Background The objective of residency recruitment is to select the most appropriate candidate. While cognitive skills are identified before an interview and can be measured objectively, non-cognitive skills can be harder to discern. These non-cognitive skills though are a good predictors of future residency performance. A structured behavioral interview is better at identifying noncognitive skills compared to a traditional interview. Objective Compare the noncognitive traits identified in the interviews with those identified in resident evaluations Methods Using the semi-annual evaluations 6 residents were split between satisfactory group and excellent group. Behavioral-based interviews and traditional unstructured interviews conducted on the same individual were compared and the results of the interview were compared to the semi-annual and annual evaluations submitted by the teaching faculty and the program directors. The interviews were analyzed for non-cognitive skills. Results Qualitative analysis of behavioral interview narratives and the narrative part of the semiannual evaluations independently identified the non-cognitive characteristics of adaptability, decisiveness, time management, judgment, and the ability to work in a team. It also identified other essential non-cognitive skills necessary for an anesthesiologist, such as ability to prioritize, study techniques, ability to destress. Conclusion The noncognitive traits found in the excellent group response to the structured interview match those found in the semi-annual evaluations. In this case individuals who are suited to the field of anesthesiology are adaptable, decisive, team-players with excellent judgment.

This study was designed to investigate the accumulation of advanced glycation end-products (AGEs) and the expression of the receptor of AGEs (RAGE) in tendinopathic tissues. In this study, tendinopathic posterior tibial tendons (PTT) were collected from patients (n=6). Redundant autografts of flexor digitorum longus tendon (FDL; n=3) were used for controls. The control and tendinopathic tendon tissues were used for extraction of proteins for western blot and sectioned for histology and immunohistochemistry. Tendinopathy of the PTT was confirmed histologically by the presentation of disorderly organized collagen fibers, high cellularity and increased vascularity. By immunohistochemistry, heterogeneous accumulation of AGEs was detected on the PTT sections and concentrated in areas, where collagen fibers were disorderly and tangled. In the PTT, roundish tenocytes were also AGEs-positive. In contrast, AGEs were diffuse, lightly stained in the FDL. A greater number of tenocytes within the tendinopathic lesions in the PTT were RAGE positive, compared to the tenocytes in the FDL. Western blot confirmed the expression of AGEs and RAGE in both tendinopathic PTT and control FDL but their band densities were not significantly different. The spatial relation of the accumulated AGEs and RAGE- positive tenocytes within the tendinopathic lesions indicates their involvement in the molecular pathology of tendinopathy.

Vitamin D deficiency is a common deficiency worldwide, particularly among women of reproductive age. During pregnancy, it increases the risk of immune-related diseases in offspring later in life. However, exactly how the body remembers exposure to an adverse environment during development is poorly understood. Herein, we explore the effects of prenatal vitamin D deficiency on immune cell proportions in offspring using vitamin D deficient mice established by dietary manipulation. We found that prenatal vitamin D deficiency alters immune cell proportions in offspring by changing the transcriptional properties of genes downstream of vitamin D receptor signaling in hematopoietic stem and progenitor cells of both the fetus and adults. Our results suggest the role of cellular differentiation properties of the hematopoiesis as the long-term memories of prenatal exposure at the adult stage. Moreover, further investigations of the associations between maternal vitamin D levels and cord blood immune cell profiles from 75 healthy pregnant women and their term babies also confirm that maternal vitamin D levels in the second trimester significantly affect immune cell proportions in the babies. This highlights the importance of providing vitamin D supplementation at specific stages of pregnancy.

Hepatitis B (HBV) and hypertension (HTN) are prevalent in West Africa (WA). Inadequate control is common, and evaluation and management are challenging among immigrants due to unfamiliarity with the United States (US) healthcare system. While HBV is stigmatised, HTN is recognised as an important condition. We describe how a HTN screening program can facilitate HBV screening in the Bronx WA community. Thirty-minute HTN educational programs were delivered in collaboration with faith-based organisations, and 5-min presentations were presented upon request at community gatherings. Arrangements were made for those interested in a clinic visit where a questionnaire was completed, blood pressure (BP) measured, a free BP cuff provided, HBV testing performed, and referrals made. For those without ongoing care, insurance was arranged, and linkage to care provided. Seven 30-min and five 5-min presentations were conducted. After the 30-min presentation, 204 of 445 attendees (45.8%) requested a visit, and 68 (33.3%) attended the visit. After the 5-min presentation, 80 requested a visit and 51 (63.8%) attended the visit. A BP>140/90mmHg was present in 122 individuals (48.4%), including 43 (17.1%) without a history of HTN and 39 (15.5%) with BP>160/90mmHg. All except two who reported previous testing agreed to HBV testing. 19 (7.5%) were hepatitis B surface antigen positive. Transition into ongoing care was provided for 60 (33.9%) with HTN who were not integrated into the US healthcare system. HTN screening with a free BP cuff promotes HBV screening and US healthcare integration. No funding.

This systematic review aims to evaluate the use of machine learning and artificial intelligence in hernia surgery. The PRISMA guidelines were followed throughout this systematic review. The ROBINS-I and Rob 2 tools were used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study design, risk of bias, publication bias, and statistical analysis. A total of 13 articles were ultimately included for this review, describing the use of machine learning and deep learning for hernia surgery. All studies were published from 2020 to 2023. Articles varied regarding the population studied, type of machine learning or Deep Learning Model (DLM) used, and hernia type. Of the thirteen included studies, all included either inguinal, ventral, or incisional hernias. Four studies evaluated recognition of surgical steps during inguinal hernia repair videos. Two studies predicted outcomes using image-based DMLs. Seven studies developed and validated deep learning algorithms to predict outcomes and identify factors associated with postoperative complications. The use of ML for abdominal wall reconstruction has been shown to be a promising tool for predicting outcomes and identifying factors that could lead to postoperative complications.

IntroductionThe International Neuromodulation Society convened a multispecialty group of physicians and scientists based on expertise with international representation to establish evidence-based guidance on intrathecal drug delivery in treating chronic pain. This Polyanalgesic Consensus Conference (PACC)® project, created more than two decades ago, intends to provide evidence-based guidance for important safety and efficacy issues surrounding intrathecal drug delivery and its impact on the practice of neuromodulation. Materials and MethodsAuthors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when PACC® last published guidelines) to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence is scant. ResultsThe PACC® examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. ConclusionsThe PACC® recommends best practices regarding intrathecal drug delivery to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.

Abstract BACKGROUND Patients with grade 2 glioma exhibit highly variable survival. Re-irradiation for recurrent disease has limited mature clinical data. We report treatment results of pulsed reduced dose rate (PRDR) radiation for patients with recurrent grade 2 glioma. METHODS A retrospective analysis of 58 patients treated with PRDR from 2000-2021 was performed. Radiation was delivered in 0.2 Gy pulses every three minutes encompassing tumor plus margin. Survival outcomes and prognostic factors on outcome were Kaplan Meier and Cox regression analyses. RESULTS The median survival from date of initial surgery was 8.6 years (95% CI 5.5-11.8 yrs). 69% of patients showed malignant transformation to grade 3 (38%) or grade 4 (31%) glioma. Overall survival following PRDR was 12.6 months (95% CI 8.3-17.0 mo) and progression free survival was 6.2 months (95% CI 3.8-8.6 mo). Overall response rate based on post PRDR MRI was 36%. In patients who maintained grade 2 histology at recurrence, overall survival from PRDR was 22.0 months with five patients remaining disease free, the longest at 8.2 and 11.4 years. PRDR was generally well tolerated. CONCLUSIONS To our knowledge, this is the largest reported series of patients with recurrent grade 2 gliomas treated with PRDR radiation for disease recurrence. We demonstrate promising survival and acceptable toxicity profiles following re-irradiation. In the cohort of patients who maintain grade 2 disease, prolonged survival (>5 years) is observed in selected patients. For the entire cohort, 1p19q co-deletion, KPS, and longer time from initial diagnosis to PRDR were associated with improved survival.

In 2020, the Association of Black Psychologists (ABPsi) drew attention to the history of racism in the United States on the creation and exacerbation of extant medical racial inequities to the detriment of Black individuals. Recognizing that solutions based solely in Western frameworks cannot fully address the mental health needs of Black individuals, ABPsi devoted collaborative efforts to develop culturally grounding healing responses for the unique experiences of race-based invisibility and trauma. Additionally, amid the pandemic, individuals of African-descent experienced various mass racial traumas, including a wave of widely publicized police violence. Beginning with COVID-19, these intersecting pandemics of racism elucidated the need for healing, particularly culturally grounding healing. In consultation with the Black Family Summit, ABPsi developed a pilot investigation, the Sawubona Healing Circle (SHC) initiative, which are culturally grounding healing circles to support Black first responders. Using an African-centered worldview, the circles recognize and validate the specific constellation of anti-Black traumas and stressors, equipping them with African-centered healing methods. This paper outlines the theory, development, implementation, and initial evaluation of the SHC intervention.

PurposeWorld Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York’s (FDNY’s) WTC Health Program cohort to estimate ILD incidence and progression.MethodsThis longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeled risk factors, including WTC-exposure and forced vital capacity (FVC), associated with ILD. Follow-up time ended at the earliest of incident diagnosis, end of study period/case ascertainment, transplant or death.ResultsILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years with the majority of deaths occurring among those with PPF (PPF: n = 13; ILD without PPF: n = 6).ConclusionsThe prevalence of post-9/11 ILD was more than two-fold greater than the general population. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.