BACKGROUND: Many hospitals are implementing requirements for disposable-only scrub caps in the operating room as an infection prevention measure. Current literature has not identified a significant difference in the infection risk between cloth and disposable scrub caps. This study seeks to address this issue at the cap level by determining the difference in bacterial colonization between cloth and paper scrub caps. With consideration for potential contamination associated with environments beyond the operating room, it was predicted that personal cloth scrub caps would have a higher infectious load than disposable caps. METHODS: This study was designed as a prospective cohort study at a non-profit, 391 bed medical center in the United States. The sample included scrub caps from 107 medical personnel within the sterile field, including surgeons, physician assistants, nurse practitioners, surgical assistants, and scrub nurses. Medical personnel wore the cap style and material of their choice. The swab collections were cultured for 3 days on blood agar plates and were evaluated for bacterial colony growth and were quantified on the following scale: 0 – no bacterial growth, 1 – few colonies, 2 – several colonies, but less than 50% coverage, 3 – significant colonization at over 50% coverage, and 4 – full or nearly full colonization. The data was then calculated for statistical significance. RESULTS: A total of 107 samples were obtained, including 58 from cloth scrub caps and 49 from paper scrub caps. On disposable paper caps, the mean number of colony forming units was 1.06 (SD = 3.60), and the mean growth rank was 0.20 (SD = 0.61). On reusable cloth caps, the mean number of colony forming units was 5.16 (SD = 11.78), and the mean growth rank was 0.93 (SD = 0.99). Using a Mann-Whitney U test to evaluate the effect of cap type on colony forming units and growth rank, reusable cloth caps were found to be associated with increased colony forming units (p < 0.001) and increased growth rank (p < 0.001). CONCLUSION: Reusable cloth scrub caps were found to have more colony forming units and higher growth ranks than disposable paper scrub caps. Attention should be given to the proper sterilization of cloth scrub caps in order to decrease the infectious load on items in the operating room.
Our objective was to quantify the association of social determinants of diabetes mortality and effect modification by race/ethnicity and COVID-19 pandemic time period. The Healthy Places Index (HPI) composites 23 indicators of neighborhood socio-economic and environmental conditions, and healthcare access. In this cross-sectional observational study of Californians aged ≥18 years, we aggregated 44,488 diabetes deaths and populations to 2010 census tracts from death certificates and U.S. census populations. Log-linear regression was used to test associations between age-adjusted diabetes mortality rates and HPI deciles in pre-pandemic (2015-2019) and pandemic (2020-2021) periods. Mortality rates in 2015-2019 were inversely related to HPI scores and declined 12.7% per HPI decile. The rate ratio (RRD1/D10) of diabetes mortality rates between HPI deciles 1 and 10 (most favorable scores) was 3.95 (CI95%: 3.43-4.55). In the pandemic period, the mortality gradient was steeper [-14.7% per decile; RRD1/D10, 4.51 (CI95%: 3.96-5.13)] and disproportionately increased at lower HPI deciles. The HPI-attributable fraction of diabetes mortality was 0.54 prior to and 0.57 during the pandemic. Pre-pandemic, Black individuals had the highest age-adjusted mortality rates, but non-Hispanic White individuals experienced the steepest HPI-mortality gradient (-14.9% per decile). Differences in mortality rates between HPI deciles 1 and 10 within race/ethnicity groups exceeded differences between race/ethnicity groups. The pandemic exacerbated pre-existing diabetes disparities. Health equity metrics incorporating area-based socioeconomic measures can be integrated into routine public health surveillance, which can inform policies that reduce diabetes health inequities.
This review highlights recent advances in understanding the role of environmental surfaces in healthcare-associated infections, focusing on pathogens like Clostridioides difficile, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant Enterococci. It emphasizes the importance of effective disinfection, including sporicidal cleaning and environmental monitoring, in reducing transmission. Despite progress, challenges remain in implementing sustainable, science-based infection control practices due to resource limitations and variability in hospital settings. The review advocates for integrating environmental hygiene and hand hygiene efforts, advancing implementation science, and leveraging genomic epidemiology to develop targeted mitigation strategies.
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Trials evaluating ulcerative colitis (UC) therapies necessitate instruments that are responsive to changes in disease status. We assessed responsiveness of the Mayo Endoscopic Subscore (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), Robarts Histopathology Index (RHI), Geboes Score (GS), Nancy Histological Index (NHI), and UC-100 score. Using data from a phase 2 placebo-controlled trial of mirikizumab, responsiveness was quantified by the probability that a patient in the treatment group would have a better score than (win over) a control patient. Inference on win probability (WinP) was conducted without normality assumption of scores. Spearman rank correlations between each index and stool frequency (SF), rectal bleeding (RB), fecal calprotectin (FCAL), and C-reactive protein (CRP) were assessed. WinP estimates showed that magnitudes of responsiveness were "medium" for the UCEIS (0.67; 95% CI 0.59, 0.74) and UC-100 score (0.68; 95% CI 0.60, 0.75) and "small" for the RHI (0.62; 95% CI 0.54, 0.70), MES (0.61; 95% CI 0.53, 0.68), and GS (0.60; 95% CI 0.52, 0.68). The NHI showed no statistical evidence of responsiveness (0.57; 95% CI 0.48, 0.65). The UCEIS and MES had weak-to-moderate correlations with SF (0.21-0.26) and RB (0.29-0.33) but no correlation with biomarkers. The UC-100 had moderate correlations with RB (0.46) and FCAL (0.42) and weak correlation with CRP (0.19). The UCEIS and UC-100 score were responsive to changes in endoscopic and global UC disease activity, respectively. Results may help inform future early phase UC drug trials but should be confirmed in larger studies.
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Artificial intelligence (AI) applications in dentistry are advancing rapidly, yet external validation studies are scarce. This pilot study evaluated 2 US Food and Drug Administration-cleared AI-based decision support systems for detecting caries and clinically relevant periodontal bone loss (≥ 33% or ≥ 5 mm of attachment loss) using longitudinal clinical data to establish ground truth. A retrospective analysis of 90 patients (mean [SD] age, 61.4 [13.2] years) records was conducted at the Veterans Affairs Greater Los Angeles Health Care System in Los Angeles, California. Each case included full-mouth radiographs and standardized clinical documentation with 6 through 12 months of follow-up. Ground truth was determined through a multiphase validation protocol involving calibrated examiners and adjudication. Analyses emphasized specificity and negative predictive value (NPV) to assess diagnostic concordance. For caries detection, vendor A achieved 78.68% concordance, 80.17% specificity, and 96.92% NPV; vendor B achieved 82.43%, 83.76%, and 97.36%, respectively. For periodontal bone loss, vendor A achieved 78.47% concordance, 94.23% specificity, and 80.64% NPV; vendor B achieved 73.89%, 93.55%, and 75.20%, respectively. The results of this external validation pilot study showed AI tools can reliably exclude disease and reduce false-positive results. The use of retrospective longitudinal ground truth with standardized validation protocols provides a practical template for future multisite studies. AI-based decision support tools are most effective as adjunctive screening aids in dental practice. Their high specificity and NPV allow clinicians to trust negative findings, avoid unnecessary interventions, and maintain clinical oversight of positive findings requiring confirmation.
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that disproportionately affects children, often causing significant physical, psychological, and social burdens. While biologic therapies have transformed AD management in adults, pediatric-specific evidence remains limited. Dupilumab, an interleukin (IL)-4 receptor α antagonist that inhibits IL-4 and IL-13 signaling, is currently the only US Food and Drug Administration (FDA)-approved biologic for pediatric AD. To systematically review the efficacy, safety, quality of life, and adherence of dupilumab in children (0-12 years) with moderate-to-severe AD. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Embase, and Cochrane Library were searched from inception to August 10, 2024, for studies involving biologic use in pediatric AD. Eligible designs included randomized controlled trials (RCTs), open-label extensions, observational studies, case series, and case reports reporting validated efficacy, safety, quality of life, or adherence outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). Results were synthesized narratively, stratified by study design and age group; meta-analysis was not performed due to heterogeneity in study designs, outcome measures, and follow-up durations. Of 1576 records screened, 20 studies (n= around 1200; age range: 5 months to 12 years) met inclusion criteria. Across study designs, dupilumab produced rapid and sustained improvements in disease severity, with mean Eczema Area and Severity Index (EASI) reductions of 62-92% and high EASI-75 response rates (53-94%) within 16-52 weeks. Quality of life gains were substantial, including large reductions in Children's Dermatology Life Quality Index scores (up to ~89%) and marked sleep improvement. Adverse events were generally mild; conjunctivitis (0-20%) was the most common, with rare herpesvirus infections and injection-site reactions. Laboratory abnormalities including eosinophilia and alkaline phosphatase (ALP) elevation were typically asymptomatic and transient. Adherence was high (≥90% in most cohorts), with low discontinuation rates. Data were synthesized across two developmental age groups where possible: children aged 6 months to 5 years and children aged 6 to 11 years. Some studies reported numerically higher or faster responses in younger children (<6 years), although findings were inconsistent across cohorts and limited by differences in disease duration, dosing, and sample size. The predominantly observational and uncontrolled study designs, heterogeneity in outcome measures and follow-up durations, and small sample sizes in several cohorts limit the certainty of the evidence. Dupilumab demonstrates robust efficacy, durable benefits, and a favorable safety profile in pediatric AD, with meaningful improvements in quality of life and adherence. Evidence supports its consideration as a systemic option for moderate-to-severe disease inadequately controlled by topical therapy. Future research should address long-term outcomes, comparative effectiveness versus conventional immunosuppressants, age-stratified response patterns and their confounders, and cost effectiveness in diverse healthcare settings.
Reverse total shoulder arthroplasty (rTSA) is a well-established treatment for cuff tear arthropathy and consistently restores active forward elevation. However, when there is a deficiency of the posterior rotator cuff (infraspinatus and teres minor), patients can exhibit lag signs at the side and a "Hornblower's sign." This loss of active external rotation (ER) in abduction can be functionally disabling, and rTSA alone may not reliably restore active ER ability in this clinical scenario. We present a series of rTSA with lower trapezius transfer (LTT) (utilizing tibialis anterior allograft) as the primary surgery for patients with a combined loss of active elevation and severe loss of active ER, both at the side and in elevation. Twelve patients (11 males and 1 female) underwent rTSA with the Tornier Perform implant with LTT (11 with tibialis anterior, 1 Achilles tendon allograft). The average patient age was 68.6 years (52.4-82.8), and the average follow-up was 35.4 months (24-52 months). All had a loss of active ER, with the average active ER at the side being -10.8° (-30 to 20). The average preoperative active elevation was 58.3° (30-90). Preoperative patient-reported outcome scores were American Shoulder and Elbow Surgeons: 46.8 (±19.82), Single Assessment Numeric Evaluation: 32.8 (±17.09), and visual analog scale for pain: 4.9 (±2.88). Preoperatively, all exhibited an external rotation lag sign at the side and the "Hornblower's sign" with the forearm falling into internal rotation with elevation. Magnetic resonance imaging revealed irreparable cuff tears involving the supraspinatus and infraspinatus. In all cases, the infraspinatus and teres minor had significant atrophy and/or fatty infiltration. All patients could actively elevate and keep the forearm pointed to the ceiling in the scapular plane following surgery, thus eliminating the "Hornblower's sign." The average postoperative active forward elevation and active ER at the side were 141.3° (100-170, P < .0001) and 35.0° (15-45, P < .0001), respectively. Postoperative outcome scores averaged: American Shoulder and Elbow Surgeons: 81.9 (±11.9, P < .0001), Single Assessment Numeric Evaluation: 67.7 (±28.9, P = .0019), visual analog scale for pain: 1.0 (±1.6, P = .0004). rTSA with latissimus dorsi transfer has been utilized to address a combined loss of elevation and ER. LTT has been described for rotator cuff deficient shoulders without arthritis to restore ER ability without a prosthetic implant. This series, with early-term follow-up, reports the results of rTSA with LTT to restore ER ability in severely dysfunctional shoulders. Consistent functional results and high patient satisfaction were obtained with rTSA and LTT with a tibialis anterior tendon allograft in patients with a combined loss of elevation and ER. The lag signs and the Hornblower's sign were eliminated in all patients.
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Male factor infertility accounts for roughly half of all infertility cases, yet receives far less clinical, research, and public attention than female infertility. Historical, cultural, and medical factors, particularly the absence of comparable therapeutic advances, contribute to this neglect. A diagnosis can threaten identity and masculinity, leading to depression, anxiety, and sexual dysfunction, while stigma and cultural taboos around semen collection compound distress. Men often feel excluded from care and remain socially invisible. Applying patient-centered frameworks such as the 4 "I" model-Invite, Inform, Involve, Intervene-can guide inclusive, psychologically informed treatment and advance understanding of male infertility's psychosocial dimensions.
Gait deviations are common in youth with Cerebral Palsy (CP), with the change in gait pattern during growth/development being influenced by a variety of individual and treatment factors. The goal of this study is to use Machine Learning (ML) to evaluate the relationship between youth and treatment-related factors to predict changes in gait kinematics. Kinematic gait data acquired from instrumented gait analysis (IGA) were collected from ambulatory youth with spastic CP (GMFCS I-III) during sequential visits. Twenty Gradient Boosting Regressor (GBR) models were trained to predict the change and the follow-up score of ten gait outcomes (Gait Profile Score (GPS), and Gait Variable Scores (GVS)) based on treatment (presence or absence of orthopedic surgery) and patient factors (age, initial gait, motor function). The study included 702 evaluation pairs (GMFCS: I [18%], II [56%], III [25%]). A baseline instrumented gait analysis was performed at an average age of 10.9 ± 3.8 years, with a subsequent analysis 2.1 ± 1.0 years later. More improvement in GPS was observed in younger (<11 years) compared to older youth (p<0.001), and in those that had intervening orthopedic surgery (p<0.001). Baseline gait pattern, motor function, and proximal positioning (trunk and pelvis) also influenced changes in gait. Improvement in gait kinematics in youth with CP is significantly influenced by age, orthopedic surgery, and baseline factors. Our findings provide a ML framework for improving clinical decision support systems to aid providers in predicting gait changes for ambulatory youth with CP.
An interlaboratory comparison study was conducted among five laboratories for determining 24,25-dihydroxyvitamin D3 (24,25(OH)2D3) in human serum using liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods. The Centers for Disease Control and Prevention (CDC), Imperial College Healthcare NHS Trust, University College Cork, University of Liège, and University of Washington analyzed 50 single-donor samples and two new Standard Reference Materials (SRMs®). The results from each laboratory were compared with target values assigned by the National Institute of Standards and Technology (NIST) using a reference measurement procedure (RMP) and evaluated using Ordinary Deming linear regression and Bland-Altman analysis. Three of the five laboratory methods provided results that were in good agreement with the NIST RMP results showing linear regression slopes ranging from 0.972 to 1.003 and Bland-Altman mean bias of -0.092 nmol/L, 0.025 nmol/L, and 0.035 nmol/L. Two laboratories demonstrated a significant positive bias with linear regression slopes of 1.158 and 1.214 and Bland-Altman mean bias of 0.162 nmol/L and 0.708 nmol/L. The CDC method is currently used to assign "information only" values for 24,25(OH)2D3 in the quarterly distributions of the Vitamin D External Quality Assessment Scheme (DEQAS). Given the agreement (linear regression slope = 0.984, R2 = 0.996 and mean bias of -0.092 nmol/L) between the CDC method and the NIST RMP observed in this study, the CDC-assigned 24,25(OH)2D3 values in DEQAS may provide a more accurate reference than the current participant consensus mean values.
In the poultry industry, green tea extract (GTE) is becoming an increasingly popular dietary supplement due to its observed beneficial effects on performance and egg quality. However, work in mammals indicates that the active ingredients in green tea extract, catechins, act as endocrine disruptors, interfering with the actions of estrogen. Given that GTE is often supplemented to hens during egg-laying, there is potential for the endocrine-disrupting properties of catechins to interfere with the sensitive process of sexual differentiation in embryos. We tested whether green tea extract (GTE) alters gonadal differentiation in Japanese quail (Coturnix japonica) embryos. We injected eggs with either GTE or a Control vehicle before the onset of differentiation on the 4th day of incubation. On day 15, we evaluated phenotypic sex (gonadal morphology) and genetic sex (via PCR). Embryos from eggs that were injected with GTE had increased genotype-phenotype mismatches, which occurred exclusively in genetic females (ZW) who developed bilateral gonads resembling testes. Among genetic females, GTE significantly increased the probability of a male phenotype. Treatment with GTE did not increase embryonic mortality compared to Controls. We conclude that GTE modifies the developmental trajectory of embryonic gonads, specifically for female embryos. We propose that GTE disrupts the critical estrogen-dependent window of female sex differentiation, leading to sex reversal.