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Behind the Curtain: Consensus Recommendations to Support University-Level Performing Arts Students' Return to the Stage After Concussion
No full textPerforming artists are at risk of head injuries, such as falling from an elevated surface, partner stunting, collisions with other performers or equipment, and/or tripping because of low ambient lighting. However, contemporary clinical guidelines have not addressed the demands of university-level performing arts students. Furthermore, current return-to-learn strategies do not take into consideration the physical aspects of performance-specific skillsets. The purpose of this study was to develop consensus on appropriate postconcussion recommendations to support university-level performing arts students returning to dance, music, and theater performance.
Prospective panelists were recruited using targeted emails from May to June 2024, to participate in a study using the modified Delphi technique. During round 1 of the Delphi process, panelists responded to open-ended questions on how to adapt the International Concussion in Sport Group's 2022 return-to-sport strategy to address the needs of university performing arts students. The research team conducted constant comparative qualitative analysis to generate statements to be voted on during the subsequent rounds. In round 2, panelists anonymously rated each statement using a 9-point scale (1 = not at all important, 9 = very important). During round 3, panelists received the aggregate group scores with their individual scores from round 2 with the option to modify their responses if desired. Consensus was established if statements achieved average scores ≥7 after the final round.
Twenty-one panelists (mean age = 41.9 ± 11.6 years; 71.4% female) enrolled in a 3-part Delphi study from May to December 2024. They included university-affiliated clinicians (n = 5), concussion researchers (n = 5), performing arts faculty/staff (n = 7), and students/alumni with concussion history during their university performing arts training (n = 4). Following the Delphi process, the panel agreed on 101 of the initial 189 statements (53.4%) resulting in the Progressive Return-to-Performance Protocol (PRTPP), a stepwise approach supporting safe return to dance (n = 26), music (n = 36), and theater performance (n = 39) after concussion.
The recommendations generated herein include considerations for participating with other performers, using stage equipment/props, increasing performance endurance, and reintroducing environmental stimuli (e.g., costumes, lighting, amplifiers, or instruments). The proposed PRTPP serves as a framework to guide university-based medical and academic teams when developing individualized postconcussion management plans for performing arts students
Failing under pressure: Sustained sympathetic arousal among individuals prone to cognitive failures
No full textThe resolution of cognitive interference incurred during the Multi-Source Interference Task (MSIT) has been linked to an elevated sympathetic stress response. The dorsal anterior cingulate cortex (dACC) has been implicated in this response; however, it is unclear whether psychophysiological and behavioral responses to the MSIT vary in individuals more susceptible to experiencing daily lapses in cognitive control.
Contrast in blood oxygen level dependent (BOLD) response to cognitive interference (incongruent trials - congruent trials), skin conductance levels (SCL), accuracy, and reaction time on the MSIT were evaluated as a function of self-reported cognitive failure in 118 healthy adults (mean age 30.6 ± 6.8 years, 62.4 % female). BOLD response to cognitive interference was also compared to SCL levels.
Greater BOLD response of the dACC during the MSIT predicted higher SCL during both incongruent and congruent trials. Although accuracy, reaction time, and BOLD response to the MSIT did not vary as a function of cognitive failure, SCL decreased by nearly 1 logarithmic unit pre- to post-task in those reporting lower levels of cognitive failure compared to no change in SCL amongst persons endorsing higher levels.
These findings confirm dACC BOLD response to cognitive interference during the MSIT as an indicator of sympathetic arousal and further suggests that while behavioral task performance is preserved among individuals reporting more frequent cognitive lapses during everyday life, they demonstrate sustained sympathetic arousal and poorer post-task recovery
Mechanistic investigation of the denitrosylation activity of a water-soluble copper(ii) compound probed by experimental and computational approaches
No full textOverproduction of nitric oxide ((NO)-N-center dot) with subsequent formation of peroxynitrite has a major impact on cell death, inflammation, and disease development. (NO)-N-center dot exerts a significant part of its biological activity through S-nitrosylation, leading to the formation of protein and low-molecular-weight nitrosothiols such as S-nitrosoglutathione (GSNO). Excessive oxidative/nitrosative stress contributes to disease by S-nitrosylating multiple targets, culminating in the accumulation of misfolded proteins and cytotoxicity. We here report on the discovery that a water-soluble copper(ii) compound [Cu(HL)Cl2] (1) (HL = N-2[(pyridine-2-ylmethyl)aminoethanol]) promotes homolytic cleavage of the S-NO bond to form (NO)-N-center dot and glutathione disulfide (GSSG), following initial coordination of the sulfur atom of GSNO to the Cu(ii) center. The X-ray crystal structure of complex 1 is presented. Potentiometric titration studies indicate that the species [Cu(HL)(H2O)2]2+ is the major species at physiological pH (Kf = 9.33 x 106). Monitoring the reaction between 1 and GSNO by EPR spectroscopy revealed that the Cu(ii) signal remains stable throughout the reaction. The release of (NO)-N-center dot was confirmed using the spin trap [Fe(DETC)2], while formation of the GS(center dot) intermediate was detected using DMPO. EPR analysis also confirmed the formation of a Cu-S bond, as evidenced by superhyperfine coupling, further corroborated by Raman spectroscopy and UV-Vis studies. The latter indicates that two equivalents of GSNO coordinate to the copper centers, in agreement with the kinetic studies. The formation of several intermediate species and production of GSSG was confirmed by ESI-(+)-MS. Gas-phase chemiluminescence experiments performed under both aerobic and anaerobic conditions showed that the amounts of (NO)-N-center dot produced are independent of the presence of oxygen. Taken together, our experimental data suggest that, during GS-NO bond cleavage, the Cu(ii) center does not undergo reduction, allowing the proposal of a novel reaction mechanism, the feasibility of which is supported by theoretical calculations. Thus, copper(ii) complexes with tridentate ligands promote efficient denitrosylation without undergoing bulk electron transfer of the transition metal, potentially opening new avenues for modulating S-nitrosothiol stability in disease conditions known to be associated with excessive nitrosation
Trends in Patient-Surgeon Sex Concordance and Surgical Volume in Cataract Surgery: A 14-Year Retrospective Cohort Study
No full textManagement of Metastatic Disease Around the Forearm, Wrist, and Hand
No full textMetastasis to the hand, wrist, radius, or ulna is rare, accounting for approximately 0.1% of all bony metastases. The appearance of hand metastases is a poor prognostic sign. Patients will typically present with pain, swelling, fracture, or concern for infection. Radiographs may demonstrate lytic lesions or extensive bony destruction. MRI provides high sensitivity to evaluate these lesions.
The primary goal of surgical intervention is to decrease pain and maintain hand function and stability when indicated. Patients may be deconditioned and unable to tolerate invasive procedures. Surgical treatment may be used to excise the metastatic lesion when indicated. Intralesional procedures as well as wide local excision are options. Reconstruction with allograft, autograft, cementation, or arthrodesis may be needed for bone lesions with concern for instability. Palliative surgical options include amputation. However, these interventions are not without risks, and overall patient prognosis should be considered before proceeding with complex reconstruction
Estimating the epidemic peak in an infection-age-structured SIR model
No full textWe investigate a susceptitble-infectious-recovered (SIR) epidemic model in which the infectious class is structured by the age of infection. We first establish the final size equation of the epidemic and prove that it admits a unique solution. We then derive two-sided estimates for the epidemic peak and provide lower and upper bounds for the peak time, which behave predictably for large population sizes. In the particular case of constant transmission and recovery rates, these bounds coincide, yielding an explicit expression for the peak time. Our results extend and refine previous findings for the classical SIR model, providing new analytical insights into epidemic dynamics with infection-age structure, which are relevant for mathematical modeling and applied studies in epidemiology
Adaptive bubble-enriched face-based smoothed finite element method for 3D structural yield design
No full textThis paper presents a novel three-dimensional adaptive kinematic yield design framework based on the bubble-enriched face-based smoothed finite element method (bFS-FEM). The enrichment of face-based smoothing with bubble functions enhances approximation capability and effectively eliminates volumetric locking, a common limitation of conventional low-order FEM in incompressible materials. To further improve accuracy without compromising efficiency, an adaptive mesh refinement strategy is incorporated into the formulation. In addition, a plastic dissipation error estimator based on the three-dimensional displacement fields of bFS-FEM is developed to guide the refinement process. The resulting discretization leads to a second-order cone programming (SOCP) problem, which ensures numerical robustness and scalability to large-scale analyses. Numerical benchmarks demonstrate that the proposed method delivers locking-free, accurate, and physically consistent solutions, highlighting its potential as an efficient and reliable tool for collapse analysis of complex three-dimensional structures
Trauma Training for Emergency Department Physicians in Low- and Middle-Income Countries: A Scoping Review
No full textBackground Trauma is a leading cause of morbidity and mortality globally, and a disproportionate burden falls on low- and middle-income countries (LMICs). Proper triage and prompt resuscitation are critical to providing life-saving care for these patients. Emergency Medicine (EM) is a rapidly growing field, and Emergency Department (ED) physicians often manage the immediate care for trauma patients. However, given a lack of EM residencies and EM-specialized physicians in many LMICs, EDs are often staffed by general practitioners who may have limited formal trauma training. This review assesses the scope of published literature on trauma-specific training for ED physicians in LMICs.Methods A literature search was conducted in April 2025 using PubMed, EMBASE, and Scopus databases for publications about trauma training efforts for ED physicians in LMICs. Titles and abstracts were screened by two independent reviewers with discrepancies resolved by a third reviewer. Full-text articles in English were included. Secondary literature and articles addressing pre-hospital settings were excluded. Full-text review and data extraction were performed by two independent reviewers.Results 261 unique articles were identified in the search and 14 articles from 12 LMICs were included. Studies primarily assessed the impact of short trauma courses averaging 2.65 days. Ten articles studied their impact on provider knowledge and confidence, three assessed clinical impact, and one detailed the process of creating a trauma course. Overall, articles were limited by small sample sizes and heterogeneous participant cohorts.Conclusions ED physicians play a critical role in trauma care, yet in LMICs their trauma-specific training is limited. This review identified various short trauma courses demonstrating promising, yet limited, results in LMICs. Longitudinal assessment of knowledge retention, evaluation of skill application in clinical practice, and measurement of training effectiveness through clinical outcomes are opportunities to ensure adequate trauma education for ED physicians and strengthen trauma systems globally.</p
Characterization and propagation of partially coherent fields radiated by sources with univariable cross-spectral density
No full textA new class of partially coherent light sources, the sources with uni-variable cross-spectral density, has been recently introduced. Their cross-spectral density is obtained starting from any function of a single complex argument having non-negative Taylor coefficients. This allows the conception of a virtually infinite number of physically realizable partially coherent sources. Here, the main characteristics of sources of this class are investigated through examples, with particular reference to the irradiance and coherence properties across the source plane and upon propagation, both in the near and in the far field. Furthermore, since the coherent modes of such sources present optical vortices, parameters quantifying the vortex structure of the field across the source plane are also evaluated for the presented cases
Chagas disease in Florida: An emerging one health challenge in the United States
No full textChagas disease, caused by Trypanosoma cruzi, poses an underrecognized public health risk in the United States, especially in states like Florida with both imported and potential for autochthonous transmission. Florida's ecological, demographic, and climatic factors—along with the presence of infected vectors and animal reservoirs—make it a high-risk region. However, limited surveillance, diagnostic infrastructure, and clinical awareness have led to significant underdiagnosis. Drawing on a One Health framework, this article highlights Florida's vulnerability in the national Chagas disease landscape by comparing its risk profile to other U.S. states such as Texas. It calls for integrated surveillance across human, animal, and environmental health sectors, improved diagnostic access, and mandatory disease reporting. By closing these gaps, Florida can serve as a model for proactive public health intervention and help prevent the silent emergence of endemic Chagas disease in the southeastern United States