Kohler Disease With Concurrent Avascular Necrosis of the Medial Cuneiform: A Report of Two Cases.

Two patients, ages five and eight, presented to a pediatric orthopedic surgeon with dorsomedial midfoot pain. After further evaluation, each was diagnosed with idiopathic avascular necrosis of the navicular, also known as Kohler disease, with concurrent avascular necrosis of the ipsilateral medial cuneiform. Both patients were treated conservatively with rest, immobilization, limited weight-bearing, and reduced activity, and both saw resolution of symptoms and radiographic findings by the completion of follow-up.

Structured Specialty-Focused Educational Onboarding Curricula for Newly Hired Advanced Practice Providers: A Scoping Review on Current Practices.

Introduction: Advanced practice providers (APPs), including physician assistants and nurse practitioners, benefit from structured onboarding curricula as they transition into specialty practice. These programs aim to enhance evidence-based knowledge, clinical skills, and core competencies, ultimately improving provider competency and health care quality. This scoping review seeks to map the existing literature on specialty-focused APP onboarding practices and identify knowledge gaps.

Outcomes of an Online, Interprofessional Stroke Simulation: Mixed Methods Analysis.

Introduction: Educational approaches used in distance learning courses may be applicable to interprofessional education (IPE) simulation events to promote student engagement and learning.

Methods: Various strategies known to be effective when teaching online courses (real world applications, self-directed learning, reliance on previous life experiences, communities of practice, and emotional engagement) were incorporated into an interprofessional simulation event. Learning outcomes were captured quantitatively through student ratings of learning objective accomplishment and qualitatively through thematic analyses of learner reflections.

Economics of Task-Shifting in Surgery: A Systematic Review.

Background And Aim: Due to the global shortage in the surgical workforce, especially in low-resource settings, one solution to increase surgical volume is to delegate certain roles of surgeons to other trained non-surgeon health workers. However, quantifying the costs and benefits of surgical task-shifting has several challenges associated with it. The purpose of this study was to conduct a critical appraisal of studies on the cost-effectiveness of task shifting in surgical care.

Acoustic Metrics of the Strain Dimension of Voice Quality: A Scoping Review.

Background: Strained voice quality-commonly referred to as vocal strain-is a hallmark of functional voice disorders such as muscle tension dysphonia and is often associated with vocal fatigue and laryngeal hyperfunction. Although listeners describe it as excessive vocal effort, strained voice quality frequently overlaps perceptually with breathiness and roughness, complicating reliable assessment. Despite its clinical relevance, no standardized acoustic definition of strained voice quality has been established.

Effects of aging and anti-aging dietary restriction on regulators of the [NADPH]/[NADP] in different neural cell types and brain regions.

Dietary restriction (DR), which slows aging, increases the ratio of reduced glutathione (GSH) to oxidized glutathione disulfide (GSSG) in the brain. DR increases liver cytoplasmic [NADPH]/[NADP] where much of the NADPH is generated by the folate cycle. This could also occur in astrocytes, the neural cell type with the highest folate cycle flux.

Trends and disparities in heart failure and heart failure with obesity mortality among U.S. adults: A 1999-2020 analysis of geographic, gender, and racial variations using CDC WONDER data.

Background: Heart failure (HF) is a leading cause of hospitalization and mortality, and it poses a significant burden on healthcare systems globally. Obesity is a considerable risk factor for HF and contributes to increased cardiac stress and metabolic demands.

Methods: Data from the CDC WONDER database were examined from 1999-2020 for HF and HF with obesity-related mortality in adults aged 25 years and older at the time of death, using ICD-10 codes.

Geospatial analysis of area-level social and behavioral factors associated with short interpregnancy intervals in North Carolina, U.S.

Objective: Short interpregnancy intervals (sIPI), defined as six months or less, are associated with adverse birth outcomes and are influenced by socioeconomic factors, which reflect a complex interplay between health outcomes, social factors, health behaviors, and geographic contexts. This study aims to examine the spatial distribution of sIPI across North Carolina, in the Southeast United States (U.S.

Inhibition of protein kinase R suppresses HIV replication and integration in CD4 T cells.

Evaluation of CD4 T cell status in early HIV infection is critical for developing strategies targeting HIV replication. In this study, we infected CD4 T cells with HIV-1 and investigated the cell survival mechanisms in HIV-infected versus uninfected cells during early HIV infection. Notably, HIV-infected CD4 T cells exhibited elevated levels of phosphorylated eukaryotic translation initiation factor 2-alpha (p-eIF2α) compared to uninfected cells.

Exploring associations of impulsivity with substance use, polysubstance use, and gambling behaviors through latent profiles.

Impulsivity is the tendency to act hastily in reaction to internal and external cues without consideration of all potential outcomes. Limited research has used a person-centered approach to explore patterns of impulsivity and risky behavior involvement, but not how different dimensions of impulsivity relate to multiple risk behaviors within the same individuals. The present study aimed to identify latent groups based on five self-report impulsivity measures and to assess differences in latent profiles as related to alcohol use and problems, drug use, gambling, and polysubstance use.

Proton Pump Inhibitor Use in Patients With Cirrhosis and Its Association With Spontaneous Bacterial Peritonitis.

Cirrhosis is a major cause of morbidity and mortality in the United States, with spontaneous bacterial peritonitis (SBP) being a serious complication. Established SBP risk factors include gastrointestinal bleeding and low ascitic protein, but the role of proton pump inhibitors (PPIs) remains unclear. This study evaluated the impact of PPI use on primary SBP development in hospitalized patients with cirrhosis.

Microbiome-Immune Interaction and Harnessing for Next-Generation Vaccines Against Highly Pathogenic Avian Influenza in Poultry.

Highly pathogenic avian influenza (HPAI) remains a persistent threat to global poultry production and public health. Current vaccine platforms show limited cross-clade efficacy and often fail to induce mucosal immunity. Recent advances in microbiome research reveal critical roles for gut commensals in modulating vaccine-induced immunity, including enhancement of mucosal IgA production, CD8 T-cell activation, and modulation of systemic immune responses.

Associations of the MIND Diet with Human Health Outcomes: A Scoping Review.

The MIND diet was designed as an intervention to delay neurodegeneration and has been explored by systematic reviews for associations with cognition and, more recently, cardiometabolic disease. Comparatively less is known about how the MIND diet is associated with other health outcomes (e.g.

Correlating Various Clinical Outcomes and Associated Dispositions in Patients with Severe Traumatic Brain Injury (TBI).

: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Patient disposition following TBI has been shown to interact with factors such as age, sex, and injury severity to impact clinical outcomes. Discharge home is associated with better functional outcomes and lower mortality, while discharge to rehabilitation or long-term care facilities is linked to greater injury severity, older age, and higher comorbidity burden.

Reframing dyslexia: language and linguistic complexity, developmental risk, and the future of science of reading policy.

Policy change around dyslexia has accelerated in recent years, yet much of it still lags behind contemporary scientific understanding. Many statutes rely on categorical models that frame dyslexia as a fixed, phonological disorder and prescribe narrowly defined interventions. This commentary calls for a shift from policy proliferation to targeted refinement, advancing developmentally grounded, scientifically accurate legislation that is feasible to implement at scale.

Severe Hemolytic Phenotype in Children With Sickle Cell Anemia and Co-Inherited Red Blood Cell Variants.

Remarkable phenotypic variability exists among individuals with sickle cell anemia (SCA), which may be explained by co-inheritance of traits affecting red blood cell (RBC) biology, such as genes affecting globin expression or glucose-6-phosphate dehydrogenase enzyme activity. Here, we describe three children with severe SCA who have co-inherited variants in genes for membrane proteins (SPTA1 and EPB1) and PIEZO1. These cases suggest that variants in RBC membrane proteins may contribute to SCA severity and phenotypic variation.

Tiered Training and Licensure for the Future of the Pharmacy Profession: Panacea or Pandora's Box?

Objective: To summarize the findings of an Academic Leadership Fellows Program (ALFP) debate and to evaluate the affirmative and opposing arguments for implementing a tiered training and licensure model within the pharmacy profession.

Findings: This analysis was conducted as part of ALFP, where fellows debated current topics in academic pharmacy. Debate participants reviewed contemporary and historical literature on the transition to the all-Doctor of Pharmacy (PharmD) degree, conducted informal polls and surveys of colleagues and key opinion leaders in pharmacy education and practice, and synthesized their findings to assess the potential impact of a tiered training model.

Treated but Uncontrolled: Characterizing Hypertension in a Sample of 357 Older Adults in the Southeastern United States.

: Hypertension (HTN) continues to be a leading cause of death and disability in older adults, especially in the southeastern United States. A cross-sectional study was conducted to evaluate the relationships among measured, diagnosed, and treated (HTN) in community-dwelling adults participating in student-led health screenings in eastern Alabama. : Between 2017 and 2019, students from health-related disciplines facilitated screenings at 23 community and independent living sites to conduct health assessments, including measuring blood pressure (BP), obtaining medical history, and evaluating current prescriptions.

Hypocretin signaling in the central amygdala drives methamphetamine self-administration in male rats.

Methamphetamine use is growing in the United States and around the world. Hypocretin/orexin (HCRT) is a neuropeptide closely associated with drug-taking behaviors and stress response systems in humans and rodents. HCRT signaling occurs at HCRT-receptor 1 (HCRT-R1) and -receptor 2 (HCRT-R2); the contribution of signaling at each of these receptors to methamphetamine self-administration in rodents is largely unknown.

Pyrethroids demonstrate effective insecticidal activity against ambrosia beetles (Coleoptera: Curculionidae: Scolytinae) within tree fruit, nut, and ornamental production systems.

The ambrosia beetles Xylosandrus crassiusculus (Motschulsky) and Xylosandrus germanus (Blandford) (Coleoptera: Curculionidae) are major pests in fruit, nut, and ornamental tree nurseries. Adult females tunnel into stressed trees, creating galleries in the sapwood and heartwood to cultivate their nutritional fungal mutualists, which are associated with branch dieback and tree death. The current management approach relies on trunk applications of permethrin and bifenthrin to decrease infestation risk in the United States.

Exploring Agreement in Voice Acoustic Parameters: A Repeated Measures Case Study Across Varied Recording Instruments, Speech Samples, and Daily Timeframes.

Aims: The aim was to assess the agreement between microphone-derived and neck accelerometer-derived voice acoustic parameters and their associations with recording moments and speech types.

Methods: Using simultaneous recordings, a 7-week study on a single individual was conducted to reduce intersubject variability. Agreement was assessed using Bland-Altman plots, and associations were examined with generalized estimating equations.

Evaluating United States Air Force hearing conservation educational materials for compliance, readability, understandability, and actionability.

Noise-induced hearing loss and tinnitus are two of the most prevalent service-connected disabilities of United States military veterans. Educational materials meant for hearing conservation program-eligible Airmen were evaluated from active-duty, continental United States (CONUS) Air Force bases for compliance with US Air Force (USAF), Department of Defense (DoD), and Occupational Safety and Health Administration (OSHA) regulations. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V), while readability was assessed with Flesch-Kincaid Grade Level (FKGL).

Beta-Hydroxybutyrate but not NMN supplementation mimics caloric restriction reducing early mortality in Daphnia.

NAD + homeostasis is an important determinant of lifespan and may be a key mechanism of caloric restriction (CR) expansion of lifespan. Ketone bodies such as beta-hydroxybutyrate (BHB) that regulate NAD + abundance and NAD + precursors such nicotinamide mononucleotide (NMN), are known to extend life in experimental animals and ameliorate age-related conditions in humans. We tested the hypothesis that chronic BHB and NMN exposure can extend lifespan similarly to the effect of CR treatment in a model organism Daphnia, a freshwater zooplankton crustacean.