Early energy analyses of agriculture revealed that behind higher labor and land productivity of industrial farming, there was a decrease in energy returns on energy (EROI) invested, in comparison to more traditional organic agricultural systems. Studies on recent trends show that efficiency gains in production and use of inputs have again somewhat improved energy returns. However, most of these agricultural energy studies have focused only on external inputs at the crop level, concealing the important role of internal biomass flows that livestock and forestry recirculate within agroecosystems. Here, we synthesize the results of 82 farm systems in North America and Europe from 1830 to 2012 that for the first time show the changing energy profiles of agroecosystems, including livestock and forestry, with a multi-EROI approach that accounts for the energy returns on external inputs, on internal biomass reuses, and on all inputs invested. With this historical circular bioeconomic approach, we found a general trend towards much lower external returns, little or no increases in internal returns, and almost no improvement in total returns. This “energy trap” was driven by shifts towards a growing dependence of crop production on fossil-fueled external inputs, much more intensive livestock production based on feed grains, less forestry, and a structural disintegration of agroecosystem components by increasingly linear industrial farm managements. We conclude that overcoming the energy trap requires nature-based solutions to reduce current dependence on fossil-fueled external industrial inputs and increase the circularity and complexity of agroecosystems to provide healthier diets with less animal products.

Abstract Retellings of the Buddha’s life story have animated and sustained Buddhist thought and practice through roughly 2,500 years of history. To this day, Buddhist holidays and rituals are pinned to the arc of his biography, celebrating his birth, awakening, teaching, and final nirvana. Buddhists embody the story when they meditate, and when novices shear their hair, don robes, and ask permission to leave home. His story is the model for hagiographies of exemplary Buddhists to follow, from experiencing a moment of insight akin to the Four Sights, to the experience of tearing themselves away from their families to make a great departure, to a period of searching, to the moment when awakening is finally accomplished. The Buddha’s story is therefore not just the Buddha’s story; it is the story upon which the tradition rests. In this volume, we articulate the Buddha Blueprint, the underlying and foundational pattern that holds the life story of a buddha together. We retell the episodes of Buddha Gautama’s extended life story, keeping in mind the cosmic arc of his narrative. The contributors are all prominent scholars of South Asian texts and traditions who have dedicated their careers to exploring hagiographical materials, each applying their own methodological and theoretical interests to shed new light on the enduring story of Buddhism. Our book, using multiple perspectives, voices, and sources, underscores the multivalent centrality of this story.

Abstract Consider the following classes of pairs consisting of a group and a finite collection of subgroups: • $ \mathcal{C}= \left \{ (G,\mathcal{H}) \mid \text{$\mathcal{H}$ is hyperbolically embedded in $G$} \right \}$ • $ \mathcal{D}= \left \{ (G,\mathcal{H}) \mid \text{the relative Dehn function of $(G,\mathcal{H})$ is well-defined} \right \} .$ Let $G$ be a group that splits as a finite graph of groups such that each vertex group $G_v$ is assigned a finite collection of subgroups $\mathcal{H}_v$ , and each edge group $G_e$ is conjugate to a subgroup of some $H\in \mathcal{H}_v$ if $e$ is adjacent to $v$ . Then there is a finite collection of subgroups $\mathcal{H}$ of $G$ such that 1. If each $(G_v, \mathcal{H}_v)$ is in $\mathcal C$ , then $(G,\mathcal{H})$ is in $\mathcal C$ . 2. If each $(G_v, \mathcal{H}_v)$ is in $\mathcal D$ , then $(G,\mathcal{H})$ is in $\mathcal D$ . 3. For any vertex $v$ and for any $g\in G_v$ , the element $g$ is conjugate to an element in some $Q\in \mathcal{H}_v$ if and only if $g$ is conjugate to an element in some $H\in \mathcal{H}$ . That edge groups are not assumed to be finitely generated and that they do not necessarily belong to a peripheral collection of subgroups of an adjacent vertex are the main differences between this work and previous results in the literature. The method of proof provides lower and upper bounds of the relative Dehn functions in terms of the relative Dehn functions of the vertex groups. These bounds generalize and improve analogous results in the literature.

Molecular testing has been used as an adjunct to morphological evaluation in the workup of thyroid nodules. This study investigated the impact of two gene fusions, RET/PTC and THADA/IGF2BP3, that have been described as oncogenic events in thyroid neoplasms. We performed a retrospective, single-centered study at a McGill University teaching hospital in Montreal, Canada, from January 2016 to August 2021. We included patients who underwent surgery for thyroid nodules that pre-operatively underwent molecular testing showing either RET/PTC or THADA/IGF2BP3 gene fusion. This study included 697 consecutive operated thyroid nodules assessed using molecular testing, of which five had the RET/PTC fusion and seven had the THADA/IGF2BP3 fusion. Of the five nodules in the RET/PTC group, 100% were malignant and presented as Bethesda V/VI. Eighty percent (4/5) were found to have lymph node metastasis. Twenty percent (1/5) had extrathyroidal extensions. Sixty percent (3/5) were a diffuse sclerosing variant of papillary thyroid carcinoma, and the rest were the classical variant. Of the seven THADA/IGF2BP3 nodules, all presented as Bethesda III/IV and 71.4% (5/7) were malignant based on the final pathology analysis, and 28.6% (2/7) were NIFTP. All the THADA/IGF2BP3 fusion malignancies were a follicular variant of papillary thyroid carcinoma. None had lymph node metastasis or displayed extrathyroidal extensions. RET/PTC nodules presented as Bethesda V/VI and potentially had more aggressive features, whereas THADA/IGF2BP3 nodules presented as Bethesda III/IV and had more indolent behavior. This understanding may allow clinicians to develop more targeted treatment plans, such as the extent of surgery and adjuvant radioactive iodine treatment.

Research in the economics field has extensively documented the impact of media sentiments on the stock market. Sentiment analysis, as a tool to predict equity prices, has been popularized in the past years. Recently, Twitter has received a lot of attention due to the diversity of opinions on social media platforms. A common obstruction to sentiment analysis is the resource gap between English and other languages. This pilot study examines the effect of polyglotism in tweets concerning bilingual companies and develops a model that extracts sentiments from polyglot tweets to make price predictions. Results suggest that taking non-English tweets into consideration decreases errors in price predictions and that the random forest models have higher performance than linear regression models. The results of this pilot study need to be confirmed with larger sets of data.

This study aimed to examine whether concurrent mutations with a TERT promoter mutation are associated with a greater likelihood of more aggressive disease than a TERT promoter mutation alone. The medical records of 1477 patients who underwent thyroid surgery at two tertiary hospitals between 2017 and 2022 were reviewed. Twenty-four patients had TERT promoter mutations based on molecular profile testing. Clinicodemographic data, mutational profiles, and histopathological features were assessed. Descriptive analysis, Fisher's exact test, and binary logistic regression were performed. Seven patients had single-gene TERT promoter mutations, and 17 had concurrent mutations, including BRAF V600E, HRAS, NRAS, PIK3CA, and EIF1AX. The overall prevalence of malignancy was 95.8%, of which 78.3% were aggressive thyroid cancers. There was a statistically significant association between concurrent mutations and disease aggressiveness. The odds of having aggressive disease were 10 times higher in patients with a TERT promoter mutation and a concurrent molecular alteration than in those with a TERT promoter mutation alone. This is an important finding for thyroid specialists to consider when counseling patients concerning risk stratification and management options.

BackgroundThe EIF1AX mutation has been identified in various benign and malignant thyroid lesions, with a higher prevalence in poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma, especially when combined with RAS or TP53 mutation. However, data and clinical significance of EIF1AX mutations in thyroid nodules is still limited. We investigated the prevalence of EIF1AX mutations and co-mutations in cytologically indeterminate thyroid nodules at our institution.MethodsA 5-year retrospective analysis was performed on surgically resected thyroid nodules with identified EIF1AX mutations on molecular testing with ThyroseqV3®. Mutation type and presence of co-mutations were correlated with histopathologic diagnosis and clinical characteristics. Histopathology diagnoses were subsequently categorized as benign, borderline, malignant or aggressive malignant (≥ 10% PDTC component). Chi-square test was used to compare the malignancy associations of the: 1) A113_splice mutation compared to non-A113_splice mutations 2) singular A113_splice mutations compared to singular non-A113_splice mutations. Fisher’s Exact Test was used to determine the association of A113_splice mutation with aggressive malignancies compared to non-A113_splice mutations. A p value of 0.05 or less was considered statistically significant.ResultsOut of 1583 patients who underwent FNA, 621 had further molecular testing. 31 cases (5%) harbored EIF1AX mutations. Of these cases, 12 (38.7%) were malignant, 2 (6.5%) were borderline, and 17 (55%) were benign. 4/31 cases (13%) were aggressive malignant (≥ 10% PDTC component). The most prevalent mutation was the A113_splice mutation at the junction of intron 5 and exon 6 (48%). All other mutations, except one, were located at the N-terminal in exon 2. 7/31 cases (22.6%) harbored ≥ 1 co-mutation(s), including 4 RAS, 3 TP53, 1 TERT and 1 PIK3CA, with 86% of them being malignant. All 4 nodules with RAS co-mutations were malignant including one PDTC.ConclusionOur study reports the largest cohort of EIF1AX mutations in Bethesda III/IV FNA samples with surgical follow-up to our knowledge. The presence of the EIF1AX mutation confers a 45.2% risk of malignancy (ROM) or borderline after surgery. However, the coexistence of EIF1AX mutations with other driver mutations such as RAS, TERT or TP53 conferred an 86% ROM. While 55% of thyroid nodules were benign at the time of surgery, the possible malignant transformation of these nodules, had they not been resected, is unknown. Finally, 13% of the nodules with EIF1AX mutations were aggressive with a significant PDTC component. These findings can further aid in clinical decisions for patients with thyroid nodules.Graphic

Abstract Background The American Thyroid Association supports same-day thyroid surgery (SDT) in select patients. In practice, it is common for thyroid surgeons to monitor patients overnight for postoperative complications such as cervical hematoma, recurrent laryngeal nerve injury (RLN) and symptomatic hypocalcemia. We sought to determine the safety profile and predictive factors of adverse postoperative outcomes for SDT based on the experience of three large institutions. Methods A retrospective cohort study was conducted for all thyroidectomies performed at three McGill University tertiary and quaternary care centers in Montreal, Canada between January 1st, 2016 and November 13th, 2020. Patient characteristics were associated with outcomes by bivariate and multivariate analyses. Results A total of 2297 records were surveyed and 1983 patients (1513 females, 470 males) met the inclusion criteria. Amongst them, 603 (30.4%) patients were discharged the same day. The overall postoperative complication rate amongst SDT was 3.6% compared with 10.7% for inpatients (p < 0.0001). Cervical hematoma was not observed in the SDT group, whereas 8 inpatients (0.6%) developed this complication (p = 0.061). RLN injury occurred in 7 SDT (1.2%), compared with 35 (2.5%) inpatients (p = 0.050). Symptomatic hypocalcemia occurred in 3 SDT (0.5%) compared with 73 (5.3%) inpatients (p < 0.0001). 36 (6%) 30-day Emergency department (ED) visits were noted for SDT compared to 172 (12.5%) for inpatients (p < 0.0001), and none required readmission or reoperation within that postoperative period. In the multivariate logistic regression analysis, SDT patients were less associated with comorbidities and had a lesser risk to develop symptomatic hypocalcemia (p < 0.0001). SDT patients had lower 30-day ED (p = 0.041) and reoperation (p = 0.037) rates compared with the inpatient group. Conclusion This study demonstrates that SDT are safe in a select group of patients under the care of experienced thyroid surgeons at high volume thyroid surgery centers. SDT can also lead to significant cost savings in a publicly funded health care system. Further exploration is needed to clarify patient profiles most amenable to SDT and inform clinical decision-making.

As of July 2021, Montreal is the epicentre of the COVID-19 pandemic in Canada with highest number of deaths. We aim to investigate the spatial distribution of the number of cases and deaths due to COVID-19 across the boroughs of Montreal. To this end, we propose that the cumulative numbers of cases and deaths in the 33 boroughs of Montreal are modelled through a bivariate hierarchical Bayesian model using Poisson distributions. The Poisson means are decomposed in the log scale as the sums of fixed effects and latent effects. The areal median age, the educational level, and the number of beds in long-term care homes are included in the fixed effects. To explore the correlation between cases and deaths inside and across areas, three different bivariate models are considered for the latent effects, namely an independent one, a conditional autoregressive model, and one that allows for both spatially structured and unstructured sources of variability. As the inclusion of spatial effects change some of the fixed effects, we extend the Spatial+ approach to a Bayesian areal set up to investigate the presence of spatial confounding. We find that the model which includes independent latent effects across boroughs performs the best among the ones considered, there appears to be spatial confounding with the diploma and median age variables, and the correlation between the cases and deaths across and within boroughs is always negative.

To examine various factors associated with an increased risk of reoperation for persistent or recurrent malignant thyroid cancers. Retrospective cohort study. Tertiary academic hospital centers. Patients undergoing surgery for thyroid cancer at 2 tertiary academic institutions from 2006 to 2020 were included. Those who underwent a reoperative procedure were compared with patients only requiring 1 procedure. The Pearson chi-square and independent t test were used to compare group data accordingly. Furthermore, a binomial logistic regression was performed, while machine learning models were used to construct a predictive algorithm. This study included 2266 patients with surgically managed thyroid malignancy, of which 54 (2.4%) necessitated reoperations. Those requiring a second surgical procedure were more likely to be male (40.7% vs 20.9%, P < .001), undergo bilateral (24.1% vs 3.3%, P < .001) and lateral (16.7% vs 1.8%, P < .001) neck dissections, and have a greater number of metastatic lymph nodes (mean, 9.1 vs 3.5; P < .001) and a larger tumor size (mean, 3.0 vs 2.0 cm; P < .001). According to the binomial logistic regression model, lateral neck dissection, greater number of metastatic lymph nodes, and larger tumor size significantly increased the odds of necessitating a second procedure by 7.8 (95% CI, 2.523-24.083), 1.1 (95% CI, 1.032-1.152), and 1.3 (95% CI, 1.064-1.559), respectively. Last, machine learning models could not significantly predict the occurrence of reoperation. This study identified patient- and cancer-related characteristics associated with an increased risk of requiring reoperation for thyroid malignancies.