Differential allelopathic effects of mangrove plants Kandelia obovata and Aegiceras corniculatum on harmful algal species: Potential applications in algal bloom control.

This study examined effects of mangrove plants Kandelia obovata and Aegiceras corniculatum on harmful algal species. While A. corniculatum leaf extract had no inhibitory effect, K. obovata leaf extract significantly inhibited the growth of two harmful algal species Alexandrium tamarense and Karenia mikimotoi. The inhibitory effect was concentration-dependent, with over 90 % inhibition at the highest concentration. Morphological changes and cell size reduction were observed in both microalgae. Excessive production of reactive oxygen species and damage to algal photosynthetic system were found. The allelopathic effect of K. obovata on K. mikimotoi with low-concentration repeated exposure was more effective than high-concentration single exposure. The EC50 of K. obovata (0.33 g L-1) was lower than reported values on other coastal plants. Higher inhibitory effects of K. obovata were found on naked algal species than the armoured ones. These findings suggest potential applications of K. obovata leaf extract in controlling harmful algal blooms.

Metrics used in quality improvement publications addressing environmental sustainability in healthcare: A scoping review protocol.

Quality improvement approaches are increasingly being used to address the problem of healthcare's climate and ecological impact. While sustainability is increasingly recognized as a domain of quality, consensus is lacking on the most appropriate measures and metrics for those looking to reduce ecological impacts through quality improvement initiatives. We propose a scoping review to summarize approaches for selecting and quantifying ecological impacts in the published quality improvement literature. We will search multiple electronic databases (MEDLINE, EMBASE, CINAHL, and Scopus) from 2000 onwards, to identify published quality improvement initiatives in the human healthcare setting intended to address ecological impact with at least one quantitative measure of ecological impact, such as kilograms of carbon dioxide equivalent greenhouse gas. Two independent reviewers working in parallel will screen studies for inclusion and abstract study data, including publication, study, and ecological impact characteristics. Charted data will be synthesized narratively as well as with descriptive tables, figures, and summary statistics. In doing so, we will map areas of relative focus as well as gaps in the measurement of ecological impact across quality improvement initiatives. This map can in turn be used to raise awareness of ecological impacts requiring broader consideration, encouraging holistic and clinically relevant approaches to measuring ecological impact in future quality improvement work.

The Influence of Mallet Mass and Velocity on the Fracture Patterns in Osteotomies.

INTRODUCTION: Osteotomies are routinely incorporated in rhinoplasty, however, the influence of mass, velocity, kinetic energy (KE), and momentum (p) of the mallet on fracture patterns has not been studied. METHODS: An experimental sledge guillotine setup was designed simulating a mallet strike with adjustable height and mass and 2 mm-thick Sawbone blocks. KE and p were calculated using KE = ½ mass × velocity2 and p = mass × velocity formulas. Fracture lengths and angles were measured. RESULTS: Ten groups with varying mallet masses and drop heights were tested with 10 bones per group. Fracture length positively correlated with KE (R = 0.542, p < 0.001) and p (R = 0.508, p < 0.001). Fracture angle also positively correlated with KE (R = 0.367, p < 0.001) and p (R = 0.329, p < 0.001). In groups with similar KE, osteotomies with higher p (heavier mallet with slower velocity) had greater fracture lengths (29.31 ± 0.68 vs. 27.68 ± 2.12 mm, p = 0.013) but similar fracture angles (p = 0.189). In groups with similar p, osteotomies with higher KE (lighter hammer with faster velocity) had significantly greater fracture lengths (28.28 ± 1.28 vs. 20.45 ± 12.20 mm, p = 0.041) and greater divergent fracture angles (3.13 ± 1.97° vs. 1.40 ± 1.36°, p = 0.031). Regression modeling of the relationship between KE and fracture lengths and angles demonstrated that cubic followed by logarithmic regression models had the best fits. CONCLUSION: Osteotomy fracture patterns positively correlated with the mallet's KE more so than its p, suggesting that the mallet's velocity has an increased impact effect than its mass. Clinically, a heavier mallet with a lower velocity will likely generate a smaller fracture length and fracture angle, indicating a more controlled and ideal fracture. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

How Medical Students Benefit from Participating in a Longitudinal Resource Stewardship Medical Education Program (STARS): An International Descriptive Evaluation.

BACKGROUND: STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders. AIM: To understand how partaking in STARS impacted participants' knowledge, skills, and influenced career plans, and aspirations. SETTING AND PARTICIPANTS: We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries. PROGRAM DESCRIPTION: STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools. PROGRAM EVALUATION: Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS. DISCUSSION: STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.

Neural mechanism underlying preview effects and masked priming effects in visual word processing.

Two classic experimental paradigms - masked repetition priming and the boundary paradigm - have played a pivotal role in understanding the process of visual word recognition. Traditionally, these paradigms have been employed by different communities of researchers, with their own long-standing research traditions. Nevertheless, a review of the literature suggests that the brain-electric correlates of word processing established with both paradigms may show interesting similarities, in particular with regard to the location, timing, and direction of N1 and N250 effects. However, as of yet, no direct comparison has been undertaken between the two paradigms. In the current study, we used combined eye-tracking/EEG to perform such a within-subject comparison using the same materials (single Chinese characters) as stimuli. To facilitate direct comparisons, we used a simplified version of the boundary paradigm - the single word boundary paradigm. Our results show the typical early repetition effects of N1 and N250 for both paradigms. However, repetition effects in N250 (i.e., a reduced negativity following identical-word primes/previews as compared to different-word primes/previews) were larger with the single word boundary paradigm than with masked priming. For N1 effects, repetition effects were similar across the two paradigms, showing a larger N1 after repetitions as compared to alternations. Therefore, the results indicate that at the neural level, a briefly presented and masked foveal prime produces qualitatively similar facilitatory effects on visual word recognition as a parafoveal preview before a single saccade, although such effects appear to be stronger in the latter case.

Impact of Tissue Handling and Size Modification on Septal Chondrocyte Viability.

INTRODUCTION: The physical modification of cartilage grafts during rhinoplasty risks chondrocyte death at the margins where the tissue is cut. This study compares chondrocyte viability between diced, scaled, and pate samples in human models, and further computes percent chondrocyte viability as a function of sequential dicing size in a computational model. METHODS: Septal cartilage from 11 individuals was prepared as follows: diced (1 mm cubic), scaled (shaved to <1 mm thickness ~ translucent), pate (0.02 g of scraped cartilage surface), positive control (2 × 2 mm diced), and negative control (2 × 2 mm diced soaked in 70% EtOH). Viability analysis was performed using Live/Dead assay™ and confocal microscopy. Numerical simulation of cartilage dicing in 0.05 mm increments was performed using MATLAB assuming 250 chondrocytes/mm3 with each average chondrocyte size of 65 µm2. RESULTS: Chondrocyte viability was similar between 1 mm diced cartilage, scaled cartilage, and positive control samples (p > 0.05). Conversely, pate samples had significantly less viability compared to positive controls, diced samples, and scaled samples (all p < 0.01 after Bonferroni correction). Pate samples had similar chondrocyte viability compared to negative controls (p = 0.36). On computational modeling, cartilage viability decreased to 50% as the diced sample was cut from 1 mm edge length to 0.7-0.8 mm. Similarly, cartilage viability decreased to 26% at 0.55-0.65 mm, 11% at 0.4-0.5 mm, and <5% at <0.4 mm edge length. CONCLUSION: Modifying septal cartilage grafts into 1 mm diced or scaled samples maintains ideal chondrocyte viability whereas pate preparations result in significant chondrocyte death. According to computational analysis, chondrocyte viability sharply decreases as the cartilage is diced below 0.7-0.8 mm. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

Development of EEG alpha and theta oscillations in the maintenance stage of working memory.

Several studies have shown developmental changes in EEG oscillations during working memory tasks. Although the load-modulated theta and alpha activities in adults are well-documented, the findings are inconsistent if children possess the adult-like brain oscillations that are similarly modulated by memory load. The present study compares children's and adults' true theta and alpha EEG oscillations, separated from aperiodic components, in the maintenance stage of working memory. The EEG was recorded in 25 Chinese-speaking children (14 male, Mage = 9.4 yrs) and 31 adults (19 male, Mage = 20.8 yrs) in Hong Kong while they performed an n-back task that included four conditions differing in load (1- vs. 2-back) and stimulus type (Chinese character vs. visual pattern). The results show that aperiodic activities (i.e., broadband power and slope) during the maintenance stage in the n-back task were significantly higher in children than adults. The periodic theta and alpha oscillations also changed with age. More importantly, adults showed significant periodic theta increase with memory load, whereas such an effect was absent in children. Regardless of age, there was a significant alpha power decrease with load increase, and a significant theta power enhancement when maintaining visual patterns than Chinese characters. In adults, load-modulated alpha peak shift (towards higher frequency) was linked to higher behavioral efficiency in the n-back task. In children, higher load-modulated theta enhancement was linked to better behavioral efficiency. The findings suggest that the load-modulated theta power during working memory maintenance matures from childhood to adulthood.

Second harmonic generation microscopy of electromechanical reshaping on corneal collagen.

Refractive errors remain a global health concern, as a large proportion of the world's population is myopic. Current ablative approaches are costly, not without risks, and not all patients are candidates for these procedures. Electromechanical reshaping (EMR) has been explored as a viable cost-effective modality to directly shape tissues, including cartilage. In this study, stromal collagen structure and fibril orientation was examined before and after EMR with second-harmonic generation microscopy (SHG), a nonlinear multiphoton imaging method that has previously been used to study native corneal collagen with high spatial resolution. EMR, using a milled metal contact lens and potentiostat, was performed on the corneas of five extracted rabbit globes. SHG was performed using a confocal microscopy system and all images underwent collagen fibril orientation analysis. The collagen SHG signal in controls is uniform and is similarly seen in samples treated with pulsed potential, while continuous EMR specimens have reduced, nonhomogeneous signal. Collagen fibril orientation in native tissue demonstrates a broad distribution with suggestion of another peak evolving, while with EMR treated eyes a bimodal characteristic becomes readily evident. Pulsed EMR may be a means to correct refractive errors, as when comparing its SHG signal to negative control, preservation of collagen structures with little to no damage is observed. From collagen fiber orientation analysis, it can be inferred that simple DC application alters the structure of collagen. Future studies will involve histological assessment of these layers and multi-modal imaging analysis of dosimetry.

Challenges in Diagnosing Extruded Hydrogel Scleral Buckle Mimicking an Orbital Abscess: A Case Report.

In this case report, we present an unusual complication linked to a hydrogel explant in a 72-year-old male presenting to the emergency department with persistent left eye pain, redness, and discharge for one month. The patient had a history of retinal detachment in 1989, which was managed with scleral buckle surgery and gas injection. Initial examination revealed an extruding scleral buckle in the superior temporal region, along with signs of an infection. CT scans revealed a 1.9 × 1.2 × 3.8 cm abscess accompanied by preseptal cellulitis. This case report highlights the importance of how hydrogel scleral buckle explants may mimic the presentation and symptoms of an abscess as a long-term complication. Nevertheless, there have been several reports of long-term issues associated with the expansion of the hydrophilic hydrogel material. This case report further illustrates how complications linked to hydrogel explants can resemble abscess symptoms, underscoring the significance of accurate diagnosis and appropriate management.

Revisiting the influence of phonological similarity on cognate processing: Evidence from Cantonese-Japanese bilinguals.

The influences of shared orthography, semantics, and phonology on bilingual cognate processing have been investigated extensively. However, mixed results have been found regarding the effects of phonological similarity on L2 cognate processing. In addition, most existing studies examining the influence of phonological similarity on cognate processing have been conducted on alphabetic scripts, in which phonology and orthography are always associated. Hence, in this study, we recruited Cantonese-Japanese bilinguals who used two logographic scripts, traditional Chinese and Japanese Kanji, to examine the influence of phonological similarity on L2 cognate lexical decision. Importantly, these scripts allow the manipulation of phonological similarity using identical characters across both languages. In addition, we examined how word frequency and L2 proficiency modulate cognate processing. Results showed that although word frequency and L2 proficiency played important roles in cognate processing, there was minimal overall influence of phonological similarity on cognate lexical decision. The latter finding suggests that theoretical models of bilingual word recognition may need to be refined to enhance our understanding of cognate processing regarding the role of phonology among diverse bilingual populations.

Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education.

Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.

In EPAs we trust, is quality and safety a must? A cross-specialty analysis of entrustable professional activity guides.

PURPOSE: The inclusion of quality improvement (QI) and patient safety (PS) into CanMEDS reflects an expectation that graduating physicians are competent in these areas upon training completion. To ensure that Canadian postgraduate specialty training achieves this, the translation of QI/PS competencies into training standards as part of the implementation of competency-based medical education requires special attention. METHODS: We conducted a cross-specialty, multi-method analysis to examine how QI/PS was incorporated into the EPA Guides across 11 postgraduate specialties in Canada. RESULTS: We identify cross-specialty variability in how QI/PS is incorporated, positioned, and emphasized in EPAs and milestones. QI/PS was primarily referenced alongside clinical activities rather than as a sole competency or discrete activity. Patterns were characterized in how QI/PS became incorporated into milestones through repetition and customization. QI/PS was also decoupled, conceptualized, and emphasized differently across specialties. CONCLUSIONS: Variability in the inclusion of QI/PS in EPAs and milestones has important implications considering the visibility and influence of EPA Guides in practice. As specialties revisit and revise EPA Guides, there is a need to balance the standardization of foundational QI/PS concepts to foster shared understanding while simultaneously ensuring context-sensitive applications across specialties. Beyond QI/PS, this study illuminates the challenges and opportunities that lie in bridging theoretical frameworks with practical implementation in medical education, prompting broader consideration of how intrinsic roles and emergent areas are effectively incorporated into competency-based medical education.

Trends in Botulinum Toxin-Related Industry Payments to Physicians.

Objectives: To evaluate trends in botulinum toxin (BTX) industry payments to physicians. Methods: Cross-sectional analysis of nonroyalty, BTX-specific payments made by Allergan (Botox), Ipsen (Dysport), and Merz (Xeomin) to physicians using the 2016-2020 Open Payments Database. Results: Between 2016 and 2020, >$27 million in payments was made for BTX-related activities to dermatologists, neurologists, ophthalmologists, otolaryngologists, and plastic surgeons, with payments ranging from $3.9 million in 2016 to $8.7 million in 2019. 21.7% was paid to dermatologists, 57.5% to neurologists, 5.9% to ophthalmologists, 5.7% to otolaryngologists, and 9.1% to plastic surgeons. Conclusions: Growing amounts are being paid to physicians for BTX-related activities-both medical and aesthetic. Despite the variety of indications for BTX within otolaryngology, otolaryngology payments were overshadowed by other specialties, which may reflect greater BTX utilization in those specialties.