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\"Based on the hit TV show, [this is an] all-new, all-ages comic book series. Join Robin, Starfire, Beast Boy, and Raven as they display their unique brand of hijinks, mayhem and justice. But giant pizza monsters are not the only dastardly and delicious villains on the menu--so dig in, Titans\"-- Provided by publisher.

ABSTRACTDiabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients’ goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.

\"Robin, Starfire, Beast Boy, Cyborg, and Raven continue their partying in this jam-packed, adventure-filled volume ... guest-starring Batman, Superman, and the Justice League\"-- Provided by publisher.

Mental illness is an important public health concern in veterinary students. Recent literature has demonstrated a negative effect of the COVID-19 pandemic on veterinary students’ mental health. Little literature to date has evaluated the mental health of veterinary students affected by the COVID-19 pandemic after most pandemic measures have been lifted. The objective of this study was to describe physical activity, diet, and mental health in veterinary students after pandemic measures were lifted. A secondary objective was to examine the association between depression symptoms and exposure factors in this cohort of veterinary students. In a cross-sectional study, veterinary students (n = 487) at a public university received an online survey with questions regarding their physical activity, diet, stress, and self-rated symptoms across 11 mental health domains. Logistic regression was used to quantify the association between exposure factors and depression symptoms. One-hundred and twelve students completed the survey. Sixty-three (56%) respondents met the criteria for concern within the mental health domain of depression, 75 (67%) for anxiety, and 16 (14%) for suicidal ideation. Fourth year students had the lowest weekly vigorous physical activity (median 0.5 hours). The odds of self-reported depression symptoms were 8 times lower in students engaged in high levels of vigorous exercise compared to students engaged in low levels, after controlling for number of years in the program (p = 0.02). Mental health concerns were high in this group of veterinary students.

In this collection of two graphic novels, the Teen Titans kill the boredom between missions by playing pranks, but when Beast Boy pranks Batman, things do not go well. In the second story a mysterious package arrives for Raven, and the others drive themselves crazy wondering what it contains.

PurposeThis study explores how sharing platforms achieve platform loyalty through various operation management strategies.Design/methodology/approachA multiple case study method has been conducted in two Chinese sharing economy industries: ride- and bike-sharing. Data were collected through 30 semi-structured interviews with managers from four platform companies (DiDi, Uber China, ofo and Mobike). Individual case studies were developed from the triangulation of all existing data. Concurrent with the development of these individual case studies was a cross-case analysis. Emerging patterns have been identified and compared to previous findings in the literature to build upon and modify the existing knowledge base and to formulate a series of propositions.FindingsPlatform asset characteristics and mergers and acquisitions affect supply network readiness and operational capacity, respectively, and this effect would consequently contribute to achieving platform loyalty through user satisfaction. Moreover, externality, as a moderator, may influence the strength of the relationship between satisfaction and platform loyalty.Practical implicationsThe proposed theoretical model provides an overarching framework for sharing platform companies to design and operate their businesses while carefully examining the situations, contexts and actions of users and other stakeholders and choosing an appropriate strategic mechanism to drive platform growth.Originality/valueThis study is one of the first to empirically explain how firms in a sharing economy sector could gain platform loyalty by adopting an expectation–confirmation theory perspective.

In this collection of two graphic novels, Starfire signs the Teen Titans up for a popular reality show and Robin becomes obsessed with the idea of them all being on television. Then, Robin is encased in ice by Captain Cold, and comes down with a virus and the rest of the team sets out to find a cure.

Background Patients with non-small cell lung cancer (NSCLC) experience a considerable disease burden, evident in symptomatic and psychological spheres. Advanced cancer represents a complex scenario for patients and the healthcare team. Early palliative care (EPC) has been proven as a clinically meaningful strategy in this context by several randomized trials but not in a resource-limited setting. This study aimed to evaluate the effect of EPC compared with standard oncological care (SOC) in patients with metastatic NSCLC in Mexico. Materials and Methods A prospective, randomized clinical trial was conducted at Instituto Nacional de Cancerologia in Mexico. All patients had histologically confirmed metastatic NSCLC without previous treatment. Patients were randomly assigned (1:1) to receive SOC or SOC + EPC. The EPC group was introduced to the palliative care team at baseline after randomization, which was integrated by psychologists, bachelor’s in nutrition, specialized nurses, and physicians. Patients randomized to this arm had programmed visits to meet with the team at baseline and through the 2nd, 4th-, and 6th cycles thereafter. The primary endpoint was overall survival (OS); secondary outcomes included quality of life (QoL), anxiety and depression, and symptom intensity. They were assessed using the instruments EORTC QLQ-C30 questionnaire, Edmonton Symptom Assessment Scale (ESAS), and the Hospital Anxiety and Depression Scale (HADS) (clinicaltrials.gov [NCT01631565]). Questionnaires were completed at baseline, at 2nd, 4th, and 6th cycles of treatment. Results Between March 2012 and June 2015, 201 patients were assessed for eligibility and 146 were enrolled and allocated to receive EPC (73) or SOC (73). Median OS for patients in the EPC vs SOC arm was 18.1 months (95% CI, 7.9-28.4) and 10.5 months (95% CI, 4.7-16.2) (P = .029). Having a poor performance status (HR 1.7 [1.2-2.5]; P = .004) and allocation to the control group (HR 1.5 [1.03-2.3]; P = .034) were independently associated with a worse OS. Those patients with a global QoL > 70 at baseline had a better OS if they were In the EPC arm (38.7 months (95% CI, 9.9-67.6) vs SOC 21.4 months (95% CI, 12.4-30.3)). Mean QoL had a numerical improvement in patients allocated to EPC after 6 cycles of follow-up, nonetheless this difference was not statistically significant (55.1 ± 23.7 vs 56.9 ± 25.3; P = .753). There were no significant differences in anxiety and depression at all study points. Conclusions EPC is associated with a significant improvement in OS, although, we observed that the greatest benefit of providing EPC was observed in those with a global QoL > 70 at baseline. This study did not identify significant changes in terms of QoL or symptom burden between the study groups after follow-up. Evidence robustly suggests that EPC should be considered part of the multidisciplinary treatment of metastatic NSCLC patients since diagnosis. According to our study, EPC can be implemented in low- or middle-income countries (LMIC). The benefit of early palliative care in a resource-limited setting is not well understood. This study examined whether early palliative care could improve the survival of Mexican patients with advanced non-small cell lung cancer compared with standard oncological care.

Abstract Background Estrogen modulates the renin-angiotensin-aldosterone system (RAAS) in women, but sex differences have not been fully explored in dogs. Objective We hypothesized that the RAAS profile of intact female (IF) Doberman Pinschers (DP) would differ from spayed female (SF) and intact male (IM) DP. Animals Eighteen healthy DP (6 IF, 6 SF, 6 IM). Methods Absolute and indexed RAAS metabolites, angiotensin-converting enzyme (ACE) and ACE2 activities, and genotypes (pyruvate kinase dehydrogenase 4, titin, and ACE variants) were compared among sex groups using Kruskal-Wallis or chi-square tests, and linear regression controlling for age. Data are expressed as median (minimum, maximum) and P < .05 was considered significant. Results The ACE activity was higher in IF DP (656 pmol/L; 436, 784) compared to SF DP (411 pmol/L; 287, 451; P = .01) and IM DP (365 pmol/L; 276, 1200; P = .04) after controlling for age. Angiotensin II, angiotensin I, and plasma renin activity marker (PRA-S) were higher in IF DP compared to SF DP, but not significantly (P ≤ .25). After controlling for age, angiotensin 1-7/angiotensin I was lower in IF DP compared to SF DP (P = .01). Genotypes did not differ among groups. Most DP (94%) were ACE variant positive. Conclusions and Clinical Significance Sex and reproductive status influenced the RAAS of DP, with IF DP showing genotype-independent higher ACE activity. These findings hold implications for sterilization practices in female dogs, and support sex and reproductive status as a source of variability in RAAS studies. Additionally, the frequency of the ACE gene variant was very high in this group of DP.

The Society of Cardiovascular Angiography and Interventions (SCAI) shock stages have been applied and validated in high-income countries with access to advanced therapies. We applied the SCAI scheme at the time of admission in order to improve the risk stratification for 30-day mortality in a retrospective cohort of patients with STEMI in a middle-income country hospital at admission. This is a retrospective cohort study, we analyzed 7,143 ST-segment elevation myocardial infarction (STEMI) patients. At admission, patients were stratified by the SCAI shock stages. Multivariate analysis was used to assess the association between SCAI shock stages to 30-day mortality. The distribution of the patients across SCAI shock stages was 82.2%, 9.3%, 1.2%, 1.5%, and 0.8% to A, B, C, D, and E, respectively. Patients with SCAI stages C, D, and E were more likely to have high-risk features. There was a stepwise significant increase in unadjusted 30-day mortality across the SCAI shock stages (6.3%, 8.4%, 62.4%, 75.2% and 88.3% for A, B, C, D and E, respectively; P < 0.0001, C-statistic, 0.64). A trend toward a lower 30-day survival probability was observed in the patients with advanced CS (30.3, 15.4%, and 8.3%, SCAI shock stages C, D, and E, respectively, Log-rank P-value <0.0001). After multivariable adjustment, SCAI shock stages C, D, and E were independently associated with an increased risk of 30-day death (hazard ratio 1.42 [P = 0.02], 2.30 [P<0.0001], and 3.44 [P<0.0001], respectively). The SCAI shock stages applied in patients con STEMI at the time of admission, is a useful tool for risk stratification in patients across the full spectrum of CS and is a predictor of 30-day mortality.