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Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) have shown promise in improving and/or preventing neuropathic pain and reducing narcotic use in amputees. However, anecdotally, some patients experience an increase in pain in the first few months post-operatively. This study explored the pain trajectory of 22 upper and lower extremity amputees following their TMR and/or RPNI procedure in their first post-operative year, with a focus on the patterns of recovery in the first few months. Our study found an overall decrease in the amount of pain and pain medication use at various time points post-operatively. Of note, several individuals had an increase in pain or required an increase in pain medications in the first three months. Different outcomes for patients who underwent primary versus secondary surgery were seen, which has been observed in other studies. Further prospective studies are warranted to evaluate these trends in pain after TMR or RPNI surgery in individuals with major limb amputations. [ABSTRACT FROM AUTHOR]

Macrophages play a central role in orchestrating the inflammatory response to implanted biomaterials and are sensitive to changes in the chemical and physical characteristics of the implant. Macrophages respond to biological, chemical, and physical cues by polarizing into pro-inflammatory (M1) or anti-inflammatory (M2) states. We previously showed that rough-hydrophilic titanium (Ti) implants skew macrophage polarization towards an anti-inflammatory phenotype and increase mesenchymal stem cell (MSC) recruitment and bone formation around the implant. In the present study, we aimed to investigate whether the adoptive transfer of macrophages in different polarization states would alter the inflammatory microenvironment and improve biomaterial integration in macrophage-competent and macrophage-ablated mice. We found that ablating macrophages increased the presence of neutrophils, reduced T cells and MSCs, and compromised the healing and biomaterial integration process. These effects could not be rescued with adoptive transfer of naïve or polarized macrophages. Adoptive transfer of M1 macrophages into macrophage-competent mice increased inflammatory cells and inflammatory microenvironment, resulting in decreased bone-to-implant contact. Adoptive transfer of M2 macrophages into macrophage-competent mice reduced the pro-inflammatory environment in the peri‑implant tissue and increased bone-to-implant contact. Taken together, our results show the importance of macrophages in controlling and modulating the inflammatory process in response to implanted biomaterials and suggest they can be used to improve outcomes following biomaterial implantation. Macrophages are central in orchestrating the inflammatory response to implanted biomaterials and are sensitive to biomaterial chemical and physical characteristics. Our study shows that a deficiency of macrophages results in prolonged inflammation and abolishes bone-biomaterial integration. Adoptive transfer of immunomodulatory macrophages into macrophage-competent mice reduced the inflammatory environment and increased bone-implant contact. [Display omitted] [ABSTRACT FROM AUTHOR]

Inflammatory skin conditions highly influence the quality of life of the patients suffering from these disorders. Symptoms include red, itchy and painful skin lesions, which are visible to the rest of the world, causing stigmatization and a significantly lower mental health of the patients. Treatment options are often unsatisfactory, as they suffer from either low patient adherence or the risk of severe side effects. Considering this, there is a need for new treatments, and notably of new ways of delivering the drugs. Stimuli-responsive drug delivery systems are able to deliver their drug cargo in response to a given stimulus and are, thus, promising for the treatment of inflammatory skin conditions. For example, the use of external stimuli such as ultraviolet light, near infrared radiation, or alteration of magnetic field enables drug release to be precisely controlled in space and time. On the other hand, internal stimuli induced by the pathological condition, including pH alteration in the skin or upregulation of reactive oxygen species or enzymes, can be utilized to create drug delivery systems that specifically target the diseased skin to achieve a better efficacy and safety. In the latter context, however, it is of key importance to match the trigger mechanism of the drug delivery system to the actual pathological features of the specific skin condition. Hence, the focus of this article is placed not only on reviewing stimuli-responsive drug delivery systems developed to treat specific inflammatory skin conditions, but also on critically evaluating their efficacy in the context of specific skin diseases. Skin diseases affect one-third of the world's population, significantly lowering the quality of life of the patients, who deal with symptoms such as painful and itchy skin lesions, as well as stigmatization due to the visibility of their symptoms. Current treatments for inflammatory skin conditions are often hampered by low patient adherence or serious drug side effects. Therefore, more emphasis should be placed on developing innovative formulations that provide better efficacy and safety for patients. Stimuli-responsive drug delivery systems hold considerable promise in this regard, as they can deliver their cargo precisely where and when it is needed, reducing adverse effects and potentially offering better treatment outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Infection is a common complication following tissue expander (TE)–based breast reconstruction. Few studies have examined risk factors specifically in the unique populations encountered at safety-net hospitals. The purpose of this study was to identify predictors of TE infection at Harris Health safety-net hospitals, which serve the third most populous county in the United States. A retrospective review was performed to evaluate women over the age of 18 years who underwent TE placement at two safety-net hospitals from October 2015 to November 2022. Demographic information, medical history, operative details, and postoperative course were recorded for each individual TE. The primary outcome was TE infection, for which univariate and multivariate analysis was conducted. The secondary outcome was the time to onset of TE infection, for which a Kaplan-Meier analysis was undertaken. There were 279 patients, totaling 372 breasts, meeting the inclusion criteria. The TE infection rate was 23%. Increased body mass index (BMI), diabetes, use of acellular dermal matrix (ADM), and prolonged surgical drain use were all significantly associated with TE infection in univariate and multivariate analysis. Similarly, BMI ≥30 kg/m2, diabetes, and ADM use were also associated with earlier onset of TE infection. This study demonstrated similar TE infection rates at our safety-net hospitals compared with previously reported literature. To optimize the quality of care for patients in safety-net institutions, these risk factors must be addressed in the context of the unique challenges encountered in these settings. [ABSTRACT FROM AUTHOR]

Preeclampsia is associated with a two-fold increase in a woman's lifetime risk of developing atherosclerotic cardiovascular disease (ASCVD), but the reasons for this association are uncertain. The objective of this study was to examine the associations between vascular health and a hypertensive disorder of pregnancy among women ≥ 2 years postpartum. Pre-menopausal women with a history of either a hypertensive disorder of pregnancy (cases: preeclampsia or gestational hypertension) or a normotensive pregnancy (controls) were enrolled. Participants were assessed for standard ASCVD risk factors and underwent vascular testing, including measurements of blood pressure, endothelial function, and carotid artery ultrasound. The primary outcomes were blood pressure, ASCVD risk, reactive hyperemia index measured by EndoPAT and carotid intima-medial thickness. The secondary outcomes were augmentation index normalized to 75 beats per minute and pulse wave amplitude measured by EndoPAT, and carotid elastic modulus and carotid beta-stiffness measured by carotid ultrasound. Participants had a mean age of 40.7 years and were 5.7 years since their last pregnancy. In bivariate analyses, cases (N = 68) were more likely than controls (N = 71) to have hypertension (18% vs 4%, P =. 034), higher calculated ASCVD risk (0.6 vs 0.4, P =. 02), higher blood pressures (systolic: 118.5 vs 111.6 mm Hg, P =. 0004; diastolic: 75.2 vs 69.8 mm Hg, P =. 0004), and higher augmentation index values (7.7 vs 2.3, P =. 03). They did not, however, differ significantly in carotid intima-media thickness (0.5 vs 0.5, P =. 29) or reactive hyperemia index (2.1 vs 2.1, P =. 93), nor in pulse wave amplitude (416 vs 326, P =. 11), carotid elastic modulus (445 vs 426, P =. 36), or carotid beta stiffness (2.8 vs 2.8, P =. 86). Women with a prior hypertensive disorder of pregnancy had higher ASCVD risk and blood pressures several years postpartum, but did not have more endothelial dysfunction or subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]

Shoulder instability continues to be a common problem that is difficult to treat. Part of this difficulty can be attributed to the numerous postoperative complications that can impact the clinical course. Our study aims to primarily identify the incidence of subclinical infection in patients undergoing revision shoulder stabilization surgery and secondarily identify any risk factors for developing a subclinical infection. From January 2012 to December 2022, 94 charts of patients who underwent revision surgery by the senior author after a previous arthroscopic or open stabilization surgery for shoulder instability were reviewed. All patients of any age who underwent either bony or soft tissue revision surgery, regardless of the number of previous surgeries or corticosteroid injections, were included. Patients were excluded if they had a previous infection in the shoulder, if there was no record of the procedures performed in the previous surgery, or if cultures were not available for review. For each patient, demographic information (age, sex, race, smoking status, previous corticosteroid injections, malnutrition, renal failure, liver failure, diabetes mellitus, immunocompromised status, and intravenous drug use), surgical information (procedures performed, type of surgery, and date of surgery), and culture results were recorded. Overall, 107 patients were included in our study. Twenty-nine patients (27.1%) had positive cultures (60 cultures in total). Twenty-six patients had positive Cutibacterium acnes (C. acnes) cultures. On average, C. acnes cultures took 10.65 days to turn positive, whereas 24 of 27 patients had cultures that were positive within 14 days of the culture being obtained. There was no difference in infection incidence rates between soft tissue and bony stabilization procedures (P =.86) or arthroscopic and open procedures (P =.59). Males were more than 5 times more likely than females to be culture positive in our cohort (93.1% vs. 73.1%, relative risk [RR] = 1.27, P =.03). Finally, 10 control cultures were taken from the operating room air environment (8 distinct surgeries had 1 control culture taken, whereas 1 surgery had 2), 2 of which were positive for C. acnes (both taken from the same patient operation). This patient had their shoulder cultures positive for C. acnes as well. More than a quarter of patients requiring revision surgery after shoulder stabilization procedures have a subclinical shoulder infection, with males being at a higher risk of developing an infection than females. Surgeons should always consider infection as a reason for the lack of clinical improvement and possibly needing revision surgery after shoulder stabilization. The prompt diagnosis and treatment of these infections could be vital in improving results after these surgeries. [ABSTRACT FROM AUTHOR]

The semi-quantitative scale of structural brain Magnetic Resonance Imaging (sqMRI) is a valid and reliable measure of brain lesion extent in children with cerebral palsy (CP) >3-years. This system scores lesion burden for each major brain region. The sum of the scores gives a global score ranging from 0 to 48. To investigate how sqMRI scores changed from infancy to school-age, and whether these were associated with lesion load, age at first assessment, and gross motor function and its changes. Twenty-eight children with CP underwent MRI and motor (Gross Motor Function Measure-66; GMFM-66) assessments when <40-months and again when 8-12-years. We investigated whether (i) toddler/preschool-age sqMRI scores (Time 1) reflected school-age sqMRI scores (Time 2); (ii) temporal changes in sqMRI scores (Time 1–Time 2 difference) were related to the child's age at Time 1 and lesion extent; (iii) early or later sqMRI scores were associated with motor functioning; (iv) sqMRI scores' longitudinal changes were associated with motor changes. Except for the corticosubcortical (grey-matter only) layers, sqMRI scores were significantly higher ('higher lesion load') at Time 1 than at Time 2. Age at Time 1 was not associated with temporal changes in global sqMRI scores. Higher lesion load at Time 2, but not at Time 1, was associated with smaller temporal changes in the global sqMRI score. The sqMRI scores were associated with concurrent, but not future or past motor GMFM-66 scores. Longitudinal changes in sqMRI scores were not associated with longitudinal changes in motor GMFM-66 scores. sqMRI scores of brain lesion extent at school-age are lower and a better indication of later-life motor functioning than very early life sqMRI scores. It may be best to interpret MRI white matter lesions with caution in very early life due to possible changes in lesion appearance and the unpredictable role of functional plasticity. • White matter lesions can be overestimated in children younger than 40-months of age. • Larger lesions at school-age are associated with smaller sqMRI score changes over time. • SqMRI scores are associated with concurrent motor function. • SqMRI scores changes over time are not associated with gross motor function changes. [ABSTRACT FROM AUTHOR]

There is a paucity of literature examining how preferences differ amongst various demographic groups. This study aimed to assess how perceptions of the ideal breast differ between respondents stratified by self-identified demographic factors. A cohort of 25 patients from the senior surgeon's practice presenting for breast surgery was assembled. Pre-operative anteroposterior photographs of these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents' impressions of 'breast attractiveness'. Respondents were asked to rate breasts on a Likert scale. Survey responses were analysed for differences in breast aesthetic preferences by sex, gender, sexual orientation, and race. Males rated all breasts higher on the Likert scale for attractiveness than females (2.8 vs 2.5, p < 0.001). Despite this discrepancy, ratings amongst male and female respondents were highly correlated with one another (R = 0.940; p < 0.0001). Considering sexual orientation, individuals attracted to women provided significantly higher attractiveness ratings to all breasts compared to individuals attracted to men only (2.8 vs 2.5, p < 0.001). White or Caucasian individuals ascribed significantly higher breast attractiveness ratings than Asian individuals (2.7 vs 2.2, p < 0.001), but not Black or African American individuals (2.7 vs 2.4, p = 0.23). Despite these racial discrepancies in mean breast attractiveness, ratings amongst the three groups were highly correlated. In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by demographic factors. These findings merit further investigation to understand these trends and observations. [ABSTRACT FROM AUTHOR]

• Identifying the necessity of a new generation of nurse leaders. • Implementation of Competency-based education programs to prepare new nurse leaders for organizational leadership roles. • The value of nurse legacy is without price. The nursing profession is continually evolving with new healthcare innovations and approaches in the care of complex clients. However, the succession plans of nursing leadership remains an area in need of growth and further development. The use of competency-based curriculums to educate a new generation of nursing leaders is of importance in the development of competent leadership. [ABSTRACT FROM AUTHOR]

The purpose was to assess clinical dental hygienists' knowledge, beliefs, and intentions regarding asking adolescents about electronic nicotine delivery systems (ENDS) use. Cross-sectional survey research was conducted with a convenience sample of dental hygienists using a validated instrument developed based on the theory of planned behavior (TPB) that contained the following sections: demographics, knowledge, behavioral belief (BB), normative beliefs, control beliefs, and behavioral intention. Outcomes were analyzed using descriptive statistics, correlations, and multivariate regression analysis. Of the 360 participants who opened the survey, 257 completed it for a completion rate of 71.4%. The knowledge score mean was 72%. BBs suggested that a majority (83%) of participants were likely to ask adolescent patient about ENDS use, however, normative beliefs showed that only about half had the support of their dentist/supervisor, and one-third (33%) felt they had sufficient tobacco/nicotine use and dependency guideline resources. This resulted in only half having the behavioral intention to ask adolescents about ENDS use. Demographic variables were not significantly correlated with the TPB subscales or intention. In the regression model all three TPB subscales predicted intention (F 3 , 251) = 46.1; p <.001). The coefficient of determination (R 2 = 0.35) suggested 35% of the variation in the intention to ask about ENDS use can be explained by the model. Most participants had favorable BBs toward asking about ENDS use among adolescents. However, adequate support from dentists/supervisors and training on guidelines for prevention and cessation of ENDS is needed to encourage dental hygienists to ask adolescents about ENDS use. [ABSTRACT FROM AUTHOR]

This study aimed to examine the stability of anterior open bite (AOB) treatment with clear aligners. This retrospective cohort study included 52 adult AOB patients (aged >18 years; 15 males, 37 females) who underwent nonextraction clear aligner treatment and were at least 1 year posttreatment. Eleven cephalometric measurements were evaluated at pretreatment, end of active treatment, and at least 1-year posttreatment. Overbite change, the primary outcome variable, and other cephalometric changes during treatment and retention were calculated, and repeated measures analysis of variance were performed. Stepwise multiple regression was used to make a prediction equation for open bite relapse. The mean retention period was 2.1 ± 1.1 years. The mean change in overbite during treatment was 3.3 ± 1.5 mm; 6% of patients presented relapse at least 1 year after treatment completion. The mean change of overbite (0.2 ± 0.5 mm) during the retention period was not statistically significant (P = 0.59). None of the 11 cephalometric measurements showed significant change during the retention period. The prediction model showed that only the coefficient for a tongue posture issue at the initial examination was statistically significant. AOB was successfully corrected in all 52 patients using only clear aligners with no additional adjunctive aids such as microimplants. When retained with maxillary and mandibular fixed retainers and maxillary and mandibular vacuum-formed retainers, there was no significant change in cephalometric measurements during the short-term retention period. • An anterior open bite can be successfully treated with clear aligners in adult patients. • With bonded and vacuum-formed retainers, 94% showed positive overbite at >1 year retention. • Stability could not be predicted by pretreatment and treatment change cephalometric variables. • Tongue posture or interincisal tongue position at the initial examination can affect stability. [ABSTRACT FROM AUTHOR]

Acellular dermal matrices (ADMs) are commonly used in prepectoral breast reconstruction. However, ADM is associated with high cost and potentially infection and seroma. Comparative studies on prepectoral reconstruction with and without ADM are limited to small, single-institution series. The purpose of this study was to perform a meta-analysis of prepectoral reconstruction with and without ADM. A systematic literature review was performed to identify studies comparing prepectoral reconstruction with and without ADM using PubMed, EMBASE, and Cochrane databases. Pooled rates of patient demographics and outcomes were analyzed. Meta-analytic effect size estimates were calculated for reconstructive complications in studies comparing reconstruction with and without ADM. In total, 515 reconstructions from four studies were included. Most cases were nipple-sparing mastectomies and utilized tissue-expander reconstructions. Meta-analysis demonstrated no significant difference in the rate of complications between cohorts with and without ADM. Short-term complications included reconstructive failure (1.2% in ADM cohort and 2.8% in no-ADM), seroma (1.2% and 8.3%, respectively), hematoma (1.2% and 2.1%), infection (4.7% and 4.2%), and mastectomy flap ischemia and/or necrosis (2.4% and 5.2%). Long-term complications included rippling (3.3% in ADM and 5.1% in no-ADM cohorts) and capsular contracture (6.8% and 3.4%, respectively). This meta-analysis demonstrated no difference in the rate of complications between cases with and without ADM. However, the outcomes data from no-ADM reconstruction mostly reflect robust mastectomy flaps. Surgeon discretion as informed by specific clinical scenarios should guide decisions regarding the use of ADM in prepectoral breast reconstruction. [ABSTRACT FROM AUTHOR]

Mental illness can be a debilitating chronic disease associated with a higher likelihood of preexisting medical comorbidities and postoperative morbidity and mortality. Given the relative prevalence of mental health disorders among the veteran population, we sought to examine postoperative outcomes in patients undergoing endovascular aortic aneurysm repair (EVAR). Retrospective review of a single institution Veterans Administration Hospital operative database was used to identify patients who underwent EVAR from January 2010 to December 2021. Patients' demographics, comorbidities, medications, and intraoperative variables were collected. In addition, mental illness status was evaluated to stratify patients based on preexisting anxiety, depression, posttraumatic stress disorder, substance abuse disorder, or major psychiatric illness. The study's primary outcomes were postoperative complications, mortality, and follow-up rates. Secondary outcomes included hospital length of stay, readmission rates, and intervention rates. A total of 241 patients underwent infrarenal EVARs at our institution. One hundred forty patients (58.1%) were diagnosed with mental illness, whereas 101 (41.9%) had no prior diagnosis of mental illness. Of the 241 patients, 65.7% had a history of substance abuse disorder, 38.6% depression, 29.3% post-traumatic stress disorder, 19.3% anxiety, and 3.6% major psychiatric illness. There was no statistical difference in the number of medical comorbidities, race, smoking status, or medications compared with patients without mental illness. We found no statistical difference in access type, wound infection rates, hypogastric coiling, estimated blood loss, and operating time. χ2 analysis demonstrated a statistically significant lower overall postoperative complication rate (28.6% vs 32.7%; P =.05) and decreased loss to follow-up (8.6% vs 15.8%; P =.05) among patients with a preexisting mental illness diagnosis. There were no statistically significant differences in readmission rate, length of stay, or 30-day mortality. When stratified by type of mental illness, binary logistic regression demonstrated no statistically significant differences in primary outcomes of postoperative complications, readmission rates, loss to follow-up, and 1-year mortality. Cox proportional hazards modeling demonstrated no significant difference in cumulative survival in patients diagnosed with a mental illness (0.56; 95% confidence interval, 0.29-0.107; P =.08). There was no association between the presence of a prior mental health diagnosis and adverse outcomes following EVAR. Preceding mental illness did not correlate with an increased rate of complications, readmission, length of stay, or 30-day mortality in a veteran population. Lower loss to follow-up rates in patients with mental illness may reflect overall Veterans Health Administration expansion in resources and surveillance of these at-risk individuals. Further research is needed to assess the association between postoperative outcomes and mental illness. [ABSTRACT FROM AUTHOR]

• Providers and patients generally agree with preoperative deprescribing feasibility. • Deprescribing engagement may be affected by hope and/or fear before surgery. • Shared decision-making is crucial to deprescribing engagement before surgery. Introduction : Deprescribing, the collaborative process between providers and patients to streamline medication regimen, may reduce the risk of adverse events following surgery among older adults with multimorbidity. However, barriers and facilitators to deprescribing for surgery has not been explored. We conducted a qualitative study of Primary Care Providers (PCP) and patients aged 65 and older who were scheduled for surgery. We used the Theoretical Domains Framework, which informed the interview guide and analysis. A total of 16 participants (n=8 providers, n=8 patients) were included. Themes were regarding: 1) attitudes towards deprescribing before surgery, 2) perceived benefits of deprescribing before surgery, 3) patient-provider relationship and shared decision-making, 4) hope for surgery, 5) barriers to deprescribing before surgery, and 6) preferences for deprescribing follow-up. Our study findings regarding provider- and patient-related barriers and facilitators for deprescribing and desired processes before surgery may inform future deprescribing intervention targets before surgery. [ABSTRACT FROM AUTHOR]

Recent clinical evidence showed that breast cancer with low HER2 expression levels responded to trastuzumab deruxtecan therapy. The HER2-low cancers comprise immunohistochemistry (IHC) score 1+ and 2+ ISH non-amplified tumours, currently classified as HER2 negative. Little data exists on the reproducibility of pathologists reporting of HER2-low cancer. Sixteen expert pathologists of the UK National Coordinating Committee for Breast Pathology scored 50 digitally scanned HER2 IHC slides. The overall level of agreement, Fleiss multiple-rater kappa statistics and Cohen's Kappa were calculated. Cases with low concordance were re-scored by the same pathologists after a washout period. Absolute agreement was achieved in 6% of cases, all of which scored 3+. Poor agreement was found in 5/50 (10%) of cases. This was due to heterogeneous HER2 expression, cytoplasmic staining and low expression spanning the 10% cut-off value. Highest concordance (86%) was achieved when scores were clustered as 0 versus others. Improvement in kappa of overall agreement was achieved when scores 1+ and 2+ were combined. Inter-observer agreement was moderate to substantial in the whole cohort but fair to moderate in the HER2-low group. Similarly, consensus-observer agreement was substantial to almost perfect in the whole cohort and moderate to substantial in the HER2-low group. HER2-low breast cancer suffers from lower concordance among expert pathologists. While most cases can reproducibly be classified, a small proportion (10%) remained challenging. Refining the criteria for reporting and consensus scoring will help select appropriate patients for targeted therapy. • Concordance of HER2 low scoring using digital whole slide images was assessed among 16 expert pathologists. • 10% of cases were challenging to classify; all were of the HER2 low and ultralow. • Heterogeneity, cytoplasmic expression and percentage expression around 10% were reasons for discordance. • Clustering of categories (0 versus others) resulted in the highest concordance levels. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Mastery learning orientation, conceptualized as a growth mindset, can be beneficial to learners in medical education and is supported by a program's learning environment. Currently, there are no instruments which reliably assess the learning orientation of a graduate medical education program's learning environment. OBJECTIVE: To explore the reliability and validity of the Graduate Medical Education Learning Environment Inventory (GME-LEI). METHODS: Leaders of the Education in Pediatrics Across the Continuum (EPAC) project revised Krupat's Educational Climate Inventory to create the GME-LEI. We investigated the GME-LEI's reliability and validity through confirmatory factor and parallel factor analyses and calculated Cronbach's alpha for each subscale. We compared mean subscale scores between residents in traditional programs and the EPAC project. As EPAC is known to foster a mastery-focused learning orientation, we hypothesized differences detected between resident groups would strengthen the instrument's validity. RESULTS: One hundred and twenty-seven pediatric residents completed the GME-LEI. The final 3-factor model was an acceptable fit to the data, and Cronbach's alpha for each subscale was acceptable (Centrality: 0.87; Stress: 0.73; Support: 0.77). Mean scores on each subscale varied by program type (EPAC vs traditional) with EPAC residents reporting statistically significant higher scores in the Centrality of Learning subscale (2.03, SD 0.30, vs 1.79, SD 0.42; P = .023; scale of 1-4). CONCLUSIONS: The GME-LEI reliably measures 3 distinct aspects of the GME learning environment with respect to learning orientation. The GME-LEI may be used to help programs better monitor the learning environment and make changes to support mastery-oriented learning. [ABSTRACT FROM AUTHOR]

To describe the development and implementation of professional and personal identity formation content in a virtual pre-health pathway program. Content within a six-week pre-health program for underrepresented and/or disadvantaged college students was redesigned to a virtual format with enhanced focus on professional and personal identity formation. Sessions on personal identity formation were also enhanced through a partnership with local mental health clinicians specializing in trauma-informed care and culturally relevant practices and strategies. The 2020 and 2021 programs were restructured to include pharmacy professional identity formation content around the following weekly themes: Roadmap to Pharmacy, What Does it Mean to be a Pharmacist?, Expanding Knowledge of Pharmacy, Gaining Insight and Dispelling Myths, Practicing Knowledge and Exploration, and Moving Forward. These pre-pharmacy components emphasized diversity of career paths, pharmacy-based clinical services, and the pharmacist's role in promoting health equity. Overarching components of interprofessional collaboration coupled with health policy applications further emphasized the professional identity of a pharmacist in the collaborative design and delivery of health care. New personal identity formation sessions were implemented in tandem with this content and centering around the following themes: Supporting Scholars in Self-Authorship, Building a Community among Peers, and Strategies for Coping in Times of Challenge. This project has the potential to serve as a model for the implementation of both personal and professional identity formation initiatives at other programs to promote pharmacy as a desirable and attainable career to pre-health students. [ABSTRACT FROM AUTHOR]

Allergic disease reflects specific inflammatory processes initiated by interaction between allergen and allergen-specific IgE. Specific immunotherapy (SIT) is an effective long-term treatment option, but the mechanisms by which SIT provides desensitization are not well understood. Our aim was to characterize IgE sequences expressed by allergen-specific B cells over a 3-year longitudinal study of patients with aeroallergies who were undergoing SIT. Allergen-specific IgE–expressing clones were identified by using combinatorial single-chain variable fragment libraries and tracked in PBMCs and nasal biopsy samples over a 3-year period with antibody gene repertoire sequencing. The characteristics of private IgE-expressing clones were compared with those of stereotyped or "public" IgE responses to the grass pollen allergen Phleum pratense (Phl p) 2. Members of the same allergen-specific IgE lineages were observed in nasal biopsy samples and blood, and lineages detected at baseline persisted in blood and nasal biopsy samples after 3 years of SIT, including B cells that express IgE. Evidence of progressive class switch recombination to IgG subclasses was observed after 3 years of SIT. A common stereotyped Phl p 2–specific antibody heavy chain sequence was detected in multiple donors. The amino acid residues enriched in IgE-stereotyped sequences from seropositive donors were analyzed with machine learning and k-mer motif discovery. Stereotyped IgE sequences had lower overall rates of somatic hypermutation and antigen selection than did single-chain variable fragment–derived allergen-specific sequences or IgE sequences of unknown specificity. Longitudinal tracking of rare circulating and tissue-resident allergen-specific IgE+ clones demonstrates persistence of allergen-specific IgE+ clones, progressive class switch recombination to IgG subtypes, and distinct maturation of a stereotyped Phl p 2 clonotype. [ABSTRACT FROM AUTHOR]

Acceptance and commitment therapy (ACT) for attention-deficit/hyperactivity disorder (ADHD) is a new and emerging area that may be helpful for adults with ADHD in promoting psychological well-being. The Understanding and Managing Adult ADHD Programme (UMAAP) is an online intervention that combines psychoeducation with ACT. Forty-nine participants provided qualitative feedback on their experiences through open-ended questions in an online survey distributed after they completed UMAAP. Thematic analysis was used to develop four themes. ' An epiphany of awareness ' and ' accepting and affirming ADHD ' highlighted the intervention's outcomes and showed UMAAP appears to increase self-acceptance and understanding of ADHD. ' Too much for an introductory programme ' suggested that UMAAP could be overwhelming for some participants, while ' the nature of being an online intervention ' explored the costs and benefits of being conducted online. Overall, participants experienced psychoeducation with ACT as positively impacting their outlook of themselves and their relationship with their thoughts and behaviours. Findings also highlight elements that may need to be adapted to better suit adults with ADHD. • Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) may benefit from ACT. • Psychoeducation with ACT for ADHD increased participants' self-acceptance. • Participants were also more understanding of their ADHD, thoughts and behaviours. • The intervention's materials could be overwhelming and need to be simplified. • The online nature of the intervention facilitated flexible engagement. [ABSTRACT FROM AUTHOR]

Proliferative verrucous leukoplakia (PVL) is a rare form of oral leukoplakia with a relatively high transformation rate resulting in oral squamous cell carcinoma (OSCC). Molecular analysis of PVL at the genome level is limited and has only identified molecular similarities between PVL and OSCC. However, the clinical profile of PVL suggests that molecular differences may be more important. Whole exome sequencing of 5 PVL-associated OSCC (PVL-OSCC) and paired blood samples was used to identify somatic mutations common to the tumors. Whole methylome analysis of samples from 4 PVL-associated OSCC and 3 OSCC of non-PVL origin samples was conducted to explore differential methylation. In contrast to conventional OSCC, PVL-associated OSCC showed infrequent TP53 mutation and altered spectra of PIK3CA and NOTCH1 mutations. Unsupervised hierarchical clustering identified 63 probes that discriminated between PVL-associated OSCC and OSCC of non-PVL origin. Differences in methylation were most significant for divalent metal ion transport, particularly calcium movement. Specific differences in mutation and methylation profiles between PVL-derived OSCC and OSCC of non-PVL origin suggest differences in their transformation pathways. Further studies of early PVL lesions may identify markers of transformation that are also applicable to more common oral premalignant disorders such as oral epithelial dysplasia. [ABSTRACT FROM AUTHOR]

• Surgical unroofing via standard median sternotomy or minimally invasive approaches stands as an effective treatment for symptomatic and hemodynamically significant myocardial bridges. Myocardial bridges (MB) are a congenital variant in which an epicardial coronary artery—most commonly the left anterior descending (LAD)—is contained within an intramyocardial segment. The clinical significance of this lesion varies from no symptoms to debilitating angina, ventricular arrhythmia, and even sudden cardiac arrest. Traditionally difficult to diagnose, symptomatic myocardial bridges remain an elusive entity with a lack of clarity regarding medical treatment and surgical indications. Importantly, studies have shown that with appropriate patient selection, MB unroofing is an effective treatment for symptomatic lesions, in both the adult and pediatric populations. This article describes the preoperative evaluation and the surgical approach for myocardial bridges. Myocardial bridges (MB) are a congenital variant in which an epicardial coronary artery—most commonly the left anterior descending (LAD)—is contained within an intramyocardial segment. The clinical significance of this lesion varies from no symptoms to debilitating angina, ventricular arrhythmia, and even sudden cardiac arrest Traditionally difficult to diagnose, symptomatic myocardial bridges remain an elusive entity with a lack of clarity regarding medical treatment and surgical indications. Importantly, studies have shown that with appropriate patient selection, MB unroofing is an effective treatment for symptomatic lesions, in both the adult and pediatric populations. This article describes the pre-operative evaluation and the surgical approach for myocardial bridges. [ABSTRACT FROM AUTHOR]

Acquired Brain Injury (ABI) describes a range of brain injuries occurring after birth, including tumor, traumatic brain injury or stroke. Although MRIs are routinely used for diagnosis, prediction of outcome following brain injury is challenging. Quantitative structural information from brain images may provide an opportunity to predict patient outcomes; however, due to the high prevalence of severe pathology in children with ABI, quantitative approaches must be robust to injury severity. In this pilot cross-sectional study, automated quantitative measures were extracted from the MRIs of a cohort of children with ABI (n = 30, 8–16 years, follow up MRI taken 1.8–13.4 years after time of injury) as well as 36 typically developing controls with no brain injury (7–17 years) using a pathology-robust technique. Measures of brain volume, lesion volume and cortical morphology were associated with concurrent motor, behavioral, visual and communicative function using Least Absolute Shrinkage and Selection Operator (LASSO) regression. These regression models were validated on a separate test set (n = 8 of the ABI cohort), which revealed significant correlations between measures of brain structure with motor, cognitive, visual and communicative function (r = 0.65–0.85, all p < 0.01). Furthermore, comparisons of the structural measures to the typically developing cohort revealed overall reductions in global grey matter volume among the ABI cohort, as well as cortical thinning in several cortical areas. These preliminary associations reveal that motor and behavioral function can be estimated from MRI alone, highlighting the potential utility of the proposed pathology-robust MRI quantification tools to provide estimates of long-term clinical prognosis of children with ABI following injury. [ABSTRACT FROM AUTHOR]

The objective of this work was to delineate career progression and research productivity of women practicing cardiothoracic surgery in the academic setting. Cardiothoracic surgeons at the 79 accredited US cardiothoracic surgery training programs in 2020 were included in this cross-sectional analysis. Data regarding subspecialization, training, practice history, and publications were gathered from public sources including department websites, CTSNet, and Scopus. A total of 1065 surgeons (51.3% cardiac, 32.1% thoracic, 16.6% congenital) were identified. Women accounted for 10.6% (113) of the population (7.9% of cardiac, 15.5% of thoracic, 9.6% of congenital surgeons). The median number of cardiothoracic surgeons per institution was 12 (interquartile range [IQR], 10-17), with a median of 1 woman (IQR, 0-2). Fifteen of 79 programs (19%) had no women. Among women faculty 5.3% were clinical instructors, 51.3% were assistant professors, 23.0% were associate professors, 16.8% were full professors, and 3.5% had unspecified titles (vs 2.0%, 32.9%, 23.0%, 37.5%, and 4.6% among men, respectively; P <.001). Women and men authored a comparable number of first-author (0.4 [IQR, 0.0-1.3] vs 0.5 [IQR, 0.0-1.1], P =.56) publications per year but fewer last-author (0.1 [IQR, 0.0-0.7] vs 0.4 [IQR, 0.0-1.3], P <.0001) and total publications per year (2.7 [IQR, 1.0-6.2] vs 3.7 [IQR, 1.3-7.8], P =.05) than men. The H-index was lower for women than for men overall (8.0 [IQR, 3.0-15.0] vs 15.0 [IQR, 7.0-28.0], P <.001) but was similar between men and women who had been practicing for 10 to 20 years. Gender disparities persist in academic cardiothoracic surgery. Efforts should be made to support women in achieving senior roles and academic productivity. [ABSTRACT FROM AUTHOR]

Objective: To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA).Design: A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains.Results: The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise.Conclusion: The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex. [ABSTRACT FROM AUTHOR]

DXA-derived reference data for visceral adipose tissue (VAT) and advanced hip analysis (AHA) parameters spanning the entire adult lifespan are limited. The purpose of this study was to develop age-, site- and sex-specific reference data for dual X-ray absorptiometry (DXA) -derived body composition, trabecular bone score (TBS) and advanced hip analysis (AHA) parameters across the adult lifespan. Adults (N = 908; female: 561 and male: 347) from Calgary and the surrounding area over the age of 20 years participated in this study. Participants received DXA scans of their hip (total hip [TH] and femoral neck [FN]), lumbar spine [LS], forearm [33 % site] and total body (iDXA, GE Lunar, GE Healthcare). Areal bone mineral density (aBMD, g/cm2) was captured at all sites, and body composition variables, including lean mass, fat mass and percent fat, were analyzed from the total body scan. VAT mass was assessed from total body DXA scans. Advanced hip analysis (AHA) was performed on hip scans and trabecular bone score (TBS) on the LS scans to assess bone quality. Site- and sex-specific centile curves and tables were generated using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Clinicians and researchers can use these Canadian reference data as a tool to assess body composition, TBS and AHA parameters across the adult lifespan. [ABSTRACT FROM AUTHOR]

Pharmacologic or genetic manipulation of O-GlcNAcylation, an intracellular, single sugar post-translational modification, are difficult to interpret due to the pleotropic nature of O-GlcNAc and the vast signaling pathways it regulates. To address the pleotropic nature of O-GlcNAc, we employed either OGT (O-GlcNAc transferase), OGA (O-GlcNAcase) liver knockouts, or pharmacological inhibition of OGA coupled with multi-Omics analysis and bioinformatics. We identified numerous genes, proteins, phospho-proteins, or metabolites that were either inversely or equivalently changed between conditions. Moreover, we identified pathways in OGT knockout samples associated with increased aneuploidy. To test and validate these pathways, we induced liver growth in OGT knockouts by partial hepatectomy. OGT knockout livers showed a robust aneuploidy phenotype with disruptions in mitosis, nutrient sensing, protein metabolism/amino acid metabolism, stress response, and HIPPO signaling demonstrating how OGT is essential in controlling aneuploidy pathways. These data show how a multi-Omics platform can disentangle the pleotropic nature of O-GlcNAc to discern how OGT fine-tunes multiple cellular pathways involved in aneuploidy. • Developed a systems biology approach to untangle the pleiotropic effects of O-GlcNAcylation. • Using Multi-Omics, we identified cellular pathways linked to aneuploidy development under O-GlcNAc regulation. • Performed liver hepatectomy (PHX) on OGT- knockout livers caused a robust increase in OGT-KO liver aneuploidy. • Verified alterations in mTOR, cell cycle, HIPPO, and p53 signaling in the OGT-KO livers. [ABSTRACT FROM AUTHOR]

Organic ultraviolet filters (UVFs) are known to contaminate many aquatic ecosystems, with much environmental contamination attributed to the use of UVF-containing skin care products such as sunscreens during aquatic recreation. Most studies addressing the impact of sunscreen contamination have focused on the effects of UVFs under the assumption that they are the primary contaminants of concern from sunscreen pollution; however, the extent to which the toxicity of UVFs is representative of the environmental impacts of the whole sunscreen mixture is unknown. To address this knowledge gap, this study compared the mixture toxicity of five off-the-shelf sunscreen spray products containing the UVFs avobenzone, homosalate, octisalate, octocrylene and oxybenzone to the toxicity of each UVF in isolation to the freshwater invertebrate Daphnia magna. It was found that sunscreen toxicity was not proportional to their total UVF content, as the sunscreen containing the fewest UVFs was approximately equivalent to the sunscreen with the most UVFs, causing ≥90 % mortality and inhibiting all daphnid reproduction over 21 d exposures. Sunscreen toxicity was typically lower than expected when compared to the toxicity of each individual UVF within the mixture, as some sunscreens causing ≤20 % mortality contained octocrylene and/or oxybenzone at concentrations exceeding those which caused 90 % mortality during exposure to the UVF alone. Despite sunscreens causing large impairments in reproduction, growth and metabolism, poor correlations existed between the severity of most sublethal endpoints with respect to the measured UVF content of each sunscreen. Overall, these results indicate that potential antagonistic relationships between sunscreen ingredients can greatly reduce the toxicity of UVFs, creating more uncertainty regarding the level of threat that UVFs pose to the environment as a result of sunscreen contamination. [Display omitted] • UV filter toxicity alone is used to estimate sunscreen contamination effects. • D. magna sensitivity to 5 sunscreen mixtures and isolated UV filters was compared. • Sunscreen toxicity correlated poorly with total UV filter concentrations. • UV filters were more toxic alone than sunscreens of equivalent concentrations. • Antagonistic mixture effects may be reducing sunscreen toxicity. [ABSTRACT FROM AUTHOR]

• A case study using CPT for CB-PTSD tailored content to meet the unique needs of postpartum women. • Following CPT for CB-PTSD, clinically significant outcomes were produced in both PTSD and depressive symptoms. • Our modified version of CPT was highly acceptable to the participant in our case study. • Our findings show initial support for CPT as a strong psychotherapeutic intervention option for targeting CB-PTSD. Having a baby is a natural biological process and commonly considered a positive and exciting time in life. However, birth and the postpartum period also represent a vulnerable time for mental health and the development of posttraumatic stress disorder (PTSD) among women who are exposed to traumatic events during birth. Childbirth-related PTSD (CB-PTSD) is a relatively new and unique construct, associated with negative impacts to the mother, her infant, and family more broadly. Research investigating psychological interventions following traumatic births remains scant and no studies have evaluated cognitive processing therapy (CPT), a well-established and empirically supported psychological therapy, in the treatment of CB-PTSD. We conducted a case study using CPT for CB-PTSD, modifying the length of the traditional protocol to eight sessions, and tailoring the content to meet the unique needs of postpartum women. Following CPT for CB-PTSD, clinically significant and meaningful treatment outcomes were produced in both PTSD and depressive symptoms, with gains maintained at 1-month follow-up. Our modified version of CPT for CB-PTSD was also highly acceptable with the participant in our case study. These findings provide initial support for CPT as a strong psychotherapeutic intervention option for targeting CB-PTSD. Further research is necessary to examine this treatment and its acceptability with a larger sample. [ABSTRACT FROM AUTHOR]

• Nurses require skills and attitudes that are accepting of people living with mental illness regardless of their specialization area. • A desire for social distance was noted in this study, in addition to significantly high self-reported rates of depression. • Nursing programs should develop educational activities that target perceptions of dangerousness and importantly, universities should increase supports for students experiencing mental health issues. Almost half (46%) of people will experience a mental health issue in their lifetime and all nurses need mental health knowledge and skills regardless of their area of specialization. Little is known, however, about student attitudes toward people with mental illness on entry to pre-registration nursing programs. The aims were to investigate Australian pre-registration nursing students' attitudes toward, and prior experience with, people with mental illness on program commencement. This cross-sectional study used the Community Attitudes Toward Mental Illness (CAMI) scale with pre-registration nursing students, and questions on students' prior experience with mental illness (self, family, friends). There were n = 311 (271 female/40 male) first year, first semester Bachelor of Nursing students at a national Australian university. Students reported prior experience with mental illness with family (49.5%/ n = 154) and friends (61.4%/ n = 191). Self-reported (36.3% / n = 113) mental illness, particularly anxiety and depression, significantly exceeded national averages. Most students held accepting attitudes toward people with mental illness, except for perceptions of dangerousness. This study provides new findings on nursing student attitudes and experience with people with mental illness on program entry. The high self-reported prevalence of anxiety and depression at program entry indicates a pressing need for early intervention and mental wellbeing strategies for students from commencement of their tertiary education. Fear-reducing education which challenges perceptions of dangerousness in relation to people with mental illness, and supportive mental health clinical placements during their program, may help improve students' attitudes and reduce fear and mental health stigma. [ABSTRACT FROM AUTHOR]

Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19. We examined 323 adult patients with COVID-19 admitted to the intensive care units (ICUs) of Massachusetts General Hospital between March 11 and June 28, 2020 who received enteral nutrition. Systematic chart review determined prevalence, clinical characteristics, and hospital outcomes (ICU complications, length of stay, and mortality) of feeding intolerance. Feeding intolerance developed in 56% of the patients and most commonly manifested as large gastric residual volumes (83.9%), abdominal distension (67.2%), and vomiting (63.9%). Length of intubation (OR 1.05, 95% CI 1.03–1.08), ≥1 GI symptom on presentation (OR 0.76, 95% CI 0.59–0.97), and severe obesity (OR 0.29, 95% CI 0.13–0.66) were independently associated with development of feeding intolerance. Compared to feed-tolerant patients, patients with incident feeding intolerance were significantly more likely to suffer cardiac, renal, hepatic, and hematologic complications during their hospitalization. Feeding intolerance was similarly associated with poor outcomes including longer ICU stay (median [IQR] 21.5 [14–30] vs. 15 [9–22] days, P < 0.001), overall hospitalization time (median [IQR] 30.5 [19–42] vs. 24 [15–35], P < 0.001) and in-hospital mortality (33.9% vs. 16.1%, P < 0.001). Feeding intolerance was independently associated with an increased risk of death (HR 3.32; 95% CI 1.97–5.6). Feeding intolerance is a frequently encountered complication in critically ill COVID-19 patients in a large tertiary care experience and is associated with poor outcomes. [ABSTRACT FROM AUTHOR]

Vein grafts, the most commonly used conduits in multi-vessel coronary artery bypass grafting surgery, have high intermediate- and long-term failure rates. The abrupt and marked increase in hemodynamic loads on the vein graft is a known contributor to failure. Recent computational modeling suggests that veins can more successfully adapt to an increase in mechanical load if the rate of loading is gradual. Applying an external wrap or support at the time of surgery is one way to reduce the transmural load, and this approach has improved performance relative to an unsupported vein graft in several animal studies. Yet, a clinical trial in humans has shown benefits and drawbacks, and mechanisms by which an external wrap affects vein graft adaptation remain unknown. This study aims to elucidate such mechanisms using a multimodal experimental and computational data collection pipeline. We quantify morphometry using magnetic resonance imaging, mechanics using biaxial testing, hemodynamics using computational fluid dynamics, structure using histology, and transcriptional changes using bulk RNA-sequencing in an ovine carotid-jugular interposition vein graft model, without and with an external biodegradable wrap that allows loads to increase gradually. We show that a biodegradable external wrap promotes luminal uniformity, physiological wall shear stress, and a consistent vein graft phenotype, namely, it prevents over-distension, over-thickening, intimal hyperplasia, and inflammation, and it preserves mechanotransduction. These mechanobiological insights into vein graft adaptation in the presence of an external support can inform computational growth and remodeling models of external support and facilitate design and manufacturing of next-generation external wrapping devices. External mechanical support is emerging as a promising technology to prevent vein graft failure following coronary bypass graft surgery. While variants of this technology are currently under investigation in clinical trials, the fundamental mechanisms of adaptation remain poorly understood. We employ an ovine carotid-jugular interposition vein graft model, with and without an external biodegradable wrap to provide mechanical support, and probe vein graft adaptation using a multimodal experimental and computational data collection pipeline. We quantify morphometry using magnetic resonance imaging, mechanics using biaxial testing, fluid flow using computational fluid dynamics, vascular composition and structure using histology, and transcriptional changes using bulk RNA sequencing. We show that the wrap mitigates vein graft failure by promoting multiple adaptive mechanisms (across biological scales). [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Late-life depression (LLD) is characterized by accelerated biological aging. Accelerated brain aging, estimated from structural magnetic resonance imaging (sMRI) data by a machine learning algorithm, is associated with LLD diagnosis, poorer cognitive performance, and disability. We hypothesized that accelerated brain aging moderates the antidepressant response.Design and Interventions: Following MRI, participants entered an 8-week randomized, controlled trial of escitalopram. Nonremitting participants then entered an open-label 8-week trial of bupropion.Participants: Ninety-five individuals with LLD.Measurements: A machine learning algorithm estimated each participant's brain age from sMRI data. This was used to calculate the brain-age gap (BAG), or how estimated age differed from chronological age. Secondary sMRI measures of aging pathology included white matter hyperintensity (WMH) volumes and hippocampal volumes. Mixed models examined the relationship between sMRI measures and change in depression severity. Initial analyses tested for a moderating effect of MRI measures on change in depression severity with escitalopram. Subsequent analyses tested for the effect of MRI measures on change in depression severity over time across trials.Results: In the blinded initial phase, BAG was not significantly associated with a differential response to escitalopram over time. BAG was also not associated with a change in depression severity over time across both arms in the blinded phase or in the subsequent open-label bupropion phase. We similarly did not observe effects of WMH volume or hippocampal volume on change in depression severity over time.Conclusion: sMRI markers of accelerated brain aging were not associated with treatment response in this sequential antidepressant trial. [ABSTRACT FROM AUTHOR]

Background: Human physiology undergoes extensive changes in space potentially leading to alterations in the way a medication functions. Understanding the efficacy behind Pharmacological Countermeasures (PCMs) and deliverable pharmacy services is imperative for the future presence of humans in space. However, while the pharmacist plays an integral role for human health terrestrially, pharmacist input has been minimal for human health in the space sector. Here, we explore the pharmacist's potential role in larger medical teams for future missions.Objective: To explore pharmacy and space sector stakeholder perspectives regarding the pharmacist's role in the space sector.Methods: Semi-structured interviews and focus groups were conducted with pharmacy (n = 31) and human health-related space sector stakeholders (n = 26) across the globe from governmental, commercial, industry and academic sectors. Purposive and snowball sampling were used to identify stakeholders. Interviews and focus groups were audio recorded, transcribed verbatim and thematically analysed.Results: Three themes - medication management, medication-related research and medication and health information - were generated. The importance of medication optimisation within commercial and federal spaceflight participant medication regimens was cited as necessary for sustainable space exploration. Both groups advocated for pharmacists' involvement with in-situ medication manufacturing and medication-related research, particularly regarding space-based pharmacokinetic and pharmacodynamic drug profiling. Other essential roles included the pharmacist's role in providing medication information to spaceflight participants and other healthcare professionals on their health status and medication use risk in the context of space.Conclusions: With the advancement of accessible, commercial space travel and humans becoming an inter-planetary species, the opportunity to tackle PCM needs via a more extensive and comprehensive collaborative effort between the space, medical and pharmacy sectors is essential for sustainable space exploration. [ABSTRACT FROM AUTHOR]

Hematomas are reported to be the most common immediate complication in patients undergoing gender-affirming mastectomy, with rates substantially higher than those associated with other types of breast surgery. This study sought to examine the breadth of current literature and provide evidence-based explanations regarding the development of hematomas in chest masculinizing surgery and technical considerations for reducing their incidence. A systematic review was conducted to identify all articles related to gender-affirming mastectomy published through September 2021. Literature search yielded 2,661 articles for screening, of which 20 met inclusion criteria. Themes from the selected articles were compiled to generate consensus statements qualified by associated level of evidence (LOE). The rate of hematoma following gender-affirming mastectomy is reported in the literature ranging from 0% to 31.2%. The use of more limited, nipple-sparing incisions is associated with a higher hematoma rate than mastectomy with free nipple grafting (Level III). There is no conclusive evidence indicating any relationship between the use of masculinizing hormones and the incidence of hematoma (Level IV). Factors such as body mass index (Level III) and breast size (Level III) were not found to influence hematoma risk, though nicotine use (Level IV) was significantly associated with the incidence of hematoma. Hematoma is a known complication following gender-affirming mastectomy. The use of limited incision approaches has the strongest association with an increased risk of hematoma. There is no evidence indicating an association between hormone use (i.e., testosterone) and hematoma incidence. Future studies are needed to better define factors, interventions, and protocols to reduce the rate of hematoma. III [ABSTRACT FROM AUTHOR]

• HOA yards with native plant requirements had greater cover of native plants. • HOA yards with lawn restriction clauses had less area of lawn cover. • Adherence to sustainable clauses varied at the HOA neighborhood level. • HOAs with multiple PECs had the greatest adherence. Homeowner's associations (HOAs) use their codes covenants, and restrictions (CCRs) to regulate yard composition. A small but growing number of HOAs include clauses in their CCRs with pro-environmental aims. This study assessed the effect of native plant requirement and lawn restriction pro-environmental clauses (PECs) on yard composition. Using front yard surveys, we found a greater mean percent cover of native species in PEC yards (29.51%) compared to non-PEC yards (6.94%) and less mean percent lawn cover in PEC yards (38.44%) than non-PEC yards (68.04%). While these results suggest that PECs are an opportunity for enhancing conservation behaviors of homeowners, we recommend further studies explore the language of PECs, homeowner knowledge of native plants and sustainable landscaping practices, and developer or HOA roles in supporting homeowners. [ABSTRACT FROM AUTHOR]

Why do people categorize others by race? Building on recent work integrating affordance management with a life history perspective, we propose that one reason perceivers categorize others by race is because race is a cue to the environments/ecologies in which groups live. In the U.S., because Black and White individuals differentially live in environments that vary in ecological harshness/unpredictability, race may be used as a cue of a person's home ecology. In three experiments (undergraduate and online U.S. samples; N = 1260) with the memory confusion paradigm ("who-said-what"), when American perceivers are presented with information on both a person's race (i.e., Black/White) and the ecologies in which they live (i.e., harsh/hopeful), racial categorization decreases, and ecology categorization emerges (Studies 1–3). Hence, in the minds of perceivers, the ecologies that others come from "replaces" others' race. However, counter to expectations, instructing perceivers to form social impressions of others on traits linked to ecological harshness (i.e., "planfulness") led to ecology categorization disappearing (Study 3). We discuss implications of our findings for race perception and for social perception at large. [ABSTRACT FROM AUTHOR]