Implementation of a High-sensitivity Troponin Assay for Adult Patients Who Present to the Emergency Department With Chest Pain: The Role of Clinical Decision Support.

Background: The objective of this study was to assess the health outcomes for patients who present to the emergency department (ED) with cardiac chest pain after the implementation of an accelerated diagnostic protocol using a high-sensitivity troponin assay (hs-TnI).

Methods: This prospective before-after cohort study used population-based linked health administrative data for adult patients who presented to a Canadian urban ED with chest pain of suspected cardiac origin over a 2-year study period. The primary outcome was ED length of stay (LOS).

Oral and maxillofacial surgery (OMFS) 'controlled' second-degree places in the UK - there are sufficient numbers (with high application ratios) to meet current and future OMFS recruitment needs in the UK.

In 2008 the Postgraduate Medical Education and Training Board (PMETB) Review of Oral and Maxillofacial Surgery (OMFS) recommended that OMFS specialty training should start with second-degree studies. This recommendation has not yet happened. Currently, no OMFS controlled places at medical/dental schools are directly linked to OMFS Specialty Training (ST) posts.

Multimodal MRI Analysis of Microstructural and Functional Connectivity Brain Changes Following Systematic Audio-Visual Training in a Virtual Environment.

Recent work has shown rapid microstructural brain changes in response to learning new tasks. These cognitive tasks tend to draw on multiple brain regions connected by white matter (WM) tracts. Therefore, behavioural performance change is likely to be the result of microstructural, functional activation, and connectivity changes in extended neural networks.

A global analysis of adaptation to societal aging across low-, middle- and high-income countries using the Global Aging Society Index.

We have previously presented a multidimensional Aging Society Index, a weighted summation of five domains central to successful adaptation to societal aging: well-being, productivity and engagement, equity, cohesion and security, as a tool to assess countries' adaptation to demographic transformation. As the index was based on data from developed countries and some of the individual metrics or weightings may not be well suited for application to low- and middle-income countries, we here present the scores on a modified index (Global Aging Society Index) on 143 countries distributed across the span of economic development. Only 5 out of 143 (3.

Gender changes in oral and maxillofacial surgery (OMFS) in the UK 1996 to 2030. Current trends suggest gender parity of those joining the OMFS specialist list may be achieved by 2048.

In their 2022 paper Newman et al compared gender diversity between UK surgical specialties. It omitted the specialty of oral and maxillofacial surgery (OMFS), which is one of the ten General Medical Council recognised surgical specialties. When challenged, the authors did not provide data for OMFS.

Tumor Lysis Syndrome in Acute Myeloid Leukemia Patients Treated With a Venetoclax Based Regimen.

Venetoclax with hypomethylating agents (HMA) is the standard of care for acute myeloid leukemia (AML) in patients ineligible for intensive chemotherapy and is associated with tumor lysis syndrome (TLS). TLS prophylaxis and the use of Cairo Bishop versus Howard diagnostic criteria are not standardized. Here we report TLS prophylaxis and incidence in a retrospective cohort of 100 consecutive AML patients treated with venetoclax and HMA.

CPX-351 +/- gemtuzumab ozogamicin as induction therapy for adult patients with newly diagnosed, favourable-intermediate risk, FLT3-ITD negative, AML: A pilot study.

This pilot study evaluated CPX-351 in adults with newly diagnosed, favourable-intermediate risk, FLT3-ITD-negative AML. Twenty patients received CPX-351 for induction, with six also receiving gemtuzumab ozogamicin (GO). The complete response rate was 95%, with 42% achieving flow-based minimal residual disease (MRD) negativity post-induction.

Guidelines for Seizure Prophylaxis in Patients Hospitalized with Nontraumatic Intracerebral Hemorrhage: A Clinical Practice Guideline for Health Care Professionals from the Neurocritical Care Society.

Background: There is practice heterogeneity in the use, type, and duration of prophylactic antiseizure medications (ASM) in patients hospitalized with acute nontraumatic intracerebral hemorrhage (ICH).

Methods: We conducted a systematic review and meta-analysis assessing ASM primary prophylaxis in adults hospitalized with acute nontraumatic ICH. The following population, intervention, comparison, and outcome (PICO) questions were assessed: (1) Should ASM versus no ASM be used in patients with acute ICH with no history of clinical or electrographic seizures? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT/fPHT) be preferentially used? and (3) If an ASM is used, should a long (> 7 days) versus short (≤ 7 days) duration of prophylaxis be used? The main outcomes assessed were early seizure (≤ 14 days), late seizures (> 14 days), adverse events, mortality, and functional and cognitive outcomes.

Changes in iPSC-Astrocyte morphology reflect Alzheimer's disease patient clinical markers.

Human induced pluripotent stem cells (iPSCs) provide powerful cellular models of Alzheimer's disease (AD) and offer many advantages over non-human models, including the potential to reflect variation in individual-specific pathophysiology and clinical symptoms. Previous studies have demonstrated that iPSC-neurons from individuals with Alzheimer's disease (AD) reflect clinical markers, including β-amyloid (Aβ) levels and synaptic vulnerability. However, despite neuronal loss being a key hallmark of AD pathology, many risk genes are predominantly expressed in glia, highlighting them as potential therapeutic targets.

Utility of Obtaining Follow-Up Blood Cultures in Gram-Negative Bacterial Bloodstream Infection Among Patients With Hematologic Malignancies.

Background: There is an ongoing debate on the benefit of obtaining repeat blood cultures for Gram-negative bacterial bloodstream infections (GNBSI). However, there is a scarcity of data concerning patients with hematologic malignancies. We sought to assess the utility of obtaining follow-up blood cultures (FUBC) in GNBSI among patients with hematologic malignancies.

Nail Disorders as clues to systemic disease.

Disorders of the nail unit can provide important clues to underlying systemic diseases. Onychodystrophy or nail abnormalities include altered nail color, shape, or texture, with morphology and growth patterns often related to local anatomic factors such as edema, vascular supply, and neurologic innervation. Associated pain or loss of function can also affect daily activities.

Antibody-Drug Conjugates Targeting the EGFR Ligand Epiregulin Elicit Robust Anti-Tumor Activity in Colorectal Cancer.

As colorectal cancer (CRC) remains a leading cause of cancer-related death, identifying therapeutic targets and approaches is essential to improve patient outcomes. The EGFR ligand epiregulin (EREG) is highly expressed in RAS wildtype and mutant CRC with minimal expression in normal tissues, making it an attractive target for antibody-drug conjugate (ADC) development. In this study, we produced and purified an EREG monoclonal antibody (mAb), H231, that had high specificity and affinity for human and mouse EREG.

An influenza mRNA vaccine protects ferrets from lethal infection with highly pathogenic avian influenza A(H5N1) virus.

The global spread of the highly pathogenic avian influenza (HPAI) A(H5N1) virus poses a serious pandemic threat, necessitating the swift development of effective vaccines. The success of messenger RNA (mRNA) vaccine technology in the COVID-19 pandemic, marked by its rapid development and scalability, demonstrates its potential for addressing other infectious threats, such as HPAI A(H5N1). We therefore evaluated mRNA vaccine candidates targeting panzootic influenza A(H5) clade 2.

Brain change trajectories in healthy adults correlate with Alzheimer's related genetic variation and memory decline across life.

Throughout adulthood and ageing our brains undergo structural loss in an average pattern resembling faster atrophy in Alzheimer's disease (AD). Using a longitudinal adult lifespan sample (aged 30-89; 2-7 timepoints) and four polygenic scores for AD, we show that change in AD-sensitive brain features correlates with genetic AD-risk and memory decline in healthy adults. We first show genetic risk links with more brain loss than expected for age in early Braak regions, and find this extends beyond APOE genotype.

Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial.

Background: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.

Methods: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test.

Incorporating systems-level stakeholder perspectives into the Design of Mobile Integrated Health Programs.

Objectives: Despite early evidence of effectiveness, cost-savings, and resource optimization, mobile integrated health (MIH) programs have not been widely implemented in the United States. System, community, and organizational-level barriers often hinder evidence-based public health interventions, such as MIH programs, from being broadly adopted into real-world clinical practice. The objective of this study is to identify solutions to the barriers impeding the implementation of MIH through interviews with multilevel stakeholders.

Complications of Estimating Hatchery Introgression in the Face of Rapid Divergence: A Case Study in Brook Trout ().

Fish stocking has been utilized for over a century to offset extirpations or declines in abundance of many native species. These historical declines and hatchery contributions have led to uncertainty surrounding whether many contemporary populations are native, introgressed with hatchery sources, or entirely of hatchery origin. Such uncertainty is problematic for the conservation of native biodiversity as it hampers management agencies' ability to prioritize the conservation of indigenous locally adapted populations.

Long-term dupilumab efficacy in type 2 asthma regardless of baseline characteristics.

https://bit.ly/3XSwX62.

High neural noise in autism: A hypothesis currently at the nexus of explanatory power.

Autism is a neurodevelopmental difference associated with specific autistic experiences and characteristics. Early models such as Weak Central Coherence and Enhanced Perceptual Functioning have tried to capture complex autistic behaviours in a single framework, however, these models lacked a neurobiological explanation. Conversely, current neurobiological theories of autism at the cellular and network levels suggest excitation/inhibition imbalances lead to high neural noise (or, a 'noisy brain') but lack a thorough explanation of how autistic behaviours occur.

A meta-synthesis of qualitative studies on citizenship and mental health.

Background: Citizenship, as conceptualized by Rowe and colleagues, emphasizes the significance of relationships and community membership, encapsulated by the '5 Rs' - rights, responsibilities, roles, resources, and relationships.

Methods: A meta-synthesis of 20 qualitative studies on citizenship and mental health was conducted.

Results: We identified four central themes: Autonomy and Empowerment, Social Inclusion and Relationships, Social Exclusion, and Non-Relational Resources and Supports.

Genetics, Fitness and Left Ventricular Remodeling: The Current State of Play.

Cardiorespiratory fitness (CRF) exists on a spectrum and is driven by a constellation of factors including genetic and environmental differences. This results in wide inter-individual variation in baseline CRF and the ability to improve CRF with regular endurance exercise training. As opposed to monogenic conditions, CRF is described as a complex genetic trait as it is believed to be influenced by multiple common genetic variants in addition to exogenous factors.

Barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems. A qualitative scoping review.

Background: People with concurrent mental health and substance use problems are among the most socially excluded groups in our society, yet little attention has been paid to what socially excluded people see as central to promoting their social inclusion. The aim of this qualitative scoping review is to provide an overview of barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems, based on first-person perspectives, to help guide future research, policies, and practice.

Methods: We explored first-person perspectives on social inclusion among people with concurrent mental health and substance use problems, employing Arksey and O'Malleys framework.

Exploring Youths' Cannabis Health Literacy Post Legalization: A Qualitative Study.

Legalization of non-medical cannabis in Canada was intended to protect youth health and safety by limiting access and raising awareness of safety and risks. The purpose of this qualitative research was to explore youths' perceptions of their cannabis health literacy and future educational needs. A convenience sample of youth aged 13 to 18 residing in Newfoundland and Labrador, Canada who may or may not have consumed cannabis were included.