The posterior use of BMP-2 in cervical deformity surgery does not result in increased early complications: A prospective multicenter study

Study designProspective cohort study.ObjectivesTo describe the rate of short-term complications following the posterior use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in cervical deformity (CD) surgery.MethodsCD patients from 2013 to 2015 were enrolled in a prospective, multicenter database. Patients were divided into those receiving rhBMP-2 (BMP) and no rhBMP-2 (NOBMP). The relationship between BMP use, demographic variables surgical variables, radiographic parameters and complications was evaluated.ResultsA total of 100 patients (47 BMP, 53 NOBMP) were included. Follow-up time averaged 7.6 months (range 3-12 months). An average of 13.6mg of BMP was used per person with 1.49 mg per level. Compared with the NOBMP group, patients in the BMP group were older (P = .03). BMP was more commonly used in patients that and had longer prior fusions (6.0 vs 2.5, P < .01). There were no differences between groups with regards to a history of surgery, Charlson Comorbidity Index, estimated blood loss, operation time, fusion levels, and surgical approach. The maintenance of radiographic parameters at 6-month follow-up was similar. There were no differences in terms of total complication incidence, total complications per person, major complications per person or any specific complication. Linear regression and Pearson correlation analysis did not reveal any strong r2 values (r2 = 0.09, 0.08, 0.06) between the use of BMP and complications (major or operative).ConclusionsBMP use was not directly associated with an increased incidence of early complications in this prospective cohort of operative adult CD patients. Its use was associated with increased number of levels instrumented and fused

The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes

Background: The Adult Social Care Outcomes Toolkit (ASCOT) measures social care related quality of life (SCRQoL) and can be used to measure outcomes and demonstrate impact across different social care settings. This exploratory study built on previous work by collecting new inter-rater reliability data on the mixed-methods version of the toolkit and exploring how it might be used to inform practice in four case study homes. Method: We worked with two care home providers to agree an in-depth study collecting SCRQoL data in four case-study homes. Data was collected about residents’ age, ethnicity, cognitive impairment, ability to perform activities of daily living and SCRQoL in the four homes. Feedback sessions with staff and managers were held in the homes two weeks after baseline and follow-up data collected three months later. Interviews with managers explored their views of the feedback and recorded any changes that had been made because of it. Results: Participant recruitment was challenging, despite working in partnership with the homes. Resident response rates ranged from 23 to 54 % with 58 residents from four care homes taking part in the research. 53 % lacked capacity to consent. Inter-rater reliability for the ASCOT ratings of SCRQoL were good at time one (IRR = 0.72) and excellent at time two (IRR = 0.76). During the study, residents’ ability to perform activities of daily living declined significantly (z = -2.67, p < .01), as did their expected needs in the absence of services (z = -2.41, p < .05). Despite these rapid declines in functionings, residents’ current SCRQoL declined slightly but not significantly (Z = -1.49, p = .14). Staff responded positively to the feedback given and managers reported implementing changes in practice because of it. Conclusion: This exploratory study faced many challenges in the recruitment of residents, many of whom were cognitively impaired. Nevertheless, without a mixed-methods approach many of the residents living in the care homes would have been excluded from the research altogether or had their views represented only by a representative or proxy. The value of the mixed-methods toolkit and its potential for use by providers is discussed

Towards an integrated model for breast cancer etiology: The lifelong interplay of genes, lifestyle, and hormones

While the association of a number of risk factors, such as family history and reproductive patterns, with breast cancer has been well established for many years, work in the past 10–15 years also has added substantially to our understanding of disease etiology. Contributions of particular note include the delineation of the role of endogenous and exogenous estrogens to breast cancer risk, and the discovery and quantification of risk associated with several gene mutations (e.g. BRCA1). Although it is difficult to integrate all epidemiologic data into a single biologic model, it is clear that several important components or pathways exist. Early life events probably determine both the number of susceptible breast cells at risk and whether mutations occur in these cells. High endogenous estrogens are well established as an important cause of breast cancer, and many known risk factors appear to operate through this pathway. Estrogens (and probably other growth factors) appear to accelerate the development of breast cancer at many points along the progression from early mutation to tumor metastasis, and appear to be influential at many points in a woman's life. These data now provide a basis for a number of strategies that can reduce risk of breast cancer, although some strategies represent complex decision-making. Together, the modification of nutritional and lifestyle risk factors and the judicious use of chemopreventive agents could have a major impact on breast cancer incidence. Further research is needed in many areas, but a few specific arenas are given particular mention

Thrombosis in vasculitis: from pathogenesis to treatment

In recent years, the relationship between inflammation and thrombosis has been deeply investigated and it is now clear that immune and coagulation systems are functionally interconnected. Inflammation-induced thrombosis is by now considered a feature not only of autoimmune rheumatic diseases, but also of systemic vasculitides such as Behçet’s syndrome, ANCA-associated vasculitis or giant cells arteritis, especially during active disease. These findings have important consequences in terms of management and treatment. Indeed, Behçet’syndrome requires immunosuppressive agents for vascular involvement rather than anticoagulation or antiplatelet therapy, and it is conceivable that also in ANCA-associated vasculitis or large vessel-vasculitis an aggressive anti-inflammatory treatment during active disease could reduce the risk of thrombotic events in early stages. In this review we discuss thrombosis in vasculitides, especially in Behçet’s syndrome, ANCA-associated vasculitis and large-vessel vasculitis, and provide pathogenetic and clinical clues for the different specialists involved in the care of these patients

A search for new physics in low-energy electron recoils from the first LZ exposure

The LUX-ZEPLIN (LZ) experiment is a dark matter detector centered on a dual-phase xenon time projection chamber. We report searches for new physics appearing through few-keV-scale electron recoils, using the experiment's first exposure of 60 live days and a fiducial mass of 5.5t. The data are found to be consistent with a background-only hypothesis, and limits are set on models for new physics including solar axion electron coupling, solar neutrino magnetic moment and millicharge, and electron couplings to galactic axion-like particles and hidden photons. Similar limits are set on weakly interacting massive particle (WIMP) dark matter producing signals through ionized atomic states from the Migdal effect.Comment: 13 pages, 10 figures. See https://tinyurl.com/LZDataReleaseRun1ER for a data release related to this pape

Searches for lepton-flavour-violating decays of the Higgs boson into eτ and μτ in \sqrt{s} = 13 TeV pp collisions with the ATLAS detector

Abstract This paper presents direct searches for lepton flavour violation in Higgs boson decays, H → eτ and H → μτ, performed using data collected with the ATLAS detector at the LHC. The searches are based on a data sample of proton-proton collisions at a centre-of-mass energy s $$\sqrt{s}$$ = 13 TeV, corresponding to an integrated luminosity of 138 fb−1. Leptonic (τ → ℓνℓντ) and hadronic (τ → hadrons ντ) decays of the τ-lepton are considered. Two background estimation techniques are employed: the MC-template method, based on data-corrected simulation samples, and the Symmetry method, based on exploiting the symmetry between electrons and muons in the Standard Model backgrounds. No significant excess of events is observed and the results are interpreted as upper limits on lepton-flavour-violating branching ratios of the Higgs boson. The observed (expected) upper limits set on the branching ratios at 95% confidence level, B $$\mathcal{B}$$ (H → eτ) < 0.20% (0.12%) and B $$\mathcal{B}$$ (H → μτ ) < 0.18% (0.09%), are obtained with the MC-template method from a simultaneous measurement of potential H → eτ and H → μτ signals. The best-fit branching ratio difference, B $$\mathcal{B}$$ (H → μτ) → B $$\mathcal{B}$$ (H → eτ), measured with the Symmetry method in the channel where the τ-lepton decays to leptons, is (0.25 ± 0.10)%, compatible with a value of zero within 2.5σ

Search for pair-produced scalar and vector leptoquarks decaying into third-generation quarks and first- or second-generation leptons in pp collisions with the ATLAS detector

Abstract A search for pair-produced scalar and vector leptoquarks decaying into quarks and leptons of different generations is presented. It uses the full LHC Run 2 (2015–2018) data set of 139 fb −1 collected with the ATLAS detector in proton–proton collisions at a centre-of-mass energy of s $$\sqrt{s}$$ = 13 TeV. Scalar leptoquarks with charge −(1/3)e as well as scalar and vector leptoquarks with charge +(2/3)e are considered. All possible decays of the pair-produced leptoquarks into quarks of the third generation (t, b) and charged or neutral leptons of the first or second generation (e, μ, ν) with exactly one electron or muon in the final state are investigated. No significant deviations from the Standard Model expectation are observed. Upper limits on the production cross-section are provided for eight models as a function of the leptoquark mass and the branching ratio of the leptoquark into the charged or neutral lepton. In addition, lower limits on the leptoquark masses are derived for all models across a range of branching ratios. Two of these models have the goal of providing an explanation for the recent B-anomalies. In both models, a vector leptoquark decays into charged and neutral leptons of the second generation with a similar branching fraction. Lower limits of 1980 GeV and 1710 GeV are set on the leptoquark mass for these two models

Inclusive-photon production and its dependence on photon isolation in pp collisions at s \sqrt{s} = 13 TeV using 139 fb−1 of ATLAS data

Measurements of differential cross sections are presented for inclusive isolated-photon production in pp collisions at a centre-of-mass energy of 13 TeV provided by the LHC and using 139 fb−1 of data recorded by the ATLAS experiment. The cross sections are measured as functions of the photon transverse energy in different regions of photon pseudorapidity. The photons are required to be isolated by means of a fixed-cone method with two different cone radii. The dependence of the inclusive-photon production on the photon isolation is investigated by measuring the fiducial cross sections as functions of the isolation-cone radius and the ratios of the differential cross sections with different radii in different regions of photon pseudorapidity. The results presented in this paper constitute an improvement with respect to those published by ATLAS earlier: the measurements are provided for different isolation radii and with a more granular segmentation in photon pseudorapidity that can be exploited in improving the determination of the proton parton distribution functions. These improvements provide a more in-depth test of the theoretical predictions. Next-to-leading-order QCD predictions from JETPHOX and SHERPA and next-to-next-to-leading-order QCD predictions from NNLOJET are compared to the measurements, using several parameterisations of the proton parton distribution functions. The measured cross sections are well described by the fixed-order QCD predictions within the experimental and theoretical uncertainties in most of the investigated phase-space region

Motivators and barriers for dog and cat owners and veterinary surgeons in the United Kingdom to using preventative medicines

Routine use of preventative medicines is advocated as part of responsible dog and cat ownership. However, it has been suggested that the number of owners in the United Kingdom (UK) using preventative medicines to protect their pets is in decline. The aim of this novel study was to use a qualitative methodology to explore the attitudes of pet owners and veterinary surgeons in the UK to using preventative medicine products in dogs and cats. Preventative medicine was defined as “a drug or any other preparation used to prevent disease, illness or injury.” Semi-structured interviews were conducted by telephone with owners and veterinary surgeons who had recently participated in a preventative healthcare consultation. Thematic analysis of transcribed recordings of these interviews identified four themes. This paper reports the theme related to motivators and barriers to using preventative medicines. Owners’ understanding varied widely about the importance of preventative medicines for pets, as did their confidence in the safety of prescription products. A good relationship with their veterinary surgeon or practice, seeing adverts on the television about specific diseases, advice from a breeder and having personally seen infected animals appeared to be motivators for owners to use preventative medicines. Concern about adverse events and uncertainty about the necessity of using preventative medicines were barriers. Owners who trusted their veterinary surgeons to advise them on preventative medicine products described little use of alternative information sources when making preventative medicine choices. However, owners who preferred to do their own research described reading online opinions, particular in relation to the safety of preventative medicines, which they found confusing. In contrast, veterinary surgeons described broad confidence in the safety and efficacy of prescription preventative medicines and described protection of pet health as a strong motivator for their use. Several expressed some concern about being seen to “sell” products, which may present a barrier to their advocacy. Veterinary surgeons were unsure about owners’ level of understanding of the necessity of preventative medicines, particularly in relation to vaccinations, and few recalled instigating conversations with owners about product safety. Owner uncertainties about preventative medicine products may not be adequately addressed in the consulting room. This first qualitative study to investigate dog and cat preventative medicines suggests strategies are needed to increase discussion between pet owners and veterinary surgeons in the UK about the necessity, safety, efficacy and cost of preventative medicines