bluuebunny/crossref_metadata_2025 huggingface dataset:
The Readiness Imperative: Leveraging Large Animal Resident Research to Enhance Expeditionary Surgical Skills
Authors: Fannon Elise E H , Dangan Andrei , Hauck Katrina , Sherazee Elan , Zakaluzny Scott , Tourtillott Brandon M , Savard Dillon J , Russo Rachel
Published: September 2024

Introduction

The Defense Health Agency aims to ensure that military surgical residents have the expeditionary general surgical skills necessary to deploy to a combat environment and maintains the Clinical Investigation Programs (CIPs) that foster research during graduate medical education. This project evaluates the potential to achieve both aims simultaneously through a large animal Combat Casualty Care Research Program (CCCRP).

Materials and Methods

Large animal experimental protocols within a single CIP’s CCCRP were collected from July 1, 2017, to June 30, 2022. Operations performed were tabulated and categorized by Emergency General Surgery procedure equivalent. In addition, procedures performed by a single resident from July 1, 2020, to June 30, 2022, were separately indexed for a more granular analysis.

Results

The results are presented with total 5-year numbers listed first, followed by single resident 2-year numbers in parentheses. The residents at the CIP carried out 8676 (1,609) tabulated procedures. Major surgical procedures included 573 (154) laparotomies, 364 (129) thoracotomies, 279 (125) splenectomies, 219 (108) craniotomies, 206 (81) hepatorrhaphies, 363 (62) nephrectomies, 383 (48) bowel resections, 215 (48) spine exposures with laminectomies, and 173 (9) sternotomies. Additional procedures included 1028 (127) central venous lines, 878 (127) arterial lines, 90 (67) tube thoracostomies, 199 (37) carotid artery exposures, 394 (29) suprapubic urostomies, and placement of 278 (10) aortic occlusion catheters. At this time, the residents had 17 (10) presentations at national meetings, 8 (7) research awards, and published 20 peer-reviewed manuscripts. Additionally, the residents involved in the CCCRP gained valuable experience in critical care, including management of 110 traumatic brain injuries, 121 Intercranial Pressure catheters, 316 cases of hemorrhagic shock, and 211 massive transfusion protocols, among a variety of other vital critical care skills.

Conclusions

This large animal CCCRP represents a unique training model that not only achieves its primary goal of fostering graduate medical education research but also bolsters Emergency General Surgery readiness for military surgical residents.
Decreased spinal cord motor neuron numbers in mice depleted of central nervous system copper
Authors: Liddell J R , Hilton J B W , Wang Y J , Billings J L , Nikseresht S , Kysenius K , Fuller-Jackson J P , Hare D J , Crouch P J
Published: September 2024

Disrupted copper availability in the central nervous system (CNS) is implicated as a significant feature of the neurodegenerative disease amyotrophic lateral sclerosis (ALS). Solute carrier family 31 member 1 (Slc31a1; Ctr1) governs copper uptake in mammalian cells and mutations affecting Slc31a1 are associated with severe neurological abnormalities. Here, we examined the impact of decreased CNS copper caused by ubiquitous heterozygosity for functional Slc31a1 on spinal cord motor neurons in Slc31a1+/− mice. Congruent with the CNS being relatively susceptible to disrupted copper availability, brain and spinal cord tissue from Slc31a1+/− mice contained significantly less copper than wild-type littermates, even though copper levels in other tissues were unaffected. Slc31a1+/− mice had less spinal cord α-motor neurons compared to wild-type littermates, but they did not develop any overt physical signs of motor impairment. By contrast, ALS model SOD1G37R mice had fewer α-motor neurons than control mice and exhibited clear signs of motor function impairment. With the expression of Slc31a1 notwithstanding, spinal cord expression of genes related to copper handling revealed only minor differences between Slc31a1+/− and wild-type mice. This contrasted with SOD1G37R mice where changes in the expression of copper handling genes were pronounced. Similarly, the expression of genes related to toxic glial activation was unchanged in spinal cords from Slc31a1+/− mice but highly upregulated in SOD1G37R mice. Together, results from the Slc31a1+/− mice and SOD1G37R mice indicate that although depleted CNS copper has a significant impact on spinal cord motor neuron numbers, the manifestation of overt ALS-like motor impairment requires additional factors.
Prediction of H3K27M alteration in midline gliomas of the brain using radiomics: A multi-institute study
Authors: Indoria Abhilasha , Arora Ankit , Garg Ajay , Chauhan Richa S , Chaturvedi Aparajita , Kumar Manoj , Konar Subhas , Sadashiva Nishanth , Rao Shilpa , Saini Jitender
Published: September 2024

Background

Noninvasive prediction of H3K27M-altered Diffuse midline gliomas is important because of the involvement of deep locations and proximity to eloquent structures. We aim to predict H3K27M alteration in midline gliomas using radiomics features of T2W images.

Methods

Radiomics features extracted from 124 subjects (69 H3K27M-altered/55 H3K27M-wild type). T2W images were resampled to 1 × 1 × 1mm3 voxel size, preprocessed, and normalized for artifact correction, intensity variations. The feature set was normalized and subjected to reduction by variance thresholding, correlation coefficient thresholding, and sequential feature selector. Adaptive synthesis oversampling technique was used to oversample the training data. Random forest classifier (RFC), Decision tree classifier (DTC), and K-nearest neighbors classifier (KNN) were trained over the training dataset and the performance was assessed over the internal test dataset and external test data set (52 subjects: 33 H3K27M-altered/19-H3K27M-wild type).

Results

DTC achieved a validation score of 77.33% (5-fold cross-validation) and an accuracy of 80.64%, 75% on internal and external test datasets. RFC achieved a validation score of 80.7% (5-fold cross-validation) an accuracy of 80.6%, and 73% on internal and external test datasets. DTC achieved a validation score of 78.67% (5-fold cross-validation) an accuracy of 80.64%, and 61.53% on internal and external test datasets. The accuracy score of DTC, RFC, and KNN on the internal test dataset was approximately 80% while on the external test dataset, DTC achieved 75% accuracy, RFC achieved 73% accuracy and KNN achieved 65.1% accuracy.

Conclusions

H3K27M alteration is a potential immunotherapeutic marker and is associated with poor prognosis and radiomics features extracted from conventional T2W-images can help in identifying H3K27M-altered cases non-invasively with high precision.
Peer Navigation for Smoking Cessation in People With HIV Who Smoke: A Pilot Randomized Controlled Trial
Authors: Cioe Patricia A , Pinkston Megan , Stang Garrett S , Tashima Karen T , Kahler Christopher W
Published: September 2024

Introduction

People with HIV (PWH) cite smoking within their social networks as a barrier to quitting. We examined the feasibility, acceptability, and preliminary efficacy of a tailored intervention, Peer Navigation Social Support for Smoking Cessation (PNSS-S), designed specifically for PWH who smoke.

Aims and Methods

We randomized 64 PWH who smoked (mean age 54.5 years; 41% female) to PNSS-S or standard care (SC). After meeting with a clinic nurse to discuss quitting strategies and pharmacotherapy, the PNSS-S group received 12 weekly phone calls from a trained HIV peer navigator (PN), who provided smoking cessation counseling and social support for quitting. Outcomes were assessed at 12 and 24 weeks.

Results

Sixty-two percent of participants indicated interest in quitting at baseline. PN utilization was high with a mean number of weekly calls completed of 8.9 (SD 3.1), demonstrating excellent feasibility. Higher treatment satisfaction scores (29.1 [SD 3.0]) were reported in PNSS-S, compared to control (25.8 [SD 4.1], t = −3.39, d = 0.89, p = .001). Notably, positive social support for quitting increased significantly from baseline to week 12 in PNSS-S (17.4 [SD 11.4] to 25.1 [SD 12.2], p = .01), whereas SC showed no significant change (t = 1.11, df 29, p = .24). At week 24, 5 (16.6%) participants in PNSS-S and 3 (8.8%) in SC endorsed 7-day point-prevalence smoking abstinence: OR = 2.05 95% CI = [0.45 to 10.88].

Conclusions

Peer-based smoking cessation counseling increased the odds of abstinence and significantly increased social support for quitting. Further study is warranted.

Implications

Cross-training HIV PNs to address smoking cessation may be a cost-effective approach, as it utilizes existing HIV clinic-based resources. By strengthening social support and providing a peer-based approach, this intervention may help reduce the burden of tobacco-related health issues in this population, ultimately contributing to better overall health and longevity for PWH. Further research is needed to refine and expand upon these findings.

Clinical Trial Registration

Clinical trials.gov registration number: NCT04327921.
Evaluating Antibiotic Misuse and Cost Analysis Among Hospitalized Dengue Virus–Infected Adults: Insights From a Retrospective Cohort Study
Authors: Ngamprasertchai Thundon , Siribhadra Ashley , Kositamongkol Chayanis , Piroonamornpun Pittaya , Pakdeewut Piyanan , Luvira Viravarn , Lawpoolsri Saranath , Rattanaumpawan Pinyo
Published: September 2024

Background

Dengue is a prevalent cause of acute febrile illness, predominantly in Asia, where it necessitates supportive care without the need for antibiotics. This study aimed to evaluate antibiotic usage and analyze hospitalization costs among adults infected with the dengue virus.

Methods

This retrospective cohort study was conducted at the Hospital for Tropical Diseases, Thailand, in 2022. Two independent reviewers assessed all adult cases with confirmed dengue from 2016 to 2021. Determinants of inappropriateness were analyzed using Poisson regression.

Results

The study included 249 participants with over half presenting with severe dengue or dengue with warning signs upon admission. The cumulative incidence of antibiotic use was 9.3% (95% CI, 8.23–10.47), predominantly involving empirical treatment strategies. Ceftriaxone and doxycycline were the most frequently prescribed antibiotics. Notably, patients who received empirical antibiotics showed no definite or presumed bacterial infections. Among those who received definite strategies, inappropriate durations, including both short treatments and the overuse of broad-spectrum antibiotics, were observed. A private ward admission was identified as a significant predictor of inappropriate use, with an incidence rate ratio of 4.15 (95% CI, 1.16–14.82) compared with intensive care unit admission. Direct medical costs did not differ significantly between appropriate and inappropriate uses.

Conclusions

The incidence of antibiotic use among dengue cases was moderate; however, inappropriate use by indication was observed. Antimicrobial stewardship strategies should be encouraged, particularly in patients with dengue with warning signs admitted to a general or private ward. Direct medical costs between appropriate and inappropriate use were comparable.
The Genetics of Plant–Plant Interactions and Their Cascading Effects on Agroecosystems—from Model Plants to Applications
Authors: Sato Yasuhiro , Wuest Samuel E
Published: September 2024

Plants are typically surrounded by neighboring individuals in agricultural fields or natural environments. In such circumstances, plant–plant interactions (PPI) are ubiquitous and represent not only important evolutionary forces but also have consequences on (agro-)ecosystem functioning, such as increased productivity and resistance. However, many mechanisms underlying these PPIs remain poorly understood. Recently, new genomic technologies and tools, such as genome-wide association studies, have facilitated genetic approaches to study PPIs, particularly among conspecific individuals. Here, we highlight emerging issues and advances in the field by focusing on three different aspects. First, we overview the current status of genetic mapping studies on PPIs and pinpoint that these studies open a new opportunity that is relevant to agriculture and breeding. Second, we introduce two proof-of-concept studies in Arabidopsis thaliana, in which genetic differences among plants improved the functioning of genotype mixtures. Both studies were able to predict effective mixtures with different experimental designs applied to different outcomes (productivity increase versus herbivory mitigation). Third, we discuss implications from these case studies about how PPIs have cascading effects that propagate to higher levels of biological organization, such as populations or communities. At the population level, plant yield or resistance can be optimized through breeding that achieves reduced competition or push–pull protection systems, respectively. At the community level, these population-level changes may have further beneficial effects on plant-associated organisms. Overall, we suggest that the increasing availability of genomic resources will improve our understanding of PPIs and thereby contribute to the management of crops or seminatural ecosystems.
Soft cells and the geometry of seashells
Authors: Domokos Gábor , Goriely Alain , Horváth Ákos G , Regős Krisztina
Published: September 2024

A central problem of geometry is the tiling of space with simple structures. The classical solutions, such as triangles, squares, and hexagons in the plane and cubes and other polyhedra in three-dimensional space are built with sharp corners and flat faces. However, many tilings in Nature are characterized by shapes with curved edges, nonflat faces, and few, if any, sharp corners. An important question is then to relate prototypical sharp tilings to softer natural shapes. Here, we solve this problem by introducing a new class of shapes, the soft cells, minimizing the number of sharp corners and filling space as soft tilings. We prove that an infinite class of polyhedral tilings can be smoothly deformed into soft tilings and we construct the soft versions of all Dirichlet–Voronoi cells associated with point lattices in two and three dimensions. Remarkably, these ideal soft shapes, born out of geometry, are found abundantly in nature, from cells to shells.
Measuring receptivity to misinformation at scale on a social media platform
Authors: Tokita Christopher K , Aslett Kevin , Godel William P , Sanderson Zeve , Tucker Joshua A , Nagler Jonathan , Persily Nathaniel , Bonneau Richard
Published: September 2024

Measuring the impact of online misinformation is challenging. Traditional measures, such as user views or shares on social media, are incomplete because not everyone who is exposed to misinformation is equally likely to believe it. To address this issue, we developed a method that combines survey data with observational Twitter data to probabilistically estimate the number of users both exposed to and likely to believe a specific news story. As a proof of concept, we applied this method to 139 viral news articles and find that although false news reaches an audience with diverse political views, users who are both exposed and receptive to believing false news tend to have more extreme ideologies. These receptive users are also more likely to encounter misinformation earlier than those who are unlikely to believe it. This mismatch between overall user exposure and receptive user exposure underscores the limitation of relying solely on exposure or interaction data to measure the impact of misinformation, as well as the challenge of implementing effective interventions. To demonstrate how our approach can address this challenge, we then conducted data-driven simulations of common interventions used by social media platforms. We find that these interventions are only modestly effective at reducing exposure among users likely to believe misinformation, and their effectiveness quickly diminishes unless implemented soon after misinformation’s initial spread. Our paper provides a more precise estimate of misinformation’s impact by focusing on the exposure of users likely to believe it, offering insights for effective mitigation strategies on social media.
Fungicide Sensitivity and Nontarget Site Resistance in Rhizoctonia zeae Isolates Collected from Corn and Soybean Fields in Nebraska
Authors: Gambhir Nikita , Kodati Srikanth , Adesemoye Anthony O. , Everhart Sydney E.
Published: September 2024

Rhizoctonia zeae was recently identified as the major Rhizoctonia species in corn and soybean fields in Nebraska and was shown to be pathogenic on corn and soybean seedlings. Fungicide seed treatments commonly used to manage seedling diseases include prothioconazole (demethylation inhibitor), fludioxonil (phenylpyrrole), sedaxane (succinate dehydrogenase inhibitor), and azoxystrobin (quinone outside inhibitor [QoI]). To establish the sensitivity of R. zeae to these fungicides, we isolated this pathogen from corn and soybean fields in Nebraska during 2015 to 2017 and estimated the relative effective concentration for 50% inhibition (EC50) of a total of 91 R. zeae isolates from Nebraska and Illinois. Average EC50 for prothioconazole, fludioxonil, sedaxane, and azoxystrobin was 0.219, 0.099, 0.078, and >100 µg ml−1, respectively. In planta assays showed that azoxystrobin did not significantly reduce the disease severity on soybean (P > 0.05). The cytochrome b gene of R. zeae did not harbor any mutation known to confer QoI resistance and had a type I intron directly after codon 143, suggesting that a G143A mutation is unlikely to evolve in this pathogen. For prothioconazole, fludioxonil, and sedaxane, the EC50 of the isolates did not differ significantly among the years of collection (P > 0.05), and their single discriminatory concentrations were identified as 0.1 µg ml−1. This is the first study to establish nontarget site resistance of R. zeae to azoxystrobin and the sensitivity of R. zeae to commonly used seed treatment fungicides in Nebraska. This information will help to guide strategies for chemical control of R. zeae and monitor sensitivity shifts in the future.
Inter- and Intrapathogen Interactions Emanating from Coinfection with Different Fungal and Viral Strains in Canola Cultivars with Differing Host Resistances
Authors: Abidin Nuraizat , You Ming P. , Barbetti Martin J. , Jones Roger A. C.
Published: September 2024

Few recent investigations examine coinfection interactions between fungal and viral plant pathogens. Here, we investigated coinfections between Leptosphaeria maculans and turnip mosaic virus (TuMV) in canola (Brassica napus). Different combinations of L. maculans isolate P11 and resistance-breaking isolates L. maculans UWA192 and TuMV 12.1 were inoculated to three cultivars with differing pathogen resistances/susceptibilities. They were inoculated first to entire or half cotyledons 10 to 12 days after emergence and second to opposite entire or half cotyledons on the same day (day 0) or 3 or 7 days afterward. The parameters measured were L. maculans cotyledon disease index (%CDI), and TuMV systemically infected leaf symptom intensity (SI) and virus concentration (VC). Except when both day 0 inoculations were with isolate UWA192, %CDI values were supressed strongly or only weakly when isolates P11 and/or UWA192 were inoculated to plants with L. maculans single-gene resistance (SGR) or polygenic resistance, respectively. However, except when isolate P11 was inoculated first and UWA192 second, these values declined after inoculation day 0 when SGR was absent. TuMV infection suppressed %CDI values, although this decrease was usually smaller following day 0 half cotyledon inoculations. When TuMV temperature-sensitive systemic invasion resistance was present and both inoculations were with TuMV, SI and VC values diminished greatly. However, the extent of this decrease was reduced when second inoculations were with L. maculans. SI and VC values were also smaller when SGR was present and second inoculations were with L. maculans. When L. maculans resistance was lacking, SI and VC values were smaller when second inoculations to entire cotyledons were with L. maculans rather than TuMV. This also occurred after second half cotyledon inoculations with isolate P11 but not isolate UWA192. Therefore, diverse intra- or interpathogen interactions developed depending upon host resistance, isolate combination, cotyledon inoculation approach, and second inoculation timing.
Does Sagittal Alignment Matter? A Biomechanical Look at Pinning Pediatric Supracondylar Humerus Fractures
Authors: Serbin Ryan , Duemmler Marc , Bonvillain Kirby , Coe Kelsie , Habet Nahir A. , Odum Susan , Paloski Michael
Published: September 2024

Objective:

Closed manipulation and percutaneous pinning is standard of care for displaced supracondylar humerus fractures, yet the optimal pin configuration, particularly in the sagittal plane, is not well defined. This study evaluates how sagittal plane pin variations affect construct strength biomechanically.

Methods:

One hundred synthetic pediatric humerus models were used to emulate supracondylar humerus fracture. The models were pinned using 4 different configurations uniformly divergent in the coronal plane with variations in the sagittal plane: (1) 2 diverging pins with the lateral pin anterior (n = 25), (2) 2 diverging pins with the lateral pin posterior (n = 25), (3) 2 parallel pins (n = 25), and (4) 3 parallel pins (n = 25). The models were tested under bending (flexion, extension, and varus) and rotational (internal and external) forces, measuring stiffness and torque. Statistical analyses identified significant differences across configurations.

Results:

The 2-pin parallel configuration (9.68 N/mm in extension, 8.76 N/mm in flexion, 0.14 N-m/deg in internal rotation, and 0.14 N-m/deg in external rotation) performed similarly to the 3-pin parallel setup (10.77 N/mm in extension, 7.78 N/mm in flexion, 0.16 N-m/deg in internal rotation, and 0.14 N-m/deg in external rotation), with no significant differences in stiffness. In contrast, both parallel configurations significantly outperformed the 2-pin anterior (5.22 N/mm in extension, 5.7 N/mm in flexion, 0.11 N-m/deg in internal rotation and 0.10 N-m/deg in external rotation) and posterior (9.86 N/mm in extension, 8.31 N/mm in flexion, 0.12N-m/deg in internal rotation, and 0.11 N-m/deg in external rotation) configurations in resisting deformation. No notable disparities were observed in varus loading among any configurations.

Conclusions:

This study illuminates the sagittal plane’s role in construct stability. It suggests that, when utilizing 2-pins, parallel configurations in the sagittal plane improve biomechanical stability. In addition, it suggests avoiding the lateral anterior pin configuration due to its biomechanical inferiority. Further research should assess ultimate strength and compare various 3-pin configurations to better delineate differences between 2-pin and 3-pin configurations regarding sagittal plane alignment.

Level of Evidence:

Level III—biomechanical study.
Preoperative Serum Albumin and TLC as Predictors of Postoperative Complications in Spine Surgery
Authors: Mohamed Ayman , Sheehan Connor , Kaur Paramveer , Schwab Frank , Butler Alexander
Published: September 2024

Study Design:

Narrative review.

Purpose:

To investigate the state of literature regarding serum albumin and total lymphocyte count and their associations with postoperative complications after spine surgery.

Methods:

Comprehensive search of the PubMed database was performed to find relevant articles addressing preoperative serum albumin, total lymphocyte count, or their respective composite scores and their associations with postoperative complications after spine surgery.

Summary of Background Data:

Serum albumin level is frequently cited as a marker of patient nutritional status. Total lymphocyte count has more recently gained attention in the literature for similar reasons. Identification of modifiable preoperative patient risk factors for postoperative complications such as malnutrition may help minimize the incidence of postoperative complications.

Results:

Review of the literature revealed 10 studies that discussed the association between preoperative hypoalbuminemia and postoperative complications. Five studies examined the relationship between either prognostic nutritional index (PNI), controlling nutritional status (CONUT), or both and postoperative complications after spine surgery. Preoperative hypoalbuminemia, low PNI, and high CONUT scores were associated with increased risk of postoperative complications after spine surgery.

Conclusions:

Preoperative malnourishment is a modifiable patient factor that is associated with an increased risk of postoperative complications after spine surgery.
Pre-operative triAge proCedure to streaMline elective surgicAl patieNts (PACMAN) improves efficiency by selecting patients eligible for phone consultation
Authors: Di Biase Manuela , van der Zwaard Babette , Aarts Fenne , Pieters Barbe
Published: September 2024

BACKGROUND

Pre-operative screening is a high volume task consuming time and resource. Streamlining patient flow by gathering information in advance reduces costs, optimises resources and diminishes patient burden whilst maintaining safety of care.

OBJECTIVE

To evaluate whether ‘Pre-operative triAge proCedure to streaMline elective surgicAl patieNts’ (PACMAN) is able to improve pre-operative screening by selecting patients eligible for evaluation by telephone.

DESIGN

A single-centre, retrospective, observational cohort analysis.

SETTING

A tertiary medical teaching hospital in ‘s-Hertogenbosch, The Netherlands.

PATIENTS AND METHODS

Adults scheduled for clinical interventions under procedural sedation and all types of elective medium or low risk surgery with anaesthetic guidance were eligible. Patients answered a questionnaire to calculate the PACMAN score. This score combined with risk factors related to surgery determines suitability for phone consultation (PhC) or the need for an in-person consultation (in-PC).

INTERVENTION

Evaluation of standard care.

MAIN OUTCOME MEASURES

Primary outcome was the reduction in number of in-PCs. Secondary outcomes included reliability of PACMAN, peri-operative patient outcomes and cost-effectiveness.

RESULTS

Of 965 patients triaged by PACMAN, 705 (73.1%) were identified as suitable for a PhC. Of those, 688 (97.6%) were classified American Society of Anesthesiologists Physical Status (ASA-PS) I to II or III with stable comorbidities. Of the 260 in-PC patients, 47.4% were classified ASA-PS III with unstable comorbidities or ASA-PS IV. The overall incidence of unanticipated adverse peri-operative events was 1.3%. Finally, implementation of PACMAN led to a 20% increase in pre-operative department efficiency due to better deployment of personnel and resources.

CONCLUSION

Implementation of PACMAN resulted in a 73.1% reduction in pre-operative in-PCs at our hospital. Given the increasing pressure on healthcare systems globally, we suggest developing further optimisation and integration of smart triage solutions into the pre-operative process.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06148701
The development and evaluation of a fact sheet resource for women managing menopausal-related cognitive complaints
Authors: Zhu Chen , Arunogiri Shalini , Thomas Elizabeth H. X. , Li Qi , Kulkarni Jayashri , Gurvich Caroline
Published: September 2024

Objectives

Cognitive symptoms are frequently reported by women during the menopause transition years. The aim of this research was to codesign and evaluate a fact sheet resource to help women understand and manage cognitive symptoms that may occur during menopause.

Methods

This study adopted a codesign approach involving women during the menopause transition years as well as professionals to develop and evaluate a fact sheet, with a focus on acceptability and safety. Four phases (discover, define, develop, deliver) were conducted to develop, refine, and evaluate the fact sheet using a mixed-methods approach of focus groups, interviews, and surveys.

Results

The discover phase identified a need for online educational resources for women in premenopause, perimenopause, and postmenopause to learn about menopause-related topics. The define and develop phases, relying on focus group sessions with perimenopausal and postmenopausal women, revealed common themes related to the experience of cognitive symptoms and a desire for management tips to optimize cognitive functioning. Structured interviews with professionals highlighted a desire for more concrete examples of cognitive symptoms. The results of the deliver phase found strong acceptability for the fact sheet, alongside requests for additional information on menopausal hormone therapy from premenopausal, perimenopausal, and postmenopausal women.

Conclusions

The study reported a wide range of cognitive symptoms among women during the menopause transition years. This study showed broad agreement on the fact sheet's acceptability and safety in addressing menopausal cognitive symptoms. Feedback on menopausal hormone therapy and management tips underscores the demand for more research on effective interventions.
Effects of Yoga on Stress in Pregnant Women
Authors: Pais Maria , Pai Muralidhar , Kamath Asha , Lewis Leslie , Nambiar Jayaraman
Published: September 2024

During pregnancy, a woman’s body undergoes physiological and metabolic changes to nourish the developing fetus. Every woman experiences pregnancy-related stress differently, with symptoms and difficulties ranging from mild to severe. However, various therapies are available to help reduce stress levels. The purpose of this study is to assess the impact of integrated yoga, which includes asanas and pranayama, on stress levels and physiological markers in pregnant women. The study is a prospective, randomized, controlled, single-blind trial with 2 parallel groups. The intervention group was provided with integrated yoga therapy, while the control group was given routine standard care from 18 to 22 weeks to 33-35 weeks of gestation. To measure the stress level, a standardized perceived stress scale was used, which has 10 items with stress scores ranging from 0 to 4, with a maximum score of 40. The average stress score was significantly lower in the intervention group (P < .001) as well as normal physiological parameters when compared to the control group. Findings suggest that practicing yoga during pregnancy is safe and effective in reducing stress and preventing complications. Women who began yoga therapy during their second trimester reported a significant decrease in physiological parameters from baseline to post-intervention. However, further randomized controlled trials are necessary to determine the validity and usefulness of yoga therapy during pregnancy.
The Effect of Face Mask Wear on the Ocular Surface and Contact Lens Microbiome
Authors: Ozkan Jerome , Majzoub Marwan E. , Khan Mahjabeen , Coroneo Minas , Thomas Torsten , Willcox Mark
Published: September 2024

Objectives:

As face mask wear can result in the redirection of nasal and oral exhalation toward the ocular region, this study investigated the impact of face mask wear on the conjunctiva, eyelid margin, and contact lens (CL) surface microbiome.

Methods:

In this prospective, cross-over study, experienced CL wearers (N=20) were randomized to wear a face mask for 6 hr/day (minimum) for a week or no mask for a week. The conjunctiva, eyelid, and CLs were then sampled. After a 1-week washout period, participants were crossed over into the alternate treatment for 1 week and sampling was repeated. Sampling was bilateral and randomly assigned to be processed for culturing or 16S ribosomal(r) RNA gene sequencing.

Results:

Culturing showed no effect of mask wear on the average number of bacterial colonies isolated on the conjunctiva, eyelid, or CL, but there was increased isolation of Staphylococcus capitis on CL samples with mask wear (P=0.040). Culture-independent sequencing found differences in the taxonomic complexity and bacterial composition between the three sites (P<0.001), but there was no effect of bacterial diversity within and between sites. Mask wear did not impact dry eye or CL discomfort, but increased ocular surface staining was reported (P=0.035).

Conclusions:

Mask wear did not substantially alter the microbiome of the conjunctiva, eyelid margin, or CL surfaces in uncompromised healthy eyes.
Objective quantification of posterior capsule opacification using swept-source AS-OCT
Authors: Tao Shuya , Liang Feiyan , Fan Shuxin , Wang Mingwei , Zhang Yimeng , Liu Xialin , He Chang
Published: September 2024

Purpose:

To objectively quantify posterior capsule opacification (PCO) using swept-source anterior segment optical coherence tomography (SS-AS–OCT) in pseudophakic eyes.

Setting:

Zhongshan Ophthalmic Center, Guangzhou, China.

Design:

Prospective cross-sectional study.

Methods:

180 eyes with PCO (37 multifocal intraocular lenses [mfIOLs] and 143 monofocal intraocular lenses [moIOLs]) were enrolled. The PCO irregular degree (PID), defined to evaluate the surface irregularity of PCO, the average and maximum thickness of PCO (AT-PCO, MT-PCO) were applied to quantify PCO based on SS-AS–OCT (CASIA2) images. Corrected distance visual acuity (CDVA), higher-order aberrations (HOAs), modulation transfer function, and Strehl ratio were recorded. The associations between SS-AS–OCT parameters and visual function parameters were assessed by Spearman correlation analysis.

Results:

PID, AT-PCO, and MT-PCO showed significant correlations with CDVA, Strehl ratio, and HOAs (CDVA: r = 0.702, 0.741, and 0.736; Strehl ratio: r = −0.746, −0.719, and −0.740; HOAs: r = 0.762, 0.734, and 0.752). The correlations of these 3 parameters with Strehl ratio and HOAs were significantly higher than those of clinical PCO grading with Strehl ratio and HOAs (all P < .05). Particularly, PID demonstrated notable correlations with Strehl ratio and HOAs. In addition, patients with mfIOLs presented worse Strehl ratio and HOAs than those with moIOLs after matching age, PID, AT-PCO, and MT-PCO.

Conclusions:

This study provides a new method for objectively quantifying PCO using successive cross-sectional SS-AS–OCT images. AT-PCO, MT-PCO, and PID are presented as new indicators to document PCO severity, with PID offering a unique perspective by considering the irregularity aspect of PCO.
Cataract and diabetes: review of the literature
Authors: Zarei-Ghanavati Siamak , Hadi Yasaman , Habibi Abbas , Ashraf Khorasani Maryam , Yoo Sonia H.
Published: September 2024

Cataracts can cause visual impairment in diabetic patients. Diabetes mellitus affects different parts of the eye and causes many complications and problems before, during, and after intraocular surgeries. In this review, we will discuss the effects of diabetes on different aspects of cataract surgery and review the current management of diabetic cataracts. Careful preoperative examination of the patient's ocular surface, cornea, iris, and posterior segment, as well as the use of advanced phacoemulsification techniques, new intraocular lenses and the appropriate use of auxiliary medications such as nonsteroidal anti-inflammatory drugs and anti-vascular endothelial growth factors have improved the outcomes of cataract surgery in diabetic patients.
Series Multiblood Pump Design With Dual Activation for Pediatric Patients With Heart Failure
Authors: Palazzolo Thomas C. , Sarkisyan Harutyun , Matlis Giselle C. , McGowan Jordon , Tchantchaleishvili Vakhtang , Stevens Randy M. , Throckmorton Amy L.
Published: September 2024

The translational development of pediatric ventricular assist devices (VADs) lags years behind adult device options, negatively impacting pediatric patient outcomes. To address this need, we are developing a novel, series-flow, double-blood pump VAD that integrates an axial and centrifugal pump into a single device. The axial pump is used for initial circulatory assistance in younger patients; then, an internal activation mechanism triggers the centrifugal pump to activate in line with the axial pump, providing additional pressure and flow to match pediatric patient growth cycles. Here, we focused on the design and improvement of the device flow paths through computational analysis and in vitro hydraulic testing of a prototype. We estimated pressure-flow generation, fluid scalar stresses, and blood damage levels. In vitro hydraulic tests correlated well with shear stress transport (SST) predictions, with an average deviation of 4.5% for the complex, combined flow path. All data followed expected pump performance trends. The device exceeded target levels for blood damage in the blade tip clearances, and this must be both investigated and addressed in the next design phase. These study findings establish a strong foundation for the future development of the Drexel Double-Dragon VAD.
Heat-related illness and sun safety strategies for pediatric populations
Authors: Krishna Shruthi , Kim Rachel , Pochtar Emily , Papaioannou Helen
Published: September 2024

Purpose of review

The ongoing rise in temperature poses significant public health concerns such as exposure to extreme heat and increased prevalence of heat-related illnesses. Given that pediatric populations are particularly vulnerable to heat-related risks, pediatricians need to be prepared to counsel caregivers and patients on heat protective strategies and treatment recommendations.

Recent findings

Children are physiologically susceptible to heat-related complications. Heat-related illness is a spectrum of illnesses ranging from mild heat rash to potentially life-threatening heatstroke. Prevention is key to protecting children from heat-related illness and hazards. Recommended prevention strategies include clothing, sun avoidance, hydration, acclimatization, and sunscreen.

It is important that pediatricians provide anticipatory guidance on summer sun safety practices to parents and patients. Should prevention fail, pediatricians must be aware of how to effectively distinguish and treat heat-related illness and harms.
Pearls for practice from the 2023 joint task force anaphylaxis practice parameter
Authors: Maddukuri Chaitanya , Kartha Navya , Conway Alexandra E. , Shaker Marcus S.
Published: September 2024

Purpose of review

To share important highlights on the management of anaphylaxis from the latest 2023 practice parameter.

Recent findings

The 2023 Allergy Immunology Joint Task Force on Practice Parameters (JTFPP) anaphylaxis practice parameter provides updated anaphylaxis guidance. Criteria for the diagnosis of anaphylaxis are reviewed. The parameter highlights that while anaphylaxis is not more severe in younger children, age-specific symptoms can vary. Activation of emergency medical services may not be required in patients who experience prompt resolution of symptoms following epinephrine use and caregivers are comfortable with observation. For children weighing <15 kg, the anaphylaxis parameter suggests the clinician may prescribe either the 0.1 mg or the 0.15 mg epinephrine autoinjector, with the 0.3 mg autoinjector prescribed for those weighing 25 kg or greater. In patients with heart disease, discontinuing or changing beta blockers and/or angiotensin converting enzyme inhibitors may pose a larger risk for worsened cardiovascular disease compared with risk for severe anaphylaxis with medication continuation. Furthermore, in patients with a history of perioperative anaphylaxis, shared decision-making based on diagnostic testing and clinical history is recommended prior to repeat anesthesia use. Beyond the recent parameter update, novel contemporary therapies can decrease risk of community anaphylaxis.

The 2023 JTFPP Anaphylaxis Guidelines offer up-to-date guidance for the diagnosis and management of anaphylaxis in infants, children, and adults.
Cystic dysplasia of the rete testis in adulthood: a case report and review of the literature
Authors: Nasrallah Oussama G. , El Mir Mohammad W. , Fawaz Mohammad W. , Mahdi Jana H. , Khouzami Riad A. , Bachir Bassel G.
Published: September 2024

Background:

Rete testis dysplasia is a cystic anomaly arising from the rete testis presenting normally in the pediatric population. These cases usually regress spontaneously without the need for surgical intervention. There are rare, reported cases of rete testis dysplasia in adulthood, which have been managed surgically.

Case presentation:

A 58-year-old man presented with lower urinary tracts symptoms and found to have a slightly larger right testicle namely in the lower pole near the epididymis. Investigation was done using ultrasound of the testicles with Doppler showing an 8 mm cyst contained in 16.5×12.1 mm cystic dysplasia near the rete testis. MRI of the testicles revealed a small intratesticular cyst with adjacent band-like signals, in keeping with rete testis dysplasia. This patient was placed under surveillance and the rete testis dysplasia is stable after 6 months and will not be operated on unless progression on ultrasound is encountered.

Clinical discussion:

The management of cystic dysplasia of the rete testis has been evolving with time. While there have never been clear-cut guidelines on the treatment of this condition, a radical orchiectomy of the affected testicle had traditionally been the preferred treatment option. There have only been three case reports of cystic dysplasia of the rete testis in adults, none of which are known to have been managed by observation.

Conclusion:

In conclusion, the authors report a unique case of rete testis dysplasia being managed conservatively showing the benign features of such a pathology, which may be actively surveyed through sequential imaging.
Point-of-Care Ultrasound Diagnosis of Early Pyomyositis in a Pediatric Patient
Authors: Ciurria Julia A. , Grither Allie
Published: September 2024

Skin and soft tissue infections are common in the pediatric emergency department. Because pyomyositis occurs deep to the fascial plane, it is often difficult to appreciate on physical examination. The utility of point-of-care ultrasound for identifying pyomyositis is of great value to the pediatric emergency physician as this diagnosis has a different expected clinical course and requires different management than other skin and soft tissue infections. This case report describes a child who presented to the pediatric emergency department with leg pain and redness, initially concerning for an abscess based on clinical findings. Point-of-care ultrasound diagnosed early pyomyositis, prompting early involvement of the pediatric surgical service and urgent computed tomography imaging, which confirmed the diagnosis.
Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods
Authors: Cowger Tori L. , Link Nicholas B. , Hart Justin D. , Sharp Madeline T. , Nair Shoba , Balasubramanian Ruchita , Moallef Soroush , Chen Jarvis , Hanage William P. , Tabb Loni Philip , Hall Kathryn T. , Ojikutu Bisola O. , Krieger Nancy , Bassett Mary T.
Published: September 2024

Context:

Monitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention’s (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level “wastewater viral activity levels.”

Program:

In October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.

Approach and Implementation:

To produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.

Evaluation:

COVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with “Very High” wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for “High” or “Low,” obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.

Discussion:

Our methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.
Avoiding Patient Abandonment: A Pathway to Ethical Resolution in Situations of Untenable Patient–Surgeon Relationships
Authors: Prescher Hannes , Gudex Leah M. , Mauch Jaclyn T. , Vercler Christian J.
Published: September 2024

Background:

A trusting partnership between patient and surgeon lies at the core of a successful therapeutic relationship. However, there are conditions that can jeopardize this partnership and create an ethical dilemma for the surgeon, who is guided by a moral obligation to care for the patient without causing unnecessary harm. The authors present a discussion of several pathways to achieve ethical resolution to therapeutic relationships that have grown untenable, with a focus on patients with comorbid psychiatric illness. The principal objective of these pathways is to prevent further delivery of futile interventions while avoiding patient abandonment.

Methods:

A review of the literature was performed, and principles of clinical ethics were applied to provide guidelines for care in situations of untenable patient–surgeon relationships.

Results:

There are no published ethical guidelines for resolving a therapeutic impasse in surgical patients with psychiatric illness. The authors applied ethical principles of treatment futility, nonmaleficence, beneficence, and patient abandonment to develop a framework for navigating difficult postoperative patient relationships.

Conclusions:

Managing postoperative surgical patients with comorbid psychiatric conditions presents a unique challenge. In severe cases, therapeutic discharge may be ethically permissible and necessary to disrupt a maladaptive treatment cycle to prevent future patient harm. Specific precautions must be taken to avoid patient abandonment.
Navigation-Guided Surgical Removal of an Orthodontic Miniscrew Accidentally Displaced Into the Prevertebral Space
Authors: Do Jiwon , Kwon Ik-Jae
Published: September 2024

In a challenging and extremely rare case, a 40-year-old female presented with an orthodontic miniscrew inadvertently lodged in the prevertebral space near the internal carotid artery following an incident at a local clinic. Traditional blind removal techniques posed significant risks due to the miniscrew’s dangerous location. An optical navigation system that utilized advanced real-time tracking and 3D imaging to precisely locate and safely remove the foreign body was applied. The successful procedure, confirmed by postoperative imaging, underscored the vital role of navigation-guided surgery in enhancing surgical precision and patient safety in complex cases.