A structural MRI study in monozygotic twins concordant or discordant for attention/hyperactivity problems: Evidence for genetic and environmental heterogeneity in the developing brain.

Several structural brain abnormalities have been reported in patients with Attention Deficit Hyperactivity Disorder (ADHD). However, the etiology of these brain changes is still unclear. To investigate genetic and environmental influences on ADHD related neurobiological changes, we performed Voxel-Based Morphometry on MRI scans from monozygotic (MZ) twins selected from a large longitudinal population database to be highly concordant or highly discordant for ratings on the Child Behavior Checklist Attention Problem scale (CBCL-AP). Children scoring low on the CBCL-AP are at low risk for ADHD, whereas children scoring high on this scale are at high-risk for ADHD. Brain differences between concordant high-risk twin pairs and concordant low-risk twin pairs likely reflect the genetic risk for ADHD; brain differences between the low-risk and high-risk twins from discordant MZ twin pairs reflect the environmental risk for ADHD. A major difference between comparisons of high and low-risk twins from concordant pairs and high/low twins from discordant pairs was found for the prefrontal lobes. The concordant high-risk pairs showed volume loss in orbitofrontal subdivisions. High-risk members from the discordant twin pairs exhibited volume reduction in the right inferior dorsolateral prefontal cortex. In addition, the posterior corpus callosum was compromised in concordant high-risk pairs, only. Our findings indicate that inattention and hyperactivity symptoms are associated with anatomical abnormalities of a distributed action-attentional network. Different brain areas of this network appear to be affected in inattention/hyperactivity caused by genetic (i.e., high concordant MZ pairs) vs. environmental (i.e., high-low discordant MZ pairs) risk factors. These results provide clues that further our understanding of brain alterations in ADHD. © 2007 Elsevier Inc. All rights reserved

Separating the Early Universe from the Late Universe: cosmological parameter estimation beyond the black box

We present a method for measuring the cosmic matter budget without assumptions about speculative Early Universe physics, and for measuring the primordial power spectrum P*(k) non-parametrically, either by combining CMB and LSS information or by using CMB polarization. Our method complements currently fashionable ``black box'' cosmological parameter analysis, constraining cosmological models in a more physically intuitive fashion by mapping measurements of CMB, weak lensing and cluster abundance into k-space, where they can be directly compared with each other and with galaxy and Lyman alpha forest clustering. Including the new CBI results, we find that CMB measurements of P(k) overlap with those from 2dF galaxy clustering by over an order of magnitude in scale, and even overlap with weak lensing measurements. We describe how our approach can be used to raise the ambition level beyond cosmological parameter fitting as data improves, testing rather than assuming the underlying physics.Comment: Replaced to match accepted PRD version. Refs added. Combined CMB data and window functions at http://www.hep.upenn.edu/~max/pwindows.html or from [email protected]. 18 figs, 19 journal page

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Continued Use and Expansion of Photodynamic TURBT

None

Prostate-specific Antigen Mass Density--A Measure Predicting Prostate Cancer Volume and Accounting for Overweight and Obesity-related Prostate-specific Antigen Hemodilution.

OBJECTIVE: To test prostate-specific antigen mass density (PSAMD) as a predictor of total tumor volume (TTV) at radical prostatectomy (RP). METHODS: We conducted a detailed pathologic analysis of 469 RP from men with NCCN low-risk prostate cancer who had Gleason score of 3 + 3 = 6 (grade group 1) at RP. We then compared the ability of PSA, PSA density (PSAD), PSA mass (PSAM-absolute amount of PSA in patient\u27s circulation), and PSAM density (PSAM divided by prostate weight without seminal vesicles) to predict TTV at RP. PSAM was calculated by multiplying plasma volume (estimated body surface [weight, kg(0.425) × height, m(0.72) × 0.007184] × 1.67) by PSA. Performance of the above measures in different BMI categories was assessed. Kruskal-Wallis test was used to compare the means and Spearman\u27s rank correlation coefficient to assess the correlations. RESULTS: The 469 men were normal weight (n = 129), overweight (n = 253), and obese (n = 87). Mean age of the patients\u27 was 57.4 years and PSA of 4.53 ng/ml. Increase of prostate weight with body mass index (BMI) was reflected in PSAM (both P \u3c.001) but not in other measures. BMI did not correlate with TTV and PSA. Among PSA, PSAD, PSAM, and PSAMD, PSAMD had the highest correlation with TTV (r = 0.336; P \u3c.001). Prostate weight had stronger (negative) association with PSAMD (r = -0.394; \u3c.001) than TTV. CONCLUSION: PSAMD is the biochemical measure with the best correlation with TTV at RP. Unlike other measures, it is not affected by BMI-related hemodilution. Thresholds should be established to use this more objective measure clinically in surveillance algorithms and in planning radical prostatectomy

ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) randomised controlled trial protocol

Introduction Transurethral resection of bladder tumour (TURBT) is one of the more common procedures performed by urologists. It is often described as an ‘incision-free’ and ‘well-tolerated’ operation. However, many patients experience distress and discomfort with the procedure. Substantial opportunity exists to improve the TURBT experience. An enhanced recovery after surgery (ERAS) protocol designed by patients with bladder cancer and their providers has been developed.Methods and analysis This is a single-centre, randomised controlled trial to investigate the effectiveness of an ERAS protocol compared with usual care in patients with bladder cancer undergoing ambulatory TURBT. The ERAS protocol is composed of preoperative, intraoperative and postoperative components designed to optimise each phase of perioperative care. 100 patients with suspected or known bladder cancer aged ≥18 years undergoing initial or repeat ambulatory TURBT will be enrolled. The change in Quality of Recovery 15 score, a measure of the quality of recovery, between the day of surgery and postoperative day 1 will be compared between the ERAS and control groups.Ethics and dissemination The trial has been approved by the Johns Hopkins Institutional Review Board #00392063. Participants will provide informed consent to participate before taking part in the study. Results will be reported in a separate publication.Trial registration number NCT0590527

The Role of Innovation in the Electric Utility Sector

Innovation is essential for future power systems to be safe and secure, clean and sustainable, affordable and equitable, and reliable and resilient, according to a recent National Academies report. But state regulatory reforms are needed to encourage adoption of new technologies to support evolution of the nation’s power systems.1 Berkeley Lab's report, The Role of Innovation in the Electric Utility Sector, provides consumer, labor, utility, third-party provider, and clean technology consultant perspectives on this theme. To achieve state targets for clean energy and greenhouse gas emissions, some state regulatory utility commissions are exploring new approaches to spur innovation: -For utilities, regulatory and marketing flexibility, increased funding for demonstration projects, and performance-based ratemaking including multi-year rate plans -For third parties, ways to provide utility customers with innovative products and services directly Among the questions the report addresses: 1. How are consumer advocate views evolving with respect to innovative regulatory and ratemaking approaches? 2. How can utility decarbonization and grid modernization initiatives provide opportunities for local communities and workers to receive tangible benefits and facilitate community support for siting electricity infrastructure? 3. How are electric utilities partnering with technology companies to provide innovative energy management services and sustainable energy solutions for utility customers? 4. What regulatory innovations are public utility commissions exploring to enable third-party providers to participate in the transition to a modern electric system? 5. What regulatory changes are needed to enable innovative solutions from utilities and third parties at the necessary speed and scale to meet state decarbonization goals? The report is the 13th in the Future Electric Utility Regulation series, which taps leading thinkers to tackle complex regulatory issues for electricity. 1 National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Electric Power in the United States. The National Academies Press. https://doi.org/10.17226/25968(link is external)