A large proportion of the global population uses solid fuels for household purposes, and limited evidence from previous studies suggests that it might be associated with reduced renal function. To investigate the association between household use of different types of fuels and kidney disease-related mortality. We analyzed data from the Golestan Cohort Study, a population-based prospective cohort study conducted in northeastern Iran, with 50 045 individuals aged 40-75 years enrolled in the period 2004-2008 and followed through April 2023. Information about household fuel use was collected using validated questionnaires. We estimated adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using Cox proportional hazards models. The outcome of interest was death due to any kidney disease, excluding kidney cancer (ICD-10 codes: N00-N19 and N25-N29). During 724,063.62 person-years of follow-up, 262 participants died due to kidney disease. The risk of kidney disease-related mortality was higher with increasing duration of biomass use for cooking or house heating (HR for every 10-year increase: 1.20; 95% CI: 1.04-1.37), while it was not associated with increased duration of using kerosene (10-y HR: 1.09; 95% CI: 0.95-1.24) or gas (10-y HR: 1.00; 95% CI: 0.86-1.16). Estimates for lifetime duration of fuel burning for both cooking and house heating (exclusive fuel use) did not differ according to whether used heating stoves were chimney-equipped or not for kerosene, while they differed for biomass (10-y HR, chimney-equipped: 1.06 [95% CI: 0.95-1.18]; 10-y HR, not chimney-equipped: 1.19 [95% CI: 1.06-1.34]; P difference = 0.025). The findings of our study suggest that burning biomass for household purposes under poor ventilating conditions is associated with kidney disease-related mortality.
Access to reliable energy is crucial for sustainable livelihood improvements across various dimensions, fostering economic growth. Therefore, addressing energy poverty becomes imperative. This paper aims to estimate the extent of multidimensional energy poverty and its determinants in the tea estates of the Moulvibazar district, Bangladesh. Primary data was collected from 382 tea workers at the Chatlapore tea estate using a multistage random sampling technique. The Multidimensional Energy Poverty Index (MEPI) and the Tobit regression were employed for data analysis. Results indicate a 51% multidimensional energy poverty rate in the study area, with cooking as the most significant contributor. The Tobit model reveals that social and economic factors significantly influence multidimensional energy poverty. Education, occupation, gender, family size, land ownership, access to improved housing, and household earnings are critical determinants. Enhancing household socio-economic status emerges as a key solution to address multidimensional energy poverty. Policies targeting housing improvement, subsidizing and expanding education, and awareness rising on clean energy access, can effectively mitigate multidimensional energy poverty effectively.
Thank you, Speaker Grice. Good afternoon delegates and colleagues. It is again my pleasure to present this state of the Association address to the House of Delegates. This afternoon I will highlight several recent accomplishments, provide an update on other developments that have affected our Association since the last House meeting in Chicago, and will mention some key objectives we have set for the year ahead.
Polyandry is widespread across animals, yet its underlying causes and consequences remain unclear in natural populations. Recent work suggests that spatial and temporal variation in the environment shape the causes and consequences of polyandry. Here, we extend this research by testing whether one consequence of polyandry, multiple paternity, is influenced by females' social environment, specifically the prevalence of male alternative reproductive tactics (ARTs), territorials and roamers. We studied semi-natural populations of house mice (Mus musculus domesticus) under different food quality treatments. Doing so allowed us to explore whether the relationship between male ARTs and multiple paternity depends on environmental conditions, which are expected to mediate the relative costs and benefits of reproductive investment. Using microsatellite genotyping, we assigned paternity to 329 litters produced by 257 females across 5 generations. We then classified the sires of these litters as territorials or roamers based on their reproductive behavior around conception and quantified each sire's reproductive contribution to each litter. Multiple paternity was strongly associated with the presence of roamers, which were twice as likely to occur in multiple-sired litters compared with territorials. Territorials still sired most offspring, an effect consistent with roamers engaging in sneaky/opportunistic matings. However, we found no clear evidence that environmental conditions shift how ARTs contribute to multiple paternity. Together, our results demonstrate a tight link between female mating outcomes and male ARTs across environments, implying that the drivers of polyandry depend on the social environment. By explicitly linking ARTs to multiple paternity, our study provides a mechanistic understanding on how social dynamics shape reproductive outcomes in mating systems where both sexes mate multiply.
Pressure injuries are a frequent and largely preventable adverse event across the whole care continuum, from intensive and acute hospital wards to community and home settings. Internationally, they are graded with the objective European Pressure Ulcer Advisory Panel and National Pressure Injury Advisory Panel (EPUAP/NPIAP) staging system. Staging describes the tissue rather than the person. How patients experience each stage is captured by patient-reported outcome measures (PROMs), and how they experience prevention is captured by patient-reported experience measures (PREMs). Both may be recorded inconsistently and remain disconnected from the objective stage. Prevention and care are increasingly delivered by community and family nurses, yet the patient-reported axis in these settings, and in the newly established community hospitals and community houses, remains under-mapped. This scoping review maps which PROMs and PREMs have been used for pressure injury prevention and care across European hospital and community nursing settings. It identifies which domains are captured at each EPUAP/NPIAP stage and during prevention, characterises the role of the community and family nurse and examines where dedicated protocols may be absent in community hospitals and community houses. The review was conducted following the updated Joanna Briggs Institute (JBI) methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Three databases, namely, PubMed, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), were searched within a Population, Concept, Context (PCC) framework. The searches yielded 891 records; after de-duplication, 666 records were screened, and 29 sources were included, of which 25 were conducted in European settings and 2 in Turkey, and 2 were multinational reviews. The instruments identified were the generic EuroQol five-dimension (EQ-5D) and 36-Item Short Form (SF-36) health surveys and the pressure ulcer-specific Pressure Ulcer Quality of Life (PU-QOL) and Wound Quality of Life (Wound-QoL) measures, together with the Quality from the Patient's Perspective (QPP) experience measure and qualitative interviews. The domains captured were pain, mobility and function, sleep, exudate and odour, dignity, psychological impact and health-related quality of life, alongside the experience domains of involvement, communication, continuity and satisfaction. Evidence was concentrated in the United Kingdom, Nordic countries, Switzerland, Spain and Italy, and community and district nursing were well represented. Across these settings, the patient-reported axis was captured with a small and heterogeneous set of instruments and qualitative methods, and it was rarely linked to a specific EPUAP/NPIAP stage. No included source addressed the Italian community hospitals or community houses, and dedicated pressure injury protocols with standardised patient-reported measurement in these new intermediate care structures were not described. Stage-aware PROM and PREM instruments validated for critically ill and proxy respondents and for community use emerge as a priority for future work.
Lack of diversity in clinical trials reduces the generalizability of treatment efficacy across different demographic groups, thereby diminishing the relevance, quality, and equity of research findings. This study aimed to evaluate the implementation of 4 recruitment strategies and their impact on clinical trial enrollment through the Trial of Sites to Increase Diversity in Clinical Trials (TOTAL) project, a collaboration between Stanford and Morehouse School of Medicine funded by the American Heart Association. Clinical trials were randomized to 1 of 3 recruitment strategy intervention arms (community ambassador, social media ads, or registry and patient engagement platforms) or the control arm (usual recruitment). The Stanford Lightning Report, a rapid qualitative approach, was used to gather insights through interviews with principal investigators (PIs) and trial staff at baseline, 3 months, and trial completion. Trial teams were supportive of increasing diversity and found the recruitment platforms generally user-friendly. External recruitment support was valued, and some trials reported improved access to participants outside their usual pool. Community ambassadors helped connect trials with community and physician networks and, in some cases, increased recruitment of Asian American participants. Registry and patient engagement platforms were easy to use and supported outreach, including direct emails to potential participants. Social media ads, particularly after the transition to BuildClinical (BuildClinical LLC), improved screening efficiency by prescreening candidates and producing a manageable number of eligible leads. Usual recruitment relied mainly on physician referrals and benefited from trusted clinician-patient relationships, but many trials exhausted their typical participant pools. Across strategies, major barriers included limited time, staff capacity, and financial resources; scarcity of diverse local populations; restrictive eligibility criteria; lack of language access; transportation burdens; and limitations of remote engagement. Additional operational barriers included institutional review board (IRB) delays, contract and vendor approval processes, and platform policy restrictions for digital advertising. Feedback from Lightning Reports led to several real-time changes, including a shift from in-house social media outreach to specialized digital recruitment support. Increasing diversity in clinical trials requires sustained financial, human, and institutional support, as well as effective recruitment strategies. Rapid qualitative feedback can identify implementation problems early and support real-time improvements.
To evaluate the effectiveness of various surgical strategies for reinnervating the facial nerve in patients who have sustained post-traumatic paralysis of the facial muscles. The cohort included six male patients with a mean age of 29±7 years. Depending on the level of nerve lesion-whether intra- or extratemporal-patients underwent either triple selective reinnervation or reinnervation via the hyoid nerve (XII), accompanied by intraoperative neurophysiological monitoring. Evaluations using the House-Brackmann scale, needle electromyography, and eFACE scores indicated statistically significant improvements (p<0.05) by 12 months of follow-up for all patients. These findings underscore the effectiveness of a tailored approach and the importance of neuromonitoring. The findings from this prospective study demonstrate the clinical efficacy of a differentiated surgical approach to facial nerve reinnervation in patients with post-traumatic paralysis of the facial muscles. Оценить эффективность дифференцированных стратегий хирургической реиннервации лицевого нерва у пациентов с посттравматическим параличом мимической мускулатуры. В исследование вошли 6 пациентов мужского пола (средний возраст 29±7 лет). В зависимости от уровня поражения (интра- или экстратемпоральный) применялись методики тройной селективной реиннервации или реиннервации через подъязычный нерв (XII) с использованием интраоперационного нейрофизиологического мониторинга. Оценка по шкале House-Brackmann, игольчатой электромиографии и шкале eFACE показала статистически значимое улучшение (p<0,05) к 12-му месяцу наблюдения у всех пациентов, демонстрируя эффективность индивидуального подхода и необходимость нейромониторинга. Представленные результаты проспективного исследования демонстрируют клиническую эффективность дифференцированной хирургической тактики реиннервации лицевого нерва у пациентов с посттравматическим параличом мимической мускулатуры.
Chronic hypertension in mid-life is a leading cause of vascular cognitive impairment (VCI), the second leading cause of age-related cognitive decline. Further, social isolation is another risk factor for dementia, and disproportionately impacts middle-aged adults. However, mechanisms by which social isolation may compound chronic hypertension to damage the cerebrovasculature and contribute to VCI remain unclear. The current study used male and female adult Wistar rats and spontaneously hypertensive rats (SHR) to investigate how social isolation during chronic hypertension disrupted blood-brain barrier (BBB) and memory function. Half of the SHR were housed individually for three months, with remaining SHR and Wistar rats housed in groups and routinely handled (n = 8/group). At six months old, long-term and spatial working memory were assessed using object recognition and continuous y maze tasks, respectively. BBB permeability was measured in-vivo in dorsal hippocampus and prefrontal cortex and serum markers of inflammation assessed. Long-term memory function was impaired only in isolated male SHR, as recognition index was lower compared to socialized male Wistar and SHR (0.59 ± 0.07 vs. 0.70 ± 0.02 and 0.77 ± 0.03; p < 0.05 by 2way ANOVA), which was associated with increased BBB permeability in the hippocampus. In contrast, spatial working memory was only impaired in isolated female SHR that had a decreased alternation index compared to socialized female Wistar rats (0.59 ± 0.04 vs. 0.74 ± 0.02; p < 0.05 by 2way ANOVA). This sex-specific deficit was associated with greater BBB disruption in prefrontal cortex that correlated with elevated levels of circulating oxidative stress marker 8-isoprostane. These findings suggest that social isolation during chronic hypertension differentially impairs memory function in a sex-dependent manner. Overall, this study advances our understanding of cerebrovascular consequences of social isolation in adulthood and indicate brain region/memory domain dysfunction differ by sex during chronic hypertension.
To investigate the association between parental incarceration and housing insecurity among a recent, nationally representative sample of children in the US. Data from the 2024 National Survey of Children's Health (NSCH), a nationally representative survey of noninstitutionalized US children aged 0-17 years, were examined. Weighted multinomial and logistic regression models were estimated to examine associations between parental incarceration and several indicators of housing insecurity (eg, frequent moves, homelessness, caregiver eviction stress, missed housing payments),adjusting for various child, caregiver, household, and neighborhood characteristics. Findings revealed substantial disparities in housing insecurity among children exposed to parental incarceration. Children with incarcerated parents disproportionately resided in households experiencing housing insecurity relative to peers, including higher rates of missed housing payments (31.66% vs 13.68%), caregiver eviction stress (22.30% vs 8.85%), lifetime childhood homelessness (17.44% vs1.95%), and lifetime moves (41.81% vs 10.77% reporting four or more moves). These associations were robust to multiple confounders. Addressing housing insecurity among children with incarcerated parents represents an important opportunity to reduce pediatric health inequities. Future research should prioritize efforts to characterize further this relationship, implement and test screenings in clinical settings, foster community partnerships, and support policies that reduce inequities in housing insecurity and parental incarceration for these children.
The northward expansion of mosquito-borne viruses such as West Nile virus (WNV) and Usutu virus (USUV) in Europe, driven partly by climate-related changes affecting vectors and hosts, poses an increasing threat to human and animal health. Reliable diagnostic tools are therefore essential for early detection and effective surveillance. This study aimed to develop and evaluate sensitive molecular assays for WNV and USUV, apply them to screen wild birds and human patients in Finland, assess bird exposure through serology, and evaluate national preparedness for emerging arboviral threats. Real-time PCR assays for WNV and USUV nucleic acids were developed, optimized and evaluated for the detection of WNV and USUV nucleic acids using bird and human samples. Bird samples were also tested for anti-WNV antibodies using an in-house immunofluorescence assay (IFA). The real-time PCR assays showed high sensitivity, with limits of detection of 13.0 copies per reaction for WNV and 14.6 copies per reaction for USUV. A total of 163 deceased birds and 337 human serum samples collected during the summer months from patients with suspected acute infections were screened. No WNV or USUV nucleic acids were detected, and bird samples tested negative for WNV antibodies. However, given the active migratory bird flyways from Africa and Southern/Central Europe, and recent detections in neighbouring countries, the introduction of WNV into Finland appears likely. Continued surveillance and the availability of efficient diagnostic tools remain critical for preparedness and early response.
Sublingual immunotherapy (SLIT) has been shown to be effective in controlling the symptoms of allergic rhinitis and asthma, but few studies have assessed its long-term preventive effects on lower-airway inflammation and asthma onset. We sought to evaluate prospectively the long-term effects of SLIT on lower-airway function in patients with allergic rhinitis caused by house dust mites (HDM). We performed a post hoc analysis of a previously published prospective, open-label study involving patients with allergic rhinitis who were monosensitized to mites and followed for 15 years. All participants had bronchial hyperreactivity and were originally assigned to 4 groups receiving either pharmacological therapy alone or SLIT for 3, 4, or 5 years (SLIT 3, SLIT 4, and SLIT 5). Skin sensitization, methacholine reactivity, and respiratory function were evaluated annually during the winter months. Seventy-eight patients were enrolled, and 59 completed the study. Over 15 years of observation, new sensitizations occurred in all participants in the control group but in fewer than one-quarter of patients who received SLIT for 3, 4, or 5 years (21%, 12%, and 11%, respectively). Among patients with rhinitis treated only with intranasal corticosteroids and systemic antihistamines, the development of asthma, defined as a decline in FEV to below 80% of the predicted value, was observed in 58% (7 of 12). In contrast, progression to asthma was significantly less frequent among patients with rhinitis treated with SLIT, regardless of treatment duration: 1 of 14 patients in the SLIT 3 group (7%), 1 of 16 in the SLIT 4 group (6%), and 1 of 17 in the SLIT 5 group (6%). In the long term, SLIT provided a significant clinical benefit in HDM-induced allergic rhinitis by reducing both the allergic march and asthma onset and by limiting the decline in lung function, as measured by FEV1.
Haylage is widely fed to all categories of stabled horses across Europe and New Zealand. Haylage can vary from high energy nutrient dense forage to low energy highly fibrous fodder, yet little is known about the impact different haylages have on metabolism in horses. This study provides the first direct comparison of feeding four different haylages: early cut (Lolium multiflorum), later cut (Lolium perenne) rye grass (R1 and R2); early and late cut meadow grass (M1 and M2), on urinary and faecal metabonomics, in ponies at maintenance. Using replicated Latin Square design, eight individually housed ponies were fed each haylage for 15 days in four periods. Faeces and urine were collected on day 12 for metabonomic profiling. Apparent digestibility was evaluated on 3 days of total faecal collection (days 10-12) before adaptation to the new diet (days 13-15). Metabolic profiles (1H NMR Spectroscopy), were phased and baseline corrected via TSP singlet δ 0.0. Principal Component Analysis (PCA) via Matlab, was used to identify metabolic profiles and Orthogonal Projections to Latent-Structures Discriminate Analysis (OPLS-DA) models to group specific metabolic changes. Digestibility was determined using multivariate mixed effects modelling +ANOVA. Pre-study urinary metabolic profiles were similar for all ponies. R1 haylage produced differentiating urinary clusters relative to R2 and M1 although no individual metabolites differed significantly. Some faecal R1 clustering was evident. Pairwise metabolites comparisons reflected underlying nutrient profiles. High inter-pony variation did not prevent dietary discrimination, with R1 > M1 > M2 = R2. This study provides the first evidence that haylages differing in maturity and botanical composition generate measurable metabolic shifts in ponies. These findings highlight the biological importance of haylage selection and indicate that metabonomic profiling is a sensitive informative tool for assessing how forage characteristics shape digestive physiology.
Age-related hearing loss (ARHL) is closely linked to mitochondrial dysfunction in cochlear hair cells; however, its molecular regulation remains unclear. Sestrin2 (SESN2), a stress-inducible protein crucial for regulating energy metabolism, has not been comprehensively studied in the context of ARHL. To investigate SESN2's role, cochlea-specific SESN2 overexpression and knockout mouse models were established via adeno-associated virus 9 (AAV9) delivery through posterior semicircular canal injection. These models, combined with an H2O2-induced accelerated-aging paradigm and H2O2-treated House Ear Institute-organ of Corti 1 (HEI-OC1) cellular oxidative injury system, were systematically evaluated using auditory brainstem response (ABR), immunofluorescence (IF), mitochondrial membrane potential assays, western blotting, and other methods. Analysis of ARHL mouse cochleae revealed downregulation of SESN2 in hair cells, accompanied by mitochondrial membrane disruption and increased apoptosis. In aged mice, SESN2 overexpression significantly improved low-frequency hearing thresholds (p < 0.01). Mechanistically, SESN2 reduced oxidative stress, restored mitochondrial function, and suppressed excessive PTEN-induced putative kinase 1 (PINK1)-Parkin-mediated mitophagy, thereby maintaining mitochondrial quality control. This study is the first to show that SESN2 protects against ARHL through a tripartite cascade: antioxidant defense, mitochondrial functional restoration, and dynamic mitophagy regulation. These findings highlight SESN2's pivotal role in auditory preservation and identify it as a promising new therapeutic target for age-related hearing deterioration.
Restoring durable allergen tolerance remains a challenge in the treatment of allergic asthma. Regulatory T cells (Tregs) represent attractive therapeutic targets since they can potently restrain allergen-specific type 2 effector T cell (Th2) responses. Agents that expand Tregs and enhance their function, such as interleukin-2 (IL-2)-based therapies, have been explored, but limited specificity has constrained their efficacy. IL-2 muteins have been engineered to preferentially target Tregs but have not been studied in the context of allergic inflammation. We explored the effects of the IL-2 mutein Fc.mut24 on allergen-induced type 2 airway inflammation. C57BL/6 mice were injected subcutaneously with Fc.mut24 in a house dust mite model of allergic airway inflammation, and clinical, cellular, and molecular biomarkers of the disease were assessed. In naïve mice, Fc.mut24 induced a rapid and transient expansion of activated Tregs in the lung. Fc.mut24 treatment prior to allergen sensitization abrogated the emergence of allergen-specific Th2 cells in the lung and prevented allergic airway inflammation and airway hyperreactivity. Further, Fc.mut24-pretreated mice failed to mount a Th2 recall response and did not develop lung inflammation upon allergen rechallenge during the memory phase, suggesting long-term protection. Maintenance of this protection required Tregs, as deletion of Tregs abolished the protective effect of Fc.mut24. In contrast, Fc.mut24 administered during the memory phase did not suppress the Th2 recall response and did not prevent allergic airway inflammation following rechallenge. Fc.mut24 therapy prevented allergic airway inflammation when delivered before Th2 cell priming but was insufficient to overcome established allergen-specific type 2 responses, defining a time-dependent window for effective Treg-directed intervention.
Prolonged immobilization worsens the patient's recovery following severe burn injury and results in a prolonged hospitalization. This study aims to assess the alterations in bone mineral density and body composition in a pre-clinical model of cutaneous burn combined with immobilization. Adult male rats (n = 24) received scald burn of ∼40% total body surface area (TBSA) (B). After burn, 16 rats had their hindlimbs suspended (H) for either 3 days (BH3) or 14 days (BH14), whereas 8 rats underwent the burn procedure without suspension (B). Additional 8 rats without burn and hindlimb suspended were paired-housed and served as baseline controls (S). All rats were euthanized 21 days after burn for assessment using a high-resolution DEXA. We found that ratios of rat whole body mass, normalized to pre-burn mass, were significantly decreased over time in all burned rats (B: 0.9072 ± 0.0517; BH3: 0.8997 ± 0.0145; BH14: 0.8618 ± 0.0666) when compared to the control (1.1542 ± 0.0206) (P < .05). The same significant reductions were observed in lean mass, bone mineral content (BMC), and fat content (P < .05). To determine whether the DEXA measurement of body parts correlates with whole-body measurement, we performed DEXA of the isolated left hindlimb dissected at the hip joint. We found the ratios of isolated hindlimb tissue mass significantly decreased in all burned rats (B: 0.0552 ± 0.0018; BH3: 0.499 ± 0.0050; BH14: 0.0459 ± 0.0033) when compared to the control (0.0738 ± 0.0046) (P < .05). In addition, there was a significant decrease in hindlimb tissue mass in burned animals suspended for 14 days compared to their burned nonsuspended counterparts (P < .05). The ratios of lean mass (0.0362 ± 0.0031) in the isolated hindlimb also significantly decreased in BH14 group compared to B group (0.0591 ± 0.0034) (P < .05). DEXA scanning of the whole body revealed a cachectic state in burned rats. The whole-body DEXA results were concordant with those obtained from the corresponding isolated hindlimbs. The isolated hindlimbs showed a further decrease in lean mass in burned rats following 14 days of immobilization. We conclude that 14-day immobilization exacerbates the cachectic state in severely burned rats. This preclinical model may be used to develop and test effective therapeutic countermeasures.
Predicting knee joint trajectory is critical for controlling intelligent walking-assistive devices, with surface electromyography (sEMG) emerging as a promising modality for motion intention decoding. However, accurate and continuous prediction remains challenging because both intersubject and intrasubject variability must be addressed simultaneously. To tackle this problem, this article proposes a semi-subject-independent deep learning framework that is pretrained on source subjects to learn shared cross-subject representations and then calibrated with only a few trials from an unseen target subject before testing on that subject's held-out trials. The framework contains two complementary components. First, gait kinematic decoupling (GKD) separates knee trajectory prediction into a shared normalized motion pattern and subject-dependent amplitude and offset terms, thereby reducing cross-subject label variability. Second, muscle activation filtering uses physiological activation priors to suppress motion-irrelevant sEMG components and enhance gait-related neuromuscular information. Experiments on both in-house and public datasets show state-of-the-art performance, with average root-mean-square errors (RMSEs) of $3.03^{\circ }~\pm ~0.49^{\circ }$ and $4.49^{\circ }~\pm ~1.14^{\circ }$ , respectively, while predicting knee angles 50 ms in advance. These results suggest that the proposed framework can support robust and practical control of intelligent walking-assistive systems.
This simulation is intended for emergency medicine residents, PGY 1-4. Postpartum hemorrhage (PPH) is defined as cumulative blood loss ≥1000 mL or any postpartum bleeding with signs of hypovolemia within 24 hours of delivery. Post-abortion hemorrhage (PAH) has no single universally adopted numeric definition but clinically is defined as excessive bleeding following spontaneous or induced abortion that results in hemodynamic instability, need for transfusion, hospital admission, or procedural intervention. Due to its rarity, PAH may be underrecognized and thus is the target of this simulation. The emergency department is the country's reproductive health safety net. With the decline of labor and delivery units and on-call, in-house OB/GYN consultants, emergency clinicians must be equipped to recognize and manage these cases.1 Effective management of these cases includes uterotonic medications and uterine tamponade devices like the Bakri balloon.2 There is mixed evidence on the use of Bakri balloons for post-abortion hemorrhage, with some hospitals moving towards vacuum-assisted devices (e.g. JADA).3 However, they have remained relevant in non-OB settings and institutions with limited obstetrical support.4-6 This simulation aims to address a gap in training for PAH for emergency medicine residents, focusing on the placement of the Bakri balloon. By the end of this simulation, learners should be able to: 1) recognize signs of post-abortion hemorrhage, 2) manage hemorrhage using appropriate physical maneuvers, uterotonic medications, and specialist consultation, 3) demonstrate proper placement of a Bakri balloon. This single-center, high-fidelity simulation was conducted at a tertiary care academic center. Simulation was chosen as the best way to teach this topic because it allows a psychologically safe environment to practice a scenario which involves high-level critical thinking and fine-motor skills that would otherwise degrade under stress during a real patient encounter. Pre- and post-simulation surveys were administered, including Likert-scale questions on comfort with the management and procedures included, and a multiple-choice knowledge assessment. Twenty-eight individuals completed the pre-simulation learner evaluation, and 31 completed the post-simulation learner evaluation. Likert-scale data was treated as ordinal (1 = strongly disagree, 5 = strongly agree) and analyzed using the Mann-Whitney U Test. The multiple-choice knowledge assessment was analyzed using a paired T-test. The simulation included 29 emergency medicine residents, four MS3 students, four MS4 students, and three junior EM PA fellows. This case was used eight times during the session. The simulation lasts approximately 20 minutes. There were statistically significant improvements across all measures. On a 5-point Likert scale, comfort in placing a Bakri balloon increased from 2.35 to 3.97 (U = 82, z = 5.34, P < 0.01); comfort in managing postpartum/abortion hemorrhage rose from 3.11 to 3.90 (U = 197, z = 3.59, P < 0.01), and recognition of hemorrhage signs increased from 3.96 to 4.39 (U = 278, z = 2.36, P = 0.02). Mean scores on the multiple-choice knowledge assessment improved from 55.79% to 90.52% (t(18) = -5.23, P < 0.001) pre- and post-intervention. This simulation successfully addressed the gap in the educational materials available to address the learning of the recognition and management of PPH/PAH, including the placement of intrauterine balloon devices. The simulation increased learners' comfort in managing PAH and placing Bakri balloons. While effective for immediate skills/knowledge acquisition, this is a high-acuity, low-occurrence procedure that requires repetition and deliberate practice for more durable learning. Postpartum hemorrhage, post-abortion hemorrhage, Bakri balloon, uterine tamponade, simulation training.
Face lift techniques have greatly evolved in the last decades. Compared with more traditional methods, an endoscopic approach has the advantage of providing access to deeper structures while reducing extensive dissection of the face. The main objectives of this study are to assess the postoperative complications, aesthetic results, and patient satisfaction following 2 different face lift approaches. We conducted a hybrid longitudinal observational study. According to patients' preference, an upper two-thirds face lift (using a minimal endoscopic approach with blepharoplasty) or a full face lift was performed (including deep superficial musculoaponeurotic system dissection). Follow-up visits were scheduled up to 12 months postsurgery. At each visit, a standardized physical examination was conducted to assess sensory nerve function, and the House-Brackmann classification was used for motor nerve testing. The FACE-Q questionnaire was also administered to assess self-reported outcomes of satisfaction. A total of 35 patients underwent a facial rejuvenation procedure. Most sensory nerve disturbances resolved, except in 1 case, and all motor nerve disturbances had resolved by 12 months postsurgery. Other visible side effects had virtually disappeared at 12 months, with 1 persistent case of tightness and 1 of alopecia. Patient satisfaction regarding facial appearance and surgical results was high (overall median Rasch score of 76 and 73, respectively). Endoscopic facial surgery can be used for facial rejuvenation with few surgical complications. Our results suggest that endoscopic facial surgery is safe and that patients are satisfied with this technique.
Facial nerve schwannomas (FNSs) are rare benign tumors that can involve any segment of the facial nerve. Comprehensive understanding of these tumors remains limited, largely due to the paucity of reports on large surgical series in the literature, and their clinical management is particularly challenging. To balance tumor control with favorable facial nerve function, the authors have adopted nerve-preserving surgery (nonradical tumor removal and bony decompression) for moderate facial nerve palsy and conventional nerve reconstruction surgery (total tumor removal and facial nerve reconstruction) for severe or complete palsy cases. In this study, the authors evaluate the utility of a function-centered surgical strategy and a five-category, location-based classification system, based on a relatively large contemporary series. A total of 67 consecutive FNS surgeries performed in 61 patients between 2004 and 2022 were retrospectively reviewed. The surgical strategy was selected according to the patient's preoperative facial nerve function and intraoperative electromyography (EMG) responses. Nerve-preserving surgery was performed in 47 cases (70.1%) and was associated with improved or stable facial nerve function in 87.2%. The mean House-Brackmann grade improved from 3.5 to 3.0 in the nerve preservation group and from 4.6 to 4.0 in the nerve reconstruction group. Overall, facial nerve function improved in 50.7% and worsened in 13.4% of cases. In the nerve preservation group, tumors confined within the temporal bone (intrameatal, tympanic, and mastoid types), younger age, and favorable EMG responses were associated with better postoperative facial nerve function. During long-term follow-up (mean 87.2 months), 27.7% of this group required additional treatment. A function-centered strategy, supported by intraoperative EMG monitoring and a tumor-centered classification, enables selective nerve preservation and was associated with favorable outcomes in FNS surgery. This strategy may serve as a practical framework for individualized surgical treatment of FNSs.
To investigate the influence of temperature on the population parameters of Muscidifurax sinesensilla, a key natural enemy to the house fly (Musca domestica), we evaluated its developmental duration, survival, fecundity, and other biological traits at four constant temperatures (18, 22, 26, and 30°C); life tables were constructed using the age-stage, two-sex life table method. The results showed that M. sinesensilla completed its life cycle across all tested temperatures. With increasing temperature, the durations of immature stages, adult longevity, reproductive period, total preoviposition period, and mean generation time decreased significantly. The net reproductive rate (R0) reached its highest values at 22-26°C, but declined significantly at 30°C. The intrinsic rate of increase (r) and finite rate of increase (λ) were highest at 26 and 30°C, with no significant difference between these two temperatures. Although population growth was fastest at 30°C due to the shortened developmental period and generation time, both survival and reproductive performance at this temperature were lower than those at 26°C. These findings suggest that 30°C is close to the upper threshold of suitable temperature for M. sinesensilla. Overall, 26°C appears to be optimal for population rearing as it provides a balance of rapid development, high reproductive output, and strong population growth potential. This study provides a basis for optimizing mass-rearing conditions and improving the application efficiency of M. sinesensilla in biological control programs.