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Purpose: Smartphones are the most frequently used digital devices globally with ~6.80 billion users. Despite the ubiquitous use of smartphones, limited information is known on the preferred viewing distance and font size of smartphone users. This study investigated viewing distance, font size and symptoms of eyestrain in non‐presbyopic and presbyopic smartphone users. Methods: In this quantitative research study, viewing distance and font size were measured in a group of non‐presbyopes (n = 107) and presbyopes (n = 53), whilst participants viewed a text message and a web page on their own smartphone. Subjects also responded to a verbal questionnaire related to the characteristics of their smartphone and the computer vision syndrome questionnaire to assess symptoms of eyestrain. Data were analysed using descriptive and inferential statistics. Results: For the total sample, the mean viewing distance for a text message was 37.13 ± 8.82 cm (median 36.00 cm), and for a web page was 36.11 ± 7.98 cm (median 36.00 cm). Presbyopes had longer median viewing distances compared with non‐presbyopes for a text message (41 cm vs. 34 cm, p < 0.001) and web page (40 cm vs. 34 cm, p < 0.001). The font size for non‐presbyopes were <1.0 M whilst for presbyopes were >1.2 M. More than twice the percentage of non‐presbyopes were classified with digital eyestrain (DES) compared with presbyopes. Conclusions: Non‐presbyopes used shorter viewing distances, smaller font sizes and were more predisposed to DES than presbyopes. The viewing distances adopted by presbyopes were similar to the conventional near‐working distance of 40 cm. Eye care practitioners should consider viewing distances when assessing near‐visual functions and prescribing a near refractive correction, particularly in non‐presbyopes. There should be greater awareness of the importance of adopting appropriate viewing distances when using smartphones. [ABSTRACT FROM AUTHOR]

Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation‐based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision‐making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single‐center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care. [ABSTRACT FROM AUTHOR]

Background: Transcranial temporal interference stimulation (tTIS) is a new, emerging neurostimulation technology that utilizes two or more electric fields at specific frequencies to modulate the oscillations of neurons at a desired spatial location in the brain. The physics of tTIS offers the advantage of modulating deep brain structures in a non-invasive fashion and with minimal stimulation of the overlying cortex outside of a selected target. As such, tTIS can be effectively employed in the context of therapeutics for the psychiatric disease of disrupted brain connectivity, such as major depressive disorder (MDD). The subgenual anterior cingulate cortex (sgACC), a key brain center that regulates human emotions and influences negative emotional states, is a plausible target for tTIS in MDD based on reports of its successful neuromodulation with invasive deep brain stimulation. Methods: This pilot, single-site, double-blind, randomized, sham-controlled interventional clinical trial will be conducted at St. Michael’s Hospital – Unity Health Toronto in Toronto, ON, Canada. The primary objective is to demonstrate target engagement of the sgACC with 130 Hz tTIS using resting-state magnetic resonance imaging (MRI) techniques. The secondary objective is to estimate the therapeutic potential of tTIS for MDD by evaluating the change in clinical characteristics of participants and electrophysiological outcomes and providing feasibility and tolerability estimates for a large-scale efficacy trial. Thirty participants (18–65 years) with unipolar, non-psychotic MDD will be recruited and randomized to receive 10 sessions of 130 Hz tTIS or sham stimulation (n = 15 per arm). The trial includes a pre- vs. post-treatment 3T MRI scan of the brain, clinical evaluation, and electroencephalography (EEG) acquisition at rest and during the auditory mismatch negativity (MMN) paradigm. Discussion: This study is one of the first-ever clinical trials among patients with psychiatric disorders examining the therapeutic potential of repetitive tTIS and its neurobiological mechanisms. Data obtained from this trial will be used to optimize the tTIS approach and design a large-scale efficacy trial. Research in this area has the potential to provide a novel treatment option for individuals with MDD and circuitry-related disorders and may contribute to the process of obtaining regulatory approval for therapeutic applications of tTIS. [ABSTRACT FROM AUTHOR]

Following Inoue et al., we define a word to be a repetition if it is a (fractional) power of exponent at least 2. A word has a repetition factorization if it is the product of repetitions. We study repetition factorizations in several (generalized) automatic sequences, including the infinite Fibonacci word, the Thue-Morse word, paperfolding words, and the Rudin-Shapiro sequence. [ABSTRACT FROM AUTHOR]

Background: Palforzia® enables the safe and effective desensitisation of children with peanut allergy. The treatment pathway requires multiple visits for dose escalation, up‐dosing, monitoring of patients taking maintenance therapy and conversion onto daily real‐world peanut consumption. The demand for peanut immunotherapy outstrips current National Health Service (NHS) capacity and requires services to develop a national consensus on how best to offer Palforzia® in a safe and equitable manner. We undertook a Delphi consensus exercise to determine guidance statements for the implementation of Palforzia®‐based immunotherapy in the NHS. Methods: We undertook focus groups with children and young people who had received peanut immunotherapy to assess what was important for them and their carers. Common themes from patients formed the basis of creating draft statements. A panel of 18 multi‐disciplinary professionals engaged in two rounds of anonymised voting to adapt the statements and score their importance. A final consensus workshop consolidated any variation in comments and scores to develop the final guidance statements. Results: The panel achieved consensus on 91% (29/32) of guidance statements, demonstrating strong consensus around pragmatic principles for assuring the integrity of consent, safety and conversion from Palforzia® to real‐world peanut products. The greatest amount of feedback was generated from three broad issues; (i) whether eligibility assessment should include compulsory peanut challenges and whether these should be designed to assess the threshold at which patients react to peanut, (ii) the governance processes to best ensure that patients' interests are prioritised and (iii) how to safely transition young people to other services, or discharge them, while they are taking daily peanut. Conclusions: This consensus highlights the urgent need for the NHS to increase capacity for undertaking diagnostic food challenges as well as developing Palforzia® immunotherapy pathways. The voting panel agreed that families of peanut allergic children should be made aware of immunotherapy, that eligibility assessment should include how co‐morbid conditions are managed and that services should monitor for adverse effects. The finalised statements are now published online for clinical practice in the UK. These guidance statements will be adapted in the coming years as more evidence is published and as the international experience of peanut immunotherapy evolves. [ABSTRACT FROM AUTHOR]

Allergen immunotherapy, also called desensitisation, is a strategic process by which the immune system is gradually "trained" to tolerate increasing amounts of an allergen, which it previously would have reacted to. In the UK, it is estimated that approximately 20% of the population suffers with at least one allergic disease. The potential to modify the disease process is no longer out of our reach for certain allergies, with the hope of improved quality of life. Immunotherapy can be offered as a treatment for IgE mediated allergic disease such as allergic rhinoconjunctivitis, immediate type food allergies, bee and wasp anaphylaxis, and can have a synergistic effect on asthma and eczema. However, it would be incorrect to consider this treatment as a panacea, as there remain pitfalls, gaps in equity of treatment, and uncertainty with longer-term efficacy of the newer food desensitisation treatments. This review focuses on our current clinical understanding and indications for immunotherapy for children and young people, delivery and monitoring within the UK, and the future scope of immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Immunosuppression reduction for BK polyoma virus (BKV) must be balanced against risk of adverse alloimmune outcomes. We sought to characterize risk of alloimmune events after BKV within context of HLA‐DR/DQ molecular mismatch (mMM) risk score. Methods: This single‐center study evaluated 460 kidney transplant patients on tacrolimus‐mycophenolate‐prednisone from 2010‐2021. BKV status was classified at 6‐months post‐transplant as "BKV" or "no BKV" in landmark analysis. Primary outcome was T‐cell mediated rejection (TCMR). Secondary outcomes included all‐cause graft failure (ACGF), death‐censored graft failure (DCGF), de novo donor specific antibody (dnDSA), and antibody‐mediated rejection (ABMR). Predictors of outcomes were assessed in Cox proportional hazards models including BKV status and alloimmune risk defined by recipient age and molecular mismatch (RAMM) groups. Results: At 6‐months post‐transplant, 72 patients had BKV and 388 had no BKV. TCMR occurred in 86 recipients, including 27.8% with BKV and 17% with no BKV (p =.05). TCMR risk was increased in recipients with BKV (HR 1.90, (95% CI 1.14, 3.17); p =.01) and high vs. low‐risk RAMM group risk (HR 2.26 (95% CI 1.02, 4.98); p =.02) in multivariable analyses; but not HLA serological MM in sensitivity analysis. Recipients with BKV experienced increased dnDSA in univariable analysis, and there was no association with ABMR, DCGF, or ACGF. Conclusions: Recipients with BKV had increased risk of TCMR independent of induction immunosuppression and conventional alloimmune risk measures. Recipients with high‐risk RAMM experienced increased TCMR risk. Future studies on optimizing immunosuppression for BKV should explore nuanced risk stratification and may consider novel measures of alloimmune risk. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review aims to discuss the unique challenges that adult congenital heart disease (ACHD) patients present in the intensive care unit. Recent Findings: Recent studies suggest that ACHD patients make up an increasing number of ICU admissions, and that their care greatly improves in centers with specialized ACHD care. Common reasons for admission include arrhythmia, hemorrhage, heart failure, and pulmonary disease. Summary: It is critical that the modern intensivist understand not only the congenital anatomy and subsequent repairs an ACHD patient has undergone, but also how that anatomy can predispose the patient to critical illness. Additionally, intensivists should rely on a multidisciplinary team, which includes an ACHD specialist, in the care of these patients. [ABSTRACT FROM AUTHOR]

A 65-year-old male patient presenting with idiopathic, intractable hiccups was to undergo bilateral thoracotomies for phrenic nerve stimulator placement but initially underwent a treatment utilizing the administration of prescriptive positive pressure ventilation as a less invasive treatment option and had successful resolution of hiccups. The patient's hiccups began after a prior hiatal hernia repair and was refractory to pharmacologic treatment and phrenic nerve blocks. Utilizing neuromuscular blockade for diaphragm paralysis and administering three vital capacity breaths to peak inspiratory pressures of 25 cm H2O via endotracheal tube, the patient had successful resolution of symptoms and further surgical intervention was not warranted. [ABSTRACT FROM AUTHOR]

Background: Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. Methods: A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1–3 as inappropriate, 4–6 as uncertain and as 7–9 appropriate). Results: Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. Conclusion: This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines. [ABSTRACT FROM AUTHOR]

Viruses pose major global challenges to crop production as infections reduce the yield and quality of harvested products, hinder germplasm exchange, increase financial inputs, and threaten food security. Small island or archipelago habitat conditions such as those in the Caribbean are particularly susceptible as the region is characterized by high rainfall and uniform, warm temperatures throughout the year. Moreover, Caribbean islands are continuously exposed to disease risks because of their location at the intersection of transcontinental trade between North and South America and their role as central hubs for regional and global agricultural commodity trade. This review provides a summary of virus disease epidemics that originated in the Caribbean and those that were introduced and spread throughout the islands. Epidemic-associated factors that impact disease development are also discussed. Understanding virus disease epidemiology, adoption of new diagnostic technologies, implementation of biosafety protocols, and widespread acceptance of biotechnology solutions to counter the effects of cultivar susceptibility remain important challenges to the region. Effective integrated disease management requires a comprehensive approach that should include upgraded phytosanitary measures and continuous surveillance with rapid and appropriate responses. [ABSTRACT FROM AUTHOR]

Background: There is variability in recommended viral monitoring protocols after kidney transplant. In response to increased demand for laboratory testing during the COVID‐19 pandemic, the Transplant Manitoba Adult Kidney Program updated its monitoring protocols for cytomegalovirus (CMV), Epstein‐Barr virus (EBV), and BK polyomavirus (BKV) to a reduced frequency. Methods: This single‐center nested case‐control study evaluated 252 adult kidney transplant recipients transplanted from 2015 to 2021, with the updated protocols effective on March 19th 2020. Cases included recipients transplanted after the protocol update who developed CMV, EBV, and BKV DNAemia and were matched to controls with DNAemia transplanted prior to the protocol update. The primary outcome was the difference in maximum DNA load titers between cases and matched controls. Secondary outcomes included time to initial DNAemia detection and DNAemia clearance. Safety outcomes of tissue‐invasive viral disease were described. Results: There were 216 recipients transplanted preupdate and 36 recipients postupdate. There was no difference between cases and controls in maximum or first DNA load titers for EBV, CMV, or BKV. Cases experienced earlier EBV DNAemia detection (26 (IQR 8, 32) vs. 434 (IQR 96, 1184) days, p =.005). Median follow‐up was significantly longer for recipients transplanted preupdate (4.3 vs. 1.3 years, p <.0001). After adjusting for follow‐up time, there was no difference in DNAemia clearance or tissue‐invasive viral disease. Conclusion: Our findings suggest that reduced frequency viral monitoring protocols may be safe and cost‐effective. This quality assurance initiative should be extended to detect longer‐term and tissue‐invasive disease outcomes. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted at the University of KwaZulu-Natal in South Africa, which examined the experiences and attitudes of optometry students towards online learning during the COVID-19 pandemic. The study found that while approximately half of the students were satisfied with online learning, many felt that it could not fully replace practical education in laboratory and clinical settings. Access to technology and digital literacy skills were also identified as important factors for successful online learning. Overall, the study suggests the need for a blended learning approach and supplementary programs to enhance practical and clinical competencies in optometry education. [Extracted from the article]

Background. Knowledge of learning style preferences is important for decisions related to teaching and learning. Even though data on learning style preferences are available in the literature, limited information is available about these preferences in optometry students in South Africa (SA). Objective. To explore the learning style preferences in an undergraduate optometry programme. Methods. The study used a quantitative research design and online questionnaires for data collection. The Index of Learning Styles questionnaire was used to assess learning style preferences. Data were analysed with descriptive and inferential statistics, where p<0.05 was considered statistically significant. Results. Overall, 159 students completed the anonymous questionnaires. Most of the students were black (n=111), <21 years of age (n=83) and in their third year of study (n=53). The majority of students showed a balanced preference (between 47% and 65% for the different learning style dimensions). There was no significant association between demographic characteristics (gender and level of study) and learning style preferences. Conclusion. Optometry students have balanced learning styles. This information can be used by stakeholders responsible for optometry education in SA to better inform curriculum review endeavours and decisions related to teaching and learning. The information would be essential to make the educational environment contextually relevant and conducive to student learning. [ABSTRACT FROM AUTHOR]

Transcranial magnetic stimulation (TMS) is often applied to the motor cortex to stimulate a collection of motor evoked potentials (MEPs) in groups of peripheral muscles. The causal interface between TMS and MEP is the selective activation of neurons in the motor cortex; moving around the TMS ‘spot’ over the motor cortex causes different MEP responses. A question of interest is whether a collection of MEP responses can be used to identify the stimulated locations on the cortex, which could potentially be used to then place the TMS coil to produce chosen sets of MEPs. In this work we leverage our previous report on a 3D convolutional neural network (CNN) architecture that predicted MEPs from the induced electric field, to tackle an inverse imaging task in which we start with the MEPs and estimate the stimulated regions on the motor cortex. We present and evaluate five different inverse imaging CNN architectures, both conventional and generative, in terms of several measures of reconstruction accuracy. We found that one architecture, which we propose as M2M-InvNet, consistently achieved the best performance. [ABSTRACT FROM AUTHOR]

Paediatric vision impairment is a significant public health issue because of the associated health and economic consequences. This study aimed to determine the clinical characteristics and causes of vision impairment in paediatric patients who presented to a university-based low vision eye clinic in KwaZulu-Natal. The study used a retrospective design and included all paediatric patients with vision impairment who were younger than 18 years and presented to the university-based low vision eye clinic between January 2015 and December 2019. The sample consisted of 156 children with vision impairment with a similar proportion of males (n = 82) and females (n = 74). The mean age of the children was 13.5 ± 2.8 years, with a range of 5–17 years. Based on the best-corrected visual acuity (VA), most of the children (n = 111) had moderate vision impairment (VA worse than 6/18 to 6/60). The most common causes of paediatric vision impairment included albinism (n = 54), refractive error (n = 11), cataract (n = 10), and glaucoma (n = 10). The retina (n = 74) and normal globe (n = 26) were the most affected anatomical sites. Spectacles were prescribed to almost half of the sample (n = 76). A total of 126 optical and non-optical devices were recommended with telescopes (n = 43) and sun-protective measures (n = 20) being the most common. Paediatric vision impairment can have a negative impact on the quality of life. Local data related to the characteristics of children with vision impairment can be used to enhance the services provided in this university-based low vision clinic. This is important as efforts aimed at early identification, management, and rehabilitation will help minimise functional limitations and improve the quality of life of affected children. [ABSTRACT FROM AUTHOR]

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

For the first time, we report the whole genome sequence of a hydrocarbonoclastic Chryseobacterium oranimense strain isolated from Trinidad and Tobago (COTT) and its genes involved in the biotransformation of hydrocarbons and xenobiotics through functional annotation. The assembly consisted of 11 contigs with 2,794 predicted protein-coding genes which included a diverse group of gene families involved in aliphatic and polycyclic hydrocarbon degradation. Comparative genomic analyses with 18 crude-oil degrading bacteria in addition to two C. oranimense strains not associated with oil were carried out. The data revealed important differences in terms of annotated genes involved in the hydrocarbon degradation process that may explain the molecular mechanisms of hydrocarbon and xenobiotic biotransformation. Notably, many gene families were expanded to explain COTT's competitive ability to manage habitat-specific stressors. Gene-based evidence of the metabolic potential of COTT supports the application of indigenous microbes for the remediation of polluted terrestrial environments and provides a genomic resource for improving our understanding of how to optimize these characteristics for more effective bioremediation. [ABSTRACT FROM AUTHOR]

Purpose: The internationalization of business has grown the production value chains and created performance challenges for industrial production. Industry 4.0, the digital transformation of industrial processes, promises to deliver performance improvements through smart functionalities. This study investigates how digital transformation translates to performance gain by adopting a systems perspective to drive smartness. Design/methodology/approach: This study uses qualitative research to collect data on the lived experiences of digital transformation practitioners for theory development. It uses semi-structured interviews with industry experts and applies the Gioia methodology for analysis. Findings: The study determined that enterprise smartness is an organizational capability developed by digital transformation, it is a function of integration and the enabler of organizational performance gains in the Industry 4.0 context. The study determined that performance gains are experienced in productivity, sustainability, safety and customer experience, which represents performance metrics for Industry 4.0. Research limitations/implications: This study contributes a model that inserts smartness in the linkage between digital transformation and organizational outcomes to the digital transformation and production management literature. Practical implications: The study indicates that digital transformation programs should focus on developing smartness rather than technology implementations, which must be considered an enabling activity. Originality/value: Existing studies recognized the positive impact of technology on performance in industrial production. The study addresses a missing link in the Industry 4.0 value creation process. It adopts a systems perspective to establish the role of smartness in translating technology use to performance outcomes. Smart capabilities have been the critical missing link in the literature on harnessing digital transformation in organizations. The study advances theory development by contributing an Industry 4.0 value model that establishes a link between digital technologies, smartness and organizational performance. [ABSTRACT FROM AUTHOR]

Societal Impact Statement: The global success and expansion of a small pool of major crops, including rice, wheat and maize, risks homogenising global agriculture. Focusing on the agriculturally diverse Ethiopian Highlands, this study tested whether farm diversity tends to be lower among farmers who grow more introduced crops. Surprisingly, it was found that farmers have successfully integrated introduced crops, resulting in more diverse and heterogenous farms without negatively impacting indigenous crop diversity. This is encouraging because diverse farms, comprising indigenous agricultural systems supplemented by introduced crops, may help address global challenges such as food insecurity. Summary: The global expansion of a handful of major crops risks eroding indigenous crop diversity and homogenising agroecosystems, with significant consequences for sustainable and resilient food systems. Here, we investigate the farm‐scale impact of introduced crops on indigenous agroecosystems.We surveyed 1369 subsistence farms stratified across climate gradients in the Ethiopian Highlands, a hotspot of agrobiodiversity, to characterise the richness and cultivated area of the 83 edible crops they contained. We further categorise these crops as being indigenous to Ethiopia, or introduced across three different eras. We apply non‐metric multidimensional scaling and mixed effects modelling to characterise agroecosystem composition across farms with different proportions of introduced crops.Crops from different periods do not differ significantly in frequency or abundance across farms. Among geographically matched pairs of farms, those with higher proportions of modern introduced crops had significantly higher overall crop richness. Furthermore, farms with a high proportion of modern introduced crops showed higher heterogeneity in crop composition. An analysis of socio‐economic drivers indicated that poverty is negatively associated with the cultivated area of introduced crops.In our Ethiopian case study, global patterns of major crop expansion are not necessarily associated with agrobiodiversity loss at the farm scale or higher homogeneity across indigenous agricultural systems. Importantly, socioeconomic factors may influence farmers' propensity to adopt novel species, suggesting targets for agricultural extension policies. Given the rapid climatic, economic and demographic changes impacting global food systems and the threats to food security these entail, robust indigenous agricultural systems enriched with diverse introduced crops may help maintain resilience. [ABSTRACT FROM AUTHOR]

An ectopic pituitary adenoma (EPA) is an uncommon type of pituitary adenoma, accounting for only 2% of all pituitary adenomas. EPAs are benign tumors that can occur anywhere along the migratory embryonic path of the pituitary gland and have no relationship to intrasellar elements. They are usually hormonally active and have a minor female predominance. The clinical features of EPAs are highly dependent on its hormonal activity, anatomical location, and its local mass effect. Appropriate radiological imaging is essential for the evaluation of EPAs. Imaging investigations show a normal pituitary gland and sellar turcica, provide details on the size of the tumor, its margins, and extent, and help with surgical planning. The criteria for diagnosing an ectopic pituitary adenoma depend on detailed histopathological examination. EPA management should be individualized. We present a case of a 71-year-old male who presented with a 9-month history of left nasal obstruction, purulent nasal discharge, and intermittent anterior epistaxis. The patient was being managed by his general practitioner for chronic rhinosinusitis but failure of his symptoms to resolve prompted a visit to the otorhinolaryngologist. The patient was diagnosed with a null-cell ectopic pituitary adenoma through histological analysis of a biopsy specimen that showed adenohypophyseal cells without cell-type-specific differentiation. The patient subsequently underwent an endoscopic endonasal excision and had an uneventful hospital stay. [ABSTRACT FROM AUTHOR]

South Africa and Ukraine share similar challenges for staff in the healthcare sector. Health care workers in South Africa have borne the brunt of the COVID-19 pandemic whereas in Ukraine health care workers, amidst the war have had to show valour and a tough spirit in caring for their patients under very trying circumstances. Arising from the above tragedies, health care workers have shown incredible bravery both in Ukraine and in South Africa, however they display extreme burn out. In Ukraine, nurses are working in the conflict zone and have to manage complex patient mental and physical health issues. Some have even been subjected to violence from traumatized patients. This article assesses the healthcare situation both in Ukraine and South Africa and provides a descriptive report utilizing The Swanson’s theory of caring. The elements of Swanson’s theory consisting of maintaining belief, knowing, being with, doing for, and enabling can be linked to characteristics such as supporting patients and colleagues, being sensitive, affectionate and empathetic while feeling a sense of responsibility towards the department and patients. The study, based at selected South African public central hospitals in two provinces, adopted a descriptive exploratory paradigm. Qualitative techniques were used to administer an interview schedule to 322 frontline participants. The results revealed that despite high commitment levels, the participants still faced challenges that impact their daily work life. The study conducted in South Africa on Quality of Work life (QWL) experiences of frontline healthcare workers leaves recommendations for the Ukrainian health care sector. [ABSTRACT FROM AUTHOR]

Background: Vertebroplasty has been recently described in the literature as a potential treatment for C2 metastatic lesions. Stentoplasty may represent a safest and equally alternative to the latter. Objective: To describe a novel technique, stentoplasty, as an alternative for the treatment of metastatic involvement of C2 and to assess its efficacy and safety. To systematically evaluate the pertinent literature regarding the clinical outcomes and complications of C2 vertebroplasty in patients with metastatic disease. Methods: A systematic review of C2 vertebroplasty, in the English language medical literature was conducted for the needs of this study. Additionally, a cohort of five patients, presenting with cervical instability (SINS > 6) and/or severe pain (VAS > 6) from metastatic involvement of C2 and treated with stentoplasty in our department is presented. Outcomes evaluated include, pain control, stability, and complications. Results: Our systematic review yielded 8 studies that met the inclusion criteria, incorporating 73 patients that underwent C2 vertebroplasty for metastatic disease. There was a reduction in VAS scores following surgery from 7.6 to 2.1. Eleven patients had complications (15%), 3 (4%) required additional stabilization and decompression, 6 (8.2%) had odynophagia and the incidence of cement leak was 31.5% (23/73). With regard to our cohort, all 5 patients presented with severe neck pain (average VAS 6.2 (2–10)) with or without instability (average SINS 10 (6–14)) and underwent C2 stentoplasty. Mean duration of the procedures was 90 min (61–145) and 2.6 mls (2–3) of cement was injected. Postoperatively VAS improved from 6.2 to 1.6 (P = 0.033). No cement leak or other complications were recorded. Conclusion: A systematic review of the literature demonstrated that C2 vertebroplasty can offer significant pain improvement with a low complication rate. At the same time, this is the first study to describe stentoplasty in a small cohort of patients, as an alternative for the treatment of C2 metastatic lesions in selected cases, offering adequate pain control and improving segmental stability with a high safety profile. [ABSTRACT FROM AUTHOR]

Methods to improve the efficiency of bioremediation of hydrocarbon-contaminated sites involves the assessment of microbial consortia in culture. In the present study, the cooperative capabilities of indigenous bacteria, yeast and fungi, as naturally-occurring consortia isolated from chronically contaminated sites in Trinidad, were screened to determine the most efficient associations that resulted in maximum oil clearance. Thirty naturally-occurring consortia involving both known biosurfactant-producing and non-producing isolates were screened. A total of sixteen combinations of yeast with fungi and bacteria with fungi were found to be the most efficient at crude oil deterioration based on >70% a zone of clearance around the original inoculum site on different media. The study revealed a difference in degradation action of strain-specific combinations which confirmed that the development of microbial consortia is both strain- and site-specific. Those consortia composed of biosurfactant-producing members were the most efficient at crude oil removal. [ABSTRACT FROM AUTHOR]

Background: Opioid use is common and associated with side effects and risks. Consequently, analgesic strategies to reduce opioid utilization have been developed. Regional anesthesia and multimodal strategies are central tenets of enhanced recovery pathways and facilitate reduced perioperative opioid use. Opioid‐free anesthesia (OFA) protocols eliminate all intraoperative opioids, reserving opioids for postoperative rescue treatment. Systematic reviews show variable results for OFA. Methods: In a series of Quality Improvement (QI) projects, multidisciplinary teams developed interventions to test and spread OFA first in our ambulatory surgery center (ASC) and then in our hospital. Outcome measures were tracked using statistical process control charts to increase the adoption of OFA. Results: Between January 1, 2016, and September 30, 2022, 19 872 of 28 574 ASC patients received OFA, increasing from 30% to 98%. Post Anesthesia Care Unit (PACU) maximum pain score, opioid‐rescue rate, and postoperative nausea and vomiting (PONV) treatment all decreased concomitantly. The use of OFA now represents our ambulatory standard practice. Over the same timeframe, the spread of this practice to our hospital led to 21 388 of 64 859 patients undergoing select procedures with OFA, increasing from 15% to 60%. Opioid rescue rate and PONV treatment in PACU decreased while hospital maximum pain scores and length of stay were stable. Two procedural examples with OFA benefits were identified. The use of OFA allowed relaxation of adenotonsillectomy admission criteria, resulting in 52 hospital patient days saved. Transition to OFA for laparoscopic appendectomy occurred concomitantly with a decrease in the mean hospital length of stay from 2.9 to 1.4 days, representing a savings of >500 hospital patient days/year. Conclusions: These QI projects demonstrated that most pediatric ambulatory and select inpatient surgeries are amenable to OFA techniques which may reduce PONV without worsening pain. [ABSTRACT FROM AUTHOR]

The prevalence and intensity of dermo Perkinsus marinus were examined in the eastern oyster Crassostrea virginica "southern oyster" population within the high salinity (35‰ or greater) waters of South Texas' lower Laguna Madre (LLM). During 2017, 192 oysters from four collection sites (approximately 111 km2 study area) were examined via culture for the presence of Perkinsus hypnospores. Additionally, dermo DNA was detected in oysters by PCR. The number of oysters infected (prevalence = 0.36), as well as the intensity of infection, were consistent within three of the four collection sites but varied between sites, suggesting that environmental differences influence P. marinus infection in the LLM. All sites showed an upward trend in the number of oysters infected as oyster size increased, yet the highest infection intensities were not found predominately in the larger oysters. Although the warm, high‐salinity waters might be expected to be ideal for dermo infection, the relative number and intensity of infections were low for most sites, suggesting that dermo in the LLM may not pose a significant threat to commercial oyster culture and that the southern oyster may be uniquely suited for developing a strain of oysters suitable for offshore culture in the Gulf of Mexico. [ABSTRACT FROM AUTHOR]

Background: Repetitive transcranial magnetic stimulation (rTMS) is widely used in both research and clinical settings to modulate human brain function and behavior through the engagement of the mechanisms of plasticity. Based upon experiments using single-pulse TMS as a probe, the physiologic mechanism of these effects is often assumed to be via changes in cortical excitability, with 10 Hz rTMS increasing and 1 Hz rTMS decreasing the excitability of the stimulated region. However, the reliability and reproducibility of these rTMS protocols on cortical excitability across and within individual subjects, particularly in comparison to robust sham stimulation, have not been systematically examined. Objectives: In a cohort of 28 subjects (39 ± 16 years), we report the first comprehensive study to (1) assess the neuromodulatory effects of traditional 1 Hz and 10 Hz rTMS on corticospinal excitability against both a robust sham control, and two other widely used patterned rTMS protocols (intermittent theta burst stimulation, iTBS; and continuous theta burst stimulation, cTBS), and (2) determine the reproducibility of all rTMS protocols across identical repeat sessions. Results: At the group level, neither 1 Hz nor 10 Hz rTMS significantly modulated corticospinal excitability. 1 Hz and 10 Hz rTMS were also not significantly different from sham and both TBS protocols. Reproducibility was poor for all rTMS protocols except for sham. Importantly, none of the real rTMS and TBS protocols demonstrated greater neuromodulatory effects or reproducibility after controlling for potential experimental factors including baseline corticospinal excitability, TMS coil deviation and the number of individual MEP trials. Conclusions: These results call into question the effectiveness and reproducibility of widely used rTMS techniques for modulating corticospinal excitability, and suggest the need for a fundamental rethinking regarding the potential mechanisms by which rTMS affects brain function and behavior in humans. [ABSTRACT FROM AUTHOR]

Paget's Disease of Bone (PDB) is a metabolic bone disease that is characterized by dysregulated osteoclast function leading to focal abnormalities of bone remodeling. It can lead to pain, fracture, and bone deformity. G protein-coupled receptor kinase 3 (GRK3) is an important negative regulator of G protein-coupled receptor (GPCR) signaling. GRK3 is known to regulate GPCR function in osteoblasts and preosteoblasts, but its regulatory function in osteoclasts is not well defined. Here, we report that Grk3 expression increases during osteoclast differentiation in both human and mouse primary cells and established cell lines. We also show that aged mice deficient in Grk3 develop bone lesions similar to those seen in human PDB and other Paget's Disease mouse models. We show that a deficiency in Grk3 expression enhances osteoclastogenesis in vitro and proliferation of hematopoietic osteoclast precursors in vivo but does not affect the osteoclast-mediated bone resorption function or cellular senescence pathway. Notably, we also observe decreased Grk3 expression in peripheral blood mononuclear cells of patients with PDB compared with age- and gender-matched healthy controls. Our data suggest that GRK3 has relevance to the regulation of osteoclast differentiation and that it may have relevance to the pathogenesis of PDB and other metabolic bone diseases associated with osteoclast activation. [ABSTRACT FROM AUTHOR]

Increasing the intensity of tumor treating fields (TTF) within a tumor bed improves clinical efficacy, but reaching sufficiently high field intensities to achieve growth arrest remains challenging due in part to the insulating nature of the cranium. Using MRI-derived finite element models (FEMs) and simulations, we optimized an exhaustive set of intracranial electrode locations to obtain maximum TTF intensities in three clinically challenging high-grade glioma (HGG) cases (i.e., thalamic, left temporal, brainstem). Electric field strengths were converted into therapeutic enhancement ratios (TER) to evaluate the predicted impact of stimulation on tumor growth. Concurrently, conventional transcranial configurations were simulated/optimized for comparison. Optimized intracranial TTF were able to achieve field strengths that have previously been shown capable of inducing complete growth arrest, in 98–100% of the tumor volumes using only 0.54–0.64 A current. The reconceptualization of TTF as a targeted, intracranial therapy has the potential to provide a meaningful survival benefit to patients with HGG and other brain tumors, including those in surgically challenging, deep, or anatomically eloquent locations which may preclude surgical resection. Accordingly, such an approach may ultimately represent a paradigm shift in the use of TTFs for the treatment of brain cancer. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of severe mpox in a newly diagnosed HIV patient concerning for Immune Reconstitution Inflammatory Syndrome (IRIS) and/or tecovirimat resistance and to describe the management approach in the setting of refractory disease. Case: 49-year-old man presented with 2 weeks of perianal lesions. He tested positive for mpox PCR in the emergency room and was discharged home with quarantine instructions. Three weeks later, the patient returned with disseminated firm, nodular lesions in the face, neck, scalp, mouth, chest, back, legs, arms, and rectum, with worsening pain and purulent drainage from the rectum. The patient reported being on 3 days of tecovirimat treatment, which was prescribed by the Florida department of health (DOH). During this admission, he was found to be HIV positive. A pelvic CT scan revealed a 2.5 cm perirectal abscess. Treatment with tecovirimat was continued for 14 days, along with an empiric course of antibiotics for treatment of possible superimposed bacterial infection upon discharge. He was seen in the outpatient clinic and initiated antiretroviral therapy (ART) with TAF/emtricitabine/bictegravir. Two weeks after starting ART, the patient was readmitted for worsening mpox rash and rectal pain. Urine PCR also returned positive for chlamydia, for which the patient was prescribed doxycycline. He was discharged on a second course of tecovirimat and antibiotic therapy. Ten days later, the patient was readmitted for the second time due to worsening symptoms and blockage of the nasal airway from progressing lesions. At this point, there were concerns for tecovirimat resistance, and after discussion with CDC, tecovirimat was reinitiated for the third time, with the addition of Cidofovir and Vaccinia, and showed an improvement in his symptoms. He received three doses of cidofovir and two doses of Vaccinia, and the patient was then discharged to complete 30 days of tecovirimat. Outpatient follow-up showed favorable outcomes and near resolution. Conclusion: We reported a challenging case of worsening mpox after Tecovirimat treatment in the setting of new HIV and ART initiation concerning IRIS vs. Tecovirimat resistance. Clinicians should consider the risk of IRIS and weigh the pros and cons of initiating or delaying ART. In patients not responding to first-line treatment with tecovirimat, resistance testing should be performed, and alternative options should be considered. Future research is needed to establish guidance on the role of Cidofovir and Vaccinia immune globulin and the continuation of tecovirimat for refractory mpox. [ABSTRACT FROM AUTHOR]

The Fibonacci word f = 010010100100101⋯ is one of the most well-studied words in the area of combinatorics on words. It is not periodic, but nevertheless contains many highly periodic factors (contiguous subwords). For example, it contains many cubes (i.e., non-empty words of the form xxx). We study the prefixes of the Fibonacci word that end with a cube. Using the computer prover Walnut, we obtain an exact description of the positions of the Fibonacci word at which a cube ends. This gives a certain measure of how close the Fibonacci word is to being periodic. [ABSTRACT FROM AUTHOR]

Background: Albinism is an inherited condition characterised by a lack of pigmentation. Foveal hypoplasia, which occurs because of disruptions in normal foveal development, is commonly observed in albinism. Previous studies using optical coherence tomography (OCT) have reported variable foveal morphology in individuals with oculocutaneous albinism. Aim: To evaluate foveal hypoplasia in individuals with oculocutaneous albinism using OCT. Setting: Eye clinic at the University of KwaZulu-Natal (UKZN). Methods: The study used a descriptive design and included 30 participants with a clinical diagnosis of oculocutaneous albinism from the UKZN eye clinic. The iVue 100 OCT device was used to assess foveal morphology and measure the foveal thickness. Descriptive statistics were used to summarise the data. Results: Most participants had wheat blond hair colour (n = 27), grey iris colour (n = 20) and horizontal jerk nystagmus (n = 24). Only one participant had grade 1 foveal hypoplasia, where a shallow foveal pit was observed. The remaining participants had grade 3 (n = 14) or grade 4 (n = 15) foveal hypoplasia, wherein the foveal pit and outer segment lengthening were absent. The binocular visual acuity (VA) and central foveal thickness ranged from 0.50 LogMAR to 1.12 LogMAR and 236 µm to 367 µm, respectively. There was no correlation between central foveal thickness and VA. Conclusion: Foveal morphology in oculocutaneous albinism varies and ranges from absent development (fovea plana) to near normal development (shallow pit). Spectral-domain OCT devices help evaluate foveal hypoplasia. Contribution: Foveal hypoplasia is common in oculocutaneous albinism and can be evaluated using OCT. [ABSTRACT FROM AUTHOR]

We study the properties of the ternary infinite word p = 012102101021012101021012⋯, that is, the fixed point of the map h : 0 → 01, 1 → 21, 2 → 0. We determine its factor complexity, critical exponent, and prove that it is 2-balanced. We compute its abelian complexity and determine the lengths of its bispecial factors. Finally, we give a characterization of p in terms of avoided factors. [ABSTRACT FROM AUTHOR]

Objective: Predicting likelihood of vaginal birth after cesarean (VBAC) is a cornerstone in counseling patients considering a trial of labor after cesarean (TOLAC). Yet, the simplified Bishop score (SBS), a score comprised cervical dilation, station, and effacement assessment used to predict successful vaginal delivery, has not been applied to the TOLAC population. We evaluated the relationship between admission SBS and likelihood of successful VBAC. We also determined the predictive characteristics of SBS, compared to cervical dilation alone, for successful VBAC. Methods: This is a secondary analysis of a prospective cohort study of patients with a singleton gestation, ≥37 0/7 weeks gestation, and prior cesarean admitted to Labor & Delivery between 2010 and 2014. The primary outcome of successful VBAC was compared between those with a favorable (score >5) and unfavorable (score ≤5) admission SBS. Secondary outcomes were select maternal and neonatal outcomes. Adjusted risk ratios were estimated using multivariable logistic regression analyses. Receiver-operating characteristic curves compared predictive capabilities of cervical dilation alone to SBS for successful VBAC. Results: Of the 656 patients who underwent a TOLAC during the study period, 421 (64%) had a successful VBAC. 203 (31%) and 453 (69%) had a favorable and an unfavorable admission SBS, respectively. After adjusting for body mass index and prior vaginal delivery, patients with a favorable admission SBS had a 30% greater likelihood of successful VBAC compared to those with an unfavorable SBS (aRR 1.30, 95% CI 1.16–1.40). Admission cervical dilation alone performed similarly to SBS as a predictor of successful VBAC, with a receiver-operator characteristic curve area under the curve (AUC) of 0.68 (95% CI 0.64–0.72) versus an AUC 0.66 (95% CI 0.62–0.70), respectively (p = .07). There were no differences in adverse maternal or neonatal outcomes between those with an unfavorable and favorable SBS. Conclusions: A favorable admission SBS is associated with an increased likelihood of VBAC. Although both admission SBS and cervical dilation alone are only modest predictors of VBAC, admission cervical dilation performs overall similarly to current models for VBAC prediction and is an objective, reproducible, and generalizable measure. Our study highlights the value of waiting until end of pregnancy (rather than the first prenatal visit) to conclude patient counseling on the decision to TOLAC in order to consider admission cervical assessment, particularly cervical dilation. [ABSTRACT FROM AUTHOR]

Introduction: Hydroxyurea reduces the incidence of vaso-occlusive episodes, stroke, and respiratory, cardiac, and renal damage in sickle cell disease by increasing fetal hemoglobin. However, because suboptimal adherence to hydroxyurea limits its effectiveness, understanding patient-specific barriers to hydroxyurea adherence could help improve adherence and health outcomes in patients with sickle cell disease. The aim of this single-site, prospective, IRB-approved study was to validate a 24-item patient- and caregiver-reported hydroxyurea treatment adherence questionnaire, the Hydroxyurea Evaluation of Adherence for Life (HEAL) scale. Methods: A sample of 24 adults with sickle cell disease and 16 caregivers of children with sickle cell disease completed the HEAL scale, and a subset of the original sample provided a second HEAL scale for test-retest reliability. HEAL scale results were validated against global adherence ratings from participants and health-care providers, records of access to pill bottles, and laboratory values for fetal hemoglobin and absolute neutrophil count. Results and Discussion: Results demonstrated excellent internal consistency for the HEAL Total score and eight (3-item) subscale scores (Dose, Remember, Plan, Cost, Understand, Effectiveness, Laboratory, and Pharmacy), as well as strong test-retest reliability for all HEAL scores except the Cost subscale. HEAL Total scores correlated significantly with validity measures, including global adherence ratings and lab values. The HEAL scale offers significant clinical potential for understanding adherence in individual sickle cell disease patients and significant research potential for characterizing adherence in persons with sickle cell disease who are treated with hydroxyurea. [ABSTRACT FROM AUTHOR]

Measurement of quality and improvement in medicine has existed since Florence Nightingale's time. In modern times, medicine has sought to learn from other high‐reliability industries such as aviation and nuclear power, where errors can result in catastrophic outcomes. Lean is a unique quality improvement strategy that seeks to improve both quality and safety by driving out waste and, where possible, standardizing work practices. It is a visual system with work aids and signals built into the workspace. An important tenet is that ideas come from the workers and that there is an iterative improvement. The improvement efforts are always viewed from the perspective of the customer, our patients, families, and coworkers. This paper describes the evolution of Lean in healthcare and highlights core principles of Lean. Examples are used to describe how various Lean tools can be applied by pediatric anesthesiologists to solve clinical problems. [ABSTRACT FROM AUTHOR]