Echographic characterization of extraocular muscles in pediatric patients with thyroid dysfunction.

PURPOSE: To characterize the size of extraocular muscles (EOMs) in a pediatric population with thyroid dysfunction using orbital echography. METHODS: Patients under age 18 with thyroid dysfunction who presented to an academic ophthalmology department from 2009 to 2020 and received orbital echography were included in this IRB-approved retrospective study. Data collected included age, clinical activity score (CAS), thyroid stimulating immunoglobulin (TSI), and extraocular recti muscle thickness on echography. Patients were organized into three age cohorts, after which statistical analysis compared recti measurements to previously reported normal ranges. RESULTS: Twenty patients with thyroid dysfunction were included. When comparing average recti muscle thicknesses of study patients to those of previously published normal children in similar age ranges, the levator-superior rectus complex was significantly increased in all age groups of children with thyroid dysfunction (p-values = <.004), and the levator-superior rectus complex was most frequently enlarged compared to published normal values (78% of eyes). CAS was not correlated with EOM size in the youngest group (5-10 years old, p-values >.315) but was significantly correlated in older groups (11-17 years old, p-values <.027). TSI was not correlated with EOM size in any group (p-values >.206). CONCLUSIONS: Echographic reference ranges for EOMs in children with thyroid dysfunction were established. There are increased rates of levator-superior rectus complex enlargement in children with TED compared to adults with TED, and EOM size is correlated with CAS in children older than 10 years. Though limited, these findings may serve as an additional tool for ophthalmologists to ascertain disease activity in pediatric patients with thyroid dysfunction.

Severity Assessment in Rats Undergoing Subarachnoid Hemorrhage Induction by Endovascular Perforation or Corresponding Sham Surgery.

INTRODUCTION: Animal models for preclinical research of subarachnoid hemorrhage (SAH) are widely used as much of the pathophysiology remains unknown. However, the burden of these models inflicted on the animals is not well characterized. The European directive requires severity assessment-based allocation to categories. Up to now, the classification into predefined categories is rather subjective and often without underlying scientific knowledge. We therefore aimed at assessing the burden of rats after SAH or the corresponding sham surgery to provide a scientific assessment. METHODS: We performed a multimodal approach, using different behavior tests, clinical and neurological scoring, and biochemical markers using the common model for SAH of intracranial endovascular filament perforation in male Wistar rats. Up to 7 days after surgery, animals with SAH were compared to sham surgery and to a group receiving only anesthesia and analgesia. RESULTS: Sham surgery (n = 15) and SAH (n = 16) animals showed an increase in the clinical score the first days after surgery, indicating clinical deterioration, while animals receiving only anesthesia without surgery (n = 5) remained unaffected. Body weight loss occurred in all groups but was more pronounced and statistically significant only after surgery. The analysis of burrowing, open field (total distance, erections), balance beam, and neuroscore showed primarily an effect of the surgery itself in sham surgery and SAH animals. Only concerning balance beam and neuroscore, a difference was visible between sham surgery and SAH. The outcome of the analysis of systemic and local inflammatory parameters and of corticosterone in blood and its metabolites in feces was only robust in animals suffering from larger bleedings. Application of principal component analysis resulted in a clear separation of sham surgery and SAH animals from their respective baseline as well as from the anesthesia-only group at days 1 and 3, with the difference between sham surgery and SAH being not significant. DISCUSSION/CONCLUSION: To our knowledge, we are the first to publish detailed clinical score sheet data combined with advanced behavioral assessment in the endovascular perforation model for SAH in rats. The tests chosen here clearly depict an impairment of the animals within the first days after surgery and are consequently well suited for assessment of the animals' suffering in the model. A definitive classification into one of the severity categories named by the EU directive is yet pending and has to be performed in the future by including the assessment data from different neurological and nonneurological disease models.

How can residents protect and promote pollinators? The diffusion of residential pollinator-friendly gardening.

Urbanization and land use change are leading causes of declines in pollinator abundance and diversity. However, researchers in different regions of the world have found that some pollinators can thrive in urban landscapes, depending on land use practices, environmental conditions, and species traits. Residential landscapes constitute a significant portion of urban green space and thus, residents' adoption of landscape practices to promote pollinators can play a central role in addressing the global pollinator challenge. Yet, although residents' willingness and intention appear strong, adoption of pollinator-friendly gardening remains low. The present study - guided by the Diffusion of Innovations theory - aimed to build empirical understanding by surveying 1598 [State] residents on their experiences and perceptions related to pollinator-friendly gardening to determine the most salient barriers and opportunities to engagement. Key findings suggest making the practice more widely observable and reducing perceived complexity in learning to do the practice are critical to promoting adoption. This demonstrates, in practical terms, that: (1) targeted efforts to build residents' actionable knowledge about pollinator-friendly gardening may significantly reduce uncertainty and boost the likelihood of adoption; and (2) examples of active pollinator gardens need to be more widely showcased and popularized (e.g., through experiential or virtual demonstrations). We also found most residents living in homeowner associations (HOAs) believed HOA policies on pollinator-friendly gardening were restrictive or the residents were unsure whether they are allowed to practice pollinator-friendly gardening. Given these perceptions strongly associated with residents' low intent to engage in pollinator-friendly gardening, a major opportunity exists to diffuse the practice and increase adoption by working with HOAs and community leaders to become promoters of - rather than barriers to - pollinator-friendly gardening.

Personal and Professional Mitigation Behavioral Intentions of Agricultural Experts to Address Climate Change.

Mitigation activities, whether at the personal level relating to lifestyle or on the professional level, especially in the agriculture sector, are widely encouraged by scientists and policymakers. This research empirically analyses the association between agricultural experts' perceptions about climate change and their intention to implement climate change mitigation. Based on survey data, individuals' reported intention to implement personal and professional mitigation behavior is explained using a conceptual model. The structural equation modeling results suggest that the new ecological paradigm (NEP), institutional trust, and risk salience indirectly influence climate change mitigation intentions. The findings indicate that risk perception, personal efficacy, responsibility, belief in climate change occurring, and low psychological distance trigger a significantly greater intention to support personal and professional mitigation behaviors. However, the research framework is much stronger at predicting the intention to mitigate climate change in professional affairs compared to personal activities. The findings suggest that hypothetical distance factors only have a moderating effect on the relationship between higher climate change environmental values, institutional trust, risk salience, and mitigation intention. This paper analytically explores the regulating role of risk perception, hypothetical distance, personal efficacy, and responsibility between institutional trust, risk salience, and the NEP as independent concepts and intention to personal and professional mitigation behaviors as dependent variables. The findings of the study have important implications for encouraging personal and professional mitigation behaviors.

Echographic Assessment of Extraocular Muscle Response to Teprotumumab.

PURPOSE: To evaluate extraocular muscle response to teprotumumab using orbital echography in thyroid eye disease. METHODS: This retrospective study included adult thyroid eye disease patients with pre- and post-teprotumumab orbital echography. Data collected included: age, Hertel measurements, clinical activity score, Gorman diplopia scores, ocular motility, and recti muscle diameters measured by echography. The patient's more proptotic eye before treatment initiation was designated as the study orbit. Ocular motility was assessed by totaling the ductions in all 4 cardinal directions. Orbital echography was obtained pre- and post-treatment to assess response of extraocular muscle diameters. RESULTS: Six patients with a mean age of 67 years were included. There was a mean improvement in proptosis of 4.3 mm in the study eye with 11/12 orbits showing improvement in globe position ( p < 0.05). All patients had a decrease in clinical activity score with a mean reduction of 2.5. Four patients had an improvement in Gorman diplopia score. Ocular motility in the study orbits improved by a total mean of 26.9° ( p < 0.05). Mean total extraocular muscle diameter was reduced from 27.4 to 23.4 mm ( p < 0.001). On average, superior recti were largest pre- and post-treatment, followed by inferior, medial, then lateral recti. However, inferior recti showed the greatest reduction of 23% ( p < 0.02). CONCLUSIONS: Orbital echography demonstrated extraocular muscle reduction in all patients after teprotumumab, correlating with improved clinical activity score, ocular motility, and proptosis. Orbital echography is a safe and cost-effective imaging alternative to monitor therapeutic response to teprotumumab.

Using a diffusion of innovation lens to understand homeowner support for septic system to sewer system conversions.

Water quality impairment linked to household septic systems presents a significant challenge for environmental management professionals given the costs and complexity of encouraging residents to convert to sewer systems. Septic-to-sewer conversion programs may be more effective if they employ innovative techniques such as social marketing to accelerate engagement, but there is a lack of the necessary formative audience research available on which to promote sanitation-related technologies and behaviors using these types of strategies. We used Diffusion of Innovations theory as a lens through which to view support for septic-to-sewer conversion programs, considering perceptions of relative advantage, compatibility, complexity, and observability as factors (i.e., barriers, motivators) in the decision to convert to sewer. We collected data from 518 septic system owners in the state of Florida, USA. Four out of ten respondents indicated there were septic-to-sewer conversion plans in place in their community, and most of these individuals reported the plans were voluntary rather than mandatory. Residents with plans in place had more favorable perceptions than those without such plans and were largely supportive of septic-to-sewer conversion programs. Ordinal regression revealed compatibility and observability were significant predictors of residents' support for septic-to-sewer conversion. When conversion project status variables were added to the final ordinal model, compatibility remained a significant predictor, and completed conversion status also predicted support. Environmental management professionals should consider using characteristics of compatibility and observability to bolster engagement in septic-to-sewer conversion programs, and consider integrating the influences of other communities with completed conversion programs.

Evaluating connections between personal well-being and adoption of landscape best management practices: An audience segmentation study.

Integrated pest management and outdoor water conservation comprise key practices encouraged by nonformal educators who work with the public to address significant issues related to water quality and availability. Disconnects among diverse audiences and educational programs pose challenges in achieving the goals of these types of programs. To discern a potential nonformal educational programming strategy, we conducted audience segmentation research incorporating residential environmental landscape best management practices and compared resulting subgroups' characteristics. We explored this paradigm through the context of Extension education and used a nationally-distributed electronic survey instrument to measure well-being and landscape management perceptions and practices in the United States. We collected 2601 complete survey responses and employed cluster analysis to divide the respondents into homogenous subgroups, followed by analysis of variance and chi-square analyses to identify differences among the subgroups. The group that indicated the highest level of engagement with water conservation and IPM practices also had significantly higher well-being, demonstrating the potential to align IPM education with more commonly promoted conservation practices. Membership in the highest IPM and water conservation group was related to several socio-demographic characteristics, including age, homeownership, and homeowners' association membership. This group was also most likely to engage with educational programs. Understanding these indicators of engagement in landscape best management practices and nonformal education, along with higher well-being, may be useful in determining target audiences and potential engagement with nonformal education programs.

Primary transoral robotic surgery +/- adjuvant therapy for oropharyngeal squamous cell carcinoma-A large observational single-centre series from the United Kingdom.

OBJECTIVES: To analyse the oncological outcomes following primary Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). DESIGN: Observational case series. SETTING: Tertiary centre; first TORS practice to commence in the UK. PARTICIPANTS: All consecutive patients undergoing primary TORS with curative intent, with or without adjuvant treatment. MAIN OUTCOME MEASURES: Descriptive analysis of patient and tumour pathology variables. Survival outcomes: Overall, Disease-Specific, Progression-Free and Locoregional control. RESULTS: The cohort comprised of 120 patients undergoing TORS with minimum 12-month follow-up data and the following characteristics: mean age 58 years, 91 males (76%), 78 tonsil (65%) and 34 base of tongue primaries (28%), 89% HPV-related OPSCC. The surgical pathology revealed 14 (12%) with positive margins, 19 (16%) had close margins <2mm and 31% with extranodal extension. The treatment was as follows: 39 (33%) treated with TORS alone, 50 (42%) received adjuvant radiotherapy and 31 (26%) received adjuvant radiotherapy with chemotherapy. There were 15 recurrences. Estimated survival for all patients at 3 years (95% CI): overall 85% (78-92), disease-specific 90% (85-96), progression-free 86% (79-92) and locoregional control 90% (84-96). The equivalent survival figures for the HPV-related cases alone were as follows: overall 88% (82-94), disease-specific 93% (87-98), progression-free 88% (81-95) and locoregional control 92% (87-98). CONCLUSIONS: Whilst TORS has become a common practice in the management of OPSCC in the UK, these are the first reported oncological outcomes. For selected patients, TORS with or without adjuvant therapy is an appropriate treatment modality.

Delving deeper: Exploring the influence of psycho-social wellness on water conservation behavior.

Public and nonprofit organizations are at the forefront of water scarcity issues using nonformal educational programs to drive behavior change towards water conservation. The efficacy of educational endeavors hinge on designing and delivering programs with considerations of the factors that will change relevant decisions and behaviors among residential landscape water users. The purpose of this study was to explore the concept of wellness and well-being, and its relationship to engagement in water conservation behaviors. To guide this evaluation, we integrated the theory of planned behavior with relevant tenets of cognitive and social psychology and included the psycho-social constructs of stress, perceived happiness and well-being. We conducted correlational and regression analyses to assess potential relationships. Overall, the results of the study show that each of the three different psycho-social measures behave differently with regards to current and future residential landscape water conservation behaviors. The models show that perceptions of well-being is the more consistent predictor for both current and future behaviors. Perceived happiness only served as a significant predictor for current behaviors. Stress simply demonstrated correlational relationships with current and future behaviors, not serving as a significant predictor. We suggest exploring the possibility of pairing and embedding educational programs focused on personal and family well-being with educational programs focused on environmental behavior. When we consider water conservation behavior as a function of more than knowledge and motivation, we can broaden our understanding of this behavior as a socially embedded experience.

Ear drops for the removal of ear wax.

BACKGROUND: Ear wax (cerumen) is a normal bodily secretion that can become a problem when it obstructs the ear canal. Symptoms attributed to wax (such as deafness and pain) are among the commonest reasons for patients to present to primary care with ear trouble.Wax is part of the ear's self-cleaning mechanism and is usually naturally expelled from the ear canal without causing problems. When this mechanism fails, wax is retained in the canal and may become impacted; interventions to encourage its removal may then be needed. Application of ear drops is one of these methods. Liquids used to remove and soften wax are of several kinds: oil-based compounds (e.g. olive or almond oil); water-based compounds (e.g. sodium bicarbonate or water itself); a combination of the above or non-water, non-oil-based solutions, such as carbamide peroxide (a hydrogen peroxide-urea compound) and glycerol. OBJECTIVES: To assess the effects of ear drops (or sprays) to remove or aid the removal of ear wax in adults and children. SEARCH METHODS: We searched the Cochrane ENT Trials Register; Cochrane Register of Studies; PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 March 2018. SELECTION CRITERIA: Randomised controlled trials (RCTs) in which a 'cerumenolytic' was compared with no treatment, water or saline, an alternative liquid treatment (oil or almond oil) or another 'cerumenolytic' in adults or children with obstructing or impacted ear wax. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes were 1) the proportion of patients (or ears) with complete clearance of ear wax and 2) adverse effects (discomfort, irritation or pain). Secondary outcomes were: extent of wax clearance; proportion of people (or ears) with relief of symptoms due to wax; proportion of people (or ears) requiring further intervention to remove wax; success of mechanical removal of residual wax following treatment; any other adverse effects recorded and cost. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS: We included 10 studies, with 623 participants (900 ears). Interventions included: oil-based treatments (triethanolamine polypeptide, almond oil, benzocaine, chlorobutanol), water-based treatments (docusate sodium, carbamide peroxide, phenazone, choline salicylate, urea peroxide, potassium carbonate), other active comparators (e.g. saline or water alone) and no treatment. Nine of the studies were more than 15 years old.The overall risk of bias across the 10 included studies was low or unclear. PRIMARY OUTCOME: proportion of patients (or ears) with complete clearance of ear waxSix studies (360 participants; 491 ears) contributed quantitative data and were included in our meta-analyses.Active treatment versus no treatmentOnly one study addressed this comparison. The proportion of ears with complete clearance of ear wax was higher in the active treatment group (22%) compared with the no treatment group (5%) after five days of treatment (risk ratio (RR) 4.09, 95% confidence interval (CI) 1.00 to 16.80); one study; 117 ears; NNTB = 8) (low-quality evidence).Active treatment versus water or salineWe found no evidence of a difference in the proportion of patients (or ears) with complete clearance of ear wax when the active treatment group was compared to the water or saline group (RR 1.47, 95% CI 0.79 to 2.75; three studies; 213 participants; 257 ears) (low-quality evidence). Two studies applied drops for five days, but one study only applied the drops for 15 minutes. When we excluded this study in a sensitivity analysis it did not change the result.Water or saline versus no treatmentThis comparison was only addressed in the single study cited above (active versus no treatment) and there was no evidence of a difference in the proportion of ears with complete wax clearance when comparing water or saline with no treatment after five days of treatment (RR 4.00, 95% CI 0.91 to 17.62; one study; 76 ears) (low-quality evidence).Active treatment A versus active treatment BSeveral single studies evaluated 'head-to-head' comparisons between two active treatments. We found no evidence to show that one was superior to any other.Subgroup analysis of oil-based active treatments versus non-oil based active treatmentsWe found no evidence of a difference in this outcome when oil-based treatments were compared with non-oil-based active treatments. PRIMARY OUTCOME: adverse effects: discomfort, irritation or painOnly seven studies planned to measure and did report this outcome. Only two (141 participants;176 ears) provided useable data. There was no evidence of a significant difference in the number of adverse effects between the types of ear drops in these two studies. We summarised the remaining five studies narratively. All events were mild and reported in fewer than 30 participants across the seven studies (low-quality evidence).Secondary outcomesThree studies reported 'other' adverse effects (how many studies planned to report these is unclear). The available information was limited and included occasional reports of dizziness, unpleasant smell, tinnitus and hearing loss. No significant differences between groups were reported. There were no emergencies or serious adverse effects reported in any of the 10 studies.There was very limited or no information available on our remaining secondary outcomes. AUTHORS' CONCLUSIONS: Although a number of studies aimed to evaluate whether or not one type of cerumenolytic is more effective than another, there is no high-quality evidence to allow a firm conclusion to be drawn and the answer remains uncertain.A single study suggests that applying ear drops for five days may result in a greater likelihood of complete wax clearance than no treatment at all. However, we cannot conclude whether one type of active treatment is more effective than another and there was no evidence of a difference in efficacy between oil-based and water-based active treatments.There is no evidence to show that using saline or water alone is better or worse than commercially produced cerumenolytics. Equally, there is also no evidence to show that using saline or water alone is better than no treatment.

Classifying Residents who use Landscape Irrigation: Implications for Encouraging Water Conservation Behavior.

Large amounts of water applied as urban irrigation can often be reduced substantially without compromising esthetics. Thus, encouraging the adoption of water-saving technologies and practices is critical to preserving water resources, yet difficult to achieve. The research problem addressed in this study is the lack of characterization of residents who use urban irrigation, which hinders the design of effective behavior change programs. This study examined audience segmentation as an approach to encouraging change using current residential landscape practices. K-means cluster analysis identified three meaningful subgroups among residential landscape irrigation users (N = 1,063): the water considerate majority (n = 479, 45 %), water savvy conservationists (n = 378, 36 %), and unconcerned water users (n = 201, 19 %). An important finding was that normative beliefs, attitudes, and perceived behavioral control characteristics of the subgroups were significantly different with large and medium practical effect sizes. Future water conservation behaviors and perceived importance of water resources were also significantly different among subgroups. The water considerate majority demonstrated capacity to conserve, placed high value on water, and were likely to engage in behavior changes. This article contributes to the literature on individuals who use residential landscape irrigation, an important target audience with potential to conserve water through sustainable irrigation practices and technologies. Findings confirm applicability of the capacity to conserve water to audience segmentation and extend this concept by incorporating perceived value of water resources and likelihood of conservation. The results suggest practical application to promoting residential landscape water conservation behaviors based on important audience characteristics.

Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer.

BACKGROUND: This is an update of a Cochrane review first published in The Cochrane Library in Issue 2, 2002 and previously updated in 2004, 2007 and 2010.Radiotherapy, open surgery and endolaryngeal excision (with or without laser) are all accepted modalities of treatment for early-stage glottic cancer. Case series suggest that they confer a similar survival advantage, however radiotherapy and endolaryngeal surgery offer the advantage of voice preservation. There has been an observed trend away from open surgery in recent years, however equipoise remains between radiotherapy and endolaryngeal surgery as both treatment modalities offer laryngeal preservation with similar survival rates. Opinions on optimal therapy vary across disciplines and between countries. OBJECTIVES: To compare the effectiveness of open surgery, endolaryngeal excision (with or without laser) and radiotherapy in the management of early glottic laryngeal cancer. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 8); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 18 September 2014. SELECTION CRITERIA: Randomised controlled trials comparing open surgery, endolaryngeal resection (with or without laser) and radiotherapy. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We identified only one randomised controlled trial, which compared open surgery and radiotherapy in 234 patients with early glottic laryngeal cancer. The overall risk of bias in this study was high.For T1 tumours, the five-year survival was 91.7% following radiotherapy and 100% following surgery and for T2 tumours, 88.8% following radiotherapy and 97.4% following surgery. There were no significant differences in survival between the two groups.For T1 tumours, the five-year disease-free survival rate was 71.1% following radiotherapy and 100.0% following surgery, and for the T2 tumours, 60.1% following radiotherapy and 78.7% following surgery. Only the latter comparison was statistically significant (P value = 0.036), but statistical significance would not have been achieved with a two-sided test.Data were not available on side effects, quality of life, voice outcomes or cost.We identified no randomised controlled trials that included endolaryngeal surgery. A number of trials comparing endolaryngeal resection and radiotherapy have terminated early because of difficulty recruiting participants. One randomised controlled trial is still ongoing. AUTHORS' CONCLUSIONS: There is only one randomised controlled trial comparing open surgery and radiotherapy but its interpretation is limited because of concerns about the adequacy of treatment regimens and deficiencies in the reporting of the study design and analysis.

Employing the TAM in predicting the use of online learning during and beyond the COVID-19 pandemic.

Online learning systems have become an applied solution for delivering educational content, especially in developing countries, since the start of the COVID-19 pandemic. The present study is designed to identify the factors influencing the behavioral intention of agricultural students at universities in Iran to use online learning systems in the future. This research uses an extended model in which the constructs of Internet self-efficacy, Internet anxiety, and output quality are integrated into the technology acceptance model (TAM). Data analysis was performed using the SmartPLS technique. The analyses showed the proposed model to be strong in terms of predicting the attitude to online learning and the intention to use it. The extended TAM model fit the data well and predicted 74% of the intention variance. Our findings show attitude and perceived usefulness to have directly affected intention. Output quality and Internet self-efficacy indirectly affected attitude and intention. Research findings can help with the design of educational policies and programs to facilitate education and improve student academic performance.

Shaping farmers' beliefs, risk perception and adaptation response through Construct Level Theory in the southwest Iran.

Due to the severe effects of climate change on the agricultural sector, urgent action is required on the part of farmers and is, indeed, critical to reducing climate change impacts. However, reports globally revealed farmers' engagement in climate change adaptation is still insufficient, ambivalent, and inconsistent and farmers do not consider adaptation to be urgent. Researchers have argued that this issue is rooted in psychological biases beside other factors. Therefore, the aim of this study is to evaluate how psychological distance determines climate change beliefs, risk perception and adaptation strategies among Iranian farmers. A cross-sectional paper-based survey was conducted in the Dasht-e Azadegan county of Khuzestan province in southwest Iran. The study sample consisted of 250 farmers selected through a multi-stage random sampling process. An expert panel review and a pilot study were conducted to confirm convergent validity and reliability of the scales. The results confirm that all four dimensions of psychological distance influence water management adaptation strategies and non-farm activities. Moreover, all psychological dimensions, except the temporal dimension, affect adaptation in farming management. Thus, making climate change more proximal to decision makers could be a strategic way of encouraging individuals to take adaptive actions. This study emphasizes that concepts of psychological distance can be applied to help organizations (e.g., agriculture extension services) to understand farmers' risk perceptions and responses to climate change impacts and improve risk communication to better engage farmers in climate action.

Transoral robotic surgery without adjuvant therapy: A systematic review and meta-analysis of the association between surgical margins and local recurrence.

BACKGROUND: Transoral robotic surgery (TORS) is increasingly employed in the management of oropharyngeal cancer without adjuvant treatment. Attaining safe surgical margins is paramount to preventing local recurrence (LR), but the necessary surgical margin dimension remains contentious. METHODS: Systematic review and meta-analysis of studies reporting margin status and LR following TORS without adjuvant therapy for primary OPSCC. RESULTS: The search identified 269 articles and 11 were selected for inclusion, with 406 patients included in the meta-analysis. Heterogeneity was noted in the definition of "close" margins. Random-effects pooled rate of positive margins was 7 % (95 % CI 0.04-0.12, I2 = 54 %, p = 0.02) and close margins was 7 % (95 % CI 0.02-0.27, I2 = 86 %, p=<0.01). The random-effects overall rate of LR was 6 % (95 % CI 0.04-0.10, I2 = 11 %, p = 0.35), 13 % (95 % CI 0.02-0.620, I2 = 0 %, p = 1.0) after a positive margin, and 3 % (95 % CI 0.03-0.24, I2 = 23 %, p = 0.26) after a close margin. Odds ratio (OR) for LR indicated higher risk of LR for positive compared to close margins (7.5; 95 % CI 1.31-42.91, I2 = 0 %, p = 0.51), and a slightly lower risk of LR between close and negative margins (2.22; 95 % CI 0.67-7.38, I2 = 0 %, p = 0.8). A lack of frozen-section analysis (OR 2.91, p = 0.36) and HPV-negative disease (OR 1.68, p = 0.03) were associated with an elevated risk of LR. CONCLUSIONS: TORS as a standalone treatment is associated with low rates of LR; however, the literature is hampered by considerable heterogeneity in margin definitions. Larger multicentre studies are required to determine the precise margin cut-off required for oropharyngeal tumours managed with TORS alone.

Opening a window to the acutely injured brain: Simultaneous retinal and cerebral vascular monitoring in rats.

Many recent research projects have described typical chronic changes in the retinal vasculature for diverse neurovascular and neurodegenerative disorders such as stroke or Alzheimer's disease. Unlike cerebral vasculature, retinal blood vessels can be assessed non-invasively by retinal vessel analysis. To date, there is only a little information about potential simultaneous reactions of retinal and cerebral vessels in acute neurovascular diseases. The field of applications of retinal assessment could significantly be widened if more information about potential correlations between those two vascular beds and the feasibility of non-invasive retinal vessel analysis in acute neurovascular disease were available. Here, we present our protocol for the simultaneous assessment of retinal and cerebral vessels in an acute setting in anesthetized rats using a non-invasive retinal vessel analyzer and a superficial tissue imaging system for laser speckle contrast analysis via a closed bone window. We describe the experimental set-up in detail, outline the pitfalls of repeated retinal vessel analyses in an experimental set-up of several hours, and address issues that arise from the simultaneous use of two different assessment tools. Finally, we demonstrate the robustness and variability of the reactivity of retinal vessels to hypercapnia at baseline as well as their reproducibility over time using two anesthetic protocols common for neurovascular research. In summary, the procedures described in this protocol allow us to directly compare retinal and cerebral vascular beds and help to substantiate the role of the retina as a "window to the brain."

Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study.

BACKGROUND: Although chronic obstructive pulmonary disease (COPD) is one of the most deadly, prevalent, and costly chronic diseases, no comprehensive estimates of the risk of developing COPD in the general population have been published. We aimed to quantify the lifetime risk of developing physician-diagnosed COPD in a large, multicultural North American population. METHODS: We did a retrospective longitudinal cohort study using population-based health administrative data from Ontario, Canada (total population roughly 13 million). All individuals free of COPD in 1996 were monitored for up to 14 years for three possible outcomes; diagnosis of COPD by a physician, reached 80 years of age, or death. COPD was identified with a previously validated case definition based on COPD health services claims. The cumulative incidence of physician-diagnosed COPD over a lifetime adjusted for the competing risk of death was calculated by a modified survival analysis technique. Results were stratified by sex, socioeconomic status, and whether individuals lived in a rural or urban setting. FINDINGS: A total of 579,466 individuals were diagnosed with COPD by a physician over the study period. The overall lifetime risk of physician-diagnosed COPD at age 80 years was 27·6%. Lifetime risk was higher in men than in women (29·7%vs 25·6%), individuals of lower socioeconomic status than in those of higher socioeconomic status (32·1%vs 23·0%), and individuals who lived in a rural setting than in those who lived in an urban setting (32·4%vs 26·7%). INTERPRETATION: About one in four individuals are likely to be diagnosed and receive medical attention for COPD during their lifetime. Clinical evidence-based approaches, public health action, and more research are needed to identify effective strategies to prevent COPD and ensure that those with the disease have the highest quality of life possible. FUNDING: Government of Ontario, Canada.

Transoral robotic surgery and neck dissection alone for head and neck squamous cell carcinoma: Influence of resection margins on oncological outcomes.

OBJECTIVES: This study reports oncological outcomes of transoral robotic surgery (TORS) and neck dissection (ND) alone for head and neck squamous cell carcinoma (HNSCC) and aims to analyse the influence of resection margins on local recurrence rates. MATERIALS AND METHODS: Fifty-one patients treated with curative intent for HNSCC, with TORS and ND alone between 2013 and 2019 at two tertiary centres were included in this observational multi-centre prospective cohort study. Oncological outcomes are reported on 47 patients for whom the aim was to treat with TORS and ND alone; this excluded four patients who were recommended adjuvant radiotherapy based on resective pathology but did not receive treatment. Local control is the primary endpoint; disease specific, progression free and overall survival are secondary outcomes. RESULTS: With a median follow up of 43 months, estimated outcomes at 3 years (n = 47) were as follows: local control 92%, progression free survival 80%, disease specific survival 94%, and overall survival 84%. Presence of a positive margin on the main specimen was the only statistically significant predictor of local recurrence on univariate Cox regression analysis. Time dependent receiver operating characteristic curve identified margins of 1.1 mm as a threshold for local control, with area under the curve 0.788 (95% CI 0.616-0.960), indicating a good classifier. CONCLUSION: This is the first UK surgery alone series reporting mature oncological outcomes following TORS and ND. Positive margins on the resected specimen are the strongest predictor of local recurrence, with conventional definitions of "close margins" having no impact.

Vascular Reactivity to Hypercapnia Is Impaired in the Cerebral and Retinal Vasculature in the Acute Phase After Experimental Subarachnoid Hemorrhage.

Objective: Impaired cerebral blood flow (CBF) regulation, such as reduced reactivity to hypercapnia, contributes to the pathophysiology after aneurysmal subarachnoid hemorrhage (SAH), but temporal dynamics in the acute phase are unknown. Featuring comparable molecular regulation mechanisms, the retinal vessels participate in chronic and subacute stroke- and SAH-associated vessel alterations in patients and can be studied non-invasively. This study is aimed to characterize the temporal course of the cerebral and retinal vascular reactivity to hypercapnia in the acute phase after experimental SAH and compare the potential degree of impairment. Methods: Subarachnoid hemorrhage was induced by injecting 0.5 ml of heparinized autologous blood into the cisterna magna of male Wistar rats using two anesthesia protocols [isoflurane/fentanyl n = 25 (Sham + SAH): Iso-Group, ketamine/xylazine n = 32 (Sham + SAH): K/X-Group]. CBF (laser speckle contrast analysis) and physiological parameters were measured continuously for 6 h. At six predefined time points, hypercapnia was induced by hypoventilation controlled via blood gas analysis, and retinal vessel diameter (RVD) was determined non-invasively. Results: Cerebral reactivity and retinal reactivity in Sham groups were stable with only a slight attenuation after 2 h in RVD of the K/X-Group. In the SAH Iso-Group, cerebral and retinal CO2 reactivity compared to baseline was immediately impaired starting at 30 min after SAH (CBF p = 0.0090, RVD p = 0.0135) and lasting up to 4 h (p = 0.0136, resp. p = 0.0263). Similarly, in the K/X-Group, cerebral CO2 reactivity was disturbed early after SAH (30 min, p = 0.003) albeit showing a recovery to baseline after 2 h while retinal CO2 reactivity was impaired over the whole observation period (360 min, p = 0.0001) in the K/X-Group. After normalization to baseline, both vascular beds showed a parallel behavior regarding the temporal course and extent of impairment. Conclusion: This study provides a detailed temporal analysis of impaired cerebral vascular CO2 reactivity starting immediately after SAH and lasting up to 6 h. Importantly, the retinal vessels participate in these acute changes underscoring the promising role of the retina as a potential non-invasive screening tool after SAH. Further studies will be required to determine the correlation with functional outcomes.