Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial.

Importance: The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness.

Objective: To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness.

Design, Setting, And Participants: Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%.

Restorative Neurostimulation Therapy Compared to Optimal Medical Management: A Randomized Evaluation (RESTORE) for the Treatment of Chronic Mechanical Low Back Pain due to Multifidus Dysfunction.

Introduction: Many interventional strategies are commonly used to treat chronic low back pain (CLBP), though few are specifically intended to target the distinct underlying pathomechanisms causing low back pain. Restorative neurostimulation has been suggested as a specific treatment for mechanical CLBP resulting from multifidus dysfunction. In this randomized controlled trial, we report outcomes from a cohort of patients with CLBP associated with multifidus dysfunction treated with restorative neurostimulation compared to those randomized to a control group receiving optimal medical management (OMM) over 1 year.

Diagnostic value of CT scans in pediatric patients with acute non-traumatic altered mental status: a systematic review and meta-analysis.

Background: Computed tomography (CT) scans are widely used for evaluating children with acute atraumatic altered mental status (AMS) despite concerns about radiation exposure and limited diagnostic yield. This study aims to assess the efficacy of CT scans in this population and provide evidence-based recommendations.

Methods: A systematic review was conducted according to PRISMA guidelines.

Zebrafish glial-vascular interactions progressively expand over the course of brain development.

Glial-vascular interactions are critical for the formation and maintenance of brain blood vessels and the blood-brain barrier (BBB) in mammals, but their role in the zebrafish BBB remains unclear. Using three glial gene promoters-, , and (a truncated )-we explored glial-vascular development in zebrafish. Sparse labeling showed fewer glial-vascular interactions at early stages, with glial coverage and contact area increasing with age.

The promise and limits of inclusive public policy: federal safety net clinics and immigrant access to health care in the U.S.

In the United States, exclusionary public policies generate inequalities within and across labor, financial, and legal status hierarchies, which together undermine immigrant well-being. But can inclusive public policies improve immigrant health? We examine whether and how an immigrant-inclusive federal program, Federally Qualified Health Centers (FQHCs), shaped health care access and use among farmworkers over nearly three decades, paying particular attention to disparities at the intersection of nativity and legal status. Linking historical administrative data on the location and funding of FQHCs with the National Agricultural Workers Survey from 1989-2017, we first document trends in farmworkers' county-level proximity to FQHCs and identify a steady increase in FQHC access among undocumented farmworkers following the Affordable Care Act.

Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique.

Background: Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality.

Objectives: Very early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration.

Gut microbial GABA imbalance emerges as a metabolic signature in mild autism spectrum disorder linked to overrepresented Escherichia.

Gut microbiota (GM) alterations have been implicated in autism spectrum disorder (ASD), yet the specific functional architecture remains elusive. Here, employing multi-omics approaches, we investigate stool samples from two distinct cohorts comprising 203 children with mild ASD or typical development. In our screening cohort, regression-based analysis for metabolomic profiling identifies an elevated γ-aminobutyric acid (GABA) to glutamate (Glu) ratio as a metabolic signature of ASD, independent of age and gender.

A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives.

Background: Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance.

A Prospective Comparison of Patient Reported Outcomes After Facial Laser Resurfacing.

Introduction: Laser resurfacing provides a minimally invasive method for addressing facial/neck skin rejuvenation neglected by modern surgical approaches. Despite its popularity, there is a paucity of outcome data. Herein, we present patient reported outcomes (PROs) to assess the effectiveness of a single surgeon's approach to skin rejuvenation.

Emerging themes in microbial stress response and mechanistic insights: key findings from the fall 2024 ASM Theobald Smith Society meeting.

The annual fall meeting for the Theobald Smith Society was held in November 2024 on the campus of Rutgers University-New Brunswick. Eighty-six branch members from across New Jersey attended the meeting, composed of undergraduate, graduate, and postdoctoral trainees, faculty members, and government and industry professionals. This report highlights the breadth and diversity of research conducted by American Society for Microbiology members in the Theobald Smith Society and celebrates their groundbreaking discoveries.

Surgical Opioid Stewardship: From the Epidemic Through the Pandemic and Beyond.

Background: In response to the opioid epidemic, prescribing guidelines and statewide surgical opioid management programs were initiated in 2018-19. This analysis aims to document the sustainability of a regional opioid stewardship consortium through the pandemic and beyond.

Study Design: From September 2019 through August 2023, 15 NSQIP hospitals in two states gathered opioid-specific variables on patients undergoing 12 procedures.

Environmental Exposures Associated with Enteropathogen Infection in Six-Month-Old Children Enrolled in the ECoMiD Cohort along a Rural-Urban Gradient in Northern Ecuador†.

Enteropathogens are major contributors to mortality and morbidity, particularly in settings with limited access to water, sanitation, and hygiene infrastructure. To assess transmission pathways associated with enteropathogen infection, we measured household environmental conditions and assayed 22 enteropathogens using TaqMan Array Cards in stool samples from 276 six-month-old children living in communities along a rural-urban gradient in Northern Ecuador. We utilized multivariable models, risk factor importance, and distance-based statistical methods to test factors associated with infection.

Strategic Management of Valve Infolding in Evolut TAVR Procedures: Enhancing Outcomes and Ensuring Patient Safety.

Transcatheter aortic valve repair (TAVR) presents a minimally invasive alternative to traditional surgical valve replacement, albeit not without its own set of complications. A rare complication is the infolding of the self-expanding valve, which can precipitate cardiac arrest. The estimated incidence rate of this complication stands at 1.

Current Applications and Future Directions for Vascular Stents with Stem Cells in the Treatment of Intracranial Aneurysms: A Mini-Review.

Vascular stents and stem cells have been used in high-acuity cases for many decades, particularly in cardiology. Providing the physician with another avenue of treatment, they have had a reasonable amount of success. However, there has been very little research conducted on seeding vascular stents with stem cells when treating intracranial aneurysms.

Identifying genetic differences between bipolar disorder and major depression through multiple genome-wide association analyses.

Background: Accurate diagnosis of bipolar disorder (BPD) is difficult in clinical practice, with an average delay between symptom onset and diagnosis of about 7 years. A depressive episode often precedes the first manic episode, making it difficult to distinguish BPD from unipolar major depressive disorder (MDD).

Aims: We use genome-wide association analyses (GWAS) to identify differential genetic factors and to develop predictors based on polygenic risk scores (PRS) that may aid early differential diagnosis.

Predictive equation derived from 6,497 doubly labelled water measurements enables the detection of erroneous self-reported energy intake.

Nutritional epidemiology aims to link dietary exposures to chronic disease, but the instruments for evaluating dietary intake are inaccurate. One way to identify unreliable data and the sources of errors is to compare estimated intakes with the total energy expenditure (TEE). In this study, we used the International Atomic Energy Agency Doubly Labeled Water Database to derive a predictive equation for TEE using 6,497 measures of TEE in individuals aged 4 to 96 years.

The integration of self-efficacy and response-efficacy in decision making.

The belief that we can exert an influence in our environment is dependent on distinct components of perceived control. Here, we investigate the neural representations that differentially code for self-efficacy (belief in successfully executing a behavior) and response-efficacy (belief that the behavior leads to an expected outcome) and how such signals may be integrated to inform decision-making. Participants provided confidence ratings related to executing a behavior (self-efficacy), and the potential for a rewarding outcome (response-efficacy).

Short- and Mid-Term Outcomes Following ALIF and TLIF in L5-S1 Isthmic Spondylolisthesis Patients.

Background: A limited number of studies have compared the outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF) for the treatment of isthmic spondylolisthesis. This study aims to compare postoperative complications between these two surgical approaches.

Methods: A retrospective review was performed using a large national database.

Occult collision tumor of the gastroesophageal junction comprising adenocarcinomas with distinct molecular profiles.

Collision tumors, characterized by the coexistence of two unique neoplasms in close approximation, are rare and pose diagnostic challenges. This is particularly true when the unique neoplasms are of the same histologic type. Here we report such a case where comprehensive tumor profiling by next generation sequencing (NGS) as well as immunohistochemistry revealed two independent adenocarcinomas comprising what was initially diagnosed as a single adenocarcinoma of the gastroesophageal (GEJ) junction.

Stress and Cardiovascular Disease: The Role of Affective Traits and Mental Disorders.

Personality traits involving negative affect, as well as mental disorders including depression, anxiety, and posttraumatic stress disorder, are cardiovascular risk factors. However, which of these confer risk independently is uncertain, and the implications of their overlap, combinations, and interactions are poorly understood. Potential explanatory mechanisms are being characterized with increasing detail and sophistication.

Efficacy of absorbable vs. non-absorbable patient-specific, 3D-printed implants for the treatment of facial bone fractures: a systematic review and meta-analysis.

Objective: This systematic review and meta-analysis compares the efficacy and complication rate of absorbable versus non-absorbable 3D-printed, patient-customized, maxillofacial implants in facial trauma patients.

Data Sources: A comprehensive search of four databases (PubMed, Scopus, Web of Science, and Cochrane) was conducted.

Methods: A systematic review and single-proportion meta-analysis was conducted employing PRISMA guidelines.

From artifacts to human lives: Investigating the domain-generality of judgments about purposes.

People attribute purposes in both mundane and profound ways-such as when thinking about the purpose of a knife and the purpose of a life. In three studies (total = 13,720 observations from = 3,430 participants), we tested whether these seemingly very different forms of purpose attributions might actually involve the same cognitive processes. We examined the impacts of four factors on purpose attributions in six domains (artifacts, social institutions, animals, body parts, sacred objects, and human lives).

PARADIGM-PV: a randomized, multicenter phase 4 study to assess the efficacy and safety of ropeginterferon alfa-2b in patients with low- or high-risk polycythemia vera.

Polycythemia vera (PV) is characterized by clonal hematopoietic stem or progenitor cells with constitutively active somatic mutation(s) in the Janus kinase 2 gene. Phlebotomy (Phl) and aspirin are often used alone for low-risk PV patients. However, data from the Low-PV study demonstrated that Phl and aspirin may not be adequate for patients.