6-month Period Research Articles

Signet-ring cell carcinoma of the transverse colon in a 10-year-old girl: A case report

BACKGROUND Signet-ring cell carcinoma (SRCC) is a rare subtype of colorectal cancer. The incidence of primary colonic SRCC is relatively rare in pediatric patients, with a limited number of reported cases currently available. The prognosis for this specific tumor type is unfavorable, and the preoperative diagnosis presents challenges, potentially leading to misdiagnosis. This case report describes the diagnosis of primary SRCC in the colon of a 10-year-old girl. CASE SUMMARY The patient was admitted to the hospital due to abdominal pain and vomiting. A computed tomography scan revealed an irregular mass with soft tissue density in her transverse colon, showing uneven density and multiple calcifications. The patient underwent surgical resection of the affected bowel and lymph node dissection, which was confirmed by pathological examination to be SRCC infiltrating both nerves and the entire intestinal wall. Additionally, tumor thrombus formation was observed in blood vessels and lymphatic vessels, multiple cancerous nodules were found in the omentum, and metastasis to 18 of 26 mesenteric lymph nodes examined. Immunohistochemistry for mismatch repair gene protein demonstrated microsatellite stability. No mutations in KRAS , NRAS , BRAF , or PIK3CA genes were detected through molecular pathology analysis. After surgery, she received standard chemotherapy for 8 cycles without tumor progression or other abnormalities during a 12-month follow-up period. CONCLUSION Primary colonic SRCC is a rare malignant tumor with atypical clinical symptoms, and timely identification and intervention are crucial for improving the prognosis.

Examining Changes in Implementation of Priority Healthy Eating and Physical Activity Practices, and Related Barriers, Over Time in Australian Early Childhood Education and Care Services: A Repeated Cross-Sectional Study.

Background: Promoting healthy eating and physical activity in early childhood education and care (ECEC) is recommended within guidelines and supported by health promotion programs; however, implementation is suboptimal. Evidence suggests implementation within the sector varies over time; however, this has not been empirically examined in relation to implementation barriers. This study aims to: (1) describe changes in the prevalence of, and barriers to, implementation of priority healthy eating and physical activity practices; and (2) explore the associations between such barriers and implementation. Methods: This was a repeated cross-sectional study over an 8-month period. A cross-section of 150-180 Australian ECEC services were prospectively randomly sampled for each month (April-November 2023), with 1127 ECEC services sampled in total and 20% of services sampled twice. Services reported via survey their implementation of two priority practices: (1) healthy menu standards and (2) educating and engaging parents in child physical activity. They also reported on implementation status, implementation stage, and five core implementation barriers. Results: Overall, 716 services completed 809 surveys. There were no significant differences in the prevalence of implementation or general trends in barriers to implementation of the two priority practices across that time. Services reporting less barriers were significantly more likely to be implementing the priority practices, and services in more advanced implementation stages were significantly less likely to report barriers. Conclusions: To enhance the implementation of priority practices in ECEC services, key barriers to implementation need to be understood and targeted to progress services through to advanced implementation stages.

Performance of a fine-scale acoustic positioning system for monitoring temperate fish behavior in relation to offshore marine developments

Rapid global expansion of offshore wind farms, tidal, and wave technologies signifies a new era of renewable energy development. While a promising means to combat the impacts of climate change, such developments necessitate fine-scale monitoring of biological communities to determine impacts associated with construction, operation, and eventual decommission. Here, we evaluate the performance of a gridded, Innovasea Systems, Inc. fine-scale acoustic telemetry positioning system (FSPS, n = 20 acoustic receivers) for tracking behaviors of diverse, temperate fish assemblages in relation to a subsea cable route supporting the Ørsted offshore wind development in coastal New York. We examined array performance through positioning error derived from receiver reference transmitters and tracked animals (n = 260) comprising 17 species of teleost and elasmobranch. We evaluated the effects of environmental variables (temperature, tilt, noise, and depth), transmitter power, individual movement rates, and receiver loss on horizontal positioning error (HPE) and route mean squared error (RMSE). Across a 16-month deployment period, many positions were derived for Atlantic sturgeon (n = 2,612), black sea bass (n = 9,175), clearnose skate (n = 10,306), summer flounder (n = 13,304), and little skate (n = 15,186), suggesting that these species may serve as sentinel candidates for assessing behavioral changes following construction, operation, and decommission. We found that receivers placed at the boundary of the grid exhibited higher HPE and RMSE, however these errors did not significantly change despite large receiver losses (25%). Generalized Linear Models revealed that temperature, noise, tilt, and depth were often significant predictors of HPE and RMSE, however, a substantial amount of variance was not explained by the models (~ 70%). Average movement rates ranged from 1.1 m s−1 (common thresher shark) to 0.03 m s−1 (little skate and summer flounder) but had minimal effects on positioning error. Finally, we observed that higher transmitter powers (158 dB) may lead to higher and more variable HPE values. Overall, these findings provide new insight into the drivers of FSPS array performance and illustrate their broad utility for monitoring fish behavior associated with offshore marine developments.

Glyphosate exposure exacerbates neuroinflammation and Alzheimer’s disease-like pathology despite a 6-month recovery period in mice

BackgroundGlyphosate use in the United States (US) has increased each year since the introduction of glyphosate-tolerant crops in 1996, yet little is known about its effects on the brain. We recently found that C57BL/6J mice dosed with glyphosate for 14 days showed glyphosate and its major metabolite aminomethylphosphonic acid present in brain tissue, with corresponding increases in pro-inflammatory cytokine tumor necrosis factor-⍺ (TNF-⍺) in the brain and peripheral blood plasma. Since TNF-⍺ is elevated in neurodegenerative disorders such as Alzheimer’s Disease (AD), in this study, we asked whether glyphosate exposure serves as an accelerant of AD pathogenesis. Additionally, whether glyphosate and aminomethylphosphonic acid remain in the brain after a recovery period has yet to be examined.MethodsWe hypothesized that glyphosate exposure would induce neuroinflammation in control mice, while exacerbating neuroinflammation in AD mice, causing elevated Amyloid-β and tau pathology and worsening spatial cognition after recovery. We dosed 4.5-month-old 3xTg-AD and non-transgenic (NonTg) control mice with either 0, 50 or 500 mg/kg of glyphosate daily for 13 weeks followed by a 6-month recovery period.ResultsWe found that aminomethylphosphonic acid was detectable in the brains of 3xTg-AD and NonTg glyphosate-dosed mice despite the 6-month recovery. Glyphosate-dosed 3xTg-AD mice showed reduced survival, increased thigmotaxia in the Morris water maze, significant increases in the beta secretase enzyme (BACE-1) of amyloidogenic processing, amyloid-β (Aβ) 42 insoluble fractions, Aβ 42 plaque load and plaque size, and phosphorylated tau (pTau) at epitopes Threonine 181, Serine 396, and AT8 (Serine 202, Threonine 205). Notably, we found increased pro- and anti-inflammatory cytokines and chemokines persisting in both 3xTg-AD and NonTg brain tissue and in 3xTg-AD peripheral blood plasma.ConclusionTaken together, our results are the first to demonstrate that despite an extended recovery period, exposure to glyphosate elicits long-lasting pathological consequences. As glyphosate use continues to rise, more research is needed to elucidate the impact of this herbicide and its metabolites on the human brain, and their potential to contribute to dysfunctions observed in neurodegenerative diseases.

Increased Wound Prevalence in those Exposed to Xylazine and Fentanyl Compared to Those Exposed to Fentanyl: An Observational Study.

The aim of this study is to determine the difference, if any, in prevalence of wounds in individuals who were exposed to xylazine and fentanyl compared to individuals who were exposed to fentanyl and not xylazine. A large inpatient substance use disorder specialty hospital provided medical records over an 8-month period from July 2023 to February 2024. Individuals were admitted to an American Society of Addiction Medicine 3.7 level of care where a urine drug screen and skin assessment was conducted on admission. If the urine screen noted a presence of fentanyl, the sample was then tested for xylazine exposure. Patients were considered positive for wounds on admission to treatment if any wound was noted during the skin assessment during the admission process. A total of 282 medical records were identified. A chi square test of association was completed and revealed a statistically significant association between xylazine exposure and wounds (P = 0.002, odds ratio = 2.420, 95% confidence interval = 1.376-4.254). This study provides early support for the previously theorized connection between xylazine exposure and wounds.

Early identification of potentially low performing community health workers using an ensemble classification model

PurposeCommunity health workers (CHWs) are vital to addressing public health system limitations in developing countries. However, effective identification and support of underperforming CHWs remains a challenge. This study develops a predictive model to proactively identify underperforming CHWs, facilitating targeted interventions for improved CHW programmes.Design/methodology/approachWe developed a predictive model to identify underperforming CHWs in Uttar Pradesh, India. Data from 140,101 CHWs over a 12-month period was used to build, test and validate the model. Classification techniques, ensemble modeling and a model tuning algorithm were employed for accuracy optimization and early identification.FindingsLogistic regression, decision trees and random forests yielded the best performance. While ensemble models offered no significant performance improvements over the base models, the model tuning algorithm effectively increased prediction accuracy by 19 percentage points. This enabled early identification of poor-performing CHWs and high-risk CHW clusters early in the year.Practical implicationsThe developed model has significant potential to improve CHW programmes. It enables targeted support, feedback and resource allocation, leading to enhanced CHW performance, motivation and healthcare outcomes in the communities they serve. The model can provide personalised feedback to help CHWs overcome challenges and dynamic clustering facilitates proactive identification and tailored support for those at risk of underperformance.Originality/valueThis study is the first attempt to use predictive modelling to identify underperforming CHWs, advancing the nascent field of CHW performance analytics. It underscores the effectiveness of digital technologies and data in improving CHW programmes.

Depression and Anxiety in 336 Elective Orthopedic Patients

Background/Objectives: Depression and anxiety are the two most common mental health disorders that can affect the well-being of the entire body. Multiple studies confirm that they can threaten the musculoskeletal system and the effects of orthopedic treatment as well. In turn, orthopedic disorders may worsen the symptoms of depression and anxiety. The study is aimed at assessing the incidence of depressive and anxiety disorders in orthopedic patients of our department and what are the characteristics of orthopedic patients regarding depressive disorders. Methods: After obtaining personal consent for trial, 336 patients undergoing elective orthopedic surgery over a 12-month period were evaluated. Preoperatively, patients completed surveys containing questions from the PHQ-9 and GAD-7 forms. The pain was assessed with the VAS scale of 0–10 points and the information on the current psychiatric treatment was acquired. Patients were divided into subgroupsand statistical analysis was performed. Results: The incidence of moderate depression and generalized anxiety symptoms in orthopedic patients was 12.2% and 11.3%, respectively (several times higher than in the general population). In the group most at risk of depression, i.e., women over 40 and with foot and ankle diseases, the incidence of treated depression was 36%. In foot and ankle patients, prevalence for depression was more than three times higher (OR = 3.24, 95% CI 1.542–7.24) compared to the reference group. Conclusions: The problem of depression and generalized anxiety in orthopedic patients is clearly more common than in the general population. In our study, patients with foot and ankle disorders are the most vulnerable to depression.

Utility of post-admission SARS-CoV-2 serial testing in hospitalized patients with cancer.

SARS-CoV-2 asymptomatic surveillance testing (AST) is a common strategy to minimize the risk of nosocomial infection in patients and healthcare personnel. In contrast to admission screening, post-admission AST was less widely adopted. This study describes the diagnostic yield of post-admission serial SARS-COV-2 testing in hospitalized patients at a large cancer center with mostly double-occupancy rooms. Retrospective cohort study design. Post-admission SARS-CoV-2 tests were examined over a 18 month study period. Positive results were reviewed to determine true hospital-onset infections using a combination criteria of screening all sample cycle threshold (Ct) values >30, results of non-concordant repeat testing, and clinical symptoms. Post-admission serial testing of 15,048 hospitalized patients during an 18-month study period at a tertiary care cancer center detected hospital-onset infection in 1.6% (n = 245 patients). Among all hospital-onset positive SARS-CoV-2 RNA tests, 13% were clinically false positive. Most true infections were mild to moderate in severity. In summary, post-admission serial testing in a high-risk setting is a low-yield strategy with several unfavorable effects and should no longer be routinely applied.

Platelet rich fibrin three-layer reconstruction of the sellar floor after endoscopic endonasal transsphenoidal approach: technical note and initial experience

BackgroundCerebrospinal fluid (CSF) leakage frequently complicates endoscopic endonasal transsphenoidal pituitary resections, despite the use of lumbar drains, nasoseptal flaps, or commercial dura sealants. Managing this complication often requires revision surgery and increases the risk of infection. Platelet-rich fibrin (PRF), an affordable autologous biomaterial derived from the patient's blood through short, angulated centrifugation, contains growth factors and leukocytes embedded in a fibrin matrix. PRF exhibits regenerative properties in various surgical disciplines. This study assesses a three-layer sellar reconstruction method employing solid membranous (s-PRF) and high-viscosity injectable (i-PRF) forms of PRF.Materials and methodsWe present our initial experience on a series of 22 patients with pituitary macroadenomas. For all patients, an endoscopic transnasal transsphenoidal approach was selected. Following the resection of the pathology, sellar reconstruction was accomplished using a three-layer orthobiologic technique. A membranous s-PRF was utilized as an inlay inside the opened sellar floor, followed by a layer of injectable i-PRF finally covered with another s-PRF membrane over the top to the sellar corridor.ResultsIn all cases the implementation of the proposed three-layer PRF reconstruction strategy was feasible and safe. During the 12-month follow-up period there were no adverse effects reported associated with the PRF application. 77% (17/22) of the patients demonstrated intraoperatively a cerebrospinal fluid (CSF) leak (Esposito Grade 1–3). In total, the proposed PRF reconstruction effectively prevented postoperative CSF leaks in 95% of the patients and in 94% of those with an Esposito Grade 1–3. One of the two patients with intraoperative Esposito Grade 3 developed a CSF leak on the first postoperative day, which was successfully managed with a lumbar drain for 5 days.ConclusionSellar reconstruction after endoscopic endonasal transsphenoidal resection of pituitary adenomas with PRF is feasible and safe. The three layer PRF augmentation is a novel technique to prevent CSF-leakage.

Predictors of mortality at 3 months in patients with skull base tumor resections in a low-income setting

ObjectiveGlobally, skull base tumors are among the most challenging tumors to treat and are known for their significant morbidity and mortality. Hence, this study aimed to identify robust associated factors that contribute to mortality of patients following surgical resection for a variety of skull base tumors at the 3-month follow-up period. This in turn helps devise an evidence-based meticulous treatment strategy and baseline input for quality improvement work.MethodologyA retrospective cohort study of patients undergoing skull base tumor resection was conducted at two large-volume neurosurgery centers in Ethiopia. The categorical variables were expressed in frequencies and percentages. Normal distribution of continuous data was checked by histogram and the Shapiro–Wilk test. Median with interquartile range (IQR) was calculated for skewed data, while mean with standard deviation (SD) was used for normally distributed data. Odds ratio and adjusted odds ratio (AOR) were used to express the result of univariate and multivariate binary logistic analyses, respectively. A p-value <0.005 was considered statistically significant at 95% confidence interval (CI).ResultThe study involved 266 patients. Of this, women accounted for 63.5% of patients. The median age of patients was 37 (±IQR = 17) years while the median size of the tumor in this study was 4.9 (±IQR 1.5) cm. The mean duration of symptoms at time of presentation was 17.3 (±SD = 11.1) months. Meningioma, pituitary adenoma, and craniopharyngioma contributed to 68.4%, 19.2%, and 9% of the skull-based tumors, respectively. Mortality following skull base tumor resection was 21.1%. On multivariable binary logistic regression analysis, intraoperative iatrogenic vascular insult (AOR = 28.76, 95% CI: 6.12–135.08, p = 0.000), intraventricular hemorrhage (AOR = 6.32, 95% CI: 1.19–33.63, p = 0.031), hospital-associated infection (AOR = 6.96, 95% CI: 2.04–23.67, p = 0.002), and extubation time exceeding 24 h (AOR = 12.89, 95% CI: 4.89–40.34, p = 0.000) were statistically significant with 3-month mortality.ConclusionMortality from skull base tumor resection remains high in our setting. Holistic pre-operative surgical planning, meticulous intraoperative execution of procedures, and post-operative dedicated follow-up of patients in a neurointensive care unit alongside quality improvement works on identified risks of mortality are strongly recommended to improve patient outcomes. The urgent need for setup improvement and further training of neurosurgeons is also underscored.

Improvement of biological and physicochemical quality of agricultural soil after three years of ultra-high dilutions treatment

Soil health is crucial for healthy crops, but pesticides, fertilizers, fungicides, and soil disinfectants can harm beneficial organisms and increase harmful ones. Agricultural practices can also damage soil, disrupting nutrient release and absorption. An economical, side-effect-free solution for soil revitalization is needed [1]. Ultra-high diluted supplements are now used for plant treatment, offering a cost-effective and easy method often added to water. This study examines the effects of ultra-high diluted supplements on soil detoxification and restoration over three years. It measured soil respiration, water absorption, residual toxins, active nitrogen, heavy metals, rheological characteristics, and bacterial diversity [2]. This study investigates the impact of ultra-high diluted supplements on detoxifying and restoring soil's biological and physicochemical characteristics after three years of treatment. For this soil respiration, water absorption, elemental and toxins contents, rheological and bacterial diversity stadied. Treatmet starts by two 6-month detox treatments with 200C sulfur and 30C petroleum. The soil was then irrigated toxin-free for 6 months and recovered for two 4-month periods with Carbo Vegetabilis 30C. After a 4-month rest, a 2-month rotation with silica 200C and calcarea carbonica 30C was applied, followed by another 4-month rest. The final treatment involved three courses of Sulfur 200C, Berberis 6C, and Carbo Vegetabilis 30C over 6 months. The soil was irrigated and rested for the last 4 months, then sampled for new characteristics. Results showed increased essential elements and decreased toxic elements after three years. Soil microbial population decreased by 2 units, gas exchange improved by 6 units, and soil pH became more acidic by one unit. Beneficial bacteria for plant growth, metabolism, fertility, and health were present.

Exploring the Effect of Environmental Conditions on Decay Kinetics of Aerosol Unsaturated Fatty Acids: New Insights Gained from Long-Term Ambient Measurements.

Unsaturated fatty acids (uFAs) are important constituents of atmospheric organic aerosols, undergoing rapid degradation in the atmosphere that significantly influences aerosol's physical and chemical properties. This study quantified the effective pseudo-first order decay rates of three abundant uFAs-oleic, elaidic, and linoleic acids under real atmospheric conditions using continuous bihourly measurement at a suburban site in Hong Kong over a 9-month period from November 2020 to August 2021. The impact of key environmental parameters, including ozone, initial uFA concentration, relative humidity, and temperature, on the decay rates was rigorously examined. Distinct kinetic behaviors were observed across different temperature ranges (TR1: 5-13 °C; TR2: 13-22 °C; TR3: 22-26 °C; TR4: 26-30 °C). Arrhenius plots of the decay rates revealed contrasting effective activation energies under TR2 and TR4, likely due to different phase states of aerosols and reaction mechanisms under varying environmental conditions. This study extends previous laboratory research by incorporating a wider range of ambient conditions, uncovering the complex interactions between environmental factors and the decay kinetics of uFAs. The findings provide critical insights for accurately modeling the fate of ambient organic aerosols and understanding the intricate impacts of atmospheric conditions on aerosol chemistry.

Vitamin D deficiency in hip fracture patients is associated with an increased mortality risk

PurposeThe aims were to assess whether vitamin D deficiency influenced mortality risk and length of acute hospital stay in patients presenting with a hip fracture.MethodsA retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels on admission, patient demographics, perioperative variables and mortality were collected. Cox regression analysis was utilised to determine the independent association between serum vitamin D levels and patient mortality.ResultsThe cohort consisted of 1510 patients with a mean age of 81.3 years and 1107 (71.4%) were female. 876 (58.0%) were vitamin D deficient (< 50 nmol/l). The median follow up was 405 (IQR 249 to 610) days. During follow-up there were 464 deaths (30.7%). Vitamin D deficiency was independently associated with higher mortality risk (hazard ratio [HR] 1.26, 95% confidence interval (CI) 1.03 to 1.53, P = 0.022). Male sex (HR 1.64, 95% CI 1.34 to 2.01, P < 0.001) was also associated with a higher mortality risk. Vitamin D deficiency was not associated with length of hospital stay (median difference 0 days, P = 0.207).ConclusionVitamin D deficiency was independently associated with increased mortality in hip fracture patients, though this finding may be influenced by lack of comprehensive adjustment for comorbidity. While the value of routine serum vitamin D measurement is debated, supplementation during hospital stays is important to reduce falls and fracture risks associated with deficiency.

LGBTQ+ Population Well-Being: Health Equity Implementation Science in Action.

Health equity is actualized when all individuals can attain the highest level of health. Youth who identify as LGBTQ+ experience health disparities and scarce access to culturally congruent mental healthcare. Our nurse-led research team recognized evidence-based practice guidance gaps and prioritized a systematic inquiry into the lived experiences of LGBTQ+ identifying youth who needed emergency care for suicidality. Concurrently, we translated new findings into practice. The purpose of this endeavor is to implement a nimble evidence-based practice adoption process for nursing staff to effectively address LGBTQ+ population health needs. Informed by Purnell's Cultural Competence Theory, qualitative findings from a prospective study and available literature, we developed an LGBTQ+ sensitive care curriculum for nursing staff using the American Nurses Credentialing Center's (ANCC) Nursing Continuing Education Professional Development (NCPD) Framework to address the intersectionality of cultural awareness and care provision. The curriculum was delivered and formally evaluated longitudinally with a focus on communication confidence and knowledge. The curriculum was delivered in one session to nursing staff during a 6-month period. Program evaluations indicated curriculum acceptability and effectiveness. Participants reported improved ability to use appropriate language when communicating with patients who identify as LGBTQ+ and their families and a moderate to high change in confidence when providing care to LGBTQ+ identifying patients. Concurrent, evidence-based efforts to uncover and apply new knowledge relevant to nursing communication with youth who identify as LGBTQ+ is possible and yield effective, positive change in nursing knowledge and confidence in providing care for these youth. Implementation science is essential to advance evidence-based nursing practice or the full positive impact of research on patient outcomes is not likely. When the implementation science program is not incorporated early in the research process, research excellence is at risk. Evolving evidence-based practices that enhance individualized holistic patient care delivery for LGBTQ+ individuals are strengthened when primary research, implementation science, and scaling research co-occurrence is achievable. This implementation strategy demonstrates that early translation of health equity research on culturally congruent care for individuals identifying as LGBTQ+ can be done effectively and replicated across practice settings. Further, this work validates the importance of the relationship between nurse scientists, translational scientists, and clinical practice and education experts in the early dissemination and adoption of new knowledge. Evidence-based practice adoption improves healthcare professionals' propensity to positively impact public health patient care outcomes. Nursing staff are equipped with the knowledge and skills to deliver equitable care. Dissemination of early research findings as an implementation science strategy supports concurrent adoption in clinical practice to advance health equity outcomes with urgency. No patient or public contribution.

Parathyroid allotransplantation for severe post-surgical hypoparathyroidism: a Brazilian experience.

This study presents the cases of two women who developed severe permanent hypoparathyroidism after neck surgery for papillary thyroid cancer and underwent parathyroid allotransplantation. Despite taking high doses of calcium and calcitriol supplements, the patients experienced persistent hypocalcemic symptoms. Fresh parathyroid tissue was removed and prepared from two patients with hyperparathyroidism secondary to end-stage kidney disease and was implanted in the non-dominant forearm of the recipients. Donors and recipients were ABO-compatible, and immunological screening was performed only in Case 2 (HLA typing, panel reactive antibody, and crossmatch tests). A short-term immunosuppressive regimen was adopted, consisting of 3days of methylprednisolone followed by 7days of prednisone. In Case 1, oral supplementation decreased to half of the initial dose 1month after transplantation and to one-fifth at the end of a 12-month follow-up period. In Case 2, intravenous calcium was discontinued 1-week post-transplantation, with no need for its use during the 12-month follow-up period. Serum parathyroid hormone levels did not increase and remained undetectable in both cases. In contrast, serum calcium levels increased significantly, and both patients experienced relief from hypocalcemic symptoms. Parathyroid allotransplantation can be an effective and safe treatment for PH and should be considered in severe cases. Nevertheless, formal recommendations depend on additional studies and validated protocols.

In situ metal silos grains storage performance: Maize and pearl millet for improved food security in an arid environment

Grains are commonly stored for improved food security. Among the grains storage facilities are metal silos. However, there is limited data on the performance of maize and pearl millet grains when stored in metal silos in real life (in situ) operations. To fill this gap, this study evaluated maize and pearl millet grains qualitative (nutritional) and quantitative (weight) losses during a 6-month storage period in metal silos in a semi-arid environment. Ash, protein, fat and carbohydrates & fiber contents were evaluated to indicate qualitative losses and moisture content was evaluated to indicate quantitative apparent weight loss of the stored grains. Percentage changes were calculated for moisture, ash, fat, protein and carbohydrates & fiber contents of the grains. In Katima Mulilo silo 1 based on % changes, fat contributed 5.76%, ash contributed 9.89% and carbohydrates & fiber contributed 1.61 % to the nutritional loss. There was no statistically significant protein loss in stored grains in all the studied silos. Pearl millet grains that were stored in Okongo silo had a % change of 30.38%, suggesting an apparent weight loss. The cause of ash, fat and carbohydrates & fiber loss of grains could be attributed to increased pest infestation at 6-month storage while moisture loss in pearl millet grains stored in Okongo silo could be attributed to increased temperature during the 6-month storage period. Maintenance of grains at appropriate relative humidity and temperature levels can mitigate grain weight loss.

Pain Control after Otologic Surgery: Do Nonopioid Analgesics Suffice?

Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery. Retrospective multicenter cohort. Two quaternary academic medical centers. Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period. Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery. Postoperative pain levels during the first week after surgery (0-10); proportion of patients requiring opioid medication. Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3-6). The median highest level of pain was 5 (IQR 4-8). The median current level of pain was 3 (IQR 1-5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers. NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.

Use of ultrasonography in the diagnosis of pneumonia in intensive care patients

Aims: A significant portion of respiratory system infections seen in intensive care units is ventilator-associated pneumonia, which has a high mortality rate and diagnosis may be delayed. Bedside lung ultrasonography offers the advantages of standard diagnostic methods as chest radiography or thorax tomography. We aim to evaluate the bedside lung ultrasonography correlation with the chest radiography or thorax tomography Methods: It was conducted prospectively on 60 patients between the ages of 18-85 who were admitted to intensive care with respiratory failure within an 8-month period. Anterioposterior chest radiographs were taken on the first day of mechanical ventilation for the patients included in the study. Ultrasonographic (USG) examination was performed separately for both hemithoraxes and recorded digitally. Simultaneously with the ultrasonographic examination, PEEP, FiO2, blood gas examination results and the highest body temperatures in the last 24 hours were recorded. The quality and quantity of tracheal secretions were evaluated, and sampling was performed for complete blood examination and tracheal aspirate culture-antibiogram. Lung injury score (LIS) and pulmonary infection score (CPIS) were calculated from the data obtained. In this process, independent of the research, the same day examination results of patients who required thorax tomography (CT) for diagnosis and treatment planning were evaluated together with USG and chest radiography. Tomographic examinations were evaluated by a radiologist. Results: In the examination of 120 hemithoraxes of 60 patients we included in the study, we were able to detect 74.17% of the pathological images obtained with chest radiography and ultrasonographic examination with bedside ultrasonography and 70.84% with chest radiography. Of the 20 patients who underwent tomographic evaluation, pathology was observed in 40 hemithoraxes in 92.5% by tomography, in 85% by ultrasonography, and in 75% by chest radiography. While isolated consolidation was detected equally on USG and CT imaging, there was a high false-positive rate of 48% on chest radiography. 58.8% of the patients with consolidation detected by CT, we observed that there was growth in the tracheal aspirate of 56.2% of the patients whose ultrasonographic examination revealed consolidation. Conclusion: Bedside lung ultrasonography is a fast, non-invasive, repeatable and reliable diagnostic method in patients followed in intensive care, and is compatible with traditionally used laboratory and clinical parameters. This reveals that USG, which is known to have other advantages such as cost, applicability, and not using radiopaque, will become an indispensable examination for ICU.

Supervisor resilience promotes employee well-being: The role of resource crossover

Drawing on Conservation of Resources theory and Crossover theory, we investigated the potential for crossover of a personal resource, resilience, from supervisors to employees. Specifically, the present study examined whether supervisor resilience influences employee well-being via a top-down resilience crossover process. The present study utilized a time-lagged design with three data points over a 9-month period. The sample consisted of 178 supervisors and 741 employees from the United States National Guard. Multi-level models controlling for baseline levels of the outcome variables demonstrated support for time-lagged resilience crossover from supervisor to employee. Moreover, results demonstrated support for the subsequent indirect effects on improved employee well-being outcomes including lower burnout and psychological distress, and greater life satisfaction. As such, our research contributes to our understanding of promoting employee resilience, crossover effects, and promoting employee well-being. In doing so, we integrate COR theory and Crossover theory to elucidate personal resource crossover as it pertains to supervisor and employee resilience. Additionally, we expand on understanding of how supervisor resilience can have indirect positive effects on employee well-being. Implications for theory and practice, as well as future research directions are also discussed in light of our findings.

Impact of switching to a dolutegravir-based regimen on body weight changes: insights from West African adult HIV cohorts.

Adverse metabolic effects related to dolutegravir (DTG) are increasingly reported as countries are adopting DTG-based regimens as first-line antiretroviral therapy (ART), but there is limited data from sub-Saharan Africa. We explored changes in body weight pre- and post-switch to a DTG-based regimen and assessed the association between DTG switch and significant weight gain (SWG) defined as a ≥10% increase over a 12-month period in people living with HIV (PLHIV) on ART in West Africa. We first included all PLHIV followed in the IeDEA West Africa cohorts between January 2017 and June 2021, with a documented switch to DTG during 2019-2021 and in care ≥36 months at the day of switch. Weight change was estimated using a two slope piecewise linear mixed model with change point at the switch date. Secondly, we emulated a sequence of target trials (ETT) based on the observational data, performing pooled logistic regression analysis to compare SWG occurrence between PLHIV who switched to DTG and those who did not. We first included 6705 PLHIV from Burkina Faso, Côte d'Ivoire and Nigeria. Their median age at the time of switch was 48 years (IQR: 42-54) with a median follow-up of 9 years (IQR: 6-12), 63% were female. Most patients switched from efavirenz (EFV)-based ART (56.6%) and nevirapine (NVP)-based ART (30.9%). The overall post-switch annual average weight gain (AAWG) was significantly elevated at 3.07 kg/year [95% CI: 2.33-3.80] compared to the pre-switch AWG which stood at 0.62 kg/year [95% CI: 0.36-0.88]. The post-switch AWG was greater in patients previously on EFV and protease inhibitor (PI)-based ART compared to those on NVP-based ART. The pooled logistic regression analyses of a sequence of 24 ETT, including 9598 person-trials, switching to DTG was significantly associated with an SWG (aOR = 2.54; 95% CI = 2.18-2.97). In West Africa, a 12-month DTG exposure was associated with substantial weight gain, especially in PLHIV previously on EFV and PI-based ARTs. Continuous weight monitoring and metabolic profiling is imperative in HIV cohorts to delineate the long-term cardiometabolic impact of DTG as patients with, or at elevated risk for cardiovascular diseases might benefit from alternative ART regimens.