Electrophysiological Correlates of Visual Memory Search.

In everyday life, we frequently engage in 'hybrid' visual and memory search, where we look for multiple items stored in memory (e.g., a mental shopping list) in our visual environment. Across three experiments, we used event-related potentials to better understand the contributions of visual working memory (VWM) and long-term memory (LTM) during the memory search component of hybrid search. Experiments 1 and 2 demonstrated that the FN400 - an index of LTM recognition - and the CDA -an index of VWM load - increased with memory set size (target load), suggesting that both VWM and LTM are involved in memory search, even when target load exceeds capacity limitations of VWM. In Experiment 3, we used these electrophysiological indices to test how categorical similarity of targets and distractors affects memory search. The CDA and FN400 were modulated by memory set size only if items resembled targets. This suggests that dissimilar distractor items can be rejected before eliciting a memory search. Together, our findings demonstrate the interplay of VWM and LTM processes during memory search for multiple targets.

An Automated Malnutrition Screening Tool Using Routinely Collected Data for Older Adults in Long-Term Care: Development and Internal Validation of AutoMal.

OBJECTIVE: To develop and internally validate a malnutrition screening tool based on routinely collected data in the long-term care setting. DESIGN: Diagnostic prediction model development and internal validation study. SETTING AND PARTICIPANTS: Residents (n = 539) from 10 long-term care facilities in Australia. METHODS: Candidate variables identified through expert consultation were collected from routinely collected data in a convenience sample of long-term care facilities. Logistic regression using the Subjective Global Assessment as the reference standard was conducted on 500 samples derived using bootstrapping from the original sample. Candidate variables were selected if included in more than 95% of samples using backwards stepwise elimination. The final model was developed using logistic regression of selected variables. Internal validation was conducted using bootstrapping to calculate the optimism-adjusted performance. Overall discrimination was evaluated via receiver operator characteristic curve and calculation of the area under the curve. Youden's Index was used to identify the optimal threshold value for classifying malnutrition. Sensitivity and specificity were calculated. RESULTS: Body mass index and weight change % over 6 months were included in the automated malnutrition screening model (AutoMal), identified in 100% of bootstrapped samples. AutoMal demonstrated excellent discrimination of malnutrition, with area under the curve of 0.8378 (95% CI, 0.80-0.87). Youden's Index value was 0.37, resulting in sensitivity of 78% (95% CI, 71%-83%) and specificity of 77% (72%-81%). Optimism-corrected area under the curve was 0.8354. CONCLUSIONS AND IMPLICATIONS: The AutoMal demonstrates excellent ability to differentiate malnutrition status. It makes automated identification of malnutrition possible by using 2 variables commonly found in electronic health records.

A cluster of results on amplituhedron tiles.

The amplituhedron is a mathematical object which was introduced to provide a geometric origin of scattering amplitudes in N = 4 super Yang-Mills theory. It generalizes cyclic polytopes and the positive Grassmannian and has a very rich combinatorics with connections to cluster algebras. In this article, we provide a series of results about tiles and tilings of the m = 4 amplituhedron. Firstly, we provide a full characterization of facets of BCFW tiles in terms of cluster variables for Gr 4 , n . Secondly, we exhibit a tiling of the m = 4 amplituhedron which involves a tile which does not come from the BCFW recurrence-the spurion tile, which also satisfies all cluster properties. Finally, strengthening the connection with cluster algebras, we show that each standard BCFW tile is the positive part of a cluster variety, which allows us to compute the canonical form of each such tile explicitly in terms of cluster variables for Gr 4 , n . This paper is a companion to our previous paper "Cluster algebras and tilings for the m = 4 amplituhedron."

Malnutrition Prevalence in Australian Residential Aged Care Facilities: A Cross-Sectional Study.

Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia.

Effect of brewer's yeast or beta-glucan on breast milk supply following preterm birth: the BLOOM study - protocol for a multicentre randomised controlled trial.

BACKGROUND: Many individuals who experience preterm birth struggle with early breast milk supply, which can translate into suboptimal longer-term breastfeeding outcomes. Further investigations into the potential role of early non-pharmacological and pharmacological interventions in improving breast milk production soon after birth is growing. While natural galactagogues, such as brewer's yeast, are widely perceived by women to be safer than pharmaceutical galactagogues and are taken by many women, evidence to support their efficacy is largely absent. The BLOOM study has been designed to determine the efficacy and safety of brewer's yeast and beta-glucans, derived from Saccharomyces cerevisiae, when administered soon after birth for increasing early breast milk supply in mothers who have delivered preterm. METHODS: The BLOOM study is a multicentre, double-blinded, randomised controlled trial that will assess if brewer's yeast or beta-glucan can increase early breast milk production following preterm birth. Target population are mothers of preterm infants born at less than 34 weeks' gestation who intend to provide breast milk for their infant, are less than 72 h following birth and able to give informed consent. Participants will be randomly allocated into three parallel groups at 1:1:1 ratio (n = 33 per group) to receive either brewer's yeast, beta-glucan or placebo capsules for seven days. The primary outcome is total expressed breast milk volume over a 24-hour period on day 7 of intervention. Participants and their infants will be followed until the infant reaches term corrected age or is discharged home from the neonatal unit (whichever occurs first). DISCUSSION: The use of brewer's yeast as a galactagogue to enhance milk production is extremely common amongst breastfeeding mothers, however, there are no trials evaluating its efficacy and safety. This will be the first randomised controlled trial to evaluate the efficacy and safety of two commonly used galactagogues, brewer's yeast and beta-glucan, compared with placebo in improving maternal breast milk supply following preterm birth. The trial will also evaluate whether early intervention with galactagogues soon after a preterm birth improves longer-term breastfeeding outcomes. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12622000968774 (registered on 8 July 2022) and UTN U1111-1278-8827.

Encouraging entrepreneurship in dietetics: A qualitative exploration of the experiences of new graduate dietitians participating in an entrepreneurship mentoring circle.

AIMS: Healthcare needs of the Australian population are changing, providing an opportunity for dietitians to embrace innovation and entrepreneurship to meet evolving demands. This study explored the expectations and experiences of participants in a 12-month mentoring circle designed to provide entrepreneurship learning and formal mentoring for the Provisional Accredited Practising Dietitians Program. METHODS: A qualitative study design was employed. New graduate dietitians (<2 years) participating in the Entrepreneurial Dietetics Mentoring Circle in 2019, 2020 or 2021 were invited to participate. Baseline demographic and employment data were collected via survey. Semi-structured interviews were conducted before mentoring circle session 1 (baseline) and after the final session (completion), exploring insights into participant expectations and experiences in entrepreneurship. Thematic analysis, using methods outlined by Braun and Clark, was conducted to identify themes and subthemes. RESULTS: Twenty-eight dietitians participated (85% of mentees). Participants were mostly female (89%), less than 12 months post-graduation (75%), registered as Provisional Accredited Practising Dietitians (82%) and employed at least part-time (55%). Forty five interviews were conducted (28 baseline, 18 completion). Themes developed were: (1) entrepreneurial career path as a deliberate choice; (2) the value of being prepared for entrepreneurial careers; and (3) the importance of networks to support entrepreneurship. CONCLUSION: The mentoring circle at this single university was seen by participants as supporting their transition into entrepreneurial careers, while meeting their requirement to be formally mentored through their Provisional status. Future research could consider the applicability of the mentoring circle model across a wider graduate population to support innovative practice.

Effectiveness of dietetic care for cancer survivors in the primary care setting: A systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Nutrition plays an important role in cancer survivorship. This systematic review and meta-analysis aim to critically assess and quantify the effectiveness of nutrition care interventions provided by dietitians to survivors who have completed treatment for cancer. METHODS: A systematic review of randomized controlled trials (RCTs) published from January 2004 to November 2023 reporting the effectiveness of primary care dietetic interventions with adult cancer survivors was conducted. PubMed, Scopus, CINAHL, Embase, ProQuest and PsycINFO databases were searched for key terms. Meta-analyses were conducted where there were sufficient studies of the same cancer type and outcomes. RESULTS: Twelve RCTs representing 1138 cancer survivors (519 breast cancer; 75 prostate cancer; 544 colorectal cancer) were included. Primary outcome measures included weight loss (n = 6), quality of life (n = 2), reducing lymphedema-related arm volume (n = 2), nutritional status (n = 1) and increasing fruit and vegetable intake (n = 1). Weight loss was observed in studies where this was the primary outcome. Results for quality of life varied. Meta-analyses of RCTs with breast cancer survivors showed that dietitian intervention achieved a mean of 3.7 kg greater intentional weight loss and 2.3% greater body fat decrease than control (p < 0.0001). CONCLUSIONS: This study provides evidence for the effectiveness of primary care dietetic interventions by dietitians with cancer survivors, particularly with respect to intentional weight and fat loss in breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Dietitians can play a key role in managing weight and improving long term health outcomes and prognosis for cancer survivors beyond the acute care setting.

Surgical Repair of Psittacine Femorotibial Luxation: A Case Series.

Luxation of the psittacine femorotibial joint most commonly occurs following trauma or as a development abnormality. Historically, this injury is considered to have a poor prognosis in birds; however, surgical management may result in acceptable and functional outcomes. This case series describes the surgical techniques, complications, and outcomes of 7 cases of femorotibial luxation in psittacine birds. Of the 7 cases, 6 were chronic injuries. Surgical repair methods included conjoined intramedullary pinning, transarticular pinning with an external skeletal fixator (ESF), a combination of extracapsular stabilization and ESF, ESF alone, and a combination of conjoined intramedullary pins with an ESF. An acceptable outcome was achieved in 75% (6/8) of luxated femorotibial joints managed with surgical methods. All cases were female birds of various species, suggesting a possible sex predisposition for stifle luxation.

South Africa's oceans and coastal and information management system towards improved ocean access, protection, and governance.

The Oceans and Coastal Information Management System (OCIMS) was launched by the South African Government in 2015 to support the development and governance of the South African ocean economy. The OCIMS has established knowledge tools for marine spatial planning, maritime domain awareness, search and rescue, water quality and harmful algal bloom monitoring. Those tools are used daily by stakeholders across government departments, industry, and civil society. Unlike many other operational oceanographic and coastal systems around the world, the OCIMS was designed from its inception using inputs from stakeholders. Continuous engagements between developers and stakeholders have ensured that the system remains fit for purpose. The OCIMS is both locally relevant and globally cognizant. Developments are undertaken to ensure inter-operability with other systems in the world and promote the exchange and discovery of data. The OCIMS project was able to leverage co-funding and the sharing of data and expertise through partnerships across the public and private sectors. These partnerships have been essential to the success of OCIMS and would not have been possible without continued engagements and the sustained funding provided by the South African national government. The development pathway followed to establish the OCIMS could benefit other countries looking to implement their own operational ocean and coastal system knowledge platform.

Dietetics student contribution to addressing malnutrition in residential aged care facilities.

AIMS: To test a model of malnutrition screening and assessment conducted by dietetics students on placement in residential aged care facilities. The secondary aim was to identify possible facilitators and barriers to the implementation of the model. METHOD: The type 1 hybrid effectiveness-implementation trial study design and reporting outcomes were developed using the Consolidated Framework for Implementation Research. An innovative placement model was developed, where students on voluntary placement visited three residential aged care facilities to identify residents at risk of malnutrition using currently available screening tools for older people. Students completed malnutrition assessments for all residents using the subjective global assessment tool. RESULTS: Thirty-two students participated; 31 completed all three sessions, with malnutrition screening completed for 207 residents and malnutrition assessment for 187 residents (July and September 2022). Based on the subjective global assessment, 31% (n = 57) of residents were mildly/moderately malnourished, and 3% (n = 5) were severely malnourished. The Innovation Domain of the Framework was the most important consideration before implementation. CONCLUSION: Whilst previous research documented student learning opportunities in residential aged care facilities, this study provides the first available evidence of the direct contribution students can make to the health of aged care residents through malnutrition screening and assessment. The model enables students to conduct malnutrition screening and assessment feasibly and efficiently in facilities that do not routinely collate and act on these data. With a limited nursing aged care workforce to undertake this vital task, the potential role of student dietitians to fulfil this role must be considered.

Allied health students' experiences of older adults in residential aged care placements: A scoping review.

AIM: To explore the attitudes and experiences of allied health students working with older adults on residential aged care placements. METHOD: A systematic literature search was conducted to identify studies of any design describing allied health student experience of residential aged care placements. Online databases searched to identify potentially relevant documents included Scopus, Web of Science, PubMed, CINAHL Complete (EBSCOhost) and Health and Medicine (ProQuest). Studies were excluded if residential aged care facilities or allied health professional students could not be extracted from the data. No restrictions were applied to methodological design, language, geographical location or year of publication. The Mixed Methods Appraisal Tool was used to assess methodological quality. Extracted studies were analysed to identify the study design, participant and placement characteristics, study methodology and student experience measures. Data from the included studies were analysed thematically using meta-synthesis. RESULTS: Six studies (total number of participants, n = 308) met inclusion criteria, with four papers scoring a 5/5 on the Mixed Methods Appraisal Tool. Studies included undergraduate and master's students from physiotherapy (n = 3), speech language pathology (n = 2), dietetics (n = 1) and audiology (n = 1). Placement length varied from two to 15 h, between one and six residential aged care visits. Three themes were identified; (1) Opportunity to improve skills and gain confidence, (2) Development of empathy and shift in attitudes towards older adults and (3) Recognised challenges associated with older adults and residential aged care settings. CONCLUSION: While the size of the evidence-base is limited, the studies were largely consistent in demonstrating an increase in positive attitudes towards older adults following residential aged care placements. Future research, innovations and planning around workforce size, preparation and motivation must be prioritised to ensure older adults receive the care they need and deserve.

The prevalence of psychological distress in adults newly diagnosed with type 2 diabetes: Data from the Australian 3D case-series study.

ISSUE ADDRESSED: This cross-sectional analysis of the Australian 3D study aimed to determine the prevalence of psychological distress and describe its associated characteristics in adults recently diagnosed with type 2 diabetes. METHODS: Adults (aged 18 years and over) who were recently diagnosed with type 2 diabetes (<6 months prior) were recruited through the Australian National Diabetes Services Scheme in 2018-2019. Demographic and health data were collected via interview-administered telephone surveys. Hierarchical regression was used to analyse whether demographic, self-care and clinical characteristics were associated with psychological distress, as measured by the K10 questionnaire. RESULTS: Of the participants (n = 223), 26.3% presented with psychological distress, with 8.4% reporting mild, 8.4% reporting moderate and 9.5% reporting severe psychological distress. Neither age, sex, body mass index or taking anti-depressant medications were associated with the presence of psychological distress (p > .05). Being a smoker, living situation, less physical activity and poorer healthy eating beliefs and intentions were significantly associated with psychological distress in those not taking anti-depressant medications (p < .05). Being female was significantly associated with psychological distress in those taking anti-depressant medications (p < .05). CONCLUSION: The study found that psychological distress is highly prevalent in adults recently diagnosed with type 2 diabetes. Behavioural factors such as smoking and low physical activity, as well as psycho-social factors such as living situation, poor healthy eating beliefs and intentions were significantly associated with psychological distress. This has implications for the management of people with newly diagnosed type 2 diabetes. SO WHAT?: Psychological distress is highly prevalent in Australian adults newly diagnosed with type 2 diabetes, emphasising the urgent need for enhanced psychological care to support this group.

Trends in Head and Neck Injuries Related to Electric Versus Pedal Bicycle Use in the United States.

OBJECTIVES: To describe the incidence of head and neck trauma related to electric bicycles and to characterize head and neck injury patterns seen in electric bicycle (eBike) users versus pedal bicyclists in the United States. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried from 2009 to 2020 for patients with head and neck injuries related to electric and pedal bicycles. Extracted data included patient demographics, injury patterns, hospital admission, and helmet use. Univariate chi-squared analyses were performed to compare demographics and injury patterns between bicycle groups. Effect sizes were reported with Cramer V values (V). RESULTS: The incidence of eBike-related head and neck injuries increased from 2993 in 2009 to 9916 in 2020. Compared to pedal bicycle users, eBike users were more likely to have head injuries (60.4% vs. 52.0%) and fractures (10.9% vs. 6.0%), and were more likely to require hospitalization (20.6% vs. 10.4%). The effect size of helmet use was significantly greater in eBike users compared to pedal bicyclists when examining distributions of age group (V = 0.203 vs. V = 0.079), injury location (V = 0.220 vs. V = 0.082), and injury type (V = 0.162 vs. V = 0.059). Helmeted injuries in eBike users more commonly involved neck injuries and sprains, rather than head injuries and fractures. CONCLUSION: Head and neck trauma related to eBike use is increasing in the United States. Injury patterns and admission rates reflect greater injury severity in eBike users compared to pedal bicyclists. Helmet use may be particularly beneficial in mitigating head and neck injury in eBike users. LEVEL OF EVIDENCE: 3 Laryngoscope, 2023.

How Can We Find Out What Indigenous Children and Their Families Need to Manage Weight? Lessons from Formative Nutrition Intervention Research with First Australians.

In Australia, Indigenous children have rates of overweight and obesity 1.5 times those of non-Indigenous children. Culturally safe and effective nutrition interventions are needed for this group. This paper aims to describe a Community-based Participatory Action Research (CPAR) approach to designing formative nutrition intervention research with First Australian children and their families and to reflect on the challenges arising from this process. After obtaining ethical approvals, a Steering Committee (SC), including nine Aboriginal and Torres Strait Islander people experienced in delivering or receiving health care, was established as a project governance body to develop culturally safe project materials and methods. The Indigenous research method of yarning circles was chosen by the SC for the community consultation, and the First Australian SC members were trained to collect the data. They liaised with community organizations to recruit yarning circle participants. Individual interviews conducted by an Aboriginal research assistant replaced yarning circles due to the COVID-19 pandemic lockdowns. While the CPAR approach to formative research was successful, the pandemic and other factors tripled the study duration. To authentically, ethically and safely engage First Australians in research, researchers need to decolonize their methodological approach, and funding bodies need to allow adequate time and resources for the process.

Building a resilient future workforce: Analysis of initiatives in Australian and New Zealand dietetics curricula.

AIM: Dietitians work in high-pressure environments and student dietitians attend placement in these settings. Resilience is a personal quality that can buffer against the stressors of professional placement; however, little is known about how dietetics students learn resilience. This study aimed to describe how resilience is embedded within Australian and New Zealand dietetics curricula. METHODS: This three-phased qualitative study examined 18 credentialed dietetics education programs in Australia (n = 16) and New Zealand (n = 2). In Phase 1 (document analysis), publicly available curricular documents were screened for key resilience terms. In Phase 2, academics were invited to participate in a semi-structured interview on Microsoft Teams to verify and advance upon documentary evidence. Extracted data were combined and evaluated according to Bloom's Taxonomy in Phase 3. RESULTS: Fifty-six courses were found to have documented mentions of resilience factors from dietetics programs in Australia and New Zealand. Academics from 14 universities (12 Australia and 2 New Zealand) were interviewed. Three themes were identified from Phase 3: Resilience is valuable content within a dietetics degree, Resilience can be taught indirectly throughout programs and Resilience education is not static. Resilience education was mostly taught by academic dietitians in courses prior to placement and assessed by students completing self-reflection while on placement. The documentation of resilience within learning objectives and graduate attributes varied between universities. CONCLUSION: While all dietetics programs included some resilience curricula, academics acknowledged that resilience content and their own knowledge base could be strengthened. The findings provide direction for program improvements and further research.

Systemic infusion of TLR3-ligand and IFN-α in patients with breast cancer reprograms local tumor microenvironments for selective CTL influx.

BACKGROUND: Presence of cytotoxic T lymphocytes (CTL) in the tumor microenvironment (TME) predicts the effectiveness of cancer immunotherapies. The ability of toll-like receptor 3 (TLR3) ligands, interferons (IFNs) and COX2 inhibitors to synergistically induce CTL-attracting chemokines (but not regulatory T cell (Treg)-attractants) in the TME, but not in healthy tissues, observed in our preclinical studies, suggested that their systemic application can reprogram local TMEs. METHODS: Six evaluable patients (33-69 years) with metastatic triple-negative breast cancer received six doses of systemic chemokine-modulating (CKM) regimen composed of TLR3 ligand (rintatolimod; 200 mg; intravenous), IFN-α2b (20 MU/m2; intravenous) and COX2 inhibitor (celecoxib; 2×200 mg; oral) over 2 weeks. The predetermined primary endpoint was the intratumoral change in the expression of CTL marker, CD8α, in the post-CKM versus pre-CKM tumor biopsies. Patients received follow-up pembrolizumab (200 mg, intravenously, every 3 weeks), starting 3-8 days after completion of CKM. RESULTS: Post-CKM biopsies showed selectively increased CTL markers CD8α (average 10.2-fold, median 5.5-fold, p=0.034) and granzyme B (GZMB; 6.1-fold, median 5.8-fold, p=0.02), but not FOXP3 (Treg marker) relative to HPRT1 expression, resulting in the increases in average CD8α/FOXP3 ratio and GZMB/FOXP3 ratio. CKM increased intratumoral CTL-attractants CCL5 and CXCL10, but not Treg-attractants CCL22 or CXCL12. In contrast, CD8+ T cells and their CXCR3+ subset showed transient decreases in blood. One clinical response (breast tumor autoamputation) and three stable diseases were observed. The patient with clinical response remains disease free, with a follow-up of 46 months as of data cut-off. CONCLUSIONS: Short-term systemic CKM selectively increases CTL numbers and CTL/Treg ratios in the TME, while transiently decreasing CTL numbers in the blood. Transient effects of CKM suggest that its simultaneous application with checkpoint blockade and other forms of immunotherapy may be needed for optimal outcomes.

Delphi Plus: A novel methodology for identifying evidence-based data standards for health service decision-making.

The underlying tenet of evidence-based decision-making in health services is assessing all the relevant evidence. Using the traditional qualitative and quantitative approaches to identifying evidence may not capture the full spectrum of factors that need to be addressed. A selective mixed-method approach may provide a comprehensive assessment of the relevant knowledge. This paper adds to the methodological literature by outlining a novel sequential, mixed-method, exploratory process for identifying evidence-based data standards that may be used for health service decision-making. The three-phase process, entitled Delphi Plus, engages peer-nominated topic-specific experts to assess all publicly available and practice-based items and, through a series of reviews, reach an evidence-based consensus on standards for decision-making. Each process phase is outlined in-depth and supplemented by practical learnings gained through its implementation. The Delphi Plus methodology provides the first comprehensive process for combining the published and practised data to develop evidence-based data standards. The routine use of Delphi Plus would provide a framework for benchmarking in health services, enabling greater monitoring and evaluation of client outcomes and improving quality care. This manuscript describes the process of implementing Delphi Plus and provides an example of data standards generated from its use, which directly inform the Australian Government's Primary Health Care 10 Year Plan.

Botulinum Toxin: A Potential Cardiovascular Agent?

Botulinum neurotoxin (BoNT) is a toxin with a wide repertoire of well-known applications in cosmetics and medicine, such as treating migraine headaches, spasticity, and achalasia, and it has generally been shown to be safe and well-tolerated. In addition to its current successes in clinical practice, studies have also demonstrated the potential of BoNT to be used as a therapeutic agent for many cardiovascular conditions. Prior investigations, as well as trials currently underway, have showcased the safety and potential efficacy of BoNT in applications such as treating ischemia-reperfusion injury, hypertension, atrial fibrillation, and heart failure. While further study in humans, as well as improved statistical power in efficacy studies, are needed before its prospective use as a treatment for the aforementioned conditions, one might consider BoNT a potential cardiovascular agent.

Association of Age and Frailty With 30-Day Outcomes Among Patients Undergoing Oral Cavity Cancer Surgery.

OBJECTIVE: To evaluate the impact of age and frailty on 30-day outcomes following surgery for oral squamous cavity carcinoma (OSCC). STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: American College of Surgeons' National Quality Improvement Program (NSQIP) database. METHODS: Patients who underwent OSCC resection were queried via NSQIP (2015-2020). Cases were stratified by age (18-65, 65-75, and older than 75) as well as by modified frailty index scores (mFI 0, mFI 1, and mFI 2+) for comparative analyses. Univariate and multivariable analyses were conducted to examine demographics, perioperative outcomes, and 30-day postoperative adverse events. RESULTS: A total of 3238 patients who underwent OSCC surgery were identified and categorized as nongeriatric ("NGA," age 18-65), younger geriatric ("YGA," age 65-75), and older geriatric ("OGA," age >75) adults. Compared to NGA, geriatric patients had higher the American Society of Anesthesiologists classification, higher modified frailty index scores, and more comorbidities such as hypertension, congestive heart failure, chronic obstructive disease, and diabetes (p < .001). YGAs and OGAs were also less likely to undergo neck dissection (p < .001), composite resection (p = .006), and free flap reconstruction compared to NGAs (p < .001). When controlling for confounders, age was not independently associated with an increased risk of poor outcomes. On the other hand, frailty was found to be independently associated with a higher risk of adverse events (odds ratio: 1.40 [1.15-1.70], p < .001 for mFI 1, odds ratio: 1.45 [1.04-2.02], p = .027 for mFI 2+). CONCLUSION: A higher mFI score, not older age, is associated with an increased risk of 30-day complications following OSCC surgery.