Design and maintenance of medical oxygen concentrators in Sub-Saharan Africa: a systematic review.

Background: Oxygen therapy is critical and vital treatment for hypoxemia and respiratory distress, however, access to reliable oxygen systems remains limited in SSA. Despite WHO initiatives that distributed over 30,000 OC oxygen concentrators worldwide, SSA faces significant challenges related to their maintenance and use, due to harsh environmental conditions, technical skill shortages and inadequate infrastructure. This review aims to systematically identify and assess the literature on OC design adaptations, maintenance challenges, and knowledge gaps in SSA, providing actionable recommendations to inform innovative and context-sensitive solutions to improve healthcare delivery in the region.

Two- and Three-Dimensional Culture Systems: Respiratory In Vitro Tissue Models for Chemical Screening and Risk-Based Decision Making.

Risk of lung damage from inhaled chemicals or substances has long been assessed using animal models. However, New Approach Methodologies (NAMs) that replace, reduce, and/or refine the use of animals in safety testing such as 2D and 3D cultures are increasingly being used to understand human-relevant toxicity responses and for the assessment of hazard identification. Here we review 2D and 3D lung models in terms of their application for inhalation toxicity assessment.

Voices of Frontline Leaders: Challenges and Opportunities from Frontline Primary Care Clinic Leaders in a Safety-Net Health Care System.

Background: Burnout, disengagement, and turnover among clinicians is a major challenge for the US health care industry. Research has shown that higher direct supervisor leadership scores correlate with decreased provider burnout and increased professional fulfillment. Safety-net health systems such as Federally Qualified Health Centers (FQHCs) face increased challenges due to limited financial resources, more complex social determinants of health among patients, and often fewer physician leaders who can serve as mentors compared to large, integrated health systems.

Mixed representations of choice direction and outcome by GABA/glutamate cotransmitting neurons in the entopeduncular nucleus.

The basal ganglia (BG) are an evolutionarily conserved and phylogenetically old set of sub-cortical nuclei that guide action selection, evaluation, and reinforcement. The entopeduncular nucleus (EP) is a major BG output nucleus that contains a population of GABA/glutamate cotransmitting neurons (EP) that specifically target the lateral habenula (LHb) and whose function in behavior remains mysterious. Here, we use a probabilistic switching task that requires an animal to maintain flexible relationships between action selection and evaluation to examine when and how GABA/glutamate cotransmitting neurons contribute to behavior.

Recalcitrant Bilateral Volar Hand Burn Contracture in a Toddler Treated With Integra and Staged Full-thickness Skin Graft: A Literature Review.

Background: Recurrent burn contractures on the volar aspect of the hand present a formidable challenge, especially in the pediatric patient. We used Integra followed by staged full-thickness skin grafting for recurrent bilateral volar hand burn contracture in a toddler. We reviewed the literature to appraise the utility of full-thickness skin graft (FTSG) combined with Integra used for volar hand contractures.

Tillage type and sentinel insect species affect the relative prevalence of the entomopathogenic fungus, Metarhizium robertsii, in soil.

Because the use of synthetic agrochemicals is generally not allowed in organic crop production systems, growers rely on natural substances and processes, such as microbial control, to suppress insect pests. Reduced tillage practices are associated with beneficial soil organisms, such as entomopathogenic fungi, that can contribute to the natural control of insect pests. The impacts of management, such as tillage, in a cropping system can affect soil biota in the current season and can also persist over time as legacy effects.

Applying Normalisation Process Theory to a peer-delivered complex health intervention for people experiencing homelessness and problem substance use.

Background: The Supporting Harm Reduction through Peer Support (SHARPS) study involved designing and implementing a peer-delivered, harm reduction intervention for people experiencing homelessness and problem substance use. Normalisation Process Theory (NPT) provided a framework for the study.

Methods: Four Peer Navigators (individuals with personal experience of problem substance use and/or homelessness) were recruited and hosted in six third sector (not-for-profit) homelessness services in Scotland and England (United Kingdom).

Synthesising enablers and barriers to hepatocellular carcinoma surveillance-A systematic review of qualitative findings.

Background & Aims: This systematic literature review of qualitative findings aims to identify the perceived barriers and enablers for hepatocellular carcinoma (HCC) surveillance from patient and clinician perspectives.

Methods: A systematic search of databases using key term combinations with the following inclusion criteria: 1) qualitative and quantitative (survey) studies exploring barriers and enablers of HCC surveillance, and 2) qualitative and quantitative (survey) studies exploring barriers and enablers of enagagement in clinical care for patients with cirrhosis and/or viral hepatitis.

Results: The search returned 445 citations: 371 did not meet the study criteria and were excluded.

Exploring Sex-Based Variations in Head Kinematics During Soccer Heading.

While studies indicate that females experience a higher concussion risk and more severe outcomes in soccer heading compared to males, comprehensive data on the underlying factors contributing to these sex-based differences are lacking. This study investigates the sex differences in the head-to-ball impact kinematics among college-aged soccer headers in a laboratory-controlled setting. Forty subjects (20 females, 20 males) performed ten headers, and impact kinematics, including peak angular acceleration and velocity (PAA, PAV) and peak linear acceleration (PLA), were measured using mouthguards.

Implantable cardioverter defibrillator deactivation and end-of-life: British Heart Rhythm Society practical consensus guideline.

Implantable cardioverter defibrillators (ICDs) are implanted in increasing numbers of patients with the aim of treating ventricular arrhythmias in high-risk patients and reducing their risk of dying. Individuals are also living longer with these devices. As a result, a greater number of patients with an ICD will deteriorate either with worsening cardiac failure, another non-cardiac condition or general frailty and will have a limited prognosis.

Hunger modulates exploration through suppression of dopamine signaling in the tail of striatum.

Caloric depletion leads to behavioral changes that help an animal find food and restore its homeostatic balance. Hunger increases exploration and risk-taking behavior, allowing an animal to forage for food despite risks; however, the neural circuitry underlying this change is unknown. Here, we characterize how hunger restructures an animal's spontaneous behavior as well as its directed exploration of a novel object.

Developing robust quantitative PCR primers for comparative biomass analysis of Tall Fescue (Festuca arundinacea) and its Epichloë endophyte.

Tall fescue ( ) is a widely adopted forage and turf grass. This is partly due to a fungal endophyte, which confers both abiotic and biotic stress tolerance. Although PCR primers exist to test for endophyte presence, these were not designed to quantitatively analyze the amount of fungus in the plant.

Sex hormone deficiency in male and female mice expressing the Alzheimer's disease-associated risk-factor TREM2 R47H variant impacts the musculoskeletal system in a sex- and genotype-dependent manner.

The R47H variant of the triggering receptor expressed on myeloid cells 2 (TREM2) is a risk factor for Alzheimer's disease in humans and leads to lower bone mass accrual in female but not male 12-mo-old mice. To determine whether, as with aging, gonadectomy results in sex-specific musculoskeletal effects, gonad removal or SHAM surgery was performed in 4-mo-old TREM2 mice and WT male and female littermates ( = 10-12/group), with sexes analyzed separately. Body weight was lower in males, but higher in females after gonadectomy, independently of their genotype.

INTERSPECIES ORGANOIDS REVEAL HUMAN-SPECIFIC MOLECULAR FEATURES OF DOPAMINERGIC NEURON DEVELOPMENT AND VULNERABILITY.

The disproportionate expansion of telencephalic structures during human evolution involved tradeoffs that imposed greater connectivity and metabolic demands on midbrain dopaminergic neurons. Despite the central role of dopaminergic neurons in human-enriched disorders, molecular specializations associated with human-specific features and vulnerabilities of the dopaminergic system remain unexplored. Here, we establish a phylogeny-in-a-dish approach to examine gene regulatory evolution by differentiating pools of human, chimpanzee, orangutan, and macaque pluripotent stem cells into ventral midbrain organoids capable of forming long-range projections, spontaneous activity, and dopamine release.

Attributing Racial Differences in Care to Health Plan Performance or Selection.

Importance: There is increased interest in public reporting of, and linking financial incentives to, the performance of organizations on health equity metrics, but variation across organizations could reflect differences in performance or selection bias.

Objective: To assess whether differences across health plans in sex- and age-adjusted racial disparities are associated with performance or selection bias.

Design, Setting, And Participants: This cross-sectional study leveraged a natural experiment, wherein a southern US state randomly assigned much of its Medicaid population to 1 of 5 plans after shifting to managed care in 2012.

Enhancing team development in an internal medicine resident continuity clinic.

Interprofessional teamwork is important for the provision of safe, high value patient care and is recognized as essential by the ACGME. We aimed to assess the impact of an interprofessional continuity clinic teamwork curriculum on perceptions of team development and patient safety. This project was conducted in an IM Resident Continuity Clinic where 96 residents, supported by 28 faculty and 48 interprofessional team members, attended continuity clinic two afternoons per week during alternating months of a 50/50 outpatient-inpatient training model.

The discontinuation of implantable cardioverter defibrillator shock therapies towards the end of life: consensus guideline from the British Heart Rhythm Society.

Implantable cardioverter defibrillators (ICDs) are implanted in increasing numbers of patients with the aim of treating ventricular arrhythmias in high-risk patients and reducing their risk of dying. Individuals are also living longer with these devices. As a result, a greater number of patients with an ICD will deteriorate either with worsening cardiac failure, another non-cardiac condition or general frailty and will have a limited prognosis.

Rev or restrain: Mechanisms of human-specific synaptic neoteny.

In the current issues of Neuron and Cell Reports, Libé-Philippot et al. and Assendorp et al. identify interactions between human-specific SRGAP2C, synaptic regulator SRGAP2A, and neurodevelopmental disorder-associated proteins SYNGAP1 and CTNND2 that slow synaptic maturation in human neurons.

Exploring the Experiences of Visiting Veterinary Service Providers in Indigenous Communities in Canada: Proposing Strategies to Support Pre-Clinical Preparation.

Many Indigenous communities in Canada lack access to veterinary services due to geography, affordability, and acceptability. These barriers negatively affect the health of animals, communities, and human-animal relationships. Canadian veterinary colleges offer veterinary services to Indigenous communities through fourth-year veterinary student rotations.

Supporting Positive Learning Experiences for Veterinary Students on Rotations in Remote Indigenous Communities in Canada.

Many health care programs in medicine, nursing, social work, and physiotherapy include practicum rotations near the end of students' studies. Increasingly, veterinary education programs also offer community-based rotations in underserved or remote communities. While these opportunities in veterinary medicine provide many learning benefits, they can also be stressful if the students do not feel adequately supported.

Availability Of Adult Dental Plans In The Affordable Care Act Marketplaces, 2016-23.

The Affordable Care Act Marketplaces may improve access to dental insurance, but little is known about the availability of such coverage. We used data from state and federal Marketplace sources to describe the availability of adult dental plans, including Stand-alone Dental Plans and those embedded in medical plans. We also examined the characteristics of counties with limited dental insurer participation and those that experienced a net loss of Stand-alone Dental Plan insurers between 2016 and 2023.

Supplemental Nutrition Assistance Program Work Requirements and Safety-Net Program Participation.

Importance: Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements.

Objective: To examine the association between work requirements and safety-net program enrollment.