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Vocal Self-Perception of Singers During COVID-19 Pandemic.

to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period. Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br). In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P=0.045), vocal restriction (P=0.002), and recovery with vocal rest (P=0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice. Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers.

Development of a Multi-site Curriculum for Inequities in Newborn Care (CINC) Informed by Pediatric Resident and Community Engagement.

Inequities in health care are a well-identified contributor to adverse outcomes in neonates of vulnerable populations. 1 2022 March of Dimes Report Card. Accessed March 8, 2023. 〈https://www.marchofdimes.org/report-card〉 Google Scholar , 2 Warren M.D. Hirai A.H. Lee V. Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030. Pediatrics. Published online January. 2022; 3e2021052800https://doi.org/10.1542/peds.2021-052800 Crossref Scopus (2) Google Scholar , 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Societal and institutional inequities rooted within implicit biases and racism result in variable quality of care in the nursery, such as differences in time spent skin-to-skin with infants, clinical resource allocation based on racial background, and a lack of motivation to establish a therapeutic alliance with families who have differing social and cultural needs. 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Most significantly, this inequitable care results in the increased mortality of non-Hispanic black and Hispanic infants as compared to infants of non-Hispanic white backgrounds. 4 National Vital Statistics Reports Volume 69, Number 7 July 16, 2020, Infant Mortality in the United States, 2018 : Data From the Period Linked Birth/Infant Death File. Google Scholar In light of these inequities, the Academic Pediatrics Association (APA) implemented initiatives rooted in active anti-racism to dismantle oppressive power structures across pediatric organizations. 5 Cohen A. et al. Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism. Academic Pediatrics. 2022; 22: 352-355https://doi.org/10.1016/j.acap.2022.01.002 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar This urgent commitment to action is further supported by the Association of Pediatric Program Directors (APPD) which maintains that anti-racism involves actively dismantling racism in all that we do. 6 Blankenburg B. et al. Dismantling Racism: Association of Pediatric Program Directors’ Commitment to Action. Academic Pediatrics. 2020; 20: 1051-1053https://doi.org/10.1016/j.acap.2020.08.017 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Focus groups of trainees at 4 Bay Area academic medical centers explored gaps in education on newborn health inequities to best understand how to support providers in actively practicing anti-racism in clinical care. Trainees spotlight inequities in their rotations, but feel helpless to address them given a lack of action-based tools, education on inequities, protected time for reflection, and faculty role-modeling. 7 Hume P. , Bowers K. , Robertson L. , et al. Residents’ Perspectives on Neonatal Health Inequities to Guide an Innovative Curriculum. Poster Presentation presented at: APPD; March 2023; Atlanta, Georgia. Google Scholar Given these highlighted gaps, we sought to provide our pediatrics faculty and trainees with action-oriented education to address inequities.

Health Equity in the Neonatal Intensive Care Unit Rounds: A Multidisciplinary Educational Conference.

Despite improving pregnancy-related morbidity and mortality in other high-income countries, birthing people and infants in the United States have disparate and worsening outcomes influenced by structural, political, and moral determinants of health including racism. 1 2021 Annual Report. America's Health Rankings, United Health Foundation. 〈https://www.americashealthrankings.org/learn/reports/2021-annual-report/international-comparison〉. Published 2021. Accessed2022. Google Scholar , 2 Clark A. Wescott P. Mitchell N. Mahdi I. Crear-Perry J. Centering equity: Addressing structural and social determinants of health to improve maternal and infant health outcomes. Semin Perinatol. 2022; 46151661 Crossref PubMed Scopus (3) Google Scholar As clinicians in the neonatal intensive care unit (NICU), we are professionally obligated to enact structural and individual changes to mitigate disparities. 3 Cohen A. Montez K. Orr C. et al. Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism. Acad Pediatr. 2022; 22: 352-355 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Therefore, recognizing and understanding how structural determinants of health (SDoH) and racism affect our patients is paramount.

Improving Diversity, Equity, and Inclusion Content in Pediatrics Grand Rounds.

Grand rounds (GR) is a quintessential component of medical education across the spectrum from undergraduate medical education to continuing medical education for established physicians with a goal of enhancing knowledge, changing physician behavior, and improving patient outcomes. The purpose and scope of GR has undergone many iterations over the hundreds of years of its practice and previous work has aimed to enhance its educational impact, 1 Van Hoof, Thomas MD, EdD, J. Monson, Robert PhD, J. et al. A Case Study of Medical Grand Rounds: Are We Using Effective Methods?. Academic Medicine. 2009; Volume 84 (August): 1144-1151https://doi.org/10.1097/ACM.0b013e3181ad1c0e Crossref Scopus (33) Google Scholar including innovations that seek to educate about the origin and ongoing consequences of the health crises of systemic racism and other structural inequities. 2 Perdomo J. Tolliver D. Hsu H. et al. Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees. MedEdPORTAL. 2019; 15: 10858https://doi.org/10.15766/mep_2374-8265.10858 Crossref PubMed Scopus (39) Google Scholar A primary audience for GR is established mid- and late-career faculty, an educational target group perhaps more in need of DEI pedagogy than our earliest medical career learners. 3 Rosenkranz Kari M. Arora Tania K. Termuhlen Paula M. et al. Diversity, Equity and Inclusion in Medicine: Why It Matters and How do We Achieve It?. Journal of Surgical Education. 2021; Volume 78 (ISSN 1931-7204): 1058-1065https://doi.org/10.1016/j.jsurg.2020.11.013 Crossref Scopus (34) Google Scholar Previous work on improving anti-racist content in medical education recognizes this group as in need of particular focus. 4 Blankenburg R. et al. Dismantling racism: Association of Pediatric Program Directors’ Commitment to Action. Academic Pediatrics. 2020; 20: 1051-1053 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Development of presentations that consistently and specifically address aspects of DEI is essential to sustainably re-orienting medical education to address health equity.

Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace-A Curriculum Update.

Racism is a public health crisis. Bias towards patients adversely affects health outcomes 1 FitzGerald C. Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017; 18 (Mar 1) (PMID: 28249596; PMCID: PMC5333436.): 19https://doi.org/10.1186/s12910-017-0179-8 Crossref PubMed Scopus (984) Google Scholar and access to care while structural racism in medicine has led to decreased diversity of the healthcare workforce, burnout, and negative career outcomes. 2 Filut A. Alvarez M. Carnes M. Discrimination Toward Physicians of Color: A Systematic Review. J Natl Med Assoc. 2020; 112 (Apr): 117-140https://doi.org/10.1016/j.jnma.2020.02.008 Crossref PubMed Scopus (46) Google Scholar Growing evidence shows that curricula addressing racism within medical education can increase providers’ perceived capacity to address racism and limit its impact on patients and staff. 3 Jindal M. Mistry K.B. McRae A. Unaka N. Johnson T. Thornton R.L.J. "It Makes Me a Better Person and Doctor": A Qualitative Study of Residents' Perceptions of a Curriculum Addressing Racism. Acad Pediatr. 2022; 22 (Mar): 332-341https://doi.org/10.1016/j.acap.2021.12.012 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar

2023 CCS/CSE Standards for Physician Training and Maintenance of Competence in Adult Echocardiography: Executive Summary.

Echocardiography is an imaging modality essential to the provision of contemporary cardiovascular care. Since the publication of the 2010 CCS/CSE Guidelines, 1 Burwash IG, Basmadjian A, Bewick D, Choy JB, Cujec B, Jassal DS, MacKenzie S, Nair P, Rudski L, Yu E, Tam JW. 2010 Canadian Cardiovascular Society/Canadian Society of Echocardiography Guidelines for Training and Maintenance of Competency in Adult Echocardiography. Can J Cardiol 2010;27:862-864. Google Scholar clinical echocardiography has expanded with respect to both technologies and applications. At the same time there has been a shift in emphasis away from quantity of training (duration and case volumes) to actual demonstration of competency to determine successful completion of training. 2 Royal College of Physicians and Surgeons of Canada “Competency by Design: Reshaping Medical Education” 2014 https://www.royalcollege.ca/rcsite/documents/educational-strategy-accreditation/royal-college-competency-by- design-ebook-e.pdf Accessed 8 March 2023. Google Scholar Concurrently, there is growing evidence of considerable variability in echocardiography competence among general cardiology trainees. 3 Nair P. Siu S.C. Sloggett C.E. Biclar L. Sidhu R.S. Yu E.H.C. The assessment of technical and interpretative proficiency in echocardiography. J Am Soc Echocardiogr. 2006; 19: 924-931 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 4 Bierowski M.J. Qureshi U. Ramedani S. Grewal S. Shah R. Park B. Peterson B.R. Variable exposure to echocardiography core competencies when applying minimum recommended procedural numbers of cardiology fellows in training. Cardiovasc Ultrasound. 2022; 20: 24-32 Crossref Scopus (0) Google Scholar , 5 Yu C.C.W. Pendrith C. Chun S. Echocardiographic interpretation skills of graduating cardiology trainees. Can J Cardiol. 2022; 38: 1304-1306 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar

Open reconstruction of severe superior vena cava syndrome with right internal jugular-Superior vena cava bypass using femoral vein.

Current treatment of chronic benign superior vena cava syndrome (SVCS) is endovascular with angioplasty/stenting1Rizvi A.Z. Kalra M. Bjarnason H. Bower T.C. Schleck C. Gloviczki P. Benign superior vena cava syndrome: Stenting is now the first line of treatment.J Vasc Surg. 2008; 47: 372-380Abstract Full Text Full Text PDF PubMed Scopus (153) Google Scholar,2Wilson L.D. Detterbeck F.C. Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes.N Engl J Med. 2007; 356: 1862-1869Crossref PubMed Scopus (355) Google Scholar. Open surgical bypass is typically considered for patients who fail endovascular therapy3Picquet J. Blin V. Dussaussoy C. Jousset Y. Papon X. Enon B. Surgical reconstruction of the superior vena cava system: Indications and results.Surgery. 2009; 145: 93-99Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar,4Kalra M. Sen I. Gloviczki P. Endovenous and Operative Treatment of Superior Vena Cava Syndrome.Surg Clin North Am. 2018; 98: 321-335Abstract Full Text Full Text PDF Scopus (20) Google Scholar. This report illustrates the surgical treatment of symptomatic SVCS. The patient consented to the publication. A 31-year-old male patient presented with recurrent edema and dilated veins of the upper extremities, head, neck, and chest, with concomitant severe headache. His history was significant for previous left lower extremity osteomyelitis six years before, being treated with antibiotics through a left upper extremity peripherally inserted central catheter (PICC). Symptoms of SVCS developed three years later. He was treated with bilateral subclavian and innominate vein stenting extending into the superior vena cava (SVC). Despite oral anticoagulation since the first intervention, the patient had multiple in-stent reocclusions and seven reinterventions with only temporary symptom improvement. Physical examination evidenced facial edema, plethoric facies, and dilated veins in the chest and abdomen. Computed tomography venogram (CTV) demonstrated occlusion of all stents. The right internal jugular vein (RIJV) was patent at the upper-neck level, close to the carotid bifurcation and the SVC was also patent caudally to the azygos vein. A left upper extremity and central venogram were performed and attempts were made to cross the occluded stents, without success. The patient then agreed to proceed with an open reconstruction. A RIJV to SVC bypass was performed using the patient´s right femoral vein, which had 8 mm in diameter, via a median sternotomy and a right neck incision (01:39). The suitable diameter of the vein-graft relies upon the main vessels’ diameter and patient´s anatomy, although a minimum dimeter of 6 mm is generally accepted. After the SVC anastomosis, a Valsalva maneuver was performed, and the clamp was opened with the patient in Trendelenburg position to minimize the risk of air embolism. At the two-year follow-up, a patent bypass was demonstrated with symptoms resolution. Annual follow-up with duplex ultrasound will be pursued. Open surgical treatment of SVC syndrome is associated with long-term symptoms relief and is an excellent option for patients who fail endovascular treatment. The femoral vein-graft was an excellent conduit with a good size-match to the RIJV, durable results and symptoms resolution. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3OTBmNTRkMDM4ODYxZjBkNTkxYTBlMWZlNDc5OGU3NyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg3NTk5NzY2fQ.cmFN_OFbjDH4lOiwl1zKkjrgnyVQ2yXQnj_hVfumqU1CX0DvODIdqDnFjP8WKhsd08e_hL8cEQf62356emnlqTr0YQ3Taf7QzqEzXDSXdshLabCLWCJSBJImuFBTwhSNEbChKp9VtQEQaGgQFyoxmim8ywtDZOp91FbZKEyqSzPRGpQZ1TaQTnYdofXOPWy6HWHwpA7L72nUSdtDa6DKZAo-7fV2qqKuAhpR-b2_-TYFZ5QDsM4894KbXMoSfpiuH1MyYN3E2RcS1dja_5IiR_wUucRBjC65wTnhE2xRmiUL_0CZXxMNdfGKpq8bBaTg1GNl69QgdXWvXJkmViQ8Mw Download .mp4 (86.14 MB) Help with .mp4 files

Obesity wars: hypothalamic sEVs a new hope.

There are currently several pharmacological therapies available for the treatment of obesity, targeting both the central nervous system (CNS) and peripheral tissues. In recent years, small extracellular vesicles (sEVs) have been shown to be involved in many pathophysiological conditions. Because of their special nanosized structure and contents, sEVs can activate receptors and trigger intracellular pathways in recipient cells. Notably, in addition to transferring molecules between cells, sEVs can also alter their phenotypic characteristics. The purpose of this review is to discuss how sEVs can be used as a CNS-targeted strategy for treating obesity. Furthermore, we will evaluate current findings, such as the sEV-mediated targeting of hypothalamic AMP-activated protein kinase (AMPK), and discuss how they can be translated into clinical application.

Cone repair after tricuspid valve replacement in Ebstein anomaly.

Cone repair after tricuspid valve replacement in Ebstein anomaly.

Pediatrician-Delivered Smoking-Cessation Messages for Parents: An Update.

Clinicians who care for children and adolescents are well positioned to help parents quit smoking – the leading preventable cause of disease and death in the US. Understanding parents’ preferences for smoking-cessation messages may help clinicians tailor interventions to increase the likelihood of quitting. A concept from behavioral economics, called message framing, can be leveraged to motivate adult smokers to quit and may help motivate parents to quit. 1 Jenssen B.P. Kelly M.K. Faerber J. et al. Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping. Acad Pediatr. 2021; 21: 129-138https://doi.org/10.1016/j.acap.2020.07.018 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In our study, “Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping,” using a discrete choice experiment and latent class analysis, we identified subgroups of parents who smoke with preferences for certain types of motivational messages: messages focused on the impact of smoking on the child, messages that were gain-framed rather than loss-framed messages (emphasizing benefits of engaging over costs of failing to engage in treatment), and messages focused on the financial impact of smoking. 1 Jenssen B.P. Kelly M.K. Faerber J. et al. Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping. Acad Pediatr. 2021; 21: 129-138https://doi.org/10.1016/j.acap.2020.07.018 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar We proposed that future work should explore how to best incorporate these messages into clinical practice as well as examine the relationship between tailored messages and subsequent behavior change. Since the publication of our study, others have expanded work in this field. In this progress report, we consider our study’s findings within the context of other studies published since January 2021, when we submitted our manuscript for publication, and discuss: 1) tailored content to help individuals who smoke quit, 2) methods to create a new system for smoking cessation for parents of pediatric patients, and 3) preliminarily evaluation of this new system in clinical practice.

Harmful algal bloom aerosols and human health.

Harmful algal blooms (HABs) are increasing across many locations globally. Toxins from HABs can be incorporated into aerosols and transported inland, where subsequent exposure and inhalation can induce adverse health effects. However, the relationship between HAB aerosols and health outcomes remains unclear despite the potential for population-level exposures. In this review, we synthesized the current state of knowledge and identified evidence gaps in the relationship between HAB aerosols and human health. Aerosols from Karenia brevis, Ostreopsis sp., and cyanobacteria were linked with respiratory outcomes. However, most works did not directly measure aerosol or toxin concentrations and instead relied on proxy metrics of exposure, such as cell concentrations in nearby waterbodies. Furthermore, the number of studies with epidemiological designs was limited. Significant uncertainties remain regarding the health effects of other HAB species; threshold dose and the dose-response relationship; effects of concurrent exposures to mixtures of toxins and other aerosol sources, such as microplastics and metals; the impact of long-term exposures; and disparities in exposures and associated health effects across potentially vulnerable subpopulations. Additional studies employing multifaceted exposure assessment methods and leveraging large health databases could address such gaps and improve our understanding of the public health burden of HABs.

Long COVID in inflammatory rheumatic diseases-what's in a name?

Long COVID in inflammatory rheumatic diseases-what's in a name?

Rheumatology congresses post COVID-19: we cannot regress.

Rheumatology congresses post COVID-19: we cannot regress.

Improving Access and Equity in a Post-Dobbs World

Improving Access and Equity in a Post-Dobbs World

Lumbar spine epidural abscess and facet joint septic arthritis in a pediatric patient.

A 13-year-old girl presented with lower back pain that began 7 days earlier after a volleyball workout. She had no history of trauma or fever. On physical examination, a contraction of the left paravertebral muscles associated with pain on flexion-extension of the spine and a positive left Lasègue's sign were evident. She had no neurological deficits in the lower limbs. Chest and lumbosacral X-rays were unremarkable, and a laboratory investigation revealed neutrophilia and elevated C-reactive protein (75.7 mg/L; normal value < 5). Urine and blood cultures were carried out before starting ceftriaxone. She developed a fever (38.8 °C) 1 day after admission, and the blood culture was positive for methicillin-sensitive Staphylococcus aureus. A lumbosacral magnetic resonance imaging (MRI) scan was performed considering the clinical and microbiological evidence and suspecting an osteoarticular infection. The MRI revealed a small amount of interarticular fluid in the left L4-L5 hemivertebral region and a posterior spinal epidural abscess on the left side extending from L4 to L5-S1 (Fig. 1). The diagnosis was lumbar spine epidural abscess (SEA) and facet joint septic arthritis (SAFJ). As the girl did not present with neurological symptoms, no surgical treatment was indicated, and cefazolin was administered intravenously with rapid resolution of the fever and pain. She was discharged after 4 weeks of intravenous antimicrobial therapy, which was followed by 4 more weeks of oral antibiotic therapy with levofloxacin. The 3-month follow-up MRI showed complete regression of the epidural fluid and almost complete normalization of the signal abnormalities in the L4-L5 soft tissues (Fig. S1). Facet joint septic arthritis is a rare condition.1Mas-Atance J. Gil-García M.I. Jover-Sáenz A. Curià-Jové E. Jové-Talavera R. Charlez-Marco A. et al.Septi carthritis of a posteriorlumbarfacet joint in an infant: a case report.Spine (Phila Pa 1976). 2009; 34: E465-E468Crossref PubMed Scopus (10) Google Scholar Few pediatric cases have been described, mainly in immunosuppressed patients. The most commonly associated pathogen is S. aureus.2Cabet S. Perge K. Ouziel A. Vandergugten S. Guibaud L. Ferry T. et al.Septic arthritis of facet joint in children: a systematic review and a 10-year consecutive case series.Pediatr Infect Dis J. 2021; 40: 411-417Crossref PubMed Scopus (0) Google Scholar The mechanism of the spread of this infection is not understood, but contamination may originate from direct inoculation, contiguity, or hematogenous dissemination. In the present case, the patient had no history of lumbar or epidural injections, so the most likely origin was hematogenous dissemination. The coexistence of localized epidural, articular, and paravertebral abnormalities on an MRI examination acquired only a few days after symptom onset led us to speculate that the infection originated in the left L4-L5 zygoapophyseal joint and spread to contiguous tissues, both inside and outside the lumbar canal. The three most common presenting symptoms of spinal epidural abscess are back pain, fever, and neurological deficit; however, these symptoms do not always occur together, contributing to the delayed diagnosis, which is reported in 50%–75% of cases.3Reihsaus E. Waldbaur H. Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients.Neurosurg Rev. 2000; 23: 175-204Crossref PubMed Google Scholar Surgery is reserved for nonantibiotic responders or in cases of neurologic deficit. Lumbar SEA and SAFJ are clinical emergencies with significant morbidity and mortality, particularly when there is a delayed diagnosis. Therefore, early clinical suspicion, diagnosis, and treatment are essential to obtain a favorable outcome.4Davis D.P. Wold R.M. Patel R.J. Tran A.J. Tokhi R.N. Chan T.C. et al.The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.J Emerg Med. 2004; 26: 285-291Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar The authors declares that there is no conflict of interest regarding the publication of this paper. The following is the supplementary data to this article: Download .docx (2.14 MB) Help with docx files Multimedia component 1

Medicate or operate: epilepsy surgery could save lives.

Drug-resistant epilepsy is a complex neurological disorder with a significant impact on the lives of affected children and their families. A child is diagnosed with drug-resistant epilepsy if seizure control is not achieved despite receiving the maximally optimised doses of two appropriately chosen antiepileptic medications. 1 Kwan P Arzimanoglou A Berg AT et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010; 51: 1069-1077 Crossref PubMed Scopus (2851) Google Scholar Mortality risk is seven times higher in children with epilepsy than in the general population. 2 Callenbach PM Westendorp RG Geerts AT et al. Mortality risk in children with epilepsy: the Dutch study of epilepsy in childhood. Pediatrics. 2001; 107: 1259-1263 Crossref PubMed Scopus (98) Google Scholar One contributor to the mortality associated with drug-resistant epilepsy is sudden unexpected death in epilepsy (SUDEP); ie, unexpected death with no obvious cause. 3 Nashef L So EL Ryvlin P Tomson T Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia. 2012; 53: 227-233 Crossref PubMed Scopus (397) Google Scholar One in 833 children with drug-resistant epilepsy is estimated to die from SUDEP every year. 4 Ryvlin P Rheims S Lhatoo SD Risks and predictive biomarkers of SUDEP. Curr Opin Neurol. 2019; 32: 205-212 Crossref PubMed Scopus (0) Google Scholar The most common risk factors for SUDEP are high seizure frequency, early age of seizure onset, and multiple antiseizure drugs. 5 Abdel-Mannan O Taylor H Donner EJ Sutcliffe AG A systematic review of sudden unexpected death in epilepsy (SUDEP) in childhood. Epilepsy Behav. 2019; 90: 99-106 Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar Other causes of death include status epilepticus, injury related to seizures, and suicide. Comparison of long-term survival with continued medical therapy, vagus nerve stimulation, and cranial epilepsy surgery in paediatric patients with drug-resistant epilepsy in the USA: an observational cohort studyPaediatric patients with drug-resistant epilepsy who underwent cranial epilepsy surgery or VNS had a higher survival rate than those who received only medical treatment. These findings highlight the importance of a multidisciplinary comprehensive team approach to the treatment of epilepsy, which includes tailored evaluation and deployment of medical and surgical treatment options for patients with this challenging disease. Full-Text PDF

A Focus on Contraception in the Wake of Dobbs.

A Focus on Contraception in the Wake of Dobbs.

An indirect method of verifying passive fit of complete arch implant-supported frameworks fabricated from photogrammetry scans

The passive fit of frameworks on multi-unit abutments has been considered crucial for the long-term success of complete arch, implant-supported, fixed prostheses. 1 Jokstad A. Shokati B. New 3D technologies applied to assess the long-term clinical effects of misfit of the full jaw fixed prosthesis on dental implants. Clin Oral Implants Res. 2015; 26: 1129-1134 Crossref PubMed Google Scholar Photogrammetry has demonstrated better accuracy than intraoral scanning and conventional impression techniques to record the position of implants. 2 Sallorenzo A. Gómez-Polo M. Comparative study of the accuracy of an implant intraoral scanner and that of a conventional intraoral scanner for complete-arch fixed dental prostheses. J Prosthet Dent. 2022; 128: 1009-1016 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar However, errors introduced during fabrication may still compromise the passive fit of the definitive prosthesis, even with accurate scanning using the photogrammetry technique. 3 Al-Meraikhi H. Yilmaz B. McGlumphy E. Brantley W. Johnston W.M. In vitro fit of CAD-CAM complete arch screw-retained titanium and zirconia implant prostheses fabricated on 4 implants. J Prosthet Dent. 2018; 119: 409-416 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar The current intraoral methods of verifying passive fit, including visual inspection, tactile sensation, radiography, disclosing materials, screw resistance test, and the Sheffield test, are subjective and not capable of detecting lingual or subgingival misfit. 4 Abduo J. Bennani V. Waddell N. Lyons K. Swain M. Assessing the fit of implant fixed prostheses: a critical review. Int J Oral Maxillofac Implants. 2010; 25: 506-515 PubMed Google Scholar In the conventional protocol, the definitive cast made from a custom tray elastomeric impression can be verified with a dental gypsum device. 5 Manzella C. Burello V. Bignardi C. Carossa S. Schierano G. A method to improve passive fit of frameworks on implant-supported prostheses: an in vivo study. Int J Prosthodont. 2013; 26: 577-579 Crossref PubMed Google Scholar However, since the frameworks made from photogrammetry are manufactured without a definitive cast, verifying the passive fit of the frameworks is challenging. 6 Rutkunas V. Larsson C. Vult von Steyern P. Mangano F. Gedrimiene A. Clinical and laboratory passive fit assessment of implant-supported zirconia restorations fabricated using conventional and digital workflow. Clin Implant Dent Relat Res. 2020; 22: 237-245 Crossref PubMed Scopus (11) Google Scholar In the treatment of the first patient, misfits were found between the frameworks and the 3-dimensional printed cast; therefore, the accuracy of the frameworks needed to be verified to determine whether the distortion was introduced during printing of the cast (Fig. 1A-C). An inexpensive and user-friendly method of verifying the passive fit of frameworks is described. Figure 1A, Intraoral view after removal of interim prosthesis. B, Impression scanning using photogrammetry technology. C, Misfits between framework and printed cast. D, Placement of abutment replicas. E, Fixture of replicas with dental gypsum. F, Evaluating fit of framework. View Large Image Figure Viewer Download Hi-res image

Measuring the global burden of diabetes: implications for health policy, practice, and research

Over the past two decades, global health practitioners and researchers have put forth evidence-based guidance on how to respond to the growing threat from non-communicable diseases (NCDs) and their risk factors. 1 WHOGlobal action plan for the prevention and control of noncommunicable diseases 2013–2020. World Health Organization, Geneva2013 Google Scholar Many goals and targets have been set, but few countries are on track to meet them, and measurement has proven challenging. 2 Watkins DA Msemburi WT Pickersgill SJ et al. NCD Countdown 2030: efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries. Lancet. 2022; 399: 1266-1278 Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar The Lancet Commission on Diabetes 3 Chan JCN Lim LL Wareham NJ et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2021; 396: 2019-2082 Summary Full Text Full Text PDF PubMed Scopus (194) Google Scholar and the Global Diabetes Compact 4 Gregg EW Buckley J Ali MK et al. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact. Lancet. 2023; 401: 1302-1312 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar sought to elevate the status of diabetes within the NCD agenda and provide focused recommendations and targets, respectively. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. Full-Text PDF Open Access

A Call for Discovery and Therapeutic Development for Cutaneous Neurofibromas

A Call for Discovery and Therapeutic Development for Cutaneous Neurofibromas