Longitudinal Associations Between Perceived Discrimination and Suicidality in Youth.

Research among adults reveals robust associations between discrimination and suicidality. However, the relationship between discrimination and suicidality is understudied in youth. Participants in the Adolescent Brain Cognitive Development study (n = 10  312) completed a measure of discrimination based on multiple attributes. The Kiddie Schedule for Affective Disorders and Schizophrenia was administered 1 year later to assess depressive disorders and suicidality (ideation and behavior). Logistic regressions, adjusting for age, sex, race/ethnicity, family income, lifetime depressive disorders, and body composition were conducted. Adjusting for covariates, discrimination based on weight (OR: 2.19), race/ethnicity/color (OR: 3.21), and sexual orientation (OR: 3.83) were associated with greater odds of reporting suicidality 1 year later (ps < 0.025). Nationality-based discrimination was not significantly associated with suicidality. Compared with those reporting no discrimination, youths reporting discrimination based on 2 or more attributes had nearly 5 times greater odds of recent suicidality (OR: 4.72; P < .001). The current study highlights the deleterious impacts of discrimination on mental health among youths reporting multiple forms of discrimination.

Somatic Symptom Severity, Not Injury Severity, Predicts Probable Posttraumatic Stress Disorder and Major Depressive Disorder in Wounded Service Members.

Although previous studies have reported an association between patient-reported somatic symptom severity and the development of posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) in injured military service members (SMs), conclusions from other studies regarding the association between clinician-determined injury severity and PTSD or MDD remain unclear. The present study investigated whether somatic symptoms or injury severity predict the development of probable PTSD or MDD in wounded SMs medically evacuated from combat areas. Data including SM demographic characteristics, clinician-determined injury severity (i.e., Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] values), and self-report assessments of PTSD (PTSD Checklist-Civilian Version), MDD (Patient Health Questionnaire [PHQ]-9), and somatic symptoms (PHQ-15) were analyzed. A total of 2,217 SMs completed at least one self-assessment between 2003 and 2014, with 425 having completed assessments at each assessment period (AP), conducted 1-75 (AP1), 76-165 (AP2), and 166-255 (AP3) days postinjury. Between AP1 and AP3, the rates of probable PTSD and MDD increased from 3.0% to 11.7% and from 2.8% to 9.2%, respectively. Somatic symptom severity at AP1 predicted probable PTSD and MDD at all three APs, odds ratios (ORs) = 3.5-11.5; however, ISS values did not predict probable PTSD or MDD at any AP, ORs = 0.6-0.9. This suggests that the initial severity of self-reported somatic symptoms rather than clinician-determined injury severity predicts the development of probable PTSD and MDD in wounded SMs.

The Epidemiology of Hand and Finger Lacerations in United States Emergency Departments.

BACKGROUND: Hand and finger lacerations presenting to U.S. emergency departments (EDs) are common, although the burden of these injuries is not well understood. OBJECTIVE: Our aim is to describe the epidemiology and causes of hand and finger lacerations in U.S. EDs. METHODS: This National Electronic Injury Surveillance System database review investigates hand and finger lacerations presenting to EDs in the United States from 2015 to 2019. RESULTS: Annually, hand and finger lacerations account for 243,844 and 587,451 ED visits, respectively. Affected patients are frequently White (70.5%), male (63.4%), and aged 18 through 44 years (46.3%). The top three products linked to hand and finger lacerations are knives (30.5%), metal containers (4.2%), and drinkware (3.8%), and men are less likely to have injuries from these products than women, especially knives (odds ratio 0.76; 95% confidence interval 0.60-0.96; p < 0.02). Although a minority of hand and finger lacerations involve alcohol (1.2%), men have greater rates of alcohol involvement than women (χ21 = 11.7; p < 0.001). Lacerations frequently occur in the home (61.3%). Many patients (44.2%) present to very large hospitals, and nearly one-half of patients younger than 5 years and one-third of patients aged 5 through 17 years present to pediatric hospitals. Most patients (97.4%) are treated and released without admission and 0.2% are transferred to another hospital. Patients with alcohol, drug, or medication involvement are more likely to leave against medical advice, be admitted, or held for observation (p < 0.001). CONCLUSIONS: Hand and finger lacerations result in a significant number of ED visits. A better understanding of injury trends and presentations can guide injury prevention in manufacturing, education, and public health.

Culturally Competent Care for LGBT Patients in Dermatology Clinics.

Lesbian, gay, bisexual, and transgender (LGBT) patients face unique health disparities.1 Routine collection of sexual orientation and gender identity (SOGI) data can optimize patient-provider interactions.2 Gender-neutral bathrooms promote inclusivity for LGBT patients.3 There is limited data on the extent to which dermatology practices make use of such features to deliver culturally competent care to LGBT patients.

Phenotypic distinctions between mosaic forms of tuberous sclerosis complex.

PURPOSE: To determine if mosaic tuberous sclerosis complex (TSC) can be stratified into subtypes that correspond with prognosis and extent of disease. METHODS: Next-generation sequencing of skin tumor and other samples was used to identify patients with mosaic pathogenic variants in TSC1 or TSC2. Extent of disease, onset age, and family history of TSC were determined through retrospective analysis of patient records. RESULTS: The median number of disease findings and age at penetrance differed between mosaic patients with asymmetrically distributed facial angiofibromas (4 findings, 24 years, n = 7), mosaic patients with bilaterally symmetric facial angiofibromas (8 findings, 10 years, n = 12), and germline TSC patients (10 findings, 4 years, n = 29). Cutaneous and internal organ involvement positively correlated in mosaic (R = 0.62, p = 0.005), but not germline (R = -0.24, p = 0.24) TSC. Variant allele fraction (VAF) in the blood (range: 0-19%) positively correlated with the number of major features (R = 0.55, p = 0.028). Five had a TSC2 variant identified in the skin that was below detection in the blood. One of 12 children from a mosaic parent had TSC. CONCLUSION: The phenotype of mosaic TSC ranged from mild to indistinguishable from germline disease. Patients with mosaicism and asymmetric facial angiofibromas exhibited fewer findings, later onset, and lower VAF in the blood.

Complete-arch accuracy of intraoral scanners.

STATEMENT OF PROBLEM: Intraoral scanners have shown varied results in complete-arch applications. PURPOSE: The purpose of this in vitro study was to evaluate the complete-arch accuracy of 4 intraoral scanners based on trueness and precision measurements compared with a known reference (trueness) and with each other (precision). MATERIAL AND METHODS: Four intraoral scanners were evaluated: CEREC Bluecam, CEREC Omnicam, TRIOS Color, and Carestream CS 3500. A complete-arch reference cast was created and printed using a 3-dimensional dental cast printer with photopolymer resin. The reference cast was digitized using a laboratory-based white light 3-dimensional scanner. The printed reference cast was scanned 10 times with each intraoral scanner. The digital standard tessellation language (STL) files from each scanner were then registered to the reference file and compared with differences in trueness and precision using a 3-dimensional modeling software. Additionally, scanning time was recorded for each scan performed. The Wilcoxon signed rank, Kruskal-Wallis, and Dunn tests were used to detect differences for trueness, precision, and scanning time (α=.05). RESULTS: Carestream CS 3500 had the lowest overall trueness and precision compared with Bluecam and TRIOS Color. The fourth scanner, Omnicam, had intermediate trueness and precision. All of the scanners tended to underestimate the size of the reference file, with exception of the Carestream CS 3500, which was more variable. Based on visual inspection of the color rendering of signed differences, the greatest amount of error tended to be in the posterior aspects of the arch, with local errors exceeding 100 µm for all scans. The single capture scanner Carestream CS 3500 had the overall longest scan times and was significantly slower than the continuous capture scanners TRIOS Color and Omnicam. CONCLUSIONS: Significant differences in both trueness and precision were found among the scanners. Scan times of the continuous capture scanners were faster than the single capture scanners.

Facial injuries in the National Basketball Association: 2013-14 through 2017-18.

OBJECTIVE: To describe the epidemiology, mechanisms, treatment, and disability for facial injuries in National Basketball Association (NBA) athletes. METHODS: This was a retrospective descriptive epidemiological chart review using NBA Electronic Medical Record (EMR) system. Responses to injuries reported in games, practices, and other activities were used for all data analysis, except for game incidence rates. Incidence rates were calculated by the game-related facial injury incidence per total athlete exposure (player-games). RESULTS: There were 440 facial injuries among 263 athletes during the 5 NBA seasons with an overall single-season risk of 12.6% and a game incidence of 2.4 per 1000 athlete-exposures (95% CI: 2.18-2.68). The majority of injuries were lacerations (n = 159, 36.1%), contusions (n = 99, 22.5%), or fractures (n = 67, 15.2%), with ocular (n = 163, 37.0%) being the most commonly injured location. Sixty (13.6%) injuries resulted in at least one NBA game missed (224 cumulative player-games) with ocular injuries resulting in the most cumulative games missed (n = 167, 74.6%). Nasal fractures (n = 39, 58.2%) were the most common fracture location followed by ocular fractures (n = 12, 17.9%) but were less likely to lead to games missed (median = 1, IRQ: 1-3) than ocular (median = 7, IQR: 2-10) fractures. CONCLUSIONS: An average of one in eight NBA players sustained a facial injury each season with ocular injuries being the most common location. While most facial injuries are minor, serious injuries, especially ocular fractures, can result in games missed.

Comparison of Tricaine Methanesulfonate (MS-222) and Alfaxalone Anesthesia in Zebrafish (Danio rerio).

The research use of zebrafish has risen exponentially over the past decade while anesthetic options have remained largely unchanged.6 ricaine methanesulfonate (MS-222) is widely accepted as an anesthetic for routine husbandry procedures, however it has limitations and safety concerns. 11 A greater variety of effective anesthetic options for surgical procedures would be advantageous for the research community. Adult zebrafish were randomly assigned to one of the following groups (n = 10, 5 males and 5 females): 200 mg/L MS-222; 6-, 10-, 13-, and 16-mg/L alfaxalone, and control. All zebrafish in the MS-222 group reached a surgical plane of anesthesia within 95 ± 32 s. By contrast, only 2 of 10, 1 of 10, 0 of 10, and 0 of 4 of the 6, 10, 13, and 16 mg/L alfaxalone groups, respectively, reached a surgical plane of anesthesia within the allotted 10-min period. Recovery time was also significantly slower in the alfaxalone groups as compared with MS-222, with some fish taking greater than 10 min to recover. In addition, 33 of 34 zebrafish (the 16 mg/L group was not completed due to safety concerns) in the alfaxalone groups lost opercular movements for greater than one minute during their anesthetic event and had to be removed to the recovery tank. The results demonstrated that alfaxalone was unable to provide a reliable and safe surgical plane of anesthesia at any of the drug doses tested. Therefore, we recommend alfaxalone not be used as an anesthetic for painful procedures on zebrafish and conclude that MS-222 remains a more viable anesthetic for immersion anesthesia in zebrafish.

Retention of En Route Cricothyroidotomy Skills in Novice Providers Following a Simulation-Based Mastery Learning Curriculum.

INTRODUCTION: Surgical cricothyroidotomy (SC) is a vital skill that combat first responders must master as airway obstruction is the third most preventable cause of death on the battlefield. Degradation of skills over time is a known problem, and there is inadequate knowledge regarding the rate of SC skill retention. Our prior study showed that simulation-based mastery learning was effective in training 89 novices how to reliably perform an en route SC to mastery performance standards. This study aims to assess the durability of this skill by bringing participants back in 3 separate cohorts at 6, 12, or 24 months following the initial training to perform SC in the same test environment. MATERIALS AND METHODS: This was a randomized prospective trial. Random cohorts of equal subjects who previously underwent SC simulation-based mastery learning training were selected to return at 6, 12, and 24 months to retest in the same en route medical evacuation (MEDEVAC) helicopter scenario. A total of 22, 14, and 10 subjects returned at 6, 12, and 24 months, respectively, due to Coronavirus-19 impacts and travel limitations. Participants in the 24-month cohort received a refresher training prior to retesting. All attempts were recorded and blindly graded using the same 10 item standardized SC checklist used in initial training. Our previous work found that mastery criteria for performing a SC were ≤40 seconds and completion of 9/10 items on the checklist. Outcome measures in this study were time to complete the procedure and percent of subjects who completed at least 9/10 items on the SC checklist. RESULTS: There was an increase in time required to complete the procedure compared to initial training in all three retesting cohorts (initial: median 27.50, interquartile range 25.38-31.07 seconds; 6 months: median 36.33, interquartile range 31.59-55.22 seconds; 12 months: median 49.50, interquartile range 41.75-60.75 seconds; 24 months: median 38.79, interquartile range 30.20-53.08 seconds; P < .0001, P < .0001, P = .0039). There was a decline in median value checklist scores compared to initial training in the 6- and 12-month retesting cohorts (initial: median 10.00/10, interquartile range 9.50-10.00; 6 months: median 8.00/10, interquartile range 6.75-9.00; 12 months: median 8.00/10, interquartile range 6.75-9.25; P < .0001, P < .001). There was no difference in median checklist scores between the initial and 24-month retesting scenario (initial: median 10.00/10, interquartile range 9.50-10.00; 24 months: 10.00/10, interquartile range 9.00-10.00; P= .125). There was a decrease in retention of skills as only 31.82% of subjects at 6 months and 14.29% at 12 months met the defined passing criteria of time to completion of ≤40 seconds and checklist score of ≥9/10. A brief refresher course several months prior to the 24-month cohort retesting greatly increased the retention of SC procedural skills, with 60% of subjects meeting the time and checklist criteria. CONCLUSIONS: This study showed that the skill required to perform a SC after initial mastery training does decay significantly. A brief refresher course can help increase retention of skills. Based on our findings SC skills should be refreshed at a minimum of every 6 months to assure optimal proficiency.

White Matter Alterations in Military Service Members With Remote Mild Traumatic Brain Injury.

Importance: Mild traumatic brain injury (mTBI) is the signature injury experienced by military service members and is associated with poor neuropsychiatric outcomes. Yet, there is a lack of reliable clinical tools for mTBI diagnosis and prognosis. Objective: To examine the white matter microstructure and neuropsychiatric outcomes of service members with a remote history of mTBI (ie, mTBI that occurred over 2 years ago) using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI). Design, Setting, and Participants: This case-control study examined 98 male service members enrolled in a study at the National Intrepid Center of Excellence. Eligible participants were active duty status or able to enroll in the Defense Enrollment Eligibility Reporting system, ages 18 to 60 years, and had a remote history of mTBI; controls were matched by age. Exposures: Remote history of mTBI. Main Outcomes and Measures: White matter microstructure was assessed using a region-of-interest approach of skeletonized diffusion images, including DTI (fractional anisotropy, mean diffusivity, radial diffusivity and axial diffusivity) and NODDI (orientation dispersion index [ODI], isotropic volume fraction, intra-cellular volume fraction). Neuropsychiatric outcomes associated with posttraumatic stress disorder (PTSD) and postconcussion syndrome were assessed. Results: A total of 65 male patients with a remote history of mTBI (mean [SD] age, 40.5 [5.0] years) and 33 age-matched male controls (mean [SD] age, 38.9 [5.6] years) were included in analysis. Compared with the control cohort, the 65 service members with mTBI presented with significantly more severe PTSD-like symptoms (mean [SD] PTSD CheckList-Civilian [PCL-C] version scores: control, 19.0 [3.8] vs mTBI, 41.2 [11.6]; P < .001). DTI and NODDI metrics were altered in the mTBI group compared with the control, including intra-cellular volume fraction of the right cortico-spinal tract (ß = -0.029, Cohen d = 0.66; P < .001), ODI of the left posterior thalamic radiation (ß = -0.006, Cohen d = 0.55; P < .001), and ODI of the left uncinate fasciculus (ß = 0.013, Cohen d = 0.61; P < .001). In service members with mTBI, fractional anisotropy of the left uncinate fasciculus was associated with postconcussion syndrome (ß = 5.4 × 10-3; P = .003), isotropic volume fraction of the genu of the corpus callosum with PCL-C (ß = 4.3 × 10-4; P = .01), and ODI of the left fornix and stria terminalis with PCL-C avoidance scores (ß = 1.2 × 10-3; P = .02). Conclusions and Relevance: In this case-control study of military-related mTBI, the results suggest that advanced magnetic resonance imaging techniques using NODDI can reveal white matter microstructural alterations associated with neuropsychiatric symptoms in the chronic phase of mTBI. Diffusion trends observed throughout widespread white matter regions-of-interest may reflect mechanisms of neurodegeneration as well as postinjury tissue scarring and reorganization.

How Well Do U.S. Primary Care and Obstetrics and Gynecology Clinicians Screen for Pregnancy Complications at Well Woman Visits? A Retrospective Cohort Study.

OBJECTIVES: Pregnancy complications, including pre-eclampsia, gestational diabetes (GDM), and perinatal mood and anxiety disorders (PMADs), impact long-term health. We compared the frequency of screening documentation for pregnancy complications versus a general medical history at well woman visits between providers in primary care and obstetrics and gynecology. METHODS: We conducted a retrospective cohort study of subjects with at least 1 prior birth who presented for a well woman visit in 2019-2020. Charts were reviewed for documentation of a general medical history (hypertension, diabetes, and mood disorders) versus screening for comparable obstetric complications (pre-eclampsia, GDM, and PMADs). The results were compared using the McNemar and chi-square tests as appropriate. RESULTS: In total, 472 encounters were identified, and 137 met the inclusion criteria. Across specialties, clinicians were significantly more likely to document general medical conditions than pregnancy complications, including hypertensive disorders (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.18 to 5.48), diabetes (OR, 7.67; 95% CI, 3.27 to 22.0), and mood disorders (OR, 10.5; 95% CI, 3.81 to 40.3). Obstetrics and gynecology providers were more likely to document any pregnancy history (OR, 4.50; 95% CI, 1.24 to 16.27); however, they were not significantly more likely to screen for relevant obstetric complications (OR, 2.49; 95% CI, 0.90 to 6.89). Overall, the rate of pregnancy complication documentation was low in primary care and obstetrics and gynecology clinics (8.8 and 19.0%, respectively). CONCLUSIONS: Obstetrics and gynecology providers more frequently documented a pregnancy history than those in primary care; however, the rate was low across specialties, and providers reported screening for clinically relevant complications less frequently than for general medical conditions.

Clinical Outcomes of Ab Interno Placement versus Ab Externo Placement of XEN45 Gel Stents.

PURPOSE: To compare the effectiveness of ab interno versus ab externo placement of XEN45 gel stents in patients with open-angle glaucoma. DESIGN: Single-center, noncontrolled, retrospective, comparative case series. PARTICIPANTS: Eighty-nine eyes of 89 patients with open-angle glaucoma who underwent XEN45 gel stent implantation. METHODS: Patients underwent either ab interno (group 1) or ab externo (group 2) placement of a XEN45 stent between 2017 and 2020 by a single surgeon. Outcomes were recorded at each follow-up visit from postoperative day 1 up to 24 months, with median follow-up lengths of 12 months and 8 months for groups 1 and 2, respectively. MAIN OUTCOME MEASURES: The primary outcome measure was the surgical success rate at 8 months. Secondary measures were postoperative intraocular pressure (IOP) and medication usage, complication rates, and bleb revision rates. RESULTS: Success rates at 8 months were 72% in group 1 (n = 29) and 74% in group 2 (n = 60). There was no difference in the median time to failure between groups (P = 0.98). The mean baseline IOPs were 22.8 ± 7.5 on 3.8 ± 0.9 medications in group 1 and 25.3 ± 10.7 on 3.7 ± 1 medications in group 2. At the last follow-up among eyes with surgical success, the mean IOPs were 12.5 ± 3.8 on 2.2 ± 1.4 medications in group 1 and 12.2 ± 2.1 on 1.8 ± 1.3 medications in group 2. The adjusted mean IOPs and numbers of medications used were significantly lower after XEN45 stent implantation at all postoperative time points compared with baseline in both groups (P < 0.05). There were no significant differences in postoperative adjusted mean IOPs or medications used between the groups at any of the follow-up time points. Complication rates and bleb revision rates were comparable between both groups (P > 0.05). CONCLUSIONS: The ab externo approach of XEN45 stent placement demonstrates comparable effectiveness to the ab interno approach in patients with open-angle glaucoma, although this study was underpowered to detect a difference in success rates between groups.

Bone Morphogenic Protein for Upper Extremity Fractures: A Systematic Review.

BACKGROUND: This review discusses success, time to healing, and complications of bone morphogenic proteins (BMPs) 7 and 2 in treating upper extremity nonunions. METHODS: Systematic review identified 26 of 479 studies that met inclusion criteria. Publications described application of BMPs to acute and chronic upper extremity delayed unions/nonunions. Unions, complications, patient demographics, and fracture/healing patterns were pooled and analyzed. RESULTS: Nonunions treated with BMP-7 (n=302) involved the humerus (64%), forearm (22%), clavicle (11%), and hand/wrist (3%), with prior surgical correction attempted in 84%. Nonunions treated with BMP-2 (n=96) involved the humerus (58%), hand/wrist (27%), forearm (14%), and clavicle (1%), with prior surgical correction attempted in all. Most nonunions (80%) were present for over 12 months before BMP application. Union rates of BMP-7 varied according to site: hand/wrist (95%), humerus (74%), forearm (29%), and clavicle (6.2%) nonunions achieved union as defined by study authors in 232 days (confidence interval=96-369, Q<0.001) on average. While not significant across studies, BMP-2 union rates were 71% of hand/wrist and 75% of humerus nonunions. Comparison of the BMPs demonstrates different proportions of success in humerus and hand/wrist fractures (P<.001) but not forearm fractures (P<.77) and longer time to radiographic union with BMP-7 (P<.011). CONCLUSIONS: Most hand/wrist and humerus nonunions treated with BMP-7 and BMP-2 achieved union, with significant similarity among BMP-7 studies not observed in BMP-2 studies. Nonunions treated with BMP-7 have longer healing times yet similar complication rates compared with BMP-2. Overall, BMPs are an effective adjunct to fracture healing with acceptable complication profile.

Potential Biomarkers for Asymptomatic Visceral Leishmaniasis among Iraq-Deployed U.S. Military Personnel.

Visceral leishmaniasis (VL) is a chronic infection caused by Leishmania (L.) donovani or L. infantum parasites. Despite having the infection, most individuals never develop the clinical disease and are able to control the parasite and remain asymptomatic. However, some progress to symptomatic VL, leading to death if untreated. The host immune response has a major role in determining the progression and severity of the clinical manifestations in VL; several immune biomarkers of symptomatic VL have been described with interferon-gamma release as a surrogate biomarker of host cellular immunity. However, new biomarkers to identify asymptomatic VL (AVL) are needed for the identification of people at risk for VL activation. In our study, levels of chemokine/cytokine in the supernatants of peripheral mononuclear blood cells (PBMC) from 35 AVL+ Iraq-deployed participants, stimulated in vitro with soluble Leishmania antigen for 72 h, were assessed by a bead-based assay that allows the measurement of multiple analytes. PBMC of AVL-negative military beneficiaries were used as controls. Monocyte Chemoattractant Protein-1, Monokine Induced by Gamma Interferon and Interleukin-8, were detected at high levels in AVL+ stimulated cultures from Iraq deployers compared to uninfected controls. Measurement of chemokine/cytokine levels can identify cellular immune responses in AVL+ asymptomatic individuals.

Innovative Curriculum to Train Medical Students on Lateral Canthotomy and Cantholysis.

PURPOSE: Orbital compartment syndrome (OCS) is an ocular emergency requiring prompt decompression with a lateral canthotomy and cantholysis (LCC) within 2 hours. This study evaluates the feasibility and effectiveness of a standardized LCC curriculum to train medical students to identify and treat OCS. METHODS: This was a prospective, non-randomized, non-comparative cohort study of 39 novice first-year medical students with no prior LCC training who underwent a standardized LCC curriculum incorporating both didactic and hands-on procedural training. Didactic knowledge of orbital anatomy and OCS was evaluated with written pre- and post-knowledge testing. Expert performance criteria were determined by expert consensus based on the performance of three oculoplastic surgeons and were defined as correctly performing all 12 critical checklist steps of an LCC within 3 minutes twice consecutively on a Sonalyst LCC training system eye model. Utilizing the principles of mastery learning, participants learned how to perform an LCC in a classroom environment and were evaluated on a final test of proficiency in a training lane designed to simulate an austere military environment. RESULTS: Participants required a median of 3.0 practice iterations to achieve expert performance in the classroom environment. During the testing phase, all participants correctly identified the eye with OCS, and 77% (n = 30) of learners successfully performed an LCC at the expert level within their first attempt. The median completion time of those who passed on their first testing was 130 seconds. The mean LCC knowledge test scores significantly improved from 48.7% to 71.2% (P < .001). CONCLUSION: This study successfully developed a standardized LCC curriculum utilizing the principles of hands-on mastery learning to train novice learners to perform an LCC efficiently and effectively.

Short-Term Outcomes of Xen-45 Gel Stent Ab Interno Versus Ab Externo Transconjunctival Approaches.

PRCIS: Ab externo transconjunctival placement of the Xen-45 gel stent offers a faster surgical approach and more rapid visual recovery with similar pressure-lowering and complication rates when compared with implantation by the ab interno approach. PURPOSE: Compare outcomes of closed conjunctival Xen-45 implantation techniques: ab interno versus ab externo transconjunctival. MATERIAL AND METHODS: Single-center, retrospective study of 70 patients undergoing Xen-45 implantation between 2017 and 2020. Group 1 (n=29) had ab interno placement, Group 2 (n=41) had transconjunctival ab externo placement. Primary outcome measures were intraocular pressure (IOP) and medication use. Secondary measures were bleb revision rates, surgical time, time to return to baseline visual acuity, and complication rates. RESULTS: Group 1, preoperative IOP was 22.8±7.5 mmHg on 3.8±0.9 IOP-lowering medications and the postoperative IOP at last follow-up was 11.6±2.8 mmHg on 1.6±1.3 medications. Group 2, preoperative IOP was 25.6 mmHg±7.8 mmHg on 3.7±1.1 medications and the postoperative IOP at last follow-up was 12.4±3.6 mmHg on 1.5±1.3 medications. There was no difference in postoperative IOP or medications between the 2 groups ( P <0.05). The average surgical time for Group 2 was 25±6.5 minutes to 37±7.3 minutes for Group 1 ( P <0.001). Group 2 showed 88% of patients returning to baseline visual acuity at week 2 compared with 66% in Group 1 ( P <0.05). Bleb revision rates, failure rates, and complication rates were comparable between both groups ( P >0.05). CONCLUSION: IOP, medication use, complications, bleb revision rates, and failure rates were similar between ab interno and ab externo transconjunctival approaches. The ab externo group had faster surgical times and postoperative visual recovery despite higher number of patients with previous glaucoma procedures.

Development of a Simulation Surgical Cricothyroidotomy Curriculum for Novice Providers: A Learning Curve Study.

INTRODUCTION: Airway obstruction is the third most common cause of preventable death on the battlefield, accounting for 1%-2% of total combat fatalities. No previous surgical cricothyroidotomy (SC) studies have analyzed the learning curve required to obtain proficiency despite being studied in numerous other surgical technique training experiments. The aims of this study were to establish expert SC performance criteria, develop a novel standardized SC curriculum, and determine the necessary number of practice iterations required by a novice to reach this pre-determined performance goal. MATERIALS AND METHODS: A standardized checklist and SC performance standards were established based on the performance of 12 board certified Military Health System surgeons with prior experience on performing a SC using a simulated trauma mannequin. Expert-level criteria were defined as a SC time to completion of 40 s or less and checklist score of at least 9/10, including all critical steps. Study subjects included 89 novice providers (54 active-duty first- and second-year medical students and 35 Navy corpsmen). Subjects received instruction on performing a SC using the principles of mastery learning and performed a final test of SC proficiency on a trauma mannequin within a realistic simulated MEDEVAC helicopter. The total number of subject practice attempts, checklist scores, and time to completion were measured and/or blindly scored. Learning curve and exponential plateau equations were used to characterize their improvement in mean time to SC completion and checklist scores. RESULTS: Mean pre-test knowledge scores for the entire group were 11.8 ± 3.1 out of 24 points. Total mean practice learning plateaued at checklist scores of 9.9/10 after 7 iterations and at a mean completion time of 30.4 s after 10 iterations. During the final test performance in the helicopter, 67.4% of subjects achieved expert-level performance on the first attempt. All subjects achieved expert-level performance by the end of two additional attempts. While a significantly larger proportion of medical students (79.9%) successfully completed the helicopter test on the first attempt compared to corpsmen (54.3%), there were no statistically significant differences in mean SC completion times and checklist scores between both groups (P > 0.05). Medical students performed a SC only 1.3 s faster and scored only 0.16 points higher than corpsmen. The effect size for differences were small to negligible (Cohen's d range 0.18-0.33 for SC completion time; Cohen's d range 0.45-0.46 for checklist scores). CONCLUSION: This study successfully defined SC checklist scores and completion times based on the performance of experienced surgeons on a simulator. Using these criteria and the principles of mastery learning, novices with little knowledge and experience in SC were successfully trained to the level of experienced providers. All subjects met performance targets after training and overall performance plateaued after approximately seven iterations. Over two-thirds of subjects achieved the performance target on the first testing attempt in a simulated helicopter environment. Performance was comparable between medical student and corpsmen subgroups. Further research will assess the durability of maintaining SC skills and the timing for introducing refresher courses after initial skill acquisition.

Incidence of sports-related sternoclavicular joint dislocations in the United States over the last two decades.

BACKGROUND: Epidemiological understanding of acute sternoclavicular (SC) dislocations secondary to sports across the United States is poorly defined. AIM: To identify and assess epidemiological trends of SC dislocations occurring secondary to sports-related mechanisms across United States over the past two decades. METHODS: This cross-sectional, descriptive epidemiological study evaluates epidemiological trends of SC dislocations from sports that present to emergency departments (EDs) across the United States. Data were obtained from the National Electronic Injury Surveillance System database spanning two decades. Data on incidence, patient demographics, mechanisms of injury, dislocation types, incident locales, and patient dispositions were collected. RESULTS: 1622 SC dislocations occurred nationwide from 2001 to 2020 [incidence = 0.262/1000000 people, confidence interval (CI) = 0.250-0.275], comprising 0.1% of shoulder/upper trunk dislocations. Most patients were male (91%, n = 1480) and aged 5-17 (61%, n = 982). Football, wrestling, and biking were the most frequently implicated sports, with contact sports responsible for 59% of athletic injuries (n = 961). Recreational vehicle-related sports injuries, such as all-terrain vehicles, dirt bikes, and mopeds accounted for 7.8% of all injuries (n = 126), with dirt bikes specifically comprising 3.7% (n = 61). Ultimately, 82% were discharged from the ED (n = 1337), 12% were admitted (n = 194), and 6% were transferred (n = 90). All recorded posterior dislocations were admitted or transferred from the ED. Patients sustaining SC dislocations from contact sports had a significantly increased risk of hospital admission or transfer rather than discharge from the ED as compared to patients whose injuries were from non-contact sports (incidence rate ratio = 1.46, CI: = 1.32-1.61, P < 0.001). CONCLUSION: SC dislocations from sports continue to be rare with a stably low incidence over the past two decades, likely comprising a smaller proportion of shoulder dislocations than previously thought. Contact sports are a frequent source of injury, especially among school-aged and teenage males. Most patients are discharged directly from the ED; however, a substantial number are hospitalized, many of which had documented posterior dislocations. Ultimately, understanding the epidemiology and mechanism-related trends of acute SC dislocations is important given the potential severity of these injuries, concentration in a specific population, and uncertainty linked to rare presentation.

The prospective relationship between weight-based discrimination and eating pathology among youth.

Among adults and adolescents, weight-based discrimination is associated with disordered eating. However, these relationships remain understudied in children. Given that weight-based discrimination is commonly reported among youth, and that childhood is a crucial developmental period for the onset of disordered eating, the current study assessed prospective associations between weight-based discrimination and eating pathology among participants in the Adolescent Brain Cognitive Development Study. At the one-year visit, children indicated whether they had experienced discrimination due to their weight within the past year. Parents completed a computerized clinical interview to determine the presence of sub-or-full threshold eating disorders (AN, BN, and BED) among their children. At the two-year visit, children completed the same assessment. Height and fasting weight were obtained. Logistic regressions, adjusting for age, sex, race/ethnicity, family income, BMI%ile, and parent-reported presence of the respective eating disorder at one-year, were conducted to assess the associations between weight-based discrimination and eating pathology. Participants were 10,299 children who completed measures at both the one- and two-year visits (Mage at one-year: 10.92 ± 0.64, 47.6 % female, 45.9 % racial/ethnic minority). The presence of weight-based discrimination, reported by 5.6 % (n = 574) of children, was significantly associated with a greater likelihood of reporting AN, BN, and BED one-year later (ORs: 1.94-4.91). Findings suggest that weight-based discrimination may confer additional risk for the onset of disordered eating, above and beyond the contribution of body weight. Intersectional research is needed to examine the role of multiple forms of discrimination in relation to the development of eating pathology.