Universal C-MAC® videolaryngoscope use in adult patients: a single-centre experience.

Universal use of Storz C-MAC® videolaryngoscopes was implemented for adult tracheal intubations in the operating theatres, intensive care unit and emergency department at Royal United Hospitals Bath NHS Foundation Trust in 2017. We report data from 1099 intubations from March 2020 to March 2022, collected contemporaneously and anonymously using a smartphone app, representing an estimated 18% of intubations in operating theatres and 30% of intubations in other locations during this period. Intubation success was 100%. The first-pass success rate was 87.3% overall: 87% with a Macintosh videolaryngoscope, 92% with a hyperangulated videolaryngoscope and 81% for users with ≤ 20 previous uses. First-pass success without complications was 87% overall: 87% in operating theatres (836/962), 93% in the emergency department (38/41) and 83% in the intensive care unit (73/88). Complications occurred during 0.6% of intubations: 0/962 in operating theatres and 7/137 in non-theatre locations. The rate of complications was unaltered by blade type (Macintosh 5/994 vs. hyperangulated 2/105, p = 0.14); intubator experience with the device (≤ 20 previous clinical uses 2/260 vs. > 20 previous uses 5/832, p = 0.67) and use of airborne personal protective equipment (PPE 6/683 vs. no-PPE 1/410, p = 0.27). Complication rates increased outside theatres (theatres 0/963 vs. non-theatre 7/136, p < 0.001) and during rapid sequence induction (RSI 6/379 (1.6%) vs. non-RSI 1/720 (0.1%), p = 0.008).

Treatment-related Adverse Events, Including Fatal Toxicities, in Patients With Extensive-stage Small-cell Lung Cancer Receiving Adjuvant Programmed Cell Death 1/Programmed Cell Death Ligand 1 Inhibitors: A Meta-analysis and Trial Sequential Analysis of Randomized Controlled Trials.

BACKGROUND/AIMS: The safety profile of programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors when associated with chemotherapy for the treatment of patients with extensive-stage small-cell lung cancer is still not fully unraveled. METHODS: We performed a comprehensive searrch of the PubMed, Embase, and Cochrane databases for randomized controlled trials that investigated the addition of PD-1 or PD-L1 inhibitors to standard investigator choice chemotherapy. We used risk -ratios (RRs) with 95% confidence intervals (CIs) for all endpoints. RESULTS: Six studies and 2,995 patients were included. At the baseline, the median age of the patients varied from 62 to 65 years, 311 (10.4%) had brain metastases, and 1,060 (35.4%) had liver metastases. PD-1/PD-L1 inhibitors were found to reduce fatal toxicities-related mortality (RR: 0.85; 95% CI: 0.80-0.91; p < 0.001; I2 = 49%). The intervention group had a higher incidence of decreased appetite (RR: 1.19; 95% CI: 1.02-1.40; p = 0.03; I2 = 0%), hyponatremia (RR: 1.51; 95% CI: 1.08-2.12; p = 0.02; I2 = 0%), and hypothyroidism (RR: 3.14; 95% CI: 1.10-8.95; p = 0.03; I2 = 81%) of any grade. Regarding adverse events of grade 3-4, there was no association of the addition of PD-1/PD-L1 inhibitors with an increased occurrence of any of the evaluated outcomes. CONCLUSION: In this systematic review and meta-analysis, the incorporation of PD-1/PD-L1 inhibitors to chemotherapy demonstrated an excellent safety profile and to be a promising prospect for reshaping the established treatment paradigms for patients with extensive-stage small cell lung cancer.

Child Access Prevention Laws and Pediatric Firearm Injury: A Rapid Review.

Introduction: US child firearm fatality rates have risen since 2013. Child Access Prevention (CAP) laws aimed at reducing minors' access to firearms have existed since the 1980s. However, specific requirements for safe storage of firearms, standards of negligence, and penalties for offenders vary significantly by state, yielding a heterogeneous body of CAP legislation. A few studies have investigated the relative impacts of these laws on child firearm injury rates, with sometimes conflicting results. Here, we present a rapid review of the existing literature on CAP laws and their apparent impact on firearm-related injuries among US children, to assess whether CAP laws are an effective tool for reducing child firearm injuries. Methods: We conducted a rapid review of published reports that evaluated the impact of CAP laws on pediatric firearm injuries and/or deaths in the United States. We extracted target population data and outcomes of each study. The data are presented narratively. Results: A total of 14 articles met criteria for evaluation. Taken together, these studies showed that implementation of CAP legislation was associated with reduced pediatric firearm injuries and fatalities. Moreover, longitudinal or time-series studies that examined changes in pediatric firearm injuries pre/post-CAP legislation yielded the most consistent and robust findings. Conclusion: CAP laws were found to be associated with reduced pediatric firearm injuries and deaths, with the magnitude of effect being proportional to CAP law stringency.

SARS-CoV-2 delta variant in African lions (Panthera leo) and humans at Utah's Hogle Zoo, USA, 2021-22.

AIMS: We conducted a One Health investigation to assess the source and transmission dynamics of SARS-CoV-2 infection in African lions (Panthera leo) at Utah's Hogle Zoo in Salt Lake City from October 2021 to February 2022. METHODS AND RESULTS: Following observation of respiratory illness in the lions, zoo staff collected pooled faecal samples and individual nasal swabs from four lions. All specimens tested positive for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR). The resulting investigation included: lion observation; RT-PCR testing of lion faeces every 1-7 days; RT-PCR testing of lion respiratory specimens every 2-3 weeks; staff interviews and RT-PCR testing; whole-genome sequencing of viruses from lions and staff; and comparison with existing SARS-CoV-2 human community surveillance sequences. In addition to all five lions, three staff displayed respiratory symptoms. All lions recovered and no hospitalizations or deaths were reported among staff. Three staff reported close contact with the lions in the 10 days before lion illness onset, one of whom developed symptoms and tested positive for SARS-CoV-2 on days 3 and 4, respectively, after lion illness onset. The other two did not report symptoms or test positive. Two staff who did not have close contact with the lions were symptomatic and tested positive on days 5 and 8, respectively, after lion illness onset. We detected SARS-CoV-2 RNA in lion faeces for 33 days and in lion respiratory specimens for 14 weeks after illness onset. The viruses from lions were genetically highly related to those from staff and two contemporaneous surveillance specimens from Salt Lake County; all were delta variants (AY.44). CONCLUSIONS: We did not determine the sources of these infections, although human-to-lion transmission likely occurred. The observed period of respiratory shedding was longer than in previously documented SARS-CoV-2 infections in large felids, indicating the need to further assess duration and potential implications of shedding.

Eficácia do sacubitril-valsartana comparado com IECA ou BRA para prevenir a recorrência de FA após ablação por cateter: uma meta-análise / Efficacy of sacubitril-valsartan compared with ACE inhibitors or ARBs to prevent AF recurrence after catheter ablation: a meta-analysis

INTRODUÇÃO: Em pacientes que foram submetidos a ablação por cateter devido a fibrilação atrial pode ocorrer a recorrência deste quadro. Não é estabelecido o efeito do S/V na prevenção da recorrência de fibrilação atrial (FA) comparado a Inibidores da Enzima Conversora da Angiotensina (IECA) ou Bloqueadores do Receptor da Angiotensina II (BRA). Essa metaanálise visa estabelecer qual a melhor escolha terapêutica para prevenção da recorrência de FA após ablação por catéter. MÉTODO: Foi realizada uma busca sistemática nas bases do PubMed, Embase e Cochrane para ensaios clínicos randomizados (ECR) e estudos observacionais comparando uso de S/V com IECA/BRA em pacientes que realizaram ablação por cateter. Os resultados foram apresentados em diferenças de médias (DM), com intervalo de confiança de 95% (IC). A heterogeneidade foi avaliada pelo I2 e desfechos expressos em riscos relativos (RR), utilizando o software R versão 4.2.3. RESULTADOS: Foram incluídos 3 ensaios clínicos randomizados e 1 estudo de coorte, composto por 642 pacientes, com 319 pacientes no grupo S/V e 323 no grupo controle. O seguimento dos estudos variou de 12 meses a 36 meses, a média de idade variou de 58.9 a 65.82 anos. Foi demonstrado a redução de ocorrência de FA persistente com uma diferença significativa favorecendo o grupo S/V (RR 0.43; 95% IC 0,25-0.76; P=0.003; I2=80%) comparado com o grupo IECA/BRA. Na análise houve uma redução significativa do Índice de Volume Atrial Esquerdo (IVAE) (MD -5.34ml/m2; 95% IC -8.77,-1.91; P=0.002; I2= 57%) no grupo S/V comparado com IECA/BRA. Não houve diferença significativa da fração de ejeção do ventrículo esquerdo com o uso de S/V (MD 1.24%; 95% IC -0.13, 2.61; P=0.076; I2= 0%) em comparação com IECA/BRA. CONCLUSÃO: Nesta metanálise, foi evidenciada a eficácia de S/V na diminuição da incidência de FA em pacientes submetidos à ablação por cateter, em comparação ao uso de IECA/ BRA. Contudo, ressalta-se a necessidade de realização de mais ensaios clínicos randomizados para uma avaliação mais abrangente de sua eficácia na redução da recorrência de FA em paciente pós ablação por cateter na prática clínica.

Eficácia e segurança da denervação renal por radiofrequência em pacientes com hipertensão resistente: uma meta-análise / Efficacy and safety of radiofrequency renal denervation in patients with resistant hypertension: a meta-analysis

INTRODUÇÃO: Diversos estudos foram publicados avaliando o uso da denervação renal por radiofrequência (DRR) no tratamento de pacientes com hipertensão arterial resistente (HAR). Essa técnica consiste em um procedimento minimamente invasivo que visa interromper a atividade dos nervosrenais via ablação. Entretanto,sua eficácia e segurança com cateter via radiofrequência ainda não foi elucidada. Essa meta-análise tem por objetivo investigar a eficácia da denervação renal por radiofrequência (DRR) comparado com sham ou anti hipertensivos. METODOLOGIA: Foi realizada uma busca nas bases de dados da PubMed, Embase e Cochrane, por ensaios clínicos randomizados que compararam a redução da pressão arterial entre a denervação renal por radiofrequência (DRR) e o sham ou tratamento padrão em pacientes com HAR. Os dados foram reunidos usando um modelo de efeito fixo, e os resultados foram dados em diferença de média (DM) e risco relativo (RR), com 95% de intervalo de confiança (IC). A heterogeneidade entre os estudos foi calculada pelo I2. Todas as estatísticas foram realizadas usando o R software(version 4.0.3). RESULTADOS: Ao todo foram incluídos 8 ensaios clínicos randomizados, composto por 934 pacientes (557 do grupo RDN e 377 do grupo controle). O seguimento dos estudos variou de 6 meses até 84 meses, a média de idade variou entre 53 a 64.5 anos e com 349 pacientes portadores de diabetes tipo 2. A DRR foi associada com redução significativa da pressão sistólica ambulatorial (DM: -6.25 mmHg, 95% IC: -8.83; -3.67, P< 0.001, I2= 52%), assim como na diastólica ambulatorial (DM: -2.67 mmHg, 95% IC: -4.38; -0.95, P=0.002, I2=50%) comparado com grupo controle. De maneira semelhante, houve redução significativa da pressão diastólica de consultório (DM: -5.11 mmHg, 95% IC: -9.19; -1.02, P=0.014, I2=72%). Não houve diferença estatística em relação à pressão sistólica de consultório (DM: -9.50 mmHg, 95% IC:-20.54; 1.54, P=0.092, I2=87%), aos efeitos adversos secundários (RR: 1.86, 95% IC: 0.66; 5.26, P=0.240, I2= 50%) e à crise hipertensiva (RR:1.10, 95% IC: 0.55; 2.22, P=0.780, I2=0%). CONCLUSÕES: Esta meta-análise demonstrou a eficácia do uso da DRR na redução da pressão arterial global ambulatorial e pressão diastólica de consultório, e não apresentou aumentos de efeitos adversos secundários e crise hipertensiva. Esses achados demonstram o potencial uso da DRR no tratamento de pacientes que possuem hipertensão arterial resistente.

Characterization of flux distribution in the pool of the RMC SLOWPOKE-2.

The neutron flux distribution within the pool of the SLOWPOKE-2 reactor at the RMC has been characterized using neutron activation measurements as well as MCNP simulations. Westcott equivalent thermal neutron flux values were calculated from measured activities of solutions of Co, Au, and Cd-shielded Au at several reactor flux settings and compared to tabulated fluxes from MCNP simulations. Good agreement was found between the simulated and experimental thermal flux values, while larger uncertainties were highlighted in higher energy neutron fluxes.

Disease and toxicity outcomes for a modern cohort of patients with squamous cell carcinoma of cutaneous origin involving the parotid gland: Comparison of volumetric modulated arc therapy and pencil beam scanning proton therapy.

OBJECTIVES: We sought to describe outcomes for locally advanced cutaneous squamous cell carcinoma (SCC) involving the parotid treated with volumetric modulated arc therapy (VMAT) versus pencil beam scanning proton beam therapy (PBT). MATERIALS AND METHODS: Patients were gathered from 2016 to 2022 from 5 sites of a large academic RT department; included patients were treated with RT and had parotid involvement by: direct extension of a cutaneous primary, parotid regional spread from a previously or contemporaneously resected but geographically separate cutaneous primary, or else primary parotid SCC (with a cutaneous primary ostensibly occult). Acute toxicities were provider-reported (CTCAE v5.0) and graded at each on treatment visit. Statistical analyses were conducted. RESULTS: Median follow-up was 12.9 months (1.3 - 72.8); 67 patients were included. Positive margins/extranodal extension were present in 34 cases; gross disease in 17. RT types: 39 (58.2 %) VMAT and 28 (41.8 %) PBT. Concurrent systemic therapy was delivered in 10 (14.9 %) patients. There were 17 treatment failures (25.4 %), median time of 168 days. Pathologically positive neck nodes were associated with locoregional recurrence (p = 0.015). Oral cavity, pharyngeal constrictor, and contralateral parotid doses were all significantly lower for PBT. Median weight change was -3.8 kg (-14.1 - 5.1) for VMAT and -3 kg (-16.8 - 3) for PBT (p = 0.013). Lower rates of ≥ grade 1 xerostomia (p = 0.002) and ≥ grade 1 dysguesia (p < 0.001) were demonstrated with PBT. CONCLUSIONS: Cutaneous SCC involving the parotid can be an aggressive clinical entity despite modern multimodal therapy. PBT offers significantly lower dose to organs at risk compared to VMAT, which seemingly yields diminished acute toxicities.

A day in the life: Couples' everyday communication and subsequent relationship outcomes.

Understanding how communication processes contribute to well-functioning versus distressed couple relationships has relied largely on brief, laboratory-based conversations. Harnessing technological advancements, the present study extends the literature by capturing couples' naturalistic communication over one full day at Time 1 (T1). This study tested associations between data-driven categories of couple communication behaviors and relationship outcomes (i.e., relationship aggression, satisfaction, and dissolution) at Time 2 (T2), approximately 1 year later. Emerging adults in different-gender dating couples (n = 106 couples; 212 individuals; Mage = 22.57 ± 2.44; M relationship length = 30.49 months ± 24.05; 72.2% non-White) were each provided a smartphone programmed to audio record approximately 50% of a typical day. Interactions between partners were transcribed and coded for location, activity, affect, and a range of positive and negative communication behaviors for each partner. Even after controlling for T1 assessments of the relevant outcome, one's own hostility and one's partner's hostility at T1 were each positively associated with T2 relationship aggression and negatively associated with T2 relationship satisfaction. One's own withdrawal at T1 was positively associated with T2 relationship aggression perpetration, whereas one's partner's withdrawal was negatively linked to relationship satisfaction at T2. One's own playfulness, unexpectedly, was linked to lower subsequent relationship satisfaction. Withdrawal increased the likelihood of relationship dissolution, whereas warmth and playfulness decreased the likelihood of dissolution. The relevance of couples' ordinary, everyday communication for meaningful relationship outcomes is discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pathways to paediatric urology subspecialisation: a study of casemix, incumbent attitudes and opinions.

OBJECTIVE: To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. METHODS: An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS: A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting (p = 0.04), bladder bowel dysfunction (p = 0.02), endourological procedures (p = 0.04), and robotics (p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction (p = 0.03), and posterior urethral valve ablation (p = 0.002). CONCLUSION: This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.

Bones and guts - Why the microbiome matters.

The importance of the gut microbiota in human health has become increasingly apparent in recent years, especially when the relationship between microbiota and host is no longer symbiotic. It has long been appreciated that gut dysbiosis can be detrimental to human health and is associated with numerous disease states. Only within the last decade, however, was the gut microbiota implicated in bone biology. Dubbed osteomicrobiology, this emerging field aims to understand the relationship between the gut microbiome and the bone microenvironment in both health and disease. Importantly, the key to one of the major clinical challenges facing both bone and cancer biologists: bone metastasis, may lie in the field of osteomicrobiology; however the link between gut bacteria and bone metastasis is only beginning to be explored. This review will discuss (i) osteomicrobiology as an emerging field, and (ii) the current understanding of osteomicrobiology in the context of cancer in bone.

Oxygen saturation index: an adjunct for oxygenation index in congenital diaphragmatic hernia.

OBJECTIVE: Our objective was to investigate the correlation of Oxygen Saturation Index (OSI) with Oxygenation Index (OI) and determine OSImax values that could predict need for ECMO and death in Congenital Diaphragmatic Hernia (CDH). STUDY DESIGN: This is a retrospective cohort study of infants with CDH admitted to a tertiary level VI NICU. Pearson's correlation coefficient and simple linear regression analysis were used to investigate the OSI: OI correlation, and logistic regression analysis to investigate OSImax values that predicted need for ECMO and death. RESULTS: Among the 180 infants, OSImax value of >13 at 6 h of life (HOL) best predicted need for ECMO and death. There was a strong correlation between OSI: OI paired values (r = 0.876, p < 0.001). The linear regression equation was OI = -2.4 + 2.4(OSI). CONCLUSION: OSI could be used as a valuable adjunct to OI in the clinical management of newborn infants with CDH.

Anti-Black violence, discrimination, and sleep difficulties amongst racially diverse Americans: The aftermath of the murder of George Floyd.

RATIONALE: Following the murders of George Floyd and other Black Americans during the summer of 2020, there was unprecedented exposure to media-disseminated depictions of anti-Black violence. Little is known about the impact of this widespread form of vicarious racism that was pervasive during that historic time. OBJECTIVE: The present study applies the concept of vicarious racism to study this secondary exposure to anti-Black violence. We investigated negative impacts of anti-Black violence (NIAV) and personal experiences with discrimination in association with sleep difficulties, a critical intermediary health process. METHODS: Racially diverse Americans (N = 487) were recruited to participate in a cross-sectional study using an online survey given between December 11, 2020 and February 11, 2021. RESULTS: Black participants endorsed greater NIAV than Asian, Latinx, and White participants. Moreover, Black, Asian, and Latinx participants reported greater direct discrimination than White participants. NIAV and direct discrimination were each associated with more sleep difficulties. Although associations between NIAV and sleep difficulties did not vary by race, race moderated the association between direct discrimination and sleep difficulties. In addition, direct discrimination moderated the association between NIAV and sleep difficulties in an unanticipated direction: the link between NIAV and sleep difficulties was weaker for those experiencing more direct discrimination. CONCLUSION: Findings suggest that anti-Black violence and police brutality not only impact direct victims but have widespread vicarious impacts on racially diverse Americans, and highlight that vicarious anti-Black racism and discrimination are important issues of public health.

Human exposure to diesel exhaust induces CYP1A1 expression and AhR activation without a coordinated antioxidant response.

BACKGROUND: Diesel exhaust (DE) induces neutrophilia and lymphocytosis in experimentally exposed humans. These responses occur in parallel to nuclear migration of NF-κB and c-Jun, activation of mitogen activated protein kinases and increased production of inflammatory mediators. There remains uncertainty regarding the impact of DE on endogenous antioxidant and xenobiotic defences, mediated by nuclear factor erythroid 2-related factor 2 (Nrf2) and the aryl hydrocarbon receptor (AhR) respectively, and the extent to which cellular antioxidant adaptations protect against the adverse effects of DE. METHODS: Using immunohistochemistry we investigated the nuclear localization of Nrf2 and AhR in the epithelium of endobronchial mucosal biopsies from healthy subjects six-hours post exposure to DE (PM10, 300 µg/m3) versus post-filtered air in a randomized double blind study, as a marker of activation. Cytoplasmic expression of cytochrome P450s, family 1, subfamily A, polypeptide 1 (CYP1A1) and subfamily B, Polypeptide 1 (CYP1B1) were examined to confirm AhR activation; with the expression of aldo-keto reductases (AKR1A1, AKR1C1 and AKR1C3), epoxide hydrolase and NAD(P)H dehydrogenase quinone 1 (NQO1) also quantified. Inflammatory and oxidative stress markers were examined to contextualize the responses observed. RESULTS: DE exposure caused an influx of neutrophils to the bronchial airway surface (p = 0.013), as well as increased bronchial submucosal neutrophil (p < 0.001), lymphocyte (p = 0.007) and mast cell (p = 0.002) numbers. In addition, DE exposure enhanced the nuclear translocation of the AhR and increased the CYP1A1 expression in the bronchial epithelium (p = 0.001 and p = 0.028, respectively). Nuclear translocation of AhR was also increased in the submucosal leukocytes (p < 0.001). Epithelial nuclear AhR expression was negatively associated with bronchial submucosal CD3 numbers post DE (r = -0.706, p = 0.002). In contrast, DE did not increase nuclear translocation of Nrf2 and was associated with decreased NQO1 in bronchial epithelial cells (p = 0.02), without affecting CYP1B1, aldo-keto reductases, or epoxide hydrolase protein expression. CONCLUSION: These in vivo human data confirm earlier cell and animal-based observations of the induction of the AhR and CYP1A1 by diesel exhaust. The induction of phase I xenobiotic response occurred in the absence of the induction of antioxidant or phase II xenobiotic defences at the investigated time point 6 h post-exposures. This suggests DE-associated compounds, such as polycyclic aromatic hydrocarbons (PAHs), may induce acute inflammation and alter detoxification enzymes without concomitant protective cellular adaptations in human airways.

A Relationship-Based Resilience Program for Promotores: Protocol for a Randomized Controlled Waitlist Trial.

BACKGROUND: Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS's potential in promoting CSPs' cardiometabolic health and, in so doing, having broader impacts on the community they serve. OBJECTIVE: This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs' cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs' threats to leaving the workforce. METHODS: We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs' threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs' delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs' threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. RESULTS: The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). CONCLUSIONS: This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. TRIAL REGISTRATION: ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51427.

A Critical Scoping Review of Mental Health and Wellbeing Research with Multiracial Subsamples 2012-2022.

This critical scoping review examined a decade of mental health and wellbeing outcome research inclusive of subsamples of multiracial participants (or persons identifying with two or more different racial groups) in order to draw initial conclusions about the contemporary state of multiracial mental health. Mental health disparities research inclusive of multiracial subsamples appears to be trending upward. Studies that used subsample analyses offer initial evidence that multiracial persons are at greater risk to experience worsened mental health in comparison to white monoracial peers, and that this disparity is compounded for multiracial persons from gender and/or sexual minoritized groups. This review uncovered numerous theoretical and methodological inconsistencies that constrained existing research from advancing more meaningful understandings of how white supremacy and systemic mono/racism differently impact the mental health and wellbeing of multiracial persons in the USA. Implications for future mental health disparities research inclusive of multiracial subsamples are presented.

Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder Bowel Dysfunction: A Prospective Multi-Institutional European Observational Study.

PURPOSE: Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis. MATERIALS AND METHODS: This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores. RESULTS: A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group. CONCLUSIONS: This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.

Gut Microbial Changes Following Fecal Microbiota Transplantation for D-Lactic Acidosis in Two Children.

D-lactic acidosis (D-LA) is an uncommon complication of short bowel syndrome characterized by elevated plasma D-lactate and encephalopathy. Treatments include rehydration, dietary carbohydrate restriction, and antibiotics to alter the gut microbiota. Fecal microbiota transplantation (FMT) has recently been used in children to successfully treat D-LA. We compared the clinical course and then utilized metagenomic shotgun sequencing to describe changes in the composition and function of the intestinal microbiome following FMT in 2 patients with recurrent D-LA. FMT altered the composition of the fecal microbiota in these 2 patients with recurrent D-LA, though not necessarily in a consistent manner. Importantly, microbial metabolic pathways were also impacted by FMT, which may be critical for achieving desired clinical outcomes. While sample size limits the generalizability of our results, these findings set the stage for further understanding of the role of microbes in the pathogenesis of recurrent D-LA.

Real-world treatment patterns and clinical outcomes after introduction of immune checkpoint inhibitors: Results from a retrospective chart review of patients with advanced/metastatic non-small cell lung cancer in the EU5.

BACKGROUND: Real-world evidence is increasingly used to guide treatment and regulatory decisions for non-small cell lung cancer (NSCLC). Real-world treatment patterns and clinical outcomes among patients with advanced/metastatic NSCLC in France, Germany, Italy, Spain, and the UK (EU5) were assessed. METHODS: This retrospective physician-completed patient chart review assessed treatment patterns (regimen, duration of treatment [DOT], time to discontinuation), and clinical outcomes (duration of response [DOR], progression-free survival [PFS], and overall survival [OS]) of patients with stage IIIB/C or IV NSCLC who received pembrolizumab-based first-line induction chemotherapy. RESULTS: Overall, 322 patients were included; at first-line maintenance (1LM), 92% had stage IV NSCLC, 68% had nonsquamous histology, and 89% had no central nervous system (CNS)/brain metastasis. The two most common 1LM regimens were pembrolizumab monotherapy (76% overall) and pembrolizumab + pemetrexed (21% overall). Docetaxel monotherapy was the most common second-line regimen in all countries except Germany (54% overall). For 1LM therapy, the overall median DOT and DOR were 5 and 10 months, respectively; PFS was 7 months and OS was 8 months. Germany had a longer duration of each outcome except for DOR which was longer in Spain. Clinical outcomes were generally poorer for patients with squamous histology and CNS/brain metastases. CONCLUSIONS: This study demonstrated differences in treatment patterns and clinical outcomes in NSCLC across the EU5 and patient subgroups. Improved survival was generally associated with response to first-line therapy, nonsquamous histology, and CNS/brain metastases absence. These real-world data provide valuable insights which may aid treatment decision-making and clinical trial design.