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Aim Methods Results Conclusions C‐reactive protein (CRP) is commonly used to assess the probability of bacterial infection and the need for empiric antibiotic treatment. We assessed the relationship between CRP levels and bacterial infection in the paediatric emergency room (PER) setting.A retrospective cohort study. Relative risks (RRs) were calculated for the relation between CRP levels and various demographic, clinical and diagnosis parameters. Additionally, the sensitivity and specificity of different CRP levels (2, 5, 7 and 10 mg/dL) for bacterial infection diagnosis was calculated.Overall, 13 092 cases were recorded. Fever, leucocytosis, hospitalisation and bacterial infection diagnosis were associated with elevated CRP levels, while lower CRP levels were associated with young age. Gender, ethnicity, hypoxemia and neutrophilia were not associated with CRP levels. The sensitivity of CRP ≥2 mg/dl for bacterial disease was 65%–70%, declining to <50% in CRP ≥5 mg/dL. The specificity of CRP ≥2 mg/dL for bacterial disease was ~60%, increasing to >80% in CRP ≥5 mg/dL.CRP levels of ≥5 mg/dl high specificity for bacterial disease, allow for its use as an indicator to start empiric antibiotic treatment, while the low sensitivity of various CRP levels probably excludes the possibility of withholding empiric antibiotic treatment, based only on CRP level. [ABSTRACT FROM AUTHOR]

Making adults learn from larger linguistic units can facilitate learning article–noun agreement. Here we ask whether initial exposure to larger units improves learning by increasing the predictive associations between the article and noun. Using an artificial language learning paradigm, we taught 106 Hebrew‐speaking participants novel article–noun associations with either segmented input first or unsegmented input first, and tested their learning of the article–noun association and their ability to use articles to predict nouns. Our results showed that participants exposed to unsegmented input first were more likely to treat the article–noun unit as one word and were more accurate at learning the correct article–noun associations. However, participants in the unsegmented‐first condition did not show increased gaze to the target compared to those in the segmented‐first condition. We discuss how these findings inform our understanding of the challenges that adults face when learning a second language. A one‐page Accessible Summary of this article in nontechnical language is freely available in the Supporting Information online and at https://oasis‐database.org [ABSTRACT FROM AUTHOR]

Most children who are removed from their homes by social services have siblings. Yet, siblinghood is an unnoticed and understudied field of interest. Professionals lack a framework for addressing this common issue in out‐of‐home placement decision‐making and caregiving. The current study examined how professionals in family group homes in Israel perceive and approach sibling bonds, as well as the main barriers and benefits they identify regarding siblinghood among children in out‐of‐home placements. Five focus groups were held with 34 professionals, and a thematic analysis was conducted. The participants identified siblings as a source of support, comfort and security to one another. On the other hand, they worried about the sibling bond inhibiting a child's development. They also revealed two approaches regarding the role of out‐of‐home placements: a space for individual development versus a transition station in the child's and family's life journey. They also referred to the uniqueness of every sibling group and, hence, the significant weight of professional intuition in decision‐making processes. The discussion addresses the challenges of intuitive decision‐making in cases of siblings in out‐of‐home placements and stresses the need for more informed decision‐making processes. [ABSTRACT FROM AUTHOR]

Background: SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient‐reported outcome measures (PROMs) in individuals with Parkinson's disease (PD). Methods: This study included 157 participants with PD who underwent an intensive 8‐week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice‐related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peak expiratory flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index‐10 and communication effectiveness questionnaire. Results: The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs. Conclusion: These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed. WHAT THIS PAPER ADDS: What is already known on the subject: Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient‐reported outcome measures has not been extensively studied. What this paper adds to existing knowledge: This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non‐speech exhalation‐related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient‐reported outcome measures, with reduced voice‐related disability and improved communication efficiency. What are the potential or actual clinical implications of this work?: The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient‐reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD. [ABSTRACT FROM AUTHOR]

The Informative Process Model (IPM) proposes an intervention to facilitate change in conflict‐supporting narratives in protracted conflicts. These narratives develop to help societies cope with conflict; but over time, they turn into barriers for its resolution. The IPM suggests raising awareness of the psychological processes responsible for the development of these narratives and their possibility for change, which may unfreeze conflict attitudes. Previous studies in the context of the Israeli–Palestinian conflict found that the IPM (versus control) increased participants' support for negotiations. In three preregistered studies (combined N = 2,509), we illuminate the importance of feeling that one's conflict‐related attitudes are accepted–that is, acknowledged without judgement–in explaining the effectiveness of the modeland expand the IPM's validity and generalizability: By showing the effectiveness of the IPM compared to an intervention similarly based on exposure to conflict‐related information (Study 1); by showing its effectiveness in unfreezing attitudes when communicating different thematic conflict‐supporting narratives–victimhood and security (Study 2); and by showing its effectiveness when using messages referring to ongoing, not only resolved conflicts, and text‐based, not only visually stimulating, message styles (Study 3). These results contribute to theory and practice on psychological interventions addressing the barrier of conflict‐supporting narratives. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a common skin disorder linked to systemic inflammation and immune dysregulation. It is believed to involve activated T cells and neutrophils. Recent research has highlighted the potential role of hematological ratios, such as neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), eosinophil‐to‐lymphocyte ratio (ELR), eosinophil‐to‐neutrophil ratio (ENR), and eosinophil‐to‐monocyte ratio (EMR), as markers for inflammatory skin diseases, including psoriasis. Objectives: We aimed to investigate hematological ratios between children and adults, patients and controls, and patients with moderate‐to‐severe and mild psoriasis. Materials and Methods: This national retrospective cohort study included over 16,000 psoriasis patients in Israel. Patients with comorbidities influencing blood counts were excluded. Ratios were calculated from blood counts taken within 30 days of diagnosis. Multivariable logistic regression, including age, gender, ethnicity, smoking status, and socioeconomic status, was performed. Results: Findings revealed age‐specific variations in blood counts, hematological ratios, and differences between mild and moderate–severe patients and patients versus controls. Moderate–severe psoriasis patients had elevated neutrophil and eosinophil counts (4.57 vs. 4.25, P < 0.001, and 0.24 vs. 0.22, P = 0.047, respectively), as well as increased NLR (2.46 vs. 2.29, P < 0.001). Multivariable logistic regression analysis confirmed the significance of neutrophil and platelet counts as well as NLR and PLR in predicting psoriasis severity. Limitations: This was a retrospective study without subjective data on disease severity. Conclusion: This study highlights hematologic ratios' diagnostic and prognostic potential in psoriasis. [ABSTRACT FROM AUTHOR]

Objective: Heliox, a mixture of helium and oxygen, has been shown to improve laminar airflow and decrease airway resistance in children. This study aims to describe the outcomes of heliox use in children with respiratory compromise and to identify variables associated with a need for airway surgical intervention. Methods: A retrospective cohort study of patients who received heliox between 2012 and 2022 at a tertiary care children's hospital. Results: A hundred and thirty‐eight heliox treatments were recorded in 119 children. Twelve patients were excluded. Most (n = 100, 84%) patients had significant comorbidities. On average, patients spent a cumulative mean of 94 ± 187 h on heliox therapy per hospital admission. Patients with croup or asthma without known airway pathology presented at an older age than patients with other indications for heliox therapy (4.0 ± 4.7 vs. 2.2 ± 3.6 years, p = 0.04) and were significantly less likely to have background diseases (n = 14, 52% vs. n = 74, 93%, p < 0.0001). Overall, 51 (47.7%) patients were recommended tracheostomy placement, airway reconstruction, or palliative care. Cumulative use of heliox for more than 47 h was associated with an increased risk of needing tracheostomy or airway reconstruction (odds ratio 6.2, 95% confidence intervals 2.56–14.13, p < 0.0001). In multivariable regression analysis, neuromuscular disease, intracranial neuropathology, and cumulative time of heliox were associated with a need for definitive airway intervention. Conclusions: Heliox may be used as a temporizing agent in children with upper airway obstruction. The effectiveness of heliox use for more than 47 h in children, especially in the presence of neuromuscular disease and intracranial neuropathology should be reconsidered. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Objective(s): Pediatric epistaxis is a common, often non‐operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers. Methods: Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed. Results: In total, 122 patients were included for analysis. Over a follow‐up duration of 20.5 months (IQR 8–36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution (n = 122). Refractory epistaxis was associated with a family history of coagulopathy (p =.007), daily epistaxis episodes (p =.043), and anemia (p <.001). Average direct hospital costs associated with nasal cautery were $187 for in‐office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in‐office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work‐up was $576. Conclusion: Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Ecological momentary assessment (EMA), a data collection method commonly employed in mHealth studies, allows for repeated real‐time sampling of individuals' psychological, behavioral, and contextual states. Due to the frequent measurements, data collected using EMA are useful for understanding both the temporal dynamics in individuals' states and how these states relate to adverse health events. Motivated by data from a smoking cessation study, we propose a joint model for analyzing longitudinal EMA data to determine whether certain latent psychological states are associated with repeated cigarette use. Our method consists of a longitudinal submodel—a dynamic factor model—that models changes in the time‐varying latent states and a cumulative risk submodel—a Poisson regression model—that connects the latent states with the total number of events. In the motivating data, both the predictors—the underlying psychological states—and the event outcome—the number of cigarettes smoked—are partially unobservable; we account for this incomplete information in our proposed model and estimation method. We take a two‐stage approach to estimation that leverages existing software and uses importance sampling‐based weights to reduce potential bias. We demonstrate that these weights are effective at reducing bias in the cumulative risk submodel parameters via simulation. We apply our method to a subset of data from a smoking cessation study to assess the association between psychological state and cigarette smoking. The analysis shows that above‐average intensities of negative mood are associated with increased cigarette use. [ABSTRACT FROM AUTHOR]

Background: We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support. Methods: A retrospective cohort study of children on ECMO between 1/2018 and 12/2022. Results: A total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty‐seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 ± 37.2 vs 6.1 ± 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not. Conclusion: Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material. Level of Evidence: 4 Laryngoscope, 134:4134–4140, 2024 [ABSTRACT FROM AUTHOR]

Introduction Design Method Findings Conclusion Clinical Relevance Nurses in southern Israel's public hospitals were exposed to unusual traumatic events following the October 7, 2023, Hamas attack on Israel, and the ensuing Swords of Iron War. This study aimed to clarify the complexity of wartime nursing by identifying profiles based on risk factors (i.e., psychological distress and adjustment disorders) and protective factors (i.e., positive affect (PA), resilience, and perceived social support [PSS]).This study utilizes a cross‐sectional design.Two hundred nurses at a major public hospital in southern Israel completed self‐report questionnaires. A latent profile analysis (LPA) was conducted to identify distinct profiles based on nurses' risk and protective factors. Differences in profiles were examined alongside sociodemographic and occupational variables and traumatic event exposure. The LPA was conducted using MPlus 8.8 Structural Equation Modeling (SEM) software.Two distinct profiles were identified: “reactive” and “resilient.” The “reactive” group included nurses who had higher risk factor scores (psychological distress and adjustment disorder), whereas the “resilient” group included nurses who had higher protective factor scores (PA, resilience, and PSS). Furthermore, nurses in the “reactive” group were younger, with greater seniority, worse self‐rated health, and a higher frequency of kidnapped family members compared to nurses from the “resilient” group.Nurses in wartime are at risk if identified as “reactive.” Identifying these profiles can assist in developing effective support practices to help nurses cope with wartime challenges and maintain their mental well‐being.Healthcare organizations should tailor interventions to prepare and support nurses of various ages and experience levels, during and after conflicts. This approach aims to reduce risk factors and promote protective factors among nurses during wartime. [ABSTRACT FROM AUTHOR]

Background: Existing research on the relationship between body mass index (BMI) and astigmatism yields inconsistent results. This study analyses this association in a nationally representative sample of adolescents. Methods: This retrospective, cross‐sectional study included Israeli adolescents who underwent medical assessments before mandatory military service between 2011 and 2022. BMI was categorised based on the US age‐ and sex‐matched percentiles. Astigmatism was categorised by magnitude [low‐moderate: 0.75 to <3.00 diopters (D), high: ≥3.00 D], and axis orientation [with‐the‐rule (WTR), against‐the‐rule (ATR), or oblique (OBL)]. Sex‐stratified regression models adjusted for sociodemographic variables were used. Results: Of 935 989 adolescents evaluated, 887 325 were included [511 465 (57.6%) males, mean age 17.2 years]. Astigmatism was diagnosed in 123 675 (13.9%) adolescents, of whom 117 081 (13.2%) had low‐moderate and 6594 (0.7%) had high astigmatism. WTR astigmatism was the most prevalent (8.2%), followed by ATR (4.1%) and OBL (1.6%) types. Compared with low‐normal BMI (5th to 50th percentile), the adjusted ORs for total astigmatism increased with increasing BMI, peaking at 1.65 (1.57–1.74) in males and 1.74 (1.64–1.86) in females with severe obesity. ORs were accentuated for high astigmatism, reaching 3.51 (3.01–4.09) in males, and 3.45 (2.83–4.22) in females with severe obesity. WTR astigmatism demonstrated the strongest association with BMI, with ORs reaching 2.26 (2.13–2.40) in males and 2.04 (1.90–2.20) in females with severe obesity. The results persisted in a series of subgroup analyses. Conclusions: Obesity is associated with higher odds of astigmatism in adolescence. Further investigation into the role of weight management in astigmatism development is warranted. [ABSTRACT FROM AUTHOR]

Although blind normal faults are common in subduction environments, their rheology, kinematics and interaction with the upper crust are poorly constrained. A month‐long shallow normal faulting sequence in the Ibaraki‐Fukushima prefectural border (IFPB), northeast Japan, which followed the Mw9.0 Tohoku‐Oki earthquake (TOE) and culminated in the Mw6.7 Iwaki earthquake, provides a window into megathrust‐to‐normal fault interaction. Stress change calculations indicate that direct triggering by the TOE co‐ and post‐seismic slip does not provide a plausible explanation for the IFPB earthquake sequence. In quest for an alternative triggering mechanism, we analyzed post‐TOE GNSS data from eastern IFPB. A key step in this analysis is the removal of the large‐scale post‐TOE displacement field, after which a distinct highly‐localized strain along the coastline becomes apparent. The accumulation of this strain was mostly aseismic, and migrated with time prior to the Iwaki earthquake in a manner that correlates well with post‐TOE local seismicity. We attribute the pre‐Iwaki earthquake strain accumulation to aseismic slip along low‐angle seaward dipping blind normal fault, activated by the TOE. Stresses transferred by this slip episode accelerated the failure along the IFPB shallow normal faults. This indirect triggering of the Iwaki earthquake sequence by the TOE highlights the complexity of stress transfers in subduction environments. Plain Language Summary: The 11 March 2011, Mw9.0 Tohoku‐Oki megathrust earthquake (TOE) triggered widespread seismicity throughout north‐east Japan. One of the most intense inland TOE aftershock sequences occurred along the Ibaraki‐Fukushima prefectural border (IFPB) during the first month following the TOE. That sequence, which ended a long period of seismic quiescence in the IFPB area, culminated with the damaging 11 April 2011, Mw6.7 Iwaki earthquake. The IFPB sequence is dominated by shallow normal faulting, suggesting regional extension. Due to its distance from the TOE slip area, activity in the IFPB cannot be explained solely due to the TOE co‐ or post‐seismic slip. Here we analyze dense GNSS data and show that early post‐seismic aseismic strain that accumulated in the IFPB greatly exceeded the seismic strain due to the IFBP shallow normal faulting. We associate that strain with slip along a low‐angle seaward dipping normal fault that is situated between the subduction interface and the IFPB. We show that the low‐angle normal fault's response to the TOE static stress change manifested in a month‐long slip transient with an equivalent moment magnitude equal to Mw6.7. We suggest that slip along the low angle normal fault greatly enhanced the failure of the shallow IFPB normal faults. Key Points: GNSS data analysis reveals a much larger aseismic than seismic strain in the Ibaraki‐Fukushima Prefectural borderThe observed strain field resulted from transient slip on a blind low‐angle normal fault offshore the study areaAmong on‐ and off‐megathrust sources, the low angle normal fault is the primary source to static stress driving the Ibaraki‐Fukushima swarm [ABSTRACT FROM AUTHOR]

Background and purpose: Subtle executive dysfunction is common in people newly diagnosed with Parkinson disease (PD), even when general cognitive abilities are intact. This study examined the Short Weekly Calendar Planning Activity (WCPA‐10)'s known‐group construct validity, comparing persons with PD to healthy controls (HCs) and nonmanifesting carriers of LRRK2 and GBA gene mutations to HCs. Additionally, convergent and ecological validity was examined. Methods: The study included 73 participants: 22 with idiopathic PD (iPD) who do not carry any of the founder GBA mutations or LRRK2‐G2019S, 29 nonmanifesting carriers of the G2019S‐LRRK2 (n = 14) and GBA (n = 15) mutations, and 22 HCs. Known‐group validity was determined using the WCPA‐10, convergent validity by also using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT), and ecological validity by using the WCPA‐10, Schwab and England Activities of Daily Living Scale (SE ADL), and Physical Activity Scale for the Elderly (PASE). Results: Known‐group validity of the WCPA‐10 was established for the iPD group only; they followed fewer rules (p = 0.020), were slower (p = 0.003) and less efficient (p = 0.001), used more strategies (p = 0.017) on the WCPA‐10, and achieved significantly lower CTT scores (p < 0.001) than the HCs. The nonmanifesting carriers and HCs were similar on all cognitive tests. Convergent and ecological validity of the WCPA‐10 were partially established, with few correlations between WCPA‐10 outcome measures and the MoCA (r = 0.50, r = 0.41), CTT‐2 (r = 0.43), SE ADL (r = 0.41), and PASE (r = 0.54, r = 0.46, r = 0.31). Conclusions: This study affirms the known‐group validity for most (four) WCPA‐10 scores and partially confirms its convergent and ecological validity for PD. [ABSTRACT FROM AUTHOR]

Secretion systems play a crucial role in microbe-microbe or host-microbe interactions. Among these systems, the extracellular contractile injection system (eCIS) is a unique bacterial and archaeal extracellular secretion system that injects protein toxins into target organisms. However, the specific proteins that eCISs inject into target cells and their functions remain largely unknown. Here, we developed a machine learning classifier to identify eCIS-associated toxins (EATs). The classifier combines genetic and biochemical features to identify EATs. We also developed a score for the eCIS N-terminal signal peptide to predict EAT loading. Using the classifier we classified 2,194 genes from 950 genomes as putative EATs. We validated four new EATs, EAT14-17, showing toxicity in bacterial and eukaryotic cells, and identified residues of their respective active sites that are critical for toxicity. Finally, we show that EAT14 inhibits mitogenic signaling in human cells. Our study provides insights into the diversity and functions of EATs and demonstrates machine learning capability of identifying novel toxins. The toxins can be employed in various applications dependently or independently of eCIS. Synopsis: Toxins delivered by the extracellular contractile injection system (eCIS) of 950 microbial genomes were identified using XGBoost classifier algorithm, four of which were experimentally confirmed and functionally characterized. eCIS is a poorly studied microbial toxin delivery system encoded by many environmental microbes. The first algorithm for predicting eCIS-associated toxins (EATs) was developed using genomic and biochemical features, and was used to identify ~2,200 EATs from 950 genomes. Features characterizing the N terminal signal peptide of EATs were identified and combined into a signal peptide score. Four new EATs genes (EAT14-17) were experimentally validated as being toxins, and critical EAT residues within the predicted catalytic sites were identified. EAT14 inhibits SRE-dependent mitogenic signaling in HEK293T cells. Toxins delivered by the extracellular contractile injection system (eCIS) of 950 microbial genomes were identified using XGBoost classifier algorithm, four of which were experimentally confirmed and functionally characterized. [ABSTRACT FROM AUTHOR]

Objective: Cannabidiol‐enriched oil (CBDO) is being used increasingly to improve seizure control in adult patients with drug‐resistant epilepsy (DRE), despite the lack of large‐scale studies supporting its efficacy in this patient population. We aimed to assess the effects of add‐on CBDO on seizure frequency as well as on gait, cognitive, affective, and sleep‐quality metrics, and to explore the electrophysiological changes in responder and non‐responder DRE patients treated with add‐on CBDO. Methods: We prospectively recruited adult DRE patients who were treated with add‐on CBDO. Patients were evaluated prior to treatment and following 4 weeks of a maintenance daily dose of ≈260 mg CBD and ≈12 mg Δ9‐tetrahydrocannabinol (THC). The outcome measures included seizure response to CBDO (defined as ≥50% decrease in seizures compared to pre‐CBDO baseline), gait testing, Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), and sleep‐quality questionnaire assessments. Patients underwent electroencephalography (EEG) recording during rest as well as event‐related potentials (ERPs) during visual Go/NoGo task while sitting and while walking. Results: Nineteen patients were recruited, of which 16 finished pre‐ and post‐CBDO assessments. Seven patients (43.75%) were responders demonstrating an average reduction of 82.4% in seizures, and nine patients (56.25%) were non‐responders with an average seizure increase of 30.1%. No differences in demographics and clinical parameters were found between responders and non‐responders at baseline. However, responders demonstrated better performance in the dual‐task walking post‐treatment (p =.015), and correlation between increase in MoCA and seizure reduction (r =.810, p =.027). Post‐CBDO P300 amplitude was lower during No/Go‐sitting in non‐responders (p =.028) and during No/Go‐walking in responders (p =.068). Significance: CBDO treatment can reduce seizures in a subset of patients with DRE, but could aggravate seizure control in a minority of patients; yet we found no specific baseline clinical or electrophysiological characteristics that are associated with response to CBDO. However, changes in ERPs in response to treatment could be a promising direction to better identify patients who could benefit from CBDO treatment. [ABSTRACT FROM AUTHOR]

Background: Pediatric tracheostomy decannulation protocols vary among institutions and may include toleration of Passy Muir Valve (PMV), microlaryngoscopy and bronchoscopy (MLB) findings, and polysomnography evaluation. Transtracheal pressure (TTP) is an objective measurement utilized to evaluate PMV toleration. We aimed to investigate the role of TTP in decannulation candidates and compare TTP measurements with polysomnography and MLB findings. Methods: A retrospective cohort study of children who underwent TTP measurement during PMV trial between December 2012 and November 2022. Results: A total of 79 patients underwent TTP measurement and MLB evaluation; of these, 16 (20.3%) patients had a capped polysomnography. Twenty‐eight (35.4%) patients had TTPs ≤10 cm H2O, and 51 (64.6%) patients had TTPs >10 cm H2O. The most common indication for tracheostomy was upper airway obstruction (n = 41, 51.9%), followed by a need for mechanical ventilation (n = 24, 30.4%). Twenty‐five (31.6%) patients were decannulated. Patients with TTPs ≤10 cm H2O had a mean Apnea‐Hypopnea Index of 0.17 ± 0.26/h compared with 6.93 ± 7.67/h in those with TTPs >10 cm H2O, p = 0.0365. Patients with TTPs >10 cm H2O were found to have a significantly higher occurrence of airway obstruction (96.1% vs. 46.4%, p < 0.0001) and multilevel airway obstruction (70.6% vs. 21.4%, p < 0.0001) on MLB. Neither TTP measured at time of PMV assessment nor capped polysomnography was associated with successful decannulation. Conclusions: TTP measurements at time of PMV evaluation are associated with polysomnography and MLB findings. One‐time PMV measurements were not indicative of decannulation success. Level of Evidence: 4 Laryngoscope, 134:3377–3383, 2024 [ABSTRACT FROM AUTHOR]

The routine of the dental profession exposes dentists not only to medical challenges but also to ethical and legal ones. Compared to other physicians, dentists are more likely to encounter children who are victims of domestic violence. This reality exposes them to legal liability due to the reporting obligations and the risk of misdiagnosing injuries. This paper aims to examine the importance of dentists in diagnosing injuries to children caused by domestic violence and the inherent dangers of failing to make such a diagnosis. [ABSTRACT FROM AUTHOR]

The brain is spatially organized into subdivisions, nuclei and areas, which often correspond to functional and developmental units. A segmentation of brain regions in the form of a consensus atlas facilitates mechanistic studies and is a prerequisite for sharing information among neuroanatomists. Gene expression patterns objectively delineate boundaries between brain regions and provide information about their developmental and evolutionary histories. To generate a detailed molecular map of the larval zebrafish diencephalon, we took advantage of the Max Planck Zebrafish Brain (mapzebrain) atlas, which aligns hundreds of transcript and transgene expression patterns in a shared coordinate system. Inspection and co‐visualization of close to 50 marker genes have allowed us to resolve the tripartite prosomeric scaffold of the diencephalon at unprecedented resolution. This approach clarified the genoarchitectonic partitioning of the alar diencephalon into pretectum (alar part of prosomere P1), thalamus (alar part of prosomere P2, with habenula and pineal complex), and prethalamus (alar part of prosomere P3). We further identified the region of the nucleus of the medial longitudinal fasciculus, as well as the posterior and anterior parts of the posterior tuberculum, as molecularly distinct basal parts of prosomeres 1, 2, and 3, respectively. Some of the markers examined allowed us to locate glutamatergic, GABAergic, dopaminergic, serotoninergic, and various neuropeptidergic domains in the larval zebrafish diencephalon. Our molecular neuroanatomical approach has thus (1) yielded an objective and internally consistent interpretation of the prosomere boundaries within the zebrafish forebrain; has (2) produced a list of markers, which in sparse combinations label the subdivisions of the diencephalon; and is (3) setting the stage for further functional and developmental studies in this vertebrate brain. [ABSTRACT FROM AUTHOR]

Objective: Epiglottopexy has been an increasingly utilized intervention in children with epiglottic prolapse and airway obstruction. Given the role of the epiglottis in protecting the airway during swallowing and the potential effect of repositioning the epiglottis on the passage of the bolus, we aimed to compare swallowing outcomes before and after epiglottopexy in children. Study Design: A retrospective cohort study. Setting: Tertiary care children's hospital. Methods: Data were extracted from charts of children who underwent epiglottopexy and had a subsequent instrumental swallowing evaluation between January 2018 and September 2022. Results: A total of 93 patients underwent epiglottopexy. Of these, 38 patients met inclusion requirements. The mean age at surgery was 41 ± 47 months. Most patients (n = 37, 97.4%) had significant comorbidities such as secondary airway lesions (n = 33, 91.7%), a genetic or syndromic disorder (n = 25, 69.4%), and dysphagia (n = 29, 76.3%). All patients had a concurrent procedure at the time of epiglottopexy with supraglottoplasty (n = 24, 63.2%) and lingual tonsillectomy (n = 16, 42.1%) being the most common. No changes in initiation or patterns of swallowing were noted postoperatively. A total of 7 (18.4%) patients had worsening swallow function: 2 had new‐onset dysphagia, and 5 had worsening pre‐existing dysphagia. Liquid or food textures penetrated remained unchanged or improved in most cases. No risk factors for worsening dysphagia were identified in our cohort. Conclusion: Children with medical comorbidities undergoing epiglottopexy with additional airway interventions may experience new or worsening dysphagia. However, the procedure is generally safe without notable patterned changes in the swallowing mechanism. [ABSTRACT FROM AUTHOR]

A variety of studies have suggested that at least some children with autism spectrum disorder (ASD) view the world differently. Differences in gaze patterns as measured by eye tracking have been demonstrated during visual exploration of images and natural viewing of movies with social content. Here we analyzed the temporal randomness of saccades and blinks during natural viewing of movies, inspired by a recent measure of "randomness" applied to micro‐movements of the hand and head in ASD (Torres et al., 2013; Torres & Denisova, 2016). We analyzed a large eye‐tracking dataset of 189 ASD and 41 typically developing (TD) children (1–11 years old) who watched three movie clips with social content, each repeated twice. We found that oculomotor measures of randomness, obtained from gamma parameters of inter‐saccade intervals (ISI) and blink duration distributions, were significantly higher in the ASD group compared with the TD group and were correlated with the ADOS comparison score, reflecting increased "randomness" in more severe cases. Moreover, these measures of randomness decreased with age, as well as with higher cognitive scores in both groups and were consistent across repeated viewing of each movie clip. Highly "random" eye movements in ASD children could be associated with high "neural variability" or noise, poor sensory‐motor control, or weak engagement with the movies. These findings could contribute to the future development of oculomotor biomarkers as part of an integrative diagnostic tool for ASD. Lay Summary: The eye movements of young children were analyzed after watching short video clips featuring social interactions. The results showed that the times of the eye movements are distributed in a way that indicates noisier and more random eye movement behavior in children with ASD compared to TD. Furthermore, greater oculomotor randomness was observed in more severe ASD cases, as well as in children with low IQ scores. This unique oculomotor behavior may lay the groundwork for the development of future diagnostic tools. [ABSTRACT FROM AUTHOR]

Background: Surveillance of high‐risk individuals for pancreatic ductal adenocarcinoma (PDAC) is recommended. This study aimed to determine the prevalence and outcomes of PDAC and its precursor lesions in BRCA1/2 pathogenic variants (PVs) carriers undergoing pancreatic surveillance. Methods: A retrospective multicenter cohort study of pancreatic surveillance outcomes in Israeli BRCA1/2 carriers preferably with a family history of PDAC. Results: A total of 180 asymptomatic carriers participated in the screening programs, including 57 (31.7%) with BRCA1 PVs, 121 (67.2%) with BRCA2 PVs, and 12 (6.6%) with PVs in BRCA1/2 and other genes, for a median follow‐up period of 4 years. Ninety‐one individuals (50.5%) fulfilled the International Cancer of the Pancreas Screening (CAPS) criteria for surveillance whereas 116 (64.4%) fulfilled the American College of Gastroenterology (ACG) criteria. There were four cases of adenocarcinoma and four cases of grade 1‐neuroendocrine tumor (G1‐NET). All were BRCA2 carriers, and two had no family history of PDAC. Three cancer patients were at resectable stages (IA, IIA, IIB) whereas one had a stage IIIB tumor. Of the G1‐NET cases, one had surgery and the others were only followed. Success rate for detection of confined pancreatic carcinoma was thus 1.6% (three of 180) in the whole cohort, 1.6% (two of 116) among individuals who fulfilled ACG criteria and 2.2% (two of 91) in those fulfilling CAPS criteria for surveillance. Conclusions: Despite the low detection rate of PDAC and its' high‐risk neoplastic precursor lesions among BRCA1/2 carriers undergoing pancreatic surveillance, 75% of cancer cases were detected at a resectable stage. In a surveillance program of 180 BRCA1/2 carriers for pancreatic cancer, four cases of cancer were detected. Despite this overall low detection rate (2.2%), 75% of them were successfully detected at relatively early, resectable stage. [ABSTRACT FROM AUTHOR]

Background: Intrahospital transport is associated with adverse events. This challenge is amplified during airway management. Although difficult airway response teams have been described, little attention has been paid to patient transport during difficult airway management versus the alternative of managing patient airways without moving the patient. This is especially needed in a 22‐floor vertical hospital. Hypothesis: Development of a rapid difficult airway response team and an associated difficult airway cart will allow for the ability to manage difficult airways in the patient's primary location. Methods: A retrospective chart review of all rapid difficult airway response activations from December 18, 2019 to December 31, 2021 was performed to determine the number of airways secured in the patient's primary location (primary outcome). Secondary outcomes included length of time until airway securement, airway device used, number of attempts, complications, use of front of neck access, and mortality. Results: There were 96 rapid difficult airway response activations in a 2‐year period, with 18 activations deemed inappropriate. Of the 78 indicated rapid difficult airway response deployments, all activations resulted in a secure airway, and 76 (97.4%) of cases had an airway secured in the patient's primary location. The mean time to airway securement was 17.1 min (standard deviation 18.8 min). The most common methods of airway securement were direct laryngoscopy (42.3%, 33/78) and video laryngoscopy (29.5%, 23/78). The mean number of attempts by the rapid difficult airway response team was 1.4. There were no documented cases requiring front of neck access. The Cormack‐Lehane airway grade at time of intubation was I‐II in 83.3% (65/78) of activations. Rapid difficult airway response activation resulted in 16 cases of cardiac arrest and 4 patient deaths within 48 h. Conclusions: A rapid difficult airway response team allows a large majority of patients' airways to be managed and secured in the patient's primary hospital location. Future directions include reducing time to airway securement and identifying factors associated with cardiac arrest. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical features of first branchial cleft anomalies (BCAs) and their relationship to pre‐operative imaging, pathologic data, and post‐operative surveillance outcomes. Additional aims were to assess the validity of the Work classification and describe features of recurrent cysts. Methods: Records for 56 children (34 females, 22 males; age at surgery of 5.6 ± 4.4 years) collected over a 12‐year period (2009–2021) were reviewed. Imaging and pathologic slides were re‐reviewed in a blinded fashion by experts in those respective areas. Parents were contacted via telephone to obtain extended follow‐up. An alternate classification method based on the presence (type II) or absence (type I) of parotid involvement is provided. Results: Only 55% of first BCAs could be successfully classified using Work's method. First BCAs within the parotid were more likely to present with recurrent infections, involve scarred tissue planes and lymphadenopathy, and demonstrate enlarged lymphoid follicles on pathology. The overall recurrence rate was 16%, and recurrence was 5.3 times more likely when external auditory canal cartilage was not resected. Preoperative imaging was useful for predicting the extent of surgery required and the presence of scarred tissue planes. Conclusion: First BCAs within the parotid gland involve more difficult and extensive surgical resection and the potential for morbidity related to facial nerve dissection. Appropriately aggressive surgical resection, which may include the resection of involved ear cartilage, is necessary to prevent morbidity related to recurrence. Level of Evidence: 4 Laryngoscope, 134:459–465, 2024 [ABSTRACT FROM AUTHOR]

Summary: Background: Previous research on the association between body mass index (BMI) and visual impairment (VI) in youth has reported inconsistent findings. We aimed to investigate this association in a national cohort of Israeli adolescents. Methods: This retrospective, population‐based, cross‐sectional study included 1 697 060 adolescents (56.4% men; mean age 17 years) who underwent mandatory pre‐military service assessments from 1993 to 2017. BMI was classified based on the US age‐ and sex‐matched percentiles. Unilateral or bilateral VI was classified as best‐corrected visual acuity (BCVA) worse than 6/9 in either or both eyes, respectively. Sex‐stratified regression models adjusted for sociodemographic variables were used to analyse the BMI‐VI relationship. Results: Overall, 17 871 (1.05%) and 5148 (0.30%) adolescents had unilateral and bilateral VI, respectively. Compared with high‐normal BMI (50th to 85th percentile), adjusted odds ratios (ORs) for unilateral and bilateral VI gradually increased with higher BMI, reaching 1.33 (1.13–1.55) and 1.80 (1.37–2.35) in men with severe obesity, and 1.51 (1.24–1.84) and 1.52 (1.08–2.14) in women with severe obesity, respectively. Men with underweight also had increased ORs for unilateral and bilateral VI (1.23; 1.14–1.33 and 1.59; 1.37–1.84, respectively), a pattern not observed in women (0.96; 0.86–1.07 and 1.02; 0.83–1.25, respectively). Results were maintained when the outcome was restricted to mild VI, as well as in subgroups of adolescents with unimpaired health and those without moderate‐to‐severe myopia. Conclusions: Abnormal BMI, and particularly obesity, is associated with increased OR for VI in late adolescence. [ABSTRACT FROM AUTHOR]

This study examines the association between posttraumatic growth (PTG) and two psychological attributes, resilience and optimism, in first‐time mothers, after controlling for demographic and motherhood‐related characteristics. PTG, the self‐examination triggered by life‐changing events, contains five factors: (1) relating to others, (2) new possibilities, (3) personal strength, (4) spiritual change, and (5) appreciation of life. Outcomes from studies conflict on whether PTG is associated with the two psychological attributes of resilience (the ability to resume one's life after adversity) and optimism (viewing life in a positive light). This study used a cross‐sectional design. A convenience sample of first‐time mothers whose infants were between 3 months and 1 year (N = 415) completed questionnaires containing several standardized and reliable instruments including those measuring the independent variables of resilience and optimism, and the dependent variable of PTG. A STROBE checklist guided the reporting of this study. Resilience was associated with overall PTG and four of its five factors. Optimism also was associated with overall PTG but only associated with two of its five factors. PTG profiles and squared semipartial correlations indicated that resilience had the stronger association, compared to optimism, with PTG and most of its factors. Our study's findings on the strong link between resilience and PTG suggest the need for research examining the impact of specific psychosocial nursing activities (e.g., providing emotional support; assisting others to identify their own strengths; encouraging the mobilization of one's internal resources; furnishing needed resources and referrals; and supplying health education and information), as these activities may not only promote resilience but also may contribute to PTG. Patient or Public Contribution: First‐time mothers responded to online questionnaires, otherwise there was no patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Our institution implemented a post‐anesthesia care unit (PACU) extended‐stay model (Grey Zone model), where the post‐operative level of care for high‐risk adenotonsillectomy patients (general care vs. intensive care unit) was decided based on the clinical course of 2–4 h of PACU admission. Objective: To assess the correlation between post‐tonsillectomy respiratory compromise and the need for respiratory support during an extended stay at PACU. To identify comorbidities associated with a need for intensive care after extended observation. Methods: A retrospective cohort study of high‐risk children who underwent adenotonsillectomy and were admitted to the Grey Zone following surgery. Results: 274 patients met inclusion criteria. 262 (95.6%) met criteria for general care unit transfer (mean oxygen saturation 94.4 ± 5.1%). Twelve (4.4%) patients were transferred from the PACU to the ICU due to respiratory distress (mean oxygen saturation 86.8 ± 11%). Of the patients admitted to general care, 4 (1.5%) secondarily developed respiratory compromise, requiring escalation of care. Three of these maintained oxygen saturation ≥95% throughout the PACU period. There was no difference between the groups with respect to demographic data, rates of morbid obesity, and severity of obstructive sleep apnea. Neuromuscular disease, chronic lung disease, seizure disorder, and gastrostomy‐tube status were more prevalent in those requiring ICU level of care compared to the general care unit. Conclusions: The Grey Zone model accurately identifies patients requiring ICU‐level care following adenotonsillectomy, allowing for a safe reduction in the utilization of ICU resources. Due to rare delayed respiratory events, overnight observation in this cohort is recommended. Level of Evidence: 4 Laryngoscope, 133:3582–3587, 2023 [ABSTRACT FROM AUTHOR]

Background: Cognitive deficits in Parkinson's disease (PD) patients are well described, however, their underlying neural mechanisms as assessed by electrophysiology are not clear. Objectives: To reveal specific neural network alterations during the performance of cognitive tasks in PD patients using electroencephalography (EEG). Methods: Ninety participants, 60 PD patients and 30 controls underwent EEG recording while performing a GO/NOGO task. Source localization of 16 regions of interest known to play a pivotal role in GO/NOGO task was performed to assess power density and connectivity within this cognitive network. The connectivity matrices were evaluated using a graph‐theory approach that included measures of cluster‐coefficient, degree, and global‐efficiency. A mixed‐model analysis, corrected for age and levodopa equivalent daily dose was performed to examine neural changes between PD patients and controls. Results: PD patients performed worse in the GO/NOGO task (P < 0.001). The power density was higher in δ and θ bands, but lower in α and β bands in PD patients compared to controls (interaction group × band: P < 0.001), indicating a general slowness within the network. Patients had more connections within the network (P < 0.034) than controls and these were used for graph‐theory analysis. Differences between groups in graph‐theory measures were found only in cluster‐coefficient, which was higher in PD compared to controls (interaction group × band: P < 0.001). Conclusions: Cognitive deficits in PD are underlined by alterations at the brain network level, including higher δ and θ activity, lower α and β activity, increased connectivity, and segregated network organization. These findings may have important implications on future adaptive deep brain stimulation. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Most aftershocks occur in areas experiencing large co‐seismic stress changes, yet some occur long after the mainshock in remote lightly stressed regions. The triggering mechanism of these remote delayed aftershocks is not well understood. Here, we study aftershocks occurring in the Dead Sea (DS) area following the 2023 Mw7.8 and Mw7.6 Kahramanmaraş earthquakes. Most aftershocks cluster along previously quiescent structures off‐ the main DS fault strand. Visual inspection disclosed three aftershocks instantaneously triggered by the Mw7.6 in the northern DS basin, and match‐filtering revealed a delayed aftershock. Waveform similarity and temporal clustering suggest the northern DS aftershocks re‐rupture a stick‐slip patch loaded by surrounding creep. Velocity‐gradient seismograms show the Mw7.6 exerted larger transient stresses than the Mw7.8, which may explain triggering by the Mw7.6, but not by the Mw7.8. This account of instantaneously triggered repeaters underscores the role of interactions between aseismic and seismic slip in remote triggering. Plain Language Summary: Most aftershocks occur in areas experiencing large co‐seismic permanent stress changes, yet some occur long after the mainshock in remote regions experiencing small stress changes. The physics controlling the triggering of remote delayed aftershocks is not well understood. Here, we report on remotely triggered aftershocks in the Palestine Territories and Israel following the 2023 Kahramanmaraş earthquake pair. The main fault within the study area is the Dead Sea (DS) Transform (DST), yet most aftershocks occur on secondary structures located off‐ the main DST fault strand. This indicates off‐fault structures are presently more pre‐stressed than the main DST fault, which has important implications for seismic hazard analysis. We document a sequence of four aftershocks re‐rupturing the same fault patch in the Northern DS basin. Three of these aftershocks were triggered during the Mw7.6 surface‐wave passage, and one aftershock is delayed. We do not observe triggering in the study area due to the larger and closer Mw7.8. The non‐triggering by the Mw7.8 and later triggering by the Mw7.6 is explained in terms of the mainshock source properties. The aftershock decay rates and moments are consistent with a model in which a stick‐slip patch is being loaded by creep in the surrounding area. Key Points: We document a dramatic earthquake rate increase in the Palestine Territories and Israel following the 2023 Kahramanmaraş earthquakesWe provide the first account of instantaneous remotely triggered repeating aftershocks triggered by the Mw7.6 mainshockNon‐triggering by the Mw7.8 and later triggering by the Mw7.6 underscores the role of aseismic and seismic fault slip interactions [ABSTRACT FROM AUTHOR]

To what extent and under what conditions do college graduates disengage from employment‐incompatible behaviors during the college‐to‐work (C2W) transition? Drawing from the life course perspective, we proposed a model highlighting considerable stability of employment‐incompatible behaviors during initial months of organizational socialization. Our model predicted that maturing out of such behaviors, which is expected by employers and beneficial to career adjustment, would be more likely to occur given a conducive transition context. Using a large dataset tracking graduates from their last semester in college to up to approximately 1.5 years after graduation and with alcohol use as our empirical referent, we demonstrated that a pattern of high‐risk drinking behavior may remain even after the transition into full‐time employment. We further showed that lower levels of perceived cohort drinking norms and higher levels of mentoring were associated with a higher probability of maturing out, manifesting in a transition from a high‐risk drinking profile before graduation to a moderate drinking profile after starting full‐time employment. Finally, we found that maturing out was associated with lagged outcomes including lower levels of sleep problems and depression and fewer workdays lost to absenteeism, thus underscoring the consequential nature of behavior profile shifts during the C2W transition. [ABSTRACT FROM AUTHOR]

Recent literature identifies childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post‐Traumatic‐Stress‐Following‐Childbirth (PTS‐FC). The current study examines whether stable symptoms of PTS‐FC during the early postpartum period may impose risk for perturbations in maternal behavior and infant social‐engagement with mother, controlling for comorbid postpartum internalizing symptoms. Mother‐infant dyads (N = 192) were recruited from the general population, during the third trimester of pregnancy. 49.5% of the mothers were primipara, and 48.4% of the infants were girls. Maternal PTS‐FC was assessed at 3‐day, 1‐month and 4‐month postpartum, via self‐report and clinician‐administered interview. Latent Profile Analysis generated two profiles of symptomology: "Stable‐High‐PTS‐FC" (17.0%), and "Stable‐Low‐PTS‐FC" (83%). Membership in the "Stable‐High‐PTS‐FC" profile associated with perturbed maternal sensitivity, which was in turn significantly associated with infant avoidance of social gaze toward mother (Indirect effect β = −0.15). Results suggest the need for early screening and inform the planning of early preventive interventions. [ABSTRACT FROM AUTHOR]

Objective: To identify variables that are associated with poor compliance to thyroid hormone replacement therapy in children after total thyroidectomy. Method: A retrospective cohort study of children who underwent total thyroidectomy by high‐volume pediatric otolaryngologists between 1/2014 and 9/2021. Postoperative poor compliance was characterized by at least three separate measurements of high TSH levels not associated with radioactive iodine treatment. Results: There were 100 patients, ages 3–20 years old who met inclusion criteria; 44 patients underwent thyroidectomy for cancer diagnosis, and 56 for Graves' disease. The mean follow‐up time was 36.5 months (range 3.0–95.6 months). Overall, 42 patients (42%) were found to have at least three measurements of high TSH during follow‐up, and 29 patients (29%) were diagnosed with clinical hypothyroidism. Sex, race, income, insurance type, and benign versus malignant etiology for thyroidectomy were not associated with adherence to therapy. Multivariate regression analysis identified patients with Graves' disease and hyperthyroidism at the time of surgery and Hispanic ethnicity to be associated with postoperative clinical hypothyroidism (OR 9.38, 95% CI 2.16–49.2, p = 0.004 and OR 6.15, 95% CI 1.21–36.0, p = 0.033, respectively). Conclusions: Preoperative hyperthyroidism in patients with Graves' disease and Hispanic ethnicity were predictors of postoperative TSH abnormalities. Preoperative counseling for patients and their families on the implications of total thyroidectomy and the need for life‐long medications postoperatively is necessary. Efforts should be made to evaluate and improve adherence to therapy pre‐and postoperatively in patients with Graves' disease. Level of Evidence: 4 Laryngoscope, 133:2402–2406, 2023 [ABSTRACT FROM AUTHOR]

Purpose: Conventional sequences are static in nature, fixing measurement parameters in advance in anticipation of a wide range of expected tissue parameter values. We set out to design and benchmark a new, personalized approach—termed adaptive MR—in which incoming subject data is used to update and fine‐tune the pulse sequence parameters in real time. Methods: We implemented an adaptive, real‐time multi‐echo (MTE) experiment for estimating T2s. Our approach combined a Bayesian framework with model‐based reconstruction. It maintained and continuously updated a prior distribution of the desired tissue parameters, including T2, which was used to guide the selection of sequence parameters in real time. Results: Computer simulations predicted accelerations between 1.7‐ and 3.3‐fold for adaptive multi‐echo sequences relative to static ones. These predictions were corroborated in phantom experiments. In healthy volunteers, our adaptive framework accelerated the measurement of T2 for n‐acetyl‐aspartate by a factor of 2.5. Conclusion: Adaptive pulse sequences that alter their excitations in real time could provide substantial reductions in acquisition times. Given the generality of our proposed framework, our results motivate further research into other adaptive model‐based approaches to MRI and MRS. [ABSTRACT FROM AUTHOR]

Whereas the desire for revenge for an unjust deed is considered natural, its use within the therapeutic setting is scarce, specifically in sexually victimized children. The study aimed to find how experiencing sexual molestation during childhood and the revenge fantasy is reflected in drawings and narratives of sexually victimized children. Following ethical approval and signing a consent form, 14 children who experienced sexual abuse and were psychologically treated (ages 11–18) were recruited. They were asked to draw two drawings: "draw an unjust event that had happened to you" and "draw what you would have liked to happen to the person that unjustly treated you." At completion, participants were asked to give a narrative to each drawing. Phenomenological analysis of the drawings and narratives indicated that most participants refrained from using more than two colours, did not draw the perpetrator and drew schematic figures. The main themes that emerged in the drawings and the narratives were feeling of loneliness, aloneness, and the desire for role reversal. [ABSTRACT FROM AUTHOR]

Introduction: Virtual worlds (VWs) are immersive three‐dimensional environments, accessible simultaneously to multiple users, and described as shared, simulated spaces, whose inhabitants represented as avatars. VWs enable freedom of expression. Using VWs in educational contexts requires a shift from teacher‐centered instruction to facilitation of student‐centered learning practices. Method: This study explores the degree of teacher centrality (Sage‐on‐the‐stage, Facilitator, Guide‐on‐the‐side, or Partner), pedagogical strategies used in the integration of an Open Sim‐based VW learning platform in face‐to‐face K‐12 classrooms, and consistency between the perspectives of teachers and students on these topics. We conducted semi‐structured interviews followed by observations of actual VW environments with 12 elementary teachers of different subject‐matters and 11 fifth and sixth graders who learn with VWs. Findings: Although all teaching prototypes were present in the data, the most dominant teaching prototypes in the VW environment were 'Guide‐on‐the‐side' and 'Facilitator', while 'Sage‐on‐the‐stage' and 'Partner' were less frequent. The findings indicate that the most prevalent pedagogical strategies used to teach in VW‐enhanced classrooms were Experiential Learning, followed by Training practice and modeling, Project‐based learning, Game‐based learning, and Collaborative learning. Minor differences were found between the perspectives of teachers and students regarding teaching prototypes and the degree of teacher centrality in the classroom. Importantly, both teachers and students positioned students as the main designers of learning activities in the VW environment. Implications: The findings of this pioneer research provide insights regarding the teaching prototypes and the degree of teacher centrality in the VW learning environment that can help improve teaching processes and professional training courses in virtual 3D environments. Lay Description: What is already known about this topic: Virtual Worlds (VWs) facilitate student‐centered pedagogy and offer opportunities for envisioning new learning environments.Using innovative technologies such as VWs does not naturally promote student‐centered learning and requires effective pedagogical design.Grasha's categorized the following five instructional types: (1) Expert, (2) Formal authority, (3) Personal model, (4) Facilitator, and (5) Delegator.Prototypes of teachers that reflect their degree of centrality in the classroom are: (1) Sage‐on‐the‐stage, (2) Facilitator, (3) Guide‐on‐the‐side, and (4) Partner. What this paper adds: The research examined the teaching prototypes and the degree of teacher centrality in integration of the innovative Open Sim‐based virtual world in K‐12 settings.Interviews with teachers and elementary school students were followed by guided observations of actual VW environments integrated in different subject‐matters.More dominant teaching prototypes were 'Guide‐on‐the‐side' and 'Facilitator', while 'Sage‐on‐the‐stage' and 'Partner' were less common.The most prevalent pedagogical strategies in VW‐enhanced classrooms were Experiential Learning, followed by Training practice and modeling, and PBL. Implications for practice and/or policy: The findings provide insights that can help improve professional training courses in virtual 3D environments and similar emerging educational technologies.The suggested integrated model of teacher prototypes can be used to analyze the role and the degree of teacher centrality in technology‐enhanced classrooms. [ABSTRACT FROM AUTHOR]

The use of weather radars to detect and distinguish between different biological patterns greatly improves our understanding of aeroecology and its consequences for our lives. Importantly, it allows us to quantify passerine bird migration at different scales. Yet, no algorithm to detect soaring bird flocks in weather radar is available, precluding our ability to study this type of migration over large spatial scales.We developed the first automatic algorithm for detecting the migration of flocks of soaring birds, an important bio‐flow phenomenon involving many millions of birds that travel across large spatial extents, with implications for risk of bird‐aircraft collisions. The algorithm was developed with a deep learning network for semantic segmentation using U‐Net architecture. We tested several models with different weather radar products and with image sequences for flock movement identification.The best model includes the radial velocity product and a sequence of two previous images. It identifies 93% of soaring bird flocks that were tagged by a human on the radar image, with a false discovery of less than 20%.Large birds such as those detected by the algorithm pose a serious risk for flight safety of civilian and military transportation and therefore the application of this algorithm can substantially reduce bird‐strikes, leading to reduced financial losses and threats to human lives. In addition, it can help overcome one of the main challenges in the study of bird migration by automatically and continuously detecting flocks of large birds over wide spatial scales without the need to equip the birds with tracking devices, unravelling the abundance, timing, spatial flyways, seasonal trends and influences of environmental conditions on the migration of bird flocks. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is a cancer of differentiated plasma cells that occurs in the bone marrow (BM). Despite the recent advancements in drug development, most patients with MM eventually relapse and the disease remains incurable. RNA therapy delivered via lipid nanoparticles (LNPs) has the potential to be a promising cancer treatment, however, its clinical implementation is limited due to inefficient delivery to non‐hepatic tissues. Here, targeted (t)LNPs designed for delivery of RNA payload to MM cells are presented. The tLNPs consist of a novel ionizable lipid and are coated with an anti‐CD38 antibody (αCD38‐tLNPs). To explore their therapeutic potential, it is demonstrated that LNPs encapsulating small interference RNA (siRNA) against cytoskeleton‐associated protein 5 (CKAP5) lead to a ≈90% decrease in cell viability of MM cells in vitro. Next, a new xenograft MM mouse model is employed, which clinically resembles the human disease and demonstrates efficient homing of MM cells to the BM. Specific delivery of αCD38‐tLNPs to BM‐residing and disseminated MM cells and the improvement in therapeutic outcome of MM‐bearing mice treated with αCD38‐tLNPs‐siRNA‐CKAP5 are shown. These results underscore the potential of RNA therapeutics for treatment of MM and the importance of developing effective targeted delivery systems and reliable preclinical models. [ABSTRACT FROM AUTHOR]

It has been recently shown that in some proteins, tertiary‐structure dynamics occur surprisingly fast, that is on the microsecond or sub‐millisecond time scales. In this State of the Art Review, we discuss how such ultrafast domain motions relate to the function of caseinolytic peptidase B (ClpB), a AAA+ disaggregation machine. ClpB is a large hexameric protein that collaborates with cellular chaperone machinery to rescue protein chains from aggregates. We used single‐molecule FRET spectroscopy to capture the dynamics of essential structural elements within this machine. It was found that the middle domain of ClpB, known to act as its activator, toggles between two states much faster than the overall activity cycle of the protein, suggesting a novel mode of continuous, tunable switching. Motions of the N‐terminal domain were observed to restrict the conformational space of the M domain in the absence of a substrate protein, thereby preventing it from tilting and spuriously activating ClpB. Finally, microsecond dynamics of pore loops responsible for substrate pulling through ClpB's central channel, together with their response to specific perturbations, point to a Brownian‐ratchet mechanism for protein translocation. Based on our findings, we propose a two‐time‐scale model for the activity of ClpB, in which fast conformational dynamics affect slower functional steps, determined by ATP hydrolysis time. Future work on this and other proteins is likely to shed further light on the role of ultrafast dynamics on protein function. [ABSTRACT FROM AUTHOR]

Ionizable lipid‐based nanoparticles (LNPs) are the most advanced non‐viral drug delivery systems for RNA therapeutics and vaccines. However, cell type‐specific, extrahepatic mRNA delivery is still a major hurdle, hampering the development of novel therapeutic modalities. Herein, a novel ionizable lipid library is synthesized by modifying hydrophobic tail chains and linkers. Combined with other helper lipids and utilizing a microfluidic mixing approach, stable LNPs are formed. Using Luciferase‐mRNA, mCherry mRNA, and Cre mRNA together with a TdTomato animal model, superior lipids forming LNPs for potent cell‐type specific mRNA delivery are identified. In vitro assays concluded that combining branched ester tail chains with hydroxylamine linker negatively affects mRNA delivery efficiency. In vivo studies identify Lipid 23 as a liver‐trophic, superior mRNA delivery lipid and Lipid 16 as a potent cell type‐specific ionizable lipid for the CD11bhi macrophage population without an additional targeting moiety. Finally, in vivo mRNA delivery efficiency and toxicity of these LNPs are compared with SM‐102‐based LNP (Moderna's LNP formulation) and are shown to be cell‐specific compared to SM‐102‐based LNPs. Overall, this study suggests that a structural combination of tail and linker can drive a novel functionality of LNPs in vivo. [ABSTRACT FROM AUTHOR]

Background: One‐third of psoriasis cases occur in the pediatric population. Pediatric psoriasis has a negative long‐term impact on the quality of life of children and their families. However, data regarding the impact of pediatric psoriasis on parental sleep quality are scarce. Objectives: This study examined the effects of pediatric psoriasis on the quality of parents' sleep compared to parents of healthy, non‐psoriatic children. Methods: A cross‐sectional questionnaire study was conducted from September 2020 to November 2021, using the validated Pittsburgh Sleep Quality Index (PSQI). The study population included parents of patients aged 2–18 years diagnosed with psoriasis and parents of healthy children of the same gender and ethnicity. We further compared sleep quality between parents of children with mild and moderate‐to‐severe psoriasis, and fathers to mothers. Results: A total of 301 parents were enrolled; 151 parents of 83 children diagnosed with psoriasis and 150 parents of 124 healthy controls. Parents of children with psoriasis had significantly longer sleep latency (p = 0.031), worse subjective sleep quality (p = 0.043), and greater use of sleep medications (p < 0.001). The comparison between parents of moderate–severe with mild psoriatic children as well as mothers with fathers showed no statistical significance. Conclusion: Poor sleep quality was demonstrated among parents of children diagnosed with psoriasis compared to parents of healthy children. This finding is crucial for the direction of treatment efforts regarding parental well‐being and functioning. [ABSTRACT FROM AUTHOR]

Chimeric antigen receptor T‐cells (CAR‐T) are widely used for the treatment of relapsed/refractory diffuse large B cell lymphoma (DLBCL). The data for CAR‐T cell therapy in patients with extra‐nodal (EN) lymphoma is restricted. We included 126 consecutive patients with DLBCL treated with commercially available CAR‐T cells (tisagenlecleucel, n = 100, 79.4% and axicabtagene ciloleucel, n = 26, 20.6%). At lymphodepletion, 72 of 126 (57%) patients had EN disease, 42 of 126 (33%) patients had nodal disease (ND)‐only and 12 of 126 (10%) showed no disease assessed by PET‐CT. There were no significant differences in CAR‐T related toxicities and in the median Progression free survival (PFS) between EN patients and ND (10.76 [95% CI: 7.8–13.6] vs. 14.1 [95% CI: 10–18.1] months, p =.126). Similarly, median overall survival (OS) was not significantly different (15.36 [95% CI 12.5–18.2] vs. 18.4 [95% CI 14.8–22.1] months, p =.100). Subgroup analysis according to the number of EN involved sites showed that median PFS and OS were significantly higher in patients with <3 EN sites (12.3 months [95% CI 9–15.5] vs. 4.28 months [95% CI 0.6–7.9], p =.010) compared to patients with >2 EN sites, respectively (16.5 months [95% CI 13.4–19.6] vs. 8.7 months [95% CI 4.6–12.8], p =.05). In multivariate cox regression analysis, increased number sites of EN disease and high lactate dehydrogenase (LDH) at lymphodepletion negatively impacted PFS (p =.021 and <.001, respectively), while sex, type of product administered, age and performance status did not predict PFS and OS. Of note, all the patients with involvement of gastrointestinal tract (n = 9), urinary tract (n = 9), or pharynx (n = 3) at lymphodepletion, progressed or had an early relapse. In conclusions, patients with >2 EN sites at lymphodepletion have significantly worse clinical outcomes compared to patients with <3 EN sites. Patients with specific sites of EN disease may demonstrate grim prognosis. [ABSTRACT FROM AUTHOR]

Objective: A vagal nerve stimulator (VNS) has been established as the treatment of choice for children with refractory epilepsy. The outcomes of the procedure have been well documented in adults but are less clear in children. The goal of our study was to review laryngopharyngeal (LP) function following VNS implantation in children. Study Design: Case series with chart review. Setting: Tertiary‐care children's hospital. Methods: Voice, swallowing, and sleep apnea symptoms were extracted from the charts of children who underwent VNS implantation between 2013 and 2021. A questionnaire was sent to parents of implanted children to ascertain the degree of the social and functional impact of the implant. Results: There were 69 patients, aged 2.3 to 21.4 years old, who met the inclusion criteria. LP symptoms were most common during the first year following implantation; 26 patients (37.6%) demonstrated at least 1 symptom (voice alteration, chronic cough, sleep‐disordered breathing, or dysphagia), and 15 patients required adjustments to their implant settings. The incidence of symptoms and the need to adjust VNS settings significantly dropped during years 2 to 5 and 6 to 8 (22% vs 7% and 5%, respectively, p =.0002). The mean score of the Pediatric Voice Handicap Index differed greatly from a normal control group on each subscale and the total score. Conclusion: LP dysfunction in children following VNS implantation is comparable to adults, with the most burden noticed during the first year after implantation. The presence of voice alterations did not correlate with the presence of dysphagia and sleep‐disordered breathing. Thorough evaluation, preferably by a multidisciplinary team, is required to assess LP dysfunction postoperatively. [ABSTRACT FROM AUTHOR]

Objective: To evaluate weight gain in children post‐thyroidectomy and identify predictors. Methods: Charts from patients at a tertiary health care facility who underwent total thyroidectomy from 2014 to 2020 were reviewed for Body Mass Index z‐scores (BMIz) at the time of thyroidectomy and at 1 and 2‐year post‐operation intervals. Patient demographic information, comorbidities, pre‐ and postoperative thyroid stimulating hormone, and postoperative free T4 levels were also extracted. Patients with other known endocrine abnormalities, chronic kidney disease, or without sufficient follow‐up were excluded. Results: A total of 56 patients (ages 3–17 years old) met the inclusion criteria (n = 17 Graves' disease; n = 39 presumed cancer). Over the first year, average BMIz significantly increased in patients with Graves' disease (∆BMIz = 0.45 ± 0.77, p = 0.03), Hispanic ethnicity (∆BMIz = 0.43 ± 0.68, p = 0.004), Medicaid/no insurance coverage (∆BMIz = 0.33 ± 0.74, p = 0.038), age <13 years at thyroidectomy (∆BMIz = 0.35 ± 0.68, p = 0.016), and persistent postoperative hypothyroidism (∆BMIz = 0.41 ± 0.41, p = 0.012). These changes remained significant after the second year. Age at thyroidectomy correlated negatively with ∆BMIz only after the first year (r = −0.40, p = 0.002). Regression analysis, controlling for Graves' status, persistent postoperative hypothyroidism, and insurance coverage, identified age at thyroidectomy as a significant predictor of ∆BMIz after the first year (b = −0.06, p = 0.004) and Hispanic ethnicity as a significant predictor after the second year (b = 0.60, p = 0.003). Conclusion: A small increase in BMIz post‐thyroidectomy was observed across several patient subgroups. Younger age at thyroidectomy and Hispanic ethnicity were associated with increased BMIz in the first 2 years post‐thyroidectomy. Level of Evidence: Level 4 ‐ Historically controlled cohort Laryngoscope, 133:1518–1523, 2023 [ABSTRACT FROM AUTHOR]

Objective: Solid‐organ transplantation (SOT) has become the standard of care for children with terminal organ failure. Long‐term immunosuppression has improved survival substantially but is associated with secondary malignancies and impaired wound healing. Our goal was to review the incidence, outcomes, complications, and rate of posttransplant lymphoproliferative disorder on pathologic examination following tonsillectomy/adenotonsillectomy (T/AT) in children after SOT. Study Design: A retrospective cohort study. Setting: Tertiary care children's hospital. Methods: Data were extracted from charts of children with a history of kidney, heart, or liver transplantation, who underwent T/AT between 2006 and 2021. Results: A total of 110 patients met the inclusion criteria, including 46 hearts, 41 kidneys, 19 livers, and 4 liver‐and‐kidney transplants. The mean age at transplantation was 4.2 years, and the mean transplantation‐to‐T/AT time interval was 28.8 months. The posttransplant lymphoproliferative disorder was diagnosed in 52 (47.3%) patients, and 25% of these had no tonsillar hypertrophy. There was no difference in age at transplantation, organ received, transplantation‐to‐T/AT time interval, immunosuppressive medications, tonsil size, or tonsillar asymmetry between patients diagnosed with the posttransplant lymphoproliferative disorder and patients with benign tonsillar/adenotonsillar hypertrophy. Posttonsillectomy complications were similar between the groups. Conclusion: The incidence of posttransplant lymphoproliferative disorder undergoing tonsillectomy for any indication was 47.3%. There was no association between preoperative signs and symptoms and the histopathological diagnosis of posttransplant lymphoproliferative disorder. Stratification by organ received and immunosuppressive medications did not identify differences among the groups relative to the incidence of posttransplant lymphoproliferative disorder and other postoperative complications. [ABSTRACT FROM AUTHOR]