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PURPOSE OF REVIEW The assessment of fracture risk and use of antiosteoporosis medications have increased greatly over the last 20-30 years. However, despite this, osteoporosis care remains suboptimal worldwide. Even in patients who have sustained a fragility fracture, fewer than 20% actually receive appropriate antiosteoporosis therapy in the year following the fracture. There is also evidence that treatment rates have declined substantially in the last 5-10 years, in many countries. The goal of this article is to consider the causes for this decline and consider how this situation could be remedied. RECENT FINDINGS A number of possible reasons, including the lack of prioritisation of osteoporosis therapy in ageing populations with multimorbidity, disproportionate concerns regarding the rare side effects of anti-resorptives and adverse changes in reimbursement in the USA, have been identified as contributing factors in poor osteoporosis care. Improved secondary prevention strategies; screening measures (primary prevention) and appropriate, cost-effective guideline and treatment threshold development could support the optimisation of osteoporosis care and prevention of future fractures.INTRODUCTION Fine lavender and lavandin are perfume and medicinal plants originate from the South of France and are widely cultivated for their essential oils. Recently, cultivated plants suffered from a severe decline in France, due to the propagation of the yellow decline disease. This disease is caused by the stolbur phytoplasma, a bacterium transmitted by a sap-sucking insect, the planthopper. OBJECTIVES In order to understand the complex relationships between host plant, pest, pathogen and environment responsible for the yellow decline of lavender, we use a metabolomic approach to highlight changes in chemical emissions from asymptomatic ("healthy") and symptomatic ("infected") plants. METHODS Volatile compounds produced by fine lavender and lavandin were collected in the field using a dynamic headspace extraction approach. Afterwards, compounds trapped on Tenax adsorbent were thermodesorbed and analysed using an automated thermal desorption-gas chromatography-mass spectrometry (ATD-GC-MS). Multivariate statistical analyses was performed using principal component analysis and partial least square discriminant analyses. RESULTS The untargeted screening of volatiles allowed the separation of asymptomatic and symptomatic plants according to their emissions. The approach was sufficiently accurate so as to separate the emissions according to the different stages of infection. Twelve compounds were found to be deregulated metabolites of yellow disease infection, common to fine lavender (variety 7713) and lavandin (variety abrial). CONCLUSION The metabolomic approach allowed for the effective identification of chemical variations between infected and healthy plants in a complex field environment.BACKGROUND Killian-Jamieson diverticulum is a rare pharyngoesophageal diverticulum. The risk of intraoperative injury of the recurrent laryngeal nerve (RLN) is high during surgical resection of Killian-Jamieson diverticulum because the RLN usually runs next to the base of the diverticulum. We present a case of Killian-Jamieson diverticulum that was safely resected with effective use of an intraoperative nerve monitoring (IONM) system with a handheld stimulating probe to prevent RLN injury. CASE PRESENTATION A 69-year-old man complaining of dysphagia was diagnosed with Killian-Jamieson diverticulum and underwent open transcervical diverticulectomy. Because the anterior aspect of the diverticulum was expected to be close to the RLN, the accurate location of the RLN was checked during dissection by intermittent stimulation using a handheld probe of the IONM system to avoid mechanical and thermal injury. The diverticulum was transected longitudinally using a linear stapler, and the staple line was buried using absorbable sutures from the distal end. During its closure, RLN was identified very close to the diverticulum stump by IONM, and the upper side of the stump was left unburied to avoid RLN injury. The postoperative course was uneventful and the patient was discharged on postoperative day 7. Postoperative evaluation showed no vocal cord paralysis. CONCLUSION IONM may be beneficial during open surgery for Killian-Jamieson diverticulum, which usually protrudes just lateral to the RLN.Clinical audit "according to national procedures" is a legal requirement as defined within the recently implemented European Council Basic Safety Standards Directive (BSSD), 2013/59/Euratom. Tofacitinib clinical trial A survey was undertaken in 2019 to assess the current status of clinical audit in European radiology departments and for feedback on the recently published "ESR Guide to Clinical Audit in Radiology" and the "ESR Clinical Audit Tool (Esperanto)". The survey was distributed within the European Society of Radiology (ESR) EuroSafe Imaging Star network and also to European national radiological societies which are institutional members of the ESR.A total of 47/116 (41%) EuroSafe Imaging Star departments responded, and responses were received from 43 radiology departments from 16/48 national radiological societies.Survey findings demonstrated a low awareness of recent key ESR audit-related publications (Esperanto), a lack of clinical audit infrastructure for BSSD compliance and by inference a poorly developed local/national communication and audit infrastructure in many cases.Key stakeholders, including the ESR and the European national radiological societies, will need to continue to work with other bodies to further promote, integrate and to encourage resourcing of clinical audit at all levels, facilitating BSSD compliance and improving patient care.A number of studies point to a demonstrated relationship between problematic Internet use (PIU) and psychopathological variables. However, explorations of PIU in relation to defense mechanisms and coping strategies remain rare. The present study sought to determine the extent of PIU among a sample of college-aged young adults resident in the United Arab Emirates. The relationship of PIU to two psychopathological variables (depression and low self-esteem) and two psychological variables (defense mechanisms and coping strategies) were examined. A sample of 697 Emirati participants aged between 18 and 33 years of age completed assessments of PIU, socio-demographic, psychopathological, and psychological variables. A total of 67.3% exhibited PIU. Problematic users produced higher scores for maladaptive coping strategies and for the use of immature, neurotic, and autistic fantasy defenses. Regression analyses revealed that PIU was predicted by the mature, immature, and autistic fantasy defenses as well as, negatively by adaptive coping, and positively by maladaptive coping.
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