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Examines a case of unilateral headache reminiscent of hemicrania continua which is resistant to indomethacin but responsive to gabapentin. Clinical manifestations; Diagnostic results; Drug dosage and administration.

Incident reporting in Emergency Medical Services (EMS) is vital for enhancing patient safety and system performance, but time constraints often impede efficient documentation. Hamad Medical Corporation Ambulance Service Group (HMCASG) implemented a streamlined "Occurrence, Variance, and Accident" (OVA) reporting system to address these challenges. This study evaluated the effectiveness of this system in reducing incident report completion time. A "Lean" approach was used to streamline the reporting process. Four-hundred eighty-two OVA reports (241 baseline, 241 post-intervention) submitted between September 13 and October 8, 2022, were analyzed. The time taken to complete an OVA report was measured. Statistical analyses included Student t-tests, bivariate regression, and a Shewhart control chart. The mean time to complete an OVA report decreased significantly from 328.9 to 145.09 seconds (p < 0.05). The Shewhart control chart visually demonstrated the intervention's impact, while regression analysis confirmed its significance (p = 0.007). The streamlined OVA reporting system significantly reduced reporting time, addressing the challenge of balancing incident reporting with emergency response availability. This lean-based approach enhanced operational efficiency, promoted risk reduction, and strengthened prehospital care's foundation for quality improvement., (© 2025 American Society for Health Care Risk Management.)

Objective: This research explored the experiences and perspectives of patients declining hospital transportation after receiving prehospital emergency care using advanced computational techniques., Method: Between 15th June and 1st August 2023, 210 patients in Qatar, treated by Hamad Medical Corporation Ambulance Service (HMCAS) but refusing transportation to hospital, were interviewed. Key outcome variables stratified by demographics included "reasons for refusing transport," "satisfaction with HMCAS service," and "postrefusal actions." Responses underwent sentiment analysis and topic modeling using latent Dirichlet allocation. Machine learning models, such as Naïve Bayes, K-nearest neighboring, random forest, and support vector machine, were used to predict patients' subsequent actions., Results: Participants had an average age of 38.61 ± 19.91 years. The chief complaints were primarily chest and abdominal pains (18.49%; n = 39). Sentiment Analysis revealed a generally favorable perception of HMCAS-provided service. Latent Dirichlet allocation identified two main topics pertaining to refusal reasons and service satisfaction. Naïve Bayes and support vector machine algorithms were most effective in predicting postrefusal actions with an accuracy rate of 81.58%., Conclusions: This study highlighted the utility of Natural Language Processing and ML in enhancing our understanding of patient behaviors and sentiments in prehospital settings. These advanced computational methodologies allowed for a nuanced exploration of patient demographics and sentiments, providing insights for Quality Improvement initiatives. The study also advocates for continuously integrating automated feedback mechanisms to improve patient-centered care in the prehospital context. Continuous integration of automated feedback systems is recommended to improve prehospital patient-centered care., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The seedling stage is the most vulnerable period of growth and development for annual weeds and an important target for weed management operations. To address this, several weed emergence models have been developed, but none are commercially available. Therefore, this study aims to develop a web application that implements predictive weed emergence models for eight different weed species, utilizing weather data sourced from public weather stations., Results: Lolium rigidum Gaudin presented a mean root mean squared error (RMSE) value of 8.9, achieving an RMSE value below 15 (success rate) in 84.5% of cases. This result may be attributed to the use of a water potential base, set at -0.4 MPa, to evaluate water availability. Centaurea diluta Aiton achieved an RMSE value below 15 in all situations, with an average value of 9.0. This weed showed higher accuracy at southern sites than northern sites. Conversely, Avena sterilis ssp. ludoviciana (Durieu) Gillet & Magne achieved higher precision at northern sites where no dry periods occurred. The newly developed model for Bromus diandrus Roth. achieved an average RMSE value of 7.7 and a 100% success rate. Papaver rhoeas L. and the three Phalaris species exhibited lower accuracy in this study than in previous ones. Nonetheless, the success rates for Papaver rhoeas and Phalaris paradoxa L. were still above 70%., Conclusion: Models for C. diluta, B. diandrus, L. rigidum, Papaver rhoeas and Phalaris paradoxa have demonstrated potential for adoption in commercial production, while Phalaris minor and Phalaris brachystachys models require refinement. © 2023 Society of Chemical Industry., (© 2023 Society of Chemical Industry.)

The major concern with COVID-19 therapeutic monoclonal antibodies is the loss of efficacy against continuously emerging variants of SARS-CoV-2. To predict antibody efficacy against future Omicron subvariants, we conducted deep mutational scanning (DMS) encompassing all single mutations of the receptor-binding domain of the BA.2 strain utilizing an inverted infection assay with an ACE2-harboring virus and library spike-expressing cells. In the case of bebtelovimab, which preserves neutralization activity against BA.2 and BA.5, a broad range of amino acid substitutions at K444, V445, and G446, and some substitutions at P499 and T500, were indicated to achieve the antibody escape. Among subvariants with current rises in case numbers, BA2.75 with G446S partially evaded neutralization by bebtelovimab, while complete evasion was observed in XBB with V445P and BQ.1 with K444T. This is consistent with the DMS results against BA.2, highlighting the potential of DMS as a predictive tool for antibody escape.

While androgen is considered a pivotal regulator of sexually dimorphic development, it remains unclear how it orchestrates the differentiation of reproductive organs. Using external genitalia development as a model, we showed that androgen, through the transcription factor MafB , induced cell migration by remodeling the local extracellular matrix (ECM), leading to increased cell contractility and focal adhesion assembly. Furthermore, we identified the matrix metalloproteinase Mmp11 as a MafB target gene under androgen signaling. MMP11 remodels the local ECM environment by degrading Collagen VI (ColVI). The reduction of ColVI led to the fibrillar deposition of fibronectin in the MafB -expressing bilateral mesenchyme both in vivo and ex vivo . The ECM remodeling and development of migratory cell characteristics were lost in the MafB loss-of-function mice. These results demonstrate the requirement of mesenchymal-derived androgen signaling on ECM-dependent cell migration, providing insights into the regulatory cellular mechanisms underlying androgen-driven sexual differentiation., Competing Interests: The authors have nothing to declare., (© 2022.)

Many industrial chemicals have been reported as antiandrogenic substances. Exposure to these substances represents a potential risk to human health, particularly to the development of reproductive organs such as embryonic external genitalia (eExG). Currently, there is a need for more assay systems that can elucidate the toxicological actions and mechanisms of endocrine-disrupting chemicals. In this study, we show that the eExG slice culture assay is useful for the evaluation of the differing modes of action of endocrine-disrupting chemicals on urethra formation. We assessed the possible endocrine-disrupting activity of 3 chemicals with reported antiandrogenic function, diazinon, dibutyl phthalate, and fenitrothion (FNT) on eExG slices. Exposure to FNT, but not diazinon and dibutyl phthalate, induced defects of androgen-induced urethral masculinization and reduced expression of the androgen-target gene Mafb. Live imaging analyses showed that FNT treatment inhibited androgen-dependent MAFB induction within 12 h. Furthermore, FNT-treated tissue slices showed reduced expression of the androgen receptor. These results indicate that FNT disrupts androgen signaling by reduction of androgen receptor expression during androgen-induced eExG masculinization. This study thus highlights the importance of animal models, which allow for the effective assessment of tissue-specific endocrine-disrupting activity to further reveal the etiology of chemical-induced congenital anomalies., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

External genitalia development in mice involves multiple developmental processes under the regulation of various signaling pathways. Wnt5a, one of the major Wnt ligands, is a crucial developmental regulator of outgrowing organs such as the limb, the mandible, and the external genitalia. Defects in Wnt5a signaling have been linked to Robinow syndrome, a genetic disorder in which male patients manifest a micropenis and defective urethral tube formation. Whereas Wnt5a is required for cell proliferation during embryonic external genitalia outgrowth, its role for urethral tube formation has yet to be understood. Here, we show that Wnt5a contributes to urethral tube formation as well as external genitalia outgrowth. Wnt5a is expressed in the embryonic external genitalia mesenchyme, and mesenchymal-specific conditional Wnt5a knockout mice resulted in hypospadias-like urethral defects. Early deletion of Wnt5a at E10.5 showed severe defects in both external genitalia outgrowth and urethral tube formation, along with reduced cell proliferation. The severe urethral tube defect persisted during later timing deletion of Wnt5a (E13.5). Further analyses revealed that loss of Wnt5a disrupted cell polarity and led to a reduction of the phosphorylated myosin light chain and the focal adhesion protein, vinculin. Altogether, these results suggest that Wnt5a coordinates cell proliferation and directed cell migration in a stage-dependent manner during male external genitalia development. Furthermore, Wnt5a may regulate cell polarity, focal adhesion formation, and cell contractility, leading to directed cell migration during male-type urethral formation in a manner that has not been reported in other organ fusion events., (© 2021 Japanese Teratology Society.)

Development of external genitalia and perineum is the subject of developmental biology as well as toxicology and teratology researches. Cloaca forms in the lower (caudal) end of endoderm. Such endodermal epithelia and surrounding mesenchyme interact with various signals to form the external genitalia. External genitalia (the anlage termed as genital tubercle: GT) formation shows prominent sexually dimorphic morphogenesis in late embryonic stages, which is an unexplored developmental research field because of many reasons. External genitalia develop adjacent to the cloaca which develops urethra and corporal bodies. Developmental regulators including growth factor signals are necessary for epithelia-mesenchyme interaction (EMI) in posterior embryos including the cloaca and urethra in the genitalia. In the case of male type urethra, formation of tubular urethra proceeds from the lower (ventral) side of external genitalia as a masculinization process in contrast to the case of female urethra. Mechanisms for its development are not elucidated yet due to the lack of suitable mutant mouse models. Because of the recent progresses of Cre (recombinase)-mediated conditional target gene modification analyses, many developmental regulatory genes become increasingly analyzed. Conditional gene knockout mouse approaches and tissue lineage approaches are expected to offer vital information for such sexually dimorphic developmental processes. This review aims to offer recent updates on the progresses of these emerging developmental processes for the research field of congenital anomalies., (© 2018 Japanese Teratology Society.)

The morphogenesis of mammalian embryonic external genitalia (eExG) shows dynamic differences between males and females. In genotypic males, eExG are masculinized in response to androgen signaling. Disruption of this process can give rise to multiple male reproductive organ defects. Currently, mechanisms of androgen-driven sexually dimorphic organogenesis are still unclear. We show here that mesenchymal-derived actomyosin contractility, by MYH10, is essential for the masculinization of mouse eExG. MYH10 is expressed prominently in the bilateral mesenchyme of male eExG. Androgen induces MYH10 protein expression and actomyosin contractility in the bilateral mesenchyme. Inhibition of actomyosin contractility through blebbistatin treatment and mesenchymal genetic deletion induced defective urethral masculinization with reduced mesenchymal condensation. We also suggest that actomyosin contractility regulates androgen-dependent mesenchymal directional cell migration to form the condensation in the bilateral mesenchyme leading to changes in urethral plate shape to accomplish urethral masculinization. Thus, mesenchymal-derived actomyosin contractility is indispensable for androgen-driven urethral masculinization., Competing Interests: The authors declare no competing interests.