Stochastic diffusion using mean-field limits to approximate master equations.

Stochastic diffusion is the noisy and uncertain process through which dynamics like epidemics, or agents like animal species, disperse over a larger area. Understanding these processes is becoming increasingly important as we attempt to better prepare for potential pandemics and as species ranges shift in response to climate change. Unfortunately, modeling of stochastic diffusion is mostly done through inaccurate deterministic tools that fail to capture the random nature of dispersal or else through expensive computational simulations.

Paradoxes in the coevolution of contagions and institutions.

Epidemic models study the spread of undesired agents through populations, be it infectious diseases through a country, misinformation in social media or pests infesting a region. In combating these epidemics, we rely neither on global top-down interventions, nor solely on individual adaptations. Instead, interventions commonly come from local institutions such as public health departments, moderation teams on social media platforms or other forms of group governance.

Ultrasound in Cardiopulmonary Arrest and Resuscitation: Constructing Comprehensive Implementation Frameworks in High-Risk Settings.

Objectives: Information obtained from point-of-care ultrasound during cardiopulmonary arrest and resuscitation (POCUS-CA) can be used to identify underlying pathophysiology and provide life-sustaining interventions. However, integration of POCUS-CA into resuscitation care is inconsistent. We used expert consensus building methodology to help identify discrete barriers to clinical integration.

Counternarratives that illuminate faculty agency: A five-year longitudinal qualitative study of physician educators in academic medicine.

Purpose: Physician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work.

Methods And Materials: We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement.

Outcomes of posterior component separation with transversus abdominis release for repair of abdominally based breast reconstruction donor site hernias.

Purpose: Abdominally based autologous breast reconstruction (ABABR) is common after mastectomy, but carries a risk of complex abdominal wall hernias. We report experience with posterior component separation (PCS) and transversus abdominis release (TAR) with permanent synthetic mesh repair of ABABR-related hernias.

Methods: Patients at Cleveland Clinic Foundation and Penn State Health were identified retrospectively.

TRACE-Omicron: Policy Counterfactuals to Inform Mitigation of COVID-19 Spread in the United States.

The Omicron wave was the largest wave of COVID-19 pandemic to date, more than doubling any other in terms of cases and hospitalizations in the United States. In this paper, we present a large-scale agent-based model of policy interventions that could have been implemented to mitigate the Omicron wave. Our model takes into account the behaviors of individuals and their interactions with one another within a nationally representative population, as well as the efficacy of various interventions such as social distancing, mask wearing, testing, tracing, and vaccination.

Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial.

Background: Open parastomal hernia repair can be performed using retromuscular synthetic mesh in a keyhole or Sugarbaker configuration. Relative morbidity and durability are unknown. Here, we present perioperative outcomes of a randomized controlled trial comparing these techniques, including 30-day patient-reported outcomes, reoperations, and wound complications in ≤90 days.

Opioid receptor antagonism and neural response to monetary rewards: Pilot studies in light and heavy alcohol users.

Alcohol use disorder (AUD) is a prevalent condition associated with high degree of comorbidity and mortality. Among the few approved pharmacotherapies for AUD, two involve opioid receptor antagonism. Naltrexone and nalmefene are thought to act via opioid receptor blockage to reduce neural response to alcohol and drug-associated cues and consumption, but there have been limited efforts to characterize these effects in humans.

Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs: A Randomized Clinical Trial.

Importance: Transfascial (TF) mesh fixation in open retromuscular ventral hernia repair (RVHR) has been advocated to reduce hernia recurrence. However, TF sutures may cause increased pain, and, to date, the purported advantages have never been objectively measured.

Objective: To determine whether abandonment of TF mesh fixation would result in a noninferior hernia recurrence rate at 1 year compared with TF mesh fixation in open RVHR.

Evidence for the utility of quantum computing before fault tolerance.

Quantum computing promises to offer substantial speed-ups over its classical counterpart for certain problems. However, the greatest impediment to realizing its full potential is noise that is inherent to these systems. The widely accepted solution to this challenge is the implementation of fault-tolerant quantum circuits, which is out of reach for current processors.

Into the Unknown: Characterizing Fellow Uncertainty During the Transition to Unsupervised Practice.

Background: Helping fellows confront and manage uncertainty in the course of diagnosis and treatment of patients has been a growing focus of medical education. How these same fellows confront uncertainty as they make a transition in their professional development is less commonly a focus of training programs. Better understanding of how fellows experience these transitions will allow fellows, training programs, and hiring institutions to navigate transitions more easily.

Incidence of asymptomatic SARS-CoV-2 infection in children undergoing elective otolaryngologic surgery throughout the COVID-19 pandemic.

Objective: Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are less clinically affected than adults, with most cases presenting as asymptomatic or mildly symptomatic. However, true rates of asymptomatic SARS-CoV-2 infection in children remain unclear. We sought to examine rates of SARS-CoV-2 in asymptomatic children and the role of children in transmission.

Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors.

Purpose: Mediumweight (MW) and heavyweight (HW) polypropylene have demonstrated similar clinical and patient-reported outcomes in the setting of open retromuscular ventral hernia repair (VHR). While MW mesh has an anecdotal risk of central mesh fracture, that phenomenon is not well-characterized. We sought to assess the incidence of and risk factors for MW polypropylene mesh fractures after VHR.

COVID-19 is Observed in Older Children During the Omicron Wave in New York City.

Background: The Omicron variant of SARS-CoV-2 has a predilection for the upper airways, causing symptoms such as sore throat, hoarse voice, and stridor.

Objective: We describe a series of children with COVID-19-associated croup in an urban multicenter hospital system.

Methods: We conducted a cross-sectional study of children ≤18 years of age presenting to the emergency department during the COVID-19 pandemic.

Opioid prescribing practices and patient-requested refill patterns following laparoscopic inguinal hernia repair.

Purpose: Excessive post-operative opioid prescribing has led to efforts to match prescriptions with patient need after surgery. We investigated opioid prescribing practices, rate of patient-requested opioid refills, and associated factors after laparoscopic inguinal hernia repair (LIHR).

Methods: LIHRs at a single institution from 3/2019 to 3/2021 were queried from the Abdominal Core Health Quality Collaborative for demographics, perioperative details, and patient-reported opioid usage.

Ileus rate after abdominal wall reconstruction: a retrospective analysis of two clinical trials.

Purpose: Postoperative ileus (POI) is the paralytic disruption of gastrointestinal motility, a common complication following abdominal wall reconstruction that often leads to increased patient morbidity and length of stay (LOS). We reviewed two randomized clinical trials to determine POI rates, predictive factors, LOS, and associated cost.

Methods: Two randomized trials were performed from 2017-2019 with all patients receiving elective open abdominal wall reconstruction with retromuscular mesh.

A point-of-care ultrasound education curriculum for pediatric critical care medicine.

Background: Diagnostic and procedural point-of-care ultrasound (POCUS) change patient management with the potential to improve outcomes. Pediatric critical care medicine trainees have limited access to education and training opportunities in diagnostic POCUS in the pediatric ICU. A dearth of published pediatric ICU curricular resources restricts these educational opportunities.

Open Retromuscular Lateral Abdominal Wall Hernia Repair: Algorithmic Approach and Long-Term Outcomes at a Single Center.

Background: Lateral abdominal wall hernias are relatively rare and present unique challenges to repair. Our group has developed an algorithm for repair based on several anatomic characteristics identified on preoperative imaging. Herein, we report our algorithm and outcomes of a large series of open retromuscular lateral abdominal wall hernia repairs.

Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients.

Objective: We aimed to report long-term clinical and patient-reported outcomes of transversus abdominis release (TAR) with permanent synthetic mesh performed in a high-volume abdominal wall reconstruction practice.

Summary Background Data: Despite increasing utilization of TAR in abdominal wall reconstruction, long-term clinical and patient-reported outcomes remain uncertain.

Methods: Prospectively collected registry data from the Cleveland Clinic Center for Abdominal Core Health were analyzed retrospectively.