Recent Encounter Research Articles

The PPP - Perineal Body Preserving PSARP (Posterior Sagittal Anorectoplasty) for anorectal malformation with rectovestibular fistula in females – report of early outcomes.

Introduction The perineal body preserving PSARP (posterior sagittal anorectoplasty) (PPP) is a novel modification of the original PSARP for female patients with rectovestibular fistulas designed to eliminate the risk of perineal body dehiscence. This study aims to examine the outcomes following PPP. Methods A retrospective, single institution study was performed examining female patients with rectovestibular fistula who underwent PPP between 1/2020-12/2023. Exposure was done through the intended anoplasty only, there was no perineal body or posterior sagittal incision utilized. No routine post-operative dilations were performed. Post-operative outcomes, day of discharge, time to first feeding, and early stooling patterns were assessed. Results Fifteen patients underwent a PPP at a median age of six months (range 2 days-19 months) and median follow up of eleven months (range 1-36). Three (20%) patients underwent repair within the first three months of life. Five (33%) had diverting ostomies prior to referral to our team. There was no incidence of dehiscence or rectal prolapse. Two (13%) patients developed an anal stricture which required revision. Fourteen (93%) patients resumed normal feeds on post operative day one. Eleven (73%) were discharged on post operative day one. All patients were stooling spontaneously at their most recent clinical encounter with eleven (73%) utilizing laxatives. Conclusions The PPP eliminates the risk of perineal body dehiscence and has a quick return to regular diet and home. There is a 13% stricture rate which could relate to a difference in the distal rectal mobilization compared to the traditional PSARP.

Running with the bulls

Context. Stars and planets form in regions of enhanced stellar density, subjecting protoplanetary discs to gravitational perturbations from neighbouring stars. Observations in the Taurus star-forming region have uncovered evidence of at least three recent, star-disc encounters that have truncated discs (HV/DO Tau, RW Aurigae, and UX Tau), raising questions about the frequency of such events. Aims. We aim to assess the probability of observing truncating star-disc encounters in Taurus. Methods. We generated a physically motivated dynamical model including binaries and a spatial-kinematic substructure to follow the historical dynamical evolution of the Taurus star-forming region. We used this model to track star-disc encounters and the resulting outer disc truncation over the lifetime of Taurus. Results. A quarter of discs are truncated below 30 au by dynamical encounters, but this truncation mostly occurs in binaries over the course of a few orbital periods, on a timescale ≲0.1 Myr. Nonetheless, some truncating encounters still occur up to the present age of Taurus. Strongly truncating encounters (ejecting ≳10 percent of the disc mass) occur at a rate ∼10 Myr−1, sufficient to explain the encounter between HV and DO Tau ∼0.1 Myr ago. If encounters that eject only ∼1 percent of the disc mass are responsible for RW Aurigae and UX Tau, then they are also expected with encounter rate Γenc ∼ 100–200 Myr−1. However, the observed sample of recent encounters is probably incomplete, since these examples occurred in systems that are not consistent with a random drawing from the mass function. One more observed example would statistically imply additional physics, such as replenishment of the outer disc material. Conclusions. The marginal consistency of the frequency of observed recent star-disc encounters with theoretical expectations underlines the value of future large surveys searching for external structures associated with recent encounters. The outcome of such a survey offers a highly constraining, novel probe of protoplanetary disc physics.

On the right track: decoding self-regulated learning in young students’ log data with the digital train track task

Assessing self-regulated learning (SRL)—the interplay between monitoring and control behavior—remains challenging, particularly in young learners. The unobtrusive assessment with log data to investigate SRL offers a promising method to deepen the understanding of the SRL process of young students. Despite the significant potential of log data to enhance the measurement of SRL, recent research encounters new challenges of operationalization, transparency, generalizability, validity, and reproducibility. This study introduces an innovative instrument, the digital train track task (TTT), for assessing SRL with log data in young learners, focusing on monitoring and controlling behavior. Log data of 85 primary school students (second to fifth grades, aged 7–13 years) performing one simple and one complex TTT were analyzed. As a novel method, finite state machines (FSM) were applied to extract SRL-related actions and states from the log data. To evaluate and explore the potential of the digital TTT, monitoring, and control behavior during simple and complex tasks were compared, employing frequency-based statistical analysis and transition graphs. Additionally, the log data were multimethodically linked with think-aloud data. The results revealed differences in monitoring and control behavior during the simple and the complex tasks regarding frequency, duration, and transitions between the SRL-related states. Extracted SRL-related states from log data and corresponding think-aloud data showed significant correlations. Adding to the growing body of log data research, this study offers an innovative task to validly assess the metacognitive self-regulation processes of young learners during problem-solving. The transparent, theory-based operationalization of SRL in this study, taking into account recent demands for SRL log data research, allows better reproducibility and transfer and adds to the generalizability of findings from SRL log data research.

Unfair Racial Treatment in Healthcare, Healthcare Utilization, and Health Status Among Black, Indigenous, Women of Color

Black, Indigenous, Women of Color (BIWOC) face well-documented health disparities in the United States. However, the extent to which recent experiences of unfair racial treatment in medical settings contribute to health disparities is not well understood. The objective of this study was to examine associations of experiencing unfair racial treatment by a provider during the most recent medical encounter with healthcare utilization and health status in BIWOC. We utilized multivariate logistic regression models to examine data from the Association of American Medical Colleges’ biannual Survey of Healthcare Access collected between 2012 and 2019. Data were extracted for 5,549 participants who identified both as a woman and a Black, Indigenous, Person of Color to generate our BIWOC sample of interest. Among BIWOC, experiencing unfair racial treatment during their most recent healthcare visit in the past year was associated with higher odds of delaying healthcare ( OR = 3.50, p < .001) and using the emergency department as their usual source of care ( OR = 1.54, p < .001). Experiencing unfair racial treatment was also associated with having chronic physical conditions ( OR = 1.31, p = .002), chronic depression ( OR = 1.56, p < .001), and activity limitations due to both emotional ( OR = 2.98, p < .001) and physical ( OR = 2.47, p < .001) impairment. Recent experience of racial discrimination by a healthcare provider was associated with lower healthcare utilization and poorer health status in a national sample of BIWOC. Reducing unfair treatment in healthcare settings is critical for improving BIWOC health.

Evaluation of Long-term Antithrombotic Management for Atrial Fibrillation Patients with a History of Coronary Stent Implantation

Purpose: American expert consensus publications recommend discontinuation of antiplatelet agents 6 to 12 months after Percutaneous Coronary Intervention (PCI) in patients with Atrial Fibrillation (AF) who require chronic anticoagulation, and use of oral anticoagulant monotherapy thereafter. This study aimed to assess real-world long-term antithrombotic therapy management practices and factors associated with the continuation of antiplatelet agents past 12 months post-PCI in patients with AF requiring chronic anticoagulation. Methods: Patients with AF and a history of PCI greater than 12 months before their most recent encounter with physicians at an outpatient electrophysiology clinic were identified by chart review. Patient demographics, clinical characteristics, and current antithrombotic regimen were collected from encounters that occurred between July 2019 and June 2022. The independent predictive factors associated with the continuation of antiplatelet agents were identified using univariate and regression analyses. Results: Out of 66 patients, 67% continued antiplatelet therapy for greater than 12 months post-PCI. Patients on antiplatelets were significantly less likely to have bare metal stents (p = 0.006), be greater than five years post-PCI (p = 0.002), and have a HASBLED score of two or less (p = 0.028) when compared to patients on oral anticoagulant monotherapy. Bare metal stent history (p = 0.045) and HASBLED score of two or less (p = 0.016) were also significant in regression analysis. Conclusion: This study found that most patients with AF and a history of PCI continued antiplatelet therapy longer than 12 months post-PCI, often despite the high bleeding risk.

Behind Prep Decisions: Understanding User Patterns and Discontinuation Factors in Real-World.

This study aimed to characterize the epidemiological aspects of PrEP use and barriers to accessing this prophylaxis. This cross-sectional study was conducted between January 2021 and April 2022, encompassing 140 PrEP users treated at the Testing and Counseling Center (CTA) in Campo Grande, Mato Grosso do Sul. Data on sociodemographic characteristics and factors associated with PrEP discontinuation were obtained using a standardized questionnaire. Most PrEP users were cisgender men (92.00%), predominantly white (51.00%), over 30years of age (56.50%), homosexual-oriented (76.50%), and had a minimum of 12years of education (77.50%). Approximately 60.00% admitted to inconsistent condom use in recent sexual encounters, primarily involving anal intercourse. Approximately 88.00% perceived themselves as at risk of contracting STIs in the upcoming year. Regarding new presentation forms, 54.00% indicated a willingness to use "on-demand PrEP," and 92.00% expressed interest in using "injectable PrEP." After 6months of follow-up, 43.60% (95.00% CI: 35.50-52.00) discontinued PrEP use, primarily due to changes in sexual behavior (38.30%) and difficulties accessing healthcare services (21.28%). This study underscores the need to involve diverse key populations and highlights the significance of PrEP as an ongoing monitoring strategy for HIV/STI prevention in addition to the importance of incorporating new formulations such as daily oral PrEP into the Brazilian National Health System (SUS).

Sexual Victimization, Emotion Dysregulation, and Sexual Consent Feelings and Communication During a Recent Sexual Encounter

ABSTRACT Sexual consent has been a major focus of campus campaigns to reduce sexual violence (SV). However, these campaigns often educate students about consent with little attention to the complex ways consent can be experienced, expressed, and interpreted by others. Further, little research has focused on the consent feelings and communication cues of students who have a history of SV, nor have studies examined how the ability to attend to and regulate emotions relates to internal feelings or external communication of consent. This secondary analysis examined SV histories, emotion dysregulation, and internal and external consent cues in a sample of 610 college students (72% women) who completed an online self-report survey. Findings revealed that students with SV histories (n = 257) reported greater emotion dysregulation, lower internal consent, and greater use of passive external consent cues compared to students without SV histories; greater emotion dysregulation was associated with lower internal consent. In a path model, SV history was indirectly related to use of direct nonverbal and passive consent cues through greater emotion dysregulation and lower internal consent. Contrary to expectations, higher internal consent was associated with greater use of passive external consent cues. Consent programming could be augmented to encourage attention to and regulation of emotions in sexual situations to improve communication and sexual well-being.

Spatiotemporal Mechanism-Based Spacetimeformer Network for InSAR Deformation Prediction and Identification of Retrogressive Thaw Slumps in the Chumar River Basin

The increasing incidence of retrogressive thaw slumps (RTSs) in permafrost regions underscores the need for detailed spatial and temporal analysis using InSAR technology to monitor and predict dynamic changes in the process of RTSs. Nevertheless, current InSAR deformation forecasting methods employing deep learning strategies such as the traditional long short-term memory (LSTM) and recent transformer models encounter difficulties in effectively capturing temporal features. Moreover, they are limited in their ability to directly integrate spatial information. In this paper, an innovative deep learning approach named Spacetimeformer is proposed for predicting medium- and short-term InSAR deformation of RTSs in the Chumar River area. This method employs a transformer architecture with a spatiotemporal attention mechanism, which enhances the long-term prediction capabilities of time series models and dynamic spatial modeling. It is applicable to multivariate InSAR spatiotemporal deformation prediction problems. The findings include a list of 72 RTSs compiled based on derived InSAR deformation maps and Sentinel-2 optical images, of which 64 have an average deformation rate exceeding 10 mm/year, indicating signs of permafrost degradation. The density distribution of the displacement maps predicted by the Spacetimeformer model aligned well with the InSAR deformation maps obtained from the small baseline subset (SBAS) method, with the overall prediction deviation controlled within 20 mm. In addition, the point-scale prediction results were compared with LSTM and transformer models. This study indicates that the Spacetimeformer network achieved good results in predicting the deformation of RTSs, with a root mean square error of 1.249 mm. The Spacetimeformer method for deformation prediction with the spacetime mechanism presented in this study can serve as a general framework for multivariate deformation prediction based on InSAR results. It can also quantitatively assess the spatial deformation characteristics and deformation trends of RTSs.

Right Brain: The Unraveling.

"The Unraveling" is a personal reflection from my perspective as a new fellow in Multiple Sclerosis/Neuroimmunology on the impact of multiple sclerosis on patients and their loved ones. I compare my more recent patient encounters with past experiences working with a different, also mostly female, patient population that included those affected by intimate partner violence. Female vulnerability and the spectrum of human suffering serve as common themes throughout. However, my ultimate goal is to empower readers, from trainees to faculty to patients, to overcome their unique challenges in life and help others do the same.

Moral landscapes and morally meaningful encounters: how interaction ritual connects conversation analysis and cultural sociology.

This article presents a theoretical argument for examining the previously unexamined interface between the strong program in cultural sociology ethnomethodology/conversation analysis (EMCA). While these two approaches have radically different theoretical and empirical commitments, they nonetheless share a common root in Durkheim's sociology, specifically with regard to the centrality of solidarity, ritual, and morality to collective life. Similarly rooted in Durkheim, Goffman's theory of interaction ritual provides an analytic pivot between EMCA and the strong program. The broader theoretical argument is illustrated using data from interviews with adults about their most recent encounter with a rude strangers in public space, which are here treated a breaches of the interaction ritual of civil inattention. Members readily draw on the specifics of a particular stranger interaction gone awry to reflect on the nature of life in public and to expound on their understandings of the ethics of face-to-face interaction and everyday morality more generally. Where EMCA focuses on the discoverability of the organizational features of everyday interaction, the position developed here is concerned with the organization of members' interpretations of everyday interaction. While centered on specific kinds of interactional breaches, by finding common ground between EMCA and cultural sociology, the argument advances a potentially more broadly applicable approach that treats everyday encounters as morally meaningful and everyday lifeworlds as moral landscapes. Developing a comprehensive understanding of copresent interaction as a basic building block of society requires attention to both the organizational dynamics of copresent encounters and to the interpretive resources that ordinary members use to account for and justify their own and others' conduct.

D2/D3 dopamine supports the precision of mental state inferences and self-relevance of joint social outcomes

Striatal dopamine is important in paranoid attributions, although its computational role in social inference remains elusive. We employed a simple game-theoretic paradigm and computational model of intentional attributions to investigate the effects of dopamine D2/D3 antagonism on ongoing mental state inference following social outcomes. Haloperidol, compared with the placebo, enhanced the impact of partner behaviour on beliefs about the harmful intent of partners, and increased learning from recent encounters. These alterations caused substantial changes to model covariation and negative correlations between self-interest and harmful intent attributions. Our findings suggest that haloperidol improves belief flexibility about others and simultaneously reduces the self-relevance of social observations. Our results may reflect the role of D2/D3 dopamine in supporting self-relevant mentalising. Our data and model bridge theory between general and social accounts of value representation. We demonstrate initial evidence for the sensitivity of our model and short social paradigm to drug intervention and clinical dimensions, allowing distinctions between mechanisms that operate across traits and states.

Impact of electronic medical record utilization on obesity screening and intervention for obese patients with endometrial cancer

ObjectiveTo identify the prevalence of obesity documented within the electronic medical record problem list.MethodsWe conducted a retrospective cohort study of adult patients with obesity and endometrial cancer receiving care from...

Decomposition of an odorant in olfactory perception and neural representation.

Molecules-the elementary units of substances-are commonly considered the units of processing in olfactory perception, giving rise to undifferentiated odour objects invariant to environmental variations. By selectively perturbing the processing of chemical substructures with adaptation ('the psychologist's microelectrode') in a series of psychophysical and neuroimaging experiments (458 participants), we show that two perceptually distinct odorants sharing part of their structural features become significantly less discernible following adaptation to a third odorant containing their non-shared structural features, in manners independent of olfactory intensity, valence, quality or general olfactory adaptation. The effect is accompanied by reorganizations of ensemble activity patterns in the posterior piriform cortex that parallel subjective odour quality changes, in addition to substructure-based neural adaptations in the anterior piriform cortex and amygdala. Central representations of odour quality and the perceptual outcome thus embed submolecular structural information and are malleable by recent olfactory encounters.

First records of the sicklefin (Mobula tarapacana), bentfin (Mobula thurstoni), and spinetail (Mobula mobular) devil rays in the Chagos Archipelago.

Recent encounters with sicklefin (Mobula tarapacana) and bentfin (Mobula thurstoni) devil rays in the Chagos Archipelago provide the first confirmed observations of live specimens of these species in this region. Examination of illegal fishing photo archives collected during enforcement revealed these endangered species, and spinetail devil rays (Mobula mobular), are being caught within the archipelago's vast no-take marine protected area. Future cooperation between authorities and mobulid ray experts is crucial to improve the availability and accuracy of enforcement data and improve management of illegal fishing and mobulid ray conservation activities.

A recent encounter with Omiodes monogona Meyrick, 1888 (Crambidae: Spilomelinae)an interesting snout moth endemic to Hawaii.

A recent encounter with Omiodes monogona Meyrick, 1888 (Crambidae: Spilomelinae)an interesting snout moth endemic to Hawaii.

Sexual behaviours and risk with women in MSM in sub-Saharan Africa.

In sub-Saharan Africa (SSA), MSM - a high HIV prevalence group - experience strong social stigma and pressure to have female partners. Accordingly, they could constitute a bridging group for HIV transmission to cisgender women. We developed a multilevel summary of MSM sexual behaviors and risk with women in various SSA regions. Following PRISMA guidelines, we conducted a mixed-method systematic review of data of sex with women in MSM in SSA. We performed meta-analyses on quantitative data (i.e. percent of recent sex and condomless sex with women) for each SSA region (when proportions reported in ≥4 studies). Pooled proportions were calculated using random-effects models. Qualitative data were analyzed using the three-step thematic synthesis methodology. The pooled proportion of MSM who had sex with women was 58% (33-83%) in East Africa (in the previous 3 months), and 27% (13-48%) in Southern Africa and 50% (95% CI 39-62%) in West Africa (in the previous 6 months); 23% (16-32%) of MSM in West Africa had condomless sex with a woman (during the most recent encounter). Approximately one quarter of MSM had recent multiple female partners. MSM reported having sex with women because of heteronormative pressure, erotic/romantic attraction, or financial needs leading to transactional sex. MSM may act as a bridging population to women in SSA, as they commonly practice sex with women and risky sexual behaviors with them. HIV programmes and community-based support for MSM should be adapted to this population to reduce this risk.

Construction Of Drug Abuses (Case Study at Class 11-A Kupang Penitentiary)

Completers reported higher alcohol use than counterparts. Explores the model's subcategories: “life choices” (substance use, criminal and sexual behavior), static (background and disposition), and dynamic situational influences (occupation, psychological state, recent and past encounters).This research aims to determine the development of drug abuse in the Kupang Class II A Correctional Institution. The method used is an analytical descriptive approach . The data collection method is data from interviews and observations, the data analysis used is qualitative data analysis . The results of the research show that drug abuse guidance in Class IIA Kupang Prison has been achieved implemented in accordance with the Decree of the Minister of Justice of the Republic of Indonesia regarding the pattern of training prisoners/detainees of the Minister of Justice of the Republic of Indonesia, however, its implementation is still not perfect due to various obstacles. The training for narcotics prisoners has so far remained the same as the training for general prisoners . Drug abuse is a special case and should receive special guidance.

The risk of fractures after entering long-term care facilities

BackgroundStratifying residents at increased risk for fractures in long-term care facilities (LTCFs) can potentially improve awareness and facilitate the delivery of targeted interventions to reduce risk. Although several fracture risk assessment tools exist, most are not suitable for individuals entering LTCF. Moreover, existing tools do not examine risk profiles of individuals at key periods in their aged care journey, specifically at entry into LTCFs. PurposeOur objectives were to identify fracture predictors, develop a fracture risk prognostic model for new LTCF residents and compare its performance to the Fracture Risk Assessment in Long term care (FRAiL) model using the Registry of Senior Australians (ROSA) Historical National Cohort, which contains integrated health and aged care information for individuals receiving long term care services. MethodsIndividuals aged ≥65 years old who entered 2079 facilities in three Australian states between 01/01/2009 and 31/12/2016 were examined. Fractures (any) within 365 days of LTCF entry were the outcome of interest. Individual, medication, health care, facility and system-related factors were examined as predictors. A fracture prognostic model was developed using elastic nets penalised regression and Fine-Gray models. Model discrimination was examined using area under the receiver operating characteristics curve (AUC) from the 20 % testing dataset. Model performance was compared to an existing risk model (i.e., FRAiL model). ResultsOf the 238,782 individuals studied, 62.3 % (N = 148,838) were women, 49.7 % (N = 118,598) had dementia and the median age was 84 (interquartile range 79–89). Within 365 days of LTCF entry, 7.2 % (N = 17,110) of individuals experienced a fracture. The strongest fracture predictors included: complex health care rating (no vs high care needs, sub-distribution hazard ratio (sHR) = 1.52, 95 % confidence interval (CI) 1.39–1.67), nutrition rating (moderate vs worst, sHR = 1.48, 95%CI 1.38–1.59), prior fractures (sHR ranging from 1.24 to 1.41 depending on fracture site/type), one year history of general practitioner attendances (≥16 attendances vs none, sHR = 1.35, 95%CI 1.18–1.54), use of dopa and dopa derivative antiparkinsonian medications (sHR = 1.28, 95%CI 1.19–1.38), history of osteoporosis (sHR = 1.22, 95%CI 1.16–1.27), dementia (sHR = 1.22, 95%CI 1.17–1.28) and falls (sHR = 1.21, 95%CI 1.17–1.25). The model AUC in the testing cohort was 0.62 (95%CI 0.61–0.63) and performed similar to the FRAiL model (AUC = 0.61, 95%CI 0.60–0.62). ConclusionsCritical information captured during transition into LTCF can be effectively leveraged to inform fracture risk profiling. New fracture predictors including complex health care needs, recent emergency department encounters, general practitioner and consultant physician attendances, were identified.

Procedural Justice and Police Legitimacy: Untangling the Effects of Racial and Ethnic Combinations Between the Police and Civilians

In the 21st century, law enforcement agencies have increasingly realized the importance of police–civilian contacts in shaping public evaluations of legal authorities. Although many studies have revealed the Black–White racial disparities in public perceptions of the police, the impact of the nexus of civilian and officer race and ethnicity has rarely been adequately examined. Drawing upon a nationwide dataset, this study examined the effects of racial and ethnic combinations between the police and civilians on attitudes toward procedural justice and police legitimacy reported by 5,201 civilians who had recent encounters with police officers during traffic or pedestrian stops. The results showed a perception disparity regarding procedural justice and legitimacy among racial/ethnic combinations involving White, Black, and Hispanic civilians and officers. The nexus of Black-civilians–White-officers yielded the most negative effect. Hispanic civilians displayed more positive attitudes toward the police than their White counterparts. Procedural justice mediated the racial/ethnic effect on the perception of police legitimacy. Findings and policy implications are discussed.

Exploring factors related to clinically advanced fibrosis in patients with nonalcoholic fatty liver disease or nonalcoholic steatohepatitis

ABSTRACT Objectives To describe the clinical profile of nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) patients in a Texas integrated delivery network (IDN) and elucidate the local relationship between patient factors and the risk of advanced fibrosis. Methods This observational, retrospective, cross-sectional study utilized existing data from the electronic health record at a large Texas IDN. Data was collected during the study period from 1 January 2019, to 1 March 2023. Patient characteristics, comorbidities, labs, and medication orders were collected from the most recent encounter in which a Fibrosis-4 (FIB-4) score could be calculated. Chi square tests and analysis of variance (ANOVA) tests were conducted to evaluate differences among the three fibrosis risk categories. Ordinal logistic regression was utilized to assess associations between select variables and a higher risk of advanced fibrosis. Results A total of 56,253 patients were included in the study. 34,839 (61.9%) were Low-Risk 15,578 (27.7%) were Intermediate-Risk, and 5,836 (10.4%) were High-Risk of advanced fibrosis. Results showed that up to 70.4% of patients within a risk group were obese. Only 49.5% of patients in the High-Risk group had at least one gastroenterologist or hepatologist visit. Males, Medicare patients, former smokers, and those with hypertension, type 2 diabetes, and chronic kidney disease were associated with a higher risk of advanced fibrosis. Conclusion This study highlights the need for early screening and proactive management of metabolic risk factors for patients with NAFLD/NASH. The findings indicate a notable prevalence of obesity in the study population, a need for specialist referral for those at High-Risk of advanced fibrosis, and the importance of routine labs to evaluate metabolic factors. Primary care providers may be ideal providers to target these interventions and address this care need.