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Presents a travel guide to England, Scotland, and Wales, providing recommendations on hotels, restaurants, shopping, local transportation, sights of interest, and nightlife.

This study examines changes in the sociodemographic patterns of deportation and voluntary return of undocumented immigrants from the United States to Mexico during three US presidential administrations (2001 to 2019) with different immigration policies. Most previous studies examining these migration flows for the United States as a whole have relied exclusively on counts of deportees and returnees, thereby ignoring changes over the past 20 y in the characteristics of the undocumented population itself, i.e., the population at risk of deportation or voluntary return. We estimate Poisson models based on two data sources that permit us to compare changes in the sex, age, education, and marital status distributions of both deportees and voluntary return migrants with the corresponding changes in the undocumented population during the Bush, Obama, and Trump administrations: the Migration Survey on the Borders of Mexico-North (Encuesta sobre Migración en las Fronteras de México-Norte) for counts of deportees and voluntary return migrants and the Current Population Survey’s Annual Social and Economic Supplement for estimated counts of the undocumented population living in the United States. We find that whereas disparities by sociodemographic characteristics in the likelihood of deportation generally increased beginning in Obama’s first term, sociodemographic disparities in the likelihood of voluntary return generally decreased over this period. Despite heightened antiimmigrant rhetoric during the Trump administration, the changes in deportation and voluntary return migration to Mexico among the undocumented during Trump’s term were part of a trend that began early in the Obama administration.

Background Objectives were first to evaluate by education level one-year trajectories of pain, function and general health, as well as hospital resource and medication needs in patients undergoing primary total hip arthroplasty (THA); and second, to evaluate whether outcome differences are related to existing baseline differences in health and disease severity. Methods We included all primary THAs from a public hospital-based prospective arthroplasty registry, performed in a high-income country 2010 to 2017. Education was classified in three levels: ≤8years of schooling (low), 9-12years (medium), and ≥13years (high). Pain and function prior to and one-year after surgery were assessed with the Western Ontario McMaster Universities score (WOMAC) and general health with the 12-item short-form health survey (SF-12). Results Overall 963 patients were included, 340 (35.3%) with low, 306 (31.8%) with medium, and 317 (32.9%) with high education. With increasing educational level preoperative scores for pain, function and SF-12 mental health component increased. One year after surgery improvement was observed in all education categories for WOMAC pain and function, SF-12 mental and physical component. However, absolute postoperative scores remained lower in all four domains for the low education group. After adjustment for baseline characteristics differences were much attenuated and no longer significant. There was also greater resource need in low educated patients. Conclusions The inferior absolute results one year after surgery in less educated patients were largely due to older age, worse preoperative health and greater symptom severity calling for greater attention to timely and equal management, for more targeted perioperative care and increased support for the lower education group.

Background As more people walk and bike in their communities, there is a corresponding increase in the number of crashes with motor vehicles. Each year, a significant number of pedestrians die in motor vehicle crashes in the U.S., and many more are injured. Safety interventions to decrease motor vehicle crashes have included roadway design, safety programs, and laws. However, there is still much that is unknown about the factors that impact motor vehicle crashes with pedestrians. This study aimed to describe the pedestrian motor vehicle crashes occurring in Wichita, Kansas, from 2008 through 2019, specifically to identify factors associated with fatalities/serious injuries of pedestrians. Methods This study was a retrospective analysis of data from the Kansas Motor Vehicle Accident Reports from January 2008 through December 2019. Bivariate and multivariate logistical regression analyses were conducted to determine factors associated with fatalities/serious injuries of pedestrians from motor vehicle crashes. Results From 2008 through 2019, 979 motor vehicle crashes involving a pedestrian were reported, with an upward trend of crashes reported over the years. Of the total motor vehicle crashes reported, 97.5% (n = 955) resulted in a pedestrian injury. In 67.3% (n = 659) of motor vehicle crash cases involving a pedestrian, medical assistance and transport to the nearest hospital occurred. The severity of injury varied per crash; 18.2% (n = 177) of crashes resulted in a severe or fatal injury for a pedestrian. There were significant associations between pedestrian serious/fatal injuries and pedestrian age, driver age, time of day, road characteristics, vehicle maneuver, vehicle damage, pedestrian location before impact, pedestrian substance abuse, and driver substance abuse. Conclusions The frequency of pedestrian crashes in Wichita either remained consistent or increased over the course of 12 years, underscoring a need for action to increase safety and implement policy efforts to decrease crash prevalence. Further exploration of pedestrian crashes through a multilevel model can yield knowledge of individual behaviors and environmental factors contributing to crashes.

Biologic monitoring (i.e., biomonitoring) is used to assess human exposures to environmental and workplace chemicals. Urinary biomonitoring data typically are adjusted to a constant creatinine concentration to correct for variable dilutions among spot samples. Traditionally, this approach has been used in population groups without much diversity. The inclusion of multiple demographic groups in studies using biomonitoring for exposure assessment has increased the variability in the urinary creatinine levels in these study populations. Our objectives were to document the normal range of urinary creatinine concentrations among various demographic groups, evaluate the impact that variations in creatinine concentrations can have on classifying exposure status of individuals in epidemiologic studies, and recommend an approach using multiple regression to adjust for variations in creatinine in multivariate analyses. We performed a weighted multivariate analysis of urinary creatinine concentrations in 22,245 participants of the Third National Health and Nutrition Examination Survey (1988-1994) and established reference ranges (10th-90th percentiles) for each demographic and age category. Significant predictors of urinary creatinine concentration included age group, sex, race/ethnicity, body mass index, and fat-free mass. Time of day that urine samples were collected made a small but statistically significant difference in creatinine concentrations. For an individual, the creatinine-adjusted concentration of an analyte should be compared with a \"reference\" range derived from persons in a similar demographic group (e.g., children with children, adults with adults). For multiple regression analysis of population groups, we recommend that the analyte concentration (unadjusted for creatinine) should be included in the analysis with urinary creatinine added as a separate independent variable. This approach allows the urinary analyte concentration to be appropriately adjusted for urinary creatinine and the statistical significance of other variables in the model to be independent of effects of creatinine concentration.

Purpose We aimed to compare the long-term outcomes of small-head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) to ceramic-on-polyethylene (CoP) THA using the same cup. Methods All primary elective MoM and CoP THAs performed 1998–2011 were prospectively included in a local registry. Patients were followed until 31 December 2022. Outcomes were all-cause revision, complications and mortality. The uncemented Morscher 28 mm monobloc press-fit cup was used in all THAs. Results Overall, 3257 THAs were included, 864 MoM (mean age 63) and 2393 CoP THAs (mean age 72). Mean follow-up of the cohort was 12.9 years (maximum 26.8 years). Revision for any cause was performed in 85 MoM and 79 CoP THAs. Cumulative incidence of all-cause revision at 20 years was 13.2% (95% CI 10.6 to 16.3) in MoM and 6.3% (95% CI 4.8 to 8.3) in CoP group. Adjusted hazard ratio for all-cause revision was 1.88 (95% CI 1.34 to 2.65) comparing MoM vs. CoP. Diagnoses at revision were mainly aseptic loosening (33%) and adverse local tissue reactions (33%) in MoM and aseptic loosening in CoP group (44%). The smoothed hazard function revealed the largest difference in instantaneous revision rate between three and 14 years postoperative. After that period no difference was observed. Conclusion Overall, the cumulative risk of all-cause revision was almost twice as high in patients with a small head MoM as compared to a CoP THA over the 20-year period. However, most of the excess in revisions among MoM patients occurred between three and 14 years postoperative.

Background The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome. Methods 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high- vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and over-riding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p  < 0.05. Results Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm. Conclusions One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.

The transformation and progression of myelodysplastic syndromes (MDS) to secondary acute myeloid leukemia (sAML) involve genetic, epigenetic, and microenvironmental factors. Driver mutations have emerged as valuable markers for defining risk groups and as candidates for targeted treatment approaches in MDS. It is also evident that the risk of transformation to sAML is increased by evasion of adaptive immune surveillance. This study was designed to explore the immune microenvironment, immunogenic tumor-intrinsic mechanisms (HLA and PD-L1 expression), and tumor genetic features (somatic mutations and altered karyotypes) in MDS patients and to determine their influence on the progression of the disease. We detected major alterations of the immune microenvironment in MDS patients, with a reduced count of CD4+ T cells, a more frequent presence of markers related to T cell exhaustion, a more frequent presence of myeloid-derived suppressor cells (MDSCs), and changes in the functional phenotype of NK cells. HLA Class I (HLA-I) expression was normally expressed in CD34+ blasts and during myeloid differentiation. Only two out of thirty-six patients with homozygosity for HLA-C groups acquired complete copy-neutral loss of heterozygosity in the HLA region. PD-L1 expression on the leukemic clone was also increased in MDS patients. Finally, no interplay was observed between the anti-tumor immune microenvironment and mutational genomic features. In summary, extrinsic and intrinsic immunological factors might severely impair immune surveillance and contribute to clonal immune escape. Genomic alterations appear to make an independent contribution to the clonal evolution and progression of MDS.

Current analysis of forensic DNA stains relies on the probabilistic interpretation of bulk-processed samples that represent mixed profiles consisting of an unknown number of potentially partial representations of each contributor. Single-cell methods, in contrast, offer a solution to the forensic DNA mixture problem by incorporating a step that separates cells before extraction. A forensically relevant single-cell pipeline relies on efficient direct-to-PCR extractions that are compatible with standard downstream forensic reagents. Here we demonstrate the feasibility of implementing single-cell pipelines into the forensic process by exploring four metrics of electropherogram (EPG) signal quality—i.e., allele detection rates, peak heights, peak height ratios, and peak height balance across low- to high-molecular-weight short tandem repeat (STR) markers—obtained with four direct-to-PCR extraction treatments and a common post-PCR laboratory procedure. Each treatment was used to extract DNA from 102 single buccal cells, whereupon the amplification reagents were immediately added to the tube and the DNA was amplified/injected using post-PCR conditions known to elicit a limit of detection (LoD) of one DNA molecule. The results show that most cells, regardless of extraction treatment, rendered EPGs with at least a 50% true positive allele detection rate and that allele drop-out was not cell independent. Statistical tests demonstrated that extraction treatments significantly impacted all metrics of EPG quality, where the Arcturus® PicoPure™ extraction method resulted in the lowest median allele drop-out rate, highest median average peak height, highest median average peak height ratio, and least negative median values of EPG sloping for GlobalFiler™ STR loci amplified at half volume. We, therefore, conclude the feasibility of implementing single-cell pipelines for casework purposes and demonstrate that inferential systems assuming cell independence will not be appropriate in the probabilistic interpretation of a collection of single-cell EPGs.

INTRODUCTION Some research suggests that blood–brain barrier (BBB) integrity is altered in Alzheimer's disease (AD). Few studies have examined markers of BBB integrity and their interactions with AD risk factors on multi‐domain cognition. METHODS 83 older adults without dementia underwent lumbar puncture, apolipoprotein E (APOE) genotyping, and neuropsychological testing with up to 5 years of follow‐up. Soluble platelet‐derived growth factor receptor beta (sPDGFRβ) was measured in cerebrospinal fluid. RESULTS Higher baseline sPDGFRβ was associated with better cross‐sectional attention, visuospatial, and executive functioning, but with steeper longitudinal decline in executive function. When considering AD risk status, higher sPDGFRβ was associated with faster longitudinal decline in all cognitive domains in biomarker‐positive relative to biomarker‐negative individuals and in language in APOE ɛ4‐positive relative to ɛ4‐negative individuals. DISCUSSION Elevated sPDGFRβ may increase risk of cognitive decline, particularly in individuals with a higher risk for AD. Future studies should explore mechanisms that contribute to these relationships. Highlights Cerebrospinal fluid (CSF) soluble platelet‐derived growth factor receptor beta (sPDGFRβ) is a promising marker of blood–brain barrier (BBB) integrity. Higher sPDGFRβ was cross‐sectionally associated with better cognition at baseline. Higher sPDGFRβ was longitudinally associated with steeper decline in cognition, particularly among amyloid beta (Aβ) 42/Aβ40+ individuals. CSF concentration of sPDGFRβ may predict cognitive decline in those with increased dementia risk.