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Forty-five (32%) programs had a protocol for oxygen prescription during exercise training. Conclusion While monitoring of SpO2 during exercise testing and using supplemental oxygen during testing and training is common in Australian pulmonary rehabilitation programs, few programs had a protocol in place for the prescription of supplemental oxygen for people with COPD who were not on long-term oxygen therapy. This may be due to lack of strong evidence to support the use of supplemental oxygen during exercise training.This report describes the fabrication of a custom healing stent for second stage implant surgery in advanced jaw reconstruction. Postoperative computed tomography data and digital dental implant component libraries were used to create a custom healing stent to fit connected implant abutments without the need for a definitive abutment impression. After segmentation of the dental implants and importation into computer-aided design software, the appropriate digital implant componentry was aligned to the dental implants. The healing stent was then virtually designed, rapid prototyped, and then converted into a biocompatible and sterilizable material by using conventional laboratory methods. The methods presented offer clinicians the opportunity to insert a healing stent at second stage implant surgery with no need to create a stent or obtain an impression during the procedure.Statement of problem The fit of a 3D printed surgical template will directly influence the accuracy of guided implant surgery. Various 3D printing technologies are currently available with different levels of resolution and printing accuracy; however, how the different systems affect accuracy is unclear. Purpose The purpose of this in vitro study was to assess the effect of using various 3D printers for the fabrication of implant surgical templates and its effect on the definitive implant position compared with the planned implant position. Material and methods A cone beam computed tomography scan from a partially edentulous patient and an extraoral digital scan of a dental cast obtained from the same patient were used. The digital imaging and communications in medicine and standard tessellation language (STL) files were imported to an implant planning software and merged, and an implant was digitally positioned in the mandibular right first molar region. A surgical template was designed and exported as an STe median and interquartile range for the angle deviation (degrees) were 1.30 (0.62) for SLA; 1.15 (1.23) for Polyjet; and 1.10 (0.65) for Multijet. No statistically significant differences were found in the angular deviation among groups (χ2(2)=3.08, P=.21). The median and interquartile range for the entry offset and apex offset (mm) were 0.19 (0.16) and 0.36 (0.16) for SLA, respectively; 0.20 (0.13) and 0.34 (0.26) for Polyjet, respectively; and 0.23 (0.10) and 0.32 (0.08) for Multijet, respectively. Similarly, nonsignificant differences were found for entry point offset (χ2(2)=0.13, P=.94) and apex offset (χ2(2)=1.08, P=.58). Conclusions The different types of 3D printing technology used in this study did not appear to have a significant effect on the accuracy of guided implant surgery.Introduction N-methyl-d-aspartate receptor antibody (NMDAR-Ab) encephalitis consensus criteria has recently been defined. We aimed to examine the prevalence of NMDAR-Ab encephalitis in patients with first episode psychosis (FEP) and treatment resistant schizophrenia (TRS) on clozapine, using clinical investigations, antibody testing and to retrospectively apply diagnostic consensus criteria. Methods Adult (18-65 years old) cases of FEP meeting inclusion criteria were recruited over three years and assessed using the Structured Clinical Interview for DSM-IV disorders (SCID). NMDAR-Ab was identified using a live cell-based assay (L-CBA). Seropositive cases were clinically investigated for features of encephalitis including neuro-imaging, EEG and CSF where possible. Serum was retested using immunohistochemistry (IHC) as part of diagnostic criteria guidelines. A cohort of patients with TRS was also recruited. Results 112 FEP patients were recruited over 3 years. NMDAR-Ab seroprevalence was 4/112 (3.5%) cases. One case ( less then 1%) was diagnosed with definite NMDAR-Ab encephalitis and treated with immunotherapy. One of the three other seropositive cases met criteria for probable encephalitis. However all three were ultimately diagnosed with mood disorders with psychotic features. None have developed neurological features at three year follow up. 1/100 (1%) of patients with TRS was 100 patients with TRS were recruited. One case (1%) seropositive for NMDAR-Ab but did not meet criteria for encephalitis. Conclusions NMDAR-Ab encephalitis as defined by consensus guidelines occured rarely in psychiatric services in this study. Further studies are needed to establish pathogenicity of serum NMDAR-Ab antibodies. Psychiatric services should be aware of the clinical features of encephalitis.While people with serious mental illness (SMI) endorse clinical pain at rates on par or exceeding those in the general population, the association between pain and functioning remains unclear. In this paper we present data on the cross-sectional association between clinical pain and global functioning in a large, mixed diagnostic sample of people with SMI. Eight-hundred ninety-eight people diagnosed with bipolar disorder, major depressive disorder, or schizophrenia were administered the Global Assessment Scale and the 12-item Short Form Survey, which includes an assessment of the extent to which the experience of pain interfered with daily activities over the past month. People with major depressive disorder reported higher pain interference than those with schizophrenia and bipolar disorder. The presence of physical health conditions and psychiatric symptoms were also assessed. After controlling for age, gender, psychiatric symptoms, education level, and physical health problems, pain interference in the past month was associated with significantly lower global functioning. The findings suggest that the experience of pain is associated with poorer global functioning across major SMI diagnoses. Moreover, the impact of pain in global functioning appears independent of physical health problems, and thus may warrant routine screening from mental health providers.Human ratings of conceptual disorganization, poverty of content, referential cohesion and illogical thinking have been shown to predict psychosis onset in prospective clinical high risk (CHR) cohort studies. The potential value of linguistic biomarkers has been significantly magnified, however, by recent advances in natural language processing (NLP) and machine learning (ML). Such methodologies allow for the rapid and objective measurement of language features, many of which are not easily recognized by human raters. Here we review the key findings on language production disturbance in psychosis. We also describe recent advances in the computational methods used to analyze language data, including methods for the automatic measurement of discourse coherence, syntactic complexity, poverty of content, referential coherence, and metaphorical language. Linguistic biomarkers of psychosis risk are now undergoing cross-validation, with attention to harmonization of methods. Future directions in extended CHR networks include studies of sources of variance, and combination with other promising biomarkers of psychosis risk, such as cognitive and sensory processing impairments likely to be related to language. Implications for the broader study of social communication, including reciprocal prosody, face expression and gesture, are discussed.Deprescribing aims to reduce polypharmacy, especially in the elderly population, in order to maintain or improve quality of life, reduce harm from medications, and limit healthcare expenditure. Coronavirus disease (COVID-19) is an infectious disease that has led to a pandemic and has changed the lives many throughout the world. The mode of transmission of this virus is from person to person through the transfer of respiratory droplets. Therefore, non-essential healthcare services involving direct patient interactions, including deprescribing, has been on hiatus to reduce spread. Barriers to deprescribing before the pandemic include patient and system related factors, such as resistance to change, patient's knowledge deficit about deprescribing, lack of alternatives for treatment of disease, uncoordinated delivery of health services, prescriber's attitudes and/or experience, limited availability of guidelines for deprescribing, and lack of evidence on preventative therapy. Some of these barriers can be mitigatng virtually. These initiatives should involve teaching elderly patients how to use technology to access health services and with technical support in place to address any concerns.Background As a result of the COVID-19 pandemic, there has been a significant disruption of the practice of pharmacy. Importantly, in many parts of the world, this disruption occurred literally overnight, requiring pharmacists to demonstrate significant adaptability and resiliency in order to manage continuing and in some cases expanding needs of patients. Objectives The objective of this research was to characterize how community pharmacy in Ontario (Canada) responded to the COVID-19 pandemic of winter/spring 2020, in particular in understanding what factors may influence or predict resiliency of individual practitioners and their workplaces. Methods One-on-one interviews mediated through technology (Microsoft Teams) were used, following a semi-structured interview protocol. Verbatim transcripts were produced and analyzed by two independent researchers, using an inductive coding process to identify and characterize themes. Results A total of 21 pharmacists participated in this study. Six themes were identified a) use of and comfort with technology; b) early adoption of corporate and professional guidance; c) workplaces that emphasized task-focus rather than multi-tasking were more resilient; d) scheduling methods and practices in the workplace are important for personal resilience; e) dedicated specialty staff allowed pharmacists to focus on their work; and f) provision of personal protective equipment was essential. Conclusions Traditionally, resilience in professional practice has been characterized as a personal, not a workplace, issue. This study suggests that personal resiliency for pharmacists requires substantial workplace support; further work in this area is required to better understand how pharmacists adapt to complex and difficult situations such as pandemics.Introduction Since the beginning of the 2020 Sars-CoV-2 Italian outbreak, healthcare workers have been among the most exposed categories. There is little information about community pharmacists' on occupational exposure, symptoms development, and testing practices in the community pharmacist cohort. Methods Between April 30th and May 10th, a questionnaire was administered through social media to Italian community pharmacists. From 67000 pharmacists currently working in community pharmacies, 1632 answered the survey. Results The survey population reflected the general Italian community pharmacists population in terms of age, gender, and number of co-workers. Protective measures were adopted in up to 99.9% of pharmacies. 624 pharmacists (38.2%) developed at least one COVID-19 related symptom in the period between February 28th and May 10th. Also, 102 pharmacists (6.2%) were tested for COVID-19 and 15, the 15% of the tested population and 0.92% of the whole survey population, resulted positive on nasopharyngeal swab. However, while the number of symptomatic pharmacists decreased, a higher number of tests were performed, thus COVID-19 prevalence among community pharmacists could have been underestimated and is probably intermediate between other healthcare workers and the general population (0.31%). Conclusion Community pharmacists have probably been one of the first categories to experience increased contact risk to SARS-CoV-2. COVID-19 prevalence among pharmacists could have been underestimated. In addition, the rates of protection measures adoption might have helped to reduce the spread of COVID-19 among co-workers and the community.Background and objective Articular cartilage (AC) is always affected in any joint with osteoarthritis. Ultrasound can be a useful tool in monitoring changes in the AC. The purpose of the present study is to ultrasound measure the thickness of the AC in the distal femur in young students and determine its relationship with body mass index (BMI), muscle mass, body fat and sports practice. Materials and methods An observational cross-sectional study was conducted with healthy volunteers, between 15 and 25 years old. Anthropometric data were collected and the thickness of the femoral cartilage of the knee was measured at 5 points. In addition, the percentage of muscle and body fat was measured in a subgroup. Results 100 subjects were included in the study. The average age was 20 years (± 2.5). The average BMI was 23 kg/m2 (± 3.1). AC was thicker in men and sportsmen, versus women and sedentary people, with a statistically significant difference. When comparing BMI with AC thickness no significant relationship was found; however, only 2 participants had BMI > 30. Conclusions Cartilage thickness has a direct relationship with the percentage of muscle, and inversely with the percentage of fat. BMI is not a good parameter when evaluating the dynamic behaviour of cartilage in non-obese youths.Rationale and objectives The use of chest computed tomography (CT) in the era of the COVID-19 pandemic raises concern regarding the transmission risks to patients and staff caused by CT room contamination. Meanwhile the Center for Disease Control guidance for air exchange in between patients may heavily impact workflows. To design a portable custom isolation device to reduce imaging equipment contamination during a pandemic. Materials and methods Center for Disease Control air exchange guidelines and requirements were reviewed. Device functional requirements were outlined and designed. Engineering requirements were reviewed. Methods of practice and risk mitigation plans were outlined including donning and doffing procedures and failure modes. Cost impact was assessed in terms of CT patient throughput. Results CT air exchange solutions and alternatives were reviewed. Multiple isolation bag device designs were considered. Several designs were custom fabricated, prototyped and reduced to practice. A final design was tested on volunteers for comfort, test-fit, air seal, and breathability. Less than 14 times enhanced patient throughput was estimated, in an ideal setting, which could more than counterbalance the cost of the device itself. Conclusion A novel isolation bag device is feasible for use in CT and might facilitate containment and reduce contamination in radiology departments during the COVID Pandemic.Rationale and objectives To develop classification and regression models interpreting tumor characteristics obtained from structural (T1w and T2w) magnetic resonance imaging (MRI) data for early detection of dendritic cell (DC) vaccine treatment effects and prediction of long-term outcomes for LSL-KrasG12D; LSL-Trp53R172H; Pdx-1-Cre (KPC) transgenic mice model of pancreatic ductal adenocarcinoma. Materials and methods Eight mice were treated with DC vaccine for 3 weeks while eight KPC mice were used as untreated control subjects. The reproducibility of the computed 264 features was evaluated using the intraclass correlation coefficient. Key variables were determined using a three-step feature selection approach. Support vector machines classifiers were generated to differentiate treatment-related changes on tumor tissue following first- and third weeks of the DC vaccine therapy. The multivariable regression models were generated to predict overall survival (OS) and histological tumor markers of KPC mice using quantitative features. Results The quantitative features computed from T1w MRI data have better reproducibility than T2w MRI features. The KPC mice in treatment and control groups were differentiated with a longitudinally increasing accuracy (first- and third weeks 87.5% and 93.75%). The linear regression model generated with five features of T1w MRI data predicted OS with a root-mean-squared error (RMSE) less then 6 days. The proposed multivariate regression models predicted histological tumor markers with relative error less then 2.5% for fibrosis percentage (RMSE 0.414), CK19+ area (RMSE 0.027), and Ki67+ cells (RMSE 0.190). Conclusion Our results demonstrated that proposed models generated with quantitative MRI features can be used to detect early treatment-related changes in tumor tissue and predict OS of KPC mice following DC vaccination.State of the art Theater actors are a high risk group for developing voice disorders. Aims The first purpose of this study was to examine and compare the objective and subjective vocal quality between professional theater actors, non-professional theater actors and a control group of professional dancers. Secondly, the impact of one theater performance on the objective and subjective vocal quality was investigated within and between the groups. It is hypothesized that actors will experience vocal fatigue and a deteriorated vocal quality compared with dancers as a result of the vocal load during the performance. Dancers will face more general fatigue and smaller vocal changes due to the impact of a performance including stress, decompensation and physical fatigue. Methods Recordings of 27 professional actors, 19 non-professional actors and 16 professional dancers were collected before and after a performance using the PRAAT software. Voice samples included sustained vowel phonation, continuous speech, aerodyna-professionals. Dancers' vocal quality is worse than actors. The results show no impact of one performance on the vocal quality in theater actors and dancers. The long-term impact of performing, however, is subject for further research.First humanoid coronavirus was discovered in the middle of 1960s, the class of viruses are considered to be a huge threat. The first onset of human coronavirus, SARS (SARS-CoV) appeared in 2003 which spanned five continents having lethal effects on human population accompanied by The Middle East Respiratory Syndrome Coronavirus in 2012 with a death rate of 35%. The viruses remain a threat till date and are of serious concern since no vaccine or specified drug therapy has been approbated for treating human coronaviruses. The viruses became a pandemic worldwide with the emergence of Wuhan coronavirus (2019-nCoV). SARS-CoV2 viral manifestation poses a serious human life risk by causing acute lung injury and various respiratory outcomes and has become a global concern. High pathogenicity and transmission rate of the viral strain has become the spotlight of research community throughout the world. With the ongoing studies on viral structure and host interactions, the intricacy of the viral proteome structure and replication cycle proposes a need to explore our understanding of host factors playing role in viral multiplication cycle. This review provides insight into our prevalent perception of coronavirus-host interactions, structure of SARS-CoV2, receptor mediated entry of virus inside the human cells, ongoing clinical trials, drug therapies and treatments that are being used to combat COVID-19 targeting viral fusion, replication and its multiplication.Research conducted on exercise in the heat has been largely conducted in males, leaving women understudied. Of research including women, results are inconsistent on the impact of menstrual cycle phase on thermoregulation. Objectives The purpose of this systematic review is to quantify published investigations in thermal physiology that include menstrual cycle comparisons and assess aggregate data of investigations that include menstrual cycle variation and aerobic exercise in the heat. Methods 367 research articles were identified via systematic review and inclusion criteria and yielded 9 papers included in this analysis for a total number of 83 research subjects. Effect size estimates (Hedge's g) were utilized for initial (pre-exercise) and post-exercise internal body temperature (rectal or esophageal, Tint), sweat rate, mean skin temperature, and exercise heart rate. Results Pooled effect size showed significantly greater initial Tint (1.231±0.186, p less then 0.01) and post-exercise Tint (0.455±0.153, p less then 0.01) in the luteal compared to follicular phases. No significant differences were present in mean skin temperature, sweat rate, or exercise heart rate across menstrual phases in analyses of aggregate data. Conclusions The limited available data suggest that observed increases in initial Tint in the luteal phase are maintained throughout and post-exercise without an observed impact in sweat rate or mean skin temperature.Objectives To determine the incidence of, and risk factors for, race-day jockey falls occurring in Thoroughbred flat and jumps (hurdle and steeplechase) racing. Design Retrospective cohort study. Methods Incidence rates for race-day jockey falls over 14 racing seasons in New Zealand (n=421,596 race-day starts) were calculated per 1000 rides. Univariable and multivariable analyses of jockey, horse and race level risk factors were conducted with Poisson regression in a generalized linear mixed model. Results Most races (97%, n=407,948 race starts) were flat racing with 10 races/race-day, whilst most jumps races were longer and had 2 races/race-day. The rate of jockey falls was higher in steeplechase racing (99.9/1000, 95% CI 92.2-108.4) than hurdle (53.2/1000, 95% CI 48.7-58.3) and flat racing (1.2/1000, 95% CI 1.1-1.3, p less then 0.001). Experienced athletes (both horse and jockey) had lower IRR. In flat racing, IRR increased linearly with the number of race-day rides by the jockey. In jumps races, IRR increased with a fall in a previous race (IRR 1.5/1000, 95% CI 1.3-1.7, p less then 0.001). A shorter jumps race distance reduced the IRR of a jockey fall. Conclusions Athlete experience was associated with risk of jockey falls. The linearity of race ride number with IRR and longer distance in jumps racing, indicated that cognitive or physiological fatigue may play a role in the risk of a race-day fall. This data highlights the role sport-specific conditioning programmes may have on reducing risk.Objective Myxomas are rare benign mesenchymal soft tissue tumors that seldom affect the head and neck area. The present report describes a rare case of intramuscular myxoma of the oral cavity and briefly reviews the literature regarding the occurrence of these lesions in the maxillofacial area. Study design A 59-year-old patient was referred for the development of a slow-growing tumefaction in the right buccal mucosa in the previous 12 months. Magnetic resonance imaging was performed to characterize the lesion's dimensions and its relationship with the surrounding structures, and it revealed intramuscular localization in correspondence with the medial pterygoid muscle. Incisional biopsy was carried out to aid in the final diagnosis. Results Histology revealed the presence of an intramuscular myxoma, characterized by discontinuous margins and locally infiltrating muscular fibers. A second surgery was performed to totally remove the lesion. Follow-up at 6 months did not show any signs of recurrence. A literature search was performed to retrieve data on the incidence of oral intramuscular myxomas. Conclusions To the best of our knowledge, this is the first case of intramuscular myxoma of the medial pterygoid muscle reported in the literature. Although rarely encountered, intramuscular myxomas should be considered when performing differential diagnoses of soft tissue masses at the level of the masticatory muscles.Objective The aim of this study was to highlight the current underestimation of the role of alcohol in facial fracture etiology and patients' daily life. Study design A prospective cross-sectional study was conducted. Alcohol consumption habits were evaluated, and data were collected through a constructed questionnaire and interview. Case-related data collection was performed, with the primary predictor variables being mechanism of injury; fracture type; and associated injury (any). Outcome variables were alcohol involved in injury (yes/no) and heavy alcohol use (yes/no). The explanatory variables were gender and age. Descriptive and bivariate statistics were computed, and the P value was set at .05. Results In total, 166 patients were included in the study. Of these, 55% of patients reported being under the influence of alcohol when they sustained the injury. Alcohol was involved most often among male patients (P = .0006) and in the younger age groups (P less then .0001). Of the study patients, 17% reported heavy alcohol use. The majority of the interpersonal violence events had taken place under the influence of alcohol (84%; P less then .0001). Conclusions The role of alcohol in facial fracture etiology is significant. A brief intervention for alcohol abuse should be included routinely in patient care to identify and, if necessary, address this problem.Cochlear implant has progressively become an essential treatment for profound hearing loss. The aim of this historical note is to briefly review the very beginnings of this technique, in 1973, with the production of a painting entitled "Mechanical ear" and the first international congress on cochlear implants. In a way, these two events marked the beginning of an antagonism that played a very important role in the development and especially the acceptance of cochlear implants in the multicultural society of the late twentieth century.Anaplasma ovis, the causative agent of ovine anaplasmosis in tropical and subtropical countries, is a tick-borne obligatory intraerythrocytic bacterium of sheep, goats and wild ruminants. In Tunisia, data about the molecular phylogeny and the genetic diversity of A. ovis isolates are limited to the analysis of msp4 and groEL genes. The aim of this study was to genetic characterize 40 A. ovis isolates infecting 28 goats, 10 sheep, one camel and one Rhipicephalus turanicus tick located in different geographic regions of Tunisia on the basis of 3 partial genes (gltA, groEL and msp1a). Sequence analysis revealed 6 and 17 different genotypes in the partial gltA and groEL genes, respectively. Phylogenetic analysis revealed, as expected for the groEL gene, that sequences from small ruminants and their infesting ticks clustered separately from those isolated from camels. The analysis of amino-acid Msp1a sequences identified 18 novel genotypes of Msp1a repeats from 20 A. ovis isolates. These Msp1a repeats were highly variable with 33-47 amino-acids, and the number of repeats is one for 19 isolates infecting 18 goats and one R. turanicus tick, and 4 for a single isolate found in one sheep. Phylogenetic trees based on Msp1a partial sequences revealed that the N-terminal region of Msp1a protein appear to be relatively more informative phylogeographically compared to other markers especially according to countries. The presented data give a more detailed knowledge regarding the molecular phylogeny and the genetic diversity of A. ovis isolates occurring in different animal species and their associated ticks in Tunisia.Objective To explore the perspectives of the decision makers and community members in primary health care (PHC) around the conceptualization of social participation (PS). Design An exploratory cross-sectional study with qualitative methodology. Location Health Centers of the Metropolitan Region (RM), Santiago, Chile. Participants Eight informants from the management level (group 1), 13 from execution level in PHC (group 2), 28 community members and four community agents of health (group 3). Method Interviews and discussion groups were conducted, which were recorded and transcribed. The organization and analysis of the data was done with Atlas.ti 8.1. The narratives were systematized using a thematic analysis. All the documents were codified, and we hold periodic meetings to review the existing codes, as well as discussing the inclusion of new codes. Results Group 1 refers to a more theoretical conception of PS. Group 2 expresses more concrete and operative dimensions. Group 3 indicates that PS is embodied in particular personal experiences. Groups 1 and 3 have more than one notion of social participation in health. Conclusions An institutional conception of participation prevails transversally, rooted since the 1990s. At the community level, the narratives take the form of collective practices lived around the improvement of the quality of community life mediated by the level of execution.Background The present study aimed to report a full overview of the incidence and epidemiology of foot fractures. Method Population-based epidemiological cohort study including all foot fractures over 5 years. All patient charts and radiology were manually assessed. Results A total of 4938 patients sustained 5912 foot fractures during the study period. Patients' mean age at the time of fracture was 36.1 (21.7 SD) years. The overall incidence of foot fractures was 142.3/100,000/year. The hind foot incidence was 13.7/100,000/year, the mid foot incidence 6.5/100,000/year, and the fore foot incidence 123.9/100,000/year. The most common mode of injury was due to low energy trauma (98.7%). Conclusion This study shows an overall incidence of foot fractures to be 142.3/100,000/year. The hind foot incidence is 13.7/100,000/year, the mid foot incidence 6.5/100,000/year, and the fore foot incidence 123.9/100,000/year.Background Hallux valgus is bilateral in up to 84 % of cases. In the setting of simultaneous bilateral correction, we aim to evaluate if minimally invasive percutaneous surgery (MIS) provides any advantage compared to conventional open surgery. Methods 52 feet (26 patients) undergoing simultaneous bilateral MIS surgery were matched by severity of deformity to 52 feet (26 patients) undergoing simultaneous conventional open surgery. Patients were followed for a minimum of six months. Pre- and post-operative radiographs and clinical records were reviewed. Results There were no significant differences in pre-operative function or pain between both groups. Post-operatively, the mean hallux valgus angle (HVA) was significantly lower in the MIS group. (HVA MIS - 8.6; Open - 11.8, P = 0.013). There were no significant differences in post-operative outcome and patient satisfaction between both groups. Conclusion This study demonstrates that simultaneous bilateral MIS hallux valgus surgery can be considered for patients with bilateral symptomatic hallux valgus.Background The number of liver transplantations is increasing worldwide, and Brazil ranks in the second position. It has one of the biggest public health care systems, which is responsible for the coordination and financial funding of transplantation procedures. Meeting the demands of such a large system of transplantation has become a challenge, particularly when attempting to minimize costs of scarce and expensive resources. The aim of this study was to investigate the process of donation, the retrieval of organs, and the transplantation itself using engineering methods based on logistics analyses. Methods Three steps were used study planning, data gathering, and data analysis. Researchers surveyed professionals to acquire raw information based on their observations, experience, and knowledge. Then, a data analysis was conducted, putting together all the information gathered during the previous steps. Bias was removed, and conflicting perceptions were resolved in order to have a standard view on the transplantation process. Results Data was gathered between 2014 and 2018 and included 5502 liver donors and 2678 (48.7%) patients who received liver transplants organs. A total of 2824 organs were refused because of logistics issues (transport and handling). Interviews of health care professionals enabled the design of a process map in which 4 stakeholders were identified patient, physician, organ, and information. Conclusions The liver transplantation process is analyzed based on a supply chain methodology applying this knowledge and putting together medical and engineering sciences to promote better efficiency and outcomes for the transplantation program. Future studies should focus on the implementation of these ideas aiming to promote optimization gains in any step of the process.Objective The objective of this study was to analyze the effects of obesity on postoperative complications and patient and graft survival after kidney transplantation. Methods We retrospectively included 506 patients who received a kidney transplant in our center during eleven years. Obesity was defined by a body mass index ≥ 30 kg/m2 based on World Health Organization criteria. Using univariate and multivariate analyses, we evaluated the impact of obesity on surgical complications according to the Clavien-Dindo classification up to 30 days after surgery. The impact of obesity on graft and patient survival was assessed using a Cox proportional regression model. Results Seventy-one patients were obese (14%), and mean follow-up was 63.1 months (59.7-66.5). By multivariable analysis, obesity was associated with delayed graft function (hazard ratio [HR] = 2.60 [1.31-5.02], P = .004). Obesity was not associated with surgical complications, but cardiovascular history was (HR = 1.68 [1.09-2.99], P = .048). By Cox regression analysis, obesity was significantly associated with a higher risk of graft loss (HR = 1.55 [1.06-2.99], P = .042) but not with patient survival (HR = 1.82 [0.88-3.79], P = .106). Conclusion Obesity was associated with delayed graft function and graft loss. However, it was not associated with surgical complications. Kidney transplantation remains the best therapy for obese patients suffering from end-stage renal disease, despite shorter graft survival.Background Respiratory complications of solid organ transplant (SOT) are a diagnostic and therapeutic challenge when requiring intensive care unit (ICU) admission. We aimed at describing this challenge in a prospective cohort of SOT recipients admitted in the ICU. Methods In this post hoc analysis of an international cohort of immunocompromised patients admitted in the ICU for an acute respiratory failure, we analyzed all SOT recipients and compared their severity, etiologic diagnosis, prognosis, and outcome according to the performance of an invasive diagnostic strategy (encompassing a fiber-optic bronchoscopy and bronchoalveolar lavage), the type of transplanted organ, and the need of invasive ventilation at day 1. Results Among 1611 patients included in the primary study, 142 were SOT recipients (kidney, n = 73; 51.4%; lung, n = 33; 23.2%; liver, n = 29; 20.4%; heart, n = 7; 4.9%). Lung transplant recipients were younger than other SOT recipients, and severity did not differ across type of received organ. An invasive diagnostic strategy was more frequently performed in lung transplant recipients with a trend toward a higher rate of bacterial etiology in lung than kidney transplant recipients. Overall ICU survival of SOT recipients was 75.4%. Invasive diagnostic strategy, type of transplanted organ, and need of invasive mechanical ventilation at day 1 did not affect ICU prognosis. Conclusions ICU management of hypoxemic acute respiratory failure in SOT recipients translated into a low ICU mortality rate, whatever the transplanted organ or the acute respiratory failure cause. The post-ICU burden of acute respiratory failure SOT recipients remains to be investigated.Poland's Central Unrelated Potential Bone Marrow Donor and Cord Blood Registry (CBMDR Poltransplant) was established in 2011. Affiliated with the World Marrow Donor Association (WMDA) as PL5, the CBMDR is an internationally recognized hematopoietic stem cell donor registry with a large, high-quality donor database. Overall, Polish resources in this domain are the second largest in Europe and the fourth largest in the world, accounting for 4.8% of the WMDA Register of over 33.5 million records. In the last 10 years, the number of potential hematopoietic stem cell donors registered in Poland has increased more than 10-fold, from about 146,000 to 1,579,809 at the end of 2018. Such a growing number of donors in the CBMDR is contributing to an increase in overall numbers of donor searches in Polish databases, as well as in donations from Polish donors.In an effort to be more inclusive and embrace the international cytology community, the American Society of Cytopathology formed the International Liaison and Membership (ILM). The Worldvision Cytopathology Contest was designed by the co-chairs of this committee (Drs. Güliz A. Barkan and Esther Diana Rossi) as an opportunity of scientific exchange in the international cytology community. The idea took its inspiration from the well-known song contest, the "Eurovision Song Contest" a competition among international singers, which started as a "light entertainment" in the 1950's to bring together a war-torn Europe. The goals of this session were to bring the worldwide cytology community together, to increase the international participation to the ASC, to attract a younger generation of pathology professionals to cytopathology, to provide education on interesting cases for the participants, and to provide training for international contestants on how to give good public presentations. The contest was successfully done at the 2019 annual meeting, and the winner was Dr. Elena Vigliar from Italy. The Worldvision Cytopathology Contest will be performed again in future meetings.Introduction Small biopsies and cytology specimens have become increasingly important for clinical trials and biomarker testing. Thus, institutions must ensure that adequate lesional material meeting the specifications for a multitude of different protocols is available. This can be achieved using rapid on-site evaluation (ROSE). The aim of the present study was to determine the recent clinical trial biopsy characteristics and study the feedback on these collections at our institution. Materials and methods Clinical trial biopsies performed at our institution and trial feedback (including "queries") were analyzed from the 2017 to 2019. The query data were reviewed in detail, in addition to any protocol modifications related to biopsy requirements and study protocol changes. Results A total of 698 biopsy collections were performed for clinical trial purposes for 95 trials, with most requiring biopsies at >1 time point (63.2%), for phase I or II trials (92.6%), and for specific tumor types (67.4%). Only 18 of the trials (18.9%) requiring fresh tissue biopsies provided feedback. The feedback included data from 90 cases (12.9%), of which 27 (30.0%) had queries regarding insufficient (n = 10; 37.0%) or borderline (n = 17; 63.0%) tumor tissue. Only 1 (3.7%) of these had had ROSE by cytology. ROSE was performed in accordance with institutional guidelines (45.3%), as required by the study (1.1%), or because of trial modification (5.3%). Conclusions The present investigation has shown the high volume of clinical trial biopsies managed at our academic cancer center. Feedback from the trials was low at 18.9% and frequently involved suboptimal cases without ROSE used at acquisition. This has led to more widespread adoption of ROSE to mitigate insufficient biopsy specimens and repeat procedures. The high volume of clinical trial biopsies and variability in trial needs necessitates a collaborative multidisciplinary network, including cytology services, to facilitate these important biopsies for patients with cancer.Purpose To find an appropriate correlation between the base curve (BC) of rigid gas permeable (RGP) contact lenses and manual keratometry findings in Iranian patients with keratoconus (KCN) in order to simplify the fitting process, reduce the time, and lower the costs. Method This retrospective study was done in 121 eyes of 69 patients with KCN fitted with a specific trial set of RGP contact lenses over a 7-year period. The specifications of the final lens parameters included power, total diameter (1), and BC, the first two of which were fixed in all of the lenses in the trial set while BC was changed in 0.1-mm steps. Javal keratometer was used to measure keratometric values. The final fit assessment was performed based on the standard criterion of "three-point touch". Result Single and multiple linear correlations were done and the result was the following equation BC = 2.455 (constant of the final multiple regression model) + 0.280 (steep keratometry) + 0.368 (flat keratometry) + 0.047 (corneal astigmatism) CONCLUSION The advantages of this study include simplifying the RGP fitting process, reducing the examination time, lowering the costs, enhancing the confidence of the examiners and patients, easier lens fitting in remote places where more advanced devices are not accessible.To examine the role of incomplete blinking in contributing to blink inefficiency, symptoms of dry eye and ocular surface disease. To review methods for diagnosing blink inefficiency (including both reduced overall blink rate and increased incomplete blink rate) and the role of remediation for efficient complete blinking as an essential part of the lacrimal functional unit in maintaining tear homeostasis. Diagnosis and remediation of blink inefficiency appear to have been somewhat misunderstood in the management of dry eye disease. To the extent that a high incomplete blink rate ranks in significance with low blink frequency in contributing to blink inefficiency, measures and remediation of only total blink rate are of reduced usefulness in the diagnosis and treatment of blink inefficiency-related ocular surface exposure, dry eye symptoms and ocular surface disease. In addition, a patient's blink performance during a biomicroscopy or any other clinical assessment of blink efficiency, is unlikely to be characteristic of or relevant to the blink inefficiency that develops and causes symptoms during their various day-to-day activities. There appears to be a strong case for prescribing blink efficiency exercises in the management of many cases of dry eye symptoms and ocular surface disease. Remediation of spontaneous blink inefficiency may require that a motor memory of voluntary complete, rapid, relaxed and natural looking blink formation is established and maintained as the basis for efficient spontaneous blinking. Voluntary forceful blinking may undermine the motor memory of efficient blinking and risk the depletion of any reserves of lipid.The evolutionary healing phenomenon of fractured tibia bone was investigated by comparing the bio-mechanical response of the human tibia following fracture fixation for two ranges of patient ages, when a body weight pressure (BWP) is applied. Three-dimensional finite element models have been developed by adopting the biomechanical characteristics of cortical and trabecular tibia bones, and considering the time-varying callus properties during the healing process for the two patients. The stress and strain levels generated within the fractured tibia bone by the screw tight fit during the assembly process revealed its dependence on the bone stiffness that degrades with age. They have an impact on primary stability of the implants prior to the osseointegration. The gap capacity to resist and allow a gradual BWP load transfer, through the callus for the tibia bone models, was analyzed. In fact, from 10 weeks after surgery, the callus allowed the BWP transfer for young patients, which guarantees sufficient structure stabilization of the fractured tibia. However, an insufficient load was transferred to the fracture gap for the old patient, even beyond 16 weeks, which delayed the bone consolidation.Aspergillus is a fungal genus that strongly affects health of humans, animals, and plants worldwide. Endophytes are now widely considered as a rich source of bioproducts with potential uses in medicine, agriculture, and bioindustry. Cupressaceae plant family hosts a variety of bioactive ascomycetous endophytes. In this study, antifungal activity of a number of such endophytes were investigated against human pathogenic fungi Aspergillus fumigatus and Aspergillus niger. To this end, 16 superior bioactive endophytic fungi from Cupressaceae were used, including Alternaria alternata, Alternaria pellucida, Ascorhizoctonia sp., Aspergillus fumigatus, Aspergillus niger, Aurobasidium sp., Cladosporium porophorum, Fusarium oxysporum, Penicillium viridicatum, Phoma herbarum, Phoma sp., Pyrenochaeta sp., Trichoderma atroviride, Trichoderma atroviride and Trichoderma koningii. In vitro bioassays indicated anti-Asperilli activity of the endophytic fungi in dual cultures. Most notably, Trichoderma koningii CSE32 and Trichod substances, our findings provide new insights into the potential use of Cupressaceae's endophytic fungi in antifungal-based drug discovery programs.With the rapidly changing landscape of the Covid-19 outbreak, how to best address the needs and continue to protect the health and well-being of people with disabilities (PwDs) is a global public health priority. In this commentary we identify three public health areas of ongoing need and offer possible strategies to address each. These areas include the types of data that would help clarify risks for PwDs and help assure their safety long term; the prevention, treatment and mitigation measures for PwDs that are needed through the duration of the outbreak; and the issues of equity in access to and quality of medical care for PwDs. Because of the rapid nature of the public health response, it is critical to reassess and readjust our approach to best address the needs of PwDs in the months and years to come and to incorporate these new practices into future emergency preparedness responses.Objective To assess the efficacy and safety profiles of different dosing regimens of tofacitinib, baricitinib, and upadacitinib, novel selective oral Janus activated kinase inhibitors, in rheumatoid arthritis (RA). Methods Randomized controlled trials of tofacitinib (5 and 10 mg twice daily) baricitinib (2 and 4 mg daily), and upadacitinib (15 and 30 mg daily) in RA were identified from MEDLINE, EMBASE, and Cochrane databases through December 11, 2019. Random-effects models were used to estimate pooled mean differences and relative risks (RRs). American College of Rheumatology 20%, Health Assessment Questionnaire-Disability Index, adverse events, risk for infection, venous thromboembolic events, and malignancy were calculated. Results Twenty trials with an overall low risk of bias involving 8982 patients were identified. Tofacitinib, baricitinib, and upadacitinib improved RA control as determined by American College of Rheumatology 20% (RR, 2.03; 95% CI, 1.87 to 2.20) and Health Assessment Questionnaire-Disability Index scores (mean differences, -0.31; 95% CI, -0.34 to -0.28) compared with placebo. Adverse events were more frequent with upadacitinib, 30 mg, daily (RR, 1.15; 95% CI, 1.02 to 1.30); upadacitinib, 15 mg, daily (RR, 1.14; 95% CI, 1.02 to 1.27); and baricitinib, 4 mg, daily (RR, 1.13; 95% CI, 1.02 to 1.24). The risk for infection was highest with tofacitinib, 10 mg, twice daily (RR, 2.75; 95% CI, 1.72 to 4.41), followed by upadacitinib, 15 mg, daily (RR, 1.35; 95% CI, 1.14 to 1.60) and baricitinib, 4 mg, daily (RR, 1.28; 95% CI, 1.12 to 1.45). Data for venous thromboembolic events were not available for tofacitinib or baricitinib, but there was no increase in risk with upadacitinib (15 mg daily RR, 2.34; 95% CI, 0.34 to 15.92). Conclusion Tofacitinib, baricitinib, and upadacitinib significantly improve RA control. Head-to-head Janus activated kinase inhibitor clinical trials are needed to further inform decision making.Objective To evaluate the effect and safety of acupuncture for the treatment of irritable bowel syndrome (IBS) through comparisons with those of polyethylene glycol (PEG) 4000 and pinaverium bromide. Patients and methods This multicenter randomized controlled trial was conducted at 7 hospitals in China and enrolled participants who met the Rome III diagnostic criteria for IBS between May 3, 2015, and June 29, 2018. Participants were first stratified into constipation-predominant or diarrhea-predominant IBS group. Participants in each group were randomly assigned in a 21 ratio to receive acupuncture (18 sessions) or PEG 4000 (20 g/d, for IBS-C)/pinaverium bromide (150 mg/d, for IBS-D) over a 6-week period, followed by a 12-week follow-up. The primary outcome was change in total IBS-Symptom Severity Score from baseline to week 6. Results Of 531 patients with IBS who were randomized, 519 (344 in the acupuncture group and 175 in the PEG 4000/ pinaverium bromide group) were included in the full analysis set. From baseline to 6 weeks, the total IBS-Symptom Severity Score decreased by 123.51 (95% CI, 116.61 to 130.42) in the acupuncture group and 94.73 (95% CI, 85.03 to 104.43) in the PEG 4000/pinaverium bromide group. The between-group difference was 28.78 (95% CI, 16.84 to 40.72; P less then .001). No participant experienced severe adverse effects. Conclusion Acupuncture may be more effective than PEG 4000 or pinaverium bromide for the treatment of IBS, with effects lasting up to 12 weeks. Trial registration Chinese Clinical Trials Register, ChiCTR-IOR-15006259.Transcatheter aortic valve replacement (TAVR) offers well established benefit for adults with severe aortic stenosis, although applications in the pediatric population remain limited. We describe a case of a 15-year-old male with complex congenital heart disease presenting with cardiogenic shock in the setting of mixed severe aortic stenosis (AS) and severe aortic insufficiency (AI). Self-expanding TAVR was performed via suprasternal approach with robust clinical improvement. At one month follow up, he had resolution of clinical heart failure with improvement in ejection fraction and no symptoms of valvulopathy. To our knowledge, there have been no described cases of suprasternal TAVR in a pediatric patient.Introduction People with schizophrenia have neurocognitive as well as social cognition deficits. Numerous studies have shown impairment in these domains in patients with chronic schizophrenia. However, these disturbances during the early phase of the disease have been less studied. Objective The aim of the study is to explore the Theory of Mind and emotional processing in first-episode patients, compared to healthy subjects. Method 40 patients with a first psychotic episode of less than 5 years' duration, and 40 healthy control subjects matched by age and years of schooling were assessed. The measures of social cognition included 4 stories of false belief, the Reading the Mind in the Eyes Test (RMET) and the Pictures of Facial Affect (POFA) series. Results The patients with a first psychotic episode performed significantly worse in all tasks of social cognition, compared to the healthy controls. The second-order ToM was impaired whereas the first-order ToM was preserved in the patients. Happiness was the emotion most easily identified by both patients and controls.