This study examined the association between adverse childhood experiences (ACEs), including discrimination due to sexual orientation and gender identity, and exposure to secondhand smoke (SHS). Using data from the 2018–2020 National Survey of Children’s Health (NSCH), logistic regression models calculated adjusted odds ratios (AORs) of two SHS measures: (1) anyone living in the household uses combustible tobacco products, irrespective of them using that product in the home or not, and (2) anyone smoking inside the home. Individual and cumulative ACEs served as independent variables. Data from the 2020 NSCH included discrimination due to sexual orientation and gender identity as an ACE, for children 6–17, but prior years did not. Each additional ACE was associated with a 36
PURPOSE:The Medtronic implantable tibial neuromodulation system is a leadless, rechargeable, minimally invasive option intended to treat the symptoms of urge urinary incontinence (UUI), a common condition that significantly impairs quality of life. TITAN 2 is a pivotal study evaluating safety and effectiveness of the Medtronic implantable tibial neuromodulation system. The results through 12 months are reported. MATERIALS AND METHODS:This prospective, multicenter, single-arm investigational device exemption study enrolled eligible overactive bladder subjects with UUI. The primary end point was the percentage of subjects who had ≥ 50% reduction in UUI episodes/day after 6 months. Safety was characterized as the rate of adverse device effects (ADEs). Data are reported as mean ± SD or with 95% CIs. RESULTS:Of 126 implanted subjects, 95% were female, the mean age was 63 ± 14 years, and BMI was 35 ± 9 kg/m2. The primary objective was met with 59% of subjects achieving ≥ 50% improvement in UUI episodes/day (95% CI: 49%-67%, P < .0001) at 6 months; at 12 months, 61% had ≥ 50% improvement. Change from baseline was statistically significant at 6 months for UUI episodes/day, voids/day (in urinary frequency subjects), and Urgency Perception Score, with improvements in all 3 symptoms maintained through 12 months. Twenty percent of subjects experienced ADEs through 12 months; 1 ADE was serious and was recovered/resolved. CONCLUSIONS:TITAN 2 met the primary and all secondary objectives by showing a statistically significant improvement of UUI, urinary frequency, and urgency symptoms. Clinical benefits and a favorable safety profile were maintained through 12 months.
PURPOSE:Distinguishing high-risk intraductal papillary mucinous neoplasms (IPMNs) from low-risk lesions remains a clinical challenge, often resulting in unnecessary procedures due to limited specificity of current methods. While radiomics and deep learning (DL) have been explored for pancreatic cancer, cyst-level malignancy risk stratification of IPMNs remains untapped. METHODS:Our multi-institutional assessed the feasibility of AI for predicting IPMN dysplasia grade using cyst-level image features using 359 T2-weighted (T2W) MRI images from seven centers. We developed and compared 2D and 3D radiomics-only, DL-only, and radiomics-DL fusion models using expert radiologist scoring as a baseline reference. Model performance was evaluated using held-out test data. RESULTS:The radiomics-DL fusion model showed the highest discriminatory ability on the test set AUC of 69.2%, outperforming the radiomics-only model, AUC of 66.5%. Expert accuracy varied widely from 37.4% to 66.7%, and the inter-rater agreement varied as well with weighted Cohen's kappa coefficients of 0.33-0.67. CONCLUSION:The fusion model, which combines DL with radiomics features from routine T2W MRI, shows promise for objective, cyst-level risk stratification of IPMNs in a multi-center cohort, outperforming radiomics-only models and nearly matching expert radiologists using only T2W and T1-weighted (T1W) sequences. While performance requires improvement for standalone clinical use, this approach offers a scalable, non-invasive method to potentially improve diagnostic accuracy and reduce unnecessary surgical interventions.
Perioperative myocardial ischemia and myocardial injury after noncardiac surgery (MINS) remain prevalent contributors to postoperative morbidity and mortality. Recent advances, including high-sensitivity biomarkers and updated 2024 American Heart Association/American College of Cardiology (AHA/ACC) guidelines, have modified the clinical approach to preoperative ischemic evaluation. This review intends to synthesize contemporary evidence and provide a framework for perioperative ischemic workup. A narrative review of the current literature and major society guidelines was conducted, focusing on perioperative risk stratification, functional capacity assessment, biomarker utilization, noninvasive and invasive diagnostic modalities, and perioperative medical optimization strategies. Contemporary perioperative evaluation favors a stepwise, risk-based approach that uses clinical risk indices, functional capacity, and selective diagnostic testing. Biomarkers such as natriuretic peptides and cardiac troponins enhance risk prediction and enable the detection of MINS, which is strongly associated with increased mortality. Evidence does not support routine preoperative stress testing or prophylactic coronary revascularization in stable patients. Guideline-directed medical therapy, including sustained statin use and attentive management of antiplatelet and beta-blocker therapy, remains central to risk mitigation. Modern perioperative ischemic workup prioritizes individualized, evidence-based evaluation over routine testing. Integration of biomarkers, structured risk assessment, and multidisciplinary management may improve outcomes, though additional research is needed to define optimal strategies for detecting and treating MINS.
The world has faced several high consequence infectious diseases or infections (HCI) over the past years with outbreaks traveling from country to country. Recent outbreaks such as Marburg virus in Tanzania (2023) Ebola virus in Uganda (2022), Middle East Respiratory Syndrome Coronavirus (MERS) in Saudi Arabia (2018) serve as a frightening reminder that HCI can circulate at any given time, generating considerable public health and economic consequences. Our Veterans Affairs Medical Center (VAMC) has a response HCI plan. We evaluated the knowledge of the existence of this plan and of HCI among health care employees (HCE) receiving the influenza vaccine during a drive-thru flu point of distribution (POD) driveFigure 1Questionnaire given to employees receiving the influenza vaccineFigure 2Education Pamphlet given to employees upon receipt of vaccine and completion of questionnaire HCE influenza vaccination was planned in the fall of 2024 as a drive-thru flu POD, a single day, 90 min event. The location was the main employee entrance at Northport VAMC. A questionnaire was given to each employee who received the influenza vaccine. Completion was voluntary. The questionnaire is depicted in figure 1. The participants were asked to circle which of the following are HCI: the choices were “FLU, RSV, MERS, EBOLA, CHICHEN POX.” The second question: “Does Northport VA have a HCI response plan, Yes/No/Unsure”. The 3rd question “Do you have a role in the HCI plan, Yes/No/Unsure.” An education pamphlet on MERS and EBOLA was provided at completion of the questionnaire. see figure 2Table 1Answers of the Questionnaire 311 employees received the vaccine and 262 completed the questionnaire. Table 1 shows the answers. Equal number of HCE (199) identified the seasonal influenza and Ebola (199) as HCI. 71% of nurses and 72% of physicians/physician assistants/extenders regarded influenza as HCI. While 210 responded of awareness of the facility HCI plan, only 125 were clear of their role in this plan. Fewer identified chicken pox as HCI (115) followed by RSV responses (146). MERS received less votes (180) than influenza In our project we identified that our fellow HCE exhibited significant knowledge gaps in identifying what constitutes a HCI and what should be their role in event of HCI event in our facility. This is an opportunity for enhanced training and education to be conducted by infection control and emergency management teams as a HCI event occurring in the United States soon may become unavoidable All Authors: No reported disclosures
