Moving Beyond Static, Individualistic Approaches to Agency: Theories of Agency for Medical Education Researchers: AMEE Guide No. 177.

Agency - the capacity to produce an effect - is a foundational aspect of medical education. Agency is usually conceptualized at the level of the , with each learner charged with taking responsibility to pull themselves up by their bootstraps. This conceptualization is problematic.

Mohs Micrographic Surgery Efficacy for Solid Organ Transplant Head and Neck Cutaneous Squamous Cell Carcinoma.

Objective: Solid organ transplant (SOT) recipients carry a higher incidence of cutaneous squamous cell carcinoma (cSCC) with more aggressive features and worse outcomes compared to immunocompetent (IC) patients. The National Comprehensive Cancer Network advocates peripheral and deep en-face margin assessment such as Mohs micrographic surgery (MMS) for very-high-risk cSCC. We aim to assess the efficacy of MMS in the treatment of SOT immunosuppressed head and neck (HN) cSCC patients.

Anion Exchange Impedes Subsequent Cation Exchange: Ion Mobility Is Altered by Vacancies and Ion Size.

One method of achieving spatially specific, multi-component nanoheterostructures is to combine multiple forms of post-synthetic modification. Applying cation or anion exchange to CuS nanorods creates complex nanoheterostructures. Combining such anion and cation exchanges generates a system which uncovers the interplay between these two processes and understands the cooperativity between postsynthetic modifications more broadly.

Characteristics and Readmission Risks Following Sepsis Discharges to Home.

Objective: To examine the characteristics and risk factors associated with 30-day readmissions, including the impact of home health care (HHC), among older sepsis survivors transitioning from hospital to home.

Research Design: Retrospective cohort study of the Medical Information Mart for Intensive Care (MIMIC)-IV data (2008-2019), using generalized estimating equations (GEE) models adjusting for patient sociodemographic and clinical characteristics.

Subjects: Sepsis admission episodes with in-hospital stays, aged over 65, and discharged home with or without HHC were included.

PSMA and SSTR2 Dual-Targeting Theranostic Agents for Neuroendocrine-Differentiated Prostate Cancer (NEPC).

Radioactive prostate-specific membrane antigen (PSMA)-targeting agents are clinically useful for the diagnosis and treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer (mCRPC). Neuroendocrine-differentiated prostate cancer (NEPC), a highly aggressive subtype that is strongly associated with a poor clinical prognosis, may present with reduced PSMA expression and evade detection with PSMA-targeted agents. Several studies have shown elevated uptake of somatostatin receptor 2 (SSTR2) ligands in PSMA-negative NEPC.

Interchangeability of Contemporary Semi-adjustable Articulators Used Over Time: An Study.

Aim: The purpose of this study is to investigate the interchangeability of newly acquired, short-term used, and long-term used semi-adjustable articulators.

Materials And Methods: Metal analogs of partially dentate maxillary and mandibular arches were mounted on twelve semi-adjustable Stratos 300 articulators, divided into three groups based on usage over time: New, short-term used (<2 years), long-term used (>2 years) articulators. Each articulator was calibrated according to manufacturer guidelines, ensuring consistency.

Impact of a Virtual Care Navigation Service on Member-Reported Outcomes Among Lesbian, Gay, Bisexual, Transgender, and Queer Populations: Case Study.

Background: While the significance of care navigation in facilitating access to health care within the lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) communities has been acknowledged, there is limited research examining how care navigation influences an individual's ability to understand and access the care they need in real-world settings. By analyzing private sector data, we can bridge the gap between theoretical research findings and practical applications, ultimately informing both business strategies and public policy with evidence grounded in real-world efficacy.

Objective: The objective of this study was to evaluate the impact of specialized virtual care navigation services on LGBTQ+ individuals' ability to comprehend and access necessary care within a national cohort of commercially insured members.

Modeling Malignant Mesothelioma in Genetically Engineered Mice.

Mesothelioma is a lethal cancer of the serosal lining of the body cavities. Risk factors include environmental and genetic factors. Asbestos exposure is considered the principal environmental risk factor, but other carcinogenic mineral fibers, such as erionite, also have a causal role.

Investigating the Uptake of Hypofractionation for Breast and Prostate Cancer in Sub-Saharan Africa: A Qualitative Study of Physician and Medical Physicist Perspectives.

Purpose: In prostate and breast cancer, moderate hypofractionation (HF) has demonstrated comparable, if not greater, efficacy than conventional fractionation. There is a stark disparity in the uptake of HF between North America and Africa. Using the Consolidative Framework for Implementation Research, we evaluated barriers and facilitators for implementing HF in Sub-Saharan Africa (SSA).

Biventricular Dysfunction Due to Chronic Mitral Valve Regurgitation Caused by Aberrant Mitral Arcade.

A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade.

Impact and Durability of the Affordable Care Act Medicaid Expansion on Lung Cancer Treatment.

Background: Medicaid expansion began in 2014 after passage of the Affordable Care Act; however, the impact and durability of the effects on lung cancer treatment utilization are poorly defined. We aimed to determine whether there is a persistent difference in utilization of lung resection, lung biopsy, and nonoperative treatment of lung cancer in states participating in Medicaid expansion compared with states that are not.

Methods: A retrospective cohort study was completed analyzing the difference in utilization between Medicaid expansion states and non-expansion states in 2012-2013, 2016-2017, and 2019.

Donor Specific Antibodies in Extracorporeal Membrane Oxygenation-Bridged Lung Transplant Recipients.

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Although other mechanical circulatory support devices have been associated with anti-human leukocyte antigen antibody formation, including de novo donor-specific antibodies (dnDSA), it is unknown whether ECMO is a sensitizing exposure.

Methods: This was a single-center retrospective cohort study of lung transplant recipients.

Staged Hybrid Management of a Mycotic Ascending Aortic Pseudoaneurysm.

Ascending aortic pseudoaneurysm may pose significant risk for reoperative repair. We describe an 18-year-old man who presented with bacteremia and a large, mycotic ascending aortic pseudoaneurysm 3 months after redo cardiac surgery. A covered stent graft sealed the pseudoaneurysm neck and facilitated safe reentry into the mediastinum.

Circumferential Pulmonary Ossification From Lung Extraskeletal Osteosarcoma With Mediastinal Shift.

Primary extraskeletal osteosarcoma of the lung is exceedingly rare and associated with a poor prognosis. This case report presents a patient with circumferential pulmonary ossification secondary to lung extraskeletal osteosarcoma with compressive mediastinal shift who underwent extrapleural pneumonectomy that led to resolution of symptoms. This case offers an approach to the operative management of primary thoracic osteosarcoma and suggests that even patients with advanced disease may be surgical candidates, particularly for symptom relief.

Pulmonary Artery Vasa Vasorum Damage in Severe COVID-19-Induced Pulmonary Fibrosis.

Background: COVID-19 patients exhibit higher incidence of thrombosis in arteries and veins, including those in lungs. Vasa vasorum, which support large blood vessels, have shown involvement in these pathologic processes.

Methods: To further explore the extent of microvascular damage caused by COVID-19 infection, we examined resected main, right, or left pulmonary artery specimens from patients undergoing bilateral lung transplantation for COVID-19- or non-COVID-19-induced pulmonary fibrosis compared with organ donors by histologic and immunohistologic analyses.

Geographic Variation in the Utilization of Services Surrounding Lung Cancer Resection.

Background: As value-based care models continue to gain emphasis, along with the need for improved profiling across the continuum of lung cancer care, a better understanding of geographic variation in utilization of services surrounding episodes of care is needed.

Methods: In this retrospective cohort study of patients undergoing lung cancer resection from 2017 to 2019, we examined geographic variation in utilization of services surrounding episodes of lung cancer resection. We utilized hierarchical logistic regression models to determine risk-adjusted utilization of services.

Intraoperative Features Improve Model Risk Predictions After Coronary Artery Bypass Grafting.

Background: Intraoperative physiologic parameters could offer predictive utility in evaluating risk of adverse postoperative events yet are not included in current standard risk models. This study examined whether the inclusion of continuous intraoperative data improved machine learning model predictions for multiple outcomes after coronary artery bypass grafting, including 30-day mortality, renal failure, reoperation, prolonged ventilation, and combined morbidity and mortality (MM).

Methods: The Society of Thoracic Surgeons (STS) database features and risk scores were combined with retrospectively gathered continuous intraoperative data from patients.

Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: National Database Analysis.

Background: Pectus excavatum (PE) is the most common congenital chest wall defect and is characterized by the inward displacement of the sternum and costal cartilages. To date, there are limited data on adult patients undergoing the Nuss procedure for PE. This study aimed to assess the complication rate between the pediatric and adult populations and assess the trends in demographics.

The Challenges of Aortic Valve Management After Left Ventricular Assist Device Implantation.

Background: Continuous retrograde flow across the aortic valve from left ventricular assist device (LVAD) therapy can result in cusp damage and progressive aortic regurgitation, potentially triggering recurrent heart and multiorgan failure. The management of aortic regurgitation after LVAD implantation has not been well defined.

Methods: This study retrospectively reviewed the investigators' experience with the management of de novo aortic regurgitation requiring intervention in patients with continuous-flow LVAD.

Institutional Experience With Robotic Lobectomy After Neoadjuvant Immunotherapy and Chemotherapy.

Background: The real-world safety of robotic resections after neoadjuvant chemoimmunotherapy remains poorly defined in patients with non-small cell lung cancer. Due to reported increased operative challenges after neoadjuvant immunotherapy, we aim to describe our early institutional experience and outcomes after robotic resection in this clinical context.

Methods: We performed a retrospective chart review of patients with non-small cell lung cancer who underwent a robotic lobectomy, comparing patients from June 1, 2022, through October 31, 2023, who were treated with neoadjuvant chemoimmunotherapy consistent with the Checkmate-816 protocol and a control group with upfront resection.

Histology and Lung Nodule Fluorescence in Intraoperative Molecular Imaging With Pafolacianine.

Background: Intraoperative molecular imaging (IMI) uses a cancer-targeted fluorescent agent injected into patients to localize tumor nodules. Pafolacianine is a folate receptor (FR)-targeted near-infrared fluorescent probe. Almost 10% of patients have false negative fluorescence findings intraoperatively.

Nucleos(t)ide Analog Treatment Discontinuation in Chronic Hepatitis B Virus Infection: A Systematic Literature Review.

Background And Aims: The aim of this systematic literature review (SLR) was to examine outcomes and associated predictors following nucleos(t)ide analog (NA) treatment cessation in adult patients with chronic hepatitis B virus infection.

Methods: The SLR was conducted according to PRISMA methodology. All included studies were quality assessed using appropriate scales or checklists.

Submitral Pseudoaneurysm Repair and Posterior Leaflet Augmentation: Reoperative Mitral Valve Repair.

A 33-year-old woman who had previously undergone mitral valve repair for native valve endocarditis presented with a submitral left ventricular pseudoaneurysm, with related mitral valve dysfunction. The operative approach to this complex pathophysiologic process is presented.