Outcomes of pediatric endoscopic ultrasound-guided celiac plexus block: A single center pilot study.

Celiac plexus blocks (CPB) using endoscopic ultrasound (EUS) guidance provide significant pain relief in adults with chronic pancreatitis. We present on EUS-guided CPB for pediatric patients with abdominal pain from chronic pancreatitis or severe functional dyspepsia necessitating clinically assisted nutrition and hydration. Patients who underwent EUS-CPB were included and followed prospectively at 2-, 4-, and 8-weeks postprocedure about pain, enteral tolerance, and school/activity attendance. Thirteen patients underwent EUS-guided CPB with a total of 21 procedures. In the pancreatitis cohort, mean pain relief was 11.7 weeks for those who responded. In the functional dyspepsia cohort, mean improvement (in either pain or enteral tolerance) was 4.8 weeks. Symptom improvement varied between the two cohorts. Acute recurrent/chronic pancreatitis patients demonstrated more sustained relief than the functional dyspepsia cohort. This study adds to the limited data investigating the utility of EUS-CPB as part of a multimodal treatment plan in pediatrics.

Effects of full-fat high-oleic soybean meal in layer diets on performance, egg quality and chemical composition.

The utilization of full-fat high-oleic soybean meal in layer diets could lead to value-added poultry products. To test this idea, 336 hens were randomly assigned to 4 isonitrogenous (18.5% CP) and isocaloric (2,927 kcal/kg) formulated diets and fed the following diets for eight weeks: conventional control solvent-extracted defatted soybean meal (CON); extruded-expelled defatted soybean meal (EENO); full fat normal-oleic soybean meal (FFNO); or full fat high-oleic soybean meal (FFHO). Body weights (BW) were collected at week 0 and week 8. Eggs were collected daily, and the totals counted each week. Feed consumption was measured weekly, and egg quality was measured bi-weekly. Eggs were collected at wk 0 and wk 8 for fatty acid analysis. There were no significant treatment differences in any of the production parameters measured, BW, feed consumption, feed conversion ratio or egg production (P > 0.05). Eggshell strength was significantly greater in eggs produced from the EENO group as compared to the control (P < 0.01), while egg yolk color was significantly darker in eggs of the control and EENO treatment groups relative to the FFNO and FFHO treatments (P < 0.0001). Eggs produced by hens fed the FFHO diet had a 52% increase in monounsaturated n-9 oleic acid content (P < 0.0001) and reduced palmitic (P < 0.01) and stearic (P < 0.0001) saturated fatty acid levels as compared to the conventional controls. These results validate the utilization of FFHO as a value-added poultry feed ingredient to enrich the eggs and/or poultry meat produced.

Beach Sprints Rowing: Injury and Illness Prevalence at the 2022 World Championships.

Background: Injury and illness surveillance helps establish the infrastructure to provide adequate medical support at regattas and is the foundation for developing prevention strategies. Objectives: To assess the prevalence and characteristics of injuries in the 4 weeks before the start of the 2022 World Rowing Beach Sprints Finals (WRBSF) (the 'Prevalence Survey') and describe the incidence and nature of new-onset injuries and illnesses incurred during the WRBSF (the 'Incidence Survey'). Methods: Athletes completed: (1) a prevalence survey recording injuries the 4 weeks before the WRBSF and (2) a recording of injuries and illnesses that occurred during the 3-day regatta. Results: Fifty-nine of 152 eligible WRBSF athletes completed the prevalence injury survey. Twenty-three (38.9%) reported experiencing at least one injury within the 4 weeks before the WRBSF. The most prevalent anatomical injury sites were the forearm (11.86%), lumbar spine (10.17%), knee (8.47%), ankle (6.78%) and hand/fingers (6.78%). During the competition, only two illness occurrences were reported; both were respiratory infections. Two athletes reported injuries: a hamstring strain and a concussion. Conclusion: Rowers presenting to the WRBSF described injuries leading up to the event that were similar to those common in classic rowing. Rowers at the event suffered injuries of the lower limb that were different from classic rowing and may be related to the addition of running to this event. An event concussion should be considered as a more likely injury in this type of rowing and future events should be prepared to manage such an injury.

A Qualitative Enquiry of On-Farm Rules About Quad Bikes (ATVs): How Rules Are Determined and Implemented at a Farm Level in Rural Australia.

OBJECTIVE: Quad bikes are a leading cause of death and incident-related injury on farms, yet little is understood about rules used by farmers to ensure their safe operation. This study explored rules about quad bikes set by those who live or work on farms. Through the case of quad bikes, this study sought to understand how rules are determined and implemented at the farm level. SETTING: A mix of farm types and locations in rural Australia including Queensland, South Australia, and New South Wales. PARTICIPANTS: Eight farmers were interviewed and recruited from information sheets at farmers' markets, through a local health organisation, and a media release. DESIGN: Thematic analysis was used to transform data from eight semi-structured interviews with farmers in rural Australia. RESULTS: Data were distilled into two themes - "Rule content" described the explicit rules farmers had set on their properties, while the theme "Underlying rule principles" explored the values and norms which underpinned the creation and implementation of these rules. CONCLUSIONS: Through the case of quad bike rules, this study illustrated how rules are determined and implemented at the farm level. Perceptions of risk were tied to farmers being experts in their own environment and therefore able to mitigate risk. In contrast to injury data, reckless use of quad bikes was perceived to cause incidents, and this was the basis of rules for adults and children.

Sedation-free transnasal esophagoscopy to evaluate and monitor esophageal diseases in children with esophageal atresia-tracheoesophageal fistula.

Patients with esophageal atresia and tracheoesophageal fistula (EA-TEF) are at increased risk of conditions including gastroesophageal reflux, peptic esophagitis, gastric metaplasia, anastomotic strictures, eosinophilic esophagitis, and dysphagia. Patients with TEF-EA may need serial endoscopy in their lifetime given the known short- and long-term GI complications. There has been increased interest in pediatric unsedated transnasal endoscopy (TNE) as an endoscopic alternative as it is lower cost, has shorter recovery time, and eliminates potential risks associated with anesthesia. We report on the use of TNE with EA-TEF in four patients: One patient had gastroesophageal reflux disease, one patient had eosinophilic esophagitis and TNE was used for surveillance in two patients. Use of TNE allowed for close endoscopic monitoring and changes in medication management. The third and fourth patients underwent TNE as part of routine EA-TEF screening which is recommended by societal guidelines (Krishnan et al, J Pediatr Gastroenterol Nutr. 2016;63(5):550-570). Unsedated TNE is an alternative endoscopic approach in the management of patients with EA-TEF.

Barriers and enablers to people-centred viral hepatitis care in Vietnam and the Philippines: Results of a patient journey mapping study.

In Vietnam and the Philippines, viral hepatitis is the leading cause of cirrhosis and liver cancer. This study aims to understand the barriers and enablers of people receiving care for hepatitis B and C to support both countries' efforts to eliminate viral hepatitis as a public health threat by 2030. Retrospective, semi-structured interviews were conducted with a purposive, quota-based sample of 63 people living with hepatitis B or C in one province of Vietnam and one region of the Philippines. A rapid deductive approach to thematic analysis produced key findings among the three phases of care: (1) pre-awareness and testing, (2) linkage and treatment initiation and (3) ongoing treatment and recovery. The research found that participants followed five typical journeys, from a variety of entry points. Barriers during the pre-awareness and testing phase included limited awareness about hepatitis and its management, stigma and psychological impacts. Enablers included being familiar with the health system and/or patients benefiting from social connections within the health systems. During the linkage and treatment initiation phase, barriers included difficult physical access, complex navigation and inadequate counselling. In this phase, family support emerged as a critical enabler. During the ongoing treatment and recovery phase, the cost of care and socially and culturally informed perceptions of the disease and medication use were both barriers and enablers. Exploring peoples' journeys with hepatitis B and C in Vietnam and the Philippines revealed many similarities despite the different cultural and health system contexts. Insights from this study may help generate a contextualized, people-centred evidence base to inform the design and improvement of primary care services for hepatitis in both research sites.

The Value of Screening for a History of Incarceration in the Palliative Care Setting.

The United States (US) has one of the highest rates of incarceration in the world. Due to the aging of the US population as a whole and limited opportunities for early release, the proportion of older people in prison continues to rise. Some correctional health systems have adopted geriatric and palliative care principles to better care for this aging population, many of whom die in prison. However, not everyone who grows old in prison will die behind bars. In this article, we explore existing literature that highlights the unique physical, cognitive, and psychosocial challenges that formerly incarcerated patients face. We proceed to argue that palliative care providers should screen for a history of incarceration to identify and address the needs of this patient population. We also offer strategies to create a safe, welcoming environment to discuss past traumas related to these patients' time in prison.

Influence of extruded soybean meal with varying fat and oleic acid content on nitrogen-corrected apparent metabolizable energy in broilers.

High oleic (HO) soybeans may serve as a value-added feed ingredient; providing amino acids and estimating their dietary energy value for broilers is essential. In this study, we determined the apparent metabolizable energy (AME), AME corrected for zero nitrogen retention (AMEn), digestibility, and nitrogen (N) retention of HO full-fat (HO-FF) soybean as compared to solvent-extracted soybean meal (SE-SBM), normal oleic full-fat (NO-FF) and extruded expeller (NO-EE) soybean. A total of 240 Ross-708 male broilers were selected, with 8 replicates per treatment and 6 chicks per cage. The AME and AMEn were estimated using the difference method with a 30% inclusion of test ingredients using a corn-soy reference diet with partial and total excreta collection. The index method with partial excreta collection used titanium dioxide as an inert marker. The same starter diet was provided for all birds for 14 d, followed by the reference and assay diets for the next 6 adaptation days. Total excreta were collected twice a day for 3 d. The AME and AMEn values determined for the HO-FF and NO-FF were higher (P < 0.001) than the NO-EE and SE-SBM. The AME of SE-SBM and NO-EE were similar with both methods, but the AMEn of SE-SBM was lower than the NO-EE only with the partial collection method. The agreement between AME and AMEn values determined by partial and total excreta collection analysis was 98%. Data from the total excreta collection method yielded higher AME and AMEn values (P < 0.001) than those from the partial collection method. In summary, HO-FF and NO-FF soybean meals had similar AME and AMEn values. The HO-FF soybean had 39 and 24% higher AME and AMEn than SE-SBM. Hence, high oleic full-fat soybean meal could serve as a valuable alternative feed ingredient to conventional SE-SBM meals in broiler diets, providing additional energy while providing amino acids and more oleic acid to enrich poultry meat products.

Case Report: Plasmodium vivax Sporozoite Melanization in the Midgut and Salivary Gland of the Malaria Vector Anopheles darlingi.

Anopheles darlingi is the primary malaria vector in the Amazon region and is highly susceptible to both Plasmodium vivax and Plasmodium falciparum parasites. Although anopheline mosquitoes may develop melanotic encapsulation in response to Plasmodium parasites, there is no record of An. darlingi exhibiting a melanization response to P. vivax, the main malaria parasite in the Americas. Here, we report the occurrence of P. vivax sporozoite melanization in An. darlingi mosquitoes.

Effects of high oleic full-fat soybean meal on broiler live performance, carcass and parts yield, and fatty acid composition of breast fillets.

The effects of high oleic oil full-fat (HO-FF) soybean meal (SBM) on broiler meat quality could lead to value-added food products. This experiment evaluated the effects of dietary normal oleic extruded expelled (NO-EE), normal oleic full-fat (NO-FF), or HO-FF SBM on live performance, carcass and parts yield, and breast fatty acid composition. Diets were formulated to be isoenergetic and isonitrogenous. A total of 540 Ross-708 male broilers were raised on floor pens with 18 broilers/pen and 10 replicates/treatment. Data were analyzed in a completely randomized design. Chickens were fed with a starter (0-14 d), grower (15-35 d), or a finisher diet (36-47 d) up to 47 d. Chickens were weighed at 7, 14, 35, and 47 d. At 48 d, 4 broilers per pen were processed. Breast samples were collected and evaluated for quality and fatty acid content. Broilers fed diets with NO-EE were heavier (P < 0.05) than chickens fed diets with full-fat SBM (NO-FF and HO-FF) at d 7, 14, 35 while feed conversion ratio (FCR) of NO-EE was best (P < 0.05) at 7 and 47 d. Carcass yield was also higher for broilers fed NO-EE than the other treatments. Diet did not affect parts yield, breast meat color, cooking, drip loss, white stripping, or SM quality parameters. More breast fillets without wooden breast (score 1) were observed (P < 0.05) for NO-FF than the other 2 treatments. The breast meat fatty acid profile (g fatty acid/100 g of all fatty acids) was significantly affected (P < 0.001) by diet. Broilers fed the HO-FF SBM diet had 54 to 86% more oleic acid, 72.5% to 2.2 times less linoleic acid, and reduced stearic and palmitic acid levels in the breast meat than NO-FF and NO-EE. In conclusion, feeding HO-FF to broilers enriched the oleic acid content of their breast meat while reducing the saturated fatty acid content relative to the NO-FF and NO-EE treatment groups.

Embedding viral hepatitis into primary healthcare: results of a strategic landscape analysis in Vietnam and the Philippines.

Chronic viral hepatitis is a significant public health concern in the Western Pacific, including in Vietnam and the Philippines. To accelerate progress toward meeting the 2030 elimination goals, the World Health Organization (WHO) encourages countries to adopt an integrated, people-centered health sector response to hepatitis, grounded in Primary Health Care (PHC). A review of the academic and grey literature, along with policy documents, was conducted to describe the national health system and PHC response to hepatitis B and C in Vietnam and the Philippines. Information was analyzed against the four strategic levers of the WHO Operational Framework for PHC to identify challenges and opportunities. The findings suggest that both countries have relatively robust policy frameworks, with some room for improvement. Vietnam may have stronger political commitment and funding than the Philippines, while the Philippines appears to be stronger in community engagement. Both countries share challenges and opportunities for learning to actualize viral hepatitis elimination utilizing a PHC approach.

How do people use reappraisal? An investigation of selection frequency and affective outcomes of reappraisal tactics.

Although the effects of different emotion regulation strategies are well-documented, most studies to date have focused on the selection and implementation of broad strategies, while overlooking the selection and implementation of specific tactics to enact those strategies. The present research investigated the strategy of cognitive reappraisal and the differences in selection frequency and affective outcomes that are associated with the implementation of different reappraisal tactics to enact that strategy. Participants completed a laboratory task in which they were instructed to reappraise or not to reappraise negative images and reported on their use of specific reappraisal tactics for every trial. Using established reappraisal tactic coding, we assessed how people selected from among common tactics for each image (Study 1) and all tactics (Study 2) and implemented those tactics to reappraise negative images. We compared reappraisal tactic selection and implementation when used during instructed reappraisal versus during spontaneous reappraisal, in the nonreappraise condition. Results of both studies indicate that tactics were used more often when instructed to reappraise versus when spontaneously reappraising. Participants used some tactics (e.g., reality challenge) more frequently compared to the rest of the tactics in both conditions. Negative affect was lower following instructed versus spontaneous reappraisal. Some tactics (e.g., change current circumstances) were more effective at decreasing negative affect in both conditions. Knowing which reappraisal tactics are most frequently selected, and their affective outcomes when used when prompted or spontaneously, may help us better understand how to improve people's ability to use reappraisal to achieve their emotional goals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Standardized ileal amino acid digestibility of high-oleic full-fat soybean meal in broilers.

High-oleic (HO) soybean may serve as a value-added feed ingredient to enrich poultry meat due to its fatty acid content. However, the amino acid (AA) nutrient digestibility of soybean meal (SBM) made from these soybeans has yet to be determined. The objective of this study was to determine apparent ileal AA digestibility (AID) and standardized ileal AA digestibility (SID) of high-oleic full-fat (HO-FF) SBM compared to normal oleic full-fat (NO-FF), normal oleic extruded expeller (NO-EE), and solvent-extracted SBM (SE-SBM) in broilers. A nitrogen-free basal diet (NFD) was fed to 1 treatment group with 10 chicks/cage to determine basal endogenous losses (BEL). Titanium dioxide was used as an inert marker. The test diets contained 57.5% of the basal NFD and 42.5% of 1 of the 4 soybean sources. A total of 272 Ross-708 male broilers were placed in 40 battery cages with 5 treatments and 8 replicates per treatment. A common starter diet was provided to all the chickens for 14 d. Experimental diets were provided as a mash for 9 d before sample collection. Chickens were euthanized with CO2 on d 23, and contents of the distal ileum were collected, frozen, and freeze-dried. The BEL were similar to the values found in the literature. At d 23, broilers fed the SE-SBM had the highest body weight gain and best FCR compared to chickens fed the HO-FF and NO-FF treatments (P < 0.001). Broilers fed the SE-SBM and NO-EE experimental diets had (P < 0.001) higher apparent ileal AA digestibility and AA SID than broilers fed the HO-FF and NO-FF treatments. In conclusion, the SID of AA from HO-FF is similar to the digestibilities of other full-fat soybeans found in the literature and is lower than that of NO-EE and SE-SBM.

Presurgical Oral Tamoxifen vs Transdermal 4-Hydroxytamoxifen in Women With Ductal Carcinoma In Situ: A Randomized Clinical Trial.

Importance: Oral tamoxifen citrate benefits women with ductal carcinoma in situ (DCIS), but concern about toxic effects has limited acceptance. Previous pilot studies have suggested transdermal 4-hydroxytamoxifen gel has equivalent antiproliferative efficacy to oral tamoxifen, with low systemic exposure. Objective: To demonstrate that 4-hydroxytamoxifen gel applied to the breast skin is noninferior to oral tamoxifen in its antiproliferative effect in DCIS lesions. Design, Setting, and Participants: This randomized, double-blind, phase 2 preoperative window trial was performed at multicenter breast surgery referral practices from May 31, 2017, to January 27, 2021. Among 408 women with estrogen receptor-positive DCIS who were approached, 120 consented and 100 initiated study treatment. The most common reasons for nonparticipation were surgical delay, disinterest in research, and concerns about toxic effects. Data were analyzed from January 26, 2021, to October 5, 2022. Intervention: Random assignment to oral tamoxifen citrate, 20 mg/d, and gel placebo or 4-hydroxytamoxifen gel, 2 mg/d per breast, and oral placebo, for 4 to 10 weeks, followed by DCIS resection. Main Outcomes and Measures: The primary end point was absolute change in DCIS Ki-67 labeling index (Ki67-LI). Secondary end points included 12-gene DCIS Score, breast tissue tamoxifen metabolite concentrations, tamoxifen-responsive plasma protein levels, and patient-reported symptoms. Noninferiority of Ki67-LI reduction by 4-hydroxytamoxifen gel was tested using analysis of covariance; within- and between-arm comparisons were performed with paired t tests for mean values or the Wilcoxon rank sum test for medians. Results: Of 90 participants completing treatment (mean [SD] age, 55 [11] years; 8 [8.9%] Asian, 16 [17.8%] Black, 8 [8.9%] Latina, and 53 [58.9%] White), 15 lacked residual DCIS in the surgical sample, leaving 75 evaluable for the primary end point analysis (40 in the oral tamoxifen group and 35 in the 4-hydroxytamoxifen gel group). Posttreatment Ki67-LI was 3.3% higher (80% CI, 2.1%-4.6%) in the 4-hydroxytamoxifen gel group compared with the oral tamoxifen group, exceeding the noninferiority margin (2.6%). The DCIS Score decreased more with oral tamoxifen treatment (-16 [95% CI, -22 to -9.4]) than with 4-hydroxytamoxifen gel (-1.8 [95% CI, -5.8 to 2.3]). The median 4-hydroxytamoxifen concentrations deep in the breast were nonsignificantly higher in the oral tamoxifen group (5.7 [IQR, 4.0-7.9] vs 3.8 [IQR, 1.3-7.9] ng/g), whereas endoxifen was abundant in the oral tamoxifen group and minimal in the 4-hydroxytamoxifen gel group (median, 13.0 [IQR, 8.9-20.6] vs 0.3 [IQR, 0-0.3] ng/g; P < .001). Oral tamoxifen caused expected adverse changes in plasma protein levels and vasomotor symptoms, with minimal changes in the transdermal group. Conclusions and Relevance: In this randomized clinical trial, antiproliferative noninferiority of 4-hydroxytamoxifen gel to oral tamoxifen was not confirmed, potentially owing to endoxifen exposure differences. New transdermal approaches must deliver higher drug quantities and/or include the most potent metabolites. Trial Registration: ClinicalTrials.gov Identifier: NCT02993159.

Inferior scapula avulsion fracture: an unusual presentation of winged scapula.

Inferior scapula avulsion fractures are rare injuries, with few cases reported and only a small number managed operatively discussed in the literature. We report the case of a man in his 40s who fell from a height and presented with right-sided scapular winging and point tenderness at the inferior pole of his right scapula with no neurological deficit. Radiographs and CT diagnosed avulsion fracture of the inferior scapula. The patient underwent surgical fixation and, following a course of physiotherapy, successfully recovered with no residual winging and full range of movement.

FORWARD: Building a Model to Hold Schools of Public Health Accountable for Antiracism Work.

Schools of public health have increasingly adopted programs, praxis, and competencies for antiracist work. Fighting Oppression, Racism and White Supremacy through Action, Research and Discourse (FORWARD) was founded to accelerate antiracist work at the Columbia University Mailman School of Public Health in New York City. Seven action corps reporting to an accountability cabinet were established with 183 participants. FORWARD achieved progress across five core pillars. We describe how an iterative, dynamic structure and explicit framework for accountability can guide future antiracism work. (Am J Public Health. 2023;113(10):1086-1088. https://doi.org/10.2105/AJPH.2023.307356).

Systematic comparisons of different quality control approaches applied to three large pediatric neuroimaging datasets.

INTRODUCTION: Poor quality T1-weighted brain scans systematically affect the calculation of brain measures. Removing the influence of such scans requires identifying and excluding scans with noise and artefacts through a quality control (QC) procedure. While QC is critical for brain imaging analyses, it is not yet clear whether different QC approaches lead to the exclusion of the same participants. Further, the removal of poor-quality scans may unintentionally introduce a sampling bias by excluding the subset of participants who are younger and/or feature greater clinical impairment. This study had two aims: (1) examine whether different QC approaches applied to T1-weighted scans would exclude the same participants, and (2) examine how exclusion of poor-quality scans impacts specific demographic, clinical and brain measure characteristics between excluded and included participants in three large pediatric neuroimaging samples. METHODS: We used T1-weighted, resting-state fMRI, demographic and clinical data from the Province of Ontario Neurodevelopmental Disorders network (Aim 1: n = 553, Aim 2: n = 465), the Healthy Brain Network (Aim 1: n = 1051, Aim 2: n = 558), and the Philadelphia Neurodevelopmental Cohort (Aim 1: n = 1087; Aim 2: n = 619). Four different QC approaches were applied to T1-weighted MRI (visual QC, metric QC, automated QC, fMRI-derived QC). We used tetrachoric correlation and inter-rater reliability analyses to examine whether different QC approaches excluded the same participants. We examined differences in age, mental health symptoms, everyday/adaptive functioning, IQ and structural MRI-derived brain indices between participants that were included versus excluded following each QC approach. RESULTS: Dataset-specific findings revealed mixed results with respect to overlap of QC exclusion. However, in POND and HBN, we found a moderate level of overlap between visual and automated QC approaches (rtet=0.52-0.59). Implementation of QC excluded younger participants, and tended to exclude those with lower IQ, and lower everyday/adaptive functioning scores across several approaches in a dataset-specific manner. Across nearly all datasets and QC approaches examined, excluded participants had lower estimates of cortical thickness and subcortical volume, but this effect did not differ by QC approach. CONCLUSION: The results of this study provide insight into the influence of QC decisions on structural pediatric imaging analyses. While different QC approaches exclude different subsets of participants, the variation of influence of different QC approaches on clinical and brain metrics is minimal in large datasets. Overall, implementation of QC tends to exclude participants who are younger, and those who have more cognitive and functional impairment. Given that automated QC is standardized and can reduce between-study differences, the results of this study support the potential to use automated QC for large pediatric neuroimaging datasets.

Ending the pandemic of inaccessibility in dermatology.

Dermatology in the United States is among the global leaders in advancing scientific discovery and practicing evidence-based medicine; however, many patients face limited access to dermatologic care due to a national shortage of dermatologists, provider clustering, and the interplay of sociodemographic and socioeconomic factors. These intertwined barriers have created a landscape where race, ethnicity, insurance subtype, education, and socioeconomic status negatively impact access to dermatologic services. Leveraging the utilization of technology and community engagement provides inroads to improve access to care. We outline how teleconsultations, telementoring, specialty care extension for community health outcomes (Project ECHO), community health centers, donated specialty care models, and community health workers can be bolstered to create more equitable access to care.