The virtues of the scapular tip free flap for reconstruction of complex midface oncologic defects have been claimed by many. To obtain optimal functional and aesthetic results, precise positioning of the free flap used for reconstruction is paramount.

Four cases illustrate our approach to midface reconstruction with angular branch-based scapular tip flaps. A standard surgical navigation device was used both to plan bone cuts for the oncologic resection and to optimise the positioning of the flap.

Case 1 illustrates the usefulness of navigation for reconstruction of total palato-septectomy defects, using a horizontally positioned flap. Optimal neo-palate height, alignment of the anterior nasal spine and nasal projection were obtained. For cases 2–4, vertical inset of the flap yielded optimal midface projection and orbital floor position.

Surgical navigation systems are useful adjuncts for midface reconstruction.

Natural remission from common mental disorders (CMDs), in the absence of intervention, varies greatly. The situation in India is unknown.

This study examined individual, village and primary health centre (PHC)-level determinants for remission across two rural communities in north and south India and reports natural remission rates.

Using pre-intervention trial data from 44 PHCs in Andhra Pradesh and Haryana, adults ≥18 years were screened for CMDs. Screen-positive people (Patient Health Questionnaire-9 Item (PHQ9) or Generalised Anxiety Disorder-7 Item (GAD7) score ≥10, or a score ≥2 on the self-harm PHQ9 question) were re-screened after 5–7 months (mean). Remission was defined <5 scores on both PHQ9 and GAD7 and <2 score on self-harm. Multilevel Poisson regression models with random effects at individual, village and PHC levels were developed for each state to identify factors associated with remission. Time to re-screening was included as offset in regression models.

Of 100 013 people in Andhra Pradesh and 69 807 people in Haryana, 2.4% and 7.1%, respectively, were screen positive. At re-screening, remission rate in Andhra Pradesh was 82.3% (95% CI 77.5–87.4%) and 59.4% (95% CI 55.7–63.3%) in Haryana. Being female, increasing age and higher baseline depression and anxiety scores were associated with lower remission rates. None of the considered village- and PHC-level factors were found to be associated with remission rate, after adjusting for individual-level factors.

Natural remission for CMDs vary greatly in two Indian states and are associated with complex, multilevel factors. Further research is recommended to better understand natural remission.

In May 2024, German EMTs ASB, Cadus, Humedica and Johanniter conducted a joint disaster response field exercise including a Cholera outbreak scenario. The RRML CIBU (Cellule d’Intervention Biologique d’Urgence) from Institut Pasteur, France, embedded in an EMT, supported the exercise. Amateur actors presented injuries and cases of acute watery diarrhea with different levels of severity. Dummy samples were collected and transported to the RRML for analysis. An external IPC-Team from the German Robert Koch Institute conducted facility assessments to provide Cholera-specific IPC advice and training.

To assess

1. 1. the implementation of Cholera-specific IPC measures.

2. 2. the need for and benefit of external IPC support.

3. 3. the interoperability between EMTs and RRML.

Qualitative evaluation through observation and interviews.

All EMTs (n=4) had access to IPC guidelines and personal protective equipment (PPE) and implemented active screening for signs of infection (n=4). 75% (n=3) of the EMTs actively isolated suspected cholera cases. EMTs underlined the benefit of external IPC support (n=3) and training provided (n=4). 48 EMT staff were trained in donning/doffing of PPE and management of spill events. The RRML provided transport material and training on packaging of samples. Occasional contamination of the outer packaging and incorrectly filled-in lab forms were reported. Sample transport was aligned to lab schedule.

The EMTs adapted competently to the Cholera scenario. Interoperability with the RRML was satisfying. The IPC team was seen as important support. Lessons learned included the need for improved isolation precautions, packaging of samples and completion of lab forms.

Many factors can impact survey completion rates, including survey length, sensitivity of the topics addressed, and clarity of wording. This study used cognitive interviews (CIs), a methodological tool that can aid in developing and refining elements for multi-faceted assessments, and previous survey response patterns to refine, streamline, and increase response rates of RADx-UP Common Data Elements (CDEs) for survey/questionnaire use.

Ten previously enrolled CO-CREATE study participants were interviewed between May–June 2023. Interviewees identified CDEs that were “confusing, uncomfortable, and/or not applicable,” along with their reasoning. Interview data were analyzed using a rapid qualitative analytic approach, resulting in a summary matrix categorized by language. For further contextualization, CDE response rates were calculated for the 9147 surveys administered during the CO-CREATE study (May 2021–March 2023) and compared against their survey position.

Of the 94 CDEs evaluated in the CIs, 20 (21.3%) were flagged by one or more interviewees. Nine (9.6%) English while fourteen (14.9%) Spanish CDEs were flagged by interviewees, with some overlap. Also, CDE response rates differed according to position in the survey, with lower response rates for questions positioned later in the survey. Following review by the research team and the RADx-UP program, 10 English and 15 Spanish were revised, and seven were removed in both languages in the final survey.

Our findings underscore the importance of integrating community member perspectives to enhance the relevance and clarity of assessment instruments, optimizing the impact of public health research among underrepresented populations.

Interoception is crucial for emotional processing. It relies on the bidirectional connections between the insula, a crucial structure in interoception, and the frontal lobe, which is implicated in emotional experiences. Acquired frontal brain injury often leads to emotional disorders. Our goal was to explore the interoceptive profiles of patients with frontal lesions with or without insular involvement.

Given the neuroanatomical links between interoception and emotions, we conducted a systematic Preferred Reporting Items for Systematic Reviews and Meta-analyses guided review of studies assessing at least one dimension of interoception in adults with acquired frontal injuries, with or without associated insular lesions.

Seven articles were included. The review indicated that interoceptive accuracy declines after frontal injuries. The two studies that investigated interoceptive sensitivity found lower scores in patient groups. Finally, inconsistent results were found for interoceptive metacognition after frontal damage.

This review is the first to explore interoceptive disorders after acquired frontal brain injury. The findings reveal deficits in cardiac interoceptive accuracy and interoceptive sensitivity following frontal damage. Inconsistent results were observed for interoceptive metacognition. Further research is needed to confirm the presence of interoceptive deficits following a frontal lesion. Additionally, the relationship between interoceptive deficits and emotional disorders, often reported after frontal brain injury, should be investigated.

Increased out-of-home consumption may elevate sodium (Na) intake, but self-reported dietary assessments limit evidence. This study explored associations between neighbourhood exposure to fast-food and sit-down restaurants and estimated 24-hour urinary Na excretion.

A cross-sectional analysis from the ORISCAV-LUX 2 study (2016–2017). 24-hour urinary Na was estimated from a morning spot urine sample using the INTERSALT formula. Spatial access to fast-food and sit-down restaurants was derived from GIS data around participants’ addresses within 800-m and 1000-m road network buffers by summing up the inverse of the road network distance between their residential address and all restaurants within the corresponding buffer size. Multi-adjusted linear models were used to assess the association between spatial access to restaurants and estimated 24-hour urinary Na excretion.

Luxembourg

Urban adults age over 18 years (n 464).

Fast-food and sit-down restaurants accounted for 58·5 % of total food outlets. Mean 24-hour urinary Na excretion was 3564 mg/d for men and 2493 mg/d for women. Health-conscious eating habits moderated associations between spatial access to fast-food and sit-down restaurants and Na excretion. For participants who did not attach great importance to having a balanced diet, greater spatial access to restaurants, combining both density and accessibility, was associated with increased urinary Na excretion at 800 m (βhighvslow = 259, 95 % CI: 47, 488) and 1000 m (βhighvslow = 270, 95 % CI: 21, 520).

Neighbourhood exposure to fast-food and sit-down restaurants influences Na intake, especially among individuals with less health-conscious eating habits, potentially exacerbating diet-related health disparities.

The determinants of door-in-door-out metrics (DIDO) at centers referring acute ischemic stroke patients for endovascular thrombectomy (EVT) and the impact of DIDO on functional outcomes are unclear. Our primary objective was to study the association between DIDO and 90-day functional outcomes. Our secondary objective was to investigate the associations between patient clinical and workflow characteristics and DIDO.

We conducted a province-wide multicentric retrospective cohort study in Québec, Canada, of adults with acute ischemic stroke who were transferred from a primary stroke center (PSC) to a comprehensive stroke center for EVT between 2017 and 2020. DIDO was calculated as the time spent in the PSC emergency department. Our co-primary outcomes, assessed 90 days after stroke, were a favorable functional outcome (modified Rankin score of 0–2) and death. We estimated associations between DIDO and co-primary outcomes and between patient characteristics and DIDO using logistic mixed models.

Among 790 included patients, the mean age was 69 (+/–14) years, and 400 (51%) were female. The median DIDO was 102 (80–135) minutes. DIDO was not associated with 90-day favorable functional outcome (aOR: 1.00, 95% CI [0.99–1.00], p = 0.54) or death (aOR: 1.00, 95% CI [0.99–1.01], p = 0.69). Arrival at the PSC outside daytime hours (aOR: 3.28, 95% CI [1.26–8.51], p = 0.01) was significantly associated with DIDO ≥ 60 minutes.

Although DIDO are long in Québec, they are not associated with 90-day functional outcomes or mortality among patients transferred for EVT. Further research is required to develop strategies to improve modifiable determinants of DIDO, including workflow outside of daytime hours.