Similar Groups Research Articles

An antenatal intervention pilot service development project in a community perinatal team

Objective The Adjustment to motherhood group was designed for women under the Hertfordshire Community perinatal team (CPT) in late 2021, as an antenatal intervention to ease the transition to motherhood, to strengthen the mother-infant relationship, and to keep baby safe despite challenges. Our hypothesis was that the group would support women who did not feel mentally or emotionally prepared for the baby’s arrival. The group consisted of four weekly hour-long virtual antenatal sessions. One session was delivered each by occupational therapist, nursery nurse, clinical psychologist and parent-infant psychotherapist, with a mix of didactic and psychoeducation. The 4 sessions enable the therapists to prepare the women for common situations they may encounter once their baby arrived, and encouraged the participants to be open to contacting the perinatal team if they recognised they were struggling. They were followed by a postnatal reunion session, approximately a month later. Psychology resources and a booklet on Adjusting to motherhood were circulated. Methods Mixed methods design. Referrals were sought from all clinicians in the community perinatal team who also obtained verbal consent. The referred women were grouped according to their gestations and estimated due date. Ethical approval was not sought as this was a service evaluation. Sample: 10 women in the pilot, 24 women in two subsequent groups, mostly first-time mums. Data collection: Quantitative: A questionnaire was circulated antenatally and postnatally, based on the Rigidity of maternal beliefs scale (RMBS) and the Pre- and Post-natal Bonding Scale (PPBS). Qualitative data was collected during feedback session in reunion groups. Results More than half of the referred women attended most sessions; there was a low response rate in the postnatal questionnaire however there was improvement in relationship with baby among those who answered. Conclusion This is an acceptable low-cost antenatal intervention that can benefit first time mums and improve the relationship with their baby. Similar groups can be created in other regions. It can be improved by co-designing future iterations, by distributing the validated questionnaires to a bigger number of mothers and to include a session addressed at fathers.

Palestine-Israel Conflict Resolution Analysis Study in the Perspective of Islamic History

<p><strong>The Palestinian-Israeli conflict lasted over half a century and has widely influenced international political currents. This article aims to unravel the roots of the Palestinian-Israeli conflict, explain alleged Israeli-American and American-Arab conspiracies, and solve the peace process in the match, which all failed. This research uses qualitative research methods by utilizing a narrative approach. The data collection technique used is library research with much secondary data, including scientific articles and textbooks related to the Palestinian-Israeli conflict. These data are collected, validated, arranged in similar groups, and processed data analysis using content analysis methods. The results show that Palestine is getting worse in the face of Israel, while Israel is getting stronger in armaments, economy and gaining support from major powers such as the United States, Britain, and France. The research also found that the Jewish bill submitted by Benjamin Netanyahu to the Israeli Parliament can potentially increase the number of Jews and reduce the rights of Arab Muslims as a minority community. In addition, the number of groups in Palestine hindered the country’s unity and resulted in the exodus and deportation of Muslims with former Israeli citizenship.<em></em></strong></p><p><strong><em>Keywords</em></strong> – <em>Analysis Study</em><em>, </em><em>Conflict</em><em>,</em><em> Islamic History</em><em>, </em><em>Palestine-Israe</em><em>l.</em></p>

Global taxonomic, functional, and phylogenetic diversity of bees in apple orchards

An essential prerequisite to safeguard pollinator species is characterisation of the multifaceted diversity of crop pollinators and identification of the drivers of pollinator community changes across biogeographical gradients. The extent to which intensive agriculture is associated with the homogenisation of biological communities at large spatial scales remains poorly understood. In this study, we investigated diversity drivers for 644 bee species/morphospecies in 177 commercial apple orchards across 33 countries and four global biogeographical biomes. Our findings reveal significant taxonomic dissimilarity among biogeographical zones. Interestingly, despite this dissimilarity, species from different zones share similar higher-level phylogenetic groups and similar ecological and behavioural traits (i.e. functional traits), likely due to habitat filtering caused by perennial monoculture systems managed intensively for crop production. Honey bee species dominated orchard communities, while other managed/manageable and wild species were collected in lower numbers. Moreover, the presence of herbaceous, uncultivated open areas and organic management practices were associated with increased wild bee diversity. Overall, our study sheds light on the importance of large-scale analyses contributing to the emerging fields of functional and phylogenetic diversity, which can be related to ecosystem function to promote biodiversity as a key asset in agroecosystems in the face of global change pressures.

A trait-based approach to both forestry and timber building can synchronize forest harvest and resilience.

Along with forest managers, builders are key change agents of forest ecosystems' structure and composition through the specification and use of wood products. New forest management approaches are being advocated to increase the resilience and adaptability of forests to climate change and other natural disturbances. Such approaches call for a diversification of our forests based on species' functional traits that will dramatically change the harvested species composition, volume, and output of our forested landscapes. This calls for the wood-building industry to adapt its ways of operating. Accordingly, we expand the evaluation of the ecological resilience of forest ecosystems based on functional diversification to include a trait-based approach to building with wood. This trait-based plant-building framework can illustrate how forecasted forest changes in the coming decades may impact and guide decisions about wood-building practices, policies, and specifications. We apply this approach using a fragmented rural landscape in temperate southeastern Canada. We link seven functional groups based on the ecological traits of tree species in the region to a similar functional grouping of building traits to characterize the push and pull of managing forests and wood buildings together. We relied on a process-based forest landscape model to simulate long-term forest dynamics and timber harvesting to evaluate how various novel management approaches will interact with the changing global environment to affect the forest-building relationships. Our results suggest that adopting a whole system, plant-building approach to forests and wood buildings, is key to enhancing forest ecological and timber construction industry resilience.

A Model for the Lithospheric Architecture of the Central Andes and the Localization of Giant Porphyry Copper Deposit Clusters

Abstract In the central Andes, giant porphyry copper deposits of similar ages group into discrete geographic clusters that are regularly spaced and aligned within orogen-parallel belts. This clustering highlights how exceptional geologic processes affected localized regions of the lithosphere during mineralization and that the spatial and temporal distribution of giant porphyry deposits is nonrandom. Development of favorable regions of lithosphere for significant metal concentration are linked to the overlap of structural pathways that focus fluid and magma flow from the mantle to upper crust during high-horizontal-compressive-strain events. These structural pathways are notoriously difficult to identify in the field due to their often-subtle surficial manifestations and continental scale. Field mapping at multiple scales in northwest Argentina and southern Peru, as well as regional structural traverses throughout the central Andes, indicates the presence of regional-scale structural corridors 5 to 25 km wide and hundreds of km long that consist of myriad fault planes. The variable width and diffuse surface expression of these corridors is interpreted to reflect the upward propagation of underlying zones of basement weakness through younger supracrustal sequences in the overriding plate. Such structural corridors are (1) apparent at multiple scales of investigation, (2) long-lived, (3) preferentially reactivated though time, and (4) evident in geophysical data sets. This structural architecture formed in response to the interplay of pre-Cenozoic tectonics and the orientation of inherited structural weaknesses. These fault systems persist in the upper crust as steep zones of enhanced permeability that can preferentially reactivate as pathways for ascending hydrous magmas and fluids during major deformation events. Linear orogen-parallel structural belts cogenetic with the magmatic arc provide the first-order control to giant porphyry copper deposit distribution. The second-order control is the intersection of orogen-oblique structural corridors with the orogen-parallel belts, localizing deposit clusters at these intersections. Such regions are inferred to have been zones of deep permeability, with vertical translithospheric pathways activated during high-strain tectonic events that affected the intra-arc stress field.

Morphological diversity of ancho chile pepper landraces from Mexico

AbstractAncho (width) chile peppers have economic, social, culinary and cultural importance in Mexico and worldwide. This chile type considers divergent subtypes that altogether have not been analysed and therefore their morphological diversity has not been systematically described. The objectives were to describe the morphological diversity of ancho pepper landraces from Mexico, to identify groups of similarity and to define the traits with the higher contribution to the total variation. Eighty-six landraces of ancho chile peppers (red, ‘mulatos’, ‘miahuatecos’, ‘cristalinos’ and ‘huacle’), collected in six states of Mexico, and two commercial controls were evaluated in two localities, in a simple randomized complete block experimental design. We recorded 76 morphological traits. Statistical analysis included a combined ANOVA, Pearson's correlation coefficient, discriminant analysis, principal components and clusters. The morphological diversity in ancho chile peppers was mainly made up of fruit width, fruit wall thickness, stem diameter, corolla length, seed weight per fruit, plant height, stem length and pubescence. We defined four groups, which made it possible to differentiate ancho chile peppers of Puebla and the huacle chile pepper of Oaxaca from populations collected in the north and ‘Bajío’ (midland) parts of Mexico. Ancho chile peppers of Mexico showed wide morphological differences according to the type of chile pepper and seed collection regions. The traits that contributed the greatest morphological diversity were fruit width, fruit wall thickness, stem diameter, corolla length, seed weight per fruit, plant height, stem length and pubescence.

Mapping the Seismicity of Mars With InSight

AbstractThe InSight seismometers have recorded more than 1,300 events. Ninety‐eight of these, named the low‐frequency (LF) family, show energy predominantly below 1 Hz down to ∼0.1 Hz. The Marsquake Service identified seismic phases and computed distances for 42 of these marsquakes, 24 of which have backazimuths. Hence, the locations of the majority of LF family events remain undetermined. Here, we use an envelope shape similarity approach to determine event classes and distances, and introduce an alternative method to estimate the backazimuth. In our analysis, we use the highest quality marsquakes with known distances as templates, including the largest event S1222a, and assign new distances to similar group of events for which distance estimates were not previously available. We find the Tharsis region to be more active than initially perceived on the basis of 5 newly located events near Valles Marineris and Olympus Mons. We relocate two marsquakes with little or no S‐wave energy in the NE of the Elysium Bulge. The event epicenters in Cerberus Fossae follow a north‐south trend due to uncertainties in location, while the fault system is in the NW‐SE direction; therefore, these events are re‐projected along the observed fault system based on our interpretations. The marsquakes in our interpreted catalog are predominantly observed in the northern hemisphere of Mars above the equatorial dichotomy boundary.

Novel N-Acylethanolamide Derivatives Affect Body Weight and Energy Balance.

Introduction - The obesity pandemic is multifactorial. Nutritional, pharmacologic and surgical interventions are limited in reach and efficacy, raising need for new therapeutics. Aims - Characterization of anorexigenic and cognitive effect and central mechanism of action of novel N-acylethanolamide derivatives. Methods - Sabra mice divided to similar experimental groups, injected IP with: oleyl-L-leucinolamide (1 A), linoleyl-L-leucinolamide (4 A), linoleyl-L-valinolamide (5 A), oleyl-oxycarbonyl-L-valinolamide (1 B), oleyl-oxycarbonyl-D-valinolamide (2 B), oleylamine-carbonyl-L-valinolamide (3 B), oleylamine-carbonyl-D-valinolamide (4 B), and oleyl-L-hydroxyvalineamide (5 B). Control group with vehicle. Body weight and food consumption followed for 39 days. Motor activity and cognitive function by open field test and eight-arm maze. Mice sacrificed and mechanism of action investigated by qPCR. The genes analyzed involved in energy balance and regulation of appetite. Catecholamines and serotonin evaluated. Results - Compounds 1 A, 5 A, 1 B-4 B, caused significant weight loss of 4.2-5.6 % and 5 A, 1 B-4 B, improved cognitive function following 8 i. p. injections of 1 mg/kg during 39 days, by different mechanisms. 5 A, 3 B and 4 B decreased food consumption, whereas 1 A, 5 A and 2 B increased motor activity. 1 A, 4 A, 1 B and 3 B elevated SIRT-1, associated with survival. POMC upregulated by 1 B and 2 B, CART by 1 B, 2 B and 1 A. NPY and CAMKK2 downregulated by 5 A. 4 B enhanced 5-HT levels. 4 A, 5 A, 1 B, 4 B, 5 B decreased FAAH, showing long lasting effect. Conclusions - These new compounds might be developed for the treatment of obesity and for improved cognitive function.

Risk Factors for Pneumonia in Toddlers During the Covid-19 Pandemic

Background: Among the period 2019-2021, Ambacang Health Center has the highestfrequency of pneumonia in toddlers in Padang CityPurpose: This study aims to determine thefactors associated with pneumonia in toddler in the Ambacang Public Health CenterWork Area, Padang City, during COVID-19 pandemic.Methods: Study used a case-control design with similar age groups. Population of toddler aged 11-59months. Cases were sampled using a simple random sampling technique based on pneumonia registration in March 2020-March 2022, controls were sampled usingpurposive sampling. Interviews and questionnaires were used to collect data, whichwas then analyzed using univariate, bivariate, and multivariate analysis. Thenumberofsampleswas74toddlerwith37samplesforeachgroupResults: Thereisassociationbetweenexclusivebreastfeeding(OR=3.67),basicimmunization(OR=2.8), air pollution (OR=5.0) and residential density (OR=3.0) on the incidenceofpneumonia.Meanwhile,historyofLBW,educationlevelandmaternalemployment were not associated with pneumonia. Household air pollution was thedominantfactorassociatedwithincidenceofpneumonia for toddler during COVID-19 pandemic in the AmbacangPublic Health Center Work Area, Padang CityConclusion: It is recommended for health workersto improve health promotion PHBS in the household and impact air pollution on thehealthof toddler.

Comparative analysis of genetic polymorphism in <i>Rhaponticum carthamoides</i> (Asteraceae) populations by ISSR markers in the Altai Republic

Background. Rhaponticum carthamoides (Willd.) Iljin (Asteraceae) is a rare species for the Altai Republic (AR). The purpose of this study was to characterize the genetic polymorphism of Rhaponticum carthamoides at the inter- and intrapopulation level in a comparative analysis for subsequent selection of seed samples from the genetically most heterogeneous natural populations of the AR for practical purposes. Materials and methods. The species was studied for ISSR variability in five habitats in the AR. DNA from dried leaves of R. carthamoides was isolated using the STAB method. For testing seventeen ISSR primers were used, seven of which were selected as most informative ones. Results and conclusion. The analysis showed that individual plants from five cenopopulations (CP) were distributed into three groups of similarity on the dendrogram. A separate clade was formed by plant samples from two CPs of the Katun Nature Reserve (KNR). Samples of one of those CPs grew on well-warmed southern slopes and exhibited a higher genetic heterogeneity than the others. The highest intrapopulation and interpopulation similarity in the distribution of DNA fragments was also found in two CPs from habitats with the smallest geographic distance from each other. Representatives of a separate population, least in size and number of individuals in the KNR, showed a high level of similarity in the distribution of DNA fragments. Significantly lower coefficients of genetic similarity with other CPs were found in plants from a small isolated CP from the Shavlinsky Protected Area. It can be assumed that one of the main reasons for the least genetic similarity of this population with others is its location in the immediate vicinity of the foothill at the pass to Achik (Ongudaysky District; absolute height: 2300 masl). This location can be a limiting factor for the exchange of genetic information with individuals from other populations.

The kraft lignin characteristics of areca leaf sheath isolated by phosphoric acid

This study reported on lignin extraction from the Areca leaf sheath (ALS) by boiling treatment before kraft pulping. OFAT (one factor, one time) was designed to determine the optimal pulping condition for the highest delignification selectivity (DS). On that optimum condition, lignin was precipitated from black liquor by 20 % phosphoric acid. The 22 % active alkali and 22 % sulfidity were the optimal conditions. The lignin was then characterized by the morphological, chemical, and thermal properties and particle size. Isolated lignin has similar functional groups to reference lignin with purity and yield of 62.7 % and 12.27 %. The thermal analysis of lignin resulted in a char residue of 30.2 % with a glass transition temperature (Tg) of 117.34 °C. The lignin has an irregular or non-uniform form in micron size. A low equivalent weight of lignin indicates its prospect as an adhesive or an adhesive filler for panels.

First Report of Leaf Spot of Sugar Beet Caused by Stemphylium vesicarium in Minnesota, USA.

In July 2021, sugar beet (Beta vulgaris L.) leaves with numerous tan to brown spots with white-bleached center and oval to irregularly shaped were collected from a field in Minnesota (MN) (46.2774° N, 96.3100° W), with 15% disease incidence and 30% disease severity. Leaves were washed with tap water then surface disinfected in 1% NaOCl aqueous solution for 1 min. Samples were rinsed thrice with sterile distilled water and dried in a laminar flow hood. A 2-cm leaf disc was plated on potato dextrose agar amended with streptomycin sulfate (200 mg/L) and incubated for four days at 25°C under 12-h light/dark cycle. Single spore cultures were obtained by suspending in sterile water spores harvested from a single colony. The suspension was streaked on a dish with V8 agar media and incubated as described. Five pure cultures were transferred to clarified V8 agar media for morphological feature observations. Colonies were uniform in appearance and developed light to olivaceous green mycelium. Conidia were dark brown to olivaceous green in color and measured 30 × 18 μm (n=20). They were oblong to broadly oval shaped muriform, and multiseptated (1 to 5 septa). Hyphae were septate and pale brown. Conidiophores were short, septate, and light to dark brown in color. Based on the morphological characteristics, isolates were identified as Stemphylium vesicarium (Simmons 1969). Genomic DNA of all five isolates were extracted using the DNeasy Plant Mini Kit (Qiagen, Hilden, Germany). PCR amplification and sequencing of the internal transcribed spacer (ITS) region (ITS1/ITS4 primers), the largest subunit of RNA polymerase II (5F2/7cR primers) (O'Donnell et al. 2009), the plasma membrane ATPase (ATPD-F1/ATPD-R1) gene (Lawrence et al. 2013), glyceraldehyde-3-phosphate-dehydrogenase gene (GAPDH) (gpd1/gpd2) (Berbee et al. 1999), and β-tubulin gene (Bt2a/Bt2b primers) (Glass and Donaldson 1995) were done using standard procedures. Sequences were submitted to GenBank under accession numbers OP584331 (ITS), OP589289 (RPB2), OP589290 (ATPase), OP994239 (GAPDH) and OP382477 (β-tubulin). The BLASTN search of the sequences showed 100% similarity with MT629829 (ITS) (525/525 bp), KC584471 (RPB2) (859/859 bp), JQ671770 (ATPase) (794/794 bp), MK105974 (GAPDH) (519/519 bp) and MN410922 (β-tubulin) (320/320 bp) reference sequences of S. vesicarium. Pathogenicity tests were done using four cv. Maribo MA 504 plants. S. vesicarium spore suspensions (1 × 106/ml) were sprayed on three leaves from each plant. This trial was repeated with three replicates. A similar group of plants were sprayed with autoclaved distilled water to serve as non-inoculated control. All plants were incubated in the mist chamber for 5 days at 25°C, under daily 14/10 light-dark cycles, and >80% relative humidity, then transferred to the greenhouse kept at 23 ± 2°C and a 12-h photoperiod. Fifteen days post-inoculation, all inoculated plants had multiple lesions with dark brown margins with a grayish center, and non-inoculated control plants were asymptomatic. The re-isolated fungus was morphologically similar to isolates retrieved from the field. S. vesicarium was reported on sugar beet in Michigan (Metheny et al. 2022). This is the first report of S. vesicarium causing disease on sugar beet in MN. Stemphylium sp. is a major problem of sugar beet in the Netherlands (Hanse et al. 2015). Efforts should be made to prevent introduction of susceptible beet cultivars so that the disease does not become widespread in the USA.

Fundamental units of numerosity estimation

Humans can approximately enumerate a large number of objects at a single glance. While several mechanisms have been proposed to account for this ability, the fundamental units over which they operate remain unclear. Previous studies have argued that estimation mechanisms act only on topologically distinct units or on units formed by spatial grouping cues such as proximity and connectivity, but not on units grouped by similarity. Over four experiments, we tested this claim by systematically assessing and demonstrating that similarity grouping leads to underestimation, just as spatial grouping does. Ungrouped objects with the same low-level properties as grouped objects did not cause underestimation. Further, the underestimation caused by spatial and similarity grouping was additive, suggesting that these grouping processes operate independently. These findings argue against the proposal that estimation mechanisms operate solely on topological units. Instead, we conclude that estimation processes act on representations constructed after Gestalt grouping principles, whether similarity based or spatial, have organised incoming visual input.

Transmitting, Mutational and Pandemic Nature of Corona: The Role oF Transposons, IS1::Tn::IS1 and CRISPR- CAS-9.

Corona/ Covid19/Omicron / SARS/ MARS similar viruses have no individual genetic mechanism to make them encapsulated spore forming microbes similar to bacteria, fungi, algal blooms involved spreading allergy. Transmission in all such cases need fluid dynamics of water and air. This flow does not require any support of matrix, i.e. nano particles of carbon, silicates and dust of animate inanimate molecules. They enter into lung alveoli surface epithelial cell, adhere on the surface of body saliva, originated due to cold and other infections. In support of ACE-I and II (Angiotensin Converting Enzyme I and II) [1]. So, there are two releasing mechanisms are existing in corona infection; one is the release of corona virus from the alveoli cells with matrix binds of one comorbid patients directly to other healthy recipient at the distance of 6 m in a closed environment by its self-development irritation and allergy, as received by sudden irritating smoke developed from kitchen, pollen, that grows during grass cutting, cleaning and sanitization. Transcription of m-RNA, in a matrix based single corona after entering into lung alveoli starts to transcribe and translate to many molecules of corona viruses, damages alveoli cells of lung, caused due to individual physiological conditions, old (above 70 years) and young (below 40), co-morbid(sick) and healthy people at similar age groups. IS::Tn::IS), Crispr/Cas-9 DNA transposons existing in corona m-RNA starts to act during transcription, and translation.

Wyjazd naukowy do Lwowa jako forma kształcenia archiwistów w Uniwersytecie Marii Curie-Skłodowskiej

Archival studies programs include periodic study visits in the modern archives. So far, no thorough publications were devoted to them, which is why this text was written. It is focused on visits to Lviv the Maria Curie-Skłodowska University (UMCS) students’, firstly those enrolled in the archivist specialization of the history program, then, since 2012, archival studies. They were organized annually within the period between 2007 and 2019 for groups of six students with their supervisors. The visits lasted seven days each, and their aim was to explore the archives and libraries of Lviv. Each year a similar student group of the Ukrainian University of Lviv in Honor of Ivan Franko came to Lublin and partook in the explorations of Polish archives along with the UMCS students. Over the described period, 74 students of UMCS altogether went to Lviv, and a similar number of Lviv’ students visited Polish archives. The article characterizes the visit program of the Lublin students to Lviv and its execution, and evaluates the effects of the visits with the use of the student reports, short essays as well as the assessments of visits drawn up after years.

Technical note: Complexity–uncertainty curve (c-u-curve) – a method to analyse, classify and compare dynamical systems

Abstract. We propose and provide a proof of concept of a method to analyse, classify and compare dynamical systems of arbitrary dimensions by the two key features uncertainty and complexity. It starts by subdividing the system's time trajectory into a number of time slices. For all values in a time slice, the Shannon information entropy is calculated, measuring within-slice variability. System uncertainty is then expressed by the mean entropy of all time slices. We define system complexity as “uncertainty about uncertainty” and express it by the entropy of the entropies of all time slices. Calculating and plotting uncertainty “u” and complexity “c” for many different numbers of time slices yields the c-u-curve. Systems can be analysed, compared and classified by the c-u-curve in terms of (i) its overall shape, (ii) mean and maximum uncertainty, (iii) mean and maximum complexity and (iv) characteristic timescale expressed by the width of the time slice for which maximum complexity occurs. We demonstrate the method with the example of both synthetic and real-world time series (constant, random noise, Lorenz attractor, precipitation and streamflow) and show that the shape and properties of the respective c-u-curve clearly reflect the particular characteristics of each time series. For the hydrological time series, we also show that the c-u-curve characteristics are in accordance with hydrological system understanding. We conclude that the c-u-curve method can be used to analyse, classify and compare dynamical systems. In particular, it can be used to classify hydrological systems into similar groups, a pre-condition for regionalization, and it can be used as a diagnostic measure and as an objective function in hydrological model calibration. Distinctive features of the method are (i) that it is based on unit-free probabilities, thus permitting application to any kind of data, (ii) that it is bounded, (iii) that it naturally expands from single-variate to multivariate systems, and (iv) that it is applicable to both deterministic and probabilistic value representations, permitting e.g. application to ensemble model predictions.

Concordance of shoulder strength assessments using a spring balance and isometric dynamometer in patients before and after arthroscopic rotator cuff repair

Shoulder strength is an essential assessment to monitor the outcome of treatment interventions. Isometric strength assessment in the Constant Score (CS) was initially measured with a cable tensiometer or spring balance (SB). Some authors have questioned the validity of this strength assessment and the resulting CS. The purpose of this study was to investigate the concordance of strength measurements using an unsecured SB vs. isometric dynamometer and outline the impact of these methods on the CS. In the context of routine clinical examination as well as participation in a Swiss national cohort study, shoulder strength was measured to calculate baseline (before surgery) and 6-month postoperative CS in adult rotator cuff tear patients who had undergone primary arthroscopic rotator cuff repair. Measurements of each of the operated and contralateral shoulders were made per patient routinely using an unsecured SB and study-specific using an isometric dynamometer in patients with the shoulder at 90° abduction in the scapular plane. Absolute and change values of strength and CS data were presented in scatter plots and assessed using concordance correlation coefficients (CCCs) and Bland-Altman plots. Between June 2020 and October 2021, baseline strength measurements from the operated shoulder of 78 patients ranged from 0.0 to 13.6 kg with a CCC of 0.64 (P<.001) and a mean difference of 0.81 kg between the SB and dynamometer methods. There were 89 measurements of the contralateral healthy shoulder that ranged from 3.6 to 15.6 kg; CCC and mean strength difference were 0.76 (P<.001) and 0.70 kg, respectively. At 6 months postsurgery, strength measurements of the operated shoulder ranged from 1.4 to 12.0 kg with a CCC of 0.66 (P<.001) and mean strength difference of 0.9 kg (n=68). Respective 6-month measurements of the contralateral side (n=52) ranged from 2.0 to 15.9 kg with a CCC of 0.73 (P<.001) and mean strength difference of 0.03 kg. Absolute and change values in shoulder strength assessments using an unsecured SB and isometric dynamometer are fairly concordant with mean differences of less than 1 kg between methods. With the variability of strength differences among patients, interpretation of these values for individual patients may be challenging. Nonetheless, unsecured SB and dynamometer methods share only slight and clinically unimportant differences that can provide similar group mean values for use in research along with the calculation of the CS.

Broadening the Berlin definition of ARDS to patients receiving high-flow nasal oxygen: an observational study in patients with acute hypoxemic respiratory failure due to COVID-19

BackgroundHigh-flow nasal oxygen (HFNO) is increasingly used in patients with acute hypoxemic respiratory failure. It is uncertain whether a broadened Berlin definition of acute respiratory distress syndrome (ARDS), in which ARDS can be diagnosed in patients who are not receiving ventilation, results in similar groups of patients receiving HFNO as in patients receiving ventilation.MethodsWe applied a broadened definition of ARDS in a multicenter, observational study in adult critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), wherein the requirement for a minimal level of 5 cm H2O PEEP with ventilation is replaced by a minimal level of airflow rate with HFNO, and compared baseline characteristics and outcomes between patients receiving HFNO and patients receiving ventilation. The primary endpoint was ICU mortality. We also compared outcomes in risk for death groups using the PaO2/FiO2 cutoffs as used successfully in the original definition of ARDS. Secondary endpoints were hospital mortality; mortality on days 28 and 90; need for ventilation within 7 days in patients that started with HFNO; the number of days free from HFNO or ventilation; and ICU and hospital length of stay.ResultsOf 728 included patients, 229 patients started with HFNO and 499 patients with ventilation. All patients fulfilled the broadened Berlin definition of ARDS. Patients receiving HFNO had lower disease severity scores and lower PaO2/FiO2 than patients receiving ventilation. ICU mortality was lower in receiving HFNO (22.7 vs 35.6%; p = 0.001). Using PaO2/FiO2 cutoffs for mild, moderate and severe arterial hypoxemia created groups with an ICU mortality of 16.7%, 22.0%, and 23.5% (p = 0.906) versus 19.1%, 37.9% and 41.4% (p = 0.002), in patients receiving HFNO versus patients receiving ventilation, respectively.ConclusionsUsing a broadened definition of ARDS may facilitate an earlier diagnosis of ARDS in patients receiving HFNO; however, ARDS patients receiving HFNO and ARDS patients receiving ventilation have distinct baseline characteristics and mortality rates.Trial registration: The study is registered at ClinicalTrials.gov (identifier NCT04719182).

Debranching abdominal aortic hybrid surgery for aortic diseases involving the visceral arteries.

Aortic diseases involving branches of the visceral arteries mainly include thoracoabdominal aortic aneurysm (TAAA), aortic dissection (AD) and abdominal aortic aneurysm (AAA). The focus of treatment is to reconstruct the splanchnic arteries and restore blood supply to the organs. Commonly used methods include thoracoabdominal aortic replacement, thoracic endovascular aortic repair and hybrid approaches. Hybrid surgery for aortic disease involving the visceral arteries, consisting of visceral aortic debranching with retrograde revascularization of the celiac trunk and renal arteries and using stent grafts, has been previously described and may be considered particularly appealing in high-risk patients. This study retrospectively analyzed recorded data of patients and contrasted the outcomes with those of a similar group of patients who underwent conventional open repair surgery. Between 2019 and 2022, 72 patients (52 men) with an average age of 61.57 ± 8.66 years (range, 36-79 years) underwent one-stage debranching abdominal aortic hybrid surgery. These patients, the hybrid group, underwent preoperative Computed Tomographic Angiography (CTA) and had been diagnosed with aortic disease (aneurysm or dissection) involving the visceral arteries and were at high risk for open repair. The criteria used to define these patients as high-risk group who are in the need of hybrid treatment were American Society of Anesthesiologists (ASA) class 3 or 4. In all cases, we accomplished total visceral aortic debranching through a previous visceral artery retrograde revascularization with synthetic grafts (customized Y or four-bifurcated grafts), and aortic endovascular repair with one of two different commercially produced stent grafts (Medtronic® and Lifetech®). In some cases, we chose to connect the renal artery to the artificial vessel with a stent graft (Viabahn) and partly or totally anastomosed. We analyzed the results and compared the outcomes of the hybrid group with those of a similar group of 46 patients (36 men) with an average age 54.15 ± 12.12 years (range, 32-76). These 46 patients, the conventional open group, were selected for having had thoracoabdominal aortic replacement between 2019 and 2022. In the hybrid group, 72 visceral bypasses were completed, and endovascular repair was successful in all cases. No intraoperative deaths occurred. Perioperative mortality was 2.78%, and perioperative morbidity was 9.72% (renal insufficiency in 1, unilateral renal infarction in 5, Intestinal ischemia in 1). At 1-month postoperative CTA showed 2 endoleaks, one of which was intervened. At follow-up, there were unplanned reoperation rate of 4.29% and 5 (7.14%) deaths. The remaining patients' grafts were patent at postoperative CTA and no endoleak or stent graft migration had occurred. In the conventional open group, 1 died intraoperatively, 4 died perioperatively, perioperative mortality was 10.87% and complications were respiratory failure in 5, intestinal paralysis/necrosis in 4, renal insufficiency in 17, and paraplegia in 2. At follow-up, 5 (12.20%) patients presented with synthetic grafts hematoma 4 (9.76%) patient died, and 6 (14.63%) patients required unplanned reoperation intervention. Hybrid surgery is technically feasible in selected cases. For aortic diseases involving the visceral arteries, the application of hybrid abdominal aorta debranching can simplify the operation process, decrease the risks of mortality and morbidity in high-risk and high-age populations and decrease the incidence of various complications while achieving ideal early clinical efficacy. However, a larger series is required for valid statistical comparisons, and longer follow-ups are necessary to evaluate the long-term efficacy of hybrid surgery.

Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy.

Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation. Retrospective cohort analysis. Academic tertiary-care center from May 2014 to September 2021. In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared amonghousehold income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints. Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percentof patients with annual incomes greater than $50kunderwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar amongsocioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted amonginsurance (p = .015) and income status (p = .003). Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.