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An increased number of climate proxy records and more refined interpretation of proxy data are crucial to improve projections of future climate at high latitudes, where internal feedbacks amplify warming and established high-resolution climate archives are especially sparse. Encrusting coralline algae are being developed as a mid- to high-latitude marine climate archive. These long-lived algae form a solid high-Mg calcite skeleton with annual growth bands similar to those of trees and tropical corals. The oxygen isotope ratio of the algal skeleton (δ18Oalg) records local environmental and climatic factors, notably sea surface temperature and seawater δ18O. Here we assess the δ18Oalg–climate relationship in diverse environments across the algal habitat range utilizing two species of coralline algae from the genus Clathromorphum. Clathromorphum is widely distributed from the cold-temperate North Atlantic and Pacific to the Arctic Ocean and has recently yielded numerous climate reconstructions of up to 650 years in length. In this study, we calibrate δ18Oalg of four specimens to gridded temperature and salinity data, the latter a proxy for seawater δ18O. These specimens were collected from a variety of algal growth environments across the high-latitude Northern Hemisphere: two specimens from the Aleutian Archipelago, one from the Canadian Arctic, and one from the Gulf of Maine. Low winter temperatures and insolation restrict the months when algae record local climate in the δ18O of their skeletons; we therefore determine these response seasons by correlating monthly temperature and salinity anomalies with annual δ18Oalg anomalies at each site. We then average gridded data over months that correlate significantly (95% confidence interval) for regression with δ18Oalg. While the timing and nature of the climate signal vary across sites, we find significant relationships between δ18Oalg and either temperature or salinity averaged over the response season at three sites. Variation in local climatology among the four sites provides a physical explanation for calibration differences, compounded by uncertainties stemming from the proxy chronology, biological variability, temporal coverage, and sparse historical climate data. This work takes an essential step toward reconstructing high-latitude marine climate patterns with coralline algal δ18O and developing algae proxy system models.

Stringent environmental legislation demands development of internal combustion engines seeking higher thermal efficiency to reduce greenhouse gas emissions. Brazilian governmental programs like ROTA 2030 and RenovaBio drive the research and development of highly efficient engines fueled with biofuels, like sugarcane bioethanol, that has a near to zero carbon footprint. Some technologies such as gasoline direct injection, variable valve train, and turbocharging were implemented in downsized Spark Ignition (SI) engines in order to reach higher thermal efficiencies and decrease CO2 emissions. Homogeneous lean combustion in SI operation can improve fuel consumption and reduce exhaust gas emissions. However, it is limited by combustion instability and the three-way-catalyst (TWC) inability to work properly converting nitrogen oxides (NOx). With lean combustion the NOx emissions could be significantly reduced, enabling the use of lean NOx trap (LNT) as an effective lower cost after treatment system. To explore the limits of homogeneous lean combustion in SI engines, experimental tests were performed to investigate performance, efficiency, combustion, and emission parameters of a multi-cylinder Ford 1.0l Ti-VCT EcoBoost engine fueled with hydrous ethanol. Hydrous ethanol is a commercial Brazilian fuel which has greater laminar flame speed and higher dilution tolerance than gasoline, and thus can increase combustion stability. Different fuel direct injection strategies were explored at part load (below 8.0 bar IMEP) at engine speed of 1500 rpm. Air-to-fuel ratio was varied from stoichiometric (lambda 1.0) to lambda 1.5. The limit of stable homogeneous lean combustion (COVIMEP ≤ 3.0%) was achieved in lambda 1.4. The lowest indicated load of 2.1 bar IMEP was limited by combustion stability at lambda 1.3. The maximum indicated efficiency was 36.9% at indicated load of 8.0 bar IMEP and lambda 1.4. The NOx emissions dropped below 1.4 g/kWh at 4.0 bar IMEP and lambda 1.4. [ABSTRACT FROM AUTHOR]

Purpose: Researchers who conduct cluster-randomized studies must account for clustering during study planning; failure to do so can result in insufficient study power. To plan adequately, investigators need accurate estimates of clustering in the form of intraclass correlation coefficients (ICCs).Methods: We used data for 5,042 patients, from 61 practices in 8 practice-based research networks, obtained from the Prescription for Health program, sponsored by the Robert Wood Johnson Fund, to estimate ICCs for demographic and behavioral variables and for physician and practice characteristics. We used an approach similar to analysis of variance to calculate ICCs for binary variables and mixed models that directly estimated between- and within-cluster variances to calculate ICCs for continuous variables.Results: ICCs indicating substantial within-practice clustering were calculated for age (ICC = 0.151), race (ICC = 0.265), and such behaviors as smoking (ICC = 0.118) and unhealthy diet (ICC = 0.206). Patients' intent-to-change behaviors related to smoking, diet, or exercise were less clustered (ICCs ≤0.007). Within-network ICCs were generally smaller, reflecting heterogeneity among practices within the same network. ICCs for practice-level measures indicated that practices within networks were relatively homogenous with respect to practice type (ICC = 0.29) and the use of electronic medical records (ICC = 0.23), but less homogenous with respect to size and rates of physician and staff turnover.Conclusion: ICCs for patient behaviors and intent to change those behaviors were generally less than 0.1. Though small, such ICCs are not trivial; if cluster sizes are large, even small levels of clustering that is unaccounted for reduces the statistical power of a cluster-randomized study. [ABSTRACT FROM AUTHOR]

This study examined the general characteristics of chief executive officers (CEOs) and their hospitals and the perceived impact of CEO turnover on various organizational activities. A mail-based survey included 156 hospital CEOs in 6 states in the West South Central, West North Central, and Mountain regions. Neither hospital and CEO characteristics nor the impact on various organizational activities and performance indicators was significantly different among the 6 states compared. Overall, CEOs reported relatively short tenures, frequent promotion from within the organization to CEO level, and common involuntary departure of their predecessors. Respondents overwhelmingly reported a positive impact of leadership change on financial performance, employee morale, and organizational culture. [ABSTRACT FROM AUTHOR]

CEO turnover, although common, is expensive and disruptive for everyone involved. Both incoming and outgoing CEOs would welcome help in making the transition a painless experience. Through a 2005 nationwide survey of 805 current hospital CEOs, the authors obtained comments and suggestions in response to three open-ended questions about specific activities or processes that would help incoming and outgoing CEOs. Mostly, CEOs felt the need for a structured orientation process, succession planning, concrete peer and organizational support, training on recruitment and retention for the board, and an adequate separation package including continued healthcare coverage. Copyright © 2007 Heldref Publications [ABSTRACT FROM AUTHOR]

Empirical evidence is scarce on chief executive officer (CEO) turnover in U.S. hospitals, with potentially serious implications for many of these organizations. This study, based on a nationwide survey of CEOs at non-federal general surgical and medical community hospitals conducted in the spring of 2004, reports the perceptions of hospital CEOs regarding the circumstances and impact of CEO turnover on U.S. hospitals. In the opinion of the respondents, the impact includes competitors taking advantage of turnover by luring employees and physicians away from the target hospital, significantly increasing the likelihood of other senior executives leaving the hospital, and many of the important strategic activities being delayed or cancelled altogether. Interestingly, the perceptions of CEOs regarding the effects of turnover do not seem to differ regardless of voluntary or involuntary circumstances of turnover. However, there is a notable bias in emphasizing the perceived negative implications of respondents' own departures and allegedly positive effects of their predecessors' departures. Copyright © 2006 Heldref Publications [ABSTRACT FROM AUTHOR]

Objective: Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes.Research Design and Methods: A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both.Results: Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (A1C) with feedback + reminders (deltaA1C 0.6%, final A1C 7.46%) were significantly better than control (deltaA1C 0.2%, final A1C 7.84%, P < 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both A1C and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final A1C 7.5 vs. 8.2%, P < 0.001).Conclusions: Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalists with diabetes specialists may be important to enhance diabetes management in other primary care settings. [ABSTRACT FROM AUTHOR]

Primary infection with Pneumocystis carinii usually occurs early in life, and young infants receiving prolonged treatment with high-dose corticosteroids may be at risk for the development of symptomatic disease. Prophylaxis with trimethoprim-sulfamethoxazole is safe and effective and should be considered for such infants, particularly those with underlying airway abnormalities. We describe a 3-month-old immunocompetent infant who developed severe P carinii pneumonia after 6 weeks of high-dose corticosteroid therapy for cervicofacial and airway hemangiomas. [ABSTRACT FROM AUTHOR]

Article Highlights: Maternally inherited diabetes and deafness (MIDD) is a mitochondrial disorder characterized primarily by hearing impairment and diabetes. m.3243A>G, the most common phenotypic variant, causes a complex rewiring of the cell with discontinuous remodeling of both mitochondrial and nuclear genome expressions. We propose that MIDD depends on a combination of insulin resistance and impaired β-cell function that occurs in the presence of high skeletal muscle heteroplasmy (approximately ≥60%) and more moderate cell heteroplasmy (∼25%-72%) for m.3243A>G. Understanding the complex mechanisms of MIDD is necessary to develop disease-specific management guidelines that are presently lacking., (© 2024 by the American Diabetes Association.)

Purpose: We examined the impact of the COVID-19 consortium recommendations on the surgical management of breast cancer during the first year of the pandemic., Methods: Patients with newly diagnosed ER + DCIS, ER- DCIS, AJCC Stage cT1-2N0-1 ER + , HER2-, HER2 + , and triple negative breast cancer were identified from the National Cancer Database from 2018 to 2021. An interrupted time series design evaluated differences in surgical delay and use of neoadjuvant chemotherapy/immunotherapy (NAC) and endocrine therapy (NET) before and after the pandemic., Results: A total of 895116 female patients were included in the study with a mean age of 61.7 years. Time to surgery decreased by an average 5.5 days from January 2020 to May 2020 for all breast cancer types, corresponding with a 62.2% decrease in breast cancer diagnoses per month from January 2020 to April 2020. The use of NET increased from 5.6 to 23.6% from January to March 2020 for patients with ER + DCIS and 8.0 to 31.1% for ER + cT1-2N0 cancer (both p < 0.01). The use of NAC for HER2 + tumors and triple negative breast cancers has been increasing since 2018 and a larger than expected increase was seen from 57.2 to 63.6% for HER2 + tumors and 55.6 to 68.7% for triple negative breast cancers (both p < 0.01). Treatment practices returned to pre-pandemic levels in June 2020., Conclusion: Prior to the publication of the Consortium recommendations, time to surgery decreased while the use of NET and NAC increased, with the resumption of pre-pandemic practices by June 2020., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The gold standard of microfluidic fabrication techniques, SU-8 patterning, requires photolithography equipment and facilities and is not suitable for 3D microfluidics. A 3D printer is more convenient and may achieve high resolutions comparable to conventional photolithography, but only with select materials. Alternatively, 5-axis computer numerical control (CNC) micro-milling machines can efficiently prototype structures with high resolutions, high aspect ratios, and non-planar geometries from a variety of materials. These machines, however, have not been catered for laboratory-based, small-batch microfluidics development and are largely inaccessible to researchers. In this paper, we present a new 5-axis CNC micro-milling machine specifically designed for prototyping 3D microfluidic channels, made affordable for research and laboratories. The machine is assembled from commercially available products and custom-build parts, occupying 0.72 cubic meters, and operating entirely from computer aided design (CAD) and manufacturing (CAM) software. The 5-axis CNC micro-milling machine achieves sub-μm bidirectional repeatability (≤0.23 μm), machinable features <20 μm, and a work volume of 50 × 50 × 68 mm. The tool compatibility and milling parameters were designed to enable fabrication of virtually any mill-able material including metals like aluminum, brass, stainless steel, and titanium alloys. To demonstrate milling high resolution and high aspect ratios, we milled a thin wall from 360 brass with a width of 18.1 μm and an aspect ratio of ∼50 : 1. We also demonstrated fabricating molds from 360 brass with non-planar geometries to create polydimethylsiloxane (PDMS) microfluidic channels. These included a channel on a 90° edge and a channel on a rounded edge with a 250 μm radius of curvature. Our 5-axis CNC micro-milling machine offers the most versatility in prototyping microfluidics by enabling high resolutions, geometric complexity, a large work volume, and broad material compatibility, all within a user-friendly benchtop system.

Purpose: The National Accreditation Program for Breast Centers (NAPBC) launched the Patient-Reported Observations for Medical Procedure Timeliness quality collaborative to assess time intervals between screening and treatment for patients with breast cancer., Methods: Sites submitted monthly timeliness data in calendar days from 2019 to 2021 along with their perceptions of timeliness at their centers and facility characteristics. All patients were included in the interval from screening to diagnosis, whereas only patients with cancer were included in the biopsy to treatment intervals. Institutions were compared and assessed for differences and associations with center characteristics via the Kruskal-Wallis test., Results: Three hundred seventy-three (64.5%) NAPBC-accredited breast centers enrolled, and 311 (83.3%) provided complete timeliness metrics. Two hundred nine (56%) sites did not have trainees, 154 (41.3%) sites were within 10 miles of a major city, and the median number of annual breast cancer cases was 280 (IQR, 189-366). From 2019 to 2021, the time between diagnosis and treatment was as follows: 11-12 days between screening mammogram (MGM) and diagnostic MGM, 8-9 days between diagnostic MGM and biopsy, 32-34 days between biopsy and neoadjuvant therapy, and 39-42 days between biopsy and surgery. The enrolled centers believe that these intervals should be 7, 7, 21, and 28 days, respectively. Higher annual case volume and a larger number of surgeons exclusively devoted to breast disease were significantly associated with longer time intervals., Conclusion: Time from biopsy to first treatment is longer than that centers expected compared with time from screening to diagnosis. There is significant variability across NAPBC in time from screening mammogram to treatment, and some institutions will face more challenges with timely quality measures than others. Further investigation into whether these differences confer outcome differences should be pursued.

Competing Interests: Disclosures: Marie L. Fefferman, Danielle M. Thompson, Lee G. Wilke, Shelley Hwang, Richard Bleicher, Laura M. Freedman, Jane L. Meisel, Kristine Kuchta, and Katharine Yao have no conflicts of interest to declare that may be relevant to the contents of this study.

Background: Since 2022, the Commission on Cancer (CoC) has developed three new breast cancer quality measures (QMs): time to surgery (BCSdx) and radiation (BCSRT) and the use of neoadjuvant therapy for triple negative and HER2/neu positive breast cancer (BneoCT). This study assesses CoC center historical performance for these measures and facility factors associated with low performance., Methods: We examined the median number of days for time to surgery and radiation, and the proportion of facilities that achieved an estimated performance rate (EPR) of 70%, 80%, and 90% from 2004 to 2020 for all three measures. Multivariable logistic regression analysis was used to determine the association between facility factors and not achieving 80% EPR for all three measures., Results: The median number of days to surgery and radiation in 2004 were 16 and 43, respectively, compared with 34 and 48 in 2020 (p < 0.01). For BneoCT, BCSdx, and BCSRT measures, the proportion of facilities that attained ≥ 80% EPR was 68.5%, 72.2%, and 35.2%, respectively. The proportion of facilities that attained ≥ 80% EPR in 2004 was 92.3% for BCSdx and 49.8% for BCSRT compared with 69.6% and 39.4%, respectively, in 2020. BneoCT performance improved over time. Academic facilities and facilities serving a larger proportion of socioeconomically disadvantaged patients were approximately twice as likely to be unable to achieve compliance with all three QMs., Conclusions: Performance levels for BCSRT are the lowest of all three measures. Academic centers and centers with a higher proportion of Medicaid patients are more likely to have lower adherence with all three QMs., Competing Interests: Disclosures: None, (© 2024. Society of Surgical Oncology.)

Objectives: Pediatric epistaxis is a common, often non-operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers., Methods: Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed., Results: In total, 122 patients were included for analysis. Over a follow-up duration of 20.5 months (IQR 8-36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution ( n  = 122). Refractory epistaxis was associated with a family history of coagulopathy ( p  = .007), daily epistaxis episodes ( p  = .043), and anemia ( p <.001). Average direct hospital costs associated with nasal cautery were $187 for in-office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in-office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work-up was $576., Conclusion: Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care. Level of Evidence : 4., Competing Interests: The authors have no conflicts of interest or financial disclosures., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Clinical studies on the treatment of type 1 diabetes with device-encapsulated pancreatic precursor cells derived from human embryonic stem cells found that insulin output was insufficient for clinical benefit. We are conducting a phase 1/2, open-label, multicenter trial aimed at optimizing cell engraftment (ClinicalTrials.gov identifier: NCT03163511 ). Here we report interim, 1-year outcomes in one study group that received 2-3-fold higher cell doses in devices with an optimized membrane perforation pattern. β cell function was measured by meal-stimulated plasma C-peptide levels at 3-month intervals, and the effect on glucose control was assessed by continuous glucose monitoring (CGM) and insulin dosing. Of 10 patients with undetectable baseline C-peptide, three achieved levels ≥0.1 nmol l -1 from month 6 onwards that correlated with improved CGM measures and reduced insulin dosing, indicating a glucose-controlling effect. The patient with the highest C-peptide (0.23 nmol l -1 ) increased CGM time-in-range from 55% to 85% at month 12; β cell mass in sentinel devices in this patient at month 6 was 4% of the initial cell mass, indicating directions for improving efficacy., (© 2023. The Author(s).)

Background: Pediatric tracheostomy decannulation protocols vary among institutions and may include toleration of Passy Muir Valve (PMV), microlaryngoscopy and bronchoscopy (MLB) findings, and polysomnography evaluation. Transtracheal pressure (TTP) is an objective measurement utilized to evaluate PMV toleration. We aimed to investigate the role of TTP in decannulation candidates and compare TTP measurements with polysomnography and MLB findings., Methods: A retrospective cohort study of children who underwent TTP measurement during PMV trial between December 2012 and November 2022., Results: A total of 79 patients underwent TTP measurement and MLB evaluation; of these, 16 (20.3%) patients had a capped polysomnography. Twenty-eight (35.4%) patients had TTPs ≤10 cm H 2 O, and 51 (64.6%) patients had TTPs >10 cm H 2 O. The most common indication for tracheostomy was upper airway obstruction (n = 41, 51.9%), followed by a need for mechanical ventilation (n = 24, 30.4%). Twenty-five (31.6%) patients were decannulated. Patients with TTPs ≤10 cm H 2 O had a mean Apnea-Hypopnea Index of 0.17 ± 0.26/h compared with 6.93 ± 7.67/h in those with TTPs >10 cm H 2 O, p = 0.0365. Patients with TTPs >10 cm H 2 O were found to have a significantly higher occurrence of airway obstruction (96.1% vs. 46.4%, p < 0.0001) and multilevel airway obstruction (70.6% vs. 21.4%, p < 0.0001) on MLB. Neither TTP measured at time of PMV assessment nor capped polysomnography was associated with successful decannulation., Conclusions: TTP measurements at time of PMV evaluation are associated with polysomnography and MLB findings. One-time PMV measurements were not indicative of decannulation success., Level of Evidence: 4 Laryngoscope, 134:3377-3383, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Private donors contributed more than $350 million to local election officials to support the administration of the 2020 election. Supporters argue these grants were neutral and necessary to maintain normal election operations during the pandemic, while critics worry these grants mostly went to Democratic strongholds and tilted election outcomes. How much did these grants shape the 2020 presidential election? To answer this question, we collect administrative data on private election administration grants and election outcomes. We then use advances in synthetic control methods to compare presidential election results and turnout in counties that received grants to counties with similar election results and turnout before 2020. While Democratic counties were more likely to apply for a grant, we find that the grants did not have a noticeable effect on the presidential election. Our estimates of the average effect on Democratic vote share range from 0.03 to 0.36 percentage points. Our estimates of the average effect of receiving a grant on turnout range from 0.03 to 0.14 percentage points. Across specifications, our 95% CIs typically include negative effects and all fail to include effects on Democratic vote share larger than 0.58 percentage points and effects on turnout larger than 0.40 percentage points. We characterize the magnitude of our effects by asking how large they are compared to the margin by which Biden won the 2020 election. In simple bench-marking exercises, we find that the effects of the grants were likely too small to have changed the outcome of the 2020 presidential election., Competing Interests: Competing interests statement:The authors declare no competing interest.

Chondrodysplasia punctata (CDP) is a rare congenital syndrome characterized by aberrant, punctate deposition of calcium during endochondral bone formation, resulting in the characteristic finding of epiphyseal stippling on radiographs. While otolaryngologic manifestations such as nasomaxillary hypoplasia and mixed hearing loss are common, tracheobronchial calcification occurs rarely in neonates with CDP. The management of CDP-related airway stenosis is complex and there is limited literature pertaining to outcomes of airway interventions. Herein, we describe the clinical course and outcome of tracheal dilation for a newborn patient with CDP. Laryngoscope, 134:1464-1468, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

This study aimed to describe a novel transphyseal osteotomy (TPO) for acute deformity correction in children with bilateral tibia vara and the atraumatic 'slipped proximal tibial epiphysis' (SPTE) entity. We described the clinical and radiological findings in five children (10 limbs) with tibia vara that were treated with the TPO. The criteria for the SPTE were met in nine (9/10) cases. The surgical technique and short-term results of the TPO are reported. The median age was 9 years (range, 6-9), with obesity (BMI > 95th centile) present in all children. The medial tibial plateau was not significantly depressed (the median angle of depression of the medial plateau measured 30° (range, 20°-32°). The mean medial proximal tibial angle of 33° (range, 8°-71°) was corrected to 82° (range, 77°-86°), the mean anatomic posterior proximal tibial angle of 48° (range, 32°-70°) was corrected to 72° (range, 61°-86°), and the median internal tibial rotation of 45° (range, 20°-50° internal rotation) was corrected to neutral rotation (range, 10° internal-10° external rotation). There were two complications: one case of recurrent deformity and one case of intra-articular extension of the osteotomy. We describe a novel TPO that aims to simultaneously correct all aspects of the deformity, stabilise the physis, and prevent recurrence through epiphysiodesis. Further research is required to determine its efficacy and safety. The atraumatic SPTE appears to represent a specific morphological presentation in tibia vara. Level of evidence: 4., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Since 2020, the world has been battling the coronavirus disease 2019 (COVID-19) pandemic. The mortality and morbidity at the height of the pandemic sparked generalised fear and uncertainty about the future. Concerns were raised about the psychological impact of the pandemic on workers in healthcare systems globally. This study was conducted to establish the degree of psychological impact of the pandemic on frontline health workers in Lesotho., Methods: The study used a quantitative cross-sectional survey design. The Kessler psychological distress screening tool (K-10) and the post-traumatic stress disorder (PTSD) checklist for civilians (PCL-C) were administered to screen for psychological distress among clinical staff at St. Joseph's Hospital in Roma and its four Health Centres. Additional open- and closed-ended questions were added for context. Data were analysed using Fisher's exact tests, Pearson chi-square tests and correlation studies., Results: Of the 101 participants, 42 (41.6%) scored ≥ 24 on the K-10 scale (95% CI: 32.0% - 51.2%) indicating moderate to severe psychological distress and 32 (31.7%) scored ≥ 50 on the PCL-C checklist suggesting severe PTSD (95% CI: 24.5% - 42.9%). High scores on the K-10 were found more among men than women (17 [37.8%] vs. 4 [7.1%]; p ≤ 0.001). Post-traumatic stress disorder was more in the younger age group (p ≤ 0.03), in those reporting anxiety (p = 0.005) and those with more co-morbidities (p ≤ 0.001)., Conclusion: This study revealed the grave psychological impact of the COVID-19 pandemic on frontline clinical health workers in Lesotho.Contribution: These data will assist health leaders and policymakers to implement mental health support interventions for health workers in future.

Objective: Epiglottopexy has been an increasingly utilized intervention in children with epiglottic prolapse and airway obstruction. Given the role of the epiglottis in protecting the airway during swallowing and the potential effect of repositioning the epiglottis on the passage of the bolus, we aimed to compare swallowing outcomes before and after epiglottopexy in children., Study Design: A retrospective cohort study., Setting: Tertiary care children's hospital., Methods: Data were extracted from charts of children who underwent epiglottopexy and had a subsequent instrumental swallowing evaluation between January 2018 and September 2022., Results: A total of 93 patients underwent epiglottopexy. Of these, 38 patients met inclusion requirements. The mean age at surgery was 41 ± 47 months. Most patients (n = 37, 97.4%) had significant comorbidities such as secondary airway lesions (n = 33, 91.7%), a genetic or syndromic disorder (n = 25, 69.4%), and dysphagia (n = 29, 76.3%). All patients had a concurrent procedure at the time of epiglottopexy with supraglottoplasty (n = 24, 63.2%) and lingual tonsillectomy (n = 16, 42.1%) being the most common. No changes in initiation or patterns of swallowing were noted postoperatively. A total of 7 (18.4%) patients had worsening swallow function: 2 had new-onset dysphagia, and 5 had worsening pre-existing dysphagia. Liquid or food textures penetrated remained unchanged or improved in most cases. No risk factors for worsening dysphagia were identified in our cohort., Conclusion: Children with medical comorbidities undergoing epiglottopexy with additional airway interventions may experience new or worsening dysphagia. However, the procedure is generally safe without notable patterned changes in the swallowing mechanism., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Background: Macroencapsulated pancreatic endoderm cells (PECs) can reverse diabetes in rodents and preclinical studies revealed that thyroid hormones in vitro and in vivo bias PECs to differentiate into insulin-producing cells. In an ongoing clinical trial, PECs implanted in macroencapsulation devices into patients with type 1 diabetes were safe but yielded heterogeneous outcomes. Though most patients developed meal responsive C-peptide, levels were heterogeneous and explanted grafts had variable numbers of surviving cells with variable distribution of endocrine cells., Methods: We measured circulating triiodothyronine and thyroxine levels in all patients treated at 1 of the 7 sites of the ongoing clinical trial and determined if thyroid hormone levels were associated with the C-peptide or glucagon levels and cell fate of implanted PECs., Results: Both triiodothyronine and thyroxine levels were significantly associated with the proportion of cells that adopted an insulin-producing fate with a mature phenotype. Thyroid hormone levels were inversely correlated to circulating glucagon levels after implantation, suggesting that thyroid hormones lead PECs to favor an insulin-producing fate over a glucagon-producing fate. In mice, hyperthyroidism led to more rapid maturation of PECs into insulin-producing cells similar in phenotype to PECs in euthyroid mice., Conclusion: These data highlight the relevance of thyroid hormones in the context of PEC therapy in patients with type 1 diabetes and suggest that a thyroid hormone adjuvant therapy may optimize cell outcomes in some PEC recipients., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The 21-gene recurrence score (RS) assay predicts the recurrence risk and magnitude of chemotherapy benefit in patients with invasive breast cancer (BC). This study examined low-grade tumors yielding a high-risk RS and their outcomes.Kindly check the edit made in the article titleOk  METHODS: We compared patients with grade 1 BC and a high-risk RS to those with low-risk RS. Histologic sections were reviewed and features reported to elevate the RS were noted, mainly biopsy cavity and reactive stromal changes (BXC)., Results: A total of 54 patients had high-risk RS (median RS of 28, range 26-36). On review, BXC were seen in all cases. Thirty BCs in this group also had low to negative PR. Treatment regimens included: chemoendocrine therapy (63%), endocrine therapy alone (31%) and no adjuvant therapy (6%). There were no additional breast cancer events over a median follow-up of 54.0 months (range 6.2 to 145.3). A total of 108 patients had low-risk RS (median RS of 7, range 0-9). BXC were seen in 47% of cases and none were PR negative. One patient had a recurrence at 64.8 months while the rest had no additional events over a median of 68.1 months (2.4 to 100)., Conclusion: We provide further evidence that reactive stromal changes and/or low-PR scores enhance the elevation of the RS. A high-RS result in low grade, PR-positive BC may not reflect actual risk and any suspected discrepancies should be discussed with the management teams. Multigene testing results should be interpreted after correlation with pathologic findings to optimize patient care., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)