Alcohol use disorder (AUD) characterized by heavy and prolonged alcohol intake could cause various forms of alcoholic liver disease (ALD). The spectrum of alcoholic liver disease (ALD) consists of steatosis, steatohepatitis, cirrhosis and hepatocellular carcinoma depending on the duration and severity of alcohol intake ,2. Inter


Knowledge of service use and costs and wider societal costs in Europe is limited; (2) Method: Using an international sample, we analysed services and costs in 357 children (4–6.99 years) with ASD based on parent reports. Costs were transformed into EU-28 average using purchasing power parity; (3) Results: 122 children (34%) received specialist autism services; 149 (42%) received sensory/motor therapy; 205 (57%) received speech/language therapy; 35 (10%) received play therapy; 55 (15%) received behavioural interventions; 31 (9%) received social skills training; 47 (13%) participated in therapeutic recreational activities; and 59 (17%) received other services. The total number of hours for these services combined over two months was M = 34 . Estimated total costs of health-related services were M = 1210 EUR (SD = 2160 EUR); indirect societal costs were M = 1624 EUR (SD = 1317 EUR). Regression analyses suggested that costs rise with age and presence of intellectual disabilities, but not with severity of autism; (4) Conclusions: The high extent of community-based services indicates good accessibility but also considerable variation in the receipt of services. The costs of autism services are considerable. Further research is needed to investigate whether services received match individual needs. Autism spectrum disorder (ASD) refers to a range of lifelong neurodevelopmental conditions characterized by the presence of early appearing symptoms in two core domains: impairments in reciprocal social communication and the presence of restricted interests and repetitive behaviours DSM-5; ICD-11) . ASD aff; ICD-11 https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders, accessed on 1 April 2020) recommend evidence-based psychosocial interventions including behavioural treatment and parent skills training programmes which can minimalize limitation in communication skills and social behavioral skills with improving well-being and quality of life for both individuals with ASD and their parents. Based on current best evidence, guidelines developed by Autism-Europe [It is important to provide individuals with ASD and their families with support to live their best possible life. There is no cure for autism nor one care package that suits everyone. People with autism require different support at each age of their lives, and it is therefore essential to ensure the right type of evidence-based therapy at the right time. Relevant guidelines often emphasize general principles in the absence of more specific evidence. One relevant policy overview by World Health Organization  , we analDetails on study procedures were described separately , while aType of therapy or intervention ;Institutional stay ;Outpatient treatment ;Dietary supplement and medication ;Special diet ;Working hours spent on treatment as described above, including driving, of all private care givers (weekly average in hours);Work situation (working or not working);Reduced hours due to the child’s needs (in percentage);Employing anybody privately to help care for the child ;Any additional assistant/aide in school/at home for the child ;Care giver investment:TIME-A used assessments by blinded clinicians as well as reports by parents/caregivers collected at several time points. For the current study purpose, only data collected at baseline on scores of the ADOS and ADI-R, IQ level, as well as costs and concomitant treatments were included. Parents answered a detailed questionnaire regarding services received and out-of-pocket expenses during the past two months. The following data were collected:Respondents were asked to reply with regard to the last 2 months. The limited recall time frame was used to minimalize the recall bias following other economic evaluations e.g., ,36. The https://data.oecd.org/conversion/purchasing-power-parities-ppp.htm, for 2018, accessed on 4 March 2021). All health services costs  were sourced from personal communication and represent typical costs in Austria, a Central European country and one of the countries where data were collected. Heath services costs were set up to be 84 EUR per 60 min (one session) based on 1:1 setting, and discounted for group settings, assuming a group size of 5. Costs of institutional stay (310.08 EUR per day) and outpatient treatment (167.10 EUR per contact/visit) were retrieved from a report of Unit Costs of Health and Social Care [https://ec.europa.eu/eurostat/en/web/products-datasets/-/ILC_DI08, accessed on 4 March 2021), the following unit costs were obtained: 1946.08 EUR per month for full-time work where both parents had a university degree; 1391.42 EUR per month where both parents had 12 or more years of education; and 1129.42 EUR per month where at least one parent had less than 12 years of education or education level was unknown. No unit costs were imputed for medication and special diets because these costs were found to be negligible in children with ASD [https://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&language=en&pcode=tec00118&plugin=1, accessed on 4 March 2021).Unit costs were inserted where a service was used but parents reported no expense for the service. Costs were transformed into EU-28 average using purchasing power parity , and intellectual disability (below-average intelligence) and health services costs and societal costs. Following literature that the age and severity of autism symptoms are significant predictors of costs for children at preschool age  and in an = 140).A sensitivity analysis was used to determine how data retrieved from non-European countries affected the obtained health services costs and societal costs. In order to determine the robustness of our results by examining the extent to which results of health services costs and societal costs are affected by country of origin, we calculated costs including only 217 children from Europe  and excluding individuals from other non-European countries  and clinical judgement (n = 140), the results of which indicate that 47% of children (n = 163) had IQ below 70. The majority of individuals attended to school (62%), while 22% to full-time care and 11% to part-time care. More details can be found in the top half of The total of 357 children (83% boys) were included with a mean of age 5.4 years (SD = 0.9). As can be seen from In regard to parents’ situation of work, the majority of mothers were homemakers (34%) followed by 26% being part-time employed, while the majority of fathers were working full-time (74%). Regarding education, many parents had a university degree , followed by education equivalent to high school , and less than high school . The bottom half of Of 357 children, 122 (34%) received specialist autism services; 149 (42%) received sensory/motor therapy; 205 (57%) received speech/language therapy; 35 (10%) received play therapy; 55 (15%) received behavioural interventions; 31 (9%) received social skills training; 47 (13%) participated in therapeutic recreational activities; and 59 (17%) received other services . The totThe sum of indirect societal costs was M = 1624 EUR  over the last 2 months with a wide range . It can be seen that the SDs are relatively high compared to the means; sometimes higher than the means. This reflects the skewed nature of these data, which is a common phenomenon in health economic data ,41.p < 0.048) and intellectual disability (p < 0.005) on health costs  attended school, 91 of included children (25%) attended kindergarten ; while 5 (1%) attended none of aforementioned. Regarding other services, 10 children (3%) had an institutional stay over the last 2 months; 24 (7%) received outpatient treatment; 55 (15%) received medication; and 38 (11%) a special diet. It can be seen from the data in n = 85; 24%); 111 had reduction in working hours (31%) due to a child care assist  and required an additional aide at school or home .The results about schooling indicate that the majority of individuals from European counties . It may be explained by the fact that communication problems belong to the core autism symptoms; thus, children may benefit the most from this kind of treatment at this early stage of life. The second and most frequently chosen form of therapy was sensory and motor therapy . High use (42%) of this intervention might be due to the core nature of sensory symptoms in individuals with ASD, particularly to sensory over-responsivity . On the Estimated total costs of health-related services were M = 1210 EUR for a 2-month period, while specialist autism services contributed to these costs the most (315 EUR) followed by behavioural intervention (284 EUR) and speech/language therapy (251 EUR).Roggie and Janssen  in theirThe present results indicated a high diversity among children’s needs and therefore health care services used. Institutional admissions occurred in 12 cases (3% of cohort), while visits to psychiatric, somatic, or other specialized outpatient services occurred in 37 cases (10%). Even though our data indicated a relatively low mean cost of institutional stay (3 EUR) and outpatient services (1 EUR) over a period of two months when averaging across the whole sample, the wide range of costs show that there were families who incurred very high costs  related to these services, whereas other families did not have these costs at all. A large and growing body of literature has investigated healthcare utilization expenditures for individuals with autism. Other research in medical and healthcare costs has emphasized the higher costs for individuals with autism compared to individuals without ,19,21,22One third (31%) of the included families in our sample experienced some costs related to medication. Even though the present data indicate a relatively low cost of medication (approx. 6 EUR) over a period of two months, the range of costs (from 0 to 290 EUR) emphasizes that there were families who incurred very high costs related to these services, and families who did not have these costs at all. There is a large volume of published studies e.g.,  describiSeventeen percent of the included children in our study experienced costs associated with a special diet; across all included children, the cost of special diet was on average 7 EUR over a period of two months. The broad range of these costs from 0 to 455 EUR indicates that some families have had a very high cost associated with a special diet. These results are likely to be related to a possible relationship between nutritional status and general condition of ASD children. Peretti and colleagues  emphasizResults of the present study indicated the indirect societal costs to be around 1624 EUR over a period of two months. In terms of societal costs, an additional aide at school or home contributed the highest costs (621 EUR), followed by reduction in working hours (M = 524 EUR), childcare/school (M = 461 EUR), and child care help (M = 18 EUR).Our findings seem to be consistent with other research which found a high economic burden linked with ASD on society . For insFamilies of individuals with ASD face significant economic burden due to reduction or interruption of employment . The resData from our study indicate that the reduction in working hours was linked with costs of 524 EUR; child care help with additional costs of 18 EUR over a period of two months. Our findings have confirmed previous results ,30 that It was hypothesized that younger participants with a diagnosis of autism with intellectual disability will bear higher costs compared to those with older age, with broader ASD category and with intellectual disability. Regression calculation of costs confirmed that health costs change with age for children with ASD during ages 4–7 and with presence of intellectual disabilities, but not with societal costs. Our results indicated that health costs increased by 213 EUR per additional year of child’s age and by 566 EUR for children with intellectual disability, indicating that both age and intellectual disability are significant factors related to total health costs. However, such a relationship was not observed for the social costs.Our results are in line with earlier findings. Research by Järbrink  found thThe results of our study did not confirm the predictive role of symptoms severity in the health costs and societal costs measured by ADOS total score, which is consistent with another study . HoweverLittle is known about autism-related costs in Europe. Total costs including health services costs and societal costs were estimated to be around 2834 EUR for the whole sample size compared to 2489 EUR for individuals from Europe. The results obtained from the sensitivity analysis showed that for children from European countries the pattern of services used is similar (but not exactly the same) for those from non-European countries. Children outside Europe attended more often health care services in the pre-school period, which has a direct impact of health services costs (1210 EUR vs. 740 EUR for the 2 months). Speech/language therapy; behavioural intervention; and sensory/motor therapy were associated with the highest costs for children from Austria, Israel, Italy, Norway, UK; while for the whole sample the main cost drivers were specialist autism services followed by behavioural intervention and speech/language therapy. Estimated societal costs  were relatively close both in Europe and outside  with the same key cost driver .The generalisability of these results is subject to certain limitations. For instance, the most important limitation lies in the fact that the study used self-reported data of costs threatened by self-reporting bias as: social desirability and recall bias , but theThe present research explores, for the first time, the costs of services received and associated costs for children with ASD bason on 5 European countries  and 4 non-European countries . Total costs including health services costs and societal costs, were estimated to be around 2834 EUR over last 2 months with a wide range from 84 EUR to 26,051 EUR. Estimated total costs of health-related services were around 1210 EUR  and indirect societal costs were 1624 EUR (with a wide range from 0 to 6263 EUR). Specialist autism services; behavioural intervention; and speech/language therapy were key cost driver in this group  followed by sensory/motor therapy (213 EUR) play therapy (32 EUR), therapeutic recreational activities (23 EUR) and social skills training (12 EUR). Among indirect societal costs the important cost driver was an additional aide at school or home (621 EUR) followed by reduction in working hours (524 EUR), childcare/school (461 EUR) and child care help (18 EUR).The current findings add to a growing body of literature on services and costs for children with ASD by confirming that families of children with ASD bear higher costs related to the child’s age  and child’s intellectual functioning . This study has also shown that the diversity of approaches recommended in guidelines across countries. The pattern of services used by children with ASD from European countries is similar (but not exactly the same) for those from non-European countries. The high extent of community-based services indicate good accessibility but also considerable variation in the receipt of these services. Notwithstanding the limitations, these results suggest that the costs of autism services are considerable. There is still abundant room for further progress in evaluating data on services received by individuals with ASD and associated costs for Europe. To develop a full picture of costs additional studies targeting adolescents and adults with ASD is recommended. Further research is needed also to investigate whether services received match individual needs.


The Centers for Medicare & Medicaid Services defines a hospital readmission as an inpatient stay that begins within 30 days of the discharge date of an index admission, to the same or a different hospital. The aims of the study were to analyze the recurrent readmissions of older persons admitted to a community hospital with diagnoses of: Chronic Obstructive Pulmonary Disease (COPD), Pneumonia (PNA), and Congestive Heart Failure (CHF). Based on the results, we will develop additional strategies that can be used to reduce the rate for hospital readmission for older patients. A retrospective chart review of hospitalizations was conducted. Among 30 readmissions, the mean age was 79.5±14. The index disposition was distributed among three destinations: self-care (27%), home health organization (40%), and to skilled nursing home (33%). Most of the readmissions were for CHF (27%), COPD (10%), and PNA (13%), the only other large category include respiratory failure (10%). The readmission disposition was different from the index disposition: self-care (7%), home health organization (47%), and to skilled nursing home (20%). After hospital readmission within 30 days, older persons were more likely to be discharged to home health care organization than self-care, p<0.05. Actions that can be taken by hospitals to reduce 30-day readmissions to maintain older person independence include: clinical readiness of patients for discharge, proper infection prevention techniques, reconciling medications, good communication, and adequate patient education. This study reports that that older persons are at higher risk for unplanned hospital re-admissions and often lose their independence.


While Alzheimer’s disease (AD) and vascular dementia (VaD) may be accelerated by hypercholesterolemia, the mechanisms underlying this association is unclear. Using a novel, 3-step study design we examined the role of cholesterol catabolism in dementia by testing whether 1) the synthesis of the primary cholesterol breakdown products (bile acids (BA)) were associated with neuroimaging markers of dementia; 2) pharmacological modulation of BAs alters dementia risk; and 3) brain BA concentrations and gene expression were associated with AD. We found that higher serum concentrations of BAs are associated with lower brain amyloid deposition, slower WML accumulation, and slower brain atrophy in males. Opposite effects were observed in females. Modulation of BA levels alters risk of incident VaD in males. Altered brain BA signaling at the metabolite and gene expression levels occurs in AD. Dysregulation of peripheral cholesterol catabolism and BA synthesis may impact dementia pathogenesis through signaling pathways in the brain.


The expression of the chosen genes was confirmed by RT-qPCR technique. Thus, it can be assumed that the identified genes involved in the regulation of growth and development of muscle tissue and the processes of protein metabolism in the examined cattle breeds may be responsible for the greater gain of muscle mass in beef-breed bulls.The aim of the study was to compare the transcriptomic profiles of fully differentiated skeletal muscle derived from bulls belonging to different breeds of varying performance. Microarray analyses were performed to determine the differences in the expression profiles of genes between semitendinosus muscles of 15-month-old beef-breed bulls (Limousin—LIM and Hereford—HER) and dairy-breed bulls (Holstein Friesian—HF). These analyses allowed for the identification of those genes the expression of which is similar and characteristic of fully differentiated muscle in beef breeds, but differs in skeletal muscle of a typical dairy breed. The analysis revealed 463 transcripts showing similar expression in the semitendinosus muscle of beef breeds (LIM/HER), in comparison with the dairy breed (HF). Among the identified genes, 227 were upregulated and 236 were downregulated in beef breeds. The ontological analyses revealed that the largest group of genes similarly expressed in LIM and HER was involved in the processes of protein metabolism and development of muscle organ. In beef breeds, some genes involved in protein synthesis and proteolysis showed an upregulation, including The online version of this article (10.1007/s13353-020-00577-1) contains supplementary material, which is available to authorized users. The quality of livestock meat is very important from an economic point of view, and hence, research has been carried out over the past few decades to increase the production of beef, accelerate the growth rate of cattle, and improve the quality of meat  cattle breed  and the early-maturing Hereford (HER) breed (with a large proportion of well-marbled muscle) are both beef breeds, whereas the early-maturing and poorly muscled Holstein Friesian (HF) is a typical dairy breed. The gains of muscle mass up to the 16th month of life are about 1000–1300, 850–1400, and 800–1000 g per day in LIM, HER, and HF breeds, respectively. The reason for these differences observed in the gain of muscle mass is not sufficiently explained, and the genes determining the rate of growth and metabolism of muscle tissue in these breeds remain to be identified  skeletal muscle in cattle depending on their breed and performance. The analysis allowed for a better understanding of the genetic regulation of the development of muscle tissue, as well as determining the putative genes involved in myogenesis and development of muscle tissue in beef-breed bulls.It was assumed that the results obtained will enable the selection of those genes that are involved in the process of myogenesis and maturation of skeletal muscle and modification of their expression for achieving greater gains of muscle mass in beef-breed bulls.All the procedures related to animal experiments were approved by the Local Ethics Committee.n = 4), HER , and HF  used as a reference. The bulls were housed, fed, and slaughtered at the age of 15 months as described earlier  and total RNA isolation and validation were done as described in previous papers  of 15-month-old bulls from beef breeds Limousin (LIM) and Hereford with bulls of the Holstein-Friesian (HF), a dairy breed (reference), was done using the GeneSpring software , t test with p ≤ 0.05 and fold change ≥ 1.3 as the criteria of significance. Each comparison was performed individually, in four biological repetitions. In the subsequent stage, a comparative analysis of both transcriptomes was performed, aiming at identifying common genes with different expression in the muscles of bulls from beef breeds . The data obtained from the microarray experiment were deposited in the NCBI  Gene Expression Omnibus database and numbered GSE137565 (HER vs. HF) and GSE137566 (LIM vs. HF).The gene expression profile was analyzed using Bovine (V2) Gene Expression Microarray 4 × 44 K oligonucleotide slides  and Two-Color Microarray-Based Gene Expression Analysis kit . Probe labeling, hybridization, signal detection, and data extraction were done as described in a previous paper  was used as a nonregulated, reference gene for normalizing the expression of the verified genes  was applied. The mRNA sequences of the genes selected for validation were obtained from the NCBI Nucleotide database. Primer sequences were designed using the Primer3 and Primer-Blast software (NCBI database) and then checked using Oligo Calculator as described previously . For the purpose of publication, the color immunoblot images were converted into black and white in the Odyssey software.The protein extracts obtained from the skeletal muscle tissues were lysed with RIPA buffer  supplemented with protease inhibitor cocktail and phosphatase inhibitor cocktail  for 30 min at 4 °C. The lysates were cleared for 30 min at 14000 rpm, and the supernatants were collected. The concentration of protein in the lysates was determined using Bio-Rad Protein Assay Dye Reagent according to the manufacturer’s instructions . The proteins (50 μg) were resolved by SDS-PAGE and transferred onto a PVDF membrane . For immunostaining, the membranes were blocked with 5% nonfat dry milk in TBS  containing 0.5% Tween 20. The membranes were then incubated with the following primary antibodies: monoclonal anti-mouse GDF-8 antibody  (1:100) and polyclonal goat GAPDH antibody  (1:500). Then, the membranes were washed three times for 15 min and incubated further with appropriate secondary antibodies conjugated with an IRDye 680 or IRDye 800 CW fluorophore  (1:5000). An Odyssey Infrared Imaging System  was used to analyze the fluorescence. The scan resolution of the instrument was set at 169 μm, and the intensity at 4. The integrated optical density (IOD) was quantified using the analysis software provided with the Odyssey scanner  and normalized to GAPDH. Immunoblot analysis was performed on the samples obtained from four individuals of each breed , two (**), and three (***) asterisks, respectively. The data are shown as means ± SEM (standard error of the mean).Statistical analysis of the microarray data was performed using the GeneSpring software . The results of qPCR and Western blot were analyzed using Prism 5.0 . Statistical significance was checked using the one-way ANOVA  with Tukey post hoc test. The differences at the level of http://www.pantherdb.org) with a statistical overrepresentation test with Bonferroni correction; DAVID  (https://david.ncifcrf.gov/), and Pathway Studio Web . In addition, during the development of data from microarrays, numerous internet databases, grouped in NCBI, such as GenBank, OMIM, PubMed, and iHOP, were used.The results were subjected to ontological analysis using the following online available databases: Panther Classification System  was performed in terms of biological processes, in which products of expression of these genes might be involved. Ontological analysis demonstrated their relationship with 13 biological processes, including the following: metabolic processes 236 genes), cellular processes (161), regulation of biological processes (101), developmental processes (63), localization (54), response to stimulus (53), cellular component organization or biogenesis (39), immune system processes (35), multicellular organismal processes (26), cell adhesion (17), apoptosis (11), reproduction (5), and locomotion (1) , followed by phosphate-containing compound metabolic process (31), nitrogen compound metabolic process (27), biosynthetic process (17), catabolic process (11), generation of precursor metabolites and energy (5), coenzyme metabolic process (3), sulfur compound metabolic process (2), and vitamin metabolic process (1).Further functional classification of DEGs demonstrated that among 195 genes involved in primary metabolic processes, the highest share was exhibited by the genes involved in protein metabolic process (99), nucleobase-containing compound metabolic process (91), lipid metabolic process 20) carbohydrate metabolic process (17), and cellular amino acid metabolic process (5) Fig. . The mul0 carbohyUsing the Pathway Studio software, a network of relationships was performed for the differentially expressed genes assigned to the processes associated with protein metabolic process. This enabled a visualization of interaction between DEGs and additionally demonstrated the affiliation of genes to two major processes associated with protein metabolic process: protein synthesis 36 genes) and proteolysis (33 genes) , mesoderm development (19), anatomical structure morphogenesis (19), ectoderm development (12), apoptosis (11), cell differentiation 5), embryonic development (3), pattern specification process (2), and endoderm development (1) . Supplementary Table In addition, an ontological analysis was performed using the Pathway Studio software, which assigned the DEGs with the same direction of expression change 454 genes) to 473 biological processes  and lower level of expression of 5 genes  in semitendinosus muscle of beef breeds (LIM and HER), compared with the dairy breed (HF). These results confirm the results obtained with microarray analysis and exhibited the same direction of expression change as in the microarray experiment.In order to verify the results of transcriptomic analysis, validation of gene expression with the use of qPCR technique has been performed. For the purposes of result verification, seven genes were selected, demonstrating similar changes of expression in both beef breeds (LIM and HER) compared with typical dairy breed (HF), associated with the processes of muscle tissue development and protein metabolism processes. Results of verification with real-time qPCR are presented in the form of block diagrams. The level of mRNA expression is presented as ΔΔCt Fig. . The qPCp ≤ 0.05) difference in the expression of MSTN in bulls from LIM and HER breeds compared with HF breed bulls. Expression of the active form of myostatin (26 kDa) in the semitendinosus muscle tissue was lower in beef breeds compared with dairy breed , the key protein inhibiting the process of myogenesis, may be one of the factors influencing differences in the musculature of bulls from beef breeds , compared with bulls of the dairy breed (HF)  and myostatin (mstn). The present study demonstrated higher expression of follistatin and lower expression of myostatin in beef bulls (LIM and HER) compared with bulls from dairy breed (HF)  is another gene identified using the microarray technique, whose expression level was lower in bulls of beef breeds than in the dairy breed  and bmpr2  in mature 15-month-old muscle tissue in LIM and HER breeds compared with HF breed   assigned this gene to protein metabolism process  Fig. , also kngsk3β expression in beef breeds  expression in the muscle of LIM and HER bulls  and atrogin 1. The authors observed that as a result of sirt1 overexpression, reduction of the protein degradation degree occurs and their synthesis is intensified, which resulted in increased muscle mass. Koltai et al.  and ctsf (cathepsin F)  and fhl3  genes, which are associated with the development of muscle organ  and decreased expression of genes responsible for inhibition of synthesis and intensification of protein degradation . Increased level of follistation expression and decreased myostatin expression level in skeletal muscles of beef breed bulls indicate the role of follistatin as antagonist of myostatin in the regulation of myogenesis, and it may play a significant role in stimulating development and growth of muscles in these breeds, and as a consequence greater gains of muscle mass. Moreover, the faster growth and development of muscle tissue in beef bulls can be associated with the elevated expression of fhl2 and fhl3 genes encoding FHL proteins , playing putative role in the process of skeletal muscle differentiation including formation of myotubes and expression of proteins characteristic of muscle fibers. The genes identified in this study, involved in the regulation processes of growth and development of muscle tissue and protein metabolism processes in the tested cattle breeds, may be responsible for greater muscle mass gains in bulls from beef breeds and may constitute a new cattle selection tool towards highly efficient meat production, which may be of considerable economic importance.Comparison of transcriptomic profiles of fully differentiated skeletal muscle originating from 15-month-old bulls from various breeds with different performance enabled formulation of the following conclusions. Greater growths of muscle mass in bulls from beef breeds  than in the dairy breed (HF) stem from the differences in protein transformations and are associated with elevated expression of genes stimulating synthesis and inhibiting degradation of proteins (ESM 1(DOCX 73 kb)


Given extended life expectancy, family caregivers are needed to provide care for older adults at home. Research has documented the deleterious effects of caregiving on mental and physical health for many. The Caregiver Health and Well-Being Initiative is a systems approach to support family caregivers of older adults by standardizing processes for identifying caregivers in ambulatory and inpatient settings, assessing caregivers’ needs, and providing relevant services and resources, including caregiver health services, a Teach Back clinic for skills development, and extended goals of care conversations. N=104 caregivers have completed assessments. Participants reported the following at baseline: depressive symptoms (54%); anxiety symptoms (69%); health being affected by the care situation (59%); financial situation decreasing (58%); feeling torn between demands of their family and demands of care (63%); and some feelings of burden from caregiving (97%). Intervention components will be discussed along with a larger systems change framework for implementation.


Bioscience Reports 39(12) https://doi.org/10.1042/BSR20190744) would like to correct several data calculation points. In the original article, they had made a mistake in extracting the minimum allele frequency (MAF) of rs10830963 polymorphism from one included study [The authors of the original article A functional polymorphism rs10830963 in melatonin receptor 1B associated with the risk of gestational diabetes mellitus (Figures and tables have been updated in order to reflect this, and can be found in their correspondence piece .


A 42-year-old patient without structural heart disease was referred for catheter ablation of salvos of outflow tract ventricular tachycardia (VT). Activation mapping of the clinical VT (VT1) revealed the earliest ventricular activation site at the right ventricular outflow tract (RVOT). Catheter ablation at this site led to a slight QRS shift of the VT morphology (VT2). Activation mapping of VT2 established the site of origin at the commissure between the right (RCC) and left (LCC) coronary cusps. This case is indicative of the presence of myocardial fibers displaying preferential conduction properties from the RCC–LCC commissure to a breakout site at the RVOT. The QRS morphology was suggestive of a right ventricular outflow tract (RVOT) site of origin (SOO). An electrophysiologic study was performed in a fasting state without sedation. Antiarrhythmic drugs (β-blocker) were stopped at least five half-times before the procedure. High-density activation mapping of the clinical VT (VT1) was performed using a three-dimensional nonfluoroscopic mapping system  via a multipolar catheter . A contact force-sensing catheter  was used for validation of the earliest activation site and ablation (contact force up to 8 g).A 42-year-old patient was referred for catheter ablation of symptomatic salvos of idiopathic ventricular tachycardia (VT). Structural heart disease was excluded by means of transthoracic echocardiography, cardiac magnetic resonance imaging, and exercise stress testing. The electrocardiogram (ECG) during VT displayed a left bundle branch block pattern (LBBB) with an inferior axis, R-wave in lead I, and precordial transition in lead V4  and 2C. The unipolar signal at this site displayed a small initial r-wave with a steep negative dV/dT. Radiofrequency (RF) energy delivery  at this site led to a slight QRS shift of the VT morphology. The ECG morphology of the second VT (VT2) was characterized by LBBB with an inferior axis, a lower-amplitude R-wave in lead I, and a precordial transition in lead V4 . Of note, the most prominent change was seen in lead V1, where the rS pattern shifted to a QS pattern with notching on the downward deflection, which is suggestive of a right coronary cusp (RCC)–left coronary cusp (LCC) commissure SOO. Following the change in QRS morphology, an additional attempt of RF delivery was performed at this site but failed to suppress the arrhythmia. Meticulous activation mapping of the VT2 was subsequently performed at the RVOT, the left ventricular outflow tract (LVOT) including the coronary cusps, and the coronary venous system [great cardiac vein (GCV)]. The new activation mapping attempt revealed the earliest activation site at the RCC–LCC commissure (−25 ms)  and 2C. Catheter ablation  at this site led to suppression of the arrhythmia. Of note, very low voltage and fragmented bipolar signals were recorded at the successful ablation site . On the contrary, the unipolar signal exhibited an initial r-wave with a less steep negative dV/dT as compared with during VT1. VT2 was not inducible by atrial or ventricular stimulation with or without isoproterenol infusion 30 minutes after ablation. The patient remained free from arrhythmias six months after the procedure.Activation mapping of the RVOT revealed the earliest activation site at the posterior septum (−23 ms) This case report is suggestive of the presence of myocardial fibers displaying preferential conduction properties from the RCC–LCC commissure to a breakout site at the RVOT.1 Of 202 patients with monomorphic VT or premature ventricular contractions (PVCs) originating from the outflow tract, six patients (3%) showed changes in QRS morphology following RF energy delivery, requiring an additional RF application at a different site, which was often the LCC. Yamada et al. reported that VAs originating from the coronary cusps display preferential conduction to the RVOT and an insulated myocardial fiber across the ventricular outflow septum may exist in these cases.2 Especially, in 25% of patients with VAs of a coronary cusp origin, pacemapping from the RVOT yielded a closer match of the QRS morphology than pacing from the coronary cusp. In these cases, pacemapping identified the preferential breakout site.2 In the study by Shirai et al., a QRS morphology shift following catheter ablation at the earliest activation site was observed in 4% of cases of idiopathic outflow-tract VAs. The shifted VT or PVC demonstrated a distinct ECG QRS pattern supporting the notion that different preferential QRS exit sites within the outflow tract were operative in these cases. After remapping, the earliest activation site of the second VT or PVC moved to a different anatomical structure adjacent to the initial ablation site in 65% of cases, which was most frequently the LVOT region (coronary cusps).Tada et al. initially investigated the prevalence and characteristics of idiopathic outflow-tract ventricular arrhythmias (VAs) with altered QRS morphology following RF catheter ablation.3 An intramural SOO with preferential conduction channels to specific sites of the outflow tract  may explain this phenomenon.3 The presence of preferential conduction can be unmasked by ablation at the first earliest activation site when the first preferential exit of the VT/PVC is eliminated.3 Unipolar signals displaying an rS pattern at both the earliest activation sites, as seen in our case, favors the presence of an intramural SOO.The complexity of the myocardial network around the outflow tract with the potential for preferential/alternative conduction and multiple exiting sites has been suggested to explain subtle variations in the QRS morphology of idiopathic outflow-tract VAs following RF ablation.In conclusion, a QRS morphology shift following catheter ablation of idiopathic outflow-tract VAs is not an uncommon phenomenon. Meticulous activation mapping usually reveals the true SOO in an adjacent site, which is more commonly the coronary cusps.


The Mong Cai pig is an indigenous breed and popularly raised as maternal line in northern Vietnam. In this study, the complete mitochondrial genome sequence of the Mong Cai pig is reported. The total length of this mitochondrial genome is 16 632 bp, including 1 non-coding control region (D-loop region), two ribosomal RNA genes, 13 protein-coding genes and 22 transfer RNA genes. The phylogenetic tree of 162 pig complete mitogenomes reveals a very close relationship between Mong Cai pig in Vietnam and Bama miniature pig in southern China. This complete mitochondrial genome sequence of Mong Cai pig is useful to further genetic studies on adaptation and performance. Mong Cai pig is one of the unique and indigenous pig breeds in Vietnam. It is originated from Mong Cai district of Quang Ninh province and is farmed widely in northern Vietnam. With its high fertility, Mong Cai pigs are commonly used as basic sows for crossing with Yorkshire and Landrace pig breeds Tra . Mong CaHere, we sequenced the complete mitochondrial genome of a Mong Cai pig in Son La province, Vietnam . The ear sample was stored in the Key Lab of Agricultural Animal Genetics and Breeding, College of Animal Science and Veterinary Medicine, Huazhong Agricultural University (ID: 20151011mongcai14). The sequence was amplified using 35 pairs of primers  similar to other mammalian mitochondrial genomes (Lin et al.


Lipoprotein(a) has long been regarded as a risk factor for cardiovasculardisease; however, its routine use in clinical practice has been hampered bydifficulties inherent in the measurement of this complex lipoprotein. The majorchallenges relate to its size heterogeneity and related issues including (1) useof appropriate calibrators (2) standardization of calibration protocols (3)traceability and (4) reporting units. In the UK, results from the current EQAschemes for lipoprotein(a) suggest that there is considerable work required tostandardize lipoprotein(a) measurement. This is becoming increasingly pertinentwith the increasing recognition of lipoprotein(a) as an independent risk factorfor cardiovascular disease in international guidelines and the emergence ofnovel antisense therapies to effectively reduce lipoprotein(a). This articleraises awareness of the importance of measurement of lipoprotein(a) for theassessment of cardiovascular disease risk and gives guidance to clinicallaboratories regarding choice of appropriate assays. Remarkably, Lp(a)plasma concentrations within the population can therefore vary by 1000-fold. Thepathophysiology underpinning Lp(a)’s role in atherosclerosis is thought to be two-fold:12,13 firstly, a pro-thrombotic effect by inhibiting fibrinolysis due to thesequence homology of apo(a) to plasminogen and secondly, a pro-atherogenic effectthrough its ability to accumulate in the intima of arteries. Epidemiological andgenetic data have now confirmed Lp(a) as an independent risk factor for coronaryheart disease, stroke and calcific aortic valve stenosis.1416Composed of an LDL-like particle, in which a single apolipoprotein B100 (apoB) iscovalently linked by a disulphide bond to a single apolipoprotein(a) (apo(a)) , Lp(a) pA personal or family history of premature atherosclerotic cardiovasculardisease (<60 years of age).First degree relatives of those with high Lp(a) plasma concentrations(>200 nmol/L).Familial hypercholesterolaemia (FH), or other genetic forms ofdyslipidaemia.Calcific aortic valve stenosis.A borderline increased (but <15%) 10-year risk of a cardiovascularevent.HEART UK (Hyperlipidaemia Education and Atherosclerosis Research Trust UK) recentlypublished a consensus statement that makes recommendations regarding the use ofLp(a) measurement in clinical practice and also reviews current and emergingtherapeutic strategies to reduce plasma Lp(a) concentrations to decrease risk ofCVD. HEART UK recommends Lp(a) measurement in the following groups: 17 to grade this risk on the basis of percentile distributions as follows:32–90 nmol/L minor; 90–200 nmol/L moderate; 200–400 nmol/L high; >400 nmol/L veryhigh. Further studies are required to derive ethnicity-specific ranges, appropriateto the UK population as Lp(a) concentration varies by race/ethnicity.18As plasma concentrations of Lp(a) are predominantly genetically determined, they arerelatively stable over a lifetime. Therefore, Lp(a) may only need to be measuredonce, unless a secondary cause is suspected or a specific treatment is instituted inorder to lower its plasma concentration. The cardiovascular risk conferred by Lp(a)may be graded depending on the lipoprotein(a) particle concentration and HEART UKhave employed data from the ongoing Copenhagen General Population Study19 and over the past two decades the questionable performance of these assayshas hampered the incorporation of Lp(a) measurement into routine clinical practice.20 However, the recent demonstration that the genetic risk of variants in theLPA gene is fully captured by measurement of Lp(a) particlenumbers (expressed in nmol/L) using commercial immunoassays standardized andcalibrated to minimize isoform sensitivity21 shows that reliable methods for assessment of Lipoprotein(a) associated CVDrisk are available on modern high throughput platforms. There is now an urgent needfor assay harmonization to allow reliable clinical decision making.Despite the efforts of the International Federation of Clinical Chemistry (IFCC) todevelop a reference material for standardization of analytical methods (WHO/IFCCSRM-2B), shortcomings of commercially available immunoassays for this complexparticle, primarily due to their sensitivity to apo(a) isoform size variation, havelong been apparent22 The antibodies used against apo(a) are usually polyclonal and cross-reactwith the multiple KIV-2 repeats thereby overestimating Lp(a) plasma concentrationsin individuals with large isoforms and underestimating the concentrations in thosewith small isoforms.22 As a consequence of this bias, the strength of the relationship between Lp(a)and CVD risk has appeared inconsistent and has frequently been underestimated. Morerecent studies using a monoclonal antibody-based ELISA22 assayinsensitive to apo(a) isoform size variability show a consistent positiverelationship between high levels of Lp(a) and CVD, whereas earlier studies usingisoform sensitive assays have missed this important relationship. In particular, twoinfluential epidemiological studies  which reported negative results, were repeated using the isoform insensitiveELISA assay and were clearly positive.23 This highlights the importance of using suitable and standardized methods forLp(a) measurement to accurately assess CVD risk.The large heterogeneity in apo(a) size between, as well as within individuals becauseof the inheritance of two different apo(a) alleles, has been a major challenge tothe accurate measurement of Lp(a).10,11 Concerted effort was made by the IFCC to select and characterize a suitablereference material and to develop a multistep standardization protocol to be used bymanufacturers and clinical laboratories. However, traceability to the WHO/IFCCSRM-2B improves assay comparability but does not eliminate the isoform sensitivityof the analytical methods.24 The target value assigned to the reference material is in nanomoles per litreof Lp(a) protein, reflecting a mole for mole interaction of antibody with apo(a).Lp(a) has historically been expressed in mass units (mg/dL) encompassing the mass ofthe entire particle, including the content of apo(a), apoB-100, cholesterol,cholesteryl ester, phospholipid, triglyceride and carbohydrate. This ismetrologically unsound because what is measured by immunoassays is the proteincomponent of Lp(a) and not its lipid and carbohydrate content. Therefore, the mostappropriate units of measurement of Lp(a) are nmol/L. Lp(a) concentrations shouldnot be converted from nmol/L to mg/dL, or vice versa, as all conversion factors areinherently isoform dependent.25Many studies have shown differences between Lp(a) assays.2628 Of the commercially availablemethods measurement are inherently isoform insensitive.methods , theDenCheck that the accuracy of the assay has been certified by the NorthwestLipid Research Laboratory in Seattle making sure the certificationapplies to the specific instrument.Do not convert results to mass units.External quality assurance programs should distribute samples with knownapo(a) isoform composition and Lp(a) values assigned by a methodvalidated to be independent of apo(a) size polymorphism and calibrationtraceable to the WHO/IFCC SRM-2B reference material.External quality assurance samples should cover the clinically meaningfulrange, especially the management threshold range of 90–200 nmol/LWe suggest the following to improve harmonization of Lp(a) assays: In the UK, there is a long way to go with assay harmonization. The vast majority oflaboratories report Lp(a) concentration in mass units , with no22 However, Lp(a) particles have been found to associate noncovalently withtriglyceride-rich lipoproteins which could result in overestimation of Lp(a)measured by immunoassays based on the apo(a) capture/apoB detection approach.22,29 Another approach to circumvent the effect of apo(a) size variability, is thedevelopment of methods that are not antibody-based. Mass spectrometry methods havealso been reported30 or are under development. However, to be of the greatest clinical utility,new assays should provide the same high throughput as the analytical platformscurrently used in clinical labs as this will facilitate a more widespreadmeasurement of Lp(a).There is clearly a need for innovation in the development of isoform insensitiveLp(a) assays. One approach could be a sandwich immunoassay with antibodies detectingthe apoB component of Lp(a) or monoclonal antibodies to apo(a) directed to a uniqueepitope not present in kringle IV type 2.31,32 Currently, lipoprotein apheresis is the only reliable means of achieving asubstantial reduction of plasma Lp(a); however, its use is limited by its high cost,low capacity and lack of accessibility. Injectable antisense oligonucleotidestargeting hepatic LPA RNA have been shown to reduce apo(a)production and apo(a) assembly with apoB, leading to >90% reduction in Lp(a)particle concentrations. These agents are now in Phase 3 trials (NCT04023552) andthe results will confirm whether selective reduction of Lp(a) levels reduces CVrisk. The need for clinical laboratories to deliver timely, accurate andstandardized measurements of this enigmatic lipoprotein has become one of vitalimportance for us all to address.There is now an urgent need for the standardization of Lp(a) assays firstly, to meetgrowing demand with the recognition in international guidelines of this important,largely unmeasured cardiovascular risk factor and secondly, due to the prospect ofnovel treatments to dramatically lower Lp(a).


We compared indicators of influenza activity in 2020 before and after public health measures were taken to reduce coronavirus disease (COVID-19) with the corresponding indicators from 3 preceding years. Influenza activity declined substantially, suggesting that the measures taken for COVID-19 were effective in reducing spread of other viral respiratory diseases. Public health measures, including public education and physical distancing, were implemented in Singapore to reduce transmission of coronavirus disease (COVID-19). However, instead of a lockdown, Singapore kept schools and workplaces open and did not advise the routine use of masks for persons who are well during the initial phase of the outbreak in January–February 2020. We examined the effect of these COVID-19 measures on influenza incidence as a proxy to determine the overall potential reduction in respiratory virus transmission.>38°C) and cough. Data included number of visits to government primary care clinics for ILI per day, ILI samples tested per week, and percentage influenza positivity. We estimated number of influenza cases per day by multiplying ILI visits per day by the proportion of ILI patients who tested positive for influenza, which better reflects influenza infection rates than either indicator alone (We obtained routine sentinel surveillance data on influenza-like illnesses (ILI) from a national network of primary care clinics and the National Public Health Laboratory. ILI was defined as fever . Influenza activity peaked in epidemiologic week 1 of 2020 but declined to below the average of the preceding years by epidemiologic week 5 (We compared indicators of influenza transmissibility in 2020 against the average from corresponding periods in the 3 preceding epidemiologic years (2016–2019). We performed weekly paired difference c week 5 . Percent0) than seasonal influenza (0 of 2.2 (Public health efforts to control COVID-19 probably reduced influenza transmission in February 2020 because both viruses have similar modes of transmission through respiratory and contact routes. Even if COVID-19 has a potentially higher basic reproduction number (ROur study has several limitations. First, a decrease in influenza transmission is expected in February–March, given the yearly bimodal pattern of influenza incidence in Singapore (In conclusion, we found a marked decline in ILI in Singapore after the implementation of public health measures for COVID-19. Our findings suggest that such measures are effective in reducing spread of viral respiratory diseases and could mitigate the impact of the COVID-19 pandemic.


As increasingly more older adults in the general population utilize smartphones to access health services, the digital divide between older adults with serious mental illness (SMI) and the general older adult population continues to widen. The purpose of this study was to examine older adult peer support specialists’ and older people with SMI’s perspectives of barriers and facilitators to utilizing Medicaid Safelink smartphone services. Data from two focus groups and five semi-structured interviews from older adult peer support specialists (N=10) and older adults with SMI (N=15) were analyzed using the Consolidated Framework for Implementation Science Research. A mixed methods convergent design integrated quantitative with qualitative data. Older adults with SMI (N= 15) had a mean age of 55 years and were mainly women (70%) and White (100%). Certified peer specialists (N= 10) had a mean age of 52 years (age range 45-67) and were mainly female (75%), 66% identified as White, and 33% identified as African American. Four themes that were identified across different aspects of barriers included technology knowledge, technology adoption, design features , and Safelink policies and procedures. Facilitators included free and continuous services, access to technical support, and smartphone capabilities to enable healthcare communications and facilitate the delivery of services. Improving upon the themes identified as barriers to utilizing Safelink may promote a continuum of care for older adults with SMI, closing the gap of services that occurs between in-person therapy and other interventions.


This review aimed to synthesize the most up-to-date evidence regarding the prevalence of urinary incontinence (UI) among adolescent female athletes. We conducted a systematic review of studies regarding UI in female athletes less than 19 years of age. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRIMSA). The electronic databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (WOS) were searched between October and November 2020. After blinded peer evaluation, a total of 215 studies were identified and nine were included. Risk of bias was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. This review identified a prevalence of UI in adolescent female athletes between 18% to 80% with an average of 48.58%. The most prevalent sports were trampolining followed by rope skipping. The prevalence of UI among adolescent female athletes practicing impact sports was significantly prevalent. There is a need for further research, education, and targeted interventions for adolescent female athletes with UI. Urinary incontinence (UI) is defined as any complaint of involuntary loss of urine . Mostly The younger female athletes seem to display isolated symptoms of pure stress UI which is an uncomplicated SUI without other symptoms of urge incontinence or bladder dysfunction . High-imThe underlying mechanisms by which young nulliparous female athletes show higher levels of UI as compared to their sedentary females ,17 are sElite female athletes experiencing UI at an early stage are more likely to report UI symptoms later in life . This isThe conduct and reporting of this systematic review complied with the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines .A systematic search of electronic databases including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (WOS) was carried out between October and November 2020 independently by two blinded authors. No restrictions on language or publication timeline were applied. The search strategy used keywords, mesh terms, and Boolean connectors (AND/OR) including: “Stress urinary incontinence” OR “urine loss” OR “pelvic floor muscles” AND sport OR athlete OR “female athlete”. Search results were limited to species (human) and age (birth–18 years) and source type .Retrieved titles and abstracts were assessed for eligibility for inclusion, and duplicate entries were removed. The same two authors independently reviewed the text of the studies for eligibility. Articles published up to November 2020 were eligible for inclusion. The criteria for inclusion were: (1) study participants included adolescent females participating in sport or athletic activities; (2) study provides an assessment of UI symptoms; (3) study published in a peer-reviewed journal in any language. Randomized controlled trials (RCTs) with two or more parallel groups and crossover trials, non-RCTs were eligible for inclusion if they met the previously mentioned criteria. The criteria for study exclusion were: (1) participants > 19 years old; (2) participants who underwent any type of pelvic floor surgery; (3) participants during their pregnancy and postpartum period and; (4) systematic review, meta-analysis, or case study.For each study, data were extracted on the characteristics of the population and intervention such as: (1) last name of the first author; (2) years of publication; (3) study design; (4) sample characteristics ; and (5) instrument assessing symptoms of UI. Risk of bias was assessed independently by two authors using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist . The samThe search strategy yielded 500 potentially relevant studies. After the removal of duplicates, 321 records were screened. Of those, 215 potential titles were selected after the database filter insertion. Among those, only nine studies met the criteria for inclusion and were selected for analysis in this systematic review. The study selection flow chart is shown in 2, and 6–19 h of training per week. We calculated a mean of prevalence of 48.58% for all the samples that were involved in different sports. Almost all study designs were cross-sectional (n = 8) where one had a pilot cross-sectional design. The risk of bias was assessed with the STROBE checklist for cross-sectional studies [Our systematic review identified nine studies published between 2002 and 2020. The total sample was 633 female athletes, with an average age of 16.15 years, BMI ranging from 18.9 to 21.7 kg/m studies . Figure  studies . ClarityThis systematic review identified a range of UI prevalence rates ranging from 18.2% to 80% and yielding a mean prevalence of 48.58%. In reports that assessed UI in one specific sport, the highest prevalence rates were found in trampolining (80%) followed by rope skipping (75%) and soccer (62.8%). On the other hand, the lowest rates of UI were found in practitioners of rhythmic gymnastics (31.8%).The main outcome for assessing UI symptoms was the International Consultation on Incontinence short form questionnaire (ICIQ-SF), which was used in 5 of the 9 studies. Only one study used a quantitative measurement of UI through the pad-test . Almost The aim of the present review was to systematically review the prevalence of UI among adolescent female athletes. Notably, we found a wide range of UI prevalence rates among young female athletes varying from 18% to 80%, with an average prevalence of UI symptoms in female adolescent athletes about 50%. Our results are slightly higher than the meta-analytic data presented by Teixeira et al.  for femaOur review included a total sample of 633 young nulliparous female athletes practicing a wide range of sports. Several studies included samples of athletes practicing different sports. We applied a classification of sport impact based on the study by Groothaussen and Siener  that has2 and 6 to 19 h of training per week. Collectively, these observations suggest that the high volume and intensity of training along with low energy availability could be potential risk factors for developing UI in adolescent female athletes.The benefits of sports practice early in life are well established; however, young female athletes are not immune to suffering sport-related injuries or illness . ParticuBø and Sundgot-Borgen described that the presence of UI early in life is a strong predictor for UI later in life (ORR of 8.57) ,21. Due Limitations of this review are the small sample size, heterogeneity, and variability of outcome measures as well as the lack of reliable quantitative outcome measures for UI. The selected studies used validated questionnaires to assess urinary symptoms in young athletes. However, these questionnaires were validated in adult populations. More reliable diagnostic outcomes would improve the quality of the studies. In addition, the analysis of co-founding factors specific to the female adolescent athlete such as menstrual cycle and nutritional status would improve the quality of the studies. We recommend the use of the STROBE checklist for risk of bias study assessment to improve the scientific report of these studies and a classification of sport characteristics and impact, which would additionally improve their comparison and assessment. The development and validation of a specific questionnaire for assessing UI symptoms in adolescent females is warranted.UI during exercise and sports is a concern for young female athletes. Our findings highlight a 48.8% prevalence rate among adolescent female athletes where practitioners of high-impact sports show the highest prevalence rates. Given the high prevalence of UI among adolescent female athletes involving impact sports graded 2 and 3, concerted efforts are needed to provide early education and implement prevention measures before young female athletes experience the burden of UI. Future research is needed to guide our understanding of the underlying physiopathology and unique characteristics of the adolescent female athlete’s pelvic floor muscle activity during impact sports.


A collaborative research team lead by an investigator from the Lyon Neuroscience Research Center and Lyon University Hospital and Lyon 1 University studied epileptogenicity of tuber and its surrounding cortex using stereoelectroencephalography (SEEG) in patients diagnosed with tuberous sclerosis complex (TSC) . A collaborative research team lead by an investigator from the Lyon Neuroscience Research Center and Lyon University Hospital and Lyon 1 University studied epileptogenicity of tuber and its surrounding cortex using stereoelectroencephalography (SEEG) in patients diagnosed with tuberous sclerosis complex (TSC) . A study cohort of eighteen patients (11 children) who underwent presurgical SEEG evaluation between 2004 and 2018 was identified from four French tertiary epilepsy centers. The electrodes were implanted bilaterally in 14 patients, and the total number of electrodes ranged from 8 to 16 per patient. The total number of tubers in each patient ranged from 3 to 30 [Epileptogenicity Index (EI)  was usedThe dominant tuber was the most epileptogenic P < .001) of the five ROI. Seven patients with a focal tuber EZ organization had 80% Engel IA postsurgical outcome and the following 4 tuber characteristics: continuous interictal discharges (100%), fluid-attenuated inversion recovery (FLAIR) hypointense center (86%), stimulation – induced seizures (71%), and center-to-rim EI gradient. A combination of the first three characteristics showed a 98% specificity for a focal tuber EZ organization. Six patients with a complex EZ organization showed 40% Engel IA outcome with nearby cortex (4 patients) and distant cortex (1) as the most epileptogenic region. The authors concluded that tubers with focal EZ organization are much like type II focal cortical dysplasia, and that identification of these tubers relate to EZ hypothesis generation and invasive EEG/resection strategies. [ of the fCOMMENTARY. Talarirach and Bancaud developed “stereoencephalographie” in the 1960s as a tool to aid in defining the EZ. Their definition of EZ was an ictal electro-clinical concept based on SEEG recordings. Over the past 50 years, the concept of EZ has evolved due to invention of sophisticated localizing tools. Hans Lüders et al. (2006) defined EZ as “the minimum amount of cortex that must be resected to produce seizure freedom .” UltimaThe authors reported the following results in consideration of EZ identification in TSC: 1. A combination of the three characteristics - continuous interictal discharges, FLAIR hypointense center, and stimulation-induced seizures, showed a 98% specificity in localizing the dominant tuber; 2. Nearby cortex (4 of 6 patients) was the most epileptogenic  in the presence of a dominant tuber that lacked center-to-rim gradient in EI. Importantly, these results may contribute to development of an effective implantation strategy of intracerebral electrodes in further defining EZ in TSC, as one of the challenges of using SEEG is determining targets and trajectories based on presurgical data and EZ hypothesis. Experience and skill of a functional neurosurgeon who places intracerebral electrodes to confirm/modify/reject the hypothesis of EZ may also influence outcome. The current work is a welcome and laudable contribution to further our understanding of epileptogenicity in TSC.The authors have declared that no competing interests exist.


The nursing home (NH) industry has experienced a shift toward care specialization. This study used NH-level panel data from 2011 to 2017 to describe unique care specialization groups in urban areas using latent profile analysis (LPA) . We focused on urban NHs because NHs specialize in care due to competition and memetic pressure, more likely to be the case for urban NHs. To identify care specialization profiles, LPA was applied using different types of specialist staffing levels  and the share of special care units aimed at chronic conditions like Alzheimer’s Disease and AIDs. Model diagnostics and information criterion guided selection of the best fitting model. Model stability over time, interpretability of results, and parsimony were also taken into consideration. The final results indicated a 4-profile model fit the underlying data best and the patterns remained comparatively stable over seven years. The 4-classes are uniquely identified as: high use of specialists of all types (3%), moderate use of specialists of all types (7%), mixed use of specialists and special care units (26%), and low specialization use (64%). From 2011 to 2017, the size of the ‘low specialization’ group became smaller, whereas the high and moderate groups grew larger. In addition to describing a clear trend towards increased care specialization, our findings indicated great heterogeneity in NHs’ care specialization patterns in urban areas. Future studies should examine market and organizational characteristics, as well as performance outcomes for different specialization groups.


The genomics and genetic data of pigmented and non-pigmented Malaysian rice varieties are still limited. Hence, we performed the genome resequencing of two black rice varieties , two red rice varieties  and two white rice varieties (MR297 and MRQ76) using Illumina HiSeq 4000 platform with 30x sequencing coverage. We aimed to identify and annotate single nucleotide polymorphisms (SNPs) from the genome of these four pigmented and two non-pigmented rice varieties. The potential SNPs will be used in developing the functional SNP markers related to nutritional  and quality (i.e. aromatic) traits. Raw data of the pigmented and non-pigmented rice varieties have been deposited into the European Nucleotide Archive (ENA) database with accession number PRJEB29070 and PRJEB32344, respectively. Specifications Table•The pigmented and non-pigmented genome data provide genomics and genetics data of Malaysian rice varieties, which can be utilized in investigating their genetic basis.•Molecular markers such as single nucleotide polymorphisms (SNPs) and microsatellites can be discovered from the genomes and will be useful in facilitating genetic improvement of rice varieties in order to enhance their nutritional and quality traits.•These genome data are valuable for evolutionary study and the identification of domestication genes.Value of the Data1https://www.ebi.ac.uk/ena) under the studies accession numbers PRJEB29070 (pigmented) and PRJEB32344 (non-pigmented).The genomes of four Malaysian pigmented and two non-pigmented rice varieties were sequenced using Illumina HiSeq 4000 sequencing technology, with the read length of 150 bp at each end. We used a 30x depth of sequencing coverage. Approximately 88 Gb raw data sequenced were generated from the genomes of four Malaysian pigmented and two non-pigmented rice varieties. After filtering the low-quality data, we obtained 87 Gb clean reads and these clean reads were used for further analyses, such as reads mapping and SNPs calling. 22.1The genomic DNA was extracted from the young leaves of each pigmented and non-pigmented rice varieties using Murray The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


Elder mistreatment (EM) complexity, while described anecdotally, lacks an empirical foundation for measurement. Improved knowledge on the range and nature of concurrent issues that complicate EM intervention would inform the development of more effective solutions and enable greater precision of evaluation research. The purpose of this qualitative study was to explore factors contributing to complexity in a sample of EM cases that was selected based on difficulty reaching resolution. The sample was drawn from those reviewed by an experienced EM Multidisciplinary team (MDT) and determined to require long-term case management (n=39) beyond the capacity of the MDT’s usual response. Case manager narrative documentation of ongoing assessment and social service records were qualitatively coded by two researchers. Inductive content analysis, with iterative code reconciliation, was used to identify issues and problems both related and concurrent to EM. Eighteen themes and 74 sub-themes emerged, with 93% initial coding agreement between researchers. The most frequent themes were problems with Caregiving (80%), Cognition (80%), Physical Health (80%), Behavioral Health (69%), Socialization (64%), and Finances (62%). Refusal of formal services was common (90%), yet all accepted visitation by the case manager, suggesting informal support may be effective. Diversity, interconnectedness, and emergence of issues along the duration of case management indicates a system approach to intervention design and evaluation is warranted. This research underscores the need for holistic intervention for highly complex EM, and lays the foundation for objective measure of complexity to standardize selection for specialized intervention.


This paper presents a semi-analytical approach for investigating the nonlinear buckling and postbuckling of spiral corrugated sandwich functionally graded (FGM) cylindrical shells under external pressure and surrounded by a two-parameter elastic foundation based on Donnell shell theory. The improved homogenization theory for the spiral corrugated FGM structure is applied and the geometrical nonlinearity in a von Karman sense is taken into account. The nonlinear equilibrium equation system can be solved by using the Galerkin method with the three-term solution form of deflection. An explicit solution form for the nonlinear buckling behavior of shells is obtained. The critical buckling pressure and the postbuckling strength of shells are numerically investigated. Additionally, the effects of spiral corrugation in enhancing the nonlinear buckling behavior of spiral corrugated sandwich FGM cylindrical shells are validated and discussed. Due to their excellent thermo-mechanical properties, functionally graded materials (FGMs) have been applied in engineering structures, such as military structures, nuclear reactors, civil engineering structures, and other technology areas . ResearcBased on Love’s shell theory, Arshad et al. ,3,4 studFor corrugated cylindrical shells, some previous studies have focused on experimental and numerical analyses of the mechanical behavior of these structures. Yang et al.  establisDue to their excellent load carrying capacity and conformance with manufacturing technology, spiral corrugated cylindrical shells are often used in engineering structures. According to the best of the authors’ knowledge, there is currently no semi-analytical approach for investigating the mechanical behavior of spiral corrugated cylindrical shells made of sandwich FGM surrounded by an elastic foundation. This paper presents a semi-analytical approach for examining the nonlinear buckling responses of spiral corrugated sandwich FGM circular cylindrical shells using a homogenization technique . The spConsider a spiral corrugated sandwich FGM cylindrical shell with an axial length Based on the geometrical calculations, the relation between the angle of corrugation and the number of full waves of corrugation in a loop coil can be established asThe geometrical parameters of the cross section of corrugations The force and moment results of a sandwich cylindrical shell  are expressed by applying the homogenization procedure for corrugated structures established by Xia et al. , as(4){The stiffness matrix terms of non-corrugated shells can be determined asBased on the coordinate transformation technique, the force and moment results of the corrugated sandwich FGM shells in the As can be recognized, the spiral corrugated sandwich FGM cylindrical shells are equivalent to the non-corrugated sandwich FGM cylindrical shells with the new stiffness matrix presented in Equation (6).Based on the nonlinear strain–displacement assumption of von Karman and Donnell shell theory, the strains at the mid-plane of non-corrugated sandwich FGM cylindrical shells can be expressed as (9)εx0=uThe strains across the shell thickness at a distance From Equation (9), the deformation compatibility equation can be directly established asThe nonlinear equilibrium equations of a non-corrugated cylindrical shell based on Donnell shell theory areConsidering the first two equations of Equation (12), a stress function Substituting Equations (6) and (13) into the third equation of (12), the nonlinear equilibrium equation is obtained in a new form, asFrom the constitutive relations of Equation (6), the inverse relations can be established, taking into account Equation (13), asBy substituting Equation (15) into the deformation compatibility Equation (11), the equation can be rewritten asConsider a spiral corrugated sandwich FGM cylindrical shell under external pressure The solution of the deflection satisfying the boundary condition in Equation (17) in an approximate sense can be applied as a three-state form:Clearly, the simply supported boundary conditions in Equation (17) are approximately satisfied.Substituting Equation (18) into Equation (16), the form of the stress function Substituting the solution form of deflection Equation (18) and stress function form Equation (19) into Equation (14) and then performing the Galerkin procedure in the integral domain Unlike the cylindrical panel, the circumferential closed condition in an average sense must be satisfied for all revolution shell types, asUsing Equations (15) and (18), the closed condition Equation (23) becomesEliminating When the nonlinear amplitude of the postbuckling state The critical buckling pressure By using Equations (20)–(22), the maximal deflection of a shell located at The postbuckling curves of spiral corrugated sandwich FGM cylindrical shells can be determined by combining Equation (25) and Equation (27).In this section, the accuracy of the semi-analytical approach presented for the critical buckling pressure of isotropic cylindrical shells and sandwich FGM cylindrical shells under external pressure is compared with the results reported by Shen et al. , Vuong aAs can be seen in 2 and Alumina 2, and the Poisson ratio was assumed to be a constant value of Numerical investigations were performed to predict the nonlinear buckling responses of spiral corrugated sandwich FGM cylindrical shells subjected to external pressure and surrounded by an elastic medium. The sandwich FGM corrugated cylindrical shells with the following geometrical parameters were considered: The effect of elastic foundation moduli is presented in The postbuckling curves of round spiral corrugated sandwich FGM cylindrical shells are shown in The effect of geometrical parameters of corrugation Corrugated sandwich FGM shells are homogenized to non-corrugated sandwich FGM shells;(2)The critical buckling pressure of a corrugated sandwich FGM cylindrical shell is greater than that of a corresponding non-corrugated sandwich FGM cylindrical shell;(3)The geometrical parameters of the cross section of corrugation and the material properties strongly influence the buckling and postbuckling behavior of sandwich FGM cylindrical shells.Some significant results have been obtained as follows:


RAD51 (rs1801320) and XRCC2 (rs3218536) genes polymorphism having association with colorectal cancer risk. For this reason the aim of this study is to ascertain their interrelation with colorectal cancer occurrence in Bangladeshi population. In case of Bangladeshi population, no report is observed till now showing the genetic variations of A case control study was conducted where 200 colorectal cancer patients and 200 healthy volunteers were figured for this research using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). RAD51 (rs1801320), G/C heterozygous genotype was found significant . On the other hand, G/G genotype was not found statistically significant  and significance was observed for GC+GG . In case of XRCC2 (rs3218536), C/T heterozygous genotype was remarked statistically significant . The T/T genotype was not recorded statistically significant  but significance found for CT+TT . Moreover, it is found that the risk factor of developing CRC is observed in G/C, C/T heterozygote and GC+GG, CT+TT (heterozygote+ mutant) in RAD51 (rs1801320) and XRCC2(rs3218536) respectively although no significance is observed in case of G/G and T/T mutant. Here, in case of RAD51 (rs1801320) and XRCC2 (rs3218536) genes polymorphism with colorectal cancer risk is observed in Bangladeshi population.So, the association of  In Bangladesh, cancer can be said as one of the uppermost reasons of expansion of death and morbidity in the approaching years. According to International Agency for Research on Cancer, in 2030 the death rate will be 13% and it was 7.5% in 2005 which determines the proportion is appraised to be precisely twofold compared to 2005 . Presumption says, by 2040 the figure will be expanded from 18.1 million to 29.5 million. Colorectal cancer is attributed as the most usual malignant tumours affecting the parts of alimentary canal appeared from large intestine due to unusual extension of cells having potential to invade several parts of human body . Depending on the initiating point, these types of cancers can be said either as colon or rectal cancer. Colon cancer is noticed to be identified in two-third cases and remaining one-third as rectal cancer . 75% of CRC can be remarked as sporadic. In tumour development, a part of modification in case of other genes can be observed and the occurrence of ultimate addition of supplementary malicious attributes such as intrusiveness of tissue and the ability to metastasize takes place .Several risk factors related to CRC are individual study of adenomatous polyps, one’s own record of inflammatory bowel disease, genealogical account of colorectal cancer or adenomatous polyps and inherited genetic risk factors, coronary artery disease notably . Familial Adenomatous Polyposis (FAP) as well as Hereditary Non-Polyposis Colorectal Cancer (HNPCC) also called Lynch syndrome are the most frequent inherited conditions and approximately 5 to 10% of CRCs are a sequel of accepted hereditary condition . The probability of colorectal cancer is actively governed by diet where modification in nutritional habits might diminish up to 70% of CRC implication . High meat consumption, diets with high fat specifically animal fats has also been bundled in colorectal cancer continuation . At adolescent period, several aspects like physical inactivity and corpulence, smoking, strong drink consumption are responsible for the starting of colorectal cancer. Evidence shows that continuing regular use of aspirin along with Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) lessen the probability of CRC considerably . 5-fluorouracil (5-FU) capecitabine, oxaliplatin and irinotecan are utilized predominantly in chemotherapy for the patients of CRC. Targeted therapy is regarded as an advanced sector of drug evolution. It is engaged with targeted therapy which consequences from expanded apprehension of the molecular differences necessitated in cancer occurrence. Particular molecules engaged in tumor magnification and development are featured by these drugs having divergent and generally less serious after effects compared to traditional chemotherapy drugs .RAD51 is up regulated in different cancers. Attachment of the DNA with RAD51 protein takes place at the site of a break and encompassed in a protein case which is indispensable introductory step in the restoring operation. RAD51 gene is an extremely protected well-designated DNA repair protein . The scheme of RAD51 along with molecular regulation has not yet been completely confirmed .The protein, indispensable for reconstructing the damaged DNA is formed by instructions provided with RAD51 gene which plays a fundamental role in homologous recombinational repair. It is evident from innumerable studies that XRCC2 (X-ray repair cross complementing 2) is 7q36.1 which is a member of the RAD51-related protein family. Chromosomal fragmentation, translocations and deletions are thought to be repaired by XRCC2. Additionally, this gene is found to be necessitated in the HR repair (HRR) pathway of DNA double-stranded breaks (DSBs). An association between XRCC2 (rs3218536) single-nucleotide polymorphisms (SNPs) and cancer incidence risk are found to be the most common mutation observed by numerous studies . The increment of cancer risk is appeared due to two known epigenetic causes of XRCC2 deficiency. One of them is the XRCC2 exponent methylation and epigenetic repression of XRCC2 by over-expression of EZH2 protein. Depletion of homologous recombinational repair and epigenetic repression of RAD51 paralogues including XRCC2 are accompanied by increased expression of EZH2. Over-expression of EZH2 protein between 40%-75% is found in breast cancer and EZH2 mRNA is up-adjusted, about 7.5-fold .The location of RAD51 (rs1801320) and XRCC2 (rs3218536) genes have been perceived in different ancestral groups. A case-control study on Bangladeshi population was conducted recently where the high risk association between altered gene expression of RAD51 (rs1801320) gene polymorphism and breast cancer development was detected. In different ethnicities, RAD51 (rs1801320) and XRCC2 (rs3218536) gene polymorphisms are certified to be a threat aspect of colorectal cancer and RAD51 (rs1801320) gene polymorphism in breast cancer evolution in Bangladeshi population. A possibility may arise basing on a correlation between RAD51 (rs1801320) and XRCC2 (rs3218536) polymorphisms with colorectal cancer risk in Bangladeshi population. Moreover, no related investigation has been supervised concerning this feasible association in Bangladeshi populace. We, consequently, presume to find out that predictable relationship of RAD51 (rs1801320) and XRCC2(rs3218536) genetic polymorphisms with colorectal cancer risk in Bangladeshi citizenry for the very first time.As a probable element for breast, colorectal, lung, prostate, endometrial as well as gastric cancers both Study populationRAD51 (rs1801320) and XRCC2 (rs3218536) polymorphism with clinic pathological characteristics of patients are mentioned in RAD51 (rs1801320) and XRCC2 (rs3218536) polymorphisms, patients who have primary location of cancer in rectum are found to be more susceptible to have colorectal cancer as statistical significances are observed; RAD51  and XRCC2  and in both cases the p values observed are less than 0.05. No other factors are found to be significantly associated with RAD51 (rs1801320) and XRCC2 (rs3218536) polymorphisms. Approval of the study protocol was done by the ethical committees of the respective hospitals and the research was executed according to the descriptions of Helsinki and its following editions . An informed consent document was signed by each patient and control subject after briefing the motive of the study. The genotyping scrutiny was done in the laboratory of Biotechnology, Faculty of Pharmacy, The University of Asia Pacific, Dhaka-1205, Bangladesh.A case control research was co-ordinated on 200 colorectal cancer patients and 200 healthy volunteers basing on age, weight and sex. Colorectal cancer patients were enlisted from Ahsania Mission Cancer and General Hospital and National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh. After that, physical analysis of controls were picked by matching age and genetic history to colorectal cancer patients. The age of patients ranged from 13 years to 89 years (mean 51 years). Most of the patients are observed having tumour stages I, II and IV (mostly stage II). Age, sex, diet, weight, BMI, TNM staging, demographic characteristics, lifestyle factors data were stockpiled via interrogations by skilled attendants in presence of specialized doctors. The demographic characteristics of the patients and the controls are presented in Genotyping RAD51 (rs1801320) and XRCC2 (rs3218536), PCR-Restriction Fragment Length Polymorphism (RFLP) approach was applied to genotype. PCR product of 157 bp and 234 bp were obtained for RAD51 (rs1801320) and XRCC2 (rs3218536) SNPs respectively. PCR amplifications conditions are given in RAD51 (rs1801320) was dispatched with BstNI  by incubating at 60° C for 4 hours which produced two fragments 86 bp and 71 bp in case of G/G allele while for C/C allele it produced only one fragment of 157 bp. Restriction enzyme Hph1  (37° C overnight) bisected the T/T allele of XRCC2 (rs3218536) giving two fragments of 147 bp and 87 bp but didn’t divide the C/C allele that is only one fragment 234 bp was observed. These DNA fragments were blemished with ethidium bromide and pictured on 2% agarose gel electrophoresis.Genomic DNA was separated from the blood specimens assembled from all patients by the help of DNA extraction mini kit, Favorgen, Taiwan. Genomic DNA amplification was executed using the predesigned forward and reverse primers. PCR was done by following the standard protocol mentioned in published method . In case of bothStatistical analysisStatistical analyses were carried out using the SPSS software package 13.0 . Mean age for cases and controls was evaluated by using Student’s t-test. Odd ratios (ORs) and the corresponding 95% confidence intervals (CI) calculated by using logistic regression analysis were used to analyse the association between the polymorphic genotypes and CRC risk, based on heterozygous and homozygous comparison models with the wild type genotype served as the reference. Odds ratios of > 1.00 specified a positive risk association and vice versa. P values of < 0.05 were significant. Study populationRAD51 (rs1801320) and XRCC2(rs3218536) with a number of 200 controls. This study included 97 males (%) and 103 females (57.5%) colorectal cancer patients with an average age of 51 and the control group covered 87 males (43.5%) and 113 females (56.5%) with an average age of 47.The study was conducted through 200 patients of RAD51 (rs1801320) polymorphismRAD51 (rs1801320). This population based case-control study was conducted to survey the prevalence of RAD51 polymorphism in Bangladeshi population of CRC patients and normal controls. The genotype frequencies in cases and controls are presented in It was evident after gel electrophoresis that DNA fragment pattern of BstNI digestion of the PCR product was done to recognize the genetic variation at XRCC2 (rs3218536) polymorphismXRCC2 (rs3218536). This population based case-control study was conducted to investigate the prevalence of XRCC2 polymorphism in Bangladeshi population of CRC patients and normal controls. The genotype frequencies in cases and controls are presented in Digestion by Hph1 shows the mutation of RAD51 (rs1801320) and CRC with present study is shown in XRCC2 (rs3218536) and CRC with present study is given in A comparison of previous association studies between HRR) genes have an extremely immediate association with cancer threat. Both RAD51 and XRCC2 proteins are fundamental constituents of DNA double strand breaks (DSBs) reconstruction by HRR. Constructional at the same time functional correspondences are noted between RAD51 and XRCC2 gene . Genomic instability is demonstrated if cell deficient with any of RAD51 or XRCC2 genes products are defective in homologous recombination. The X-ray repair complementing defective repair in Chinese hamster cells 2 (XRCC2) gene plays an important role in the homologous recombination repair (HRR) pathway at the same time can be said a functional member for taking part in tumor progression . Improvement of unrepaired DNA destructions would be conducted by under expression of RAD51 gene. Replication blunders past these destructions would guide to the growth of mutations and cancer.Protein haploinsufficiency regulation by genetic polymorphisms in homologous recombination repair . Another Chinese case control study says that in CRC tissue, the expression of XRCC2 is inflated and notable interdependences are also found among positive XRCC2 expression, tumor size, Dukes’ stage and TNM stage . In case of Australian population, a comparative consequence of the XRCC2 alteration to cancer threat is remarked for members of this family . Another case study on Polish population (Warsaw) also said that the feasible character of XRCC2 gene polymorphism is responsible for neoplastic diseases. Therefore, XRCC2 polymorphisms may take part dominant role in colorectal cancer tumorigenesis, conferring susceptibility to rectal tumors in Polish population . Similar relationship is also observed when studied on English population . The investigation on RAD51 and XRCC2 gene polymorphism was done by being encouraged with strong association between these genes and these gene polymorphisms may be used in several areas in colon cancer management, such as early detection of the carcinogenesis, prediction of tumor biologic behaviour and being a candidate therapeutic target for colon cancer. Evidence is yielded by this study that RAD51 and XRCC2 gene polymorphisms may be risk factors for colon cancer progress . A result of meta-analysis says that the RAD51 135 G/C polymorphism is responsible for increased risk of CRC in total using allele (OR=1.21) and recessive models (OR=1.62). However, XRCC2 rs3218536 A/G was not associated with the risk of CRC in total or in subgroups in that particular study. As claimed by the consequences of meta-analysis, the RAD51 135 G/C polymorphisms might influence colorectal cancer risk . Few reports are also made out regarding the impact of RAD51135G>C in spread of CRC in Asian populations. In a subgroup of population of Kashmir, RAD51135G>C has marked the association with CRC . On the other hand, in case of Iranian population RAD51 135G>C presumably does not impact on CRC susceptibility and other risk factors should be contemplated for furtherance of management potentials of the disease in Iran .Colon carcinoma can occur due to elevated-expression of RAD51 (rs1801320) and XRCC2 (rs3218536) genes have increased probability of colorectal cancer and both genes are significantly associated with colorectal cancer occurrence and further elucidate the relationship of multiple genotypes at the RAD51(rs1801320) and XRCC2 (rs3218536) locus with colorectal cancer occurrence. The outcomes found from our research are harmonious with various prior studies yet corresponding genotyping analysis in more racial communities is still necessary to confirm the association between SNPs and susceptibility to colorectal cancer. Our results confirmed that RAD51 (rs1801320) and XRCC2 (rs3218536) genes helps to recognize the malfunction of these proteins and can lead to successful therapies for colorectal cancer. In this study, it is observed that the risk factor of developing CRC is noticed in G/C, C/T heterozygote and GC+GG, CT+TT (heterozygote+ mutant) in RAD51 (rs1801320) and XRCC2 (rs3218536) respectively but no significance is found in case of G/G and T/T mutant. So, it can be said that a significant association between RAD51 (rs1801320) and XRCC2 (rs3218536) and colorectal cancer development is confirmed in our population. If the study can be conducted by using more samples from different areas, G/G and T/T mutant can also be found significant. However, it is the first study in Bangladesh and with a limited number of cases and controls. Therefore, RAD51(rs1801320) and XRCC2 (rs3218536) genes polymorphism and colorectal cancer risk is an important research area that needs much more attention as some statistically strong risk factors required to be excluded because of a small number of sample and control. It will also reduce the number of injuries or deaths resulting from incorrect or ineffective prescriptions prescribed for cancer patients and tend to integrate into personalized medicine.In summary, studying SNP in


The 4Ms of an Age-Friendly Health System start with What Matters to the older adult. A unique method for asking that question is through film. Schaalman Senior Voices (SSV) films older adults talking about What Matters to them, and uses the films to stimulate discussion about later life with older adults in the community (n=264), with health care professions students learning to listen to older adults (n=1250), and health system executives considering implementation of the Age-Friendly Health Systems (AFHS) initiative (n=100). SSV has completed longer professional films interviewing 12 older adults. Using a mobile platform, SSV has filmed 50 older adults in the community and at health events. Outcomes of film discussions will be presented, including inspiration for older adults having conversations with family and physicians about What Matters, health care students effectively using skills in asking What Matters to enhance the care they provide, and executives considering AFHS implementation.


More than 19% of third-graders in Georgia had untreated dental caries (tooth decay) in 2016–2017 . The mosDental sealants , topicalWe developed a data visualization tool that maps county-level need for caries prevention and treatment programs and the distribution of dental safety-net programs in Georgia. This tool can be used by public health decision makers to 1) assess how well dental safety-net programs are currently allocated and 2) plan and target future programs.short). We obtained data on the prevalence of untreated tooth decay from a study that estimated this information for children aged 6 to 9 years , DeKalb (143 census tracts), Fulton (202 census tracts), and Gwinnett (113 census tracts). Level of need was based on the estimated prevalence of untreated tooth decay and the severity of a dental workforce shortage  as high Dshort areas  and census tracts below the median  as low Dshort areas.We used data from the Health Resources and Services Administration (HRSA)  on the sshort, 2) low prevalence of untreated tooth decay and high Dshort, 3) high prevalence of untreated tooth decay and low Dshort, and 4) high prevalence of untreated tooth decay and high Dshort. We designated counties in category 4 as having the greatest need for dental safety-net programs and counties in category 1 as having the least need. We designated counties in category 3 as having a greater need for dental safety-net programs than those in category 2 because of their higher prevalence of untreated tooth decay.We assigned counties to 1 of 4 categories: 1) low prevalence of untreated tooth decay and low DWe then overlaid information on current Georgia dental safety-net programs onto county need for such programs. Dental safety-net programs included 1) state-sponsored school sealant programs, 2) county-funded public health departments offering dental services, 3) federally qualified health centers offering dental services, and 4) dental hygiene programs providing community dental services. We obtained information on school sealant programs from the Georgia Department of Public Health Oral Health Program , informaOur visualization indicated good allocation of scarce dental public health resources. Of the 131 dental safety-net programs, 88 (67.2%) were in high-need counties, which is twice the number in low-need counties (43 or 32.8%). Many high-need counties, however, did not have dental safety-net programs. Among the 80 high-need counties, 52 had no programs . In high-need areas, programs were more common in the metropolitan Atlanta area than in the rest of the state. This information is important for planning purposes, although the state may not be able to immediately address the problem of dental shortages in nonmetropolitan counties because of resource constraints and the higher cost  of serving areas farther away from the State Oral Health Program, which is based in Atlanta.The maps also illustrate the importance of a granular visualization in areas with diverse populations, such as metropolitan areas. If only county levels are used, small pockets of need may be missed, as in Fulton County. Visualization at the census-tract level in Fulton County provides a better assessment of need and targeting.Our mapping technique provides decision makers in Georgia with a visual tool for assessing how well current dental safety-net programs are allocated across the state and identify gaps in resource allocation where needs could be addressed in future program planning. The data used to generate these maps are publicly available for states nationwide and thus, these maps could be replicated throughout the United States.