Large Sample Research Articles

Fire setting in the custodial environments: developing the evidence base for improving fire safety in prisons

Purpose The HMPPS National Fire Safety Team commissioned three research studies from HMPPS National Psychology Services to explore fire setting in prisons. The purpose of this paper is to share the outcomes of these studies which explored the characteristics of known fire-setters; the act of repeat fire setting and its relationship to fire severity and level of injury; and the triggers for fire-setting incidents in prisons. Design/methodology/approach A quantitative matched-groups design allowed for a direct comparison between 100 known adult male fire-setters and 100 adult males in prison who had not set fires. The second study identified 4,003 fire-setting incidents recorded in Sphera Cloud. It used a series of categorical variables to explore repeat custodial fire setting and its relationship to fire severity and level of injury sustained. The third study was qualitative, comprising seven semi-structured interviews with adult males in custody. Findings Mental illness, being supported via a Challenge, Support and Intervention Plan, and self-harm history predicted fire setting in custody, with the statistical model able to correctly classify 86% of the fire-setting incidents. Fire severity and level of injury alone do not distinguish first from repeat fires, but their interaction does. Themes from prisoner interviews include emotional coping and mental health, fire setting to affect change and costs of fire setting, with subthemes such as grievances towards staff and prolonged periods in cell. Research limitations/implications Both quantitative studies were subject to the known limitations of secondary data which include incomplete or inaccurate reporting and/or recording. There was also missing information which could have included unreported fires. The qualitative study struggled to secure interviews with known fire-setters who were suspicious of the research/er. The study also coincided with the Covid-19 lockdowns which may have impacted what the people in prison reported. Practical implications The research suggests that there are some likely predictors for fire setting in prisons, and that a statistical model could be worthy of replication with a larger sample. The finding that those who set fires learn from their experiences, and thus can minimise their potential for serious injury suggests a need to prevent cycles of fire setting from the very first fire. The triggers for fire setting in prison suggest that a preventative approach to fire safety must go beyond physical measures and also address environmental factors. This includes staff−prisoner relationships, encourage the recognition of mental health problems and the need for procedurally just approaches to be consistently applied. Originality/value Little is known about individuals who set fires in prison or repeat fire setting and its relationship to fire severity and level of injury. The qualitative study involving known fire-setters is likely the first in an English prison.

Sagittal Split Ramus Osteotomy Without Segmental Fixation in Skeletal Class II.

The new orthognathic treatment strategy of non-segmental fixation (non-fix) sagittal split ramus osteotomy (SSRO) with jaw exercise initiation on the second postoperative day, the so-called physiological positioning strategy (PPS), induces good skeletal stability with few temporomandibular joint (TMJ) symptoms after surgery in skeletal class III. This study aimed to clarify whether non-fix SSRO with modified PPS can be applied to skeletal class II. This retrospective study included skeletal class II patients who underwent non-fix SSRO to correct mandibular retrognathia. Jaw exercise was initiated within 10 postoperative days. Cephalometric analyses were performed before (T1), immediately after (T2), and more than 6 months after (T3) surgery. Skeletal and dental stability, and TMJ symptoms were evaluated. Twelve patients (2 men, 10 women; mean age 22.9±7.1y) were included. The mean mandibular advancement was 6.8±1.8mm. angle between S-N and N-B. was 73.6±4.5, 77.1±3.9, and 75.1±4.4 degrees at T1, T2, and T3, meaning 60.5% relapse. The Menton moved forward by 6.3mm from T1 to T2 and relapsed by 4.6mm at T3. The duration of intermaxillary traction showed a moderate negative correlation with angle between S-N and N-B. relapse (r=-0.42, P=0.1787). Only 2 TMJ symptoms (2/24, 8.3%) developed postoperatively. This study suggests that non-fix SSRO with modified PPS is a suitable method for skeletal class II malocclusion. Further research with a larger sample size and detailed analysis of the effect of intermaxillary traction on skeletal stability after surgery is needed.

An Integrative Review of Brainwave Entrainment Benefits for Human Health.

Brainwave Entrainment (BWE) is a noninvasive method of neuromodulation based on the principle that auditory or visual stimulation at a specific frequency can lead the brain's electrocortical activity to oscillate at the frequency of the external signal or its multiples. This phenomenon could be used to alter physiological and psychological states. Therefore, we conducted an integrative review to answer the question: "What are the observed benefits of BWE on human health and well-being?" We searched for studies published in the last ten years in the Directory of Open Access Journals (DOAJ), EMBASE, Virtual Health Library (BVS), PubMed, SciELO, and Cochrane Library databases in April 2024. Searches were conducted in English, Portuguese, and Spanish. A total of 84 studies were included in our review. Studies showed improvements in various conditions, such as pain, sleep disturbances, mood disorders, cognition, and neurodegenerative disorders. In conclusion, our findings align with previous reviews and underscore the need for further research on BWE, particularly with larger sample sizes, robust control groups, and randomized clinical trial designs. Nevertheless, BWE demonstrates promising therapeutic potential and may support the management of various health conditions, enhancing individuals' quality of life.

Development of differential diagnostic models for distinguishing between limb-girdle muscular dystrophy and idiopathic inflammatory myopathy

ObjectiveLimb-girdle muscular dystrophy (LGMD) is usually confused with idiopathic inflammatory myopathy (IIM) in clinical practice. Our study aimed to establish convenient and reliable diagnostic models for distinguishing between LGMD and IIM.MethodsA total of 71 IIM patients, 24 LGMDR2 patients and 22 LGMDR1 patients diagnosed at our neuromuscular center were enrolled. Differences in clinical, laboratory and histopathological characteristics were comprehensively compared. A nomogram and a decision tree were developed to distinguish between LGMD and IIM patients.ResultsCompared to patients with LGMD, IIM patients exhibited a significantly older age of onset, a higher prevalence of cervical flexor weakness and a more commonly diffuse MHC-I expression on muscle pathology. The ratio of synchronous serum myoglobin (Mb, ng/ml) to creatine kinase (CK, U/L) before immunotherapy was significantly higher in IIM patients than in LGMD patients. Receiver operating characteristic analysis indicated a high differential diagnostic efficiency of synchronous Mb/CK with a cutoff value of 0.18. A nomogram prediction model and a decision tree were developed based on four independent indicators (age of onset, cervical flexor weakness, synchronous Mb/CK and diffuse MHC-I expression). Five-fold cross-validation and bootstrapping techniques substantiated the discriminate efficacy of the nomograph and decision tree.ConclusionWe developed two practical differential diagnosis models for LGMD and IIM based on the analysis of four accessible indicators, including the age of onset, cervical flexor weakness, the ratio of synchronous Mb/CK values and diffuse MHC-I expression. Further studies with larger samples are needed to refine the predictive efficiency of the differential diagnostic models.

Ultrasound-Guided Percutaneous Cryoneurolysis for the Treatment of Pain following Traumatic Rib Fracture: A Randomized, Active-Controlled, Participant- and Observer-Masked Study

Background. Traumatic rib fractures are associated with pain lasting weeks to months and a decreased ability to inspire deeply or cough to clear secretions. Ultrasound-guided percutaneous cryoneurolysis involves reversibly ablating peripheral nerve(s) using exceptionally low temperature with a transdermal probe, resulting in a prolonged nerve block with a duration measured in months. We hypothesized that cryoneurolysis would improve analgesia and inspired volume following rib fracture. Methods. Adults with 1-6 traumatic rib fractures were randomized to either active cryoneurolysis and a sham peripheral nerve block (PNB), or sham cryoneurolysis and active PNB in a participant/observer-masked fashion. The primary endpoint was the maximum inspired volume the day after the procedure as measured with an incentive spirometer. Results. The day after the procedure, the unadjusted median [IQR] maximum inspired volume for participants who received cryoneurolysis (n=11) was 2,250 mL [1,500; 2,500] versus 1,300 mL [750; 2,500] for PNB (n=9, mean difference 496; 95%CI -428 to 1420; t-test P=0.269). When adjusted for covariates (e.g., baseline lung volume), the cryoneurolysis group had an estimated 793 mL greater mean volume than PNB (95%CI 273 to 1,312; ANCOVA P=0.005). Improvement from baseline in maximum inspired volume for cryoneurolysis was 1,000 mL [1,000; 1,375] versus 300 mL [0; 1,000] for PNB (t-test P=0.002). This was equivalent to an improvement over baseline of 100% [90%, 188%] for cryoneurolysis versus 30% [0%, 50%] for PNB (t-test P=0.003). Average daily pain scores were generally lower for the cryoneurolysis group throughout the first month. Total cumulative oxycodone equivalents were 5 mg [0, 13] for cryoneurolysis vs 45 mg [43, 135] for PNB (t-test P=0.013). Conclusions. Ultrasound-guided percutaneous cryoneurolysis improves maximum inspired lung volume while concurrently decreasing pain and opioid consumption after traumatic rib fracture. These results should be considered preliminary, requiring confirmation with a trial including a larger sample size.

A Novel Training Modality for Providers in the Emergency Department Using a Computer-Based Scenario: A Pilot Study.

Individuals with substance use disorders (SUD) are increasingly admitted in emergency departments (EDs) nationwide. However, ED providers often have limited knowledge about and lack confidence in treating SUDs. This limited knowledge often results in poor treatment outcomes among patients with SUD in the ED setting. The aims of this pilot study were to (a) assess the desirability, applicability, and acceptability of a computer-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) education scenario and (b) examine changes in SUD knowledge scores among ED providers before and after engaging in the computer-based SBIRT education scenario. A tailored computer-based education scenario was developed based on the SBIRT framework for ED providers in an academic medical center. Participants (N = 15) evaluated the desirability, applicability, and acceptability of the education tool. Also, a single-group pre-/post-design was used to examine changes in participants' SUD knowledge and proficiency scores. Participants rated the computer-based SBIRT education scenario as desirable, applicable, and acceptable based on 4.0/5.0 or greater evaluation scores for each component. Overall knowledge scores increased from 3.5 to 3.8, albeit non-significantly. Proficiency score percentages increased by 25%. Computer-based SBIRT education scenario training may be acceptable by ED providers and may improve proficiency in addressing SUD for patients. Future studies should evaluate this training method with a larger sample size.

Identification and evaluation of plasma exosome RNA biomarkers for non-invasive diagnosis of hepatocellular carcinoma using RNA-seq

BackgroundNon-invasive diagnostic methods, including medical imaging techniques and blood biomarkers such as alpha-fetoprotein (AFP), have been crucial in detecting hepatocellular carcinoma (HCC). However, imaging techniques are only effective for tumor size larger than 2 cm. AFP measurement remains unsatisfactory due to high rate of misdiagnosis and underdiagnosis. Therefore, new reliable biomarkers and better non-invasive diagnostic approach are necessary for HCC identification.MethodsThe differentially expressed genes were identified using multiple public RNA-seq data of liver tissues from healthy individuals and HCC patients including peritumoral and tumor tissues. The hub genes for HCC diagnosis were identified combining pathway enrichment analysis and protein–protein interaction network analysis. The performance of hub genes for non-invasive HCC diagnosis was analyzed in plasma of healthy individuals, HBV infected patients, and HCC patients based on exosomal RNA-seq data. A multi-layer perceptron (MLP) model based on exosomal hub genes was developed for non-invasive HCC diagnosis.ResultsThrough differential gene expression and pathway enrichment analysis on multiple public RNA-seq datasets, we first identified 30 dysregulated genes in HCC tissues. Protein-protein interaction analysis further narrowed down this list to 10 key genes: BRCA2, CDK1, MCM4, PLK1, DNA2, BLM, PCNA, POLD1, BRCA1 and FEN1. By further evaluation using additional public HCC tissue datasets, POLD1 and MCM4 were excluded from consideration as potential biomarkers due to their suboptimal performance. Notably, CDK1, FEN1, and PCNA gene were found to be significantly elevated in the plasma exosomes of HCC patients compared to non-HCC individuals, including those with HBV-infected hepatitis and healthy controls. The MLP model, based on three biomarkers, showed an area under the curve (AUC) of 0.85 and 0.84 in training and test dataset respectively, after adjusting for the covariates sex and age.ConclusionWe identified three key genes, CDK1, FEN1, and PCNA, as exosomal biomarkers for non-invasive diagnosis of HCC. The MLP model utilizing three biomarkers showed good differentiation between non-HCC individuals and HCC patients, which exhibits promising potential as a non-invasive diagnostic tool for detecting HCC. Additional validation with a larger sample size is essential to thoroughly assess the reliability of the biomarkers and the model’s performance.

Association between CLOCK gene polymorphisms with circadian rhythm, chrononutrition, dietary intake, and metabolic parameters in adolescents

IntroductionCircadian Locomotor Output Cycles Kaput (CLOCK) is one of the transcription factors from the positive end of the molecular clock and regulates biological rhythm in mammals. Studies have shown that genetic variations in the CLOCK genes are associated with chronotype, sleep patterns, obesity, dietary energy, and nutrient consumption. Although interest in the field of chrononutrition continues to increase, investigations into the temporal aspects of dietary habits in adolescents are notably limited. This study aims to investigate the relationship between CLOCK rs3749474, rs4580704, and rs1801260 polymorphisms and circadian rhythm, metabolic parameters along with chrononutrition in adolescents.Materials and methodsThis cross-sectional study included a total of 300 adolescents between the ages of 11 and 18. Anthropometric measurements, dietary intake, chrononutrition, circadian as well as biochemical and lifestyle data were collected. CLOCK rs3749474, rs4580704, and rs1801260 gene polymorphisms were analyzed.ResultsThe CLOCK rs3749474 minor T allele carriers showed a statistically significant increased risk of being overweight or obese (OR: 2.106, p = 0.003). The minor G allele carriers of the CLOCK rs4580704 indicated statistically increased dietary energy intake and eating jetlag (p < 0.05). The frequency of snacking after the last meal was positively correlated with body mass index (BMI) z-scores in minor allele carriers of the CLOCK rs3749474 (β = 0.134, p = 0.003) and rs4580704 (β = 0.142, p = 0.012) variants. The minor G allele carriers of CLOCK rs4580704 revealed a negative link between breakfast frequency along with BMI z-scores (β = −0.178, p = 0.009). Individuals with the rs1801260 minor G allele showed a positive link between BMI z score and meal frequency (β = 0.367, p = 0.049). In CLOCK gene variants, minor allele carriers in addition to non-carriers had similar biochemical parameters and distribution of dietary intake at meal (p> 0.05).ConclusionThese results suggest that the impact of some chrononutrition behaviors on BMI z-scores are partially modulated by the variability in the CLOCK gene variants. Chrononutrition may be important in the shift toward “personalized nutrition” based on gene-diet interactions. For this reason, new dietary approaches may be implemented, including the circadian distribution of macronutrients and chrononutrition behaviors according to genotype. However, studies with larger samples in different populations are needed.

Closed trans-intersphincteric fistulotomy: a new modified sphincter-sparing technique for high transsphincteric anal fistula

BackgroundThe main goals of surgery for fistula-in-ano are to completely resolve the condition and maintain optimal anal function. Effective management of the internal opening during and proper postoperative drainage of the intersphincter plane are crucial for achieving successful outcomes. This study evaluated the clinical efficacy of a novel sphincter-sparing technique for treating high transsphincteric anal fistula (HTAF).MethodsThis prospective study included 55 patients with HTAF who underwent closed trans-intersphincteric fistulotomy (CTiF) between July 2021 and April 2022 at our institution. Preoperative anorectal magnetic resonance imaging was performed for all patients. The primary outcome measures assessed the rate of fistula healing while the secondary outcome measures evaluated healing time, Cleveland Clinic Florida fecal incontinence score (CCF-FIS), 11-point visual analog scale (VAS) pain score and postoperative complications.ResultsWe included 55 patients with HTAF in this study. During a mean follow-up period of 9.3 months, CTiF achieved a healing rate of 90.91% (50/55). The mean time to recovery was 7.09 ± 1.94 weeks. Four (7.27%) patients developed postoperative urinary retention. At the 6-month follow-up, the CCF-FIS and VAS score were 0 [(0,0) range, 0–3] and 0 [(0,1); range, 0–4], respectively. Two patients with recurrent HTAF recovered after treatment with a transanal opening of intersphincteric space procedure, and three recovered after seton placement.ConclusionsCTiF is a promising and effective sphincter-sparing technique for treating HTAF. To confirm long-term outcomes, larger sample size prospective randomized controlled trials are required.

A study of stressful life events in patients with first-episode acute coronary syndrome (ACS)—a hospital-based case–control study

BackgroundThere is considerable evidence in the literature highlighting the impact of psychological factors on the development of coronary heart disease. In India, there's a rising incidence of traumatic life events alongside coronary heart disease, yet the connection between them remains relatively understudied. Therefore, this study aims to investigate stressful life events among patients experiencing their first episode of acute coronary syndrome (ACS) and compare this with controls.ResultsThe mean number of stressful life events (SLEs) observed was 5.07 ± 2.04 in cases and 4.35 ± 1.88 in controls, with a p-value of < 0.05. Cases had a significantly higher prevalence of medical and psychiatric morbidity than controls, with rates of 89.3% compared to 69.6% for medical issues, and 56.7% versus 24.0% for psychiatric conditions, respectively. Univariate analyses revealed a significant difference between cases and controls in the types of stressors experienced, with cases showing higher odds ratios (OR) for specific events such as Fire or Explosion (OR = 4.5), Transportation accident (OR = 3.4), and Captivity (OR = 2.3). Additionally, bivariate analyses indicated that presence of a comorbid medical illness had an OR of 5.95. At the same time, specific life events like Exposure to fire or explosion (OR = 3.35) and Transportation accidents (OR = 3.08) were more likely to occur in cases. Overall, there were significant differences in the prevalence and pattern of various types of SLEs between cases and controls.ConclusionThe higher number of SLEs observed in cases compared to controls underscores their potential role in cardiac risk. While transportation accidents and fires/explosions demonstrated robust associations with ACS, the variable significance across different types of SLEs suggests a complex relationship between stressor type and cardiac outcomes. These findings highlight the need for prospective studies with larger sample sizes and further research to ascertain and quantify the role of stressful events and the risk of a cardiac event.

Two-Dimensional and Three-Dimensional Changes in Deformational Head Shapes During Repositioning Therapy and Cranial Remolding Treatment

Backgrounds/Objectives: The surge in deformational head shapes (DHSs) over the past 30 years has led to increased interest in comparing the treatment options of Repositioning Therapy (RT) and a Cranial Remolding Orthosis (CRO). This study investigates the amount and rate of 2D and 3D correction in infants with DHSs during these treatments. Methods: A total of 34 infants with DHSs were enrolled (RT group, n = 18; CRO group, n = 16). Infants were discharged after achieving correction or reaching 12 months of age. Two-dimensional scan/caliper measurements and three-dimensional scan measurements were collected at treatment initiation and conclusion (or 12 months of age). Results: Asymmetric infants in the RT group averaged a 2dCVAI reduction of 3.59 ± 1.57 and 3dCVAI correction of 12.17 ± 13.02 versus 4.44 ± 2.99 and 21.72 ± 15.36 correction in the CRO group (2d p = 0.6656; 3d p = 0.1417). Disproportionate infants in the RT group averaged a 2dCI reduction of 3.13% ± 2.57% and 3dCI reduction of 24.53 ± 24.01 while the CRO group averaged 5.21% ± 2.78% and 55.98 ± 25.77 (2d p = 0.0383*; 3d p = 0.0254*). Asymmetrical RT mean 2dCVAI weekly change was 0.21 ± 0.15 while CRO was 0.23 ± 0.17 (p = 0.7796). The 3dCVAI weekly change was 1.05 ± 1.55 in the RT group versus 1.17 ± 0.95 in the CRO group (p = 0.4328). Disproportionate RT mean 2dCI weekly change was 0.12 ± 0.11 while CRO was 0.23 ± 0.11 (p = 0.0440*). The 3dCI weekly change was 0.87 ± 0.91 in the RT group versus 3.02 ± 2.16 in the CRO group (p = 0.0143*). Conclusions: Results indicate that CRO treatment achieves greater total correction and rate of correction. Statistical significance was found in the treatment of disproportional DHSs, but further investigation is needed with a larger sample size.

Arm weight effects on dynamic walking stability in individuals with hemiparetic stroke.

This study examined the effects of arm weights on dynamic stability during overground walking in individuals with hemiparetic stroke. Arm weights have been shown to improve mobility in stroke survivors, potentially at the cost of decreased dynamic stability and increased fall risk. Data from nine stroke survivors (8 males, 1 female; age: 58.0 ± 6.8 years) were assessed under four conditions: no weight, weight attached to the non-hemiparetic side, weight attached to the hemiparetic side, and bilateral weights. Each condition used 0.45 kg sandbags. Kinematic data were captured using an eight-camera motion system and analyzed to assess center of mass position and velocity relative to the base of support. Although repeated measures ANOVA showed no significant differences in stability across conditions, individual scatter plots revealed variable responses among participants. Some maintained or improved their stability, while others experienced decreases under specific conditions. These findings underscore the need for personalized approaches in rehabilitation planning, suggesting that integrating arm weights into rehabilitation protocols may not compromise dynamic stability for most stroke survivors. Further research with larger sample sizes and varied weights is essential to validate these findings and tailor the use of arm weights in stroke rehabilitation more effectively.

The Heads Up Checkup Digital Mental Health &amp; Behavioral Risk Screening System: Clinical Inter‐Rater Reliability for Identifying Youth in Crisis

ABSTRACTThe present study evaluated the inter‐rater reliability of the Heads Up Checkup (HCU), a brief digital mental health and behavioral adaptive screening system designed for use in primary care and diverse school settings. Two independent licensed clinical psychologists reviewed a random sample of 30 (N = 30) HCU clinical screening reports of 13−14 year old adolescents drawn from a larger sample (N = 846) enrolled in a public middle school in California. Results showed strong inter‐rater agreement (Fleiss kappa = 0.93) between clinician ratings and the screener's priority risk index (HPI) in identifying students “in crisis.” In addition, clinicians' ratings of confidence in their priority judgments were found to be significantly higher for the “in crisis” cases. Reasonable evidence of convergent validity emerged due to a strong relationship between clinician ratings of psychological distress and the HPI. Overall findings suggest that as an online universal school‐based screener, the HCU has valid utility for identifying young adolescents “in crisis” which can translate into timely interventions and pragmatic real‐world therapeutic solutions. Future research directions with respect to the refinement of the HCU's measurement characteristics and its feasibility as an online screener at the population‐level in schools are discussed.

Measuring Scholarly Practice in Respiratory Therapists: The Development and Initial Validation of a Scholarly Practice Tool.

Respiratory therapists (RTs) must apply competencies to address the health care needs of the public. Although all competencies are deemed essential, scholarly practice requires that professionals critically assess their practices, integrate evidence-based literature, and enhance the care they deliver to patients. Though scholarly practice is also associated with professional empowerment, role satisfaction, and improved patient care, it is rarely measured. The purpose of this study was to develop, pilot, and generate preliminary validity evidence of a tool designed to measure scholarly practice among RTs. We used DeVellis' nine-step scale development process and exploratory factor analysis to develop the tool. The results of a scoping review and qualitative study were used to generate an item pool and pilot test it with 81 RTs across Canada. The refined tool was tested on a larger sample (n = 832) and analyzed using exploratory factor analysis. Using principal axis factoring with Promax rotation, we retained 18 items across 4 factors, explaining 56.7% of the variance in the data (31.7%, 10.2%, 8.6%, 6.2%): (Factor 1) professional development and credibility, (Factor 2) elements supporting scholarly practice, (Factor 3) the perceived impact of scholarly activities on practice, and (Factor 4) scholarly practitioner identity and ability. Internal consistency of the final 18-item scale was suitable overall (Cronbach alpha = 0.879) and for each factor (F1 = 0.888; F2 = 0.774; F3 = 0.842; F4 = 0.746). Our results provide preliminary evidence for a scholarly practice tool that can encourage self-reflection and/or foster peer-based reflection. Using the tool with other health care professionals and conducting confirmatory factor analysis could generate additional validity evidence.

Outcomes Associated With Airway Management of Adult Trauma Patients Admitted to Surgical Intensive Care.

Advanced airway management and ventilation of trauma patients are often needed during acute stabilization and resuscitation and later, in those admitted. In addition to endotracheal intubation for advanced airway management, tracheostomy is commonly used in critically ill patients when prolonged mechanical ventilation is required. However, the outcomes associated with airway management approaches and the timing of a tracheostomy in critically ill patients are mixed. This protocol intended to compare the effect of tracheostomy in major trauma patients vs. management with non-invasive techniques and endotracheal intubation during admission, examine complications and outcomes associated with the three types of airway management approaches, and explore the association of clinical and social determinants of health variables with complications in patients requiring advanced airway management. A total of 911 adult trauma patients admitted to a Level 1 trauma center surgical intensive care unit (SICU) were included in this retrospective, single-center, quantitative study from 2019 to 2021. Descriptive and correlational analyses were used to examine outcomes of ventilator days, length of stay, pneumonia, readmission, mortality, and associations with the airway management approach. The outcomes of ventilator days and length of stay were compared between groups with a one-way ANOVA, and differences between groups on outcomes of pneumonia, readmission, and mortality were estimated using crosstabulations and chi-square (x²) statistics. Hypothesized relationships of clinical and social determinants of health variables associated with outcomes of ventilator days, hospital length of stay, pneumonia, readmission, and mortality in patients requiring advanced airway management ≥ four days were estimated. There was no significant difference in outcomes of pneumonia and mortality between the advanced airway management groups (p=0.856 and p=0.167, respectively). There were significant differences in ventilator days, length of stay (LOS), and readmission. Between the groups: endotracheal intubation only, early (<10 days post-intubation) tracheostomy, and late (>10 days post-intubation) tracheostomy in SICU patients (p <0.001, p=0.028, and p=0.003, respectively). Specifically, patients in the early tracheostomy group had a higher readmission rate (33.3%) as compared to endotracheal tube patients (2.3%) and late tracheostomy patients (0.0%). Social determinants of health variables (smoking and functional dependence) were also significantly correlated with readmission in the early tracheostomy and endotracheal tube airway management groups (p=.047 and p=.022, respectively). Additionally, clinical variables of injury severity scores, ED arrival systolic blood pressure (SBP), and presence of pre-existing comorbidities were found to be significantly associated with complications of pneumonia, readmission, and mortality within the patients (n=229) requiring advanced airway approaches. Adult trauma patients with early tracheostomy airway management may experience a higher readmission rate related to the complexity of their injuries than patients managed with endotracheal intubation or late tracheostomy. Clinical and social determinants of health factors may be associated with complications. Further studies examining these associations in larger samples are needed to examine the validity of these findings.

The Relationship Between Reduced Hand Dexterity and Brain Structure Abnormality in Older Adults

Background: Hand dexterity is affected by normal aging and neuroinflammatory processes in the brain. Understanding the relationship between hand dexterity and brain structure in neurotypical older adults may be informative about prodromal pathological processes, thus providing an opportunity for earlier diagnosis and intervention to improve functional outcomes. Methods: this study investigates the associations between hand dexterity and brain measures in neurotypical older adults (≥65 years) using the Nine-Hole Peg Test (9HPT) and magnetic resonance imaging (MRI). Results: Elastic net regularized regression revealed that reduced hand dexterity in dominant and non-dominant hands was associated with an enlarged volume of the left choroid plexus, the region implicated in neuroinflammatory and altered myelination processes, and reduced myelin content in the left frontal operculum, the region implicated in motor imagery, action production, and higher-order motor functions. Distinct neural mechanisms underlying hand dexterity in dominant and non-dominant hands included the differences in caudate and thalamic volumes as well as altered cortical myelin patterns in frontal, temporal, parietal, and occipital regions supporting sensorimotor and visual processing and integration, attentional control, and eye movements. Although elastic net identified more predictive features for the dominant vs. non-dominant hand, the feature stability was higher for the latter, thus indicating higher generalizability for the non-dominant hand model. Conclusions: Our findings suggest that the 9HPT for hand dexterity might be a cost-effective screening tool for early detection of neuroinflammatory and neurodegenerative processes. Longitudinal studies are needed to validate our findings in a larger sample and explore the potential of hand dexterity as an early clinical marker.

The Influence of General Facilities, General Service, Registration Service, Service Providers and Accessibility on Patient Satisfaction of Antenatal Care at XYZ Hospital

The aim of this research is to examine and analyze the influence of public facilities, public services, service providers and accessibility on patient satisfaction with antenatal services at XYZ Hospital. Testing of the modified research model from previous research was carried out using data from midwifery services at the hospital. The method in this research is a quantitative approach with surveys and cross sectional. Respondent data was taken in 2024 by purposive sampling with questionnaires from individuals who had received antenatal care services at XYZ Hospital. There are 180 samples that meet the requirements described by PLS-SEM. The results of this research show that the five variables are proven to have a significant and positive influence. This research adds a contribution that focuses more on antenatal care services in hospitals. It is recommended in future research to include more hospitals of various types and a larger sample size so that the analysis results can be more generalized at the population level. Future research is recommended to consider adding other variables that may potentially influence patient satisfaction.

The tumor immune microenvironment and therapeutic efficacy of trastuzumab deruxtecan in gastric cancer.

Trastuzumab deruxtecan (T-DXd), an anti-HER2 antibody-drug conjugate with a topoisomerase I inhibitor connected by a cleavable linker, has been approved for patients with HER2-positive gastric or gastroesophageal junction tumors. This biomarker study assessed HER2 expression and immune cell infiltration in relation to the therapeutic response to T-DXd. This retrospective analysis included samples from patients treated with T-DXd in three clinical trials. We performed RNA sequencing and multiplex immunohistochemistry on archival tumor samples obtained at baseline, during treatment, and after treatment. Flow cytometry was performed on tumor infiltrating immune cells freshly isolated from tumor tissues. Samples from 28 patients were included in this study. ERBB2 mRNA levels and CD20+ cell infiltration in tumors were significantly higher at baseline in responders than in nonresponders. Patients were classified into three biological groups based on their baseline tumor/stroma-infiltrating immune cell densities. Two groups reported similar response rates, but a trend was observed toward a shorter progression-free-survival in the group with more immunosuppressive regulatory T cells and programmed death-ligand 1 (PD-L1) expression at baseline. T-DXd treatment tended to increase the levels of tumor-infiltrating CD8+ T cells and PD1+CD8+ T cells, particularly in responders. Gene expression signatures of CTL and helper T cells increased during treatment, whereas signatures related to hypoxia, MYC targets, collagen formation, and interleukin-10 were downregulated. Our data suggest that HER2 expression levels and baseline tumor microenvironment (TME) characteristics correlate with T-DXd efficacy. Furthermore, this treatment may modulate TME immune profiles. Further validation using a larger sample size is warranted.

Anhedonia Links Sleep Problems and Suicidal Thoughts: An Intensive Longitudinal Study in High-Risk Adolescents.

Growing research indicates that sleep problems are a robust independent risk factor for suicidal thoughts and behaviors among youth. However, relatively little is known about how this risk is conferred. This study used an intensive longitudinal design to investigate anhedonia as a mechanism linking sleep problems and next-day suicidal thoughts in a clinically high-risk sample of adolescents. Adolescents (N = 48; Mage=14.96; 77.1% white, 64.6% female) completed an ecological momentary assessment (EMA) study design for 28 days following discharge from acute psychiatric care for suicide risk. Daily sleep diaries were used to assess prior night total sleep time and sleep onset latency. Ecological momentary assessment was used to assess anhedonia and suicidal thoughts up to six times per day. A series of multi-level structural equation models were used to examine facets of anhedonia as parallel mediators of the association between sleep problems and next-day suicidal thoughts. Significant direct effects were found between sleep problems and consummatory anhedonia, consummatory anhedonia and suicidal thoughts, and anticipatory anhedonia and suicidal thoughts. There were significant indirect (mediated) effects between sleep problems and next-day suicidal thoughts through consummatory anhedonia, but not anticipatory anhedonia. Findings provide initial evidence as to how sleep problems may confer risk for next-day suicidal thoughts- by increasing consummatory anhedonia. Future research is needed to replicate these findings in larger samples and investigate how modifying anhedonia may mitigate suicide risk in youth.

Podological Analysis in Children with Neuromotor Disabilities

Background. Pediatric patients with neuromotor disorders often present with a variety of podiatric conditions. Despite the use of treatments like orthotics and insoles, the effectiveness of these interventions in managing associated foot problems is not well understood. Aim. This study aims to evaluate common podiatric issues in children with neuromotor disorders and to assess the associations between these conditions and various interventions, such as orthotics, insoles, and surgeries. Methods. An observational study was conducted with 20 pediatric patients (aged 4–16 years) diagnosed with neuromotor disorders, including cerebral palsy, idiopathic toe walking, and genetic syndromes. Podiatric conditions such as ingrown toenails, hyperhidrosis, and toe walking were documented. Chi-square tests were used to determine the relationships between treatments and podiatric conditions Results. Orthotic use was significantly associated with ingrown toenails (χ² = 5.69, p = 0.017). Insole usage was linked to increased hyperhidrosis (χ² = 4.44, p = 0.035), while orthotics were more prevalent in patients who had undergone Achilles tendon lengthening (χ² = 8.15, p = 0.017). Common podiatric issues included hyperkeratosis (30%), ingrown toenails (40%), and toe walking (40%). Conclusions. The aim of this study was to describe the podiatric issues of the foot in children with neuromotor disorders. The findings reveal a high prevalence of conditions such as ingrown toenails, hyperkeratosis, and toe walking. The study also identifies associations between these conditions and the use of orthotics, insoles, and surgical interventions, demonstrating that while these treatments are common, they may sometimes exacerbate certain conditions. This underscores the importance of regular, individualized podiatric care to manage and mitigate these issues effectively. However, further research with larger sample sizes and long-term follow-up is necessary to fully understand the impact of these interventions and develop optimized care strategies. Keywords: neuromotor disorders; podiatric conditions; pediatric patients; foot health; podiatrists.