Endosutured Aneurysm Repair of Abdominal Aortic Aneurysms with Short Necks Achieves Acceptable Midterm Outcomes-Results from the Peru Registry.

BACKGROUND: The study aims to describe midterm outcomes following treatment of infrarenal abdominal aortic aneurysms (AAAs) with short necks by endosutured aneurysm repair using the Heli-FX EndoAnchor system. METHODS: This is a retrospective study of prospectively collected data from 9 vascular surgery departments between June 2010 and December 2019, including treated AAAs with neck lengths ≤10 mm. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each center's practice. There were 2 Groups further assessed according to neck length, A (≥4 and <7 mm) and B (≥7 and ≤10 mm). The main outcomes analyzed were technical success, freedom from type Ia endoleaks (TIaELs), sac size increase, all-cause and aneurysm-related mortality. RESULTS: Seventy-six patients were included in the study, 17 fell into Group A and 59 into Group B. Median follow-up for the cohort was 40.5 (interquartile range 12-61) months. A median of 6 (interquartile range 3) EndoAnchors were deployed in each subject. Technical success was 86.8% for the total group, 82.4% and 88.1% (P = 0.534) for Groups A and B respectively. Six out of 10 (60%) of TIaELs at the completion angiographies showed spontaneous resolution. Cumulative freedom from TIaEL at 3 and 5 years for the total group was 89% and 84% respectively; this was 93% and 74% for Group A and 88% at both intervals in Group B (P = 0.545). In total, there were 7 (9.2%) patients presenting with TIaELs over the entire study period. Two (11.8%) in Group A and 5 (8.5%) in Group B (P = 0.679). There were more patients with sac regression in Group B (Group A = 6-35.3% vs. Group B = 34-57.6%, P = 0.230) with no statistical significance. All-cause mortality was 19 (25%) patients, with no difference (4-23.5% vs. 15-25.4%, P = 0.874) between groups; whereas aneurysm-related mortality occurred in 1 patient from Group A and 3 from Group B. CONCLUSIONS: This study demonstrates reasonable outcomes for patients with short-necked AAAs treated by endosutured aneurysm repair in terms of TIaELs up to 5-year follow-up. EndoAnchor use should be judiciously evaluated in short necks and may be a reasonable option when anatomical constraints are encountered, mainly for those with 7-10 mm neck lengths. Shorter neck length aspects, as indicated by the results from Group A, may be an alternative when no other options are available or feasible.

HELICOBACTER SCREENING OF GRAND CAYMAN BLUE IGUANA (CYCLURA LEWISI) AND NORTH ANTILLEAN SLIDER (TRACHEMYS DECUSSATA ANGUSTA) ON GRAND CAYMAN, CAYMAN ISLANDS.

The endemic Grand Cayman or blue iguana (Cyclura lewisi) is endangered. Beginning in 2015 significant morbidity and mortality occurred in captive and wild blue iguanas within Grand Cayman's Queen Elizabeth II Botanic Park (QEIIBP). Investigation identified a novel Helicobacter sp., provisionally named Helicobacter sp. Grand Cayman Blue Iguana 1 (GCBI1), as the cause. Invasive green iguanas (Iguana iguana) are believed to play a role in GCBI1 transmission to the blue iguana; however, the origin and transmission pathways have not been determined. To assess the likelihood of blue iguanas asymptomatically harboring GCBI1, in May 2022 population-level screening of captive blue iguanas at QEIIBP was conducted on half (n = 102) of the captive blue iguana population (n = 201) including half of each age class. Helicobacter sp. GCBI1 is closely related to a chelonian Helicobacter sp. and 10 sympatric wild north Antillean sliders (Trachemys decussata angusta) were sampled in October 2019. Combined choana/cloacal swabs were screened by a GCBI1-specific quantitative polymerase chain reaction (qPCR) assay. All samples were negative, suggesting that GCBI1 is not present asymptomatically in the captive blue iguana population or in north Antillean sliders. These results provide support for the hypothesis that GCBI1 is periodically introduced to captive and wild blue iguanas from another species or source.

HEMATOLOGIC AND BIOCHEMICAL VALUES OF FREE-RANGING HAWKSBILL SEA TURTLES (ERETMOCHELYS IMBRICATA) IN GLOVER'S REEF, BELIZE.

Blood samples were obtained from the dorsal cervical sinus of free-ranging hawksbill sea turtles (Eretmochelys imbricata) collected at Glover's Reef Marine Reserve, 42 km east of the coast of Belize, for hematology and plasma biochemistry analysis. Unknown sex, subadult turtles (N = 32) were sampled in 2013 (n = 22) and 2017 (n = 10). To provide a more robust data set, parameters that did not have statistically significant differences were pooled and treated as a single population. Eleven hematologic parameters were evaluated; of these, five were pooled. Twenty-three plasma biochemical parameters were evaluated; of these, 15 were pooled. The PCV observed in this study (mean 33.44%) was double that observed in two studies of juvenile hawksbills in Dubai (means 17% and 16%), whereas the total WBC count was half that observed in immature and adult hawksbills sampled in the Galápagos (mean 2.91 × 103 versus 5.3 × 103/µl). Total protein and albumin were lower than regionally similar, adult female hawksbills in Brazil (means 3.36 versus 5.45 g/dl and 0.93 versus 2.11 g/dl, respectively). Globulins were higher (mean 2.43 versus 1.06 and 0.5 g/dl), driving the albumin:globulin ratio lower than that observed in two studies of juvenile hawksbills in Dubai (0.4:1 versus 1.1:1 and 1:1, respectively). These findings represent a geographically distinct population from previous reports, highlight the variability in blood parameters from disparate populations, and reaffirm the vital importance of considering a multitude of variables when interpreting reptilian blood values. The similarities in the majority of values observed in 2013 and 2017 provide confidence in the stability of these parameters in this population.

HEMATOLOGY, PLASMA BIOCHEMISTRY, AND PLASMA PROTEIN ELECTROPHORESIS REFERENCE INTERVALS FOR BLUE IGUANAS (CYCLURA LEWISI) FROM GRAND CAYMAN ISLAND.

The blue iguana (Cyclura lewisi) is an endangered rock iguana species native to Grand Cayman, in the Cayman Islands. Health assessments were conducted on captive and free-roaming iguanas in 2001 and 2003-2014 and were performed in the summer wet season (June-July) of 2003-2004 and 2010-2014 and in the winter dry season (November-December) of 2001 and 2005-2009. Morphometric data were recorded from iguanas when blood samples were collected: 903 samples were collected and data from 890 samples from 775 iguanas were included. Samples were analyzed for hematology, plasma biochemistry, protein electrophoresis, mineral panels, 25-hydroxyvitamin D, and testosterone. Reference intervals were created for captive subadults, captive adults, and free-roaming adults when data were sufficient. Significant differences among these groups were described, as were differences on the basis of sex, season, and origin (captive vs free-roaming). In captive iguanas, most analytes were significantly different between subadults and adults, mature heterophils and copper were significantly higher in the dry season, zinc levels were significantly higher in the wet season, and cholesterol and triglycerides were significantly higher in adult females than adult males. Testosterone in adult males was significantly higher in the dry season. These results will aid in future health assessments and disease investigations in wild and captive populations of blue iguanas and are of comparative value for other Cyclura species that are free-roaming, captive, and, especially, in similar conservation release programs.

Implications of Admission and Surgical Timing on Hospital Length of Stay in Patients with Hip Fractures.

INTRODUCTION: Hospital reimbursements for geriatric hip fractures are contingent on patient outcomes and hospital length of stay (LOS). This study examined if the day of the week (DOTW) and time of day (TOD) of both admission and surgery are associated with increased LOS. METHODS: LOS, time from admission to surgery, DOTW of admission/surgery, TOD of admission/surgery, and demographics were retrospectively collected. The average LOS was 4.5 days. Patients were grouped into cohorts of LOS 1 to 4 days (short-stay) and 5 to 12 days (long-stay). The percentage of short-stay patients was compared with the percentage of long-stay patients for each DOTW/TOD of admission/surgery with chi square tests. RESULTS: One hundred patients were included, 58 short stays and 42 long stays. Both groups were similar regarding demographics. Long-stay patients were 4.2 times more likely to have been admitted ([95% confidence interval 1.2 to 14.6], P = 0.02) and 4.8 times as likely to have undergone surgery ([95% confidence interval 1.0 to 5.6], P = 0.01) on a Thursday, respectively. TOD of admission/surgery did not demonstrate any association with LOS. DISCUSSION: Thursday admission/surgery was associated with longer LOS. Delayed surgical optimization coupled with insurance companies' observance of regular business hours may delay admission to inpatient rehab or skilled nursing facilities, resulting in avoidable healthcare expenditures.

Effect of fremanezumab on quality of life and productivity in patients with chronic migraine.

OBJECTIVE: To evaluate fremanezumab quarterly or monthly vs placebo on health-related quality of life, health status, patients' global impression of change, and productivity in patients with chronic migraine (CM). METHODS: HALO CM was a double-blind, placebo-controlled trial in patients with CM. Patients were randomized 1:1:1 to treatment with fremanezumab quarterly (675 mg at baseline, placebo at weeks 4 and 8), fremanezumab monthly (225 mg at baseline, weeks 4 and 8), or placebo. This article assessed the effect of treatment with fremanezumab on health-related quality of life and productivity using the following prespecified assessments: the Migraine-Specific Quality of Life (MSQoL) questionnaire at baseline and weeks 4, 8, and 12; Patient Global Impression of Change (PGIC) questionnaire at weeks 4, 8, and 12; and EuroQoL 5-dimension, 5-response level (EQ-5D-5L) questionnaire and Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire at baseline and week 12. RESULTS: The full analysis set included 1,121 patients: 375 patients with quarterly dosing, 375 with monthly dosing, and 371 with placebo. Fremanezumab quarterly and monthly was associated with significant improvements over placebo in change from baseline mean scores in MSQoL domains (all, p < 0.05) to week 12. At week 12, fremanezumab also showed significant improvements in EQ-5D-5L visual analog scale (p < 0.05) and PGIC scores (p < 0.0001) as well as significant reductions from baseline in WPAI:GH scores (p < 0.01) and presenteeism (impairment while working; p < 0.05) vs placebo. CONCLUSIONS: Fremanezumab quarterly or monthly was associated with improvement over placebo in migraine-specific quality of life, overall health status, patients' global impression of change with treatment, and productivity in patients with CM. CLINICALTRIALSGOV IDENTIFIER: NCT02621931. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with CM, treatment with fremanezumab quarterly or monthly is associated with improvements in health-related quality of life and productivity.

Tar Spot: An Understudied Disease Threatening Corn Production in the Americas.

Tar spot of corn has been a major foliar disease in several Latin American countries since 1904. In 2015, tar spot was first documented in the United States and has led to significant yield losses of approximately 4.5 million t. Tar spot is caused by an obligate pathogen, Phyllachora maydis, and thus requires a living host to grow and reproduce. Due to its obligate nature, biological and epidemiological studies are limited and impact of disease in corn production has been understudied. Here we present the current literature and gaps in knowledge of tar spot of corn in the Americas, its etiology, distribution, impact and known management strategies as a resource for understanding the pathosystem. This will in tern guide current and future research and aid in the development of effective management strategies for this disease.

PARASITES OF THE BLUE IGUANA (CYCLURA LEWISI) FROM GRAND CAYMAN ISLAND.

Feces (n = 226; 2004-2015) from healthy captive and wild blue iguanas (Cyclura lewisi) from Grand Cayman, Cayman Islands, were examined for endoparasites. Parasites identified included Nyctotherus sp. and Entamoeba sp. cysts and trophozoites, trichomonad trophozoites, and oxyurid and trichostrongylid eggs. Endoparasites from postmortem examinations (n = 13) included adult and larval nematodes: Ozolaimus megatyphlon, Ozolaimus monhystera, Alaeuris travassosi, Atractis mega, and an unidentified species of Oswaldocruzia. Entamoeba spp. were more likely in captive juveniles of both sexes than captive or wild adults of either sex; Entamoeba spp. were more likely in captive adult females than captive adult males; trichomonad trophozoites were more likely in adult captive and wild iguanas of both sexes than in captive juveniles of either sex; and Nyctotherus spp. were more likely in juvenile captive males than captive adult males or females and more likely in adult wild males than captive juvenile males. Trichostrongylid eggs were more likely in adult wild females than adult captive females and more likely in captive and wild adults of both sexes than in captive juveniles of both sexes. Oxyurid eggs were more likely in adult captive and wild iguanas of both sexes than captive juveniles of either sex. Blue iguanas have a variety of endoparasites regardless of age, sex, or captive vs wild status, with no type found exclusively in either captive or wild populations. Ectoparasites from wild adults included adult ticks (Amblyomma torrei) and a single adult mite (Hirstiella trombidiformis). All are new host records for this species and Grand Cayman. Knowledge of parasite status of captive and wild populations is important to evaluate the relative risk of introduction of captive animals into wild populations.

Evaluation of the Combined Effect of Heterodera glycines and Macrophomina phaseolina on Soybean Yield in Naturally Infested Fields with Spatial Regression Analysis and in Greenhouse Studies.

Heterodera glycines, the soybean cyst nematode, and Macrophomina phaseolina, causal agent of charcoal rot, are economically important soybean pathogens. The impact and effect of these pathogens on soybean yield in coinfested fields in the Midwest production region is not known. Both pathogens are soilborne, with spatially aggregated distribution and effects. Spatial regression analysis, therefore, is an appropriate method to account for the spatial dependency in either the dependent variable or regression error term from data produced in fields naturally infested with H. glycines and M. phaseolina. The objectives of this study were twofold: to evaluate the combined effect of H. glycines and M. phaseolina on soybean yield in naturally infested commercial fields with ordinary least squares and spatial regression models; and to evaluate, under environmentally controlled conditions, the combined effect of H. glycines and M. phaseolina through nematode reproduction and plant tissue fungal colonization. Six trials were conducted in fields naturally infested with H. glycines and M. phaseolina in Ohio. Systematic-grid sampling was used to determine the population densities of H. glycines and M. phaseolina, and soybean yield estimates. Though not used in any statistical analysis, M. phaseolina colony forming units from plant tissue, charcoal rot severity, and H. glycines type were also recorded and summarized. In two greenhouse experiments, treatments consisted of H. glycines alone, M. phaseolina alone, and coinfestation of soybean with both pathogens. Moran's I test indicated that the yield from five fields was spatially correlated (P < 0.05) and aggregated. In these fields, to account for spatial dependence, spatial regression models were fitted to the data. Spatial regression analyses revealed a significant interaction effect between H. glycines and M. phaseolina on soybean yield for fields with high initial population densities of both pathogens. In the greenhouse experiments, H. glycines reproduction was significantly (P < 0.05) reduced in the presence of M. phaseolina; however, soybean tissue fungal colonization was not affected by the presence of H. glycines. The direct mechanisms by which H. glycines and M. phaseolina interact were not demonstrated in this study. Future studies must be conducted in the field and greenhouse to better understand this interaction effect.

Health assessment of Conolophus subcristatus, Conolophus pallidus, and C. subcristatus X Amblyrhynchus cristatus hybrid (Galápagos land iguanas).

The land iguanas, Conolophus pallidus and Conolophus subcristatu are large and charismatic lizards endemic to the Galápagos archipelago, but little information exists on their normal health parameters. The former is restricted to Santa Fe island, while C. subcristatus inhabits the islands of the central and western region of the archipelago. Both species are classified as vulnerable by the IUCN Red List of Threatened Species. As part of a population health assessment authorized by the Galápagos National Park, wild adult iguanas from three islands (North Seymour, South Plazas, and Santa Fe) were captured in July 2018. Data from a single C. subcristatus X Amblyrhynchus cristatus hybrid captured on South Plazas is also included. We analyzed blood samples drawn from 52 healthy wild adult land iguanas captured on three islands. An iSTAT portable blood analyzer was used to obtain values for pH, lactate, pO2, pCO2, HCO3-, sO2%, hematocrit, packed cell volume (PCV), hemoglobin Na, K, iCa, and glucose. Standard laboratory hematology techniques were employed for PCV determination; resulting values were also compared to the hematocrit values generated by the iSTAT. Body temperature, heart rate, respiratory rate, and body measurements were also recorded and compared to previously published data for the marine iguana (Amblyrhynchus cristatus), which shares a common ancestor with the land iguana. The data reported here provide preliminary baseline values that may be useful in comparisons between captive and wild populations, between wild populations, and in detecting changes in health status among Galápagos land iguanas affected by anthropogenic threats, climate change, or natural disturbances.

Methods of body temperature assessment in Conolophus subcristatus, Conolophus pallidus (Galápagos land iguanas), and Amblyrhynchus cristatus X C. subcristatus hybrid.

Since cardiovascular, respiratory, and metabolic systems of reptiles are affected by temperature, accurate measurements are of great importance in both captive husbandry and research. Ectothermic animals generally have core body temperatures close to ambient temperature but can differ from the immediate environment if they are using sunlight to thermoregulate. Many zoological facilities and exotic pet caregivers have begun using infrared temperature guns to assess ambient temperatures of reptile enclosures but there are currently few studies assessing the efficacy of these devices for measuring the body temperatures of reptiles. Conolophus subcristatus, Conolophus pallidus (Galápagos land iguanas), and Amblyrhynchus cristatus X C. subcristatus hybrid are robust land iguanas endemic to the Galápagos archipelago. By comparing the infrared body temperature measurements of land iguanas against virtual simultaneous collection of cloacal temperatures obtained using a thermocouple thermometer, we sought to assess the efficacy of this non-invasive method. We found that internal body temperature can be predicted with a high level of accuracy from three external body temperature sites, providing a good non-invasive method that avoids the capture of animals.

PREVALENCE, INCIDENCE, AND IDENTIFICATION OF SALMONELLA ENTERICA FROM WILD AND CAPTIVE GRAND CAYMAN IGUANAS ( CYCLURA LEWISI).

From 2005 to 2017, a total of 334 fresh fecal samples was obtained from 236 captive and free-ranging Grand Cayman iguanas ( Cyclura lewisi) in a captive breeding and release program. One-hundred-sixteen samples were obtained from individual captive iguanas living in enclosures with natural substrate, 161 samples from captive iguanas living in elevated wire-bottom enclosures, and 57 samples from free-ranging wild iguanas. These samples were cultured to isolate subspecies of Salmonella enterica. as part of prerelease health evaluations, and to determine baseline health assessments of captive and wild populations of these iguanas. There was a 5.45% (95% confidence interval [CI]: 1.14-15.12) prevalence of S. enterica in iguanas housed on natural substrate ( n = 51), 3.85% (CI: 1.42-8.19) in iguanas housed in elevated wire-bottom enclosures ( n = 157), and 6.06% (CI: 0.74-20.23) in wild free-ranging iguanas ( n = 38). These results demonstrate no significant difference ( P = 0.73) in S. enterica prevalence among these housing conditions. The incidence of S. enterica from 2005 to 2017 in the population sampled was 4.19% (CI 3.10-5.29). Ten different serotypes of S. enterica were isolated from 14 iguanas. Salmonella enterica ser. Saintpaul was the most frequent isolate. Annual S. enterica prevalence was calculated for iguanas housed in different enclosure types, for free-roaming wild iguanas, and for all cultured iguanas. The highest yearly prevalence was 23.08% (CI: 5.04-53.81) in iguanas tested in 2007 ( n = 21). No Salmonella enterica were cultured in 2005, 2008, 2009, 2010, 2011, 2012, and 2015. These results suggest that the shedding of S. enterica was not significantly different between housing types or between captive versus wild iguanas and therefore that release of captive iguanas did not significantly affect the health of the wild population or their exposure to S. enterica.

Soil analysis in discussions of agricultural feasibility for ancient civilizations: A critical review and reanalysis of the data and debate from Chaco Canyon, New Mexico.

Questions about how archaeological populations obtained basic food supplies are often difficult to answer. The application of specialist techniques from non-archaeological fields typically expands our knowledge base, but can be detrimental to cultural interpretations if employed incorrectly, resulting in problematic datasets and erroneous conclusions not easily caught by the recipient archaeological community. One area where this problem has failed to find resolution is Chaco Canyon, New Mexico, the center of one of the New World's most vibrant ancient civilizations. Discussions of agricultural feasibility and its impact on local population levels at Chaco Canyon have been heavily influenced by studies of soil salinity. A number of researchers have argued that salinized soils severely limited local agricultural production, instead suggesting food was imported from distant sources, specifically the Chuska Mountains. A careful reassessment of existing salinity data as measured by electrical conductivity reveals critical errors in data conversion and presentation that have misrepresented the character of the area's soil and its potential impact on crops. We combine all available electrical conductivity data, including our own, and apply multiple established conversion methods in order to estimate soil salinity values and evaluate their relationship to agricultural productivity potential. Our results show that Chacoan soils display the same salinity ranges and spatial variability as soils in other documented, productive fields in semi-arid areas. Additionally, the proposed large-scale importation of food from the Chuska Mountains region has serious social implications that have not been thoroughly explored. We consider these factors and conclude that the high cost and extreme inflexibility of such a system, in combination with material evidence for local agriculture within Chaco Canyon, make this scenario highly unlikely. Both the soil salinity and archaeological data suggest that there is no justification for precluding the practice of local agriculture within Chaco Canyon.

Stereotactic Radiosurgery for ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-Eligible Spetzler-Martin Grade I and II Arteriovenous Malformations: A Multicenter Study.

OBJECTIVE: ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) found better short-term outcomes after conservative management compared with intervention for unruptured arteriovenous malformations (AVMs). However, because Spetzler-Martin (SM) grade I-II AVMs have the lowest treatment morbidity, sufficient follow-up of these lesions may show a long-term benefit from intervention. The aim of this multicenter, retrospective cohort study is to assess the outcomes after stereotactic radiosurgery (SRS) for ARUBA-eligible SM grade I-II AVMs. METHODS: We pooled SRS data for patients with AVM from 7 institutions and selected ARUBA-eligible SM grade I-II AVMs with ≥12 months follow-up for analysis. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes. RESULTS: The ARUBA-eligible SM grade I-II AVM cohort comprised 232 patients (mean age, 42 years). The mean nidus volume, SRS margin dose, and follow-up duration were 2.1 cm3, 22.5 Gy, and 90.5 months, respectively. The actuarial obliteration rates at 5 and 10 years were 72% and 87%, respectively; annual post-SRS hemorrhage rate was 1.0%; symptomatic and permanent radiation-induced changes occurred in 8% and 1%, respectively; and favorable outcome was achieved in 76%. Favorable outcome was significantly more likely in patients treated with a margin dose >20 Gy (83%) versus ≤20 Gy (62%; P < 0.001). Stroke or death occurred in 10% after SRS. CONCLUSIONS: For ARUBA-eligible SM grade I-II AVMs, long-term SRS outcomes compare favorably with the natural history. SRS should be considered for adult patients harboring unruptured, previously untreated low-grade AVMs with a minimum life expectancy of a decade.

Temporal Dynamics of Soybean Rust Associated With Leaf Area Index in Soybean Cultivars of different Maturity Groups.

Experiments were conducted in Mato Grosso, Brazil, from 2009 to 2011 to evaluate the effects of planting date (October, November, December, and January) on soybean rust (SBR) and leaf area index (LAI) in SBR-susceptible soybean cultivars of different maturity groups (early-maturing, midseason, and late-maturing). Mean relative area under the LAI progress curve (RAULAIPC) was significantly higher (P < 0.05) for the late-maturing than early-maturing and midseason cultivars. The October planting date had significantly higher (P < 0.05) mean RAULAIPC than the December and January planting dates. Mean relative area under the SBR progress curve was significantly lower (P < 0.05) for the late-maturing than the midseason and early-maturing cultivars, and significantly higher (P < 0.05) for the December and January than the October and November planting dates. Based on the logistic population growth model, SBR severity increased over time at a significantly higher mean rate for the early-maturing than the midseason and late-maturing cultivars. It took longer for SBR to reach a certain severity level for the late-maturing cultivar planted in January than the early-maturing cultivar planted in October. This implies that fungicides would need to be applied early to the early-maturing cultivar planted in October to minimize yield loss.

Integrating modern concepts of insomnia and its contemporary treatment into primary care.

Insomnia affects one-third of the adult population. Ten percent of adults surveyed in America consider it a serious problem. Chronic insomnia is associated with poor quality of life and the potential for various psychiatric and medical conditions, notably depression and cardiovascular disease. Since most patients with insomnia are unlikely to disclose obvious sleeping difficulties, the first step in diagnosing and managing patients is having a high index of suspicion in patients with specific complaints, comorbidities, and risk factors. This is followed by a complete evaluation of the patient's medical and physical history to determine if the insomnia is primary or comorbid with another disease. The management of insomnia should consider the extent of impairment associated with the disorder, as well as duration, causes, and comorbidities. In some cases, referral to a specialist is warranted. Recently, there have been new definitions of insomnia proposed; elucidation of the role of orexin-mediated hyperarousal brain neural pathway in the sleep-wake cycle; and new drugs available that target this system. Thus, a review and update for today's primary care physician is warranted.

The association between ownership of common householddevices and obesity and diabetes in high, middle and lowincome countries

Household devices (e.g., television,car, computer) are common in highincome countries, and their use has been linked to obesity and type 2 diabetes mellitus.We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake.We performed a cross sectional analysis using data from the Prospective UrbanRural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels.Ownership of a household deviceincreased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass indexand waist circumference. There was anincreased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32–1.55;diabetes: OR 1.38, 95% CI 1.28–1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequentadjustment for lifestyle factors modestlyattenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29–1.49) and diabetes (OR 1.33, 95% CI 1.23–1.44).When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR1.97, 95% CI 1.53–2.53) and ecreased through country income levels such that we did not detect an association in high income countries...

Weak and strong confinements in prismatic and cylindrical nanostructures.

Cylindrical nanostructures, namely, nanowires and pores, with rectangular and circular cross section are examined using mirror boundary conditions to solve the Schrödinger equation, within the effective mass approximation. The boundary conditions are stated as magnitude equivalence of electron's Ψ function in an arbitrary point inside a three-dimensional quantum well and image point formed by mirror reflection in the walls defining the nanostructure. Thus, two types of boundary conditions - even and odd ones - can be applied, when Ψ functions in a point, and its image, are equated with the same and the opposite signs, correspondingly. In the former case, the Ψ function is non-zero at the boundary, which is the case of a weak confinement. In the latter case, the Ψ function vanishes at the boundary, corresponding to strong quantum confinement. The analytical expressions for energy spectra of electron confined within a nanostructure obtained in the paper show a reasonable agreement with the experimental data without using any fitting parameters.