Significant and Distinct Impacts of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Acid Exposure, Esophageal Motility and Endoscopic Findings: A Systematic Review and Meta-analysis.

OBJECTIVE: To study esophageal acid exposure, esophageal motility, and endoscopic findings before and after Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB BACKGROUND: The lack of standardized objective assessment of esophageal physiology and anatomy contributes to the controversies regarding the impact of SG and RYGB on gastroesophageal reflux disease. METHODS: We conducted a systematic review and meta-analysis of studies reporting at least one objective measure of esophageal physiology and/or EGD, at baseline and after SG or RYGB. The changes in pH-test, manometry, and EGD parameters were summarized. RESULTS: Acid exposure time (AET) and DeMeester Score (DMS) significantly increased after SG: Mean Difference (MD) 2.1 (95%CI 0.3 to 3.9) and 8.6 (95%CI 2 to 15.2), respectively. After RYGB, both AET and DMS significantly decreased: MD -4.2 (95%CI -6.1 to -2.3) and - 16.6 (95%CI -25.4 to -7.8). Lower esophageal sphincter resting pressure and length significantly decreased following SG: MD - 2.8 (95%CI - 4.6 to - 1.1) and - 0.1 (95%CI - 0.2 to - 0.02), respectively. There were no significant changes in esophageal manometry after RYGB. The Relative Risk of erosive esophagitis after SG was 2.3 (95%CI 1.5 to 3.5), while after RYGB it was 0.4 (95%CI 0.2 - 0.8). The prevalence of Barrett's Esophagus changed from 0% to 3.6% after SG, and from 2.7% to 1.4% after RYGB. CONCLUSIONS: SG resulted in worsening of all objective parameters, while RYGB showed improvement in AET, DMS, and EGD findings. Determining the risk factors associated with those outcomes could aid in surgical choice.

Activitybudget and foraging patterns ofNubian giraffe (Giraffa camelopardalis camelopardalis) in Lake Nakuru National Park, Kenya.

The activity budget of giraffe in various African populations has been studied extensively, revealing that it is affected by body size, foraging patterns, and sex. Foraging patterns show an animal's feeding choices in its environment and are influenced by resource availability, competition, and predation risk. The ability of giraffe to survive and reproduce is significantly impacted by the variation in activity budget and foraging across different ecosystems. Our study focused on evaluating the seasonal activity budgets and foraging patterns of Nubian giraffe in Lake Nakuru National Park, Kenya. We used the scan sampling method to record the activity budget of giraffe which included foraging, movement, resting, and drinking water. We then evaluated if activities varied with the seasons. A total of 11,280 activities were documented, with 4560 (40.4%) occurring during the dry season and 6720 (59.6%) during the wet season. Foraging accounted for 53% of the time budget during the dry season, but increased to 57% during the wet season. There was a slight drop in records of movement (22%; n = 995 of 4560) and resting (25%; n = 1145 of 4560) from the dry season to the wet season (20%; n = 1375 out of 6720 and 22%; n = 1515 of 6720). During the dry season, females (53%) foraged longer than males (47%), whereas males (44%) had longer resting periods than females (56%). Giraffe frequently fed on Vachellia xanthophloea (67%; n = 4136 of 6215 foraging records), Maytenus senegalensis (19%), and Solanum incanum (9%) over both seasons. Overall, seasons had little impact on giraffe activity time budgets and foraging patterns in Lake Nakuru National Park. A better insight into the behavioural patterns of this subspecies will allow managers to enhance the protection and conservation of the species and its habitat. Heavy foraging on Vachellia by giraffe at LNNP has been associated with a population decline in number, so perhaps planting more of this species in LNNP could promote a rebound in numbers.

Phase I quality control framework for monitoring organ-at-risk dose.

Objective.The aim of this work was to develop a Phase I control chart framework for the recently proposed multivariate risk-adjusted Hotelling'sT2chart. Although this control chart alone can identify most patients receiving extreme organ-at-risk (OAR) dose, it is restricted by underlying distributional assumptions, making it sensitive to extreme observations in the sample, as is typically found in radiotherapy plan quality data such as dose-volume histogram (DVH) points. This can lead to slightly poor-quality plans that should have been identified as out-of-control (OC) to be signaled in-control (IC).Approach. We develop a robust iterative control chart framework to identify all OC patients with abnormally high OAR dose and improve them via re-optimization to achieve an IC sample prior to establishing the Phase I control chart, which can be used to monitor future treatment plans.Main Results. Eighty head-and-neck patients were used in this study. After the first iteration, P14, P67, and P68 were detected as OC for high brainstem dose, warranting re-optimization aimed to reduce brainstem dose without worsening other planning criteria. The DVH and control chart were updated after re-optimization. On the second iteration, P14, P67, and P68 were IC, but P40 was identified as OC. After re-optimizing P40's plan and updating the DVH and control chart, P40 was IC, but P14* (P14's re-optimized plan) and P62 were flagged as OC. P14* could not be re-optimized without worsening target coverage, so only P62 was re-optimized. Ultimately, a fully IC sample was achieved. Multiple iterations were needed to identify and improve all OC patients, and to establish a more robust control limit to monitor future treatment plans.Significance. The iterative procedure resulted in a fully IC sample of patients. With this sample, a more robust Phase I control chart that can monitor OAR doses of new plans was established.

Application of machine learning techniques to predict groundwater quality in the Nabogo Basin, Northern Ghana.

The main objective of this study was to map the quality of groundwater for domestic use in the Nabogo Basin, a sub-catchment of the White Volta Basin in Ghana, by applying machine learning techniques. The study was conducted by applying the Random Forest (RF) machine learning algorithm to predict groundwater quality, by utilizing factors that influence groundwater occurrence and quality such as Elevation, Topographical Wetness Index (TWI), Slope length (LS), Lithology, Soil type, Normalize Different Vegetation Index (NDVI), Rainfall, Aspect, Slope, Plan Curvature (PLC), Profile Curvature (PRC), Lineament density, Distance to faults, and Drainage density. The groundwater quality of the area was predicted by building a Random Forest model based on computed Arithmetic Water Quality Indices (WQI) (as dependent variable) of existing boreholes, to serve as an indicator of the groundwater quality. The predicted WQI of groundwater in the study area shows that it ranges from 9.51 to 69.99%. This implied that 21.97 %, 74.40 %, and 3.63 % of the study area had respectively the likelihood of excellent. The models were found to perform much better with an RMSE of 23.03 and an R2 value of 0.82. The study conducted highlighted an essential understanding of the groundwater quality in the study area, paving the way for further studies and policy development for groundwater management.

Reliability assessment of the OMERACT whole-body magnetic resonance imaging scoring system for juvenile idiopathic arthritis.

Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue changes for commonly involved joints and entheseal sites. Five radiologists rated 17 WBMRI scans through an online rating platform. Item-wise reliability was calculated for 117 items with non-zero scores in >10 % of readings. Interquartile ranges of the five-reader Kappa reliability coefficients were 0.58-0.73 (range: 0.36-0.88) for the joints, 0.65-0.81 (range: 0.39-0.95) for the entheses, and 0.62-0.75 (range: 0.60-0.76) for chronic nonbacterial osteomyelitis-like lesions.

Implantable Collamer Lens Procedure Planning: A Review of Global Approaches.

More than 2 million implantable collamer lenses (ICLs) have been implanted worldwide. With a central port to improve aqueous flow through the ICL, the latest iteration of this phakic intraocular lens (pIOL) has been shown to have stable outcomes with very low rates of adverse events. However, correct planning and ICL size selection continue to be important to achieve an optimal vault. Shallow or excessive vaults are not complications in and of themselves but may increase the risk of complications. Historically, surgeons have relied on measurements of anterior chamber depth (ACD) and manual, caliper-measured white-to-white (WTW) distance to select the ICL size. New diagnostic and imaging technologies such as optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) provide additional opportunities for visualization and measurement of the intraocular dimensions involved in phakic intraocular lens implantation, including sulcus-to-sulcus (STS) and angle-to-angle (ATA) diameters. This paper reviews various approaches to ICL planning and sizing that have been published in the peer-reviewed literature, all of which produce acceptable results for predicting vault and size selection. Surgeons may also want to identify a methodology for patient evaluation and ICL size selection that best aligns with their personal preferences, diagnostic technology, and familiarity with analytical optimization tools.

Phakic intraocular lenses (pIOLs) are one method for correcting nearsightedness, with or without astigmatism. This category of refractive surgery has been growing rapidly in the US and around the world. Implantation of the implantable collamer lens (ICL), one type of pIOL, is safe and effective, with stable outcomes and low adverse event rates. When complications do occur, they are typically associated with an inappropriate vault, or distance between the implant and the natural lens. Preoperative planning and accurate ICL sizing are required to achieve an optimal vault and varies, depending on the diagnostic technology available to the surgeon. This paper reviews the current approaches to ICL planning and sizing in order to provide guidance to surgeons implanting this pIOL.

A quantitative survey of the blueberry (Vaccinium spp.) culturable nectar microbiome: variation between cultivars, locations, and farm management approaches.

Microbes in floral nectar can impact both their host plants and floral visitors, yet little is known about the nectar microbiome of most pollinator-dependent crops. In this study, we examined the abundance and composition of the fungi and bacteria inhabiting Vaccinium spp. nectar, as well as nectar volume and sugar concentrations. We compared wild V. myrsinites with two field-grown V. corymbosum cultivars collected from two organic and two conventional farms. Differences in nectar traits and microbiomes were identified between V. corymbosum cultivars but not Vaccinium species. The microbiome of cultivated plants also varied greatly between farms, whereas management regime had only subtle effects, with higher fungal populations detected under organic management. Nectars were hexose-dominant, and high cell densities were correlated with reduced nectar sugar concentrations. Bacteria were more common than fungi in blueberry nectar, although both were frequently detected and co-occurred more often than would be predicted by chance. "Cosmopolitan" blueberry nectar microbes that were isolated in all plants, including Rosenbergiella sp. and Symmetrospora symmetrica, were identified. This study provides the first systematic report of the blueberry nectar microbiome, which may have important implications for pollinator and crop health.

Overflow waters in the western Irminger Sea modify deep sound speed structure and convergence zone propagation.

Deep sound speed structure in the western Irminger Sea is found to be highly dynamic in comparison to the adiabatic (uniform) sound speed gradient underpinning data assimilation and modeling efforts around the globe. A beamed source parabolic equation model is used to illustrate how the resulting non-uniform sound speed structure at 1 to 1.5 km in depth and sound speed inversion near the seafloor produce observable effects on acoustic signals between a shallow source and shallow vertical line array at convergence zone ranges. Beamforming analysis shows that a uniform sound speed gradient leads to "ideal" interference patterns that do not capture or represent modeled convergence zone properties, such as location, strength, and sharpness. Overall findings suggest that in situ information about sound speed below 1 km is necessary for low frequency, long-range propagation studies, particularly in areas of complex thermohaline circulation.

Diagnostic Accuracy Study of the Pediatric-Specific Ultrasound Scoring System for the Knee Joint in Children With Juvenile Idiopathic Arthritis.

OBJECTIVE: We undertook this study to validate the Pediatric Arthritis Ultrasound Scoring System for the knee joint (PAUSS-knee) in children with juvenile idiopathic arthritis (JIA). METHODS: Children with JIA were enrolled to prospectively receive a musculoskeletal ultrasound (MSUS) examination of the knee and a physical examination to determine presence/absence of clinical arthritis. MSUS images were scored using the PAUSS-knee, a semiquantitative MSUS scoring system (0-3, normal to severe) for B-mode and power Doppler mode. In addition to MSUS, a subset of participants also received magnetic resonance imaging (MRI) of the knee, which was scored according to the combined Juvenile Arthritis MRI Scoring (JAMRIS) system. Spearman's correlations (rs ) were used to calculate associations between variables. Test characteristics of the PAUSS-knee were calculated with MRI as the reference standard. Inflammatory biomarkers were assessed in synovial fluid from involved knees. RESULTS: Eighty children with JIA contributed 112 MSUSs and 25 MRIs of the knee. Of the knees, 41% (n = 46) had clinical evidence of arthritis. The B-mode PAUSS-knee score moderately correlated with clinically determined arthritis (rs = 0.54, P < 0.001) and strongly correlated with the JAMRIS score (rs = 0.75, P < 0.001). Compared with MRI, the area under the curve for the B-mode PAUSS-knee was 0.92. For a cutoff of >1, the B-mode PAUSS-knee had a sensitivity of 83% and specificity of 82%. Biomarker analysis indicates that interleukin-2R levels correlate with PAUSS score. CONCLUSION: Our data indicate that the PAUSS-knee has excellent accuracy for the diagnosis of arthritis when compared with MRI. The PAUSS-knee has the potential to effectively inform JIA medical decision-making in real time.

Systematic calibration reduces sources of variability for the preliminary OMERACT juvenile idiopathic arthritis MRI- sacroiliac joint score (OMERACT JAMRIS-SIJ).

OBJECTIVE: To determine whether systematic calibration enhances scoring proficiency of the OMERACT juvenile idiopathic arthritis MRI-Sacroiliac Joint score (JAMRIS-SIJ) and whether contrast-enhancement enhances its performance. METHODS: MRI SIJ scans of 50 cases with juvenile spondyloarthritis were scored by 7 raters after calibration with 3 different knowledge transfer tools. RESULTS: Calibrated readers achieved greater reliability for scoring certain inflammatory and structural lesions. Sensitivity and reliability for scoring inflammatory lesions was greater on fluid-sensitive compared to contrast-enhanced sequences. CONCLUSION: Systematic calibration should be implemented prior to the use of JAMRIS-SIJ for clinical trials. It is unlikely that contrast-enhanced MRI will improve the performance of this method.

Volatile compounds of hexane extract from Pterodon pubescens Benth seeds and its significant in vitro potential against different bacterial strains.

Pterodon pubescens Benth is a Brazilian medicinal plant (sucupira, in Brazilian Portuguese). This paper aims to determine the volatile composition and antibacterial activities of hexane extract from P. pubescens seeds (HE-PP). Antibacterial activities were screened by the microdilution broth method in 96-well culture plates and MIC values were expressed as µg/mL. HE-PP was active against several oral bacteria whose MIC values ranged between 12.5 µg/mL and 50 µg/mL and against three mycobacterial strains (MIC = 125 µg/mL and 500 µg/mL). In addition, HE-PP was active against Xanthomonas citri strain (MIC = 100 µg/mL). Cytotoxic activity of the extract was evaluated in human tumour and non-tumour cell lines. HE-PP showed selective cytotoxicity to cervical adenocarcinoma (HeLa cells - IC50 = 53.47 µg/mL). Its major constituents were identified by GC-MS and GC-FID: E-caryophyllene, vouacapane, E-geranylgeraniol and dehydroabietol. Results reinforce the biological potential of HE-PP against a broad spectrum of pathogenic and phytopathogenic bacteria.

Dissemination of a Pediatric Musculoskeletal POCUS Scoring System via Virtual Education: A Proof-of-Concept Study.

Point of care pediatric musculoskeletal POCUS scanning and scoring protocols for childhood arthritis have emerged in recent years. However, pediatric musculoskeletal POCUS curricula in rheumatology fellowship programs are limited due to availability of trained faculty and resources. This proof-of-concept study investigated the effectiveness of educational methods for a pediatric musculoskeletal POCUS scoring protocol among fellows and physicians of differing subspecialties. Educational methods assessed included recorded videos and virtual review sessions. Effectiveness was assessed by calculating interrater reliability for the musculoskeletal POCUS scoring systems using the intra-class correlation coefficient (ICC). Following training sessions, participants then underwent scoring exercise(s) until the goal of an excellent ICC ≥ 0.75 was reached. Four participants completed two rounds of virtual education, review, and scoring sessions. Excellent interrater reliability was achieved for most views. This proof-of-concept study demonstrated virtual education covering advanced concepts of pediatric musculoskeletal POCUS provides a knowledge base for physicians from different subspecialties and various experience.

Skin cancer characteristics during the first year of the COVID-19 pandemic at a tertiary hospital in Latin America.

BACKGROUND: The influence of the novel human coronavirus disease (COVID-19) pandemic on skin cancer characteristics in Latin America is still poorly elucidated. METHODS: This was a cross-sectional study which included patients diagnosed with skin cancer (basal cell carcinoma [BCC], cutaneous squamous cell carcinoma [cSCC], and primary cutaneous melanoma [cMM]) during the first year of the COVID-19 pandemic (from March 1, 2020, to February 28, 2021) and the preceding year at our institution. The total number of skin cancer diagnoses and surgeries, as well as their topography, clinicopathological staging at diagnosis, and treatment delay were compared between the two periods. RESULTS: There was a 31.8% reduction in skin cancer diagnoses during the first year of the COVID-19 pandemic at our institution. There was an increase in the proportion of low-risk cancers according to the NCCN guidelines for BCCs (40.8-49%, P < 0.001) and cSCCs (41.7-49.6%, P = 0.03), but there was no difference in the distribution of other staging systems for the three types of cancer. We also found a significant reduction in surgeries for BCCs (-57.6%, P < 0.001) and cSCCs (-44.7%, P < 0.001) but not for cMM. CONCLUSIONS: The first year of the COVID-19 pandemic was associated with reduced numbers of skin cancer diagnoses and surgeries at our institution. This study provides an assessment of skin cancer characteristics during the first year of the pandemic in the Latin American population.

Explanted Skull Flaps after Decompressive Hemicraniectomy Demonstrate Relevant Bone Avitality-Is Their Reimplantation Worth the Risk?

BACKGROUND: Reimplantations of autologous skull flaps after decompressive hemicraniectomies (DHs) are associated with high rates of postoperative bone flap resorption (BFR). We histologically assessed the cell viability of explanted bone flaps in certain periods of time after DH, in order to conclude whether precursors of BRF may be developed during their storage. METHODS: Skull bone flaps explanted during a DH between 2019 and 2020 were stored in a freezer at either -23 °C or -80 °C. After their thawing process, the skulls were collected. Parameters of bone metabolism, namely PTH1 and OPG, were analyzed via immunohistochemistry. H&E stain was used to assess the degree of avital bone tissue, whereas the repeated assays were performed after 6 months. RESULTS: A total of 17 stored skull flaps (8 at -23 °C; 9 at -80 °C) were analyzed. The duration of cryopreservation varied between 2 and 17 months. A relevant degree of bone avitality was observed in all skull flaps, which significantly increased at the repeated evaluation after 6 months (p < 0.001). Preservation at -23 °C (p = 0.006) as well as longer storage times (p < 0.001) were identified as prognostic factors for higher rates of bone avitality in a linear mixed regression model. CONCLUSIONS: Our novel finding shows a clear benefit from storage at -80° C, which should be carefully considered for the future management and storage of explanted skull flaps. Our analysis also further revealed a significant degree of bone avitality, a potential precursor of BFR, in skull flaps stored for several weeks. To this end, we should reconsider whether the reimplantation of autologous skull flaps instead of synthetic skull flaps is still justified.

Middle-schoolers' misconceptions in discretized nonsymbolic proportional reasoning explain fraction biases better than their continuous reasoning: Evidence from correlation and cluster analyses.

Early emerging nonsymbolic proportional skills have been posited as a foundational ability for later fraction learning. A positive relation between nonsymbolic and symbolic proportional reasoning has been reported, as well as successful nonsymbolic training and intervention programs enhancing fraction magnitude skills. However, little is known about the mechanisms underlying this relationship. Of particular interest are nonsymbolic representations, which can be in continuous formats that may emphasize proportional relations and in discretized formats that may prompt erroneous whole-number strategies and hamper access to fraction magnitudes. We assessed the proportional comparison skills of 159 middle-school students (mean age = 12.54 years, 43% females, 55% males, 2% other or prefer not to say) across three types of representations: (a) continuous, unsegmented bars, (b) discretized, segmented bars that allowed counting strategies, and (c) symbolic fractions. Using both correlational and cluster approaches, we also examined their relations to symbolic fraction comparison ability. Within each stimulus type, we varied proportional distance, and in the discretized and symbolic stimuli, we also manipulated whole-number congruency. We found that fraction distance across all formats modulated middle-schoolers' performance; however, whole-number information affected discretized and symbolic comparison performance. Further, continuous and discretized nonsymbolic performance was related to fraction comparison ability; however, discretized skills explained variance above and beyond the contributions of continuous skills. Finally, our cluster analyses revealed three nonsymbolic comparison profiles: students who chose the bars with the largest number of segments (whole-number bias), chance-level performers, and high performers. Crucially, students with a whole-number bias profile showed this bias in their fraction skills and failed to show any symbolic distance modulation. Together, our results indicate that the relation between nonsymbolic and symbolic proportional skills may be determined by the (mis)conceptions based on discretized representations, rather than understandings of proportional magnitudes, suggesting that interventions focusing on competence with discretized representations may show dividends for fraction understanding.

Determination of Relative Weightings for Sacroiliac Joint Pathologies in the OMERACT Juvenile Arthritis Magnetic Resonance Imaging Sacroiliac Joint Score.

This study aims to determine the relative weights (point value) of items of the juvenile idiopathic arthritis magnetic resonance imaging-sacroiliac joint scoring system (JAMRIS-SIJ). An adaptive multicriteria decision analysis was performed using the 1000Minds web application to determine the relative weights of the items in the JAMRIS-SIJ inflammation and damage domains. Experts in imaging and rheumatology independently completed a conjoint analysis survey (CAS) to determine the point value of the measurement items of the JAMRIS-SIJ. Each CAS survey question asked the expert to compare two hypothetical patient profiles, which were otherwise similar but different at two items at a time, and to select which item showed a more severe stage of inflammation or osteochondral damage. In addition, experts ranked 14 JAMRIS-SIJ grade only or image + grade patient vignettes while blinded to the CAS-derived weights. The validity of the weighted JAMRIS-SIJ was tested by comparing the expert CAS-weighted score and the image + grade ranking method. Seventeen experts completed the CAS (11 radiologists and 6 rheumatologists). Considering the point value for inflammation domain items, osteitis (24.7%) and bone marrow edema (24.3%) had higher group-averaged percentage weights compared to inflammation in erosion cavity (16.9%), joint space enhancement (13.1%), joint space fluid (9.1%), capsulitis (7.3%), and enthesitis (4.6%). Similarly, concerning the damage domain, ankylosis (41.3%) and erosion (25.1%) showed higher group-averaged weights compared to backfill (13.9%), sclerosis (10.7%), and fat metaplasia lesion (9.1%). The Spearman correlation coefficients of the CAS-weighted vignette order and unweighted JAMRIS-SIJ grade only order vignettes for all experts were 0.79 for inflammation and 0.80 for damage. The correlations of image vignettes among imaging experts to CAS were 0.75 for inflammation and 0.90 for damage. The multicriteria decision analysis identified differences in relative weights among the JAMRIS-SIJ measurement items. The determination of the relative weights provided expert-driven score scaling and face validity for the JAMRIS-SIJ, enabling the future evaluation of its longitudinal construct validity.

Assessment of Human Health Risk of Metal(Loid) Content in Brazilian Sardine Along the Southwestern Atlantic.

The Brazilian sardine (Sardinella aurita) is an important food resource found in the subtropical Southwestern Atlantic Continental Shelf (CSSWA), but limited information about its metal(loid) concentrations is available, restricting effective risk assessment by its consumption. On this research, we hypothesized that S. aurita presents different metal(loid) concentrations within a latitudinal gradient in the CSSWA (northern and southern sectors). We also assessed the S. aurita consumption contamination risk in both sectors of the CSSWA. The results indicated that S. aurita might present different chemical and contamination profiles between the observed sectors, with highlights to As, Cr, and Fe at greater levels than the safety limits established by regulatory agencies. Such finds could be explained by urbanization, industrialization, continental and oceanographic processes along the CSSWA, corroborating our hypothesis for most observed metals(loid). On the other hand, our risk assessment analysis of metal(loid) concentrations did not indicate hazards for human consumption.