搜索结果：Holmes

This article reports the case of a 40-year-old man who underwent right primary pterygium surgery, resulting in the successful removal of the pterygium and a good cosmetic outcome. However, one month after surgery, the patient noticed that his right pupil was enlarged. He was referred for a neuro-ophthalmologic examination, and a diagnosis of Holmes-Adie syndrome was made. The pupil abnormality was considered unlikely to be iatrogenic from the surgery. Both of the patient's pupils demonstrated light-near dissociation due to bilateral Holmes-Adie syndrome, indicating a pre-existing, previously undiagnosed tonic pupil in the left eye. The pupillary findings were confirmed using the handheld NPi-200 electronic pupillometer.

Acute hypoxia can impair cognitive performance, yet the underlying systemic and cerebral physiological mechanisms remain unclear. The objective of this study was to elucidate the systemic and cerebral physiological responses associated with changes in cognitive performance during acute hypoxia. There were 11 healthy subjects (5 females) who completed a cognitive test during baseline normoxia (21% fraction of inspired oxygen, FIO2) followed by 2 randomized hypoxia trials: 11.8% FIO2 (moderate hypoxia) and 7.7% FIO2 (severe hypoxia). Subjects were instrumented with an arterial catheter, transcranial doppler ultrasound, and near-infrared spectroscopy to measure systemic (arterial O2 saturation) and cerebral oxygenation (cerebrovascular conductance and cerebral tissue saturation). Moderate hypoxia reduced arterial O2 saturation and cerebral tissue saturation, with no change in cerebrovascular conductance. Severe hypoxia decreased arterial O2 saturation, cerebrovascular conductance, and cerebral tissue saturation. Cognitive performance did not differ from baseline during either hypoxia condition (omission rate, errors/min: baseline 0 ± 1 vs. moderate hypoxia 1 ± 1; baseline 1 ± 1 vs. severe hypoxia 1 ± 1). No associations were observed between physiological changes and cognitive performance during moderate hypoxia. During severe hypoxia, smaller declines in arterial O2 saturation (r = 0.643) and greater declines in cerebrovascular conductance (r = -0.651) were associated with increased omission rates. Cognitive performance during acute severe hypoxia correlated with cerebral oxygenation and blood flow. Associations differed between moderate and severe hypoxia, suggesting that both duration and severity of hypoxia influence the relationship between physiological responses and cognitive performance. Dillon GA, Webb KL, Uchida K, Wiggins CC, Senefeld JW, Shepherd JRA, Buchholtz ZA, Baker SF, Trenerry MR, Haider CR, Holmes III DR, Joyner MJ, Curry TB. Cognitive performance during acute hypoxia is associated with cerebral oxygenation and blood flow. Aerosp Med Hum Perform. 2026; 97(7):496-504.

Diagnosing wrist ligament injuries is challenging; early detection and treatment are important to prevent osteoarthritis progression. Interosseous proximity maps, a proxy measure for joint space, can be generated from volumetric imaging data and may provide important information about wrist health. Artificial intelligence (AI) could enhance accuracy of noninvasive diagnosis based on imaging-derived metrics. This work demonstrates feasibility of AI training using synthetic proximity map data generated from finite element models (FEMs). Personalized wrist FEMs for two asymptomatic participants were created from four-dimensional computed tomography-derived anatomic and kinematic data. Monte Carlo sampling varied 22 ligament material properties and simulated 7,500 unique injury scenarios generating 9,000,000 labeled red, green, and blue (RGB) images of interosseous proximity vector fields from FEM-derived motions. Images were associated with 17 descriptive metrics, including gross wrist angles and bone surface pairs, and used to develop mixed-input convolutional neural networks (CNNs). Model performance was evaluated for identifying specific ligament injuries. Average area under receiver operating characteristic curve (AUROC) for CNNs was 0.757 across all injury types and kinematics. In a subset with clinically-relevant functional angles, the average AUROC was 0.824. Best-performing individual ligament AUROCs ranged from 0.807 to 0.999. Sensitivities and specificities exceeded 0.99 for some ligament injury simulations under specific wrist angles and bone surface pairs. This study demonstrates the feasibility of using synthetic data from FEMs to train AI models for classifying wrist ligament injuries. Proximity-based RGB images may be a relevant biomarker of ligamentous injury.

The Gambusia holbrooki (eastern mosquitofish) reference genome will offer a crucial resource for understanding the evolution and adaptation of invasive freshwater fish species. The genome of G. holbrooki was assembled into two haplotypes through a phased assembly approach; however, only the primary haplotype was designated as the reference genome for annotation and downstream analyses. The entirety of the genome sequence was assembled into 24 contiguous chromosomal pseudomolecules and 1 mitochondrial genome. This chromosome-level assembly encompasses 0.67 Gb, composed of 421 contigs and 318 scaffolds, with contig and scaffold N50 values of 15.9 Mb and 29.6 Mb, respectively.

The early hydration of calcium silicate hydrate (C-S-H) plays a crucial role in the development of key mechanical properties in cement, yet an atomic-level description of this reaction remains elusive. Here, to understand the early stages of the hydration reaction, we introduce a method to quantify dilute silicate species as a function of reaction time using ex-situ solid-state 29Si magic-angle spinning dynamic nuclear polarization (DNP) nuclear magnetic resonance (NMR) spectroscopy. Samples are flash-frozen and separated by centrifugation, allowing for kinetic analysis of the supernatant and structural studies of the precipitate over time. With DNP-enhanced 29Si NMR, we can determine the concentrations of various silicate species throughout the reaction and track the growth of the silicate chains, which form the dreierketten backbone of C-S-H. In our low Ca/Si ratio system, we observe a vast majority of the supernatant silicate species to be monomers, with small amounts of dimers. The initially precipitated C-S-H, which has a mean chain length of 2.6 and is composed primarily of dimers, is shown to significantly differ from the C-S-H present after 3 h of hydration, which has an average length of 4.2.

Large Language Models (LLMs) demonstrate strong capabilities in healthcare applications. However, recruiting human evaluators to assess usability and effectiveness becomes challenging in the large-scale LLM-generated outcomes. Existing metrics are often outdated for evaluating LLM-based healthcare technologies. This paper proposes a Research through Evaluation (RtE) approach that can refine metrics and improve assessments of LLM-generated outputs. We deploy RtE in a retrospective comparative study of prostate cancer patient inquiries, comparing responses from human clinical care teams with those generated by a GPT-4-based in-basket bot. Through three rounds of co-evaluations with clinical professionals and an LLM-as-graders study with four LLMs, the RtE method shows that starting with small, iterative evaluations helps human graders adjust metrics to suit their daily practices better. Additionally, in the LLM-as-graders study, LLMs exhibit similar behavior, preferring the in-basket bot's responses over the clinical care team. Our methodology and findings demonstrate that the RtE method can enhance the transparency and robustness of evaluation metrics for LLM-generated content, with the potential to generalize to evaluations in other clinical practices.

Amyotrophic lateral sclerosis (ALS) is a fatal, rapidly progressive neurodegenerative disease of motor neurons for which therapeutics are limited. Improved biomarkers are imperative to improve patient care and therapeutic development. Here, we employed 35-plex isobaric tandem mass tag labeling based on isobutyl-proline reporter group (TMTpro) to perform unbiased proteomic analysis of cerebrospinal fluid (CSF) and plasma from control (n= 28, n= 31) and sporadic ALS (sALS) (n= 39, n= 41), from the Target ALS Global Natural History Study (TALS GNHS). We identified 2,875 proteins in CSF and 1,118 proteins in plasma and identified known and novel differentially expressed proteins (DEPs) between controls and sALS, some of which were orthogonally validated using immunoassay. Comparison of TMTpro-MS and Olink proximity extension assay proteomics revealed common and non-overlapping differentially expressed proteins illustrating strengths unique to each platform. This initial cross-sectional proteomic study of biofluids from the TALS GNHS, with unrestricted availability of study results to the research community, highlights the potential of this resource as a potent platform for ALS biomarker discovery.

Adolescents living with HIV struggle to accept their HIV status and remain adherent to antiretroviral therapy (ART). Support groups are one way to assist adolescents overcome these barriers. This evaluation, conducted in health facilities in Abidjan, Côte d'Ivoire, explored the acceptability of peer-led support groups using a ten-topic curriculum and a 'storytelling' model in which fictional or real-life scenarios were used to make information more relatable and encourage discussion and sharing of personal experiences. In-depth interviews were conducted to explore the acceptability of the new model among adolescents enrolled in peer-led HIV support groups, peer support group leaders, and health care workers. The study also sought to describe the experiences of peer leaders and HCWs involved in implementing the latest model. Data were collected on the percentage of adolescents who created treatment plans, and session and topic attendance, from six facilities providing peer-led support groups. Interviews were audio-recorded, transcribed, and translated. Data were approached from a constructivist perspective, and thematic analysis was used to identify themes within participants' accounts. A code list was created using a combined inductive and deductive approach. Transcripts were coded using MAXQDA v.12. A total of 45 in-depth interviews were conducted from August to September 2021. Across participant groups, peer-led support groups were perceived as highly important sources of support for adolescents living with HIV. Adolescents reported increased comfort in sharing their personal experiences and engaging with content delivered through storytelling. Participants described the development of trust and peer support within groups, while peer leaders were viewed as role models for medication adherence. Health care workers reported improved communication and relationships with their adolescent patients. Key barriers to participation included scheduling constraints and transport costs Participants attended an average of six of the ten sessions, with the highest attendance observed for sessions on safe sex and disclosure of HIV status. Peer-led support groups provide critical support to adolescents in accepting their HIV status. The support groups helped adolescents to learn the importance of ART adherence and create a supportive environment for them to live positively with HIV.

The intricate network of axonal fibers forming the mammalian cortical connectome exhibits a complex topology, being neither completely regular nor random. It also has a characteristic topography in which distinct regions have specific connectivity profiles. How such properties arise remains a mystery. Here, we formulate a simple analytical model derived from neural field theory that prioritizes physical constraints on connectome architecture, assuming that connectivity is preferentially concentrated between cortical locations that facilitate the excitation of resonant geometric modes of the cortex. Our model outperforms existing approaches in reproducing topological and topographical properties of cortical connectomes mapped via either non-invasive diffusion magnetic resonance imaging (MRI) or invasive viral tract tracing at spatial scales spanning multiple orders of magnitude in humans, chimpanzees, macaques, marmosets, and mice. Our findings point to a fundamental role of geometry in shaping the multiscale architecture of cortical connectomes that has been conserved across 90 million years of evolution.

Care-experienced individuals are at elevated risk of mental health difficulties, yet less is known about their mental health needs in motherhood. This study aims to explore (a) disparities in trajectories of psychological distress in care-experienced versus non-care-experienced mothers as they raise their child from age 3 to 14, and (b) putative postpartum-associated pathways shaping disparities in maternal distress at child age 14. We conducted longitudinal secondary data analysis using the prospective United Kingdom Millennium Cohort Study data. 11&#x2009;252 mothers and their children were included in the analysis, including mothers who experienced out-of-home care in their childhood (N=156). The primary outcomes were psychological distress of mothers at child ages 3, 5, 7, 11 and 14. Relative to non-care-experienced mothers, care-experienced mothers were consistently more likely to experience distress across child ages 3-14 (coefficient (B)=1.36 (95% CI 0.85 to 1.87)&#x2009;p<0.001). The association between maternal care experience and increased maternal distress in their child's adolescence was mediated by mental health difficulties (B=0.57 (95% CI 0.18 to 0.96)&#x2009;p=0.005), lower locus of control (B=0.31 (95% CI 0.11 to 0.51)&#x2009;p=0.002), lower income (B=0.28 (95%&#x2009;CI 0.15 to 0.41)&#x2009;p<0.001) and lower social support (B=0.16 (95% CI 0.05 to 0.28)&#x2009;p=0.006) in their child's infancy. Our evidence underscores the potential value of holistically considering postpartum mental health, psychosocial and financial resources in maternal and early childhood public health interventions to disrupt the cumulative inequity likely faced by care-experienced mothers and prevent their mental ill-health in the long term.

Salmonella Paratyphi A (SPA) causing paratyphoid fever, a significant health concern in South Asia, particularly in Pakistan. This research aimed to explore the antibiotic resistance pattern, genetic diversity, and the evolutionary dynamics of SPA isolated from suspected paratyphoid patients in Pakistan. Whole-genome sequencing (WGS) of (n&#x2009;=&#x2009;10) isolates predicted predominantly serotype O-2, H1: a, H2:1,5. Sequence type (ST85) was detected, alongside three STs (ST21eb, ST6d3b, ST95c4) and eight pathogenicity islands. The study reported extensively drug resistant (XDR) isolates (SPA 2,14,27,79) as per the AMR genes detected in IncY and IncQ1 plasmids (blaTEM-1, blaCTX-M-15, sul1, sul2, dfrA7, catA1, qnrS1) along with multiple resistance associated mutations in gyrA (S83F, E133G), gyrB (T14M), ParC (T57S) and AcrB (L40P) genes. These genomic results were co-related with phenotypic resistance exhibited by XDR Paratyphi A isolates against different class of antibiotics. The Paratyphi A strains (SPA 1,2,14,27 and 79) harbored highest number of unique genes determined by pangenome analysis. Interestingly these strains were highly virulent and exhibited XDR profile which indicated significant resistance and virulence genes transfer through horizontal gene transfer mechanism. The phylogenetic Tree constructed by maximum likelihood method showed that eight of the ten SPA isolates of the study belonged to genotype 2.3 as they formed a tight cluster with reference strain (AKU_12601). The present study represents a well-characterized genomic profiling of Salmonella Paratyphi A isolates from Pakistan. The detection of XDR alarms the situation in the country as no XDR reported yet in Paratyphi A. Unavailability of vaccines for Paratyphi A strains further warns of limited treatment and prevention strategies thus possess serious public health threat. The findings emphasize the need for urgent action by public health authorities to mitigate the potential emerging XDR Salmonella Paratyphi A and prevent its future outbreaks in Pakistan.

Pediatric new daily persistent headache (NDPH) is a clinically defined headache subtype that remains controversial due to a lack of unique and objective mechanistic features. For many headache subtypes, different, and sometimes unique, patterns of structural and functional changes can be observed in the brain, supporting a unique role for neuroimaging in identifying the presence and type of headache experienced. To date, there has been little research into pediatric NDPH and how it may have a unique mechanism relative to other headache subtypes. We review published research that addressed structural and functional neuroimaging in persons with NDPH. We found that research to date supports differences in both brain structure and function in persons with NDPH relative to healthy controls. Such differences reflect both cortical and sub-cortical regions of the brain. No studies to date have evaluated brain data between persons with NDPH and other headache subtypes. We discuss application of machine learning and artificial intelligence to validate NDPH as a unique headache diagnosis. We believe that future work pursuing both neuroimaging alongside machine learning can help inform the classification and differential diagnosis of pediatric patients with NDPH from other chronic headache conditions.

Implantable and wearable devices require antennas that are both miniaturized and efficient, yet conventional designs are constrained by narrow bandwidth and orientation sensitivity. We report overtone ultrawideband magnetoelectric (OUWB-ME) antennas that exploit higher-order acoustic modes in polished silicon substrates to achieve a 22.6-gigahertz -10-decibel bandwidth and overtone capability in the 3- to 4-gigahertz range. Packaged into "&#x3bc;Bots," these magnetoelectric heterostructures bonded with silver nanoparticle inks maintain stable operation under biological loading. In vitro assays confirm the biocompatibility of aluminum nitride and the protective role of parylene encapsulation for iron-gallium. Ex vivo rat and human tissues reshape transmission and reflection spectra, with reproducible frequency windows near 3.3 and 3.9&#xa0;gigahertz. &#x3bc;Bots enable real-time audiovisual telemetry using software-defined radios and exhibit compatibility with 7-tesla magnetic resonance imaging. By combining wideband response, robustness to misalignment, and biocompatible packaging, OUWB-ME &#x3bc;Bots provide a scalable platform for wireless bio-integrated communication and telemetry.

Popular methods for analyzing the brain's functional connectome examine statistical associations between pairs of atlas-defined brain regions, viewing the strength of these links as independent values. However, edges within a standard connectivity matrix, that is, correlations between individual regions or nodes, are not independent. They are part of an interconnected system. Here, we propose that consideration of both independent, linear relationships (as in standard approaches such as linear kernel ridge regression and connectome-based predictive modeling) and higher order statistical associations-such as tertiary interactions between matrix components and global features of the matrix space-will enhance identification of meaningful individual differences. To test this, we adopt a geometrically grounded measure of similarity that accounts for higher-order local statistical relationships and global interactions, the Wasserstein metric. Results indicate that considering connectivity matrices as representations of their associated Gaussian distributions significantly improves identification of individuals based on their connectivity matrices (aka, "fingerprinting"). We further show that when incorporated into our novel pipeline, "connectome-regression in any metric (CRAM)" the Wasserstein and (the CRAM pipeline itself) improve prediction of individual differences in phenotypes such as fluid intelligence and openness to experience. Thus, both pairwise local and global brain connectivity properties encode for meaningful individual differences that relate to phenotypic expressions and should be considered in brain-behavior predictive models.

Acute massive pulmonary embolism (PE) represents a potentially lethal condition causing acute right ventricular heart dysfunction and cardiogenic shock. We aim to provide an overview of interventional and surgical options for PE management, with a focus on surgical techniques and outcomes. This was a narrative review so a systematic literature search was not performed. Catheter-directed thrombolysis and catheter-directed mechanical thrombectomy have demonstrated improved outcomes in several recent trials compared to medical management alone for higher risk PE. Surgical pulmonary embolectomy techniques have also evolved greatly over the years. Both in-hospital and short-term outcomes after surgical management show significant improvement from historical data that have limited the widespread acceptance of surgical management for acute PE. Veno-arterial extracorporeal membrane oxygenation has also emerged as a potential strategy to bridge high risk patients to definitive therapies. Surgical pulmonary embolectomy has gained popularity in recent years for PE management, with evolving techniques and improving outcomes compared to historical data. A thorough understanding of interventional and surgical techniques and options, combined with a multidisciplinary approach to care, are crucial to ensure timely and effective management of patients with acute PE.

Burnout affects millions of healthcare workers worldwide, from food service and nurses to physicians and leaders, impairing worklives and threatening health system stability. An international collaborative, PREVAIL, was created to reduce burnout globally. Leaders from six continents shared structured insights into the local state of wellness and burnout contributors and mitigators, which were then subjected to a formal thematic (qualitative) analysis to identify common and region-specific themes. Across continents, findings showed the global state of well-being was in danger, though threats varied by region: long shifts in Africa, heavy workloads in Asia, austerity-prone environments in Europe and financially driven care in North America. Vulnerable worker groups included women, nurses, and primary care. Mitigators included workload and schedule adjustments (Africa), shift policies with fair pay (Asia), leader support and regular well-being assessments (Australia), improved psychosocial services (Europe), organizational wellness support and career development (North America), and trainee support (South America). A proposed "common pathway" framework explains shared drivers of poor workforce well-being and provides actionable steps for promoting compassionate, supportive environments worldwide. Adopting a coordinated international approach may prevent devastating workforce shortages over the comingdecades. Burnout assessment and reduction in the global workforce is a high priority.

Detecting fluorescence using consumer-accessible imaging devices could enable low-cost authentication and sensing technologies. Here we present a smartphone-based fluorescence detection method that exploits decorrelation between [Formula: see text] camera channels under controlled illumination. Using 16-bit smartphone images, we measured responses from fluorescent and colour-matched non-fluorescent samples under 125 illumination conditions defined by combinations of red, green, and blue LED intensities. Pearson correlation coefficient (PCC) values were calculated across the pixel intensities within cropped image regions, quantifying the statistical relationship between pairs of camera colour channels, ([Formula: see text], [Formula: see text], [Formula: see text]), to assess inter-channel relationships. Non-fluorescent samples exhibited consistently strong correlations (PCC &#x2248; 1), reflecting proportional scaling of reflected light across channels. In contrast, fluorescent materials produced broader PCC distributions spanning -&#xa0;1 to 1 due to Stokes-shifted emission that disrupts linear channel relationships. Simple PCC thresholding enabled robust discrimination between fluorescent and non-fluorescent samples across illumination conditions. This RGB-PCC approach demonstrates that fluorescence signatures can be detected using correlation structure rather than absolute intensity, enabling a low-cost, hardware-efficient method for visible-light fluorescence detection with potential applications in authentication, materials analysis, and portable sensing.

Criminal legal system-involved individuals face barriers to care after release from carceral settings. Elevated SARS-CoV-2 risk while incarcerated, together with living in congregate settings post-incarceration, increase the risk of respiratory viral infection transmission. This study evaluated a community health worker-led point-of-care SARS-CoV-2 testing and education intervention in a re-entry-focused community-based organisation compared with standard referrals. This non-blinded, parallel group, randomised controlled trial, conducted in partnership with a community-based organisation in New York City (NYC), NY, USA, enrolled clients who were released from incarceration in the previous 90 days, fluent in English or Spanish, and residing within NYC for the study duration. Participants were randomly assigned (1:1) via computer-generated randomisation to onsite point-of-care testing and education or standard of care referral to offsite testing sites over 12 months. All participants were advised to test every 3 months. The study was not masked due to the nature of the intervention. The primary outcome was the proportion of patients with at least one SARS-CoV-2 test performed with results received during the 12-month period. Primary analyses were done by intention-to-treat using logistic or Poisson regression modelling. This trial was registered with ClinicalTrials.gov, NCT04878328, and is completed. Between April 14, 2022, and May 22, 2024, 572 formerly incarcerated individuals were assessed for study eligibility. After the exclusion of 247 individuals, and a further 75 who did not attend enrolment, 250 participants were randomly assigned to the two study groups (125 to onsite point-of-care testing and education and 125 to standard of care). 216 (86%) participants were cisgender men, 30 (12%) were cisgender women, two (1%) were transgender women, and two (1%) were non-binary; 120 (48%) were Black and 82 (33%) were Hispanic; mean age was 42&#xb7;0 years (SD 11&#xb7;8). 109 (87%) of the 125 participants in the onsite point-of-care testing and education group and 67 (54%) of 125 participants in the standard of care group had at least one complete SARS-CoV-2 test (odds ratio 5&#xb7;9 [95% CI 3&#xb7;1-11&#xb7;1]; p<0&#xb7;0001). The absolute difference was 34 percentage points (95% CI 23-44; p<0&#xb7;0001). The incidence rate ratio of complete SARS-CoV-2 tests was 2&#xb7;4 times (95% CI 1&#xb7;9-3&#xb7;0, p<0&#xb7;0001) as high among participants in the intervention group versus those in the standard of care group. No serious adverse events occurred. Community-health worker-led testing and education at a re-entry-focused community-based organisation could potentially increase uptake of SARS-CoV-2 testing among formerly incarcerated individuals. Although further, larger trials are required, trusted community health workers can provide onsite point-of-care testing and health education, which has relevance for respiratory viral infections such as SARS-CoV-2 and might potentially be applicable to other infectious diseases such as HIV and hepatitis C virus. US National Institutes of Health.

The Mediterranean diet (MD), known for its high intake of fruits, vegetables, whole grains, legumes, and healthy unsaturated fats, has been linked to a diverse and beneficial gut microbiome. However, its effect on the gut microbiome during pregnancy remains understudied. This study aimed to investigate the impact of high adherence to a Mediterranean diet on gut microbiome composition and function in pregnant women by analysing their metabolic profiles and faecal microbiome composition. Stool, serum, and urine samples were collected from 48 pregnant women at weeks 20/28 and at week 36. Participants were stratified based on MD adherence using a validated questionnaire. Stool samples underwent 16&#xa0;S rRNA gene amplicon sequencing, and serum short-chain fatty acids (SCFAs) were measured using UPLC-MS. Women with high MD adherence showed significantly higher &#x3b1;-diversity in their faecal microbiomes at both time points. Significant differences in microbiome composition were observed between low and high adherence groups at weeks 20/28, but not at week 36. No significant differences in serum short-chain fatty acid concentrations were found between the groups. Our findings suggest that adherence to the Mediterranean diet during pregnancy is associated with changes in gut microbiome diversity and function. These results contribute to a better understanding of how dietary patterns during pregnancy may influence gut microbiome ecology.