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Over the past decade, several multi-institutional research consortia have formed within the North American pediatric surgical community. In this article, we describe our experience with the creation and implementation of the Eastern Pediatric Surgery Network, a large and comprehensive research consortium designed to produce a wide array of high-quality clinical studies within our subspecialty. In 2020, a vision statement and rules of governance were established at thirteen academic pediatric surgery divisions in the eastern United States. The research consortium was organized based on four major pillars, namely legal ownership of aggregate data, horizontal leadership structure, mandatory participation in adopted studies, and a broad research portfolio that encompasses the full breath of the specialty. Over the past five years, the number of research projects has dramatically expanded over time and includes participation from 24 different medical centers. Despite a lack of dedicated sponsored extramural support for most projects, there have been 28 abstracts presented at national conferences and 12 manuscripts published in peer-reviewed journals. It is our hope that sharing our experience with creating this organization can help to inform others interested in establishing the academic infrastructure to engage in multi-institutional, evidence-based clinical research in other medical specialties and beyond.
Grandiose delusions have received comparatively little attention in the literature and there is limited empirical evidence assessing the efficacy of cognitive behaviour therapy for psychosis (CBTp) for individuals with grandiose beliefs. This case study presents Noah, a 23-year-old referred to our Early Intervention Service with persistent grandiose beliefs alongside other psychotic experiences. Noah received 26 sessions of CBTp. Scores on measures of perseverative thinking, delusional distress and conviction, wellbeing, and daily functioning were completed at baseline, mid-therapy, end of therapy, and at follow-up 12 weeks after the end of therapy. Results demonstrated improvement across all measures, particularly preservative thinking about beliefs. Improvement in all but one outcome was not only sustained but continued to increase at follow-up. This is one of few known reports on using CBTp with an individual with current grandiose delusions.
Highlights
(1) To explore the use of CBTp with a young male experiencing grandiose beliefs.
(2) To apply learning from recent research on grandiose delusions into the delivery of CBTp.
This study presents the first record of Miyalachnus sorini Kanturski & Lee, 2024 (Aphididae: Lachninae) in South Korea, thereby extending its known distribution beyond Japan and identifying a new host plant, Prunus sargentii (Rosaceae). We describe diagnostic morphological traits across multiple life stages and compare them with those of Japanese populations. Comparative analyses with Japanese populations demonstrated consistent morphological differentiation, notably elevated ratios of the ultimate rostral segment to antennal segments across multiple morphs in the Korean population, indicating potential ecological adaptation. DNA barcoding using the mitochondrial cytochrome c oxidase I gene revealed low intraspecific divergence (average 0.2%) and interspecific divergence (average 10.5%) between Miyalachnus sp. and M. sorini. Haplotype analysis was performed to investigate the relationship between host plants and cryptic genetic diversity. These findings enhance our understanding of the morphological and genetic diversity of M. sorini and underscore the importance of monitoring its spread for informed pest management strategies.
Rural cancer survivors have worse outcomes than their urban counterparts. To improve outcomes, it is essential that rural survivors participate in research, yet they are underrepresented in cancer research. The aim of this study was to assess urban-rural differences in participation in a cancer survivorship survey and differences in mode of participation (mail, online, or phone) by rurality and age.
Methods:
We developed a survivorship needs assessment survey and invited cancer survivors to participate by mail, online, or phone. We compared participation between rural and urban invitees and examined differences in mode of participation by rurality and age.
Results:
A quarter (25.47%) of invited rural patients and 27.84% of invited urban patients participated in the survivorship study. The probability of participation by urban survivors was approximately 1.09 times higher than for rural survivors (χ2(1) = 4.31, p = 0.038). Rural survivors were more likely to participate by mail (average difference [Rural-Urban] = 9.64%, p < 0.001), while urban survivors were more likely to participate online (average difference [Urban-Rural] = 8.77%, p < 0.001). As participant age increased, the likelihood of survey participation by mail increased (1.16% per year of age, p < 0.001) while the probability of participating online decreased by 1.20% per year of age (p < 0.001).
Conclusion:
To ensure equitable access to research for rural and older cancer survivors, researchers should design studies with a range of participation modes. Non-digital methods, such as mailed paper surveys, appear to promote participation among rural and older survivors.
The concept of an omnigenous locally finite group was introduced in [15] as a generalization of Hall’s universal countable locally finite group. In this article we show that the class of all countable omnigenous locally finite groups is Borel complete, hence it has the maximum Borel cardinality of isomorphism types among all countable structures.
This article combines book history and urban history to examine the spread of the print trade and facilities for reading in Scotland by the 1820s, using a Scotland-wide trade directory as its main source. The article demonstrates how support for reading, including printers, bookshops and venues for reading, extended far and wide within the Scottish urban hierarchy – from the largest cities to the smallest towns and villages. Variations between different types of towns are discussed, and local case studies provide further insights. The article provides fresh perspectives on Scottish urbanization, through its snapshot view of Scotland’s towns in the mid-1820s.
Admission to shared hospital rooms are a risk factor of healthcare-associated (HA) SARS-CoV-2. Quantifying the impact of engineering controls such as ventilation and filtration is essential to informing resource utilization and infection prevention guidelines.
Methods:
Multicenter test-negative study of patients exposed to SARS-CoV-2 in shared rooms across five hospitals between January and October, 2022. Independent variables tested were measured air changes per hour (ACH), presence of any room mechanical ventilation (RMV), or portable high-efficiency particulate air (HEPA) filter. Covariates included facility (number of beds in room, outbreak status of unit), source patient (presence of symptoms, RT-PCR cycle threshold (Ct) value), and exposed patient factors (age, sex, time from last SARS-CoV-2 vaccine, previous SARS-CoV-2 infection, exposure duration). Multilevel logistic mixed models used to estimate the impact of engineering controls on transmission.
Results:
Among 468 exposed patients, secondary attack rate was 26.3% (range 7.5–33.3% across hospitals). In multivariable analysis, increased ACH was associated with decreased odds of infection (adjusted odds ratio (aOR) 0.88, 95% CI 0.78–1.00; p=.046) as were exposure duration and Ct value of source patient. Presence of RMV was also associated with decreased odds of infection (aOR 0.51, 95% CI 0.27–0.95; p=.034) while use of portable HEPA filter was not significant (aOR 0.58, 95% CI 0.26–1.31; p=.18).
Conclusions:
Improved ventilation was independently associated with lower odds of SARS-CoV-2 infection among exposed roommates. Ensuring RMV is present and optimizing ACH may significantly mitigate the risk of HA-SARS-CoV-2. Future prospective studies should assess optimal ACH thresholds and the impact of portable HEPA filters.
This paper presents a new problem for the inference rule commonly known as “inference to the best explanation” (IBE). The problem is that uncertainty about parts of one’s evidence may undermine the inferrability of a hypothesis that would provide the best explanation of that evidence, especially in cases where there is an alternative hypothesis that would provide a better explanation of only the more certain pieces of evidence. A potential solution to the problem is sketched, in which IBE is generalized to handle uncertain evidence by invoking a notion of evidential robustness.
Continuous glucose monitoring (CGM) has revolutionized diabetes management by providing real-time data on blood glucose fluctuations. Unlike traditional methods, CGM systems offer continuous feedback, enabling individuals to better regulate glucose levels in response to lifestyle factors such as diet, exercise, and stress. This technology has been shown to improve glycemic control and stabilize HbA1c levels. Beyond its primary role in diabetes management, emerging research highlights the relationship between metabolic health and mental wellbeing. Glucose dysregulation has been implicated in mood instability, and fluctuations in blood glucose levels may directly influence emotional states. Notably, some researchers have proposed reclassifying major depressive disorder (MDD) as “Metabolic Syndrome Type II” due to shared pathophysiological mechanisms involving glucose homeostasis and inflammation. Given these connections, CGM technology may offer mental health benefits by promoting glucose stability. For individuals with diabetes who also experience psychiatric conditions such as MDD or generalized anxiety disorder (GAD), CGM use may contribute to improved mood regulation and reduced psychiatric symptoms. By addressing both metabolic and mental health concerns, CGM holds promise as a valuable tool in enhancing overall wellbeing. Further research is warranted to explore the full potential of CGM in supporting mental health outcomes in individuals with metabolic disorders.
The utility of routine environmental sampling to monitor the airborne fungal load (AFL) in healthcare settings is uncertain.
Methods:
AFL was measured by monthly cultures at a tertiary-care pediatric hospital from November 2018 through October 2023 on eleven units caring for patients at risk for invasive mold infection (IMI). Surveillance for healthcare-associated IMI was conducted for all patients in the healthcare system using locally developed definitions for possible, probable, and definite hospital-onset infections. Poisson regression was used to analyze the association between AFL and monthly IMI rates.
Results:
78 cases of IMI were identified during the period of AFL monitoring. Of these, 51 infections were classified as healthcare-associated probable or proven IMI and were tested for association with AFL measurements. There was not a significant facility-wide association between the average monthly AFL and the overall IMI rate. On units where hematology/oncology patients were treated, however, an increase in average monthly local AFL for opportunistic fungal pathogens of 1 CFU/m3 was associated with a 1.48-fold increase in the IMI rate for these patients (95% CI 1.00–2.19, P = .05). The AFL for Aspergillus species on these units showed a particularly strong association with the hematology/oncology IMI rate (15.9-fold elevation for an increase of 1 CFU/m3 [95% CI 2.8–90.7, P = .002]). Neither hematology/oncology nor facility-wide IMI rates showed comparable associations with changes of the AFL in outdoor air.
Conclusions:
Regular monitoring of AFL on targeted hospital units may identify periods when hematology/oncology patients are at increased risk for IMI.
In recent scholarship on the Ottoman Mediterranean, it has become commonplace to challenge narratives of heroic discovery and cultural superiority expounded in publications by European travellers. Rather than taking a polished, published account as its starting point, this paper discusses the travels of Edward Falkener (1814–96), a lesser-known Victorian architect and writer whose extensive tour around Anatolia (1844–5) was never communicated to a broader audience. If Falkener is remembered today, it is usually as the author of the first anglophone monograph on ancient Ephesus and editor of the first British academic journal devoted to classical art and architecture. This paper reviews Falkener’s career, but instead of these publications, the focus is on his remarkable personal archive of diaries, sketchbooks, watercolours, contracts and notes for an incomplete book about his tour of Anatolia. Drawing on this collection, it explores his fluctuating interests in heritage from different periods of Anatolia’s history and well-documented interactions with a variety of local actors who helped or hindered his meandering tour. Representing the first attempt to study Falkener’s journey, this paper explores the utility of his archive for understanding the challenges and contingencies of Victorian travel in the Ottoman Empire.
Public service internships are a staple in contemporary political science curricula. Research shows that internships produce better thinkers, employees, and citizens. Yet, political science interns are on the frontlines in observing the firsthand trauma, stress, and mental health challenges of many people seeking support and services from government. In turn, students may internalize this stress and trauma, a phenomenon recognized as secondary traumatic stress (STS). This study addresses a significant gap in the discipline’s understanding of the frequency and severity of STS experienced by political science interns in their fieldwork. We relied on surveys and written assessments from students enrolled in internship courses at two public universities. We find that interns report increased exposure to STS at the end of the semester. Furthermore, STS vulnerability varies among interns, with higher incidence rates among those with a history of primary trauma, older students, and women. We outline coping strategies for students, propose adaptations to experiential learning to enhance support, and emphasize the need for further research on this issue.
Current efforts to reduce the incidence of non-communicable disease (NCD) are slow, but increasing evidence highlights the microbiome as a potential target for prevention. The majority of microbial development occurs in the first 1,000 days of life, presenting opportunities for strategic intervention to reduce the prevalence of future NCDs. In this review, we explore the social, structural, and political barriers that may hinder physiological gut microbial development in the first 1,000 days in the context of current scientific knowledge, focusing on nutritional factors in pregnancy, and during the exclusive breastfeeding and complementary feeding periods. We summarise emerging evidence and explore obstacles to nutritional choices affecting microbial development, and unpack the rhetoric that healthy eating to develop a microbiome that supports optimum health is an individual choice. As evidence on the role of the microbiome in health and disease grows, specific attention must be applied to existing social, structural, and political barriers that may hinder optimal microbial development. Addressing the role of corporate actors and social determinants influencing dietary choices and barriers surrounding breastfeeding must be prioritised, alongside efforts to advance basic scientific research. Until a wider public health perspective is taken, the success of interventions and recommendations will be limited.
This study investigates structural abnormalities in hippocampal subfield volumes and shapes, and their association with plasma CC chemokines in individuals with major depressive disorder (MDD).
Methods
A total of 61 patients with MDD and 65 healthy controls (HC) were recruited. All participants underwent high-resolution T1-weighted imaging and provided blood samples for the detection of CC chemokines (CCL2, CCL7, and CCL11). Comparisons of hippocampal subregion volumes, surface shapes, and plasma CC chemokine concentrations were conducted between the MDD and HC groups. Furthermore, partial correlation analysis was performed to assess the relationship between structural abnormalities (hippocampal subfield volume and shape) and plasma CC chemokine levels.
Results
The MDD group exhibited a significant reduction in the volume of the left hippocampal tail compared to the HC group (F = 9.750, Bonferroni-corrected p = 0.026). No significant outward or inward deformation of the hippocampus was detected in MDD patients relative to the HC group (all FWE-corrected p > 0.05). Additionally, plasma CCL11 levels were elevated in the MDD group compared to the HC group (F = 9.982, p = 0.002), with these levels showing a positive correlation with the duration of the illness (r = 0.279, p = 0.029). Partial correlation analysis further revealed a negative correlation between the smaller left hippocampal tail volume and plasma CCL11 levels in MDD patients (r = −0.416, p = 0.001).
Conclusion
Abnormally elevated plasma CCL11 in MDD patients may mediate damage to specific hippocampal substructures.
Direct numerical simulations of a uniform flow past a fixed spherical droplet are performed to determine the parameter range within which the axisymmetric flow becomes unstable. The problem is governed by three dimensionless parameters: the drop-to-fluid dynamic viscosity ratio, $\mu ^\ast$, and the external and internal Reynolds numbers, ${\textit{Re}}^e$ and ${\textit{Re}}^i$, which are defined using the kinematic viscosities of the external and internal fluids, respectively. The present study confirms the existence of a regime at low-to-moderate viscosity ratio where the axisymmetric flow breaks down due to an internal flow instability. In the initial stages of this bifurcation, the external flow remains axisymmetric, while the asymmetry is generated and grows only inside the droplet. As the disturbance propagates outward, the entire flow first transits to a biplanar-symmetric flow, characterised by two pairs of counter-rotating streamwise vortices in the wake. A detailed examination of the flow field reveals that the vorticity on the internal side of the droplet interface is driving the flow instability. Specifically, the bifurcation sets in once the maximum internal vorticity exceeds a critical value that decreases with increasing ${\textit{Re}}^i$. For sufficiently large ${\textit{Re}}^i$, internal flow bifurcation may occur at viscosity ratios of $\mu ^\ast = {\mathcal{O}}(10)$, an order of magnitude higher than previously reported values. Finally, we demonstrate that the internal flow bifurcation in the configuration of a fixed droplet in a uniform fluid stream is closely related to the first path instability experienced by a buoyant, deformable droplet of low-to-moderate $\mu ^\ast$ freely rising in a stagnant liquid.
Trust judgments involve rapidly evaluating others’ appearance and are critical in psychosocial development. Trust biases may be linked to psychopathology risk, particularly in vulnerable, adversity-affected populations, but very little is known about trust perception in refugee context. Here, we measured trust perception of Syrian refugee children (N = 324, Mage = 6.32 years) displaced in Jordan, using a validated trust task with computer-generated faces varying in perceived trustworthiness (data collection: May-August 2021). Mothers (N = 324, Mage = 32.59) reported on child and mothers’ mental health, and mother-child relationship. Child trust perception was not associated with child or mothers’ mental health, or mother-child relationship (all p > .10), but we found age-related changes in perceived trust, with older children reporting faces as less trustworthy than younger children (B = .32, p < .001). Although children’s social judgments might be associated with socio-emotional functioning in non-refugee populations, our results suggest that refugee children’s mental health does not seem to be linked to their perception of trust, and that trusting others might diminish with age in displaced, at-risk children.
Through examining three areas of focus within public mental health; prevention, healthy environments and reducing inequalities, we consider how interventions in these domains also have the potential to create a more sustainable healthcare system.
Results
We show how psychiatrists and mental health professionals alongside the wider health and social care system can be involved in advocating for this change.
Clinical implications
We aim to empower individuals working within mental health to advocate for change and consider how public mental health approaches can be integrated into their practice to improve outcomes.
In Antimicrobial Stewardship and Infection Prevention and Control, programmatic goals often strive to achieve clinical benefit by practice change in the direction of doing less. Practically, this may include reducing the number of tests ordered, encouraging shorter and more narrow courses of antimicrobials, or discontinuing practices that are no longer contextually appropriate. Because promoting practice change in the direction of doing less is a critical aspect of day-to-day operations in Antimicrobial Stewardship and Infection Prevention and Control, the goals of this Society for Healthcare Epidemiology Research Committee White Paper are to provide a roadmap and framework for leveraging principles of implementation and de-implementation science in day-to-day practice. Part II of this series focuses on some practical case studies, including real-world examples of applied de-implementation science to promote discontinuation of practices that are ineffective, overused, or no longer effective.