Increases in biodiversity often lead to greater, and less variable, levels of ecosystem functioning. However, whether species are less likely to go extinct in more diverse ecosystems is unclear. We use comprehensive estimates of avian taxonomic, phylogenetic and functional diversity to characterise the global relationship between multiple dimensions of diversity and extinction risk in birds, focusing on contemporary threat status and latent extinction risk. We find that more diverse assemblages have lower mean IUCN threat status despite being composed of species with attributes that make them more vulnerable to extinction, such as large body size or small range size. Indeed, the reduction in current threat status associated with greater diversity far outweighs the increased risk associated with the accumulation of extinction-prone species in more diverse assemblages. Our results suggest that high diversity reduces extinction risk, and that species conservation targets may therefore best be achieved by maintaining high levels of overall biodiversity in natural ecosystems.

Keywords: biodiversity; bird traits; conservation status; extinction risk; macroecology.

Background: Lack of early risk detection, diagnosis, and treatment of pregnant women at high risk for pre-eclampsia can result in high maternal mortality and morbidity not only in Pakistan but also in other low- to middle-income countries (LMICs). A potential tool for supporting pregnant women at high risk for pre-eclampsia for early detection is telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM programs for pregnant women at high risk for pre-eclampsia, specifically in LMICs such as Pakistan.

Objective: This study aims to explore the needs of TM for pregnant women at high risk for pre-eclampsia in Karachi, Pakistan, to inform a potential future feasibility trial of a mobile phone-based TM program.

Methods: An interpretive qualitative description approach was used to conduct and analyze 36 semistructured interviews with 15 (42%) pregnant women and 21 (58%) key informants, including clinicians; nurses; maternal, neonatal, and child health specialists; and digital health experts to explore the perspectives, needs, and preferences of a mobile phone-based TM program to support pregnant women at high risk for pre-eclampsia. Pregnant women were identified through heterogeneous sampling, whereas key informants were selected through purposive sampling. The interview transcripts were analyzed using a conventional content analysis technique.

Results: The following four themes emerged from the analysis of the transcripts: poor use of antenatal care during pregnancy, the value of a TM program in high-risk pregnancy, barriers influencing the adoption of TM programs and potential strategies, and considerations for implementing TM programs. The pregnant women and health care providers were willing to use a TM program as they perceived many benefits, including early identification of pregnancy complications, prompt treatment, convenience, cost-effectiveness, increased sense of empowerment for one's health care, improved care continuity, and reduced clinical workload. However, some providers and pregnant women mentioned some concerns regarding the adoption of a TM program, including malfunctioning and safety concerns, potential inaccuracy of blood pressure machines, increased clinical workload, and resistance to learning new technology. Our study recommends building the capacity of patients and providers on TM program use, sensitizing the community and family members on the usefulness of the TM program, using an approach incorporating user-centered design and phased implementation to determine the clinical workload and whether additional staff for the TM program is required, and ensuring greater levels of co-design and the engagement of consumer representatives.

Conclusions: Our findings highlight the perceived feasibility of a mobile phone-based TM program for pregnant women at high risk for pre-eclampsia and provide insights that can be directly used for the design of future TM programs with the aim of reducing mortality and morbidity from pre-eclampsia and eclampsia in LMICs.

Keywords: Pakistan; low- to middle-income country; mobile phone; pre-eclampsia; pregnancy; pregnant; pregnant women at high risk; qualitative study; telemonitoring; women.

Objectives: To estimate the incidence of anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies utilising different testing criteria, and review the clinical details of a series of patients with associated autoimmune myopathy.

Methods: The incidence of anti-HMGCR antibodies in 2019 from 3 groups, South West London, Berkshire/Surrey and Southampton, were compared in the adult population. Anti-HMGCR antibodies were measured by commercial chemiluminescent and immunodot assays. The case notes of patients with anti-HMGCR antibodies were reviewed for the case series.

Results: The estimated incidence of anti-HMGCR antibodies in the first 2 groups was 1.94 per million adults per year, and in the third group 10.3 per million adults per year. In the first 2 groups the test criteria restricted analysis to specific clinician request for anti-HMGCR. In the third group test criteria included cases with less specific clinical features or a cytoplasmic indirect immunofluorescence anti-nuclear antibody pattern. The latter strategy had a positive predictive value of 66.1% for anti-HMGCR associated myopathy. A case series of 27 patients with anti-HMGCR antibodies revealed 19 with myopathy, oesophageal involvement in 26% and median peak CK 8000 IU/L. Response to treatment, including intravenous immunoglobulin, was good with CK normalising after median 5.5 months. In 8 cases there was no evidence of autoimmune muscle disease, 7 not statin exposed.

Conclusions: Varying criteria result in a 5-fold difference in estimated incidence of anti-HMGCR antibodies, revealing positive cases without evidence of myopathy. Patients with anti-HMGCR myopathy respond well to immune suppression, supporting wider testing for these antibodies amongst patients with myopathy.

Background: Atrial fibrillation (AF) is the most common arrhythmia to appear in clinical practice. People with AF have 5 times the risk of stroke compared to the general population.

Objective: This study aimed to determine the prevalence of AF in people over the age of 50 without known AF, who presented to a community pharmacy to check their cardiovascular risk factors, to identify risk factors associated with AF, and to assess the risk of stroke in people who screened positive for AF.

Methods: A multicenter observational descriptive study of a screening program took place from May to December 2016. A blood pressure monitor (Microlife Watch BP Home) was used to screen for AF, and the CHA2DS2-VASc questionnaire was used to assess stroke risk.

Results: The study included 452 adults over the age of 50. The CRIFAFARMA study detected a prevalence of AF of 9.1%. Risk factors for AF were: age of 75 years or older (P = .024), lack of physical activity (P = .043), diabetes (P < .001), dyslipidemia (P = .003), and history of cardiovascular disease (P = .003). Diabetes (OR 2.79, P = .005) and dyslipidemia (OR 2.16, P = .031) had a combined explanatory capacity in the multivariable logistic regression model adjusted for age. 85% were at high risk of stroke according to the CHA2DS2-VASc scale.

Conclusions: AF was detected in more than 9% of the included population. Factors associated with AF were advanced age, lack of physical activity, diabetes, dyslipidemia, and history of cardiovascular disease, with diabetes and dyslipidemia standing out as the factors with independent explanatory capacity.

Keywords: Microlife Watch BP Home; atrial fibrillation; community pharmacy; hypertension; pharmacist.

Network meta-analysis has been used to answer a range of clinical questions about the preferred intervention for a given condition. Although the effectiveness and safety of pharmacological agents depend on the dose administered, network meta-analysis applications typically ignore the role that drugs dosage plays in the results. This leads to more heterogeneity in the network. In this paper, we present a suite of network meta-analysis models that incorporate the dose-effect relationship using restricted cubic splines. We extend existing models into a dose-effect network meta-regression to account for study-level covariates and for groups of agents in a class-effect dose-effect network meta-analysis model. We apply our models to a network of aggregate data about the efficacy of 21 antidepressants and placebo for depression. We find that all antidepressants are more efficacious than placebo after a certain dose. Also, we identify the dose level at which each antidepressant's effect exceeds that of placebo and estimate the dose beyond which the effect of antidepressants no longer increases. When covariates were introduced to the model, we find that studies with small sample size tend to exaggerate antidepressants efficacy for several of the drugs. Our dose-effect network meta-analysis model with restricted cubic splines provides a flexible approach to modelling the dose-effect relationship in multiple interventions. Decision-makers can use our model to inform treatment choice.

Keywords: Evidence synthesis; dose-response; meta-regression; multiple treatments; splines.

This study aimed to identify the effects of playing with additional individual (IND), collective (COL) or individual-collective (MIX) variability on youth football players' performance during small-sided games. Twelve youth football players (U17, age = 16.1 ± 0.9 years) played a goalkeeper (Gk) + 6 outfield players a-side (Gk+6vs6+Gk) under four conditions: (i) playing in the 1:2:3:1 formation without any other rule (control condition, CTR); (ii) 1:2:3:1 formation with additional body restrictions changing each minute (individual condition, IND); (iii) using different tactical formations modified each minute (collective condition, COL; (iv) using different tactical formations and body restrictions varied each minute (individual-collective condition, MIX). Generally, there were similar behaviours across conditions, especially for the CTR and the MIX. Nevertheless, the CTR condition presented moderate higher values in the lateral direction (p ≤ .05), while also higher longitudinal synchronization compared to the IND (p ≤ .05). The COL condition presented higher spatial exploration (p ≤ .05), which may justify the higher values for distance covered while running and sprinting (p ≤ .05). Overall, coaches may use the IND condition to refine players' technical actions, while the COL condition to develop players' ability to perform in different playing positions and team structures.

Keywords: Positioning variables; adaptability; movement variability; team sports; technical performance.

Human mesenchymal stem cells (HMSCs) are important for cell-based therapies. However, the success of HMSC therapy requires large-scale in vitro expansion of these multipotent cells. The traditional expansion of HMSCs on tissue-culture-treated stiff polystyrene induces significant changes in their shape, multipotency, and secretome, leading to early senescence and subdued paracrine activity. To enhance their therapeutic potential, here, we have developed two-dimensional soft hydrogels with imprinted microscale aligned grooves for use as HMSC culture substrates. We showed that, depending on the dimensions of the topographical features, these substrates led to lower cellular spreading and cytoskeletal tension, maintaining multipotency and osteogenic and adipogenic differentiate potential, while lowering cellular senescence. We also observed a greater capacity of HMSCs to produce anti-inflammatory cytokines after short-term priming on these hydrogel substrates. Overall, these soft hydrogels with unique surface topography have shown great promise as in vitro culture substrates to maximize the therapeutic potential of HMSCs.

Keywords: cytokines; differentiation; mesenchymal stem cells; multipotency; polyacrylamide hydrogels; surface topography.

Heteroaromatic biaryls are core scaffolds found in a plethora of pharmaceuticals; however, their direct synthesis by the Suzuki cross-coupling is limited to heteroaromatic halide starting materials. Here, we report a direct synthesis of diverse nitrogen-containing heteroaromatic biaryls by Pd-catalyzed decarbonylative Suzuki cross-coupling of widely available heterocyclic carboxylic acids with arylboronic acids. The practical and modular nature of this cross-coupling enabled the straightforward preparation of >45 heterobiaryl products using pyridines, pyrimidines, pyrazines, and quinolines in excellent yields. We anticipate that the modular nature of this protocol will find broad application in medicinal chemistry and drug discovery research.

Patients with end-stage renal disease develop changes in bone quality and quantity, which can be assessed using different methods. This study aimed to compare and to correlate bone parameters obtained in vivo using high-resolution peripheral quantitative computed tomography (HR-pQCT) with those obtained by bone biopsy using histomorphometry and microcomputed tomography (microCT) analysis of the iliac crest core, and to evaluate if HR-pQCT is helpful in aiding with categorization of those with high turnover. Twenty hemodialysis patients, 13 females (7 postmenopausal), underwent bone biopsy from 2018 to 2020. The mean age was 48.5 ± 10.6 years, and the mean hemodialysis vintage was 15 years. Histomorphometry identified mineralization defects, low turnover, and high turnover in 65%, 45%, and 35% of the patients, respectively. The highest values of trabecular bone volume (BV/TV) were obtained by histomorphometry, while the highest values of cortical thickness (Ct.Th) were obtained by HR-pQCT at the distal tibia. Moderate correlations were found between BV/TV values obtained by microCT of the bone core and HR-pQCT at the distal radius (r = 0.531, p = 0.016) and at the distal tibia (r = 0.536, p = 0.015). BV/TV values obtained from the bone core by histomorphometry and microCT were also significantly correlated (r = 0.475, p = 0.04). Regarding Ct.Th, there was a strong correlation between the radius and tibia HR-pQCT (r = 0.800, p < 0.001), between bone core microCT and the distal radius HR-pQCT (r = 0.610, p < 0.01), as between histomorphometry and microCT (r = 0.899, p < 0.01). In groups classified by bone turnover, patients with high turnover presented lower BV/TV, Tb.N, Tb.Th, and Ct.Th than those with low turnover in peripheral sites using HR-pQCT. By this method, it was possible to identify low turnover from tibia BV/TV > 12,4% plus Tb.Sp ≤ 0.667 mm (AUC 0.810, 95% CI 0.575 to 0.948) and high turnover from total bone mineral density (BMD) ≤ 154.2 mg HA/cm³ (AUC 0.860, 95% CI 0.633 to 0.982, p < 0.001) and cortical BMD ≤ 691.6 mg HA/cm³ (AUC 0.840, 95% CI 0.609 to 0.963, p < 0.001). In conclusion, HR-pQCT had significant correlation with iliac crest bone in BV/TV and Ct.Th, which are known to provide bone strength. This method is quick and non-invasive and may be helpful in categorizing those with high versus low turnover in hemodialysis patients.

Keywords: Bone biopsy; HR-pQCT; Hemodialysis; Histomorphometry; MicroCT; Renal osteodystrophy.

Background: The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection.

Methods: We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality.

Results: Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age >50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33-1.95) and fungal (OR, 2.20; 95% CI, 1.28-3.76) coinfections.

Conclusions: Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.

Keywords: CAPA (COVID-19-associated pulmonary aspergillosis); COVID-19; bacterial infections; mucormycoses; viral infections.

Introduction/objectives: We examined an initial step towards co-generation of clinic notes by inviting patients to complete a pre-visit questionnaire that could be inserted into clinic notes by providers and describe the experience in a safety-net and non-safety-net clinic.

Methods: We sent an electronic pre-visit questionnaire on visit goals and interim history to patients at a safety-net clinic and a non-safety-net clinic before clinic visits. We compared questionnaire utilization between clinics during a one-year period and performed a chart review of a sample of patients to examine demographics, content and usage of patient responses to the questionnaire.

Results: While use was low in both clinics, it was lower in the safety-net clinic (3%) compared to the non-safety-net clinic (10%). We reviewed a sample of respondents and found they were more likely to be White compared to the overall clinic populations (p < 0.05). There were no statistically significant differences in patient-typed notes (word count and number of visit goals) between the safety-net and non-safety-net samples however, patients at the safety-net clinic were less likely to have all of their goals addressed within the PCP documentation, compared to the non-safety-net clinic.

Conclusions: Given potential benefits of this questionnaire as a communication tool, addressing barriers to use of technology among vulnerable patients is needed, including access to devices and internet, and support from caregivers or culturally concordant peer navigators.

Keywords: digital divide; electronic health records; health equity; health information technology; vulnerable populations.

Rye (Secale cereale L.) is one of the most important cereal crops cultivated in the world due to its ability to produce high yields even when grown under environmental stress conditions. About 27,000 Secale accessions have been collected and preserved in 70 gene banks worldwide. Although the germplasm represents a great source of genetic diversity, the molecular characteristics refers only to the part of them. Here, we present data obtained by the Simple Sequence Repeat markers (SSR) analysis of 100 rye accessions preserved in the gene bank of the Polish Academy of Sciences Botanical Garden - Center for Biological Diversity Conservation in Powsin. Additionally, the data presented in this article refers to evaluation of agronomoic traits and weather conditions measured for 14 years. The data was used in the research article "Investigation of obsolete diversity of rye (Secale cereale L.) using multiplexed SSR fingerprinting and evaluation of agronomic traits" [1].

Keywords: Agronomic traits; Diversity; Gene bank germplasm; Meteorological data; Molecular markers.

Oxidative stress is a key feature in hypertension, since reactive oxygen species are involved in all stages of cardiovascular diseases. Saliva is a body fluid that can be used to investigate alterations in the oxidative system with several specific advantages over blood. Nebivolol is a third-generation selective β1-adrenergic receptor antagonist that promotes vasodilation and has been shown to reduce oxidative stress in pre-clinical and clinical studies. The use of Nebivolol in different periods of treatment demonstrated that it is an efficient anti-hypertensive drug. We evaluated the oxidative stress biomarkers and the enzymatic and non-enzymatic antioxidant systems in saliva of hypertensive patients before and after the use of anti-hypertensive therapeutic doses of Nebivolol, since saliva can be used as an auxiliary tool to analyze parameters of oxidative stress.

Keywords: Human beings; Hypertension; Nebivolol; Oxidative stress.

Basin tests were performed at the Aalto Ice Tank to gather data on ice-structure action and interaction from ice failing against a vertically sided cylindrical pile. The tests were performed with a real-time hybrid test setup, which combined physical and numerical components to simulate a range of test structures in real-time. The dataset includes results from tests with offshore wind turbine structures, structural models representing a series of single- and multi-degree-of-freedom oscillators, and scaled dynamic models of the Norströmsgrund lighthouse and the Molikpaq caisson structure. In addition, forced vibration tests and rigid structure tests were performed. Ice loads and structural response were measured with accelerometers, displacement sensors, potentiometers, strain gauges and load cells and the ice-structure interaction process was filmed from three different camera angles. The resulting raw data have been categorized and stored as unfiltered time series. A total of 259 different tests are included in the dataset. The model ice formation procedure and the test temperature were aimed at creating model ice that mimics the material behavior of full-scale saline ice during crushing failure, with a specific focus on the transition from brittle to ductile behavior. The data can be used for validation of models for dynamic ice-structure interaction. The offshore wind turbine data can be used to study the effect of wind loading on the interaction with ice and the effect of the specific dynamic properties of wind turbine structures with monopile foundations on the ice-structure interaction process. The forced-oscillation data can be used to quantify the time and speed dependant aspects of ice loading. The Norströmsgrund lighthouse and the Molikpaq data can be used as a reference comparison to full-scale data on ice loads.

Keywords: Crushing; Forced vibration test; Frequency lock-in; Ice-induced vibration; Ice-structure interaction; Intermittent crushing; Offshore wind turbine; Real-time hybrid testing.

In this paper, all measurement and calculation data and their preparation process are presented in detail, which supplements the information published in this co-submission are related to the article "Characterization of the Pore Wetting Process of Equal-Sized Granular Coals based on LF-NMR" [1]. This includes the preparation and component analysis of samples, surface contact angle measurement, analysis of original T₂ spectrum and wetting pore size distribution (W-PSD) conversion calculation process. Hence the reader can use the data for their validations and analysis. LF-NMR experiments were conducted for the granular coal pore wetting characterization at the large-diameter MacroMR12-150H-I imaging and analysis system, of Suzhou Niumai Corporation in Jiangsu Province, China. Combined with contact angle measurement, which used the JY-PHb contact angle test instrument, we analyzed the pore wetting process in porous media and its characterization method.

Keywords: Contact angle; Granular coal; Pore wetting; Wetting pore size distribution.

This dataset presents data collected from joint cropland management practices survey in agri-food cooperatives of Mediterranean Spanish Regions. The objective was to examine to what extent cooperatives offer joint services, including joint management or integral exploitation of smallholdings, for the incorporation of new professionals. Data collection was conducted to five agri-food organizations: three agri-food cooperatives federations -Castilla-La Mancha, Comunitat Valenciana, and Murcia-, two second-degree agri-food cooperatives -Anecoop and Unió Nuts-, all of them located in Mediterranean Spanish Regions. A total of 1.168 survey questionnaires were distributed between July 2020 and February 2021 across five organizations through the snowball sampling method. Data from 112 collected questionnaires were correctly answered, but 106 were selected for analysis. The dataset includes socioeconomic data, productive information, and innovative characteristics from agri-food cooperatives surveyed, all in order to be able to examine the relationship between those factors and joint cropland management practices they carry on.

Keywords: Agri-food cooperatives; Joint cropland management; Land abandonment; Social capital; Social innovation.

Background: /Objective: The treatment of bone defect has always been a difficult problem in orthopedic clinic. The search for alternative biodegradable implants is a hot topic. The development of biodegradable magnesium scaffolds for the treatment of bone defects has long been a goal of the public.

Methods: In this study, we proposed a porous magnesium scaffold prepared by 3D gel printing and surface modification with an additional calcium phosphate coating and use of its strength, degradability and slow degradation rate in a bone graft substitute material. The porous magnesium granular scaffold was prepared by 3D gel printing technology and modified by DCPD (Dibasic Calcium Phosphate Dihydrate) coating. The biocompatibility, degradation rate, and osteogenic ability of the scaffold were evaluated in vitro and in vivo.

Results: The biocompatibility, in vivo degradation and bone defect healing response of the implants were investigated. Porous magnesium scaffolds were successfully prepared, and the strength of sintered scaffolds reached 5.38 ​MPa. The degradation rates of scaffolds were significantly reduced after coating with DCPD. The cell compatibility evaluation showed that DCPD-coated Mg scaffold was suitable for cell proliferation. In vivo biosafety monitoring showed that scaffold implantation did not cause an increase in Mg ion concentration in vivo, and no toxic damage was detected in the liver or kidney. Micro-CT and pathological results showed that a large amount of new bone was formed at 6 weeks. At 12 weeks, approximately 52% of the scaffold volume remained. At 24 weeks, osteogenesis, which was stimulated by some residual scaffold, still can be observed. In summary, this study suggests that 3D gel-printed DCPD-coated porous magnesium scaffolds have great potential as bone graft alternatives.

Conclusion: In summary, this study suggests that 3D gel-printed DCPD-coated porous magnesium scaffolds have great potential as bone graft alternatives.

The translational potential of this article: The translational potential of this article is to make use of the advantages of 3D gel printing technology with higher efficiency and lower cost compared with SLM and SLS technologies, and use pure magnesium powder as raw material to prepare degradable porous magnesium metal scaffolds, opening up a new technical route for the preparation of degradable porous magnesium scaffolds which are made for bone defect regeneration in the future.

Keywords: Biodegradation; Bone defect; Dicalcium phosphate dihydrate coating; Magnesium scaffold; Osteoanagenesis.

Optical-resolution photoacoustic microscopy (OR-PAM) is one of the major implementations of photoacoustic (PA) imaging. With tightly focused optical illumination and high-frequency ultrasound detection, OR-PAM provides micrometer-level resolutions as well as high sensitivity to optical absorption contrast. Traditionally, it is assumed that the detected PA signal in OR-PAM has a linear dependence on the target's optical absorption coefficient, which is the basis for quantitative functional and molecular PA imaging. In this paper, we demonstrate that, due to the limited detection bandwidth and detection view, OR-PAM can have a strong nonlinear dependence on the optical absorption, especially for weak optical absorption (<10 cm^-1). We have investigated the nonlinear dependence in OR-PAM using numerical simulations, analyzed the underlining mechanisms, proposed potential solutions, and experimentally confirmed the results on phantoms. This work may correct a traditional misunderstanding of the OR-PAM signals and improve quantitative accuracy for functional and molecular applications.

Keywords: Detection sensitivity; Limited detection bandwidth; Limited detection view; Molecular imaging; Nonlinear effect; Optical-resolution photoacoustic microscopy.

Extremity amputation is a common procedure performed to treat a variety of different problems and affects quality of life in a number of ways. In addition to acute postoperative pain, amputations have been shown to cause chronic pain that is often neuropathic in many amputees. This study sought to better characterize the role of opioids in postoperative pain control in lower extremity amputees.

Methods: Patients who underwent lower extremity amputation between 2010 and 2018 were identified in a national insurance-claims database using ICD-9, ICD-10, and CPT codes. Patient demographics, comorbidities, perioperative opioid use, and prolonged postoperative opioid use were then determined for both groups. Descriptive statistics and logistic regression analysis were utilized to evaluate the association of patient-related risk factors and neuropathic pain conditions with perioperative and prolonged postoperative opioid use.

Results: In total, 2247 opioid-naive lower extremity amputees were identified. An estimated 54.7% of patients utilized opioids in the perioperative period, and 44.6% were found to have prolonged opioid use. Younger age (ages 40-50 versus older), history of chronic pain, migraines, lower back pain, Charlson Comorbidity Index greater than 1, preoperative benzodiazepine, muscle relaxant, anticonvulsant, and antidepressant use were all significantly related to prolonged postoperative opioid use.

Conclusions: Prolonged postoperative opioid use is a problem that affects nearly half of lower extremity amputees and seems to be significantly related to the preoperative use of benzodiazepines, muscle relaxants, anticonvulsants, and antidepressants. Further research into the diagnosis and treatment of postamputation neuropathic pain is needed to prevent reliance on opioids in this patient population.

Strongyloidiasis is endemic in tropical and sub-tropical regions however cases of strongyloidiasis have been reported in temperate climates. Corticosteroid use, immunosuppression, infection with human T-lymphotropic virus type 1 (HTLV1), and chronic alcohol use are the most common and well-established risk factors for strongyloidiasis. Due to Strongyloides stercoralis characteristic features of hyperinfection and dissemination, it can potentially cause a lethal infection in an immunocompromised individual. Strongyloidiasis is predominantly asymptomatic, however some unusual manifestations of strongyloidiasis include duodenal obstruction, ileus, reactive arthritis, ascites, hepatic lesions, and pancreatitis. Here we present a case of a 47-year-old-St. Lucian female who was found to have duodenitis and pancreatitis secondary to Strongyloides stercoralis in the setting of underlying HTLV-1 infection and chronic alcohol use.

Keywords: Dissemination; Duodenitis; HTLV 1; Hyperinfection; Strongyloidiasis.

Despite advances in treatment, human immunodeficiency virus/tuberculosis (HIV/TB) coinfection remains highly prevalent in selected low- and middle income countries. The diagnosis of tuberculosis frequently proves challenging in the setting of advanced HIV, as patients may present with atypical features. A high index of suspicion must be maintained for TB in this setting, but it is critical that alternative diagnoses are considered. A myriad of opportunistic infections may mimic TB and a definitive microbiological diagnosis prior to TB treatment should always be sought. We report on a case of a young, HIV positive male who presented with a delayed diagnosis of nocardiosis that was thought to be TB of the spine. Despite extensive laboratory and radiological investigations, the diagnosis was only made after tissue was cultured. Earlier diagnosis of this mimic would have led to appropriate therapy and may have improved the outcome for this patient.

Keywords: HIV; Nocardia; Spinal tuberculosis.