Extreme Locations Research Articles

Infection Rate and Antibiotic Administration for Urban Low-Energy Gunshot Wounds at an Academic Level 1 Trauma Center.

The purpose of this study was to review rates of infection after civilian ballistic fractures and assess the effect of early antibiotic administration (EAA) on infection rates. This was a retrospective cohort study done at an urban Level 1 Trauma Center. Patients ages 16 years and older with ballistic orthopaedic extremity injuries between May 2018 and December 2020 were enrolled. A total of 827 ballistic fractures were identified, and 371 fractures were analyzed after exclusions. The primary outcome measure was the incidence of infection within 90 days postinjury, correlated with the timing of antibiotic administration. Seventy percent of the extremity injuries received EAA (<3 hours of hospital admission) and 30% did not. Infections occurred in 6.9% of patients with EAA and in 7.3% of those without. We found no notable association between EAA and infection on multivariate logistic regression (odds ratio [OR] 1, 95% Confidence Interval [CI] 0.4 to 2.4, P = 0.99). Compartment syndrome (OR 5.4, 95% CI 1.1 to 26.4, P = 0.04) and surgical treatment of fracture (OR 12.9 95% CI 1.7 to 97.9, P = 0.01) were independently associated with higher odds of infection. We found no notable association between vascular injury or visceral injury and infection. Lower extremity fracture location was markedly associated with infection on multivariate logistic regression (OR 2.8; 95% CI 1 to 7.8; P = 0.05) when compared with upper extremity, hand, and foot locations. The highest infection rate was observed in tibial shaft fractures at 22%. Early antibiotic treatment did not markedly reduce infection odds in civilian low-energy ballistic fractures. The study underscores the need for context-specific, evidence-based treatment strategies. III (retrospective cohort study).

Using spruces (Picea spp.) for Icelandic afforestation

Afforestation can help address climate change and biodiversity loss. Iceland is a valuable case study to assess afforestation at extreme locations at high latitudes (63–68°N). We used a ~ 23-year dataset of a provenance trial from the Icelandic Forest Service (now Land & Forest Iceland) to determine the best spruce species (Picea spp.) and provenances for afforestation. Sites were either frost-prone or protected (i.e., non-frost-prone) locations, and the latest height and survival data were assessed from six sites (out of nine) in 2018. Provenances were mainly from three spruce species from southwestern Canada and southern Alaska (53–61°N). Sitka spruce (Picea sitchensis) and its hybrids or introgressants with white spruce (P. glauca) survived and grew well in protected areas (≥ 60% and ≥ 275 cm), while white spruce and its hybrids or introgressants with Sitka spruce performed better in frost-prone areas (≥ 55% and ≥ 285 cm, based on combined frost-prone sites). The only provenance suitable for both frost-prone and protected places was a Sitka/Lutz spruce (P. x lutzii) introgressant from Iniskin Bay, Alaska. Additional genetic research would help guide afforestation in harsh areas at high latitudes (a distributional limit of many tree species) and inform forest management about novel environments and sustainable practices. Climate change should also be considered for afforestation efforts.

Artificial intelligence-based computer-aided diagnosis for breast cancer detection on digital mammography in Hong Kong.

Research concerning artificial intelligence in breast cancer detection has primarily focused on population screening. However, Hong Kong lacks a population-based screening programme. This study aimed to evaluate the potential of artificial intelligence-based computer-assisted diagnosis (AI-CAD) program in symptomatic clinics in Hong Kong and analyse the impact of radio-pathological breast cancer phenotype on AI-CAD performance. In total, 398 consecutive patients with 414 breast cancers were retrospectively identified from a local, prospectively maintained database managed by two tertiary referral centres between January 2020 and September 2022. The full-field digital mammography images were processed using a commercial AI-CAD algorithm. An abnormality score <30 was considered a false negative, whereas a score of ≥90 indicated a high-score tumour. Abnormality scores were analysed with respect to the clinical and radio-pathological characteristics of breast cancer, tumour-to-breast area ratio (TBAR), and tumour distance from the chest wall for cancers presenting as a mass. The median abnormality score across the 414 breast cancers was 95.6; sensitivity was 91.5% and specificity was 96.3%. High-score cancers were more often palpable, invasive, and presented as masses or architectural distortion (P<0.001). False-negative cancers were smaller, more common in dense breast tissue, and presented as asymmetrical densities (P<0.001). Large tumours with extreme TBARs and locations near the chest wall were associated with lower abnormality scores (P<0.001). Several strengths and limitations of AI-CAD were observed and discussed in detail. Artificial intelligence-based computer-assisted diagnosis shows potential value as a tool for breast cancer detection in symptomatic setting, which could provide substantial benefits to patients.

Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction.

Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic basilar artery (BA) anatomy in ECW in patients with AIPI is herein studied. In 146 AIPI patients, infarcts were grouped into tegmental, lateral, anterolateral, anteromedial horizontally; and low, mid, mid-up, and upper pontine vertically. BA dolichoectasia was categorized according to Smoker criteria. An additional criteria of BA laterality angle was described. The length between the infarct long-axis and BA cross-sectional center was measured, and named as "branch length (BL)." ECW was defined as any increase in NIHSS. ECW was seen in 22 (15%) patients. Univariate analysis documented a higher female ratio (22% vs. 10%, P=0.007), higher atrial fibrillation (18% vs. 7%, P=0.067), more common anteromedial infarct location (77% vs. 49%, P=0.025), and Smoker category-3 BA height (32% vs. 10%, P=0.043) in these patients. In anteromedial infarcts, BL was longer (8.3 vs. 6.1mm, P=0.052), and reaching to significance in those located at mid-up/upper pontine level (1.22 vs. 0.62mm, P=0.006). BL >4.4mm showed an acceptable discriminatory capacity for ECW with an AUC of ROC: 0.615 (95% CI: 0.511-0.712). A regression model indicated female sex (β±SE=1.129±0.551, P=0.040), BL (per 4.4mm, β±SE=1.236±0.614, P=0.044), and BA height-category-3 (β±SE=1.711±0.645, P=0.008) as independent predictors for ECW. Some features of basilar dolichoarteriopathy, such as the extreme location of the height of the BA tip and the length of the involved perforator in the prepontine cistern, may be predictors of early clinical worsening in acute isolated pontine infarcts.

Active surveillance in patients with extra-abdominal desmoid-type fibromatosis: a pooled analysis of three prospective observational studies.

Three prospective observational studies (Italy, the Netherlands, France) on active surveillance (AS) in patients with extra-abdominal desmoid-type fibromatosis (DTF) support AS as a frontline approach. Identifying prognostic factors for the failure of AS will help determine the strategy. The aim of this study was to investigate the prognostic impact of clinical and molecular variables in a larger series. Data available as of January 31st, 2024, from the three studies, in which patients were followed for ≥3 years, were pooled. Patients ≥18 years old, with primary sporadic DTF and with CTNNB1 mutations available, were eligible. The primary study endpoint was treatment-free survival (TFS). Secondary endpoints included the incidence of RECIST progression, spontaneous RECIST regression and regression post-RECIST progression. Two hundred and eighty-two patients (n = 282) with a median follow-up of 53 months (IQR, 39-63) were included. Three-year and five-year TFS were 67% and 66%, crude cumulative incidences (CCI) of RECIST progression were 33% and 34%, of RECIST regression 26% and 34% and of regression post-RECIST progression 33% and 38%. In multivariable analysis, larger tumour size, mutation type, tumor locations were associated to lower TFS. The specific mutation (S45F), larger tumor size, and extremity and trunk location were all associated with a lower probability of spontaneous RECIST regression. This study confirms that spontaneous regression occurs in a significant proportion of patients and that two-thirds are treatment-free at 5 years. Initial tumor size, CTNNB1 mutation, and location should be factored into the initial decision-making process.

Space use and seasonal migrations of the wild forest reindeer (&lt;i&gt;rangifer tarandus fennicus&lt;/i&gt; (Lönnb. 1909)) in the republic of Karelia

The results of studying the space use and seasonal migrations of the Topozero territorial group of wild forest reindeer females in the Republic of Karelia are presented. Telemetry (GPS-collars) was used to assess the migration of the wild forest reindeer. Individual variations were noted in seasonal migrations: two individuals were relatively sedentary, whereas the third moved long distances during the year, with the distance between the extreme locations amounting to more than 70 km. The timing of the start of seasonal migrations varied between years. The use of the same summer habitats in different years was revealed, but the territories of the rut and winter pastures were different for the same animals. Movements of animals over fairly long distances have been noted, which is probably associated with the disturbance factor on the part of predators and/or humans.

A Theoretical Derivation and Comparison Method for the Optimal Location for Energy Dissipation Boxes

In long-distance, high-elevation gravitational water supply systems, it is essential to incorporate energy dissipation to lower pipeline pressures. The energy dissipation box is a novel device for pressure reduction, extensively utilized in gravitational flow transition systems. Despite its appealing contribution, systematic selection methods still need to be used regarding its optimum location. Hence, this paper considers the sum-of-the-maximum hydrostatic pressure head (SMHPH) and derives an extreme location equation for the energy dissipation box (EDB) in the design stage, and then, it comprehensively accounts for the overcurrent capacity and proposes a theoretical comparison and selection method for the optimal location (OL) between the critical and extreme locations. A theoretical analysis with an engineering case study is conducted to compare the theoretical OL, and numerical simulations are carried out to compare the pressure protection effect of the same box cross-sectional area and initial water volume of the theoretical OL and other possible locations with different initial water depths. The results show that the location of the EDB in the design stage should comprehensively consider the overcurrent capacity and the SMHPH. On the basis of both conditions, the oscillation amplitudes of the pressure gradient beyond the box are significantly decreased as the OL approaches closer to the downstream pipe. If the initial water depth in the box is large, the EDB provides greater protection to the pressure head (PH) by decreasing the cross-sectional area and then maximizing the utilization of water depth in the box and decreasing the volume of the EDB.

Long-Term Patency Between Brachiocephalic and Brachiobasilic Fistulas: A Single Institution Review

Dialysis access is a fundamental procedure performed by vascular surgeons. Commonly, upper extremity access is utilized via a brachiobasilic fistula (BBF) or brachiocephalic fistula (BCF). BCF is preferred due to ease compared to BBF without documented improved function. Few studies compare patency outcomes between BBF and BCF over time. Our goal was to evaluate the difference in outcomes between BBF and BCF. This is a retrospective review of patients with BCF or BBF between 2019 and 2022. Patients were split by procedure: BCF and BBF. Data collected included demographics, vein size, tunneled catheter, and previous access. Primary outcomes included primary patency (PP), primary assisted patency (PAP) and secondary patency (SP). Secondary outcomes included 30-day complications, access abandonment, interventions and mortality. Linear regression, Kaplan-Meier, and log-rank test were performed. Our study had 184 patients, 109 (59%) with BCF and 75 (41%) with BBF. There were no differences in demographics except for body mass index and vein size (BBF: 4 vs. BCF: 3.6mm, P=0.020). There was no difference in PP at 1year (41% vs. 47%, P=0.547) or SP at 2years (73% vs. 84%, P=0.058) in BBF versus BCF. However, PAP was significantly greater in BCF (80% vs. 67%, P=0.030) at 1year. Secondary outcomes revealed no difference in wound complications (1% vs. 0%, P=0.408), access abandonment (35% vs. 28%, P=0.260), or number of interventions (1 vs. 1, P=0.712) in BBF versus BCF. Mortality was significantly greater in the BBF patients (19% vs. 6%, P=0.005). On adjusted analysis, BBF had 43min longer operative time (P<0.001) and 22cc greater blood loss (P<0.0001). In this single center review comparing BBF and BCF, no difference was seen between BBF and BCF in terms of PP or SP. Even with larger vein size, BBF did not confer a benefit in long term patency or access abandonment. Additionally, BBF did not confer decreased procedures to maintain patency and BBF had greater operative length and blood loss, as well as mortality. We believe this study demonstrates that for patients who must use an upper extremity location, when the cephalic vein is satisfactory, using the cephalic vein is preferred as it does not negatively impact long-term patency.

Vascular flora of Punta Arenas city: comparative analysis of composition, life forms, and biogeographic origins

The composition of the vascular flora in Punta Arenas city, found in the city’s public spaces, was studied. The species were identified and recorded in a database, which was supplemented with information on taxonomic classification, growth habit, Raunkiaer’s life form, origin status (native or exotic), and original continent-level distribution. These data were compared with studies conducted in five other cities in central Chile, together with an analysis of compositional similarity with these cities, by using the additive complement of Simpson’s index (1– βsim). In Punta Arenas, 119 species were identified, showing a higher proportion of Gymnosperms compared to central Chilean cities. The most represented families were Asteraceae (16 species), Fabaceae (14), Rosaceae (14), Poaceae (12), and Pinaceae (10), which together accounted for 55% of the floristic richness. The compositional similarity between Punta Arenas and the other central Chilean cities ranged from 0.187 to 0.315, showing lower similarity than expected by chance (Montecarlo randomization test; P < 0.05). The primary origin distribution of Punta Arenas’ vascular flora was European, unlike central Chilean cities where it was Asian. Finally, the proportion of exotic species (91.6%) and the number of exotic species per native species (16 exotics/native) were the highest documented for cities in Chile and higher than in other 114 cities worldwide. These results indicate that Punta Arenas’ urban flora differs from the flora in central Chilean cities, not only in taxonomic composition but also in growth habit, biogeographical origin, and high level of exoticism. These differences are likely due to the city’s territorial isolation and extreme southern location (53°S), leading to a unique urban flora configuration.

The timing and location of entry in growing markets: subgame perfection at work

AbstractWe develop and analyze a dynamic model in which firms decide when and where to enter a growing market. We do not pre‐specify the order of entry, allowing instead for the leader and follower to be determined endogenously. We characterize the subgame perfect equilibria of the dynamic game and show the times and locations of entry are governed by the threat of preemption, which leads to premature entry, less extreme locations, and the dissipation of rents. Using data on gas stations, restaurants, and hotels in isolated markets, we find results consistent with subgame perfection for gas stations and three‐star hotels.

Comparison of Socio-demographic Characteristics, Tumour Features, and Surgical Treatment Outcomes in Phenotypic Variants of Basal Cell Carcinoma.

Basal cell carcinoma (BCC) cases exhibit variations in tumour number, location, and growth patterns. While some patients develop only one BCC, approximately one-third of patients later develop one or more additional lesions. The aim of the study was to identify risk factors for further BCC lesions in patients with different phenotypic presentations. We retrospectively evaluated 1052 histopathologically diagnosed tumours of 861 patients, who were divided into four phenotypic presentation groups according to tumour number at initial diagnosis and during follow-up. Age, sex, tumour characteristics, surgical margins, re-excision and residual tumour rates were compared. Univariate and multivariate logistic regression analyses were performed to determine risk factors for multiple tumour development. There were 723 patients in the single presentation phenotype 1 (SPP1) group, 19 in the SPP-more group, 114 in the multiple presentation phenotype (MPP)-cluster initial group, and five patients in the MPP-cluster later group. Male sex was more common in the MPP-cluster later group (P = 0.028). The mean age was lower in the SPP1 and SPP-more groups (P = 0.002). Ear involvement was more common in the MPP-cluster later group (P < 0.05). Superficial and basosquamous subtypes were more common in the SPP-more and MPP-cluster later groups (P < 0.05). Re-excision and residual tumour rates were lowest in the SPP1 group (P < 0.05). Age over 69 years, male sex, and periorbital or upper extremity location were significant risk factors for multiple tumour development (P < 0.05). The limitations of our study include the inability to evaluate environmental risk factors, phenotypic and ethnic characteristics, and the short follow-up period for newly added patients. Predicting different phenotypic presentations by taking the age, gender, and tumour characteristics (localization, histopathological subtype) of the patients into account may allow new tumours to be detected at an early stage.

Vortex-induced vibration of the variable cross-sectional cylinder cases in transverse direction at Re = 3900 using OpenFOAM

The one-degree-of-freedom (1-DOF) vortex-induced vibration in structures with varying cross-sectional shapes and incoming flows have been conducted using numerical simulation. The investigation centers on amplitude, frequency, spectrum, phase and fluid force coefficients. Additionally, the temporal and spatial characteristics as well as vortex dynamics mechanism are scrutinized, particularly during the cross-flow amplitude extremes. It can be indicated through studies that the cross-flow amplitudes in different incoming flows exhibit a distinctive distribution with three discernible branches. Frequency locking is found to amplify the dynamic response of the structure. Four tapered cylinder cases exhibit a delay in the location of the cross-flow amplitude extremes compared to two cylinder cases attributable to the influence of structural shear rate, which expands the upper branch. Superimposing incoming shear rate in the same direction as the structural shear rate not only enhances the cross-flow amplitude extremes but also broadens the range of forces and velocities distribution acting on the structure. Conversely, the imposition of incoming shear rate in the opposite direction to the structural shear rate leads to a contrary outcome. The incoming shear rate introduces secondary frequencies with higher energy in the spectrum characteristics of two cylinder cases, consequently promoting the amplification of the cross-flow amplitudes.

Lipophilic bioactive compounds from thermophilic cyanobacterium Leptolyngbya sp. HNBGU-004: Implications for countering VRSA resistance

Extremophiles thrive in extreme conditions, showcasing rich and unexplored diversity. This resilience hints at the existence of novel biochemical pathways and unique bioactive compounds. In contrast, the issue of drug resistance and excessive misuse of antibiotics in various settings, such as healthcare, agriculture, and veterinary medicine, has contributed to the emergence and spread of drug-resistant microorganisms.In the present research, Leptolyngbya sp. HNBGU-004, was obtained from an extreme location, a hot water spring in the Garhwal Himalayan region of India. The lipophilic fraction derived from Leptolyngbya sp. HNBGU-004 exhibited significant inhibitory effects against vancomycin-resistant Staphylococcus aureus (VRSA), displaying a bactericidal concentration of 0.5 mg mL−1. Furthermore, gas chromatography-mass spectrometry (GC-MS) analysis of the lipophilic extract unveiled the major constituents.Leptolyngbya sp. HNBGU-004 holds significant promise as a primary source of potent anti-vancomycin-resistant S. aureus components. These findings emphasize the importance of Leptolyngbya sp. HNBGU-004 as a foundational source for use as both a synergistic and alternative agent against VRSA.

Eurasian mid-latitude jet stream bridges an Atlantic to Asia summer teleconnection in heat extremes

Northern Europe and Northeast Asia, which are climatologically mild and temperate in early summer, both witnessed record-breaking heat extremes in June 2023. With a focus on the subseasonal time scale, this study highlights a teleconnected relationship in historical early-summer heat extremes between Northern Europe and Northeast Asia. By diagnosing the thermal budget and wave activity flux, we show that over one third of historical Northeast Asian heat extremes are initialized by Eurasian mid-latitude Rossby wave packets. The wave packets manifest as strong anticyclonic anomalies over subpolar North Atlantic, cyclonic anomalies over Ural region and anticyclonic anomalies over Northeast Asia, which directly cause coexisting heat extremes in Northern Europe and Northeast Asia. Such wave packets are strongly modulated by the Eurasian jet stream. By carrying out numerical experiments, we further explain why the wave packet is significant in early summer. We find that the quasi-stationary response of the Eurasian midlatitude Rossby wave packets to a specified heating in subpolar North Atlantic is dependent on the background jet structure. In early summer, the double-jet state over Eurasia favors Rossby wave propagation. This is of great practical importance for accurate prediction of Northeast Asian heat extreme amplitude and location.

Molecularly Confirmed Pseudomyogenic Hemangioendothelioma with Unusual EGFL7::FOSB Fusion in the Head and Neck Region of an Older Patient

Pseudomyogenic hemangioendothelioma (PMHE), a rare vascular neoplasm, was first described in 1992 asa fibroma-like variant of epithelioid sarcoma, and would be termed as epithelioid sarcoma-like hemangioendothelioma a decade later due to its significant histologic overlap with epithelioid sarcoma and diffuse cytokeratin expression. PHME is currently defined as a distinct, potentially intermediate malignant, rarely metastasizing neoplasm with vascular/endothelial differentiation. It is characterized by young age (typically less than 40 years old), extremity location (approximately ~80%), and t(7:19) SERPINE1::FOSB fusion as the most common molecular alteration. Herein, we report a case of a 59-year-old male presenting with multifocal lesions, including in the right temporalis muscle, right frontoparietal calvarium, right pterygoid muscles, and right mandibular condyle. Histologic examination of the right temporal lesion revealed a multinodular biphasic lesion composed of sheets and fascicles of elongated spindle and epithelioid cells infiltrating into the adjacent skeletal muscle. Admixed abundant neutrophilic infiltration is noted; however, areas of necrosis, increased mitosis, nuclear atypia, or rhabdomyoblast-like cells are absent. Immunohistochemical (IHC) staining showed that the tumor cells were diffusely and strongly positive for FOSB, pan-cytokeratin (AE1/AE3), CD31, and ERG. Molecular testing demonstrated a t(9:19) EGFL7::FOSB fusion mRNA. This constellation of morphological, IHC and molecular findings was consistent with a diagnosis of PMHE. This is the first reported case of multifocal PMHE with EGFL7::FOSB fusion in the head and neck area of a patient aged more than 50 years old. Since the differential diagnoses for PMHE includes high-grade malignancies with aggressive clinical behavior, coupled with the rare reports of PMHE in the head and neck region, awareness of this tumor in the head and neck region will avoid the misdiagnosis and overtreatment of this entity.

Cloud-Kitchens: Value Creation Through Co-Location

“Cloud Kitchens” are delivery-only facilities that house multiple restaurants. Food-delivery platforms operate such kitchens to exploit two advantages: (a) Location advantage, arising due to a cloud-kitchen’s central location—this enables lower delivery times to customers. (b) Consolidation advantage, which accrues when multiple restaurants choose to co-locate at the cloud kitchen—this enables the platform to use a common pool of delivery drivers, thereby reducing costs. However, a cloud-kitchen’s eventual impacts on both the restaurants and the platform are intricately connected through their respective decisions—namely, the restaurants’ location decisions and the platform’s delivery capacity and delivery time. We examine conditions under which a cloud kitchen simultaneously benefits the primary stakeholders: delivery platform, restaurants, and customers. Our game-theoretic analysis considers two restaurants and a delivery platform. The restaurants simultaneously decide whether to stay at their initial (extreme) locations or relocate to a centrally located cloud kitchen. The platform decides the driver headcount and the delivery times for customers. In line with industry trends, we show that as population density increases beyond a threshold, the restaurants co-locating at the cloud kitchen is first a Pareto-dominant equilibrium and then the unique equilibrium. The platform and customers also prefer this equilibrium, leading to a win-win-win for the stakeholders. A cloud-kitchen’s benefit to the platform further increases as the drivers’ operational environment becomes more constrained, i.e. drivers’ carry-limit and speed decrease, and driver cost increases.

Impact of pain and adverse health outcomes on long-term US testicular cancer survivors.

No study has quantified the impact of pain and other adverse health outcomes on global physical and mental health in long-term US testicular cancer survivors or evaluated patient-reported functional impairment due to pain. Testicular cancer survivors given cisplatin-based chemotherapy completed validated surveys, including Patient-Reported Outcomes Measurement Information System v1.2 global physical and mental health, Patient-Reported Outcomes Measurement Information System pain questionnaires, and others. Multivariable linear regression examined relationships between 25 adverse health outcomes with global physical and mental health and pain-interference scores. Adverse health outcomes with a β^ of more than 2 are clinically important and reported below. Among 358 testicular cancer survivors (median age = 46 years, interquartile range [IQR] = 38-53 years; median time since chemotherapy = 10.7 years, IQR = 7.2-16.0 years), median adverse health outcomes number was 5 (IQR = 3-7). A total of 12% testicular cancer survivors had 10 or more adverse health outcomes, and 19% reported chemotherapy-induced neuropathic pain. Increasing adverse health outcome numbers were associated with decreases in physical and mental health (P < .0001 each). In multivariable analyses, chemotherapy-induced neuropathic pain (β^ = -3.72; P = .001), diabetes (β^ = -4.41; P = .037), obesity (β^ = -2.01; P = .036), and fatigue (β^ = -8.58; P < .0001) were associated with worse global mental health, while being married or living as married benefited global mental health (β^ = 3.63; P = .0006). Risk factors for pain-related functional impairment included lower extremity location (β^ = 2.15; P = .04) and concomitant peripheral artery disease (β^ = 4.68; P < .001). Global physical health score reductions were associated with diabetes (β^ = -3.81; P = .012), balance or equilibrium problems (β^ = -3.82; P = .003), cognitive dysfunction (β^ = -4.43; P < .0001), obesity (β^ = -3.09; P < .0001), peripheral neuropathy score (β^ = -2.12; P < .0001), and depression (β^ = -3.17; P < .0001). Testicular cancer survivors suffer adverse health outcomes that negatively impact long-term global mental health, global physical health, and pain-related functional status. Clinically important factors associated with worse physical and mental health identify testicular cancer survivors requiring closer monitoring, counseling, and interventions. Chemotherapy-induced neuropathic pain must be addressed, given its detrimental impact on patient-reported functional status and mental health 10 or more years after treatment.

Incidence and Survival Outcomes of Dermatofibrosarcoma Protuberans From 2000 to 2020: A Population-Based Retrospective Cohort Analysis.

Recent changes in the incidence and survival of dermatofibrosarcoma protuberans (DFSP) have not been described. To characterize the incidence and survival of DFSP. A retrospective cohort study of patients with DFSP from 2000 to 2020 in the Surveillance, Epidemiology, and End Results database was performed. Cox and Fine-Gray regression models were used to assess overall and DFSP-specific survival. The incidence of DFSP has not changed from 2000 to 2020 with 4.6 cases/million person-years, with higher rates in dark-skinned and middle-age individuals. Factors associated with overall mortality in DFSP patients include advanced age ( p < .0001), male sex (hazard ratio [HR] 1.8, p < .0001), larger tumors (HR 1.002 per millimeter, p < .001), lower household income (HR 1.8, p = .0002), and lower extremity location (HR 1.7, p = .008). Mohs surgery is associated with improved overall survival (HR 0.4, p = .02). Large tumor size (6.0+ cm, HR 6.7, p = .01) and advanced age (age 80+ years, HR 21.3, p = .003) were associated with worse DFSP-specific mortality. Dermatofibrosarcoma protuberans incidence has remained constant from 2000 to 2020. Increasing age and tumor size, decreased income, male sex, and lower extremity location are associated with worsened survival. Mohs surgery is associated with improved overall survival. Increased age and tumor size are associated with worsened DFSP-specific mortality.

Increased extreme humid heat hazard faced by agricultural workers

Increases in population exposure to humid heat extremes in agriculturally-dependent areas of the world highlights the importance of understanding how the location and timing of humid heat extremes intersects with labor-intensive agricultural activities. Agricultural workers are acutely vulnerable to heat-related health and productivity impacts as a result of the outdoor and physical nature of their work and by compounding socio-economic factors. Here, we identify the regions, crops, and seasons when agricultural workers experience the highest hazard from extreme humid heat. Using daily maximum wet-bulb temperature data, and region-specific agricultural calendars and cropland area for 12 crops, we quantify the number of extreme humid heat days during the planting and harvesting seasons for each crop between 1979–2019. We find that rice, an extremely labor-intensive crop, and maize croplands experienced the greatest exposure to dangerous humid heat (integrating cropland area exposed to >27 °C wet-bulb temperatures), with 2001–2019 mean rice and maize cropland exposure increasing 1.8 and 1.9 times the 1979–2000 mean exposure, respectively. Crops in socio-economically vulnerable regions, including Southeast Asia, equatorial South America, the Indo-Gangetic Basin, coastal Mexico, and the northern coast of the Gulf of Guinea, experience the most frequent exposure to these extremes, in certain areas exceeding 60 extreme humid heat days per year when crops are being cultivated. They also experience higher trends relative to other world regions, with certain areas exceeding a 15 day per decade increase in extreme humid heat days. Our crop and location-specific analysis of extreme humid heat hazards during labor-intensive agricultural seasons can inform the design of policies and efforts to reduce the adverse health and productivity impacts on this vulnerable population that is crucial to the global food system.

Test-retest reliability of quantitative sensory testing, active joint position sense, and functional hop testing in amateur adult athletes with unilateral anterior cruciate ligament reconstruction

ObjectivesThe somatosensory system fulfils a critical role in functional knee joint stability (FKJS) by providing afferent feedback necessary for neuromuscular control. Individuals with anterior cruciate ligament reconstruction (ACLr) have altered somatosensory function. Somatosensory characteristics are assessed by proprioception and quantitative sensory testing. The purpose of the study was to examine intra-rater and inter-rater reliability of methods used to assess somatosensory characteristics and FKJS in amateur adult athletes with unilateral ACLr. DesignRepeated measures. SettingUniversity. Participants8 female, 4 male with unilateral autogenous ACLr. Main outcome measuresBilateral measurements at 5 lower extremity locations and the anterior forearm: light touch (LT), vibration sense (VS), pressure pain threshold (PPT); knee active joint position sense (AJPS); adapted crossover hop for distance (ACHD). Intraclass correlation coefficients (ICC) determined reliability, defined as: poor (<0.50), moderate (0.50–0.75), good (0.75–0.90). ResultsACLr-side intra-rater/inter-rater ICCs ranged: LT, −0.27-0.80/-0.01-0.84; VS, 0.12–0.90/0.25–0.90; PPT, 0.49–0.98/0.86–0.99; AJPS, 0.15–0.79/0.55–0.87; ACHD, 0.98/0.99. Uninjured-side intra-rater/inter-rater ICCs ranged: LT, 0.12–0.66/-0.09-0.64; VS, 0.35–0.89/0.05–0.81; PPT, 0.65–0.99/0.45–0.95; AJPS, 0.07–0.81/0.37–0.99; ACHD, 0.99/0.98. ConclusionsIntra-rater and inter-rater reliability was poor to good for both limbs. Overall, PPT and the ACHD demonstrated the highest ICCs. Some somatosensory assessments can be employed with confidence, while others should be used with caution.