Generative AI coding assistants are increasingly used to write machine-learning code, yet their ability to produce reliable LSTM implementations for financial prediction remains underexplored. This study evaluates the LSTM code generated by seven assistants ChatGPT 4.5, GitHub Copilot, Deepseek 3, Perplexity, Gemini 2.0 Pro, Claude 3.7 Sonnet, and Meta's Llama from a single standardized prompt, on three indices (Nikkei 225, S&P 500, STOXX Europe 600). Each assistant's generated script was re-executed over independent runs; accuracy (MAE, MSE, RMSE, R2, execution time) is reported as mean ± standard deviation on the original price scale, complemented by a static code-quality analysis (Pylint, Radon, SonarQube, Pytest, Bandit). The assistants converge on nearly identical LSTM architectures, so performance differences arise mainly from data-handling and code-correctness defects: Meta's Llama near-zero errors are an artifact of normalized-scale metrics combined with a shuffled train/test split (data leakage), and once corrected its accuracy is among the weakest; Gemini 2.0 Pro, once its predictions are evaluated consistently on the price scale, is among the most accurate assistants. Differences are validated with Diebold-Mariano and Wilcoxon tests. AI-generated forecasting code can be accurate but is not uniformly trustworthy: its generated preprocessing and evaluation code must be audited before use.
As robotic-assisted total knee arthroplasty (TKA) gains traction in revision procedures, the urgent need to investigate its effectiveness compared with manual methods becomes apparent. Data were retrospectively obtained from the TriNetX Collaborative Network. Revision TKA (rKA) cases were identified using CPT codes and categorized as manual or robotic assisted using ICD-10 procedure codes. Cohorts were balanced with 1:1 propensity score matching for demographics, comorbidities, and revision history. Complication rates were compared across follow-up using chi-square analysis. An initial query identified 19,088 manual and 2,709 robotic-assisted rKA cases. After 1:1 propensity matching, 2,010 patients remained in each group. Robotic rKA had significantly lower mechanical implant‑related complications at 3 and 6 months (OR 1.67 and 1.66; P < 0.001) and lower early VTE, while PJI, readmission, and revision rates were not significantly different. Manual rKA showed higher opioid use at 0 to 3 months (OR 1.40, 95% CI, 1.14 to 1.71, P < 0.001) and 3 to 6 months (OR 1.28, 95% CI, 1.12 to 1.47, P < 0.001) and throughout the 3 years of follow-up.Throughout the follow-up period, patellar dislocation, wound infection, non‑implant-related complications, and transfusion did not differ. At 1 year, manual rKA had higher instability (OR 1.59; P = 0.001) and higher hazard of mechanical implant‑related complications (HR 1.52, 95% CI, 1.32 to 1.75; P = 0.049). Instability, loosening, and periprosthetic fracture remained higher at 2 to 3 years, and revision was significantly more frequent at 3 years (13.5% vs. 11.4%; OR 1.22, 95% CI, 1.02 to 1.46; P = 0.03). Robotic-assisted rKA was associated with markedly lower mechanical implant‑related complications across early and midterm follow-up, including reduced rates of instability, aseptic loosening, periprosthetic fracture, VTE, and lower opioid requirements. Rates of PJI, readmission, and revision were largely comparable, although manual rKA demonstrated a markedly higher revision rate by 3 years. These findings suggest that robotic assistance may improve implant reliability and postoperative recovery, but prospective studies and cost-effectiveness analyses remain necessary.
ASCVD and stroke remain leading causes of death in the United States, sharing overlapping risk factors and clinical consequences. Long-term declines in vascular mortality have slowed while disparities persist. We evaluated national trends and disparities in mortality involving coexisting ASCVD- and stroke-related conditions among U.S. adults from 1999 to 2025. We performed a retrospective population-based study using the CDC WONDER Multiple Cause of Death database. Adults aged ≥25 years were included. Deaths were identified when prespecified ASCVD-related and stroke-related ICD-10 codes were both documented on the same death certificate, whether as underlying or contributing causes. The outcome represents a death-certificate-defined mortality phenotype rather than clinically adjudicated concurrent disease. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Trends were assessed overall and by sex, age group, race/ethnicity, census region, urbanization, and state. Urbanization analyses were restricted to 1999-2020. Sensitivity analyses included restriction to atherosclerotic-specific codes (I25.x) and exclusion of provisional 2025 data. A total of 876,383 deaths were identified. Overall average AAMR was 15.01 per 100,000. Mortality declined from 26.82 in 1999 to 10.91 per 100,000 in 2025, with an AAPC of -3.53% (95% CI, -4.27 to -2.78; p < 0.001). After sustained declines through 2018, AAMR showed a borderline significant increase during 2018-2021 (APC: 6.06%; 95% CI, 0.01-12.48; p = 0.050), not replicated under stricter cause-of-death definitions, followed by renewed decline from 2021 to 2025 (APC: -2.85%; 95% CI, -4.58 to -1.09; p = 0.004). Mortality burden remained higher among men, older adults, Black individuals, residents of the South, and non-metropolitan populations. Adults aged 25-44 years showed a significant increase after 2015, though absolute rates remain low and this finding warrants cautious interpretation. Although mortality involving coexisting ASCVD- and stroke-related conditions declined substantially from 1999 to 2025, this progress was interrupted by a borderline reversal in the pandemic period and remained marked by persistent disparities. These findings support the need for stronger and more equitable prevention strategies, particularly for younger adults and high-burden populations and regions.
The experiences foster caregivers have while providing care are linked to important outcomes including placement stability for the child and foster caregiver retention within the child welfare system. Understanding the expectations prospective caregivers have about fostering, and how this compares to their lived experience while fostering, is important for building realistic expectations and addressing unmet needs. The current study used a phenomenological approach through semi-structured qualitative interviews with 45 foster parents (71% female) to assess their recollections of what they had expected fostering to be like, and their thoughts about their fostering experiences to date. Inductive coding revealed positive, negative and neutral expectation and experience themes, as well as a "no expectations" theme, with several subcodes within each. Participants were mixed in terms of whether they agreed their experience had matched their expectations. While a subset of foster caregivers felt their expectations were in alignment with what their lived experience fostering has been, many felt that there were multiple experiences they had not expected, both positive and negative. The themes revealing unmet expectations as well as unforeseen negative experiences have implications for foster care licensing agencies, who can work to assess and develop appropriate expectations for prospective caregivers.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol have been associated with neutropenia and agranulocytosis with inconsistent results. To investigate the risk of neutropenia in association with frequently used NSAIDs compared to paracetamol. We conducted a cohort study using the UK-based Clinical Practice Research Datalink (CPRD) GOLD. In three pairwise comparisons, we compared the risk of neutropenia including agranulocytosis (defined by Read codes) between new NSAID users (diclofenac, ibuprofen, and naproxen) and new paracetamol users (active comparator) during a maximum follow up of 60 days. Secondary and tertiary outcomes additionally included (1) in-patient diagnosed agranulocytosis and (2) laboratory values indicating neutropenia. Both were additionally restricted to only agranulocytosis. We applied propensity score-fine stratification to control for measured confounding and quantified incidence rates (IRs) as well as hazard ratios (HRs) with 95% confidence intervals (CIs). Our weighted cohorts included 1,003,314 (paracetamol) to 2,207,612 (diclofenac) patients. Weighted IRs of neutropenia (primary outcome) were between 2.1/10,000 person years (PYs) and 2.3/10,000 PYs. HRs for the primary outcome ranged between 1.00 (95% CI 0.51-1.94) and 1.12 (95% CI 0.57-2.23) for NSAIDs versus paracetamol. The secondary and tertiary outcome yielded reduced HRs between 0.53 and 1.03, and even lower HRs when restricted to agranulocytosis (HR between 0.19 and 0.51). Our results indicate no risk of neutropenia for NSAIDs when compared to paracetamol. An increased risk of agranulocytosis in association with paracetamol is possible, but residual confounding by frailty may at least partially explain this association.
Falls are the leading cause of facial fractures in the elderly, contributing to significant morbidity and mortality. This study aimed to identify the trends, epidemiology, characteristics, and outcomes of facial fractures in the elderly resulting from mechanical falls. The 2018 to 2020 NEDS HCUP database was queried for facial fracture encounters using the ICD-10 codes. Demographics, causes of injury, concomitant injuries, and cost data were evaluated. Multivariable logistic regression analysis was performed to ascertain the factors associated with facial fracture from etiology and mortality. Of 420,105 geriatric facial fractures, 320,209 (76%) resulted from falls. Fall-related facial fractures occurred in older patients (mean age, fall: 79 y versus non-fall: 75 y, P < 0.001). Mortality was lower following falls compared with non-fall mechanisms (fall: 2.2% versus non-fall: 4.3%, P < 0.001), though falls were associated with substantial morbidity, with 43.7% requiring discharge to skilled nursing facilities and 30.6% requiring hospital admission. Increasing age, higher injury severity score, skull vault, skull base, and occipital fractures independently predicted mortality (all P < 0.001). Injury severity score ≥25 was associated with 9-fold increased odds of death (OR: 9.03, 95% CI: 7.98-10.20). Mechanical falls account for the majority of geriatric facial fractures and are associated with significant morbidity and mortality, particularly among older individuals with high injury severity and cranial fractures. These findings highlight the need for early risk stratification and targeted fall-prevention strategies to reduce adverse outcomes in the elderly. Findings may supplement a clinician's judgment in cases where the mechanism and severity of a patient's injuries are ill-defined.
Community-acquired pneumonia (CAP) is a major cause of hospitalization, and pathogen identification is often limited by low diagnostic yield of conventional microbiological methods. Respiratory multiplex PCR (mPCR) enables rapid pathogen detection, but its role in antimicrobial treatment modification for inpatients with CAP remains unclear. This study evaluated the association between mPCR testing and antimicrobial modification in hospitalized patients with CAP. This retrospective, single center cohort study included hospitalized patients with CAP identified using ICD-10 codes between July 2023 and February 2025. Respiratory mPCR was performed within the first 24 hours of admission using combined nasopharyngeal/oropharyngeal (NP/OP) swabs. The primary outcome was antimicrobial treatment modification guided by mPCR results and documented by physicians. Secondary outcomes included antimicrobial de-escalation and hospital length of stay. In this cohort of 145 patients, mPCR detected a pathogen in 56 patients (38.6%): viral pathogens in 30 (20.7%) and bacterial pathogens in 26 (17.9%). Overall antimicrobial treatment was modified in 54 patients (37.2%). Modification guided by mPCR results and documented by physicians occurred in 37 patients (25.5%). Among these 37 modifications, 35 (94.6%) were classified as antimicrobial de-escalation. Hospital length of stay did not differ significantly across mPCR results. In hospitalized patients with CAP, mPCR facilitates targeted antimicrobial treatment modification and drives high rates of de-escalation. These findings demonstrate the significant utility of mPCR in optimizing clinical decisions and enhancing antimicrobial stewardship.
High tibial osteotomy (HTO) is a joint-preserving procedure used to relieve pain and delay, or even eliminate, the need for total knee arthroplasty (TKA). The aim of this study was to quantify the incidence of TKA after HTO and identify risk factors associated with conversion. Patients undergoing HTO at a single academic center from 1996 to 2015 were identified using a validated deidentified synthetic data platform from real patient data, ensuring a minimum of 10 years of follow-up. Patients aged 18 years with procedural codes for HTO were included. The primary outcome was TKA incidence; the secondary outcome was time to TKA. A modified Poisson regression evaluated associations between TKA, age, and BMI among individuals with complete BMI data. A total of 207 patients (mean age, 41.3 ± 11.2 years; 62.8% male) were identified. Mean follow-up was 17.8 ± 4.8 years. Overall, 20 patients (9.9%) underwent TKA. Those converting to TKA were significantly older at HTO (45.3 ± 6.1 vs. 40.9 ± 11.6 years; P = 0.009) and had higher BMI (35.7 ± 6.4 vs. 29.4 ± 5.2; P = 0.01). TKA incidence increased over time: 5.9% at 10 years, 10.8% at 15 years, and 22.0% at 20 years. Higher BMI was independently associated with increased TKA risk (RR = 1.13; 95% CI, 1.04 to 1.23; P = 0.004). In this cohort with minimum 10-year follow-up, HTO demonstrated approximately a 90% knee survivorship at a mean of 17.8 years. Age and BMI at the time of HTO were associated with increased risk of TKA conversion and should be considered during patient counseling and selection.
Thoracic radiation therapy (TRT) is commonly used for breast, lung, and lymphoid cancers. While its cardiotoxic effects, particularly coronary artery disease, are well recognized, less is known about its association with arrhythmia-related hospitalizations. A retrospective cohort study using the National Inpatient Sample (2016-2022) was conducted. Hospitalizations for atrial fibrillation or flutter were identified using ICD-10 codes. Documented prior thoracic irradiation was defined using a history of radiation therapy code in combination with thoracic malignancy codes. Propensity score matching followed by post-matching multivariable regression adjustment was used to evaluate outcomes. The primary endpoint was in-hospital mortality; secondary endpoints included length of stay (LOS) and total costs. Among 3,198,304 weighted admissions, 8,570 (0.27%) had prior TRT. After matching, TRT was associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR] 1.97; 95% CI 1.17-3.32; p=0.010) and longer LOS (+0.30 days; 95% CI 0.05-0.55; p=0.019) without increased costs (p=0.202). Hospitalizations with documented prior thoracic irradiation also had higher odds of palliative consultation (aOR 2.60, p<0.001) and DNR status (aOR 1.97, p<0.001), but lower odds of acute kidney injury (aOR 0.66, p<0.001). Documented prior thoracic irradiation identified a clinically complex subgroup of atrial fibrillation or flutter hospitalizations with higher in-hospital mortality, slightly longer length of stay, and greater goals-of-care utilization.
Comprehensive data on municipal specialized infectious disease (ID) departments in Germany are scarce. To analyze ID cases at Hospital St. Georg in Leipzig with regard to patient characteristics, spectrum of infections, care concepts, length of stay (LOS), clinical outcomes, and economic indicators. Retrospective descriptive analysis of all adult inpatient cases between January 2020 and December 2025. Of 17,878 adult patients (11.5% of all patients) discharged with a primary ID diagnosis, 28.7% (5,135/17,878) were treated as inpatients in the 40-bed ID department itself, while 3.8% (671/17,878) received organ-specific treatment in another specialty department with concurrent care provided by the antimicrobial stewardship (AMS) team, and 5.2% (935/17,878) received care via the ID consultation service (telephone consultations not included). A total of 4,492 individual ICD-10 codes were assigned, with 740 of them being classified as ID diagnoses. ID patients were older (median 70 vs. 66 years) and more frequently male (59% vs. 51%) than the reference population. The median LOS was longer for ID patients (7.0 vs. 4.1 days). The median case-mix index (CMI) was 1.344 (€ 5,356 per case) in the ID population vs. 1.113 (€ 4,352 per case) in the reference group. This six-year analysis shows that ID patients represent a significant, complex, and older inpatient population with longer LOS, causing high clinical burden. Since coding data suggest that 62.3% of these patients did not receive specific treatment by ID specialists, there is potential for expanding structured ID consultation and AMS services, requiring additional resources.
To identify the marketing strategies employed on the Mexican websites of the International Food and Beverage Alliance (IFBA) members and to evaluate whether these strategies appealed to children or adolescents. Additionally, we assessed the healthiness of marketed products using the Mexican Nutrient Profile Model (NPM) and the use of the Covid-19 pandemic as a marketing strategy. We conducted a content analysis of IFBA website members (including brands, foods, and beverages) during the Covid-19 lockdown in Mexico. The Mexican NPM was used to determine whether a product can be advertised to children. Codes (e.g., face masks, shields) were designed to determine whether a website used Covid-19 as a marketing strategy. 269 websites were analyzed. 95% had a link to social media, 74% used a social responsibility/philanthropy strategy, 60% appealed to children, 32% to adolescents, and 28% used a Covid-19 strategy. Furthermore, 89% of the products marketed were determined unhealthy according to the NPM. During the Covid-19 pandemic, IFBA websites marketed their products to Mexican children and adolescents by using links to social media, philanthropy strategies, and adopting the pandemic as a marketing strategy, which contradicts IFBA's food marketing self-regulations. Evidence-based mandatory regulations should be reinforced.
Recognize how rurality impacts safe discharge planning and home management for complex airway patients. This study explores the distribution of durable medical equipment (DME) companies for patients with tracheostomies and/or ventilators, aiming to identify patterns in service access statewide. Key informant phone surveys assessed active DME companies statewide. DME companies were identified through hospital referral lists, discharge directories, and online searches. Data collected included service radius, respiratory supplies, and ventilation types. Geographic information system (GIS) mapping visualized coverage. Rural-urban status was classified using rural-urban commuting area (RUCA) codes. Of 16 companies identified, 6 were closed, leaving 50 active locations. Among these, 22% (n = 11) support invasive ventilation (average service radius 168.8 km [104.9 mi], range 80.5-402.3 km [50-250 mi]), 52% (n = 26) serve tracheostomy patients (average service radius 129.7 km [80.6 mi], range 68.9-289.7 km [42.8-180 mi]), and 88% (n = 44) offer noninvasive ventilation, such as CPAP/BiPAP (average service radius 116.5 km [72.4 mi], range 25.3-289.7 km [15.7-180 mi]). Among invasive ventilation locations, 18% (n = 2) are rural (RUCA 4-10) and 82% (n = 9) urban (RUCA 1-3). For tracheostomy, 46% (n = 12) are rural and 54% (n = 14) urban. Geographic disparities limit DME access for rural patients requiring tracheostomy and invasive ventilation. Surgeons should be aware that patients may live over 1.5 h from a capable DME company. Presence of a DME company does not ensure a specific location offers specialized supplies or equipment. Realistic discharge planning is essential to ensure care continuity, reduce emergency department visits, hospital readmissions, and preventable complications. 4.
ObjectiveBlack sexual minority men (SMM) in the United States experience disproportionate HIV burden and lower engagement across the HIV Continuum of Care (HIV-CoC), partly due to intersecting stigmas. Structural interventions addressing these barriers remain limited.MethodsWe developed This is Your Moment (TiYM), a culturally-grounded media campaign designed to mitigate stigma and encourage engagement in care for Black SMM in Atlanta, Georgia. To inform implementation, we conducted focus groups with 63 stakeholders from six clinics and community-based organizations (March-October 2023), guided by the Consolidated Framework for Implementation Research. Transcripts were analyzed thematically.ResultsParticipants described TiYM as highly acceptable, engaging, and relatable. Facilitators included alignment with organization priorities; ease of QR code integration; potential to improve health literacy and reduce stigma. Barriers included concerns about inclusivity and unintended disclosure.ConclusionKey partners perceived TiYM as having strong implementation potential, while identifying barriers for refinement and implementation strategy. Black sexual minority men in the United States are disproportionately affected by HIV and are less likely to stay engaged in care. This is partly due to overlapping forms of stigma, including HIV-related stigma, racism, and homophobia. There is a need for practical, sustainable approaches that address these barriers and improve access to and engagement in HIV care. We developed This Is Your Moment (TiYM), a media campaign designed to reduce stigma and encourage engagement in HIV treatment and support services among Black sexual minority men in Atlanta, Georgia. The campaign features short, culturally relevant videos focused on mental health (“mind”), physical health and HIV care (“body”), and overall well-being (“soul”). To understand how best to implement this campaign, we gathered feedback from 63 staff members, healthcare providers, and administrators across six clinics and community-based organizations in Atlanta. Participants shared their perspectives through group discussions and interviews. Overall, participants responded positively to the campaign, describing it as engaging, authentic, and relatable. They noted that it aligned well with their organizations’ goals, could be easily shared using QR codes, and had potential to improve health knowledge and reduce stigma among patients. However, they also raised concerns about ensuring the campaign is inclusive of other populations served and about the risk of unintentionally revealing someone’s HIV status or sexual orientation. This study shows that key stakeholders perceive TiYM as having the potential to be a feasible and acceptable intervention. The feedback gathered will help refine the campaign and support successful implementation in real-world settings.
In 2024, the Pediatric Emergency Care Applied Research Network published a cervical spine injury (CSI) prediction rule derived from level 1 pediatric trauma centers. The epidemiology and clinical characteristics of CSI among young children presenting to community emergency departments (EDs) are less well described. We therefore sought to describe the baseline risk and clinical characteristics of CSI among young children presenting to community EDs and to provide context for the application of existing imaging recommendations in this setting. We conducted a retrospective chart review of ED encounters among children aged 0 to 8 years within Kaiser Permanente Northern California between January 1, 2010 and December 31, 2024. Diagnosis and procedure codes were used to identify potential CSI cases, which were confirmed by manual chart review. Clinical characteristics and outcomes were abstracted, and the presence of PECARN imaging criteria was assessed. A total of 723,459 unique children aged 0 to 8 years accounted for 1,826,598 ED visits. Nine patients were diagnosed with traumatic CSI (1 per 202,955 visits). None required surgery or had neurological deficits at discharge. PECARN imaging criteria were present in all cases, with CT suggested in 1 patient (11.1%) and radiography in 8 (88.9%). In 2 cases, initial radiographs were normal, and injuries were subsequently identified on advanced imaging. CSI in young children presenting to community EDs was exceedingly rare and associated with favorable outcomes. The very low prevalence highlights the importance of balancing diagnostic sensitivity with minimization of radiation exposure in neurologically intact children.
Tirzepatide is a once-weekly injectable dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors; in Japan, it is approved for the treatment of type 2 diabetes and marketed under the brand name Mounjaro, which is available in six strengths. Japanese studies of tirzepatide have primarily evaluated efficacy, real-world effectiveness, safety, persistence, and patient-level maintenance doses. National patterns in dispensing settings and longitudinal changes in the product-strength mix have not been described. We examined whether increases in claim-recorded quantities were accompanied by structural changes in outpatient dispensing and strength mix. We analyzed injectable-drug quantity tables for the fiscal year 2024 from the 11th National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. Full National Health Insurance drug codes were used to identify all six Mounjaro strengths. The primary tables excluded public-expense claims, and public-expense-inclusive tables were used in a sensitivity analysis. Monthly analyses required numeric values for every strength in both the within-institution and outside-institution outpatient prescription worksheets. Outcomes included annual quantities by dispensing category and strength, monthly total quantity, the share dispensed outside medical institutions, strength-mix indicators, and each strength's contribution to the increase from June 2024 to March 2025. The primary outpatient total was 7,829,974.7 kit units. Of this total, 6,748,743.5 kit units (86.2%) were recorded as outpatient prescriptions dispensed outside medical institutions. Complete monthly data were available from June 2024 through March 2025. During this interval, monthly quantity increased from 392,354 to 1,027,955 kit units; outside-institution quantity increased from 329,431 kit units (84.0%) to 899,994 kit units (87.6%); and the quantity represented by strengths of 7.5 mg or higher increased from 50,902 kit units (13.0%) to 246,316 kit units (24.0%). The quantity of the 2.5-mg product increased from 159,318 kit units (40.6%) to 278,540 kit units (27.1%), while its share decreased. The 5-mg product accounted for 320,965 kit units (50.5%) of the absolute increase, whereas strengths of 7.5 mg or higher collectively accounted for 195,414 kit units (30.7%). The public-expense-inclusive sensitivity analysis preserved the ranking of strengths and the predominance of outside-institution dispensing. Tirzepatide dispensing in Japan was concentrated in the outside-institution outpatient category, and the share in this category increased over the fully observable period. Growth was also accompanied by a measurable shift in the product-strength mix. This study provides an auditable national description of dispensing-setting and product-mix dynamics rather than an analysis of patient uptake, adherence, clinical outcomes, or individual titration.
To address the systemic financial and equity burdens of preventable diabetes-related lower-extremity amputations, this perspective evaluates current structural failures in US healthcare financing and proposes a scalable, prevention-oriented framework. Current fee-for-service models consistently reimburse expensive disease deterioration while neglecting early surveillance. Meanwhile, omitting preventive foot metrics from federal quality frameworks renders early intervention organizationally invisible. In response, this analysis incorporates data from a peer-reviewed, 5-year implementation study within a medically complex population using low-overhead, multilingual, digital patient education and risk-stratified surveillance. This low-friction intervention model achieved a diabetic foot ulcer rate of 2.8% and a major amputation rate of 0.43%, significantly outperforming the federal Healthy People 2030 benchmark of 0.55%. To replicate these results nationally, public payers must integrate risk-stratified podiatric surveillance into core quality reporting frameworks, expand reimbursement codes for asynchronous digital education, and formally classify patient-centered education as vital health infrastructure. Such policy prioritization will mitigate profound health disparities, reduce avoidable public spending, and preserve patient mobility.
BackgroundNon-tobacco nicotine dependence (NTND) products, such as vaping, nicotine patches/pouches, gum, and lozenges, have become increasingly prevalent. While the negative effects of cigarette smoking on bone healing are well established, the impact of NTND on surgical outcomes remain unclear, particularly in foot and ankle surgery. This study aimed to evaluate the effect of NTND on short- and long-term postoperative complications following midfoot arthrodesis, a procedure commonly performed for arthritis, trauma, and congenital deformities.MethodsThis retrospective cohort study was conducted utilizing the TriNetX database. Patients undergoing midfoot arthrodesis were identified and stratified into NTND (ICD-10: F17, excluding tobacco-specific codes) and nonsmoker cohorts. 1:1 propensity score matching was performed based on demographic and comorbid variables. Postoperative complications were assessed at both 90 days and 2 years utilizing risk ratios (RRs) and 95% confidence intervals (CIs).ResultsAfter matching, 1235 patients were included in each cohort. At 90 days, NTND patients had significantly higher rates of opioid prescriptions (RR 1.18, 95% CI: 1.11-1.26), emergency department visits (RR 1.52, 95% CI: 1.20-1.93), hospitalizations (RR 1.59, 95% CI: 1.28-1.99), postoperative infections (RR 1.95, 95% CI: 1.13-3.37), and wound complications (RR 1.72, 95% CI: 1.14-2.58) (all P < .05). At 2 years, NTND was associated with increased rates of pseudoarthrosis (RR 1.27, 95% CI: 1.06-1.51) and mechanical implant failure (RR 1.39, 95% CI: 1.11-1.75) (both P < .05).ConclusionNon-tobacco nicotine dependence is associated with significantly increased risk of both early and late postoperative complications following midfoot arthrodesis. These findings suggest that vaping may adversely affect bone healing and implant integrity. Surgeons should incorporate NTND screenings and cessation counseling into preoperative planning to optimize patient outcomes.Level of Evidence:III-Retrospective Comparative Study.
Memory reconsolidation refers to the postreactivation restabilization process through which consolidated memories may become modifiable under specific boundary conditions. Transcranial magnetic stimulation (TMS) offers a causal method for perturbing cortical processing during this putative window of lability. However, whether human TMS studies truly support a reconsolidation-based interpretation, rather than broader postretrieval modulation, has not been systematically synthesized. We conducted a systematic review of human studies examining TMS in relation to explicit memory reactivation or reconsolidation-oriented interventions. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020, was protocolized according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 and was registered in PROSPERO (CRD420261334930). PubMed/MEDLINE, Scopus, and Web of Science were searched without date restriction. Eligible studies were original human investigations using any TMS modality applied in relation to a recognizable reactivation procedure and reporting delayed changes in later memory expression or performance. Data extraction included methodologic variables and theory-based coding of reconsolidation-oriented inferences. Risk of bias was assessed using RoB 2. Five studies met the inclusion criteria-three on fear memory, one on episodic memory, and one on procedural memory. Two low-frequency stimulation approaches were represented: 1 Hz repetitive TMS and continuous theta-burst stimulation. The dorsolateral prefrontal cortex was the predominant target, whereas one procedural-memory study stimulated the primary motor cortex. In fear paradigms, postreactivation prefrontal stimulation was generally associated with attenuation of physiologic fear expression, and in the strongest designs, it reduced return of fear. In episodic memory, right prefrontal stimulation was associated with enhanced delayed recall. In procedural memory, stimulation during reactivation was associated with blockade of subsequent offline memory modification. Four studies provided comparatively strong reconsolidation-oriented support through explicit reactivation, critical controls, and delayed testing; one translational clinical-analog study yielded a null primary effect and weaker mechanistic certainty. Risk of bias ranged from low to high, with the main concerns related to randomization reporting and prespecified analyses. Current human evidence suggests that TMS can modulate postreactivation memory outcomes in ways that are, in some cases, compatible with a reconsolidation framework. However, effects are memory-system dependent, methodologically heterogeneous, and currently strongest in tightly controlled laboratory paradigms rather than in more naturalistic translational settings.
E-cigarettes (ECs) are the most used tobacco product among adolescents and young adults. While most research investigates initiation, few studies focus on protective factors that discourage vaping. To examine protective factors against e-cigarette use, participants (N = 48) aged 18-25 who had never used e-cigarettes completed a virtual individual interview lasting up to 15 minutes. The interviews explored three key areas: (1) perceptions of EC health risks, (2) exposure to and influence of EC-related media (social media and marketing), and (3) perspectives on why others use ECs. An inductive thematic analysis of the transcripts identified themes and patterns within the three topic areas. All transcripts were coded by two independent coders (NVivo) and cross-checked by a third researcher to resolve discrepancies. On average, participants (N=48) were 20.5 years old (SD = 1.92 years). A large proportion of participants identified as White = 41.6%, Female (81.2%), and non-Latinx/Hispanic/Latino (81.25%). Participants (83%) cited harm to physical health, to mental health (35%), and addiction (27%) as primary concerns of EC-use. Participants (44%) cited exposure to content in the media and online anti-tobacco campaigns (65%). Participants perceived others' EC use as driven by social appeal (50%), appealing product characteristics (75%, primarily citing flavors), and coping (33%). Findings suggest that negative risk perceptions and exposure to anti-EC content may deter EC use initiation. Findings from this and similar studies can inform prevention campaigns by emphasizing the values, beliefs, and social factors that motivate young people to avoid EC use.
Disease-specific aspects of pet owners' caregiver burden could be missed by generic burden measures. This study aimed to assess whether a framework developed to describe caregiver burden in parents of children with epilepsy was applicable to caregivers of dogs with epilepsy. An online questionnaire incorporated a novel 10-item qualitative and quantitative caregiver impact assessment (CIA) tool. Exploratory factor analysis was conducted to determine the underlying factor structure of the CIA. Participant scores were calculated, risk factors for burden statistically identified, and free text coded into item-specific topic summaries. The mean CIA score indicated an overall negative impact of canine epilepsy among 590 international respondents. Caregivers of dogs receiving anti-seizure drug polytherapy and/or with a history of status epilepticus reported the greatest burden. Impacts included increased anxiety/worry (83.7%), poor sleep quality (68.6%) and tiredness (57.1%). Caregivers' fear of not being present during a seizure appeared to be a catalyst for multiple burdens. Caregivers most negatively impacted by their dogs' disease may have been more likely to participate, limiting generalisability. Caring for a dog with epilepsy is associated with substantial caregiver burden, with notable parallels with caring for a child with epilepsy. The CIA shows promise as a tool for capturing disease-specific caregiver burden in pet owners.