Enhancement Pattern Mapping for Early Detection of Hepatocellular Carcinoma in Patients with Cirrhosis.

Background and Aims: Limited methods exist to accurately characterize the risk of malignant progression of liver lesions. Enhancement pattern mapping (EPM) measures voxel-based root mean square deviation (RMSD) of parenchyma and the contrast-to-noise (CNR) ratio enhances in malignant lesions. This study investigates the utilization of EPM to differentiate between HCC versus cirrhotic parenchyma with and without benign lesions. Methods: Patients with cirrhosis undergoing MRI surveillance were studied prospectively. Cases (n=48) were defined as patients with LI-RADS 3 and 4 lesions who developed HCC during surveillance. Controls (n=99) were patients with and without LI-RADS 3 and 4 lesions who did not develop HCC. Manual and automated EPM signals of liver parenchyma between cases and controls were quantitatively validated on an independent patient set using cross validation with manual methods avoiding parenchyma with artifacts or blood vessels. Results: With manual EPM, RMSD of 0.37 was identified as a cutoff for distinguishing lesions that progress to HCC from background parenchyma with and without lesions on pre-diagnostic scans (median time interval 6.8 months) with an area under the curve (AUC) of 0.83 (CI: 0.73-0.94) and a sensitivity, specificity, and accuracy of 0.65, 0.97, and 0.89, respectively. At the time of diagnostic scans, a sensitivity, specificity, and accuracy of 0.79, 0.93, and 0.88 were achieved with manual EPM with an AUC of 0.89 (CI: 0.82-0.96). EPM RMSD signals of background parenchyma that did not progress to HCC in cases and controls were similar (case EPM: 0.22 ± 0.08, control EPM: 0.22 ± 0.09, p=0.8). Automated EPM produced similar quantitative results and performance. Conclusion: With manual EPM, a cutoff of 0.37 identifies quantifiable differences between HCC cases and controls approximately six months prior to diagnosis of HCC with an accuracy of 89%.

Current surveillance and diagnostic methods in hepatocellular carcinoma are suboptimal. Enhancement pattern mapping is an imaging technique that quantifies lesion signals and may be useful in diagnostic and surveillance methods. Enhancement pattern mapping describes quantifiable differences between malignant and benign liver tissue on contrast-enhanced MRI. It amplifies lesion signal and distinguishes malignancy in a surveillance population. The novel imaging technique was investigated at single institution and analyzed lesions compared to cirrhotic parenchyma. Future efforts will include further risk stratification across LI-RADS group categories. The results provide evidence that enhancement pattern mapping uses available imaging data to distinguish hepatocellular carcinoma from non-cancerous parenchyma with and without benign lesions on scans six months prior to diagnosis with standard MRI. The technique introduces a prospective modality to improve diagnostic accuracy and early detection with the goal of improving clinical outcomes.

A Comprehensive Retrospective Analysis of EVO/EVO+ Implantable Collamer Lens: Evaluating Refractive Outcomes in the Largest Single Center Study of ICL Patients in the United States.

Purpose: We evaluate visual outcomes in patients with EVO/EVO+™ (posterior chamber phakic intraocular lens with a central port) within approved United States (US) age and refractive range indications. Patients and Methods: This single-center retrospective study evaluated one-month, single-center postoperative data for 225 eyes meeting inclusion criteria and undergoing EVO/EVO+ implantation from April to October 2022. Data included lens size (mm), lens power (diopters of spherical and cylindrical power), preoperative best corrected visual acuity, preoperative spherical equivalent from manifest refraction, achieved postoperative uncorrected visual acuity, postoperative refraction, intraocular pressure (mmHg), and adverse events. Results: A total of 225 eyes underwent EVO/EVO+ Implantable Collamer Lens (ICL) implantation from April to October 2022, with 51.5% receiving toric lenses. The most common ICL size was 12.6mm (56.4%), followed by 13.2mm (27.5%), 12.1mm (15.1%), and 13.7mm (0.9%). Among patients with preoperative BCVA of 20/20 or better (149 eyes), 95.2% achieved postoperative UCVA of 20/20 or better, and 99.3% achieved UCVA of 20/25 or better at postoperative month one. About 75% of eyes were within a spherical equivalent target of ±0.50 D and 94% within ±1.00 D. Toric ICLs were implanted in 116 eyes (51.8%). Of these, anticipated residual cylinder >1 diopter was seen in 21 eyes (18.1%) resulting in three rotations, three explants, and three laser vision correction (LVC) enhancements. The postoperative adjustment rate (including rotations, exchanges, and LVC enhancement) was minimal (4.8%). Incidence of major adverse events was 0%. Conclusion: Our study, the largest US single-center analysis of EVO/EVO+ ICL implantation, demonstrates strong early results and infrequent adverse events, supporting ICL safety and effectiveness. High predictability and favorable visual outcomes, including 20/20 or better, highlight the reliability of this technology. Despite study limitations, our findings underscore this technology's effectiveness. Future research should refine patient criteria and assess long-term outcomes in this evolving landscape.

Exploring behavioral traits over different contexts in four species of Australian funnel-web spiders.

Australian funnel-web spiders are arguably the most venomous spiders in the world, with much research focusing on this aspect of their biology. However, other aspects related to their life history, ecology and behaviour have been overlooked. For the first time, we assessed repeatability, namely risk-taking behaviour, aggressiveness and activity in the contexts of predation, conspecific tolerance and exploration of a new territory in four species of Australian funnel-web spiders: two are closely related, Hadronyche valida and H. infensa, and two have overlapping distributions but occupy different habitats, H. cerberea and Atrax robustus. We also compared behaviors between species. At the species level, we found that H. valida showed consistency in risk-taking behavior when exposed to a predator stimulus, aggressiveness against conspecifics, and exploration of a new territory. In contrast, in the other species, only A. robustus showed repeatability in the context of exploration of a new territory. These results suggest that some behavioral traits are likely more flexible than others, and that the repeatability of behaviors may be species-specific in funnel-webs. When we compared species, we found differences in risk-taking behavior and defensiveness. This study provides novel insights to understanding variation in behavioral traits within and between species of funnel-web spiders, suggesting that some behavioral traits are likely context and/or species dependent, as a result of their evolutionary history. These findings provide key insights for understanding the ecological role of behavior and venom deployment in venomous animals, and a greater understanding of behavior in these medically significant and iconic spiders that are of conservation concern.

Interactions between physiology and behaviour provide insights into the ecological role of venom in Australian funnel-web spiders: Interspecies comparison.

Australian funnel-web spiders are iconic species, characterized as being the most venomous spiders in the world. They are also valued for the therapeutics and natural bioinsecticides potentially hidden in their venom molecules. Although numerous biochemical and molecular structural approaches have tried to determine the factors driving venom complexity, these approaches have not considered behaviour, physiology and environmental conditions collectively, which can play a role in the evolution, complexity, and function of venom components in funnel-webs. This study used a novel interdisciplinary approach to understand the relationships between different behaviours (assessed in different ecological contexts) and morphophysiological variables (body condition, heart rate) that may affect venom composition in four species of Australian funnel-web spiders. We tested defensiveness, huddling behaviour, frequency of climbing, and activity for all species in three ecological contexts: i) predation using both indirect (puff of air) and direct (prodding) stimuli; ii) conspecific tolerance; and iii) exploration of a new territory. We also assessed morphophysiological variables and venom composition of all species. For Hadronyche valida, the expression of some venom components was associated with heart rate and defensiveness during the predation context. However, we did not find any associations between behavioural traits and morphophysiological variables in the other species, suggesting that particular associations may be species-specific. When we assessed differences between species, we found that the species separated out based on the venom profiles, while activity and heart rate are likely more affected by individual responses and microhabitat conditions. This study demonstrates how behavioural and morphophysiological traits are correlated with venom composition and contributes to a broader understanding of the function and evolution of venoms in funnel-web spiders.

Seasonal variations in vitamin D do not change the musculoskeletal health of physically active ambulatory men with cerebral palsy: a longitudinal cross-sectional comparison study.

Increased levels of vitamin D in the summer months from natural seasonal variations in sun exposure have been linked to improvements in musculoskeletal health and function in UK populations; however, studies have shown that differences in lifestyles because of disability can inhibit the natural vitamin D increase in these populations. We hypothesized that men with cerebral palsy (CP) will experience smaller increases in 25-hydroxyvitamin D (25(OH)D) from winter to summer and men with CP will not experience any improvements in musculoskeletal health and function during the summer. A longitudinal observational study in 16 ambulant men with CP aged 21.0 ± 1.3 years and 16 healthy, physical activity matched, typically developed controls aged 25.4 ± 2.6 years, completed assessments of serum 25(OH)D and parathyroid hormone during winter and summer. Neuromuscular outcomes included vastus lateralis size, knee extensor strength, 10-m sprint, vertical jumps, and grip strength. Bone ultrasounds were performed to obtain radius and tibia T and Z scores. Men with CP and typically developed controls showed a 70.5% and 85.7% increase in serum 25(OH)D from winter to summer months, respectively. Neither group showed seasonal effect on neuromuscular outcomes muscle strength, size, vertical jump, or tibia and radius T and Z scores. A seasonal interaction effect was seen in the tibia T and Z scores (P < .05). In conclusion, there were similar seasonal increases in 25(OH)D observed in men with CP and typically developed controls, but serum 25(OH)D levels were still considered insufficient to improve bone or neuromuscular outcomes.

Interventions to treat and prevent postpartum depression: a protocol for systematic review of the literature and parallel network meta-analyses.

INTRODUCTION: Postpartum depression has costly consequences for the mother, baby, and society. Numerous pharmacological and non-pharmacological interventions are available for the prevention and treatment of postpartum depression. To date, no attempt has been made to synthesize the evidence from comparisons of interventions both within and across these categories. METHODS: We will perform a systematic review of the literature and perform network meta-analysis of interventions to (a) prevent and (b) treat postpartum depression. This review will include studies of primiparous or multiparous women during pregnancy or within 12 months of delivery of their baby that assess either interventions initiated during pregnancy or within 1 year of childbirth. Comparators will be other eligible interventions or control conditions. The outcome of interests will be related to the antidepressant efficacy of the interventions as well as their acceptability. The published literature will be searched in Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. The search will use a combination of standardized terms and keywords for postpartum depression, a sensitive search filter to limit for randomized controlled trials, and a librarian-created "humans" filter. The search results will be uploaded to the Covidence online systematic review platform (Veritas Health Information Ltd., Victoria, Australia) where two review team members will independently screen articles. We will extract data to include year of publication, language, country, participants (number, demographic data, eligibility criteria, psychiatric symptoms, and co-morbidities), characteristics of the intervention and control conditions, and reported outcomes. Risk of bias for each study will be assessed independently by two review authors using the RoB 2: A revised Cochrane risk of bias tool for randomized trials. Network meta-analysis will be performed using a Bayesian hierarchical model supplemented with a Markov chain Monte Carlo approach. DISCUSSION: Postpartum depression is a devastating disease with long-lasting consequences. Given the numerous available interventions to both prevent and treat postpartum depression and the great number of studies comparing them, it is imperative that clinicians and patients are provided with an assessment of their comparative efficacy and acceptability. SYSTEMATIC REVIEW REGISTRATION: Prospero registration (CRD42022303247).

A randomized feasibility pilot-study of intravenous and subcutaneous administration of ketamine to prevent postpartum depression after planned cesarean delivery under neuraxial anesthesia.

BACKGROUND: Evidence suggests ketamine may prevent postpartum depression (PPD) after cesarean delivery (CD) although intolerability and inconvenience of administration are problematic. We assessed the feasibility of studying ketamine (0.5 mg/kg, via subcutaneous injection or 40-min intravenous infusion) to prevent PPD after CD. METHODS: Twenty-three women scheduled for cesarean delivery under neuraxial anesthesia were randomized to one of three groups: subcutaneous ketamine (SC Group, n = 8), intravenous ketamine (IV Group, n = 8) or placebo (n = 7). We measured depression (Edinburgh Postpartum Depression Scale [EPDS]) scores pre-operatively and at 1, 2, 21 and 42 days postoperatively. Anxiety, adverse effects, surgical site pain and analgesic consumption were also assessed. Feasibility was assessed based on acceptability, burden of disease, ability to collect study data and, tolerability of interventions. RESULTS: Baseline characteristics of groups were similar, however, more women in the placebo group had pre-existing anxiety disorder (p = 0.03). 20.7% (25/121) of those approached consented to participate and 34.8% (8/23), of those assessed, screened positive for depression in the postpartum (EPDS > 12). PPD screening data was complete in 78.3% (18/23). No differences were observed for any adverse effect outcomes except for fewer incidences of intraoperative shivering with ketamine (SC: 25%, IV: 0% and Placebo: 85.7%, p = 0.01). No statistically significant difference in positive screening for PPD was observed (SC: 14.3%, IV: 50% and Placebo: 42.9%, p = 0.58). CONCLUSION: An RCT was judged to be feasible and there was no evidence of intolerability of either route of ketamine administration. Dispensing with the need for intravenous access makes the subcutaneous route a particularly attractive option for use in the postpartum population. Further examination of these interventions to prevent, and possibly treat, postpartum depression is warranted. TRIAL REGISTRATION: NCT04227704, January 14th, 2020.

Enteropathogenic Escherichia coli (EPEC) expressing a non-functional bundle-forming pili (BFP) also leads to increased growth failure and intestinal inflammation in C57BL/6 mice.

Bundle-forming pili (BFP) are implicated in the virulence of typical enteropathogenic E. coli (EPEC), resulting in enhanced colonization and mild to severe disease outcomes; hence, non-functional BFP may have a major influence on disease outcomes in vivo. Weaned antibiotic pre-treated C57BL/6 mice were orally infected with EPEC strain UMD901 (E2348/69 bfpA C129S); mice were monitored daily for body weight; stool specimens were collected daily; and intestinal tissues were collected at the termination of the experiment on day 3 post-infection. Real-time PCR was used to quantify fecal shedding and tissue burden. Intestinal inflammatory biomarkers lipocalin-2 (LCN-2) and myeloperoxidase (MPO) were also assessed. Infection caused substantial body weight loss, bloody diarrhea, and intestinal colonization with fecal and intestinal tissue inflammatory biomarkers that were comparable to those previously published with the wild-type typical EPEC strain. Here we further report on the evaluation of an EPEC infection model, showing how disruption of bfp function does not impair, and may even worsen diarrhea, colonization, and intestinal disruption and inflammation. More research is needed to understand the role of bfp in pathogenicity of EPEC infections in vivo.

WHO working group meeting to amend WHO Recommendations to assure the quality, safety and efficacy of live attenuated yellow fever vaccines.

The current WHO Recommendations to assure the quality, safety and efficacy of live attenuated yellow fever vaccines were adopted in 2010. This document recommends that vaccine virus master and working seed lots should be tested for viscerotropism, immunogenicity and neurovirulence in monkeys. A vaccine manufacturer has reported, recently, discrepancies on the clinical scoring of monkeys during assessment of working seed lots and suggested aligning neurotropism assessment of yellow fever vaccines virus seed lots with that of neurovirulence testing of polio vaccines virus seed lots. In this approach, clinical signs are recorded but do not form part of the assessment or pass/fail criteria. At its 71st meeting in August 2020, the ECBS agreed to establish a drafting group and to consult with manufacturers and other stakeholders on the proposed amendment. Then a survey had been conducted to seek opinions of stakeholders on the neurotropism testing and revision of current WHO Recommendations for yellow fever vaccines. It was recognized from the answers of the survey that the test for neurovirulence in monkeys presents several technical challenges which could be addressed in the amended version of the Recommendations. On 18-19 March 2021, a virtual WHO working group meeting was held to discuss a proposed draft of the amended text with participants of yellow fever vaccine manufacturers and relevant regulators. Overall, there was a consensus among manufacturers and regulators that clinical evaluation provides important information and should be retained as part of the neurotropism test. However, there was also agreement that the test is somewhat subjective, and that analysis can be difficult. It was recognized that there was potential for improvement in both test execution and analysis to increase harmonization between manufacturers. Alternative tests to the non-human primates neurovirulence test would be useful but it was agreed that none seem to be sufficiently developed at present. Based on these working group discussions, it was proposed that the appendix on neurotropism test to be further revised by the WHO drafting group and submitted to ECBS for review and adoption. Issues other than neurotropism test were discussed in the meeting as well. There were a number of points identified during the meeting, such as new platform of production, animal models, deep sequencing, international standards, that are outside the current recommendations that are worthy of further discussion. Therefore, it is recommended that there would be a future meeting with various stakeholders to discuss the potential revision of the whole Recommendations for yellow fever vaccines in order to meet the current needs.

Behaviour of the Sydney funnel-web spider Atrax robustus over different contexts, time, and stimuli.

Atrax robustus is an iconic Australian spider because the venom can be lethal to humans. Moreover, some of the venom biomolecules have promise as therapeutic and bioinsecticidal leads. Nonetheless, aspects related to the life history and behaviour of this species, which might influence changes in venom components, have been overlooked. We assessed different behavioural traits (antipredator behaviour, defensiveness and activity) of juveniles and adult females across different contexts (predation, conspecific tolerance and exploration of a new territory) and stimuli (puff of air versus prod) over time. Adults responded to a puff of air faster than juveniles, but in response to a prod, both juveniles and adults become more defensive over time. No differences were observed between adults and juveniles for conspecific tolerance and exploration. Understanding behaviour of venomous species is important because behaviours may affect physiological traits, such as venom, and the ability of spiders to adapt to different conditions.

Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents.

BACKGROUND: Postpartum hemorrhage causes a quarter of global maternal deaths. The World Health Organization recommends oxytocin as the first line agent to prevent hemorrhage during cesarean delivery. However, some randomized controlled trials suggest that other uterotonics are superior. OBJECTIVE: We conducted a network meta-analysis comparing the ability of pharmacologic agents to reduce blood loss and minimize the need for additional uterotonics during cesarean delivery. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials, Embase, and MEDLINE databases from inception to May 2020. STUDY ELIGIBILITY CRITERIA: We included randomized controlled trials that compared oxytocin, carbetocin, misoprostol, ergometrine, carboprost, or combinations of these in the prevention of postpartum hemorrhage during cesarean delivery. METHODS: We performed a systematic review followed by an NMA in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of the evidence was assessed with the Confidence in Network Meta-Analysis approach and Grading of Recommendations, Assessment, Development and Evaluations tool within the summary of findings table. Our primary outcomes were the estimated blood loss and need for additional uterotonics. Secondary outcomes included nausea and postpartum hemorrhage of >1000 mL. We performed sensitivity analyses to explore the influence of surgical context and oxytocin administration strategy. RESULTS: A total of 46 studies with 7368 participants were included. Of those, 21 trials (6 agents and 3665 participants) formed the "estimated blood loss" network and, considering the treatment effects, certainty in the evidence, and surface under the cumulative ranking curve scores, carbetocin was assessed to probably be superior to oxytocin, but only in reducing the estimated blood loss by a clinically insignificant volume (54.83 mL; 95% confidence interval, 26.48-143.78). Misoprostol, ergometrine, and the combination of oxytocin and ergometrine were assessed to probably be inferior, whereas the combination of oxytocin and misoprostol was assessed to definitely be inferior to oxytocin. A total of 37 trials (8 agents and 6193 participants) formed the "additional uterotonic" network and, again, carbetocin was assessed to probably be superior to oxytocin, requiring additional uterotonics 185 (95% confidence interval, 130-218) fewer times per 1000 cases. Oxytocin plus misoprostol, oxytocin plus ergometrine, and misoprostol were assessed to probably be inferior, whereas carboprost, ergometrine, and the placebo were definitely inferior to oxytocin. For both primary outcomes, oxytocin administration strategies had a higher probability of being the best uterotonic, if initiated as a bolus. CONCLUSION: Carbetocin is probably the most effective agent in reducing blood loss and the need for additional uterotonics. Oxytocin appears to be more effective when initiated as a bolus.

Dynamic spatial progression of isolated lithium during battery operations.

The increasing demand for next-generation energy storage systems necessitates the development of high-performance lithium batteries1-3. Unfortunately, current Li anodes exhibit rapid capacity decay and a short cycle life4-6, owing to the continuous generation of solid electrolyte interface7,8 and isolated Li (i-Li)9-11. The formation of i-Li during the nonuniform dissolution of Li dendrites12 leads to a substantial capacity loss in lithium batteries under most testing conditions13. Because i-Li loses electrical connection with the current collector, it has been considered electrochemically inactive or 'dead' in batteries14,15. Contradicting this commonly accepted presumption, here we show that i-Li is highly responsive to battery operations, owing to its dynamic polarization to the electric field in the electrolyte. Simultaneous Li deposition and dissolution occurs on two ends of the i-Li, leading to its spatial progression toward the cathode (anode) during charge (discharge). Revealed by our simulation results, the progression rate of i-Li is mainly affected by its length, orientation and the applied current density. Moreover, we successfully demonstrate the recovery of i-Li in Cu-Li cells with >100% Coulombic efficiency and realize LiNi0.5Mn0.3Co0.2O2 (NMC)-Li full cells with extended cycle life.

Associations of school night sleep duration and circadian preference with middle school-aged student attendance, tardiness, and suspension.

OBJECTIVES: Research has associated both school night sleep duration (SNSD) and circadian preference (CP) with middle school-aged students' attendance and tardiness, but the interaction between these characteristics remains unexplored within this context, along with the impact of SNSD and CP on school suspension likelihood. Thus, this study investigated associations between SNSD, CP, and their interaction with middle school-aged student attendance, tardiness, and suspension, while accounting for sociodemographic characteristics. PARTICIPANTS: About 4175 students from 12 middle schools in the Madison, Wisconsin, Metropolitan School District. METHODS: Students completed a computer-based, sleep-related survey during class. Students reporting SNSD between 4 and 12 hours were included in the final analytical sample (N = 3860; mean age ± standard deviation = 12.0 ± 0.86 years; range = 10-16 years). CP was characterized using the single-item self-morningness/eveningness question. Linear mixed-effects regression estimated associations of SNSD and CP with tardiness and attendance. Logistic mixed-effects regression assessed associations with school suspension. Fully adjusted multilevel models included sociodemographic covariates, nesting students within schools. RESULTS: About 3860 student responses comprised the final sample, which had a SNSD of 8.15 ± 1.37 hours and general eveningness preference. Short-and-long SNSD associated with lower attendance and increased out-of-school suspension. Greater eveningness preference was negatively associated with attendance and tardiness. No SNSD and CP interactions emerged. Associations between sociodemographic characteristics and attendance, tardiness, and suspension were observed. CONCLUSIONS: Results support need for efforts to improve middle school-aged student sleep health and account for eveningness preference. Research clarifying the interactive influence of sleep, circadian, and sociodemographic characteristics on attendance and achievement is warranted.

Musculoskeletal Health in Active Ambulatory Men with Cerebral Palsy and the Impact of Vitamin D.

PURPOSE: (1) To determine the contribution of diet, time spent outdoors, and habitual physical activity (PA) on vitamin D status in men with cerebral palsy (CP) compared to physical activity matched controls (TDC) without neurological impairment; (2) to determine the role of vitamin D on musculoskeletal health, morphology, and function in men with CP compared to TDC. MATERIALS AND METHODS: A cross-sectional comparison study where 24 active, ambulant men with CP aged 21.0 ± 1.4 years (Gross Motor Function Classification Score (I-II) and 24 healthy TDC aged 25.3 ± 3.1 years completed in vivo assessment of musculoskeletal health, including: vastus lateralis anatomical cross-sectional area (VL ACSA), isometric knee extension maximal voluntary contraction (KE iMVC), 10 m sprint, vertical jumps (VJ), and radius and tibia bone ultrasound (US) Tus and Zus scores. Assessments of vitamin D status through venous samples of serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, dietary vitamin D intake from food diary, and total sun exposure via questionnaire were also taken. RESULTS: Men with CP had 40.5% weaker KE iMVC, 23.7% smaller VL ACSA, 22.2% lower VJ, 14.6% lower KE iMVC/VL ACSA ratio, 22.4% lower KE iMVC/body mass (BM) ratio, and 25.1% lower KE iMVC/lean body mass (LBM) ratio (all p < 0.05). Radius Tus and Zus scores were 1.75 and 1.57 standard deviations lower than TDC, respectively (p < 0.05), whereas neither tibia Tus nor Zus scores showed any difference compared to TDC (p > 0.05). The 25(OH)D was not different between groups, and 90.9% of men with CP and 91.7% of TDC had low 25(OH)D levels when compared to current UK recommendations. The 25(OH)D was positively associated with KE iMVC/LBM ratio in men with CP (r = 0.500, p = 0.020) but not in TDC (r = 0.281, p = 0.104). CONCLUSION: Musculoskeletal outcomes in men with CP were lower than TDC, and despite there being no difference in levels of 25(OH)D between the groups, 25 (OH)D was associated with strength (KE iMVC/LBM) in the CP group but not TDC. The findings suggest that vitamin D deficiency can accentuate some of the condition-specific impairments to musculoskeletal outcomes.

Hematoma Block: An Effective Alternative for Pain Management and Procedural Sedation.

Management of traumatic extremity injuries in the emergency department is typically time consuming, often requiring multiple resources including pain control and procedural sedation. A hematoma block is a safe and effective alternative treatment of pain and may eliminate the need for procedural sedation. The hematoma block requires fewer emergency department resources and may decrease time and costs that are associated with procedural sedation and analgesia. This technique is easily performed by the emergency nurse practitioner, and complications are rare. This article presents the appropriate technique required to perform a hematoma block for pain control and fracture reduction in patients with closed traumatic injuries.

Beyond spider personality: The relationships between behavioral, physiological, and environmental factors.

Spiders are useful models for testing different hypotheses and methodologies relating to animal personality and behavioral syndromes because they show a range of behavioral types and unique physiological traits (e.g., silk and venom) that are not observed in many other animals. These characteristics allow for a unique understanding of how physiology, behavioral plasticity, and personality interact across different contexts to affect spider's individual fitness and survival. However, the relative effect of extrinsic factors on physiological traits (silk, venom, and neurohormones) that play an important role in spider survival, and which may impact personality, has received less attention. The goal of this review is to explore how the environment, experience, ontogeny, and physiology interact to affect spider personality types across different contexts. We highlight physiological traits, such as neurohormones, and unique spider biochemical weapons, namely silks and venoms, to explore how the use of these traits might, or might not, be constrained or limited by particular behavioral types. We argue that, to develop a comprehensive understanding of the flexibility and persistence of specific behavioral types in spiders, it is necessary to incorporate these underlying mechanisms into a synthesized whole, alongside other extrinsic and intrinsic factors.

Potential Maladaptive Sleep-Related Cognitions in Depression with Comorbid Hypersomnolence: An Exploratory Investigation.

Objective/Background: Dysfunctional sleep-related cognitions (SRCs) have been demonstrated in both insomnia and depression, but have not been evaluated in patients experiencing depression with co-occurring hypersomnolence. Given the prominence of maladaptive thinking in depression with comorbid insomnia, dysfunctional SRCs may also exist in depressed persons experiencing hypersomnolence. Identifying potentially maladaptive SRCs may assist development of cognitive-behavioral strategies to alleviate hypersomnolence and its related impairment, particularly when comorbid with depression. Participants: Twenty-two unmedicated persons with major depressive disorder (MDD) with comorbid hypersomnolence (MDD+/HYP+), as well as age- and sex-matched persons with MDD without hypersomnolence (MDD+/HYP-) and healthy controls (HC). Methods: Participants completed the Dysfunctional Beliefs and Attitudes About Sleep-16-item (DBAS-16) and underwent overnight polysomnography. Groups were compared across clinical and sleep domains, as well as DBAS-16 global, subscale, and individual item scores. Additional analyses evaluated DBAS-16 components while controlling for depression severity. Results: Groups significantly differed across all collected sleep and mood metrics consistent with diagnostic classification. MDD+/HYP+ DBAS-16 global score was significantly elevated, relative to HC, and was comparable to MDD+/HYP-. A DBAS-16 global score significant group effect was maintained while controlling for depression symptom severity, however only individual DBAS-16 items related to quantity and quality of sleep demonstrated particular relevance to MDD+/HYP+ compared to other groups. Conclusions: Results suggest potentially maladaptive SRCs in MDD+/HYP+. Further efforts are needed to clarify whether these beliefs and attitudes about sleep in persons with hypersomnolence are in fact dysfunctional, as well as identify relevant content for development of a novel hypersomnolence-related SRC metric.

Hospital entrance smoking is reduced by broadcasting recorded antitobacco messages from Australian primary school children over entrance public address system.

ISSUE ADDRESSED: Smoking near hospital entrances occurs frequently despite smoke-free policies, resulting in multiple issues including second-hand smoke exposure (SHS) to vulnerable populations. Primary school children were engaged through their health curriculum to produce antismoking audio recordings for broadcast over a hospital entrance loudspeaker system to determine if this reduced smoking. METHOD: Students produced original recordings against hospital grounds smoking during class workshops, from which a collection (n = 16) was selected. Episodes of entrance smoking and total entrance traffic were recorded using security camera infrastructure over a 5-week period. A computer-controlled entrance loudspeaker played a message which was followed by silence until a new (different) message was played. Intensity of messaging was moderate in week 3 (every 5 minutes), increasing to high in week 4 (3 minutely) and compared to no messages (weeks 1-2 preintervention) and week 5 (postintervention). RESULTS: Smokers presented 316 times, smoking 523 cigarettes over 155 hours of observation (patients 70.6%, visitors 29.4%). SHS exposure was high given 172 others used the entrance/hour. Smoking was highest in the preintervention period (weeks 1-2), median five cigarettes/hr [IQR,3-7 (min = 0, max = 12)], falling to four cigarettes/hr during 5-minutely broadcasts [IQR,2-5 (min = 1, max = 14)] (P = .06), but zero cigarettes/hr during 3-minutely broadcasts [IQR,0-1(min = 0, max = 7)] (P < .0001). Postintervention (no broadcasts), smoking increased from zero to 1 cigarette/hr [IQR,0-3 (min = 0, max = 5)]; (P = .052). Nonsmoker movements did not change significantly between each period. CONCLUSION: Intensive (3 minutely) broadcasting of short antismoking messages significantly reduced hospital entrance smoking. SO WHAT?: Health services can positively interact with the health curriculum of primary schools against tobacco use while developing low-cost strategies to effectively deter entrance smoking.