the current deployed environment, small teams are dispersed to provide damage control surgical capabilities within an hour of injury. Given the well-developed evacuation system, these teams do not typically have a significant patient hold capability. Improved understanding of the shortfalls and problems encountered when caring for combat casualties in prolonged care situations will facilitate improved manning, training, and equipping of these resource-limited teams. We present the case of two critically injured soldiers who were evacuated to a 10-person split Forward Surgical Team (FST) during a weather system that precluded further evacuation. The casualties underwent damage control procedures necessitating temporary abdominal closures. The FST had to organize itself to provide intensive care significantly longer than traditional timelines for this role of care. Additionally, most team members had scarce critical care experience. An after-action review confirmed that most team members felt that they had not received adequate pre-mission training in postoperative intensive care and were not comfortable managing ventilated patients. In the current mature theaters of operations, there are robust evacuation capabilities, and presentations of scenarios like that are rare. However, as combat casualty care becomes increasingly austere and remote, small surgical teams need to train and be equipped to provide care outside of normal operation and doctrinal limits, including robust team cross-training. Incorporating principles of the prolonged care of combat casualties into the training of military surgeons will improve preparedness for these challenging situations. [ABSTRACT FROM AUTHOR]

Background: With an increasing number of primary anterior cruciate ligament reconstructions (ACLRs), the burden of revision ACLR (rACLR) has also increased. Graft choice for rACLR is complicated by patient factors and the remaining available graft options. Purpose: To examine the association between graft type at the time of rACLR and the risk of repeat rACLR (rrACLR) in a large US integrated health care system registry while accounting for patient and surgical factors at the time of revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Data from the Kaiser Permanente ACLR registry were used to identify patients who underwent a primary isolated ACLR between 2005 and 2020 and then went on to have rACLR. Graft type used at rACLR, classified as autograft versus allograft, was the exposure of interest. Multivariable Cox proportional hazard regression was used to evaluate the risk of rrACLR, with ipsilateral and contralateral reoperation as secondary outcomes. Models included factors at the time of the rACLR (age, sex, body mass index, smoking status, staged revision, femoral fixation, tibial fixation, femoral tunnel method, lateral meniscal injury, medial meniscal injury, and cartilage injury) and a factor from the primary ACLR (activity at injury) as covariates. Results: A total of 1747 rACLR procedures were included. The crude cumulative rrACLR incidence at 8-year follow-up was 13.9% for allograft and 6.0% for autograft. Cumulative ipsilateral reoperation incidence at 8-year follow-up was 18.3% for allograft and 18.9% for autograft; contralateral reoperation cumulative incidence was 4.3% for allograft and 6.8% for autograft. With adjustment for covariates, a 70% lower risk for rrACLR was observed for autograft compared with allograft (hazard ratio [HR], 0.30; 95% CI, 0.18-0.50; P <.0001). No differences were observed for ipsilateral reoperation (HR, 1.05; 95% CI, 0.73-1.51; P =.78) or contralateral reoperation (HR, 1.33; 95% CI, 0.60-2.97; P =.48). Conclusion: The use of autograft at rACLR was associated with a 70% lower risk of rrACLR compared with allograft in this cohort from the Kaiser Permanente ACLR registry. When accounting for all reoperations outside of rrACLR after rACLR, the authors found no significant difference in risk between autograft and allograft. To minimize the risk of rrACLR, surgeons should consider using autograft for rACLR when possible. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum est une dermatose neutrophilique rare, se présentant par des ulcérations cutanées inflammatoires et douloureuses, riches en infiltrat à PNN, souvent prises pour des lésions infectieuses ou ischémiques, et le plus souvent localisées au niveau du tronc et des membres inférieurs. Dans la moitié des cas, il est associé à des pathologies inflammatoires ou onco-hématologiques. On note une forte association avec les pathologies inflammatoires digestives notamment. Pyoderma gangrenosum peut s'étendre à des tissus extra-cutanés, avec des atteinte pulmonaires ou articulaires. Nous rapportons ici le cas d'une patiente de 56 ans, prise en charge pour un Pyoderma gangrenosum pulmonaire. Elle avait pour principale antécédent une maladie de Crohn colique, non sténosante et non fibrosante, initialement traitée par infliximab, en combothérapie avec du méthotrexate. Les principales complications de ce traitement ont été, en 2020, une infection pulmonaire à mycobactérie atypique de type Xenopi traitée par quadrithérapie (azithromycine, éthambutol, clofazimine et isoniazide) et une aspergillose pulmonaire cavitaire apicale droite, traitée par voriconazole. Un relai de la combothérapie a également été réalisé, par du védolizumab, sans un contrôle entièrement satisfaisant de l'activité de la maladie de Crohn. Dans le cadre du suivi pneumologique, malgré une évolution scanographique initiale favorable et la poursuite du voriconazole, un PET-scanner avait mis en évidence la persistance d'un épaississement de la paroi avec un hypermétabolisme de la cavité apicale droite. Par la suite, du fait d'une évolution défavorable avec un nouveau contrôle scanographique en faveur d'un comblement cavitaire et d'une extension de l'atteinte en sous-pleural, une bronchoscopie a été réalisée. Des sécrétions purulentes ont été retrouvées, avec des prélèvements bactériologiques, mycologiques et mycobactériologiques négatifs. L'anatomopathologie éliminait une lésion néoplasique bronchique et concluait à un matériel de lavage légèrement inflammatoire à polynucléaires neutrophiles. Le diagnostic de Pyoderma gangrenosum a été posé, et après discussion entre les pneumologues et les gastro-entérologues, l'introduction d'un traitement commun à l'atteinte digestive et pulmonaire par upadacitinib 30 mg a été décidée. Le contrôle scanographique à un mois était en faveur d'une diminution du comblement et de l'épaisseur de la paroi de la cavité pulmonaire. On notait également un contrôle satisfaisant de l'inflammation digestive. Les anti-JAK sont de plus en plus présents dans notre pratique et dans l'arsenal thérapeutique de différentes spécialités, avec une efficacité plus ou moins démontrée dans les atteintes inflammatoires dermatologiques, rhumatologiques et gastro-entérologiques notamment. Favoriser les discussions collégiales pluridisciplinaires permettrait un meilleur contrôle d'atteintes inflammatoires multiples, avec un traitement unique. [ABSTRACT FROM AUTHOR]

It is well established that the chemistry in microdroplets has been found to be radically different from reactions in bulk, particularly in the case of water. It has also been established that there is a threshold size for microdroplets to behave differently than droplets near the 10 µm diameter range. We present a three-dimensional electrostatic treatment in the spirit of the Gouy–Chapman model for double layers at interfaces. Our treatment predicts a strong concentration of charged molecules toward the surface of the droplet. As the droplet size deceases, the majority of the volume of the liquid experiences a large DC electric field. Such electric fields are highly unusual in a conducting fluid such as water. We believe that this unique environment helps to explain the reaction rate acceleration and new chemistry that have been observed in microdroplets compared to bulk phase. [ABSTRACT FROM AUTHOR]

Naïve T cells and regulatory T cells, when purified, do not proliferate to the γc-cytokines IL-2, IL-7, or IL-15, despite their expression of cognate cytokine receptors. Dendritic cells (DCs) enabled the T cell proliferation to these cytokines, through cell-to-cell contact, but independent of T cell receptor stimulation. This effect lasted after separation of T cells from DCs, enabling enhanced proliferation of the T cells in DC-depleted hosts. We propose calling this a "preconditioning effect". Interestingly, IL-2 alone was sufficient to induce phosphorylation and nuclear translocation of STAT5 in T cells, but could not activate MAPK and AKT pathways and failed to induce transcription of IL-2 target genes. "Preconditioning" was necessary to activate these two pathways and induced weak Ca2+ mobilization independent of calcium release-activated channels. When preconditioning was combined with IL-2, full activation of downstream mTOR, 4E-BP1 hyperphosphorylation, and prolonged S6 phosphorylation occurred. Collectively, accessory cells provide T cell preconditioning, a unique activation mechanism, controlling cytokine-mediated proliferation of T cells. [ABSTRACT FROM AUTHOR]

Background: Reducing avoidable healthcare-associated harm is a global health priority. Progress in evaluating the burden and aetiology of avoidable harm in prisons is limited compared with other healthcare sectors. To address this gap, this study aimed to develop a definition of avoidable harm to facilitate future epidemiological studies in prisons. Methods: Using a sequential mixed methods study design we first characterised and reached consensus on the types and avoidability of patient harm in prison healthcare involving analysis of 151 serious prison incidents reported to the Strategic Executive Information System (StEIS) followed by in-depth nominal group (NG) discussions with four former service users and four prison professionals. Findings of the NG discussions and StEIS analysis were then synthesised and discussed among the research team and study oversight groups to develop an operational definition of avoidable harm in prison healthcare which was subsequently tested and validated using prison patient safety incident report data derived from the National Reporting and Learning System (NRLS). Results: Analysis of StEIS incident reports and NG discussions identified important factors influencing avoidable harm which reflected the unique prison setting, including health care delivery issues and constraints associated with the secure environment which limited access to care. These findings informed the development of a new working two-tier definition of avoidable harm using appropriate and timely intervention, which included an additional assessment of harm avoidability taking into the account the prison regime and environment. The definition was compatible with the NRLS incident report narratives and illustrated how the prison environment may influence identification of avoidable harm and judgements of avoidability. Conclusions: We have developed a working definition of avoidable harm in prison health care that enables consideration of caveats associated with prison environments and systems. Our definition enables future studies of the safety of prison healthcare to standardise outcome measurement. [ABSTRACT FROM AUTHOR]

Objective: Haemorrhagic shock is a life-threatening complication of trauma, but remains a preventable cause of death. Early recognition of retroperitoneal haemorrhage (RPH) is crucial in preventing deleterious outcomes including mortality. Injury to the 9-11th intercostal arteries (i.e. arteries of the lower thoracic region) are complicit in RPH. However, the associated injuries, implications and management of such bleeds remain poorly characterised. Methods: We performed a retrospective review of the medical records of patients diagnosed with RPH who presented to our level-1 trauma centre (2009-2019). We described the associated injuries, management and outcomes relating to RPH of the lower thoracic region (the 9-11th intercostal arteries) from this cohort to identify potential predictors and evaluate the impact of early identification and management of non-cavitary bleeds. Results: Haemorrhage of the lower intercostal arteries (LIA) into the retroperitoneal space is associated with an increased number of posterior lower rib fractures and pneumothorax/haemothorax. A higher proportion of patients in the LIA group required massive transfusion, angioembolisation or surgical ligation when compared to other causes of RPH. Conclusion: The present study highlights the importance of injury patterns, particularly posterior lower rib fractures, as predictors for early recognition and management of RPH in the prevention of deleterious patient outcomes. RPH secondary to bleeding of the LIA may require early and aggressive management of haemorrhage through massive transfusion, and angioembolisation or surgical ligation when compared to RPH because of other causes. [ABSTRACT FROM AUTHOR]

Abstract In a supersaturated design, the number of factors is greater than the number of observations. A design that is not supersaturated but has more parameters to be estimated than observations results in a supersaturated model (SSM). An SSM may occur when two-factor interactions exist in addition to main effects. The goal is to find the few active effects from the many in the SSM. Several approaches may be used to find a set of potential models and then to select the best model using some criterion. This may be done in a single stage by considering all main effects and two-factor interactions simultaneously, or by screening main effects first, then identifying the active interactions. In this paper, we study a single-stage and multiple two-stage approaches as well as different algorithms and criteria for selecting the models. For the Plackett-Burman design we study, we find that the SCAD algorithm with the corrected Akaike Information criterion (cAIC) generally performs well, but the best procedure depends on the true, unknown, underlying model. [ABSTRACT FROM AUTHOR]

Cardiovascular ageing contributes to cognitive impairment. However, the unique and synergistic contributions of multiple cardiovascular factors to cognitive function remain unclear because they are often condensed into a single composite score or examined in isolation. We hypothesized that vascular risk factors, electrocardiographic features and blood pressure indices reveal multiple latent vascular factors, with independent contributions to cognition. In a population-based deep-phenotyping study (n = 708, age 18–88), path analysis revealed three latent vascular factors dissociating the autonomic nervous system response from two components of blood pressure. These three factors made unique and additive contributions to the variability in crystallized and fluid intelligence. The discrepancy in fluid relative to crystallized intelligence, indicative of cognitive decline, was associated with a latent vascular factor predominantly expressing pulse pressure. This suggests that higher pulse pressure is associated with cognitive decline from expected performance. The effect was stronger in older adults. Controlling pulse pressure may help to preserve cognition, particularly in older adults. Our findings highlight the need to better understand the multifactorial nature of vascular aging. [ABSTRACT FROM AUTHOR]

Epilepsy is a common and serious neurological disorder, to which a high proportion of patients continue to be considered "drug-resistant", despite the availability of a host of anti-seizure drugs. Investigation into new treatment strategies is therefore of great importance. One such strategy is the use of the nose to deliver drugs directly to the brain with the help of pharmaceutical formulation to overcome the physical challenges presented by this route. The following review explores intranasal delivery of anti-seizure drugs, covering the link between the nose and seizures, pathways from the nose to the brain, current formulations in clinical use, animal seizure models and their proposed application in studying intranasal treatments, and a critical discussion of relevant pre-clinical studies in the literature. [ABSTRACT FROM AUTHOR]

Researchers, governments, ethics watchdogs, and the public are increasingly voicing concerns about unfairness and bias in artificial intelligence (AI)-based decision tools. Psychology's more-than-a-century of research on the measurement of psychological traits and the prediction of human behavior can benefit such conversations, yet psychological researchers often find themselves excluded due to mismatches in terminology, values, and goals across disciplines. In the present paper, we begin to build a shared interdisciplinary understanding of AI fairness and bias by first presenting three major lenses, which vary in focus and prototypicality by discipline, from which to consider relevant issues: (a) individual attitudes, (b) legality, ethicality, and morality, and (c) embedded meanings within technical domains. Using these lenses, we next present psychological audits as a standardized approach for evaluating the fairness and bias of AI systems that make predictions about humans across disciplinary perspectives. We present 12 crucial components to audits across three categories: (a) components related to AI models in terms of their source data, design, development, features, processes, and outputs, (b) components related to how information about models and their applications are presented, discussed, and understood from the perspectives of those employing the algorithm, those affected by decisions made using its predictions, and third-party observers, and (c) meta-components that must be considered across all other auditing components, including cultural context, respect for persons, and the integrity of individual research designs used to support all model developer claims. [ABSTRACT FROM AUTHOR]

Introduction: Reducing the occurrence of drug-related problems is a global health concern. In mental health hospitals, drug-related problems are common, leading to patient harm, and therefore understanding their potential risk factors is key for guiding future interventions designed to minimise their frequency. Objective: The aim of this systematic review was to explore the potential risk factors of drug-related problems in mental health inpatient units. Methods: Six databases were searched between 2000 and 2021 to identify studies that investigated the potential risk factors of drug-related problems in adults hospitalised in mental health inpatient units. Data extraction was performed by two authors independently and Allan and Barker's criteria were used for study quality assessment. Studies were categorised based on drug-related problem types and potential risk factors were stratified as patient, medication, and hospital related. Results: A total of 22 studies were included. Studies mostly originated in Europe (n = 19/22, 86.4%), and used a multivariable logistic regression to identify potential risk factors (n = 13, 59%). Frequently investigated factors were patient age (n = 14/22), sex (n = 14/22) and the number of prescribed medications (n = 14/22). Of these, increasing the number of prescribed medications was the only factor consistently reported to be significantly associated with the occurrence of most types of drug-related problems (n = 11/14). Conclusions: A variety of patient, medication and hospital-related potential risk factors of drug-related problems in mental health inpatient units were identified. These factors could guide the development of interventions to reduce drug-related problems such as pharmaceutical screening tools to identify high-risk patients for timely interventions. Future studies could test a wider range of possible factors associated with drug-related problems using standardised approaches. Clinical Trial Registration: PROSPERO: CRD42021279946. [ABSTRACT FROM AUTHOR]

The experience of novelty can enhance memory for information that occurs close in time, even if not directly related to the experience—a phenomenon called "behavioural tagging." For example, an animal exposed to a novel spatial environment shows improved memory for other information presented previously. This has been linked to neurochemical modulations induced by novelty, which affect consolidation of memories for experiences that were encoded around the same time. Neurophysiological research in animals has shown that novelty benefits weakly encoded but not strongly encoded information. However, a benefit that is selective to weak memories seems difficult to reconcile with studies in humans that have reported that novelty improves recollection, but not familiarity. One possibility is that the novelty increases activity in hippocampus, which is also associated with processes that enable recollection. This is consistent with another prediction of behavioural tagging theory, namely that novelty only enhances consolidation of information that converges on the same neuronal population. However, no study has directly explored the relationship between encoding strength and retrieval quality (recollection versus familiarity). We examined the effects of exposure to a novel immersive virtual reality environment on memory for words presented immediately beforehand, under either deep or shallow encoding tasks, and by testing both recall memory immediately, and recognition memory with remember/know instructions the next day. However, Bayes factors showed no evidence to support the behavioural tagging predictions: that novelty would improve memory, particularly for shallowly encoded words, and this improvement would differentially affect familiarity versus recollection. [ABSTRACT FROM AUTHOR]

The article introduces a way to look at how people can lead organizations to reduce the number of people being injured and killed and provides a case study that illustrates the merits of leading in this way. The case study contrasts a highly participative leadership approach with the traditional top-down management approach. The total recordable case (TRC) injury rate was used in the case study to compare the effectiveness of two leadership approaches.

Temperate grassland ecosystems support highly diverse assemblages of plants and animals but have been predominantly cleared for urban infrastructure and modified for agriculture. Temperate grasslands that remain in south‐eastern Australia are often degraded. For example, surface rocks have been extensively removed, potentially affecting long‐term persistence of grassland reptiles that depend on this resource. Rock habitat restoration is a strategy that can promote the survival of grassland reptiles and restore degraded temperate grasslands. In this study, we examined the benefit of supplementing locally sourced rock to improve reptile outcomes in degraded grassland reserves in the ACT. We established a BACI design across five ACT grassland reserves with 10 plots where rocks were added and 10 equivalent control plots to assess (i) the effect of rock supplementation on reptile relative abundance and composition, and (ii) the characteristics of the sites and rocks that reptiles used. Surveys were conducted over the spring and summer period each year over 3 years (2015–2017). Early results (one‐year post‐study) indicate that reptiles used supplemented rock and that reptiles show a preference for large (7600–29 000 cm3), flat rocks. Reptiles also show a preference for sites with higher grass cover and native vegetation composition, highlighting the need to manage site‐scale conditions to maximize the success of rock supplementation. Our study concludes rock restoration will support the persistence of grassland reptile populations, particularly if coupled with site‐scale grassland management, and will likely be an important strategy to use under changing climate regimes. [ABSTRACT FROM AUTHOR]

Objective: To preliminary evaluate the clinical effects of probiotics in individuals with symptomatic oral lichen planus and the possible mechanisms of action. Subjects and Methods: A group of 30 individuals with symptomatic oral lichen planus were recruited in a randomised double‐blind parallel group controlled (1:1) proof‐of‐concept pilot trial of probiotic VSL#3 vs placebo. Efficacy outcomes included changes in pain numeric rating scale, oral disease severity score and the chronic oral mucosal disease questionnaire. Adverse effects, home diary and withdrawals were assessed as feasibility outcomes. Mechanistic outcomes included changes in salivary and serum levels of CXCL10 and IFN‐γ and in oral microbial composition. Results: The probiotic VSL#3 was safe and well tolerated. We observed no statistically significant change in pain, disease activity, quality of life, serum/salivary CXCL10 or oral microbial composition with respect to placebo. Salivary IFN‐γ levels demonstrate a trend for a reduced level in the active group (p = 0.082) after 30 days of probiotic consumption. Conclusions: The present proof‐of‐concept study provides some weak not convincing indication of biological and clinical effects of probiotic VSL#3 in individuals with painful oral lichen planus. Further research in this field is needed, with the current study providing useful information to the design of future clinical trials. [ABSTRACT FROM AUTHOR]

Background: Joint arthroplasty registries traditionally report survivorship outcomes mainly on primary joint arthroplasty. The outcome of first revision procedures is less commonly reported, because large numbers of primary procedures are required to analyze a sufficient number of first revision procedures. Additionally, adequate linkage of primary procedures to revisions and mortality is required. When undertaking revision hip surgery, it is important for surgeons to understand the outcomes of these procedures to better inform patients.Questions/purposes: Using data from a large national joint registry, we asked: (1) What is the overall rate of revision of the first aseptic revision procedure for a primary THA? (2) Does the rate of revision of the first revision vary by the diagnosis for the first revision? (3) What is the mortality after the first revision, and does it vary by the reason for first revision?Methods: The Australian Orthopaedic Association National Joint Replacement Registry longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The analyses for this study were performed on primary THA procedures in patients with a diagnosis of osteoarthritis up to December 31, 2020, who had undergone subsequent revision. We excluded all primary THAs involving metal-on-metal and ceramic-on-metal bearing surfaces and prostheses with exchangeable necks because these designs may have particular issues associated with revisions, such as extensive soft tissue destruction, that are not seen with conventional bearings, making a comparative analysis of the first revision involving these bearing surfaces more complicated. Metal-on-metal bearing surfaces have not been used in Australia since 2017. We identified 17,046 first revision procedures from the above study population and after exclusions, included 13,713 first revision procedures in the analyses. The mean age at the first revision was 71 ± 11 years, and 55% (7496 of 13,713) of the patients were women. The median (IQR) time from the primary procedure to the first revision was 3 years (0.3 to 7.3), ranging from 0.8 years for the diagnosis of dislocation and instability to 10 years for osteolysis. There was some variation depending on the reason for the first revision. For example, patients undergoing revision for fracture were slightly older (mean age 76 ± 11 years) and patients undergoing revision for dislocation were more likely to be women (61% [2213 of 3620]). The registry has endeavored to standardize the sequence of revisions and uses a numerical approach to describe revision procedures. The first revision is the revision of a primary procedure, the second revision is the revision of the first revision, and so on. We therefore described the outcome of the first revision as the cumulative percent second revision. The outcome measure was the cumulative percent revision, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the second revision. Hazard ratios from Cox proportional hazards models, adjusting for age and gender, were performed to compare the revision rates among groups. When possible, the cumulative percent second revision at the longest follow-up timepoint was determined with the available data, and when there were insufficient numbers, we used appropriate earlier time periods.Results: The cumulative percent second revision at 18 years was 26% (95% confidence interval [CI] 24% to 28%). When comparing the outcome of the first revision by reason, prosthesis dislocation or instability had the highest rate of second revision compared with the other reasons for first revision. Dual-mobility prostheses had a lower rate of second revision for dislocation or instability than head sizes 32 mm or smaller and when compared to constrained prostheses after 3 months. There was no difference between dual-mobility prostheses and head sizes larger than 32 mm. There were no differences in the rate of second revision when first revisions for loosening, periprosthetic fracture, and osteolysis were compared. If cemented femoral fixation was performed at the time of the first revision, there was a higher cumulative percent second revision for loosening than cementless fixation from 6 months to 6 years, and after this time, there was no difference. The overall mortality after a first revision of primary conventional THA was 1% at 30 days, 2% at 90 days, 5% at 1 year, and 40% at 10 years. A first revision for periprosthetic fracture had the highest mortality at all timepoints compared with other reasons for the first revision.Conclusion: Larger head sizes and dual-mobility cups may help reduce further revisions for dislocation, and the use of cementless stems for a first revision for loosening seems advantageous. Surgeons may counsel patients about the higher risk of death after first revision procedures, particularly if the first revision is performed for periprosthetic fracture.Level of Evidence Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Purpose: (1) Report concomitant cartilage and meniscal injury at the time of anterior cruciate ligament reconstruction (ACLR), (2) evaluate the risk of aseptic revision ACLR during follow-up, and (3) evaluate the risk of aseptic ipsilateral reoperation during follow-up. Methods: Using a United States integrated healthcare system's ACLR registry, patients who underwent primary isolated ACLR were identified (2010–2018). Multivariable Cox proportional-hazards regression was used to evaluate the risk of aseptic revision, with a secondary outcome evaluating ipsilateral aseptic reoperation. Outcomes were evaluated by time from injury to ACLR: acute (< 3 weeks), subacute (3 weeks–3 months), delayed (3–9 months), and chronic (≥ 9 months). Results: The final sample included 270 acute (< 3 weeks), 5971 subacute (3 weeks–3 months), 5959 delayed (3–9 months), and 3595 chronic (≥ 9 months) ACLR. Medial meniscus [55.4% (1990/3595 chronic) vs 38.9% (105/270 acute)] and chondral injuries [40.0% (1437/3595 chronic) vs 24.8% (67/270 acute)] at the time of ACLR were more common in the chronic versus acute groups. The crude 6-year revision rate was 12.9% for acute ACLR, 7.0% for subacute, 5.1% for delayed, and 4.4% for chronic ACLR; reoperation rates a 6-year follow-up was 15.0% for acute ACLR, 9.6% for subacute, 6.4% for delayed, and 8.1% for chronic ACLR. After adjustment for covariates, acute and subacute ACLR had higher risks for aseptic revision (acute HR 1.70, 95% CI 1.07–2.72, p = 0.026; subacute HR 1.25, 95% CI 1.01–1.55, p = 0.040) and aseptic reoperation (acute HR 2.04, 95% CI 1.43–2.91, p < 0.001; subacute HR 1.31, 95% CI 1.11–1.54, p = 0.002) when compared to chronic ACLR. Conclusions: In this cohort study, while more meniscal and chondral injuries were reported for ACLR performed ≥ 9 months after the date of injury, a lower risk of revision and reoperation was observed following chronic ACLR relative to patients undergoing surgery in acute or subacute fashions. Level of evidence III. [ABSTRACT FROM AUTHOR]

The increasing use of social media like YouTube as a news platform provides new opportunities for the public to react to news reporting. This convergence produces multi-narrative framings of police violence-related evidence that requires further attention, especially given the potential impact on state accountability processes. Using a frame analysis of news outlets and content analysis of comments on YouTube, we identify frames, responses, and the multi-narrative framing that results from this converging environment. Our findings suggest a triumvirate of competing frames around police brutality, with mistrust of media complicating the role news media plays in accountability. [ABSTRACT FROM AUTHOR]

Recent decades have witnessed a profound increase in scholarly work and scientific research conducted under the banner of evolutionary psychology. Although evolutionary psychologists typically disavow any historical or conceptual link to the political or scientific project of eugenics, or at the very least downplay the current relevance of such linkages, a growing number of evolutionary thinkers have begun to embrace a biological science of cognitive and moral enhancement. This article examines some of the ways in which advocates of enhancement assume human agency as central to their project even as their naturalistic explanations of human behavior deny that agency. The article also argues that the utopian moral project that animates the evolutionary enhancement movement is undercut by the materialist metaphysics that undergirds the neo-Darwinian worldview employed to ground the project in the first place, a metaphysics that relativizes and ultimately rejects any meaningful morality or moral endeavor whatsoever. [ABSTRACT FROM AUTHOR]

Background: Reverse shoulder arthroplasty (RSA) is increasingly being utilized for the treatment of primary osteoarthritis. However, limited data are available regarding the outcomes of RSA as compared with anatomic total shoulder arthroplasty (TSA) in the setting of osteoarthritis.Methods: We performed a retrospective matched-cohort study of patients who had undergone TSA and RSA for the treatment of primary osteoarthritis and who had a minimum of 2 years of follow-up. Patients were propensity score-matched by age, sex, body mass index (BMI), preoperative American Shoulder and Elbow Surgeons (ASES) score, preoperative active forward elevation, and Walch glenoid morphology. Baseline patient demographics and clinical outcomes, including active range of motion, ASES score, Single Assessment Numerical Evaluation (SANE), and visual analog scale (VAS) for pain, were collected. Clinical and radiographic complications were evaluated.Results: One hundred and thirty-four patients (67 patients per group) were included; the mean duration of follow-up (and standard deviation) was 30 ± 10.7 months. No significant differences were found between the TSA and RSA groups in terms of the baseline or final VAS pain score (p = 0.99 and p = 0.99, respectively), ASES scores (p = 0.99 and p = 0.49, respectively), or SANE scores (p = 0.22 and p = 0.73, respectively). TSA was associated with significantly better postoperative active forward elevation (149° ± 13° versus 142° ± 15°; p = 0.003), external rotation (63° ± 14° versus 57° ± 18°; p = 0.02), and internal rotation (≥L3) (68.7% versus 37.3%; p < 0.001); however, there were only significant baseline-to-postoperative improvements in internal rotation (gain of ≥4 levels in 53.7% versus 31.3%; p = 0.009). The overall complication rate was 4.5% (6 of 134), with no significant difference between TSA and RSA (p = 0.99). Radiolucent lines were observed in association with 14.9% of TSAs, with no gross glenoid loosening. One TSA (1.5%) was revised to RSA for the treatment of a rotator cuff tear. No loosening or revision was encountered in the RSA group.Conclusions: When performed for the treatment of osteoarthritis, TSA and RSA resulted in similar short-term patient-reported outcomes, with better postoperative range of motion after TSA. Longer follow-up is needed to determine the ultimate value of RSA in the setting of osteoarthritis.Level Of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Introduction: Pseudoaneurysms are uncommon but potentially life‐threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound‐guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. Methods: Retrospective single‐centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010–2020). Results: There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound‐guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was <9 h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. Conclusion: In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting. [ABSTRACT FROM AUTHOR]

Phenytoin is a powerful antiseizure drug with complex pharmacokinetic properties, making it an interesting model drug to use in preclinical in vivo investigations, especially with regards to formulations aiming to improve drug delivery to the brain. Moreover, it has a major metabolite, 5‐(4‐hydroxyphenyl)‐5‐phenylhydantoin, which can be simultaneously studied to achieve a better assessment of its behaviour in the body. Here, we describe the development and validation of a sensitive LCMS/MS method for quantification of phenytoin and 5‐(4‐hydroxyphenyl)‐5‐phenylhydantoin in rat plasma and brain which can be used in such preclinical studies. Calibration curves produced covered a range of 7.81 to 250 ng/mL (plasma) and 23.4 to 750 ng/g (brain tissue) for both analytes. The method was validated for specificity, sensitivity, accuracy, and precision and found to be within the acceptable limits of ±15% over this range in both tissue types. The method when applied in two in vivo investigations: validation of a seizure model and to study the behaviour of a solution of intranasally administered phenytoin as a foundation for future studies into direct nose‐to‐brain delivery of phenytoin using specifically developed particulate systems, was highly sensitive for detecting phenytoin and 5‐(4‐hydroxyphenyl)‐5‐phenylhydantoin in rat plasma and brain. [ABSTRACT FROM AUTHOR]