Examining the Impact of Structural Uncertainty Across 10 Type 2 Diabetes Models: Results From the 2022 Mount Hood Challenge.

OBJECTIVES: The Mount Hood Diabetes Challenge Network aimed to examine the impact of model structural uncertainty on the estimated cost-effectiveness of interventions for type 2 diabetes. METHODS: Ten independent modeling groups completed a blinded simulation exercise to estimate the cost-effectiveness of 3 interventions in 2 type 2 diabetes populations. Modeling groups were provided with a common baseline population, cost and utility values associated with different model health states, and instructions regarding time horizon and discounting. We collated the results to identify variation in predictions of net monetary benefit (NMB) and the drivers of those differences. RESULTS: Overall, modeling groups agreed which interventions had a positive NMB (ie, were cost-effective), Although estimates of NMB varied substantially-by up to £23 696 for 1 intervention. Variation was mainly driven through differences in risk equations for complications of diabetes and their implementation between models. The number of modeled health states was also a significant predictor of NMB. CONCLUSIONS: This exercise demonstrates that structural uncertainty between different health economic models affects cost-effectiveness estimates. Although it is reassuring that a decision maker would likely reach similar conclusions on which interventions were cost-effective using most models, the range in numerical estimates generated across different models would nevertheless be important for price-setting negotiations with intervention developers. Minimizing the impact of structural uncertainty on healthcare decision making therefore remains an important priority. Model registries, which record and compare the impact of structural assumptions, offer one potential avenue to improve confidence in the robustness of health economic modeling.

Hoodplasty: Individualized Approach for Labiaplasties.

INTRODUCTION: Hoodplasties and labia minora reductions are some of the most requested operative procedures by women distressed with the appearance of their vulvar region. In the majority of cases, a concomitant hoodplasty (HP) is performed to achieve a better aesthetic appearance. Various surgical methods have been described for the removal of excess tissue within the clitoris hood area. MATERIALS AND METHOD: This study aims to describe a single surgeon's preference and results in her private practise in 630 patients who underwent labiaplasty mainly because of dissatisfaction with the aesthetic appearance. RESULTS: Of the 630 labiaplasties performed, 303 had clitoris hood excess, 44% of cases with concomitant HP and in 7.9% of cases only a HP was performed. The study was done between September 2009 and December 2021 and the HP technique was longitudinal excision in 97% of patients and horseshoe excision in 4.95% of them. Surgeries lasted between 30 and 60 min. 98% of the patients claimed an improvement in self-esteem and 96% claimed improvement in sex life post-surgery. No major complications occurred. DISCUSSION: An isolated labiaplasty technique in patients with hood excess results in disharmony in the area. HP can be considered as a subdivision of a labioplasty. Extended central wedge labia minora resection (V-plasty) is a commonly used procedure in LP operations but can limit the excess clitoris hood resection. Edge labia minora resection can easily be combined with longitudinal excision of the clitoral hood, and when also horizontal clitoris hood excess is present can also be addressed by converting the resection from longitudinal into a horse hose resection. Limitations in the study include lack of use of validated assessments for the satisfaction of aesthetic outcomes and that all the procedures were performed by a single senior surgeon, which can be seen as a strength but also a limitation because of the high risk of bias. Moreover, there was no comparative cohort for the study population. Furthermore, we could not find comparative cohorts in previously reported techniques in the literature either. CONCLUSION: Clitoris hood resections should be treated on an individualized approach and adapted according to the excess present. It is important when a patient requests a labiaplasty to always address the clitoris hood during the consultation to avoid unsatisfied patients afterwards. Many patients come just focussed on their labia minora excess and when corrected, realize the clitoris hood excess was also part of the problem. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

The application of target trials with longitudinal targeted maximum likelihood estimation to assess the effect of alcohol consumption in adolescence on depressive symptoms in adulthood.

Time-varying confounding is a common challenge for causal inference in observational studies with time-varying treatments, long follow-up periods, and participant dropout. Confounder adjustment using traditional approaches can be limited by data sparsity, weight instability and computational issues. The Nicotine Dependence in Teens (NDIT) study is a prospective cohort study involving 24 data collection cycles from 1999 to date, among 1,294 students recruited from 10 high schools in Montreal, Canada, including follow-up into adulthood. Our aim is to estimate associations between the timing of alcohol initiation and the cumulative duration of alcohol use on depression symptoms in adulthood. Based on the target trials framework, we define intention-to-treat and as-treated parameters in a marginal structural model with sex as a potential effect-modifier. We then use the observational data to emulate the trials. For estimation, we use pooled longitudinal target maximum likelihood estimation (LTMLE), a plug-in estimator with double robust and local efficiency properties. We describe strategies for dealing with high-dimensional potential drinking patterns and practical positivity violations due to a long follow-up time, including modifying the effect of interest by removing sparsely observed drinking patterns from the loss function and applying longitudinal modified treatment policies to represent the effect of discouraging drinking.

Hood attached vs conventional triangular tip-jet knife in peroral endoscopic myotomy: a propensity score matching cohort study.

BACKGROUND & AIM: Peroral endoscopic myotomy (POEM) is a safe and effective endoscopic treatment for achalasia and other esophageal motility disorders, and TTJ (Triangle Tip Knife J; Olympus, Tokyo, Japan) is currently widely used in POEM. Recently, we reported a novel modification of TTJ, which was adjusted to knife length 2 mm by attaching a disposable clip (QuickClip Pro; Olympus) sheath to the tip as a hood attachment. In this study, we compared the safety and effectiveness of TTJ and TTJ with hood attachment (TTJ-H) in POEM. METHODS: In this 1:1 propensity score matched retrospective cohort study, we compared the procedure time, myotomy efficiency, number of coagulation forceps usage, adverse events, length of hospital stay after POEM, procedural success and clinical success between TTJ and TTJ-H groups. RESULTS: We examined 682 consecutive patients who underwent POEM between January 2021 and June 2023. We excluded 134 patients who had already undergone POEM or laparoscopic Heller myotomy as prior myotomy. Finally, we identified 98 propensity score-matched pairs (n = 196). The mean procedure time was shortened from 93.5 to 80.2 min (14% reduction, P = 0.012) when comparing TTJ-H group to TTJ group. The mean myotomy efficiency was improved from 2.76 to 2.32 min/cm (16% improvement, P = <0.001), and usage of coagulation forceps for hemostasis was decreased from 3.87 to 0.55 (86% reduction, P = <0.001). CONCLUSIONS: This study showed that use of TTJ-H could reduce total procedure time, improve myotomy efficiency, and reduce costs compared to TTJ.

Comparison of energy expenditure measurements by a new basic respiratory room vs. classical ventilated hood.

BACKGROUND: Nutritional support is often based on predicted resting energy expenditure (REE). In patients, predictions seem invalid. Indirect calorimetry is the gold standard for measuring EE. For assessments over longer periods (up to days), room calorimeters are used. Their design makes their use cumbersome, and warrants improvements to increase utility. Current study aims to compare data on momentary EE, obtained by a basic respiration room vs. classical ventilated hood. The objective is to compare results of the basic room and to determine its 1)reliability for measuring EE and 2)sensitivity for minute changes in activity. METHODS: Two protocols (P1; P2)(n = 62; 25 men/37 women) were applied. When measured by hood, participants in both protocols were in complete rest (supine position). When assessed by room, participants in P1 were instructed to stay half-seated while performing light desk work; in P2 participants were in complete rest mimicking hood conditions. The Omnical calorimeter operated both modalities. Following data were collected/calculated: Oxygen uptake ([Formula: see text] O2(ml/min)), carbon dioxide production ([Formula: see text] CO2ml/min), 24h_EE (kcal/min), and respiratory exchange ratio (RER). Statistical analyses were done between modalities and between protocols. The agreement between 24h_EE, [Formula: see text] O2 and [Formula: see text] CO2 obtained by both modalities was investigated by linear regression. Reliability analysis on 24h_EE determined ICC. RESULTS: No significant differences were found for 24h_EE and [Formula: see text] O2. [Formula: see text] CO2 significantly differed in P1 + P2, and P2 (hood > room). RER was significantly different (hood > room) for P1 + P2 and both protocols individually. Reliability of 24h_EE between modalities was high. Modality-specific results were not different between protocols. DISCUSSION/CONCLUSION: The room is valid for assessing momentary EE. Minute changes in activity lead to a non-significant increase in EE and significant increase in RER. The significant difference in [Formula: see text] CO2 for hood might be related to perceived comfort. More research is necessary on determinants of RER, type (intensity) of activity, and restlessness. The design of the room facilitates metabolic measurements in research, with promising results for future clinical use.

A single-center retrospective comparative analysis of urinary continence in robotic prostatectomy with a combination of umbilical ligament preservation and Hood technique.

OBJECTIVES: Data available on the effect of the recently developed Hood technique and its modified iterations in robot-assisted radical prostatectomy on postoperative urinary continence are insufficient. We evaluated the time to achieve urinary continence with the modified Hood technique compared with the standard or umbilical ligament preservation robot-assisted radical prostatectomy. METHODS: This retrospective analysis examines patient records for those who underwent robot-assisted radical prostatectomy at the Jyoban Hospital of Tokiwa Foundation in Fukushima, Japan, from 2017 to 2021. The main outcome was to determine significant differences in the time taken to achieve urinary continence among the three procedure types. We employed the Kaplan-Meier survival analysis to estimate the time to achieve urinary continence in the three procedure types of robot-assisted radical prostatectomy. Additionally, we used a Cox regression hazard model to evaluate the association between the time to achieve urinary continence and the procedure types. RESULTS: We considered 196 patients in this study. The estimated rates of achieving urinary continence at 6 months following standard, umbilical ligament preservation, and modified Hood technique robot-assisted radical prostatectomy were 77.6%, 89.5%, and 100%, respectively. The multivariable Cox hazard regression model showed that patients who underwent the modified Hood technique were significantly more likely to achieve urinary continence than those who underwent the standard robot-assisted radical prostatectomy. CONCLUSIONS: The modified Hood technique achieved better urinary continence outcomes, with all patients with the procedure achieving urinary continence at 6 months. Further randomized controlled trials are required to validate this finding.

Physiological Effects of a Spit Restraint Device Saturated With Artificial Saliva.

BACKGROUND: Spit restraint devices, also referred to as spit hoods, spit masks, or spit socks, are used by law enforcement and medical personnel to minimize transmission of communicable disease from bodily fluids from agitated individuals. Several lawsuits have implicated spit restraint devices as contributing to the death of individuals who are physically restrained by means of asphyxiation due to saturation of the mesh restraint device with saliva. OBJECTIVES: This study aims to evaluate whether a saturated spit restraint device has any clinically significant effects on the ventilatory or circulatory parameters of healthy adult subjects. METHODS: Subjects wore a spit restraint device dampened with 0.5% carboxymethylcellulose, an artificial saliva. Baseline vitals were taken, and a wet spit restraint device was then placed over the subject's head, and repeat measurements were taken at 10, 20, 30, and 45 min. A second spit restraint device was placed 15 min after the first. Measurements at 10, 20, 30, and 45 min were compared with baseline using paired t-tests. RESULTS: The mean age of 10 subjects was 33.8 years, and 50% were female. There was no significant difference between baseline and while wearing the spit sock for 10, 20, 30, and 45 min for the measured parameters including heart rate, oxygen saturation, end-tidal CO2, respiratory rate, or blood pressure. No subject indicated respiratory distress or had to terminate the study. CONCLUSIONS: In healthy adult subjects, there were no statistically or clinically significant differences in ventilatory or circulatory parameters while wearing the saturated spit restraint.

Simultaneous Surgery of the Clitoral Hood-Labia Minora Complex with the Central Neurovascular Pedicle Retained.

BACKGROUND: Hypertrophy of the labia minora with clitoral hood redundancy always occurs simultaneously and should be considered in its entirety. This study investigated a new simultaneous procedure for the clitoral hood-labia minora complex (CLC) that retains the central neurovascular pedicle. METHODS: This retrospective observational study, conducted between January 2021 and August 2022, included 29 patients with labia minora hypertrophy and clitoral hood redundancy who underwent a surgery wherein procedures on the CLC were performed simultaneously. A divisional design to separate the medial and lateral labia minora and to remove the skin and subcutaneous tissue asymmetrically, while retaining the central neurovascular pedicle and the natural margin of labia minora, was employed. Postoperatively, all patients were followed up via the Internet or at the outpatient clinic. The follow-up included observing postoperative outcomes and any complications and completing the satisfaction questionnaires. RESULTS: All the patients who underwent surgery showed good wound healing without discomfort of thread friction. Postoperatively, the labia minora had a natural appearance and retained sexual sensitivity. The scarring on the surgical incision was not evident. Hematoma and evident bilateral asymmetry occurred in one patient each. The satisfaction rate within 14 days and after 3 months of surgery was 96.6% and 92.6%, respectively. CONCLUSIONS: This method uses a hidden incision, to remove the hypertrophic tissue and retain the natural edge and shape of the labia minora. Qualitatively, the patients were highly satisfied. This method was safe, effective, and easy to implement. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Bilateral genital asymmetry in livebearer fishes of the genus Phalloceros Eigenmann, 1907, with description of a new species from coastal drainages of southern Brazil (Cyprinodontiformes: Poeciliidae).

A new species of Phalloceros is described from the Tijucas, Maruim, Aririú, Cubatão do Sul, Rio da Madre, D'Una and Tubarão river basins in southern Brazil. The new species is diagnosed among congeners by the bilateral asymmetry of a hood-like structure located immediately anterior to the urogenital papilla of females. The hood is fused with the urogenital papilla on the right side, but free from the papilla on the left side. This hood is reported for the first time in the genus and is present in six of the 21 valid species of Phalloceros, but its bilateral asymmetry is an exclusive condition of the new species. These species do not constitute a monophyletic group. The new species is likely to be phylogenetically related to P. caudimaculatus, whose females have a symmetrical hood.

Endo-wing versus transparent hood-assisted colonoscopy for colorectal adenoma detection: A randomized controlled trial.

BACKGROUND AND AIM: This study aimed to compare the mean number of adenomas in patients undergoing Endo-wing-assisted colonoscopy (EAC) and transparent hood-assisted colonoscopy (TAC). METHODS: Patients undergoing colonoscopy for positive fecal immunochemical tests, colon polyp surveillance, and evaluation of abdominal symptoms at a single institution were randomly assigned to the EAC or TAC group. The mean number of adenomas per patient, adenoma detection rate, cecal intubation time, withdrawal time, mean number of adenomas per location, and adenoma size were compared. RESULTS: Overall, 800 patients were enrolled. The EAC and TAC groups comprised 372 and 393 patients, respectively. The groups did not significantly differ with respect to cecal intubation and withdrawal times. The mean number of adenomas per patient was significantly higher in the EAC group (1.13 vs 0.90, P = 0.04), particularly in the sigmoid colon (0.54 [201/372] vs 0.38 [149/393], P = 0.04). The adenoma detection rates were 48.1% and 45.0% in the EAC and TAC groups, respectively, albeit without significant difference between the two groups (P = 0.393). The total number of sessile-type adenomas (0.73 [270/372] vs 0.47 [183/393], P < 0.0001) and small polyps (≤ 5 mm) (0.53 [198/372] vs 0.41 [159/393], P = 0.016) was significantly higher in the EAC group. CONCLUSION: Endo-wing-assisted colonoscopy is significantly superior to TAC in terms of the mean number of adenomas per patient.

Prediction of indoor PM2.5 concentrations and reduction strategies for cooking events through various IAQ management methods in an apartment of South Korea.

Indoor PM2.5 in apartments must be effectively managed to minimize adverse impacts on human health. Cooking is the one of the main PM2.5 sources in apartments, and indoor air quality (IAQ) management methods (natural ventilation, mechanical ventilations, range hoods, and air purifiers) are typically used to reduce PM2.5 generated during cooking. For effective control of indoor PM2.5 , prediction of PM2.5 reduction for various IAQ management methods is necessary. This study carefully predicted indoor PM2.5 concentrations in an apartment when IAQ management methods were applied separately and/or in combination during cooking. The infiltration and exfiltration were verified by comparing the experimental results of CO2 concentration with those predicted with or without mechanical ventilation. The deposition rate for PM2.5 generated by cooking was also derived by comparing the experimental PM2.5 changes with the predicted values for PM2.5 natural decay. Through this method, effective PM2.5 control ways during cooking in apartments can be proposed, such as natural ventilation with a range hood for 30 min and then the operation of an air purifier for 30 min. Additionally, if this prediction is combined with energy consumption, it will be possible to propose the most energy-efficient indoor PM2.5 control methods for various seasons and outdoor conditions.

Trilobal Methods for Composite Reduction Labiaplasty.

BACKGROUND: It is difficult to plan a simple and effective surgical strategy for patients with horizontal and vertical redundant tissue of the labia minora and clitoral hood redundancy. A single edge resection or wedge resection labiaplasty with clitoral hood reduction that simultaneously resolves these three issues has yet to be reported. This study investigated the clinical effects and safety of trilobal labiaplasty via a composite incision. METHODS: The single-center, retrospective, observational study included data from patients with hypertrophy of the labia minora and clitoral hood who underwent trilobal labiaplasty. RESULTS: Altogether, 136 patients (average age: 31.6 ± 8.82 years; range: 21-53 years; 224 sides) sought surgery for aesthetic (39/136, 28.7%), functional (17/136, 12.5%), or both reasons (80/136, 58.8%). Overall, 134 patients (134/136, 98.5%) were followed up for 3 months. No serious complications or malformations occurred. Three patients (2.2%) underwent secondary repair surgery due to incomplete bilateral symmetry, 122 (91.0%) scored ≥ 21 points on the Female Genital Self-Image Scale, 107 (91.5%) were satisfied with the cosmetic outcomes, and 93 (95.9%) were satisfied with the functional improvement. CONCLUSIONS: Trilobal labiaplasty performed via a composite incision using edge and wedge labiaplasty to adjust horizontal and vertical hypertrophy of the labia minora and remove lateral folds of the clitoris is a safe and effective method to improve the appearance and rearrange the position of the clitoral hood and clitoral frenulum while preserving the fine structure of the surrounding tissue. This method results in few complications and high functional and aesthetic satisfaction rates. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Preliminary Exploration of a New Clitoral Hood Classification System and Treatment Strategy.

BACKGROUND: Increasing attention has been given to clitoral hoods in recent years, but few studies have been conducted on the classification and treatment strategies of clitoral hood hypertrophy. The purpose of this article is to introduce a new system of clitoral hood classification based on relevant anatomy and make recommendations for clitoral hood reduction. METHODS: The clitoral hood region is divided into the central zone (zone C) and the lateral zone (zone L). According to the anatomical characteristics of each zone, patients can be divided into 5 types: standard form, central hypertrophy, lateral hypertrophy, composite hypertrophy and special type. Central hypertrophy is further divided into wide and long clitoral hoods, and horizontal and vertical redundancy are addressed using bilateral clitoral hood triangular skin resection and inverted horizontal V-shaped skin resection, respectively. Lateral hypertrophy can be treated with vertically oriented excision. Composite hypertrophy is corrected by combining these methods to remove redundant tissue depending on the situation. RESULTS: 1135 patients were classified according to the new classification system and 789 participants were given corresponding treatment measures. Thirty-four patients (4.3%) experienced complications, and 15 (1.9%) underwent revision surgery. Six months after the procedure, clitoral hood images improved significantly without paresthesia, and the overall satisfaction rate of the patients regarding clitoral hood reduction was 95.7%. CONCLUSIONS: The clitoral prepuce is an important part of the aesthetic unit of female vulva. The new clitoral hood classification strategy systematically summarizes the anatomical characteristics of the clitoral hood and clearly makes recommendations for surgical options. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Measuring volatile emissions from biosolids: A critical review on sampling methods.

As a by-product of wastewater treatment, biosolids are a source of volatile emissions which can lead to community complaints due to odours and other pollution risks. Sampling methods play a significant role in collecting gas emissions from biosolids-related sources (i.e., pure biosolids, landfilling, land application and composting of biosolids). Though a range of different sampling techniques (flux hood, wind tunnel, static chamber, headspace devices) have been explored in many published papers, the management and best practice for sampling emissions from biosolids is unclear. This paper presents a comprehensive review of sampling methods for collecting gaseous emissions from biosolids. To account for the inconsistent terminologies used to describe sampling devices, a standard nomenclature by grouping sampling devices into five categories was proposed. Literature investigating emission sampling from biosolids-related sources was reviewed. Subsequently a critical analysis of sampling methods in terms of design, advantages, and disadvantages were compiled based on literature findings and assumed mechanistic understanding of operation. Key operational factors such as the presence of fans, purge gas flow rates, insertion depth, and incubation conditions were identified and their level of influence on the measurement of emissions were evaluated. From the review, there are still knowledge gaps regarding sampling methods used to collect gases from biosolids-related sources. Therefore, a framework for the management of emission sampling methodologies based on common sampling purposes was proposed. This critical review is expected to improve the understanding of sampling methodologies used in biosolids-related sources, by demonstrating the potential implications and impacts due to different choices in sampling methods.

Ransomware and the Robin Hood effect?: Experimental evidence on Americans' willingness to support cyber-extortion.

Objectives: Ransomware attacks have become a critical security threat worldwide. However, existing research on ransomware has largely ignored public opinion. This initial study identifies patterns in the American public's support for the use of ransomware, specifically when it is framed to provide benefits to others (i.e., in-group members). Drawing on the Robin Hood decision-making literature and Moral Foundations Theory, we offer theoretical predictions regarding ransomware support. Methods: In a survey of 1013 Americans, we embedded a split-ballot experiment in which respondents were randomly assigned to indicate their level of support or opposition to one of two sets of six ransomware scenarios. We manipulated the nationality, authority level, and political affiliation of the actors. Results: We find that people are more supportive of ransomware use when the actors are from their own in-group, and the outcomes benefit their in-group members. Also, the more strongly participants endorsed the moral foundations of authority and harm/care, the more supportive they were of the use of ransomware that may benefit others from their in-group. Conclusions: These findings suggest political actors may be able to generate public support for morally questionable actions by emphasizing in-group benefits and the Robin Hood nature of an attack (e.g., outcome-based morality).

A prospective clinical evaluation of a patient isolation hood during the COVID-19 pandemic.

BACKGROUND: Healthcare workers (HCWs) have frequently become infected with severe acute respiratory syndrome coronavirus 2 whilst treating patients with coronavirus disease 2019 (COVID-19). A variety of novel devices have been proposed to reduce COVID-19 cross-contamination. OBJECTIVES: The aim of the study was (i) to test whether patients and HCWs thought that a novel patient isolation hood was safe and comfortable and (ii) to obtain COVID-19 infection data of hospital HCWs. METHODS: This is a prospective cohort study of 20 patients, entailing HCW/patient questionnaires and safety aspects of prototype isolation hoods. COVID-19 data of HCWs were prospectively collected. Assessment of the hood's safety and practicality and adverse event reporting was carried out. OUTCOME MEASURES: The outcome measures are as follows: questionnaire responses, adverse event reporting, rates of infections in HCWs during the study period (20/6/2020 to 21/7/2020), and COVID-19 infections in HCWs reported until the last recorded diagnosis of COVID-19 in HCWs (20/6/2020 to 27/9/2020). RESULTS: Of the 64 eligible individual HCW surveys, 60 surveys were overall favourable (>75% questions answered in favour of the isolation hood). HCWs were unanimous in perceiving the hood as safe (60/60), preferring its use (56/56), and understanding its potential COVID-19 cross-contamination minimisation (60/60). All eight patients who completed the questionnaire thought the isolation hood helped prevent COVID-19 cross infection and was safe and comfortable. There were no reported patient safety adverse events. The COVID-19 attack rate from 20/6/2020 to 27/9/2020 among registered nurses was as follows: intensive care units (ICUs), 2.2% (3/138); geriatric wards, 13.2% (26/197); and COVID-19 wards, 18.3% (32/175). The COVID-19 attack rate among medical staff was as follows: junior staff, 2.1% (24/932); senior staff, 0.7% (4/607); aged care/rehabilitation, 6.7% (2/30); and all ICU medical staff, 8.6% (3/35). CONCLUSIONS: The isolation hood was preferred to standard care by HCWs and well tolerated by patients, and after the study, isolation hoods became part of standard ICU therapy. There was an association between being an ICU nurse and a low COVID-19 infection rate (no causality implied). ICU HCWs feel safer when treating patients with COVID-19 using an isolation hood.

Indoor air quality in new and renovated low-income apartments with mechanical ventilation and natural gas cooking in California.

This paper presents pollutant concentrations and performance data for code-required mechanical ventilation equipment in 23 low-income apartments at 4 properties constructed or renovated 2013-2017. All apartments had natural gas cooking burners. Occupants pledged to not use windows for ventilation during the study but several did. Measured airflows of range hoods and bathroom exhaust fans were lower than product specifications. Only eight apartments operationally met all ventilation code requirements. Pollutants measured over one week in each apartment included time-resolved fine particulate matter (PM2.5 ), nitrogen dioxide (NO2 ), formaldehyde and carbon dioxide (CO2 ) and time-integrated formaldehyde, NO2 and nitrogen oxides (NOX ). Compared to a recent study of California houses with code-compliant ventilation, apartments were smaller, had fewer occupants, higher densities, and higher mechanical ventilation rates. Mean PM2.5 , formaldehyde, NO2 , and CO2 were 7.7 µg/m3 , 14.1, 18.8, and 741 ppm in apartments; these are 4% lower, 25% lower, 165% higher, and 18% higher compared to houses with similar cooking frequency. Four apartments had weekly PM2.5 above the California annual outdoor standard of 12 µg/m3 and also discrete days above the World Health Organization 24-hour guideline of 25 µg/m3 . Two apartments had weekly NO2 above the California annual outdoor standard of 30 ppb.

Is Evidence Supporting the Subtelomere-Telomere Theory of Aging?

The telomere theory tries to explain cellular mechanisms of aging as mainly caused by telomere shortening at each duplication. The subtelomere-telomere theory overcomes various shortcomings of telomere theory by highlighting the essential role of subtelomeric DNA in aging mechanisms. The present work illustrates and deepens the correspondence between assumptions and implications of subtelomere-telomere theory and experimental results. In particular, it is investigated the evidence regarding the relationships between aging and (i) epigenetic modifications; (ii) oxidation and inflammation; (iii) telomere protection; (iv) telomeric heterochromatin hood; (v) gradual cell senescence; (vi) cell senescence; and (vii) organism decline with telomere shortening. The evidence appears broadly in accordance or at least compatible with the description and implications of the subtelomere-telomere theory. In short, phenomena of cellular aging, by which the senescence of the whole organism is determined in various ways, appear substantially dependent on epigenetic modifications regulated by the subtelomere-telomere-telomeric hood-telomerase system. These phenomena appear to be not random, inevitable, and irreversible but rather induced and regulated by genetically determined mechanisms, and modifiable and reversible by appropriate methods. All this supports the thesis that aging is a genetically programmed and regulated phenoptotic phenomenon and is against the opposite thesis of aging as caused by random and inevitable degenerative factors.

Surgical Technique and Outcomes of Inverted-Y Plasty Procedure in Clitoral Hoodoplasty Operations.

STUDY OBJECTIVE: Labia minora reduction is the most common operation requested by women concerned with the appearance of their vulvar area. In most cases, a concomitant clitoral hoodoplasty (CP) should be performed to achieve better esthetic outcomes. There are different surgical methods for removing excess tissue in the clitoral hood area. This study aims to describe the surgical technique of inverted-Y plasty as with central longitudinal excision in CP and to elaborate on different hoodoplasty techniques in the literature. DESIGN: Case series. SETTING: Private practice. PATIENTS: A total of 63 patients who underwent labiaplasty with curvilinear labial excision and concomitant CP with the inverted-Y plasty technique. INTERVENTIONS: The operations were performed by a single senior surgeon between May 2017 and December 2019. The inverted-Y plasty technique is described in detail regarding its advantages and important issues. MEASUREMENTS AND MAIN RESULTS: The patients' median age was 33.2 (19-47) years. Of the patients, 57 (90.5%) requested the operation because of dissatisfaction with the esthetic appearance. Furthermore, 60 (95.2%) patients requested minimum remaining labia. The median operation time was 45 (35-62) minutes in labiaplasty and 34 (25-42) minutes in CP. No major complications occurred. At the postoperative second month, 96.9% of the patients were satisfied with the esthetic results. CONCLUSION: CP with the inverted-Y plasty technique is extremely safe and highly satisfactory in most patients, allowing maximum trimming of the excess tissue and providing lifting of the clitoral hood area.

Suitability of Hood Geometry for Design of a PCM Neonate Incubator for Resource-Limited Clinical Applications.

To reduce dependence on electric-powered incubators, a number of alternate heat sources have been proposed. Phase change materials (PCM) are one of such because of their availability and cost effectiveness in rural areas. This study intends to explore the use of phase change material (PCM) such as paraffin wax as an alternative heat source over a variety of incubator hood geometries. This study presents three incubator hood geometries and their respective effects on maximum hood temperatures and time to reach these temperatures for a mainstream incubator. The three designs, cubic, pyramidal, and oval, were created using CAD software; mathematical computations for heat transfer analysis were undertaken using COMSOL Multiphysics software. Results show the maximum temperatures reached in the hoods were 308, 314.5, and 315 K for the cubic, pyramidal, and oval-shaped geometries respectively. This offers a promising application of PCM-based as a choice material for incubator design for rural applications.