Ponce Health Sciences University

Anti-Inflammatory Reliever (AIR) therapy-the use of inhaled corticosteroids (ICS)/formoterol or ICS with short-acting beta-agonists as reliever therapy is guideline-recommended for mild asthma. However, its uptake remains low in community settings. To improve AIR adoption, we developed an AIR Asthma Plan (AIR-AP) and implementation strategies to support its adoption, which we then pilot-tested to assess feasibility and acceptability. Using an exploratory sequential design, we collaborated with stakeholders and pilot site providers to: (1) assess provider needs, (2) co-develop multicomponent provider support tools, (3) tailor workflows, and (4) conduct a 3-5-month pilot test of the tools and implementation strategies in three diverse community practices (pediatrics, family medicine, and allergy). We evaluated usability, acceptability, and feasibility of our implementation strategy using validated questionnaires and provider interviews. Asthma patients were asked to evaluate the usability of the AIR-AP and instructional videos. We co-developed multi-component provider support tools for adoption of AIR, including: (1) AIR-AP (patient-level), (2) instructional videos (patient-level), (3) patient selection tool (provider-level),(4) AIR implementation guide (provider-level), and (5) practice training materials (slide deck). Seven providers from three pilot sites participated. AIR provider support tools were generally feasible and acceptable; however, ongoing barriers to AIR adoption persisted, including limited visit time, unfamiliarity and communication challenges, patients' health literacy and hesitancy to change, and inadequate institutional dissemination. Based on pilot testing, co-developed tools for AIR adoption were feasible and acceptable in community settings. Future efforts should focus on evaluating the effectiveness and other implementation outcomes of these tools.

Introduction: Flourishing is a key indicator of positive mental health and psychosocial functioning. However, evidence on the measurement performance of the Flourishing Scale (FS) in sexual and gender minority (LGBT/SGM) populations in the Spanish-speaking Caribbean remains limited. Objective: To evaluate the psychometric properties of the FS among LGBT adults in Puerto Rico. Method: Participants were recruited online (N = 300). Given item-level and multivariate non-normality, a robust one-factor CFA was estimated and examined global fit, standardized loadings, and reliability (α, ω). Evidence for validity included (a) Average Variance Extracted (AVE) as an indicator-level convergence index and (b) associations with external criteria (PHQ-8, GAD-7). Multi-group CFA tested configural, metric, and scalar invariance across gender identity and sexual orientation. Results: The robust CFA supported a unidimensional structure with strong standardized loadings and high internal consistency. AVE exceeded .50, indicating adequate indicator-level convergence within the measurement model. As hypothesized, FS scores correlated negatively with PHQ-8 and GAD-7. Multi-group CFA supported metric and scalar invariance by gender identity and scalar invariance by sexual orientation, with borderline evidence at the metric step, enabling latent-mean comparisons under supported conditions. Conclusions: The FS is a brief, reliable, and valid indicator of psychological flourishing among LGBT adults in Puerto Rico, suitable for research, screening, and program evaluation; however, convergent validity with an independent positive well-being measure should be established in future work.

Struma ovarii is a rare ovarian teratoma composed predominantly of thyroid tissue, representing less than 1% of all ovarian tumors. The clinical presentation of struma ovarii can vary widely, from an asymptomatic palpable abdominal mass, hyperthyroidism (elevated free T4 and/or T3; low TSH), and, in rare cases, pseudo-Meigs syndrome. Diagnosis is often based on postoperative histopathological confirmation of thyroid tissue. We present a case of a 44-year-old Hispanic female with an incidental finding of an adnexal mass, pleural effusion, and ascitic fluid, but with normal tumor markers, cancer antigen 125 (CA-125), and carcinoembryonic antigen (CEA). Postoperative pathological examination confirmed struma ovarii, with pseudo-Meigs syndrome. Unexpectedly, the patient developed ovarian remnant syndrome (ORS). This case contributes to the limited literature describing struma ovarii associated with pseudo-Meigs syndrome and normal tumor markers, highlighting the diverse clinical spectrum of this tumor. It also underscores the need for a high index of suspicion for struma ovarii in atypical cases, regardless of tumor marker levels. The development of ORS further emphasizes the importance of long-term follow-up after definitive surgical management.

Stress exposure can disrupt fear extinction, which is a hallmark of some stress-related disorders. The underlying molecular mechanisms of impaired extinction, especially in females, remain poorly understood. In this study, we investigated proteomics changes in the infralimbic cortex, a region critical for fear suppression, in female rats exposed to single prolonged stress (SPS). One week after SPS exposure, adult female rats underwent auditory fear conditioning and extinction training and were classified as susceptible or resilient based on their extinction performance. Quantitative proteomics using tandem mass tag labeling combined with bioinformatics analysis identified distinct proteins and pathways differentiating the groups. Susceptible rats displayed unique proteomic profiles in the infralimbic cortex. Several of the 53 differentially expressed proteins are associated with synaptic plasticity and memory, including neurogranin and microtubule-associated protein tau (MAPT). Pathway enrichment analysis identified alterations in synaptogenesis, clathrin-mediated endocytosis, calcium signaling, and chaperone-mediated autophagy. Functional validation using AAV-shRNA knockdown of neurogranin or MAPT in CAMKIIα-expressing neurons of the infralimbic cortex improved extinction memory in SPS-exposed animals. Our findings suggest that dysregulated protein expression in the infralimbic cortex contributes to impaired extinction memory and traumatic stress susceptibility in female rats, offering insight into the neurobiological mechanisms underlying vulnerability to stress-related disorders.

Background: Music has been shown to influence cognitive performance and emotional regulation, yet its role within the surgical environment remains incompletely understood. In the operating room (OR), music may enhance mood and teamwork, but concerns persist regarding distraction and communication. This study evaluated perceptions of intraoperative music among surgical trainees and perioperative staff within an academic training environment.Objective: This study aimed to assess the perceived effects of intraoperative music on mood, focus, communication, and performance among surgical trainees, incorporating perspectives from attending surgeons, nurses, anesthetists, and OR personnel.Methods: This cross-sectional study was conducted at Centro Médico Episcopal San Lucas between October and November 2024. A total of 107 participants, including attending physicians, surgical residents, nurses, anesthetists, surgical technologists, and administrative OR staff, were surveyed via Research Electronic Data Capture (Vanderbilt University, Nashville, TN). A Likert scale was used to assess perceptions of music’s influence on mood, focus, communication, and resident performance.Results: All 107 participants reported exposure to music in the OR, and overall perceptions were largely favorable. Among residents, 25 of 29 (86.2%) reported that music improved their mood, and 21 (72.4%) indicated that it helped them feel calmer during procedures. Improved focus was reported by 16 residents (55.2%), while 12 (41.4%) indicated some degree of distraction. Only three residents (10.3%) reported having committed an error they attributed to music, and one (3.4%) reported witnessing such an event. The majority of residents, 21 (72.4%), disagreed that music prolonged operative time.Faculty responses demonstrated similar trends. Most faculty members reported that music improved residents’ mood (17 of 20, 85%) and enhanced focus during procedures (12 of 20, 60%). Although a minority expressed concern regarding distraction or communication interference, the majority did not perceive music as detrimental. Only five faculty (25%) reported ever requesting that music be turned off, and none reported music-related operative errors.Conclusions: This study shows that intraoperative music is generally perceived by trainees and faculty as beneficial, particularly for enhancing mood and promoting calmness. While many residents reported improved focus, a notable subset experienced overstimulation and communication challenges, especially during complex procedures. These findings highlight the need for context-sensitive use of music, guided by procedural demands and team consensus. To validate and optimize its role in surgical education, future studies should incorporate objective performance metrics and explore standardized approaches to the use of music.

Performing endodontic procedures on existing crowns is common when replacing the crown is not feasible. Traditional triangular access (TTA) is standard for maxillary molars, but more conservative designs are reported in the literature. However, research comparing the fracture resistance of maxillary molar zirconia crowns using traditional and novel endodontic access sealed with composite resin remains limited. The purpose of this in vitro study was to evaluate the fracture resistance of maxillary molar zirconia crowns with various endodontic cavity designs: traditional triangular access (TTA), conservative triangular access (CTA), and conservative circular access (CCA). A control group with no endodontic access (NEA) was also included. A maxillary right first molar typodont tooth was prepared for a full all-ceramic crown. The preparation was scanned, and 48 dies were 3D-printed based on the tooth preparation. A total of 48 zirconia crowns were fabricated (n = 12 per group) and divided into four groups according to the endodontic access cavity design: TTA, CTA, CCA, and a control group without an endodontic cavity. To ensure consistency, all restorations were designed and fabricated using a digital workflow. Endodontic access was created using a specialized bur kit and sealed using a repair kit for damaged ceramic restorations along with resin composite. The restorations were cemented, and all samples underwent artificial aging with 10,000 thermal cycles between 5°C and 55°C, with a dwell time of 30 s. The samples were then loaded to failure using a universal testing machine. The maximum load to fracture was analyzed using a one-way ANOVA and post hoc Tukey honestly significant difference (HSD) test (α = 0.001). Additionally, the fracture patterns of the specimens were evaluated descriptively using a scanning electron microscope. The mean fracture resistance of maxillary molar zirconia crowns varied significantly by endodontic access type. CCA showed the highest resistance (3677 N) among access groups, followed by CTA (3385 N) and TTA (2927 N). The control group NEA (3834 N) exhibited the highest overall resistance, exceeding all access groups. Conservative access designs increased the fracture resistance of zirconia crowns compared with traditional access, with circular access showing the highest strength. However, all access preparations reduced resistance relative to crowns without endodontic access.

El suicidio es la tercera causa de muerte a nivel mundial en personas de 15 a 29 años. Lo que representa un desafío de gran relevancia en Salud Pública, ya que el suicidio en etapas tempranas del ciclo de vida del individuo genera una carga significativa en términos de Años de Vida Potencial Perdidos (AVPP). En Puerto Rico, la mortalidad de suicidio en adolescentes (15 a 19 años) para el 2023 tuvo una tasa de 3.2 por cada 100,000 habitantes. Objetivo. Desarrollar un audiovisual educativo sobre el comportamiento suicida dirigido a adolescentes puertorriqueños. Método. Se revisó la literatura publicada en los últimos cinco años sobre el suicidio en la población de interés, abarcando estudios de PR, EE.UU. y Latinoamérica. En base a la revisión se elaboró el video educativo con contenido dirigido a la prevención del suicidio. El producto fue validado en su contenido por Contextual Behavioral Research Alliance de PHSU y no se requirió de un comité de revisión institucional, ya que no se interactuó con sujetos. Resultados. El audiovisual de tres minutos incluye el siguiente material adaptado culturalmente a PR: qué es el suicidio, las diferencias entre conducta suicida y muerte por suicidio, las señales de alerta del suicidio, cómo ser un ente de ayuda y recursos de apoyo. Conclusiones. Recomendamos realizar un grupo focal para evaluar el material y facilitar su diseminación entre adolescentes en Puerto Rico.