Explore the vast range of titles available.

Chronic pancreatitis is a progressive fibroinflammatory disease that exists in large-duct (often with intraductal calculi) or small-duct form. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals) and genetic factors (eg, mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator); a few patients have hereditary or autoimmune disease. Pain in the form of recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells) or constant and disabling pain is usually the main symptom. Management of the pain is mainly empirical, involving potent analgesics, duct drainage by endoscopic or surgical means, and partial or total pancreatectomy. However, steroids rapidly reduce symptoms in patients with autoimmune pancreatitis, and micronutrient therapy to correct electrophilic stress is emerging as a promising treatment in the other patients. Steatorrhoea, diabetes, local complications, and psychosocial issues associated with the disease are additional therapeutic challenges.

Acute cholangitis is more common in older people, and increasing age is a determinant of morbidity and mortality, as is early biliary decompression by ERCP. This study aims to identify factors that may contribute to delays in the diagnosis and treatment of older people with acute cholangitis. Case notes of 122 patients (45 aged < 75 years, 77 > 75 years) with a final diagnosis of acute cholangitis who underwent ERCP were reviewed for presenting clinical features (pain, jaundice, rigors, fever, falls, incontinence, confusion), liver function tests, blood count, and the interval from admission to diagnosis, ultrasonography, and ERCP. The most common symptom at presentation was abdominal pain (81%), followed by jaundice (55%). These symptoms were no less common in older patients. Charcot's triad was present in only 15.6% of young and 18.8% of older patients. Jaundice was not detected in 16% of significantly hyperbilirubinemic older patients, but only the presence of functional symptoms was associated with significant diagnostic delay (median, 1 day [range: 0-11] vs. 9.5 days [3-25]; P< 0.001) and delay in performing ERCP (median: 4 days [0-24] vs. 16.5 days [2-29], P< 0.001). Overall mortality was 10%, and the incidence of septic shock was similar in both groups. Charcot's classical triad is infrequent in patients suffering from acute cholangitis. Given the greater difficulty assessing jaundice in older people and the confounding effect of falls, incontinence, and confusion, a routine policy of liver function tests, with further investigation of abnormal results in such presentations, may reduce delays in diagnosing and treating acute cholangitis.

Background The STOPBANG questionnaire is used to predict the presence of obstructive sleep apnea (OSA). We sought to assess the performance of the STOPBANG questionnaire in younger, thinner patients referred to a sleep medicine clinic. Methods We applied the STOPBANG questionnaire to patients referred for level I polysomnography (PSG) at our sleep center. We calculated likelihood ratios and area under the receiver operator characteristic (AUROC) curve and performed sensitivity analyses. Results We performed our analysis on 338 patients referred for PSG. Only 17.2% ( n  = 58) were above age 50 years, and 30.5 and 6.8% had a BMI above 30 and 35 years, respectively. The mean apnea-hypopnea index (AHI) was 12.9 ± 16.4 and 63.9% had an AHI ≥5. The STOPBANG (threshold ≥3) identified 83.1% of patients as high risk for an AHI ≥5, and sensitivity, specificity, positive (PPV), and negative predictive values (NPV) were 83.8, 18.0, 64.4, and 38.0%, respectively. Positive and negative likelihood ratios were poor at 1.02–1.11 and 0.55–0.90, respectively, across AHI thresholds (AHI ≥5, AHI ≥15 and AHI ≥30), and AUROCs were 0.52 (AHI ≥5) and 0.56 (AHI ≥15). Sensitivity analyses adjusting for insomnia, combat deployment, traumatic brain injury, post-traumatic stress disorder, clinically significant OSA (ESS >10 and/or co-morbid disease), and obesity did not significantly alter STOPBANG performance. Conclusions In a younger, thinner population with predominantly mild-to-moderate OSA, the STOPBANG Score does not accurately predict the presence of obstructive sleep apnea.

Objectives. We assessed associations between psychosocial factors and preterm birth, stratified by race in a prospective cohort study. Methods. We surveyed 1898 women who used university and public health prenatal clinics regarding various psychosocial factors. Results. African Americans were at higher risk of preterm birth if they used distancing from problems as a coping mechanism or reported racial discrimination. Whites were at higher risk if they had high counts of negative life events or were not living with a partner. The association of pregnancy-related anxiety with preterm birth weakened when medical comorbidities were taken into account. No association with preterm birth was found for depression, general social support, or church attendance. Conclusions. Some associations between psychosocial variables and preterm birth differed by race.

Background This study aimed to evaluate the role of the Obesity Surgery Mortality Risk Score (OS-MRS) to predict the risk of post-operative adverse events, in addition to death, from any laparoscopic bariatric procedure. Methods The OS-MRS was applied to consecutive patients at a single hospital during October 2008–September 2009. The composite end point comprised one or more of the following adverse events: mortality, re-intervention, re-admission to hospital, venous thromboemobolism, or blood transfusion. Results There were 381 patients (men, 19%). The median age was 43 years (range, 19–67 years), with 42% patients aged ≥45 years. The median weight was 126 kg (75–295 kg) and median BMI 46 kg/m 2 (30–84 kg/m 2 ); 37% had BMI ≥50 kg/m 2 . Twenty-seven percent of patients had hypertension and 3% had a past history of venous thromboembolism. The OS-MRS classes were A (60.1%), B (35.9%), or C (4.0%). Operations comprised adjustable gastric band (37%), Roux-en-Y gastric bypass (54%), sleeve gastrectomy (8%), or biliopancreatic diversion (1%). Of the operations, 1.6% were revisional procedures. An adverse outcome occurred in 19 patients, with distribution in 3.5% of class A patients, 5.8% of class B, and 20.0% of class C (A vs. B, P  = 0.451; A vs. C, P  = 0.002; B vs. C, P  = 0.025). There was one death: OS-MRS class C. On multivariate analysis, OS-MRS (class C vs. A or B; Odds Ratio [OR], 4; P  = 0.050) and type of operation (band vs. bypass or sleeve; OR, 9.2; P  = 0.033) were independently predictive of the composite end point. Conclusion OS-MRS and type of the bariatric operation are independently predictive of the risk of post-operative adverse events.

Hymns that celebrate God's creative power remind us that the earth is not ours to exploit but God's handiwork, entrusted to our care. Lament is a powerful tool for naming loss, expressing sorrow, and crying out to God for justice. In this time of ecological peril, may our voices rise in harmony with the cries of the earth and the Creator's call, bearing witness to the hope that sustains us all.

The past few years have seen significant change for The Hymn Society, including the establishment of The Center for Congregational Song, staff expansion, new programs, new conversation partners, and increasing diversity in membership, leadership, and programming. [...]we have faced some difficult challenges, including cluding a pandemic that put a halt to in-person gatherings. Into the Future Over the past year the Executive Committee has engaged in a process of strategic planning that involved broad consultation and intensive reflection. Programs and Activities for 2024-2025 Our plans for the coming year include: * a three-day Writing the Church's Song retreat, led by Dan Damon, FHS, and Richard Leach, to be held in-person near Denver, Colorado, in November; * a continued partnership with Red Crearte for more events in the Latinx Connection Program; * an Ambassadors program to be held at Wingate University; * a new webinar series with a broader variety of topics, including seasonal planning, copyright, the legacy of Erik Routley, and singing in Cebuano and Black British congregations; * an online course to be held in January on congregational song in worship, led by Jonathan Hehn, OSL, and geared to musicians, pastors, and other leaders; * a fourth series of nine interviews with Hymn Society leaders; * colloquia for text and tune writers to be held online, led by Carl Daw, FHS (text) and Zach Stachowski and Bex Gaunt (tune), beginning in March 2024; * Annual Conference to be held July 13-16, 2025, in Detroit, with a theme of \"We Believe: Faith, Community, and Congregational Song.\"

In the United States and Canada, up to one quarter of all infants are delivered by cesarean section 1 – 5 ; approximately half these procedures are performed only because the woman has had a previous cesarean section. 1 For years, allowing labor after a previous cesarean section was thought to be dangerous, and many clinicians recommended that any woman who had had a cesarean section should deliver all subsequent babies by cesarean section. However, others have questioned the necessity for elective cesarean section in many such cases and have considered a trial of labor after a previous cesarean section a reasonable strategy. . . .