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Introduction: Patient oriented research (POR) invites patients to partner with researchers, clinicians, and other stakeholders, incorporating diverse perspectives to generate scientific evidence meaningful to all parties involved. We adopted a POR approach for this study evaluating the feasibility of conducting a randomized control trial of a novel tri-compartment offloader brace for knee osteoarthritis. We involved patients as partners to enhance study design, implementation and interpretation of key outcomes. Approach: Patient involvement consisted of two patient leaders and five patient advisors. Patients participated in 2 virtual focus groups to discuss study outcomes, protocol, results and knowledge translation. Patients were involved in all aspects of the research cycle. Outcomes: Patient feedback resulted in changes to study design, documentation, participant recruitment, data collection, results interpretation and knowledge dissemination, improving the participant experience and aligning study outcomes with patient priorities. Study participants showed a high level of protocol adherence and follow-up rates were excellent. We experienced several unexpected benefits including genuine friendships, a deeper understanding of the patient experience, a more pragmatic approach to clinical research, and leadership opportunities for patients. Recommendations: We agreed on POR "non-negotiables" to ensure a positive experience for everyone, including creating a safe and comfortable environment, being genuinely receptive to patient feedback, and providing appropriate supports for patients. We strongly recommend that researchers (1) involve patients as early as possible, (2) provide ample and equal opportunities for all patients to be involved, and (3) address system hierarchy by involving patients as equals and fully considering all patient ideas from the beginning of the project. Conclusions: While POR is a learning process that is often more challenging than the traditional clinical research approach, the benefits are well worth the additional time and effort required to do it well. Over time, our team experienced a cultural shift and evolution from a top-down research approach to a more inclusive approach considering patient voices as equal to those of researchers. Patient involvement in all aspects of the research process, from question development to results interpretation and dissemination is integral to clinical research advancing equitably. Plain English Summary: Involving patients as partners in research can be challenging. However, the benefits are well worth the additional time and effort required to do it well. Patients improve the relevance, success and impact of clinical research, and are central to clinical research advancing. We partnered with seven patients from the community to conduct a research study assessing the effectiveness of a new knee brace for people with knee osteoarthritis. Patients participated in 2 virtual Zoom discussions and were involved in all aspects of the research process. The feedback received from patients led to many helpful changes to the study design, documents, recruitment strategies, data collection, and how to understand and share our results. These changes made the study more aligned with patient priorities and improved participants' experience. Study participants followed study instructions and the majority completed the study. Our team also experienced many unexpected benefits of involving patients in research including genuine friendships, a deeper understanding of the patient experience, a more practical approach to clinical research, and more leadership opportunities for patients. We agreed that for everyone on the team to have a good experience, it's important to create a safe and comfortable environment, really listen to and consider patient input, and provide patients the tools and trainings they need to fully participate. We recommend that researchers involve patients in their studies as early as possible, give patients lots of opportunities to be involved, and involve patients as equals, considering their ideas from start to finish. [ABSTRACT FROM AUTHOR]

The nuclear factor erythroid 2-related factor 2 (NRF2) transcription factor activates cytoprotective and metabolic gene expression in response to various electrophilic stressors. Constitutive NRF2 activity promotes cancer progression, whereas decreased NRF2 function contributes to neurodegenerative diseases. We used proximity proteomic analysis to define protein networks for NRF2 and its family members NRF1, NRF3, and the NRF2 heterodimer MAFG. A functional screen of co-complexed proteins revealed previously uncharacterized regulators of NRF2 transcriptional activity. We found that ZNF746 (also known as PARIS), a zinc finger transcription factor implicated in Parkinson's disease, physically associated with NRF2 and MAFG, resulting in suppression of NRF2-driven transcription. ZNF746 overexpression increased oxidative stress and apoptosis in a neuronal cell model of Parkinson's disease, phenotypes that were reversed by chemical and genetic hyperactivation of NRF2. This study presents a functionally annotated proximity network for NRF2 and suggests a link between ZNF746 overexpression in Parkinson's disease and inhibition of NRF2-driven neuroprotection. Editor's summary: The cell death that occurs in neurodegenerative diseases is due partly to decreased function of the transcription factor NRF2, which mounts cellular responses to oxidative stress. LaPak et al. sought to identify binding partners for NRF2 and related family members with proximity proteomic analysis. They found that the transcription finger ZNF746 (also known as PARIS), which is increased in abundance in Parkinson's disease, bound to and repressed the activity of NRF2. A neuronal cell line commonly used in Parkinson's disease studies showed greater apoptosis and oxidative stress upon ZNF746 overexpression. These data reveal a potential mechanism that may contribute to the suppression of NRF2 activity in Parkinson's disease. —Wei Wong [ABSTRACT FROM AUTHOR]

Background: Laser hyperthermia‐induced lipolysis is a non‐invasive method of localized fat treatment. Non‐invasive approaches could be an option for a growing number of patients who are risk‐averse and are seeking out non‐invasive alternatives to surgical procedures such as liposuction. This study evaluated the safety and efficacy of a 1060 nm diode laser for the non‐invasive fat reduction of the flanks. Methods: A total of 30 subjects were enrolled in this prospective, single center study. Subjects received one 25‐min treatment with a 1060 nm diode laser to both flanks. Follow‐up visits were conducted at 6 and 12 weeks after the last treatment. Ultrasound adipose thickness, body weight, and circumference measurements were taken at baseline and at the 6‐ and 12‐week follow‐up visits. Subject satisfaction was assessed using a self‐assessment of fat reduction, pain, and tolerability scales, and a subject satisfaction questionnaire. Safety was assessed via the presence or absence of any adverse events. Results: The average age of subjects was 47.3 years. A total of 27 subjects completed the treatment and returned for both follow‐up visits. An adipose reduction of 7.57 ± 1.15% at 6 weeks post‐treatment (p < 0.0001) was measured using ultrasound. High subject satisfaction was seen, with 74% of subjects reporting being either "satisfied" or "very satisfied" with their results on a 5‐point Likert Scale. Eighty‐two percent of subjects stated they would recommend the treatment to their friends. All subjects had either mild or moderate pain, with 52% of subjects rating their pain as "mild" (1–3), while 48% rated their pain as moderate (4–7) on the Wong‐Baker Scale. Conclusions: A single treatment with a 1060 nm diode laser was both safe and effective in reducing unwanted fat in the flanks without any unanticipated adverse events. Subjects described their treatment pain as mild or moderate and were highly satisfied with their treatment outcomes. [ABSTRACT FROM AUTHOR]

This article seeks to provide a comprehensive re-evaluation of the redistributive models of democracy advanced by Carles Boix, and Daron Acemoglu and James Robinson, their reception within the democratization literature, and the subsequent trajectories of their authors. Contrary to the existing literature, which commonly envisions RMDs as a unified framework, this article argues that Boix and Acemoglu and Robinson's models should be understood as divergent theories of democratic transitions. In the aftermath of numerous criticisms, both authors have developed sharply different understandings of democratization. We argue that Acemoglu and Robinson have backtracked from their original formulation toward a "Whiggish" history of the rise of liberty, while Boix has increasingly reverted to the core propositions of classical modernization theory. In the process, this article argues that RMDs have lost, and reneged on, much of their apparent explanatory power regarding transitions to and reversions from democracy. [ABSTRACT FROM AUTHOR]

Traditionally, neuroscience and psychology have studied the human brain during periods of "online" attention to the environment, while participants actively engage in processing sensory stimuli. However, emerging evidence shows that the waking brain also intermittently enters an "offline" state, during which sensory processing is inhibited and our attention shifts inward. In fact, humans may spend up to half of their waking hours offline [Wamsley, E. J., & Summer, T. Spontaneous entry into an "offline" state during wakefulness: A mechanism of memory consolidation? Journal of Cognitive Neuroscience, 32, 1714–1734, 2020; Killingsworth, M. A., & Gilbert, D. T. A wandering mind is an unhappy mind. Science, 330, 932, 2010]. The function of alternating between online and offline forms of wakefulness remains unknown. We hypothesized that rapidly switching between online and offline states enables the brain to alternate between the competing demands of encoding new information and consolidating already-encoded information. A total of 46 participants (34 female) trained on a memory task just before a 30-min retention interval, during which they completed a simple attention task while undergoing simultaneous high-density EEG and pupillometry recording. We used a data-driven method to parse this retention interval into a sequence of discrete online and offline states, with a 5-sec temporal resolution. We found evidence for three distinct states, one of which was an offline state with features well-suited to support memory consolidation, including increased EEG slow oscillation power, reduced attention to the external environment, and increased pupil diameter (a proxy for increased norepinephrine). Participants who spent more time in this offline state following encoding showed improved memory at delayed test. These observations are consistent with the hypothesis that even brief, seconds-long entry into an offline state may support the early stages of memory consolidation. [ABSTRACT FROM AUTHOR]

On July 27, 1859, "Canada" Kate Clark met two Americans, Nellie Stem and Mary Dwyer, for a pair of prize fights in Fort Erie, Canada West. Beginning their adventure in Buffalo, New York, they rowed their way across the Niagara River to the fighting grounds in the British colony. Like pugilists before them, they stripped to the waist to limit potential grappling in battle. Both the journey and pre-fight fight preparations were tried and true components of mid-nineteenth century prize fighting. Although the press, and later historians, overwhelmingly associated such performances with male combatants, women were indeed active in Canadian pugilistic circles, settling scores, testing their mettle, and displaying their fistic abilities both pre- and post-Confederation. In this article, we begin to untangle the various threads of female pugilism, situating these athletes and performers within the broader literature on both boxing and women's sport in Canada. By examining media reports of female boxers—both in sparring and prize fighting—we hope to provide a historiographic foundation for further discussions of early female pugilism, highlighting the various ways these women upheld and challenged the notion of the "new woman" in Canada. [ABSTRACT FROM AUTHOR]

Political economy literature has sought to explain the rapid shift from fiscal stimulus to austerity after the 2008 crisis. Influential contributions highlight the relative explanatory value of ideational or structural factors in contributing to post-crisis austerity. Drawing on Stephen Gill's (1998) analysis of new constitutionalism and Peter Burnham's (2001) understanding of depoliticisation, I contend that these frameworks offer a more useful lens to understand how post-2010 austerity in the US and UK was shaped by an enduring consensus on macroeconomic policy governance consolidating during the 1990s. Examining the role of fiscal mechanisms such as PAYGO in the US and the 'Fiscal Golden Rules' in the UK, and the operational independence conferred to central banks, I illustrate how Third Way governments institutionalised budgetary reforms and distanced macroeconomic policymaking from popular political contestation. Despite temporary lapses with this logic of fiscal restraint, as well as the rollout of historic monetary policies after 2008, I argue that these practices became deeply embedded within state institutions. Focusing on PAYGO in the US and the OBR in the UK, I show how policymakers redeployed policies and practices from the 1990s amidst the 2008 crisis to externalise responsibility for implementing austerity measures. [ABSTRACT FROM AUTHOR]

Background Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. Although lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis. Objectives This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars. Methods Patients underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3 and 6 months posttreatment. Scars were assessed with standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed with patient and clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation. Results Ten patients between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. Clinician GAIS and patient GAIS scores showed clinical improvement at both 3- and 6-month follow-up compared with baseline (P <.05). Blinded clinician GAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (P <.0001). The attenuation coefficient increased at 6-month follow-up, suggesting collagen remodeling and reorganization over the study period. Patients experienced anticipated posttreatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported. Conclusions Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Objective Severe coronavirus disease 2019 (COVID-19) can result in irreversible lung damage, with some individuals requiring lung transplantation. The purpose of this case series is to describe the initial experience with the rehabilitation and functional outcomes of 9 patients receiving a lung transplant for COVID-19. Methods Nine individuals, ranging in age from 37 to 68 years, received bilateral orthotopic lung transplantation (BOLT) for COVID-19 between December 2020 and July 2021. Rehabilitation was provided before and after the transplant, including in-hospital rehabilitation, postacute care inpatient rehabilitation, and outpatient rehabilitation. Results Progress with mobility was limited in the pretransplant phase despite rehabilitation efforts. Following transplantation, 2 individuals expired before resuming rehabilitation, and 2 others had complications that delayed their progress. The remaining 5 experienced clinically important improvements in mobility and walking capacities. Conclusion Considerable rehabilitation resources are required to care for individuals both before and after BOLT for COVID-19. Rehabilitation can have a profound impact on both functional and clinical outcomes for this unique patient population. Impact There is limited literature on the rehabilitation efforts and outcomes for patients who received BOLT for COVID-19. Occupational therapists and physical therapists play an important role during the pretransplant and posttransplant recovery process for this novel patient population. Lay Summary Patients with a bilateral orthotopic lung transplant due to COVID-19 require a unique rehabilitation process. They have significant difficulties with activities of daily living and functional mobility across the pretransplant and posttransplant continuum of care, but progressive gains in functional performance may be possible with a comprehensive multidisciplinary rehabilitation program. [ABSTRACT FROM AUTHOR]

In the post-war period of 1940s Montreal, in part characterized by the Quebec nationalism of Premier Maurice Duplessis, the businessman Adrien Gagnon challenged the monopoly on bodybuilding, physical training, and physical culture enjoyed by fitness entrepreneurs Ben and Joe Weider. Gagnon mobilized sentiment against the dominance of English businessmen in Montreal, through his magazine Santé et Développement Physique. This article examines how Gagnon wielded aspects of French Canadian nationalism, and the respective influences of language and religion as cultural and moral enterprises, in the sale of his publications and products as he attempted to dislodge the market share and influence of the Weiders in the business of health and exercise. [ABSTRACT FROM AUTHOR]

Objectives: A microneedling pen has been cleared by the US Food and Drug Administration, indicated for improving the appearance of adult facial acne scars. The objective of this study was to assess the device's effectiveness for treating wrinkles of the face area. Materials and Methods: Healthy adults seeking to improve the appearance of face wrinkles were enrolled (N = 35), receiving four monthly microneedling procedures by a trained aesthetician who treated the face skin per manufacturer instructions. Wrinkle assessments were performed by two trained blinded raters by comparing baseline images of each subject with images obtained at 90 days post‐procedure. Subsequently, the two raters were unblinded for the Clinician's Global Aesthetic Improvement Scale (CGAIS) assessment. Subjects completed the Subject's Global Aesthetic Improvement Scale (SGAIS) and a Satisfaction Questionnaire at 30 and 90 days post‐treatment. Results: The study was completed by 32 subjects with a mean (SD) age of 56.3 (5.0) years. Wrinkle assessments demonstrated significant improvement in the face areas (p < 0.001). The SGAIS scores showed significant improvements after 30 and 90 days post‐treatment (for each, p < 0.001). The CGAIS scores also showed significant improvements at 90 days post‐treatment (p < 0.001). Most subjects reported some level of improvement in their appearance at 30 days (73.3%) and 90 days (68.8%) post‐treatment. The satisfaction questionnaire showed high levels of improvement in wrinkles (93.8%), satisfaction with the treatment procedure (87.5%) and would recommend microneedling to friends and family members (80.6%) on the face and neck. Conclusion: Microneedling is a viable, minimally invasive option for treating wrinkles of the face. ClinicalTrials.gov Identifier: NCT03803059. [ABSTRACT FROM AUTHOR]

The optimal antithrombotic therapy following combined coronary artery bypass graft (CABG) and surgical valve replacement (SVR) surgery remains unclear. The aim of this single-center, retrospective cohort study was to assess the safety and effectiveness of a vitamin K antagonist (VKA) plus either aspirin or clopidogrel in patients following combined CABG and SVR. The primary endpoint was the occurrence of bleeding within six months. The secondary endpoint was the occurrence of CV death, stroke, acute coronary syndrome (ACS), or valve dysfunction. Outcomes were identified by pre-specified ICD codes. A total of 629 patients were included in the analysis, with 583 patients receiving aspirin and 46 patients receiving clopidogrel. Bleeding occurred in 1.7% of patients receiving aspirin and in 0% of patients receiving clopidogrel (p = 0.99). CV death, stroke, ACS, or valve dysfunction occurred in 3.1% of patients receiving aspirin and 4.3% of patients receiving clopidogrel (p = 0.65). In this study, there were no differences in the safety or effectiveness of a VKA plus either aspirin or clopidogrel following combined CABG and SVR. [ABSTRACT FROM AUTHOR]

Neuropsychiatric disorders classically lack defining brain pathologies, but recent work has demonstrated dysregulation at the molecular level, characterized by transcriptomic and epigenetic alterations1–3. In autism spectrum disorder (ASD), this molecular pathology involves the upregulation of microglial, astrocyte and neural–immune genes, the downregulation of synaptic genes, and attenuation of gene-expression gradients in cortex1,2,4–6. However, whether these changes are limited to cortical association regions or are more widespread remains unknown. To address this issue, we performed RNA-sequencing analysis of 725 brain samples spanning 11 cortical areas from 112 post-mortem samples from individuals with ASD and neurotypical controls. We find widespread transcriptomic changes across the cortex in ASD, exhibiting an anterior-to-posterior gradient, with the greatest differences in primary visual cortex, coincident with an attenuation of the typical transcriptomic differences between cortical regions. Single-nucleus RNA-sequencing and methylation profiling demonstrate that this robust molecular signature reflects changes in cell-type-specific gene expression, particularly affecting excitatory neurons and glia. Both rare and common ASD-associated genetic variation converge within a downregulated co-expression module involving synaptic signalling, and common variation alone is enriched within a module of upregulated protein chaperone genes. These results highlight widespread molecular changes across the cerebral cortex in ASD, extending beyond association cortex to broadly involve primary sensory regions.RNA sequencing reveals widespread transcriptomic changes across the cerebral cortex in autism spectrum disorder, including primary sensory regions, in addition to association regions, as well as an attenuation of regional identity. [ABSTRACT FROM AUTHOR]

Background: A microneedling pen has been cleared by the US FDA and is indicated for improving the appearance of facial acne scars in adults.Objectives: The aim of this study was to assess the effectiveness of this microneedling pen for treating wrinkles. This paper focuses on the results on the neck, an area of recent importance with video meetings placing physical stress on the neck area, leading to wrinkles.Methods: Healthy adult men and women were enrolled (N = 35). Subjects received 4 monthly microneedling procedures at depths of up to 2.5 mm. Wrinkle assessments were performed by 2 trained blinded raters by comparing images of each subject at baseline and at 90 days postprocedure. The 2 raters were unblinded for the Clinician's Global Aesthetic Improvement Scale assessment. Subjects completed the Subject's Global Aesthetic Improvement Scale and a questionnaire regarding satisfaction with the treated areas of the face and neck at 30 and 90 days posttreatment.Results: The study was completed by 32 subjects. Wrinkle assessments demonstrated significant improvement in the neck areas (P < 0.001). Both Global Aesthetic Improvement Scales showed significant improvements at 90 days posttreatment (P < 0.001). Most subjects reported some level of improvement in their appearance at 30 days (73.3%) and 90 days (68.8%) posttreatment. The satisfaction questionnaire showed high levels of improvement in wrinkles (93.8%), satisfaction with the results (87.5%), and would recommend microneedling to friends and family members (80.6%).Conclusions: Microneedling is a viable, minimally invasive option for treating wrin kles of the neck.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Memories of the past help us adaptively respond to similar situations in the future. Originally described by Schacter & Addis in 2007, the "constructive episodic simulation" hypothesis proposes that waking thought combines fragments of various past episodes into imagined simulations of events that may occur in the future. This same framework may be useful for understanding the function of dreaming. N = 48 college students were asked to identify waking life sources for a total of N = 469 dreams. Participants frequently traced dreams to at least one past or future episodic source (53.5% and 25.7% of dreams, respectively). Individual dreams were very often traced to multiple waking sources (43.9% of all dreams with content), with fragments of past memory incorporated into scenarios that anticipated future events. Waking-life dream sources are described in terms of their phenomenology and distribution across time and sleep stage, providing new evidence that dreams not only reflect the past, but also utilize memory in simulating potential futures. [ABSTRACT FROM AUTHOR]

Efficient management of invasive species benefits from understanding patterns of persistence and change over time. In this study, we compare distribution and abundance of the invasive macrophyte parrotfeather (Myriophyllum aquaticum) in an unregulated river system between the time near its presumed introduction and 20 years later. Initial surveys were conducted in 1996–1997, and were repeated in 2015–2016 using similar methodology. Moderate increases in the proportion of river kilometers with parrotfeather between the two periods were observed, but the distribution of sites with low, medium, and high abundance remained consistent, with small numbers of sites in either period having well-established extents of parrotfeather. The distributional extent has moved downstream, with the most upstream and downstream presences shifted by 17 and 28 river kilometers, respectively; however, parrotfeather remains sparse in the lower reaches below the historical downstream extent. Sites with high abundance and stable presence over time are in the intermediate segment of the river, indicating longitudinal and hydrologic controls on distribution. In contemporary sites, area of parrotfeather cover was associated with larger, deeper habitats, whereas dominance of parrotfeather occurred in smaller sites having uniformly shallow depth and low bank slopes. Sites where both abundance and dominance were low had dense canopy cover. Our results demonstrate that landscape and site-level characteristics restrict establishment and persistence of parrotfeather, and that hydrologic alterations to stabilize flow regimes and land use changes should be considered for their potential to increase presence of parrotfeather and other invasive aquatic plants in dynamic floodplain habitats. [ABSTRACT FROM AUTHOR]

To improve health, physicians are increasingly called to advocate. Yet medical schools have only recently focused on health advocacy skill-building. Limited work to date addresses assessing medical student advocacy on behalf of patients. We describe how students and clinical supervisors (CS) in two urban longitudinal integrated clerkships (LIC) experience patient advocacy and how introducing a new advocacy assessment impacts them. Using a thematic approach, we analyzed transcripts of focus groups during 2018–2019. Seventeen of 24 (71%) students and 15 of 21 (71%) CS participated in the focus groups. We describe how students perceive their advocacy role as they accompany the patient, amplify their voice, and facilitate connection. The rationale for advocacy assessment includes that it (1) adds a novel dimension to the written and verbal assessment, (2) drives student learning, (3) aligns with the institutional goal to promote equity, and (4) impacts CS teaching and clinical practice. Challenges are the ambiguity of expectations, pressure to 'perform,' and a moral overlay to advocacy assessment. Findings demonstrate how educational alliances between students and CS and longitudinal relationships between LIC students and patients offer a constructive opportunity for advocacy assessment. We describe suggestions to hone and expand the reach of advocacy assessment. [ABSTRACT FROM AUTHOR]

Background: Dual antiplatelet therapy (DAPT) is recommended over single antiplatelet therapy (SAPT) in patients following coronary artery bypass grafting (CABG). The compilation of evidence has focused on the efficacy of DAPT to limit risk of graft occlusion, however the safety, especially in the on-pump CABG population, is less well described. The aim of this study was to assess the safety of DAPT versus SAPT after on-pump CABG. Methods: This was a single-center, retrospective cohort analysis of adult patients following isolated on-pump CABG between January 2012 and December 2019 not on oral anticoagulation at discharge. The primary endpoint was occurrence of a composite bleeding event identified by pre-specified ICD codes. Secondary endpoints consisted of 30-day and 1-year mortalities along with individual bleeding components. Results: Of the 2341 patients included 1250 patients were in the SAPT arm and 1091 patients in the DAPT arm. The study populations differed by age, prior MI, PAD, and CHF status/stage. Bleeding events occurred in a total of 70 patients (3.0%), with 36 patients (2.9%) in the SAPT arm and 34 patients (3.1%) in the DAPT arm (P =.74). 30-day (SAPT 0.7% vs DAPT 0.4%) and 1-year (SAPT 3.3% vs DAPT 2.3%) mortality were not significantly different between groups. The most frequent bleed event was in the gastrointestinal tract. Conclusion: In this study, DAPT was not associated with an increase in composite bleeding compared to SAPT. This study could reduce the barrier to prescribing of DAPT given previous efficacy data. [ABSTRACT FROM AUTHOR]

The article discusses the life and career of the late Black Canadian heavyweight boxer Lawrence "Larry" Gains, and it mentions his boxing record and his efforts to secure opportunities to battle for championship titles between 1927 and 1932. The lowering of racial barriers for Black boxers such as Gains is examined, along with his Canadian, World Coloured, and British Empire boxing title victories in the twentieth century. The social conditions of Black athletes in the 1900s are assessed.

Background: Noninvasive treatments for skin tightening are gaining popularity. However, no studies have assessed bipolar fractional radiofrequency treatment on suprapatellar skin.Objectives: The purpose of this study was to evaluate the efficacy of bipolar fractional radiofrequency treatment on suprapatellar skin.Methods: Twenty patients received 1 bilateral suprapatellar bipolar fractional radiofrequency treatment. They returned 7 days, 3 weeks, 3 months, and 6 months posttreatment. Noninvasive measurements were obtained at each visit, including high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and skin elasticity. Microbiopsies were collected in the treatment area for histologic and gene expression analyses. Three clinicians completed photographic evaluations comparing texture and laxity at baseline vs 6 months posttreatment.Results: Fifteen subjects completed all 6 visits. Both transepidermal water loss and dermal-epidermal junction roughness were increased at 3 weeks and 3 months posttreatment. Both attenuation coefficient and stiffness were increased significantly at 3 and 6 months posttreatment. Blood flow 0.5 mm below the surface and expression of epidermal hyaluronic acid and inflammatory genes IL-1b and IL-6 were significantly higher at 7 days posttreatment compared with pretreatment and 3 months posttreatment. There were no statistically significant changes in collagen- or elastin-related genes and proteins at 7 days or 3 months posttreatment. An improvement in texture and laxity was observed at 6 months posttreatment in 17.7% and 24.4% of photographs, respectively.Conclusions: Radiofrequency treatment by microneedling of suprapatellar skin shows limited effects in decreasing skin laxity and improving skin appearance. At a molecular level, the treatment resulted in lower elastin and hyaluronic acid levels and increased dermal-epidermal junction roughness based on histology and optical coherence tomography imaging.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: It is dangerous, although not uncommon, in some clinical settings for laser operators to place gauze underneath external patient protective eyewear when performing laser procedures.Objectives: The purpose of this study was to evaluate 4 lasers, commonly used for aesthetic facial procedures, on 3 materials commonly found in the clinical setting.Methods: We performed tests with 4 lasers: the 2940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser, the 532-nm potassium titanyl phosphate (KTP) laser, the 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, and a Lumenis UltraPulse 10,600-nm carbon dioxide (CO2) laser. Their effects were evaluated on dry gauze pads, wet gauze pads, and adhesive external eye shields.Results: When exposed to the 2940-nm Er:YAG and 10,600-nm CO2 lasers, dry gauze smoked on the first pulse and ignited on the second pulse, whereas no damage occurred to the wet gauze or adhesive eye shields after 8 and 4 pulses, respectively. No damage to any material or the underlying surface was seen after 30 pulses of the 532-nm KTP laser. After 2 pulses of the 1064-nm Nd:YAG laser, the adhesive eye shields sparked; dry gauze smoked after 1 pulse, but no damage to the underlying surface occurred after 30 pulses.Conclusions: The results of our study highlight the inherent flammability of gauze when exposed to lasers commonly used to address aesthetic facial concerns. Although moistened gauze conveyed more protection than dry gauze, these results do not guarantee patient ocular safety. Therefore, we do not recommend the use of any gauze under protective eyewear. [ABSTRACT FROM AUTHOR]

Background: Despite the proven efficacy of liposuction, there is a population of patients who prefer non-surgical alternatives. Laser hyperthermia-induced lipolysis has emerged as one non-invasive alternative to liposuction.Objectives: The authors sought to evaluate the safety and efficacy of a 1060-nm (±10 nm) diode laser for non-invasive fat reduction of the abdomen.Methods: This single-arm, 2-center study enrolled 30 patients. Patients received a 25-minute 1060-nm diode laser treatment on their abdomen. Ultrasound adipose measurements, body weight, and circumference were taken at baseline and at 6- and 12-week follow-up visits. Blinded evaluators identified "before" and "after" photos of each patient. A patient satisfaction questionnaire was completed by each patient at study exit.Results: A total 29 patients completed all treatment and follow-up visits. Ultrasound images showed an adipose reduction of 8.55% at 12 weeks post-treatment (P < 0.0001). Blinded evaluators correctly identified 67% of the pre- and post-treatment images at site 01 (Sacramento, CA) and 56% at site 02 (Dallas, TX). Satisfaction was high, with 72% of patients reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert scale. Pain was rated as mild by 62% of patients, moderate by 38%, and severe by none on the Wong-Baker Scale.Conclusions: These results indicate that a single treatment with a 1060-nm (±10 nm) diode laser, per the treatment protocol, is safe and effective in reducing unwanted fat in the abdomen as objectively measured employing ultrasound. The treatment was well-tolerated among all patients, with minimal discomfort reported and high patient satisfaction.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

The advancement of laser technology has seen its use gain popularity across a wide range of specialties to treat diseases, as well as address aesthetic concerns. In order to protect both the patient and the healthcare personnel providing treatment, instruction and knowledge of laser safety remain of utmost importance. In this paper, we discuss the classification of laser systems, review ocular injuries that may be caused by inappropriate laser exposure, and provide background on laser protective eyewear. In addition, we highlight the current recommendations for proper eyewear during laser use outlined in the American National Standards Institute standard Z136.3, Safe Use of Lasers in Health Care. Finally, although it is common in some healthcare facilities to place gauze under external eye shields or use gauze alone over eyes during laser procedures, this practice poses an extreme risk to both patients and healthcare personnel. Therefore, we discuss why the use of gauze under eyewear for any laser procedures is not recommended, and instead, offer suggestions to consider when acquiring safe and comfortable patient eyewear. [ABSTRACT FROM AUTHOR]

There is a pressing need for strategies to slow or treat the progression of functional decline in people living with HIV. This paper explores a novel rehabilitation robotics approach to measuring cognitive and motor impairment in adults living with HIV, including a subset with stroke. We conducted a cross-sectional study with 21 subjects exhibiting varying levels of cognitive and motor impairment. We tested three robot-based tasks – trajectory tracking, N-back, and spatial span – to assess if metrics derived from these tasks were sensitive to differences in subjects with varying levels of executive function and upper limb motor impairments. We also examined how well these metrics could estimate clinical cognitive and motor scores. The results showed that the average sequence length on the robot-based spatial span task was the most sensitive to differences between various cognitive and motor impairment levels. We observed strong correlations between robot-based measures and clinical cognitive and motor assessments relevant to the HIV population, such as the Color Trails 1 (rho = 0.83), Color Trails 2 (rho = 0.71), Digit Symbol – Coding (rho = 0.81), Montreal Cognitive Assessment – Executive Function subscore (rho = 0.70), and Box and Block Test (rho = 0.74). Importantly, our results highlight that gross motor impairment may be overlooked in the assessment of HIV-related disability. This study shows that rehabilitation robotics can be expanded to new populations beyond stroke, namely to people living with HIV and those with cognitive impairments. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this paper is to describe the curriculum and self-reported outcomes on measures of interdisciplinary leadership skills for work within the field of developmental disabilities from trainees in one interprofessional training program. Methods: The paper highlights one program's curriculum and strategy for capturing self-report survey measures from trainees in cohorts from 2014–2018 (n = 86) on two surveys (Interdisciplinary Attitudes and Skills and Leadership Self-Evaluation Form) and three time points across the training year: before training (T1), mid-year (T2), and after training (T3). Results: Data from 86 trainees are reported including demographics (nearly 80% white, 92% female), non-descriptive statistics due to non-normative samples, and tertiles demonstrating changes between time points. Significant differences between medians are reported between T1-T3 specifically related to utilizing interdisciplinary skills and gains in leadership competencies. Specific utilization of skills was reported to be 'Greatly' attributable to the LEND program related to sharing ideas and asking for help across disciplines. Discussion: Trainees' self-report from before training to after training indicates an increase in competence and utilization of interdisciplinary skills to be expected from participation in the curriculum. Self-report measures are [ABSTRACT FROM AUTHOR]

The article discusses the work of sport historian Don Morrow. Topics include his work as a university teacher, his supervision of graduate students in sports history, and his work on the relationship of sports history to Canadian history. His role in editing the journal "Sport History Review," formerly known as the "Canadian Journal of History of Sport," is noted.

We appreciate Natalie M. Hull and Karl G. Linden's interest in our recent article in which we examined a novel application of a CyQuant®-based approach for examining DNA concentrations of UV- and chlorination-treated organisms. Hull and Linden questioned our work, which was conducted to inform considerations of regulating ballast water discharges on the basis of the number of viable organisms, and several concerns were identified. Here we provide our response to the specific concerns raised about experimental design, procedure, and interpretation. [ABSTRACT FROM AUTHOR]

Large, comprehensive collections of single-cell RNA sequencing (scRNA-seq) datasets have been generated that allow for the full transcriptional characterization of cell types across a wide variety of biological and clinical conditions. As new methods arise to measure distinct cellular modalities, a key analytical challenge is to integrate these datasets or transfer knowledge from one to the other to better understand cellular identity and functions. Here, we present a simple yet surprisingly effective method named common factor integration and transfer learning (cFIT) for capturing various batch effects across experiments, technologies, subjects, and even species. The proposed method models the shared information between various datasets by a common factor space while allowing for unique distortions and shifts in genewise expression in each batch. The model parameters are learned under an iterative nonnegative matrix factorization (NMF) framework and then used for synchronized integration from across-domain assays. In addition, the model enables transferring via low-rank matrix from more informative data to allow for precise identification in data of lower quality. Compared with existing approaches, our method imposes weaker assumptions on the cell composition of each individual dataset; however, it is shown to be more reliable in preserving biological variations. We apply cFIT to multiple scRNA-seq datasets of developing brain from human and mouse, varying by technologies and developmental stages. The successful integration and transfer uncover the transcriptional resemblance across systems. The study helps establish a comprehensive landscape of brain cell-type diversity and provides insights into brain development. [ABSTRACT FROM AUTHOR]

Background: Occipital neuralgia (ON) is a primary headache disorder characterized by sharp, shooting, or electric shock-like pain in the distribution of the greater, lesser, or third occipital nerves.Aim: To review the existing literature on the management of ON and to describe our technique of an endoscopic-assisted approach to decompress the GON proximally in areas of fibrous and muscular compression, as well as distally by thorough decompression of the occipital artery from the nerve.Methods: Relevant literature on the medical and surgical management of ON was reviewed. Literature on the anatomical relationships of occipital nerves and their clinical relevance were also reviewed.Results: While initial treatment of ON is conservative, peripheral nerve blocks and many surgical management approaches are available for patients with pain refractory to the medical treatment. These include greater occipital nerve blocks, occipital nerve stimulation, Botulinum toxin injections locally, pulsed radiofrequency ablation, cryoneuroablation, C-2 ganglionectomy, and endoscopic-assisted ON decompression.Conclusion: Patients of ON refractory to medical management can be benefitted by surgical approaches and occipital nerve blocks. Endoscopic-assisted ON decompression provides one such approach for the patients with vascular, fibrous or muscular compressions of occipital nerves resulting in intractable ON. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has necessitated a reorganization of healthcare delivery, shedding light on the many unrealized advantages telehealth has to offer. In addition to facilitating social distancing, minimizing the risk of pathogen exposure, and preserving healthcare resources, there are many benefits of utilizing this platform that can extend beyond the current pandemic, which will change the way healthcare is delivered for generations to come. With the rapid expansion of telehealth, we present data from our high-volume academic institution's telehealth efforts, with a more focused analysis of plastic surgery. Although state legislation regarding telehealth varies greatly, we discuss challenges such as legal issues, logistical constraints, privacy concerns, and billing. We also discuss various advantages and the future direction of telehealth not only for plastic surgery but also its general utilization for the future of medicine in the United States. [ABSTRACT FROM AUTHOR]

Background: Clinician-educator (CE) careers in academic medicine are heterogeneous. Expectations for CEs have grown, along with a need to better prepare CEs for these roles. Objective: To assess whether advanced education training is associated with productivity and success. Design: We used a sequential mixed methods approach, collecting quantitative survey data and qualitative focus groups data. We developed a three-tiered categorization of advanced training to reflect intensity by program type. Participants: We surveyed CEs in the Society of General Internal Medicine (SGIM) and conducted two focus groups at an SGIM annual meeting. Main Measures: Primary outcomes were academic productivity (manuscripts, presentations, etc.) and leadership role attainment. Secondary analysis examined the interactive effect of gender and training intensity on these outcomes. Key Results: A total of 198 completed the survey (response rate 53%). Compared with medium- or low-intensity training, high-intensity training was associated with a greater likelihood of publishing ≥ 3 first- or senior-author manuscripts (adjusted OR 2.6; CI 0.8–8.6; p = 0.002), teaching ≥ 3 lectures/workshops at the regional/national/international level (adjusted OR 5.7; CI 1.5–21.3; p = 0.001), and having ≥ 3 regional/national committee memberships (adjusted OR 3.4; CI 1.0–11.7; p = 0.04). Among participants in the "no training" and "high-intensity training" categories, men were more likely to have ≥ 3 publications (OR 4.87 and 3.17, respectively), while women in the high intensity category had a likelihood similar to men with no training (OR 4.81 vs. OR 4.87). Participants felt the value of advanced training exists not only in content but also in networking opportunities that programs provide. Conclusions: While opinions were divided as to whether advanced training is necessary to position oneself for education roles, it is associated with greater academic productivity and reduced gender disparity in the publication domain. Institutions should consider providing opportunities for CEs to pursue advanced education training. [ABSTRACT FROM AUTHOR]

Moments of inattention to our surroundings may be essential to optimal cognitive functioning. Here, we investigated the hypothesis that humans spontaneously switch between two opposing attentional states during wakefulness—one in which we attend to the external environment (an "online" state) and one in which we disengage from the sensory environment to focus our attention internally (an "offline" state). We created a data-driven model of this proposed alternation between "online" and "offline" attentional states in humans, on a seconds-level timescale. Participants (n = 34) completed a sustained attention to response task while undergoing simultaneous high-density EEG and pupillometry recording and intermittently reporting on their subjective experience. "Online" and "offline" attentional states were initially defined using a cluster analysis applied to multimodal measures of (1) EEG spectral power, (2) pupil diameter, (3) RT, and (4) self-reported subjective experience. We then developed a classifier that labeled trials as belonging to the online or offline cluster with >95% accuracy, without requiring subjective experience data. This allowed us to classify all 5-sec trials in this manner, despite the fact that subjective experience was probed on only a small minority of trials. We report evidence of statistically discriminable "online" and "offline" states matching the hypothesized characteristics. Furthermore, the offline state strongly predicted memory retention for one of two verbal learning tasks encoded immediately prior. Together, these observations suggest that seconds-timescale alternation between online and offline states is a fundamental feature of wakefulness and that this may serve a memory processing function. [ABSTRACT FROM AUTHOR]