A further case of chondrodysplasia with growth failure occurring after hematopoietic stem cell transplantation (HSCT).

There is an emerging body of evidence showing that young patients, post haematopoietic stem cell transplantation (HSCT), can develop skeletal changes that mimic an osteochondrodysplasia process. The key discriminator is that these children have had otherwise normal growth and skeletal development before the therapeutic intervention (HSCT), typically for a haematological malignancy. Herein we present that case of a boy who underwent HSCT for Haemophagocytic Lymphohistiocytosis (HLH) aged 2 years. Following Intervention with HSCT this boy's growth has severely decelerated (stature less than 1st centile matched for age) and he has developed a spondyloepiphyseal dysplasia.

Predicting histopathological features of aggressiveness in lung cancer using CT radiomics: a systematic review.

PURPOSE: To examine the accuracy of CT radiomics to predict histopathological features of aggressiveness in lung cancer using a systematic review of test accuracy studies. METHODS: Data sources searched included Medline, Embase, Web of Science, and Cochrane Library from up to 3 November 2023. Included studies reported test accuracy of CT radiomics models to detect the presence of: spread through air spaces (STAS), predominant adenocarcinoma pattern, adenocarcinoma grade, lymphovascular invasion (LVI), tumour infiltrating lymphocytes (TIL) and tumour necrosis, in patients with lung cancer. The primary outcome was test accuracy. Two reviewers independently assessed articles for inclusion and assessed methodological quality using the QUality Assessment of Diagnostic Accuracy Studies-2 tool. A single reviewer extracted data, which was checked by a second reviewer. Narrative data synthesis was performed. RESULTS: Eleven studies were included in the final analysis. 10/11 studies were in East Asian populations. 4/11 studies investigated STAS, 6/11 investigated adenocarcinoma invasiveness or growth pattern, and 1/11 investigated LVI. No studies investigating TIL or tumour necrosis met inclusion criteria. Studies were of generally mixed to poor methodological quality. Reported accuracies for radiomic models ranged from 0.67 to 0.94. CONCLUSION: Due to the high risk of bias and concerns regarding applicability, the evidence is inconclusive as to whether radiomic features can accurately predict prognostically important histopathological features of cancer aggressiveness. Many studies were excluded due to lack of external validation. Rigorously conducted prospective studies with sufficient external validity will be required for radiomic models to play a role in improving lung cancer outcomes.

Acoustic metasurfaces with Frieze symmetriesa).

Frieze patterns follow a set of tiling instructions including reflection, rotation, and translation, and tile the infinite strip. Many metamaterials function due to the underlying symmetry, and its strategic breaking, of their constituent sub-structures that allow tailoring of the dispersion of modes supported by the structure. We design, simulate, and experimentally characterize seven one-dimensional acoustic metasurfaces whose unit cells each belong to one of the distinct Frieze groups.

Cognitive function and the longitudinal hippocampal axis in mesial temporal sclerosis.

OBJECTIVE: The relationship of preoperative memory deficits in patients with mesial temporal lobe epilepsy (mTLE) and hippocampal sclerosis (HS) to the distribution of neuronal loss is uncertain. Building on the material specificity theory, we tested the hypothesis that visual memory deficits are associated with posterior hippocampal atrophy, whereas verbal memory deficits are associated with anterior hippocampal atrophy. METHODS: We studied 22 adults with mTLE and HS, calculating hippocampal head, body, and tail volumes, correcting for estimated total intracranial volume, using automated segmentation. Preoperative memory ability was evaluated with the Wechsler Memory Scale (WMS-II: logical memory, verbal paired associates, family pictures, and faces subtests). We correlated memory ability with hippocampal division volumes using SPSS 26.1 (repeated measures ANOVAs, one-way ANOVAs, Pearson r correlations) for statistical analysis. RESULTS: We found a significant main effect of hippocampal subdivision, reporting volumetric differences between the head, body, and tail. Pairwise comparisons reported that the hippocampal head had significantly greater volume than both the body and tail (p < 0.001). For both left and right focus groups, the ipsilateral hippocampi were significantly smaller than the contralateral. Linear regression reported a left hippocampal model (head, body, and tail volumes) predicted performance on logical memory with the left hippocampal tail volume being the strongest predictor. A right hippocampal model (head, body, and tail volumes) predicted memory ability for family pictures and verbal paired associates at a trend level. CONCLUSIONS: Ipsilateral hippocampal head and tail seem more vulnerable to injury than the body in both the left and right mTLE. Our study suggests there may be functional differences along the hippocampal longitudinal axis, particularly for the left hippocampal tail with verbal memory. Our findings are consistent with material-specific right-left differences in memory processing.

Fate of thiamethoxam from treated seeds in mesocosms and response of aquatic invertebrate communities.

Thiamethoxam is a neonicotinoid insecticide widely applied in the Canadian Prairies. It has been detected in surface waters of agro-ecosystems, including wetlands, but the potential effects on non-target invertebrate communities in these wetlands have not been well characterized. In an effort to understand better the fate of thiamethoxam in wetlands and the response of invertebrates (zooplankton and emergent insects), model systems were used to mimic wetland flooding into planted fields. Outdoor mesocosms were treated with a single application of thiamethoxam-treated canola seeds at three treatment levels based on a recommended seeding rate (i.e., 6 kg/ha; 1×, 10×, and 100× seeding rate) and monitored over ten weeks. The mean half-life of thiamethoxam in the water column was 6.2 d. There was no ecologically meaningful impact on zooplankton abundances or community structure among treatments. Statistically significant differences were observed in aquatic insect abundance between control mesocosms and the two greatest thiamethoxam treatments (10× and 100× seeding rate). The observed results indicate exposure to thiamethoxam at environmentally relevant concentrations likely does not represent a significant ecological risk to abundance and community structure of wetland zooplankton and emergent insects.

Water fluoride concentrations in England, 2009-2020.

OBJECTIVES: Contemporary research, surveillance and monitoring of water fluoridation requires an understanding of the population coverage of this intervention. The aims of this research are to create the first publicly available record of water fluoride concentrations in England and to describe and visualise the observed variation in water fluoride concentrations and optimal fluoridation (⟩/= 0.7 mg F/L) between 2009-2020. BASIC RESEARCH DESIGN: Routine water quality sampling data were requested from water companies in England from 2009-2020 under the provisions of the Environmental Information Regulations 2004. Fluoride concentrations of Water Supply Zones (WSZs) were assigned to Lower Super Output Areas (LSOAs) using population-weighted centroids. RESULTS: Between 2009-2020 4247 LSOAs (12.9%) had an annual mean water fluoride concentration of ⟩/= 0.7 mg F/L in at least one year, and 3019 LSOAs (9.1%) had a grand mean fluoride concentration of ⟩/= 0.7 mg F/L. Coverage of optimal fluoridation varied over time; from 10.9% of LSOAs in 2014 to 6.3% in 2016. DISCUSSION: This study confirms previous work identifying variability in the coverage and achieved concentrations of water fluoridation programmes. The current provision for accessing, collating and utilising these data are a barrier to essential monitoring, surveillance and research. An annually maintained and publicly accessible database of water fluoride concentrations is urgently required.

The Greater Manchester Child Friendly Dental Practice Scheme: Using a Transformational Commissioning Approach to Align Paediatric Dental Service Provision with Childhood Oral Health Needs in Greater Manchester.

In response to the impact of the COVID-19 pandemic on access to already oversubscribed specialist paediatric dental services, a pilot of an enhanced primary care paediatric dental pathway, known as the Child Friendly Dental Practice (CFDP) scheme, was commissioned by the Greater Manchester Health and Social Care Partnership. Supported by a transformational commissioning approach, the ambition of the CFDP pilot was to manage or stabilise the oral health of high-need paediatric patients who had been referred to specialist dental services within Community or Hospital Dental Service settings, through timely access to primary care clinicians who were confident and experienced in treating children. The theory of change of the CFDP pilot proposed that rapid access to enhanced primary dental care would reduce the need for onward referral to specialist paediatric dental services, whilst also stabilising the oral health of children who require more complex management in specialist services. A formative evaluation of the phase one pilot implementation of the CFDP Scheme has demonstrated the potential of the CFDP Scheme to improve access to dental services for paediatric patients referred from their General Dental Practitioner. Comparison of waiting times between the CFDP pathway and the standard paediatric dental referral pathway have revealed substantially reduced waiting times to access care along the CFDP pathway, while less than 30% of those who attended CFDPs required onward referral to specialist paediatric dental services. Encouragingly, similar attendance and treatment completion rates were noted among patients from all levels of socio-economic deprivation, reducing concerns regarding the potential for service-based interventions to increase oral health inequalities. Following successful completion of the phase one pilot implementation and evaluation, the CFDP Scheme has now been rolled out across all localities in Greater Manchester as part of a second phase pilot implementation. Public Health Competencies; Equitable healthcare provision, Partnership working, Evidence-based public health, Systems thinking, Transformational commissioning, Healthcare evaluation.

Who are the 10%? Characteristics of the populations and communities receiving fluoridated water in England.

OBJECTIVES: In England, around 10% of the population receive optimally fluoridated water. This coverage has evolved through a combination of historical local decision-making and natural geography, rather than being strategically targeted at the national level. It is important to understand if the current distribution is equitable according to indicators of oral health need and to identify any population-level differences in socio-demographic characteristics that could introduce bias to studies evaluating the effectiveness of water fluoridation. BASIC RESEARCH DESIGN: Descriptive analysis comparing the census characteristics of populations that received optimally fluoridated (=/⟩ 0.7 mg F/L) and non-fluoridated water (⟨0.7 mg F/L) between 2009 and 2020. RESULTS: Populations receiving fluoridated water between 2009-2020 were on average slightly younger, more urban, more deprived, with lower education levels, higher unemployment and lower car and home ownership than the populations who received non-fluoridated water. They are more ethnically diverse, with a higher proportion of Asian ethnicity and a lower proportion of White ethnicity, compared to the non-fluoridated population. DISCUSSION: This descriptive analysis provides evidence that water fluoridation coverage within England is targeted reasonably equitably in relation to population-level indicators of need. It also confirms the need to consider the impact of underlying differences in age, deprivation, rurality, and ethnicity when evaluating the impact of water fluoridation on health outcomes in England.

Good mid- to long-term results of the cemented oxford phase 3 unicompartmental knee arthroplasty in a non-designer centre.

PURPOSE: Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment to TKA in isolated medial compartment osteoarthritis providing better functional outcomes and faster recovery in the short term. Our aim was to quantify revision rates, predictors of revision, mortality rate and functionality of the Oxford Phase 3 UKA in a non-designer institution. METHODS: This was a retrospective review of prospectively collected regional registry data. All Oxford Phase 3 UKAs performed for medial tibio-femoral osteoarthritis of the knee joint were included from a single academic institution between the period of January 1st 2006 and December 30th 2009. Kaplan-Meier survivorship curves adjusting for loss to follow-up and deceased patients were generated. Primary outcome variables included all-cause and aseptic revision. Secondary outcome variables included functional outcome scores. Patients were reviewed at 6 months, 2 years, 5 years, 10 years and 15 years. RESULTS: A total of 64 cemented Oxford phase 3 UKAs were performed between January 2006 and November 2009. Fifteen-year follow-up data were available for 51 patients, of these 12 required revision. Survival rates, adjusting for patients that were either lost to follow-up or deceased, were 87.5% at 5 years, 81.4% at 10 years and 76.4% at 15 years. The overall aseptic revision rate at the time of review was 18.75% (n = 12). The only significant predictor of postoperative WOMAC score at 15 years was the preoperative WOMAC score (p = 0.03). CONCLUSION: The Oxford Phase 3 UKA for medial tibio-femoral arthritis has promising outcomes at 15-year follow-up with a survival rate of 76.4% in a non-designer centre. LEVEL OF EVIDENCE: III.

Opportunities for Education in Heart Failure Pharmacotherapy Demonstrated by a Survey of Clinicians.

Aim We conducted a survey of practitioners' knowledge of the clinical application of the major drug classes in HF, with reference to the European Society of Cardiology guidelines. The aim was to identify areas for practice development through education, which may improve HF morbidity and mortality. Methods We distributed a 14 item questionnaire assessing doctors knowledge of indications and contraindications for the major HF drug classes. Results Total number of responses was 127: Intern (N=21), SHO (N=64), Registrar (N=12), SpR (N=14), Consultant (N=4), GP (N=2). Consultants and GPs were excluded from analysis due to underrepresentation. Median years of practice was 4. Indications were correctly identified in a mean of 78% of responses overall. Of participants who felt comfortable with initiation and up-titration of beta blockers (N=84), only 31% (N=26) correctly identified an optimal target heart rate of less than 70 beats per minute. Forty-five percent (N=50) identified serum potassium and creatinine concentrations generally considered safe as contraindications to the initiation of MRA. Twenty-five percent of respondents (N=28) were unaware of a specialist HF service that catered to their institution, and how to refer to it, but 99% (N=110) felt that their practice would benefit from further education on HF pharmacotherapy. Conclusion Results of this survey suggest a need, and indeed a demand, for further education for clinicians in order to reduce mortality, morbidity, and hospital readmission in HF, as well as their attendant costs.

Gender disparities operate in opposite directions for hospitalizations and mortality among individuals receiving long-term ART in rural Uganda.

OBJECTIVES: We conducted an analysis to determine if differences in health-seeking behaviour can explain gender disparities in mortality among long-term survivors receiving antiretroviral therapy (ART) in rural Uganda. METHODS: From June 2012 to January 2014, we enrolled patients receiving a first-line ART regimen for at least 4 years without previous viral load (VL) testing in Jinja, Uganda. We measured HIV VL at study entry. We switched participants to second-line therapy, if VL was ≥ 1000 copies/mL on two measurements, and followed participants for 3 years. We collected clinical and behavioural data at enrolment and every 6 months after that. We used Poisson regression to examine factors associated with hospitalizations and Cox proportional hazards modelling to assess mortality to September 2016. RESULTS: We enrolled 616 participants (75.3% female), with a median age of 44 years and a median duration of ART use of 6 years. Of these, 113 (18.3%) had VLs ≥ 1000 copies/mL. Hospitalizations occurred in 101 participants (7% of men vs. 20% of women; P < 0.001). A total of 22 (3.6%) deaths occurred, 9% of men vs. 2% of women (P < 0.001). Multivariate modelling revealed that mortality was associated with age [adjusted hazard ratio (AHR) = 1.07 per year increase; 95% confidence interval (CI): 1.01-1.13], male gender (AHR = 2.57; 95% CI 1.06-6.23) and time-updated CD4 counts (AHR = 0.67 per 100 cell increment; 95% CI: 0.52-0.88). Virological failure was not associated with mortality (P = 0.762). CONCLUSION: Female patients receiving ART in rural Uganda were three times more likely to be hospitalized than men, but male mortality was nearly four times higher. Facilitating care for acute medical problems may help to improve survival among male ART patients.

Insight into the chemistry of TNT during shock compression through ultrafast absorption spectroscopies.

Thin films of trinitrotoluene (TNT) were shock compressed using the ultrafast laser shock apparatus at Los Alamos National Laboratory. Visible (VIS) and mid-infrared (MIR) transient absorption spectroscopies were simultaneously performed to probe for electronic and vibrational changes during shock compression of TNT. Three shock pressures (16 GPa, 33 GPa, and 45 GPa) were selected to observe no reaction, incipient reaction, and strongly developed reactions for TNT within the experimental time scale of <250 ps. Negligible absorption changes in MIR or VIS absorptions were observed at 16 GPa. At 33 GPa, MIR absorptions in the 3000 cm-1-4000 cm-1 range were observed to increase during the shock and continue to increase during the rarefaction, in contrast to the VIS absorption measurements, which increased during the shock and almost fully recovered during rarefaction. At 45 GPa, both VIS and MIR absorptions were strong and irreversible. The intense and spectrally broad MIR absorptions were attributed to short lived intermediates with strong, spectrally broad absorptions that dominate the spectral response. The MIR and VIS absorption changes observed at 33 GPa and 45 GPa were credited to shock induced chemistry, most likely including the formation of a very broad hydrogenic stretch feature. The results from these experiments are consistent with the chemical mechanisms that include O-H or N-H formation such as CH3 oxidation or C-N homolysis.

Describing motivation for health and treatment decisions and communication choices of calf-care workers on western United States dairies.

On large dairy farms, animal health assessments and treatments are made by farm employees. Little is known about how employees make decisions about illness detection or treatment, information critical to improving antimicrobial stewardship. The objectives of this study were to describe calf-care employee motivations for decisions associated with preweaned calf health and treatments, describe on-farm worker communication networks, and determine information sources used by these employees to support their decisions. Personal interviews were conducted with 103 calf-care employees on 28 farms in the western United States. The interview consisted of 10 motivation source type (MST) questions and questions about training, communication and educational opportunities. A latent class analysis created a summary for MST and resulted in 4 classes. Forty-three percent of calf-care employees fell into a class where responses were a combination of internal and intrinsic (personal beliefs or values and task fulfillment, respectively) and 23% were a combination of internal and goal internal (aligned with organizational goals). This latter class aligned health decisions with internal motivation and treatment decisions with goal internal. A network analysis summarized dominant communication relationships and established that feeders and treaters perceived more communication with supervisors than was reciprocated by supervisors, and that there was less communication between workers and management for tasks relative to daily work. Employee training was primarily done by herdsman, calf manager, or coworkers, and information for skill improvement and problem solving was sought from these individuals. Although veterinarians were not often involved in employee training, when they were involved, employees were likely to use them as an information source for skill improvement and problem solving. Few participants had ever used social media, but almost all had a device that could access the internet; more than 60% indicated interest in a social media platform for work-related information. Work motivation for many calf caretakers appeared to be sourced from personal beliefs, values, and job fulfillment, particularly when deciding to treat a sick calf. Investigation and incorporation of beliefs and values in training programs could help with alignment of protocols with actual treatment and further efforts to implement judicious use of antimicrobials.

The majority of patients return to athletic activity following biceps tenodesis.

PURPOSE: Biceps tenodesis is widely used as a primary treatment for long head of the biceps brachii pathology and superior labral anterior and posterior (SLAP) lesions. However, rates and timing of full return to sports (RTSs)/duty have not been systematically analysed. This systematic review examines the literature to ascertain the rate and timing of return to athletic activity, and the availability of specific criteria for safe return to atheletic activity following the biceps tenodesis. METHODS: Based on PRISMA guidelines, this systematic review utilised the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to athletic activity following biceps tenodesis. Statistical analysis was performed using SPSS. RESULTS: This review identified 17 studies including 374 cases meeting the inclusion criteria. The majority of patients were men 260 (69.7%), with an median age of 42.2 years (range 16-88) and a mean follow-up of 37.4 months. The overall rate of RTS was 217/269 (80.7%), with 43/59 (72.9%) returning to the same level. In overhead athletes, the overall rate of return to play was 39/49 (79.6%). Among military personnel, the overall rate of return to duty was 61/74 (82.4%). The average time to RTS was 5.4 (range 3-11) months. 10 (58.8%) Studies reported a recommended time window within which patients were allowed to return to full activity. Specific criteria for return to play were not reported in any of the identified studies. CONCLUSION: While overall rate of return to athletic activity was reportedly high following biceps tenodesis, one in four patients were not able to resume athletic activity at the same level. At present, there is no objective assessment of when patients can return to full activity reported in the literature. LEVEL OF EVIDENCE: IV.

Lack of effectiveness of adherence counselling in reversing virological failure among patients on long-term antiretroviral therapy in rural Uganda.

OBJECTIVES: The current World Health Organization and Uganda Ministry of Health HIV treatment guidelines recommend that asymptomatic patients who have a viral load (VL) ≥ 1000 HIV-1 RNA copies/mL should receive adherence counselling and repeat VL testing before switching to second-line therapy. We evaluated the effectiveness of this strategy in a large HIV treatment programme of The AIDS Support Organisation Jinja in Jinja, Uganda. METHODS: We measured the HIV VL at enrolment, and for participants with VL ≥ 1000 copies/mL we informed them of their result, offered enhanced adherence counselling and repeated the VL measurement after 3 months. All blood samples with VL ≥ 1000 copies/mL were sequenced in the polymerase (pol) region, a 1257-bp fragment spanning the protease and reverse transcriptase genes. RESULTS: One thousand and ninety-one participants were enrolled in the study; 74.7% were female and the median age was 44 years [interquartile range (IQR) 39-50 years]. The median time on antiretroviral therapy (ART) at enrolment was 6.75 years (IQR 5.3-7.6 years) and the median CD4 cell count was 494 cells/µL (IQR 351-691 cells/µL). A total of 113 participants (10.4%) had VLs ≥ 1000 copies/mL and were informed of the VL result and its implications and given adherence counselling. Of these 113 participants, 102 completed 3 months of follow-up and 93 (91%) still had VLs ≥ 1000 copies/mL. We successfully genotyped HIV for 105 patients (93%) and found that 103 (98%) had at least one mutation: eight (7.6%) had only one mutation, 94 (89.5%) had two mutations and one sample (1%) had three mutations. CONCLUSIONS: In this study, enhanced adherence counselling was not effective in reversing virologically defined treatment failure for patients on long-term ART who had not previously had a VL test.

Insight into the Chemistry of PETN Under Shock Compression Through Ultrafast Broadband Mid-Infrared Absorption Spectroscopy.

Thin films of pentaerythritol tetranitrate (PETN) were shock compressed using the laser driven shock apparatus at Los Alamos National Laboratory (LANL). Two spectroscopic probes were available to this apparatus: visible white light transient absorption spectroscopy (VIS) from 400 to 700 nm and mid-infrared transient absorption spectroscopy (MIR) from 1150 to 3800 cm-1. Important PETN vibrational modes are the symmetric and antisymmetric NO2 stretches at 1280 and 1650 cm-1, respectively, as well as CH stretches at ∼2900 cm-1. Shock strength was varied from approximately 3 to 55 GPa to span from the chemically unreactive regime to the regime in which fast chemical reaction took place on the 250 ps time scale of the measurements. VIS and MIR results suggest irreversible chemistry was induced in PETN at pressures above 30 GPa. At lower shock pressures, the spectroscopy showed minimal changes attributable to pressure induced effects. Under the higher-pressure reactive conditions, the frequency region at the antisymmetric NO2 stretch mode had a significantly increased absorption while the region around the symmetric NO2 stretch did not. No observable increased absorption occurred in the higher frequency regions where CH-, NH-, and OH- bond absorptions would be observed. A broad absorption appeared on the shoulder at the red-edge of the CO2 vibrational band around 2200 cm-1. In addition to the experiments, reactive molecular dynamics were carried out under equivalent shock conditions to correlate the evolution of the infrared spectrum to molecular processes. The simulations show results consistent to experiments up to 30 GPa but suggest that NO and NO2 related features provided the strongest contributions to the shocked infrared changes. Proposed mechanisms for shocked PETN chemistry are analyzed as consistent or inconsistent with the data presented here. Our experimental data suggests C≡O or N2O bond formation, nitrite formation, and absence of significant hydroxyl or amine concentrations in the initial chemistry steps in PETN shocked above 30 GPa.

A meta-synthesis of women's experiences of online forums for maternal mental illness and stigma.

Perinatal mental illness affects 15% of women; however, only half of these women access treatment. Some women with untreated perinatal mental illness may continue to suffer with mental illness after the perinatal period. Evidence suggests that one barrier to accessing treatment is stigma. Forums may provide an acceptable place for women to converse about the stigmatised symptoms of maternal mental illness. Reducing stigma may increase treatment uptake. This study aimed to review and synthesise the qualitative research on maternal mental illness forums and stigma so that stigma can be addressed and treatment improved. A meta-synthesis was conducted to describe and interpret qualitative studies regarding forum use and maternal mental illness stigma. A systematic search of seven electronic databases and Google Scholar was performed. Additional references were collected through screening references of the identified studies. Five studies were identified that reported women's experiences of online forums for maternal mental illness and stigma. The synthesis identified four key themes: (1) a safe place to talk; (2) virtual support; (3) stigma and identity; and (4) repair of the mother identity. Stigma maybe reduced by forum discourse that reconceptualises what is to be a "good mother" and separates stigma and maternal identity. This synthesis provides a novel and more detailed framework for the stigma of maternal mental illness and forum use. This suggests forums may enable women to explore their dual identity and repair their maternal identity, and this may reduce stigma. Healthcare providers could discuss forum use with their clients.

Consensus recommendations on calf- and herd-level passive immunity in dairy calves in the United States.

Passive immunity in calves is evaluated or quantified by measuring serum or plasma IgG or serum total protein within the first 7 d of age. While these measurements inform about circulating concentrations of this important protein, they are also a proxy for evaluating all of the additional benefits of colostral ingestion. The current individual calf standard for categorizing dairy calves with successful passive transfer or failure of passive transfer of immunity are based on serum IgG concentrations of ≥10 and <10 g/L, respectively. This cutoff was based on higher mortality rates in calves with serum IgG <10 g/L. Mortality rates have decreased since 1991, but the percentage of calves with morbidity events has not changed over the same time period. Almost 90% of calves sampled in the USDA National Animal Health Monitoring System's Dairy 2014 study had successful passive immunity based on the dichotomous standard. Based on these observations, a group of calf experts were assembled to evaluate current data and determine if changes to the passive immunity standards were necessary to reduce morbidity and possibly mortality. In addition to the USDA National Animal Health Monitoring System's Dairy 2014 study, other peer-reviewed publications and personal experience were used to identify and evaluate potential standards. Four options were evaluated based on the observed statistical differences between categories. The proposed standard includes 4 serum IgG categories: excellent, good, fair, and poor with serum IgG levels of ≥25.0, 18.0-24.9, 10.0-17.9, and <10 g/L, respectively. At the herd level, we propose an achievable standard of >40, 30, 20, and <10% of calves in the excellent, good, fair, and poor categories, respectively. Because serum IgG concentrations are not practical for on-farm implementation, we provide corresponding serum total protein and %Brix values for use on farm. With one-third of heifer calves in 2014 already meeting the goal of ≥25 g/L serum IgG at 24 h of life, this achievable standard will require more refinement of colostrum management programs on many dairy farms. Implementation of the proposed standard should further reduce the risk of both mortality and morbidity in preweaned dairy calves, improving overall calf health and welfare.

A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults.

BACKGROUND: Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses the effectiveness of biofeedback therapy for dyssynergic defaecation using global clinical improvement as the primary outcome, and resolution of the dyssynergic pattern on anorectal physiology and quality of life as secondary outcomes. METHODS: MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Scopus, and Web of Science were searched from inception to March 2019 using a predefined strategy. Randomised controlled trials of adult patients with dyssynergic defaecation and a biofeedback treatment arm were eligible for review. Studies including patients with secondary forms of constipation were excluded. Data abstraction and risk of bias assessments were conducted by consensus between two authors. RESULTS: Eleven trials including 725 participants were included in the narrative review. Sixty-three percent of patients treated with biofeedback reported clinical improvement. Six studies included in the meta-analysis showed biofeedback superior to non-biofeedback therapy for the primary outcome (OR 3.63, CI 1.10-11.93, p = 0.03). Heterogeneity between trials and overall risk of bias was high. CONCLUSIONS: Biofeedback therapy is recommended for patients referred to tertiary units with dyssynergic defaecation who fail conservative therapy. Future research should be directed towards identifying validated outcomes and the optimum method for delivering biofeedback therapy. Home biofeedback therapy may improve accessibility and recruitment to future clinical trials.

Cosmetic benefits of a novel biomimetic lamellar formulation containing niacinamide in healthy females with oily, blemish-prone skin in a randomized proof-of-concept study.

OBJECTIVE: A randomized study was designed to evaluate the potential cosmetic benefit of a biomimetic, niacinamide-containing moisturizing cream in oily, blemish-prone skin. METHODS: Healthy adult women with oily, blemish-prone skin were randomized to one of three treatment groups: test, control, or positive control. In the test group, subjects used the test product (containing 4% niacinamide), plus the standard cleanser (Simple® Kind to Skin Moisturizing Facial Wash). In the control group, subjects received no moisturizer but used the standard cleanser. In the positive control group, subjects used Vivatinell Acnecinamide® Gel Cream (containing 4% niacinamide) as a moisturizer and Neutrogena Visibly Clear® Spot Clearing Facial Wash (containing 2% salicylic acid) as a cleanser. The positive control regimen was included to provide a comparison for estimates of effect size. The primary objective was to evaluate skin moisturization as a change from baseline in corneometer values at 8 h for the test regimen vs. the control regimen. Analysis of covariance was applied for the primary efficacy analysis. RESULTS: A total of 132 subjects were randomized with 44 included in each treatment group. A significant difference was observed in the primary endpoint for the test regimen compared with the control regimen (least-squares mean difference [95% CI]: 3.12 [0.68, 5.56], P = 0.0128). A trend was observed in favour of the positive control regimen compared with the control regimen. Secondary measurements of moisturization supported the primary efficacy outcome. Assessment of blemishes showed a significant difference between the test regimen vs. the control regimen for change from baseline in mean total blemish count at Week 8 (least-squares mean difference [95% CI]: -1.80 [-3.41, -0.19], P = 0.0290). No statistical comparisons between the positive control group and the test group were performed. CONCLUSION: This study provides proof-of-concept evidence that a novel lamellar lipid moisturizer containing niacinamide, in combination with a standard cleanser, can help moisturize the skin and provide an overall improvement in the complexion appearance of people with blemish-prone skin. STUDY REGISTRATION: NCT03093181.

OBJECTIF: Une étude randomisée a été conçue pour évaluer le bénéfice cosmétique potentiel d'une crème hydratante biomimétique contenant du niacinamide sur une peau grasse sujette aux imperfections. MÉTHODES: Des femmes adultes en bonne santé, à peau grasse sujette aux imperfections, ont été randomisées dans l'un des trois groupes de traitement : test, témoin ou témoin positif. Dans le groupe test, les sujets ont utilisé le produit testé (contenant 4 % de niacinamide), plus le nettoyant standard (Nettoyant visage Simple® doux pour la peau). Dans le groupe témoin, les sujets n'ont reçu aucune crème hydratante mais ont utilisé le nettoyant standard. Dans le groupe témoin positif, les sujets ont utilisé le gel crème Vivatinell Acnecinamide® (contenant 4 % de niacinamide) comme crème hydratante et le nettoyant visage pour réduire les imperfections Neutrogena Visibly Clear® (contenant 2 % d'acide salicylique) comme nettoyant. Le schéma de traitement du groupe témoin positif était inclus pour fournir une comparaison des estimations de la taille de l'effet. L'objectif principal était d'évaluer l'hydratation de la peau par le changement par rapport à la référence des valeurs du cornéomètre à 8 h pour le schéma de traitement testé par rapport au schéma de traitement témoin. Une analyse de covariance a été appliquée pour l'analyse de l'efficacité primaire. RÉSULTATS: Un total de 132 sujets ont été randomisés, dont 44 inclus dans chaque groupe de traitement. Une différence significative a été observée dans le critère d'évaluation principal en faveur du schéma de traitement testé par rapport au schéma de traitement témoin (différence moyenne des moindres carrés [IC à 95 %] : 3,12 [0,68, 5,56], P = 0,0128). Une tendance a été observée en faveur du schéma de traitement témoin positif par rapport au schéma de traitement témoin. Les mesures secondaires de l'hydratation ont appuyé le résultat principal d'efficacité. L'évaluation des imperfections a montré une différence significative entre le schéma de traitement testé par rapport au schéma de traitement témoin en ce qui concerne le changement par rapport à la référence dans le nombre moyen total d'imperfections à la semaine 8 (différence moyenne des moindres carrés [IC à 95 %] : _1,80 [_3,41, _0,19], P = 0,0290). Aucune comparaison statistique entre le groupe témoin positif et le groupe test n'a été réalisée. CONCLUSION: Cette étude fournit des éléments de preuve de concept qu'une nouvelle crème hydratante lipidique lamellaire à base de niacinamide, en association avec un nettoyant standard, peut permettre d'hydrater la peau et fournir une amélioration globale de l'aspect du teint chez des personnes dont la peau est sujette aux imperfections. Numéro d'enregistrement de l'étude : NCT03093181.