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AI decision support systems can assist clinicians in planning adaptive treatment strategies that can dynamically react to individuals' cancer progression for effective personalized care. However, AI's imperfections can lead to suboptimal therapeutics if clinicians over or under rely on AI. To investigate such collaborative decision-making process, we conducted a Human–AI interaction study on response-adaptive radiotherapy for non-small cell lung cancer and hepatocellular carcinoma. We investigated two levels of collaborative behavior: model-agnostic and model-specific; and found that Human–AI interaction is multifactorial and depends on the complex interrelationship between prior knowledge and preferences, patient's state, disease site, treatment modality, model transparency, and AI's learned behavior and biases. In summary, some clinicians may disregard AI recommendations due to skepticism; others will critically analyze AI recommendations on a case-by-case basis; clinicians will adjust their decisions if they find AI recommendations beneficial to patients; and clinician will disregard AI recommendations if deemed harmful or suboptimal and seek alternatives. AI decision support system non-homogenously influences clinical decisions in dynamic treatment regimen, as it depends on several factors including prior knowledge, preference, disease type, treatment modality, and AI's learned behavior and inherent biases. [ABSTRACT FROM AUTHOR]

Background: Preclinical studies and anecdotal case reports support the potential therapeutic benefit of low-dose oral ketamine as a treatment of clinical symptoms in Rett syndrome (RTT); however, no controlled studies have been conducted in RTT to evaluate safety, tolerability and efficacy. Design: This was a sequentially initiated, dose-escalating cohort, placebo-controlled, double blind, randomized sequence, cross-over study of oral ketamine in 6–12-year-old girls with RTT to evaluate short-term safety and tolerability and explore efficacy. Methods: Participants were randomized to either five days treatment with oral ketamine or matched placebo, followed by a nine-day wash-out period and then crossed-over to the opposite treatment. Ketamine was dosed twice daily at 0.75 mg/kg/dose (Cohort 1) or 1.5 mg/kg/dose (Cohort 2). An independent safety monitoring committee evaluated safety and approved proceeding to the next dose cohort. Caregivers, participants, outcome assessors, and study staff except pharmacists were blinded to allocation. The primary endpoint was safety and tolerability. Exploratory efficacy endpoints included change in clinician- and caregiver-rated measures of RTT features, brain activity on electroencephalography, and wearable biosensors to measure respiration, heart rate, sleep, and activity. Results: Twenty-three participants enrolled (11 in Cohort 1, 12 in Cohort 2) from 3/12/2019–11/22/2021. One participant was excluded from analysis due to not meeting inclusion criteria on blinded review prior to analysis. One participant was withdrawn from the study due to an adverse event (vomiting) after the first dose of ketamine. Although planned for four dose cohorts, the trial was stopped after Cohort 2 due to enrollment challenges associated with the COVID-19 pandemic. Ketamine was safe and tolerated in both cohorts, with 1 related treatment emergent adverse event of vomiting. No difference was observed in efficacy between ketamine and placebo. Electroencephalography showed the expected increase in high frequency power with ketamine. Conclusions: Short-term, low-dose oral ketamine was safe and well tolerated in girls with RTT. No clinical efficacy of ketamine in treating symptoms of RTT was observed with 5 days of treatment, despite electroencephalography evidence of ketamine target engagement during the first dose. Further studies are needed to evaluate safety and efficacy of higher dose and longer exposure to ketamine in RTT. Trial registration: Registered at clinicaltrials.gov NCT03633058. [ABSTRACT FROM AUTHOR]

Proper personal protective equipment (PPE) use is critical to prevent disease transmission to healthcare providers, especially those treating patients with a high infection risk. To address the challenge of monitoring PPE usage in healthcare, computer vision has been evaluated for tracking adherence. Existing datasets for this purpose, however, lack a diversity of PPE and nonadherence classes, represent single not multiple providers, and do not depict dynamic provider movement during patient care. We introduce the Resuscitation Room Personal Protective Equipment (R2PPE) dataset that bridges this gap by providing a realistic portrayal of diverse PPE use by multiple interacting individuals in a healthcare setting. This dataset contains 26 videos, 10,034 images and 123,751 bounding box annotations for 17 classes of PPE adherence and nonadherence for eyewear, masks, gowns, and gloves, and one additional head class. Evaluations using newly proposed metrics confirm R2PPE exhibits higher annotation density than three established general-purpose and medical PPE datasets. The R2PPE dataset provides a resource for developing computer vision algorithms for monitoring PPE use in healthcare. [ABSTRACT FROM AUTHOR]

Introduction: Open ureteroenteric reimplantation (OUER) of ureteroenteric strictures (UESs) is related to important morbidity. Robot-assisted ureteroenteric reimplantation (RUER) has been proposed to provide similar outcomes with lower morbidity. We aimed to compare perioperative and functional outcomes between RUER and OUER. Methods: A retrospective multicenter study of 80 patients, who underwent 82 ureteroenteric reimplantations (17 OUER vs 65 RUER) at 8 institutions between 2009–2021 for benign UESs after radical cystectomy. All the open procedures were performed by the same center in order to compare the robotic approach with a standardized technique. Data were reviewed for demographics, stricture characteristics, and perioperative outcomes. Complication and stricture recurrence rates were compared between both groups. Results: Among 82 reimplantations, 44 were left sided (54%) and 12 bilateral (14%). Median time from cystectomy to diagnosis of stricture was 6 months (range 3–18). Baseline characteristics (gender, age, BMI, side, type of urinary diversion and previous abdominal radiotherapy) were comparable between RUER and OUER groups, except for ASA score and rates of prior robotic cystectomy. The 30-day overall postoperative complication rate was 37% in RUER compared to 70.6% in OUER (p = 0.026). Patients who underwent a RUER had statistically significant lower rate of intraoperative blood transfusion (0% vs 12%, p = 0.041), urinary tract infection (12% vs 53%, p < 0.001), bowel injury (0% vs 12%, p = 0.041) and high-grade complications (Clavien III-IV) (4.6% vs 23.5%, p = 0.031). RUER patients had shorter median length of hospital stay (3 days IQR[1–6] vs 6 IQR[3–9], p = 0.018) and lower readmission rate (4.6% vs 29.4%, p = 0.008). After a median follow-up of 23.5 months (8.7–43), 80% of RUER cases were stricture free compared to 90% of OUER (p = 0.42). Conclusions: RUER achieved a success rate comparable to that of open revisions and may provide some advantages in terms of perioperative outcomes. Prospective and larger studies are warranted to prove its superiority compared to the standard open technique. [ABSTRACT FROM AUTHOR]

High-grade soft tissue sarcomas (STS) are a heterogeneous and aggressive set of cancers. Failure to respond anthracycline chemotherapy, standard first-line treatment, is associated with poor outcomes. We investigated the contribution of STS cancer stem cells (STS-CSCs) to doxorubicin resistance. We identified a positive correlation between CSC abundance and doxorubicin IC50. Utilizing patient-derived samples from five sarcoma subtypes we investigated if a common genetic signature across STS-CSCs could be targeted. We identified Enhancer of Zeste homolog 2 (EZH2), a member of the polycomb repressive complex 2 (PRC2) responsible for H3K27 methylation as being enriched in CSCs. EZH2 activity and a shared epigenetic profile was observed across subtypes and targeting of EZH2 ablated the STS-CSC population. Treatment of doxorubicin-resistant cell lines with tazemetostat resulted in a decrease in the STS-CSC population. These data confirm the presence of shared genetic programs across distinct subtypes of CSC-STS that can be therapeutically targeted. [ABSTRACT FROM AUTHOR]

Introduction: Ankle fractures represent a significant portion of orthopedic injuries, with fracture dislocations tending to have worse outcomes. Logsplitter fractures represent a subset of fracture dislocations in which the talus is axially wedged in the tibiofibular joint. We aim to comprehensively investigate and report on the complications and functional outcomes associated with ankle fracture-dislocations. Materials and Methods: Following PRISMA guidelines, a medical librarian conducted a literature search in Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, and The Cochrane Database of Systematic Reviews. Studies examining ankle fracture-dislocations and reporting on functional or employment outcomes were included. Excluded were non-English studies, abstracts, conference proceedings, letters, perspective pieces, reviews, editorials, and case reports or series with fewer than five patients. Data on functional outcomes were extracted and reported using descriptive statistics. A comparative analysis of AOFAS scores between Logsplitter and ankle fracture-dislocations was conducted using pooled means and independent t-tests. Results: A total of 21 studies involving 810 cases of ankle fracture-dislocations were included. The pooled mean AOFAS score across 13 studies was 81.5, indicating “good” outcomes, while Logsplitter injuries had a significantly lower mean score of 75.8 compared to 82.9 for other ankle fracture-dislocations (p = 0.016). Complications included wound infection (7.3%), posttraumatic osteoarthritis (29.2%), nonunion/malunion (12.6%), and malunion. No studies reported on employment outcomes. Conclusions: Ankle fracture-dislocations are high-energy injuries that affect a younger population compared to non-dislocated ankle fractures. Their functional outcomes resemble those of pilon fractures more than common ankle fractures. Logsplitter injuries are a subset of fracture dislocations that occur in even younger patients, with worse functional outcomes. This information can guide perioperative discussion and expectations for functional recovery. Additional studies are needed to evaluate the impact of these injuries on return to employment. [ABSTRACT FROM AUTHOR]

Context: Natural selection favors species with strong fidelity to seasonal ranges where resources are predictable across space and time. Extreme disturbance events may negate the fitness benefits of faithfulness—with consequences for population distributions. Objectives: We hypothesized that extreme events fragment population distributions through two mechanisms: (1) reductions in fidelity or (2) elevated mortality. We tested the relative contributions of these mechanisms to population dynamics of mule deer (Odocoileus hemionus)—a long-lived mammal—with long-term, individual-based information before and after disturbance occurred. Methods: We evaluated our hypotheses in response to disturbance during winter using a unique dataset of the movement and fate of adult females from a migratory population of mule deer over 8 years in western Wyoming, USA. First, we calculated fidelity of individuals between progressive winters and identified vacant space between population-level ranges to represent gaps in the population distribution. We then assessed: (1) how internal state and disturbance conditions affected fidelity, (2) how internal state, disturbance conditions, and fidelity affected survival, and (3) how survival and fidelity affected creation of gaps in population distribution. Results: Disturbance weakened fidelity, but fidelity did not affect survival. Nutritional condition and age affected survival. Weakened fidelity did not change population distribution; rather, nutritional condition underpinned population dynamics, meaning that behavior alone may not prevent the creation of gaps in distribution following extreme disturbances. Conclusions: Extreme events may render behavioral plasticity incapable of mitigating mortality risk, and the environmental conditions that animals experience during the months, seasons, or even years before an event may regulate population-level organization in its aftermath. [ABSTRACT FROM AUTHOR]

Objective: Tools for classifying adverse drug reactions (ADRs) have not yet been validated in the context of the neonatal intensive care unit (NICU). The study aims to investigate the inter-rater reliability of the Hartwig tool and the Liverpool avoidability assessment tool (LAAT) in assessing the severity and avoidability of ADR cases in hospitalized neonates. Methods: An observational and prospective study was conducted in the NICU of a maternity hospital in Natal, Brazil. The Hartwig tool and LAAT were employed to assess the severity and avoidability of ADRs, respectively. Three experienced clinical pharmacists independently assessed all ADR cases. Inter-rater reliability was measured using Cohen's kappa coefficient (k) with corresponding 95% confidence intervals (CI). Results: Among 79 ADR cases, the mean gestational age was 29.7 ± 4.4 weeks, and the birth weight averaged 1446.0 ± 1179.3 g. The assessment of ADR severity using the Hartwig tool revealed a significant overall correlation (overall k = 0.573; 95% CI 0.395 to 0.753) with exact agreement (EA) and extreme disagreement (ED) rates between evaluators of 86.5% and 2.5%, respectively. However, no statistically significant correlation was observed for determining avoidability using the LAAT (overall k = 0.017; 95% CI − 0.048 to 0.082), with an EA rate of 83.6% and ED rate of 10.1%. Conclusion: The Hartwig tool demonstrates good reproducibility among different evaluators in determining the severity of ADRs, unlike the LAAT for assessing avoidability. [ABSTRACT FROM AUTHOR]

Plants host an array of microbial symbionts, including both bacterial and fungal endophytes located within their roots. While bacterial and fungal endophytes independently alter host plant growth, response to stress and susceptibility to disease, their combined effects on host plants are poorly studied. To tease apart interactions between co-occurring endophytes on plant growth, morphology, physiology, and survival we conducted a greenhouse experiment. Different genotypes of Spartina alterniflora, a foundational salt marsh species, were inoculated with one bacterial endophyte, Kosakonia oryzae, one fungal endophyte, Magnaporthales sp., or co-inoculated. Within the greenhouse, an unplanned herbivory event occurred which allowed insight into the ways bacteria, fungi, and co-inoculation of both endophytic microbes alters plant defense chemicals and changes herbivory. Broadly, the individual inoculation of the bacterial endophyte increased survival, whereas the fungal endophyte increased plant growth traits. Following the herbivory event, the proportion of stems grazed was reduced when plants were inoculated with the individual endophytes and further reduced when both endophytes were present. Across genotypes, anti-herbivore defense chemicals varied by individual and co-inoculation of endophytes. Bacterial inoculation and genotype interactively affected above:below-ground biomass and S. alterniflora survival of ungrazed plants. Overall, our results highlight the variable outcomes of endophyte inoculation on Spartina growth, morphology, phenolics, and survival. This study furthers our understanding of the combined effects of symbionts and plant multitrophic interactions. Further, exploring intra and inter specific effects of plant––microbe symbiosis may be key in better predicting ecosystem level outcomes, particularly in response to global change. [ABSTRACT FROM AUTHOR]

Background: The Guatemalan Foundation for Children with Kidney Diseases collaborated with Bridge of Life, a not-for-profit charitable organization, to establish a vascular access program. We reviewed our experience with graded surgical responsibility and structured didactic training, creating arteriovenous fistulas (AVF) for Guatemalan children. Methods: Pediatric vascular access missions were completed from 2015 to 2023 and analyzed retrospectively. Follow-up was completed by the Guatemalan pediatric surgeons, nephrologists, and nursing staff. AVF patency and patient survival were evaluated by Kaplan–Meier life-table analysis with univariate and multivariable association between patient demographic variables by Cox proportional hazards models. Results: Among a total of 153 vascular access operations, there were 139 new patient procedures, forming the study group for this review. The mean age was 13.6 years, 42.6% were female, and the mean BMI was 17.3. Radial or ulnar artery-based direct AVFs were established in 100 patients (71.9%) and ten of the 25 transposition procedures. Brachial artery inflow was required in 29 direct AVFs (20.9%). Two patients underwent femoral vein transpositions. Access-related distal ischemia was not encountered. Seven of the AVF patients later required access banding for arm edema; all had previous dialysis catheters (mean = 9, range 4–12). Primary and cumulative patency rates were 84% and 86% at 12 months and 64% and 81% at 24 months, respectively. The median follow-up was 12 months. Overall patient survival was 84% and 67% at 12 and 24 months, respectively. There were no deaths related to AVF access. Conclusions: Safe and functional AVFs were established in a teaching environment within a Guatemalan comprehensive pediatric nephrology center. [ABSTRACT FROM AUTHOR]

Purpose of Review: Detail the evolution, utility, and future directions of the da Vinci SP® in pediatric urology, focusing on perioperative outcomes and intraoperative details. Recent Findings: The SP has been safely and successfully utilized in various pediatric urological procedures, from pyeloplasty to nephroureterectomy to appendicovesicostomy. Reports indicate mixed operative times but similar hospital stays and postoperative outcomes compared to multiport (MP) robotic surgery. The learning curve for transitioning from MP to SP systems in pediatric patients appears manageable, though the smaller abdominal circumference in children poses a notable challenge. This review assumes that SP systems will primarily be acquired for adult services, not considering initial and ongoing costs to hospital systems. Summary: The SP serves as a complementary option, rather than a replacement, for MP robotic surgery in pediatric urology, offering potential advantages in specific scenarios. Cosmetic outcomes with the SP appear at least as favorable as MP surgery, but further research is needed. Future research should focus on patient-centered outcomes to optimize SP robotic surgery use in pediatric patients. [ABSTRACT FROM AUTHOR]

Background: The addition of IV triapine to chemoradiation appeared active in phase I and II studies but drug delivery is cumbersome. We examined PO triapine with cisplatin chemoradiation. Methods: We implemented a 3 + 3 design for PO triapine dose escalation with expansion, starting at 100 mg, five days a week for five weeks while receiving radiation with weekly IV cisplatin for locally advanced cervical or vaginal cancer. Maximum tolerated dose (MTD), dose limiting toxicity (DLT), adverse events, pharmacokinetics (PK), pharmacodynamics (PD), and metabolic complete response (mCR) were assessed. Results: 19/21 patients were DLT evaluable. DLTs included grade 4 neutropenia (n = 2), leukopenia (n = 2), lymphopenia (n = 2), and hypokalemia (n = 1). Grade 3 toxicities at least possibly related were as expected for cisplatin chemoradiation: lymphopenia (n = 12), anemia (n = 10), neutropenia (n = 4), leukopenia (n = 8), decreased platelets (n = 2), hypertension (n = 1), and hyponatremia (n = 1). MTD and RP2D were established at 100 mg. 8/13 evaluable patients had a mCR. Triapine had a bioavailability of 59%. Methemoglobin levels correlated with triapine exposure. Smoking almost doubled CYP1A2 mediated triapine clearance. Conclusions: Oral triapine is safe when given with cisplatin chemoradiation, convenient, bioavailable. Exposure is negatively impacted by smoking, and methemoglobin is a biomarker of exposure. Clinical trial registration: NCT02595879. [ABSTRACT FROM AUTHOR]

This interview with Randall Collins explores the role of interaction rituals (IR) in our increasingly digital world. For Collins, IR is a micro-sociological mechanism that provides both the glue that holds social groups together and the energy that fuels disputes and domination. Crucially, Collins posits that IRs are most effective under face-to-face or "bodily copresent" conditions. The pivotal question of this interview is how well this proposition holds in an age where interaction increasingly takes place through and with technologies. The interview begins with Collins explaining how he became interested in IR, before moving on to consider topics such as whether bodily copresence is as important today as it was when he wrote Interaction Ritual Chains (2004); the relative importance of online and offline IRs; how AI might change our ritual landscape; the role of materiality in the ritual process; and whether IR theory will continue to be as relevant in the future. [ABSTRACT FROM AUTHOR]

The goal of this special issue is to highlight recent work advancing supportive interventions that facilitate meaningful access for persons with autism, intellectual and developmental disabilities to inclusive community-based settings. The special issue includes a literature synthesis focused on informal education settings, interventions for critical skills such as pool side safety, and articles focused on adults with disabilities. Notable strengths include long-term follow-up of intervention effects, investigation of novel settings such as airports and informal educational settings, and inclusion of adults with disabilities. [ABSTRACT FROM AUTHOR]

Opinion statement: Antibody–drug conjugates (ADCs) are a novel class of anti-cancer agents that have changed the standard of care for patients with breast cancer. Their targeted approach delivers potent anti-cancer drugs to cancer cells bearing specific surface antigens, thereby maximizing anti-cancer effects and minimizing systemic toxicity. Currently, there are three ADCs available for use in breast cancer: trastuzumab emtansine for HER2 positive breast cancer (early stage and metastatic), trastuzumab deruxtecan for HER2 positive and HER2 low breast cancer (metastatic) and sacituzumab govitecan for triple negative and hormone receptor positive (HR +), HER2 negative breast cancer(metastatic). Trials have shown that these drugs have improved both progression free survival and overall survival in the metastatic setting, and trastuzumab emtansine has improved overall survival in early-stage breast cancer as well. The future of this class of compounds is very exciting. This field is rapidly evolving with new ADCs being investigated and clinical trials looking at the use of known ADCs in earlier stage disease. [ABSTRACT FROM AUTHOR]

Most living shoreline site selection and design decision support tools are based upon existing environmental conditions. We developed a web-based, geospatial tool called Future Shorelines that integrates high-resolution landscape elevation data and a matrix of locally derived NOAA Interagency Sea Level Rise Scenarios to characterize future conditions of submergence and shoreline translation induced by sea level rise. Once the practitioner selects a location of interest, sea level rise scenario (e.g., high), and target year (e.g., 2050), the tool will generate plan view and cross-sectional informational graphics specific to their choices. This information can then be paired with other menu options, like parcel ownership, to facilitate the planning and construction of nature-based shoreline stabilization solutions that (1) are located where opportunities for horizontal migration are optimized, (2) remain accessible for monitoring and maintenance, and (3) perform as intended over the design life of the installation. The tool's menu options and the user interface were informed by project partner input solicited during numerous workshops convened over the duration of the 2-year project. This coproduction created a product that was familiar to the end user and therefore increased the likelihood that it would be utilized by them during the planning and design of living shoreline projects. Although developed for use in the Indian River Lagoon, located along the east-central Florida coast, it can be seamlessly replicated for application in other coastal regions of the USA where the requisite data are available. [ABSTRACT FROM AUTHOR]

The Austrian school of economics was well within the mainstream of economic thought into the 1930s. By mid-twentieth century the Austrian school had established a distinct identity, partly because of methodological developments in mainstream economics, but moreso because of its policy conclusions. Austrian school was best known for its claim that rational economic calculation was not possible without markets and market prices, challenging the mainstream view that looked favorably on central economic planning. In addition, the Austrian business cycle theory challenged the Keynesian macroeconomics that dominated macroeconomic thought up through the mid-1970s. While there were methological differences between the Austrian school and the mainstream, these policy differences defined the Austrian episode. By the end of the twentieth century, the Austrian school had won the economic calculation debate, Keynesian macroeconomics had been displaced, and the methodological differences between the Austrian school and the mainstream had narrowed. The Austrian episode had passed. In the twenty-first century, the Austrian school's ideas, still relevant, have been combined with complementary ideas from other heterodox traditions, diminishing the distinctive identity the Austrian school had in the second half of the twentieth century. [ABSTRACT FROM AUTHOR]

Soils are among Earth’s most vital yet slowly renewable natural resources. Chernozem stands out as the most fertile soil globally, capable of yielding high agricultural productivity, and it continues to play a significant role in modern agriculture. The Vojvodina region of Serbia is renowned for its fertile soil, including Chernozem. This study aims to evaluate the current condition and geotourism potential of ten captivating Chernozem sites in the Vojvodina region by using the method for assessment of tourism potential of soil sites. The analysis emphasizes that all evaluated sites possess notable tourism potential due to their natural attractions and appeal to visitors. However, the findings underscore the need for improved services and infrastructure to facilitate tourism development at these sites, essential for attracting larger tourist groups. This study serves as an initial step towards creating educational soil trails to promote the natural, socio-economic, and cultural aspects of this pedo-geoheritage. Additionally, this article aims to provide insights into key aspects of the current tourist features at these destinations that could benefit from further enhancement. [ABSTRACT FROM AUTHOR]

Background: Much of the global chronic kidney disease burden is experienced in low- and middle-income countries. Children living with chronic kidney disease (CKD) face medical and social challenges, and they need support at the individual and family levels. This study aimed to explore children's experiences living with kidney replacement therapy (KRT) who attend the largest pediatric nephrology department in Guatemala. Methods: This qualitative study used photovoice and asked children to take pictures that represented what is like to live with CKD. Each child and their caregiver underwent an interview where the photos were used to elicit and facilitate discussion. The interviews were recorded, transcribed, and then analyzed using thematic analysis. Results: Eight children and their mothers participated in the study. Three themes were identified: interactions with the health system, changing and difficult family dynamics, and strains on social interactions. Children face social challenges including self-isolation and alienation. The family dynamics and familial structures often are forced to change, inducing stress. This is all exacerbated by the difficulties that arise in navigating the Guatemalan health system. Conclusions: Photovoice techniques are a feasible way to understand the experiences of children and their families who face CKD. The disease affects all aspects of life and recognizing this while advising and administering care can help provide a comprehensive level of care. Health systems need to make efforts aimed at improving the quality of care as well as the multidisciplinary support available to children and their families. [ABSTRACT FROM AUTHOR]

Breathing patterns (respiratory kinematics) contain vital prognostic information. This dimension of physiology is not captured by conventional vital signs. We sought to determine the feasibility and utility of quantifying respiratory kinematics. Using inertial sensors, we analyzed upper rib, lower rib, and abdominal motion of 108 patients with respiratory symptoms during a hospital encounter (582 two-minute recordings). We extracted 34 features based on an explainable correspondence with well-established breathing patterns. K-means clustering revealed that respiratory kinematics had three dimensions apart from the respiratory rate. We represented these dimensions using respiratory rate variability, respiratory alternans (rib-predominant breaths alternating with abdomen-predominant ones), and recruitment of accessory muscles (increased upper rib excursion). Latent profile analysis of the kinematic measures revealed two profiles consistent with the established clinical constructs of labored and unlabored breathing. In logistic regression, the labored breathing profile improved model discrimination for critical illness beyond the Sequential Organ Failure Assessment (SOFA) score (AUROC 0.77 v/s 0.72; p = 0.02). These findings quantitatively confirm the prior understanding that the respiratory rate alone does not adequately represent the complexity of respiratory kinematics; they demonstrate that high-dimensional signatures of labored breathing can be quantified in routine practice settings, and they can improve predictions of clinical deterioration. [ABSTRACT FROM AUTHOR]

Background: Multi-ligament Knee Injuries (MLKI) are often caused by a high-energy impact resulting in dislocation of the knee joint. Given the higher degree of instability associated with these MLKIs, surgical fixation with adjunctive internal bracing and the use of suture augmentation have been proposed with the intention of better restoring knee stability and improving the long-term outcomes of surgery. This systematic review seeks to appraise the current literature in relation to the role of internal bracing in the management of MLKI. Methods: All randomised control trials, observational studies, cohort studies, and cross-sectional studies containing patients with multi-ligamentous knee injuries managed with the use of internal bracing or suture tape augmentation were included in this review. The primary outcomes of interest were re-operation and failure rates, with secondary outcomes focussed on patient-reported outcome measures (PROMs) and examination findings of knee stability. Results: 282 studies were identified for screening, 13 of which were suitable for inclusion and five of these had injuries with Schenck grade III or above. Of the studies identified, failure rates ranged from 0 to 13.6%. Lysholm score was the most commonly utilised PROM tool with scores ranging from 61.8 to 95. Stiffness requiring MUA ± adhesiolysis was a common complication identified across studies. Conclusions: The use of internal bracing in Multi-ligament Knee Injuries appears to be as effective as not using an internal bracing technique. The post-operative PROMs and relatively low failure rates reflect promising outcomes for the ongoing use of internal bracing in MLKI. However, further prospective studies directly comparing braced versus non-braced ligamentous repairs are required in order to definitively determine if the use of the internal brace does allow for increased joint stability and early rehabilitation. [ABSTRACT FROM AUTHOR]

A cohort of individuals in care for HIV infection who were identified as being recently out-of-care (OOC) was recruited for a trial using a data-to-care approach and an intervention to facilitate re-engagement and retention in care. This allowed for analysis of demographic and clinical characteristics correlated with recently being OOC, re-engagement, and successful retention in care and viral suppression. Recently OOC persons with HIV infection (PWH) were identified for enrollment in the Cooperative Re-engagement Controlled Trial (CoRECT). CoRECT employed a data-to-care strategy, using both clinical and surveillance data, and an active public health re-engagement intervention. We estimated relative risks (RRs), unadjusted and with multivariate log binomial regression models, to analyze associations between sociodemographic and clinical predictors of being OOC, re-engagement, retention in care, and viral suppression. Of the 630 OOC PWH enrolled in CoRECT, most were male (72.7%) and over 30 years old (91.3%). Almost 40.0% were Black non-Hispanic, 29.7% were non-US born, and 41.6% were men who have sex with men (MSM). Possible predictors of re-engagement, retention in care, and viral suppression included younger age, Hispanic race/ethnicity, birth in a US dependency, AIDS status, and HIV exposure mode. Viral suppression status within 1-year pre-enrollment was significantly associated with all outcomes: re-engagement (aRR 1.28), retention (aRR 1.72), viral suppression (aRR 1.81), and durable viral suppression (aRR 3.30). Findings elucidate factors associated with care engagement and continuity for recently OOC PWH which can be used to inform targeted re-engagement activities for priority populations and guide future data-to-care interventions. [ABSTRACT FROM AUTHOR]

Background: HPV- associated squamous cell carcinoma (SCC) is uncommon in non-oropharynx sites and not well characterized. This study aims to investigate uncommon phenotypes of HPV-associated head and neck carcinoma, the prevalence and morphologic spectrum of HPV-associated SCC in the oral cavity, larynx and hypopharynx. Method: P16 immunostaining and HPV E6/7 in situ hybridization (ISH) were performed on tissue microarrays comprised of SCCs from different anatomic sites: oropharynx (n = 270), hypopharynx (n = 52), oral cavity (n = 95) and larynx (n = 123). Tumors were classified as HPV-associated based on a positive E6/7 ISH testing. RNA sequencing was performed on several selected cases. Result: 66% oropharynx SCCs (OPSCCs) were HPV-associated; all were p16/HPV testing concordant except one which was p16 negative. The p16-/HPV + OPSCC resembled similar gene expression signature with p16+/HPV + OPSCCs by transcriptome analysis. 6/95 (6%) oral cavity SCCs were HPV-associated, all from male patients and 5/6 (83%) arose from the floor of mouth. Morphologically, 3/6 (50%) showed keratinizing SCC and 5/6 (83%) demonstrated HPV-associated squamous dysplasia in adjacent mucosa. 1/123 (less than 1%) larynx SCCs and 0/52 hypopharynx SCCs were HPV-associated. Conclusion: Although uncommon, p16 negative HPV-associated OPSCC can occur, emphasizing the importance of judicious HPV testing. The morphology of HPV-associated oral cavity SCCs may deviate from prototypic nonkeratinizing SCC, making them difficult to recognize. Presence of HPV-associated squamous dysplasia could serve as a morphologic clue. [ABSTRACT FROM AUTHOR]

The KATITA-25 (Kidney AlloTransplant Immunosuppressive Therapy Adherence) Questionnaire is a multidimensional self-administered scale developed in Brazilian Portuguese that measures the predisposition for non-adherence to immunosuppressive medication in candidate patients for kidney transplantation, in the pre-transplant setting. The aim of this study was the cross-cultural validation of the Spanish version of the KATITA-25 scale. The translation/back-translation method was used, followed by cognitive interviews and a pre-test. The Spanish version of KATITA-25 was administered to 163 candidate patients for kidney transplantation from 2 kidney transplant centres and 2 dialysis centres in Catalonia, Spain. The scale was re-administered to the first 79 patients included into the study, after a 2 to 4 weeks interval. Internal consistency was assessed using Cronbach's alpha, test–retest reliability with the intraclass correlation coefficient (ICC); construct validity with goodness of fit indices after confirmatory factor analysis using structural equation modelling. The Cronbach's alpha of the Spanish version was 0.83, the ICC was 0.86. Confirmatory factor analysis showed adequate fit of the structural model. Overall, the analytical results closely resembled those obtained in the validation of the original scale. In conclusion, this cross-cultural validation study showed adequate reliability and construct validity of the Spanish version of the KATITA-25 questionnaire. [ABSTRACT FROM AUTHOR]

Layer 5 extratelencephalic (ET) neurons are present across neocortical areas and send axons to multiple subcortical targets1–6. Two cardinal subtypes exist7,8: (1) Slco2a1-expressing neurons (ETdist), which predominate in the motor cortex and project distally to the pons, medulla and spinal cord; and (2) Nprs1- or Hpgd-expressing neurons (ETprox), which predominate in the visual cortex and project more proximally to the pons and thalamus. An understanding of how area-specific ETdist and ETprox emerge during development is important because they are critical for fine motor skills and are susceptible to spinal cord injury and amyotrophic lateral sclerosis9–12. Here, using cross-areal mapping of axonal projections in the mouse neocortex, we identify the subtype-specific developmental dynamics of ET neurons. Whereas subsets of ETprox emerge by pruning of ETdist axons, others emerge de novo. We outline corresponding subtype-specific developmental transcriptional programs using single-nucleus sequencing. Leveraging these findings, we use postnatal in vivo knockdown of subtype-specific transcription factors to reprogram ET neuron connectivity towards more proximal targets. Together, these results show the functional transcriptional programs driving ET neuron diversity and uncover cell subtype-specific gene regulatory networks that can be manipulated to direct target specificity in motor corticofugal pathways.Using cross-areal mapping of axonal projections in the mouse neocortex, we identify the subtype-specific developmental dynamics of extratelencephalic neurons and show the functional transcriptional programs driving extratelencephalic neuron diversity. [ABSTRACT FROM AUTHOR]

In this paper, we describe the challenges of collecting data in the Māori population for automatic detection of schizophrenia using natural language processing (NLP). Existing psychometric tools for detecting are wide ranging and do not meet the health needs of indigenous persons considered at risk of developing psychosis and/or schizophrenia. Automated methods using NLP have been developed to detect psychosis and schizophrenia but lack cultural nuance in their designs. Research incorporating the cultural aspects relevant to indigenous communities is lacking in the design of existing automatic prediction tools and one of the main reasons is the scarcity of data from indigenous populations. This paper explores the current design of the New Zealand health care system and its potential impacts on access and inequities in the Māori population and details the methodology used to collect speech samples of Māori at risk of developing psychosis and schizophrenia. The paper also describes the major obstacles faced during speech data collection, key findings, and probable solutions. [ABSTRACT FROM AUTHOR]

Screening measures are increasingly being recommended to identify children who have experienced adversity, as these experiences are associated with a range of health concerns. However, concerns have been raised that many of these measures are not feasible to use in settings where time is limited or do not have empirical support. Even among screening measures with empirical support deemed to be feasible, there remain significant differences in how adversity is operationalized. This review aimed to identify brief adversity screening measures with psychometric information available and to describe how adversity was operationalized across these measures. Studies were located through eight academic databases, grey literature, and through forward and backwards searching of the reference lists of included studies. Screening, full text review, and data extraction were completed independently by two authors. In total, 42 studies describing 41 measures were located. The most commonly assessed form of adversity was bullying. Additional forms of adversity assessed for included violence exposure, racial and ethnic discrimination, abuse, multiple forms of adversity, childbirth, neglect, and poverty. Though multiple measures have been developed to assess the same form of adversity, measures assessing a common adversity type frequently contained similar items. Currently, many brief child-completed adversity screening measures exist for bullying. More research is needed to develop brief screening measures for other forms of adversity, to screen for multiple types of adversity at once, or to provide empirical support for existing measures. Highlights: This review identified 41 brief, child-completed adversity measures with at least some empirical support through a comprehensive systematic review of the literature. Measures assessed for bullying, violence exposure, racial and ethnic discrimination, abuse, multiple forms of adversity, childbirth, neglect, and poverty. These screening measures can be used by child-serving professionals to identify children who have experienced adversity and may benefit from additional assessment, support, or services. [ABSTRACT FROM AUTHOR]

While many theories assume that sleep is critical in stabilizing and strengthening memories, our recent behavioral study (Liu & Ranganath, 2021, Psychonomic Bulletin & Review, 28[6], 2035–2044) suggests that sleep does not simply stabilize memories. Instead, it plays a more complex role, integrating information across two temporally distinct learning episodes. In the current study, we simulated the results of Liu and Ranganath (2021) using our biologically plausible computational model, TEACH, developed based on the complementary learning systems (CLS) framework. Our model suggests that when memories are activated during sleep, the reduced influence of temporal context establishes connections across temporally separated events through mutual training between the hippocampus and neocortex. In addition to providing a compelling mechanistic explanation for the selective effect of sleep, this model offers new examples of the diverse ways in which the cortex and hippocampus can interact during learning. [ABSTRACT FROM AUTHOR]

The northern leopard frog (Lithobates pipiens) has undergone dramatic declines in population size and range over recent decades in western Canada and the United States. In British Columbia, only a single population remains at the Creston Valley Wildlife Management Area. Yet, the continuing viability of this population is uncertain. In this paper, the current genetic structure of northern leopard frog populations in western Canada was assessed using microsatellite markers. Historical samples from the extinct population of Fort Steele in British Columbia were compared with the Creston Valley population to understand changes in population genetic parameters over time. Genotypic data from four populations (Creston Valley, Drain K, Prince Spring, and Cypress Hill) sampled in 2004 and 2019 were compared. To evaluate changes in the genetic diversity of the Creston Valley population over time, allelic richness and expected heterozygosity of the population were compared at three time points using genotypes from 2000, 2004, and 2019. Northern leopard frog populations in western Canada showed high genetic differentiation, with genetic diversity decreasing from east to west. Although there weren't notable changes in genetic parameters between 2004 and 2019, there was evidence of a decline in diversity between 2000 and 2019. The extinct population of Fort Steele had private alleles, while the current Creston Valley population did not, suggesting a genetic bottleneck in the Creston Valley population. Therefore, genetic rescue, specifically for the endangered Creston Valley population, can be considered as an action to support recovery. Additionally, continued genetic monitoring will help in the effective management of the species by providing information on the success of conservation actions. [ABSTRACT FROM AUTHOR]

Industrialized environments, despite benefits such as higher levels of formal education and lower rates of infections, can also have pernicious impacts upon brain atrophy. Partly for this reason, comparing age-related brain volume trajectories between industrialized and non-industrialized populations can help to suggest lifestyle correlates of brain health. The Tsimane, indigenous to the Bolivian Amazon, derive their subsistence from foraging and horticulture and are physically active. The Moseten, a mixed-ethnicity farming population, are physically active but less than the Tsimane. Within both populations (N = 1024; age range = 46–83), we calculated regional brain volumes from computed tomography and compared their cross-sectional trends with age to those of UK Biobank (UKBB) participants (N = 19,973; same age range). Surprisingly among Tsimane and Moseten (T/M) males, some parietal and occipital structures mediating visuospatial abilities exhibit small but significant increases in regional volume with age. UKBB males exhibit a steeper negative trend of regional volume with age in frontal and temporal structures compared to T/M males. However, T/M females exhibit significantly steeper rates of brain volume decrease with age compared to UKBB females, particularly for some cerebro-cortical structures (e.g., left subparietal cortex). Across the three populations, observed trends exhibit no interhemispheric asymmetry. In conclusion, the age-related rate of regional brain volume change may differ by lifestyle and sex. The lack of brain volume reduction with age is not known to exist in other human population, highlighting the putative role of lifestyle in constraining regional brain atrophy and promoting elements of non-industrialized lifestyle like higher physical activity. [ABSTRACT FROM AUTHOR]

Working memory (WM) is a critical cognitive function allowing recent information to be temporarily held in mind to inform future action. This process depends on coordination between prefrontal cortex (PFC) subregions and other connected brain areas. However, few studies have examined the degree of functional specialization between these subregions throughout WM using electrophysiological recordings in freely-moving mice. Here we record single-units in three neighboring mouse medial PFC (mPFC) subregions—supplementary motor area (MOs), dorsomedial PFC (dmPFC), and ventromedial (vmPFC)—during a freely-behaving non-match-to-position WM task. The MOs is most active around task phase transitions, when it transiently represents the starting sample location. Dorsomedial PFC contains a stable population code, including persistent sample-location-specific firing during the delay period. Ventromedial PFC responds most strongly to reward-related information during choices. Our results reveal subregionally segregated WM computation in mPFC and motivate more precise consideration of the dynamic neural activity required for WM. Neural recordings from three mouse prefrontal cortex subregions reveal divergent and dynamic task-related representations during working memory. [ABSTRACT FROM AUTHOR]

Purpose: Myocardial infarction (MI) with subsequent inflammation is one of the most common heart conditions leading to progressive tissue damage. A reliable imaging marker to assess tissue viability after MI would help determine the risks and benefits of any intervention. In this study, we investigate whether a new mitochondria-targeted imaging agent, 18F-labeled 2'-deoxy-2'-18F-fluoro-9-β-d-arabinofuranosylguanine ([18F]F-AraG), a positron emission tomography (PET) agent developed for imaging activated T cells, is suitable for cardiac imaging and to test the myocardial viability after MI. Procedure: To test whether the myocardial [18F]-F-AraG signal is coming from cardiomyocytes or immune infiltrates, we compared cardiac signal in wild-type (WT) mice with that of T cell deficient Rag1 knockout (Rag1 KO) mice. We assessed the effect of dietary nucleotides on myocardial [18F]F-AraG uptake in normal heart by comparing [18F]F-AraG signals between mice fed with purified diet and those fed with purified diet supplemented with nucleotides. The myocardial viability was investigated in rodent model by imaging rat with [18F]F-AraG and 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG) before and after MI. All PET signals were quantified in terms of the percent injected dose per cc (%ID/cc). We also explored [18F]FDG signal variability and potential T cell infiltration into fibrotic area in the affected myocardium with H&E analysis. Results: The difference in %ID/cc for Rag1 KO and WT mice was not significant (p = ns) indicating that the [18F]F-AraG signal in the myocardium was primarily coming from cardiomyocytes. No difference in myocardial uptake was observed between [18F]F-AraG signals in mice fed with purified diet and with purified diet supplemented with nucleotides (p = ns). The [18F]FDG signals showed wider variability at different time points. Noticeable [18F]F-AraG signals were observed in the affected MI regions. There were T cells in the fibrotic area in the H&E analysis, but they did not constitute the predominant infiltrates. Conclusions: Our preliminary preclinical data show that [18F]F-AraG accumulates in cardiomyocytes indicating that it may be suitable for cardiac imaging and to evaluate the myocardial viability after MI. [ABSTRACT FROM AUTHOR]

The design of electrode architecture plays a crucial role in advancing the development of next generation energy storage devices, such as lithium-ion batteries and supercapacitors. Nevertheless, existing literature lacks a comprehensive examination of the property tradeoffs stemming from different electrode architectures. This prospective seeks to bridge this gap by focusing on the diverse nanocomposite electrode architectures. Furthermore, the challenges related to designing well-defined electrode architectures for enhanced energy storage are discussed. Finally, this review addresses the interdisciplinary nature of this field by examining the integration of advanced characterization and fabrication techniques, and machine learning methodologies for electrode optimization. Designing electrodes with controlled architecture and leveraging emerging tools such as in situ characterization, additive manufacturing methods, and machine learning facilitates the advancement of energy storage systems. [ABSTRACT FROM AUTHOR]

Adoptive cell therapy (ACT) is an immunotherapy strategy for cancer that has seen widespread clinical success. During ACT, patient-derived lymphocytes are stimulated with the antigen of interest ex vivo, proliferated, then returned to the patient to initiate an antigen-specific antitumor response. While effective, this process is resource-intensive and logistically impossible for many patients. Particulate artificial antigen presenting cells (aAPCs) offer a potential "off-the-shelf" alternative to ex vivo ACT. While particulate aAPCs perform well in vitro, they have had limited success in vivo due to poor bioavailability after injection. Barriers to bioavailability include rapid clearance, unfavorable biodistribution, and inadequate interactions with CD8+ T cells at sites of interest. Biomaterial properties such as elasticity have been shown to vastly impact the bioavailability and particle-cell interactions, but this has yet to be investigated in the context of aAPCs for in vivo T-cell stimulation. Previous literature likewise indicates that biomaterial properties, especially elasticity, can modulate T-cell activation in vitro. With the goal of creating a more biomimetic, next-generation particulate aAPC, we developed a poly(ethylene) glycol hydrogel particle platform with tunable elasticity to investigate the impact of elasticity on antigen-specific T cell activation for in vivo adoptive transfer. Using this knowledge, we were able to gain more precise control over in vivo T cell activation and investigate possible mechanisms including the effects of aAPC elasticity on T cell binding, macrophage uptake, and the protein corona. [ABSTRACT FROM AUTHOR]

The gametogenic cycle in broadcast spawning corals takes several months, with oogenesis culminating in synchronized maturation when seawater temperatures rise. Temperature is known for governing reproductive seasonality, yet little is known about how multiple stressors may affect spawning timing. The semi-enclosed lagoon of Bouraké in New Caledonia is subjected to high fluctuations in seawater temperature, pH, salinity, and oxygen, representing an ideal playground to explore possible effects of extreme environmental variability on coral gametogenesis. Here, the spawning window and fecundity metrics (i.e., colony- and polyp-level fecundity, and egg size) of Acropora tenuis, Montipora digitata, and M. stellata from Bouraké were compared with four reference sites located at variable distances from Bouraké. Results suggest that Bouraké and its nearby control site largely spawned synchronously, but there was a spawning asynchrony between Bouraké and the sites further south, in all three species. Interestingly, no reduction in the number of eggs per fecund polyp or number of fecund polyps was observed in Bouraké compared with the reference sites, in any species. However, A. tenuis and M. digitata had smaller eggs in Bouraké compared to reference sites, with possible repercussions for coral fitness. In conclusion, some reproductive traits are maintained in coral species inhabiting a highly variable environment, but smaller gametes may alter population recovery processes. Furthermore, since our data are limited to 2 yrs of observations, spawning synchronization between Bouraké and its surroundings warrant continued investigation to determine whether coral colonies from this area harbor traits that increase fitness under future climate scenarios. [ABSTRACT FROM AUTHOR]

Rubble is ubiquitous on coral reefs and can aggregate into fields, forming a significant component of the reef substrate. Rubble fields often remain unconsolidated, with the component rubble pieces subject to movement that is dependent on hydrodynamic forcing, rubble size, shape, and other factors. Settlement of corals to rubble fields has long been assumed, but the dynamic movement of rubble pieces has been presumed to deter settlement and is thought to contribute to high post-settlement mortality. Rubble often forms on coral reefs following severe disturbances, and is predicted to increase under climate change, with the potential to impact settlement and recruitment-dependent recovery processes. Through a series of laboratory and field experiments, we demonstrate that corals from broadcast spawning species on the Great Barrier Reef will settle on unstable substrates, even those in constant motion. We also observed more coral spat on settlement tiles suspended in the water column than those fixed to the reef using a common approach to censusing settlement. Sampling of natural rubble on the reef 50 days after a mass-spawning event confirmed the presence of similar numbers of coral settlers on rubble and on tiles fixed to the reef. These results suggest that rubble fields are places of significant settlement for broadcast spawning corals. Suspended tiles were also surprisingly effective in collecting coral settlers, demonstrating that a change in sampling protocol can produce significant variation in settlement data and strengthening the argument for standardisation of settlement-monitoring protocols, particularly at a time of growing need for reliable metrics. These results also suggest that movement of rubble is not precluding settlement outright, but rather post-settlement processes (i.e. competition, predation, shading or burial by shifting rubble) are limiting recruitment to rubble patches. Consequently, rubble stabilisation may increase the survival of spat that have settled in these environments. [ABSTRACT FROM AUTHOR]

Recent trials have shown the efficacy of trastuzumab deruxtecan (T-DXd) in HER2-negative patients, but there is not yet a way to identify which patients will best respond, especially with the inability of current HER2 IHC and FISH assays to accurately determine HER2 expression in the unamplified setting. Here, we present a heavily pre-treated patient with triple-negative breast cancer (HER2 IHC 0 who had a complete response to T-DXd. In this case, we used a CLIA-certified reverse-phase protein array-based proteomic assay (RPPA) to determine that the patient had moderate HER2 protein expression (HER2Total 2+, 42%) and activation (HER2Y1248 1+, 23%). Using these results, we determined that the patient may benefit from T-Dxd despite being traditionally qualified as HER2 IHC 0. These findings highlight the potential for proteomics-based assays that may more accurately quantitate HER2 and (its activation) in the HER2 unamplified/IHC 0 setting to better select patients whose tumors are classically molecularly defined as HER2 IHC 0, but still could respond to HER2-directed therapy, and give patients access to therapies which for which they otherwise would not be eligible. [ABSTRACT FROM AUTHOR]

Highly pathogenic H5N1 avian influenza (HPAI H5N1) viruses occasionally infect, but typically do not transmit, in mammals. In the spring of 2024, an unprecedented outbreak of HPAI H5N1 in bovine herds occurred in the USA, with virus spread within and between herds, infections in poultry and cats, and spillover into humans, collectively indicating an increased public health risk1–4. Here we characterize an HPAI H5N1 virus isolated from infected cow milk in mice and ferrets. Like other HPAI H5N1 viruses, the bovine H5N1 virus spread systemically, including to the mammary glands of both species, however, this tropism was also observed for an older HPAI H5N1 virus isolate. Bovine HPAI H5N1 virus bound to sialic acids expressed in human upper airways and inefficiently transmitted to exposed ferrets (one of four exposed ferrets seroconverted without virus detection). Bovine HPAI H5N1 virus thus possesses features that may facilitate infection and transmission in mammals.HPAI H5N1 virus isolated from infected cow milk is characterized in mice and ferrets, was inefficiently transmitted in ferrets, and bound to sialic acids expressed in human upper airways, showing features that may facilitate infection in mammals. [ABSTRACT FROM AUTHOR]

This paper reports the results of a hybrid effectiveness-implementation randomized trial that systematically varied levels of human oversight required to support the implementation of a digital medicine intervention for persons with mild-to-moderate alcohol use disorder (AUD). Participants were randomly assigned to three groups representing possible digital health support models within a health system: self-monitored use (SM; n = 185), peer-supported use (PS; n = 186), or a clinically integrated model CI; (n = 187). Across all three groups, the percentage of self-reported heavy drinking days dropped from 38.4% at baseline (95% CI [35.8%, 41%]) to 22.5% (19.5%, 25.5%) at 12 months. The clinically integrated group showed significant improvements in mental health and quality of life compared to the self-monitoring group (p = 0.011). However, higher attrition rates in the clinically integrated group warrant consideration in interpreting this result. Results suggest that making a self-guided digital intervention available to patients may be a viable option for health systems looking to promote alcohol risk reduction. This study was prospectively registered at clinicaltrials.gov on 7/03/2019 (NCT04011644). [ABSTRACT FROM AUTHOR]

Gaming adjacent platforms have created an expanding ecosystem of online gaming, esport, and social media actors sharing online space, content, communication tools, and users. Esport, in particular, has grown beyond all expectations and is now a global leader in sport fandom and spectatorship. At the same time, the online infiltration and influence of far-right extremism have resulted in increased challenges of online radicalization. Gaming and esport form a foundational part of youth digital culture today, and this has provided a fertile ground for far-right extremist groups to communicate and connect with users globally. This paper uses framing theory and qualitative document analysis to examine how media articles frame the relationship between far-right extremism and esport. The findings enhance our understanding of how narratives of far-right extremist influence in esport and gaming are framed in the media and how this coverage shapes contemporary societal discussion. This is important because as far-right extremism continues to be propagated and performed in esport and gaming spaces, how this is framed to public audiences can have a critical influence on esport and gamer identities, victimization or criminalization of online spaces, and future activities or approaches to counter radicalization within the online environment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio‐fibular ligament. Methods: Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed included pre‐ and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return‐to‐work data and return‐to‐sport data. Results: Thirty‐two patients with a mean follow‐up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio‐fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio‐fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio‐fibular ligament. Conclusion: This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio‐fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs. Level of Evidence: Level IV, Retrospective case series. [ABSTRACT FROM AUTHOR]

There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all. [ABSTRACT FROM AUTHOR]