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Atenas Bustamante,1 Barbara Beatriz Salazar Lopez,1,* Emily Marie Jones,1,* Marvee Turk,2 Maria Fernanda Tapia Arellano,1 Sonia Treminio,1 Mikyla Jade Rata,1 Chifundo Msokera,1,3,4 Hebah Daradkeh,1 Ainaz Dory Barkhordarzadeh,5 Alice Umutoni,1 Alyssa Bautista,1 Priyanka Naidu,2 Naikhoba C O Munabi,2 William P Magee III,1,2 Elizabeth A Cote,1 Kathy Magee,1 Allyn Auslander1 1Operation Smile Inc., Virginia Beach, VA, USA; 2Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA; 3Department of Clinical Medicine, University of Oxford, Oxford, England; 4Clinical Services, Ministry of Health, Lilongwe, Malawi; 5David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA*These authors contributed equally to this workCorrespondence: Allyn Auslander, Research and Innovation, Operation Smile Inc., Virginia Beach, VA, USA, Email allyn.auslander@operationsmile.orgBackground: Globally, billions of people lack access to safe surgical care. Women represent a valuable resource to tackle the healthcare workforce shortage which impedes the delivery of surgery. With women entering the global health workforce at an increasing rate, Operation Smile (OS) launched the Women in Medicine program to create women-led leadership and mentorship opportunities for women healthcare workers to empower them to become leaders in healthcare.Purpose: This multi-regional study aims to evaluate the experiences of healthcare providers on OS all-women surgical programs and the impact of participation on leadership and mentorship opportunities.Methods: In 2022, OS conducted four cleft surgical programs with all-women providers in Morocco, Peru, Malawi, and the Philippines. Providers from various specialties participating in the programs were surveyed. Participants were invited to complete the surveys anonymously in the final two days of each program. Analysis involved descriptive statistics and chi-square tests.Results: Across all programs, 215 providers from 36 countries were surveyed. Ninety-seven percent of participants reported improvement in their technical and non-technical skills. Eighty-two percent reported that the program motivated them to seek leadership positions, despite only 37% having prior leadership experience on an OS program. Participating in an all-women team motivated 96% to seek mentorship from another woman and 99% to mentor others. Overall, 98% of providers across all regions and specialties supported the importance of women leadership, and 95% endorsed women mentorship.Conclusion: Promoting gender equity is crucial to address the ongoing healthcare workforce shortage and improve access to safe surgical care. This study demonstrates the importance of mentorship between women to advance into leadership positions. Programs that provide women in healthcare with educational, mentorship, and leadership opportunities can effectively equip them with the skills needed to advance their careers and strengthen the global workforce.Keywords: gender equity, healthcare workforce, surgery, global health

Behzad Nasseri,1– 3 Mustafa Turk,4 Kemal Kosemehmetoglu,5 Murat Kaya,2 Erhan Piskin,1 Navid Rabiee,6 Thomas J Webster7 1Chemical Engineering Department, Bioengineering Division and Bioengineering Centre, Hacettepe University, Ankara 06800, Turkey; 2Chemical Engineering and Applied Chemistry Department, Atilim University, Ankara 06830, Turkey; 3Bioscience Faculty, Shahid Beheshti University, Tehran, Iran; 4Bioengineering Department, Kirikkale University, Kirikkale, Turkey; 5Department of Pathology, Hacettepe Medical Science University, Ankara, Turkey; 6Department of Chemistry, Shahid Beheshti University, Tehran, Iran; 7Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USACorrespondence: Behzad Nasseri; Thomas J Webster Email bnaseri2000@gmail.com; th.webster@neu.eduBackground: The development of highly efficient nanoparticles to convert light to heat for anti-cancer applications is quite a challenging field of research.Methods: In this study, we synthesized unique pimpled gold nanospheres (PGNSs) for plasmonic photothermal therapy (PPTT). The light-to-heat conversion capability of PGNSs and PPTT damage at the cellular level were investigated using a tissue phantom model. The ability of PGNSs to induce robust cellular damage was studied during cytotoxicity tests on colorectal adenocarcinoma (DLD-1) and fibroblast cell lines. Further, a numerical model of plasmonic (COMSOL Multiphysics) properties was used with the PPTT experimental assays.Results: A low cytotoxic effect of thiolated polyethylene glycol (SH-PEG400-SH-) was observed which improved the biocompatibility of PGNSs to maintain 89.4% cell viability during cytometry assays (in terms of fibroblast cells for 24 hrs at a concentration of 300 μg/mL). The heat generated from the nanoparticle-mediated phantom models resulted in ΔT=30°C, ΔT=23.1°C and ΔT=21°C for the PGNSs, AuNRs, and AuNPs, respectively (at a 300 μg/mL concentration and for 325 sec). For the in vitro assays of PPTT on cancer cells, the PGNS group induced a 68.78% lethality (apoptosis) on DLD-1 cells. Fluorescence microscopy results showed the destruction of cell membranes and nuclei for the PPTT group. Experiments further revealed a penetration depth of sufficient PPTT damage in a physical tumor model after hematoxylin and eosin (H&E) staining through pathological studies (at depths of 2, 3 and 4 cm). Severe structural damages were observed in the tissue model through an 808-nm laser exposed to the PGNSs.Conclusion: Collectively, such results show much promise for the use of the present PGNSs and photothermal therapy for numerous anti-cancer applications.Keywords: plasmonic, photothermal therapy, gold nanoparticles, colorectal cells, pathology

Monika Turk, Marjan Zaletel, Janja Pretnar-OblakDepartment of Vascular Neurology and Intensive Neurological Therapy, University Medical Centre Ljubljana, Ljubljana, SloveniaBackground: Ischemic leukoaraiosis (ILA) is associated with cognitive decline and aging. Its pathophysiology is believed to be ischemic in origin due to its association with cerebrovascular risk factors and similarity in location to lacunar infarctions. ILA diagnosis is still based on magnetic resonance imaging (MRI) as well as exclusion of other causes of white matter hyperintensities. So far, there are no known confirming diagnostic tests of ILA. Ultrasound studies have recently shown increased large artery stiffness, increased cerebrovascular resistance, and lower cerebral blood flow in patients with ILA. Increased arterial stiffness and decreased blood flow could have a synergistic effect, and their ratio could be a useful diagnostic index of ILA.Methods: In this post hoc analysis, we introduced new ILA indices (ILAi) that are ratios of the carotid stiffness parameters (pulse wave velocity beta [PWVβ], pressure–strain elasticity modulus [Ep], β index), and diastolic and mean blood flows in the internal carotid artery: Q-ICAd and Q-ICAm. We compared the ILAi of 52 patients with ILA and 44 sex- and risk factor-matched controls with normal MRI of the head. ILA diagnosis was based on MRI and exclusion of other causes of white matter hyperintensities. The diagnostic significance of ILAi for the prediction of ILA was analyzed.Results: All ILAi significantly differed between the groups; the most significant were PWVβ/Q-ICAd (ILA group: 1.96±0.64 vs control group: 1.56±0.40, P=0.001) and PWVβ/Q-ICAm (ILA group: 1.13±0.32 vs control group: 0.94±0.25, P=0.003). All ILAi were significantly associated with ILA (P

Background: Studies have noted high rates of specific health disorders in adults with cerebral palsy (CP). However, it remains unclear how growing older with a lifelong neuromotor physical disability confers risk for health outcomes in adults who have both intellectual disability (ID) and CP. Aim: To assess the relationship between health status in older adults with ID either with or without coincident diagnoses of CP. Method: Health status data were drawn from 1373 adults aged 33 to 79 years with ID living in small group homes in New York State. Their health status was defined by the presence of common health disorders. Of these, 177 subjects had coincident CP. Prevalence data for nine diseases representing different organ systems were obtained and compared in individuals with and without CP. A Severity of Functional Impairment Index (SFII) was developed based on subjects' capabilities in activities of daily living (ADLs) and mobility. Two logistic regression analyses were conducted to determine if CP diagnosis was an independent predictor of health disorder prevalence, or rather exerted effects similar to those without CP via severity of functional impairment as determined by SFII scores. In addition, older age, gender, and severity of intellectual disability were examined as predictors of health disorder prevalence in all study subjects. Results: Individuals with CP had higher frequencies in four out of the nine health disorders (overweight/obesity, gastroesophageal reflux, urinary tract infections and dysphagia). Analysis revealed a statistically significant association between SFII score and CP diagnosis. CP diagnosis alone was a statistically significant predictor for all of the above four common disorders; however, after adjustment for SFII score was included in health disorder models, only dysphagia showed an independent correlation with a CP diagnosis. Conclusion: With the exception of dysphagia, impairment in ADLs and walking capabilities, and not CP diagnosis alone, accounted for disparities in specific diseases. Although the diagnosis of CP may be correlated with functional impairment, it alone may play a minor role in determining health trajectories in older persons with conjoint ID and CP.

Epidemiological, clinical and laboratory data were collected during an outbreak of trichinellosis, which occurred in Izmir, Turkey, between January and March 2004. The source of the infection was raw meatballs made with a mixture of uncooked beef and pork. Of 474 persons who were admitted at the Ataturk Training and Research Hospital during this period with a history of raw meatball consumption, the diagnosis of trichinellosis was confirmed for 154 (32.5 %, 87 males and 67 females; mean age 31 years, range 6-67 years). Among persons with a confirmed diagnosis, 79 % had myalgia, 77 % weakness and malaise, 63 % arthralgia, 40 % jaw pain, 68 % fever, 63 % periorbital and/or facial oedema, 49 % oedema at the trunk and limb, 42 % abdominal pain, 40 % nausea and vomiting, 28 % diarrhoea, 23 % subconjunctival haemorrhage, 25 % macular or petechial rash, 4 % subungual haemorrhage, 15 % cardiac complaints and 0.2 % neurological complaints. Nine patients (5.8 %) were hospitalised due to severe myalgia (n = 2), high fever (n = 3), neurological manifestations (n = 1), thrombophlebitis (n = 2) and palmar erythema (n = 1). Eosinophilia was present in 88 % of the confirmed cases at the admission. Elevated levels of serum creatine phosphokinase, lactic dehydrogenase and aspartate aminotransferase were detected in 72 %, 70 % and 16 % of the confirmed cases, respectively. The seroconversion occurred in most of the infected people between the 4th and 6th weeks after the infection. All of the confirmed cases were treated with mebendazole. People with severe symptoms were treated also with prednisolone (60 mg/day for three days) and those with a moderately severe clinical pattern received a non-steroid anti-inflammatory drug (naproxen sodium, 550 mg/day). All confirmed cases recovered without any clinical sequela.

Background: Efforts aimed at preventing premature mortality for people with Down syndrome are hindered by the practice of reporting disability as the underlying cause of death. Prior research suggests this form of diagnostic overshadowing may be the result of increased uncertainty surrounding the death. Methods: This study uses bivariable analysis and multivariable logistic regression models to investigate associations between sociodemographic characteristics, comorbidities, and death context and processing characteristics with the reporting of Down syndrome as the underlying cause of death in 2005–2017 US Multiple Cause of Death data files. Results: The reporting of Down syndrome as the underlying cause of death was associated with characteristics indicative of an increased amount of uncertainty surrounding the death. Results also suggest other mechanisms may inform inaccurate reporting, such as racial bias, and the continued conflation of disability and health. Conclusions: Medical personnel certifying death certificates should strive for accuracy when reporting the causes of death. To ensure this outcome, even in the midst of increased uncertainty, Down syndrome should not be reported as the underlying cause of death unless the decedent was diagnosed with Alzheimer's disease or unspecified dementia. Future research should further explore the possibility that increased death certification errors for adults with Down syndrome, or other developmental disabilities, are associated with racial bias. [ABSTRACT FROM AUTHOR]

Background: Prior studies report that adults with intellectual disability (ID) have cause of death patterns distinct from adults in the general population but do not provide comparative analysis by specific causes of death. Methods: Data are from the National Vital Statistics System 2005–2017 US Multiple Cause‐of‐Death Mortality files. We utilised adjusted odds ratios to identify causes of death that were more common for adults whose death certificate indicated ID (N = 22 512) than for adults whose death certificate did not indicate ID (N = 32 738 229), controlling for severity level of ID. We then examine the associations between biological sex and race‐ethnicity and causes of death solely among adults with ID. Results: The leading cause of death for adults with and without ID indicated on their death certificate was heart disease. Adults with ID, regardless of the severity of the disability, had substantially higher risk of death from pneumonitis, influenza/pneumonia and choking. Adults with mild/moderate ID also had higher risk of death from diabetes mellitus. Differences in cause of death trends were associated with biological sex and race‐ethnicity. Conclusions: Efforts to reduce premature mortality for adults with ID should attend to risk factors for causes of death typical in the general population such as heart disease and cancer, but also should be cognisant of increased risk of death from choking among all adults with ID, and diabetes among adults with mild/moderate ID. Further research is needed to better understand the factors determining comparatively lower rates of death from neoplasms and demographic differences in causes of death among adults with ID. [ABSTRACT FROM AUTHOR]

Background: Although increased attention has been devoted to mortality trends for adults with developmental disability, research has not accounted for possible differences in age at death between disability types. We examine whether heterogeneity is present in age at death between adults with different types of developmental disability. Methods: Data were from the 2012–2016 U.S. Multiple Cause‐of‐Death Mortality files. Mean age at death and age at death distributions were analysed for adults, aged 18–126, with and without developmental disability collectively and then stratified by biological sex. Results: There were 33 154 decedents with and 13 026 759 without developmental disability. Compared with adults without developmental disability, age at death was lower for all decedents with developmental disability but varied markedly by disability type and biological sex. Among adults with developmental disability, those with intellectual disability had the highest age at death, and those with cerebral palsy or other rare developmental disabilities, especially if co‐morbid for a second developmental disability, had the lowest age at death. Conclusion: Research on age at death for adults with developmental disability must account for heterogeneity among disability types in order to ensure reliable estimates. Failure to do so conceals important differences between disability types, which can misguide public health and preventive care efforts to reduce premature mortality and/or provide aging‐related supports. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the post-legislation change in tributyltin (TBT) pollution at Croatian Adriatic coast. Gastropod Hexaplex trunculus and sediments were collected, nearly 10 years after TBT based antifouling paints were banned, at 12 locations along the coast where a previous study was conducted in 2005. The study showed a decline of TBT levels over the investigated period, although all gastropods populations were highly affected by imposex meaning that prohibition did not result in the recovery of populations. The further aim was to propose the Ecological Quality Ratio (EQR) boundaries for potential use of H . trunculus as a principal bioindicator in the assessment of the ecological status of the Mediterranean regarding TBT pollution, under the Water Framework Directive (WFD). According to the proposed EQR classes, the WFD target for achieving the Good ecological status of the marine environment by 2015 was not reached. [ABSTRACT FROM AUTHOR]

The cathode of theNa-NiCl2 battery discharges through a complex process of NiCl2 reduction coupled with microstructural growth of Ni particulates. The electrochemical mechanism of this process is a leading determinant of the battery's power rating and cyclability. The present work investigates this cathode discharge mechanism by employing a half-cell test system, and combining scanning electron microscopy (SEM) with cyclic voltammetry (CV) and chronoamperometry. The charge/discharge characteristics of a Ni cathode are probed in a chloro-basic melt of NaCl-saturated NaAlCl4 at 280°C. The CV and chronoamperometric data are fitted to established models of electrodeposition kinetics. From these analyses, the rate determining step of cathode discharge is identified as instantaneous nucleation and growth of electrodeposited Ni. SEM results indicate that, NaCl-decorated sites of the cycled cathode surface facilitate this nucleation mechanism. Scan rate dependent CV indicates that, the charge transfer step of the nucleation reaction involves electro-reduction of NiCl4 2-. The CV data also reveal the equilibrium concentration and the diffusion coefficient of this dissolved species of NiCl2. The oxidation of Ni to NiCl2 (cathode-charge step) under potentiostatic conditions follows a modified Cottrell equation for interfacial diffusion of Cl-. [ABSTRACT FROM AUTHOR]