Digital divide as a determinant of health in the U.S. older adults: prevalence, trends, and risk factors.

Background: The rapid development of digital technologies has fundamentally changed the care for older adults. However, not all older adults have equal opportunities to access and use the technologies, more importantly, be able to benefit from the technologies. We aimed to explore (1) the prevalence and the trend in the prevalence of digital divide in older adults, including digital access gap, digital use gap (specifically, using digital technologies for health commutation [e-communication gap]), and self-efficacy in information seeking gap (cognitive gap); (2) sociodemographic factors related to three perspectives of digital divide; and (3) the association between digital divide and self-rated health (exploratory).

Genomic Biomarkers Associated with Enfortumab Vedotin Outcomes for Patients with Advanced Urothelial Carcinoma: Analysis of UNITE Study Data.

Enfortumab vedotin (EV) is used as monotherapy or combined with pembrolizumab in advanced urothelial carcinoma (aUC), but biomarker data associated with EV outcomes are limited. We identified 170 patients in the UNITE study who received EV monotherapy and had molecular biomarker data available. Outcomes for groups with and without a particular biomarker were compared using logistic regression (unadjusted) for the objective response rate (ORR), and a log-rank test and Cox proportional-hazard models (CPHMs) for progression-free survival (PFS) and overall survival (OS) from EV initiation.

Accuracy and user experience of dental diagnosis of a patient with cleidocranial dysplasia using immersive virtual reality and cone-beam computed tomography multiplanar reconstructions.

Introduction: Accuracy and user experience of dental diagnosis for a patient with cleidocranial dysplasia (CCD) using immersive virtual reality (VR) and cone-beam computed tomography multiplanar reconstruction methods were evaluated.

Methods: Dental students (n = 40) were randomly assigned to VR or MP groups. VR participants manipulated and visualized the rendered 3-dimensional model using VR hardware and software.

Opioid consumption in the first 30 days after surgery was independently associated with new persistent opioid use.

Introduction: Previous studies suggest that new persistent opioid use (NPOU) after surgery was associated with larger perioperative opioid prescriptions, but the association between NPOU and postoperative opioid consumption is unknown.

Methods: This retrospective study included opioid naïve individuals aged 18-64 who underwent surgical procedures across 70 Michigan hospitals between July 1, 2018 and November 15, 2021 and were prescribed opioids at discharge. We used clinical and patient-reported opioid consumption data from the Michigan Surgical Quality Collaborative, a statewide surgical registry, linked with the state Prescription Drug Monitoring Program.

Molecular characterization of archival adrenal tumor tissue from patients with ACTHindependent Cushing syndrome.

Cushing syndrome represents a multitude of signs and symptoms associated with long-term and excessive exposure to glucocorticoids. Solitary cortisol-producing adenomas (CPAs) account for most cases of ACTH-independent Cushing syndrome (CS). Technological advances in next-generation sequencing have significantly increased our understanding about the genetic landscape of CPAs.

Health System Purchasing Professionals' Approaches to Considering Equity in Procurement.

Background: Continuing data on racial bias in pulse oximeters and artificial intelligence has sparked calls for health systems to drive innovation against racial bias in healthcare device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.

Research Question: How do healthcare purchasing professionals integrate equity concerns into purchasing decision-making?

Study Design And Methods: Between 8/2023-3/2024, we conducted semi-structured interviews via videoconferencing with healthcare purchasing professionals about purchasing processes for pulse oximeters and other devices-and whether and where equity concerns arise in decision-making. An abductive approach was used to analyze perspectives on how equity and disparity concerns are currently integrated into healthcare purchasing decision-making.

Paneth Cells: Dispensable yet Irreplaceable for the Intestinal Stem Cell Niche.

Intestinal stem cells replenish the epithelium throughout life by continuously generating intestinal epithelial cell types, including absorptive enterocytes, and secretory goblet, endocrine, and Paneth cells. This process is orchestrated by a symphony of niche factors required to maintain intestinal stem cells and to direct their proliferation and differentiation. Among the various mature intestinal epithelial cell types, Paneth cells are unique in their location in the stem cell zone, directly adjacent to intestinal stem cells.

A modiolar-pillar gradient in auditory-nerve dendritic length: A novel post-synaptic contribution to dynamic range?

Auditory-nerve fibers (ANFs) from a given cochlear region can vary in threshold sensitivity by up to 60 dB, corresponding to a 1000-fold difference in stimulus level, although each fiber innervates a single inner hair cell (IHC) via a single synapse. ANFs with high-thresholds also have low spontaneous rates (SRs) and synapse on the side of the IHC closer to the modiolus, whereas the low-threshold, high-SR fibers synapse on the side closer to the pillar cells. Prior biophysical work has identified modiolar-pillar differences in both pre- and post-synaptic properties, but a comprehensive explanation for the wide range of sensitivities remains elusive.

Neonatal Seizures and Associated Neurobehavioral Profiles in Preschool Age Children.

Background: Neonatal seizures are common with acute brain injury. Up to 25% of survivors develop postneonatal epilepsy. We hypothesized postneonatal epilepsy diagnosed by age 24 months would increase risk for early markers of neurobehavioral disorders than acute provoked neonatal seizures alone.

The Cullin3-Rbx1-KLHL9 E3 ubiquitin ligase complex ubiquitinates Rheb and supports amino acid-induced mTORC1 activation.

Mechanistic target of rapamycin complex 1 (mTORC1) is recruited to the lysosomal membrane by the active Rag heterodimer, where mTORC1 interacts with active Rheb for its activation. It has been shown that polyubiquitination of Rheb is crucial for enhancing its interaction with mTORC1 on the lysosome. However, the specific ubiquitin ligases for Rheb, which promotes mTORC1 activation, remain elusive.

Relationship of Structural Abnormalities of Papillary Muscles to the Site of Origin of Ventricular Arrhythmias.

Background: Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.

Objectives: The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.

Dental hygiene and dental students' patient communication skills: Is public speaking education relevant?

Purpose: Commission of Dental Accreditation (CODA) Standards require graduates to be competent in patient-provider communication. The objectives were (a) to assess dental hygiene and dental students' general communication-related attitudes and self-reported skills related to establishing rapport, utilizing facilitative listening, and summarizing, as well as having oral health literacy-related expertise; (b) to evaluate students' prior public speaking experiences, their motivation to learn more about public speaking and evaluations of the public speaking-related educational intervention; (c) and explore the relationships between communication-related attitudes and skills and public speaking-related education.

Methods: Anonymous web-based survey data were collected from 43 dental hygiene and 206 dental students after they participated in a zoom-based educational intervention entitled "Utilizing Public Speaking Principles in Patient-Dental Care Provider Communication: An Exploration.

Self-reported history of physical intimate partner violence and longitudinal cognitive performance in midlife women.

Background: Intimate partner violence affects about a third of women in their lifetimes and can result in short- and long-term health consequences, including less favorable performance on measures of cognitive function.

Objectives: We assess whether experiencing physical intimate partner violence in midlife was associated with steeper declines in subsequent tests of cognitive performance.

Design: This study used data from 1713 women in the longitudinal cohort Study of Women's Health Across the Nation to relate baseline information on physical intimate partner violence to declines in scores from the Symbol Digit Modalities Test, the East Boston Memory Test and the Digit Span Backwards spanning follow-up visits 7 through 15.

Prevalence of gender-based violence and factors associated with help-seeking among university students in sub-Saharan Africa.

Background: Gender-based violence (GBV) is a global public health problem. While research exists on GBV and associated help-seeking behaviors among university students, few studies have assessed the prevalence of GBV, including experiences and barriers to help-seeking, within sub-Saharan African university settings.

Objectives: The objective of this study was to examine the prevalence of GBV victimization among university students in six sub-Saharan African countries and describe experiences of formal and informal help-seeking among students who self-identified as victims of GBV since attending university.

Factors associated with placebo response rate in randomized controlled trials of antiseizure medications for focal epilepsy.

Objective: Randomized controlled trials (RCTs) are necessary to evaluate the efficacy of novel treatments for epilepsy. However, there have been concerning increases in the placebo responder rate over time. To understand these trends, we evaluated features associated with increased placebo responder rate.

Physician, know thyself: Applying brand management principles to professional identity in academic medicine.

Context: A career in medicine is a journey of countless opportunities, challenges and choices. Determining the "right" decision for any given career choice ultimately must come from within; thus, a clear understanding of a physician's core professional identity is critical. Existing conceptualizations of professional identity within medicine focus primarily on medical training; however, it is clear that professional identity evolves throughout one's career.

Germline loss-of-function variant in the E3 ubiquitin ligase TRAF2 in a young adult patient with medulloblastoma: a case report.

We identified a rare heterozygous germline loss-of-function variant in the tumor necrosis factor receptor-associated factor 2 (TRAF2) in a young adult patient diagnosed with medulloblastoma. This variant is located within the TRAF-C domain of the E3 ubiquitin ligase protein and is predicted to diminish the binding affinity of TRAF2 to upstream receptors and associated adaptor proteins. Integrative genomics revealed a biallelic loss of TRAF2 via partial copy-neutral loss-of-heterozygosity of 9q in the medulloblastoma genome.

Sarcomatous transformation of IDH-mutant astrocytoma matching to methylation class oligosarcoma following embolization, a case report.

The mesenchymal transformations of infiltrating gliomas are uncommon events. This is particularly true of IDH-mutant astrocytomas and oligodendrogliomas, in which mesenchymal transformation is exceedingly rare. oligosarcoma is a newly recognized methylation class (MC) that represents transformed 1p/19q co-deleted oligodendrogliomas, but recent studies indicate it may be non-specific.

Teaching conflict management to medical students: a randomized controlled trial.

Background: Conflict is an inevitable aspect of healthcare team collaboration. Effective conflict management training can improve the performance of healthcare teams. This study aimed to investigate the effect of conflict management education based on the Fogg model on the attitude of medical students toward conflict management.

Reasoning on Rounds Volume 2: a Framework for Teaching Management Reasoning in the Inpatient Setting.

Management reasoning (MR) is a key domain of clinical reasoning that is distinct from the more heavily studied and taught diagnostic reasoning (DR). Despite MR's importance to patient care, there are few published strategies for incorporating MR education into the clinical learning environment. In this perspective, the authors review key theories and clinical principles relevant to MR and integrate these concepts with previously described tools for teaching MR to provide frontline clinical teachers with practical, theory-informed framework for teaching MR during inpatient rounds.

Increased sampling reveals the complex evolution of sauropod dinosaur tooth replacement rates.

Unlike most herbivores, sauropod dinosaurs evolved simple teeth that were replaced rapidly. Sauropod craniodental morphology is conserved relative to that of many archosaur clades, but tooth breadth and replacement rate vary substantially. Two neosauropod clades, Titanosauria and Diplodocoidea, independently evolved both narrow-crowned teeth and high tooth replacement rates among a suite of other convergent features.