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Brain dynamics reflecting an intra-network brain state is associated with increased posttraumatic stress symptoms in the early aftermath of trauma.
No full textPost-traumatic stress (PTS) encompasses a range of psychological responses following trauma, which may lead to more severe outcomes such as post-traumatic-stress disorder (PTSD). Identifying early neuroimaging biomarkers that link brain function to PTS outcomes is critical for understanding PTSD risk. This longitudinal study examines the association between brain dynamic functional network connectivity and current/future PTS symptom severity, and the impact of sex on this relationship. By analyzing 275 participants’ dynamic functional network connectivity data obtained ~2 weeks after trauma exposure, we noted that brain dynamics of an inter-network brain state link negatively with current (r = −0.197, P corrected = 0.0079) and future (r = –0.176, Pcorrected = 0.0176) PTS symptom severity. In addition, dynamics of an intra-network brain state correlated with future symptom intensity (r = 0.205, P corrected = 0.0079). We additionally observed that the association between the network dynamics of the inter-network and intra-network brain state with symptom severity is more pronounced in the female group. Our findings highlight a potential link between brain network dynamics in the aftermath of trauma with current and future PTSD outcomes, with a stronger effect in the female group, underscoring the importance of sex differences
Multicenter Validation of Video-based Deep Learning to Evaluate Defecation Patterns on 3-dimensional High-definition Anorectal Manometry
No full textBACKGROUND & AIMS: Deep learning technologies have demonstrated the ability to identify dyssynergic defecation for diagnosis of common gastrointestinal motility disorders through nuanced interpretation of 3-dimensional high-definition anal manometry (3D-HDAM). We aimed to validate a deep learning algorithm capable of spatiotemporal analysis of 3D-HDAM in a multicenter setting.
METHODS: We included 1214 consecutive anorectal manometry studies performed across 3 large health care systems between 2018 and 2022. Deep learning results were compared with expert interpretation according to the London consensus protocol as reference standard. Diagnostic accuracy was assessed using bootstrap sampling to calculate area under the curve (AUC). We used Wilcoxon tests to analyze how well the confidence scores from the deep learning model correlated with the likelihood that experts would assign ambiguous labels in cases where determinations were uncertain. Video-based deep learning features were clustered using Gaussian Mixture Modeling to reveal novel dyssynergia subtypes.
RESULTS: The deep hybrid learning algorithm achieved AUCs of 0.99 (± 0.001 standard deviation), 0.90 ± 0.008, and 0.79 ± 0.003 at Dartmouth Health, Henry Ford Hospital, and University of Pittsburgh Medical Center, respectively, performance comparable or superior to solely deep learning or traditional modeling on every cohort. The algorithm appeared capable of reporting confidence aligned with manual expert interpretation of ambiguity (W = -20.50; P \u3c .001; -1.73; P = .08; and -3.22; P = .001). We further identified 2 novel classes of dyssynergia patterns that may represent clinically relevant phenotypes of dyssynergia.
CONCLUSIONS: 3D-HDAM combined with video-based deep learning is a useful and clinically relevant technology for evaluating anorectal dyssynergia. Future use cases can be expanded to evaluate other motility disorders and their treatment
Psychologists\u27 Well-Being, Stressors, and Practices in Academic Health Centers: A Peri-Pandemic Update
No full textThe SARS-CoV-2 (COVID-19) pandemic strained healthcare systems and professionals. Psychologists were not immune from these effects. This study examined stressors, well-being, and the roles of psychologists in academic health centers during the second year of the pandemic. Members of the Association of Psychologists in Academic Health Centers (APAHC) completed a survey addressing burnout, work capacity, stress, career satisfaction, sources of professional stress, and changes in practices. Items were compared with the 2017 APAHC Membership Survey. Compared to 2017, the 2021 respondents reported increased stress and burnout, as well as diminished work capacity, without decreased career satisfaction. Additionally, the number of professional stressors endorsed by the majority of respondents increased from four stressors in 2017 and seven in 2021 when retrospectively reporting prior to March 2020, to thirteen stressors in post-March 2020 reporting. In 2021, burnout was associated with greater overall stress, perceived faculty stress, fewer hours for relaxation or to pursue enjoyable activities, more non-billable clinical hours, and time spent on non-clinical consultation. Higher stress levels and fewer hours for relaxation were associated with being overextended in one\u27s work capacity. These findings may inform well-being initiatives for psychologists in academic health centers and highlight the imperative for well-being for psychologists
Neuroimmunology in ageing and longevity: a special collection issue of Biogerontology
No full textAgeing is associated with neuroimmune shifts from a resting to a hyperactive and inflammatory state, termed \u27Neuroinflammageing\u27, attributed to microglial priming, hyperactive astrocytes, cytokine and chemokine release, blood brain barrier leakage, and infiltration of peripheral immune cells. This special issue of Biogerontology on \u27Neuroimmunology in Ageing and Longevity\u27 brings together 11 reviews and original research papers dealing with the complex cross-talk between CNS and peripheral immune cells and molecules in the context of ageing. The articles compiled under this issue further address how understanding neuroimmune pathways may help to identify targets to design interventional regimens for healthy brain ageing and longevity
Lower socioeconomic status is associated with recurrent shoulder instability before surgical shoulder stabilization
No full textBACKGROUND: Social determinants of health (SDOH) encompass social and economic factors that influence healthcare access and outcomes. In orthopaedic surgery, disparities in SDOH contribute to unequal access to care and differences in post-surgical recovery. Prior studies indicate that an increased number of preoperative shoulder dislocations raises the likelihood of recurrent instability following stabilization procedures. However, limited research explores the association between SDOH and preoperative dislocation frequency. This study examines how SDOH factors influence the number of shoulder dislocations before surgical intervention.
METHODS: Patients that underwent shoulder instability surgery at a single center in a large metropolitan area between January 1, 2021, and April 30, 2023, were identified. Patients\u27 demographic and social determinant variables were extracted using the electronic medical record. Socioeconomic status was assessed using the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI), based on patient zip codes. Statistical analyses, including univariate and multivariate regression models, evaluated predictors of multiple dislocations before surgery, focusing on factors such as age, body mass index (BMI), and socioeconomic indicators.
RESULTS: Among 106 patients, 54% identified as White, 29% as Black, and 17% as other. Thirty-eight (35.8%) had a single dislocation before surgery, while 68 (64.2%) experienced multiple instability events. Univariate analysis showed younger age (odds ratio [OR] 0.94, P = 0.02), lower BMI (OR 0.90, P = 0.02), higher SVI (OR 1.21, P = 0.006), and higher ADI (OR 6.04, P = 0.003) were associated with recurrent instability. Multivariate analysis confirmed lower BMI (OR 1.15, P = 0.02) and higher ADI (OR 7.46, P = 0.02) as independent predictors.
CONCLUSIONS: Lower socioeconomic status, as measured by ADI, is an independent predictor of a higher likelihood of recurrent instability before surgery. Recognizing these relationships can motivate surgeons to create pathways to prevent these treatment disparities among shoulder instability patients.
LEVEL OF EVIDENCE: III retrospective cohort study
Short-Term Outcomes of a Reinforced Greater Trochanter Stabilization Technique in Revision Total Hip Arthroplasty After Periprosthetic Fracture: A Novel Technique and Case Series
No full textThis preliminary study introduces a novel surgical technique for short-term fixation of greater trochanter fractures, in periprosthetic fractures, using nonabsorbable sutures and a metal cable, supported by a case series of 6 patients. The technique employs a 1.8-mm cable and 3 #5 nonabsorbable sutures, anchored through the trochanter and secured at the abductor tendon, with sequential tying to ensure stability. Among the 6 patients (mean age 77.3 ± 9.2 years), all demonstrated callus formation of the trochanteric fragment at final follow-up, with minimal migration relative to initial postoperative imaging (mean 2.1 ± 2.3 mm). At follow-up, ambulatory status included: 2 patients using walkers, 1 wheelchair-bound (preoperatively), and 3 ambulating independently. These outcomes suggest that this technique reduces hardware reliance and improves load distribution, promoting functional recovery
Childhood Social and Economic Disadvantage and the Risk of Uterine Fibroids among Black Women
No full textThe association of childhood social and economic disadvantage ( disadvantage ) and uterine fibroid risk is understudied. We examined the association between disadvantage and fibroid incidence using standardized ultrasound exams at repeated visits, among 1,230 participants 23-35 years of age in the Study of Environment, Lifestyle and Fibroids. Six disadvantage variables collected at baseline (i.e., food insecurity, neighborhood safety, childhood income, mother\u27s educational attainment, household composition, and quiet bedroom for sleep) were evaluated separately, and using a latent class dichotomous (high/low) disadvantage variable. We also looked at possible modifying effects of a supportive childhood environment. Using Cox models to estimate incidence rate ratios (RR) and 95% confidence intervals (CI), with age as the time scale, we found little evidence for an increased risk of fibroids for any of the disadvantage variables or with the latent class construct. Having a supportive social environment in childhood had little impact on the associations between disadvantage and fibroid incidence. These findings are consistent with and expand upon prior findings from large studies with more limited data on social and economic disadvantage and less accurate data on timing of fibroid incidence
Understaffed and overworked: The stark reality of acute care surgeon staffing in the United States, an Eastern Association for the Surgery of Trauma multicenter study
No full textOBJECTIVES: Rightsizing the workforce to clinical demand requires a balance of work intensity, productivity, and a definition of clinical full-time equivalent (cFTE). We hypothesized a shortage of acute care surgeons based on a 204-shift per year (average, 17 per month) definition of a 1.0 cFTE established in our prior mixed-methods study (two service weeks plus five calls per month).
METHODS: This multicenter study used mixed methods, integrating clinical schedules (CY2022), work relative value units, and qualitative insights from semistructured interviews (July 2023 to June 2024). Schedules were converted to shifts (8-14 hours). Hospitals were short-staffed when shift demand exceeded supply based on each surgeon\u27s cFTE. Interviews explored clinical demand and staffing challenges. Descriptive analysis and a deductive-inductive thematic analysis were performed.
RESULTS: Forty Level I/II hospitals representing 412 acute care surgeons (287 cFTEs) from 25 states were included. Seventy-nine percent of hospitals were short-staffed. Compared with well-staffed hospitals, short-staffed hospitals had fewer cFTEs (6.5 [interquartile range (IQR), 3] vs. 8.6 [IQR, 3], p \u3c 0.05), a higher demand for clinical work (1,889 [IQR, 933] vs. 1,388 [IQR, 674] shifts, p = 0.05) and a higher work relative value unit/cFTE (8,779 vs. 7,456, p = 0.12). The aggregate clinical demand exceeded available surgeon capacity by 21% overall. Based on volume, a 1.0 cFTE is needed for every 285 (IQR, 169) trauma admissions. There was a deficit of 75 cFTEs across the centers. Key themes identified were related to the value of acute care surgery and balancing unpredictable demand, intensity, and efficiency.
CONCLUSION: There appears to be a shortage of acute care surgeons in the United States when a definition of 204 shifts per year cFTE is applied. Hospitals face significant financial and administrative barriers to workforce expansion despite the overabundance of clinical volume. Future research is needed to ascertain the effects of expanding the existing workforce on both clinical outcomes and surgeon well-being.
LEVEL OF EVIDENCE: Mixed-Methods Study; Level III
The Global State of Contemporary Andrology Practice: A Comprehensive Analysis of Clinical Practice, Training Pathways, and Emerging Challenges
No full textPURPOSE: This study evaluates the current state of andrology practice worldwide, identifies challenges faced by clinicians, and explores training, certification, and research opportunities. It also seeks to redefine the qualifications necessary to be recognized as an andrologist and to propose areas for standardization and improvement.
MATERIALS AND METHODS: A global, cross-sectional survey was conducted using a 48-question online questionnaire designed by international experts. The survey, distributed in English, covered various domains of modern andrology practice. Responses from 405 participants across 59 countries were analyzed using R version 4.1.2, with categorical variables reported as frequencies and percentages.
RESULTS: Among respondents, 47.3% held medical doctor (MD) degrees, with urologists (31.1%) and clinical andrologists (25.3%) being the most represented specialties. Formal, board-certified andrological training was reported as available in only 48.1% of countries. While half of the respondents identified as andrologists based on experience, only one-third did so through certification, obtained from diverse, nationally recognized organizations. The primary areas of practice included male infertility (36.7%), male sexual dysfunction (27.2%), and sexually transmitted infections (14.5%). Many participants were actively engaged in assisted reproductive technologies, imaging, and andrological surgical emergencies. Despite strong interest in clinical, basic, and translational research, respondents highlighted significant challenges, including inconsistent training pathways, insufficient certification standards, and the complexity of managing diverse andrological conditions.
CONCLUSIONS: Andrology is an evolving multidisciplinary specialty where board-certified urologists, clinical andrologists, and reproductive medicine specialists collaborate to address male reproductive and sexual health challenges. Despite their advanced competencies in medical, surgical, and laboratory interventions, specialists face significant global disparities in training and certification. This survey highlights the urgent need for standardized training, evidence-based guidelines, and unified certification to ensure consistency, enhance patient care, and advance andrology\u27s academic and clinical excellence worldwide