Mean Age Research Articles

Differential aging trends among Liver Transplant candidates with and without hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) has become a leading indication for liver transplant (LT), with HCC registrants increasing more than six-fold in the past two decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older HCC patients are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger HCC patients, and non-HCC patients. All adult LT candidates (18+) in the UNOS/OPTN registry (2012-2022) were analyzed, categorized by HCC status and age (<70 or 70+). Regression coefficients compared HCC and non-HCC registrants and recipients by age group. The aging trend among LT registrants was more pronounced in HCC patients. From 2012 to 2022, the mean age of HCC registrants rose from 58.7 to 62.9, with those aged 70+ increasing from 4.2% to 15.0%. Non-HCC registrants saw minimal change, with a stable mean age of 53 years and a modest rise in those 70+ from 2.1% to 4.7%. HCV prevalence among HCC patients decreased from 37.5% to 27.4%, while non-HCC patients dropped from 14.8% to 5%. Post-transplant outcomes for older HCC recipients remained favorable, with 1-year and 5-year survival rates of 91% and 71%, respectively, comparable to older non-HCC patients (87% and 69%). Among over 132,000 liver transplant registrants from 2012 to 2022, the age of HCC candidates increased, with a growing proportion aged 70 and older, while the age and proportion of older adults among non-HCC registrants remained stable. This demographic shift underscores the importance of enhanced frailty assessments to improve outcomes for older HCC patients.

Metabolic Syndrome in Patients with Depressive Disorder: A Cross-sectional Study

Background: Depression not only fosters the development of metabolic syndrome through behavioral, physiological, genetic, and treatment-related factors, but it also doubles the risk of experiencing metabolic syndrome. The objectives were to assess the sociodemographic and clinical profile of patients with depressive disorder, to assess the various metabolic parameters of metabolic syndrome in patients with depressive disorder, and to study the association between the severity of depression and metabolic syndrome. Methods: A cross-sectional study was conducted among patients diagnosed with depression (n = 160) attending the Psychiatry outpatient department of a tertiary healthcare facility in Puducherry. The Hamilton Depression Rating Scale (HAM-D) and modified National Cholesterol Education Program—Adult Treatment Panel-III (NCEP ATP-III) criteria were used to assess the severity of depression and diagnose metabolic syndrome, respectively. Results: The mean age at onset of depression was 31.4 years (+11.3); the duration of depression was 41.2 months (+32.5); and the severity of depression as assessed using the HAM-D was 17.9 (+6.3). The results showed that 27.5% of patients had metabolic syndrome. Factors associated with higher rates of metabolic syndrome included increasing age, female gender (79.5%), being single (25.0%), belonging to upper socioeconomic class (65.9%), non-Hindu religion (20.5%), and urban residence (72.7%) ( P &lt; .05). Patients with metabolic syndrome had later onset (36.4 years) and longer duration (51.6 months) of depression, more severe symptoms (18.2), and were more likely to have recurrent depressive disorder or dysthymia (88.6%) ( P &lt; .05). Furthermore, the current use of psychotropic medications (59.1%) and obesity (93.2%) were significantly associated with metabolic syndrome ( P &lt; .05). Conclusion: This study reveals a high prevalence of metabolic syndrome among patients with depressive disorders linked to factors such as age, gender, marital status, socioeconomic status, religion, and urban residence. Integrated care approaches, including comprehensive screening and targeted interventions, are crucial for improving both mental and metabolic health outcomes.

Evaluation of Accommodation Amplitude and Convergence Insufficiency in Patients with Multiple Sclerosis

ABSTRACT Purpose To evaluate the near reflex components, including accommodation, convergence, and binocular fusional vergences in patients with multiple sclerosis (MS). Material-Method MS patients under 35 years of age without visual evoked potential (VEP) abnormalities (MS Group) and age-matched healthy individuals of (Control Group) were included in the study. Fusional vergence amplitudes, the amplitude of accommodation (AA), stereopsis measurements, near-object fixation and near point of convergence (NPC) measurements, Convergence Insufficiency Symptoms Survey (CISS) results, and the presence of nystagmus were recorded retrospectively from the files of the cases. Statistical comparison was made between the groups. Results The mean age was 28.04 ± 3.7 years in the MS group (20 females, 4 males) and 27.16 ± 3.1 years in the control group (20 females, 5 males) (p = .763). There was no statistically significant difference between groups in stereopsis (p = .395), mean convergence (p = .666), and divergence amplitudes (p = .773) at a distance, and mean convergence and (p = .836) divergence amplitudes (p = .877) at near, and NPC measurements (p = .908). The mean AA was 5.31 ± 0.7 D in the MS group and 6.1 ± 0.8 D in the control group (p < .001). CISS results were lower in the control group (p < .001). In addition, gaze-evoked nystagmus was statistically significantly higher in the MS group (p < .001). Conclusion Compared to the healthy control group, MS patients under 35 who did not have optic neuritis had lower accommodation amplitude and more signs in favor of convergence insufficiency symptoms. In addition, gaze evoked nystagmus was observed at a higher rate in the MS group. These findings may guide us in understanding the asthenopia findings of MS patients without optic neuritis.

Differences and contributors to global cognitive performance in the underrepresented Latinx Parkinson's disease population.

Objective: Despite significant progress in understanding the factors influencing cognitive function in Parkinson's disease (PD), there is a notable gap in data representation for the Latinx population. This study aims to evaluate the contributors to and disparities in cognitive performance among Latinx patients with PD. Methods: A retrospective analysis was conducted based on cross-sectional data encompassing demographic, environmental, motor, and non-motor disease characteristics from the Latin American Research Consortium on the Genetics of PD (LARGE-PD) and the Parkinson's Progression Markers Initiative (PPMI) cohorts. Linear regression multivariable models were applied to identify variables affecting Montreal Cognitive Assessment (MoCA) scores, accounting for age, sex, and years of education. Results: The analysis comprised of 3,054 PD patients (2,041 from LARGE-PD and 1,013 from PPMI) and 1,303 Latinx-controls. Latinx-PD patients (mean age 63.0 ± 11.8, 56.8% male) exhibited a significantly lower average MoCA score (p < .001) compared to white Non-Hispanic PD patients from PPMI (mean age 67.5 ± 9.9, 61.7% male). This difference persisted when comparing the Latinx-PD to the Latinx-controls (mean age 58.7 ± 9.3, 33.2% male; p < .001). Factors significantly associated with better MoCA scores in Latinx-PD included unilateral symptom onset (p = .009), and higher educational attainment (p < .001). Conversely, those associated with worse scores included the use of dopamine agonists (p = .01), previous tobacco use (p = .01), older age (p < .001), and a higher Hoehn and Yahr scale score (p < .001). Conclusions: Latinx-PD patients demonstrated significantly lower cognitive scores compared to their white non-Hispanic PD counterparts and Latinx-controls. These results highlight the importance of interpreting MoCA scores in a nuanced manner within diverse populations.

Association of chronic stress during studies with depressive symptoms 10 years later

The long-tern implications of stress during university for individuals’ mental health are not well understood so far. Hence, we aimed to examine the potential effect of stress while studying at university on depression in later life. We analysed data from two waves of the longitudinal Study on Occupational Allergy Risks. Using the ‘work overload’ and ‘proving oneself’ scales of the Trier Inventory for Chronic Stress and the Patient Health Questionnaire-2 (PHQ-2), participants reported chronic stress during university (2007–2009, mean age 22.2 years, T1) and depressive symptoms ten years later (2017–2018, mean age 31.6 years, T2). We performed linear regression analyses to explore the association between stress during university (T1) and later depressive symptoms (T2). Participants (N = 548, 59% female) indicated rather low levels of stress and depression (PHQ-2 mean score: 1.14 (range: 0–6)). We observed evidence for a linear association between overload at T1 and depression at T2 (regression coefficient (B) = 0.270; 95% confidence interval (CI) = 0.131 to 0.409; standardised regression coefficient (β) = 0.170). Our analyses yielded evidence for an association between chronic stress while studying and risk of depressive symptoms later in life. This finding underlines the importance of implementing sustainable preventive measures against stress among students.

Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison.

Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery. To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex. Cohort study; Level of evidence, 3. Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade >1, or dysplasia (lateral center-edge angle <25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index. A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% (P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening (P < .0001 and P < .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P < .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P < .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P < .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 (P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [P = .008]; and ΔVAS: -4.6 ± 2.7 vs -3.5 ± 2.0, respectively [P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups. After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction score and a greater magnitude of improvement in PROs postoperatively.

Ds-FCRN: three-dimensional dual-stream fully convolutional residual networks and transformer-based global-local feature learning for brain age prediction.

The brain undergoes atrophy and cognitive decline with advancing age. The utilization of brain age prediction represents a pioneering methodology in the examination of brain aging. This study aims to develop a deep learning model with high predictive accuracy and interpretability for brain age prediction tasks. The gray matter (GM) density maps obtained from T1 MRI data of 16,377 healthy participants aged 45 to 82 years from the UKB database were included in this study (mean age, , 7811 men). We propose an innovative deep learning architecture for predicting brain age based on GM density maps. The architecture combines a 3D dual-stream fully convolutional residual network (ds-FCRN) with a Transformer-based global-local feature learning paradigm to enhance prediction accuracy. Moreover, we employed Shapley values to elucidate the influence of various brain regions on prediction precision. On a test set of 3,276 healthy subjects (mean age, , 1561 men), our 3D ds-FCRN model achieved a mean absolute error of 2.2 years in brain age prediction, outperforming existing models on the same dataset. The posterior interpretation revealed that the temporal lobe plays the most significant role in the brain age prediction process, while frontal lobe aging is associated with the greatest number of lifestyle factors. Our designed 3D ds-FCRN model achieved high predictive accuracy and high decision transparency. The brain age vectors constructed using Shapley values provided brain region-level insights into life factors associated with abnormal brain aging.

Bayesian Spatio-Temporal Modeling of Hyperlipidemia Risk in IRAN; A Repeated Cross- Sectional Analysis

Introduction: The incidence of hyperlipidemia in Iran is on a consistent rise, potentially contributing significantly to increased susceptibility to cardiovascular diseases and other health complications linked to elevated blood lipid levels. This study employs hierarchical Bayesian model to assess the heightened lipid risk on a broader scale across Iran's provinces. Methods: This study included individuals diagnosed with hyperlipidemia from all provinces of Iran in 2019. The primary focus of the investigation included essential variables such as the mean age, gender distribution, and the documented incidence of hyperlipidemia cases in each province. Population data, stratified by province, age group, and gender, were sourced from the Iranian Statistics Center database. The analysis employed the Besag-York-Mollié (BYM) model, with parameter estimation executed through the Hamiltonian Monte Carlo method. Results: In this investigation, the prevalence and spatial distribution of hyperlipidemia were explored within a diverse population of 1,609,538 patients across various regions in Iran. The relative risk of hyperlipidemia surpassed 1 in 16% of Iranian provinces (Posterior probability [PP] &gt; 0.8), with a calculated 95% Confidence interval (CI) of 0.304 to 0.879. The overall prevalence of hyperlipidemia was determined to be 0.815. Significant heterogeneity in hyperlipidemia was identified among different provinces, with Tehran exhibiting the highest relative risk (RR=1.701; 95% CrI: 1.69, 1.713). Notably, gender (RR=1.008; CI: 1.007, 1.009 for males and RR=1.005;CI: 1.003, 1.007 for females) and age were not found to have a statistically significant effect on the relative risk of the disease. Conclusion: In conclusion, the study sheds light on the spatial dynamics of hyperlipidemia in Iran. 16% of provinces displayed a heightened relative risk, emphasizing the need for targeted public health strategies.

Preoperative prediction of tumor budding and lymphovascular invasion in colon cancer using dual-energy CT: a prospective study with internal model validation.

This study evaluates the potential of dual-energy CT (DECT) for preoperative prediction of tumor budding (TB) and lymphovascular invasion (LVI) in colon cancer. This prospective study enrolled 153 patients (mean age 61.33 years ± 0.88) with pathologically confirmed colon cancer. All participants underwent arterial and venous phase DECT scans within one week before surgery. Two radiologists independently analyzed the images, assessing tumor location, clinical N stage (cN stage), iodine concentration (IC), effective atomic number (Z-eff), and dual-energy index (DEI). The normalized iodine concentration (nIC) was obtained by comparing measured IC to the abdominal aortic IC. Logistic regression identified independent risk factors for high-grade TB and LVI positivity. The Akaike Information Criterion guided model selection, and the area under the curve (AUC) was calculated. Bootstrap validation with 1000 iterations was used for internal validation. Tumor location and cN stage were identified as independent risk factors for high-grade TB, and nICA tumor and cN stage for LVI positivity. The optimal model for predicting high-grade TB included tumor location, cN stage, and DEIV tumor, with an AUC of 0.763 (sensitivity: 75.0%; specificity: 64.7%) and a mean AUC of 0.712. Similarly, the model for LVI positivity included nICA tumor, cN stage, and nICA peripheral fat, with an AUC of 0.811 (sensitivity: 71.7%; specificity: 76.6%) and a mean AUC of 0.814. DECT could consistently quantify colon cancer characteristics, and DECT-based models performed well in the preoperative prediction of TB and LVI.

Neighborhood-level socioeconomic disadvantage is associated with multiple cognitive domains in a community sample of older adults.

Greater neighborhood disadvantage is associated with poorer global cognition. However, less is known about the variation in the magnitude of neighborhood effects across individual cognitive domains and whether the strength of these associations differs by individual-level factors. The current study investigated these questions in a community sample of older adults (N = 166, mean age = 72.5 years, 51% women), who reported current addresses, linked to state-level Area Deprivation Index rankings, and completed remote and validated neuropsychological tests of verbal intelligence (North American Adult Reading Test), verbal fluency (Controlled Oral Word Association Test), attention (Digit Span Forward), and working memory (Digit Span Backward and Sequencing, Letter-Number Sequencing). Linear regressions tested associations between neighborhood disadvantage and each cognitive test, controlling for individual-level factors (age, sex, education). Exploratory analyses tested moderation by each individual-level factor. Independent of individual-level factors, greater neighborhood disadvantage was associated with lower cognitive performance across domains: verbal intelligence (β = 0.30, p < .001), verbal fluency (β = -0.19, p = .014), attention (β = -0.19, p = .024), and two of three tests of working memory (β = -0.17- -0.22, ps = .004-.039). Results were robust to correction for multiple comparisons and tests of spatial autocorrelation. In addition, higher neighborhood disadvantage was associated with lower verbal fluency for older - but not younger-older adults (p = .035) and with poorer working memory in women but not men (p < .001). Education did not moderate associations. Findings suggest that older adults living in more disadvantaged neighborhoods exhibit lower cognitive performance, particularly in the domain of verbal intelligence. Continued investigation of effect modification may be fruitful for uncovering for whom associations are strongest.

Predictors of Service Awareness: Results from a Community Survey in an Urban Area

ABSTRACT We examined information seeking strategies and predictors of service awareness from a 2019 survey of Detroit area adults. Participants were age 60+ (mean age = 72.10; SD = 8.08), and most were African American (89.0%) and female (86.9%). Most (74.80%) reported finding information most or all of the time, and 87.50% reported awareness of 12 to 15 services. Respondents with more frequent family/friend interaction (OR = 2.374, 95% CI = 1.054, 5.347), greater use of information seeking strategies (OR = 1.188, 95% CI = 15 1.073, 1.315), and higher health status (OR = 3.445, 95% CI =1.625, 7.306) were more likely to be aware of needed services. Women were aware of a greater number of services compared with men (OR = 2.682, 95% CI = 1.005, 7.160), while Hispanics/Latinos were aware of fewer services relative to African Americans (OR = 0.100, 95% CI = 0.012, 0.837. Greater information seeking strategies was associated with higher awareness (OR = 1.328, 95% CI = 1.150, 1.534). Results suggest the need for particular attention to linguistically and culturally appropriate outreach strategies for people who are Hispanic/Latino and those with a low level of social interaction.

Role of Cytokines in Predicting Early Major Bleeding in Patients With Acute Pulmonary Embolism.

Anticoagulant therapy is critical for venous thromboembolism (VTE) management, though bleeding remains a major concern, ranging from mild to fatal events. This study aimed to assess the predictive value of cytokines for major bleeding in patients with acute pulmonary embolism (PE). In this prospective, observational study, patients aged ≥ 18 years with acute PE were enrolled from April 2021 to September 2022 and followed for 30 days. Exclusion criteria included asymptomatic PE, VTE without PE, and chronic anticoagulation. Major bleeding was defined as bleeding that required ≥ 2 transfused units of red blood cells, occurred in critical areas, or was fatal. Blood samples were collected at diagnosis to measure IL-6, IL-1beta, IL-8, IL-10, and TNF-alpha. Statistical analyses used bivariate and multivariate logistic regression (p < 0.05). Out of 191 patients (mean age 68.6 years, 52.9% male), 8.4% died, and 4.2% experienced major bleeding within 30 days. IL-8 > 40 pg/mL and TNF-alpha > 8.5 pg/mL were linked to major bleeding. IL-8 > 40 pg/mL independently predicted early major bleeding (adjusted OR 9.40; 95% CI 1.38-63.69). Cox regression showed HRs of 12.60 for IL-8 and 5.61 for TNF-alpha. High IL-8 levels at diagnosis were predictive of major bleeding in acute PE patients. Further studies are required to confirm these findings.

Vulvar lichen planus a retrospective analysis.

Vulvar lichen planus (VLP) is a rare mucocutaneous disorder with significant impacts on quality of life and a potential risk of malignancy. Comprehensive data on its clinical features and treatment outcomes remain limited. To analyze the demographic and clinical characteristics of patients diagnosed with VLP and to evaluate the efficacy of current therapeutic approaches. A retrospective review was conducted on 70 female patients diagnosed with VLP at a single institution between January 2014 and August 2024. Clinical characteristics, treatment modalities, and outcomes were analyzed. Statistical comparisons were performed using Student's t-test, Mann-Whitney U test, and χ² test as appropriate. The mean age at diagnosis was 59.3 ± 12.4 years, with a median disease duration of 2 years (range: 6 months-10 years). Pruritus (80.0%) and dyspareunia (62.9%) were the most prevalent symptoms. Corticosteroid therapy was the mainstay treatment, administered to 97.1% of patients, with superpotent topical corticosteroids being the most common (47.1%). Remission was achieved in 25.7% of cases, with younger patients exhibiting significantly higher remission rates (p = 0.005). Thyroid disease was the most common comorbid autoimmune condition, present in 32.9% of patients. VLP predominantly affects middle-aged women, with corticosteroids remaining the first-line therapy. Younger age appears to be associated with better treatment outcomes. These findings underscore the importance of early intervention and individualized therapeutic strategies. Further studies are warranted to explore the underlying mechanisms driving age-related differences in disease outcomes.

Effectiveness of single-energy metal artifact reduction algorithm in CT: application to contrast-enhanced CT with EVAR and coil embolization.

This study aimed to evaluate the efficacy of the single-energy metal artifact reduction (SEMAR) algorithm in reducing metal artifacts and enhancing image quality in contrast-enhanced computed tomography (CT) for patients undergoing endovascular aneurysm repair (EVAR) with coil embolization. Thirty-eight patients (mean age 81.0 ± 6 years; 31 men, 7 women) who underwent contrast-enhanced CT following EVAR and internal iliac artery coil embolization between September 2022 and May 2023 were retrospectively analyzed. The Artifact Index (AI) quantified metallic artifacts from internal iliac artery aneurysm coils in CT images, calculated from the standard deviation of the artifact-containing region relative to a reference region. CT values of the external iliac artery at the same slice were also evaluated and compared. Two radiologists independently performed qualitative assessments of SEMAR and non-SEMAR images. SEMAR significantly reduced metal artifacts, decreasing the AI from 171.9 ± 74.5 HU to 35.8 ± 16.9 HU (p < 0.001). The mean CT values of the external iliac artery were similar for SEMAR (259.4 ± 63.7 HU) and non-SEMAR (257.1 ± 63.6 HU, indicating no significant difference. Qualitative assessment scores improved significantly with SEMAR (from 1.0 ± 0.0 to 2.5 ± 0.5; p < 0.001), enhancing visualization of internal iliac artery aneurysms. Interobserver agreement was high (κ = 0.83). The SEMAR algorithm effectively reduces metal artifacts in contrast-enhanced CT, significantly enhancing image quality without altering adjacent artery CT values. These improvements enhance the image quality of post-operative assessments in patients undergoing EVAR with coil embolization.

Relationship among post-quake traumatic stress, insomnia, and eating behaviour: analysis of directly and indirectly affected individuals from the Kahramanmaraş (Türkiye) earthquake

ABSTRACT This study aimed to investigate the relationship between earthquake-related post-traumatic stress disorder, eating behaviours, and sleep disorders. Conducted online with 515 participants (80.2% female; mean age: 32.1 ± 14.0), it utilized a questionnaire including socio-demographics, PTSD-Short Scale (PTSD), Insomnia Severity Index (ISI), and the Three-Factor Eating Questionnaire (measuring cognitive restraint-CR, uncontrolled eating-UE, emotional eating-EE, and hunger sensitivity-HS). 28.5% of the participants lived in the earthquake zone. The rate of destroyed house, losing a loved one, and injury were significantly higher in those with PTSD. A significant correlation was found between the ISI and PTSD scores (r = 0.509, p < 0.001). PTSD score (β = 0.162), age (β=-0.335), body mass index (β = 0.269), and body weight change (β=-0.179) significantly related the CR. ISI and PTSD scores were positively associated with UE and HS. PTSD triggers the occurrence of insomnia and maladaptive eating behaviours such as emotional or uncontrolled eating..

Perspectives on which health settings geriatricians should staff: a qualitative study of patients, care providers and health administrators

BackgroundWith a shortage of geriatricians and an aging population, strategies are needed to optimise the distribution of geriatricians across different healthcare settings (acute care, rehabilitation and community clinics). The perspectives of knowledge users on staffing geriatricians in different healthcare settings are unknown. We aimed to understand the acceptability and feasibility (including barriers and facilitators) of implementing a geriatrician-led comprehensive geriatric assessment (CGA) in acute care, rehabilitation, and community clinic settings.MethodsA qualitative description approach was used to explore the experience of those implementing (administrative staff), providing (healthcare providers), and receiving (patients/family caregivers) a geriatrician-led CGA in acute care, rehabilitation and community settings. Semi-structured interviews were conducted in Toronto, Canada. The theoretical domains framework and consolidated framework for implementation research informed the interview guide development. Analysis was conducted using a thematic approach.ResultsOf the 27 participants (8 patients/caregivers, 9 physicians, 10 administrators), the mean age was 53 years and 14 participants (52%) identified as a woman (13 [48%] identified as a man). CGAs were generally perceived as acceptable but there was a divergence in opinion about which healthcare setting was most important for geriatricians to staff. Acute care was reported to be most important by some because no other care provider has the intersection of acute medicine skills with geriatric training. Others reported that community clinics were most important to manage geriatric syndromes before hospitalization was necessary. The rehabilitation setting appeared to be viewed as important but as a secondary setting. Facilitators to implementing a geriatrician-led CGA included (i) a multidisciplinary team, (ii) better integration with primary care, (iii) a good electronic patient record system, and (iv) innovative ways to identify patients most in need of a CGA. Barriers to implementing a geriatrician-led CGA included (i) lack of resources or administrative support, (ii) limited team building, and (iii) consultative model where recommendations were made but not implemented.ConclusionsOverall, participants found CGAs acceptable yet had different preferences of which setting to prioritise staffing if there was a shortage of geriatricians. The main barriers to implementing the geriatrician-led CGA related to lack of resources.Clinical trial numberNot applicable.

Reducing Healing Period with DDM/rhBMP-2 Grafting for Early Loading in Dental Implant Surgery.

Traditionally, dental implants require a healing period of 4 to 9months for osseointegration, with longer recovery times considered when bone grafting is needed. This retrospective study evaluates the clinical efficacy of demineralized dentin matrix (DDM) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) during dental implant placement to expedite the osseointegration period for early loading. Thirty patients (17 male, 13 female; mean age 55.0 ± 8.8years) requiring bone grafts due to implant fixture exposure (more than four threads; ≥ 3.2mm) were included, with a total of 96 implants placed. Implants were inserted using a two-stage protocol with DDM/rhBMP-2 grafts. Early loading was initiated at two months postoperatively in the mandible and three months in the maxilla. Clinical outcomes evaluated included primary and secondary stability (implant stability quotient values), healing period, bone width, and marginal bone level assessed via cone-beam computed tomography. All implants successfully supported final prosthetics with a torque of 50Ncm, without any osseointegration failures. The average healing period was 69.6days in the mandible and 90.5days in the maxilla, with significantly higher secondary stability in the mandible (80.7 ± 6.7) compared to the maxilla (73.0 ± 9.2, p < 0.001). Histological analysis confirmed new bone formation and vascularization. DDM/rhBMP-2 grafting appears to significantly reduce the healing period, enabling early loading with stable and favorable clinical outcomes.

Business innovation intent among college students: Contributions of psychological capital and entrepreneurial self-efficacy

Business innovation is centre stage in fostering social and economic growth and entrepreneurial ventures. We explored how entrepreneurial self-efficacy mediates the link between psychological capital and entrepreneurial intent in business innovation. A sample of 365 female and male black African final year Technical and Vocational Education and Training (TVET) college students participated in the study (mean age = 24.3 years, SD = 2.38 years). Following simple mediation analysis and structural equation modelling, results indicated resilient hope and self-regulated optimism as promotors of self-efficacious entrepreneurial planning, which in turn enhanced business innovation (entrepreneurial) intent. Our findings add to entrepreneurship theory by highlighting psychological capital and entrepreneurial self-efficacy as passion attributes of business innovation intent. College modules should include training in business innovation that develops students’ psychological capital and entrepreneurial planning skills to enhance their passion for business creation.

Quantitative Pupillometry Predicts Neurologic Deterioration in Patients with Large Middle Cerebral Artery Stroke.

This study assesses whether longitudinal quantitative pupillometry predicts neurological deterioration after large middle cerebral artery (MCA) stroke and determines how early changes are detectable. This prospective, single-center observational cohort study included patients with large MCA stroke admitted to Boston Medical Center's intensive care unit (2019-2024). Associations between time-to-neurologic deterioration and quantitative pupillometry, including Neurological Pupil Index (NPi), were assessed using Cox proportional hazards models with time-dependent covariates adjusted for age, sex, and Alberta Stroke Program Early CT Score. Models using dilation velocity were compared with partial likelihood ratio tests. Pupillometric changes over 2-h intervals in the 12 h preceding deterioration were analyzed with linear mixed-effects modeling and Tukey's test. Matched referents (age, sex, stroke side, follow-up duration) were used for comparison. Optimal thresholds were identified using the Youden Index. Among 71 patients (mean age 66.5 years; 59.2% women), 32 (45.1%) experienced deterioration. A 1-unit decrease in NPi was associated with a higher hazard of deterioration (hazard ratio 2.46; 95% confidence interval 1.68-3.61). Dilation velocity improved model performance compared to NPi alone. NPi was significantly lower at 0-2 h (3.81 vs. 4.38, p = 0.001) and 2-4 h (3.71 vs. 4.38, p < 0.001) before deterioration compared to 10-12 h prior. Optimal thresholds were 4.01 for NPi, 0.49 mm/s for dilation velocity, and -0.15 change in NPi over 12 h. Quantitative pupillometry predicts neurological deterioration in MCA stroke, with declines detectable up to 12 h prior. Dilation velocity shows promise as a novel biomarker. ANN NEUROL 2025.

Symptomatic Accessory Navicular Treated With Endoscopic Accessory Navicular and Partial Navicular Resection.

This study aims to report the results of the patients with symptomatic accessory navicular (AN) who underwent endoscopic AN and partial navicular resection. The medical records of patients with type 2 symptomatic AN who underwent the aforementioned surgery at our hospital from November 2019 to May 2022 with a follow-up of >2 years were reviewed. Data on clinical, radiographic, and patient-reported outcomes were obtained. The analysis included 29 patients (20 females; mean age, 19.6 years; mean body mass index, 21.5) with a mean follow-up duration of 39.5 months. Comparing the preoperative and postoperative scores, visual analog scale score improved from 74.6 to 5.4, and the Japanese Society for Surgery of the Foot score improved from 63.0 to 95.9. We had one wound dehiscence and no other recognized complications. Magnetic resonance and ultrasonographic imaging done 1 year postoperatively revealed that the empty space that remained after resection of the AN was filled with tendonlike tissue. Endoscopic AN and partial navicular resection for treating symptomatic AN resulted in good outcomes and only one case with wound complications.