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Abstract Feedlot cattle may be subjected to digestive disorders, including ruminal acidosis, due to high concentration of grain in their diet. Therefore, novel feeding strategies are required to maximize animal performance and mitigate economic losses in the operation. This study employed a two-period crossover design to assess the effect of direct ruminal administration of native rumen microorganisms (NRM) inoculation on cattle that underwent a high-grain challenge. The NRM inoculation consisted of six microorganisms (1.70 M CFU /day/animal) isolated from the rumen of healthy feedlot cattle: Succinivibrio dextrinosolvens ASCUSBF53, Prevotella albensis ASCUSBF41, Chordicoccus furentiruminis ASCUSBF65, Bacteroides xylanisolvens ASCUSBF52, Clostridium beijerinckii ASCUSBF26, and Syntrophococcus sp. ASCUSBF60. The trial consisted of 16 Angus heifers receiving NRM (n = 8) or a CON (CON = Carrier Buffer; n = 8) inoculation daily for 14-days as pre-challenge while on a high-grain diet and continued daily for a 21-day treatment period. The combined 35 days of microbial supplementation resulted in an improved average daily gain (ADG) of 29% (P = 0.037) and a tendency toward a 19% decrease in the feed efficiency metric, gain to feed ratio (G: F) (P = 0.055). Additionally, administration of NRM to animals on a high-grain diet, improved ruminal microbiome stability (P

Patients benefit from and appreciate the option to use telehealth with their providers. Such patient expectations have therefore led to new questions about the factors that affect providers’ willingness to adopt telehealth as part of their clinical practice. We interviewed 19 physicians across four specialties with differential rates of telehealth use (Psychiatry, Anesthesiology, Physical Medicine & Rehabilitation [PM&R], and Ophthalmology) to discern the barriers and incentives to telehealth adoption among physicians. We then conducted a qualitative analysis of interview transcripts, following precepts of Directed Content Analysis. Conclusions drawn from matrix building and thematic analysis were verified with negative evidence searches and if-then tests. Robust investigations for outliers and rival explanations in responses were used to disconfirm findings. The results of this analysis revealed distinct barriers and incentives to telehealth adoption for the four specialties. Physicians in psychiatry and anesthesiology are refining the strengths and applications of telehealth based on the characteristic needs of their specialties. Physicians in PM&R and ophthalmology face additional barriers to acquiring physical exam data, leading them to use telehealth as a supplement to, rather than as a replacement for, core functions of patient care. The insights stemming from these barriers and incentives can be used to build thoughtful telehealth applications for physicians, allowing them to provide effective clinical care while also improving the patient experience.

This is a comprehensive review of facial fillers including landmark studies and expert commentary spanning the years from 2003 (when the first hyaluronic acid [HA] dermal filler underwent Food and Drug Administration approval in United States) to present. [ABSTRACT FROM AUTHOR]

Patients benefit from and appreciate the option to use telehealth with their providers. Such patient expectations have therefore led to new questions about the factors that affect providers' willingness to adopt telehealth as part of their clinical practice. We interviewed 19 physicians across four specialties with differential rates of telehealth use (Psychiatry, Anesthesiology, Physical Medicine & Rehabilitation [PM&R], and Ophthalmology) to discern the barriers and incentives to telehealth adoption among physicians. We then conducted a qualitative analysis of interview transcripts, following precepts of Directed Content Analysis. Conclusions drawn from matrix building and thematic analysis were verified with negative evidence searches and if-then tests. Robust investigations for outliers and rival explanations in responses were used to disconfirm findings. The results of this analysis revealed distinct barriers and incentives to telehealth adoption for the four specialties. Physicians in psychiatry and anesthesiology are refining the strengths and applications of telehealth based on the characteristic needs of their specialties. Physicians in PM&R and ophthalmology face additional barriers to acquiring physical exam data, leading them to use telehealth as a supplement to, rather than as a replacement for, core functions of patient care. The insights stemming from these barriers and incentives can be used to build thoughtful telehealth applications for physicians, allowing them to provide effective clinical care while also improving the patient experience. [ABSTRACT FROM AUTHOR]

Chlamydia trachomatis (Ct) is the most common bacterial sexually transmitted infection globally, and a vaccine is urgently needed to stop transmission and disease. Chlamydial Protease Activity Factor (CPAF) is an immunoprevalent and immunodominant antigen for CD4 T cells and B cells, which makes it a strong vaccine candidate. Due to the tolerogenic nature of the female genital tract (FGT) and its lack of secondary lymphoid tissue, effective induction of protective cell-mediated immunity will likely require potent and safe mucosal adjuvants. To address this need, we produced CPAF in a cell-free protein synthesis platform and adjuvanted it with the TLR9-agonist CpG1826, a synthetic cyclic-di-AMP (CDA) STING (stimulator of interferon genes) agonist ADU-S100, and/or the squalene oil-in-water nanoemulsion, AddaS03. We determined that intranasal immunization with CPAF plus ADU-S100 was well tolerated in female mice, induced CD4 T cells characterized by TNFα production alone or in combination with IL-17 A or IFNγ, significantly reduced bacterial shedding, and shortened the duration of infection in mice intravaginally challenged with Chlamydia muridarum. These data demonstrate the potential for CDA as a mucosal adjuvant for vaccines against Chlamydia genital tract infection. [ABSTRACT FROM AUTHOR]

Aims: To understand how the US public defines recovery from opioid misuse and the recovery-related resources it views as most helpful, and to compare differences by opioid misuse history and demographic characteristics., Design: Observational study of data from the nationally representative AmeriSpeak® Panel survey administered in October/November 2021., Setting: United States., Participants: 6515 adults (≥ 18 years)., Measurements: Respondents ranked 10 definitions of recovery (religious in nature; spiritual in nature; physical/mental in nature; contributing to society; enhanced quality of life; seeking professional help; having a sense of purpose; moderate/controlled substance use; no drug use; abstaining from all substance use) and 9 resources that might contribute to recovery (primary care physician; intensive inpatient program; residential rehabilitation program; self-help group; therapist/psychologist/social worker; prescribed medication; talking to family/friends; spiritual/natural healer; faith-based organization). We explored differences in rankings by opioid misuse history (personal vs. family/friend vs. no history) and demographic characteristics (race, sex, age) using multivariable ordinal logistic regression., Findings: Seeking professional help was the most endorsed recovery definition overall [mean (M) = 6.97, standard error (SE) = 0.03]. Those with personal opioid misuse history ranked enhanced quality of life (B = 0.16, P = 0.049) and having a sense of purpose (B = 0.16, P = 0.029) significantly higher, and ranked abstaining from substance use (B = -0.20, P = 0.009) significantly lower as recovery definitions than those without a history of opioid misuse. Compared with White respondents, Black (B = 0.60, P < 0.001) and Hispanic (B = 0.55, P < 0.001) respondents defined recovery as more religious in nature. Residential rehabilitation program was identified as the most helpful resource for recovery (M = 7.16, SE = 0.02), while prescribed medication received a relatively low ranking overall (M = 4.05, SE = 0.03). Those with family/friend opioid misuse history ranked prescribed medication as less helpful than others (B = -0.14, P = 0.003)., Conclusions: The general US public's views around recovery from opioid misuse appear to focus on abstinence and formal treatment receipt, while people with a history of opioid misuse place less emphasis on abstinence and greater emphasis on other aspects of well-being., (© 2024 Society for the Study of Addiction.)

We present an interesting case of a 74-year-old female who presented with spinal accessory neuropathy following an ipsilateral right-sided carotid endarterectomy 6 months after the initial injury. Subsequent surgical exploration revealed a surgical clip that had been placed directly across the spinal accessory nerve. Clip removal and neurolysis was subsequently performed, leaving the nerve intact. After surgical intervention, she immediately demonstrated increased bilateral shoulder shrug motion and continues to improve her function with physical therapy. This case demonstrates a fascinating case of cranial nerve recovery after delayed intervention in the context of existing literature. Laryngoscope, 2025., (© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)

The coronavirus-19 (COVID-19) pandemic presented unique challenges for pregnant women and birthing individuals, particularly those from Black and Latino communities. Understanding the impact of the pandemic on their experiences is crucial for providing adequate support and care during vulnerable times. This research delves into the specific effects of COVID-19 on maternal stress and resilience. We conducted in-depth interviews with a subsample of 19 women from a larger study examining the effects of maternal stress and anxiety, racism, and resilience and coping on pregnancy among Black and Latina pregnant women in the San Francisco Bay Area, a diverse region where nearly two-thirds of residents are people of color. Using thematic analysis, we identified three dominant themes that illuminate the impact of the COVID-19 pandemic on participants' pregnancy, birth, and postpartum experiences. Firstly, the pandemic shifted participants' focus away from their pregnancy and birth experiences, compelling them to prioritize safety measures against COVID-19 infection. Secondly, the study highlighted the profound value of high-quality, supportive care from healthcare providers during the pandemic, which significantly impacted participants' well-being. Lastly, we uncovered various resilience-building strategies employed by participants to navigate the challenges of pregnancy and parenting during the pandemic. This research provides essential insights into the lived experiences of Black and Latina pregnant women in the San Francisco Bay Area during the COVID-19 pandemic. The findings underscore the need for targeted support and interventions to address the unique stressors faced by these communities. By understanding the personal lived experience of Black and Latina participants' pregnancy, birth, and postpartum during the pandemic, healthcare providers and policymakers can develop more tailored and effective approaches to assist and empower Black and Latina pregnant individuals., Competing Interests: Declarations. Competing Interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

The posterior parietal cortex (PPC) is an associative neocortical region that integrates multiple streams of information and is implicated in spatial cognition and decision making. In some cases, however, the PPC is not required for these functions. One possibility is that the PPC is recruited when spatial complexity is high. Yet, few studies of PPC function have explicitly manipulated environmental complexity, complexity of spatial changes, or the temporal structure of spatial tasks. To examine whether task complexity recruits PPC function, we tested rats with neurotoxic damage to the dorsal PPC on a series of tasks varying in spatial and temporal complexity. Recognition memory was first assessed in standard exploration tasks, including object recognition, object location, and object in place, as well as a more complex object task in which spatial changes occurred across multiple delays. Spatial navigation was assessed in the circular hole board maze (Barnes maze), and temporal processing was assessed in a temporal order task. PPC damage spared performance on standard recognition memory tasks but caused deficits on tasks involving changes in object configuration or multiple changes across time. PPC damage spared acquisition on the Barnes maze but impaired retention and decreased efficiency of search strategies. PPC damage did not impact temporal order memory. Overall, these results suggest that the PPC is necessary when spatial complexity of the task increases attentional and long-term memory demands. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Pilon fractures are associated with high-energy injuries, and there is presently much debate as to optimal fixation strategies and timing of intervention. There is little evidence comparing the type of fibular fixation during pilon fracture fixation. The purpose of this study was to compare fibular fixation methods in complex pilon injuries as it relates to pilon union rates and development of post-traumatic arthritis. Methods : This was a retrospective review from an urban Level 1 trauma center from January 2009 to May 2019, including patients age ≥ 18 who sustained a pilon fracture with an associated fibula fracture. Patients were allocated into one of three groups based on fibular fracture treated with plating, intramedullary device, or no fixation. Radiographic analysis was performed postoperatively and at final follow up to evaluate for tibial or fibular nonunion, malunion, talocrural angle, and ankle Kellgren-Lawrence grade. Results : Of the 107 patients in this study, 42 underwent surgical fixation of their fibular fracture. There were no differences with respect to tibial or fibular union rates amongst the three groups. Furthermore, there were no differences in the presence of radiographic ankle arthritis at final follow up. However, Kellgren-Lawrence arthritis grading did appear to be a more severe grade in patients who did not undergo fibular fixation ( p = 0.001). Conclusions : Fibular intramedullary fixation does not appear to influence tibial or fibular nonunion rates as compared to plating in complex pilon injuries.

The COVID-19 pandemic has been associated with increased neuropsychiatric conditions in children and youths, with evidence suggesting that SARS-CoV-2 infection may contribute additional risks beyond pandemic stressors. This study aimed to assess the full spectrum of neuropsychiatric conditions in COVID-19 positive children (ages 5-12) and youths (ages 12-20) compared to a matched COVID-19 negative cohort, accounting for factors influencing infection risk. Using EHR data from 25 institutions in the RECOVER program, we conducted a retrospective analysis of 326,074 COVID-19 positive and 887,314 negative participants matched for risk factors and stratified by age. Neuropsychiatric outcomes were examined 28 to 179 days post-infection or negative test between March 2020 and December 2022. SARS-CoV-2 positivity was confirmed via PCR, serology, or antigen tests, while negativity required negative test results and no related diagnoses. Risk differences revealed higher frequencies of neuropsychiatric conditions in the COVID-19 positive cohort. Children faced increased risks for anxiety, OCD, ADHD, autism, and other conditions, while youths exhibited elevated risks for anxiety, suicidality, depression, and related symptoms. These findings highlight SARS-CoV-2 infection as a potential contributor to neuropsychiatric risks, emphasizing the importance of research into tailored treatments and preventive strategies for affected individuals.

Following our previous experience with cardiac xenotransplantation of a genetically modified porcine heart into a live human, we sought to achieve improved results by selecting a healthier recipient and through more sensitive donor screening for potential zoonotic pathogens. Here we transplanted a 10-gene-edited pig heart into a 58-year-old man with progressive, debilitating inotrope-dependent heart failure due to ischemic cardiomyopathy who was not a candidate for standard advanced heart failure therapies. He was maintained on a costimulation (anti-CD40L, Tegoprubart) blockade-based immunomodulatory regimen. The xenograft initially functioned well, with excellent systolic and diastolic function during the first several weeks posttransplantation. Subsequently, the xenograft developed rapidly progressing diastolic heart failure, biventricular wall thickening and, ultimately, near-complete loss of systolic function necessitating initiation of extracorporeal membranous oxygenation on day 31. Given these setbacks, the patient chose to transition to comfort care after 40 days. As with our first patient, histology did not reveal substantial immune cell infiltration but suggested capillary endothelial injury with interstitial edema and early fibrosis. No evidence of porcine cytomegalovirus replication in the xenograft was observed. Strategies to overcome the obstacle of antibody-mediated rejection are needed to advance the field of xenotransplantation., Competing Interests: Competing interests: This study was supported by the University of Maryland Medical Center and University of Maryland School of Medicine. The source animal was provided by Revivicor, and the Tegoprubart antibody was provided by Eledon Pharmaceuticals, both in kind. CareDx and Karius analytics were provided in kind. United Therapeutics Inc. provided funding to the University of Maryland Foundation to help defray the cost of this transplant. No financial support was provided by Eledon Pharmaceuticals or XVIVO. Federal funding was used for the preclinical trial studies leading to this work. M.R. is the CEO of United Therapeutics. D.A., K.K. and L.S. are employees of Revivicor, a subsidiary of United Therapeutics. S.P. is the CEO of Eledon Pharmaceuticals. Members of the Program in Cardiac Xenotransplantation received research funding from United Therapeutics. There are no other competing interests to disclose., (© 2025. The Author(s), under exclusive licence to Springer Nature America, Inc.)

We describe here a case of the sinus roundworm, Skrjabingylus chitwoodorum , found incidentally in a rabies-positive striped skunk ( Mephitis mephitis ) in Texas, USA. Skunks serve as a natural definitive host for this metastrongylid nematode in North America, in which infections result in observable damage to the host cranium, where adult parasites reside. Additionally, skunks are considered the primary reservoir of rabies in Texas. In November 2022, the animal was discovered in northern Texas displaying neurologic signs before euthanasia and submission to the Oklahoma Animal Disease Diagnostic Laboratory for rabies testing. Direct fluorescent antibody testing indicated that the animal was rabies-positive, and, upon tissue collection, numerous adult nematodes were recovered from the cranium and identified as S. chitwoodorum by morphology and amplification of the mitochondrial cytochrome c oxidase subunit I gene. Histologically, we found lymphohistiocytic meningitis in several loci and chronic sinusitis rostral to the cribriform plate. Due to behavioral abnormalities, we additionally tested for Toxoplasma gondii via PCR, but no parasite DNA was detected. Concurrent infection by S. chitwoodorum and rabies virus may contribute to neurologic signs in skunks., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To determine the change in English emergency postnatal maternal readmissions 2007-2017 (pre-COVID-19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS)., Design: National cohort study., Setting: All English National Health Service hospitals., Population: A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017., Methods: Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database., Main Outcome Measures: Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS., Results: A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28-1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31-1.39); age < 20 years (aOR 1.09, 95% CI 1.05-1.12); 40+ years (aOR 1.07, 95% CI 1.03-1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91-0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82-1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53-1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06-2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83-2.21)., Conclusions: The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those < 20 and ≥ 40 years old; primiparous women; and those with specified obstetric risk factors., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Achieving competence in performing complex neurosurgical operations and learning new techniques after qualification take time. The improvement in skill over time (or as more procedures are performed) can be represented graphically as a learning curve. While surgeons are operating on patients to acquire the required skills, patients might be harmed. This is often referred to colloquially but incorrectly as "a steep learning curve." Although this may be an accepted learning practice for surgeons, it is unlikely to be acceptable to patients. Surgeons need to find ways of reaching a competent level of practice before operating on patients. To this end, the need for new techniques, what skills they require, and how they can be learned in a nonclinical environment should be defined. This can help surgeons determine where they start on a learning curve and what skills they need to achieve competence., Competing Interests: Conflict of Interest Statement.  The authors have no conflicts of interest to declare. No funding was received for this paper., (© 2025. The Author(s).)