Notes

Discriminating in between allele- as well as genotype-specific indication ratio distortion.
We conclude that multiple functional axes of phytochemical diversity should be integrated with the functional axis of plant growth forms to study phenotypic convergence along large-scale ecological gradients.
We evaluated clinical performance when the TCu380A intrauterine device (IUD) and the levonorgestrel (LNG) 52-mg intrauterine system (IUS) were inserted by different categories of healthcare professionals.

A retrospective study was conducted at the University of Campinas, Brazil. The medical records were reviewed of all women in whom an IUD was inserted between January 1980 and December 2018, with data for at least 1year, and for whom information on the healthcare provider who inserted the device was available.

Overall, 19 132 (76.9%) IUD and 5733 (23.1%) LNG-IUS insertions were included, with residents/interns performing 13 853 (55.8%), nurses 7024 (28.2%), and physicians 3988 (16.0%). Removals for pregnancy and infection were significantly higher when physicians inserted the device, while removals for bleeding/pain and other medical reasons were more common when nurses performed the insertion. Expulsion and removals for personal reasons were similar for all three categories.

Clinical outcomes were similar regardless of whether trained nurses, residents/interns, or physicians inserted the device, and were irrespective of users' age and parity. These results could stimulate other healthcare services, particularly in regions where there is a shortage of physicians, to invest in training nurses to perform insertions of IUDs.
Clinical outcomes were similar regardless of whether trained nurses, residents/interns, or physicians inserted the device, and were irrespective of users' age and parity. These results could stimulate other healthcare services, particularly in regions where there is a shortage of physicians, to invest in training nurses to perform insertions of IUDs.
Greater occipital nerve blocks (GONB) are used increasingly to treat acute migraine.

We conducted a randomized controlled trial to determine whether GONB was as effective as intravenous metoclopramide for migraine.

This was a double-dummy, double-blind, parallel-arm, non-inferiority study conducted in 2 emergency departments (EDs). Patients with migraine of moderate or severe intensity were randomized to receive bilateral GONB with each side administered 3mL of bupivacaine 0.5% or metoclopramide 10mg IV, the putative standard of care. The primary outcome was improvement in pain on a 0-10 scale between time 0 and 1hour later. To reject the null hypothesis that metoclopramide would be more efficacious in relieving pain, we required that the lower limit of the 95% CI for the difference in pain improvement between those randomized to GONB vs those randomized to metoclopramide be >-1.3, a validated minimum clinically important difference. Secondary outcomes included sustained headache relief, defined as aI for (rounded) difference of 6% -13, 25%).

GONB with bupivacaine was not as efficacious as IV metoclopramide for the first-line treatment of migraine in the ED.
GONB with bupivacaine was not as efficacious as IV metoclopramide for the first-line treatment of migraine in the ED.ABC transporters use the energy of ATP binding and hydrolysis to transport substrates across cellular membranes. They comprise two highly conserved nucleotide binding domains and two transmembrane domains that form the transmembrane channel and contain the substrate binding sites. Structural analyses have found a variety of seemingly unrelated folds for the ABC transporter transmembrane domains, and from these, a set of diverse mechanistic models has been inferred. Nevertheless, in spite of the explosion in structure determination of ABC transporters in the last decade, advancement in certainty and clarity as to fundamental aspects of their molecular mechanisms remains elusive. With this in mind, here we put and examine the question Could current ABC structures differ from the physiologic membrane-embedded forms?Plant traits are increasingly being used to improve prediction of plant function, including plant demography. However, the capability of plant traits to predict demographic rates remains uncertain, particularly in the context of trees experiencing a changing climate. Here we present data combining 17 plant traits associated with plant structure, metabolism and hydraulic status, with measurements of long-term mean, maximum and relative growth rates for 176 trees from the world's longest running tropical forest drought experiment. We demonstrate that plant traits can predict mean annual tree growth rates with moderate explanatory power. However, only combinations of traits associated more directly with plant functional processes, rather than more commonly employed traits like wood density or leaf mass per area, yield the power to predict growth. Critically, we observe a shift from growth being controlled by traits related to carbon cycling (assimilation and respiration) in well-watered trees, to traits relating to plant hydraulic stress in drought-stressed trees. We also demonstrate that even with a very comprehensive set of plant traits and growth data on large numbers of tropical trees, considerable uncertainty remains in directly interpreting the mechanisms through which traits influence performance in tropical forests.
Epidemiological evidence suggests an increased risk of cancer related to computed tomography (CT) scans, with children exposed to greater risk. The purpose of this work is to test the reliability of a linear Boltzmann transport equation (LBTE) solver for rapid and patient-specific CT dose estimation. This includes building a flexible LBTE framework for modeling modern clinical CT scanners and to validate the resulting dose maps across a range of realistic scanner configurations and patient models.

In this study, computational tools were developed for modeling CT scanners, including a bowtie filter, overrange collimation, and tube current modulation. The LBTE solver requires discretization in the spatial, angular, and spectral dimensions, which may affect the accuracy of scanner modeling. To investigate these effects, this study evaluated the LBTE dose accuracy for different discretization parameters, scanner configurations, and patient models (male, female, adults, pediatric). The method used to validate LBTE solver is proposed as an alternative to Monte Carlo for patient-specific organ dose estimation. This study demonstrated accurate organ dose estimates for the rapid LBTE solver when considering realistic aspects of CT scanners and a range of phantom models. Future plans will combine the LBTE framework with deep learning autosegmentation algorithms to provide near real-time patient-specific organ dose estimation.
The LBTE solver is proposed as an alternative to Monte Carlo for patient-specific organ dose estimation. This study demonstrated accurate organ dose estimates for the rapid LBTE solver when considering realistic aspects of CT scanners and a range of phantom models. Future plans will combine the LBTE framework with deep learning autosegmentation algorithms to provide near real-time patient-specific organ dose estimation.
The aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort.

Cardiotocographic recordings from 4988 singleton term childbirths over 1year were evaluated retrospectively and blinded to the pregnancy and neonatal outcomes in a university teaching hospital in Helsinki, Finland. Umbilical artery pH, base excess and pO
, low Apgar scores at 5minutes, need for intubation and resuscitation, early neonatal hypoglycemia, and neonatal encephalopathy were used as outcome variables. According to the severity of the neonatal complications at birth, the cohort was divided into three groups no complications (Group 1), moderate complications (Group 2) and severe complications (Group 3).

Of the 4988 deliveries, the ZigZag pattern (FHR baseline amplitude changes of >25bpm with a duration of 2-30minutes) occurred in 11es late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance.
ZigZag pattern and late decelerations during the last 2 hours of labor are significantly associated with cord blood acidemia at birth and neonatal complications. The ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance.There is a well-established bidirectional, negative association between couple satisfaction and depressive symptoms. Yet, a family systems perspective emphasizes the role of the therapist in interrupting this recursive cycle between couple satisfaction and depressive symptoms. The current study utilized longitudinal data to explore the bidirectional associations between depressive symptoms and couple satisfaction, moderated by the therapeutic alliance over the course of therapy. The study included 108 couples participating in couple therapy at a university training clinic. Couples rated their depressive symptoms and couple satisfaction separately before the intake session and at the end of the fourth session, and they also reported their individual therapeutic alliance with the therapist at the end of the second and third sessions. Actor-partner interdependence moderation model analysis revealed several moderation effects. In general, with low therapeutic alliance, couples with higher initial symptoms (such as depressive symptoms and low couple satisfaction) reported more severe symptoms at the fourth session, compared to those who had fewer initial symptoms. The moderating effect of alliance on a couple's symptoms was found both among individuals, and between partners. Systemic clinical implications and suggestions for future research are discussed.The present study aimed to describe patterns of risk and protective factors affecting U.S. Army families and their association with mental health diagnoses among military-connected children. Wartime military service is associated with increased adverse outcomes for military-connected youth, but few studies have explored the impact of concurrent risk and access to protective factors. Using big data methods to link existing datasets, protective factors (e.g., marital and family functioning) were drawn from a voluntary survey completed by 1,630 US Army spouses. Risk factors (e.g., parent mental health, family moves, deployment) were drawn from Department of Defense (DoD) archival data. Rates of mental health diagnoses among youth were derived from DoD healthcare records. Using the three-step method of latent profile analysis, five profiles emerged with variability across risk and protective factors. The largest group (40% of the sample) had considerable protective factors and limited risk exposure. Statistically significant differences in the prevalence of mental health diagnoses among military-connected youth were observed across profiles (χ2 = 30.
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