The combined effects of growth and maturity status on injury risk in an elite football academy.

This study aimed to explore the interaction between growth rate on specific injury incidence and burden on pre-, circa- and post-peak height velocity (PHV) periods. Injury and stature data collected during the 2000-2020 seasons in an elite football academy were retrospectively analysed. Only players with height measurements from childhood until the attainment of adult height were included in the study (N = 84). Growth data were smoothed using a cubic spline to calculate daily growth rate and height. Growth rate was categorised into three groups: fast (> 7.2 cm/year), moderate (3.5-7.2 cm/year) and slow (< 3.5 cm/year). Percentage of observed adult height was used to classify players as pre-PHV (< 88%), circa-PHV (88-95%) or post-PHV (> 95%). Overall and specific injury incidence and burden and rate ratios for comparisons between growth rate groups were calculated on pre-, circa- and post-PHV periods, separately. Overall injury incidence and burden were greater in pre-PHV players with quicker growth rates compared to players growing moderately and slowly. All in all, players with more rapid growth-rates were at higher risk for growth-related injuries in all pre-, circa- and post-PHV periods. Post-PHV, the incidence and burden of joint/ligament injuries were 2.4 and 2.6-times greater in players growing slowly compared to players growing moderately. Practitioners should monitor growth rate and maturity status and consider their interaction to facilitate the design of targeted injury risk reduction strategies.

Friesodielsia parvimitra (Annonaceae), a New Species from Peninsular Thailand and a Note on F. argentea.

During botanical expeditions focused on the study of Annonaceae in Thailand, specimens resembling Friesodielsia glauca were collected from the lower part of peninsular Thailand but were believed to differ from that species in vegetative, flower, and fruit characters. A morphological investigation of the new specimens and species complex was conducted. Specimens (including types of F. glauca and similar species collected from Thailand and adjacent regions) were examined in the following herbaria: A, BK, BM, BKF, E, K, KEP, KKU, L, PSU, QBG, SING, and US. As a consequence, the new species Friesodielsia parvimitra, endemic to peninsular Thailand, is described and illustrated. The conservation status of the new species was provisionally assessed as Critically Endangered (CR, B2ab(iii)) following the IUCN's guidelines. In addition, F. argentea, previously regarded F. glauca, is reinstated here as a distinct species based on several morphological differences and is reported as a new record from Thailand. Photographs, line drawings, and a revised key to F. glauca and similar species are presented.

Dispersal from Africa to the Neotropics was followed by multiple transitions across Neotropical biomes facilitated by frugivores.

BACKGROUND AND AIM: Plant disjunctions have fascinated biogeographers and ecologists for a long time. We use tribe Bocageeae (Annonaceae), a predominantly Neotropical plant group distributed across several present-day Neotropical biomes and with an African-American disjunction, to investigate long-distance dispersal mediated by frugivorous animals at both intercontinental and intracontinental scales. METHODS: We reconstructed a species-level phylogeny of tribe Bocageeae with a dataset composed of 116 nuclear markers. We sampled 70% of Bocageeae species, covering its geographic range and representing all eight genera. We estimated divergence times using BEAST, inferred ancestral range distributions and reconstructed ancestral states for fruit traits related to long-distance dispersal in a Bayesian framework. KEY RESULTS: The ancestral Bocageeae date to the Early Eocene and were inferred to occur in Africa and proto-Amazonia. Its ancestral fruits were large and dehiscent. The first lineage split gave rise to an exclusively Neotropical clade during the Middle Eocene, in proto-Amazonia. Range exchange between the Amazon and the Atlantic Forest occurred at least once during the Miocene, and from Amazonia to Central America and Mexico, during the Early Miocene. Transitions in different sets of fruit morphologies were inferred to be related to dispersal events across South American regions/biomes. CONCLUSIONS: In Bocageeae mammals may have been responsible for long-distance dispersal through the Boreotropics. In the Neotropics, proto-Amazonia is proposed to be the source for dispersal to other tropical American biomes. Long-distance dispersal may have happened via a wide range of dispersal guilds, depending on frugivore radiations, diversity, and abundance at particular time periods and places. Hence, inter- and intracontinental dispersal may not rely on a single dispersal syndrome or guild, but more on the availability of frugivorous lineages for seed dispersal.

The effect of polyvinyl chloride (PVC) color on biofilm development and biofilm-heavy metal chemodynamics in the aquatic environment.

Plastic surfaces are colonized by microorganisms and biofilms are formed in the natural aquatic environment. As the biofilm develops, it changes the density and buoyancy of the plastic-biofilm complex, results in plastic sinking, and increases the heavy metals accumulated by biofilm's mobility and availability in aquatic ecosystems. In this experiment, biofilms were cultured on five colors of polyvinyl chloride (PVC; transparent, green, blue, red, black) in an aquatic environment to investigate the effects of plastic color on biofilm formation and development (Phase 1) and to study the effects of being sunk below the photic zone on biofilm (Phase 2). The PVC color significantly affected the biofilm formation rate but had no impact on the final biofilm biomass. After sinking the biofilm-PVC below the photic zone in Phase 2, the layer of diatoms on the biofilm surface began to disintegrate, and the biomass and Chlorophyll-a (Chla) content of the biofilm decreased, except on the red PVC. Below the photic zone, the microbial community of the biofilm changed from primarily autotrophic microbes to mostly heterotrophic microbes. Microbial diversity increased and extracellular polymeric substances (EPS) content decreased. The primary factor leading to microbial diversity and community structure changes was water depth rather than PVC color. The changes induced in the biofilm led to an increase in the concentration of all heavy metals in the biofilm, related to the increase in microbial diversity. This study provides new insights into the biofilm formation process and the effects on a biofilm when it sinks below the photic zone.

Enhancement of electrokinetic-phytoremediation by Ophiopogon japonicus: stimulation of electrokinetic on root system and improvement of polycyclic aromatic hydrocarbon degradation.

Root systems are sensitive to voltage and tend to improve the degradation of organic pollutants by promoting the root exudates and increasing microbial enzyme activity in the rhizosphere under the effect of electrokinetic. In this study, electrokinetic-assisted phytoremediation (EKPR) was applied for the remediation of soil containing phenanthrene (PHE) and pyrene (PYR). Direct current (DC) voltage (1 V cm-1) was applied across the soils for 30 days following 3 treatment schedules (0 h, 4 h, and 12 h per day), referred to as treatments EK0, EK4, and EK12. Electrokinetic assistance improved phytoremediation. Compared to EK0, the removal of PHE and PYR increased by 51.79% and 45.07% for EK4 and by 43.18% and 38.75% for EK12. The applied voltage promoted root growth, stimulated the root exudate release, and increased accumulation of PHE and PYR by plants, and the effect was most pronounced in treatment EK4. Catalase and urease activities in rhizosphere soil also increased, by respective increments of 44.51% and 40.86% for EK4 and by 28.53% and 21.24% for EK12. In this study, we demonstrated that a low voltage applied for an appropriate duration (4 h per day) improves removal of PAHs by stimulating root growth, promoting the root exudate release and enhancing enzyme activity in the microbiome of rhizosphere soil.

The influence of exposure, growth and maturation on injury risk in male academy football players.

Adolescence is a period of increased injury risk in youth footballers; however, no studies have considered the influence of growth-related factors and exposure time upon injury risk. Forty-nine elite male youth footballers were prospectively monitored for growth, lower-limb growth, maturation, training volume and injury for one season. Generalised linear mixed-effects models were used to model growth rate, lower-limb growth rate, maturation, and smoothed week-to-week changes in exposure on time-loss injury risk. The relationship between growth rate and injury incidence was linear (P = 0.031) and injury burden was non-linear (P = 0.019). The relationship between lower-limb growth rate and injury incidence was linear and positive (P = 0.098). A non-linear relationship was observed between lower-limb growth rate and injury burden (P = 0.001). A non-linear relationship between Percentage of Predicted Adult Stature and both injury incidence and injury burden were found, with peak risk occurring at 92% and 95% , respectively. There was a positive linear relationship between week-to-week changeand injury incidence (P = 0.001), and a non-linear relationship between week-to-week change and injury burden (P = 0.01). Practitioners should monitor the timing and rate of the growth spurt and exposure time to identify players at greater injury risk.

Distribution, sources and risk assessment of PAHs in soil from the water level fluctuation zone of Xiangxi Bay, Three Gorges Reservoir.

Information on PAH distribution in the water level fluctuation zone (WLFZ) of Three Gorges Reservoir is limited. In this study, we investigated PAH distribution and sources and assessed PAH risks, over one annual water level fluctuation cycle (June 2017-June 2018) at four elevations spanning the WLFZ (145 m, 155 m, 165 m and 175 m) at seven locations in the water level fluctuation zone along Xiangxi River. The mean total PAH concentration in June 2018 (953 ng g-1) was significantly higher than in June 2017 (494 ng g-1), and the horizontal and vertical distributions of PAHs changed significantly. The changes in distribution patterns provided evidence for the cause of increased PAH levels, which were attributed to construction of the Xiangxi River Bridge. Thus, this study of PAH dynamics in the WLFZ soils of Xiangxi Bay also provided valuable information on the impact of bridge construction on WLFZ soils. The change in PAH levels among stations implicated sediment disturbance resulting from bridge construction as the major contributor to the increased PAH levels. Source characterization, based on the ratios of certain PAHs, indicates that PAHs are mainly from the combustion of petroleum fuels, biomass and coal. These ratios indicated that the proportion of PAHs from fuel combustion increased from 2017 to 2018, implicating the heavy equipment used during bridge construction as another source of the increased PAH levels. The incremental lifetime cancer risk (ILCR) model was used to assess the health risk of the PAHs and the range among all age groups (10-5-10-4) indicates a potential health risk. The mean effects range-median quotient (M-ERM-Q) was used to assess the ecological risk of PAHs and the range (0.1-0.5) indicates low to medium risk. The increase in PAH levels from 2017 to 2018 increased the risk to public health and the environment. The results of this investigation provide a reference for ecological restoration of the WLFZ and support development of effective policies for environmental and public health. Further, the results provide information on the impact of bridge construction on WLFZ soils and identify research needed to more fully understand PAH dynamics in WLFZ soils.

Flora of Cameroon - Annonaceae Vol 45.

Annonaceae is a major pantropical family with 113 genera and about 2550 species. Cameroon is one of the most biodiverse countries in Africa but its flora remains incompletely known. In this volume of the Flora of Cameroon, we describe 166 native taxa representing 163 species in 28 native genera within the family Annonaceae. A total of 22 species (about 13%) are endemic to the country. We provide keys to all native genera, species, and infraspecific taxa. For each species a detailed morphological description and a map of its distribution in Cameroon are provided. Distribution maps and diversity analyses are based on a taxonomically verified database of 2073 collections. Across Africa, Cameroon is a center of diversity for Annonaceae harboring one of the highest numbers of species and genera. For example, Cameroon harbors the highest number of African species for the only pantropical genus of Annonaceae, Xylopia. Annonaceae are found across all 10 administrative regions of Cameroon but diversity is concentrated within the tropical rain forest areas situated in the south and South-West. The areas around Bipindi and Mount Cameroon show the highest levels of diversity, but this is correlated with collection effort. Line drawings and/or photographs accompany most species. One species new to science Uvariopsisetugeana Dagallier & Couvreur sp. nov. is described. We also undertake a number of nomenclatural changes such as lectotypifications, six new synonymies and two new combinations (Uvariaanisotricha (Le Thomas) Couvreur, comb. nov.; Uvariodendronfuscumvar.giganteum (Engl.) Dagallier & Couvreur, comb. nov.).

RésuméLes Annonacées sont une grande famille pantropicale avec 113 genres et 2550 espèces. Le Cameroun est l'un des pays les plus riches en biodiversité d'Afrique mais sa flore reste incomplètement connue. Dans ce volume de la Flore du Cameroun, nous décrivons 166 taxons représentant 163 espèces dans 28 genres au sein de la famille des Annonaceae. Au total, 22 espèces (environ 13%) sont endémiques du pays. Nous fournissons une clé de tous les genres et espèces et des infra-espèces au sein des genres. Pour chaque espèce une description morphologique détaillée et une carte de sa répartition au Cameroun sont fournies. Les cartes de distribution et les analyses de diversité sont basées sur une base de données taxonomiquement vérifiée de 2073 collections. À travers l'Afrique, le Cameroun est un centre de diversité pour les Annonacées abritant l'un des plus grands nombres d'espèces et de genres. Par exemple, le Cameroun abrite le plus grand nombre d'espèces africaines pour le seul genre pantropical d'Annonaceae, Xylopia. Les Annonaceae sont présentent dans les 10 régions du Cameroun, mais la plus grande diversité est concentrée dans les régions abritant la forêt tropicale humide située au sud et au sud-ouest. Les zones autour de Bipindi et du Mont Cameroun présentent les niveaux de diversité les plus élevés, mais cela est corrélé à l'effort de collecte. Des dessins et/ou des photographies accompagnent la plupart des espèces. Une espèce nouvelle pour la science Uvariopsisetugeana Dagalier & Couvreur sp. nov. est décrite. Nous entreprenons également un certain nombre de changements nomenclaturaux tels que des lectotypifications, six nouvelles synonymies et deux nouvelles combinaisons (Uvariaanisotricha (Le Thomas) Couvreur, comb. nov.; Uvariodendronfuscumvar.giganteum (Engl.) Dagalier & Couvreur, comb. nov.).

Zilovertamab Vedotin Targeting of ROR1 as Therapy for Lymphoid Cancers.

BACKGROUND: Receptor tyrosine kinase-like orphan receptor 1 (ROR1) is an oncofetal protein present on many cancers. Zilovertamab vedotin (ZV) is an antibody­drug conjugate comprising a monoclonal antibody recognizing extracellular ROR1, a cleavable linker, and the anti-microtubule cytotoxin monomethyl auristatin E. METHODS: In this phase 1, first-in-human, dose-escalation study, we accrued patients with previously treated lymphoid cancers to receive ZV every 3 weeks until the occurrence of cancer progression or unacceptable toxicity had occurred. RESULTS: We enrolled 32 patients with tumor histologies of mantle cell lymphoma (MCL) (n=15), chronic lymphocytic leukemia (n=7), diffuse large B-cell lymphoma (DLBCL) (n=5), follicular lymphoma (n=3), Richter transformation lymphoma (n=1), or marginal zone lymphoma (n=1). Patients had received a median of four previous drug and/or cellular therapies. Starting dose levels were 0.5 (n=1), 1.0 (n=3), 1.5 (n=3), 2.25 (n=11), and 2.5 (n=14) mg per kg of body weight (mg/kg). Pharmacokinetic and pharmacodynamic data documented systemic ZV exposure and exposure-dependent ZV targeting of ROR1 on circulating tumor cells. As expected with an monomethyl auristatin E-containing antibody­drug conjugate, adverse events (AEs) included acute neutropenia and cumulative neuropathy resulting in a recommended ZV dosing regimen of 2.5 mg/kg every 3 weeks. No clinically concerning AEs occurred to suggest ROR1-mediated toxicities or nonspecific ZV binding to normal tissues. ZV induced objective tumor responses in 7 of 15 patients with MCL (47%; 4 partial and 3 complete) and in 3 of 5 patients with DLBCL (60%; 1 partial and 2 complete); objective tumor responses were not observed among patients with other tumor types. CONCLUSIONS: In heavily pretreated patients, ZV demonstrated no unexpected toxicities and showed evidence of antitumor activity, providing clinical proof of concept for selective targeting of ROR1 as a potential new approach to cancer therapy. (ClinicalTrials.gov number, NCT03833180.)

Color-induced changes in oxygen consumption and swimming performance of juvenile bighead carp (Aristichthys nobilis).

Fish physiology and behavior are affected by exposure to light of varying colors, but little is known about the effects on swimming performance and metabolism. The purpose of this study was to measure the effects of light color on the swimming performance of bighead carp (Aristichthys nobilis), a planktivorous fish species widely used in aquaculture. Stepped velocity testing was conducted in a modified Brett-type swim tunnel respirometer to determine critical swimming speed (Ucrit), oxygen consumption (MO2), and excess post-exercise oxygen consumption (EPOC) for juvenile bighead carp under red, yellow, blue, and green lights at 25 °C. Ucrit was significantly lower for fish swimming under yellow and green lights compared with red and blue light. Cost of transport (COT), a measure of swimming efficiency, also varied with color. The results, obtained under controlled conditions, add to our knowledge on the effects of artificial color light on fish physiology and behavior and inform decisions on the use of artificial color light in aquaculture and fishway design.

Se enhanced phytoremediation of diesel in soil by Trifolium repens.

A pot-culture experiment was conducted to assess the effects of selenium (Se) (0.5 mg kg-1) on Trifolium repens exposed to various levels of diesel (0, 15, 20, 25 g kg-1) for 30 days and 60 days. Exposure to diesel for 60 day led to concentration-dependent decreases in root morphogenesis, chlorophyll content and CAT activity, and to dose-dependent increases in MDA content and SOD activity. The residual diesel concentration in soil increased and the removal efficiency decreased with soil diesel concentration. The chlorophyll content and residual diesel concentration after were slightly higher at 30 days than at 60days. Application of Se to soil increased Trifolium repens tolerance to diesel and significantly increased the phytoremediation effect at 60 days, with a removal rate of 36 ±â€¯8%, compared to 28 ±â€¯7% in the control. These results contribute to the ongoing effort to develop an effective phytoremediation system for soils highly contaminated by diesel.

A revision of Xylopia L. (Annonaceae): the species of Tropical Africa.

A revision of the 45 species of the pantropical genus Xylopia in Tropical Africa includes descriptions of six new species and a new section of the genus. The fruits and seeds of Xylopia show specializations that promote vertebrate dispersal, primarily by hornbills and monkeys. Over half of the African species have an Area of Occupancy (AOO) less than 80 km2, suggesting that they are in need of protection. African species are classified into five sections. Section Neoxylopia , with four species, is centered in the Guineo-Congolian Region and includes X.globosasp. nov. Section Ancistropetala, with three species, occurs in the same region. Both of these sections are endemic to Africa. Section Xylopia, which extends to Madagascar and the American tropics, has only a single species in Africa, X.aethiopica. The three species of section Verdcourtiasect. nov. are restricted to the East African coast and Madagascar. The largest number of African species, (34) belong to section Stenoxylopia, in which the seeds lack the arils found in the other sections and instead have a fleshy sarcotesta. Section Stenoxylopia is divided into two informal groups, one centered in eastern and southern Africa (X.odoratissima group) and the other centered in the wetter forests of western and central Africa (X.acutiflora group). Five new species are described in section Stenoxylopia: Xylopianiloticasp. nov. from Sudan, South Sudan, and Uganda, Xylopiacalvasp. nov. from Nigeria and Cameroon, which is allied to X.phloiodora, and Xylopiamonticolasp. nov. from Nigeria and Cameroon, X.pirataesp. nov. from Ivory Coast and Ghana, and X.unguiculatasp. nov. from Gabon. The latter three species are segregates of the former Xylopiaacutiflora s. l. One new combination is made at the species level, X.shirensiscomb. nov. Keys, descriptions, illustrations, distribution maps, and an index to numbered collections document diversity and assist with species identification. The name Unonaoliveriana Baill. was found to pre-date the name Unonalepidota Oliv., requiring the combination Meiocarpidiumoliverianumcomb. nov.

Updated Nasal Surgery for Obstructive Sleep Apnea.

Numerous studies report that difficulty breathing through the nose is associated with reduced sleep quality, increased daytime dysfunction, and increased risk of snoring and obstructive sleep apnea (OSA). Additionally, chronic nasal obstruction often complicates and limits successful medical device therapy for OSA, particularly with continuous positive airway pressure (CPAP). When medical evaluation and management of the nose is inadequate, surgical therapy to lower nasal resistance has been shown to substantially improve sleep and breathing outcome measures. Although nasal surgery in isolation does not have a consistent effect on the apnea-hypopnea index in OSA patients, it does have robust evidence on improving snoring, subjective sleep quality, daytime sleepiness, sleep-related quality of life measures, and other important OSA outcome measures. Furthermore, in OSA patients with sinonasal disease who are struggling with CPAP and other medical devices, sinonasal surgery also has the potential to lower pressure requirements and improve adherence rates. Nasal surgery plays a key adjunctive role in the management of an OSA patient population.

Interventions to Increase Male Attendance and Testing for Sexually Transmitted Infections at Publicly-Funded Family Planning Clinics.

PURPOSE: We assessed the impact of staff, clinic, and community interventions on male and female family planning client visit volume and sexually transmitted infection testing at a multisite community-based health care agency. METHODS: Staff training, clinic environmental changes, in-reach/outreach, and efficiency assessments were implemented in two Family Health Center (San Diego, CA) family planning clinics during 2010-2012; five Family Health Center family planning programs were identified as comparison clinics. Client visit records were compared between preintervention (2007-2009) and postintervention (2010-2012) for both sets of clinics. RESULTS: Of 7,826 male client visits during the time before intervention, most were for clients who were aged <30 years (50%), Hispanic (64%), and uninsured (81%). From preintervention to postintervention, intervention clinics significantly increased the number of male visits (4,004 to 8,385; Δ = +109%); for comparison clinics, male visits increased modestly (3,822 to 4,500; Δ = +18%). The proportion of male clinic visits where chlamydia testing was performed increased in intervention clinics (35% to 42%; p < .001) but decreased in comparison clinics (37% to 33%; p < .001). Subgroup analyses conducted among adolescent and young adult males yielded similar findings for male client volume and chlamydia testing. The number of female visits declined nearly 40% in both comparison (21,800 to 13,202; -39%) and intervention clinics (30,830 to 19,971; -35%) between preintervention and postintervention periods. CONCLUSIONS: Multilevel interventions designed to increase male client volume and sexually transmitted infection testing services in family planning clinics succeeded without affecting female client volume or services.

Active Clustering with Model-Based Uncertainty Reduction.

Semi-supervised clustering seeks to augment traditional clustering methods by incorporating side information provided via human expertise in order to increase the semantic meaningfulness of the resulting clusters. However, most current methods are passive in the sense that the side information is provided beforehand and selected randomly. This may require a large number of constraints, some of which could be redundant, unnecessary, or even detrimental to the clustering results. Thus in order to scale such semi-supervised algorithms to larger problems it is desirable to pursue an active clustering method-i.e., an algorithm that maximizes the effectiveness of the available human labor by only requesting human input where it will have the greatest impact. Here, we propose a novel online framework for active semi-supervised spectral clustering that selects pairwise constraints as clustering proceeds, based on the principle of uncertainty reduction. Using a first-order Taylor expansion, we decompose the expected uncertainty reduction problem into a gradient and a step-scale, computed via an application of matrix perturbation theory and cluster-assignment entropy, respectively. The resulting model is used to estimate the uncertainty reduction potential of each sample in the dataset. We then present the human user with pairwise queries with respect to only the best candidate sample. We evaluate our method using three different image datasets (faces, leaves and dogs), a set of common UCI machine learning datasets and a gene dataset. The results validate our decomposition formulation and show that our method is consistently superior to existing state-of-the-art techniques, as well as being robust to noise and to unknown numbers of clusters.

A new species in the tree genus Polyceratocarpus (Annonaceae) from the Udzungwa Mountains of Tanzania.

Polyceratocarpus askhambryan-iringae, an endemic tree species of Annonaceae from the Udzungwa Mountains of Tanzania, is described and illustrated. The new species is identified as a member of the genus Polyceratocarpus by the combination of staminate and bisexual flowers, axillary inflorescences, subequal outer and inner petals, and multi-seeded monocarps with pitted seeds. From Polyceratocarpus scheffleri, with which it has previously been confused, it differs in the longer pedicels, smaller and thinner petals, shorter bracts, and by generally smaller, less curved monocarps that have a clear stipe and usually have fewer seeds. Because Polyceratocarpus askhambryan-iringae has a restricted extent of occurrence, area of occupancy, and ongoing degradation of its forest habitat, we recommend classification of it as Endangered (EN) on the IUCN Red List.

Male Attendance at Title X Family Planning Clinics - United States, 2003-2014.

Although both men and women have reproductive health care needs, family planning providers traditionally focus services toward women (1,2). Challenges in providing family planning services to men, including preconception health, infertility, contraceptive, and sexually transmitted disease (STD) care (3,4), include their infrequent use of preventive health services, a perceived lack of need for these services (1,5), and the lack of provider guidance regarding men's reproductive health care needs (4). Since 1970, the National Title X Family Planning Program has provided cost-effective and confidential family planning and related preventive health services with priority for services to low-income women and men. To examine men's use of services at Title X service sites, CDC and the U.S. Department of Health and Human Services' Office of Population Affairs (OPA) analyzed data from the 2003-2014 Family Planning Annual Reports (FPAR), annual data that are required of all Title X-funded agencies. During 2003-2014, 3.8 million males visited Title X service sites in the United States and the percentage of family planning users who were male nearly doubled from 4.5% (221,425 males) in 2003 to 8.8% (362,531 males) in 2014. In 2014, the percentage of family planning users who were male varied widely by state, ranging from ≤1% in Mississippi, Tennessee, and Alabama to 27.2% in the District of Columbia (DC). Title X service sites are increasingly providing services for males. Health care settings might want to adopt the framework employed by Title X clinics to better provide family planning and related preventative services to men (3).

A phase 2 study of idelalisib plus rituximab in treatment-naïve older patients with chronic lymphocytic leukemia.

Idelalisib is a first-in-class oral inhibitor of PI3Kδ that has shown substantial activity in patients with relapsed/refractory chronic lymphocytic leukemia (CLL). To evaluate idelalisib as initial therapy, 64 treatment-naïve older patients with CLL or small lymphocytic leukemia (median age, 71 years; range, 65-90) were treated with rituximab 375 mg/m(2) weekly ×8 and idelalisib 150 mg twice daily continuously for 48 weeks. Patients completing 48 weeks without progression could continue to receive idelalisib on an extension study. The median time on treatment was 22.4 months (range, 0.8-45.8+). The overall response rate (ORR) was 97%, including 19% complete responses. The ORR was 100% in patients with del(17p)/TP53 mutations and 97% in those with unmutated IGHV. Progression-free survival was 83% at 36 months. The most frequent (>30%) adverse events (any grade) were diarrhea (including colitis) (64%), rash (58%), pyrexia (42%), nausea (38%), chills (36%), cough (33%), and fatigue (31%). Elevated alanine transaminase/aspartate transaminase was seen in 67% of patients (23% grade ≥3). The combination of idelalisib and rituximab was highly active, resulting in durable disease control in treatment-naïve older patients with CLL. These results support the further development of idelalisib as initial treatment of CLL. This study is registered at ClinicalTrials.gov as #NCT01203930.

Markers of increased aeration in the paranasal sinuses and along the skull base: association between anatomic variants.

BACKGROUND: There may be substantial variation in paranasal sinus pneumatization across patients and between right and left sides. Patients with extensive sinus aeration, especially of the sphenoid sinus and along the skull base, often have protrusion of critical structures into the pneumatized sinus cavities, which potentially places these structures at risk during sinus surgery. OBJECTIVE: To evaluate associations between anatomic markers of increased paranasal sinus aeration along the skull base and to determine whether the presence of certain markers predicts other critical anatomic variants. METHODS: Submillimeter axial computed tomography (CT) scans and associated triplanar reconstructions from 100 subjects were reviewed for the presence of 22 anatomic variants by two separate evaluators. Twelve of these variants were selected as markers of increased pneumatization. Average numbers of markers were compared with t-tests; associations between markers were evaluated by logistic regression analyses. The Holm-Bonferroni method was used to correct for multiple tests. RESULTS: Five anatomic variants were associated with increased paranasal sinus pneumatization, as defined by total number of markers of pneumatization: anterior ethmoid artery below the skull base, dehiscent/protruding internal carotid artery (ICA), dehiscent/protruding optic nerve (ON), pneumatized pterygoid recess, and middle turbinate (MT) concha bullosa (all p < .02). Significant associations were found between pneumatized pterygoid recesses and dehiscent or protruding ONs (odds ratio [OR] 3.06, p = .0120), dehiscent or protruding ICAs (OR 6.64, p < .0001), and anterior ethmoid arteries below the skull base (OR 2.65, p = .0189). Significant association was also found between dehiscent or protruding ONs and dehiscent or protruding ICAs (OR 3.57, p = .0047). CONCLUSION: The markers of increased pneumatization and anatomic associations identified in this study have important implications for surgeons planning and undertaking operative approaches in and around the sinuses.

Validation of a telephone screening tool for spasmodic dysphonia and vocal fold tremor.

OBJECTIVES/HYPOTHESIS: The objective of this study was to ascertain whether clinicians can reliably distinguish between spasmodic dysphonia (SD)/vocal tremor and other voice disorders by telephone, despite this modality's limited frequency response. STUDY DESIGN: Randomized, single-blinded, and prospective study. METHODS: Voice-disordered patients with (n = 22) and without (n = 17) SD and/or vocal tremor recorded standardized utterances via landline telephone. A laryngologist and two speech-language pathologists blinded to the diagnoses rated each recording as "yes" or "no" to "SD or tremor present?," and if "yes" categorized into adductor, abductor, tremor only, or adductor with tremor subtypes. Twenty-one recordings were presented twice at random so intrarater reliability could be assessed. All ratings were compared with gold standard diagnosis by a second laryngologist who performed a full examination, including videostroboscopy, on each patient. RESULTS: For the comparison "SD or tremor" yes versus no, sensitivity, specificity, positive predictive value, and negative predictive value are 90%, 95%, 96%, and 89%, respectively. Interrater reliability (Cohen kappa) compared with the gold standard ranged from 0.70 to 0.93 (substantial to almost perfect agreement). Cronbach alpha among three raters was 0.90 for this comparison. Intrarater reliability (number matched/number inspected) was very high, ranging from 0.97 to 1.0. Comparing gold standard and telephone rating of SD/tremor subtypes, kappa ranged from 0.48 to 0.60 (moderate agreement). Cronbach alpha among three raters was 0.88 for this comparison. Intrarater reliability ranged from 0.84 to 0.97. CONCLUSIONS: SD and tremor can be reliably distinguished from other voice disorders over the telephone.