The Cost of Gaps in Care: A Case of Lidocaine Toxicity and Postpartum Seizures.

This report describes the case of a 20-year-old Spanish-speaking female at 39 weeks gestation who experienced a generalized seizure immediately after lidocaine administration for a labial fold episiotomy repair following a complicated vaginal delivery. With limited prenatal care, language barriers, and socioeconomic challenges, the patient required intubation and intensive care unit (ICU) transfer for management. Extensive workup ruled out common causes, and the likely diagnosis was an atypical presentation of preeclampsia.

Challenges and Recommendations for Proxy Reporting in Aging Research: A Brief Commentary.

The US has an aging population that is under-represented in research. Many older adults face barriers to research participation, such as mobility issues, comorbidities, and declining physical and cognitive health, which make it harder for them to understand study processes and give informed consent. Proxies can be family members, paid or unpaid caregivers, or healthcare providers who provide health information for older adults.

A Rare Case of Viral Meningitis and Probable Metabolic Encephalopathy in a Renal Transplant Patient.

This case report highlights the complex clinical presentation of a 43-year-old male with a history of renal transplantation, hypertension, and diabetes mellitus, who developed viral meningitis with probable metabolic encephalopathy. The multidisciplinary approach involved infectious disease specialists, transplant nephrologists, and neurologists. This case provides unique learning points such as highlighting the complexities of diagnosing and managing viral meningitis in an immunocompromised post-transplant patient, emphasizing the importance of a multidisciplinary approach, innovative medication delivery, and awareness for complications such as metabolic encephalopathy and persistent fevers.

Risk Factors for 30-Day Readmission and Reoperation Following Clavicle Open Reduction Internal Fixation.

Introduction Clavicle open reduction internal fixation (ORIF) is an effective treatment for the surgical management of clavicle fractures. However, the literature surrounding the risk factors for readmission and reoperation following clavicle ORIF remains understudied. The purpose of this study is to investigate the specific risk factors for 30-day readmission and reoperation following clavicle ORIF.

Comparative main effects, mediators, and moderators of cognitive behavioral therapy, acceptance and commitment therapy, and emotional awareness and expression therapy for chronic spinal pain: Randomized controlled trial rationale and protocol.

Background: Chronic spinal (back/neck) pain is common and costly. Psychosocial treatments are available but have modest effects. Knowledge of treatment mechanisms (mediators and moderators) can be used to enhance efficacy.

Strategies for recruitment and retention of diverse and underserved cancer survivor and caregiver dyads in clinical trials.

Background: Cancer survivor-caregiver dyads from underrepresented racial and ethnic groups and those with lower socioeconomic status are less likely to participate in clinical research. Sociocultural and socioeconomic barriers perpetuate health inequity and increase disparities in cancer care.

Purpose: We describe our systematic approach to recruiting and retaining diverse survivor-caregiver dyads in supportive cancer care studies.

Assessing the Impact of Patient-Specific Instrumentation and Fixation on Accuracy and Radiation Exposure in a Cadaveric Model of Medial Opening-Wedge High Tibial Osteotomy.

Background: Traditional freehand techniques in high tibial osteotomy (HTO) have been shown to lack precision and accuracy. Patient-specific instrumentation (PSI) and fixation created from cross-sectional imaging have recently been introduced to address this problem.

Purpose/hypothesis: The purpose of the study was to compare traditional freehand techniques versus PSI in a human cadaveric model of HTO.

Ranking Surgeon Performance After ACL Reconstruction Using the Knee Injury and Osteoarthritis Outcome Score (KOOS) Subscales.

Background: Patient-reported outcomes (PROs) are considered the gold standard for evaluating value-based care in orthopaedics. However, there is little evidence to guide implementation of PROs for surgeon performance evaluation.

Purpose: To develop a risk-adjusted surgeon performance measure using the Knee injury and Osteoarthritis Outcome Score (KOOS) for patients undergoing anterior cruciate ligament reconstruction (ACLR).

Application of Bayesian Decision Theory in Detecting Test Fraud.

This article suggests a new approach based on Bayesian decision theory (e.g., Cronbach & Gleser, 1965; Ferguson, 1967) for detection of test fraud.

Anesthetic Management and Considerations for Cesarean Delivery in a Patient With Cystic Fibrosis.

Recent advancements in therapeutics and risk reduction in the management of cystic fibrosis have increased the life expectancy of cystic fibrosis patients to the fifth decade of life. As the life expectancy of cystic fibrosis patients has increased, more cystic fibrosis patients have opted to pursue pregnancy. Normal pregnancy is accompanied by physiological changes that affect anesthetic management.

Developing a Novel Integrative Health Equity and Anti-racism Tool (IHEART) for Pilot Application in a Multicenter Integrative Health Elective for Medical Students and Resident Physicians: A Study Protocol.

Background: This study protocol introduces the Integrative Health Equity and Anti-Racism Tool (IHEART), an innovative instrument designed to infuse equity, diversity, and inclusion (EDI) into Integrative Health (IH) education. Recognizing the gaps in current IH training that fail to address social and systemic inequities adequately, the IHEART is intended to respond to the growing need for inclusivity in IH practices and educational materials. The tool is mainly focused on addressing issues such as accessibility of complementary and integrative health (CIH) therapies, cultural misappropriation, anti-racism, gender diversity, disability justice, trauma-informed care, weight inclusivity, and planetary health, which are currently inconsistently covered in IH training.

Prophylactic clemastine treatment improves influenza A virus-induced cognitive dysfunction in mice.

Respiratory infection by influenza A virus (IAV) is known to cause systemic inflammation, neuroinflammation, and cognitive impairment. We previously found that experimental infection with IAV affected oligodendrocyte homeostasis, which was associated with altered expression of genes involved in myelin maintenance as well as the lipidome. In this study, we sought to determine if clemastine, an antihistamine with myelin promoting properties, could reverse the effects of IAV on oligodendrocyte (OL) specific genes, as well as mitigate infection-induced cognitive impairment.

The mind, brain, and body study: A protocol for examining the effects of the gut-brain-immune axis on internalizing symptoms in youth exposed to caregiving-related early adversity.

Experiences of caregiving-related adversity are common and one of the strongest predictors of internalizing psychopathology (i.e., anxiety and depression).

Transcriptomics and psychotherapy: An integrative review.

Gold-standard psychotherapies like cognitive-behavioral therapy (CBT) show beneficial effects, but patient responses vary, indicating a need to predict and optimize treatment efficacy. Gene expression analysis may offer insights into the interplay between psychosocial processes and biological factors that impact psychopathology and therapeutic response. This integrative review examines 17 studies that assess gene expression in the context of psychotherapy, highlighting innovative frameworks for incorporating gene expression analysis in diagnosis, predicting treatment response, and monitoring treatment progress.

LASF: a local adaptive segmentation framework for coronary angiogram segments.

Coronary artery disease (CAD) remains the leading cause of death globally, highlighting the critical need for accurate diagnostic tools in medical imaging. Traditional segmentation methods for coronary angiograms often struggle with vessel discontinuity and inaccuracies, impeding effective diagnosis and treatment planning. To address these challenges, we developed the Local Adaptive Segmentation Framework (LASF), enhancing the YOLOv8 architecture with dilation and erosion algorithms to improve the continuity and precision of vascular image segmentation.

Case report: Clinical workflow considerations for treating soft-tissue sarcoma on a 1.5-T MR-Linac.

We present specific issues that arose when using a 1.5-Tesla MR-Linac to treat a series of 4 soft-tissue sarcoma (STS) patients. These issues arose from the combination of typical STS attributes (long, off-axis target) and MR-Linac design-specific limitations on field size and patient positioning.

Analysis of over 1600 chemistry YouTube channels from 2005 to 2023.

Chemistry has found broad appeal on the freely available global video-sharing platform YouTube, with some YouTube videos even being cited in the peer-reviewed chemistry literature. By applying both manual and semi-automated search methods, we identified, categorized and analysed publicly available data for 1619 chemistry YouTube channels that were available in 2023. Forty-nine per cent of channels were active in 12 months prior to sampling.

Porphyric encephalopathy in a 15-year-old girl: A case report.

A 15-year-old girl presented with new onset tonic-clonic seizures, encephalopathy, abdominal pain, and hypertension with a history of weight loss and emesis. Brain magnetic resonance imaging scans showed diffuse, bilateral cortical and subcortical gray and white matter signal abnormalities. Electroencephalography showed background slowing and disorganization.

Assessing the detection and interaction of and porcine circovirus 2 in low and high-performance wean-to-finish pig groups in different porcine reproductive and respiratory syndrome virus detection scenarios.

Introduction: Effective disease management strategies are essential for achieving optimal pig performance, ensuring high-quality animal health and welfare, and maintaining the economic viability of swine systems. Thus, understanding factors that lead to more or less severe disease are critically important. Porcine circovirus type 2 (PCV2) and () are endemic pathogens in the U.

Assessing the stability of psychobiological stress reactivity during adolescence: mixed-effect modelling of cortisol responses to laboratory stressors.

Background: Puberty has been historically considered as a time of risk and vulnerability for young people. It is associated with rapid development in the hypothalamus, which is central in the production of both stress and sex steroids. While patterns of stress reactivity are calibrated in early life, this time of rapid development may provide a means for these patterns to change.

Assessing ChatGPT's Capability in Addressing Thyroid Cancer Patient Queries: A Comprehensive Mixed-Methods Evaluation.

Context: Literature suggests patients with thyroid cancer have unmet informational needs in many aspects of care. Patients often turn to online resources for their health-related information, and generative artificial intelligence programs such as ChatGPT are an emerging and attractive resource for patients.

Objective: To assess the quality of ChatGPT's responses to thyroid cancer-related questions.

Discrepancies Between Sex Prediction and Fetal Sex After Prenatal Noninvasive Cell-Free DNA Screening.

In the last 10 years the field of prenatal diagnosis has been significantly reshaped followed by the implementation of noninvasive prenatal cell-free DNA (cfDNA) testing methodologies in clinical practice. Based on a superior performance and higher sensitivity and specificity than the former practice of biochemical markers screening, the American College of Obstetricians and Gynecologists and American College of Medical Genetics and Genomics recommend noninvasive prenatal cfDNA screening for trisomy 21, 18, 13, and sex chromosome aneuploidy to all pregnant people. While cfDNA screening is helpful in risk assessment for the most common autosomal trisomies, cfDNA also provides information about fetal sex chromosomes.

Systemic bupropion treatment reduces long-access cocaine self-administration in male and female rats.

Background: More than 1 million people in the United States meet the criteria for cocaine use disorder (CUD), and over 19,000 people died from cocaine-related overdoses in 2020, but there are currently no FDA-approved medications for the treatment of CUD. Bupropion is an antidepressant currently prescribed to treat depression and nicotine addiction that acts by inhibiting norepinephrine and dopamine transporters.

Methods: In this study, we tested the effect of several doses of systemic bupropion on cocaine self-administration in male and female Wistar rats.

The impact of a patient advisory board on a clinical comparative effectiveness trial: a comparison of patient and researcher perspectives.

To examine contributions of a patient advisory board (PAB) to the design and conduct of The Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER) Trial (NCT02810704) and compare perceptions of PAB members and researchers on the Trial. This evaluation of the PAB was conducted by Clinical Coordinating Center (CCC) members who first discussed PAB contributions, leading to the design of a semi-structured WebEx interview individually querying PAB members on their experience. Two study team members analyzed transcriptions of the interviews for common themes, which were discussed and affirmed at an in-person meeting with PAB members.