Racial differences in real-world outcomes of first-line therapies for advanced renal cell carcinoma.

Background: Given the historical underrepresentation of racial minorities in clinical trials, little is known about racial differences in outcomes of first-line therapies for advanced renal cell carcinoma (aRCC). This study described patient characteristics and clinical outcomes of first-line therapies for aRCC, including nivolumab + ipilimumab, pembrolizumab + axitinib, and tyrosine kinase inhibitors, by race in the real-world setting.

Methods: We conducted a retrospective medical chart review of patients with intermediate/poor-risk clear-cell aRCC.

Complex Nasal Reconstruction: A Methodical Approach to the Three-Stage Paramedian Forehead Flap.

Complex nasal reconstructions require adequate planning with an accurate estimation of the time necessary to perform each stage. Reconstructions of the entire nose, multiple subunits, or a substantial subunit typically require lining replacement and cartilage grafting. Securing the lining prior to a staged reconstruction is preferred, but options such as the Menick folded paramedian forehead flap (PMFF) allow for lining coverage at the time of the first stage.

Approaches to Cheek Reconstruction following Mohs Surgery.

The native features of the cheek allow for a variety of approaches when considering reconstruction following Mohs surgery. Selecting the best approach requires consideration of deficit size and location, skin laxity, surrounding anatomy, aesthetic outcomes, and specific patient factors. Reconstruction options vary based on the zone of the cheek affected, but direct closure remains the gold standard.

Facial Reconstruction: The Nuances of Managing Undesirable Results.

Given the visibility of the face and the importance of its cosmesis, undesirable results following facial reconstruction present significant challenges for both the patient and the surgeon. Intraoperative measures and postoperative management can ameliorate some unfavorable outcomes, but others may require more extensive intervention. Approaching undesirable results with a frank assessment followed by shared decision-making not only improves outcomes but is also essential for patient satisfaction.

Judging Surgical Quality in Facial Reconstruction.

Judging surgical quality within facial reconstruction is challenging for many reasons. Factors beyond the completion of surgery influence the quality of the result, demanding the surgeon to predict and mitigate potential confounders of quality. This skill is honed over years of experience and practice.

Challenges and Strategies in Post-Mohs Reconstructive Surgery.

Facial reconstruction following Mohs excision presents many challenges. The unpredictable nature of Mohs surgery can yield surprising deficits that require far more extensive reconstructions than originally anticipated. It is up to the reconstructive surgeon to guide the patient through the shock of the excision, initial reconstruction, definitive reconstruction, and postoperative management.

Allied health work readiness capabilities: a qualitative comparison of graduates, supervisors, and managers' perspectives.

Researchers have highlighted gaps in the work readiness (WR) of allied health (AH) graduates and the capabilities required to successfully work in an interprofessional collaborative practice healthcare environment. In the studies conducted, the focus has generally been on one AH discipline or on one participant group across disciplines, such as new graduates. We explored WR capability of new AH graduates across three participant groups (managers, supervisors, and graduates) and across several AH disciplines in the health sector.

Design and Synthesis of Clinical Candidate PF-06852231 (CVL-231): A Brain Penetrant, Selective, Positive Allosteric Modulator of the M Muscarinic Acetylcholine Receptor.

Selective activation of the M muscarinic acetylcholine receptor subtype offers a novel strategy for the treatment of psychosis in multiple neurological disorders. Although the development of traditional muscarinic activators has been stymied due to pan-receptor activation, muscarinic receptor subtype selectivity can be achieved through the utilization of a subtype of a unique allosteric site. A major challenge in capitalizing on this allosteric site to date has been achieving a balance of suitable potency and brain penetration.

Stakeholder perspectives following implementation of Vietnam's first speech-language pathology degrees: recommendations for future curriculum development.

Purpose: To investigate perspectives of multiple stakeholders involved in development and delivery of Vietnam's first speech-language pathology degrees and derive recommendations for future degrees in Vietnam and other Majority World countries.

Methods: An exploratory-descriptive qualitative research design using focus groups and individual semi-structured interviews in the preferred language (English or Vietnamese) was used, with 70 participants from five stakeholder groups: project managers, students, academic educators, placement supervisors and interpreters. Transcriptions were analysed using thematic network analysis.

Do hypoallergenic skincare products contain fewer potential contact allergens?

Personal care products (PCPs) commonly cause allergic contact dermatitis (ACD). Skincare companies often market their products as 'hypoallergenic'; however, this term is not regulated by industry standards. To determine whether PCPs marketed as hypoallergenic are truly less likely to precipitate ACD, we conducted a study of ingredients found in 'hypoallergenic PCPs' from two major UK retailers in 2022.

The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms.

Unlabelled: The Countdown is an international research collaboration that independently monitors the evolving impacts of climate change on health, and the emerging health opportunities of climate action. In its eighth iteration, this 2023 report draws on the expertise of 114 scientists and health practitioners from 52 research institutions and UN agencies worldwide to provide its most comprehensive assessment yet. In 2022, the Countdown warned that people’s health is at the mercy of fossil fuels and stressed the transformative opportunity of jointly tackling the concurrent climate change, energy, cost-of-living, and health crises for human health and wellbeing.

Majority of new patient referrals to a large pediatric rheumatology center result in non-rheumatic diagnosis.

Objective: Pediatric rheumatology faces a looming supply-demand crisis. While strategies have been proposed to address the supply shortfall, investigation into the increased demand for pediatric rheumatic care has been limited. Herein, we analyze new patient visits to a large tertiary care pediatric rheumatology center to identify emerging trends in referrals and areas for potential intervention to meet this increased demand.

Viewing both sides of the coin for infectious disease diagnosis.

Optimal management of lower respiratory tract infection relies on distinguishing infectious from noninfectious etiologies and identifying the microbiologic cause if applicable. This process is complicated by overlapping clinical symptoms and the colonizing lung microbiota. In a recent issue of the JCI, Mick, Tsitsiklis, and colleagues apply RNA-Seq to tracheal aspirates from critically ill children and demonstrate how integration of the host response with microbial identification results in a harmonious and accurate diagnostic classifier.

Load and fatigue monitoring in musicians using an online app: A pilot study.

Background/aims: High occupational injury rates are reported in musicians, with a career prevalence of up to 89%. Fatigue and playing (over)load are identified as key risk factors for musicians' injuries. Self-report fatigue management strategies in sport have demonstrated preventive effects.

Repercussions of patrilocal residence on mothers' social support networks among Tsimane forager-farmers.

While it is commonly thought that patrilocality is associated with worse outcomes for women and their children due to lower social support, few studies have examined whether the structure of female social networks covaries with post-marital residence. Here, we analyse scan sample data collected among Tsimane forager-farmers. We compare the social groups and activity partners of 181 women residing in the same community as their parents, their husband's parents, both or neither.

Community-based rehabilitation workers in Vietnam need assistance to support communication and swallowing: Sustainable Development Goals 3, 4, 8, 10, 17.

Purpose: Communication and swallowing disabilities (CSwD) impact health and well-being (Sustainable Development Goal SDG 3), educational attainment (SDG 4) and employment (SDG 8) and contribute to poverty (SDG 1). In Vietnam, community-based rehabilitation (CBR) workers are often the first point of contact for people with CSwD. This commentary reports research exploring the knowledge, experiences and training needs of CBR workers and their preparedness to provide services to people with CSwD and their families living in a province of Vietnam.

The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels.

Unlabelled: The 2022 report of the Countdown is published as the world confronts profound and concurrent systemic shocks. Countries and health systems continue to contend with the health, social, and economic impacts of the COVID-19 pandemic, while Russia’s invasion of Ukraine and a persistent fossil fuel overdependence has pushed the world into global energy and cost-of-living crises. As these crises unfold, climate change escalates unabated.

A descriptive case report of telesupervision and online case-based learning for speech and language therapy students in Vietnam during the COVID-19 pandemic.

Background:  Vietnam's first speech and language therapy (SLT) degrees commenced in 2019 utilising international educators. Continuity of the degrees was impacted by travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic.

Objectives:  This article presents a descriptive case report exploring the viability of online learning to continue clinical education (CE) of SLT students in Vietnam during the pandemic.

Idiopathic Intracranial Hypertension: A Case Study of Patient Engagement in the Treatment of a Chronic Disease.

Idiopathic intracranial hypertension is a rare neurological disorder characterized by increased intracranial pressure, which can lead to visual loss and headaches. While medical therapy exists, weight loss is the only disease-modifying treatment. Weight loss is the only therapy that leads to sustained resolution of papilledema.

Twelve tips for introducing E-Portfolios in health professions education.

Portfolios have been used in health professions for many decades as a means of documenting reflective practice that inform change, supports the understanding of professionals' development needs and changing care options for clients. Electronic versions of one's portfolio of evidence or E-Portfolios became more prevalent in the early 2000s as a repository to store evidence and reflections. However, in recent years E-Portfolios have evolved from a repository to an articulation of authentic learning and development.

Exponentially Small Cosmological Constant in String Theory.

We construct a supersymmetric vacuum of string theory in which the magnitude of the vacuum energy is <10^{-123} in Planck units. The mechanism that we introduce generates a well-controlled exponential hierarchy from an appropriate choice of the quantized parameters in the superpotential. Our approach provides a new angle on the cosmological constant problem.