Retooling the Massive Transfusion Protocol at a Veterans Affairs Medical Center.

Introduction: Massive transfusion protocols (MTPs) ensure the timely and life-saving delivery of blood products to patients who are rapidly exsanguinating. Although essential, MTPs are also highly resource-intensive. Effective MTP implementation must balance the resources of the hospital with the needs of the patient population that they serve, as well as avoid instances of unjustified activations.

The people behind the papers - Stephen DiNardo and Gabriela Vida.

Stem cells exist within a niche, a microenvironment that regulates their activity, but the mechanisms by which niche cells influence stem cell behaviour are poorly understood. In this issue, Stephen DiNardo and colleagues reveal that the shape of the adult Drosophila testes niche, which is dependent on the cytoskeleton of the niche cells, is crucial to maintaining germinal stem cell function. To learn more about this work, we spoke to first author Gabriela Vida and corresponding author Stephen DiNardo, Professor of Cell and Developmental Biology at the University of Pennsylvania, USA.

Pulsed Ultrasound-Mediated Drug Delivery Enhancement Through Human Sclera.

Purpose: The purpose of this study was to characterize whether pulsed ultrasound (PUS) affects transscleral drug delivery.

Methods: Fluorescein sodium (NaF, 376 Da) and fluorescein isothiocyanate-conjugated dextran 40 (FD-40, 40 kDa) were used as model drugs. Human sclera grafts were placed in modified Franz diffusion cells and were treated by PUS (1 megahertz [MHz], 0.

Eye posture and screen alignment with simulated see-through head-mounted displays.

When rendering the visual scene for near-eye head-mounted displays, accurate knowledge of the geometry of the displays, scene objects, and eyes is required for the correct generation of the binocular images. Despite possible design and calibration efforts, these quantities are subject to positional and measurement errors, resulting in some misalignment of the images projected to each eye. Previous research investigated the effects in virtual reality (VR) setups that triggered such symptoms as eye strain and nausea.

Prehospital endotracheal intubation success rates for critical care nurses versus paramedics.

Objectives: Prehospital endotracheal intubation (ETI) is a lifesaving procedure with known complications. To reduce ETI-associated morbidity and mortality, organizations prioritize first-pass success (FPS). However, there are few data evaluating the association of FPS with clinician licensure.

Longer Total Interhospital Transfer Times for Rural Sepsis Patients Not Associated with Increased Mortality.

Objectives: Sepsis is a time-sensitive condition, and many rural emergency department (ED) sepsis patients are transferred to tertiary hospitals. The objective of this study was to determine whether longer transport times during interhospital transfer are associated with higher sepsis mortality or increased hospital length-of-stay (LOS).

Methods: A cohort of rural adult (age ≥ 18y) sepsis patients transferred between hospitals were identified in the TELEmedicine as a Virtual Intervention for Sepsis Care in Emergency Departments (TELEVISED) parent study.

Regional Trends and Spatial Gradients of Total Column Methane over India, China, and USA─Implications for Emissions from Coal Mining and Oil/Gas Exploitation.

Observation-based verification of regional/national methane (CH) emission trends is crucial for transparent monitoring and mitigation strategy planning. Although surface observations track the global and sub-hemispheric emission trends well, their sparse spatial coverage limits our ability to assess regional trends. Dense satellite observations complement surface observations, offering a valuable means to validate emission trends, especially in regions where emissions changes are substantial but debated.

Rural Communities in the Deep South: Examining the Relationship Between Social Function and General Health Perceptions in Older Black Americans.

Background: Increased mortality in rural southern areas has persisted and worsened among older Black adults due to high prevalence of chronic conditions combined with limited healthcare access resulting from social and structural factors.

Objective: Our objective was to examine the relationship between general health perceptions, social functioning, mental health, and demographic characteristics among Black adults living in the rural south.

Methods: This cross-sectional study examined health perceptions in older Black Americans residing in four rural towns within Alabama (Clayton, Fort Deposit, Hobson City, and York).

Understanding the Role of Trust in Healthcare and Intentions to Pursue Live Donor Kidney Transplant Among African American End Stage Kidney Disease Patients.

African Americans (AAs) with end-stage kidney disease (ESKD) experience significant barriers to accessing living donor kidney transplantation (LDKT), largely due to individual and systemic factors, including a lack of trust in healthcare systems resulting from a legacy of and continued experiences with medical racism. This cross-sectional study analyzed survey data from 416 AA patients with ESKD undergoing transplant evaluation in 2019-2023 at two kidney transplant centers in the Southeast United States, examining whether trust (specifically trust in kidney doctors, hospitals, and healthcare) modifies the relationship between attitudes towards LDKT and behavioral intentions to discuss LDKT with family and friends. Multivariable analyses revealed significant interactions.

Children's executive functioning and health behaviors across pediatric life stages and ecological contexts.

Executive functioning (EF) has been linked to chronic disease risk in children. Health behaviors are thought to partially explain this association. The current cross-sectional study evaluated specific domains of EF and varied health behaviors in three pediatric life stages.

Upper Leg Muscular Co-Contraction During Maximal-Speed Sprinting in Male Club Ice Hockey Athletes.

Background: Little is known about the lower extremity muscle co-contraction patterns during sprinting and its relation to running velocity (i.e., performance).

Outcomes of catheter ablation in cardiac sarcoidosis patients with ventricular tachycardia: a propensity score-matched retrospective analysis.

Background: Ventricular tachycardia (VT) in patients with cardiac sarcoidosis (CS) can lead to sudden cardiac death. The role of ventricular tachycardia ablation (VTA) in CS has been investigated in a few small, single-center, and larger observational studies, but the evidence still needs to be provided. This study aimed to investigate the clinical outcomes of VTA in patients with CS admitted with a diagnosis of VT.

Central Nervous System Metastases in Breast Cancer.

Breast cancer metastasizing to the central nervous system (CNS) encompasses two distinct entities: brain metastases involving the cerebral parenchyma and infiltration of the leptomeningeal space, i.e., leptomeningeal disease.

Unidirectional and bidirectional causation between smoking and blood DNA methylation: evidence from twin-based Mendelian randomisation.

Cigarette smoking is associated with numerous differentially-methylated genomic loci in multiple human tissues. These associations are often assumed to reflect the causal effects of smoking on DNA methylation (DNAm), which may underpin some of the adverse health sequelae of smoking. However, prior causal analyses with Mendelian Randomisation (MR) have found limited support for such effects.

Ethics that Fails to Regulate War, Ethics that Enhances War.

This short perspective piece argues that wars are often conducted in settings where ethical injunctions are ignored or overridden and where ethical oversight is avoided or circumvented. This is particularly the case with intrastate conflicts and is exacerbated by novel military technologies. In these and other settings ethics is often invoked actually to promote or prolong war.

Circulating metabolomic biomarkers of 5-year body weight and composition change in a biracial cohort of community-dwelling older adults.

Unintentional weight loss in older populations is linked to greater mortality and morbidity risks. This study aims to understand the metabolic mechanisms of unintentional weight loss and their relationship with body composition changes in older adults. We investigated plasma metabolite associations with weight and body composition changes over 5 years in 1335 participants (mean age 73.

Implementation of carceral medicaid suspension and enrollment programs: perspectives of carceral and medicaid leaders.

Background: Medicaid expansion via the Affordable Care Act, more recent legislation and Medicaid 1115 waivers offer opportunity to increase health care access among individuals involved in the carceral system. Effective enrollment of new beneficiaries and temporary suspension and reactivation of existing Medicaid benefits upon release is key to the success of these efforts. This study aims to characterize how jails, prisons and Medicaid agencies are implementing Medicaid suspension and enrollment programs and identifies barriers and facilitators to implementation.

Expert Rater Agreement for Symptoms and Diagnosis of Bipolar Disorder in Youth.

The diagnosis of bipolar disorder (BD) in young children has been a topic of debate, in part owing to varied interpretation of manic-like symptoms. We examined how expert academic clinicians participating in the pediatric bipolar biobank varied in their interpretation and application of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and diagnoses. Study co-investigators reviewed 12 standardized narratives and for each marked a visual analog scale with their confidence in the presence of manic episodes and criteria.

Heterogeneity in Developmental Trajectories of Internalizing and Externalizing Symptomatology: Associations with Risk and Protective Factors.

Among a large sample of youth (9-10 years old at baseline) from the Adolescent Brain Cognitive Development (ABCD) Study® (n = 11,661) we modeled trajectories of psychopathology over three years and associated risk and protective factors. Growth mixture modeling characterized latent classes with distinct psychopathology trajectories. Results indicated four different internalizing trajectories: a high-decreasing class, a moderate-decreasing class, a moderate-increasing class, and a low-stable class.

The Challenging Problems of Cancer and Serious Mental Illness.

PURPOSE OF REVIEW: Patients with Serious Mental Illness (SMI) are reported to be at higher risk for somatic disorders (e.g. cardiovascular and metabolic diseases) and higher mortality, compared to the general population, because of the consequences of SMI including psychotropic medication side effects, sedentary and unhealthy lifestyle, difficult access to physical health care.

Automated Lesion and Feature Extraction Pipeline for Brain MRIs with Interpretability.

This paper introduces the Automated Lesion and Feature Extraction (ALFE) pipeline, an open-source, Python-based pipeline that consumes MR images of the brain and produces anatomical segmentations, lesion segmentations, and human-interpretable imaging features describing the lesions in the brain. ALFE pipeline is modeled after the neuroradiology workflow and generates features that can be used by physicians for quantitative analysis of clinical brain MRIs and for machine learning applications. The pipeline uses a decoupled design which allows the user to customize the image processing, image registrations, and AI segmentation tools without the need to change the business logic of the pipeline.

COping with Rheumatic Stressors (CORS) questionnaire: validated German translation and cross-cultural adaptation for patients with axSpA.

Background: Patients with Rheumatic and Musculoskeletal Diseases, including axial spondyloarthritis (axSpA), may suffer from stressors like pain and functional impairments leading to limitations in their self-perceived health status. The COping with Rheumatic Stressors (CORS) questionnaire was developed to analyze how patients cope with these stressors. The CORS is currently not available in German.

Registry versus claims-based index dates for studies of cancer diagnosis in administrative data.

Purpose: Studies of healthcare encounters leading to cancer diagnosis have increased over recent years. While some studies examine healthcare utilization before the cancer registry date of diagnosis, relevant pre-diagnosis interactions are not always immediately prior to this date due to date abstraction guidelines. We evaluated agreement of a registry date with a claims-based index and examined Emergency Department (ED) involvement in cancer diagnosis as an example of possible pre-diagnostic healthcare misclassification that could arise from improper date choice.

Temporal trends and patterns for early- and late-onset adult liver cancer incidence vary by race/ethnicity, subsite, and histologic type in the United States from 2000 to 2019.

Purpose: To examine incidence trends and patterns for early- and late-onset liver cancer.

Methods: Liver and intrahepatic bile duct (IBD) cancers diagnosed between 2000 and 2019 were acquired from 22 SEER registries. Variables included early-onset (20-49) vs.