Mortality and diurnal temperature range in Virginia.

The relationship between diurnal temperature range (DTR) and daily mortality from 2005 to 2020 is examined for seven large metropolitan areas in Virginia using distributed lag non-linear models that control for temperature and humidity. The relative risk of mortality increases for very high DTR, and there is a short lag effect of several days. High risk DTR days are rare, typically occurring less than 1% of the time at most locations.

A Statistically-Robust Model of the Axomyelin Unit under Normal Physiologic Conditions with Application to Disease States.

Despite tremendous progress in characterizing the myriad cellular structures in the nervous system, a full appreciation of the interdependent and intricate interactions between these structures is as yet unfulfilled. Indeed, few more so than the interaction between the myelin internode and its ensheathed axon. More than a half-century after the ultrastructural characterization of this axomyelin unit, we lack a reliable understanding of the physiological properties, the significance and consequence of pathobiological processes, and the means to gauge success or failure of interventions designed to mitigate disease.

Stressors and Support Experienced by Active Duty U.S. Navy Sailors at Sea.

Introduction: High occupational stress is generally associated with poorer mental health and reduced performance in military personnel, whereas access to support resources is associated with positive outcomes. However, little research has examined the unique stressors and supports experienced by sailors on ships while underway at sea. The objectives of this study were to (1) identify sailors' underway stressors and supports and (2) examine how these differ as a function of demographic and operational factors.

Accuracy of two-compartment modelling of gas exchange with ventilation-perfusion mismatch in inhalational anesthesia.

Background: Multi-compartment computer models of heterogeneity in alveolar ventilation-perfusion ratios (VA/Q scatter) across the lung explain the significant alveolar-arterial (A-a) partial pressure gradients and associated alveolar dead-space fractions (VDA/VA) seen in anesthetized patients for both carbon dioxide and for anesthetic gases of different blood solubilities. However, the accuracy of a simpler two-compartment model of VA/Q scatter to do this has not been tested or compared to calculations from the traditional Riley model with "ideal", unventilated (shunt) and unperfused (deadspace) compartments.

Methods: Measurements of gas partial pressures in inspired and expired gas and arterial and mixed venous blood from 29 patients undergoing inhalational general anesthesia for cardiac surgery was used to compare the accuracy of two simple models of VA/Q scatter and lung gas exchange in predicting measured alveolar and arterial partial pressure differences, and associated alveolar dead-space calculations for the modern anesthetic gases isoflurane, sevoflurane and desflurane.

Cryo-EM structure of AAV2 Rep68 bound to integration site AAVS1: insights into the mechanism of DNA melting.

The Rep68 protein from Adeno-Associated Virus (AAV) is a multifunctional SF3 helicase that performs most of the DNA transactions necessary for the viral life cycle. During AAV DNA replication, Rep68 assembles at the origin of replication, catalyzing the DNA melting and nicking reactions during the hairpin rolling replication process to complete the second-strand synthesis of the AAV genome. We report the cryo-electron microscopy structures of Rep68 bound to the adeno-associated virus integration site 1 in different nucleotide-bound states.

The Role of Social Support in Bridging the Digital Divide for Older Veterans.

Background: For nearly a decade, the US Veterans Health Administration (VA) has distributed tablets to Veterans with access barriers who may benefit from video telehealth visits. Older Veterans' lower likelihood of tablet use relative to younger Veterans has prompted interest in factors influencing tablet utilization.

Objectives: We examined whether social support facilitates video telehealth utilization among older Veterans who received VA tablets.

Evaluating allograft risk models in organ transplantation: Understanding and balancing model discrimination and calibration.

In the field of organ transplantation, the accurate assessment of donor organ quality is necessary to efficient organ allocation and to informed consent for recipients. A common approach to organ quality assessment is the development of statistical models that accurately predict post-transplant survival by integrating multiple characteristics of the donor and allograft. Despite the proliferation of predictive models across many domains of medicine, many physicians may have limited familiarity with how these models are built, the assessment of how well models function in their population and the risks of a poorly performing model.

A Framework for Assessing Viral Pathogens: A Key Element of the BARDA Emerging Infectious Diseases Strategy.

The COVID-19 pandemic has revealed the need for nations to prepare more effectively for emerging infectious diseases. Preparing for these threats requires a multifaceted approach that includes assessing pathogen threat, building flexible capabilities for rapid medical countermeasure (MCM) development, and exercising, maintaining, and improving those response capabilities. The Biomedical Advanced Research and Development Authority (BARDA) promotes the advanced development of MCMs in response to natural and manmade threats.

Sudden cardiac death after acute myocarditis with arrhythmic presentation: hunting for risk predictors - a systematic review and meta-analysis.

Background: Ventricular arrhythmias (VAs) frequently occur in the acute phase of myocarditis. Possible arrhythmic recurrences and the risk of sudden cardiac death (SCD) in this setting are reasons for concern, and limited data have been published to guide clinical management of these patients. The aim of the present paper is to report the incidence of major arrhythmic events, defined as sustained VA, SCD and appropriate implantable cardiac-defibrillator (ICD) treatment, in patients with acute myocarditis and ventricular arrhythmic phenotype.

Therapeutic benefits of glycerol in dry eye disease.

Dry eye disease (DED) is one of the most commonly diagnosed eye disorders, with a prevalence ranging from 5 to 50%, depending on the geographic location. DED is a multifactorial disorder of the tears and ocular surface, which results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is also accompanied by increased osmolarity of the tear film and inflammation of the surface of the eye.

Feasibility of the area reduction post-closure technique for bedside weaning of veno-arterial extracorporeal membrane oxygenation.

Objective: To evaluate the safety and efficacy of the area reduction post-closure technique for bedside weaning of veno-arterial extracorporeal membrane oxygenation (V-A ECMO).

Methods: A retrospective study was conducted from December 2022 to November 2023, analyzing data from patients who underwent V-A ECMO weaning at our center. The area reduction post-closure technique, utilizing two ProGlide devices (Abbott Vascular, Santa Clara, CA), was adopted as a standard practice.

High-risk electrocardiogram presentations in the acute coronary syndrome patient - Beyond ST-segment elevation myocardial infarction.

This review considers high-risk electrocardiographic patterns in the acute coronary syndrome (ACS) patient; we review 7 electrocardiogram presentations lacking diagnostic criteria for ST-segment elevation myocardial infarction (STEMI) yet likely representing either STEMI equivalent syndromes or ACS presentations with significant short-and long-term risk. The STEMI equivalent presentations include acute posterior wall myocardial infarction, the hyperacute T-wave of early STEMI, de Winter syndrome, first diagonal of the left anterior descending artery occlusion, and left bundle branch block modified Sgarbossa positive findings. High-risk presentation, not felt to be STEMI equivalent entities yet still possessing significant risk of short-and long-term adverse outcome, include lead aVR ST-segment elevation and Wellens syndrome.

Sex in aging matters: exercise and chronic stress differentially impact females and males across the lifespan.

Assessing sex as a biological variable is critical to determining the influence of environmental and lifestyle risks and protective factors mediating behavior and neuroplasticity across the lifespan. We investigated sex differences in affective behavior, memory, and hippocampal neurogenesis following short- or long-term exposure to exercise or chronic mild stress in young and aged mice. Male and female mice were assigned control, running, or chronic stress rearing conditions for 1 month (young) or for 15 months (aged), then underwent a behavioral test battery to assess activity, affective behavior, and memory.

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.

Oregon's Emerging Psilocybin Services Workforce: A Survey of the First Legal Psilocybin Facilitators and Their Training Programs.

New legal frameworks for supervised psychedelic services are emerging, with Oregon and Colorado implementing programs to train and license psilocybin facilitators. This study describes Oregon's early psilocybin facilitator workforce and assesses state-approved training programs. The Open Psychedelic Evaluation Nexus (OPEN) reviewed Oregon Health Authority-approved training programs and surveyed facilitators who had completed or were enrolled in these programs between July and November 2023.

Evaluation of the Femoral Condyle Radius of Curvature at the Chondral Surface Shows Significant Correlation With the Anterior-Posterior Length.

Background: Accurate donor-recipient matching of the femoral condyle radius of curvature (ROC) in osteochondral allograft (OCA) transplantation may aid in minimizing articular surface incongruities. Matching linear femorotibial dimensions, such as the femoral condyle anterior-posterior length (APL), femoral condyle width (lateral-medial length, LML), femoral hemicondyle width (HCW), and tibial plateau width (TPW), can provide similar results if they correlate well with ROC. This study investigates the relationship between femorotibial dimensions and ROC at the cartilage surface using magnetic resonance imaging (MRI).

The Benefits of Intentional Nurse Rounds in Schools.

Nurse rounds have long been an established practice in clinical settings, resulting in improved patient care through accurate assessment, evaluation, and communication. This practice has also been shown to create seamless patient-centered care among the medical team, the patient, and their family members. While nurse rounds are an important component of clinical care, school nurses have not adopted this practice.

Depot-specific acetylation profiles of adipose tissues-therapeutic targets for metabolically unhealthy obesity.

Background: Adipose tissue plays a critical role in the development of metabolically unhealthy obesity (MUO), with distinct adipose depots demonstrating functional differences. This study aimed to investigate the unique characteristics of subcutaneous (SA) and visceral adipose tissue (VA) in MUO.

Methods: Paired omental VA and abdominal SA samples were obtained from four male patients with MUO and subjected to Four-Dimensional Data Independent Acquisition (4D-DIA) proteomic and lysine acetylation (Kac) analyses.

AI-based analysis of fetal growth restriction in a prospective obstetric cohort quantifies compound risks for perinatal morbidity and mortality and identifies previously unrecognized high risk clinical scenarios.

Background: Fetal growth restriction (FGR) is a leading risk factor for stillbirth, yet the diagnosis of FGR confers considerable prognostic uncertainty, as most infants with FGR do not experience any morbidity. Our objective was to use data from a large, deeply phenotyped observational obstetric cohort to develop a probabilistic graphical model (PGM), a type of "explainable artificial intelligence (AI)", as a potential framework to better understand how interrelated variables contribute to perinatal morbidity risk in FGR.

Methods: Using data from 9,558 pregnancies delivered at ≥ 20 weeks with available outcome data, we derived and validated a PGM using randomly selected sub-cohorts of 80% (n = 7645) and 20% (n = 1,912), respectively, to discriminate cases of FGR resulting in composite perinatal morbidity from those that did not.

Increased serum GM-CSF at diagnosis of biliary atresia is associated with improved biliary drainage.

Background: The immune heterogeneity of biliary atresia (BA) presents a challenge for development of prognostic biomarkers. This study aimed to identify early immune signatures associated with biliary drainage after Kasai Portoenterostomy (KPE).

Methods: Serum samples, liver slides, and clinical data were obtained from patients enrolled in the NIDDK-supported Childhood Liver Disease Research Network.

A deep learning analysis for dual healthcare system users and risk of opioid use disorder.

The opioid crisis has disproportionately affected U.S. veterans, leading the Veterans Health Administration to implement opioid prescribing guidelines.

Academic Achievement, Externalizing Problems, and Close Friends in Middle School: Testing a Developmental Cascade Model Leading to Educational Attainment in the Late Twenties.

Because educational attainment is associated with well-being in the long term, it is important to understand the developmental processes that enhance academic outcomes during adolescence. Also, although the importance of friends is well documented in adolescence, little is known about how close friends' characteristics work together with youth's own characteristics to shape adolescents' educational trajectories. This study fills an important gap in knowledge by focusing on how middle school students' academic achievement and externalizing problems are associated with their friends' achievement and externalizing problems over time, and how these variables predict educational attainment in adulthood.

Engaging Patients in Discussions About Medication Deprescribing.

Background: Deprescribing, intentional medication discontinuation or dose reduction, can reduce potentially inappropriate medication use and medication-related harms. Engaging patients in deprescribing discussions may increase likelihood of deprescribing and promote shared decision-making.

Objective: To examine the impact of patient-directed educational brochures on patient engagement and deprescribing discussions with primary care providers (PCPs).