Alternative Options Research Articles

Studies on in-flight aircraft rerouting

With the publication of this article, the authors continue the research on the development and testing of a methodology for in-flight aircraft rerouting which have begun in previously published articles in the Civil Aviation High Technologies of the Moscow State Technical University of Civil Aviation. This article presents the results of the study in terms of developing the potentials of the methodology from reconfiguring a route of a hypothetical aircraft and obstacles in the horizontal plane, which were previously demonstrated, prior to rerouting in both the horizontal and vertical planes for two different types of obstacles: 1) ground natural or artificial (mountain, power line support, etc.); 2) air (squall line, prohibited flight area, etc.) and their combinations using an example of a Mi-8 helicopter flight on route using a real digital map of the terrain. As mentioned above, a large amount of aviation accidents is associated with the loss of control in-flight, as well as the collision with terrain in a controlled flight (categories LOC-I, CFIT, LALT). As a result of the investigation of the aviation accidents, it was found that these accidents are often caused by the requirement to reroute quickly due to obstacles, for example, a squall line. When determining alternatives to avoid an obstacle, as well as while implementing the selected route for avoiding action, the crew makes errors due to the increased psychophysiological load and lack of time. The methodology and the algorithms, proposed by the authors, make it possible to assess the safety of an original route, estimate options for alternatives to avoid around obstacles detected in-flight, check them for feasibility, taking into account aircraft performance, flight envelope, and also select the optimal route from the view of some criterion, for example, based on minimizing the route length increase, reducing additional fuel consumption, the time required to implement a new route of flight, etc.

Personalized 125I Seed Interstitial Brachytherapy for Patients Aged 80 Years and Over with Early Primary High-risk Non-melanoma Skin Cancer.

The aim of this study is to explore the safety and efficacy of iodine-125 seeds interstitial brachytherapy (PISI-BT) for patients aged 80 and above with early primary high-risk non-melanoma skin cancer (NMSC). In this retrospective single-center study, we collected and analyzed data from patients ≥ 80 years of age with early primary high-risk NMSC treated with PISI-BT between December 2003 and May 2020. Survival status, efficacy, adverse effects (AEs), cosmetic outcomes, and treatment cost were analyzed (data cut-off: November 20th, 2021). Only 9 patients met the inclusion criteria (median age, 86 years (81-90)). Five patients had an Eastern Cooperative Oncology Group (ECOG) score of 1, and allthe patients had at least one comorbidity. Six patients showed complete responseand three showed partial response, while none had stable or progressive disease. No recurrences, disease persistence, or AEs were detected during the follow-up period. After a median follow-up of 29.3 months (3-99), only two patients were alive, but the cause of death in the remaining patients was not related to NMSC. The cosmetic outcomes were excellent and good in two and four patients, respectively, while they could not be evaluated in three patients. The cost (which was within the scope of medical insurance reimbursement) was acceptable. PISI-BT could be an alternative treatment option in patients above 80 years old with early primary high-risk NMSC and comorbidities.

Calcium-fortified fresh milk ameliorates postmenopausal osteoporosis via regulation of bone metabolism and gut microbiota in ovariectomized rats

The aging of the global population has made postmenopausal osteoporosis prevention essential; however, pharmacological treatments are limited. Herein, we evaluate the effect of calcium-fortified fresh milk (FM) in ameliorating postmenopausal osteoporosis in a rat model established using bilateral ovariectomy. After 3 months of FM (containing vitamin D, and casein phosphopeptides, 1000 mg Ca/100 g) or control milk (110 mg Ca/100 g milk) supplementation, bone changes were assessed using dual-energy X-ray absorptiometry, microcomputed tomography, and bone biomechanical testing. The results revealed that FM can regulate bone metabolism and gut microbiota composition, which act on bone metabolism through pathways associated with steroid hormone biosynthesis, relaxin signaling, serotonergic synapse, and unsaturated fatty acid biosynthesis. Furthermore, FM administration significantly increased bone mineral content and density in the lumbar spine and femur, as well as femoral compressive strength, while improving femoral trabecular bone parameters and microarchitecture. Mechanistically, we found that the effects may be due to increased levels of estrogen, bone formation marker osteocalcin, and procollagen type I N-propeptide, and decreased expression of the bone resorption marker C-telopeptide and tartrate-resistant acid phosphatase 5b. Overall, the findings suggest that FM is a potential alternative therapeutic option for ameliorating postmenopausal osteoporosis.

Comments on 'Comparison between off-pump versus on-pump beating heart CABG'.

On-pump beating heart coronary artery bypass grafting helps the surgeon in his learning curve period on off-pump heart surgery, however, it increases the risk of incomplete revascularization. Off-pump with cannulas in readiness is an alternative option.

Heavy menstrual bleeding in adolescence: who to investigate and how to manage it

Key content Adolescent heavy menstrual bleeding (HMB) is commonly related to hypothalamic pituitary ovarian axis immaturity, which improves with age. This article outlines when and how to investigate for underlying pathological causes. Medical treatment for adolescent HMB consists predominantly of hormonal contraceptives. Preparation choice depends upon patient preference, comorbidities and co‐existing conditions. Acute adolescent HMB is rare; a suggested framework for assessing and managing such cases is provided within this article. Learning objectives To understand how to clinically evaluate adolescent HMB. To understand when and how to investigate adolescent HMB. To understand the different medical treatment options for HMB, their efficacy, risks and alternatives. To understand the management of acute adolescent HMB. Ethical issues Duties of confidentiality must be balanced against safeguarding concerns.

Effects of Bipolaris yamadae strain HXDC-1-2 as a bioherbicide against Echinochloa crus-galli in rice and dry fields.

Barnyardgrass (Weed Science Society of America recommended) or Barnyard grass (Britannica recommended) (Echinochloa crus-galli (L.) P. Beauv.) is one of the most problematic and dominant weeds in world agricultural systems, especially in paddy fields, where tillering and grain yield can be reduced by 50-70% because of its competitive pressure. The frequent use of chemical herbicides to control E. crus-galli has led to the evolution of herbicide resistance. Developing bioherbicides using pathogenic fungi to control E. crus-galli could be an alternative option. In a previous study we showed that a strain of Bipolaris yamadae (HXDC-1-2) was promising in controlling gramineous weeds. Here we present a study that evaluated this fungus as a mycoherbicide against E. crus-galli in greenhouse and paddy fields, characterized mycelium growth and conidial production, and examined the infection development. The median effective dose (ED50) and 90% effective dose (ED90) values of microcapsulated B. yamadae strain HXDC-1-2 on E. crus-galli in the greenhouse were 7.17 × 102 and 9.35 × 103 conidia mL-1, respectively. Conidial germination, mycelial growth, and attachment formation occurred on E. crus-galli leaves within 1 to 6 h. The hyphae directly invaded cells and stomata, primarily from the appressorium on the epidermis, and necrotic lesions were observed on the leaf surface within 20 to 24 h. Applied to E. crus-galli plants at 1 × 105 conidia mL-1, the fungus reduced the weed's fresh weight of 75%. B. yamadae strain HXDC-1-2 has the potential to be developed as a bioherbicide against E. crus-galli plants, especially in rice fields. © 2024 Society of Chemical Industry.

Gender gap in standardized tests: What are we measuring?

Typically, in standardised tests, girls underperform boys in mathematics while boys underperform girls in reading. Can these educational inequalities be driven by specific testing practices? This study addresses this question by innovatively using data from the largest worldwide standardized test and exploiting the random variation in the format of the tests assigned to students. I find that there is a noticeable widening of the gender gap when a larger share of questions is multiple-choice, rather than filling-the-gap questions. A 10 percentage point increase in the share of multiple-choice questions inflates female under-performance in mathematics by 0.025 standard deviations and male under-performance in reading by 0.035 standard deviations. This accounts for nearly one-quarter of the overall gender disparity found in these subjects. I provide suggestive evidence that ruling out alternative options, rather than coming up with an entire answer, may contribute to cognitive information overload among students with lower confidence levels (generally girls in mathematics and boys in reading). These cognitive loads, in turn, have implications for a student's future level of effort and performance.

Acute treatment of migraine: quantifying the unmet need through real-world data in Italy.

This study is describing subjects with migraine interrupting or not receiving triptans for acute treatment and providing a national-level estimate of people who might benefit from different therapeutic approaches. This is a retrospective analysis using IQVIA Longitudinal Patient Database. Starting from 18 + years old individuals with migraine, we selected two cohorts: subjects with triptans prescriptions before and no triptans prescriptions after Index Date (triptan withdraw) and subjects without triptans prescriptions both before and after Index Date (no triptan prescriptions). Index Date was the first record of a health encounter for migraine in 2019. Individuals with cardiovascular disease (CVD) within no triptan prescriptions group were also quantified. Triptan withdraw and no triptan prescriptions cohorts numbered 605 and 3270, respectively, 5% and 29% of subjects with migraine. Mean age was 47 and 51years respectively; women were more represented (~ 80%). Hypertension and thyroid disease were most frequent comorbidities; non-steroidal anti-inflammatory drugs were among most frequently recorded treatments. Subjects with CVD within no triptan prescriptions cohort were 621 and with triptan withdraw cohort subjects represented the basis to estimate those who might benefit from alternative options for the acute treatment of migraine, who were around 60,000 and accounted for 11% of subjects seeking primary care due to migraine. This analysis provides a real-word estimate of Italian people that might benefit from different therapeutic approaches as an alternative to triptans, which sometimes might be not effective and/or poorly tolerated. Such estimate should be intended as the lower limit of a wider range due to strict criteria adopted.

Advanced Interventional Treatments in Retinoblastoma Management: A Comprehensive Review.

Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy.

Use of crushed tranexamic acid tablets in water for paediatric patients with bleeding disorders.

Ε-Aminocaproic acid oral solution (EACA OS) is the only commercially available antifibrinolytic for patients who cannot swallow tablets. Insurance denials and high costs remain barriers to its use. To determine the safety and efficacy of crushed tranexamic acid tablets in water (cTXAw) for children with bleeding disorders. We retrospectively reviewed records of children (<10 years) with bleeding disorders who received cTXAw or EACA OS from 1 December 2018, through 31 July 2022, at Mayo Clinic (Rochester, Minnesota). Bleeding outcomes were defined according to ISTH criteria. Thirty-two patients were included (median age, 3 years; male, n=23). Diagnoses were VWD (n=17), haemophilia (n=5), FVII deficiency (n=3), inherited platelet disorder (n=4), ITP (n=2), and combined FV and FVII deficiencies (n=1). Thirty-two courses of cTXAw (monotherapy 24/32; mean duration 6 days) and fifteen courses of EACA (monotherapy 12/15; mean duration 5 days) were administered. No surgical procedures (n=28) were complicated by bleeding. Of the 19 bleeding events, 16 had effective haemostasis, two had no reported outcome, and one had no response. cTXAw and EACA were equally effective in preventing and treating bleeding (p value>.1). No patients had adverse effects. Eight of 19 patients (42%) who were initially prescribed EACA OS did not receive it because of cost or insurance denial. The estimated average wholesale price of one treatment was $94 for cTXAw and $905 for EACA OS. CTXAw appears to be an effective, safe, and low-cost alternative option to EACA OS for young children with bleeding disorders.

Cytomegalovirus Treatment in Solid Organ Transplantation: An Update on Current Approaches.

The article reviews the safety and efficacy of treatments for cytomegalovirus (CMV) in solid organ transplantation. A literature review was conducted in PubMed, MEDLINE, and Clinicaltrials.gov from database inception through January 2024, using terms CMV, therapy, and solid organ transplantation. Clinical trials, meta-analyses, cohort studies, case reports, and guidelines were included. Letters to the editor, reviews, and commentaries were excluded. After abstract screening and full-text review of 728 citations for eligibility, 53 were included. Valganciclovir and intravenous ganciclovir are drugs of choice for CMV management and, until recently, the availability of alternative options has been restricted due to toxicity. For instance, foscarnet and cidofovir serve as second-line agents due to potential bone marrow and renal toxicity. In patients with refractory or resistant CMV, maribavir, a novel oral agent, has proven efficacy and a lower adverse effect profile. However, in refractory or resistant CMV, foscarnet and cidofovir are preferred in invasive disease (CMV gastritis, CMV retinitis, and CMV encephalitis), high viral loads, and inability to tolerate oral preparations. Consensus guidelines have not been revised since approval of novel antivirals in solid organ transplantation. Valganciclovir and ganciclovir remain drugs of choice for initial CMV therapy. Foscarnet, cidofovir, and maribavir are treatments for refractory or resistant-CMV. Selection of CMV antiviral treatment should be determined by patient-specific factors, including severity of illness, resistant or refractory disease, dose-limiting adverse effects, and the preferred route of administration.

Invitro antibacterial activity of bark, leaf and root extracts of combretum molle plant against streptococcus equi isolated from clinical cases of strangles in donkeys and horses

BackgroundEffective therapy for many infections is becoming difficult due to the evolutionary development of drug resistance, and hence, the development of alternative treatment options mainly from herbs is crucial. The objective of this study was to investigate the antibacterial effects of ethanol extracts of stem bark, leaves and roots of Combretum molle against Streptococcus equi isolated from clinical cases of strangles using in vitro tests.MethodsPlant extraction was performed using a maceration technique with 80% ethanol. The mean zone of inhibition was determined using the agar well diffusion method. Six serial dilutions with different concentrations (10%, 5%, 2.5%, 1.25%, 0.625% and 0.3125%) of each plant extract were prepared using dimethyl sulfoxide (DMSO). A modified agar microdilution method was used to determine the minimum inhibitory concentration (MICs) of the extracts.ResultsThe results revealed that all plant extracts showed significant antibacterial activity. The root extract showed the best antibacterial effect compared to the others at all concentrations, with MZI values of 27.5, 23.225, 20.5, 17.9, 15.65 and 12.25 for the respective concentrations mentioned above and an MIC of 250 µg/ml. It was followed by the stem bark extract, which had MZI values of 24.67, 22.35, 18.225, 16.175, 11.125 and 8.2 millimeters and an MIC of 375 µg/ml. The leaf extract also had significant activity, with MZI values of 20.175, 18.25, 15.7, 13.125, 9.4 and 6.75 in millimeters and an MIC of 500 µg/ml. There was a direct relationship between the concentrations of the plant extracts and the level of inhibition.ConclusionThe test plant extracts were compared with the conventional antibiotic penicillin G, and the results indicated that the parts of the test plant have significant antibacterial activity, which may support traditional claims and could be candidates for alternative drug discoveries.

Smartphone-Integrated Wireless Portable Potentiostat to Develop 5th-Generation Dengue Pocket Aptasensor toward Portronicx-Approach.

Smartphones' widespread availability and worldwide connection are advancing the idea of mobile-based healthcare and promise to transform the business of biosensors. Biosensors based on smartphones have been investigated in several ways, including employing a smartphone in place of a detector or as an instrumental interface. The current work demonstrates the first successful detection of dengue virus using a smartphone-based pocket sensor combined with a wireless potentiostat. The platform developed comprises a smartphone, a wireless portable potentiostat, an Android app, and a three-electrode setup. The combination of portable diagnostic with electronic application is referred to as "Portronicx", and this is the first time that the term "Portronicx" has been used in a dengue sensor, so the current study has the potential to be commercialized in the market with the tag line "Portronicx-commercialization" in the future. Miniaturization improves alternative setup options in terms of instrument size, affordability, mobility, touch-mobile display, and design versatility. The current work proved the excellent combination of a wireless potentiostat with an aptasensor to detect dengue antigen within 20 s with good LOD (0.1 μg/mL) and easy to carry in their pockets. The created platform also performed effectively in human serum. This study replaced all of the instruments with a lightweight touch smartphone, paving the way for the production of fifth-generation electrochemical aptasensors, with potential implications for healthcare applications on the verge of commercialization.

Experiences of Workplace Violence in Graduate Nursing Clinical Education.

Exposure to workplace violence (WPV) is common in health care, and little is known about nurse practitioner (NP) students' experiences during graduate nursing clinical education. This study described experiences of WPV among NP students during their clinical education. We conducted a cross-sectional, quantitative survey of a random sample of NPs licensed in Texas examining graduate nursing education experiences. A total of 334 NPs responded, a 12% response rate. More than a quarter (27%) experienced WPV during their graduate nursing clinical experience. Preceptors were the most reported perpetrators (44%). Most NPs remained in their clinical site after their WPV experience (55%); a majority felt they had no alternative clinical placement option. Nurse practitioner students experience WPV, and there may be implications for educational persistence and their careers. Future work should attempt to reduce the frequency of student WPV experiences and examine implications for NP careers.

Combination biologic therapy in pediatric inflammatory bowel disease: Safety and efficacy over a minimum 12-month follow-up period.

The severe course of inflammatory bowel diseases (IBDs) refractory to advanced therapies in children results in the search for new therapeutic methods. The aim of this study was to evaluate the efficacy and safety of dual therapy with biologics in a cohort of children with IBD. Retrospective analysis of data from 29 children with a diagnosis of IBD, 19 with ulcerative colitis (66%), 10 with Crohn's disease (CD) (34%) qualified for dual biological therapy (DBT). The median age of patients was five (interquartile range[IQR], 1-15) years at diagnosis of IBD and 14 (IQR, 3-17) years at eligibility for dual therapy. Thirteen (45%) patients were treated with vedolizumab/adalimumab (VDZ + ADA), 13 (45%) with ustekinumab/adalimumab (UST + ADA), three (10%) with infliximab/vedolizumab (IFX + VDZ). Clinical remission was achieved in 13 (45%; sevenUCand sixCD) and 12 (41%; sevenUCand fiveCD) Pediatric Weighted Crohn's Disease Activity Index(wPCDAI)/Pediatric Ulcerative Colitis Activity Index(PUCAI) patients after 4 and 12 months at the initiation of dual therapy. Clinical response based on wPCDAI/PUCAI was reported in 16 (55%; nineUCand sevenCD) and 12 (41% sevenUC andfiveCD) children after 4 and 12 months of follow-up, respectively. The median fecal calprotectin decreased significantly from 1240 µg/g (53-10,100) to 160 µg/g (5-2500; p = 0.004) between baseline and Month 4 and from 749 at baseline (57-10,100) to 17 (5-3110; p = 0.12) over 12 months. Moreover, 34% (six UCand fourCD) of patients achieved endoscopic remission. DBT seems to be an effective alternative therapeutic option for patients with moderate and severe IBD.

Bedside preoperative predictors of difficult laryngeal exposure in microlaryngeal surgery.

Successful microlaryngeal surgery relies on an adequate laryngeal exposure. Recognizing the likelihood of challenging exposure prior to microlaryngeal surgery may assist in selecting the appropriate surgical approach and even prompt consideration of alternative treatment options. We aim to apply the mini-Laryngoscore, a preoperative assessment tool, to our study population and incorporate novel variables to optimize the prediction model. This single-center prospective cohort study included 80 consecutive patients undergoing elective microlaryngeal surgery, from January 1, to June 30, 2023. Each patient underwent a presurgical evaluation of 15 parameters and an intraoperative scoring of the anterior commissure visualization. These parameters were assessed for their association with difficult laryngeal exposure, using multiple logistic regression analysis. We created a novel prediction model for DLE and compared it with the existing model, the mini-Laryngoscore. Out of 80 patients, 24 (30%) patients had difficult laryngeal exposure, including 3 cases (3.8%) in which visualization of the anterior commissure was not possible. A large neck diameter (OR, 1.4; CI 1.1-1.9) and the presence of upper teeth (OR, 8.9; CI 1.3-62.8) were independent risk factors for a difficult laryngeal exposure, while a larger interincisors gap was the only independent protector factor (OR, 0.3; CI 0.1-0.8). The logistic regression model combining these three independent risk factors displayed a high discriminative value AUC = 0.89 (CI 0.81-0.97). The predictive performance of the mini-Laryngoscore was 0.73 (CI 0.62-0.85). Combining two parameters from the mini-Laryngoscore (upper jaw dental state and interincisors gap distance) with neck circumference measurement can accurately predict the risk of difficult laryngeal exposure.

TREM1/DAP12 based novel multiple chain CAR-T cells targeting DLL3 show robust anti-tumour efficacy for small cell lung cancer.

Small cell lung cancer (SCLC), recognized as the most aggressive subtype of lung cancer, presents an extremely poor prognosis. Currently, patients with small cell lung cancer face a significant dearth of effective alternative treatment options once they experience recurrence and progression after first-line therapy. Despite the promising efficacy of immunotherapy, particularly immune checkpoint inhibitors in non-small cell lung cancer (NSCLC) and various other tumours, its impact on significantly enhancing the prognosis of SCLC patients remains elusive. DLL3 has emerged as a compelling target for targeted therapy in SCLC due to its high expression on the membranes of SCLC and other neuroendocrine carcinoma cells, with minimal to no expression in normal cells. Our previous work led to the development of a novel multiple chain chimeric antigen receptor (CAR) leveraging the TREM1 receptor and DAP12, which efficiently activated T cells and conferred potent cell cytotoxicity. In this study, we have developed a DLL3-TREM1/DAP12 CAR-T (DLL3-DT CAR-T) therapy, demonstrating comparable anti-tumour efficacy against SCLC cells in vitro. In murine xenograft and patient-derived xenograft models, DLL3-DT CAR-T cells exhibited a more robust tumour eradication efficiency than second-generation DLL3-BBZ CAR-T cells. Furthermore, we observed elevated memory phenotypes, induced durable responses, and activation under antigen-presenting cells in DLL3-DT CAR-T cells. Collectively, these findings suggest that DLL3-DT CAR-T cells may offer a novel and potentially effective therapeutic strategy for treating DLL3-expressing SCLC and other solid tumours.

Recent Advances in the Development of Polymyxin Antibiotics: 2010-2023.

The polymyxins are nonribosomal lipopeptides produced by Paenibacillus polymyxa and are potent antibiotics with activity specifically directed against Gram-negative bacteria. While the clinical use of polymyxins has historically been limited due to their toxicity, their use is on the rise given the lack of alternative treatment options for infections due to multidrug resistant Gram-negative pathogens. The Gram-negative specificity of the polymyxins is due to their ability to target lipid A, the membrane embedded LPS anchor that decorates the cell surface of Gram-negative bacteria. Notably, the mechanisms responsible for polymyxin toxicity, and in particular their nephrotoxicity, are only partially understood with most insights coming from studies carried out in the past decade. In parallel, many synthetic and semisynthetic polymyxin analogues have been developed in recent years in an attempt to mitigate the nephrotoxicity of the natural products. Despite these efforts, to date, no polymyxin analogues have gained clinical approval. This may soon change, however, as at the moment there are three novel polymyxin analogues in clinical trials. In this context, this review provides an update of the most recent insights with regard to the structure-activity relationships and nephrotoxicity of new polymyxin variants reported since 2010. We also discuss advances in the synthetic methods used to generate new polymyxin analogues, both via total synthesis and semisynthesis.

Immediate rehabilitation of severely atrophic maxillae using conventional and extended length subcrestal angulated (ELSA) implants: A retrospective analysis of 187 implants in 33 patients with up to three years of function.

The purpose of this study was to evaluate and determine clinical outcomes and survival rates of straight and extended length subcrestal angulated (ELSA) implants (20-24mm lengths) placed for immediate (up to 72h post-operative) or delayed rehabilitation (4 months post-operative) of severely atrophic maxillae. Prosthetic treatment consisted of interim and definitive implant-supported fixed implant-supported prostheses with up to 3 years of function. A retrospective analysis was conducted of 38 patients (five dropped out; final total was 33), treated between 2017 and 2019 in a private practice. Extended length subcrestal angulated (ELSA) implants and conventional endosseous straight implants (Southern Implants, Irene, South Africa) with (fixed) full arch prostheses were used to restore patients with edentulous maxillae immediately (within 72hs) or delayed (4 months). ELSA implants have subcrestal angulations of 24° and 36° of the restorative platforms, external hexagon crestal anti-rotation abutment connections, and lengths between 18 and 26mm. Implant loading was determined by implant insertion torque values (as determined on the surgical units); 120Ncm was the threshold level for immediate loading. Clinical and radiographic examinations were done that recorded the clinical outcomes of implants and prostheses. SPSS was used to process the data. Thirty-three patients and 187 implants were included with follow-up periods of at least 12 months (range 12-36 months). The mean age of the study population was 62.6 ± 8.4 years old (at the time of implant placement). Thirty-three patients (86.8%) were followed for 12 months; 13 patients (39.4%) were followed for 24-35 months; 9 patients (27.3%) were followed for 36 months. In total, 13 implants in six patients failed secondary to sinus infections. Mean bone levels (MBLs) were respectively: 0.88±2.12mm at loading, -1.53±2.03mm at 12 months, -2.26±1.45mm at 24 months, and -2.54±1.46mm at 36 months. The ELSA implants showed significantly lower (p = 0.014) MBL at 36 months than did the conventional implants. One hundred thirty-seven implants were placed and loaded within 72h; 50 implants were placed and loaded 4 months post placement. The combined implant survival rates were 93.0% at 12 months, 91.1% at 24 months, and 100% at 36 months. The ELSA implants showed significantly lower (p = 0.014) MBLs at 36 months when compared to the conventional implants. The results of this retrospective clinical chart review indicated that the use of ELSA implants placed into anterior maxillae and nasal crests with accentuated distal tilts (>30°) and simultaneous sinus augmentation provided favorable outcomes for prosthetic rehabilitation in patients with severe atrophic maxillae. ELSA implants placed with simultaneous sinus augmentation are an alternative option to zygomatic implants (ZI) when immediate loading is prescribed. Sinus infections were thought to be the proximate causes of all implant failures. Further long-term clinical studies are warranted with larger patient populations.

Learning to cope with the reality of endometriosis: A mixed-methods analysis of psychological therapy in women with endometriosis.

Despite the need and uptake of mental health support by women with endometriosis, no research to date has explored their experience of psychological therapy. We aimed to understand the factors that predict engagement in psychological therapy by Australian women with endometriosis and to qualitative explore their experience of psychological support. Mixed-methods design. A total of 200 women with self-reported endometriosis were recruited from the community. We explored; (1) the demographic and clinical predictors of engagement in psychological therapy, (2) the psychological approaches that seem most valuable to women in the management of endometriosis and (3) their experience engaging in psychological therapy for endometriosis. Nearly half of women reported to have seen a psychologist within the past year, particularly for pain. Younger age (OR, .94; 95% CI, .886-.993), depressive symptoms (OR, 1.05; 95% CI, 1.002-1.099), and working part time compared to full time (OR, 2.17, 95% CI, 1.012-4.668), increased the likelihood of engaging in psychological therapy. Template thematic analysis identified three themes; (1) endometriosis and pain have multi-faceted psychological effects, (2) psychological support is sought to adjust and live with endometriosis and (3) there are helpful and unhelpful psychological tools for women with endometriosis. Our findings support the use of psychological therapy in the management of endometriosis, and the need for psychological therapy to acknowledge the chronicity and impact of symptoms, to enlist multidisciplinary support and to consider alternative options. Further advocacy is required to educate women on the benefits of psychological therapy for endometriosis.