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Psychiatric emergencies in the geriatric population are expected to increase in the next decade and pose a unique challenge for clinicians in the emergency department or emergency consult setting. This cohort generally presents with numerous medical comorbidities and polypharmacy, and clinicians must be aware of age-related changes in physiology and pharmacokinetics. Geriatric psychiatric emergencies may also be precipitated by psychosocial factors such as retirement, grief, or elder abuse. Evaluation should initially focus on safety and typically requires utilization of collateral sources of history. Underlying medical etiologies of delirium should be ruled out, in addition to dementia screening and evaluation of depression or decompensated psychiatric illness. Medications should be used judiciously if indicated, and particular attention should be given to drug interactions and risk of toxicity. The COVID-19 pandemic has complicated the evaluation and management of psychiatric emergencies because there must now be clear procedures for screening, isolating, and treating COVID-19-positive patients. Age remains one of the most robust risk factors for both morbidity and mortality due to COVID-19. The growing use of telepsychiatry has improved access to emergency psychiatric services, geriatric patients included, but can be challenging.

Telemedicine is a modern tool for healthcare delivery that uses various forms of technology to provide medical services remotely. Telemedicine use by healthcare providers and patients has been increasing in frequency for the past several years. The increasing utilization of telemedicine has been fueled by various reasons, including: The onset of the COVID19 pandemic; decrease in the number of healthcare providers available to see patients; the increasing number of insured patients seeking healthcare access. The survey was conducted by family residents working within the Texas Institute of Graduate Medical Education And Research (TIGMER) Family Medicine program. The patients surveyed are all patients of Communicare, a federally qualified health care (FQHC) facility. Out of 353 patients, 125 patients provided responses to the six questions mentioned above. Overall, patients seem to have enjoyed and benefited from the telemedicine visit over the weekend. While further follow-up questions and bigger sample size would be necessary to provide better insights, the survey shows that weekend telemedicine definitely benefits both patients and primary care clinics in terms of patient-provider satisfaction, access to healthcare, and financial benefits.

Background: Facial attractiveness influences our perceptions of others, with beautiful faces reaping societal rewards and anomalous faces encountering penalties. The purpose of this study was to determine associations of visual attention with bias and social dispositions toward people with facial anomalies.Methods: Sixty subjects completed tests evaluating implicit bias, explicit bias, and social dispositions before viewing publicly available images of preoperative and postoperative patients with hemifacial microsomia. Eye-tracking was used to register visual fixations.Results: Participants with higher implicit bias scores fixated significantly less on the cheek and ear region preoperatively (P = 0.004). Participants with higher scores in empathic concern and perspective taking fixated more on the forehead and orbit preoperatively (P = 0.045) and nose and lips (P = 0.027) preoperativel.Conclusions: Participants with higher levels of implicit bias spent less visual attention on anomalous facial anatomy, whereas participants with higher levels of empathic concern and perspective taking spent more visual attention on normal facial anatomy. Levels of bias and social dispositions such as empathy may predict layperson gaze patterns toward those with facial anomalies and provide insights to neural mechanisms underlying the “anomalous is bad” paradigm.

Immune checkpoint inhibitors (ICIs) are a new class of cancer pharmacotherapy consisting of antibodies that block inhibitory immune regulators such as cytotoxic T lymphocyte antigen 4, programmed cell death 1 and programmed death-ligand 1. Checkpoint blockade by ICIs reactivates a tumor-specific T cell response. Immune-related adverse events can occur in various organs including skin, liver, and gastrointestinal tract. Mild to severe colitis is the most common side effect with some experiencing rapid progression to more serious complications including bowel perforation and even death. Prompt diagnosis and management of ICI-induced colitis is crucial for optimal outcome. Unfortunately, its clinical, endoscopic and histopathologic presentations are non-specific and overlap with those of colitis caused by other etiologies, such as infection, medication, graft

Background: Facial proportionality and symmetry are positively associated with perceived levels of facial attractiveness.Objective: The aims of this study were to confirm and extend the association of proportionality with perceived levels of attractiveness and character traits and determine differences in attractiveness and character ratings between "anomalous" and "typical" faces using a large dataset.Methods: Ratings of 597 unique individuals from the Chicago Face Database were used. A formula was developed as a proxy of relative horizontal proportionality, where a proportionality score of "0" indicated perfect proportionality and more negative scores indicated less proportionality. Faces were categorized as "anomalous" or "typical" by 2 independent reviewers based on physical features.Results: Across the ratings for all faces, Spearman correlations revealed greater proportionality was associated with attractiveness ( ρ = 0.292, P < 0.001) and trustworthiness ( ρ = 0.193, P < 0.001), while lesser proportionality was associated with impressions of anger (ρ = 0.132, P = 0.001), dominance (ρ = 0.259, P < 0.001), and threateningness ( ρ = 0.234, P < 0.001). Mann-Whitney U tests revealed the typical cohort had significantly higher levels of proportionality (-13.98 versus -15.14, P = 0.030) and ratings of attractiveness (3.39 versus 2.99, P < 0.001) and trustworthiness (3.48 versus 3.35, P < 0.001).Conclusions: This study demonstrated that facial proportionality is not only significantly associated with higher ratings of attractiveness, but also associated with judgements of trustworthiness. Proportionality plays a role in evoking negative attributions of personality characteristics to people with facial anomalies.

Data regarding expression of intestinal markers in hepatocellular carcinoma (HCC) are limited. We determined the clinicopathological associations of cytokeratin (CK)19, a progenitor liver epithelial cell marker as well as biliary epithelial marker, and intestinal immunohistochemical markers expression in HCC and assessed their prognostic value.Tissue sections and/or tissue microarrays (TMAs) from 202 known HCCs were immunostained using CK19, CK20, CDH17, CDX2 and SATB2 antibodies. Haematoxylin and eosin (HE)-stained slides were reviewed for tumour grading. Clinical and oncological outcomes were retrieved. Associations of staining with clinicopathological features and survival outcomes were evaluated. CK19, CK20, CDH17, CDX2 and SATB2 were positive in 12.8, 5.4, 10.3, 8.6 and 59.9%, respectively. All but SATB2 were strongly associated with higher tumour grade and AFP levels 400 ng/ml (P 0.05). CK19-positive HCC were more likely to express CDX2 (P = 0.001), CDH17 (P 0.001) and/or CK20 (P = 0.012). CK20, CDX2 and CDH17 co-expression was seen in five cases (2.5%). CK19 and SATB2 positivity, tumour size ≥ 5 cm, background cirrhosis, AFP 400 ng/ml and having no treatment were associated with decreased overall survival by log-rank test and univariable proportional hazards regression. However, in a multivariable model, CK19 and SATB2 positivity were not independent predictors of decreased survival while their association with known poor prognosticators in HCC was evident.HCC can express markers of intestinal differentiation. This phenotypical aberrancy correlates with variable clinicopathological parameters, some of which are independent predictors of poor survival.

Background Little is known regarding important long-term outcomes following robotic paraesophageal hernia (PEH) repairs, such as symptom relief and recurrence rates. The aim of this study was to evaluate the long-term clinical outcomes in a large series of patients undergoing robotic PEH repair. Methods This prospective, IRB-approved study analyzed adult patients who underwent robotic PEH repair from 2010 to 2014 at a high-volume tertiary academic medical center. Detailed information on patient characteristics, perioperative factors, and long-term patient reported outcomes for up to 5-years post-operatively were collected. Objective long-term outcomes included radiographic evidence of PEH recurrence at 1, 3, and 5-years post-operatively. Results A total of 233 patients underwent robotic PEH repair during the study period – 70% were primary, while 30% were revisional. Seventy-eight percent of patients (181) had a type III PEH, 21% (49) had a type IV, and 1% ( 3 ) had a type II. At 5-years post-operatively, 62% (145/233) of patients were available for follow-up with a radiographic recurrence rate of 9% (13/145). Additionally, there was a significant improvement in the GERD-HRQL score at 5-years post-operatively (pre-operative: 25.6 ± 8.7, 5-year post-operative, 4.5 ± 1.7, p Conclusion This study represents one of the largest longitudinal robotic foregut surgical databases to date. Our results demonstrate that robotic PEH repair with an experienced surgical team is a safe and effective alternative to laparoscopic repair with excellent long-term outcomes including a very low recurrence rate.

Cemiplimab; Càncer de coll uterí metastàtic; Càncer de coll uterí recurrent Cemiplimab; Cáncer de cuello uterino metastásico; Cáncer de cuello uterino recurrente Cemiplimab; Metastatic cervical cancer; Recurrent cervical cancer Objectives To characterize the safety, tolerability, and anti-tumor activity of cemiplimab as monotherapy or in combination with hypofractionated radiation therapy (hfRT) in patients with recurrent or metastatic cervical cancer. To determine the association between histology and programmed death-ligand 1 (PD-L1) expression. Methods In non-randomized phase I expansion cohorts, patients (squamous or non-squamous histology) received cemiplimab 3 mg/kg intravenously every 2 weeks for 48 weeks, either alone (monotherapy cohort) or with hfRT during week 2 (combination cohort). Due to insufficient tissue material, PD-L1 protein expression was evaluated in commercially purchased samples and mRNA expression levels were analyzed from The Cancer Genome Atlas (TCGA). Results Twenty patients enrolled in both cohorts in total; 10 had squamous histology. The most common adverse events of any grade were diarrhea, fatigue, and hypokalemia, occurring in 35%, 25%, and 25%, respectively. Objective response rate was 10% in each cohort; responders had squamous histology. Duration of response was 11.2 months and 6.4 months for the responder in the monotherapy and combination cohort, respectively. Irradiated lesions were not included in the response assessments. In separate archived specimens ( N = 155), PD-L1 protein expression in tumor and immune cells was negative (

The robotic surgical approach offers enhanced visualization, dexterity and reach, which may facilitate the more technically demanding portions of paraesophageal hernia (PEH) repair such as hiatal reconstruction and mediastinal dissection. We sought to compare the peri-operative clinical outcomes of the laparoscopic vs. robotic approach to PEH repair. A prospective, IRB-approved database was maintained for all robotic PEH repairs performed by a single surgeon at a tertiary academic hospital from 2009 to 2019. A retrospective review of laparoscopic PEH over this same time period was used as a comparison group. Outcome measures included: operative time, conversion to open, need for an esophageal lengthening procedure, operative equipment costs and length of stay (LOS). 1854 patients underwent PEH repair during this time period (830 robotic; 1024 laparoscopic). Demographics of both groups were similar, including BMI and PEH type, although a higher proportion of robotic cases were re-operative PEH repairs (32.5% vs 24.0%; p

Context: Eating disorders (EDs) in male athletes are potentially debilitating disorders with significant medical, psychological, and athletic performance consequences. Evidence Acquisition: Searches were performed across PubMed, EBSCOhost, and PSYCinfo from 1990 to 2019. Keywords searched were eating disorder, male, athlete, anorexia nervosa, bulimia nervosa, muscularity, muscle dysmorphia, and sports. Search results included articles written in the English language and encompassed reviews, empirical studies, and theoretical articles. Study Design: Clinical review. Level of Evidence: Level 3. Results: EDs among male athletes may lead to serious negative outcomes, including increased susceptibility to injury, inconsistent performance, problematic recovery, muscle deficiencies, impairment of optimal athletic functioning, and medical, social, and emotional problems. Male athletes with EDs may be more difficult to identify and diagnose for a variety of reasons related to differential presentation of symptoms, secretiveness or shame around behaviors, and sex-related stigma. Conclusion: Professionals working closely with athletes are uniquely positioned to identify and screen those who may require further evaluation and treatment.

Background. The risk of active TB among solid organ transplant (SOT) recipients and patients initiating chronic dialysis in a country with low incidence of TB is not well elucidated. Methods. Patients aged >18 years who were transplanted with a solid organ or initiated chronic dialysis at Copenhagen University Hospital in the period 2004-2017 were followed from date of transplantation or initiation of dialysis. Data on demographics and outcomes were obtained from nationwide registries. Results. We included 1,989 SOT recipients and 1,305 patients initiating chronic dialysis, who were followed for a total of 9,785 and 4,196 person-years (PY), respectively. Only a minority of patients had been screened for latent TB prior to SOT or initiation of dialysis. The incidence rates (IRs)/100,000 PY of TB among patients from medium/high TB endemic areas were 358 (95% CI 115-1,110) and 1,266 (95% CI 681-2354) for SOT and dialysis patients, respectively, whereas IRs among patients of Danish origin were 11 (95% CI 2-81) and 31 (95% CI 4-218). Conclusion. The incidence of TB among immunosuppressed immigrants from medium/high TB endemic countries was very high, while the risk of TB among patients from low-endemic countries was minimal.

Peer victimization is a common concern in adolescence that includes both relational (e.g., exclusion, rumor spreading) and overt (e.g., hitting, threatening) forms (CrickBigbee, 1998). Relational and overt peer victimization have shown to be differentially associated with depressive symptoms, with relational peer victimization showing a stronger association to depressive symptoms than overt peer victimization (CasperCard, 2017). The current study uses an accelerated longitudinal research design to investigate: (a) how relational and overt peer victimization and depressive symptoms change over an accelerated age period from 11.1 to 16.8 years (centered at 12.5 years), and (b) concurrent and prospective associations of relational and overt peer victimization with depressive symptoms. Gender differences are investigated. Participants included 1,434 adolescents in grades 7 to 9 (53.5% girls

BackgroundDuoBody-PD-L1×4-1BB (GEN1046) is a class-defining, bispecific immunotherapy designed to induce an antitumor immune response by simultaneous and complementary PD-L1 blockade and conditional 4-1BB stimulation. Encouraging clinical activity and manageable safety were observed during dose escalation in the ongoing phase 1/2a trial in patients with advanced solid tumors (NCT03917381). We report exploratory pharmacodynamic analyses and potential biomarkers of response in an expansion cohort of patients with PD-(L)1–R/R NSCLC.MethodsPatients with metastatic/unresectable NSCLC who had multiple lines of prior systemic therapy, including a checkpoint inhibitor, received flat-dose DuoBody-PD-L1×4-1BB (100 mg) intravenously every 3 weeks. Immunophenotyping of peripheral blood and measurements of soluble immune mediators were evaluated in serial blood samples in cycles 1–2. Tumor PD-L1 and 4-1BB expression and additional immune markers were evaluated by immunohistochemistry in core needle tumor biopsy specimens collected before treatment and at cycle 2.ResultsAs of May 2021, 40 patients with PD-(L)1–R/R NSCLC were enrolled (median age, 63 years). Treatment with DuoBody-PD-L1×4-1BB elicited pharmacodynamic modulation of immune endpoints within the first 2 cycles. Induction of peripheral IFN-y, CXCL9/10, and expansion of peripheral CD8+ effector memory T cells and activated NK cells were observed starting at cycle 1 (>2-fold from baseline) and maintained or increased through cycle 2. Based on 9 paired tumor biopsy samples, increased PD-L1 and 4-1BB expression and cytotoxic CD8+/GZMB+ cell density were detected following treatment. In a subset of patients with clinical response (n=5 confirmed PRs), a trend of greater induction of IFN-y, CXCL9/10, and activated NK cells was observed vs nonresponders. Disease control rates were higher in patients who had progressed on prior anti–PD-1 therapy within 8 months (64% [16/25]) from the first dose of DuoBody-PD-L1×4-1BB. As expected, among patients with evaluable baseline tumors (n=26), most with any degree of tumor reduction (best change, ConclusionsIn patients with NSCLC who progressed on PD-(L)1 therapy, DuoBody-PD-L1×4-1BB elicited pharmacodynamic effects consistent with its proposed mechanism of action. Relationships between disease control and PD-L1 tumoral expression, as well as time from last prior anti–PD-1 therapy, were observed. These findings support that patient selection and/or anti–PD-1 combination therapy may lead to improved clinical efficacy. Further analyses are ongoing and updated results will be presented.AcknowledgementsThe authors thank Hrefna Kristin Johannsdottir, Lei Pang, and Kate Sasser at Genmab A/S and Friederike Gieseke at BioNTech SE for their valuable contributions. This trial was funded by Genmab A/S and BioNTech SE.Trial RegistrationNCT03917381Ethics ApprovalThis trial is undertaken following full approval of the final protocol, amendments, informed consent form, applicable recruiting materials, and subject compensation programs by the Independent Ethics Committee/Institutional Review Board.ConsentWritten informed consent, in accordance with principles that originated in the Declaration of Helsinki 2013, current ICH guidelines including ICH-GCP E6(R2), applicable regulatory requirements, and sponsor policy, was provided by the patients.

Objectives The aim of this systematic literature review was to focus on the use of diffusion-weighted magnetic resonance imaging (DWI) in the evaluation of salivary gland diseases. Study Design Databases were searched, and original research manuscripts up to 2018 were identified by using the keywords “diffusion” combined with “salivary gland,” “salivary gland neoplasm,” “sialadenitis,” “parotid gland,” “submandibular gland,” “sublingual gland,” “minor salivary gland,” “salivary gland fistula,” “salivary gland calculi,” “salivary ducts,” “xerostomia,” and “sialorrhea.” Only English language manuscripts and studies pertaining to DWI were selected. Results In all, 66 investigations regarding various salivary gland diseases, such as neoplasms, postirradiation changes, and inflammatory and autoimmune diseases, were included. Most study objectives involved the use of the apparent diffusion coefficient (ADC) in differentiating between benign lesions and malignant neoplasms. Histologic features of evaluated samples were heterogeneous. Conclusions DWI may improve the differential diagnosis of salivary gland diseases, particularly in distinguishing between benign and malignant neoplasms. A unique ADC cutoff value could not be established because of the heterogeneity of the methods applied for ADC assessment and the heterogeneity of the diseases. DWI and the ADC are valuable tools in the diagnosis of salivary gland disease.

The Deep Space Optical Communication (DSOC) project will demonstrate free-space optical communication at almost 3 AU, or 3 orders of magnitude further than any previous attempt. DSOC will utilize the 5m Palomar Hale Telescope to receive the downlink signal, which will couple the downlink light onto an optical table and into a superconducting nanowire single photon detector (SNSPD). The output of the SNSPD is digitized by the Ground Laser Receiver Signal Processing Assembly (GSPA) using a high throughput streaming time to digital converter (TDC). The GSPA is a scalable FPGA-based receiver which demodulates and decodes the DSOC downlink signal through novel signal processing algorithms implemented on Xilinx UltraScale+ FPGAs, as well as Python-based software monitor and control routines. Exploiting the unique TDC-based architecture, the GSPA supports over four orders of magnitude of downlink data rates across multiple orders of magnitude of signal and background powers. In this paper we present an overview of the hardware, firmware and software architectures to implement this system, as well as performance analysis for links ranging from near-Earth to 2.8 AU.

Autism Spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and social interaction, repetitive and stereotyped behaviors, and/or sensory aberrations. On the other hand, obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions. In consideration of these distinct pathologies, research suggests that anxiety disorders and OCD are highly prevalent in individuals with ASD. This case report will discuss an adolescent patient with ASD and OCD who experiences an exacerbation, most notably, in his symptoms of OCD. We outline the hospital course of a 13 year-old male who ultimately requires nasogastric (NG) tube feeding resulting from an acute worsening in symptoms and refusal of oral intake during the COVID-19 pandemic. The patient demonstrated significant improvement in symptoms following the administration of high-dose selective serotonin reuptake inhibitor (SSRI) and low-dose antipsychotic therapy.

Self-injurious behaviors (SIB) are elevated in autism spectrum disorder (ASD) and related genetic disorders, but the genetic and biological mechanisms that contribute to SIB in ASD are poorly understood. This study examined rates and predictors of SIB in 112 individuals with disruptive mutations to ASD-risk genes. Current SIB were reported in 30% of participants and associated with poorer cognitive and adaptive skills. History of severe abdominal pain predicted higher rates of SIB and SIB severity after controlling for age and adaptive behavior; individuals with a history of severe abdominal pain were eight times more likely to exhibit SIB than those with no history. Future research is needed to examine associations between genetic risk, pain, and SIB in this population.

Background T-cell targeting of mutation-derived epitopes (neoantigens) has shown to drive anti-tumor responses. Immunizing patients against such neoantigens in combination with a checkpoint inhibitor (CPI) may elicit greater anti-tumor responses than CPI alone. Mutations are rarely shared between patients, thus requiring a personalized approach to vaccine design. mRNA-4157 is a lipid encapsulated mRNA based personalized cancer vaccine encoding neoantigens selected using a proprietary algorithm to induce neoantigen specific T cells and associated anti-tumor responses. This report includes updates from the mRNA-4157 Phase1(P1) study. The initial data was presented at ASCO2019.1 Methods This study evaluates the safety and efficacy of mRNA-4157 as monotherapy in patients with resected solid tumors (Part A) and in combination with pembrolizumab in patients with advanced/metastatic solid tumors (Parts B). The selected solid tumors in Part A-B includes melanoma, bladder carcinoma, HPV-negative (HPV-neg) HNSCC, NSCLC, SCLC, MSI-High (MSI-h), or TMB-High cancers. Expansion cohorts includes patients with CPI-naive MSS-CRC and HPV-neg HNSCC (Part C) and with resected melanoma (Part D). Patients receive up to 9 cycles (Q3W) of mRNA-4157 by intramuscular injection at up to 1 mg alone (Part A) or in combination with pembrolizumab (200 mg IV Q3W, Parts B-D). Pembrolizumab is administered for two cycles before the first dose of mRNA-4157 and may continue after 9 cycles of combination. Endpoints include safety, tolerability, efficacy and biomarker assessments. Results 79 patients received mRNA-4157; 16 as monotherapy and 63 in combination with pembrolizumab. Only low grade and reversible treatment related AEs were reported. 14/16 Part A patients (3 melanoma, 11 NSCLC, 2 MSI-h CRC) remained disease free on study. 28 patients in Parts B (6 bladder, 2 HNSCC, 3 melanoma, 10 NSCLC, 2 SCLC, 4 MSI-h tumor, 1 TMB-h tumor), 27 patients in Part C (10 HNSCC and 17 MSS-CRC), and 8 patients with resected melanoma (Part D) received combination. 3 CR (1 HNSCC, 1 MSI-h CRC and 1 MSI-h prostate), and 8 PR (1 bladder, 4 HNSCC, 2 SCLC and 1 MSI-h endometrial) were observed with combination. Of 10 CPI-naive HPV-neg HNSCC patients, the response rate was 50% (1CR, 4PR, 4SD) mPFS 9.8months, which compared favorably to published rates of ~14.6% mPFS 2.0months for pembrolizumab monotherapy.2 3 Biomarker assessments including immune gene expression profiling will be presented. Conclusions mRNA-4157 has an acceptable safety profile along with observed clinical responses in combination with pembrolizumab. Preliminary efficacy analysis from CPI-naive relapsed/refractory HPV-neg HNSCC cohort suggests activity of this combination. Study is ongoing. Trial Registration NCT03313778 Ethics Approval The study was approved by each participating sites’ local IRB. References Burris H, et al. A phase I multicenter study to assess the safety, tolerability, and immunogenicity of mRNA-4157 alone in patients with resected solid tumors and in combination with pembrolizumab in patients with unresectable solid tumors. Journal of Clinical Oncology20 May 2019;37(15):2523-2523. Seiwert T, et al. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol 2016;17:956–65. Cohen E, et al. Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study. Lancet 2019;393:10167:156-16.

Asian citrus psyllid, Diaphorina citri Kuwayama, negatively impacts the citrus industry as it transmits Candidatus Liberibacter spp., the causal agent of citrus greening. Monitoring D. citri population levels is critical for management of vectors and citrus greening and is usually through use of yellow sticky traps. In our study, use of odors, odor blends, and visual targets were evaluated to determine whether attraction to yellow sticky traps could be improved. Methyl salicylate consistently increased D. citri attraction to decoy yellow but not to other yellow or yellow/green traps. Addition of a visual target did not enhance attraction to sticky traps. While several chemical blends were evaluated, they did not increase psyllid attraction to decoy yellow traps. The increased attraction to traps with methyl salicylate is promising and may contribute to trapping efficiency under field conditions.

The robotic surgical approach offers enhanced visualization, dexterity and reach, which may facilitate the more technically demanding portions of paraesophageal hernia (PEH) repair such as hiatal reconstruction and mediastinal dissection. We sought to compare the peri-operative clinical outcomes of the laparoscopic vs. robotic approach to PEH repair.A prospective, IRB-approved database was maintained for all robotic PEH repairs performed by a single surgeon at a tertiary academic hospital from 2009 to 2019. A retrospective review of laparoscopic PEH over this same time period was used as a comparison group. Outcome measures included: operative time, conversion to open, need for an esophageal lengthening procedure, operative equipment costs and length of stay (LOS).1854 patients underwent PEH repair during this time period (830 robotic; 1024 laparoscopic). Demographics of both groups were similar, including BMI and PEH type, although a higher proportion of robotic cases were re-operative PEH repairs (32.5% vs 24.0%; p 0.001). Patients who underwent a robotic PEH had a significant reduction in esophageal lengthening procedures performed (0.1% vs. 11.0%; p 0.001), conversion to open (0% vs. 7.0%; p 0.001), and LOS (1.8 days vs. 3.1 days; p 0.001). Intra-operative equipment costs were similar.In one of the largest robotic PEH case series reported to date, there were significant improvements in peri-operative outcomes in patients undergoing a robotic-assisted approach. Although a greater number of patients in the robotic group were redo PEH repairs, when compared to the laparoscopic group, there were no conversions to open and significantly fewer esophageal lengthening procedures, both of which carry significant morbidity. The similar intra-operative costs were likely balanced by the higher costs associated with stapling equipment and conversions in the laparoscopic group. Our findings show that the robotic PEH repair is safe and can result in improved peri-operative outcomes.

Podcasts are increasingly being used for medical education, both within teaching institutions and on an international scale by major journals. To date, there are no evidence-based guidelines for the development of educational podcasts. To review the state of the literature, MEDLINE, SCOPUS, and ERIC were searched in May 2016 for articles describing audio format podcasts used in medical education. Eighty-four articles met inclusion criteria. A qualitative synthesis of the evidence was done using Kirkpatrick’s model for evaluating outcomes. Twenty-four articles described reaction outcomes, eleven described learning outcomes, and one described behavioral outcomes. None measured patient impact. The literature demonstrates that podcasts are both feasible and accepted by learners. The mean length of reported podcasts was 18 minutes, which falls within the recommended range in at least one paper, and is consistent with reported listener preference. Interview format, clear disclosures, and accurate information were reported as desirable. There is limited evidence showing the efficacy of podcasts as teaching tools, or regarding best practices in making podcasts. More rigorous studies evaluating efficacy, changes in behavior, and changes in patient outcomes need to be performed in order to prove podcasts’ value and to justify production costs.