Decreasing Unnecessary Resource Utilization for New-onset, Unprovoked, Afebrile Seizure in the Emergency Department.

Introduction: Pediatric seizures account for approximately 1% of emergency department (ED) presentations. Laboratory evaluation and emergent electroencephalogram (EEG) are not indicated in patients with a new-onset, unprovoked, afebrile seizure with a normal physical examination. This study aimed to reduce unnecessary ED resource utilization.

Bladder Wash: A Proof of Concept as an Alternative Specimen for Postmortem Toxicology.

In postmortem forensic investigation cases where the bladder is voided or dehydrated prior to autopsy, it is possible to wash the bladder with saline and collect the 'bladder wash' and any residual urine for toxicological analysis. While not conventional, this study aims to determine the use of bladder washes as alternative specimens in postmortem forensic toxicology. Comprehensive drug and alcohol analysis was performed on blood, urine, vitreous humor and bladder wash samples.

Association of Pre- and Postinjury Mental Health With Long-term Clinical and Financial Outcomes.

Background: As increased attention is placed on optimizing long-term outcomes of trauma patients by addressing mental health, little is known regarding the interplay of pre- and postinjury mental health on long-term financial and functional outcomes.

Methods: Patients from 19 Level 1 and 2 trauma centers took part in serial surveys 1 to 24 months postdischarge. Preinjury mental health diagnoses were identified using trauma registry data and postinjury mental health symptoms from survey data.

Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage.

Background: Ethnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions (ECMH) for Indigenous women in Mexico. Documenting progress in reducing maternal health inequities, particularly given the disproportionate impact of the Covid-19 pandemic on ethnic minorities, is essential to improving equity in health systems.

Genetic predisposition to high circulating levels of interleukin 6 and risk for Alzheimer's disease. Discovery and replication.

Importance: Aging is accompanied by immune dysregulation, which has been implicated in Alzheimer's disease (AD) pathogenesis. Individuals who are genetically predisposed to elevated levels of proinflammatory mediators might be at increased risk for AD.

Objective: To investigate whether genetic propensity for higher circulating levels of interleukin 6 (IL-6) is associated with AD risk.

Use of a periodontal resective procedure (proximal wedge technique) for treating gingival and periodontal pockets of mandibular canine teeth in dogs.

Objectives: This study aims to evaluate the ability of a periodontal resective procedure (the Proximal Wedge Technique) to improve the long-term health of the mandibular canines by reducing probing depths immediately post-surgery via targeted tissue recontouring and precise debridement. The technique aims to enhance periodontal health and stabilize the supporting structures of strategically important adjacent canine teeth, including alveolar bone, rather than relying solely on mandibular incisor extractions with simple closure.

Materials And Methods: A retrospective records review compiled data from patients with suprabony pockets of 6 mm or greater at the mesial aspect of the mandibular canines treated with the proximal wedge technique (PWT).

Delayed or forgone medical care associated with increased resource utilization and health care expenditures among patients with peripheral artery disease in the United States.

Background: PAD affects >12 million Americans and poses significant financial burdens on patients, but the relationship between delayed/forgone (D/F) care and resource use in this population is unknown. We sought to assess the relationship between D/F care, resource use, and health care expenditures among patients with PAD.

Methods: Adults with PAD in the US were identified in the Medical Expenditure Panel Survey for years 2007-2017.

The North American Repository for Archaeological Isotopes.

Here, we present the North American Repository for Archaeological Isotopes (NARIA), the largest open-access compilation of previously reported isotopic measurements (n = 28,374) from bioarchaeological samples in North America (i.e., Canada, Greenland, Mexico, and the United States of America) covering a time-frame of more than 12,000 years.

Aarskog-Scott syndrome: a clinical study based on a large series of 111 male patients with a pathogenic variant in and management recommendations.

Background: Aarskog-Scott syndrome (AAS) is a rare condition with multiple congenital anomalies, caused by hemizygote variants in the gene. Its description was based mostly on old case reports, in whom a molecular diagnosis was not always available, or on small series. The aim of this study was to better delineate the phenotype and the natural history of AAS and to provide clues for the diagnosis and the management of the patients.

Effect of mass campaigns with full and fractional doses of pneumococcal conjugate vaccine (Pneumosil) on the reduction of nasopharyngeal pneumococcal carriage in Niger: a three-arm, open-label, cluster-randomised trial.

Background: In settings with low pneumococcal conjugate vaccine (PCV) coverage, multi-age cohort mass campaigns could increase population immunity, and fractional dosing could increase affordability. We aimed to evaluate the effect of mass campaigns on nasopharyngeal pneumococcal carriage of Pneumosil (PCV10) in children aged 1-9 years in Niger.

Methods: In this three-arm, open-label, cluster-randomised trial, 63 clusters of one to four villages in Niger were randomly assigned (3:3:1) using block randomisation to receive campaigns consisting of a single full dose of a 10-valent PCV (Pneumosil), a single one-fifth dose of Pneumosil, or no campaign.

Procalcitonin-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection in the UK (BATCH): a pragmatic, multicentre, open-label, two-arm, individually randomised, controlled trial.

Background: Procalcitonin is a rapid response biomarker specific for bacterial infection, which is not routinely used in the UK National Health Service. We aimed to assess whether using a procalcitonin-guided algorithm would safely reduce the duration of antibiotic therapy compared with usual care, in which C-reactive protein is the commonly used biomarker.

Methods: The BATCH trial was a pragmatic, multicentre, open-label, parallel, two-arm, individually randomised, controlled trial conducted in 15 hospitals in England and Wales.

Beyond the Herald Patch: Exploring the Complex Landscape of Pityriasis Rosea.

Pityriasis rosea (PR) is a prevalent dermatological condition characterized by a distinctive herald patch, followed by secondary eruptions, often forming a "Christmas tree" pattern on the trunk. Despite its recognizable clinical presentation, the etiology of PR remains uncertain, with hypotheses pointing to both infectious and noninfectious origins. Human herpesviruses (HHV) 6 and 7 have been implicated, with evidence suggesting viral reactivation as a potential trigger.

On fostering employee participation in voluntary corporate-sponsored wellness programs.

As organizations are increasingly turning to voluntary wellness programs to improve employee well-being, the majority of studies in literature have focused on corporate-level benefits of wellness programs, such as productivity. However, there is a scarcity of studies that examine the intrinsic motivators that influence employee participation in such programs. In this study, we use a unique secondary dataset from a voluntary corporate wellness program and propose a novel theoretical framework based on motivational and behavioral theories to examine and understand the participants' behavior.

Folic Acid and Methyltetrahydrofolate Supplementation in the Mouse Model with Hepatic Steatosis.

Background/objectives: The gene variant results in a thermolabile MTHFR enzyme associated with elevated plasma homocysteine in TT individuals. Health risks associated with the TT genotype may be modified by dietary and supplemental folate intake. Supplementation with methyltetrahydrofolate (methylTHF) may be preferable to folic acid because it is the MTHFR product, and does not require reduction by DHFR to enter one-carbon folate metabolism.

Longitudinal study of care needs and behavioural changes in people living with dementia using in-home assessment data.

Background: People living with dementia often experience changes in independence and daily living, affecting their well-being and quality of life. Behavioural changes correlate with cognitive decline, functional impairment, caregiver distress, and care availability.

Methods: We use data from a 3-year prospective observational study of 141 people with dementia at home, using the Bristol Activities of Daily Living Scale, Neuropsychiatric Inventory and cognitive assessments, alongside self-reported and healthcare-related data.

A qualitative exploration of the enablers of and barriers to conformance with antibiotic withdrawal periods on smallholding, peri-urban pig farms in Kiambu County, Kenya.

Non-conformance with antibiotic withdrawal period guidelines represents a food safety concern, with potential for antibiotic toxicities and allergic reactions as well as selecting for antibiotic resistance. In the Kenyan domestic pig market, conformance with antibiotic withdrawal periods is not a requirement of government legislation and evidence suggests that antibiotic residues may frequently be above recommended limits. In this study, we sought to explore enablers of and barriers to conformance with antibiotic withdrawal periods for pig farms supplying a local independent abattoir in peri-urban Nairobi.

Treatment of 50 Acute and Chronic Wounds of Multiple Etiologies: A Case Series Looking at Outcomes and Utility of an Extended-Wear Transforming Powder Dressing.

Increasing healthcare costs, limited healthcare resources, an aging population, and lifestyle-related diseases make wound management a growing clinical, social, and economic burden. This case series investigated the use of a novel, biocompatible, polymer-based transforming powder dressing (TPD) that transforms in situ to a shape-retentive wound matrix upon hydration for treating wounds of various etiologies.In this institutional review board-approved single-center retrospective case series, the researchers evaluated various acute and chronic wounds treated with TPD over a period of 2 years.

Prevalence, Etiology and Outcomes of Native Pulmonary Regurgitation in the General Adult Population.

Aims: Pulmonary regurgitation (PR) after reparative intervention for congenital heart disease has been studied extensively. However, the burden, distribution of causes, and outcome of PR in adults is unknown. The study aimed to evaluate the prevalence, types, and outcomes of moderate/severe PR in adults in the community setting.

Frontal lobe intra-axial schwannoma harboring a CHD7::VGLL3 fusion and heterozygous TSC2 p.F1510del mutation in a young child.

Background: Brain intraparenchymal schwannoma is a rare clinical entity, generally curable with adequate resection.

Methods And Results: We describe a case in a male patient first presenting at 19 months of age, the youngest reported age for this lesion. It also appears to be the first case connected to a germline TSC2 p.

Developing structured clinical review templates in an integrated respiratory team during COVID-19: a qualitative review.

Introduction: In response to the SARS-CoV-2 pandemic in March 2020 and required adherence to infection control measures and patient and staff safety, an integrated respiratory team (IRT) developed guideline-based templates to support the team in teleconsultation reviews of their patients. Patients had been diagnosed with sleep disordered breathing, chronic obstructive pulmonary disease, asthma, interstitial lung disease or had oxygen assessment needs.

Methods: Nine IRT members collaboratively developed content for the templates to assist in clinical reviews.

A Novel Case of Biallelic MLH3 Variants in a Patient With Rectal Cancer and Polyps.

An increasing number of autosomal recessive forms of adenomatous polyposis have been described, but some in very few cases. Here, we describe a rare case of biallelic germline pathogenic variants in the MLH3 gene, implicating it as a potential cause of early colorectal cancer. The patient, a 47-year-old woman, presented with rectal bleeding, leading to the discovery of a malignant rectal tumor and adenomas during colonoscopy.

Prospective validation of ORACLE, a clonal expression biomarker associated with survival of patients with lung adenocarcinoma.

Human tumors are diverse in their natural history and response to treatment, which in part results from genetic and transcriptomic heterogeneity. In clinical practice, single-site needle biopsies are used to sample this diversity, but cancer biomarkers may be confounded by spatiogenomic heterogeneity within individual tumors. Here we investigate clonally expressed genes as a solution to the sampling bias problem by analyzing multiregion whole-exome and RNA sequencing data for 450 tumor regions from 184 patients with lung adenocarcinoma in the TRACERx study.

Development of a predictive model for loss of functional and cognitive abilities in long-term care home residents: a protocol.

Introduction: Long-term care (LTC) residents require extensive assistance with daily activities due to physical and cognitive impairments. Medical treatment for LTC residents, when not aligned with residents' wishes, can cause discomfort without providing substantial benefits. Predictive models can equip providers with tools to guide treatment recommendations that support person-centred medical decision-making.

Chronic GIPR agonism results in pancreatic islet GIPR functional desensitisation.

Objectives: There is renewed interest in targeting the glucose-dependent insulinotropic polypeptide receptor (GIPR) for treatment of obesity and type 2 diabetes. G-protein coupled receptor desensitisation is suggested to reduce the long-term efficacy of glucagon-like-peptide 1 receptor (GLP-1R) agonists and may similarly affect the efficacy of GIPR agonists. We explored the extent of pancreatic GIPR functional desensitisation with sustained agonist exposure.