Wake Forest University

To assess factors associated with retinal detachment (RD) in eyes presenting with endogenous endophthalmitis (EE). Multicenter retrospective study of individuals with an EE diagnosis from seven tertiary care centers. Demographics, medical history, ocular examination findings, microbial cultures (blood or intraocular), and management strategies were assessed relative to subsequent RD occurring within 6 months of EE diagnosis. Of note, this study did not distinguish between intraocular cultures without growth and eyes that were not sampled for an intraocular organism. A total of 201 eyes from 171 patients presented with EE. Of these, 22.4% (45/201) had a subsequent RD. Eyes that experienced a subsequent RD had worse presenting visual acuity ( P = 0.006) and lower intraocular pressure at presentation (RD: 13.7 ± 5.4 mmHg vs. No RD: 15.7 ± 6.5 mmHg, P = 0.04). Compared with other forms of bacteremia, S. aureus bacteremia was associated with increased odds of subsequent RD (OR: 6.10, CI: 1.82-20.41, P = 0.003). Eyes with a subsequent RD did not have significantly greater rates of therapeutic pars plana vitrectomy (RD: 11/48, 22.9% vs. No RD: 36/153, 23.5%). Eyes presenting with visual acuity ≤ light perception or S. aureus bacteremia had a higher risk of subsequent RD and may warrant closer surveillance. Although no therapeutic strategies were associated with reduced odds of subsequent RD, a pars plana vitrectomy was not associated with an increased risk of RD, suggesting that it may aid in eyes with lackluster responses to systemic and intravitreal pharmacotherapy.

Occupational credentials connect to broader power relations, provide authority used to justify appearance-based inequalities, and are linked to the social contexts implicated in cosmetic medical procedures and other beauty interventions. Plastic surgeons, cosmetic dentists, and other medical professionals offering cosmetic procedures advertise to global audiences on digital platforms, where they compete with less prestigiously credentialed counterparts offering beauty interventions of their own. How do content creators promoting cosmetic medicine procedures portray themselves and the procedures they offer to audiences, and how might these portrayals differ across creators’ occupational credentials and other identity characteristics? We apply thematic and categorical content analysis to TikTok videos produced by medical professionals, credentialed aestheticians, and adjacent content creators, in which creators promote consumer medicine procedures and other beauty interventions. Additionally, we analyze comments responding to these videos. We find men with higher-status occupational credentials frequently practice parasocial paternalism , portraying themselves as affable and approachable while centering themselves and other men in the beauty intervention process. Women across credential hierarchies conversely employ embodied advice , themselves pursuing showcased interventions rather than solely advertising them. Our findings illustrate interlinked empowerment and subjugation in online content showcasing cosmetic medicine procedures, and the complex ways online audiences respond to content creators’ reliance on legacy and populist symbols of expertise.

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.

Crystal growth of ternary rare-earth iridium germanides RE –Ir–Ge ( RE = Ce, Yb) was investigated in indium flux. These experiments resulted in the formation of two polymorphs of CeIrGe 2 , termed α and β , as well as Yb 4 Ir 7 Ge 6 and Yb 5 Ir 4 Ge 10 . Single-crystal X-ray diffraction analysis revealed that α -CeIrGe 2 adopts the CeNiSi 2 -type structure (orthorhombic, Cmcm , a = 4.3312(16) Å, b = 17.101(6) Å, c = 4.3803(16) Å, Z = 4) containing zigzag chains of Ge atoms, whereas β -CeIrGe 2 adopts the YIrGe 2 -type structure (orthorhombic, Immm , a = 4.3842(7) Å, b = 8.8960(14) Å, c = 16.258(3) Å, Z = 8) containing dumbbells of Ge atoms. The structure of Yb 4 Ir 7 Ge 6 was determined at 296 and 193 K, and confirmed to be the U 4 Re 7 Si 6 -type. Yb 5 Ir 4 Ge 10 adopts the Sc 5 Co 4 Si 10 -type structure (tetragonal, P 4/ mbm , a = 12.8799(6) Å, c = 4.2797(2) Å, Z = 2) containing squares and dumbbells of Ge atoms; the structure contracts anisotropically, faster along a than c , upon cooling to 100 K. Crystal growth in indium flux led to two polymorphs of CeIrGe 2 (α and β), Yb 4 Ir 7 Ge 6 , and Yb 5 Ir 4 Ge 10 . • Ternary germanides in Ce–Ir–Ge and Yb–Ir–Ge systems were prepared in indium flux. • A new polymorph, β -CeIrGe 2 , was formed together with α -CeIrGe 2 . • Temperature-dependent structures of Yb 4 Ir 7 Ge 6 and Yb 5 Ir 4 Ge 10 were determined.

The relationship between the structural connectome and functional activity in the brain is highly complex, and understanding of the connection between the two is limited. Previous work has shown a marginal reliance of functional brain activity on underlying structural connections, indicating significant flexibility of neural communication. Here, we introduce a new method to quantify structure-function coupling and compare it with a standard coupling technique by evaluating the structure-function relationship across numerous fMRI task paradigms. Through this comparison, we investigate how structure-function relationships change during different cognitive demands and we evaluate how they relate to behavior. The new method introduced here, structural reliance, exhibits different structure-function correspondence patterns throughout the brain, and it generally outperforms the standard coupling measure in coupling-based behavioral measure predictions.

Intradetrusor chemodenervation with onabotulinumtoxinA (BOTOX) injections, a common office-based procedure for overactive bladder (OAB), is associated with patient anxiety and discomfort. Aromatherapy and music have been shown to decrease procedure-related anxiety and pain with improved satisfaction. The objectives of this study were to determine whether a relaxing environment consisting of lavender aromatherapy, calming music, and dim lighting compared with a typical office environment decreases patients' anxiety level before undergoing intradetrusor chemodenervation. We hypothesized that a relaxing environment would decrease patients' anxiety level before the procedure as measured by the Visual Analog Scale (VAS). Secondary outcomes included the VAS for pain, satisfaction, and staff energy level. This was a single-center randomized trial of women receiving office intradetrusor chemodenervation for overactive bladder. Participants were randomized to receive their procedures in a relaxing versus typical office environment. Eighty patients were needed to detect a clinically significant 12mm difference on the anxiety VAS. Staff completed a preclinic and postclinic Burnout Battery VAS to measure change in their energy level during the day. Patients in the relaxing environment reported a clinically significant reduction in anxiety (-13.8 ± 18.1 vs -4.7 ± 14.7, P = 0.015). Pain was lower for the relaxing environment group, although it did not reach statistical significance (21.9 vs 28.9, P = 0.261). Satisfaction scores were high in both groups (91.4 vs 89.3, P = 0.599) and not significantly different. The procedure room environment did not affect staff energy levels. A relaxing environment of lavender aromatherapy, calming music, and dim lighting is a noninvasive, easily implemented technique to decrease patients' anxiety before office intradetrusor chemodenervation.

• Seismic performance of steel moment frames with fuse connections is studied. • Archetype buildings of 2, 4, 6, and 8 stories are designed for comparative analysis. • The effect of column design variations on seismic performance is analyzed. • Various fuse failure models are explored to assess their effects on performance. Fuse connections featuring replaceable components that yield before beams or columns have been proposed for steel special moment-resisting frames (SMRFs) as low-damage connection concepts in seismic systems. While several are prequalified or under review for prequalification in the United States, the impact of column design requirements and fuse behavior on seismic performance has not yet been thoroughly investigated. This study analyzed typical steel SMRFs of varying heights (2, 4, 6, and 8 stories) using a prequalified yield-type fuse connection, specifically the Simpson Strong Tie™ (SST) Yield-Link (YL)® connection. Current prequalified design procedures for this connection allow columns to be designed for larger overstrength demands without meeting certain seismic compactness limits. This study investigates the impacts of column design variations (i.e., column overstrength, compactness, and capacity-limited forces) on collapse performance. Nonlinear static pushover and incremental dynamic analyses revealed that designs that considered seismic compactness, even with relaxed overstrength demands, outperformed those with higher overstrength but no compactness requirements, particularly in taller buildings. However, since the shallower column sections for shorter buildings were more likely to meet width-to-thickness limits for highly ductile members, relaxing overstrength requirements could reduce the collapse margin ratios in SST-YL SMRFs. These results indicate that there is potential to consider modified column design requirements for SST-YL connections, offering a cost-effective approach to improving structural resilience without compromising seismic collapse performance.

Emerging evidence shows that Proton FLASH radiotherapy can spare normal tissues while maintaining anti-tumor efficacy. However, its impact on intestinal stem cells (ISCs) and the gut microbiome remains unclear. Gut microbiome influences ISC's radiosensitivity.In a mouse model of abdominal irradiation, Proton FLASH exposure exhibited improved survival and less crypt-villus damage compared to Proton Conventional dose rate. Using scRNA-sequencing, we demonstrated that Proton FLASH exposure using pulsed pencil beam scanning spares two distinct ISC populations, Lgr5+ Crypt-based columnar cells (CBCs) and a Ly6a+, Clu+, Areg+, Anxa2+ revival stem cell (revSC) population-by modulating oxidative stress and cell cycle progression. Analysis of α and β-diversity demonstrated that Proton FLASH modulates gut microbiota composition without compromising overall species richness. Notably, Proton FLASH-irradiated mice had higher abundances ofAlistipessp. andAkkermensiasp., both known for protective effects on ISCs and the intestinal mucosa. The role of microbiome in Proton FLASH-mediated sparing effect was further confirmed by fecal microbiota transplantation, where Proton FLASH-donor microbiota demonstrated reduced lethality with protection of crypt villus morphology in recipient mice exposed to Proton Conventional dose rate. Our findings highlight the crucial role of the microbiome in the Proton FLASH-mediated sparing of the mucosal epithelium.