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Sustained asymptomatic hypertension in ED patients is a powerful predictor of chronic uncontrolled hypertension. In this study, we assess the feasibility of using a storyboard video and communicating real-time cardiovascular imaging results on blood pressure control and primary care engagement. This was a prospective observational exploratory sub-study. Following Institutional Review Board approval (#18-00197), 20 English-speaking adults in an urban emergency department with an initial blood pressure ≥160/100 mm Hg and a second blood pressure ≥140/90 mm Hg were enrolled. Patients watched a 60-second storyboard video about uncontrolled hypertension in the ED setting, featuring racially and ethnically diverse avatars. They then received a real-time bedside echocardiogram. Emergency nurses communicated the echocardiogram results using a standard script and advised follow-up within 2 weeks after discharge. Patient characteristics, blood pressure control, primary care engagement, and acceptability of the intervention were assessed at baseline, 12 weeks, and 24 weeks post-discharge. All 20 enrolled patients (mean age 55, 70% female, and 95% from underrepresented groups [30% Black, 50% Hispanic, and 15% Black and Hispanic]) exhibited subclinical heart disease on echocardiograms. Blood pressure control improved from baseline (systolic 166 mm Hg, diastolic 97 mm Hg) to 24 weeks (systolic 137 mm Hg, diastolic 78 mm Hg). Seventy percent of patients engaged with primary care post-discharge, and the intervention had high acceptability (94.8% approval). The Brief Risk Communication for ED patients with sustained asymptomatic hypertension study demonstrates the feasibility and acceptability of using a brief video and real-time cardiovascular imaging for risk communication in the emergency department. Future research will build on these findings with a larger, more comprehensive study. [ABSTRACT FROM AUTHOR]

In this invited expert review, we focus on evolving lifetime management strategies for adolescents and young adults with congenital aortic valve disease, acknowledging that these patients often require multiple interventions during their lifetime. Our goal is to preserve the native aortic valve when feasible. Leveraging advanced multimodality imaging, a detailed assessment of the aortic valve and root complex can be obtained, and a surgically approach tailored to an individual patient's anatomy and pathology can be used. In turn, aortic valve repair and reconstruction can be offered to a greater number of patients, either as a definitive strategy or as a component of a staged strategy to delay the need for aortic valve replacement until later in life when more options are available. [Display omitted] [ABSTRACT FROM AUTHOR]

Obesity has been correlated with heightened risk of complications after orthopedic surgeries. Bariatric surgery (BS) is an effective tool commonly utilized for the reduction of body mass index. However, the impact of BS on complications in total shoulder arthroplasty (TSA) remains inadequately investigated. This study examines the 5-year risk of revision following TSA in patients with a history of BS compared to matched cohorts without history of BS. Utilizing the PearlDiver Mariner database, a retrospective cohort analysis was conducted on over 157 million U.S. patients from January 2010 to October 2021. Inclusion criteria identified patients undergoing primary TSA with a minimum 2-year follow-up. Propensity-score matching was employed to control for covariates, comparing BS patients with a matched control and a matched class III obesity control without history of BS. Demographics, comorbidities, and outcomes, including 5-year cumulative incidence of revision were analyzed. The 5-year cumulative incidence of all-cause revision within the BS group was found to be 4.6%. While this represented a higher risk than that of the general population (hazard ratio 1.70; 95% confidence interval 1.21-2.39), there was no significant difference when compared to controls with class III obesity. The BS cohort had higher risk of revision secondary to dislocation/subluxation and rotator cuff tear than in the general population. When compared to the class III obesity cohort, only the risk of revision due to rotator cuff tear was found to be higher. Individuals with a history of BS showed a higher risk of revision than a cohort without history of BS and an equivalent risk of revision compared to a cohort of class III obesity controls after undergoing TSA. Though obesity is an important risk factor for complications after TSA, BS might not be an effective tool for preoperative risk optimization. [ABSTRACT FROM AUTHOR]

There are sex differences in left ventricular ejection fraction (LVEF) relevant to prognosis where women experience greater mortality at relatively higher LVEF compared to men, yet mechanistic understanding of this adverse prognosis is limited. Women with suspected ischemia with no obstructive coronary disease (INOCA) develop heart failure with preserved ejection fraction (HFpEF), yet contributors to LVEF remain largely unknown. In 370 women with suspected ischemia with no obstructive coronary disease (INOCA) who prospectively underwent cardiac magnetic resonance imaging (CMRI), we investigated the contributions of LV morphology, function, and myocardial perfusion reserve on LVEF using univariate and multiple linear regression. A majority 71% of participants had high LVEF (>65%), followed by 24% having normal LVEF (55%-65%), and only 5% having low EF (<55%). Baseline characteristics were comparable among the 3 groups, with the exception of age which was 6 years higher in the high LVEF group (P <.01). Women in the high LVEF group also had the lowest LV cavity volume, greatest LV mass-volume ratio, and highest LV end-systolic elastance (all P <.05, adjusted for age, BMI, diabetes, and blood pressure). Myocardial perfusion reserve index was low in all groups (mean MPRI < 2.1) but was not significantly different across the spectrum of LVEF (P =.458). Taken together, these data demonstrate that the majority of women with suspected INOCA have elevated LVEF related to smaller, thicker ventricles with greater contractility. Future work is needed to better understand the specific mechanisms driving morphologic and functional changes in women with INOCA, and relations to longer-term HFpEF and mortality. NCT02582021. [ABSTRACT FROM AUTHOR]

Academic nurse leadership is associated with nurse faculty job satisfaction, yet there is a gap between theoretical understanding of leadership concepts and specific actionable behaviors that can be implemented to increase nurse faculty job satisfaction. The purpose of this study was to create an evidence-based action guide for academic nurse leaders at all leadership levels to use to improve nurse faculty job satisfaction. A two-phase approach was used. In Phase 1, a review of the literature was conducted to identify core concepts of 5 relational leadership theories (adaptive, authentic, servant, transformational, and human-centered leadership in healthcare). In Phase 2, the leadership core concepts were cross analyzed and mapped to academic nurse leader behaviors that impact nurse faculty job satisfaction. Human-centered leadership in healthcare emerged as the best-fit leadership theory to academic nurse leader behaviors that improve nurse faculty job satisfaction. Servant, transformational, and authentic leadership were somewhat aligned, and adaptive leadership was least aligned. Core concepts of human-centered leadership in healthcare informed the creation of an action guide for academic nurse leaders, which details getting to know your faculty, contributing to a positive work environment, and investing in yourself. The action guide can be used by academic nurse leaders at all levels to enhance nurse faculty satisfaction. • Human-centered leadership aligns best with academic nurse leader behaviors that enhance nurse faculty job satisfaction. • To boost faculty satisfaction, leaders should know their faculty, create a positive environment, and invest in themselves. • Implementing the action guide for academic nurse leaders will enhance nurse faculty job satisfaction. [ABSTRACT FROM AUTHOR]

Angiographic assessment of left main coronary artery (LMCA) stenosis severity can be unreliable. In cases of ambiguity, intravascular ultrasound (IVUS) can be utilised with a minimal lumen area (MLA) of ≥6 ​mm2 an accepted threshold for safe deferral of revascularization. We sought to assess whether quantitative computer tomography coronary angiography (CTCA) measures could assist clinicians making LMCA revascularization decisions when compared with IVUS as gold standard. Consecutive patients undergoing IVUS assessment of angiographically intermediate LMCA stenosis were included. All patients had undergone 320-slice CTCA <90 days prior to IVUS imaging. Offline quantitative assessment of IVUS- and CT-derived measures were undertaken with the cohort divided into those with significant (s-LMCA) versus non-significant (ns-LMCA) disease using the accepted IVUS threshold. Fifty-eight patients were included, with no difference in mean age (61.5 ​± ​12.2 vs. 59.7 ​± ​11.9 years, p ​= ​0.57), diabetic status (24.2% vs 16.0%, p ​= ​0.44) or other baseline demographics between groups. Patients with ns-LMCA had larger CT luminal area (8.64 ​± ​3.91 vs. 5.41 ​± ​1.54 ​mm2, p ​< ​0.001), larger minimal lumen diameter (MLD) (3.25 ​± ​0.74 vs. 2.56 ​± ​0.38 ​mm, p ​< ​0.001) and lower area stenosis (45.74 ​± ​18.10 vs. 60.93 ​± ​14.68%, p ​= ​0.001). There was a significant positive correlation between CTCA and IVUS MLA (r ​= ​0.68, p ​< ​0.001) and MLD (r ​= ​0.67, p ​< ​0.001). ROC analysis demonstrated CTCA MLA cut-off <8.29 ​mm2 provides the greatest negative predictive value and sensitivity in predicting the presence of significant LMCA disease. CTCA derived MLA and MLD have a strong correlation with IVUS. A CTCA derived MLA cut-off <8.29 ​mm2 showed greatest clinical utility for predicting the need for further assessment, based on IVUS gold standard. [ABSTRACT FROM AUTHOR]

• Using one of the largest heart failure pragmatic trials (CONNECT-HF; (Care Optimization Through Patient and Hospital Engagement For HF), we assessed the completeness and validity of remote follow-up, integrating participant-reported via a centralized call center and site-reported approaches. • Both participant-reported via centralized call center- and site-reported approaches substantially missed hospitalization events. In contrast, both approaches demonstrated high and comparable adjudication rates for hospitalizations among the reported hospitalization events. • Our study highlighted that integrating both approaches remains essential to capture and validate effective clinical outcomes in the context of current pragmatic trials. Randomized controlled trials typically require study-specific visits, which can burden participants and sites. Remote follow-up, such as centralized call centers for participant-reported or site-reported, holds promise for reducing costs and enhancing the pragmatism of trials. In this secondary analysis of the CONNECT-HF (Care Optimization Through Patient and Hospital Engagement For HF) trial, we aimed to evaluate the completeness and validity of the remote follow-up process. The CONNECT-HF trial evaluated the effect of a post-discharge quality-improvement intervention for heart failure compared to usual care for up to 1 year. Suspected events were reported either by participants or by health care proxies through a centralized call center or by sites through medical-record queries. When potential hospitalization events were suspected, additional medical records were collected and adjudicated. Among 5942 potential hospitalizations, 18% were only participant-reported, 28% were reported by both participants and sites, and 50% were only site-reported. Concordance rates between the participant/site reports and adjudication for hospitalization were high: 87% participant-reported, 86% both, and 86% site-reported. Rates of adjudicated heart failure hospitalization events among adjudicated all-cause hospitalization were lower but also consistent: 45% participant-reported, 50% both, and 50% site-reported. Participant-only and site-only reports missed a substantial number of hospitalization events. We observed similar concordance between participant/site reports and adjudication for hospitalizations. Combining participant-reported and site-reported outcomes data is important to capture and validate hospitalizations effectively in pragmatic heart failure trials. Both approaches (centralized call center and site reports) substantially missed hospitalization events. However, both approaches demonstrated high and comparably adjudicated hospitalization rates among the reported potential hospitalization events. Integrating both approaches remains essential to capture and validate clinical outcomes effectively.   [ABSTRACT FROM AUTHOR]

[Display omitted] Noninfectious (inflammatory) cutaneous granulomatous disorders include cutaneous sarcoidosis (CS), granuloma annulare (GA), necrobiosis lipoidica (NL), and necrobiotic xanthogranuloma (NXG). These disorders share macrophage-predominant inflammation histologically, but the inflammatory architecture and the pattern of extracellular matrix alteration varies. The underlying molecular explanations for these differences remain unclear. We sought to understand spatial gene expression characteristics in these disorders. We performed spatial transcriptomics in cases of CS, GA, NL, and NXG to compare patterns of immune activation and other molecular features in a spatially resolved fashion. CS is characterized by a polarized, spatially organized type 1-predominant response with classical macrophage activation. GA is characterized by a mixed but spatially organized pattern of type 1 and type 2 polarization with both classical and alternative macrophage activation. NL showed concomitant activation of type 1, type 2, and type 3 immunity with a mixed pattern of macrophage activation. Activation of type 1 immunity was shared among, CS, GA, and NL and included upregulation of IL-32. NXG showed upregulation of CXCR4-CXCL12/14 chemokine signaling and exaggerated alternative macrophage polarization. Histologic alteration of extracellular matrix correlated with hypoxia and glycolysis programs and type 2 immune activation. Inflammatory cutaneous granulomatous disorders show distinct and spatially organized immune activation that correlate with hallmark histologic changes. [ABSTRACT FROM AUTHOR]

Limited data are available on locations of public access defibrillation programs across communities in the United States, despite their widespread presence. Our goal was to determine publicly available AED locations of large businesses in a mixed urban-rural county. We then compared our survey results to a NC state-mandated AED registry and the county's emergency medical dispatch center AED registry. We conducted structured phone surveys of all large businesses (>19 employees) and select small businesses (healthcare, government, childcare, educational, and religious organizations with 1–19 employees) in Forsyth County, NC (n = 1702) to determine AED ownership and location. In addition, AED lists were elicited from multi-building organizations (e.g., health systems, universities, and local government), the NC Office of Emergency Medical Services (OEMS), and the Forsyth County emergency medical dispatch center. Our survey yielded a response rate of 79.1 % and identified 411 businesses with ≥ 1 AEDs. An additional 162 AED locations were contained in AED lists from multi-building organizations and registries. In total, our canvas identified 963 AEDs at 573 unique locations. The majority of AEDs (65.1 % [627/963]) were not previously registered in the NC OEMS AED registry. Few identified AEDs (11.8 % [114/963]) were listed in the county emergency medical dispatch center registry. • Many businesses own AEDs that may be used by trained laypersons. • Current AED registries are incomplete, making public AEDs difficult to find. • Increased reporting of publicly available AEDs is needed to increase AED utilization. [ABSTRACT FROM AUTHOR]

Gabapentinoids increasingly utilized for neuropathic pain, possibly to curb opioid prescribing. At the same time, data suggest subsequent increases in misuse and overdose of gabapentinoids, often in mixed overdoses. We sought to determine national trends and characteristics of gabapentinoid prescribing, including co-use with opioids, from the emergency department (ED). This is a retrospective review of the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 to 2021. Our primary outcome was the trend in ED visits in which gabapentinoids were prescribed at discharge. Secondarily, we identified trends in gabapentinoid and opioid co-prescribing and gabapentin and pregabalin prescribing at ED discharge. We examined demographic data and used descriptive statistics, Shapiro Wilke's test, Pearson's Spearman's rho (SR) or Pearson's correlation coefficient (PC) as applicable. Neural networks were used to identify the most important predictors of opioid utilization during the same visit. Between 2012 and 2021, there were an estimated 7,242,694 (0.53% of all ED visits) visits in which gabapentinoids were prescribed at ED discharge. Prescriptions increased from a total of 138,479 (0.1%) in 2012 to 893,495 (0.63%) in 2021 (PC: 0.85, p < 0.001). Opioids were co-prescribed in 27.2% of all visits in which gabapentinoids were prescribed, with no change over time (PC: −0.47, p = 0.09). Pregabalin prescription increased linearly over time (PC: 0.64, p = 0.02). The most important predictors of opioid administration or co-prescribing were whether an alternative provider (e.g., consult or nurse practitioner) saw the patient (100%), insurance (94.4%), age (75.9%), and region (75.2%). Despite an association of misuse and overdose, often associated with opioids, gabapentinoids were increasingly prescribed at ED discharge. While these agents may be safer alternatives to opioids, misuse may be an associated consequence of increased prescribing, which warrants further investigation. [ABSTRACT FROM AUTHOR]

To translate and cross-culturally adapt the University of Wisconsin Running Injury and Recovery (UWRI) to Brazilian Portuguese (UWRI-BR) and assess its psychometric properties. The Brazilian version of the UWRI questionnaire was based on the guideline proposed by Guillemin. The UWRI was translated, back-translated, and culturally adapted. Fifty runners responded to the pre-final version to validate the final version. Ninety-seven runners participated in the content validity of the UWRI-BR, and 58 runners in the assessment of reliability baseline 48–72 h after the first response. The Lower Extremity Functional Scale (LEFS) and 12-item Short Form Health Survey (SF-12) version 2 (SF-12_2) were applied to construct validity. The final version of UWRI-BR showed a positive moderate correlation with LEFS (r = 0.65, p < 0.01) and weak with SF-12_2 (r = 0.31, p < 0.01). UWRI-BR showed excellent internal consistency (α = 0.92) and test-retest Reliability (ICC = 0.83; 95% CI (0,72–0,90). The Brazilian version of the UWRI was a valid and reliable tool for evaluating and monitoring the progression of runners with running-related injuries. • The UWRI is a self-reported questionnaire to evaluate runners with running-related injuries. • The UWRI evaluates longitudinal changes in the rehabilitation process and self-perception of runners regarding symptoms. • The Brazilian version of the UWRI is a valid and reliable tool for clinical practice and research. [ABSTRACT FROM AUTHOR]

There has been a recent push to transition procedures previously performed at hospital-based outpatient surgical departments (HOPDs) to ambulatory surgery centers (ASCs). However, limited data regarding differences in early postoperative complications and care utilization (eg, emergency department visits and unplanned admissions) may drive increased overall costs or worse outcomes. The purpose of this study was to examine differences in early 90-day adverse outcomes and postoperative emergency department visits associated with shoulder surgeries excluding arthroplasties that were performed in HOPDs and ASCs in a closed military health care system. We hypothesized that there would be no difference in outcomes between treatment settings. We retrospectively evaluated the records for 1748 elective shoulder surgeries from 2015 to 2020. Patients were considered as 1 of 2 cohorts depending on whether they underwent surgery in an ASC or HOPD setting. We evaluated groups for differences incomplexity, surgical time, and medical risk. Outcome measures were emergency department visits, unplanned hospital admissions, and complications within the first 90 days after surgery. There was no difference in 90-day postoperative emergency department visits between procedures performed at HOPDs (n = 606) and ASCs (n = 1142). There was a slight increase in rate of unplanned hospital admission within 90 days after surgery in the HOPD cohort, most commonly for pain or overnight observation. The surgical time was significantly shorter (105 vs. 119 minutes, P <.01) at the ASC, but there was no difference in case complexity between the cohorts (P =.28). Our results suggest that in appropriate patients, surgery in ASCs can be safely leveraged for its costs savings, efficiency, patient satisfaction, decreases in operative time, and potentially decreased resource utilization both during surgery and in the early postoperative period. [ABSTRACT FROM AUTHOR]

This project tackles the challenge of subjectivity in the nutritional assessment of meals, specifically within the context of the Ecuadorian diet. It introduces a computer vision solution based on advanced convolutional neural networks, utilizing two adapted YOLO V8 models: one for detection and the other for segmentation. The system accurately identifies and analyzes the different food portions in served dishes, categorizing them into three classes: builders foods, regulators, and energy sources, ultimately determining whether the dish is well-balanced. This approach addresses the need for a precise estimate of meal proportions and nutritional composition, which is essential for promoting healthy diets and preventing issues related to nutritional imbalances. The project utilized refined datasets tailored to the Ecuadorian menu, resulting in a system that enhances the accuracy of nutritional assessments based on images of served meals. The findings highlight the effectiveness of the tool and recommend expanding the dataset to include a wider range of typical Ecuadorian foods, thus improving the precision and applicability of the system in various nutritional contexts. [ABSTRACT FROM AUTHOR]

Cupping therapy involves lifting and separating fascial tissue to facilitate stretching and promote blood flow. Although cupping is a common treatment modality for pain, various protocols exist and studies are inconsistent in regards to whether cupping improves outcomes such as range of motion. We aimed to determine the acute effect of different types of cupping therapy on ankle dorsiflexion. Thirty-five generally healthy adults (mean ± SD; age: 22.1 ± 4.52 y; baseline ankle ROM: 34.68 ± 4.22°) were randomly assigned to one of four cupping therapy treatment groups: static, dynamic, static sham, or dynamic sham. Ankle ROM was measured using a digital inclinometer pre- and immediately post-intervention. ANCOVA was used to determine whether ROM differed between groups post-treatment when controlling for baseline ROM and the minimal detectable change (MDC) was used to determine clinical meaningfulness of the changes. Baseline ROM was significantly associated with post-intervention ROM (post-ROM: 38.41 ± 4.95°; p <.001), indicating an overall increase in ROM regardless of the intervention received. There was no difference in ROM between therapy groups post-intervention after controlling for baseline ROM. The dynamic cupping group experienced a change in ROM (baseline ROM: 34.11 ± 4.62°, post-ROM: 39.19 ± 6.44°) above the MDC (5.08°). Our findings support cupping as a modality for improving ankle ROM in individuals with limited ROM. Dynamic cupping may be effective for improving ankle ROM due to the addition of functional movement. Clinicians may consider dynamic cupping as a potential intervention to address limited ankle ROM. Regardless of therapy received, all groups showed improvement in ankle dorsiflexion immediately post intervention. Dynamic cupping increased ROM above the MCD threshold, indicating functional movement with cupping may improve ROM more than other cupping techniques. Further investigation is warranted to explore the long-term effects of cupping therapy, as well as the underlying mechanisms that contribute to its therapeutic effects. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of preoperative pain neuroscience education (PNE) on pain intensity, kinesiophobia, catastrophizing, and disability in individuals undergoing hip or knee arthroplasty. A search was conducted on MEDLINE, CINAHL, Epistemonikos, Scopus, and Web of Science from their inception to March 2023. Two investigators independently assessed the risk of bias with Risk of Bias 2 (ROB2) and Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) of the studies, as well as the certainty of the evidence with Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) for pain intensity, catastrophizing, kinesiophobia and disability at one month, three months and six months of follow-up. A total of 1716 papers were found and two studies on knee arthroplasty were included (n = 147). The intergroup effect sizes for pain intensity were 0.29, 0.07, and 0.25 at one-, three-, and six-months post-surgery, whereas the effect sizes for disability were 0.4, 0.46, and 0.21 (GRADE analysis, moderate certainty, respectively). Catastrophizing showed intergroup effect sizes of 0.78, 1.08, and 0.25, and kinesiophobia of 1.56, 0.92, and 0.33 at follow-up (GRADE analysis, low-moderate certainty). Preoperative PNE in individuals undergoing knee arthroplasty has low to moderate certainty for improving pain intensity, catastrophizing, kinesiophobia, and disability with low to high effect sizes and discrepancy between studies. More research on the effect of a preoperative PNE intervention in people undergoing knee or hip arthroplasty is required. [ABSTRACT FROM AUTHOR]

• Identifying which patients with coronary artery disease (CAD) and acute heart failure (HF) or left ventricular systolic dysfunction will benefit from revascularization is challenging owing to population heterogeneity. • We propose a treatment algorithm that categorizes patients with CAD and HF/left ventricular systolic dysfunction into 2 frameworks: those exhibiting CAD-predominant symptoms (acute myocardial infarction, refractory angina, or positive stress test) vs those with HF-predominant symptoms (dyspnea, orthopnea, peripheral edema without angina or positive stress test). • Randomized controlled trials and observational data indicate that revascularization benefits patients with CAD-predominant symptoms, but does not confer symptomatic or mortality benefit in those with HF-predominant symptoms. Patients with heart failure (HF) and underlying coronary artery disease (CAD) have a substantially higher risk of mortality compared with those with HF from other causes. However, identifying individuals with HF for whom revascularization is likely to improve prognosis is a complex clinical decision. Revascularization is likely beneficial for patients with CAD-predominant symptoms, such as those with acute myocardial infarction or stable ischemic heart disease with refractory angina. However, for patients with HF-predominant symptoms, characterized by dyspnea without acute myocardial infarction or refractory angina, the benefits of revascularization are less clear. This state-of-the-art review summarizes the outcomes, clinical trials, and therapeutic approaches for patients with both CAD and HF, and proposes a therapeutic algorithm to guide the diagnosis and comprehensive workup of these complex patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Malnutrition is shown to be associated with worse outcomes among surgical patients, yet its postdischarge outcomes in trauma patients are not clear. This study aimed to evaluate both index admission and postdischarge outcomes of geriatric trauma patients who are at risk of poor nutritional status. This is a secondary analysis of the prospective observational American Association of Surgery for Trauma Frailty Multi-institutional Trial. Geriatric (≥65 years) patients presenting to 1 of the 17 Level I/II/III trauma centers (2019–2021) were included and stratified using the simplified Geriatric Nutritional Risk Index (albumin [g/dL] + body mass index [kg/m2]/10) into severe (simplified Geriatric Nutritional Risk Index <5), moderate (5.5> simplified Geriatric Nutritional Risk Index ≥5), mild level of nutritional risk (6> simplified Geriatric Nutritional Risk Index ≥5.5), and good nutritional status (simplified Geriatric Nutritional Risk Index ≥6) and compared. Of the 1,321 patients enrolled, 22% were at risk of poor nutritional status (mild: 13%, moderate: 7%, severe: 3%). The mean age was 77 ± 8 years, and the median [interquartile range] Injury Severity Score was 9 [5–13]. Patients at risk of poor nutritional status had greater rates of sepsis, pneumonia, discharge to the skilled nursing facility and rehabilitation center, index-admission mortality, and 3-month mortality (P <.05). On multivariable analyses, being at risk of severe level of nutritional risk was independently associated with sepsis (adjusted odds ratio 6.21, 95% confidence interval 1.68–22.90, P =.006), pneumonia (adjusted odds ratio 4.40, 95% confidence interval 1.21–16.1, P =.025), index-admission mortality (adjusted odds ratio 3.16, 95% confidence interval 1.03–9.68, P =.044), and 3-month mortality (adjusted odds ratio 8.89, 95% confidence interval 2.01–39.43, P =.004) compared with good nutrition state. Nearly one quarter of geriatric trauma patients were at risk of poor nutritional status, which was identified as an independent predictor of worse index admission and 3-month postdischarge outcomes. These findings underscore the need for nutritional screening at admission. [Display omitted] [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? To what extent do activity limitation and emotional distress serially mediate the association between pain characteristics and sleep quality among older adults? • What is the main finding of this study? Pain characteristics (i.e., pain intensity and pain interference) were significantly associated with increased sleep problems among older adults in the sub-Saharan African context, where research on this topic is largely neglected. Most importantly, the association was significantly and serially mediated by activity limitation and emotional distress. • What is the meaning of the finding? Older adults with pains may be at greater risk of sleep problems, underscoring the need for conscious policy and public health interventions to manage pain-induced sleep problems in later life effectively. Indeed, before intervening in pain-induced sleep problems in old age, clinicians should screen for functional status and emotional distress. Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016–2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: β = 0.049–0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: β = 0.264, Bootstrap 95% confidence interval [CI] = 0.165–0.362; direct effect: (β = 0.107, Bootstrap 95% CI = 0.005–0.210; total indirect effect: β = 0.156, Bootstrap 95% CI = 0.005–0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: β = 0.404, Bootstrap 95% CI = 0.318–0.490; direct effect: β = 0.292, Bootstrap 95% CI = 0.201–0.384; and total indirect effect: β = 0.112, Bootstrap 95% CI = 0.069–0.156) yielding ∼28%. Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life. [ABSTRACT FROM AUTHOR]

Porous tantalum metaphyseal cones may facilitate reconstructions of severe bone defects during revision total knee arthroplasty (TKA), but there remains a paucity of data on their outcomes at mean 5 years of follow-up. This study reports the component survivorship, patient satisfaction, functional outcomes, radiographic osseointegration, and complications of revision TKA with porous tantalum metaphyseal cones at mid-term (mean 5-year) follow-up. This study included 152 patients who had a mean age of 66 years (range, 33 to 86 years) undergoing revision TKA with porous tantalum metaphyseal cones. Indications for surgery included aseptic loosening (n = 87, 57.3%), second-stage reimplantation for infection (n = 42, 27.6%), osteolysis with well-fixed components (n = 20, 13.2%), and periprosthetic fracture (n = 3, 2.0%). Component survivorship, clinical outcomes, radiographic outcomes, and any complications were recorded. The mean follow-up time was 5.6 years (range, 2.2 to 13.7). Survivorship was 100% when the end point was revision of the metaphyseal cone (no cones were revised) and 83.8% (95% confidence interval: 77.9 to 90.2%) when the end point was reoperation for any reason at 5-year follow-up. Reoperations were performed for infection (n = 10), instability (n = 4), periprosthetic fracture (n = 2), and quadriceps rupture/dehiscence (n = 3). The mean patient satisfaction score was 78.8 ± 11.3 and the mean Forgotten Joint Score was 62.2 ± 16.7 at the final follow-up. The preoperative median University of California at Los Angeles score improved from 2 (interquartile range 2 to 3) to 6 points (interquartile range 5 to 6) (P <.001), and the preoperative Oxford knee score improved from 15.2 ± 3.8 to 39.4 ± 5.1 points (P <.001) at the final follow-up. All metaphyseal cones showed radiographic evidence of osteointegration without any subsidence or loosening. Porous tantalum metaphyseal cones enabled robust reconstructions of severe femoral and tibial bone defects during revision TKA. These reconstructions were associated with excellent survivorship, improvements in functional outcomes, and reproducible radiographic osseointegration at mean 5-year follow-up. The most common reasons for reoperation were infection and instability. [ABSTRACT FROM AUTHOR]

There is a paucity of literature regarding the mid-term (greater than 2 years) outcomes of revision for adverse local tissue reaction to metal debris due to corrosion at the head-neck junction (trunnionosis) in metal-on-polyethylene total hip arthroplasty (THA), and risk factors for re-revision remain largely unknown. We aimed to report the re-revision-free survival and functional outcomes for this patient population and to identify risk factors for re-revision. A total of 80 hips (79 patients) with a metal-on-polyethylene THA who had undergone revision for trunnionosis at our institution were included. The mean study follow-up from index trunnionosis revision was 4.6 years (range, 2.0 to 9.4). Kaplan-Meier survival analysis was performed with all-cause re-revision as the end point, and multivariate logistic regression was used to identify risk factors for re-revision. We saw that twenty-one hips (26%) underwent re-revision at a mean of 8.0 months (range, 0.03 to 36.3) after the index trunnionosis revision, most commonly for instability and infection. The two- and five-year all-cause re-revision-free survival rates were 75.0 and 73.2%, respectively. The mean Oxford Hip Score was 33.7 (range, 11 to 48); 76% were satisfied, and 24% were dissatisfied with their hip. Multivariate analysis identified not undergoing a cup revision (odds ratio: 4.5; 95% confidence interval: 1.03 to 19.7) and time from primary THA to the index trunnionosis revision (odds ratio: 0.77; 95% confidence interval: 0.62 to 0.97) as risk factors for undergoing re-revision. The risk of early re-revision for these patients is high (26%), mostly due to infection and instability, and functional outcomes are fair. Not performing a cup revision appears to be a risk factor for re-revision, as is the shorter time from primary THA to trunnionosis revision. III. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is a leading cause of morbidity and mortality for pregnant patients. A significant portion of cardiac morbidity and mortality is preventable and related to poor or delayed recognition of clinical warning signs and oversights in management. The establishment of pregnancy heart teams facilitates multidisciplinary planning to improve management of people with cardiovascular disease. Core members of the pregnancy heart team include obstetricians, midwives, cardiologists, anesthesiologists, nurses, and patient care coordinators. Additional specialists and subspecialists are included on pregnancy heart teams based on individual patient needs. This review discusses the practical aspects of the pregnancy heart team's approach to caring for pregnant people with cardiovascular disease. [ABSTRACT FROM AUTHOR]

• 86% of patients with peripheral artery disease (PAD) are frail or pre-frail. • Patients with PAD who are frail and pre-fail have more barriers to physical activity than non-frail patients. • Specific interventions promoting PA are essential for these patients to improve their health outcomes. Frailty syndrome is prevalent among many patients experiencing intermittent claudication symptoms. Considering that components of the frailty syndrome can affect both physical and psychological functions, it is likely that barriers to physical activity are heightened in these individuals. To analyze the association between barriers to physical activity and frailty in patients with symptomatic peripheral artery disease (PAD). This cross-sectional study included 216 patients with symptomatic PAD (64.8% men, 65.6±9.4 yrs.). Nine personal and 8 environmental barriers to physical activity were investigated through a questionnaire on barriers to practicing physical activity in patients with intermittent claudication. Frailty was defined according to Fried et al. (2001) criteria which included unintentional weight loss, exhaustion, low grip strength, slow walking speed, physical inactivity. Three or more criteria defined frail, one or 2 criteria defined pre-frail, and absence of criteria defined non-frail. Data are presented as median (interquartile range). Frail and pre-frail patients have more barriers than non-frail patients [frail: 11 (4); pre-frail: 10 (6); non-frail: 8 (7), p = 0.001]. Absence of a companion for physical activity, lack of knowledge and uncertainty about the benefits of physical activity, pain induced by walking and presence of obstacles that worsen leg pain were associated with frail and pre-frail status, independent of sex, age, ankle-brachial index, and total walking distance. Patients with PAD who are frail and pre-frail have more barriers to physical activity than non-frail patients. Therefore, specific interventions promoting PA are essential for these patients to improve their health outcomes. [ABSTRACT FROM AUTHOR]

To examine associations of vibration sensitivity and pressure pain sensitivity with knee osteoarthritis (OA) outcomes across sex and race, which may relate to known sex and race disparities in clinical outcomes. Data were from the 2013–2015 visit of the Johnston County Osteoarthritis Project. Exposures were vibration perception threshold (VPT) measured at the bilateral medial femoral condyle (MFC) and first metatarsophalangeal joint (MTP), and pressure pain threshold (PPT) measured at the bilateral upper trapezius. Outcomes were knee pain severity and presence of knee symptoms, radiographic knee OA, and symptomatic knee OA in each knee. Cross-sectional associations of the exposures with the outcomes were examined using logistic regression models, overall and separately by sex and race. In the VPT and PPT analyses, 851 and 862 participants (mean age 71 years, 68% female, 33% Black, body mass index 31 kg/m2) and 1585 and 1660 knees were included, respectively. Higher VPT (lower vibration sensitivity) at the MFC and first MTP joint was associated with all outcomes. Lower PPT (greater pressure pain sensitivity) was associated with greater knee pain severity. Associations of VPT and PPT with all outcomes were similar among females and males and Black and White individuals. Diminished vibration perception and greater pressure pain sensitivity were cross-sectionally associated with worse knee OA outcomes. Despite differences in VPT and PPT among females and males and Black and White adults, associations with knee OA outcomes did not differ by sex or race, suggesting neurophysiological differences do not relate to established disparities. [ABSTRACT FROM AUTHOR]

Moral distress affects registered nurses' job dissatisfaction, and may ultimately be associated with higher rates of turnover. Nurse-physician relationships have been shown to affect moral distress in the intensive care unit setting, but no research has evaluated this impact on emergency nurses. The purpose of this study was to investigate the impact of nurse-physician relationships on the moral distress of emergency nurses. A quantitative correlational design was used to evaluate the study's aim. Point-of-care nurses currently working in an emergency department were asked to complete the Measure of Moral Distress Scale for Healthcare Professionals and the collegial nurse-physician relations domain of the Practice Environment Scale of the Nursing Work Index. Univariate and multivariate analyses were conducted to determine the impact of nurse-physician relationships on moral distress, controlling for demographic characteristics. Thirty-two participants completed the survey. Multivariate regression showed that nurse-physician relationships are associated with moral distress in emergency nurses. Years of experience and gender did not affect moral distress in univariate or multivariate analyses. Given current staffing shortages and the need to retain expert nurses in high-acuity settings, strategies to improve nurse-physician collaboration opportunities should be explored in ED settings. [ABSTRACT FROM AUTHOR]

Although coarctation of the aorta without concomitant intracardiac pathology is relatively common, there is lack of guidance regarding aspects of its management in neonates and infants. A panel of experienced congenital cardiac surgeons, cardiologists, and intensivists was created, and key questions related to the management of isolated coarctation in neonates and infants were formed using the PICO (Patients/Population, Intervention, Comparison/Control, Outcome) Framework. A literature search was then performed for each question. Practice guidelines were developed with classification of recommendation and level of evidence using a modified Delphi method. For neonates and infants with isolated coarctation, surgery is indicated in the absence of obvious surgical contraindications. For patients with risk factors for surgery, medical management before intervention is reasonable. For those stable off prostaglandin E 1 , the threshold for intervention remains unclear. Thoracotomy is indicated when arch hypoplasia is not present. Sternotomy is preferable when arch hypoplasia is present that cannot be adequately addressed through a thoracotomy. Sternotomy may also be considered in the presence of a bovine aortic arch. Antegrade cerebral perfusion may be reasonable when the repair is performed through a sternotomy. Extended end-to-end, arch advancement, and patch augmentation are all reasonable techniques. Surgery remains the standard of care for the management of isolated coarctation in neonates and infants. Depending on degree and location, arch hypoplasia may require a sternotomy approach as opposed to a thoracotomy approach. Significant opportunities remain to better delineate management in these patients. [ABSTRACT FROM AUTHOR]

Opioid use prior to total joint arthroplasty may be associated with poorer postoperative outcomes. However, few studies have reported the impact on postoperative recovery of mobility. We hypothesized that chronic opioid users would demonstrate impaired objective and subjective mobility recovery compared to nonusers. A secondary data analysis of a multicenter, prospective observational cohort study in which patients used a smartphone-based care management platform with a smartwatch for self-directed rehabilitation following hip or knee arthroplasty was performed. Patients were matched 2:1 based on age, body mass index, sex, procedure, Charnley class, ambulatory status, orthopedic procedure history, and anxiety. Postoperative mobility outcomes were measured by patient-reported ability to walk unassisted at 90 days, step counts, and responses to the 5-level EuroQol-5 dimension 5-level, compared by Chi -square and student's t -tests. Unmatched cohorts were also compared to investigate the impact of matching. A total of 153 preoperative chronic opioid users were matched to 306 opioid-naïve patients. Age (61.9 ± 10.5 versus 62.1 ± 10.3, P =.90) and sex (53.6 versus 53.3% women, P =.95) were similar between groups. The proportion of people who reported walking unassisted for 90 days did not vary in the matched cohort (87.8 versus 90.7%, P =.26). Step counts were similar preoperatively and 1-month postoperatively but were lower in opioid users at 3 and 6 months postoperatively (4,823 versus 5,848, P =.03). More opioid users reported moderate to extreme problems with ambulation preoperatively on the 5-level EuroQol-5 dimension 5-level (80.6 versus 69.0%, P =.02), and at 6 months (19.2 versus 9.3%, P =.01). Subjective and objective measures of postoperative mobility were significantly reduced in patients who chronically used opioid medications preoperatively. Even after considering baseline factors that may affect ambulation, objective mobility metrics following arthroplasty were negatively impacted by preoperative chronic opioid use. [ABSTRACT FROM AUTHOR]

• Meta-analysis involving 390 patients across 18 studies examined the efficacy of simultaneous biopsy and ETV techniques. • Our analysis found that 92% of patients achieved overall good clinical outcomes, with children exhibiting a remarkable 100% success rate. Moreover, adults demonstrated an 84% biopsy success rate. • In terms of complications, the study indicated minimal risks in adults, with a reported rate of 0%. Furthermore, the overall requirement for shunting post-procedure was relatively low, standing at 8%. • The research underscores the importance of individualized treatment approaches, showcasing the viability, safety, and effectiveness of the technique. Due to their delicate and deep-seated location, tumors in the pineal region of the brain pose exceptional challenges in neurosurgical management. Highly precise procedures have become crucial to address these complexities, such as the simultaneous performance of biopsy and endoscopic third ventriculostomy (ETV). Our aim was to assess the feasibility, safety, and efficacy of simultaneous biopsy and ETV for treating patients with pineal region tumors. Medline, Embase, and Web of Science were searched for English studies from January 2000 to February 2024, following Cochrane and PRISMA guidelines. Eligible studies encompassed a minimum of four patients and examined at least one of the following outcomes: good clinical outcomes and the necessity of shunt placement. Single proportion analysis with 95% confidence intervals was conducted under a random-effects model, employing the I2 statistic to assess heterogeneity. Additionally, publication bias was evaluated using the ROBINS-I tool. After a meticulous selection process, eighteen studies involving 390 patients were included in the analysis. Overall, good clinical outcomes were observed in 131 out of 147 patients, representing a rate of 92 % (95 % CI: 84 % to 100 %, I2 = 62 %) through random effects analysis. Subgroup analysis showed that children exhibited a notably high rate of good clinical outcomes, reaching 100 % (95 % CI: 96 % to 100 %, I2 = 0 %). Regarding the need for shunt placement, out of the 356 patients assessed, only 39 required shunt placement, yielding a rate of 8 % (95 % CI: 4 % to 12 %, I2 = 63 %). Further sub-analyses indicated shunt requirement rates of 12 % for children and 3 % for adults. Specifically focusing on adults, data from 46 patients who underwent biopsy revealed a success rate of 84 % (95 % CI: 62 % to 100 %, I2 = 81 %). Remarkably, no major complications were reported among adults, resulting in a rate of 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Additionally, low rates of mortality related to the procedure were observed in adults, with two deaths recorded among the 46 patients analyzed, resulting in a mortality rate of 1 % (95 % CI: 0 % to 7 %, I2 = 0 %). In conclusion, our study aimed to assess the feasibility, safety, and efficacy of performing simultaneous biopsy and ETV for patients with pineal region tumors. We meticulously examined clinical aspects and patient outcomes, including good clinical outcomes, the requirement for shunt placement after ETV, biopsy success rates, mortality, and complications. [ABSTRACT FROM AUTHOR]

[Display omitted] The cytokine TSLP promotes type 2 immune responses and can induce adipose loss by stimulating lipid loss from the skin through sebum secretion by sebaceous glands, which enhances the skin barrier. However, the mechanism by which TSLP upregulates sebaceous gland function is unknown. This study investigated the mechanism by which TSLP stimulates sebum secretion and adipose loss. RNA-sequencing analysis was performed on sebaceous glands isolated by laser capture microdissection and single-cell RNA-sequencing analysis was performed on sorted skin T cells. Sebocyte function was analyzed by histological analysis and sebum secretion in vivo and by measuring lipogenesis and proliferation in vitro. This study found that TSLP sequentially stimulated the expression of lipogenesis genes followed by cell death genes in sebaceous glands to induce holocrine secretion of sebum. TSLP did not affect sebaceous gland activity directly. Rather, single-cell RNA-sequencing revealed that TSLP recruited distinct T-cell clusters that produce IL-4 and IL-13, which were necessary for TSLP-induced adipose loss and sebum secretion. Moreover, IL-13 was sufficient to cause sebum secretion and adipose loss in vivo and to induce lipogenesis and proliferation of a human sebocyte cell line in vitro. This study proposes that TSLP stimulates T cells to deliver IL-4 and IL-13 to sebaceous glands, which enhances sebaceous gland function, turnover, and subsequent adipose loss. [ABSTRACT FROM AUTHOR]

Answering calls in the literature, we developed and introduced an evidence-based tool for surgeons facing errors in the operating room: the STOPS framework (stop, talk to you team, obtain help, plan, succeed). The purpose of this research was to assess the impact of presenting this psychological tool on resident coping in the operating room and the related outcome of burnout while examining sex differences. In a natural experiment, general surgery residents were invited to attend 2 separate educational conferences regarding coping with errors in the operating room. Three months later, all residents were asked to fill out a survey assessing their coping in the operating room, level of burnout, and demographics. We assessed the impact of the educational intervention by comparing those who attended the coping conferences with those who did not attend. Thirty-five residents responded to the survey (65% response rate, 54% female respondents, 49% junior residents). Our hypothesized moderated mediation model was supported. Sex was found to moderate the impact of the STOPS framework—female residents who attended the coping educational conference reported higher coping self-efficacy, whereas attendance had no statistically significant impact on male levels of coping self-efficacy. In turn, higher coping self-efficacy was associated with lower levels of burnout. Our results suggest that there is evidence of efficacy in this instruction—female residents presented this material report higher levels of coping in the operating room compared to those who did not receive the framework. Further, increase in coping ability was associated with reduced levels of burnout for both genders. [ABSTRACT FROM AUTHOR]

Obicetrapib, a novel, selective cholesteryl ester transfer protein (CETP) inhibitor, reduces low-density lipoprotein cholesterol (LDL-C), LDL particles, apolipoprotein (Apo) B, and lipoprotein(a) [Lp(a)] and increases high-density lipoprotein cholesterol (HDL-C) when added to statins with or without ezetimibe. By substantially reducing LDL-C, obicetrapib has the potential to lower atherogenic lipoproteins in patients with atherosclerotic cardiovascular disease (ASCVD) or heterozygous familial hypercholesterolemia (HeFH) whose LDL-C levels remain high despite treatment with available maximally tolerated lipid-modifying therapies, addressing an unmet medical need in a patient population at high risk for cardiovascular events. BROADWAY (NCT05142722) and BROOKLYN (NCT05425745) are ongoing placebo-controlled, double-blind, randomized Phase III trials designed to examine the efficacy, safety, and tolerability of obicetrapib as an adjunct to dietary intervention and maximally tolerated lipid-modifying therapies in participants with a history of ASCVD and/or underlying HeFH whose LDL-C is not adequately controlled. The primary efficacy endpoint was the percent change in LDL-C from baseline to day 84. Other endpoints included changes in Apo B, non-HDL-C, HDL-C, Apo A1, Lp(a), and triglycerides in addition to parameters evaluating safety, tolerability, and pharmacokinetics. BROADWAY also included an adjudicated assessment of major adverse cardiovascular events, measurements of glucose homeostasis, and an ambulatory blood pressure monitoring substudy. A total of 2,532 participants were randomized in BROADWAY and 354 in BROOKLYN to receive obicetrapib 10 mg or placebo (2:1) for 365 days with follow-up through 35 days after the last dose. Results from both trials are anticipated in 2024. These trials will provide safety and efficacy data to support the potential use of obicetrapib among patients with ASCVD or HeFH with elevated LDL-C for whom existing therapies are not sufficiently effective or well-tolerated. [ABSTRACT FROM AUTHOR]

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths. • Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in AI/AN adults. • Social connectedness (as thwarted belongingness), social support, and engaging in AI/AN ceremonies were protective against suicidal ideation. • Social connectedness and AI/AN practices protected against suicide attempts; traumatic events and historical trauma symptoms were risks. • Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths. [ABSTRACT FROM AUTHOR]

Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. We conducted a 12-consecutive-year observational study using Oklahoma's hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P =.001) when compared within their respective category. Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention. [ABSTRACT FROM AUTHOR]

The marketplace has become focal point in the ecosystem of electronic commerce, particularly in Indonesia, which has seen rapid growth in the usage of online platforms. Two major marketplaces, Bukalapak and Blibli, stand out as leaders in this market. This study aims to compare the features and user experiences between these two platforms. Employing a survey with 50 respondents, the research found Bukalapak to outperform Blibli in all usability and user satisfaction metrics measured by the USE Questionnaire. While the overall UI/UX advantage for Bukalapak was slight (3.13%), Bukalapak was perceived as better in usefulness, ease of use, ease of learning, and user satisfaction. These findings suggest that Bukalapak has a slight UI/UX advantage over Blibli, but further research with a larger sample size is recommended. [ABSTRACT FROM AUTHOR]

Academic accomplishments and demographics for presidents of hip and knee arthroplasty societies are poorly understood. This study compares the characteristics of presidents nominated to serve the Hip Society, Knee Society, and American Association of Hip and Knee Surgeons. This was a cross-sectional study of arthroplasty presidents in the United States (1990 to 2022). Curriculum vitae and academic websites were analyzed for demographic, training, bibliometric, and National Institutes of Health (NIH) funding data. Comparisons were made between organizations and time periods (1990 to 2005 versus 2006 to 2022). There were 97 appointments of 78 unique arthroplasty presidents (80%). Most presidents were male (99%) and Caucasian (95%). There was 1 woman (1%) and 5 non-Caucasian presidents (2% Asian, 3% Hispanic). There were no differences in demographics between the 3 arthroplasty organizations and the 2 time periods (P >.05). Presidents were appointed at 55 ± 10 years old, which was on average 24 years after completion of residency training. Most presidents had arthroplasty fellowship training (68%), and the most common were the Hospital for Special Surgery (21%) and Massachusetts General Hospital (8%). The median h-index was 53 resulting from 191 peer-reviewed publications, which was similar between the 3 organizations (P >.05). There were 2 presidents who had NIH funding (2%), and there were no differences in NIH funding between the 3 organizations (P >.05). Arthroplasty society presidents have diverse training pedigrees, high levels of scholarly output, and similar demographics. There may be future opportunities to promote diversity and inclusion among the highest levels of leadership in total joint arthroplasty. [ABSTRACT FROM AUTHOR]

3D positioning cameras that automate the positioning of patients with respect to the CT isocentre have been developed and are in common use in CT departments. This study aimed to compare the performance of radiographers and a 3D camera system with respect to positioning accuracy and the effect on patient radiation dose for chest-abdomen-pelvis scans. Patient positioning and dose data obtained from a dose management system was evaluated over a two-month period for patients positioned with (CAM on) and without (CAM off) the positioning camera. Median vertical and lateral offset values were compared between the groups whilst doses were evaluated as a function of patient water equivalent diameter (WED) for the thorax and abdomen-pelvis acquisitions for both cohorts. Radiographers demonstrated high levels of positioning accuracy, however significant improvements in median vertical offset were identified for the CAM on cohort for both thorax (8 mm vs. 17 mm (p = 0.001)) and abdomen-pelvis (7 mm vs. 16 mm (p = 0.003)) scans. The percentage of patients positioned within 5 mm of the isocentre was 39.0% and 16.1% for the CAM on and CAM off cohorts. For CAM off scans, 77.4% of patients were positioned below the isocentre, but this was reduced to 45.8% for CAM on scans. No significant changes in dose as a function of WED were identified related to the camera use (thorax: p = 0.569, abdomen-pelvis: p = 0.760). Use of a 3D camera delivered significant improvements in the accuracy and reproducibility of patient positioning when compared with radiographers. Improvements in positioning accuracy were observed at the research site and hence positioning camera use has the potential to become standard practice in CT to help ensure appropriate doses are delivered to patients according to their size. [ABSTRACT FROM AUTHOR]

Critically ill patients requiring urgent interventions or subspecialty care often require transport over significant distances to tertiary care centers. The optimal method of transportation (air vs. ground) is unknown. We investigated whether air transport was associated with lower mortality for patients being transferred to a specialized critical care resuscitation unit (CCRU). This was a retrospective study of all adult patients transferred to the CCRU at the University of Maryland Medical Center in 2018. Our primary outcome was hospital mortality. The secondary outcomes included the length of stay and the time to the operating room (OR) for patients undergoing urgent procedures. We performed optimal 1:2 propensity score matching for each patient's need for air transport. We matched 198 patients transported by air to 382 patients transported by ground. There was no significant difference between demographics, the initial Sequential Organ Failure Assessment score, or hospital outcomes between groups. One hundred sixty-four (83%) of the patients transported via air survived to hospital discharge compared with 307 (80%) of those transported by ground (P =.46). Patients transported via air arrived at the CCRU more quickly (127 [100-178] vs. 223 [144-332] minutes, P <.001) and were more likely (60 patients, 30%) to undergo urgent surgical operation within 12 hours of CCRU arrival (30% vs. 17%, P <.001). For patients taken to the OR within 12 hours of arriving at the CCRU, patients transported by air were more likely to go to the OR after 200 minutes since the transfer request (P =.001). The transportation mode used to facilitate interfacility transfer was not significantly associated with hospital mortality or the length of stay for critically ill patients. [ABSTRACT FROM AUTHOR]

We developed and evaluated the accuracy and reliability of a convolutional neural network (CNN) in detecting external carotid artery calcifications (ECACs) in cone beam computed tomography scans. Using TensorFlow, we developed a program to identify calcification in 427 cone beam computed tomography scans evaluated to determine the presence of ECACs. We compared the results to the findings of a human evaluator. Using an 80:20 training-to-validation ratio, we calculated the k-fold cross-validation accuracy of the initial dataset and extrapolated the F1 score and Matthews Correlation Coefficient. We calculated a k-fold cross-validation accuracy of 76%, with a recall and precision of 66% and 79%, respectively, and a combined F1 score of 0.72. We extrapolated a Matthews correlation coefficient of 0.53, showing a strong balance between confusion matrix categories. Our CNN model can reliably identify ECACs in cone beam computed tomography scans. [ABSTRACT FROM AUTHOR]

Cutting edge preparation is an established approach in the field of machining technology for optimizing the performance of cutting tools. However, the potential of asymmetric geometries has not yet been sufficiently utilized for filigree micromilling tools. In this regard, the study presents investigations on the adjustment of asymmetric microgeometries through the design of the pressurized air wet abrasive jet machining (PAWAJM). The study features results regarding the design of the preparation process as well as subsequent application tests in a hard micromilling process of the hardened high-speed steel AISI M3:2. The application tests focus on the effect of the conditioned cutting edge on the process forces and the surface quality as well as the tool life. The results show that asymmetrical microgeometries with small average cutting edge rounding and a form-factor of K > 1.2 can be achieved by PAWAJM. Machining tests revealed a potential reduction of the wear development and process forces for modified tools with low cutting edge rounding and asymmetrical microgeometry. [ABSTRACT FROM AUTHOR]

Understanding the causes of amputation is crucial for defining health policies that seek to avoid such an outcome, but only a few studies have investigated the epidemiology of patients submitted to amputations in developing countries. The objective of this study was to analyse all lower limb amputations performed in the public health system in Brazil over a 13 year period, evaluating trends in the number of cases, patient demographics, associated aetiologies, hospital length of stay, and in hospital mortality rate. This was a retrospective, population based analysis of all lower limb amputations performed in the Brazilian public health system between 1 January 2008 and 31 December 2020. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, anatomical level of limb loss, demographic data, regional distribution, and other variables of interest. A total of 633 455 amputations were performed between 2008 and 2020, mostly (55.6%) minor amputations, predominantly in males (67%). There was an upward trend in the number of amputations, determined mainly by the increase in major amputations (50.4% increase in the period). Elderly individuals have the highest rates of amputation. Diabetes mellitus (DM) is becoming the main primary diagnosis associated with amputations over the years. The highest in hospital mortality rate occurred after major amputations and was associated with peripheral arterial disease (PAD). Amputation rates in Brazil show an upward trend. DM is becoming the most frequent associated primary diagnosis, although PAD is the diagnosis most associated with major amputations and in hospital death. [ABSTRACT FROM AUTHOR]

Technological trends such as big data have generated interest in its application in digital marketing, due to the ease of precision in business and in daily decision-making, where there is a need to respond to the needs of the market in real time and achieve competitiveness. We aim to describe the bibliometric behavior of big data and digital marketing as real-time multimedia applications during the period from 2012 to 2023. We based our methodology on the bibliometric analysis of statistical relationships using VOSviewer software. We employed the normalization technique and applied the association strength method for keyword co-occurrence analysis and author co-citation analysis. Additionally, we used the hermeneutic technique to interpret the results. The findings indicate that research trends are associated with social networks; data processing; machine learning techniques; real-time system; online system; data analysis; data management. The contributing authors were Wang Y.; Chen Y.; Liu Y.; Zhang X.; Wang X.; Wang J.; Zhang Y.; Li J. We concluded that the common software in the study includes Hadoop, Reduced Map, Apache Spark, Twitter, Apache Storm, Spark Transmission, Transformer, and Weibo. [ABSTRACT FROM AUTHOR]

This paper focuses on the monitoring and prediction of the energy consumption of IT equipment to make informed decisions in terms of energy efficiency. The challenge with current monitoring systems lies in their specialization, scalability and integration complexities. To overcome these challenges, we propose a monitoring and prediction system for energy consumption of IT equipment. The proposed solution combines an adaptable, cost-effiective and energy-Efficient embedded device with open source software and a service-oriented architecture (SOA), which offers flexibility and integration capabilities, facilitating the easy inclusion of several workstation working from different environments. Several traditional Linear Regression (LR) models were evaluated prediction models using a temporal window of hour taking into account several features. As a result of the LR models evaluation, it is established that the Bayesian Ridge model was the best model since it presented the lowest error and the highest coefficient of determination. Finally, two approaches were evaluated to predict energy consumption: a Kernel Density Estimation (KDE)-based mechanism proposed to generate predictor variables in order to predict future energy using the best LR model, and a KDE-based energy model. Numerical results show that the energy prediction using KDE for the energy measurements provides lower time response than the LR based mechanism for the available dataset. [ABSTRACT FROM AUTHOR]

IoT technologies are becoming more and more common in our daily activities because the networks they create are capable of collecting information, monitoring and controlling remotely. However, these devices are not exempt from security attacks, as they become vulnerable entry points to data networks. The use of traditional methods to secure networks (e.g., Next Generation Firewalls (NGFW), encryption, etc.) is not recommended because the devices used in this type of network are limited in terms of computing power and storage availability (e.g., nodeMCU). In this paper, we propose to design two intrusion detection systems in embedded systems using machine learning (ML) algorithms, Artificial Neural Networks and K-means. In a distributed architecture Wireless Sensor Network scenario (WSN), we evaluate their performance in terms of connection and response times, detection accuracy and intruder detection time. Simulation results show that both models are able to find irregularities in network traffic within milliseconds. [ABSTRACT FROM AUTHOR]

• Six-minute walk test (6MWT) is used to quantify morbidity. • Normalization of 6MWT by body weight (DW) brings a more precise assessment. • In PAD, absolute 6MWT and DW correlated with functional capacity. • DW showed a stronger relationship than the absolute value of 6MWT. • In PAD, absolute 6MWT and DW did not correlated with cardiovascular health. The six-minute walk test (6MWT) is extensively employed to evaluate gait impairment in patients with symptomatic peripheral artery disease (PAD) and has been associated with different health outcomes. However, various approaches exist for calculating and interpreting the six-minute test in order to address the needs of patients more effectively. Therefore, we investigated how these different approaches correlate with functional capacity and cardiovascular health in patients with symptomatic PAD. In total, 227 PAD patients [65.2% men and 67 (13) y.o.] were included in this cross-sectional study. The 6MWT was performed along a 30-meter corridor and the distance was expressed in three ways: absolute (described as the meters walked during the test), relativized (based on the results of the 6MWT in healthy individuals), and DW (multiplying the body weight in kilograms by the absolute distance in the 6MWT). A functional capacity z-score was calculated using the results of the handgrip strength test, 4-meter walking test, and sit-and-stand test. A cardiovascular parameter z-score was calculated with data on brachial and central blood pressure, the low-frequency component/high-frequency component ratio, and carotid-femoral pulse wave velocity. The absolute (b = 0.30, 95%CI: 18-0.43, R² = 0.11, p < 0.001) and DW (b = 0.40, 95%CI: 27-0.53, R² = 0.17, p < 0.001) measures were related to functional capacity, independently of sex, age, and the ankle-arm index of the patients. Neither absolute nor DW were related to cardiovascular health. The relativized measure was not associated with either functional capacity or cardiovascular health. In patients with symptomatic PAD, absolute and DW measures are related to functional capacity, but not cardiovascular function. [ABSTRACT FROM AUTHOR]

The closure of multiple muscular ventricular septal defects poses a unique challenge to the surgeon with inherent risks of residual defects, conduction blocks, and ventricular dysfunction. The trabeculations in the right ventricle often make it difficult to identify and visualize the edges of the defects. More recently 3 dimensional (3D) models are increasingly being used in the management of various complex congenital heart defects. We present our technique of closing multiple muscular ventricular septal defects (VSDs) using individualized 3D printed models. The stepwise process requires a multidisciplinary approach between the cardiologist, cardiac surgeon, cardiac radiologist, and 3D engineer. As the 3D model exactly replicates the intracardiac anatomy including that of the trabeculations in the region of the multiple VSDs, this technique facilitates the precise location of the defects and obviates the requirement to 'search' for the defects intraoperatively. The defects can be located through a shorter right ventricular incision and the defects can be closed with a shorter myocardial ischemia time. Three-dimensional printing facilitates individualization of surgical management, and we recommend the addition of 3D printing to the armamentarium of surgeons dealing with the challenge of closing multiple muscular VSDs in children. [ABSTRACT FROM AUTHOR]