Compensatory cognitive training for unstably housed, post-9/11 veterans in residential mental health treatment: A randomized controlled trial.

Living donor liver transplantation (LDLT) is an established therapy with curative intent for pediatric and adult patients with acute liver failure and end-stage liver disease. Donor safety remains paramount and commences during preoperative evaluation and assessment. Given the importance of the topic, the International Liver Transplantation Society and International Living Donor Liver Transplantation Group consensus conference on Living Liver Donor Safety was convened in March 2025 (Toronto, Canada). Recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for assessment of recommendations, and the Danish model of consensus was followed. This report presents 28 recommendations from the working group focused on addressing clinically relevant questions related to the preoperative aspects of living donor safety including assessment of donor acceptability (age, body mass index and hepatic steatosis; medical conditions and contraindications), medical and surgical workup (liver function and procoagulant workup; anatomical considerations and safe remnant), and psychosocial evaluation (timing and team; underlying conditions; non-directed, paired, and anonymous directed donors; urgent living donor workups for acute liver failure).

Recent advances in drug repurposing for dentin repair.

It all began, so they say, with Theodore Woodward, "Don't look for zebras on Greene Street." This aphorism has since been passed on to generations of residents and medical students at the University of Maryland School of Medicine and beyond. A zebra is a "medical condition whose appearance at a particular time and place, in a particular person, is both unexpected and astonishing. The 'condition' may be an item from the history, a physical finding, a laboratory test, or a diagnosis." This maxim nudges clinicians to consider competing or paradoxical hypotheses when assessing patients for common, unexpected, and rare diseases. Whereas errors are unavoidable, considering zebras (uncommon diagnoses) helps avoid "not-to-miss" diagnoses, patient harm, and the associated regret of failure. Perhaps there's also the tug to "bag the big one." On the one hand, pursuing zebras may result in overestimating probability assessments with the potential for harming patients and wasting resources, while applying the science of formal medical decision-analysis lessens the chances of overzealous workups. Unfortunately, conducting studies to evaluate the utility of clinical findings for rare diseases is difficult. The key is to identify symptoms and signs, preferably in combination, with high specificity and sensitivity. On the other hand, assuming horses (common diagnoses) for too long also has its risks. Both the failure to recognize when the current therapeutic plan is ineffective and to appreciate the diagnostic value of the history, physical, and routine laboratory tests can delay the search for alternative hypotheses and ultimately efficacious treatment. Sir William Osler admonished us over a century ago, "Use the knife and cautery to cure the moral necrosis which you will feel in the posterior parietal region, in Gall and Spurzheim's centre of self-esteem, where you will find a sore spot after you have made a mistake in diagnosis."

Introduction: Multiple Sclerosis (MS) is not just a medical condition but it is also an emotional and quite intrusive condition in the life of the patient as it leads to progressive disability. The uncertainty of permanent therapeutic intervention and the high risk of disability and side effects make patient’s psychological adjustment difficult and dramatically affect mental health. Aim: The aim of the study was to explore the psychological experience of a patient with MS. Methods: To explore the under-study phenomenon, a qualitative thematic analysis was conducted using a semistructured interview. To enhance the credibility and validity of findings, the strategy of triangulation was adopted. Three different researchers analyzed and compared the evidences. Results: The results showed that the first thoughts and feelings at the time of diagnosis included fear of the unknown and denial of acceptance, but over time led to compromise and acceptance. The challenges that the MS patient has to face were mainly related to the physical problems, the limitations imposed by the disease and the reactions of others. In this difficult path of the disease, the sources of support for the MS patient were the family and friendly environment, while the source of strength was faith in god and faith in the patient himself. Conclusions: Effective management of MS could be achieved through patients’ supportive environment. The need to provide psychological and social support to MS patients at all stages of their disease is considered imperative.

Anorexia nervosa (AN) is a severe psychiatric disorder with high morbidity and increased relative mortality compared to the general population. Involuntary treatment (IT) is implemented after exhausting voluntary treatment options. This study investigates mortality in patients with AN following IT, using IT as an indicator of patient vulnerability. A register-based cohort study including individuals diagnosed with AN (ICD-10: F50.0, F50.1) from 2000 to 2016 at any Danish hospital and with an inpatient admission following their AN diagnosis. The exposure was the first instance of any IT event and categories of IT after AN. IT could be associated with AN or any other diagnosis. The outcome was mortality; all-cause and divided into deaths from diseases and medical conditions, external causes, or suicide. Excess mortality was estimated as hazard ratios (HR) using Cox proportional hazards regression. The model was adjusted for sex, age at AN diagnosis, birth year, prior IT, self-harm, and other psychiatric morbidities. Over the study period 4425 individuals (93.3% female; mean age at diagnosis = 22, SD = 12) were included in the study. Of these, 821 individuals received IT (18.5%) and 206 individuals (4.7%) died. The HRs were elevated for all-cause mortality (HR = 2.21, [95% CI: 1.54-3.17]), external causes (HR = 3.88, [95% CI: 1.94-7.77]), and suicide (HR = 5.30, [95% CI: 2.07-13.54]). The analysis of IT categories only showed an elevated HR for electroconvulsive therapy and somatic concerns (HR = 1.96, [95%CI: 1.04-3.67]). Despite IT primarily being used to safeguard the life of the most vulnerable patients, mortality for those who received IT was elevated. The results indicate that this patient group requires sustained clinical attention.

Venous thromboembolism risk assessment in hospital-at-home setting: A prospective cohort study (the TROMBODOM study).

Fashion or necessity? Trendy device or assistive technology? Throughout history, eyewear has played various roles in human civilization. It can be a reflection of personality, a symbol of social class, an indication of a medical condition, a bellwether of trending cultural and political phenomenon or a wearable technology that intrigues the mass consumers. Eyewear as a product category is embedded in fashion, while also far beyond fashion. In this article, we explore the multifaceted relationship between eyewear fashion and its influence on society by examining a series of projects developed by the author over a decade-long career in the eyewear design industry. These case studies include a collaboration with a fashion house and a celebrity, investigating human facial ergonomics and eyewear fitting, utilizing advanced manufacturing platforms and materials, and reviewing the latest technology and smart eyewear offerings. Drawing on insider knowledge of the eyewear industry, the author guides you through the impact of fashion as a design element on the eyewear development process, and conversely, how eyewear as a product imposes constraints on the fluidity of fashion.

Preeclampsia was recognized as a serious medical condition affecting both mother and fetus. Recent investigations revealed infectious agents such as H. pylori, CMV, and T. gondii could seriously affect the progression of preeclampsia but these findings are contradictory. The aim of the study was to evaluate the seroprevalence of IgG and IgM antibodies against Helicobacter pylori (H. pylori), Toxoplasma gondii (T. gondii), and Cytomegalovirus (CMV) between pregnant women with preeclampsia and healthy pregnant women. This case-control study was conducted on 90 pregnant women with preeclampsia (case group) and 90 matched healthy pregnant women (control group), who were matched by their age and gestational age from July to December 2024 in Hamadan. A checklist was employed to assess the demographic and laboratory parameters of case and control groups, especially the seroprevalence of IgG and IgM antibodies against H. pylori, T. gondii, and CMV. Statistical analysis was performed utilizing a logistic regression model with the SPSS 26 software program. There was a significant difference in the serum levels of IgM against H. pylori and IgG against CMV in patients compared to control groups, whereas the seroprevalence of other antibodies was not significantly changed. There was a significant association between women in case and control groups in terms of laboratory parameters such as HCT, BUN, ALT, BMI, NLR, and proteinuria. H. pylori and CMV could be regarded as the associated factors for the progression of preeclampsia. Novel therapeutic approaches could reduce the prevalence of preeclampsia by targeting inflammatory pathways.

Overweight and obesity have been steadily increasing worldwide. Metabolic/bariatric surgery (MBS) is the most effective treatment for obesity and its associated medical conditions. Obesity complications increase with age, however, older patients face a higher perioperative risk necessitating a clear risk-benefit balance. This study evaluated weight-loss outcomes, remission of associated medical conditions, and complications in patients aged ≥ 65 years undergoing MBS. This retrospective analysis included patients aged ≥ 65 years who underwent MBS at the Medical University of Vienna between 2008 and 2025. Weight and associated medical complications were assessed at baseline and at 1, 2, and 5 years postoperatively. Early (< 30 days) and late complications up to 5 years were recorded. In total, 111 patients were included. Baseline weight was 125.8 ± 22.3kg and BMI 45.2 ± 7.4kg/[Formula: see text]. At 5 years, mean BMI decreased to 27.5 ± 6.2kg/[Formula: see text] corresponding to a total weight loss of 37.3 ± 14.7%. The prevalence of type II diabetes decreased from 54.1% to 22.9% and arterial hypertension from 87.4% to 56.2%. Early and late complications each occurred in 7.2%. MBS achieves substantial long-term weight reduction and remission of associated medical conditions. Complication rates are relatively high, underscoring careful patient selection is essential. Larger prospective studies focusing on elderly populations are warranted. MBS in elderly patients is effective in terms of weight loss and remission of associated medical complications. - MBS in elderly patients was associated with a relatively high complication rate. - Deaths within the study period were not associated with the MBS procedure.

To compare the clinical outcome of patients electing to undergo the Cross Bracing Protocol (CBP) for ACL rupture with those choosing surgical stabilization. Observational prospective cohort study with 2-year follow-up. Private subspecialist sports orthopedics and sports medicine practice. The 80 patients who both entered and completed the study were skeletally mature 16 to 40 years old, presenting with an acute noncontact isolated ACL rupture, taking part in pivoting sports and intent on returning to that activity. ACL rupture was diagnosed on both clinical assessment and MRI. Patients were fit for general anesthetic and free of significant medical conditions. Group A (40 patients) underwent surgical stabilization, and group B (40 patients) followed the CBP. The groups were similar regarding the following independent variables: age, body mass index, gender, dominance of the injured knee, and posterior tibial slope ( P > 0.05). Recurrent instability, incidence of meniscal tears, and the following patient-reported outcome measures (PROMs); Tegner Activity Scores; Knee Injury Osteoarthritis Outcome Score subscales of sport/recreation and knee-related quality of life; subjective International Knee Documentation Committee score; and Lysholm Knee Score. Group B had significantly higher risk of recurrent instability (70% vs 2.5%, P < 0.001), medial meniscal tear (62% vs 2.5%, P < 0.001), and inferior performance on all PROMs ( P < 0.001). The CBP is associated with an unacceptably high rate of recurrent instability when used to treat ACL ruptures in patients taking part in pivoting sports.

BackgroundPerioperative acute myocardial infarction (POMI) complicates 1-5% of non-cardiac operations, influenced by patient risk factors and surgical complexity. The present study used a contemporary, nationally representative cohort of non-cardiac operation patients to characterize current trends in the incidence and impact of POMI. We hypothesized that POMI remains associated with increased mortality, complications, and resource utilization.MethodsAll adult (>18years) hospitalizations entailing non-cardiac surgical procedures were identified from the 2016-2022 Nationwide Readmissions Database. Non-cardiac operations included intraabdominal, vascular, orthopedic, thoracic, urinary, gynecology, and otolaryngology procedures. Those experiencing POMI comprised the POMI cohort (others: Non-POMI). Multivariable logistic and linear regression models were developed to evaluate the association of POMI with outcomes of interest including in-hospital mortality, postoperative complications, and non-elective readmissions.ResultsOf an estimated 8 633 451 non-cardiac operations, 66% were elective and 0.92% experienced POMI. Relative to others, POMI were older and had a greater burden of chronic medical conditions. Following comprehensive risk-adjustment, POMI was associated with greater in-hospital mortality. Furthermore, POMI was linked with increased hospitalization duration by 4.25days and costs by $23 710. Additionally, POMI was associated with increased odds of 30-day non-elective readmissions. A modest increase in POMI incidence was observed over time across operative categories.ConclusionThe incidence of perioperative acute myocardial infarction following non-cardiac operations remains low (∼1%), with modest increases observed across select operative categories. This complication remains associated with substantial mortality, increased resource utilization, and higher rates of non-elective readmissions, underscoring the critical importance of perioperative cardiac risk stratification and optimization.

Home modification services, including durable medical equipment (HM-DME), are crucial for helping veterans age in place. While the U.S. Veterans Health Administration (VHA) provides these services, rural veterans may face limited access due to health care disparities. This study analyzed HM-DME service use in VHA facilities within Veterans Integrated Service Network (VISN) 8, focusing on the proportion of veterans who received the service, common medical conditions, and specific types of HM-DME, using descriptive statistics and Pearson's chi-square tests. The results showed that 19.7% of veterans received at least one HM-DME, with most of these services focused on improving bathroom safety. Despite the higher prevalence of health issues among rural veterans, there were no significant differences in service utilization between rural and urban veterans. These findings highlight possible gaps in service delivery in VISN 8 and emphasize the importance of enhancing continuous access to HM-DME services, especially for veterans living in rural areas.

The 21-valent pneumococcal conjugate vaccine (PCV21) covers 83-88% of IPD in US adults but does not include serotype 4 (ST4), which is covered by previously recommended vaccines (PPSV23, PCV15, PCV20). Recent increases in IPD cases due to ST4 have been observed, particularly among adults under 65, including Native American/Alaskan Native and those with social risk factors. As a result, the Advisory Committee on Immunization Practices (ACIP) recommends ST4-containing vaccines (PPSV23, PCV15, and PCV20) for populations with ≥ 30% ST4 IPD cases. In this study, we aimed to analyze ST4 attributable fraction (AF) thresholds for health and economic outcomes of PCV21 versus PCV20 vaccination in US adults aged 19-49 and 50-64 years with underlying medical conditions. We used a validated Markov model to estimate incremental cost-effectiveness ratios (ICERs) for PCV21 versus PCV20 and identified ST4 AF thresholds in which the ICER shifted from 'cost-saving' to 'not cost-effective'. The analysis involved a hypothetical 1 million at-risk adults aged 19-49 and 50-64years. PCV21 remained cost-saving compared to PCV20 when ST4 accounted for ≤ 27% (age 19-49) or ≤ 36% (age 50-64) of IPD. When ST4 increases wereapplied to both IPD and NBPP, these thresholds decreased to ≤ 21% and ≤ 28%, respectively. For populations experiencing moderate increases in the proportion of ST4 (i.e., < 30%), PCV21 may offer health and economic benefits over PCV20 for US adults aged 19-64years with underlying medical conditions. However, in populations with ≥ 30% ST4, ST4-containing vaccines should be used as per ACIP guidance.

This ongoing phase 2/3 interventional, open-label study evaluated nirmatrelvir/ritonavir (NMV/r) in pediatric participants with mild-to-moderate COVID-19 at risk for severe disease (due to underlying medical conditions). Primary objectives were pharmacokinetics (PK) and safety. We report data from participants aged at least 6years. Twice daily (BID) oral NMV/r was administered for 5days to participants aged at least 6years weighing at least 40kg (Cohort 1) or 20 to <40kg (Cohort 2). Day 1 and 5 sparse PK samples were incorporated into a previously developed population PK model to simulate exposure. Efficacy was extrapolated from adults by matching pediatric exposure to that in COVID-19-infected adults. Safety through Day 34 and supportive efficacy endpoints (hospitalization/death, SARS-CoV-2 RNA concentration over time) were evaluated. Overall, 75 participants received at least 1 dose. Simulated exposure of NMV/r 300/100mg BID for Cohort 1 and 150/100mg BID for Cohort 2 indicated more than 90% of participants achieved minimum NMV concentrations above the 90% effective concentration after dose 1 and at steady state. NMV/r was safe and well tolerated. The most frequently reported adverse events (AEs) were diarrhea and headache (n = 3 [4%] participants each). No discontinuations because of treatment-related AEs occurred. No treatment-related serious AEs were reported. No COVID-19-related hospitalizations or all-cause deaths were reported. Robust reductions in SARS-CoV-2 RNA from baseline to the end of treatment were observed. In pediatric participants aged at least 6years, NMV/r 300/100mg BID (weighing ≥40kg) and 150/100mg BID (weighing 20-<40kg) regimens achieved exposures similar to adults that were safe and had an antiviral effect.

Contemporary management of superior vena cava syndrome.

Mandela Yoga Project aims to improve health outcomes and reduce costs for communities with lived experience of chronic illness and systemic racism. Codeveloped with diverse staff at a safety-net health center, the Mandela Yoga Group Medical Visit model was piloted (n = 32) in two five- to six-week groups for patients with multiple chronic conditions. We report qualitative and quantitative findings (reduced pain, increased belonging, healing relationships), and discuss systems alignment to scale this peer-led, trauma-informed, culturally resonant public health intervention. (Am J Public Health. 2026;116(S3): S138-S142. https://doi.org/10.2105/AJPH.2026.308594).

The efficacy of virtual reality interventions for depressive disorder due to another medical condition: A three-level meta-analysis.

Art has historically reflected prevailing medical conditions and societal responses to disability. Hieronymus Bosch's The Procession of Cripples depicts numerous individuals with visible musculoskeletal deformities, providing a unique historical perspective on disability in late medieval Europe. A visual and historical analysis of Bosch's ink-on-paper illustration was performed. Each depicted figure was evaluated for observable limb deformities, gait abnormalities, amputations, and use of assistive devices. Findings were interpreted using contemporary pediatric orthopaedic diagnostic principles. Thirty-one individuals demonstrate a spectrum of abnormalities consistent with congenital limb deficiencies, posttraumatic deformities, postinfectious sequelae, and neuromuscular conditions. Multiple figures rely on primitive mobility aids, including crutches, limb boards, and early prosthetic constructs. These devices reflect foundational orthotic and prosthetic principles that parallel modern pediatric orthopaedic interventions aimed at restoring function and ambulation. The Procession of Cripples provides a detailed visual record of musculoskeletal pathology and early assistive technology in the medieval period. The work illustrates historical continuity in the goals of pediatric orthopaedics: restoring mobility, alignment, and independence in children with limb deformities and neuromuscular conditions. Level V-expert opinion/historical analysis.

Elevated Incidence of Emotional Morbidity in Critically Ill Sepsis Survivors, Not Mediated by Incidence of Other Chronic Medical Conditions.