Touro University Nevada

The goal of this review was to identify and summarize technology-assisted methods that assess nonverbal behaviors known to influence the quality of the therapeutic alliance between health care providers and patients in clinical, research, or educational settings. Strong therapeutic alliances in health care provider-patient relationships contribute to positive patient outcomes. Previous studies have shown that nonverbal behaviors from providers, such as tone of voice, facial expression, eye contact, and physical positioning, help build strong therapeutic relationships. Technological advances have created opportunities to automate detection and feedback about nonverbal behaviors in clinical interactions without the intervention of highly trained instructors. Automated detection and feedback will increase opportunities to develop better nonverbal communication, which is expected to improve the quality of the therapeutic alliance. Participants were current or aspiring health care providers who routinely would be expected to have patient encounters in clinical, educational, or research settings. Interactions could include actual patient interactions, model patients, virtual patients, or simulated patients. Included studies involved technology-assisted methods to collect or analyze at least 1 nonverbal behavior. This review included qualitative and quantitative studies and review articles. PubMed, Embase, CINAHL, ERIC, Scopus, and Google Scholar were searched for published and unpublished literature in English between 2010 and 2023. Two reviewers independently completed title and abstract screening, full-text review, and data extraction. Any conflicts that arose were resolved by a third reviewer. Extraction was completed by 2 reviewers. Twenty-five sources were included. The most frequently measured behaviors included gaze frequency or duration on the patient's face (52% of studies) and facial expression (48%), with 24% of studies measuring social touch or speech patterns, 20% measuring posture and gestures, 12% measuring proximity to patient, 8% measuring synchrony, and 4% measuring voice. Technologies for data collection included audio or video recordings and other technologies such as eye-tracking glasses or multi-functional headsets, used alone or integrated into augmented reality or virtual reality systems. Challenges associated with analyzing data included recognition of patients' and providers' voices, facial features, and body parts, and classifying body posture and movement as well as facial expression and movements. Studies used commercial, open source, or customized software to meet each challenge. Many incorporated machine learning or algorithms associated with artificial intelligence (AI), which required significant training data. Technology-assisted methods for analyzing voice and social touch were limited, whereas there were several available analysis techniques for analyzing synchrony, gestures, posture, and proximity to patients. The use of technology in collection and analysis of provider-patient interactions to enhance nonverbal behaviors and communication skills is rapidly developing, with multiple options available. Future efforts should focus on technology-assisted methods to analyze voice and social touch, and should transparently report contributing factors and training data for machine learning models or AI-associated algorithms. Development of systems will require significant testing to ensure accessibility to the intended audience and broadly accurate and meaningful nonverbal behaviors. OSF ( https://osf.io/kedmf ).

IntroductionMixed reality (MR) technology has emerged as a promising technology to endoscopic spine surgery by enhancing surgeon visualization. This early feasibility study introduces the Apple Vision Pro (Apple Inc., Cupertino, CA) Head Mounted Display (AVP HMD) as an intraoperative visualization tool during biportal endoscopic spine surgeries. The SURG-TLX is an established workload assessment tool specifically tailored for surgical procedures and is a specialized modification of the NASA-TLX, a widely established multidimensional measure for cognitive workload.MethodsAdult patients undergoing biportal endoscopic lumbar surgery using the AVP HMD were prospectively followed. SURG-TLX Scores were recorded immediately after each operation to document the cognitive workload of using the AVP HMD during surgery. Demographics, intraoperative, and postoperative complications were collected and assessed. Patient reported outcomes (PROs) were recorded with visual analogue scores (VAS) Back and Leg pain, as well as Oswestry Disability Index (ODI).ResultsForty patients were included in this study. Patients were followed for 3 months after surgery. The mean age of the population was 62.78 ± 16.12 years, with a BMI of 27.90 ± 5.86, with 47.5% being female. Preoperative average VAS Back score was 5.4 ± 3.26, VAS Leg scores was 6.85 ± 2.43, ODI score was 44% ± 18.67%. Average SURG-TLX score was 22.24 ± 7.46. There were 2 intraoperative dural tears with no clinical sequelae, otherwise there were no perioperative complications. At 3 months follow-up, the average post-operative VAS Back was 2.71 ± 3.29, VAS Leg was 2.11 ± 3.19, and ODI was 21.0% ± 22.74, which were significant reductions as compared to the preoperative scores (p < 0.05).ConclusionThis early feasibility study introduced the use of the AVP HMD during biportal endoscopic spine surgeries and showed that the AVP HDM did not increase the operating surgeon's perceived cognitive workload. The intraoperative use of AVP HMD did not worsen early clinical outcomes and did not increase the risk of complications. We describe the feasibility of incorporating MR technology such as the Apple Vision Pro for surgical visualization during endoscopic spine surgery.

Cutaneous leishmaniasis, a protozoal skin infection transmitted by the bite of infected female phlebotomine sandflies, can present a diagnostic challenge outside endemic regions. We describe a twenty-nine-year-old woman who recently emigrated from Ecuador and presented with an enlarging ulcer on the left thigh that failed to respond to multiple courses of antibiotics. Histopathology and tissue culture from skin biopsies were nondiagnostic, but polymerase chain reaction (PCR) testing identified Leishmania braziliensis. Intravenous liposomal amphotericin B resulted in complete ulcer resolution within two months. This case highlights the importance of considering leishmaniasis as a diagnosis for non-healing skin ulcers in patients from endemic areas and underscores the value of molecular pathogen identification.

Distinguishing postoperative ileus (POI) from early mechanical small bowel obstruction (SBO) remains a challenging clinical dilemma after abdominal surgery, especially among elderly, frail patients with baseline gastrointestinal dysfunction. We describe an 83-year-old man with multiple comorbidities who underwent a robotic umbilical hernia repair converted to open due to incarcerated omentum and small-bowel dilation. The postoperative course was notable for persistent abdominal distention, high nasogastric output, alternating imaging interpretations of jejunal obstruction versus ileus, severe malnutrition requiring total parenteral nutrition, multidrug-resistant urinary infection, and progressive debility. Despite partial return of bowel function, the patient remained debilitated and elected hospice care. This case underscores the diagnostic ambiguity between persistent POI and partial SBO, emphasizes multidisciplinary management, and highlights the importance of aligning treatment with patient-centered goals in frail postoperative patients.

The fourth annual meeting of the American Society for Intercellular Communication (ASIC) was held in Baltimore, Maryland, from October 17th-19th, 2024, and featured groundbreaking findings that are pushing the field of extracellular vesicles (EVs).Highlights included the discovery of a new pathway for selective RNA loading into EVs, new evidence linking EVs to neuroinflammation, cancer progression, and immune suppression, and compelling demonstrations of their potential in brain-targeted delivery, tissue repair, and cancer immunotherapy.Collectively, these advances underscore EVs as both key drivers of disease and powerful tools for next-generation diagnostics and therapeutics.The meeting drew over 130 participants and was supported by twelve sponsors, including Caerus, Ceres Nano, Kinetic River, Particle Metrix, Beckman Coulter Life Sciences, Alpha Nano Tech, Spectradyne, Univercells Technologies, Unchained Labs, MetvareBio, USA Scientific, and Kinetic River.The three-day program featured fifty oral presentations, an NIH Grant Writing Workshop designed for early-career investigators and trainees, and an NIH roundtable with six program officers.Additionally, a poster session was held on the evening of the second day, showcasing twenty-eight posters.

Lemierre’s syndrome and spontaneous coronary artery dissection (SCAD) are rare and potentially life-threatening conditions that seldom occur concurrently. Lemierre’s syndrome typically presents as septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection, while SCAD is a non-atherosclerotic tear in the coronary artery wall, often associated with pregnancy. The co-occurrence of these two conditions is exceedingly rare and presents complex diagnostic and management challenges, particularly in pregnant patients. We describe a case of a 36-year-old woman at 22 weeks of gestation who presented with a three-day history of left-sided neck pain, chest pain, and shortness of breath. Initial workup included an electrocardiogram, which showed nonspecific T-wave changes, serial troponin measurements that revealed a rising trend, and a duplex ultrasound of the neck, which revealed an intramural hematoma in the coronary arteries suggestive of SCAD, along with an occlusive thrombus in the left internal jugular vein consistent with Lemierre’s syndrome. This case highlights a rare overlap of SCAD and Lemierre’s syndrome in pregnancy. Hormonal and hemodynamic changes likely contributed to both conditions. Treatment required careful balancing of anticoagulation risks and benefits. To our knowledge, this is one of the first reported cases of concurrent SCAD and Lemierre’s syndrome in a pregnant patient. It underscores the need for vigilant assessment and coordinated care in rare, high-risk vascular presentations during pregnancy.

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction, and metabolic disturbances, with insulin resistance (IR) playing a critical role in its pathogenesis. Emerging evidence suggests that epigenetic mechanisms, such as DNA methylation, may influence insulin signaling and metabolic pathways in PCOS by altering gene expression without changing the DNA sequence. This systematic review aims to evaluate the impact of DNA methylation on IR and metabolic dysfunction among PCOS patients by analyzing key genes involved in these processes. A comprehensive literature search was conducted using the databases Ovid, EMBASE, and Web of Science to analyze studies published between 2010 and 2025. Studies that evaluated DNA methylation and its association with IR and metabolic parameters in PCOS patients were included. Eligibility criteria followed the PRISMA guidelines. A total of 10 studies met the inclusion criteria. Hypermethylation of insulin receptor (INSR) and lamin A/C (LMNA) was associated with reduced insulin sensitivity, while hypomethylation of insulin receptor substrate 1 (IRS1) and bone morphogenetic protein 4 (BMP4) led to increased gene expression, contributing to metabolic dysregulation through increased androgen production. Epigenetic alterations were observed in granulosa cells and skeletal muscle tissues, highlighting tissue-specific differences. However, variability in study design and small sample sizes limited the generalizability of these findings. DNA methylation is pivotal in IR and metabolic dysfunction in PCOS. Understanding these epigenetic modifications may provide insights into potential therapeutic targets and lifestyle modifications aimed at reversing gene expression abnormalities and improving metabolic outcomes in patients suffering from PCOS and other metabolic disorders.

Aging has been thought to be factual, inherited, and obligatory. However, aging can be divided into primary (i.e., inevitable physiological changes) and secondary (i.e., age-associated changes driven by life choices, environment, and society) aging. The impact of social norms and life choices is why no two 70-year-olds look the same. The life choice that appears to have the strongest impact on aging is physical activity. Research continues to highlight the power of mitigating age-related losses via physical activity and debunking the notion that age-related changes such as falls, frailty, and functional decline are inevitable. Physiotherapists are the healthcare professionals who reverse or slow down age-related changes and prevent secondary aging from occurring. Physiotherapists are the health profession's experts in movement science, whose interventions primarily center around physical activity as medicine. Thus, physiotherapists function as pharmacists of physical activity and are well-positioned to prescribe the dosages needed for wellness promotion as well as disease prevention and management. This paper provides guidance from the perspective of the physiotherapist on exercise prescription most optimal and consumable for an older population.

"HSR25-171: Risk of Health-Related Quality of Life (HRQOL) Events in Patients with EGFR-Mutated Non-Small Cell Lung Cancer (NSCLC) Treated With Amivantamab: A Meta-Analysis of Phase III Randomized Controlled Trials" published on 28 Mar 2025 by National Comprehensive Cancer Network.