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The article discusses factors associated with language-concordant cognitive testing among linguistically diverse older adults. A retrospective cohort study of patients aged 65 and older in Toronto, Canada, revealed that only 17.8% received language-concordant or interpreter-mediated cognitive testing. Patients referred for cognition, with curative treatment intent, and preferring a Chinese language had increased odds of language-concordant testing, while those with higher comorbidity and longer residency in Canada had reduced odds. The study highlights the importance of providing cognitive testing in patients' preferred languages to avoid delays in dementia diagnosis and management. [Extracted from the article]

Purpose Acquisition and validation methods Data format and usage notes Potential applications Evaluating deformable image registration (DIR) algorithms is vital for enhancing algorithm performance and gaining clinical acceptance. However, there is a notable lack of dependable DIR benchmark datasets for assessing DIR performance except for lung images. To address this gap, we aim to introduce our comprehensive liver computed tomography (CT) DIR landmark dataset library. This dataset is designed for efficient and quantitative evaluation of various DIR methods for liver CTs, paving the way for more accurate and reliable image registration techniques.Forty CT liver image pairs were acquired from several publicly available image archives and authors’ institutions under institutional review board (IRB) approval. The images were processed with a semi‐automatic procedure to generate landmark pairs: (1) for each case, liver vessels were automatically segmented on one image; (2) landmarks were automatically detected at vessel bifurcations; (3) corresponding landmarks in the second image were placed using two deformable image registration methods to avoid algorithm‐specific biases; (4) a comprehensive validation process based on quantitative evaluation and manual assessment was applied to reject outliers and ensure the landmarks’ positional accuracy. This workflow resulted in an average of ∼56 landmark pairs per image pair, comprising a total of 2220 landmarks for 40 cases. The general landmarking accuracy of this procedure was evaluated using digital phantoms and manual landmark placement. The landmark pair target registration errors (TRE) on digital phantoms were 0.37 ± 0.26 and 0.55 ± 0.34 mm respectively for the two selected DIR algorithms used in our workflow, with 97% of landmark pairs having TREs below 1.5 mm. The distances from the calculated landmarks to the averaged manual placement were 1.27 ± 0.79 mm.All data, including image files and landmark information, are publicly available at Zenodo (https://zenodo.org/records/13738577). Instructions for using our data can be found on our GitHub page at https://github.com/deshanyang/Liver‐DIR‐QA.The landmark dataset generated in this work is the first collection of large‐scale liver CT DIR landmarks prepared on real patient images. This dataset can provide researchers with a dense set of ground truth benchmarks for the quantitative evaluation of DIR algorithms within the liver. [ABSTRACT FROM AUTHOR]

The article discusses a randomized trial comparing ibrutinib-R-GDP (IR-GDP) with R-GDP in adults with relapsed and refractory diffuse large B-cell lymphoma. The study found that IR-GDP led to more documented infections without improving overall response compared to R-GDP. The trial was approved by research ethics boards, and after reviewing toxicity and efficacy, the IR-GDP arm was closed prematurely due to futility. The study highlights the importance of biomarker-driven trials and the evolving landscape of therapy for relapsed and refractory DLBCL. [Extracted from the article]

Objective: To compare post operative pain, wound infection, intraoperative time and length of hospital stay in both groups of simple excision and Limberg flap. Study Design: Comparative Prospective study. Setting: CMA Teaching and Research Hospital/Azra Naheed Medical and Dental College, Lahore, Pakistan. Period: 1st September 2021 to 1st September 2023. Methods: After approval from the Institutional review board of Azra Naheed Medical & Dental College/CMA Hospital, the sample was 120 patients was raised using non-convenience probability sampling divided into 2 groups. Group A patients underwent simple excision while Group B patients underwent Limberg flap Inclusion criteria include all the patients with age more than 13 years and diagnosed as case of pilonidal sinus. All the data was entered and processed by using SPSS 26. Comparison of two groups was done by apply independent sample t-test. A p-value of ≤ 0.05 was considered significant. Results: The average age of the patients was 45.88 ± 9.78 years with minimum and maximum ages were 15 & 59 year respectively. Mean post operative pain was 2.6 ± 1.9 in group A while 3.9 ± 2.7 in group B (p value = <0.05). Similarly wound infection, duration of surgery and length of hospital stay were also less in group A patients as compared to group B patients. Conclusion: Simple excision of pilonidal sinus is better from Limberg flap in terms of post operative pain, wound infection, duration of surgery and length of hospital stay. [ABSTRACT FROM AUTHOR]

Background/Objectives: osteoarthritis (OA) is a leading cause of disability. With an aging population and rising obesity rates, OA presents a growing challenge to health systems worldwide. Current OA treatments involve a mix of pharmacological and nonpharmacological interventions. Viscosupplementation with hyaluronic acid (HA) has proven effective, especially in knee OA, leading to its recommendation in international guidelines. This study investigates the sustained benefits of a single intra-articular HA injection beyond one year in patients coming from the SOYA trial, considering the EU MDR 2017/745 emphasis on post-market follow-up. Methods: A prospective, observational, open, post-marketing study in a cohort of patients that participated in the SOYA trial. Follow-up was carried out by means of a telephone survey, and the data were anonymized and coded so that patients could not be identified. The study was approved by the Alcorcón Hospital Institutional Review Board (Alcorcón, Madrid, Spain). Results: In the follow-up of the SOYA trial, 81.5% of patients sustained positive effects for over 6 months after the trial ended. This correlated with improved daily functioning, enhanced mood, and high patient satisfaction. Younger age and milder OA grades were associated with prolonged treatment effects. Notably, 82% of patients with >6 months of improvement did not require additional medication. Conclusions: the results of this study support the safety and performance of Adant® Plus as a treatment for patients with mild and moderate knee OA, with results lasting more than one year. Post-marketing studies are particularly relevant to examine the experience gained with the use of the device in routine clinical practice. [ABSTRACT FROM AUTHOR]

The letter to the editor discusses the importance of long-term follow-up of autologous stem cell transplantation (ASCT) for mantle cell lymphoma (MCL). A retrospective study in Alberta, Canada, involving 141 patients who underwent ASCT as part of first-line therapy for MCL between 2000 and 2022, revealed a median progression-free survival (PFS) of 11.3 years and an overall survival (OS) of 14.0 years. The study suggests that ASCT achieves durable remissions in MCL, with a subset of patients experiencing remissions lasting 10-20 years, indicating potential functional cure. The findings highlight the need for further research and longer-term follow-up data to determine the efficacy of ASCT in MCL treatment. [Extracted from the article]

Introduction Movement quality screening in early-career military populations, like Army Reserve Officers' Training Corps (AROTC) cadets, could decrease the negative impact of musculoskeletal injury observed within the military. Movement quality screening techniques should be valid before being pursued in the field. Normative data describing movement quality of AROTC cadets are also needed. Therefore, the aims of this study were to determine criterion validity of several movement quality assessments and report normative jump-landing kinematics of AROTC cadets. Materials and Methods This cross-sectional research was approved by the Institutional Review Board. As part of a larger study, 20 AROTC cadets (21.3 ± 3.4 years; 1.7 ± 0.1 m; 73.8 ± 14.8 kg) had 3-dimensional (3D) and 2-dimensional (2D) kinematic data collected simultaneously while performing a jump-landing task. Variables of interest were 3D hip and knee sagittal, frontal, and transverse joint angles at maximum knee flexion. An experienced rater calculated sagittal and frontal 2D joint angles at maximum knee flexion. Averages of 2D and 3D angles were calculated to describe normative data and for further data analysis. Bivariate correlations between 3D and 2D variables were used to determine criterion validity. Results Moderate correlations were found between 2D and 3D hip frontal plane angles (P  = .05, r  =−0.33), 2D and 3D knee sagittal plane angles (P  = .04, r  = 0.35), and 2D and 3D knee frontal plane angles (P  = .03, r  = −0.36). Normative values of knee and hip kinematics demonstrated averages of 17.58° of knee adduction, 16.48° of knee external rotation, 11.57° of hip abduction, 10.76° of hip internal rotation, and 103.47° of knee flexion during landings. However, ranges demonstrated that landing patterns vary within AROTC cadets. Conclusions The normative values of 3D jump-landing kinematic data indicate that movement quality varies greatly within AROTC cadets, and some cadets display potentially injurious movements. Therefore, screening movement quality could be beneficial to determine musculoskeletal injury risk in AROTC cadets. Based on the correlations discovered in this study, we recommend the 2D techniques used in this study be researched further as they may serve as alternatives to expensive, timely 3D techniques that could be better utilized in military environments. [ABSTRACT FROM AUTHOR]

Introduction During the novel coronavirus disease 2019 pandemic, health care workers experienced facial problems from prolonged use of N95 masks, including skin irritation, pigmentation changes, and contact dermatitis. We assessed the use of hydrocolloid dressing versus dimethicone cream to prevent skin breakdown among military health care workers while wearing an N95. Materials and Methods Participants were recruited using convenience and snowball sampling in this nonblinded, randomized, cross-over study with 2 active treatments, hydrocolloid dressing and dimethicone cream, across 3 time points. The skin was assessed using photographs and subepidermal moisture scanner (SEM). N95 seal integrity was assessed using qualitative fit test. Institutional review board approval was obtained from the Madigan Army Medical Center Institutional Review Board. Results Among the 73 participants, wearing an N95 alone versus with dimethicone cream or hydrocolloid dressing caused more adverse skin reactions. There were no significant differences in qualitative fit test failure rate between groups. Participants experienced minimal to no dizziness, loss of energy/tiredness/fatigue, claustrophobia, shortness of breath, difficulty breathing, and dry or itchy eyes. For all interventions, wearing an N95 did not interfere with participants' concentration, verbal communication, hearing, vision, and, importantly, delivery of care. Conclusions Using a skin protectant with an N95 may prevent adverse skin reactions while preserving health care workers' ability to safely and competently care for patients in routine and pandemic conditions. [ABSTRACT FROM AUTHOR]

Introduction Mentorship programs have well-documented benefits to both mentees and mentors. Military medical students face unique challenges in medical school given their service-specific requirements and separate military match process. We therefore aimed to determine whether military medical students' participation in a mentorship program impacts their confidence in applying to obstetrics and gynecology (OB/GYN) residency. Materials and Methods First, a needs assessment survey regarding the use of a mentorship program was sent to medical students, residents, fellows, and attendings. A structured mentorship program was then developed for military medical students applying to OB/GYN residency based on the survey results. Mentors were randomly paired with mentees and asked to appraise curriculum vitaes, review personal statements, and perform mock interviews. Following completion of these activities, participants were sent a post-intervention questionnaire. This project was exempt by our institution's Institutional Review Board. Results Our program had 56 participants, with 29 individuals completing our post-intervention survey (response rate 51.8%). After participating in the program, 92.3% of mentors stated they plan to continue a relationship with their mentee. All the mentee respondents stated they would participate in this program again. Before participating in the program, 16.7% of mentees felt "prepared" or "extremely prepared" for the match, compared to 87.6% post-intervention. Most mentee respondents (75%) reported that this program made them a more competitive applicant. Following the mentorship program, 66.7% of participants successfully matched into OB/GYN residency. Conclusions This reproducible, well-received intervention can be implemented to facilitate mentoring connections regardless of geographic location. As the OB/GYN specialty develops its own application process, civilian medical schools should consider adopting similar programs to aid their students in navigating the match process. [ABSTRACT FROM AUTHOR]

Introduction The population of the Republic of Korea often experiences heat-related illnesses during summer that are exacerbated by significant variations. With rising temperatures attributed to global warming and other environmental changes within the military, combined with the military medical services' mission to uphold combat capabilities and promote health, it has become crucial to accurately understand the status of heat-related illnesses and integrate more comprehensive and systematic preventive measures. This study aimed to analyze data on heat-related illnesses between 2018 and 2022 to assess and reflect on the said diseases in the South Korean Military. Materials and Methods We performed a secondary analysis using data provided by the Defense Medical Statistic Information System. This single-institution retrospective, cross-sectional study was approved by the Institutional Review Board of the Armed Forces Medical Command (approval number: AFMC-2023-11-001). Results Over the past 5 years, the annual number of soldiers treated for heat-related illnesses, whether as outpatients or inpatients, at division medical facilities and military hospitals ranged from 846 to 1,250 cases per year. The proportion of severe cases fluctuates annually between 1.1% and 1.8%. Notably, 94 to 96% of all heat-related illnesses were recorded between May and September, with peak rates in July and August. Conclusion The army reported the highest number of heat-related illnesses among military branches, with soldiers comprising the majority of cases. This highlights the urgent need for enhanced heat illness prevention measures within army ranks. Notably, the incidence of these illnesses peaked during July and August, underlining the critical periods for intensified preventive efforts. [ABSTRACT FROM AUTHOR]

Introduction Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls. Materials and Methods The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n  = 9), snipers (n  = 9), and healthy, unexposed controls (n  = 7). The former 2 groups were combined into an RHI group (n  = 18) and compared to controls (n  = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t -tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command. Results The results from t -tests supported group differences for age (P  = .012), participant-reported symptoms (P  = .006), and all VOMS items (P range = <.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P  = .01), RightEye saccades (P  = .04), participant-reported total symptom severity (P  = .03), and VOMS total scores (P  = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure. Conclusions Participant-reported concussion symptoms, VOMS scores, and age were useful in identifying SOF operators exposed to RHI from controls. RightEye metrics were not useful in differentiating RHI groups from controls. Differences between snipers and breachers warrant further research. Overall, the findings suggest that VOMS may be a useful tool for screening for the effects of exposure to RHI in SOF operators. Future investigations should be conducted on a larger sample of military SMs, consider additional factors (e.g. RHI exposure levels, medical history, and sex), and include additional assessment domains (e.g. balance, cognitive, and psychological). [ABSTRACT FROM AUTHOR]

Introduction The U.S. Military members experiencing combat-related injuries have a higher chance of developing infections by multidrug-resistant (MDR) bacteria at admission to military hospitals. MDR wound infections result in higher amputation rates and greater risks for subsequent or chronic infections that require readmission or extended stay in the hospital. Currently, there is no FDA-clear, deployable early diagnostic system for suitable field use. We are reporting our efforts to improve a previously developed Rapid Label-free Pathogen Identification (RAPID) system to detect viable MDR bacteria in wound infections and perform antibiotic susceptibility testing (AST). Specifically, we added multiplex and automation capability and significantly simplified the sample preparation process. A functional prototype of the improved system was built, and its performance was validated using a variety of lab-prepared spiked samples and real-world samples. Materials and Methods To access the baseline performance of the improved RAPID system in detecting bacteria presence, we selected 17 isolates, most of them from blood or wound infections, and prepared mono-strain spiked samples at 104 to 106 cfu/mL concentration. These samples were processed and analyzed by the RAPID system. To demonstrate the AST capability of the system, we selected 6 strains against 6 different antibiotics and compared the results from the system with the ones from the gold standard method. To validate the system's performance with real-world samples, we first investigated its performance on 3 swab samples from epicutaneous methicillin-resistant Staphylococcus aureus –exposed mouse model. The AST results from our system were compared with the ones from the gold standard method. All animal experiments were approved by the Johns Hopkins University Animal Care and Use Committee (Protocol No. MO21M378). Then, we obtained swab samples from 7 atopic dermatitis (AD) patients and compared our AST results with the ones from the gold standard method. The human subject protocol was approved by the Johns Hopkins Medicines Institutional Review Boards (Study No. CR00043438/IRB00307926) and by USAMRDC (Proposal Log Number/Study Number 20000251). Results High-quality data were obtained from the spiked samples of all 17 strains. A quantitative analysis model built using these data achieved 94% accuracy in predicting the species ID in 8 unknown samples. The AST results on the spiked samples had shown 100% matching with the gold standard method. Our system successfully detects the presence/absence of viable bacteria in all 3 mouse and 7 AD patient swab samples. Our system shows 100% and 85.7% (6 out of 7) accuracy when compared to the oxacillin susceptibility testing results for the mouse and the AD patient swabs, respectively. Conclusions Our system has achieved excellent performance in detecting viable bacteria presence and in performing AST in a multiplex, automated, and easy-to-operate manner, on both lab-prepared and real samples. Our results have shown a path forward to a rapid (sample-to-answer time ≤3 hours), accurate, sensitive, species-specific, and portable system to detect the presence of MDR combat-related wound infections in the field environment. Our future efforts involve ruggedizing the RAPID system and evaluating performance under relevant environmental conditions. [ABSTRACT FROM AUTHOR]

Introduction A dilation and evacuation (D&E) is a safe and effective option for patients undergoing a second trimester abortion. Recent legislation and geographic restrictions threaten patients' access to this surgical procedure, prompting a call to action to strengthen abortion training. This quality improvement project aimed to assess if a standardized lecture and checklist would improve military trainee knowledge and comfort with performing D&Es. Materials and Methods Using society recommendations and incorporating available level I to III evidence, a standardized checklist for D&Es was created to include necessary equipment, procedural steps, perioperative considerations, and potential complications. The checklist and associated lecture were presented to gynecology residents from seven of the nine military training programs. Residents completed a six-question assessment regarding comfort and knowledge in performing D&Es prior to and following the intervention. Responses were ranked on a five-point Likert scale and analyzed with the Wilcoxon sign-rank test. This project was deemed exempt by the Institutional Review Board. The standard Plan, Do, Study, Act (PDSA) methodology was used for ongoing assessment of the efficacy of this quality improvement project. Results There were 67 trainees that completed the pre-intervention assessment and 44 who completed it post-intervention, with 27 responses paired for statistical analysis. All trainees self-reported improved comfort and knowledge in all procedural aspects of D&Es, with the largest improvement observed in equipment knowledge (mean difference 1.44, P <0.001), performing procedural steps (mean difference 1.26, P <0.001), and managing complications (mean difference 1.33, P <0.001). Conclusions Use of an evidence-based checklist significantly improves resident knowledge and comfort with performing second trimester D&Es. In a post Dobbs environment, the military is an appropriate proxy for larger society and training programs need to develop alternatives and adjuncts to clinical training. [ABSTRACT FROM AUTHOR]

The study published in the Journal of the European Academy of Dermatology & Venereology explores the association between comorbidities, itch intensity, and quality of life in patients with Chronic Nodular Prurigo (CNPG). The research involved 513 adult CNPG patients from 12 European countries and found that hypertension was significantly associated with itch intensity, while depression was significantly associated with impaired quality of life. The study suggests that conditions like diabetes, hypertension, and arthritis may impact itch perception, highlighting the need for further investigation into the pathophysiological significance of these associations. [Extracted from the article]

The article discusses the challenges in diagnosing dermatophytomas, a subtype of onychomycosis, characterized by dense fungal masses in the nail plate. The study analyzed patient data to identify clinical, dermoscopic, and histopathologic characteristics of dermatophytomas. Dermatophytomas are difficult to treat and may be underrecognized, with dermoscopy aiding in diagnosis by highlighting central yellow coloration. The study recommends histopathological confirmation and identification of the causative organism through culture or PCR testing. Limitations include a small sample size and the need for further research to improve diagnosis and treatment of dermatophytomas. [Extracted from the article]

Objectives: Stroke is a leading cause of death in Taiwan. Poor public knowledge of stroke may lead to delays in prehospital arrival, resulting in unfavorable prognoses. Studies have investigated public knowledge of stroke and highlighted the importance of stroke education, however, few such studies have been conducted in Taiwan. This study assessed the changes in public knowledge of stroke between 2012 and 2020 by conducting a survey during two World Stroke Day events. Furthermore, this study identified areas where educational efforts may have been insufficient. Materials & Methods: Questionnaires were distributed to the participants of 2012 and 2020 World Stroke Day events in Taiwan. In total, 328 and 336 questionnaires were completed, respectively. Stroke literacy and knowledge were analyzed between 2012 and 2020. Data were analyzed using the chi-square test or independent t-test. p < 0.05 indicates statistical significance. Results: Hypertension was the most recognized risk factor for stroke in both years (p < 0.001), and recognition of most of the given risk factors significantly increased. In addition, recognition of more than half of the stroke warning signs significantly increased, awareness of the correct acute stroke response also increased (p < 0.001), and overall stroke literacy in Taiwan increased (p = 0.001). Conclusion: Stroke literacy and knowledge in Taiwan have improved significantly between 2012 and 2020, but many people still lack adequate stroke knowledge and awareness. Government health department must take this sort of intervention continually (campaigns) and novel approaches (e.g. board game...) to improve stroke literacy and knowledge in public health. Registration ID: N202109072, approved by the Joint Institutional Review Board of Taipei Medical University on 2021/11/02 [ABSTRACT FROM AUTHOR]

Serious and continuing research noncompliance and integrity violations undermine the quality of research and trust in science. When researchers engage in these behaviors, institutional officials (IOs) often develop corrective action plans. Ideally, such plans address the root causes so noncompliance or research integrity violations discontinue. The aim of this study was to identify what IOs perceive as causes and action plan activities typically prescribed. We conducted semi-structured in-depth interviews with 47 IOs at research institutions across the U.S. including: institutional review board and institutional animal care and use committee chairs and directors, chief research officers, research compliance and integrity officers, and institutional conflicts of interest chairs and directors. The most common root causes identified were: 1) lack of knowledge or training, 2) failure to provide research team supervision, and 3) researcher attitudes toward compliance. The most common action plan activities include: 1) retraining in compliance or research integrity, 2) follow-up and hands-on involvement with the researcher, and 3) mandated oversight or mentoring. Because the most commonly identified action plan activities fail to adequately address the majority of root causes, our findings suggest a need for IOs to rethink existing approaches to action plan development to more effectively target root causes. [ABSTRACT FROM AUTHOR]

Practitioners aim to improve healthcare systems and clinical care through a variety of activities as part of a learning healthcare system. Yet the distinction between projects requiring Research Ethics Board (REB) approval or not is becoming increasingly blurred, making it difficult for researchers and others to classify projects and then navigate the required compliance pathway appropriately. To address this challenge, the Provincial Health Services Authority (PHSA) of British Columbia (BC) created a decision tool called the "PHSA Project Sorter Tool" to serve its diverse community while also meeting the unique needs of the BC regulatory and policy environment. The goal of the tool was to standardize and clarify organizational project review and ensure project leads were referred to the appropriate review body or service provider within the PHSA in the most efficient manner possible. In this paper, we describe the ethics needs assessment that was conducted to inform the tool and the results of our ongoing evaluation of the tool since it was launched in January, 2020. Our project shows that this simple tool can reduce burdens on staff and provide clarity to users by standardizing processes and terms and directing users to appropriate internal resources. [ABSTRACT FROM AUTHOR]

In February 2023, the U.S. Government Accountability Office (GAO) released another report acknowledging that we still lack meaningful, validated, widely-accepted measures for evaluating institutional review board (IRB) quality and effectiveness. This challenge is well known to the Consortium to Advance Effective Research Ethics Oversight (), a collaborative group of human research protection (HRP) professionals, researchers, and research ethicists founded in 2018 to do precisely what GAO recommends: examine approaches for measuring IRB effectiveness in protecting human subjects, and implement the approaches as appropriate. Two underlying tenets have been central to AEREO's as approach to thinking about IRB quality and effectiveness: (1) IRBs exist to protect participants and thus the participant perspective should be central to all IRBs do; and (2) because IRBs are tasked with applying subjective ethical and regulatory standards about which people may disagree, their approach and decisions should at least meet the basic standard of reasonableness in terms of accounting for relevant perspectives, considering key factors, and providing defensible justifications. Critical to each of these tenets, IRBs should include diverse perspectives in their deliberations, find ways to meaningfully engage with relevant communities about their views regarding ethical research and appropriate participant protections, and be accountable to the public. [ABSTRACT FROM AUTHOR]

Questions of ethics in randomized controlled trials (RCTs) in development economics need greater attention and a wider perspective. RCTs are meant to be governed by the three principles laid out in the Belmont Report, but often violated them, for example, when local laws are flouted. In other cases, the framework of the Belmont Report itself has proved inadequate: for instance, when there are unintended outcomes or adverse events for which no‐one is held accountable. Primarily using RCTs conducted in India, this paper highlights eight areas of concern. RCTs also have a disproportionate influence on shaping research agendas and on policy. Though ethical issues have been raised, there has been little engagement from the RCT community—a manifestation of its power in the profession. As current safeguards (such as oversight by Institutional Review Boards) have failed to protect human subjects, the concluding section discusses possible ways to resolve these issues. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to evaluate the bone union rate between infected vertebrae after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis. Methods: This retrospective multicenter cohort study evaluated 75 patients of posterior fixation for thoracolumbar pyogenic spondylitis that have been recorded at six relevant institutions from January 2016 to December 2022. Data on age, sex, location of infected vertebrae, number of infected disks, comorbidity, Pola classification, number of vertebrae fixed according to surgery, implant failure requiring revision surgery, and distance according to the type of infected vertebrae after surgery were evaluated. Further, their association with postoperative bone union was investigated > 12 months postoperatively. Results: Finally, 40 patients were included in the study. In total, 32 (80%) patients achieved bone union at the infected vertebrae after minimally invasive posterior fixation without bone grafting. The mean duration from surgery to union was 10.7 months. Twenty-six (65%) patients initially achieved bone union at the lateral and/or anterior bridging callus. Patients with multiple-level infected disks (33%, 2/6 patients) had a lower bone union rate than those with a single-level infected disk (88%, 30/34 patients) (p = 0.0095). Conclusions: In 80% of patients, bone union at the infected vertebrae was achieved after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis. A total of 65% of the patients achieved initial bone union at the lateral and/or anterior bridging callus. Moreover, patients with multiple-level infected disks had a low bone union rate. Hence, the treatment strategy should be cautiously considered. Trial registration: This study was registered retrospectively and all procedures used in this study including the review of patient records were approved by the institutional review board. [ABSTRACT FROM AUTHOR]

The article explores the potential of cell population data (CPD) as a diagnostic tool for distinguishing between venous thrombo-embolism (VTE), superficial vein thrombosis (SVT), and erysipelas. By analyzing CPD parameters in patients with these conditions, the study found differences in the intensity and type of cellular inflammation, with erysipelas showing more intense inflammation compared to DVT. The research suggests that CPD could be a promising tool for diagnosing VTE, but larger studies are needed to evaluate its true value in clinical practice. [Extracted from the article]

Background: Among the emerging treatments for erectile dysfunction (ED), platelet-rich plasma (PRP), known for its ability to enhance tissue repair and regeneration, stands out as a promising therapeutic approach. In this innovative study, we aimed to assess the efficacy of intracavernous injections of platelet lysate (PL), a derivative of PRP, in improving erectile function among ED patients. Methods: We enrolled twenty-six patients, aged between 35 and 70 years (mean age 51.6 ± 11.3 years), who had been experiencing ED for over six months and had an International Index of Erectile Function-5 (IIEF-5) score of 21 or less. Participants received autologous PL injections intracavernously every two weeks for a total of five administrations. We assessed Erection Hardness Score (EHS) and International Index of Erectile Function-5 (IIEF-5) bi-weekly for 16 weeks and conducted penile Doppler ultrasounds pre- and post-treatment to record peak systolic velocity (PSV) and resistance index (RI). Results: Before treatment, the mean EHS was 2.15 ± 0.88 and IIEF-5 was 10.92 ± 5.28. Remarkable improvements were observed post-treatment, with the EHS significantly increasing to 3.15 ± 0.83 (p < 0.05) and IIEF-5 to 17.23 ± 5.26 (p < 0.05). Penile Doppler ultrasound exhibited an increase in both PSV and RI post-treatment, with the rise in RI being statistically significant. Conclusions: Our findings indicate that intracavernous injections of PL substantially enhance erectile function, as evidenced by improvements in EHS, IIEF-5, and the RI of penile Doppler ultrasound, without hemorrhagic events or other adverse reactions apart from temporary pain at the injection site during the 16-week follow-up period. These encouraging results suggest that PL injections are a safe and effective treatment modality for patients with moderate ED, potentially providing a less invasive and more physiologically friendly alternative to current ED management strategies. Trial registration: The study received approval from the Institutional Review Board of National Taiwan University Hospital (IRB Number 202008061RIPC, date of registration 08/28/2020). [ABSTRACT FROM AUTHOR]

Background: Duodenal papillary adenoma, a potentially malignant benign tumor is primarily treated with endoscopic papillectomy. Despite its efficacy, endoscopic papillectomy has a high complication rate. This study investigates whether pancreatic duct and common bile duct stent placement can mitigate these complications. Methods: In a retrospective observational analysis, 79 patients with duodenal papillary adenoma, treated with endoscopic papillectomy at our center, were studied. The cohort included patients who underwent endoscopic papillectomy with no stents placement, common bile duct stent placement alone, pancreatic duct stent placement alone, or stents placement in both ducts. We assessed the outcomes of endoscopic papillectomy, including complete resection rate and recurrence rate as the primary and secondary outcomes respectively. In the meantime, the incidence of complications were also analysed as the safety outcomes. Results: Complete resection rates did not significantly differ between patients with or without stent placement (85.7% P group vs. 89.2% N-P group, P = 0.64). Early complication rates were similar across groups. However, significant reduction in common bile duct stenosis was observed in the stenting group (0% B group vs. 10.5% N-B group, P = 0.03). Furthermore, stent placement correlated with lower adenoma recurrence rates during follow-up (2.4% P group vs. 16.2% N-P group, P = 0.03; 2.4% B group vs. 15.8% N-B group, P = 0.04). Conclusions: Pancreatic duct and common bile duct stent placement in endoscopic papillectomy may decrease late complications, particularly common bile duct stenosis, and reduce the recurrence of duodenal papillary adenoma. Trial registration: This study received approval from the Institutional Review Board and Ethics Committee of Beijing Friendship Hospital (Approval No. BFHHZS20230203), and retrospectively registered in www.ClinicalTrials.gov (NCT06301048, Initial Release date: 02/18/2024, Last Public Release date: 03/03/2024). [ABSTRACT FROM AUTHOR]

The article discusses the management of lower extremity venous congestion during peripheral venoarterial extracorporeal membrane oxygenation (ECMO). A case study of a 76-year-old female patient with heart failure is presented, where lower extremity congestion occurred after ECMO support initiation. The patient's condition improved after inserting an additional 8-Fr drain sheath cannula into the superficial femoral vein, resolving the congestion and preventing deep vein thrombosis. The successful treatment allowed the patient to undergo a heart transplant and be discharged without complications, highlighting the importance of effective venous drainage methods during ECMO support. [Extracted from the article]

The article delves into the experiences of older surgical patients and their care partners amidst the COVID-19 pandemic, shedding light on issues like scheduling delays, virtual care transitions, and policy adjustments. Older adults, often with complex medical needs and limited tech proficiency, leaned on care partners for assistance. The study pinpointed four main themes affecting surgical encounters: the urgency of procedures, the significance of face-to-face consultations, the necessity of care partner participation, and inconsistent communication from surgical teams. Recommendations include recognizing the significance of surgery for patient-care partner pairs, facilitating in-person meetings, advocating for care partner involvement, and establishing dependable communication channels. [Extracted from the article]

With the continuous advancement of medical research, the number of multi-center clinical studies has been steadily increasing, bringing about significant challenges to ethical review. Improving the efficiency and quality of ethical review has become a necessity driven by national policies and the development of the industry. Mutual recognition of ethical reviews is one of the most effective ways to enhance the efficiency of ethical review in multi-center clinical trials. The promotion of mutual recognition of ethical reviews is both feasible and practically significant; however, progress has been less than ideal. Through conducting surveys, this study attempts to understand the status of mutual recognition of ethical reviews in Jiangsu Province, identify the reasons hindering the implementation of mutual recognition, and propose possible solutions. The results indicate that while most medical and health institutions are aware of the policies related to mutual recognition of ethical reviews, the majority remain in a wait-and-see attitude. Ensuring policy guarantees and the high quality and homogeneity of ethical review across institutions are considered necessary conditions for achieving mutual recognition of ethical reviews. [ABSTRACT FROM AUTHOR]

Background: The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented systemwide to address diabetes and obesity risk on all 10 campuses. As little is known about implementing lifestyle change programs in university settings, we examined implementation partners' (i.e., UC DPP leaders and campus leads) perceptions of factors influencing program success on UC campuses. Methods: We conducted qualitative interviews with UC DPP leaders and campus leads to examine challenges and opportunities with university-based DPP delivery models. Interviews were recorded, professionally transcribed, and reviewed in detail by the research team. Transcripts were analyzed using rapid qualitative analysis (RQA). The study was approved by the UCLA Institutional Review Board. All implementation partners provided verbal informed consent. Results: Twenty-six implementation partners (8 UC DPP leaders and 18 campus leads) completed interviews in 2021. Seven themes were identified as critical for implementation, including (1) marketing and recruitment (i.e., market and recruit broadly through established channels as well as target at-risk populations); (2) enrollment (i.e., offer the program during convenient times and let participants know what to expect); (3) use an adaptable, evidence-based program; (4) secure funding for the program, participants, lifestyle coaches, and space; (5) hire experienced and dedicated staff and lifestyle coaches; (6) ensure leadership support; and (7) utilize campus linkages and resources. Perceptions of challenges faced with respect to these themes are also described. Conclusions: This is one of the first studies to examine the challenges and opportunities of delivering an intensive lifestyle change program across 10 university sites. Understanding factors that enhance success of university-based diabetes prevention programs can facilitate UC DPP efforts and help inform delivery strategies of health and wellness programs across other university settings more broadly. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Materials and Methods Results Conclusion IRB Protocol Number Radiofrequency (RF) microneedling produces patient discomfort which deters patients from completing the recommended treatment series.The primary objective was to determine the tolerability, safety, and efficacy of a neurocosmetic postprocedure cream post‐RF microneedling in reducing patient discomfort and enhancing recovery across the length of the study and, secondarily, to evaluate against a leading comparator. The third objective was to evaluate the efficacy of the neurocosmetic on self‐perceived improvement and objective grading.An Institutional Review Board (IRB) approved, fourteen‐day, randomized, single‐center, double‐blind, controlled clinical case study was conducted with 11 healthy female subjects, 6 randomized to the neurocosmetic and 5 to the comparator cell. Following a 7‐day washout period, subjects received RF microneedling (face and neck) and applied the postprocedure cream twice daily for 7 days. Objective and subjective tolerability, self‐assessments, and clinical photography were performed immediately postprocedure, 24 h, three and seven days following the procedure.The neurocosmetic was tolerable and safe. Erythema and stinging immediately decreased postprocedure, postneurocosmetic application. After 24 h, 83% favorably agreed the neurocosmetic “reduced irritation on the skin post‐procedure,” and after 7 days, 100% favorably agreed “experience with the product was positive and I would be interested in returning for a second treatment.” The neurocosmetic reduced skin tone redness in the face and neck faster and to a greater degree when measured against a comparator.The neurocosmetic postprocedure cream improved patient discomfort and enhanced recovery when used immediately post‐RF microneedling and after 7 days.Pro00064211 [ABSTRACT FROM AUTHOR]

Background: Historically, some of the worst abuses of human research participants have involved populations which are vulnerable to coercion, harm, or exploitation, such as prisoners, children, and people with compromised decision-making abilities. Although there has been considerable philosophical and ethical debate about how to protect vulnerable populations, there have been only a handful of empirical studies on vulnerable population policies. Methods: We conducted a cross-sectional study on vulnerable population policies from the 105 top funded U.S. academic research institutions. We used deductive and inductive methods to develop our framework for coding the policies. We tested for associations between policies and research and development expenditure rank, public vs. private status, geographic region, and Association for Accreditation of Human Research Protection Programs accreditation (AAHRRP). Results: U.S. academic institutions have a variety of policies for research with vulnerable populations. Every institution in our sample had at least 2 policies for research with vulnerable populations (including a general policy) and most had 8 or more. As expected, the most highly prevalent policies pertained to populations covered in subparts B, C, and D of the Common Rule (pregnant women, fetuses, neonates, prisoners, and children) but other groups were well-represented, including people with disabilities; people with impaired decision-making capacity; students/trainees; and people with limited English proficiency including illiteracy. AAHRRP accreditation was positively associated with eight different types of policies. Conclusion: U.S. academic institutions have a variety of policies for research with vulnerable populations. Additional research is needed to better understand the types of safeguards that institutions have adopted to protect vulnerable populations and the factors that influence policy development. [ABSTRACT FROM AUTHOR]

This article describes the development of an institutional quality improvement review board (QIRB) as an effective and efficient method for reviewing and overseeing institutional quality improvement (QI) initiatives. QI projects involve the systematic collection and analysis of data and the implementation of interventions designed to improve the quality of clinical care and/or educational programs for a distinct population in a specific setting. QI projects are fundamentally distinct from human subjects research (HuSR); however, the differences between them are subtle and highly nuanced. Determining whether a project meets the definition of QI or qualifies as HuSR, thus requiring institutional review board (IRB) review, can be confusing and frustrating. Nevertheless, this distinction is highly consequential due to the heavy regulatory requirements involved in HuSR and IRB oversight. Making the correct determination of a project's regulatory status is essential before the project begins. Project leaders may not realize that their work meets the definition of HuSR and, therefore, might conduct the project without appropriate IRB review. Therefore, best practices dictate that project leaders should not decide which type of institutional review is appropriate for their projects. In addition, when QI project teams attempt to disseminate the results of their work, documentation of formal review and approval is generally required by peer-reviewed journals and professional organizations. However, institutional review mechanisms are rarely available. Projects that do not meet the definition of HuSR fall outside the purview of IRBs and most institutions do not have an alternative review body. This creates frustration for both project leaders and IRB administrators. Apart from IRB review, a separate process for reviewing QI projects offers several benefits. These include (1) relieving the burden on busy IRB staff; (2) promoting scholarly activity; (3) protecting the institution, project leaders, and participants from HuSR conducted outside of appropriate IRB review; and (4) promoting rigorous QI methods. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to evaluate the effectiveness of using a vibration device to ease pain during upper extremity injections. Specifically, the study aims to compare the pain levels of patients who receive the injection with and without the use of vibration therapy. The results of this study may have implications for improving patient outcomes and satisfaction during routine injection procedures. Material and Methods: This randomized controlled trial included patients aged 18 years or older who were scheduled to receive an injection in the upper extremity. A total of 60 patients were enrolled and randomized to either the intervention group or the control group using a computer‑generated randomization sequence. The level of satisfaction and pain levels were assessed using a visual analog scale. The study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board. Results: The mean pain score immediately after the injection was 4.03 ± 2.11 out of 10 in the vibration group (n = 30), compared to 7.4 ± 1.37 out of 10 in the control group (n = 30) (P < 0.001). Patients in the vibration group also reported higher levels of satisfaction and comfort during the injection (P < 0.001). No adverse events were reported in either group. Conclusion: Our study proves that using a vibration device during upper extremity injections can effectively reduce postinjection pain and improve patient satisfaction. Further research is needed to explore this intervention’s long‑term effects and feasibility in different clinical settings. [ABSTRACT FROM AUTHOR]

Cerebral arteriovenous malformations (AVMs) are a challenging pathology in pediatric patients, carrying a high risk of morbidity and mortality. Treatment modalities include resection, endovascular embolization, and stereotactic radiosurgery. There is currently no consensus favoring one modality over another. Timing of multimodal therapy with embolization/stereotactic radiosurgery and resection is not well explored in the literature. We present a series of pediatric patients with AVMs, with special attention directed to the timing of treatment. Electronic medical records of all pediatric patients (<18 years old at treatment) with AVMs treated at our institution were retrospectively reviewed after institutional review board approval. Demographic information, AVM characteristics, treatment variables, and outcomes were recorded. In our cohort of 27 patients, 21 (77.8%) presented with a ruptured AVM. Of these patients, 6 (28.6%) had a Glasgow Coma Scale score of 3–10 and underwent treatment within 24 hours of presentation, and 10 (47.6%) with a Glasgow Coma Scale score of 12–15 were treated between 24 and 120 hours after presentation. The remaining 5 patients (23.8%) were treated 3 weeks to 14 months after AVM rupture. Regardless of rupture status, 96% of our cohort had a modified Rankin Scale score of 1–2 at most recent follow-up. We present our institution's experience with pediatric AVMs, focusing on the timing of treatment. Based on our experience, early treatment of AVMs seems to be safe and effective regardless of rupture status. [ABSTRACT FROM AUTHOR]

Background: It can be challenging for children to cooperate for a magnetic resonance imaging (MRI) exam. General anesthesia is often used to ensure a high-quality image. When determining the need for general anesthesia, many institutions use a simple age cutoff. Decisions on the necessity for anesthesia are often left to schedulers who lack training on determination of patient compliance. Objective: The study aimed to evaluate whether screening questions administered by certified child life specialists (CCLS) could successfully predict which children could complete an MRI without sedation. Materials and methods: This is a retrospective, institutional review board approved study. Data was collected as part of a quality improvement program, where a CCLS screened 4- to 12-year-old children scheduled for MRI scanning using a questionnaire. Parent responses to the screening questions, CCLS's recommendation for scheduling the MRI awake, start and end time for the MRI scan, and scan success were recorded. A predictive model for the CCLS's recommendation was developed using the child's age, estimated scan length, scan difficulty, and the parent's responses to the screening questions. The primary outcome measure was a successfully completed MRI not requiring additional imaging under anesthesia. Results: Of the 403 screened children, 317 (79%) were recommended to attempt the MRI without anesthesia. The median age of participants was 7 (IQR 4–17) years. Overall, 309 of 317 (97.5%) participants, recommended by the CCLS for the program, met the primary outcome of successful MRI completion on their first attempt. The multivariable regression model which included clinical information about the child's age, estimated scan length, scan difficulty, and four of the six parent screening questions had excellent performance (area under the curve = 0.89). Conclusion: Information collected by the CCLS via screening along with the child's age, the estimated scan length, and difficulty can help predict which children are likely to successfully complete a non-sedate MRI. [ABSTRACT FROM AUTHOR]

We describe the national health research ethics review system of Uzbekistan and identify policy and program gaps that impede the protection of human research subjects. We find that the National Ethic Committee (NEC), functioning at the national level, is solely responsible for conducting research ethics review. There is little evidence that regional ethics committees work as intended, and there is no research ethics review at medical institutes and research centers even though they conduct CDTs (clinical drug trials). There is no national policy for the ethical review of non-clinical trials. We recommend the establishment of institutional review boards (IRBs) at medical institutes and research centers while at the same time building capacity at the national level to oversee and support the research ethics review system of the entire country. [ABSTRACT FROM AUTHOR]

This article explores the significance of trust in public health response efforts, specifically in relation to the COVID-19 pandemic. Trust in authorities and institutions is crucial for promoting compliance with health protocols and behaviors. Various factors, such as information sources, media credibility, and personal experiences, influence trust. The article focuses on the New York City Test and Trace program and identifies both facilitators and barriers to trust, including the involvement of reputable organizations, adapting to community needs, and forming partnerships. The findings emphasize the importance of trust in public health initiatives and offer insights for enhancing trustworthiness. The article also discusses the implementation of the Test & Trace (T2) program in New York City during the COVID-19 pandemic. The program established partnerships with community-based organizations (CBOs) and community advisory boards (CABs) that had existing relationships with the Department of Health and Mental Hygiene (DOHMH). Trusted sources of information, such as local media outlets, were utilized to effectively communicate COVID-19 information and resources. Hiring frontline staff from local communities who shared similar demographics and identities with community members helped to foster trust. However, barriers to trust included historical mistrust in government and the medical establishment, inconsistent messaging, and misinformation. Recommendations for enhancing trust in public health responses include building relationships with trusted organizations, conducting early media campaigns, and actively addressing misinformation. [Extracted from the article]

Background: Acetaminophen toxicity remains one of the most common causes of liver failure and is treated with a course of n-acetylcysteine (NAC). This exceptionally effective medication is traditionally administered using a complicated three-bag protocol that is prone to administration errors. Objective: We aimed to assess whether switching to a novel two-bag protocol (150 mg/kg over 1 h followed by 150 mg/kg over 20 h) reduced administration errors while not increasing liver injury or anaphylactoid reactions. Methods: This was a retrospective chart review of hospital encounters for patients with acetaminophen toxicity, comparing outcomes before and after the change from a three-bag protocol to a two-bag protocol at two affiliated institutions. The primary outcome was incidence of medication errors with secondary outcomes including acute liver injury (ALI) and incidence of non-anaphylactoid allergic reactions (NAAR). The study was approved by the health system's Institutional Review Board. Results: 483 encounters were included for analysis (239 in the three-bag and 244 in the two-bag groups). NAAR were identified in 11 patients with no difference seen between groups. Similarly, no differences were seen in ALI. Medication administration errors were observed significantly less often in the two-bag group (OR 0.24) after adjusting for confounders. Conclusion: Transitioning to a novel two-bag NAC regimen decreased administration errors. This adds to the literature that two-bag NAC regimens are not only safe but also may have significant benefits over the traditional NAC protocol. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively evaluate the long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis (AWE). Method: The Institutional Review Board approved this retrospective observational review of 40 consecutive patients, of a median age of 37 years (interquartile range [IQR] 32–40 years), presenting with a total of 52 symptomatic AWE nodules. All patients underwent cryoablation between January 2013 and May 2022 with a minimum follow-up period of 12 months. Outcomes were assessed using a visual analog scale (VAS) that measured pain, as well as by magnetic resonance imaging (MRI). The pain-free survival rates were derived using the Kaplan–Meier estimator. Adverse events were analyzed and graded using the classification system of the Cardiovascular and Interventional Radiological Society of Europe. Results: The median follow-up time was 40.5 months (IQR 26.5–47.2 months). The median VAS score before cryoablation was 8 (IQR 7–9). Complete relief of symptoms was documented in 80% (32/40) of patients at 3 months after initial cryoablation and correlated with the absence of residual endometriosis nodules on MRI. The median pain-free survival rates were 89.2% [95% CI, 70.1–96.4%] at 36 months and 76.8% [95% CI, 55.3–83.8%] after 60 months. No patient or lesion characteristics were found to be prognostic of failure. No major adverse events or side effects were reported in long term. Conclusion: Cryoablation safely and effectively afforded long-term pain relief for patients with AWE nodules. Clinical relevance statement: AWE cryoablation was found to be safe and effective in the long-term. Key Points: • Cryoablation is highly effective with 80% of patients experiencing complete relief of AWE symptoms after a single procedure. • Cryoablation is safe without long-term adverse events or side effects. • The median pain-free survival rates are 89.2% at 36 months and 76.8% at 60 months. [ABSTRACT FROM AUTHOR]

Background: Despite the great feasibility of video conferencing platforms, concerns regarding Zoom fatigue, the exhaustion experienced after prolonged virtual meetings, arise. Although often examined from a quantitative standpoint, there remains a significant lack of qualitative exploration of Zoom fatigue. Objective: This study aimed to explore Indian university students' qualitative experiences with synchronous classes and zoom fatigue. Method: Thematic Analysis (TA) was used to analyze in-depth interviews of 24 university students (age = 20.38 ± 1.74, 15 females) enrolled in synchronous courses, i.e. online courses attended by students at the same time they are delivered. Results: Nine primary themes and ten sub-themes were identified by study participants for zoom-delivered courses: (i) beyond screen time; (ii) physical issues; (iii) anxiety; (iv) cognitive difficulties (difficulty in sustaining attention and remembering, multi-tasking, and distraction); (v) experiencing awkwardness (turn-taking and interruption, eye-contact, self-consciousness, and home environment); (vi) technological barriers and discomforts; (vii) lack of sympathy from instructors and administration (regarding self and family's health and regarding technical glitches); (viii) mixed feelings toward instructors (ineffective teaching pedagogy and gratitude and admiration for instructors); and (ix) feeling gratitude. Conclusion: Participants in this study were generally fatigued and dissatisfied with the experience of zoom-delivered classes. Addressing factors contributing to zoom fatigue can ensure the sustainability and effectiveness of synchronous learning. [ABSTRACT FROM AUTHOR]

Background: Patients undergo regular clinical follow-up after laminoplasty for cervical myelopathy. However, those whose symptoms significantly improve and remain stable do not need to conform to a regular follow-up schedule. Based on the 1-year postoperative outcomes, we aimed to use a machine-learning (ML) algorithm to predict 2-year postoperative outcomes. Methods: We enrolled 80 patients who underwent cervical laminoplasty for cervical myelopathy. The patients' Japanese Orthopedic Association (JOA) scores (range: 0–17) were analyzed at the 1-, 3-, 6-, and 12-month postoperative timepoints to evaluate their ability to predict the 2-year postoperative outcomes. The patient acceptable symptom state (PASS) was defined as a JOA score ≥ 14.25 at 24 months postoperatively and, based on clinical outcomes recorded up to the 1-year postoperative timepoint, eight ML algorithms were developed to predict PASS status at the 24-month postoperative timepoint. The performance of each of these algorithms was evaluated, and its generalizability was assessed using a prospective internal test set. Results: The long short-term memory (LSTM)-based algorithm demonstrated the best performance (area under the receiver operating characteristic curve, 0.90 ± 0.13). Conclusions: The LSTM-based algorithm accurately predicted which group was likely to achieve PASS at the 24-month postoperative timepoint. Although this study included a small number of patients with limited available clinical data, the concept of using past outcomes to predict further outcomes presented herein may provide insights for optimizing clinical schedules and efficient medical resource utilization. Trial registration: This study was registered as a clinical trial (Clinical Trial No. NCT02487901), and the study protocol was approved by the Seoul National University Hospital Institutional Review Board (IRB No. 1505-037-670). [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite scholarly activity being an accreditation requirement for residency programs by the Accreditation Council for Graduate Medical Education (ACGME) since 2006, many family medicine programs have struggled to meet this requirement. A myriad of approaches and curricula have been proposed to enhance the scholarly output of residency programs. OBJECTIVES: To determine the impact of a multimodal curricular intervention consisting of clear expectations, structured roadmap, availability of resources, and standardized accountability on the scholarly activity of residents. METHODS: This is a quasi-experimental study with a retrospective data collection. The scholarly activities of residents completing training in the pre-intervention (2009-2012) and post-intervention period (2013-2017) were compared. Chi-square, Fisher's exact, Mann Whitney U, and Kruskal Wallis H tests were utilized to detect differences between the pre- and post-intervention groups. Multivariable Poisson regression models were used to detect independent predictors of per-resident scholarly activity. The institutional review board determined that the study was exempt from full review. RESULTS: A total of 67 residents, 20 (30%) pre-intervention and 47 (70%) post-intervention, were included in the analysis. The number of total scholarly activities per resident increased significantly in the post-intervention period after adjusting for confounding factors (1.9 vs 6.4). The number of scholarly activities per resident also showed an increasing trend over time (P =.04). Moreover, traditional scholarship, including published manuscripts (0.35 vs 2.43) and national-level presentations (0.35 vs 1.27) also increased in the post-intervention period. CONCLUSION: Implementing this comprehensive curriculum increased the scholarly output of residents and helped enrich the scholarship culture in the residency program. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TXA) effectively attenuates hyperfibrinolysis and preemptive administration has been employed to reduce bleeding and blood transfusions in various surgical settings. However, TXA administration could be associated with adverse effects, such as seizures and thromboembolic risks. While patients with fibrinolysis shutdown showed greater thromboembolic complications and mortality, TXA administration may aggravate the degree of shutdown in these patients. Selective TXA administration based on the results of rotational thromboelastometry (ROTEM) would be non-inferior to preemptive TXA administration in reducing postoperative bleeding and beneficial in reducing its risks in patients undergoing cardiovascular surgery. Methods: This non-inferiority, randomized, double-blind, placebo-controlled, multicenter trial will be performed in 3 tertiary university hospitals from August 2023 to March 2025. Seven hundred sixty-four patients undergoing cardiovascular surgery will be randomly allocated to get TXA as a preemptive (Group-P) or goal-directed strategy (Group-GDT) in each institution (with a 1:1 allocation ratio). After anesthesia induction, TXA (10 mg/kg and 2 mg/kg/h) and a placebo are administered after anesthesia induction in Group-P and Group-GDT, respectively. ROTEM tests are performed immediately before weaning from CPB and at the considerable bleeding post-CPB period. After getting the test results, a placebo is administered in Group-P (regardless of the test results). In Group-GDT, placebo or TXA is administered according to the results: placebo is administered if the amplitude at 10 min (A10-EXTEM) is ≥ 40 mm and lysis within 60 min (LI60-EXTEM) of EXTEM assay is ≥ 85%, or TXA (20 mg/kg) is administered if A10-EXTEM is < 40 mm or LI60-EXTEM is < 85%. The primary outcome is inter-group comparisons of postoperative bleeding (for 24 h). The secondary measures include comparisons of perioperative blood transfusion, coagulation profiles, reoperation, thromboembolic complications, seizures, in-hospital mortality, fibrinolysis phenotypes, and hospital costs. Discussion: The absence of inter-group differences in postoperative bleeding would support the selective strategy's non-inferiority in reducing postoperative bleeding in these patients. The possible reduction in thromboembolic risks, seizures, and fibrinolysis shutdown in Group-GDT would support its superiority in reducing TXA-induced adverse events and the cost of their management. Trial registration: This trial was registered at ClinicalTrials.gov with the registration number NCT05806346 on March 28, 2023. Trial status: recruiting. Issue date: 2023 March 28 (by Tae-Yop Kim, MD, PhD). The trial was registered in the clinical registration on March 28, 2023 (ClinicalTrials.gov, NCT05806346) and revised to the latest version of its protocol (version no. 8, August 26, 2024) approved by the institutional review boards (IRBs) of all 3 university hospitals (Konkuk University Medical Center, 2023–07-005–001, Asan Medical Center, 2023–0248, and Samsung Medical Center, SMC 2023–06-048–002). Its recruitment was started on August 1, 2023, and will be completed on December 31, 2024. Protocol amendment number: 08 (protocol version 08, August 26, 2024). Revision chronology: 2023 March 28:Original. 2023 April 10:Amendment No 01. The primary reason for the amendment is the modification of Arms (adding one arm for sub-group analyses) and Interventions, Outcome Measures, Study Design, Study Description, Study Status, Eligibility, and Study Identification. 2023 May 03:Amendment No 02. The primary reason for the amendment is to modify the Outcome Measures and update the study status. 2023 July 06:Amendment No 03. The primary reason for amendment is to update the chronological study status. 2023 July 07:Amendment No 04. The primary reason for the amendment is the modification of study information (the treatment category was changed to diagnostic, and Phase 4 was changed to not applicable) and a chronological update on the study status. 2023 September 12:Amendment No 06. The primary reason for the amendment is a chronological update in the study status and the inclusion of additional information regarding contacts/locations and oversight. 2023 December 29:Amendment No 07. The primary reason for the amendment is to modify the outcome measures (including detailed information on outcome measures, addition of extra secondary measures, and chronological updates in study status). 2024 August 26:Amendment No 08. The primary reason for the amendment is to add detailed descriptions regarding data handling and the names and roles of the participating institutions and to update the chronological process of the trial. [ABSTRACT FROM AUTHOR]

The approval and effectiveness of immune checkpoint inhibitors in head-and-neck squamous cell carcinoma (HNSCC) highlights the role of the immune system in this tumor entity. HNSCCs not only interacts with the immune system in the tumor tissue, but also induce systemic effects that may be additionally influenced by further factors such as the microbiome. Nonetheless, reliable immunological biomarkers that predict treatment response and outcome in HNSCC patients are lacking. The currently available biomarkers are mainly limited to analyses from tumor biopsies, while biomarkers from liquid biopsies, such as peripheral blood are not well-established. Thus, the here presented trial aims to identify interactions of intra-tumoral and systemic immune responses and to define prognostic immune signatures. Consequently, not only samples from the tumor tissue, but also from peripheral blood and the microbiome will be studied/are being evaluated and correlated with the clinical outcome. In this prospective, multi-center trial, 1000 HNSCC patients and 100 patients in the control cohort with non-tumor head-and-neck surgery will be enrolled. The local immune status from of the tumor and the microbiome will be sampled before treatment. In addition, the systemic immune status from peripheral blood will be analyzed before and after surgery and after the adjuvant and definitive radio-chemotherapy (RCT). Clinical baseline characteristics and outcome will additionally be collected. Data mining and modelling approaches will finally be applied to identify interactions of local and systemic immune parameters and to define prognostic immune signatures based on the evaluated immune markers. Approval from the institutional review board of the Friedrich-Alexander-Universität Erlangen-Nürnberg was granted in December 2021 (application number 21-440-B). By now, 150 patients have been enrolled in the intervention cohort. The results will be disseminated to the scientific audience and the general public via presentations at conferences and publication in peer-reviewed journals. [ABSTRACT FROM AUTHOR]

Background: Patients affected by ulcerative colitis (UC) often require surgery, involving two or three-stage procedures, including ileostomy creation. While ileostomy has some advantages, it can lead to complications, such as dehydration. The aim of this study was to evaluate the impact of a new individualized stoma-therapeutic-care-pathway (STCP) on dehydration-related readmissions. Secondary endpoints were stoma-related complications. Methods: The study compares two series of consecutive patients with UC undergoing diverting ileostomy during restorative ileo-pouch-anal-anastomosis. The STCP group consists of patients enrolled from January 2020 to December 2021 who followed the pathway. The older group was selected from 2015 to 2017 (control group). Clinical data were collected, including patient characteristics, hospital stay, complications, and readmissions. The study was approved by the local institutional review board. Results: Overall, 30-day dehydration-related readmission occurred in one (1.4%) versus nine (15.3%) patients in the STCP group versus control group, respectively (p = 0.005). In-hospital peristomal skin complications were significantly lower in STCP group (6 patients, 8.5%) versus control (35, 59.3%), as well as ostomy complications that occurred in 5 (7%) patients in the STCP group versus 8 (13.5%) in the control group (both p < 0.001). Ostomy complications reduced significantly in the STCP group after discharge (two patients, 2.8% versus eight, 13.5%), p = 0.001, and after 30-days (three patients, 4.2% versus five, 8.5%). Conclusions: This study underscores the effectiveness of STCP in reducing dehydration-related readmissions and stoma-related complications in patients with UC undergoing stoma creation. It emphasizes the significance of patient education, close follow-up, and multidisciplinary care. Further research and standardized stoma education are essential. [ABSTRACT FROM AUTHOR]

This document presents two studies on the use of reslizumab as a treatment for severe asthma with persistent sputum eosinophilia. The first study examines the effects of higher doses of reslizumab on sputum eosinophils in patients who did not respond to the standard dose. The study found that 40% of patients achieved normalized sputum eosinophils after four infusions, while the remaining 60% required a higher dose. The second study focuses on the use of inhaled corticosteroids and found that higher doses of reslizumab led to better suppression of eosinophils and improved asthma control. The studies highlight the potential benefits of higher doses of reslizumab in treating severe asthma with persistent sputum eosinophilia and the importance of assessing and classifying patients based on sputum cytokines. [Extracted from the article]

Background: Semiquantitative and quantitative sonographic techniques have the potential for screening and surveillance of children at risk of nonalcoholic fatty liver disease. Objective: To determine diagnostic performance and interobserver agreement of hepatorenal index (HRI) for pediatric ultrasound-based liver fat quantification. Materials and methods: In an institutional review board (IRB)-approved retrospective study (April 2014 to April 2023), children (< 18 years) with clinically performed magnetic resonance imaging (MRI) scans for liver fat quantification were assessed. Inclusion criteria required availability of abdominal ultrasound within 3 months of quantitative MRI. Three blinded readers subjectively assessed for sonographic hepatic steatosis and calculated HRI. MRI proton density fat fraction (PDFF) was the reference standard. Interobserver agreement, correlation with PDFF, and optimal HRI (using ROC analysis) values were analyzed. The significance level was set at p < 0.05. Results: A total of 41 patients (25 male) with median (interquartile range (IQR)) age of 13 (10–15) years were included. Median (IQR) MRI PDFF was 11.30% (2.70–17.95%). Hepatic steatosis distribution by MRI PDFF included grade 0 (34%), grade 1 (15%), grade 2 (22%), and grade 3 (29%) patients. Intraclass correlation coefficient for HRI among the three readers was 0.61 (95% CI 0.43–0.75) (p < 0.001). Moderate correlation was observed between manually estimated HRI and PDFF for each reader (r = 0.62, 0.67, and 0.67; p < 0.001). Optimal HRI cutoff was found to be 1.99 to diagnose hepatic steatosis (sensitivity 89%, specificity 93%). Median (IQR) HRI for each MRI grade of hepatic steatosis (0–4) was as follows: 1.2 (1.1–1.5), 2.6 (1.1–3.3), 3.6 (2.6–5.4), 5.6 (2.6–10.9), respectively (p < 0.001). Conclusion: Ultrasound-estimated HRI has moderate interobserver agreement and moderate correlation with MRI-derived PDFF. HRI of 1.99 maximizes accuracy for identifying pediatric liver fat. [ABSTRACT FROM AUTHOR]