A Second-Generation (44-Channel) Suprachoroidal Retinal Prosthesis: A Single-Arm Clinical Trial of Feasibility.

Purpose: To assess the feasibility of a second-generation (44-channel) suprachoroidal retinal prosthesis for provision of functional vision in recipients with end-stage retinitis pigmentosa (RP) over 2.7 years. Design: Prospective, single-arm, unmasked interventional clinical trial. Participants: Four participants, with advanced RP and bare-light perception vision. Methods: The 44-channel suprachoroidal retinal prosthesis was implanted in the worse-seeing eye. Device stability, functionality, and adverse events were investigated at approximately 12-week intervals up to 140 weeks (2.7 years) postdevice activation. Main Outcome Measures: Serious adverse event (SAE) reporting, visual response outcomes, functional vision outcomes, and quality-of-life outcomes. Results: All 4 participants (aged 39-66 years, 3 males) were successfully implanted in 2018, and there were no device-related SAEs over the duration of the study. A mild postoperative subretinal hemorrhage was detected in 2 recipients, which cleared spontaneously within 2 weeks. OCT confirmed device stability and position under the macula. Improvements in localization abilities were demonstrated for all 4 participants in screen-based, tabletop, and orientation and mobility tasks. In addition, 3 of 4 participants recorded improvements in motion discrimination and 2 of 4 participants recorded substantial improvements in spatial discrimination and identification of tabletop objects. Participants reported their unsupervised use of the device included exploring new environments, detecting people, and safely navigating around obstacles. A positive effect of the implant on participants' daily lives in their local environments was confirmed by an orientation and mobility assessor and participant self-report. Emotional well-being was not impacted by device implantation or usage. Conclusions: The completed clinical study demonstrates that the suprachoroidal prosthesis raises no safety concerns and provides improvements in functional vision, activities of daily living, and observer-rated quality of life. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Quantification of Lanthanides on a PMMA Microfluidic Device with Three Optical Pathlengths Using PCR of UV-Visible, NIR, and Raman Spectroscopy.

Microfluidic devices (MFDs) offer customizable, low-cost, and low-waste platforms for performing chemical analyses. Optical spectroscopy techniques provide nondestructive monitoring of small sample volumes within microfluidic channels. Optical spectroscopy can probe speciation, oxidation state, and concentration of analytes as well as detect counterions and provide information about matrix composition. Here, ultraviolet-visible (UV-vis) absorbance, near-infrared (NIR) absorbance, and Raman spectroscopy are utilized on a custom poly(methyl methacrylate) (PMMA) MFD for the detection of three lanthanide nitrates in solution. Absorbance spectroscopies are conducted across three pathlengths using three portions of a contiguous channel within the MFD. Univariate and chemometric multivariate modeling, specifically Beer's law regression and principal component regression (PCR), respectively, are utilized to quantify the three lanthanides and the nitrate counterion. Models are composed of spectra from one or multiple pathlengths. Models are also constructed from multiblock spectra composed of UV-vis, NIR, and Raman spectra at one or multiple pathlengths. Root-mean-square errors (RMSE), limit of detection (LOD), and residual predictive deviation (RPD) values are compared for univariate, multivariate, multi-pathlength, and multiblock models. Univariate modeling produces acceptable results for analytes with a simple signal, such as samarium cations, producing an LOD of 5.49 mM. Multivariate and multiblock models produce enhanced quantification for analytes that experience spectral overlap and interfering nonanalyte signals, such as holmium, which had an LOD reduction from 7.21 mM for the univariate model down to 3.96 mM for the multiblock model. Multi-pathlength models are developed that maintain model errors in line with single-pathlength models. Multi-pathlength models have RPDs from 9.18 to 46.4, while incorporating absorbance spectra collected at optical paths of up to 10-fold difference in length.

A New Era of Ophthalmology Leadership? A Descriptive and Comparative Analysis of Ophthalmology Department Chairs in 2024.

PURPOSE: To (1) characterize and analyze the demographics and scholarly achievements of United States (US) academic ophthalmology department chairs, and (2) to elucidate trends in the academic and demographic profiles of newly hired department chairs. DESIGN: Cross-sectional study. METHODS: none SETTING: Online search of publicly available resources conducted January 1, 2024. PATIENT OR STUDY POPULATION: 107 ophthalmology chairs of accredited US departments. MAIN OUTCOME MEASURES: Department chair demographic and academic data. RESULTS: Of the 107 chairs analyzed, 83% (89/107) are male. The mean age of chairs is 60.9 ± 7.9 years and the mean age at appointment is 51.9 ± 7.6 years. There has been significant turnover in department chairs recently, with 47 (44%, 47/107) chairs newly appointed in the past seven years. Approximately 40% (41/107) of current chairs completed at least one component of their medical training at the program where they are currently chair. Approximately 1/3 (31%, 33/107) of current chairs earned an additional graduate degree, most frequently a PhD (16%, 17/107), MBA (8%, 10/107), and MS (4%, 8/107). More than 96% (103/107) of chairs completed a clinical fellowship, often in vitreoretinal surgery (28%, 30/107), cornea (25%, 27/107), or glaucoma (22%, 24/107). The average number of peer-reviewed publications amongst chairs is 214.9 ± 294.7 (range 0-1901), and the mean h-index is 35.0 ± 25.4 (range 0-147). When comparing profiles of newly appointed chairs in the past 7 years to chairs appointed prior to 2017, there was not a statistically significant difference in gender distribution (21% female vs. 13% female, respectively, p = 0.276). Newly hired chairs were significantly older at the time of their appointment to chair (54 years vs. 50 years, respectively, p = 0.008) and averaged significantly more years from residency completion to appointment as chair (23 years vs. 19 years, respectively, p = 0.005). CONCLUSIONS: Ophthalmology department chairs remain predominantly fellowship-trained males who have frequently trained at the institution they currently chair. Newly hired chairs have accumulated more experience prior to their appointment, starting the role later in their careers, with implications for the frequency of future chair turnover. While females compose a higher proportion of newly hired chairs in the past 7 years compared to prior, females remain underrepresented in ophthalmology chair positions.

Impacts of increasing levels of salt on intake, digestion, and rumen fermentation with beef cattle consuming low-quality forages.

The objectives of this study were to evaluate the levels of supplemental salt on low-quality forage intake, water intake, dry matter digestibility, and rumen fermentation. Six ruminally cannulated, Angus crossbred heifers (14 mo of age; 449 kg ± 24 kg BW) were used in a dual 3 × 3 Latin square design. The heifers were housed in individual stalls with two animals assigned to each treatment per period. Salt treatments were mixed into a protein supplement of 50% cracked corn and 50% soybean meal and fed at 0.3% of shrunk BW. Salt treatments consisted of: 1) control, no salt (CON), 2) 0.05% of BW salt (LOW), and 3) 0.1% of BW salt (HIGH). Chopped, low-quality (CP = 7.4%; NDF = 64.2%), grass hay was used as the base ration and was provided daily at 120% of the average daily intake of the previous 3 days. Each period included a 14-day diet adaptation, 6 days of sample collection, 1 day collection of rumen fluid samples for ruminal and microbial profiles. Individual forage dry matter intake, water intake, and dry matter digestibility were measured during the 6-day collection period. Rumen pH, ammonia levels, and VFA concentrations were measured during the 1-day ruminal profile. Rumen DM and liquid fill were determined with a 5-hour post feeding rumen evacuation. Supplemental salt had no influence on forage intake (P = 0.19) expressed on a kg/day basis yet tended to decrease linearly (P = 0.06) with increasing levels of salt when expressed on a grams/kg body weight basis. Dry matter digestibility was not influenced by salt levels (P > 0.05), but DM fill tended to increase linearly with increasing salt levels (P = 0.06). Water intake and liquid fill, however, increased linearly with increasing level of salt (P < 0.01) with an 18.9% increase in water intake and 17.0% increase in liquid fill compared to control animals. Ruminal pH and ammonia levels both decreased linearly with increasing salt (P < 0.01). Acetate concentration and acetate: propionate ratio increased linearly with increasing levels of salt (P < 0.01). In contrast, isobutyrate and butyrate concentrations decreased linearly with increasing levels of salt (P < 0.01). Our research suggests that increasing levels of salt tends to influence dry matter intake, DM fill, liquid kinetics, and rumen fermentation characteristics. Results from this research provides additional information on how salt-limited supplements may impact beef cattle consuming low-quality forage diets.

Social Determinants of Health in Diverticulitis: A Systematic Review.

BACKGROUND: There is growing interest in social determinants of health for surgical populations. Within diverticulitis, no systematic collation of available evidence has been performed. OBJECTIVE: To assess frequency, variety, and association directions for social determinants of health in colonic diverticular disease. DATA SOURCES: Four electronic databases were queried: PubMed, Embase, Cochrane, and Web of Science. STUDY SELECTION: Included studies reported symptomatic left-sided colonic diverticular disease with respect to a social determinant of health according to the Healthy People 2030 initiative or applicable proxy variable. Studies with non-English full text, cohort size fewer than 50, pediatric cohorts, and exclusively non-left sided disease were excluded. MAIN OUTCOME MEASURES: Quality assessment through modified Newcastle-Ottawa scale, frequency of variables reported, and effect size trends for common comparisons. RESULTS: Among 50 included studies, 40 were good and 10 were fair in quality. Social determinants of health in diverticulitis were identified across Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context domains. The two most common variables were self-reported race and ethnicity (n = 33) and insurance (n = 22). Among 18 unique studies reporting comparisons of white versus any other self-reported race and ethnicity, twelve identified a disparity disadvantaging non-white groups with effect sizes (95% confidence interval ranging from 1.23 [1.10 -1.37] to 5.35 [1.32 - 21.61]). Among 15 unique studies reporting a non-private versus private insurance comparison, nine identified non-private insurance as a risk factor with effect sizes (95% confidence intervals ranging from 1.15 [1.02 - 1.29] to 3.83 [3.01 - 4.87]). LIMITATIONS: Retrospective studies, heterogeneity across cohort and variable definitions. CONCLUSIONS: Social determinants of health domains are associated with a variety of diverticulitis outcomes. Additional studies are needed to address infrequently reported domains and identify optimal strategies for intervening in clinical settings. PROSPERO ID: CRD42023422606.

Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study.

BACKGROUND: Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking. OBJECTIVE: This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. METHODS: We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. RESULTS: Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. CONCLUSIONS: Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.

Diseases of marine fish and shellfish in an age of rapid climate change.

A recurring trend in evidence scrutinized over the past few decades is that disease outbreaks will become more frequent, intense, and widespread on land and in water, due to climate change. Pathogens and the diseases they inflict represent a major constraint on seafood production and yield, and by extension, food security. The risk(s) for fish and shellfish from disease is a function of pathogen characteristics, biological species identity, and the ambient environmental conditions. A changing climate can adversely influence the host and environment, while augmenting pathogen characteristics simultaneously, thereby favoring disease outbreaks. Herein, we use a series of case studies covering some of the world's most cultured aquatic species (e.g., salmonids, penaeid shrimp, and oysters), and the pathogens (viral, fungal, bacterial, and parasitic) that afflict them, to illustrate the magnitude of disease-related problems linked to climate change.

Precursor central memory versus effector cell fate and naïve CD4+ T cell heterogeneity.

Upon antigenic stimulation, naïve CD4+ T cells can give rise to phenotypically distinct effector T helper cells and long-lived memory T cells. We computationally reconstructed the in vivo trajectory of CD4+ T cell differentiation during a type I inflammatory immune response and identified two distinct differentiation paths for effector and precursor central memory T cells arising directly from naïve CD4+ T cells. Unexpectedly, our studies revealed heterogeneity among naïve CD4+ T cells, which are typically considered homogeneous save for their diverse T cell receptor usage. Specifically, a previously unappreciated population of naïve CD4+ T cells sensing environmental type I IFN exhibited distinct activation thresholds, suggesting that naïve CD4+ T cell differentiation potential may be influenced by environmental cues. This population was expanded in human viral infection and type I IFN response-lined autoimmunity. Understanding the relevance of naïve T cell heterogeneity to beneficial and maladaptive T cell responses may have therapeutic implications for adoptive T cell therapies in cancer immunotherapy and vaccination.

Comparing the Ability of Google and ChatGPT to Accurately Respond to Oculoplastics-Related Patient Questions and Generate Customized Oculoplastics Patient Education Materials.

Purpose: To compare the accuracy and readability of responses to oculoplastics patient questions provided by Google and ChatGPT. Additionally, to assess the ability of ChatGPT to create customized patient education materials. Methods: We executed a Google search to identify the 3 most frequently asked patient questions (FAQs) related to 10 oculoplastics conditions. FAQs were entered into both the Google search engine and the ChatGPT tool and responses were recorded. Responses were graded for readability using five validated readability indices and for accuracy by six oculoplastics surgeons. ChatGPT was instructed to create patient education materials at various reading levels for 8 oculoplastics procedures. The accuracy and readability of ChatGPT-generated procedural explanations were assessed. Results: ChatGPT responses to patient FAQs were written at a significantly higher average grade level than Google responses (grade 15.6 vs 10.0, p < 0.001). ChatGPT responses (93% accuracy) were significantly more accurate (p < 0.001) than Google responses (78% accuracy) and were preferred by expert panelists (79%). ChatGPT accurately explained oculoplastics procedures at an above average reading level. When instructed to rewrite patient education materials at a lower reading level, grade level was reduced by approximately 4 (15.7 vs 11.7, respectively, p < 0.001) without sacrificing accuracy. Conclusion: ChatGPT has the potential to provide patients with accurate information regarding their oculoplastics conditions. ChatGPT may also be utilized by oculoplastic surgeons as an accurate tool to provide customizable patient education for patients with varying health literacy. A better understanding of oculoplastics conditions and procedures amongst patients can lead to informed eye care decisions.

Restoring transient connectivity during development improves dysfunctions in fragile X mice.

Early-generated circuits are critical for the maturation of cortical network activity and the formation of excitation/inhibition (E/I) balance. This process involves the maturation of specific populations of inhibitory neurons. While parvalbumin (PV)-expressing neurons have been associated with E/I impairments observed in neurodevelopmental disorders, somatostatin-expressing (SST) neurons have recently been shown to regulate PV neuron maturation by controlling neural dynamics in the developing cortex. SST neurons receive transient connections from the sensory thalamus, yet the implications of transient connectivity in neurodevelopmental disorders remain unknown. Here, we show that thalamocortical connectivity to SST neurons is persistent rather than transient in a mouse model of Fragile X syndrome. We were able to restore the transient dynamics using chemogenetics, which led to the recovery of fragile X-associated dysfunctions in circuit maturation and sensory-dependent behavior. Overall, our findings unveil the role of early transient dynamics in controlling downstream maturation of sensory functions.

Technique for surgical replacement of the ascending aorta with concomitant aortic valve and hemiarch replacement: a procedural guide.

In this video tutorial case report, we show how to perform an open surgical correction of an ascending aortic aneurysm in a 74-year-old patient requiring concomitant aortic valve and hemiarch replacements, presenting with symptomatic stenosis of the aortic valve and moderate dilatation of the ascending aorta.

How a speaker herds the audience: multibrain neural convergence over time during naturalistic storytelling.

Storytelling-an ancient way for humans to share individual experiences with others-has been found to induce neural alignment among listeners. In exploring the dynamic fluctuations in listener-listener (LL) coupling throughout stories, we uncover a significant correlation between LL coupling and lagged speaker-listener (lag-SL) coupling over time. Using the analogy of neural pattern (dis)similarity as distances between participants, we term this phenomenon the "herding effect." Like a shepherd guiding a group of sheep, the more closely listeners mirror the speaker's preceding brain activity patterns (higher lag-SL similarity), the more tightly they cluster (higher LL similarity). This herding effect is particularly pronounced in brain regions where neural alignment among listeners tracks with moment-by-moment behavioral ratings of narrative content engagement. By integrating LL and SL neural coupling, this study reveals a dynamic, multibrain functional network between the speaker and the audience, with the unfolding narrative content playing a mediating role in network configuration.

Gas-Phase Structures of Fucosylated Oligosaccharides: Alkali Metal and Halogen Influences.

Fucosylated carbohydrate antigens play critical roles in physiology and pathology with function linked to their structural details. However, the separation and structural characterization of isomeric fucosylated epitopes remain challenging analytically. Here, we report for the first time the influence of alkali metal cations (Li+, Na+, K+, Rb+, and Cs+) and halogen anions (Cl-, Br-, and I-) on the gas-phase conformational landscapes of common fucosylated trisaccharides (Lewis A, X, and H types 1 and 2) and tetrasaccharides (Lewis B and Y) using trapped ion mobility spectrometry coupled to mass spectrometry and theoretical calculations. Inspection of the mobility profiles of individual standards showed a dependence on the number of mobility bands with the oligosaccharide and the alkali metal and halogen; collision cross sections are reported for all of the observed species. Results showed that trisaccharides (Lewis A, X, and H types 1 and 2) can be best mobility resolved in the positive mode using the [M + Li]+ molecular ion form (baseline resolution r ≈ 2.88 between Lewis X and A); tetrasaccharides can be best mobility resolved in the negative mode using the [M + I]- molecular ion form (baseline separation r ≈ 1.35 between Lewis B and Y). The correlation between the number of oligosaccharide conformers as a function of the molecular ion adduct was studied using density functional theory. Theoretical calculations revealed that smaller cations can form more stable structures based on the number of coordinations, while larger cations induced greater oligosaccharide reorganizations; candidate structures are proposed to better understand the gas-phase oligosaccharide rearrangement trends. Inspection of the candidate structures suggests that the interplay between ion size/charge density and molecular structure dictated the conformational preferences and, consequently, the number of mobility bands and the mobility separation across isomers. This work provides a fundamental understanding of the gas-phase structural dynamics of fucosylated oligosaccharides and their interaction with alkali metals and halogens.

Integrated clinical risk prediction of type 2 diabetes with a multifactorial polygenic risk score.

Combining information from multiple GWASs for a disease and its risk factors has proven a powerful approach for development of polygenic risk scores (PRSs). This may be particularly useful for type 2 diabetes (T2D), a highly polygenic and heterogeneous disease where the additional predictive value of a PRS is unclear. Here, we use a meta-scoring approach to develop a metaPRS for T2D that incorporated genome-wide associations from both European and non-European genetic ancestries and T2D risk factors. We evaluated the performance of this metaPRS and benchmarked it against existing genome-wide PRS in 620,059 participants and 50,572 T2D cases amongst six diverse genetic ancestries from UK Biobank, INTERVAL, the All of Us Research Program, and the Singapore Multi-Ethnic Cohort. We show that our metaPRS was the most powerful PRS for predicting T2D in European population-based cohorts and had comparable performance to the top ancestry-specific PRS, highlighting its transferability. In UK Biobank, we show the metaPRS had stronger predictive power for 10-year risk than all individual risk factors apart from BMI and biomarkers of dysglycemia. The metaPRS modestly improved T2D risk stratification of QDiabetes risk scores for 10-year risk prediction, particularly when prioritising individuals for blood tests of dysglycemia. Overall, we present a highly predictive and transferrable PRS for T2D and demonstrate that the potential for PRS to incrementally improve T2D risk prediction when incorporated into UK guideline-recommended screening and risk prediction with a clinical risk score.

Long-term Clinical Outcomes of Patients With Negative Pathology (pN0) at Primary Retroperitoneal Lymph Node Dissection.

BACKGROUND: Patients who undergo primary retroperitoneal lymph node dissection (pRPLND) for early-stage testicular cancer and have no cancer (pN0) found in the retroperitoneum are believed to have an excellent prognosis. However, some experience relapse, potentially due to limitations of current staging methods. We aim to describe long-term outcomes and relapse patterns among a contemporary cohort of patients found to be pN0 at pRPLND to identify opportunities for improved diagnostic approaches and optimal patient selection. METHODS: We reviewed our prospectively maintained database for patients who underwent pRPLND for nonseminomatous germ cell tumors at our tertiary cancer center during the period from January 1, 2000, through September 30, 2023 (n = 628). We excluded 282 patients with node-positive pathology for a final analytic cohort of 346 patients. Our primary outcome was recurrence-free survival (RFS). Secondary outcomes included timing and location of recurrence. RESULTS: Of 346 included patients with pN0 pathology, 23 experienced relapse with a 2-year RFS rate of 93% (95% confidence interval: 90, 96). Most recurrences (70%) occurred in the lungs and within 6 months of pRPLND. Serum tumor markers were positive in 43% of patients at the time of relapse. All patients who relapsed were treated with salvage chemotherapy; 6 patients required additional surgical procedures. There was no testis cancer-related deaths. CONCLUSIONS: Two-year RFS for patients with pN0 pRPLND pathology is excellent. All recurrences were outside of the retroperitoneum, suggesting subclinical distant metastases at time of surgery and the benefits of a bilateral template dissection. Improved diagnostics may help better identify patients with disease within or outside of the retroperitoneum prior to pRPLND, helping guide treatment decisions.

Measuring the impact of multiple social cues to advance theory in person perception research.

Forming impressions of others is a fundamental aspect of social life. These impressions necessitate the integration of many and varied sources of information about other people, including social group memberships, apparent personality traits, inferences from observed behaviors, and so forth. However, methodological limitations have hampered progress in understanding this integration process. In particular, extant approaches have been unable to measure the independent contributions of multiple features to a given impression. In this article, after describing these limitations and their constraints on theory testing and development, we present a multinomial processing tree model as a computational solution to the problem. Specifically, the model distinguishes the contributions of multiple cues to social judgment. We describe an empirical demonstration of how applying the model can resolve long-standing debates among person perception researchers. Finally, we survey a variety of questions to which this approach can be profitably applied. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identification of specific injury-related SNPs in high-level athletes of Arab origin: A pilot study.

Valuable insights for preventing sports injuries in athletes have been achieved through advancements in genetics. This study aimed to determine the allelic frequency of distinct single nucleotide polymorphisms (SNPs) in a group of high-level athletes of Arab origin and to explore whether any significant relationship exists between specific genotypes in the selected SNPs with the prevalence and severity of non-contact soft tissue injuries (NCSTIs) and stress fracture injuries (SFIs). A cohort of 30 Arab male adult athletes trained at the same Sports excellence Centre from various individual sports was recruited and genotyped for collagen type 5 alpha 1 (COL5A1) rs12722 and vitamin D receptor (VDR) rs10735810 variants. The injury data of participant athletes were collected over two training seasons and categorized according to the site and type (muscle, tendon, ligament, or stress fracture) and severity (mild, moderate, or severe). For the COL5A1 rs12722, the examined genotypes were not related to the NCSTIs occurrence, while for VDR rs10735810, the CT and TT genotypes showed a prevalence for increased stress fracture injuries (RR = 7.72; 95 % CI: 1.66-35.87; p = 0.011 and RR = 9.93; 95 % CI: 2.83-34.89; p < 0.001, respectively), and increased odds for severe stress fractures (OR = 10.91, 95 % CI: 1.34-126.92, p = 0.033). This pilot study indicates a possible association between specific genotypes in the examined polymorphisms and the prevalence and severity of NCSTIs and SFIs. Given the constraints of the small sample size in the current study, additional research is required to gain a comprehensive understanding of this specific population.

Needs and experiences of postgraduate nursing students in Nigeria during the COVID-19 pandemic.

AIM: To explore the experiences and needs of postgraduate nursing students within the Nigerian context. DESIGN: This qualitative study was conducted using a descriptive phenomenological approach. METHOD: Data were collected between February and April 2022 using a purposive sampling method and telephone semi-structured interviews. Colaizzi's method of Qualitative data Analysis was utilized. Twenty-two Nigerian postgraduate nursing students were interviewed. RESULTS: Three themes emerged: challenges of Nigerian postgraduate students before the pandemic, the impact of the pandemic on postgraduate education, and innovations to improve postgraduate education in Nigeria. The challenges include the burden of physical lectures, lack of infrastructure, and poor mentorship of postgraduate nursing students. The impact of the pandemic on postgraduate education includes abrupt disruption of the academic program, a prolonged academic calendar, and a communication gap between students and their research supervisors. Innovations to improve postgraduate nursing education in Nigeria also include adoption and sustainability of e-learning, upgrading post-basic to postgraduate nursing programmes, proper structuring of postgraduate nursing education, commencement of postgraduate nursing programmes in more universities and provision of financial aid for students. Our primary finding is that funding, mentorship and infrastructure were issues peculiar to all the respondents. CONCLUSION: This study concludes that efforts should be made to maintain a seamless educational program by ensuring an uninterrupted flow of learning through virtual means, thereby enhancing effective teaching and learning. IMPLICATIONS: Graduate nursing studies is one of the suggested solutions in the WHO strategic direction for nursing and midwifery globally to achieve Universal Health Coverage . The reason is that nurses can practice with more and better skills in any work setting, thus improving the quality of health care services. Our study provides insights into the experiences of postgraduate students and how these could discourage other nurses who might have thought about furthering their studies. Efforts should be made to provide all the support that these students need, using evidence from this study and similar studies to ensure they have a good learning experience and others can be motivated to learn at the graduate level as well. This will increase the proportion of nurses and midwives honed with better skills to provide more standard quality services that will improve patient care outcomes.

Further evidence that peritraumatic 17ß-estradiol levels influence chronic posttraumatic pain outcomes in women, data from both humans and animals.

ABSTRACT: Chronic posttraumatic pain (CPTP) is common after traumatic stress exposure (TSE) and disproportionately burdens women. We previously showed across 3 independent longitudinal cohort studies that, in women, increased peritraumatic 17ß-estradiol (E2) levels were associated with substantially lower CPTP over 1 year. Here, we assessed this relationship in a fourth longitudinal cohort and also assessed the relationship between E2 and CPTP at additional time points post-TSE. Furthermore, we used a well-validated animal model of TSE to determine whether exogenous E2 administration protects against mechanical hypersensitivity. Using nested samples and data from the Advancing Understanding of RecOvery afteR traumA study (n = 543 samples, 389 participants), an emergency department-based prospective study of TSE survivors, we assessed the relationship between circulating E2 levels and CPTP in women and men using multivariate repeated-measures mixed modeling. Male and ovariectomized female Sprague Dawley rats were exposed to TSE and administered E2 either immediately after or 3 days post-TSE. Consistent with previous results, we observed an inverse relationship between peritraumatic E2 and longitudinal CPTP in women only (ß = -0.137, P = 0.033). In animals, E2 protected against mechanical hypersensitivity in female ovariectomized rats only if administered immediately post-TSE. In conclusion, peritraumatic E2 levels, but not those at post-TSE time points, predict CPTP in women TSE survivors. Administration of E2 immediately post TSE protects against mechanical hypersensitivity in female rats. Together with previous findings, these data indicate that increased peritraumatic E2 levels in women have protective effects against CPTP development and suggest that immediate post-TSE E2 administration in women could be a promising therapeutic strategy for reducing risk of CPTP.