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The objective of this retrospective study was to evaluate and compare the safety characteristics of patients with chronic low back pain (cLBP) without a recent positive history of opioid use disorder (OUD). This study was conducted using the Merative MarketScan&#xae; database (January 2019-December 2023). The first date of Belbuca&#xae;, buprenorphine patch, or oral schedule II (CII) opioid prescription was designated as the index date. The observational period covered a 6-month preindex period and a follow-up period that lasted until the end of index treatment or continuous healthcare coverage. Patients were required to have two low back pain diagnoses and no OUD in the preindex period and continuous healthcare coverage during the observational period. The primary outcomes were serious treatment-emergent adverse event (TEAE) rates reported as incidence rate ratios (IRR) or absolute incidence rate difference (IRD) per 1,000 person-years for TEAEs occurring in one cohort. Propensity-score matching was employed to balance differences in patient characteristics and minimize their impact on study outcomes. There were no serious TEAEs associated with higher occurrence in the Belbuca&#xae; cohort compared with oral CII opioids. Belbuca&#xae; treatment was associated with a significantly lower rate of serious opioid abuse/dependence (IRD -33.76 per 1,000 person-years, p&#x2009;=&#x2009;0.032), osteoarthritis (IRD -78.77 per 1,000 person-years, p&#x2009;=&#x2009;0.001), urinary discomfort (IRD -146.28 per 1,000 person-years, p&#x2009;<&#x2009;0.001), seizures (IRR 0.11, p&#x2009;=&#x2009;0.019), dehydration (IRR 0.13, p&#x2009;=&#x2009;0.003), abdominal pain (IRR 0.25, p&#x2009;<&#x2009;0.001), and nausea/vomiting (IRR 0.30, p&#x2009;=&#x2009;0.001). The subanalysis compared incidence rates of serious TEAEs between Belbuca&#xae; and buprenorphine patch cohorts. Belbuca&#xae; demonstrated higher rates of serious coronary artery disease (IRD 39.01 per 1,000 person-years, p&#x2009;=&#x2009;0.035), cholecystitis (IRD 39.01 per 1,000 person-years, p&#x2009;=&#x2009;0.035), and headache (IRD 39.01 per 1,000 person-years, p&#x2009;=&#x2009;0.035). However, the buprenorphine patch cohort had higher incidence rates of serious QT prolongation (IRD -52.78 per 1,000 person-years, p&#x2009;=&#x2009;0.009), opioid abuse/dependence (IRD -184.75 per 1,000 person-years, p&#x2009;<&#x2009;0.001), confusion (IRR 0.10, p&#x2009;=&#x2009;0.007), hypertension (IRR 0.22, p&#x2009;=&#x2009;0.043), and cellulitis (IRR 0.41, p&#x2009;=&#x2009;0.011). The study findings suggest that Belbuca&#xae; may have a favorable safety profile relative to oral CII opioids and buprenorphine patch treatments in cLBP patients without a positive history of OUD.

The GBD (Global Burden of Disease) study provides a unique opportunity to better understand the socioeconomic and geographical drivers of clinical outcomes and mortality in adult congenital heart disease (ACHD) in the United States. We performed a secondary data analysis using a population-based observational study design that studied state specific data on mortality and disability-adjusted life years from 1990 to 2021 for patients with ACHD aged 20&#x2009;years and older in the United States. These data were acquired from the GBD study. We subsequently correlated these data with median household income and percentage of uninsured people in each state by using the US census bureau poverty and income data. In 2021, the GBD study identified 292&#x2009;624 (95% CI, 258&#x2009;956-342&#x2009;906) adults &#x2265;20&#x2009;years with CHD living in the United States with 1074 (95% CI, 964-1331) ACHD related deaths and 62&#x2009;244 (95% CI, 51&#x2009;820-76&#x2009;301) disability-adjusted life years. The state with the highest mortality and disability-adjusted life years (West Virginia) also has one of the lowest median household incomes ($51&#x2009;122). States with lower ACHD related mortality have higher median household incomes (r2=0.62, P&#x2009;<&#x2009;0.001). There is a lower correlation between mortality and the percentage of patients uninsured in each state (r2=0.14, P=0.0068). The GBD study provides unique insight into ACHD mortality and disability in the United States. Although mortality and disability rates have decreased from 1990 to 2021, patients with ACHD living in states with lower median household income and higher percentage of uninsured people have higher rates of mortality and disability. Ensuring adequate access to specialized care is warranted for this population.

A prior study of living kidney donors demonstrated a substantially higher long-term risk of hydrocelectomy among male living kidney donors who underwent laparoscopic nephrectomy compared with nondonors. Given the potential shared anatomical pathways between hydrocele and indirect inguinal hernia formation, we aimed to evaluate the donation-attributable risk of inguinal hernia repair. To evaluate long-term rates of inguinal hernia repair in male living kidney donors compared to nondonors. Population-based, retrospective matched cohort study using linked health administrative databases from Ontario, Canada. 848 male living kidney donors aged &#x2265;18 years who underwent laparoscopic donor nephrectomy between April 1, 2002, and March 31, 2023, were matched (1:10) to 8480 healthy male nondonors based on age, cohort entry date, rurality, neighbourhood income, and prior vasectomy. Individuals with prior scrotal conditions or previous inguinal hernia repair were excluded. The primary outcome was inguinal hernia repair. Risk was assessed using Cox proportional hazards models with robust variance. Cumulative incidence was estimated at key time points using Aalen-Johansen methods, treating death as a competing event. To contextualize the findings, incidence rates were also examined after other renal (e.g., nondonor nephrectomy, pyeloplasty) and abdominal surgeries. Over a median follow-up of 8.8 years, 4.7% of donors (40 of 848) and 3.4% of nondonors (287 of 8480) underwent inguinal hernia repair. Donors had a modestly higher risk of undergoing inguinal hernia repair than nondonors (4.9 vs. 3.5 events per 1000 person-years; hazard ratio (HR) 1.40; 95% CI, 1.01-1.93; P = 0.043). The cumulative incidence of inguinal hernia repair after laparoscopic donor nephrectomy was comparable to that observed after other renal and abdominal surgeries. This study relied on administrative data, which lacked information on hernia type (direct or indirect), laterality, pre-existing asymptomatic hernias, and key confounders such as body mass index and occupation. Donors may differ from nondonors in care-seeking behaviours and lifestyle factors, which could influence the observed risk. In contrast to the markedly higher risk of hydrocele repair, the donation-attributable risk of inguinal hernia repair in the years following laparoscopic donor nephrectomy appears modest, and in some comparisons was not evident. These findings support current counselling and selection practices for prospective donors, for which this outcome does not warrant specific consideration.

Citation-based indicators are widely used to assess scientific impact, yet they often overlook the temporal dynamics of knowledge dissemination. Time to first citation has gained relevance as an indicator of early research visibility, particularly in emerging research systems. To analyze time to first citation of Ecuadorian medical publications and identify publication characteristics associated with citation timing using a survival analysis approach. A scientometric study was conducted on Ecuadorian medical publications indexed between 2015 and 2024, with citation follow-up through December 31, 2024. Descriptive statistics summarized publication characteristics and citation counts at 2 and 5 years. Time to first citation was analyzed using Kaplan-Meier estimators and Cox proportional hazards regression models, accounting for right-censored data. A total of 3,968 publications were included. Most articles were published in open access journals (63.0%) and involved international collaboration (69.3%). Publications were predominantly in English (85.1%). Most records were original research articles (2,917; 73.5%), while 597 (15.0%) were review articles; article type information was unavailable for 454 records (11.4%). The median number of cumulative citations was 3 (IQR 1-7) at 2 years and 6 (IQR 3-14) at 5 years. Kaplan-Meier analysis showed that approximately 50% of articles received their first citation within the first year, and most were cited within 4 years. In the multivariable Cox regression analysis, international collaboration (HR = 0.81; 95% CI: 0.67-0.97), non-English language (HR = 0.53; 95% CI: 0.42-0.65), original article type (HR = 1.40; 95% CI: 1.09-1.79), and number of authors (HR = 1.001; 95% CI: 1.001-1.002) were significantly associated with time to first citation, whereas open access status was not independently associated with citation timing after adjustment. Ecuadorian medical publications demonstrated relatively rapid early citation uptake. Publication language, article type, international collaboration, and authorship characteristics were associated with time to first citation. These findings should be interpreted cautiously given the observational design and limitations in metadata completeness. The study highlights structural factors that may influence early research visibility in emerging research systems.

High-dose (HD) influenza vaccines have demonstrated robust effectiveness in preventing severe influenza-related outcomes, including pneumonia, cardiorespiratory complications, and mortality, with evidence from randomized clinical trials, meta-analyses, and real-world studies consistently showing superiority over standard-dose (SD) vaccines and supporting international recommendations for adults aged &#x2265;60 years. This is increasingly relevant in the context of global aging and immunosenescence, which weakens vaccine-induced immune responses and heightens biological frailty, functional decline, and the risk of severe complications in older adults, especially those with comorbidities. The objective of this work is to describe the introduction, uptake, and current use of HD influenza vaccines in Spain and to summarize the evidence supporting their broader adoption in adults &#x2265;60 years of age. Methods include a narrative synthesis of clinical evidence and an analysis of vaccination strategies implemented across Spanish autonomous communities since the introduction of HD vaccines during the COVID-19 pandemic. Available evidence supports extending HD vaccine use as a population-based strategy to enhance protection and promote equitable access. The results show that the incorporation of HD influenza vaccines marked a significant shift in national vaccination strategies, with heterogeneous uptake across regions: while some prioritized institutionalized or dependent populations, others implemented mixed approaches that also included community-dwelling adults aged &#x2265;60 years. In conclusion, a clear trend toward wider adoption is emerging, with an increasing number of autonomous communities incorporating HD vaccines into their programs and progressively lowering the recommended age threshold, in alignment with international guidance and the biological rationale for strengthened protection in older adults.

Depression is a persistent mental illness that affects more than 5% of individuals worldwide. The co-occurrence of depression in individuals with diabetes may be linked to worse treatment. There is evidence to support a bidirectional relationship between diabetes and depression, in which diabetes elevates the risk of depression later in life and depression increases the risk of diabetes earlier in life. Depression increases the chance of acquiring diabetes-related complications, apart from being a risk factor for diabetes itself. This study aimed to determine the prevalence of depression and associated factors among adult diabetic men on follow-up at Robe and Goba hospitals. An institution-based cross-sectional study was conducted from March 1 to April 30, 2022, involving 420 adult diabetic men. The Patient Health Questionnaire-9 was used to screen for depression. Data were entered using Epidata version 4.6 and analyzed using SPSS version 26. Bivariable and multivariable logistic regression analysis were used to identify associations between depression and independent variables. The prevalence of depression was 65 (15.5%) [95% CI: 12.1-19.5]. Age greater than 60 years compared to <&#x2009;30 years (AOR&#x2009;=&#x2009;4.2, 95% CI: 1.8-9.9), diabetes duration of 5-10 years (AOR&#x2009;=&#x2009;5.7, 95% CI: 2.6-12.3), and moderate erectile dysfunction (AOR&#x2009;=&#x2009;6.2, 95% CI: 1.7-22.9) were found to be associated with depression. According to this study, 15% of adult diabetic men suffer from depression. The study also found that the prevalence of depression increased with age, protracted sickness, and moderate erectile dysfunction.

As adolescent mental health issues are increasingly recognized as a public health concern, evaluating the accuracy of the DASS-Y is important for early detection and intervention. This study evaluated the diagnostic accuracy of the Indonesian version of the DASS-Y in screening internalizing disorders among adolescents aged 10-18 years. We conducted a cross-sectional observational study across eight schools in Palembang, South Sumatra, Indonesia, from July to December 2025. A total of 274 adolescents were included. Diagnostic accuracy of the DASS-Y for screening internalizing disorders, such as major depressive disorder, anxiety disorders, and Post-Traumatic Stress Disorder (PTSD), was evaluated against psychiatric clinical assessment based on the DSM-5 as the gold standard. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff score. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the curve (AUC). Among 274 adolescents aged 10-18 years, a DASS-Y total score cutoff of &#x2265;24 showed good sensitivity (0.83) and specificity (0.85), with excellent overall diagnostic accuracy (AUC = 0.93), indicating strong ability to discriminate between adolescents with and without internalizing disorders. The Indonesian version of the DASS-Y demonstrated excellent diagnostic accuracy for screening internalizing disorders among adolescents. The DASS-Y may be considered as a potential screening tool for adolescents aged 10-18 years in Indonesia. Further studies are needed to evaluate its implementation in routine practice.

Menopause can affect women's quality of life through vasomotor, psychological and urogenital symptoms. This study assessed the prevalence and correlates of impaired quality of life across menopausal stages in Bangladeshi women. This cross-sectional study included 3000 women aged 45-55&#x2009;years attending outpatient gynecology clinics in Dhaka between December 2022 and June 2024. Menopausal stage was classified using Stages of Reproductive Aging Workshop +10 (STRAW&#x2009;+10) criteria. Symptoms and quality of life were assessed using the Menopause Rating Scale (MRS), with impaired quality of life defined as MRS >16. Multivariable logistic regression identified factors associated with impaired quality of life. Overall, 825 women (27.5%) had impaired quality of life. Symptom severity increased across menopausal stages, and hot flush prevalence rose from 22.1% in premenopause to 47.8% in late postmenopause. Hot flushes showed the strongest association with impaired quality of life (adjusted odds ratio [aOR] 10.28, 95% confidence interval [CI]: 8.84-11.95). Psychotropic medication use (odds ratio [OR] 2.00) and vaginal dryness (OR 1.28) were also associated with impairment, whereas sexual activity (OR 0.75), hormone therapy use (OR 0.70) and good self-rated health (OR 0.58) were associated with lower odds. Early postmenopause had the highest risk (aOR 2.14, 95% CI: 1.71-2.69). Early postmenopause is a vulnerable period for impaired quality of life among Bangladeshi women. Vasomotor and urogenital symptoms were important correlates of poorer well-being, supporting routine symptom assessment and culturally appropriate menopausal care. Menopause is a natural stage of life, but it can bring physical and emotional changes that affect how women feel and function in everyday life. In Bangladesh, many women experience menopausal symptoms without enough medical guidance or social support. This study looked at how common these symptoms are and how strongly they affect women&#x2019;s quality of life.Researchers surveyed 3000 women aged 45&#x2013;55&#x2009;years who attended gynecology clinics in Dhaka. The women answered simple questions about common menopausal symptoms, such as hot flushes, mood changes, sleep problems and vaginal dryness, and how these symptoms affected their daily activities and well-being.About one in four women reported that menopause had a negative effect on their quality of life. Hot flushes were the most common and most disruptive symptom, and women who experienced them were much more likely to report difficulties in daily living. Vaginal dryness and the use of medicines for anxiety or depression were also linked to poorer well-being. Women who were sexually active or who used hormone therapy reported better overall quality of life.The early years after menopause were the most challenging period for many women. These findings highlight the need for better awareness, routine screening and culturally appropriate menopausal care in Bangladesh and similar settings, so women can receive timely support and maintain a good quality of life.

Anticholinergic medications are widely prescribed in older adults and contribute to cumulative anticholinergic burden (ACB), which is associated with adverse clinical outcomes. Hospitalized geriatric patients frequently experience multimorbidity and polypharmacy, increasing the risk of elevated ACB. Data from low- and middle-income settings, particularly at transitions of care, remain limited. To assess prescribing patterns of medications with anticholinergic properties and quantify anticholinergic burden at admission and discharge among geriatric inpatients, and to evaluate its association with polypharmacy and clinical predictors. A retrospective observational cohort study was conducted in the cardiology and nephrology departments of a tertiary care hospital in Islamabad, Pakistan, from January 2021 to December 2022. Patients aged &#x2265;60 years with complete medication records were included. Anticholinergic burden was measured using the Anticholinergic Cognitive Burden (ACB) scale. A total of 1100 patients were analyzed (median age 65 years). Polypharmacy increased from 49.5% at admission to 84.5% at discharge (p<0.001). The proportion of patients with ACB &#x2265;1 rose from 36.1% to 43.6% (p<0.001), and the median ACB score increased from 1 to 2 (p<0.001). Heart failure, renal disorders, higher comorbidity count, and longer hospital stay were independently associated with higher ACB at discharge. Male gender was associated with lower odds of ACB. Anticholinergic burden and polypharmacy are common and increase during hospitalization among geriatric patients. Targeted medication review at admission and discharge may help reduce cumulative anticholinergic exposure.

The subcutaneous implantable cardioverter-defibrillator (S-ICD) avoids transvenous leads and is a promising option for sudden cardiac death (SCD) prevention in pediatric patients. However, mid-term outcomes and post-shock management strategies remain insufficiently characterized. This multicenter, retrospective observational study included pediatric patients (&#x2264;&#x2009;18&#x2009;years) who underwent S-ICD implantation between February 2016 and July 2021. Clinical characteristics, pre-implant screening, procedural details, device-related events, and follow-up data were analyzed. The incidence and management of appropriate and inappropriate therapies and subsequent recurrence were evaluated. Ninety-six patients (median age 14.5&#x2009;years) were enrolled and followed for a median of 70&#x2009;months (29-75.0&#x2009;months). Sensing vector suitability remained stable despite somatic growth. Appropriate shocks occurred in 32 patients (33.7%), while inappropriate shocks occurred in 27 (28.4%). After appropriate therapy, intensified pharmacological treatment and catheter ablation prevented recurrent device therapy in 45.5% and 50.0% of cases, respectively, although device shock occurred in 50.9% despite intervention. Following inappropriate therapy, device reprogramming and lifestyle guidance prevented recurrence in 71.4% of patients (15/21). Device-related infection was rare (2 cases), and no lead fractures were observed. S-ICD therapy demonstrated favorable mid-term safety and efficacy in pediatric patients, with durable sensing performance and a low incidence of device-related infection. Although inappropriate shocks were not uncommon, appropriate post-shock management effectively reduced recurrence, supporting S-ICD as a viable option for selected pediatric patients without pacing requirements.

Heat stroke is a leading cause of mortality during the Hajj season, yet data on its clinical progression remain limited. This study evaluates the clinical characteristics, complications, and outcomes of heat stroke among pilgrims. This prospective exploratory cohort study included adult pilgrims (&#x2265;18 years) who were admitted with a confirmed diagnosis of heat stroke, defined as a core temperature &#x2265;40&#xb0;C and central nervous system dysfunction, across nine hospitals. The primary endpoint measure is the frequency of at least one heat stroke-related complication. Patients were stratified into those discharged from the treating ICU and those transferred to an advanced referral center, with transfer used as a pragmatic surrogate for greater clinical severity within the Hajj healthcare system. Twenty-three patients were included (mean age 65.1 &#xb1; 10.5 years; 56.5% male). Fifteen (65.2%) were discharged from the treating ICU, whereas eight (34.8%) were transferred to an advanced referral center. Compared with discharged patients, the transferred group showed higher ccreatinine upon admission (165.50 (146.00-185.50) vs. 130.50 (114.25-152.25); P=0.02), Peak creatinine values (275.90 (223.32-328.80) vs. 143.00 (126.00-160.50); p = 0.001), peak Urea values (17.40 (13.70-23.95) vs. 11.00 (8.70-13.00); p = 0.01); and the highest AST during admission was also higher in the transferred group (P=0.015). The lowest platelet counts during the patient's admission were significantly reduced in the transferred group (p = 0.007). Mechanical ventilation was required more often in the transferred group (75.0% vs. 26.7%; p = 0.026), and its duration was longer (p = 0.019). Given the small sample size, these findings should be considered exploratory. In this small, exploratory cohort, patients requiring transfer to an advanced referral center generally had a greater burden of organ dysfunction and required more critical care interventions. These observations should not be interpreted as establishing predictors of severe heat stroke because transfer status may also reflect healthcare system factors. Larger prospective multicentre studies are required to determine whether these observed differences are reproducible and clinically meaningful.

Cannabis use during pregnancy and the postpartum period has increased in recent years, raising clinical concerns regarding maternal and infant health, particularly during lactation. However, evidence regarding &#x394;9-THC concentrations in breast milk during the early postpartum period and their relationship with other biological matrices remains limited. This study aimed to assess &#x394;9-THC concentrations in breast milk and saliva, and 11-nor-9-carboxy-&#x394;9-tetrahydrocannabinol (THC-COOH) concentrations in urine, among postpartum women with cannabis use at the time of delivery. A secondary objective was to explore correlations between these biological matrices during early lactation. A longitudinal observational study was conducted at Vall d'Hebron University Hospital (Barcelona, Spain) between April 2022 and December 2023. Thirteen postpartum women aged over 18 years with a positive urine test for cannabis at delivery and intent to breastfeed were included. Saliva, urine, and breast milk samples were collected at 24 hours, 48 hours, and one week after birth. &#x394;9-THC concentrations in breast milk and saliva and THC-COOH concentrations in urine were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Among participants who remained abstinent during the first postpartum week, urinary THC-COOH concentrations progressively decreased but remained quantifiable across all study stages. In contrast, &#x394;9-THC concentrations in breast milk decreased over time and were below the limit of quantification (LOQ) one week postpartum. Salivary &#x394;9-THC concentrations were generally low and frequently below the LOQ. Breast milk &#x394;9-THC concentrations at the first sampling stage were significantly correlated with salivary &#x394;9-THC and urinary THC-COOH concentrations, whereas no significant correlations were observed at later stages. This preliminary study suggests that &#x394;9-THC concentrations in breast milk may decline rapidly after postpartum cannabis cessation, becoming non-quantifiable within the first postpartum week among participants who discontinued use after delivery. In contrast, urinary THC-COOH remained quantifiable for a longer period. Salivary &#x394;9-THC showed limited concordance with breast milk &#x394;9-THC and should therefore be interpreted cautiously as a potential surrogate marker. Larger prospective studies are needed to confirm these findings and to support evidence-based breastfeeding counseling for women with recent cannabis use.

Ovarian senescence is the fundamental cause of reduced fertility in female animals,however, the molecular characteristics of ovarian ageing in sheep remain insufficiently defined. In this study, ovarian tissues were collected from 12 Qira Black sheep and assigned to group D (1-2&#x202f;years, n&#x202f;=&#x202f;6) and group H (5-6&#x202f;years, n&#x202f;=&#x202f;6) for LC-MS/MS-based proteomic profiling. A total of 458 differentially expressed proteins (DEPs) were identified between the two groups, including 211 upregulated and 247 downregulated proteins. Functional enrichment analyses indicated that these DEPs were mainly involved in cell-cycle regulation, oocyte maturation, amino acid metabolism, and inflammation-related signalling pathways, with the Rat Sarcoma(Ras) and Mitogen-Activated Protein Kinase Pathway(MAPK) signalling pathways showing particularly strong enrichment. Protein-protein interaction (PPI) network analysis revealed close interactions among Intraflagellar transport 80(IFT80), Insulin receptor(INSR), Angiopoietin-like 4(ANGPTL4), Receptor interacting serine/threonine kinase 3(RIPK3), Nuclear receptor corepressor 1(NCOR1), and Fms-Related Tyrosine Kinase 4(FLT4), with Insulin receptor(INSR) occupying a central hub position. Collectively, this study establishes a differential proteomic atlas of ovarian ageing in Qira Black sheep, highlights the potential importance of Rat Sarcoma(Ras) and Mitogen-Activated Protein Kinase Pathway(MAPK) signalling in this process, and identifies Insulin receptor(INSR) as a candidate target, thereby providing a theoretical basis for subsequent mechanistic studies and the development of molecular markers.

Superabsorbent water beads can be used in projectile toy guns. We aimed to characterize water bead-related hyphema and compare the prevalence with other causes of traumatic hyphema. In this 10-month retrospective review, we identified 35 consecutive patients with traumatic hyphema presenting to the emergency department. Cases were grouped by injury mechanism, water bead-related compared with all other causes. Clinical data on initial presentation and subsequent visits were compared. In the patients with traumatic hyphema, 8 (23%) cases were due to water bead trauma. Bead-related cases involved significantly younger patients (16 &#xb1; 9 years) compared with other cases (32 &#xb1; 21 years; p = 0.004). No statistically significant differences were found in peak intraocular pressure (p = 0.14) or need for surgical intervention (p = 0.3). The proportion of hyphema related to water bead injuries was higher in pediatric (42%) compared with adult patients (10%). The odds ratio of water-bead hyphema in pediatric compared with adult patients was 6.44 (95% CI:1.15-57.1; p = 0.021). In this study, approximately a quarter of patients with traumatic hyphema during the study period were water bead-related, with approximately six-fold increased risk in younger patients. These findings suggest a need for public health awareness about water bead projectile injuries.

As medical education shifts toward competency-based curricula, faculty must navigate evolving expectations for teaching, mentoring, assessment, and scholarship. Despite their central role in training future health professionals, medical educators often face ambiguity regarding career advancement through teaching. Promotion criteria in academic institutions are frequently research-focused, leaving faculty unclear about how to document and demonstrate teaching excellence and educational innovation. This gap can hinder motivation, professional identity, and faculty retention. This study aims to explore the faculty development activities at Avalon University School of Medicine, a Caribbean medical school. This is a descriptive case study examining outcomes, including scholarly output, faculty ranking promotions, and fellowships, following the implementation of faculty development activities. Over 10 years, 20 medical educators involved in preclinical teaching were included in this study. They participated in various faculty development activities, including teaching, designing assessments, delivering effective feedback, developing curricula, and applying medical education research methodologies. Faculty members reflected on and practiced these practices in their teaching methods, assessment practices, and research in medical education. A total of eight faculty members received the Academy of Medical Educators (AoME) Fellowship. Four faculty members completed the IAMSE fellowship. One received the AMEE fellowship, and another received an associate fellowship. One received the AdvanceHE fellowship, and another received a principal fellowship. During these 10 years, 42 publications by faculty members in peer-reviewed journals in educational research were published, 26 abstracts were accepted at International medical education conferences, and 8 faculty members were promoted in faculty rankings. The findings from this case study indicate that the faculty development initiatives implemented at AUSOM were associated with enhanced faculty engagement in educational scholarship, professional recognition through educator fellowships, and academic career advancement. This experience suggests how a structured, longitudinal faculty development program can support faculty capacity building.

To investigate the incidence of idiopathic epistaxis in Changshu, China, and its correlations with meteorological factors. We retrospectively enrolled 24,193 patients with idiopathic epistaxis from March 2011 to November 2022. Matched clinical, population, and meteorological data were analyzed. Spearman's correlation and variance inflation factor analyses were performed to assess multicollinearity. We conducted quartile stratification and sequential robust negative binomial regression with three progressively adjusted models, as well as 1-4&#x202f;day lag effect analyses. The highest incidence was in patients <18&#x202f;years (40.3%) and the lowest in those &#x2265;60&#x202f;years (14.3%), while males accounted for approximately 60% of all cases. Incidence was higher in spring (32%) and summer (27%). Regression analysis showed that higher relative humidity reduced disease risk by 17% (IRR&#x202f;=&#x202f;0.83, 95% CI: -21 - -12%, p <&#x202f;0.001). Extremely low atmospheric pressure increased risk by 85% with a threshold effect and no significant linear trend. Higher temperature raised risk by 12% (IRR&#x202f;=&#x202f;1.12, 95% CI: 0-24%, p <&#x202f;0.05). Wind speed and daily temperature difference showed no significant associations. During lag days 1-4, effects of humidity and daily temperature difference peaked at lag 1&#x202f;day. Temperature exerted divergent effects at lag 1 and 2&#x202f;days. No lag effects were observed for wind speed or atmospheric pressure. Low humidity and high temperature are independent risk factors for idiopathic epistaxis. Atmospheric pressure presents a threshold effect, and meteorological factors exert diverse short-term lag effects on disease onset.

Despite the growing clinical use of dry needling, the anatomical accuracy and safety of ultrasound-unguided approaches to the soleus remain insufficiently standardized and validated. This study aimed to evaluate (i) the anatomical accuracy and safety of a standardized ultrasound-unguided dry needling protocol targeting the mid-third of the soleus, (ii) intra- and inter-rater reliability of key procedural outcomes, and (iii) agreement between ultrasound imaging and cadaveric dissection as validation methods for needle placement. An experimental cross-sectional cadaveric study was conducted on five fresh-frozen human cadavers (10 lower limbs), yielding 24 dry needling events. Two physiotherapists with different levels of dry needling experience (intermediate: 5&#x2009;years; advanced: >10&#x2009;years) performed the protocol independently. A blinded sonographer assessed needle tip location and quantitative safety margins using high-resolution ultrasound. Anatomical dissection was subsequently performed to confirm final needle placement in a subset of approaches. Outcomes included soleus placement accuracy, septum puncture (lateral and posterior/deep), and neurovascular/vascular compromise. Reliability was assessed using percentage agreement and Cohen's kappa. Accurate needle placement within the soleus was achieved in 22/24 procedures (91.7%), with 2 failures (8.3%), both performed by the intermediate-experience physiotherapist. Lateral septum puncture occurred in 5/24 cases (20.8%), and posterior/deep septum puncture in 3/24 cases (12.5%). No puncture of the tibial neurovascular bundle or vascular structures was observed (0%). Intra-rater agreement for the advanced physiotherapist was 100% across dichotomous outcomes. Inter-rater agreement was 80% for soleus accuracy and overall procedural success. Ultrasound imaging and cadaveric dissection demonstrated 100% agreement across accuracy and safety outcomes in the advanced physiotherapist approaches. In this cadaveric model, a standardized ultrasound-unguided dry needling protocol targeting the soleus achieved high anatomical accuracy with no neurovascular injury, and showed excellent agreement between ultrasound and dissection for the advanced operator.

Case-based learning (CBL) in medical microbiology teaching serves as a crucial pedagogical link that bridges foundational knowledge and clinical thinking, but student participation, enthusiasm, and initiative are often lacking during the foundational learning stage. We designed a scenario-case discussion (SCD) model and evaluated its effectiveness in ensuring that under the student-centered principle, each student is motivated to actively participate and engages in self-directed learning and knowledge reconstruction. SCD activity was conducted over three academic years involving 240 second-year undergraduate medical students majoring in clinical medicine for a prospective quasi-experiment. Participants were divided into two classes: one receiving conventional CBL (120 students) and the other receiving SCD model (120 students). Knowledge comprehension and retention were assessed through content-based tests, while student engagement was evaluated based on classroom interactions and post-class feedback. Participant perceptions of the SCD were evaluated via questionnaires. Despite slight variability in participants' age and gender, both the SCD and control classes showed significant improvement in pre- and post-test scores. Particularly noteworthy is&#xa0;the greater gain observed in the SCD group compared to the control class (mean increase: 1.99 vs. 1.03 points; P < 0.05). Analysis of final examination revealed that scores in the SCD class were significantly higher than those in the control class across all academic years (P < 0.05 for all). Post-class questionnaires showed that over 74% of students gained a positive learning experience, such as stimulated interests, enhanced initiative, proactivity, a first-hand understanding of the doctor-patient relationship, and a better comprehension of the course content. Most notably, as many as 96.67% of the students agreed that the SCD approach ensured the participation of every student. Encouragingly, the SCD class demonstrated a significantly higher frequency of questions raised both in and after class. The SCD teaching model significantly improved the educational outcomes of CBL sessions in medical microbiology. Given the current educational goal of fostering students as constructors and creators of knowledge, the SCD teaching practice may serve as a positive driver.