The Effect of Power Grip on Ulnar Variance A Computed Tomography Study of the Wrist and Elbow.

Although an increase in ulnar variance with power grip is well documented in the medical literature, there is a paucity of information concerning its mechanism. This concept was examined in five healthy individuals using computed tomography of their wrists and elbows. Images were obtained of both joints in the resting position and with maximum power grip. Ulnar variance at the wrist increased an average of 0.64 mm (range: 0.3 to 1.2 mm). While the ulnohumeral joint remained unchanged, the radiocapitellar distance shortened an average of 0.62 mm (range: 0.3 to 1.0 mm; p = 0.03), which correlated directly with the change at the wrist. Our study showed that the increase in ulnar variance with grip was due to proximal shift of the radius and not to any distal migration of the ulna, which may have clinical implications in reconstruction or arthroplasty of the elbow.

Antenatal depression and drug use among deaf and hard-of-hearing birthing parents: results from a U.S. National Survey.

PURPOSE: This study aimed to investigate antenatal depression and drug use among deaf and hard-of-hearing (DHH) birthing parents who use American Sign Language (ASL), spoken English, or bilingually both ASL and English. METHODS: DHH participants in the United States responded to the Survey on Pregnancy Experiences of Deaf and Hard-of-Hearing Women. Respondents self-reported their antenatal depression diagnoses and drug use (i.e., pain relievers, cannabis, or illicit drugs) during their last pregnancy. Poisson regression models were used to estimate prevalence ratios, adjusting for age, race/ethnicity, education, marital status, and parity. RESULTS: The average age of respondents (n = 587) was 35 years. Respondents were predominantly non-Hispanic white (80%), college educated (60%), and married (74%). Relative to DHH English-speakers, DHH ASL-users had lower prevalence of reporting antenatal depression diagnosis (aPR = 0.40, 95% CI: 0.23 to 0.72). DHH people who reported antenatal depression diagnosis had higher prevalence of reporting antenatal drug use (PR = 2.34, 95% CI: 1.65 to 3.33). There were no significant associations between preferred language and antenatal drug use. CONCLUSIONS: DHH ASL-users are less likely to report receiving an antenatal depression diagnosis compared to DHH English-speakers. Given well-documented patient-provider communication barriers among DHH ASL-users, it is unclear if the lower prevalence observed in this study is the result of inadequate or inaccessible screening during pregnancy. Future work should consider universal use of linguistically appropriate screening tools for DHH birthing parents in both clinical and research settings.

Tongue exercise ameliorates structural and functional upper airway deficits in a rodent model of hypoglossal motor neuron loss.

Introduction: Tongue weakness and atrophy can lead to deficits in the vital functions of breathing and swallowing in patients with motor neuron diseases (MNDs; e.g., amyotrophic lateral sclerosis (ALS) and pseudobulbar palsy), often resulting in aspiration pneumonia, respiratory failure, and death. Available treatments for patients with MNDs are largely palliative; thus, there is a critical need for therapies targeting preservation of upper airway function and suggesting a role for tongue exercise in patients with MNDs. Here, we leveraged our inducible rodent model of hypoglossal (XII) motor neuron degeneration to investigate the effects of a strength endurance tongue exercise program on upper airway structure and function. Our model was created through intralingual injection of cholera toxin B conjugated to saporin (CTB-SAP) into the genioglossus muscle of the tongue to induce targeted death of XII motor neurons. Methods: Rats in this study were allocated to 4 experimental groups that received intralingual injection of either CTB-SAP or unconjugated CTB + SAP (i.e., control) +/- tongue exercise. Following tongue exercise exposure, we evaluated the effect on respiratory function (via plethysmography), macrostructure [via magnetic resonance imaging (MRI) of the upper airway and tongue], and ultrafine structure [via ex vivo magnetic resonance spectroscopy (MRS) of the tongue] with a focus on lipid profiles. Results: Results showed that sham exercise-treated CTB-SAP rats have evidence of upper airway restriction (i.e., reduced airflow) and structural changes present in the upper airway (i.e., airway compression) when compared to CTB-SAP + exercise rats and control rats +/- tongue exercise, which was ameliorated with tongue exercise. Additionally, CTB-SAP + sham exercise rats have evidence of increased lipid expression in the tongue consistent with previously observed tongue hypertrophy when compared to CTB-SAP + exercise rats or control rats +/- tongue exercise. Conclusion: These findings provide further evidence that a strength endurance tongue exercise program may be a viable therapeutic treatment option in patients with XII motor neuron degeneration in MNDs such as ALS. Future directions will focus on investigating the underlying mechanism responsible for tongue exercise-induced plasticity in the hypoglossal-tongue axis, particularly inflammatory associated factors such as BDNF.

The Confluence Model of Sexual Aggression in the Context of Acute Intoxication and State Emotion Regulation.

Understanding the mechanisms underlying sexual aggression perpetration is critical for the development of targeted, evidence-based prevention. The current study evaluates the effects of state emotion regulation (ER), acute alcohol intoxication, and Confluence Model constructs on sexual aggression perpetration intentions. Single, male social drinkers, aged 21-30 years, with a history of sexual risk-taking (N = 90) were randomly assigned to an alcohol (BrAC = 0.1%) or sober control condition and completed measures of hypothetical sexual aggression intentions, state ER, and Confluence Model constructs. Logistic regression demonstrated men high in hostile masculinity expressed significantly greater sexual aggression intentions. In addition, men with poor state ER endorsed significantly greater sexual aggression intentions, although this relationship only held for the men in the sober condition. Results suggest that interventions targeting state ER may be beneficial to sexual aggression perpetration prevention programming.

On The Ground: Methodological and Ethical Considerations of a Field Study on Alcohol Intoxication and Sexual Misperception among Drinking Venue Patrons.

Decades of research have been dedicated to the study and prevention of sexual aggression (SA) perpetration. Despite robust evidence linking acute intoxication and SA perpetration, few studies have examined this association in naturalistic contexts like drinking settings. Field studies are needed to inform etiological models and interventions that generalize to the naturalist environment. OBJECTIVE: The goal of this paper is to provide guidance to researchers on the logistical and ethical considerations involved in conducting an alcohol field study by detailing the methodology employed in a field study on alcohol and sexual misperception. METHOD: This article presents a field study protocol for measuring sexual misperception, a precursor to SA, in patrons exiting bars. One hundred forty-three participants completed study procedures. In-depth information on procedures for site selection, recruitment, screening, measure selection, consent, and capacity assessment is provided. CONCLUSIONS: Field studies can evaluate proximal causes of alcohol-involved sexual aggression and intermediary processes like sexual misperception in naturalistic settings. Greater implementation of field studies is required for a comprehensive understanding of alcohol-involved SA perpetration and for generalizable interventions.

T-cell large granular lymphocytic leukaemia in rheumatoid arthritis.

T-cell large granular lymphocytic (T-LGL) leukaemia is frequently associated with an autoimmune phenomenon; approximately one-third of patients have rheumatoid arthritis (RA). Intriguingly, one-third of patients with rheumatoid arthritis exhibit clonal T-cell patterns. Here, we present a patient with RA undergoing evaluation for neutropenia and splenomegaly who was later diagnosed with T-LGL leukaemia.

Closer to Home: A Quality Improvement Initiative to Optimize Satellite Site Bed Capacity.

BACKGROUND: The coronavirus disease 2019 pandemic resulted in the underutilization of inpatient beds at our satellite location. A lack of clarity and standardized admission criteria for the satellite led to frequent transfers to the main campus, resulting in patients traveling larger distances to receive inpatient care. We sought to optimize inpatient resource use at the satellite campus and keep patients "closer to home" by admitting eligible patients to that inpatient unit (LA4). Our aim was to increase bed capacity use at the satellite from 45% to 70% within 10 months. Our process measure was to increase the proportion of patients needing hospitalization who presented to the satellite emergency department (ED) and were then admitted to LA4 from 76% to 85%. METHODS: A multidisciplinary team used quality improvement methods to optimize bed capacity use. Interventions included (1) the revision and dissemination of satellite admission guidelines, (2) steps to create shared understanding of appropriate satellite admissions between ED and inpatient providers, (3) directed provider feedback on preventable main campus admissions, and (4) consistent patient and family messaging about the potential for transfer. Data were collected via chart review. Annotated run charts were used to assess the impact of interventions over time. RESULTS: Average LA4 bed capacity use increased from 45% to 69%, which was sustained for 1 year. The average percentage of patients admitted from the satellite ED to LA4 increased from 76% to 84%. CONCLUSIONS: We improved bed capacity use at our satellite campus through transparent admission criteria and shared mental models of patient care needs between ED and inpatient providers.

Cesarean birth and adverse birth outcomes among sub-populations of deaf and hard-of-hearing people.

BACKGROUND: Deaf and hard-of-hearing (DHH) people are at higher risk than their non-DHH counterparts of experiencing adverse birth outcomes. There is a lack of research focusing on social, linguistic, and medical factors related to being DHH which may identify groups of DHH people who experience more inequity. OBJECTIVE: Examine difference in prevalence of cesarean and adverse birth outcomes among diverse sub-groups of DHH people. METHODS: We conducted a cross-sectional survey of DHH birthing people in the U.S. who gave birth within the past 10 years. The sample was predominantly white, college educated, and married. We assessed cesarean birth and three adverse birth outcomes: preterm birth, low birthweight, and NICU admission post-delivery. DHH-specific variables were genetic etiology of hearing loss, preferred language (i.e., American Sign Language, English, or bilingual), severity of hearing loss, age of onset of hearing loss, and self-reported quality of perinatal care communication. We estimated prevalence, 95 % confidence intervals, and unadjusted prevalence ratios. RESULTS: Thirty-one percent of our sample reported a cesarean birth. Overall, there were no significant differences in prevalence across the outcome variables with respect to preferred language, genetic etiology, severity, and age of onset. Poorer perinatal care communication quality was associated with higher prevalence of preterm birth (PR = 2.37) and NICU admission (PR = 1.91). CONCLUSIONS: Our study found no evidence supporting differences in obstetric outcomes among DHH birthing people across medical factors related to deafness. Findings support the important role of communication access for DHH people in healthcare environments.

Informing the Need for a SARS-CoV-2 Booster Based Upon the Immune Responses among Young Healthy Adults to Variants Circulating in Late 2023.

BACKGROUND: COVID-19 remains a global public health challenge due to new immune-evasive SARS-CoV-2 variants and heterogeneous immunity. METHODS: In this cross-sectional study, we evaluated the adaptive immune responses in U.S. active-duty personnel who completed a COVID-19 primary vaccine series and with heterogenous SARS-CoV-2 vaccination and infection histories to 3 previously dominant variants (Ancestral, Delta, BA.5) and 3 circulating variants (XBB.1.5, EG.5, and BA.2.86) in late 2023. Analyses were performed based upon timing (within or beyond 12 months) and type (vaccine or infection) of the most recent exposure. RESULTS: Significant reduction was observed in binding antibodies, neutralization antibodies, memory B cells, and CD8+ T cells against circulating variants compared to previous variants. The reduction in antibody response was more pronounced in those whose most recent exposure was greater than 12 months from enrollment. In contrast, the CD4+ T cell response was largely consistent across all tested variants. The type of most recent exposure was not a significant factor in determining the magnitude of current immune responses. CONCLUSIONS: Administration of the XBB.1.5-based booster is likely to enhance cross-reactive humoral responses against SARS-CoV-2 circulating lineages. Ongoing surveillance of immune responses to emerging variants is needed for informing vaccine composition and timing.

Mechanisms of Near-Peer Learning in a Longitudinal Clerkship: A Grounded Theory Study.

PURPOSE: Many medical schools incorporate longitudinal clerkships, which promote continuity and may offer early clinical exposure during the preclinical curriculum. However, the mechanisms of near-peer learning and how it contributes to the development of clinical skills in longitudinal clinical experiences are less clear. The authors explored how peer-to-peer interactions among medical students influenced their developmental trajectories from nascent clinicians to more seasoned practitioners capable of juggling dual roles of clinical care and clinical supervision within longitudinal clerkships. METHOD: The Education-Centered Medical Home (ECMH) at Northwestern University Feinberg School of Medicine is a longitudinal clerkship that represents an ideal setting to explore peer learning. At ECMH, continuity is established across all 4 years of medical school among small groups of students from each year, a preceptor, and a panel of outpatients. The authors conducted 6 focus groups and 9 individual interviews between March 2021 and February 2023 with medical students from all years. Using constructivist grounded theory, the authors collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. RESULTS: Within ECMH, peer relationships fostered an informal learning culture that enabled meaningful peer interactions while reinforcing the established culture. The authors identified 3 essential learning practices between senior and junior medical students: preparing for patient encounters, shifting roles dynamically during the joint encounter, and debriefing encounters afterward. These practices strengthened learning relationships and supported students' developmental trajectories. CONCLUSIONS: Longitudinal peer learning relationships enabled meaningful peer interaction that influenced medical students' clinical development and capability for clinical supervision. Mutual trust, familiarity, and continuity facilitate targeted feedback practices and growth at the edge of junior students' capabilities. Optimizing this peer learning environment and seeking new opportunities to use longitudinal peer learning in clinical environments could promote psychological safety and professional identity formation for medical students.

Determining bifurcations to explosive synchronization for networks of coupled oscillators with higher-order interactions.

We determine bifurcations from gradual to explosive synchronization in coupled oscillator networks with higher-order coupling using self-consistency analysis. We obtain analytic bifurcation values for generic symmetric natural frequency distributions. We show that nonsynchronized, drifting, oscillators are non-negligible and play a crucial role in bifurcation. As such, the entire natural frequency distribution must be accounted for, rather than just the shape at the center. We verify our results for Lorentzian- and Gaussian-distributed natural frequencies.

Mathematical models of Plasmodium vivax transmission: A scoping review.

Plasmodium vivax is one of the most geographically widespread malaria parasites in the world, primarily found across South-East Asia, Latin America, and parts of Africa. One of the significant characteristics of the P. vivax parasite is its ability to remain dormant in the human liver as hypnozoites and subsequently reactivate after the initial infection (i.e. relapse infections). Mathematical modelling approaches have been widely applied to understand P. vivax dynamics and predict the impact of intervention outcomes. Models that capture P. vivax dynamics differ from those that capture P. falciparum dynamics, as they must account for relapses caused by the activation of hypnozoites. In this article, we provide a scoping review of mathematical models that capture P. vivax transmission dynamics published between January 1988 and May 2023. The primary objective of this work is to provide a comprehensive summary of the mathematical models and techniques used to model P. vivax dynamics. In doing so, we aim to assist researchers working on mathematical epidemiology, disease transmission, and other aspects of P. vivax malaria by highlighting best practices in currently published models and highlighting where further model development is required. We categorise P. vivax models according to whether a deterministic or agent-based approach was used. We provide an overview of the different strategies used to incorporate the parasite's biology, use of multiple scales (within-host and population-level), superinfection, immunity, and treatment interventions. In most of the published literature, the rationale for different modelling approaches was driven by the research question at hand. Some models focus on the parasites' complicated biology, while others incorporate simplified assumptions to avoid model complexity. Overall, the existing literature on mathematical models for P. vivax encompasses various aspects of the parasite's dynamics. We recommend that future research should focus on refining how key aspects of P. vivax dynamics are modelled, including spatial heterogeneity in exposure risk and heterogeneity in susceptibility to infection, the accumulation of hypnozoite variation, the interaction between P. falciparum and P. vivax, acquisition of immunity, and recovery under superinfection.

Diverse array of neutralizing antibodies elicited upon Spike Ferritin Nanoparticle vaccination in rhesus macaques.

The repeat emergence of SARS-CoV-2 variants of concern (VoC) with decreased susceptibility to vaccine-elicited antibodies highlights the need to develop next-generation vaccine candidates that confer broad protection. Here we describe the antibody response induced by the SARS-CoV-2 Spike Ferritin Nanoparticle (SpFN) vaccine candidate adjuvanted with the Army Liposomal Formulation including QS21 (ALFQ) in non-human primates. By isolating and characterizing several monoclonal antibodies directed against the Spike Receptor Binding Domain (RBD), N-Terminal Domain (NTD), or the S2 Domain, we define the molecular recognition of vaccine-elicited cross-reactive monoclonal antibodies (mAbs) elicited by SpFN. We identify six neutralizing antibodies with broad sarbecovirus cross-reactivity that recapitulate serum polyclonal antibody responses. In particular, RBD mAb WRAIR-5001 binds to the conserved cryptic region with high affinity to sarbecovirus clades 1 and 2, including Omicron variants, while mAb WRAIR-5021 offers complete protection from B.1.617.2 (Delta) in a murine challenge study. Our data further highlight the ability of SpFN vaccination to stimulate cross-reactive B cells targeting conserved regions of the Spike with activity against SARS CoV-1 and SARS-CoV-2 variants.

Can Asymmetry in Total Knee Arthroplasty Design Lead to More Normal-Like Postoperative Kinematics? A Multi-Implant Evaluation.

BACKGROUND: Few studies have evaluated the effects of symmetrical versus asymmetrical implant designs, more specifically the femoral condyles, trochlear groove, joint line, and bearing surfaces. The objective of this study was to investigate multiple posterior cruciate-retaining (PCR) total knee arthroplasty (TKA) designs influencing factors related to TKA asymmetry, and to investigate whether asymmetry can improve postoperative knee kinematics. METHODS: In vivo tibio-femoral kinematics for 99 subjects was evaluated in this retrospective study. Overall, 10 subjects had a nonimplanted, normal knee, and 89 subjects had 1 of 3 PCR TKAs with varying degrees of asymmetry within their femoral and tibial components (PCR #1 = 30, PCR #2 = 29, PCR #3 = 30). All TKAs were implanted by the same surgeon and were analyzed using fluoroscopy during a deep knee bend. RESULTS: At full extension, all 3 PCR TKAs experienced a more posteriorized position of the femoral condyles compared to the normal knee, with the 2 asymmetrical PCR TKAs experiencing more anteriorization compared to the third, symmetrical PCR TKA. Both the normal knee and the PCR TKA with greatest amount of asymmetry experienced statistically more posterior femoral rollback of the lateral condyle than the other 2 PCR TKAs. The PCR TKA with greater asymmetry also experienced statistically greater range of motion than the other 2 PCR TKAs. CONCLUSIONS: With increasing flexion, the design with the most asymmetry also experienced the most posterior femoral rollback, axial rotation, and greatest range of motion. The results in this study seem to suggest that the inclusion of asymmetry in a TKA could be beneficial for achieving more normal-like kinematics and greater weight-bearing knee flexion.

Adults' Understandings and Experiences of the Capacity to Consent to Substance-Involved Sexual Activity.

Most research on capacity to consent to substance-involved sex has focused exclusively on the implications of alcohol with little attention given to other or additional psychoactive drugs. This study aimed to explore people's understanding and experiences of the capacity to consent to alcohol- and/or drug-involved sexual activity. UK adults (N = 354) completed an online mixed-methods survey on sexual consent during sober, alcohol- and/or drug-involved sex. Qualitative data were analyzed using thematic analysis. Themes for capacity to consent were: (1) "There is no normative understanding of substance-involved sexual consent," (2) "Moving beyond the binary of consciousness versus incapacitation" and (3) "Substance-involved sexual decisions are viewed as irresponsible." The findings illustrated that capacity to consent is nuanced and multidimensional, and that people's understandings and experiences of capacity to consent to substance-involved sex are not solely individual, but rather, they are also shaped by their environment. We call for a multidimensional view of capacity to consent, where a standard of "unimpaired," rather than sober, is used and modeled by academics, legislators, and educators.

Exploring the Advantages and Challenges of MR-Guided Radiotherapy in Non-Small-Cell Lung Cancer: Who are the Optimal Candidates?

The landscape of lung radiotherapy (RT) has rapidly evolved over the past decade with modern RT and surgical techniques, systemic therapies, and expanding indications for RT. To date, 2 MRI-guided RT (MRgRT) units, 1 using a 0.35T magnet and 1 using a 1.5T magnet, are available for commercial use with more systems in the pipeline. MRgRT offers distinct advantages such as real-time target tracking, margin reduction, and on-table treatment adaptation, which may help overcome many of the common challenges associated with thoracic RT. Nonetheless, the use of MRI for image guidance and the current MRgRT units also have intrinsic limitations. In this review article, we will discuss clinical experiences to date, advantages, challenges, and future directions of MRgRT to the lung.

Multimodal pathways to joint attention in infants with a familial history of autism.

Joint attention (JA) is an early-developing behavior that allows caregivers and infants to share focus on an object. Deficits in JA, as measured through face-following pathways, are a defining feature of autism spectrum disorder (ASD) and are observable as early as 12 months of age in infants later diagnosed with ASD. However, recent evidence suggests that JA may be achieved through hand-following pathways by children with and without ASD. Development of JA through multimodal pathways has yet to be studied in infants with an increased likelihood of developing ASD. The current study investigated how 6-, 9- and 12-month-old infants with (FH+) and without (FH-) a family history of ASD engaged in JA. Parent-infant dyads played at home while we recorded the interaction over Zoom and later offline coded for hand movements and gaze. FH+ and FH- infants spent similar amounts of time in JA with their parents, but the cues available before JA were different. Parents of FH+ infants did more work to establish JA and used more face-following than hand-following pathways compared to parents of FH- infants, likely reflecting differences in infant motor or social behavior. These results suggest that early motor differences between FH+ and FH- infants may cascade into differences in social coordination.

Risk perception or hazard perception? Examining misperceptions of miners' personal exposures to noise.

While perceptions of risk have been examined in the workplace to understand safety behavior, hazard perception has been overlooked, particularly for chemical, physical, and biological agents. This study sought to establish the prevalence of one type of mismatch in hazard perception, - noise misperception - among miners, to examine whether different types of noisy environments (e.g., continuous, highly variable, etc.) alter workers' misperception of their noise exposures, and to evaluate whether noise misperception is associated with hearing protection device (HPD) use behavior. In this cross-sectional study across 10 surface mines in the USA, 135 normal-hearing participants were surveyed on their perceptions of exposure to noise at work and were monitored for three shifts, each with personal noise dosimetry, to examine which workers had a mismatch in perceived versus true noise exposure by 8-hr, time-weighted average, NIOSH exposure limits (TWANIOSH). Mixed effects logistic regression and probit Bayesian Kernel Machine Regression (BKMR) models examining on the odds of noise misperception associated with four different noise metrics (kurtosis, crest factor, variability, and number of peaks >135 dB) were used to determine which types of noisy environments may influence noise misperception. The relationship between noise misperception and odds of not wearing HPDs during a work shift was further examined. Our findings showed that nearly 1 in 3 workers underestimated their exposure to noise when their true exposure was in fact hazardous (TWANIOSH≥85 dBA) for at least one shift, and 6% misperceived hazardous exposures for all shifts. Work shifts with highly kurtotic noise distributions (>3) had 3.1 (95% CI: 1.1 to 8.4) times significantly higher odds of resulting in misperceived noise; no other noise metric was significantly associated with noise misperception. BKMR modeling provided further evidence that kurtosis dominates this relationship, with an IQR increase in kurtosis significantly associated with 1.68 (95% CI: 1.13 to 2.50) higher odds of noise misperception. Although not statistically significant, misperception of hazardous noise exposure was associated with 3.2 (95% CI: 0.8 to 12.5) times higher odds of not using earplugs during a work shift. Misperception of noise occurs in the workplace, and likely occurs for other physical, chemical, and biological exposures. This hazard misperception may influence risk perceptions and worker behavior and reduce the effectiveness of behavior-related training. Elimination, substitution, or engineering controls of exposures is the best way to prevent hazard misperceptions and exposure-related diseases.