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This paper presents TimelinePTC, a web-based tool developed to improve the collection and analysis of Pathways to Care (PTC) data in first episode psychosis (FEP) research. Accurately measuring the duration of untreated psychosis (DUP) is essential for effective FEP treatment, requiring detailed understanding of the patient's journey to care. However, traditional PTC data collection methods, mainly manual and paper-based, are time-consuming and often fail to capture the full complexity of care pathways. TimelinePTC addresses these limitations by providing a digital platform for collaborative, real-time data entry and visualization, thereby enhancing data accuracy and collection efficiency. Initially created for the Specialized Treatment Early in Psychosis (STEP) program in New Haven, Connecticut, its design allows for straightforward adaptation to other healthcare contexts, facilitated by its open-source codebase. The tool significantly simplifies the data collection process, making it more efficient and user-friendly. It automates the conversion of collected data into a format ready for analysis, reducing manual transcription errors and saving time. By enabling more detailed and consistent data collection, TimelinePTC has the potential to improve healthcare access research, supporting the development of targeted interventions to reduce DUP and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Patient-selected music during cataract surgery was a safe and effective method to reduce anxiety, fear, nervousness, and confusion perioperatively. This inexpensive, low-risk method directly impacted patient experience during surgery. Purpose: To determine the effect of playing patient-selected music intraoperatively on patient self-reported anxiety and the amount of sedative administered during cataract surgery. Setting: Yale New Haven Hospital health system, New Haven, Connecticut. Design: Prospective, randomized, controlled clinical trial. Methods: Patients were randomized to either a music group or a control group, which had no music played. Patients were blinded to the purpose of the study. On postoperative day 1, patients were consented to participate in the study and asked to complete a 6-question Likert-style survey (modified from the State-Trait Anxiety Inventory) assessing anxiety at baseline and during surgery. Patients' intraoperative and postoperative vitals were recorded. The medication, dosage, and number of sedative injections given were also recorded. Paired t tests were used to assess for significant differences between the 2 groups. Results: 107 patients (mean age 71.2 years) were enrolled in the study. There was no significant difference in baseline anxiety between the 2 groups. Patients randomized to the music group had significantly lower total self-reported anxiety (mean 5.98) than the control group (mean 7.13, P =.006). Moreover, patients exposed to music felt significantly less frightened, nervous, and confused during surgery (P =.002,.007, and 0.017, respectively). There was no significant difference between the groups in number and dosage of sedatives given. Conclusions: Playing patient-selected music during cataract surgery is an effective way to decrease anxiety. Music directly affects patient experience and is an inexpensive, low-risk method of reducing patient anxiety during surgery. [ABSTRACT FROM AUTHOR]

Review of: The Warrior, the Voyager, and the Artist: Three Lives in an Age of Empire, Kate Fullagar (2020) New Haven, CT and London: Yale University Press, 320 pp., ISBN 978 0 30024 306 2 (hbk), US$44 [ABSTRACT FROM AUTHOR]

Whether within or outside of the psychoanalytic consulting room, when individuals or professional groups can recognize their limitations in addressing familiar challenges and have the opportunity to find partners to explore and understand the underlying sources of their distress, opportunities for new adaptive solutions emerge as well. Shared concerns about the challenges of violence exposure and childhood trauma formed the basis of what at first seemed an unlikely collaboration between psychoanalysts and other clinicians at the Yale Child Study Center and members of the New Haven Police Department. This paper will describe the development of the Child Development-Community Policing partnership and later, our engagement with policymakers. The story of how these collaborations emerged illustrates ways in which the application of the most basic psychoanalytic principles of listening, close observation, and collaborative learning led to the development of early intervention and clinical treatment that have helped to advance the field of childhood trauma. Mobilizing these collaborative efforts outside of the consultation room has, most importantly, led to a far greater number of traumatized children who no longer need to remain alone in the immediate aftermath of the traumatic realization of their worst nightmares. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: Primary extranodal diffuse large B-cell lymphoma (DLBCL) is a rare, yet highly aggressive and invasive malignancy that can masquerade as a solid organ tumor. Timely diagnosis is critical for improving prognosis; however, it is challenging to achieve. Case Reports: We report 2 cases treated at Yale New Haven Hospital (New Haven, CT, USA) and the West Haven Veteran's Affairs Medical Center (West Haven, CT, USA) in 2023. Case 1 describes a 69-year-old woman who presented with a large left adrenal mass that was suspicious for adrenocortical carcinoma and was found to have primary adrenal DLBCL following surgical resection. Case 2 describes a 59-year-old woman with Hashimoto's thyroiditis and goiter who was found to have primary thyroid DLBCL following partial thyroidectomy. Conclusions: Primary extranodal DLBCL should be included in the differential diagnosis of solid adrenal and thyroid tumors. The risks of biopsy, given currently available techniques, should be weighed against the benefits of achieving a definite diagnosis, allowing for timely initiation of systemic immunochemotherapy. When biopsy can be safely performed, techniques designed to evaluate for DLBCL should be incorporated. [ABSTRACT FROM AUTHOR]

Background and Aims Early diagnosis of aortic stenosis (AS) is critical to prevent morbidity and mortality but requires skilled examination with Doppler imaging. This study reports the development and validation of a novel deep learning model that relies on two-dimensional (2D) parasternal long axis videos from transthoracic echocardiography without Doppler imaging to identify severe AS, suitable for point-of-care ultrasonography. Methods and results In a training set of 5257 studies (17 570 videos) from 2016 to 2020 [Yale-New Haven Hospital (YNHH), Connecticut], an ensemble of three-dimensional convolutional neural networks was developed to detect severe AS, leveraging self-supervised contrastive pretraining for label-efficient model development. This deep learning model was validated in a temporally distinct set of 2040 consecutive studies from 2021 from YNHH as well as two geographically distinct cohorts of 4226 and 3072 studies, from California and other hospitals in New England, respectively. The deep learning model achieved an area under the receiver operating characteristic curve (AUROC) of 0.978 (95% CI: 0.966, 0.988) for detecting severe AS in the temporally distinct test set, maintaining its diagnostic performance in geographically distinct cohorts [0.952 AUROC (95% CI: 0.941, 0.963) in California and 0.942 AUROC (95% CI: 0.909, 0.966) in New England]. The model was interpretable with saliency maps identifying the aortic valve, mitral annulus, and left atrium as the predictive regions. Among non-severe AS cases, predicted probabilities were associated with worse quantitative metrics of AS suggesting an association with various stages of AS severity. Conclusion This study developed and externally validated an automated approach for severe AS detection using single-view 2D echocardiography, with potential utility for point-of-care screening. [ABSTRACT FROM AUTHOR]

In this paper, we study functional ordinary least squares estimator and its properties in testing the hypothesis of a constant zero mean function or an unknown constant nonzero mean function. We exploit the recent work by Cho, Phillips, and Seo (Int Econ Rev 170:391–456, 2022) and show that the associated Wald test statistics have standard chi-square limiting null distributions, standard noncentral chi-square distributions for local alternatives converging to zero at a n rate, and are consistent against global alternatives. These properties permit computationally convenient tests of hypotheses involving nuisance parameters. In particular, we develop new alternatives to tests for regression misspecification using the neural network model, that involves nuisance parameters identified only under the alternative. Our Monte Carlo simulations affirm the theory of the current study. Finally, we apply our methodology to the probit models for voter turnout that are estimated by Wolfinger and Rosenstone (Who votes? Yale University Press, New Haven, 1980), Nagler (Am Political Sci Rev 85:1393–1405, 1991) and test whether the models are correctly specified or not. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) commonly causes hospitalization, particularly for individuals disproportionately impacted by structural racism and other forms of marginalization. The optimal approach for engaging hospitalized patients with AUD in treatment post-hospital discharge is unknown. We describe the rationale, aims, and protocol for Project ENHANCE (ENhancing Hospital-initiated Alcohol TreatmeNt to InCrease Engagement), a clinical trial testing increasingly intensive approaches using a hybrid type 1 effectiveness-implementation approach. Methods: We are randomizing English and/or Spanish-speaking individuals with untreated AUD (n = 450) from a large, urban, academic hospital in New Haven, CT to: (1) Brief Negotiation Interview (with referral and telephone booster) alone (BNI), (2) BNI plus facilitated initiation of medications for alcohol use disorder (BNI + MAUD), or (3) BNI + MAUD + initiation of computer-based training for cognitive behavioral therapy (CBT4CBT, BNI + MAUD + CBT4CBT). Interventions are delivered by Health Promotion Advocates. The primary outcome is AUD treatment engagement 34 days post-hospital discharge. Secondary outcomes include AUD treatment engagement 90 days post-discharge and changes in self-reported alcohol use and phosphatidylethanol. Exploratory outcomes include health care utilization. We will explore whether the effectiveness of the interventions on AUD treatment engagement and alcohol use outcomes differ across and within racialized and ethnic groups, consistent with disproportionate impacts of AUD. Lastly, we will conduct an implementation-focused process evaluation, including individual-level collection and statistical comparisons between the three conditions of costs to providers and to patients, cost-effectiveness indices (effectiveness/cost ratios), and cost–benefit indices (benefit/cost ratios, net benefit [benefits minus costs). Graphs of individual- and group-level effectiveness x cost, and benefits x costs, will portray relationships between costs and effectiveness and between costs and benefits for the three conditions, in a manner that community representatives also should be able to understand and use. Conclusions: Project ENHANCE is expected to generate novel findings to inform future hospital-based efforts to promote AUD treatment engagement among diverse patient populations, including those most impacted by AUD. Clinical Trial Registration: Clinicaltrials.gov identifier: NCT05338151. [ABSTRACT FROM AUTHOR]

Background: The Community Research Fellows (CRF) program seeks to mobilize New Haven residents with lower incomes or from communities of color who are educated and equipped to engage as equal partners in health research at Yale University. The training program combines curriculum-based information with 'on-the-ground' experience with Yale research projects, while building relationships between CRFs and researchers. The Community Alliance for Research and Engagement launched two consecutive cohorts of the program in 2018–2020. Objectives: To assess the effect of the CRF program on participants' knowledge of the research process and confidence to engage in research and participants' satisfaction and perspectives on the program. Methods: The evaluation of the CRF program included four components: 1) Pre- and Post- Program Surveys to assess change in confidence and self-reported knowledge. 2) Curriculum Feedback Satisfaction Survey to gauge satisfaction and make program improvements after each training session. 3) Post-Program CRF Interviews to explore their CRF experiences. 4) Research Team Surveys to assess program satisfaction and areas for improvement. Results: CRFs reported increased confidence and knowledge, personal and professional growth, and interest in community-engaged research. Overall, participants were very satisfied with each training module. Conclusions: The CRF program demonstrated that community members are well-suited, well-positioned, and eager to engage in and inform public health research. CRFs bring capacity and valuable perspective to research teams. The CRF training program offers an innovative approach to address power imbalances in research and to move towards more equitable community–university partnerships for improved health outcomes. [ABSTRACT FROM AUTHOR]

Background: We describe the rationale and study design for "TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN)," a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma. Design: TRUE HAVEN is an ongoing, multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome. Discussion: Results from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence. Trial registration: ClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023. Please refer to https://clinicaltrials.gov/ct2/show/NCT05723614 for public and scientific inquiries. [ABSTRACT FROM AUTHOR]

Patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) often receive antibacterial prophylaxis. Antibacterial agents can cause elevations in the prothrombin time and international normalized ratio (INR). The impact of prophylactic antibacterials on the coagulation profiles and bleeding risk in patients with AML/MDS is unknown. We evaluated patients with AML or MDS who were being admitted to the hospital. The cohort was divided into two groups of patients: (1) those receiving and (2) those not receiving prophylactic antibacterials, at the time of admission. We conducted a retrospective cohort study of adult patients with AML/MDS admitted to Yale-New Haven Hospital between 2015–2019. The study was approved by the Yale Institutional Review Board. Inclusion criteria included patients >18 years old with a diagnosis of AML or MDS admitted to the hospital. We identified 150 individual patient encounters with active AML/MDS admitted to Yale-New Haven of which 32 occurred while on and 118 while off antibacterial prophylaxis. Median duration of pre-admission antibacterial exposure was 2 (range: 0.07–24) months. Patients on antibacterial prophylaxis had higher INR (median 1.14 vs. 1.03, p = 0.0002), and higher partial thromboplastin time prolongation (median 26.5 vs. 24.3, p < 0.0014), than patients without antibacterial prophylaxis. Patients without antibacterial prophylaxis had higher rates of bleeding using the ISTH-defined criteria (24.6% vs. 6.3%, p = 0.043), including higher rates of ISTH major (2 vs. 0) and clinically relevant bleeding (9 vs. 0). Patients with AML/MDS on antibacterial prophylaxis were more likely to have an abnormal coagulation profile when compared with their counterparts not on prophylaxis. Conversely, rates of bleeding were higher in patients not on prophylaxis. These data suggest that prophylactic antibacterials do not increase bleeding risk in patients with AML/MDS. [ABSTRACT FROM AUTHOR]

To surgically demonstrate preconceptional laparoscopic repair of a chronic myometrial defect with mesh reinforcement, resulting in a successful pregnancy outcome. Video case report. The Institutional Ethical Committee was consulted, and the requirement for approval was waived because the video describes a modified surgical technique. The patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, and others), and other applicable sites. A referral advanced gynecological endoscopy center. A 27-year-old woman (P 0 A 1) was diagnosed with myomas during pregnancy, resulting in miscarriage at 22 weeks. Laparotomy and myomectomy were performed 2 months later, and three 8-cm myomas were removed. The endometrial cavity opened posteriorly during surgery, and retained products of conceptions were removed. Periconceptional imaging done after two years showed few intramural myomas and a deficient myometrium in the posterior fundal region. Laparoscopy revealed a defect in the posterior fundal aspect of the uterus with leakage of dye, which was converted to laparotomy and myomectomy with the repair of the myometrial defect. After 1 year, follow-up magnetic resonance imaging showed thinned-out posterior myometrium with a focal area of absent myometrium in the midline and endometrial prolapse. The patient was advised on surrogacy, but she wanted to repair the defect again and try for pregnancy, so she was referred to our center. With the background of a few case reports using mesh to reinforce myometrial repair (1, 2), we counseled the patient about the myometrial repair with the additional use of mesh as an off-label use. The risk of uterine rupture after myomectomy is rare (<1%) (3), but it is a severe complication. High-risk cases, like significant myometrial defects or previous ruptures, may require surgical correction. Native repair may not achieve optimal results in all cases. Alternative approaches, like the additional use of mesh or biological materials, have been reported (4). In this case, we demonstrate the use of dual mesh for scar repair. Synthetic mesh over the uterus is used in laparoscopic procedures like sacrohysteropexy and cerclage. We used Parietex (Covidien, New Haven, CT, USA) mesh, a composite macroporous polyester mesh usually used for ventral hernia repair. It has an outer hydrophilic, absorbable collagen barrier that reduces adhesion formation. Laparoscopically, after adhesiolysis, a significant defect was demonstrated on the posterior wall of the uterus (Fig. 1). A complete resection of the fibrotic tissue along the edges of the scar defect was done to expose healthy myometrium. Myometrium was repaired in two layers, excluding the endometrium, with a V-Loc (Covidien, Dublin, Ireland) No. 1–0 suture. Parietex mesh was sutured over the repaired posterior myometrium to reinforce it (Fig. 2). The postoperative myometrial thickness on imaging and pregnancy outcome. Postoperative ultrasound scan after 6 weeks demonstrated restoration of posterior wall myometrial thickness of 14 mm. The patient was conceived through in vitro fertilization techniques 4 months after surgery. Antenatal follow-up was uneventful except for suspicion of posterior placenta accreta. She underwent an elective cesarean section with uterine artery embolization at 34 weeks and delivered a healthy infant weighing 1,950 g. Placental removal was uneventful. On inspection, the posterior surface of the uterus was intact without dehiscence, meshing in situ with minimal adhesions (Fig. 3). Myometrial scar defects can cause potential obstetric complications. Native repair of scar defects may not achieve optimal results, as in our case. Mesh repair of myomectomy scar defects can be used as an alternative approach, as exemplified in this case. However, further studies are required to establish the safety and efficacy of this approach. [ABSTRACT FROM AUTHOR]

Recurrent Clostridioides difficile infection (RCDI) causes an increased burden on the healthcare system. We calculated RCDI incidence and identified factors associated with RCDI cases in New Haven County, Connecticut, USA, during 2015–2020 by using data from populationbased laboratory surveillance. A subset of C. difficile cases had complete chart reviews conducted for RCDI and potentially associated variables. RCDI was defined as a positive C. difficile specimen occurring 2–8 weeks after incident C. difficile infection. We compared cases with and without RCDI by using multiple regression. RCDI occurred in 12.0% of 4,301 chart-reviewed C. difficile cases, showing a U-shaped time trend with a sharp increase in 2020, mostly because of an increase in hospital-onset cases. Malignancy (odds ratio 1.51 [95% CI 1.11–2.07]) and antecedent nitrofurantoin use (odds ratio 2.37 [95% CI 1.23– 4.58]) were medical risk factors for RCDI. The 2020 increase may reflect the impact of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Our study survey assessed HIV risk profile and pre-exposure prophylaxis (PrEP) use among HIV-negative individuals seeking mpox vaccination, elucidating HIV prevention gaps and opportunities. Methods: Anonymous cross-sectional surveys were self-administered at an urban academic center clinic in New Haven, CT, U.S. (August 18–November 18, 2022). Inclusion criteria included adults presenting for mpox vaccination who consented to the study. The study assessed STI risk (sexual practices, STI history, substance use). For HIV-negative participants, PrEP knowledge, attitudes, and preferences were assessed. Results: Eighty-one of 210 individuals approached completed surveys (survey acceptance and completion rate 38.6%). Majority were cisgender-male (76/81; 93.8%), Caucasian (48/79; 60.8%), with median age 28 years (IQR-15). Nine of 81 (11.5%) self-reported HIV-positivity. Median sexual partner number (6 months prior) was 4 (IQR-5.8). Majority, 89.9% and 75.9%, reported insertive and receptive anal intercourse, respectively. 41% reported lifetime STI history, of whom 12.3% had an STI 6 months prior. Majority (55.8%) used ≥ 1 illicit substance; 87.7% moderate alcohol use. Among HIV-negative respondents, most (95.7%) were aware of PrEP, but only 48.4% used PrEP. Conclusion: Individuals seeking mpox vaccination engage in behaviors placing them at increased STI risk and would benefit from PrEP assessment. [ABSTRACT FROM AUTHOR]

Higher rate of substance use, including cannabis, has been reported in individuals with a history of childhood trauma, but less is known about the association between cannabis use with lifetime history of trauma and chronic stress, and potential gender differences in this association. This study systematically examined this association in a cross-sectional study of 841 individuals recruited between 2007 and 2012 from the community in New Haven, Connecticut. The Cumulative Adversity Index (CAI) was used to measure cumulative lifetime major life events, life trauma, and recent life events and chronic stress. Childhood Trauma Questionnaire (CTQ) was used to measure childhood trauma. Current and regular use of drugs were assessed using self-report questionnaires and objectively verified with urine drug testing. Higher rates of childhood trauma as well as lifetime trauma, and major life events were found in cannabis users, compared to non-users. The association between cannabis use with childhood trauma (total CTQ scores) was significant after controlling for age, gender, ethnicity and regular use of alcohol or cocaine. In logistic regression analysis, cannabis use had a significant positive association with major life events and lifetime trauma, but not with chronic stress, controlling for confounding factors including age, gender, ethnicity, and regular use of alcohol and cocaine. When analyzed separately, only in women the association between cannabis use and childhood trauma was significant. These associations point to further assessment of the impact of these gender differences on neurobiology of stress and cannabis misuse risk. • Childhood trauma was positively associated with cannabis use in women. • Lifetime cumulative adversity was positively associated with cannabis use in both men and women. • Evaluation of the role of stress and trauma in cannabis use and related gender differences deserve further attention. • Endocannabinoid system dysregulation may explain why trauma exposed individuals have high rates of cannabis use. [ABSTRACT FROM AUTHOR]

How does the parchment codex inform a text's meditations on what it is to be bound by and to one's body? The Yale Girdle Book (New Haven, Beinecke MS 84) contains Boethius's Consolation of Philosophy; it is bound with a soft leather wrapper that, shroud-like, envelops the codex and reveals that it was meant to be worn. Enabled by the material and affective turns and the field of skin studies, I argue that the binding and parchment alter the text in a synergistic, reciprocal relationship that speaks back to the Consolation's explicit derision of the body. As a girdle book, the manuscript had the first and last word in the reader's experience of its text. Every step with which it swung and pulled, every slap against its wearer's thigh, every turn of the page between the reader's fingers encouraged a process of cooperative unbinding of both the manuscript and the reader's self, revealing the Consolation's debt to embodied sensation. The marks left by MS 84's medieval readers confirm that it exerted interpretive control over its text and that the affective power of the meeting and merging bodies of manuscript and reader is not a figment of modern theory's imagination. [ABSTRACT FROM AUTHOR]

Evidence of how illumination workshops functioned within commercial manuscript production has, for the most part, been lost to time. Therefore, the remnants of workshop practices that have survived provide a rare window into the inner workings of such workshops. This annotation considers a key system located in the New Haven, Beinecke Rare Book and Manuscript Library, MS 1216, often referred to as the Clumber Park Chartier. It provides some suggestions as to how the key system may have functioned as a form of communication to coordinate members of the illumination workshop. [ABSTRACT FROM AUTHOR]

In 2016, only one in five eligible U.S. households received rental assistance and waiting lists averaged two years nationally. The gap between available rental assistance and need requires systems to allocate this scarce resource. The way potential rental assistance recipients experience and navigate these systems is likely to shape who ultimately receives assistance. We draw on repeated qualitative interviews (N=238) with low-income New Haven residents (N=54) to examine how participants understand and navigate rental assistance applications and waiting lists. Participants encountered multiple challenges in their search for rental assistance. They described an opaque and complex application and waiting process requiring significant knowledge to navigate. They also described considerable labor associated with monitoring waiting lists, a challenge made more difficult for some by their lack of a stable address. Additionally, participants described significant labor and knowledge required to strategically navigate prioritization systems that often required them to advocate for their deservingness of scarce housing resources. Our findings suggest that the allocation of rental assistance through complex processes that depend on applicant knowledge, labor, and advocacy may create barriers to housing, particularly for more vulnerable and marginalized housing seekers. [ABSTRACT FROM AUTHOR]

aim,1 Bin Zhou,2 Robert B Schonberger,1 Jinlei Li11Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Yale Center for Analytical Sciences, Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USACorrespondence: Jinlei Li, Department of Anesthesiology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA, Tel +1 917 601 6828, Fax +1 203 785 6664, Email [email protected] Purpose: Glucocorticoids are commonly used as regional anesthesia adjuvants to improve blockade quality and duration. There are limited data in the literature regarding the potential systemic effects and safety of perineural glucocorticoids. This study examines the effects of perineural glucocorticoids on serum glucose, potassium, and white blood cell count (WBC) in the immediate postoperative period after primary total hip arthroplasty (THA). Patients and Methods: A retrospective cohort study was carried out at a tertiary academic medical center utilizing electronic health records of 210 patients who underwent THA, for which patients received either a periarticular local anesthetic injection alone (PAI, N=132) or additional peripheral nerve blocks (PNB, N=78) containing 10 mg dexamethasone and 80 mg methylprednisolone acetate (PAI+PNB). The primary outcome was change in serum glucose from a preoperative baseline on postoperative days (POD) 1, 2, and 3. Secondary outcomes included changes in WBC and serum potassium. Results: The change in serum glucose from baseline was found to be significantly higher in the PAI+PNB group compared to the PAI group on POD 1 (mean difference 19.87 mg/dL, 95% CI [12.42, 27.32]; P< 0.001) and POD 2 (mean difference 17.5 mg/dL, 95% CI [9.66, 25.44], P< 0.001). No significant difference was found on POD 3 (mean difference − 8.18 mg/dL, 95% CI [− 19.07, 2.70], P=0.14). Statistically significant but clinically insignificant differences were detected in serum potassium in the PAI+PNB group compared to the PAI group on POD1 (mean difference 0.16 mEq/L, 95% CI [0.02, 0.30], P=0.03) and WBC on POD 2 (mean difference 3.18 × 1000/mm3, 95% CI [2.14, 4.22], P< 0.001). Conclusion: Patients who underwent THA and received PAI+PNB with glucocorticoid adjuvants demonstrated higher elevations in serum glucose for the first two PODs compared to patients who received PAI alone. These differences resolved by a third POD and are likely to be of no clinical significance. [ABSTRACT FROM AUTHOR]

Background: Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health. Methods: Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. Results: Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias. Conclusion: Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States. [ABSTRACT FROM AUTHOR]

The article explores the New Haven County Courthouse as a case study in classical architecture and its relationship to justice and race. It discusses the tensions between the beauty of classical architecture and the potential injustices it may hide. The article argues for a broader narrative surrounding classical architecture that includes diverse perspectives. It also examines the courthouse's design, sculptural program, and its connection to notions of justice and civic pride. The article encourages readers to critically examine the narratives associated with classical architecture and consider the diverse perspectives that shape our understanding of these buildings. [Extracted from the article]

Scientists first identified Human Coronavirus in the year 1965. Then, a study was performed on different human and animal viruses, which were named based on their crown-like appearance. Human coronaviruses are responsible for many children's upper respiratory tract infections. At least five new human coronaviruses have been identified since 2003, including the severe acute respiratory syndrome (SARS) coronavirus, which caused significant morbidity and mortality.1 Per NL and the New Haven, the virus associated with upper and lower respiratory tract disease and likely common human pathogens are identified as the Group-I coronaviruses (SARS-CoV-I). The novel coronavirus (SARS-CoV-II), which appeared in Wuhan, China, in December 2019, is responsible for Coronavirus disease 2019 (COVID-19) and causes respiratory symptoms that can feel like a cold, flu, or pneumonia. Geographical transmission of the virus and the sudden increase in cases are much faster than SARS and Middle East respiratory syndrome (MERS). COVID-19 is the first global pandemic caused by a coronavirus causing outbreaks in 211 countries. The vaccine against COVID-19 is an effective prophylactic strategy for controlling and preventing the virus. The vaccine is being developed in about 90 institutions worldwide. This research paper focuses on COVID-19 vaccine development strategies implemented by various institutions and pharmaceutical companies worldwide and regulatory requirements for vaccine approval. [ABSTRACT FROM AUTHOR]

This article is an interview with Joseph Bristow, a professor of English at UCLA, about his book "Oscar Wilde on Trial: The Criminal Proceedings from Arrest to Imprisonment." Bristow discusses his research process and the challenges of editing such a lengthy study. He highlights the significance of certain documents in shedding light on the Wilde trials and mentions the existing records and their limitations. The text also explores the history of queer blackmail and the fear faced by men who were blackmailed for homosexual activity. It discusses the relationship between Oscar Wilde and Lord Alfred Douglas during Wilde's prison term and mentions Wilde's interest in Italian culture and literature. Further research is needed on Wilde's connections to queer communities in Italy. [Extracted from the article]

In 1971, Heinrich Klotz, who had returned from a stay as a visiting professor at Yale University in New Haven, Connecticut, founded architectura. Zeitschrift für Geschichte der Baukunst/Journal of the History of Architecture with the financial support of the Deutsche Forschungsgemeinschaft (DFG). Klotz experiments with different formats of essays but retires as editor in 1976. Under subsequent editors, architectura continues to develop into the leading journal for the history of architecture, whose essays are not subject to any temporal or local limitations and reflect the entire breadth of research in the history of architecture. [ABSTRACT FROM AUTHOR]

Societal Impact Statement: The coronavirus pandemic has reminded us that green spaces provide sanctuary and comfort, as well as opportunities for release and relief, during difficult times. However, to ensure continuing viability, botanical gardens can do more to address important societal concerns, especially around the environment. Sustaining relevance through action, especially local action, while also thinking beyond botanical science, and making creative use of electronic outreach will help botanic gardens to flourish. Summary: This paper is a personal reflection on high‐level issues relevant to future of botanic gardens and similar organisations, based on the personal experiences of the author at the Field Museum in Chicago, the Royal Botanic Gardens, Kew, in London, the Yale School of Forestry and Environmental Studies (now the Yale School of the Environment) in New Haven, Connecticut, and the Oak Spring Garden Foundation in northern Virginia. Botanic gardens have the inherent advantage that passages of nature, especially in cities, are vital for individual and social well‐being. But this natural advantage needs to be supplemented by actions that take into account a changing world and that respond in meaningful ways to the concerns of supporters and stakeholders. I emphasise five principles that are important now and for the future: (1) Sustaining relevance is key; (2) science is not enough; (3) actions speak louder than words; (4) local action is disproportionately important; and (5) electronic outreach is not optional. Leadership from outstanding individuals is also vital. Finding, encouraging and developing energetic people who are open minded, determined to make a difference and willing to embrace change is vital for institutional success. [ABSTRACT FROM AUTHOR]

Alboglossiphonia pallida (Verrill, 1872) comb. nov. is resurrected and redescribed based on morphological and molecular data from specimens of the type locality (New Haven County, Connecticut, USA) that demonstrate it is distinct from North American Alboglossiphonia heteroclita, European Alboglossiphonia heteroclita, and Alboglossiphonia papillosa. Alboglossiphonia pallida is characterized by having dark chromatophores on the dorsal surface arranged lateral to patrilaterally and medially as a thin line or interrupted thin line along with three pairs of eye spots (with the first pair closest together), six pairs of crop ceca, and a united gonopore. Additional sampling of specimens of the genus Alboglossiphonia is needed to understand its phylogeny especially as many species have not been collected since their description. [ABSTRACT FROM AUTHOR]