Welch Foundation

Young people aged 15-24 represent approximately 21% of the global population and increasingly inhabit urban environments. Traditional wellbeing assessment tools typically depend on surveys that use predefined indicators failing to capture emergent, context-specific factors affecting youth navigating complex urban landscapes. This study addresses: How can we identify situations that impact the subjective wellbeing of young city dwellers during their daily commutes? We introduce “Youth-Targeted Mapped Crowd Sourced Storytelling for Wellbeing-Impacting Situation Identification” (YT-MCSST-4WISI), a novel methodology that combines Mapped Crowd-Sourced Storytelling (MCSST) for narrative collection, with a youth-targeted open-call recruitment strategy, and an analysis strategy encompassing thematic, narrative, phenomenological, and phenomenographic analyses with a focus on subjective wellbeing. We piloted YT-MCSST-4WISI via a participatory contest in Envigado, Colombia, engaging 34 ethically recruited participants aged 15-24. Using the open-source Ushahidi platform, participants submitted geotagged narratives describing their commute experiences. Narratives underwent multi-method analysis to identify recurring situations and emotional patterns. Results identified 30 wellbeing-impacting situations mostly overlooked by conventional surveys, including structural issues like steep topography (14.7% prevalence), heat exposure (23.5%), and transit unreliability, plus symbolic moments such as nature as refuge and social affirmations. By merging empathetic storytelling with scalable participatory tools, YT-MCSST-4WISI bridges constructivist and positivist paradigms, offering a scalable framework for youth-centred urban planning and policy, with strong potential for global scalability.

Hyponatremia is a very common electrolyte imbalance in clinical practice and can result from diverse etiologies. Initial evaluation includes assessment of serum and urine osmolality, along with urinary sodium levels. Only a few causes of hyponatremia present with a urine osmolality of less than 100 mOsm/kg. We describe a case of severe hyponatremia with low urine osmolality in a hypertensive woman who presented with insomnia and vomiting. Due to persistent vomiting, she had been consuming a liquid, carbohydrate-only diet with low salt intake and tea, leading to low solute intake hyponatremia, similar to the "tea and toast" syndrome commonly reported in Western countries. In this case, it is more appropriately called "tea and porridge" syndrome.

The QUIC protocol increasingly replaces TCP as the dominant transport protocol on the Internet. Its design closely integrates TLS 1.3 with modern transport features such as faster connection establishment and stream multiplexing. QUIC uses unique and monotonically increasing packet numbers compared to the wrapping TCP sequence number.

Dorsal wrist spanning plate (DWSP) fixation is a technique used to treat distal radius fractures with severe metaphyseal comminution, diaphyseal extension, and other complex fracture patterns. One concern of this technique is the potential risk of stiffness due to prolonged immobilization. The purpose of our study was to examine the association of DWSP duration on range of motion (ROM) outcomes after plate removal. Patients who underwent DWSP fixation for distal radius fracture with greater than 6 months of follow-up after DWSP removal at a single institution were retrospectively identified. Patients with a concomitant upper extremity injury were excluded. The primary outcome of interest was ROM. Secondary outcomes included visual analog scale pain scores and radiographic measurements. A piecewise regression analysis was run to evaluate for a nonlinear relationship between DWSP duration and ROM. Fifty-one patients were included for analysis. DWSP removal occurred at a mean of 110 days (range, 59-182 days). Median duration of follow-up after DWSP removal was 11.7 months (interquartile range = 8.2 months to 1.8 years). No significant association was observed between DWSP duration and visual analog scale ( P = 0.11), complication rate ( P = 0.45), radial inclination ( P = 0.57), radial height ( P = 0.74), or volar tilt ( P = 0.13). Piecewise regression demonstrated a statistically significant reduction in supination ( P = 0.001), pronation ( P = < 0.001), and wrist flexion ( P = 0.014) for DWSP >120 days when controlling for age, sex, polytrauma, duration of follow-up, and additional fixation. There is a nonlinear association between DWSP duration and wrist ROM (flexion, supination, and pronation). When DWSP duration is longer than 120 days, there is a negative correlation with ROM when controlling for covariates. When DWSP duration is less than or equal to 120 days, there is no correlation with ROM. Our findings suggest that patients with longer duration of DWSP duration (>120 days) are more likely to have range-of-motion limitations; additional research is necessary to determine whether implant retention longer than 120 days by itself or fracture or patient-specific factors which require longer implant retention are the causative agents for this motion limitation. Retrospective cohort, Level IV.

Transient global amnesia, coined by Fisher and Adams, is characterized by a sudden, complete inability to retain new information, lasting for several hours, in a middle-aged or older person, with preservation of alertness and all other cognitive functions. It affects 3 to 10 persons per 100,000 people. It has a benign prognosis with low rates of recurrence. MRI brain taken during the episode is often normal and often shows dot like diffusion restriction in hippocampus when MRI brain is taken 24 to 72 hours after the ictus. Presence of hippocampal dot sign is helpful in confirming the diagnosis of TGA and ruling out the usual differential diagnosis.

Abstract Despite growing criticism from human rights scholars and international medical experts, non-therapeutic penile circumcision of newborns in the United States continues to be widely accepted among American healthcare practitioners. While a wealth of literature exists on the topic, it can leave out cultural depictions of the foreskin as aesthetically displeasing, unhygienic, or as extra skin, presumptions that normalize its physical and psychological erasure. Highlighting how a cultural attitude treats a healthy body part as worthy only of excision, I show how this vilification rationalizes the wide-scale performance of a practice that in any other context is seen as grossly unethical: the painful and unnecessary modification of the sexual anatomy of a non-consenting person. I also discuss how this rationalization enables profit-driven trafficking in infant sexual tissue.

Few studies investigate whether psychosocial factors (social isolation, social support, trait anger, and depressive symptoms) are associated with cardiovascular health, and none with the American Heart Association's new definition of cardiovascular health, Life's Essential 8 (LE8). Therefore, we assessed the cross-sectional associations of psychosocial factors with Life's Essential 8 and individual components of Life's Essential 8. We included 11,311 Atherosclerosis Risk in Communities cohort participants (58% females; 23% Black; mean age 57 (standard deviation: 6) years) who attended Visit 2 (1990-1992) in this secondary data analysis using cross-sectional data from the ARIC cohort study. Life's Essential 8 components included diet, physical activity, nicotine exposure, sleep quality, body mass index, blood lipids, blood glucose, and blood pressure. Life's Essential 8 was scored per the American Heart Association definition (0-100 range); higher scores indicate better cardiovascular health. Associations of categories (high, moderate, and low) of each psychosocial factor with continuous Life's Essential 8 score and individual Life's Essential 8 components were assessed using multivariable linear regressions. 11% of participants had high Life's Essential 8 scores (80-100), while 67% and 22% had moderate (50-79) and low Life's Essential 8 scores (0-49) respectively. Poor scores on psychosocial factor assessments were associated with lower Life's Essential 8 scores, with the largest magnitude of association for categories of depressive symptoms (low β = Ref.; moderate β = -3.1, (95% confidence interval: -3.7, -2.5; high β = -8.2 (95% confidence interval: -8.8, -7.5)). Most psychosocial factors were associated with Life's Essential 8 scores for diet, physical activity, nicotine, and sleep, but psychosocial factors were not associated with body mass index, blood lipids, blood glucose, or blood pressure. Less favorable measures of psychosocial health were associated with lower Life's Essential 8 scores compared better measures of psychosocial health among middle-aged males and females.