Bisphosphonate-associated osteonecrosis of the jaw: the rheumatologist's role

Several recent reports have described osteonecrosis of the jaws (ONJ) associated with the use of bisphosphonates. Rheumatologists treating bone diseases with bisphosphonate need, therefore, to be aware of this potential risk and plan the prophylaxis, early diagnosis and prevention of potential consequences. We review the literature on this newly described complication, with particular focus on systemic and local predisposing pathologies, preventive measures suggested before and during therapy with bisphosphonates, and the most frequent clinical presentation of the oral lesions. The expert panel recommendations for the management of care of patients who develop ONJ are summarized

Semiclassical almost isometry

Let M be a complex projective manifold, and L an Hermitian ample line bundle on it. A fundamental theorem of Gang Tian, reproved and strengthened by Zelditch, implies that the Khaeler form of L can be recovered from the asymptotics of the projective embeddings associated to large tensor powers of L. More precisely, with the natural choice of metrics the projective embeddings associated to the full linear series |kL| are asymptotically symplectic, in the appropriate rescaled sense. In this article, we ask whether and how this result extends to the semiclassical setting. Specifically, we relate the Weinstein symplectic structure on a given isodrastic leaf of half-weighted Bohr-Sommerfeld Lagrangian submanifolds of M to the asymptotics of the the pull-back of the Fubini-Study form under the semiclassical projective maps constructed by Borthwick, Paul and Uribe.Comment: exposition improve

Existence of orthogonal geodesic chords on Riemannian manifolds with concave boundary and homeomorphic to the N-dimensional disk

In this paper we give a proof of the existence of an orthogonal geodesic chord on a Riemannian manifold homeomorphic to a closed disk and with concave boundary. This kind of study is motivated by the link of the multiplicity problem with the famous Seifert conjecture (formulated in 1948) about multiple brake orbits for a class of Hamiltonian systems at a fixed energy level.Comment: 59 pages, 3 figures. To appear on Nonlinear Analysis Series A: Theory, Methods & Application

LIDERANÇA PEDAGÓGICA E COMPLEXIDADE DA GESTÃO ESCOLAR: UM ESTUDO EM ESCOLAS DE SÃO PAULO, BRASIL

This research aims to analyze the pedagogical leadership practices of principals and pedagogical coordinators who support teacher professional development in schools with high academic performance, in an intermediate socioeconomic context and with different levels of complexity in school management. A multiple case study was conducted in three public schools in São Paulo. Data collection included semi-structured in-depth interviews, focus groups, non-participant observation, shadowing, and documentation gathering. As a result, we found seven central pedagogical leadership practices directly or indirectly related to teacher professional development. The complexity in school management is focused on the implementation of such practices, that cross 14 mapped factors, distributed in five axes: student, teacher, pedagogical coordination, school organization, and educational policy. It is recommended that more complex schools have larger and more competent management teams. The study contributes to the formulation of local educational policies, highlighting the importance of leadership in school improvement and suggesting the need for additional research on management strategies.Esta investigación tiene como objetivo analizar las prácticas de liderazgo pedagógico de directores y coordinadores pedagógicos que apoyan el desarrollo profesional docente en escuelas con buen desempeño académico, en un contexto socioeconómico intermedio y con diferentes niveles de complejidad en la gestión escolar. Se realizó un estudio de caso múltiple en tres escuelas estatales de São Paulo ubicadas en la capital. La recolección de datos incluyó entrevistas en profundidad, grupos focales, observación no participante, shadowing y recolección de documentos solicitados y no solicitados. Como resultado, se encontraron siete prácticas centrales de liderazgo pedagógico relacionadas directa o indirectamente con el desarrollo profesional docente. La complejidad de la gestión escolar ha influido en estas prácticas, que se llevan a cabo a través de 14 factores distribuidos en cinco ejes: alumno, profesor, coordinación pedagógica, organización escolar y política educativa. Se recomienda que las escuelas más complejas cuenten con equipos de gestión más grandes y competentes. El estudio contribuye a la formulación de políticas educativas locales, destacando la importancia del liderazgo en la mejora escolar y sugiriendo la necesidad de investigaciones adicionales sobre estrategias de gestión.Esta investigação tem por objetivo analisar as práticas de liderança pedagógica de diretores e coordenadores pedagógicos que apoiam o desenvolvimento profissional docente em escolas com bom desempenho acadêmico, em um contexto socioeconômico intermediário e com diferentes níveis de complexidade da gestão escolar. Realizou-se um estudo de casos múltiplos em três escolas estaduais de São Paulo localizadas na capital. A coleta de dados contou com entrevistas em profundidade, grupo focal, observação não participante, shadowing e coleta de documentos solicitados e não solicitados. Como resultado encontrou-se sete práticas centrais de liderança pedagógica que estão direta ou indiretamente relacionadas ao desenvolvimento profissional docente. A complexidade da gestão escolar tem incidido sobre a implementação de tais práticas, que são realizadas por intermédio de 14 fatores, distribuídos em cinco eixos: estudante, professor, coordenação pedagógica, organização escolar e política educacional. Recomenda-se que escolas mais complexas tenham equipes de gestão maiores e mais competentes. O estudo contribui para a formulação de políticas educacionais locais, destacando a importância da liderança na melhoria escolar e sugerindo a necessidade de pesquisas adicionais sobre estratégias de gestão

The cost-effectiveness of influenza vaccination for people aged 50 to 64 years: An international model

Objectives: Routine influenza vaccination is currently recommended in several countries for people aged more than 60 or 65 years or with high risk of complications. A lower age threshold of 50 years has been recommended in the United States since 1999. To help policymakers consider whether such a policy should be adopted more widely, we conducted an economic evaluation of lowering the age limit for routine influenza vaccination to 50 years in Brazil, France, Germany, and Italy.Methods: the probabilistic model was designed to compare in a single season the costs and clinical outcomes associated with two alternative vaccination policies for persons aged 50 to 64 years: reimbursement only for people at high risk of complications (current policy), and reimbursement for all individuals in this age group (proposed policy). Two perspectives were considered: third-party payer (TPP) and societal. Model inputs were obtained primarily from the published literature and validated through expert opinion. the historical distribution of annual influenza-like illness (ILI) incidence was used to simulate the uncertain incidence in any given season. We estimated gains in unadjusted and quality-adjusted life expectancy, and the cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted.Results: Comparing the proposed to the current policy, the estimated mean costs per QALY gained were R$4,100, 13,200, 31,400 and 15,700 for Brazil, France, Germany, and Italy, respectively, from a TPP perspective. From the societal perspective, the age-based policy is predicted to yield net cost savings in Germany and Italy, whereas the cost per QALY decreased to R$2800 for Brazil and 8000 for France. the results were particularly sensitive to the ILI incidence rate, vaccine uptake, influenza fatality rate, and the costs of administering vaccination. Assuming a cost-effectiveness threshold ratio of 50,000 per QALY gained, the probabilities of the new policy being cost-effective were 94% and 95% for France, 72% and near 100% for Germany, and 89% and 99% for Italy, from the TPP and societal perspectives, respectively.Conclusions: Extending routine influenza vaccination to people more than 50 years of age is likely to be cost-effective in all four countries studied.I3 Innovus, Uxbridge UB8 1QG, Middx, EnglandUniv Jena, Inst Virol & Antiviral Therapy, Jena, GermanyINSERM, U444, Paris, FranceUniv Genoa, Dept Hlth Sci, Genoa, ItalyUniversidade Federal de São Paulo, Reg Influenza Surveillance Grp, São Paulo, BrazilUniv York, Ctr Hlth Econ, York YO10 5DD, N Yorkshire, EnglandI3 Innovus, Medford, MA USAHarvard Univ, Sch Publ Hlth, Boston, MA 02115 USAUniversidade Federal de São Paulo, Reg Influenza Surveillance Grp, São Paulo, BrazilWeb of Scienc

Gravitational waves: search results, data analysis and parameter estimation

The Amaldi 10 Parallel Session C2 on gravitational wave (GW) search results, data analysis and parameter estimation included three lively sessions of lectures by 13 presenters, and 34 posters. The talks and posters covered a huge range of material, including results and analysis techniques for ground-based GW detectors, targeting anticipated signals from different astrophysical sources: compact binary inspiral, merger and ringdown; GW bursts from intermediate mass binary black hole mergers, cosmic string cusps, core-collapse supernovae, and other unmodeled sources; continuous waves from spinning neutron stars; and a stochastic GW background. There was considerable emphasis on Bayesian techniques for estimating the parameters of coalescing compact binary systems from the gravitational waveforms extracted from the data from the advanced detector network. This included methods to distinguish deviations of the signals from what is expected in the context of General Relativity

The Lie algebroid Poisson sigma model

The Poisson--Weil sigma model, worked out by us recently, stems from gauging a Hamiltonian Lie group symmetry of the target space of the Poisson sigma model. Upon gauge fixing of the BV master action, it yields interesting topological field theories such as the 2--dimensional Donaldson-Witten topological gauge theory and the gauged A topological sigma model. In this paper, generalizing the above construction, we construct the Lie algebroid Poisson sigma model. This is yielded by gauging a Hamiltonian Lie groupoid symmetry of the Poisson sigma model target space. We use the BV quantization approach in the AKSZ geometrical version to ensure consistent quantization and target space covariance. The model has an extremely rich geometry and an intricate BV cohomology, which are studied in detail.Comment: 52 pages, Late

Forming consensus to advance urobiome research

Urobiome research has the potential to advance the understanding of a wide range of diseases, including lower urinary tract symptoms and kidney disease. Many scientific areas have benefited from early research method consensus to facilitate the greater, common good. This consensus document, developed by a group of expert investigators currently engaged in urobiome research (UROBIOME 2020 conference participants), aims to promote standardization and advances in this field by the adoption of common core research practices. We propose a standardized nomenclature as well as considerations for specimen collection, preservation, storage, and processing. Best practices for urobiome study design include our proposal for standard metadata elements as part of core metadata collection. Although it is impractical to follow fixed analytical procedures when analyzing urobiome data, we propose guidelines to document and report data originating from urobiome studies. We offer this first consensus document with every expectation of subsequent revision as our field progresses

Peer-led healthy lifestyle program in supportive housing: study protocol for a randomized controlled trial

Background The risk for obesity is twice as high in people with serious mental illness (SMI) compared to the general population. Racial and ethnic minority status contribute additional health risks. The aim of this study is to describe the protocol of a Hybrid Trial Type 1 design that will test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention in supportive housing agencies serving diverse clients with serious mental illness who are overweight or obese. Methods The Hybrid Trial Type 1 design will combine a randomized effectiveness trial with a mixed-methods implementation study. The effectiveness trial will test the health impacts of a peer-led healthy lifestyle intervention versus usual care in supportive housing agencies. The healthy lifestyle intervention is derived from the Group Lifestyle Balanced Program, lasts 12 months, and will be delivered by trained peer specialists. Repeated assessments will be conducted at baseline and at 6, 12, and 18 months post randomization. A mixed-methods (e.g., structured interviews, focus groups, surveys) implementation study will be conducted to examine multi-level implementation factors and processes that can inform the use of the healthy lifestyle intervention in routine practice, using data from agency directors, program managers, staff, and peer specialists before, during, and after the implementation of the effectiveness trial. Discussion This paper describes the use of a hybrid research design that blends effectiveness trial methodologies and implementation science rarely used when studying the physical health of people with SMI and can serve as a model for integrating implementation science and health disparities research. Rigorously testing effectiveness and exploring the implementation process are both necessary steps to establish the evidence for large-scale delivery of peer-led healthy lifestyle intervention to improve the physical health of racial/ethnic minorities with SMI. Trial registration www.clinicaltrials.gov; NCT02175641, registered 24 June 201

Hundreds of variants clustered in genomic loci and biological pathways affect human height

Most common human traits and diseases have a polygenic pattern of inheritance: DNA sequence variants at many genetic loci influence the phenotype. Genome-wide association (GWA) studies have identified more than 600 variants associated with human traits, but these typically explain small fractions of phenotypic variation, raising questions about the use of further studies. Here, using 183,727 individuals, we show that hundreds of genetic variants, in at least 180 loci, influence adult height, a highly heritable and classic polygenic trait. The large number of loci reveals patterns with important implications for genetic studies of common human diseases and traits. First, the 180 loci are not random, but instead are enriched for genes that are connected in biological pathways (P = 0.016) and that underlie skeletal growth defects (P < 0.001). Second, the likely causal gene is often located near the most strongly associated variant: in 13 of 21 loci containing a known skeletal growth gene, that gene was closest to the associated variant. Third, at least 19 loci have multiple independently associated variants, suggesting that allelic heterogeneity is a frequent feature of polygenic traits, that comprehensive explorations of already-discovered loci should discover additional variants and that an appreciable fraction of associated loci may have been identified. Fourth, associated variants are enriched for likely functional effects on genes, being over-represented among variants that alter amino-acid structure of proteins and expression levels of nearby genes. Our data explain approximately 10% of the phenotypic variation in height, and we estimate that unidentified common variants of similar effect sizes would increase this figure to approximately 16% of phenotypic variation (approximately 20% of heritable variation). Although additional approaches are needed to dissect the genetic architecture of polygenic human traits fully, our findings indicate that GWA studies can identify large numbers of loci that implicate biologically relevant genes and pathways.