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The 5-factor modified Frailty Index (mFI-5) is a risk-stratification tool utilized to predict complications and mortality following major lower extremity (LE) amputation. However, its prognostic value for long-term mortality is unknown. The study aim was to assess whether a high mFI-5 score relates to long-term mortality following major LE amputation for chronic wounds. Patients ≥60 years who underwent major LE amputation from 2017 to 2021 were retrospectively reviewed. Data regarding demographics, comorbidities, perioperative factors, amputation type, and postoperative complications was collected and mFI-5 was calculated. Survival analysis was performed with Kaplan-Meier curves and differences were assessed with Log-Rank test. A total of 172 patients were identified. Mean age was 70.7 ± 8.0 years. Median time to ambulation was 3.7 months (IQR 4.0). By final follow-up of 17.5 ± 15.9 months, ambulatory rate was 51.7% (n = 89), overall mortality 36.0% (n = 62), 1-year mortality 14.0% (n = 24), and 3-year mortality 27.9% (n = 48). Patients with an mFI-5 of ≥4 (26.7%, n = 46) compared with patients with mFI-5 <4 (73.3%, n = 126) had a higher rate of prolonged postoperative LOS (34.8% vs 19.8%, p = .042), overall mortality (52.2% vs 30.2%, p = .008), 1-year mortality (23.9% vs 10.3%, p = .023), and 3-year mortality (45.7% vs 21.4%, p = .002). Multivariate analysis demonstrated mFI-5 was an independent predictor of 3-year mortality (OR 2.35, p = .043). At a threshold ≥4, the mFI-5 demonstrated utility in predicting long-term mortality. The value of this prognostic indicator is in its preoperative application of assessing risk of mortality, which should be utilized in conjunction with other measures., (Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Thyroid chondroplasty (TC) in facial gender-affirming surgery (FGAS) is aimed at modifying the thyroid cartilage to achieve a more feminine laryngeal appearance. This study evaluated open versus endoscopic techniques to TC and associated outcomes and complications. A systematic review (SR) of articles pertaining to TC was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve articles representing 368 patients were included for analysis. Nine articles described open approaches, and three articles described endoscopic techniques. The rate of total complications was 4.3% (n = 12) in the open approach compared to 15% (n = 13) in the endoscopic approach. Positive esthetic results were reported in 92% of cases performed with the open approach and 90% with the endoscopic approach. In the open approach, seven (2.5%) patients requested additional removal of cartilage, and three (1.1%) requested scar revision. In the endoscopic approach, three (3.7%) patients requested additional cartilage removal. In addition, data of individuals who underwent "cervical tracheoplasty" for gender dysphoria from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed, and there was no incidence of wound or major complications among patients who underwent tracheoplasty alone. Although the advantage of the endoscopic approach is a scarless neck incision, the rate of complications is higher with the open approach. Endoscopic approaches are still not widely used, and continued investigations are warranted to improve familiarity with this approach and reduce postoperative complications., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: Given the consequences of delayed treatment and diagnosis of craniosynostosis, this study reviews the literature on sociodemographic risk factors and disparities associated with delayed craniosynostosis treatment., Design: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search of PubMed/Medline and Embase was performed by two independent reviewers. Included studies discussed craniosynostosis health disparities. Demographic characteristics and outcomes were analyzed., Setting: Not applicable., Patients: Patients with craniosynostosis., Interventions: Standard surgical intervention for craniosynostosis., Results: Our literature search yielded 273 studies, of which 18 were included for analysis. Included studies represented data from 31 256 U.S. patients with craniosynostosis. Sixty percent of patients (n = 16 510) were White, 13.8% were Hispanic/Latino, 6.2% were Black/African American, 1.3% were Asian, 0.3% were American Indian or Alaska Native, and 0.1% were Native Hawaiian or Pacific Islander. Average age at surgery was 6.36 months for White patients, 10.63 months for Black patients, and 9.18 months for Hispanic patients. Minority racial and/or ethnic status was a risk factor for delayed presentation, and increased incidence of open surgery, complication rates, hospital charges, operative time, anesthesia duration, and hospital length of stay. Government-funded health insurance was associated with delayed intervention and increased complications., Conclusions: Minority craniosynostosis patients experience delays in intervention and increased complication rates. Our findings highlight the importance of expedited and equitable referrals, screenings, and treatment, and the need for a standardized approach to investigating longitudinal demographic and outcomes data in this population.

Introduction: As anti-immigrant hostility toward Latino populations grows, more fervent attention is needed to consider strength-based approaches to attenuate the effects of perceived discrimination. This systematic review synthesizes the evidence about the effects of racial/ethnic discrimination on mental, physical, and health behaviors of Latinos and examines the coping mechanisms and cultural factors that attenuate the negative association between discrimination and health among adult Latinos living in the United States., Method: The search criteria included articles that (a) examined ethnic/racial discrimination in relationship to a health outcome, (b) had study samples composed of least 25% Latino adults, and (c) were written in English., Results: A total of 33 studies were included in the review. Our findings demonstrated the negative relationship between perceived discrimination, mental health, and health behaviors. The evidence for the relationship between perceived discrimination and physical health was less robust. For mental health, greater feeling of ethnic pride and belonging attenuated the negative relationship between perceived discrimination and mental health., Conclusions: Our findings highlight the potential for building on ethnic identity for addressing mental health and perceived discrimination. Future research directions are outlined to address identified gaps.

Background: Increased intakes of ready-made and fast foods paralleled with decreased homemade food consumption have been associated with increased rates of obesity. Researchers have shown associations between cooking self-efficacy (SE) and cooking frequency (CF) with dietary quality and weight status. Some cooking interventions have shown positive associations with dietary outcomes, such as increased fruit and vegetable intake and decreased fast food consumption. There is still much unknown about SE and CF, especially among youth., Objective: Determine baseline SE and CF and the associations with dietary quality and body mass index (BMI) of youth enrolled in iCook 4H., Methods: Youth (n = 228, ages 9-10 years) completed online surveys assessing SE, CF, dietary quality, and demographics. Anthropometrics were collected to calculate BMI-for-age percentiles and weight categories. Descriptive statistics were completed for CF, SE, BMI categories, and demographics. Differences in CF and SE by sex, race, and participation in government assistance programs were determined through independent-sample t tests. Pearson correlations were used to assess the association between dietary quality and CF and SE. Associations between CF and dietary quality were assessed further through 2-way analyses of variance (ANOVAs) that included CF and sex and CF and race as independent variables. Associations between SE and CF and BMI were assessed through ANOVAs., Results: Thirty-seven percent of youth were overweight or obese. Females reported significantly higher CF than males ( P  = .042). Cooking frequency was positively associated with dietary quality ( P  < .001), but BMI was not associated with dietary quality. SE was not associated with dietary quality or BMI., Conclusion: Based on results, CF was positively associated with dietary quality among youth. More research is needed to assess how different types of cooking relate to diet and BMI. Interventions are needed to determine whether increasing CF leads to better diet outcomes., Competing Interests: Declaration Of Conflicting Interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In the era of eHealth, eHealth literacy is emerging as a key concept to promote self-management of chronic conditions such as HIV. However, there is a paucity of research focused on eHealth literacy for people living with HIV (PLWH) as a means of improving their adherence to HIV care and health outcome., Objective: The objective of this study was to critically appraise the types, scope, and nature of studies addressing eHealth literacy as a study variable in PLWH., Methods: This systematic review used comprehensive database searches, such as PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, to identify quantitative studies targeting PLWH published in English before May 2017 with eHealth literacy as a study variable., Results: We identified 56 unique records, and 7 papers met the eligibility criteria. The types of study designs varied (descriptive, n=3; quasi-experimental, n=3; and experimental, n=1) and often involved community-based settings (n=5), with sample sizes ranging from 18 to 895. In regards to instruments used, 3 studies measured eHealth literacy with validated instruments such as the eHealth Literacy Scale (eHEALS); 2 studies used full or short versions of Test of Functional Health Literacy in Adults, whereas the remaining 2 studies used study-developed questions. The majority of studies included in the review reported high eHealth literacy among the samples. The associations between eHealth literacy and health outcomes in PLWH were not consistent. In the areas of HIV transmission risk, retention in care, treatment adherence, and virological suppression, the role of eHealth literacy is still not fully understood. Furthermore, the implications for future research are discussed., Conclusions: Understanding the role of eHealth literacy is an essential step to encourage PLWH to be actively engaged in their health care. Avenues to pursue in the role of eHealth literacy and PLWH should consider the development and use of standardized eHealth literacy definitions and measures., (©Hae-Ra Han, Hyejeong Hong, Laura E Starbird, Song Ge, Athena D Ford, Susan Renda, Michael Sanchez, Jennifer Stewart. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 10.09.2018.)

We calculate the density of photon states (DOS) of the normal modes in dye-doped chiral nematic liquid crystal (LC) cells in the presence of various loss mechanisms. Losses and gain are incorporated into the transmission characteristics through the introduction of a small imaginary part in the dielectric constant perpendicular and along the director, for which we assume no frequency dispersion. Theoretical results are presented on the DOS in the region of the photonic band gap for a range of values of the loss coefficient and different values of the optical anisotropy. The obtained values of the DOS at the photonic band gap edges predict a reversal of the dominant modes in the structure. Our results are found to be in good agreement with the experimentally obtained excitation thresholds in chiral nematic LC lasers. The behavior of the DOS is also discussed for amplifying LC cells providing additional insight to the lasing mechanism of these structures.

Background: Using patient-specific cutting blocks for TKA increases the cost to the hospital for these procedures, but it has been proposed they may reduce operative times and improve implant alignment, which could reduce the need for revision surgery., Questions/purposes: We compared TKAs performed with patient-specific cutting blocks with those performed with traditional instrumentation to determine whether there was improved operating room time management and component coronal alignment to support use of this technology., Methods: We retrospectively reviewed 57 patients undergoing primary TKAs using patient-specific custom cutting blocks for osteoarthritis and compared them with 57 matched patients undergoing TKAs with traditional instrumentation during the same period (January 2009 to September 2010). At baseline, the groups were comparable with respect to age, sex, and BMI. We collected data on operative time (total in-room time and tourniquet time) and measured component alignment on plain radiographs., Results: On average, TKAs performed with patient-specific instrumentation had similar tourniquet times (61.0 versus 56.2 minutes) but patients were in the operating room 12.1 minutes less (137.2 versus 125.1 minutes) than those in the standard instrumentation group. We observed no difference in the femorotibial angle in the coronal plane between the two groups., Conclusions: Patient-specific instrumentation for TKA shows slight improvement in operating room time management but none in component alignment postoperatively. Therefore, routine use of this new technology may not be cost-effective in its current form., Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

In this study we have fabricated eight different liquid-crystal lasers using the same gain medium but different homologues from the bimesogenic series alpha-(2',4-difluorobiphenyl-4'-yloxy)-omega-(4-cyanobiphenyl-4'-yloxy)alkanes, whereby the number of methylene units in the spacer chain varied from n=5 to n=12. To quantify the performance of these lasers, the threshold energy and the slope efficiency were extracted from the input-output characteristics of each laser. A clear odd-even effect was observed when both the excitation threshold and the slope efficiency were plotted as a function of the number of methylene units in the spacer chain. In all cases, the bimesogen lasers for which n is even exhibit lower threshold energies and higher slope efficiencies than those for which n is odd. These results are then interpreted in terms of the macroscopic physical properties of the liquid-crystalline compounds. In accordance with a previous study [S. M. Morris, A. D. Ford, M. N. Pivnenko, O. Hadeler, and H. J. Coles, Phys. Rev. E. 74, 061709 (2006)], a combination of a large birefringence and high order parameters are found, in the most part, to correlate with low-threshold energy and high slope efficiency. This indicates that the threshold and slope efficiency are dominated by the host macroscopic properties as opposed to intermolecular interactions between the dye and the liquid crystal. However, certain differences in the slope efficiency could not be explained by the birefringence and order parameter values alone. Instead, we find that the slope efficiency is further increased by increasing the elastic constants of the liquid-crystal host so as to decrease the scattering losses incurred by local distortions in the director field under high-energy optical excitation.

In order to understand how the performance of a liquid-crystal laser depends on the physical properties of the low molar mass nematic host, we have studied the energy threshold and slope efficiency of ten optically pumped liquid-crystal lasers based on different hosts. Specifically, this leads to a variation in the birefringence, the orientational order parameter, and the order parameter of the transition dipole moment of the dye. It is found that low threshold energies and high slope efficiencies correlate with high order parameters and large birefringences. To a first approximation this can be understood by considering analytical expressions for the threshold and slope efficiency, which are derived from the space-independent rate equations for a two-level system, in terms of the macroscopic liquid crystal properties.