Spencer Foundation

Pemphigoid gestationis is a rare autoimmune blistering disorder associated with pregnancy that may present diagnostic challenges, particularly when onset occurs postpartum. We describe a woman in her 30s who developed an intensely pruritic blistering eruption 1 day after delivery. Histopathology was nondiscriminatory, but direct immunofluorescence demonstrated specific findings—including linear complement deposition along the basement membrane—confirming the diagnosis. This case highlights a practical diagnostic approach to postpartum blistering eruptions and underscores the importance of immunofluorescence studies and neonatal monitoring.

Although common, insomnia is often undertreated and underrecognized in primary care settings. Few studies have examined primary care provider (PCP) perspectives to better understand the context of insomnia assessment and treatment. The purpose of the current study was to examine Veterans Affairs (VA) provider knowledge and practice regarding the assessment and treatment of insomnia by utilizing qualitative inquiry. We recruited PCPs at a VA healthcare facility located in the southeastern United States to engage in a qualitative descriptive study of their perspectives on the management of insomnia in the primary care setting. Participants completed a demographic form and semi-structured interviews. Interview data were analyzed using a rapid qualitative analysis approach. 12 PCPs participated in semi-structured interviews. Themes were knowledge gaps in appropriate assessment, treatment, and documentation practices. Providers tended to focus on the event that precipitated insomnia rather than factors that perpetuate it and relied heavily on sleep hygiene recommendations. Systemic barriers, such as time constraints, also impeded the highest quality of care. PCPs may benefit from additional training on factors that maintain insomnia and on evidence-based treatments for insomnia. There may also be an opportunity to develop tools such as shared decision-making aids to increase referrals to evidence-based treatments. Development of strategies to facilitate assessment and treatment of insomnia disorder in the context of busy, fast-paced primary care settings may be beneficial to veterans and civilians with sleep disorders.

Social determinants of health continue to drive persistent disparities in perioperative care. Our team has previously demonstrated racial and socioeconomic disparities in perioperative processes, notably in the administration of antiemetic prophylaxis, in several large perioperative registries. Given how neighborhoods are socially segregated in the United States, we examined geospatial clustering of perioperative antiemetic disparities. The study aimed to determine whether disparities in perioperative antiemetic prophylaxis exhibit geographic clustering based on neighborhood-level disadvantage and whether patients from disadvantaged communities are more likely to be undertreated after adjusting for individual postoperative nausea and vomiting risk. We conducted a retrospective cohort study of anesthetic records from the University of Utah Hospital involving 19,477 patients who met the inclusion criteria. We geocoded patient home addresses and combined them with the census block group-level neighborhood disadvantage, a composite index from the National Neighborhood Data Archive. We stratified our patients by antiemetic risk score and calculated the number of antiemetic interventions. We used Poisson spatial scan statistics, implemented in SaTScan (Information Management Services, Inc), to detect geographic clusters of undertreatment. We identified 1 significant cluster (P<.001) of undertreated perioperative antiemetic prophylaxis cases. The relative risk of the whole cluster was 1.44, implying that patients within the cluster were 1.44 times more likely to receive fewer antiemetics after controlling for antiemetic risk. Patients from more disadvantaged neighborhoods were more likely to receive below-median antiemetic prophylaxis after controlling for risk. To our knowledge, this is the first geospatial cluster analysis of perioperative process disparities; we leveraged innovative geostatistical methods and identified a spatially defined, geographic cluster of patients whose home address census-tract level neighborhood deprivation index predicted disparities in risk-adjusted antiemetic prophylaxis.

This cross-sectional study assesses the potential impact of a smartwatch hypertension notification feature for US adults who have not been diagnosed with hypertension.

Abstract Healthy articular cartilage can sustain near-frictionless motion within the joint; in vivo friction coefficients fall well within the superlubricity regime (&amp;lt;0.01). However, despite nearly a century of study, the mechanisms underpinning these behaviors remain unclear. This uncertainty has been compounded by how cartilage's operating conditions have been defined and extended to explant testing approaches, resulting in drastically varied tribological responses. To address these discrepancies, we compared friction coefficients results from a comprehensive set of historical cartilage explant tribology studies, and from new data evaluating testing configuration (stationary contact area [SCA] vs convergent SCA [cSCA]) and lubricant choice (phosphate-buffered saline [PBS] vs. synovial fluid [SF]) on friction. These data demonstrate that the SCA, the most common testing configuration utilized, consistently reports friction greater than the migrating contact area (MCA) and cSCA configurations. Intriguingly, while the SCA and MCA are almost universally slid at sub-physiological speeds (∼1mm/s), the cSCA has routinely been tested at greater, and more physiologically consistent speeds (∼60mm/s). Nevertheless, SF drives noticeable reductions in friction within both SCA and cSCA studies. Importantly, particularly in vivo, only rapidly slid, SF-lubricated cSCA cartilage explants reliably demonstrate biofidelic friction (&amp;lt;0.005), indicating that hydrodynamic-related phenomena must not be discounted in cartilage lubrication. Collectively, these results underscore the need to further probe mechanisms of sustained cartilage superlubricity, a key finding only recently replicated via the cSCA configuration. Such knowledge will be crucial to understanding the true lubrication capacity of articular cartilage.

ABSTRACT Objectives This study aimed to estimate the prevalence of geriatric depression and identify its associated socio‐demographic, lifestyle, health, and psychosocial determinants among community‐dwelling older adults in Bangladesh. Methods A community‐based cross‐sectional study was conducted between April and December 2024 among 719 adults aged ≥ 60 years, selected by multistage random sampling across four administrative divisions. Data were collected using interviewer‐administered questionnaires. Depression was assessed using the GDS‐15 (cut‐off ≥ 5). Logistic regression models were applied to identify determinants, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results The prevalence of geriatric depression was 35.2%. Poor family bonding (AOR = 6.580, 95% CI = 3.540–12.210, p &lt; 0.001), financial instability (AOR = 3.660, 95% CI = 2.550–5.260, p &lt; 0.001), dissatisfaction with lifestyle (AOR = 3.590, 95% CI = 2.240–5.770, p &lt; 0.001), and daily life stress (AOR = 3.640, 95% CI = 2.560–5.190, p &lt; 0.001) were significant predictors. Comorbidities, lack of regular exercise, mobility, and hearing problems also increased depression risk. Conclusion Geriatric depression is common in Bangladesh and influenced by multidimensional determinants. Integrating geriatric mental health services into primary care and strengthening family and social support systems are essential for prevention and early management.

Anterior shoulder instability, which includes dislocations and subluxations, is a significant concern in pediatric populations (≤19 years). Following an initial dislocation or subluxation, these patients often develop recurrent instability, which can result in long-term functional compromise. While timely and appropriate treatment is crucial, there remains a lack of consensus in the literature regarding the optimal management of pediatric shoulder instability. This systematic review aims to compare the efficacy of conservative and operative treatments for traumatic, isolated anterior shoulder instability in pediatric populations using recurrence of instability and return to play (RTP) at pre-injury levels as outcome measures. This study also provides a contemporary analysis that reflects evolving treatment strategies.This systematic review targeted studies published between 2013 and 2023 that evaluated pediatric patients (≤19 years), most between 13 and 19 years of age, who received conservative or operative treatment for a first-time or recurrent traumatic isolated anterior shoulder dislocation or subluxation. Statistical analysis was performed to compare rates of recurrence of instability and RTP within each group. Pooled effects (odds ratios) were estimated using fixed-effects models where heterogeneity was absent; otherwise, random-effects models were applied.A total of 1,459 patients (1,468 shoulders) met the inclusion criteria. Of these, 593 (40.4%) underwent conservative treatment, while 885 (60.3%) received operative interventions. Recurrence rates of instability were higher in the conservative group (236/543, 43.5%) compared to the primary operative group (182/875, 20.8%) and secondary operative group (2/26, 7.7%). RTP rates included 145/193 (75.1%) of conservatively treated patients, 380/480 (79.2%) of primary operative patients, and 8/11 (72.7%) of secondary operative patients returning to pre-injury levels. Among the four studies that directly compared conservative and primary operative treatments, the nonoperative group was more likely to have recurrence compared to the primary operative group (OR = 6.90; 95% CI, 2.28-20.91; p < 0.001). One of these studies was excluded due to methodological differences. A subsequent meta-analysis revealed a significantly higher likelihood of recurrent instability in conservatively treated patients (odds ratio (OR) = 9.55; 95% confidence interval (CI): 5.10-17.88; p < 0.001). In contrast, there was no statistically significant difference in RTP between groups (OR = 3.11; 95% CI: 0.31-30.97; p = 0.33).The findings support early surgical intervention in pediatric patients to reduce recurrence and improve functional outcomes. Conservative management, while recently shown to be successful for patients with less severe injuries such as subluxations, is still primarily associated with higher recurrence rates compared to operative treatment. Further studies are needed to refine treatment protocols by distinguishing effective strategies for subluxations versus dislocations. Future research should also explore the influence of factors such as sex, skeletal maturity, and activity level in determining optimal management strategies in pediatric patients.