Multilevel Mediators on the Associations of Neighborhood Social Environmental Factors and Severity of Metabolic Syndrome: The Jackson Heart Study.

Background: Neighborhood characteristics serve as risk factors for metabolic syndrome (MetS). However, the intermediary factors linking this relationship remain understudied. Thus, we investigated the sex-specific mediating role of C-reactive protein, physical activity (PA), and perceived stress in the associations of perceived neighborhood social environment (PNSE) with MetS severity among Black adults.

The incidence of lung cancer amongst primary care chest radiograph referrals-an evaluation of national and local datasets within the United Kingdom.

Objectives: To determine the incidence of lung cancer amongst primary care referrals for investigation with a chest radiograph (CXR).

Methods: Retrospective evaluation of datasets from the national Clinical Practice Research Datalink (CPRD) and from a single large regional centre. Data were extracted for cohorts of consecutive adults aged over 40 years for whom a CXR had been performed between 2016 and 2018.

One-hundred Consecutive Physician-Modified Fenestrated Endovascular Aneurysm Repair of Pararenal and Thoracoabdominal Aortic Aneurysms Using the Terumo TREO Stent Graft.

Background: Fenestrated endovascular aortic aneurysm repair (FEVAR) has been widely applied for the treatment of pararenal (PAA) and thoracoabdominal aortic aneurysms (TAAA). If custom-made devices or off-the-shelf devices are not available, physician-modified endografts (PMEGs) are an alternative device option. Several different endograft platforms have been used for PMEG; however, minimal data exists on utilizing the Terumo TREO abdominal stent graft system in this setting.

Predictors of Breastfeeding among Women Admitted with Severe Preeclampsia before 34 Weeks.

Objective: Patients with severe preeclampsia (sPREX) face barriers to successful breastfeeding (BF), including an increased risk of maternal and newborn complications, prematurity, and low birth weight. Patients with early-onset sPREX (before 34 weeks' gestation) may be at even greater risk, yet there are little data available on factors associated with BF challenges in this population. We describe rates of BF initiation at hospital discharge and BF continuation at postpartum (PP) visit and identify factors associated with BF noninitiation and BF cessation among patients admitted with early-onset sPREX.

Staging by Thoracoscopy in potentially radically treatable Lung Cancer associated with Minimal Pleural Effusion (STRATIFY): protocol of a prospective, multicentre, observational study.

Introduction: Recurrence rate following radical therapy for lung cancer remains high, potentially reflecting occult metastatic disease, and better staging tools are required. Minimal pleural effusion (mini-PE) is associated with particularly high recurrence risk and is defined as an ipsilateral pleural collection (<1/3 hemithorax on chest radiograph), which is either too small to safely aspirate fluid for cytology using a needle, or from which fluid cytology is negative. Thoracoscopy (local anaesthetic thoracoscopy (LAT) or video-assisted thoracoscopic surgery (VATS)) is the gold-standard diagnostic test for pleural malignancy in patients with larger symptomatic effusions.

Nanoscale Titanium Surface Engineering via Low-Temperature Hydrothermal Etching for Enhanced Antimicrobial Properties.

Bioinspired nanotopography artificially fabricated on titanium surfaces offers a solution for the rising issue of postoperative infections within orthopedics. On a small scale, hydrothermal etching has proven to deliver an effective antimicrobial nanospike surface. However, translation to an industrial setting is limited by the elevated synthesis temperature (150 °C) and associated equipment requirements.

Comparative outcomes of physician-modified fenestrated/branched endovascular aortic aneurysm repair in the setting of prior failed endovascular aneurysm repair.

Objective: Endovascular treatment of aortic aneurysms involving renal-mesenteric arteries, especially in the setting of prior failed endovascular aneurysm repair (EVAR) typically requires fenestrated/branched endovascular aneurysm repair (F/BEVAR) with a custom-made device (CMD). CMDs are limited to select centers, and physician-modified endografts are an alternative treatment platform. Currently, there is no data on the outcomes of physician-modified F/BEVAR (PM-F/BEVAR) in the setting of failed prior EVAR.

Canine Neonatal Health.

This article provides a high-level overview of canine neonatal health for clinicians to use as a mental framework so that when presented with a canine neonate it is easier to construct a logical and systematic clinical approach that is less overwhelming. As early detection of the at-risk neonate results in earlier intervention, and improved health outcomes, there will be a focus on pro-active care. Where appropriate, other articles in this issue will be mentioned for a more in-depth discussion of specific areas.

SAIL study of stroke, systemic embolism and bleeding outcomes with warfarin anticoagulation in non-valvular atrial fibrillation (S-BOW-AF).

Aims: In patients with non-valvular atrial fibrillation (NVAF) prescribed warfarin, the association between guideline defined international normalised ratio (INR) control and adverse outcomes in unknown. We aimed to (i) determine stroke and systemic embolism (SSE) and bleeding events in NVAF patients prescribed warfarin; and (ii) estimate the increased risk of these adverse events associated with poor INR control in this population.

Methods And Results: Individual-level population-scale linked patient data were used to investigate the association between INR control and both SSE and bleeding events using (i) the National Institute for Health and Care Excellence (NICE) criteria of poor INR control [time in therapeutic range (TTR) <65%, two INRs <1.

Modelling daily plant growth response to environmental conditions in Chinese solar greenhouse using Bayesian neural network.

Understanding how plants respond to environmental conditions such as temperature, CO, humidity, and light radiation is essential for plant growth. This paper proposes an Artificial Neural Network (ANN) model to predict plant response to environmental conditions to enhance crop production systems that improve plant performance and resource use efficiency (e.g.

Human health risk associated with metal exposure at Agbogbloshie e-waste site and the surrounding neighbourhood in Accra, Ghana.

Agbogbloshie in Accra, Ghana, was a center for informal e-waste recycling until it was closed recently. This study investigated the potential health risks of toxic metals (including As, Cd, Cu, Ni, Pb, Sb, and Zn) found in the surface soils based on their concentrations and in vitro bioaccessibility. Mean concentrations at the burning sites were As: 218; Cd: 65; Cr: 182; Cu: 15,841; Ni: 145; Pb: 6,106; Sb: 552; and Zn: 16,065 mg/kg while the dismantling sites had mean concentrations of As: 23; Cd: 38; Cr: 342; Cu: 3239; Ni: 96; Pb: 681; Sb: 104; and Zn: 1658 mg/kg.

Bifidobacterium bacteraemia is rare with routine probiotics use in preterm infants: A further case report with literature review.

Prophylactic administration of oral probiotics is associated with significant reductions in the morbidity and mortality of necrotising enterocolitis in preterm infants. We document the first case of Bifidobacterium longum subsp. infantis sub-clinical bacteraemia, in an extremely low birth weight preterm infant, since introduction of routine probiotic treatment at the Norfolk and Norwich University Hospital 10 years ago.

Is There a Role for Coronary Calcium in Patients With Diabetes?

In the primary prevention of atherosclerotic cardiovascular disease (ASCVD), a significant portion of high-risk patients have diabetes. Two decades ago, patients with or without cardiovascular disease were identified as having coronary heart disease (CHD) risk equivalents because prospective studies showed that they were at risk for future CHD events equivalent to that of patients with established CHD. Thus, for patients with CHD, cholesterol guidelines recommended that patients with diabetes should be treated routinely with statins.

Statin therapy for primary prevention in men: What is the role for coronary artery calcium?

Current cholesterol guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) base statin treatment decisions on multiple risk factor algorithms (e.g., Pooled Cohort Equations [PCEs]).

Guidelines for the management of hyperlipidemia: How can clinicians effectively implement them?

Guidelines support lowering cholesterol to decrease atherosclerotic cardiovascular disease (ASCVD) risk across the entire lifespan with intensive lifestyle intervention, as well as statin and non-statin pharmacotherapy for those at highest risk. Modest improvements in the initiation, use, and adherence to statin therapy in patients with ASCVD have occurred over the past decades. However, studies continue to document a less than desired implementation of guidelines highlighting a substantial and persistent treatment gap.

Comprehensive Reform Urgently Needed in Hospital Shackling Policy for Incarcerated Patients in the United States.

Approximately 2.2 million people are incarcerated in the United States. The carceral population is aging due to strict sentencing laws, which has increased the frequency and acuity of off-site medical care.

Intimate Partner Violence and Contraception among Adolescent Girls and Young Women: A Longitudinal Analysis of the Girl Power-Malawi Cohort.

Purpose: In sub-Saharan Africa, sexually active adolescent girls and young women (AGYW) experience high rates of intimate partner violence (IPV) and low levels of contraceptive use, but the effect of IPV on contraceptive use is not well understood.

Methods: In the Girl Power-Malawi study, AGYW aged 15-24 were recruited from 4 health centers in Lilongwe, Malawi, and followed for 1 year. At baseline, AGYW were assessed for IPV using the modified Conflict Tactics Scale.

Breastfeeding: The Basics, the History, and Barriers in the Modern Day.

Importance: The scientific benefits of breastfeeding for the parent and baby are clear, but the goal is often simplified to "breast is best." Patients' decisions to breastfeed are more nuanced than this approach implies, and it is essential for providers to understand other factors that contribute to this complex decision.

Objective: We reviewed the current literature of the health benefits of breastfeeding, local and global breastfeeding trends and current disparities, and the historical, political, and social factors that influence a patient's decision to breastfeed.

Statin therapy for primary prevention in women: What is the role for coronary artery calcium?

By current guidelines, statin treatment decisions depend on multiple risk factor algorithms (e.g., pooled cohort equations [PCEs]).