Search Results (18,886)

In pregnancies with vasa previa, prenatal diagnosis and pre-labor cesarean delivery are associated with significantly improved perinatal outcomes compared to undetected cases. However, a universally accepted ultrasonographic definition of vasa previa is lacking. Specifically, the distance from the cervical internal os beyond which vaginal delivery can be safely recommended remains to be determined. Field experts and recently published societal guidelines agree that a 2 cm cut-off is suboptimal, given that complete cervical dilation during labor risks unprotected fetal vessels within a 5 cm radius from the internal os. Thus, in the setting of a scarcity of evidence and case reports of perinatal death with unprotected fetal vessels beyond 2 cm from the internal os, a more conservative definition that includes unprotected fetal vessels located within 5 cm of the internal os is imperative to improve outcomes. Full article

Santa María Bay–La Reforma (SMBLR), with its 58,300 ha is one of Mexico’s most extensive estuarine lagoon systems. It is made up of islands, estuaries, and mangrove areas, which provide a vital part of the habitat and refuge of a significant number of birds, fish, amphibians, reptiles, and mammals. The fishing of blue and brown shrimp, marine and estuarine fish, as well as the exploitation of crab and bivalve mollusks, represent an important economic value for the communities that live there and for the state of Sinaloa, Mexico. This state ranked second in fisheries production and first in aquaculture production by 2023. However, the biological richness of this ecosystem has historically been threatened by economic activities such as agriculture, livestock, and aquaculture that, via watersheds, translate into continuous inputs of nutrients and other pollutants. This has led to modifications to the system such as changes in the structure of pelagic and benthic communities, mainly in response to eutrophication. To understand the dynamics of nutrient inputs to the ecosystem, this work presents a comparative analysis of the system’s carrying capacity and the magnitude of the main economic activities from 2007 to 2019. We found that during each season of the year and its transitions, the system functions as a nitrogen and phosphorus sink, which is associated with autotrophic net ecosystem metabolism and nitrogen fixation processes. We suggest that while water residence times in SMBLR are short, these are strongly influenced by the high volumes of water and nutrient loads determined by the spatio-temporal variations in hydrological drainage from the basins of influence of the system. The discharge of agriculture and aquaculture drains into SMBLR are areas of concern due to the high amount of nutrients. Although SMBLR is mostly an autotrophic system, there are signs that the carrying capacity during some seasons has been exceeded, and adverse ecological and socioeconomic effects in the basin are evident. Full article

Can advertising improve firm value following an incident of negative sustainability (i.e., a negative environmental, social or governance (NESG) occurrence?) This study provides an empirical investigation into NESG, its individual domains, and the mitigating role of advertising on firm value. We investigate firm level ESG sustainability violations and any corresponding advertising expenditures, utilized to counter negative opinions. First, we examine whether an NESG occurrence reduces firm value. Next, we investigate if firms experiencing an NESG occurrence alter their advertising expenditures and assess the resulting impact of this advertising spending on firm value. Finally, we determine if certain NESG occurrences benefit more from advertising than others. Using a sample of firms which engaged in at least one NESG event between 1995 and 2019, we find that firms increase advertising as a way to engage in damage control. Increasing advertising expenditures to offset NESG occurrences ultimately impacts firm value. Specifically, increasing advertising helps to reduce the NESG occurrence’s effect on firm value, but the individual domains of ESG do not respond the same to advertising efforts, suggesting that advertising as a mitigation tool remains nuanced, with the greatest positive effect being for environmental crises, no significant effect for social crises, and a negative effect for governance crises. Full article

Prescription digital therapeutics (PDTs) are emerging as a pivotal component of digital healthcare, providing software-based therapies for various diseases. This review aims to analyze the regulatory landscape in the U.S., safety, efficacy, and current challenges of PDTs, focusing on mental health conditions. Relevant articles were searched on PubMed, Google Scholar, ClinicalTrials.gov, and FDA Guidance Documents databases, supplemented by manual searches of reference lists from included studies. Inclusion criteria covered English-language studies on the development and application, therapeutic efficacy, and regulatory guidelines of PDTs in mental health. Data extraction and synthesis were conducted to summarize key findings and trends in the literature. FDA regulatory frameworks for PDTs are evolving through pathways of de novo and 510(k) applications, with patient-centric guidance. Clinical trials and real-world data support PDTs’ safety and efficacy, while highlighting regulatory needs. Challenges include payer coverage, patient accessibility, and data privacy concerns. Mixed patient feedback reveals areas for improvement. Limited healthcare provider engagement and payer coverage contributed to financial challenges for PDT manufacturers. Future trends suggest that PDTs will expand beyond mental health. The evolving landscape underscores the need for continued research, regulatory refinement, and collaborative efforts across stakeholders to ensure the successful integration of PDTs into healthcare. Full article

Background/Objectives: 5DCT was first proposed in 2005 as a motion-compensated CT simulation approach for radiotherapy treatment planning to avoid sorting artifacts that arise in 4DCT when patients breathe irregularly. Since March 2019, 5DCT has been clinically implemented for routine use at our institution to leverage this technological advantage. The clinical workflow includes a quality assurance report that describes the output of primary workflow steps. This study reports on the challenges and quality of the clinical 5DCT workflow using these quality assurance reports. Methods: We evaluated all thoracic 5DCT simulation datasets consecutively acquired at our institution between March 2019 and December 2022 for thoracic radiotherapy treatment planning. The 5DCT datasets utilized motion models constructed from 25 fast-helical free-breathing computed tomography (FHFBCTs) with simultaneous respiratory bellows signal monitoring to reconstruct individual, user-specified breathing-phase images (termed 5DCT phase images) for internal target volume contouring. Each 5DCT dataset was accompanied by a structured quality assurance report composed of qualitative and quantitative measures of the breathing pattern, image quality, DIR quality, model fitting accuracy, and a validation process by which the original FHFBCT scans were regenerated with the 5DCT model. Measures of breathing irregularity, image quality, and DIR quality were retrospectively categorized on a grading scale from 1 (regular breathing and accurate registration/modeling) to 4 (irregular breathing and inaccurate registration/modeling). The validation process was graded according to the same scale, and this grade was termed the suitability-for-treatment-planning (STP) grade. We correlated the graded variables to the STP grade. In addition to the quality assurance reports, we reviewed the contour sessions to determine how often 5DCT phase images were used for treatment planning and delivery. Results: There were 169 5DCT simulation datasets available from 156 patients for analysis. The STP was moderately correlated with breathing irregularity, image quality, and DIR quality (Spearman coefficients: 0.26, 0.30, and 0.50, respectively). Multiple linear regression analysis demonstrated that STP was correlated with regular breathing patterns (p = 0.008), image quality (p < 0.001), and better DIR quality (p < 0.001). 5DCT datasets were used for treatment planning in 82% of cases, while in 12% of cases, a backup image process was used. In total, 6% of image datasets were not used for treatment planning due to factors unrelated to the 5DCT workflow quality. Conclusions: The strongest association with STP was with DIR quality grades, as indicated by both Spearman and multiple linear regression analysis, implying that improvements to DIR accuracy and evaluation may be the best route for further improvement to 5DCT. The high rate of 5DCT phase image use for treatment planning showed that the workflow was reliable, and this has encouraged us to continue to develop and improve the workflow steps. Full article

Microbial succession on urban masonry surfaces is a critical yet understudied aspect of environmental microbiology, with implications for public health within the One Health framework. This study investigated how building age, orientation, and vegetative cover influence microbial diversity on masonry, metal, and glass substrates at the University of La Verne, California. Biophysical characterizations were conducted, and microbial communities were analyzed using morphospecies richness and DNA sequencing. Significant variation in microbial species richness (χ² = 20.3882, p = 0.0011) and diversity (Fisher’s LSD, p < 0.05) was observed. Masonry surfaces exhibited the highest microbial diversity, with a mean richness of 23 morphospecies compared to 14 on metal and 12 on glass. Penicillium fungi dominated masonry sites, comprising 45% of colonies, while Pseudomonas and Klebsiella were more prevalent on metal and glass surfaces (35% and 28%, respectively). Microbial succession did not follow a linear progression but showed non-sequential shifts influenced by local conditions. The abundance of Penicillium, known for antibiotic production, raises concerns about spreading antibiotic resistance genes. Opportunistic pathogens further highlight potential health risks. These findings underscore the importance of understanding primary successional processes in urban environments to manage microbial communities and mitigate public health risks. Full article

The Aryl-hydrocarbon Receptor (AhR) is implicated in the regulation of several genes, including those encoding CYP1A1. Although it is an orphan receptor, the amount of data about its relationship with skin homeostasis and nosology is constantly increasing. Interestingly, 6-formylindolo[3,2-b]carbazole (6-FICZ), one of the most active AhR inducers and amongst the proposed receptor’s endogenous ligands, has been detected in Malassezia furfur isolates from lesional skin, as well as in skin scales from patients with seborrhoeic dermatitis. Aiming to study the structure–activity relationships of the indolo[3,2-b]carbazole (ICZ) scaffold and to clarify if the formyl group of 6-FICZ has any specific role in AhR induction, a series of analogues of ICZ (substituted at position 6 with methyl, formyl and hydroxymethyl groups) were synthesized and evaluated for their activity on AhR in cell lines of four different species. A new simple method for the synthesis of 6-FICZ was developed. 6-Methylindolo[3,2-b]carbazole (6-MICZ) showed higher activity than 6-FICZ in human, rat and guinea pig cell lines, and all synthesized derivatives showed comparable activity in the mouse cell line. Therefore, the formyl group does not seem to play a significantly specific role in the affinity for AhR, and 6-FICZ seems less likely to be an endogenous ligand. Full article

Background: We have applied an anterior locking compression mini plate in addition to a conventional superior locking compression plate for the treatment of wedge or multifragmentary clavicular fractures. Methods: Medical and radiologic data were retrospectively reviewed for patients who underwent surgical fixation with an anterior locking compression mini plate and conventional anatomical locking compression plate in a clavicle fracture of AO/OTA 15.2 B and 15.2 C. The primary outcome was bone union, and the secondary outcome was postoperative complications associated with the procedure. The functional outcomes included the Visual Analog Scale (VAS), University of California at Los Angeles Shoulder Scale (UCLASS), and Constant Shoulder Scale (CSS). Results: Nineteen patients with AO/OTA 15.2 B and 2 C clavicular fractures were followed for an average of 16 months (range: 12–30). The average patient age was 41 (range: 21–76) years, and 17 male and 2 female patients were included. The most common cause of clavicle fractures was sports activity (36.8%). A total of 10 patients had AO/OTA classification 15.2 C, and 9 patients had AO/OTA classification 15.2 B clavicular fractures. Primary fracture union healing was observed in all 19 (100%) patients, and the average time to bone union was 11 weeks (range: 7~21). There was no fixation failure or postoperative infection. The mean VAS, UCLASS, and CSS scores at the final follow-up were 0.6, 33.4, and 65 on a 75-point scale (87 on a 100-point scale), respectively. Conclusions: Dual plating using an anterior mini plate with a superior LCP could be considered as an option to minimize soft-tissue injury in comminuted mid-shaft clavicle fractures. Full article

Recent interest in musculoskeletal connective tissues like tendons, aponeurosis, and deep fascia has led to a greater focus on in vivo medical imaging, particularly MRI. Given the rapid T₂* decay of collagenous tissues, advanced ultra-short echo time (UTE) MRI sequences have proven useful in generating high-signal images of these tissues. To further these advances, we discuss the integration of UTE with Diffusion Tensor Imaging (DTI) and explore image processing techniques to enhance the localization, labeling, and modeling of connective tissues. These techniques are especially valuable for extracting features from thin tissues that may be difficult to distinguish. We present data from lower leg scans of 30 healthy subjects using a non-Cartesian MRI sequence to acquire axial 2D images to segment skeletal muscle and connective tissue. DTI helped differentiate aponeurosis from deep fascia by analyzing muscle fiber orientations. The dual echo imaging methods yielded high-resolution images of deep fascia, where in-plane spatial resolutions were between 0.3 × 0.3 mm to 0.5 × 0.5 mm with a slice thickness of 3–5 mm. Techniques such as K-Means clustering, FFT edge detection, and region-specific scaling were most effective in enhancing images of deep fascia, aponeurosis, and tendon to enable high-fidelity modeling of these tissues. Full article

Porcine reproductive and respiratory syndrome (PRRS) is a highly contagious immunosuppressive disease caused by the porcine reproductive and respiratory syndrome virus (PRRSV) that is characterized by a highly variable gene sequence and a high rate of recombination, thereby contributing to difficulties in the clinical prevention and control of this virus. Glycosylated protein 3 (GP3) is the most glycosylated protein in PRRSV, and is closely associated with the composition of PRRSV virus particles, infection, and immune evasion. This review summarizes the structural features, genetic evolutionary patterns, glycosylation of GP3 and its interactions with other PRRSV and host proteins, associations with PRRSV infection and virulence, and immunomodulatory roles. Additionally, it provides an overview of research progress on monoclonal antibodies and vaccines targeting GP3. This study aims to provide a theoretical foundation for better understanding the structure and function of GP3, of the mechanisms of PRRSV infection, and the development of novel vaccines. Full article

Introduction: Demographic disparities in musculoskeletal (MSK) health exist in the US. Racial representation in advertising has been shown to influence consumer behavior and buying patterns. Direct-to-consumer advertising that does not target a racially diverse audience may exacerbate MSK disparities by failing to reach minorities. We explore the hypothesis that minorities are underrepresented in direct-to-consumer MSK advertisements in this cross-sectional analysis. Methods: Using magazines from four databases, eight health-related magazine types were selected and advertisement categories were established. Racial distribution was analyzed using Pearson’s Chi-squared and Chi-squared tests. Fisher’s Exact test was used when >20% of cells had expected frequencies <5. Significance was set at α = 0.05. Results: Of the advertisements featuring at least one model, 68.5% featured a white-presenting model, followed by 17.6% with a black model. Further, 92.7% of advertisements were monoethnic or monoracial with an overrepresentation of white models (p < 0.001). Black models were overrepresented as athletes (p < 0.001) and underrepresented in advertisements for pain relief (p < 0.001). Hispanic/Latinx and Asian models were underrepresented across all advertisement categories (p < 0.001). Discussion: The causes of musculoskeletal health disparities are multifactorial. One potential influence is adjacent industries such as MSK health-related advertisements. When controlling for US population demographics, white models were overrepresented and minority race models were underrepresented, demonstrating racioethnic disparities in MSK advertising. Improving the racial and ethnic diversity of models within MSK advertisements may serve to improve patient perceptions of orthopaedic products and services and improve MSK disparities. Full article

Water distribution networks (WDNs), which are responsible for delivering water of adequate quantity and quality, are vulnerable to threats such as leaks, pipe breaks, and contaminant intrusions. Hence, it is important to identify critical network elements to develop more assertive maintenance strategies for water systems. This paper aims to perform a risk assessment on leaks and pipe breaks to support the identification of critical elements in water supply systems. To this end, complex network theory (CNT) is applied as an alternative to conventional approaches that rely on multiple hydraulic simulations. Metrics such as robustness, redundancy, centrality, and connectivity are used to analyze graphs representing WDNs. Failures are modeled using hydraulic simulations to evaluate their impact on parameters such as pressure and flow. CNT metrics are then applied, including shortest path calculations between water sources and demand vertices to assess pipe importance, and vertex centrality metrics to evaluate node influence on the network. The results of the hydraulic simulations are compared with the outcomes of CNT-based analyses. Multi-criteria analysis is then employed to determine the asset maintenance priority, considering multiple failures and the associated impacts on the system. The results highlight a novel approach that shifts the focus from hydraulic state-based assessments to topology-driven analysis, reducing the influence of uncertainties inherent in water distribution network models. Full article

A nanomaterial life-cycle risk assessment (Nano LCRA) was conducted for second-generation functionalized cellulose nanomaterials (CNs) in five case studies, including applications in water filtration, food contact packaging (including as an additive and coating), and food additives, to identify and prioritize potential occupational, health, consumer, and environmental risks. Exposure scenarios were developed and ranked for each product life-cycle stage. A Safer-by-Design Toolbox (SbD Toolbox) representing a compendium of high-throughput physical, chemical, and toxicological new approach methodologies (NAMs) was used for a screening-level hazard assessment. Overall, risks identified for the CN-enabled products were low. Of the exposure scenarios, occupational inhalation exposures during product manufacturing and application ranked the highest. Despite differences in chemistry and morphology, the materials behaved similarly in oral, dermal, and inhalation models, supporting their grouping and read-across. The screening-level hazard assessment identified potential lung inflammation associated with CN exposure, and a review of the literature supported this funding, suggesting CNs behave as poorly soluble, low-toxicity dusts with the potential to irritate the lung. Key research gaps to reduce uncertainty include evaluating long-term, low-dose exposures typical of the workplace, as well as the potential release and toxicity of CN-containing composite particles. Full article

Background: Oxycodone has an elevated abuse liability profile compared to other prescription opioid medications. However, many human and rodent metabolomics studies have not been specifically focused on oxycodone. Objectives: Investigating metabolomics changes associated with oxycodone exposure can provide insights into biochemical mechanisms of the addiction cycle and prognosis prediction. Methods: Plasma samples from 16 rats at pre-exposure and intoxication time points were profiled on the Metabolon platform. A total of 941 metabolites were characterized. We employed a k-Nearest Neighbor imputation to impute metabolites with low levels of missingness and binarized metabolites with moderate levels of missingness, respectively. Results: Of the 136 binarized metabolites, 6 showed differential abundance (FDR < 0.05), including 5 that were present at pre-exposure but absent at intoxication (e.g., adenine), while linoleamide (18:2n6) exhibited the opposite behavior. Among the 798 metabolites with low levels of missingness, 364 showed significant changes between pre-exposure and intoxication (FDR < 0.01), including succinate, oleamide, and sarcosine. We identified four pathways, including tryptophan metabolism, that were nominally enriched among the metabolites that change with oxycodone exposure (p < 0.05). Furthermore, we identified several metabolites that showed nominal correlations with the Addiction Index (composite of oxycodone behaviors): 17 at pre-exposure and 8 at intoxication. In addition, the changes in abundance between pre-exposure and intoxication time points of 9 metabolites were nominally correlated with the Addiction Index, including sphingomyelins, methylhistidines, and glycerols. Conclusions: In summary, not only were we able to capture oxy-induced changes in metabolic pathways using easily accessible blood samples, but we also demonstrated the potential of blood metabolomics to better understand addiction liability. Full article

We developed a membraneless-microfluidic biofuel cell (MBFC) for the quantification of ethanol. The system employs anolyte and catholyte solutions, each containing a biocatalyst and redox mediator. The laminar flow conditions in the microfluidic chip minimize the mixing between anolyte and catholyte and obviate the need for a membrane to separate them. When ethanol is added to the anolyte, alcohol dehydrogenase (ADH) catalyzes its oxidation to acetaldehyde, releasing electrons to the anode. On the cathode, electrons are transferred to horseradish peroxidase (HRP), which reduces hydrogen peroxide in the catholyte to water. We optimized key design factors and operating conditions. We also studied the incorporation of glycerol as a viscosity modifier, which improved the power and current density supplied by the MBFC, with a maximum power output of 307 µW cm⁻² and an open circuit voltage of 0.733 V. The proposed ethanol/hydrogen peroxide MBFC was successfully applied as a biofuel cell-based sensor for the quantification of ethanol in a commercial liquor. Full article