Landmark College

Introduction: The role of systemic corticosteroids in influenza-associated acute respiratory distress syndrome (ARDS) remains debated, with limited real-world data available. This study evaluated short- and intermediate-term outcomes following corticosteroid therapy in patients with influenza-related ARDS. Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network, encompassing electronic health records from 146 healthcare organizations. Adult patients with concurrent diagnoses of ARDS and influenza were identified and divided into two groups: those treated with systemic corticosteroids (n = 7,146) and those not treated (n = 19,300). Propensity score matching was used to balance baseline characteristics. Outcomes were assessed at 1, 3, and 6 months. The primary outcome was in-hospital mortality. Secondary outcomes included myocardial infarction (MI), stroke, respiratory failure, mechanical ventilation, heart failure exacerbation, acute kidney injury (AKI), dialysis, and readmission. Odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated. Results: Corticosteroid use was associated with significantly higher odds of in-hospital mortality at 1 month (OR 1.71, 95% CI 1.55–1.88), 3 months (OR 1.70, 95% CI 1.56–1.86), and 6 months (OR 1.69, 95% CI 1.55–1.85; all p < 0.001). Increased risks were also observed across all timepoints for respiratory failure (ORs 1.37–1.57), mechanical ventilation (ORs 2.03–2.10), heart failure exacerbation (ORs 2.49–2.58), dialysis (ORs 1.81–2.18), and hospital readmission (ORs 4.27–5.64). At 6 months, hazard ratios confirmed elevated risks for heart failure exacerbation (HR 2.13, p < 0.001) and dialysis (HR 1.778, p < 0.001). No significant differences were found for MI, stroke, or AKI. Conclusions: In this large multicenter analysis, systemic corticosteroid use in influenza-related ARDS was associated with increased mortality and higher rates of several complications up to 6 months. These findings suggest potential harm and underscore the need for caution when prescribing corticosteroids in this setting. Further randomized trials are needed to better define their role.

Anterior knee pain remains a leading cause of dissatisfaction following total knee arthroplasty (TKA), often without overt mechanical complications. The biomechanical consequences of altered patellar thickness remain incompletely understood. This study evaluated the effects of reconstructed patellar thickness on patellofemoral joint (PFJ) kinematics and kinetics using a cadaveric model. Eleven knees from six unembalmed whole-lower-extremity cadaveric specimens were tested with a robotic simulator and optical motion capture. Patellar thickness was altered in three conditions: understuffed (-3 mm), neutral (native) and overstuffed (+4 mm). PFJ kinematics and contact forces were assessed during passive flexion and simulated stair descent. Total force and regional pressures at the medial facet C1, central ridge C2 and lateral facet C3 were recorded using a custom multi-sensor array. Overstuffing significantly altered PFJ kinematics, including increased posterior translation (p < 0.001), reduced flexion (p = 0.001) and altered valgus alignment (p = 0.020). Composite PFJ force increased with thickness during passive flexion (overstuffed 59.9 N; neutral 33.9 N; understuffed 23.5 N; p < 0.001) and stair descent (50.5 N, 27.5 N, 17.9 N; p < 0.001). Regional analysis showed a lateral shift in loading, with the lateral facet most affected (p < 0.001). Understuffing reduced joint pressures with minimal kinematic change. Small increases in reconstructed patellar thickness significantly alter PFJ motion and load distribution, particularly lateral facet forces. These results highlight the biomechanical sensitivity of the PFJ to thickness variation and support the need for thinner, modular or patient-specific components to enable finer intraoperative control. Restoring native geometry may help reduce anterior knee pain and dissatisfaction after TKA. Level IV, controlled laboratory study.

Improving reading outcomes for students with reading disabilities/difficulties (RD) has been commonly studied relative to 'what' a reading intervention entails. Here, we offer a broader perspective on 'when' we implement reading services to improve our interpretation of reading progress. We address several aspects related to timeframes (i.e., temporal contexts) to contextualize reading changes associated with score increase or decrease trends. First, we review learning trajectories that can provide baseline expectations for reading and changes among students with RD. Second, we call attention to fade-out effects, which describe the positive impact of intervention programs gradually neutralizing in the years following program completion. Third, we discuss learning outcomes associated with suspended formal schooling, including the expected summer vacation from school and the unexpected COVID-19 school interruptions. We highlight the value of contextualizing reading progress in broader circumstances and conditions for readers.

Background:Stevens–Johnson syndrome (SJS) is an uncommon, severe skin and mucous membrane illness that is frequently triggered by some medications and infections like herpes simplex virus infection or Mycoplasma pneumoniae infection.Case presentation:This case report describes an uncommon but severe side effect that happened after taking two antiviral medications, sofosbuvir and daclatasvir, to treat hepatitis C virus infection. A 54-year-old man developed mild rash after taking prescribed medications for 3 days, which rapidly progressed to typical SJS with significant mucosal and skin involvement. With passing days, the patient’s condition kept on getting worse despite conservative care and cessation of sofosbuvir and daclatasvir. The patient was given continuous supportive and symptomatic treatment, but despite of intensive care, the patient expired on fourth day of hospital admission.Discussion:“Daclatasvir and Sofosbuvir Co-therapy” is considered an effective regime for Hepatitis C (Hep C) infection; however, we have a rare occurrence of SJS due to this drug regime that has not been reported in literature previously. By presenting this case, we hope to offer valuable insights that will help clinicians in the identification and management of similar cases ensuring patient safety while maintaining the benefits of this effective regime.Conclusion:Even though SJS is rare, the possibility that it might have occurred due to sofosbuvir–daclatasvir highlights the need for clinicians to be vigilant while prescribing this regime and educate the patients about the signs and symptoms of SJS. Clinical practices can lower hazards and improve patient safety by implementing these measures.

This study investigates the use of webcam-based eye tracking to model attention and comprehension in both neurotypical and neurodivergent learners. Leveraging the WebGazer, a previously used online data collection tool, we collected gaze and interaction data (N=354) during online reading tasks to explore task unrelated thought (TUT) and comprehension in an ecologically valid setting. Our findings challenge the "one size fits all" approach to learner modeling by demonstrating distinct differences in indicators of both constructs between neurotypical and neurodivergent learners. We compared general models trained on the entire population with tailored models specific to neurodivergent and neurotypical groups. Results indicate that diagnosis-specific models provide more accurate predictions (AUROC's .59-.70 vs. .57 for the general model), and through SHAPley analysis, we note that the strongest indicators of each construct vary as the training population is refined, highlighting the limitations of generalized approaches. This work supports the scalability of webcam-based cognitive modeling and underscores the potential for personalized learning analytics and modeling to better support diverse learning needs.

ABSTRACTIn a 1‐credit evolving STEM Community and Identity course, low‐income and neurodivergent students participate in cohort activities to build community and develop their professional STEM portfolios. The strengths‐based Birkman Method personality survey is used to enhance STEM identity and clarify communication and work styles. This course involves collaboration between STEM faculty, education faculty, and career counselors. Many neurodivergent students entering college lack confidence and struggle to identify and communicate their strengths, which can affect their academic performance and professional growth. This study documents the benefits of using a common language, based on the Birkman Method, for students, mentors, and career counselors. The language is integrated into the course, mentoring sessions, and students' professional portfolios. As a result, students feel a stronger sense of belonging within their cohort and build more meaningful connections with mentors and career counselors. The Birkman Method also helps neurodivergent students take a more informed approach to job searching, improving their morale, mental health, and employment retention. This paper outlines activities designed to foster a community of scientific thinkers and support professional development at all academic levels of postsecondary education.

The goal of this study is to determine whether two commonly used generative learning activities for text-based lessons-writing a summary or creating a drawing-help students learn from a multimedia lesson involving animations with short text captions without prior training in the generative activities. Students viewed a series of four annotated animations on greenhouse gases. During pauses between the animations, students were asked to generate a written summary, to create a drawing, or to do both, whereas a control group viewed the lesson without any generative learning activities. Students were tested immediately (Experiment 1) or after a one-week delay (Experiment 2). In both experiments, students who produced written summaries scored significantly higher on the posttest than those who engaged in no generative learning activities (d = 0.48 in Experiment 1, d = 0.54 in Experiment 2), but there was no significant difference on the posttest for students who generated drawings compared to those who engaged in no generative learning activities. In addition, those who engaged in drawing and summarizing did not have significantly different posttest performance than those engaged in summarizing alone. We conclude that writing summaries during a highly visual animated lesson is effective for learning, possibly because it encourages students to engage in generative processing during learning more than drawing and we discuss potential reasons for this in the discussion. This work helps extend generative learning theory by pinpointing potential boundary conditions for learning by drawing and learning by summarizing.

His research focuses on better understanding how Alzheimer's disease affects synaptic transmission between neurons in the brain by utilizing mathematical models to study calcium regulation in Alzheimer's disease environments.

A s educators we have attempted to increase the enrollment and retention of diverse learners into our computer science programs. These efforts might have included summer programs, mentoring programs, or inviting girl scouts onto campus. One area we might not have considered may be the most significant: how we assess students. This article considers the impact of grading practices, guided by "Grading for Equity" by Joe Feldman [5]. Feldman recommends practices that are accurate, bias resistant, motivational, and that reduce failure rates. In addition to presenting Feldman's recommendations, I highlight my preliminary experiences integrating grading for equity practices into my teaching.

Environmental DNA (eDNA) metabarcoding is a powerful tool that can enhance marine ecosystem/biodiversity monitoring programs. Here we outline five important steps managers and researchers should consider when developing eDNA monitoring program: (1) select genes and primers to target taxa; (2) assemble or develop comprehensive barcode reference databases; (3) apply rigorous site occupancy based decontamination pipelines; (4) conduct pilot studies to define spatial and temporal variance of eDNA; and (5) archive samples, extracts, and raw sequence data. We demonstrate the importance of each of these considerations using a case study of eDNA metabarcoding in the Ports of Los Angeles and Long Beach. eDNA metabarcoding approaches detected 94.1% (16/17) of species observed in paired trawl surveys while identifying an additional 55 native fishes, providing more comprehensive biodiversity inventories. Rigorous benchmarking of eDNA metabarcoding results improved ecological interpretation and confidence in species detections while providing archived genetic resources for future analyses. Well designed and validated eDNA metabarcoding approaches are ideally suited for biomonitoring applications that rely on the detection of species, including mapping invasive species fronts and endangered species habitats as well as tracking range shifts in response to climate change. Incorporating these considerations will enhance the utility and efficacy of eDNA metabarcoding for routine biomonitoring applications.