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There is a little evidence regarding long-term safety and efficacy for atrial shunt devices in heart failure (HF). The REDUCE LAP-HF I (n = 44) and II (n = 621) trials (RCT-I and -II) were multicenter, randomized, sham-controlled trials of patients with HF and ejection fraction >40%. Outcome data were analyzed from RCT-I, a mechanistic trial with 5-year follow-up, and RCT-II, a pivotal trial identifying a responder group (n = 313) defined by exercise PVR <1.74 WU and no cardiac rhythm management device with 3-year follow-up. At 5 years in RCT I, there were no differences in cardiovascular (CV) mortality, HF events, embolic stroke, or new-onset atrial fibrillation between groups. After 3 years in RCT II, there was no difference in the primary outcome (hierarchical composite of CV mortality, stroke, HF events, and KCCQ) between shunt and sham in the overall trial. Compared to sham, those with responder characteristics in RCT-II had a better outcome with shunt (win ratio 1.6 [95% CI 1.2-2.2], P =.006; 44% reduction in HF events [shunt 9 vs. control 16 per 100 patient-years], P =.005; and greater improvement in KCCQ overall summary score [+17.9 ± 20.0 vs. +7.6 ± 20.4], P <.001), while nonresponders had significantly more HF events. Shunt treatment at 3 years was associated with a higher rate of ischemic stroke (3.2% vs. 0%, 95% CI 2%-6.1%, P =.032) and lower incidence of worsening kidney dysfunction (10.7% vs. 19.3%, P =.041). With up to 5 years of follow up, adverse events were low in patients receiving atrial shunts. In the responder group, atrial shunt treatment was associated with a significantly lower HF event rate and improved KCCQ compared to sham through 3 years of follow-up. NCT02600234, NCT03088033. [Display omitted] [ABSTRACT FROM AUTHOR]

Prophylactic antibiotics are routinely prescribed by surgeons for their patients who undergo septorhinoplasty. However, the literature to support this remains controversial, especially in complex cases, those that require grafts, revision cases, extended surgical time, and an American Society of Anesthesiologists (ASA) value greater than or equal to 3. The study purpose was to evaluate for a potential association between increased anesthetic complexity and the risk for surgical site infection (SSI) following complex septorhinoplasty. Retrospective cohort study of patients who underwent a complex septorhinoplasty between 2005 and 2022 at the Dallas Veterans Affairs Medical Center. Patients were excluded if they did receive a septorhinoplasty, did not follow up, or had insufficient records. All patients were assigned an ASA value prior to surgery, with an ASA value of 3 serving as this study's independent variable. The main outcome variable of interest was the development of a postoperative SSI, defined as findings consistent with cellulitis, purulence, or fistula development necessitating antibiotic treatment. The demographic covariates included patient age and sex. Clinical covariates included diabetes status, history of nasal trauma or surgery, and smoking status. The operative covariates were surgical duration, perioperative antibiotic, intraoperative complication, and type of cartilage graft used. χ2 Analysis and t-tests were used for calculations, with P values <.05 being considered significant. A total of 182 patients were included in this study, 81 (45%) with an ASA ≤2 and 101 (55%) with an ASA of 3. A patient's age (P <.01), male sex (P <.01), and a diagnosis of diabetes (P <.01) were associated with an ASA value of 3. In total, there were 6 (3.3%) SSIs, with 2 (1%) occurring in those with an ASA of 3. An ASA value of 3 (P =.27, relative risk of.40) was not shown to be associated with an increased risk of SSI. Our results suggest that an ASA of 3 is not significant with regard to postoperative infection in patients who undergo a complex nasal septorhinoplasty, and prophylactic postoperative antibiotics are not warranted. [ABSTRACT FROM AUTHOR]

[Display omitted] Human IgE (hIgE) mAbs against major mite allergen Der p 2 developed using human hybridoma technology were used for IgE epitope mapping and analysis of epitopes associated with the hIgE repertoire. We sought to elucidate the new hIgE mAb 4C8 epitope on Der p 2 and compare it to the hIgE mAb 2F10 epitope in the context of the allergenic structure of Der p 2. X-ray crystallography was used to determine the epitope of anti–Der p 2 hIgE mAb 4C8. Epitope mutants created by targeted mutagenesis were analyzed by immunoassays and in vivo using a human high-affinity IgE receptor (FcεRIα)–transgenic mouse model of passive systemic anaphylaxis. The structure of recombinant Der p 2 with hIgE mAb 4C8 Fab was determined at 3.05 Å. The newly identified epitope region does not overlap with the hIgE mAb 2F10 epitope or the region recognized by 3 overlapping hIgE mAbs (1B8, 5D10, and 2G1). Compared with wild-type Der p 2, single or double 4C8 and 2F10 epitope mutants bound less IgE antibodies from allergic patients by as much as 93%. Human FcεRIα–transgenic mice sensitized by hIgE mAbs, which were susceptible to anaphylaxis when challenged with wild-type Der p 2, could no longer cross-link FcεRI to induce anaphylaxis when challenged with the epitope mutants. These data establish the structural basis of allergenicity of 2 hIgE mAb nonoverlapping epitopes on Der p 2, which appear to make important contributions to the hIgE repertoire against Der p 2 and provide molecular targets for future design of allergy therapeutics. [ABSTRACT FROM AUTHOR]

Approximately two-thirds of Latinx college students attend Hispanic Serving Institutions (HSIs). Despite the growing number of HSIs, these institutions often fail to result in better educational outcomes and success for Latinx students. As such, more research is needed to explore factors that may hinder HSIs in their ability to support Latinx students. Whiteness—defined as the invasive system of White supremacy that permeates society—is systemically embedded throughout higher educational systems. However, little research has explored the specific ways that whiteness may influence the construction and maintenance of HSIs by senior administrators, staff, and faculty. To address this gap, the present study centered theories from critical whiteness studies (Nayak, 2007) and Garcia's (2018) decolonizing HSIs organizational framework to assess how whiteness operates at a recently designated HSI. We used a critical qualitative case study design that included thematic analysis of 14 student affairs staff, faculty, and senior administrator interviews and document analysis of public-facing institutional materials. Results indicated three predominant themes related to how whiteness is maintained by senior administrators, staff, and faculty, including the rhetoric of all as a tool of White appeasement, the taxation of bodies of people of color, and whiteness through good intentions. The study concludes with recommendations for identifying and disrupting whiteness at HSIs, including specific recommendations at the individual and institutional levels. [ABSTRACT FROM AUTHOR]

To address the challenges associated with initial point selection and to enhance the speed of analysis in ellipsometry data interpretation, this study introduces a novel algorithm based on whale optimisation. The algorithm is designed to accurately determine samples' thickness and refractive index across transparent wavelength ranges. Comparative analysis demonstrates that the Psi and Delta spectra generated by the proposed algorithm align more closely with those obtained through the traditional transfer matrix method (TMM), underscoring the algorithm's improved accuracy. Furthermore, the algorithm's efficacy is validated by the excellent agreement between the properties of the established sample model (thickness and refractive index) and those acquired by transfer matrix data. This validation confirms the utility of the proposed algorithm in fitting ellipsometry data, establishing it as a robust tool for extracting essential fitting parameters of samples with enhanced precision and efficiency. [ABSTRACT FROM AUTHOR]

Untreated severe tricuspid regurgitation (TR) carries a poor prognosis. The authors report the 1-year outcomes of transcatheter edge-to-edge repair (TEER) with the TriClip system (Abbott Structural Heart) in patients with complex tricuspid valve anatomies. The multicenter, international TRILUMINATE Pivotal (Trial to Evaluate Cardiovascular Outcomes in Patients Treated with the Tricuspid Valve Repair System Pivotal) trial included a single-arm cohort, with complex tricuspid valve anatomies excluded from the randomized arm (ie, anticipated TR reduction but not to moderate or less after TEER). The primary outcome endpoint of the single arm was 1-year survival with a Kansas City Cardiomyopathy Questionnaire score improvement ≥10 points. In the primary analysis population (N = 100), the mean age was 80 ± 6 years, and 35% had a cardiac implantable electronic device lead. Nearly 90% of patients had massive or torrential TR, 44% had prior left-sided valve interventions, 63% had ≥4-segmental tricuspid leaflet morphology, and the coaptation gap averaged 7.4 ± 2.7 mm. The primary endpoint was met (outcome: 46.2%, performance goal: 30%; P = 0.0008). A total of 81% of subjects had moderate or less TR at 1 year. No major adverse events or deaths occurred within 30 days postprocedure. One-year all-cause mortality and heart failure hospitalization were 15% and 24%, respectively. Significant improvements in NYHA functional class and Kansas City Cardiomyopathy Questionnaire overall scores occurred and were maintained at 1 year. In patients with complex tricuspid anatomies, TEER with the TriClip system demonstrated excellent procedural safety with significant TR reduction and associated improvements in quality of life at 1 year. [Display omitted] [ABSTRACT FROM AUTHOR]

In PARAGLIDE-HF, in patients with ejection fraction (EF) > 40%, stabilized after worsening heart failure (WHF), sacubitril/valsartan led to greater reduction in plasma NT-proBNP levels and was associated with clinical benefit compared to valsartan alone, despite more symptomatic hypotension (SH). Concern about SH may be limiting the use of sacubitril/valsartan in appropriate patients. We characterized patients by the occurrence of SH (investigator-reported) after randomization to either sacubitril/valsartan or valsartan. A key trial inclusion criterion was systolic blood pressure (SBP) ≥ 100 mmHg for the preceding 6 hours and no SH. We also compared outcomes based on baseline SBP stratified by the median blood pressure. The primary endpoint was time-averaged proportional change in NT-proBNP levels from baseline through weeks 4 and 8. A secondary hierarchical outcome (win ratio) consisted of: (1) cardiovascular death; (2) hospitalizations due to HF; (3) urgent HF visits; and (4) change in NT-proBNP levels. Among 466 randomized patients, 92 (19.7%) experienced SH (sacubitril/valsartan, n = 56 [24.0%]; valsartan, n = 36 [15.5%]; P = 0.020). The median time to the first SH event was similar between treatment arms (18 days vs 15 days, respectively; P = 0.42) as was the proportion of first SH events classified as serious by investigators. Patients who experienced SH with sacubitril/valsartan were more likely to be white (OR 1.87 [95% CI: 0.31, 11.15]), to have a lower baseline SBP (per 10 mmHg increase, OR 0.68 [95% CI: 0.55, 0.85]), or to have a left ventricular ejection fraction (LVEF) of > 60% (OR 2.21 [95% CI: 1.05, 4.65]). Time-averaged change in NT-proBNP levels did not differ between patients with baseline SBP ≥ 128 mmHg vs SBP < 128 mmHg (interaction, P = 0.43). The composite hierarchical outcome for sacubitril/valsartan in patients with baseline SBP ≥ 128 mmHg had a win ratio of 1.34 ([95% CI: 0.91, 1.99]; P = 0.096) vs SBP < 128 mmHg with a win ratio of 1.09 ([95%CI: 0.73, 1.66]; P = 0.62; interaction P value = 0.42). Among patients with LVEF > 40% stabilized after WHF, incident SH was more common with sacubitril/valsartan compared with valsartan. SH was associated with lower baseline SBP, being white, and having higher LVEF. Treatment benefits with sacubitril/valsartan may be more pronounced in patients with higher baseline SBP and lower LVEF (≤ 60%). (Funded by Novartis Pharmaceutical Corporation; ClinicalTrials.gov number, NCT03988634.) [ABSTRACT FROM AUTHOR]

Potentially Traumatic Events (PTEs) are common in current society, including college life. When exposed to PTE, stress reactions are greatly heterogeneous, and what contributes to psychological resilience is not well known. The purpose of the present study is to investigate the relationships among the antecedents, defining attributes, and consequences of resilience in a sample of 450 college students. Students completed an online questionnaire about PTEs, ego-resiliency, emotion regulation strategies and flexibility, perceived social support, mental health outcomes, and Sense of Coherence (SOC). The majority were young (average age = 20.4 years), White/Caucasian (80.0 %), and single (98.0 %) females (79.3 %). First, the bivariate correlation analyses indicated PTEs and emotion regulation suppression were negatively associated with some but not all variables at a significant level. Second, simple linear regression indicated the number of PTEs significantly predicted negative mental health outcomes (β = −2.98, t = −0.63, p <.001) and SOC (β = −2.05, t = −5.69, p <.001). Third, multiple regression analysis revealed that social support significantly moderated the relationship between PTEs and mental health outcomes, F (14, 382) = 14.13, p <.001. More specifically, perceived affectionate social support moderated the relationship between PTEs and mental health outcomes among women. Nurses may deliver interventions to promote these resilience factors, such as social support, and the results suggest that young women may benefit more from perceived affectionate social support after being exposed to PTEs. Further studies, ideally with a longitudinal design, are needed to understand resilience in this population more deeply. • The more exposed to potentially traumatic events (PTEs), the worse the mental health outcomes and Sense of Coherence • However, the effect of PTEs on mental health outcomes was weaker among college students with strong social support • Women with stronger affectionate social support were more resilient with better mental health despite exposure to PTEs [ABSTRACT FROM AUTHOR]

Intracranial haemorrhage and traumatic brain injury are entities commonly encountered by the Coroner's autopsy pathologist. Whilst some of these cases are straightforward, others are not, and these present challenges in the post-mortem room that require careful consideration and, at times, prompt decision making. Some of the questions a pathologist should ask themselves when considering the post-mortem are: are these external injuries suspicious, and should I be involving a forensic pathologist; is the pathology natural or unnatural; should I cut the brain fresh or fix, retain and refer the whole brain for neuropathology input? This review aims to serve as a practical guideline for approaching adult cases of intracranial haemorrhage and traumatic brain injury; pathologies that are encountered frequently but that can entrap the unwary. We consider the factors that should be considered before, during and after the autopsy, and the medicolegal factors of relevance in these cases. [ABSTRACT FROM AUTHOR]

In the absence of left-sided cardiac/pulmonary disease, functional tricuspid regurgitation (FTR) is referred to as isolated or idiopathic. Relationships between left ventricular diastolic dysfunction (DD) and FTR remain unknown. The purpose of this study was to investigate the prevalence, incidence, and outcome of DD in patients with idiopathic FTR. Adults without structural heart disease were identified. Severe DD was defined by ≥3 of 4 abnormal DD parameters (medial e′, medial E/e′, TR velocity, left atrial volume index) and ≥ moderate DD by ≥2. Propensity-score matching was performed (3:1) between each less-than-severe TR group and severe TR based on age, sex, body mass index, and comorbidities. Among 30,428 patients, FTR was absent in 73%, mild in 22%, moderate in 4%, and severe in 0.4%. In the propensity-matched sample, severe DD was present in 2%, 6%, 9%, and 13% patients, and ≥ moderate DD in 11%, 18%, 28%, and 48%, respectively (P < 0.001). The probability of heart failure with preserved ejection fraction using the H 2 FPEF score increased with increasing FTR (median 29.7%, 45.5%, 61.4%, and 88.7%, respectively), as did the prevalence of impaired left atrial strain <24% (35%, 48%, and 69% in mild, moderate, and severe TR). Incident severe and ≥ moderate DD developed more frequently with increasing FTR (HR: 8.45 [95% CI: 2.60-27.50] and HR: 2.82 [95% CI: 1.40-5.69], respectively for ≥ moderate vs no FTR) over a median of 3.0 years. Findings were confirmed in patients without lung disease or right ventricular enlargement. Over a median of 5.0 years, patients with ≥ moderate FTR and DD had the greatest risk of worse outcomes (multivariable P < 0.001). The association between TR and adverse outcomes was significantly diminished in the absence of DD. Diastolic dysfunction, increased heart failure with preserved ejection fraction probability, and impaired left atrial strain are commonly present in patients with idiopathic FTR, suggesting that the latter may not be truly isolated. Patients with FTR without DD or heart failure are at increased risk of incident DD. Patients with FTR and DD display worse outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Cardiac arrest (CA) remains a major cause of death despite advancements in cardiopulmonary resuscitation (CPR), post-resuscitation care, and international efforts to develop evidence-based guidelines. Effectively managing ventilation and oxygenation during and after CPR is vital for patient survival and neurological outcomes, yet it remains a challenging task. This review examines current strategies for ventilation and oxygenation during and after CPR, focusing on evidence-based guidelines, the balance between ventilation effectiveness and risks, and proposed methods for monitoring ventilation quality. It emphasizes the need to provide adequate ventilation and oxygenation during and after CPR while avoiding hyperventilation and hypoventilation, which can negatively impact resuscitation and post-CA outcomes. The review also explores mechanical ventilation as an alternative to manual methods and the use of feedback devices. The impact of post-CA ventilation and oxygenation on patient outcomes and recommended management strategies are discussed. Finally, the review highlights current gaps in the literature and the need for more well-designed large clinical studies, such as the impact of different ventilation variables (tidal volume and breathing frequency) on the return of spontaneous circulation and long-term outcomes. [ABSTRACT FROM AUTHOR]

[Display omitted] Responder analyses of SINUS phase 3 study data have shown clinically meaningful improvements across multiple outcomes of treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) with dupilumab. Our aim was to gain a better understanding of dynamics of the response to dupilumab over 52 weeks. We used data from the SINUS-52 (ClinicalTrials.gov identifier NCT02898454) intention-to-treat population to perform a post hoc analysis of patients with severe CRSwNP who had received dupilumab, 300 mg once every 2 weeks, or placebo. Response, which was defined as an improvement from baseline of at least 1 point in Nasal Polyp Score (NPS), nasal congestion (NC) score, and loss of smell (LoS) score, as well as an improvement of at least 8.9 points on the 22-Item Sino-Nasal Outcome Test (SNOT-22), was assessed for rapidity, maintenance, and durability. The study included 303 patients (150 of whom received dupilumab and 153 of whom received placebo). For each outcome measure, a greater proportion of patients achieved a first response by week 16 (rapidity) with dupilumab versus with placebo; NPS, 75.3% versus 39.2%; NC score, 60.0% versus 24.2%; LoS score, 60.7% versus 15.7%; and SNOT-22 score, 83.3% versus 66.0%, respectively. Of those patients given dupilumab who had a response by week 16, more than 80% maintained their response at week 52 (maintenance). Over 52 weeks, greater proportions of those patients given dupilumab than patients given placebo were responders on at least 80% of time points: NPS, 46.7% versus 2.6%; NC score, 46.7% versus 9.2%; LoS score, 47.3% versus 3.9%; and SNOT-22 score, 62.0% versus 21.6%, respectively (durability). Most patients with CRSwNP achieve clinically meaningful responses to dupilumab by week 16, and most such patients in our study had maintenance and durability of response with continued treatment over time. [ABSTRACT FROM AUTHOR]

To compare dual task cost (DTC) during gait initiation (GI) between a population of patients with persistent concussion symptoms (PCS) and age-matched healthy participants. Cohort study. University research center. A cohort sample including 15 participants with PCS (43.9±11.7y, 73.3% female) and 23 age-matched healthy participants (42.1 ± 10.3y, 65.2% female) as controls. Participants were tested on a single occasion where they performed 5 trials of single task and 5 trials of dual task GI with 12-camera motion capture and 3 force plates. The dependent variables of interest were the DTC for the center of pressure (COP) displacement and velocity during the anticipatory postural adjustment (APA) phase, the COP-center of mass (COP-COM) separation, and the response accuracy during the auditory cognitive tasks. There were significant group differences with worse DTC for the PCS participants in anterior (A)/posterior (P) displacement (PCS, −37.5±22.1%; Control, −9.7±39.2%; P =.016, d=0.874), APA medial (M)/lateral (L) velocity (PCS, −34.8±28.8%; Control, −17.0±40.21%; P =.041, d=0.866), and the peak COP-COM separation (PCS, −7.3±6.7%; Control, 0.6±6.5%; P =.023, d=1.200). There were no significant group differences in the APA A/P velocity (PCS, −38.8±33.1%; Control, −19.8±43.9%; P =.094), APA M/L displacement (PCS, −34.8±21.8%; Control, −10.6±25.3%; P =.313), or cognitive task performance (PCS, −2.7±10.8%; Control, −0.2±4.3%; P =.321). PCS participants had greater (worse) DTC during both the planning and execution of the task, with large effect sizes (d>0.80). PCS participants also used a posture-second strategy whereby attentional resources were inappropriately allocated to the cognitive task. These deficits may challenge a patient's ability to complete activities of daily living and limit their functional independence. [ABSTRACT FROM AUTHOR]

Copyright of Kiva is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Hereditary optic neuropathies comprise a group of clinically and genetically heterogeneous disorders. Optic neuropathy has been previously reported in families with spastic paraplegia type 7 (SPG7) gene mutations. However, the typical time course and clinical presentation of SPG7 -associated optic neuropathy is poorly understood. We report a series of 5 patients harboring pathogenic SPG7 mutations who originally presented to a neuro-ophthalmology clinic with symptoms of optic neuropathy. Methods: Retrospective case series of 5 patients with pathogenic SPG7 mutations and optic atrophy from 3 neuro-ophthalmology clinics. Demographic, clinical, diagnostic, and treatment data were collected and reported by the clinician authors. Results: Five patients ranging in age from 8 to 48 years were evaluated in the neuro-ophthalmology clinic. Although there were variable clinical presentations for each subject, all noted progressive vision loss, typically bilateral, and several also had previous diagnoses of peripheral neuropathy (e.g., Guillain-Barré Syndrome). Patients underwent neuro-ophthalmic examinations and testing with visual fields and optic coherence tomography of the retinal nerve fiber layer. Genetic testing revealed pathogenic variants in the SPG7 gene. Conclusions: Five patients presented to the neuro-ophthalmology clinic with progressive vision loss and were diagnosed with optic atrophy. Although each patient harbored an SPG7 mutation, this cohort was phenotypically and genotypically heterogeneous. Three patients carried the Ala510Val variant. The patients demonstrated varying degrees of visual acuity and visual field loss, although evaluations were completed during different stages of disease progression. Four patients had a previous diagnosis of peripheral neuropathy. This raises the prospect that a single pathogenic variant of SPG7 may be associated with peripheral neuropathy in addition to optic neuropathy. These results support the consideration of SPG7 testing in patients with high suspicion for genetic optic neuropathy, as manifested by symmetric papillomacular bundle damage without clear etiology on initial workup. Applied judiciously, genetic testing, including for SPG7 , may help clarify the cause of unexplained progressive optic neuropathies. [ABSTRACT FROM AUTHOR]

Introduction: This article explores the potential challenges in implementing a national-level standardized curriculum for physician associate (PA) programs in India, an initiative under the directions of the National Commission for Allied and Healthcare Professionals Act of 2021. Methods: Initiated in August 2023, a multistage process began with emailing a draft curriculum for review to key stakeholders, followed by a virtual meeting on September 3. Key stakeholders, including faculty from various universities, participated in focus group discussions (FGDs) at the International Association of Physician Associate Educators and the Indian Association of Physician Assistants annual conference on September 21, 2023, in Gandhinagar. Results: Four major themes emerged: (1) faculty development, (2) faculty recruitment, (3) alignment with the National Educational Policy, and (4) the necessity of master's degree programs for PAs. Challenges identified included shortage of qualified faculty, uncompetitive salaries for academic roles, and low enrollment in master's programs. Recommendations included increasing financial compensation for teaching PAs, developing more PA educators through additional master's programs, encouraging hospitals to mandate clinical and teaching roles for recruits, and introducing pedagogical training for PAs interested in teaching. Discussion: Implementing a standardized curriculum for PAs faces significant challenges, especially in faculty recruitment and retention. Engaging a broader range of stakeholders is essential for the successful rollout of the curriculum and for meeting India's evolving health care needs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pediatric high blood pressure (BP) predicts future cardiovascular disease events. High BP is improperly measured, underrecognized, and undermanaged especially in disadvantaged populations. In a large, diverse, academic pediatric practice, we detail the associations of a comprehensive initiative with high BP provider recognition. METHODS: A comprehensive BP initiative was promulgated including (1) retraining providers and staff on BP management; (2) deploying equipment at 55+ sites; and (3) electronic decision support tool alerting staff and clinicians and suggesting management. During the 14-month preintervention and 14-month postintervention periods, data on BP and patient characteristics were collected. The outcome was incident BP recognition defined as any of the following: BP-specific International Classification of Diseases, Tenth Revision , diagnosis; problem list entry; specialty referral; diagnostic testing; repeat visit; or antihypertensives. Dichotomized as under versus at or over 13 years of age, analyses utilized interrupted time series and multivariable-adjusted logistic regression. RESULTS: From preintervention (children, n=105 674; adolescents, n=54 365) to postintervention (children, n=87 917; adolescents, n=56 470), the proportion measured with high BP declined in children and adolescents (30% versus 14% and 30% versus 15%, respectively, each P <0.001). Post-intervention, high BP provider recognition was 58% higher in children (4.6%–7.3%) and 43% higher in adolescents (7.9% versus 11.3%; P <0.001 for both). The improvement was not different in disadvantaged race, ethnicity, or zip codes. CONCLUSIONS: A comprehensive BP initiative was associated with more appropriate high BP measurement and recognition including in disadvantaged populations. Future work may address the low overall and nonsustained recognition and consideration of electronic decision support for pediatric BP management and mitigating disparities. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Key Takeaways: The Pure Water Antelope Valley (AV) program, the first inland potable reuse program in California, aims to augment water supplies to overcome current and projected reductions. Pure Water AV will use groundwater recharge via subsurface injection to increase the reliability and resilience of Antelope Valley's water supply. A collaboration between the Palmdale Water District, City of Palmdale, and Los Angeles County Sanitation Districts, the program will improve the groundwater quality over time. Besides overcoming technical challenges, Pure Water AV's success depends on well‐thought‐out strategies for funding and public outreach. [ABSTRACT FROM AUTHOR]

Residual tumor is not always clinically apparent following biopsy of cutaneous carcinomas, which may prompt patients to question the need for definitive treatment. We investigated the percentage of cases in which residual tumor was histologically present at the time of Mohs micrographic surgery (MMS) for basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) and investigated factors associated with residual tumor. We examined 483 MMS cases performed for biopsy-proven BCC (n = 287) and SCC (n = 196) between October 2022 and April 2023. Single-stage MMS specimens were step-sectioned en face to exhaust the block. Univariate and multivariable logistic regression models were created. Residual tumor was identified in 83.3% of BCC and 66.8% of SCC at the time of MMS (P =.01). In patients clinically appearing tumor-free following biopsy, residual histologic tumor was identified in 68.2% of BCC and 41.5% of SCC. Residual tumor was significantly more likely in men (P =.04), high-risk sites (P =.002), smaller biopsy sizes (P =.0003), and larger preoperative sizes (P <.0001). Single center, retrospective cohort. The majority of patients with BCC and SCC have residual histologic tumor at the time of MMS, oftentimes even when tumor is not clinically apparent. Multiple factors impact the presence/absence of residual tumor. [ABSTRACT FROM AUTHOR]

Despite the poor prognosis associated with missed or delayed spontaneous bacterial peritonitis (SBP) diagnosis, <15% get timely paracentesis, which persists despite guidelines/education in the United States. Measures to exclude SBP non-invasively where timely paracentesis cannot be performed could streamline this burden. Using Veterans Health Administration Corporate Data Warehouse (VHA-CDW) we included patients with cirrhosis between 2009 and 2019 who underwent timely paracentesis and collected relevant clinical information (demographics, cirrhosis severity, medications, vitals, and comorbidities). XGBoost-models were trained on 75% of the primary cohort, with 25% reserved for testing. The final model was further validated in 2 cohorts: Validation cohort #1: In VHA-CDW, those without prior SBP who received 2nd early paracentesis, and Validation cohort #2: Prospective data from 276 non-electively admitted University hospital patients. Negative predictive values (NPVs) at 5%,10%, and 15% probability cutoffs were examined. Primary cohort: n = 9643 (mean age, 63.1 ± 8.7 years; 97.2% men; SBP, 15.0%) received first early paracentesis. Testing-set NPVs for SBP were 96.5%, 93.0%, and 91.6% at the 5%, 10%, and 15% probability thresholds, respectively. In Validation cohort #1: n = 2844 (mean age, 63.14 ± 8.37 years; 97.1% male; SBP, 9.7%) with NPVs were 98.8%, 95.3%, and 94.5%. In Validation cohort #2: n = 276 (mean age, 56.08 ± 9.09; 59.6% male; SBP, 7.6%) with NPVs were 100%, 98.9%, and 98.0% The final machine learning model showed the greatest net benefit on decision-curve analyses. A machine learning model generated using routinely collected variables excluded SBP with high NPV. Applying this model could ease the need to provide paracentesis in resource-limited settings by excluding those unlikely to have SBP. [ABSTRACT FROM AUTHOR]

To report the 24-month outcomes and subgroup analysis evaluating the safety and effectiveness of the genicular artery embolization (GAE) for the treatment of symptomatic knee osteoarthritis (OA). Forty participants with symptomatic moderate-to-severe knee OA from a single-center, single-arm, prospective investigational device exemption trial of GAE were included in this study. Abnormal genicular artery neovascularity was identified at the subject's focal knee pain with digital subtraction angiography and cone-beam computed tomography (CT). Embolization was performed with 100-μm microspheres. The primary end point was treatment effectiveness as measured by sustained improvement in OA symptoms at 24 months, quantified using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Treatment success was defined as ≥50% decrease in WOMAC relative to baseline. Clinical outcomes were assessed with mean age of 66.0 years (SD ± 8.1) and body mass index of 30.1 kg/m2 (SD ± 6.2). Of the 40 patients, 2 (5.0%) were lost to follow-up. Overall, 18 of 38 (47.4%) patients demonstrated ≥50% reduction in WOMAC at 24 months. In the subset of patients with initial clinical success at 12 months, 18 of 25 (72.0%) reported sustained clinical success at 24 months. Seven of 25 (28.0%) patients had symptom recurrence between 12 and 24 months and were determined to be clinical failures. All treatment-related adverse events occurred within 12 months after GAE, without additional events after 12 months. GAE is effective in achieving sustained symptom relief related to moderate-to-severe knee OA for up to 24 months with an acceptable safety profile. [Display omitted] [ABSTRACT FROM AUTHOR]

This article explores two proposed instances of patristic prosopological exegesis in Ps 24: the identification of the King of glory with the resurrected and ascending Jesus, and the antiphonal speakers of vv. 7–10 with angelic guards at the gates of heaven. Far from being arbitrary connections, notable textual ambiguities and typological elements accessible to ancient authors ground the identifications in the psalm text. These examples of patristic exegesis fit generally within the research of Matthew Bates, but they provide a basis for slightly modifying his proposed definition of prosopological exegesis. [ABSTRACT FROM AUTHOR]

This American Gastroenterological Association (AGA) living guideline is intended to support practitioners in the pharmacological management of moderate-to-severe ulcerative colitis (UC). A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to prioritize clinical questions, identify patient-centered outcomes, conduct an evidence synthesis, and develop recommendations on the pharmacological management of moderate-to-severe UC. The AGA guideline panel made 14 recommendations. In adult outpatients with moderate-to-severe UC, the AGA recommends the use of infliximab, golimumab, vedolizumab, tofacitinib, upadacitinib, ustekinumab, ozanimod, etrasimod, risankizumab, and guselkumab, and suggests the use of adalimumab, filgotinib, and mirikizumab over no treatment. In patients who are naïve to advanced therapies, the AGA suggests using a higher-efficacy medication (eg, infliximab, vedolizumab, ozanimod, etrasimod, upadacitinib, risankizumab, and guselkumab) or an intermediate-efficacy medication (eg, golimumab, ustekinumab, tofacitinib, filgotinib, and mirikizumab) rather than a lower-efficacy medication (eg, adalimumab). In patients who have previously been exposed to 1 or more advanced therapies, particularly tumor necrosis factor (TNF)-α antagonists, the AGA suggests using a higher-efficacy medication (eg, tofacitinib, upadacitinib, and ustekinumab) or an intermediate-efficacy medication (eg, filgotinib, mirikizumab, risankizumab, and guselkumab) rather than a lower-efficacy medication (eg, adalimumab, vedolizumab, ozanimod, and etrasimod). In adult outpatients with moderate-to-severe UC, the AGA suggests against using thiopurine monotherapy for induction of remission, but suggests using thiopurine monotherapy over no treatment for maintenance of (typically corticosteroid-induced) remission. The AGA suggests against using methotrexate monotherapy, for induction or maintenance of remission. In adult outpatients with moderate-to-severe UC, the AGA suggests the use of infliximab, adalimumab, and golimumab in combination with an immunomodulator over corresponding monotherapy. However, the AGA makes no recommendation in favor of, or against, the use of non-TNF antagonist biologics in combination with an immunomodulator over non-TNF biologic alone. In patients with UC who are in corticosteroid-free clinical remission for at least 6 months on combination therapy of TNF antagonists and an immunomodulator, the AGA suggests against withdrawal of TNF antagonists, but makes no recommendation in favor of, or against, withdrawing immunomodulators. In adult outpatients with moderate-to-severe UC, who have failed 5-aminosalicylates, and have escalated to therapy with immunomodulators or advanced therapies, the AGA suggests stopping 5-aminosalicylates. Finally, in adult outpatients with moderate-severe UC, the AGA suggests early use of advanced therapies and/or immunomodulator therapy, rather than gradual step-up after failure of 5-aminosalicylates. The panel also proposed key implementation considerations for optimal use of these medications and identified several knowledge gaps and areas for future research. This guideline provides a comprehensive, patient-centered approach to the pharmacological management of patients with moderate-to-severe UC. [ABSTRACT FROM AUTHOR]

We performed an updated systematic review and network meta-analysis to inform the 2024 American Gastroenterological Association (AGA) Clinical Guidelines on the management of moderate-to-severe ulcerative colitis (UC). We searched multiple electronic databases through November 21, 2023, to identify randomized controlled trials in adults with moderate-to-severe UC, comparing different advanced therapies (tumor necrosis factor antagonists, vedolizumab, sphingosine-1-phosphate receptor modulators, interleukin 12/23 or selective interleukin 23 antagonists, and Janus kinase [JAK] inhibitors) against placebo or another active comparator. Our primary outcomes were induction and maintenance of clinical remission, and our secondary outcome was endoscopic improvement. We performed a network meta-analysis using a frequentist approach and applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to appraise certainty of evidence. After excluding JAK inhibitors as potential first-line treatment (in accordance with the United States Food and Drug Administration), low-certainty evidence supports clinically important benefit with infliximab, ozanimod, risankizumab, and guselkumab over adalimumab and mirikizumab for achieving remission with induction therapy in biologically naïve patients with moderate-to-severe UC, with risankizumab and ozanimod being ranked the highest for induction of clinical remission. With the inclusion of JAK inhibitors as first-line therapy, upadacitinib was more efficacious compared with all other medications except ozanimod and risankizumab, with low- to moderate-certainty evidence. In patients with prior biologic exposure, upadacitinib, tofacitinib, and ustekinumab were ranked highest for achieving remission. Using Grading of Recommendations, Assessment, Development and Evaluation to appraise quality of evidence, this updated network meta-analysis will be used to inform comparative efficacy and positioning of advanced therapies for the treatment of biologic-naïve and biologic-exposed patients with moderate-to-severe UC. [ABSTRACT FROM AUTHOR]

Present in all eukaryotic cells, the integrated stress response (ISR) is a highly coordinated signaling network that controls cellular behavior, metabolism, and survival in response to diverse stresses. The ISR is initiated when any 1 of 4 stress-sensing kinases (protein kinase R-like endoplasmic reticulum kinase [PERK], general control non-derepressible 2 [GCN2], double-stranded RNA-dependent protein kinase [PKR], heme-regulated eukaryotic translation initiation factor 2α kinase [HRI]) becomes activated to phosphorylate the protein translation initiation factor eukaryotic translation initiation factor 2α (eIF2α), shifting gene expression toward a comprehensive rewiring of cellular machinery to promote adaptation. Although the ISR has been shown to play an important role in the homeostasis of multiple tissues, evidence suggests that it is particularly crucial for the development and ongoing health of the pancreas. Among the most synthetically dynamic tissues in the body, the exocrine and endocrine pancreas relies heavily on the ISR to rapidly adjust cell function to meet the metabolic demands of the organism. The hardwiring of the ISR into normal pancreatic functions and adaptation to stress may explain why it is a commonly used pro-oncogenic and therapy-resistance mechanism in pancreatic ductal adenocarcinoma and pancreatic neuroendocrine tumors. Here, we review what is known about the key roles that the ISR plays in the development, homeostasis, and neoplasia of the pancreas. [ABSTRACT FROM AUTHOR]

Prehabilitation programs have been shown to improve functional status prior to surgery, postoperative recovery, and even long-term outcomes. However, these programs often lack participation, often by patients who seem to need it the most. This study aimed to identify the primary reasons for patients' declining enrollment or low adherence to a prehabilitation program. We recruited adult patients who had undergone or planned to undergo major abdominal surgery for semistructured one-on-one audio-recorded interviews. Interviews were transcribed verbatim and iteratively coded deductively and inductively. Thematic analysis was performed. We interviewed 11 patients, at which point we reached thematic saturation. The patients were on average 53 years old (range 38–75) and 27% were women and 73% were men. The pooled kappa score was 0.81, indicating concordance among the coding researchers. Seven potential barriers to prehabilitation participation and adherence were identified: poorly timed recruitment efforts, misconceptions about prehabilitation diet recommendations, competing priorities that made prehabilitation less feasible, lack of family alignment, belief that prehabilitation would not be helpful, concerns over specific prehabilitation program components, and belief that prehabilitation is helpful for others but not for themselves. Low participation and adherence limit the success and reach of many prehabilitation programs. Improved timing and content of communication by the prehabilitation team is critical for improving recruitment of patients. Flexibility and customization may reframe prehabilitation as feasible rather than a difficult chore, increasing participation and adherence. Understanding patients' concerns and readiness to adopt new health behaviors is a necessary component of any behavioral intervention. [ABSTRACT FROM AUTHOR]

Parathyroidectomy has been shown to be superior to medical management in treating hypercalcemia and preserving renal allograft function in patients with tertiary hyperparathyroidism after kidney transplant. Despite this evidence, parathyroidectomy remains underused. We aimed to evaluate outcomes in patients with tertiary hyperparathyroidism after kidney transplant based on management strategy (cinacalcet or parathyroidectomy) and optimal timing of parathyroidectomy. Data from TriNetX Dataworks included adult kidney transplant patients diagnosed with tertiary hyperparathyroidism between 1998 and 2021. Patients who underwent parathyroidectomy were compared with those receiving cinacalcet. Subgroups based on parathyroidectomy timing after transplant were analyzed (within 6 months, 6 months to 1 year, and between 1 and 3 years). Descriptive statistics and relative risks were calculated using TriNetX Live. Patients receiving cinacalcet (n = 162) had a 77% higher risk of persistent hypercalcemia and a 73% higher risk of elevated parathyroid hormone levels than those who underwent parathyroidectomy (n = 338) within 3–10 years after the index event (start of cinacalcet or surgery). Parathyroidectomy performed 1 year after transplant (n = 132) was associated with a 57% lower risk of kidney stone formation and patients were 2 times more likely to maintain normal glomerular filtration rate than parathyroidectomy performed 1–3 years after transplant (n = 57). Even earlier parathyroidectomy (within 6 months of kidney transplant, n = 55) showed a 62% lower risk of persistent hypercalcemia, hyperphosphatemia, and kidney stone formation than surgery between 6 months and 1 year after transplant (n = 77). Parathyroidectomy is more effective than cinacalcet in managing tertiary hyperparathyroidism after kidney transplant. In addition, opting for early parathyroidectomy (within 6 months after transplant) could enhance long-term outcomes. [ABSTRACT FROM AUTHOR]

Clear cell odontogenic carcinoma (CCOC) is a rare malignancy of the jaw, presenting significant diagnostic challenges. This report aims to highlight the complexities associated with biopsy-based diagnoses of oral and maxillofacial lesions, as demonstrated in a case of intraosseous mandibular CCOC initially suggestive of Ewing's sarcoma due to its presentation with small round blue cells. The patient, a 37-year-old male, presented with a mandibular lesion that on incisional biopsy was suggestive of Ewing's sarcoma. Subsequent, comprehensive histologic evaluation after definitive resection via mandibulectomy revealed a CCOC, characterized by a biphasic pattern of clear and basaloid cells. Histological examination confirmed the presence of glycogen-rich clear cells, supported by periodic acid-Schiff (PAS) staining and confirmed by PAS diastase staining, which demonstrated glycogen digestion. Immunohistochemistry was positive for AE1/AE3, p40, and p63, while negative for c-kit and CD34, confirming CCOC and excluding other malignancies such as Ewing's sarcoma, which would have been treated with neoadjuvant chemotherapy instead of primary surgical treatment as in CCOC. This case highlights the essential need for thorough histopathological evaluation and the value of a second opinion via additional histologic consultation, particularly due to the diagnostic challenges of heterogeneous lesions in the oral and maxillofacial region. [ABSTRACT FROM AUTHOR]

The article discusses the use of essential oil isolates to enhance the effectiveness of insecticide-treated nets against pyrethroid-resistant mosquitoes. The study focuses on the Aedes aegypti mosquito, which transmits multiple viruses. Certain essential oil isolates, delivered as vapors, were found to increase the efficacy of the nets. Another text analyzes the genetic sequences of the mosquito species Culex gelidus, a vector for infectious diseases. The study compares specimens from India with sequences from other regions, providing insights into the species' genetic relatedness and potential for spreading to new areas. Lastly, a document provides technical details for a PCR process, including temperature and time intervals, for sequencing amplicons. [Extracted from the article]