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This study explores whether marital quality mediates the effects of a parenting intervention on preschoolers' conduct problems and effortful control. Using data from 209 children in a two‐wave randomized controlled trial of the Hitkashrut program, participants were assigned to either a 14‐session co‐parent training group or a minimal intervention control group. Intent‐to‐treat analysis revealed that improvements in marital quality significantly mediated the intervention's impact on both conduct problems and effortful control. An alternative model, which hypothesized that changes in child behavior would lead to improvements in marital quality, was not supported, reinforcing the importance of targeting marital dynamics to achieve better child outcomes. These findings highlight the potential of marital‐focused strategies within parenting interventions to foster healthier family environments and improve long‐term developmental trajectories in children. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness and mechanisms of "Hitkashrut", a "common elements" co-parent training (PT) program for early intervention with preschoolers (3-5 years of age) at risk for conduct problems (CP). Method: A randomized controlled trial with 140 participants in PT and 69 in a minimal intervention control group. The primary outcome (presence of CP) was assessed at pre-intervention, post-intervention, and 1-year follow-up. Callous-unemotional traits, effortful control, parental distress, negative/inconsistent parenting, and couple relationship quality were assessed at pre- and post-intervention, whereas callous-unemotional traits and effortful control were also assessed in the PT group at follow-up. Retention was 87.1% at post-intervention and 60% at follow-up. "Hitkashrut" incorporated evidence-based components of established PT programs into a culturally adapted protocol. The facilitators were trained and supervised psychologists working in Israel's Educational Psychology Services. Results: Intervention effect (Cohen's d) was large at post-intervention (ES = 0.76, p less than 0.001), and an additional medium effect was found at follow-up (ES = 0.63, p less than 0.001). Parallel post-intervention and follow-up intervention effects were also found in the degree of clinically significant improvements. Effects of the intervention on callous-unemotional traits (ES = 0.85, p less than 0.001) and effortful control (ES = 0.47, p less than 0.001) were maintained at follow-up. Follow-up improvement in CP was mediated by improvements in parental practices and distress. Conclusions: "Hitkashrut"'s implementation and subsequent dissemination in real-world settings demonstrates the potential effectiveness of common elements programs to promote innovations within service-delivery systems. Improvements in dispositional variables and the mediated follow-up effect support theoretical cascade models that emphasize early developmental malleability and the growing preventive effects of PT's facilitated parental changes on disruptive developmental trajectories. Clinical trial registration information--The effect of a "common elements" co-parent training program (called "Hitkashrut") on conduct in preschoolers at risk for conduct problems; http://www.anzctr.org.au; ACTRN12612000148875. (Contains 4 tables and 1 figure.)

Research of psychological distress (PD) needs to differentiate between anxiety/depression and hostility/suspiciousness, which are associated with different motivational systems. In this study, structural equation modeling was used to test two hypothesized models for the prediction of each facet of PD. Hypotheses were proposed about the effects of callousness and attachment insecurity, and the mediating role of adherence to honor code (AHC), with respect to each PD facet. AHC was defined by the endorsement of honor culture attitudes. The sample included 136 adolescent boys from high- and low-level Israeli schools. The results supported the differentiation between two PD models. AHC mediated the prediction of hostility/suspiciousness by callousness and attachment insecurity. Age and attachment insecurity predicted anxiety/depression. However, AHC and callousness did not predict anxiety/depression.

Although there is considerable evidence that culture-related factors are associated with aggressive behavior, their effect on the development of conduct problems (CP) has been insufficiently studied. This study focused on adherence to honor code (AHC), defined by the endorsement of honor culture attitudes at the identity narrative level of personality assessment, as a mediator in the prediction of CP by callousness, insecure attachment, and socioeconomic status. Our sample of 136 adolescent boys (M age = 15.02, SD = 1.48) oversampled high- and low-level Israeli schools, both academically and behaviorally. Structural equation modeling supported the theoretical model: AHC was a significant predictor of CP and partially mediated the prediction of CP by callousness and socioeconomic status. Insecure attachment predicted AHC but was not an independent predictor of CP. (Contains 4 tables and 1 figure.)

Abstract Previous studies have explored two scenarios wherein diaspora members fight for their ancestral homeland: (1) in response to immediate threats, and (2) when the homeland’s conscription laws mandate enlistment. This study investigates diaspora military service (DMS) in Israel, where DMS occurs voluntarily outside of acute crises or compulsory conscription requirements. Utilizing survey and interview data from over 1100 diaspora soldiers, it compares enlistment motivations across three diaspora groups with varied ties to Israel and Judaism: North Americans, Israeli Americans, and individuals from the Former Soviet Union. The study conceptualizes DMS as a state led effort to cultivate an engaged diaspora and advance Jewish immigration. This framework enables examining DMS, beyond the immediate military context, as a site for identity exploration, cultural assimilation, and contemplating permanent immigration. Despite varied emphases, results show that DMS occurs in a migratory context as soldiers from all groups recognize service as essential for immigration, integration, and acceptance in Israel. The study formulates three motivational models that drive transnational military engagement across contexts: the “ideological model” among conviction-driven actors; the “mobility model” among those focused on upward mobility; and the “reconnection model” for cementing national belonging and avoid stigma.

We develop a general theory of higher semiadditive Fourier transforms that includes both the classical discrete Fourier transform for finite abelian groups at height $n=0$ , as well as a certain duality for the $E_n$ -(co)homology of $\pi $ -finite spectra, established by Hopkins and Lurie, at heights $n\ge 1$ . We use this theory to generalize said duality in three different directions. First, we extend it from $\mathbb {Z}$ -module spectra to all (suitably finite) spectra and use it to compute the discrepancy spectrum of $E_n$ . Second, we lift it to the telescopic setting by replacing $E_n$ with $T(n)$ -local higher cyclotomic extensions, from which we deduce various results on affineness, Eilenberg–Moore formulas and Galois extensions in the telescopic setting. Third, we categorify their result into an equivalence of two symmetric monoidal $\infty $ -categories of local systems of $K(n)$ -local $E_n$ -modules [-12pc] and relate it to (semiadditive) redshift phenomena. The Great Wave off Kanagawa, Katsushika Hokusai.

BackgroundPediatricians daily see large numbers of patients with skin disorders. However, they encounter limited guidance as a result of a marked deficiency in pediatric dermatologists. Hence, reevaluation of training opportunities during pediatric residency has become essential. Our aim was to evaluate the confidence level of pediatric residents and specialists in diagnosing and treating skin disorders in children and to determine career and training-related characteristics that influence it.MethodsConducted as a cross-sectional study, we administered a questionnaire to 171 pediatricians across Israel. We assessed respondents’ self-efficacy about their ability to diagnose and treat skin disorders and collected data regarding their previous dermatology training and preferred training methods.Results77.8% of respondents reported below or average self-efficacy scores in diagnosing and managing children with skin disorders. Older age (>40 years old; OR = 5.51, p = 0.019), treating a higher number of patients with skin disorders (OR = 2.96, p = 0.032), and having any training in dermatology, either during medical school or residency (OR = 7.16, p = 0.031, OR = 11.14, p = 0.003 respectively), were all significant parameters involved in pediatricians reporting high self-efficacy in skin disorder management.ConclusionMost pediatric residents and pediatricians have average or below-average confidence in managing pediatric skin disorders. We suggest incorporating dermatology rotations during pediatric residency to improve young pediatricians’ self-efficacy in managing skin disorders and ultimately help pediatricians provide better care for patients presenting with dermatological conditions. These findings can ultimately help refine a pilot program in dermatology that might be implemented during pediatric residency.

Introduction: To evaluate the effectiveness of paracetamol and ibuprofen as non-opioid treatments for postpartum pain control after vaginal delivery., Materials and Methods: This randomized controlled study at a university-affiliated medical center involved parturient who received blindly oral tablets of either 1000 mg of paracetamol or 400 mg of ibuprofen, post-vaginal birth. Pain levels were assessed using a numeric rating scale (NRS) at four time points: before treatment, and 1, 4, and 6 h post-treatment (T0, T1, T4, and T6, respectively). We also compared the need for additional analgesia, breastfeeding initiation, mobilization, and urination following the delivery between the groups. To ensure statistical power, the study was designed to detect differences of one point on the NRS with at least 37 women per group., Results: A total of 107 women participated, including paracetamol (n = 52) and ibuprofen (n = 55) groups. Demographics and perinatal outcomes were similar across groups. No significant differences were found in the interval between delivery and request for pain control (8 ± 6-10.5 and 11 ± 6-16 h for the paracetamol and the ibuprofen, respectively, P = .13). Pain levels on the NRS were similar for both groups at all intervals. There were also no group differences in the time to the initiation of breastfeeding, mobilization, urination, or the need for additional analgesia., Conclusion: Both, paracetamol and ibuprofen, can be considered equivalent and effective non-opioid alternatives for postpartum pain control. REGISTRY AT CLINICALTRIALS.GOV: (NCT04653506), https://register., Clinicaltrials: gov/prs/beta/studies/S000AFOR00000066/recordSummary ., (© 2024. The Author(s).)

Objective: To identify the key risk factors contributing to re-hospitalization after term cesarean delivery (CD)., Methods: This retrospective cohort study included women who underwent CD at term at a university-affiliated tertiary medical center (January 2021 to March 2023). The primary outcome was risk factors for re-hospitalization within 30 days post-discharge. Data on selected maternal demographic, pregnancy-related and delivery variables were extracted from electronic medical records. A multivariable logistic regression analysis was conducted to identify independent risk factors for re-hospitalization. Logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for various independent risk factors., Results: A total of 2878 women were included in the study, of whom 76 required re-hospitalization (2.6%). The rates of high-risk pregnancies were more prevalent among those who were re-hospitalized (41 [62.1%] vs. 1148 [49.1%], P = 0.043). Furthermore, the rates of emergency CDs (42 [56%] vs. 1040 [37.8%], P = 0.001), prolonged surgery duration (17 [22.4%] vs. 292 [10.4%], P = 0.001) and hospitalization duration (14 (18.4%) vs. 273 (9.7%), P = 0.015) were significantly higher in the re-hospitalized group. Emergency CD (OR 1.90, 95% CI 1.06-3.42, P = 0.030) and prolonged surgery duration (OR 2.44, 95% CI 1.25-4.77, P = 0.016) remained significant risk factors of re-hospitalization in the multivariate analysis., Conclusions: The need for emergency CD and prolonged surgery duration were found as independent risk factors for re-hospitalization after CD at term., (© 2024 International Federation of Gynecology and Obstetrics.)

This retrospective study describes the surgical outcomes of our first 20 transgender women to undergo feminization thyroid laryngochondroplasty (FLC) by a direct transvestibular FLC (DTV-FLC) approach from December 2019 to October 2023. The medical records of all patients were retrieved and reviewed. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic outcomes were retrieved. The cosmetic results were evaluated by four independent facial plastic surgeons. Thirteen patients underwent DTV-FLC combined with genioplasty or genioplasty with mandibular angle reduction and seven underwent isolated DTV-FLC. DTV-FLC was feasible in all planned cases. Complications (skin flap perforation, thyroid cartilage fracture, mental hypoesthesia, hematoma, dehiscence of the vestibular incision, vestibular scar adhesions, and anemia) were minor and resolved spontaneously. The preoperative grade of thyroid cartilage protrusion was 1.9 ± 0.9 on a scale from 1 to 3. The postoperative cosmetic results of 18 patients were judged as having improved (a score of 2.1 ± 0.8 on a scale from -1 to 3). Eighteen patients were satisfied with the cosmetic result, one was dissatisfied (the revision surgery patient), and one was lost to follow-up. In conclusion, DTV-FTLC is a valid surgical approach for FLC, yielding high patient satisfaction and good cosmetic results., Competing Interests: Declaration of competing interest There are no conflicts of interest to disclose. The authors have no funding, financial relationships, or conflicts of interest to disclose. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study aims to examine the association between voice experience and levels of depression, anxiety, and stage of gender affirmation in transgender women., Study Design: A cross-sectional study., Methods: Adult transgender women attending a tertiary referral center were recruited between April 2022 and January 2023. They filled in a demographic and health survey, the Hebrew Trans Woman Voice Questionnaire (H-TWVQ), the Hebrew Patient Health Questionnaire, and the Hebrew version of the Generalized Anxiety Disorder Screener. Descriptive statistics and data regarding the associations between voice experience, grades of anxiety and depression, and stage of gender affirmation were compiled., Results: Sixty-seven transgender women were included (mean age 26.7 ± 7.78 years, mean time of presenting socially as a woman 5.2 ± 5.2 years). The median H-TWVQ score was 71 (maximal score 120). Most participants reported mild anxiety and mild depression levels. Those who reported a more positive voice experience (H-TWVQ score ≤71) had lower median depression and anxiety scores than participants with a less-positive voice experience (H-TWVQ score >71) (P = 0.028 vs P = 0.044, respectively), complained less of hoarseness (2.9% vs 19.4%, P = 0.045,) and more were employed (78.8% vs 41.9%, P = 0.003). No association was found between voice experience and cross-sex hormone treatment, affirmation surgery undertaken, or number of years presenting socially as a woman., Conclusions: We observed a potential association between better voice experience and lower anxiety and depression levels among transgender women. No association was found between voice experience and the stage of gender affirmation. Physicians treating this population should be aware of these associations and consider therapeutic means for voice adjustment., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

This study explores whether marital quality mediates the effects of a parenting intervention on preschoolers' conduct problems and effortful control. Using data from 209 children in a two-wave randomized controlled trial of the Hitkashrut program, participants were assigned to either a 14-session co-parent training group or a minimal intervention control group. Intent-to-treat analysis revealed that improvements in marital quality significantly mediated the intervention's impact on both conduct problems and effortful control. An alternative model, which hypothesized that changes in child behavior would lead to improvements in marital quality, was not supported, reinforcing the importance of targeting marital dynamics to achieve better child outcomes. These findings highlight the potential of marital-focused strategies within parenting interventions to foster healthier family environments and improve long-term developmental trajectories in children., (© 2024 American Association for Marriage and Family Therapy.)

Background: Spinal Muscular Atrophy (SMA) is manifested by deformation of the chest wall, including a bell-shaped chest. We determined the ability of a novel non-ionizing, non-volitional method to measure and quantify bell-shaped chests in SMA., Methods: A 3D depth camera and a chest x-ray (CXR) were used to capture chest images in 14 SMA patients and 28 controls. Both methods measure the distance between two points, but measurements performed by 3D analysis allow for the consideration of the curve of a surface (geodesic measurements), whereas the CXR allows solely for the determination of the shortest path between two points, with no regard for the surface (Euclidean measurements). The ratio of the upper to lower chest distances was quantified to distinguish chest shape in imaging by both the 3D depth camera and the CXR, and the ratios were compared between healthy and SMA patients., Results: The mean 3D Euclidean ratio of distances measured by 3D imaging was 1.00 in the control group and 0.92 in the SMA group ( p  = 0.01), the latter indicative of a bell-shaped chest. This result repeated itself in the ratio of geodesic measurements (0.99 vs. 0.89, respectively, p  = 0.03)., Conclusion: The herein-described novel, noninvasive 3D method for measuring the upper and lower chest distances was shown to distinguish the bell-shaped chest configuration in patients with SMA from the chests of controls. This method bears several advantages over CXR and may be readily applicable in clinical settings that manage children with SMA., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Amirav, Rabin, Levi, Har-Even Cohn, Lior, Shiran, Sagi, Fatal, Zvirin, Honen, Lavie and Kimmel.)

Background: Feminization laryngochondroplasty (FLC) methods have evolved from using a midcervical incision to a submental, less visible incision. The scar may be unacceptable to the patient because it signals gender reassignment surgery. An endoscopic transoral approach to FLC inspired by transoral endoscopic thyroidectomy was recently suggested to avoid the neck scar; however, it requires special equipment and has a long learning curve. A vestibular incision is used to approach the chin in lower-third facial feminization surgery. The authors propose that this incision may be extended to the thyroid cartilage in performing direct FLCs. The authors describe their experience with a novel, minimally invasive, direct transvestibular use of the chin-reshaping incision., Methods: The medical records of all patients who underwent direct transvestibular FLC (DTV-FLC) from December of 2019 to September of 2021 were retrieved and reviewed for this retrospective cohort study. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic results were retrieved., Results: Nine transgender women were included. Seven DTV-FLCs were performed during lower-third facial feminization surgery, and two were isolated DTV-FLCs. One was a revision DTV-FLC. Transient minor complications were encountered and resolved by the postoperative visit at 1 to 2 months. Vocal fold function and voice quality remained intact. Eight available patients were satisfied with the surgical results. A blinded assessment by eight plastic surgeons determined that seven procedures were successful., Conclusion: The novel DTV-FTLC approach either in isolation or as part of lower-third facial feminization surgery facilitated scar-free FLC with satisfactory cosmetic and functional results., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2023 by the American Society of Plastic Surgeons.)

α1-Antitrypsin (AAT), an acute-phase reactant not unsimilar to C-reactive protein (CRP), is a serine protease inhibitor that harbors tissue-protective and immunomodulatory attributes. Its concentrations appropriately increase during conditions of extensive tissue injury, and it induces immune tolerance, in part, by inhibiting the enzymatic activity of the inflammatory serine protease, proteinase 3 (PR3). Typically administered to patients with genetic AAT deficiency, AAT treatment was recently shown to improve outcomes in patients with steroid-refractory graft-versus-host disease (GVHD). GVHD represents a grave outcome of allogeneic hematopoietic stem cell transplantation (HSCT), a potentially curative intervention for hematological diseases. The procedure requires radio/chemotherapy conditioning of the prospective marrow recipient, a cytotoxic process that causes vast tissue injury and, in some formats, interferes with liver production of AAT. To date, changes in the functional profile of AAT during allogeneic HSCT, and during the cytotoxic intervention that precedes HSCT, are unknown. The present study followed 53 patients scheduled for allogeneic HSCT (trial registration NCT03188601). Serum samples were tested before and after HSCT for AAT and CRP levels and for intrinsic anti-proteolytic activity. The ex vivo response to clinical-grade AAT was tested on circulating patient leukocytes and on a human epithelial cell line treated with patient sera in a gap closure assay. According to the ex vivo experiments, circulating leukocytes responded to AAT with a favorable immune-regulated profile, and epithelial gap closure was enhanced by AAT in sera from GVHD-free patients but not in sera from patients who developed GVHD. According to serum collected prior to HSCT, non-relapse mortality was reliably predicted by combining three components: AAT and CRP levels and serum anti-proteolytic activity. Taken together, HSCT outcomes are significantly affected by the anti-proteolytic function of circulating AAT, supporting early AAT augmentation therapy for allogeneic HSCT patients.

While many military positions are characterized by rigorous routines and long-hour shifts, some positions also require the practice of sensitivity and empathy alongside diligence and attention. Prolonged exposure to such conditions may promote emotional exhaustion, depersonalization and diminished self-accomplishment perception, all part of work-related burnout which may affect soldiers' ability to practice their duty. The service in the Israel Defense Forces (IDF) checkpoint unit is an example of such conditions due to the soldiers' constant interaction with civilian population. In this questionnaire-based cross-sectional study which included 404 responders from the IDF checkpoint battalions, we examined the effects of demographical, situational and personal variables on soldiers' burnout. A hierarchical multivariate linear regression (R2 = 0.47) identified sense of coherence, the core concept in the salutogenic model of health, as the most prominent protective factor, followed by service motivation and perceived well-being (WB). Taken together, the results revealed several factors associated with military work-related burnout. These findings can serve as a base for burnout prevention programs, which may potentially improve not only the soldiers' WB but also the interfaces between military and civilian populations., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: The purpose of this study is to evaluate the effectiveness of changing the teaching method in the radiology course at a medical school from lecture-based learning to clinically case-based learning using interactive methods, with the aim to improve undergraduate radiology education and students' diagnostic abilities., Methods: During the 2018-2019 academic year, we compared the achievements of medical students in the radiology course. Teaching in the first year was primarily conducted through conventional lectures (traditional course; TC), while in the following year, a case-based teaching approach along with an interactive web application called "Nearpod" (clinically-oriented course; COC) was employed to motivate student participation. The student knowledge assessments were composed of identical post-test questions, which included five images of common diagnoses. The results were compared using Pearson's Chi-Square test or Fisher Exact Test., Results: There were 72 students who answered the post-test in the first year and 55 students responded in the second year. Post-test student achievements following the methodological changes were significantly higher as compared with the control group in the total grade (65.1 ± 21.5 vs. 40.8 ± 19.1, p < 0.001). An improvement in the identification rates of all assessed cases was noticed, with the most prominent improvement in pneumothorax recognition (4.2% vs. 61.8%, p < 0.001)., Conclusion: Teaching radiology using clinical case-based teaching methods combined with web-based interactive applications like Nearpod results in significant improvements in identifying key imaging pathologies when compared to traditional teaching methods. This approach has the potential to enhance radiology learning and better prepare students for their future roles as clinicians., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: While commonly thought to be effective for management of limb and junctional hemorrhage, the manual pressure points technique was excluded from leading prehospital guidelines over a decade ago following the publication of a single human-volunteers study presenting unfavorable results. This work aimed to re-assess the efficacy and feasibility of the femoral and supraclavicular pressure points technique for temporary hemorrhage control distal to the pressure point., Methods: A prospective, non-randomized, human volunteer, controlled environment study. In the study 35 healthy male combat medics (age 21.1 ± 1.3 years) received brief training after which they were requested to apply pressure in the femoral and supraclavicular points in attempts to stop regional blood flow, measured distally by Doppler ultrasound. Success rates in achieving flow cessation in under 2 minutes, time required for achievement of flow cessation, and cumulative flow cessation duration within a 3-minute follow-up after initial success were measured., Results: For the supraclavicular point, success rates were 97.1% with a mean time to success of 12.5 (±20.9) seconds, lasting for 76.2% (±23.7) of the follow-up time. For the femoral point, success rates were 100% with a mean time to success of 5.5 (±4.3) seconds, lasting for 98.7% (±3.8) of the follow-up time., Conclusions: Manual pressure on the femoral and supraclavicular points is an applicable and efficient method for temporary hemorrhage control distal to the pressure point. As such, with additional study, this method may be considered for re-introduction to prehospital care guidelines and training programs.

Epidural analgesia is effective and an accepted treatment for postoperative pain. Urinary retention is a known complication, but its description is mostly in the adult literature. Management of urinary catheter (UC) placement and removal is an important consideration in children receiving epidural analgesia. This is a single-center, retrospective observational study which examined UC management in children undergoing lower extremity orthopedic surgery under general anesthesia with or without epidural analgesia from January 2019−June 2021. Of 239 children included, epidural analgesia was used in 57 (23.8%). They were significantly younger and had more co-morbidities. In total, 75 UCs were placed in the OR, 9 in the ward, and 7 re-inserted. UC placement in the epidural group was more common (93% vs. 17%, p < 0.001) and remained longer (3 days vs. 1 day, p = 0.01). Among children without intra-operative UC, ward placement was more common in the epidural cohort (60% vs. 1.6%, p = 0.007). OR UC placement and ward re-insertion were more common in children with neuromuscular disease (61% vs. 22%, p < 0.001), (17% vs. 3%, p = 0.001), respectively. Based on these findings, we hypothesize that it is justifiable to routinely place a UC intra-operatively in children who undergo hip or lower extremity surgery and are treated with epidural analgesia, and caution is advised before early UC removal in orthopedic children with NMD.

Objective: To assess the feasibility of Fractional exhaled Nitric Oxide (FeNO) as a simple, non-invasive, cost-effective and portable biomarker and decision support tool for risk stratification of COVID-19 patients., Methods: We conducted a single-center prospective cohort study of COVID-19 patients whose FeNO levels were measured upon ward admission by the Vivatmo-me handheld device. Demographics, COVID-19 symptoms, and relevant hospitalization details were retrieved from the hospital databases. The patients were divided into those discharged to recover at home and those who died during hospitalization or required admission to an intensive care unit, internal medicine ward, or dedicated facility (severe outcomes group)., Results: Fifty-six patients were enrolled. The only significant demographic difference between the severe outcomes patients (n = 14) and the home discharge patients (n = 42) was age (64.21 ± 13.97 vs. 53.98 ± 15.57 years, respectively, P = .04). The admission FeNO measurement was significantly lower in the former group compared with the latter group (15.86 ± 14.74 vs. 25.77 ± 13.79, parts per billion [PPB], respectively, P = .008). Time to severe outcome among patients with FeNO measurements ≤11.8 PPB was significantly shorter compared with patients whose FeNO measured >11.8 PPB (19.25 ± 2.96 vs. 24.41 ± 1.09 days, respectively, 95% confidence interval [CI] 1.06 to 4.25). An admission FeNO ≤11.8 PPB was a significant risk factor for severe outcomes (odds ratio = 12.8, 95% CI: 2.78 to 58.88, P = .001), with a receiver operating characteristics curve of 0.752., Conclusions: FeNO measurements by the Vivatmo-me handheld device can serve as a biomarker and COVID-19 support tool for medical teams. These easy-to-use, portable, and noninvasive devices may serve as valuable ED bedside tools during a pandemic., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Wound healing requires a non-compromising combination of inflammatory and anti-inflammatory processes. Human α1-antitrypsin (hAAT), a circulating glycoprotein that rises during acute-phase responses and during healthy pregnancies, is tissue-protective and tolerance-inducing; although anti-inflammatory, hAAT enhances revascularization. hAAT blocks tissue-degrading enzymes, including neutrophil elastase; it is, therefore, unclear how wound healing might improve under hAAT-rich conditions. Here, wound healing was examined in the presence of recombinant hAAT (hAAT WT ) and protease-inhibition-lacking hAAT (hAAT CP ). The impact of both hAAT forms was determined by an epithelial cell gap closure assay, and by excisional skin injuries via a microemulsion optimized for open wounds. Neutrophilic infiltration was examined after 8 h. According to results, both hAAT forms accelerated epithelial gap closure and excisional wound closure, particularly at early time points. Unlike dexamethasone-treated wounds, both resulted in closed borders at the 8-h time point. In untreated and hAAT CP -treated wounds, leukocytic infiltrates were widespread, in hAAT WT -treated wounds compartmentalized and in dexamethasone-treated wounds, scarce. Both hAAT forms decreased interleukin-1β and increased VEGF gene expression. In conclusion hAAT improves epithelial cell migration and outcomes of in vivo wounds irrespective of protease inhibition. While both forms of hAAT allow neutrophils to infiltrate, only native hAAT created discrete neutrophilic tissue clusters.

Objectives: To investigate whether the three nationwide coronavirus disease 2019 (COVID-19) lockdowns imposed in Israel during the full first pandemic year altered the traditional seasonality of pediatric respiratory healthcare utilization., Methods: Month by month pediatric emergency department (ED) visits and hospitalizations for respiratory diagnoses during the first full COVID-19 year were compared to those recorded for the six consecutive years preceding the pandemic. Data were collected from the patients' electronic files by utilizing a data extraction platform (MDClone © )., Results: A significant decline of 40% in respiratory ED visits and 54%-73% in respiratory hospitalizations during the first COVID-19 year compared with the pre-COVID-19 years were observed (p < 0.001 and p < 0.001, respectively). The rate of respiratory ED visits out of the total monthly visits, mostly for asthma, peaked during June 2020, compared with proceeding years (109 [5.9%] versus 88 [3.9%] visits; p < 0.001). This peak occurred 2 weeks after the lifting of the first lockdown, resembling the "back-to-school asthma" phenomenon of September., Conclusions: This study demonstrates important changes in the seasonality of pediatric respiratory illnesses during the first COVID-19 year, including a new "back-from-lockdown" asthma peak. These dramatic changes along with the recent resurgence of respiratory diseases may indicate the beginnings of altered seasonality in pediatric pulmonary pathologies as collateral damage of the pandemic., (© 2022 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Human α1-antitrypsin (hAAT) has two distinguishing functions: anti-protease activity and regulation of the immune system. In the present study we hypothesized that those two protein functions are mediated by different structural domains on the hAAT surface. Indeed, such biologically active immunoregulatory sites (not associated with canonical anti-protease activity) on the surface of hAAT were identified by in silico methods. Several peptides were derived from those immunoregulatory sites. Four peptides exhibited impressive biological effects in pharmacological concentration ranges. Peptidomimetic (14) was developed, based on the structure of the most druggable and active peptide. The compound exhibited a potent anti-inflammatory activity in vitro and in vivo. Such a compound could be used as a basis for developing novel anti-inflammatory drug candidates and as a research tool for better understanding hAAT functions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days ( p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient's age.

Primarily known as an elastase inhibitor, human alpha1-antitrypsin also exerts anti-inflammatory and immunomodulatory effects, both in vitro and in vivo. While the anti-protease mechanism of alpha1-antitrypsin is attributed to a particular protein domain coined the reactive center loop, anti-inflammatory and immunomodulatory loci within the molecule remain to be identified. In the present study, directed evolution and back-to-consensus algorithms were applied to human alpha1-antitrypsin. Six unique functional candidate sites were identified on the surface of the molecule; in manipulating these sites by point mutations, a recombinant mutant form of alpha1-antitrypsin was produced, depicting a requirement for sites outside the reactive center loop as essential for protease inhibition, and displaying enhanced anti-inflammatory activities. Taken together, outcomes of the present study establish a potential use for directed evolution in advancing our understanding of site-specific protein functions, offering a platform for development of context- and disease-specific alpha1-antitrypsin-based therapeutics., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Pelvic floor dysfunction (PFD) symptoms are prevalent during pregnancy and are mostly reversible thereafter. The pelvic floor muscles and their surrounding connective tissue support are estrogen-responsive. Breastfeeding is a condition of estrogen deficiency. We hypothesized that in breastfeeding women there may be a slower spontaneous recovery of PFD symptoms following birth. We aimed to determine the impact of breastfeeding on recovery from gestational PFD symptoms., Methods: We conducted a prospective cohort study of women who gave birth at the Soroka University Medical Center, Beer-Sheva, Israel. Those who have consented completed the Pelvic Floor Distress Inventory-20 (PFDI-20), after delivery and three months postpartum. Breastfeeding status was evaluated three months after delivery. Clinical and obstetrical characteristics were retrieved from the participants' medical records., Results: A total of 119 women had completed the PFDI-20 after delivery and three months postpartum. We found a significant difference between PFD during pregnancy, and PFD three months postpartum (P < 0.001). The overall PFDI-20 score was significantly decreased from a scale score of 64 to 27 (delta 36, P < 0.001), and this decrease remained significant for all components of the PFDI-20: pelvic organ prolapse distress (delta 14, P < 0.001); colorectal and anal dysfunction (delta 3.9, P = 0.01); and urinary dysfunction (delta 18, P < 0.001). No significant differences were noted in the extent of recovery of PFD symptoms between women who did and did not breastfeed (P = 0.59)., Conclusions: There is a clinical and statistically significant spontaneous recovery from gestational PFD symptoms at three months postpartum. Women with PFD symptoms prior to or during pregnancy can be reassured that breastfeeding probably does not delay the pelvic floor recovery., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest, (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: PRECICE intramedullary magnetic lengthening nails, introduced in 2011, have changed the landscape of long bone limb lengthening. The implants have a stroke ranging from 5 to 8 cm, but it may be desirable to perform part of the lengthening at one treatment, allow bone healing, leave the implant in place, dormant, and then return one or more years later to re-lengthen with the same implant. We call this the "sleeper" nail concept. This strategy may be gentler for the joints and soft tissues. Would the nail mechanism still be functional one or more years later?, Methods: We tested 102 intact, consecutively explanted nails. Using a "fast magnet," the male part was lengthened to 5 mm short of its maximum stroke capacity and retracted back to 35 mm (all nails start with the male part exposed 30 mm). The nails passed the test if the male part succeeded in lengthening to 5 mm short of the maximum stroke capacity and back to 35 mm (or only retract in case fully deployed at testing). During our testing, the nails were prevented from reaching their full capacity of lengthening/retraction to avoid jamming the gears. Failure was defined as the inability or partial ability to complete the process., Results: Eighty-six nails (84.3%) performed successfully according to our testing standard. When comparing successful and failed nails in terms of nail type, generation, diameter, length and in vivo interval, there was no statistical significance. Comparing both groups in terms of status at testing (fully deployed or not) showed statistical significance with 9 of the 16 failed nails fully deployed at testing (p < 0.001)., Conclusion: Dormant PRECICE nails can be reactivated for further lengthening. The results imply that full deployment may damage the mechanism, making future re-use by retracting and then re-lengthening unsuccessful. The candidate nails for this purpose should not have any signs of clear damage (bending or breakage) and should not have been fully deployed. However, surgeons and patients should be aware of the need for possible nail exchange if the "sleeper" nail fails to wake up., Level of Evidence: Level IV case series analysis of retrieved surgical implants., Competing Interests: HHE and HMA declare that they have no conflicts of interest. JEH is a consultant for NuVasive Specialized Orthopedics., (© 2020 Delhi Orthopedic Association. All rights reserved.)

Background: After decades of constant increase in HIV diagnoses among men who have sex with men (MSM), a gradual decrease has been reported in recent years. Timely detection of HIV leads to early treatment and behavioral changes which decrease further transmissions. This cross-sectional study aimed to assess demographic and behavioral characteristics of individuals who were tested for HIV in Jerusalem, Israel., Methods: This study compared individuals who were tested at Hadassah AIDS Center (HAC) with those tested at the Jerusalem Open House (JOH) - an LGBTQ community center. Participants completed anonymous questionnaires regarding their demographic, HIV-testing history, and sexual behaviors. High-risk sexual behavior (HRSB) was defined as a diagnosis of sexually transmitted disease or condomless anal/vaginal sex during the last year., Results: Among 863 participants, 104 (12.1%) were tested in HAC and 759 (87.9%) in JOH. Of those, 19 (18.3%) and 227 (29.9%) were HRSB, respectively. Two MSM were tested positive in JOH. JOH received more MSM, HRSB and individuals who were previously tested for HIV, while HAC received more migrants and health-care workers. HRSB-participants were more commonly younger, males, non-Jewish, with lower income, previously tested for HIV, reported more sexual partners, payed for sex or used drugs., Conclusions: MSM and HRSB-individuals were more likely to be tested in JOH, while migrants and health-care workers in HAC, possibly due to the geographic location, reputation and specific atmosphere. In order to encourage HIV-tests among HRSB and non-Jews, additional interventions should be employed, including outreach activities, extending opening hours and reducing testing costs should be employed.

Background: Imperforated hymen is a rare condition usually diagnosed at puberty due to amenorrhea accompanied by cyclic pelvic pain and sometimes other significant complications such as hematometra, endometriosis, and infertility. The accepted surgical treatment for imperforate hymen and some other hymenal malformation is hymenectomy. However, given low incidence rates, long-term obstetrical and gynecological outcomes in post-hymenectomy women remain poorly understood. Objective: To investigate long-term obstetrical and gynecological outcomes in nulliparous women who underwent a hymenectomy. Study design: Retrospective study comparing gynecological and perinatal outcomes of nulliparous women with and without hymenectomy, who delivered between the years 1988 and 2015 at the Soroka University Medical Center. Univariate analysis was performed as accepted with multivariate logistic regression model used to assess long-term effects of hymenectomy. Results: During the study period, 56 of 74,598 nulliparous women who delivered at the Soroka University Medical Center had previously undergone a hymenectomy. In a univariate analysis, cesarean deliveries were significantly more prevalent among women who had undergone a hymenectomy (30.4 versus 17.6% p  = .01) as were infertility treatments (10.7 versus 4.4% p  = .04) and dyspareunia (42.9 versus 0.2% p <.001). In a multivariate logistic regression model hymenectomy was found to be an independent risk factor for significant obstetrical and gynecological outcomes defined as one or more of the following: caesarean deliveries, cervical laceration, vaginal laceration, perineal laceration, preterm delivery, cervical incompetence, endometriosis, infertility, and dyspareunia (OR 2.5, 95% CI 1.26-4.93; p  = .001). Conclusions: Hymenectomy is associated with significant long-term obstetrical and gynecological complications. Informing medical teams of these risks might promote early detection and minimize associated complications such as laceration-associated blood loss and preterm delivery.

Background: Predicting the mortality risk of patients un-dergoing hemodialysis (HD) is challenging. Cell-free DNA (cfDNA) is released into circulation from dying cells, and its elevation is predictive of unfavorable outcome. In a pilot study, we found post-HD cfDNA level to be a predictor of all-cause mortality. Thus, the aim of this study was to confirm the prognostic power of cfDNA in a larger prospective cohort study conducted at 2 medical centers., Methods: CfDNA levels were measured by a rapid fluorometric assay on sera obtained before and after 1 HD session. One hundred fifty-three patients were followed up to 46 months for mortality during which time 47 patients died. We compared the predictive value of cfDNA to age, comorbidities, and standard blood tests., Results: Examining standard blood tests, only post-HD cfDNA levels were elevated in the non-survivor group compared to survivors (959 vs. 803 ng/mL, p = 0.04). Pre- and post-HD cfDNA levels correlated with age and diabetes. Patients with elevated cfDNA (>850 ng/mL) showed lower survival than those with normal levels. A Cox proportional hazard regression model demonstrated a significant hazard ratio of 1.92 for post-HD cfDNA levels. Logistic regression models showed that post-HD cfDNA was a significant predictor of mortality at 1-3 years with odd ratios of 4.61, 4.36, and 6.22, respectively., Conclusions: Post-HD cfDNA level was superior to standard blood tests and could serve as a biomarker to assist in decision-making for HD-treated patients., (© 2020 S. Karger AG, Basel.)

Purpose: To determine the effect of the hormones estrogen and progesterone on the biomechanical properties of porcine corneas., Methods: Thirty fresh porcine corneas were acquired from an abattoir. The corneas were equally divided into three groups. Groups were incubated for 1 week in Eusol-C solution containing supra-physiologic concentrations of estrogen, progesterone, or control (no added hormone). After incubation, the central corneal thickness (CCT) of each cornea was measured using an electronic caliper, and then the corneas were cut into strips. The strips were then clamped in the pneumatic jaws of a computer-controlled biomaterial tester (Instron 4502, USA) and stretched at a constant rate of 1 mm/min until tissue rupture while constantly recording the stress and strain of the tissue. Stress-strain curves were plotted and Young's modulus was calculated for each corneal strip., Results: Average corneal thickness was 873.5 ± 143.1 μm for the control group, 928.0 ± 97.7 μm for the estrogen group, and 922.0 ± 116.7 μm for the progesterone group (data presented as mean ± SD). There was no statistically significant difference between the groups regarding the CCT (p = 0.89). The average Young's modulus was 17.00 ± 3.46 MPa for the control group, 16.95 ± 6.83 MPa for the progesterone group, and 12.33 ± 3.24 MPa for the estrogen group. The difference between the control and estrogen groups was statistically significant (p = 0.018) while the difference between the control and progesterone groups was not (p = 0.72)., Conclusion: Estrogen has a relaxing effect on the porcine cornea, resulting in reduced stiffness of the tissue. Progesterone has no significant effect on the biomechanical properties of porcine corneas. Estrogen and progesterone do not significantly affect CCT.

The significance of minimal bone marrow (BM) involvement in diffuse large B cell lymphoma (DLBCL), as determined by flow cytometry (FC), is unclear. Patient outcomes were retrospectively analyzed based on their BM biopsy and FC involvement. Eighty-one patients were included, 21 and 51 were positive for biopsy(B+) and FC(FC+) respectively. B+ FC+ patients had a 52.3%CR rate, the B- FC+ group had 76.7%, and the B- FC- had 73.3%. Mean time to progression (TTP) was 67.45, 76.8, and 79.3 months and median Overall survival(OS) was 54.4, 76.6 and 69.5 months for the B+ FC+, B- FC+, and B- FC- groups respectively. A cutoff of 1% pathologic cells was an independent risk factor for TTP. In a multivariable analysis including International Prognostic Index (IPI), sex and HB, FC+ was independently associated with TTP (but not OS) at 5 years (HR 2.64, 95%CI 1.03-6.77) and at 7 years(HR 2.83, 95%CI 1.08-7.39). In summary, FC determined minimal involvement may suggest an intermediate risk group of DLBCL patients.