Early Time Period Research Articles

Inflammatory bowel disease among first generation immigrants in Israel: A nationwide epi-Israeli Inflammatory Bowel Disease Research Nucleus study.

Israel has a high rate of Jewish immigration and a high prevalence of inflammatory bowel disease (IBD). To compare IBD prevalence in first-generation immigrants vs Israel-born Jews. Patients with a diagnosis of IBD as of June 2020 were included from the validated epi-IIRN (Israeli IBD Research Nucleus) cohort that includes 98% of the Israeli population. We stratified the immigration cohort by IBD risk according to country of origin, time period of immigration, and age group as of June 2020. A total of 33544 patients were ascertained, of whom 18524 (55%) had Crohn's disease (CD) and 15020 (45%) had ulcerative colitis (UC); 28394 (85%) were Israel-born and 5150 (15%) were immigrants. UC was more prevalent in immigrants (2717; 53%) than in non-immigrants (12303, 43%, P < 0.001), especially in the < 1990 immigration period. After adjusting for age, longer duration in Israel was associated with a higher point prevalence rate in June 2020 (high-risk origin: Immigration < 1990: 645.9/100000, ≥ 1990: 613.2/100000, P = 0.043; intermediate/low-risk origin: < 1990: 540.5/100000, ≥ 1990: 192.0/100000, P < 0.001). The prevalence was higher in patients immigrating from countries with high risk for IBD (561.4/100000) than those originating from intermediate-/low-risk countries (514.3/100000; P < 0.001); non-immigrant prevalence was 528.9/100000. Lending support to the environmental effect on IBD etiology, we found that among immigrants to Israel, the prevalence of IBD increased with longer time since immigration, and was related to the risk of IBD in the country of origin. The UC rate was higher than that of CD only in those immigrating in earlier time periods.

Analysis of Extracranial Cerebrovascular Injuries: Clinical Predictors of Management and Outcomes

Optimal management of traumatic extracranial cerebrovascular injuries (ECVIs) remains undefined. We sought to evaluate the factors that influence management and neurologic outcomes (stroke and brain death) following traumatic ECVI. A retrospective review of a single level 1 trauma center's prospectively maintained data registry of patients older than 18years of age with a diagnosis of ECVI was performed from 2013 to 2019. Injuries limited to the external carotid artery were excluded. Patient demographics, type of injury, timing of presentation, Biffl Classification of Cerebrovascular Injury Grade, Injury Severity Score (ISS), and Abbreviated Injury Scale were documented. Ultimate treatments (medical management and procedural interventions) and brain-related outcomes (stroke and brain death) were recorded. ECVIs were identified in 96 patients. The primary mechanism of injury was blunt trauma (89.5% vs. 10.5%, blunt versus penetrating), with 70 cases (66%) of vertebral artery injury and 37 cases of carotid artery injury. Treatments included vascular intervention (6.5%) and medical management (93.5%). Overall outcomes included ipsilateral ischemic stroke (29%) and brain death (6.5%). In the carotid group, vascular intervention was associated with higher Biffl grades (mean Biffl 3.17 vs. 2.23; P=0.087) and decreased incidence of brain death (0% vs. 19%, P=0.006), with no difference seen in ISS scores. Brain death was associated with higher ISS scores (40.29 vs. 24.17, P=0.01), lower glascow coma score on arrival (3.57 vs. 10.63, P<0.001), and increased rates of ischemic stroke (71% vs. 30%, P=0.025). In the vertebral group, neither Biffl grade nor ISS were associated with treatment or outcomes. Regarding the timing of stroke in ECVI, there was no significant difference in the time from presentation to cerebral infarction between the carotid and vertebral artery groups (24.7hr vs. 21.20hr, P=0.739). After this window, 98% of the ECVI cases demonstrated no further aneurysmal degeneration or new neurological deficits beyond the early time period (mean follow-up 9.7months). Blunt cerebrovascular injuries should be viewed distinctly in the carotid and vertebral territories. In cases of injury to the carotid artery, Biffl grade and ISS score are associated with surgical intervention and neurologic events, respectively; vertebral artery injuries did not share this association. Neurologic deficits were detected in a similar time frame between the carotid artery and the vertebral artery injury groups and both groups had rare late neurologic events.

Postoperative Seizure Prophylaxis in Meningioma Resection: A Systematic Review and Meta-Analysis.

Seizures in the early postoperative period may impair patient recovery and increase the risk of complications. The aim of this study is to determine whether there is any advantage in postoperative seizure prophylaxis following meningioma resection. This systematic review was conducted in accordance with PRISMA guidelines. PUBMED, Web of Science, Embase, Science Direct, and Cochrane were searched for papers until April 2023. Among nine studies, a total of 3249 patients were evaluated, of which 984 patients received antiepileptic drugs (AEDs). No significant difference was observed in the frequency of seizure events between patients who were treated with antiepileptic drugs (AEDs) and those who were not. (RR 1.22, 95% CI 0.66 to 2.40; I2 = 57%). Postoperative seizures occurred in 5% (95% CI: 1% to 9%) within the early time period (<7 days), and 9% (95% CI: 1% to 17%) in the late time period (>7 days), with significant heterogeneity between the studies (I2 = 91% and 97%, respectively). In seizure-naive patients, the rate of postoperative seizures was 2% (95% CI: 0% to 6%) in the early period and increased to 6% (95% CI: 0% to 15%) in the late period. High heterogeneity led to the use of random-effects models in all analyses. The current evidence does not provide sufficient support for the effectiveness of prophylactic AED medications in preventing postoperative seizures in patients undergoing meningioma resection. This underscores the importance of considering diagnostic criteria and conducting individual patient analysis to guide clinical decision-making in this context.

Evaluating experiences of HIV-related stigma among people living with HIV diagnosed in different treatment eras in British Columbia, Canada

ABSTRACT There is mixed evidence on whether experiences of HIV-related stigma are mitigated with lived experience. We sought to examine whether people living with HIV (PLWH) with longer living experience reported varying levels of HIV-related stigma. Between January 2016-September 2018, we used purposive sampling to enrol PLWH aged ≥19 across British Columbia, Canada, where participants completed the 10-item Berger HIV Stigma Scale. We conducted bivariate analyzes examining key sociodemographic characteristics and HIV-related stigma scores. Multivariable linear regression modelled the association between year of HIV diagnosis by treatment era and HIV-related stigma scores. We enrolled 644 participants; median age at enrolment was 50 years (Q1–Q3: 42–56), with 37.4% (n = 241) diagnosed before the year 2000. The median HIV-stigma scores of all participants (19.0, Q1–Q3: 13–25, range 0–40) stratified by treatment era were: 17.0 (pre-1996), 20.0 (1996–1999), 20.0 (2000–2009), 19.0 (2010–2018) (p = 0.03). While there was a significant association at the univariate level, year of HIV diagnosis by treatment era was not associated with stigma scores after controlling for age, gender, HIV key populations, ethnicity, relationship status, social support, and ever having a mental health disorder diagnosis. This suggests that PLWH still experience HIV-related stigma today, compared to those diagnosed in earlier time periods.

Designing climate change dynamic adaptive policy pathways for agricultural water management using a socio-hydrological modeling approach

Deep climate uncertainties create challenges to long-term planning in the management of complicated water resources and agricultural systems. The use of an innovative decision-making approach under deep climate uncertainties is helpful to deal with these challenges in such systems. The research aims to develop an appropriate methodology for designing and evaluating robust adaptable plans in the agricultural sector in the face of deep climate uncertainties which covers hydrological aspects and stakeholders’ preferences and behaviors. For this purpose, Dynamic Adaptive Policy Pathways (DAPP) approach in conjunction with socio-hydrological modeling is utilized to design and evaluate comprehensive robust adaptable plans under future climate uncertainties in the Hablehroud River Basin, Iran. In this context, an agent-based modeling (ABM) approach is linked to the Soil and Water Assessment Tool (SWAT) model to account for the social behavior of various stakeholders as well as the impact of climate change on water resources and agricultural systems and their interactions. The results indicated that encouraging farmers to cooperate in changing cropping patterns and deficit irrigation should be proposed as a main plan in both short- and long-term planning. If the implementation issues are also considered, penalty-based adaptation actions (robustness range of 56–72 %) can be prioritized in the early years to gradually educate farmers about the benefits of cooperative behavior. Therefore, taking into account all issues: 1) sustainability of water resources, 2) agricultural income, 3) climate change impacts, and 4) implementation plans in the time period, it is suggested to impose a penalty on deficit irrigation (56–76 % of robustness) during the early time periods and then shift to changes in cropping patterns through training of farmers (76–82 %). Considering limits to allowable water withdrawal through penalties (56–72 %) can be implemented as another suggested alternative in the early time periods, but imposing penalties on deficit irrigation (62–68 %) should be implemented in the long-term.

MDM2 Regulation of HIF Signaling Causes Microvascular Dysfunction in Hypertrophic Cardiomyopathy.

Microvasculature dysfunction is a common finding in pathologic remodeling of the heart and is thought to play an important role in the pathogenesis of hypertrophic cardiomyopathy (HCM), a disease caused by sarcomere gene mutations. We hypothesized that microvascular dysfunction in HCM was secondary to abnormal microvascular growth and could occur independent of ventricular hypertrophy. We used multimodality imaging methods to track the temporality of microvascular dysfunction in HCM mouse models harboring mutations in the sarcomere genes Mybpc3 (cardiac myosin binding protein C3) or Myh6 (myosin heavy chain 6). We performed complementary molecular methods to assess protein quantity, interactions, and post-translational modifications to identify mechanisms regulating this response. We manipulated select molecular pathways in vivo using both genetic and pharmacological methods to validate these mechanisms. We found that microvascular dysfunction in our HCM models occurred secondary to reduced myocardial capillary growth during the early postnatal time period and could occur before the onset of myocardial hypertrophy. We discovered that the E3 ubiquitin protein ligase MDM2 (murine double minute 2) dynamically regulates the protein stability of both HIF1α (hypoxia-inducible factor 1 alpha) and HIF2α (hypoxia-inducible factor 2 alpha)/EPAS1 (endothelial PAS domain protein 1) through canonical and noncanonical mechanisms. The resulting HIF imbalance leads to reduced proangiogenic gene expression during a key period of myocardial capillary growth. Reducing MDM2 protein levels by genetic or pharmacological methods normalized HIF protein levels and prevented the development of microvascular dysfunction in both HCM models. Our results show that sarcomere mutations induce cardiomyocyte MDM2 signaling during the earliest stages of disease, and this leads to long-term changes in the myocardial microenvironment.

Biomolecular characterization of 3500-year-old ancient Egyptian mummification balms from the Valley of the Kings

Ancient Egyptian mummification was practiced for nearly 4000 years as a key feature of some of the most complex mortuary practices documented in the archaeological record. Embalming, the preservation of the body and organs of the deceased for the afterlife, was a central component of the Egyptian mummification process. Here, we combine GC–MS, HT-GC–MS, and LC–MS/MS analyses to examine mummification balms excavated more than a century ago by Howard Carter from Tomb KV42 in the Valley of the Kings. Balm residues were scraped from now empty canopic jars that once contained the mummified organs of the noble lady Senetnay, dating to the 18th dynasty, ca. 1450 BCE. Our analysis revealed balms consisting of beeswax, plant oil, fats, bitumen, Pinaceae resins, a balsamic substance, and dammar or Pistacia tree resin. These are the richest, most complex balms yet identified for this early time period and they shed light on balm ingredients for which there is limited information in Egyptian textual sources. They highlight both the exceptional status of Senetnay and the myriad trade connections of the Egyptians in the 2nd millennium BCE. They further illustrate the excellent preservation possible even for organic remains long removed from their original archaeological context.

Single-Time-Point Imaging for Dosimetry After [177Lu]Lu-DOTATATE: Accuracy of Existing Methods and Novel Data-Driven Models for Reducing Sensitivity to Time-Point Selection.

Estimation of the time-integrated activity (TIA) for dosimetry from imaging at a single time point (STP) facilitates the clinical translation of dosimetry-guided radiopharmaceutical therapy. However, the accuracy of the STP methods for TIA estimation varies on the basis of time-point selection. We constructed patient data-driven regression models to reduce the sensitivity to time-point selection and to compare these new models with commonly used STP methods. Methods: SPECT/CT performed at time period (TP) 1 (3-5 h), TP2 (days 1-2), TP3 (days 3-5), and TP4 (days 6-8) after cycle 1 of [177Lu]Lu-DOTATATE therapy involved 27 patients with 100 segmented tumors and 54 kidneys. Influenced by the previous physics-based STP models of Madsen etal. and Hänscheid etal., we constructed an STP prediction expression, TIA = A(t) × g(t), in a SPECT data-driven way (model 1), in which A(t) is the observed activity at imaging time t, and the curve, g(t), is estimated with a nonparametric generalized additive model by minimizing the normalized mean square error relative to the TIA derived from 4-time-point SPECT (reference TIA). Furthermore, we fit a generalized additive model that incorporates baseline biomarkers as auxiliary data in addition to the single activity measurement (model 2). Leave-one-out cross validation was performed to evaluate STP models using mean absolute error (MAE) and mean square error between the predicted and reference TIA. Results: At days 3-5, all evaluated STP methods performed very well, with an MAE of less than 7% (between-patient SD of <10%) for both kidneys and tumors. At other TPs, the Madsen method and data-driven models 1 and 2 performed reasonably well (MAEs < 17% for kidneys and < 32% for tumors), whereas the error with the Hänscheid method was substantially higher. The proof of concept of adding baseline biomarkers to the prediction model was demonstrated and showed a moderate enhancement at TP1, especially for estimating kidney TIA (MAE ± SD from 15.6% ± 1.3% to 11.8% ± 1.0%). Evaluations on 500 virtual patients using clinically relevant time-activity simulations showed a similar performance. Conclusion: The performance of the Madsen method and proposed data-driven models is less sensitive to TP selection than is the Hänscheid method. At the earliest TP, which is the most practical, the model incorporating baseline biomarkers outperforms other methods that rely only on the single activity measurement.

Usefulness of additional diffusion MRI acquisition prior to mechanical thrombectomy for acute large vessel occlusion in the early time period at a CT-based stroke center

ObjectiveThis study aimed to investigate whether evaluating the infarction core using additionally acquired diffusion magnetic resonance imaging (MRI) could help improve the assessment of prognosis including complication rates and modify the strategy for mechanical thrombectomy in endovascular procedures at a computed tomography (CT)-based stroke center. MethodsSingle-center data from patients with acute large-vessel occlusion in the anterior circulation who underwent mechanical thrombectomy between May 2018 and January 2021 were analyzed. Diffusion MRI sequences were performed during the preparation period for mechanical thrombectomy after CT angiography. We set the infarction core reference volume on diffusion MRI to 60 cc and divided the patients into two groups: a small infarction core group (less than 60 cc) and a large infarction core group (more than 60 cc). The baseline characteristics, radiological and clinical outcomes of the patients were investigated and compared between the two groups. ResultsThe difference in numbers between the two groups was not significant in the Alberta Stroke Program Early Computed Tomography (ASPECT) score; however, the ASPECT score on diffusion MRI showed a remarkable difference between the two groups. The large infarction core volume group on diffusion MRI had a poor prognosis, with the modified Rankin score at 90 days showing a statistically significant difference (p = 0.011). Complications after the procedure, such as hemorrhagic transformation, that can occur after reperfusion, symptomatic intracerebral hemorrhage, decompressive craniectomy for increased intracranial pressure, and mortality, were significantly more frequent in the large infarction core volume group. ConclusionAt a CT-based stroke center, additionally acquired diffusion MRI without a time delay for reperfusion would improve the assessment of prognosis including complication rate, and could help neurointerventionists determine the extent of recanalization of occluded vessels during mechanical thrombectomy.

Political Attitudes and Disease Threat: Regional Pathogen Stress Is Associated With Conservative Ideology Only for Older Individuals.

What environmental factors are associated with individual differences in political ideology, and do such associations change over time? We examine whether reductions in pathogen prevalence in U.S. states over the past 60 years are associated with reduced associations between parasite stress and conservatism. We report a positive association between infection levels and conservative ideology in the United States during the 1960s and 1970s. However, this correlation reduces from the 1980s onwards. These results suggest that the ecological influence of infectious diseases may be larger for older people who grew up (or whose parents grew up) during earlier time periods. We test this hypothesis by analyzing the political affiliation of 45,000 Facebook users, and find a positive association between self-reported political affiliation and regional pathogen stress for older (>40 years) but not younger individuals. It is concluded that the influence of environmental pathogen stress on ideology may have reduced over time.

Practical implications of the update to the 2015 Japan Standard Population: mortality archive from 1950 to 2020 in Japan.

The 2015 Japan Standard Population (2015 JSP) was established in response to changes in the age structure. However, the effects of major updates, especially the recategorization of older age groups, for interpreting various health metrics have not been clarified. Population data were collected and estimated for older age categories (85-89, 90-94, 95 years and over). Data on the number of deaths were also collected from the Vital Statistics. We recalculated the all-cause and leading cause-specific age-standardized mortality rate (ASMR) using the 2015 JSP by the direct standardization method for data from 1950 to 2020. We compared ASMRs calculated using the 2015 JSP with those calculated using the 1985 JSP. Pearson's correlation coefficients were used to evaluate the consistency of mortality trends between the 2015 and 1985 JSPs. The absolute all-cause ASMRs calculated using the 2015 JSP were 2.22-3.00 times higher than those calculated using the 1985 JSP. The ASMR ratios increased gradually over time. While trends in all-cause and cause-specific ASMRs calculated using the 2015 JSP and 1985 JSP were generally highly correlated (Pearson's correlation coefficient (r): 0.993 for all-cause), correlations were relatively low for malignant neoplasms (r: 0.720 for men and 0.581 for women) and pneumonia/bronchitis (r: 0.543 for men and 0.559 for women) due to non-monotonous trends over time and fluctuations in earlier time periods. The effect of introducing the new JSP for interpreting trends in all-cause mortality was considered minimal. However, caution is needed when interpreting trends in some cause-specific mortality rates.

New records of vegetation and climate changes in the Sea of Marmara during the Marine Isotope Stages 3, 4 and 5 (a-c)

A giant piston core MRS-CS27 sedimentary sequence in the Sea of Marmara (SoM) was investigated by palynological analysis to evaluate the paleoenvironmental and climate changes, corresponding to the Marine Isotope Stages MIS-5 (c-a), MIS-4, MIS-3, and the earliest part of the MIS-2. During MIS-5c, the palynological analysis indicates a warm and humid climate in the SoM. The pollen assemblage is characterized by the presence of broad-leaved deciduous woody taxa, with a predominance of deciduous Quercus. Following MIS-5c, a relatively colder and drier climate is inferred during MIS-5b, as indicated by the herbaceous assemblages found in the sedimentary sequence. The presence of herbaceous plants in the pollen record suggests less favorable conditions for woody vegetation and a shift towards a cooler and drier climate compared to the previous phase. Within the MIS-5a interval, the palynological analysis reveals the presence of abundant mesophyllous woody taxa. This indicates a return to a warm and humid climate during this period, supporting the growth of diverse forest vegetation. Distinct changes in vegetation are observed during MIS-4, with the presence of abundant Cedrus pollen. This suggests the survival of montane trees in the region under a cooler climate compared to the previous stages. Relict plants such as Cathaya, Tsuga, and Carya are identified during MIS-3 and MIS-4. Their presence can be attributed to the reworking of older sediments during these periods, indicating that these plants were not contemporary with the sediment but were preserved from earlier time periods.

Detrimental effects of fresh frozen plasma transfusions on postoperative outcomes in patients undergoing liver resection for hepatocellular carcinoma

Perioperative fresh frozen plasma (FFP) is commonly transfused to patients undergoing liver resection for hepatocellular carcinoma (HCC), but its impacts in this population remain unknown. This study aimed to investigate the association of perioperative FFP transfusion with short-term and long-term outcomes in these patients. We retrospectively identified and retrieved clinical data for HCC patients undergoing liver resection between March, 2007 and December, 2016. Study outcomes included postoperative bacterial infection, extended length of stay (LOS) and survival. Propensity score (PS) matching was used to determine the association of FFP transfusion with each outcome. A total of 1427 patients were included, and 245 of them received perioperative FFP transfusions (17.2%). Patients received perioperative FFP transfusions were older, underwent liver resection in the earlier time period, and had more extensive resection, poorer clinical conditions, and higher proportions of receiving other blood components. Perioperative FFP transfusion was associated with higher odds of both postoperative bacterial infection (OR=1.77, p=0.020) and extended LOS (OR=1.93, p=<0.001), and the results remained similar after PS-matching. However, perioperative FFP transfusion did not significantly affect survival in these patients (HR=1.17, p=0.185). A potential association of postoperative FFP transfusions and poorer 5-year but not overall survival was observed in a subgroup of patients with low postoperative albumin levels after PS-matching. Perioperative FFP transfusions were associated with poorer short-term postoperative outcomes in HCC patients undergoing liver resection, including postoperative bacterial infection and extended LOS. Reducing perioperative FFP transfusions has the potential to improve their postoperative outcomes.

Comparison of real-world outcomes over time in a large population-based cohort of patients with metastatic breast cancer.

e13112 Background: The treatment of metastatic breast cancer (MBC) has evolved over the past two decades, with a number of new therapeutics being introduced. Real-world evidence is needed to evaluate whether these new therapeutics have made an impact on population survival, as improvements in survival seen within clinical trials do not necessarily translate into the real world. The purpose of this study was to investigate whether survival for each subtype of MBC has improved in patients diagnosed with MBC between 2003 and 2017. In addition, for the HER2+ subtype, we aimed to characterize and correlate changes in the use of anti-HER2 therapeutics with any observed real-world survival changes. Methods: The study included residents of British Columbia, Canada who were diagnosed with de novo or recurrent MBC during one of the following four time periods: 2003 to 2005, 2007 to 2009, 2011 to 2013, and 2014 to 2017. Patients were included whether or not they received any systemic therapies for MBC. Patient, disease, and treatment characteristics were obtained through medical records and the Breast Cancer Outcomes Unit database. Survival estimates were calculated using the Kaplan-Meier method. Univariable analyses were performed using the log-rank test, and multivariable analyses (MVA) were performed using the Cox proportional hazards model. Results: 5,924 patients were diagnosed with MBC during one of the four time periods. 3,756 (63%) had hormone receptor positive (HR+) subtype, 1,145 (19%) had HER2+ subtype, 770 (13%) had triple negative (TN) subtype, and 253 (4%) had unknown subtype. For the HR+ subtype, overall survival (OS) was similar for cohorts 1 to 3 (median survivals: 751 days, 704 days, and 702 days). However, OS was longer for cohort 4 (median survival: 855 days) compared to cohort 3 ( p &lt; 0.001). For the HER2+ subtype, OS was similar for cohorts 1 to 3 (median survivals: 594 days, 511 days, and 592 days). However, OS was longer for cohort 4 (median survival: 791 days) compared to cohort 3 ( p = 0.03). For the TN subtype, there was no significant change in OS for the four cohorts (median survivals: 234 days, 236 days, 274 days, and 255 days). On MVA, younger age, non-TN subtype, time cohort 4, de novo presentation, and disease-free interval of &gt; 12 months were associated with improved OS. For the HER2+ subtype, a greater percentage of patients in the later cohorts were treated with pertuzumab ( p &lt; 0.001) and trastuzumab emtansine (T-DM1) ( p &lt; 0.001), with 12.4% and 36.3% respectively receiving these drugs in cohort 3 compared to 80.9% and 52.5% respectively in cohort 4. Conclusions: Patients diagnosed with MBC of the HR+ or HER2+ subtypes in the 2014 to 2017 time period had improved real-world outcomes compared to those diagnosed in earlier time periods. Improvements in real-world outcomes were likely associated with new therapeutic agents with demonstrated OS benefit in trial settings.

Tachyarrhythmias after extracardiac conduit Fontan procedure in the long-term follow-up: may native anatomy of single ventricle predict their occurrence?

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmic complications, especially tachycardias, represent a common and important comorbidity during long-term follow up (FU) in patients with Fontan palliation for complexes congenital heart diseases (CHDs) with univentricular hearts. Surgical Fontan technique has evolved from direct atrio-pulmonary connection via the intracardiac lateral tunnel to the latest extracardiac conduit (ECC) procedure. Despite its shorter FU compared to previous techniques, the ECC variation is nowadays the main approach for many improvements, including lower incidence of arrhythmic complications (especially atrial arrhythmias). Purpose The aim of this study was to evaluate, during a long-term FU, the incidence of tachyarrhythmias and their correlation with the morphology of CHDs’ single ventricle native anatomy in a large cohort of patients with previous ECC Fontan procedure. Methods In this single centre observational cohort study, we retrospectively evaluated 351 patients treated with ECC Fontan palliation in our Institution between January 1987 and October 2017. Exclusion criteria were ECC Fontan take-down and a FU less than 5 years. CHD diagnosis, single ventricle native anatomy and surgical history were reviewed. Patients had cardiac examination once a year. We divided the overall study population in 2 groups based on unique ventricle's morphology: left-type (LV group) or right-type (RV group). Results A total of 303 patients [56% males; mean age at last FU 20 (IQR 15-28) years; 64.7% LV group] with ECC Fontan were enrolled. The mean FU was 16 (IQR 11-20, the longest 33) years. No sudden arrhythmic cardiac death occurred. Ten patients (6 of the LV group) underwent cardiac transplantation for Fontan failure. During FU, 34 patients of the LV (17.3%) and 22 of the RV group (20.2%) showed at least one tachyarrhythmia after a mean time of 12.1 and 12.9 years from ECC procedure, respectively. One patient (LV group) had one tachyarrhythmia in the early time period, &amp;lt;30 days from procedure. LV group showed a higher incidence of supraventricular tachyarrhythmias (SVTs) than RV group (68% vs 41% of total arrhythmias, p=0.08); in contrast, in RV group we found a higher number of ventricular tachyarrhythmias (VTs) compared to the other group (73% vs 41%, p=0.04). We observed both types of tachyarrhythmias (SVT and VT) in 3 patients of LV and 2 of RV group. Conclusions This study, with one of the largest cohort and longest FU after ECC Fontan, shows that ECC is associated with higher arrhythmic complications than previously reported, even though with longer latency period than other Fontan procedures. Moreover, our results suggest that patients with right-type single ventricle native anatomy are significantly more prone to develop VTs compared to those with left-type ventricle. This may reflect the drawbacks of the right ventricle physiology within Fontan circulation where the right ventricle acts for long time as the main pump of the circulatory system.

Influence of participant and reviewer characteristics in application scores for a hematology research training program

AbstractThe American Society of Hematology Clinical Research Training Institute (CRTI) is a clinical research training program with a competitive application process. The objectives were to compare application scores based on applicant and reviewer sex and underrepresented minority (URM) status. We included applications to CRTI from 2003 to 2019. The application scores were transformed into a scale from 0 to 100 (100 was the strongest). The factors considered were applicant and reviewer sex and URM status. We evaluated whether there was an interaction between the characteristics and time related to application scores. In total, 713 applicants and 2106 reviews were included. There was no significant difference in scores according to applicant sex. URM applicants had significantly worse scores than non-URM applicants (mean [standard error] 67.9 [1.56] vs 71.4 [0.63]; P = .0355). There were significant interactions between reviewer sex and time (P = .0030) and reviewer URM status and time (P = .0424); thus, results were stratified by time. For the 2 earlier time periods, male reviewers gave significantly worse scores than did female reviewers; this difference did not persist for the most recent time period. The URM reviewers did not give significantly different scores across time periods. URM applicants received significantly lower scores than non-URM applicants. The impact of reviewer sex and URM status changed over time. Although male reviewers gave lower scores in the early periods, this effect did not persist in the late period. Efforts are required to mitigate the impact of applicant URM status on application scores.

U.S. Community Banks post the 2008 Financial Crisis

Although community banks hold a small proportion of U.S. banking assets and market share, they perform a crucial function in the U.S. economy by offering vital financial services to businesses and individuals in regions where major banks do not operate. Their diseconomies of scale put them at a competitive disadvantage in relation to large, national commercial banks when coping with digital transformation and regulatory requirements. These challenges mounted after the Great Recession. This research, with the usage of four key financial ratio categories and the implementation of logit regression, looks into how U.S. community banks evolved in the aftermath of the financial crisis, 2009-2017. It divides the entire sample period into two sub-sample periods, 2009-2012 and 2013-2017, and comparing community banks with their larger counterpart and within the community bank sector between the largest and the smallest asset size quartiles of the group. This study, to the best of our knowledge, represents the only known research at the time of publication that compares recovery of banks post the Great Recession based on whether they are community or non-community banks. It finds that community banks tended to recover more slowly in terms of the bottom line, ROE, after the Great Recession than large national banks. Additionally, community banks are more likely to carry even less capital than their national counterparts in the later time period as compared with the earlier time period. In contrast, banks with higher liquidity and greater operating efficiency are more associated with community banks than non-community banks. Also, the empirical findings posit that size matters, to a certain extent. That is, while size does not command an absolute advantage, a certain threshold may be necessary for a bank to stay competitive. This provides a rationale for mergers and acquisitions taking place in the banking sector.

Time-dependent behavioural plasticity influences oviposition latency in no-choice host-specificity trials for a candidate weed biocontrol agent

Laboratory no-choice trials are standard bioassays used to evaluate the host range of arthropods under investigation as potential biological control agents against weeds. In these trials false positives can occur when oviposition and development occur on test plants that are not utilised as a host in the field. Deprivation from preferred hosts can lead to insects accepting a wider range of plant species for oviposition. Observations of what appears to be undiscriminating behaviour in host-specificity trials can result in a decision to not release what would otherwise be a safe, specialised agent.In conducting host specificity testing of the weevil, Listronotus sordidus (Gyllenhal) against the aquatic macrophyte, Sagittaria platyphylla (Engelm.) J.G.Sm. (Alismataceae) we observed oviposition on non-target species in no-choice quarantine laboratory trials ranging from only a few eggs being laid on test species to an abundance of eggs on others. While data showing high and very low (or no) oviposition provides a clear indication of the weevil’s likely acceptance of these plant species in the field, interpretation of the results becomes more difficult when intermediate levels of oviposition occur. In this study we sought to gain further insights into oviposition behaviour on ‘intermediate’ hosts.Oviposition by L. sordidus was observed over a range of time periods in no-choice host trials to determine if lower oviposition counts represented consistently low oviposition over time, or whether this was due to oviposition latency. Test species that were accepted for oviposition at intermediate levels at the conclusion of the trial were less likely to be oviposited on than the host during earlier time periods. Oviposition latency may indicate these species are not utilised as hosts in the field as we predict that the agent would initially reject these species and continue searching for a more suitable host. We recommend measures of time-dependent changes in oviposition be recorded in host-specificity trials, and that post-release host range studies could be used to validate the utility of oviposition latency as a predictor of host use in the field. In time, this information could be incorporated into risk assessment processes to reduce the risk of rejecting safe agents.

Pour le Sport: Physical Culture in French and Francophone Literature ed. by Roxanna Curto and Rebecca Wines

Reviewed by: Pour le Sport: Physical Culture in French and Francophone Literature ed. by Roxanna Curto and Rebecca Wines Jodie Barker Curto, Roxanna and Rebecca Wines, eds. Pour le Sport: Physical Culture in French and Francophone Literature. Liverpool UP, 2021. ISBN 978-1-80085-689-9. Pp 332. When choosing this book to review over the summer, I believed that I would be embarking upon a reading voyage full of fun and amusement, as the title might imply. While these characteristics do make appearances throughout the edited volume, the work as a whole presents the nuanced—and often thorny—circumstances and perspectives that sport and physical culture highlight in the literatures and cultures of the French-speaking world. The volume opens with a thorough introduction that outlines its organization and explains the content of each essay, which is particularly useful considering the large scope and diversity of its essays. According to the editors, the essays are ordered "more or less chronologically" and while their theoretical tone is at times heavy, the observational quality that many of them embrace as part of their style is a welcome point de repère for the reader. For scholars working in early time periods whose physical culture is often overshadowed by contemporary sport phenomena, Part I, "Physical Activities and Games Prior to the Twentieth Century," will be of particular interest. Each of the three chapters performs unique and insightful readings of physical culture that include jeu de paume, mountaineering, and trictrac in works by Chrétien de Troyes, Montaigne, and Mérimée. In the four parts that follow, the essays explore sports including rugby, running, boxing, cycling, and, as one might expect, soccer as seen in literature and in contemporary culture. One of the volume's most important contributions is its exposure of the common themes that arise regardless of the century or sport, such as the relationship between sport and power, between sport and social class, between sport and race, and also between sport and gender, which is demonstrated in Cynthia Laborde's engaging analysis of Le petit Nicolas. Yet it is the relationship between sport and violence that is perhaps not only the most fascinating, but also the most disturbing and urgent issue, which the volume brings to light. With a work that encompasses so much, then, what could be missing? Sports like fencing, pétanque, and sailing, which one could assume as inexorably linked to some French-language cultures, do not make an appearance in the volume. This, however, is not necessarily evidence of an oversight or inherent lack. Rather, it reveals further opportunities to explore physical culture in French-speaking countries in scholarly contexts, or even just pour le sport. [End Page 272] Jodie Barker University of Nevada, Reno Copyright © 2023 American Association of Teachers of French

Construction and analysis of a nomogram prediction model for post-infectious bronchiolitis obliterans in children with adenovirus pneumonia after invasive mechanical ventilation

BackgroundPost-infectious bronchiolitis obliterans (PIBO) is the most common sequelae in children with adenovirus pneumonia (ADVP). However, there are few studies on the risk factors for PIBO occurrence. This study aims to investigate the risk factors for PIBO in pediatric patients with severe ADVP, especially after invasive mechanical ventilation (IMV), as well as to build a nomogram prediction model.MethodsThe clinical data, laboratory and imaging features, and treatment of 863 children with ADVP under 3 years old who were admitted to our hospital from January to December 2019 were retrospectively analyzed. Among them, 66 children with severe ADVP received IMV treatment. The situation and the influencing factors of PIBO in children with severe ADVP were explored, and a nomogram prediction model was constructed.ResultsAmong the 863 cases of ADVP, 46 cases (5.33%) developed PIBO. Duration of fever, IMV, complications, and neutrophil percentage were independent risk factors for PIBO in children with ADVP. Among the 66 patients with ADVP who underwent IMV, 33 patients (50.0%) developed PIBO. Gender, duration of fever, adenovirus (ADV) load, and mixed fungal coinfections were independent risk factors for PIBO. In the nomogram prediction model analysis, the area under the curve (AUC) was 0.857; in addition, Hosmer‒Lemeshow (H–L) detection reflected good alignment (χ2 = 68.75, P < 0.01).ConclusionsA nomogram prediction model, which can be utilized to predict PIBO occurrence in pediatric patients with ADVP after IMV at an early time period, was successfully built.