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ghtened surveillance using laboratory screening will allow detection in children with unrecognized SARS-CoV-2 infection.

In this case series study, inapparent infections in children may have been associated with silent COVID-19 transmission in the community. Heightened surveillance using laboratory screening will allow detection in children with unrecognized SARS-CoV-2 infection.Dermatology programs seeking osteopathic recognition under the new single graduate medical education (GME) accreditation system are required to demonstrate osteopathic competencies within their teaching curriculum. Although the Accreditation Council for Graduate Medical Education has put forth guidelines to obtain osteopathic recognition, ambiguity lingers regarding specialty-specific content that would fulfill these requirements. To date, there are no set curriculum guidelines addressing osteopathic principles within the field of dermatology. In this article, we review the existing literature surrounding key competencies and propose a dermatology-focused educational model, "DERMS (Direct, Empathy, Restore, Mobilize, Senses) DO 5," to encourage the teaching of osteopathic competencies within GME training programs. Our proposed curriculum model addresses the 5 osteopathic care models and applications of osteopathic manipulative treatment within the realistic realm of dermatology.Knowledge of target features can guide attention in many conjunction searches in a top-down manner. For example, in search of a red vertical line among blue vertical and red horizontal lines, observers can guide attention toward all red items and all vertical items. In typical conjunction searches, distractors often form perceptually vivid, categorical groups of identical objects. This could favor the efficient search via guidance of attention to these "segmentable" groups. Can attention be guided if the distractors are not neatly segmentable (e.g., if colors vary continuously from red through purple to blue)? We tested search for conjunctions of color × orientation (Experiments 1, 3, 4, 5) or length × orientation (Experiment 2). In segmentable conditions, distractors could form two clear groups (e.g., blue steep and red flat). In non-segmentable conditions, distractors varied smoothly from red to blue and/or steep to flat; thus, discouraging grouping and increasing overall heterogeneity. We found that the efficiency of conjunction search was reasonably high and unaffected by segmentability. The same lack of segmentability had a detrimental effect on feature search (Experiment 4) and on conjunction search, if target information was limited to one feature (e.g., find the odd item in the red set, "subset search," Experiment 3). Guidance in conjunction search may not require grouping and segmentation cues that are very important in other tasks like texture discrimination. Our results support an idea of simultaneous, parallel top-down guidance by multiple features and argue against models suggesting sequential guidance by each feature in turn.A normally sighted person can see a grating of 30 cycles per degree or higher, but spatial frequencies needed for motion perception are much lower than that. It is unknown for natural images with a wide spectrum how all the visible spatial frequencies contribute to motion speed perception. In this work, we studied the effect of spatial frequency content on motion speed estimation for sequences of natural and stochastic pixel images by simulating different visual conditions, including normal vision, low vision (low-pass filtering), and complementary vision (high-pass filtering at the same cutoff frequencies of the corresponding low-vision conditions) conditions. Speed was computed using a biological motion energy-based computational model. In natural sequences, there was no difference in speed estimation error between normal vision and low vision conditions, but it was significantly higher for complementary vision conditions (containing only high-frequency components) at higher speeds. In stochastic sequences that had a flat frequency distribution, the error in normal vision condition was significantly larger compared with low vision conditions at high speeds. On the contrary, such a detrimental effect on speed estimation accuracy was not found for low spatial frequencies. The simulation results were consistent with the motion direction detection task performed by human observers viewing stochastic sequences. Together, these results (i) reiterate the importance of low frequencies in motion perception, and (ii) indicate that high frequencies may be detrimental for speed estimation when low frequency content is weak or not present.

The 2014 publication of the Society of Surgical Oncology-American Society for Radiation Oncology (SSO-ASTRO) Consensus Guideline on Margins for Breast-Conserving Surgery recommended a negative margin definition of no ink on tumor. Adoption of this guideline would represent a major change in surgical practice that could lower the rates of reoperation.

To assess changes in reoperation rates after publication of the SSO-ASTRO guideline.

A systematic search of Embase, PREMEDLINE, Evidence-Based Medicine Reviews, Scopus, and Web of Science for biomedical literature published from January 2014 to July 2019 was performed. This search was supplemented by web searches and manual searching of conference abstracts.

Included studies compared the reoperation rates in preguideline vs postguideline cohorts (actual change), retrospectively applied the SSO-ASTRO guideline to a preguideline cohort (projected change), or described the economic outcomes of the guideline.

Study characteristics and reoperation rates wereideline adoption between centers. These early outcomes may be conservative estimates of longer-term implications.

Current indications for Medicare beneficiaries to receive a cochlear implant are outdated. Multichannel cochlear implant systems may be effective when provided to Medicare beneficiaries using expanded indications.

To examine the effectiveness of cochlear implants, as measured by improvement on the AzBio Sentence Test, for newly implanted Medicare beneficiaries who meet the expanded indications of an AzBio Sentence Test score of 41% to 60% in their best-aided condition.

A multicenter nonrandomized trial examined preoperative and postoperative speech recognition, telephone communication, hearing device benefit, health utility, and quality of life for 34 participants enrolled at 8 different centers who received a cochlear implant between September 17, 2014, and July 10, 2018. All participants were 65 years or older, had bilateral moderate to profound hearing loss, and had a best-aided preoperative AzBio Sentence Test score in quiet of 41% to 60%. Analysis was performed on an intention-to-treat basis. Statition. This outcome represents a median change of 36% (range, -22% to 75%) for the best-aided condition (lower bound of 1-sided 95% CI, 31%) and a median change of 53% (range, -15% to 93%) for the cochlear implant-alone condition (lower bound of 1-sided 95% CI, 45%).

Intervention with a cochlear implant was associated with improved sentence, word, and telephone recognition in adult Medicare beneficiaries whose preoperative AzBio Sentence Test scores were between 41% and 60%. These findings support expansion of the Center for Medicare & Medicaid current indications for cochlear implants.

ClinicalTrials.gov Identifier NCT02075229.

ClinicalTrials.gov Identifier NCT02075229.Skeletal muscle atrophy in the aged causes loss in muscle mass and functions. Naturally occurring antioxidant flavonoid apigenin is able to ameliorate obesity- and denervation-induced muscle atrophies, but its effects on age-related muscle atrophy remain unknown. We hypothesized that apigenin can relieve muscle atrophy in aged mice, probably through special effects on reactive oxygen species and enzymes with antioxidant functions. For the male mice of the study, apigenin showed significant dose-dependent effects in relieving aging-related muscle atrophy according to results of frailty index as indicator of frailty associated with aging, grip strength, and running distance. Apigenin also improved myofiber size and morphological features and increased mitochondria number and volume, as manifested by succinate dehydrogenase staining and transmission electron microscopy. Our tests also suggested that apigenin promoted activities of enzymes such as superoxide dismutase and glutathione peroxidase for antioxidation and those for aerobic respiration such as mitochondrial respiratory enzyme complexes I, II, and IV, increased ATP, and enhanced expression of genes such as peroxisome proliferator-activated receptor-γ coactivator 1α, mitochondrial transcription factor A, nuclear respiratory factor-1, and ATP5B involved in mitochondrial biogenesis. The data also suggested that apigenin inhibited Bcl-2/adenovirus E1B 19kD-interacting protein 3 and DNA fragmentation as indicators of mitophagy and apoptosis in aged mice with skeletal muscle atrophy. Together, the results suggest that apigenin relieves age-related skeletal muscle atrophy through reducing oxidative stress and inhibiting hyperactive autophagy and apoptosis.Aging is the greatest risk factor for most chronic diseases. The somatotropic axis is one of most conserved biological pathways that regulates aging across species. 17α-estradiol (17α-E2), a diastereomer of 17β-estradiol (17β-E2), was recently found to elicit health benefits, including improved insulin-sensitivity, and extend longevity exclusively in male mice. Given that 17β-E2 is known to modulate somatotropic signaling in females through actions in the pituitary and liver, we hypothesized that 17α-E2 may be modulating the somatotropic axis in males, thereby contributing to health benefits. Herein, we demonstrate that 17α-E2 increases hepatic IGF1 production in male mice without inducing any changes in pulsatile GH secretion. Using growth hormone receptor knockout (GHRKO) mice, we subsequently determined that the induction of hepatic IGF1 by 17α-E2 is dependent upon GH signaling in male mice, and that 17α-E2 elicits no effects on IGF1 production in female mice. We also determined that 17α-E2 failed to feminize the hepatic transcriptional profile in normal (N) male mice, as evidenced by a clear divergence between the sexes, regardless of treatment. Conversely, significant overlap in transcriptional profiles was observed between sexes in GHRKO mice, and this was unaffected by 17α-E2 treatment. Based on these findings, we propose that 17α-E2 acts as a pleiotropic pathway modulator in male mice by uncoupling IGF1 production from insulin sensitivity. In summary, 17α-E2 treatment upregulates IGF1 production in wild-type (and N) male mice in what appears to be a GH-dependent fashion, while no effects in female IGF1 production are observed following 17α-E2 treatment.

The purpose of this study was to investigate the association between fundus autofluorescence (FAF) and visual field (VF) sensitivities in eyes with retinitis pigmentosa (RP). We also investigated the model we developed to predict VF sensitivity using the FAF ring and its prediction accuracy.

The training dataset consisted of 51 eyes of 28 patients, and the testing dataset consisted of 42 eyes of 25 patients with RP. VF and FAF measurements were conducted using the Humphrey Field Analyzer (HFA) 10-2 test and Optos. The HFA 10-2 test was divided into three sectors according to the association with the FAF (IN, ON, and OUT). Moreover, concentric curves were drawn at 1-degree intervals outside the FAF ring and OUT was divided into six sectors (from OUT1 to OUT6 toward the periphery). Finally, the total deviation (TD) value was predicted using age and visual acuity (VA) in the whole field, and each of the eight sectors was compared.

The TD value decreased significantly from IN, ON, and then toward OUT6. The absolute prediction error with the FAF ring (average, 7.