A Framework to Optimize Primary Care of Older Surgical Patients: A Qualitative Study of Geriatricians.

Importance: An increasing number of older adults are undergoing surgery. Older adults face significant challenges throughout the spectrum of perioperative care. No frameworks exist to support primary care clinicians in helping older adults navigate perioperative care beyond preoperative medical clearance.

Electro-oxidative Deoxyfluorination of Arenes with NEt·3HF.

This report describes the design, development, and optimization of an electrochemical deoxyfluorination of arenes using a tetrafluoropyridine-derived leaving group. NEt·3HF serves as the fluoride source, and the reactions are conducted using either constant potential or constant current electrolysis in an undivided electrochemical cell. Mechanistic studies support a net oxidative pathway, in which initial single-electron oxidation generates a radical cation intermediate that is trapped by fluoride.

Healthcare Resource Utilization Among Patients With Generalized Pustular Psoriasis: The Impact of Flares and Disease Severity.

Background: Generalized pustular psoriasis (GPP) is a rare, chronic, often unpredictable, severe multisystemic autoinflammatory skin disease from which patients can experience flares, episodes of widespread eruptions of painful, sterile pustules often accompanied by systemic symptoms. The impact of GPP flares and underlying GPP severity on the healthcare resource utilization (HCRU) is not well characterized.

Objective: To quantify HCRU among US GPP patients by flare status and underlying severity.

Liver fibrosis classification on trichrome histology slides using weakly supervised learning in children and young adults.

Background: Traditional liver fibrosis staging via percutaneous biopsy suffers from sampling bias and variable inter-pathologist agreement, highlighting the need for more objective techniques. Deep learning models for disease staging from medical images have shown potential to decrease diagnostic variability, with recent weakly supervised learning strategies showing promising results even with limited manual annotation.

Purpose: To study the clustering-constrained attention multiple instance learning (CLAM) approach for staging liver fibrosis on trichrome whole slide images (WSIs) of children and young adults.

Clinical, immunophenotypic, and genomic findings of acute myeloid leukemia with RAM immunophenotype: Comparison with other CD56-positive acute leukemias.

Background: Acute myeloid leukemia (AML) with RAM immunophenotype is a newly recognized high-risk AML immunophenotypic subcategory characterized by blasts with bright expression of CD56 and weak to absent expression of CD45, HLA-DR, and CD38, as first described by the Children's Oncology Group (COG). The relationship between AML-RAM and other CD56-positive acute leukemias is unclear. The goal of this study is to characterize the clinicopathological characteristics of AML with RAM phenotype and compare them with other CD56 co-expressing acute leukemias.

Long-term outcomes and resource Utilization related to upper extremity off-roading vehicle injuries.

Purpose: We aim to evaluate outcomes after off-roading injuries to determine their impact on patients' pain and function. Further, we aim to evaluate the burden on the healthcare system that result from these injuries.

Methods: Patients treated surgically for an off-roading injury at a single tertiary academic center completed surveys about their current level of upper extremity pain and function using QuickDASH and VAS-Pain scores.

Your Brain's "Save" Button: The Amygdala.

Do you ever wonder why you remember some experiences better than others? Why you remember that funny joke your friend told at lunch a few months ago or the scary snake you saw in your backyard, but not that time you went to the post office with your parents? Just like a computer has a save button, our brains do, too! When something scary, exciting, or strange happens, a small part of the brain, the amygdala, helps us click save on that event so we can remember it later. Decades of research have helped scientists understand what parts of the brain are important for memory and how the amygdala works with other brain regions to tag experiences as worth remembering. This research is important for understanding how memories are formed and can help us create new therapies for people with memory problems, who have trouble forming new memories and remembering past experiences.

Changes in HER2 Amplification Status for Breast Cancer Patients After Immunohistochemistry Directed In Situ Hybridization.

The 2018 ASCO/CAP guidelines for HER2 testing for breast cancer implemented the addition of immunohistochemistry (IHC) directed in situ hybridization (ISH) recount to resolve equivocal results. The implementation of an additional 2+ IHC-directed ISH recount adds additional complexity to the testing workflow for an unclear impact on HER2 results. A retrospective review of all equivocal ISH cases (groups 2, 3, and 4) that underwent 2+ IHC-directed ISH, since the 2018 guidelines, which were finalized as either amplified or not amplified, was performed.

Volume-Outcome Relationship of Norwood Procedures: Insights from the National Pediatric Cardiology - Quality Improvement Collaborative Database.

Background: Prior investigations of the center-specific case volume on outcomes in hypoplastic left heart syndrome have conflicting results. This study utilized the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry to investigate the center volume-outcome relationship in patients following the Norwood procedure with consideration of pre-operative high-risk features.

Methods: Between 2016 and 2023, centers were categorized by Norwood procedure volume into low (≤ 5 cases/year), medium (6 to 10 cases/year), and high-volume centers (> 10 cases/year).

Insurance-Based Disparities in Cardiac Allograft Vasculopathy Following Heart Transplantation Are Mediated by Care at High Volume Centers.

Background: Socioeconomic disadvantage and Medicaid insurance have been linked with inferior survival following heart transplantation, yet the contributing mechanisms remain to be elucidated. We evaluated the association of Medicaid with the development of cardiac allograft vasculopathy(CAV).

Methods: We considered heart transplant recipients ≥18years within the 2004-2022 Organ Procurement and Transplantation Network.

The Society of Thoracic Surgeons National Intermacs Database Risk Model for Durable Left Ventricular Assist Device Implantation.

Background: Statistical risk models for durable left ventricular assist device (LVAD) implantation inform candidate selection, quality improvement, and evaluation of provider performance. We developed a 90-day mortality risk model utilizing The Society of Thoracic Surgeons National Intermacs Database (STS Intermacs).

Methods: STS Intermacs was queried for primary durable LVAD implants from 1/ 2019 - 9/2023.

Global impact of 10- and 13-valent pneumococcal conjugate vaccines on pneumococcal meningitis in all ages: the PSERENADE project.

Background: Pneumococcal conjugate vaccines (PCVs) introduced in childhood national immunization programs lowered vaccine-type invasive pneumococcal disease (IPD), but replacement with non-vaccine-types persisted throughout the PCV10/13 follow-up period. We assessed PCV10/13 impact on pneumococcal meningitis incidence globally.

Methods: The number of cases with serotyped pneumococci detected in cerebrospinal fluid and population denominators were obtained from surveillance sites globally.

Insights into the use of DNA content in head and neck squamous cell carcinoma as a method for patient stratification and targeted therapy: Revisiting old concepts and exploring new possibilities.

Background: This review aimed to emphasize the implications of DNA content in head and neck squamous cell carcinoma (HNSCC), focusing on its predictive value, role in patient stratification, and potential as a therapeutic target for this malignancy.

Methods: A narrative review of the literature was conducted through electronic database searches.

Results: In conventional HNSCC, aneuploid tumors are associated with increased lymph node metastasis, locoregional recurrences, poor response to radiotherapy and chemotherapy, and worse prognosis.

The Anatomy of Gossip: Dissecting Dynamics and Impacts in Surgical Residency.

Background: Gossip, defined by social scientists as "evaluative talk about an absent third party," is anecdotally pervasive yet poorly understood in surgical residency programs. Gossip is known to have both positive and negative impacts. This study sought to deconstruct the role of gossip in surgical residency and evaluate its impact through the lens of surgical residents.

Survival disparities among Asian, Native Hawaiian and Pacific Islander (ANHPI) patients with non-Hodgkin lymphoma (NHL) in the United States.

Background: Non-Hodgkin lymphoma (NHL) is the seventh most common cancer among Asian, Native Hawaiian and Pacific Islanders (ANHPIs), yet the risk of death in specific ANHPI subgroups in the US is unknown.

Methods: We used Surveillance, Epidemiology, and End Results data to investigate relative survival and the risk of death among NHL patients in ANHPI subgroups. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals (CI), comparing ANHPI subgroups to non-Hispanic White (NHW) NHL patients for all-cause death and NHL-specific death.

Comparison of Interportal and Periportal Capsulotomies and Axial Distraction Resistance During Hip Arthroscopy: An In Vivo Propensity-Matched Cohort Study.

Background: Intraoperative hip capsule management is increasingly recognized as an important component of hip arthroscopy for the prevention of capsular-related instability. The periportal capsulotomy, relative to the interportal capsulotomy, has been proposed as a minimally invasive technique for decreasing postarthroscopy hip instability; however, the biomechanical effects of this technique are not well established.

Purpose/hypothesis: This study aimed to provide a biomechanical characterization of interportal and periportal capsulotomies, helping inform surgeon choice of capsulotomy type and repair, potentially guiding clinical practice in hip arthroscopy.

Inductive Power Transfer Coil Misalignment Perception and Correction for Wirelessly Recharging Underground Sensors.

Field implementations of fully underground sensor networks face many practical challenges that have limited their overall adoption. Power management is a commonly cited issue, as operators are required to either repeatedly excavate batteries for recharging or develop complex underground power infrastructures. Prior works have proposed wireless inductive power transfer (IPT) as a potential solution to these power management issues, but misalignment is a persistent issue in IPT systems, particularly in applications involving moving vehicles or obscured (e.

Clinical and Genomic Features of Androgen Indifferent Prostate Cancer.

Androgen-indifferent prostate cancer (AIPC) is increasingly common and particularly lethal. Data describing these tumors are sparse, and AIPC remains a poorly understood malignancy. Utilizing the Oncology Research Information Exchange Network (ORIEN) database, we enriched for tumors with features of AIPC using previously described characteristics.

A Multidisciplinary Approach to Diagnosing Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN): Practical Recommendations and Insights from Countries of the Gulf Cooperation Council.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive orphan hematopoietic malignancy characterized by cutaneous and systemic hematologic involvement. BPDCN is frequently misidentified, but early, accurate diagnosis is critical to extending patient survival using tagraxofusp, a first-in-class CD123-targeted therapy, and increasing their chances of receiving a potentially curative stem cell transplantation. Cases of BPDCN in countries of the Gulf Cooperation Council are lower than the extrapolated incidence from other geographic locations due to lack of awareness of key diagnostic features, lack of consensus on the minimal phenotype for diagnosis, and lack of local immunohistochemistry testing facilities, contributing to underdiagnosis in this region.

Evaluating Tumor Tissue Modified Viral (TTMV)-HPV DNA for the Early Detection of Anal Squamous Cell Carcinoma Recurrence.

Background: The incidence and mortality of anal squamous cell carcinoma (ASCC) are rising, with greater than 80% of cases linked to human papillomavirus (HPV), primarily HPV16. Post-treatment surveillance can be challenging due to the limitations of anoscopy, digital anal rectal exam (DARE), and imaging. Plasma tumor tissue modified viral (TTMV)-HPV DNA has shown strong sensitivity, specificity, and predictive value in detecting the recurrence of HPV-driven oropharyngeal cancer.

Exploring the Role of Communication Asset Mapping (CAM) as a Strategy to Promote Hereditary Cancer Risk Assessment Information Within African American Communities.

: African Americans (AAs) carry the largest burden for almost every type of cancer in the US and are also more likely to die from cancer. Approximately 10% of cancers can be explained by a hereditary factor and detected earlier. Many AAs, however, have inequitable access to hereditary cancer risk assessment (HCRA) tools and information, further exacerbating disparities in cancer rates.

A community-engaged qualitative study of factors affecting sleep among Hispanic/Latinos with short sleep duration.

Background: Despite having high prevalence of short sleep duration, poor sleep quality, and sleep disorders in adult Hispanics living in the US, there is limited understanding of the underlying barriers to sleep and effective interventions in these groups. This study aimed to increase understanding of sleep duration and attitudes toward sleep interventions among Hispanic adults.

Methods: We conducted 5 online focus group discussions with male and female participants aged 18-65 recruited from the Hispanic community who reported sleeping <7 hours per night.

Exploring the impact of insurance switching on the cost-effectiveness of population genetic screening for familial hypercholesterolemia to US payers.

Background: Widespread familial hypercholesterolemia screening requires a large upfront economic investment, but the health benefits and cost savings of cardiovascular disease prevention directed by screening occur over many years.

Objective: We evaluated the cost-effectiveness of population genetic screening for familial hypercholesterolemia compared to cascade testing to US payers while accounting for patient insurance switching between commercial and Medicare insurance.

Methods: We developed a hybrid decision-tree Markov model to assess genetic screening in 20-year-old adults over a lifetime horizon in which cohort members transitioned between commercial payers representing three commercial plans and Medicare.